WQ0037995_GW-1_20210112

WELL CONSTRUCTION RECORD (GW-1)
1. Well Contractor Information:
Mel rk. soft, tem ■w
Well Contractor Name
2 789A ,1AEw 1 2 2U2i
NC Well Contractor Certification Number
£ 7.0 BY:
Company Name
2. Well Construction Permit tf: Vi C • WO 003 7? ?a '
l.i.st al/ applicable well construction permits (i.e. Cif(:, County, Slate, Variance, etc.)
3. Well Use (check well use):
Water Supply Well:
DAgricultural ❑Municipal/Public
DGeothermal (Heating/Cooling Supply) DResidential Water Supply (single)
❑Industrial/Commercial OResidential Water Supply (shared)
❑Irrigation ❑Wells > 100,000 GPD
Non -Water Supply Well:
OMonitoring ❑Recovery
Injection Well:
DAquifer Recharge XGroundwater Remediation
❑Aquifer Storage and Recovery ❑Salinity Barrier
❑Aquifer Test ❑Stormwater Drainage
❑Experimental Technology DSubsidence Control
DGeothermal (Closed Loop) DTracer
DGeothermal (Heating/Cooling Retum) ❑Other (explain under ii21 Remarks)
4. Date Well(s) Completed: iiii/SVAO Well IN r"'1 1 14/ ` 9
5a. Well Location:
Lein e
Facility/Owner Name
,.jile 61& 0Ui3
Physical Address. City, and Zip
vs MC
N/q
Facility IDe (if applicable)
Pip 1-42,j city
AJ , n •
N/.LI
County Parcel identification No. (PIN)
5b. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(it well field, one tat/long is sufficient)
S'G_/► c_ rc�S fib g,,% Nhy'
drilled.•
0 .�� ;) ::. ' "24. SUBMITTAL INSTRUCTIONS
9. Total well depth below land surface: Q 16' L \'� � � D (ft.)
For multiple wells list all depths fdifferent (example- 3 c@200' and 2 a,100')
W'
For internal Use Only:
47erial
14. WATER ZONES
FROM
TO
DESCRIPTION
.T7 ft
g
17 h ft'
Ccri . S71, .t.Z i2J.,
(72, 0.
137' ft.
(Gt(,cr 67.8-1-1' l4c'yn C.
a15. OUTER CASING (for multi -cased wells) OR LINER (if applicable)
FROM
TO
DIAMETER
THICKNESS I MATERIAL
0 ft.
ry
3!t ft.
41 in.
Sl.''t..80 I
p1,r
16. INNER CASING OR TUBING (geothermal dosed -coop)
FROM
TO DIAMETER sjTHICKNESS
MATERIAL
ft.
ft.
ft.
it I 'in.
17. SCREEN
FROM
TO
DIAMETER
SLOT SIZE
MATERIAL.
3 7 Ift.
9!6) ft.
Ct in.
r 0 (6,.:,r'.tt
�THI,CKNESS
eo
pl!c
ft.
ft.
in.
18. GROUT
FROM
TO
MATERIAL
EMPLACEMENT METHOD & AMOUNT
0 ft.
96 ft.
$t.,rtf•C
Tr6Ml'! Phi t?tpe
ft.
ft.
3.3'- r%i/!i
/'Z)..-//ai,e
ft.
ft.
/G..s-frS •
de?i -et, ,',14‹.
19. SAND/GRAVEL PACK (if applicable)
FROM
'ro
MATERIAL
EMPLACEMENT METHOD
ft.
ft.
il/A
N� tvro. / - ccti ✓t...
ft.
ft.
20, DRILLING LOG (attach additional sheets if necessary)
FROM
TO
DESCRIPTION (color, hardness, soiVrock type, grain size, etc.)
ft.
ft.
ft.
ft.
574wL' 411e,4:1ti14r
p ft.
-7 7 it.
Tcw.. ciY-tea, f%> Y ..42! r, C1,7
-L -1 ft.
i 7 L 0.
c r(.47, S-, , ;e, ' -.Qs- Li c_ K
i 7 7.ft.
e ,; ft.
c. i.e.. 14.0in e
ft.
ft.
ft.
ft.
21. REMARKS
f-ibni -2.0,1424 Wire? lrr'!►: 2..r-11 14o,
, n'- - el ix 47,1 /G ie.rit ,,...„ - ,57/ s ,0 c?/► 76n .-Yit _
22. Certification:
r)70l e. 47..4.[/7_C
9 Gd /arms•
Signature of Certified Well Contractor
el /S1zo
Date
Sydt signing this form, 1 hereby certify that the well(t) was (were) constructed in accordance wish
15.4 N(AC 02C .0)00 or I5A NC:AC 02C .0200 Well ('on.struction Standard, and that a copy
of this record hos been provided to the well owner.
6. Is(are) the well(s): Permanent or ❑Temporary
7. Is this a repair to an existing well: DYes or IkiVo ;)
l f rigs is a repair, fill out known well construction information and ex/,la(ri ibcnc ttc4the
repair under 2/ remarks .section or on the back of this form. �•
. Site di gram or additional well details:
8. For Geoprobe/DPT or Closed -Loop Geothermal Wells havin�j sable Yoµ Iti se the back of this page to provide additional well construction info
construction, only 1 GW-1 is needed. Indicate TOTAL NUMBER.kffwells r c >l�dd)See Over' in Remarks Box). You may also attach additional pages if necessary.
10. Static water level below top of casing: �3- 5 (ft.)
If water lerel is above casing. use "
r
11. Borehole diameter: f 2- nn'" • (in.)
12, Well construction method: Pi (t.� - tt4tar7
(i.e auger, rotary, cable, direct push, etc.)
FOR WATER SUPPLY WELLS ONLY:
13a. Yield (gpm) 4,f f, Method of test:
13b. Disinfection type: ! Amount:
A
Submit this CW-1 within 30 days of well completion per the following:
24a. For All Wells: Original fonn to Division of Water Resources (DWR),
Information Processing Unit, 1617 MSC, Raleigh, NC 27699-1617
24b. For Injection Wells: Copy to DWR, Underground Injection Control (IUC)
Program, 1636 MSC, Raleigh, NC 27699-1636
24c. For Water Supply and Open -Loop Geothermal Return Wells: Copy to the
county environmental health department of the county where installed
24d. For Water Wells producing over 100,000 GPD: Copy to DWR, CCPCUA
Permit Program, 161 I MSC, Raleigh. NC 27699-1611
Fonn GW-I

TrueGyde Steer : Directional Data Report
Job Name 20-191 HIW-9 Line Az 175.9°
Service Company Sharewell H.D.D. Customer Ellingson/DTD
Location Jacksonville, NC Description Horizontal Injection Well
Product Size/Type Probe SIN
Survey MD CL Away Lateral Elev Inc! Raw Az Pig Az Pilot Rad Reamed R DLS DS Probe G Total H T
Tie -In 0.00 N/A -377.68 -13.93 -3.51 72.78 180.68 180.68 N/A N/A N/A TI N/A N/A
1 14.10 14.10 -364.26 -12.82 -7.68 72.78 180.68 180.68 N/A N/A N/A KB N/A N/A
2 45.94 31.84 -333.95 -10.29 -17.10 72.80 180.75 180.75 N/A N/A N/A KB N/A N/A
3 77.24 31.30 -304.17 -7.90 -26.43 72.52 180.27 180.27 17021 INF 0.34 KB N/A N/A
4 108.93 31.69 -273.96 -6.07 -35.84 72.94 178.56 178.56 33958 INF 0.17 KB N/A N/A
5 140.75 31.82 -243.46 -4.65 -44.79 74.38 179.20 178.66 3438 5871 1.67 KB N/A N/A
6 172.76 32.01 -212.55 -3.06 -52.93 76.16 179.09 179.09 1504 1830 3.81 KB N/A N/A
7 204.63 31.87 -181.45 -1.29 -59.66 79.48 179.30 179.30 838 931 6.83 KB N/A N/A
8 235.94 31.31 -150.58 -0.07 -64.76 81.76 177.13 177.13 739 811 7.75 KB N/A N/A
9 267.40 31.46 -119.39 0.32 -68.79 83.50 176.18 176.18 739 811 7.76 KB N/A N/A
10 299.42 32.02 -87.52 0.35 -71.84 85.59 175.81 175.81 888 995 6.45 KB N/A N/A
11 330.97 31.55 -56.03 0.20 -73.79 87.31 175.54 175.54 981 1112 5.84 KB N/A N/A
12 362.54 31.57 -24.48 -0.35 -74.71 89.34 174.33 174.33 933 1051 6.14 KB N/A N/A
13 394.23 31.69 7.21 -0.63 -74.93 89.87 176.15 176.52 1271 1500 4.51 KB N/A N/A
14 426.31 32.08 39.29 -0.64 -74.96 90.01 175.34 175.34 2023 2666 2.83 KB N/A N/A
15 458.24 31.93 71.22 -0.92 -74.83 90.48 175.53 175.53 4810 11158 1.19 KB N/A N/A
16 490.13 31.89 103.10 -0.83 -74.62 90.27 176.67 176.67 13737 INF 0.42 KB NIA N/A
17 522.24 32.11 135.21 -0.56 -74.61 89.77 176.17 176.17 22902 INF 0.25 KB N/A N/A
18 554.27 32.03 167.24 -0.72 -74.72 89.82 175.16 175.16 8337 INF 0.69 KB N/A N/A
19 585.49 31.22 198.46 -0.76 -74.79 89.93 176.57 176.57 16070 INF 0.36 KB N/A N/A
20 616.61 31.12 229.58 -0.36 -74.78 90.09 176.79 176.79 16897 INF 0.34 KB N/A N/A
21 648.00 31.39 260.96 0.16 -74.73 90.11 176.99 176.99 18518 INF 0.31 KB N/A N/A
22 679.36 31.36 292.32 0.29 -74.75 89.82 175.34 175.34 48894 INF 0.12 KB N/A N/A
23 711.13 31.77 324.09 0.46 -74.73 90.24 177.16 177.16 36104 INF 0.16 KB N/A N/A
24 742.81 31.68 355.77 0.54 -74.71 89.83 175.03 175.03 19401 INF 0.30 KB NIA NIA
25 774.14 31.33 387.10 0.19 -74.83 89.73 175.55 175.55 INF INF 0.09 KB N/A N/A
26 805.38 31.24 418.34 0.04 -74.87 90.14 175.77 175.77 54001 INF 0.11 KB N/A N/A
27 836.78 31.40 449.74 -0.12 -74.75 90.31 175.53 175.53 11217 INF 0.51 KB N/A N/A
28 868.60 31.82 481.55 -0.06 -74.80 89.49 176.58 176.58 22551 INF 0.25 KB N/A N/A
Bit 878.62 10.02 491.57 0.05 -74.89 89.49 176.58 176.58 N/A N/A N/A PR N/A N/A
hcdier M ..... w)
It
JAN 1 2 ni.1
BY:.

Profile
a
2
Plan
8....,,,.,.. .
,,,,....--fiv,-,-....
„AN I 2 .d21 E.

