Ru 1 CY2006

.."• "' uuurnm - Department of Environment and Natural Resources — Division
1636 Mail Service Center — Raleigh, N.C. 27699-1636 — Phone [phone] of Water Quality _Groundwater Section
WELL CONSTRUCTION RECORD WELL CONTRACTOR JEFF�ON
WELL CONTRACTOR CERTIFICATION #: 3417
STATE WELL CONSTRUCTION PERMIT #:
1. WELL USE (Check Applicable Box): ® Residential
0 Municipal ❑Industrial Agricultural Monitoring
0 Recovery
❑ Heat Pump Water Injection 0 Other
If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: LAKE LURE County: RUTH
BUFFALO CREEK RD.-TATANKA SUBDV.
(Road Name and Numbers, Communi DRILL LING DEPTH
3. OWNER TO_� TZOG �° O1 Subdivision and Lot No.) From To
Formation Description
Address BUFFALO CREEK RD.- TATANKA SUBDV. WELL 1
(Street or Route No.)
LAKE LRUE NC
City or Town28ode
4. DATE DRILLED 12/11/06 State Zip Code
5. TOTAL DEPTH 245
6. CUTTING COLLECTED 0 YES ® NO
7. DOES WELL REPLACE EXISTING WELL? 0 YES ® NO
8. STATIC WATER LEVEL Below Top of Casing: 80 FT.
(Use "+" if Above Top of Casing)
9. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated atfor below land surface requires a variance in accor-
dance with 15A NCAC 2C.01I8
10. YIELD (gpm): 75 METHOD OF TEST: ARD
11. WATER ZONES (depth): — —"
12. CHLORINATION: Type: CHLORYTE
13. CASING: Amount: 6
Wall Thickness
Depth Diameter or Weight/Ft Material
From 0 To 75 Ft. 6.1/4" SDR.21 PVC
From To Ft.
From To Ft. 14. GROUT: Depth Material Method
From 0 To 20 Ft. L1)ICETE POURED
From To Ft.
15. SCREEN:
Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. m._ in.
From To Ft. in._ ia
16. SAND?GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft
17. REMARKS:
If additional space is needed use back of fowl
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other'delonce points)
HWY. #64/74A W. FROM RUTHERFORDTON. RIGHT ON
BILL'S CREEK RD. LEFT ON BUFFALO CREEK RD. RIGHT
INTO TATANKA SUBDV. STAY LEFT ABOUT 1/2 MILE ON
RT.
D
DIV. OF WATER QUALITY
.JAN 0 5 Z007
I DO CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THLSRECORD HAS BEEN PROVIDED TO THE WELL OWNER. FOR OFFICE USE ONLY
Quad No:
Serial No.
SIGNA OF PERSON CO STRUC 1 THE �L
Submit original to Division of Water Quality, Groundwater Section within 30 days DATE
GW-1 REV. 12/99

riorm t.arolma —Department of Environment and Natural Resources
1636 Mail Service Center — Raleigh, N.C. 27699-1636 —Phone (919) 733 Division2 of Water Quality _Groundwater Section
WELL CONSTRUCTION RECORD WELL CONTRACTOR: JEFF MELTON
WELL CONTRACTOR CERTIFICATION #: 3417
STATE WELL CONSTRUCTION PERMIT #:
1. WELL USE (Check Applicable Box): ® Residential
0 Recovery 0 Heat 0 Municipal ❑ Industrial LJ Agricultural
Pump location
Injection Other If Other, List Use: Monitoring
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: LAKE LURE County: RUTH
BUFFALO CREEK RD.-TATANKA SUBDV.
DRILLING LOG DEPTH
(Road Name and Numbers, Community or Subdivision and Lot No.) From To 3. OWNER TOMMY HARTZOGFormation Description
Address BUFFALO CREEK RD.-TATANKA SUBDV. WELL 3
(Street or Route No.)
LAKE LURE NC 28746
City or Town State Zip Code
4. DATE DRILLED 12/12/06
5. TOTAL DEPTH 185
6. CUTTING COLLECTED 0 YES ® NO
7. DOES WELL REPLACE EXISTING WELL? 0 YES ® NO
8. STATIC WATER LEVEL Below Top of Casing: 60 FT.
(Use "-r" if Above Top ofCasing)
9. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a variance in accor-
dance with 15ANCAC 2C.0118
10. YIELD (gpm): 100 METHOD OF TEST: ARD
11. WATER ZONES (depth):
12. CHLORINATION: Type: CHLORYTE Amount: 4.5
13. CASING:
Wall Thickness
Depth Diameter or Weight/Ft Material
From 0 To 75 Ft. 6-1/4" SDR.21 PVC
From To Ft.
From To Ft.
14. GROUT:
Depth Material Method
From 0 To 20 Ft. QUIKRETE POURED
From To Ft.
15. SCREEN:
Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in From To Ft. in. in
16. SAND?GRAVEL PACK:
Depth Size Material
From To Ft.
From _ To Ft.
17. REMARKS:
If additional space is needed use back of form
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other reference points)
HWY. #64/74A W. FROM RUTHERFORDTON. RIGHT ON
BILL'S CREEK RD. LEFT ON BUFFALO CREEK RD. RIGHT
INTO TATANKA SUBDV. STAY LEFT ABOUT 1/2 MILE ON
RT.
DIV OREEIVE
F WATER Qd ALITY
JAN 0 5 200?
I DO CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THISRECORD HAS BEEN PROVIDED TO THE WELL OWNER
FOR OFFICE USE ONLY
Quad No:
Serial No.
�`17(‘O— ; .�O.n, £CRCItdCi n77/1�L /4 -/, l l
SIGNA O RSON CONSTRU THE WELL DATE
Submit original to Division of Water Quality, Groundwater Section within 30 days
GW-I REV. 12/99

Norm Carolma —Department of Enviromnent and Natural Resources —
1636 Mail Service Center — Raleigh, N.C. 27699-1636 —Phone [phone] ision of Water Quality —Groundwater Section
WELL CONSTRUCTION RECORD WELL CONTRACTOR: RODNEY ROBBINS
WELL CONTRACTOR CERTIFICATION #: 2785
STATE WELL CONSTRUCTION PERMIT #:
1. WELL USE (Check Applicable Box): ® Residential ❑ Municipal 0 Industrial ❑ Agricultural ❑ Monitoring
❑ Recovery ❑ Heat Water Injection 0
2. WEi.1 LOCATION: (Show sketch of the location below) Other Homer, List Use:
Nearest Town: LAKE LURE County: RUTH
BIRD DOG BLVD.
G
(Road Name and Numbers, Community, or Subdivision and Lot No.) FromR�L To LOG DEPTH
3. OWNER BOB MOSKOS Formation Description
Address BIRD DOG BLVD.
(Street or Route No.)
LAKE LURE NC 28746
City or Town State Zip Code
4. DATE DRILLED 12/01/06
5. TOTAL DEPTH 345
6. CUTTING COLLECTED 0 YES ® NO
7. DOES WELL REPLACE EXISTING WELL? 0 YES ® NO
8. STATIC WATER LEVEL Below Top of Casing: 40 FT.
(Use "+" if Above Top of Casing)
9. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated aUor below land surface requires a variance in accor-
dance with 15ANCAC 2C.0118
10. YIELD (gpm): 40 METHOD OF TEST: ARD
11. WATER ZONES (depth):
12. CHLORINATION:
13. CASING:
Depth
From 0 To 70
From _ To
From To
14. GROUT:
Depth
From 0 To 20
From _ To
15. SCREEN -
Type: CHLORYTE Amount: 9
Wall Thickness
Diameter or Weight/Ft Material
Ft. 6-1/4" SDR21 PVC
Ft.
Ft.
Material Method
Ft QUILKRETE POURED
Ft.
Depth Diameter Slot Size Material
From _ To Ft _ in. in.
From _ To Ft in. in.
From _ To Ft. in, in.
16. SAND?GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
17. REMARKS:
If additional space is needed use back of form
tin
Con
Zit
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other reference points)
HWY. 64/74A W. FROM RUTHERFORDTON. LEFT INTO
RIVERBEND. LEFT ON WILDCAT BLVD. LEFT ON
PHEASANT ST. LEFT ON BIRD DOG BLVD. 1/2 MILE ON
RIGHT.
DIV. OF WATER OV ALITY
lAN 9 5 2007
I DO CERTIFY THAT THIS WELL WAS CONSTRUC 1 at IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THISRECORD HAS BEEN PROVIDED TO THE WELL OWNER
FOR OFFICE USE ONLY
Quad No:
Serial No.
GNATORE OF ONJ ONCi S1xuu�G 7HE WELL
Submit ota(inal to Division of Water QupIity, Groundwater Section within 30 days
f /?
DATE
GW-1 REV. 12/99

Mil ui 'arolma — Department of Environment and Natural Resources —
ivision
1636 Mail Service Center — Raleigh, N.C. 27699-1636 — Phone [phone] of Water Quality —Groundwater Section
WELL CONSTRUCTION RECORD WELL CONTRACTOR RODNEY ROBBINS
WELL CONTRACTOR CERTIFICATION #: 2785
STATE WELL CONSTRUCTION PERMIT #:
I. WELL USE (Check Applicable Box): Residential Munici
0 Recovery ❑ Heat Pump Water Injection 1� Industrial Agricultural Monitoring
2. WELL LOCATION: (Show sketch of the location below) ❑Other If Other, List Use:
Nearest Town: LAKE LURE County: RUTH
BIRD DOG BLVD
3. OWNER JOHNP(Road Name and Numbers, Community or Subdivision and Lot No.) DRILLING LOG DEPTH
_._ ATERACM
Address BIRD DOG BLVD.
(Sheet or Route No.)
LAKE LURE NC 28746
City or Town State Zip Code
4. DATE DRILLED 12/07/06
5. TOTAL DEPTH 505
6. CUTTING COI.r.FCTED ❑ YES ® NO
7. DOES WELL REPLACE EXISTING WELL? 0 YES ® NO
8. STATIC WATER LEVEL Below Top of Casing: 40 FT.
(Use `+" if Above Top of Casing)
9. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
'Top of casing terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2C.0118
10. YIELD (gpm): 1-1/2 METHOD OF TEST: ARD
11. WATER ZONES (depth):
12. CHLORINATION: Type: CHLORYTE Amount: 13.5
13. 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.
14. GROUT: Depth Material Method
From 0 To 20 Ft. QUILKRETE POURED
From To Ft.
15. SCREEN: Depth Diameter Slot Size Material
From To FL in. in.
From To FL in. in.
From To Ft. in. in.
16. SAND?GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
17. REMARKS:
If additional space is needed use back of form
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other reference points)
HWY. #64/74A W. FROM RUTHERFORDTON. LEFT INTO
RIVERBEND. LEFT ON WILD CAT BLVD. LEFT ON
PHEASANT ST LEFT ON BIRD DOG BLVD. 1/2 MILE ON
LEFT.
RECEIVED
DIV. OF WATER QUALITY
lAN 0 5 2U07
I DO CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THISRECORD HAS BEEN PROVIDED TO THE WELL OWNER
FOR OFFICE USE ONLY
Quad No:
Serial No.
Submi
0 Division of Water Quality, Groundwater Section within 30 days
OF PERSON CO TRUCTING THE DATE
GW-I REV. 12/99

mom �arouna — Department of Environment and Natural Resources — Division of Water 1636 Mail Service Center — Raleigh, N.C. 27699-1636 — Phone [phone] Quality — Groundwater Section
WELL CONSTRUCTION RECORD WELL CONTRACTOR RODNEY ROBBINS
WELL CONTRACTOR CERTIFICATION #: 2785
STATE WELL CONSTRUCTION PERMIT #: _
1. WELL USE (Check Applicable Box): ® Residential ❑ Municipal 0 Industrial
❑ Recovery 0 Heat PumpWater Injection Agricultural ❑Monitoring
J ❑Other If Other, List Use:
2. WELL LOCATION: (Show sketch of the ]ovation below)
Nearest Town: LAKE LURE County: RUTH
BIRD DOG BLVD.
(Road Name and Numbers, Community,DRILLING LOG DEPTH
3. OWNER CARLOS It DE LA FUENTES Subdivision and Lot No.) From To Formation Description
Address BIRD DOG BLVD.
(Street or Route No.)
LAKE LURE NC 28746
City or Town State Zip Code
4. DATE DRILLED 12/11/06
5. TOTAL DEPTH 305
6_ CUTTING COJ.T.FCTED ❑ YES ®NO
7. DOES WELL REPLACE EXISTING WELL? 0 YES ® NO
8. STATIC WATER LEVEL Below Top of Caging: 60 FT.
(Use "+" if Above Top of Casing)
9. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated alor below land surface requires a variance in accor-
dance with 1SANCAC 2C.0118
10. YIELD (gpm): 4 METHOD OF TEST: ARD
11. WATER ZONES (depth):
12. CHLORINATION: Type: CHLORYTE Amount: 7.5
13. CASING:
Wall Thickness
Depth Diameter or Weight/Ft Material
From 0 To 120 Ft. 6-1/4" SDR.21 PVC
From _ To Ft.
From To Ft.
14. GROUT:
Depth Material Method
From 0 To 20 Ft. OUILKRETE POURED
From To Ft.
15. SCREEN:
Depth Diameter Slot Size Material
From To Ft. _ in. in.
From To Ft. in._ in.
From To Ft. in. in.
16. SAND?GRAVEL PACK:
Depth Size Material
From To Ft _
From To Ft
17. REMARKS:
If additional space is needed use back of form
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other reference points)
HWY. 64/74A W. FROM RUTHERFORDTON. LEFT INTO
RIVERBEND. LEFT ON WILD CAT BLVD. LEFT ON
PHEASANT ST. LEFT ON BIRD DOG BLVD. 1 MILE ON LEFT.
RECEIVED
OIV. OF WATER QUALM'
pAW 4 5 2007
I DO CERTIFY THAT THIS WELL WAS CONSTRUCI'BD IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THISRECORD HAS BEEN PROVIDED TO THE WELL OWNER,
FOR OFFICE USE ONLY
Quad No:
Serial No.
r^
„ SIG TUTURE OF P ON CONSTRUCTING THE WELL, DATE
Su original to Division of Water Quality, Groundwater Section within 30 days
GW-I REV. 12/99

North Carolina —Department of Environment and Natural Resources
1636 Mail Service Center — Raleigh, N.C. 27699-1636 — Phone (7 — Division of Water Quality — Groundwater Section
WELL CONSTRUCTION RECORD WELL CONTRACTOR ROBIN MCNEELY
WELL CONTRACTOR CERTIFICATION #: 2567
STATE WELL CONSTRUCTION PERMIT #:
1. WELL USE (Check Applicable Box): ® Residential
0 RecoveryMunicipal ❑Industrial ❑Agricultural Monitoring
2. WELL LOCATION: (Show❑sketch of thpe location below) ater Injection 0 Other If Other, List Use:
Nearest Town: RUTHERFORDTON County:RUTH
242 LEE CUDD RD. —
LRI IN G LOG DEPTH
(Road Name and Numbers, Communityor Subdivision and Lot No.) From To
3. OWNER JANICE B. JOLLEY Formation Description
Address 342 LEE CUDD
(Street or Route No.)
RU'THERFORDTON NC 28139
City or Town State Zip Code
4. DATE DRILLED 12/11/06
5. TOTAL DEPTH 42
6. CUTTING COI L.FCTED 0 YES NO
7. DOES WELL REPLACE EXISTING WELL? 0 YES ® NO
8. STATIC WATER LEVEL Below Top of Casing: 22 FT
(Use "+" if Above Top of Casing)
9. TOP OF CASING IS I-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2C.0118
10. YIELD (gpm): 20 METHOD OF TEST: S 1'EEL TAPE
11. WATER ZONES (depth):
12. CHLORINATION: Type: CHLORYTE Amount 9.2
13. CASING:
Depth Diameter
From 0 To 42 Ft. 24
From _ To Ft.
From To Ft.
14. GROUT:
From Depth o 20 Ft. CEMENT aterial Method
OURED
From To FL
15. SCREEN:
Depth Diameter Slot Size Material
From To FL
in in
From To Ft. in in.
From To Ft in in
16. SAND?GRAVEL PACK:
Depth Size Material
From 22 To 42 FL 78M GRAVEL
From To FL
17. REMARKS:
Wall Thickness
or Weight/Ft Material
CEMENT
If additional space is needed use back of form
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other reference points)
POORS FORD RD FROM SHILOH. CROSS BROAD RIVER
LEFT ON LEE CUDD RD. NEW HOUSE ON LEFT. 3 MILES.
D
DIV OF WATER O IAliry
IAN (1 200/
I DO CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THISRECORD HAS BEEN PROVIDED TO THE WELL OWNER
FOR OFFICE USE ONLY
Quad No:
Serial No.
' Id , i i , -/l - D
/o G
S GNA O ERSO S C G THE WELL Submit original to Division of Water DATE
Groundwater Section within 30 days
GW-1 REV. 12/99
n 1 -
1:,1.

worm t arotma - Department of Environment and Natural Resources - 1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone] of Water Quality - Groundwater Section
WELL CONSTRUCTION RECORD WELL CONTRACTOR: ROBIN MCNEELY
WELL CONTRACTOR CERTIFICATION ATIOC#: 2567
STATE WELL CONSTRUCTION PERMIT #:
1. WELL USE (Check Applicable Boa): Residential
0 Recoveryt Municipal Industrial Agricultural Monitoring
❑ater 2. WELL LOCATION: (Showsketch the locatio Injection below) ❑� If der, List Use:
Nearest Town: FOREST CITY
370 CROWE DAIRY RD. County: RU7TI
(Road Name and Numbers, Cotumuni DRI L LOG DEPTH
3. OWNER FRANC.__ IS LUMAS or Subdivision and Lot No.) From To
Formation Description
Address 370 CROWS DAIRY RD.
(Street or Route No.)
FOREST CITY NC
City or Town 28043
4. DATE DRILLED 12/11/06 State Zip Code
5. TOTAL DEPTH 60
6. CUTTING COLLECTED 0 YES ® NO
7. DOES WELL REPLACE EXISTING WELL? YES ® NO
8. STATIC WATER LEVEL Below Top of Casing: 40 FT (Use "+" if Above Top of Casing)
9. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface
dance with 15A NCAC 2C.0118 requires s variance in
YIELD (gpm): 20 METHOD OF TEST: STEEL TAPE
11. WATER ZONES (depth):
12. CHLORINATION: Type: CHLORyTE Amount: 9.2
13. CASING:
Wall Thickness
Depth Diameter or Weight/FL Material
From 0 To 60 Ft. 24 CEMENT
From To Ft. From To Ft. 14. GROUT: Depth Material Method
From 0 To 20 Ft. CEMENT POURED
From To Ft.
15. SCREEN: Depth Diameter Slot Size Material
From To Ft.
in. in.
From To Ft. in. in.
From To Ft
16. SAND?GRAVEL PACK:
Depth Size Material
From 40 To 60 Ft. 78M GRAVEL
From To Ft
17. REMARKS:
in
in.
CD
CID
rep
44.
If additional is needed use back of form
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other reference points)
FROM OAKLAND RD. GO DOWN OAKLAND RD. RIGHT ON
CROWE DAIRY RD. GO 3/4 MILE ON RIGHT.
t. �FWAIERQUALITY
JAN 0 5 200?
I DO CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THISRECORD HAS BEEN PROVIDED TO THE WELL OWNER
N
S NA
Submit original to Division
ON ONSTRUCTING THE DA
ater Quality, Groundwater Section within 30 days
GW-1 REV. 12/99

*o, u, Lumina — Department of Environment and Natural Resources — Division of Water Quality — Groundwater Section
1636 Mail Service Center — Raleigh, N.C. 27699-1636 —Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR ROBIN MCNEELY
WELL CONTRACTOR CERTIFICATION #: 2567
STATE WELL CONSTRUCTION PERMIT #: .32654-8
1. WELL USE (Check Applicable Box): ® Residential
0 Recove ❑ Municipal ❑Industrial ❑Agricultural ❑Monitoring
ry ❑Heat Porch Water Injecton ❑Other If Other, List Use:
location
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: ELLENBORO County: RUTH
CAMPFIELD CHURCH RDD.
G
(Road Name and Numbers, Community, or Subdivision and Lot No.) FromRII L ToLOG DEPTH
3. OWNER DAVID & DIANE WARE Formation Description
Address CAMPFIELD CHURCH RD.
(Street or Route No.)
ELLENBORO NC 28040
City or Town State Zip Code
4. DATE DRILLED 12/12/06
5. TOTAL DEPTH 60
6. CUTTING COLLECTED 0 YES ® NO
7. DOES WELL REPLACE EXISTING WELL? 0 YES ® NO
8. STATIC WATER LEVEL Below Top of Casing: 42 FT.
(Use "+" if Above Top of Casing)
9. TOP OF CASING IS aFT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2C.0118
10. YIELD (gpm): 18 METHOD OF TEST: S IEEL TAPE
11. WATER ZONES (depth):
12. CHLORINATION:
13. CASING:
Depth
From 0 To 60
From To
From To__
14. GROUT:
Depth
From 0 To 20
From _ To
15. SCREEN:
Depth
From To
From _ To
From To
16. SAND?GRAVEL PACK:
Depth Size
From 42 To 60 Ft. 78M
From To FL
17. REMARKS:
Type: CHLORYTE Amount: 8.28
Wail Thickness
Diameter or Weight/Ft. Material
Ft. 24 CEMENT
Ft.
Ft.
Material Method
Ft. CEMENT POURED
Ft.
Diameter Slot Size Material
FL in. in.
Ft. in. in.
Ft in. in.
Material
GRAVEL
If additional space is needed use back of fonn
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other reference points)
BUS. 74 E. FROM ELLENBORO. LEFT ON CAMPFIELD
CHURCH RD. 1/2 MILE ON RT.
D!v otttut
r WUATF& r. L L !
JAN (g 6 2007
I DO CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THISRECORD HAS BEEN PROVIDED TO THE WELL OWNER.
FOR OFFICE USE ONLY
Quad No:
Serial No.
SIt A '.OF
Submit original to Division of W
CO ' STRUCTING THE WELL ti DATE
Quality, Groundwater Section within 30 days
GW-I REV. 12/99
6

=llir u, ..arolma — Department of Environment and Natural Resources 1636 Mail Service Center— Raleigh, N.C. 27699-1636 —Phone () 733_ 22i of Water Quality _Groundwater Section
WELL CONSTRUCTION RECORD WELL CONTRACTOR ROBIN MCNEELY
WELL CONTRACTOR CERTIFICATION p #: 2567
STATE WELL CONSTRUCTION PERMIT #:
1. WELL USE (Check Applicable Box): Residential
0 Recovery ❑ Heai Municipal Industrial A Pump Water Injection 0 Other If Other, List Use: Agricultural Monitoring
2 WELL LOCATION: (Show sketch of the location below)
Nearest Town: RUTHEON County: RUTH
DUN CAN RD
(RoadName and Numbers, Community,DRILLING LOG DEPTH
3. OWNER LYNN GRAN' or Subdivision and Lot No.) From To
Address DUNCAIN RD Forniation Description
(Street or Route No.)
RUTHF_O1�T�N NC
City or Town State 28139
4. DATE DRILLED 12/14/06 Zip Code
5. TOTAL DEPTH 47
6. CUTTING COLLECTED 0 YES NO
7. DOES WELL REPLACE EXISTING WELL? 0 YES CO NO
8. STATIC WATER LEVEL Below Top of Casing: 27 FT
(Use `+^ if Above Top of Casing)
9. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
`Top of casing terminated ator below land surface requires a variance in accor-
dance with 15ANCAC 2C.0118
10. YIELD (gpm): 20 METHOD OF TEST: STEEL TAPE
11. WATER ZONES (depth):
12. CHLORINATION: Type: CHLORYTE
13. CASING: Amount: 9.2
Wall Thiclmess
Depth Diameter or Weight/Ft. Material
From 0 To 47 Ft. 24 CEMENT
From To Ft
From To Ft. 14. GROUT:
Depth Material Method
From 0 To 20 Ft. CEMENT POURED
From To Ft.
15. SCREEN:
Depth Diameter Slot Size Material
From To Ft in. in.
From To Ft. in.
From To�
Ft. in.
16. SAND?GRAVEL PACK: — —
Depth Size Material
From 27 To 47 Ft. 78M GRAVEL
From To FL
17. REMARKS:
If additional space is needed use back of form
336547
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other reference points)
HWY. #221 S. FROM RUTHERFORDTON. RIGHT ON JACK
MCKINNEY RD. RIGHT ON DUNCAN RD. 1ST DIRT DRIVE ON
RIGHT.
DIV OREEIED
F WATER OI ALITY
JAN (l 5 200?
I DO CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THISRECORD HAS BEEN PROVIDED TO THE WELL OWNER
FOR OFFICE USE ONLY
Quad No:
Serial No.
AVA
0�
GNA 0tV• O CONSTRUCTING T WELL
Submit original to Division . Water Qndity, Groundwater DATE
Section within 30 days
GW-1 REV. 12199

City or Town NC 28139
State 4. DATE DRILLED 12/15/06 Zip Code
5. TOTAL DEPTH 54
6. CUTTING COLLECTED ❑ YES
7. DOES WELL REPLACE EXISTING WELL? NO YES 8. STATIC WATER LEVEL Below To ®NO
(Use "+" if Above Top of Casing) P of Casing: 34 FT,
9. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated atlor below land
dance with 15A NCAC 2CA11 g surface requires a variance in actor_
10. YIELD (gpm): 20 METHOD OF TEST: STEEL TAPE
11. WATER ZONES (depth):
12. CHLORINATION: Type: CHLORYTE
13. CASING: Amount: 9.2
""' `u ..al mina — Department of Environment and Natural Resources —Division of Water
1636 Mail Service Center— Raleigh, N.C. 27699-1636 — Phone [phone] Quality — Groundwater Section
WELL CONSTRUCTION RECORD WELL CONTRACTOR: ROBIN MCNEELY
WELL CONTRACTOR CERTIFICATION #: 2567
1. WELL USE (Check Applicable Box): Residentia STATE WELL CONSTRUCTION PERMIT #:
0 Recovery ❑ HeatMunicipal Industrial
2 WELL LOCATION: (Show sketch Pump tWaterocalionj below) 0 Other Agricultural Monitoring
If Other, List Use:
Nearest Town: RUTHE RFORJTON County RUTH
LEWIS RD
(Road Name and Numbers, Communion DRILLING LOG
3. OWNERTOM_ STOVER ty, or Subdivisiand Lot No.) Fro ' DEPTH
Address LEWIS RD Formation Description
(Street or Route No.)
RUTHE RFORDTON
De
From 0 To
54
From To
From To
14. GROUT:
Depth
From 0 To 20
From To
15. SCREEN:
Depth
From To
From To
From To
16. SANDTGRAVEL PA
Depth
From 34 To 54
From To
17. REMARKS:
Wa11 Thickness
Diameter or Weight/Ft Material
Ft. 24 CEMENT
Ft.
Ft.
Material Method
Ft. CEMENT POURED
Ft.
Diameter Slot Size Material
Ft. in.
Ft. in. in.
Ft in. in.
CK:
Size Material
Ft 78M GRAVEL
Ft
336546
If additional ce is needed use back of form
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other reference points)
HWY. #221 N. FROM RUTHERFORDTON LEFT ON MTN.
CREEK RD. RIGHT ON LEWIS RD. CROSS OVER BRIDGE.
LAST HOUSE ON RIGHT.
0/V.OREEIVE
FINATER ED Atiry
JAN 0 5 2007
I DO CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WEI L
CONSTRUCTION STANDARDS, AND THAT A COPY OF THISRECORD HAS BEEN PROVIDED TO THE WELL OWNER
NOR OFFICE UST fl&t v i
0
SIGNA OF
Submit original to Division of Water
S GCTING THE WELL
ty, Groundwater Section within 30 days DATE
GW-1 REV. 12/99

From: Scott Gantt 7044347212 To: Stephenie Wlson
Date: 1/512007 Time: 12:16:16 PM rage
RESIDENTIAL WELL CONSTRUCTION RECORD
333697
RECEIVED
DIV. OF WATER QUALITY
North Carolina Department of Environment and Natural Resources — Division of Water Quality
Well Contractor Certification it 2584
1. WELL CONTRACTOR:
ALAN SCOTT GANTT
Well Contractor (Individual) Name
CAROLINA WELL DRILLERS, INC.
Well Contractor Company Name
STREET ADDRESS: 522 GANTT'S GROVE CHURCH RD
MOORESBORO, NC 28114
[phone]
Area code — Phone number
2. WELL INFORMATION
SITE WELL ID #(ww APPLIACBLE)
STATE WELL PERMIT # (IF APPLICABLE)
DWQ or OTHER PERMIT # (IF APPLICALBE)
WELL USE (Check Applicable Box): Residential Water Supply
DATE DRILLED 12/1/06
TIME COMPLETED 4 AM ❑ PM El
3. WELL LOCATION:
CITY: LAKE LURE COUNTY: RUTHERFORD
SHANNONS WALK, RIVERBEND SUB.
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
❑ Slope ❑ Valley ® Flat ❑ Ridge ❑ Other
Latitude/Longitude Source: ❑ GPS ❑ Topographic map
LATITUDE 35.25.993
LONGITUDE 82.09.670
(location of well must be shown on a USGS topo map and
attached to this form if not using GPS)
4. WELL OWNER
OWNER'S NAME JAY EBERHARDT
STREET ADDRESS 158 PLEASANT CIRCLE
LAKEL LURE NC 28746
City or Town State Zip Code
828-625-1376
Area code — Phone number
5. WELL DETAILS:
A. TOTAL DEPTH: 640
B. DOES WELL REPLACE EXISTION WELL? YES ❑ NO Ei
C. WATER LEVEL Below Top of Casing: 380 FT
D. TOP OF CASING IS 2 FT Above Land Surface*
*Top of casing terminated at/or below land surface may require
a variance in accordance with 15NCAC 2C .0118.
E. YIELD (gpm): 2 METHOD OF TEST ARDM
JAN 0 8 2007
f.DISINFECTION:TypeHYPOCHLORITEAmt:130Z
g. WATER ZONES ( depth)
From 351 To 351 From
From To
From To
From
From
To
To
To
6. CASING: Thickness/
Depth Diameter Weight Material
From + 2 To 25 Ft. 6 1/8 SDR2I PVC
From To
Ft.
From To Ft.
7. GROUT: Depth Material Method
From 0 To 2 Ft. GRAVEL MIX GRAVITY
From 2 To 25 Ft EASY SEAL GROUTER
From To
8. SCREEN: Depth
From To Ft.
From To Ft.
From To Ft.
9. SAND/GRAVEL PACK:
Depth Size
From To
From To
From To
10. DRILLING LOG
From To • Formation
0 20 CLAY
20 640 CONSOLIDATED ROCK
Ft
Diameter Slot Size Material
in in
in in
in in
Material
11. REMARKS:
Ft
Ft
Ft
I DO HF.aFBY CERTIFY THAT THIS WELL WAS CONSTRUCTED
124OF ACCORDANCE
RECORD HAS DANCE WITH 5
NCAC 2c. WELL CONSTRUCTN STANDARDS, AND
THAT
BEEN
PROVIDED TO 1Hk, WELL OWNER
SIGNATURE OF CERTIFIED WELL CONTRACTOR
DATE 1/1/07
ALAN S. GANTT
PRINTED NAME OF PERSON CONSTURCTING THE WELL
r
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt.,
1617 Mail Service Center — Raleigh, NC 27699-1617
Form GW-1a
Rev. 7/05

North Carolina —Department of Environment and Natural Resources — Division of Water Quality — Groundwater Section
1636 Mail Service Center — Raleigh, N.C. 27699-1636 — Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR ROBIN MCNEELY
WELL CONTRACTOR CERTIFICATION #: 2567
STATE WELL CONSTRUCTION PERMIT #:
1. WELL USE (Check Applicable Box): ® Residential 0 Municipal
0 Recovery 0 Heat Pump Water Injection 0 Other
2 WELL LOCATION: (Show sketch of the location below)
Nearest Town: SPINDALE County: RUTH
OLD STONECUTTER RD. DRILLING LOG DEPTH
(Road Name and Numbers, Community, or Subdivision and Lot No.) From To Formation Description
3. OWNER RICKY PA1 TERSON
Address OLD STONECUTTER RD .
(Street or Route No.)
SPINDALE NC 28160
U Industrial 0 Agricultural 0 Monitoring
If Other, List Use:
City or Town State Zip Code
4. DATE DRILLED 12/18/06
5. TOTAL DEPTH 60
6. CUTTING COLLECILD 0 YES ® NO
7. DOES WELL REPLACE EXISTING WELL? 0 YES ® NO
8. STATIC WATER LEVEL Below Top of Casing: 45 FT.
(Use "+" if Above Top of Casing)
9. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
'Top of casing terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2C.0118
10. YIELD (gpm): 15 METHOD OF TEST: STEEL TAPE
11. WATER ZONES (depth):
12. CHLORINATION: Type: CI-ILORYTE Amount 6.9
13. CASING:
Depth Diameter
From 0 To 60 Ft. 24
From To Ft.
From To Ft.
14. GROUT:
Depth Material Method
From 0 To 20 Ft. CEMENT POURED
From To Ft.
15. SCREEN:
Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
From To Ft. in. in.
16. SAND?GRAVEL PACK:
Depth Size Material
From 45 To 60 Ft. 78M GRAVEL
From To Ft.
17. REMARKS:
Wall Thickness
or Weight/Ft Material
CEMENT
"3 r
If additional space is needed use back of form
CAD
cta
trD
Cal
227
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other reference points)
BY-PASS 74 E. FROM RUTHERFORDTON. EXIT RT. ON
OAKLAND RD. RT. ON POORS FORD RD. RT. ON OLD
STONECUTTER RD. 1 MILE ON RT.
RECEIVED
ON. OF WATER QUALITY
JAN (! 5 ZOU7
I DO CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THISRECORD HAS BEEN PROVIDED TO THE WELL OWNER.
FOR OFFICE USE ONLY
Quad No:
Serial No.
Submit original to Division of Water
� a e7(XC /a / ,� c
SIGNAYURE Olt PERS NSTItGCTING THE WELL DATE
ty, Groundwater Section within 30 days
GW-1 REV. 12/99

]� G?Ot-%3U/ 1c
. RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Div. ion of Water Quality
WELL CONTRACTOR CERTIFICATION # 3 )12
1. WELL CONTRACTOR:
C Loa Ce d1O. L-k (5
Well Contractor (Individual) Name
Well Contractor Company
/Name
STREET ADDRESS 67od 5ialetG,e in-17
GGcx-1e1k ter.
city or Town State Zip Cale
i76'I } i 3°K 57.) a
Area code- Phone number
2. WELL INFORMATION:
SITE WELL ID #(if applicable)
STATE WELL PERMIT#(if applicable)
DWQ or OTHER PERMIT #(i1 applicable)
WELL USE (Check Applicable Box): Residential Water Supply Q
DATE DRILLED /.71- 20- (.)G,
TIME COMPLETED I D.3C)
3. WELL LOCATION: ` ,
CITY:r)Al vtA vt. y ROCL COUNTY�v�s�AQ(h)r
PM ❑
,287
,20
(Street Name. Numbers, Community. Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
❑Slope ❑Valley ❑Flat ID Ridge ❑Other
(check ap{pr�r riete box)
LATITUDE 3 UJ` -`r(d
LONGITUDE � / . /l.'(i
Latitude/longitude source: 31GPS ❑Topographic map
(location of well must be shown on a USGS topo map and
attached to this form if not using GPS)
4. WELL OWNER W 'An ,n�
OWNER'S NAME I [.(s U S-C
May be in degrees,
minutes, seconds or
in a decimal format
STREET ADDRESS 55
C-Von ntka ihr k j/, f. n7iR0
City or Tod, State Zip Code
(&2W)- 62- — 9& (
Area code - Phone number
5. WELL DETAILS: ^^�� rr��--��
a. TOTAL DEPTH: oCs-li
b. DOES WELL REPLACE EXISTING WELL? YES 0
c. WATER LEVEL Below Top of Casing: 7 p�
(Use `+' if Above Top of Casing)
d. TOP OF CASING IS ' ' / FT. Above Land Surface-
. *Top of casing terminated at/or below land surface may require
a variance in accordance with 15A NCAC 2C .0118. 1
e. YIELD(gpm): 3U METHOD OF TEST v/0 CL
NOM"
FT.
31x
L DISINFECTION: Type t-c k 4-k- Amount t tc tr/j.
g. WATERZONES (depth):
Front. To?II 6 From To
From /AO To /2 From To
From ilfg To /625< i From
To
6. CASING: Thickness/
Depth �^t Diameter Weight Material
From G To y,� Ft.
From To Ft.
From To Ft.
7. GROUT: Depth Material
From 0 To 9a Fttlea-cerneit7
From To Ft.
From To Ft.
Method /
Fslua-
8. SCREE., /r• Depth Diameter Slot Size Material
Frorrf" To Ft. in. in.
From To Ft. in. in.
From To Ft. in.. in.
9. SAND/GRAVEL PACK:
DeB Size Material
Fro nTo Ft.
From To Ft.
From -To Ft.
10. DRILLING LOG
From To •
D-
5/y- O
11. REMARKS:
Formation Description
O(/e/4'wrt e
Orgy PLC[.
r111
t?Er.Fn1Pr,
OF W1TEP OVA
AN l 4 2007
I00 HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
ISA NCAC 2C. WELL CONSTRUCTION STANDARDS. AND IHATA DOPY OF THIS
RECORD HP?S BE PROVIDED TO THE ELL OWNER.
LI /C /-oZU-C4)
SIGNATURE OF CERTIFIED WELL CONTRACTOR DATE
(1,ar t;e tlicL0015
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
UTv
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

Noah Carolina -Department of Environment and Natural Resources -Division of Water Quality - Groundwater Section
1636 Mail Service Center - Raleigh, N.C. 27699-1636 -Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR JEFF MELTON
WELL CONTRACTOR CERTIFICATION #: 3417
STATE WELL CONSTRUCTION PERMIT #:
1. WELL USE (Check Applicahle fax): U Residential 0 Municipal U Industrial U Agricultural 0 Monitoring
❑ Recovery 0 Heat Pump Water Injection ® Other If Other, List Use: PUBLIC
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: LAKE LURE County: RUTH
BOYS CAMP RD. DRILLING LOG DEPTH
(Road Name and Numbers, Community, or Subdivision and Lot No.) From To Formation Description
3.OWNER BLUE HERON POINT -WELL #1
Address BOYS CAMP RD.
(Street or Route No.)
LAKE LURE N.0 28746
City or Town State
4. DATE DRILLED 02/28/06
5. TOTAL DEPTH 705
6. CUTTING COLLECTED 0 YES ® NO
7. DOES WELL REPLACE EXISTING WELL? 0 YES ® NO
8. STATIC WATER LEVEL Below Top of Casing: 0_FT.
(Use "+" if Above Top ofCesiog)
dance Ywith
ith 1DSA(gNpCAC 2C.01189T10oO
.fPcmOFgCtermitdAmatr1 b-
Ml/2owETFlaHnd.ODmfeAbOFreTqEire Land
a Svrbxaorface4L
moor.
MW
11. WATER ZONES (depth):
Zip Code
12. CHLORINATION: Type: CHLORYTE Amount 19.5
13. CASING:
Wall Thickness
Depth Diameter or Weight/Ft Material
From 0 To 83 Ft. 8" 250 WALL GALV.
From _ To Ft. _ __
From To Ft
14. GROUT:
Depth Material Method
From 0 To 20 Ft OU1 an POURED
From To Ft._ ___
15. SCREEN:
Depth Diameter Slot Size Material
From To Ft. i in.,,,^. in._
From To Ft in. in.
From To Ft in. in.
16. SAND?GRAVEL PACK:
Depth Size Material
From To Ft. _,_
From _ To Ft. _ ___
17. REMARKS:
333713
RECEIVED
JAN 05 2007
Asheville Regional Office
_.. uifer Protection
FEB 21 2017
If additional space is needed use back of form
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or otter reference points)
HWY. #64/74 W. FROM RUTHERFORDTON. RT. ON BOYS
CAMP RD. IN LAKE LURE, GO TO DEAD END. BLUE HERON
IS ON LEFT
DIV. OF WATFR QD ALITY
JAN 0 9 2007
I DO CERTIFY THAT THIS WELL WAS CONSTRUL MO IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THISRECORD HAS BEEN PROVIDED TO THE WELL OWNER.
FOR OFFICE USE ONLY
Quad No:
Serial No.
I T�I SIGNA OF PERSON CONSTRU G THE WELL DATE
Submit original to Division of Water Quality, Groundwater Section within 30 days
GW-1 REV. 12/99

North Carolina —Department of Environment and Natural Resources —Division of Water Quality— Groundwater Section
1636 Mail Service Center— Raleigh, N.C. 27699-1636 —Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR JEFF MELTON
WELL CONTRACTOR CERTIFICATION #: 3417
STATE WELL CONSTRUCTION PERMIT if:
1. WELL USE (Check Applicable Boit): 0 Residential t Mtn icipal 0Industrial 0 Agriculhual 0 Monitoring
0 Recovery 0 Heat Pump Water Injection ® Other If Other, List Use: PUBLIC
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: LAKE LURE County: RIM
BOYS CAMP RD DRILLING LOG ping
TH
(Road Name and Numbers, Community, or Subdivision and Lot No.) From To Formation Description
3. OWNER BLUE HERON POINT -WELL #3
Address BOYS CAMP RD.
(Street or Route No.)
LAKE LURE IQ 28746
City or Town State Zip Code
4. DATE DRILLED 04/22/06
5. TOTAL DEPTH 585
6. CUTTING COLLECTED 0 YES ® NO
7. DOES WELL REPLACE EXISTING WELL? 0 YES ® NO
8. STATIC WATER LEVEL Below Top of Casing: 120 FT.
(Use'+" if Above Top of Casing)
9. TOP OF CASING IS 1-1/2 FT. Above Land S» rfaco'
'Tap of wing terminated at/or below land surface narked a variance in accor-
dance with 15AHCAC 2C.0118
10. YIELD (gpm): 30 METHOD OF TEST: ARD
11. WATER ZONES (depth): _
12. CHLORINATION: Type: CHLORYTE Amount: 15.5
13. CASING:
Wall Thickness
Depth Diameter or Weight/Ft Material
From 0 To 93 Ft. 8" 322 WALL GALV.T&C
From To Ft.
From To Ft.
14. GROUT:
Depth Material Method
From 0 To 20 Ft.OUIKRETE POURED
From To Ft.
15. SCREEN:
Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft _ in._ in.
From To Ft. in. in.
16. SAND?GRAVEL PACK:
Depth Size Material
From To Ft. _
From To Ft
17. REMARKS:
FEB 2, 1
If additional space is needed use back of form
3711
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other reference points)
HWY. #64I74 W. FROM RU HERFORDTON. RT. ON BOYS
CAMP RD. IN LAKE LURE. GO TO DEAD END. BLUE HERON
IS ON LEFT.
RECEIVED
DIV OF WATER QUALITY
TAN 0 9 2007
I DO CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THLSRECORD HAS BEEN PROVIDED TO THE WELL OWNER.
FOR OFFICE USE ONLY
Quad No:
Serial No.
l SIGNATURE OF PERSON CONSTR G THE WELL DATE
Submit original to Division of Water Quality, Grotmdwnter Section within 30 days
GW-1 REV. 12/99
¢ CEIVED
J4N 05 2007
Ashev! o Regional Office

North Carolina —Department of Environment and Natural Resources —Division of Water Quality — Groundwater Section
1636 Mail Service Center— Raleigh, N.C. 27699-1636 — Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR JEFF MELTON
WELL CONTRACTOR CERTIFICATION #: 3417
STATE WELL CONSTRUCTION PERMIT #:
1. WELL USE (Check Applicable Box): U Residential U Municipal U Industrial 0 Agricultural 0 Monitoring
0 Recovery 0 Heat Pump Water Injection ® Other If Other, List Use: PUBLIC
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: LAKE LtJ1P County: RUTHERFORD
BOYS CAMP RD DRILLING LOG D_ P
(Road Name and Numbers, Community, or Subdivision and Lot No.) From To Formation Description
3. OWNER BLUE HERON POINT -WELL. #2
Address BOYS CAMP RD,
(Street or Route No.)
LAKE LURE IJtr 28746
City or Town State Zip Code
4. DATE DRILLED 03/03/06
5. TOTAL DEPTH 705
6. CUTF1NG COLLECrEU 0 YES ® NO
7. DOES WELL REPLACE EXISTING WELL? 0 YES ® NO
8. STATIC WATER LEVEL Below Top of Casing: 60 FT.
(Use"+" if Above Top of Cosieg)
9. TOP OF CASING IS 1-1/2 FT. Above Land Surface'
"Top of casing tan,Sted at/or below land surface requires ■ variaooe in accor-
dance with 15ANCAC 2C.011S
10. YIELD (gpm): 8 METHOD OF TEST: ARD
11. WATER ZONES (depth): _
12. CHLORINATION: Type: CHIARYTB Amount 19.5
13. CASING:
Wall Tlrickness
Depth Diameter or Weight/Ft. Material
From 0 To 70 Ft. 6-5/8" 250 WALL
GALV.W/DRIVESHOE
Farm To Ft _
From To Ft. _
14. GROUT:
Depth Material Method
From 0 To 20 Ft. OUIKRETE POURED
From To Ft.
15. SCREEN:
Depth Diameter Slot Size Material
From To Ft. _ in.^ in.
From To Ft. in. in.
From To Ft _ in. in.
16. SAND?GRAVEL PACK:
Depth Size Material
From To Ft
From To Ft.
17. REMARKS:
}':.>'a 41 an.
If additional space is needed use back of form
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other reference points)
HWY. #64/74 W. FROM RUTHERFORDTON. RT. ON BOYS
CAMP RD. IN LAKE LURE. GO TO DEAD END. BLUE HERON
IS ON LEFT.
RECEIVED
DIV. OF WATER QUALITY
JAN 0 9 Z007
I DO CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THISRECORD HAS BEEN PROVIDED TO THE WELL OWNER.
FOR OFFICE USE ONLY
Quad No:
Serial No.
SIGNATIEE a PERSON CONSTRU G THE WELL DATE
Submit original to Division of Water Quality, Groundwater Section within 30 days
GW-1 REV. 12/99
RECEIVED
JAN 05 2007
evilly Regional Office
ifer Protection

RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION# 21 38
1. WELL CONTRACTOR:
James W. Camp
Well Contractor (Individual) Name
Camp 's Well & PumD Co. Inc.
Well Contractor Company Name
STREET ADDRESS P 0 BOX 429
Ellenboro NC 28040
City or Tarn " State Zip Code
( 8281. 453-7322
Area code- Phone number
2. WELL INFORMATION:
SITE WELL ID #Of applicable)
STATE WELL PERMIT#(e applicable)
DWQ or OTHER PERMIT #(If applicable)
WELL USE/Check Applicable Boor): Residential Water Supply 6d
DATE DRILLED la - .l l . D 1.
TIME COMPLETED 1 I . u AM /PM Ilk-
1. WELL LOCATION:
CITY: a04Q.. COUNTY ____
Cjaa•C iA
(Sues Nam umbers. Community. Subdivision, Lot No., Parceialp Code)
TOPOGRAPHIC / LAND SETTING:
❑Slope °Vafey °Flat Staidge ❑Other
(check appropriate box)
LATITUDE 15 s \ y 4_g
LONGITUDE,,,_ SI) leI_1
Latitude/longitude source: D$PS OTopograpbic map
(bcatbn of wel must be shown On a USGS topo map and
attached fa fhb form l not using GPS)
May be In degrees,
minutes, seconds or
Ina decimal format
4.WELL OWNER
OWNER'S NAME u Q
STREET ADDR SS
M (itv.. State
agLiSS
City
own Stator
Area code Phone number
Jac"
3
c
Zip Code
5. WELL DETAILS: 41 C
a. TOTAL DEPTH: rf
b. DOES WELL REPLACE EXISTING WELL? YES p NO LIY
e. WATER LEVEL Below Top of Casing: ?c() FT,
(Use '+•.ifAbove Top of Casing)
d. TOP OF CASING IS 1 . FT. Above Land Surface*
'Top of casing temllnated at/or below land surface may require
a variance In accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): ) 0 METHOD OF TEST
336737
t. DISINFECTION: Type chlorine Amount I kA Cry
g. WATER ZONES (depth):
From To From To
From To From To
From To From - To
6. CASING: Thickness/
Depth Dlamoter Weight Material
From 0 To Ft. 6# SDR21 'PVC
From To Ft.
Rom To -Ft
7. GROUT: Depth Material Method
From 0 To 20 Ft Sackrete Hand
Front_______ To Ft
Fran To Ft
S. SCREEN: Depth Diameter Slot Size .Material
From_____ To Ft In. In.
From To Ft. In. In.
Fnan_ To Ft In. In.
e. SANDIGRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
From To Ft
10. DRILLING LOG
From To.
ins-
11. REMARKS:
Formation Descdptbn
t t(,FI LED
rw tA/ArTrc QUALI
!AN T1 4) 2007
I DO HEREBY CERTIFYMATTHIB WELL WAS OONSTRUCTED N ACCORDANCE Wml
15A NOAC 20, WELL CONSTRUCTION STANDARDS, AND THATACOPY QFTHIS •
RCECORD�RAASIBEEN PRO
VIDERTOt TTH/AE/WELL
�OWNER. ' _
SIGtIAT.URE O CE� IED WELL QONTRACTOR GATE
Lames W. Camp
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
y
Submit the original to the Division olWater Quality within ;30.days. Attn: lnfonnatlon Mgt.,
1617 Mall Service Center— Raleigh, NC 27699-1617 ' Phone No. [phone] ext 568.
Form GW-la
Rev. 7/05

City or Town ' State
( 828). 453-7322
Area code- Phone number
2. WELL INFORMATION:
SITE WELL ID #(Ir applicable)
STATE WELL PERMIT#(lfapplicable)
DWQ or OTHER PERMIT #(if applicable)
WELL USE/Check Applicable Box): Residential Water Supply
DATE DRILLED ) a . I I .
TIME COMPLETED I. 3 0
3. WELL LOCATIO
CITY: e+,,Lt A
RESIDENTIAL WELL CONSTRUCTION 'RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 21 38
1. WELL CONTRACTOR:
James W. Came
Well Contractor./Individual) Name
Camp's Well & Pump Co, Tnc
Well Contractor Company Name
STREET ADDRESS P 0 BOX
429
Ellenboro NC 28040
Zip Code
AM❑ PM ID--
r1�' COUN1
A..[ ono
(Street ems, Numbera. Canmu ty. SubdMNsion:Lot No., Parcel; in Code)
TOPOGRAPHIC / LAND SETTING:
['Slope Malley ['Fiat Cl Ridge ID Other
(shack appropriate boa)
LATITUDE 3 -:g 2 A P
LONGITUDE± 1 fi 0 /0
Latitude/longitude source: [' GPS ['Topographic map
(location of wel must be shown on a USGS topo map and
attached to this form I not ushg GPS)
WELL
4. WNER SN OWNER'S CAsi cr ONAME .� C` VI S
May be in degw,
minutes, seconds or
in • decimal format
STREDIc ADDRESS P() (JG Y. alI>nb�iic NG 2.40Ig
City or Town State Zip Code
Area code• Phone number
WELL
S a. TOTAL DEPTH: I+-ttrob
b. DOES WELL REPLACE EXISTING WELL? YES p NO q
c. WATER LEVEL Below Top of Casing: SU FT,
(Use '+'.11 Above Top of Casing)
d. TOP OF CASING IS 1 . FT. Above Land Surface*
'Top of casing terminated at/or below land surface may require
a vadance In accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): 3 METHOD OF TEST (1.42(
f. DISINFECTION: Type chlorine Amount 1,y�1
g. WATER ZONES (depth):
Fran To From To
From To From To
From To
6. CASING:
Depth
From 0 To Ft.
From..... To Fty
From To FL
From To
' .Thickness)
6inetWelt PVC
Material
GROUT: Depth Material Method
From 0 To20 Ft. Sackrete Hand
From To Ft.
From_ To Ft.
e. SCREEN: Depth Diameter - Slot Sim .Material
From To FL_in. In.
From To Ft. In. In.
From To Ft. In. In.
9. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
From To Ft.
10. DRILLING LOG
From0• 2To
�. ( ormaOggDesegp�
111 'a 3 SAA-vat
11. REMARKS:
tttLAUVE.0
OF WA f k QJIJALJ Fr?
JAN •I 9 '007
1 DO HEREBY CERTIFY THATTHW WELL WAS CONSTRUC1ED N ACCORDANCE Wrm
16A MAC 20. WELL CONSTRUCT ON STANDARDS. MDTHATACOPY OF THIS
RECORD HAS BBaEEEN VROVIDEDTOTRE WELL OWNER.rktilt ^ q
SIGNR.TURE OF CERT FIED WELL C�INTRACTOR I d A E O
James W. Camp
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Minion cif Water Quality wlthln;30.days. Attn: Information Mgt.,
1617 Mall Service Center- Raleigh, NC 27699-1617 ' Phone No. [phone] ext 568. .
Form GW.1a
Rev. 7/05

• RESIDENTIAL WELLCONSTRU.CTIONRECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION N 21 38
333734
1. WELL CONTRACTOR:
James W. Camp
Well Contractor.(IndMdual) Name
Camp's Well & PumD
Well Contractor Company Name
STREET ADDRESS
P 0 BOX
Co, Inc
429
E1lenboro NC
CityorTown State
( 828). 453-7322
Area code- Phone number
2. WELL INFORMATION:
SITE WELL ID Cif applicable) •
STATE WELL PERMIT/ATapplicable)
DWQ or OTHER PERMIT p(11 applicable)
WELL USE (Check Applicable Box): Residential Water Supply 0
DATE DRILLED (F t 0 b
TIME COMPLETED 2:.NTt
3. WELL LOCATION:
CITY:
28040
Zip Cade
AM Ilk" PMa/
COUNTY KAAi.)I LIts6M
(Street Name, Numbers, Communl . Subdivlsion:Lot No., Pertel;Zip Code)
TOPOGRAPHIC / LAND SETTING:
❑Slope °Valley Oylat CI Ridge El Other
(cheat appropriateebIox)
LATITUDE om$__• .��bGA tff\''4 t,
LONGITUDEIL_ '4S b 3 U
Latitude/longitude source: D GPS DTopographic map
(location
to this form /not s l must be shown onGP3) GS topo map and
May be in degrees,
minutes, seconds or
in a decimal format
4. WELL OWNER iY/�OWNERS NAME
STRE DDRESS jn6 r
a)1d55a4/ VA
City or Town State
io rnAn
r ter4hkkrq ct
,2D 101
Area code - Phone number
5. WELL DETAILS: `
a. TOTAL DEPTH: L`L\ 3
Zip Code
b. DOES WELL REPLACE EXISTING WELL? YES l7
e. WATER LEVEL Below Top of Casing: 14 I
(User" 11 Above Top of Casing)
d. TOP OF CASING IS 1 . FT. Above Land Surface'
'Top of casing terminated atlor below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD(gpm): METHOD OF TEST ftAA
NOS
ET.
f. DISINFECTION: Type chlorine Amount ' 3/�4 curl
g. WATER ZONES (depth):
From To
From To
From To
From To
From To
From To
6. CASING: never Thicimess/
From 0 Depth
FL Weight 6# SDR21
From To Ft
From_____ To .Ft.
7. GROUT: Depth Material
Fron 0_To 20 Ft Sackrete
From To Ft.
From To FL
8. SCREEN: Depth Diameter Slot Size _Material
From To Ft. In. In.
From To___ Ft. in. In.
From_ To Ft in. In.
9. SANDIGRAVEL PACK:
Depth Size Material
From ' To Ft
From To Ft.
From To Ft.
10. DRILLING LOG
From To Formatlop.Desyetiptpn
. 0 • 11 r4_a") t» a14
Material
'PVC
Method
Hand
1 1 c4,4 S ✓„iv 7L nt..
11. REMARKS:
rnv. ()r JuASFR ()LIMA
AN 1 0 ZUU/
I DO HEREBY CERTIFYTHATTHIS WELL WAS CONSTRUCTED N ACCORDANCE WMH
16A /CAC 2C. WELLCONSTRUCTTDN STANDARDS. AND THAT ACOPY OF THIS
RECORD HAS BEEN PROVIDEDTOTHE WELL OWNER.
0 ) 4) Ci> l� Q--C
SIG��TL OF CERTIFIEDWELL'CO CTOR DATE
James W. Camp
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
1617ty
In 30 days. Attn:
Mali Servicge C nter- Raleigh, NC 27699.4617 ivision Of Water Qua((Phone hinformation Mgt.,
No. (9 91733 7015 ext 68.
Form GW-1a
Rev. 7/05

FEB2 i LT
• RESIDENTIAL WELL CONSTRUCTION 'RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 21 3 8 '
331733
1. WELL CONTRACTOR:
James W. Camp
Well C.ontractor.(Individual) Name
Camp's Well & P_umo Co. Inc
Well Contractor Company Name
STREET ADDRESS P 0 BOX
Ellenboro NC
City or Town ' State
(828t. 453-7322
Area code- Phone number
2. WELL INFORMATION:
SITE WELL ID #(It applicable) '
STATE WELL PERMIT#(if applicable)
DWQ or OTHER PERMIT Cif applicable)
WELL USE (Check Applicable Box): Residential Water Supply C—
DATE DRILLED I a. • O L • o I/
TIME COMPLETED `D . D D
3. WELL LOCATION:
CITY::p.(c.c igve
(SpeFiMrds, Numbers: Community, SubdMslon,Lot No., Paru&2Ip Code)
TOPOGRAPHIC / LAND SETTING:.
❑Slope OValley °Flat (Ridge ❑Other
(Check appropdatebox)
LATITUDE 35' I`I gale
LONGITUDES L 13S
Latitude/longitude source: OOPS OTopographic map
attacof we/ must be shown on a GS topo map and
attached to this form I not using GPS)
4. WELL OWNER ,
OWNER'S NAME RiIly tC.hYis.11 +Talc- ID1,0
STREET ADDRESS 5c5V &rek!5 YCI
Ratker rc sri NL z Code
City a own
Area code Phone number
5. WELL DETAILS: c-
a. TOTAL DEPTH: b S ..
b. DOES WELL REPLACE EXISTING WELL? YES 0 NO ❑
e, WATER LEVEL Below Top d Casing: 4 0 FL
(Use if Above Top of Casing)
d. TOP OF CASING IS 1 . FT. Above Land Surface'
'Top of casing terminated eUor below land surface mqy require
a variance in accordance With 15A NCAC 20.0118.
e. YIELD (gpm): 1. METHOD OF TEST OM.
429
28040
Zip Cale
AMO PM0
COUNTY ears
May be In depea,
minutes, seconds or
In a decimal bmut
f. DISINFECTION: Type chlorine Amount cups
g. WATER ZONES (depth):
To From To
To From To
From To From - To
From
Frain
6. CASING:
From 0
DTotLIDiameter
le Ft. t 6
From To Ft.
Ft.
From
7. GROUT: Depth
Fraru-To 20
Frani__To
From To
•
e. SCREEN: Depth
From To
From__ To
From__ To
9. SAND/GRAVEL PACK:
Depth Size Material
From,_ Ta Ft.
From To Ft.
.Thickness/
SDR21Weigh
PVC
Material Method
Ft Sackrete Hand
Ft.
FL
Diameter Slot Size Material
Ft. In in,
Ft In. In.
Ft in. _ In.
From To FL
10. DRILLING LOG
F%m t.70
b
11. REMARKS:
iLiForrhat.%Descrirtion
rOrUEIVF_D
UVAIER of IA[IT',
Z007
I DO HEREBY 16A NCAC 2C, WEELL CONSIRUO1ION STANDARDS.NID THATACOPPY OF WitsCORDANCE wall
RECORD HAS BEEN PROVIDEDTIDTHEI/WELL
�OAWN1,E..
R.RI 6-
SIGK*U E OF CERTIEDWELLCONTRACTOR DATE
James W. Camp
)'RINTED NAME OF PERSON CONSTRUCTING THE WELL
1617Submit the original to the Mall Service Center- Raleigh, NC 27699-1617 vEsion of Water aLiPh nehNo. (9 9) 733 7 5 ext 68.tt . Mgt.,
Form GW-la
Rev. 7/05

2I.2]U7
' RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 21 3 8
1. WELL CONTRACTOR:
James W. Caron
Well Contracts. (Individual) Name
Camp 's Well & Pliny Co. Inc
Well Contractor Company Name
STREET ADDRESS P O Bo* 429
Ellenboro NC 28040
City or Town ' State ZIP code
( 824 453-7322
Area code- Phone number
2. WELL INFORMATION:
SITE WELL ID#0f applicable)
STATE WELL PERMIT#(8applleable)
DWI or OTHER PERMIT #(If applic
WELL USE{Check Applicable Box):
DATE DRILLED i 7 n4 () '
TIME COMPLETED •3So
3. WELL I.QCAT jpN:
CITY:
able)
Ras dentlel Water Supply My AM O PM W—
COUNTY RA 1-41
Doi RA.
(Street Name, Numbers . munIty, SubdMelon, Lot No., Parcel, Zip Code)
TOPOGRAPHIC`I LAND SETTING:
❑Slope Whaley OFlat ❑Ridge ❑Other
(check appropriate. box)
LATITUDE ,,is_ (a n s 3
LONGITUDE. • 0 sa I a S
Latitude/longitude source: 8743PS OTopographic map
(location of wel must be shown on a USGS topo map and
attached to this form /not using GPS)
4. WELL OWNER y��
OWNER'S NAME (' I0.r VIA AIQ I�
STREET ADDRESS I rtL I,r P c.)l77 121 .
Lst RAY/ e stet V t D-01-6QZip e
City or Tam
Area code • Phone number
5. WELL DETAILS:
a. TOTAL DEPTH:, `,h s
b. DOES WELL REPLACE EXISTING WELL? YES p NO'A
S. WATER LEVEL Belau Top of Casing: \ (i Fr.
(Use "9 if Above Top of Casing)
d. TOP OF CASING IS 1 . FT. Above Land Sudan*
casing terminated atfor below
a variance In accordance with 15A NCAC 2C01requirerequire18.
e. YIELD (Opm): () METHOD OF TEST a A tt
IMay be degree,
minutes, seconds or
in a decimal tomcat
From
From To From To From To - From To
6. CASING:
Depth Dt eter
'From 0 -To Ft. 6*
From To Ft.
From To Ft.
• 330730
f. DISINFECTION: Type Chl Orine Amount 3/4 cup
g. WATER ZONES (depth):
To From To
7. GROUT: Depth
Front 0 To 20
From To
From To
8. SCREEN: Depth
From To
From To
From To ._.
Thickness/
SDRh21 PVC
Material
Ft. Sackrete
Ft.
Ft.
Method
Hand
Diameter - Slot Size
Ft In In.
Ft. In. n.
Ft In. _^_ In.
.Material
9. SANDIGRAVEL PACK: Depth SMe Material
From ' ro_ Ft.
From To Ft.
From To Ft.
10. DRILLING LOG
From To . Formn Dandelion0 • S ,g,AA
LtC. IDS • 4t Cpfvl.J)
11. REMARKS:
p QUALITY
JAN200/
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED N ACCORDANCE WM4
ISA NCAC WELL 20.
Th CONSCTION TO SWELLOWN OWNER.
THAT ACOPY OF. THIS
RECORD HAS
SIGNAT. RE OFCER IED'WELTRACTOR • GATE
James W. Camp
)'RINTED NAME OF PERSON CONSTRUCTING THE WELL
1617ty
in 30 days. Attn:
Mall Seroriinalto the Division cif Water vice Center- Raleigh, NC 2 699 1617 aliPhone htton Mgt.,
No. (9 9) 733 i 5 ext 68.
Form GW-la
Rev. 7105

FEB 2.1 2L1
• RESIDENTIAL WELLcoNsrRvcrzoNRECORD
North Carolina Department of Environment end Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION N 21 38
1. DISINFECTION: Type chlorine Amount I 2 raid
g. WATER ZONES (depth):
From To From To
From To From To
From To - Rom - To
6. CASING: Thickness/
SDR21 PVC
1. WELL CONTRACTOR:
James W. Camo
Well Contractor.(IndMdual) Name
Camp's Well & Pump Co. Inc_
Well Contractor Company Name
STREET ADDRESS P O BOX
E1lenboro NC
City or Tenn ' State
(828} 453-7322
Area code- Phone number
2. WELL INFORMATION:
SITE WELL ID d(If applicable) '
STATE WELL PERMITI(6 applicable)
DWG or OTHER PERMIT egf applicable)
WELL USE (Check Applicable Bar): Residential Water Supptyo
DATE DRILLED I Q.. - - O L
TIMECOMPLETED-- AM1 PM"'
a. WELL LOCATION: 4
CITY: L'-� COUNTY✓
429
28040
Zip ode
2q S n.;,. P2.I.�Pk
(Street fjame, Numbers, Community SubdM _ Lot No., Parcel;Zlp Code)
TOPOGRAPHIC I LAND SETTING:
D Slope !Valley !Flat Ql Idge Other
(check appropriate box)
LATITUDE._ a V .t0frL
LoworruDE$•I_, 4I .1'� 1
Latitude/longitude source: SgC'1PS oTopograpbic map
(bcatbn of wel must be shown on a USGS topo map and
attached to this form I not using GPS)
4, WELL OWNER ^ 1I�7
OWNER'S NAME \ )Std ��r-i"
STREE�,ADDRESS D O
bc4fi C.— 2SOI
City or Town State Zip Code
•
Area code Phone number
5. WELL DETAILS:
a. TOTAL DEPTH: 3 Q s -
b. DOES WELL REPLACE EXISTING WELL.? YES p NO ok
c. WATER LEVEL Below Top of Casing: A FT,
(Use '+'.If Above Top of Casing)
d. TOP OF CASING IS 1 . _ FT. Above Land Surface*
'Top of casing terminated nth beelo NCAC surface
.0118.my require
a variance In accordance
e. YIELD(gpm):METHOD OFTEST QM
May be In degrees,
minutes, seconds or
in a decimal brmst
Depth Dlaineter Weight Material
From 0 To 1 Iq Eta__ R
Frora__To Ft. __
From To .FL
7. GROUT: Depth Material Method
Frora _To 20 FL Sackrete Hand
From To FL
From To FL
S. SCREEN: Depth Diameter Slut Size •Material
From To Ft. In In.
From To Ft In. __ In.
From To Ft. In. In.
9. SANDIGRAVEL PACK: Depth Size Matedal
Fraq� To_ FL
Fran To Ft.
From___„_To
TO Ft.
..
10. DRILLING LOG
From .To . SFf n DesgtSon
o 119 pt.
11 _ [IDA AGad reel tod<
11. REMARKS:
RECEIVED
L^JATEf QUALITY
.N 1 0 2007 •
I D0 HEREBY CERTIFY THAT TIP WELL WAS CONSTRUCTED el ACCORDANCE WIM
15A NCA BE
EN WELL ENp OS1RUO1ON SANDODS. AN
THAT ACOPY OEM*•
RECORD
I� bOL
OF CERTIFIED L'CO TRACTOR DATE
antes W. Camp
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
thin 30
161 Mall Servloe Centerinal to - —Raleigh, NC 276994617 e Division VVater slip ono 110. (9 9) 733 7Attn: ext 68.tion Mgt.,
Form GW-la
Rev. 7/05

RESIDENTIAL WELL CONSTRUCTION -RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACT OR CERTIFICATION# 2138
33
728
1. WELL CONTRACTOR:
James W. Camp
Well Contractor.(Individual) Name
Camp's Well & Pumn Co. Inc
Well Contractor Company Name
STREET ADDRESS
P 0 Box 429
Ellenboro NC 28040
City orTown ' State ZIP Cale
(828). 453-7322
Area code- Phone number
2. WELL INFORMATION:
SITE WELL ID ear epp knit )
STATE WELL PERMIT/Mtapplicable)
DWQ or OTHER PERMIT Cif applicable)
WELL USE{Check Applicable Brno: Residential Water Supply (�
DATE DRILLED I d . `` • 6 1a
TIME COMPLETED 3 AM 0 PM to-
S. WELL L CAT,I,y�T�N)� oo
CITY: * C L A ` t„ tls. COUNTY V,I
AAAA „inns)
(SbeinNerne- Numbem. Community. Su d Nslon _Lot No.. Parcel«Zip Code)
TOPOGRAPHIC 1 LAND SETTING:
Stops Malley Flat CIRidge D Other
(check appropdatabox) LATITUDE 3S • �+ 1 SC(G
LONGITUDE, a(� IA S L3
Latitude/longitude source: o CPS DTopographic map
(location
�at eof d to this cast b knotshown
usion a g GPSSGS topo map and
)
4. WLL OWNER'S
1 cab/n a
•
OWNER'S NAME�(,! q
STREET ADDRESS 0 O k ¶4 1
I�LYe NC, 9 74Co
City or Town
May be In degas,
minutes, laonds or
in a decimal brmat
Area code Phone number
State Zip Code
5. WELL DETAILS:
a. TOTAL DEPTH: `-1 O
In
b. DOES WELL REPLACE EXISTING WELL? YES a NO 0
c. WATER LEVEL BelowTop of Casing: 6 0 FT,
(Limo -tit Above Top of Casing)
d. TOP OF CASING IS 1 . FT. Above Land Surface*
:Top d casing terminated atlor belay land surface may require
a variance In accordance with 15A NCAC 2C .011 B.
e. YIELD(gpm):-__, �____ METHOD OF TEST QAJc
L DISINFECTION: Type chlorine Amount I Ya. cup
g. WATER ZONES (depth):
From To
Fran To
From To
6. CASING:
Depth Dl eter
•'Fran To Ft. 6t
From To Ft.
From_ To .Ft.
From To
From To
From To
7. GROUT: Depth
From_ 0 To 2 0
Front_____ To
Front To Ft.
Thlelmessl
Weight
Material
C
' Material Method
FL Sackrete Hand
Ft•
8. SCREEN: Depth
Fran To
From To
From To
Diameter - Slut Size .Material
19. In. In.
Ft. In. In.
Ft. In. In.
8. SANDIGRAVEL PACK:
Depth Slur Materiel
From To Ft.
From_To Ft.
From�_To Ft.
ID. DRILLING LOG
From . S . r n FormaftAn Description
,(�i7w,� �:tl/ritY
6S DS .414M4..6
11. REMARKS:
REGEIvtD
DIV.Iit- UK' ER OUAL11 Y
JAN [ 0 2007
I DO HEREBY CERTIPVTHAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE Wfl
15A MAC 2C, WELL CONSTRUCTION STANDARDS, AND 1HATACOPY QFTNIS •
RECORD HAS BEEN PROVIDEDTOTHE WELL OWNER.
l,J WELL CO t � DATE
SIG OF CERTIFIED WELL'CO TRACTOR DATE
`ames W. Camp
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
of)
Submit the original to the Division Of Water Quality within ;30.days. Attn: Information Mgt.,
1617 Mall Service Center — Raleigh, NC 276994617 Phone No. [phone] ext 568.
Form GW-la
Rev. 7105

RESIDENTIAL WELL CONSTRUCTION 'RECORD
North Carolina Department of Environment end Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 2138
1. WELL CONTRACTOR:
James W. Camp
Well Contractor.(IndMdual) Name
Camp' s Well & PUIRD CQ. Tnc
Well Contractor Company Name
STREET ADDRESS P 0 BOX 429
Ellenboro NC 28040
Cityor ToState
( 828>. 45wn3-7322
Zip bode
Area code- Phone number
2. WELL INFORMATION:
SITE WELL ID i1(Ir applicable)
STATE WELL FERMIUM applicable)
DWQ or OTHER PERMIT «If applicable)
WELL USE{Check Applicable Bag:
11 Residential Water Supply Ill.. DATE DRILLED rL • 4 n
TIME COMPLETED I g• 45- AM O PM Q
3. WELL LOCATIO�N-•(�
CITY: 0 - OUNTY
(Stet! ame, Numbers, Community. SubdMslon, Lot No., Parcel p Code)
TOPOGRAPHIC / LAND SETTING:
❑Slope &'galley OFat ['Ridge ❑Other
(theca appreedaaboa)
LATITUDE ..g...1�.0 .3/), g.-73N
LONGITUDE S L' 47. /602A)
Latitude/longitude source: ❑GPS oTopographic map
(location of wel must be shown on a USGS topo map and
attached to this form (not using GPS)
4.WELLOWNER t�A ((n��
•
OWNER'S NAME V YI3. 7L
STRE ADDRESS 1 I f� rVAa1- YO7 LA reitr�Ct
'ri�1f r Vta. t l L- i"71 1h1
City or Tc'4n State Zip Code
Area code Phone number
May be in deem,
minutes, secondser
in a decimal bract
5. WELL DETAILS: 4
a. TOTAL DEPTH: p`• 5 0
b. DOES WELL REPLACE EXISTING WELL? YES p NO k
c, WATER LEVEL Below Top of Casing: 1. n (9 FT.
(Use '+'.If Above Top of Casing)
d. TOP OF CASING IS 1 FT. Above Land Surface'
. 'Top of casing terminated at/ar below land surface may require
a variance In accordance with 15A NCAC 2C .0118.
e. YIELD(gpm): 1Q METHOD OF TEST (LCA
L.
333727
f, DISINFECTION: Type chlorine Amount I cut
g. WATER ZONES (depth):
From To - From To
From To From To
From To - From To
6. CASING: Thickness/
Depth Dieter Weight Material
From 0 To Ft 6* SDR21 PVC
From To Ft. _
From To .FL
7. GROUT: Depth Material Method
From 0 To 20 a Sackrete Hand
Front_ To FL
Fro i To Ft.
II. SCREEN: Depth Diameter Slot Size Material
From_ To Ft. In In.
From To Ft. In. In.
From To FL In. In.
S. SAND/GRAVEL PACK:
Depth Sim Material
Front. TcL Ft.
From To
From To Ft.
1D. DRILLING LOG
From To.
o (n'
•
Ftomla�Des 'ptbn
(I) n2.5o NJ 61-4At.71
11. REMARKS:
DIV. OF Wm EIP 1 IALUT
AN Y 0 2007
1 DO HEREBY CERTIFY THAT THIS WELL WAS ODNSTRUC=ED N ACCORDANCE Wmt
1SA NCAC 2C, WELL CONSTRUCTION STANDARDS, AND NATACOPY OF THIS
RECORD HAS BEEN PROVIDED TO THE WELL OWNER
S)vrA UE OF CERTIFIED NTRACTOR DATE
James W. Camp
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
IED WELLY70
y
Submit the original tothe Division ofWater Quality within 30.days. Attn: Information Mgt.,
1617 Mali Service Center— Raleigh, NC 276994617 ' Phone No. [phone] ext 568.
Form GW-1a
Rev. 7/05

North Carolina —Department of Environment and Natural Resources — Division of Water Quality — Groundwater Section
1636 Mail Service Center — Raleigh, N.C. 27699-1636 — Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR RODNEY ROBBINS
WELL CONTRACTOR CERTIFICATION #: 2785
STATE WELL CONSTRUCTION PERMIT It:
1. WELL USE (Check Applicable Bore 0 Residential 0 Municipal 0 Industrial 0 Agricultural 0 Monitoring
0 Recovery 0 Heat Pump Water Injection El Other If Other, List Use: PUBLIC
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: LAKE LURE County: RUTH
BOYS CAMP RD. FIREFLY COVE DRILLING LOG
(Road Name and Numbers, Community, or Subdivision and Lot No.) From To
3. OWNER JOHN CLOUD
Address BOYS CAMP RD. FIREFLY COVE
(Street or Route No.)
LAKE LURE NC 28746
City or Town State Zip Code
4. DATE DRILLED 10/04/06
5. TOTAL DEPTH 805 WELL #02
6. CUTTING COLLECTED 0 YES El NO
7. DOES WELL REPLACE EXISTING WELL? 0 YES El NO
8. STATIC WATER LEVEL Below Top of Casing: 300 FT.
(Use "+^ if Above Top of raging)
9. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
'Top of casing terminated aUor below land surface requires a variance in accor-
dance with I5ANCAC 2C.0118
10. YIELD (gpm): 1 METHOD OF TEST: ARD
11. WAIERZONES (depth):
12. CHLORINATION: Type: CHLORYTE Amount: 5 LB.
13. CASING:
Depth
From 0 To
From To
From To
14. GROUT:
DepthFrom 0 To
From To
15. SCREEN:
Depth
From To
From To
From To
Diameter
63 Ft 8"
Ft
Ft.
Wall Thickness
or Weight/Ft. Material
250 WALL GALV.
Material Method
63 Ft. CEMENT SLURRY PUMPED
Ft.
Diameter Slot Size Material
Ft in. in.
Ft in. is
Ft in. in.
16. SAND?GRAVEL PACK:
Depth Size Material
From To Ft
From To Ft
DEPTH C▪ a
Formation Description en
ert
Ct
r-r�
#-CC7 2 .4
If additional space is needed use back of form
Li I
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other reference points)
RT- ON BOYS CAMP RD. IN LAKE LURE. 3/4 MILE ON RT.
17. REMARKS: REVISED COPY -ERROR ON GROUT ON FIRST COPY.
RECEIVED
DIV OF WATER QUALITY
IAN b 9 2007
I DO CF.RTIFY THAT THIS WELL WAS CONSTRUC IW IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THISRECORD HAS BEEN PROVIDED TO THE WELL OWNER.
FOR OFFICE USE ONLY
Quad No:
Serial No.
ao-rre-- /d`Ul/-c 6
SIGNATURE OF N CONSTRUCTING THE WELL DATE
iginal to Division of Water Quality, Groundwater Sion within 30 days
GW-1 REV. 12/99

North Carolina — Department of Environment and Natural Resources — Division of Water Quality — Groundwater Section
1636 Mail Service Center— Raleigh, N.C. 27699-1636 — Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR RODNEY ROBBINS
WELL CONTRACTOR CERTIFICATION #: 2785
STATE WELL CONSTRUCTION PERMIT #:
I. WELL USE (Check Applicable Box): U Residential U Municipal U Industrial U Agricultural 0 Monitoring
❑ Recovery 0 Heat Pump Water Injection ® Other If Other, List Use: PUBLIC
2 WELL LOCATION: (Show sketch of the location below)
Nearest Town: LAKE LURE County. RUTH
BOYS CAMP RD. FIREFLY COVE DRILLING LOG
(Road Name and Numbers, Community, or Subdivision and Lot No.) From To
3. OWNER JOHN CLOUD
Address BOYS CAMP RD. FIREFLY COVE
(Street or Route No.)
LAKE LURE NC 28746
City or Town State Zip Code
4. DATE DRILLED 10/02/06
5. TOTAL DEPTH 985 WELL 401
6. CUTTING COLLECTED ❑ YES ® NO
7. DOES WELL REPLACE EXISTING WELL? 0 YES ® NO
8. STATIC WATER LEVEL Below Top of Casing: 300 FT.
(Use "+" if Above Top of Casing)
9. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
'Top of casing terminated at/or below land surface requires a variance in accor-
dance with ISANCAC 2C0118
10. YIELD (gpm): 1 METHOD OF TEST: ARD
11. WATER ZONES (depth):
12. CHLORINATION: Type: CHLORYTE Amount: 5 LB.
13. CASING:
Wall Thickness
Depth Diameter or Weight/Ft Material
From 0 To 63 FL 8a 250 WALL GALV.
From To FL
From To FL
14. GROUT:
Depth Material Method
From 0 To 63 Ft. CEMENT SLURRY PUMPED
From To Ft.
15. SCREEN:
Depth Diameter Slot Size Material
From To FL in, in.
From To FL _ in._ in.
From To FL in. in._
16. SAND7GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
17. REMARKS: REVISED COPY -ERROR ON GROUT ON FIRST
DEPTH C�
Formation Description C
c�a
CJZ
Ca
If additional space is needed use back of form
2G07
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other reference points)
RT. ON BOYS CAMP RD. IN LAKE LURE. 3/4 MILE ON RT.
COPY.
REGEIvEu
DIV. OF WATER QUALITY
JAN _I 0 Z007
I DO CERTIFY THAT THIS WELL WAS CONS tRUCTED IN ACCORDANCE WITH 1SA NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THISRECORD HAS BEEN PROVIDED TO THE WELL OWNER.
FOR OFFICE USE ONLY
Quad No:
Serial Na
IFCI`P.. l6-0.2 - 6 �o
SIGNATURE OF N CONSTRUCTING THE DATE
ginal to Division of Water Qa1ity, Groundwater Section within 30 days
GW-1 REV. 12/99

North Carolina — Department of Environment and Natural Resources —Division of Water Quality — Groundwater Section
1636 Mail Service Center— Raleigh, N.C. 27699-1636 — Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR RODNEY ROBBINS
WELL CONTRACTOR CERTIFICATION #: 2785
STATE WELL CONSTRUCTION PERMIT #:
1. WELL USE (Check Applicable Box): U Residential U Municipal 0 Industrial ❑ Agricultural ❑ Monitoring
0 Recovery ❑ Heat Pump Water Injection ® Other If Other, List Use: PUBLIC
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: LAKE LURE County: RUTH
BOYS CAMP RD. FIREFLY COVE DRILLING LOG DEPTH
(Road Name and Numbers, Community, or Subdivision and Lot No.) From To Formation Description
3. OWNER JOHN CLOUD
Address BOYS CAMP RD. FIREFLY COVE
(Street or Route No.)
LAKE LURE NC 28746
City or Town State Zip Code
4. DATE DRILLED 10/19/06
5. TOTAL DEPTH 405 WFJ I #2
6- CUTTING COLLECTED ❑ YES ® NO
7. DOES WELL REPLACE EXISTING WELL? 0 YES ® NO
8. STATIC WATER LEVEL Below Top of Casing: 60 FT.
(Use "+" if Above Top of Casing)
9. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2C.0I18
10. YIELD (gpm): 9 METHOD OF TEST: FLOW METER
11. WATER ZONES (depth):
12. CHLORINATION: Type: CHLORYTE Amount: 5 LB.
13. CASING:
Wall Thickness
Depth Diameter or Weight/Ft Material
From 0 To 63 FL 8" 250 WALL GALV.
From To Ft
From To FL _
14. GROUT:
Depth Material Method
From 0 To 63 Ft CEMENT SLURRY PUMPED
From To Ft.
15. SCREEN:
Depth Diameter Slot Size Material
From To Ft. _ in.
From To Ft in. in.
From To Ft. in. in.
16. SAND?GRAVEL PACK:
Depth Size Material
From To Ft _
From To Ft.
If additional space is needed use back of form
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other reference points)
RT. ON BOYS CAMP RD. IN LAKE LURE. 1/2 MILE ON RT.
RECEIVED
Div OF WATER OUALITY
JAN I U 2007
17. REMARKS: REVISED COPY ERROR ON GROUT ON FIRST COPY.
I DO CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THISRECORD HAS BEEN PROVIDED TO THE WELL OWNER
FOR OFFICE USE ONLY
Quad No:
Serial No.
orsat-.- /6-/9-6t
SIGNATURE OF PERSO CONSTRUCTING T`IJE WEI•1 ' DATE
Su original to Division of Water Quality, Groundwater Section within 30 days
GW-1 REV. 12/99
JAN 08 2007
in

North Carolina -Department of Environment and Natural Resources - Division of Water Quality- Groundwater Section
1636 Mail Service Center- Raleigh, N.C. 27699-1636 - Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR RODNEY ROBBINS
WELL CONTRACTOR CERTIFICATION #: 2785
STATE WELL CONSTRUCTION PERMIT #:
1. WELL USE (Check Applicable Box): 0 Residential 0 Municipal ❑ Industrial 0 Agricultural 0 Monitoring
0 Recovery 0 Heat Pump Water Injection ® Other If Other, List Use: PUBLIC
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: LAKE LURE County: RUTH
BOYS CAMP RD. FIREFLY COVE DRILLING LOG DEPTH
(Road Name and Numbers, Community, or Subdivision and Lot No.) From To Formation Description
3. OWNER JOHN CLOUD
Address BOYS CAMP RD. FIREFLY COVE
(Street or Route No.)
LAKE LURE NC 28746
City or Town State Zip Code
4. DATE DRILLED 10/12/06
5. TOTAL DEPTH 605 WF.I J #1
6. CUTTING COLLECTED 0 YES 0 NO
7. DOES WELL REPLACE EXISTING WELL? 0 YES ® NO
8. STATIC WATER LEVEL Below Top of ("acing: 63 FT.
(Use"+" if Above Top of Casing)
9. TOP OF CASING IS 1-1/2 FT. Above Land Surfaces
*Top of easing terminated atfor below land surface requires a variance in accor-
dance with 15A NCAC 2C.0118
10. YIELD (gpm): 23 METHOD OF TEST: FLOW ME F R
11. WATER ZONES (depth):
12. CHLORINATION:
13. CASING:
pe:
CHLORYTE Amount: 5 LB.
Wall Thickness
Depth Diameter or Weight/Ft Material
From 0 To 62 Ft. 8" 250 WALL GALV.
From To Ft
From To Ft
14. GROUT:
Depth Material Method
From 0 To 62 Ft CEMENT SLURRY PUMPED
From To Ft.
15. SCREEN:
Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft in. in.
From To Ft in. in.__
16. SAND?GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
If additional space is needed use back of form
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other reference points)
RT. ON BOYS CAMP RD. IN LAKE LURE. 1/2 MILE ON RT.
17. REMARKS: REVISED COPY -ERROR ON GROUT ON FIRST COPY.
RECEIVED
OW OF WATER QUALITY
JAN I. 9 ?0U7
I DO CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THISRECORD HAS BEEN PROVIDED TO THE WF.I d OWNER
FOR OFFICE USE ONLY
Quad No:
Serial No.
SIGNATURE OF PERSO CO STRUCTING THE WELL DA
ginal to Division of Water Quality, Grormdwater Section within 30 days
GW-1 REV. 12/99

From: Scott Gantt 7044347212 To: Stephenie Wilson
Date: 2/8/2037 Time: 11:10:36 PM
Page 3 of 4
RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources - Division of Water Quality
Well Contractor Certification # 2584
1. WELL CONTRACTOR:
ALAN SCOTT GANTT
Well Contractor (Individual) Name
CAROLINA WELL DRILLERS, INC.
Well Contractor Company Name
STREET ADDRESS: 522 GANTT'S GROVE CHURCH RD
MOORESBORO, NC 28114
[phone]
Area code — Phone number
2. WELL INFORMATION
SITE WELL ID #(IF APPLIACBLE)
STATE WELL PERMIT # OF APPLICABLE)
DWQ or OTHER PERMIT # (IF APPLICALBE)
WELL USE (Check Applicable Boa): Residential Water Supply El
DATE DRILLED 12/14/06
TIME COMPLETED 11:25 AM © PM ❑
3. WELL LOCATION:
CITY: LAKE LURE COUNTY: RUTHERFORD
205 WILDCAT ST RIVERBEND SUB
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
❑ Slope 0 Valley © Flat 0 Ridge ❑ Other
Latitude/Longitude Source: ❑ GPS 0 Topographic map
LATITUDE 35.25.300
LONGITUDE 82.09.840
(location of well must be shown on a USGS topo map and
attached to this form if not using GPS)
4. WELI. OWNER
OWNER'S NAME RIDGELINE DEVELOPMENT CORP
STREET ADDRESS 112 COCOPLUM CIRCLE
ROYAL PALM BEACH FL 33411
City or Town State Zip Code
561-798-2729
Area code - Phone nurnber
5. WELL DETAILS:
A. TOTAL DEPTH: 160
B. DOES WELL REPLACE EXISTION WELL? YES 0 NO ❑
C. WATER LEVEI. Below Top of Casing: 88 FT
D. TOP OF CASING IS 2 FT Above Land Surface*
"'Top of casing terminated agar below and surface may require
a variance in accordance with I5NCAC 2C .0112,
E. YIELD (gpnl): 18 METHOD OF TEST ARDM
£DISINFECTION: TypeHYPOCHLORITEAmt:40Z
g. WATER ZONES ( depth)
From 158 To 158 From To
From To From To
From To From To
6. CASING:
Depth
From + 2 To 50 Ft. 6 1/8 SDR21 PVC
From To
From To
7. GROUT:
Thickness/
Diameter Weight Material
Ft.
Ft.
Depth Material
From 0 To 2 Ft. GRAVEL MIX
From 2 To 20 Ft EASY SEAL
Method
GRAVITY
GRAVITY
From To Ft
S. SCREEN: Depth Diameter Slot Size Material
From To Ft. in in
From To Ft. _ in in _
From To Ft. in in
9. SAND/GRAVEL PACK:
Depth Size Material
From To Ft
From To Ft
From To Ft
10. DRILLING LOG
From To Formation
0 45 CLAY
45 160 CONSOL
11. REMARKS:
D
HA i
`=EH ( 9 20U?
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED G1 ACCORDANCE WITH 15
NCAC 2c WELL CONSTRUCTEE STANDARDS, AND THAT A 2,0P Y OF THIS RECORD HA3 BEEN
F5OVIDED TO THE WELL OWNER_
SIGNATURE OF CERTIFIED WELL CONTRACTOR DATE 1/1/(17
ALAN S. GANTT
PRINTED NAME OF PERSON CONSTURCTING 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
Fom1 GW-la
Rev. 7/05

Noah Carolina —Department of Environment and Natural Resources — Division of Water Quality — Groundwater Section
1636 Mail Service Center — Raleigh, N.C. 27699-1636 —Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR: JEFF MELTON
WELL CONTRACTOR CERTIFICATION #: 3417
STATE WELL CONSTRUCTION PERMIT #:
1. WELL USE (Check Applicable Box): 0 Residential 0 Municipal 0 Industrial 0 Agricultural ❑ Monitoring
❑ Recovery 0 Heat Pump Water Injection N Other If Other, List Use: PUBLIC
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: LAKE LURE County: RUTHERFORD
BOYS CAMP RD. DRILLING LOG DEPTH
(Road Name and Numbers, Community, or Subdivision and Lot No.) From To Formation Description
3. OWNER BLUE HERON POINT -WELL #4
Address BOYS CAMP RD.
(Street or Route No.)
LAKE LURE NC 28746
City or Town State Zip Code
4. DATE DRILLED 08/08/06
5. TOTAL DEPTH 605
6. CUTTING COLLEtal) 0 YES N NO
7. DOES WELL REPLACE EXISTING WELL? 0 YES N NO
8. STATIC WATER. LEVEL Below Top of Casing: 180 FT.
(Use "+" if Above Top of Casing)
9. TOP OF CASING IS I-1/2 FT. Above Land Surface*
'Top of casing terminated atior below land surface requires a variance in accor•
dance with 15ANCAC2C.0118
10. YIELD (gpm): 26 METHOD OF TEST: ARD
11. WA fat ZONES (depth):
12. CHLORINATION: Type: CHLORYTE Amount 16.5
13. CASING:
Wall Thickness
Depth Diameter or Weight/Ft Material
From 0 To 95 Flu 6-5/ 8" 250 WALL GALV.
T&C
From To Ft.
From To Ft.
14. GROUT:
Depth Material Method
From 0 To 95 FL CONCRETE SLURRY PUMPED
From To Ft.
15. SCREEN:
Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
From To Ft in. in.
16. SAND2GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft
If additional space is needed use back of fonn
33.7769
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other reference points)
HWY. #64/74 W. FROM RUTHERFORDTON. RT. ON BOYS
CAMP RD. IN LAKE LURE. GO TO DEAD END. BLUE HERON
IS ON LEFT.
ON. OF tutlVED
n/ATER QUALITY
FEB 0 2 2007
17. REMARKS: AMENDED RECORD -GROUT & METHOD
I DO CERTIFY THAT THIS WELL WAS CONSTRUC! hD IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF TI-IISRECORD HAS BEEN PROVIDED TO THE WELL OWNER
FOR OFFICE USE ONLY
Quad No:
Serial No.
SIGNA G oN o NSea& - G � Wt.tiELL f7/lS/DATE
ubmrt original to Division of Water Quality, Grotmdwater Section within 30 days
GW-1 REV. 12/99

North Carolina— Department of Environment and Natural Resources —Division of Water Quality — Groundwater Section
1636 Mail Service Center — Raleigh, N.C. 27699-1636 —Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR: JEFF MELTON
WELL CONTRACTOR CERTIFICATION #: 3417
STATE WELL CONSTRUCTION PERMIT #:
1. WELL USE (Check Applicable Box): ❑ Residential 0 Municipal 0 Industrial ❑ Agricultural 0 Monitoring
0 Recovery 0 Heat Pump Water Injection 0 Other If Other, List Use: PUBLIC
2 WELL LOCATION: (Show sketch of the location below)
Nearest Town: LAKE LURE County: RUTHERFORD
BOYS CAMP RD, DRILLING LOG DEPTH
(Road Name and Numbers, Community, or Subdivision and Lot No.) From To Formation Description
3. OWNER BLUE HERON POINT -WELL #3
Address BOYS CAMP RD.
(Street or Route No.)
LAKE LURE NC 28746
City or Town State Zip Code
4. DATE DRILLED 04/22/06
5. TOTAL DEPTH 585
6. CUTTING COLLECTED 0 YES 0 NO
7. DOES WELL REPLACE EXISTING WELL? 0 YES ® NO
8. STATIC WATER LEVEL Below Top of Casing: 120 FT.
(Use "+" if Above Top of Casing)
9. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a variance in accor-
dance with 1SANCAC 2C.011S
10. YIELD (gpm): 30 METHOD OF TEST: ARD
11. WATER ZONES (depth):
12. CHLORINATION: Type: CHLORYTE Amount 15.5
13. CASING:
Depth Diameter
From 0 To 93 Ft 8"
From To Ft
From To Ft.
14. GROUT:
Depth
From 0 To 93
From To
15. SCREEN:
Depth
From To
From To
From To
Wall Thickness
or Weight/Ft Material
322 WALL GALV. T&C
Material Method
Ft. CONCRETE SLURRY PUMPED
Ft
Diameter Slot Size Material
Ft is in.
Ft in. in.
Ft _ in. in.
16. SAND?GRAVEL PACK:
Depth Size Material
From To Ft.
From To FL
17. REMARKS: AMENDED RECORD -GROUT & METHOD
If additional space is needed use back of fort
337768
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other reference points)
HWY. #64/74 W. FROM RUTHERFORDTON. RT. ON BOYS
CAMP RD. IN LAKE LURE. GO TO DEAD END. BLUE HERON
IS ON LEFT.
OFWA ERQ°UUALITY
EH 0 2 2007
I DO CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THISRECORD HAS BEEN PROVIDED TO THE WELL OWNER.
FOR OFFICE USE ONLY /I /� /�A p
SIGNATURE OF PERSON CONSTRU G THE WELL DATE
Submit original to Division of Water Quality, Groundwater Section within 30 days
GW-1 REV. 12/99
Quad No:
Serial No.

North Carolina —Department of Environment and Natural Resources —Division of Water Quality — Groundwater Section
1636 Mail Service Center —Raleigh, N.C. 27699-1636 —Phone [phone]
WELL CONSTRUCTION RECORD L CONTRACTOR: JEFF MELTON
W LL CONTRACTOR CERTIFICATION #: 3417
STATE WELL CONSTRUCTION PERMIT #:
1. WELL USE (Check Applicable Boa): ❑ Residential 0 Municipal
0 Recovery 0 Heat Pump Water Injection ® Other
2. WFJ J LOCATION: (Show sketch of the location below)
Nearest Town: LAKE LURE County: RUTHERFORD
BOYS CAMP RD.
(Road Name and Numbers, Community, or Subdivision and Lot No.)
3. OWNER BLUE HERON POINT -WELL #2
Address BOYS CAMP RD.
(Street or Route No.) NC 28746
LAKE LURE
City or Town State Zip Code
4. DATE DRILLED 03/03/06
5. TOTAL DEPTH 705
6. CUTTING COLLECTED 0 YES ® NO
7. DOES WELL REPLACE EXISTING WELL? 0 YES ® NO
8. STATIC WATER LEVEL Below Top of racing: 60 FT.
(Use "+" if Above Top of Casing)
9. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a variance in accor-
dance with I5ANCAC 2C.0118
10. YIELD (gpm): 8 METHOD OF TEST: ARD
11. WAIERZONES (depth):
12. CHLORINATION: Type: CHLORYTE Amount: 19.5
13. CASING:
Wall Thickness
Depth Diameter or Weight/Ft Material
From 0 To 70 Ft. 6-5/8 250 WALL GALV.
W/DRIVE SHOE
From To Ft.
From To Ft
14. GROUT:
Depth Material Method
From 0 To 70 Ft CONCRETE SLURRY PUMPED
From To Ft.
15. SCREEN:
Depth Diameter Slot Size Material
From To Ft.
From To Ft.
From To Ft
16. SAND?GRAVEL PACK:
Depth Size Material
From To Ft _
From To Ft
17. REMARKS: AMENDED RECORD -GROUT & METHOD
in._ in.
in. in.
in. in.
Industrial ❑ Agricultural 0 Monitoring
If Other, List Use: PUBLIC
DRILLING LOG DEPTH
From To Formation Description
If additional space is needed use back of
337767
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other reference points)
HWY. #64/74 W. FROM RUTHERFORDTON. RT. ON BOYS
CAMP RD. IN LAKE LURE. GO TO DEAD END. BLUE HERON
IS ON LEFT.
REGti vt..
DIV OF WATER QUUAL'TY
FEB 0 2 2007
I DO CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THISRECORD HAS BEEN PROVIDED TO THE WELL OWNER
FOR OFFICE USE ONLY
Quad No:
Serial No.
7
, r 3- C) 6
SIGNA OF P ON CONSTRUCTING WELL DATE
bmit original to Division of Water Qu jity, Groundwater Section within 30 days GW-I REV. 12J99

At� 3 � 515
WELL CONSTRUCTION RECORD WELL/ WELL CONTRACTOR CERTIFICATION#: 2S G9
STATE WELL CONSTRUCTION PERMIT t! :
North Carolina Department of Environment and Natural Resources -Division of Water Quality -Groundwater Section
1636 Mall Service Canter - Ralelgh,N.C. 27699-1636 Ph one [phone]
WELI USE (Check Applicable Box): Residential D4 Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring 1_'
Recovery i Heat Pump Water Injection in Other in If Other. List Use.
nlaL I OCATION. 'Show sketch of the location below)
Nearost town
S i�ir4o County ai!/r t: i.fc.. icN
'53 wc:Fh's ad DEPTH
Pond Name and Numbers. Community, or Subdivision and Lot No) DRILLING LOG
nWNER -Cet ;&sirr Coos. roe"( Hots0 S From To Formation Descriptio
47r1reS5 Jr%a.
7 �45 ,ar.
(Street orzout No y
/76 rt. Ed, GaH h.,"
Crtv or Town State Zip Code
e GATE DRILLED Alt
-.�' o L'
rQTAI DEPTH �'2
TTINGS COLLECTED YES FR NO❑
vEE- WELL REPLACE EXISTING WELL? YES 1 NOf
rc- r. WATER LEVEL Below Top of Casing. 84 FT.
(Use "-I' if above Top of Casing)
If ',DP OF CASING IS .X � /� FT. Above Land Surface'
-'or o' rasurg iermmated atlor below land surface requires a variance m accor-
lanrr vIfh FP NCAC 2C 0118
vP II n (GPMi. 3* METHOD OF TEST finI'F /' 1'
2'sTLR ZONES (depth)
It CHLORINATION- Type
;,ASING. Depth
rm94.1416"tr- To es Ft
Id ;RCIIIT
-ILN
H7"H
To Ft
To ---Ft
Diameter
Amount
`L—
If additional space is needed use hack of form
Wall Thickness
or a77 e�hL t Material�L LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other map reference points)
Depth Material Method
To Ft
To Pt
Depth Diameter Slot .Size Material
1c Ft in in
To Ft in __ in.
-,rim To ct in In
'r- ;ANL/GRAVEL PACK
Depth Size Material
k-on, To Ft
c.om To Ft
1' REMARKS.
RECEIVED
DIV. OF WATER DUALITY
JAN 0 4 2007
DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
'7ONSTRUCTION STANDARDS. AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNED.
/5;-r'-e- i2.i/? .. /2-s--d L
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Suhmd original to Division of Water Quality. Groundwater Section within 30 days
GW 1 REV ':loft
FOR OFFICE USE ONLY
Quad No.
Serial No
r-1-11
2037

RESIDENTIAL WELL CONSTRUCTION RECOAze
North Carolina I .w,rtinent of Environment and Natttal Resources- Division of Warr Quaid;
WELL CONTRACTOR CERTIFICATION 8 - o[ l3/6
338768
1. WELL CONTRACTOR
NAQcAah Li'-'^jecS
We$ Contractor (Individual) Name
Q JJ ckrL ` 'S 4+wl-'I t-c S '*
Well Contractor Company Nape
STREET ADDRESS 4"V p b :WWI aCq
1-\o'E ! Tr;n ) NC : a-W-V-13
City or Tam —Code
($9%)- (n(o5--
Area code- Phone number
2. WELL INFORMATION:
SITE WELL ID MPappl.cab)e)
STATE WELL PER1/11T3(y applicable)
DWQ or OTHER PERMR #(d.pytir.ab
WELL USE (Check Applicable lioc): Reside -dial Water Supply
DATE DRILLED //-�2 r ./
TIMECOMPLETED S%i!)fi Amo PM[�
3. WELL LOCATION: /
CITY: / ,4 �GF :/` COUNTY /I /1,44- C r1y1/)
//5 AO/ LO* \\\
{Street Name_ Numbers. Commurty. Sa er/sem, Lot No.. Parcel, Zip Cede) ' .-
TOPOGRAPHIC/LAND NG:
❑Slope C /alley ID Rat i uddoa ❑Otter
(check apwwr box)
LATITUDE 3
LONGITUDE
Latitude/longitude sauce: O GPS ❑ Topographic map
(location of wed mwstbe shown on a USGS topo map apd
attached lodes fo ifnot using GPS)
May be m degrees,
minutes, se:aldbor
in a decimal format
&win OWNER CAA
�p
hT OWNER'S NAME VL. eiu04ttS
STREET ADDRESS 'PO Q,oX SOS
/04.?tp S I.0 arlio0
City or T&wn State Zip Code
( $ere (DS V ossb
Area code - Phone numbs
5. WELL DETAILS:
a. TOTAL DEYT1t Cf 6S
b. DOES WELL REPLACE EXISTING WELL?
YES ❑ NO7
c. WATER LEVEL Below Top of Casing: ll FT.
(Use'+ if Above Top of Casing)
d. TOP OF CASING IS \ FT. Above Lad Surface'
'Too of casing unmated atfa below Iad surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD(gprn): /qZ METHOD OF TEST fR•
L DISINFECTION: Typa4' \ \.S Amount 30
g. WATER ZONES (depth):
From To
From To
From To
From To
From To
From To
6. CASING: Thickness/
DePth
D QI ior
nic
From --\ ro i-� -Fi. ly ivl -- .
From To F1.
From To Fl.
7. GROUT: Depth Material I Methodt/
FIom� To ® FT. &aryl-. ih tte is
From To FL.
From To Ft.
8. SCREEN: Depth Da neter Stt Size Material
From To R. in. in.
From To R. in.. in.
From To R. in. in.
9- SANDIGRAVB. PACK:
Depth Size Material
From To' Ft.
From To Ft
From To FL
10. DRIWNG LOG
From To
sV
_Fonnatiot//D�e.,r..' .,rj
tier C'l.,4„
sf 605
11. REMARKS:
Jn\, or iniAtFR WUrtra
MAR 08 NO/
100 HEREBY mach i -Y THAT ILLS WELL V 'AS CONSTRLCim N ACCORDANCE W IM
15A NCAC 2C. WELL CONSTRUCTION IMP WARDS. M1P rH TA COPY OF The
PROVVED1O TM= N ELL OW✓<IER.
SIGNATURE OF C WELL OFFIRACTO+RDATE
breCe.C.k 1A40.Fh, 43-1Ay@'S
r
PRINTED NAME OF PERSON XiNSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: information M 3L.,
1617 Mail Service Center - Raleigh, NC 27699-1617 Phone No. [phone] ext 568.
Form GW-la
Rev. 7105

RESIDENTIAL WELL coNSTRUGTxoN REco;2D
North Carolina Apartment of Environment and Natural Resources- Division of Vl'ater Qual.g
WELL CONTRACTOR CERTIFICATION #-
338767
1. WELL CONTRACTOR:
Qtc • c ' Ae _...kh -sp-' Y'de.cs
Well Contractor (Individual) Name -
Q'.\\ $4 ' S est ll e.-c S S G n
Well C Compaq Nalrhe
STREET ADDRESS \' \ V O S .\'ti1AY Qq
No'r 51r;'n%. I NC : fa8''t,13
City or Twin store -Zip Code
(8(oto5-
Area code- Phone number
2. WELL INFORMATION:
SITE WELL ID #fdappreaa4e)
STATE WELL FERMfIN?appGoMe)
DMZ or OTHER PERMIT #(d appficable)
WELL USE (Cheek Applicable Boar): Resideratial Water Supply Vs
DATE DRILLED //. 20 -
TIME COMPLETED `. C AML MAW
--
3. WELL LOCATION:
!
GE..,? COUNTY ,4„rrt:.2!4/
/ //S %y(a/ 1..031" \\3
{Sbxt Name. Numbers. Canmursly. S&Amwion, Lot No.. Parcel, Zap Code) -
TOPOGRAPHIC! LAND SETTING:
CISbpe ❑M gwdValley OFge ❑Other
(check app cmiate box)
LATITUDE 3 _
LONGITUDE
May be in degrees,
minutes, seconds or
in a deduct format
Latitude/Iongitude source: DOTS ❑Topographic map
(location of wermust be shown on a USGS topo man
at+n.t+r.•1 to :his form rnot tang GPS) _-
4. WELL OWNER OWL.
�a
OWNER'S NAME .A.-'e Oyu:, \d.e CS
STREET ADDRESS ?o (Sol 605
No.?leS NC. Sri too
City Town State Zip Code
( leap). (054• 065io
Area code- Phone numbs
5. WELL DETAILS: �--
a TOTAL DEPTH:
b. DOES WELL REPLACE EXISTING WELL? YES 0 NOV
c- WATER LEVEL BelowTop of Casing: C. FT.
(Use' ' TAbove Top of Casing)
d. TOP OF CASING IS ` FT. Above Land Surface'
'Tap of casing terininated aiWW below land surface may require
a variance in aaordancewitr 15A NCAC 2C .0118.
e. YIELD (gpm): 4 METHOD OF TEST >Z•(1
f. DISINFECTION: Type4Z\ \$
g. WATER ZONES (depth):
From To
From To
From To
6. CASING:
From To
From To
From To
Thickness/
Depth -p DiYra�k-* WegM ink
From -+ X To „s ,i 'P. ro:. 4 A/L C k
Fran To FL
Fran To Ft.
7_ GROUT: Depth Material
From 0 To oCo P. lent n1'�'.
Flom To Fl.
From To - Ft.
Method
ih tee
8. SCREEN: Depth DienHer Sbt Size Material
From To Fl. in. in.
From To R. ir... in.
From To FR. _in. in.
9. SAND/GRAVEL PACK:
Depth
Flom
To- Ft
From To Ft.
Size Material
From To Ft.
10. DRIWNG LOG
From To
) 3
11. REMARKS:
Formation D 0 Orr evi
— c_'nj. t't'e
tek,SJUth
DIV OF WATFPQUAI1
MAR 0 8 2007
I DO WREST CEAiEY THAT THIS WEL L. V 'AS CWWFLCIED IIACCORDA NE WITH
15.4 ?CAC 2C, WELL CONSTRUCTION:TANWRDS. NSTNATA COPT OF THIS
RECORD 't!S.BEEN PROi'DEDTO TMNELL : OWNER.
SIGNATURE OF CERTLMED WE)1 CONTRACTOR DATE
Wsece C - H¢LVie'%
s.4r
PRINTED NAME OF PERSON :ONSTRUCTI N jr71t� G WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information NW.,
1617 Mali Service Center -Raleigh, NC 27699-1617 Phone No. [phone] ext 568.
Form GW-Ia
Rev. 7/05

RESIDENTIAL WELL coNsntucrxoNRECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 21 38
1. WELL CONTRACTOR:
James W. Camn
Well Contractor.(Indi)Adual) Name
Camp's Well & Pump Co. Inc.
Well Contractor Company Name
STREET ADDRESS P 0 Bog 429
Ellenboro NC
28040
City or Town State
(828). 453-7322
Zip Code
Area code- Phone number
2. WELL INFORMATION:
SITE WELL ID 40f applicable) '
STATE WELL PERMITA#(ltapplicable)
DWQ or OTHER PERMIT #(if applicable)
WELL USE (Check Applicable Box): Residential Water Supply 0
DATE DRILLED S - D
TIME COMPLETED 6. OU AMID PMpi
3. WELL LOCATION:
CITY:, ALL ((�� p (gyp tI (�
Ld . a ML . LL.L Ry .o Skeet
(attest Na Numbers. Ctmmunl • Subd ,Loh No., Parcel, .i Ip Code)
TOPOGRAPHIC / LAND SETTING:
❑Slope °Valley °Flat Ibi4ldge ❑Other
(cheat wpropdatabox)
LATITUDE 3L 41. S
LONGITUDE,Q;t' �1 L‘ r
Latitude/Iongitude source: COPS ['Topographic map
(location of wel must be shown on a USGS topo map and
attached to this tom I not ushg GPS)
4. WELL OWNER A A
OWNER'S NAME 0(L W.
STREET AgIlDR E S Y0
SAY/ � 11 4
City or Town
COUNTa"
May be in depea,
minutes, seconds or
in a decimal format
Area code - Phone number
5. WELL DETAILS:
a. TOTAL DEPTH: 6 n S
b. DOES WELL REPLACE EXISTING WELL? YES p NO'V
e. WATER LEVEL Below Top of Casing: - I Q n FT,
(Use'+-.8 Above Top d Casing)
d. TOP OF CASING 1S 1 . FT. Above Land Surface'
'Top of casing terminated at/or baton land surface may require
a variance In accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): METHOD OF TEST Of A
f. DISINFECTION: Type chlorine Amount
g. WATER ZONES (Qppth):
From To
From To
From To
6. CASING: Tmcknessl
DDepthd Diameter Weight Material
Fran 0 To CO a Ft 6* SDR21 PVC
From To Ft
From To Ft.
A,%ac4.,
From To
From To
From To
7. GROUT: Depth Materiel Method
From 0 To 20 FL Sackrete Hand
Ran To Ft.
Rom - To FL
S. SCREEN: Depth Diameter - Slot Size
From To Ft. In.
From To Ft. In. In.
From To FL In. In.
Material
h.
9. SANDIGRAVEL PACK:
Depth Size Material
From To Ft.
Fron{_To Ft.
From To Ft.
10. DRILLING LOG
From To.
0 VA
11. REMARKS:
Formation Description
J
I OD HEREBY CERTIFY THATTHIS WELL WAS OONSTRUCIED IN ACCORDANCE WRH
15A NCAC 2C, WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
RECORD
HAS
SBBEEN PROVIDED TOTHE
WELL
OWNER.NE
SIQ 4Tl7RE OF CERIED WELLNCQNTRACTOR , DATE
James W. Cam
PRINTED NAME OF PERSON CONS!!! tilt LJ
r77CCll..C'��//
Submit the original to the Division of Water Quality within 30-days. Attn: Infonnati
1617 Mall Service Center -Raleigh, NC 27699-1617 Phone No. [phone] ext 568.
Mgt, Form GW-la
FEB 07 Z noS
Asheville Regional Office
Aquifer Protection

RESIDENTIAL WELL coNSTRUCTION-RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 21 38
1. WELL CONTRACTOR:
James W. Camp
Well Contracta.(IndMdual) Name
Camp's Well & Pomo Co. Tnc
Well Contractor Company Name
STREET ADDRESS P 0 Poi
429
Ellenboro NC 28040
City or Toren State Zip Code
(828). 453-7322
Area code- Phone number
2. WELL INFORMATION:
SiTE WELL ID Aar applicable)
STATE WELL PERMIT#(8apparable)
DWQ or OTHER PERMIT It(lf applicable)
WELL USE (Check Applicable Box): RAsidential Water Supply 0
DATE DRILLED i ` i (} • ID L
TIME COMPLETED tt • 36 AMO PMB'
3. WELL LOCATION:
CITY: V.0 ‘,2 \uA1
csAA cAa
(Street Name, Numbers, Community, SubdiNalon, Lot No., Pareel;.Zip Code)
COUNTY 1\IAA 1.
TOPOGRAPHIC / LAND SETTING:
❑Slope Valley °Flat °Ridge °Other
(shear appropriatebox)
LATITUDE 3S a n i b1/4
LONGITUDE_ • OS - Ola 310
Latitude/longitude source: (GOTS °Topographic map
(location of we/ must be shown on a USGS topo map and
attached to this form Inot using GPS)
4. WELL OWNER
OWNER'S e
NAME LAAjke CaA4
May be in degrees,
minutes, seconds a
in a decimal format
/''• r7£
STREET ADDRESS Cr' l'X, RJ.
l&Ke !_'Ayr t N C
//��2
City or Tam n State
l2
( } U1S
Area code - Phone number 0 q1
Zip Code
5. WELL DETAILS: 61 f
a. TOTAL DEPTH: US
b. DOES WELL REPLACE EXISTING WELL? YES Q N0 &
c. WATER LEVEL Below Top of Casing: itiN /+ T(j1.tC4
(Use's' 0 Above Top of Casing)
d. TOP OF CASING 1S 1 FT. Above Land Surface*
'Top of casing terminated ava below land surface may require
a variance In accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): 0 METHOD OF TEST O.nti
t DISINFECTION: Type chlorine Amount Irk (.ap
g. WATER ZONES (depth):
From To 3S0
From To
From To
6. CASING:
Dept Dilater
From 0 To Ft. b#
From To Ft
From To Ft
From To
From To
From To
Thidmess/
Weight Material
SDR21 PVC
7. GROUT: Depth Material Method
From 0 To 20 Ft. Sackrete Hand
From To Ft.
From To FL
8. SCREEN: Depth Diameter Slot Size .Material
From To Ft. In. In.
From To Ft. In. in.
From_____, To Ft In. in.
9. SAND/GRAVEL PACK:
Depth Size Material
From To FL
From To Ft.
From To Ft.
10. DRILLING LOG
From .To
0 `5n
11. REMARKS:
�., CFormatio�scriptlon
ry
. -4
0
c7T
1 D0 HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED N ACCORDANCE WM
ISA /CAC 20. WELL CONSTRUCTION STANDARDS. AND THAT ACOPY OF THIS
RECORD HAS BEEN PROVIDEDTOTHE WELL OWNER
SUTURE O ACERTIFIE WELL CONTRACTOR bI 6 `/
James W. Camp
PRINTED NAME 0 P
RECEIVED
Submit the original to the Division of Water Quality within 30. days. Attn: menation Mgt,
1617 Mall Service Center -Raleigh, NC 27699-1617 Phone No. [phone] e t 566. FEB 0 7 2006
Asheville Regional Office
Aquifer Protection
Form N -la
Rev.7 5

RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 21 38
1. WELL CONTRACTOR:
James W. Cann
Well Contractor (Individual) Name
Camp' s Well & Pun(p Co„, Inc.
Well Contractor Company Name
STREET ADDRESS P 0 Bo* 429
Ellenboro NC 28040
City or Town State Zip code
(828). 453-7322
Area code- Phone number
2. WELL INFORMATION:
SITE WELL ID #(Itapplicable)
STATE WELL PERMIT#Olapplicable)
DWG or OTHER PERMIT #Qf applicable)
WELL USE (Check Applicable Sox): Residential Water Supply 0
DATE DRILLED I — 3 — D 4 '/
TIME COMPLETED 3 o AM tie O PM
3. WELL LOCATION:
CITY: 4u-re Lure COUNTY Wittilyr teri
(Street Name, �� �munity, Su16dhisIon, Lot No.. Parcel, 2.1p Code)
TO9OGRAPHIC I LAND SETTING:
(¢Slope Malley OFlat ❑Ridge ❑Otter
(check eppmpdatebox)) '' ,'
LATITUDE 1 _/ I 2` V
LONGITUDE1 2.. i I . 49 S1ti
Latitude/longitude source: ❑OPS oTopographic map
(bastion of well must be shown on a USGS topo map and
attached to this form lnot using GPS)
May be in degrees,
minutes, seconds or
in • decimal format
4. WELL OWNER
OWNER'S NAME
AdeAosiivk
STREET ADDRESS 1 (L=- S 3 I ek r ♦1 E `I Rd
Lake Lu.vr tJC .29'7(q 6
City or Town State Zip Code
(g2g )•6zra13 -
Area code - Phone number
5. WELL DETAILS: ���
a. TOTAL DEPTH:
b. DOES WELL REPLACE EXISTING WELL? YESp NO)h{
c. WATER LEVEL Below Top of Casing: - FT, 1
(Use'+' If Above Top d Casing)
d. TOP OF CASING 18 1 FT. Above Land Surface'
'Tap of casing terminated at/or below land surface may require
a variance In accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): GD METHOD OF TEST CAI r
t. DISINFECTION: Type chlOrine Amount 1 Ld,4
g. WATER ZONES (depth):
From To From To
From To From To
From To From To
6. CASING:
Fran 0 DTo hI A 0 Ft. ( eter
Fran To Ft.
From To Ft.
Thickness/
Weight
Material
7. GROUT: Depth Material Method
From 0 To 20 Ft. Sackrete Hand
From To FL
From To FL
8. SCREEN: Depth Diameter - Sic Size .Material
From To Ft. In. kt.
From To FL In. In.
From To FL In. In.
9. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
From To Ft.
10. DRILLING LOG
From .To.
0 /94
Fo rnation Description
sand deo/
/
1.25 . !SS ecr(sblldA1ed rick
11. REMARKS:
NV
0
I DO HEREBY CERTIFY111011 S WELL WAS COHSTRUCIED N ACCORDANCE WITH
15A NCAC 2C, WELL CONSTRUOTION STANDARDS, AND BAT A COPY OF THIS •
RECORD HAS BEEN PROVIDED TO THE WELL OWNER
D.144-€2
SI r TUBE OF CERTIFIED WELL CONT
ames W---Camp
CTOR DATE
PRINTED NAME OF PERSR EleplIVIEly WELL
Submit the original to the Division of Water Quality within 30.days. Attn:
1617 Mall Service Center -Raleigh, NC 27699-1617 Phone No. [phone]
format(on ,i , t 568. FEB p 7 2006
Form
Rev. 7
W-la
05
Asheville Regional Office
- Aquifer Protection

North Carolina — Department of EWELL CONSTRUCTION RECORD
WELL COQuEnvironment And Natural Resources — Division of Water
CERTIFIC
DITRACTOR (INDIVIDUAL) NAME (print) JEFF MELTON FICATION # 3417
lrty — Groundwater Section
WELL CONTRACTOR COMPANY NAME PITTMAN
WELL BORING LLC
STATE WELL CONSTRUCTION PERMIT # PHONE # {82814_ 5�62
(if applicable) ASSOCIATED WQ PERMIT #
(if applicable)
1. WELL USE (Check Applicable Box): Residential ® Municipal/public Monitoring 0 Recovery 0 Heat Pump Water Injection Other ❑ Other, Industrial 0 Agricultural ❑
2. WELL LOCATION:0 If Other, List Use
Nearest Town: LAKE LURE
WILLtAMS CIRCLE County RUTH
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code) ❑Ridge 0 Slope Topographic/Land setting
Valley
3. OWNER: GREG BELLI I a c/Land 0 ❑Flat
(check apprr opriatee box)
Address WILLIAMS CIRCLE Latitude/longitude of well location
LAKE LURE (Street or Route No.)
City EoTown State NC 28746 (degrees/minutes/seconds)
Zip Code Latitude/longitude source: 0 GPS ❑ Topographic map
828 — 674-8974 (check box)
Area Code Phone number DEPTH DRII L�LO o
4. DATE DRILLED 01/06/06 From To
5. TOTAL DEPTH: 805 From To
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 7. STATIC WATER LEVEL Below Top of Casing: 0 FT
8. TOP OF CASING IS 1-1/2FT. Above Land Surface*f Casing)
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 0 METHOD OF TEST ARDLOCATION SKETCH
10. WATER ZONES (depth): Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
11. DISINFECTION: Type CHLORYTE Amount 22number and common names
12. CASING: .5 HWY, #64/74A W. FROM RFTN. RIGHT ON
BI Depth Diameter or WeWall i�t/Weight/Ft.ss LL'S CREEK RD. LEFT ON CEDAR CREEK
From 0 To 30 Ft. SDR27.6 6-1/4" From RD. LEFT ON RIDGECREST. LEFT ON
From To _ Ft PVC HICKORY NUT LANE. RIGHT ON WILLIAMS
From To Ft CIRCLE. LOT APPROX.1/10 MILE ON RIGHT.
13. GROUT: Depth Material Method
From 0 To 20 Ft. UIKIIETE POURED
From To Ft
14.SCREEN: Depth Diameter Slot Size
From _ To Ft. Material
in. n
From To Ft.r
in. - RECEIVED '
15. SAND/GRAVEL PACK: ill.
From Depth Size Material
Ft
From �ToFt
MAR 0 8 2006
16. REMARKS: Asheville Regional Office
A. uifer Protection
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CWSTRUCTION STANDARDS, AND THAT A COPY OF THIS REC • • a HAS BEEN PROVIDED TO THE WELL OWNER
0
SIGNATURE 0 �•
ERSON CONSTRUC t G 1 WE L ,
Submit the original to the Divisionof Water Quality,Groundwater SG Raleigh, NC
DATE
27699-1636 Phone No. [phone], within 0 days.Section, Mail Service Center —
GW-1 REV. 07/2001
N

North Carolina - D WELL CONSTRUCTION RECORD
WELL Carolina
Department of Environment And Natural Resources - Division of Water
CONTRACTOR (INDIVIDUAL) NAME (print) JEFF MELTON Quality -Groundwater Section
WELL CONTRACTOR COMPANY NAME PI CERTIFICATION # 3417
STATE WELL CONSTRUCTION PERMIT # TTMAN WELL BORING LLC
ASSOCIATED WQPERMIT # PHONE # [phone]
(if applicable)
(if applicable)
1. WELL USE (Check Applicable Box): Residential Municipal/Public Monitoring 0 Recovery 0 Heat Pumper0 Other, Li 0 Agricultural
2. WELL LOCATION: Water Injection 0 Other 0 If Other, List Use
Nearest Town: BOSTICl County RUTH
BLACK RIDGE DR. -LOT #79
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: BOB BURGH
Address BLACK RIDGE DR
B(Street or Route No.)
OSTIC
NC 28018
City or Town State Zip Code
8[_03) - 276-1212
Area Code Phone number
4. DATE DRILLED 01/10/06
5. TOTAL DEPTH: 705
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: _2__FT.
8. TOP OF CASING IS 1-1/2 FT. Above Land
se "+" S�ce*f Casing)
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): METHOD OF TEST ARD
10. WATER ZONES (depth):
11. DISINFECITON: Type CH --LOB Amount 19.5
12. CASING: Wall Thickness
From 0 Depth Diameter or Weight/Ft Material
To 55 Ft 6-1/4" SDR21 PVC
From__ To_ Ft
From _ To Ft
13. GROUT: Depth Material
From 0 To 20 Ft UIKRETE
From To
14.SCREEN: Depth
From To
From To
15. SAND/GRAVEL PACK:
Depth Size Material
To Ft.
To Ft
t
Diameter Slot
Ft. in.
Ft.
Method
POURED
c fr,r /1 /fix
Topographic/Land setting
0 Ridge 0 Slope 0 Valley 0 Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source: ❑ GPS 0
❑Topographic map
DEPTH (check box)
From DRILLING LOG
To From To
________LOCATION TCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
FROM BOSTIC. GO OUT BOSTIC/SUNSHINE
HWY. LEFT ON TONEY RD. LEFT ON WATERS
RD. RIGHT INTO YELLOW TOP MTN. LEFT ON
BLACK RIDGE RD. 1/4 MILE ON RIGHT. LOT
#79.
RECEIVED
MAR 0 8 2006
Asheville RegionEal WIOffiTHce15A NCAC 2C, WELL
I DO HEREBY CERTIFY A • uifer Protection
THAT THIS WELL WAS CONSTRUCTED IN ACCORDANC
CONSTRUCTION STANDARDS AND THAT COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
From
From
16. REMARKS:
Size Material
in. _
in.
-n
3
0
0
SIGNA OF PERSON CON ''
UCTING t WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section,1636 Mail Service Center -
Raleigh, NC
27699-1636 Phone No. [phone], within 30 days.
GW-1 REV. 07/2001

North Carotins - WELL CONSTRUCTION RECORD
WELL CONTRACTOR tent of Environment And Natural Resources — Division of Water Quality — Groundwater Section
WELL CONTRACTOR COMPANY NAME NAME
(print)
JEFF MELTON CERTIFICATION # 3417
STATE WELL CONSTRUCTION PERMIT # ITTMAN WELL BORING LLC PHONE [phone]
(if applicable)
ASSOCIATED WQ PERMIT #
(if applicable)
1. WELL USE (Check Applicable Box): Residential
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other unicipal/Public IOtheri 0 Agricultural
0 If Other,
2. WELL LOCATION: List Use _
Nearest Town: RUTHERFORDTON County RUTH
PLEASANTVIEW UBDV LOT #31 Topographic/Land setting
(Street Name, Numbers, CommunitySubdivision, Lot No., Zip Code) 0 Ridge ❑Slope ❑Valley ❑Flat
3. OWNER: JIMMY HOOPER (check appropriate box)
Address PLEASANTVIEW SUBDV. Latitude/longitude of well location
(Street or Route No.)
RUTHERFORDTON NC 28139 (degrees/minutes/seconds)
City or Town State Zip Code Latitude/longitude source: 0 GPS 0 Topographic map
(828) — 429-4671 (check box)
Area Code Phone number DEPTH DRILLING LOG
4. DATE DRILLED 01/12/06 From To From To
5. TOTAL DEPTH: 405 _
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
EI
7. STATIC WATER LEVEL Below Top of Casing: 40 FT.
(Use "+" if Above Top of Casing)
8, TOP OF CASING IS 114/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 5 METHOD OF TEST ARD
10. WATER ZONES (depth):
11. DISINFECTION: Type �yTE Amount 10.5
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft Material
From 0 To 155 Ft 6-L4" SDR.21 PVC
From To __ Ft _
From To Ft.
13. GROUT: Depth Material Method
From 0 To 20 Ft UIKRETE POURED
From ToFt _
14.SCREEN: Depth Diameter Slot Size Material
From __ To _ Ft. _ in _ in
From _ To _ Ft. __ in.
15. SAND/GRAVEL PACK: --
Depth Size Material
From To Ft.
From To Ft
16. REMARKS:
e rr d
�, t)
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
HWY. #64/74A W. FROM RUTHERFORDTON
LEFT ON MAPLE CREEK RD. RIGHT INTO
PLEASANTVIEW SUBDV. APPROX. 1/2 MILE
ON RIGHT (LOT #31)
RECEIVED
MAR 08 2006
Asheville Regional Office
A.uifer Protection
0
OTh
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— O PERSON CONSTRUCTING THE
DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center— Raleigh, NC
27699-1636 Phone No. [phone], within 30 days.
GW-1 REV. 07/2001

North CarolinaDepartment of Env
— D WELL CONSTRUCTION RECORD V
WELL ironment And Natural Resources — Division of Water Quality — Groundwater Section
WELL CONTRACTOR COMPANY NAME P TMAN W F MELTON
CERTIFICATION # ON
STATE WELL CONSTRUCTION PERMIT # ITI�IAN WELL BORING LLC
(if applicable)WQ PERMIT # PHONE # [phone]
ASSOCIATED ---
1. WELL USE (Check Applicable Box): Residential
Monitoring 0 Recovery j Heat Pump Water IMnjection
Other [
2. WELL LOCATION: P 1 Other 0
Nearest Town: BOSTIC County RUTH
WALKER MILL RD.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER FRANKL�STIC
Address WALKER MILL RD.
(Street or Route No.)
NC
BOSTIC
City or Town State
_ — 248-3305
Area Code Phone number
4. DATE DRILLED 01/20/06
5. TOTAL DEPTH: 145
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
El
7. STATIC WATER LEVEL Below Top of Casing: 20 FT.
8. TOP OF CASING IS 1-1/2 FT. (Use+ Above Top of Casing)
t Above Land Surface*
*Top of
mg terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 100+ METHOD OF TEST ARD
10. WATER ZONES (depth): __
11. DISINFECTION: Type —yj Amomtt 3 12. CASING: Wall Thickness
Depth Diameter or Weight/Ft Material
From 0 To 25 Ft 6-1/4" SDR21
From To Ft PVC
From To Ft 13. GROUT: Depth Material
From 0 To 20 Ft. Method
From To Ft UH{RETE POURED
14.SCREEN: Depth Diameter Slot Size
From To Ft. Material
From _o inm.
15. SAND/GRAVEL PACK:
in. in.
Depth Size Material
To Ft.
To FL
From
From
16. REMARKS:
28019
Zip Code
Latitude/longi
DEPTH
From
(if applicable)
Industrial 0 Agricultural ❑
If Other, List Use
Topographic/Land setting
0 Ridge 0 Slope 0 Valley 0 Flat
(check appropriate box)
Latitude/longitude of well location
(degrees(minutes/seconds)
lode source: ❑ GPS ❑ Topographic map
(check box)
DRILLING LOG
To
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
FROM BOSTIC. GO OUT BOSTIC/SUNSHINE
RD. RIGHT ON WALKER MILL RD. CROSS
BRIDGE. 1 DRIVE ON RIGHT.
RECEIVED
MAR 08 21106
Asheville Regional Office
A uifer Protection
-71
-t
CJ
cp
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CO TRUCTION STANDARDS, AND THAT A OPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE 4FPERSON CONSTR CTING
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center— Ralei ' NC
27699-1636 Phone No. [phone], within 30 days.
GW-1 REV. 07/2001
WELL DATE

North Carolina- WELL CONSTRUCTION
WELL CO Department of Enviromnent And Natural Resources RECORD
CONTRACTOR (INDIVIDUAL) NAME yes Division of Water (print) JEFF LMELTONBORIN arty - Groundwater Section
WELL CONTRACTOR COMPANY NAME PI CERTIFICATION # 3g17
STATE WELL CONSTRUCTION PERMIT # TTMAN WELL BORING LLC
(if applicable) ASSOCIATED WQ PERMIT # PHONE # [phone]
1 • WELL USE (Check Applicable (if applicable)
MOLL npp cable Box): Residential Municipal/Public
2. WELL LOCATION: Recovery 0 Heat Pump Water Injection Other0 Od
❑ Other 0 IfOthue�L �ceAlFncultural 0
Nearest Town: LAICE LURECounty RUTH
WESCDR
(Street Name, Numbers, Communi Topographic/Land setting
ty Subdivision Lot No., Zip Code) ❑Ridge ❑klope ❑ Valley ❑Flat
3. OWNER: DAVID & AND RIGHTS (check appropriate
Address WES REA
R Latitude/lon •tudeo box)
(Street or Route No.) Latitude/longitude of well location
LAKE LURE NC
City or Town State 28746 (degreLatitudeao a source: 0t GPeconds)
City - 978-0439 Zip Code ngitude source: ❑ Gbo 0 Topographic map
4. DATE Code LED 01/31/06 From El'TFI DRILLING LOG
5. TOTAL DEPTH: 325 To From To
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: 80 FT
8. TOP OF CASING IS 1- (Use "+" if Above Top of Casing)
*Top of casing terminated U2 FT. Above Land Surface*
ated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 40 METHOD OF TEST ARD
10. WATER ZONES (depth):
11. DISINFECTION: Type CULpy ,mount 8
12. CASING:
Wall Thiclmess
Depth Diameter or Weight/Ft Material
From 0
From To 80 Ft 6-1/4" SDR21 PVC
To Fi.
From — _
13. GROUT: Depth Ft. _ --
From 0 Material Method
To 20 Ft UIKRETE PAD
From To
14.SCREEN: Depth Diameter. Slot Size Material
From To Ft.
From To Ft. in. in.
in.
15. SAND/GRAVEL PACK: in.
From Depth Size Material
To Ft
From
ToFt__
16. REMARKS:
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
HWY. #64/74A W. FROM RUTHERFORDTON
RT. ON BILLS CREEK RD.
LEFT ON
SWEETBRIAR RD. S. INTO SWEETBRAIR
SIBDV. RT. ON WESTRIDGE DR LOT #9 ON
LEFT.
RECEIVED
MAR 08 2006
Asheville Regional Office
A. offer Protection
I DO HEREBY CERTIFY THAT THIS WELL ARDS AND WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CON UCTION STAND
THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WEL -
DATE
27699-1636 Phone No. [phone], within30 days.
Submit the original to the Division of Water , DATE
Section, 1636
Mail Service Center Raleigh, NC
GW-1 REV. 07/2001

North Carolina - Department of EWELL CONSTRUCTION RECORD
WELL CO nvironment And Natural Resources - Division of Water Quality - Groundwater Section
NTRACTOR (INDIVIDUAL) NAME (print) RODNEY ROBBINS
WELL CONTRACTOR COMPANY NAME PITTMAN WELLBORING GLLC CERTIFICATION # 2785
STATE WELL CONSTRUCTION PERMIT # PHONE # (828)_ -45`_
(if applicable) ASSOCIATED WQ PERMIT #
(if applicable)
1. WELL USE (Check Applicable Box): Residential ® Munici Monitoring 0 Recovery 0 Heat PumpPaOtheric 0 Other, Li ❑ Agricultural
2. WELL LOCATION: Water Injection 0 Other 0 If Other, List Use
Nearest Town: BOSTIC County RUTH
SALEM CHURCH RD. Topographic/Land setting
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code) 0 Ridge 0 Slope 0 Valley ❑Flat
3. OWNER: �LOUISROBERSRSON (check
Address SALEM CHURCH RD. appropriate box)
LabtudeQongitude of well location
(Street or Route No.)
BOSTIC NC 28018 (degrees/minutes/seconds)
City or Town State Zip Code Latitude/longitude source: 0 GPS 0 To
(VI) - 429-4248 (check box) Topographic map
Area Code Phone number DEPTH
4. DATE DRILLED 01/03/06 From
5. TOTAL DEPTH: 165 To
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 0 DRILLING LOG
7. STATIC WATER LEVEL Below Top of Casing: 20 FT From
To
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*Cas) — *Top of casing temtinated 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): 50 METHOD OF TEST ARD Two State Roads or County Roads. Include the road
10. WATER ZONES (depth): number and common names
11. DISINFECTION: T BUS • 74 E FROM FOREST CITY. LEFT ON
12. CASING: CITE Amount 3.5 BOSTIC/SUNSHINE HWY. RT. ON SALEM
Wall Thickness CHURCH RD. 2 DRIVE ON LEFT PAST HARVEY
Depth Diameter or Weight/Ft Material From 0 LOGAN RD.
To 70 Ft.6-1/4" SDR.21 PVC
From To FtFrom
13. GROUT: Depth Ft.
th
From 0 To 20 Ft. UHCRE'1'D, Material MethodPO
From To Ft �--- POURED
14.SCREEN: Depth Diameter Slot Size
From To Ft. _ Material
m
From To Ft. ' in.
in. in.
15. SAND/GRAVEL PACK:
From Depth Size Material
To Ft.
From To Ft
16. REMARKS:
RECEIVED
MAR 08 2006
Asheville Regional Office
A.uifer Protection
0
0'
0
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE
CONS Ile CTIO. STANDARDS AND THAT A COPY OF THIS WITH I5AED TO THE 2C,W WELL
OWNER
ORD HAS BEEN PROVIDED WELL p
IGNA OF PERSON CG, STRUCTING THE WELL �� •
DATE
27699-1636 Phone No. [phone], within 30 days.
Submit the original to the Division of Water Quality,Groundwater Section, 1636 Mail Service Center -Raleigh, NC
GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina — Department of Environment And Natural WELL CONTRACTOR (INDIVIDUAL) NAME (print)OResources
oNEY RO BINS of Water Quality WELL CONTRACTOR COMPANY N — Groundwater Section
STATE WELL CONSTRUCTION PERMIT # CERTIFICATION # 2785
PITTMAN WELL BORING LLC
(if applicable) ASSOCIATED WQ PERMIT # PHONE # (828)�4g3
1. WELL USE (Check A (if applicable)
MonitoringLUApplicable Box): Residential Municipal/Public
0 Recovery 0 Heat Pump Water InjectionOthe0 IndustOther,, i Agricultural
2. WELL LOCATION: 0 Other 0 If Other List Use
GRENearest Town: RUTHERFORDTON
NearENHILL FARMS DR County RUTH
(Street Name, Numbers, Community,Subdivision,Topographic/Land alec/La t setting
3. OWNER: PETER R— Lot No., Zip Code) ❑ midge ❑Slope ❑Valley ❑ Flat
(check appropriate box)
Address GREENHILL FARMS DR
(Street or Route No.) Latitude/longitude of well location
RUTHERFORDTON
City or Town NC 28139 (degrees/minutes/
Area Code 7-4239 State Zip Code Latitude/longitude source: ❑ GPS ❑Topographic map
Phone number (check box)
4. DATE DRILLED 01/11/06 DEPTH
5. TOTAL DEPTH: 60g From To
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
®
7. STATIC WATER LEVEL Below Top of Casing: D� L—Cr LOG
g 100 FT.From To
8. TOP OF CASING IS 1-1/2 FT (Use + if Above Top of Casing)
'Top of casing terminated at1/2r Above Land Surface*
*Trance as accordancedain with 1 r NCAa lan
d
g requires a LOCATION SKETCH
9. YIELD (Rpm): 1 METHOD OFCA TEST ARD Show direction and distance in miles from at least
10. WATER ZONES Two State Roads or County Roads. Include the road
(depth):
number and common names
11. DISINFECf10DI: Type CHLORYTE HWY. #64/74A W.FROM RUTHERFORDTON.
12. CASING: �-- Amotrrtt 16.5 LEFT ON GREENHH L FARMS DR STAY
Depth
Wall Thickness STRAIGHTATCROSSROADS. 1/10
From 0 Diameter or Weight/Ft Material MILE ON LEFT.
To 60 Ft. 6-1/4" SDR21 From To Ft PVC
From To Ft
13. GROUT: Depth Material
i. Method
From 0 To 20 F
From _ To Ft �IIi{RETE POND
14.SCREEN: Depth Diameter Slot Size Material
From
T°Ft.
in. RECEIVED ,� 15. SAND/GRAVEL PACK:
From To Ft. in.
From Depth Size Material MAR 08 2006
From To Ft o
To Ft _ Asheville Regional Office al
16. REMARKS: A. uifer Protection
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE
CONS r • UC r a N STANDARDS AND THAT A COPY • ,
THIS RECO' r WITH i 2C, WELL
,� HAS BEEN PROVIDEEDD TOO THE WELL OWNER
a4I/�
SIG 0 P INTNS • CMG THGTHE LL DA
a 1 al to the Division of Water Quality, Groundwater Section, 1636 Mail
27699-1636 Phone No. [phone], within 30 days.
Submit the o
Service Center —Raleigh, NC
GW-1 REV. 07/2001
00)

rrum. xvu menu I o. oiepnenie vvuson
Date: 2/14/2006 Time: 8:28:14 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)
1. WELL USE (Check Applicable Box): Residential El
Recovery ❑ Heat Pump Water Injection ❑
2. WELL LOCATION:
Nearest town: RUTHERFORDTON
MOUNTAIN CREEK RD
(if applicable)
Municipal 0 Industrial ❑ Agricultural ❑
Other ❑ If Other, List Use:
County RUTHERFORD
(Street Name, Numbers, Community, Subdivision, Lot No,. Zip Code)
3. OWNER HORTON HOME OF RUTHERFORDTON
ADDRESS 342 HW Y 74 BYPASS
(Street or Route No.)
RUTHERFORDTON
City or Town
828-287-3366
NC
State
Area Code - Phone Number
4. DATE DRILLED 1 /27106
5. TOTAL DEPTH 120
6. DOES WELL REPLACE EXISTING WELL?
7. STATIC WATER LEVEL Below Top of Casing:
28139
Zip Code
YES ❑ NO ID
40 FT.
(Use "+" If Above Top of Casing)
8. TOP OF CASING IS 2 FT. Above Land Surface`
"Top of casing tennmated at/or below lard surface requires a variance m
accordance with 15A NCAC 2C.0I18
9, YIEI D (gpm): 12 METHOD OF TEST ARDM
ID. WATER ZONES (depth): 115
11. DISINFECTION: TYPE HYPOCHLORITE Amount 5
322592
Monitoring 0
Topographic/Land setting
❑ Ridge ❑ Slope ❑ Valley ❑ Flat
Latitude/Longitude of well location
35.25.200 / S2.00.255
(degrees/minutes/seconds)
Latitude/longitude source: ❑ GPS ❑ Topographic map
DEPTH DRILLING LOG
From To Formation Description
0 50 Clay
50 120 Consolidated Rock
12. CASING: Wall Thickness
Depth
From 0 To
U. GROUT:
Depth
From 0 To
14. SCREEN
Depth
From NA To
Diameter
49 Ft. 61/4"
20 FL
15. SAND/GRAVEL PACK:
Depth
From NA To
16. REMARKS:
or Weight/FL Material
SDR21 PVC
Oz
Material Method
GRAVEL MIX GRAVITY
Diameter
FL in
Ft,
Size
Slot Size Material
in.
Material
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
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.
c1 F .v 2/1/06
SIGNATURE OF PERSON CONSTRUCTING TILE WELL Date
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days.
GW-1 REV. 07/2001
RECEIVED
MAR 08 2006
Asheville Regional Office
A uifer Protection

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oeeiNis
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WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources - Division of Water Quality
WELL CONTRACTOR(DNIVWVAL) NAME (paint) JASON MANTAK
WELL cO nt CTORCOMPANY NAME GEOLOGIC EXPLORATION, INC.
CERTIFICATION #2580
PHONE # f 704 )872-7686
STATE WELL CONSTRUCTION FERMITN ASSOCIATED WQ PERMIT"
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential SI Municipal/Public 0 Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: UNION MILLS County RUTHERFORD
FROG CREEK ROAD
(Street Name, Numbers, Camwnity, Subdivision, Las No., Zip Code)
3. OWNER LAND RESOURCE COMPANIES
Address 2000 RNERFDrK PARKWAY SURE 580
(Street or Route No.)
ATLANTA GA
30328
City or Town State Zip Code
C_)-
Aree code- Phone number
4. DATE DRILLED 01/09/06
5. TOTAL DEPTH: 300.0 FEET
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO El
7. STATIC WATER LEVEL Below Top of Casing:50.0 FT.
(Use "+" ifAbove Top of Casing)
8. TOP OF CASING IS 10 FT. Above Land Surface*
*Top Meaahgte n eased atlsr below had surface mirages •
mina is aocerdaacewith ISA NCAC 2C Ilk
9. YIELD (gpm): N/A METHOD OF TEST N/A
10. WATER ZONES (depth): N/A
11. DISINFECTION: Type N/A
12. CASING:
Depth Diameter
From To Ft 6 1/4 INCH
From To Ft.
From To Ft.
13. GROUT: Depth Material
From 0.0 Top•0 Ft. GROUT
Amount
Wall Thickness
or Weight/Ft Material
SCH 40 PVC
From To Ft
14. SCREEN: Depth Diameter
From To Ft in.
From To Ft in.
15. SAND/GRAVEL PACK:
From
From
Depth Size
To Ft.
To Ft
Method
POURED
Slot Size Material
in.
in.
Material
16, REDS- TW-1 OPEN HOLE FROM 56.0 TO 300.0 FT.
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(dcgteedmimnea/ucaods)
Latitude/longitude source:❑GPS❑Topogtaphic mar
(check box)
DEPTH DRILLING LOG
From To Formation Description
0.0 6.0 RED CLAY
6.0 30.0 BROWN WEATHERED ROCK
30.0 53.0
53.0
GREY ROCK WITH WEATHERED LAVERS
300.0 GREY ROCK WITH QUARTZ
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARD, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
a
SIGNATURE OF PERSON CONSTRUCTING THE WELL
RECEIVED
Submit the original to the Division of Water Quality, Attu: Information Management,1617 Mai
Raleigh, NC 27699-1617, Phone No. [phone], within 3( days.
MAR 27 2006
Asheville Regional Office
Aquifer Protection
ATE
Service Centel

WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources - Division of Water Quality
WELL CONPRACTOR (INDfV07UAL) NAME (print) JASON MANTAK CERI7FICATION y2580
WELL CONTRACTOR COMPANY NAMB GEOLOGIC EXPLORATION, INC. pHONE y /704)872-7686
STATE WELL CONSTRUCTION PERMIT" ASSOCIATED WQ PERMIT"
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ® Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: UNION MILLS County RUTHERFORD
FROG CREEK ROAD
(Street Name, Numbaa, Comuamity, Subdivision, Lot No., Zip Code)
3. OWNER: LAND RESOURCE COMPANIES
Address 2000 RIVEREDGE PARKWAY SUITE 580
(Street or Route No.)
ATLANTA GA
30328
City or Town State Zip Code
( Area code- Phone number
4. DATE DRILLED ovioios
5. TOTAL DEPTH: 300 o FEET
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO El
7. STATIC WATER LEVEL Below Top of Casing.3o.o FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS t D FT. Above Land Surface*
'Top of casing terminated at/or below lad nit rewires a
valiance In accordancewith ISA NCAC 2C A11t
9. YIELD (gpm): NIA METHOD OF TEST N/A
10. WATER ZONES (depth): N/A
11. DISINFECTION: Type N/A
12. CASING:
From
From
From
13. GROUT:
From 0.0
Depth Diameter
To Ft 6 1/4 INCH
To Ft.
From
To Ft.
TDe
Material
Ft. GROUT
Amount
Wall Thickness
or Weight/Ft Material
SCH 40 PVC
To Ft.
Method
POURED
14. SCREEN: Depth Diameter Slot Size
From To Ft in. in.
From To Ft in. in.
15. SAND/GRAVEL PACK:
Depth Size
To Ft.
From
From To Ft.
Material
Material
16. REMARKS- TW 2 OPEN HOLE FROM 33.0 TO 300.0 FT.
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appmgvte box)
Latitude/longitude of well location
(dcgtecdmiumcs/seconds)
Latitude/longitude source:❑GPS❑Topographic mar
(cheek box)
DEPTH DRILLING LOG
From To Formation Description
0.0 6.0 RED CLAY
6.0 30.0 BROWN WEATHERED ROCK
30.0 300.0
GREY ROCK
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. include the road
numbers and common road names.
eye
0
o'
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WTIH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, ANQ4FRAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONST
Submit the original to the Division of Water Quality, Attn: In
Raleigh, NC 27699-1617, Phone No. [phone], within 30 day
ormadfl Maid dt Pmri1
MAR 2 7 2006
Asheville Regional Office
As uifer Protection
rim
ce Center -

WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources - Division of Water Quality
WELL CONTRACTOR (INDIVIDUAL) NAME (prise JASON MANTAK CERTIFICATION p2580
WELLCON EACTORCOMPANYNAME GEOLOGIC EXPLORATION, INC. pppNE # (7041872-7686
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMITS
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ® Municipal/Public ❑ Industrial 0 Agricultural ❑
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: UNION MILLS
FROG CREEK ROAD
(Sweet Name, Numbers, Ce.noity, Subdivision, Lot No., Zip Code)
County RUTHERFORD
3. OWNER: LAND RESOURCE COMPANIES
Address 2000 RIVEREDGE PARKWAY SUITE 580
(Street or Rase No.)
ATLANTA GA 30328
City or Town State Zip Code
Area code-Phoa number
4. DATE DRILLED ovl otos
5. TOTAL DEPTH: 400.0 FEET
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO El
7. STATIC WATER LEVEL Below Top of Casing:66.0 Fr.
(Use R+" if Above Top ofCasmg)
8. TOP OF CASING IS 1 A FT. Above Land Surface;
'Top of easing termluted at/or below IS aafee requires a
variance In accordance with ISA NCAC 2C All la.
9. YIELD (gpm): N/A METHOD OF TEST NIA
10. WATER ZONES (depth): N/A
11. DISINFECTION: Type N/A
12. CASING:
Depth
From To
From To
From To
13. GROUT: Depth
From 0.0 In20.0
From To Ft.
Diameter
Ft, 6 1/4 INCH
Ft.
Ft.
Material
Ft. GROUT
14. SCREEN: Depth Diameter
From To FL in.
From To Ft in.
15. SAND/GRAVEL PACK:
Depth Size
From To Ft
From To Ft.
Amount
Wall Thickness
or Weight/Ft Material
SCH 40 PVC
Method
POURED
Material
16. REMARKS' TW-3 OPEN HOLE FROM 73.0 TO 300.0 FT.
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(dcPeea/minufds de)
Latitude/longitude source:❑GPS❑Topographic mar
(check box)
DEPTH DRILLING LOG
From To Formation Description
0.0 10.0 RED CLAY
10.0 40.0 BROWN WEATHERED ROCK
40.0 69.0 GREY ROCK WITH BROM WEATHERED ROCK
69.0 4000 GREY ROCK
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. include the road
numbers and common road names.
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUC MD IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STAND .4%$ DS, 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: Info
Raleigh, NC 27699-1617, Phone No. [phone], within 30 days.
atODflifeenitre Service
MAR 27 2006 •
Asheville Regional Office
Aquifer Protection
ter -

WELL CONSTRUCTION RECORD
North Carolina — Department of Environment And Natural Resources — Division of Water Quality — Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) ROBIN MCNEELY CERTIFICATION # 2567
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING. LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # _ ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ® Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: RUTHERFORDTON
HICKS GROVE EXT. RD.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: JAMES BROOKS
Address HICKS GROVE EXT. RD.
(Street or Route No.)
RUTHERFORDTON NC 28139
City or Town State Zip Code
(828) — 289-1040
Area Code Phone number
4. DATE DRILLED 02/07/06
5. TOTAL DEPTH: 39
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: 27 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface'
'Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 12 METHOD OF TEST STEEL TAPE
10. WATER ZONES (depth):
County RUTH
11. DISINFECTION: Type CHLORYTE Amount 5_52
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft Material
From 0 To 39 Ft 24" CEMENT
From _To_Ft -
From _ To _ Ft. _
13. GROUT: Depth Material
From 0 To 20 Ft. CEMENT
From _To_Ft.
14.SCREEN: Depth Diameter Slot Size
From _To ____ Ft.
_ in _
From _To_Ft. _ in _
15. SAND/GRAVEL PACK:
Depth Size Material
From 27 To 39 Ft. 78M GRAVEL
From _To_Ft_
Method
POURED
Material
in.
in.
Topographic/Land setting
❑ Ridge ❑ Slope ❑ Valley ❑ Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source: ❑ GPS 0 Topographic map
(check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
FROM RUTHERFORD GO DOWN HWY. #221 S.
RIGHT ON HICKS GROVE RD. LEFT ON HICKS
GROVE EXT. RD. GO TO END OF PAVEMENT.
SHOP ON RIGHT.
RECEIVED
MAR 2 7 2006
Asheville Regional Office
Aquifer Protection
r)
0
16. REMARKS-
' DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTIt4,1CTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SI NA OF PER$ C NSTRU 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

WELL CONSTRUCTION RECORD
North Carolina — Department of Environment And Natural Resources — Division of Water Quality — Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) ROBIN MCNEELY CERI INICATION # 2567
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING. LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # _ ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ® Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: RUTHERFORDTON
HAMILTON RD.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER MELISSA HUMPHRIES
Address HAMILTON RD.
(Street or Route No.)
RUTHERFORDTON NC 28139
City or Town State Zip Code
(828) — 286-8818
Area Code Phone number
4. DATE DRILLED 02/08/06
5. TOTAL DEPTH: 62
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: 50 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
'Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 12 METHOD OF TEST STEEL TAPE
10. WATER ZONES (depth):
County RUTH
11. DISINFECTION: Type CHLORYTE Amount 5_52
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft Material
From 0 To 62 Ft 24" CEMENT
From To Ft _
From _ To _ Ft.
13. GROUT: Depth Material Method
From 0 To 20 Ft. CEMENT POURED
From To Ft
14.SCREEN: Depth Diameter Slot Size Material
From To Ft. _ is _ in.
From ToFt. _ in. _ in.
15. SAND/GRAVEL PACK:
Depth Size Material
From 50 To 62 Ft. 78M GRAVEL
From To Ft_
Topographic/Land setting
❑ Ridge ❑ Slope ❑ Valley ❑ Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source: ❑ GPS ❑ Topographic map
(check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
FROM RUTHERFORD GO UP HWY. #64/74.
RIGHT ON COVE RD. LEFT ON HAMILTON RD.
1/10 MILE ON RIGHT.
RECEIVED
MAR 2 7 2006
Asheville Regional Office
Aquifer Protection
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRJ.JCTION STANDARDS, AND THAT A COPY OF7H1 iRECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIG ATURE 0
CTING THE WELL
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center — Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

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 ® Munictpal/Pab
Monitoring 0 Recovery D Heat Pump Water Injection ❑
2. WELL LOCATION:
Nearest Town: RUTHERFORDTON County RUTH
MIDDLE OAKS TRAIL
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: DARRON BYERS
Address MIDDLE OAKS TRAIL
(Street or Route No.)
RUTHERFORDTON NC 28139
City or Town State Zip Code
(828) — 288-0289
Area Code Phone number
4. DATE DRILLED 02/22/06
5. TOTAL DEPTH: 39
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO El
7. STATIC WATER LEVEL Below Top of Casing: 21 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 18 METHOD OF TEST STEEL TAPE
10. WATER ZONES (depth):
11. DISINFECTION: Type CHLORYTE Amount 8_28
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft Material
From 0 To 39 Ft 24" CEMENT
From To_Ft.
From To Ft _
13. GROUT: Depth Material Method
From 0 To 20 Ft. CEMENT POURED
From ToFt
14.SCREEN: Depth Diameter Slot Size Material
From To Ft _ in. _ in.
From To Ft _ in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From 21 To 39 Ft 78M GRAVEL
From To Ft.
16. REMARKS:
he ❑ Industrial 0 Agricultural 0
Other ❑ If Other, List Use
Topographic/Land setting
❑ Ridge ❑ Slope ❑ Valley ❑ Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source: 0 GPS ❑ Topographic map
(check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
FROM RUTH GO UP HWY. 064/74.1/2 MILE
PAST TOMMY'S BP. RIGHT ON MIDDLE OAKS
TRAIL. LAST TRAILER ON LEFT.
RECEIVED
MAR 27 2006
Asheville Regional Office
Aquifer Protection
0
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUC1ED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONS UCTION STANDARDS, AND THAT A COPY OF T1 RECORD BEEN PROVIDED TO THE WELL OWNER
4NATURE F P:
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center— Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

t i Fr, <*
tea. sr..
WELL CONSTRUCTION RECORD
North Carolina — Department of Environment And Natural Resources — Division of Water Quality — Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) ROBIN MCNEELY CERI IFICATION # 2567
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING. LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # _ ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ® Municipal/Public 0 Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: RUTHERFORDTON
131 TIMBER RIDGE
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: KRIS STINES
Address 131 TIMBER RIDGE
(Street or Route No.)
RUTHERFORDTON NC 28139
City or Town State Zip Code
S(28) — 288-2977
Area Code Phone number
4. DATE DRILLED 02/23/06
5. TOTAL DEPTH: 38
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of (king: 20 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS a FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): 18 METHOD OF TEST STEEL TAPE
10. WATER ZONES (depth):
County RUTH
11. DISINFECTION: Type CHLORYTE Amount 8_28
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 38 Ft. 24" CEMENT
From To Ft
From To Ft
13. GROUT: Depth Material Method
From 0 To 20 Ft. CEMENT POURED
From To Ft
14.SCREEN: Depth Diameter Slot Size Material
From To Ft. _ in. _ in.
From To _ Ft. _ in. _ in.
15. SAND/GRAVEL PACK:
Depth Size Material
From 20 To 38 Ft 78M GRAVEL
From To _ Ft _
16. REMARKS:
Topographic/Land setting
❑ Ridge ❑ Slope ❑ Valley ❑ Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source: 0 GPS ❑ Topographic map
(check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at (east
Two State Roads or County Roads. Include the road
number and common names
FROM RUTHERFORDTON. GO UP HWY. #221N.
LEFT ON LARLINGTON RD. RIGHT ON
CARPENTER RD. GO 14/2 MILE. RIGHT ON
TIMBER RIDGE. 1n HOUSE ON LEFT.
RECEIVED
MAR 2 7 2006
Asheville Regional Office
Aquifer Protection
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
it SIGMA OF P O CON U TING THELL
ram- ,9 - , 2.3-C (
DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center— Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

' G.•F,
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)
H C
1. WELL USE (Check Applicable Box): Residential ® Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: RUTHERFORDTON
HICKS GROVE CHURCH RD.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: FRANK & RACHEL BYRD
Address HICKS GROVE CHURCH RD.
(Street or Route No.)
RUTHERFORDTON NC 28139
City or Town State Zip Code
8�28) — 289-9905
Area Code Phone number
4. DATE DRILLED 02/07/06
5. TOTAL DEPTH: 185
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: 60 FT.
(Use "+" if Above Top of Casing)
8, TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated atior below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 25 METHOD OF TEST ARD
10. WA1ERZONES (depth):
County RUTH
11. DISINFECTION: Type CHLORYTE Amount 3.5
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft Material
From 0 To 100 Ft. 6-1/4" SDR.21 PVC
From To_Ft_ _
From To____ ____ _
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.
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 C ;':' • THIS ' CORD HAS BEEN PROVIDED TO THE WELL OWNER
Topographic/Land setting
❑ Ridge ❑ Slope ❑ Valley ❑ Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source: 0 GPS 0 Topographic map
(check box)
DEPTH DRILLING LOG
From To From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
FROM RUTHERFORDTON. TAKE HWY. #221
S. RIGHT ON HICKS GROVE RD. RIGHT INTO
SMALL TRAILER PARK. GO TO END OF ROAD.
RECEIVED
MAR 2 7 20fl6
Asheville Regional Office
A. uifer Protection
S GNATURE OF P RSON CONSTRUCTING
DATE
1
Su mit the original to the Division 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 E M
Monitoring ❑ Recovery ❑ Heat Pump Water Injection
2. WELL LOCATION:
Nearest Town: RUTHERFORDTON County RUTH
ROCK CORNER RD.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3.OWNER: THOMAS GALLMAN
Address ROCK CORNER RD.
(Street or Route No.)
RUTHERFORDTON NC 28139
City or Town State Zip Code
8(28) — 288-8463
Area Code Phone number
4. DATE DRILLED 02/27/06
5. TOTAL DEPTH: 52
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO E
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*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 20 METHOD OF TEST STEEL TAPE
10. WATER ZONES (depth):
11. DISINFECTION: Type CHLORYTE Amount 9.2
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft Material
From 0 To 52 Ft. 24" CEMENT
From _ To
From To Ft_ _
13. GROUT: Depth Material Method
From 0 To 20 Ft. CEMENT POURED
From To Ft
14.SCREEN: Depth Diameter Slot Size Material
From To Ft. _ in. _ in.
From To _ Ft _ in. _ in.
15. SAND/GRAVEL PACK:
Depth Size Material
From 32 To 52 Ft 78M GRAVEL
From To Ft
16. REMARKS:
wucipa1/Public 0 Industrial ❑ Agricultural 0
D Other ❑ If Other, List Use
Topographic/Landsetting
❑ Ridge ❑ Slope ❑ Valley ❑ Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source: 0 GPS 0 Topographic map
(check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
FROM RUTH GO OUT RR AVENUE. LEFT ON
WHITESIDES. RIGHT ON ROCK CORNER RD. GO
1.5 MILES. DRIVE ON RIGHT.
RECEIVED
MAR 27 2056
Asheville Regional Office
A*uifer Protection
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 IIAS BEEN PROVIDED TO THE WELL OWNER
4ree-r � >
SIL'rNA
CO
,1 n\Q - 2 7-6 6
DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center— Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

' RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 2138.
1. WELL CONTRACTOR:
James W. Camp
Well Contractor. (Individual) Name
Camp's Well & Pumo Co. Tnr.
Well Contractor Company Name
STREET ADDRESS P 0 BOX: 429
Ellenboro NC 28040
City or Torn ' State Zip Cosie
(828} 453-7322
Area code- Phone number
2. WELL INFORMATION:
SITE WELL ID #Or applicable)
STATE WELL PERMIT/RSapplcable)
DWQ or OTHER PERMIT SST applicable)
WELL USE (Check Applicablein Box): Residential Water Supply
li
DATE DRILLED ` - --o t'
TIME COMPLETED I� Keen AM❑ PM
3.WELL LOC TIO
CITY: OS7) G
eIIDu1k1' - 1-Dt 1414
(Saes Name, Numbers!
TOPOGRAPHIC I LANDS ING:
❑ Slope Malley oflat Rldue 0 Other
(eh adr ,PPropdNab?x)
LATITUDE S ,z' a8 . .9. +
•
LONGITUDE J I ` 50. +1 g
Latitude/longitude source: oGPS OTopographic map
(bcatbn ofwelmust be shown on a USGS topo map and
attached to this term I nottyu hirg G S) ,!
d.WELL OWNER A . jt COz — -I-,•
OWNER'S NAME I �7 ff--t7� --yyLC�^ (UTIS-Ip,L[CTfOYI
STREET ADDRESS a^4'5r4 term wrack Ct.
igC-"+TC ,-'dam C-e�?•, .
City or Town Nit 0 Poyl Ric{te> rot
7 t s
Area code- Phone number
5. WELL DETAILS:
e. TOTAL DEPTH:
b. DOES WELL REPLACE EXISTING WELL? YES D NOX
c. WATER LEVEL Baba Top of Casing: 4-6 FTC
(Use'+' If Above Top of Casing)
d. TOP OF CASING IS, 1 . FT. Above Land Surface'
below. Icy et easing laminated attor
a variance in accordance with 15A NCA 2C .0118.,., require
e. YIELD (gam):---�5 METHOD OF TEST a i r
COUNTY gtA±ice r;(�
artery, Subdhesion, Lot No., Parcel, an Code)
IMay be. in degas,
minutes, seconds or
in a decimal format
f, DISINFECTION: Type chlorine Amount 1
g. WATER ZONES (depth):
From To From To
Ron To From To
From To From To
6. CASING: 77a�et� ThWickness/
DFrom 0 To�`3a2 Ft, Dirt SDRht Material
21 PVC
From To Ft
From To .Ft
7. GROUT: Depth Material Method
Fio„L0 _To 20 Ft Sackrete Hand
From To Ft.
From . To FL
8. SCREEN: Depth Diameter - Slot Size .Material
From To Ft. In. In.
From To FL In. in.
Fran To FL In. et.
8. SAND/GRAVEL PACK:
Depth Sim Material
Fran To_ Ft.
From To Ft.
From To Ft
10. DRILLING LOG
F m ...y Oz
11. REMARKS:
Formation Description
resit 5 an-d
(1pfSthriafed YoriC
773
tV
J
CY1
I DO HEREBY CERTIFYTHATTHIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
15A MAC 20. WELL SEEN CONSTRUCTOR
4SSD UC11 RSTANDARDS.
ANDDLRD AND
THATACOPY OF THi3
RECORD HAS.
s14 1A Ltv' ra l V -06
RE OF
SIG CERTIFIED WE L CONTRACTOR DATE
ames W. Camp
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
11i617 MailServicoriginal to te Center - Rale lvision of Water eigh, NC 276994617 Quality
P Phone No. (9 9)133 7Attn: ext 68.gon Mgt,
Form GW-la
Rev. 7/05

RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 21 3 8
1. WELL CONTRACTOR:
James W. Camp
Well Contractor.Ondividual) Name
Camp's Well & Pump Co. Tnc-
Well Contractor Company Name
STREET ADDRESS P 0 Poi 429
E1lenboro NC 28040
City or Town State Zip bode
(828} 453-7322
Area code- Phone number
2. WELL INFORMATION:
SITE WELL ID #lit applicable)
STATE WELL FERMIUM? applcable)
DWQ a OTHER PERMIT #(if applicable)
WELL USE (Check Applicable Box): Residential Water Supply ID
DATE DRILLED hr3-G/o
TIME COMPLETED I�: 30 AMO PM/
3. WELLL
CITY:
TION' e I
DST, i c. COUNTY g14 eY /(/
(Buss Nglrie, Numbers, Canmunity, SubdM slon)Lot No., Parcel;Zip Code)
TOPOGRAPHIC / LAND SETTING:'�
❑Slope OVaeey OFlat IYHidge ❑Other
(eMrk appropdatabor0(j
LATITUDE . 'J ' ,24 • I + ,
LONGITUDE $ L` Co `6l t.
Latitude/longitude source: MOPS OTopographic map
(location of we/ must be shown on a USGS topo map and
attached to this form snot ushg GPS)
May be in degrees„
minutes, seconds or
in a decimal format
4. WELL OWNER
OWNER'S NAME
STREET ADDRESS
Orange
City orTown
t DISINFECTION: Type chl orine Amount 1 CLt l
g. WATER ZONES (depth): /
From To
From To
From To
6. CASING: j
From_aDepth
,O Ft 0bt
leter
From To Ft
Ran To .Ft
7. GROUT: Depth
From 0 To 20
Froni To
From To
a. SCREEN: Depth
From To
From To
From To
From To
From To
From To
Thickness!
ial
Weight
P C
Material Method
Ft. Sackrete Hand
Ft.
Ft
Diameter Slot Size .Material
Ft In. In.
Ft. In. In.
Ft In. In.
9. SAND1GRAVEL PACK:
Depth Size Material
Fran To Ft.
From To Ft
Ran To Ft
10. DRIWNG LOG
Rom .To.
0 (e o
6goLIKeyk
63o I J, Cerra I Poet- 4,
r it(
P L � (0 3 i T Zip Code
Area code Phone number
5. WELL DETAILS:
a. TOTAL DEPTH:
117o
b. DOES WELL REPLACE EXISTING WELL? YES O N0
1)(
c. WATER LEVEL Below Top d Casing: FT,
(Use "+" 11 Above Top of Casing)
d. TOP OF CASING IS 1 • FT. Above Land Surface'
'Top of casing temtnated at/or below lend surface may require
a variance In accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): METHOD OF TEST et / 1'
ECOOV i_,D
11. REMARKS:
Formation Desaiptbn
(It ✓ T c/a /
/o)1so/idated roLI<
ry
J
CD
I DO HEREBY CRIMPY THAT THIS WELL WAS OONSWRUC1ED/IACCORDANCE Wmt
16A MAC 2C. WELL CONSTRUCTION
STANDARDS.
RECORD HAS BEEN PROVIDDD
PROVIDED TO WELLLL OWNER 'r(
SIGN URE OF CERTIFIED WELCCOMRACTOR DATE
Ci
James W. Camp
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit 1617 Mall the
Centernal to - — Rallvision of Water eigh, NC 27699-1617 QualityPhone No. (9 9) 733 7Attn: ex! 68.gon Mgt.,
Fonn GW-la
Rev. 7105

' RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolins Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION M 21 38
1, DISINFECTION: Type Chlorine Amount 1 7N rap
g. WATER ZONES (depth):
From To From To
Fran To From To
Fran To From To
Thylloglahalss/
SDRZ1 'PVC
1. WELL CONTRACTOR:
James W. Camn
Well Contractor. (Individual) Name
Camp 's Well & Pumn Co. Inc_
Well Contractor Company Name
STREET ADDRESS P BOX 429
E1lenboro NC 28040
Zip Code
C
i
t
yorTaan State
[phone]
Area code- Phone number
2. WELL INFORMATION:
SITE WELL ID Milt applicable)
STATE WELL FERMIUM( applicable)
DWQ or OTHER PERMIT M(H applicable)
WELL USE (Check Applicable Box): Residential Water Supply ❑
DATE DRILLED 3- 2 -O G
TIME COMPLETED 3: 45 AM ❑ PM [g/
3. WELL LOCATION: r }� I
CITY:La (e / LL(e couriTYRul1tCfl/(1
Oct), Ravt — i3ctck5Krn Ci -- LDt5
(Street Name. Number, Community. SubdMcion. Lot No.. Parcel;Zlp Code)
TO OGRAPHIC / LAND SETTING:
(p'tnpe Walley OFlat ORidge ❑Other
(check appropriate box)
LATITUDE , if ��• 6et
LONGITUDE•_¢. /011
Latitude/longitude source: v6PS °Topographic map
(location of wet must be shown on a USGS topo map and
attached to this form 'not using GPS)
4.W OWNER'S NAME
5r- -{�e,f —
OWNER'SNAME .J— I45�i"t/LG DIL
STREET ADDRESS 33 0 a 11 e
/ LovK Dtt 44611
Zip Code
IMay be. in degrees, I
minutes, woods or
in a decimal format
City or Town State
Area code Phone number
5. WELL DETAILS:
a. TOTAL DEPTH:° D `'
b. DOES WELL REPLACE EXISTING WELL? YES p NO @
c. WATER LEVEL Below Top of Casing: 1
(Use'+'. if Above Top of Casing)
d. TOP OF CASING IS 1 • FT. Above Land Sudare•
casing'Top of terminated at/or below land surface rney .0118.
require
variance accordance With 15A NCAC 2C .001 8.
n
e. YIELD METHOD OF TEST 111 r
6. CASING:
Fran DToh7b
FL Water
From To Ft.
From To FL
7. GROUT: Depth Material Method
From 0 To 20 FL Sackrete Hand
From To FI.
From To FL
8. SCREEN: Depth Diameter Slot Size Materiel
From To FL In. __ n.
Fran To Ft. in. __ In.
From To Ft. M. In.
e. SANDIGRAVEL PACK: Size
Depth Material
From 7o Ft.
From To Ft.
From To_ Ft.
10. DRILLING LOG
From .To . Formation Description
• 0' 9l0 ,Formation
Clay To .5o0 col5clidate) rock
11. REMARKS:
D
L
O
cn
100 HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED N ACCORDANCE WIN
STANDARDS,
THATACOPY OEM*
RECORD HAS EEN POVIDEDTOTHE WELL OWNER. •
SIG NA7uR/ED CERTIFIED WELL COS
CTOR DATE
James W. Camp
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
617mMall Seroriinal to the vlc9e Center — Ral)eigh, NC 2 699-16117 Qualityvision of Water Phoninformation Mgt.,e No. (9 9) 733 7 5 ext 6B.
Form GW-1a
Rev. 7105

3. WELL
LOCATION: �� iate i%r�
CITY: �651C COUNTY ` 7{�( �p
u)e6tr e Dr. - Lot i71
(6
PRESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 2138
1. WELL CONTRACTOR:
James W. Camp
Well Contractor (IndMdual) Name
Camp 's Well & PumO Co. Inc'.
Well Contractor Company Name
STREET ADDRESS P 0 BOX 429
Ellenboro NC 28040
City or TaNn State Zip Code
( 828)- 453-7322
Area code- Phone number
2. WELL INFORMATION:
SITE WELL ID #Or applicable)
STATE WELL PERMIT#NUPPIIcaWS)
DWG or OTHER PERMIT #(It applkable) /
WELL USE (Cheek Applicable Box): Residential Water SWOT Id
DATE DRILLED ` �Ij ` d
TIME COMPLETED I � AM CI PM V
Nuns. Num . , CammuNry. Su , La No., ParceliZIp Code)
TOPOGRAPHIC / LAND SETTING:
CI Slope Whitey O.FIat ORidge CI Other
(clod: appropriate box)
LATITUDE . fl' 24 7
LONGITUDE $ L: 5-0' 9/ 9
Latitude/longitude source: rPS nTopographic map
(bcatbn of wet must be shown on a USGS topo map and
attached to this form /not using GPS)
4. WELL OWNER �7.11 ►�2
OWNER'S NAME L(YY��F( Ar 1
iroo
STRE� ADDRESS t 9 J 6 C tut IQ X.a
USA -rev' Spfle14FL. 3ifs
City orTown slat8 Zlp
IMay be In depeet.
minutes, seconds or
Inc decimal brunt
Area code Phone number
5. WELL DETAILS: q L�
a. TOTAL DEPTH:,_l.Sd
b. DOES WELL REPLACE EXISTING WELL? YES D NOX
o. WATER LEVEL Beta Top d Casing: 5 5 FT,
(Use'+.11 Above Top d Casing)
d. TOP OF CASING IS 1 FT. Above Land Surface'
'Top of casing terminated et/or below lend surface mw require
a variance In accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): / METHOD OF TEST Air.
r. DISINFECTION: Type chlorine Amount l rttd
g. WATER ZONES (depth): I
From To From To
From To From To
From To Ran To
6. CASING: • From 0 Depth',
in
n Ft 6t
Diameter
From t To F
o
From To Ft
7. GROUT: Depth Material
From2 _To 20 a Sackrete
From To Ft.
Fran . To Ft
Thlcknessl
Weight Material
SDf21 'PVC
IL SCREEN:
Fran
From
From
Depth
To
To
To
Diameter Slot Sim
Ft in.
Ft. In
Ft In.
Method
Hand
In.
in.
In.
Material
9. SANDIGRAVEL PACK: Depth Sim Manorial
From To______ FL
Fray To Ft
From To Ft.,
10. DRIWNG LOG
From To.
0' .rys
If Formation Descriptbn
lliY�( Saner 3YAJe1
76" .g/Ccttsolid *fed rck
a .
11. REMARKS:
100 HEREBY CERIIFYTHAT 11 S WELL WAS CONSTRUCTED N ACCORDANCE WITH
16A NCAC 2C, WELLCONSTRUCTIDN STANDARDS. *NOWT A COPY OF NIS
RECORD HAS
j9BEENPROVIDEDTOTHE WELL
E LOWNER.C/^MAPA &rL14 4t 1'2,91.191k
SIGNAE OF CERTIFIED WELL CONTITOR
DATE
James W. Cam
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
ity
mService Center - Raleigh, NC 2 699 1617 al
originaltothe Division of Water Phone No. (9 9) 733 7n.30 days. Attn: information Mgt.,
eat 68.
1 17Mall
Fonn GW1a
Rev. 7/05

RESIDENTIAL
RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 21 38
1. WELL CONTRACTOR:
James W. Camp
Well Contractor.(IndMduaq Name
Camp's Well & Pump Co. Inc_
Well Contractor Company Name
STREET ADDRESS P 0 BOX 429 Ellenboro NC 28040
City or Town State
( 828). 453-7322
Area code- Phone number
2. WELL INFORMATION:
SITE WELL ID #(If applicable)
STATE WELL PERMIT#(a applicable)
DWQ or OTHER PERMIT #(6 applicable)
WELL USE (Check Applicable Box): Residential Water Supply (per
DATE DRILLED ,"J '1—C�
TIME COMPLETED ; 4S AMP PM pa/
3. WELL L TIID-:
CITY: U- Y`et'to(Q h)YL COUNTY
✓Ai0>1 Rc.-veKJ liet)
Zip Code
(Street Name, Numbers. Community, SubdMsion, LotNo., Parcel;2'Ip Code)
TOPOGRAPHIC / LAND SETTING:
in slope t%aUey (3Fet ❑Ridge ❑Other
(check eppropdatebmq May be in domes.
LATITUDE J S AD • T i J minutes, seconds or
LONGITUDE .1 1: fJ I y27,9 in a decimal font
Latitude/longitude source: GPS oTopogaphic map
Oration of wel must be shown on a USGS topo map and
attached to this form I not ushg GPS)
O.wSt"An LrAl 11
OWNER'S
NER'S NAA ME
ST ET ADDRESS p .gox 6-.g
iffker-cordac Ni C. c ')3el
City or Town State Zip Code
(__t•
Area code - Phone number
5. WELL DETAILS: a. TOTAL DEPTH: 4!n�
v t,
b. DOES WELL REPLACE EXISTING WELL? YES CI NOX
c. WATER LEVEL Below Top of Casing: 56FT,
(Use '+' 1 Above Top of Casing)
d. TOP OF CASING 1S 1 FT. Above Land Surface*
'Top or casing terminated etror below land surface may require
a variance In accordance with 15A NCAC 2C .0118.
e. YIELD (Bpm): (1� METHOD OF TEST LA if
t. DISINFECTION: Type chlorine Amount _JA/7'S
g. WATER ZONES (depth): 1'
Fran To
From To
From To
6. CASING: Depth
e L) Ft
From 0 �To /
From To Ft
From To .Ft.
From To
From To
From To
Thickness/
D)ameter SDR21 PVC
7. GROUT: Depth Material Method
From 0 To 20 Ft Sackrete Hand
From To FL
Fran To FL
S. SCREEN: Depth Diameter . Slot Size .Materiel
From To Ft in. In.
From. To Ft. In. In.
From To Ft. In. In.
9. SAND/GRAVEL PACK:
Depth Size Malarial
From Tq Ft
From To Ft.
From To Ft
10. DRIWNG LOG
From To.
0•
Ai,
11. REMARKS:
Formation Description
SAKI) flirt
✓.oNSoliflfate d ✓o4C
0
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WIN
15A NCAC 2C. WELL CONSTRUCTION STANDARDS, At1DTHATACOPY QFTHI$ •
RECORD HAS BEEN PROVIDED TOTHE WELL OWNER.
��p ✓�L
f`J`Io1'
SIGUREOFCERTIFlEDWELLtNTRA TOR DATE
ames W. Camp
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within30. days. Attn: Information Mgt,
1617 Mall Service Center- Raleigh, NC 27699.1617 Phone No. [phone] ext 568.
Form GW-la
Rev. 7/05

CityerTam ' State
( 828). 453-7322
Area code. Phone number
2. WELL INFORMATION:
SITE WELL ID air applicable)
STATE WELL PERMITINVappliable)
DWO or OTHER PERMIT I(8 applicable)
WELL USE(Check Applicable�By�_: Residential Water Supply
DATE DRILLED _'r /`t -0�
TIME COMPLETED 422,D AM ❑ PM6/
2. WELL LOCATION: y+�/_ -{/-�
CITY: .I F)}US I�/ jL - coukTy?Lf / I e rt rid
104 /T utkc11f I YAII Moult Code
(Stre$Noma NuabeA unty. SubdM4oa.LM Na. P )
T OGRAPHIC/ LAND SETTING:
Slpe OValey OFlet ORidge ❑Otter
Ohm* eppropdatabmj
LATITUDE _a_n caq. D 3
LONGITUDE. ,- 41. 73
Latitude/longitude source: GPS °Topographic map
(bcaton smell must be shown on a USGS topo map and
atmehad to this town not using GPS)
RESIDENTIAL WELL CONSTRUCTION' RECORD
North Carolina Department of Environment and Natant Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION a 21 3 8
1. WELL CONTRACTOR:
James W. Camp
W el Conaacta.pndividual) Name
Camp's Well & PumD
Well Contractor Company Name
STREET ADDRESS P 0 Bo,
Co. Inc
429
Ellenboro NC 204Ow.
May ba in depxs;
minutia, seconds or
in s decimal lancet
4. WELL OWNER
OWNER'S NAME �/J JA A.
STREET ADDRESS IVt 8'
D Tqs Me Iv c
og
Zip Cede
nee code
• Phone number
6. WELL DETAILS: 44 5--
a. TOTAL DEPTH:
b. DOES WELL REPLACE EXISTING WELL? YES NO al
c. WATER LEVEL Below Top el Casing: SOP Ft
(Use '+'.I Above Top Of Casing)
d. TOP OF CASING IS 1 . — ET. Abas Lend Surface•
*Top d asl g terminated at/a below land suttees may require
a variance In accadance YAM 15A NCAC 20 .0118.,
e. YIELD (gpm):_i__METHOD OFTEST Ai
1. DISINFECTION:Typa Chlorine Amount .2 tutu
g WATER ZONES (depth): I/
Fran To From To
From__ To From To
Ran To - From _ To
6. CASING: Thickness;
]ynsler
Frcm 0 Tom I0 Ft. bt SDR21 PVC
From To Ft _
From__To .Ft.
7. GROUT: Depth Material Method
Fran 0 To 20 Ft Sackrete Hand
Front______ To R.
From_____ To Ft
S. SCREEN: Depth
Fran__ To
From__ To
Fmk__ To
Diameter Slut Size .Material
in In. In.
Ft. In. In.
Ft In. In.
e. SAND/GRAVEL PACK:
Depth Size Matedd
Free„ .,To Ft.
From _To Ft.
From _ _ To Ft._,__,_
10. DRILLING LOG
From To
0' ^10
J Farallon Deacdpton
dor ttt4
'
9t . 5-45" ('o115n I; date yec k
r;
11. REMARICS:
MOMENT/ CERTIFY TIUTT IS WELL WAS CDNSTRUCIEDNAccORDANCEYAnf
1M NCAC2C. WELL CONS RUCT:7N STANDARDS. NIVHATit COPY171111.1
moats HAS SEEN PROVIDEDToTHE WELLOWNER
FC�GOrnHA
SI TUare OFCERTIFl WELL 'CONT CTOR BATE
James W. Camp
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
1617Submit the original to the Division of VVater Ma Service Center hEQuality Rale , NC gg-18117PhPhone No. (9 91733 9 6 ex! 6S.tton Mgt.,1
Form GW-la
Rev. 7/05

RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION R 21 38
1. WELL CONTRACTOR:
James W. Camp
Well Contractor.(Indhdtual) Name
Camp's Well & PumO Co. Tnc
Well Contractor Company Name
STREET ADDRESS P 0 BOX 429
Ellenboro NC 28040
City or Town State Zip ode
( 828). 453-7322
Area code- Phone number
2. WELL INFORMATION:
SITE WELL ID Alf appncable)
STATE WELL PERMIT/USappfcable)
DWQ or OTHER PERMIT tt(If applicable)
WELL USE (Check Applicable Box): Residential Water Supply
DATEDRILLED 2%--r�
TIME COMPLETED a: iS AMP PM(0J
3. WELL L ATION:
CITY: a..Ke Lan —
COUNTY Ru_tke4 rll
Lattice 1 Lakes
(Stroat Name, Numbers. Community. Subddsion _Lot No.. Parcel;. Zip Code)
TOPOGRAPHIC / LAND SETTING:
CI Slope °Valley OFlet ❑Ridge ❑Other
(cheer appropriate bed
LATITUDE � �' 5-11 N
Latitude/longitude source: GPS °Topographic map
LONGITUDE g ;Le e ge6 03 it)
(bcatbn of wet must be shown on a USGS topo map and
attached to this form Inot ushg GPS)
4.WELLOWNER D
OWNER'S NAME ire ntIer 5
STREET ADDRES D 5KW( ,, ��
Lit
City or Tam State
May be in dgree,
minutes, meads or
in a dedmal format
Area code - Phone number
Zip Code
5. WELL DETAILS:
a. TOTAL DEPTH:
b. DOES WELL REPLACE -EXISTING WELL? YES (7 NOA
c. WATER LEVEL BeloW Top of Casing: 53- FT.
(Use '+-.IfAbove Top of Casing)
d. TOP OF CASING IS 1 • FT. Above Land Surface'
'Top of casing terminated at/or belay land surface may require
a variance In accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): CO METHOD OF TEST Gi.) r
t. DISINFECTION: Type chlorine Amount 1 74 GNUS
g. WATER ZONES e epf):
From To U
From To
From To
From To
From To
From To
��
Fran To"'31 Diameter
Ft 6#
From To Ft.
From To Ft
6. CASING:
Thickness/
SDR21 PVC
7. GROUT: Depth Material Method
Fran 0 To 20 Ft Sackrete Hand
Frad To Ft
Fram_a_To Ft
e. SCREEN: Depth Diameter Slot Size .Material
From_ To Ft In. h.
From To Ft. In. h.
From_ To FL In. ki.
9. SAND/GRAVEL PACK:
Depth Size Material
FromTq Ft
From To Ft
Fran_,_To Ft.
10. DRILLING LOG
From To.
..0• 31
Formation Description
(lift saved
31 .365 renso))datea rock
11. REMARKS:
fV
O
ion
^e.
I DOFERRY CUM THAT THIS WELL WAS CONSTRUCTED N ACCORDANCE WIN
15A NCAC 2C, WELL CONSTRUCTION STANDARDS, AND MAT ACOPT OF TWS .
RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
1.
f7A OF CERTIFIED 'WELL CONTRACTOR DATEDATE G
James W. Camp
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within30. days. Attn: Information Mgt,
1617 Mall Service Center - Raleigh, NC 27699-1617 Phone No. [phone] eat 568.
Form GW-la
Rev. 7/05

RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Depenmalt of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION 9 a 1 I S
1. WELL CONTRACTOR:
Jtarops (3eody
Wen Contactor (Individual) Name
(VI,d-Snu.M- wets Cot -newly Irc-
Wel Codee,.4. Company Name
STREET ADDRESS$5c1 5k O m nc, YYV. it ano2
DI n NC OS640
City or Town State Zp Code
('704r 53c 55 (5
Area cola Phone mamba
2. WELL INFORMATIOtt
SITE WELL ID 0(tapptlraUe)
STATE WELL PERMIT#-Ppawme)
DWQ or OTHER PERMIT Nit applicable)
WELL USE (Check Appica/ble Bag: Residential Wales Supply EIV
DATE DRILLED / 2 —,C ® —of)
TIME COMPLETED 2 %z° AM ❑ "PM$-'
3. WELL LOCATION: /7 1�
CRT: COUNTY u'MMI.+a'Cava.
(street Numbers. A A aY. Sbebeciin. Lot No, Parent. Zip Code)
TOPOGRAPHIC / LAND SETTING_
OSlope OValeyPAK ❑Ridge OOter
(check appropriate box)
LATITUDE
LONGITUDE
I May be in degas,
minutes, sends or
I
in a decimal format
Latitude/longitude source: DOPS °Topographic map
(bcafbn ofwelmust be shown on a USGS typo map and
attached to this loan Pilot using GPS)
4. WELL OWNER
Vs'
OWNER'S NAME e �c wT Tin
ADDRESS R-Cold—Cold- T v L� (Zd
City or Towo State
f L
Area code - Phone number
S WELL DETAILS: r —
a TOTAL DEPTH: 0145
rip Code
b. DOES WELL REPLACE EXISTING WELL? YES p
NO—
c. WATER LEVEL Below Tap of Casing: FT.
(Use -+' tAbate Top of Casing)
d. TOP OF CASING FT. Above Lad Surface'
?op of casFFrg aIa belay hid surface may respire
a variance In accordance with 15A NCAC 2C .0118. /
e. YIELD (gpm): .3 METHOD OF TEST Bur{ t
1. DISINFECTION: TypeC3 44 D/ctrlPmoult i te-i 72
g. WATER ZONES (depth):
From To From To
Fran To From To
Fran To From To
6. CASING: a 9� Thicbressl
From 0 DTpoth-1� d in. 4hi�"k %V C.
From To Ft
From To FL
7. GROUT: Depth Material �-m M�a i Method
Fran 0 Toot,(/ Ft tirt—
Franrom To FL
From To Ft.
8. SCREEN: Depth Diameter Slot Size Material
Fran To Ft in. in.
Fran To FL in. in.
From To Ft. in. in.
9. SAIB)IGRAVEL PACK
Depth Size Material
Fran To Ft
From To Ft.
From To Ft
10. DRIWNG LOG
From To FormationDescription
/
ocK
u) - /TY
11. REMARKS:
100 NAY CERTIFY -MATINS WELL WAS CONSTRUMED N ACCORDANCE 1M M
ISA IOC 2C. WELL CONS1RUGMON STANDARDS. AND THAT A COP/ OF Ire
RECORD HAS BEEN PROVIDED TO THE WELL OWNER.^��
'-r -e / 2 t 106-
RE OF CERTIFIED WELL CTOR DATE
C�meS (3s
ao.
PRINTED NAME OF PERSON R NG THE WELL
Submit the original to the Division of Water quality within 30 days. Ain: information Mgt.
1617 Wail Service Center— Raleigh, NC 27699-1617 Phone No. [phone] ext 568.
Form GW-la
Rev. 7I05

, ESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Deparbnent of Environment and Natural Resource- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 2138
1. WELL CONTRACTOR:
James W. Camp
Well Contractor.(IndMdual) Name
Camp's We11 & PumD Co. Inc
Well Contractor Company Name
STREET ADDRESS P 0 BOX 429
Ellenboro NC 28040
Zip Code
CltyorTawn State
828). 453-7322
Area code- Phone number
2. WELL INFORMATION:
SITE WELL ID Mir applicable)
STATE WELL PERMIT/RV applicable)
DWQ a OTHER PERMIT d(8 applicable)
WELL USE (Check Ap�liable Box): Residential Water Supply El
DATE DRILLED �v" -I -b1.
TIME COMPLETED R ; 30 AMO nub'
3. WELL LO jCATIOM ,(/,^
CITY: !�-�•�l�F y e cou tvvs titer lul .
GA1dern J-a.yle
(Stein Name. Nunbeea. Canunundy, Subdivision, Lod No., Paroe ;21p Cods)
TOJOGRAPHIC / LAND SETTING:
Mope OVaiey OFiat ❑Ridge ❑Other
(caeca rppropdan be./ ry
IATINDE .&L 24,'yy /„7 iv
LONGITUDE] %2-•' `it U)
Latitude/longitudesource: OGPS OTopographicmap
(locetbn of wet must be shown on a USGS topo map and
attached to this form I not ushg GPS)
May be In degree,
minutes, mama a
in a decimal %rmat
4. WELL OWNER
OWNER'S NAME 1 /(
STREETADDRESS
4Krt.:
City a Town
Area coda - Phone number
MINS 5`ktrlctkbt(yil
rwt� t ELL
n 445)9
State Zip Cede
5. WELL DETAILS: J� —
a. TOTAL DEPTH: •-7 75
b. DOES WELL REPLACE EXISTING WELL? YES
YES (7 NOX
GE
c. WATER LEVEL Below Top of Casing:
(Use's' 8 Above Top of Casing)
d. TOP OF CASING 1S 1 FT. Above Land Surface*
'Tap of easing terminated et/or beloiv land surface may require
a valance In accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): :2° METHOD OF TEST G1) r
t. DISINFECTION: Type chlorine Amount /,M tulle
g. WATER ZONES (depth):
From To 50 o From
From To From
From To From To
To
To
6. CASING: 1
From 0 DTo�/ 90 Ft.
From To Ft.
From To Ft
Der"
Thickness/
SDR21 PVC
7. GROUT: Depth Material Method
Fran 0 To 20 Ft Sackrete Hand
Fron_ To FL
From To Ft
8. SCREEN: Depth
From To
From To
Diameter . Skit Size .Material
Ft In. bn.
Ft. In. In.
From To FL in. In.
9. SANDIORAVEL PACK:
Depth
From
From
To Ft.
_To Ft
From To Ft
Size Material
10. DRILLING LOG
Rom To Fottmabn D Bon
. o • 13o Clay ianiDri'
S[o .345 Li:')1f2c/lc&ttei y2cK
11. REMARKS
I DO HEREBY CERTIFY
tea NCAC 2C, WELL CONSTRUCTDN STANDARDS. ANDTHATACOPY OF. THI$ •
RECORD-WS BEEN PRODDED TO THE WELL OWNER.
» (6L*ry1
SIGNATURE OF CERTIFIED WELL'CONIVRACTOR DATE
James W. Camp
r,)
CO
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality wlthin.30.days. Attn: Information Mgt., .
1617 Mall Service Center -Raleigh, NC 27699.1617 Phone No. (919)_733.7016 ext 568. .
Form GW-la
Rev. 7/g5
V
sl
I
7A
tt
3D
or
i,N

v
RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # )3 S
1. WELL. CONTRACTOR:
Tmes Ii• Cctkry
Well Contractor
» (Individ1ual) Name
n 1 n
WeIlC&C e Nate 1't I`v(,4 lO �YtC.,
STREET ADDRESS P D Po A 419
LE 11 efr ©t0 N c 2so40
City or Town State
Zip Code
(g )- 453-7327
Area code- Phone number
2. WELL INFORMATION:
SITE WELL ID #(if applicable)
STATE WELL PERMIT#('d applicable)
DWQ or OTHER PERMIT #(e applicable)
WELL USE (Check ApplicableBox): `Residential Water Supply ID
DATE DRILLED eg— !
/ -Dip
TIME COMPLETED. - AM ❑ PM V
3. WELL LOCATION: �(J
CITY: 461:ke•• Lan e_ COUNTY %V41}-1te1Z' re]
(Str 3Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SE G:
°Slope °Valley ❑Flat idge ❑Other
(check appropriate box)
LATITUDE _. eJ • 0 & )
LONGITUDE g &° G9.gozw
Latitude/longitude source: BiGPS ❑Topographic map
(bcation of wet must be shown on a USGS topo map and
attached to this form tnot using GPS)
May be in degrees,
minutes, seconds or
in a decimal format
'Jer6e &A
4. WELL OWNER
OWNER'S NAME
t_-oVJ }{ • Greene
STREET ADDRESS `74 9 a `'
6 i tovy C4 14
Mill Ge f ivv& N C £L 75�v
City or Town State Zip Cale
Area code - Phone number
5. WELL DETAILS: �S /
a. TOTAL DEPTH: S
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO IJt
c. WATER LEVEL. Below Top of Casing: (07 FT..
(Use'+• 0 Above Top of Casing)
d. TOP OF CASING 1S I FT. Above Land Surface
'Top of casing terminated al/or below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): 1 METHOD OF TEST it r
f. DISINFECTION: Type c h) e Yn N e Amount / IX cop
g. WATER ZONES (depth):
From To ei 17 From
Fran To From
From To From
6. CASING:
Depth Diameter
From D To 40 Ft. /, rk
From To Ft.
From To Ft.
To
To
To
Thickness)Weit t� gn
6DR11 1'
C
7. GROUT: Depth Material .{-
From D To 20 FL cetC k're (e
From To Ft
From To Ft.
Method
8. SCREEN: Depth Diameter Slot Size
From To Ft. in. In.
From To Ft. in. in.
From To Ft. in. in.
9. SAND/GRAVEL PACK:
Depth
From To Ft.
From To Ft.
Material
Size Material
From To Ft.
10. DRILLING LOG
From To
/9 05
�0S 0485
Formation Description
50Ladr Cla1
i'onso I; date d
rcc K
7J
0
11. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL NMS CONSTRUCTED N ACCORDANCE WITH
ISA NCAC 2C, WELL CONSTRUCTION STANDARDS, AND THATA COPY OF THIS
RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
F CERTIFIED WELL C NTRACTOR A TEa I URE O
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. 7/05

North Carolina Department of Environment and Natural Resources -Division of Water Quality -Groundwater Section E' -. ,,.1
6
1636 Mall Service Center - Raleigh,N.C. 27699-1636-Phone [phone] ^
WELL CONSTRUCTION RECORD WELL CONTRACTOR: , 5'7-S ✓a Kin i tiN / N S-
WELL CONTRACTOR CERTIFICATION # : 3,261 Cie
STATE WELL CONSTRUCTION PERMIT # :
�pI al Munici n Industrial ❑ Agricultural ❑ Monitoring Li.NFI ',. USE (Check ADDlicable Box): Residential P
Recovery n Heat Pump Water Injection in Other ❑ If Other, List Use:
Ft I t OCAT ION (S ow sketch of the location belowi 7, �,r o it i. i_arit'N
Neamst town
(So5T'G county 1
L :i zi
�d Name an Nu �' DRILLING LOG DEPTH
rRoad Name and Numbers, Community, or Subdivision and Lot No) From To Formation Description
3. OWNER /Y1t C S/�I/rA
Address 7 3 % ree ATClV P d
or oue o. ..��
/3°ST.C. NL" ' Zip Ci
City or Town State
4 DATE DRILLED 7-3Code
0
TOTAL DEPTH J 'Q
TTINGS COLLECTED YES ❑ NOIN
(� NO
STATIC WATER LEVEL Below Top of Casing: '�/ FT.
^AGES WELL REPLACE EXISTING WELL? YES
(Use "✓' if above Top of Casing)
9 FOP OF CASING IS FT. Above Land Surface'
''op ;,t casing terminated at/or below land surface requires a variance in accor-
'ianr_e with 'SA NCAC 29 011819 ��{.1:
+FIL ;� (GPM): /Or METHOD OF TEST /?
19 t. WATFR 7ONES (depth)
12 CHLORINATION'. Type
(`/TH Amount / P b If additional space is needed use back of form
Wall Thickness
13. CASING: Depth Diameter or � n5 Weight/Ft Material , LOCATION SKETCH
�rnm to z 1.--�— -- (Show direction and distance from at least two State
I rnm To rt Roads, or other map reference points)
,-.nrr 10 =t.
14 GROUT
Depth Material Method
%
rrnrr To Ft
GCR To Ft
1„
15 SCREEN
Depth Diameter Slot_Size Material Ca,
L ',Inn To Ft in In at i
a r ,nm To Ft in in.
rFt �nm To in In
�� pi ;i LLnU'
IF SANDtGRAVELPACK:
Depth Size Material
c.,m To Ft
From To Ft
17. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS. AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
8-3 --o C.
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit original to Division of Water Quality, Groundwater Section within 30 dayysW 1 REV 12/99
FOR OFFICE USE ONLY
Quad No.1
Serial No

From: Scott Gantt 7044347212 To: Stephenie Wilson Date: 10/18/2006 Time. 9.57.08 PM
Page 2 of 4
333843
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)
1. WELL USE (Check Applicable Box) : Residential ❑
Recovery ❑ Heat Pump Water Injection ❑
2. WELL LOCATION:
Nearest town: RUTHERFORDTON County
HOLE # 4 CLEGHORN GOLF PLANTATION, CORE RD
RUITHERFORD
(Street Name, Numbers, Community, Subdivision, Lot No,. Zip Code)
3. OWNER CLEGHORN GOLF PLANTATION
ADDRESS 316 COXE RD
(Street or Route No.)
RUTHERFORDTON
City or Town
828-287-4949
NC
State
Area Code - Phone Number
4. DATE DRILLED 9/11/06
5. TOTAL DEPTH 240
6. DOES WELL REPLACE EXISTING WELL?
7. STATIC WA tdc LEVEL Below Top of Casing:
(Use v" If Above Top of Casing)
8. TOP OF CASING IS 2 FT. Above Land Surface'
'Top of easing terminated atior below and surface requires a variance in
accordance with 15A NCAC 2C.0118
28139
Zip Code
YES ❑ NO 0
52 FT.
9. YIELD (gpm): 2 METHOD OF TEST ARDM
to. WATER ZONES (depth): 125
ti. DISINFECTION: TYPE HYPOCHLORITE Amount
12. CASING:
Depth
From 0 To 72
13. GROUT:
Depth
From 0 To 20 FL
t4. SCREEN
Depth Diameter
From NA To Ft.
15. SAND/GRAVEL PACK:
Depth Size
From NA To Ft,
Diameter
FL 61/4"
(if applicable)
Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Other © If Other, List Use: WELL FOR REST ROOMS
Topographic/Land setting
❑ Ridge ❑ Slope ❑ Valley © Flat
Latitude/Longitude of well location
35.18.563 / 81.58.432
(degrees/minuteaiseconds)
Latitude/loneitude source: ❑ GPS ❑ Topographic map
DEPTH DRILLING LOG
From To Formation Description
0 65 Clay
65 240 Consolidated Rock
10
Wall Thickness
or Weight/FL Material
SDR 21 PVC
Oz
16. REMARKS:
Material Method
GRAVEL MIX GRAVITY
ut
Slot Size Material
Material
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
DIV. ORE
F Wq IR QD
TER
OCT 19 2000
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15 A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
10'1/06
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
NOV 0
Ll,

RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 2138
1. WELL CONTRACTOR:
James W. Camn
Well Contractar.(IndMdual) Name
Camp's Well & Pump Co. Tnc
Well Contractor Company Name
STREET ADDRESS P 0 BOX 429
Ellenboro NC 28040
City or Town State Zip Code
(828} 453-7322
Area code- Phone number
2. WELL INFORMATION:
SITE WELL ID #9f applicable)
STATE WELL PERMIT#Orapplicable)
DWQ or OTHER PERMR Cif applicable)
WELL USE (Check Applicable Box): Residential Water Supply 0
DATE DRILLED ./(1 I " d 4.
TIME COMPLETED 5 : 30 AMID PM V
S. WELL. LOCATION: b.
Ir
CITY: [305) 1 C.-COUNTY gN�e r7E Y�
,uwlln;/ 1.01-39
(Street Name, Numbers, Community. SubdMNsion, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETJING:
❑slope OValley OFlat IgRldge ['Other
(check appropriate box)
LATITUDE _LE. AR 6 rl
LONGITUDE, I
Latitude/longitude source: PS oTopogaphic map
(location or wee must be shown on a USGS topo map and
attached to this form not ushg GPS)
May be in degrees,
minutes, seconds or
in a decimal format
4. W OWNERLL �kIO
OWNNER'SER'SNAME !e 5 ;Cie Lt t e ✓S
STREET ADDRESS P 0Rio 6-4
l-elke lute NC 2 244
City or Town State Zip Code
Area code- Phone number
6. WELL DETAILS: a. TOTAL DEPTH: [ /� D 5
b. DOES WELL REPLACE EXISTING WELL? YES p NoX
c. WATER LEVEL Below Top c( Casing: FT,
(Use *9 8 Above Top c( Casing)
d. TOP OF CASING IS 1 FT. Above Land Surface*
'Top et casing terminated at/or below land surface may require
a variance In accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): 7 METHOD OF TEST a .)
33 258
L DISINFECTION: Type chlorine Amount,ay,7 cud
g. WATER ZONES (depth): / _
From To From To
From To From To
From To From To
6. CASING:
Depth Diameter
From 0 To s Ft 6a
From To Ft.
From To .Ft.
Thiclmesa/
Weight
PC
7. GROUT: Depth Material Method
From 0 To 20 Ft. Sackrete Hand
From To Ft.
From . To Ft
8. SCREEN: Depth Diameter Slot Size .Material
From__ To FL in. in.
From To Ft. in. In.
From To Ft. In. In.
9. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
From To Ft.
10. DRILLING LOG
From .To
0• 35
/705
11. REMARKS:
Formation Description
COY15c 1i 4r to Yc r.:C
1 DO HEREBY CERTIFY THAT TNIS WELL WAS CONSTRUCTED N ACCORDANCE WDN
ISA NCAC 2C, WELL CONSTRUCTION STANDARDS, AND THAT ACOPY OE THIS •
RECD HAS BEEN PROVIDED TO THE WE LOWNER
•
4417LC-4- lit) . l d -3o ,e6
SIG,N/ATURE OF CERTIFIED W ELLCOtyl'RACTOR DATE
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.,
1617 Mall Service Center- Raleigh, NC 27699.1617 Phone No. [phone] ext 568.
Form GW-la
Rev. 7/05

RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 2138.
T. DISINFECTION: Type Ch1Orin@ Amount / 914
g. WATER ZONES (depth):
To From To
To From Tom.
To From To
Thlelmeas/
SDR21
1. WELL CONTRACTOR:
James W. Camp
Wes Contractor(Individual) Name
Camp's Well & EUMD
Well Contractor Company Name
STREET ADDRESS P 0 Bo €
Ellenboro NC
City orTomt ' State
(828- 453-7322
Area code- Phone number
2. WELL INFORMATION:
RITE WELL ID apt applicable)
STATE WELL PERMITS(eapplicable)
DWG or OTHER PERMIT #(0 applicable)
WELL USE (Check A3pStable Ban): Residential Water Supply
DATE DRILLED (jug
TIME COMPLETED 5 00
3. WELL TION:` � '(\ , ^ T
CITY:. IIAA COUNTY j•➢.l-1
Co._Tnc-
429
28040
ZIP Code
(Seat Name, Numbers. C�mueib. SubdMsion, Lot No., Parcel. Bp Code)
TOPOGRAPHIC / LAND SETTING:
❑slope Malay OFlat HhswTI!ge ❑otter
(chart epwopdaltb0s)
_16 • �.�\>\69
LONGITUDE 1W__ \ 0 • 93 S
Lafhdelongiude source: tp6PS OTopographie map
to achGS logo map end
attached this lam l not GPS)
4.WELLOWNER (I�� art
OWNER'S NAME h)9.A-A9m, C(X.%k/rt Ybill f' 9
� me5t i�
STREET ADDRESS .�3D S�yviyile.Y in
Mil ( C1 J 1 State 8 1 ��code
City a Town J
Area cde• Phone numbs
5. WELL DETAILS: f1
a. TOTAL DEPTH: \` 3, S ..
b. DOES WELL REPLACE EXISTING WELL? YES 0 NO Li
e. WATER LEVEL Bei=Top of Casing: (DU FT,
(Use '+'_I Above Top d Casing)
d. TOP OF CASING IS 1 . FT. Above Land Surface*
'kg e( casing terminated at/or below land surface m1y tequila
a variance hit accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): _1.— METHOD OF TEST (11✓L-A
LATITUDE
AM PM
May be in degrees,
minutes, woods or
in a decimal format
331255
From
Frain.
From
6. CASING:Depth I
From _g_. To %1/ _trig 0
From To Ft
From To FL
7. GROUT: Depth
Fiona_ To 20
From To
From,To
8. SCREEN: Depth
From To
From To
From To
terial
PVC_
Materiel Method
FL Sackrete Hand
FL
FL
Diameter Slot Size .Material
FL__In. In.
Ft In. In.
Ft In. In.
9. SANDIGRAVEL PACK: Depth Size Material
Front To_ Ft.
From To FL
From To Ft.
10F DRILLING LOG otmatI Descdpgon
0 S�lp 6n 1UMAY
St y14
11. REMARICS:
Re -Jeri. Ot) MA 11
NUd `S a LO
I DO HEREBY CERIWYTNATTNIS WELL WAS WNSIRUCTEO NAccORDANCE WtM
CORD HAS BEEN PR E)TOTWELL NHE STANAND DARDS,
!HATA COPY DE THIS •
_II k�w�)\ rL——o‘b
51 JF E OF CERTIFIED WELL'cONTRACTOR BATE
James W. Camp
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the
original to the Division of Water
Center — Raleigh, NC 2 699. 6117 Quality
within Ph neNo. (9 9) 733-70 5 eat 568 Son Mgt.,
1617 Mall Service
Form GW1a
Rev. 7I05

,RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION N 21 38
1. WELL CONTRACTOR:
James W. Cam
Wee Cantractar.(IndMdual) Flame
Camp's Well & Pump Co, flit- .
Well Contractor canpany Name
STREET ADDRESS P 0 BOX 429
Ellenboro NC 2§040
city orTa/m ' State ZIP code
(82(3} 453-7322
Area code- Phone number
2. WELL INFORMATION:
SITE WELL ID *Or applicable) '
STATE WELL PERMITI Oapplicable)
DWQ or OTHER PERMIT WS aPplloable)
WELL USE (Check�A9IIlleajble Sao4: Rest Medial Water Supply ❑
DATE DRILLED TIME COMPLETED I I 30 0 AM II PM O
1. WELL LOCATION:
CITY:
`y� COUNTY•A X/IlD4,I
�15D' Maxi e_ l�/I�1211101/4-. Dr.
(Sheet Name. Nsnbare..Community. SubdMslon, L.ot No., PareeLZIP Code)
TOPOGRAPHIC / LAND SETTING:
chsriope OVa➢ey, Ong Ridge ❑Omer
onatabten
IATTTUDE .,1,i6' a 0ck
LONGITUDE SI _ 6o t4 \
Latitude/longitude source: SIPS OTopographic map
poaatbn alma must be shown on a USGS topo map and
attached to this lam Inot using GPS)
4. WELL OWNER
OWNER'S NAME
STREET ADDRESS
City orTown Zip Code
keacode . Phone number
6. WELL DETAILS: s
a. TOTAL DEPfH:
b. DOES WELL REPLACE EXISTING WELL?
c. WATER LEVEL Below 7op d Casing �i 0 FT.
Now 8 Above Top d Casing)
d. TOP OF CASING IS 1 FT. Above Lend Suds*
'Top d easing terminated eUa below land surfs= mpy require
a variance In meeadanoe with 15A NCAG 2C .0118.
IMay be to degrees.
mbstes, seconds or
in a decimal format
YESV NO D
e. YIELD (gpm)I_Sit.--METHOD OFTEST (tAJ^
334254
L OISINFECTION:Typechlorine Amount 1 cue
e. WATER ZONES (depth):
From To
From To From To
From_ To From To
6. CASINO: Thickness/
pIanneter Weight Malarial•F� p To So So Ft, b# SDR21 'PVC
Fran_ To FL
Fran To
7. GROUT: Depth Material
Fran 0 To 20 FL Sackrete
Ran To Ft.
Frain To FL
S. SCREEN: Depth Diameter Slut Size .Materiel
From To Ft. In.
From To Ft. in _ In.
From�_To Ft. _IR In.
9. SANDIGRAVEL PACK: Depth Sim Matedd
Frait._..__,To_ FL
From To FL
Fmm - To Ft
From To
method
Hand
10. DRILLING LOG p�FFo�gDe.p�Qn
F0• c.CB, /YLtO
S.,1L% (cute.
c•r�iCP
O•
o� 9, L00%
11. REMARKS:
I Do MEIN CERTVYTWINS WELL
WAS
0OHTRUCTETA SE
IMNCAC 2G, WELL CONSTRUCTION .
ANDRECORD HAS BEEN PRWIDEOTOTHEWELL OWNER
p o-06
.._.►tom..
SIGMA OF CERTIFlED WELL'CO PACTOR DATE
James W. Cam
RINTED NAME OF PERSON CONSTRUCT I G THE WELL
n;30. clays. Attn:
11 17mMai SBrvloriginal
e Center- Raleigh, NC 2 6991617 a• )IP Wit
No. (9 9 733 4015 ext 68.0 . Mgt.,
Form GW-la
Rev. 7/05

CltyorTOAn State
(828)- 453-7322
Area code- Phone number
2. WELL INFORMATION:
SITE WELL ID alit applicable) •
RESIDENTIAL WELLCONSTRUCTIONRECORD 3 3
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 21 38
1. WELL CONTRACTOR:
James W. Caron
Well Qonuacta.(Indivlduaq Name
Camp's Well & Pumn Co. Inc
Well Contractor gompanY Name
STREET ADDRESS P 0 BOX 429
Ellenboro NC 28040
Zip bode
STATE WELL PERMIT#N appkabla1
DWQ or OTHER PERMIT #(t epplkablel
WELL USE (Check Applicable Box '
): Residential Water Supply
DATE DRILLED `C .. II ,"J�•
TIME COMPLETED a-' `f AMO PM CI
7. WELL 1(pC TION: InU.C_E-'�-
CITY: \A� rCOU
s'AAA s5
(Street Name. Numbers. eanmunity, SubdMs _,Lot No., Parcel', Zip Cods)
TOPOGRAPHIC I LAND SETTING:
❑Slope Malley MFG ()Ridge ❑Otter
(ehsck aDPrDPriabilx.00 LATITUDE .. S 4463
LONGITUDE (R its - 0 D- °2 1M
Latitudeftongitude source: S ()Topographic map
Markin
to fhb form Ynotshown
sing GPS)GS topo map and
OWNER'S NAME 1C"`A'-ll• ii W'"—Y P KID
INA-
STRTR EETT ADDRESS � �'leaY0.fie Y
KMi%er4 r div N c Z£s'139
City or Town State Zip Code
Area code Phone number
IMay be In degrees, i
minutes, seconds or
in ■ decimal tomcat
5. WELL DETAILS:
a. TOTAL DEPTH: ��
b. DOES WELL REPLACE EXISTING WELL? YES p NO*
c. WATER LEVEL Below Top of Casing: 6o . . FT.
(Use '*'t Abate Top of Casing)
d. TOP OF CASING IS 1 FT. Above Land Surface
'Top of easing terminated at/or below land surface may require
a vedance In accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): _Ea— METHOD OF TEST 0.-A-A
25.3
f. DISINFECTION: Type Ch 10r 7. ne Amount In r++d
g. WATER ZONES (depth): I
Fran To From To
From To From To_�
From To - From To
6. CASING:
Dept
From 0 To FL
From To Ft.
From To .Ft.
ThIcImesa/
67ameter. SDR21 PVCl
7. GROUT: Depth Material Method
FronL_To 20 Ft. Sackrete Hand
From To FL
From To FL
B. SCREEN: Depth .Material
From To
From To
-
Fran To
9. SANDIGRAVEL PACK: Depth Sim Maledat
From To Ft.
From To Ft
From To Ft.
10. DRILLING LOG
F om /T _ApiFo aZstriq
Diameter . slot Size
FL In N.
Ft. In. in.
FL__. In. _ In.
' 9 ark,
11. REMARKS:
•
acre. � 1F\--
I DO HEREBY ClR'NFYTNA,TTH1S WELL WAS CONSTRUCTED N ACCORDANCE Wmi
16A WAG
20, BEEN PROVIDED THE
TAN STANDARDS,
�TACOPT OF THIS •
A
W C"ry r P /6-30-06
SIG U OF CERTIFIED WELL CO CTOR DATE
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.,
1617 Mall Service Center— Raleigh, NC 27699-1617 ' Phone No. [phone] ext 568.
Form GWia
Rev. 7/05

RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION ti 21 3 8
•I. WELL CONTRACTOR:
James W. Camp
wed Cen raetor.(Irldhedual) Name
Camp's Well & .Pump
Well Contractor Company Name
STREET ADDRESS P 0 BOX
Ellenboro NC
chy orTown State
( 828} 453-7322
Area code- Phone number
2. WELL INFORMATION:
SITE WELL ID air applicable) •
STATE WELL PERMIT*/appdoable)
DWQ a OTHER PERMIT s(aeppdcable)
WELL USE 1Check Applicable Boo): Residential Water Supply IS
DATE DRILLED
TIME COMPLETED,
3. WELL LOCATION:
CITY: 17D5 i 0 COUNTY �N
o u)to
Co. Tnc.
429
2804o
zip Code
g4,
(Street e, Numbete,. unity. SubdMslon, I.ot No., Pare&
TOdOGRAPHIC /LAND SETTING:
ope OVadey [Ind ORIdge OOther
(chick MereP *Inch
LATITUDE ,a L .g . g 3 0
LONGRUDE,Q L
Latitude/longitude source: PS ❑Topographic map
docabn wel must be embed
(ashon a g GPS) GS tdPd map end
toads Imn 1 n
4. WELL OWNER (�
OWNER'S NAME Gpe. I l9• e Cc Corus
STREET ADDRESS 10 I3 o X 23
c_ olB
Zip Code
,Z30 AM CI PM1
her OY(.1
code)
IMay baindepea,
minutes, seconds or
in a decimal tercet
CIF/ a -room State
Area coda • Phone nu—
6. WELL DETAILS: /� D 5
a. TOTAL DEPTH: 1) .
b. DOES WELL REPLACE EXISTING WELL? YES 0 NO,*
c. WATER LEVEL Belo wTop d Casing: I S () FT,
(Use'? 8 Above Top d Casing)
d. TOP OF CASING IS 1 FT, Above Land Surface'
'Top of casing terminated et/or below land surface may require
a variance In accordance with 15A NCAC 2C .0118.
e. YIELD Wpm): I ---METHOD OFTEST a)
334252
_t DISINFECTION: Type chlorine Amount A c. u f 5
p, WATER ZONES (depth):
From To From To
From To From To
From To From - To
6. CASING: T Ictossai
From0 DTo .23 Ft. Dirt SDR21 ?PVC
Fran To FL
Fran To .Ft
7. GROUT: Depth . MaterW Mearod
Front) _To 20 Ft Sackrete Hand
Fran To Ft.
Fri To Fr
a. SCREEN: Depth Diameter • Slot Size .Material
Frog_ To Ft, In. __ In.
From To Et._,_In. In.
From To Ft. In. In.
9. SANDIGRAVEL PACK: SW MaterialDepth
Fran _:_To FL
Fran To Ft
From To Ft
to. DRILLING LOG From Fo
To. rmation Dasedp8on
,,�1)) �VtC, �t
S.ttM r
--r Fri (t,p..4A
11. REMARKS:
RttatIVti)
!i.104+.
I DO HEREBY CERTFYTHATTHIS WELL WAS CONSIRUCIED NACCORDANCE WITH
MCC 2C, EDLCONSTRUCTOR S STANDARDS. A
DLOWNN 'MAYACOPY PFTWS
RECORDING BEEN
IO p -0G
S • TURE OF CERTIFIED WELL CONTRACTOR BATE
ames W. Cam
RINTED NAME OF PERSON CONSTRUCTI G THE WELL
ity
ln,30. days.
16 7 Mall Service Centerinal to - Raleigh, NC 2 699. 0117 e DIvIsiOn of Water err PhonehNo. (9 9) 733 9Attn: ext 568.S . Mgt.,
Fam GW.1a
Rev. 7/05

RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICAT ON # 2571
334345
1. WELL CONTRACTOR:
Anthony Bryant Smith
Wed Cdnbactor (Individual) Name
Green River Well & Pump Company
Well Contractor Company Name
STREET ADDRESS PO Box 204
East Flat Rods, NC 28726
City or Torsi State
( 828 ). 693-1200
Area code- Phae number
2. WELL INFORMATION:
SITE WELL ID Ike epplinpe)
Zip Code
STATE WELL PERMITI(eapplicade)
DWQ or OTHER PERMIT I(if applicable)
WELL USE (Check Applicable Box): Residential Water Supply
DATE DRILLED / d " 6 O C
TIME COMPLETED // ' :go AM I2KPM ❑
3. WELL LOCATION: 1/
CITY: / &Ice. I( ye_ COUNTY ei i pler"rti
Sop ryl Tra c e.
(Street Name, Numbers, Community, Subdivision. Lot No.. Peril, Zip Code)
TOPOGRAPHIC / LAND SETTING:
mope OVakey ❑Flat ORidge ❑Other
(check appropriate box)
LATITUDE ,_3;° a$ 10 Zd
LONGITUDE CD f 01 L/r-7 SD
May be m degrees,
minutes, seconds a
in a decimal format
Latitude/longitudc source: ardPS ❑Topographic map
(bcaticn of wet must be shown on a USGS topo map and
attached to this loan not using GPS)
4. WELL OWNER
OWNER'S NAME 1% k e, c •
STREET ADDRESS ft.)(4 i r1,jDY/t,r2
La,L-e Lu r2 NC ZS'7'U
City or Twin State Zip Code
(Tat )- 62 -930
Area code - Phone rubber
6. WELL DETAILS: p
a. TOTAL DEPTH: pO J5
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO Er.--
b WATER LEVEL Below Tap c( Casing: 2 00 FT.
(Use'+• If Above Tap err Casing)
d. TOP OF CASING IS / FT. Above Land Surface*
'Top of casing terminated atior belay land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): 3 METHOD OF TEST r
1. DISINFECTION: Type 1 Amount
g. WATER ZONES (depth):
From .3 90 To 3 93 From To
From To From To
From To From To
8. CASING: Thickness/
Depth Diameter Weight Material
From / To 13.2 FL C t 2./. L /" /VL
From To Ft.
From To Ft.
7. GROUT: Depth Material Method
Fran 0 To it 0 Ft. 3447?.sir.`- A1;1racPnpc
Fran To FI.
From To Ft.
8. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ftin. in.
From To Ft. in. in.
8. SAND/GRAVEL PACK:
Depth
Fran
To Ft.
From To Ft.
From To Ft.
Size Matenal
10. DRILUNG LOG
From To
/r7 - /00
/0O —/x5
/ —S'OS
1I. REMARKS:
Formation agscription
Rn%Ci
REr.pa/c.n
©Iv.of;NI _c;i:
ALITy
_NOY_ e 8 2006
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 SEEN PROVIDEtYT4, THE WELL OWNER.
ID r'0(
SIGNATU E OF CERTI D WELL CONTRACTOR DATE
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water quality within 30 days. Attn: Information Mgt.,
1617 Mall Service Center- Raleigh, NC 27699-1617 Phone No. [phone] ext 668.
Form GW-1a
Rev. 7/05

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR: RODNEY ROBBINS
WELL CONTRACTOR CERTIFICATION #: 2785
STATE WELL CONSTRUCTION PERMIT #:
1. WELL USE (Check Applicable Box): ® Residential 0 Municipal ❑ Industrial ❑ Agricultural 0 Monitoring
0 Recovery ❑ Heat Pump Water Injection ❑ Other If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: LAKE LURE County: RUTH
BOULDER DR. -LOT #15 DRILLING LOG DEPTH
(Road Name and Numbers, Commtmity, or Subdivision and Lot No.) From To Formation Description
3. OWNER JEFF KING
Address BOULDER DR - LOT #15
(Street or Route No.)
LAKE LURE NC 28746
City or Town State Zip Code
4. DATE DRILLED 10/06/06
5. TOTAL DEPTH 305
6. CUTTING COLLECIID ❑ YES ® NO
7. DOES WELL REPLACE EXISTING WELL? 0 YES ® NO
8. STATIC WATER LEVEL Below Top of Casing: 80 FT.
(Use "+" if Above Top of Casing)
9. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or--below land surface requires a variance in accor-
dance with 15A NCAC 2C.0118
10. YIELD (gpm)- 10 METHOD OF TEST: ARD
11. WATER ZONES (depth):
12. CHLORINATION:
13. CASING:
Depth
From 0 To 110
From To
From
14. GROUT:
Depth
From 0 To 20
From To
15. SCREEN:
Type: CHLORYTE Amount: 7.5
Wall Thickness
Diameter or Weight/Ft Material
Ft.6-1/4" SDR.21 PVC
Ft.
Ft.
Material Method
Ft. OUILKRETE POURED
Ft.
Depth Diameter Slot Size Material
From _ To Ft. _ in. in.
From To Ft. in. in.
From To Ft. in. in.
16. SAND?GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
17. REMARKS:
I DO CERTIFY THAT THIS WELL WAS CONSTRUC 1 ED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THISRECORD HAS BEEN PROVIDED TO THE WELL OWNER
If additional space is needed use back of form
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other reference points)
HWY. #64/74A W. FROM RUTHERFORDTON. LEFT ON
ISLAND CREEK RD. LEFT INTO "THE PEAKS". LEFT ON
BOULDER DR 1ST HOUSE ON LEFT.
FOR OFFICE USE ONLY
Quad No:
Serial No.
RECEIVED ; Al'TV
DN. OF WATER
NOV 0 6 2006
) 7pixD
SIGNA OF PERSON CONSTRUCTING THE WELL DATE
Submi ginal to Division of Water Quality, Groundwater motion within 30 days
GW-1 REV. 12/99

Groundwater Section
North Carolina - Department of Environment and Natural Resources - Division of Water Quality -
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone]
WELL CONSTRUCTION RECORD WEWELL CONTRACTOR CERTIFICATION #:LL CONTRACTOR: RODNEY S 2785
STATE WELL CONSTRUCTION PERMIT #:
3 4
1. WELL USE (Check Applicable Boa): ® Residential U Municipal ❑ Industrial U Agricultural ❑ Monitoring
0 Recovery 0 Heat Pump Water Injection 0 Other If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: LAKE LURE County: RUTH DRII LING LOG DEPTH
JOBES TRAIL -LOT #31
(Road Name and Numbers, Community, or Subdivision and Lot No.) From To Formation Description
3. OWNER BILL SOMMERS
Address JOBES TRAIL -LOT #31
(Street or Route No.)
LAKE LURE NC 28746
City or Town State Zip Code
4. DATE DRILLED 10/13/06
5. TOTAL DEPTH 305
6. CUTTING COLLECTED 0 YES ® NO
7. DOES WELL REPLACE EXISTING WELL? 0 YES ® NO
8. STATIC WATER LEVEL Below Top of Casing: 60 FT.
(Use "+" if Above Top of Casing)
9. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2C.0118
10. YIELD (gpm): 9 METHOD OF TEST: ARD
11. WATER ZONES (depth):
If additional space is needed use back of form
12. CHLORINATION: Type: CHLORYTE Amount: 7.5 LOCATION SKETCH
13. CASING:
(Show direction and distance from at least two State
Roads, or other reference points)
HWY. #9 N. FROM MILL SPRING. RT. ON GRASSY KNOB RD.
LEFT INTO STONECREST SUBDV. LEFT ON JOBES TRAIL.
LOT #31 ON RT.
Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 130 Ft. 6-1/4" SDR21 PVC
From _ To Ft. _
From _ To Ft.
14. GROUT:
Depth Material Method
From 0 To 20 Ft. QUILKRETE POURED
From _ To Ft. _
15. SCREEN:
Depth Diameter Slot Size Material OF
From ToFt. in. in Dlv 2op6
From _ _ ToFt. in. in. NOv Q
From To Ft. in. in._
16. SAND?GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
17. REMARKS:
I DO CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THISRECORD HAS BEEN PROVIDED TO THE WELL OWNER
era U G
SIGNA+URE OF PERS CONSTRUCTING THE WELL DATE
ginal to Division of Water Quality, Groundwater Section within 30 days
GW-1 REV. 12/99
FOR OFFICE USE ONLY
Quad No:
Serial No.

North Carolina — Department of Environment and Natural Resources — Division of Water Quality — Groundwater Section
1636 Mail Service Center — Raleigh, N.C. 27699-1636 — Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR: RODNEY ROBBINS
WELL CONTRACTOR CERTIFICATION #: 2785
STATE WELL CONSTRUCTION PERMIT #:
1. WELL USE (Check Applicable Box): ❑ Residential ❑ Municipal ❑ Industrial ® Agricultural ❑ Monitoring
❑ Recovery ❑ Heat Pump Water Injection ❑ Other If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: BOSTIC County: RUTH DRILLING LOG DEPTH
131 LUCKADOO RD.
(Road Name and Numbers, Community, or Subdivision and Lot No.) From To Formation Description
3. OWNER JOE ROBBINS
Address 131 LUCKADOO RD.
(Street or Route No.)
BOSTIC NC 28018
City or Town State Zip Code
4. DATE DRILLED 10/26/06
5. TOTAL DEPTH 705
6. CUTTING COLLECTED ❑ YES ® NO
7. DOES WELL REPLACE EXISTING WELL? ❑ YES ® NO
8. STATIC WATER LEVEL Below Top of Casing: 0 FT.
(Use "+" if Above Top of Casing)
9. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated allor below land surface requires a variance in accor-
dance with 15A NCAC 2C.0118
10. YIELD (gpm): 0 METHOD OF TEST: ARD
11. WATER ZONES (depth):
If additional space is needed use back of form
12. CHLORINATION: Type: CHLORYTE Amount: 19.5 LOCATION SKETCH
13. CASING:
(Show direction and distance from at least two State
Roads, or other reference points)
BUS. 74 E. FROM FOREST CITY. LEFT ON SUNSHINEBOSTIC
RD. LEFT ON TONEY RD. IN SUNSHINE. LEFT ON
LUCKADOO RD. BIRCK HOUSE ON RT. 331 ON BOX.
From
From To
From To
14. GROUT:
Wall Thickness
Depth Diameter or Weight/Ft. Material
0 To 130 Ft. 6-1/4" SDR.21 PVC
Ft.
Ft.
Depth Material Method
From 0 To 20 Ft. OUILKRETE POURED
From To Ft.
15. SCREEN:
Depth Diameter Slot Size Material
From To Ft. in.
From To Ft. in.
From To Ft. in.
16. SAND?GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
17. REMARKS:
I DO CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THISRECORD HAS BEEN PROVIDED TO THE WELL OWNER
FOR OFFICE USE ONLY
Quad No:
Serial No.
RECEIVED
Qtv of WATER QUALITY
NOV 9 6 2006
GN TURE OF PERS N CONSTRUC G TE� L DATE
iginal to Division of Water Quality, Groundwater Section within 30 days GW-1 REV. 12/99

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR: RODNEY ROBBINS
WELL CONTRACTOR CERTIFICATION #: 2785
STATE WELL CONSTRUCTION PERMIT #:
334427
1. WELL USE (Check Applicable Box): ® Residential U Municipal U Industrial ❑ Agricultural U Monitoring
0 Recovery 0 Heat Pump Water Injection 0 Other If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: RUTHERFORDTON County: RUTH
N. DAKOTA DR -LOT #313 DRILLING LOG DEPTH
(Road Name and Numbers, Community, or Subdivision and Lot No.) From To Formation Description
3. OWNER BEVERLY NEWBURGER
Address N. DAKOTA DR -LOT #313
(Street or Route No.)
RUTHERFORDTON NC 28139
City or Town State Zip Code
4. DATE DRILLED 10/27/06
5. TOTAL DEPTH 285
6. CUTTING COLLECTED 0 YES ® NO
7. DOES WELL REPLACE EXISTING WELL? 0 YES ® NO
8. STATIC WATER LEVEL Below Top of Casing: 60 FT.
(Use "+" if Above Top of Casing)
9. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a variance in accor-
dance with I5A NCAC 2C.0118
10. YIELD (gpm): 8 METHOD OF TEST: ARD
11. WATER ZONES (depth):
12. CHLORINATION: Type: CHLORYTE Amount: 7.5
13. CASING:
Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 140 Ft. 6-1/4" SDR.21 PVC
From To Ft.
From To Ft.
14. GROUT:
Depth Material Method
From 0 To 20 Ft. QUILKRETE POURED
From To Ft.
15. SCREEN:
Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
From To Ft. in. in.
16. SAND?GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
17. REMARKS:
If additional space is needed use back of form
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other reference points)
HWY. #221 N. FROM RFIN. LEFT ON MTN. CREEK,RD. LEFT
INTO CLEARWATER CRK. ESTATES. RT. ON N. DAKOTA
DR APPROX. 1/2 MILE ON RT. (LOT #313)
REGE Eo sp,OTN
TER
DN OE DNA
0 b 2006
I DO CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THISRECORD HAS BEEN PROVIDED TO THE WELL OWNER.
FOR OFFICE USE ONLY
Quad No:
Serial No.
Submit
GNA PERSON CO STRbCTING TIC WELL171i910—.
DATE V "rTh
final to Division of Water Quality, Groundwater Section within 30 days
GW-1 REV. 12/99

North Carolina — Department of Environment and Natural Resources — Division of Water Quality — Groundwater Section
1636 Mail Service Center — Raleigh, N.C. 27699-1636 — Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR: RODNEY ROBBINS
WELL CONTRACTOR CERTIFICATION #S 2785
STATE WELL CONSTRUCTION PERMIT #:
1. WELL USE (Check Applicable Box): ® Residential ❑ Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring
❑ Recovery ❑ Heat Pump Water Injection ❑ Other If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: BOSTIC County: RUTH DRILLING LOG DEPTH
ED THOMPSON RD.
(Road Name and Numbers, Community, or Subdivision and Lot No.) From To Formation Description
3. OWNER BOB WEST
Address ED THOMPSON RD.
(Street or Route No.)
BOSTIC NC 28018
City or Town State Zip Code
4. DATE DRILLED 10/31/06
5. TOTAL DEPTH 705
6. CUTTING COLLECTED ❑ YES ® NO
7. DOES WELL REPLACE EXISTING WELL? ❑ YES ® NO
8. STATIC WATER LEVEL Below Top of Casing: 80 FT.
(Use "+" if Above Top of Casing)
9. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a variance in accor-
dance with 15ANCAC 2C.0118
10. YIELD (gpm): 3 METHOD OF TEST: ARD
11. WATER ZONES (depth):
12. CHLORINATION:
13. CASING:
Depth
From 0 To
From To
From To
14. GROUT:
Depth
From 0 To
From To
15. SCREEN:
Depth
From To
From To
From To
Type: CHLORYTE Amount: 19.5
Wall Thickness
Diameter or Weight/Ft. Material
70 Ft. 6-1/4" SDR21 PVC
Ft.
20
Ft.
Material Method
Ft. OUILKRETE POURED
Ft.
Diameter Slot Size Material
Ft. in. in.
Ft. in. in.
Ft. in. in.
If additional space is needed use back of form
33442
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other reference points)
HWY. #64 E. FROM RUTHERFORDTON. RT. ON ED
THOMPSON RD. GO 1-1/2 MILES. DRIVE ON RIGHT. RED
GATE
R NPEE EpUAOr(
DIV Or
11,V 4 6 2006
16. SAND?GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
17. REMARKS:
I DO CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THISRECORD HAS BEEN PROVIDED TO THE WELL OWNER.
FOR OFFICE USE ONLY
Quad No:
Serial No.
Sub
g a�
SIGNAL rOF PERSO CONSTRUCTING THE WELL DATE
nginal to Division of Water Quality, Groundwater Section within 30 days
GW-1 REV. 12/99
r

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR: JEFF MELTON
WELL CONTRACTOR CERTIFICATION #: 3417
STATE WELL CONSTRUCTION PERMIT #:
1. WELL USE (Check Applicable Box): N Residential U Municipal U Industrial 0 Agricultural 0 Monitoring
0 Recovery 0 Heat Pump Water Injection 0 Other If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: RUTHERFORDTON County: RUTH
ORCHARD RD. DRILLING LOG DEPTH
(Road Name and Numbers, Community, or Subdivision and Lot No.) From To Formation Description
3. OWNER DOUG & PAT WINNE
Address ORCHARD RD.
(Street or Route No.)
RUTHERFORDTON NC 28139
City or Town State Zip Cod -
4. DATE DRILLED 10/26/06
5. TOTAL DEPTH 205
6. CUTTING COLLECTED 0 YES ® NO
7. DOES WELL REPLACE EXISTING WELL? 0 YES ® NO
8. STATIC WATER LEVEL Below Top of Casing: 80 FT.
(Use `+" if Above Top of Casing)
9. TOP OF CASING IS 1-1/2 FT. Above Land Surface'
*Top of casing terminated at/or below land surface requires a variance in accor-
dance with I5A NCAC 2C.0118
10. YIELD (gpm): 15 METHOD OF TEST: ARD
11. WATER ZONES (depth):
12. CHLORINATION: Type: CHLORYTE Amount: 4.5
13. CASING:
Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 85 Ft. 6-1/4" SDR.21 PVC
From To Ft.
From To Ft.
14. GROUT:
Depth Material Method
From 0 To 20 Ft.OUIKRETE POURED
From To Ft.
15. SCREEN:
Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in.� in.
From To Ft. in. in
16. SAND?GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
17. REMARKS:
If additional space is needed use back of form
33
20
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other reference points)
HWY. #221 N. FROM RUTHERFORDTON. LEFT ON LIBERTY
HILL CHURCH RD. RT. ON ORCHARD RD. 3'n DRIVE ON
LEFT.
RECEIVED ALITY
DV. OF WATE
NOV 0 E 2006
I DO CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THISRECORD HAS BEEN PROVIDED TO THE WELL OWNER.
FOR OFFICE USE ONLY
Quad No:
Serial No.
l ull � i( �G Tf VEL' 7z/ A ' I -6 b
IGNATURE F PER ON CONSTRUCTIN LL DATE
ubmit original to Division of Water Quality, Groundwater Section within 30 days
GW-1 REV. 12/99

North Carolina — Department of Environment and Natural Resources — Division of Water Quality — Groundwater Section
1636 Mail Service Center — Raleigh, N.C. 27699-1636 — Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR: JEFF MELTON
WELL CONTRACTOR CERTIFICATION #: 3417
STATE WELL CONSTRUCTION PERMIT #:
1. WELL USE (Check Applicable Box): ® Residential 0 Municipal 0 Industrial 0 Agricultural 0 Monitoring
0 Recovery 0 Heat Pump Water Injection 0 Other If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: LAKE LURE County: RUTH
PINEY CREEK ACRES -LOT #6 DRILLING LOG DEPTH
(Road Name and Numbers, Community, or Subdivision and Lot No.) From To Formation Description
3.OWNER CHUCK & SHIRLEY LANDEVER
Address PINEY CREEK ACRES -LOT #6
(Street or Route No.)
LAKE LURE NC 28746
City or Town State Zip Code
4. DATE DRILLED 10/30/06
5. TOTAL DEPTH 245
6. CUTTING COLLECTED 0 YES ® NO
7. DOES WELL REPLACE EXISTING WELL? 0 YES ® NO
8. STATIC WATER LEVEL Below Top of Casing: 60 FT.
(Use "+" if Above Top of Casing)
9. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated ator below land surface requires a variance in accor-
dance with 15A NCAC 2C.0118
10. YIELD (gpm): 10 METHOD OF TEST: ARD
11. WATER ZONES (depth):
12. CHLORINATION: Type: CHLORYTE Amount: 6
13. CASING:
Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 80 Ft. 6-1/4" SDR.21 PVC
From To Ft.
From To Ft.
14. GROUT:
Depth Material Method
From 0 To 20 Ft. QUIKRETE POURED
From To Ft.
15. SCREEN:
Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in.
From To Ft. in.
16. SAND?GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
17. REMARKS:
If additional space is needed use back of form
334418
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other reference points)
HWY. #64/74A W. FROM RUTHERFORDTON. RT. ON BILL'S
CREEK RD. RT. ON PINEY CREEK ACRES. LOT LEFT NEAR
DEAD END. 2NC. DRIVE TO LOT.
meD
®1V. OF ,N.
;AO l 70U6
I DO CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THISRECORD HAS BEEN PROVIDED TO THE WELL OWNER
FOR OFFICE USE ONLY
Quad No:
Serial No.
SIGNA OF P RSON CONSTRUCTING T31E WELL DATE
Subnut original to Division of Water Quality, Groundwater Section within 30 days
GW-1 REV. 12/99

North Carolina — Department of Environment and Natural Resources — Division of Water Quality — Groundwater Section
1636 Mail Service Center — Raleigh, N.C. 27699-1636 — Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR: ROBIN MCNEELY
WELL CONTRACTOR CERTIFICATION #: 2567
STATE WELL CONSTRUCTION PERMIT #:
1. WELL USE (Check Applicable Bo:): N Residential 0 Municipal ❑ Industrial 0 Agricultural ❑ Monitoring
0 Recovery 0 Heat Pump Water Injection 0 Other If Other, List Use:
2. WELL LOCATION: (Show sketch of the Location below)
Nearest Town: CLIFFSIDE County: RUTH
ISLAND FORD RD. DRILLING LOG DEPTH
(Road Name and Numbers, Community, or Subdivision and Lot No.) From To Formation Description
3. OWNER BOBBY HAWIUNS
Address ISLAND FORD RD.
(Street or Route No.)
CLIFFSIDE NC 28024
City or Town State Zip Code
4. DATE DRILLED 10/04/06
5. TOTAL DEPTH 31
6. CUTTING COLLECTED 0 YES NO
7. DOES WELL REPLACE EXISTING WELT ? 0 YES ® NO
8. STATIC WATER LEVEL Below Top of Casing: 21 FT.
(Use "+" if Above Top of Casing)
9. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2C.0118
10. YIELD (gpm): 10 METHOD OF TEST: S 'EEL TAPE
11. WATER ZONES (depth):
12. CHLORINATION:
13. CASING:
Depth
From 0 To 31
From To
From To
14. GROUT:
Depth
From 0 To 20
From To
15. SCREEN:
Depth
From To
From To
From To Ft.
16. SAND?GRAVEL PACK:
Depth Size Material
From 21 To 31 Ft. 78M GRAVEL
From To Ft.
17. REMARKS:
Type: CHLORYTE Amount: 4.6
Wall Thickness
Diameter or Weight/Ft Material
Ft. 24 _ CEMENT
Ft.
Ft.
Material Method
Ft. CEMENT POURED
Ft.
Diameter Slot Size Material
Ft. in. in.
FL ^ in. in.____
in. in
If additional space is needed use back of form
C
LOCATION SKETCH
(Show direction and dictanm from at least two State
Antis, or other reference points)
HWY. #221A $. FROM CLIFFSIDE. RT. ON ISLAND FORD RD.
APPROX. 1/2 MILE ON LEFT.
Gov
I DO CERTIFY THAT THIS WELL WAS CONSTRUC PhD IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THISRECORD HAS BEEN PROVIDED TO THE WELL OWNER
FOR OFFICE USE ONLY
Quad No:
Serial No.
TURE AF PER CONSiRU�G TE L f/i Tel D TE v' 7 - C
Submit original to Division of Wa
ty, Groundwater Section within 30 days
GW-1 REV. 12/99

North Carolina — Dtp ntment of Environment and Natural Resources — Division of Water Quality — Groundwater Section
1636 Mail Service Center — Raleigh, N.C. 27699-1636 — Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR: ROBIN MCNEELY
WELL CONTRACTOR CERTIFICATION #: 2567
STATE WELL CONSTRUCTION PERMIT #:
334
1. WELL USE (Check Applicable Box): El Residential 0 Municipal 0 Industrial 0 Agricultural 0 Monitoring
0 Recovery 0 Heat Pump Water Injection 0 Other If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: ELLENBORO County: RUTH
241 SPURLING RD. DRILLING LOG DEPTH
(Road Name and Numbers, Community, or Subdivision and Lot No.) From To Formation Description
3. OWNER JOE MCDANIEL
Address 241 SPURLING RD.
(Street or Route No.)
ELLENBORO NC 28040
City or Town State Zip Code
4. DATE DRILLED 10/16/06
5. TOTAL DEPTH 44
6. CUTTING COLLECTED 0 YES ® NO
7. DOES WELL REPLACE EXISTING WELL? ® YES 0 NO
8. STATIC WATER LEVEL Below Top of Casing: 24 FT.
(Use "+" if Above Top of Casing)
9. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a variance in accor-
dance with 15ANCAC 2C.0118
10. YIELD (gpm): 20 METHOD OF TEST: STEEL TAPE
11. WATER ZONES (depth):
12. CHLORINATION: Type: CHLORYTE Amount: 9.2
13. CASING:
Depth Diameter
From 0 To 44 Ft. 24
From To Ft.
From To Ft.
14. GROUT:
Depth Material Method
From 0 To 20 Ft. CEMENT POURED
From To Ft.
15. SCREEN:
Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. im
From To Ft. in. is
16. SAND?GRAVEL PACK:
Depth Size Material
From 24 To 44 Ft. 78M GRAVEL
From To Ft.
17. REMARKS:
Wall Thickness
or Weight/Ft. Material
CEMENT
oc
If additional space is needed use back of form
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other reference points)
FROM ELLENBORO. GO DOWN RAC PATH CHURCH RD.
LEFT ON SPURLING RD. 2/10 MILE. DRIVE ON LEFT. (#241
ON BOX)
RECE R 00pUP
WQ
I DO CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THISRECORD HAS BEEN PROVIDED TO THE WELL OWNER
FOR OFFICE USE ONLY
Quad No:
Serial No.
6
� �,. ,% cyr ie _. /O -/G Q
SIGNATURE OF P �` CONSTRUCTING THE WELL DATE
Submit original to Division of W-Quality, Groundwater Section within 30 days
GW-1 REV. 12/99
c

North Carolina — Department of Environment and Natural Resources — Division of Water Quality — Groundwater Section
1636 Mail Service Center — Raleigh, N.C. 27699-1636 — Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR: ROBIN MCNEELY
WELL CONTRACTOR CERTIFICATION #: 2567
STATE WELL CONSTRUCTION PERMIT #:
ry .
J 4 4
1. WELL USE (Check Applicable Boa): ® Residential 0 Municipal 0 Industrial 0 Agricultural 0 Monitoring
0 Recovery ❑ Heat Pump Water Injection 0 Other If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: FOREST CITY County: RUTH
HOGAN RD.. DRILLING LOG DEPTH
(Road Name and Numbers, Community, or Subdivision and Lot No.) From To Formation Description
3. OWNER MALIURE DOBBINS
Address HOGAN RD.
(Street or Route No.)
FOREST CITY NC 28043
City or Town State Zip Code
4. DATE DRILLED 10/26/06
5. TOTAL DEPTH 63
6. CUTTING COLLECTED 0 YES ® NO
7. DOES WELL REPLACE EXISTING WELL? 0 YES 0 NO
8. STATIC WATER LEVEL Below Top of Casing: 51 FT.
(Use "+" if Above Top of Casing)
9. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2C.0118
10. YIELD (gpm): 12 METHOD OF TEST: S1EEL TAPE
11. WATER ZONES (depth):
12. CHLORINATION: Type: CHLORYTE Amount: 5.52
13. CASING:
Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 63 Ft. 24 CEMENT
From To Ft.
From To Ft.
14. GROUT:
Depth Material Method
From 0 To 20 Ft. CEMENT POURED
From To Ft.
15. SCREEN:
Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
From To Ft. in. in.
16. SAND7GRAVEL PACK:
Depth Size Material
From 51 To 63 Ft. 78M GRAVEL
From To Ft.
17. REMARKS:
If additional space is needed use back of form
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other reference points)
HWY. #221 S. FROM RUTHERFORDTON. RIGHT ON HOGAN
RD. APPROX. 1 MILE ON LEE 1 PAST CAMPGROUND. NEW
DRIVE.
REGENR D ,p,\SCNI
F '•p1D
I DO CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE Wim 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THISRECORD HAS BEEN PROVIDED TO THE WELL OWNER..
FOR OFFICE USE ONLY
Quad No:
Serial No.
A"tF{ n� �cam DI?. &a. % d ,ET ` "f)4
SI NA T-WRAF P i�`Tj COTNSSTRUC'TTfIIAINf1G THE WFLi DATE
Submit original to Division of W Quality, Groundwater Section within 30 days
GW-1 REV. 12/99

North Carolina — Delnutment of Environment and Natural Resources — Division of Water Quality — Groundwater Section
1636 Mail Service Center — Raleigh, N.C. 27699-1636 — Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR: ROBIN MCNEELY
WELL CONTRACTOR CERTIFICATION #: 2567
STATE WELL CONSTRUCTION PERMIT #:
1. WELL USE (Check Applicable Boa): ® Residential 0 Municipal U Industrial 0 Agricultural U Monitoring
❑ Recovery ❑ Heat Pump Water Injection ❑ Other 1f Other, List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: FOREST CITY County: RUTH
144 S. WOODLEAF RD. DRILLING LOG DEPTH
(Road Name and Numbers, Community, or Subdivision and Lot No.) From To Formation Description
3.OWNER RANDY & JESSIE HANNA
Address 144 S. WOODLEAF RD.
(Street or Route No.)
FOREST CITY NC 28043
City or Town State Zip Code
4. DATE DRILLED 10/26/06
5. TOTAL DEPTH 63
6. CUTTING COLLECTED ❑ YES ® NO
7. DOES WELL REPLACE EXISTING WELL? ® YES 0 NO
8, STATIC WATER LEVEL Below Top of Casing: 43 FT.
(Use "+" if Above Top of Casing)
9. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2C.0118
10. YIELD (gpm): 20 _ METHOD OF TEST: STEEL TAPE
11. WATER ZONES (depth):
12. CHLORINATION: Type: CHLORYTE Amount: 9.2
13. CASING:
Depth Diameter
From 0 To 63 Ft. 24
From To Ft.
From To Ft.
Wall Thickness
or Weight/Ft Material
CEMENT
14. GROUT:
Depth Material Method
From 0 To 20 Ft. CEMENT POURED
From To Ft.
15. SCREEN:
Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in.
From To Ft. in. in
16. SAND?GRAVEL PACK:
Depth Size Material
From 43 To 63 Ft. 78M GRAVEL
From To Ft.
17. REMARKS:
If additional space is needed use back of form
33 44
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other reference points)
HWY. #221 S. FROM RUTHERFORDTON. LEFT ON SOUTH
WOODLEAF RD. BEFORE HARRIS SCHOOL.
ow aF NPR
�Q4 Q � 2006
I DO CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THISRECORD HAS BEEN PROVIDED TO THE WELL OWNER
FOR OFFICE USE ONLY
Quad No:
Serial No.
c0 ` ]V 'PURE �1 RSON
SIG ` A F ON
Submit original to Division of Water
�IRG THE WELT DATE
Groundwater Section within 30 days
GW-1 REV. 12/99
1

North Carolina — Department of Environment and Natural Resources — Division of Water Quality — Groundwater Section
1636 Mail Service Center — Raleigh, N.C. 27699-1636 — Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR: ROBIN MCNEELY
WELL CONTRACTOR CERTIFICATION #: 2567
STATE WELL CONSTRUCTION PERMIT #:
1. WELL USE (Check Applicable Box): 0 Residential 0 Municipal 0 Industrial 0 Agricultural 0 Monitoring
0 Recovery 0 Heat Pump Water Injection 0 Other If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: ELLENBORO County: RUTH
OLD MOORESBORO RD. DRILLING LOG DEPTH
(Road Name and Numbers, Community, or Subdivision and Lot No.) From To Formation Description
3. OWNER ALLEN FISHER
Address OLD MOORESBORO RD.
(Street or Route No.)
ELLENBORO NC 28040
City or Town State Zip Code
4. DATE DRILLED 10/30/06
5. TOTAL DEPTH 57
6. CUTTING COI3.FCIED ❑ YES ®NO
7. DOES WELL REPLACE EXISTING WELL? 0 YES ® NO
8. STATIC WATER LEVEL Below Top of Casing: 45 FT.
(Use "+" if Above Top of Casing)
9. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
'Top of casing terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2C.0118
10. YIELD (gpm): 12 METHOD OF TEST: S 1 EEL TAPE
11. WATER ZONES (depth):
12. CHLORINATION: Type: CHLORYTE Amount: 5.52
13. CASING:
Depth Diameter
From 0 To 57 Ft. 24
From To Ft.
From To Ft.
14. GROUT:
Depth Material Method
From 0 To 20 Ft. CEMENT POURED
From To Ft.
15. SCREEN:
Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
From To Ft. in. in.
16. SAND?GRAVEL PACK:
Depth Size Material
From 45 To 57 Ft. 78M GRAVEL
From To Ft.
17. REMARKS:
Wall Thickness
or Weight/Ft Material
CEMENT
If additional space is needed use back of form
3 •
v
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other reference points)
HENRIETTA/ELLENBORO RD. FROM ELLENBORO. LEFT ON
DOBBINSVILLE RD. LEFT ON OLD MOORESBORO RD. 2an.
LOT ON LEFT.
RECEF4ED PUN
�N.OF WP
ou
tCv 6 EL°
I DO CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THISRECORD HAS BEEN PROVIDED TO THE WELL OWNER.
FOR OFFICE USE ONLY
Quad No:
Serial No.
n
OF(PERSO
Submit original to Division of Water
w ...q/ a /6— le -04
G THE LL DATE
Groundwater Section within 30 days
GW-1 REV. 12/99

01/04/2007 11:13 828-453-0665
PITTMAN WELL BORING PAGE 03
North Carolina - Dominica of Enviuwment and Napzd Resources -Division of Water Quality - Goundweter Section
1636 Mail Service Ceuta - Raleigh, N.C. 27699-1636 -Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR: RODNEY RO$WNQ
WILL CONTRACTOR CERTIFICATION #: 2785
STATE WELL CONSTRUCTION PERMIT #:
1. WELL USE (Check Applicable Bo:): Q Residential 0 Municipal 0 Industrial 0 Agricultural 0 Monitoring
0 Recovery 0 Heat Pump Water Injection ® Other If Other, List Use: PUBLIC
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: LAKE LURE Coomy: RIM
BOYS CAW RD. t;'IREFLY QOVE DRILLING LOG
(Road Name and Numbers, Community, or Subdivision and Lot No.) From To Formation Description
3. OWNER JOHN CLOUp
Address BOYS CAMP.RD FIREFLY COVE
(Street or Route No.)
LAKE LURE T 28746
City or Town State Zip Code
4, DATE DRILLED 10/12/06
5. TOTAL DEPTH 605 WELL #I
6. CUTTING COLLECTED 0 YES ® NO
7, DOES WELL REPLACE EXISTING WELL? ❑ YES ® NO
8. STATIC WATER LEVEL Below Tap ofCasing: 63 ET.
(Uae'4" if Above Top of Casing)
9. TOP OF CASING IS 1-1/2 FT. Above Land Surface'
w7'ap of ratios tarroingad stkt below 1.adraqufea a 'Sine in acoor.
dmce wiib I5ANCA�C 2C.0118
10. YIELD (gpm): 23 METHOD OF TEST: FLOW METER
11. WATER ZONES (depth):
12. CHLORINATION: Type: CHLORYTE Amount 5 LB.
13. CASING:
Wall Tmclmap
Depth 17iatneter or Weight/Pt. Material
Frain 0 To 62 FL AL,250 WALL GAIN.
From To FL
From To Ft.
14. GROUT:
Depth Material Method
From 0 To 62 Ft. CEMENT SLURRY PUMPED
From _To Ft._
15. SCREEN:
Depth Diameter Slot Size Material
From To FL _ in._ in._
From To FL in. in.
From _ To Ft. in. in.
16. SAND7GRAVEL PACK:
T
Depth Size Material
From _ To___._ Ft.
• From _To 1i._
17. REMARKS: REVISED COPY -ERROR ON GROUT ON FIRST COPY.
I DO CERTIFY THAT THIS WE).i WAS CONSTRUCIU.) IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THISRECORD HAS BEEN PROVIDED TO THE WELL OWNER.
DEPTH
if additional space is needed use beck of farm
FOR OFFICE USE ONLY
Qaad No:
Serial No.
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other reference points)
)4T. ON BOYS CAMP RI) IN LAKE LURE. 1/2 MILE ON RT.
11s/k
SIGNATURE OF PER8WTI019 C STRUCTING THWTIDATE
to Division of Water Quality, Groundwater Section within 30 days
GW-1 REV. 12/99
JAN 04 2007

01/04/2007 11:13 828-453-0665
PITTMAN WELL BORING PAGE 02
North Carolina -➢epmffiunt ofFavvnnmad and Natural Resources- Division of Water Quality- Groundwater Section
1636 Mail Service Centex -Raleigh, N.C. 27699-1636 -Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR: DN ROEY Mata
WELL CONTRACTOR CERTIFICATION M: 7785
STATE WELL CONSTRUCTION PERMIT a:
1. WILL USX (Check Applicable Box): 0 Reaidetdial 0 Municipal 0 Industrial 0 Agricultural ❑ Monitoring
0 Recovery ❑ Heat Pump Water Injection ® Other If Other, List Use: PUBLIC
2. WPC 1 LOCATION: (Show sketch of the location below)
Nearest Town: LAKE LURE County: RUTH
BOYS CAMP RD. FIREFLY COVE Subdivision and Lot No.) From ING
(Road Name and Nutnbcrs, Community, Formation pdon
3. OWNER JOHN CLOUD
Address BOYS CAMP RD FIREFLY COVE
(Street or Route No.)
LAKE LURE 28746
City or Town State Zip Code
4. DATE DRILLED 10/04/06
5. TOTAL DEPTH 805 WELL NO2
6, CUTTING COLLECTED ❑ YES a NO
7. DOES WELL REPLACE EXISTING WELL? 0 YES ® NO
8. STATIC WATER LEVEL Below Top of Casing: 300 FT.
(Use • +" if Above Top ofCasiag)
9. TOP OF CASING IS 1-1/2 FF. Above Land Surfaces
wrap of owing tamiasied at/or below hod surface requires a vvianoe in woor-
daece with ISA NCAC 2C.0118
10. YIELD (pm): 1 METHOD OF TEST: ARD
11. WATER ZONES (depth):
If addilioosl apace is needed use back of form
12. CHLORINATION: Type: CHLORITE Amami: 5 LB.
13. CASING: LOCATION SKETCH
Wall Thickness (Show direction and distance from at least two State
Dcpth Dia*Ktcr or Wedgbt/Ft Material Roads, or other reference points)
From 0 To 63 Ft. 8" 250 WALL GALV. RT. ON BOYS CAMP RD. IN LAKE LURE. 3/4 MILE ON RT.
From, , ToFt.
Front ToFt.
14. GROUT:
Depth Mataial Method
From 0 To 63 , Ft. CEMENT SLURRY PUMPED
From To FL
15. SCREEN:
Depth Diameter Slot Size Material
From To Ft. in_____
From To Ft. in. in.
From To FL in.in,____
16. SAND?GRAVEL PAQC:
Depth Size Material
From _ ToFL
From To Ft.
17. REMARKS: REVISED COPY -ERROR ON GROUT ON FIRST COPY,
I DO CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WfIH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF TILSRECORD HAS BEEN PROVIDED TO THE WELL OWNER
FOR OFFICE USE ONLY
Quad No:
Serial No.
SIGNATURE OF PER9ON CONSTRUCTING THE WELL DATE
Su t original to Division of Wata Quality, Oro�dwater Section within 30 days
OW-1 REV. 12/99

01/04/2007 11:13 828-453-0665
PITTMAN WELL BORING PAGE 04
North Carolina - Depmhneut of Environment and Natural Resources - Divium of Water Quality - Groundwater Section
1636 Mail Service Center -Raleigh, N.C. 27699-1636 - Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR RODNEY ROBBINS
WELL CONTRACTOR CERTIFICATION 0: 2785
STATE WELL CONSTRUCTION PERMIT Al
1. WELL USE (Check Applicable Bo:): ❑ Residential ❑ Municipal 0 Industrial 0 Agricultural ❑ Monitoring
❑ Recovery ❑ Heat Pump Water Injection ® Other If Other, List Use: PUBLIC
2. WELL LOCATION: (Show sketch of the loCatioa below)
Nearest Town: LAKE LURE Crony: RUM
BOYS CAMP RD, FIREFLY COVE
(Road Name and Numbers, Community, or Subdivision and Lot No.) From To
3. OWNER JOIN CLOUD
Address BOYS CAMP RD. FIREFLY COVE
(Street or Route No.)
LAKE LURE NC 28746
City or Town State Zip Code
4. DATE DRILLED 10/19/06
5. TOTAL DEFILE 405 WELL !12
6- CUTTING COLLECT ED 0 YES ® NO
7. DOES WEI.T REPLACE EXISTING WELL? 0 YES ® NO
8. STATIC WATER LEVEL Below Top of Casing: 60 FT.
(P.c "r^ if Above Top of Caring)
9. TOP OF CASING IS 1-1/2 FT. Above Land Surface'
crop of smg bmindcd Nor below Ind wrSce regwra a variawae in aCJw-
dnce with 1SANCAC 2Co118
10. YIELD (gpm): - 9 METHOD OF TEST: FLOW METER
11. WATER ZONES (depth):
12. CHLORINATION: Type: CHLORYTF Amount 5 LE.
13. CASING:
Wall ThicWness
Depth Dimaeta a WeighNFt Material
From 0 To 63 FL 8" 250 WALL GALV.
From To Ft
From To Ft.
DRILW4G LOG
RIEOff
Formation Description
If additional space is Healed use bark of him
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other 'detente points)
AT. ON BOYS CAMP RD. IN LAKE LURE. 1/2 MILE ON RT
14. GROUT:
Depth Material Method
From 0 To 63 FL CEMENT SLURRY PUMPED
From To Ft. — —
15. SCREEN:
Depth Diameter Slot Size Material
From ToFLin. itt
From To - Ft. in. inn_,_,
From To Ft in. in.___
16. SAND7GRAVEL PACK:
Depth Size Material
From To FL _ From ToR.
17. REMARKS: REVISED COPY -ERROR ON GROUT ON FIRST COPY.
I DO CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THISRECORD HAS BEEN PROVIDED TO THE WELL OWNER
FOR OFFICE USE ONLY
Quad No:
Serial No.
Aiur� IONSTRf' /ur/ 9-o&
SIGN OF CONSTRUCTING WELL DATE
original to Division of Water Quality, Groundwater Section within 30 days
GW-1 REV. 12/99
JAN 04 2007

01/04/2007 11:13 828-453-0665
PITTMAN WELL BORING PAGE 05
North Carolina—Depelhaemt of Environment aaiNatural Resources — Division of Water Quality — Groundwater Section
1636 Mail Service Center —Raleigh, N.C. 27699-1636 —Phone [phone]
WELL CONSTRUCTION RECORD WELL ORI! ROBBINS
WCONTRCCTCEE1TFAT10NN M 221,1
STATE WELL CONSTRUCTION PERMIT it:
1. WELL USK (CbxkApplcableDos): Residential Municipal Industrial Agricultural Momtocir4
0 Recovery 0 Heat Pwnp Water Injection ® Other If Other, List Use: PUBLIC
2. WELT LOCATION: (Show sketch of the location below)
Nearest Town: LAKE LURE CAI: g. I DRILLING LOG E
BOYS CAMP RD. FIREFLY COVE To Formation Description
331
(Road Name and Numbers, Contnmity, or Subdivision and Lot No.) From
3. OWNER JOHN CLOUD
Address BOYS CAMP RD. FIREFLY COVE
(Street or Route No.) C 28746
LAKE LURE State Ii
City or Town
Zip Code
4. DATE DRILLED 10/02/06
5. TOTAL DEPTH Q85 WELL 801
6. CUTTING COLLECTED ❑ YES ® NO
7. DOES WFJ I REPLACE EXISTING WELL? ❑ YES ® NO
8. STATIC WATER LEVEL Below Top of Casing: 300 FT.
(Ilse.+^ if Above Top of Cain)
9. TOP OF CASING IS 1 j/2 FT. Above Land Swfacef
*Top of Ming terminated alto below Imd suffice requires. variance in .own
dance with 15A NCAC 2C.0118
10. YIELD (gpm): I METHOD OF TEST: ARD
11. WATER ZONES (depth):
If additional space is netted use back of form
12. CHLORINATION: Type: CHLORYTE Amount: 5 LB. r tx s rrON SKETCEI
13. CASING:
Wall Thickness (Show direction and distance from at least two State
Depth Diameter or Weight/Ft Material Roads, or other reference points)
From 0 To 63 Ft 8" 250 WALL GALV, RT. ON UOYS CAMP RD. IN LAKE LURE- 3/4 MILE ON RT.
From _ To Ft.
From To Ft.
14. GROUT:
Depth Material Method
From 0 To 63 FL GWEN' SLURRY PUMPED
From To Ft _.
15. SCREEN:
Depth Diameter Slot Size Material
From To Ft. in. in._
From To Ft. in. in.
From ToFt in. ia__,
16. SAND/GRAVEL PACK.:
Depth Size Material
From To Ft From T To Ft
17. REMARKS: REVISED COPY -ERROR ON GROUT ON FIRST COPY.
I DO CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THISRECORD HAS BEEN PROVIDED TO THE WEIL OWNER.
FOR OFFICE USE ONLY
Quad No:
Serial No.
�� �s"`TIN art v - /4-0 DATE
- a G
SIGNA DF PI?.(ts«Q ON3IRUCTQdG THE DT
iginal to Division of Water Quality, Urouodwater Section within 30 days
GW-1 REV. 12/99
JAN 04 2007

North Carolina — Department of Environment and Natural Resources — Division of Water Quality — Groundwater Section
1636 Mail Service Center — Raleigh, N.C. 27699-1636 — Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR RODNEY ROBBINS
WELL CONTRACTOR CERTIFICATION #: 2785
STATE WELL CONSTRUCTION PERMIT #:
335721
1. WELL USE (Check Applicable Box): E Residential ❑ Municipal ❑ Industrial ❑ Agricultural 0 Monitoring
❑ Recovery El Heat Pump Water Injection ❑ Other If Other, List Use:
2 WFT.T LOCATION: (Show sketch of the location below)
Nearest Town: BOSTIC County: RUTH
CHERRY RIDGE SUBDV. DRILLING LOG DEPTH
(Road Name and Numbers, Community, or Subdivision and Lot No.) From To Formation Description
3. OWNER RITA HAYNES
Address CHERRY RIDGE SUBDV.
(Street or Route No.)
BOSTIC NC 28018
City or Town State Zip Code
4. DATE DRILLED 11/21/06
5. TOTAL DEPTH 205
6. CUTTING COLLFCTED 0 YES ® NO
7. DOES WELL REPLACE EXISTING WELL? ❑ YES ®NO
8. STATIC WA TER LEVEL Below Top of Casing: 60 FT.
(Use `+" if Above Top of Casing)
9. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2C.0118
10. YIELD (gpm): 60 METHOD OF TEST: ARD
11. WATER ZONES (depth):
12. CHLORINATION: Type: CHLORYTE Amount: 4.5
13. 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.
14. GROUT:
Depth Material Method
From 0 To 20 Ft. QUILKRETE POURED
From To Ft.
15. SCREEN:
Depth Diameter Slot Size Material
From To Ft in. in.
From To Ft. in. in.
From To Ft. in. in.
16. SAND?GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
17. REMARKS:
If additional space is needed use back of form
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other reference points)
BUS. 74 E. FROM FOREST CITY. LEFT ON BOSTIC/SUNSHINE
RD. RT. ON SALEM CHURCH RD. LEFT INTO CHERRY
RIDGE SUBDV. RT. ACROSS DAM. DRIVE ON RT. (c(7 TOP OF
HILL.
RECEIVED
WPIEROIALl
{
I DO CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THISRECORD HAS BEEN PROVIDED TO THE WELL OWNER.
FOR OFFICE USE ONLY
Quad No:
Serial No.
/ire o-t� /`1`t�-4.�� ; �A„s i'E 'L�,�7,� / - ('i (.
OF PERSO CO TRUCTING THE V L DATE
Submit Arii:inal to Division of Water Quality, Groundwater Section within 30 days
GW-I REV. 12/99

From _ To Ft
16. SAND?GRAVEL PACK:
Depth Size Material
From To Ft.
From To FL
17. REMARKS:
North Carolina — Department of Environment and Natural Resources — Division of Water Quality — Groundwater Section
1636 Mail Service Center — Raleigh, N.C. 27699-1636 — Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR: RODNEY ROBBINS
WELL CONTRACTOR CERTIFICATION #: 2785
STATE WELL CONSTRUCTION PERMIT #:
I. WELL USE (Check Applicable Box): Z Residential 0 Municipal 0 Industrial 0 Agricultural 0 Monitoring
0 Recovery 0 Heat Pump Water Injection 0 Other If Other, List Use:
2 WELL LOCATION: (Show sketch of the location below)
Nearest Town: RUTHERFORDTON County: RUTH
DEWITT OWENS RD. DRILLING LOG DEPTH
(Road Name and Numbers, Community, or Subdivision and Lot No.) From To Formation Description
3. OWNER JERRY WHITE
Address DEWITT OWENS RD.
(Street or Route No.)
RUTHERFORDTON NC 28139
City or Town State Zip Code
4. DATE DRILLED 11/20/06
5. TOTAL DEPTH 305
6. CUTTING COI I FCTED ❑ YES ®NO
7. DOES WELL REPLACE EXISTING WELL? 0 YES ® NO
8. STATIC WATER LEVEL Below Top of Casing: 60 FT.
(Use "+" if Above Top of Casing)
9. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a variance in accor-
dance with 15ANCAC 2CD118
10. YIELD (gpm): 100 METHOD OF TEST: ARD
11. WATER ZONES (depth):
12. CHLORINATION: Type: CHLORYTE Amount: 7.5
13. CASING:
Wall Thickness
Depth Diameter or Weight/Ft Material
From 0 To 70 Ft.6.1/4" SDR21 PVC
From To Ft.
From To Ft.
14. GROUT:
Depth Material Method
From 0 To 20 Ft OUILKRETE POURED
From To Ft.
15. SCREEN:
Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
in. in.
If additional space is needed use back of form
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other reference points)
HWY. #221 S. FROM RUTHERFORDTON. RIGHT ON SHILOH
RD. LEFT ON BIG ISLAND RD. RIGHT ON DEWITT OWENS
RD. APPROX. 1/2 MILE ON RIGHT.
RECEIVED v
'NV. F WATER QUALM
I DO CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND TTHAT A COPY OF THISRECORD HAS BEEN PROVIDED TO THE WELL OWNER
FOR OFFICE USE ONLY
Quad No:
Serial No.
�d /r ��l - ,2
nS SIGNA OFFPPERSO CONSTRUCTING THE LL DATE
Submil{atlginal to Division of Water Quality, Groundwater Section thin 30 days
GW-1 REV. 12/99

North Carolina —Department of Environment and Natural Resources — Division of Water Quality — Groundwater Section
1636 Mail Service Center — Raleigh, N.C. 27699-1636 — Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR; RODNEY ROBBINS
WELL CONTRACTOR CERTIFICATION #: 2785
STATE WELL CONSTRUCTION PERMIT #:
335723
1. WELL USE (Check Applicable Box): ® Residential ❑ Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring
❑ Recovery ❑ Heat Pump Water Injection ❑ Other If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: LAKE LURE County: RUTH
RIDGECREST RD. DRILLING LOG DEPTH
(Road Name and Numbers, Community, or Subdivision and Lot No.) From To Formation Description
3. OWNER JERRY DYSON
Address RIDGECREST RD.
(Street or Route No.)
LAKE LURE NC 28746
City or Town State Zip Code
4. DATE DRILLED 11/15/06
5. TOTAL DEPTH 605
6. CUTTING COLLFCTED ❑ YES ® NO
7. DOES WELL REPLACE EXISTING WELL? ❑ YES ® NO
8. STATIC WATER LEVEL Below Top of Casing: 0 FT.
(Use "+" if Above Top of Casing)
9. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
'Top of casing terminated at/or below land surface requires a variance in accor-
dance with 15ANCAC 2C.0118
10. YIELD (gpm): 0 METHOD OF TEST: ARD
11. WATER ZONES (depth):
12. CHLORINATION: Type: CHLORYTE Amount: 16.5
13. 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.
14. GROUT:
Depth Material Method
From 0 To 20 Ft. OUILKRETE POURED
From To Ft.
15. SCREEN:
Depth Diameter Slot Size Material
From To FL in. in.
From To Ft. in. itt
From To Ft. in. in.
16. SAND?GRAVEL PACK:
Depth Size Material
From To Ft.
From To FL
17. REMARKS:
If additional space is needed use back of form
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other reference points)
HWY. #64/74A W. FROM RFTN. RT. ON BILLS CRK. RD. LEFT
ON CEDAR CRK. RD. LEFT ON RIDGECREST RD. 4m DRIVE
ON LEFT.
RECENED �.
A;7
01V.OFWA7ER -.
I DO CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THISRECORD HAS BEEN PROVIDED TO THE WFI .1 OWNER
FOR OFFICE USE ONLY
Quad No:
Serial No.
77geic1CO� �rr/�`Lti //-/�'aC
SIGN TURE OF PE CO TRUCTING THE WELL DATE
ginal to Division of Water Quality, Groundwater Section within 30 days
GW-1 REV. 12/99

North Carolina — Department of Environment and Natural Resources —Division of Water Quality — Groundwater Section
1636 Mail Service Center — Raleigh, N.C. 27699-1636 — Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR: RODNEY ROBBINS
WELL CONTRACTOR CERTIFICATION #: 2785
STATE WELL CONSTRUCTION PERMIT #:
1. WELL USE (Check Applicable Box): ® Residential ❑ Municipal ❑ Industrial ❑ Agricultural
0 Recovery 0 Heat Water ❑m U Other
Injection ❑Monitoring
2. WELL LOCATION: (Show sketch Pof the location below) , List Use:
Nearest Town: BOSTIC County: RUTH
2479 CANE CRK. RD. DRILLING LOG
DEPTH
(Road Name and Numbers, Community, or Subdivision and Lot No.) From To Formation Description
3. OWNER MARTY CAMPBELL
Address 2479 CANE CREEK RD.
(Street or Route No.)
BOSTIC N C 28016
City or Town State Zip Code
4. DATE DRILLED 11/11/06
5. TOTAL DEPTH 285
6. CUTTING COLLECTED 0 YES ® NO
7. DOES WELL REPLACE EXISTING WELL? 0 YES ® NO
8. STATIC WATER LEVEL Below Top of Casing: 60 FT.
r z
(Use `4" if Above Top of Casing)cm
cm
9. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2C.0118
10. YIELD (gpm): 50 METHOD OF TEST: ARD
11. WATER ZONES (depth):
335724
12. CHLORINATION: Type: CHLORYTE Amount: 6.5
13. CASING:
Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 70 Ft. 6-1/4" SDR21 PVC
From To Ft.
From To Ft.
14. GROUT:
Depth Material Method
From 0 To 20 Ft.OUILKRETE POURED
From To Ft.
15. SCREEN:
Depth Diameter Slot Size Material
From To Ft. in._ in.
From To Ft. in. in,
From To Ft. in, in
16. SAND?GRAVEL PACK:
Depth Size Material
From _ To Ft. _
From To Ft.
17. REMARKS:
If additional space is needed use back of form
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other reference points)
BUS. 74 E. FROM FOREST CITY. LEFT ON BOSTIC/SUNSHINE
RD. LEFT ON HWY. #226 (rd, GOOD OLE BOYS. LEFT ON
CANE CREEK RD. 1ST DRIVE ON LEFT.
RECEIVED
')tV Cr ;NATEH °DAL"
I DO CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THISRECORD HAS BEEN PROVIDED TO THE WELL OWNER
FOR OFFICE USE ONLY
Quad No:
Serial No.
SIG ATURE OF P CONSTRUCTING WELL DATE
ginal to Division of Water Quality, Groundwater Section within 30 days
GW-I REV. 12/99

North Carolina — Department of Environment and Natural Resources — Division of Water Quality — Groundwater Section
1636 Mail Service Center — Raleigh, N.C. 27699-1636 — Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR: RODNEY ROBBINS
WELL CONTRACTOR CERTIFICATION #: 2785
STATE WELL CONSTRUCTION PERMIT #:
1. WELL USE (Check Applicable Bon): ® Residential ❑ Municipal ❑ Industrial ❑ Agricultural 0 Monitoring
❑ Recovery 0 Heat Pump Water Injection 0 Other If Other, List Use:
2, WELL LOCATION: (Show sketch of the location below)
Nearest Town: RUTHERFORDTON County: RUTH
MAPLE CREEK RD. DRILLING LOG DEPTH
(Road Name and Numbers, Community, or Subdivision and Lot No.) From To Formation Description
3. OWNER GARY RICHARDSON
Address MAPLE CREEK RD.
(Street or Route No.)
RUTHERFORDTON NC 28139
City or Town State Zip Code
4. DATE DRILLED 11/10/06
5. TOTAL DEPTH 605
6. CUTTING COLLECTED ❑ YES ® NO
7. DOES WELL REPLACE EXISTING WELL? ❑ YES ® NO
8. STATIC WATER LEVEL Below Top of Casing: 60 FT.
(Use "+" if Above Top of Casing)
9. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
'Top of casing terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2C.0118
10. YIELD (gpm): 2 METHOD OF TEST: ARD
11. WATER ZONES (depth):
12. CHLORINATION: Type: CHLORYTE Amount: 16.5
13. CASING:
Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 110 Ft. 6-1/4" SDR.21 PVC
From To Ft.
From To Ft.
14. GROUT:
Depth Material Method
From 0 To 20 Ft QUILKRETE POURED
From To Ft.
15. SCREEN:
Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
From To Ft. in. in.
16. SAND?GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
17. REMARKS:
If additional spare is needed use back of form
D
0
1ND
C
0
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other reference points)
HWY. #64/74A W. FROM RUTHERFORDTON. LEFT ON
MAPLE CREEK RD. NEW DRIVE, 1/4 MILE ON LEFT.
QECErr
NED (At_rrplc WATE
I DO CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THISRECORD HAS BEEN PROVIDED TO THE WELL OWNER
FOR OFFICE USE ONLY
Quad No:
Serial No.
SIGNATCTRE OF PERSON CONSTR CU TING�T WELL ` C DATE/ I / C/ C
ginal to Division of Water Quality, Groundwater Section within 30 days
GW-1 REV. 12/99