WELL CONSTRUCTION RECORD (GW-1)
1. Well Contractor Information:
M' r r�; £': S e / Qr
Well Contractor Name
2-789,
NC Well Contractor Certification Number
BY:
Company Name
2. Well Construction Permit #: V iC • O Q3 y 9 ?3
Liss all applicable well construction permits (i.e. (IIC., County, State. Variance. etc.)
3. Well Use (check well use):
Water Supply Well:
❑Agricultural
DGeothennal (Heating/Cooling Supply)
°Industrial/Commercial
❑Irrigation
°Municipal/Public
❑Residential Water Supply (single)
❑Residential Water Supply (shared)
°Wells > 100,000 GPD
Non -Water Supply Well:
DMonitoring
injection Well:
❑Aquifer Recharge
°Aquifer Storage and Recovery
°Aquifer Test
°Experimental Technology
❑Geothermal (Closed Loop)
❑Geothermal (Heating/Cooling Return)
❑Recovery
Xtroundwater Rernediation
❑Salinity Barrier
❑Stonnwater Drainage
°Subsidence Control
❑Tracer
❑Other (explain under #21 Remarks)
4. Date Well(s) Completed: /40-J
5a. Well Location:
Cr/ rlr. Le j .n v_
Facility/Owner yName
se OVi,
Physical Address, City, and Zip
4r�sic� w
WeIIIDt/ H We
VS MC
County.
AVA
Facility IDk (if applicable)
w, e -
N/A
Parcel Identification No. (PIN/
5b. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one lat/long is sufficient)
Ni A N
a-9
6. Is(are) the well(s):.Permanent or °Temporary
7. Is this a repair to an existing well: DYes or SNo
!phis is a repair, fill out known well construction information and exploinjhe (u reof,Ih
repair under ,21 remarks section or on the back of this form. r
8. For Geoprobe/DPT or Closed -Loop Geothermal Wells havingtI e
construction, only 1 GW-1 is needed. indicate TOTAL NUMBER d tMT)s
drilled: /
9. Total well depth below land surface: � ` �` �;•� �' (it.)'
1 or multiple srelis list all depths if different (example- 3 a 200' and 2 a 100')
� -/
10. Static water level below top of casing:I (iL)
if water level is above casing. use " • '
it
11. Borehole diameter: t' . n4")'‘1 • (in.)
12. Well construction method: AlCfJ - K4tQr
(i e auger, rotary. cable, direct push, etc.)
W-
m.
FOR WATER SUPPLY WELLS ONLY:4
13a. Yield (gpm) W Method of test:
13b. Disinfection type; /t Amount:
/V/A
For internal Use Only:
=47654
14. WATER ZONES
FROM
TO
DESCRIPTION
/ S ft.
SO ft.
C. i'a..2 . S;<, .(L.. c.--3,442,
3q0 ft.
Lg ? ft.
L-a,,,e, Ca Nc7 '.., .
o 15. OUTER CASING (for multi -cased wells) OR LINER (jf ap limbic)
FROM
TO
DIAMETER
THICKNESS
MATERIAL
0 ft.
//3Sft.
C./ in.
SfA 0
pvc_
16. INNER CASING OR TUBING (geothermal closed -loop)
FROM
TO DIAMETER giiTHICKNESS
MATERIAL
ft.
ft.
ft.
ft. I 'in.
17. SCREEN
FROM
TO
DIAMETER
SLOT SIZE
THICKNESS
MATERIAL
Car ft.
97$ft
r in.
r d it.,
5. , eo
Pc'c
ft.
ft.
in.
18. GROUT
FROM
TO
MATERIAL
EMPLACEMENT METHOD & AMOUNT
O ft.
eo ft.
Jf
FP/t'!I•C lT
TrP,M/ i.e_/'AI Pipe
ft.
ft
Q/ - 9% J,L
PSt'f, /�-
ft.
ft'
g/ 0 6 /fir
/. e Ticottc
19. SAND/GRAVEL PACK (if applicable)
FROM
TO
MATERIAL
EMPLACEMENT METHOD
ft.
ft,
f IA
/10fvra./- Caat,..
ft.
ft.
�V
20. DRILLING LOG (attach additional sheets if necessary)
FROM
TO
DESCRIPTION (color, hardness, soiUrock type, grain size, etc.)
ft.
ft.
ft.
ft.
5.:e .� -• rT t-'.e 1
A /{ �/e.
0 ft.
')U ft.
"To..., Om..? a .7i,, .: St: c
"-
7 G ft.
t '7 Ct ft.
C.; r -. i - 5 < Z2, L✓ C el
'76 ft.
ft.
lei ..J , . h c C-i
ft.
ft.
ft.
ft.
21. REMARKS
* /•-&. rt 2 O- c,..1 1•V ire /.Ay- Dr.7/i4o,
* G rI,.Ji`, i'7 i N ' / i 4 i'6r-iniv - ss /(s ee,r43 -4.,
22. Certification:
Gallo/is' `a
a ', . .(<21_,c 42/2o
Signature ofCenified Well Contractor Date
ljy:gigrring thi.sfornr. 1 hereby certify that the lien()) was (were) constructed in accordance with
/�A NCA(.' 02C .0100 or ISA,V(:AC 02(' .0200 Well ('onttruclion Standards and that a copy
of dais record has been provided to the well owner.
O1% Site diagram or additional well details:
ou m Ty* the back ot'this
Over' in Remarks Box). You may also attach additional pages if necessary.
24:s�SUBMITTAL INSTRUCTIONS
provide
s, page to p ide additional well construction info
Submit this GW-1 within 30 days of well completion per the following:
24a. For All Wells: Original form to Division of Water Resources (DWR),
Information Processing Unit, 1617 MSC, Raleigh, NC 27699-1617
24b. For Injection Wells: Copy to DWR, Underground Injection Control (IUC)
Program, 1636 MSC, Raleigh, NC 27699.1636
24c. For Water Supply and Open -Loop Geothermal Return Wells: Copy to the
county environmental health department of the county where installed
24d. For Water Wells producing over 100,000 GPD: Copy to DWR, CCPCUA
Permit Program, 1611 MSC, Raleigh, NC 27699-1611

TrueGyde Steer : Directional Data Report
Job Name 20-191 HIW-10 Line Az 175.9°
Service Company Sharewell H.D.D. Customer Ellingson/DTD
Location Jacksonville, NC Description Horizontal Injection Well
Product Size/Type Probe S/N
Survey MD CL Away Lateral Elev Incl Raw Az Plg Az Pilot Rad Reamed R DLS DS Probe G Total H -
Tie -In 0.00 N/A -429.59 -14.71 -5.13 70.25 186.29 186.29 N/A N/A N/A TI N/A N/A
1 16.15 16.15 -414.64 -11.98 -10.59 70.25 186.29 186.29 N/A N/A N/A KB N/A N/A
2 47.99 31.84 -385.00 -6.96 -21.09 71.23 184.83 184.83 N/A N/A N/A KB N/A N/A
3 79.29 31.30 -355.62 -3.18 -31.19 71.13 181.72 181.72 5162 46752 1.11 KB N/A N/A
4 110.98 31.69 -325.60 -1.01 -41.09 72.46 178.41 178.41 2459 3493 2.33 KB N/A N/A
5 142.80 31.82 -295.22 0.02 -50.49 73.17 177.36 177.36 2800 4226 2.05 KB N/A N/A
6 174.81 32.01 -264.58 0.55 -59.74 73.27 176.51 176.51 2557 3673 2.24 KB N/A N/A
7 206.68 31.87 -234.13 0.52 -69.13 72.46 176.60 175.27 INF INF 0.00 KB N/A N/A
8 237.99 31.31 -204.34 0.12 -78.78 71.61 175.05 175.05 3496 6007 1.64 KB N/A N/A
9 269.45 31.46 -174.25 0.15 -87.92 74.63 176.92 176.92 3987 7701 1.44 KB N/A N/A
10 301.47 32.02 -143.23 0.76 -95.85 76.69 177.23 177.23 1284 1519 4.46 KB N/A N/A
11 333.02 31.55 -112.38 0.89-102.45 79.16 175.14 175.14 721 789 7.94 KB N/A N/A
12 364.59 31.57 -81.25 0.17-107.64 81.92 174.08 174.08 748 821 7.66 KB N/A N/A
13 396.28 31.69 -49.79 -0.16-111.39 84.47 176.62 176.62 698 762 8.21 KB N/A N/A
14 428.36 32.08 -17.81 0.08-113.86 86.72 175.90 176.09 723 791 7.93 KB N/A N/A
15 460.29 31.93 14.10 0.25-114.96 89.32 175.90 176.42 741 812 7.73 KB N/A N/A
16 492.18 31.89 45.98 0.43-115.05 90.36 175.50 176.11 933 1048 6.14 KB N/A N/A
17 524.29 32.11 78.09 0.83-115.04 89.66 177.19 177.19 1870 2397 3.06 KB N/A N/A
18 556.32 32.03 110.11 1.55-115.12 90.05 177.25 177.25 7537 INF 0.76 KB N/A N/A
19 587.54 31.22 141.33 1.91-114.79 91.17 175.98 175.98 6745 34343 0.85 KB N/A N/A
20 618.66 31.12 172.44 1.73-114.37 90.36 175.21 175.21 7724 INF 0.74 KB N/A N/A
21 650.05 31.39 203.83 1.42-114.29 89.94 175.54 175.54 48821 INF 0.12 KB N/A N/A
22 681.41 31.36 235.19 1.21-114.44 89.52 175.57 175.57 3260 5439 1.76 KB N/A N/A
23 713.18 31.77 266.96 0.93-114.69 89.59 175.00 175.32 7033 47795 0.81 KB N/A N/A
24 744.86 31.68 298.64 0.60-114.78 90.08 175.32 175.38 37464 INF 0.15 KB N/A N/A
25 776.19 31.33 329.97 0.35-114.75 90.00 175.55 175.55 11314 INF 0.51 KB N/A N/A
26 807.43 31.24 361.21 0.15-114.73 90.09 175.62 175.62 10800 INF 0.53 KB N/A N/A
27 838.83 31.40 392.60 -0.04-114.53 90.62 175.56 175.56 10064 INF 0.57 KB N/A N/A
28 870.65 31.82 424.42 -0.12-114.51 89.46 176.03 176.03 10023 INF 0.57 KB N/A N/A
29 902.12 31.47 455.89 0.15-114.74 89.70 176.03 176.84 13911 INF 0.41 KB N/A N/A
30 934.20 32.08 487.97 0.48-114.86 89.88 176.84 176.20 7384 INF 0.78 KB N/A N/A
31 965.95 31.75 519.72 0.54-114.86 90.13 176.78 175.91 8150 INF 0.70 KB N/A N/A
32 970.95 5.00 524.72 0.54-114.85 90.13 175.91 175.91 9171 INF 0.62 KB N/A N/A
Bit 980.97 10.02 534.74 0.53-114.82 90.13 175.91 175.91 N/A N/A N/A PR N/A N/A
pieiciFi,„, .:37..........\

E!
Profile
3
2 1
2
Plan
•
.g
4'4
ana
7,111,
ik4e
JAN 12 `11‘
BY:

WELL CONSTRUCTION RECQQRD (GW-11
1. Weill Contractor information:
I� r -
Well Contractor Name
?_789A
NC Well Contractor Certification Number
D.7:0 n..v,�
flfti 2 t.i►LI
BY:
Company Name
2. Well Construction Permit 4: V C Wa 003 '7 7 ?
List all applicable well construction permits (i.e. UK', County, State, Variance. ere)
3. Well Use (check well use):
Water Supply Well:
❑Agricultural
❑Geothermal (Heating/Cooling Supply)
❑ 1 nd u st ri a l /Commercial
❑irrigation
Non -Water Supply Well:
°Monitoring
Injection Well:
❑Aquifer Recharge
❑Aquifer Storage and Recovery
❑Aquifer Test
❑Experimental Technology
❑Geothermal (Closed Loop)
❑Geothermal (Heating/Cooling Return)
°Municipal/Public
❑Residential Water Supply (single)
°Residential Water Supply (shared)
❑Wells > 100,000 GPD
❑Recovery
./gGroundwater Remediation
❑Salinity Barrier
OStormwater Drainage
DSubsidence Control
❑Tracer
❑Other (explain under 421 Remarks)
4. Date Well(s) Completed: 61/2 11--43 Well IDk / 1 t'✓ --
5a. Well Location:
C_ q mr L,�, jv.
P
Facility/Owner Name
.!� 4e ee OV i3•
Physical Address, City, and Zip
O f?,: /n W
Facility iD# (if applicable)
VS MC COMy'1 jtin
e -
N/A
County Parcel identification No. (PiN)
5b. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one lat/long is sufficient)
to 4- T` , 67,2-474198 N 77,319cam 7
;nrrty 3V. G °alto 6.524 - 77.3'14720393
6. Is(are) the well(s): APermanent or ❑Temporary
W
For Internal Use Only:
7654E
, WATER ZONES
OM
TO
DESCRIPTION
O ft.
il.
70 ft.
ci ft.
700 ft,
-.
15.OUTER CASING (for multi -cased wells) OR LINER (if ap !feeble)
FROM
TO
DIAMETER
THICKNESS
MATERIAL
O ft.
37Oft.
4.1/ in.
SP. ,880
?tic
16. INNER CASING OR TUBING (geothermal closed -loop)
FROM
TO I. DIAMETER rf.r,THICKNESS
MATERIAL
ft.
ft.
ft.
ft. I •in.
17. SCREEN
FROM
TO
DIAMETER
SLOT SIZE
THICKNESS
MATERIAL
70 ft.
-75-0 ft,
cf in.
t d it,
Skit 80
Pt"c
ft.
ft.
in.
18. GROUT
FROM
TO
MATERIAL
EMPLACEMENTMETHOD & AMOUNT
o ft'
'9 d ft.
igcartll•O
71-er t e - (r%Y ?. fJ e,
ft.
ft.
3 '7, - r6
t�($rtht.aQ
ft.
ft.
3 67!) i6
/3e,0.>1.t
19. SAND/GRAVEL PACK (if applicable).
FROM
TO
MATERIAI.
EMPLACEMENT METHOD
ft.
ft.
iv `r�?
N�fv% - CAaf.!
f1.
ft.
IA
20. DRILLING LOG (attach additional sheets if necessary)
FROM
TO
DESCRIPTION (color, hardness, soil/rock type, grain size, etc.)
ft.
ft.
ft.
ft.
n e
SaLarr -. Aff F, ..0..s - r tC,
p ft.
Co ft.
O rr4 ile 'To", 517: -(, s, at.4.s'
(3© ft.
76 S ft•
cpr e r Ctarf'(g. -C-1 a.0, e
Je,S ft.
e;7- ft.
Cara e-("(Oa(Ane CeAteortr# rci,,Or
ft.
ft.
- rtsedi Ft-
f
ft.
ft.
21. REMARKS
# Hors itai4a..1 Wirt? /,sly Dr: Oi4,
*Z. GrrJI`- MIN qti(//) i6ei 1pe.e - v" 74,t- t . tfker e1:4{,
22. Certification:
Signature of Certified Well Contractor
_P ">y,%3vsigning this fora. I hereby certify that the wells, was (were) constructed in accordance with
7. Is this a repair to an existing well: ❑Yes or IKNo ^ e, \ ?. t,....; 15A N(AC 02C .0100 or I5A NCAC 02(' .0200 Well Construction Standards and that a copy
!f this is a repair, fill out known u•e!l conatrncvion information and erpl[erh�itg
ztvol• the of this record has been provided to the well owner.
repair under .21 remarks section or on the bock of this form.
8. For Geoprobe/DPT or Closed -Loop Geothermal Wells havtnrt�ll�sale�l Y use the back of this page to provide additional well construction info
construction, only 1 GW-I is needed. Indicate TOTAL NUMBE[Zjdl wells rdd'See Over' in Remarks Box). You may also attach additional pages iCnecessa
9 C:1(ans' K 2'O
drilled: ' `r ,"
r t •` �� f4, SUBMITTAL INSTRUCTIONS
4' 103. Site diagram or additional well details:
Yo `a'
ry
9. Total well depth below land surface: 75O RAS (ft.)
For multiple hif ells list all depths different (example- 3@200' 200' and 2 cc I00')
10. Static water level below top of casing:
If water level is above casing. use •• • "
1 . AA.M . (in.)
11. Borehole diameter:
alaPf®.r
12. Well construction method: /'1Cf " K4iQr
(i.e. auger, rotary, cable, direct push, etc.)
(ft)
FOR WATER SUPPLY WELLS ONLY:
13a. Yield (gpm) N/A Method of test:
,VtAt
/ a%q/2-v
Date
Submit this GW-1 within 30 days of well completion per the following:
24a. For All Wells: Original form to Division of Water Resources (DWR),
Information Processing Unit, 1617 MSC, Raleigh, NC 27699-1617
24b. For Injection Wells: Copy to DWR, Underground Injection Control (IUC)
Program, 1636 MSC, Raleigh, NC 27699-1636
24c. For Water Supply and Open -Loop Geothermal Return Wells: Copy to the
county environmental health department of the county where installed
24d. For Water Wells producing over 100,000 GPD: Copy to DWR, CCPCUA
Permit Program, 1611 MSC, Raleigh, NC 27699-1611
13b. Disinfection type:
Amount:

TrueGyde Steer : Directional Data Report
Job Name 20-191 HIW-2 Line Az 154.1`
Service Company Sharewell H.D.D. Customer Ellingson/DTD
Location Jacksonville, NC Description Injection Well
Product Size/Type 4"/PVC Probe S/N 004
Survey MD CL Away Lateral Elev Inc' Raw Az Pig Az Pilot Rad Reamed R DLS DS Probe G Total H 1
Tie -In 0.00 N/A -369.96 6.49 0.63 74.29 154.31 154.31 NIA N/A N/A TI N/A N/A
1 12.27 12.27 -358.15 6.55 -2.70 74.28 154.39 154.39 N/A N/A N/A KB N/A N/A
2 43.82 31.55 -327.92 6.86 -11.74 72.40 154.95 154.95 N/A N/A N/A KB N/A N/A
3 75.84 32.02 -297.58 6.90 -21.96 70.40 153.38 153.38 1117 2317 5.13 KB N/A N/A
4 107.30 31.46 -267.84 6.83 -32.21 71.56 154.49 154.49 2005 4918 2.86 KB N/A N/A
5 138.61 31.31 -238.03 6.80 -41.79 72.81 153.56 153.56 13247 INF 0.43 KB N/A N/A
6 170.30 31.69 -207.57 6.29 -50.53 75.17 152.68 152.68 1135 1717 5.05 KB NIA N/A
7 202.17 31.87 -176.61 5.63 -58.05 77.52 153.04 153.04 913 1251 6.28 KB NIA N/A
8 234.18 32.01 -145.24 4.97 -64.33 79.84 152.72 152.72 779 1008 7.36 KB N/A N/A
9 266.00 31.82 -113.84 3.86 -69.36 81.99 152.00 151.39 804 1050 7.13 KB N/A N/A
10 297.69 31.69 -82.38 2.11 -72.67 85.99 152.00 150.43 646 797 8.87 KB N/A N/A
11 328.99 31.30 -51.16 0.48 -74.28 88.14 152.50 151.75 654 812 8.75 KB N/A N/A
12 360.83 31.84 -19.34 -0.47 -74.83 89.85 153.20 152.98 691 870 8.29 KB N/A N/A
13 392.07 31.24 11.89 -0.36 -74.89 89.94 155.59 155.59 1369 2320 4.19 KB N/A N/A
14 423.40 31.33 43.22 0.24 -74.83 90.27 154.76 154.76 2540 10572 2.26 KB N/A N/A
15 454.35 30.95 74.17 0.26 -74.77 89.98 153.47 153.47 41218 INF 0.14 KB N/A N/A
16 486.03 31.68 105.85 0.21 -74.83 89.78 154.50 154.50 33647 INF 0.17 KB N/A NIA
17 517.80 31.77 137.61 0.11 -74.86 90.11 153.29 153.29 33805 INF 0.17 KB N/A NIA
18 549.16 31.36 168.97 0.23 -74.94 89.60 155.56 155.32 14295 INF 0.40 KB N/A N/A
19 580.55 31.39 200.36 0.75 -75.19 89.51 154.75 154.75 20058 INF 0.29 KB N/A N/A
20 611.67 31.12 231.48 1.07 -75.29 90.10 154.58 154.58 INF INF 0.01 KB N/A NIA
21 642.89 31.22 262.69 0.82 -75.16 90.39 153.99 152.65 6798 INF 0.84 KB N/A N/A
22 674.92 32.03 294.72 0.33 -74.99 90.21 152.62 153.78 7724 INF 0.74 KB N/A N/A
23 707.03 32.11 326.82 0.71 -75.01 89.72 151.98 155.74 14378 INF 0.40 KB N/A NIA
24 738.92 31.89 358.67 2.25 -75.15 89.79 155.95 157.94 9170 INF 0.62 KB N/A N/A
Bit 749.74 10.82 369.47 2.98 -75.19 89.79 155.95 157.94 N/A N/A N/A PR N/A N/A
iiitE........;;;wriir
JAN 1 2 2621
BY:

•A San
iiji
i
t
iA0
Er;
i.gi;°
!Ili
i
I p
Tr
1,1
''il
IP
!II
IHI
'HT half
01*1
i if! ,s';
; B.
a
fi E,,-..,..„--,i.vir„._:,
,,,
JAN 1 2 2g
azi
ii BY:

WELL CONSTRUCTION RECORD (GW-1)
1. Well Contractor Information:
M‹.1 r k £'.• S i le r Sr 4; + ! " 1140
•
Well Contractor Name
2 789 A JAN 12
NC Well Contractor Certification Number
/ n7, v. D
BY:
Company Name 2. Well Construction Permit #: Vic. -- wo O 02 9 9 9J "
List all applicable well construction permits (i.e. (NC, County, Slate, Variance, etc)
3. Well Use (check well use):
For Internal Use Only:
14. Wii; ATER ZONES
Water Supply Well:
❑Agricultural
❑Geothennal (Heating/Cooling Supply)
❑Ind ustrial/Commercial
❑ Irrigation
Non -Water Supply Well:
❑Monitoring
Injection Well:
❑Aquifer Recharge
❑Aquifer Storage and Recovery
DAquifer Test
❑Experimental Technology
❑Geothermal (Closed Loop)
❑Geothermal (Heating/Cooling Retum)
❑Municipal/Public
❑Residential Water Supply (single)
❑Residential Water Supply (shared)
❑ Wells > 100,000 GPD
❑Recovery
XGroundwater Reined iation
❑Salinity Barrier
❑Stormwater Drainage
❑Subsidence Control
❑Tracer
❑ Other (explain under 421 Remarks)
4. Date Well(s) Completed: of/t,120 Well ID# 1 /W 3
5a. Well Location:
Ce4M Lejatine_
Facility/Owner Name
,J"i l C' 6'e O V js.
Physical Address. City, and Zip
m/A
Facility ID1? (if applicable)
VS MC COMP L %c.'n�,
A/. �' .
N/A
County
Parcel Identification No. (PIN)
5b. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one lat/long is sufficient)
S-C.l,n++.e et. S a% 2_N,*
6. Is(are) the wetl(s): Nermanent or ❑Temporary
270 fL
FROM
TO
f 9 S ft.
DESCRIPTION
p,el-Op-
e.u4'p _
15. OUTER CASING (for multi -cased wells) OR LINER (if apcae li bl )
FROM
O ft.
6 T fL
TO
c60ft.
DIAMETER
9 in.
THICKNESS MATERIAL
5?L 80 ?Vc
16. INNER CASING OR TUBING (geothermal closed -loop)
FROM
ft.
TO
ft.
17. SCREEN
ft.
IL ,
DIAMETER e4r.y
THICKNESS
MATERIAL
'in.
FROM
TO
DIAMETER
SLOT SIZE
THICKNESS
MATERIAL
416011
ego ft.
et in.
, 0 tt�
4190
/DvC
ft.
ft.
in.
18. GROUT
FROM
O ft.
ft.
TO
610 ft,
ft.
MATERIAL
pt?�fit•�rl7G,�f'
EMPLACEMENT METHOD & AMOUNT
Tre i - /'/y Piet
ft.
ft.
7. s r.Yd
A lCe
19. SAND/GRAVEL PACK (if applicable)
FROM
To
MATERIAL
EMPLACEMENT METHOD
ft.
ft.
ft.
ft.
A//A
Aid-orc? l - Quit..
20. DRILLING LOG (attach additional sheets if necessary)
FROM
ft.
TO
ft.
DESCRIPTION (color, hardness, soil/rock type, grain size, etc.)
ft.
ft,
0 ft.
7 ft.
y1 fL
2.1 o ft.
s-1 C(a (is
7'lo ft.
..CS-' ft'
SS1 ft,
4 T ft.
f--pt•P. C. ka..yne
4.6 war- C. fi(t3 if e i e (/.haf,f2
ft.
ft.
21. REMARKS
)ter, ao-rlc ./ W tr/,/a bt r i/1"),
y'1/6 &Picinet " v'C/lss /y t'rs+vne,
22. Ce�rtiification:,v �}
Vii„
{ ,.' ,)Signature of Certified We1I Contractor
,+' -'•, bra By signing this forn.1 hereby certify that the well(s) was (were) constructed in accordance with
7. Is this a repair to an existing well: ❑Yes or IkNo ((0'"' Ce' WA N(AC 02C.0100 or 15A NCAC 02C'.0200 Well Construction Standards and that a copy
'Irks is a repair, fill out known well construction information and ei�( the?wtt7ture of ((oe ��t� this`q(�d has been provided to the well owner.
repair under -21 remarks section or on the back of this fa•nt. ,. �' t�. )
r7, ite diagram or additional well details:
8. For Geoprobe/DPT or Closed -Loop Geothermal Wells having�t�samee,�r`-P';81t may use the back of this page to provide additional well construction info
constriction, only I GW-1 is needed. Indicate TOTAL NUMBER of well6c\'< •r„6`--`a d'See Over' in Remarks Box). You may also attach additional pages if necessary.
drilled: ,•\ ,t
�,,,�++441 ,4` 24. SUBMITTAL INSTRUCTIONS
9. Total well depth below land surface: e e 9C b't (ft,)
For multiple ells list all depths Ifdifferem (example- 3 r(J200'and 2 /Om) Submit this GW-1 within 30 days of well completion per the following:
10. Static water level below top of casing: Ape ra Je L[ , t•%
if water level is above casing. use "' "
iI
Galla2r
11. Borehole diameter:
114111. (in.)
12. Well construction method: Al vJ - KOtar'
(i.e. auger, rotary. cable, direct push, etc.)
K�o
/ o (6 /Z a
Date
(fh) 24a. For All Wells: Original form to Division of Water Resources (DWR),
Information Processing Unit, 1617 MSC, Raleigh, NC 27699-1617
FOR WATER SUPPLY WELLS ONLY:
13a. Yield (gpm) /(//, Method of test:
13b. Disinfection type: Amount:
A//A
24b. For Injection Wells: Copy to DWR, Underground Injection Control (IUC)
Program, 1636 MSC, Raleigh, NC 27699-1636
24c. For Water Supply and Open -Loop Geothermal Return Wells: Copy to the
county environmental health department of the county where installed
24d. For Water Wells producing over 100,000 GPD: Copy to DWR, CCPCUA
Permit Program, 1611 MSC, Raleigh, NC 27699-1611
ft.