Material Method
Ft. OUILKRETE POURED
Ft.
North Carolina — Department of Environment and Natural Resources — Division of Water
1636 Mail Service Center — Raleigh, N.C. 27699-1636 — Phone [phone] QualityGroundwater Section
WELL CONSTRUCTION RECORD WELL CONTRACTOR: RODNEY ROBBINS
WELL CONTRACTOR CERTIFICATION #: 2785
STATE WELL CONSTRUCTION PERMIT #:
1. WELL USE (Check Applicable Box): ❑ Residential ❑ Municipal ❑ Industrial ® Agricultural 0 Monitoring
Diameter Slot Sizen
Ft. in._ i_
Ft. in. in.
From To Ft. _ in. in
16. SAND?GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
17. REMARKS:
0 Recovery 0 Heat Pump Water Injection 0 Other If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: RUTHERFORDTON County: RUTH
826 DARK CORNER RD. DRILLING LOG DEPTH
(Road Name and Numbers, Community, or Subdivision and Lot No.) From To Formation Description
3. OWNER JOHNNY BRADLEY
Address 826 DARK CORNER RD.
(Street or Route No.)
RUTHERFORDTON NC 28139
City or Town State Zip Code
4. DATE DRILLED 11/03/06
5. TOTAL DEPTH 385
6. CUTTING COLLECTED 0 YES ® NO
7. DOES WELL REPLACE EXISTING WELL? 0 YES El NO
8. STATIC WATER LEVEL Below Top of Casing: 60 FT.
(Use "+" if Above Top of Casing)
9. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2C.0118
10. YIELD (gpm): 30 METHOD OF TEST: ARD
11. WATER ZONES (depth):
12. CHLORINATION: Type: CHLORYTE Amount: 9.5
13. 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.
14. GROUT:
Depth
From 0 To 20
From To
15. SCREEN:
Depth Material
From To
From To
335726
0
rc
0
O
0
J
If additional space is needed use back of form
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other reference points)
FROM SHILOH. GO DOWN BIG ISLAND RD. RIGHT ON 15T
DARK CORNER RD. 1 MILE ON RIGHT. (826 ON POST)
ter or voiFRE� Irk
I DO CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THISRECORD HAS BEEN PROVIDED TO THE WELL OWNER.
FOR OFFICE USE ONLY
Quad No:
Serial No.
Sub
P/it7/ .sJ ..�1Q� //- 3 "
SIG ATURE OF P ON CONSTRUCTING THE LL DATE
original to Division of Water Quality, Groundwater Section within 30 days
GW-1 REV. 12/99

North Carolina — Department of Environment and Natural Resources — Division of Water
1636 Mail Service Center — Raleigh, N.C. 27699-1636 — Phone [phone] QualityGroundwater Section
WELL CONSTRUCTION RECORD WELL CONTRACTOR: RODNEY ROBBINS
WELL CONTRACTOR CERTIFICATION #: 2785
STATE WELL CONSTRUCTION PERMIT #:
I. WELL USE (Check Applicable Box): ® Residential ❑ Municipal 0 Industrial 0 Agricultural gn 0 Monitoring
0 Recovery 0 Heat Pump Water Injection 0 Other If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: RUTHERFORDTON County: RUTH
OVERSTONE DR (LOT #281) DRILLING LOG DEPTH
(Road Name and Numbers, Community, or Subdivision and Lot No.) From To Formation Description
3. OWNER BILL SOMMERS
Address OVERSTONE DR -LOT #281
(Street or Route No.)
RUTHERFORDTON NC 28139
City or Town State Zip Code
4. DATE DRILLED 11/02/06
5. TOTAL DEPTH 505
6. CUTTING COLLECTED 0 YES ® NO
7. DOES WELL REPLACE EXISTING WELL? 0 YES ® NO
8. STATIC WATER LEVEL Below Top of Casing: 80 FT.
(Use "+" if Above Top of Casing)
9. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2C.0118
10. YIELD (gpm): 3 METHOD OF TEST: ARD
11. WATER ZONES (depth):
12. CHLORINATION: Type: CHLORYTE Amount: 13.5
13. CASING:
From 0 T 7
From
From To
14. GROUT:
Depth
From 0 To 20
From To
15. SCREEN:
Depth
From To
From To
From To
16. SAND?GRAVEL PACK:
Depth Size
From To Ft.
From To Ft.
17. REMARKS:
0
Wall Thickness
Depth Diameter or Weight/Ft. Material
0 Ft. 6-1/4" SDR21 PVC
To Ft.
Ft.
Material Method
Ft. QUILKRETE POURED
Ft.
Diameter Slot Size Material
Ft. in. in.
Ft. in. in.
Ft. in. in.
Material
If additional space is needed use back of form
335727
lu
0
0
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other reference points)
HWY. #64 W. FROM RUTH. LEFT ON MTN. CREEK RD. LEFT
ON CLEARWATER PKWY. LEFT ON CHIMNEY CRK. LANE.
LEFT ON BITTEROOT CIRCLE. STRAIGHT ON OVERSTONE
DR. LOT #281 ON RT.
uv_ r,RECEep i lAl )Ty
I DO CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THISRECORD HAS BEEN PROVIDED TO THE WELL OWNER
FOR OFFICE USE ONLY
Quad No:
Serial No.
Submit
A OF ' RSON CO' • TRU t G THE WE L DATE
o Division of Water Quality, Groundwater Section within 30 days
GW-1 REV. 12/99

North Carolina — Department of Environment and Natural Resources — Division of Water Quality — Groundwater Section
1636 Mail Service Center — Raleigh, N.C. 27699-1636 — Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR: JEFF MELTON
WELL CONTRACTOR CERTIFICATION #: 3417
STATE WELL CONSTRUCTION PERMIT #:
1. WELL USE (Check Applicable Box): In Residential 0 Municipal 0 Industrial ❑ Agricultural
❑ RecoveryEl Monitoring
Heat Pump Water Injection 0 Other If Other, List Use:
2. WELT LOCATION: (Show sketch of the location below)
Nearest Town: LAKE LURE County: RUTH
HICKORY NUT RD. DRILLING LOG DEPTH
(Road Name and Numbers, Community, or Subdivision and Lot No.) From To Formation Description
3. OWNER PHIL DAVIS
Address HICKORY NUT RD.
(Street or Route No.)
LAKE LURE NC 28746
City or Town State Zip Code
4. DATE DRILLED 11/15/06
5. TOTAL DEPTH 605
6. CUTTING COLLECTED 0 YES NO
7. DOES WELL REPLACE EXISTING WELL? 0 YES ® NO
8. STATIC WATER LEVEL Below Top of Casing: 0 FT.
(Use `4" if Above Top of Casing)
9. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2CA118
10. YIELD (gpm): 0 METHOD OF TEST: ARD
11. WATER ZONES (depth):
12. CHLORINATION: Type: CHLORYTE Amount: 16.5
13. CASING:
Wall Thickness
Depth Diameter or Weight/Ft Material
From 0 To 45 Ft. 6-1/4" SDR.21 PVC
From To Ft.
From To Ft.
14. GROUT:
Depth Material Method
From 0 To 20 Ft. QUIKRETE POURED
From To Ft.
15. SCREEN:
Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
From To Ft. in. in.
16. SAND?GRAVEL PACK:
Depth Size Material
From To Ft. _
From To Ft.
17. REMARKS:
If additional space is needed use back of form
33,5729
0
e.a
0
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other reference points)
HWY. #64/74A W. FROM RFTN. RT.ON BILLS CREEK RD.
LEFT ON CEDAR CREEK RD. LEFT ON SEARCY RD. LEFT
ON PEAR TREE. LEFT ON HICKORY NUT RD. NEW DRIVE
1/4 MILE ON LEFT.
RECEIVED
0IV. OF WATER QUALITY
DEC 12 Zoos
I DO CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THISRECORD HAS BEEN PROVIDED TO THE WELL OWNER.
FOR OFFICE USE ONLY
Quad No:
Serial No.
�✓ Z7/7P -/ 5-- 6
SIGNATURE O1' PERSON CONSTRUCTING T1tIE WELL DATE
ubmit original to Division of Water Q tlity, Groundwater Section within 30 days
GW-1 REV. 12/99

North Carolina — Department of Environment and Natural Resources — Division of Water Quality — Groundwater Section
1636 Mail Service Center — Raleigh, N.C. 27699-1636 — Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR: JEFF MELTON WELL CONTRACTOR CERTIFICATION #: 3417 333732
STATE WELL CONSTRUCTION PERMIT #:
1. WELL USE (Check Applicable Box): ® Residential 0 Municipal
0 Recovery❑IndusLat ❑Agricultural 0 Monitoring
0Heat Pump Water Injection 0 Other If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: LAKE LURE County: RUTH
THE PEAKS DRILLING LOG (Road Name and Numbers, Community, or Subdivision and Lot No.) From To DEPTH
3. OWNER NED KISNER Formation Description
Address THE PEAKS
(Street or Route No.)
LAKE LURE NC 28746
City or Town State Zip Code
4. DATE DRILLED 11/08/06
5. TOTAL DEPTH 205
6. CUTTING COLLEC 1'ED 0 YES NO
7. DOES WELL REPLACE EXISTING WELL? 0 YES ® NO
8. STATIC WATER LEVEL Below Top of Casing: 120 FT.
(Use "+" if Above Top of Casing)
9. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
Top of casing terminated at/or below land surface requires a variance in accor-
dance with I5A NCAC 2C.0118
10. YIELD (gpm): .( METHOD OF TEST: ARD
11. WATER ZONES (depth):
12. CHLORINATION:
13. CASING:
From 0 ToDepth 30
From To____
From To_
14. GROUT:
Depth
From 0 To 20
From To
15. SCREEN:
Depth
From To
From To
From To
16. SAND?GRAVEL PA
Depth
From To
From To
17. REMARKS:
Type: CHLORYTE Amount: 4.5
Wall Thickness
Diameter or Weight/Ft Material
FL 6-1/4" SDR21 PVC
Ft.
Ft.
Material Method
Ft. OUIKRETE POURED
Ft.
Diameter Slot Size Material
Ft. in. in.
Ft. in. in,
Ft. in.__ in.
CK:
Size Material
Ft.
Ft.
If additional space is needed use back of form
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other reference points)
HWY. 64/74 A W. FROM RFTD. LEFT ON ISLAND CREEK RD.
LEFT INTO "THE PEAKS" 1ST. LOT ON LEFT.
kEGENED
nr,r GF �Nql ER C1llAlti�
OEC 2 2006
I DO CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THISRECORD HAS BEEN PROVIDED TO THE WELL OWNER.
FOR OFFICE USE ONLY
Quad No:
Serial No.
'1a • �5 2 or7u� . c 06 SIGNA OF PE N CONSTRUCTING THE WELL DATE
Submit original to Division of Water Quality, Groundwater gel -lion within 30 days
GW-I REV. 12/99

North Carolina — Department of Environment and Natural Resources — Division of Water Quality Groundwater Section
1636 Mail Service Center — Raleigh, N.C. 27699-1636 — Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR: JEFF MELTON
WELL CONTRACTOR CERTIFICATION #: 3417
STATE WELL CONSTRUCTION PERMIT #:
335733
1. WELL USE (Check Applicable Box): ® Residential ❑ Municipal 0 Industrial U Agricultural 0 Monitoring
❑ Recovery ❑ Heat Pump Water Injection 0 Other
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: FOREST CITY County: RUTH
3618 WHITESIDE RD.
(Road Name and Numbers, Community, or Subdivision and Lot No.)
3. OWNER SHERYL BURNHAM
Address 3618 WHITESIDE RD.
(Street or Route No.)
FOREST CITY NC 28043
City or Town State Zip Code
4. DATE DRILLED 11/06/06
5. TOTAL DEPTH 225
6. CUTTING COLLECTED 0 YES ® NO
7. DOES WELL REPLACE EXISTING WELL? 0 YES ® NO
8. STATIC WATER LEVEL Below Top of Casing: 60 FT.
(Use "+" if Above Top of Casing)
9. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
'Top of casing terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2C.0118
10. YIELD (gpm): 5 METHOD OF TEST: ARD
11. WATER ZONES (depth):
12. CHLORINATION: Type: CHLORYTE Amount: 5
13. CASING:
Wall Thickness
Depth Diameter or Weight/Ft Material
From 0 To 75 Ft. 6-1/4" SDR21 PVC
From To Ft.
From To Ft. _
14. GROUT:
Depth Material Method
From 0 To 20 Ft. OUIKRETE POURED
From To Ft.
15. SCREEN:
Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in.
From To
in.
Ft. _ in._ in.
16. SAND?GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
17. REMARKS:
If Other, List Use:
DRILLING LOG DEPTH
From To Formation Description
0
0
0
0
ti
If additional space is needed use back of form
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other reference points)
BUS. 74 E. FROM FOREST CITY. LEFT ON BOSTIC/SUNSHINE
RD. LEFT ON PEA RIDGE RD. IN BOSTIC. LEFT ON
WHITESIDE RD. APPROX 1/2 MILE, SINGLE WIDE ON LEFT.
RECEIVED
plv. OF 1NATPR OIJAL1TF
h.".� `2- ?OOP:
I DO CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THISRECORD HAS BEEN PROVIDED TO THE WELL OWNER.
FOR OFFICE USE ONLY
Quad No:
Serial No.
dte
) k r'hr( n, %/ (a - 6
SIGNATURE 0 PERSON CONSTRUCTING THE WELL DATE
Submit original to Division of Water Quality, Groundwater Section within 30 days
GW-1 REV. 12/99

North Carolina — Department of Environment and Natural Resources — Division of Water
1636 Mail Service Center — Raleigh, N.C. 27699-1636 — Phone [phone] Quality — Groundwater Section
WELL CONSTRUCTION RECORD WELL CONTRACTOR: JEFF MELTON
WELL CONTRACTOR CERTIFICATION #: 3417
STATE WELL CONSTRUCTION PERMIT #:
1. WELL USE (Check Applicable Box): 0 Residential 0 Municipal 0 Industrial 0 Agricultural ❑ Monitoring
0 Recovery 0 Heat Pump Water Injection 0 Other If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: RUTHERFORDTON County: RUTH
220 MUSTANG TRAIL DRILLING LOG DEPTH
(Road Name and Numbers, Community, or Subdivision and Lot No.) From To Formation Description
3. OWNER COY BLANKENSHIP
Address 220 MUSTANG TRAIL
(Street or Route No.)
RUTHERFORDTON NC 28139
City or Town State Zip Code
4. DATE DRILLED 11/02/06
5. TOTAL DEPTH 705
6. CUTTING COLLECTED L
7. DOES WELL REPLACE EXISTING WELL? ® YES 0 NO0
IND
8. STATIC WATER LEVEL Below Top of Casing: 0 FT.
(Use "+" if Above Top of Casing)
9. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2C.0118
10. YIELD (gpm): 0 METHOD OF TEST: ARD
11. WATER ZONES (depth):
12. CHLORINATION: Type: CHLORYTE Amount: 19.5
13. CASING:
Wall Thickness
Depth Diameter or Weight/Ft Material
From 0 To 45 Ft. 6-1/4" SDR21 PVC
From To Ft. _
From To Ft.
14. GROUT:
Depth Material Method
From 0 To 20 Ft.OUIKRETE POURED
From To Ft.
15. SCREEN:
Depth Diameter Slot Size Material
From To Ft. in. in.
From _ To Ft. in. in.
From To Ft. in. in.
16. SAND?GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
17. REMARKS:
If additional space is needed use back of form
335735
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other reference points)
FROM SHILOH. GO DOWN POORS FORD RD. RIGHT ON
MUSTANG TRAIL. 3 RD. DRIVE ON RIGHT.
RECEIVED
niv OF WATER QUALITY
(I 1 '9, Z006
I DO CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THISRECORD HAS BEEN PROVIDED TO THE WELL OWNER
FOR OFFICE USE ONLY
Quad No:
Serial No.
SIGNATURE PER CONSTRUCTING WELL DATE
ubmit original to Division of Water Quality, Groundwater Section within 30 days
GW-1 REV. 12/99

North Carolina — Department of Environment and Natural Resources — Division of Water Quality — Groundwater Section
1636 Mail Service Center — Raleigh, N.C. 27699-1636 — Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR ROBIN MCNEELY
WELL CONTRACTOR CERTIFICATION #: 2567
STATE WELL CONSTRUCTION PERMIT #:
1. WELL USE (Check Applicable Box): ® Residential 0 Municipal 0 Industrial 0 Agricultural 0 Monitoring
0 Recovery 0 Heat Pump Water Injection 0 Other If Other, List Use:
2 WFI.I LOCATION: (Show sketch of the location below)
Nearest Town: RUTHERFORDTON County: RUTH
MEADOWS DR DRILLING LOG
(Road Name and Numbers, Community, or Subdivision and Lot No.) From To Formation
3. OWNER LARRY LATTIMORE
Address MEADOWS DR
(Street or Route No.)
RUTHERFORDTON NC 28139
City or Town State Zip Code
4. DATE DRILLED 11/27/06
5. TOTAL DEPTH 73
6. CUTTING COLLECTED 0 YES ® NO
7. DOES WELL REPLACE EXISTING WELL? 0 YES ® NO
8. STATIC WA That LEVEL Below Top of Casing: 53 FT.
(Use "+" if Above Top of Casing)
9. TOP OF CASING IS 1-1/2 FT. Above Land Surface'
'Top of casing terminated at/or below land surface requires a variance in accor-
dance with 15ANCAC 2C.0118
10. YIELD (gpm): 20 METHOD OF TEST: STEEL TAPE
11. WATER ZONES (depth):
12. CHLORINATION:
13. CASING:
Depth
From 0 To 73
From To
From To
14. GROUT:
Depth
From 0 To 20
From To
15. SCREEN:
Depth
From To
Type: CHLORYTE Amount: 9.2
Diameter
Ft. 24
Ft.
FL
Wall Thickness
or Weight/Ft Material
CEMENT
Material Method
Ft. CEMENT POURED
Ft.
Diameter Slot Size Material
FL in. in.
From To Ft. in. in.
From To Ft. in. in.
16. SAND?GRAVEL PACK:
Depth Size Material
From 53 To 73 Ft. 78M GRAVEL
From To FL
17. REMARKS:
DEPTH
If additional space is needed use back of' form
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other reference points)
HWY. #64/74A W. FROM RUTHERFORDTON. LEFT ON
MAPLE CREEK RD. RT. ON STARVIEW RD. RT. ON
MEADOWS DR 2ro LOT ON RIGHT.
RECEIVED
OIV. OF WATER QUALITY
DEL 1 t ?1,106
I DO CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THISRECORD HAS BEEN PROVIDED TO THE WELL OWNER
FOR OFFICE USE ONLY
Quad No:
Serial No.
IGNA
Submit original to Division
Ori ihaf1 /% ^i- (:h
ONL'ONSTRUCTTNG THE LL DATE
ater Quality, Groundwater Section within 30 days
GW-1 REV. 12/99

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
I636 Mail Service Center - Raleigh, N.0 27699-1636 - Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR: ROBIN MCNEELY
WELL CONTRACTOR CERTIFICATION #: 2567
STATE WELL CONSTRUCTION PERMIT #:
335706
1. WELL USE (Check Applicable Box): ® Residential ❑ Municipal ❑ Industrial 0 Agricultural U Monitoring
❑ Recovery 0 Heat Pump Water Injection ❑ Other If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: FOREST CITY County: RUTH
CAPPS RD. DRILLING LOG
(Road Name and Numbers, Community, or Subdivision and Lot No.) From To
3. OWNER BILLY & DONNA CAMPBELL
Address CAPPS RD.
(Street or Route No.)
FOREST CITY NC 28043
City or Town State Zip Code
4. DATE DRILLED 11/14/06
5. TOTAL DEPTH 68
6. CUTTING COLLECTED 0 YES ® NO
7. DOES WELL REPLACE EXISTING WELL? ❑ YES ® NO
8. STATIC WATER LEVEL Below Top of Casing: 48 FT.
(Use "+" if Above Top of Casing)
9. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
"Top of casing terminated atior below land surface requires a variance in accor-
dance with ! SA NCAC 2C.0118
10. YIELD (gpm): 20 METHOD OF TEST: STEEL TAPE
11. WATER ZONES (depth):
12. CHLORINATION: Type: CHLORYTE Amount: 9.2
13. CASING:
Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 68 Ft. 24 CEMENT
From To Ft.
From To Ft.
14. GROUT:
Depth Material Method
From 0 To 20 Ft. CEMENT POURED
From To Ft.
15. SCREEN:
Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
From To Ft. in. in.
16. SAND?GRAVEL PACK:
Depth Size Material
From 48 To 68 Ft. 78M GRAVEL
From To Ft.
17. REMARKS:
DEPTH
Formation Description
If additional she is needed use back of form
(Show
POORS FORD
CHURCH RD.
LOCATION SKETCH
direction and distance from at least two State
Roads, or other reference points)
RD. FROM SHILOH. RT. ON GRAYS CREEK
LEFT ON CAPPS RD. 2r7D HOUSE ON LEF 1.
RECEIVED
fIV. OF WATER QUALITY
nEC I °I 7006
I DO CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THISRECORD HAS BEEN PROVIDED TO THE WELL OWNER
FOR OFFICE USE ONLY
Quad No:
Serial No.
SIG 4ATIx
Submit original to Division of W*
J � CerAS //- /SV -GE
3 1 CQ" SI (.UCTING THE WELL DATE
Quality, Groundwater Section within 30 days
(3 -I REV. 12/99

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mail Service Center - Raleigh, N.C. 27699-1636 -Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR: ROBIN MCNEELY
WELL CONTRACTOR CERTIFICATION #: 2567
STATE WELL CONSTRUCTION PERMIT #:
33 707
I. WELL USE (Check Applicable Box): ® Residential ❑ Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring
❑ Recovery ❑ Heat Pump Water Injection ❑ Other If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: FOREST CITY County: RUTH
GODFREY RD. DRILLING LOG DEPTR
(Road Name and Numbers, Community, or Subdivision and Lot No.) From To Formation Description
3. OWNER GLENN JORDAN
Address GODFREY RD.
(Street or Route No.)
FOREST CITY NC 28043
City or Town State Zip Code
4. DATE DRILLED 11/13/06
5. TOTAL DEPTH 71
6. CUTTING COLLECTED ❑ YES Z NO
7. DOES WELL REPLACE EXISTING WELL? ❑ YES ® NO
8. STATIC WATER LEVEL Below Top of Casing: 51 FT.
(Use "+" if Above Top of Casing)
9. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
'Top of casing terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2C.0118
10. YIELD (gpm): 20 METHOD OF TEST: S PEEL TAPE
11. WATER ZONES (depth):
12. CHLORINATION: Type. CHLORYTE Amount: 9.2
13. CASING:
Depth Diameter
From 0 To 71 Ft. 24
From To Ft.
From To Ft.
14. GROUT:
Depth Material Method
From 0 To 20 Ft. CEMENT POURED
From To Ft.
15. SCREEN:
Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
From To Ft. in. in.
16. SAND?GRAVEL PACK:
Depth Size Material
From 51 To 71 Ft. 78M GRAVEL
From To Ft.
17. REMARKS: .
Wall Thickness
or Weight/Ft Material
CEMENT
If additional space is needed use back of form
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other reference points)
HWY. #221 S. FROM RUTTHERFORDTON. RT. ON SHILOH
RD. LEFT ON GODFREY RD. APPROX. 1 MILE. LEFT INTO
2"'o ENTRANCE TO TRAILER PARK. DEAD END ON RT.
:.CE'JED
NA—N.=;r QUALITY
1 z: 21106
I DO CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THISRECORD HAS BEEN PROVIDED TO THE WELL OWNER.
FOR OFFICE USE ONLY
Quad No:
Serial No.
Submit original to Division of Wa
SIGNATURE OF PCONSTRUCTING THE WELL DATE
Quality, Groundwater Section within 30 days
GW-I REV. 12/99

❑ Recovery ❑ Heat Pump Water Injection ❑ Other
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: RUTHERFORDTON County: RUTH
LEWIS RD.
(Road Name and Numbers, Community, or Subdivision and Lot No.)
3. OWNER TOM STOVER
Address LEWIS RD.
(Street or Route No.)
RUTHERFORDTON NC 28139
City or Town State Zip Code
4. DATE DRILLED 11/01/06
5. TOTAL DEPTH 49
6. CUTTING COLLECTED ❑ YES ® NO
7. DOES WELL REPLACE EXISTING WELL? ❑ YES ® NO
8. STATIC WATER LEVEL Below Top of Casing: 29 FT.
(Use "+" if Above Top of Casing)
9. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2C.0118
10. YIELD (gpm): 20 METHOD OF TEST: STEEL TAPE
11. WATER ZONES (depth):
12. CHLORINATION: Type: CI -IL ORYTE Amount: 9.2
13. CASING:
Wall Thickness
Depth Diameter or Weight/Ft Material
From 0 To 49 FI. 24 CEMENT
From To Ft.
From To Ft.
14. GROUT:
Depth Material Method
From 0 To 20 Ft. CEMENT POURED
From To Ft.
15. SCREEN:
Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. _ in. in.
From To Ft. in. in.
16. SAND?GRAVEL PACK:
Depth Size Material
From 29 To 49 Ft. 78M GRAVEL
From To Ft.
17. REMARKS:
North Carolina — Department of Environment and Natural Resources — Division of Water Quality — Groundwater Section
1636 Mail Service Center — Raleigh, N.C. 27699-1636 — Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR: ROBIN MCNEELY
WELL CONTRACTOR CERTIFICATION #: 2567
STATE WELL CONSTRUCTION PERMIT #:
335799
1. WELL USE (Check Applicable Boa): ® Residential 0 Municipal ❑ Industrial 0 Agricultural 0 Monitoring
If Other, List Use:
DRILLING LOG DEPTH
From To Formation Description
If additional space is needed use back of form
0
iV
0
0
0
ti
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other reference points)
HWY. #221 N. FROM RUTHERFORDTON. LEFT ON MTN.
CREEK RD. RT. ON LEWIS RD. CROSS OVER BRIDGE. LAST
HOSUE ON RT. (YELLOW)
RECEIVED
illl!_ OF WATRR C)lt TV
nE_1` t 70D6
I DO CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THISRECORD HAS BEEN PROVIDED TO THE WELL OWNER.
FOR OFFICE USE ONL
Quad No:
Serial No
Submit original to Division of W
n Ct
SIGNATUIYE OF PFyiN C STRUCTING THE WELL DATE
Quality, Groundwater Section within 30 days
GW-1 REV. 12/99

636 Mail Service Center— Raleigh, N.C. 27699-1636 — Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR: JEFF MELTON
WELL CONTRACTOR CERTIFICATION #: 3417
STATE WELL CONSTRUCTION PERMIT #:
335710
. WELL USE (Check Applicable Box): U Residential Li Municipal 0 Industrial 0 Agricultural 0 Monitoring
❑ Recovery 0 Heat Pump Water Injection ® Other If Other, List Use: PUBLIC
. WELL LOCATION: (Show sketch of the location below)
dearest Town: LAKE LURE County: RUTHERFORD
JOYS CAMP RD. DRILLING LOG DEPTH
Road Name and Numbers, Community, or Subdivision and Lot No.) From To Formation Defrcriptiott
OWNER BLUE HERON POINT -WELL #2 _
Wddress BOYS CAMP RD.
Street or Route No.)
JAKELIRIF NC 28746
:ity or Town State Zip Code
DATE DRILLED 03 03/06
1. TOTAL DEPTH 705
�. CUTTING COLLECLED 0 YES ® NO
r. DOES WELL REPLACE EXISTING WFII 7 ❑ YES ® NO
1. STATIC WATER LEVEL Below Top of Casing. 60 FT.
Use "+" if Above Top of Casing)
TOP OF CASING IS I-1/2 FT. Above Land Surface*
Top of casing terminated ator below land surface requires a variance in accor-
Iaaco with 15ANCAC 2C.0118
1.0. YIELD (gpm): 8 METHOD OF TEST: ASD
t1. WAIERZONES (depth):
t2. CHLORINATION:
t3. CASING:
Depth
From 0 To 70
3ALV.W/DRIVESHOE
From To____
From To
l4. GROUT:
Depth
From 0 To20
From To
l5. SCREEN:
Depth
From To
From To
From To
Type: CHLORYTE Amount 19.5
Wall Thickness
Diameter or Weight/Ft. Material
Ft. 6-5/8" 250 WALL
Ft.
Ft.
Material Method
Ft.OUIKRETE POURED
Ft.
Diameter Slot Size Material
Ft. _ in. in.
FL in. in._
FL in. in._
16. SAND?GRAVEL PACK:
Depth Size Material
From To FL
From To_Ft. ___
17. REMARKS: _
If additional space is needed use back of form
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other reference points)
HWY. #64/74 W. FROM RUTHERFORDTON. RT. ON BOYS
CAMP RD. IN LAKE LURE. GO TO DEAD END. BLUE HERON
IS ON LEFT.
RECEIVED
ON or 1\NATTE. R OnnULLALITY
[ DO CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THISRECORD HAS BEEN PROVIDED TO THE WELL OWNER.
FOR OFFICE USE ONLY
Quad No:
Serial No.
3- 3 -o(
SIGNATdRE PERSON C NSO TRUdING THE WELL DATE
Submit original to Division of Water Quality, Groundwater Section within 30 days
/N/
GW-1 REV. 12/99

636 Mail Service Center— Raleigh, N.C. 27699-1636 — Phone [phone]
YELL CONSTRUCTION RECORD WELL CONTRACTOR: JEFF MELTON
WELL CONTRACTOR CERTIFICATION #: 3417
STATE WELL CONSTRUCTION PERMIT #:
335711
. WELL 173E (Check Applicable Box): 0 Residential 0 Municipal 1J Industrial 0 Agricultural 0 Monitoring
❑ Recovery 0 Heat Pump Water Injection ® Other If Other, List Use: PUBLIC
. WELL LOCATION: (Show sketch of the location below)
dearest Town: LAKE LURE County: RUTH
SOYS CAMP RD. DRILLING LOG DEPTH
Road Name and Numbers, Community, or Subdivision and Lot No.) From To Formation Description
OWNER BLUE HERON POINT -WELL #3
Wires BOYS CAMP RD,
Street or Route No.)
,AKE LURE N.0 28746
ity Town State Zip Code
. DAorTE DRILLED 04/22/06
TOTAL DEPTH 585
i. CUTTING COLLEc1w 0 YES ® NO
'. DOES WELL REPLACE EXISTING WELL? 0 YES ® NO
1. STATIC WATER LEVEL Below Top of Casing: JALFT.
Use "+" if Above Top of Casing)
t. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
Top of easing terminated at/or below Land surface requires a valiance in acror-
have with 15ANCAC 2C.ot 18
.0. YIELD (gpm): 30 METHOD OF TEST: ARD
[1. WATER ZONES (depth):
[2. CHLORINATION: Type: CHLORYTE Amount 15.5
l3. CASING:
Wall Thickness
Depth Diameter or Weight/Ft Material
From 0 To 93 Ft. 8" 322 WALL GALV.T&C
From To, Ft.
From To Ft
l4. GROUT:
Depth Material Method
From 0 To 20 Ft OUIKRETE POURED
From _ To Ft.
l5. SCREEN:
Depth Diameter Slot Size Material
From To Ft in. in._
From _ To Ft _ in. in.�
From To Ft in. _ in.
16. SAND7GRAVEL PACK:
Depth Size Material
From _ To Ft _
From _ To� Ft
17. REMARKS:
If additional space is needed use back of form
1.ACATION SKETCH
(Show direction and distance from at least two State
Roads, or other reference points)
HWY. 464/74 W. FROM RUTBERFORDTON. RT. ON BOYS
CAMP RD, IN LAKE LURE. GO TO DEAD END. BLUE HERON
IS ON LEFT.
RECEIVED
me VJtTr ' (II iAIITV
l- . 1, 9 'il(U:
[ DO CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WRII
CONSTRUCTION STANDARDS, AND THAT A COPY OF THISRECORD HAS BEEN PROVIDED TO THE WELL OWNER.
FOR OFFICE USE ONLY
Quad No:
Serial Na
' -e SIGNATIJREOFPERSON CON TRUCI"ING THE WELL DATE
Submit original to Division of Water Quality, Gramdwater Section within 30 days
GW-1 REV. 12/99

15. SCREEN:
Depth
From _T
From _T
636 Mail Service Center- Raleigh, N.C. 27699-1636 - Phone [phone]
NELL CONSTRUCTION RECORD WELL CONTRACTOR JEFF MELTON
WELL CONTRACTOR CERTIFICATION #: 3417
STATE WELL CONSTRUCTION PERMIT it:
335712
WELL USE (Check Applicable Bo:): ❑ Residential Cj M�� 0 Industrial 0 Agricultural El Monitoring
El Recovery 0 Heat Pump Water Injection El Other If Other, List Use: PUBLIC
!. WELL LOCATION: (Show sketch of the location below)
1ear� Town: LAKE LURE County: RUTH
30YS CAMP RD, DRILLING LOG DEPTH
Road Name and Numbers, Community, or Subdivision and Lot No.) From To Formation Description
1.OWNER BLUE HERON POINT -WELL #4 _
Address BOYS CAMP RD.
Street or Route No.)
;AKE LURE NC 28746
:ity or Town State Zip Code
I. DATE DRILLED 08/08✓06
3. TOTAL DEPTH 605
i. CUTTING COLLEefhi El YES ►5 NO
7. DOES WELL REPLACE EXISTING WELL? 0 YES it NO
I. STATIC WATER LEVEL Below Top of Casing 180 FT.
User "+" if Above Top of Casing)
j. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
'Top of casing tarmiortod at/or below Lndsurface stokes a variance in acorn --
lance with 15ANCAC 2C.0118
10. YIELD (gpm): 26 METHOD OF TEST: ARA
11. WATER ZONES (depth):
12. CHLORINATION: Type: CHLORYTE Amount: 16.5
13. CASING:
Wall Third
Depth Diameter or Weight/Ft Materiel
From 0 To 95 Ft. 6 5/8" 250 WALL GALV.T&C
From _To_ Ft. �
From To Ft _
14. GROUT:
Depth Material Method
From 0 To 20 Ft. QUIICRETE POURED
From To Ft
o_
Material
If additional space is needed use back of fork
0
zCts
0
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other reference points)
HWY. #64/74 W. FROM RUTHERFORDTON. RT. ON BOYS
CAMP RD. IN LAKE LURE. GO TO DEAD END. BLUE HERON
IS ON LEFT.
RECEIVED
ONS6, OF WATER QUALITY
9; 2006
I DO CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THISRECORD HAS BEEN PROVIDED TO THE WELL OWNER.
FOR OFFICE USE ONLY /% (��
Quad No: // jf,0 ,f .�T///iJo'hQ-. f /CA G THE WELL DATE'
Serial No I l SIGNA PERSON CONSTR.')
R
Submit original to Division of Water Quality, Groundwater Section within 30 days
GW-1 REV. 12/99

North Carolina — Department of Environment and Natural Resources — Division of Water Quality — Groundwater Section
1636 Mail Service Center — Raleigh, N.C. 27699-1636 — Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR: RODNEY ROBBINS
WELL CONTRACTOR CERTIFICATION #: 2785
STATE WELL CONSTRUCTION PERMIT #:
335713
1. WELL USE (Check Applicable Bos): ❑ Residential ❑ Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring
❑ Recovery ❑ Heat Pump Water Injection ® Other If Other, List Use: PUBLIC
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: LAKE LURE County: RUTH
BOYS CAMP RD. FIREFLY COVE DRILLING LOG DEPTH
(Road Name and Numbers, Community, or Subdivision and Lot No.) From To
3. OWNER JOHN CLOUD
Address BOYS CAMP RD. FIREFLY COVE
(Street or Route No.)
LAKE LURE NC 28746
City or Town State Zip Code
4. DATE DRILLED 10/12/06
5. TOTAL DEPTH 605 WELL #1
6. CUTTING COLLECTED ❑ YES ® NO
7. DOES WELL REPLACE EXISTING WELL? ❑ YES ® NO
8. STATIC WATER LEVEL Below Top of Casing: 63 FT.
(Use "+" if Above Top of Casing)
9. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a variance in accor-
dance with 15ANCAC 2C.0118
10. YIELD (gpm): 23 METHOD OF TEST: FLOW METER
11. WATER ZONES (depth):
12. CHLORINATION: Type: CHLORYTE
13. CASING:
Amount: 5 LB.
Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 62 Ft. 8" 250 WALL GALV.
From To Ft.
From To Ft.
14. GROUT:
Depth Material Method
From 0 To 20 Ft. QULKRETE POURED
From To Ft.
15. SCREEN:
Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
From To Ft. in. in.
16. SAND?GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
17. REMARKS:
Formation Description
If additional space is needed use back of form
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other reference points)
RT. ON BOYS CAMP RD. IN LAKE LURE. 1/2 MILE ON RT.
RECEIVED
;:UV. OF WATER QUALITY
oEC 2006
I DO CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THISRECORD HAS BEEN PROVIDED TO THE WELL OWNER
FOR OFFICE USE ONLY
Quad No:
Serial No.
0/a/a•6
SIGNATURE OF PERSO CON UCTING THE WELL DATE
ginal to Division of Water Quality, Groundwater Section within 30 days
GW-1 REV. 12/99

North Carolina — Department of Environment and Natural Resources — Division of Water Quality — Groundwater motion
1636 Mail Service Center — Raleigh, N.C. 27699-1636 — Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR: RODNEY ROBBINS
WELL CONTRACTOR CERTIFICATION #: 2785
STATE WELL CONSTRUCTION PERMIT #:
335714
1. WELL USE (Check Applicable Box): ❑ Residential ❑ Municipal (J Industrial 0 Agricultural ❑ Monitoring
❑ Recovery ❑ Heat Pump Water Injection ® Other If Other, List Use: PUBLIC
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: LAKE LURE County: RUTH
BOYS CAMP RD. FIREFLY COVE DRILLING LOG DEPTH
(Road Name and Numbers, Community, or Subdivision and Lot No.) From To Formation Description
3. OWNER JOHN CLOUD
Address BOYS CAMP RD. FIREFLY COVE
(Street or Route No.)
LAKE LURE NC 28746
City or Town State Zip Code
4. DATE DRILLED 10/19/06
5. TOTAL DEPTH 405 WELL #2
6. CUTTING COLLECTED 0 YES ® NO
7. DOES WELL REPLACE EXISTING WELL? ❑ YES ® NO
8. STATIC WATER LEVEL Below Top of Casing: 60 FT.
(Use "+" if Above Top of Casing)
9. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
'Top of casing terminated at/or below land surface requires a variance in accor-
dance with I5ANCAC 2C.0118
10. YIELD (gpm): 9 METHOD OF TEST: FLOW METER
11. WATER ZONES (depth):
12. CHLORINATION: Type: CHLORYTE Amount: 5 LB.
13. CASING:
Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 63 Ft. 8" 250 WALL GALV.
From To Ft.
From To Ft.
14. GROUT:
Depth Material Method
From 0 To 20 Ft. OUILKRETE POURED
From To Ft.
15. SCREEN:
Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft in. in.
From To Ft. in. in.
16. SAND?GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
17. REMARKS:
If additional space is needed use back of form
r_
F
O
Iv
0
0
0
v
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other reference points)
RT. ON BOYS CAMP RD. IN LAKE LURE. 1/2 MILE ON RT.
RECEIVED
fIV OF WATER QUALITY
DEC 1 2 zoos
I DO CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THISRECORD HAS BEEN PROVIDED TO THE WELL OWNER.
FOR OFFICE USE ONLY
Quad No:
Serial No.
6
.e-,t . %l-- /n / Y-e
SIGNATURE OF PERSON CONSTRUCTING THE Wl LL DATE
original to Division of Water Quality, Groundwater Section within 30 days
GW-1 REV. 12/99

North Carolina — Department of Environment and Natural Resources — Division of Water Quality — Groundwater Section
1636 Mail Service Center — Raleigh, N.C. 27699-1636 — Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR: RODNEY ROBBINS
WELL CONTRACTOR CERTIFICATION #: 2785
STATE WELL CONSTRUCTION PERMIT #:
33571.5
1. WELL USE (Check Applicable Box): 0 Residential ❑ Municipal 0 Industrial ❑ Agricultural 0 Monitoring
❑ Recovery ❑ Heat Pump Water Injection ® Other If Other, List Use: PUBLIC
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: LAKE LURE County: RUTH
BOYS CAMP RD. FIREFLY COVE DRILLING LOG DEPTH
(Road Name and Numbers, Community, or Subdivision and Lot No.) From To Formation Description
3. OWNER JOHN CLOUD
Address BOYS CAMP RD. FIREFLY COVE
(Street or Route No.)
LAKE LURE NC 28746
City or Town State Zip Code
4. DATE DRILLED 10/02/06
5. TOTAL DEPTH 985 WELL #01
6. CUTTING COLLECTED 0 YES ® NO
7. DOES WELL REPLACE EXISTING WELL? ❑ YES ® NO
8. STATIC WATER LEVEL Below Top of Casing: 300 FT.
(Use "+" if Above Top of Casing)
9. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a variance in accor-
dance with I5ANCAC 2C.0118
10. YIELD (gpm): 1 METHOD OF TEST: ARD
11. WATER ZONES (depth):
12. CHLORINATION: Type: CHLORYTE Amount: 5 LB.
13. CASING:
Wall Thickness
Depth Diameter or Weight/Ft Material
From 0 To 63 Ft. 8" 250 WALL GALV.
From To Ft.
From To Ft.
14. GROUT:
Depth Material Method
From 0 To 20 Ft.OUILKRETE POURED
From To Ft.
15. SCREEN:
Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
From To Ft. in. in.
16. SAND?GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
17. REMARKS:
If additional space is needed use back of form
D
0
0
0
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other reference points)
RT. ON BOYS CAMP RD. IN LAKE LURE. 1/2 MILE ON RT.
RECEIVED
OI\t. OF WATER QUALITY
OE I_ I ) LOOfi
I DO CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THISRECORD HAS BEEN PROVIDED TO THE WELL OWNER
FOR OFFICE USE ONLY
Quad No:
Serial No.
-* cO ./6- a - 6
SIG A OF PEfC$O1tCONSTRUCTING THE WFI.I DATE
original to Division of Water Quality, Groundwater Section within 30 days
GW-1 REV. 12/99
r

North Carolina — Department of Environment and Natural Resources — Division of Water Quality — Groundwater Section
1636 Mail Service Center — Raleigh, N.C. 27699-1636 — Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR: RODNEY ROBBINS
WELL CONTRACTOR CERTIFICATION #: 2785
STATE WELL CONSTRUCTION PERMIT #:
335716
1. WELL USE (Check Applicable Box): 0 Residential 0 Municipal 0 Industrial 0 Agricultural 0 Monitoring
0 Recovery 0 Heat Pump Water Injection ® Other If Other, List Use: PUBLIC
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: LAKE LURE County: RUTH
BOYS CAMP RD. FIREFLY COVE DRILLING LOG DEPTH
(Road Name and Numbers, Community, or Subdivision and Lot No.) From To Formation Description
3. OWNER JOHN CLOUD
Address BOYS CAMP RD. FIREFLY COVE
(Street or Route No.)
LAKE LURE NC 28746
City or Town State Zip Code
4. DATE DRILLED 10/04/06
5. TOTAL DEPTH 805 WELL #02
6. CUTTING COLLECTED 0 YES ® NO
7. DOES WELL REPLACE EXISTING WELL? 0 YES ® NO
8. STATIC WATER LEVEL Below Top of Casing: 300 FT.
(Use "+" if Above Top of Casing)
9. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2C.0118
10. YIELD (gpm): 1 METHOD OF TEST: ARD
11. WATER ZONES (depth):
12. CHLORINATION: Type: CHLORYTE
13. CASING:
Amount: 5 LB.
Wall Thickness
Depth Diameter or Weight/Ft Material
From 0 To 63 Ft. 8" 250 WALL GALV.
From To Ft.
From To Ft.
14. GROUT:
Depth Material Method
From 0 To 20 Ft. QUILKRETE POURED
From To Ft.
15. SCREEN:
Depth
From To
From To
From To
16. SAND?GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
17. REMARKS:
Diameter Slot Size Material
Ft. in.
Ft in. itt
Ft. in. in.
If additional space is needed use back of form
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other reference points)
RT. ON BOYS CAMP RD. IN LAKE LURE. 1/2 MILE ON RT.
aiALITV
at" ; 1 °4 ZOOS
I DO CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THISRECORD HAS BEEN PROVIDED TO THE WELL OWNER
FOR OFFICE USE ONLY
Quad No:
Serial No.
IGN TURF OF PE ON CONSTRUCTING L ATE
ginal to Division of Water Quality, Groundwater Section within 30 days
GW-1 REV. 12/99

636 Mail Service Center — Raleigh, N.C. 27699-1636 — Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR: JEFF MELTON
WELL CONTRACTOR CERTIFICATION #: $417
STATE WELL CONSTRUCTION PERMIT #:
335717
WELL USE (Check Applicable Box): 0 Residential 0 Municipal 0 Industrial LJ Agucultural 0 Monitoring
0 Recovery 0 Heat Pump Water Injection ® Other If Other, List Use: PUBLIC
:. WELL LOCATION: (Show sketch of the location below)
dearest Town: LAKE LURE County: RUTH
TOYS CAMP RD. DRILLING LOG DEPTH
Road Name and Numbers, Community, or Subdivision and Lot No.) From To Formation Description
OWNER BLUE HERON POINT -WELL #1
,ddress BOYS CAMP RD.
Street or Route No.)
-AKE LURE NC 28746
,ity or Town State Zip Code
E. DATE DRILLED 02/28/06
i. TOTAL DEPTH 705
CUTTING COLLECTED 0 YES ® NO
F. DOES WFI.I REPLACE EXISTING WELL? 0 YES ® NO
t. STATIC WATER LEVEL Below Top of Casing: 80 FT.
Use "+" if Above Top of Casing)
). TOP OF CASING IS 1-1/2 FT. Above Land Surface*
Top of casing terminated at/or below Iand surface requires a variance in accor-
Iance with ISANCAC 2C.0118
[0. YIELD (gpm): 70 METHOD OF TEST: ARD
t 1. WATER ZONES (depth):
[2. CHLORINATION: Type: CIILORYTE Amount 19.5
13. CASING:
Depth Diameter
From 0 To 83 Ft. 8"
Wall Thickness
or Weight/Ft Material
250 WALL GALV.
From _ To Ft.
From, To Ft.
14. GROUT:
Depth Material Method
From 0 To 20 FtOUIKRETE POURED
From To Ft. ____
t5. SCREEN:
Depth Diameter Slot Size Material
From _ To Ft. in. in.
From _ To Ft. __ in. __ in.
From _ To Ft. __ in. in.
16. SAND?GRAVEL PACK:
Depth Size Material
From _ To Ft.
From To Ft. _
17. REMARKS: _
If additional space is needed use back of form
1y�
0
rya
0
0
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other reference points)
IIWY. #64/74 W. FROM RUTHERFORDTON. RT. ON BOYS
CAMP RD. IN LAKE LURE. GO TO DEAD END. BLUE HERON
IS ON LEFT.
f); / OF ATEER QUALITY
°FC " °4 '006
1 DO CERTIFY THAT THIS WELL WAS CONSTRUC1bI) IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THISRECORD HAS BEEN PROVIDED TO THE WELL OWNER.
FOR OFFICE USE ONLY
Quad No:
Serial No.
' '24SS ��ra�x�-
SIGNA OF PERSON CONSTRU G THE WFJJ DATE
Submit original to Division of Water Qwality, Groundwater Section within 30 days
GW-1 REV. 12/99

STREET ADDRESS
Ellenboro NC 28040
City or Town State Zip Code
(828). 453-7322
Area code- Phone number
2. WELL INFORMATION:
SITE WELL ID #(II applicable)
STATE WELL PERMIT#(8 applicable)
DWQ or OTHER PERMIT #(If applicable)
WELL USE (Check Applicable Box): Residential Water Supply Q
DATE DRILLED I I _ (_ 0 to
TIME COMPLETED 3'ao AMO PMO-
3. WELLL CA_TI1O�N�}- (� (�
CITY: t3 ITdne. COUNTY RASA V4,9
muNH. Subdivision, Lot No., Parcel, Zip Code)
RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 2138
f. DISINFECTION: Type Chlorine Amount 1).2 [up
g. WATER ZONES (depth):
From To From To
From To From To
From To From To
6. CASING: Thickness/
Depth f Diameter Weight Material
From 0 To I n Ft. 64 SDR21 PVC
From To Ft.
From To Ft.
1. WELL CONTRACTOR:
James W. Camp
Well Contractor.(IndNidual) Name
Camp's Well & Pump Co. Inc
Well Contractor Company Name
P 0 Box 429
(S�me, Numbers,
TOPOGRAPHIC / LAND SETTING:
❑Slope ❑Valley ❑Flat 6ltldge ❑Other
(check appropriate box)
LATITUDE J$_ AA gq
LONGITUDE a 54 614
Latitude/longitude source: tadPS oTopographic map
(scan nof d ro well
lll must
be sothown
rr�on ag GPS) GS fopo map and
4. OWNER'S WELL NEAME40) Jj t t C el 'sQ
R
STREET ADDRESS 'C• D TJ c" tact A II
s
City or Town State Zip Code
(S,104.). uia. 311\
Area code - Phone number
May be in degrees,
minutes, seconds or
in a decimal format
5. WELL DETAILS: a. TOTAL DEPTH: a to S
b. DOES WELL REPLACE EXISTING WELL? YES 0 NO [%
c. WATER LEVEL Below Top of Casing: I 0 (9 FT,
(Use '+' 1 Above Top of Casing)
d. TOP OF CASING IS 1 . FT. Above Land Surface'
*Top of casing terminated at/or below land surface may require
a variance in accordance with 15A NCAC 2C .0118. a
e. YIELD (gpm): ') u METHOD OF TEST Q.A.
335460
7. GROUT: Depth Material Method
From 0 To 20 FL Sackrete Hand
From To FL
From To FL
8. SCREEN: Depth Diameter Slot Size Material
From To Ft. In. In.
From To Ft. In. in. c_
From To FL in. in.
7-1
9. SAND/GRAVEL PACK: 0
Depth Size Material
From To Ft.
ram,
From To Ftc-n
w
Ram To Ft. —"'
10. DRILLING LOG
From To
o Inh
Formation Description
I D ell, 5 G1A/Yt.t
11. REMARKS:
fly'RECEIVED
arnTFS`e OtlALlt
flF ( ti 5 ZD
I DO HEREBY CERTIFY IN ACCORDAI
1SA NCAC 2C, WELL CONSSTRUCTON T THIS WESTANDARDS, AND THAWAS T A COPY OF THISE VJIrH
RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
.C_VALO 11)3
04
SIGNATURE OF CERTIFIED WELL CONTRACTOR �' / DATE
James W. Camp
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
1617Submit Mali Servioriginal Center— Raleigh, NC 2 699 167 Quality PhoneNo. 9 9) 733 7Attn: ext 68.Uon Mgt.,
Form GW-la
Rev. 7/05

RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 21 38
1. WELL CONTRACTOR:
James W. Camp
Well Contractor. (Individual) Name
Camp's Well & Pumo Co. Inc
Well Contractor Company Name
STREET ADDRESS P 0 BOX 429
Ellenboro NC 28040
Zip Code
City or Tam State
(828)- 453-7322
Area code- Phone number
2. WELL INFORMATION:
SRE WELL ID #(If applicable)
STATE WELL PERMIT#(a applicable)
DWQ or OTHER PERMIT #(if applicable)
WELL USE (Check Applicable Box): Residentiat Water Supply L9r
DATE DRILLED I I -,2• D •
11L
TIME COMPLETED 4. 3 U
3. WELL L_OCA-TLON:
CITY:
AM ❑ PM ID —
COUNTY PLI, vQAA)
C11 �a C.J \Y 11
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC I LAND SETTING:
Slope °Valley ❑Flat °Ridge ❑Other
(check_""ee
yapppropdatbox) pp
LATITUDE 1_1, 3O O
' S
LONGITUDE,4L
Latitude/longitude source: (y(3PS °Topographic map
(ocean of we0 must be shown on a USGS topo map and
attached to this form 1 not using GPS)
4. WELL OWNER `T� (�
OWNER'S NAME Lr1hnU d-.1i� k1�.Q,()IsAi
STREET ADDRESS 0" o /3o )' ¶ 0
titYe Lu,'e NC
City or Town State Zip Code
May be in degrees,
minutes, seconds or
in a decimal format
Area code Phone number
5. WELL DETAILS:
a. TOTAL DEPTH: O S ,y,
b. DOES WELL REPLACE EXISTING WELL? YES 0 NO k
c. WATER LEVEL Below Top of Casing: `T 0 FT,
(Use'+' 8 Above Top of Casing)
d. TOP OF CASING IS 1 FT. Above Land Surface
'Top of casing terminated at/or below land surface may require
a variance In accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): w2 METHOD OF TEST CtA
f, DISINFECTION: Type Chlorine Amount 2,4 C N�
g. WATER ZONES (depth):
From To From To
From To From To
Fran To From To
6. CASING: Thickness/
Depth Diameter Wei ht Material
From 0 To Ft. 6e SDli21 PVC
From To Ft.
From To -Ft.
7. GROUT: Depth Material Method
From 0 To 20 Ft. Sackrete Hand
From To Ft
From To FL
8. SCREEN: Depth Diameter Slot Size .Material
Ft. In. in.
From To
From To Ft. In. In.
From To FL in. In.
9. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
From To Ft.
10. DRILLING LOG
From 8T;
0' V
•
<b Spy
11. REMARKS:
,, tVTir Y e eY�wni86 i
tit
OGEE Lc 1P.0
Ct� TNA
li'
5 'IUD'
I DO HEREBY CERTIFY THATTNIS WELL WAS CONSTRUCTED N ACCORDANCE WITH
15A NCAC 2C, WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF DNS •
RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
SIyNgI UI OF CERTIFIED WELL CONTRACTOR I'' DATE d
ames W. Camp
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt.,
1617 Mali Service Center - Raleigh, NC 27699-1617 Phone No. [phone] ext 568.
Fonn GW-la
Rev. 7(05

RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of' Water Quality
WELL CONTRACTOR CERTIFICATION # 2138
335462
1. WELL CONTRACTOR:
James W. Camp
Well Contractor. (Individual) Name
Camp's Well & Pump Co. Inc
Well Contractor Company Name
STREET ADDRESS P 0 BOX 429
Ellenboro NC 28040
City or Town State Zip Code
(828} 453-7322
Area code- Phone number
2. WELL INFORMATION:
SITE WELL ID #(If applicable)
STATE WELL PERMIT#(s applicable)
DWQ or OTHER PERMIT #(If applicable)
WELL USE (Check Applicable Box): Residential Water Supply V
DATE DRILLED I 0 • ri\ • D '
TIME COMPLETED 0' 30 AM a PM ❑
3. WELL LQ LTI :CIT3gLQ trh COUNTY eui ,
cc) 6„Lb c ,. c&fThia aoc
(Street Name, Number. Community Subdivision Lot No., Parcel,Zip Code)
TOPOGRAPHIC/ / LAND SETTING:
°Slope Lgvalley ❑Flat ❑Ridge ❑Other
(check appropriate box)
LATITUDE issi\
LONGITUDE.L. 51 L`S 1
Latitude/longitude source: tErCPS ❑Topographic map
(location of we/ must be shown on a USGS topo map and
attached to this form snot using GPS)
4. WELL OWNER
OWNER'S NAME VAk
STREET ADDRESS
May be in degrees,
minutes, seconds or
in a decimal format
�I `&A)12491 A,
UP6nsq
take !J4re NC- re946
City or Town State Zip Code
Area code)- Phone number
5. WELL DETAILS: C
a. TOTAL DEPTH: 15 (1
b. DOES WELL REPLACE EXISTING WELL? YES 0 NO tit
c. WATER LEVEL Below Top of Casing: U FTC
(Use'+' if Above Top of Casing)
d. TOP OF CASING IS 1 . FT. Above Land Surface'
'Top of casing terminated at/or below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): 50 METHOD OF TEST (VA %
f. DISINFECTION: Type chlorine Amount / C
g. WATER ZONES (depth):
From To From To
From To From To
From To From To
6. CASING: Thickness/
Depth Diameter Weight Material
From 0 To V Ft. 6r SDR21 PVC
From To Ft.
From To FL
7. GROUT:
Frorn 0
Depth Material Method
To 20 Ft Sackrete Hand
From To FL
From To Ft.
8. SCREEN: Depth Diameter - Slot Size Material
From To Ft. in. In.
From To Ft. in. In.
From To FL in. _ In.
9. SAND/GRAVEL PACK:
Depth
From
From
From
Sim Material
To FL
Djw-
C
lr
To Ft. rat
e.
To FL
10. DRILLING LOG
From To
0 Uu
�1U l SI/
11. REMARKS:
QrrmS D r3tbn
ALA
RECEIVcC
niv C'F'NATCn QUALI I Y
DEL so 5 20U8
DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED N ACCORDANCE WITH
15A NCAC 2C. WELL CONSTRUCTION STANDARDS. AND THAT A COPY OF THIS
RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
CIAO) fL) 11-3v-o6
SI TUREOF CERTIFIED WELL C NTRACTOR DATE
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.,
1617 Mall Service Center - Raleigh, NC 27699-1617 Phone No. [phone] ext 568.
Farm GW-la
Rev. 7/05

RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 2138
1. WELL CONTRACTOR:
James W. Camp
Well Contractor (Individual) Name
Camp' s Well & Pump Co
Inc
Well Contractor Company Name
STREET ADDRESS P 0 BOX 429
Ellenboro NC 28040
City or Town - State
( 828)- 453-7322
Zip Code
Area code- Phone number
2. WELL INFORMATION:
SITE WELL ID mil applicable)
STATE WELL PERMIT#(0 applicable)
DWQ or OTHER PERMIT it(if applicable)
WELL USE (Check Applicable Box): RlIesidentiat Water Supply H
DATE DRILLED I L--.24 - o b
TIME COMPLETED 3 (f AM O PM [3'
3. WELL LOCATION: / - 1
CITY: q)? COUNTY \eIALk/'
mj -r (>;
(Street Nhme, Numbers, Comm nity, SubdMsion, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
❑Slope ❑Vaeey ❑Flat IbRTdge ID Other
(check"" appropriate boox)
LATITUDE .1'l5_ i) 3qc
LONGITUDE12 Vq G 6U
Latitude/longitude source: TOPS ❑Topographic map
(location of wel must be shown on a USGS topo map and
attached to this form 1 not using GPS)
4. WELL OWNER
OWNER'S NAME YV a AN It/in
May be in degrees,
minutes, seconds or
in a decimal format
STREET ADDRESS oLa ox 'N
s
( Ab3 > qs1- L54, 2
Area code- Phone numbe
CotYYIe
‘2t9
4-4011
City a T State Zip Cade
5. WELL DETAILS:
a. TOTAL DEPTH: 4 3 S
b. DOES WELL REPLACE EXISTING WELL? YES CI NO ryt
c, WATER LEVEL BelowTop of Casing: 100 FT,
(Use'+- 0 Above Top of Casing)
d. TOP OF CASING IS 1 FT. Above Land Surface'
'Top of casing terminated at/or below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): 'IJD METHOD OF TEST (LtA
335463
f. DISINFECTION: Type chlorine Amount ct Cad5
g. WATER ZONES (depth): /
From To From To
From To From To
From To From To
6. CASING: 11 Thicgkkness)
Depth From 0 To 1 to Ft. D6ia4___L SDR21 PVC
From To Ft. _
From To Ft.
7. GROUT: Depth Material Method
From 0 To 20 Ft Sackrete Hand
From To Ft.
From To Ft.
8. SCREEN: Depth Diameter Slot Size .Material
From To Ft. in. in.
From To Ft. In. In.
From To Ft. In. in.
9. SAND/GRAVEL PACK: C"
Depth Size Material
From To Ft. M1.2
From To Ft. c—
From To Ft.
10. DRILLING LOG
From To
O 71,
I�
AU Se
y 3 t a+# (IL
11. REMARKS:
Rt(:tIVtU
f )IV OF VVAI tH LuuALRY
DEC 0 6. 200E
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED N ACCORDANCE Wrm
15A NCAC 2C, WELL CONSTRUCTION STANDARDS, AND THATA COPY OF THIS •
RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
CliA
(Mali Li)
TORE OF CERTIFIED WELL CONTRACTOR ' I D D _n�
dames W. Camp
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. 7/05

RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 2138
1. WELL CONTRACTOR:
James W. Camp
Well Contractor. (Individual) Name
Camp's Well & Pump Co. Tno
Well Contractor Company Name
STREET ADDRESS P 0 BOX 429
Ellenboro NC 28040
City or Town - State Zip Code
( 828)_ 453-7322
Area code- Phone number
2. WELL INFORMATION:
SITE WELL ID riot applicable)
STATE WELL PERMIT#(N applicable)
DWQ or OTHER PERMIT #(If applicable)
WELL USE (Check Applicable Box): Residential Water Supply (tr.
DATE DRILLED I D• I' 0 L
TIME COMPLETED c2•10 AM In PMIY
3. WELL LOCATI
CITY:
'
M
i
�rX El
(Street Name, Number, CammuNl�SubdMaion, Lot No., Parcel, Lp Code)
TOPOGRAPHIC / LAND SETTING:
ID Slope cValley ['Flat ❑Ridge ❑Other
(check appropdate box)
LATITUDE 3�Eir D 7-0 L
LONGITUDE_OL th al s
Latitude/longitude source: lig6PS ❑Topographic map
(location of well must be shown on a USGS topo map and
attached to this form (not using GPS)
May be in degrees,
minutes, '.cards or
in a decimal format
4. WELL OWNER (� /^
OWNER'S NAME Vt CI\ C(PnA
STR T ADDRESS R C x ?3
0 D 5±I C
City or Town State Zip Code
( )-
Area axle - Phone number
ozgO )
5. WELL DETAILS:
a. TOTAL DEPTH: li 0 c
b. DOES WELL REPLACE EXISTING WELL? YES 0 NO tk
c. WATER LEVEL BelowTop of Casing: 1 O FT,
(Use'*' if Above Top of Casing)
d. TOP OF CASING IS 1 FT. Above Land Surface*
'Top of casing laminated at/or belay land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): S METHOD OF TEST C ICA
f. DISINFECTION: Type chlorine Amount Cu
g. WATER ZONES (depth):
From To From To
From To From To
From To From To
6. CASING: Thickness)
Depth DiamWeight Material
From 0 To I la Ft. 6� SD)21 PVC
From To Ft.
From To Ft
7. GROUT: Depth Material Method
From 0 To 20 Ft. Sackrete Hand
From To Ft.
From To Ft.
8. SCREEN: Depth Diameter Slot Size .Material
From To Ft. in. in.
From To Ft. in. in.
From To Ft in. in.
9. SAND/GRAVEL PACK:
Depth Size Materiel
From To Ft.
From To Ft.
From To Ft.
10. DRILLING LOG
From T
0 lc/
119 b U 5
11. REMARKS:
S» 7 Cir,1a 4J tbi n� {
-IEC-'�L:J
11V. C1?'•n T�F (a11F*LIiY(
DEC u 5 200S
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED N ACCORDANCE WM1
15A NCAC 2C, WELL CONSTRUCTION STANDARDS, AND THAT ACOPY OF TH$
RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
SIG
e L, (4AV 1f-36-o6
OF CERTIFIED WELL CONTPo4CTOR DATE
ames W. Camp
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt.,
1617 Mall Service Center - Raleigh, NC 27699-1617 Phone No. [phone] ext 568.
Form GW-la
Rev. 7105

RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 2138
335457
1. WELL CONTRACTOR:
James W. Camp
Well Contractor. (Indhriduat) Name
Camp's Well & PumD
Co. Inc
Well Contractor Company Name
STREET ADDRESS P 0 Bo* 429
Ellenboro NC 28040
City or Tam - State
(828). 453-7322
Area code- Phone number
2. WELL INFORMATION:
SITE WELL ID #Qf applicable)
STATE WELL PERMIT#(r applicable)
DWQ or OTHER PERMIT #(if applicable)
WELL USE (Check Applicable Box): Residential Water Supply In---
DATE DRILLED 11 — I O• O t ii
TIME COMPLETED l Of) AM O PM ❑
3. WELL LOCppTION:t ,,p.(���. (�
CITY: \1)n 1 COUNTY Q 11 X A1Y.1.�11)A%
/P \ CiAI.t.�
(Street Name, Numbers, Canmunly, Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
❑Slope OValley ❑Flat Ridge ❑Other
(check appropriate box)
LATITUDE 3 S PA %Cf telt�•
LONGRUDE•„g,t 0111, LIU d-
Latitude/longitude source: 116S ❑Topographic map
(bcatbn of weI must be shown on a USGS topo map and
altached to this form I not using GPS)
21p Code
May he in degrees,
minutes, seconds or
in a decimal format
4. WLL OWNER'S
A 4 \_�r (uk
OWNER'S NAME �J �.r ./-
STREET ADDRESS P 0 o x ¥+1
LAY( lure_ NL 2t?'/6
City or Tarn State Zip Code
( }
Area code - Phone number
5. WELL DETAILS:
a. TOTAL DEPTH: 61 3
b. DOES WELL REPLACE EXISTING WELL? YES 0 NO 11)
c. WATER LEVEL Below Top of Casing: 0 0 FT,
(Use '+ if Above Top of Casing)
d. TOP OF CASING IS 1 FT. Above Land Surface*
'Top of casing terminated at/or belov land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): METHOD OF TEST OKA
f. DISINFECTION: Type chlorine Amount ) % P a.yS
g. WATER ZONES (depth):
From To From To
From To From To
From To From To
6. CASING: Thickness/
Depth, Diameter Weight Material
From 0 To )3 Ft. 6# SDR21 PVC
From To Ft.
From To FL
7. GROUT: Depth Material Method
From 0 To 20 FL Sackrete Hand
From To Ft.
From To Ft.
8. SCREEN: Depth Diameter Slot Size Material
From To Ft. In. In.
From To Ft. in. in.
From To Ft._In. _ in. c_
9. SAND/GRAVEL PACK:
Depth Size Materiel
From To Ft. 7�II
From To Ft. R'
From To Ft.
10. DRIWNG LOG
From T o
0'
FogpX)afon Descriptbn
At
13 6 0 S UL-Iifi-4.
11. REMARKS:
QL.. JTY
UEU g 5 2006
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED N ACCORDANCE went
15A NCAC 2C. WELL CONSTRUCTION STANDARDS, ANDTHATA COPY OF THIS
RECORD HAS BEEN PROVIDED TO THE WELL OWNER
/ in,LO 1 A) (. ,1 11-3a-aG
TORE OF CERTIFIED W CO TRACTOR DATE
dames W. Camp
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, 7/05

RESIDENTIAL WELL CONSTRUCTION RECORD 4
North Carolina Department of Environment and Natural Resources- Division of Water Quality 3 3 ' J
WELL CONTRACTOR CERTIFICATION # 21 38
1. WELL CONTRACTOR:
James W. Camp
Well Contractor. (individual) Name
Camp' s Well & Pumo Co.
Well Contractor Company Name
STREET ADDRESS P 0 BOX 429
Inc
Ellenboro NC 28040
City a Town State
(828>_ 453-7322
Zip Code
Area cafe- Phone number
2. WELL INFORMATION:
SITE WELL ID #(it applicable)
STATE WELL PERMIT#(a applicable)
DWQ or OTHER PERMIT #(if applicable)
WELL USE (Cheek Applicable Box): Residential Water Supply W
DATE DRILLED I \ - J • 6 V /
TIME COMPLETED 3! GQ AM ❑ PM p'
1. WELL LOCATION:
CITY: Q l'/C COUNTY
c11m1Y* I^I9t 65
(Street Name, Numbers. Community. subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
❑Slope cValiey ❑Flat ❑Ridge ['Other
(check appropriate box)
LATITUDE 3' lei 3 '
_Cla R •o y3
Latitude/longitude source: 2OPS ❑Topographic map
(bcatbn of well must be shown on a USGS topo map and
attached to this form l not using GPS)
4. WELL OWNER
May be in degrees,
minutes, seconds or
in a decimal tormat
OWNER'S NAME
yy�fr.
ST,(R5-3
- 1W�
STREET ADDRESS ,'73U • CE11 iA) A..ue •
(/(Anrj P, C'tv FL 3,1163
City a T�.vn State Zip Code
Area code - Phone number
5. WELL DETAILS: a. TOTAL DEPTH: S O S
b. DOES WELL REPLACE EXISTING WELL? YES 0 NO L
e, WATER LEVEL Below Top of Casing: j p FT.
(Use'+' if Above Top of Casing)
d. TOP OF CASING 1S 1 FT. Above Land Surface*
'Top of casing terminated at/or below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD(gpm): (39 METHOD OF TEST CtiA
1. DISINFECTION: Type chlorine Amount ,V. ca d5
g. WATER ZONES (depth): /
From To From To
From To From To
From To From To
6. CASING: Thickness/
Depth\.\ Diameter Weight Material
From 0 To FL 67 SDK21 PVC
From To Ft.
From To Ft.
7. GROUT: Depth Material Method
From 0 To 20 Ft Sackrete Hand
From To FL
From - To FL
8. SCREEN: Depth Diameter Slot Size .Material
From To Ft. In. In.
From To Ft. in. In.
From To Ft. in. in.
9. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
From To FL
10. DRILLING LOG
From )To
o' d
c, _ FrtiOrriptbn
0
1P-U bOS (A A/'nW
11. REMARKS:
RECEIVED
rl'v lF vvA1-E12 QUM In
•
--nEC 5 AD/
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED N ACCORDANCE WRH
15A NCAC 2C. WELL CONSTRUCTON STANni2PS. AND THATA COPY OF THIS
REC RDSS HAS
P�RROOVVIDEDITTOOITHE WELL O!W/N/E�,R
.
SIG&TURE OF CERTIFIED WEL CONTRACTOR it' DATE
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.,
1617 Mall Service Center - Raleigh, NC 27699-1617 Phone No. [phone] ext 568.
Form GW-la
Rev. 7I05

RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 2138
1. WELL CONTRACTOR:
James W. Camp
Well Contractor. (Individual) Name
Camp's Well & PumD Co. Inc
Well Contractor Company Name
STREET ADDRESS P 0 BOX 429
Ellenboro NC
28040
City or Town State
( 828)- 453-7322
Zip Code
Area code- Phone number
2. WELL INFORMATION:
SITE WELL ID #(if applicable)
STATE WELL PERMIT#(If applicable)
DWG) or OTHER PERMIT #(II applicable)
WELL USE (Check Applicable Box): Residential. Water Supply V
DATE DRILLED a1 — t 7- 6
TIME COMPLETED / 30 AM PME
3. WELL LOCATION: I
CITY: lake ✓e COUNTY FAA re
Sif>etthy la)- t 98
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LA_ND SETTING:
❑Slope (Valley VIM 0 Ridge ID Other
(check appropriate box)
LATITUDE 3 ,z 02rg, 65-4
LONGITUDE .1 a° D / •//47 1
Latitude/longitude source: 4-,(GPS ❑Topographic map
(location of we, must be shown on a USGS topo map and
attached to this form not using GPS)
4. WELL OWNER Q -I
OWNER'S NAME j41 e5f �}e SJLC! Ide(5
STREET ADDRESS 7' 0 D C x S t
1-a&e Lai', A/C t;g746
City or Town State Zip Code
Area code - Phone number
May be in degrees,
minutes, seconds or
in a decimal format
5. WELL DETAILS:
a. TOTAL DEPTH: . S.4J
b. DOES WELL REPLACE EXISTING WELL? YES p NO (q
•
c. WATER LEVEL Belau Top of Casing: 60 FT..
(Use'+' 0 Above Top of Casing)
d. TOP OF CASING IS 1 FT. Above Land Surface'
'Top of casing terminated at/or below land surface may require
a variance in accordance with 15A NCAC 2C .01113.
e. YIELD (gpm): 40 METHOD OF TEST AI V
335452
1. DISINFECTION: Type chlorine Amount
g. WATER ZONES (depth):
From To
From To
From To
6. CASING:
Depth A r
From 0 To lob
From To
From To
cu
From To
From To
From To
Thickness/
Diameter Weight Material
Ft. 6 SD*21 • PVC
Ft.
Ft.
7. GROUT: Depth Material Method
From 0 To 20 FL Sackrete Hand
From To FL
From To FL
8. SCREEN: Depth Diameter Slot Size .Material
From To Ft. In. In.
From To Ft. In. In.
From To Ft. in. In.
9. SAND/GRAVEL PACK:
Depth Size Materiel
From To Ft.
From To Ft.
From To Ft.
10. DRILLING LOG
From To
0' g6
11. REMARKS:
Formation Derpriptlon
Moot Sand
&rk Hi to
REP:FIVtU
Jr thmTFR QUALITY
,IFE 0 5 200E
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED N ACCORDANCE WITH
ISA NCAC 2C, WELL CONSTRUCTION STANDARDS, AND THAT COPY OF THIS
RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
SIGN URE OF CERTIFIED WELL CON)I'RACTOR DATE
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,
1617 Mail Service Center — Raleigh, NC 27699-1617 Phone No. [phone] ext 568.
Form GW-la
Rev. 7/05

RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of' Water Quality
WELL CONTRACTOR CERTIFICATION # 2138
1. WELL CONTRACTOR:
James W. Camp
Well Contractor (Individual) Name
Camp' s Well & Ramp Co. Inc
Well Contractor Company Name
STREET ADDRESS P 0 Box
Ellenboro
429
NC 28040
City or Town State
( 824 453-7322
Area code- Phone number
2. WELL INFORMATION:
SITE WELL ID #(it applicable)
STATE WELL PERMIT#(ir applicable)
DWQ or OTHER PERMIT #(If applicable)
WELL USE (Check Applicable Box): Residentlat Water Supply
DATE DRILLED I I- )u. h 1a
TIME COMPLETED 3. 'AU AM p PM ISI.
3. WELL LOCATIO
CITY: (1(
Zip Code
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
❑Slope galley °Flat ❑Ridge ❑Other
(check appropriate box)
LATITUDE 3 S �
LONGITUDE
Latitude/longitude source: a61TS °Topographic map
(location of wel must be shown on a USGS topo map and
attached to this form Anot using GPS)
May be in degrees,
minutes, seconds or
in a decimal format
4, WELL OWNER
OWNER'S NAME WO FU J4'a
STREET ADDRESS ) 0 4 Liz -KC pc i )1 f Pr,
Prosperity 5c 029)a9
City or lawn State Zip Code
Area code - Phone number
5. WELL DETAILS: So r,
a. TOTAL DEPTH:
b. DOES WELL REPLACE EXISTING WELL? YES V f7 NO'
c. WATER LEVEL Below Top of Casing: 1 0 Ft
(Use if Above Top of Casing)
d. TOP OF CASING IS 1 FT. Above Land Surface*
'Top of casing tenninated at/or below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): 3 METHOD OF TEST (IA A
335453
f. DISINFECTION: Type Chlorine AmountCLA5
g. WATER ZONES (depth): l
From To From To
From To From To From To From To
6. CASING:
Thlcknesal
Depth Diameter Weight Material
From 0 To Ft. 6 s SDR21 PVC
From To Ft.
From To - Ft.
7. GROUT: Dept Material Method
From 0 To 20 Ft Sackrete Hand
From To Ft.
From To Ft.
6. SCREEN: Depth Diameter Slot Size .Material
From To Ft. in. In.
From To Ft. In. In.
Front To Ft. In. In.
9. SAND/GRAVEL PACK:
Depth Size Material
From - To Ft.
From To Ft.
From To Ft.
10. DRILLING LOG
FOrn i n rmatip(tDes rion
go
Z[l/nwlJ
p so s-
11. REMARKS:
IV
RFCt1V tU .Ty
WATE'H e�UAli
?Q(1E
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED N ACCORDANCE WITH
15A NCAC 20, WELL CONSTRUCTION STANDARDS. AND THAT A COPY OF THIS .
RE HAS BEEN PROVIDED TO THE WELL OWNER.
11-30-06
.R)RE OF CERTIFI W ELL CONTRACTOR DATE
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.,
1617 Mali Service Center — Raleigh, NC 27699-1617 Phone No. [phone] ext 568.
Form GW-la
Rev. 7105
C
2\D
r_4
a

RESIDENTIAL WELL coNSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 21 38
335454
1. WELL CONTRACTOR:
James W. Camp
Well Contractor (Individual) Name
Camp's Well & Pump ro. Tnr
Well Contractor Company Name
STREET ADDRESS P 0 BOX 429
Ellenboro NC 28040
City or Town State Zip Code
(828). 453-7322
Area code- Phone number
2. WELL INFORMATION:
SITE WELL ID Cif applicable)
STATE WELL PERMIT#(ir applicable)
DWQ or OTHER PERMIT #(if applicable)
WELL USE (Check Applicable Box): Residential Water Supply IQ.--
DATE DRILLED I I- II 21. o V
TIME COMPLETED 1— U AM ❑ PM 0
3. WELL LOCATI``ON��: o ^
CITY: ci) f A. COUNTY__________ . /
AJJNwtlh t a 2
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
❑Slope °Valley ❑Flat 1a'Ridge 0 Other
(check appropriate box)
LATITUDE _3S nu L 10
LONGITUDE„j)
Latitude/longitude source: LICPS °Topographic map
(location of we# must be shown on a USGS topo map and
attached to this form I not using GPS)
4. WELL OWNER OWNERS NAME ' W £Lvt..K 1 A
STREET ADDRESS I �I I I kr C r vJ av
Mt. �Dr& Fi- 3),?5V564
City or Town State Zip Code
May be in degrees,
minutes, seconds or
in a decimal format
( }
Area code - Phone number
5. WELL DETAILS:
a. TOTAL DEPTH: h 0
b. DOES WELL REPLACE EXISTING WELL? YES p NO f*
c. WATER LEVEL Below Top of Casing: S- Il 0 FT-.
(Use "1" if Above Top of Casing)
d. TOP OF CASING IS 1 FT. Above Land Surface*
'Top of casing terminated at/or below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): METHOD OF TEST 04
f. DISINFECTION: Type chlorine Amount .3 5
g. WATER ZONES (depth):
From To From To
From To From To
From To From To
8. CASING: Thickness/
Depth Diameter Wei� M Material
From 0 To L 1 Ft. 6a SDR21 PVC
From To Ft.
From To Ft.
7. GROUT: Dept Material Method
From 0 To 20 Ft. Sackrete Hand
From To Ft.
From To Ft
8. SCREEN: Depth Diameter Slot Size .Material
From To Ft. In. in.
From To Ft In. tn.
From To FL In. in.
9. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
From To Ft.
1e. DRILLING LOG
From To
0 Lk 1._
__ Fpnn�nQ@scription
k\a_ $b fn 9m.
11. REMARKS:
C: /MI?h.,l IT`S
t)kG 41 r. l00
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED N ACCORDANCE WITH
1 5A NCAC 2C, WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
RECORD HAS BEEN PROVIDED TO THE WELL OWNER,
E6 II-3
SIG - E OF CER ERtIFIED ONTRACTOR DATE a-66
a.
mes W. Camp
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. 7/05

RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 21 38
1, WELL CONTRACTOR:
James W. Camp
Well Contractor (Individual) Name
Camp's Well & Pump Co. Inc
Well Contractor Company Name
STREET ADDRESS P 0 BOX
429
Ellenboro NC 28040
City or Town State Zip Code
( 828). 453-7322
Area code- Phone number
2. WELL INFORMATION:
SITE WELL ID #(it applicable)
STATE WELL PERMIT#(ITapplicable)
DWG or OTHER PERMIT *Cif applicable) /
WELL USE (Check Applicable Box): Residential Water Supply (F'
DATE DRILLED \ • d 3. • (I L
TIME COMPLETED 2 b AMID PM
3. WELL LOCATION:
CITY:
it -
(Street Name, I•tlfkn, Community, Subdivision Lot N o., Parcel;. Zip Code)
TOPOGRAPHIC / LAND SETTING:
❑Slope °Vafey ❑Flat tagrige ['Other
(check appropriate ryrybox)
LATITUDE 3S .1(,b 3pp 011b
LONGRUDE j� 4I) 1 dq
Latitude/Iongitude source: m•6PS °Topographic map
(bcation or we9 must be shown on a USGS topo map and
attached to this form I not using GPS)
4. WELL OWNER may}
OWNER'S NAME I YC'I'>11er LogdmII e��s
STREET ADDRESS a D 6 L rk e i' �l
VI)) SO. V I in i L agi5b
City or Town U State Zip Code
COUNTY,.
May be in degrees,
minutes, seconds or
in a decimal format
Area code - Phone number
5. WELL DETAILS:
a. TOTAL DEPTH: 6 6 S
b. DOES WELL REPLACE EXISTING WELL? �\YES p NO di
c. WATER LEVEL Below Top of Casing: J U FT:
(Use if Above Top of Casing)
d. TOP OF CASING IS 1 FT. Above Land Surface
'Top of casing terminated at/or below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD Wpm): s METHOD OF TEST QAA
335449
f. DISINFECTION: Type ChlOrine Amount pig oys
g. WATER ZONES (depth):
From To From To
From To From To
From To From To
6. CASING: Thickness/
Depth Diameter Weight Material
From 0 Tojj` Ft. 6 SD21 PVC
From To Ft.
From To FL
7. GROUT: Depth Material Method
From 0 To 20 Ft Sackrete Hand
From To Ft
From To Ft.
8. SCREEN: Depth Diameter Slot Size -Material
From To Ft. in. In.
From To Ft. In. _ in.
From To Ft. in. in.
9. SANDIGRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
From To Ft.
10. DRILLING LOG
From To at n DeccArption
0 mnV
C
tV
to SOS ift4,111%.+
11. REMARKS:
REGEIVLU
O wATE12 QUALITY'
1)FIII 5 (006
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED N ACCORDANCE WMI
i5A NCAC 2C, WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
RECORD HAS BEEN PROVIDED TOTHE
WWEE/LLL OWNER.
S U OF CE IFIED WELL CbNTRACTOR I' DATE
ames W. Camp
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. 7/05

13. CASING:
1. WELL USE (Check Applicable Box)• ❑ Municipal 0 Industrial A
❑Residential❑ gricultural 0 Monitoring
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: LAKE LURE County: RUTH
BOYS CAMP RD. FIREFLY COVE
(Road Name and Numbers, Community, or Subdivision and Lot No.)
3. OWNER JOHN CLOUD
Address BOYS CAMP R.D. FIREFLY COVE
(Street or Route No.)
LAKE LURE NC 28746
City or Town State Zip Code
4. DATE DRILLED 10/19/06
5. TOTAL DEPTH 405 WELL #2
6. CUTTING COLLECTED 0 YES ® NO
7. DOES WELL REPLACE EXISTING WELL? 0 YES ® NO
8. STATIC WATER LEVEL Below Top of Casing: 60 FT.
(Use "+" if Above Top of Casing)
9. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
'Top of casing terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2C.0118
10. YIELD (gpm): 9 METHOD OF TEST: FLOW METER
11. WATER ZONES (depth):
12. CHLORINATION: Type: CHLORYTE Amount: 5 LB.
Wall Thickness
From 0 Depth 63 Diameter
8"er 0r 250 Weight/Ft L GALV.
From To Ft.
From _ To Ft.
14. GROUT:
Depth Material Method
From 0 To 20 Ft. QUILKRETE POURED
From To Ft.
15. SCREEN:
Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in._ in.
From To Ft. _ in. in.
16. SAND?GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
17. REMARKS:
North Carolina — DLpwtwent of Environment and Natural Resources — Division of Water Quality — Groundwater Section
1636 Mail Service Center — Raleigh, N.C. 27699-1636 — Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR RODNEY ROBBINS
WELL CONTRACTOR CERTIFICATION #: 2785
STATE WELL CONSTRUCTION PERMIT #:
0 Recoveryutherpa
0 Heat Pump Water Injection ®Other
If Other, List Use: PUBLIC
DRILLING LOG DEPTH
From To Formation Description
If additional space is needed use back of form
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other reference points)
RT. ON BOYS CAMP RD. IN LAKE LURE, 1/2 MILE ON RT.
RECEIVED
DIV. OF WATER QUALITY
DEC 0 7 2006
I DO CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THISRECORD HAS BEEN PROVIDED TO THE WELL OWNER.
FOR OFFICE USE ONLY
Quad No:
Serial No.
SI NATURE OF ' ' ON CONSTRUCTING THE WELL •
DATE
original to Division of Water Quality, Groundwater Section within 30 days
GW-1 REV. 12/99
JAN 0 2 2001
EC 04 2006

North Carolina - Department of Environment and Natural Resources - Division of Water
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone] Quality - Groundwater Section
WELL CONSTRUCTION RECORD WELL CONTRACTOR: RODNEY ROBBINS
WELL CONTRACTOR CERTIFICATION #: 2785
STATE WELL CONSTRUCTION PERMIT #:
1. WELL USE (Check Applicable Box): ❑ Residential 0 Municipal 0 Industrial
0 Recovery 0 Heat PumpWater Injection ❑ Agricultural ❑Monitoring
J ®Other If Other, List Use: PUBLIC
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: LAKE LURE County: RUTH
BOYS CAMP RD. FIREFLY COVE DRILLING LOG (Road Name and Numbers, Community, or Subdivision and Lot No.) From DEPTH
3. OWNER JOHN CLOUD To Format Description
Address BOYS CAMP RD. FIREFLY COVE
(Street or Route No.)
LAKE LURE NC 28746
City or Town State Zip Code
4. DATE DRILLED 10/02/06
5. TOTAL DEPTH 985 WELL #01
6. CUTTING COLLECTED 0 YES ® NO
7. DOES WELL REPLACE EXISTING WELL? 0 YES ® NO
8. STATIC WATER LEVEL Below Top of Casing: 300 FT.
(Use "+" if Above Top of Casing)
9. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
'Top of casing terminated at/or below land surface requires a variance in accor-
dance with I5A NCAC 2C.0118
10. YIELD (gpm): 1 METHOD OF TEST: ARD
11. WATER ZONES (depth):
12. CHLORINATION: Type: CHLORYTE Amount: 5 LB.
13. CASING:
Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 63 Ft. 8" 250 WALL GALV.
From To Ft.
From To Ft.
14. GROUT:
Depth Material Method
From 0 To 20 Ft. QUILKRETE POURED
From To Ft.
15. SCREEN:
Depth Diameter Slot Size Material
From To Ft. in. in.
From _ To Ft. in. in.
From To Ft. in. in.
16. SAND?GRAVEL PACK:
Depth Size Material
From _ To Ft.
From To Ft.
17. REMARKS:
If additional space is needed use back of form
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other reference points)
RT. ON BOYS CAMP RD. IN LAKE LURE. 1/2 MILE ON RT.
RECEIVED
Did/ OF WATER QUALITY
DEC 0 7 2006
I DO CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THISRECORD HAS BEEN PROVIDED TO THE WELL OWNER.
FOR OFFICE USE ONLY
Quad No:
Serial No.
• % /� �, P.. Imo, / •e)- cc SI ATURE OF RSON CONSTRUCTING THE WELL DATE
Su original to Division of Water Quality, Groundwater Section within 30 days
GW-1 REV. 12/99
JAN 0 2 2007
DEC 0<:' 2E06

North Carolina — Department of Environment and Natural Resources — Division of Water uali 1636 Mail Service Center — Raleigh, N.C. 27699-1636 — Phone [phone] Q ty —Groundwater Section
WELL CONSTRUCTION RECORD WELL CONTRACTOR: RODNEY ROBBINS
WELL CONTRACTOR CERTIFICATION #: 2785
STATE WELL CONSTRUCTION PERMIT #:
1. WELL USE (Check Applicable Box): 0 Residential ❑ Municipal ❑ Industrial 0 Agricultural 0 Monitoring
0 Recovery 0 Heat Pump Water Injection ® Other If Other, List Use: PUBLIC
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: LAKE LURE County: RUTH
BOYS CAMP RD. FIREFLY COVE DRILLING LOG (Road Name and Numbers, Community, or Subdivision and Lot No.) From To DEPTH
3. OWNER JOHN CLOUD Formation Description
Address BOYS CAMP RD. FIREFLY COVE
(Street or Route No.)
LAKE LURE NC 28746
City or Town State Zip Code
4. DATE DRILLED 10/04/06
5. TOTAL DEPTH 805 WELL #02
6. CUTTING COLLECTED 0 YES ® NO
7. DOES WELL REPLACE EXISTING WELL? 0 YES ® NO
8. STATIC WATER LEVEL Below Top of Casing: 300 FT.
(Use "+" if Above Top of Casing)
9. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
'Top of casing terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2C.0118
10. YIELD (gpm): 1 METHOD OF TEST ARD
11. WATER ZONES (depth):
12. CHLORINATION: Type: CHLORYTE Amount: 5 LB.
13. CASING:
Wall Thickness
From 0 Depth
o 63 Ft. 8"� 0r Weight/Ft. 2 0 WALL Material
GALV.
From To Ft.
From To Ft. _
14. GROUT:
Depth Material Method
From 0 To 20 Ft. OUILKRETE POURED
From To Ft.
15. SCREEN:
Depth Diameter Slot Size Material
From _ To Ft. in. in.
From To Ft. in. in
From To Ft. _ in. in. 16. SAND?GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
17. REMARKS:
If additional space is needed use back of form
335631
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other reference points)
RT. ON BOYS CAMP RD. IN LAKE LURE. 1/2 MILE ON RT.
RECEIVED
Div OF WATER QUALITY
DEC 0 7 2006
I DO CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THISRECORD HAS BEEN PROVIDED TO THE WELL OWNER
FOR OFFICE USE ONLY
Quad No:
Serial No.
n-ticieen fie. //.�.iL°�'ai71k& %ll-
SI'GNATURE OF P RSO ' " •NSTRUCTING THE WELL DATE
SubMit original to Division of Water Quality, Groundwater Section within 30 days
GW-1 REV. 12/99
ji'
0 4 28@5