TrueGyde Steer : Directional Data Report
Job Name 20-191 HIW-3 Line Az 154.1°
Service Company Sharewell H.D.D. Customer Ellingson/DTD
Location Jacksonville, NC Description Horizontal Injection Well BY:
Product Size/Type 4"/PVC Probe S/N 005
JAN 12201
Survey MD CL Away Lateral Elev Inc' Raw Az Pig Az Pilot Rad Reamed R DLS DS Probe G Total H T
Tie -In 0.00 N/A -457.91 5.76 1.23 74.86 154.14 154.14 N/A N/A N/A TI N/A N/A
1 9.47 9.47-448.77 5.77 -1.24 74.86 154.14 154.14 N/A N/A N/A KB N/A N/A
2 41.02 31.55 -418.49 5.80 -10.10 72.53 154.14 154.14 N/A N/A N/A KB N/A N/A
3 73.04 32.02 -387.83 5.74 -19.35 73.90 153.81 153.81 4359 37980 1.31 KB N/A N/A
4 104.50 31.46 -357.69 5.58 -28.34 72.89 153.91 153.74 2764 4135 2.07 KB N/A N/A
5 135.81 31.31 -327.70 5.31 -37.34 73.70 151.80 153.36 4642 10542 1.23 KB N/A N/A
6 167.50 31.69 -297.27 4.94 -46.19 73.86 153.85 153.41 INF INF 0.04 KB N/A N/A
7 199.37 31.87 -266.66 4.07 -55.00 74.03 153.57 151.52 4768 11191 1.20 KB N/A N/A
8 231.38 32.01 -235.95 2.92 -63.94 73.54 151.19 152.35 34223 INF 0.17 KB N/A N/A
9 263.19 31.81 -205.33 2.28 -72.56 75.03 152.21 153.40 4686 10516 1.22 KB N/A N/A
10 294.88 31.69 -174.65 2.33 -80.47 76.04 153.95 154.93 2723 4023 2.10 KB N/A N/A
11 326.18 31.30 -144.12 2.78 -87.36 78.54 154.80 154.93 1086 1250 5.27 KB N/A N/A
12 358.02 31.84 -112.76 2.82 -92.85 81.62 153.00 153.38 824 915 6.95 KB N/A N/A
13 389.26 31.24 -81.77 2.64 -96.73 84.09 153.38 154.12 671 731 8.53 KB N/A N/A
14 420.59 31.33 -50.54 2.44 -99.24 86.70 153.66 153.31 663 721 8.64 KB N/A N/A
15 451.54 30.95 -19.62 2.12-100.33 89.27 153.27 153.68 700 767 8.18 KB N/A N/A
16 483.22 31.68 12.06 1.98-100.43 90.39 153.68 153.96 855 955 6.70 KB N/A N/A
17 514.99 31.77 43.83 2.07-100.29 90.10 153.61 154.53 1591 1972 3.60 KB N/A N/A
18 546.35 31.36 75.19 2.28-100.00 90.97 154.35 154.40 3195 5197 1.79 KB N/A N/A
19 577.74 31.39 106.57 1.95 -99.72 90.05 152.94 152.54 15928 INF 0.36 KB N/A N/A
20 608.86 31.12 137.69 1.44 -99.65 90.19 152.66 153.75 INF INF 0.10 KB N/A N/A
21 640.08 31.22 168.91 1.36 -99.67 89.76 153.70 154.13 4438 9804 1.29 KB N/A N/A
22 672.11 32.03 200.94 1.61 -99.56 90.62 154.97 154.91 9486 INF 0.60 KB NIA N/A
23 704.22 32.11 233.05 1.50 -99.53 89.47 153.84 152.87 7589 INF 0.76 KB N/A N/A
24 736.11 31.89 264.93 0.94 -99.68 89.99 152.47 153.26 23922 INF 0.24 KB N/A N/A
25 768.04 31.93 296.86 0.98 -99.79 89.64 154.08 155.03 5609 16508 1.02 KB N/A N/A
26 800.12 32.08 328.94 1.14 -99.83 90.20 154.69 153.70 7527 INF 0.76 KB N/A N/A
27 829.53 29.41 358.34 1.38 -99.87 89.64 154.15 155.42 15293 INF 0.37 KB N/A N/A
Bit 840.35 10.82 369.16 1.64 -99.94 89.64 154.15 155.42 N/A N/A N/A PR N/A N/A
c,,.. 4a flnnn
')n 1ny 1-II1Al'1 in Pana 1 of 1

1;2i
a
8
ir.....4...•,...,,,,,„ ...... itzk.,..0.vot.,
JAN i 2 2021 li
RY:

10. Static water level below top of casing: R PP lox Z 2.0
If water level is above casing. use " "
11. Borehole diameter: 1 2. nt') M • (in.)
ti
12. Well construction method: Cf) ' Kd7'Gtr
(i.e. auger, rotary, cable, direct push, etc.)
WELL CONSTRUCTION RECORD (GW=11)„ For Internal Use.Qnly:
�r1 •
uY�
1. VI'ell Contractor Information:
Met : £ .cei ter Sr
Well Contractor Name
2.789 A
NC Well Contractor Certification Number
ttt�
BY:
n t- 6 4r
a.s al".• w ea as
1 ;di` ELL"" # 110 14. WATER ZONES
FROM TO
AEd 2 2u21
Company Name
2. Well Construction Permit 4: VPC. • WU 003'7'? 9j -
List all applicable well con.ssrucu w, permits (i.e. UIC, County, State, Variance. etc)
3. Well Use (check well use):
Water Supply Well:
❑Agricultural
❑Geothermal (Heating/Cooling Supply)
❑Industrial/Commercial
❑Irrigation
ZO ft.
,yy7 ft.
s0 ft.
6.7,"ir.
DESCRIPTION
lm- Crk., f, , S"cw.,Qf
C. ({4,.1€.__
15. OUTER CASING (for multi -cased wells) OR LINER (if ap licable)
THICKNESS MATERIAL
SQL. 8 d i'' N�
16. INNER CASING OR TUBING (geothermal closed -loop)
TO
FROM
FROM
O ft.
ft.
TO
3 r 21t•
ft.
ft.
ft.
C/ in.
DIAMETER 414
THICKNESS
MATERIAL
in.
❑Municipal/Public
❑Residential Water Supply (single)
OResidential Water Supply (shared)
❑Wells > 100,000 GPD
Non -Water Supply Well:
❑Monitoring ❑Recovery
Injection Well:
Aquifer Recharge
❑Aquifer Storage and Recovery
❑Aquifer Test
❑Experimental Technology
❑Geothermal (Closed Loop)
OGeothermal (Heating/Cooling Return)
Ji(Groundwater Remediation
❑Salinity Barrier
❑Stormwater Drainage
❑Subsidence Control
❑Tracer
❑Other (explain under #21 Remarks)
4. Date Well(s) Completed: 0424
5a. Well Location:
Cq!►'lr� Letiain e
Facility/Owner Name
Site 6'e ovis.
Physical Address. City, and Zip
County
WeII ID# f /l W"- d7C
N/ 4
Facility ID# (if applicable)
Us M1~ Crtr►+t^t �� jcPnZ
/✓, e,
N/A
Parcel Identification No. (PIN)
5b. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one lat/long is sufficient)
tit 3KG'7A5(Gc/l! 77.3f'oOC9f(f
N
;wilt 3ct1.`7//8 y(o
6. Is(are) the well(s): ,Permanent or ❑Tem orary u, tN'`y'gneture of Certified Well Contractor Date
P 10 �. }, , `signing this form. I hereby certify that the well(s) was (were) constructed in accordance with
7. Is this a repair to an existing well: ❑Yes or )KN � r1 � 5 - N(:AC 0 0100 or 15A NCAC 02C .0200 Well ('onstruwion Standards and that a copy
a' 4,-, A\ 1.
If this is a repair, fill out known well nnstrucdon information and erg/ck'n Inc nature o4lu ,f this rettoj as been provided to the well owner.
repair under .21 remarks section or on the back of this form. PN 1r� '(':51
r(23: $ite diagram or additional well details:
>'+art`'' 1
8. For Geoprobe/DPT or Closed -Loop Geothermal Wells having the s 1 r r E') may use the back of this page to provide additional well construction info
construction, only 1 GW-1 is needed. Indicate TOTAL NUMBER [, )1 ;;at L' (add See Over' in Remarks Box). You may also attach additional pages if necessary.
drilled: v�
24. SUBMITTAL INSTRUCTIONS
9. Total well depth below land surface: 79r!-P Z._ U9•q b (ft.)
for multiple. wells list all depths If (Efferent (example- 3@200' and 2@/00')
e
17. SCREEN
FROM
3
TO
7'9 2ft•
DIAME TER
C in.
SLOT SIZE
,0IC,
THICKNESS
9'480
MATERIAL.
?tic
ft.
ft.
in.
18. GROUT
FROM
0 ft.
ft.
TO
80 ft.
ft.
MATERIAL
2-3 q9/4
EMPLACEMENT METHOD & AMOUNT
T-�P,Mt4° - 1111 ?,Pt.
ft.
fr.
Z ro(f
19. SAND/GRAVEL PACK (if applicable)
FROM
To
ft.
ft.
ft.
ft.
MATERIAL
/V/sal
EMPLACEMENT METHOD
Nnfvt-a /
20. DRILLING LOG (attach additional sheets if necessary)
FROM
TO
ft.
ft.
DESCRIPTION (color, hardness, soil/rock type, grain sae, etc.)
ft.
ft.
A tf e. -e .19
ft.
Z c./r1 ft.
Z y ft.
44:yd ft.
N7 ft.
ft.
SFo o ft•
fl rl7 ft.
/t',T ft.
ft.
ra-u,St:e(,, 4-(0r9AnisCs'- A.e0. -
Glee? , a /•Levy 3F, C(G-?
tippet C. b(rr y,
21. REMARKS
*
* ti ? ro Ii r ); (7%, /!a &./"Ictfv,e-. vs /(► bet .'Itq
22. Certification: g GC?((Q/tr r( a0
(ft.)
FOR WATER SUPPLY WELLS ONLY:
13a. Yield (gpm) /f//A Method of test:
/V / A
Submit this GW-1 within 30 days of well completion per the following:
24a. For All Wells: Original form to Division of Water Resources (DWR),
Information Processing Unit, 1617 MSC, Raleigh, NC 27699-1617
24b. For Injection Wells: Copy to DWR, Underground Injection Control (IUC)
Program, 1636 MSC, Raleigh, NC 27699-1636
24c. For Water Supply and Open -Loop Geothermal Return Wells: Copy to the
county environmental health department of the county where installed
24d. For Water Wells producing over 100,000 GPD: Copy to DWR, CCPCUA
Permit Program, 1611 MSC, Raleigh. NC 27699-1611
DIAMETER
13b. Disinfection type:
Amount:

TrueGyde Steer : Directional Data Report
Job Name 20-191 HIW-4 Line Az 165.5°
Service Company Sharewell H.D.D. 13y:
Customer Ellingson/DTD
Location Jacksonville, NC Description Horizontal Injection Well
Product Size/Type Probe S/N
Survey MD CL Away Lateral Elev Incl Raw Az Pig Az Pilot Rad Reamed R DLS DS Probe G Total H
Tie -In 0.00 NIA -306.17 -7.47 -0.01 74.78 165.23 165.23 N/A N/A N/A TI N/A N/A
1 12.12 12.12 -294.48 -7.53 -3.19 74.78 165.23 165.23 N/A N/A N/A KB N/A NIA
2 43.67 31.55 -263.99 -7.38 -11.30 75.44 166.00 166.30 N/A N/A N/A KB N/A N/A
3 75.69 32.02 -232.98 -6.96 -19.30 75.63 166.26 166.26 5102 INF 1.12 KB N/A N/A
4 107.15 31.46 -202.41 -5.93 -26.61 77.50 169.00 168.58 2002 2769 2.86 KB N/A N/A
5 138.46 31.31 -171.90 -4.81 -33.56 76.85 168.58 166.63 3852 8299 1.49 KB N/A N/A
6 170.15 31.69 -140.90 -3.81 -40.04 79.53 165.62 168.07 1388 1723 4.13 KB N/A N/A
7 202.02 31.87 -109.44 -2.08 -44.76 83.43 165.62 169.22 917 1050 6.25 KB N/A N/A
8 234.03 32.01 -77.61 -0.69 -47.83 85.57 165.62 166.78 628 687 9.12 KB N/A N/A
9 265.85 31.82 -45.85 -0.33 -49.80 87.35 166.00 165.53 701 775 8.17 KB N/A N/A
10 ' 297.54 31.69 -14.17 -0.60 -50.31 90.81 165.53 164.47 742 825 7.73 KB N/A N/A
11 328.84 31.30 17.12 -0.92 -50.11 89.91 165.00 165.36 1252 1515 4.58 KB N/A N/A
12 360.68 31.84 48.96 -0.78 -49.96 90.64 166.16 166.16 1651 2144 3.47 KB N/A N/A
13 391.92 31.24 80.20 -0.50 -49.64 90.52 165.87 165.87 18647 INF 0.31 KB N/A N/A
14 423.25 31.33 111.53 -0.12 -49.73 89.14 166.51 166.51 7025 INF 0.82 KB N/A N/A
15 454.20 30.95 142.47 0.06 -49.71 90.95 165.15 165.15 17285 INF 0.33 KB N/A N/A
16 485.88 31.68 174.15 0.18 -49.45 89.99 166.29 166.29 10158 INF 0.56 KB N/A N/A
17 517.65 31.77 205.92 0.45 -49.17 91.01 166.29 165.70 2892 4867 1.98 KB N/A N/A
18 549.01 31.36 237.28 0.57 -49.11 89.20 165.71 165.71 3104 5462 1.85 KB N/A N/A
19 580.40 31.39 268.67 0.75 -49.28 90.18 165.32 165.96 28503 INF 0.20 KB N/A N/A
20 611.52 31.12 299.78 0.67 -49.46 89.16 165.47 164.76 2907 4948 1.97 KB N/A N/A
21 642.74 31.22 331.00 0.23 -49.89 89.26 164.43 164.63 INF INF 0.06 KB N/A N/A
22 674.77 32.03 363.02 -0.32 -50.02 90.28 165.20 164.38 54070 INF 0.11 KB N/A N/A
23 706.88 32.11 395.13 -0.47 -49.87 90.28 165.63 166.08 4878 14809 1.17 KB N/A N/A
24 738.77 31.89 427.01 0.20 -49.79 89.99 166.08 167.34 7537 INF 0.76 KB N/A N/A
25 770.70 31.93 458.94 0.74 -49.80 89.96 167.34 165.59 17176 INF 0.33 KB N/A N/A
26 780.70 10.00 468.94 0.75 -49.86 89.36 165.59 165.52 4597 INF 1.25 KB N/A N/A
Bit 791.52 10.82 479.76 0.75 -49.99 89.36 165.59 165.52 N/A N/A N/A PR N/A N/A

Profile
11
12
I
11
21
x7,
24
plan
•••,,
J /4 IV 1 41:1 II

e 66 Ovi5. vsM1! %'I..tmp LE�lt�i)Z
/✓. e
© ri V.0 vv N/A
County
WELL CONSTRUCTION RECORD (GW-1)
1. Well Contractor Information:
Mirk £'. J'1re -
Well Contractor Name
2 789 A
NC Well Contractor Certification Number
liECEFFIVit: WATER ZONES
J aka 1 7 2021
BY
Company Name
2, Well Construction Permit #: V r C • "' Wa G 03 'r 7 9J
List all applicable well construction permits (i.e. UIC, County, State. Variance, etc.)
3. Well Use (check well use):
Water Supply Well:
❑Agricultural
DGeothermal (Heating/Cooling Supply)
Olnd ustria l/Commercial
❑Irrigation
Non -Water Supply Welk
❑Monitoring
injection Well:
DAquifer Recharge
❑Aquifer Storage and Recovery
❑Aquifer Test
❑Experimental Technology
❑Municipal/Public
❑Residential Water Supply (single)
❑Residential Water Supply (shared)
❑Wells > 100,000 GPD
DRecovery
Groundwater Rernediation
❑Salinity Barrier
❑Stormwater Drainage
❑Subsidence Control
❑Geothermal (Closed Loop) ❑Tracer
❑Geothermal (Heating/Cooling Retum) ❑Other (explain under #21 Remarks)
4. Date Well(s) Completed: /0/211°•t Well ID# /'1/ W "S
5a. Well Location:
C.:(3 /Yip Lejak Y
Facility/Owner Name
N/A
Facility IN (if applicable)
Physical Address. City, and Zip
Parcel Identification No. (PiN)
5b. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one latllong is sufficient)
cct ct.s' / W .'( N
8. For Geoprobe/DPT or Closed -Loop Geothermal Wells havi i t
constntction, only 1 GW-I is needed. Indicate TOTAL NUA4tI'R of
drilled:
M
ft.
TO
/QO ft,
2.30 ft.
DESCRIPTION
. OUTER CASING (for multi -cased wens) OR LINER (if ap licae bl )
--FROM
ft.
TO
3 7 � ft.
DIAMETER
4./ in.
THICKNESS
MATERIAL
Set, el 0 vr
16. INNER CASING OR TUBING (geothermal closed -loop)
FROM TO
ft. ft.
ft.
17. SCREEN
ft.
DIAMETER ulf,.q
THICKNESS
MATERIAL
FROM
TO
DIAMETER
SLOT SIZE
THICKNESS
MATERIAI.
37 ! ft.
es/ ft.
1 in.
,dr6,
rrl f. OO
?vC
ft.
ft.
in.
18. GROUT
FROM
ft,
ft.
TO
ea ft.
ft.
MATERIAL
.57 - T Ttd
EMPLACEMENT METHOD & AMOUNT
Teem 'Ai rape
ft.
ft.
19. SAND/GRAVEL PACK (if applicable)
FROM
TO
MATERIAI,
EMPLACEMENT METHOD
ft.
ft.
ft,
ft.
A/A
Nature / - Cci u�
20. DRILLING LOG (attach additional sheets if necessary)
FROM
ft.
TO
ft.
DESCRIPTION (color, hardness, soiVrock type, grain size, etc,)
fr.
ft.
a ft.
(Z ft.
CZ ft.
04,4 ft.
C Let- roy .54
fLTk ft.
$ea ft.
ft.
Z3cs fr,
21. REMARKS
�� • ft.
ft.
T�We .�vbj(r Scsd•cer
ram(
? A c.'
*. rl �' P rk.f 1q//PE? /ri?'k�,. Dr //'r4,
jk GroLii--mix (7%i/6 keirlive -, S/ls,r Re6766.4.e
22. Certification: 9 Go! r'Qltt' 1 f .20
6. is are the wells .cp,s' Si natuureofCertified We]I Contractor ( ) O• ?Permanent or ❑Temporar I �O g Date
y`�+�' ..10 Hv.sigm' g This form. / hereby certify that the well(s) was (were) constructed in accordance with
7. Is this a repair to an existing well: ❑Yes or liNo ,k 1, 04\f`(' 02C.0100 or 15A NCAC 02('.0200 Well Construction Standards and that a copy
If this is• a repair, fill out known well construction information and explain yWtiture of die .: :%If is• record has been provided to the well owner.
repair under .21 remarks .secuon or on the back of this form. Js �f�r s' . 1
. .c.\ J��, • .Site •diagram or additional well details:
You may use the back of this page to provide additional well construction info
•ells (add 'See Over' in Remarks Box). You may also attach additional pages if necessary.
9. Total well depth below land surface: a Sl C+. %c), Z._ (ft.)
For multiple wells li.si all depths if different (example- 3@}a 200' and 2 a I00')
10. Static water level below top of casing:A, " ZC-
O-water level is above casing, use " • "
.r
11. Borehole diameter: f 2 f 'M • (in.)
12. Well construction method: ilv a - /c07tRr
(i.eauger, rotary, cable, direct plush, etc.)
(ft.)
FOR WATER SUPPLY WELLS ONLY:
13a. Yield (gpm)
N/A
Method of test:
/i/.Al
24. SUBMITTAL INSTRUCTIONS
Submit this GW-1 within 30 days of well completion per the following:
24a. For All Welts: Original form to Division of Water Resources (DWR),
Information Processing Unit, 1617 MSC, Raleigh, NC 27699-1617
24b. For injection Wells: Copy to DWR, Underground Injection Control (iUC)
Program, 1636 MSC, Raleigh, NC 27699-1636
24c. For Water Supply and Open -Loop Geothermal Return Wells: Copy to the
county environmental Health department of the county where installed
24d. For Water Wells producing over 100,000 GPD: Copy to DWR, CCPCUA
Permit Program, 1611 MSC, Raleigh, NC 27699-1611
13b. Disinfection type: .Amount:

TrueGyde Steer : Directional Data Report
Job Name 20-191 HIW-5 Line Az 165.5°
Service Company Sharewell H.D.D. Customer Ellingson/DTD
Location Jacksonville, NC Description Injection Well
Product Size/Type 4'/PVC Probe S/N 005
R74N kr it
, 2 By 2,8,1
41
Survey MD CL Away Lateral Elev Inci Raw Az Pig Az Pilot Rad Reamed R DLS DS Probe Total
tal H
Tie -In 1 0.00 N/A -359.21 -7.08 0.83 76.60 167.06 167.06 N/A N/A N/A TI N/A N/A
2 11.27 11.27 -348.25 -6.78 -1.78 76.60 167.06 167.06 N/A N/A N/A KB N/A N/A 3 42.82 31.55 -317.76 -6.06 -9.85 73.78 166.64 166.64 N/A N/A N/A KB N/A N/A
74.84 32.02 -286.97 -5.01 -18.57 74.59 168.25 168.28 2133 3632 2.69 KB N/A N/A
4 106.30 31.46 -256.64 -3.76 -26.83 74.97 168.80 167.44 3340 5574 1.72 KB N/A N/A
5 137.61 31.31 -226.52 -2.62 -35.28 73.72 167.63 167.89 INF INF 0.06 KB N/A N/A
6 169.30 31.69 -196.00 -1.33 -43.71 75.43 167.94 167.94 6443 29592 0.89 KB N/A N/A
7 201.17 31.87 -165.07 -0.32 -51.35 76.83 166.70 166.80 2922 4508 1.96 KB N/A N/A
8 233.18 32.01 -133.74 0.22 -57.86 79.71 166.61 166.18 914 1025 6.27 KB N/A N/A
9 265.00 31.82 -102.34 0.63 -63.02 81.62 166.20 166.32 886 989 6.47 KB N/A N/A
10 296.69 31.69 -70.88 0.48 -66.76 84.82 165.00 164.15 685 746 8.36 KB N/A N/A
11 327.99 31.30 -39.67 -0.20 -68.94 87.18 164.15 164.34 727 797 7.88 KB N/A N/A
12 359.83 31.84 -7.84 -0.30 -69.83 89.63 166.30 166.30 678 739 8.45 KB N/A N/A
13 391.07 31.24 23.39 -0.09 -70.08 89.46 166.30 165.47 1165 1358 4.92 KB N/A N/A
14 422.40 31.33 54.72 -0.06 -70.20 90.09 166.14 165.65 1859 2401 3.08 KB N/A N/A
15 453.35 30.95 85.67 -0.11 -70.31 89.51 165.88 165.18 44653 INF 0.13 KB N/A N/A
16 485.03 31.68 117.35 -0.62 -70.41 90.12 164.18 163.96 8157 INF 0.70 KB N/A N/A
17 516.80 31.77 149.11 -0.38 -70.31 90.23 166.42 167.90 38634 INF 0.15 KB N/A N/A
18 548.16 31.36 180.45 0.57 -69.93 91.16 167.66 166.59 3292 5458 1.74 KB N/A N/A
19 579.55 31.39 211.84 0.73 -69.38 90.87 166.25 164.98 7221 INF 0.79 KB N/A N/A
20 610.67 31.12 242.95 0.56 -69.38 89.11 164.70 165.41 4802 11724 1.19 KB N/A N/A
21 641.89 31.22 274.17 0.34 -69.65 89.92 165.50 164.79 4331 9295 1.32 KB N/A N/A
22 673.92 32.03 306.20 0.02 -69.85 89.34 165.60 165.06 3534 6199 1.62 KB N/A N/A
23 706.03 32.11 338.31 -0.11 -70.09 89.81 165.58 165.47 7805 INF 0.73 KB N/A N/A
24 737.92 31.89 370.20 -0.33 -70.15 89.99 165.87 164.74 INF INF 0.07 KB N/A N/A
25 769.85 31.93 402.12 -0.72 -70.22 89.74 164.86 164.86 13741 INF 0.42 KB N/A N/A
26 801.93 32.08 434.20 -1.01 -70.31 89.96 165.11 165.11 36631 INF 0.16 KB N/A N/A
27 833.33 31.40 465.60 -1.08 -70.26 90.21 165.64 165.64 24848 INF 0.23 KB N/A N/A
28 840.33 7.00 472.60 -1.04 -70.24 90.02 165.64 166.02 14422 INF 0.40 KB N/A N/A
Bit 851.15 10.82 483.42 -0.94 -70.24 90.02 165.64 166.02 N/A N/A N/A PR N/A N/A

Profile
Plan
rEcisivc.
JAN 12 2021
BY.

WELL CONSTRUCTION RECORD (GW-1)
1. Well Contractor Information:
Mtq r k £': fee !er
Well Contractor Name
2789A
NC Well Contractor Certification Number
1;# 7-4 / /Q . 0.1)
1 i
Company Name
2. Well Construction Permit H: V i C . WO 0 03 9 7 ?j
List all applicable well construction permits (i.e. UIC, County, State, Variance, etc)
3. Well Use (check well use):
Water Supply Well:
°Agricultural
°Geothermal (Heating/Cooling Supply)
❑Industrial/Commercial
°Irrigation
DMunicipal/Public
❑Residential Water Supply (single)
❑Residential Water Supply (shared)
❑Wells> 100,000 GPD
Non -Water Supply Well:
❑Monitoring ❑Recovery
Injection Well:
❑Aquifer Recharge
❑Aquifer Storage and Recovery
❑Aquifer Test
°Experimental Technology
❑Geothermal (Closed Loop)
❑Geothermal (Heating/Cooling Retum)
xGroundwater Remediation
❑Salinity Barrier
❑Stormwater Drainage
❑Subsidence Control
❑Tracer
❑Other (explain under #21 Remarks)
4. Date Well(s) Completed: /O/Zci/ZQ Well ID#
5a, Well Location:
C41 rip Levu P
Facility/Owner Name
/v/A
Facility IDk (if applicable)
£lee 6'e 0Vis vs Mr_' cop
Physical Address. City, and Zip n/ f2 t
afiNSIO
County
a/
Parcel Identification No. (PIN)
5b. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(dwell field, one 1st/long is sufficient)
C f, f•/ tW (5` rfrC' ,Gta°, � . cation:
N S'bre..40 • c‘,41,, ,t`y ,
6. Is(are) the well(s): Nermanent or ❑Temporary
14. WATER
FROM
T
DESCRIPTION
Zo ft.:.
i (Q 0:21 ft.
6 fa! . c,,,00.ee rt-...,�
zoo ft.
3 3) ft.
I/d e, C -L e A( vt-t�,
15. OUTER
CASING (for
multi -cased wells) OR LINER (if ap libable)
FROM
TO
DIAMETER
THICKNESS/
MATERIAL
O ft.
(if f Oft.
9 in.
5F.A $ 0
? V G
16. INNER
CASING OR. TUBING
(geothermal closed -loop)
FROM
TO
DIAMETER lj
,THICKNESS
M !`IM - 1
ft.
ft.
kr, CZ
ft.
ft.
I 'in.
JAN 1
I7. SCREEN
,
FROM
TO
DIAMETER
SLOT SIZE
THICKNE
MATERIAI.
VA) ft.
g 90 ft.
cf in,
,0 it,
r_ P1�V�
s�+. G T
ve
ft.
ft.
in.
18. GROUT
FROM ._
TO
MATERIAL
EMPLACEMENT METHOD & AMOUNT
0 ft'
8 iat,ft.
8t. nt.CZTeJ7'//
Tie.M1.e - ! 1/Y ?aloe-
ft.
ft.
sa- - WA
II. i )
ft.
ft.
20 /b Bt , . fe P
19. SAND/GRAVEL PACK
(if applicable)
FROM
TO
MATERIAI, '
EMPLACEMENT METHOD
ft.
ft.
IVIA
y J�j
NedzirO l - tl ✓�
ft.
ft.
20. DRILLING
LOG (attach additional sheets if necessary)
FROM
TO
DESCRIPTION (color, hardness, soil/rock type, grain size, etc.)
ft.
ft.
ft.
ft.
A // , p . ,471�
p ft.
80 rt.
ia.r cQom?v ire) 57A4r6'-
61 ft.
f 7J fi.
Ce.-1' 0..4. 5"r45-6•as Loos
F ^l a ft.
Q .T ft.
e".St/aL (-(te.)e+.0 �e%u- Ti961
ft.
ft.
ft.
ft.
21. REMARKS
l ria', fa, (tit/J.-eh/le Z» a'114,
G IA•rt-M.1., r#,•l /b &ripr.,e -. .57Q: lie r6A. it
9 Coal I asi-r K `o
.• p, - I art9f Z6
Date
\ P\v Ny SrnmcT�is• rtn.1 hereby certify that the mulls) was (were) constructed in accordance with
n: e of Cerllipcs Vell Contractor
r.
u
7. Is this a repair to an existing well: ❑Yes or *No a, 6(YC .0100 or 15A NC.AC 02C .0200 Well Construction Standards and that a copy
If this is a repair, fill out known well construction information and explain the nature of ihe,,.c.::C\t_lbfretbrd has been provided to the well owner.
repair under .21 remarks section or on the back of this form. S J' \' v ti'
\�:• 23. Site diagram or additional well details:
You may use the back of this page to provide additional well construction info
8. For Geoprobe/DPT or Closed -Loop Geothermal Wells having the same
construction, only 1 GW- l is needed. Indicate TOTAL NUMBER of wells (add 'See Over' in Remarks Box). You may also attach additional pages if necessary.
drilled:
9. Total well depth below land surface: 'sow)f L eq. S ' (ft.)
l'or multiple wells list all depths ',different (example- 3@200' 200' and 2 f /00)
10. Static water level below top of casing: Z'2 ' A (ft.)
If water level is above casing, use "
.r
12. nom. (in.)
11. Borehole diameter:
ti
12. Well construction method: f (.f .) - KO Qr
(i.e. auger, rotary, cable, direct push, etc.)
FOR WATER SUPPLY WELLS ONLY:
13a. Yield (gpm)
N/A
Method of test:
N%t
24. SUBMITTAL INSTRUCTIONS
Submit this GW-1 within 30 days of well completion per the following:
24a. For All Wells: Original form to Division of Water Resources (DWR),
Information Processing Unit, 1617 MSC, Raleigh, NC 27699-1617
24b. For Injection Wells: Copy to DWR, Underground Injection Control (IUC)
Program, 1636 MSC, Raleigh, NC 27699-1636
24c. For Water Supply and Open -Loop Geothermal Return Wells: Copy to the
county environmental health department of the county where installed
24d. For Water Wells producing over 100,000 GPD: Copy to DWR, CCPCUA
Permit Program, 1611 MSC, Raleigh, NC 27699-1611
2021
13b. Disinfection type: Amount:

Job Name
Service Company
Location
Product Size/Type
Survey
20-191 HIW-6
Sharewell H.D.D.
Jacksonville, NC
TrueGyde Steer : Directional Data Report
Line Az
Customer
Description
Probe SIN
165.5°
Ellingson/DTD
Horizontal Injection Well
ii.c.,.-171,71.e.:
JAN 12 2021
By:
MD CL Away Lateral Elev Ind Raw Az Plg Az Pilot Rad Reamed R DLS DS Probe G Total
Tie -In 0.00 N/A -396.02 -3.95 1.09 71.55 166.66 166.66 N/A N/A N/A TI N/A
1 13.74 13.74 -382.99 -3.69 -3.26 71.55 166.66 166.66 N/A N/A N/A KB N/A
2 45.31 31.57 -353.12 -3.07 -13.48 70.69 166.72 166.72 N/A N/A N/A KB N/A
3 76.86 31.55 -323.24 -2.45 -23.56 72.03 168.29 166.65 9174 INF 0.62 KB N/A
4 108.88 32.02 -292.89 -2.60 -33.76 70.81 163.78 163.78 7416 INF 0.77 KB N/A
5 140.34 31.46 -263.09 -2.95 -43.85 71.80 165.86 165.86 4905 11919 1.17 KB N/A
6 171.65 31.31 -233.18 -2.59 -53.08 73.92 165.86 166.52 2874 4397 1.99 KB N/A
7 203.52 31.87 -202.54 -2.47 -61.83 74.18 164.93 164.93 1609 1998 3.56 KB N/A
8 235.53 32.01 -171.56 -2.56 -69.89 76.66 165.73 165.73 1122 1296 5.11 KB N/A
9 267.35 31.82 -140.45 -2.34 -76.54 79.22 166.07 166.07 1035 1179 5.54 KB N/A
10 299.04 31.69 -109.22 -1.79 -81.89 81.33 166.94 166.94 765 842 7.49 KB N/A
11 330.34 31.30 -78.18 -1.10 -85.83 84.22 166.63 166.63 719 787 7.97 KB N/A
12 362.18 31,84 -46.45 -0.99 -88.44 86.36 166.00 164.77 761 838 7.53 KB N/A
13 393.42 31.24 -15.24 -1.10 -89.62 89.32 166.00 165.83 677 737 8.47 KB N/A
14 424.75 31.33 16.09 -0.70 -89.96 89.44 165.83 166.63 1036 1186 5.53 KB N/A
15 455.70 30.95 47.04 -0.49 -90.12 89.96 165.14 165.14 1488 1825 3.85 KB N/A
16 487.38 31.68 78.71 -0.81 -89.94 90.69 165.14 164.68 3930 7589 1.46 KB N/A
17 519.15 31.77 110.48 -1.07 -89.68 90.25 165.41 165.41 6677 35473 0.86 KB N/A
18 550.51 31.36 141.84 -1.11 -89.55 90.21 165.45 165.45 21729 INF 0.26 KB N/A
19 581.90 31.39 173.23 -0.88 -89.65 89.46 166.37 166.37 4403 9446 1.30 KB N/A
20 613.02 31.12 204.35 -0.53 -89.77 90.08 165.94 165.94 31637 INF 0.18 KB N/A
21 644.24 31.22 235.57 -0.51 -89.74 90.03 165.11 165.11 29835 INF 0.19 KB N/A
22 676.27 32.03 267.59 -0.46 -90.16 88.45 166.08 166.08 5353 15349 1.07 KB N/A
23 708.38 32.11 299.70 0.01 -90.53 90.23 166.58 166.58 36425 INF 0.16 KB N/A
24 740.27 31.89 331.58 0.50 -90.37 90.35 166.19 166.19 17194 INF 0.33 KB N/A
25 772.20 31.93 363.51 0.42 -90.67 88.58 164.53 164.53 42280 INF 0.14 KB N/A
26 804.28 32.08 395.58 0.03 -90.85 90.79 165.60 165.06 9812 INF 0.58 KB N/A
27 835.68 31.40 426.98 -0.42 -90.36 90.99 164.70 164.32 8542 INF 0.67 KB N/A
28 867.50 31.82 458.79 -0.87 -89.78 91.09 165.06 165.06 2175 2938 2.63 KB N/A
29 878.50 11.00 469.79 -1.00 -89.63 90.53 164.59 164.59 16356 INF 0.35 KB N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
Bit 888.79 10.29 480.07 -1.16 -89.53 90.53 164.59 164.59 N/A N/A N/A PR N/A N/A