North Carolina — Department of Environment and Natural Resources — Division of Water
1636 Mail Service Center — Raleigh, N.C. 27699-1636 — Phone [phone]
Quality — Groundwater Section
WELL CONSTRUCTION RECORD WELL CONTRACTOR: RODNEY ROBBINS
WELL CONTRACTOR CERTIFICATION #: 2785
STATE WELL CONSTRUCTION PERMIT #:
1. WELL USE (Check Applicable Box): U Residential U Municipal ❑ Industrial ❑ A cultural
❑ RecoveryU Monitoring
El Pump Water Injection ®Other If Other, List Use: PUBLIC
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: LAKE LURE County: RUTH
BOYS CAMP RD. FIREFLY COVE DRILLING LOG DEPTH
(Road Name and Numbers, Community, or Subdivision and Lot No.) From To
3. OWNER JOHN CLOUD
Address BOYS CAMP RD. FIREFLY COVE
(Street or Route No.)
LAKE LURE NC 28746
Cityor TownZip
State Code
4. DATE DRILLED 10/12/06
5. TOTAL DEPTH 605 WELL #1
6. CUTTING COLLECTED ❑ YES ® NO
7. DOES WELL REPLACE EXISTING WELL? ❑ YES ® NO
8. STATIC WATER LEVEL Below Top of Casing: 63 FT.
(Use "+" if Above Top of Casing)
9. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2C.0118
10. YIELD (gpm): 23 METHOD OF TEST: FLOW METER
11. WATER ZONES (depth):
12. CHLORINATION: Type: CHLORYTE Amount: 5 LB.
13. CASING:
Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 62 Ft. 8" 250 WALL GALV.
From To Ft.
From To Ft.
14. GROUT:
Depth Material Method
From 0 To 20 Ft. OUILKRETE POURED
From To Ft. _
15. SCREEN:
Depth Diameter Slot Size Material
From To Ft. _ in. in.
From To Ft. in. in.
From To Ft. _ in. in.
16. SAND?GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft. _
17. REMARKS:
Formation Description
If additional pace is needed use back of form
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other reference points)
RT. ON BOYS CAMP RD. IN LAKE LURE. 1/2 MILE ON RT.
RECEIVED
DIV. OF WATER QUALITY
DEC 0 7 2006
I DO CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THISRECORD HAS BEEN PROVIDED TO THE WELL OWNER
fiZa
SIGNATURE R ON ONSTRUCTAIG THE WELL / DATE
original to Division of Water Quality, Groundwater Section within 30 days
GW-1 REV. 12/99
FOR OFFICE USE ONLY
Quad No:
Serial No.
JAN 0 2 2001
DEC 04 2006

Date: 11/26/2006 Time: 8:09:08 PM
Page 1 of 2
RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources - Division of Water Quality
Well Contractor Certification # 2584
1. WELL CONTRACTOR:
ALAN SCOTT GANTT
Well Contractor (Individual) Name
CAROLINA WELL DRILLERS, INC.
Well Contractor Company Name
STREET ADDRESS: 522 GANTT S GROVE CHURCH RD
MOORESBORO, NC 28114
[phone]
Area code — Phone number
2. WELL INFORMATION
SITE WELL ID #(IF APPLIACBLE)
STATE WELL PERMIT # (IF APPLICABLE)
DWQ or OTHER PERMIT # (IF APPLICALBE)
WELL USE (Check Applicable sox): Residential Water Supply
DATE DRILLED 10/27/06
TIME COMPLETED 0215 AM ❑ P.M
3. WELL LOCATION:
CITY: UNION MILLS COUNTY: RUTHERFORD
SHOAL RIDGE SUBDIVISION LOT 1
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
0 Slope ❑ Valley ® Flat ❑ Ridge 0 Other
Latitude/Longitude Source: 0 GPS ❑ Topographic map
LATITUDE 35.30.225
LONGITUDE 42.03.506
(location of well must be shown on a USGS topo map and
attached to this form if not using GPS)
4. WELL OWNER
OWNER'S NAME HICKORY NUT DEVELOPEMENT
STREET ADDRESS POB 276
LAKE LURE NC 28746
City or Town State Zip Code
828-625-0866
Area code —Phone number
5. WELL DETAILS:
A. TOTAL DEPTH: 380
B. DOES WELL REPLACE EXISTION WELL? YES 0 NO
C. WATER LEVEL Below Top of Casing: 110 FT
D. TOP OF CASING IS 2 FT Above Land Surface*
*Top of casing terminated al/or below land surface may require
a variance in accordance with 15NCAC 2C .0118.
E. YIELD (gpm): 30 METHOD OF TEST ARDM
33>5231
f. DISINFECTION:TypeHYPOCHLORITEAmt:15
g. WATER ZONES ( depth)
From 375 To 376 From To
From To From To
From To From To
6. CASING: Thickness/
Depth Diameter Weight Material
From + 2 To 44 Ft. 6 1/8 SDR21 PVC
From To Ft
From To Ft.
7. GROUT: Depth Material Method
From 0 To 2 Ft. GRAVEL MIX GRAVITY
From 2 To 20 Ft EASY SEAL GRAVITY
From To Ft ""�"�"�'-
8. SCREEN: Depth Diameter Slot Size Materiall
From To Ft in in
From _ To Ft. in i
in
From To Ftin in O
9. SAND/GRAVEL PACK S -
Depth Size Material ~
From To Ft
From _ To Ft
From To Ft
10. DRILLING LOG
From To Formation
38 380 CLAY
1. REMARKS:
CONSOLIDATED ROCK
DIV or
NOV
DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15
NCAC Zc. WELL CONSTRUCTIN STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN
PROVIDED TO THE WELL OWNER
.ub
TY
11/1/06
SIGNATURE OF CERTIFIED WELL CONTRACTOR DATE
ALAN S. GANTT
PRINTED NAME OF PERSON CONSTURCTING 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
Form GW-la
Rev. 7/05

uale. 1 II2OI000b lime: a:ue:ua YM Page 2 of 2
RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources -Division of Water Quality
Well Contractor Certification # 2584
3 3 2 3 2
1. WELL CONTRACTOR:
ALAN SCOTT GANTT
Well Contractor (Individual) Name
CAROLINA WELL DRILLERS, INC.
Well Contractor Company Name
STREET ADDRESS: 522 GANTT'S GROVE CHURCH RD
MOORESBORO, NC 28114
[phone]
Area code — Phone number
2. WELL INFORMATION
SITE WELL ID #(IF APPLIACBLE)
STALE WELL PERMIT # (IF APPLICABLE)
DWQ or OTHER PERMIT # (IF APPLICALBE)
WELL USE (Check Applicable Box): Residential Water Supply
DATE DRILLED 10/24/06
TIME COMPLETED 0615 AM ❑ PM
3 WELL LOCATION:
CITY: LAKE LURE COUNTY: RUTHERFORD
RIVERBEND RESORTS, LOT 163, SECT. 3
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
El Slope ❑ Valley ❑ Flat ❑ Ridge ❑ Other
Latitude/Longitude Source: 0 GPS ❑ Topographic map
LATITUDE 35.26.299
LONGITUDE 82.11.122
(location of well must be shown on a USGS topo map and
attached to this form if not using GPS)
4. WELL OWNER
OWNER'S NAME NEIL'I'OWNSEND
STREET ADDRESS 456 NC 210 E.
HARRELLS, NC 28444
City or Town State Zip Code
910-990-7565
Area code — Phone number
5. WELL DETAILS:
A. TOTAL DEPTH: 280
B. DOES WELL REPLACE EXISTION WELL? YES ❑ NO ❑
C. WATER LEVEL Below Top of Casing: 65 FT
D. TOP OF CASING IS 2 FT Above Land Surface*
*Top of casing terminated at/or below land surface may require
a variance in accordance with 15NCAC 2C .0118.
E. YIELD (gm): 8 METHOD OF TEST ARDM
f.DISINFECTION:TypeHYPOCHLORITEAmt:11
g. WATER ZONES ( depth)
From 270 To 271 From To
From To From To
From To From To
6. CASING: Thickness/
Depth Diameter Weight Material
From + 2 To 28 Ft. 6 1/8 SDR21 PVC
From To Ft.
From To Ft.
7. GROUT: Depth Material
From 0 To 2 Ft. GRAVEL MIX
From 2 To 20 Ft EASY SEAL
Method
GRAVITY
GRAVITY
From To Ft
8. SCREEN: Depth Diameter Slot Size Material
From To Et. in in
From To Ft. in in
From To _ Ft. in in —�
9. SAND/GRAVEL PACK:
Depth Size Material
From To Ft
From To Ft
From To Ft
10. DRILLING LOG
From To Formation
0 23 CLAY
23 280 CONSOLIDATED ROCK
11. REMARKS: pN OF VV#
NOV 2 6•
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE W:TH 15
NCAC 2c WELL CONSTRUCTIN STANDARDS AND THAT A COPY OF THIS RECORD HAS BEEN
PROVIDED TO 1Ht WELL OWNER
SIGNATURE OF CERTIFIED WELL CONTRACTOR DATE
ALAN S. GANTT
PRINTED NAME OF PERSON CONSTURCTING 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
Form GW-1a
Rev. 7/05
0
m
0
1-
tv
0
O,

/aw c.Jc�
o Afl1
!.
1. WELL Milkmen Ain is W Set): Rehde*ES ([ unkipat ❑ Industrial ❑ Agricultural ❑ Mordtodrlp 0
Recovery 0 Heel Pump WMit lnluCVon 0 Cam 0 11 Owar, UM Um:
2. WELL LOCATION: (Show meth of ms loeauar tallow)
monist by" /Tu7:4 aA- 2 ✓ Tna) Cou+tr. Aii 7 ,c#— h✓ ra-
/-/.eA1c z.,h7— C—ALe.et�i L T//
3. OWNER A,: r� .� ,7 �.1 _lnJo,I G�lh+„�i�t! Pr TO
Nann Car•an• • WM el Erwirann nt and Nuhnl R•aovt:a• • OMalon or WIN the/ • OroundwSOSN S•
faMS 3a Sr** Coder - RSAyb N.C. ITeeF4Ar H3an• BHT)T33.3221
aL WELL CONSTRUCTION RECORD wax CONTRACTOR* 4S T r� F//_AA //t-du 1
WELL CONTRACTOR CERTIFICATION e:� X 4
STATE WELL CONSTRUCTION PERMIT!:
Muaa
d Ne rate Omws *d a y. sr Weddand Ns.)
Arkin*
4. DATE DRILLED ` -06
S. TOTAL DEPTH t'f.-
a. CutflP4 QS COU•ECTED YESISTQ NO
7. DOES WELL REPLACE PAWING WEU.T YES ❑ NO[r
mComberS. STATIC WATER LEVEL Show Top 01 Ca17c) FT.
ryas O' I lean TM
S. TOP OF cam IS /" i AD "FT ow Land Surface'
Top or *Sn, I. M hr M J Nrs Tend ape••• rNdb•• • inn in •ccol-
deme nt*OANCACICAl1 r
It YIELD (sr):METHOD OF TEST 4-
11. WATER ZONES (dap* 0 h a
O
DRILLING LOG
OW T
•.w oar Code
1E. CHLORINATION: Type .. /AL. efP
13. CASING: Gy 1
Depth
From /4t To 4' FL
From To FL.
From To FL•
14. GROUT:
Depth
From 17/0 To Q z5' FI
From To FL
1S. SCREEN:
Depth Olan»ter Slot Slzi Mendel
From —.To Pi In In.
From To FL In h.
From ._To FLIn. h.
15. SAt40/GRAVEL PACK:
Depth Sian McMrlm
From . To FL
Ems To FL _
17. REMARKS:
Amount 0ni•a%r7
A&F WELL DRILLING
AND PUMP SERVICE INC.
911 Hwy.
c, NC 28018
D: B 247 1773
FswaSwk Demit Ten
11 Want sonce to needed w WA or Mon
olemsw, er Maria Man (Pea dkaetbn and d'.trxe
6 1-1/ J/°« Ry6/1 (I C (bads. Of elf map nlnerra Pam*
n�b
A&F WELL DRILLING
AND PUMP SERVICE, INC
Ni 911 Hwwyy. Business 74 .
c,e.y,-I, BosiieANC 4;te /<
2,
WM Meow LOCATION SKETCH
Irr ad mar too IBIS
FAMerlq Method
9 dl.jC %ors,rwo/
N y eat
IDOHEREBY CERTIFY THAT THIS WELL .WAS CONSTRUCTED INAccont WCEWRNIse NCAC*C.WELL
CONSTRUCTION STANDARDS. ANO TNAT A CO►T OF THIS RECORD HA9 SEEN PROVIDED TOME WELL °er e_
SPMATUP11OP PERSO•• COtarnuoala nil WELL o• V E i. i
Shwa WOO le Chide tWalar oa. Gowteniw Siam *Wh 70 an tom FrEV.1=n
FOR OFFICE USE ONLY
O•N Na
*HIM
--24-2003 M]N 11:31 ID:
PAGE:1

FOR OFFICE UK Oft
Henn oasis aspensse1.b__SandNenw.aaso•o►.wn«rrw•Gait • Gana Sow
ion Nil 5MMaa PNv- ndsY. Mom.=M idairt MNM 73an
WELL CONSTRUCTION RECORD wets CONTRACTOR /% 171F4 F-/( '`O'er" /7J."y
visa CONTRACTOR CSatW1CATiON r.
STATE WEU. CONSTRUCTION PERMIT,:
1. nu. USE wises-go.Inn nS.FcJ--M aid0 wnmtsi0
�,'n It.M Fvm►wwa Lt11ellon 0 Ober 0 11 OMR. UM Us;
2. we i wc*Taft Ss *doh d tau betty Allow)
Hamm Trim ' _est A 4, /-�>cos "et-, r/TAd c •
Ilaartrimwrwr.raO__- .es r3n4telNa.I ORIUNOLAO
2. OWNER jd Hi, Aj!EA- 1w• Ts
Adds
gm toe eso- 1�o4a
4. CATECM'UUD 9 —2/-0G
6. TOTAL DEPTiI `7 A.S' /
6. CUTTINGS COLLECTED 'IES Q ► O
7 OOSS WILL R ACII WALL
S. STATIC Una LESOohs Tap usCods ran.
fuse -.awe up 0OW71
t, TOP OF (.A*S 1114/.4C4 FT. Mtn Land WNW
'7wasisms Ibmill daaMASANeia•Ma•tenissverboseMassay
11
it TSUI4 r* MA �. MIM1017 OF TOTAL; •1-^
1t. wATM20NESIiltIk /V'i (
12. CHLORINATIOf! T CnOl%e•4r" a =QMqur4 jinn
O. CASINO: (0 o
wrinmrn NMAr (Nw_Im71•0 dbI All INMCrNM
Depth , team AM*"
ENS' 2, Ts ' R -ate- / li _ Rook sole asSousa Pet
AEnermis0
landlsal ❑
A&F WELL DRILLING
AND PU wP SERVICE, INC.
911°H,R
remain INmeg ra
iC1c16
ttSIIe mbasked aMbode 11s
Fe T6
FaNa TA A
it. GROUT:
Ouse, I MINIS 611Swd
FiMN /.> Tt cf) K <n-15.C/Tt/J?;JL f ei r.
T•
1S. SCREEN
OAS PSIS Eat SSA 6U11W&I
Fad —_Ts FI— h. -.—In
Fad ____To __ P1 __ h _ h
Firs _..._Ts R. in. h
IS. $NCSPI 1IELPSOK:
DOS SUP Work
Fad _._. To FLU ----
Fad . To FL
17. REMM.a
14h____ YTmDoswattsiASCONtiNUCTSOIN400041C I0EMfWMSA N lC.wet
Mp
A&F WELL DRILL!Nr.
AND PUMP SERVICr
911- Hwy. Busine.^
Bostic, NC 2t •
2'LE
4,- jQ n h*-4-
100
CONSIIILCCIN STN4W tMIDT►ATACOPYOF'1113 OIIA$b IM0WIWEOTOTItiMLL
$SIATAN Or F W SW COCnJC W» fl wet INTL
Ilant inCO ASVOWOinkoa.Iwa ItiSan TeaartSIN 121I
-24 -2013 1UN 11: 31R,1 ID:
PAGE:1

PAGE 01
Nora Conano
1117. Loam oam Orp.rimont - Rae* el M G Z7Ni NanaRnoianOMW a - an eI War pwGy. Orountlwaar Union.Siff n (OM 731-072,
WELL CONSTRUCTION RECORD
v
`% A
x003
WELL CONTR ACTOR /% lk/L—A-) ///Ji5 •//t;
WELL CONTRACTOR CERTIFICATION 0: c / 3 '
STATE WELL CONSTRUCTION PERMIT': -
1. WELL USE Appose fa,t) poNdrbafI� dl0 Industrial El
Rseovu 0 H..1 Pump Warr In9.olIon 0 OWL 0 If Other, Lat Um:
2. WELL LOCATKxi4ShoW Wow)
of Me beapon owt
Taw,) Has, To /) 1 > = /7 i
to Cop or Taw �r
aW. to Cods
4. DATE DRILLE0%-4-- >
5. TOTAL DEPTH %Zs�
5. ammo S COLLECTED YES 0�1]
P. DOES WELL REPLACE EXISTING W&LL NO�
S. STATIC WATER LEVEL Wort Top of Owing \ rr.
a. TOP OF GASINO L9 ( rf TTV. r A.en T elF. Above Land Swfacr• µ, ,
•Tnr.r ar o I.rw.nrq/ Wet Maw lad mace ratan ..Deana rr occur-
Pan
vat IIIA *ICAO N
ICI. YIELD WmNIL"
METHOD OF TEST - %C
11. WATER ZONES *pW: • CC)
Agricultural ❑ Monno/W s 0
DawLLIUQ L00
From To
A&F WELL DRILLING
AND PUMP SERVICFS,!Ilr
Dewy. Busir .: 7
'F, Nor t%
Foram wswie t,:
ISM sin ono... w.. O / �lo -
> w tall NI-)
3. RR 77,22 fjya7ir.
Address
Ras N0�
12. CHLORINATION Typa4— /f/G/-, ,- R Amouml >z- k ri
13. CASINO: lQ 5 /
tr add War E Naha u, bales of form
Fos Fromm O•PM to/as" , DIrIMiu orYlatatFLa MINAS
S % FL.! _'' yF, 7.70 c_
From To FL'
From To a Cc5 `Jet/,-S
1!•. GROUT;
/� Depth M.arWl Msl hod
From ',Z �O Tor0° .FL ')'7-k-sc A_r `E,ccJ
Prom — To FL
15. SCREEN
Depth Dlwn.I.r Slot Sizb Marla
Fain To F1 In rl
From ____ To __ FL._ In. In.
From __To FL._ In. h.
IS. SAFgFORAYEL PACK:
Otpph Biz. Malaria
From ..- — To FL
From . To FL
17. REMARKS:
LOC/N SKETCH
(Snow dlracVon and tFrummor ram AI aax trio Salo
Rota. or orrr atop r faaral POWs!
A&F WELL DRILLING
AND PUMP SERVICE, INC.
911 Hwy. Business 74
Bostic, NC 28018
328.247.1773
2-r.Cc . j 4 4.1 j • tt2e /`74-
I OOP/MEW CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCOROMCE WITH ISA MACS. VIELL
CONSTRt1GT1C11 STANDARDS, AND THAT A COPY OFF THIS RECORD WAS SEEN PROVIDED TO THE WELL Owe!.(' ✓✓Lc v �a� /• ( —. c
SMARM OP PER v
DONSTRUCTWO W E nu D.. E
Srbal sdpInSa OMAN M WSrr Omar.ON101041W proem wake SS cejn
Gem plat. U11
FOR OFFICE USE ONLY
NMI*
S.ASN..
r:
N)
C r/
-24-2003 ION 11:31RM ID:
PAGE:1

PAGE 01
fleet Nino ono MaeOare, et ,r�d-yt
Oeae.dlT. altYdddsnanrWlMt) _piPTH
a. OWNER /2 ;/,rrr/, ),��,, /&//c elo Fa.wafan Dar+y�let
%aerieiiielpid -1n4a &2 Q"/
a,etisi our t4MENU
�'"Cedae.
4. DATE DRILLED /r • 11— c2 E
5. TOTAL DEPTH > �r
a. CUT71Np! CEO YE$OD NO
7. DOES WELL REPLACE EXISTING WELL? YES Cj NOB--
S. STATIC WATER LEVEL Wow Top al Cuing: G/,A FT.
P. Oleo .'1Alerola elCOSS
CASINO IS / -etc FT. Above Land Statute,.1 NOD? TOP OF
'Tor or ntq Mr.a.led etrer Slow lend torten aMuWe a meek k
donee wilt ISAMAC IC.atta ..
1 D. YIELD (ppn): r' METHOO OF TEST .: %h-- € "QS
1t. WATERZONES(duplA): v °��I
teeth
IEEE MM� p Depommem Environment En.Nnt .. 'WWII MaowM e•. • OSel on Water Cluny . flmuMwatr Section
PSIS M.C. *7010-1021•Phone (OM T33.3221
3 30
WELL CONSTRUCTION RECORD WELL CONTRACTOR • r'I 1�' 4lcse/ Ate, //1 iy
WELL CONTRACTOR CERTIFICATION I:
STATE WELL CONSTRUCTION PERMITI.
1. WELL USE,,j�,� Appease Ss*REahjand$LJ MoRklp&I � industrial El�1 M RHut Pttrnp Ws InfocPon [] Ortsr (, If Obit, (Nat UN:
2. WELL LOCATION (Shoe okelch of t11s location below)
Wont Toms ? c r' - 4.1 ce Canty
1
ADrkdWral ❑
AILF WFI
AND PUMP
1 HWY
ere u r.,
Monilosig CI
L DRILLING
SERVIGF., INL.
Busi :ec. 74
tar F
iZi j2)21/KEL- e k- ,cr%
DRILLING 0OO
from TO
12. CHLORINATION: Typo C f/ :/, • Amoun1pe•firvi_
13. CASING
ww Manse
Fror 1.2-i4 i P1. y" <s ayudr
Elsa. To.. ---
From To 9.
14. GROUT;
T. .h Marini
/n
From .�.(� To () FL ,S-9al✓ro. `,c
From -- To FL
15. SCREEN
DIM Okrnstsr Slot Sze
From _, To F1. In. In.
From .r To FL _ In. In.
From _ To FL,.__, In. In.
111. SANOISFMAVELPACK:
Dope% Sits MEISIW
IA•lhod
/1 i'
From To FL
FmM To FL
17. REMARK&
1t ormoo of year b nosed use back or teem
LOCATIOfI_yKETCII
(show 01HKEHn aM tTilwlu Yen 01Inctoo Sidle
Rooks! M1wmap S nesPEW
Metro(
A&F WELL DRILLING ,'ckt
AND PUMP SERVICE, IN
911}iwy, Business 7,,
Bostic, NC 2801P
82a-247.177 ;.
.�tC
f ,A
51il4 A
i3•.5;7, , 5-c4 ,l,:Are, Hid"
1 DO HERESY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA HCAC IC. V/ELL
CONSTRUGTICN STANOARWS, AND THAT Awry OF THIS RECORD HAS SEEN PROVIDEO TOIH' WELL D%SER-
c- . --./1/0 I.-- rat' 1 /ems- / l ry /'
•
RONAt1FME DF PERSDM D eem 1CTINE THE trealL Or'.E
5*'*.d flw s Mien O Waler OWES, O oundwllme been tiMlYt 30 esys
C4.1PSE.en
FOR OFFICE USE ONLY
Ono /In
Ned Me.
1-
-24-2003 101d 11:31AM ID:
PAGE:1

rflV[. Di
iqK a /y9g
M Cues • Gopentwont el Ernew.w.nt end Naval $sate . Minn cd Went 0us1tr • Groundwater S.cYsn d 'Allart* Chew • RdelaIti N.C. Donionmono mil T33J221 e) `� 3 J. G j
ELL CONSTRUCTION RECORD WELL CONTRACTOR' R- jLF 1cciL 494 -' '.fy
WELL CONTRACTOR CERTIFICATION 0: a/3
STATE WELL CONSTRUCTION PERMITS:
WELL USE AFFSSot Rheldonis( dclpsi ❑ Indwtrhl ❑ ROIN omi 0
R.car.ry HPiroost I.W Nq War InloeSon ❑ oft,❑ II Oter. Udt WE,
WELL LOCATION. (Show Met tt of Iwo loca110n bolow)
Mew Trot /l'. 77 •.c.fTirt! Ca.dtteni'& •r,••:1 rC.
L07/3 7_ CI49-A r,,A .e- Cx.o e
flied t.ww wet tom.. Cee.wrika S.bdWse W IMNap �� DRILLING LOG
OWNER aI'/-TC% 'J('s�c`i' �-r't 44frLd7l-S Fe To
9,9 icome AA-' .
rah /fc• 61/tZCV F/q, 3 y-I'S
air wnail Etr. ilp
DATE ORILLEO/J7 /_? 4
TOTAL DEPTH . 2 g' ti'
CUTTINGS COLLECTED YES 0 NOG
DOES WELL REPLACE EXISTING WEU,1 YES NOG
" -
STATIC WATER LEVEL Wow Top of Coding: fT.
—•.•Mont metro
TOP OF CASING tS / '//4 FT, Sion- Lund snot.
F .t..dq twfl4 Woo beltw lad sets taltete . wfe.s bM eon's
sswilt MA CAC M Alla
YIELD (WII* "9 METHOO OF TEST ,O -
WATER ZONES (done: -76l r
Moeelog ❑
A&F WELL DRILLING
AND PUMP SERVICE, INC.
911 Hwy. Business 74
DEPTH Bostic, NC 28018
Fawn Damai247-1773
.t k '
. CHLORINATION: Typo c /}/ASS : i' Q "7iweet / 1 SWIGS Una le medal maI lam
CA&Nt a <7 / ;
NM beau
�.. Depth / ohms /r NFL *WNW
From///^To b ' Rai^7.�i.5:41di>r fhtC
Ftodt Td Ft--e-Le
From To Fib
. GROUT:
Depth M/I.rW Method
Rom To aci • FL CA- ithi..,.'4t Ir�l..¢,1
From To R / G `_ A
. SCREEN: / ain't`
Dope Mons'SIol Siti MNNN, Y
FrontTe FI _ h • bL h c_f,.rl.ca /err:- G.�rc,e
From _To_FL_ In. M. x \U
Rom To FL_ h. ___ h. • 1
SANDIORAVB. PACK: `�`
I*
O.pth Wm Molod.1 k )
From . To FL
From To FI.
'. REMARKS:
_Liaranainfli.
Wow dieetlon dr.t saw Mot ohms Mart
h..dt. ve sow mar MwN,Oa mks)
A&F WELL DRILLING
AND PUMP SERVI NC
911 Hwy. Bus" ess 7
Bostic, NC
828-247-177
/>eoy R.
18-
h Ito moor maw v THAT THIS WEI.t. WAS CONSTRUCTED P4 ACCORDANCE Mg1N i SA HCAC EC. WEIL
CONSTRUCTION STANDARDS, NOTNAT ALOFT OP 111S RECORO HAS MEN FRONDED TONE WELL out
FOR OFFICE USE ONLY
o.rNE
Geed fie.
iz in --y --e-/
SIONA1 EOP PERSON CONSTRUCTgC tat wilt 0. fl
SSA MOWS Mao dMew Oust M.I.edwNwSeam IMPS 30 GIP
Wm My. tie
24-200-, I10N . _:3114' ID:
PAGE:1

_oov10C.
F'Alt 171
lw7w own wrA,o CRAINS
a elwawl.M"a •^e NUNSRnouew • O►,Mtek, a WWI QNLa. OaFaWwmw SuwwF 3
Rm ,, M.C. l/wa►153S.nces Pig) 711-721I
WELL CONSTRUCTION RECORD wa t. CONTRACTOR: :'`l `�; / .CJA / %/ re
WELL CONTRACTOR CUPTEiCAT10N /: , 7 l ? c
STATE WELL CONSTRUCTION PERIWTS:
1. WELL USE Apposite V*nususla-MunIcht1[] banana
tiecoven O Hem Pun War kdtcl+on 0 IS 0 It OMu, LMl Us:
AErtal/W l0 Nordic** 0
A&f'Wttt'DRICCING
AND PUMP SERVICE, INC.
911 Hwy. Business 74
Bostic, NC 28018
828-247-1773
2. WELL LOCATIOFt (Show each of IM balbn below)
NNW'S, Tnc NC 72t- C_ , rf . (-- c,,ny- tea -if er <_re , r/
mod?C i6N //ler &9-.it/JJ /1i
••�•r•�►•.r t�laii,�na>r LeIt.) MILLING LOG
O. OWNER 4c 6GF2---1— � f�.i�i�t l �r e / Feow To
RIMS --i ejo a ,) ny I rs .©V.'-y /4 7
Wirli
48(/Zir'C_ ti-C _
mow TOM OS
A. DATE DRILLS —7t '17" al
5. TOTAL DEPTH -- s '
S. CUTTING $ COLLECTED v�E�8fa NO®
7. DOSS WELL MISPLACE EXISTING WOW YE2 Ss S NO
alCAPIN: rr.
S. STATIC WATER LEVEL'S°. Tap
S. TOP OF CASINO IS / / 7' FFT. Above Land Surface'
'Ter *why l'rMM ear kin MS awMer r t± •wbaaswscar'
Sean tab ISA 'CAC tttmta
*D. YIELD * OIL war 4
11. WATER ZONES (dopEl): 7'r)
12- CIS.ORIMATlON: Typo
13. CASINO: 30 r.
nh
Fw1R-.44.To
Fes. To
F1wnF To
1a. GROUT:
From •
From
15. SCREEN
C Arnouri 7 t,he?L
flat 11ttl•rw
tn. D/Wn�1w WWI ISFL ISMS
�Eii7 -� `-IL 1 C'
FL
at.
Ct9.
DEPTH
Fw•dn Dowwnta
ITY
tlnv 1 'd ZOC6
tr od64Cn1l opoot b rwSdw bilk el loon
r
OWES AbSoo
To ` " FL T.9 ' u 72RAfc.t. -‘
To FL
Mph
Fan To.
Ftom .. To FL
from To FL
1S. $ANOIORAVELPACK
Doer
From .,.__ To
From To
17. REIAARF S;
OIwn•I.r Sol Sot. MaI nal
P1 h. . In.
In
In. In.
Ff.
FN.
Slaw
Malone'
Mew Ando ad wanes tint Y batty Mar
Made. mower orpSara pabr!
A&FWELL D !E
AND PUMP SERVICE, NC. l(' / )'1-'
911 Hwy. Business 74 YD '
Bostic, NC 28018
828-247-1773
✓
'' phi
/ 1
-E
- SL- ,&/
'Do MOM CERTIFY THAT THIS WELL WAS CONSTRICTS° N ACCORDANCE WITH ISA /CAC AC. Wgl
CONETNucTiC/F STANDNIDS, AND THAT ACOPY OF THIS RECORD NAS SEEN MOWED TO TIE WELL DMp
FOR OFFICE USE ONLY
DANNa
leaaNa.
osr r c
MAZE OF PINION °D►a11R1cirraT111Yrlla or:c
ASAwi eisPa wWarONO,.CIa1.m.,Ba.pislS10cep
514 Mv. UN
-24-2023 'ION 11:311:4M ID:
PAGE:1

C Ul
!Iona Canes . Depermant or Hwranment and Natural Meoureaa - OI.lFan e1 wale Oualtq. • Oroundwse S.csn
1e3e Mee Nate Censer - Ralelaa, N.C. 71nNae3S•P ana tall) T33.3.21
WELL CONSTRUCTION RECORD WELL CONTRACTOR: /9 j' 7T le,`/
WELL CONTRACTOR CERTIFICATION.: I9 J 3 5`
STATE WELL CONSTRUCTION PERMIT.:
1. WELL USES had Apeocais tea): Retddenllal ud— ►Aunklpal ❑ Industrial 0 Agricultural ❑ Monito*. 0
:WongHeat Pump Water In4ac$on 0 Other Lj It Oihw, tbt Uee:
2. WELL LOCATION: (Show ekmkh of the balbn below)
Neal Tem A/ A (1 /1/ G cou,ey. J2/rTXC . „Clod etc) e
Ythrc
Paean. et wWLat►al DRILLING LOG
3. jj
UVYNER 5 r.� "�90� %., i Fnm to
AddrW GY%ie y
Carer lour / ` 44
4. DATE WILLED c ,' -f�
3. TOTAL DEPTH a7 at)`
S. CUTTNMIS COLLECTED YES NOD
7. DOES WELL REPLACE EXISTING WELL? YES [] NO.E
S. STATIC WATER LEVEL palm Top of Camp: 6:7/t > FT.
8Ne .a. a mew rep M Carel
0. TOP OF CAS'#lQ 1.9 /"/t)"FT. Above Land Swims'
Tar ae whop 1n.Mr.aM a.e Woo MS aaaMwe eeeaaaa a MMlamw M WOOF
Mon voNt 1/A Mao .C.e to _
10. YIELD (ppm): MEMO OF TEST /y'Z : /-
11. WATER ZONES (dpth): / yS '
A&F W
OND RELLb SERVICE, INC.
FiNr4.1.0, NGAI2801 74
Bostic, N a018
098 2' 7'7fl
aG�
tuu
12. CHLORINATION: Type Cif /c1 'G .0 Arlqunli/G',imr4 .--. fleabite
13. CASINO:
TMdmas
, Olamarr Minn Made
From_i2,o_.T�
From Te FL
From To Ft
14. GROUT:
Depth r MiUAS Method
From /9 To FL 5A iln' ><
From To FL
15. SCREEN:
Depth Diameter SAolSlti Material
From To Ft In. In.
From -- To FL_ In. In.
From To r.. FL_ In. __ In.
111. SANOIGRAYELPACK:
Depth Sit/ Material
�t.7 A(5:
From To FL
From To FL
17. REMARKS:
LOCATION SKETCH
Phew dkscVon and Sian* ram al Nstro stare
Roods. w oemt eta esM.enoa pore!
919
' `a
A&F WELL DRILLING
AND PUMP SERVICE, INC
911 Hwy. Busing>
Bostic, NC ':
828-247.i-.
//,9 iCc/ �yf tG rr �'
IDOninon CERTWYTHAT THIS WELL WAS CONSTRUCTEDINACCORDANCE VAIN IS/. IOC zC.WELL
CONSTRUCTION STANDARDS, AND THAT A COFY OF TIES RECORD HAS BEEN PROVIDED TO THE WELL CasEF..
Sr0NA1U$E or FERSCN CONaNUCfMO 1NE yratlt 0. 4
IStA surd le MAW al WMN G.ay. BleundNMs Swam w*M 39 esy.
M.I flV• I2?I
FOR OFFICE USE ONLY
omeNa
M4S Ns.
2q-2F03 MOti 11:31A'1 ID:
PAGE:1

o- Oma, /ems✓/'_ i2 _7 T
re6n Tour "°`°a
Foraltnp..allaw
tow* Geo Ogoromet of swrifronsoo.r u d a u.a Anosues. - Owwo,..r Win Pont. Oounowis Seaton
tan as Owl.. Goer - Rola *Cr Thownsaaru.a. n1H17i1-rn
WELL CONSTRUCTION RECORD w6ucoNTAAc7on:
Wen COMTPACTON CRP TWICATION O.
STATE MSU. CONSTRUCTION riIOMTF
1. WILL OS ESaink aortas use flooldonOd�c�lkdelool [] mews's 0 Arians 0 web. ❑
ReosvM1 LJ Hod FMB MAN 4 j6eMon D Otter 0 It oM.. LMt us.:
2. wp.L LOCATION *Rsldt of Wm to m below) f
Nataal TFwc /.,✓i Z <&' e- cowdr
awl 1Ms NNunn Owrr`,wlads .nato MI
or Tom 1�1 ^ /S �1
4. DATEDNtlISCGC
6. TOTAL DEPTH , 5 ' , s-d
6. CUTTING, ODLLECTED�,v�ts_�fl''�.��J
T. OCAS WILL RSPI.AOM eAtite4 till
O. STATIC IMAM LEA Sake Tap
nOsa
CE USN ONL
•L
61TreD N0[--
sCars !-, FT-
e. TOP OP CASSc IS, /'/I " FT. Men IawI Swf
'Too or sal b.oMU4.F.r tad ssss. rya...wafflers M.x.r
us...t1. tM .is Wan
to TISLOSoap; tame OP Tor 44::/-
11. WATER 2oNSS Fr,-i r
1L CRIMP ATIOtt Typ. C22 'Y /,,,.
ti. CASSIO. G O
FIMI./ s,-1h
.14
F"_ To
Fat Te_
14. C; CUT:
Of* ; Maid IUStoat
Fos To R es-et,/,✓I-1%- �dJne a 4-
From To R
15. SCMEN
DNS
FM* ____TO.
FrbSt TO
hoot _ _ To _— R
10. SAIRMIS MIIELPACK
OAS
Fiat To
FIO41 To
we twattens or14411pon _
PL
Okat.l.r Sol Sta MMw,I
FI �_ h h,
PL__
Sbe 6AalarW
A&F WELL DRILLING
AND PUMP SERVICE, It,
911 Hwy. Business
Bostic, NC 2801:
Dorm 828-247-1'7-
r`2vi:ti`d�u
•ATV
NOV
aMOatstsionkaoN 1awsMd4krra
*fibs •.rao.wOblongata onbone as
R%M.- ar oFe no ens pas!
p A&F WELL DRILLING
I Z:na("R AND PUMP SERVICE, INC.
t� 911 Hwy. Business 74
Bostic, NC 28018
828.247-1773
17. NEWS S: 44S%6fr'-7j e1/4)
t DO t.H1EST Centre THAT THIS WELL WAS CON$TauCTSo M Acccaomce MIIN ISA FICAC 6C vow
CONS1lK nieSTAFEIANDS,AND'MATACOPYOFT1pSRECORDNASONES PROVO[DTOT111 MIL DMA
E41MTm norMOON ootontucToot VS S TE
11.1iaipalYDMAdwrMMlrp.wtr—_-ebPM 1116141FMIS
asjFit t211
24-2003 TUN 11:31P81 ID:
PAGE:1

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PAGE 01
Ho*-amDM weer Qwky.a�owWwaur s�eYon
ton Ma soma Rank Kt 170Natural
n1
WELL CONSTRUCTION RECORD WELL CONTRACTOR: OVA' 416/7" fo A_ Y G2r/
WELL CONTRACTOR CERTIFICATION 9: -9 / 4S'
4
* " A.iln(Vi '1 e
t
STATE WELL CONSTRUCTION PERMITS:
1. WELL USE mstaAppease am): Residm*& nlclpal 0 IndualeI O AgdcuSerel ❑ Mon110/ g 0
Recovery O Keel Pump Wald Injection 0 Omer p It Otar, Lot Um:
2. WELL LOCATION: Blrowvq deh of the Medan below)
Nome Tomo b'�j -' 6C.L' G' County.
C&c{ ,Q d
phSNw0w tooriors. Oormally.oa sawLaNs.) DRILLINGLOQ
3. OWNER lJy i/ SS c...alo_ /r }l A. Pmm 7.
AddreN 7 �Ia 9 11nMe taA) ri o )r�/ .QQi
bs
Clow Tao lodo Dy
4. DATE GRILLED ,rj' s? ¶ - a
6. TOTAL DEPTH
S. curnnGS COLLECTED YES NO(
7. DOES WELL REPLACE EXISTING —WOW YES 0 NOI - '
S. STATIC WATER LEVEL plow Tap of Casing: FT.
(Um •r' I Mows Top M CUS
P. TOP OF CASINO I97'"i"FT. Above Land Surbtca•
our N arm wens eve. MMw bad .Stir. MPS*.. nine M octet -
donee wMr IBA MAC SO 4t1
I D. YIELD Be* METHOD OF mar #'--
11. WATER ZONES Blpll): ,x-c'
IZ. CHLORINATION: Type r-/,&C.'nle MquM)llrz»4 c
13. CASINO: 4/15-/
Depth r /�Le Lennie
ROT7-140 To .. . FL 6r ' /e
Fre m— To FL
From To FL
14. GROUT:
we TW*nsu
erMe aFL oasis
/sic
,7✓o 44-ar- toCi= c4t4 PUMP SERVIC_,
A&F WELL DRILLiUN C
911 Hwy. Bushiest " 4
QE -247-17&7318
Fonran Dnc'S
1 ITV
It addeiorl& ip.cs Is needed at better teem
LOCATION SKETCH
(Stew dirndls: and Oolong ban 0less: mu Steel
Ronde, o ofwr MAP Siena POYritkp W ELL DRILLING
AND flint," CI(`
91•
Bostic, 1..
828-247.177S
Depth WHOM Method
From To 31, r FL ,c s-c i// .jc ,lit..,//
From To FL
15. SCREEN
Depth Diameter Slot See Meted&
From To Ft , in. ___ _ In.
From __._ To ___ FL.__ In __ In.
From To FL _ In. _ In.
IS. BAPgpRAVELPACK
Dplt Sire MaledS
From ,_._ To Pi.
From To FL
17. REMARKS:
/515
t A&FWELL DPit.L,"`'
AND pUMP SEa'1"'' �`
911 HWY. BUS S _-_
B'
828_247 1 73
IDp1lERESTCERTIFY THAT THIS WELL WAS CONSTRUCTED INACCORDANCE WITH ISA HCACIC. WELL
CONSTRUCTION STANDARDS, AND THAT ACOPY OF THIS RECORD HAS SEEN PROVIDEO TO THE WELL O mEE-
FOR OFFICE USE ONLY
one Na
‚.4'"'
G
NDNA1 JW OP 1rinfltr COIGTRUCTN61Ni WEII ion
8,9.1 Mee M DMlen M W$sr Oak ONV drlv Icon *W*I70 cos
6s.1 pas. en
24-2003 ION 11:31AM ID:
PAGE:1

ur..r 2ea411tI
PAGE 01
r x tCnlaa t Ratak aWw 6nrrnt Ord Natural RMaouea Groundwater el War Quay . GroudwSection
Mall . tak N.O.27e1e-1e31.Rwr p11) 733-3221
WELL CONSTRUCTION RECORD
WELL CONTRACTOR '72 2(7,C/7 2,c //. aJk7
WELL CONTRACTOR CERTIFICATION S: �� / S-
MITE WELL CONSTRUCTION PERMITS:
1. WELL USE Agte aM Iran Rnidan*ul❑ Municipal 0 Induablal ❑ Agricultural 0
Recovery 0 Heat Pump Water Irreoion ❑ Other I1 OMr, Ust Uss:
2. WELL LOCAT104 (Show *Nth of Iha locator
Nano Tow¢ A'? 721F.tF.ca% r 3A 1 county- /C #- z cc/ raj
•�!71 6'J�(�i •�/-� - 2 PlL
and Nye ar�a Cenweeyy. w . et SuedaLai No.) DRILLING LOO
— 3. OWNER it,; LCg��-re a,qe t.
Addis" /- eleginto ig,( Al Dar, . 3
eA) e
Ole taro arM g cS.
•. DATE Onus)a 6
5. TOTAL DEPTH. /'.S,`
6. curtsies COLLECTED YES NO[
7. DOES WELL REPLACE EXISTING WELL? YES Q NO[a-
6. STATIC WATER LEVEL Oaks Top o1 Cuts: f'() FT.
TIN.. aMOW. ape Calm*
S. TOP OF CASINO 1O. ///iFT. Above Land
Sud •
'Ter er seraF'.. wt.d .vor Sew Mad swim tyNMo a wtMew M.aor-
Ante wM 111A NCAC o0 Stijl
10. YIELD (opm): S METHOD OF TEST 4--
11. WATER ZONES WON: /2
WON
ILLING
A' PUMP SEViCE, INC.
n
911 Hwy. nua,css 74
Bostic, NC 28018
828-247-1773
DEPTH
Permian D..aelaer
ITY
12. CHLORINATIOtt Tyne/%/•s/-.:e)e Amour ie,--1 t v7't- itodd4Cm1specs bneeded toe SSW 1cnn
13. CASINO: 5
watt nedure.
Depth ! t*aulur *Winn Modal
Fain-244-.14 alga. FL— cid,CapC
Frorn To FL
From Toe FL
14. GROUT:
�� Depth Material Method
From 'J'7"' To .. .2.: FL .�
Prom _� To Fi.
15. SCREEN
t OCATN SKETCH
(thew *attar aM Santa from MC TEE SOW
Reeds, or ate nap uulsin' polnti!
/A ()niter/
Depth Dlaneet.r Sot SIM Mahal
From To F1 __ h. In.
FOM — To _ FI. ` in.
From To FL_ In. b.
11. SMANGRJ VEL PACK:
Omer Site MaISriM
From To
FL
From To FL
17. REMARKS:
ce(uw.Tsk..
c-/2rrr cc, tr--7-c6-
‘1,
A&F WELL DRILLING
AND PUMP SERVICE, INC.
911 Hwy. Business 74
Bostic, NC 28018
828-247-1773
l/e`'y a rr C
00 HERESY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WRM ISA NCAC IC. WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD 14*5 BEEN PROVIDED TOTNE WELL DaE-
FOR OFFICE USE ONLY
Oaiso
/�> ,2--v*C
SIONAIMIE OF VERSOS CONSTRUCTER THE WELL so TS
Subrtlwytnall.O Iti W Wayr OWtiy Oretetdgr town wtt 70 ayS
Sw.t FEY. OR
v
24-2003 ION 11:31AM ID:
PAGE:1

Y
I VYYJYI G IL
P.o
RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources - Division of Water Quality
Well Contractor Certification # 2584
1. WELL CONTRACTOR:
ALAN SCOTT GANTT
Well Contractor (Individual) Name
CAROLINA WELL DRILLERS, INC.
Well Contractor Company Name
STREET ADDRESS: 522 GANTT'S GROVE CHURCH RD
MOORESBORO, NC 28114
[phone]
Area code - Phone number
2. WELL INFORMATION
SITE WELL ID #(IF APPLIACBLE)
STATE WELL PERMIT # OF APPLICABLE)
DWQ or OTHER PERMIT # (IF APPLICALBE)
WELL USE (Check Applicable Box): Residential Water Supply
DATEDRB,LED 11/21/06
TIME COMPLETED 4:30 AM ❑ PM
3. WELL LOCATION:
CITY: HENRIETTA COUNTY: RUTHERFORD
OLD HENRIETTA RD
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
❑ Slope ❑ Valley 181 Flat ❑ Ridge ❑ Other
Latitude/Longitude Source: 0 CPS ❑ Topographic map
LATITUDE 35.15.766
LONGITUDE 81.49.117
(location ofwea must be shown on a USGS topo map and
attached to this form ifnot using GPS)
4. WELL OWNER
OWNER'S NAME MANLEYDUBOSE
STREET ADDRESS 112 LIN-MAR LANE
STANLEY NC 28164
City or Town Stale Zip Code
704-263-1525
Area code— Phone number
5. WELL DETAILS:
A. TOTAL DEPTH: 200
B. DOES WELL REPLACE EXISTION WELL? YES ❑ NO
G WATER LEVEL Below Top of Casing: 75 FT
D. TOP OF CASING IS 2 TT Above Land Surface
'Top of casing terminated atlor below land surface may require
a variance in accordance with I SNCAC 2C .OI1S.
E. YIELD (gpm): 8 METHOD OF TEST ARDM
t DISINFECTION:TypeHYPOCHLORITEAmt:70Z
g. WATER ZONES ( depth)
From 120 To 120 From
From To
From To
From
From
To
To
To
6. CASING: Thickness/
Depth Diameter Weight Material
From +2 To77 Ft. 61/8 SDR21 PVC
From To Ft.
From To
7. GROUT:
From 0
Ft.
Depth Material
To 2 Ft. GRAVEL MIX
Method
GRAVITY
From 2 To 20 Ft EASY SEAL GRAVITY
From To Ft
8. SCREEN: Depth Diameter Slot Size Material
From To FL in in
From To Ft. in in
From To _ Ft in in
9. SAND/GRAVEL PACK:
Depth Size Material
From To Ft
From To Ft
From To Ft
to. DRILLING LOG
From To Formation
0 70
70 200
II. REMARKS:
CLAY
CONSOLIDATED ROCK
REGElvtU
OIV OF WATER QUALITY
MEC 14 Saab
t DO HEREBY CERTIFY THATTHIS WELL WAS CONSTRUCTED IN ACCORDANCE WTm 15
NCAC 2c. War. CONSTRUCEN STANDARDS, AND THAT A COPY OFT IS RECORD HAS BEEN
PROVIDED TO THE WELL OWNER.
a-- %L - / - ll�
SIGNATURE OF CERTIFIED WELL CONTRACTOR DATE
ALAN S. GANTT
PRINTED NAME OF PERSON CONSTURCTRNG 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
Form GW-la
Rev. 7/05

tu4404/L IZ
p.'2
RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources - Division of Water Quality
Well Contractor Certification # 2584
1. WELL CONTRACTOR:
ALAN SCOTT GANTT
Well Contractor (Individual) Name
CAROLINA WELL DRILLERS, INC.
Well Contractor Company Name
STREETADDRIFSS: 522 GANTT'S GROVE CHURCH RD
MOORFSBORO. NC 28114
[phone]
Area code - Phone mmmber
2. WELL INFORMATION
SITE WELL ID #(IF APPLLCBLE)
STATE WELL PERMIT # OF APPLICABLE)
DWQ or OTHER PERMIT # OF APPLICALLE)
WELL USE (Check Applicable Box): Residential Water Supply EI
DATE DRILLED 11/1/06
TIME COMPLETED 22:155 AM 0 PM ID
3. WELL LOCATION:
art UNION MILLS co(rvey: RUTHERFORD
ARROWOOD RD
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND St I I ING:
0 Slope ❑ Valley ID Flat 0 Ridge ❑ Other
Latitude/Longitude Source: EI GPS ❑ Topogaphic map
LATITUDE 35.28.672
LONGITUDE 82.04.538
(locmion of well must be shown en a USGS topo map and
attached to this form if not using GPS)
4. WELL OWNER
OWNER'S NAME HORTON HOMES OF
RUTHERFORDTON
sTREET ADDRESS 342 HWY 74 BYPASS
RUTHERFORDTON NC 28139
City or Town State Zip Code
828-287-3366
Area code— Phone number
5. WELL DETAILS:
A. TOTAL DEPTH: 380
B. DOES WELL REPLACE EXISTION WELL? YES ❑ NO
C. WATER LEVEL Below Top of Casing: 65 FT
D. TOP OF CASING IS 2 FT Above Land Surface*
'Top of casing terminated atlor below land surface may require
a variance in accordance with I5NCAC 2C .0118.
E. YIELD (gpm): 2 METHOD OF TEST ARDM
From To
From To
EDISINFECTION:TypeHYPOCHLORITEAmt:16OZ
g. WATER ZONES ( depth) >~
From 180 To 180 To Ci
t*a
From
From To
From To
6. CASING: Thickness/
Depth Diameter Weight Material
From+2 To50 Ft. 61/8 SDR21 PVC
From To
From To
7. GROUT:
From 0
From 2
Ft.
Ft.
Depth Material
To 2 Ft GRAVEL MIX
To 20 Ft EASY SEAL
From To Ft
Method
GRAVITY
GRAVITY
8. SCREEN: Depth Diameter Slot Size Material
From To Ft in in
From To Ft. in in
From To Ft. in in
9. SAND/GRAVEL PACK
Depth Size Material
From To Ft
From To Ft
From To Ft __
lo. DRILLING LOG
From To
0 45
45
Formation
CLAY
380 CONSOLIDATED ROCK
RECEIVED
NV OF WATER QUALITY
11. REMARKS:
EJEEC 1 4 2006
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WRIT 15
NCAC 2c. WELL CONSTRUCrIN STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN
PROVIDED TO THE WELL OWNER.
SIGNATURE OF CERTIFIED WELL CONTRACTOR DATE
ALAN S. GANTT
PRINTED NAME OF PERSON CONSTURCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: nformation Mgt.,
1617 Mail Service Center - Raleigh, NC 27699-1617
FEB 21 2v 7
Form GW-la
Rev. 7/05

1 V'4J'-11 L I L
RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources — Division of Water Quality
Well Contractor Certification # 2584
1. WELL CONTRACTOR:
ALAN SCOTT GANTT
Well Contractor (Individual) Name
CAROLINA WELL DRILLERS, INC.
Well Contractor Company Name
sTREer.ADDttess: 522 GANTT'S GROVE CHURCH RD
MOORESBORO, NC 28114
[phone]
Area code — Phone number
2. WELL INFORMATION
SHE WELL ID #(IF APPLIACBLE)
STATE WELL PERMIT # (IF APPLICABLE)
DWQ or OTHER PERMIT # (IF APPLICALBE)
WELL USE (Check Applicable Box): Residential Water Supply El
DATE DRILLED 11/8/06
TIME COMPLETED 3 AM ❑ PM El
3. WELL LOCATION:
CITY: UNION MILLS coUNTY: RUTHERFORD
BOLAND RD
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC/LAND SETTING:
❑ Slope ❑ Valley ® Flat ❑ Ridge 0 Other
Latitude/Longitude Source: N GPS ❑ Topographic map
LATITUDE 35.29.482
LONGITUDE 82.05.878
(location of well must be shown on a USGS topo map and
attached to this form if not using GPS)
4. WELL OWNER
OWNER'S NAME LEWIS GORDON
STREET ADDRESS 1840 MEMORIAL HWY
LAKE LURE NC 28746
City or Town State Zip Code
828-625-0555
Area code - Phone number
5. WELL DETAILS:
A. TOTAL DEPTH: 220
B. DOES WELL REPLACE FYISTION WELL? YES ❑ NO El
C. WATER LEVEL Below Top of Casing: 80 FT
D. TOP OF CASING IS 2 Fr Above Land Surface*
'Top of casing terminated at/or below land surface may require
a variance in accordance with I SNCAC 2C .DI 18.
E. YIELD (gpm): 4 METHOD OF TEST ARDM
f.DISINFECTION:TypeHYPOCHLORITEAmt:70Zeo
g. WATER. ZONES ( depth)
From 112 To 112 From To
From To From To
From To From To
6. CASING: Thickness/
Depth Diameter Weight Material
From+2 To 107 Ft. 6 1/8 SDR2I PVC
From To Ft.
From To FL
C
two
7. GROUT: Depth Material Method
From 0 To 2 Ft. GRAVEL MIX GRAVITY
From 2 To 20Ft EASY SEAL GRAVITY
From To Ft
8. SCREEN: Depth Diameter
From To Ft.
From To Ft.
From To Ft.
9. SAND/GRAVEL PACK:
Depth Size Material
Slot Size Material
in in
in in
in in
From To Ft
From To Ft
From To Ft
10. DRILLING LOG
From To Formation
0 100 CLAY
100 220 CONSOLIDATED ROCK
RECEIVED
DIV. OF WATER QUALITY
11. REMARKS:
DEC 1 4 2006
t DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE RATH 15
NCAC E. WELL CONSTRUCTEN STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN
PROVIDED TO THE WELL OWNER.
SIGNATURE OF CERTIFIED WELL CONTRACTOR DATE
ALAN S. GANTT
PRINTED NAME OF PERSON CONSTURCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: nformation Mgt.,
1617 Mail Service Center — Raleigh, NC 27699-1617
Form GW-la
Rev. 7/05

CV✓g1UU
PAGE 01
Hann
NOSan Camino • Mallonment of Environment and Naomi Renter. - Oirylon et WNn Guilty • Gratmdwv Section
motel" N.C. SlR1-1e35 pn•na IONS 733 3221
WELL CONSTRUCTION RECORD
336362
WELL CONTRACTOR.
WELL CONTRACTOR ConTIFICATION e:6{-Vc•,n7 err !% //
STATE WELL CONSTRUCTION PERMIT : f
1. WELL �E1chask NOW* omit Roakhl[ u
ntlanIcipai ❑ Inoualrlal 0 Agrkullural
Hoot Pump Wain Miaellon Other 0 It Other, Lbt Use.
2. WELL LOCATION: (Show oath of the IoaYon below)
Hoene' Towns 4-R%.p/dmr.s a2 i county.
A2r3f - `7 Qn l.t,o Fr
WSW Nara welNad ,,CMtenfy.eraeeataate„andtaaNO OtHLLING LOG
3. OWNER zing -I) i5'r.4-7co...' Prom Tit
Addia$2,a 4 /•
.' � .. al CY, � s i
44-/CeM,,e2 A C—
C*erlam
4. DATE MILLED
5. TOTAL DEPTH
5. CUrTINQS CULLS TEO YES NOC9---
7. DOES WELL NEPLACE EXISTING WELL? YES ❑ ND[�
g. STATIC WATER LEVEL below Top of Casing: raj FT.
Wes •.• a MOW Tee e1 Carnal
S. TOP OF CASING !S)>% '1/ r' FT. ADon L nd Surtaes•
Tee et nano ew.dnoted eew bales MS swim ree•Yea • tonnes la SCOW
Pane Milt ISA *GAG tilts
10. YIELD (SPn4: MEMO OF TEST /2 L
11. WATER ZONE (dplh}: 3' •
Ira as
Monitoring 0
✓Qs i alcr.Fn.tn/Cv_
A&F WELL DRILLING,
AND PUMP SERVICE, air:
911 Hwy. Busine.s-,
QEPTH Rnctj0, NC 22.0.
roman gincail -247-1773
RECFNE
DIV.OF VtIATFR
DEC 2 4 20Ub
12. CHLORINATION: Type .c...4:.r2a.40-Ar eunt/ n -&cr ,_ p add%Uonat space b needed use beet oI been
13. CASINO: 6S.•
i Depth DiNnwr Wee Deane*
ROT / v - at WIgNVFL Mattel
P To m ft.A 2_ /7w c
F�em- Te FL
From To FL
14. GROUT:
Depth Matadi MAW
FFroomm To /PO 1 FL 5 4/4 raise A.vu.o//
_ To FL
15. SCREEN:
Depth tlWnswr Scot Ski Material
Fran __ To Ft ___.__ wt. , M.
From To FL In In.
From To FLin. ._ In.
18. SANORiRAVEL PACK:
Depth Sire WWII
From To FL
From To FL
17. REMARKS:
LOCATION SKETCH
(Msv oirsown and SM.we Yam al *acme Saw
Amt. «tdhw nwp,slnace Pole?
A&F WELL DRILLING
AND PUMP SERVICE, INC.
911 Hwy. Business 74
Bostic, NC 28018
828-247-1773
21 loge' 2C
cit
tDOHERESY CERTIFY THAT THIS WELL WAS CONSTRUCTED StACCORDANCE WITH I5A HCACPC. WELL
CONSTRUCTION STANDARDS, AND THAT ACOPY OF THIS RECORD HAS SEEN PROVIDEO TONE WELL CADGER.
FOR OFFICE USE ONLY
Owl Nat
Seed.*
SIONA1URE OP PERSON CONSTRUCTING THE WELL ` C SE
3*4 otgblI N MOPS NNer *ma rot rdnto Dawn ***i 39 CRFS
6a.t net am
-24-2E03 IlOL 11 : 31 i4t1 1D:
PAGE:1

1-14tat. oa
FOR OFFICE USE ONLY
owns
•
Saar NO
Wash Canino Osprowint
sue ma ofdam" t end Nylon Aaaoweaa. Dora, o1 Waif Orally. Or undwe" Salon
MOOS M.C. MIIIm)Mfwno.(elel 733.37a1
336361
WELL CONSTRUCTION RECORD WWLL CONTRACTOR /A',&6//,9,,c , il,'mil
WELL CONTRACTOR CEPTINCATHHI S:
STATE WELL CONSTRUCTION PERMITS:
1. WELL USED- oak AFi,aaela,aa)tReeldemlolci t,Mebel0 Industrial ❑ Rocovo y LJ Hest Fumy Moor ledeeeon 0 Outer ❑ If Oiler, List Use:
2. WEU. LOCATION: (Sfww ekqedt of the balm below)
snow Truc L.
.4 0/..44-O M'L c Cans �a, ,rj�.� - .- .
find Illw'~118 os .111 tm'l WILLING LOG
3. OWNER Ot a2 l /-oCe j,1 L` irons Ta
AddtSM Sb 'o /jc &J4i-S,-,.rp,%%».O
E/en �^ •N"lNiler� .
Cep arTS etr. >iBade
4. TODATE D1 PTI1 - j
S. TOTAL DI -Pins
LED
,. CUTTSJO I courant YES
r. oats W6tlREPLACE mama WELL? YESNOr�
,. amine WATER LEV/L woo Tay of Owing: /.2 D FT. `',
B. TOP OF CASINO / "3" I` Mte'o•IaweTgilCwy
MW
FT. Above Lend Surfaces
e owWO ISA*CAD NOMU
to. °no OSA" I. mewled awn e Sod swifts fyidiwawrYMaMeecar-
10. YIELD (op* Aaa METHOD OF TEST /9-- o�
11. WATER ZONES pep/ Mtn r
AgkrMurel 0 Mordlodne p
12. CNLORRH111m1! Type C 4 4r ' Muni nW ',
13. CASINO: c9 — / %�&
WO tw s
4UMow e f*arFam-4ye 7eeQ )5 FL 2 C,
From T. FL
Front To M.
14. GROUT:
A&F WELL DRILLING
AND PUMP SERVICE, INC,
911 Hwy. Business 74
Bostic, NC 22.018
j)E 247-1773
Fulmar Dnsi l
OnkouturY
(1N OF
IC; 2 9 2006
tt edduktwl geoe b trrbd w be* or lam
Deptfi
From - To
From To a�R c5�' �7. k �tn.v
1S. SCREEN
Depui DYnwNr Slot Sou NINON
From To Ft In. It.
From To FL In. ___. W.
Front To FL__In. In.
18. 5ANoORi4V:LPACK:
Dept Sine MoiIM
TRW ,,.__, To PI.
From To R.
r
17. REMARK &
Lr1t`-ATION ao curl
(ilrn.dime* edeela. born MISS fore
Roach, or air Mop ralsno POW
AND PUM
A&F W ELLP DRNO
SER 10,
911 Hwy_
Bostic, Busf
NC ""
828-247-i;
c ce-
I00 HERESY CERTIFY TNAT THIS WELL WAS CONSTRUCTED ins ACCORDANCE WWII
ISA
CONST*cRONSTNIDARCS.NCWPROVIDEDTOTN
THATACOPYOFPPSREGORORSEEN T TICW
W6l1Ona,Ei
r �'�f c r7 c4ie t c nC:7
N,NA11elEOF PERSON cammuorom NI WIL TE
SODS WOW W Cabot Mar Ow4 oaelta•elet ban vita goys
--, -eler
-24-20213 104 11:31AM ID:
oat! rev. 1271

YHIL 01
FOR OFFICE USE ONLY
&rr
gnaw aro
4, DATE OJULLUt/V' S f,C
a. TOTAL. DI FM a 1
6. CUTTING 9 COLLECTEDYESNO
7. OCEs WELL REPLACE Eat EU.7
S. STATIC WATER LEVEL Wow Tap of Cooly pr.
E. TOP OFCASINO IS �;luoreImown /�nat.
Yu, a• > �' FT. Above Land Swine
sMaa Fwrnsyd t/w Edsw Nod trMss MOM t or4an M asct► Most wan IM NQAC t0.atp
10. YIELD (op n METHOD OF TEST 4:24_
1 I. WATERONE7f PBS - . /7p / - -
Noah Cates O'Mrin,tmNEnw,rs�,y 4„d Ntswtl A&F WELL DRILLING
leaf MN COMP Cr* - Rat N.C. 2TEOon1 , ., W T �'p^ N WNv QwNIy • rtrou,awrr EteaOillD 1 Hwy.y SERVICE, Business A
��10�' (OW �'��� 911 7<!
WELL. CONSTRUCTION RECORD way. CONTRACTOR- ,f }E �V.,'zxi;Bosticwcy
Wall CONTRACTOR CRRTIFICAnON /: 174
STATE WELL CONSTRUCTION PERMIT/:
1. WELL USe Appose osatr NiIdrWW Ali pal ❑ %lua w 0
RocovoryU Hem Pump was, I j$Hgn p pus p M Omer, Last UM:
2. WELL LOCATION: (Show Ek/tdt of the localon below)
mem Thwit Dr//77/0-Fnt/Oi/7,../l -
Agv bSurd 0 Mordbtig 0
AO r
Bo
MD Pt)
911
Assnant meSinnCommaraUtas And Lill "Li DRILLING LOCI siPTH 6
3. OWNER ir�eti 4 , a , ce, q/es ., bons Ta Fawaln_ar.010
WINS
c (G'
ro ^
le.
a
RECEIVED
C IV. cr VA-Ito1i IALITY
DEC 2 3 29f1G
11 CHLORINATION* Typo , _ A4 o/.,•i>r Antourn
it CASINO: S6 /� a addWwwl spas t.Irabd w flea if Iona
Thidene
F ,� Depth UNMI j/ * W NMMS Mew INF.dOn,n/ Mt Ho Ss
.�f�To_/Ft.4r rO17c7.7 Rae&,00wn I
Fnm-----To FL ^+EPrt
Front To R
14. GROUT:
Front
�pDepth MEWS &ISO
Front _Ta Toga —FL .E/4ai-r :Ae.7,O4 446 _ee
To FL h
1a. SCREEN
Opplh OWnMor Slot Ski Mu4sflI
From TO Ft _ E-":
_ h.
ROM eel&To R. _ M. FrontToFL_In. l
1E. SANOIIORAVELPACK
DEp1 Stu WHEW
Front •..._ To PI.
From To FL
17. REMtAR6t
y Le
c/-C4 1047r 6s.
A&F WELL DRILLING
AND PUMP SERVICE, I,NC
911 Hwy. Bushy,, a
Bostic, NC
828-24-,,
-
IDoHERESYCENTIFYTHATTIESWELLWASCONSTRUCTEDIIACCOIIOANCETIIIyHRSA caw. was
CONSTRUCTIDNI STANDARDS, ANO THAT A VOPY OF THIS RECORD 14A$ SEEN PROVIDED TOM WILL Or1
NoNAWIEor PERSON COnsmuT/16 NH win D. .i
SOraMAS* CMhiwatITM4CooktkoondrSNSus 91Mb70CRri
Sea FOY. tan
-24 -2003 ION 11: 31RM I D:
PfAGE:1

Noah Green • Depoanent of EmMenr4M end Natural Remain - Division of Warm away • Groundwater Section qq 107{ MdI state. Corder - RNelp i, N.C. 9TEIIF,07E-Phan. (mist 733-3221 3 ej 3 e7
WELL CONSTRUCTION RECORD WELL CONTRACTOR. '9 ¢/C tad tc/r 12A l7 or) L (�
WELL CONTRACTOR CERTIFICATION 0: . (3 S
STATE WELL CONSTRUCTION PERMITI:
1. WELL USE Appkew aot): Residential iZ.r Municipal El Industrial Q Agricultural ❑
Rncowry Hoot Pump Water ktlecUon 0 Other 0 It Other, Ust Use:
2. WELL LOCATION: (Show Mulch of the bc*Son below)
Nets room >-A ro 5 i C rr 5 County: 9
-.- n n i<. r
Name goal learb•re. ConwrtNtY• x!
and tot Nt)
3. OWNER �1�-1,/�
Add" /S2.4 itic. a; Tip ' a j
Irv< r. ,-�7 •.0 c. n2 5?
OwZIP
O ?
OYawn /Mob ZIPcorm '
4. DATE DRILLED /,� iw—b6
S. TOTAL DEPTH V. - 6 C
6. CUTTINGS COLLECTED YES ❑ NODS
7. 00E3 WELL REPLACE EXISTING WELL? YES
S. STATIC WATER LEVEL Behove Top of Casing: FT.
poreIAaowT olGaol
a. TOP OF CASING 1S_" FT. Mow Lend Surface'
'Too or Mona Mon Motod r how_ / Mao loMee t.qubn • w1Nneeoeaoos-
donee slat tut NCAC as .011
10. YIELD (pink METHOD OF TEST.' 7 # '
11. WATER ZONES (depth): / 0
DRILLING LOG
From 70
12. CHLORINATION: Type r 4 t'c Antolini „eV/twicei
13. CASING: 4/
Monitoring El
A&F WELL DRILLINQ
/TEI C:AND PUMP SERVICE. INC
11 Hwy. Susie{-1'd
Bostic,8j..
Fortran D
RECEIVED
or um Try
ow
IS- 29OR
If additional ono M needed tea bads at form
was INd oast LOCATIOS SKFTC)4 Depth , Dlettwtn xflMasaiwe gi M(Show dkecuon end Sumo Morn a1 Mao too Star.
From /Oii'' To .�•C• Ft. �' — f Floods. or other Peep retam+ta tom!
Rom-- To FL
From To FL
14. GROUT:
� Depth r Material Method
From / To go FL 1S.9,J/'a' X �� uiFri
Prom To F1.
15. SCREEN:
Depth Diameter Slot Sizi
From To - Ft , In. ln.
From ._—. To FL in
From To FL_ In. In.
16. SAND ORMVEL PACK:
Depth Size Materiel
From To Ft ---
From To FL
Material
17. REMARKS:
A&F WELL DRILLING
AND PUMP SERVICE, INC.
911 Hwy. Busina&s 74
Bostic, NC zuoia
828-247.772
—
r
-7—
1DONEREOVCERTIFY THAT THIS WELL WAS CONSTRUCTED INACCORDANCE WITH ISA HCACIC•WELL
CONSTRUCTION STANDARDS, MID THAT AGOPY OPP1/1WES RECORD WAS SEEN PRINKED 10THE YrE!).O NEP.-
Ce
SIGNATURE OP PERSON CO$STRUC1aID 1NE WE4 os : E
Eubdlwirdso 0M1110110WSW Da.O.ov liter $stem wltHa 7p GWre
Ewa fly. ini
FOR OFFICE USE ONLY
Oat Nm
Seal No

• ....- ul
maaaMa ar.lef M amfroani.a and Naaaat Rw aaeea. • Division 01 WWI
Robe" N.O.17RF111]f?hono (St1( 133-072t
WELL CONSTRUCTION RECORD WELL CONTRACTOR.
Oltal•ty • Orou dr a se Sfeaen
n (; 0 l r
WELL CONTRACTOR ERRTIRCATION l:
STATE WELL CONSTRUCTION PERIM:
1. WILL usekasols APF es Nero Raeldu sO— 111atkipa1 ❑ MWuaNal ❑ ASdpllaral 0
IrocovoryO Nero Pomp WMN k*cII.n ❑ Other p II ORor, t.M1 UM:
T. WELL LOCATION: (Show Wroth oR lee Donlon below)
tfe Nfal Ti.+c/r%i��F. I'Y)Ar/l Count19%/ff6, /--0.4.7 rrp.
anon" men a. owNEA A °"""A. • orbIR 1.14
Addrero
—i>rRlFin "`I
OWwTeo as *Bede
A. DATE DIULLED,%g- O_�
5. TOTAL DI PM 3 rn -5--
S. CUTTINGS COLLECTED YES NO13)--
7. DOES WELL REPLACE EXIST11NtYES 0 NOD- EC+EWg� it(iV
E. STATIC WATER LEVEL Salon Top al Cooing: 0 es FT.
WELL?WAi[
D
il Cobol
S. TOP OF CASINO IS / .( `` FFT• .irAbove Land Swims' � if 3 1110b
'TMMs.ae.M^eMMW,,RR, lend Reba Mraaewriaoaaaaar• i)t�• dines sass Ili CAC SCR fa
1t YIELDWI* 'IQ_ METHOD OF TEST.-
11. WATER ZONES z4$.o '
Marble D
A&F WELL DRILLING
AVM!:P SERVICE, INC.
R!LSiness 74
Fwaualiiillac, "" 28018
828-247-1773
1st. CHLORINATIO1t Typer'1/O.Ie;t)'v Amount
13. CASING:. y
Feats
Ie. GROUT:
Clepth ry D/lrnuaTao nossoo
rt. nt. Mahal
FAR-•Lt,_To a Ft.'y�— '-' �% �p nC
F To FL
To FL
From To 0V, FL .1,4- A ,14,a1(
Flarn -- To FL
15. SCREEN
Depth Maladel Method
Depth
From To
From .__ To
From —._To_..
1S. SAND16RI1VEL PACK
0apft
From To.__
Fromm To
17. REIIARIt$
DMttrler Sbl Ski
FI In
FL.___ In.
FL.___ In.
M.Islnl
lot
.h
11.
E1Lf Materiel
naddM lwMneaYtra/admiliaria, loon
tDCATa sxjT�t
Mew Gael on r4 Eau..dInuto 1st M Is be SOW
Roads. or ow Pup tontenca pea!
\(Q5
ij
A&F WELL DRILLING
AND PUMP SERVICE, INC.
911 Hwy. Business 74
Bostic, NC 28018
-riffs
I co NNW WELL WAS CONSTRUCTED INACCoRDANCE w(TN ISA Nvat
L
ERESY
CONSTR uCTIONSTANDARDS,N10TINGACOPYOFTHISRECORDI4ASBEEN PROVIDED TONE WELL owe
. s
FOR OFFICE USE ONLY
row No
Rid Na.
FL
FL
c " ' �ne4�� /r, / ±Z r9C
apronwLIt/1oDMd Raw
Pro ms cONsTRUCron 1*ISL D.=
aM&OwwW+Wr 2aef,et 35 GM
Stl4 FEY. U11
24 --20E13 /ON 11: 31AM I D:
PAGE:1

vote. in40,Iuub lime: 11:38:16 AM
Page 1 of 2
RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources - Division of Water Quality
Well Contractor Certification # 2584
336372
1. WELL CONTRACTOR:
ALAN SCOTT GANTT
Well Contractor (Individual) Name
CAROLINA WELL DRILLERS, INC.
Well Contractor Company Name
STREET ADDRESS: 522 GANTT'S GROVE CHURCH RD
MOORESBORO, NC 28114
[phone]
Area code - Phone number
2. WELL INFORMATION
SITE WELL ID #(IF APPLIACBLE)
STATE WELL PERMIT # (IF APPLICABLE)
DWQ or OTHER PERMIT # (IF APPLICABBE)
WELL USE (Check Applicable Box): Residential Water Supply
DATE DRILLED 11/29/06
TIME COMPLETED 4 AM ❑ PM El
3. WELL LOCATION:
crry: LAKE LURE COUNTY: RUTHERFORD
SHANNONS WALK, RIVERBEND RESORTS
LOT 329
(Street Name, Numbers, Community, Subdivision, Lot No.. Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
❑ Slope 0 Valley 0 Flat ❑ Ridge 0 Other
Latitude/Longitude Source: 0 GPS 0 Topographic map
LATITUDE 35.26.175
LONGITUDE 82.10.080
(location of well must be shown on a USGS topo map and
attached to this form if not using GPS)
4. WELL OWNER
OWNER'S NAME D. L. WALKE CONST. CO.
STREET ADDRESS 5523 US HWY 74A/64
LAKE LURE NC 28746
City or Town State Zip Code
828-288-3000
Area code —Phone number
5. WELL DETAILS:
A. TOTAL DEPTH: 300
B. DOES WELL REPLACE EXISTION WELL? YES 0 NO
C. WATER LEVEL Below Top of Casing: 48 FT
D. TOP OF CASING IS 2 FT Above Land Surface*
*Top of casing terminated aUor below land surface may require
a variance in accordance with I5NCAC 2C .0118.
E. YIELD (gpm): 2 METHOD OF TEST ARDM
f. DIS INFECTION: TypeHYPOCHLORITEAmt:120Z
g. WATER ZONES ( depth)
From 160 To 160 From To
From To From To
From To From To
i. CASING: Thickness/
Depth Diameter Weight Material
From + 2 To 79 Ft. 6 1/8 SDR21 PVC
From
To Ft.
From To Ft.
7. GROUT: Depth Material Method
From 0 To 2 Ft. GRAVEL MIX GRAVITY
From 2 To 20 Ft EASY SEAL GRAVITY
From To Ft
8. SCREEN: Depth Diameter
From To Ft.
From To _ Ft.
From To Ft.
9. SAND/GRAVEL PACK:
Depth Size Material
From To Ft
From To Ft
From To Ft
10. DRILLING LOG
From To Formation
0 72 CLAY
72 300 CONSOLIDATED ROCK
IRECEIVEDkO QUALITY
DEC 2 9 100E
Slot Size Material
in in
n in
in in
11. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED N ACCORDANCE WITH 15
NCAC 2c WELL CONSTRUCTIN STANDARDS, AND THAT A COP Y OF THIS RECORD HAS BEEN
PROVIDED TO THE WELL OWNER.
SIGNATURE OF CERTIFIED WELL CONTRACTOR DATE 12/1/06
ALAN S. GANTT
PRINTED NAME OF PERSON CONSTURCTING 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
Form GW-la
Rev.7/05

North Carolina Department of Environment and Natural Resources -Division of Water Quality -Groundwater Section
1636 Mall Service Center • Ralelgh,N.C. 27699-1636-Phone [phone]
WELL CONSTRUCTION RECORD
WELL CONTRACTOR: ' 1 -ht Nd n/`/ `.4% 1
WELL CONTRACTOR CERTIFICATION # :
STATE WELL CONSTRUCTION PERMIT # :
33151.2
WNELL USE (Check Applicable Box): Residential Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring
Recovery (1 Heat Pump Water Injection O Other ❑ If Other. List Use:
'`v Fr _ L LOCATION:AShow sketch of the location below)
Nearest town
L,r%L'h Cs) ATGAti County
4TSVi CO✓is rid
Road Name and Numbers. Community, or Subdivision and Lot No ) V
3 OWNER Q /%N &Lai
"[, id, ess af% m/-/J.yC4i4Ly .0e.
(Street or 'Route No. ) ;�' ?Ai
:qv or Town State Zip Code
()ATE DRILL FD �� _t-t t"
'CTAJ DEPTH /4'?
• TTINGS COLLECTED YES n NOL
n'-3ES WELL REPLACE EXISTING WELL? YES NO©
C. TA''C WATER LEVEL Below Top of Casing. n FT .
(Use "+" if above Top of Casing)
9. TOP OF CASING IS /S " FT Above Land Surface'
• Top oi casing terminated aVor below land surface requires a variance in accor-
dance with ' SA NCAC 2C 0118 2L y
'r vEILD (GPM)'. /i'a METHOD OF TEST
1' WATER ZONES (depth)
/?wr1 H :.Tn,s
DRILLING LOG
From To
CHLORINATION: Type
13 CASING.
Hr.,/
Depth Diameter
to
'1 ;ROUT
SCREEN
f'nm
om
rim
AND/GRAVEL PACK
Depth
To —
om To
Tr
In
DEPTH
Formation Description
Amount "L If additional space is needed use back of form
Wall Thickness
or Weight/Ft. Material
11.6' P,.id67-,c
(Show direction and distance from at least two State
Roads. or other map reference points)
Depth Material Method
To Ft
To Ft
Depth
— To To -
Diameter SIot.Size Material
Ft in in
Ft in in.
Ft in in
Ft
Ft
Size Material
LOCATION SKETCH
rNV. 0RVRTTER QUALITY
IAN 0 4 2007
17 REMARKS.
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;4t?. /z ems% /4 -`
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit original to Division of Water Quality. Groundwater Section within 30 days
GW-1 REV 12,g6
FOR OFFICE USE ONLY
Quad No
Serial No
ITS 9 1 2031

North Carolina — Department of Environment and Natural Resources — Division of Water Quality — Groundwater Section
1636 Mail Service Center — Raleigh, N.C. 27699-1636 — Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR JEFF MELTON
WELL CONTRACTOR CERTIFICATION #: 3417
STATE WELL CONSTRUCTION PERMTT #:
I. WELL USE (Check Applicable Box): N Residential ❑ Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring
❑ Recovery ❑ Heat Pump Water Injection ❑ Other If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: LAKE LURE County: RUTH
428 STARLING RD. DRILLING LOG DEPTH
(Road Name and Numbers, Community, or Subdivision and Lot No.) From To Formation Description
3. OWNER CHARLES F. WOMACK
Address 428 STARLING RD.
(Street or Route No.)
LAKE LURE NC 28746
City or Town State Zip Code
4. DATE DRILLED 12/04/06
5. TOTAL DEPTH 365
6. CUTTING COIS.FCTED ❑ YES N NO
7. DOES WELL REPLACE EXISTING WELL? ❑ YES N NO
8. STATIC WATER LEVEL Below Top of Casing: 100 FT.
(Use "+" if Above Top of Casing)
9. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a variance in accor-
dance with 15ANCAC 2C.0118
10. YIELD (gpm): 20 METHOD OF TEST: ARD
11. WATER ZONES (depth):
12. CHLORINATION: Type: CHLORYTE Amount: 9
13. CASING:
Wall Thickness
Depth Diameter or Weight/Ft Material
From 0 To 60 Ft. 6-1/4" SDR.21 PVC
From To Ft.
From To Ft.
14. GROUT:
Depth Material Method
From 0 To 20 Ft. OUIKRETE POURED
From To Ft.
15. SCREEN:
Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
From To Ft. in. in.
16. SAND?GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
17. REMARKS:
If additional space is needed use back of four
VSZ
r.)
INB
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other reference points)
HWY. 64/74A W. FROM RUTHERFORDTON. RIGHT ON
BILL'S CREEK RD. LEF 1 ON STARLING RD. NEW LOG
HOUSE ON RIGHT.
RECEIVED
DIV. OF WATER QUALITY
JAN 0 5 200?
I DO CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THISRECORD HAS BEEN PROVIDED TO THE WELL OWNER
FOR OFFICE USE ONLY
Quad No:
Serial No.
SI(rNATURE OF P.
snit original to Division of W
N CONSTRUCTRJG THE WELL DATE
Quality, Groundwater Section within 30 days
GW-1 REV. 12/99

WELL CONSTRUCTION RECORD
North Carolina - De
partment of Environment And Natural Resources - Division of Water
WELL CONTRACTOR (INDIVIDUAL) NAME (print) RODNEY ROBBINS WELL -Groundwater Section
_[_THAN WELL B
WELL CONTRACTOR COMPANY NAME P CERTIFICATION # 278
STATE WELL CONSTRUCTION PERMIT # BORING LLC
PHONE #
ASSOCIATED WQPERMIT # (8281` 2
(if applicable)
(if applicable)
1. WELL USE (Check Applicable Box): Residential ® Municipal/Public
Monitoring 0 Recovery 0 Heat Pump Water Injection Other 2 WELL LOCATION: 0 If Other, List Use _
Nearest Town: MILL SPRING
---_ County POLK
SPRING HILL LANE Topographic/Land setting
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code) ❑ Ridge ❑ Slope ❑ Valley ❑ Flat
3. OWNER: DAVID EDGERTON (check appropriate box)
Address SPRING HILL LANE Latitude/longitude of well location
(Street or Route No.)
MILL SPRING NC 28756 (degrees/minutes/seconds)
City or Town State Zip Code Latitude/longitude source: 0 GPS 0 To
(STh) - 429-1142 (check box) PoPcmap
Area Code Phone number DEPTH
4. DATE DRILLED 01/06/06 From To
5. TOTAL DEPTH: 285
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO ® O
7. STATIC WATER LEVEL Below Top of Casing: 60 FL From From To
of
8. TOP OF CASING IS 1-1/2 FT. Above Land Surffaace*Casmg)
*Top of casing terminated at/or below land surface requires a LOCATION SKETCH
variance in accordance with 15A NCAC 2C .0118. Showleastm at
9. YIELD m : Two Statdirectionods or County Roads. Inclstance in miles ude the road
(gP ) 9 METHOD OF TEST ARD
10. WATER ZONES (depth): number and common names
11. DISINFE HWY. #9 S. FROM MILL SPRING. LEFT ON
CTION: Type CHLORYTE Amount 6.5 SILVER CREEK RD. RIGHT ON
12. CASING:Wall LEFT ON ffiG TAKE ADGER RD.
Depth Diameter or Weight/Ft ThicknessMaterial MOUNTAIN SPRING LANE, RIGHT O . SPRING
From 0 To 100 Ft 6-1/4" SDR21 PVC HILL LANE.LEFT ON DRivtr From To Ft RIGHT AT TOP coF AT BOX #145.
From To Ft -- GATE HII L ------GO THROUGH GREEN
13. GROUT: Depth Material
From 0 To 20 Ft. UIIOttTPOUREDod
E Mc
From To Ft -
14.SCREEN: Depth Diameter Slot Size Material
From To Ft. — in. in.
From To Ft.
15. SAND/GRAVEL PACK: in.RECEIVED
Depth Size Material --I
From To Ft r 1—'
MAR 08 2006
From To Ft _ _
scr
16. REMARKS: Asheville Regional Office `D
CD
I DO HEREBY CERTIFY
THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONS ; CTIO STANDARDS, i THAT A COPY OF t RECORD HAS BEEN PROVIDED TO THE WELL OWNER
/• GNA OF PERSON ' ONSTRU ,� /, - � - i CTING THE WE L DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center- Raleigh, NC
27699-1636 Phone No. [phone], within 30 days.
GW-1 REV. 07/2001
o J

Area code- Phone number
2. WELL INFORMATION:
SITE WELL ID #(i1 applicable)
STATE WELL PERMIT/hi( applicable)
DWQ or OTHER PERMIT #(if applicable)
WELL USE (Check Applicable Box) Monitoring ❑ MunicipaVPubiic ❑
Indushial/Commercial 0 Agricultural D Recovery 0 Injection 0
Irrigation[ Other ID (f t use)
TIME COMPLETED 1f ! 10
NON RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # c:ZS B
3 3 .• .L ., L' e
i.
1. WELL CONTRACTOR:
`�'t L Le—Well
e— •r--
W ell Contractor (Ihdividual) Name
SiIMPtcSn
Well Contractor Company Name
STREET ADDRESS 9a8 I3(22 &T-td tJ
�f w,/]I s.L v31-7IS
City et Town State
Soo )-8'gfq - 03-5'3
Zip Code
DATE DRILLED
3. WELL
CITY.
CATION:
71,5- mad AVC
City or Town State
(70(4 )- 7LfS- l /D 9 7
Area code - Phone number
5. WELL DETAILS:
a. TOTAL DEPTH:
ASIope [Valley ❑Flat DRidge CI Other
(check appropriate box)
LATITUDE 3
LONGITUDE
May be in degrees,
minutes, seconds or
in a decimal format
Latitude/longitude source: OGPS ❑Topographic map
(location of well must be shown on a USGS opo map and
attached to this form d not using GPS)
4. FACILITY -is the name of me business where the well is loc;tetl;
FACILITY ID (i]
#(d
applicable
NAME OF FACILITY &r O.. C .. i l cw I
STREET ADDRESS -"it YGp t I road V
a.oi .m.c.
City or own State - Zip • • e
CONTACT PERSON YS� V TY1
MAILING ADDRESS q OS .n •-Q-
S u T 3 Gho r o � C.. a?a7Q
Zip Code
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
c. WATER LEVEL Below Top of Casing: / IC FT.
(Use'+• if Above Top of Casing)
AMA PM
COUNTIPPLA.a6 From To
d. TOP OF CASING IS rS FT. Above Land Surface'
'Top of casing terminated at/or below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD(gpm): METHOD OF TEST
9
DISINFECTION: Type Amount
WATER ZONES (depth):
From To From To
From To From To
From To From To
6. CASING:
q Dept
Fromma/,S To Ft.
From To Ft.
From To Ft.
7. GROUT: Depth
Diameter
rr
Thickness/
Sei n cies (erial
ci
M� Material Method
From l) To OZ Ft.-Pdl ' card -rii%ih/YV•
From To Ft.
From To Ft.
8. SCREEN: Depth Diameter Slot Size Material
From '-a(.., Toss Ft.•• 2 in. .020in. PVC
From To Ft. in. in.
Ft. in. in.
9. SAND/GRAVEL PACK:
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code) Depth
TOPOGRAPHIC / LAND SETTING: From_3t-1) To
S� Ft.
From To Ft.
From To Ft.
10. DRILLING LOG
From le
o- a S
11. REMARKS:
11417 a ,v\31
ormation DescrCipdo
w rnrl J'I I
rcliOn i eh GRee IA (.►ti
N c
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED N ACCORDANCE WITH
2C, CONSTRUCN STAI¢jARDS, AND THAT A COPY OF THIS
PROVIDE4�ifCiHE
TUR
CERTIFIED
ELL CONTRACTOR
D E6�
PRINTED NAMt OF PERSON NS•t;Rl1GTING THE WELL
Submit the original to the Division of Water Quality within 30 days, Attn: Infonhation Mgt./tr, 5
GW Form -1b
1617 Mail Service Center— Raleigh, NC 27699-1617 Phone No. [phone] eat 568. _ `
Rev.7105

NONRESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
17
WELL CONTRACTOR CERTIFICATION # 2L0 /�j
41 J 0 1 11.
1. W LL CONT CTOR:
�. n n
Contractor (Individual) Nam
eker+ rn,tl
Well Contractor Com
STREET ADDRESS
pa�'}LNat Aloril-tiitield be,
Fit. MILL S
City or Town
Lad
Stale Zip Cone
Area code- Phone number
2. WELL INFORMATION: �� J �yL
SITE WELL ID #(if applicable) M e — 9
STATE WELL PERMIT#(I( applicable)
DWQ or OTHER PERMIT #(if applicable)
WELL USE (Check Applicable Box) Monitoring,^[ Municipal/Public ❑
Industrial/Commercial O Agricultural ❑ Recovery O Injection ❑
Irrigationp Other O (list use)
TIME COMPLETED / 00 AM D PM-X.
r�
WELL
3. CITY: ,U SON:
^' COUNTY /�, htrick?)
DATE DRILLED
7/S k'9fce D Ave',
(Street Name, Numbers, Community. Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
❑Slope�Valley ❑Flat ORidge O Other
(check appropriate box)
LATITUDE 3
LONGITUDE
May be in degrees,
minutes, seconds or
in a decimal format
Latitude/longitude source: OGPS ID Topographic map
(location of well must be shown on a USGS opo map and
attached to this form Knot using GPS) 4. FACILITY -is to name or the business where the well is located.
FACILITY ID Cif applicable)/�
NAME OF FACILITYIJr raC!a' kawr— lie Lief $li ens
ST EET ADDRESS 7IS /c4I l.0.OQD AV2.
Caiker�rpioN NC.
City or Town State Zip Code
CONTACT PERSON Rar1dV A. .ci rnr'f4
MAILINGADDRESS 93�5-r MONroz Rik
CWarto plc- 2.ex��� .
City or Town State Zip Code
(']Gel )- 816•ilo 1O
Area code - Phone number
5. WELL DETAILS: 1
a. TOTAL DEPTH: 4
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
c. WATER LEVEL Below Top of Casing: FT.
(Use "+" if Above Top of Casing)
d. TOP OF CASING IS
FT. Above Land Surface'
'Top of casing terminated at/or below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
3'
e. YIELD (gpm)'.
f. DISINFECTION: Type
g. WATER ZONES !depth)
From
F rom
From
6. CASING.
Tc.
Tr
To
METHOD OF TEST
Amount
From
From
From
Depth Diameter
From 0 To 7)._ Ft._1 '
From Q To,, fl Ft _Coll
From To Ft.
7. GROUT: Depth
To
To
Thic��klInn�ess/
1/ YO
kaio
Sot
PvU
Material Method
/� (( t
From �,,,/ To lD FL Pori -Laid) �tM)
From To Ft.
From To Ft.
8. SCREEN: Depth Diameter Slot Size
From 7.� To Q Lib Ft._��_in. , Ole in.
From To Ft. in.
From To Ft. in.
9- SAND/GRAVEL PACK:
Depth
From '7 l r To 19 Ft
From To Ft.
From To Ft,
Size
in.
in.
Material
pvr✓
Material
S,Lrca So/4b
10. DRILLING LOG
From To Formation Description
CO
cob
c"
11. REMARKS:
geN-tom/*e Seal 69 'I/ r
I DO HEREBY CER
15A NCAC
RECO
SIG 7ATUR
FY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE W rrH
STRUCTION STANDARDS. MID THAT A COPY OF THIS
DE TO THE
WLL OWNER
OF CERTIFIED WELL CONTRACTOR
1Rc/LeT L. M/ttele,
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
7f
ATE
Submit the original to the Division of Water Quality within 30 days. Attn: Inforrgation GW-1
1617 Mail Service Center— Raleigh, NC 27699-1617 Phone No. [phone] ext 566.. _. Rev. 7/05
,AUGJ)Gi3 7

NON RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION #
rt 9 n 41
0 0 I tt 1 go-
1. WELL CONTRACTOR:
Rob' er L, m 1(Lek.
Well Contractor (Individual, Name
Seted 044.0
trued Contractor Company Name
ST HE ET ADDRESS -jo3Q NQrP ]Fe ,
�,, ttLL SG
City or Town State Zip Code
Area code- Phone number
2. WELL INFORMATION:
SITE WELL ID #(if applicable) /111 (A)'"3
STATE WELL PERMIT#il applicable%
DWQ or OTHER PERMIT #(ii applicable)
WELL USE (Check Applicable Box) Monitorinl Municipal/Public 0
Industrial/Commercial 0 Aoricuttural p Recovery Injection
Irrigational Other 07(listt use)
J
DATE DRILLED (/tl�6/0C2
TIME COMPLETED {) G 3 AM ❑ P11;IX
3. WELL W'L�.0 AT�II)O}}N: .,.^,�/ e+
CITY: J1 LA,+ts�( rOr��A/C0uNTYBtt&e rror,3
1 IS Rat t.koa-D Rye. -
(Street Nam9, Numbers. Community, Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
❑Slope Valley ❑Flat ❑Ridge p Other
(check appropriate box)
LATITUDE 3
LONGITUDE
May be in degrees,
minutes, seconds or
in a decimal format
Latitude/longitude source: ❑GPS Topographic map
(location of well must be shown on a USGS topo map and
attached to this form if not using GPS)
4. FACILITY. is the name of Ine business where the well is located.
FACILITY ID #(if applicable) f� (�
NAME OF FACILITY�ra-t e. PcaNf-ket€_JC eroTZoegi
S/ R ET ADDRESS ']/SILL'l+l-ROab AUZ.
1S miker Fora iON NG
City or Town State Zip Code
CONTACT PERSON /`„a tidy A
MAILING ADDRESS R?a5--a-- oNrtoei CD,
„UartoS NCi fl tjO
City or Town State Zip Code
(?04 )- ?1S= /670
Area code - Phone number
5. WELL DETAILS:
A
a. TOTAL DEPTH: 66
b. DOES WELL REPLACE EXISTING WELL? YES 0 NOO>
c. WATER LEVEL Belau Top of Casing: FT.
(Use "+' if Above Top of Casing)
d. TOP OF CASING IS FT. Above Land Surface
'Top of casing terminated at/or below land surface may require
a variance in accordahce with 15A NCAC 2C .0118.
e. YIELD (gpm)'.
f. DISINFECTION: Type
g. WATER ZONES (depth)
From Tc
From To
From To
6. CASING.
METHOD OF TEST
Depth - r
From O To .3 ./ Ft.
From To Ft.
From To Ft.
7. GROUT: Depth
From (J To LIT a Ft.
From To Ft,
From To Ft,
From
From
From
Amount
Diameter
a'
To
To
To
Thickness/
Wei ht Material
Material Method
ParR.a N7 it:
8. SCREEN: Depth
r Depth Diameter Slot Size /'Material
From Si To , r Ft.), 'a '• in. . CV in. ` C"
From To Ft. in. in.
From To Ft. in. in.
9. SAND/GRAVEL PACK:
Depth
From (-1q'To (.421 Ft.
From To Ft.
From To Ft.
Size - Material
10. DRILLING LOG
From To Formation Description
C=
11. REMARKS:
-' eNth/tt ref- 3-aJ 4 i' - 0 441
I DO HEREBY C 11FY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE Wm-1
15A NCAC 2 E NSyPUCT1ON STANDARDS, AND THAT A COPY OF THIS
RECORD Ab B R ED TO E W LL WNER
7,ef %1o4 SIGNA EEO�F CERTIFIED WELL CONTRACTOR DATE
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. : _
p.UtJl <
;P,; arrn GW-lb
. 7/05

NON RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
L WELL CONTRACTOR CERTIFICATION # .0 75
Xi
9
0 J O
1. WELL CONTRACTOR:
1R;1Lrr C. ril)czeK
Well Contractor (Inds dual) Name
Satdccrcfxj
'JJ eli Contractor ComoaarrrJO A,J 7/-�Name /�
STREET ADDRESS /VarAtretd tie
frl,tc. sc.
City or Town State
Zip Code
Area code- Phone number
2. WELL INFORMATION:
SITE WELL ID #(if applicable, �t ''1
STATE WELL PERMIT#(if applicable) AA U .)DWQ or OTHER PERMIT #Of applicable)
WELL USE (Check Applicable Box) Monitoring Municipal/Public E
Industrial/Commercial 0 Agricultural 0 Recovery 0 Injection 0
Irrigation❑ Other 0 (list use)
DATE DRILLED I/dG/AJY
TIME COMPLETED /0 - O AF PM 0
3. WELL TIP N: y.,,
CITY: 'f4 errorbt'rr11 COUNTY erThr)
1/Ska:Lkoab ,AUe
(Street Name. Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
Slope DValley ❑Flat ❑Ridge ❑ Other
(check appropriate box)
LATITUDE 3
LONGITUDE
May be in degrees,
minutes, seconds or
in a decimal format
Latitude/longitude source: ❑GPS ❑Topographic map
(location of well must be shown on a USGS opo map and
attached to this form if not using GPS) 4. FACILITY -Ls the name of the business where the well is located.
FACILITY ID #(if applicable) NAME OF FACILITY Grate $'�v_
whit - eeeae<S [ttp'i etS
SHEET ADDRESS f i -Ka n 2ooA A tue,
title r ortnLoAl NCi
City or Town State Zip Code
CONTACT PERSON A. As 5/11)-414
MAILING ADDRESS 930Stylotireg, k1.
CfiarLctk, Nr, 2-P1.7n
City or Town State Zip Code
(170Y } ?!S --/6 %O
Area code - Phone number
5. WELL DETAILS:
I/Oa- TOTAL DEPTH: O
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NON
c. WATER LEVEL Below Top of Casing: FT.
(Use "+' d Above Top of Casing)
3'
d. TOP OF CASING IS FT. Above Land Surface
'Top of casing terminated at/or below land surface may require
a variance in accordance with 15A NCAC 2C 0118.
e. YIELD (gpm) METHOD OF TEST
f DISINFECTION: Type Amount
WATER ZONES (depth)
From
From Tc
From To From
9
To
6, CASING.
Depth /�
From r,/ ' To /O'Ft
From 0 To g/J Ft
From To Ft
F orr.
From
To
Thickness/
Diameter Weioh Mayjerlay'
1 1/ �
es; go
6' saHLIC
7. GROUT: Depth Material Methoc
From 0 To q&' Ft. 'PQrft.aND ltl yrl )
From To Ft.
From To Ft.
B. SCREEN: Depth Diameter Slot Size
w^s
From % To/ % 0 ' Ft.,," in.. G%O in.
From To Ft. in. in.
From To Ft. in. in.
Material
9. SAND/GRAVEL PACK:
Depth�r To 1�O s Size • Material
From "1 sFt. 2 LiGAL So N16
From To Ft.
From To Ft,
10. DRILLING LOG
From To
Formation Description
C
a`>
<.
C
11. REMARKS: Oendeiv r-+e Sea J QCf�3o T T-
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED N ACCORDANCE WITH
ISA NCAC 2 L ONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
RECORD 5 B R DEO TQ THE WELL OWI✓,ER.
€. 11 �— TE6
SIGN T OF CERTIFIED WEL CONTRACTOR
PR
suet..
AME OF GGt4STRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Info ation l lgt Farm GW-1
1617 Mail Service Center— Raleigh, NC 27699-1617 Phone No. [phone] ext 508. _. AL[j � �;, J Rev. 7/05

orth Carolina —Department of Environment and Natural Resources — Division of Water Quality — Groundwater Section
'36 Mad Service Center — Raleigh, N.C. 27699-1636 —Phone [phone]
JELL CONSTRUCTION RECORD WELL CONTRACTOR: JEFF MELTON
WELL CONTRACTOR CERTIFICATION #: 3417
STATE WELL CONSTRUCTION PERMIT #:
WELL USE (Check Applicable Box): ® Residential ❑ Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring
El Recovery 0 Heat Pump Water Injection ❑ Other If Other, List Use:
. WELL LOCATION: (Show sketch of the location below)
Ieartst Town: FOREST CITY County: RUTH
05 UTHELLA LANE DRILLING LOG
Road Name and Numbers, Community, or Subdivision and Lot No.) From To
. OWNER COIFFN CLONTZ
uddress 205 UTHELLA LANE
Street or Route No.)
'OREST CITY NC 28043
:ity or Town State Zip Cade
DATE DRILLED 07/24/06
I. TOTAL DEPTH 305
CUTTING COLLEc1ED 0 YES ® NO
'. DOES WELL REPLACE EXISTING WELL? 0 YES El NO
STATIC WATER. LEVEL Below Top of Casing: 80 FT.
Use `+" if Above Top of Casing)
). TOP OF CASING IS 1-1/2 FT. Above Land Surface'
Top of casing terminated at/or below land surface requires a variance in actor -
Lance with 15A NCAC 2C.0I1S
.0. YIELD (gpm): 5 METHOD OF TEST: ARD
i 1. WATER ZONES (depth):
12. CHLORINATION: Type: CHLORYTE Amount 7.5
[3. CASING:
Wall Thickness
Depth Diameter or Weight/Ft Material
From 0 To 100 FL 6-1/4" SDR.21 PVC
From
From
14. GROUT:
Depth
From 0 To
From To
15. SCREEN: rept h
� F�
D
From To
From To
From To
To Ft
To FL
Material Method
20 FL QUIKRETE POURED
Ft.
Diameter Slot Size Material
Ft in. in.
Ft in. is
Ft in. in.
16. SAND?GRAVEL PACK:
Depth Size Material
From To Ft
From To Ft.
17. REMARKS:
DEPTH
Formation Description
If additional is needed use ba&k of form
�� 3 4 3L
ti
crT
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other reference points)
BUS. 74 E. FROM FOREST CITY. LEFT ON PEA RIDGE RD. IN
BOSTIC. LEFT ON WHITESIDE RD. LEFT ON UTHELILA
LANE.
[ DO CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THISRECORD HAS BEEN PROVIDED TO THE WFI 1 OWNER.
FOR OFFICE USE ONLY
Quad No:
Serial No.
GNATURE PEltSrON CONSTRUCTING THE'WELL DATE
original to Division of Water Quality, Groundwater Section within 30 days
GW-1 REV. 12/99

nth Carolina — Department of Environment and Natural Resources — Division of Water Quality — Groundwater Section
)36 Mail Service Center — Raleigh, N.C. 27699-1636 — Phone [phone]
'ELL CONSTRUCTION RECORD WELL CONTRACTOR: JEFF MELTON
WELL CONTRACTOR CERTIFICATION #: 34T7
STATE WELL CONSTRUCTION PERMIT #: _
.. WELL USE (Check Applicable Box): (21 Residential 0 Municipal 0 Industrial ❑ Agricultural C] Monitoring
❑ Recovery 0 Heat Pump Water Injection ❑ Other If Other, List Use:
. WELL LOCATION: (Show sketch of the location below)
Iearest Town: RUTHERFORDTON County RUTH
I. DAKOTA-LOT #250 DRILLING LOG DEPTH
toad Name and Numbers, Community, or Subdivision and Lot No.) From To Formation Description
. OWNER TRIPP WRIGHT
.ddress N. DAKOTA-LOT #250
Street or Route No.)
tUTI-IERFORDTON NC 28139
:ity or Town State Zip Code
DATE DRILLED 07/28/06
i. TOTAL DEPTH 265
CUTTING COLLECTED ❑ YES ® NO
r. DOES WELL REPLACE EXISTING WELL? 0 YES ® NO
t. STATIC WATER LEVEL Below Top of Casing: 80 FT.
Use "+" if Above Top of Casing)
). TOP OF CASING IS 1-1/2 FT. Above Land Surface*
Top of casing terminated at/or below Imd surface requires a variance in accor-
lance with 1SANCAC 2C.0118
10. YIELD (gpm): 20 METHOD OF TEST: ARD
11. WA 1 hR ZONES (depth): _
12. CHLORINATION: Type: CHLORYTE Amount 6
13. CASING:
Depth
From 0 To
From To Ft
From To Ft
14. GROUT:
Depth Material Method
From 0 To 20 Ft OUIKRETE POURED
Ft
Wall Thickness
Diameter or Weight/Ft Material
120 Ft. 6-1/4" SDR21 PVC
From To
15. SCREEN:
Depth
From To
From To Ft.
From To Ft.
16. SAND?GRAVEL PACK:
Depth Size
From To Ft.
From To Ft.
17. REMARKS:
Diameter Slot Size Material
Ft. in. in.
in. in.
in. in.
Material
If additional space is needed use back of form
LOCATION SKETCH
'(Show direction and distance from at least two State
Roads, or other reference points)
HWY. #221 N. FROM RUTHERFORDTON. LEFT ON MTN.
CREEK RD. LEFT INTO CLEARWATER CRK. SUVDV. ON
CLEARWATER PKWY. RT. ON N. DAKOTA. LOT #250 ON
RT.
c
c0
J
CJ
Cr,
•
0
J
I DO CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THISRECORD HAS BEEN PROVIDED TO THE WELL OWNER
FOR OFFICE USE ONLY
Quad No:
Serial No.
7)2-L.
SIGNATUREF PEEN CONSTRUCTING THE WFT 1 DATE
Submit original to Division of Water Quality, Groundwater Section within 30 days
GW-1 REV. 12/99

From. Scott Gantt 7044347212 To- Stepoerne Vauson Date. 81612(106 Time. 3.21.18 PM
Page 6 of 6
STATE WELL CONSTRICTION PERMIT #
( if applicable)
1. \VELL L:SE (Check Applicable Box} Residential ❑
Recover): ❑ Heat Pump Water Injection ❑
2. WELL LOCATION:
Nearest town. ELLENBORO
224 ASHELAND DR
D
WELL CONSTRUCTION RECORD a 3 is 3 2 7
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]
ASSOCIATED WQ PERMIT #
(if applicable)
Agricultural
Municipal E Industrial ❑
Other ❑ If Other, List Use:
County RUTHERFORD
(Street Name. Numbers. Community. Subdivision, Lot No,. Zip ('odes
J. OWNER DAN SWAHLAN (degrees/minutes/seconds)
ADDRESS 224 ASHELAND DR Latitude4ongitude source: *❑' GPS ❑ Topographic map
❑ Monitoring ❑
Topographic/Land setting
❑ Ridge ❑ Slope ❑ Valley ❑ Flat
Latitude/Longitude of well location
35.20-85 7 1 81.48.189
IStrccl or Route No.1
ELLENBORO
City or Town
828-245-3603
NC
State
Area Code - Phone Number
4. DATE DRILLED _
5. TOTAL DEPTH 380
28040
Zip Code
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO lZ
7. STATIC WATER LEVEL Below Top of Casing: 50 F it
fuse "" IrAbove Top of Casing)
8. TOP OF CASING IS 2 FT. Above Land Surface`
'Top of casing icneimatcd a✓or below lard surface requires a variance in
accordance with 15A NCAC 2C0I18
9. YIELD (piny 15 METHOD OF TEST ARDM
10. WATER ZONES tdepthy 360
DEPTH
From To
0 76 Clay
DRILLING LOG
Formation Description
76 380 Consolidated Rock
11. DISINFECTION: TYPE HYPOCHLORITE Amount 16
12. CASING: Wall Thickness
Depth Diameter or WeightTt. Material
From 0 To 82 FL 61/4" SDR21 PVC
u. GROUT:
Depth
From 0 To
14 SCREEN
Depth
From NA To
oz LOCATION SKETCH
Show Qlirectidn and distance in mils from at least
two St4te Roads or County Roads, lfnclude the road
numbers and common road names. I
Material Method
20 Ft GRAVEL MIX GRAVITY
15. SAND/GRAVEL PACK:
Depth
From NA To
16. REMARKS
Diameter
FL in.
Ft.
Slot Size Material
in.
Size Material
1
v
ti
0
ch
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITI-I ISA NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
8/1/06
SIGNATURE OF PERSON CONSTRUCTING THE WELL Date
Submit the original to the Division of water Quality, Groundwater Section, 1636 Mall Service center - Raleigh, NC
27699-1636 Phone No. [phone]. within 30 days.
GW-1 REV. 07/2001

From: Scott Gantt 7044347212 To: Stephenie Wilson Date: 8)612006 Time: 3:21:18 PM
Page 4 of 6
STATE WELL CONSTRUCTION PERMIT #
(if applicable)
1. WELL USE (Check Applicable Box) : Residential 0
Recovery ❑ Heat Pump Water Injection ❑
2. WELL LOCATION.
Nearest town: LAKE LURE
LOT IS RALEIGH DR, CAROLINA MTN ESTATES
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]
ASSOCIATED WQ PERMIT #
• �)
V V V :i N
Municipal ❑ Industrial ❑ ❑ Monitoring ❑
Other 0 If Other, List Use:
County RUTHERFORD
(Street Name, Numbers, Community, Subdivision, Lot No.. Zip Code)
3. OWNER JEFF GILBERT
ADDRESS 1339 VIRGINIA AVE.
(Street or Route No.)
DAITONA BEACH
City or Town
954-450-0473
Area Code - Phone Number
4. DATE DRILLED 7/24/06
5. TOTAL DEPTH
FL
State
240
6. DOES WELL REPLACE EXLSTING WELL^
7. STATIC WATER LEVEL Below Top of Casing:
32114
Zip Code
YES ❑ NO 0
35 FT.
(Use -4" If above Top of Casing)
8. TOP OF CASING IS 2 FT. Above Land Surface'
'Top of casing terminated at/or below laud surface requires a variancein
with 15A NCAC 2C 0118
9. YIELD (Wm): 40 METHOD OF TEST ARDM
to. WATER ZONES (depth): 240
(if applicable)
Agricultural
Topographic/Land setting
❑ Ridge Slope ❑ Valley ❑ Flat
Latitude/Longitude of well location
35.26.698 / 82.09.794
(degrees/minutestseconds)
Latitude/longitude source: 0 GPS 0 Topographic map
DEPTH DRILLING LOG
From To Formation Description . _..
0 90 Clay
90 240 Consolidated Rock
H. DISINFECTION: TYPE HYPOCHLORITE Amount 10
12. CASING: Wall Thickness
Depth
From 0 To 96 FL
13. GROUT:
Depth
Diameter or Weight/Ft. Material
61/4" SDR21 PVC
Oz
Malenal Method
From 0 To 20 FL GRAVEL MIX GRAVITY
14. SCREEN
Depth
From NA To
t5. SAND/GRAVEL PACE.:
Depth
NA To
From
16. REMARKS:
Diameter
FL in.
Ft,
Slot Size Material
m
Size Material
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
O
PTh
C •
_
G7
l i•
ce.
ram:
ry
N J
o Crr
cr.
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.%1/06
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 7044347212 To: Stephenie W lson
Date: 8/6/2006 Time: 3:21:18 PM Page 5 of 6
Depth
From 0 To
13. GROUT:
Depth
From 0 To
14. SCREEN
WELL CONSTRUCTION RECORD 33 0326.
North Carolina - Department of Environment, and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) SCOTT GANTT CERTIFICATION # 2584
WELL CONTRACTOR COMPANY NAME CAROLINA WELL DRILLERS, INC. PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential 0 Municipal ❑ Industrial 0 Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other 0 If Other, List Use:
2. WELL LOCATION:
Nearest town: LAKE LURE
LOT 26 RAVEN ST, RIVERBEND RESORTS
County RUTHERFORD
(Street Name, Numbers, Community, Subdivision, Lot No,. Zip Code)
3. OWNER HICKORY NUT DEVELOPMENT CORP
ADDRESS POB 276
(Street or Route No.)
LAKE LURE
City or Town
828-625-0866
NC
State
Area Code - Phone Number
4. DATE DRILLED 7/26/06
Topographic/Land setting
❑ Ridge ❑ Slope ❑ Valley ❑ Flat
Latitude/Longitude of well location
35.25.742 / 82.10.192
(degrees/minutesrseconds)
Latitudeilongitude source: 0 GPS ❑ Topographic map
28746 From
Zip Code 0
5. TOTAL DEPTH 125
6. DOES WELL REPLACE EXISTING WELL? YES NO El
7. STATIC WATER LEVEL Below Top of Casing
(Ure "E" IfAbeivc Top of Casing)
8. TOP OF CASING IS 2 FT. Above Land Surface'
"Top of casing terminated actor blow laid nrfacc requires a variance m
accordance with 15A NCAC 2C.0118
9. YIELD (gpm): 8 METHOD OF TEST ARDM
l0.WA1LR ZONES (depth): 50 110
45 FT.
DEPTH
To
22 Clay
22
DRILLING LOG
Formation Description
125 Consolidated Rock
1l. DISINFECTION: TYPE HYPOCHLORITE Amount 5
12. CASING: Wall Thickness
Diameter or Weight/Ft Material
30 Ft. 6 114 " SDR 21 PVC
20 FI.
Depth
From NA To
15. S.ANDIGRAVEL PACK:
Depth
NA To
From
16. REMARKS:
FL
Ft,
oz LOCATION SKETCH
Diameter
Material Method
GRAVEL MIX GRAVITY
m
Size
Slot Size Material
in.
Material
Show direction and distanceitrmit23frbin at (east
two State Roads orCounty Roads. Include the road
numbers and common road names.
y
G-7
0
0
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C. WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
8./1 /06
SIGNATURE OF PERSON CONSTRUCTING THE WELL Date
Submit the original to the Division &Water Quality, Groundwater Section, 1636 Mall Service center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days.
GW-1 REV. 07;2001

From: Scott Gantt 7044347212 To: Stephenie Wilson Date: 8/6/2006 Time: 3:21:18 PM
Page 1 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 # 2=84
WELL CONTRACTOR COMPANY NAME CAROLINA WELL DRILLERS, INC. PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # ASSOCIATED WQ PERMIT #
(if applicable) I. WELL USE (Check .Applicable Box): Residential
Recovery 0 Heat Pump Water Injection ❑
2. WELL LOCATION:
Nearest town: BOSTIC
MOUNTAIN VIEW RD LOT 81
33 G 0Li
(if applicable)
Municipal 0 Industrial 0 Agricultural 0 Monitoring
Other 0 If Other, List Use:
County RUTHERFORD
(Street Name, Number, Community, Subdivision. Lot No.. Zip Code)
3. OWNER D.L. WALKE CONSTRUCTION
ADDRESS 5523 US HWY 74A/64
(Street or Rout< No.)
LAKE LURE
City or Town
828-288-3000
NC
State
Area Code - Phone Number
4. DATE DRILLED 7/31/06
5. TOTAL DEPTH 410
6. DOES WELL REPLACE EXISTING WELL^
7. STATIC WATER LEVEL Below Top of Casing:
YES ❑ NO
360 FT
(Use "t" If Above Top of Casing)
8. TOP OF CASING 1S 2 FT. Above Land Surface*
'Top of casing tcemiaatsd Nor below land surface requite a variance in
accordance with 15A NCAC 2C.0118
9. YIELD ((pm): 12 METHOD OF TEST
to. WATER ZONES (depth): 402
ARDM
28746
Zip Code
Topographic/Land setting
❑ Ridge ❑ Slope ❑ Valley ❑ Flat
latitade/Longitude of well location
35.31.509 / 81.48.300
(degrees/minutes/seconds)
Latitude,/longitude source: E GPS ❑ Topographic map
From
0
DEPTH
To
10
DRILLING LOG
Formation Description
Clay
10 410 Consolidated Rock
it. DISINFECTION: TYPE HYPOCHLORITE
12. CASING:
Depth
From 0 To
13. GROUT:
From 0
14. SCREEN
Diameter
20 FL 61'4"
Depth
To 20 FL
Depth
From NA To
13. SAND/GRAVEL PACK:
Depth
From NA To
16. REMARKS'.
Amount 5
Wall Thickness
or WeighUF'l. Material
SDR 21 PVC
Oz
Material Method
GRAVEL MIX GRAVITY
Diameter
FL n
FL
Size
.Sloe Size Material
in.
Material
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
v
N
0
0
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
81 06
SIGNATURE OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service center- Raleigh,. C
27699-1636 Phone No. [phone], within 30 days.
19W-i,RFBV.. 07/52001
AUG 2 5 2173

RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Nature -Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # )2Co S
1.(LLI) C7q`P J
Well Contractor (Individual) Pine
,`rice (re v.
Well Contractor Company Name
STREET ADDRESS C4 L ) 5 rcX\ 5�
V 'Y�ry ,N) :
City or Town State
Zip Code
Area code- Phone number
2. WELL INFORMATION:
SITE WELL ID #(It applicable)
STATE WELL PERMIT#°, applicable)
DWQ or OTHER PERMIT #(# applicable)
WELL USE (Check Applicable Box) Monitoring O Municipal/Public 0
Industrial/Commercial 0 Agricultural I7 Recovery 0 Injection 0
Irrigation: Other O (list use)
CC
DATE DRILLED O - i s - l ` l^•
TIME COMPLETED AM 0 PM 0
3. WELL LOCATION: CITY: t. i COUNTY (41 A�: 1-4
Skye Crr.c-Y
(Street ame. Numbers. Commonly. Subdivision. Lot No.. Parcel. Zip Code)
TOPOGRAPHIC / LAND SE't'f LNG:
❑Slope OVasey OFiat pRbge 0 Other
(check appropriate box)
LATITUDE 3
LONGITUDE
May be in degrees,
minutes, seconds or
in a decimal format
Latitude/longitude source: oGPS oTopographic map
(location of we# must be shown on a USGS topo map and
attached to this form #not using GPS)
4. FACILITY -is ale name et me Malaise wherethe wee iie baited.
FACILITY ID #(V applicable)
NAME OF FACILITY (. i' C�1.
STREET ADDRESS O+-1B ILc ,}Au (A (o+
inocityan-4-A) N C iDab SS
City or T wn State Zip Code
CONTACT PERSON
MAILING ADDRESS
City a Town State . Zip Code
( )- ) EC_
Area code - Phone number
5. WELL. DETAILS:
a. TOTAL DEPTH:
b. DOES WELL REPLACE DUSTING WELL? YES 0 NO II
c. WATER LEVEL Below Top of Casing: CILA FT.
(Use '+• if Above Top of Casing)
9. SANDIGRAVEL PACK:
Fran To Ft.
From To Ft.
Fran To Ft.
d. TOP OF CASING IS i T. FT. Above Land Surface'
Top d casing terminated aVor below land surface may require
a variance in accordance with 15A NCAC 2C .0118. ))
e. YIELD (gpm): � METHOD OF TEST Ct r r hl O AAj t
f. DISINFECTION: Type Amount
g. WATER ZONES (depth):
From To From To
From To From To
From To From To
6. CASING: Thickness/
Depth
Ft. Diameter Weight Material
Fron�
From To Ft.
From To Ft.
7. GROUT: Depth Materiel Method
From 0 To(it' Ft. (.1-r'77,\?OVr TnMt\.
Fran To FL
Fran To Ft. _..
a. SCREEN: Depth Diameter Slot Size Malarial
Fran To FL in. _ in.
Fran To Ft. In. in.
From . To FL in. _ in. - C
0
LN.-P
CI
N
0
Crfl
0,
Size - - Material.-_. ..
10. DRILLING LOG
From To Fo - . n Desgriptlon
Gs l C
L`5 L4/\'(
7)t () gin 0
'krp ',SY'S
11. REMARKS:
4Y
FLU
Su-'-) p]U; c,/r%-r,A
t Oo HEREBY CERTIFY TWINE WELL WAS CONSTRUCTEDN Arener an Wtn4
15A NCAC 2C. WELL CONSTRUCTON STANDARDS. AND THAT A COPY OF 11es
REOORD SEEN PRI V ED TO THE WELL OWNER
K(4
KiNATURE OF C
PRNTED NAME OF PERSON CONSTRUCTING THE WELL
S ei5-06
WELL CONTRACTOR DATE
Submit the original to the Division of Water Quality within 90 days. Attn: kdonnatlon Mgt,
1617 Mali Semite Center — Raleigh, NC 27699-1617 Phone No. [phone] ext 5611.
Fain GW-11,
Rev. 7/05

RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of' Environment and Natural Resoourcces- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # ty % 5 1
LLB CONTRi)CTOR:
Well Contractor (Individu Name
pri110rit\\n(GI
Well Contractor Company Name
STREET ADDRESS q6a- 0-54 c�'T S
t ( \) p1^v tJ c 3-b S 1
City or Trim State Zip Code
(411)-%)- 3:4-T Oa-6%
Area code- Phone number
2. WELL INFORMATION:
SITE WELL ID Wit amicable)
STATE WELL PERMITefd applicable)
DWQ or OTHER PERMIT Wit applicable)
WELL USE (Check Applicable Sc)oMonitoring 0 Municipal/Public 0
lndustriaucan meraal o Agriadkaa 0 Recovery 0 Ir$eelias 0
Inigation0 Other 0 (list use)
DATEDRII IFRS- )S - n6
TIME COMPLETED
3. WELL LOCATION:
CITY: (prorrja.rkMm
CiiILir.rI,rtdic
inset Name- Numbers. Can rnudk'. Subdivision, Lot No..Pacel. ZIP Code)
T POGRAPHIC / LAND SETTING:
lope OVatley ❑Flat ❑Ridge 0 Other
(urea appropriate box)
LATITUDE 3
LONGITUDE
AM0 PM0 L,
COUNTYf,rl Ka\I-N7 0 ri
May be in degrees.
minutes, muds or
in a decimal comet
Latitude/Iongitude source: O GPS ❑Topographic map
(location of wet must be shofar on a USGS typo map and
attached to this corm Snot ushg GPS)
4. FACILITY-k me swop of the business were the snag k mend
FACILITY ID 11(d applicable)
NAME OF FACILITY CS G\' C-
STREET ADDRESS 1r itaJSt+up, ( (ree (Yl*
Moo4,n--1nN NC.. 2' o55
City or Tarn State Zlp Code
CONTACT PERSON
MAILING ADDRESS
City or Town
State Zip Code
Area code - Phone number
5. WELL DETAILS:
a. TOTAL DEPTH: t e• O D
b. DOES WELL REPLACE EXISTING WELL? YES O NO
c. WATER LEVEL. Sava Top of CasMg'-. , FT.
(Use --elf Above Top d Casing)
d. TOP OF CASING IS t FT. Above land Surface'
-Top d casing to ikiated alior below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): 1 METHOD OF TEST
f. DISINFECTION: Type Amount
g. WATER ZONES (depth):
From To From To
From To Fran To
Fran To From To
6. CASING: Thickness/
wff�
��/ ,p Weight
From Q To S.t-T FLh
From To Ft. 0
Fran To Ft.
7. GROUT: Depth - Material
Fran t' To -a- FL (1'r O 1.\* pat (
Fran To FL
From To Ft.
B. SCREEN: Depth
Method
Diameter Slot Size Material
Fran To FL,
From To FL
From , To Ft.
9. SANDIGRAVEL PACK:
Fran To Ft.
From To FL
in. in.
in. In.
in. In.
S®--- Material
Fran To Ft.
10. DRIWNG LOG
From To n Description
p S �.
C6 3cn
2n (,c(
P.e, rare
11. REMARKS:
WO MEREST CERTWV MATINS WELL WAS CONSTRUCTED N ACCososon wine
15A NCAC 2C. WELL CONSTRUCTION STANDARDS. MA THAT A COPY OF n85
R�WID S�EN P1OVOFDTOTHE WELL OWNER
K Ji.�cG..M�
SIGNATURE OF CER�TIGFIE,, `WELL CONTRACTOR
PRINTEDNAM PER„. CONSTHU6TINGTHE WELL
Subml the original to the Division of Water Quality within 30 days. Attn: Ylfonnaton Mgt., Form GW-lb
1617 Mall Service Center— Raleigh, NC 27699-1617 Phone No. [phone] ext 566, AUG 2 5 2O3 7i
DATE
9

33 c
RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION g U • S 7
1. WELL {:ONTRACjOR:
1 uP
eellContractContractor(individ) rune
�Y1Ge (A e\�* prl IZtns
Well Contractor Company Name
STREET ADDRESS CV-1)- S;P1 s�
}-\, c .oc , 6o
City or Town State Zip Code
( Ca- - Is - U)-(ctb
Area code- Phone number
2. WELL INFORMATION:
SITE WELL ID e(a applicable)
STATE WELL PERMITIW applicable)
DWQ or OTHER PERMIT 9(8 applcable)
WELL USE (Check Applicable Box) Monitoring 0 Municipal/Public 0
Industrial/Commercial 0 Agricultural0 Recovery Infection
Irrigalicn0 Other 0 (list use) 77��
DATE DRILLED .S ' J Q — l l (7
TIME COMPLETED AM 0 PM 0
3. WELL LOCATION: A\ µC
cfTY: ,(Y) QC r7oo-etbnc, COUNTY () to Yl ' /
Ss NCI C tt\N
(street Name. Manbeis,Commusly, Subdivision, Lot Na. Prcel, Da Code)
TOPOGRAPHIC / LAND S ING:
QSkrpe oVaeey ❑Fiat 0 Other
(check appropriate led
LATITUDE
LONGITUDE
Latitude/longitude source: 0 GPS 0Topographic map
(location USGS topo map and
attached fo this form End using GPS)
4. FACILITY -le the name or the leaknecvAwen well is located.
FACILITY ID e(d applicable)
NAME OF FACILITY cri0_, me LaG,A
STREET ADDRESS CO yin S (i VP.rCVPP K IKTVW
May be in degrees.
minutes, seconds or
in a decimal fwmet
r6a%i!-o tv State (VC, 2(05 5
CityorT
CONTACT PERSON
MAILING ADDRESS
City a Tam State
Area code - Phone number
Zip Code
& WELL DETAILS: r
a. TOTAL DEPTH: CIO 0
b. DOES WELL REPLACE EXISTING WELL? YES 0
c. WATER LEVEL selcw Tap d Cashg: S( IA FT.
(Use's" it Above Top d Casing)
NOa
d. TOP OF CASING IS \IS-- FT. Above Lard Surfaces
'Top of casing laminated &or below land surface may require
a vaiance in accordance with 15A NCAC 2C .0118. 11 II
e. YIELD (gpm): 3 METHOD OF TESTC ., I( !'Y f: LU N
f. DISINFECTION: Type Amount
g. WATER ZONES (depth):
From To From To
From To From To
From To From To
6. CASING: Material
Thickness(
Diameter eight
Fran 11 S 7 FL_ .19VC-
Fran To Ft.
Fran To Ft.
7. GROUT: Depth Mari
Fronte_ Ft. £rfr c p()V`T
Fran To Ft.
Fran To Ft.
Diameter Slot Size Material
8. SCREEN: Depth
Fran To FL_
Fran To Ft._
Fran To Ft.
9. SANDIGRAVEL PACK:
Fran To FL
Fran To Ft.
Fran To Ft.
10. DI6WNG LOG
From To
AC(
)0 Ex UOQ
tInC\ hn(i
11. REMARKS:
in.
in.
in.
in.
in.
in.
Method
Size -_.. Material ._.
rA o Lion
hv-ra $Ivt r/r,h\
�,.rdr_• arty,
C
I oo HEREBY CERTIFY TIATTa9 WELL WAS CONSIr1elED r ACCORDANCE wiM
16A NCAC ZC. WEtlr�CONSSIRUCOVIDED roTM SAND tNAT A COPY OF THIS
LL CONTRACTOR DATE
i
PRINTED NAME OF PE
N a e N
THE. WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt,
1617 Mall Service Center — Raleigh, NC 27699-1817 Phone No. [phone] ezt 663.
-.. _ Farm GW-tb
Rev. 7I05

aLRESIDENTL4L WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # LJS 5 7
1. WELL CONTRACTOjt:
ell Contractor (Indivduai) Nacfe
In VC- W .i> \\v1v5
Well Contractor Company Name
STREET ADDRESS C21G -5- r C- L\ >)st
10aCYC11" INJc -.)-5CC,
City or Town 1 State Zip Code
l�,a> 3a1 Ca-c,`b
Area code- Phone number
2. WELL INFORMATION:
SITE WELL ID ff (a applicable)
STATE WELL PERMIT#fd applicable)
DWQ or OTHER PERMIT 00( applicable)
WELL USE (Check Applicable Box) Monitoring 0 Municipal/Public 0
Industrial/Commercial 0 Agricultural 0 Recovery 0 Infect -an ❑
Inigation0 Other 0 (list use) f
DATE DRILLED ' a- ` — C)
TIME COMPLETED
3. WELL LOCATION:
CITY: cry\ r a ^. Y1� 1 N lade,
( \\Jn.Y
(Street Name. Numbers Comment* Subdivision. Lot No.. RIMS, Zip Code)
TOPOGRAPHIC / LANDSETTING:
()Slope (Valley ❑Fiat RMge 0 Other
(check amanitas box)
LATITUDE 3
LONGITUDE
AM ❑ PM ❑
in\ \Crrf-CW
I
May be in degrees.
minutes, seconds or
in a decimal format
Latitude/longitude source: QGPS (Topographic map
(location of wet must be shown on a USGS topo map and
attached to this form if not using GPS)
4. FACILITY- is pie ne se eree business when eN wall is beanie.
FACILITY ID *if applicable)
NAME OF FACILITY G tC, " frlc'/�(h ��
STREET ADDRESS c.D CSLk[/ kCJtl uerCre•eF-U-
n,,
ANt
nr) ht� kd r\Y J a t ss
City or Tgim State Zip Code
CONTACT PERSON
MAILING ADDRESS
City or Tarn State Zip Code
f 1-
Area code - Phone number
5. WELL DETAILS:
a. TOTAL DEPTH: \ n 5 0 1
b. DOES WELL REPLACE EXISTING WElrL9 0 NO
e. WATER LEVEL Below Top of Castr . rbo _ FT.
+
(Use '-is if Abae Top d Cas )
btOb
d. TOP OF CASING IS 1 FT. Above land Surface'
-Top of casing terminated aVor below lard surface may require
a variance in accordance wlh 15A NCAC 2C .0118..
e. YIELD (gpm): METHOD OF TEST), t ( !Y [j ✓
f. DISINFECTION: Type Amount
g. WATER ZONES (depth):
Fran To From To
From To From To
From To From To
6. CASING: Thickness/
Fom
�Alptght Material
T I 1 �Ft �j 7I/r
DMA)ion eS
D
From To Ft.
Fran To FL
7. GROUT: Depth // Material Method
Fran_0 To-b Ft.lr(QL \ you (I YVcl,\
From To Ft.
Fran To Ft.
8. SCREEN: Depth Diameler Slot Size Material
Fran To FL in. in.
Fran To FL in. In.
From . To Ft in. in.
9. SANI#GRAVEL PACK:
Svc ---.. Material
Fran To Ft.
Fran To FL
From To FL
10. DRILLING LOG
From To
a -
Soo Gnn
�nn t1bf:
Gun S05C.
11. REMARKS:
Fonn Description
c)v�-j o f C\ _
1 Svc. ,,..r�i
ZtxSC� � \ -.
^i
100 HEREBY COMFY T1ATTlat WELL WAS CONSTRUL'TEDN ACCORDMCE WUH
15A NCAC 2C. WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF Tab
RECORD NAS BEEN PRINCE TO THE WELL OWNER
TTU OF CERTIFl�ELL CONTRACTOR DATE
P A 1 C u—`` )/c
PRINTED NAME OF PERSON _CONSTRUCTING THE WELL
Subml the original to the Division of Water Quality Within 30 days. Attn: Information Mgt..
1617 Map Service Center— Raleigh, NC 27699-1617 Phone No. [phone] ext 568.
Form GW-ib
Rev 7105

rth Carolina - Department of Environment and Natural Resources -Division of Water Quality - Groundwater Section
36 Mail Service Center- Raleigh, N.C. 27699-1636 - Phone [phone]
TELL CONSTRUCTION RECORD WFI 1 CONTRACTOR: RODNEY ROBBINS
WELL CONTRACTOR CERTIFICATION #: 2785
STATE WELL CONSTRUCTION PERMIT #:
327697
WELL USE (Check Applicable Boa ® Residential 0 Municipal 0 Industrial ❑ Agricultural 0 Monitoring
0 Recovery 0 Heat Pump Water Injection 0 Other If Other, List Use:
WELL LOCATION: (Show sketch of the location below)
rarest Town: UNION MILLS County: RUTH •
SINTERS GAP RD. DRILLING LOG DEPTH
.oad Name and Numbers, Community, or Subdivision and Lot No.) From To Formation Description
OWNER ANTHONY COLARULO
ddress PAINTERS GAP RD.
treet or Route No.)
NION MILLS NC 28167
ay or Town State Zip CA&
DATE DRILLED 05/11/06
TOTAL DEPTH 805 r
CUTTING COLLEUI ED ❑ YES ®NO
DOES WELL REPLACE EXISTING WELL? ❑ YES ® NO
STATIC WATER LEVEL Below Top of Casing: 0 FT.
se "+" if Above Top of Casing)
TOP OF CASING IS 1-1/2 FT. Above Land Surface*
op of casing terminated at/or below land surface requires a variance in accor-
ace with 15ANCAC 2C.0118
t. YIELD (gpm): 0 METHOD OF TEST: ARD
.. WATER ZONES (depth):
'. CHLORINATION: Type: CHLORYTE Amount: 22.5
+. CASING:
Wall Thickness
Depth Diameter or Weight/Ft Material
From 0 To 35 Ft. 6-1/4* SDR21 PVC
From To Ft.
From To Ft.
4. GROUT:
Depth Material Method
From 0 To 20 FL QUILKRETE POURED
From To Ft.
SCREEN:
Depth Diameter Slot Size Material
From To Ft. in._ in.
From To Ft. in. in.
From To Ft.
i. SAND?GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
7. REMARKS:
If additional space is needed use back of form ._.
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other refut.nce points)
HWY. #221 N. FROM RUTHERFORDTON. LEFT ON
SCHOOLHOUSE RD. IN GILKY. LEFT ON PAINTERAP RD.
APPROX. 6.2 MILES, LEFT ON NEW DRIVE. o
PC)
3>0
Nt1
N c r'
crn
m 1
r
-c
DO CERTIFY THAT THIS WELL WAS CONSTRU(,1ED IN ACCORDANCE WITH 15A NCAC 2C, WELL
ONSTRUCTION STANDARDS, AND THAT A COPY OF THISRECORD HAS BEEN PROVIDED TO THE WELL OWNER
FOR OFFICE USE ONLY
Quad No:
Serial No.
�. Lit� .t . rIO. tit,/ r()
IGNAI'(JRE OP PERSON ONSTRUCTING W$LL L DATE
Submit oshinal to Division of Water Quality, Groundwater Section within 30 days
GW-1 REV. 12/99

Nth Carolina —Department of Envimmuent and Natural Resources — Division of Water Quality — Groundwater Section
36 Mail Service Center — Raleigh, N.C. 27699-1636 —Phone [phone]
TELL CONSTRUCTION RECORD WELL CONTRACTOR: RODNEY ROBBINS
WELL CONTRACTOR CERTIFICATION #: 2785
STATE WELL CONSTRUCTION PERMIT #:
327696
WELL USE (Check Applicable Box): ® Residential 0 Municipal ❑ Industrial 0 Agricultural ❑ Monitoring
❑ Recovery 0 Heat Pump Water Injection 0 Other If Other, List Use:
WELL LOCATION: (Show sketch of the location below)
rarest Town: UNION MILLS County: RUTH
SINTERS GAP RD. DRILLING LOG DEPTH
nad Name and Numbers, Community, or Subdivision and Lot No.) From To Formation Description
OWNER ANTHONY COLARULO
idress PAINTERS GAP RD.
Erect or Route No.)
NION MILS NC 28167
ity or Town State Zip Code
DATE DRILLED 05/13/06
TOTAL DEPTH 605
CUTTING COLLECTED 0 YES ® NO
DOES WELL REPLACE EXISTING WELL? 0 YES ® NO
STATIC WA I Elt LEVEL Below Top of Casing: 360 FT.
se "+" if Above Top of Casing)
TOP OF CASING IS 1-1/2 FT. Above Land Surface*
op of casing terminated aVor below land surface requires a variance in accor-
ace with I5A NCAC 2C.01113
). YIELD (gpm): 7 METHOD OF TEST: ARD
L. WA I ER ZONES (depth):
!. CHLORINATION: Type: CHLORYTE Amount 16.5
J. CASING:
Wall Thickness
Depth Diameter or Weight/Ft Material
From 0 To 40 Ft. 6-1/4" SDR.21 PVC
From _ To Ft.
From To Ft.
4. GROUT:
Depth Material Method
From 0 To 20 Ft QUILKRETE POURED
From _ To Ft.
5. SCREEN:
Depth Diameter Slot Size Material
From To Ft. is in.
From _ To Ft. in. in.
From To Ft. in. in.
5. SAND?GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
7. REMARKS:
If additional space is needed use back of form
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other reference points)
HWY. #221 N. FROM RUTHERFORDTON. LEFT ON
SCHOOLHOUSE RD. IN GILKY. LEFT ON PAINTERS GAP RD.
APPROX. 6.2 MILES, LEFT ON NEW DRIVE.
0
DO CERTIFY THAT THIS WFJ.1 WAS CONSTRUCIE) IN ACCORDANCE WITH 15A NCAC 2C, WELL
ONSTRUCTION STANDARDS, AND THAT A COPY OF THISRECORD HAS BEEN PROVIDED TO THE WELL OWNER
FOR OFFICE USE ONLY
Quad No:
Serial No.
SIGNA ' OF PERSON ON ' UCT1NG THE WELL DATE
Submi . ginal to Division of Water Quality, Groundwater Section within 30 days
GW-1 REV. 12/99

forth Carolina — Department of Environment andNanaal Resources —Division of Water Quality — Groundwater Section
636 Mail Service Center — Raleigh, N.C. 27699-1636 — Phone [phone]
HELL CONSTRUCTION RECORD WEE Ii CONTRACTOR RODNEY ROBBINS
WELL CONTRACTOR CERTIFICATION #: 2785
STATE WELL CONSTRUCTION PERMIT #:
. WELL USE (Check Applicable Box): ® Residential ❑ Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring
❑ Recovery ❑ Heat Pump Water Injection ❑ Other If Other, List Use:
WELL LOCATION: (Show sketch of the location below)
learest Town: UNION MILLS County: RUTH
'AINTERS GAP RD DRILLING LOG
Road Name and Numbers, Community, or Subdivision and Lot No.) From To Formation Description
OWNER ANTHONY COLARULO
lddress PAINTERS GAP RD.
Street or Route No.)
JMON MILLS NC 28167
:ity or Town State Zip Code
DATE DRILLED 05/15/06
;. TOTAL DEPTH 225
CUTTING COLLECTED ❑ YES ® NO
'. DOES WELL REPLACE EXISTING WELL? ❑ YES ® NO
t. STATIC WATER LEVEL Below Top of Casing: 60 FT.
Use `+" if Above Top of Casing)
). TOP OF CASING IS 1-1/2 FT. Above Land Surface*
Top of casing terminated at/or below land surface requires a variance in accor-
ance with I5A NCAC 2C.0118
0. YIELD (gpm): 50 METHOD OF TEST: ARD
.1. WATER ZONES (depth):
.2. CHLORINATION: Type: CHLORYTE Amount: 5
.3. CASING:
From
From
From
14. GROUT:
Depth
From 0 To 20
From To
15. SCREEN:
Wall Thickness
Depth Diameter or Weight/Ft Material
0 To 45 Ft.6-1/4" SDR21 PVC
To Ft.
To Ft.
Material Method
FL QUILKRETE POURED
FL
Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
From To Ft. in. in.
16. SAND?GRAVEL PACK:
Depth Size Material
From To Ft.
From To FL
17. REMARKS:
DEPTH
If additional spare is needed use back of form
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other reference points)
HWY. #221 N. FROM RUTHERFORDTON. LEFT ON
SCHOOLHOUSE RD. IN GILKY. LEFT ON PAINTERS GAP RD.
NEW DRIVE APPROX. 6 MILES ON LEFT.
I DO CERTIFY THAT THIS WFJ.L WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WFJ.1
CONSTRUCTION STANDARDS, AND THAT A COPY OF THISRECORD HAS BEEN PROVIDED TO THE WELL OWNER.
FOR OFFICE USE ONLY
Quad No:
Serial No.
it7A0
S1Qt ATURE OF PE CONSTRUCTING THE L DATE
ginal to Division of Water Quality, Groundwater Section within 30 days
GW-1 REV. I2/99

Borth Carolina =Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone]
YELL CONSTRUCTION RECORD WELL CONTRACTOR RODNEY ROBBINS
WELL CONTRACTOR CERTIFICATION #: 2785
STATE WELL CONSTRUCTION PERMIT #: _
327695
. WELL USE (Check Applcabie Bork ® Residential 0 Municipal 0 Industrial 0 Agricultural 0 Monitoring
0 Recovery ❑ Heat Pump Water Injection 0 Other If Other, List Use:
WFd d LOCATION: (Show sketch of the location below)
dearest Town: RUTHERFORDTON County: RUTH
:ENTENNIAL RD. DRILLING LOG DEPTH
Road Name and Numbers, Community, or Subdivision and Lot No.) From To Formation Description
1. OWNER CHRIS DALE
kddress CENTENNIAL RD.
Street or Route No.)
LUTHERFORDTON NC 28139
:ity or Town State Zip Code
-. DATE DRILLED 05/17/06
i. TOTAL DEPTH 665
CUTTING COLLEC1W 0 YES ® NO
'. DOES WELL REPLACE EXISTING WFi.1 ? 0 YES ® NO
STATIC WATER LEVEL Below Top of Casing: 60 FT.
"+" if Above Top of Casing)
TOP OF CASING IS 1-1/2 FT. Above Land Surface*
Top of casing terminated at/or below Land surface requires a variance in accor-
ance with 15A NCAC 2C.0118
0. YIELD (gpm): 2 METHOD OF TEST: ARD
1. WAIERZONES (depth):
2. CHLORINATION: Type: CHLORYTE Amount: 18
3. 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
,4. GROUT:
Depth Material Method
From 0 To 20 Ft. OUILKRETE POURED
From To Ft
5. SCREEN:
Depth Diameter Slot Size Material
From To Ft. in. in.
From _ To Ft. in. in.
From To Ft. in. in.
.6. SAND?GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
.7. REMARKS:
If additional space is needed use back of form
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other reference points)
HWY. #64 E. FROM RUTHERFORDTON. LEFT ON
CENTENNIAL RD. NEW DRIVE 2 MILES ON LEFT.
0
0
c i
- mrrl
N 0pi
- CJ
✓
DO CLRTIFY THAT THIS WELL WAS CONSTRUC 1 hD IN ACCORDANCE WITH 15A NCAC 2C, WFJ d
CONSTRUCTION STANDARDS, AND THAT A COPY OF THISRECORD HAS BEEN PROVIDED TO THE WELL OWNER.
FOR OFFICE USE ONLY
Quad No:
Serial No.
FJs�il` 'AC." ,`� /7 - 0 in
SIGNATURE OF P ON ONSTRUCTING THE LL DATE
riginal to Division of Water Quality, Groundwater Section within 30 days
GW-1 REV. 12/99

Vorth Carolina --Department of Environment and Natural Resources —Division of Water Quality — Groundwater Section
1636 Mail Service Center— Raleigh, N.C. 27699-1636 —Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR RODNEY ROBBINS
WFI T CONTRACTOR CERTIFICATION #: 2785
STATE WELL CONSTRUCTION PERMIT #: _
327608
1. WELL USE (Check Applicable Box): ® Residential ❑ Municipal ❑ Industrial 0 Agricultural 0 Monitoring
❑ Recovery ❑ Heat Pump Water Injection ❑ Other If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: UNION MILLS County: RUTH
'AINTERS GAP RD. DRILLING LOG
;Road Name and Numbers, Community, or Subdivision and Lot No.) From To
3. OWNER ANTHONY COLARULO
Address PAINTERS GAP RD.
(Street or Route No.)
UNION MILLS NC 28167
City or Town State Zip Code
4. DATE DRILLED 05/08/06
5. TOTAL DEPTH 805 /
6. CUTTING COLLELIED YES NO
7. DOES WELL REPLACE EXISTING WEI I ? ❑ YES ® NO
3. STATIC WATER LEVEL Below Top of Casing: 0 FT.
Use "+" if Above Top of Casing) ' CD
9. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
'Top of casing terminated at/or below land surface requires a variance in acorn -
lance with 15A NCAC 2C.0118
10. YIELD (gpm): 0 METHOD OF TEST: ARD
11. WATER ZONES (depth):
Formatio Desc
ption
12. CHLORINATION: Type: CHLORYTE Amount: 22.5
13. CASING:
Wa11 Thickness
Depth Diameter or Weight/Ft Material
From 0 To 65 Ft.6-1/4' SDR21 PVC
From To Ft.
From To Ft.
14. GROUT:
Depth Material Method
From 0 To 20 Ft.OUILKRETE POURED
From To Ft.
15. SCREEN:
Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
From To Ft in. in.
16. SAND?GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
17. REMARKS:
If additional space is needed use back of form
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other reference points)
HWY. #221 N. FROM RUTHERFORDTON. LEFT ON
SCHOOLHOUSE RD. IN GILKY. LEFT ON PAINTERS GAP RD.
APPROX 6.2 MILES. LEFT ON NEW DRIVE.
c
0
t_ -r1�
- Dn
N n-
pa<
N O ;?
• CI 7,
• r
I DO CERTIFY THAT THIS WELL WAS CONSTRUUIEll IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THISRECORD HAS BEEN PROVIDED TO THE WELL OWNER.
P yetw�LC��( '� 5� v 6
SIGNAT URh OF PERSON C U G THE DATE
Submiiginal to Division of Water Quality, Groundwater Section within 30 days
GW-1 REV. 12/99
FOR OFFICE USE ONLY
Quad No:
Serial No.

North Carolina-Depmtmeni of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mail Service Center- Raleigh, N.C. 27699-1636 -Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR ROBIN MCNEELY
WELL CONTRACTOR CERTIFICATION #: 2567
STATE WELL CONSTRUCTION PERMIT #:
327701
1. WELL USE (Check Applicable Boz): El Residential 0 Municipal
0 Recovery 0 Heat Pump Water Injection 0 Other
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: FOREST CITY County: RUTH
477 MORNING STAR LAKE RD. DRILLING LOG
Road Name and Numbers, Community, or Subdivision and Lot No.) From To
3. OWNER ALLAN BUCHANAN
Address 477 MORNING STAR LAKE RD.
'Street or Route No.)
FOREST CITY NC 28043
City or Town State Zip Code
I. DATE DRILLED 05/23/06
5. TOTAL DEPTH 70
J. CUTTING COLLECli ll ❑ YES ®NO
7. DOES WELL REPLACE EXISTING WELL? ® YES 0 NO
3. STATIC WATER LEVEL Below Top of Casing: 50 FT.
Use "+" if Above Top of Casing)
). TOP OF CASING IS 1-1/2 FT. Above Land Surface*
Top of casing terminated at/or below land surface requires a variance in accor-
lance with I5A NCAC 2C.0118
10. YIELD (gpm): 20 METHOD OF TEST: S 1I±L TAPE
11. WATER ZONES (depth):
12. CHLORINATION: Type: CHLORYTE Amount: 9.2
13. CASING:
Wall Thickness
Depth Diameter or Weight/Ft Material
From 0 To 70 Ft 24 CEMENT
From To Ft.
From To Ft.
14. GROUT:
Depth Material Method
From 0 To 20 Ft. CEMENT POURED
From To Ft.
15. SCREEN:
Depth Diameter Slot Size Material
From To Ft. in. in.
From _ To Ft. in. in.
From _ To Ft. in. in.
16. SAND?GRAVEL PACK:
Depth Size Material
From 50 To 70 Ft. 78M GRAVEL
From To Ft
i7. REMARKS:
❑ Industrial 0 Agricultural ❑ Monitoring
If Other, List Use:
DEPTH
Formation Description
If additional space is needed use back of form
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other reference points)
HWY. #221 S. FROM RUTHERFORDTON. LEFT ON MORNING
STAR LAKE RD. 3/4 MILE ON LEFT.
DO CERTIFY THAT THIS WFI S WAS CONSTRUC LLD IN ACCORDANCE WITH 15A NCAC 2C, WELL
:ONSTRUCTION STANDARDS, AND THAT A COPY OF THISRECORD HAS BEEN PROVIDED TO THE WELL OWNER
FOR OFFICE USE ONLY
Quad No:
Serial No.
516 TIME PNSTta,, 3
R CTING THE WELL DATE
Submit original to Division of Water ty, Groundwater Section within 30 days
GW-1 REV. 12/99

orth Carolina :Department of Environment and Natural Resources — Division of Water Quality — Groundwater Section
i36 Mail Service Center — Raleigh, N.C. 27699-1636 —Phone [phone]
JELL CONSTRUCTION RECORD WELL CONTRACTOR RODNEY ROBBINS
WE1.1 CONTRACTOR CERTIFICATION #: 2785
STATE WELL CONSTRUCTION PERMIT #:
327700
WELL USE (Check Applicable Box): 0 Residential ❑ Mtmicipal ❑ industrial ❑ Agricultural ❑ Monitoring
❑ Recovery ❑ Heat Pump Water Injection ❑ Other If Other, List Use:
WELL LOCATION: (Show sketch of the location below)
Barest Town: RUTHERFORDTON County: RUTHO
ENTENNIAL RD. DRILLING LOG DEPTH
toad Name and Numbers, Community, or Subdivision and Lot No.) From To
OWNER CHRIS DALE
ddress CENTENNIAL RD.
street or Route No.)
UTHERFORDTON NC 28139
ity or Town State Zip Code
DATE DRILLED 05/03/06
TOTAL DEPTH 605
CUTTING COLLECTED ❑ YES NO
DOES WELL REPLACE EXISTING WET ? ❑ YES ® NO
STATIC WATER LEVEL Below Top of Casing: 0 FT.
se "+" if Above Top of Casing)
TOP OF CASING IS 1-1/2 FT. Above Land Surface*
'op of casing terminated atlor below land surface requires a variance in accor-
nce with 15A NCAC 2C.0118
1. YIELD (gpm): 0 METHOD OF TEST: ARD
. WATER ZONES (depth):
'.. CHLORINATION: Type: CHLORYTE Amount: 16.5
;. CASING:
Wall Thickness
Depth Diameter or Weight/Ft Material
From 0 To 65 Ft.6-1/4" SDR21 PVC
From To Ft. _
From To Ft.
1. GROUT:
Depth Material Method
From 0 To 20 Ft.OUILKRETE POURED
From To Ft.
;.SCREEN:
Depth Diameter Slot Size Material
From To Ft. _ in. in.
From To Ft. in. in.
From To Ft in. in.
i.SAND?GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
7. REMARKS:
Formation Description
If additional space is needed use back of form
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other reference points)
HWY. #64 E. FROM RUTHERFORDTON. LEFT ON
CENTENNIAL RD. NEW DRIVE 2 MILES ON LEFT.
0
0
r_ 7
c =Lim
DC
N rn-
z<
N Orli
o
m
r—
DO CERTIFY THAT THIS WELL WAS CONSTRUC,FED IN ACCORDANCE WITH 15A NCAC 2C, WELL
ONSTRUCTION STANDARDS, AND THAT A COPY OF THISRECORD HAS BEEN PROVIDED TO THE WELL OWNER.
C� e; dt��Gia L per , -� 3-<
IGNA OF PERSON ONSTRUCTING THE L DATE
Submi ginal to Division of Water Quality, Groundwater Section within 30 days
GW-1 REV. 12/99
FOR OFFICE USE ONLY
Quad No:
Serial No.

Wall Thickness
Depth Diameter or Weight/Ft Material
From 0 To 57 Ft. 24 CEMENT
From To Ft.
From To Ft.
4. GROUT:
Depth Material Method
From 0 To 20 Ft. CEMENT POURED
From To Ft.
5. SCREEN:
Depth Diameter Slot Size Material
From To Ft. in. in._
From To Ft. in. in.
From To Ft. in. in.
5. SAND?GRAVEL PACK:
Depth Size Material
From 37 To 57 Ft 78M GRAVEL
From To Ft.
7. REMARKS:
rth Carolina -Department of Environment and Natural Resources -Division of Water Qiplity - Groundwater Section
36 Mail Service Center- Raleigh, N.C. 27699-1636 - Phone [phone]
ELL CONSTRUCTION RECORD WELL CONTRACTOR ROBIN MCNEELY
WELL CONTRACTOR CERTIFICATION #: 2567
STATE WELL CONSTRUCTION PERMIT #:
327706
WELL USE (Check Applicable Box): ® Residential 0 Municipal ❑ Industnai 0 Agricultural ❑ Monitoring
❑ Recovery 0 Heat Pump Water Injection 0 Other If Other, List Use:
WELL LOCATION: (Show sketch of the location below)
:arestTown: BOSTIC County: RUTH
)GAN RD. DRILLING LOG DEPTH
oad Name and Numbers, Community, or Subdivision and Lot No.) From To Formation Description
OWNER BRUCE JUSTIN
'dress LOGAN RD.
treet or Route No.)
)STIC NC 28018
ty or Town State Zip Code
DATE DRILLED 05/03/06
TOTAL DEPTH 57
CUTTING COLLECTED ❑ YES ® NO
DOES WELL REPLACE EXISTING WELL? ❑ YES ® NO
STATIC WATER LEVEL Below Top of Casing: 37 FT.
:e "+" if Above Top of Casing)
TOP OF CASING IS 1-1/2 FT. Above Land Surface*
op of casing terminated at/or below land surface requires a variance in accor-
we with 15A NCAC 2C.0118
i. YIELD (gpm): 20 METHOD OF TEST: S LEEL TAPE
. WA1tit ZONES (depth):
rc
c,-
If additional space is needed use back of form
'. CHLORINATION: Type: CHLORYTE Amotmt: 9.2
1. CASING: LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other reference points)
FROM BOSTIC GO OUT BOSTIC/SUNSHINE RD. LEFT ON
ANDREW MILL RD. RIGHT ON LOGAN RD. 1sr DRIVE ON
LEFT.
0
0
t_ n—
>0
N - --in
C
N Qrt
o
Cr, D�
r-
-4
DO CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
ONSTRUCTION STANDARDS, AND THAT A COPY OF THISRECORD HAS BEEN PROVIDED TO THE WELL OWNER.
FOR OFFICE USE ONLY
Quad No:
Serial No.
o-D �J A„,e: 5 - 3--
S A 0 ERSOTRUCTING THE WEII DATE
Submit original to Division of Water •�ity, Groundwater Section within 30 days
GW-1 REV. 12/99

orth Carolina .paatment of Environment and Natural Resources —Division ofWafer Quality — Groundwater Section
136 Mail Service Center— Raleigh, N.C. 27699-1636 — Phone [phone]
YELL CONSTRUCTION RECORD WELL CONTRACTOR: ROBIN MCNEELY
WELL CONTRACTOR CERTIFICATION #: 2567
STATE WELL CONSTRUCTION PERMIT #: _
327705
WELL USE (Check Applicable Box): ® Residential ❑ Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring
❑ Recovery ❑ Heat Pump Water Injection ❑ Other If Other, List Use:
WFJ.T LOCATION: (Show sketch of the location below)
earest Town: ELLENBORO County: RUTH
/ALLS CHURCH RD. DRILLING LOG DEPTH
toad Name and Numbers, Community, or Subdivision and Lot No.) From To Formation Description
OWNER LLOYD SILVER
ddress WALLS CHURCH RD.
Street or Route No.)
LLENBORO NC 28040
ity or Town State Zip Code
DATE DRILLED 05/04/06
TOTAL DEPTH 64
. CUTTING COLLECTED 0 YES ® NO
DOES WFT I REPLACE EXISTING WELL? ❑ YES ® NO
STATIC WATER LEVEL Below Top of Casing: 44 FT.
:se `-" if Above Top of Casing)
TOP OF CASING IS 1-1/2 FT. Above Land Surface*
Cop of casing terminated at/or below land surface requires a variance in accor-
nce with 15A NCAC 2C.0118
). YIELD (gpm): 20 METHOD OF TEST: S 1EEL TAPE
1. WATER ZONES (depth):
2. CHLORINATION: Type: CHLORYTE Amount: 9.2
3. CASING:
Wall Thickness
Depth Diameter or Weight/Ft Material
From 0 To 64 Ft. 24 CEMENT
From To Ft.
From To Ft.
4. GROUT:
Depth Material Method
From 0 To 20 Ft. CEMENT POURED
From To Ft.
5. SCREEN:
Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
From To Ft in. in.
6. SAND?GRAVEL PACK:
Depth Size Material
From 44 To 64 Ft 78M GRAVEL
From To Ft.
7. REMARKS:
If additional space is needed use back of form
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other reference points)
HOLLIS RD. FROM ELLENBORO. LEFT ON WALLS CHURCH
RD. 2r7D DRIVE ON LEFT.
DO CERTIFY THAT THIS WELL WAS CONSTRUC 1 ED IN ACCORDANCE WITH 15A NCAC 2C, WELL
:ONSTRUCTION STANDARDS, AND THAT A
COPY`'�OF THISRECORD HAS BEEN PROVIDED TO THE
WELL OWNER �s
F-1�c�J i�6%lJ4&9j.L
i s 9
SIGNA O ON COG^ELL DATE
Submit original to Division of Water Qualityf undwater Section within 30 days
GW-1 REV. 12/99
FOR OFFICE USE ONLY
Quad No:
Serial No.

forth Carolina - Di.pmtuient of Environment and Natural Resources — Division of Water Quality — Groundwater Section
636 Mail Service Center — Raleigh, N.C. 27699-1636 — Phone [phone]
WELL CONSTRUCTION RECORD WE.I 1 CONTRACTOR: ROBIN MCNEELY
WELL CONTRACTOR CERTIFICATION #: 2567
STATE WELL CONSTRUCTION PERMIT #:
327'704
1. WELL USE (Check Applicable Box): ® Residential ❑ Municipal ❑ Industrial ❑ Agricultural D Monitoring
❑ Recovery ❑ Heat Pump Water Injection ❑ Other If Other, List Use:
'.. WELL LOCATION: (Show sketch of the location below)
Yearest Town: RUTHERFORDTON County: RUTH
-IONEY WAGON DR DRILLING LOG DEPTH
Road Name and Numbers, Community, or Subdivision and Lot No.) From To
3. OWNER TERRY CANTRELL
address HONEY WAGON DR
Street or Route No.)
2UTHERFORDTON NC 28139
:ity or Town State Zip Code
L. DATE DRILLED 05/04/06
5. TOTAL DEPTH 76
i. CUTTING COLLECTED ❑ YES ® NO
7. DOES WELL REPLACE EXISTING WELL? ❑ YES ® NO
3. STATIC WATER LEVEL Below Top of Casing: 61 FT.
Use "+" if Above Top of Casing)
1. TOP OF CASING IS 1-1/2 FT. Above Land Surface"
Top of casing terminated at/or below land surface requires a variance in accor-
znce with I5A NCAC 2C.0118
.0. YIELD (gpm): 15 METHOD OF TEST: S 1.LEL TAPE
11. WAFER ZONES (depth):
12. CHLORINATION: Type: CHLORYTE Amount: 6.9
13. CASING:
Wall Thickness
Depth Diameter or Weight/Ft Material
From 0 To 76 Ft. 24 CEMENT
From To Ft.
From To Ft.
14. GROUT:
Depth Material Method
From 0 To 20 Ft. CEMENT POURED
From To Ft.
15. SCREEN:
Depth Diameter Slot Size Material
From To Ft in. in.
From To Ft. in. in.
From To Ft. in. in.
16. SAND7GRAVEL PACK:
Depth Size Material
From 61 To 76 Ft. 78M GRAVEL
From To Ft.
17. REMARKS:
Formation Description
If additional space is needed use back of form
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other reference points)
BIG ISLAND RD. FROM SHILOH. RIGHT ON 2r n DARK
CORNER RD. RIGHT ON 1st' PAVED DR (J.J. BLVD.) RIGHT
ON HONEY WAGON DR
0
crl •1
▪ D0
- rn
<
N L 1^.`
o ,L
o ▪ i
DO CERTIFY THAT THIS WELL WAS CONSTRUC MD IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THISRECORD HAS BEEN PROVIDED TO THE WELL OWNER
FOR OFFICE USE ONLY
Quad No:
Serial No.
if /�'! //L r �1� i V G
S NA OF P O CO TRUCT1NG THE i DATE
Submit original to Division of W Quality, Groundwater Section within 30 days
GW-1 REV. 12/99

Date: 6/21/2006 lime: 11:07.36 PM Page 5 of 5
From: Scott Gantt To: Stephenie Wilson
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) Of 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 0 Slope ❑ valley ❑ Flat
McENTIRE RD Latitude/Longitude of well location
(Street Name, Numbers, Community, Subdivision, Lot No,. Zip Code) 35.26.472 i 82.04 773
ck 51 '7. 4 t 6
0i4O1J
3. OWNER HORTON HOME OF RUTHERFORDTON (degrees/minutes/seconds)
ADDRESS 342 HWY 74 BYPASS Latitude/longitude source. ❑ GPS ❑ Topographic map
(Street or Rome No.) DEPTH DRILLING LOG
RUTHERFORDTON NC 28139 From To Formation Description
City or Town State Zip Code 0 25 Clay
828-287-3366
Area Code - Phone Number
4. DATE DRILLED 5/25/06
5. TOTAL DEPTH 105
6. DOES WELL REPLACE EXISTING WELL?
7. STATIC WA TER LEVEL Below Top of Casing:
YES 0 NO 0
75 FT.
(Use `4' If Above Top of Casing)
8. TOP OF CASING IS 2 FT. Above Land Surface*
'Top of casing tenninand ardor below land surface repines a variance m
accordance with 15A NCAC 2C0118
9. YIELD (gpm): 18 METHOD OF TEST ARDM
l0. WATER ZONES (depth): 100
25 105 Consolidated Rock
11. DISINFECTION: TYPE HYPOCHLORITE Amount 3 oz LOCATION SKETCH
12. CASINO: Wall Thickness Show direction and distance to miles from at least
Depth Diameter or Weight/Ft. Material two State Roads or County Roads. Include the road
From 0 To 39 Ft. 61/4" SDR 21 PVC numbers and common road names. -�
13. GROUT: _ =,_
Depth Material Method
From 0 To 20 Ft GRAVEL MIX GRAVITY
14. SCREEN
Depth
From NA To
15. SAND/GRAVEL PACK:
Depth
From NA To
16. REMARKS:
Ft.
Ft,
Diameter Slot Size Material
in. in.
Size Material
W
GVv
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.
6/1/06
SIGNATURE OF PERSON CONSTRUCTING THE WELL
Date
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service center - Raleigh, N C
27699-1636 Phone No. [phone], within 30 days.
GW-1 REV. 07/2001

From: Scott Gantt To: Stephenie Wilson Date: 6/21/2006 Time: 1 t:07:36 PM
Page 4 of 5
From
(if applicable)
1 WELL USE (Check Applicable Box) : Residential E
Recovery ❑ Heat Pump Water Injection ❑
2. WELL LOCATION:
Nearest town: LAKE LURE
3501 BILLS CREEK RD
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment, and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) SCOTT GANTT CERTIFICATION # 2584
WELL CONTRACTOR COMPANY NAME CAROLINA WELL DRILLERS, INC. PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # ASSOCIATED WQ PERMIT #
(if applicable)
Municipal ❑ Industrial ❑ .Agricultural ❑ Monitoring
Other ❑ If Other, List Use:
County RUTHERFORD
(Street Name, Numbers, Community, Subdivision, Lot No,. Zip Code)
3. OWNER CHARLEY ABBOTT
ADDRESS 3501 BILLS CREEK RD
LAKE LURE
City or Town
NA
(Start or Routc No.)
NC
State
Area Code - Phone Number
4. DATE DRILLED 5/22/06
5. TOTAL DEPTH 240
6. DOES WELL REPLACE EXISTING WELL?
7. STATIC WATER LEVEL Below Top of Casing:
28746
Zip Code
YES ❑ NO 3
60 FT.
(Use "+' If Above Top of Caamgt
8. TOP OF CASING IS 2 Fr. Above Land Surface'
'Top of casing tcnnmatcd actor below land cornice rcgimce a Yaianee b,
accordancc with 15A NCAC 2C.0118
9. YIELD (gym): 8 METHOD OF TEST
10- WATER ZONES (depth): 110 230
ARDM
Topographic/Land setting
❑ Ridee ❑ Slope ❑ Valley 0 Flat
Latitude/Longitude of well location
35.29.483 / 82.06.924
2 S. 1
tI
(degrees/minutes/seconds)
Latitude/longitude source: ❑ GPS ❑ Topographic map
From
0
DEPTH
To
57 Clay
DRILLING LOG
Formation Description
57 240 Consolidated Rock
11. DISINFECTION: TYPE HYPOCHLORITE
12 CASING:
Depth Diameter
From 0 To 66 FL 61/4"
13. GROUT:
Depth
From 0 To 20 FL
14. SCREEN
Depth
From NA To
15. SAND./GRAVEL PACK:
Depth
NA To
16. REMARKS:
Amount 9
Wall Thickness
or Weight/FL Material
SDR21 PVC
Or
Diameter
Ft.
Ft
Size
Material Method
GRAVEL MIX GRAVITY
Slot Size Material
R 1R
Material
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 1SA NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
6/1/06
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

From: Scott Gantt To: Stephenie Wilson
Date: 6/21/2006 Time: 11:07:36 PM Page 1 of 5
WELL CONSTRUCTION RECORD V 2 c. 1 r u ie•2
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 D Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring 0
Recovery 0 Heat Pump Water Injection 0 Other ❑ If Other, List Use:
2. WELL LOCATION:
Nearest town: LAKE LURE
LOT 7, SWEET BRIAR FARMS SUB
County RUTHERFORD
(Street Name, Numbers, Community. Subdivision, Lot No„ Zip Code)
3. OWNER C. L. SCHOPMEYER
ADDRESS LOT 7 SWEET BRIAR FARMS SUB
Topographic/Land setting
❑ Ridge ❑ Slope ❑ Valley ❑ Flat
Latitude/Longitude of well location
(deg ees/minutesrseconds)
Latitude.9ongitude source: ❑ GPS ❑ Topographic map
(Street or Rome No.) DEPTH DRILLING LOG
LAKE LURE NC 28746 From To Formation Description
City or Town State Zip Code 0 Clay
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: FT.
disc "a- IfAbovc Top of Casing)
8. TOP OF CASING IS 2 FT Above Land Surface'
'Top of cosine terminated at/or blow land surface requires a vansnee in
accordance with 15A NCAC 2C.0118
Consolidated Rock
9. YIELD (ppm): METHOD OF TEST ARDM
CD
to WATER ZONES (depth):
tt. DISINFECTION: TYPE HYPOCHLORITE Amount oa LOCATION SKETCH p
12. CASING: Wall Thickness Show direction and distance in miles from at least L- `.TJ
Depth Diameter or WeiehVFL Material two State Roads or County Roads. Include the road = 7,— 0
From 0 To FL 6 1/4 " SDR 21 PVC numbers and common road names. W r 71
r.❑
3. GROUT: ,<
N 0f 7
Depth Material Method o C
From 0 To 20 FL GRAVEL MIX GRAVITY "l r
14. SCREEN —I
Depth Diameter Slot Size Material
From NA To FL itt 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.
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

mono care Ds sn w En4r nwati end *MuralRHYUCM - Maslen ofNW y caw • GMUMWr« $K.«I J • i Y U S
laze ma Sodas Cow-11.1.10► N.C. SNS►N3L411°6. PI.) 733-322I I
WELL CONSTRUCTION RECORD WELL CONTRACTOR ,4i / _)tt7 4,5' /72
WELL CONTRACTOR CEPTIRCAT(ON S: e/0 .5
—
STATE WELL CONSTRUCTION PERMITS:
1. WELL US e(Oi.+Amos Me} R.$d«+rSlls;l Munkip.I C] leduNll.i O As:aurSi C7 Moldaby 0
hoeonth 0 Now Pump Ws Mjscuon 0 Ones 0 I1 Ono. wI UN.
2. WELL L0I:AT1OttiGhow SOO of o/e baron below) /7
Neel Tore i �` / . C L') . c Cunt A" /// 4 /74,
/t‘e.iMotowsOo smo.orSANS.'tWIIM.)
1-; 4/
DRILLING WO
0. OWNER Temp otas,-7,49, SEtiifrn tact Free To
/tc:IS_ fad Qd
APRs
% _ et / - C y f o /
et Ts elrl Cob
4, DATE OFbLLW 7-1/, —!j 6
5. TOTAL DEPTH 3p 'S '
5. CUTTpq l COU.ECTED YES ❑ NOCZ]�
7. DOES WELL REPLACE EXISTING WELL? YES 0 No [?r
E. STATIC WATE11 LEVEL odor Tap S Carr / n FT.
fuss •:.IMwlep CS.
S. TOP OF CA*IG W / ' " FT. Above La11M Sudan'
'IM N o.* hn.Yy114 NW beb. tad poen Nitos.•wrlo.KNac«-
OnoM.IIfANCAC stn �
%O. YIELD (Spa): i00 OF TEST /9. 1+
11. WATER ZONES ISpfl
it. CNLARS&TIOIt Tppo C4144 e'di.o Amota l
%3. CASING:66
wr 1nW.«
Depth'Urn «MICMsf1.
Fina.'.•/'� S.4S
Pt_c.
froalr— To FL
From To FL
14. GROUT:
Depth Mon! I MO
From To .' 0 MFL -s-'i a"'; u tip AL -jet
Pr _ _ To Ft.
15. SCREEN 1' \
DDeptDIrIwt.r Slot Ste MMuS.I
From ----To Ft__ h. _._._In.
tom ___ Fm To _ FL _ h. W.
From _ _ To __ Ft..__ In. h
1S. SAND/ORAYELPACK: M
le olio .1e11oi
Flom To FC Gt flw,, & a 6
�� /tw' C
Flom TO FL 1705 ; `' 5aal 5. 4i•*
17. RERAN' &
100MEPESYCERTIFY THAT TMSWEU. WAS CONSTRUCTED OIACOOn4NCEram ISA NOCRC.WSJ.
CONSTRUCTICII STANDARDS, MID THAT ADOPT Or TTHIS PECORD RAS MEW FROVIOED TONE WLtL a>B
SSNIAIYREOF pitl0M DONSR1 ICmS flR nu. D• :E
i»rotMIIM
S_PIMiti/'O./eI. LONImollpUspIROM 39aye adFEr.f211
A&F WELL DRILLING
AND 9P HMP BSERVICE, INC
1
Bostic, NC 2E01
DEP1828-247.1 '
Foposeso Dou11F.M
II soon/ moos Y NSW use brAM lam
SEEM -
Moo Seam isof detenet hes oi SM.
Finis. of sew amo w1el.rpe PS W
A&F WELL DRILLING
AND PUMP SERMtCE, INC..
El Hwy. Busitass
Bostic, NC 2321
828-247-1 �
r#OII OFFICE USE ONLY
awNe
intim
-24-2023 ION 11: 31A11 ID:
PAGE: 1

Rath Calve MnMwwWO" .a Sawn
tom Nsikon cons -A iC ab►osietonoimmoa:
WELL CONSTRUCTION RECORD was. coNTPAnon : /7�" G>e/t QA, J(
WELL COMPACTOR CRPTWICATION It: e / 3S
STATE WELL CONSTRUCTION PERMTTO:
331160
1. WILL US! Moms may MMds S urddpN 0 IntutMsl Li*9* at tl0 lAordloolny
twawal US Hod Pr, Was I*ollon 0 Osw 0 It ors, um Um: A&F WELTDR1L ;LONGtANC
2. WELL LOCATlOtt(Show sketch tINValorrWbw) AND PUMPSERVI,CE, 74
N. lPllynt A"12 h� 72ai cony:A2,ccriij,toEy/ cam?' 911 Hwy. Bus;.:'. •
/� Bostic, NQ 2: t 1
''
‘ ! /77a 5 5'4 1 828�-247-`1:7 .
FyMrs eernwrmies,orwr;.eSASS @suitNo OOit11NGLOG WPM
3. OWNER /oi,- 4.41 c,.a/ot , . Fits To Forolrrr DesiMp YS
Ades 9 f/47 s ?C4 I .T r. qd C
,7el/'.7a.J iRENRfI y s ad
Cyr Tips aa«
4. DATE 17111LL1SD 6
6. TOTAL DEPTH , -,--71 r
6. airman COLLECTED YES
7. 00113 WEi L macs SXISi1N0 W 6LLT YES 0 110a'
S. STATIC WATWI LEVEL MawTap orC0tUig zCe?FT.
��TIM'.ATaps,' s r Ts, Cum* CT.."?�� i F
s. TOP OF cal i3 / k FT. Abrrw Lana Surber
'tor d n*'u obooress1 riot Mow Mrd rwMee 1eMrnw a,owtsss M oars -
fan SSIMPIQAQWSW
it YIELD (WNW ,Q.M11HOOOPTEST 19-' 1`
it WATER ZONES WO* V `f n
T2. CHLORINAT10tt Typo Cdri . -Jm Arrrosnlf r.,sn2fe--- it sd c wl meow to omor SAW W bern
1O. CASINO: SD /
wrtriMAerer
Depth
r WeyM4t Moms Mao Shan and dMimrNw Miss MMSono
FiNP .L
I4,—R. _' ..-42L-%0i'C— Sa'RWMamp Soros pots! A&F WELL DRILLI!
F To FL— AND PUMP SERVICE
From To R. 911 Hwy. BusinSS
Bostic, NC 2^
1t. GROUT: 829-247--,7'3
Depth
M6Mdd IdrSrsa
Fern _ _ To R
1 s. SCREEN
Dept OMmalsr Mot Wm IWSuI
From To Ft I1. In.
Fmon ,___TO R_ In. YL
From __ToR. In. In.
IS. SM DIRRAVELPACK
OSA al MSS'
From ,__ To
Fi0111 To
17. REIMTO&
7J
le_o Alt
y
c
0
rn
r
0
17)
IDDMERESYCOMFY THAT TENS WELLWAS CONSTRUCTED MACO ANCETI MIIA NCIC1C.WWL
CONSTRUCT, InlSTWCNi0S,/MOTHATACOPYOFTINREECORDWOMEN PROYAEDTOM VlSI. 0 S-
NO AAFROE PROM DSIs1R CW4 min/ oca
SSW MOM to OMNI SWAN 0100/rrr siesSanvainl0eD/s
FOR orrice use ONLY
+Writ
014 PMt WI
-24-2e 3 9UN 11:3IPM ID:
PAGE:1

RESIDENTIAL WELL CONSTRUCTION RECORD
Noah CamBna Depenman of Environment end Natural Resotnees- Division of Water Quality
WELL CONTRACTOR CERTIIHCATION A 213 8 '
1. WELL CONTRACTOR:
James W.
Well Cantrada.(ndhAduajFmne
Camp's Well & Pump Co, Inc_
Well Contracts Company Neme
STREET ADDRESS P 0 BOX 429
E1lenboro NC 28040
ap cods
City cTavn ' State
( 828). 453-7322
Area cede- Phone number
I. WELL INFORMATION:
SITE WELL ID Eta applicable)
STATE WELL PERASfINappllablo)
DWQ a OTHER PERMIT tl(0 applicable)
WELL USE (Check PgpfableBo* RBeidenu� al Water Supplyp
y
DATE DRILLED /'—o(o 1/
TIME COMPLETED i{" ; .3O Am PM�"
wELL
a. CITY: car- / / K t y cougre 4 v l ord
7reew tt,/I Comm,
(Sf.e*Num Number!, Caamanit*, SubdMelontLot No., PSV&AZlp Code)
TOPOGRAPHIC/LANDS NG:
OSlope °Veeiny DFht Ridge DODmr
TOPOGRAPHIC I LAND ;•
(rhea ceem databot)
IATt1UDE ,� L` • 2 • AG
LONGITUDES a 15 i . ) (o 4
Latitudeflongimde source: , t?63 OTopographio map
Watts oftre/Rutbe shown on a USGS topo mop and
earthed to this ftsm 'not using GPS)
4. WELL OWNER
OWNER'S NAME l%ya b e jI0frf i ry
ST/
Rer EADDRESS / / K Ne /V I11
Clly
N. 1/!.1
m
eLo
FL 3a0
oraShia
minutes, semdser
in a dedmst forma
np Cede
L�
Afeacode• Phone number
6. WELL DETAILS: a. TOTALDEPnt 17
I5
b. DOES WELL REPLACE EXISTING WELL? YES p NON
c. WATER LEVEL. DekaTop dCann; fY5 FT.
(Use W.9 Above Top or Casing)
d TOP OF CASING IS 1 FT. Above Land Surface`
'Tap deobg hnniseted @trochaic/) Imd aahee nays
valance in madame wlth 15A NCAC 2C.011a
e. YIELD(apm) 3 METHOD OF TEST_ Q
v el F F.'
? ^. z # n
t DISINFECTION: Type chlorine Amount c9, r S
g. WATER ZONES (depth):
Rom— . To From To
Fran To From To
From To Fran _ to
6, CASING: "•�/ 'mlclmesd
Weight
Fren�DTo� l�o Ft, Triter SDR21 'Materiel Pyc.
Fran_ To Ft
From To .Ft
7. GROUT: Depth Material
Fran 0 To 20 Ft. Sackrete
Ron To FL
FratL,_To FL
Method
Hand
e. SCREEN: Depth Diameter . Slot Sirs .MatmW
Frm(_TA__Ft. In. in.
From__ To FH`_In. In.
Fran_ To FL In. —_ In.
9. SAND/GRAVELPACK:
Depth Sim Materiel
Ftar____ _To FL
Fran To Ft
Frmt,T_To Ft.
10. DRILLING LQG
From To
.0 ¥o
40 .S'l<
11. REMARKS:
�
Fojnnatbp Deseripton I r( L ay SA p
1V ^t
a
Ul
cri
!DOWER? CERWYTHATRIS WELL WAS OONSmUCIEDNACCORDANCE WRN
IRANCACIC, WELL CONS'IRDCnoN STANDARDS.AMfln& ACOPYOEmIS •
RECORD Wy} BEEN PRCJIOEQTOINE WELL OWNER
g-C8
SIGNA�I RE OF CERTIFIED' WELL:COIdTRACTOR I AT
James W. Camp •
ARINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the odgthal to the olvlslon.of lWatat Quality within 20.days. AtM: lefonnatipn Mgt , •
1617 Nall Service Center— Raleigh, NC 27699 4617 • Phone No. (919Z733.7015 ext 668. .
Fore GW-1a
Rev, 7405

RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 21 38
3i 3Iti 44
J
1. WELL CONTRACTOR:
James W. Camp
Well Contractor. (Individual) Name
Camp' s We11 & Pump f'n Tnr
Well Contractor Company Name
STREET ADDRESS
P 0 Box 429
Ellenboro NC 28040
City or Town State Zip Code
( 828). 453-7322
Area code- Phone number
2. WELL INFORMATION:
SITE WELL ID #(N applicable)
STATE WELL PERMIT/MI applicable)
DWQ or OTHER PERMIT #(if applicable)
_WELL USE (Check Applicable Box): Residential Water Supply 0
3-0
DATE DRILLED
TIME COMPLETED I NOD /I
AMO PM0
3. WELL LOCATif IN: u file
CITY: U O S-�G COUNTI'Y " � h d
e.IIoN)Icf1±)4`t.
(Street N e, Numbers, moony, Subdivision, Lot No., Parcel, Zip Code)
TOPOG
❑ Slope
HIC / LAND SETTING:
alley ❑Flat 0Ridge ❑Other
(check approPdat° box)
LATITUDE 3 L°
LONGITUDES ( °
Rig
M ybe' degrees,
minutes, seconds or
in a decimal format
Latitude/longitude source: PS ❑Topographic map
(bcatbn of well must be shown on a USGS topo map and
attached to this form I not usfg GPS)
4. WELL OWNER
OWNER'S NAME
STREET Alp
RESS
Oe ar�
City or Town
rr
a ei 5 ro wk.
Area code - Phone number
5. WELL DETAILS: ��D
a. TOTAL DEPTH:
b. DOES WELL REPLACE EXISTING WELL? YES 0 NO,
c. WATER LEVEL Below Top of Casing: 40 FT.
(Use '1" if Above Top of Casing)
d. TOP OF CASING IS 1 FT. Above Land Surface*
"fop of caseg terminated id/or belrw land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): 6-1' METHOD OF TEST at r
f. DISINFECTION: Type Chlorine Amount i/� C:��l
. g. WATER ZONES (depth): II.
From To From To
From To From To
From To From To
6. CASING: Thickness/
Depth Diameter Weight Material
From 0 To '.� 9- Ft. F I SDR21 PVC
From To Ft.
From To Ft.
7. GROUT: Depth Material Method
From 0 To 20 Ft. sackrete hand
From To Ft.
From To Ft.
8. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
From To FL in. in.
9. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From • To Ft.
From To Ft.
10. DRILLING LOG
From To
o 54
Fremotion DedFriptbn
IrT Sctatri
3�1 .23o C )46olydated r
11. REMARKS:
I DO HEREBY CERTFY THAT THIS WELL WAS CONSTRUCTED N ACCORDANCE WITH
15A NCAC 2C. WELL CONSTRUCTION STANIVIRDS AND THATA COPY OF 1HS
RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
SIGNAA E OF CERTIFIED WELL CONTRACTOR DATE
James W. Camp
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
,'3rabfntt the original to the Division of Water Quality within 30 days. Attn: Information Mgt, 1617 Mail Service Center— Raleigh, NC276901617 Phone N0. (9191733-7015 ext 566.
Form GW-la
Rev. 7/05

RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 2138
39
43
1. WELL CONTRACTOR:
James W. Camp
Well Contractor (Individual) Name
CampS We) 1 & Pump rn , Tnr
Well Contractor Company Name
S"fREET ADDRESS P 0 Box 429
Ellenboro NC 28040
City or Town State
( 828). 453-7322
Area code- Phone number
2. WELL INFORMATION:
SITE WELL ID ff(if applicable)
STATE WELL PERMIT/KO applicable)
DWQ or OTHER PERMIT #(N applicable)
_WELL USE (Check Applicable Box): Residential Water Supply
DATE DRILLED I - I3 -D6 1
TIME COMPLETED J i I S AM 2 PM ❑
3. WELL LOC/n1ATIOJt�,� '1T��
CITY: UItt I SIda COUNTY IDOL f`eY dYC7
Zip Code
tgo L�nYL
. NuCK R.
(Street Name. munity. Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC /LAND SETT G:
❑Slope [Valley ❑Flat Oidge ❑Other
(check appropdale box)
LATITUDE 3 Er I le •• g4-g
LONGITUDE I0 55"l
Latitude/longitude source: '6PS OTopographic map
(location of web must be shown on a USGS topo map and
attached to this form 1 not using GPS)
May be in degrees,
minutes, seconds or
in a decimal format
4. WELL OWNER
OWNER'S NAME
STREET ADDRESS-
Ye5-}Cl
City or Town
TA,) I s ace e Rea
I01 (>t'eehu)ood St.1
�yl N c- 2SZo 43
State Zip Code
Area code - Phone number
S. WELL DETAILS:
a. TOTAL DEPTH: \'
b. DOES WELL REPLACE EXISTING WELL? YES NO
c. WATER LEVEL Below Top. of Casing: 3 D FT.
(Use me if Abwe Top 01 Casing)
d. TOP OF CASING IS 1,_ FT. Above Land Surfae
'Top c( casing terminated at/or below land surface may require
a variance in accadance with 15A NCAC 2C .0118.
e. YIELD (gpm): c0 METHOD OF TEST al if
f. DISINFECTION: Type chlorine Amount I
g. WATER ZONES (depth):
From To From To
From To From
From To From To
6. CASING: Thickness/
Depth Diameter Weight
From 0 To 65- Ft. 6 1 SDR21
From To Ft.
From To Ft.
To
7. GROUT: Depth Material
From 0 To 20 FL sackrete
From To Ft.
From To Ft.
Material
PVC
Method
hand
8. SCREEN: Depth Diameter Slot Size
From To Ft in. in.
From To Ft. in. in.
From To Ft. in. In.
Material
9. SANDIGRAVEL PACK:
Depth Size Material
From To Ft.
From' To Ft.
From To Ft.
10. DRILLING LOG
From To Formation Description
5
D' (aeI0.1)5AAcI
4 7 )Jo
11. REMARKS:
So It 5tarttte
r
t—, c
I DO HEREBY CERTIFY THAT THIS WETS WAS CONSTRUCTED N ACCORDANCE WITH
15A NCAC 2C, WELL CONSTRUCTION STANDARDS. AND THAT A COPY OF THIS
RECORD BEEN PROVIDED TO THE WELL OWNER.
Wr C _L11,24
SIGNA E OF CERTIFIED WELL C RACTOR DATE
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.,
1617 Mall Service Center— Raleigh, NC`276994617 Phone NO. [phone] ext 568.
Fonn GW-la
Rev. 7/05

RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 2138
1. WELL CONTRACTOR:
James W. Camp
Well Contractor (Individual) Name
Camps Well R Pump ('n ,
Well Contractor Company Name
STREET ADDRESS P 0 BOX 429
Ellenboro NC 2,8040
City or Town State Zip Code
( 828)- 453-7322
Area code- Phone number
2. WELL INFORMATION:
SITE WELL ID #(ir applicable)
STATE WELL PERMIT#(s applicable)
DWQ or OTHER PERMIT #(if applicable)
WELL USE (Check Applicable Box): Residential Water Supply
Q
DATE DRILLED O — I U I' y�
TIME COMPLETED a- , 15- AM 0 PM Lu
3. WELL LOCATION
CIrY: I�D5T1 L COUNTY Rk r` te)
An.rreu)6 yin Rd-Cabin!K.l�r.
(Street Name, Numbers, Community. Subdivision, Tat No., Parcel, Zip Code)
T POGRAPHIC I LAND SETTING:
7 Slope ❑Valley El Flat ❑Ridge ❑Other
(check appropriate box)
LATITUDE 5°, 61 l
LONGITUDE I ° IS, 633
Latitude/longitude source: ❑GPS ❑Topographic map
(location of wet must be shown on a USGS topo map and
attached to this form ifnot using GPS)
4. WELL OWNER
OWNER'S NAME VC. \\// I e
ST EFT AIODRESS i 3
ertdeYSnnof e f q
Zip Code
May be in degrees,
minutq seconds or
Inc decimal format
City or Town State
( —)•
Area code- Phone number
5. WELL DETAILS: a�S
a. TOTAL DEPTH: \ /
h. UOES WELL REPLACE EXISTING WELL? YES 0 NOk
c. WATER LEVEL BelowTop of Casing: 44) FT.
(Use if Above Top of Casing) d. TOP OF CASING IS 1 FT. Above Land Surface'
'Top of casing terminated atla below land surface may require
a variance in accordance with 1SA NCAC 2C .0118.
e. YIELD (gpm): 9-0 METHOD OF TEST air.
331259
f. DISINFECTION: TypeChiorine Amount I y1- Ca/6
g. WATER ZONES (depth): /
From To From To
From To From To
From To From To
6. CASING: ThiUmessl
Depth Diameter Weight Material
From 0 To /03 Ft.6 SDR21 PVC
From To Ft
From To Ft.
7. GROUT: Depth Material Method
From 0 To 20 Ft. sackrete hand
From To Ft.
From To Ft.
8. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
From To Ft. in. in.
9. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
From To Ft.
10. DRILLING LOG
From To Formation Description
0 103 Glaa ; say‘
103 04c Cov15olidated Yock
SEP
11. REMARKS:
n
no C.r
0
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED N ACCORDANCE WIN
15A NCAC 2C. WELL CONSTRUCTION STANDARDS. AND THATA COPY OF THIS
RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
SIGNRE OGF CERTIFIED WELL CONTRA OR DATE
James W. Camp
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
S-IB-nC
1T1l40 1ho original to the Division of Water Quality within 30 days. Attn: information Mgt,
1's'11 mall Service Center —Raleigh, NC27699-1617 Phone No. [phone] ext 568.
Foml GW-la
Rev. 7(05

RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 3 g
1. WELL CONTRACTOR:
— I
T�awe5 LA). anal _ Well Contractor (lI (Individual) Name
Comp e I 1 'd 14,1 P Loop.� (O ' i �
Well Contract �L
c orC
STREET ADDRESS t 0 L/C X
EI(incc.NC aCif)4o
City or Town State Zip Code
(g)-g)-Lf53-73;0_
Area code- Phone number
2. WELL INFORMATION:
SITE W ELL ID #(it applicable)
STATE WELL PERMIT#(it applicable)
DWQ or OTHER PERMIT #(if applicable)
WELL USE (Check Applicable Box): Residential Water Supply 0
DATE DRILLED CA -111 LY - C (
TIME COMPLETED -3: J -C AM ❑ PMV
3. WELL LOCATION:
CITY://R�, "iet 4c ri�YL COUNTY Pu�leY`-crel
Clearwa/er'l.nnreck'1--o± 131
(Street Name, Numbers. Community. Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETT
❑Slope °Valley ❑Flat Idge ❑Other
(check appropriate ox)
LATITUDE 3 '' '' 4-, 25
LONGITUDE J S4- q74
Latitude/longitude source: L(GPS ❑Topographic map
(location of web must be shown on a USGS topo map and
attached to this form not using GPS)
4. WELL OWNER ✓ I 1
May be in degrees,
minutes, seconds or
in a decimal format
OWNER'S NAME �(1 i i ClA/E 5
S REET ADDRESS —C)iZ ParKer I Dr.
�•
lu.rre k i �IFt 5 C_ .9\gs'�6
City or Town State Zip Cale
Area code - Phone number
5. WELL DETAILS:
a. TOTAL DEPTH: C 5
b. DOES WELL REPLACE EXISTING WELL? YES 0 NO p]
/
c. WATER LEVEL Below Top of Casing: Lc'3 FT.
(Use `+- if Above Top of Casing)
d. TOP OF CASING 15 I FT. Above Land Surface*
'Top of casing terminated auor below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): `� METHOD OF TEST (XI r
f. DISINFECTION: Type Ck
33;257
9YIne Amount 1 / Cu
g. WATER ZONES (depth):
From To From To
Fran To From To
From To From To
6. CASING: Thickness/
Depth /7 Differ Weight Material
From 0 To / 0 FL & Ig 6.0Q� T
From To Ft. /
From To Ft.
7. GROUT: Depth
From 0 To e20 Ft.
From To Ft.
From To Ft.
Material
644Krefe
8. SCREEN: Depth Diameter Slot Size
From To
From To Ft. in.
Ft. in.
From To
Material
in.
in.
Ft. in. in.
9. SAND/GRAVEL PACK:
Depth
From To
From! To
From To
10. DRILLING LOG
From To
Size Material
Ft.
Ft.
FL
O
Formation Description o
D '7o C Ia J, aYA✓e,� rt'i =.
r
In ¥n5 C0N44 'dated rcck.°
11. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED N ACCORDANCE WITH
ISA NCAC 2C. WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF TIC
RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
C
SIG URE OF CERTIFIED WELL CO FACTOR DATE
awes W , CQn
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. 7/05

RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # ,z 13 g
1. WELL CONTRACTOR:
TaAmC5lid .Conn
Well Contractor (Individif'jat) Narne II
C0. H1 rS 1/1)e I f I 14141 , T14C
Well Contraltor Company Name
A ame
STREET ADDRESS 1 0 V b X gig
11 PVC lIL :1-Se DIED
City or Town State Zip Code
(Q24 )- 4-53 13�
Area code- Phone number
2. WELL INFORMATION:
SITE WELL ID #(if applicable)
STATE WELL PERMIT#CII applicable)
DWQ or OTHER PERMIT if{ if applicable) /
WELL USE (Check Applicable Box): Residential Water Supply I)d'
DATE DRILLED 7 - q - 0 6
TIME COMPLETED I• 3 o AMID PM I
3. WELL LOCAbON:
sl /+i IJ COUNTY gutkey`C rc1
%o3 S a-clx4� l�/u> Spas, Pc .
(Street Name, Numbers, Ctnmunity, Sub vi on, Lot No.. Parcel, Zip Code)
TQPOGRAPHIC / LAND SETTING:
lope ❑Valley ❑Flat ❑Ridge ❑Other
(check appropriate box) 22
LATITUDE �-v ISJo
n
LONGITUDE b I 5 13
Latitude/longitude source: PS ❑Topographic map
(location of wel must be shown on a USGS topo map and
attached to this form 1 not using GPS)
May be in degrees.
minutes,seconds or
in a decimal format
4. WELLOWNER " P. tiCIA-6OWNER'S NAME .ti I i
STREET ADDRESS 7fO 5 S I.L l ee A ur 3e 5.. tVl
Fr rest City Alt (So¢3 I
City or Tam State Zip Code
( }
Area code - Phone number
5. WELL DETAILS:. J �I
a. TOTAL DEPTH: d`V J
b. DOES WELL REPLACE EXISTING WELL? II YES 0 NO
7
c. WATER LEVEL Below Top of Casing: .6- FT.
(Use'+' if Above Top of Casing)
d. TOP OF CASING IS 1 FT. Above Land Surface'
'Top of casing tenn,nated et/or below land surface may require
a variance in accordance with 15A NCAC 2C .0118. ,
e. YIELD (gpm)' 5 D METHOD OF TEST a 1 r
3
6 1.,'
1 V A Q l a
CJ
f. DISINFECTION: Type Chitty/4 e
Amount j..7at
g. WATER ZONES (depth):
From To From To
From To From To
From To From To
6. CASING: Thickness/
Depth Diameter WeightgMateriall
From 6 To AO Ft. _ y
From To Ft.
Fran To Ft.
7. GROUT: Depth Material . Methode1
From 0 To Ft. 5�Crefe r10
From To Ft.
From To Ft.
8. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
From To Ft. in. in.
9. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From' To Ft.
From To Ft.
10. DRILLING LOG
From To Formation Description
0 'a.O d"y1 . Sand
02-0 .2(5
C0115P/,dale cl yock
r
r7
C"D , t:
11. REMARKS:
u
0
I DO HEREBY CERTFY THAT THIS WELL WAS CONSTRUCTED N ACCORDANCE WITH
15A 'CAC 2C, WELL CONSTRUCRON STANDARDS. AND THAT A COPY OF THIS
RECORD JIA.5 BEEN PROVIDED TO THE WF*L OWNER.
'9- 1g Gc,
SIGpOIRE OF CERTIFIED WELL CONTRACTOR DATE
T&n e6 W . 1f�0.i11
PRINTED NAME OF PERSON CO TRUCTING THE WELL
Suhrnit the original to the Division of Water Quality within 30 days. Attn: Information Mgt.,
Mail Service Center— Raleigh, NC 27699-1617 Phone No. [phone] ext 568.
Fonn GW-la
Rev. 7/05

RESIDENTIAL. WELL CONSTRUCTION RECORD
Nonh Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION A 2138
1. WELL CONTRACTOR:
James W. Camp
Well Contractor (Individual) Name
Camp's Well & Pump Col. Inc
-
W Well Contractor Company Name
STREET ADDRESS P 0 Box 429
Ellenboro, NC 28040
City or Town State Zip Code
828 453-7322
Area code- Phone number
2. WELL INFORMATION:
SITE WELL ID #(if applicable)
STATE WELL PERMIT#(H applicable)
DWQ or OTHER PERMIT #(if applicable)
WELL USE (Check App�
�licablle Box): Residential Water Supply (
ll DATE DRILLED J - o
TIME COMPLETED I - ' 3° AM 0 PM IA/
3. WELL LOCATION:
CITY: Pore's l C1 COUNTY
eLykn r_ witciti �d .
(Street ame. Numbers, munity. Subdivision, Lot No.. Parcel, Zip Code)
TOPOGRAPHIC / D SETTING:
❑Slope [Valley t Flat ❑Ridge ❑Other
(check appropriate box) r
LATITUDE 3 7a II g. 05-g
D1
LONGITUDE L 73. 4SR
(1
May be in degrees,
minutes, seconds or
in a decimal format
Latitude/longitude source: OOPS ❑Topographic map
(location of web must be shown an a USGS topo map and
attached to this form %not using GPS)
4. WELL OWNER •II - t
OWNER'S NAME dJl`1 e - OI Vl6 5
STREETTT- ADDRESS
1-C{2.5t
City or Town
Area code - Phone number
5. WELL DETAILS: a. TOTAL DEPTH: 3,0 '7 /
`/
b. DOES WELL REPLACE EXISTING WELL? YES 0 NO DO
c. WATER LEVEL Below Top of Casing: 3 b rr..���•••
(Use "+' if Above Top of Casing)
d. TOP OF CASING IS 1 FT. Above Land Surface
'Top of casting terminated at/or below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD(gpm): IC METHOD OF TEST air
331254
f. DISINFECTION: TypeCh loti ne Amount 1 Cttp
g. WATER ZONES (depth):
From To From To
From To From To
From To From To
6. CASING: Thickness/
Depth Oiamgler Weight Material
From 0 To 40 Ft. 6 r SDR21 PVC
From To Ft.
From To Ft.
7. GROUT: Depth Material Method
From 0 To21_Ft. sackrete hand
From To Ft.
From To Ft.
8. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
From To Ft. in. in.
9. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From • To Ft.
From To Ft.
10. DRILLING LOG
From To
0 (D
Formation Description
dirtr clay
w0 ;05 Con501;d4ted Yccc,
11. REMARKS:
c
—
(71
0
a
I Do HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED N ACOORDANCE WM1
15A NCAC 2C. WELL CONSTRUCTION STANDARDS. AND THAT A COPY OF THIS
RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNAT OF�✓CERT FIED WELL CONT CTOR ' DATE b
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.,
1617 Mali Service Center— Raleigh, NC27699-1617 Phone No.[phone] ext 568.
Form GW-la
Rev. 7/05

4. WELL OWNER
OWNER'S NAME
RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 21 38
1. WELL CONTRACTOR:
James W. Camp
W dl Contractor. (Individual) Name
Camp's Well & Pump rn Tnr
Well Contractor Company Name
STREET ADDRESS P 0 Box 429
Ellenboro NC 28040
City or Tam State
( 8284.453-7322
Area code- Phone number
. WELL INFORMATION:
SITE WELL ID #(it applicable)
STATE WELL PERMIT#(" appbcabk)
Zip Code
DWQ or OTHER PERMIT #(If applicable)
WELL USE (Check 'Applicable Bar): Residential Water Supply ll
DATE DRILLED ('AI-d�' �/
TIME COMPLETED 6 AM ❑ PM fi
3. WELL LOC{{l!y��yjjION: (�
IJII'Y: ()O5+1 C COUNTY Rik 4cr 4rYl
Si/t o/w i t - Lot ip
(Street Name, Numbers, Community. SubdMsion, Lot No., Parcel, Zip Code)
TOPOGRAPHIC I LANDS NG:
❑Slope °Valley ❑Flat ERidge ❑Other
(check appropriate box)
LATITUDE 3 5: Lq-
,I�l0 7
LONGITUDEL /' 4-b. ill
Latitude/iongitude source: 'O.iPS ❑Topographic map
(location of wel must be shown on a USGS topo map and
attached to this form snot usitg GPS)
L4t6Ide R�,
/l/de(s
'3 IRriET ADDRESS t' 0 boK 6 1
)aVe I—IAYe KL ag75LL
city., Town State Zip Code
A rFa cafe - Phone number
May be in degrees,
minutes, seconds or
in a decimal format
. WELL DETAILS: n D
a. TOTAL DEPTH: .
h, OO tS WELL REPLACE EXISTING WELL? YES 0 NO 71
c. WATER LEVEL Below Top of Casing: FT.
(Use '+' 8 Above Top of Casing)
d. TOP OF CASING IS 1 FT. Above Land Surface'
'Top of casing laminated et/or below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): I METHOD OF TEST a- I r
331253
f. DISINFECTION: Type chlorine Amount 9,7a cko
g. WATER ZONES (depth):
From To From To
From To From To
From To From To
6. CASING:
Thickness/
Depth Diameter Weight Material
From 0 To tip Ft.6 + SDR21 PVC
Fran To Ft.
From To Ft.
7. GROUT: Depth Material Method
Fran 0 To 20 FL sackrete hand
From To Ft.
From To Ft.
8. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
From To Ft. in. in.
9. SANDIGRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
From To Ft
10. DRILLING LOG
From To Formation Description
0 41-2 Sana Clay
O
271, 7D c (_v n so ll -CI At(' d rs c k o
11. REMARKS:
IV
C,.�D V ry
0
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED at ACCORDANCE WRH
15A NCAC 2C. WELL CONSTRUCTION STANDARDS, AND THATA COPY OF 'THIS
RECORD HAS BEEN PROVIDED TO THE WE OWNER.
SIGNANRE OF CERTIFIED WELL CO RACTOR DATE
v
James W. Camp
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
fidl'l rt ?no original to the Division of Water Quality within 30 days. Attn: Information Mgt.,
161 / Mall Service Center— Raleigh, NC27699=1U7 Phone Nt3: (919):733-7015 ext 568.
Form GW-la
Rev. 7/05

RESIDENTIAL WELL CONSTRvtfION'RECORD
North Catalina Depen mant of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION p 2138.
1. WELL CONTRACTOR:
James W. Camp_
Well Cantractoraellvdual) Name
Camp's Well & Puwo Co. Inn_
Well Contractor Canpany Neme
STREET ADDRESS 1' 0 BOX $29
Ellenboro NC
City or Tam ' State
(828} 453-7322
Area code- Phone number
2. WELL INFORMATION:
SITE WELL ID9(eapplkaNe) .
STATE WELL PERMITi(Oappliabie)
DWQ or OTHER PERMIT Sof applicable)
WELL USE (CheicApplicable Eked: Residential Water Supply V/
DATE DRILLED 7-(—6°
I�I�
/ ''
TIME COMPLETED 1 ' 75 AM PM�❑ (`
' CITY: A e✓icLL✓(i'�"o Pt COUNiy ea l {tey7DYd
rLe&r Later Creek
(Sheet Nell. Number, Canmudly. SubNNabn,Lot No.. Parmalp Coen)
TOPOGRAPMCtLAND SETTING: .
❑Slope QVaaley Drat ORdes ❑Other
(dredc apgeMtah?s)
tATTTUDE 1° . (n/ t,
LONGITUDES/1° CI •L �q
Latitudelongiede source:. DIPS OTopogmpbic map
(beatbn clod must be show one USGS topo mop and
atteehedtothb loony not using
GPS) ,/f
A•
OWNER'S NAME /�' t. l•-Yeek 2_QKc-' 6•
81R TAIWESS /3/ /k✓imaac Dr,
KaTNei ;V tort. / ((21 13g
28010
DP ode
May be m depea,
miaow; mac&er
inadeelmal bneat
CEy or Tam State ' - Zip Cede
ACea code • Phone number
5. WELL DETAILS: �J
a. TOTAL DEPT)b �C
b. DOES WELL REPLACE EXISTING WELL? YESNOlf
c. WATER LEVEL Seim Top etCasing: CO FT,
(Use W.9Aboue Tap of Casing)
d. TOP OFCASNGi3_ ' 1 . FT. Above Land Surfeit
. 'Tap rinsing tomb ded tier beam bed smtoee mw require
t=Ism In accordance vdlh 16A NCAC 2C.01/IL
e. YIELD (gpm). el\O METHOD .OFTEST a r
33 I 251
t DISINFECTION: Type chlorine Amount
p. WATER ZONES (depth):
From To From To
Ran_ To From To
From To - From • To
8. CASINO: .TNee�lawal
•From 0 �D DePth R SDR1 'PVCW.
From To _ Ft
Fran To .FL
7. GROUT: Depth Material Method
From 0 To 20 PL Sackrete Hand
Fran To Ft,
Fran To FL
S. SCREEN: Depth Diameter . slot Size Asia/
From_____ To__ FL_In. In.
From______ To Ft In, M.
From To Ft in. in.
9. SAND/GRAVEL PACK:
Depth Size Materiel
flan^Tee__ FL
From To Ft
From To Ft
10. DRILLING LOG
From ..To . Formation Dasaip60n
.0' So /irmrt, 5Anel
•
CD
SD _Doc • LO)1So/, (jetted )Gd c-K
fV _.
11. REMARKS:
2
0'
I COIEREBY CERTFYTHATTNIB WELL WAR CONSTRUCTED NACOCKINCEwrM
111.00.C2C. WELL CONSTRUCTION STANDARDS.AND1HATACOPY DF INS •
RECORD HAS BEEN PRONWEQTOME WELLOWHEO.
SIGN/5UREbF �ERT1FlEDiNELLCO RACTOR TEG6
James W. Camp "
'PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Subroh the origihal to the DivtSion.of Water Quality within 30.days. Attn: lnformatlpn Mgt., .
1617 Mali Service Center— Raleigh, NC 27699-1617 ' Phone No. (919t733-7015 ext 568.
Form GW-1a
Rev. 7W05

RESIDENTIAL WELL CONSTRUCTION RECORD
North Camara Lhp.rvnaal of tnvlronmont and Ragland Kc u rCor L)
WELL CONTRACTOR CERTIFICATION s 2571
1 WELL CONTRACTOR:
&y.nt SInpl
WM Catrsctor (hdn+dnp Nana
Groan Row W M 8 Pump Company
W M Catraga Company Notre
STREET ADDRESS PD Boa 204
Eau Fat Roa. NC 28726
Day Of Town Sono Zp Code
( 828 ). 693•1200
Ana coda- Phone nunt.r
2 WELL INFORMATION:
SITE WELL ID Ca moan,'
STATE WELL PERMITNI acacia*/
DWG or OTHER PERMIT INt appbbw)
WELL LAE (Clock cabs 8oa) Reenentel Wino Supply 0
DATE GRILLED 611'4'I O (.
TIME COMPLETED 3' OD
AM O PM tiE.
3 WELL L OC--AT))otl: CITY , COUNTY 114-,,U,4 Vd
41( (4.urel labs Rio
I9raS Nam.. Nump.r. Community SQWw.9n Lq P.rcil Zip Coo*I
TOPOGRAPHIC 1 LAND SETTING
92'ilop. OVM*y OFiS ORop. OOvur_
Ian •OaW MU COO
LATITUDE `�j5 j7' Slog
LDNCITUDEQI£z O 08 2W
Laurucknongmide source giPS °Topograptuc rnap
(ocean of wW mar a *mown on . VSGS tope map .rid
.m.cr.rd N The /omr / not wing GPS)
•. WELL. OWNER
OWN ER'S NAME I✓it-Ft-ern-lc
•
May be a esr,
mama. noon* a
■ a dcmal Tonne'
STREET ADDRESS 409 1✓u1Q-4 br.
410 Lure_ uC zfr9k,
nCry a Town Axe
t en ,. (cab - 42-1.1
Aar cvlu. • Phone ifWroer
Zb Cods
6. WELL DETAILS: 1
.. TOTAL DEPTH: 3 /-
D DOES WELL REPLACE EXISTING WELL7 YES 0 NQ+L2
c WATER LEVEL BWW Top d Caan9 •O0 FT
(Via -.- F ADow Top d C..np)
CI . TOP OF CASINO IS I FT ADuw Land Surr.a-
icy d casing w,mnmed sea Doom and surface nay require
..Yam e n .cr c eo.r.. o 1SA NCAC 2C .0118
e YIELD (ppm) onl0 ME I$00 OF TEST nor
f. DISINFECTION Type .ITN Amount
p. WATTE'RaZ ONES .CCappiinn
m .TOO
To D l'a
From To
From
From
ro
ro
from to from To
6. CASINO Thicknend
pspm2a tat Weir'4
From / to O FI 21.G
From I Ft
Flom to Ft
7. GROUT D.ptn Mannal
From,_ To 20 FI 64kRtJp
From To FI
From 10 FT
M aNrai
P2
M�eeU^lo�d'
a;fJtic
6. SCREEN D. pi D,.nain S.or 54.
From To Fi n n
From To FI n n
From To FI n n
Mat.un
SANDfGRAVEL PACA
Deem Svc Maier!ai
Flom to
From to
From To
10. DRILLING LOG
From To
/ — ID
10 - Ri
2)- 20
30 - 337
II REMARKS
F orrnaoo Descrptnn
Red �I4y
AAt-
4n14E// JtDc✓k
f'S
rwef
IM iCAC 2C Cry Ett CO.TVC rvELi• OmiasTO TheuCTEy A can owacccar "r••,
RECDRO n5 BEEN PM>,0(D•O 1 cif It fR
SIGNATURE F CERTIFIED WELL CONTRACTOR
PRI�/Ptiorf S
1YYEahAME OF PER SON �STRLCTING TrIE WELL
S2i -Oc
DAIS
Submit the or101nal to t711 Division of Water Quality within 30 days. Ann- ntormaoon
1817 Mall Service Center - Raleigh. NC Z71199.1617 Phone No. [phone] cal 568
w m OW is

North Carolina — Department of Environment and Natural Resources — Division of Water Quality — Groundwater Section
1636 Mail Service Center — Raleigh, N.C. 27699-1636 — Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR: JEFF MELTON
WELL CONTRACTOR CERTIFICATION #: 3417
STATE WELL CONSTRUCTION PERMIT #:
1. WELL USE (Check Applicable Bos): El Residential 0 Municipal 0 Industrial ❑ Agricultural 0 Monitoring
0 Recovery 0 Heat Pump Water Injection ❑ Other If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: FI.I.FNBORO County: RUTH
GOLDEN EAGLE DR DRILLING LOG DEPTH
(Road Name and Numbers, Community, or Subdivision and Lot No.) From To Formation Description
3. OWNER WAYNE BREEDEN
Address GOLDEN EAGLE DR.
(Street or Route No.)
ELLENBORO NC 28040
City or Town State Zip Code
4. DATE DRILLED 08/29/06
5. TOTAL DEPTH 185
6. CUTTING COLLECTED ❑ YES ® NO
7. DOES WELL REPLACE EXISTING WELL? 0 YES ® NO
8. STATIC WATER LEVEL Below Top of Casing: 40 FT.
(Use "+" if Above Top of Casing)
9. TOP OF CASING IS 1-1/2 FT. Above Land Surface'
*Top of casing terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2C.0118
10. YIELD (gpm): 20 METHOD OF TEST: ARD
11. WATER ZONES (depth):
12. CHLORINATION: Type: CHLORYTE Amount: 3.5
13. 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.
14. GROUT:
Depth Material Method
From 0 To 20 Ft. OUIKRETE POURED
From To Ft.
15. SCREEN:
Depth Diameter Slot Size Material
From To Ft in. in.
From To Ft in. in.
From To Ft. in. in.
16. SAND?GRAVEL PACK:
Depth Size Material
From To FL _
From To Ft
17. REMARKS: .
If additional space is needed use back of form
LOCATION SKETCH
• (Show direction and distance from at least two State
Roads, or other reference points)
BY-PASS 74 E. FROM FOREST CITY. EXIT RT. ON
HARRIS/HENRIETTA/ELLENBORO EXIT. LEF 1 ON
DOBBINSVILLE RD. RT. ON GOLDEN EAGLE DR 2/10 MILE
ON LEFT. (NEW DRIVE)
fl
J
I DO CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C. WEI L
CONSTRUCTION STANDARDS, AND THAT A COPY OF THISRECORD HAS BEEN PROVIDED TO THE WELL OWNER
FOR OFFICE USE ONLY
Quad No:
Serial No.
SIGNATURE OF N CONSTRUCTING WELL DATE
ubmit original to Division of Water Quality, Groundwater Section within 30 days
GW-1 REV. 12/99

orth Carolina —Department of Environment and Natural Resources — Division of Water Quality — Groundwater Section
536 Mail Service Center — Raleigh, N.C. 27699-1636 — Phone [phone]
VELL CONSTRUCTION RECORD WELL CONTRACTOR ROBIN MCNEELY
WELL CONTRACTOR CERTIFICATION #: 2567
STATE WELL CONSTRUCTION PERMIT #:
. WELL USE (Check Applicable Box): ® Residential 0 Municipal 0 Industrial 0 Agricultural 0 Monitoring
0 Recovery 0 Heat Pump Water Injection 0 Other If Other, List Use:
. WELL LOCATION: (Show sketch of the location below)
dearest Town: RUTHERFORDTON County: RUTH
20 CENTENNIAL RD. DRILLING LOG DEPTH
Road Name and Numbers, Comnnmity, or Subdivision and Lot No.) From To Formation Description
. OWNER JIMMY BOWEN
ddress 120 CENTENNIAL RD.
Street or Route No.)
LUTHERFORDTON NC 28139
:ity or Town State Zip Code
. DATE DRILLED 08/01/06
. TOTAL DEPTH 34
. CUTTING COJJ.FCIED ❑ YES ®NO
t. DOES WELL REPLACE EXISTING WELL? ❑ YES ® NO
;. STATIC WATER LEVEL Below Top of Casing: 20 FT.
Use "+" if Above Top of Casing)
1. TOP OF CASING IS 1-1/2 FT. Above Land Surface;
Top of casing terminated at/or below land surface requires a variance in accor-
lance with I5ANCAC 2C0118
W. YIELD (gpm): 14 METHOD OF TEST: STEEL TAPE
11. WATER ZONES (depth):
12. CHLORINATION: Type: CHLORYTE Amount: 9.2
13. CASING:
Wall Thickness
Depth Diameter or Weight/Ft Material
From 0 To 34 Ft. 24 CEMENT
From To Ft.
Front To Ft
14. GROUT:
Depth Material Method
From 0 To 20 Ft CEMENT POURED
From To Ft
15. SCREEN:
Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft in. in.
From To Ft. in. in.
16. SAND?GRAVEL PACK:
Depth Size Material
From 20 To 34 Ft 78M GRAVEL
From To Ft.
17. REMARKS:
If additional space is needed use back of form
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other reference points)
HWY. #64 E. FROM RUTH. LEFT ON CENTENNIAL RD.
APPROX. 1-1/2 MILES ON RT. (120 ON BOX) GREEN &
WHITE TRAILER na END OF DRIVE.
ces
b
I DO CERTIFY THAT THIS WFJJ WAS CONSTRUC 1tD IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THISRECORD HAS BEEN PROVIDED TO THE WELL R.
FOR OFFICE USE ONLY
Quad No:
Serial No.
SIGNA
Submit original to Division
.C,AtiLl.Et . tP-/ • fl
O ONSTRUCDNG THE WELL DATE
.ter Quality, Groundwater Section within 30 days
GW-1 REV. 12/99

North Carolina — Department of Environment and Natural Resources — Division of Water Quality — Groundwater Section
1636 Mail Service Center — Raleigh, N.C. 27699-1636 — Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR ROBIN MCNEELY
WELL CONTRACTOR CERTIFICATION #: 2567
STATE WELL CONSTRUCTION PERMIT #:
n n
e}
1. WELL USE (Check Applicable Bo:): ® Residential U Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring
0 Recovery 0 Heat Pump Water Injection ❑ Other If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: LAKE LURE County. RUTH
MELROSE RD. DRILLING LOG DEPTH
(Road Name and Numbers, Community, or Subdivision and Lot No.) From To Formation Description
3. OWNER LLOYD BAILEY
Address MELROSE RD.
(Street or Route No.)
LAKE LURE NC 28746
City or Town State Zip Code
4. DATE DRILLED 08/09/06
5. TOTAL DEPTH 70
6. CUTTING COLLECTED ❑ YES ® NO
7. DOES WELL REPLACE EXISTING WELL? 0 YES EI NO
8. STATIC WATER LEVEL Below Top of Casing: 55 FT.
(Use `+" if Above Top of Casing)
9. TOP OF CASING I5 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2C.0118
10. YIELD (gpm): 15 METHOD OF TEST: STEEL TAPE
I I. WATER ZONES (depth):
If additional space is needed use back of form
t lS 4
12. CHLORINATION: Type: CHLORYTE Amount 6.9
13. CASING: LOCATION SKETCH
Wall Thickness • (Show direction and distance from at least two State
Depth Diameter or Weight/Ft Material Roads, or other reference points)
From 0 To 70 Ft. 24 CEMENT HWY. #64/74A W. FROM RUTHERFORDTON. RIGHT ON
From To Ft. COVE RD. LEFT ON BILL'S CREEK RD. RIGHT ON CONNER
From To Ft RD. APPROX 1 MILE LEFT ON MELROSE RD. 2ND DRIVE OI
14. GROUT: RT. (246 ON MAILBOX)
Depth Material Method
From 0 To 20 Ft CEMENT POURED
From _ To Ft.
15. SCREEN:
Depth Diameter Slot Size Material
From To Ft in. in.
From To Ft _ in. in. y
From To Ft in. in. r <
16. SAND?GRAVEL PACK:
Depth Size Material N
From 55 To 70 Ft 78M GRAVEL O0i ;
From To Ft
17. REMARKS:
I DO CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THISRECORD HAS BEEN PROVIDED TO THE WELL OWNER.
FOR OFFICE USE ONLY
Quad No:
Serial No.
>1 - 9 -
SIGNATURE OE PERSO v! S , CTING THE WELL DATE
Submit original to Division of Water bi .i ty, Groundwater Section within 30 days
GW-1 REV. 12J9S

Qorth Carolina — Deportment of Environment and Natural Resources — Division of Water Quality — Groundwater Section
[636 Mail Service Center — Raleigh, N.C. 27699-1636 — Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR ROBIN MCNEELY
WELL CONTRACTOR CERTIFICATION #: 2567
STATE WELL CONSTRUCTION PERMIT #:
n
1. WELL USE (Check Applicable Bo:): ® Residential ❑ Municipal 0 Industrial 0 Agricultural 0 Monitoring
0 Recovery 0 Heat Pump Water Injection 0 Other If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: ELLENBORO County: RUTH
OLD MOORESBORO RD. DRILLING LOG DEPTH
(Road Name and Numbers, Community, or Subdivision and Lot No.) From To Formation Description
3. OWNER GREG SHORT
Address OLD MOOSRESBORO RD.
(Street or Route No.)
ELLENBORO NC 28040
City or Town State Zip Code
4. DATE DRILLED 08/15/06
5. TOTAL DEPTH 65
6. CUTTING COLLECTED 0 YES ® NO
7. DOES WELL REPLACE EXISTING WFT J ? 0 YES ® NO
8. STATIC WATER LEVEL Below Top of Casing: 45 FT.
(Use "+" if Above Top of Casing)
9. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
prop of casing terminated at/or below land surface requires a variance in accor-
dance with 15ANCAC 2C.0118
10. YIELD (gpm): 20 METHOD OF TEST: S LEE., TAPE
11. WAIE'RZONES (depth):
12. CHLORINATION: Type: CHLORYTE Amount: 9.2
13. CASING:
Wall Thickness
Depth Diameter or Weight/Ft Material
From 0 To 65 Ft 24 CEMENT
From _ To Ft.
From To Ft.
14. GROUT:
Depth Material Method
From 0 To 20 Ft CEMENT POURED
From To Ft.
15. SCREEN:
Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
From To Ft in. in_
16. SAND?GRAVEL PACK:
Depth Size Material
From 45 To 65 Ft. 78M GRAVEL
From To Ft.
17. REMARKS:
If additional space is needed use back of form
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other reference points)
ELLENBORO/HENRIETTA RD. FROM ELLENBORO. LEFT ON
MCCRAW RD, STRAIGHT c(D, STOP SIGN- STILL MCCRAW
RD. LEFT ON OLD MOORESBORO RD. @ STOP SIGH. 1sT
DRIVE ON RT.
y
rri to
rV
rn " 53
a
1 DO CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THISRECORD HAS BEEN PROVIDED TO THE WFI J OWNER
FOR OFFICE USE ONLY
Quad No:
Serial No.
r
SINA ': OF ' a'. aN CONSTRUCTING THE WELL
Submit original to Division of Quality, Groundwater Section within 30 days
DATE
GW-1 REV. 12/99

Borth Carolina — Department of Environment and Natural Resources — Division of Water Quality — Groundwater Section
636 Mail Service Center — Raleigh, N.C. 27699-1636 — Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR: RODNEY ROBBINS
WELL CONTRACTOR CERTIFICATION #: 2785
STATE WELL CONSTRUCTION PERMff #:
9 el
1. WELL USE (Cheek Applicable Box): ® Residential 0 Municipal 0 Industrial 0 Agricultural 0 Monitoring
0 Recovery 0 Heat Pump Water Injection 0 Other If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: BOSTIC Canty: RUTH
296 MTN. LOOKOUT DR DRILLING LOG DEPTH
Road Name and Numbers, Community, or Subdivision and Lot No.) From To Formation Description
3. OWNER BILL SMITH
Address 296 MTN. LOOKOUT DR
(Street or Route No.)
BOSTIC NC 28018
City or Town State Zip Code
4. DATE DRILLED 08/02/06
5. TOTAL DEPTH 305
6. CUTTING COLLECTED 0 YES ® NO
7. DOES WELL REPLACE EXISTING WELL? ® YES 0 NO
8. STATIC WATER LEVEL Below Top of Casing: 100 FT.
(Use "+" if Above Top of Casing)
9. TOP OF CASING IS 1-1/2 FT. Above Land Surface'
'Top of casing terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2C.0118
10, YIELD (gpm): 20 METHOD OF TEST: ARD
11. WA1h1&ZONES (depth):
12. CHLORINATION: Type: CHLORYTE Amount: 7.5
13. CASING:
Wall Thickness
Depth Diameter or Weight/Ft Material
From 0 To 40 Ft 6-1/4" SDIt21 PVC
From To Ft.
From To Ft.
14. GROUT:
Depth Material Method
From 0 To 20 Ft. QUILKRETE POURED
From To Ft.
15. SCREEN:
Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft in. in.
From To Ft in. in.
16. SAND?GRAVEL PACK:
Depth Size Material
From To Ft
From To Ft
17. REMARKS:
If additional space is needed use back of form
LOCATION SKETCH
, (Show direction and distance from at least two State
Roads, or other reference points)
BUS. 74 E. FROM FOREST CITY. LEFT ON BOSTIC/SUNSHINE
RD. LEFT ON LUCKADOO MTN. RD. LEFT ON FIRE TOWER
RD. RT. ON AMIELA LANE ITNO GOLDEN VALLEY
ESTATES. RT, ON MTN. LOOKOUT DR. APPROX 1 MILE ON
RT.
o•
m •
a
I DO CERTIFY THAT THIS WELL WAS CONSTRUC FhD IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THISRECORD HAS BEEN PROVIDED TO THE WELL OWNER
FOR OFFICE USE ONLY
Quad No:
Serial No.
4 L'i�C/Jlv i> �i49
TUBE OF ON CONSTRUCTIN THE VE�. DATE
SIGN
f(
to Division of Water Quality, Gmtmdwater Section within 30 days
GW-1 REV
2/99

North Carolina — Deportment of Environment and Natural Resources — Division of Water Quality — Groundwater Section
1636 Mail Service Center — Raleigh, N.C. 27699-1636 — Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR: RODNEY ROBBINS
WELL CONTRACTOR CERTIFICATION #: 2785
STATE WELL CONSTRUCTION PERMIT #:
1. WELL USE (Cheek Applicable Box): ® Residential U Municipal ❑ Industrial ❑ Agricultural 0 Monitoring
0 Recovery 0 Heat Pmnp Water Injection 0 Other If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: BOSTIC County: RUTH
886 SALEM CHRUCH RD. DRILLING LOG DEPTH
(Road Name and Numbers, Community, or Subdivision and Lot No.) From To Formation Description
3. OWNER VERLIN BIRCHFIELD
Address 886 SALEM CHRUCH RD.
(Street or Route No.)
BOSTIC NC 28018
City or Town State Zip Code
4. DATE DRILLED 08/18/06
5. TOTAL DEPTH 185
6. CUTTING COLLECTED 0 YES to NO
7. DOES WELL REPLACE EXISTING WFT d ? ® YES 0 NO
8. STATIC WATER LEVEL Below Top of Casing: }I FT.
(Use "+" if Above Top of Casing) 2 0
9. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
'Top of casing terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2C.0118
10. YIELD (gpm): 60 METHOD OF TEST: ARD
11. WATER ZONES (depth):
If additional space is needed use back of form
12. CHLORINATION: Type: CHLORYTE Amount: 3.5
13. CASING: LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other reference points)
BUS. 74 E. FROM FOREST CITY. LEFT ON BOSTIC/SUNSHIN
RD. RT. ON SALEM CHRUCH RD. 2ND HOUSE ON RT.
Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 50 Ft. 6-1/4" SDR.21 PVC
From To Ft
From To Ft.
14. GROUT:
Depth Material Method
From 0 To 20 Ft OUILKRETE POURED
From To Ft.
15. SCREEN:
Depth Diameter Slot Size Material
From _ To Ft. in. in.
From To Ft in. in.
From To Ft. _ in. in.
16. SAND?GRAVEL PACK:
Depth Size Material
From _ToFt.
From To Ft.
17. REMARKS:
LI u
I DO CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WFJ I
CONSTRUCTION STANDARDS, AND THAT A COPY OF THISRECORD HAS BEEN PROVIDED TO THE WFJI OWNER
FOR OFFICE USE ONLY
Quad No:
Serial No.
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
iginel to Division of Water Quality, Groundwater Section within 30 days
GW-1 REV. 12/99

forth Carolina — Department of Environment and Natural Resources — Division of Water Quality — Groundwater Section
1636 Mail Service Center — Raleigh, N.C. 27699-1636 — Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR: RODNEY ROBBINS
WELL CONTRACTOR CERTIFICATION #: 2785
STATE WELL CONSTRUCTION PERMIT #:
9 t> R f
ej <) %.' V v
1. WELL USE (Check Applicable Box): N Residential ❑ Municipal ❑ Industrial 0 Agricultural ❑ Monitoring
0 Recovery 0 Heat Pump Water Injection 0 Other If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: RUTHERFORDTON County: RUTH
OVERSTONE DR. -LOT #291 DRILLING LOG DEPTH
(Road Name and Numbers, Community. or Subdivision and Lot No.) From To Formation Description
3. OWNER BILL SOMMERS
Address OVERSTONE DR. LOT #291
(Street or Route No.)
RUTHERFORDTON NC 28139
City or Town State Zip Code
4. DATE DRILLED 08/23/06
5. TOTAL DEPTH 325
6. CUTTING COLLECTED ❑ YES N NO
7. DOES WELL REPLACE EXISTING WELL? ❑ YES N NO
8. STATIC WATER LEVEL Below Top of Casing: 60 FT.
(Use "+" if Above Top of Casing)
9. TOP OF CASING IS 1-1/2 FT. Above Land Surface'
*Top of casing terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2C.0118
10. YIELD (gpm): 50 METHOD OF TEST: ARD
11. WATER ZONES (depth):
12. CHLORINATION: Tvpe: CHLORYTE Amount: 8
13. CASING:
Wall Thickness
Depth Diameter or Weight/Ft Material
From 0 To 160 Ft. 6-1/4" SDR.21 PVC
From To Ft
From To Ft.
14. GROUT:
Depth Material Method
From 0 To 20 Ft. OURKRETE POURED
From To Ft.
15. SCREEN:
Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
From To Ft _ in. in.
16. SAND?GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
17. REMARKS:
If additional space is needed use back of fort
LOCATION SKETCH
• (Show direction and distance from at least two State
Roads, or other reference points)
HWY. #221 N. FROM RUTHERFORDTON. LEFT ON MTN.
CREEK RD. LEFT ON CLEARWATER PKWY. LEFT ON
CHIMNEY CRK. LANE. LEFT ON BITFEROOT CIRCLE. STAY
STRAIGHT ON OVERSTONE DR 1/10M MILE ON LEFT. LOT
#291.
I DO CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS. AND THAT A COPY OF THISRECORD HAS BEEN PROVIDED TO THE WELL OWNER
FOR OFFICE USE ONLY
Quad No:
Serial No.
SIGNATURE OF PERS CO STRUCTING THE ELz DATE
ginal to Division of Water Quality, Groundwater Section within 30 days
GW-1 REV. 12/99

forth Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
[636 Mail Service Center - Raleigh, N.C. 27699-1636 -Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR: RODNEY ROBBINS
WELL CONTRACTOR CERTIFICATION it: 2785
STATE WELL CONSTRUCTION PERMIT #:
e) 0 r: ii v
1. WELL USE (Check Applicable Box): ® Residential 0 Municipal ❑ industrial 0 Agricultural 0 Monitoring
0 Recovery 0 Heat Pump Water Injection 0 Other If Other, List Use:
2. WFT I LOCATION: (Show sketch of the location below)
Nearest Town: RUTHERFORDTON County: RUTH
BI11'EROOT CIRCLE -LOT #237 DRILLING LOG DEPTH
(Road Name and Numbers, Community, or Subdivision and Lot No.) From To Formation Description
3. OWNER BILL SOMMERS
Address BIT IUtOOT CIRCLE -LOT #237
(Street or Route No.)
RUTHERFORDTON NC 28139
City or Town State Zip Cole
4. DATE DRILLED 08/24/06
5. TOTAL DEPTH 505
6. CUTTING COLLECTED 0 YES ® NO
7. DOES WELL REPLACE EXISTING WELL? 0 YES Z NO
8. STATIC WATER LEVEL Below Top of Casing: 60 FT.
(Use `+" if Above Top of Casing)
9. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*top of casing terminated at/or below land surface requires a variance in accor-
dance with 15ANCAC 2C.0118
10. YIELD (gpm): 2 METHOD OF TEST: ARD
11. WATER ZONES (depth):
12. CHLORINATION: Type: CHLORYTE Amount: 13.5
13. 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.
14. GROUT:
Depth Material Method
From 0 To 20 Ft.OUILKRETE POURED
From To Ft
15. SCREEN:
Depth Diameter Slot Size Material
From To Ft. _ in. in.
From To Ft. in. in.
From To Ft in. in.
16. SAND?GRAVEL PACK:
Depth Size Material
From To Ft.
From _ To Ft.
17. REMARKS.
If additional space is needed use back of form
LOCATION SKETCH
' (Show direction and distance from at least two State
Roads, or other reference points)
HWY. #221 N. FROM RUTHERFORDTON. LEFT ON MTN.
CREEK RD. LEFT ON CLEARWATER PKWY. LEFT ON
CHIMNEY CRK. LANE. LEFT QN Bit ibROOT CIRCLE. 1sT
DRIVE ON LEFT. (LOT #237)
16
re
n
:n
I DO CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THISRECORD HAS BEEN PROVIDED TO THE WELL OWNER
FOR OFFICE USE ONLY
Quad No:
Serial No.
°7a> 9-7rr RE CONSTRUCTING (771.0
SIGNAOF CONSTRUCTING THE WELL DATE
Su original to Division of Water Quality, Groundwater Section within 30 days
GW-1 REV. 12/99
'

North Carolina — Department of Environment and Natural Resources — Division of Water Quality — Groundwater Section
1636 Mail Service Center — Raleigh, N.C. 27699-1636 — Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR RODNEY ROBBINS
WELL CONTRACTOR CERTIFICATION #: 2785
STATE WELL CONSTRUCTION PERMIT #:
to 'J 8S
1. WELL USE (Check Applicable Box): ® Residential 0 Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring
❑ Recovery ❑ Heat Pump Water Injection ❑ Other If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: RUTHERFORDTON County: RUTH
475 COVE RD. DRILLING LOG DEPTH
(Road Name and Numbers, Community, or Subdivision and Lot No.) From To Formation Description
3. OWNER JERRY ALEXANDER
Address 475 COVE RD.
(Street or Route No.)
RUTHERFORDTON NC 28139
City or Town State Zip Code
4. DATE DRILLED 08/28/06
5. TOTAL DEPTH 605
6. CUTTING COLLECTED ❑ YES ® NO
7. DOES WELL REPLACE EXISTING WELL? ❑ YES ® NO
8. STATIC WATER LEVEL Below Top of Casing: 60 FT.
(Use "+" if Above Top of Casing)
9. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated atlor below land surface requires a variance in accor-
dance with I5A NCAC 2C.0118
10. YIELD (gpm): 2 METHOD OF TEST: ARD
11. WATER ZONES (depth):
12. CHLORINATION: Type: CHLORYTE Amount: 16.5
13. CASING:
Wall Thickness
Depth Diameter or Weight/Ft Material
From 0 To 120 Ft 6-1/4" SDR.21 PVC
From To Ft.
From To Ft.
14. GROUT:
Depth Material Method
From 0 To 20 Ft QUILKRETE POURED
From To Ft.
15. SCREEN:
Depth Diameter Slot Size Material
From To Ft in. in.
From To Ft in. in.
From To Ft in. in.
16. SAND?GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
17. REMARKS:
If additional space is needed use back of form
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other reference points)
HWY. #64/74A W. FROM RUTHERFORDTON. RT. ON COVE
RD. LEF 1 ON LON WIHTE GRAVEL DRIVE NEXT TO OLD
NURSERY.
I DO CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WEI L
CONSTRUCTION STANDARDS, AND THAT A COPY OF THISRECORD HAS BEEN PROVIDED TO THE WEI OWNER
FOR OFFICE USE ONLY
Quad No:
Serial No.
o�QDl� 1r7to f. ,7n- c
SIGNATURE OF N C TRUCTING THE WELL DATE
Subinif original to Division of Water Quality, Groundwater Section within 30 days
GW-1 REV. 12/99

4orth Carolina — Department of Environment and Natural Resources — Division of Water Quality — Groundwater Section
i636 Mail Service Center— Raleigh, N.C. 27699-1636 — Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR: RODNEY ROBBINS
WELL CONTRACTOR CERTIFICATION #: 2785
STATE WELL CONSTRUCTION PERMIT #:
n
1. WELL USE (Check Applicable Box): 0 Residential ❑ Municipal
U Industrial U Agricultural 0 Monitoring
❑ Recovery 0 Heat Pump Water Injection 0 Other If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: RUTHERFORDTON County: RUTH
CLARK RD. DRILLING LOG DEPTH
(Road Name and Numbers, Community, or Subdivision and Lot No.) From To
3. OWNER ROBBY OAKMAN
Address CLARK RD.
(Street or Route No.)
RUTHERFORDTON NC 28139
City or Town State Zip Code
4. DATE DRILLED 08/30/06
5. TOTAL DEPTH 545
6. CUTTING COLLECTED 0 YES ® NO
7. DOES WELL REPLACE EXISTING WFI ? 0 YES ® NO
8. STATIC WATER LEVEL Below Top of Casing: 60 FT.
(Use "+" if Above Top of Casing)
9. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
'Top of casing terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2C.0118
10. YIELD (gpm): 50 METHOD OF TEST: ARD
11. WATER ZONES (depth):
12. CHLORINATION: Type: CHLORYTE Amount: 15
13. CASING:
Wall Thickness
Depth Diameter or Weight/Ft Material
From 0 To 100 Ft 6-1/4" SDR21 PVC
From To
From To
14. GROUT:
Depth
From 0 To
From To
15. SCREEN:
Depth
From To
From To
From To
16. SAND?GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
17. REMARKS:
Ft.
Ft.
Material Method
20 Ft. OUILKRETE POURED
Ft.
Diameter Slot Size Material
Ft in. in.
Ft in. in.
Ft in. in.
Formation Description
If additional space is needed use back of form
LOCATION SKETCH
' (Show direction and distance from at least two State
Roads, or other reference points)
HWY. #64/74A W. FROM RUTHERFORDTON. LEFT ON
CLARK RD. 2"ro DRIVE (NEW) ON LEFT.
rn
frl
—0
—o
0
rn
1k7Y1! "IW W 1.0 AO 0039
I DO CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THISRECORD HAS BEEN PROVIDED TO THE WELL OWNER
FOR OFFICE USE ONLY
Quad No:
Serial No.
� - -r
SIGNATURE OF PERS N S UCTING THE
Submit original to Division of Water Quality, Groundwater Section within 30 days
nJ/.1li//
DATE
GW-1 REV. 12/99

North Carolina — Department of Environment and Natural Resources — Division of Water Quality — Groundwater Section
1636 Mail Service Center — Raleigh, N.C. 27699-1636 — Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR: JEFF MELTON
WELL CONTRACTOR CERTIFICATION #: 3417
STATE WELL CONSTRUCTION PERMIT #:
U
c} 4: , p
3334
1. WELL USE (Check Applicable Box): ® Residential ❑ Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring
❑ Recovery 0 Heat Pump Water Injection ❑ Other If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: RUTHERFORDTON County: RUTH
CROSS CRK. DR. DRILLING LOG DEPTH
(Road Name and Numbers, Community, or Subdivision and Lot No.) From To Formation Description
3. OWNER DON & SHARON SMITH
Address CROSS CRK. DR
(Street or Route No.)
RUTHERFORDTON NC 28139
City or Town State Zip Code
4. DATE DRILLED 08/08/06
5. TOTAL DEPTH 185
6. CUTTING COLLEC.11 D ❑ YES ® NO
7. DOES WELL REPLACE EXISTING WELL? 0 YES ® NO
8. STATIC WATER LEVEL Below Top of Casing: 40 FT.
(Use "+" if Above Top of Casing)
9. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
'Top of rasing terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2C.01I8
10. YIELD (gpm): 25 METHOD OF TEST: ARD
11. WATER ZONES (depth):
12. CHLORINATION: Type: CHLORYTE Amount: 3.5
13. CASING:
Depth
From 0 To
From To
From To
14. GROUT:
Depth
From 0 To 20
From To
15. SCREEN:
Depth
From To
From To
From To
16. SAND?GRAVEL P
Depth
From To
From To
17. REMARKS:
Wall Thickness
Diameter or Weigbt/Ft Material
60 Ft. 6-1/4" SDR21 PVC
Ft.
Ft.
Material Method
Ft. QUIKRETE POURED
Ft.
Diameter Slot Size Material
Ft. in. in.
Ft. in. in.
Ft. in. is
ACK:
Size Material
Ft.
Ft.
If additional space is needed use back of form
LOCATION SKETCH
' (Show direction and distance from at least two State
Roads, or other reference points)
HWY. #221 N. FROM RUTHERFORDTON. LEFT ON MIN.
CRK RD. LEFT ON CLEARWA 1 E1( PKWY. RT. ON CHIMNEY
CRK LANE. LEFT ON CREEKSIDE CIRCLE. LEFT ON CROSS
CRK. DR LOT #123 ON LEFT.
I DO CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THISRECORD HAS BEEN PROVIDED TO THE WFI.f OWNER
FOR OFFICE USE ONLY
Quad No:
Serial No.
ON ONSTRUCTING4HE WELL DATE
original to Division of Water Quality, Groundwater Section within 30 days
GW-1 REV. 12/99

North Carolina — Department of Environment and Natural Resources — Division of Water Quality — Groundwater Section
1636 Mail Service Center — Raleigh, N.C. 27699-1636 — Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR: JEFF MELTON
WELL CONTRACTOR CERTIFICATION #: 3417
STATE WELL CONSTRUCTION PERMIT #:
0
•3
1. WELL USE (Check Applicable Bo:): ® Residential ❑ Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring
❑ Recovery ❑ Heat Pump Water Injection ❑ Other If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: ELLENBORO County: RUTH
455 WALKER STORE RD. DRILLING LOG DEPTH
(Road Name and Numbers, Community, or Subdivision and Lot No.) From To Formation Description
3. OWNER CLARENCE HUTCHINS
Address 455 WALKER STORE RD.
(Street or Route No.)
ELLENBORO NC 28040
City or Town State Zip Code
4. DATE DRILLED 08/14/06
5. TOTAL DEPTH 205
6. CUTTING COLLECTED ❑ YES ® NO
7. DOES WFI T REPLACE EXISTING WELL? ® YES ❑ NO
8. STATIC WATER LEVEL Below Top of facing: 40 FT.
(Use "+" if Above Top of Casing)
9. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2C.0I18
10. YIELD (gpm): 100+ METHOD OF TEST: ARD
11. WA IER ZONES (depth):
12. CHLORINATION: Type: CHLORYTE Amount: 4.5
13. CASING:
Wall Thickness
Depth Diameter or Weight/Ft Material
From 0 To 45 Ft. 6-1/4" SDR.21 PVC
From To Ft _
From To Ft
14. GROUT:
Depth Material Method
Fmm 0 To 20 Ft OUIKRETE POURED
From To Ft.
15. SCREEN:
Depth Diameter Slot Size Material
From To Ft. in._ in.
From To Ft. in. is
From To Ft in. in.
16. SAND?GRAVEL PACK:
Depth Size Material
From _ To Ft
From To Ft
17. REMARKS:
If additional space is needed use back of form
Q :1
LOCATION SKETCH
• (Show direction and distance from at bast two State
Roads, or other reference points)
HENRIETTA/ELLENBORO RD. FROM ELLENBORO. RT. ON
SOCO RD. LEFT ON WALKER STORE RD.. 455 ON BOX
a
I DO CERTIFY THAT THIS WE.I.1 WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THISRECORD HAS BEEN PROVIDED TO THE WFI.1 OWNER
FOR OFFICE USE ONLY
Quad No:
Serial No.
original to Divisi
J- «-e
GNATURE ' PERSa l CONSTRUCTING DATE
of Water Quality, Groundwater Section within 30 days
GW-1 REV. 12/99
S E 2.7 2

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR JEFF MELTON
WELL CONTRACTOR CERTIFICATION #: 3417
STATE WELL CONSTRUCTION PERMIT #:
ej 9
Des, <
I. WELL USE (Check Applicable Box): ® Residential Li Municipal ❑ Industrial ❑ Agricultural 0 Monitoring
❑ Recovery 0 Heat Pump Water Injection ❑ Other If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: FOREST CITY County: RUTH
MORNINGSTAR LAKE RD. DRILLING LOG DEPTH
(Road Name and Numbers, Community, or Subdivision and Lot No.) From To Formation Description
3. OWNER BRYAN POPE
Address MORNINGSTAR LAKE RD.
(Street or Route No.)
FOREST CITY NC 28043
City or Town State Zip Code
4. DATE DRILLED 08/24/06
5. TOTAL DEPTH 145
6. CUTTING COLLEC1hD ❑ YES ® NO
7. DOES WELL REPLACE EXISTING WELL? 0 YES ® NO
8. STATIC WATER LEVEL Below Top of Casing: 60 F.
(Use "+" if Above Top of Casing)
9. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
'Top of casing terminated atior below land surface requires a variance in accor-
dance with 15A NCAC 2C.0118
10. YIELD (gpm): 50 METHOD OF TEST: ARD
11. WATER ZONES (depth):
12. CHLORINATION: Type: CHLORYTE Amount: 3
13. CASING:
Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 55 Et 6-1/4" SDR21 PVC
From To FL _
From To Ft.
14. GROUT:
Depth Material Method
From 0 To 20 Ft OUIKRETE POURED
From _ To Ft.
15. SCREEN:
If additional space is needed use back of form
LOCATION SKETCH
• (Show direction and distance from at least two State
Roads, or other reference points)
BY-PASS 74A E. FROM FOREST CITY, RT. ON BETHANY
CHURCH RD. LEFT ON DOGGETT RD. RT. ON
MORNINGSTAR LAKE RD. RT. ON 1sr PAVED STREET. 1sT
DRIVE ON LEFT.
Depth Diameter Slot Size Material a
From To Ft. in. in. g
From To Ft in. in. N w
From To Ft. _ in. in. rn -4
16. SAND?GRAVEL PACK: a
— a
Depth Size Material ry --
From To Ft. o
From To Ft. CM '
-20
17. REMARKS:
in
I DO CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THISRECORD HAS BEEN PROVIDED TO THE WELL OWNER.
FOR OFFICE USE ONLY
Quad No:
Serial No.
SIGNATURE PERSON CONSTRUCTING THE WFLI DATE
,ubmit original to Division of Water Quality, Groundwater Section within 30 days
GW-1 REV. 12/9c

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR: JEFF MELTON
WELL CONTRACTOR CERTIFICATION #: 3417
STATE WELL CONSTRUCTION PERMIT #:
1. WELL USE (Check Applicable Box): ® Residential U Municipal 0 Industrial 0 Agricultural 0 Monitoring
0 Recovery ❑ Heat Pump Water Injection ❑ Other If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: FOREST CITY County: RUTH
LILLIAN FARMS DRILLING LOG DEPTH
(Road Name and Numbers. Community, or Subdivision and Lot No.) From To Formation Description
3. OWNER JOEY PETERSON
Address LILLIAN FARMS
(Street or Route No.)
FOREST CITY NC 28043
City or Town State Zip Code
4. DATE DRILLED 08/24/06
5. TOTAL DEPTH 185
6. CUTTING COLLEC1ED 0 YES ® NO
7. DOES WELL REPLACE EXISTING WELL? 0 YES ® NO
8. STATIC WATER LEVEL Below Top of Casing: 40 FT.
(Use "+" if Above Top of Casing)
9. TOP OF CASING IS 1-1/2 FT. Above Land Surface"
*Top of casing terminated at/or below land surface requires a variance in accor-
dance with 15ANCAC 2C.0118
10. YIELD (gpm): 40 METHOD OF TEST: ARD
11. WATER ZONES (depth):
12. CHLORINATION: Tvpe: CHLORYTE Amount: 3.5
13. 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.
14. GROUT:
Depth Material Method
From 0 To 20 Ft. QUIKRETE POURED
From To Ft.
15. SCREEN:
Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
From To Ft. in. in.
16. SAND?GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
17. REMARKS:
If additional space is needed use back of form
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other reference points)
BY-PASS 74A W. FROM FOREST CITY. EXIT ON OAKLAND
RD. & LEFT BACK ACROSS BY-PASS. RT. INTO LILLIAN
FARMS. (JUST BEFORE UNDERPASS) GO STRAIGHT ON
DRIVE (a. DEADEND. HOUSE ON LEFT.
A
I DO CERTIFY THAT THIS WELL WAS CONSTRUC I LI) IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS. AND THAT A COPY OF THISRECORD HAS BEEN PROVIDED TO THE WELL OWNED
FOR OFFICE USE ONLY
Quad No:
Serial No.
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
ubmit original to Division of Water Quality, Groundwater Section within 30 days
GW-1 REV. 12/99

Iorth Carolina — Ik.yartinent of Environment and Natural Resources — Division of Water Quality — Groundwater Section
636 Mail Service Center — Raleigh, N.C. 27699-1636 — Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR JEFF MELTON
WELL CONTRACTOR CERTIFICATION #: 3417
STATE WELL CONSTRUCTION PERMIT #:
' Fin
O I
WELL USE (Check Applicable Box): ❑ Residential 0 Municipal ❑ Industrial ® Agricultural ❑ Monitoring
❑ Recovery ❑ Heat Pump Water Injection ❑ Other If Other, List Use:
!. WELL LOCATION: (Show sketch of the location below)
Dearest Town: SPINDALE County: RUTH
LLD STONECUTTER RD. DRILLING LOG DEPTH
Road Name and Numbers, Community, or Subdivision and Lot No.) From To Formation Description
3. OWNER JOHN PADGETTE
kddress OLD STONECUTTER RD.
Street or Route No.)
3PINDALE NC 28160
L'ity or Town State Zip Code
1. DATE DRILLED 08/28/06
5. TOTAL DEPTH 305
5. CUTTING COLLECTED ❑ YES ® NO
7. DOES WELL REPLACE EXISTING WELL? 0 YES ® NO
3. STATIC WATER LEVEL Below Top of Casing: 80 FT.
Use "+" if Above Top of Casing)
?. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
'Top of casing terminated at/or below land surface requires a variance in accor-
lance with 15A NCAC 2C.0118
10. YIELD (gpm): 3 METHOD OF TEST: ARD
11. WATER ZONES (depth):
12. CHLORINATION: Type: CHLORYTE Amount: 7.5
13. 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.
14. GROUT:
Depth Material Method
From 0 To 20 Ft. OUIKRETE POURED
From To Ft
15. SCREEN:
Depth Diameter Slot Size Material
From To Ft in_ in.
From To Ft in. in.
From To Ft in. in.
16. SAND?GRAVEL PACK:
Depth Size Material
From To Ft
From To Ft
17. REMARKS: .
If additional space is needed use back of form
LOCATION SKETCH
•(Show direction and distance from at least two State
Roads, or other reference points)
BY-PASS 74 E. FROM RUTHERFORDTON. EXIT RT. ON
OAKLAND RD. RT. ON POORS FORD RD. RT. ON OLD
STONECUTTER RD. 1 MILE ON RT.
rn
rn
-D
O
[ DO CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL m
CONSTRUCTION STANDARDS, AND THAT A COPY OF THISRECORD HAS BEEN PROVIDED TO THE WELL 0
FOR OFFICE USE ONLY
Quad No:
Serial No.
SIGNAT[JRE OF PERSON CONSTRUCTING THE WELL
Submit original to Division of Water Quality, Groundwater Section within 30 days
'bitL l:'3e) ,4o UO ii
DATE
GW-1 REV. 12/99

From: Scott Gantt 7044347212 To. Stephenie Wilson Date. 9/14/2006 Time: 8:57:34 PM
Page 9 of 9
t...,.,ai.0
From
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment, and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) SCOTT GANTT CERTIFICATION # 2584
WELL CONTRACTOR COMPANY NAME CAROLINA WELL DRILLERS, INC. PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box) : Residential Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring 0
Recovery ❑ Heat Pump Water Injection ❑ Other 0 If Other, List Use:
2. WELL LOCATION:
Nearest town: LAKE LURE County RUTHERFORD
LOT 56, 306 SPARROWS WAY RD, RIVERBEND SUBDIVISION
(Street Name. Numbers, Community, Subdivision, Lot No.. Zip Code)
3. OWNER RIDGELINE DEVELOPMENT CORP.
ADDRESS 112 COCOPLUM CIRCLE
(Street or Route No.)
ROYAL PALM BEACH
City or Town
561-798-2729
FL
State
33411
Zip Code
Area Code - Phone Number
4. DATE DRILLED 8/28/06
5.TOTAL DEPTH 205
6. DOES WELL REPLACE EXLSTING WELL?
7. STATIC WATER LEVEL Below Top of Casing:
YES ❑ NO
179 Fr.
(Ilse'w- If Above Top of Casing)
8. TOP OF CASING LS 2 Fr. Above Land Surface'
"Top of easing terminated at/or below land surface regimes a variance m
accordance with 15A NCAC 2C.0118
9. YIELD (gpm): 20 METHOD OF TEST ARDM
10 WATER ZONES (depth): 195
Topographic/Land setting
❑ Ridge 0 Slope 0 Valley 0 Flat
Latitude/Longitude of well location
35.25.815 / 82.09.811
(degrees/minutes/seconds)
Latitude./longitude source: 0 GPS 0 Topographic map
DEPTH
From To
DRILLING LOG
Formation Description
0 30 Clay
30 205 Consolidated Rock
u. DISINFECTION: TYPE HYPOCHLORITE Amount 3
12. CASING:
Depth
From 0 To
13. GROUT:
From 0
14. SCREEN
Diameter
41 Ft 61/4"
Wall Thickness
or Weight/FL Material
SDR21 PVC
oz LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
Depth Material Method
To 20 Ft GRAVEL MIX GRAVITY
Depth Diameter Slot Size Material
From NA To Ft in. in.
15- SAND/GRAVEL PACK:
Depth
NA To
16. REMARKS:
Ft,
Size Material
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
8/30106
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.
en
E't
t'U
GIN-1 REV. 07/2001

From: Scott Gantt 7044347212 To. Stepnenie Wilson Date: 9/142006 Time: 8:57:34 PM
Page 8 of 9
f; n n 2 n 7
o J 1
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment, and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) SCOTT GANTT CERTIFICATION # 2584
WELL CONTRACTOR COMPANY NAME CAROLINA WELL DRILLERS, INC. PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box) : Residential © Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATION:
Nearest town: LAKE LURE
LOT 6 ACORN TRAIL, OFF GRASSEY KNOB RD
County RUTHERFORD
(Street Name Numbers, Comnumity, Subdivision, LotNo,. Zip Code)
3. OWNER RIDGELINE DEVELOPMENT CORP.
ADDRESS 112 COCOPLUM CIRCLE
(Street or Route No.)
ROYAL PALM BEACH FL
City or Town State
561-798-2729
Area Code - Phone Number
4. DATE DRILLED 8/23/06
5. TOTAL DEPTH 400
6. DOES WELL REPLACE EXISTING WELL?
7. STATIC WATER LEVEL Below Top of Casing:
YES ❑ NO
50 FT
(rise "+" If Above Top of Casing)
8. TOP OF CASING IS 2 FT. Above Land Surfaces
"Top of casing terminated at/or below laid surface requires a variance m
accordance with 15A NCAC 2C.0118
9. YIELD (]rpm): 2 METHOD OF TEST ARDM
10. WATER ZONES (depth): 320
33411
Zip Code
Topographic/Land setting
❑ Ridge ❑ Slope ❑ valley © Flat
Latitude/Longitude of well location
35.24.295 / 82.09/711
(degrees/minutes/seconds)
Latitude'ongitude source: GPS ❑ Topographic map
DEPTH DRILLING LOG
From To Formation Description
0 65 Clay
65 400 Consolidated Rock
u. DISINFECTION: TYPE HYPOCHLORITE Amount 17
12. CASING: Wall Thickness
Depth
From 0 To 71
13. GROUT:
Depth
From 0 To
14. SCREEN
Diameter or Weight/Ft Material
Ft. 61/4" SDR21 PVC
Oz
Material Method
20 FL GRAVEL MIX GRAVITY
Depth
From NA To
15. SAND/GRAVEL PACK:
Depth
From NA To Ft,
16. REMARKS:
Diameter
FL w
Size
Slot Sae Material
Material
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
Fc.2CUS
V)
ITT
-v
CO
CD
Ql'
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
8/25/06
SIGNATURE OF PERSON CONSTRUCTING THE WELL Date
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service center - Raleigh, N C
27699-1636 Phone No. [phone], within 30 days.
GW-1 REV. 07/2001
6
Gt
C

From: Scott Gantt 7044347212 To: Stepnenie Wilson
Date: 9/14/2006 Time: 8:57:34 PM Page 7 of 9
C
V '.)
.1 \T
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment, and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) SCOTT GANTT CERTIFICATION # 2_84
WELL CONTRACTOR COMPANY NAME CAROLINA WELL DRILLERS, INC. PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box) : Residential ❑ Municipal ❑ Industrial ❑ Agricultural D Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATION:
Nearest town: LAKE LURE
113 TRAVERLERS REST LANE
County RUTHERFORD
(Street Name. Numbers, Community, Subdivision Lot No, Zip Code)
3 OWNER TERRIE TRAVIS
ADDRESS 113 TRAVERLERS REST LANE
(Street or Route No.)
LAKE LURE
City or Town
Topographic/Land setting
❑ Ridge ® Slope ❑ Valley ❑ Flat
Latitude/Longitude of well location
35.24.510 / 82.07.321
(degrees/minutes/seconds)
Latitude/longitude source: ❑ GPS ❑ Topographic map
DEPTH DRILLING LOG
NC 28746 From To Formation Description
State Zip Code 0 41 Clay
704-770-8340 41 400 Consolidated Rock
Area Code - Phone Number
4. DATE DRILLED 8/19/06
5. TOTAL DEPTH 400
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO ID
7. STATIC WAItK LEVEL Below Top of Casing: 65 FT.
(Ilse v" If Above Top of Casing)
8. TOP OF CASING /S 2 FT. Above Land Surface'
'Top of casing terminated at/or below land surface regimes a valance m
accordance with 15A NCAC 2C.13118
9. YIELD (ppm): 2 METHOD OF TEST ARDM
to. WA TER ZONES (depth): 320
t1. DISINFECTION: TYPE HYPOCHLORITE Amount 16
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 46 FL 6 1/4 " SDR 21 PVC numbers and common road names.
13. GROUT:
From 0
Depth Material Method
To 20 FL GRAVEL MIX GRAVITY
14. SCREEN
Depth Diameter Slot Size Material
From NA To FL im im
15. SAND/GRAVEL PACK:
Depth Size Material
From NA To FL
16. REMARKS:
SF -..
21105
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 1SA NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
8/21/06
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 7044347212 To: Stepheme Wilson Date: 9/14/2006 Time: 8:57:34 PM
Page 6 of 9
From
""`_2,9�
zf z;
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment, and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) SCOTT GANTT CERTIFICATION # 2584
WELL CONTRACTOR COMPANY NAME CAROLINA WELL DRILLERS, INC. PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box) : Residential ❑ Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATION:
Nearest town: LAKE LURE
CHIPMONK TRAIL, RIVERBEND SUBDIVISION
County RUTHERFORD
(Street Name, Numbers, Community, Subdivision, Lot No,. Zip Code)
3. OWNER D.L. WALK CONSTRUCTION
ADDRESS 5523 US HWY 74A/64
(Street or Route No.)
LAKE LURE
City or Town
828-288-3000
NC
State
Area Code - Phone Number
4. DATE DRILLED 8/17/06
5. TOTAL DEPTH 220
6. DOES WELL REPLACE EXISTING WELL'
7. STATIC WATER LEVEL Below Top of Casing
28746
Zip Code
YES 0 NO El
110 FT.
(ss "+" If Above Top of Casing)
8. TOP OF CASING IS 2 FT. Above Land Surface'
'Top of casing terminated ator below land reface requires a variance in
accordance with ISA NCAC 2C.0118
9 YIELD (gym):
m_ WATER ZONES (depth):
METHOD OF TEST
155
ARDM
Topographic/Land setting
❑ Ridge ❑ Slope ❑ Valley © Flat
Latitude/Longitude of well location
35.25.684 182.09.855
(degreeslminutes/seconds)
Latitude/longitude source: © GPS ❑ Topographic map
DEPTH DRILLING LOG
From To Formation Description
0 60 Clay
60 220 Consolidated Rock
11. DISINFECTION: TYPE H]POCHLORITE Amount 6
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft Material
From 0 To 70 FL 61/4" SDR 21 PVC
13. GROUT:
From 0
14. SCREEN
From
Depth
To 70 FL
Depth
NA To
FL
15. SAND/GRAVEL PACK:
Depth
NA To
16. REMARKS:
Ft,
Diameter
o= LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
Material Method
GRAVEL MIX GRAVITY
yr
Slot Size
in
Material
Material
vL r� ( ?GCE
cn rn ?
htba
CT
Wl
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONS IRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
8/20/06
SIGNATURE OF PERSON CONSTRUCTING THE WELL Date
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days.
GW-1 REV. 07/2001

rrom. Scott Gantt 7044347212 lo: Stepnenie Wilson Date: 9/14/2006 Time: 8.57:34 PM
Page 5 of 9
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)
1. WELL USE (Check Applicable Box): Residential ❑
Recovery ❑ Heat Pump Water Injection ❑
2. WELL LOCATION:
Nearest town: RUTHERFORDTON County RUTHERFORD
140 FALLYN COURT, AMBER OAKS SUBDIVISION
(if applicable)
Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Other ❑ If Other, List Use:
(Street Name. Numbers, Community, Subdivision, Lot No,. Zip Code)
3. OWNER
ADDRESS
D.L. WALKS CONSTRUCTION
5523 US HWY 74A/64
(Strict or Route No.)
LAKE LURE
City or Town
828-288-3000
NC
State
Area Code - Phone Number
4. DATE DRILLED 8/7/06
5. TOTAL DEPTH
185
6. DOES WELL REPLACE EXISTING WELL?
7. STATIC WAIER LEVEL Below Top of Casing:
Topographic/Land setting
❑ Ridge © Slope ❑ Valley ❑ Flat
Latitude/Longitude of well location
35.24.180 / 81.59.033
(degrees/minutesiseconds)
Latitudedongitude source: D GPS ❑ Topographic map
DEPTH
28746 From To
Zip Code 0 80 Clay
YES ❑ NO El
30 FT.
(Use `+' If Above Top of Casing)
8. TOP OF CASING IS 2 FT. Above Land Surface'
•Top of casing terminated atlor below land surface requires a valiance m
accordance with I5A NCAC 2C.01I8
9. YIELD (rpm): 8 METHOD OF TEST ARDM
10. WA Lhit ZONES (depth): 95 175
tt. DISINFECTION: TYPE HYPOCHLORITE Amount 8
12. CASING:
Depth
From 0 To
a. GROUT:
Depth
From 0 To
t4. SCREEN
Depth
From NA To
t5. SAND/GRAVEL PACK:
Depth
From NA To
l6. REMARKS:
Diameter
88 FL 6 1/4
20 FL
DRILLING LOG
Formation Description
80 185 Consolidated Rock
Wall Thickness
or Weight/FL Material
SDR 21 PVC
Oz
Diameter
FL
Ft,
Material Method
GRAVEL MIX GRAVITY
in
Size
Slot Size Material
in.
Material
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
8/7/06
SIGNATURE OF PERSON CONSTRUCTING THE WFI I Date
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days.
GW-I REV. 07/2001

From: Scott Gantt 7044347212 To: Stephene Wilson Date: 9/14/2006 Time: 6:57:34 PM
Page 3 of 9
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment, and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) SCOTT GANTT CERTIFICATION # 2584
WELL CONTRACTOR COMPANY NAME CAROLINA WELL DRILLERS, INC. PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box) : Residential ❑ Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATION:
Nearest town: RUTHERFORDTON
1815 BOY SCOUT RD
County RUTHERFORD
(Street Name. Numbers, Community, Subdivision, Lot No.. Zip Code)
3. OWNER SOUTHERN SHOWCASE HOMES
ADDRESS 6080 ASHEVILLE HWY
(street or Rome No.)
HENDERSONVILLE
City or Town
828-687-2883
NC
State
Area Code - Phone Number
4. DATE DRILLED 8/2/06
5. TOTAL DEPTH 200
6. DOES WELL REPLACE EXISTING WELL'
7. STATIC WATER LEVEL Below Top of Casing:
28791
Zip Code
YES ❑ NO HI
60 FT.
(Usc "s" If Above Top of Casing)
8. TOP OF CASING IS 2 FT. Above Land Surface"
'Top of casing terminated at/or below Iaad surface requires a variance in
accordance with 15A NCAC 2C.0118
9. YIELD (gm): 5 METHOD OF TEST ARDM
10. WATER ZONES (depth): 160
11. DISINFECTION: TYPE
12. CASING:
Topographic/Land setting
❑ Ridge ❑ Slope ❑ Valley Q Flat
Latitude/Longitude of well location
35.27.684 / 8155.011
(degreeslminutes/seconds)
Latitude/longitude source: fl GPS ❑ Topographic map
DEPTH
From To
0 75 Clay
DRILLING LOG
Formation Description
75 200 Consolidated Rock
HYPOCHLORITE Amount 8
Depth Diameter
From 0 To 82 FL 61/4"
13. GROUT:
Depth
From 0 To 20 Ft.
14. SCREEN
Wall Thickness
or Weight/Ft. Material
SDR21 PVC
Oz
Material Method
GRAVEL MIX GRAVITY
Depth Diameter
Frorn NA To FL is
I5. SAND/GRAVEL PACK:
Depth
From NA To
16. REMARKS:
Ft,
Size
Slot Size Material
m
Material
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads_ Include the road
numbers and common road names.
SEP 2? 2006
cn
"O
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
8/15/06
Date
SIGNATURE OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days.
GW-I REV. 07/2001

From'. Scott Gann 7044347212 To: Stepneme Wilson
Date: 9/14/2006 Time: 8E7''34 PM Page 2 of 9
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment, and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) SCO7T GANTT CERTIFICATION # 2584
WELL CONTRACTOR COMPANY NAME CAROLINA WELL DRILLERS, INC. PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box) : Residential 0 Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery D Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATION:
Nearest town: RUTHERFORDTON
486 HWY 64
County RUTHERFORD
(Street Name, Numbers, Communiy. Subdivision, Lot No,. Zip Code)
Topographic/Land setting
❑ Ridge 0 Slope 0 Valley © Flat
Latitude/Longitude of well location
35.39.331 / 81.93.267
3. OWNER WILBERT HUTCHINS (degrees/minutesiseconds)
ADDRESS 486 HWY 64 Latitude'oneitude source: ❑ GPS 0 Topographic map
(stew or Rome No.) DEPTH DRILLING LOG
RUTHERFORDTON NC 28139 From To Formation Description
City or Town State Zip Code 0 90 Clay
828-286-9334
Area Code - Phone Number
4. DATE DRILLED 8/1/06
S. TOTAL DEPTH 360
6. DOES WELL REPLACE EXLSTING WELL?
7. STATIC WATER LEVEL Below Top of Casing:
YES El NO ❑
65 FT.
(]use "+" If Above Top of Casing)
8. TOP OF CASING IS 2 FT. Above Land Surface*
'Top of easing terminated at/or below Ind surface requires a variance m
accordance with 15A NCAC 2C.0118
9. YIELD (gpm): 5 METHOD OF TEST ARUM
10. WA ILK ZONES (depth): 120
90 360 Consolidated Rock
ti. DISINFECTION: TYPE HYPOCHLORITE Amount 15
12. CASING: Wall Thickness
Depth Diameter or Weight/FL Material
From 0 To 97 Ft 61/4" SDR21 PVC
13. GROUT:
0z
Depth Material Method
From 0 To 20 FL GRAVEL MIX GRAVITY
14. SCREEN
Depth
From NA To FL
15. SAND/GRAVEL PACK:
Depth
From NA To Ft,
16. REMARKS:
Diameter
IR
Slot Size Material
Size Material
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
SEE' 27 2330
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.
8/1/06
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 7044347212 To: Stephenie Wilson Date: 9/14/2006 Time: 8:57:34 PM
Page 1 of 9
AtO
fit '73 tl 0 0
E ci !. Fo
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment, and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) SCOTT GANTT CERTIFICATION # 2584
WELL CONTRACTOR COMPANY NAME CAROLINA WELL DRILLERS, INC. PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box) : Residential ® Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2, WELL LOCATION:
Nearest town: LAKE LURE
108 PHEASANT ST, RIVERBEND SUBDIVISION
County RUTHERFORD
(Street Name, Numbers, Community, Subdivision Lot No,. Zip Code)
3. OWNER D.L. WALKE CONSTRUCTION
ADDRESS 5523 US HWY 74A/64
(Street or Route No.)
LAKE LURE
City or Town
828-288-3000
NC
State
Area Code - Phone Number
4. DATE DRILLED 8/30/06
5. TOTAL DEPTH 145
6. DOES WELL REPLACE EXISTING WELL?
7. STATIC WATER LEVEL Below Top of Casing:
28746
Zip Code
YES ❑ NO El
45 FT.
(Use "+" If Above Top of Casing)
8. TOP OF CASING IS 2 FT. Above Land Surface'
*Top of easing terminated a/or below land surface requires a variance m
accordance with 14A NCAC .2C.0118
9. YIELD (gym): _
to. WATER ZONES (depth):
METHOD OF TEST
95
ARDM
Topographic/Land setting
❑ Ridge ❑ Slope ❑ Valley ❑ Flat
Latitude/Longitude of well location
35 25,479 82..09.994
(degrees/minutes/seconds)
Latitudellongitude source: © GPS ❑ Topographic map
DEPTH
From To
DRILLING LOG
Formation Description
0 83 Clay
83 145 Consolidated Rock
11. DISINFECTION: TYPE HYPOCHLORITE
12. CASING:
Depth
From 0 To 93
13. GROUT:
Diameter
FL 61/4"
Depth
From 0 To 20 FL
14. SCREEN
Depth
From NA To
15, SAND/GRAVEL PACK:
Depth
From NA To
16. REMARKS:
Amount 6
Wall Thickness
or Weight/FL Material
SDR2I PVC
oz
Material Method
GRAVEL MIX GRAVITY
Diameter
FL in.
Ft,
Size
Slot Size Material
in
Material
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
SEP 2 7 2006
CD
CT
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.
9/1/06
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 or Environment and Natural Ressacwces I- Division of Water Quality - Grotmdwater Section
WELL. CONTRACTOR (INDIVIDUAL) NAME (prhq fir y ,` Uct, -.t c€m,nc rrau02/✓6
W ELL CONTRACTOR COMPANY NAME—WS 1 e e
STATE WELL CONSTRUCTION PERMIT. ASSOCIATED WQ PERMIT*
(if applicable)
la if Dr 11: .,5 PHONE I ( _ ti
1. WELL USE (Check Applicable Box): Residential Er Muuicipai/Public 0 industrial 0 Aariculturai ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 if Other, List Use
2. WELL LOCATION:
Nearest Town: bLD for' '
Lei )7 Cesar erre�
red-
(Street Name. Numbers. Community, Subdivision Lot No- rip Code)
3. OWNER: 4^ eorep. err AJSk11taw
Address t'1$ Gt. eredo :et.4 54-
I� (Stow lYA No.)
3r)o(0 3
City or Town State Tap Code
13. GROUT:
From D
From
iaa-251- cal
Area code- Phone numbers.,
4- DATE DRILLED - Z 2 - o (O
5. TOTAL DEPTH: SOS'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 8f
7. STATIC WATER LEVEL Below Top ofCas►ng: /po' FT.
S. TOP OF CASING [S I Woe n4-'fAbe eToperCaoaa)
FT Above Land Surface*
"Top attains ter tuatd athe hem land swine rtwmces a
vartaom is accordance with ISA NCAC 2C.0118.
9. YIELD (spin): joayPali METHOD OFTEST SfAIA
10. WATER ZONES (depth). 200 1 O 40 (4 Go JP if At
11 _ DISINFECTION: Type !t a Amount O 7
12. CASING: Wall Thiektiess
Depth Diamrkr or Weight/Ft. Material
From 0 To /DO FL ter%/ tan )t/G
From) OO To 420 FL (o /k S(c) PVG
From)d° To)o7,2 Ft.lei4 /it r,FlIV
Depth Material Pulp-
Medod
To FL
c:
To ;%O FL 7 r
County QU'1cd-1cij 1 - - lope O alley ii ia1
4�+N (check appropriate box)
Laljt n iude�f wclllocation
35 3/.Z'ZIk OXz v:.84etN
(tkgees/miwooti owdr)
Latitude/longitude sourccMGPSOTopogcaphic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To FL in_ is
15. SAND/GRAVEL PACK:
Depth Size ' Material
From To Ft.
From To FL
16. REMARKS:
Topo hic/Land setting
ORid MS V
ED
DIV. OF WATERR QUALITY
OCT 0 6.2006
4
O /ISO JD, ter .
/Do-//o Rack tQ.rtF
//o r-SOT yr2A-,✓t'tee
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
• o 4-+•12 b tAay
gal kit Cr. sovrik
gockn
hf
gagit
creels /et
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2G WELL
CONS 9WCTION STANDARDS. AND THATA COPY OFTHIS RECORD HAS BEEN PROVIDED TOTEM WELL OWNER
4 7 -SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE (5(9
Submit the original to the Division of Water Quality, G
27699-1636 Phone No. [phone], within 30 days.
nthiRiEe€4,4441in
OCT 17 2!JC3
Asheville Regional Office
Aquifer Protection
Center -Raleigh, NC
GW-I REV.07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department or Environment and Nanual Resources - Division of Water
WELL CONTRACTOR (INDIVIDUAL) NAME C^ QualityGroundwater
(print) l�Q r �/ J US( Ce, cERTIFiCATreNv 92 I SU
WELL CONTRACTOR COMPANY NAME ,SUST.'CQ wdl Df�'I���
PHONE i (�i) tit- `�S`/$
STATE WELL CONSTRUCTION PERMITY
tifapplicawc) _ ASSOCIATED W Q PERMIT*
/ cable)
1. WELL USE (Check Applicable Box): Residential ID/ Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other O If Other, List Use
2. WELL LOCATION:
3. OWNER: Ye4er LA w.s- 4-c
Address )+{$/IS 19er1eg wo br. a ( )
lstr«x or R No., `i q2 z LatittulerlongituRle sotecc iPSOTppoy.mphic map
Route
N�stTown: CowuyfZuTkCr r�-ioN gip
LG"r Ca Cec rl ORidge 11�Slope OValley 0Fla1
titer Name. Nnnfbcn Community. Subdiviyoq Lot No.. Code) (check appropriate box)
La 'itude lon 'rude of well location.
35°31.07CII ovs2G10.095w
Topo bic/Land setting
'�L�y/. Ttp Code
2ce/- ea 9( - 79 16
Area code- Plane ameba
4. DATE DRILLED '1-27 - 04
5. TOTAL DEPTH: '3 q 5 / 6. DOES WELL REPLACE EXISTING WELL? YES I7 NO lid
7. STATIC WATER LEVEL Below Top ofCasing_ 0 Fr.
8. TOP OF (Ur:v-irAbowro►otEaura)
CASING IS 1 FT Above Laud S��«
'Top orcariue terminated ethic below lead surface require; a
variance in taordaace with ISA NCAC 2c.otlt
9. YIELD (gpm): .20 METHOD OF TEST /i.
10. WATER ZONES (depth)_ 0O i'r „t t0 . S ZO
1 I. DISINFECTION: Type e �;,,t A� �.o Z
I2 CASING: Wall Thickness
Depth From 0 T Dina or Wei br7Ft *lateral
12 t/ Ft1. 'AI _ PVC.
From 124 To 2L,y Ft %g 5(6 PUS,
Ftom2t9 To ALL FI. (Aryl — Jig g AIV
13. GROUT: Depth
From_,__ TQ 0 FL 2 £awl Method
)tir+ Kites FL
City nrT v Saxe
From To FL
14. SCREEN: Depth
From To
From_ To
15. SAND/GRAVEL PACK:
Depth
Fron,�_To Ft.
From To
16. REMARKS:
Diameter Slot Size Material
Ft in. in.
Ft in. in.
Size Material
FL
DEPTH
From To
o- >Ro
/9O- ZSo
2Se — t60
240— 3t�S
(d,vci bozo
DRILLING LOG
Formation Description
Seri' Keck
Mai &Cif geL/c
LOCATION SKETCH
Show direction and distance in miles from at )east
two State Roads or County Roads. Include the road
numbers and common road names.
EARicw/y0os;754;
DIV. OF VED
fey me OF QUALITY
OC 0 s 2006
CePA2 PRe€k
rzc
131•q
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED 1NACCORDANCE WITH ISA NCAC 2C, WELL
CONSTRUCTION STANDARDS. AND THATA COPY OFTHIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
ll 2y-DL
IGNATURE OF PERSON CON •r.,, a. ..,
Submit the original to the Division of Water Quality, G
27699-1636 Phone Na. (919) 733-32221, within 30 days.
waterbtlliQ 1I5Oo
OCT 1/2
Asheville Regional Office
Aet uifer Protertinn
DATE
G
er-Raleigh, NC
-I REV. 07/200I
o.

North Carolina — Department of Environment and Natural Resources — Division of Water Quality — Groundwater Section
1636 Mail Service Center — Raleigh, N.C. 27699-1636 — Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR: JEFF MELTON
WELL CONTRACTOR CERTIFICATION #: 3417
STATE WELL CONSTRUCTION PERMIT #:
1. WELL USE (Check Applicable Box): ® Residential 0 Municipal 0 Industrial 0 Agricultural 0 Monitoring
0 Recovery 0 Heat Pump Water Injection 0 Other If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: LAKE LURE County: RUTH
HICKORY NUT DR DRILLING LOG DEPTH
(Road Name and Numbers, Community, or Subdivision and Lot No.) From To Formation Description
3. OWNER TOMKASTNER
Address HICKORY NUT DR
(Street or Route No.)
LAKE LURE 28746
City or Town State Zip Code
4. DATE DRILLED 09/18/06
5. TOTAL DEPTH 805
6. CUTTING COLLECTED 0 YES ® NO
7. DOES WELL REPLACE EXISTING WELL? 0 YES 0 NO
8. STATIC WATER LEVEL Below Top of Casing: 0 FT.
(Use "+" if Above Top of Casing)
9. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
'Top of casing terminated at/ar below land surface requires a variance in accor-
dance with I5A NCAC 2C.0118
10. YIELD (gpm): 0 METHOD OF TEST: ARD
11. WATER ZONES (depth): _
12. CHLORINATION:
13. CASING:
Depth
From 0 To 20
From To
From To
14. GROUT:
Depth
From 0 To 20
From To
15. SCREEN:
Depth
Type: CHLORYTE Amount: 22.5
Wall Thickness
Diameter or Weight/Ft. Material
Ft. 6-1/4" SDR21 PVC
Ft. ____
Ft.
Material Method
Ft. OUIKRETE POURED
Ft.
Diameter Slot Size Material
From ___ To Ft. in._ in.
From __ To Ft _ in
_
From _ To Ft. _ in.
16. SAND?GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
17. REMARKS:
in.
in.
e7 8 1 ;e i '.a
DIV.OFRWATER L)
QUALITY
OCT 0 6 200s
If additional space is needed use back of form
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other reference points)
HWY. #64/74A W. FROM RUTHERFORDTON. RIGHT ON
BILLS CREEK RD. LEFT ON CEDAR CREEK LEFT ON
SEARCY RD. LEFT ON PEAR TREE. LEFT ON HICKORY NUT
DR Isr HOUSE ON RIGHT.
RECEIVED
OCT 1 7 2UUl
Asheville Regional Office
Aquifer Protartinn
I DO CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THISRECORD HAS BEEN PROVIDED TO THE WELL OWNER
FOR OFFICE USE ONLY
Quad No:
Serial No.
SIGNATUREPERSON CONSTRUCTING WELL DATE
ubmit original to Division of Water Qujdity, Groundwater Section within 30 days
GW-1 REV. 12/99

North Carolina — Department of Environment and Natural Resources — Division of Water Quality — Groundwater Section
1636 Mail Service Center — Raleigh, N.C. 27699-1636 — Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR: JEFF MELTON
WELL CONTRACTOR CERTIFICATION #: 3417
STATE WELL CONSTRUCTION PERMIT #:
1. WELL USE (Check Applicable Box): 0 Residential 0 Municipal 0 Industrial [f Agricultural 0 Monitoring
0 Recovery 0 Heat Pump Water Injection ® Other If Other, List Use: CAMPGROUND
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: BOSTIC County: RUTH
1079 SOUTH MTN. RD. DRILLING LOG DEPTH
(Road Name and Numbers, Community, or Subdivision and Lot No.) From To Formation Description
3. OWNER SOUTH MTN. CHRISTIAN CAMP
Address 1079 SOUTH MTN. RD.
(Street or Route No.)
BOSTIC NC 28018
City or Town State Zip Code
4. DATE DRILLED 09/08/06
5. TOTAL DEPTH 560
6. CUTTING COLLECTED 0 YES NO
7. DOES WELL REPLACE EXISTING WELL? 0 YES ® NO
8. STATIC WATER LEVEL Below Top of Casing: 80 FT.
(Use "+" if Above Top of Casing)
9. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Tap of casing terminated aUar below land surface requires a variance in accor-
dance with 15A NCAC 2C.0118
10. YIELD (gpm): 100+ METHOD OF TEST: ARD
11. WATER ZONES (depth):
12. CHLORINATION: Type: CHLORYTE Amount: 15
13. CASING:
Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 55 Ft. 6-1/4" SDR21 PVC
From To Ft.
From To Ft.
14. GROUT:
Depth Material Method
From 0 To 20 Ft. QUIKRETE POURED
From To Ft.
15. SCREEN:
Depth Diameter Slot Size Material
Ft. in. in.
Ft. in. in.
o Ft. in. in.
From To
From T To
From _T
16. SAND?GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
17. REMARKS:
RECEIVED
DIV. OF WATER QUALITY
OCT 0 6 2006
If additional space is needed use back of form
t.
O."
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other reference points)
BUS. 74 E. FROM FOREST CITY. LEFT ON
BOSTIC/SUNSHINE. RD. RT. ON SALEM CHURCH RD. LEFT
ON SOUTH MTN. RD. 2ND DRIVE ON RT. PAST SOUTH MTN.
CHRISTIAN CAMP.
I DO CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A
CONSTRUCTION STANDARDS, AND THAT A COPY OF THISRECORD HAS BEEN PROVIDED TO THE WELL OWNER.
FOR OFFICE USE ONLY
Quad No:
Serial No.
RECEIVED
OCT 1 7 2011E
Asheville Regional
epgional Office
NC Zia-CAVtrLLf Gteclion
1/4
SIGN C CONSTRUCTING THE WEL ilDATE
;
bmit original to Division of Water Quality, Groundwater Section within 30 days
GW-1 REV. 12/99

North Carolina — Department of Environment an4 Natural Resources — Division of Water Quality — Groundwater Section
1636 Mail Service Center — Raleigh, N.C. 27699-1636 — Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR: RODNEY ROBBINS
WELL CONTRACTOR CERTIFICATION #: 2785
STATE WELL CONSTRUCTION PERMIT #:
1. WELL USE (Check Applicable Box): ® Residential iJ Municipal
❑ Recovery ❑ Heat Pump Water Injection ❑ Other
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: BOSTIC County: RUTH
AMELIA LANE (LOT #33) DRILLING LOG DEPTH
(Road Name and Numbers, Community, or Subdivision and Lot No.) From To
3. OWNER DEL GRECO CONST.
Address AMELIA LANE (LOT #33)
(Street or Route No.)
BOSTIC 28019
City or Town State Zip Code
4. DATE DRILLED 09/20/06
5. TOTAL DEPTH 805
6. CUTTING COLLECTED ❑ YES ® NO
7. DOES WELL REPLACE EXISTING WELL? ❑ YES ® NO
8. STATIC WA 1 kit LEVEL Below Top of Casing: 100 FT.
(Use "+" if Above Top of Casing)
9. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land =face requires a variance in accor-
dance with 15A NCAC 2C.o118
10. YIELD (gpm): 1 METHOD OF TEST: ARD
11. WATER ZONES (depth): _
12. CHLORINATION: Type: CHLORYTE Amount: 22.5
❑ Industrial ❑ Agricultural U Monitoring
If Other, List Use:
13. CASING:
Wall Thickness
Depth Diameter or Weight/Ft Material
From 0 To 70 Ft. 6-1/4" SDR21 PVC
From To Ft.
From ToFt.
14. GROUT:
Depth Material Method
From 0 To 20 Ft. OUILKRETE POURED
From To Ft.
15. SCREEN:
Depth Diameter Slot Size Material
From To Ft. _ in.___ in
From To__ Ft. in.___ in
From To___ Ft. ___ in._ is
16. SAND/GRAVEL PACK:
Depth Size Material
From To Ft
From To Ft.
17. REMARKS:
Formation Description
of
RECEIVED
OCT I 7 Lu
Asheville Regional Office
A*uifer Protection
If additional space is needed use back of form
8
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other reference points)
BUS. 74 E. FROM FOREST CITY. LEFT ON BOSTIC/SUNSHINE
RD. LEFT ON LUCKADOO MTN, RD. IN SUNSHINE. LEFT ON
FIRE TOWER RD. INTO GOLDEN VALLEY ESTATES. RT. ON
AMELIA LANE. 3/4 MILE ON LEFT. (LOT #33)
%k OFRFCFIV
®C%WATER QOALITY
0,6 2006.
I DO CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THISRECORD HAS BEEN PROVIDED TO THE WELL OWNER
FOR OFFICE USE ONLY
Quad No:
Serial No.
- - 7/
A OF PERSON CO STRUCTING THE WELL DATE
Submit original to Division of Water Quality, Groundwater Section within 30 days
GW-1 REV. 12/99

North Carolina — Department of Environment and Natural Resources — Division of Water Quality — Groundwater Section
1636 Mail Service Center — Raleigh, N.C. 27699-1636 — Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR: RODNEY ROBBINS
WELL CONTRACTOR CERTIFICATION #: 2785
STATE WELL CONSTRUCTION PERMIT #:
1. WELL USE (Check Applicable Box): ® Residential 0 Municipal 0 Industrial 0 Agricultural
0 Recovery Q Heat Pun Water Injection❑Monitoring
2. WELL LOCATION: (Show sketch of the location below) 0� If Other, List Use:
Nearest Town: BOSTIC County: RUTH
ANGORA DR.
DRILLING LOG DEPTH
(Road Name and Numbers, Community, or Subdivision and Lot No.) From To
3. OWNER VERLIN CLARKSON
Address ANGORA DR (Street or Route No.)
BOSTIC NC 28019
City or Town State Zip Code
4. DATE DRILLED 09/21/06
5. TOTAL DEPTH 605
6. CUTTING COLLECTED 0 YES ® NO
7. DOES WELL REPLACE EXISTING WELL? 0 YES ® NO
8. STATIC WATER LEVEL Below Top of Casing: 0 FT.
(Use "+" if Above Top of Casing)
9. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
'Top of casing terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2C.0118
10. YIELD (gpm): 0 METHOD OF TEST: ARD
11. WATER ZONES (depth): _
12. CHLORINATION:
13. CASING:
Depth
From 0 To 80
From _ To
From To
14. GROUT:
Depth
From 0 To 20
From ___ To_,_
15. SCREEN:
Depth
From _ To
From To
From To
16. SAND?GRAVEL PA
Depth
From To
From _ To
17. REMARKS:
Ft.
CK:
Size Material
Ft. _
Ft.
Type: CHLORYTE Amoum; 16.5
Wall Thickness
Diameter or Weight/Ft Material
Ft. 6-1/4" SDR21 PVC
Ft.
Ft.
Material Method
Ft.OUILKRETE POURED
Ft. _
Diameter Slot Size Material
Ft in.___ in._
Ft. ` in. in._
in. in.
Formation Description
RECEIVED
OCT 1 7 2Qa a
Asheville Regional Office
Aquifer Protection
If additional space is needed use back of form
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other reference points)
BUS. 74 E. FROM FOREST CITY. LEFT ON BOSTIC/SUNSHINE
RD. LEFT ON ANGORA DR IN SUNSHINE. LOT ON LEFT.
iv O WgTEIVFERQD
Li 1
OCT 46?006 1-11
I DO CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THISRECORD HAS BEEN PROVIDED TO THE WELL OWNER.
FOR OFFICE USE ONLY
Quad No:
Serial No.
% �Z
/Jl3IGNA OF PERSON CONSTRUCTING THE WELL
//a /1/ / • C DATE
Submit brtgnal to Division of Water Quality, Groundwater Section within 30 days
GW-1 REV. 12/99

North Carolina — Department of Environment and Natural Resources — Division of Water Quality — Groundwater Section
1636 Mail Service Center — Raleigh, N.C. 27699-1636 — Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR: RODNEY ROBBINS
WELL CONTRACTOR CERTIFICATION #: 2785
STATE WELL CONSTRUCTION PERMIT #:
1. WELL USE (Check Applicable Box): Q9 Residential U Municipal ❑ Industrial U Agricultural 0 Monitoring
0 Recovery 0 Heat Pump Water Injection 0 Other If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: RUTHERFORDTON County: RUTH
V.S. DALTON RD. DRILLING LOG DEPTH
(Road Name and Numbers, Community, or Subdivision and Lot No.) From To Formation Description
3. OWNER RON KISTLER
Address V.S. DALTON RD.
(Street or Route No.)
RUTHERFORDTON NC 28139
City or Town State Zip Code
4. DATE DRILLED 09/25/06
5. TOTAL DEPTH 605
6. CUTTING COLLECTED 0 YES ® NO
7. DOES WELL REPLACE EXISTING WELL? 0 YES ® NO
8. STATIC WATER LEVEL Below Top of Casing: 600 FT.
(Use "+" if Above Top of Casing)
9. TOP OF CASING IS 1-1/2 FT. Above Land Surface}
*Top of casing terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2C.0118
10. YIELD (gpm): 0 METHOD OF TEST: ARD
11. WATER ZONES (depth): _
12. CHLORINATION: Type: CHLORYTE Amount: 16.5
13. CASING:
Wall Thickness
Depth Diameter or Weight/Ft Material
From 0 To 90 Ft. 6-1/4" SDR.21 PVC
From To Ft.
From ToFt. _
14. GROUT:
Depth Material Method
From 0 To 20 Ft. QUILKRETE POURED
From To Ft,
15. SCREEN:
Depth Diameter Slot Size Material
From To Ft. ___ in.__ in.
From To Ft. in.in.
From To Ft. in. in.
16. SAND?GRAVEL PACK:
Depth Size Material
From To Ft. _
From To Ft.
17. REMARKS:
r a
t.
V. RECEIVED
DI
OF WATER QUALITY
OCT 0.6 2006
If additional space is needed use back of form
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other reference points)
HWY. #108 W. FROM RUTHERFORDTON. RT. ON COUNTY
LINE RD. RT. ON V.S. DALTON RD. 18T DRIVE ON LEFT PAST
GATE.
RECEIVED
OCT 17 24c5
Asheville Regional Office
A•uifer Protection
I DO CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIISSRRECORD HAS BEEN PROVIDED TO THE WELL OWNER.
s72.a A "URE OF S�� i / "G17 S'GC�.
G THE WELL DATE
Submit dnl;tnal to Division of Water Quality, Groundwater Section within 30 days
GW-1 REV. 12/99
FOR OFFICE USE ONLY
Quad No:
Serial No.

North Carolina — Department of Environment and Natural Resources — Division of Water Quality — Groundwater Section
1636 Mail Service Center — Raleigh, N.C. 27699-1636 — Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR RODNEY ROBBINS
WELL CONTRACTOR CERTIFICATION #: 2785
STATE WELL CONSTRUCTION PERMIT #:
1. WELL USE (Check Applicable Box): IA Residential ❑ Municipal ❑ Industrial 0 Agricultural 0 Monitoring
0 Recovery 0 Heat Pump Water Injection 0 Other If Other, List Use: __
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: RUTHERFORDTON County: RUTH
V.S. DALTON RD. DRILLING LOG DEPTH
(Road Name and Numbers, Community, or Subdivision and Lot No.) From To Formation Description
3. OWNER RON KISTLER
Address V.S. DALTON RD.
(Street or Route No.)
RUTHERFORDTON NC 28139
City or Town State Zip Code
4. DATE DRILLED 09/26/06
5. TOTAL DEPTH 305
6. CUTTING COLLECTED 0 YES ® NO
7. DOES WELL REPLACE EXISTING WELL? 0 YES ® NO
8. STATIC WATER LEVEL Below Top of Casing: 40 FT.
(Use "+" if Above Top of Casing)
9. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
'crop of casing tpminated al/or below land surface requires a variance in accor-
dance with 15A NCAC 2C.0118
10. YIELD (gpm): 8 METHOD OF TEST: ARD
11. WATER ZONES (depth):
12. CHLORINATION: Type: CHLORYTE Amount: 7.5
13. 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. _
14. GROUT:
Depth Material Method
From 0 To 20 Ft.OUILKRETE POURED
From To Ft. _
15. SCREEN:
Depth Diameter Slot Size Material
From To Ft. _ in. in.
From To Ft. in. in.
From To Ft. in. in.
16. SAND?GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
17. REMARKS:
RECEIVED
DIV. OF WATER QUALITY
OCT 0 6 2006
If additional space is needed use back of form
;i,,, Vie,.,
u
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other reference points)
HWY. #108 W. FROM RUTHERFORDTON. RT. ON COUNTY
LINE RD. RT. ON V.S. DALTON RD. 1n DRIVE ON LEFT PAST
GATE.
RECEIVED
OCT 17 2006
Asheville Regional Office
Aquifer Protection
I DO CERTIFY THAT THIS WELL WAS CONSTRUC 1 ED IN ACCORDANCE WITH 15A NCAC 2C, WEI
CONSTRUCTION STANDARDS, AND THAT A COPY OF THISRECORD HAS BEEN PROVIDED TO THE WELL OWNER
FOR OFFICE USE ONLY
Quad No:
Serial No.
•2� THE Pil L ` /i7.tQ. 7' . 4/IGNATJ OF� ON U G L DATE
Submi pu final to Division of Water Quality, Groundwater Section within 30 days
GW-1 REV. 12/99

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR ROBIN MCNEELY
WELL CONTRACTOR CERTIFICATION #: 2567
STATE WELL CONSTRUCTION PERMIT #:
1. WELL USE (Check Applicable Box): ® Residential 0 Municipal 0 Industrial 0 Agricultural
0 Recovery ❑ Heat PumpWater InjectionMonitoring
J 0Other If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: RUTHERFORDTON County: RUTH
SO. WOOD LEAF RD. DRILLING LOG DEPTH
(Road Name and Numbers, Community, or Subdivision and Lot No.) From To Formation Description
3. OWNER JOE CARSON
Address SO, WOOD LEAF RD.
(Street or Route No.)
RUTHERFORDTON NC 28139
City or Town State Zip Code
4. DATE DRILLED 09/21/06
5. TOTAL DEPTH 62
6. CUTTING COLLECTED 0 YES 0 NO
7. DOES WELL REPLACE EXISTING WELL? 0 YES ® NO
8. STATIC WATER LEVEL Below Top of Casing: 47 FT.
(Use "+" if Above Top of Casing)
9. TOP OF CASING IS I-1/2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2C.0118
10. YIELD (gpm): 15 METHOD OF TEST: STEEL TAPE
11. WATER ZONES (depth): __
12. CHLORINATION: Type: CHLORYTE Amount 6.9
13. CASING:
Wall Thickness
Depth Diameter or Weight/Ft Material
From 0 To 62 Ft. 24 CEMENT
From __ To Ft.
From To__ Ft.
14. GROUT: —
Depth Material Method
From 0 To 20 Ft. CEMENT POURED
From To Ft. _
15. SCREEN: —
Depth Diameter Slot Size Material
From To Ft in. in.
From To Ft. _ _ in. in,
From To Ft. in.____ in._
16. SAND7GRAVEL PACK:
Depth Size Material
From 47 To 62 Ft. 78M GRAVEL
From To Ft.
17. REMARKS: — —
RECEIVED�r
OCT 1 r 2L5
Asheville Regional Office
Asuifer Protection
If additional space is needed use back of form
^.%-e �a rt
�°' iJ
,y
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other reference points)
HWY. #221 S. FROM RFTD. ABOUT 2 MILES PAST ALL
AMERICAN HOMES. LEFT ON WOODLEAF RD. SOUTH. GO
TO DEAD END. NEW DRIVE ON LEFT.
RECEIVED
DIV. OF WATER QUALITY
OCT 6,6 ZOOS
I DO CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THISRECORD HAS BEEN PROVIDED TO THE WELL OWNER.
FOR OFFICE USE ONLY
Quad No:
Serial No.
67-g A 7
SIGN TORE EL t''
l� PER+a ONSYfRUCTINGTHE WELL DATE.
Submit original to Division of Wa - • : 'ty, Groundwater Section within 30 days
GW-1 REV. 12/99

North Carolina — Department of Environment and Natural Resources — Division of Water Quality — Groundwater Section
1636 Mail Service Center— Raleigh, N.C. 27699-1636 — Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR: ROBIN MCNEELY
WELL CONTRACTOR CERTIFICATION #: 2567
STATE WELL CONSTRUCTION PERMIT #:
1. WELL USE (Check Applicable Box): ® Residential ❑ Municipal 0 Industrial 0 Agricultural [] Monitoring
0 Recovery ❑ Heat Pump Water Injection 0 Other If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: FOREST CITY County. RUTH
SHILOH RD. DRILLING LOG DEPTH
(Road Name and Numbers, Community, or Subdivision and Lot No.) From To Formation Description
3. OWNER KYLE SISK
Address SHILOH RD.
(Street or Route No.)
FOREST CITY NC 28043
City or Town State Zip Car
4. DATE DRILLED 09/26/06
5. TOTAL DEPTH 58
6. CUTTING COLLECTED 0 YES NO
7. DOES WELL REPLACE EXISTING WELL? ❑ YES ® NO
8. STATIC WATER LEVEL Below Top of Casing: 38 FT.
(Use "+" if Above Top of Casing)
9. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
'Top of casing terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2C.0118
10. YIELD (gpm): 20 METHOD OF TEST: STEEL TAPE
11. WATER ZONES (depth):
12. CHLORINATION: Type: CHLORYTE Amount: 9.2
13. CASING:
Depth Diameter
From 0 To 58 Ft. 24
From _ To Ft.
From To Ft. _
14. GROUT:
Depth Material Method
From 0 To 20 Ft. CEMENT POURED
From To Ft. _
15. SCREEN:
Depth Diameter Slot Size Material
From To Ft in. in.
From ToT Ft. in. in.
From _ To Ft. _ in._ in.
16. SAND?GRAVEL PACK:
Depth Size Material
From 38 To 58 Ft 78M GRAVEL
From To Ft.
17. REMARKS:
Wall Thickness
or Weight/Ft. Material
CEMENT
9 9 " 9
Ci. p. f tl (J13
RECEIVED
OCT 1 7 20U5
Asheville Regional Office
Aquifer Protection
If additional space is needed use back of form
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other reference points)
HWY. #221 5. FROM RUTHERFORDTON. RT. ON SHILOH RD.
NEW BUILDING ON RT. ST PAST TRUCKING CO. & DR'S.
OFFICE.
DIV. OF 1VVNTF k
OCT 06 2006
I DO CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THISRECORD HAS BEEN PROVIDED TO THE WELL OWNER
FOR OFFICE USE ONLY
Quad No:
Serial No.
SIG TURE F PE
Submit original to Division of Wab
7k 1IIE J <'( <nnEp G— E6
ONS UCTING WELL ATE
ty, Groumdwater Section within 30 days
GW-1 REV. 12/99

ien
onrw. 11 WOr Galas • Gaw Ownr t
M CannaM � � Oaf,10110 1N1 Marti
a MISlentjus•fM t1C.!/SP
'ELL CONSTRUCTION RECORD watt. CONTRACTOR -
WILL CONTRACTOR apTtrcATION S:
STATE WILL CONSTRUCTION PERIAIT!
p�µniepol CI
aetootway a Arseese nF Hoot Fyn InNIDen D ONst CI It
alatatlesEm Wee
. WELL
Wt:Mt01t (QIM•wI � c - cows
New - /. ---�." nna t CA Oreytw
4:4_ _
rIb+Niron Cl1 •w same re Jai ma T• F�tP�
I. �A
ASH
A&F WELL DRILLING
AND PUMP SERVICE,
911 H e. NC Business
2:3014
A .8 1779
miniese CI
w tpa�
A. DATE OR'LL.W
6
5TOTAL OEM
AS =
YES soar—
.
7. CV sWELLIpassLL�T1NIFLACII O WE(l.TTES
Q
II. SSalomTop weCAS gip' FT.
µt : Onsoni`M�CM'M
S. TOP OF (An t FT. Above LS Wage
'Toy d .eeFtdtewd— l a Iasi .ssnas- a .Saw Ysee r
aese ISAINCAS e�.fMt1NOPOpTEli /�---
sew -
it vain VP*
11. WATER2ONESMsPt*
.G / 4aid . Moun7a
t2. CHLORIN VIEWS Type
ta. CASINO 1 p !
ottt.t. Llot w..
� tllrnee
Depth r
Rant fit
Fww Te---
Fnta To
it GROUT:
MANS
Few IMrd o o._.ft :
R.
is. WOMEN Dsow OMt asi .
Fast To _Ftkt. "In
FLAIR ._-To Ft— h — In.
Rent _—To —..tL--- In. h
tt. SNCSRAVELPACK
Opts
Roo To
Roo To
17. F _IMPF k ACCORDANCE NMI ISA F1�C>IC. Wall
t00M R SYtau# T►MTTIMSPASCONSTRUCT10 4AC0OAD FIgYgE MUM
. �
CONSTN EDAISTANDPflS.NCTN11TAtria S OORD$ASDt JI
FL
FL
F1
FOR OFFICE '-ONLY
ono Ne
INS R1.
-24-20E3 t*4 11:31RM ID:
sObtotol tows twoled as WAS Ws
IShisso s1eiMMeassMINOIloSolo
IbatM
faityl-C-- 'logic gravy etwasis fee
MSG
ralaaei—
M.IS*I
MSS
A&F WELL DRILLING
AND PUMP SERVICE, INC.
911 Hwy. Business 74
Bostic, NC 28018
828-24 -1773
r+1lo"M�
ransom capowamos lea sea
tWrit owe" aa+te'lteue"""11'It7FcrFi wrsr.+tn
J94
PAGE: 1

I.WELL Us Eigoasmoroas
Tat
Romoim Hoot 2. WELL IAt'
NMesi Tree ..nn
Wee M elo re ,Cerawne4ef /,an T.
Fnd4 O'r
Use:
Pump
S. OWNEII
Rests. • tlwww+ N Wele• Ky. GraMdwt r IkeOOn
tuew wr. WI) 737d221 {� .
WELL CONTRACT CONTRACTOR TWIOATION e:
watWELL CMR PERKS:
STATE WELL CONSTRUCTION
IAonfO*4
u O/t.r. Litt
Whet
- AN PUMP SERVICE,
Ike1Ch d tM bgMon tM>to+A i� T� r 1 C� Bostic, NC 2b0
C/� Farc7� �%fJrfL CW�' � 47 1773
INC.
R,e. iJ /9 tt� CS
4. OATS ONU*'.--ir'
E. TOTAL DEPTH cougars)0 N0�'Gj� _
e. 7. 000 will SartIiXISTR10 W ELL9 YES CI, No (`- —
$. STATIC WATER LEVEL WOW Top ofOS FT.
F. TOP Of CASINO IS FT. Above Lord Swine
-toy of meg o ems worms, sod mom moms • mown s le at»'
/L WNW OP Test _ash," o".`vlEua laP�l: sT �---
s.er IIA' CAC Wits
TT. WATER 2Of,Wog 1t1;
12. CIl.ORR+AT10►t
Type C. .f/� _AnMUM
12. CASINO: 7po loos M MK.w ft/t.
Depth , Vimmer vi.I/em. w.A.l 131r+ •ems Md dews
�4G goed+,otobruaieF�'/npe�,
Vmse �--•Tee^ FL�T�
1a. GROUT:Depth MOOS MSS
Ftom ' 1— T ..u2- FL - �'-t {
From _. — To FL _.
OwMMNt Slot She WHOM
Ft kt In. -_
FL_� in..--h .�--
FL �- h .
Slue swim
firer Geier ,M K i'"""'"""'t'"° Mural
ow .Ito won Comor -ROAN M.C. bPee►
NELL CONSTRUCTION RECORD
./•a,eiWn.r�u S
FOR OFFICE USE OM.
Ono No
A&F WELL DRILLING
D Business 74
911 Hwy. 18
�i2
--
15. sCREEN
Om*
From ...--To-
FWe _---TO -
ism _—Te
IS. $N gIAVELPACK:
Defn
From To — Ft.
fielll — To —FL
1T. REI S Ik
rteeluatM statNn'd'°'ssbalII—
,Pa tc4= ftr:/,
A&F WELL DRILLING
AND PUMP SERVICE, INC.
911 Hwy. Bustss 74
Bostic NC016
BT247-3
b
CORel
IFYMATDOSWELLWASCONSTRt1LKEOINA000Rb' EWitsISA TOME lr� s.Gaut.
R STANDARDS,WOTHATACOPYOFTMISRECORONAft>E O
GONSIVIUGTICTI
pool Mount O,d 11 'Maw ONMO.OmoMMo slam WoliMunsof ransom 03NsTRUCEic He M 39 COP (Pm fE+l. WI
aw+s.
-24-2003 'ION 11:31RM ID:
PAGE:1

FOR OFFICE USE ONLY
as NA
GOMM Deweeen+o+ E1wtenwenl erd Naha w,wcos - Olvillona WS, amb, . o.eurawfl .ecoen
toe Me. Own Crap - RSI*. r.C. MwE a.4Fle+ee r+n 133-3a+
WELL CONSTRUCTION RECORD WEuCONTPACT OR T _
wets CONTPACT on citpTIFICATION r.
STATE WEU. CONSTRUCTION •ERMrrr.
1. AFFAee-- -- n adinisar►+uolay.ID leouob$II❑ marD 1S
0
WELT Ui! it Oils. Lb+ Us.
Fincee,1 Hot Pump War *tamD O'"' D
2. WEU. LOCAT10* (Show dcddl old �Imam mow)
NwoMTi+n: a44C °
Ore TOO -- Se17
4. OATECOMU.EO �Of
S. TOTAL DEM
S. CUTF1H02 COLLECTED YES 110Er
7. DOESWILL EX WELLYES HO
® =
e_ STATIC WATE*1LEVEL Odw Tap al C _al_ FT.
,: iSOlop elOn
P. TOP OF CASINO IA s FT. Move Land Witt'
• er 94 Miry Is a.aa / e4r bdew � Rolla Seam • sees w ecc W
Seesd* tIAHCAC SCAM 00 OF TEST -' �"'� —
to.YIELD(S * Z
11. WATER ZONES (dIPN —_
�' k' 6 "t,4 Amo+er 7 a .r/f .4-
12 C�pRI.ATION 7� .---� /
13. CASINO: 2.62
IRO Cloth , growInal SOS
row erwdrAFt
Fnr0-o To
Fwet TA---- FL —
Fan ----To FL
14. GROUT: MOWS MSG
Fsn T DepthOde—n. asz 2iv
Font _ _— To FL -----
15.6CREEN OL.rr+eWE Maio►Werel
OeFEr
Fan TIT Ft .____ In. ____ In.. _—
F an _-__ Ts __ FL In. -_" h.
Imo _....To R._ in. h
IS. $NC4GPAYELPACK:
Os*
Finn To FL
To
17. BMW t
Sits
Matins(
nnn+u G(-'fl
Feta TO
A&F WELL DRILLING INC.
A"911HWP. Business 74
osiic, NC 28018
Finnan 73
Fwra7ro
11 Ones goo b . ar;s. •d:0Os
Saga.
I.+r+ dbedlee milearalsem.1wsre sw
Rode. ee Otter AreSWOP is
A&F WELL DRILUN�G _^
AN911 Hwy. Business y74C.
Bostic, 828-247-177 38
G/,.a?A 42 a'7
OC IC. WEIL
IDoNERMCERTIFY TWIT THIS WELL WAS CaNsTRUCTSOINACCORDANCE! wrtNISA THE WEALoCOWLCOMM: K ETANDMIDS. NC THAT ACOPY 0P 1rutPECORDIMS DEEN FRO11010 ,
.psATW.DFFond. ewn.eewtoo onus oe
52
subs, son coos 'n u' De..ADHona s Woo + 130 e ri p.t FIEr. WI
9
—IN.
-24-20E13 'ION 11:31AN ID:
PAGE:1

is* Cease Oeparirarratqq 1.1 IS MidResta - O�Ylsn N WPM' Oaf" S$�
La RS band. Cos - wank M.C- s/ s 1s7sFla* PM RLTan
NELL CONSTRUCTION RECORD waittmNT$ QR
WHIZ COMP scion caw71FlCATION
STATE WELL, CONSTRUCTION PERMITF
1. WILL UBE task Apse assR.edarAdii3-indai0 leaaaabl0 AS0
Reewery 0 Hatt Pep Wear M•ll•^ 0 Des Ci u 06". LIP 1M:
2. Vila IA4111101k (Slaw It1s O s1 Ms bedon bead) ��� G ✓ c_o�
Rao Tray r//,c. �d _ J Cwny:.,.,_:.
sl— .+dear .1 .acid r rp1f1 lt]O
prsMrs ad lMa tC�4.i ��'M"� is T. IseOr•4o'
a. OMEN
L 6 E:, ;� (�tp
MordasInp 0
AA&�DRILLINIGIC
AND PUMP SERVICE •
911 Hwy. Business 74
Bostic, NC 28013
828-247-1773
Addis
Go
lept
•
ea 050
4. DATE OPLLtO
6. TOTAL DEPTH
s. CU1lSGICOaECTmy MOO NDt
T. oatsWIU. alma ourIALVIEW1 YES 0 NO.
S. Stan WAWA LEVSCWow Tap alCarinri -FT.
•••• ismalrop1OaMM
S. TOP OF CASINO 111 _ 'r FT. ARM LAM sails.'
'1M.rawesibaaeaa/ — baba mad stoma moss sswan M wail
aaa..lwLaPaatleAtea Waco 0PTEST A
fO. YI[Lbb1PI•1: �� 11. WAFER 20 S$ Id•F O ,
12. CFHAIMMATIOtt Tics r_X .. L Amour4 "2-
13. CASSIO: ?© /
we mo r
Owns lacier sWr/SFL ISllW
Fan- --Ts
Fsw ---Ts
1a, GROUT:
DepthFws To 62 o
Papa_ ___ To
1s.6C11E04 O�nrlr Oka eke sMMAaI
DNS
1 a _.._Ts N in. In.
lit in.FaH►..._Te�._R-- In. __ham---
fisa _—To FI.__
1s. sANOpF1AVELPACK: SKe IAa1s1M
ass*
Fwlw i TS. —FLf-- �—
ate=
R
WYdalIMMO
lila
"Q
FL
Ft
Falk ._— To —1=
F1M1 — Ts R.
/7�9 /�`1/% 4-
11. REMANt I Thal HMS % U.WASWNSWCTONACCyfg1MN ISA MACS. Wkt
CONSTRUGTICM Np7►NTAVWYOfTell RECORD NSE&FIWYMEC VS
IR-
, pNNnsts porsw101s mint ton
M1;eMar01NONOIMMdFOaadrs nNOSS CIIIsK
tan
t ere* apse b a.MM use S e Sara
Mee an am. drataapaas si~
Ras
n&F icso
Nona.arratar tine I828.2a
W11 R 11 IN1�;:,
UPUMEP �}
91Bo c, N, ` rs
FOR °Fact UsaONLY
ails Ns
Ind wo.
-24-20F3 4t4 11:31RM ID:
PAGE:1

Coe. «bw(e.eo.e4 er1 N...r www ne• oe.wen N NM(' O..w • owWr e.e•e
t.en
US C4,400 CMY►- ase, N.C. sweemineerae (0+n 132•7n I
NELI CONSTRUCTION RECORD wnu. CONAC
TRTOR rLQC-aari
W6lL COMM ACTOR C*$MnCATIOM S �-►--
STATE WELL CONSTRUCTION ►*SMTTF
I. WILL USE AppOodie seep ReeklertiderflAsidpel0 kicuMd.l❑ ApkuMni❑ Moedl.Ay
il.arr.rl I ► ew Pep Wes leSedlon 0 War p II 01'.', Ur Us:
/i i/rF.c Fig -r � AU
WELL DRILLING
4'ATI�k�a• AND PUMPS .o'
t. WELL L0r'
Nast Tye c.S 911 Hwy-
- n.eo►I y
tww T.
3. OWNER
Addles /.-Jign� `
4. DATE ML EC CYO'.
5. TOTAL OEPTN
I. C1/TTI os00u.ECTI0 YEs WS N ---
T. DOES WELLRWr. NS O
S. STATIC WATER LEVEL Swm. Tap al C..NW
T.
NNW .•.I Meow is O.NM
II. TOP OF CASINO IIS.�• FT. Aba lane Sae'
nee I nee beams .sP a ss nerr.mMmees • new... I.ec.t
i*an
t YEW ua'c tan I OP TEST
10. VISLO(WIk a'fl c
11. WATS11use N.Fwk
Ffir¢� •,rf czMqunl cQ r✓'G•
,z GIS_OIWeATN)It TToo
13. CASING: 6S-f
isms
Depth w'I � pM 1perso L
Pleat/ � —Te .(fast n. -
Fww Te "IL
Fen Te R
It. GROUT:
J
MOOS MSG
Feet
T//,� TT1g .R n.sc tnQa
Prey — To R
,s. SCREEN
WS Me SIMM Sb M.wA.I
Fnm __ _Te R..__ In. _,..in.
Fa rTO R_— In. In.
Fria —....Tt R. h —h
IS. SAFppTNVELPAON: Meters,
Se
Rem To FL�--
F r To Ft.
iT. JEM1dat
,OOPERM CENTWYTINTNWWELL WAS CONSI*ZTIOINACC(M EWENFWA ISCAC SC. WELL
CONSTRUCTION STANDEN*A IDWIATACOPYOFTES RECORD MIS E!!R FIVATOIOTOl10 VEILCIe'd
FOR OFFICE In OWL
e.w IS
.ddeeneems L+...dedtee s Ione
Isea Sias .Md.l aseNeMSeeSM
:Welt wear ewe wlwe-- pellme
A&F WELL DRILLING G
AND PUMP SERVICE,
911 Hwy. Businese
Bostic, NC ^
L.
82B-2?"'':.,
\I N.
•l
-5loos—
mow►Tiss mews mg win seIrt
We�i.M�+r e.rlaN'OratimeSpWg11.631GeI1 0141lttuw
-24-20E'3 'ICM 11:31AM ID:
PAGE:1

otion
en
MtCalm D.r•r..a+'fs'-t_.-'oondMani
Moos - O
ofWw-a.w-a .'"[..
Soon HO SCS - ma., KC. 7I1••►
'ELL CONSTRUCTION RECORD WILL CONTRACTOR
WELL CoNTS ACToRCIIIpng6ATTOMr
STATE Mt COMSTIMIC110M FKAM
M irMuoldpelCI h
WELLUEERomnion0IW h.Waur►eds0 ohmo IIatm. unuaa:
. was1.0O:ATIOt( sow /,,.T�%� r' , _/ rj„
/.M. T. F..raIM
pas we sea asoris eyes wc.
I. OwMER
AddNNs
"IrtiAer-- Toe
A MATE OPIUM 20- —
[. TOTAL DEPiM NO
S. 001* osoouI-T� WSL, rWs[> eaoO =
T. ITAT W* flLEVReusT al Cans Za -FT.
[ iTATICMATlIILE+��O. 1S : ISM lip •
/. TOF OF ISO 111f 2 _.. FT. AbsVS IS
nil, ire Mae relloweed Mir bake OS suotomMollm• • yams in wars
See Si 111A NCaO SnJ1
t I. WATER lair SOO
%L MOM ATOM Type ` bak- b Maur .
is. CASINO: �b / w.nSan
owlsprniw •• to MM'M
Fwa T FI-6a.42..
FIMr�� Ts— A.-- �--^
R —
Fes To
tit. GROUT: lh MOMS
MOWS
�d T��a�-FL 'r"r�rr a —
Frsn !�/"�
Fin —_ To
15. SCAM 01.1nosurast kw MAWS
FNMI wD Ft In—__ h.
FrNE To FL h _ Yt
It goo To
IS. SMOIWO►VELPACK
Ds*
nom —_. To
Fos Ts
tT. MOM
+DOMESKIC TTFM•IEL[MACOOM[ �DINA yIO TOTIOMOL
GOMstAcla{TAN an.M1D.. ..- OF Trb[NEOOADSAS [F.OI
swum or pro* isis vas. sat
L•r•11►ylrp IA'°w`D.sl< sea MP
11 1211
A&F WELL DRILLING
AND PUMP SERVI"
911,Fywy Bu_.,
+r waaw— Y _1Us use WWI lone
litin an. one Istaireliria el Ingle OS
gamicsrsireirednMbs pat
A&F WELL DRILLINR
AND PUMP SEPT,"
911 Hwy. R-
Bostic. sn
828 773 6a
gra „6Ece�
VON OFFICE Val°OIL
twd Ms
R
R
FL
h
s!w
MOOS
/6CF
�-jls ��/G "-RA_
CO SIID4NOe NM ISA at WILL
8 �ti
-24-24303 ION 11:31AM ID:
PAGE:1

filar
t end MSS . DPW 11 WSWOMW- OS Aa4F WELL DRILLING
rMs* Capers e7r MS W° ,'"""I UN.C.:,S /BAITS r+n *n-3fI AND PUMP SERVICE, INC.
�`-.,�.. _AI�:Fi7N?�Business84
WELL CONSTRUCTION RECORD WILL comp Acton
Mill COMPACTOR C[NTFICATION r.
STATS WELL CONSTRUCT10N MISTS:
1. WILL US Stash MMhamp M a *Jt1 S•I0 MbwMd0 Arplialsol
mann Hod Pond Waver Inddlon ❑ oils ❑ al LIP Us:
2. W S%. LOCAT101t (SMw *Alta 41 Sae IIa:a lon below)
Nnr Teat k/ris-. a -;caw* --41-44A- r46d r 14—
e v
T4e /ter ti ,ter/r4"ftogmnttun L00
S. OWNER /3AcE' /( 17(.K4:,tee — tow u
Addis" .J e . &-. c c, -.. s-
iirdi
__ Vat
4. DATE OI itlaDi
6. TOTAL DEPTH s
T. oats Mu, iSrLAGSWYAW N095. CUTTNGIODLttCTID_Y Q
t. $TAT1C WATT LEYSL Rim Tap da .*
/' : de amosUM �CWM
P. TOP OFCASSO111,G._- ¶— FT. Al aelandSo11eo
'Top dnee ►Help• OWmin tad tMMap owes wisr-
Ise SS
IteVIEWVPae.a+e„w � OPTESTA-
+a TRLO(/paeT:
11. WATER 2ONES Wed* n�
t2 CHUMP Type C. -(,� "f-'jam Pe/0 - -
13. CASINO S e
townot
Depth Cheraw erWt1/rf SWIM
FaaR�Tt-�. R -�'/� d r.
Fwn,t.-- To 'L^--
Foos Te FL
14. GROUT:
Dodh MOPS Moto. .
Farr t� T T. _ R. tra2A 7-41: v y -_
ce-
mem _ _ To FL
15. SCRSETI
Oda 0lrndw SW SW WOW
Flom TO PI h. h
Fate _ To__R.
Flea _ _ Ts R. h _ K
11. SNIDNRAVELPACK
Do* Stu Word
From Ts R -- _
K p PUMP SERVICE, INC.
CONSTRUCTION STANDARDS.
DE/M
FIMS114DtrtM
It Wend Aare Y ended w Sfl bra
tile. ro � � m/�
Roods. orate wag ti/wned pat
Q ri
Fad To ill
17• PEW' Business 74
LLWASCOMSTINETIDW ACOd+DaWCf flD WA NDICN.WSL AND
tc, BNCusiness
28018
Hess
4&TAOCFYCP1MI$PEOORDNASSE9IFIIDMDEOTOIISMSLL�'d 828-24C-1773
•
i.ncPFW,OM" SDIs11nderd araL 6Y:e
•rMedwlllntYDWedMMV Oa t � 11MY17ia01/>< W OV f211
OO/wF
OFFICE
UM ONLY
-24-20E3 ION 11: 31R-M ID:
RaGE:1

FOR OFFICE USE ONLY
ono No
- Arne. 2iM
tax w Waitmo to NA.►Iax•F�.ar ta
ltq 72L7721
tCarr.
WELL CONSTRUCTION RECORD
WELL CONTRACTOR:WELL CONTRACTOR CUPTIPICATION 0:
STATE WELL CONSTRUCTION FERMI:
1. WELL US t Apse snit Rrrldrrrailc Y MunWPal InduNrlal
Naval 3 Hen kWaalwt ❑ ors ❑ It Ohs, Lip Uw:
Pump WS
2. WELL LOGATION:Swils120, d Mto be SOn below)
Nrrwrl Trr*c A2 G1 —F- ON*: -�
�l•,,Jr1/' ire/. —
pal Niro wwrwa CMn w um Gwi
3. OWNER
Addrs
/et iX
a.« Twt
a. T0114.L C3 -
If. TOTAL DEPTH
. CUTITMORco YesQ
7. 0015 WILL REPLACE W1EL? TES
S. iTATIC*AMA LEVEL
uMIun Top al Corp n NOFT.
pore
G
__
• moo Top olCMM
0. TOP OF CASINO LEL' "FT' Above LIM Eudssr•
Pilo of flag MmMr.f NM brlrt. toad maw, rr
. swag ar rrew-
RUM lMOMlitia - OF 7E8T
t0- YIELDVPall �
to. M 1 ,.� FT -
1I. WATER ZONES jdr lh)
t2. CIL0111MATgN: TYVMC_4-'"'
t3. CASINO: 9
From To FL
Fr To FL ----
Fr —_--To R
it GROUT:
trope
(P ' To .� : FL �.
Pr _ __ To R.
15. SCREEN Orr Slot SIN Mo aI
Out Orr
-._._ In. ..-.—.
Flan 7a H...._-
From ._—To FL— h ____ h
f'rons _ _. To FL M. h
*S. SNCIORAVELPAOK: No1Arlorlil
Dorn
From To FL_._---- From To FL
IMP Irilmer MSS
OaPth /r «�/ /?41L-
Calera priwrrM -- Eifiker rrwl Grid MANS MamaoMama. OMtaa, M Was Ouo:d • Oaueasse Wien
tie
ApAwArrd ❑
DfirLLllKi LCi<}
ins 1I
A&F WELL DRILLING
AND PUMP SERVICE, INC.
911 Hwy. Business87"
Bostc+ Neu 28018
e0
Mori,0
Frrr nDrrMIM.
urr4d' ended maabad MM:era
411*4 Swdo bra Sew
Roods. rrtar cap ttiMrr'aa pros!
fr A&F WELL DRILLINC
h ' \AND PUMP S VICE.
NDr 911 Hwy. B ine:;Si :
Bostic, N 28018
8-24 773
IV
< T
.4a
did?/
.Le
\
00NERE N COMFY THAT WU WU& WAS CONSTRUCTED IN ACCORCIAP CRrRf/t 1SA
MCVAIL
�twion11STNSfl.AN) THAT ACOFYOFMIS MOROPNS BEEN ROL
rgNA
watt 0•74
kW* aAiYEMPro riMOoMIA Ft An nets
SIMM .t211
e.
Ms IA.
_24 2003 10N 11:31AN ID:
PAGE:1

Nom Caroni, obormo a a lrnirrrant vd NrIsal Rt wve OMdrn M Wow Gamy • U,arrdW .' INdlon
Tax w Sorbs Cs.S - RIIMM4 N.O.1 Iax Rwnr h
WELL CONSTRUCTION RECORD COMMAnon
WELL CO1TEACT TM CERTIFICATION I:
STATE WEI.L CONSTRUCTION PERMITS:
„ ,rd0 Moollabg0
1. WILL USWpu k
Prom•«) a
2. WELL LOCH
Nevem Tomo
•
r Ir+iN
3. OWNER
Adding
ANIS Hem Pump Wolor Irwsbn ❑ cow
7IOfN: (Show dI,eI d Mg baton boon)
carob
r«torm as
4, DATE ORhLLED+ a 6. TOTAL O6c _
7. C SWEu.nwiiTE0 was, YES No Er
7. DOES WE LL * LEVEL
Cs tztic
S. STATIC WAWALEV0.Oro Top ofCoins: e.t.a_ FT.
!� :tFM ImooTnolo
ATOI OF CASINO is Fr. Abgw Lo d slate
wWmawm b..•rrYnrrM«c«-
"iM a*is HOW
*so —_�
trim YIELD NAHOW !IL
WHOP OP WET s i p_
to. Sp OP O j ��-
i i. WATER ZONES 1depSE -�—"
MglMtl a _iFid•c4-- it MO4CIS smog Y pia r W Maw boo
it CHLORIN ATOM
t3. CASINO: ya f
TMw oosow brNMbwCtroSaM
"err wM MSS Oh Eyre sod Sono
_la. �-- . ice--- /04 'LC Roach. wows mop wb'o^0o �!
Or,plh/, i.
From��To -tom" FL
j
p,stdortstr aucidnI C) bauaMMO
t1 Oow, LMr Us:
zery71e F
A&F WELL DRILLING
AND VICE, MC.
9PUMPw, Bus
11n ss 74
Bostic, NC 28012
. 112-247.1773
33a7t5
fwmimOo Mj°
Fwow. To PL.--_
From ---•To A. —
14. GROUT:
From
Freres _ _ Ts R•
15. SCREEN DoFEI Obinolor Wol Site Macaw!
ftom --a. To FI ....._.- In. _._..- W.---..---
From --- TO _— FL h -- YL ...— —
Fiom — To R. In. — in. —
11I. CANDIOPAVELf+ACKONO 84a Malarial
From . To M•�
Fees — To FL "�--
17. HEMAFIF
I Do KNOTD DWIEN PROVIDED TOM CONSINCTION
$ NIPAD TATACOPYOfTIUSRECOR µ1�
Ti win y'.i
ggNAlyROF F6t DONNINUOING
wbtord W ombb or ow oboorsow000lor Sawn 70 Sot PET. an
DINS MSS M*O4
To FL 4-idega-C4 yaidAdi-caerf
FOR OFFICE USE ONLY
Ore*
A&F WELL DR ING
AND PUMP SER E, INC.
91 H usins 74
s' C 2 8
7.17
I,"
-) r 0
/Ir
SCE i4C
1NY No.
-24-20E3 'ON 11:31AM ID:
PAGE: 1

Nee Calm . Crier ~a.1 /lF+wi. Rama
otalon 11 WSW a»w • oourwwr Sean
WELL CONSTRUCTION RECORD WELL COMM ACTOR /9 ''fAj) 124' ' lticr
Well CONTRACTOR CUPTIFICATION
STATS MU. CONSTRUCTION FSRMRt:
1. WILL In ESaink ageilleeete ow+ NoaIpweal Mwde*.I O Into dsl0 Anent MonlINq 0
Roa.«► O N.M Pomp Was Wad** D ohm ❑ 11 Ober. Un u..:
2. WELL LOCATIOF* (Slrw eke* d Ike WSW baba)
�7N.wa. Trot f'o.; .e r:r r� A/. ebony #2r7Tr...r: Pr/ CA .1
L]79 %AA9sl Ar-✓/ ,9T,j As' 4Js4t ' .0 . OCULlIf1OIQO
nwe.rr.areresa ermeis 1
i. OWNER Q-XonAdj jar i7rJn.) i.a.r To CwsO-ur
Neeistra
O is �r 7� C..
4. DATE Mat 9l'-�-t 6
S. TOTAL DEPTH 7 n T
s. corms COLLECTED wane NDO"
T. oats WI U. RSPLACS O STINOVtL. YES NO(
O. STATIC Ws Tap al CS 4, FT.
fen ••FN.wTepMC.NM
P. TOP OP CASINOY ISPA ' FT. Nan ISM Swop•
R.. w oa7►rw-.wd 1NMr Wow NS 0 •Jt.M.• ..rl.rr.. M.wew•
ASS
,a MOLD kW* IM Pat �-!CMl1II00OFTEST 4lre..
11. WRNS 20N $Woos* CC()
12 CIE.OIMIAT101t Typo
13 CASINO: q
Owns
FIwR ,— Ts
To
Feor. To
14. GROUT:
Foos
Fes TO R
Fan To_R
Fisn1 _.,To Ft
Is. SMSNOPAVELPACK:
MINA SY.
Rohl _ To P. -
Rs To Ft
17. MESA"
Jr- 4hik:07cr( Mpwd b.en"6*--
T, pes
/20
Figs _ _ To R.
15. SCREEN
Mw mama
anew , _.� . W.*fl maaIe1
FL. rq� e fausdl 7r
FL--
R
A&F WELL ILLIN NG
ptMP SERDRVCE,
911 HWY usme�ss 7a
Bostic, NC 27-
AND 6
. ,
828-247-
OE,TN
7r soden ens b..dasbead Iona
wbd.l
FL .T9.'sc rated
Dept Ob-NM► SW Skrs
h
h
Rosh. Irate insJ- - PSI /Q
d
At) Ae
etas
'OW/
1
Uf
0
ro
O►
A&F WELL DRILLING
AND PUMP SERVICE, INC
911 Hwy. Business 74
2 828-247.1173
IDOleer COMFY THAT lin vita vat CON5T1eCTEOIN*CCcmoaNCE1MiNISA MAC IC. Vat
COMMON* PI Plant AHOTHATACOPYOFTINSPECOROMASMIEN PROVIDED TOW WOC MAP-
rFOl1 DFPFcE ONLY
ow owns
c..+N1.
•c2:10talic,Cf� l
o4NATAo. moor WSTa1CFMnefl*. D.%E
Sololloarroo okidnne wise O.wsOwes so.s.TANANOW
sod Aft ow
-24-20E3 ION 11:31AM ID:
PAGE:1

RESIDENTIAL WELL CONSTRUCTION SECORp
North Corollas Deportment of Environment atdNonni Stomata* Division of Water Quaky
WELL CONTRACTOR CERTEFICATION a 213 8
1. wEu. cor1TRACTOR:
James W. Can
Wd canoacter.(bdlvldt * Cantu,
Cam •'s Well SLUM
Wen Docent Gnat Nene
[TREET ADORERS P O BOX
Ellenboro NC
CayaTaw ebb
828. 453-7322
Ana cos.
number
Cep tnr
429
2804Q_
2. WELL INFORMATION: p
EWE WELLmaaq. Pa t)
STATE WELLPERMITNrappaaablo)
DWQoOTTER PERMIT WeappOuM$) /
WELL USE t%honkAppto.LMs* F waist Supply
DATE DRILLED C •`S6 D
WYE COMPLETED .a 5 © AM PM ltia
3. WELL LOCATICIN • 1`�1 o n (���pry 1
CITY: Lk MIA M, ,,� i ^ COUNTY Q X)u A %itA J
,tCa/vit9tn.e ��OlOebalNebn, Lai No, Pita CS.)
mesa"some.. Mere
TO IC 'LAND SETTING:
0MR* y DFW ORUS, Dolbur
Mt Eft*** bed
LATITUDE aS - t n 6 3
LowAtucL2 L �`► 38u
tatlwd naI$W6C sour= p4Ps °Topogtapbk map
Mown dial and
obehall to ha /arm not oftAPES) Mown on a USGS typo mop
4. WELL OWNER
OWNER'S NAME
STREET ADDRESS g-17 0 2. S' n .. J e
Uhrcrl Mink NC ..2s16?-1o61
Gay aTavn Saab ZlpCeds
Mgbink WPM
tam
bednbel Meer
Arm cede • Phone number
tRY
6. WELL DETAILS:
a. TOTAL DEPTI.t A 0 S
b. DOES WELL REPLACE EXISTING WELL? YES Q NO
a WATER LEVEL Below Top (1088 %W 3 I FT,
(Weer BAbweTop dC> k9)
d. TOP OP DAWN* 13 1 . FT. Above Ltd Sunni'
&Toper eta tem* sda1MbelowWeiaahoamWtoques
s mitre* In amardw oa 48116A NCAC 2C .0118.
a. WED �.0 METHOD .OFTEST Q t
t, cis* ncnoto typo ch1orine Amount jAisyrs
e, WATERWORN! Wipe*
From TR_
!Marl_ TR
e. CASINO:
p . 0 _°7otl' Ft Ira sDA41 PVC
Form To Ft
pra,L_ Te .FL
T.OROUT: DSP1h
• p0,-_To 20
Front__ To
Fta4 ., _ To
Frent___To
Fran Te
Form To
West MOM
Ft Sackrete Hana3
Ft,
e. SCREEN: Depth DbmWt . Slash Mott
FIoaR_---To F1----M. b.
Rye__ To Ft_Jn. in
It 8A8m1ORAVELPAWt
Depth St tend
p --.Te Ft
Fran To__,__•_ Ft
Fran. —__To Ft.-
10. DNLUNG LOG
From T .
.0' Q,
GU bbS ' 4. AV re;
11. REMARKS:
IDONU9YCERW'YTHATTNe WELL WAS oo?a vwJc1FDNM.0e tt WIN
11* ICAWO WILL SEENM�TI STMOMDEAMWATACC%'Ql! $•
• OF RTIFEDNVC CONTiv1CTOR indMan
TE
James W. Camp •
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the origihal to the DMslon of Water Quality within 30.days. Ann:Information Mgt.,
1817 Mall Mimics Center- Raleigh, NC 27699-1517 ' Phone No. [phone] ext 566. .
Fenn I3W.1a
Rev. 7a06

«ESIDENTIAL yaaacoNerWer1OPTPL&CORD
Ninth Carolina Dsputteaf ofEnvimmnatt ad NOS Ramos DEvblon of Water Quality
WELL CONTRACTOR CERTmCATION a 213 8'
1. WELLCONnRACTOR:
James W. Camp
wet Gahes&4vdMduM) Name
Camp's Well &_Puma Co- Ter
Well CoNnela GamPm9Nom
STREET ADDRESS P O SOX
429
Ellenboro NC 250
CUyoToa ebb. Z�pCoVide
( 8281. 453-7322
Ana sir Ns, number
2. WEU.INFOAw1ATION:
SITE WELL I*WreN-br-)
STATE WELL PERMITS(,appteWb)
DWQ et OTHER PERMIT e(11 appeals) )
WELL USE (CluckApplicable So* RiaideniMWater swpty
OAT! DRILLED Q • ac n L
TIMECOIPLETED I`: 45AM 67FMO
e. WM.
Cm:
cOtel IAX.hY t JQJ
6aeMNaINQoM�codeuray, ab=naP.'aCS)
TOPOORAPHIC 1 LARD SETTING: •
DSC. DwNy toAd ORldp Other
fence seh-Plela
LATITUDE 351
LONonwS 5
1sfiSs lenehede murex . t(OPS OTopo$aphie nnp
Oren ewe must be abets an a USQS top* rap aid
PSISlo Kb bon Ind using GPS)
4.W0.LOWNER -�
OWNER'S NAME :J ✓Y� St �,Q10aM
STREET ADDRESS /'i _Dennis R;dge
Oct: c N c-
J
am Via ZlO Cede
r 3S�, 2N.r) - H s 7
Arm Dods- Phone number •
Tay wledhow.
adman, Modulo W
in aSatin'
6. WELL DETAILS:
a TOTALDEPTI! 3 O C
b. DOES WELL REPLACE DIETING WELL? Yee D NO
c. WATER LEVEL Noe Top d eedrg: tau FT.
(user IAtom Top of CMk1O)
d. Toper CABINS I 1 FT. Above Lad anleai•
cop denim tamintad aIm below land autos Me/ twain
nano b axerdaoswtih 16A NCAC 20.11115.
a. YIELD (pill): (Q METHOD OF TEST Q A A
t. coetteecTtottType chlorine AmMMad /cup
g. WATOt LONle (depth):
Ran Te Praq__T __
FhNn To Front_ To
6. CASING: r� �e�bee SD' yTi�hbpwefMartel
'Flom 0 °•Tooh /I) , Ft. D6* 1 PVC
Ft--
To— .FL _
7. GROUT: Depth Weed IWhS
Fra�_Te 20 Ft Sackrete Jana_
Front__ To
R`
Rest---- T4--Ft
I. SCREEN: Depth Dreier . 6161M a JAMS
Fnm__Ta,._- _Jr bh
From _To In.
Frole __To Ft—lit
h
a. 6Al,1DE1 IGRAVPACK:
Depth Size MaWYI
FhahLL,�,-.,�Ta FL
Fran TR Ft.,_—
Fra6_,._TRw-..-_
t0. DRRLNG LOG
From - 1 u
„e
('1.erlin
U' os . (L4J'&,
11. RLMAR1cst
ID01RR9Y 0lRIfYlf S WILL WAS Caifluoltohlsc 0RDANCa W6m
RAMeS.WILL 1CI014STANDARDS, AlmimATAWPY WWI.
• R60atDNA$ eau* VCaiTOTNI wesammea.
S a ) W U q-21-06
R F CERTIFIED W CO RACTOR DATE
James W. Camp
PRINT® NAME OF PERSON CONSTRUCTING TIES WELL
Submit the orlglhei to the DWt5Yton of Wate►Quailty within .3Od ys. Mtn: Information Mgt.,
1617 Mall S4rvla Cantor - Raleigh, NC 27619.1617 ' Phone No. (919) 73341315 axt 565. .
Form OW-1.
Rea T/D6

RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 21 38
1. WELL CONTRACTOR:
?ames W. Camp
ea Contractor(Individual) Name
camp's Well & Pump Co. Inc
k'J ell Contractor Company Marne
STREET ADDRESS P 0 Bok 429
Ellenboro NC 28040
City orTavn • State ZIP ode
( n,?!_.). 453-7322
aApr Phone number
2 V 'ALL INFORMATION:
.SWELL ID#Of applicable) .
CT/TE WELL FERMIUM aPP le)
C W Q or OTHER PERMIT 10 applicable)
WELL USE (Check Applicable Box): Residential Water Supply'6 "
C E DRILLED Q • d
^iECOMPLETED II AM® PM CI
3.'.. -_L LOC TION: n �}
//�� ,j COUNTY \Vir )(�`Q
YI11I IOGt
i e ozei Rama, Numbers, Community, Subdivision, Lot No., Parcel, ZIR Code)
GRAPHIC/ LAND SETTING:
_ OValley OFlat ORWge Other
(check appropriate box)
TUDE �77 �q, PS k i�
I t tud UDE,.p_ 0b 4- 3 nil
Latitude/)ongitudesource: GPS Giopographic map
;'.canoe of wen must be shown on a USGS topo map and
ttached to this form lnot using GPS)
4.1Ni' OWNER
OW NER'S NAME
ST^'ET ADDRESS u 21 at; Y 1.0 ,JY'
�..,.f or Town State Zip Code
Ar _de Phone number
5. WE ' '. ETAILS:
a. T (AL DEPTH: I ir ..
b. r ES WELL REPLACE EXISTING WELL? YESO NO UV'
c. " TER LEVEL Below Top of Casing: 1O FT,
(Use'+' If Above Top of Casing)
d. T' P OF CASING IS 1 FT. Above Land Surface*
Lop d casing terminated et/or below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. Y LD(gpm): ,� METHOD OF TEST CU.A
May be' in degrees,
minutes, sewods or
in a decimal format
Lag L&le_ 14C 8 46
f. DISINFECTION: Type Ch 1 Or ire Amount I C m e
g. WATER ZONES (depth):
From To From To
To From To
To Ram To
From
From
8. CASING:
Thickness/
Depth D 9neter Wei ht
Ftom 0 To t0 Ft 6a SDR21
From TD Ft.
From To Ft.
7. GROUT: Depth
From 0 To 20
From To
From To
8. SCREEN: Depth
ROM To
From To
From To
8. SANDIGRAVEL PACK:
Depth
From .. To Ft.
From To Ft.
From
Material
Ft Sackrete
Ft.
Ft.
Material
PVC
Method
Hand
Diameter - Slot Size .Material
Ft. In. In.
Ft. In. tn.
Ft In. In.
TO
10. DRILLING LOG
From TD'
0' y0
11. REMARKS:
Ft
Size Material
ormationD/teserip n
ram.
'A.w In elnt��r�
'K.tn. R-
n
C'.
I Do RDANCE
ISA NHERECAC SC. WE
ELL CONSRRUCTgN STANDARDS. AND THATAC'MATINS WELL WAS CONSIRUCTED IN COPPYWilli
OF IRIS
RECORD HAS BEEN PROVIDEDTOTHE WELL OWNER
In W C -, 8 -06
SI0RP7u`'IEOFCERTIFIED WEL`CO RACTOR DATE
James W. Camp
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
1617n,.30.clays. Attn:
i.e.,.! I the
Center- RalvItion.of Water eigh, NC 276994617 Quality
No. (9 9) 733 7 5 ext 568.tI . Mgt.,
Form GWla
Rev. 7105

RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment end Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 21 38
1. WELL CONTRACTOR:
James W. Camp
Well Contractor (Individual) Name
Camo' s Well & Pump ('n Tnr
W NI Contractor Company Neale
STREET ADDRESS P 0 Box 429
Ellenboro NC 28040
City or Town State Zip Code
( 828).453-7322
Area code- Phone number
2. WELL INFORMATION:
SITE WELL ID it(II applicable)
STATE WELL PERMITS°, applicable)
DWG! or OTHER PERMIT a(if applicable)
WELL USE (Check Applicable Box): Residential Water Supply ❑
DATE DRILLED Cl • A. (\ k
TIME COMPLETED 1. / AM PM
S. WELL LOCATION:
CITY: V
COUNTYM.JL
1 �s.� )T�
(Seat Name
Numbers. Cantu Subdivision, Lot No., Perch, Zip Cole)
TOPOGRAPHIC 1 LAND SETTING:
❑Slope p IlIW ❑Flat ❑Ridge Caner
(crack appropriate box)
LATITUDE .6CY ,, 2r Li")
LONGITUDE ri 51i2.1.0
Latitudeflongitude source: thtS DTopographic map
(bcalbn orwea must be shown on a USGS logo map and
attached to this form a not using GPS)
4. WELL OWNER nI�
OWNERS NAME �1� AnnY
STREET ADDRESS 34 p-0 )l it ✓✓AY) et
hoyl;ta Spr4nr6 FL- 34I 4
City or Tavn SO. Zip Code
Area cede • Phale number
May be In degrees,
minutes, seconds or
in s decimal format
5. WELL DETAILS:
a. TOTAL DEPTH: n�
b. DOES WELL REPLACE EXISTING WELL? YES IDNO
c. WATER LEVEL Below Top of Casing: kilo FT.
(Use's' 11 Above Top d Casing)
d. TOP OF CASING IS 1 FT. Above Lad Sudace'
*Top el casing laminated at/or below land surface may require
a varlaned In 'madam with 15A NCAC 2C .0116.
e. YIELD (gpm): 10 METHOD OF TEST QAA
I. DISINFECTION: Type Chlorine Amount I,/7. Cc:ds
g. WATER ZONES (depth): f
From To Front
To
Fran To Fran To
Fran To From To
6. CASING: Thickness/
asW
Depth ty DIa7leter Wit Materiel
From 0 To IS Ft # SDR21 PVC
Fran To Ft.
From To Ft.
7. GROUT: Depth Material Method
Fran 0 To 20 Ft. sackrete hand
From To Ft.
From To Ft.
B. SCREEN: Depth Diameter Slot Size Materiel
From To Ft. in. in.
From To FL M. M.
From To Ft. in. In.
e. SAND/GRAVEL PACK:
Depth Stu Meaner
From To Ft.
From To Ft.
From To Ft.
10. DRILLING LOG
From To Formation Description
t) 12 ,21MA13
`1; 3 Os CA.d Au
11. REMARKS:
O
O
100 HERESY CERTMY THAT 'ROS WELL WAS CONSTRUCTED N ACCORDANCE WIN
15A NGAC 2C, WELL CONSTRUC1tN STANDARDS, AND TINT A COPY OF Oa
RECORD RAS BEEN PROVIDEDTO TIE WELL OWNER.
L) q-M-DG
SIG. E OF CERTIFIES WELL CDNTRACTOR DATE
ames W. Camp
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt.,
1617 Mall Service Center— Raleigh, NC 27699.1617 Phone No. [phone] sxt 566.
Form GW-la
Rev. 7105

RESIDENTIAL vitl. CONSTRUCTION RECORD
North Crimea Department of Environment and Moot Resources- Mahlon of Water Quality
WELL CONTRACTOR CERTIFICATION A 21 3 8
f. olslNFEcnomType chlorine Anima J)6 i'�a,n
g. WATER ZONES (depth)
From To
Fran To
Fran To
s. CASINO:
Depth
'Fara _To
From__..._ To
Ran To
1. MU. CONTRACTOR:
James W. Camp?
Wee Contractor (ineuldush Nrl»
Camp's Well & Pumn Co._Snr
Well Contractor company Name
STREET ADDRESS P 0 BOX
429
El1enboro NC 21
04Q
City oTam State
(828). 453-7322
Ara code- Pion number
4. WELL IHF0RMATIONt
SITE WELL D*Of nP CS.)
STATE WELL PERMITepleppeaabS)
DWQ or OTHER PERMIT IRE app icabb)
WELL USE (CMelt Appetabls Box): Residential Water Guppy dr-
DATE ORBA.ED Q.31. e b
Tate COMPLETED -3: 2.o AM O PM <17
3. WELL LOCH (n�
CITY: 1 ant COUNTY ttMY
owes nitres', Caaaaae' Lot No.. PerceLbb coils)
TOPOORMyyJIC (LAND srrrluG:
asks d'0aesy trig °Ridge °Other
(ands esproanosm�
LATITUDE Jja�vv``� 2g
LOt1GITUDEjp1
Latitude/longitude source: 9 OTopogrephim map
ematta MSS dGS tops map and
ro Oils fmust orm not g sham G P )
4. WELL OWNER (f
OWNER'S NAME 0� 11 pr r O VI.S
STREET ADORF9rS [[[[JJJJ G�Cg
tTj! G 5-II-I C. �~VI 9161
City or Tam Stale ZIP Cede
Araoods- Phan number
6. WELL DETAILS: pp�
a. TOTAL DEPTH:
b. DOES WELL REPLACE MEMO WELL? YES O N0‘
c. WATER LEVEL Belay Top d Casing: X0 FT,
More a Atom Tot d Casing)
d. TOP OF CASNO M 1 FT. Atom Land Weal*
'Tap d casing Mtnnelad'Mx balm land suds* my require
a variants In aooada ce with 15A NCAC 2C .0118.
e. YIELD (gpm): pL METHOD OF TEM (JA x
May s m depot,
redraw
is a dedmsl bar
7. GROUT: O*b
Frond:I_._To 20
From To
Fran To
8. SCREEN: Dorm
From,.,.,....,,.. To
Fla __ To
From To
From To
From Tom_____
From To
o ThlcN
lmea
FL, ofua SDR1
Ft
FL _.
Materiel
Ft Sackrete
Ft
Waal
moats
Nand
olsneter Slot Size .Motored
Ft In. In.
Ft In In.
FL In. In.
e. SAND/GRAVEL PACK:
Depth Size Metered
From To Ft
From To Ft`_
Front_, To FL
10. DRILLING LOG
From To
0c,
Forr-rag n Description
5 y 4 D l (LAVA.'
11. REMARKS:
S
I DORMER CERTIFY TNT THIS WELL WAS CONSTRUCTED I/1 ACCORDANCE WEN
IAA NCA02C. WELL CONSTRUCTION STANDARDS, AND THAT ACOPY W T S •
RECORD ItAS SEEN PROVIDED TO THE WELL OWNER.
owth w Gavl q-a1-o,6
T E OF CERTIFIED WELL CONT TOR bATE
James W. Camp
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the D1vlslon.ot Water Quality Within 30.days. Attu: Information Mgt.,
1617 Mali service Center - Raleigh, NC 276994617 Phone No. (9191733.7015 ext 568.
EchoGWla
.L Pa(, 7/OS

RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 2138
1. WELL CONTRACTOR:
Well Contractor (Individual) Nano
Camp'S Well R Pump en.., Tnr
Well Contractor Company Nome
STREET ADDRESS P 0
Ellenboro NC
City or Torn State
( 828f453-7322
Area code- Photo number
2. WELL INFORMATION:
SITE W ELL ID *Of epeik:aM)
STATE WELL PERMIT*e( eppiioabe)
DWQ or OTHER PERMIT e(e applicable).-/
WELL USE (Check Applicable Sca): Residential Wales Supply IV
DATE DRILLED Q • �2'n' ii A ID/
TIME COMPLETED d `� AM PM 151
Box 429
28040
Zip Code
3. WELL LOCATION: 6
CITY: Ris COUNTY n,3
Subdivision, ho., Parch, ZW Code)
(Street Name
TOPOGRAPHIC 1 LAND SETTING:
❑Slope DVaIey ❑Flat teArltge ❑Other
(chock epi op ete box)
LATITUDE bke(0
LONGITUDE
Latitude longitude source: QPS OTopograPhie map
(atttached tothis form f not unto GPS)ation of *el must be shown on • lopo mep end
4. WELL OWNER
OWNER'S NAME
STREET ADDRESS
lake lure Stale
City or Town
(_ ).
Area code • Phone number
May be in degrees.
minutes, seconds or
in a decimal forest
S. WELL DETAILS: �(
a. TOTAL DEPTH: S O(3
b. DOES WELL REPLACE EXISTING WELL? YES ID NO Ith
c. WATER LEVEL Soon Top at Casing: _IL ----FT'
(Use •+' 11 Above Top d Casing)
d. TOP OF CASING IS 1 FT. Above Land Surface'
'Top d casing terminated at/or below land solace may require
a variance in acaodaice v4th 15A NCAC 2C .0118.
s. YIELD (gpin): 3 METHOD OF TEST KNA
z ,. :1 IJ 4
t. DISINFECTION: Typo chlorine Amours
g. WATER ZONES (depth):
From To From
From To From,
From To From
6. CASING: Thickness/
SDR
_atcsca
To
To
To
Maryut&
Frnm_Q_To Ft. 6
From To FL
From To Ft.
Material
PVC
1. GROUT: Depth Materiel Methodin
Frain, 0 To 20 a sackrete hand
From To Ft.
From To Ft
S. SCREEN: Depth Dimmer Slot Size Materiel
From To FL in. -- in. From To Ft. In. ____ in.
From To FtIn. __. n.
9. SANDIGRAYEL PACK: Depth Size Material
From To Ft.
From_ To Ft.
From To Ft.
10. DRILLING LOG
From To
c % hec
11. REMARKS:
rmation Description
1 Cal m.r9
f7
m
1001EREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED a ACrmgnsNre Wm 4
ISA NCAC ZC. WELL CONSIRUCr10N STANDARDS. AND THAT ACOPY OF DOS
RECORD NAS SEEN PROVIDED TO THE WELL OWNER.
W /lam, CQ$T y'3o
-06
SIG RE OFF CERTIFIED WELL CONTRACTOR DATE
ames W. Camp
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the oiginal to the
in 30 days. Attn:
81/ Mai S rvice Center- Raleigh, NC 2 699-1817 vision of Water Quality Phone No. tlon Mgt,
No. (9 9) 733-7015 t S55
Fdm GW1 ■
Rev. 7106
.a'

RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 21 38
1. WELL CONTRACTOR:
James W. Camp
Well Contractor. (Individual) Name
Camp' s Well & Pump Cr) Tnr
Well Contractor Company Name
STREET ADDRESS P 0 Box 429
Ellenboro NC
City or Town State
( 828} 453-7322
Area code- Phone number
2. WELL INFORMATION:
SITE WELL ID #(if applicable)
28040
Zip Code
STATE WELL PERMIT#(f applicable)
DWQ or OTHER PERMIT #(if applicable)
WELL USE (Check Applicable Box): Residential Water Supply
li11H
DATE DRILLED R• V- 0 V
TIME COMPLETED h !.J D AM 0 PM
3. WELL LO) TIOP{: ^ -
CITY: (Y•Z-UC.tit COUNTY a„�ic�_,�"a�
`�+,�,r ,(1' �-�,• � � 1324
(StiaZUame, Numbers. unity, Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
❑Slope DValley ❑Flatdge ❑Other
(check appropdqaatpe box), t,�
LATITUDE 3.i d% t \ I4
LONGITUDE Et) 1.1.0cd w
Latitude/longitude source: vrPS oTopographic map
(location of web must be shown on a USGS topo map and
attached to this form A not using GPS)
May be in degrees,
minutes, seconds or
in a decimal format
4. WELL OWNER 4
OWNER'S NAME 1 1 F 'I
STREET ADDRESS 0 'Box 5`Y
lake 1_/,tre
City or Town
Area code- Phone number
lei.' &AEU Al
N (9.874-'
State Zip Code
5. WELL DETAILS:
a. TOTAL DEPTH: 6 g S
b. DOES WELL REPLACE EXISTING WELL? YES NO1.
c. WATER LEVEL Below Top d Casing: ? be FT.
(Use .1-* if Above Top of Casing)
d. TOP OF CASING IS 1 FT. Above Land Surface*
*Top of casing terminated at/or below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): 3) METHOD OF TEST MA.
.
6. CASING:
f. DISINFECTION: Type chlorine Amount c.2 cu� s
g. WATER ZONES (depth):
From To From To
From To Fran To
From To From To
Thickness/
Depth Diameter Weight Material
From 0 To Trod FL 6 i SDR21 PVC
From To Ft
From To Ft
7. GROUT: Depth Material Method
From 0 To 20 Ft sackrete hand
From To Ft.
From To Ft.
8. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
From To Ft. in. in.
9. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
From To Ft.
10. DRILLING LOG
From To
0 5.a
11. REMARKS:
Fomiation_,Qesq�pt m
`1�RJvt.
0
r
w
C
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED N ACCORDANCE WDH
ISA NCAC 2C. WELL CONSTRUCTION STANDARDS. AND THAT A COPY OF THIS
RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
�a / Lt) 29Ea4
SI *Id 1p. OF CERTIFIED WALL C RACTOR DATE
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.,
1617 Mail Service Center— Raleigh, NC 27699-1617 Phone No. [phone] ext 568.
Form GW-la
Rev. 7/05

RESIDENTIAL 'VEIL CONSTRUCTIONRECORD
North Carolina Department of Environment and Natural Resource. Division of Water Quslhy
WELL CONTRACTOR CERTIFICATION N 21 38
1. 'WELL CONTRACTOR:
James W. CBiD
Wet Qatada.(kidMdual) Nwi.
Camp's Well & PINED Co Tile*
Wall Contractor Compact Name
STREET ADDRESS P 0 Bok 429
Ellenboro NC '40
City or Town Stole ZIP nod.
( 828). 453-7322
Ares code- Phaw number
2. WELL INFORMATION:
SITE WELL ID geappeoeeta)
STATE WELL PERWTSpap;Eabe)
DWQ orOTHER PERMIT ilifir appecablN
WELL USE (Cheek Applicable BaQ: R6tMsn4I3 Water Supply IV
DATE DRLLED q • 2q • Q 1.
TIME COMPLETED ) 33 o AM VPM
3. WELL LO/CATIOIt� Lin
CITY: ppP`�olt(1� �X�1 ,,�.. (1 / COUNTY
(6uaelf&au.r s.;'�Ca�ma#b _LOINt:gjemj
Paro.t21p Cot)
TOPOORAPNIC I LAND SETTING:
galore ovrey acts sae oothv
(asset appropriatebaq
LATITUDE 34. 2.si %g
LONGITUDE$\_ i»i
Latitude/longitude source: SIOPS oTopographic map
(bateau dwet rant be down on a USGS fop* map and
WSW to this form /not using GPS)
4. WELL OWNER
OWNERS NAME lc1 C .c-r C'fab Cr
STREET • , - s8 D BOX A 3 •
NC gge45
May bs to digws,
mimW, womb a
In admiral bmrt
IC.
City or Town Suds ZIP Cede
At( ucods • Mayo number
e. WELLDETAILt:
a. TOTAL DEPTH: 4 \A
b. DOES WELL REPLACE E%ISTINO WELL? YES( NO Lx
c. WATER LEVEL Bibs Top d Casing: V FT.
(Uss'+' t Above Top of Casing)
d. TOP OF CASINO _ 1 . PT. Above Land St asi*
'Top d easing to ndnWsd attar beluw land sur(aa mW tsmuks
.wanes in meadows vph 15A NCAC 2C .0115.
e. YIELD (gpm): S t METHOD OF TEST Q A a
t omswacnattTyp.chlorineAmount 0e is
g. WATER ZONES (depth):
Fran__ To
Fran__ To
Fran To
& CASING:
From To
Fran_,_ To
From To
ThlclowsU
Fran 0 Tom i7o Ft Dispoter Weill
b Z1 PVC
From To Ft,
From To .FL
7. OROVT: Depth Materiel Method
Front a _To 20 FL Sackrete Hand
Fmk__ To FL
Fmm_ To Ft.
IL SCREEN: psptb DLmster Stet Sum .Mstedal
Fren sTo_. _Ft. In. M.
From__ To_______ Ft_____in. In.
From To Ft. In. in.
e. SAND/GRAVEL PACK:
Depth
Ft
From To Ft.
Sim
Matra
Fraq,_^To FL
10. DRILLING LOG
From To
0 141,
11. REMARKS:
Foorrgq&n Desalptbn
LPP AU
isiAAtak
WO MEP CER2r2TNATTH* WELL WAS OORBtRUCtED N ACCORDANCE WITH
1SA WC 2C, WELLCONkmUCIUN STANDARDS, AND AwTACOPY QS MIS
RECORD HAS SEEN PROVIDED TOTHE WELL OWNER.
S
() COLONIO gjeS0
CERTIFIED WELLCONT CTOR DATE
ames W. Camp
ARINTED NAME OF PERSON CONSTRUCTItIG THE WELL
1617Submit Malle original to the Division of Water ServiceCenter— Raleigh, NC 27 99-1417 Quality hon No. (g 9) 733-701g at S558. Mgt,
with n 30.days. Attn:
Fenn OW -ter
Rev. 7/05

RESIDENTIAL WELL C9NSTRvt ITON RECORD
North Carolina Deportment of Environment and Natural R Division of Water Quality
WELL CONTRACTOR CERTIFICATION N 2138
1. WILL CONTRACTOR:
m 6
Wd :nano .Qndhldud)
Camp' E el a n`•mn, Co Tn-c __
We0Gt4*$ torCor/WW1'Nsn•
STREET ADDRESS ! 0 Bog 429
Eller—NC4ca
CRyorTam Sty Zip
( 828t• 453-7322
Arm ado Phone number
2. WELL SNPCRMATION:
SITE WELL ID #N app&eei•
STATE WELL pERMITe(sspaaoable)
DWDorOTHER PERMIT #(EapPlt1e1 - _.
WELL USE (Chm3APOISMDa9: Reslssupply�
DATEDWIJFD 7i_er W
nue COYPterso o —. AMO PMIL
3. WELL
CITY:
(Stmal Rumen
TOP RAPHIC 1 LAND SETTING:
lops OVsWW OFW anise OQlher
(duck woroFFFIME
,1.,t-, L�
LATITUDE �n�--
`1.A .
LOHGITUDE V.� Q
Latitait longibade source: TOPS OToposraphio map
(lorafbn of wit must M shown on a (JIGS Opp map and
attached to VS Pone #not WSW GP$)
4. WELL OWNER
OWNER'S NAME
ADDRESS
r - a TA_ std• Zip Cede
City Town
ny COUNTY! u X .N'A Awi
OMR
May be In depns.
mlautat, moods or
In a dodmd Immat
Atm oast• Peons Number
6. WELL DETAILS:
a. TOTAL DEPTH: S S ,v,vI.
b. DOES WELLREPLACE EXISTING WELL? YES O
c. WATER LEVELWoe Top d Casing:
NN•✓Y Above Top d Casing)
d. TOP OFCASWOts — FT. Above Lund Surrroti'
d easing •nW tNrdrrat•d atior balm land surface m g n-idt•
yarn;n accpdRgs MTh 15A NCAC 2C .011f6,
•. vtELa t9pmk i_ METHOD OF TE6T�
t. DISINFECTION: Typachlorine Amount'
g. WATER ZONES (depth):
Fran To
Fmm_ To
From To
6. CASING: I r
From U `-t 7 Ft
Fran To Ft
�_ FranTo Ft,
I
J ruf 5
From To
Fran —
From To
Ewa Thlokn rsl
Db� r SDR21 PVC
T.
ORCUT: Deptt Me1Md
Frts D_To 20 Ft Sackrete
From To F
From To Ft.
S. SCREEN: Dept Diameter Slot Sim
Fran To Ft. in. __ In.
Firm _ To _ Ft._____k'.
Fran To Ft_ in.
& SAND/GRAVEL PACK: Sim
Depth
Frain To Ft
Fmm To Ft,_--
F_To FL
10. DRILLING LOG
F0
77. REMARKS;
method
Hand
In.
Malenel
MOMS
Formation ggscri{Ltbn
CIkm.s dGcX fie
n r`
DD NERVY RCRSWAS TA�TCE
15A20. CERTIFY
T STANDARDS, AND wnN
REDORD HAS SEEN PROVIDED TO INE WELL OWNER
CCAPN"\2 21.1)4
TURE OF CERTIFIED WELL 'CDR TRACTOR DATE
James W. Camp
TENTED NAME OF PERSON CONSTRUCTING THE WELL
Submitthe original to the Division of Water Quailty within ;30.days. Attn: Information Mgt.,
1617 Mall service Canter — Raleigh, NC 27699-1617 ' Phone No. [phone] eat 66S.
Fain GPM
Rev. 7106

$BSIDENTb4L WELL C9NSTRSTI0N.S OlPt
Mouth Carolina Department etEmhmanont mid Nora Roomed- Malat et Water Qutety
WELL CONTRACTOR CERTIFICATION a 213 8
T. WELL oONypACTOR:
James
Wd Cantrada.
Camp' s Well & Put%D ('e
WasCa*SWganpwfll y
STREET AOORU S P 0 Boi
Cay
(826} 453-7322
Ares es* Phone number
i. WILLDa�RMAT'ION:
SUE WELLIDSprs,vcs)
STATE WELL PERAaTINVeg stare)
DWQ or OTHER PERMtT IRK applIabN)
WELL USE (Cheek APattbls ResWralr Water Supply be
a45
429
7n�
E1lenboro NC 2%OQ0
Stoke
DATE DRILLED Q g . b ke
TINECENIM.ETED 6 ,- PAID
PM�
3. WELL LC(��CA� (�-�
CITY: \AA ne ' �MCOUNTTY Y,NInMtnl
slid‘ NnI. �s t&Nab,5Latlllb., 1111(((( 9999
TOPOGR�A�PPHYC. / LAND SETTING:
DSW wY'� OPtd ORldps OGiglio
NookopFroPdatOod
LA rnscE a S , ,a 1, I a2%
LONturtm€S
Iadtod&iongltude sourca S OTopopaphio tmtp
Ones, of et mg be shoat on a (MGS typo mop and
SOH tothls Inot us G 7tt
A YL
WlOJ.011tISR Y-1 e
owners NAME WA NJT"1
STREET ADDRESS go/f&j
u4thrr+o✓ctori j
Eya Oro Sbto
May be hassle,hassle,.. L 1.- srmlaa
hos dna bast
once LLC_
(o lL
, g)39
Zip Cats •
Lam)
Ata*do • Phone number
5. %M. DETAILS:
e. TOTAL PEPTit t b
b. ooaWELLREPLACEEXISTINGWELL? YESQ No
a WATER LEVEL6dwFTopdCuln; • 0 FT,
(Care IIAbetTWdCasty) ' '
dTOrOFSMOG IS 1 ._FT. AboraUMSuite'
?op d snag rinsed a tr bolos W d sera mss sputa
a Wino In a xakrIS V4th 16A WAG 2C .0118.
a. YIELD(Opm)' !() METHOD OF TEST OA.l
t. DORNFIOGrOttTypech1orin%Amortr „2 cars
g. WATER ZONES WepOt):
1NaR Tt` Fort-- To
pottL. To Bran To
To Fmm To
s. came: TNt.wu
Tram 0 ,Ta Ia Ft an PaatialirVO
Fran.-_�,To Ft.
Frain 70 .Ft —�
7. GROUT: Depth Weal MOS
0 _To 20yt Sackrete Hand
Frero_,__To F1,
IL SCREEN: Oapth Dirnder . Slat Site .MebIW
Frar�_To Ft�J<r M•
FrsatL.- __To Ft. In.
L SMMARAV L PACK
D,p h Sbe Len
FrgA____ToTo Ft,
FmM•_,,,,,Ft.
It DRIWNG LOG
Prom.To
t0 5N
TrCt":111
t()3 1OS ' Cnt1MvC
11. REMARKS:
• C3
0
V
Lt i [, 21.103
IiDOWDY CERIPYM TWRL WAS COFSRUCIFCNCMAI WRN
11M02C.WELL�
STANDARDS, Alt 1fl1TACOPY VS 7NS
MCCOMAS SEEN PROD®TOTHE WEII OWNER
81GFK - A
"OF I)RDWETRACOR 9TE
James W. Camp
) RNTED NAME OP PERaON CONSTRUCTING THE WELL
Submit the original to the Winton of Water Quality within:35days. Atfn: Information Mf,
1817 Mali Starks Conti,- Relsigh, NC 27699.1¢17 Phone No. (91917334015 axt 568. .
Farm GW-1w
Rev. 7105

North Carolina Department of Environment and Natural Resources -Division of Water Quality -Groundwater Section
1636 Mall Service Center - Ralelgh,N.C. 27699-1636-Phone [phone] R` ` "id A J I. L.
W
WELL CONSTRUCTION RECORD WELL
CONTRACTOR CERTIFICATION # : 3er '' o
STATE WELL CONSTRUCTION PERMIT #
nrE LI- USE (Check Applicable Box): Residentially'-I
,_,/Municipal E Industrial ❑ Agricultural El Monitoring Li
Recovery D Heat Pump Water Injection El Other El If Other. List Use:
2 WELL. LOCATION: (Show sketch of the location below) /} </'Oii Ed -a, 0. d ; /'Y
Qo1STi C County
Nearest town.
7iV/ 0E5ri.c-.5c'fr e
.Rnad Name and Numbers, Community. or Subdivision and Lot No.)
4:iyr rNdQSCH
7/P oSflC -—r±---, ve iVY
ree or ou e o. 2 ffD/8
/36 Syr c iv' c
City Or Town
State Zip Code
L-IS-�L
Gr FA DRILLED
"I
".TAI DEPTH NOL�I
CUTTINGS COLLECTED YES ❑
DOES WELL REPLACE EXISTING WELL? YES FT .
STATIC WATER LEVEL Below Top of Casing: ��
(Use "." if above Top of Casing)
9 TOP OF CASING IS /8 �' FT. Above Land Surface'
''on ni rasing terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2C 011 B A�
1( 4'f' YEILD (GPM). METHOD OF TEST•-t�----
11 WATER ZONES (depth).
nWNEP
Andress
17 CH( ORINATION: Type Amount!
Wall Thickness
=; ASING. Drnth Diameter or Weight/Ft. Material nrennN SKF_TCH
17, ! c. ?iaini G_
rrnm 70�t. (Showdirection and distance from at least two State
rn To Gt. Roads, or other map reference points)
TO
rim
01,31
DRILLING LOG DEPTH
From To Formation Description
1a ;ROUT
ti
Depth Material Method
To Ft
crow To Ft
15 SCREEN
,om
c rorn
rnm
1g. SAND/GRAVEL PACK: Material
Depth Size
l-/nrr To Ft
r 'OM 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 ` DATE
Quad No. SIGNATURE OFF PERSON CONSTRUCTING THE WELL
Submit original to Division of Water Quality. Groundwater Section within 30 daysGW-1 REV 12!99
If additional space is needed use back of form
Serial No
Depth
Diameter Slot.Size Material
To Ft in in.
- To Ft in in.
To
R in in
200E