Z.
Profile
li,,il
tg •
it=
1!..A
L.
IF
Pi
Plan
(0,
Fci
JAN I 2 2021
BY:

WELL CONSTRUCTION RECORD (GW-1)
1. Well Contractor Information:
Mirk £: Jei'ler
Well Contractor Name
q89 •4
Facility IDsi (if applicable)
F,444 i.- .1 y: t; 2 " " - /U 77 ..; n ? 6�rL��-o ff;' f_ , � (/ _.c 1�c
6, Is(are) the weIl(s): ?Permanent or ❑Temporary
sr.-
V /CR A &
NC Well Contractor Certification Number
D.7:0, /; O.!.)
BY:
h. r_
hoi
1 For Internal Use Only:
i 2
Company Name
2. Well Construction Permit #: Vi C • '- WCi, 003 r ? ?
list ull applicable well eansiruclion permits (i.e. (//(:, County, Slate, Variance, elc.)
3. Well Use (check well use):
Water Supply Well:
❑Agricultural
❑Geothermal (Heating/Cooling Supply)
D1ndustrial/Commercial
°Irrigation
Non -Water Supply Well:
°Monitoring
Injection Well:
❑Aquifer Recharge
❑Aquifer Storage and Recovery
❑Aquifer Test
❑Experimental Technology
OGeothermal (Closed Loop)
❑Geothermal (Heating/Cooling Return)
❑Municipal/Public
❑Residential Water Supply (single)
❑Residential Water Supply (shared)
❑Wells > 100,000 GPD
❑ Recovery
XGroundwater Remediation
❑Salinity Barrier
OStormwater Drainage
❑Subsidence Control
°Tracer
°Other (explain under #21 Remarks)
4. Date Well(s) Completed: /O/3°/ Well ID# /-I' ►v- 7
Sa. Well Location:
C13 nit Let jatfil e
Facility/Owner Name
4-1 88 ovis vs
� Mc tC'ettlym, LA? join Z
Physical Address, City. and Zip
C3n�/®1✓V
County
A/, C.
N/A
Parcel Identification No. (PIN)
5b. Latitude and longitude in degrees/minutes/seconds or decimal degre e:•';
(i(well 6 Id, o 'at/long is sufficient) r ;
a t..tt 22. Certification:
S-'crt< y,4.7),V6,(-9(-&) '71 • a'rp =f`'
Pam{, Si A e Certified Well Contractor
34
l .. ATER ZONES
O
TO
DESCRIPTION
- ft.
3 p ft.
n
-t•...v, L ra-1..S-t, rc
n.
cl,?‘ ft.
�,.x.qm Kc'.ef4 64'.•--f
-...15.-OUTER CASING (far multi -cased wells) OR LINER (if ap livable)
FROM
TO
DIAMETER
THICKNESS
MATERIAL
O ft.
co ft.
:.l% in.
$?c°.l- 8 0
% NC.-
16. INNER CASING OR TUBING (geothermal closed -loop)
FROM
TO DIAMETER fillo.3THICKNESS
MATERIAL
ft
ft.
ft.
ft. I 'in.
17. SCREEN
FROM
TO
DIAMETER
SLOT SIZE
MATERIAL
y(-1,;)",78 ft.
! r,[ in.
r d IC,
�THI/CKNESS
:xcz 90
?VC
ft.
ft.
in.
18. GROUT
FROM
TO
MATERIAL
EMPLACEMENT METHOD & AMOUNT
V ft.
g G ft.
$c,/tic eic1f'
71.-,e,4I.e - i VY ?+P e,
ft.
ft.
5•-ck'9q a
/bri(g
ft.
ft.
24.(} • I. b heitto)4
19. SAND/GRAVEL PACK (if applicable)
FROM
To
MATERIAL
EMPLACEMENTMETHOD
ft.
ft.
`A
NC lvro.l - (_,a ij .
ft.
ft.
/
20. DRILLING LOG (attach additional sheets if necessary)
FROM
TO
DESCRIPTION teeter, hardness, soil/rock type, grain sne, etc.)
ft,
ft.
ft.
/
cS ft.
90 ft,
• cdn,. G ; 5; ,. S, --Jet
th, ft.
94 ft.
s-;.. Cl,j '7 ✓ieJ( P-/�7
�b ft.
i co ft.
�cr7.
t9 4 , •$7., t).-:. :aLn.32.5..
rno ft.
47,7 ft.
e_o6✓ff Ce,/r%! 1,1 ei .► 1...-
ft.
ft.
21. REMARKS
/ `./ j�
A( (:"*i1 2l /Lcc 1 vY'' irf�J t/iici (Jr-' 1 //4`h
41, 6rr+;Jl'--Mix ;N/b &,rinta" .574, ;6'.n`76-n:4,-,_.
4' GC1 /a,ir K p
/i7Rfz.0
Date
' 15r.y(L'ning this form. / hereby cerlifv that the a e//(s)c 0 (were) constructed in accordance with
7. Is this a repair to an existing well: ❑Yes or *No ( ( 0_C .0l l0 of 15A A(A( 02(..0.00 Well Construction Standards and that a copy
^`c.• �o this record has been provided to the well owner.
If this is a repair, fill out known well construction injonnatinn and erpkrir;, Ihv'q'utur4.Of btj p
repair under ;?/ remarks section or on the back of this form.
8. For Geoprobe/DPT or Closed -Loop Geothermal Wells having the same
construction, only 1 GW- I is needed. Indicate TOTAL NUMBER of wells
drilled:
9. Total well depth below land surface: 43b L -' 10 q 1_i, (ft.)
For midaple wells As/ all depths if different (example- 3E0200' and 2 tt 100')
1
10. Static water level below top of casing: 2-1. Y.(ft)
I water level is above casing. use " '
rt
II. Borehole diameter: f G- nr5A1 • (in.)
12. Well construction method: (.! - K47Qt'�
(i.eauger, rotary, cable, direct push. etc.)
FOR WATER SUPPLY WELLS ONLY:
13a. Yield (gpm)
N/A Method of test: /.//A
23. Site diagram or additional well details:
You may use the back of this page to provide additional well construction info
(add' See Over' in Remarks Box). You may also attach additional pages if necessary.
24. SUBMITTAL INSTRUCTIONS
Submit this GW-I within 30 days of well completion per the following:
24a. For All Wells: Original form to Division of Water Resources (DWR),
Information Processing Unit, 1617 MSC, Raleigh, NC 27699-1617
24b. For Injection Wells: Copy to DWR, Underground Injection Control (IUC)
Program, 1636 MSC, Raleigh, NC 27699-1636
24c. For Water Supply and Open -Loop Geothermal Return Wells: Copy to the
county environmental health department of the county where installed
24d. For Water Wells producing over 100,000 GPD: Copy to DWR, CCPCUA
Permit Program, 1611 MSC, Raleigh, NC 27699-1611
13b. Disinfection type: Amount:

TrueGyde Steer : Directional Data Report
Job Name 20-191 HIW-7 Line Az 165.5°
Service Company Sharewell H.D.D. Customer Ellingson/DTD
Location Jacksonville, NC Description Horizontal Injection Well
Product Size/Type 4'/PVC Probe SIN 005
JAN 1 2 2021
SY:
Survey MD CL Away Lateral Elev Inc! Raw Az Plg Az Pilot Rad Reamed R DLS DS Probe G Total H T
Tie -In 0.00 N/A -436.48 -8.30 1.51 72.00 165.50 165.50 N/A N/A N/A TI N/A N/A
1 14.39 14.39 -422.77 -8.39 -2.86 72.63 164.77 164.77 N/A N/A N/A KB N/A N/A
2 45.96 31.57 -392.80 -7.72 -12.74 70.90 166.50 168.80 N/A N/A N/A KB N/A N/A
3 77.51 31.55 -362.97 -6.29 -22.91 71.51 166.91 167.71 9063 INF 0.63 KB N/A N/A
4 109.53 32.02 -332.49 -5.04 -32.64 73.11 167.95 167.95 11357 INF 0.50 KB N/A N/A
5 140.99 31.46 -302.49 -3.97 -42.06 72.04 167.16 167.16 4776 INF 1.20 KB N/A N/A
6 172.30 31.31 -272.73 -3.13 -51.75 71.90 167.05 167.05 13926 INF 0.41 KB N/A N/A
7 204.17 31.87 -242.22 -1.98 -60.86 74.88 168.27 168.27 3064 34853 1.87 KB N/A N/A
8 236.18 32.01 -211.50 -1.12 -69.79 72.71 165.92 165.92 8140 INF 0.70 KB N/A N/A
9 268.00 31.82 -181.08 -0.94 -79.15 73.09 165.75 165.75 4608 INF 1.24 KB N/A N/A
10 299.69 31.69 -150.58 -0.58 -87.71 75.57 166.61 166.61 7932 INF 0.72 KB N/A N/A
11 330.99 31.30 -120.06 0.08 -94.63 78.89 166.86 166.86 879 1189 6.52 KB N/A N/A
12 362.83 31.84 -88.68 0.49 -99.97 81.79 165.64 165.64 625 766 9.17 KB N/A N/A
13 394.07 31.24 -57.79 0.83-104.65 80.99 165.64 166.64 998 1423 5.74 KB N/A N/A
14 425.40 31.33 -26.68 1.19-108.18 86.06 165.64 165.70 754 974 7.59 KB N/A N/A
15 456.35 30.95 4.24 1.14 -109.49 89.09 165.64 165.10 734 946 7.81 KB N/A N/A
16 488.03 31.68 35.92 1.04-110.01 89.01 165.64 165.54 671 842 8.54 KB N/A N/A
17 519.80 31.77 67.68 1.21-109.99 91.06 166.08 166.08 1083 1602 5.29 KB N/A N/A
18 551.16 31.36 99.04 1.36-109.54 90.62 165.46 165.46 3550 INF 1.61 KB N/A N/A
19 582.55 31.39 130.43 1.34-109.43 89.78 165.46 165.46 7033 INF 0.81 KB N/A N/A
20 613.67 31.12 161.55 1.17-109.56 89.74 164.91 164.91 4090 INF 1.40 KB N/A N/A
21 644.89 31.22 192.77 1.06-109.64 89.97 165.70 165.70 8262 INF 0.69 KB N/A N/A
22 676.92 32.03 224.80 0.77-109.57 90.27 164.27 164.27 11035 INF 0.52 KB N/A N/A
23 709.03 32.11 256.90 0.38-109.59 89.66 165.34 165.34 INF INF 0.08 KB N/A N/A
24 740.92 31.89 288.79 0.18-109.75 89.77 164.94 164.94 27511 INF 0.21 KB N/A N/A
25 772.85 31.93 320.72 0.02-109.79 90.08 165.48 165.48 28928 INF 0.20 KB N/A N/A
26 804.93 32.08 352.80 0.18-109.80 89.87 166.09 166.09 26165 INF 0.22 KB N/A N/A
27 836.33 31.40 384.20 0.40-109.85 89.94 165.69 165.69 32156 INF 0.18 KB N/A N/A
28 868.15 31.82 416.02 0.56-109.81 90.23 165.89 165.89 36402 INF 0.16 KB N/A N/A
29 899.62 31.47 447.49 0.54-109,91 89.39 165.89 165.04 11303 INF 0.51 KB N/A N/A
30 926.62 27.00 474.49 0.59-109.93 90.54 166.18 166.18 8622 INF 0.66 KB N/A N/A
Bit 936.64 10.02 484.51 0.71-109.83 90.54 166.18 166.18 N/A N/A N/A PR N/A N/A I

Profile
6
w
---------------
Cal
17;
14!
E C. EiVi:
JAN 1 2 2021
BY:

TrueGyde Steer : Directional Data Report
Job Name 20-191 HIW-8 Line Az 175.9°
Service Company Sharewell H.D.D. Customer Ellingson/DTD
Location Jacksonville, NC Description Horizontal Injection Well
Product Size/Type Probe S/N
Survey MD CL Away Lateral Elev Inca Raw Az Pig Az Pilot Rad Reamed R DLS DS Probe G Total H 1
Tie -In 0.00 N/A -338.52 -15.28 -2.92 76.86 177.85 177.85 N/A N/A N/A TI N/A N/A
1 11.95 11.95 -326.89 -14.89 -5.64 76.86 177.85 177.85 N/A N/A N/A KB N/A N/A
2 43.79 31.84 -296.08 -13.25 -13.50 74.53 180.15 180.15 N/A N/A N/A KB N/A N/A
3 75.09 31.30 -265.96 -11.32 -21.78 74.81 179.05 179.05 2099 3517 2.73 KB N/A N/A
4 106.78 31.69 -235.40 -9.58 -30.00 75.13 179.35 179.35 3141 5052 1.82 KB N/A N/A
5 138.60 31.82 -204.48 -7.75 -37.27 78.46 179.32 179.32 1382 1659 4.15 KB N/A N/A
6 170.61 32.01 -173.09 -5.96 -43.27 79.91 179.07 179.07 1073 1230 5.34 KB N/A N/A
7 202.48 31.87 -141.64 -4.77 -48.25 82.11 177.17 177.17 786 866 7.29 KB N/A N/A
8 233.79 31.31 -110.55 -3.87 -51.80 84.88 178.02 178.02 850 946 6.74 KB NIA N/A
9 265.25 31.46 -79.19 -2.69 -53.92 87.38 178.15 178.15 726 796 7.89 KB N/A N/A
10 297.33 32.08 -47.14 -1.69 -54.78 89.56 177.31 177.31 729 800 7.85 KB N/A N/A
11 328.88 31.55 -15.59 -1.12 -54.84 90.22 176.64 176.64 1020 1162 5.62 KB N/A N/A
12 360.45 31.57 15.97 -0.50 -54.54 90.87 177.49 177.49 1563 1922 3.67 KB N/A N/A
13 392.14 31.69 47.66 -0.09 -54.38 89.70 175.89 175.89 38802 INF 0.15 KB N/A N/A
14 424.22 32.08 79.73 -0.21 -54.67 89.26 175.53 175.53 5690 17681 1.01 KB N/A N/A
15 456.15 31.93 111.66 -0.73 -54.87 90.03 174.49 174.49 6528 28647 0.88 KB N/A N/A
16 488.04 31.89 143.54 -1.43 -54.80 90.22 174.88 174.88 10567 INF 0.54 KB N/A N/A
17 520.15 32.11 175.64 -1.07 -54.79 89.83 178.30 178.30 9643 INF 0.59 KB N/A N/A
18 552.18 32.03 207.66 -0.15 -54.82 90.04 176.84 176.84 INF INF 0.01 KB N/A N/A
19 583.40 31.22 238.88 0.05 -54.87 89.79 175.78 175.78 12706 INF 0.45 KB N/A N/A
20 614.52 31.12 270.00 -0.11 -54.96 89.87 175.51 175.51 INF INF 0.04 KB N/A N/A
21 645.91 31.39 301.39 -0.34 -54.99 90.03 175.53 175.53 INF INF 0.01 KB N/A N/A
22 677.27 31.36 332.75 -0.30 -54.86 90.43 176.49 176.49 8404 INF 0.68 KB N/A N/A
23 709.04 31.77 364.52 -0.13 -54.70 90.15 176.02 176.02 19341 INF 0.30 KB N/A N/A
24 740.72 31.68 396.20 0.00 -54.69 89.90 176.32 176.32 41786 INF 0.14 KB N/A N/A
25 772.05 31.33 427.53 0.08 -54.82 89.61 175.80 175.85 6623 32890 0.87 KB N/A N/A
26 803.29 31.24 458.76 -0.03 -54.98 89.81 175.62 175.62 15883 INF 0.36 KB N/A N/A
27 834.69 31.40 490.16 -0.61 -55.03 90.02 174.14 174.14 44867 INF 0.13 KB N/A N/A
28 866.51 31.82 521.97 -1.05 -55.16 89.49 176.16 176.16 45101 INF 0.13 KB N/A N/A
Bit 876.95 10.44 532.41 -1.01 -55.26 89.49 176.16 176.16 N/A N/A N/A PR N/A N/A I
JAN1221:1
BY:

WELL CONSTRUCTION RECORD (GW-1)
1. Weil Contractor Information:
Well Contractor Name
2989A - SI/f
NC Well Contractor Certification Number
/tin . L
Company Name
2. Well Construction Permit h: Vr . W( 003 -y 9 ?3
List al/ applicable well construction permits (i.e. UIC, County, Stale. Variance. ek.)
3. Well Use (check well use):
Water Supply Well:
❑Agricultural
OGeothennal (Heating/Cooling Supply)
❑IndustriallComtnercial
❑Irrigation
Non -Water Supply Well:
❑Monitoring
Injection Well:
❑Aquifer Recharge
❑Aquifer Storage and Recovery
❑Aquifer Test
❑Experimental Technology
❑Municipal/Public
❑Residential Water Supply (single)
❑Residential Water Supply (shared)
❑Wells > 100,000 GPD
DRecovery
XGroundwater Remediation
❑Salinity Barrier
❑Stormwater Drainage
DSubsidence Control
DGeothermal (Closed Loop) DTracer
DGeothermal (Heating/Cooling Return) " ❑Other (explain under #2I Remarks)
4. Date Well(s) Completed: / r/6f .c' Well ID# I /L I'✓- 8
5a. Well Location:
C�rlr Le,n s
Facility/Owner Name
Sne &3 0VIS.
Physical Address, City, and Zip
County
Facility IDlt (if applicable)
red t etfl L-a 1 e ail Z
Ai, (,?
iV/11
Parcel Identification No. (PIN)
5b. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one lat/long is sufficient)
re„.tr� 3 �r 6,--Lty,Q�L g
F',idrtt 3c1. (,-1co39r( ° w
r
6. Is(are) the well(s): APermanent
'77,3S0S/st41
77. 3s89goVS" \41'
, y1,+
or ❑Temporary <' °"�a J•
J
�y {( ' , O By .signing this form, I hereby certify that the well(s) a as (were) constructed in accordance with
7. Is this a repair to an existing well: DYes �r :yiKNol +�0� � (1 NCA(.' 02C .0100 or ISA NCA(' 02C'.0200 Well Construction Standards and that a copy
If this is o repair, fr!l out known well construction informs l�i?'w lrerpinin $e « e of the \' o This record has been provided to the well owner.
repair under .21 remarks section or on the back of this form.
For Internal Use Only:
14. WATER ZONE * '
FROM
TO
DESCRIPTION
Zs7 ft.
as' ft.
re......, oh, ter►-er 5-,...s.IG t
Lye) ft.
s,T ft.
c -/f genii n'e. 4..r
15. OUTER CASING (for multi -cased wells OR L14ER (if ap
licable) " ~
FROM
TO
DIAMETER
THICKNESS
MATER
a ft.
3 (,(AOft.
9 in.
S� 8 0
f'V /A
16. INNER
CASINGJ/y
OR TUBING (geothermal closed -loop) 4
FROM
TO DIAMETER eX.yTHICKNESS
MATE
rt.
a,
8y`
ft.
ft. I in.
17. SCREEN
FROM
TO
DIAMETER
SLOT SIZE
MATERIAL
O g8ft,
&?rw ft.
ci in.
/
,0 IC,
�THI,CKNESS
:.44L 90
PVC
ft.
ft.
in.
I8. GROUT
FROM
TO
MATERIAL
EMPLACEMENT METHOD & AMOUNT
G ft.
6, a ft.
8ewrltt•l.A,:n4
77-eem.. - 1'/, ?,Pe.,
ft.
ft.
la „ 'PO
Por /c
ft.
fL
Aid 161 -
4cm�:in,t ,
19. SAND/GRAVEL PACK
(if applicable)
FROM
To
MATERIAL,
EMPLACEMENT METHOD
ft.
ft.
v/A
Naivrct / CR ad..,
ft.
ft.
20. DRILLING LOG (attach additional sheets if necessary)
FROM
TO
DESCRIPTION (color, hardness, soil/rock type, grain size, etc.)
ft.
ft
D ft.tik5ft.
S•r_e_ - r'9 ►T f t..1tit i
ft.
ft.
7exae !!%rr✓lr'r}e-J 1-, -
96 ft.
/ 2 i1 ft.
0yv,i r4YG LGYPl
(ZO ft.
Zjo ft.
�'r�. sf. � s,, c(w y
Z 2'o ft.
err- ft.
Gr.., Caa-tte_ pt e pt
ft.
ft.
21. REMARKS
* /-*rt 20,1 e7..l 'Wart,./rile- D %%%i4,
* Gr>1i:.'1`-mix Wit, &Fiirin•e -s S/4s 8e-e` (u1t'1
22. Certification:
8. For Geoprobe/DPT or Closed -Loop Geothermal Wells havjngi!e'satge`'•
construction, only 1 GW-I is needed. Indicate TOTAL NUMB �"9�`yaells
drilled: �` ` '
9. Total well depth below land surface: If92(ft.)
For multiple wells list all depths ifdifferenr (example- 3@200' 200' and 2(3100')
10. Static water level below top of casing: 1 q r A. f f) r (ft.)
lfwater level is above casing. use ": "
11. Borehole diameter: t 4' "'m • (in.)
12, Well construction method: Pi /COtGtr
(i.e. auger, rotary, cable, direct push, etc.)
FOR WATER SUPPLY WELLS ONLY:
13a. Yield (gpm)
N/A
Method of test:
A//,
//t om�/' 8 G-Ilans• K �p
2?7a ,u I . ,1 Ct��( ,>�� , / i f 7(z
Signature of Certified Well Contractor
Date
23. Site diagram or additional well details:
You may use the back of this page to provide additional well construction info
(add 'See Over' in Remarks Box). You may also attach additional pages if necessary.
24. SUBMITTAL INSTRUCTIONS
Submit this GW-I within 30 days of well completion per the following:
24a. For All Wells: Original form to Division of Water Resources (DWR),
Information Processing Unit, 1617 MSC, Raleigh, NC 27699-1617
24b. For Injection Wells: Copy to DWR, Underground Injection Control (IUC)
Program, 1636 MSC, Raleigh, NC 27699-1636
24c. For Water Supply and Open -Loop Geothermal Return Wells: Copy to the
county environmental health department of the county where installed
24d. For Water Wells producing over 100,000 GPD: Copy to DWR, CCPCUA
Permit Program, 161 1 MSC, Raleigh, NC 27699-1611
13b. Disinfection type: Amount: