WI0100141_Regional Office Physical File Scan Up To 9/14/2022

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PQ
Y M� NCDENR
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Beverly Eaves Perdue Coleen H. Sullins
Governor Director
December 08, 2011
Macon County Schools
5 West Main St.
Franklin, NC 28734
Attn: Mr. Jack Horton — County Manager
Re: Review of NOV-2011-PC-0606 Response
WI0100141
Macon County, North Carolina
Dear Mr. Horton:
Dee Freeman
Secretary
On December 5, 2011, I made a site visit to 1166 Iotla Church Road in Macon County to inspect
the installation of a geothermal well field. While on site I met with Mr. Terry Bell who was very helpful in
updating me of your progress toward complying with the referenced notice of violation. As of today Mr.
Bell has provided me with a site map of the area, a listing of each parcel with a water supply well, and a
time line of the events that have taken place since Mr. Ralph Phau's water supply well was destroyed.
Based upon a review of the documents submitted in response to the NOV and the recent site,
inspection, the following items are missing or incomplete:
1.. Please provide an onsite well map identifying all UIC wells. Please note that all well construction
records submitted must be signed by the appropriate North Carolina Certified Well Contractor;
2. Please provide detailed construction as -built specifications for each well. The grouting activities being
conducted in the field do not match the well specifications listed in your permit application (i.e., full
borehole grout versus just top 20 ft grouted). Please also include an explanation detailing as to why
the grout specification was altered;
3. The required corrective actions, as stated in the NOV, are to include a written response as to your
intentions on replacing the impacted well owned by Mr. Phau. Macon County should also consider
discussing this issue with other adjacent water supply well owners to determine if they have been
negatively impacted by onsite drilling activities;
4. The large sand bags placed on top of the well points may prevent some surface fluids from entering
un-grouted wells, however, we feel that additional measures are necessary to include but not limited
to soil berms around the well points. The large sand bags placed on some of the well points make it
difficult to monitor if water is entering the well or well annulus. Please note that if surface water or
fluids enter a well and contaminate the groundwater resource, it is considered to be an illegal
injection. Additionally, please be aware that you have five days to grout a well once the bore hole
has been completed;
5. All completed wells that have become compromised due to ejection of grout, subsidence of grout or
any other means shall be repaired immediately; and,

WI0100141
Page, 2 of 2
6. Please provide a well abandonment record for Mr. Phau's water supply well.
Please address the missing or incomplete items listed above and report them to the Asheville
Regional Office, 2090 US Highway 70, Swannanoa, NC 28778 no later than December 29th. If you have
questions regarding any of these items please do not hesitate to call me at 828.296.4684.
Sincerely,
Jonathan Stepp
Senior Hydrological Technician
NC DENR-APS
Asheville Regional Office
ec: Jack Horton

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NCDENR
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Beverly Eaves Perdue Chuck Wakild Dee Freeman
Governor Director Secretary
November 28, 2011
CERTIFIED MAIL
RETURN RECEIPT REQUESTED
7009 1680 0000 7515 2663
Macon County Schools
5 W. Main St.
Franklin, North Carolina 28734
Attn.: Mr. Jack Horton - County Manager
Reference: NOTICE OF VIOLATIONS of the NORTH CAROLINA
WELL CONSTRUCTION STANDARDS
1166 lotla Church Road
Franklin, 28734
NOV-2011-PC-0606
BIMS Incident 201102332
Macon County, N.C.
Dear Mr. Horton,
The Aquifer Protection Section (APS) of the Division of Water Quality (DWQ) is responsible for the
regulation of well construction activities within the State of North Carolina. On November 3, 2011 a staff member
from the Asheville Regional Office APS visited the site referenced above to inspect the installation of a geothermal
well field. Upon review of the site and an interview with Gus Callihan, Project Manager, it was confirmed that well
drilling activities related to )the construction of this well field caused damage to a nearby private water supply
well. Upon review of the site and related permit, the Division is notifying you that multiple violations exist as listed
below.
VIOLATION 1:
Violation of permit condition Part II, 1. for failure to notify the Division and regional office forth -eight (48)
hours prior to constructing the system. The Division has no record of the required notification. When Division staff
inquired about the notification, onsite staff was unaware of the requirement and could not offer any information
regarding compliance with this permit condition.
REQUIRED CORRECTIVE ACTION FOR VIOLATION:
Comply with permit condition Part II, number 1. Retain a record of your notification event.
VIOLATION 2:
Failure to accurately provide information required on the permit application regarding water supply wells.
North Carolina Administrative Code (NCAC) .0211(d)(1)(D)(v) requires the identification of "any other existing or
abandoned well, including water supply and monitoring wells, with the area of review of the injection well or well
system." Section J. of your signed permit application asks if potable wells are present on the subject property or
adjacent properties. According to our field inspection, water supply wells are present on the subject property and on
the adjacent property including the impacted water supply well owned by Mr. Ralph Phau. The 'area of review' is
defined by rule as a'/4 mile radius or greater, as determined by the Director of the Division.
One
North Carolina Division of Water Quality —Asheville Regional Office NorthCarolina�g.�uy�R //�
2090 U.S. Highway 70, Swannanoa, N.C. 28778 Phone [phone] FAX [phone] !� "
Customer Service 1-877-623-6748
Internet: h2o.enr.state.nc.us
An Equal Opportunity 1 Affirmative Acton Employer

NOV-2011-PC-0606
Page 2 of 3
November 28, 2011
REQUIRED CORRECTIVE ACTION FOR VIOLATION:
Provide a map, as required by the permit application and rule that accurately identifies all potable water wells
located onsite and on adjacent properties within the area of review.
VIOLATION 3:
Title 15A of the NCAC 2C Section .0211(l) states that a permit may be revoked by the Director in whole or part
for actions which would adversely impact human health or the environment. On September 23, 2011, drilling activities
being conducted on the subject site caused the destruction, including ejection of the pump and well seal, of an
adjacent water supply well owned by Mr. Phau. Moreover, the destruction of the adjacent property owner's water
supply well is not consistent with the Findings and Policy (§ 87-84) or the Scope (§ 87-86) of the North Carolina Well
Construction Act (Chapter 87, Article 7 of the NC General Statutes). Those sections of the Well Act state:
9 87-84. Findings and policy.
The General Assembly of North Carolina finds that improperly constructed, operated, maintained, or abandoned wells can adversely affect the
public health and the groundwater resources of the State. Consistent with the duty to safeguard the public welfare, safety, health and to protect
and beneficially develop the groundwater resources of this State, it is declared to be the policy of this State to require that the location,
construction, repair, and abandonment of wells, and the installation of pumps and pumping equipment conform to such reasonable requirements as
may be necessary to protect the public welfare, safety, health and groundwater resources. (1967, c. 1157, s. 2.
3 87-86. Scope.
No person shall construct, operate, repair, or abandon, or cause to be constructed, operated, repaired, or abandoned, any well, nor shall any
person install, repair, or cause to be installed or repaired, any pump or pumping equipment contrary to the provisions of this Article and applicable
rules and regulations, provided that this Article shall not apply to any distribution of water beyond the point of discharge from the pump. (1967,
c. 1157, s. 4; 1987, c. 496, ss. 2, 3.
REQUIRED CORRECTIVE ACTION FOR VIOLATION:
You are to submit to the Division a corrective action plan that describes the events that led to the destruction
of the subject supply well and all corrective actions that have been and will be taken, including plans for the
abandonment and replacement of the subject water supply well. The corrective action plan is to describe in technical
detail site activities that were occurring during the time that impact to the water supply well occurred. This detailed
description shall include, but not be limited to, the dates, times, and personnel involved, number of rigs operating,
pressures that were used during installation, observations made regarding the condition of adjacent completed
geothermal wells during the same time frame, drilling problems that occurred onsite before the event, and what was
done to address those problems (i.e., modifications to the supply well). The corrective action plan is be received by
this office no later than 30 days following your receipt of this Notice.
Pursuant to North Carolina General Statute 87-91(a), you are hereby notified of your regulatory requirements
in regard to Well Construction Standards indicated in Subchapter 2C, Title 15A, of the North Carolina Administrative
Code. These Standards were adopted by the Environmental Management Commission under authority granted by the
North Carolina Well Construction Act. This Notice is given in accordance with North Carolina General Statutes 87-93, et
seq.
Please take the corrective actions for the above violation as necessary to achieve compliance. Corrective
actions must be taken and reported to the Asheville Regional Office, 2090 US Highway 70, Swannanoa, NC 28778,
within 30 days, unless otherwise noted in the above corrective actions, from receipt of this Notice to avoid
recommendation of civil penalties for violations.
North Carolina Division of Water Quality — Asheville Regional Office
2090 U.S. Highway 70, Swannanoa, N.C. 28778 Phone [phone] FAX [phone]
Customer Service 1-877-623-6748
Internet: h2o.enr.state.nc.us
NorthCarolina
Naturali'm
An Equal Opportunity 1 Affirmative Acton Employer

NOV-2011-PC-0606
Page 3 of,3
November 28, 2011
Your prompt attention to the items described herein is required. Failure to comply with the State's rules, in
the manner and time specified, could result in the assessment of civil penalties and/or the use of other enforcement
mechanisms available to the State. Each day that a violation continues may be considered a separate violation. If you
should have any questions please do not hesitate to call Jonathan Stepp at 828.296.4684.
G. Landon Davidson, L.G.
Aquifer Protection Section Regional Supervisor
Asheville Regional Office
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North Carolina Division of Water Quality — Asheville Regional Office
2090 U.S. Highway 70, Swannanoa, N.C. 28778 Phone [phone] FAX [phone]
Customer Service 1-877-623-6748
Internet: h2o.enr.state.nc.us
None hCarolina
atuPZt
An Equal Opportunity 1 Affirmative Action Employer

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NCDETIR
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Beverly Eaves Perdue Chuck Wakiid Dee Freeman
Governor Director Secretary
CERTIFIED MAIL November 28, 2011
RETURN RECEIPT REQUESTED
7009 1680 0000 7515 2663
Macon County Schools
5 W. Main St.
Franklin, North Carolina 28734
Attn.: Mr. Jack Horton - County Manager
Reference: NOTICE OF VIOLATIONS of the NORTH CAROLINA
WELL CONSTRUCTION STANDARDS
11661otla Church Road
Franklin, 28734
NOV-2011-PC-0606
BiMS Incident 201102332
Macon County, N.C.
Dear Mr. Horton,
The Aquifer Protection Section (APS) of the Division of Water Quality (DWQ) is responsible for the
regulation of well construction activities within the State of North Carolina. On November 3, 2011 a staff member
from the Asheville Regional Office APS visited the site referenced above to inspect the installation of a geothermal
well field. Upon review of the site and an interview with Gus -Callihan, Project Manager, it was confirmed that well
drilling activities related to the construction of this well field caused damage to a nearby private water supply
well. Upon review of the site and related permit, the Division is notifying you that multiple violations exist as listed
below.
VIOLATION 1:
Violation of permit condition Part i1, 1. for failure to notify the Division and regional office forth -eight (48)
hours prior to constructing the system. The Division has no record of the required notification. When Division staff
inquired about the notification, onsite staff was unaware of the requirement and could not offer any information
regarding compliance with this permit condition.
REQUIRED CORRECTIVE ACTION FOR VIOLATION:
Comply with permit condition Part II, number 1. Retain a record of your notification event,
VIOLATION 2:
Failure to accurately provide information required on the -permit application regarding water supply wells.
North Carolina Administrative Code (NCAC) .0211(d)(1)(D)(v)' requires the identification of "any other existing or
i abandoned well, including water supply and monitoring wells, with the area of review of the injection well or well
system." Section J. of your signed permit application asks if potable wells are present on the subject property or
adjacent properties. According to our field inspection, water supply wells are present on the subject property and on
the adjacent property including the impacted water supply well owned by Mr. Ralph Phau. The 'area of review' is
defined by rule as a'A mile radius or greater, as determined by the Director of the Division.
ne
North Carolina Division of Water Quality —Asheville Regional OfficeNoCarolina
�?g.���R, //�
2090 U.S. Highway 70, Swannanoa, N.C. 28778 Phone [phone] FAX [phone] (/ V Li
Customer Service 1-877-623-6748
Internet: h2o.enr.state.nc.us
An Equal Opportunity 1 Affirmative Action Employer

•t,
NOV-2011=PC-0606
Page 2 of 3
November28, 2011
REQUIRED CORRECTIVE ACTION FOR VIOLATION:
Provide a map, as required by the permit application and rule that accurately identifies all potable water welts
located onsite and on adjacent properties within the area of review.
VIOLATION 3:
Title 15A of the NCAC 2C Section .0211(1) states that a permit may be revoked by the Director in whole or part
for actions which would adversely impact human health or the environment. On September 23, 2011, drilling activities
being conducted on the subject site caused the destruction, including ejection of the pump and well seat, of an
adjacent watef supply well owned by Mr. Phau. Moreover, the destruction of the adjacent property owner's water
supply well is not consistent with the Findings and Policy (§ 87-84) or the Scope (§ 87-86) of the North Carolina Well
Construction Act (Chapter 87, Article 7 of the NC General Statutes). Those sections of the Well Act state:
5 87.84. Findings and policy.
The General Assembly of North Carolina finds that improperly constructed, operated, maintained, or abandoned wells can adversely affect the
public health and the groundwater resources of the State. Consistent with the duty to safeguard the public welfare, safety, health and to protect
and beneficially develop the groundwater resources of this State, it is declared to be the policy of this State to require that the location,
construction, repair, and abandonment of wells, and the installation of pumps and pumping equipment conform to such reasonable requirements as
may be necessary to protect the public welfare, safety, health and groundwater resources. (1967, c. ii57, s. 2.
3 87-86. Scope.
No person shall construct, operate, repair, or abandon, or cause to be constructed, operated, repaired, or abandoned, any well, nor shall any
person install, repair, or cause to be installed or repaired, any pump or pumping equipment contrary to the provisions of this Article and applicable
rules and regulatidns, provided that this Article shall not apply to any distribution of water beyond the point of discharge from the pump. (1967,
c. 1157, s. 4;'1987, c. 496, ss. 2, 3.
REQUIRED CORRECTIVE ACTION FOR VIOLATION:
You are to submit to the Division a corrective action plan that describes the events that led to the destruction
of the subject supply well and all corrective actions that have been and will be taken, including plans for the
abandonment and replacement of the subject water supply well. The corrective action plan is to describe in technical
detail siteactivities that were occurring during the time that impact to the water supply well occurred. This detailed
description shall include, but not be limited to, the dates, times, and personnel involved, number of rigs operating,
pressures that were used during installation, observations made regarding the condition of adjacent completed
geothermal wells during the same time frame, drilling problems that occurred onsite before the event, and what was
done to address those problems (i.e., modifications to the supply well). The corrective action plan is be received by
this office no later than 30 days following your receipt of this Notice.
Pursuant to North Carolina General Statute 87-91(a), you are hereby notified of your regulatory requirements
In regard to Well Construction Standards indicated in Subchapter 2C, Title 15A, of the North Carolina Administrative
Code. These Standards were adopted by the Environmental Management Commission under authority granted by the
North Carolina Well Construction Act. This Notice is given in accordance with North Carolina General Statutes 87-93, et
seq.
Please take the corrective actions for the above violation as necessary to achieve compliance. Corrective
actions must be taken and reported to the Asheville Regional Office, 2090 US Highway:70, Swannanoa, NC 28778,
within 30 days, unless otherwise noted in the above corrective actions, from receipt of this Notice to avoid
recommendation of civil penalties for violations.
North Carolina Division of Water Quality —Asheville Regional Office
2090 U.S. Highway 70, Swannanoa, N.C. 28778 Phone [phone] FAX [phone]
Customer Service I-877-623-6748
Internet: h2c.enr,state.no.us
oo e
NhCarolina
AdAMM!!11
.ty
An Equal Opporturdty I AffirmaM Action Employer

NOV-2011- PC-0606
Page 3 of 3
November 28, 2011
Your prompt attention to the items described herein is required. Failure to comply with the State's rules, in
the manner and time specified, could result in the assessment of civil penalties and/or the use of other enforcement
mechanisms available to the State. Each day that a violation continues may be considered a separate violation If you
should have any questions please do not hesitate to call Jonathan Stepp at 828.296.4684.
G. Landon Davidson, L.G.
Aquifer Protection Section Regional Supervisor
Asheville Regional Office
CC: NCWCCC
North Carolina Division of Water Quality — Asheville Regional Office
2090 U.S. highway 70, Swannanoa, N.C. 28778 Phone [phone] FAX [phone]
Customer Service 1-877-623.6748
Internet: h2o.enr.state nc.us
No1e hCarolina
;WUM!!1/
An Equal Opportunity l Af irmaWa Action Employer

Stepp, Jonathan
From:
Terry Bell [[e-mail]]
Sent:
Monday, December 05, 2011 9:48. PM
To:
Stepp, Jonathan
Cc:
[e-mail]; [e-mail]; GBorden@h-
mconstructors.com
Subject:
Corrective Action for Violation #3
Attachments:
Pfau Well.doc
Jonathan,
This is a timeline for the Pfau well incident. Please let me know if you need any additional information.
Thanks,
Tes-jy $edL
828-371-1234
RECINVE®
E-C 0 0 2511
Asheville Regional Office
Andfer Protection!

Chronological Events in Regard to Violation 0 3 of Ralph Pfau Well
September 26, 2011
- "Blow back" from geothermal drilling rig resulting in the total
destruction of Pfau well at approximately 11 A.M.
- Two well drilling rigs on site, Tarheel and Primetime. Tarheel crew
consisted of Roger Williams (certified NC driller) and Justin Cowart.
Primetime crew consisted of Mark & Kyle Anderson. Mid -South
Geothermal representatives were Tim Hornsby (certified NC driller)
and Gus Callahan.
- Well driller notifies Terry Bell, Macon County representative on site
- Terry Bell notifies Jack Horton, County Manager
- Jack Horton notifies Barry Patterson, Environmental Health
supervisor.
- Jack Horton and Barry Patterson arrive on site to meet with Ralph
Pfau, property owner of damaged well .
- Ralph Pfau is informed that Macon County will repair any damage to
Mr. Pfau's satisfaction
- A discussion as to well repair occurred resulting in further
investigation needed. Barry Patterson to investigate repair of
existing well or drill a new well.
- Well capped
- A plan to restore water to Mr. Pfau using the existing school well is
done within 3 hours from time of incident by Tarheel Water
- Water samples are taken by the Macon County Health Department
- Bottled drinking water is delivered to residence by Terry Bell
• September 27, 2011
- Diverter installed on well to prevent property damage and place
protective cap on well
• October 1-15
- Mr. Pfau out of town
- Recommended to complete the geothermal well drilling before doing
anything to restore Mr. Pfau's water.
- Actual communication between geothermal field and Pfau's well
occurs during this period
October 17 -21
- Barry Patterson informs that we can not repair Mr. Pfau's well,
thus` a new well must be drilled
EEC 06 25i1
Asheville Regional Office
Aquifer ifer Protection

• November 2
- Well specifications developed in order to get pricing from all local
well drillers
• November 3
- Jonathan Stepp, regional office NCDENR, visits site
• November 9
- Permit for Mr. Pfau's well issued
• November 7
- Local well drillers given specifications to price new well for Mr. Pfau
• November 21
- Well drillers on site request the abandonment of Mr. Pfau's well be
done
due to recent communication between wells
- Mr. Pfau and Macon County officials informed
• November 23
- Well abandonment procedure attempted. Tiffany Plemmons,
Environmental Health Specialist was present. Grouting failed and
was suspended to determine next step.
• November 30
- Jack Horton informs Terry Bell of Notice of Violations
• December 2
Well abandonment failed again. This process was under the advise of
Landon Davidson, Aquifer Section NCDENR
Barry Patterson and Tiffany Plemmons on site to observe.
• December 5
- Well abandonment successful. This process was under the advise of
Landon Davidson, Aquifer Section NCDENR
- Charles Womack, Environmental Specialist, on site to observe
Note:
The pressures used by the drill rigs on the September 26tn
-Tarheel 310
-Primetime 350
The well driller was in fractured rock at 420 ft. when the event occurred

Chronological Events in Regard to Violation # 3 of Ralph Pfau Well
• September 26, 2011
- "Blow back" from geothermal drilling rig resulting in the total
destruction of Pfau well at approximately 11 A.M.
- Two well drilling rigs on site, Tarheel and Primetime. Tarheel crew
consisted of Roger Williams (certified NC driller) and Justin Cowart.
Primetime crew consisted of Mark & Kyle Anderson. Mid -South
Geothermal representatives were Tim Hornsby (certified NC driller)
and Gus Callahan.
Well driller notifies Terry Bell, Macon County representative on site
- Terry Bell notifies Jack Horton, County Manager
- Jack Horton notifies Barry Patterson, Environmental Health
supervisor.
- Jack Horton and Barry Patterson arrive on site to meet with Ralph
Pfau, property owner of damaged well
- Ralph Pfau is informed that Macon County will repair any damage to
Mr. Pfau's satisfaction
- A discussion as to well repair occurred resulting in further
investigation needed. Barry Patterson to investigate repair of
existing well or drill a new well.
- Well capped
- A plan to restore water to Mr. Pfau using the existing school well is
done within 3 hours from time of incident by Tarheel Water
- Water samples are taken by the Macon County Health Department
- Bottled drinking water is delivered to residence by Terry Bell
September 27, 2011
- Diverter installed on well to prevent property damage and place
protective cap on well
• October 1 -15
Mr. Pfau out of town
Recommended to complete the geothermal well drilling before doing
anything to restore Mr. Pfau's water.
Actual communication between geothermal field and Pfau's well
occurs during this period
October 17 -21
Barry Patterson informs that we can not repair Mr. Pfau's well,
thus a new well must be drilled
RIECENED
e!C 0 6 26i1
Asheville Regional Office
Aquifer Protection

• November 2
- Well specifications developed in order to get pricing from all local
well drillers
• November 3
- Jonathan Stepp, regional office NCDENR, visits site
• November 9
- Permit for Mr. Pfau's well issued
• November 7
- Local well drillers given specifications to price new well for Mr. Pfau
• November 21
- Well drillers on site request the abandonment of Mr. Pfau's well be
done
due to recent communication between wells
- Mr. Pfau and Macon County officials informed
• November 23
Well abandonment procedure attempted. Tiffany Plemmons,
Environmental Health Specialist was present. Grouting failed and
was suspended to determine next step.
• November 30
- Jack Horton informs Terry Bell of Notice of Violations
• December 2
Well abandonment failed again. This process was under the advise of
Landon Davidson, Aquifer Section NCDENR
Barry Patterson and Tiffany Plemmons on site to observe.
• December 5
Well abandonment successful. This process was under the advise of
Landon Davidson, Aquifer Section NCDENR
Charles Womack, Environmental Specialist, on site to observe
Note:
The pressures used by the drill rigs on the September 26tn
-Tarheel 310
-Primetime 350
The well driller was in fractured rock at 420 ft. when the event occurred

PROP_ADDR
NBR_BLDGS
ACREAGE
OWNER NAME
OWNER_ADDR1
CSZ
PIN
WOODHAVEN DR
0
0.81
PRINGLE ROBERTALLEN SR p
10801 SW 61STTERRACE
MIAMI FL 33173
6586187179
1219 IOTLA CHURCH RD
2
0.72
HARDIN BILL R YES
4909 WESLYAN WOODS DRIVE
MACON GA 31210
6586178903
42 HICKORY BARN RD
3
1.89
CASADAJASON MALONE v tS
42 HICKORY BARN ROAD
FRANKLIN NC 28734
6586175958
145 MCCALL CIR
1
0.75
ELLIS SARA YVONNE ves
145 MCCALL CIRCLE
FRANKLIN NC 28734
6586183653
491 MCCALL CIR
2
2.23
BEGY GAIL F S
491 MCCALL CIRCLE
FRANKLIN NC 28734
6586087497
SPRINGBROOK DR
0
1.04
SEMLER RICHARD W 0
204 SPRINGBROOK DR
FRANKLIN NC 28734
6586185623
WOODHAVEN DR
0
0.67
BURNETTE HELEN Alo
93 WOODHAVEN DR
FRANKLIN NC 28734
6586270840
983 IOTLA CHURCH RD
1
3.28
BRADLEY EDWARD J V t S '
983 IOTLA CHURCH ROAD
FRANKLIN NC 28734
6586371608
IOTLA CHURCH RD
0
9
PENLAND BETTY T / p
517 IOTLA CHURCH RD
FRANKLIN NC 28734
6586076337
IOTLA CHURCH RD
0
4.69
BRADLEY EDWARD J p
983 IOTLA CHURCH RD
FRANKLIN NC 28734
6586373228
1571 IOTLA CHURCH RD
4
9
IOTLA BAPTIST CHURCH tS
1537 IOTLA CHURCH RD
FRANKLIN NC 28734
6586074932
IOTLA CHURCH RD
2
17.37
BRADLEY EDWARD J VVo
983 IOTLA CHURCH RD
FRANKLIN NC 28734
6586288124
1055 IOTLA CHURCH RD IOTLA CHURCH RD
2
0.81
SHULER MICHAEL DWIGHT LJEFS
1055 IOTLA CHURCH ROAD
FRANKLIN NC 28734
6586272885
76 HICKORY BARN RD
0
0.63
CASADA JASON MALONE p
42 HICKORY BARN ROAD
FRANKLIN NC 28734
6586186134
WOODHAVEN DRIVE
0
0.96
PRINGLE ROBERTALLEN SR No
10801 SW 61STTERRACE
MIAMI FL 33173
6586186305
200 WOODHAVEN DR
1
1.87
PRINGLE ROBERTALLEN SR ES
10801 SW 61STTERRACE
MIAMI FL 33173
6586187466
SPRINGBROOK DR
0
0.94
SEMLER RICHARD W INC,
204 SPRINGBROOK DR
FRANKLIN NC 28734
6586184403
120 MCCALL CIR
3
6
STENGER LAWRENCE 4 S
2540 ELLIJAY ROAD
FRANKLIN NC 28734
6586180394
1319 IOTLA CHURCH RD
1
1.05
BROWN ELAINE D 414FS
13717SE 1ST RD
NEWBERRY FL32669
6586183022
SPRINGBROOK DR
0
0.19
SEMLER RICHARD W o
204 SPRINGBROOK DR
FRANKLIN NC 28734
6586183390
110 HICKORY BARN RD
1
1.17
VANHOOK TIFFANI PEYTON
110 HICKORY BARN ROAD
FRANKLIN NC 28734
6586184139
1173 IOTLA CHURCH RD
3
5
IOTLA METHODIST CHURCH
GEN DEL
FRANKLIN NC 28734
6586174619
1386 IOTLA CHURCH RD
5
18.63
RIDDLE BRUCE C tS
1386 IOTLA CHURCH ROAD
FRANKLIN NC 28734
6586172141
IOTLA CHURCH RD
0
17.43
MACON COUNTY
5 WEST MAIN STREET
FRANKLIN NC 28734
6586160316
1237 AIRPORT RD
9
114.08
MACON COUNTY AIRPORT AU ORITY
1241 AIRPORT RD
FRANKLIN NC 28734
6576948822
874IOTLA CHURCH RD
2
17.71
LIBERTY WOOD PRODUCTS INC S
874IOTLA CHURCH RD
FRANKLIN NC 28734
6586360696
1218 IOTLA CHURCH RD
1
24.94
MACON COUNTY
5 WEST MAIN STREET
FRANKLIN NC 28734
6586361626
1118 IOTLA CHURCH RD
3
00 1.65
PFAU RALPH CIES
1118 IOTLA CHURCH ROAD
FRANKLIN NC 28734
6586272424
978 IOTLA CHURCH RD
6
12.48
BRADLEY EDWARD) 1S
983 IOTLA CHURCH RD
FRANKLIN NC 28734
6586276173
1114 IOTLA CHURCH RD
2
1.5
PADG ETT STACEY L t7S
1114 IOTLA CHURCH RD
FRANKLIN NC 28734
6586274446
1101 IOTLA CHURCH RD
2
5.83
SHULER DWIGHT JI&S
1101 IOTLA CHURCH RD
FRANKLIN NC 28734
6586272668
93 WOODHAVEN DR
1
1.94
BURNETTE HELEN
93 WOODHAVEN DR
FRANKLIN NC 28734
6586189193
185 WOODHAVEN DR
1
1.28
BURNETTE BRIAN WILLIAM
185 WOODHAVEN DR
FRANKLIN NC 28734-9349
6586280372
LOT 10 SECA IOTLA HILLS
0
0.43
GREATHOUSE WILLIAM THOMAS o
919 ANDREWS RD
W PALM BCH FL 33405
6586187658
245 WOODHAVEN DR
3
2.18
REESEY WILLIAM SR 4'4ssl
245 WOODHAVEN DR
FRANKLIN NC 28734
6586281628
LOT 9 SECA IOTLA HILLS
01
1.03
GREATHOUSE WILLIAM THOM S p
919 ANDREWS RD I
W PALM BCH FL 33405
6586189603

NORTH CAROLINA
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES (NCDENR)
APPLICATION FOR PERMIT TO CONSTRUCT AND/OR USE A WELL(S) FOR
INJECTION WITH A GEOTHERMAL HEAT PUMP SYSTEM FOR:
TYPE 50M WELDS)
X New Permit Application OR Renewal (check one)
DATE: 10/26 2010
PERMIT NO. qJI: 0-11. QU 141 (leave blank if NEW permit application)
A. PROPERTY OWNER(S)/APPLICANT(S)
List each Property Owner listed on property deed (if owned by a business or government agency, state name of
entity and a representative w/authority for signature): Macon County Goverrten
(1) Mailing Address: 5 West Main Street
City: Franklin State: NC Zip Code: 28734 County: Macon
Home/Office Tele No.: 828-349-2000 Cell No.: n/a
EMAIL Address: n/a
T o. -LA
(2) Physical Address of Site (if different than above): 1166 Lotla Church Road
City: Franklin State: NC Zip Code: 28734 County: Macon
Home/Office Tele No.: Cell No.:
EMAIL Address:
AUTHORIZED AGENT OF OWNER, IF ANY (if the/ Applicant does not own the subject property,
attach a letter from they>operty owner Wthorizing Agent to install and operate UIC well)
Company Name: ✓ `1 CLCZ i'1 L. O t t
Contact Person: V GtCk 'q_C r4-0n EMAILAddress: i ho ► Arl Q Mc G r7 J')G ,. fir'
Address: J5' ' L'Je T' J( �' C�= 11 rL f —
City: ►ctn n State:'VC- Zip Code: j- F7 3 �K County: OX6 /7
Office Tele No.: g'. Fi — �%— _0 Z2Z Cell No.
Website Address of Company, if any:
STATUS OF APPLICANT
Private: Federal:
State: Municipal:
Commercial:
Native American Lands: .
RECEIVED / DENR / DWQ
GPU/UIC 5QM Well Permit Application (Revised 7/2008) Aquifer Protection Section' Page 1
FEB 14 2011

u
D. WELL DRILLER INFORMATION
Company Name: MidSouth Geothermal, LLC
Well Drilling Contractor's Name: Tarheel Water Treatment Inc./Michael McClure
NC Contractor Certification No.: NC-3424-A
Contact Person: Janice Scott EMAIL Address: jscott�midsouthQeothenna] com
Address: 8275 Tournament Dr. Ste 185
City: Memphis Zip Code: 38125 County: Shelby
Office Tele No.: 901-748-9095 Fax No.: 901-748-9097
E. HEAT PUMP CONTRACTOR INFORMATION (if different than driller)
Company Name: MidSouth Geothermal, LLC
Contact Person: Janice Scott EMAIL Address: iscotto)midsouthgeothermal com
Address: 8275 Tournament Dr. Ste 185
City: Memphis Zip Code: 38125 County: Shelby
Office Tele No.: 901-748-9695 Fax No.: 901-748-9097
F. INJECTION PROCEDURE (briefly describe how the injection well(s) will be used)
G. WELL CONSTRUCTION DATA (Skin to Section H if this is a Permit RENEWAL//)
(1) Proposed date to be constructed: // Number of borings: g CP
Approximate depth of each boring (feet):_%
(2) Chemical additives to be used in closed -loop system (only those chemicals indicated have been approved):
R-22 propylene glycol ethanol other (other additives will
need prior approval by NCDENR before use)
(3) Type of tubing to be used (copper, PVC, etc): , _
(4) Well casing. Is the well(s) cased? (check either (a.) YES or (b.) O below)
(a) YES if yes, then provide casing information such as tie (steel, PVC, plastic, etc.), diameter,
de& and extent of casing appearing above ground:
(b) NO
(5) Grout (material surrounding well ca,tn an or t tti
i /1�� j
(a) Grout type: Cement Bentomte �b`— Other (specify)
(b) Grout depth of tubing (reference to land surface): from _(� to (feet)
If well has casing, indicate grout depth: from to (feet)
H. INJECTION -RELATED EQUIPMENT
Attach a diagram showing the engineering layout or proposed modification of the injection equipment and exterior
piping/tubing associated with the injection operation. The manufacturer's brochure may provide supplementary
information.
GPUIUIC 5QM Well Pennit Application (Revised 712008)
Page 2

I. LOCATION OF WELL(S)
Attach two copies of maps showing the following information:
(1) Include a site map (can be drawn) showing: buildings, property lines, surface water bodies, potential sources
of groundwater contamination and the orientation of and distances between the proposed well(s) and any
r existing wells) or waste disposal facilities such as septic tanks or drain fields located :within_ 1000 feet of the
geothermal heat pump well system. Label all features clearly and include a north arrow.
(2) Include a topographic map of the area extending one mile from the property boundaries and
indicate the facility's location and the map name.
J. POTABLE WATER WELL(S)
Are there any potable water well(s) on the subject property or adjacent properties? YES X­NO
If Yes, than indicate location on attached map(s).
K CERTIFICATION
Note: This Permit Application must be signed by each person appearing on the recorded legal.property deed.
"I hereby certify, under penalty of law, that I have personally examined and am familiar with the information
submitted in this document and all.atfachments thereto and that, based on my inquiry of those individuals
immediately responsible for obtaining said information, I believe that the information is true, accurate and complete.
I am aware that there are significant penalties, including the possibility of fines and imprisonment, for submitting
false information. I agree to construct, operate, may repatr, and if applicable, abandon the injection well and
all related appurtenances in accordance with the prove cification,�and conditions of the Permit."
SSiij` atur Ptopffi—r��� 7 wner/Applicant cou
jcZc k )qw-0 ,� _ ✓I unaC
Print or Type Full Name
Signature of Property Owner/Applicant
Print or Type Full Name
S a116 Iof Aut1h_ edd Agent, if any
c.l�C r-At _ Q-t q, / n 1 flo�qtict' t
Print or Type Full Name
t,J
Please return two copies of the completed Application package to:
North Carolina DENR-DWQ
Aquifer Protection Section RECEIVED / DENR / DWQ
UIC Program Aquif(;r Protection Section
1636 Mail Service Center FEB 14 2011
Raleigh, NC 27699-1636
Telephone [phone]
GPU/UIC 5QM Well Permit Application (Revised 7/2008) Page 3

tit
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Site Plan prcvlded by Bradshaw Englneednp 1004
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*S&M� Boring Location Plan Date: 10/9/07
Macon County K-4 School
SBME Job No. 1411-07-111 Figure No: 1

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MCD
North Carolina Department of Environment and Natural Resources
Beverly Eaves Perdue
Governor
C. Jack Horton, County Manager
Macon County Government
- 5 W . Main St.
Franklin, NC 28734
Division of Water Quality
Coieen I <. Sullins
Director
February 28, 2011
Ref: Issuance of Injection Well Permit W10100141
Issued to Macon County Government
Franklin, Macon County, North Carolina
Dear Mr. Horton:
Dee Freeman
Secretary
2 E-�VED
Asheville Regional Office
In accordance with the application received on February 14, 2011, I am forwarding permit number WI0100141 for
the construction and operation of a vertical closed -loop geothermal mixed -fluid heat pump injection well system to
be located at Macon County K-4 Elementary School, 1166 Iotla Church Road, Franklin, Macon County, NC 28734.
This permit shall be effective from the date of issuance until January 31, 2016, and shall be subject to the
conditions and limitations stated therein, including the requirement to install well identification tags as
specified in Part 11.3 and to submit well construction records as specified in Part VII.2. Be sure to read the
entire permit to ensure that you are aware of all compliance requirements of the permit. -
You will need to notify this office at least 48 hours prior to beginning construction and operation of the injection
well system. In order to continue uninterrupted legal use of the injection facility for the stated purpose, you must
submit an application to renew the permit 120 days prior to its expiration date. This permit is not transferable to
any person without prior notice to and approval by the Director of the Division of Water Quality.
Please contact me at [phone] or michael.rogers ,ncdenr.t?ov if you have any questions about your permit.
cc: Lando y _av dsonYAsheville,Re7 no aLOffice
WI0100141 Permit File
Macon County Environmental Health Dept.
AQUIFER PROTECTION SECTION
1636 IViall Service Center, Raleigh, North Carolina 27699-1635
Location: 2728 Capital Boulevard. Raleigh, North Carolina 2750A
Phone: [phone] i FAX 1: 919-715-0588', FAX 2: 915-715-60481, Cusromer Service: 1-877-623-6748
lnternt: Unrnai.ncivateraualitv.oro
-r:
Best Regards,
f
Michael Rogers, P.G. (NC & L)
TOr1E
I� o,rdi Carol .na
,A' N F

NORTH CAROLINA
ENVIRONMENTAL MANAGEMENT COMMISSION
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
RALEIGH, NORTH CAROLINA
PERMIT FOR THE CONSTRUCTION AND OPERATION OF A WELL FOR INJECTION
In accordance with the provisions of Article 7, Chapter 87; Article 21, Chapter 143; and other applicable
Laws, Rules, and Regulations
PERMISSION IS HEREBY GRANTED TO
Macon County Government
FOR THE CONSTRUCTION AND OPERATION OF 96 TYPE 5QM INJECTION WELL(S), defined in Title
15A North Carolina Administrative Code 2C .0209(e)(3)(F), for the purpose of operating a vertical closed loop
geothermal mixed fluid heat pump system. This system is located at Macon County K-4 Elementary School,
1166 Iotla Church Road, Franklin, Macon County, NC 28734, and will be constructed and operated in
accordance with the application received February 14, 2011, and in conformity with the specifications and
supporting data submitted, all of which are filed with the Department of Environment and Natural Resources
and are considered a part of this permit.
This permit is for Construction and Operation of an injection well and shall be in compliance with Title-15A of
the North Carolina Administrative Code 2C .0100 and .0200 plus any other applicable Laws, Rules, and
Regulations pertaining to well construction and use.
This permit shall be effective, unless revoked, from the date of its issuance until January 31, 2016, and shall be
subject to the specified conditions and limitations set forth in Parts I through IX hereof.
Permit issued this the 28th day of February, 2011.
ap" 3 U43
t
oleen H. Sullins, Director
ivision of Water Quality
By Authority of the Environmental Management Commission.
Permit #W10100141 UIC/5QM Page 1 of 5
ver. 03/2010

t
PART I - WELL CONSTRUCTION GENERAL CONDITIONS
1. The Permittee must comply with all conditions of this permit and with the standards and criteria specified
in Criteria and Standards Applicable to Injection Wells (15A NCAC 2C .0200). Any noncompliance with
conditions of this permit constitutes a violation of the North Carolina Well Construction Act and is
grounds for enforcement action as provided for in N.C.G.S. 87-94.
2. This permit shall become voidable unless the facility is constructed in accordance with the conditions of
this permit, the approved plans and specifications, and other supporting data.
3. Each injection well shall not hydraulically connect separate aquifers.
4. Each injection well shall not be located in an area generally subject to flooding. Areas that are generally
subject to flooding include those with concave slope, alluvial or colluvial soils, gullies, depressions, and
drainage ways.
5. Each injection well shall be afforded reasonable protection against damage during construction and use.
PART II — WELL CONSTRUCTION SPECIAL CONDITIONS
1. At least forty-eight (48) hours prior to constructing system, the Permittee shall notify the Aquifer
Protection Section's Underground Injection Control (UIC) Program Central Office staff, telephone
number [phone] and the Asheville Regional Office Aquifer Protection Section Staff, telephone
number [phone]. .
2. The location of each of the system manifolds shall be recorded by triangulation from three permanent
features on the site (e.g., building foundation corners) and shown on an updated Site Map. The Permittee
shall retain a copy of this record on site.
3. One well identification tag per grouping or `cluster' of wells shall be permanently affixed to the heating
and cooling unit or other nearby permanently fixed location in accordance with 15A NCAC 2C .0213(g).
PART III — OPERATION AND USE GENERAL CONDITIONS
1. This permit is effective only with respect to the nature, volume of materials and rate of injection, as
described in the application and other supporting data.
2. This permit is not transferable without prior notice to, and approval by, the Director of the Division of
Water Quality (Director). In the event there is a desire for the facility to change ownership, or there is a
name change of the Permittee, a formal permit amendment request must be submitted to the Director,
including any supporting materials as may be appropriate, at least 30 days prior to the date of the change.
3. The issuance of this permit shall not relieve the Permittee of the responsibility of complying with any and
all statutes, rules, regulations, or ordinances, which may be imposed by other local, state, and federal
agencies, which have jurisdiction. Furthermore, the issuance of this permit does not imply that all
regulatory requirements have been met.
Permit #W10100141 UIC/5QM Page 2 of 5
ver. 03/2010 -

0
PART IV — PERFORMANCE STANDARDS
1. The injection facility shall be effectively maintained and operated at all times so that there is no
contamination of groundwater that will render it unsatisfactory for normal use. In the event that the
facility fails to perform satisfactorily, including the creation of nuisance conditions or failure of the
injection zone to adequately assimilate the injected .fluid, the Pernittee shall take immediate corrective
actions including those actions that may be required by the Division of Water Quality such as the repair,
modification, or abandonment of the injection facility.
2. The Permittee shall be required to comply with the terms and conditions of this permit even if compliance
requires a reduction or elimination of the permitted activity.
3. The issuance of this permit shall not relieve _the Permittee of the responsibility for damages to surface or
ground water resulting from the operation of this facility.
PART V — OPERATION AND MAINTENANCE REQUIREMENTS
1. The injection facility shall be properly maintained and operated at all times.
2. The Permittee must notify the Division and receive prior written approval from the Director of any
planned physical alterations or additions in the permitted facility or activity not specifically authorized by
the permit.
3. At least forty-eight (48) hours prior to the _initiation of the -operation _of the facility for_--injection,--they
Permittee must notify by telephone the Aquifer Protection Section's Underground Injection Control (UIC).
Program Central Office staff, telephone number [phone]. Notification is -required so that Division
staff can inspect or otherwise review the injection facility and determine if it is in compliance with permit
conditions.
PART VI - INSPECTIONS
1. Any duly authorized officer, employee, or representative -of the Division of Water Quality may, upon
presentation of credentials, enter and inspect any property, premises, or place on or related to the injection
facility at any reasonable time for the purpose of determining compliance with this permit, may inspect or
copy any records that must be maintained under the terms and conditions of this permit, and may obtain
samples of groundwater, surface water, or injection fluids.
2. Division representatives shall have reasonable access for purposes of inspection, observation, and
sampling associated with injection and any related facilities as provided for in N.C.G.S. 87-90.
3. Provisions shall be made for collecting any necessary and appropriate samples associated with the
injection facility activities.
Permit #W10100141 UIC/5QM Page 3 of 5
ver. 03/2010

ti
PART VII — MONITORING AND REPORTING REQUIREMENTS
1. All required documentation shall be submitted to:
Aquifer Protection Section — UIC Program
DENR — Division of Water Quality
1636 Mail Service Center and
Raleigh, NC 27699-1636
Ph# 919-715-3221
Aquifer Protection Section
Asheville Regional Office
2090 US Highway 70
Swannanoa, NC 28778
[phone]
2. A completed Well Construction Record (Form GW-1) for each injection well must be submitted to the
Aquifer Protection Section Central Office and the Asheville Regional Office within 30 days of completion
of well construction. Copies of the GW-1 form(&) shall also be given to the Permittee and retained on site
to be made available for inspection.
3. A copy of the site map updated with manifold locations required in Part I1.2 of this permit shall be
submitted to the Aquifer Protection Section Central Office and the Asheville Regional Office within 30
days of completion of well construction.
4. Any monitoring (including groundwater, surface water, or soil sampling) deemed necessary by the
Division of Water Quality to insure surface and ground water protection will be established and an
acceptable sampling reporting schedule shall be followed. _
5. The Permittee shall report by telephone, within 48 hours of the occurrence or first knowledge of the
occurrence, to the Asheville Regional Office, telephone number [phone], any of the following:
(A) Any occurrence at the injection facility that results in any unusual operating circumstances;
(B) Any failure due to known or unknown reasons that renders the facility incapable of proper
injection operations, such as mechanical or electrical failures;
(C) Any loss of refrigerant in the system, regardless of the origin of the loss;
(D) Any recharging of the refrigerant system.
6. Where the Permittee becomes aware of an omission of any relevant facts in a permit application, or of any
incorrect information submitted in said application or in any report to the Director, the relevant and
correct facts or information shall be promptly submitted to the Director by the Permittee.
7. In the event that the permitted facility fails to perform satisfactorily, the Permittee shall take such
immediate. action as may be required by the Director.
PART VIII — PERMIT RENEWAL
In order to continue uninterrupted legal use of the injection facility for the stated purpose, the Permittee shall
submit an application to renew the permit 120 days prior to its expiration date.
Permit #W10100141 UIC/5QM Page 4 of 5
ver. 03/2010

PART IX — CHANGE OF WELL STATUS
1. The Permittee shall provide written notification within 15 days of any change of status of an injection
well. Such a change would include the discontinued use of a well for injection. If a well is taken
completely out of service temporarily, the Permittee must install a sanitary seal. If a well is not to be used
for any purpose, then that well must be permanently abandoned according to 15A NCAC 2C .0213(h)(1).
Notification shall be submitted to the addresses given in Part VII.1 of this permit.
2. When operations have ceased at the facility and a well will no longer be used for any purpose, the
Permittee shall abandon that injection well in accordance with -the procedures specified in 15A NCAC 2C
.0214, including but not limited to, the following:
(A) All casing and -materials may be removed prior to initiation of abandonment procedures if the -
Director finds such removal will not be responsible for, or contribute to, the contamination of an
underground source of drinking water.
(B) The entire depth of each well -shall- be sounded before it is sealed to insure freedom from
obstructions that may interfere with sealing operations.
(C) Each well shall be thoroughly disinfected, prior to sealing, if the Director determines that failure
to do so could lead to the contamination of an underground source of drinking water.
(D) Each well shall be completely filled with cement grout, which shall be introduced into the well
through a pipe that extends to the bottom of the well and is raised as the well is filled.
() In the case ,of gravel -packed wells in which the casing and screens .have not been removed, the
casing shall be perforated opposite the gravel pack, at intervals not exceeding 10 feet, and grout
injected through the perforations.
(F) In those cases when, as a result of the injection operations, a subsurface cavity has been created,
each well shall be abandoned in such a manner that will prevent the movement of fluids into or
between underground sources of drinking water and in accordance with the terms and conditions
of the permit.
(G) The Permittee shall submit a copy of the Well Abandonment Record (Form GW-30) as specified
in 15A NCAC 2C .0213(h)(1) within 30 days of completion of abandonment. Copies shall be
submitted to the addresses given in Part VII.1 of this permit.
Permit M101001111 UIC/50,M Page 5 of 5
ver. 03/2010

AQUIFER PROTECTION SECTION - GROUNDWATER.PROTECTION UNIT
REGIONAL STAFF REPORT
Date: 02/24/2011 Permittee(s): John C. Williams
Permit No.: WI0100141
To: APS Central Office County: Macon
Central Office Reviewer: Michael Rogers Project Name: N. Macon Elem.
Regional Login No:
I. GENERAL INFORMATION
1. This application is (check all that apply): ❑ SFR Waste Irrigation System ® UIC Well(s)
® New ❑ Renewal
❑ Minor Modification ❑ Major Modification
❑ Surface Irrigation ❑ Reuse ❑ Recycle ❑ High Rate Infiltration ❑ Evaporation/Infiltration Lagoon
❑ Land Application of Residuals ❑ Attachment B included ❑ 503 regulated ❑ 503 exempt
❑ Distribution of Residuals ❑ Surface Disposal
❑ Closed -loop Groundwater Remediation ❑ Other Injection Wells (including in situ remediation)
Was a site visit conducted in order to prepare this report? ® Yes or ❑ No.
a. Date of site visit: 02/24/2011
b. Person contacted and contact information: Terry Bell
c. Site visit conducted by: Jonathan Stepp
d. Inspection Report Attached: ® Yes or ❑ No.
2. Is the following information entered into the BIMS record for this application correct?
❑ Yes or ❑ No. If no, please complete the following or indicate that it is correct on the current application.
For SFR Treatment Facilities:
a. Location:
b. Drivins: Directions:
c. USGS Quadrangle Map name and number: __--
d. latitude.: Longitude:._______ . Method Used (GPS, GoogleT'f, etc.); _
e. Regulated Activities /'hype of Wastes (e.g., subdivision, food processing, municipal wastewater):
For UIC Injection Sites:
(If multiple sites either indicate which sites the information applies to, copy and paste a new section into the
document for each site, or attach additional pages for each site)
a. Location(s): Franklin, NC, Macon Co.
b. Driving Directions: See Attached
c. USGS Quadrangle Map name and number:
d. Latitude: Longitude: _
Method Used (GPS 9�9
l TM etc.);
sl�IGtl
APS-GPU Regional Staff Report (Sept 09) Page 1 of 6 Pages

AQUIFER PROTECTION SECTION - GROUNDWATER PROTECTION UNIT
REGIONAL STAFF REPORT
II. NEW AND MAJOR MODIFICATIONAPPLICATIONS (this section not needed for renewals or minor
modifications, skip to next section)
Description of Waste System and Facilities
1. Please attach co.nipleted rating sheet. J.'acifit,', Classification.:
2 �. Are the nexv treatment facilities adequate for the type ofwaste and disposal systern?
❑ Yes F] No R N/A. lf.'no, please explain:
3. Are the new site conditions (soils, topography, depth to w-x,,-ater table, etc) consistent with Nvhat was reported by
the soil scientist and/or Professional Engineer') El Yes D NoEl N/A. If no, please explain:
I
4. I)oes the application (maps, plans, etc.) represent the actual site (property lines, wells, surface drainage)" ❑
Yes [:] NoF-1 N/A. If no, please explain:
5. Is the proposed residuals management plan adequate and/or acceptable to the Division. 0 Yes [:] No ❑
zn
N/A. If no, please explain:
6. Are the proposed application rates for new sites (hydraulic or nutrient) acceptable?
[:] YesF-1 NoF-1 N/A. If no, please explain: -
7. Are the neA, treatment facilities or any new disposal sites located in a I 00-vear floodplain?
F-]Yes [-] No [-] N/A. I l.'ves, please attach a map showing areas of 100-year floodplain and please explain
yes, - -
and recommend any mitigative 1110,1SLIMS/SpeCial conditions in Part IV:
8. Are there any buffer conflicts (new treatment facilities ornew disposal sites)? F-1 Yes or E]No. If yes, please
attach a map showing conflict areas or attach any new maps you have received from the applicant to be
incorporated. into the permit:
9. Is proposed and/or existing g (117OLindwater monitoring program (number of wells, frequency of monitoring
Z
monitoring parameters, etc.) adequate? [:1 Yes ❑ No ❑ N/A. Attach map of existing monitoring well
network if applicable. Indicate the review and compliance boundaries. If No,, explain and recommend any
changes to the i-,rMlndwater monitoring program:
10. f"Or reSidi.1,41S, will Seasonal or other restrictions be I-C(IL1ired9 ❑ Yes❑ NoF-1 N/A If yes. attach list of.'s.itcs
with restrictions (Certification B?)
III RENEWAL AND MODIFICATIONAPPLICATIONS (use previous section for new or maior modirleation
systems)
Description of Waste System and Facilities
1. Are there appropriately certified ORC's for the ficicitities'.,'F] Yes or 0 No.
Operator in Charge: Certificate
Backup- Operator in Charge: _ Certificate #:
APS-GPU Regional Staff Report (Sept 09) Page 2 of 6 Pages

AQUIFER PROTECTION SECTION - GROUNDWATER PROTECTION UNIT
REGIONAL STAFF REPORT
2. Is the design, maintenance and operation (e.g. adequate aeration, sludge wasting, sludge storage, effluent
storage, etc) of the treatment .facilities adequate for the type of waste and disposal. system? ❑ Yes or ❑ No.
If no, please explain:
3. Are the site conditions (soils, topography, depth to water table, etc) maintained. appropriately and adequately
assimilating the waste? ❑ Yes or ❑ No. If no, please explain:
4. Has the site changed in any way that may affect permit (drainage added, new wells inside the compliance
boundary, new development, etc.)? if yes, please explain:
5. Is the residuals management plan for the facility adequate andlor acceptable to the Division?
❑ Yes or ❑ No. If no, please explain.:
6. Are the existing application rates (hydraulic or nutrient) still accept:a.ble? ❑ Yes or ❑ No. if no, please
explain:
7. Is the existing groundwater monitoring program (.number of wells, frequency of monitoring, monitoring
parameters, etc.) adequate? ❑ Yes ❑ No ❑ N/A. Attach map of existing monitoring well network if
applicable. Indicate the review and compliance boundaries. If No, -explain and recommend any changes to the
groundwater monitoring program:
8. Will seasonal or other restrictions be required for added sites? ❑ Yes ❑ No ❑ N/A If yes, attach List of sites
with restrictions (Certification B?)
9. the there any buffer conflicts (treatment facilities or disposal sites)? ❑ Yes or ❑ No. If yes, please attach a
map showing conflict areas or attach. any new :maps you have received from the applicant to be incorporated
into the permit:
10. -Is the description of the facilities, type and/or volume of waste(s) as written in the existing permit correct? ❑
Yes or ❑ No. If no, please. explain: 11. Were monitoring wells properly constructed and located`? ❑ Yes or ❑ No ❑ N/A. if no, please explain:
12. Has a review of all self=rnonit:oring data been conducted (GW, NDMR, and NDAR. as applicable)? ❑ Yes or
❑ No ❑ N/A. Please summarize any findings resulting from this review:
13. Check all that apply: ❑ No compliance issues; ❑ Notice(s) of violation within the last permit cycle; ❑
Current enforcement action(s) ❑ Currently under- SOC; ❑ Currently under JOC; ❑ Currently under
moratorium. I:f any items checked, please explain. and attach any documents that may help clarify
answer/comments (such as NOV, NOD etc):
14. have all compliance dates/conditions in the existing permit, (SOC, .IOC, etc.) been complied with? ❑ Yes
❑ No ❑ Not Determined ❑ N/A.. If no. please explain:
15. Are there- any issues related to compliance/enforcement that should be resolved before issuing this permit'? ❑
Yes or ❑ No ❑ N/A. if ycs, please explain:
APS-GPU Regional Staff Report (Sept 09) Page 3 of 6 Pages

AQUIFER PROTECTION SECTION - GROUNDWATER PROTECTION UNIT
REGIONAL STAFF REPORT
ITS INJECTION WELL PERMITAPPLICATIONS (Complete these two sections for all systems that use injection
wells, including closed -loop groundwater remediation effluent injection wells, in situ remediation injection wells, and heat
pump injection wells.)
Description of Well(s) and Facilities — New, Renewal, and Modification
1. Type of injection system:
❑ Heating/cooling water return flow (5A7)
® Closed -loop heat pump system (5QM/5QW)
❑ In situ remediation (5I)
❑ Closed -loop groundwater remediation effluent injection (5L/"Non-Discharge")
❑ Other (Specify:
2. Does system use same well for water source and injection? ❑ Yes ® No
3. Are there any potential pollution sources that may affect injection? ❑ Yes ® No
What is/are the pollution source(s)? . What is the distance of the infection wells from the pollution
source(s)? ft.
4. What is the minimum distance of proposed injection wells from the property boundary? ft.
5. Quality of drainage at site: ® Good ❑ Adequate ❑ Poor
6. Flooding potential of site: ® Low ❑ Moderate ❑ High
7. For groundwater remediation systems, is the proposed and/or existing groundwater monitoring proo rain
(dumber of wells, frequency of monitoring, monitoring parameters, etc.) adequat:e`.? ❑ Yes ❑ No. Attach
.neap of existing monitoring well network :if applicable. 1.fNo. explain and recommend any chari, cs to die
grourldlyater monitoring program:
8. Does the map presented represent the actual site (property lines, wells, surface drainage)? ® Yes or ❑ No. If
no or no map, please attach a sketch of the site. Show property boundaries, buildings, wells, potential pollution
sources, roads, approximate scale, and north arrow.
Injection Well Permit Renewal and Modification Only:
1. For heat pump systems, are there any abnormalities in heat pump or injection well operation ('e.g. turbid water,
faihIre to assimilate injected fluid, poor heating/cooling')`?
❑ Yes ❑ No. Ifyes, explain:
2. For dosed -loop heat pump systems, has system lost pressure or required make-up fluid since permit issua rice
<?r last inspection? ❑ Yes ❑ No. if yes. explain:
3. For renewal or modification of"aroundwat:er remediation pernnit:s (of any type), dvill
continued/additionalfinodiFted injections have an adverse impact on migration of the plume or manat7ement of.
the contamination incident?_❑ Yes No. Cyes p._lan:
APS-GPU Regional Staff Report (Sept 09) Page 4 of 6 Pages

AQUIFER PROTECTION SECTION - GROUNDWATER PROTECTION UNIT
REGIONAL STAFF REPORT
4. Drilling Contractor: Name:
Address:
NC Certification number:
5. Coin plete and attach NEW injection Facility Inspection Report, if applicable
U. EVALUATIONAND RECOMMENDATIONS
1. Provide any additional narrative regarding your review of the Application:
2. Attach new Injection Facility Inspection Form, if applicable
3. Do you foresee any problems with issuance/renewal of this permit? ❑ Yes Z No. If yes, please explain
briefly.
4. List any items that'you would like APS Central Office to obtain through an additional information request.
Make sure that you provide a reason for each item:
Item Reason
5. List specific Permit conditions that you recommend to be removed from the permit when issued. Make sure
that you provide a reason for each condition:
Condition Reason
6. List specific special conditions or compliance schedules that you recommend to be included in the permit when
issued. Make sure that you provide a reason for each special condition:
Condition Reason
APS-GPU Regional Staff Report (Sept 09) Page 5 of 6 Pages

AQUIFER PROTECTION SECTION - GROUNDWATER PROTECTION UNIT
REGIONAL STAFF REPORT
7. Recommendation: ❑ Hold, pending receipt and review of additional information by regional office; ❑ Hold,
pending review of draft permit by regional office; ❑ Issue upon receipt of needed additional information;
Issue; ❑ Deny. If deny, please state reasons:
8. Signature of report Preparer(s):
Signature of APS regional supervisor:
Date: 00 ` Z1 • 2.i,
VI. ADDITIONAL INFORMATIONAND SITE MAP (Sketch of site showinz house and waste irrigation
system, spray or drip field, location of well(s), and/or other relevant information- SHOW NORTHARROW)
See Permit App.
APS-GPU.Regional Staff Report (Sept 09) Page 6 of 6 Pages

Driving Directions from 2090 Us 70 Hwy, Swannanoa, North Carolina to 1166 Iotla Church Rd,... Page 1 of 1
��++ _ "^ Notes
map.quesI Meet with Terry Bell at 10:30am
G828-731-1234
Trip to:
1166 lotla Church Rd !
Franklin, NC 28734-6542
79.46 miles
1 hour 36 minutes I
2090 Us 70 Hwy
Miles Per
Miles
Swannanoa, NC 28778-8211
Section
Driven
1. Start out going WEST on US-70 / BLACK MOUNTAIN HWY toward NEW SALEM
Go 2.4 Mi
2.4 mi
RD.
2. Turn LEFT onto PORTER COVE RD.
Go 0.1 Mi
2.5 mi
PORTER COVE RD is just past BURLESON RD
rr
3. Merge onto 1-40 W toward 1-26 / ASHEVILLE.
Go 27.4 Mi
29.9 mi
®�
4. Merge onto US-74 W via EXIT 27 toward US-19 / CLYDE / US-23 / WAYNESVILLE /
Go 1.4 Mi
31.3 mi
74.
MAGGIE VALLEY / FRANKLIN / MURPHY / ATLANTA.
r0a
i4
5. Merge onto US-23 S / US-74 W via EXIT 107 toward E JONES COVE.
Go 25.0 Mi
56.3 mi
®
6. Merge onto US-23 S / US-441 S via EXIT 81 toward DILLSBORO / FRANKLIN /
Go 16.9 Mi
73.2 mi
44
ATLANTA.
RAtAP
7. Take the US-441-BR ramp toward FRANKLIN.
Go 0.1 Mi
73.3 mi
0.4 miles past HUNTERS TRL
71
FA
gTp
8. Turn SLIGHT RIGHT onto E MAIN ST / US-441-BR W.
; Go 1.5 Mi
74.8 mi
9. Turn RIGHT onto HARRISON AVE / NC-28: Continue to follow NC-28.
NC-28 is just MACON AVE
Go 3.5 Mi
78.3 mi
2s
past
y.
10. Turn LEFT onto IOTLA CHURCH RD.
Go 0.4 Mi
78.7 mi
I
IOTLA CHURCH RD is 0.2-miles past PARRISH LN
11. Turn RIGHT to stay on IOTLA CHURCH RD.
Go 0.8 Mi
79.6 mi
12.1166 IOTLA CHURCH RD is on the LEFT. 79.5 mi
Your destination is just past WOODHAVEN DR
If you reach MCCALL CIR you've gone about 0.1 miles too far
1166 lotla Church Rd 79.5 mi 79.5 mi
Franklin, NC 28734-6542
Total Travel Estimate: 79.46 miles - about 1 hour 36 minutes
AIR rights_r..eserv_ed..Ose subject_to License/Copyright
Directions and maps are informational only. We make no warranties on the accuracy of their content, road conditions or route usability or expeditiousness. You
assume all risk of use. MapQuest and its suppliers shall not be liable to you for any loss or delay resulting from your use of MapQuest. Your use of MapQuest means
you agree to our Termsof Use
http://www.mapquest.com/print?a=app.core.ce366ad5670033efa3a20796 2/23/2011

Macon C011WIV
December 26, 2011
Jonathan Stepp
NC DENR-APS
Asheville Regional Office
2090 US Highway 70
Asheville, NC 28778
CS 29 Wtl
Dear Mr. Stepp:
I am replying to your correspondence dated December 8, 2011 in regard to the Iotla
School project. I am responding to each of the numbered items in your letter. I have
included written responses to each concern. Drill logs, geothermal well site plan,
geothermal, well grout procedure, permit for construction of private well damaged,
chronological events of damaged well (2❑d submittal), and well abandonment record are
included.
Please contact me for any additional information.
Sincerely,
Terry Be
terry. [e-mail] 2.nc.us
828-371-1234
cc: Jack Horton
MACON COUNTY COURTHOUSE ANNEX
PHONE [phone]
5 WEST MAIN STREET
FRANKLIN, NORTH CAROLINA 28734
FAX: [phone]

A�
NCDENR
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Beverly Eaves Perdue Coleen H. Sullins Dee Freeman
Governor Director Secretary
December 08, 2011
Macon County Schools
5 West Main St,
Franklin, NC 28734
Attn: Mr. Jack Horton — County Manager
Re: Review of NOV-2011-PC-0606 Response
WI0100141
Macon County, North Carolina
Dear Mr. Horton:
On December 5, 2011, I made a site visit to 1166 Iotla Church Road in Macon County to inspect
the installation of a geothermal well field. While on site I met with Mr. Terry Bell who was very helpful in
updating me of your progress toward complying with the referenced notice of violation. As of today Mr.
Bell has provided me with a site map of the area, a listing of each parcel with a water supply well, and a
time line of the events that have taken place since Mr. Ralph Phau's water supply well was destroyed.
Based upon a review of the documents submitted in response to the NOV and the recent site
inspection, the following Items are missing or incomplete: .
1. Please provide an onsite well map Identifying all UIC wells. Please note that all well construction
records submitted must be signed by the appropriate North Carolina Certified Well Contractor;
2. Please provide detailed construction as -built specifications for each well. The grouting activities being
conducted in the field do not match the well specifications listed in your permit application (Le., full
borehole grout versus just top 20 ft grouted). Please also include an explanation detailing as to why
the grout specification was altered;
3. The required corrective actions, as stated in the NOV, are to include a written response as to your
intentions on replacing the impacted well owned by Mr. Phau. Macon County should also consider
discussing this issue with other adjacent water supply well owners to determine if they have been
negatively impacted by onsite drilling activities;
4. The large sand bags placed on top of the well points may prevent some surface fluids from entering
un-grouted wells, however, we feel that additional measures are necessary to include but not limited
to soil berms around the well points. The large sand bags placed on some of the well points make it
difficult to monitor if water is entering the well or well annulus. Please note that if surface water or
fluids enter a well and contaminate the groundwater resource, it is considered to be an illegal
injection. Additionally, please be aware that you have five days to grout a well once the bore hole
has been completed;
5. All completed wells that have become compromised due to ejection of grout, subsidence of grout or
any other means shall be repaired immediately; and,

WI0100141
Page 2 of 2
6. Please provide a well abandonment record for Mr. Phau's water supply well.
Please address the missing or incomplete items listed above and report them to the Asheville
Regional Office, 2090 US Highway 70, Swannanoa, NC 28778 no later than December 29th. If you have
questions regarding any of these items please do not hesitate to call me at 828.296.4684.
Sincerely,
Jonathan Stepp
Senior Hydrological Technician
NC DENR-APS
Asheville Regional Office
ec: Jack Horton

Per my previous e-mail below, I would like to offer the following updates to the referenced DENR
NOV items cited in Mr. Horton's 12/8/2011 letter, as follows:
Item #1, "Onsite well map identifying all UIC wells" - Please find attached an updated geothermal
site map showing the locations of all geothermal underground injection control (UIC) wells.
Item #2, "As -built specifications for each well" - The grout specification was altered, due to
fractured and unstable geology encountered and to the resulting underground communication
between geothermal wells. In all cases, grout was placed along the entire cased section of
borehole from 5' below the casing to surface. A detailed profile of the well cross section and
modified grouting/backfill procedure is attached for the record and inclusion with the well permit.
Item #4, "protecting well points from surface fluids" - As each well is grouted to the surface or
subsequently topped off due to subsidence, the sand bag is removed. Currently all completed
wells have been grouted. Going forward, if becomes necessary to protect a well, a berm will be
built up around the well point before the sand bag is placed over the well. As a side note, the
2,000 lb. sand bags are fitted with an impervious plastic liner, and are commonly used to hold
back flood waters, so we feel they do an excellent job protecting the well point.
Item #5, "Compromised wells due to ejection of grout" - As pointed out in Item #2, the
grouting/backfilling method was modified due to communicating wells ejecting grout from
previously completed wells. The modified method detailed in Item #2 has enabled us to repair
and complete all of the affected wells.
Please don't hesitate to call me if you would like to discuss this in more detail or should you need
additional information.
Sincerely,
Scott W. Triplett
Mid -South Geothermal, LLC
[phone] office
[phone] fax
[phone] cell

Item # 3 "replacement of well impacted owned by Ralph Pfau" - The county is
ready to drill a new well at no cost to owner. We have been advised by
the Macon County Environmental Office and you that it would be wise to
wait until all geothermal drilling are finished. Mr. Ralph Pfau is in total
agreement with this plan for replacement. Our visible presence is very
apparent to all property owners near this site. We have not had anyone to
complain in regard to their water sources. Macon County would treat
anyone with a legitimate complaint in the same manner as Mr. Pfau.
Item # 6 Well abandonment procedures was done by Tarheel Water Treatment. I
have enclosed a copy of their documentation. The entire process was
observed by a representative from the Macon County Environmental
office.
Terry Bell 1,6r

ZONE' A
,Gig OVFRAt
Y
L
7 -r B
NE
FRAC T t_IRF: Z,.
r
Z0N!r C
COMP:= T tN l I
GEOTHERMAL WELL GROUTING
PROCEDURE
1. STEEL CASING SET TO A MINIMUM
DEPTH OF 5' INTO ZONE C.
2. WASHED PEA GRAVEL IS USED TO
BACKFILL ZONE C TO BOTTOM OF STEEL
CASING.
3. BENTONITE GROUT SEAL IS PLACED
FROM BOTTOM OF CASING TO TOP OF
FRACTURE ZONE
4. GEOTHERMAL GROUT IS PUMPED
THROUGH A TREMIE LINE FROM TOP OF
GROUT SEAL TO GROUND SURFACE.
(:�eotF.��rrnci Croat
r
} :. ,:_ competent rock
'J (:�rol.,t ;F.(.I _ PE;riC't1"atE',S rninimu,?7 :� ��"' compete
r,
Washeal f?r'�3 ea Gravel
,10 _`If ICl' /a, 1 i ; . I.`!C: I:_f'.., 1 f.._RMI T ,�_,�'�,/!()1 C) 1
T
0
zo
c=
UU z
QN r
ate::
t

Qiote r
W �� �m Macon County
r d Public Health
��d a7J
CONSTRUCTION AUTHORIZATION
PRIVATE DRINKING WATER WELL
Ralph Pfau MGM 081011-a ' existing
• • 1118 lotla Church Road ' ' ' 6586272424 1.65
Single Family, Residential
28N> lotla Church Rd> house just before the new North Macon School
Permit Conditions
Well shall be constructed in compliance with all NCAC 2C Rules
Maintain minimum setbacks, as applicable
This permit is amended for the replacement new well due to the hydraulically linked existing well to adjacent geothermal well field
This permit is conditioned with the proper abandonmet of the existing well before the driller -permanently leaves the site.
Diagram (Not to Scal
Iotla, Church Road
ist
! well '
I
I area
...::..
--------
Well to be i ................ ?. ° .:._...._................._.._...... , s ! N
abandoned(tta�:frlkkfC:gtL:::l: .
® ....
...�..�..:. 3...3...3...i .: ..: S S
61'
I_ 2nt_- i
I
I
---------------- 125'......_•-•-•-•-•-••N well t*---------------- 57' •-•-•-•-•-•-•-•-•-
area
64'
This Permit is valid for a period of five years except that it may be revoked at any time if it is determined that there has been a material change in any fact or
circumstance upon which the permit is issued. Well location, installation, and protection must meet state regulations. The well shall be inspected and approved by Macon County
Public Health before it is put into use. The location of the well indidated by MCPH is to provide protection from possible sources of contamination. Flow volume (well yield) is NOT .
guaranteed at any site by MCPH.
A WELLHEAD COMPLETION INSPECTION MUST BE APPROVED BEFORE FINAL POWER IS GRANTED OR THE WELL IS PLACED
INTO SERVICE. PLEASE SCHEDULE A WELLHEAD INSPECTION AFTER PUMP INSTALLATION. QUESTIONS? [phone]
n
Issue Date: 11-9-11 Harold Faircloth, REHS 2189 Auth. State Agent

Chronological Events in Regard to Violation # 3 of Ralph Pfau Well
September 26, 2011
- "Blow back" from geothermal drilling rig resulting in the total
destruction of Pfau well at approximately 11 A.M.
- Two well drilling rigs on site, Tarheel and Primetime. Tarheel crew
consisted of Roger Williams (certified NC driller) and Justin Cowart.
Primetime crew consisted of Mark & Kyle Anderson. Mid -South
Geothermal representatives were Tim Hornsby (certified NC driller)
and Gus Callahan.
- Well driller notifies Terry Bell, Macon County representative on site
- Terry Bell notifies Jack Horton, County Manager
- Jack Horton notifies Barry Patterson, Environmental Health
supervisor.
- Jack Horton and Barry Patterson arrive on site to meet with Ralph
Pfau, property owner of damaged well
- Ralph Pfau is informed that Macon County will repair any damage to
Mr. Pfau's satisfaction
- A discussion as to well repair occurred resulting in further
investigation needed. Barry Patterson to investigate repair of
existing well or drill a new well.
- Well capped
- A plan to restore water to Mr. Pfau using the existing school well is
done within 3 hours from time of incident by Tarheel Water
- Water samples are taken by the Macon County Health Department
- Bottled drinking water is delivered to residence by Terry Bell
September 27, 2011
- Diverter installed on well to prevent property damage and place
protective cap on well
• October 1 -15
Mr. Pfau out of town
Recommended to complete the geothermal well drilling before doing
anything to restore Mr. Pfau's water.
Actual communication between geothermal field and Pfau's well
occurs during this period
• October 17 -21
- Barry Patterson informs that we can not repair Mr. Pfau's well,
thus a new well must be drilled

• November 2
- Well specifications developed in order to get pricing from all local
well drillers
• November 3
- Jonathan Stepp, regional office NCDENR, visits site
• November 9
- Permit for Mr. Pfau's well issued
• November 7
- Local well drillers given specifications to price new well for Mr. Pfau
• November 21
- Well drillers on site request the abandonment of Mr. Pfau's well be
done
due to recent communication between wells
- Mr. Pfau and Macon County officials informed
• November 23
- Well abandonment procedure attempted. Tiffany Plemmons,
Environmental Health Specialist was present. Grouting failed and
was suspended to determine next step.
• November 30
- Jack Horton informs Terry Bell of Notice of Violations
• December 2
Well abandonment failed again. This process was under the advise of
Landon Davidson, Aquifer Section NCDENR
Barry Patterson and Tiffany Plemmons on site to observe.
• December 5
- Well abandonment successful. This process was under the advise of
Landon Davidson, Aquifer Section NCDENR
- Charles Womack, Environmental Specialist, on site to observe
Note:
The pressures used by the drill rigs on the September 26tn
-Tarheel 310
-Primetime 350
The well driller was in fractured rock at 420 ft. when the event occurred

WELL ABANDONMENT RECORD
North Carolina Department of Environment and Natural Resources- D�ipvision of Water Quality
WELL CONTRACTOR CERTIFICATION # L% `7 a
1. W L C NTRA TOR:
We I Contras or (Indivi ual) Name
owhlee
Well Contractor Company Name ,
31494 G-e®r-�„0 -
Street Address
I� 1t r� ✓UL a8 73y a�
City or Town State Zip Code
Area code Phone number
2. WELL INFORMATION:
SITE WELL ID # Cif applicable)
STATE WELL PERMIT # (if applicable) y� /
COUNTY WELL PERMIT # (if applicable) p8�0 f I — '-'-)'—
DWQ or OTHER PERMIT # (if applicable)
WELL USE (Check applicable used Monitoring Residential
❑ M unicipal/Public ❑ Industrial)Commercial ❑ Agricultural
❑ Recovery ❑ Injection ❑ Irrigation
❑ Other (list use)
3. WELL LOCATION:
COUNTY QUA
D
R
ANGLE NAME
NEAREST TOWN: cam IL I t
(Street/Road Name, Number, Community, Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHC / LAND SETTING:
Slope ❑ Valley ❑ Flat ❑ Ridge❑ Other
(Check appropriate setting)
LATITUDE 36 _1,3' _" DMS OR 3X.XXXXXXXXmD
LONGITUDE i °vim` "DMS OR 7X.XXXXXXX)MD
Latitude/longitude source: PPS QTopographic map
(location of well must be shown on a USGS topo map andattached to
this form if not using GPS)
4a. FACILITY - The name of the business where the well is located. Complete 4a;
(If a residential well, skip 4a; complete 4b, well owner information only.)
FACILITY ID # (if applicable)
NAME OF FACILITY
STREET ADDRESS
City or Town State Zip Code
4b. CONTACT ER O MIELL O ER:
NAME go
STREET ADDRESS �D� �- (Mi
6. WELL DETAILS: )'n
a.Totai Depth Oyc ft. Diameter: / in.
b. Water Level (Below Measuring Point):
Measuring point is �_ ft. above land surface.
S. CASING:
Length
a. Casing Depth (if known): ft.
b. Casing Removed: ft.
7. DISINFECTION:
Diameter
42 in.
� in.
(Amount of 65%75% calcium hypochlorite used)
8. SEALING MATERIAL:
Neat Cement
Cement lb.
Water gal.
Bentonite
Bentonite �3��lb.
Type: ❑ Slurry *ellets
Water gal.
Other
Type material
Amount
Sand Cement
Cement lb.
Water gal.
10. WELL DIAGRAM : Draw a detailed sketch of theeli on the back of this
form showing total depth, depth and diameter of screens (if any) remaining
in the well, gravel interval, intervals of casing perforations, and depths and
types of fill materials,sed ` J
11. DATE WELL ABANDONED
I DO HEREBY CERTIFY THAT THIS WELL WAS ABANDONED IN ACCORDANCE
WITH 15A NCAC 2C, WELL STRUCTIO STANDARDS, AND THAT A COPY OF
THIS RECORD HA BEE IDED TO E WELL OWNER.
: SIG ATURE OF CERTIFIED WELL CONTRACTOR DATE
SIGNATURE OF PRIVATE WELL OWNER ABANDONING THE WELL DATE
(The
p�/riivate wellownerowner%must be an individual wbampnalbabandons his/her residential well
in a
thiSA
PRINTED NAME OF PERSON ABANDONING THE WE LL
Submit a copy to the owner and the original to: Division of Water Quality - Information Processing, Form GW-30
1617 Mail Service Center, Raleigh, NC 27699-1617, Phone: [phone] Rev. 5/10

NONRESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 3118-A
1. WELL CONTRACTOR:
Timothy R Hamby
Well Contractor (Individual) Name
Midsouth Geothermal
Well Contractor Company Name
8275 Tournament Dr Suite 185
Street Address
Memphis TN 38125
City or Town State Zip Code
d. TOP OF CASING IS �- FT. Above Land Surface'
'Top of casing terminated at/or below land surface may require
a van ancerrin accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): O'� 3� METHOD OF TEST RIOW Down
f. DISINFECTION: Type HTC Amount 12 n7
g. WATER ZONES (depth):
Top Bottom Top Bottom
Top Bottom Top Bottom
9( 01 ) 748-9095 ; Top Bottom Top Bottom
Area code Phone number Thickness/
2. WELL INFORMATION: : 7. CASING: Depth Diameter Weight Material
WELL CONSTRUCTION PERMIT# W10100141 : Top_ Bottom 3 Ft. 6 1/8 .188 Steel
OTHER ASSOCIATED PERMIz#fjf li applicable)
SITE WELL ID #(if applicable] If�1
3. WELL USE (Check One Box) Monitoring ❑ Municipal/Public ❑
Industrial/Commercial ❑ Agricultural ❑ Recovery ❑ Injection ❑
Irrigation❑ Other l((lisstt use) Closed (OOD Geotherno
DATE DRILLED Ia•' Oaf I
4. WELL LOCATION:
1166 Lotla Church Rd
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
CITY: Franklin COUNTY Macon
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
❑ Slope ❑ Valley Flat ❑ Ridge ❑ Other
LATITUDE 36 " DMS OR 3X.XXXXXXXXX DD
LONGITUDE 75 " DMS OR 7X.XXXXXXXXX DD
Latitude/longitude source: [-JGPS (]topographic map
(location of well must be shown on a USGS topo map andattached to
this form if not using GPS)
5. FACILITY (Name of the business where the well is located.)
Macon Elementary —
Facility Name Facility ID# (if applicable)
1166 L otla_ Church Rd
Street Address
Franklin NC 28734
City or Town State Zip Code
Maron County Goyernment
Contact Name
Mailing Address
Franklin NC' 28743
City or Town State Zip Code
Area code Phone number
S. WELL DETAILS:
t
a. TOTAL DEPTH:
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO p/
c. WATER LEVEL Below Top of Casing: FT.
(Use "+" if Above Top of Casing)
Top Bottom
Ft.
Top Bottom
Ft.
8. GROUT: Depth
Material Method
C
Top 0 Bottom d
Ft. Bentonite Pumped
Top _ BottomqS 0
Ft. Washed stone poured
Top Bottom
Ft.
9. SCREEN: Depth
Diameter Slot Size Material
Top Bottom
Ft.
in. in.
Top Bottom
Ft.
in. in.
Top Bottom
Ft.
in, in.
10. SAND/GRAVEL PACK:
Depth
Size Material
Top Bottom
Ft.
Top Bottom
Ft.
Top Bottom
Ft.
11. DRILLING LOG
Top Bottom
Formation Description
O /tea
GA'y
r
/
12. REMARKS:
leasing Re, noved
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 P OVIDED TO THE WELL OWNER
SJ�MATURE OF CERTIFIED WELL CONTRACTOR DATE
Submit within 30 days of completion to: Division of Water Quality - Information
1617 Mail Service Center, Raleigh, NC 27699-161, Phone : [phone]
Cons)
' Form GW-1b
FIEQ 2 4 20 jF�,. 2/09
Asheville Regional Office
Aouifer Prctecti 11,

NONRESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 3118-A
1. WELL CONTRACTOR:
Timothy R Hamby
Well Contractor (Individual) Name
Midsouth Geothermal
Well Contractor Company Name
8275 Tournament Dr Suite 185
Street Address
Memphis TN 38125
City or Town State Zip Code
9( 01 ) 748-9095
Area code Phone number
2. WELL INFORMATION:
WELL CONSTRUCTION PERMIT# W10100141
OTHER ASSOCIATED PERMIjT�#(if applicable)
SITE WELL ID #(ifapplicable)
3. WELL USE (Check One Box) Monitoring ❑ Municipal/Public ❑
Industrial/Commercial ❑ Agricultural ❑ Recovery ❑ Injection ❑
Irrigation[] Other t((list use) Closed IooD Geothernd
DATE DRILLED ) a. - Q D - ) I
4. WELL LOCATION:
1166 Lotla Church Rd
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
CITY: Franklin COUNTY Macon
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
❑Slope []Valley JjFlat ❑Ridge []Other
LATITUDE 36 " DMS OR 3X.XXXXXXXXX DD
LONGITUDE 75 " DMS OR 7X.XXXXXXXXX DD
Latitude/longitude source: ❑GPS (]Topographic map
(location of well must be shown on a USGS topo map andattached to
this form if not using GPS)
5. FACILITY (Name of the business where the well is located.)
Macon Elementary
Facility Name Facility ID# (if applicable)
1166 Lotla Church Rd
Street Address
Franklin NC 28734
City or Town State Zip Code
Macon County Government
Contact Name
Mailing Address
Franklin NC 29743
City or Town State Zip Code
Area code
Phone number
6. WELL DETAILS: j
a. TOTAL DEPTH: (l
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO qI
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 15A NCAC 2C .0118.
: e. YIELD (gpm): L - 1 METHOD OF TEST Row Down
f. DISINFECTION: Type HTC Amount 12 n7
: g. WATER ZONES (depth):
Top
Bottom
Top Bottom
Top
Bottom
Top Bottom
Top
Bottom
Top Bottom
Thickness/
7. CASING:
Depth
Diameter Weight Material
:Top O
Bottom 2a
Ft. 6 1/8 .188 steel
Top
Bottom
Ft.
Top
Bottom
Ft.
8. GROUT:
Depth
Material Method
Top 0
Bottom S !
Ft._Bentonite Pumped
:Top _
Bottom K�
Ft. Washed stung poured
Top
Bottom
Ft.
9. SCREEN:
Depth
Diameter Slot Size Material
Top
Bottom
Ft. in. in.
: Top
Bottom
Ft. in. in.
Top
Bottom
Ft. in. in.
10. SAND/GRAVEL PACK:
Depth Size Material
Top Bottom Ft.
Top Bottom Ft.
Top Bottom Ft.
11. DRILLING LOG
Top Bottom Formation Description
\\l
T /
12. 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 CERTIFIED WELL CONTRACTOR DATE
c. WATER LEVEL Below Top of Casing: SO FT. : Timothy R Hamby
(Use "+" if Above Top of Casing) : PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit within 30 days of completion to: Division of Water Quality Information Processing, Form 109
y p ty - g Rev. 2/09
1617 Mail Service Center, Raleigh, NC 27699-161, Phone: [phone]

NONRESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 3118 A
1. WELL CONTRACTOR:
Timothy R Hamby
Well Contractor (Individual) Name
Midsouth Geothermal
Well Contractor Company Name
8275 Toumament Dr STE 5
Street Address
Memphis TN 38125
City or Town State Zip Code
9( 01 ).748-9095
Area code Phone number
2. WELL INFORMATION:
WELL CONSTRUCTION PERMIT# W10100141
OTHER ASSOCIATED PEPIIT#(if ap ble)
SITE WELL ID ftf applicable) ` _ ' 3
3. WELL USE (Check One Box) Monitoring ❑ MunicipaUPublic ❑
Indushial/Commercial ❑ Agricultural ❑ Recovery ❑ Injection ❑
Irrigation❑ Omer JI( ist use) Closed Loop Geothern
DATE DRILLED_ _ =�
4. WELL LOCATION:
1166 Lotla Church Rd
(Street Name; Numbent, Community, Subdivision, Lot No., Parcel, Zip Code)
CITY. Franklin COUNTY Macon
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
❑Slope []Valley OFFIal []Ridge ❑Omer
LATITUDE 36 " DMS OR 3X.XXXM00= DD
LONGITUDE 75 " DMS OR 7X.X*0M'10= DD
Latitude/lorgitude source: 03PS Dropographic map
(location of we# must be shown on a USGS topo map andattached to
this form if not using GPS)
5. FACILITY (Name of the business where the well is located.)
Marron Flementry School
Facility Name Facility ID# (d applicable)
1'1RR Lotla Church Rd
Street Address
Franklin NC 28734
City or Tam State Zip Code
Contact Name
Mailing Address
Franklin NC 28743
City or Town State Zip Code
U
Area code Phone number
d. TOP OF CASING IS 2 FT. Above Land Surfae
'Top of casing terminated at/or below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
= e. YIELD (gprn): 100 METHOD OF TEST Blow Down
: f. DISINFECTION: Type HTC Amount 1207
g. WATER ZONES (depth):
Top 250 Bottom 254 Top Bottom
Top Bottom Top Bottom
Top Bottom Top Bottom
Thickness/
7. CASING: Depth Diameter Weight Material
Top +; Bottom _ Ft. 61 /8 .188 steel
Top Bottom Ft.
Top Bottom Ft
8. GROUT: Depth a¢ Material Method
: Top_ 4 Bottom_ O_T Ft +fir Pa
:TOP k2 Bottom �-f D Ft W 4A ed Sf+oNe Ny ".4
Top Bottom FL
S. SCREEN: Depth Diameter Slot Site Material
Top Bottom Ft in. in.
Top Bottom Ft in. in.
Top Bottom Ft. in. in.
10. SAND/GRAVEL PACK:
Depth Size Material
= Top Bottom Ft
Top Bottom Ft
Top Bottom Ft.
: 11. DRILLING LOG
Top Bottom Formation Description
0 177 Dirt
77 / 82 Granite
82 / 250 Granite
250 / 254 Broken Granite 40opm
254 / 450 Granite
/
12. REMARKS:
easing rerpoved
6. WELL DETAILS: I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
15A NCAC 2C. WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
a. TOTAL DEPTH: 450 : RECORD HAS BEEN PROVIDED TO THE WELL OWNER-
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO ❑ . : SIGNA WI E OF CERTIFIED WELL CONT ACTOR DATE
c. WATER LEVEL Below Top of Casing: 60 FT. Timothy R Hamby
(Use °+" if Above Top of Casing) : PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Form GW-1 b
Subirlii vlrlthin 30 days of completion to: Division of_Water:Quahty Info mtatiomProcessing . Rev.2/09
1601117ait SeMceCenter; Raleigh NC47699-161 Phone :.[phone]• .

1 r ONR SIDEM L WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 3118 A
1. WELL CONTRACTOR:
Timothy R Hamby
Well Contractor (Individual) Name
Midsouth Geothermal
Well Contractor Company Name
8275 Toumament Dr STE 5
Street Address
Memphis TN 38125
City or Town State Zip Code
9( 01 ).748-9095
Area code Phone number
2. WELL INFORMATION:
WELL CONSTRUCTION PERMIT# WI0100141
OTHER ASSOCIATED PERMIT#(if applicable)
SITE WELL ID #(f applicabie)_ 4 �— L4
3. WELL USE (Chedc One Box) Monitoring ❑ Municipal/Public ❑
Industrial/Commercial ❑ Agricultural ❑ Recovery ❑ Injection ❑
Irrigation❑ Oltw idow use) Closed Loop Geothern
DATE DRILLED_�Z
4. WELL LOCATION:
1166 Lotla Church Rd
(Steel Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
CITY: Franklin COUNTY Macon
TOPOGRAPHIC I LAND SETTING: (check appropriate boot)
❑Slope ❑Valley Olat ❑Ridge []Other
LATITUDE 36 " DMS OR 3x-X*000000t DD
LONGITUDE 75 " DMS OR 7X.XX700D000( DD
Latiiudellongitude source: CISPS ❑ropographic map
(location of wep must be shown on a USGS topo map andattached to
this form if not using GPS)
5. FACILITY (Name of the business where the well is located.)
Macon Fiementry School
Facility Name Facility ID# (d applicable)
-�t166 Lotla Church Rd
Street Address
Franklin NC 28734
City or Town State Zip Code
Contact Name
Mailing Address
Franklin NC 28743
City or Town State Zip Code
U
Area code
Phone number
S. WELL DETAILS:
a. TOTAL DEPTH: 450
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO ❑
c. WATER LEVEL Below Top of Casing: 60 FT.
(Use "+" if Above Top of Casing)
d. TOP OF CASING IS 2 FT. Above Land Surface'
'Top of casing terminated alfor below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
- e. YIELD (gpm): 100 METHOD OF TEST BLOW DDWn
f. DISINFECTION: Type HTC Amount 12n7
g. WATER ZONES (depth):
Top 250 Bottom 254 Top Bottom
Top Bottom Top Bottom
Top Bottom Top Bottom
ThlckneW
7. CASING: Depth Diameter Weight Material
Top +2 BottomOrOFt. 61/8 .188 steel
Top Bottom Ft
Top Bottom Ft.
• 8. GROUT: Depth Material Method
: Top_ 0 Bottom_ q(V Ft .t Pu
TapC1 .1 BottomL57 Fttu4d1,.J-S, +-P&-/'"
Top Bottom Ft
9. SCREEN: Depth Diameter Slot Size Material
Top Bottom Ft in. in.
Top Bottom Ft in. in.
Top Bottom Ft. in. In.
10. SANDlGRAVEL PACK:
Depth Size
Top
Bottom Ft
Top
Bottom Ft
Top
Bottom Ft.
11. DRILLING LOG
Material
: Top Bottom Formation Description
0 177
zz
/
/ 250
250 / 254
254 / 450
12. REMARKS:
Dirt
Granite
Granite
Broken Granite 40opm
Granite
easing removed
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 PROM TO THE WELLOWNER
= SIGNAd' E OF CERTIFIED WELL CONTRACTOR DATE
: PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Form GW-1 b
SubrMit Within 30 days_of compietion to: Division'of,Water Quality... Information Processing;, Rev. 2tos
1617 M.AI S ice Center, Raleigh; NC` 27609/461 Phone :.[phone]

NONRESII)ENTL4L WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 3118 A
1. WELL CONTRACTOR:
Timothy R Hamby
Well Contractor (IndividuaQ Name
Midsouth Geothermal
Well Contractor Company Name
8275 Toumament Dr STE 5
Street Address
Memphis TN 38125
City or Town State Zip Code
9( 01 .748-9095
Area code Phone number
2. WELL INFORMATION:
WELL CONSTRUCTION PERMIT# W10100141
OTHER ASSOCIATED PEaM1T#(if applliic�able)
SITE WELL ID #(if applicable)_:_
3. WELL USE (Check One Box) Monitoring ❑ Municipal/Public ❑
lndustriaVCommercial ❑ Agricultural ❑ Recovery ❑ Injection ❑
Irigation❑ Other N(pist use Closed Loop Geother®
DATE DRILLED_
4. WELL LOCATION:
1166 Lotla Church Rd
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
CITY: Franklin COUNTY Macon
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
❑ Slope ❑ Valley Flat []Ridge ❑ Other
LATITUDE 36 " " DMS OR 3X.XXXM)O= DD
LONGITUDE 75 " " DMS OR 7X.XX*OLXM DD
Latitudeilongitude source: LAPS propographic map
(location of weN must be shown on a USGS topo map andattached to
this form /f not using GPS)
5. FACILITY (Name of the business where the well is located.)
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 15A NCAC 2C .0118.
= e. YIELD (gprr): 100 METHOD OF TEST Blow Down
E DISINFECTION: Type HTC Amount 1207
g. WATER ZONES (depth):
Top 250 Bottom 254 Top Bottom
Top Bottom Top Bottom
Top Bottom Top Bottom
Thickness/
7. CASING: Depth / Diameter Weight Material
Top +2 Bottom (�� Ft. 61/8 .188 steel
Top Bottom Ft.
Top Bottom Ft
8. GROUT. Depth `` nn Material Method
Tap_ O Bottom_ I64� FL '1J = PvrM -
:TOP _ Bottom�Q Ft tVAS► 44 yalu
Top Bottom Ft
9. SCREEN: Depth Diameter Slot Size Material
Top Bottom Ft. in. in.
Top Bottom Ft in. in.
Top Bottom Ft. in. in.
10. SAND/GRAVEL PACK:
Depth Sae
Top Bottom Ft.
Top Bottom Ft
Top Bottom Ft.
11. DRILLING LOG
Top Bottom
Macon Flementry Schooi 0 / 77----�7�--
Facility Name Facility ID# (if applicable)
'L166 Lotla Church Rd
Street Address
Franklin NC 28734
City or Town State Zip Code
Contact Name
Mailing Address
Franklin NC 28743
City or Town State Zip Code
U
Area code
Phone number
6. WELL DETAILS:
a. TOTAL DEPTH: 450
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO ❑
12. REMARKS:
Material
Formation Description
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
15A NCAC 2C. WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
RECORD HAS BEEN PROVIDED TO THE WELL OWNER
= SIG RE OF CMTIRED WELL CONTRACTOR DATE
c. WATER LEVEL Below Top of Casing: 60 -FT. Timothy R Hamby
(Use "+" if Above Top of Casing) : PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Form GW-1b
Submit wnthi"n 36 days of: completion to: Division`of.Water Quality: Information -Processing; Rev. 2/09
1617 AAail Servlce'Center; Raleigh; .NC 27699461,. Phone : (9.1.9) 807=6300'

NONlLESIDENTUL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 3118 A
1. WELL CONTRACTOR:
Timothy R Hamby
Well Contractor (Individual) Name
Midsouth Geothermal
Well Contractor Company Name
8275 Tournament Dr STE 5
Street Address
d. TOP OF CASING IS 2 FT. Above Land Surface*
'Top of casing terminated atfor below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): 100 METHOD OF TEST BIOW )0Wn
: E DISINFECTION: Type HTC Amount 1 n7
9. WATER ZONES (depth):
Memphis TN 38125
: Top 250
Bottom 2254 Top
Bottom
City or Town State Zip Code
: Top
Bottom
Top
Bottom
9( 01 ). 748-9095
Top
Bottom
Top
Bottom
Area code Phone number
Thickness/
2. WELL INFORMATION:
7. CASING:
Depth
Diameter
Weight Material
WELL CONSTRUCTION PERMIT# W10100141
:Top +2 .
Bottom_I6-1
Ft. 61/8
.188 steel
OTHER ASSOCIATED PE.QMITffR applicable)
: Top
Bottom
Ft.
SITE WELL ID #{d applicable)_'`��
:Top
Bottom
Ft
3. WELL USE (Check One Box) Monitoring ❑ MunicipaUPublic ❑
IndushialfCommercial ❑ Agricultural ❑ Recovery ❑ Injection ❑
Irrigation❑ Other Wpm use) Closed Loop Geothere
DATE DRILLED- �.
4. WELL LOCATION:
1166 Lotla Church Rd
(Street Name, Numbers, Community, Subdivision, Lot No_, Parcel, Zip Code)
CITY. Franklin COUNTY Macon
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
[]Slope ❑Valley WFlat []Ridge ❑Other
LATITUDE 36 ° " DMS OR 3XJt)00aXXXX DD
LONGITUDE 75 " DMS OR 7X.XXX)00D= DD
LafitudeAorigitude source: BPS ❑ropographic map
(location of well must be shown on a USGS topo map andatfached to
this form if not using GPS)
S. FACILITY (Name of the business where the well is located.)
Macon Flementry School
Facility Name Facility ID# (if applicable)
.1_168 Lotla Church Rd
Street Address
Franklin NC 28734
City or Town State Zip Code
Contact Name
Mailing Address
Franklin NC 28743
City or Town State Zip Code
U
Area code
Phone number
S. WELL DETAILS:
a. TOTAL DEPTH: 450
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO ❑
c. WATER LEVEL Below Top of Casing: 60 FT.
(Use "+" if Above Top of Casing)
8. GROUT:
Depth -
Material Method
Top G
Bottom 16 /
Ft t5hL,,-,r.}G-: -
Top16 r)
Bottom �1SG
_
Ft
• Top
Bottom
Ft.
9. SCREEN:
Depth
Diameter Slot Sirs Material
Top
Bottom
Ft. in. in.
: Top
Bottom
Ft. in. in.
Top
Bottom
Ft. in. in.
10. SAND/GRAVEL PACK:
Depth
Sine Material
: Top
Bottom
Ft.
Top
Bottom
Ft.
Top
Bottom
Ft
11. DRILLING LOG
Tap Bottom
GYJ_ _I 60
12. REMARKS:
Formation Description
C / A--.e
,_�irol4_•� V'oc,IS
- 5 rh--t A9
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WRH
15A NCAC 2C, WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
: RECORD HAS BEEN PROVIDED TO THE WELL OWNER
: SIGNATURE OF CESWIED WELL CONTRACTOR ( DATE J
: PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Form GW-1b
Submit within 30days of:completionjo: Division .of Water Quality; Information Processing;: Rev. 2/09
1617 Mail Smice Ceelter lZaleigh . NC 27699-161, Phone. :`[phone]

5i TE
NONRESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 3118-A
1. WELL CONTRACTOR:
Timothy R Hamby
Well Contractor (Individual) Name
Midsouth Geothermal
Well Contractor Company Name
8275 Tournament Dr Suite 185
Street Address
Memphis TN 38125
City or Town State Zip Code
9� 01 ) 748-9095
Area code Phone number
2. WELL INFORMATION:
WELL CONSTRUCTION PERMIT# W10 100 141
d. TOP OF CASING IS 2 FT. Above Land Surface -
•Top of casing terminated attor below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): J � METHOD OF TEST BIOW Down
f. DISINFECTION: Type HTC Amount 12 07
g. WATER ZONES (depth):
:Top Bottom Top Bottom
Top Bottom Top Bottom
Top Bottom Top Bottom
Thickness/
7. CASING: Depth Diameter Weight Material
: Top `O Bottom ) (P-1 Ft. 6 1/8 .188
OTHER ASSOCIATED PERMIT if a plicarbl7e)
Top Bottom Ft.
SITE W ELL ID #(if applicable) - 1 ; Top Bottom Ft.
3. WELL USE (Check One Box) Monitoring ❑ Municipal/Public ❑ : 8. GROUT: Depth Material Method
Industrial/Commercial ❑ Agricultural ❑ Recovery ❑ Injection [I: Topes Bottom / lv� Ft. Bentonite Pumped
Irrigation❑ Other N((list use) Closed 100D Geotherra :Top i_ Bottom qW Ft. washed Stone poured
DATE DRILLED a 19
l " I ; Top Bottom Ft.
4. WELL LOCATION:
1166 Lotla Church Rd
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
CITY: Franklin COUNTY Macon
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
[]Slope []Valley Flat []Ridge []Other
LATITUDE 36 " DMS OR 3X-XXXXXXXXX DD
LONGITUDE 75 " DMS OR 7X.XXXXXXXXX DO
Latitude/longitude source: ❑GPS aopographic map
(location of well must be shown on a USGS topo map andattached to
this form if not using GPS)
S. FACILITY (Name of the business where the well is located.)
Macon Elementary
Facility Name Facility ID# (if applicable)
1166 Lotla Church Rd
Street Address
Franklin NC 28734
City or Town State Zip Code
Macon County Government
Contact Name
Mailing Address
Franklin NC 28743
City or Town State Zip Code
U
Area code Phone number
6. WELL DETAILS:
/
a. TOTAL DEPTH: L��
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NOW
c. WATER LEVEL Below Top of Casing: S FT.
(Use "+" if Above Top of Casing)
9. SCREEN: Depth Diameter Slot Size Material
Top Bottom Ft. in. in.
Top Bottom Ft. in. in.
Top Bottom Ft. in. in.
10. SAND/GRAVEL PACK:
Depth Size
Top Bottom Ft.
: Top Bottom Ft.
Top Bottom Ft.
11. DRILLING LOG
Top Bottom
)k-fj- C.
/
/
12. REMARKS:
Material
Formation Description
100 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
: S1139ATURE OF CERTIFIED WELL CONTRACTOR DATE
: PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Form GW-1b
Submit within 30 days of completion to: Division of Water Quality - Information Processing, Rev. 2/09
1617 Mail Service Center, Raleigh, NC 27699-161, Phone : [phone]

NONRESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 3118 A
1. WELL CONTRACTOR:
Timothy R Hamby
Well Contractor (Individual) Name
Midsouth Geothermal
Well Contractor Company Name
8275 Tournament Dr Suite 185
Street Address
Memphis TN 38125
City or Town State Zip Code
9( 01 ) 748-9095
Area code Phone number
2. WELL INFORMATION:
WELL CONSTRUCTION PERMIT# W10100141
d. TOP OF CASING IS 2 FT. Above Land Surface*
'Top of casing terminated attor below land surface may require
a variance in accordance with 15A.NCAC 2C .0118.
: e. YIELD (gpm):O METHOD OF TEST BIOW Down
f. DISINFECTION: Type HTC Amount 12 07
g. WATER ZONES (depth):
:Top Bottom Top Bottom
Top Bottom Top Bottom
Top Bottom Top Bottom
Thickness/
7. CASING: Depth Diameter Weight Material
Top_0 Bottom I G Z Ft. 6 1 /8 .188 steel
OTHER ASSOCIATED PERMIT#(if applicable) : Top Bottom Ft.
SITE WELL ID #(if applicable) A3 — I ' Top Bottom Ft.
3. WELL USE (Check One Box) Monitoring ❑ Municipal/Public ❑ : 8. GROUT: Depth Material Method
Industrial/Commercial ❑ Agricultural ❑ Recovery ❑ Injection ❑ : Top 0 Bottom_ Ft. Bentonite Pumped
Irrigation❑ Other N((list use) Closed IOOD Geotherna Top!(AL BottomIL
SP Ft. Washed StOf1E poured
DATE DRILLED Z - / 5 - / 1 Top Bottom Ft.
4. WELL LOCATION:
1166 Lotla Church Rd
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
CITY: Franklin COUNTY Macon
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
[]Slope []Valley p(Flat ❑ Ridge ❑ Other
LATITUDE 36 DMS OR 3X.XXXXXXXXX DD
LONGITUDE 75 " DMS OR 7X.XXXXXXXXX DD
Latitude/longitude source: ❑GPS Qropographic map
(location of well must be shown on a USGS topo map andattached to
this form if not using GPS)
S. FACILITY (Name of the business where the well is located.)
Macon Elementary
Facility Name Facility ID# (if applicable)
1166 Lotla Church Rd
Street Address
Franklin NC 28734
City or Town State Zip Code
Macon County Government
Contact Name
Mailing Address
Franklin NC 29743
City or Town State Zip Code
U
Area code
Phone number
6. WELL DETAILS:
a. TOTAL DEPTH: S�
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO 0/
; 9. SCREEN: Depth Diameter Slot Size Material
Top Bottom Ft. in. in.
Top Bottom Ft. in. in.
Top Bottom Ft. in. in.
10. SAND/GRAVEL PACK:
Depth Size
Top Bottom Ft.
: Top Bottom Ft.
Top Bottom Ft.
11. DRILLING LOG
Top Bottom
v I 1 ems"
ogs`
/CaZ l ySa
/
: 12. REMARKS:
easel ig Ren loved
Material
Formation Description
5,%.-a CtuX
r3ro leL Z (�
100 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
42
SIGNATURE OF CERTIFIED WELL CONTRACTOR DATE
c. WATER LEVEL Below Top of Casing: S 6 ,1. : Timothy R Hamhy
(Use "+" if Above Top of Casing) : PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit within 30 days of completion to: Division of Water Quality information Processing, Form
y P ty - IftiPi9� Rev. 2/0909
1617 Mail Service Center, Raleigh, NC 27699-161, Phone : [phone]

t L NONRESIDENTIAL WELL CONSTRUCTION RECORD
J North Carolina Department of Environment and Natural Resources- Division of 'Water Quality
7 1�
�,•,Y:_- WELL CONTRACTOR CERTIFICATION #
1. !!� CONCT) ON CT
Well Contractor (n Iwdual) Name
Tarheel Water Treatment
Well Contractor Company Name
3494 Georoia RD
Street Address
Franklin NC 28734
City or Town State Zjp Code
8( 28 ) 369-0740
Area code Phone number
2. WELL INFORMATION:
WELL CONSTRUCTION PERMIT# W101 00 141
OTHER ASSOCIATED PERMIT#(if applicable)
SITE WELL ID #(if applicable) A t
d. TOP OF CASING IS 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): t' _ METHOD OF TEST BIOW Down
f. DISINFECTION: Type HTC Amount 19 07
g. WATER ZONES (depth):
: Tope Bottom
Top Bottom
Top Bottom
Top
Bottom
Top
Bottom
Top
Bottom
Thickness/
7. CASING: Depth Diameter Weight Material
Top
Bottom
Ft.
Top
Bottom
Ft.
Top
Bottom
Ft.
3. WELL USE (Check One Box) Monitoring ❑ Municipal/Public ❑ ; 8. GROUT: Depth Material
Industrial/Commercial ❑ Agricultural ❑ Recovery ❑ Injection ❑ : TopQ_ Bottom Ft. BentOnite
Irrigation❑ Other [If (list use) Closed 100D Geotherrla T.p_s.� Bottom@ Ft. washed stone
DATE DRILLED :Top Bottom Ft.
4. WELL LOCATION:
1166 Lotla Church Rd
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
CITY: Franklin COUNTY Macon
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
❑Slope ❑valley Flat ❑Ridge ❑Other
K4gg,ISTCD 36 iAAAA&AAAAAAAAI CL R OR 3X^XRl(?t(PA)Mx CC
MWISTCD75 iAAAA&AAAAAAAAI CLROR 7A'.t )tf(9C90(X` CC
Latitude/longitude source: []GPS []Topographic map
(location of well must be shown on a USGS topo map andattached to
this form if not using GPS)
S. FACILITY (Name of the business where the well is located.)
Mnron Elem _ntary
Facility Name Facility ID# (if applicable)
11 FF I otla Church Rd
Street Address
Franklin NC 28734
City or Town State Zip Code
Macon County [government
Contact Name
Mailing Address
Franklin NC 28743
City or Town State Zip Code
U
Area code Phone number
6. WELL DETAILS: %
a. TOTAL DEPTH:
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO q/
c. WATER LEVEL Below Top of Casing: FT.
(Use "+" if Above Top of Casing)
S. SCREEN: Depth Diameter
Top Bottom Ft. in.
Top Bottom Ft. in.
Top Bottom Ft. in.
10. SAND/GRAVEL PACK:
Depth Size
Top Bottom Ft.
Top Bottom Ft.
Top Bottom Ft.
11. DRILLING LOG
Top Bottom
1
/
; 12. REMARKS:
Method
Pumped
loured
Slot Size Material
in.
in.
in.
Material
Formation escription
Sv!
I DO HEREBY CER THAT T 1 WELL WAS CCASTRUCTED IN ACCORDANCE WITH
• 15A AN C, Y'E CONST O STA UER
T A COPY OF THIS
RECO S BE PROVI
S NATUREO CERTIFIED WELL CONTRACTOR DATE
THE WELL
Form GW-1b
Submit within 30 days of completion to: Division of Water Quality - Information Processing, Rev.1/08
1617 Mail. Service Center, Raleigh, NC 27699-161, Phone: [phone]

STATE -^y,
v � w NONRESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION a
1. WELL CONTRACTOR,
Well C ntractor (Individual) Name
Tarheel Water Treatment
Well Contractor Company Name
3494 Georaia RD
Street Address
Franklin NC 28734
City or Town State Zip Code
8( 28 ) 369-0740
Area code Phone number
2. WELL INFORMATION:
WELL CONSTRUCTION PERMIT# W10100141
OTHER ASSOCIATED PERMIT#(if applicable)
SITE WELL ID #(if applicable)
3. WELL USE (Check One Box) Monitoring ❑ Municipal/Public ❑
Industrial/Commercial ❑ Agricultural ❑ Recovery ❑ Injection ❑
Irrigation❑ Other (Iist use) Closed 100D Geotherrm
DATE DRILLED
d. WELL LOCATION:
1166 Lotla Church Rd
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
CITY: Franklin COUNTY Macon
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
❑Slope []Valley VFW []Ridge ❑Other
K4WhWCD 36 iAAAA&AAAAAAAAI CL R OR 3mXXX'XrAxXxx CC
INIMFISTCD75 iAAAA&AAAAAAAAI CLROR Tx'.'1Ck`X'1kX%1 ff CC
Latitude/longitude source: DGPS aopographic map
(location of well must be shown on a USGS topo map andattachad to
this form if not using GPS)
5. FACILITY (Name of the business where the well is located.)
Maron Elementary
Facility Name Facility ID# (if applicable)
_ 11 FR I ntla Chi irch Rd
Street Address
Franklin NC 28734
City or Town State Zip Code
Marnn Count rnyp-mment
Contact Name
Mailing Address
Franklin NC 28743
City or Town State Zip Code
U
Area code
Phone number
: d. TOP OF CASING IS FT. Above Land Surface'
'Top of casing terminated attor below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
: e. YIELD (gpm):
METHOD OF TEST glow Down
f. DISINFECTION: Type HTC Amount 19 07
g. WATER ZONES (depth):
Topes Bottom
Top Bottom
:Top Bottom
Top Bottom
Top Bottom
Top Bottom
Thickness/
7. CASING: Depth
Diameter Weight Material
Top Bottom
TO BatorFt.
Top bottom
Ft.
8. GROUT: Depth
Material Method
: Topes_ Bottom (�(d
Ft. $enWnAg Pumped _
Top­L= Bottom —
Ft. washed stone poured
Top Bottom
Ft.
9. SCREEN: Depth
Diameter Slot Size Material
Top Bottom
Ft. in. in.
Top Bottom
Ft. in. in.
Top Bottom
Ft. in. in.
10. SAND/GRAVEL PACK:
Depth Size
: Top Bottom Ft.
Top Bottom Ft.
Top Bottom Ft.
11. DRILLING LOG
Top Bottom
Z) 04
12. REMARKS:
: easing Removed
113101 HEREBY CERTI HAT THI WAS
6. WELL DETAILS: J� 15A NCA C WELL NSTRU TANDA
RECOR BE OVID T �L
a. TOTAL DEPTH: (�
lo. DOES WELL REPLACE EXISTING WELL? YES ❑ NOG/ : SI NATURE bF-CERttF1tD WELL C
c. WATER LEVEL Below Top of Casing: FT. C LIE l ia s
(Use "+" if Above Top of Casing) : PRINTED NAME OF PERSON CONS
Material
Formation Description
Submit within 30 days of completion to: Division of Water Quality - Information Processing,
1617 Mail Service Center, Raleigh, NC 27699-161, Phone: [phone]
CTBD IN ACCORDANCE WITH
THAT A COPY OF THIS
I do -J I
C�OR — DATE
THE WELL
Form GW-1b
Rev. 1/08

r
' NONRESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Emironment and Natural Resources- Division of Water Quality
i `+' ~• WELL CONTRACTOR CERTIFICATION # :14a
1. WELL CosTRACTOR:
�-
Well Contractor (Individual) Nance
Tarheel Water Treatment
Well Contractor Company Name
3494 Georaia RD
Street Address
Franklin NC 28734
City or Town State Zip Code
8( 28 ) 369-0740
Area code Phone number
2. WELL INFORMATION:
WELL CONSTRUCTION PERMIT#W101 00 141
OTHER ASSOCIATED PERMIT#(if 2pplicable)
SITE WELL ID #(if applicable)
3. WELL USE (Check One Box) Monitoring ❑ Municipal/Public ❑
Industrial/Commercial ❑ Agricultural ❑ Recovery ❑ Injection ❑
Irrigation❑ Other (list use) Closed IooD Geotherre
DATE DRILLED
4. WELL LOCATION:
1166 Lotla Church Rd
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel. Zip Code)
CITY: Franklin COUNTY Macon
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
❑ Slope []Valley elat ❑ Ridge ❑ Other
K@51'STCD 36 iAAAA&AAAAAAAA! CL R OR aiKA)f)fxxooOm CC
KNMFISTCD75 iAAAA&AAAAAAAAI CL ROR 7)0bCX7CX' )W CC
Latitude/longitude source: []GPS []Topographic map
(location of well must be shown on a USGS topo map andattached to
this forth if not using GPS)
5. FACILITY (Name of the business where the well is located.)
Macon Elpmentary
Facility Name Facility ID# (if applicable)
1196 I otla Church Rel
Street Address
Franklin NC 28734
City or Town State Zip Code
Mainnn County Govemment
Contact Name
Mailing Address
Franklin NC 98743
City or Town State Zip Code
Area code
Phone number
6. WELL DETAILS:
a. TOTAL DEPTH:
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NOW
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 attor below land surface may require
a variance in a rdance with 15A NCAC 2C .0118.
e. YIELD (gpm): _ METHOD OF TEST BLOW ❑OWn
f. DISINFECTION: Type HTC Amount 17 n7
g. WATER ZONES (depth):
Top ttom Bottom
Top Bottom op ottom
Top B6ffom Top Bottom
Thickness/
7. CAS G: Depth Diameter Wight Material
Top Ft.
Top Bottom
Top B fi Ft.
8. GROUT: Depth Material Method
TopQ_ Bottom—gL Ft. Bentonite Pumped
Top: Bottom11;�L Ft. washed stone poured
Top Bottom Ft.
9. SCREEN: Depth Diameter Slot Size Material
Top Bottom Ft. in. in.
Top Bottom Ft. in, in.
Top Bottom Ft. in, in.
10. SAND/GRAVEL PACK:
Depth Size
: Top
Bottom Ft.
Top
Bottom Ft.
Top
Bottom Ft.
11. DRILLING LOG
Top Bottom
12. REMARKS:
Material
Formation Description
i Q ice/
6-C A /
easing Res, loved
1 DO HEREBY CERTI THAT
WELL WAS C STRUCTED IN ACCORDANCE WITH
• 15A NCAC WE ,CON
STAN - S, AND THAT A COPY OF THIS
RECOR PRO D
T E WWNER.
SIGNATURE O CERTIFIED
WELL CONTRACTOR DATE
/1.� J
OF
THE
Form GW-1 b
Submit within 30 days'bf completion to: Division of Water Quality - Information Processing, Rev.1/08
1617 Mail Service Center, Raleigh, NC 27699-161, Phone: [phone]

1. WELL CONTRACTOR:
RC
11 I
Well Contractor (Individual) Name
T a Tr e
Well Contractor company Nara
Street Address NC
r niclin stave Zp Code
City or Town
A�Ph 3r9-0740
1e number
2. WELL INFORMATION:
WELL CONSTRUCTION PERMIT# W IO 1 OO 141
OTHER ASSOCIATED PERMIT#(d icable)I
SITE WELL ID #(if applicable)
3. WELL USE (Check One Box) Monitoring C Municipal/Public C
IndusbiWiCommernal C Agncuttural C Recovery ❑ Injection ❑
Ino Other d{ list tie) Closed I o G othe
DATE DRILLED I - 7j —
4. WELL LOCATION:
11 LOU"!h r Rd
(Street Nance. Numbers. Community, Subdivision. Lot No.. Parcel. Tap Code)
CITY: Franklin COUNTY Macon
TOPOGRAPHIC I LAND SETTING: (d*& MVOWwrle box)
C Slope ❑ Valley d�lst C Fridge ❑ Other
TCD I AAAA&AAAAAAAAI CL ROR `axA�a V0lXW CC
MWISTCD75 iAAAA&AAAAAAAAICLROR%7t.9('10l`) CC
Latitudellongitude source: 013PS [3ropographic map
(location of well must be shown on a USGS topo map endeftached to
this form if not using GPS)
5. FACILITY (Name of the business where the well is located.)
Faatity Name Facility ID# (if appiicat>le)
street Address NG 297 U
l State Zip Code
City or Town
Contact Name
Mailing Address
Franklin State Zip Code
City or Town
Area Phone number
6. WELL DETAILS: SO
a. TOTAL DEPTH:
b. DOES WELL REPLACE EXISTING WELL? YES C NO Ci
s!%_
C. WATER LEVEL Below Top of Casing: FT.
(Use -+• if Above Top of Casing)
NONI�ESjjpENTM WELL CONSTRUCTION RECORD
ironment and Natural Resources- Division of Water Quality
North Carolina Department .RF of Env
WELL CONTRACTOR CERTIFICATION � 3065"A
TOP OF CASING is FT. Above Land Surface'
-Top of casing terminated aUcr below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
YIELD (gpm): r� METHOD OF TEST
DISINFECTION' TypC: Amount 1 i GZe HT
d.
e.
g• WATER ZONES (depth):
Top Bottom Tap
Bottom
' Top _ Bottom— Top —
BWL°m
Top
Bono m
Bottom
Thickness/
7. CASING: Depth Diameter Weight
Material
Bottom aZFt.
Top
Top ­Bottom Ft.
Top- Bottom Ft
: 8. GROUT: Depth Material
Method
Top n anMefre
0 Bottom
Topop
T a -r — Bottom Ft• l� .ilel.. (_ S/f d
G�✓�
9. SCREEN: Depth Drerrmter Slot Sao Mate"
Top Bottom Ft. in.
in.
' Top Bottom Ft. in.
in.
Ft. —in.
BottomTop
in.
1o. SANDIGRAVEL PACK: Size Material
Depth
Top Bottom Ft
Top Ft. —
Top Bottcrrr FL------
11. DRILLING LOG
Top Bottom
!
12. REMARKS:
Formation Description
h eelk
er
I Do HEREBY CERMY THAT TARS WELL WAS CONSTRl1CT1ED IN ACCORDANCE WITH
STANDARDS. AND THAT A COPY OF THIS
• 15A NiCAC 2C, W� CONStRUCT O ,
RECORD J y
DATE
SIG AT CERTIFIED WELL CONTRAC OR
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Form GW-1b
Submit within 30 days of completion to: Division Of Water duality - illft nab processing' Rev' 1108
1617 Mail Serlfiae Center, Raleigh, NC 27699-161, phone: [phone]

NON RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 3065-A
1. WELL CONTRACTOR:
R r L Williams
Welt Contractor (Individual) Name
Tar 'leel Water Trft1 r1 nt
Well Contractor Company Name
34 i RD
Street Address NC 2$734
Franklin S Zip code
City or Town
$( 28 369-0740
Area code Phone number
2. WELL INFORMATION:
WELL CONSTRUCTION PERMIT# WIO100141
OTHER ASSOCIATED PERMIT#(ff pplicaWe)
SITE WELL ID #(it applicable) - -
3. WELL USE (Check One Box) Monitoring ❑ MunicipaUPublic ❑
Industrial/Commercial ❑ Agricultural ❑ Recovery ❑ Injection
Irigation❑ Other ; t use) Closed loon Geotherrs
DATE DRILLED ��
4. WELL LOCATION.:
1166 Lotla Church Rd (Street Name. Numbers, Community, Subdivision, Lot No., Parcel, Zip code)
CITY: Franklin couwry Macon
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
❑ Sbpe ❑ valley Mat ❑ Ridge ❑ Other
K4§MCD 36 1AAAA&AAAAAAAAI CL ROR 3tC?7ba..%r/@6W CC
KNMFISTCD 75 IAAAARAAAAAAAA! CL R OR 7A-'1 ll' `*XX"%txl( CC
Latitude/longitude source: QGPS Qropographic map
(location of well must be shown on a USGS topo map andattached to
this form if not [sing GPS)
S. FACILITY (Name of the business where the well is located.)
Facility Name Facility ID# (if applicable)
Street Address N(' 28734
Franklin State Zip Code
City or Town
Macnn n my i`nunmmPnt
Contact Name
Mailing Address N
Franklin Smote Zip Code
City or Town
Area code Phon mne nu—ber
6. WELL DETAILS: 41
a. TOTAL DEPTH: U
b. DOES WELL REPLACE EXISTING WELL? ES ❑ NO Gib
c. WATER LEVEL Below Top of Casing:4ip-01'
•
(Use'+• if Above Top of Casing)
d. TOP OF CASING IS FT. Above Land Surface'
*Top of casing terminated atior below land surface may require
a variance in accordance With 1 SA NCAC 2C .011S.
e. YIELD (gpm): METHOD OF TEST 61aW DOW 0
I. DISINFECTION: Type HjL Amount, o
g. WATER ZONES (depth):
Top
Bottom
Top
Bottom
Top
Bottom
Top
Bottom
Top
Bottom
Top
Bottom
Thickness/
7. CASING:
Depth
Diameter
Weight Material
Top
Bottom
Ft.
-
Top
Bottom
Ft.
Top
Bottom
Ft.
a. GROUT:
Depth
Material
Method
Top_0 __ Bottom 450, Ft. RPntOnite_ ff R IC9
Top Bottom Ft­�
Top Bottom Ft.
9. SCREEN: Depth Diameter Slot Size Material
Top Bottom Ft. in. in.
Top
Bottom Ft. in. in.
BottomTop
Ft. in. in.
: 10. SANDIGRAVEL PACK: Depth Sin Material
Top Bottom Ft.
Top Bottom Ft.
Top Bottom Ft
—
1, DRILLING LOG
Top Bottom Formation Description
--------------
!
12. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE W(rF1
I SA NCAC 2C. WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
RECORD pROVM TO THE R.
4e
• SIGNATUR F CERTIFIED WELL CONTRA/C OR DATE
D e, Z-
PRINTED NA E OF PERSON CONSTRUCTING THE WELL
Forth GW-1b
SubmitWithin
7 Mail Service CenteroRale Raleetion to: Diviion igh, Z769&161Sphonef V( 18) 8d7-6300ater QualitY - IttMrmation processing, Rev. 1108
161

NON RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 3065--A
1. WELL CONTRACTOR:
Roger L Willi ms
Well Contractor (Individual) Name
Tarheel Water Treatment
Well Contractor Company Name
3494 Geom'a RD
Street Address NC 28734
Franklin state Zip code
City or Town
8( 28 369-0740
Area code Phone number
2. WELL INFORMATION:
WELL CONSTRUCTION PERMIT# W IO 1 OO 141
OTHER ASSOCIATED PERMIT#(H ppli able)
SITE WELL ID #(if applicable) ✓
3. WELL USE (Check One Box) Monitoring ❑ MunicipaliPublic ❑
Industrial/Commercial ❑ Agricultural ❑ Recovery ❑ Injection ❑
inig�,p Other ist use) Closed loon Geotherrl
DATE DRILLED
4. WELL LOCATION:
1166 Lotla Church Rd
(Street Name, Numb, ty, Subdivision. Lot No., Parcel, Zip Code)
CITY: Franklin COUNTY Macon
TOPOGRAPHIC I LAND SETTING: (check appropriate box)
❑ Slope ❑ Valley Jhat ❑ Ridge ❑ Other
K(@TCD 36 iAAAA&AAAAAAAAI CL ROR 3l0)EXKy400W CC
MWISTCD75 iAAAA&AAAAAAAAI CLROR T7l.'1<l *X7P1W CC
Latitude/longitude source: DGPS Qropographic map
(location of wed must be shown on a USGS topo map andeftached to
this form if not using GPS)
5. FACILITY (Name of the business where the well is located.)
acQn 1=1pmPntary
Facility Name Facllrty ID# (ifapplicable)
1166 I ntla Chi trr:h Rd
Street Address
Franklin State Zip code
City or Town
Maran Qntin +.. Gnyemment
Contact Name
Mailing Address
Franklin
City or Town State Zip Code
Area code Phone number
6. WELL DETAILS:
a. TOTAL DEPTH: U
b. DOES WELL REPLACE EXISTING WELL? ES ❑ NO (V
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 tertnmated at or below land surface may require
a variance in accordance with 1 SA NCAC 2C .011 S.
e. YIELD (gpm): _-METHOD OF TEST g(a m Down
f. DISINFECTION: Type BI - Amount Q7
g. WATER ZONES (depth):
Top Bottom "'�
Top
Bottom
Top Bottom
Top
Bottom
Top— Bottom —
Top
Bottom—
Thickness/
Thickness/
7. CASING: Depth
Diameter
Weight Material
Top Bottom
Ft.—
Top— . Bottom
Ft.
Top Bottom
Ft;
8. GROUT: Depth Material
: Top _QBott rn 450, —Ft• 3gnMnl1e
Top Bottom Ft. -
Top Bottom Ft.
Method
Pumped-
9. SCREEN: Depth Diameter Slot Size Material
Top Bottom Ft. in. in.
Top Bottom Ft. in. in.
Top Bottom Ft. in. in.
1o. SANDIGRAVEL PACK:
Deter Sue Material
Tap Bottom Ft.
Top Bottom Ft.
Top Bottom Ft.
11. DRILLING LOG
Top Bottom
l
/ -
12. REMARKS:
Formation Description
A
4 �
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED INACCORDANCE WITH
15A NCAC 2C, WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
RECORD H PRO Z THE
• SIGNATUR F CERTIFIED WELL CONTRAAC TNO_Rn DATE
Q e
PRINTED NA OF PERSON CONSTRUCTING THE WELL
Form GWAb
Submit within 30 days of completion to: Division of -Water Quality - Information Processing, Rev.1/08
1617 Mail Service Center, Raleigh, NC 27699-161, Phone: [phone]

STA
surF„�
NONRESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 3065 A
1. WELL CONTRACTOR:
Roaer L Williams
Well Contractor (Individual) Name
Tarheel Water Treatment
Well Contractor Company Name
3494 Georaia RD
Street Address
Franklin NC 28734
City or Town State Zip Code
8c 28 ) 369-0740
Area code Phone number
2. WELL INFORMATION:
WELL CONSTRUCTION PERMIT# W101 00 141
OTHER ASSOCIATED PERMIT#(if applicable)
SITE WELL ID #(if applicable) A1-5
3. WELL USE (Check One Box) Monitoring ❑ Municipal/Public ❑
Industrial/Commercial ❑ Agricultural ❑ Recovery ❑ Injection ❑
Irrigation❑ Other il6ist use) Closed IOOD Geotherre
DATE DRILLED 11-30-11
4. WELL LOCATION:
1166 Lotla Church Rd
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
CITY: Franklin COUNTY Macon
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
❑ Slope []Valley Flat []Ridge []Other
K SMTCD 36 iAAAA&AAAAAAAA! CL ROR 3MXX)XPA)W)1 CC
KNW I$TCD 75 iAAAA&AAAAAAAA! CL R OR 7`x.")kYA W CC
LatitudeAongitude source: E]GPS (]Topographic map
(location of well must be shown on a USGS topo map andattached to
this form if not using GPS)
5. FACILITY (Name of the business where the well is located.)
Macon Elementary
Facility Name Facility ID# (if applicable)
1166 Lotla Church Rd _
Street Address
Franklin NC 28734
City or Town State Zip Code
Macon County Government
Contact Name
Mailing Address
Franklin NC 28743
City or Town State Zip Code
Area code
Phone number
d. TOP OF CASING IS FT. Above Land Surface-
-Top of casing terminated attor below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): 5 METHOD OF TEST glow Down
f. DISINFECTION: Type I-iM Amount 12 n7
g. WATER ZONES (depth):
Top 340 Bottom. 342 Top Bottom
Top Bottom Top Bottom
;Top Bottom Top Bottom
Thickness/
7. CASING: Depth Diameter Weight Material
Top (�_ Bottoms Ft.
Top Bottom Ft.
Top Bottom Ft.
S. GROUT: Depth Material Method
Topes_ Bottom_ 89 Ft. Bentonite Pumped
Topes Bottom 450 Ft. washed stone poured
Top Bottom
Ft.
9. SCREEN: Depth
Diameter Slot Size Material
Top Bottom
Ft. in. in.
Top Bottom
Ft. in. in.
Top Bottom
Ft. in. in.
10. SAND/GRAVEL PACK:
Depth
Size Material
Top Bottom
Ft.
Top Bottom
Ft.
Top Bottom
Ft.
11. DRILLING LOG
Top Bottom
0 / 78
78 / 84
84 / 450
12. REMARKS:
Formation Description
Sand and clay
Granite casino set
Granite
6. WELL DETAILS: ; I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
• 15A NCAC L CONSTRUCTION S ANDARDS, AND THAT A COPY OF THIS
a. TOTAL DEPTH: 450 : RECOR AS B N PROVIO D TO TH NEE.
0 11-30-11
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO G/ : SIGNATURE OF CERTIFIED WELL CONTRACTOR DATE
c. WATER LEVEL Below Top of Casing: 50 FT. ; Roqpr I__ WIIIIamS
(Use "+" if Above Top of Casing) : PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Form GW-1b
Submit within 30 days of completion to: Division of Water Quality - Information Processing, Rev.1/08
1617 Mail Service Center, Raleigh, NC 27699-161, Phone : [phone]

STA1Fa
NONRESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 3065-A
1. WELL CONTRACTOR:
Roaer L Williams
Well Contractor (Individual) Name
Tarheel Water Treatment
Well Contractor Company Name
3494 Georaia RD
Street Address
Franklin NC 28734
City or Town State Zip Code
8( 28 ) 369-0740
Area code Phone number
2. WELL INFORMATION:
d. TOP OF CASING IS 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): 1159_ METHOD OF TEST BIOW Down
f. DISINFECTION: Type HTC: Amount 19 O
g. WATER ZONES (depth):
:Top 260 Bottom 264 Top Bottom
:Top Bottom Top Bottom
;Top Bottom Top Bottom
Thickness/
7. CASING: Depth Diameter Weight Material
WELL CONSTRUCTION PERMIT# W10100141
: Top 0 Bottom_ 89 Ft.
OTHER ASSOCIATED PERMIT#(if applicable)
:Top Bottom
Ft.
SITE WELL ID #(if applicable) Al-6
Top Bottom
Ft.
3. WELL USE (Check One Box) Monitoring ❑ Municipal/Public ❑
: 8. GROUT: Depth
Material Method
Industrial/Commercial ❑ Agricultural ❑ Recovery ❑ Injection ❑
: Top 0 Bottom 94
Ft. Bentonite Pumped
Irrigation[]Other !J((list use) Closed loop Geotherro
Top_94 Bottom 450
Ft. washed stone poured
DATE DRILLED 1 1-23-1 1
;Top Bottom
Ft.
4. WELL LOCATION:
: 9. SCREEN: Depth
Diameter Slot Size Material
1166 Lotla Church Rd
: Top Bottom
Ft. in. in.
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
: Top Bottom
Ft. in. - in.
CITY: Franklin COUNTYMacon
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
❑ Slope []Valley ii(Flat []Ridge []Other
KI315:TCD 36 iAAAA&AAAAAAAA! CL R OR 3mXXXXO&WX CC
KNMFI$TCD75 1AAAAg1AAAAAAAAI CLROR 7x.1 MXXX00ft CC
Latitude/longitude source: ❑GPS OTopographic map
(location of well must be shown on a USGS topo map andattached to
this form if not using GPS)
5. FACILITY (Name of the business where the well is located.)
Marren Elementary
Facility Name Facility ID# (if applicable)
1166 I otla Church Rd
Street Address
Franklin NC 28734
City or Town State Zip Code
Marren County GOVAmment
Contact Name
Mailing Address
Franklin NC 28743
City or Town State Zip Code
U)
Area code Phone number
6. WELL DETAILS:
a. TOTAL DEPTH: 4`50
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO LV
: Top Bottom Ft. in.
10. SAND/GRAVEL PACK:
Depth Size
Top Bottom Ft.
Top Bottom Ft.
Top Bottom Ft.
11. DRILLING LOG
Top Bottom
0 / 80
80 / 89
89 / 450
/
12. REMARKS:
in.
Material
Formation Description
Sand and clay
Granite casino set
Granite
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
• 15A NCAC 2C, WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
: RECORD7ENPROVI TO WNER
11-23-11
SIGFJATURE OF CERTIFIED WELL CONTRACTOR DATE
c. WATER LEVEL Below Top of Casing: 50 FT. tiger I _ WIIIIams
(Use °+" if Above Top of Casing) : PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Form GW-1b
Submit within 30 days of completion to: Division of Water Quality - Information Processing, Rev.1/08
1617 Mail Service Center, Raleigh, NC 27699-161, Phone : [phone]

NONRESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 3065-A
1. WELL CONTRACTOR:
Roger L Williams
Well Contractor (Individual) Name
Tarheel Water Treatment
Well Contractor Company Name
3494 Georaia RD
Street Address
Franklin NC 28734
City or Town State Zip Code
8( 28 ) 369-0740
Area code Phone number
2. WELL INFORMATION:
: d. TO_ P OF CASING IS 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): 100 METHOD OF TEST Blow Down
f. DISINFECTION: Type I -ITC Amount 19 n7
g. WATER ZONES (depth):
:Top 260 Bottom_264 Top Bottom
:Top Bottom Top Bottom
Top Bottom Top Bottom
Thickness/
7. CASING: Depth Diameter Weight Material
WELL CONSTRUCTION PERMIT# W101 00 141 : Top 0 Bottom Ft.
OTHER ASSOCIATED PERMIT#(if applicable) :Top Bottom Ft.
SITE WELL ID #(if applicable) Al-7 Top Bottom Ft.
3. WELL USE (Check One Box) Monitoring ❑ Municipal/Public ❑ : 8. GROUT: Depth Material Method
Industrial/Commercial ❑ Agricultural ❑ Recovery ❑ Injection ❑
Irrigation❑ Other m((list use) Closed IOOD Geotherrla
DATE DRILLED 1 1-18-11
4. WELL LOCATION:
1166 Lotla Church Rd
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
CITY: Franklin COUNTY Macon
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
[]Slope CiValley JiFlat []Ridge ❑Other
Kg,MTCD 36 iAAAA&AAAAAAAA1 CL ROR 3lC"xXxxo0t➢ x CC
KNWBTCD75 IAAAA&AAAAAAAAI CLROR 7k.AAN)W'1(9('kW CC
Latitude/longitude source: ❑GPS Qropographic map
(location of well must be shown on a USGS topo map andattached to
this form if not using GPS)
5. FACILITY (Name of the business where the well is located.)
Macon Elementary
Facility Name Facility ID# (if applicable)
1166 Lotla Church Rd
Street Address
Franklin NC 28734
City or Town State Zip Code
Macon County Governmant
Contact Name
Mailing Address
Franklin NC 28743
City or Town State Zip Code
U
Area code
Phone number
S. WELL DETAILS:
a. TOTAL DEPTH: 450
b. DOES WELL REPLACE EXISTING WELL? YES Cl NO LY
Top 0 Bottom 9A-- Ft. Bentonite Pumped
Top_4_ Bottom. 450 Ft. washed stone poured
Top Bottom Ft.
9. SCREEN: Depth Diameter Slot Size Material
Top Bottom Ft. in.
Top Bottom Ft. in.
Top Bottom Ft. in.
: 10. SAND/GRAVEL PACK:
Depth Size
Top Bottom Ft.
Top Bottom Ft.
Top Bottom Ft.
11. DRILLING LOG
Top Bottom
0 / 80
80 / 89
89 / 450
/
12. REMARKS:
in.
in.
in.
Material
Formation Description
Sand and clay
Granite casino set
Granite
easing Removed
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
• 15A NCAC 2C4ELL CONSTRUCTION PTANDARDS, AND THAT A COPY OF THIS
RECORD EEN PR VIDED WNER
11-18-11
SI NAT RE OF CERTIFIED WELL CONTRACTOR DATE
c. WATER LEVEL Below Top of Casing: 50 FT. ; Roger I - Williams
(Use "+^ if Above Top of Casing) : PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Form GW-1b
Submit within 30 days of completion to: Division of Water Quality - Information Processing, Rev.1/08
1617 Mail Service Center, Raleigh, NC 27699-161, Phone : [phone]

NONRESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 3065-A
1. WELL CONTRACTOR:
Roger L Williams
Well Contractor (Individual) Name
Tarheel Water Treatment
Well Contractor Company Name .
3494 Georaia RD
Street Address
Franklin NC 28734
City or Town State Zip Code
8( 28 ) 369-0740
Area code Phone number
2. WELL INFORMATION:
WELL CONSTRUCTION PERMIT# W101 00 141
OTHER ASSOCIATED PERMIT#(if applicable)
SITE WELL ID #(if applicable) A1-8
3. WELL USE (Check One Box) Monitoring ❑ Municipal/Public ❑
Industrial/Commercial ❑ Agricultural ❑ Recovery ❑ Injection ❑
Irrigation❑ Other l((list use) Closed loon Geotherra
DATE DRILLED 1 1-16-11
4. WELL LOCATION:
1166 Lotla Church Rd
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
CITY: Franklin COUNTY Macon
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
[]Slope []Valley Flat ❑Ridge ❑Other
KOI$TCD 36 1AAAA&AAAAAAAAI CL R OR 3X^XXiKIK90t➢ X CC
KNMF IIBTCD 75 iAAAA&AAAAAAAA! CL R OR 7)t.hA"1kXX)0M CC
LatitudeAongitude source: DGPS []Topographic map
(location of well must be shown on a USGS topo map andattached to
this form if not using GPS)
5. FACILITY (Name of the business where the well is located.)
Macon IPmentary
Facility Name Facility ID# (if applicable)
1166 I otla Church Rd
Street Address
Franklin NC 28734
City or Town State Zip Code
Macon County Government
Contact Name
Mailing Address
_ Franklin NC 28743
City or Town State Zip Code
(U)
Area code
Phone number
6. WELL DETAILS:
a. TOTAL DEPTH: 450
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO qI
d. TOP OF CASING IS FT. Above Land Surface'
'Top of casing terminated aVor below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): 100 METHOD OF TEST Rinw Down
f. DISINFECTION: Type HT . Amount 12 n7
g. WATER ZONES (depth):
Top 260 Bottom 264 Top Bottom
:Top Bottom Top Bottom
Top Bottom Top Bottom
Thickness/
7. CASING: Depth Diameter Weight Material
Top_0 Bottom Ft.
Top Bottom Ft.
Top Bottom Ft.
8. GROUT: Depth Material Method
Topes_ Bottoms Ft. bentonite Pumped
Top 94 Bottom 450 Ft. washed stont aoured
Top Bottom Ft.
9. SCREEN: Depth
Diameter Slot Size Material
Top Bottom
Ft. in. in.
Top Bottom
Ft. in. in.
Top Bottom
Ft. in. in.
10. SAND/GRAVEL PACK:
Depth
Size Material
Top Bottom
Ft.
Top Bottom
Ft.
Top Bottom
Ft.
11. DRILLING LOG
Top Bottom
0 / 80
80 / 89
89 / 450
/
V
: 12. REMARKS:
Formation Description
Sand and clay
Granite casino set
Granite
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
• 15A NCAC 2C, WF4 CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
RECORD tl S"B PROVIDED TO THE EL O NER.
o 11-16-11
SIGNATU E OF CERTIFIED WELL CONTRACTOR DATE
c. WATER LEVEL Below Top of Casing: 50 FT. ; Roger I _ WIIIIams
(Use "+" if Above Top of Casing) : PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Form GW-1b
Submit within 30 days of completion to: Division of Water Quality - Information Processing, Rev. 1/08
1617 Mail Service Center, Raleigh, NC 27699-161, Phone: [phone]

NONRESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 3065 A
1. WELL CONTRACTOR:
Roger L Williams
Well Contractor (Individual) Name
Tarheel Water Treatment
Well Contractor Company Name
3494 Georaia RD
Street Address
Franklin NC 28734
City or Town State Zip Code
8( 28 ) 369-0740
Area code Phone number
2. WELL INFORMATION:
WELL CONSTRUCTION PERMIT# W101 00 141
OTHER ASSOCIATED PERMIT It applicable)
SITE WELL ID *(if appticable) 2-- 1
3. WELL USE (Check One Box) Monitoring ❑ Municipal/Public ❑
Industrial/Commercial ❑ Agricultural ❑ Recovery ❑ Injection ❑
Irrigation❑ Other m6istruse) Closed IooD Geotherrm _
DATE DRILLED
4. WELL LOCATION:
1166 Lotla Church Rd
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
CITY: Franklin COUNTY Macon
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
❑ Slope ❑ Valley &Iat []Ridge ❑ Other
K4g;fSTCD 36 iAAAA&AAAAAAAAI CL ROR 3J10XMYJ@CMX CC
KNMF I STCD 75 iAAAA&AAAAAAAAI CL R OR N..PiMItlXNW CC
Latitude/longitude source: ❑GPS OTopographic map
(location of well must be shown on a USGS topo map endattached to
this form if not using GPS)
5. FACILITY (Name of the business where the well is located.)
Macon Elementary
Facility Name Facility ID# (if applicable)
1166 Lotla Church Rd
Street Address
Franklin NC 28734
City or Town State Zip Code
Macon County GovemmPnt
Contact Name
Mailing Address
Franklin N . 28743
City or Town State Zip Code
L-)
Area code
Phone number
d. TOP OF CASING IS 0 FT. Above Land Surface'
'Top of casing terminated at/or below land surface may require .
a variance in Caccordance with 15A NCAC 2C .0118.
e. YIELD (gpm): S METHOD OF TEST Blow Down
f. DISINFECTION: Type I -ITC Amount 12 07
g. WATER ZONES (depth):
Top .LCO Bottom q- Top Bottom
Top Bottom Top Bottom
Top Bottom Top Bottom
Thickness/
7. CASING: Depth Diameter Weight Material
Top ji+ Bottom Ft.
Top Bottom Ft.
Top Bottom Ft.
8. GROUT: Depth Cill Material Method
Top 0 Bottom 51 Ft. Bentonite Pumped
Top qA Bottom 4100 Ft, W484 d S604& 10AW —d
Top Bottom Ft.
9. SCREEN: Depth Diameter Slot Size Material
Top Bottom Ft. in. in.
Top Bottom Ft. in. in.
Top Bottom Ft. in. in.
10. SANDIGRAVEL PACK:
Depth Size
Top Bottom Ft.
Top Bottom Ft.
: Top Bottom Ft.
11. DRILLING LOG
Top Bottom
/�_
/
12. REMARKS:
leasing Removed
Material
Formation Description
�Arvii �C l � J
6. WELL DETAILS: : I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
15A NCAC 2C. WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
a. TOTAL DEPTH: �-1/ : RECORDH PROVIDE TOTH L WNEPL ' /� /2
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO G/
: SIG 74oge�
OF CERTIFIED WELL CONTRACTOR DATE
c. WATER LEVEL Below Top of Casing: G FT. (Use'+' if Above Top of Casing) Q f
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit within 30 days of completion to: Division of Water Quality Form /08
y p ty - Information Processing, Rev. 1/08
1617 Mail Service Center, Raleigh, NC 27699-161, Phone: [phone]

NONRESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 3065-A
1. WELL CONTRACTOR:
Roger L Williams
Well Contractor (Individual) Name
Tarheel Water Treatment
Well Contractor Company Name
3494 Georaia RD
Street Address
Franklin NC 28734
City or Town State Zip Code
8( 28 ) 369-0740
Area code Phone number
2. WELL INFORMATION:
WELL CONSTRUCTION PERMIT# W 10100141
OTHER ASSOCIATED PERMIT#(if�pplicable)
SITE WELL ID #(if applicable) 2 Z
3. WELL USE (Check One Box) Monitoring ❑ Municipal/Public ❑
Industrial/Commercial ❑ Agricultural ❑ Recovery ❑ Injection ❑
Irrigation❑ Other t,((list use) Closed IooD Geothernd
DATE DRILLED 1-2 L1 '12
4. WELL LOCATION:
1166 Lotla Church Rd
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel. Zip Code)
CITY: Franklin COUNTY Macon
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
❑ Slope ❑ Valley 01at ❑ Ridge ❑ Other
K�TCD 36 1AAAA&AAAAAAAA! CL R OR 31(o)UP)C90®m CC
KNWISTCD 75 IAAAA&AAAAAAAA! CL R OR 7`A'..ftM)tXY-4M CC
Latitude/longitude source: ❑GPS Qropographic map
(location of well must be shown on a USGS topo map andattached to
this form if not using GPS)
5. FACILITY (Name of the business where the well is located.)
Macon Flementary
Facility Name Facility ID# (if applicable)
1166 Lotla Church Rd
Street Address
Franklin NO 28734
City or Town State Zip Code
Macon County Government
Contact Name
Mailing Address
Franklin NC 28743
City or Town State Zip Code
U
Area code
Phone number
d. TOP OF CASING IS O 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): .S METHOD OF TEST Blow Down
f. DISINFECTION: Type HTC Amount 12 A7
g. WATER ZONES (depth):
Top PY0 ' Bottom
Top Bottom
Top Bottom
Top Bottom
Top Bottom
Top Bottom
Thickness/
7. CASING: Depth
Diameter Weight Material
p
Top �.2 Bottom 8� r
Ft
Top Bottom
Ft.
Top Bottom
Ft.
8. GROUT: Depth
Material Method
Top__ Bottom
Ft. Sentonite U e
: Top_ Bottom _Ft.
k j „ra S(u�� o✓✓'�
Top Bottom
Ft.
9. SCREEN: Depth
Diameter Slot Size Material
Top Bottom
Ft, in. in.
: Top Bottom
Ft. in. in.
Top Bottom
Ft. in, in.
10. SAND/GRAVEL PACK:
Depth Size
Top Bottom Ft.
Top Bottom Ft.
Top Bottom Ft.
11. DRILLING LOG
Top Bottom
l 4jro)
/
12. REMARKS:
easing Removed
Material
Formation Description
I
S. WELL DETAILS: : I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
15A NCAC 2C, WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
a. TOTAL DEPTH: -3 U ( : RECORD HABSF7N PROVIDED TO THE VjOr=LL OWNER
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO qI : SIGNAT OF CERTIFIED WELL CONTRACTOR DATE
c. WATER LEVEL Below Top of Casing: 6 FT.
(Use "+^ if Above Top of Casing) : PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit within 30 days of completion to: Division of Water Quality Information Processing, Form GW-1b
y P ty " IftiPig+ Rev. 1l08
1617 Mail Service Center, Raleigh, NC 27699-161, Phone : [phone]

NONRESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 3065-A
1. WELL CONTRACTOR:
Roner L Williams
Well Contractor (individual) Name
Tarheel Water Treatment
Well Contractor Company Name
3494 Georaia RD -
Street Address
Franklin NC 28734
City or Town State Zip Code
8( 28 ) 369-0740
Area code Phone number
d. TOP OF CASING IS r FT. Above Land Surface'
'Top of casing terminated atfor below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): —y METHOD OF TEST BIOW Dnwn
I. DISINFECTION: Type, F- M Amount 12 n7
g. WATER ZONES (depth):
Top Bottom Top Bottom
Top Bottom Top Bottom
Top Bottom Top Bottom
2. WELL INFORMATION: : 7. CASING: Depth Diameter
WELL CONSTRUCTION PERMIT# WI0100141 : Top Bottom Ft.
OTHER ASSOCIATED PERMIT applicable) Top Bottom Ft.
SITE WELL ID #(it applicable) i �2- ^'
3. WELL USE (Check One Box) Monitoring ❑ Municipal/Public ❑
Industrial/Commercial ❑ Agricultural ❑ Recovery ❑ Injection ❑
Irrigation❑ Other (list use) Closed loot) Geotherrle
DATE DRILLED — a !-
4. WELL LOCATION:
1166 Loda Church Rd
(Street Name, Numbers, Community; Subdivision, Lot No., Parcel, Zip Code)
CITY: Franklin COUNTY Mahn
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
❑ Slope ❑ Valley 94hat ❑ Ridge []Other
Kt WCD 36 iAAAA&AAAAAAAAI CL ROR 3X9(X1PXD6"X CC
IQ WISTCD 75 iAAAARAAAAAAAAI CL ROR 71k..PAW'3t'XX1W CC
Latitudellongitude source: []GPS []Topographic map
(location of well must be shown on a USGS topo map andattached to
this form if not using GPS)
S. FACILITY (Name of the business where the well is located.)
Macon Flementary
Facility Name Facility ID# (if applieable)
1166 1 ntla Chum Rd
Street Address
Franklin NC 28734
City or Town State Zip Code
Macon C minty GnV mment
Contact Name
Mailing Address
Franklin NC 28743
City or Town State Zip Code
U
Area code Phone number
G. WELL DETAILS:
a. TOTAL DEPTH: _
b. DOES WELL REPLACE EXISTING WELL? YES NO pI
c. WATER LEVEL Below Top of Casing: FT.
(Use "+" if Above Top of Casing)
Thickness/
Weight Material
Top Bottom Ft.
8. GROUT: Depth Material Method
Top_ Bottom• 450, Ft. Bentonite Pumped
Top Bottom Ft.
Top Bottom Ft.
9. SCREEN: Depth Diameter Slot Size Material
Top Bottom Ft. in. in.
Top Bottom Ft. in. in.
Top Bottom Ft in. in-
: 10. SANDIGRAVEL PACK:
Depth Size
Top
Bottom Ft.
Top
Bottom Ft.
Top
Bottom Ft.
11. DRILLING LOG
Top Bottom
D / '�S
/
1
12. REMARKS:
Material
Formation Description
easing Removed
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 EN PROED TOER.
2—
S71GNATUM OF CERTIFIED WELL CONT;CTOR DATE
: PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit Within 30 days of completion to: Division of Water Quality - information Processing, Forth GW-1bRev. 1/08
1617 Mall Service Center, Raleigh, NC 27699-161, Phone : [phone]

NONRESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 3065 A
1. WELL CONTRACTOR:
Roaer L Williams
Well Contractor (Individual) Name
Tarheel Water Treatment
Well Contractor Company Name
3494 Georaia RD
Street Address
_ Franklin NC 28734
City or Town State Zip Code
8( 28 ) 369-0740
Area code Phone number
2. WELL INFORMATION::
d. TOP OF CASING IS - 'I _ 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): U�� l) METHOD OF TEST Rlnw Down
f. DISINFECTION: Type HTC Amount 12 07
g. WATER_ ZONES (depth): _
{
Top.2-Jc
Bottom
Top
Bottom
Top
Bottom
Top
Bottom
Top
Bottom
Top
Bottom-
-Thickness/
T. CASING:
Depth Diameter
Weight Material
WELL CONSTRUCTION PERMIT# W10100141
: Top Bottom
FL
OTHER ASSOCIATED PERMIT#(N applicable)
Top Bottom
Ft.
SITE WELL ID #(if appucabie) , - Z 'A
Top Bottom
Ft.
3. WELL USE (Check One Box) Monitoring ❑ Municipal/Public ❑
; 8. GROUT: Depth
Material Method
Industrial/Commercial ❑ Agricultural ❑ Recovery ❑ Injection ❑
: Top 0 Bottom 450,
Ft. Bentonite Pumped
Irrigation❑ Other (tt (list use) Closed looD Geotherm
: Top Bottom
Ft.
DATE DRILLED ` ��i
Top Bottom
Ft.
4. WELL LOCATION:
; S. SCREEN: Depth
Diameter Slot Sin Material
1166 Lotla Church Rd
: Top Bottom
Ft.
in. in.
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
:Top Bottom
Ft.
In. in.
CITY: Franklin COUNTY Macon
; Top Bottom
Ft.
in. in.
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
❑ Skip® ❑ Valley JiMat ❑ Ridge ❑ Other
: 10. SAND/GRAVEL PACK:
Depth
Size Material
, 36 IAAAA nnAAAnnn( n
CD CL R OR aN1.)ElUC�1CNOtiNk)f CC
: Top Bottom
Ft.
IQ W FSTCD 75 IAAAAaAAAAAAAA! CL R OR 7kX.."WX7C0W CC
: Top Bottom
Ft-
Latitude/longitude source: C)GPS Oropographic map
; Top Bottom
Ft
(focatian of well must be shown on a USGS topo map andattached to
this form if not using GPS)
11. DRILLING LOG
S. FACILITY (Name of the business where the well is located.)
Top Bottom
Formation Description
Macon Elementary
/�_
-SGi7 c1' C le '
Facility Name Facility ID# (if applicable)
-7'c-,-_JY
'_,Z4l
1166 Lotla Church Rd
r-� �
Street Address
I
Franklin NC 99734
/
City or Town State Zip Code
J
Macon County Govemme_nt
/
Contact Name
/
Mailing Address
/
Franklin NC 99743
1
City or Town state zip Code
' 12. REMARKS:
U
Area code
Phone number
6. WELL DETAILS:
a. TOTAL DEPTH: Gl
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO U/
c. WATER LEVEL Below Top of Casing: U FT.
(Use'+' if Above Top of Casing)
easing Removed
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 yl"EEN PROVIDED TO THEeWMI�,4 R.
SIGNAT
�fM OF CERTIFIED WELL CgNTRACTOR DATE
g
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit within 30 days of completion to: Division Of Water Quay Information Processing, Form 108
aY P dY ' ►19� Rev. 1/08
1617 Mail Service Center, Raleigh, NC 27699-161, Phone : [phone]

NON RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Di%rision of Water Quality
WELL CONTRACTOR CERTIFICATION # 3065-A
1. WELL CONTRACTOR:
R I
oger L Williams
Well Contractor (Individual) Name
Tarheel Water Treatment
Well Contractor Company Name
3494 Georgia RD
Street Address
Franklin NC 28734
City or Town State Zip Code
8( 28 ) 369-0740
Area code Phone number
2. WELL INFORMATION:
WELL CONSTRUCTION PERMIT# L10100141
OTHER ASSOCIATED PERMIT#(rf applicable) (�
SITE WELL ID #(ifapplicable)
3. WELL USE (Check One Box) Monitoring ❑ Municipal/Public ❑
Industrial/Commercial ❑ Agricultural ❑ Recovery ❑ Injection ❑
Irrigation❑ Other Imo. (list use) Closed loop Geotherrm .
DATE DRILLED—, ` % T / ~'Z
4. WELL LOCATION:
1166 Lotla Church Rd
(Street Name, Numbers, Community, Subdivision, Lot No.. Parcel, Zip Code)
CITY: Franklin COUNTY Macon
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
❑ Slope ❑ Valley Wr lat ❑ Ridge ❑ Other
KjgWCD 36 iAAAA&AAAA^AAA! CL R OR 3w*xXY—A6 x CC
KNMF t$TCD 75 i^AAA&AAAAAAAA! CL R OR 7kX'!XX*)tX%0W CC
Latitude/longitude source: CIGPS ❑ropographic map
(location of well must be shown on a USGS topo map andattached to
this form if not using GPS)
S. FACILITY (Name of the business where the well is located.)
Macon lementary Facility Name Facility ID# (if applicable)
HAIRS I f)tlq CIt.rnh Rd
Street Address
Franklin NC 28734
City or Town State Zip Code
Contact Name
Mailing Address
Franklin NC 28743
City or Town State Zip Code
Area code Phone number
6. WELL DETAILS:
a. TOTAL DEPTH:
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO W
c. WATER LEVEL Below Top of Casing: 0 FT.
(Use "+^ if Above Top of Casing)
d. TOP OF CASING IS ZL7 — FT. Above Land Surface'
'Top of casing terminated atior below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
: e. YIELD (gpm):.1I-0METHOD OF TEST BIQW D0M
: f. DISINFECTION: Type ±T. _ Amount 12oz— —
: g. WATER ZONES (depth):
Top 0 Bottom„ 6 Top
Bottom
Top Bottom
Top
Bottom
Top Bottom
Top
Bottom
Thickness/
7. CASING: Depth
Diameter
Weight Material
Top Bottom
Ft.
Top Bottom
Ft.
Top Bottom
Ft.
8. GROUT: Depth
Material Method
Top—_ Bottom 450,
Ft. Rentotli1A Pumped
: Top Bottom
Ft.
Top Bottom
Ft.
9. SCREEN: Depth
Diameter
Slot Size Material
Top Bottom
Ft. in.
in.
Top Bottom
Ft. in.
in.
Top Bottom
Ft. in.
in.
10. SAND/GRAVEL PACK:
Depth Size Material
Top Bottom Ft
Top Bottom Ft.
Top Bottom Ft.
11. DRILLING LOG
: Top Bottom Formation Description
lit. B
.4? �
/
12. REMARKS:
easing Rel,ioved
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
15A NCAC 2C, WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
RECORD H�N PROVIDE TO THE WE
„OWNER
SIGN TUR OF CERTIFIED WELL CONT CTOR DATE
PRINTED NAPE OF PERSON CONSTRUCTING THE WELL
Form GW-1b
Submit within 30 days of completion to: Division of Water Quality - Information Processing, Rev. 1108
1617 Mail Service Center, Raleigh, NC 27699-161, Phone: [phone]

NONRESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 3065-A
1. WELL CONTRACTOR:
Roaer L Williams
Well Contractor (Individual) Name
Tarheel Water Treatment
Well Contractor Company Name
3494 Georgia RD
Street Address
Franklin NC 28734
City or Town State Zip Code
8( 28 ) 369-0740
Area code Phone number
2. WELL INFORMATION:
WELL CONSTRUCTION PERMIT# W10100141
OTHER ASSOCIATED PERMIT#(' pplipbte)
SITE WELL ID #(dapplicat>!e) %
3. WELL USE (Check One Box) Monitoring ❑ Municipal/Public Q
Industrial/Commercial ❑ Agricultural ❑ Recovery ❑ Injection ❑
Irrigation❑ Other g{(Iist use) Closed (ooD Geotherra
DATE DRILLEDT — Zy " % ,2-
4. WELL LOCATION:
1166 Lotla Church Rd
(Street Name. Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
CITY: Franklin COUNTY Macon
TOPOGRAPHIC I LAND SETTING: (check appropriate box)
❑Slope ❑Valley @fhat ❑Ridge ❑Other
KrfISTCD 36 innnA&AAAAAAAAI CL ROR UmXXVX009M CC
KNWISTCD75 IAAAAaAAAAAAAA! CLROR 7kX.rXW)tpL%P0& CC
Latitude/iongitude source: 03PS [3ropographic map
(location of well must be shown on a USGS fopo map andettached to
this form if not using GPS)
S. FACILITY (Name of the business where the well is located.)
Macon 1pm n ary
Facility Name Facility ID# (if applicable)
1166 1 otla Church Rd
Street Address
Franklin NC 28734
City or Town State Zip Code
Mnr+nn County GOVemment
Contact Name
Mailing Address
Franklin NC 28743
City or Town State Zip Code
U
Area code
Phone number
6. WELL DETAILS: r
a. TOTAL DEPTH: v
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO I/
c. WATER LEVEL Below Top of Casing: - FT.
(Use'+" it Above Top of Casing)
d. TOP OF CASINO IS _.0 FT. Above Land Surface'
'Top of casing terminated attor below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm):_ METHOD OF TEST gIOW Down
I. DISINFECTION: Type dTC Amount 1 n
g. WATER ZONES (do -nth):
Top2C1 Bottort>vaL Top Bottom
Top Bottom Top Bottom
Top Bottom Top Bottom
Thickness/
7. CASING, Depth Diameter Weight Material
Top Bottom Ft.
Top Bottom Ft.
Top Bottom Ft.
8. GROUT: Depth
Material Method
TopQ__ Bottom 450,
Ft. Bentonite Pumped
Top Bottom
Ft.
Top Bottom
Ft.
9. SCREEN: Depth
Diameter Slot Size Material
Top Bottom
Ft.
in. in.
Top Bottom
Ft.
in. In.
Top Bottom
Ft.
in. in.
10. SANDIGRAVEL PACK:
Depth
Size Material
Top Bottom
Ft
Top Bottom
Ft.
Top Bottom
Ft
11. DRILLING LOG
Top+ Bottom
Formation Description
lJ l V
S Ci 11G� r✓ �fr
I
G7 ruir• C a l,ft r S
/
/
12. 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
: RECORDF'ROVID TO THE WEJ&OWNIA
�-
SIGNA REf OF CERTIFIED WELL ONTRACTOR DATE
: PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Form GW-1b
Submit within 30 days of completion to: Division of Water Quality - information Processing, Rev. 1108
1617 Mail Service Center, Raleigh, NC 27699-161, Phone: [phone]

3� ti
North Carolina Department of Em lronment
� WELL CONTRACTOR CERTMC
1. WELL CONTRACTOR:
R r Will'
WaU Corrtrador (IndividuaI) Name
Ta III I Water Treatment —
Wen Contractor Company Name
�e194 ra,mi� Rp
street Address NC
Fran tin state zip code
City or Town
Sr 26 ) 369-0740
Area code Phone number
2. WELL INFORMATION:
WELL CONSTRUCTION PERMIT# W10100141
OTHER ASSOCIATED PERMIT#(if applicable)
SITE WELL ID #(if appucabk0 -
3. WELL USE (Check One Box) Monitoring Municipal/Public ❑
Indusirial Commercm, ❑ Agricultural ❑ Recovery ❑ Injection ❑
Inigaeon❑ Other iN k,sel Closed loon Geotherno
DATE DRILLED Z
4. WELL LOCATION:
1 66 Lott hurch Rd
(Street Name. Numbers. Community, Subdivision. Lot No., Parcel. Zip Coda)
CITY: Franklin COUNTY Macon
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
❑ Slope ❑ Val'lley tat ❑ Ridge ❑ Other
1( " TCD '`�' iAAAA&AAAAAAAAI CL ROR 3W%XXKCC
IQ,INFPSTCD75 iAAAARAAAAAAAAI CL ROR N.10*111 x"ICDC CC
Latitude/longitude source: BPS 11ToPographkc map
(location of weft must be shown on a USGS topo map endelteched to
this form H not using GPS)
S. FACILITY (Name of the business where the well is located.)
Facility Name Facility ID# (it applicable)
Street Address N(; !A734
it .,L Gn State Zip Code
City or Town
.. r nhi ('nVPtT1rTlPilt
Contact Name
L WELL CONSTRUCTION RECORD
and Natural Resources- Division of Water Quality
ATION # 3065-A
d. TOP OF CASING IS -- - FT. Above Land Surface'
_Top of casing terminated allor below land surface may require
a variance
once with 15A NCAC 2C .011S.
: e. YIELD lgPml 1, .0 SHOD OF TEST BIOW 20MM
: f. DISINFECTION: Type C= ETAmount 1 2 n7
g. WATER ZONES (depth))):
TopAk Bottompt— Top
Bum
Top Bottom Top Bottom
B Top Bottom
roe This/
7. CASING: Depth Diameter Weight I/aterisl
Top Bottom Ft.
Top Bottom Ft.
Mailing Address NC 98743
it I' City or Town State Zip Code
Ar-o-a � Phone number
6. WELL DETAILS: � _ i
a. TOTAL DEPTH: /_—)
b. DOES WELL REPLACE EXISTING WELL? YES C NO 1�
c. WATER LEVEL Below Top of casing: `S 2 FT.
(Use'+" if Above Top of Casing)
: Top Bottom Ft.
Material 8. GROUT: l Method Depth purnned
TopQ_ B-,,omA Ft. 1Q=nite
Top Bottom Ft.�—
Top Bottom Ft.
9. SCREEN: Depth Diameter Slat Sire Material
Top Bottom Ft. in. in.
Top Bottom Ft. in. in.
op Bottom
TFt. in. in.
10. SAND►GRAVEL PACK: Size Material
Depth
Top Bottom Ft
ToP Ft._
Top Bottom Ft
11. DRILLING LOG Formation Description
Top Bottom
! i sir' GC! is J e 74
i
I
12. REMARKS:
easing Re,1109et-
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTR=`ED IN ACCORDANCE Wn"
tsiG;.NTURE
A PICAC 2C, WELL 'ONSTRU T STANDARDS. AND THAT A COPY OF THIS
O THE
DATE
OF CERTIFIED WELL 7CONTRAC'1
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Forth GW-1b
Submit within 30 days
a f Completion
n to: Division
ision I� Ware Quality - Infomuldw Process", Rev.1/08
1617 Mall Service

� �r
NONRESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 3118 A
1. WELL CONTRACTOR:
Timothy R Hamby
Well Contractor (Individual) Name
Midsouth Geothermal
Well Contractor Company Name
8275 Tournament Dr Suite 185
Street Address
Memphis TN 38125
City or Town State Zip Code
9( 01 ) 748-9095
Area code Phone number
2. WELL INFORMATION:
WELL CONSTRUCTION PERMIT# W101 00 141
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 15A NCAC 2C .0118.
e.
YIELD (gpm): 40 METHOD OF TEST Blow DOWn
f. DISINFECTION: Type HTC Amount 12 o7
g. WATER ZONES (depth):
Top 250, Bottom 254, Top
Bottom
Top
Bottom
Top
Bottom
;Top
Bottom
Top
Bottom
Thickness/
7. CASING:
Depth
Diameter
Weight Material
Top +2
Bottom 67,
Ft. 6 1/8
.188 steel
OTHER ASSOCIATED PERMIT#(if applicable) Top Bottom Ft.
SITE WELL ID #(if applicable) A-1 ; Top Bottom Ft.
3. WELL USE (Check One Box) Monitoring ❑ Municipal/Public ❑ : 8. GROUT: Depth Material Method
Industrial/Commercial ❑ Agricultural ❑ Recovery ❑ Injection ❑ : Topes_ Bottom-72 _ Ft. Bentonite Pumped
Irrigation[] Other d(list use) Closed looD Geotherra Top 72 Bottom_45._Q__ Ft. washed stone poured
DATE DRILLED 9-29-1 1 ; Top Bottom Ft.
4. WELL LOCATION:
9. SCREEN: Depth Diameter Slot Size Material
1166 Lotla Church Rd : Top Bottom Ft. in. in.
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code) Top Bottom Ft. in. in.
CITY: Franklin COUNTY Macon ; Top Bottom Ft. in. in.
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
❑ Slope ❑ Valley Flat ❑ Ridge ❑ Other
KW,BTCD 36 IAAAA&AAAAAAAA! CL R OR 3X^XXX'X9t)WX CC
KNWKTCD 75 iAAAA&AAAAAAAA! CL R OR 71k.WXXXXW* CC
Latitude/longitude source: ❑GPS ❑ropographic map
(location of well must be shown on a USGS topo map andattached to
this form if not using GPS)
5. FACILITY (Name of the business where the well is located.)
Macon Elementary
Facility Name Facility ID# (if applicable)
1166 Lotla Church Rd
Street Address
Franklin NCL 28734
City or Town State Zip Code
Macon County Government
Contact Name
Mailing Address
Franklin NC 2874.1
City or Town State Zip Code
U
Area code
Phone number
10. SAND/GRAVEL PACK:
Depth Size
Top Bottom Ft.
Top Bottom Ft.
Top Bottom Ft.
11. DRILLING LOG
Top Bottom
0 /61
61 / 67
72 250
250 / 254
254 / 450
/
12. REMARKS:
Material
Formation Description
Overburden
Granite
Granite
_Broken Granite 40 GPM
Granite
S. WELL DETAILS: ; I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
• 15A NCAC 2C, WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
a. TOTAL DEPTH: 450' : RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO pI ' � '`
SIGNATURE OF CERTIFIED WELL CONTRACTOR DATE
c. WATER LEVEL Below Top of Casing: 60 FT. Timothy R Hamby
(Use "+^ if Above Top of Casing) : PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit within 30 da s Of Completion to: Division of Water Quality Form /08
Y P ty - Information Processing, Rev. 1/08
1617 Mail Service Center, Raleigh, NC 27699-161, Phone : [phone]

]��
1 r ONRESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
,✓ r
�` •ng "° �"" WELL CONTRACTOR CERTIFICATION # 3118-A
1. WELL CONTRACTOR:
Timothy R Hamby
Well Contractor (Individual) Name
Midsouth Geothermal
Well Contractor Company Name
8275 Tournament Dr Suite 185
Street Address
Memphis TN 38125
City or Town State Zip Code
9( 01 ) 748-9095
Area code Phone number
2. WELL INFORMATION:
WELL CONSTRUCTION PERMIT# Wl0100141
OTHER ASSOCIATED PERMIT#(if applicable)
SITE WELL ID #(if applicable) A-2
3. WELL USE (Check One Box) Monitoring ❑ Municipal/Public ❑
Industrial/Commercial ❑ Agricultural ❑ Recovery ❑ Injection ❑
Irrigation[] Other l((Iistuse) Closed IOOD Geotherre
DATE DRILLED 9-28-11
4. WELL LOCATION:
1166 Lotla Church Rd
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
CITY: Franklin COUNTY Macon
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
[]Slope []Valley J'Flat ❑Ridge ❑Other
K@31STCD 36 IAAAA&AAAAAAAAI CL R OR 3mXX1(XN)WX CC
KNMFISTCD75 iAAAA&AAAAAAAAI CLROR 7)t.wxxxxxim CC
Latitude/longitude source: []GPS i]ropographic map
(location of well must be shown on a USGS topo map andattached to
this form if not using GPS)
5. FACILITY (Name of the business where the well is located.)
Macon Flementary
Facility Name Facility ID# (if applicable)
1166 Lotla Church Rd
Street Address
Franklin NC 28734
City or Town State Zip Code
Macon County Government
Contact Name
Mailing Address
Franklin NC 28743
City or Town State Zip Code
Area code Phone number
6. WELL DETAILS:
a. TOTAL DEPTH: 450'
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO qI
c. WATER LEVEL Below Top of Casing: 60-FT.
. (Use "+" if Above Top of Casing)
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 15A NCAC 2C .0118.
e. YIELD (gpm): 40 METHOD OF TEST Blow Down
f. DISINFECTION: Type HTC; Amount 12 07
g. WATER ZONES (depth):
Top 250' Bottom 254, Top Bottom
Top Bottom Top Bottom
Top Bottom Top Bottom
Thickness/
7. CASING: Depth
Diameter Weight Material
Top +2 Bottom" 67,
Ft. 6 1/8 .188 steel
Top Bottom
Ft.
Top Bottom
Ft.
8. GROUT: Depth
Material Method
Topes_ Bottom_
d
Ft. Bentonite Pumped
Top 72 Bottom 450
Ft. Washed StonE poured
Top Bottom
Ft.
9. SCREEN: Depth
Diameter Slot Size Material
Top Bottom
Ft. in. in.
Top Bottom
Ft. in. in.
Top Bottom
Ft. in. in.
10. SAND/GRAVEL PACK:
Depth
Size Material
Top Bottom
Ft.
Top Bottom
Ft.
Top Bottom
Ft.
11. DRILLING LOG
Top Bottom
Formation Description
0 / 61
Overburden
61 167
Granite
_ 2 / 250
Granite
250 / 254
Broken Granite 40 GPM
254 / 450
Granite
/
12. REMARKS:
easing Renioved
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.
SIGNA RE OF CERTIFIED WELL CONTRACTOR DATE
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit within 30 days of completion to: Division of Water Quality Information Processing, Form /08
Y p tY - ge Rev. 1/08
1617 Mail Service Center, Raleigh, NC 27699-161, Phone : [phone]

d w57Ar£ o
NONRESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 3118-A
1. WELL CONTRACTOR:
Timothy R Hamby
Well Contractor (Individual) Name
Midsouth Geothermal
Well Contractor Company Name
8275 Tournament Dr Suite 185
Street Address
Memphis TN 38125
City or Town State Zip Code
9( 01 -) 748-9095
Area code Phone number
2. WELL INFORMATION:
WELL CONSTRUCTION PERMIT# W101 00 141
OTHER ASSOCIATED PERMIT#(if applicable)
SITE WELL ID #(if applicable) A-3
3. WELL USE (Check One Box) Monitoring ❑ Municipal/Public ❑
Industrial/Commercial ❑ Agricultural ❑ Recovery ❑ Injection ❑
Irrigation[] Other oi((list use) Closed 100D Geotherrla
DATE DRILLED 9-27-1 1
4. WELL LOCATION:
1166 Lotla Church Rd
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
CITY: Franklin COUNTY Macon
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
[]Slope []Valley JIFlat []Ridge ❑Other
KOI$TCD 36 iAAAA&AAAAAAAA! CL R OR 3X^XXXXN3MX CC
! NNF[$TCD75 iAnnA&AAAAAAAA! CLROR 7)t.'X5=XX)W CC
Latitude/longitude source: ❑GPS []Topographic map
(location of well must be shown on a USGS topo map andattached to
this form if not using GPS)
5. FACILITY (Name of the business where the well is located.)
Macon Elementary
Facility Name Facility ID# (if applicable)
1166 Lotla Church Rd
Street Address
Franklin NC 28734
City or Town State Zip Code
Macon County Government
Contact Name
Mailing Address
Franklin NC 28743
City or Town State Zip Code
Area code
Phone number
d. TOP OF CASING IS �_ FT. Above Land Surface -
'Top of casing terminated atior below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): 40 METHOD OF TEST Blow Down
f. DISINFECTION: Type HTC Amount 12 07
: g. WATER ZONES (depth):
Top 250' Bottom 254, Top
Bottom
:Top
Bottom
Top
Bottom
;Top
Bottom
Top
Bottom
Thickness/
7. CASING:
Depth
Diameter
Weight Material
Top +2
Bottom 72_
Ft. 6 118
.188 steel
Top
Bottom
Ft.
Top
Bottom
Ft.
:8. GROUT: Depth
Material Method
Top 0 Bottom 77'
Ft. Bentonite Pumped
Top 77 Bottom 450
Ft. washed stone poured
Top Bottom
Ft.
9. SCREEN: Depth
Diameter Slot Size Material
Top Bottom
Ft. in. in.
Top Bottom
Ft. in. in.
Top Bottom
Ft. in. in.
10. SAND/GRAVEL PACK:
Depth
Size Material
Top Bottom
Ft.
Top Bottom
Ft.
Top Bottom
Ft.
11. DRILLING LOG
Top Bottom
Formation Description
0 / 55
Overburden
55 / 72
Granite
: _2_/ 250
Granite
250 1254
Broken Granite 40 GPM
254 / 450
Granite
12. REMARKS:
S. WELL DETAILS: : 100 HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
• 15A NCAC 2C, WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
a. TOTAL DEPTH: 450' RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO G / 9-27-11
SIgNATURE OF CERTIFIED WELL CONTRACTOR DATE
c. WATER LEVEL Below Top of Casing: 60 FT. Timothy R Hamby
(Use "+" if Above Top of Casing) : PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit within 30 days of completion to: Division of Water Quality Information Processing, Form /08
if P tY - g Rev. 1/08
1617 Mail Service Center, Raleigh, NC 27699-161, Phone: [phone]

NONRESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 3118 A
1. WELL CONTRACTOR:
Timothy R Hamby
Well Contractor (Individual) Name
Midsouth Geothermal
Well Contractor Company Name
8275 Tournament Dr Suite 185
Street Address
Memphis TN 38125
City or Town State Zip Code
9( 01 ) 748-9095
Area code Phone number
2. WELL INFORMATION:
WELL CONSTRUCTION PERMIT# W10100141
d. TOP OF CASING IS 2 FT. Above Land Surface'
'Top of casing terminated attor below land surface may require
a variance in accordance with 15A NCAC 2C .011 S.
e. YIELD (gpm): 40 METHOD OF TEST Blow Down
f. DISINFECTION: Type HTC Amount 12 07
g. WATER ZONES (depth):
Top 250' Bottom 254, Top Bottom
:Top Bottom Top Bottom
Top Bottom Top Bottom
Thickness/
7. CASING: Depth Diameter Weight Material
Top +2 Bottom 72' Ft. 6 1/8 .188 steel
OTHER ASSOCIATED PERMIT#(if applicable) Top Bottom Ft.
SITE WELL ID #(if applicable) A-4 Top Bottom Ft.
3. WELL USE (Check One Box) Monitoring ❑ Municipal/Public ❑ . 8. GROUT: Depth Material Method
Industrial/Commercial ❑ Agricultural ❑ Recovery❑ Injection ❑ : Top_0 Bottom 77' Ft. Bentonite Pumped
Irrigation[] Other (((list use) Closed IOOD Geotherra Top 77 Bottom 450 Ft. washed stont poured
DATE DRILLED 9-23-1 1 ; Top Bottom Ft.
4. WELL LOCATION:
1166 Lotla Church Rd
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
CITY: Franklin COUNTY Macon
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
❑Slope []Valley JiFlat []Ridge ❑Other
PQOMTCD 36 iAAAA&AAAAAAAAI CL R OR 3XmXX900WX CC
KNMFtSTCD75 iAAAA8IAAAAAAAAI CLROR 7k!XhCkXxxmix CC
Latitude/longitude source: C]GPS Oropographic map
(location of well must be shown on a USGS topo map andattached to
this form if not using GPS)
5. FACILITY (Name of the business where the well is located.)
Macon Flementary
Facility Name Facility ID# (if applicable)
1166 Lotla Church Rd
Street Address
Franklin NC 28734
City or Town State Zip Code
Macon County Government
Contact Name
Mailing Address
Franklin NC 28743
City or Town State Zip Code
Area code
Phone number
S. WELL DETAILS:
a. TOTAL DEPTH: 450'
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO LJ
9. SCREEN: Depth Diameter Slot Size Material
Top Bottom Ft. in. in.
Top Bottom Ft. in. in.
Top Bottom Ft. in. in.
10. SAND/GRAVEL PACK:
Depth Size
Top Bottom Ft.
Top Bottom Ft.
Top Bottom Ft.
: 11. DRILLING LOG
Top Bottom
0 / 75
75 / 77
77 250
250 254
254 / 450
: 12. REMARKS:
Material
Formation Description
Overburden
Granite
Granite
Broken Granite 40 GPM
Granite
100 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.
°�^--- 9-23-11
SIGNATURE OF CERTIFIED WELL CONTRACTOR DATE
c. WATER LEVEL Below Top of Casing: 60 FT. Timothy R Hamby
(Use "+" if Above Top of Casing) : PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit within 30 days of completion to: Division of Water Quality Information Processing, Form /08
y p � " g Rev. 1/08
1617 Mail Service Center, Raleigh, NC 27699-161, Phone : [phone]

NONRESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 3118-A
1. WELL CONTRACTOR:
Timothy R Hamby
Well Contractor (Individual) Name
Midsouth Geothermal
Well Contractor Company Name
8275 Tournament Dr Suite 185
Street Address
Memphis TN 38125
City or Town State Zip Code
9( 01 ) 748-9095
Area code Phone number
2. WELL INFORMATION:
WELL CONSTRUCTION PERMIT# W l0100141
OTHER ASSOCIATED PERMIT#(if applicable)
SITE WELL ID #(if applicable) A-5
3. WELL USE (Check One Box) Monitoring ❑ Municipal/Public ❑
Industrial/Commercial ❑ Agricultural ❑ Recovery ❑ Injection ❑
Irrigation❑ Other N((list use) Closed IDDD Geotherra
DATE DRILLED 9-22-1 1
4. WELL LOCATION:
1166 Lotla Church Rd
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
CITY: Franklin COUNTY Macon
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
❑ Slope []Valley Flat []Ridge ❑ Other
K@3t$TCD 36 iAAAA&AAAAAAAAI CL R OR 3mXXXX00MX CC
KNWMTCD75 IAAAA&AAAAAAAAI CL ROR 7k!XkJQR!(7Ck)CfC CC
Latitude/longitude source: ❑GPS []Topographic map
(location of well must be shown on a USGS topo map andattached to
this form if not using GPS)
5. FACILITY (Name of the business where the well is located.)
Macon Elementary
Facility Name Facility ID# (if applicable)
1166 Lotla Church Rd
Street Address
Franklin NC 28734
City or Town State Zip Code
Macon County Government
Contact Name
Mailing Address
Franklin NC 28743
City or Town State Zip Code
U
Area code
Phone number
6. WELL DETAILS:
a. TOTAL DEPTH: 450'
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO qI
c. WATER LEVEL Below Top of Casing: 60 FT
(Use "+" if Above Top of Casing)
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 15A NCAC 2C .0118.
: e. YIELD (gpm): 40 METHOD OF TEST Blow Down
f. DISINFECTION: Type HTC Amount 12 07
g. WATER ZONES (depth):
Top 250, Bottom 254, Top Bottom
Top Bottom Top Bottom
Top Bottom Top Bottom
Thickness/
7. CASING: Depth Diameter Weight Material
Top +2 Bottom 72' Ft. 61 _ .188 steel
Top Bottom Ft.
Top Bottom Ft.
8. GROUT: Depth Material Method
Top_ Bottom 77' Ft. Bentonite Pumped
Top77Bottom_450 Ft. washed stone poured
Top Bottom Ft.
9. SCREEN: Depth Diameter Slot Size Material
Top Bottom Ft. in.
Top Bottom Ft. in.
Top Bottom Ft. in.
10. SAND/GRAVEL PACK:
Depth Size
Top Bottom Ft.
: Top Bottom Ft.
Top Bottom Ft.
11. DRILLING LOG
Top Bottom
0 / 75
75 177
77 / 250
250 / 254
254 / 450
/
in.
in.
in.
Material
Formation Description
Overburden
Granite
Granite
Broken Granite 40 GPM
Granite
12. REMARKS:
6asing Removed
100 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 PROV(VIDJED TO THE WELL OWNER.
9-22-11
SIGNATURE OF CERTIFIED WELL CONTRACTOR DATE
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Form GW-1b
Submit within 30 days of completion to: Division of Water Quality - Information Processing, Rev.1/08
1617 Mail Service Center, Raleigh, NC 27699-161, Phone : [phone]

NONRESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 3118-A
1. WELL CONTRACTOR:
Timothy R Hamby
Well Contractor (Individual) Name
Midsouth Geothermal
Well Contractor Company Name
8275 Tournament Dr Suite 185
Street Address
Memphis TN 38125
City or Town State Zip Code
9c 01 ) 748-9095
Area code Phone number
2. WELL INFORMATION:
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 15A NCAC 2C .0118.
e. YIELD (gpm): 40 METHOD OF TEST Blow Down
f. DISINFECTION: Type HTC Amount 12 n7
g. WATER ZONES (depth):
Top 250, Bottom 254, Top Bottom
Top Bottom Top Bottom
Top Bottom Top Bottom
Thickness/
7. CASING: Depth Diameter Weight Material
:Top +_Bottom 72� Ft. 61/8 .188 steel
WELL CONSTRUCTION PERMIT#W10100141
OTHER ASSOCIATED PERMIT#(if applicable)
Top
Bottom
Ft.
SITE WELL ID #(if applicable) A-6
Top
Bottom
Ft.
3. WELL USE (Check One Box) Monitoring [IMunicipal/Public ❑
Industrial/Commercial ❑ Agricultural ❑ Recovery El Injection [I
]Other N((list use) Closed 100D Geotherre
DATE DRILLED 9-20-1 1
4. WELL LOCATION:
1166 Lotla Church Rd
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
CITY: Franklin COUNTY Macon
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
❑ Slope ❑ Valley Flat ❑ Ridge ❑ Other
K@3MTCD 36 1AAAA&AAAAAAAAI CL R OR 3XC XXXXPA)W�X CC
KNIVIFKTCD75 1AAA A&AAAAA AAA! CLROR 7`k!X9CkXX9C0oft CC
Latitude/longitude source: QGPS Dropographic map
(location of well must be shown on a USGS topo map andattached to
this form if not using GPS)
S. FACILITY (Name of the business where the well is located.)
Macon Elementary
Facility Name Facility ID# (if applicable)
1166 Lotla Church Rd
Street Address
Franklin NC 28734
City or Town State Zip Code
Macon County Government
Contact Name
Mailing Address
Franklin NC 28743
City or Town State Zip Code
Area code
Phone number
8. GROUT:
Depth
Material Method
Top Q_Bottom
77L
Ft. Bentonite Pumped
Top 77
Bottom 450
Ft. Washed stong poured
Top
Bottom
Ft.
9. SCREEN:
Depth
Diameter Slot Size Material
Top
Bottom
Ft. in. in.
Top
Bottom
Ft. in. in.
Top
Bottom
Ft. in. in.
10. SAND/GRAVEL PACK:
Depth
Size Material
Top
Bottom
Ft.
Top
Bottom
Ft.
Top
Bottom
Ft.
: 11. DRILLING LOG
Top Bottom
0 / 75
75 / 77
77 / 250
250 / 254
254 / 450
12. REMARKS:
leasing Re, noved
Formation Description
Overburden
Granite
Granite
Broken Granite 40 GPM
Granite
6. WELL DETAILS: : I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
• 15A NCAC 2C, WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
a. TOTAL DEPTH: 450' RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO qI L 9-20-11
SIGN URE OF CERTIFIED WELL CONTRACTOR DATE
c. WATER LEVEL Below Top of Casing: 60 FT. . _Tlrriottl�R Harrtbyl...lamhy
(Use "+" if Above Top of Casing) : PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit within 30 days of completion to: Division of Water Quality Form /08
y p ty - Information Processing, Rev. 1/08
1617 Mail Service Center, Raleigh, NC 27699-161, Phone : [phone]

.. 57A7E;; •.
' J NON ONRESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
��<,;„• _,: WELL CONTRACTOR CERTIFICATION # 3118 A
1. WELL CONTRACTOR:
Timothy R Hamb
Well Contractor (Individual) Name
Midsouth Geothermal
Well Contractor Company Name
8275 Tournament Dr Suite 185
Street Address
Memphis TN 38125
City or Town State Zip Code
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 15A NCAC 2C .0118.
: e. YIELD (gpm): 40 METHOD OF TEST Blow Down
f. DISINFECTION: Type HTC Amount 12 n7
g. WATER ZONES (depth):
Top 250, Bottom 254, Top Bottom
Top Bottom Top Bottom
9c 01 ) 748-9095 ; Top Bottom Top Bottom
Area code Phone number Thickness/
2. WELL INFORMATION: : 7. CASING: Depth Diameter Weight Material
WELL CONSTRUCTION PERMIT#W10100141 :Top ++2 Bottom 77� Ft. 61/8
OTHER ASSOCIATED PERMIT#(if applicable)
SITE WELL ID #(if applicable) A-7
3. WELL USE (Check One Box) Monitoring ❑ Municipal/Public ❑
Industrial/Commercial ❑ Agricultural ❑ Recovery ❑ Injection ❑
Irrigation❑ Other I1((list use) Closed loop Geotherrla
DATE DRILLED 9-20-1 1
4. WELL LOCATION:
1166 Lotla Church Rd
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
CITY: Franklin COUNTY Macon
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
❑ Slope ❑ Valley 6fFlat ❑ Ridge ❑ Other
KOMTCD 36 IAAAA&AAAAAAAA! CL R OR 3XN(XXXAAX X CC
KNWt$TCD75 1AAAA&AAAAAAAA! CL ROR 7A."XX7C)W CC
Latitude/longitude source: EIGPS Qropographic map
(location of well must be shown on a USGS topo map andattached to
this form if not using GPS)
5. FACILITY (Name of the business where the well is located.)
Macon Elementary
Facility Name Facility ID# (if applicable)
1166 Lotla Church Rd
Street Address
Franklin NC 28734
City or Town State Zip Code
Macon County Government
Contact Name
Mailing Address
Franklin NC 28743
City or Town State Zip Code
Area code Phone number
6. WELL DETAILS:
a. TOTAL DEPTH: 450'
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO qI
: Top Bottom Ft.
Top Bottom Ft.
8. GROUT: Depth Material Method
Top 0 Bottom 82' Ft. Bentonite Pumped
Top_$_,?_ Bottom 450 Ft. washed stone poured
Top Bottom Ft.
9. SCREEN: Depth Diameter Slot Size Material
Top Bottom Ft. in.
Top Bottom Ft. in.
Top Bottom Ft. in.
10. SANDIGRAVEL PACK:
Depth Size
Top Bottom Ft.
Top Bottom Ft.
Top Bottom Ft.
11. DRILLING LOG
Top Bottom
0 / 77
77 / 250
250 / 254
254 / 450
/
12. REMARKS:
easing Removed
in.
in.
in.
Material
Formation Description
Overburden
Granite
Broken Granite 40 GPM
Granite
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
15A NCAC 2C, WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
P 9-20-1
SIGNATORE OF CERTIFIED WELL CONTRACTOR DATE
c. WATER LEVEL Below Top of Casing: 60 FT. Timothy R Hamby
(Use "+" if Above Top of Casing) : PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit within 30 days of completion to: Division of Water Quality Information Processing, Form /08
y p y - 9� Rev. 1/08
1617 Mail Service Center, Raleigh, NC 27699-161, Phone : [phone]

NONRESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 3118-A
1. WELL CONTRACTOR:
Timothy R Hamby
Well Contractor (Individual) Name
Midsouth Geothermal
Well Contractor Company Name
8275 Tournament Dr Suite 185
Street Address
Memphis TN 38125
City or Town State Zip Code
d. TOP OF CASING IS 2 FT. Above Land Surface -
'Top of casing terminated attor below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): 40 METHOD OF TEST Blow Down
f. DISINFECTION: Type HTC Amount 12 07
g. WATER ZONES (depth):
Top 250, Bottom 254, Top Bottom
Top Bottom Top Bottom
9( 01 ) 748-9095 ; Top Bottom Top Bottom
Area code Phone number Thickness/
2. WELL INFORMATION: : 7. CASING: Depth Diameter Weight Material
WELL CONSTRUCTION PERMIT# W I01 OO 141 ; Top +_ Bottom 80' Ft. 6 1 /8 .188 Steel
OTHER ASSOCIATED PERMIT#(if applicable)
SITE WELL ID #(if applicable) A-8
3. WELL USE (Check One Box) Monitoring ❑ Municipal/Public ❑
Industrial/Commercial ❑ Agricultural ❑ Recovery ❑ Injection ❑
Irrigation❑ Other 4'(list use) Closed loop Geotherna
DATE DRILLED 9-15-1 1
4. WELL LOCATION:
1166 Lotla Church Rd
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
CITY: Franklin COUNTY Macon
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
❑ Slope ❑ Valley Flat ❑ Ridge ❑ Other
No STCD 36 iAAAA&AAAA^AAA! CL R OR 3X^Xli X00"X CC
IWMFI'fiTCD75 iAAAA&AAAAAAAA! CLROR 7A.'X'X` XXXMft CC
Latitude/longitude source: ❑GPS Qropographic map
(location of well must be shown on a USGS topo map andattached to
this form if not using GPS)
S. FACILITY (Name of the business where the well is located.)
Macon Flementary
Facility Name Facility ID# (if applicable)
1166 Lotla Church Rd
Street Address
Franklin NC 28734
City or Town State Zip Code
Macon County Government
Contact Name
Mailing Address
Franklin NC 28743
City or Town State Zip Code
Area code
Phone number
6. WELL DETAILS:
a. TOTAL DEPTH: 450'
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO q/
Top Bottom Ft.
Top Bottom Ft.
8. GROUT: Depth Material Method
Top_ Bottom 85, Ft. Bentonite Pumped
Tope Bottom 450 Ft. washed stont poured
Top Bottom Ft.
9. SCREEN: Depth Diameter Slot Size Material
Top Bottom Ft. in.
Top Bottom Ft. in.
Top Bottom Ft. in.
10. SAND/GRAVEL PACK:
Depth Size
Top Bottom Ft.
Top Bottom Ft.
Top Bottom Ft.
11. DRILLING LOG
Top Bottom
0 / 80
80 / 250
250 / 254
2�5 _/ 450
12. REMARKS:
in.
in.
in.
Material
Formation Description
Overburden
Granite
Broken Granite 40 GPM
Granite
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.
SIGNATVAE OF CERTIFIED WELL CONTRACTOR DATE
c. WATER LEVEL Below Top of Casing: 60 -FT. Timothy R HamhV
(Use "+" if Above Top of Casing) : PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Form GW-1b
Submit within 30 days of completion to: Division of Water Quality - Information Processing, Rev. 1/08
1617 Mail Service Center, Raleigh, NC 27699-161, Phone : [phone]

NONRESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 3118-A
1. WELL CONTRACTOR:
Timothy R Hamby
Well Contractor (Individual) Name
Midsouth Geothermal
Well Contractor Company Name
8275 Tournament Or Suite 185
Street Address
Memphis TN 38125
City or Town State Zip Code
9( 01 ) 748-9095
Area code Phone number
d. TOP OF CASING IS 2 FT. Above Land Surface'
'Top of casing terminated attor below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): 40 METHOD OF TEST Blow Down
f. DISINFECTION: Type HTC Amount 12 o7
g. WATER ZONES (depth):
Top 950 Bottom 254 Top Bottom
:Top Bottom Top Bottom
Top Bottom Top Bottom
2. WELL INFORMATION: ; 7. CASING: Depth Diameter
WELL CONSTRUCTION PERMIT# W101 00 141 : Top Bottom 74 Ft.
OTHER ASSOCIATED PERMIT#(if applicable)
SITE WELL ID #(if applicable) B-1
3. WELL USE (Check One Box) Monitoring ❑ Municipal/Public ❑
Industrial/Commercial ❑ Agricultural ❑ Recovery ❑ Injection ❑
Irrigation❑ Other !v((listuse) Closed IooD Geotherra
DATE DRILLED-1 0-12-11
4. WELL LOCATION:
1166 Lotla Church Rd
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
CITY: Franklin COUNTY Macon
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
❑ Slope ❑ Valley VFW ❑ Ridge ❑ Other
K(c3F$TCD 36 iAAAA&AAAAAAAAI CL ROR 3X^XXX+X9"X CC
MMFKTCD75 jAAAAIAAAAAAAAA! CLROR 7)I!.WAAXX'XW CC
LatitudeAongitude source: E33PS ❑Topographic map
(location of well must be shown on a USGS topo map andattached to
this form if not using GPS)
5. FACILITY (Name of the business where the well is located.)
Macon Flementary
Facility Name Facility ID# (if applicable)
1166 Lotla Church Rd
Street Address
Franklin NC 28734
City or Town State Zip Code
Macon County Government
Contact Name
Mailing Address
Franklin NC 28743
City or Town State Zip Code
Area code
Phone number
Top Bottom Ft.
Top Bottom Ft.
Thickness/
Weight Material
8. GROUT: Depth Material
Topes_ Bottom_ Ft. bentonite
Top 79 Bottom 450 Ft. washed stone
Top Bottom Ft.
: 9. SCREEN: Depth Diameter Slot Size
Top Bottom Ft. in
Top Bottom Ft. in
Top Bottom Ft. in
10. SAND/GRAVEL PACK:
Depth Size
Top Bottom Ft.
Top Bottom Ft.
: Top Bottom Ft.
11. DRILLING LOG
Top Bottom
0 / 70
70 / 75
75 / 250
250 / 254
254 / 450
12. REMARKS:
in.
in.
in.
Method
bumped
poured
Material
Material
Formation Description
Dirt
Granite
Granite
Broken Granite
Granite
S. WELL DETAILS: : I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
• 15A NCAC 2C, WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
a. TOTAL DEPTH: 450' RECORD HAS BEENAROVIDEDD TO THE WELL OWNER.
1
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO qI SIG TURE OF CERTIFIED WELL CONTRACTOR
R DATE
c. WATER LEVEL Below Top of Casing: 60 FT.
(Use "+° if Above Top of Casing)
Timothy R Hamby
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit within 30 days of completion to: Division of Water Quality Form /08
y p ry - Information Processing, Rev. 1/08
1617 Mail Service Center, Raleigh, NC 27699-161, Phone : [phone]

A- n4-en-1-
NoNRESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 3118-A
1. WELL CONTRACTOR:
Timothy R Hamby
Well Contractor (Individual) Name
Midsouth Geothermal
Well Contractor Company Name
8275 Tournament Dr Suite 185
Street Address
_ Memr)his TN 38125
City or Town State Zip Code
9� 01 ) 748-9095
Area code Phone number
2. WELL INFORMATION:
WELL CONSTRUCTION PERMIT# W10100141
: d. TOP OF CASING IS 2 FT. Above Land Surface -
'Top of casing terminated attor below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): 40 METHOD OF TEST RIOw Down
f. DISINFECTION: Type HTC -Amount 12 07
g. WATER ZONES (depth):
Top 250 Bottom 254 Top Bottom
Top Bottom Top Bottom
Top Bottom Top Bottom
Thickness/
7. CASING: Depth Diameter Weight Material
Top +_2_ Bottoms Ft.
OTHER ASSOCIATED PERMIT#(if applicable) Top Bottom Ft.
SITE WELL ID #(if applicable) B-2 :Top Bottom Ft.
3. WELL USE (Check One Box) Monitoring ❑ Municipal/Public ❑ ; B. GROUT: Depth Material Method
Industrial/Commercial ❑ Agricultural ❑ Recovery ❑ Injection ❑ : Top_ Bottoms Ft. bentonite Dumped
Irrigation❑ Other &((list use) Closed loco Geotherne Top 75 Bottom 450 Ft. washed stone poured
DATE DRILLED 10-1 1-1 1 :Top Bottom Ft.
4. WELL LOCATION:
1166 Lotla Church Rd
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
CITY: Franklin COUNTY Macon
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
❑ Slope ❑ Valley elat ❑ Ridge ❑ Other
KOISTCD 36 1AAAA&AAAAAAAA! CLROR31oxxXxxxxxx CC
KNWMTCD75 1AAAA&AAAAAAAA! CLROR 7A.fX Jl`7(XXfXW CC
LatitudetIongitude source: E]GPS Qropographic map
(location of well must be shown on a USGS topo map andattached to
this form if not using GPS)
5. FACILITY (Name of the business where the well is located.)
Macon FlIAmpritary
Facility Name Facility ID# (if applicable)
1166 I ntla (phi irch Rd
Street Address
Franklin NO 28734
City or Town State Zip Code
Mar on rni into Government
Contact Name
Mailing Address
Franklin NC 28743
City or Town State Zip Code
()
Area code
Phone number
6. WELL DETAILS:
a. TOTAL DEPTH: 450'
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO qI
c. WATER LEVEL Below Top of Casing: 80 FT
(Use "+" if Above Top of Casing)
S. SCREEN: Depth Diameter Slot Size Material
Top Bottom Ft. in. in.
Top Bottom Ft. in.
Top Bottom Ft. in.
: 10. SAND/GRAVEL PACK:
Depth Size
Top Bottom Ft.
Top Bottom Ft.
Top Bottom Ft.
: 11. DRILLING LOG
Top
Bottom
0
/ 70
70
/ 75
5 250
250
/ 254
254
/ 450
: 12. REMARKS:
in.
in.
Material
Formation Description
Dirt
Granite
Granite
Broken Granite
Granite
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
• 15A NCAC 2C, WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
• C;I1 _ n dll­ A^ AA A A
SIGNA44RE OF CERTIFIED WELL CONTRACTOR DATE
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Form GW-1b
Submit within 30 days of completion to: Division of Water Quality - Information Processing, Rev. 1/08
1617 Mail Service Center, Raleigh, NC 27699-161, Phone : [phone]

'
NONRESIDENTIAL ONRESIDENTIAL
WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 3118-A
1. WELL CONTRACTOR:
Timothy R Hamb
Well Contractor (Individual) Name
Midsouth Geothermal
Well Contractor Company Name
8275 Tournament Dr Suite 185
Street Address
Memphis TN 38125
City or Town State Zlp Code
d. TOP OF CASING IS 2 FT. Above Land Surface -
`Top of casing terminated attor below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): 40 METHOD OF TEST Blow Down
f. DISINFECTION: Type HTC Amount 12 07
g. WATER ZONES (depth):
Top 250 Bottom 254 Top Bottom
Top Bottom Top Bottom
9c 01 ) 748-9095 ; Top Bottom Top Bottom
Area code Phone number
Thickness!
2. WELL INFORMATION: ; 7. CASING: Depth Diameter Weight Material
WELL CONSTRUCTION PERMIT# W 10 100 141 : Top +2 Bottom 73 Ft.
OTHER ASSOCIATED PERMIT#(if applicable) Top Bottom Ft.
SITE WELL ID #(if applicable) B-3 ; Top Bottom Ft.
3. WELL USE (Check One Box) Monitoring ❑ Municipal/Public ❑
Industrial/Commercial ❑ Agricultural ❑ Recovery ❑ Injection ❑
Irrigation❑ Other [,((list use) Closed IooD Geotherre
DATE DRILLED-1 0-10-11
4. WELL LOCATION:
1166 Lotla Church Rd
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
CITY: Franklin COUNTY Macon
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
❑ Slope ❑ Valley Flat []Ridge ❑ Other
K0I$TCD 36 iAAAA&AAAAAAAAI CL ROR 3X,=XX00WX CC
KNW BTCD 75 iAAAA&AAAAAAAAI CL R OR 71x.'X` "xxoom CC
Latitudellongitude source: DGPS (]topographic map
(location of well must be shown on a USGS topo map andattached to
this form if not using GPS)
5. FACILITY (Name of the business where the well is located.)
Macon Elementary
Facility Name Facility ID# (if applicable)
1166 Lotla Church Rd
Street Address
Franklin NC 28734
City or Town State Zip Code
Macon County Government
Contact Name
Mailing Address
Franklin NC 28743
City or Town State Zip Code
Area code Phone number
8. GROUT: Depth Material Method
Top 0 Bottoms Ft. bentonite pumped
Top Bottom 450 Ft. washed stone poured
Top Bottom Ft.
9. SCREEN: Depth Diameter Slot Size Material
Top Bottom Ft. in.
Top Bottom Ft. in.
Top Bottom Ft. in.
10. SAND/GRAVEL PACK:
Depth Size
Top Bottom Ft.
Top Bottom Ft.
Top Bottom Ft.
: 11. DRILLING LOG
Top Bottom
0 / 70
70 /75-
75
—/ 250
250 / 254
254 / 450
: 12. REMARKS:
ease, ig Removed
in.
in.
in.
Material
Formation Description
Dirt
Granite
Granite
Broken Granite
Granite
S. WELL DETAILS: ; I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
• 15A NCAC 2C, WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
a. TOTAL DEPTH:_ 450' RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO 10-10-1
qI : SIGN URE OF CERTIFIED WELL CONTRACTOR DATE
c. WATER LEVEL Below Top of Casing: 60 FT. Timothy R Hamhy
(Use "+^ if Above Top of Casing) : PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Form GW-1b
Submit within 30 days of completion to: Division of Water Quality - Information Processing, Rev.1/08
1617 Mail Service Center, Raleigh, NC 27699-161, Phone : [phone]

A
A4
NONRESIDENTIAL ONRESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 3118 A
1. WELL CONTRACTOR:
Timothy R Hamby
Well Contractor (Individual) Name
Midsouth Geothermal
Well Contractor Company Name
8275 Tournament Dr Suite 185
Street Address
Memphis TN 38125
City or Town State Zip Code
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 15A NCAC 2C .0118.
: e. YIELD (gpm): 40 METHOD OF TEST Blow Down
f. DISINFECTION: Type HTC; Amount 12 o2
g. WATER ZONES (depth):
Top 250 Bottom 254 Top Bottom
Top Bottom Top Bottom
9( 01 ) 748-9095 : Top Bottom Top Bottom
Area code Phone number Thickness/
2. WELL INFORMATION: : 7. CASING: Depth Diameter Weight Material
WELL CONSTRUCTION PERMIT# W101 00 141 : Top +2 Bottom 73 Ft.
OTHER ASSOCIATED PERMIT#(if applicable) : Top Bottom Ft.
SITE WELL ID #(if applicable) B-4 Top Bottom Ft.
3. WELL USE (Check One Box) Monitoring ❑ Municipal/Public ❑
Industrial/Commercial ❑ Agricultural ❑ Recovery ❑ Injection ❑
Irrigation[] Other i((list use) Closed loop Geotherra
DATE DRILLED-1 0-6-11
4. WELL LOCATION:
1166 Lotla Church Rd
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
CITY: Franklin COUNTY Macon
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
❑Slope ❑Valley p(Flat []Ridge ❑Other
PCOMTCD 36 iAAAA&AAAAAAAA1 CL R OR 3mXXXXNXMX CC
IQVMFATCD75 iAAAA&AAAAAAAA! CLROR 7x.'X9CX'7tXX'AM CC
Latitude/longitude source: E]GPS Oropographic map
(location of well must be shown on a USGS topo map andattached to
this form if not using GPS)
5. FACILITY (Name of the business where the well is located.)
Macon Elementary
Facility Name Facility ID# (if applicable)
1166 Lotla Church Rd
Street Address
Franklin NC 28734
City or Town State Zip Code
Macon County Government
Contact Name
Mailing Address
Franklin NC 28743
City or Town State Zip Code
U
Area code
Phone number
6. WELL DETAILS:
a. TOTAL DEPTH: 450'
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO [3J(
8. GROUT: Depth Material Method
Top 0 Bottom 78 Ft. bentonite pumped
Top 78 Bottom 45Q_ Ft. washed stone poured
Top Bottom Ft.
9. SCREEN: Depth Diameter Slot Size Material
Top Bottom Ft. in. in.
Top Bottom Ft. in.
Top Bottom Ft, in.
10. SAND/GRAVEL PACK:
Depth Size
Top Bottom Ft.
Top Bottom Ft.
Top Bottom Ft.
11. DRILLING LOG
Top Bottom
0 / 70
70 / 75
75 250
250 / 254
254 / 450
12. REMARKS:
in.
in.
Material
Formation Description
Dirt
Granite
Granite
Broken Granite
Granite
100 HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
• 15A NCAC 2C, WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
SIGN RE OF CERTIFIED WELL CONTRACTOR DATE
c. WATER LEVEL Below Top of Casing: 60 FT. Timothy R Hamhy
(Use "+^ if Above Top of Casing) : PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit within 30 days of completion to: Division of Water Quality - Information Processing, Form Rev. 1/08/08
1617 Mail Service Center, Raleigh, NC 27699-161, Phone : [phone]

NONRESIDENTIAL ONRESIDENTIAL WELL CONSTRUCTION RECORD
' North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 3118 A
1. WELL CONTRACTOR:
Timothy R Hamby
Well Contractor (Individual) Name
Midsouth Geothermal
Well Contractor Company Name
8275 Tournament Dr Suite 185
Street Address
Memphis TN 38125
City or Town State Zip Code
9( 01 ) 748-9095
Area code Phone number
2. WELL INFORMATION:
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 15A NCAC 2C .0118.
e. YIELD (gpm): 40 METHOD OF TEST Blow Down
f. DISINFECTION: Type HTC Amount 12 07
g. WATER ZONES (depth):
:Top 250 Bottom 254 Top Bottom
Top Bottom Top Bottom
;Top Bottom Top Bottom
Thickness/
7. CASING: Depth Diameter Weight Material
WELL CONSTRUCTION PERMIT#WI0100141 : Top +2 Bottom 73 Ft.
OTHER ASSOCIATED PERMIT#(if applicable) : Top Bottom Ft.
SITE WELL ID #(if applicable) B-5 : Top Bottom Ft.
3. WELL USE (Check One Box) Monitoring ❑ Municipal/Public ❑
Industrial/Commercial ❑ Agricultural ❑ Recovery ❑ Injection ❑
Irrigation[] Other N((list use) Closed loop Geotherre
DATE DRILLED 10-6-1 1
4. WELL LOCATION:
1166 Lotla Church Rd
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
CITY: Franklin COUNTY Macon
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
❑Slope []Valley Flat ❑Ridge ❑Other
K45KTCD 36 iAAAA&AAAAAAAAI CL R OR &X XXR?t(9t)t9P X CC
KNMFISTCD75 iAAAABMAAAAAAAI CLROR 7`X.'X"R`A1ky9W* CC
Latitude/longitude source: ❑GPS aopographic map
(location of well must be shown on a USGS topo map andattached to
this form if not using GPS)
5. FACILITY (Name of the business where the well is located.)
Macon Elementary
Facility Name Facility ID# (if applicable)
1166 Lotla Church Rd
Street Address
Franklin N . 28734
City or Town State Zip Code
Macon County Government
Contact Name
Mailing Address
Franklin NC 28743
City or Town State Zip Code
Area code
Phone number
6. WELL DETAILS:
a. TOTAL DEPTH: 450'
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO qI
8. GROUT: Depth Material Method
Top Bottom_ Ft._ bentonite pumped
Top Bottom 450 Ft. washed stone poured
Top Bottom Ft.
9. SCREEN: Depth Diameter Slot Size Material
Top Bottom Ft. in. in.
Top Bottom Ft. in. in.
Top Bottom Ft. in. in.
10. SAND/GRAVEL PACK:
Depth Size
: Top Bottom Ft.
Top Bottom Ft.
Top Bottom Ft.
11. DRILLING LOG
Top Bottom
0 / 70
70 / 75
75 / 250
250 / 254
254 / 450
12. REMARKS:
6asing Removed
Material
Formation Description
Dirt
Granite
Granite
Broken Granite
Granite
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
15A NCAC 2C, WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
RECORD HAS BEEN PROVIDED -TO THE WELL OWNER
10-6-11
SIGNATURE OF CERTIFIED WELL CONTRACTOR DATE
c. WATER LEVEL Below Top of Casing: 60 FT. Timothy R Hamby
(Use "+" if Above Top of Casing) : PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit within 30 days of completion to: Division of Water Quality Form /08
y p ry - Information Processing, Rev. 1/08
1617 Mail Service Center, Raleigh, NC 27699-161, Phone: [phone]

NONRESIDENTIAL ONRESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 3118 A
1. WELL CONTRACTOR:
Timothv R Hamb
Well Contractor (Individual) Name
Midsouth Geothermal
Well Contractor Company Name
8275 Tournament Dr Suite 185
Street Address
Memphis TN 38125
City or Town State Zip Code
(901 ) 748-9095
Area code Phone number
2. WELL INFORMATION:
WELL CONSTRUCTION PERMIT# W101 00 141
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 15A NCAC 2C .0118.
e. YIELD (gpm): 40 METHOD OF TEST Blow DOWn
f. DISINFECTION: Type HTC Amount 12 r)7
g. WATER ZONES (depth):
Top 250' Bottom 254' Top Bottom
Top Bottom Top Bottom
Top Bottom Top Bottom
Thickness/
7. CASING: Depth Diameter Weight Material
Top +2— Bottom 65' Ft. 6 1 /8 1. 88
OTHER ASSOCIATED PERMIT#(if applicable) Top Bottom Ft.
SITE WELL ID #(if applicable) B-6 Top Bottom Ft.
3. WELL USE (Check One Box) Monitoring ❑ Municipal/Public ❑
Industrial/Commercial ❑ Agricultural ❑ Recovery ❑ Injection ❑
Irrigation❑ Other ((list use) Closed 100D Geotherra
DATE DRILLED 10-5-1 1
4. WELL LOCATION:
1166 Lotla Church Rd
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
CITY: Franklin COUNTY Macon
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
[]Slope ❑Valley Flat ❑Ridge ❑Other
KOISTCD 36 iAAAA&AAAAAAAAI CL R OR 3X^XXXXOOMX CC
KNMFISTCD75 iAAAAXAAAAAAAAI CL ROR 7)t.'X xXX'X * CC
Latitude/longitude source: DGPS aopographic map
(location of well must be shown on a USGS topo map andattached to
this form if not using GPS)
5. FACILITY (Name of the business where the well is located.)
Macon Elementary
Facility Name Facility ID# (if applicable)
1166 Lotla Church Rd
Street Address
Franklin N C 28734
City or Town State Zip Code
Macon County Government
Contact Name
Mailing Address
Franklin N , 28743
City or Town State Zip Code
Area code
Phone number
6. WELL DETAILS:
a. TOTAL DEPTH: 450'
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO pI
8. GROUT: Depth Material Method
Top 0 Bottom Ft. Bentonite Pumped
Top 70 Bottom 450 Ft. washed stone poured
Top Bottom Ft.
9. SCREEN: Depth Diameter Slot Size Material
Top Bottom Ft. in. in.
Top Bottom Ft. in. in.
Top Bottom Ft. in. in.
10. SAND/GRAVEL PACK:
Depth Size
Top Bottom Ft.
Top Bottom Ft.
Top Bottom Ft.
11. DRILLING LOG
Top Bottom
0 / 65
65 / 250
250 / 254
254 / 450
12. REMARKS:
Material
Formation Description
Overburden
Granite
_Broken Granite 40GPM
Granite
100 HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
• 15A NCAC 2C, WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
10-5-11
SIGNATMRE OF CERTIFIED WELL CONTRACTOR DATE
c. WATER LEVEL Below Top of Casing: 60 FT. Timothy R Hamby
(Use "+^ if Above Top of Casing) : PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit within 30 days of completion to: Division of Water Quality Form /08
y p ty - Information Processing, Rev. 1108
1617 Mail Service Center, Raleigh, NC 27699-161, Phone : [phone]

�'�,i�SrATt'o•r..
NONRESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
- ;"°"';, •7 WELL CONTRACTOR CERTIFICATION # 3118-A
1. WELL CONTRACTOR:
Timothy R Hamby
Well Contractor (Individual) Name
Midsouth Geothermal
Well Contractor Company Name
8275 Tournament Dr Suite 185
Street Address
Memphis TN 38125
City or Town State Zip Code
9( 01 ) 748-9095
Area code Phone number
2. WELL INFORMATION:
WELL CONSTRUCTION PERMIT#W10100141
d. TOP OF CASING IS 2 FT. Above Land Surface -
'Top of casing terminated attor below land surface may require
a variance in accordance with 15A NCAC 2C .011 S.
: e. YIELD (gpm): 40 METHOD OF TEST BIOW Down
f. DISINFECTION: Type HTC Amount 12 07
g. WATER ZONES (depth):
Top 250, Bottom 254, Top Bottom
Top Bottom Top Bottom
Top Bottom Top Bottom
Thickness/
7. CASING: Depth Diameter Weight Material
: Top +2 Bottom 65, Ft. 6 1 /8 .188
OTHER ASSOCIATED PERMIT#(if applicable) Top Bottom Ft.
SITE WELL ID #(ifapplicable) 13-7A : Top Bottom Ft.
3. WELL USE (Check One Box) Monitoring ❑ Municipal/Public ❑
Industrial/Commercial ❑ Agricultural ❑ Recovery ❑ Injection ❑
Irrigation[] Other IS{(list use) Closed 100D Geotherra
DATE DRILLED 10-3-1 1
4. WELL LOCATION:
1166 Lotla Church Rd
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
CITY: Franklin COUNTY Macon
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
[]Slope ❑ Valley Flat ❑ Ridge ❑ Other
KOISTCD 36 iAAAA&AAAAAAAAI CL R OR 3X^XXXXNXXkX CC
KNWBTCD75 iAAAA&AAAAAAAAI CL ROR 1AA. QXX!(9()W CC
Latitude/longitude source: OGPS Qropographic map
(location of well must be shown on a USGS topo map andattached to
this form if not using GPS)
5. FACILITY (Name of the business where the well is located.)
8. GROUT: Depth Material Method
Top 0 Bottom 70 Ft. Bentonite Pumped
Top 70 Bottom 254 Ft. washed stone poured
Top Bottom Ft.
9. SCREEN: Depth Diameter Slot Size Material
Top Bottom Ft. in. in.
Top Bottom Ft. in. in.
Top Bottom Ft. in. in.
10. SAND/GRAVEL PACK:
Depth Size
Top Bottom Ft.
Top Bottom Ft.
Top Bottom Ft.
11. DRILLING LOG
Top Bottom
Macon Elementary 0 / 65
Facility Name Facility ID# (if applicable) 65 / 250
1166 Lotla Church Rd 250 / 254
Street Address 254
Franklin NC 28734 /
City or Town State Zip Code /
Macon County Government
Contact Name
Mailing Address
Franklin NC 28743
City or Town State Zip Code
L---)
Area code
Phone number
S. WELL DETAILS:
a. TOTAL DEPTH: 254'
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO Cil�
12. REMARKS:
Material
Formation Description
Overburden
Granite
Broken Granite 40 GPM
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
• 15A NCAC 2C, WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
J 10-3-1
SIGN RE OF CERTIFIED WELL CONTRACTOR DATE
c. WATER LEVEL Below Top of Casing: 60 FT. Timothy R Hamby
(Use "+" if Above Top of Casing) : PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit within 30 days of completion to: Division of Water Quality Information Processing, Form /08
Y P tY - gr Rev. 1/OS
1617 Mail Service Center, Raleigh, NC 27699-161, Phone : [phone]

ft � NONRESIDENTIAL ONRESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
�`� • '"""'" • WELL CONTRACTOR CERTIFICATION # 3118-A
1. WELL CONTRACTOR:
Timothy R Hamby
Well Contractor (Individual) Name
Midsouth Geothermal
Well Contractor Company Name
8275 Tournament Dr Suite 185
Street Address
Memphis TN 38125
City or Town State Zip Code
9( 01 ) 748-9095
Area code Phone number
2. WELL INFORMATION:
WELL CONSTRUCTION PERMIT# W10100141
d. TOP OF CASING IS 2 FT. Above Land Surface -
'Top of casing terminated attor below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): 40 METHOD OF TEST BIOW Down
f. DISINFECTION: Type_ HTC Amount 12 07
g. WATER ZONES (depth):
Top 250, Bottom 254, Top Bottom
Top Bottom Top Bottom
Top Bottom Top Bottom
Thickness/
7. CASING: Depth Diameter Weight Material
Top +_ Bottom 65' Ft. 6 1 /8 188 steel
OTHER ASSOCIATED PERMIT#(if applicable) Top Bottom Ft.
SITE WELL ID #(if applicable) B-7B ; Top Bottom Ft.
3. WELL USE (Check One Box) Monitoring Cl Municipal/Public ❑
Industrial/Commercial ❑ Agricultural ❑ Recovery ❑ Injection ❑
Irrigation❑ Other N((list use) Closed loop Geotherre
DATE DRILLED 10-3-1 1
4. WELL LOCATION:
1166 Lotla Church Rd
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
CITY: Franklin COUNTY Macon
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
❑ Slope ❑ Valley Flat []Ridge ❑ Other
Ktgl$TCD 36 iAAAAXAAAAAAAAI CL R OR 3XK XXXA(NXWXX CC
KNMFI$TCD75 iAAAA&AAAAAAAAi CLROR -7)k. QkX7(9[om CC
Latitude/longitude source: ❑GPS Qropographic map
(location of well must be shown on a USGS topo map andattached to
this form if not using GPS)
5. FACILITY (Name of the business where the well is located.)
Macon Elementary
Facility Name Facility ID# (if applicable)
1166 Lotla Church Rd
Street Address
Franklin KIC 28734
City or Town State Zip Code
Macon County Government
Contact Name
:a. GROUT: Depth Material Method
Top0 Bottom_ Ft. Bentonite Pumped
Top 7O Bottom 1�96 _ Ft. washed stone poured
Top Bottom Ft.
9. SCREEN: Depth Diameter Slot Size Material
Top Bottom Ft. in. in.
Top Bottom Ft, in. in.
Top Bottom Ft. in. in.
10. SAND/GRAVEL PACK:
Depth Size
Top Bottom Ft.
Top Bottom Ft.
Tap Bottom Ft.
11. DRILLING LOG
Top Bottom
0 / 65
65 / 196
/
/
Mailing Address /
Franklin NC 28743
City or Town State Zip Code : 12. REMARKS:
U
Area code Phone number
Material
Formation Description
Overburden
Granite
6. WELL DETAILS: I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
• 15A NCAC 2C, WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
a. TOTAL DEPTH: 196� : RECORD
/HASSBBEEN
%PRRO✓VIDDEEDDTOTHE WELL OWNER
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO qI , `""—�_'3�—
SIGNATURE OF CERTIFIED WELL CONTRACTOR DATE
c. WATER LEVEL Below Top of Casing: 60 FT. : Timothy R Hamby
(Use "+" if Above Top of Casing) : PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit within 30 days of completion to: Division of Water Quality Form /08
Y P ty - Information Processing, Rev. 1I08
1617 Mail Service Center, Raleigh, NC 27699-161, Phone : [phone]

NONRESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 3118-A
1. WELL CONTRACTOR:
Timothv R Hamb
Well Contractor (Individual) Name
Midsouth Geothermal
Well Contractor Company Name
8275 Tournament Dr Suite 185
Street Address
Memphis TN 38125
City or Town State Zip Code
9( 01 ) 748-9095
Area code Phone number
d. TOP OF CASING IS 2 FT. Above Land Surface -
*Top of casing terminated attor below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): 40 METHOD OF TEST BIOW Down
f. DISINFECTION: Type HTC Amount 12 07
g. WATER ZONES (depth):
Top 250, Bottom 254, Top Bottom
:Top Bottom Top Bottom
Top Bottom Top Bottom
Thickness/
2. WELL INFORMATION: : 7. CASING: Depth Diameter Weight Material
WELL CONSTRUCTION PERMIT# W10100141 : Top ++22 _ Bottom 80, Ft. 61/8 .188 steel
OTHER ASSOCIATED PERMIT#(ifapplicable) : Top Bottom Ft.
SITE WELL ID #(if applicable) B-8 ; Top Bottom Ft.
3. WELL USE (Check One Box) Monitoring ❑ Municipal/Public ❑ ; 8. GROUT: Depth Material Method
Industrial/Commercial ❑ Agricultural ❑ Recovery ❑ Injection ❑
Irrigation❑ Other N((list use) Closed IOOD Geotherra
DATE DRILLED 9-30-1 1
4. WELL LOCATION:
1166 Lotla Church Rd
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
CITY: Franklin COUNTY Macon
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
❑Slope ❑Valley Flat []Ridge ❑Other
Kg3BTCD 36 iAAAA&AAAAAAAA1 CL R OR 3)0XXXrX(90(9Q)FX CC
KNMFMTCD75 iAAAA&AAAAAAAA! CLROR CC
Latitude/longitude source: ❑GPS Erropographic map
(location of well must be shown on a USGS topo map andattached to
this form if not using GPS)
5. FACILITY (Name of the business where the well is located.)
Macon Elementary
Facility Name Facility ID# (if applicable)
1166 Lotla Church Rd
Street Address
Franklin NC 28734
City or Town State Zip Code
Macon County Government
Contact Name
Mailing Address
Franklin NG. 28743
City or Town State Zip Code
Area code
Phone number
Top 0 Bottoms Ft. Bentonite Pumped
Tope Bottom 450 Ft. washed stone poured
Top Bottom Ft.
: 9. SCREEN: Depth Diameter Slot Size Material
Top Bottom Ft. in. in.
Top Bottom Ft. in. in.
Top Bottom Ft. in. in.
10. SAND/GRAVEL PACK:
Depth Size
Top Bottom Ft.
Top Bottom Ft.
Top Bottom Ft.
: 11. DRILLING LOG
Top Bottom
0 / 80
80 / 250
250 / 254
254 / 450
12. REMARKS:
Material
Formation Description
Overburden
Granite
Broken Granite 40 GPM
Granite
6. WELL DETAILS: I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
• 15A NCAC 2C, WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
a. TOTAL DEPTH: 450' RECORD HAS BE PROVIDED TO THE WELL OWNER.
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO q/ G / 9-30-11
SIGNATURE OF CERTIFIED WELL CONTRACTOR DATE
c. WATER LEVEL Below Top of Casing: 60 FT- Timothy R Hamby
(Use "+^ if Above Top of Casing) : PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit within 30 days of completion to: Division of Water Quality Form /08
y p ty - Information Processing, Rev. 1Io8
1617 Mail Service Center, Raleigh, NC 27699-161, Phone : [phone]

NONRESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 3118-A
1. WELL CONTRACTOR:
_Timothy R Hamby
Well Contractor (Individual) Name
Midsouth Geothermal
Well Contractor Company Name
8275 Tournament Dr Suite 185
Street Address
Memphis TN 38125
City or Town State Zip Code
9f 01 ) 748-9095
Area code Phone number
d. TOP OF CASING IS 2 FT. Above Land Surface*
'Top of casing terminated attor below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): 100 METHOD OF TEST Blow Down
f. DISINFECTION: Type HTC; Amount 12 n7
g. WATER ZONES (depth):
:Top 250 Bottom_254 Top Bottom
:Top Bottom Top Bottom
;Top Bottom Top Bottom
Thickness/
2. WELL INFORMATION: ; 7. CASING: Depth Diameter Weight Material
WELL CONSTRUCTION PERMIT# W 10100141 : Top +_ Bottom 82 Ft. 6 1 /8 •188 steel
OTHER ASSOCIATED PERMIT#(if applicable) : Top Bottom Ft.
SITE WELL ID #(ifapplicable) C-1 ; Top Bottom Ft.
3. WELL USE (Check One Box) Monitoring ❑ Municipal/Public ❑ : 8. GROUT: Depth Material Method
Industrial/Commercial ❑ Agricultural ❑ Recovery ❑ Injection ❑ : Top 0 Bottom 87 Ft._ Bentonite pumped
Irrigation❑ Other N((list use) Closed IOOD Geotherrla Top 87 Bottom 450 Ft. washed stone poured
DATE DRILLED 10-25-1 1 ; Top Bottom Ft.
4. WELL LOCATION:
1166 Lotla Church Rd
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
CITY: Franklin COUNTY Macon
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
❑ Slope []Valley QrFlat ❑ Ridge ❑ Other
PCOBTCD 36 iAAAA&AAAAAAAA! CL ROR 3X^Xxxxo0wx CC
KNWBTCD75 IAAAA&AAAAAAAA! CLROR 71k.'X9wxx9t9(o w CC
Latitudefiongitude source: ❑GPS []Topographic map
(location of well must be shown on a USGS topo map andattached to
this form if not using GPS)
6. FACILITY (Name of the business where the well is located.)
Ma .on Flernentary
Facility Name Facility ID# (if applicable)
1166 Lotla Church Rd
Street Address
Franklin NC 287,94
City or Town State Zip Code
Macon Cnunty Government
Contact Name
Mailing Address
Franklin NG 28743
City or Town State Zip Code
Area code
Phone number
6. WELL DETAILS:
a. TOTAL DEPTH: 450'
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO qI
9. SCREEN: Depth Diameter Slot Size Material
Top Bottom Ft. in. in.
Top Bottom Ft. in
Top Bottom Ft. in.
10. SAND/GRAVEL PACK:
Depth Size
Top Bottom Ft.
Top Bottom Ft.
Top Bottom Ft.
11. DRILLING LOG
Top Bottom
0 / 77
77 / 82
82 / 250
250 / 254
254 / 450
12. REMARKS:
in.
in.
Material
Formation Description
Dirt
_Granite
Granite
Broken Granite 40 GPM
Granite
100 HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
•' 15A NCAC 2C, WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
RECORD HAS BEEN PROVIDED TO THE WELL OWNER
�'^ ✓� 10-25-11
SIGNATURE OF CERTIFIED WELL CONTRACTOR DATE
c. WATER LEVEL Below Top of Casing: _60 FT. : Timothy R Hamby
(Use "+" if Above Top of Casing) : PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit within 30 days of completion to: Division of Water Quality - Information Processing, Form Rev. 1 /08 /08
1617 Mail Service Center, Raleigh, NC 27699-161, Phone : [phone]

NONRESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 3118-A
1. WELL CONTRACTOR:
Timothv R Hamb
Well Contractor (Individual) Name
Midsouth Geothermal
Well Contractor Company Name
8275 Toumament Dr Suite 185
Street Address
Memphis TN 38125
City or Town State Zip Code
9( 01 ) 748-9095
Area code Phone number
2. WELL INFORMATION:
WELL CONSTRUCTION PERMIT# W10100141
OTHER ASSOCIATED PERMIT#(if applicable)
SITE WELL ID #(ifapplicable) C-2
3. WELL USE (Check One Box) Monitoring ❑ Municipal/Public ❑
Industrial/Commercial ❑ Agricultural ❑ Recovery ❑ Injection ❑
Irrigation❑ Other ti((Iist use) Closed IooD Geotherra
DATE DRILLED 10-24-1 1
4. WELL LOCATION:
1166 Lotla Church Rd
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
CITY: Franklin COUNTY Macon
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
[]Slope ❑ Valley Flat ❑ Ridge ❑ Other
P(OMTCD 36 iAAAA&AAAAAAAAI CL R OR 3X^XXXXIAX xX CC
MWISTCD75 iAAAA&AAAAAAAAI CL ROR N!X9C Xxxow CC
Latitude/longitude source: (BPS Dropographic map
(location of well must be shown on a USGS topo map andattached to
this form if not using GPS)
b. FACILITY (Name of the business where the well is located.)
Macon Elementary
Facility Name Facility ID# (if applicable)
1166 Lotla Church Rd
Street Address
Franklin NC 28734
City or Town State Zip Code
Macon County Government
Contact Name
Mailing Address
Franklin NC 28743
City or Town State Zip Code
U
Area code
Phone number
6. WELL DETAILS:
a. TOTAL DEPTH: 450'
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO r1/
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 15A NCAC 2C .0118.
: e. YIELD (gpm): 100 METHOD OF TEST Blow Down
f. DISINFECTION: Type HTC Amount 12 07
g. WATER ZONES (depth):
:Top 250 Bottom 254 Top Bottom
Top Bottom Top Bottom
Top Bottom Top Bottom
Thickness/
7. CASING: Depth Diameter Weight Material
Topes Bottom_ Ft. 6 1 /8 .188 steel
Top Bottom Ft.
Top Bottom Ft.
8. GROUT: Depth Material Method
Top 0 Bottom_ 7 Ft. Bentonite Dumped
Top 87 Bottom 450 Ft. washed stone poured
Top Bottom Ft.
9. SCREEN: Depth Diameter Slot Size Material
Top Bottom Ft. in. in.
Top Bottom Ft. in. in.
: Top Bottom Ft. in.
: 10. SAND/GRAVEL PACK:
Depth Size
Top Bottom Ft.
Top Bottom Ft.
Top Bottom Ft.
11. DRILLING LOG
Top
Bottom
0
/ 77
77
/ 82
82 250
250
/ 254
254
/ 450
/
: 12. REMARKS:
in.
Material
Formation Description
Dirt
Granite
Granite
Broken Granite 40 GPM
Granite
100 HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
• 15A NCAC 2C, WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
10-24-1
SIGN RE OF CERTIFIED WELL CONTRACTOR DATE
c. WATER LEVEL Below Top of Casing: 60 FT. Timothy/ R Hamhy
(Use "+" if Above Top of Casing) : PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit within 30 days of completion to: Division of Water Quality Information Processing, Form
y p � - IfiPig� Rev. 1//OS08
1617 Mail Service Center, Raleigh, NC 27699-161, Phone : [phone]

NONRESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 3118-A
1. WELL CONTRACTOR:
Timothv R Hamb
Well Contractor (Individual) Name
Midsouth Geothermal
Well Contractor Company Name
8275 Tournament Dr Suite 185
Street Address
Memphis TN 38125
City or Town State Zip Code
9c 01 ) 748-9095
Area code Phone number
2. WELL INFORMATION:
WELL CONSTRUCTION PERMIT# Wl0100141
d. TOP OF CASING is 2 FT. Above Land Surface -
*Top of casing terminated abor below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): 40 METHOD OF TEST Blow Down
f. DISINFECTION: Type HTC Amount 12 m
g. WATER ZONES (depth):
Top 250 Bottom 254 Top Bottom
Top Bottom Top Bottom
Top Bottom Top Bottom
Thickness/
7. CASING: Depth Diameter Weight Material
: Topes Bottom 82 Ft. 6 1 /8
OTHER ASSOCIATED PERMIT#(if applicable) :Top Bottom Ft.
SITE WELL ID #(ifapplicable) C-3 Top Bottom Ft.
3. WELL USE (Check One Box) Monitoring ❑ Municipal/Public ❑ : 8. GROUT: Depth Material Method
Industrial/Commercial ❑ Agricultural ❑ Recovery ❑ Injection ❑ : Topes_ Bottom 87 Ft. Bentonite Dumped
Irrigation❑ Other M(vist use) Closed looD Geotherra Top$ Bottom 450 Ft. washed stone poured
DATE DRILLED 10-20-1 1 ; Top Bottom Ft.
4. WELL LOCATION:
1166 Lotla Church Rd
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
CITY: Franklin COUNTY Macon
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
❑Slope []Valley &(Flat ❑Ridge ❑Other
KtWMTCD 36 iAAAA&AAAAAAAAI CL R OR 3X^X'XXXIAXMX CC
KNMFISTCD75 IAAAA&AAAAAAAAI CLROR 7X.rXW)tlXNW CC
Latitude/longitude source: BPS []Topographic map
(location of well must be shown on a USGS topo map andattached to
this form if not using GPS)
5. FACILITY (Name of the business where the well is located.)
Macon Elementary
Facility Name Facility ID# (if applicable)
1166 Lotla Church Rd
Street Address
Franklin NC 28734
City or Town State Zip Code
Macon County Government
Contact Name
Mailing Address
Franklin NC 28743
City or Town State Zip Code
U
Area code
Phone number
S. WELL DETAILS:
a. TOTAL DEPTH: 450'
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO q/
: 9. SCREEN: Depth Diameter Slot Size Material
Top Bottom Ft. in. in.
Top Bottom Ft. in. in.
Top Bottom Ft. in. in.
10. SAND/GRAVEL PACK:
Depth Size
Top Bottom Ft.
Top Bottom Ft.
Top Bottom Ft.
11. DRILLING LOG
Top Bottom
0 / 77
77 / 82
2 / 250
250 / 254
254 / 450
/
/
: 12. REMARKS:
Material
Formation Description
Granite
Granite
Broken Granite 40 GPM
Granite
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
15A NCAC 2C, WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
RECORD HAS BEEN PROVIDED TO THE WELL OWNER
10-20-1
SIGNferURE OF CERTIFIED WELL CONTRACTOR DATE
c. WATER LEVEL Below Top of Casing: 60 FT. Timothy R Hamby
(Use "+" if Above Top of Casing) : PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit within 30 days of completion to: Division of Water Quality Information Processing, Form /08
Y p tY - 9 Rev. 1/08
1617 Mail Service Center, Raleigh, NC 27699-161, Phone : [phone]

NONRESIDENTIAL ONRESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Di%7sion of Water Quality
WELL CONTRACTOR CERTIFICATION # 3118-A
1. WELL CONTRACTOR:
Timothv R Hamb
Well Contractor (Individual) Name
Midsouth Geothermal
Well Contractor Company Name
8275 Tournament Dr Suite 185
Street Address
Memphis TN 38125
City or Town State Zip Code
9( 01 ) 748-9095
Area code Phone number
2. WELL INFORMATION:
WELL CONSTRUCTION PERMIT# W10100141
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 15A NCAC 2C .0118.
: e. YIELD (gpm): 40 METHOD OF TEST Blow Down
f. DISINFECTION: Type HTC: Amount 19 07
g. WATER ZONES (depth):
Top 250 Bottom 254 Top Bottom
Top Bottom Top Bottom
;Top Bottom Top Bottom
Thickness/
7. CASING: Depth Diameter Weight Material
Top +2 Bottom 82 _Ft. 61/8 .188 steel
OTHER ASSOCIATED PERMIT#(if applicable) Top Bottom Ft.
SITE WELL ID #(if applicable) C-4 : Top Bottom Ft.
3. WELL USE (Check One Box) Monitoring ❑ Municipal/Public ❑
Industrial/Commercial ❑ Agricultural ❑ Recovery ❑ Injection ❑
Irrigation❑ Other I((Ilst use) Closed IooD Geotherra
DATE DRILLED-1 0-19-11
4. WELL LOCATION:
1166 Lotla Church Rd
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
CITY: Franklin COUNTY Macon
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
❑Slope ❑Valley Flat ❑Ridge []Other
KOISTCD 36 iAAAA&AAAAAAAAI CL R OR 3X^XXX7(NX9XX CC
KNW KTCD 75 iAAAA&AAAAAAAA! CL R OR 771.WX'XXX"M CC
Latitude/longitude source: ❑GPS ❑ropographic map
(location of well must be shown on a USGS topo map andattached to
this form if not using GPS)
5. FACILITY (Name of the business where the well is located.)
Macon Filamentary
Facility Name Facility ID# (if applicable)
1166 Lotla Church Rd
Street Address
Franklin NC 28734
City or Town State Zip Code
Macon County Government
Contact Name
Mailing Address
Franklin NC ?8743
City or Town State Zip Code
U
Area code Phone number
6. WELL DETAILS:
a. TOTAL DEPTH: 4501
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO V
: 8. GROUT: Depth Material Method
Top_ Bottom Ft. Bentonite pumped
Top 87 Bottom 450 Ft. washed stone poured
Top Bottom Ft.
9. SCREEN: Depth Diameter Slot Size Material
Top Bottom Ft. in. in.
Top Bottom Ft. in. in.
Top Bottom Ft. in. in.
10. SAND/GRAVEL PACK:
Depth Size
Top Bottom Ft.
Top Bottom Ft.
Top Bottom Ft.
: 11. DRILLING LOG
Top
Bottom
0
/ 77
77
/ 82
82_/ 250
250
/ 254
254
/ 450
1
12. REMARKS:
Dirt
Material
Formation Description
Granite
Granite
Broken Granite 40 GPM
Granite
100 HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
• 15A NCAC 2C, WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
RECORD HAS BEEN PROVIDED TO THE WELL OWNER
10-19-11
SIGNAMURE OF CERTIFIED WELL CONTRACTOR DATE
c. WATER LEVEL Below Top of Casing: _ 60 FT. ; _Timothy R Hamhy
(Use "+" if Above Top of Casing) : PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit within 30 days of completion to: Division of Water Quality - Information Processing, Form Rev. 1 /08 /08
1617 Mail Service Center, Raleigh, NC 27699-161, Phone : [phone]

1ry
11
NONRESIDENTLQL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
•� WELL CONTRACTOR CERTIFICATION # 3118 A
1. WELL CONTRACTOR:
Timothy R Hamby
Well Contractor (Individual) Name
Midsouth Geothermal
Well Contractor Company Name
8275 Tournament Dr Suite 185
Street Address
Memphis TN 38125
City or Town State Zip Code
9( 01 ) 748-9095
Area code Phone number Thickness/
2. WELL INFORMATION: ; 7. CASING: Depth Diameter Weight
WELL CONSTRUCTION PERMIT# W 10100141 : Top +_ Bottoms Ft. 6 1 /8 .188
OTHER ASSOCIATED PERMIT#(if applicable)
SITE WELL ID #(if applicable) C-5
3. WELL USE (Check One Box) Monitoring ❑ Municipal/Public ❑
Industrial/Commercial ❑ Agricultural ❑ Recovery ❑ Injection ❑
Irrigation❑ Other d(list use) Closed IooD Geotherre
DATE DRILLED-1 0-18-11
4. WELL LOCATION:
1166 Lotla Church Rd
(Street Name, Numbers, Community, Subdivision, Lot No.. Parcel, Zip Code)
CITY: Franklin COUNTY Macon
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
[]Slope ❑ Valley Q(Flat ❑ Ridge ❑ Other
Itgg;IIBTCD 36 iAAAABIAAAAAAAAI CLROR 3X0XXXX00t9PRX CC
KNWI'STCD75 IAAAA&AAAAAAAAI CLROR 7X..")CD(9=* CC
Latitude/longitude source: ❑GPS ❑topographic map
(location of well must be shown on a USGS topo map andattached to
this form if not using GPS)
5. FACILITY (Name of the business where the well is located.)
Macon Flementary
Facility Name Facility ID# (if applicable)
1166 Lotla Church Rd
Street Address
Franklin NC 28734
City or Town State Zip Code
Macon County Government
Contact Name
Mailing Address
Franklin NC 98743
City or Town State Zip Code
U
Area code Phone number
6. WELL DETAILS:
a. TOTAL DEPTH: 450'
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO Wr
d. TOP OF CASING IS _2 FT. Above Land Surface`
'Top of casing terminated attor below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): 40 METHOD OF TEST BIOW Down
f. DISINFECTION: Type HTI : Amount 12 07
g. WATER ZONES (depth):
:Top 250 Bottom 254 Top Bottom
:Top Bottom Top Bottom
Top Bottom Top Bottom
Material
steel
Top Bottom Ft.
Top Bottom Ft.
8. GROUT: Depth Material Method
Top 0 Bottom—BZ_Ft._Bentonite pumped
Topes Bottom 450 Ft. washed stone poured
Top Bottom Ft.
9. SCREEN: Depth Diameter Slot Size Material
Top Bottom Ft. in. in.
Top Bottom Ft. in. in.
Top Bottom Ft. in. in.
10. SAND/GRAVEL PACK:
Depth Size
Top Bottom Ft.
Top Bottom Ft.
Top m BottoFt.
11. DRILLING LOG
Top Bottom
0 / 77
77 / 82
82/ 250
250 / 254
254 / 450
12. REMARKS:
easing Removed
Material
Formation Description
Dirt
Granite
Granite
Broken Granite 40 GPM
Granite
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 CERTIFIED WELL CONTRACTOR DATE
c. WATER LEVEL Below Top of Casing: 60 FT. Timothy R Hamby
(Use "+•• if Above Top of Casing) : PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit within 30 days of completion to: Division of Water Quality - Information Processing, Form Rev. 1 /08 /OS
1617 Mail Service Center, Raleigh, NC 27699-161, Phone : [phone]

i coa STAtF o 4
a
NONRESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 3118-A
1. WELL CONTRACTOR:
Timothy R Hamby
Well Contractor (Individual) Name
Midsouth Geothermal
Well Contractor Company Name
8275 Tournament Dr Suite 185
Street Address
Memphis TN 38125
City or Town State Zip Code
9( 01 ) 748-9095
Area code Phone number
2. WELL INFORMATION:
WELL CONSTRUCTION PERMIT# W10100141
OTHER ASSOCIATED PERMIT#(if applicable)
SITE WELL ID #(if applicable) C-6
3. WELL USE (Check One Box) Monitoring ❑ Municipal/Public ❑
Industrial/Commercial ❑ Agricultural ❑ Recovery ❑ Injection ❑
Irrigation❑ Other p{(list use) Closed looD Geotherra
DATE DRILLED-1 0- 17-11
4. WELL LOCATION:
1166 Lotla Church Rd
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
CITY: Franklin COUNTY Macon
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
❑ Slope ❑ Valley p(Flat ❑ Ridge ❑ Other
KOISTCD 36 iAAAA&AAAAAAAA! CL ROR 3X^xxxxo0wx CC
KNMFMTCD75 iAAAA&AAAAAAAA! CLROR 71X.' X3kX7(9 M CC
Latitude/longitude source: ❑GPS Qropographic map -
(location of well must be shown on a USGS topo map andattached to
this form if not using GPS)
S. FACILITY (Name of the business where the well is located.)
Macon Elementary
Facility Name Facility ID# (if applicable)
1166 Lotln Church Rd
Street Address
Franklin N 8734
City or Town State Zip Code
Macon County Goyernm .nt
Contact Name
Mailing Address
Franklin NG 28743
City or Town State Zip Code
Area code
Phone number
S. WELL DETAILS:
a. TOTAL DEPTH: 4501
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO qI
d. TOP OF CASING IS 2 FT. Above Land Surface -
'Top of casing terminated attor below land surface may require
a variance in accordance With 15A NCAC 2C .011 B.
e. YIELD (gpm): 40 METHOD OF TEST Slow DOWn
f. DISINFECTION: Type HTC: Amount 12 n7
g. WATER ZONES (depth):
Top_ 250 Bottom 254 Top Bottom
Top Bottom Top Bottom
Top Bottom Top Bottom
Thickness/
7. CASING: Depth Diameter Weight Material
Topes_ Bottom_52 _Ft. 6 1 /8 .188 steel
Top Bottom Ft.
Top Bottom Ft.
: 8. GROUT: Depth Material Method
Topes_ Bottom—ff_ Ft._ Bentonite
Top_87 Bottom 450 Ft. Washed Stone
Top Bottom Ft.
9. SCREEN: Depth Diameter Slot Size Material
Top Bottom Ft. in. in.
Top Bottom Ft. in. in.
Top Bottom Ft. in. in.
10. SAND/GRAVEL PACK:
Depth Size
Top Bottom Ft.
Top Bottom Ft.
Top Bottom Ft.
11. DRILLING LOG
Top
Bottom
0
/ 77
77
/ 82
82/ 250
250
/ 254
254
/ 450
: 12. REMARKS:
Material
Formation Description
Dirt
Granite
_Granite
Broken Granite 40 GPM
Granite
100 HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
• 15A NCAC 2C, WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
RECORD HAS BEEN PROVIDED TO THE WELL OWNER
10-17-11
SIGNATURE OF CERTIFIED WELL CONTRACTOR DATE
c. WATER LEVEL Below Top of Casing: 60 FT. Timothy R Hamby
(Use "+" if Above Top of Casing) : PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit within 30 days of completion to: Division of Water Quality Form /08
Y p ty - Information Processing, Rev. 1/O8
1617 Mail Service Center, Raleigh, NC 27699-161, Phone : [phone]

NONRESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural -Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 3118-A
1. WELL CONTRACTOR:
Timothy R Hamby
Well Contractor (Individual) Name
Midsouth Geothermal
Well Contractor Company Name
8275 Tournament Dr Suite 185
Street Address
Memphis TN 38125
City or Town State Zip Code
9(_ 01 ) 748-9095
Area code Phone number
2. WELL INFORMATION:
WELL CONSTRUCTION PERMIT# W10100141
OTHER ASSOCIATED PERMIT#(if applicable)
SITE WELL ID #(if applicable) C-7
3. WELL USE (Check One Box) Monitoring ❑ Municipal/Public ❑
Industrial/Commercial ❑ Agricultural ❑ Recovery ❑ Injection ❑
Irrigation❑ Other /((list use) Closed IooD Geotherra
DATE DRILLED-1 0- 14-11
4. WELL LOCATION:
1166 Lotla Church Rd
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
CITY: Franklin COUNTY Macon
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
❑ Slope []Valley Flat ❑ Ridge ❑ Other
KgISTCD 36 IAAAA&AAAAAAAAI CL R OR 3mXXX7(Oomx CC
INIMFISTCD75 1AAAA&AAAAAAAAI CLROR 7x.WX7t1(9(90V CC
Latitude/longitude source: ❑GPS Dropographic map
(location of well must be shown on a USGS topo map andattached to
this form if not using GPS)
5. FACILITY (Name of the business where the well is located.)
Macon Flementary
Facility Name Facility ID# (if applicable)
1.166 Lotla Church Rd
Street Address
Franklin N ,9734
City or Town State Zip Code
Macon County Government
Contact Name
Mailing Address
_Franklin NC 28743
City or Town State Zip Code
Area code
Phone number
6. WELL DETAILS:
a. TOTAL DEPTH: 450'
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO q/
d. TOP OF CASING IS 2 FT. Above Land Surface'
'Top of casing terminated attor below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): 40 METHOD OF TEST BIOW Down
f. DISINFECTION: Type_HTC: Amount 12 n7
g. WATER ZONES (depth):
:Top 250 Bottom_254 Top Bottom
:Top Bottom Top Bottom
Top Bottom Top Bottom
Thickness/
7. CASING: Depth Diameter Weight Material
Top +2_ Bottom_a2 Ft. 6 1 /8 .188 Steel
Top Bottom Ft.
Top Bottom Ft.
8. GROUT: Depth Material Method
Top 0 Bottom 97 Ft. Bentonite Dumped
Top�97 Bottom 450 Ft. washed stone poured
Top Bottom Ft.
9. SCREEN: Depth Diameter Slot Size Material
: Top Bottom Ft. in. in.
Top Bottom Ft. in. in.
Top Bottom Ft. in. in.
10. SAND/GRAVEL PACK:
Depth Size
Top Bottom Ft.
Top Bottom Ft.
Top Bottom Ft.
11. DRILLING LOG
Top Bottom
0 / 90
90 / 92
92—/ 250
250 /_254
254 / 450
12. REMARKS:
leasing Removed
Material
Formation Description
Dirt
Granite
Granite
Broken Granite 40 GPM
Granite
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
15A NCAC 2C, WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
RECORD HAS /
BEEN PROVIDED TO THE WELL OWNER.
__q it 10 U% I _ / A A A A A A
SIGPOTURE OF CERTIFIED WELL CONTRACTOR DATE
c. WATER LEVEL Below Top of Casing: 60 FT. Timothy R Hamby
(Use "+" if Above Top of Casing) : PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit within 30 days of completion to: Division of Water Quality Form /08
Y P ty - Information Processing, Rev. 1/08
1617 Mail Service Center, Raleigh, NC 27699-161, Phone : [phone]

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NONRESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 3118-A
1. WELL CONTRACTOR:
Timothy R Hamby
Well Contractor (Individual) Name
Midsouth Geothermal
Well Contractor Company Name
8275 Tournament Dr Suite 185
Street Address
Memphis TN 38125
City or Town State Zip Code
9r 01 ) 748-9095
Area code Phone number
2. WELL INFORMATION:
WELL CONSTRUCTION PERMIT# W10100141
OTHER ASSOCIATED PERMIT#(if applicable)
SITE WELL ID #(ifapplicable) C-8
3. WELL USE (Check One Box) Monitoring ❑ Municipal/Public ❑
Industrial/Commercial ❑ Agricultural ❑ Recovery ❑ Injection ❑
Irrigation❑ Other 6((list use) Closed 1000 Geotherre
DATE DRILLED-1 0-13-11
4. WELL LOCATION:
1166 Lotla Church Rd
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
CITY: Franklin COUNTY Macon
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
❑Slope ❑Valley JJFlat ❑Ridge ❑Other
KOISTCD 36 iAAAA&AAAAAAAAI CL ROR 3Xo*XXX90tmx CC
KNMFwrCD75 IAAAA&AAAAAAAAI CL ROR 7`x..W"XX"W CC
Latitude/longitude source: ❑GPS Qropographic map
(location of well must be shown on a USGS topo map andattached to
this form if not using GPS)
5. FACILITY (Name of the business where the well is located.)
Macon Flernentary
Facility Name Facility ID# (if applicable)
1166 Lotla Church Rd
Street Address
Franklin NC 28734
City or Town State Zip Code
Macon County Government
Contact Name
Mailing Address
Franklin NG 28743
City or Town State Zip Code
Area code
Phone number
S. WELL DETAILS:
a. TOTAL DEPTH: 450'
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO qI
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 15A NCAC 2C .0118.
e. YIELD (gpm): _40 METHOD OF TEST Blow Down
f. DISINFECTION: Type HTC Amount 12 o7
g. WATER ZONES (depth):
Top, 250 Bottom 254 Top Bottom
: Top Bottom Top Bottom
Top Bottom Top Bottom
Thickness/
7. CASING: Depth Diameter Weight Material
Top +_ Bottom 94 Ft. 6 1/8 .188 steel
Top Bottom Ft.
Top Bottom Ft.
8. GROUT: Depth Material Method
Top 0 Bottom-99 Ft._ Bentonite pumped
Top 9L_ Bottom 450 Ft. washed stone poured
Top Bottom Ft.
9. SCREEN: Depth Diameter Slot Size Material
Top Bottom Ft. in.
: Top Bottom Ft. in.
Top Bottom Ft. in.
10. SAND/GRAVEL PACK:
Depth Size
Top Bottom Ft.
Top Bottom Ft.
: Top Bottom Ft.
11. DRILLING LOG
Top Bottom
0 / 90
90 / 94
94 /_250
250 / 254
254 / 450
: 12. REMARKS:
in.
in.
in.
Material
Formation Description
Dirt
Granite
Granite
Broken Granite 40 GPM
Granite
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
• 15A NCAC 2C, WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
RECORD HAS BEEN PROVIDED TO THE WELL OWNER
:c �� _10-13-11
SI ATURE OF C TIFIED WELL CONTRACTOR DATE
c. WATER LEVEL Below Top of Casing: 60 FT. Timothy R Hamhy
(Use "+" if Above Top of Casing) : PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit within 30 days of completion to: Division of Water Quality Form /08
Y p ty - Information Processing, Rev. 1/08
1617 Mail Service Center, Raleigh, NC 27699-161, Phone : [phone]

NONRESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 3065-A
1. WELL CONTRACTOR:
Roaer L Williams
Well Contractor (Individual) Name
Tarheel Water Treatmant
Well Contractor Company Name
3494 Georaia Rd
Street Address
Franklin NC 28734
City or Town State Zip Code
8( 28 ) 369-0740
Area code Phone number
d. TOP OF CASING IS i FT. Above Land Surface -
'Top of casing terminated allor below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): 10 METHOD OF TEST_ Aar Uft
f. DISINFECTION: Type HTC; Amount 1 /4 C'I1p
g. WATER ZONES (depth):
Top 303 Bottom 304 Top Bottom
Top Bottom Top Bottom
Top Bottom Top Bottom
Thickness/
2. WELL INFORMATION: ; 7. CASING: Depth Diameter Weight Material
WELL CONSTRUCTION PERMIT# WI0100141 ; Top 0 Bottom 84 Ft.
OTHER ASSOCIATED PERMIT#(if applicable) TOP Bottom Ft.
SITE WELL ID #(if applicable) D-1 Top Bottom Ft.
3. WELL USE (Check One Box) Monitoring ❑ Municipal/Public ❑ : 8. GROUT: Depth Material Method
Industrial/Commercial ❑ Agricultural ❑ Recovery ❑ Injection ❑ : Top 0 Bottom 899 Ft. bentonate pumped
Irrigation❑ Other p{(list use) Closed LoOD Geothera : Top 89 Bottom 450 Ft. Washed stonE poured
DATE DRILLED 9-29-1 1 ; Top Bottom Ft.
4. WELL LOCATION:
1166 lotla Church Rd
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
CITY: Franklin COUNTY Macon
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
❑ Slope ❑ Valley Flat ❑ Ridge ❑ Other
IG0I'.6TCD 36 IAAAA&AAAAAAAAI CL R OR 3X0XXR90t)MX CC
KNMFISTCD75 IAAAA&AAAAAAAAI CLROR 7`k.WX7t)t4(9xx CC
Latitude/longitude source: EIGPS aopographic map
(location of well must be shown on a USGS topo map andattached to
this form if not using GPS)
5. FACILITY (Name of the business where the well is located.)
Ma .on Flerrientary School
Facility Name Facility ID# (if applicable)
1166 lotla Church Rd
Street Address
Franklin NC 287.4
City or Town State Zip Code
Macon County Gnmernment
Contact Name
Mailing Address
Franklin NC ?8734
City or Town State Zip Code
Area code
Phone number
6. WELL DETAILS:
a. TOTAL DEPTH:_450'
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO D/
9. SCREEN: Depth Diameter Slot Size Material
Top
Bottom
Ft. in.
Top
Bottom
Ft. in.
Top
Bottom
Ft. in.
10. SAND/GRAVEL PACK:
Depth
Size
Top
Bottom
Ft.
Top
Bottom
Ft.
Top
Bottom
Ft.
11. DRILLING LOG
Top Bottom
0 / 75
75 / 84
4 / 450
12. REMARKS:
in.
in.
in.
Material
Formation Description
Sand and Clay
Granite Casing set
Granite
100 HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
• 15A NCAC L CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
RECO AS B N PROVIDED TO THE NER.
SIGNATURE OF CERTIFIED WELL CONTRACTOR DATE
C. WATER LEVEL Below Top of Casing: 60 FT. Roger L WIIIaamR
(Use "+" if Above Top of Casing) : PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit within 30 days of completion to: Division of Water Quality - Information Processing, Form Rev. 1108108
1617 Mail Service Center, Raleigh, NC 27699-161, Phone : [phone]

NONRESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 3065 A
1. WELL CONTRACTOR:
Roger L Williams
Well Contractor (Individual) Name
Tarheel Water Treatmant
Well Contractor Company Name
3494 Georgia Rd
Street Address
Franklin NC 28734
City or Town State Zip Code
8( 28 ) 369-0740
Area code Phone number
2. WELL INFORMATION:
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 15A NCAC 2C .0118.
e. YIELD (gpm): 40 METHOD OF TEST Air Lift
f. DISINFECTION: Type HTC Amount 1 /4 Cttp
g. WATER ZONES (depth):
Top 950 Bottom 252 Top Bottom
:Top Bottom Top Bottom
;Top Bottom Top Bottom
Thickness/
7. CASING: Depth Diameter Weight Material
WELL CONSTRUCTION PERMIT# WI0100141 : Top_0 Bottom-Md Ft.
OTHER ASSOCIATED PERMIT#(if applicable) Top Bottom Ft.
SITE WELL ID #(f applicable) Q-2 Top Bottom Ft.
3. WELL USE (Check One Box) Monitoring ❑ Municipal/Public ❑
Industrial/Commercial ❑ Agricultural ❑ Recovery ❑ Injection ❑
Irrigation❑ Other !((listuse) Closed LoOD Geotherm
DATE DRILLED 9-28-1 1
4. WELL LOCATION:
1166 lotla Church Rd
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
CITY: Franklin COUNTY Macon
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
❑Slope []Valley Flat []Ridge []Other
KI@PI$TCD 36 iAAAA&AAAAAAAA! CL R OR 3X0XXXXX9t)t9@ X CC
KNMFI$TCD75 iAAAA&AAAAAAAAI CLROR 7)VA*W)tXX0ft `CC
Latitude/longitude source: OGPS Oropographic map
(location of well must be shown on a USGS topo map andattached to
this form if not using GPS)
5. FACILITY (Name of the business where the well is located.)
Macon Flementary School
Facility Name Facility ID# (if applicable)
1166 lotla Church Rd
Street Address
Franklin NC 28734
City or Town State Zip Code
Macon County Govemment
Contact Name
: 8. GROUT: Depth Material Method
Topes Bottom 09 _ Ft. bentonite gum end
Top-B-Q_ Bottom 450 Ft. washed stone poured
Top Bottom Ft.
9. SCREEN: Depth Diameter Slot Size Material
Top Bottom Ft. in. in.
Top Bottom Ft. in. in.
Top Bottom Ft. in. in.
: 10. SAND/GRAVEL PACK:
Depth Size
Top Bottom Ft.
Top Bottom Ft.
: Top Bottom Ft.
: 11. DRILLING LOG
Top Bottom
0 / 51
51 / 64
4 77
77 84
84 / 450
Mailing Address /
Franklin NC 28734 /
City or Town State Zip Code ; 12. REMARKS:
Area code
Phone number
S. WELL DETAILS:
a. TOTAL DEPTH: 4501
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO qI
c. WATER LEVEL Below Top of Casing: 50 FT.
(Use "+" if Above Top of Casing)
Material
Formation Description
Sand and Clay
Granite
Brown Sand
Granite Casing Set
Granite
100 HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
• 15A NCAC 2C L CONSTRUCTION ST NDARDS, AND THAT A COPY OF THIS
RECORD N PROVIDED TO TH E L WNER.
O �8 11
SIGNATU E OF CERTIFIED WELL CONTRACTOR DATE
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit within 30 days of completion to: Division of Water Quality Form /08
y p ty - Information Processing, Rev. 1/08
1617 Mail Service Center, Raleigh, NC 27699-161, Phone : [phone]

NONRESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 3065 A
1. WELL CONTRACTOR:
Roger L Williams
Well Contractor (Individual) Name
Tarheel Water Treatmant
Well Contractor Company Name
3494 Georaia Rd
Street Address
Franklin NC 28734
City or Town State Zip Code
8( 28 ) 369-0740
Area code Phone number
2. WELL INFORMATION:
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 15A NCAC 2C .0118.
: e. YIELD (gpm): _2n METHOD OF TEST Air Lift
f. DISINFECTION: Type HTC Amount 1/4 riil3
g. WATER ZONES (depth):
Top 230 Bottom 232 Top Bottom
Top Bottom Top Bottom
Top Bottom Top Bottom
Thickness/
7. CASING: Depth Diameter Weight Material
WELL CONSTRUCTION PERMIT# W10100141 : Top _ Bottom 84 Ft.
OTHER ASSOCIATED PERMIT#(if applicable) Top Bottom Ft.
SITE WELL ID #(if applicable) Q-3 ; Top Bottom Ft.
3. WELL USE (Check One Box) Monitoring ❑ Municipal/Public ❑
Industrial/Commercial ❑ Agricultural ❑ Recovery ❑ Injection ❑
Irrigation❑ Other N((list use) Closed LoOD Geothere
DATE DRILLED 9-26-1 1
4. WELL LOCATION:
1166 lotla Church Rd
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
cITY: Franklin COUNTY Macon
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
❑ Slope []Valley Flat ❑ Ridge []Other
Kg[STCD 36 IAAAA&AAAAAAAAI CL R OR 3X^X'Xxxo0f9 x Cc
KNWF $TCD75 iAAAA&AAAAAAAAI CL ROR 7x'!X9(lt'XX7(w CC
Latitude/longitude source: EIGPS Dropographic map
(location of well must be shown on a USGS topo map andattached to
this form if not using GPS)
S. FACILITY (Name of the business where the well is located.)
Macon FI _mentary S .hool
Facility Name Facility ID# (if applicable)
1166 lotla Church Rd
Street Address
Franklin NC 28734
City or Town State Zip Code
Macon County Gov _rnm nt
Contact Name
Mailing Address
Franklin NG 28734
City or Town State Zip Code
Area code
Phone number
6. WELL DETAILS:
a. TOTAL DEPTH:_4501
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO q/
: 8. GROUT: Depth
Material Method
Topes Bottom_BD
Ft. bentonite pumped
Top 89 Bottom 450
Ft. washed stonE poured
Top Bottom
Ft.
9. SCREEN: Depth
Diameter Slot Size Material
Top Bottom
Ft. in. in.
Top Bottom
Ft. in. in.
Top Bottom
Ft. in. in.
10. SAND/GRAVEL PACK:
Depth
Size Material
Top Bottom
Ft.
Top Bottom
Ft.
Top Bottom
Ft.
11. DRILLING LOG
Top Bottom
0 / 78
78 / 84
84 / 450
/
12. REMARKS:
Formation Description
_Sand and Clay
Granite Casing Set
Granite
100 HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
• 15A NCAC 2C, WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
RECORDIHP27EN PROVIDE TO THE ELL OWNER.
v� 9-26-11
SI ATAE OF CERTIFIED WELL CONTRACTOR DATE
c. WATER LEVEL Below Top of Casing: 50 FT. Roger L williams
(Use "+^ if Above Top of Casing) : PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit within 30 days of compl6tion to: Division of Water Quality - Information Processing, Form Rev. 1 /08 /08
1617 Mail Service Center, Raleigh, NC 27699-161, Phone : [phone]

SrA] a`
Tr j try@ NONRESIDENTIAL WELL CONSTRUCTION RECORD
5 ate' Y A( North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 3065-A
1. WELL CONTRACTOR:
Roger L Williams
Well Contractor (Individual) Name
Tarheel Water Treatmant
Well Contractor Company Name
3494 Georaia Rd
Street Address
Franklin NC 28734
City or Town State Zip Code
8( 28 ) 369-0740
Area code Phone number
2. WELL INFORMATION:
WELL CONSTRUCTION PERMIT# W 10100141
OTHER ASSOCIATED PERMIT#(if applicable)
SITE WELL ID #(if applicable) D-4
3. WELL USE (Check One Box) Monitoring ❑ Municipal/Public ❑
Industrial/Commercial ❑ Agricultural ❑ Recovery ❑ Injection ❑
Irrigation❑ Other p{(list use) Closed LoCID Geother©
DATE DRILLED 9-23-1 1
4. WELL LOCATION:
1166 lotla Church Rd
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
CITY: Franklin COUNTY Macon
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
❑Slope []Valley Flat ❑Ridge ❑Other
K( MTCD 36 iAAAABAAAAAAAAI CL R OR 3X^XXXX 0t9PX'X CC
KNMFI'STCD75 iAAAA&AAAAAAAAI CLROR 7A.'X1Q XXXOW CC
Latitudefiongitude source: ❑GPS aopographic map
(location of well must be shown on a USGS topo map andattached to
this form if not using GPS)
5. FACILITY (Name of the business where the well is located.)
Ma on Elementary School
Facility Name Facility ID# (if applicable)
1166 lotla Church Rd
Street Address
Franklin NC 28734
City or Town State Zip Code
Mnrnn County (-IrniprmmPnt
Contact Name
Mailing Address
Franklin NC 28734
City or Town State Zip Code
(_)
Area code Phone number
S. WELL DETAILS:
a. TOTAL DEPTH: 450'
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO qI
d. TOP OF CASING IS i FT. Above Land Surface -
'Top of casing terminated attor below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): 0 METHOD OF TEST Alr Llft
If. DISINFECTION: Type HT . Amount 1 /4 Cup
g. WATER ZONES (depth):
Topes_ Bottom_ Top Bottom
: Top Bottom Top Bottom
Top Bottom Top Bottom
Thickness/
7. CASING: Depth Diameter Weight Material
Top 0 Bottom 84 Ft.
Top Bottom Ft.
Top Bottom Ft.
8. GROUT: Depth Material Method
Top 0 Bottom 8_ Ft. bentonite pumped
Topes Bottom 450 Ft. washed stone loured
Top Bottom Ft.
9. SCREEN: Depth Diameter Slot Size Material
Top Bottom Ft. in.
Top Bottom Ft. in.
Top Bottom Ft. in.
: 10. SAND/GRAVEL PACK:
Depth Size
Top Bottom Ft.
Top Bottom Ft.
Top Bottom Ft.
in.
in.
in.
Material
11. DRILLING LOG
Top Bottom Formation Description
0 / 77
77 / 87
87 / 450
/
12. REMARKS:
Sand and Clay
Granite Casino Set
Granite
I DO HEREBY CERT FY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
• 15A NCAC 2C CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
RECORD B N PROVID TO THE EL ER.
SIGNA—TURE OF CERTIFIED WELL CONTRACTOR DATE
c. WATER LEVEL Below Top of Casing: 0 FT. er I Williams
(Use "+" if Above Top of Casing) : P—INTTED NAME OF PERSON CONSTRUCTING THE WELL
Form GW-1 b
Submit within 30 days of completion to: Division of Water Quality - Information Processing, Rev. 1/08
1617 Mail Service Center, Raleigh, NC 27699-161, Phone : [phone]

NONRESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 3065 A
1. WELL CONTRACTOR:
Roaer L Williams
Well Contractor (Individual) Name
Tarheel Water Treatmant
Well Contractor Company Name
3494 Georgia Rd
Street Address
Franklin NC 28734
City or Town State Zip Code
8( 28 ) 369-0740
Area code Phone number
2. WELL INFORMATION:
WELL CONSTRUCTION PERMIT# W IO1 OO 41
OTHER ASSOCIATED PERMIT#(if applicable)
SITE WELL ID #(if applicable) D-rJ
3. WELL USE (Check One Box) Monitoring ❑ Municipal/Public ❑
Industrial/Commercial ❑ Agricultural ❑ Recovery ❑ Injection ❑
Irrigation❑ Other [(list use) Closed Loop Geothern
DATE DRILLED 9-22-1 1
4. WELL LOCATION:
1166 lotla Church Rd
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
CITY: Franklin COUNTY Macon
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
❑Slope ❑Valley Flat ❑Ridge ❑Other
K@31STCD 36_ IAAAA&AAAAAAAAI CL R OR 3X^XXXXOOt9PX`X CC
KNMFISTCD75 iAAAA&AAAAAAAAI CL ROR 7X."X}t9('kXlt` CC
Latitudellongitude source: BPS ❑Topographic map
(location of well must be shown on a USGS topo map andattached to
this form if not using GPS)
S. FACILITY (Name of the business where the well is located.)
Facility Name Facility ID# (if applicable)
1166 Intla r`hurch Rd
Street Address
Franklin NC 28734
City or Town State Zip Code
ne..ron County (_nvernmant
Contact Name
Mailing Address
Franklin NC 28734
City or Town State Zip Code
Area code Phone number
6. WELL DETAILS:
a. TOTAL DEPTH: 450'
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO qI
c. WATER LEVEL Below Top of Casing: 0 FT.
(Use "+" if Above Top of Casing)
d. TOP OF CASING IS 2 FT. Above Land Surface'
*Top of casing terminated attor below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): 0 METHOD OF TEST Air I Ift
f. DISINFECTION: Type AI Amount 9 /4 C:1D
g. WATER ZONES (depth):
Topes_ Bottom_ Top Bottom
: Top Bottom Top Bottom
Top Bottom Top Bottom
Thickness/
7. CASING: Depth Diameter Weight Material
Top Bottom 84 Ft.
Top Bottom Ft.
Top Bottom
Ft.
: 8. GROUT: Depth
Material
Method
Top_ Bottoms Ft. bentonite
pumped
ropes Bottom 450
Ft. washed StonE
po Ired -
Top Bottom
Ft.
9. SCREEN: Depth
Diameter Slot Size Material
Top Bottom
Ft. in.
in.
Top Bottom
Ft. in.
in.
Top Bottom
Ft. in.
in.
; 10. SAND/GRAVEL PACK:
Depth Size
: Top
Bottom Ft.
Top
Bottom Ft.
Top
Bottom Ft.
Material
11. DRILLING LOG
Top Bottom Formation Description
0 / 77 Sand and Clay
77 / 87 Granite Casina Set
87 / 450 Granite -
12. REMARKS:
easing Removed
100 HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
• 15A NCAC 2C, WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
RECORD H $ PROVIDED TO THE WELL WN "R
SIGPrATUR5 OF CERTIFIED WELL CONTRACTOR DATE 1
RnaPr L WIIIIar1lS
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Form GW-1b
Submit within 30 days of completion to: Division of Water Quality - Information Processing, Rev. 1/08
1617 Mail Service Center, Raleigh, NC 27699-161, Phone : [phone]

NONRESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 3065-A
1. WELL CONTRACTOR:
Roaer L Williams
Well Contractor (Individual) Name
Tarheel Water Treatmant
Well Contractor Company Name
3494 Georgia Rd
Street Address
Franklin NC 28734
City or Town State Zip Code
8( 28 ) 369-0740
Area code Phone number
2. WELL INFORMATION:
WELL CONSTRUCTION PERMIT# WIO100141
OTHER ASSOCIATED PERMIT#(if applicable)
SITE WELL ID #(if applicable
3. WELL USE (Check One Box) Monitoring ❑ Municipal/Public ❑
Industrial/Commercial ❑ Agricultural ❑ Recovery❑ Injection ❑
Irrigation❑ Other ((list use) Closed LoOD Geotherla
DATE DRILLED 9-21 -11
4. WELL LOCATION:
1166 lotla Church Rd
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
CITY: Franklin COUNTY Macon
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
❑ Slope []Valley Flat []Ridge ❑ Other
i AAAA&AAAAAAAAI CL ROR 3xoxxxxonmX CC
iAAAA&AAAAAAAAI CL ROR 7`X':XhCX'7iXX'kXk` CC
K@3fSTCD 36
KN MF IST CD 75
Latitude/longitude source: ❑GPS Oropographic map
(location of well must be shown on a USGS topo map andattached to
this form if not using GPS)
5. FACILITY (Name of the business where the well is located.)
Macon CllemprItary cd,nnl
Facility Name Facility ID# (if applicable)
1166 In la r`hrnh C7fl
Street Address
Franklin NC: 28734
City or Town State Zip Code
Marnn CrIiinty f'`nvernment
Contact Name
Mailing Address
_ Franklin Nt'
919734
City or Town State Zip Code
I-)
Area code Phone number
6. WELL DETAILS:
a. TOTAL DEPTH: 450'
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO EJ(
c. WATER LEVEL Below Top of Casing: 0 FT.
(Use "+" if Above Top of Casing)
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 15A NCAC 2C .0118.
e. YIELD (gpm): 0 METHOD OF TEST Ajr L Ift_
f. DISINFECTION: Type hJL Amount /4 C In
g. WATER ZONES (depth):
Top_Q _ Bottom_ Top Bottom
Top Bottom Top Bottom
:Top Bottom Top Bottom
Thickness/
7. CASING: Depth Diameter Weight Material
TopQ_ Bottom_ Ft.
Top Bottom Ft.
Top Bottom Ft.
8. GROUT: Depth Material Method
Top 0 Bottom 8_ Ft. bentonite pumped
Top S9 Bottom 450 Ft. washed stone poured
Top Bottom Ft.
9. SCREEN: Depth Diameter Slot Size Material
Top Bottom Ft. in.
Top Bottom Ft. in.
Top Bottom Ft. in.
10. SAND/GRAVEL PACK:
Depth Size
Top
Bottom Ft.
Top
Bottom Ft.
Top
Bottom Ft.
in.
in.
in.
Material
11. DRILLING LOG
Top Bottom Formation Description
: 0 / 77
77 / 87
87 / 450
/
12. REMARKS:
leasing Re, -loved
Sand and Clay
Granite Casino Set
Granite-
100 HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
• WAC2CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
PROV OED TOTE E OWNERCERTIFIED WELL CONTRACTOR DATE
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Form GW-1b
Submit within 30 days of completion to: Division of Water Quality - Information Processing, Rev.1/08
1617 Mail Service Center, Raleigh, NC 27699-161, Phone : [phone]

ti NONRESIDENTIAL ON RESIDENTIAL WELL CONSTRUCTION RECORD
_g: North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 3065-A
1. WELL CONTRACTOR:
Roger L Williams
Well Contractor (Individual) Name
Tarheel Water Treatmant
Well Contractor Company Name
3494 Georaia Rd
Street Address
Franklin NC 28734
City or Town State Zip Code
8( 28 ) 369-0740
Area code Phone number
2. WELL INFORMATION:
WELL CONSTRUCTION PERMIT# W10100141
OTHER ASSOCIATED PERMIT#(if applicable)
SITE WELL ID #(if applicable) Q-7
3. WELL USE (Check One Box) Monitoring ❑ Municipal/Public ❑
Industrial/Commercial ❑ Agricultural ❑ Recovery ❑ Injection ❑
Irrigation❑ Other (((list use) Closed Loop Geothere
DATE DRILLED 9-20-1 1
4. WELL LOCATION:
1166 lotla Church Rd
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
CITY: Franklin COUNTY Macon
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
❑Slope ❑Valley Flat ❑Ridge ❑Other
K0I$TCD 36 iAAAA&AAAAAAAA! CL ROR 3mAxXxoexx CC
KNMFATCD75 1AAAA&AAAAAAAA! CLROR 7k)t. )tXXAAX* CC
Latitude/longitude source: ❑GPS Oropographic map
(location of well must be shown on a USGS topo map andattached to
this form if not using GPS)
5. FACILITY (Name of the business where the well is located.)
Macon Elementary School
Facility Name Facility ID# (if applicable)
1166 lotla Church Rd
Street Address
Franklin NC 28734
City or Town State Zip Code
Marnn Cnt tnty Government
Contact Name
Mailing Address
Franklin NC 28734_
City or Town State Zip Code
Area code
Phone number
6. WELL DETAILS:
a. TOTAL DEPTH: 450'
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO EJ(
d. TOP OF CASING IS 2 FT. Above Land Surface'
"Top of casing terminated attor below land surface may require
a variance in accordance with 15A NCAC 2C .011S.
e. YIELD (gpm): 0 METHOD OF TEST Aar Loft
f. DISINFECTION: Type HIC Amount 1 /4 Ctip
g. WATER ZONES (depth):
Top 0 Bottom 0 Top Bottom
:Top Bottom Top Bottom
Top Bottom Top Bottom
Thickness/
7. CASING: Depth Diameter Weight Material
TOP 0 Bottoms Ft.
Top Bottom Ft.
Top Bottom Ft.
8. GROUT: Depth Material Method
TopQ_ Bottom_07 Ft. bentonite pumped
Top 83_ Bottom 450 Ft. washed stonE poured
Top Bottom Ft.
9. SCREEN: Depth Diameter Slot Size Material
Top Bottom Ft. in. in.
Top Bottom Ft. in, in.
Top Bottom Ft. in. in.
10. SAND/GRAVEL PACK:
Depth Size
Top Bottom Ft.
Top Bottom Ft.
Top Bottom Ft.
Material
11. DRILLING LOG
Top Bottom Formation Description
0 / 74 Sand and Clay
74 / 87 Granite Casing Set
87 /_450 Granite
/
/
12. REMARKS:
ease, ig Removed
100 HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
• 15A NCAC 2C, 3U4L CONSTRUCTION STA DARDS, AND THAT A COPY OF THIS
RECORD B �N PROVID TOZELLOW ER.
L9-2
SI AT E OF -CERTIFIED WELL CONTRACTOR DATE
c. WATER LEVEL Below Top of Casing: 0 FT. ; _Rnuar L willaamq
(Use "+" if Above Top of Casing) : PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Form GW-1b
Submit within 30 days of completion to: Division of Water Quality - Information Processing, Rev.1/08
1617 Mail Service Center, Raleigh, NC 27699-161, Phone : [phone]

y�`t.. STArJ; o
NONRESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 3065-A
1. WELL CONTRACTOR:
Roaer L Williams Well Contractor (Individual) Name
Tarheel Water Treatmant
Well Contractor Company Name
3494 Georaia Rd
Street Address
Franklin NC 28734
City or Town State Zip Code
8( 28 ) 369-0740
Area code Phone number
2. WELL INFORMATION:
WELL CONSTRUCTION FERMIT# W IO100141
OTHER ASSOCIATED PERMIT#(if applicable)
SITE WELL ID #(if applicable) D-8
3. WELL USE (Check One Box) Monitoring ❑ Municipal/Public ❑
Industrial/Commercial ❑ Agricultural ❑ Recovery ❑ Injection ❑
Irrigation❑ Other [(list use) Closed Loop Geothere
DATE DRILLED 9-16-1 1
4. WELL LOCATION:
1166 lotla Church Rd
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
CITY: Franklin COUNTY Macon
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
❑Slope ❑Valley I;i(Flat ❑Ridge ❑Other
ICIot$TCD 36 iAAAA&AAAAAAAAI CL R OR 3mX) XX%)WX CC
MKFI$TCD75 iAAAABAAAAAAAAi CLROR 7k.")k"X9t)W CC : Top Bottom Ft.
Latitude/longitude source: j]GPS ❑topographic map
(location of well must be shown on a USGS topo map andattached to
this form if not using GPS)
5. FACILITY (Name of the business where the well is located.)
aeon Elempritgry Snhof)l
Facility Name Faculty ID# (if applicable)
A 1 66 lotln Churnh Rd
Street Address
Franklin NC 28734
_
City or Town State Zip Code
nearnn County Government
Contact Name
Mailing Address
Franklin NC 82734
City or Town State Zip Code
(U)
Area code Phone number
6. WELL DETAILS:
a. TOTAL DEPTH: 450'
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO 0J
Top Bottom Ft.
11. DRILLING LOG
Top Bottom
: 0 / 80
80 / 87
8Z—/ 450
12. REMARKS:
d. TOP OF CASING IS i 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): 1 nn METHOD OF TEST Air Lift
f. DISINFECTION: Type HTC: Amount 'I /4 G11n
g. WATER ZONES (depth):
:Top ?60 Bottom 261 Top Bottom
:Top Bottom Top Bottom
;Top Bottom Top Bottom
Thickness/
7. CASING: Depth Diameter Weight Material
Top_Q_ Bottom 84 Ft.
Top Bottom Ft.
Top Bottom Ft.
8. GROUT: Depth Material Method
Top 0 Bottom 89 Ft. bentonite pumped
Top9 _Bottom 450 Ft. washed stone poured
Top Bottom Ft.
9. SCREEN: Depth Diameter Slot Size Material
Top Bottom Ft. in. in.
Top Bottom Ft. in. in.
Top Bottom Ft. in. in.
10. SAND/GRAVEL PACK:
Depth Size Material
Top Bottom Ft.
Formation Description
Sand and Clay
Granite Casing Set
Granite
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
• �15A�C2 CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
RE PROVIDED TO TH E OWNER.
: SIGNATU OF CERTIFIED WELL CONTRACTOR DATE
c. WATER LEVEL Below Top of Casing: 50 FT Rnapr L Williams
(Use "+" if Above Top of Casing) : PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Form GW-1b
Submit within 30 days of completion to: Division of Water Quality - Information Processing, Rev. 1108
16117 Mail Service Center, Raleigh, NC 27699-161, Phone : [phone]

�► _3. S� NONRESIDENTIAL ONRESIDENTIAL WELL CONSTRUCTION RECORD
( North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 3065-A
1. WELL CONTRACTOR:
Roaer L Williams
Well Contractor (Individual) Name
Tarheel Water Treatmant
Well Contractor Company Name
3494 Georaia Rd
Street Address
Franklin NC 28734
City or Town State Zip Code
8( 28 ) 369-0740
Area code Phone number
2. WELL INFORMATION:
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 15A NCAC 2C .0118.
e. YIELD (gpm): _ 10 METHOD OF TEST Air Lift
f. DISINFECTION: Type_ HTC Amount 1 /4 run
g. WATER ZONES (depth):
:Top 210 Bottom 219 Top Bottom
: Top Bottom Top Bottom
Top Bottom Top Bottom
Thickness/
7. CASING: Depth Diameter Weight Material
WELL CONSTRUCTION PERMIT# W10100141 : Top 0 Bottom 84 Ft.
OTHER ASSOCIATED PERMIT#(if applicable) : Top Bottom Ft.
SITE WELL ID #(if applicable) E-1 Top Bottom Ft.
3. WELL USE (Check One Box) Monitoring ❑ Municipal/Public ❑
Industrial/Commercial ❑ Agricultural ❑ Recovery ❑ Injection ❑
Irrigation[] Other (((list use) Closed LOOD Geother©
DATE DRILLED-1 0- 18-11
4. WELL LOCATION:
1166 lotla Church Rd
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
CITY: Franklin COUNTY Macon
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
❑Slope ❑Valley JyFlat ❑Ridge ❑Other
Krrs MTCD 36 iAAAA&AAAAAAAAI CL ROR 3mxXxlxxxxxx CC
KNMFI$TCD75 iAAAA&AAAAAAAAI CLROR TX.")kX9(ow cc
Latitude longitude source: ❑GPS aopographic map
(location of well must be shown on a USGS topo map andattached to
this form if not using GPS)
5. FACILITY (Name of the business where the well is located.)
Macon Elementary School
Facility Name Facility ID# (if applicable)
1166 lotla Church Rd
Street Address
Franklin NO 28734
City or Town State Zip Code
Macon County Government
Contact Name
Mailing Address
Franklin N . 287.34
City or Town State Zip Code
Area code Phone number
6. WELL DETAILS:
a. TOTAL DEPTH: 450'
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO 0/
8. GROUT: Depth Material Method
Top 0 Bottom 89 Ft. bentonite Dumped
Top 89 Bottom 450 Ft. Washed stone poured
Top Bottom Ft.
9. SCREEN: Depth Diameter Slot Size Material
Top Bottom Ft. in. in.
Top Bottom Ft. in. in.
Top Bottom Ft. in. in.
10. SAND/GRAVEL PACK:
Depth Size
Top Bottom Ft.
Top Bottom Ft.
Top Bottom Ft.
11. DRILLING LOG
Top Bottom
0 / 79
79 / 84
4 / 450
12. REMARKS:
Material
Formation Description
Sand and Clay
Granite Casino Set
Granite
100 HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
• 15A NCAC 2C LL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
RECORD bIAS VEN PRO 1DEYTOT W L NER.
l 10-18-11
S19NATURE OF CERTIFIED WELL CONTRACTOR DATE
c. WATER LEVEL Below Top of Casing: _50 FT. ROsjer L WIIIIamG
(Use "+" if Above Top of Casing) : PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit within 30 days of completion to: Division of Water Quality Form /08
Y P ty - Information Processing, Rev. 1/08
1617 Mail Service Center, Raleigh, NC 27699-161, Phone : [phone]

NONRESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 3065-A
1. WELL CONTRACTOR:
Roder L Williams
Well Contractor (Individual) Name
Tarheel Water Treatmant
Well Contractor Company Name
3494 Georgia Rd
Street Address
Franklin NC 28734
City or Town State Zip Code
d. TOP OF CASING IS 2 FT. Above Land Surface*
'Top of casing terminated attor below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
: e. YIELD (gpm): 60 METHOD OF TEST Alr Lift
f. DISINFECTION: Type HTC: Amount 1 /4 Clip
g. WATER ZONES (depth):
Top 210 Bottom 212 Top Bottom
Top 330 Bottom 332 Top Bottom
8( 28 ) 369-0740 ; Top Bottom Top Bottom
Area code Phone number
Thickness/
2. WELL INFORMATION: : 7. CASING: Depth Diameter Weight Material
WELL CONSTRUCTION PERMIT# W10100141 : Top 0 Bottoms Ft.
OTHER ASSOCIATED PERMIT#(if applicable) :Top Bottom Ft.
SITE WELL ID #(if applicable) E-2 ; Top Bottom Ft.
3. WELL USE (Check One Box) Monitoring ❑ Municipal/Public ❑
Industrial/Commercial ❑ Agricultural ❑ Recovery ❑ Injection ❑
Irrigation❑ Other 0ii( list use) Closed LoOD Geotherm
DATE DRILLED 10-17-1 1
4. WELL LOCATION:
1166 lotla Church Rd
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
CITY: Franklin COUNTY Macon
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
[]Slope ❑ Valley Flat ❑ Ridge ❑ Other
K 3BTCD 36 IAAAA&AAAAAAAA! CL R OR 3X0§XXX9t)(9@kX CC
KNMFMTCD75 iAAAA&AAAAAAAA! CL ROR 7k"1kXX00W CC
Latitude/longitude source: ❑GPS ❑topographic map
(location of well must be shown on a USGS topo map andattached to
this form if not using GPS)
5. FACILITY (Name of the business where the well is located.)
Macon Elementary School
Facility Name Facility ID# (if applicable)
1166 lotla Church Rd
Street Address
Franklin NC 28734
City or Town State Zip Code
Macon County Government
Contact Name
: 8. GROUT: Depth Material Method
Top 0 Bottom 89 Ft. bentonite pumped
Top 89 Bottom 450 Ft. washed stone poured
Top Bottom Ft.
9. SCREEN: Depth Diameter Slot Size Material
Top Bottom Ft. in. in.
Top Bottom Ft. in. in.
Top Bottom Ft. in. in.
10. SAND/GRAVEL PACK:
Depth Size
Top Bottom Ft.
Top Bottom Ft.
Top Bottom Ft.
11. DRILLING LOG
Top Bottom
0 / 75
: 75 / 81
81 450
Mailing Address /
Franklin NC 28734 /
City or Town State Zip Code
: 12. REMARKS:
(U)
Area code Phone number
S. WELL DETAILS:
a. TOTAL DEPTH: 450'
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO q/
Material
Formation Description
Sand and Clay
Granite Casino Set
Granite
100 HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
• 15A NCAC 2C, W CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
RECORD H�BE PROVI ED TOTE E NER.
� 10-17-11
SIGNATUflE OF CERTIFIED WELL CONTRACTOR DATE
c. WATER LEVEL Below Top of Casing: 50 FT. : Roger L wllllamS
(Use "+^ if Above Top of Casing) : PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit within 30 days of completion to: Division of Water Quality Information Processing, Form /08
Y P tY - 9 Rev.1/oa
1617 Mail Service Center, Raleigh, NC 27699-161, Phone : [phone]

rs STAIE��
NONRESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 3065-A
1. WELL CONTRACTOR:
Roper L Williams
Well Contractor (Individual) Name
Tarheel Water Treatmant
Well Contractor Company Name
3494 Georaia Rd
Street Address
Franklin NC 28734
City or Town State Zip Code
8( 28 ) 369-0740
Area code Phone number
2. WELL INFORMATION:
WELL CONSTRUCTION PERMIT# Wl0100141
: 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 15A NCAC 2C .0118.
e. YIELD (gpm): 80 METHOD OF TEST Air Lift
f. DISINFECTION: Type HTC: Amount 1 /4 CIt1]_
g. WATER ZONES (depth):
:Top 332 Bottom 334 Top Bottom
:Top Bottom Top Bottom
;Top Bottom Top Bottom
Thickness/
7. CASING: Depth Diameter Weight Material
Top 0 Bottom 84 Ft.
OTHER ASSOCIATED PERMIT#(if applicable)
Top
Bottom
Ft.
SITE WELL ID #(if applicable) E-3
Top
Bottom
Ft.
3. WELL USE (Check One Box) Monitoring ❑ Municipal/Public ❑
: 8. GROUT:
Depth
Material Method
Industrial/Commercial ❑ Agricultural ❑ Recovery ❑ Injection ❑
: Top 0
Bottom 89
Ft. bentonite Dumped
Irrigation❑ Other IS((IiSt use) Closed LOOD Geother©
: Top_33 _Bottom 450
Ft. washed stone poured
DATE DRILLED 10-14-1 1
;Top
Bottom
Ft.
4. WELL LOCATION:
1166 lotla Church Rd
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
CITY: Franklin COUNTY Macon
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
[]Slope []Valley Flat ❑Ridge ❑Other
KOI$TCD 36 iAAAA&AAAAAAAA! CL R OR 3K0X)gXX00t9 X CC
KNMF BTCD 75 iAAAA&AAAAAAAA! CL R OR 7)1!. )kX9 Mft CC
Latitude/longitude source: ❑GPS Elropographic map
(location of well must be shown on a USGS topo map andattached to
this form if not using GPS)
5. FACILITY (Name of the business where the well is located.)
Macon Elementary School
Facility Name Facility ID# (if applicable)
1166 In_tla_ Church Rd
Street Address
Franklin NC 28734
City or Town State Zip Code
Macon County Government
Contact Name
Mailing Address
Franklin NC 28734
City or Town State Zip Code
()
Area code Phone number
9. SCREEN: Depth Diameter Slot Size Material
Top Bottom Ft. in. in.
Top Bottom Ft. in. in.
: Top Bottom Ft. in
: 10. SAND/GRAVEL PACK:
Depth Size
Top Bottom Ft.
Top Bottom Ft.
Top Bottom Ft.
11. DRILLING LOG
Top Bottom
0 / 75
75 / 81
81 / 450
12. REMARKS:
in.
Material
Formation Description
Sand and Clay
Granite Casino Set
Granite
6. WELL DETAILS: ; I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
• 15A NCAC 2 L CONSTRUCTIOP STANDARDS, AND THAT A COPY OF THIS
a. TOTAL DEPTH: 450� :RECORD S N PRO DED TO E E OWNER.
J - 10-14-11
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO d : SI NAT E OF CERTIFIED WELL CONTRACTOR DATE
c. WATER LEVEL Below Top of Casing: 50 FT. Roger L williamG
(Use "+" if Above Top of Casing) : PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Form GW-1b
Submit within 30 days of completion to: Division of Water Quality - Information Processing, Rev.1/08
1617 Mail Service Center, Raleigh, NC 27699-161, Phone : [phone]

NONRESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 3065-A
1. WELL CONTRACTOR:
Roaer L Williams
Well Contractor (Individual) Name
Tarheel Water Treatmant
Well Contractor Company Name
3494 Georaia Rd
Street Address
Franklin NC 28734
City or Town State Zip Code
d. TOP OF CASING IS 2 FT. Above Land Surface'
'Top of casing terminated attor below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): 0 METHOD OF TEST Air Lift
f. DISINFECTION: Type HTC Amount 1 /4 C up
g. WATER ZONES (depth):
:Top 0 Bottom_ Top Bottom
Top Bottom Top Bottom
8( 28 ) 369-0740
; Top
Bottom Top Bottom
Area code Phone number
Thickness/
2. WELL INFORMATION:
: 7. CASING:
Depth Diameter Weight Material
WELL CONSTRUCTION PERMIT# W101 00 141
: Top_0
Bottom 84 Ft.
OTHER ASSOCIATED PERMIT#(if applicable)
Top
Bottom Ft.
SITE WELL ID #(if applicable) EA
Top
Bottom Ft.
3. WELL USE (Check One Box) Monitoring ❑ Municipal/Public ❑
: 8. GROUT:
Depth Material Method
Industrial/Commercial ❑ Agricultural ❑ Recovery ❑ Injection ❑
: Top 0
Bottom 89 Ft. bentonite pumped
Irrigation❑ Other I1(11st use) Closed LoOD Geotherd
; Top 89
Bottom 450 Ft. Washed StonE poured
DATE DRILLED-1 0-6-11
; Top
Bottom Ft.
4. WELL LOCATION:
1166 lotla Church Rd
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
CITY: Franklin COUNTY Macon
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
❑Slope ❑Valley 601at []Ridge ❑Other
K 3BTCD 36 IAAAA&AAAAAAAA! CL ROR 3X^XXX'XPAMWX CC
KNMFISTCD75 IAAAABAAAAAAAA! CLROR tA)t5=XXX)W CC
Latitude longitude source: EIGPS aopographic map
(location of well must be shown on a USGS topo map andattached to
this form if not using GPS)
S. FACILITY (Name of the business where the well is located.)
Macon Elementary School
Facility Name Facility ID# (if applicable)
1166 lotla Church Rd
Street Address
Franklin NC 28734
City or Town State Zip Code
Macon County Government
Contact Name
Mailing Address
Franklin NC 28734
City or Town State Zip Code
Area code
Phone number
S. WELL DETAILS:
a. TOTAL DEPTH: 450'
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO qI
9. SCREEN: Depth Diameter Slot Size Material
Top Bottom Ft. in. in.
Top Bottom Ft. in.
Top Bottom Ft. in.
: 10. SAND/GRAVEL PACK:
Depth Size
Top Bottom Ft.
Top Bottom Ft.
Top Bottom Ft.
11. DRILLING LOG
Top Bottom
0 / 80
80 / 87
87 / 450
/
/
12. REMARKS:
in.
in.
Material
Formation Description
Sand and Clay
Granite Casino Set
Granite
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
• 15A NCAC 2C LL CONSTRUCTION ST DARDS, AND THAT A COPY OF THIS
RECORD 1B N PROVID TO THE E ER.
10-6-11
: SlafikPSRE OF 6ERTIFIED WELL CONTRACTOR DATE
c. WATER LEVEL Below Top of Casing: 0 FT. Roper L Williams
(Use "+" if Above Top of Casing) : PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Form GW-1b
Submit within 30 days of completion to: Division of Water Quality - Information Processing, Rev.1/08
1617 Mail Service Center, Raleigh, NC 27699-161, Phone : [phone]

NONRESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 3065-A
1. WELL CONTRACTOR:
Roger L Williams
Well Contractor (Individual) Name
Tarheel Water Treatmant
Well Contractor Company Name
3494 Georaia Rd
Street Address
Franklin NC 28734
City or Town State Zip Code
8( 28 ) 369-0740
Area code Phone number
2. WELL INFORMATION:
: d. TOP OF CASING IS 9_ 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): 0 METHOD OF TEST Air Lift
f. DISINFECTION: Type HT . Amount 1 /4 Cup
g. WATER ZONES (depth):
Top 0 Bottom 0 Top Bottom
Top Bottom Top Bottom
Top Bottom Top Bottom
Thickness/
7. CASING: Depth Diameter Weight Material
WELL CONSTRUCTION PERMIT# W10100141 : Topes_ Bottom 84 Ft.
OTHER ASSOCIATED PERMIT#(if applicable) Top Bottom Ft.
SITE WELL ID #(if applicable) E-5 : Top Bottom Ft.
3. WELL USE (Check One Box) Monitoring ❑ Municipal/Public ❑
Industrial/Commercial ❑ Agricultural ❑ Recovery ❑ Injection ❑
Irrigation❑ Other !t((!istuse) Closed LOOD Geothern
DATE DRILLED 10-5-1 1
4. WELL LOCATION:
1166 lotla Church Rd
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
CITY: Franklin COUNTY Macon
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
[]Slope []Valley Flat []Ridge []Other
KOMTCD 36 iAAAA&AAAAAAAAI CL R OR 3mXXXXrAX MX CC
KNMFk6TCD75 iAAAA&AAAAAAAA! CL ROR 7A.') XXX'XW CC
Latitude/longitude source: ❑GPS aopographic map
(location of well must be shown on a USGS topo map andattached to
this form if not using GPS)
S. FACILITY (Name of the business where the well is located.)
Macon Elementary School
Facility Name Facility ID# (if applicable)
1166 lotla Church Rd
Street Address
Franklin NC 28734
City or Town State Zip Code
Macon County Government
Contact Name
Mailing Address
Franklin NC 28734
City or Town State Zip Code
()
Area code
Phone number
6. WELL DETAILS:
a. TOTAL DEPTH: 450'
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO qI
8. GROUT: Depth Material Method
Top_0 Bottom 8_ Ft. bentonite bumped
Top 89 Bottom 450 Ft. washed stone poured
Top Bottom Ft.
9. SCREEN: Depth Diameter Slot Size Material
Top Bottom Ft. in. in.
Top Bottom Ft. in. in.
Top Bottom Ft. in. in.
10. SAND/GRAVEL PACK:
Depth Size
Top Bottom Ft.
Top Bottom Ft.
Top Bottom Ft.
11. DRILLING LOG
Top Bottom
0 / 77
77 / 84
84 1 450
/
12. REMARKS:
Material
Formation Description
Sand and Clay
Granite Casino Set
Granite
100 HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
15A NCAC 2C, L CONSTRUCTI�DARDS, AND THAT A COPY OF THIS
RECORD B N PRO DED TO TH EL O NER.
10-5-11
S16NATURE OF CERTIFIED WELL CONTRACTOR DATE
c. WATER LEVEL Below Top of Casing: 0 FT. ; RQQPr L Williams
(Use "+" if Above Top of Casing) : PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Form GW-1b
Submit within 30 days of completion to: Division of Water Quality - Information Processing, Rev.1/08
1617 Mail Service Center, Raleigh, NC 27699-161, Phone : [phone]

t NONRESIDENTIAL ONRESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 3065-A
1. WELL CONTRACTOR:
Roaer L Williams
Well Contractor (Individual) Name
Tarheel Water Treatmant
Well Contractor Company Name
3494 Georaia Rd
Street Address
Franklin NC 28734
City or Town State Zip Code
8( 28 ) 369-0740
Area code Phone number
2. WELL INFORMATION:
WELL CONSTRUCTION PERMIT# W10100141
OTHER ASSOCIATED PERMIT#(if applicable)
SITE WELL ID #(if applicable) E-6
3. WELL USE (Check One Box) Monitoring ❑ Municipal/Public ❑
Industrial/Commercial ❑ Agricultural ❑ Recovery ❑ Injection ❑
Irrigation❑ Other N((list use) Closed LooD Geothero
DATE DRILLED-1 0-4-11
4. WELL LOCATION:
1166 lotla Church Rd
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
CITY: Franklin COUNTY Macon
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
[]Slope ❑ Valley Flat ❑ Ridge []Other
Krc�ISTCD 36 iAAAA&AAAAAAAA! CL R OR 3X0AX t'XXXMt X CC
KNMFKTCD75 IAAAA&AAAAAAAA! CL ROR 7X:X7 "XX`XX* CC
Latitude/longitude source: E]GPS aopographic map
(location of well must be shown on a USGS topo map andattached to
this fort if not using GPS)
5. FACILITY (Name of the business where the well is located.)
Macon Flerripiritaryqchoni
Facility Name Facility ID# (if applicable)
1166 lotla Church Rd
Street Address
Franklin NC 28734
City or Town State Zip Code
Macon County Gov .mm _nt
Contact Name
Mailing Address
Franklin NC 28734
City or Town State Zip Code
Area code
Phone number
d. TOP OF CASING IS 2 FT. Above Land Surface'
'Top of casing terminated attor below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): _ 0 METHOD OF TEST Air Loft
f. DISINFECTION: Type_HTC Amount 1/4 Ctil]_
g. WATER ZONES (depth):
Top 0 Bottom_0 Top Bottom
: Top Bottom Top Bottom
Top Bottom Top Bottom
Thickness/
7. CASING: Depth Diameter Weight Material
Top 0 Bottom 84 Ft.
Top Bottom Ft.
Top Bottom Ft.
: 8. GROUT: Depth Material Method
Top_0 Bottom 89 Ft. bentonite pumped
Top 89 Bottom 450 Ft. washed stone poured
Top Bottom Ft.
9. SCREEN: Depth Diameter Slot Size Material
Top Bottom Ft. in.
Top Bottom Ft. in.
Top Bottom Ft. in.
10. SAND/GRAVEL PACK:
Depth Size
Top Bottom Ft.
Top Bottom Ft.
Top Bottom Ft.
in.
in.
in.
Material
: 11. DRILLING LOG
Top Bottom Formation Description
0 / 80
80 / 87
87 / 450
12. REMARKS:
Sand and Clay
Granite Casino Set
Granite
6. WELL DETAILS: 100 HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
• 15A NCAC 2C ELL CONSTRUCTION y�TANDARDS, AND THAT A COPY OF THIS
a. TOTAL DEPTH: 450� : RECORD B EN PRO TO T E W WNER
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO G/ Gff 10-4-11
SIGNATLIRE OF CERTIFIED WELL CONTRACTOR DATE
c. WATER LEVEL Below Top of Casing: 0 FT. : Roger L Williams
(Use "+" if Above Top of Casing) : PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit within 30 days of completion to: Division of Water Quality - Information Processing, Form Rev. 1 /08 /OS
1617 Mail Service Center, Raleigh, NC 27699-161, Phone : [phone]

NONRESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 3065 A
1. WELL CONTRACTOR:
Roger L Williams
Well Contractor (Individual) Name
Tarheel Water Treatmant
Well Contractor Company Name
3494 Georgia Rd
Street Address
Franklin NC 28734
City or Town State Zip Code
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 15A NCAC 2C .0118.
e. YIELD (gpm): 20 METHOD OF TEST Air Lift
f. DISINFECTION: Type HTC Amount 1 /4 (,up
g. WATER ZONES (depth):
Top 250 Bottom 252 Top Bottom
Top Bottom Top Bottom
8( 28 ) 369-0740 : Top Bottom Top Bottom
Area code Phone number Thickness/
2. WELL INFORMATION: : 7. CASING: Depth Diameter Weight Material
WELL CONSTRUCTION PERMIT# W10100141 : Top 0 Bottom 84 Ft.
OTHER ASSOCIATED PERMIT#(if applicable)
SITE WELL ID #(if applicable) E-7
3. WELL USE (Check One Box) Monitoring ❑ Municipal./Public ❑
Industrial/Commercial ❑ Agricultural ❑ Recovery ❑ Injection ❑
Irrigation❑ Other N((list use) Closed Loop Geotherla
DATE DRILLED 10-3-1 1
4. WELL LOCATION:
1166 lotla Church Rd
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
CITY: Franklin COUNTY Macon
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
❑Slope ❑Valley JrFlat ❑Ridge []Other
K@3ATCD 36 . iAAAA&AAAAAAAA! CL R OR 3X^XXXXOOMX CC
KNMFMTCD75 iAAAA&AAAAAAAA! CL ROR 7k!X4QlM1kXX)0ft CC
Latitude/longitude source: ❑SPS E]ropographic map
(location of well must be shown on a USGS topo map andattached to
this form if not using GPS)
6. FACILITY (Name of the business where the well is located.)
Macon Flementary School
Facility Name Facility ID# (if applicable)
1166 lotla Church Rd
Street Address
Franklin NC 28734
City or Town State Zip Code
Macon County Government
Contact Name
Mailing Address
Franklin NC 28734
City or Town State Zip Code
U
Area code
Phone number
6. WELL DETAILS:
a. TOTAL DEPTH: 4501
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO qI
: Top Bottom Ft. _
Top Bottom Ft. _
8. GROUT: Depth Material Method
Top 0 Bottom 89 Ft. bentonite pumped
Top__ Bottom, 450 Ft. washed stone poured
Top Bottom Ft.
9. SCREEN: Depth Diameter Slot Size Material
Top Bottom Ft. in. in.
Top Bottom Ft. in
Top Bottom Ft. in
10. SAND/GRAVEL PACK:
Depth Size
Top Bottom Ft,
Top Bottom Ft.
Top Bottom Ft.
11. DRILLING LOG
Top Bottom
0 / 80
80 / 87
87 1 450
/
12. REMARKS:
in.
in.
Material
Formation Description
Sand and Clay
Granite Casing Set
Granite
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
• 15A NCAC 2C LL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
RECORD S EN PROV ED EW! WNER
10-3-11
SIGNAT RE OF CERTIFIED WELL CONTRACTOR DATE
c. WATER LEVEL Below Top of Casing: 50 FT. : ROper L Williams
(Use "+^ if Above Top of Casing) : PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Form GW-1b
Submit within 30 days of completion to: Division of Water Quality - Information Processing, Rev.1/08
1617 Mail Service Center, Raleigh, NC 27699-161, Phone : [phone]

NONRESIDENTL4L WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 3118 A
1. WELL CONTRACTOR:
Timothy R Hamby
Wen Contractor (individual) Name
Midsouth Geothermal
Well Contractor Company Name
8275 Toumament Dr STE 5
Street Address
Memphis TN 38125
City or Town State Zip Code
9c 01 .748-9095
Area code Phone number
2. WELL INFORMATION:
WELL CONSTRUCTION PERMIT# WI0100141
OTHER ASSOCIATED PEOIIT#('If applicable)
SITE WELL ID #(if applicable)_:
3. WELL USE (Check One Box) Monitoring ❑ Municipal/Public ❑
Industrial/Commercial ❑ Agricultural ❑ Recovery ❑ Injection ❑
Irrigation❑ other_ idpist use) Closed LoOD Geothenn
DATE DRILLED_ �—il _
4. WELL LOCATION:
1166 Lotla Church Rd
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
CITY: Franklin COUNTY Macon
TOPOGRAPHIC I LAND SETTING: (check appropriate box)
[]Slope []Valley @Flat ❑Ridge []Other
LATITUDE 36 ° " DMS OR 3x.x)00tJO0txx DD
LONGITUDE 75 " DMS OR 7x.)000OD000 DD
Latitudellongitude source: (BPS propographic map
(location of well must be shown on a USGS topo map andattached to
this form if not using GPS)
5. FACILITY (Name of the business where the well is located.)
Macon Flementry School
Facility Name Facility ID# (f applicable)
1166 Lotla Church Rd
Street Address
Franklin NC 28734
City or Town State Zip Code
Contact Name
Mailing Address
Franklin NC 28743
City or Town State Zip Code
U
Area code Phone number
6. WELL DETAILS:
a. TOTAL DEPTH:'2g-S-
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 2 FT. Above Land Surface*
'Top of casing terminated at/or below land surface may require
a variance in accordance with 1 SA NCAC 2C .0118.
= e. YIELD (gpm): 100 METHOD OF TEST BIOW Down
: f. DISINFECTION: Type )-ITC Amount 1207
: g. WATER ZONES (depth):
Tom Bottom Top Bottom
Top2L6 Bottom .2-61 Top Bottom
: Top Bottom Top Bottom
Thickness/
: 7. CASING: Depth Diameter Weight Material
Top +2 Bottom M I Ft. 1 8 .188 steel
Top Bottom Ft
: Top Bottom Ft
8. GROUT: Depth Material Metho#
Top Bottom_ Ft_A!jLia[. `t—
TopBottom Ft L- Yr" r-A
- Top Bottom Ft
9. SCREEN: Depth Diameter Slot Siza Material
Top Bottom Ft. in. in.
= Top Bottom Ft. in. in.
Top Bottom Ft. in. in.
10. SAND/GRAVEL PACK:
Depth size Material
: Top Bottom Ft..
Top Bottom Ft.
Top Bottom Ft.
: 11. DRILLING LOG
Top Bottom Formation Description
4W �l�nMo
�/
: 12. REMARKS:
easing rentoved
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
15A NCAC 2C. WELL CONSTRUCTION STANDARDS. AND THAT A COPY OF THIS
RECORD HAS BEEN PROVIDED O THE WELL OWNER.
: SIGN RE OF CERTIFIED WELL CONTRACTOR DATE
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit within 30 days. of completion toForth GW-1 b: Division of Water Quality - Information Processing,. Rev. 2/09
1617 Mail Service Center, Raleigh; NC 27699461, Phone: [phone].

1 ♦ ON RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
>u?� WELL CONTRACTOR CERTIFICATION # 3065-A
1. WELL CONTRACTOR:
Roaer L Williams
Well Contractor (Individual) Name
Tarhe I Water Treatment
Welt Contractor Company Name
3494 Georgia RD
Street Address
Franklin NC 28734
City or Town State Zip Code
8( 28 ) 369-0740
Area code Phone number
2. WELL INFORMATION:
WELL CONSTRUCTION PERMIT# W101 00 141
OTHER ASSOCIATED PERMIT#(if Iicable)
SITE WELL ID #(if applicable) Z d'
3. WELL USE (Check One Box) Monitoring ❑ Municipal/Public ❑
Industrial/Commercial ❑ Agricultural ❑ Recovery ❑ Injection ❑
Irrigation❑ Other (list use) Closed IooD Geotherm
DATE DRILLED
4. WELL LOCATION:
1166 Lotla Church Rd
(Street Name. Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
CITY: Franklin COUNTY Macon
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
❑ Slope ❑ Valley elat ❑ Ridge ❑ Other
K@iNSTCD 36 IAAAA&AAAAAAAA! CL ROR 21mxxxxo0®PJkrx CC
IWMF 16TCD 75 iAAAABtAAAAAAAA! CL R OR 7)t.'X%A]tX (VM CC
Latitude/longitude source: ❑GPS []Topographic map
(location of well must be shown on a USGS topo map andattached to
this form if not using GPS)
5. FACILITY (Name of the business where the well is located.)
Macon Rpmentary
Facility Name Facility ID# (if applicable)
1166 L ntla Church Rd
Street Address
Franklin NC 28734
City or Town State Zip Code
M,qrnn County GOVPmment
Contact Name
Mailing Address
Franklin NC 28743
City or Town State Zip Code
Area code Phone number
6. WELL DETAILS: /
a. TOTAL DEPTH:
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO qI
c. WATER LEVEL Below Top of Casing: d FT.
(Use'+" if Above Top of Casing)
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 15A NCAC 2C .0118.
e. YIELD (gpm): - 0 METHOD OF TEST RIOW DOWn
f. DISINFECTION: Type Hj . Amount 12 7
g. WATER ZONES (depth):
Top16'nC Bottom Top Bottom
Top Bottom Top Bottom
Top Bottom Top Bottom
Thickness/
7. CASING, Depth _ Diameter Weight Material
Top � Bottom Ft.
Top Bottom Ft.
Top Bottom Ft.
8. GROUT: Depth IGv Material Method
Topes_ Bottom 4'a + Ft. Bentonite Pumped
Top (00 Bottom Ft ut ,&44 gn!. Po&--d
Top Bottom Ft.
9. SCREEN: Depth Diameter Slot Size Material
Top Bottom Ft. in. in.
Top Bottom Ft. in. in.
Top Bottom Ft. in. in.
10. SAND/GRAVEL PACK:
Depth Size
Top Bottom Ft.
Top Bottom Ft.
Top Bottom Ft.
Material
11. DRILLING LOG
Top Bottom Formation Description
12. REMARKS:
easing Removed
I DO HEREBY RTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
• 15A NCAC CONSTRUCTION ANDARDS, AND THAT A COPY OF THIS
RECORD AS AEN PRO D TO EWE OWNER
SI Aroeqe-K
OF CERTIFIE WELL CONTRACTOR DATE
�_, ki%711'atni
: PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Form GW-1b
Submit Within 30 days of completion to: Division of Water Quality - Information Processing, Rev. 1108
1617 Mail Service Center, Raleigh, NC 27699-161, Phone: [phone]

.'\'d
NONRESIDENTIAL ONRESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 3065-A
1. WELL CONTRACTOR:
Roder L Williams
Well Contractor (Individual) Name
Tarheel Water Treatmant
Well Contractor Company Name
3494 Georaia Rd
Street Address
Franklin NC 28734
City or Town State Z!p Code
8( 28 ) 369-0740
Area code Phone number
2. WELL INFORMATION:
WELL CONSTRUCTION PERMIT#W10100141
OTHER ASSOCIATED PERMIT#(if applicable)
SITE WELL ID #(ifapplicable) F-1
3. WELL USE (Check One Box) Monitoring ❑ Municipal/Public ❑
Industrial/Commercial ❑ Agricultural ❑ Recovery ❑ Injection ❑
Irrigation❑ Other !i ((list use) Closed LOOD Geothere
DATE DRILLED 11 -3-11
4. WELL LOCATION:
1166 lotla Church Rd
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
CITY: Franklin COUNTY Macon
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
❑Slope []Valley JiFlat ❑Ridge ❑Other
K016TCD 36 iAAAA&AAAAAAAA! CL R OR 3) XXXXfAXMX CC
KNIMF I$TCD75 iAAAA&AAAAAAAA! CL ROR 7)t.X9 xXXt'kW CC
Latitude/longitude source: ❑GPS OTopographic map
(location of well must be shown on a USGS topo map andattached to
this form if not using GPS)
5. FACILITY (Name of the business where the well is located.)
Macon FIPmPntary School
Facility Name Facility ID# (if applicable)
1166 lotla Church Rd
Street Address
Franklin NC 28734
City or Town State Zip Code
Macon County Government
Contact Name
Mailing Address
Franklin NC 28734
City or Town State Zip Code
Area code
Phone number
S. WELL DETAILS:
a. TOTAL DEPTH: 450'
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO G✓
d. TOP OF CASING IS 0 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): 20 METHOD OF TEST Aar Laft
f. DISINFECTION: Type HT . Amount 1 /4 Cup
: g. WATER ZONES (depth)
:Top 240 Bottom 242 Top Bottom
:Top Bottom Top Bottom
Top Bottom Top Bottom
Thickness/
7. CASING: Depth Diameter Weight Material
Top Bottom 89 Ft.
Top Bottom Ft.
Top Bottom Ft.
8. GROUT: Depth Material Method
Topes_ Bottom 94 Ft. bentonite pumped
Top 9_ Bottom 450 Ft. washed stone poured
Top Bottom Ft.
9. SCREEN: Depth Diameter Slot Size Material
Top Bottom Ft. in. in.
Top Bottom Ft. in. in.
Top Bottom Ft. in. in.
10. SAND/GRAVEL PACK:
Depth Size
Top Bottom Ft.
Top Bottom Ft.
Top Bottom Ft.
11. DRILLING LOG
Top Bottom
0 / 84
84 / 89
89 / 450
: 12. REMARKS:
Material
Formation Description
Sand and Clay
Granite Casino set
Granite
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
• 15A NCAC 2C, W4L CONSTRUCTION ST NDARDS, AND THAT A COPY OF THIS
RECORD B N PROV ED TO TH E NER.
l 11-3-11
S16NATLTkE OF CERTIFIED WELL CONTRACTOR DATE
c. WATER LEVEL Below Top of Casing: 50 FT. ; _ tiger L walliams
(Use "+^ if Above Top of Casing) : PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Form GW-1b
Submit within 30 days of completion to: Division of Water Quality - Information Processing, Rev.1/08
1617 Mail Service Center, Raleigh, NC 27699-161, Phone : [phone]

-! NONRESIDENTIAL ON ESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
.+, ELL CONTRACTOR CERTIFICATION #
3065-A
W
1. WELL CONTRACTOR:
Roaer L Williams
Well Contractor (Individual) Name
Tarheel Water Treatmant
Well Contractor Company Name
3494 Georaia Rd
Street Address
Franklin NC 28734
City or Town State Zip Code
8t 28 ) 369-0740
Area code Phone number
2. WELL INFORMATION:
WELL CONSTRUCTION PERMIT# W IO100141
OTHER ASSOCIATED PERMIT#(if applicable)
SITE WELL ID #(if applicable) F-2
3. WELL USE (Check One Box) Monitoring ❑ Municipal/Public ❑
Industrial/Commercial Cl Agricultural ❑ Recovery ❑ Injection ❑
Irrigation❑ Other 661ist use) Closed Loop Geotherla
DATE DRILLED 11-1-11
4. WELL LOCATION:
1166 lotla Church Rd
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Cade)
CITY: Franklin COUNTY Macon
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
❑ Slope []Valley 6(Flat []Ridge []Other
K(W,ISTCD 36 iAAAA&AAAAAAAAI CL R OR 3mxXxxo0wx CC
KNIVFBTCD75 iAAAA&AAAAAAAAI CLROR 7`X'!X'X`R`7(1(9)OM CC
Latitude/longitude source: ❑GPS ❑Topographic map
(location of well must be shown on a USGS topo map andattached to
this form if not using GPS)
S. FACILITY (Name of the business where the well is located.)
ItA'+nnn Rementary School
Facility Name Facility ID# (if applicable)
1 166 Intla Church Rd
Street Address
Franklin NC 28734
City or Town State Zip Code
nAaran Coi into Gnyernmpat
Contact Name
Mailing Address
Franklin NG 28734
City or Town State Zip Code
U
Area code
Phone number
S. WELL DETAILS:
a. TOTAL DEPTH: 45n,
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO qI
d. TOP OF CASING IS n 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): 20 METHOD OF TEST Alr Ift
f. DISINFECTION: Type 3JG Amount J /4 dID
g. WATER ZONES (depth):
:Top 240 _ Bottom 242 ToP Bottom
:Top Bottom Top Bottom
Top Bottom Top Bottom
Thickness/
7. CASING: Depth Diameter Weight Material
Topes_ Bottom 89 _ Ft.
Top Bottom
Ft.
Top Bottom
Ft.
8. GROUT: Depth
Material Method
Topes_ Bottom 94 —
Ft. benW0 t9 PUMPed
Top 94 Bottom 450
Ft. washed stone -poured
Top Bottom
Ft.
9. SCREEN: Depth
Diameter Slot Size Material
: Top Bottom
Ft. in. in.
Top Bottom
Ft, in. in.
Top Bottom
Ft. in. in.
10. SAND/GRAVEL PACK:
Depth Size
Top
Bottom Ft.
Top
Bottom Ft.
Top
Bottom Ft.
11. DRILLING LOG
Top Bottom
0 / 84
84 / 89
89 1 450
/
: 12. REMARKS:
Material
Formation Description
Sand and CIS
Granite Casing set
Granite -
100 HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
• 15A NCAC LL CONSTRUCTION ST DARDS, AND THAT A COPY OF THIS
RECORR` AS PEtN PROV D D TO TH NER.
Lvi� 11_1_11
SIdINATURE OF CERTIFIED WELL CONTRACTOR DATE
c. WATER LEVEL Below Top of Casing: Sn FT. Rnqpr L Williams
(Use "+" if Above Top of Casing) : PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Form GW-1b
Submit within 30 days of completion to: Division of Water Quality - Information Processing, Rev. 1/08
1617 Mail Service Center; Raleigh, NC 27699-161, Phone : [phone]

STArF 'A3.
NONRESIDENTIAL ONRESIDENTIAL WELL CONSTRUCTION RECORD
.`t North Carolina Department of Environment and Natural Resources- Division of Water Quality
��` ° ^' • WELL CONTRACTOR CERTIFICATION # 3065-A
•hg paw .4•'.:
1. WELL CONTRACTOR:
Roger L Williams
Well Contractor (Individual) Name
Tarheel Water Treatmant
Well Contractor Company Name
3494 Georaia Rd
Street Address
Franklin NC 28734
City or Town State Zip Code
8( 28 ) 369-0740
Area code Phone number
2. WELL INFORMATION:
d. TOP OF CASING IS 0 FT. Above Land Surface -
'Top of casing terminated attor below land surface may require
a variance in accordance with 15A NCAC 2C .011 S.
: e. YIELD (gpm): 10 METHOD OF TEST Air Lift
f. DISINFECTION: Type HT . Amount 1 /4 Ctip
g. WATER ZONES (depth):
Top 240 Bottom 242 Top Bottom
Top Bottom Top Bottom
Top Bottom Top Bottom
Thickness/
7. CASING: Depth Diameter Weight Material
WELL CONSTRUCTION PERMIT# W101 00 141 : Top O Bottom_ 89 Ft.
OTHER ASSOCIATED PERMIT#(if applicable) Top Bottom Ft.
SITE WELL ID #(if applicable) F-3 ;Top Bottom Ft.
3. WELL USE (Check One Box) Monitoring ❑ Municipal/Public ❑
Industrial/Commercial ❑ Agricultural ❑ Recovery ❑ Injection ❑
Irrigation[:] Other !J((listuse) Closed Loop Geothere
DATE DRILLED 10-31 -11
4. WELL LOCATION:
1166 lotla Church Rd
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
CITY: Franklin COUNTY Macon
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
[]Slope ❑Valley JiFlat ❑Ridge ❑Other
Koll$TCD 36 iAAAA&AAAAAAAA! CL ROR 3R0X1KXX?AW&X CC
KNW BTCD 75 iAAAA&AAAAAAAA! CL R OR 7)c."XXX)W CC
Latitude/longitude source: ❑GPS Oropographic map
(location of well must be shown on a USGS topo map andattached to
this form if not using GPS)
5. FACILITY (Name of the business where the well is located.)
Marnn FIPm_ pntary School_
Facility Name Facility ID# (if applicable)
1166 Intla Chl Irnh Rd
Street Address
Franklin NC 28734
City or Town State Zip Code
Macon County Government
Contact Name
Mailing Address
Franklin NC 28734
City or Town State Zip Code
Area code
Phone number
6. WELL DETAILS:
a. TOTAL DEPTH: 450'
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO qI
8. GROUT: Depth Material Method
Top 0 Bottom 94 Ft. bentonite pumped
Top_94 Bottom 450 Ft. washed stone poured
Top Bottom Ft.
9. SCREEN: Depth Diameter Slot Size Material
Top Bottom Ft. in. in.
Top Bottom Ft. in. in.
Top Bottom Ft. in. in.
10. SAND/GRAVEL PACK:
Depth Size
Top Bottom Ft.
Top Bottom Ft.
Top Bottom Ft.
11. DRILLING LOG
Top Bottom
0 / 82
82 / 89
89 1 450
/
: 12. REMARKS:
Material
Formation Description
Sand and Clay
Granite Casino set
Granite
100 HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
• 15A NCAq2LLCONSTRUCTION ST NDARDS, AND THAT A COPY OF THIS
RECORDN PROVI TO TH E NER. 10-31-11
SIGNATUkE OF CERTIFIED WELL CONTRACTOR DATE
c. WATER LEVEL Below Top of Casing: 50 FT. ; Rngpr L williams
(Use "+" if Above Top of Casing) : PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Form GW-1b
Submit within 30 days of completion to: Division of Water Quality - Information Processing, Rev.1/08
1617 Mail Service Center, Raleigh, NC 27699-161, Phone : [phone]

NONRESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 3065-A
1. WELL CONTRACTOR:
Roaer L Williams
Well Contractor (Individual) Name
Tarheel Water Treatmant
Well Contractor Company Name
3494 Georgia Rd
Street Address
Franklin NC 28734
City or Town State Zip Code
81 28 ) 369-0740
Area code Phone number
2. WELL INFORMATION:
WELL CONSTRUCTION PERMIT# W 10100141
OTHER ASSOCIATED PERMIT#(if applicable)
SITE WELL ID #(if applicable) F-4
3. WELL USE (Check One Box) Monitoring ❑ Municipal/Public ❑
Industrial/Commercial ❑ Agricultural ❑ Recovery ❑ Injection ❑
Irrigation❑ Other N((list use) Closed Loop Geothern
DATE DRILLED 1 0-27-1 1
4. WELL LOCATION:
1166 Iotla Church Rd
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
CITY: Franklin COUNTY Macon
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
[]Slope []Valley Q(Flat []Ridge ❑Other
K 3BTCD 36 iAAAA&AAAAAAAAI CL ROR 331(^XXXXIIDMX CC
KNMFISTCD75 iAAAA&AAAAAAAAI CL ROR 7`X.XhCx`7fY(9()W CC
Latitude/longitude source: ❑GPS E]ropographic map
(location of well must be shown on a USGS topo map andattached to
this form if not using GPS)
5. FACILITY (Name of the business where the well is located.)
Macon Elementary School
Facility Name Facility ID# (if applicable)
1166 Intla C'hurrh Rd
Street Address
Franklin NC 28734
City or Town State Zip Code
Macon f of mfii Goyernmant
Contact Name
Mailing Address
Franklin NC 28734
City or Town State Zip Code
(-)
Area code
Phone number
6. WELL DETAILS:
a. TOTAL DEPTH: 450'
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO d
d. TOP OF CASING IS Q FT. Above Land Surface -
'Top of casing terminated attor below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
: e. YIELD (gpm): 20 METHOD OF TEST Air Lift
f. DISINFECTION: Type HTC: Amount 1 /4 C:Iip
g. WATER ZONES (depth):
:Top 340 Bottom 342 Top Bottom
:Top Bottom Top Bottom
;Top Bottom Top Bottom
Thickness/
7. CASING: Depth Diameter Weight Material
Topes_ Bottom 89_ Ft.
Top Bottom Ft.
Top Bottom Ft.
8. GROUT: Depth Material
Method
Top 0 Bottom. 94 Ft. bentonitia
pumped
Top 94 Bottom 450 Ft. washed stone
poured
Top Bottom Ft.
9. SCREEN: Depth Diameter Slot Size Material
Top Bottom Ft. in.
in.
: Top Bottom Ft. in.
in.
Top Bottom Ft. in.
in.
: 10. SAND/GRAVEL PACK:
Depth Size
: Top
Bottom Ft.
Top
Bottom Ft.
Top
Bottom Ft.
11. DRILLING LOG
Top Bottom
0 / 84
84 / 89
89 / 450
12. REMARKS:
Material
Formation Description
Sand and Clay
Granite Casino set
Granite
: 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 HA N PROVIr TO THE WE E
oc r 1027-11
SIG ATU E OF CERTIFIED WELL CONTRACTOR DATE
c. WATER LEVEL Below Top of Casing: Sn FT. ; BQopr L 1erilliamS
(Use "+" if Above Top of Casing) : PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Form GW-1b
Submit within 30 days of completion to: Division of Water Quality - Information Processing, Rev.1/08
1617 Mail Service Center, Raleigh, NC 27699-161, Phone : [phone]

NONRESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 3065-A
1. WELL CONTRACTOR:
Roaer L Williams
Well Contractor (Individual) Name
Tarheel Water Tr atmant
Well Contractor Company Name
3494 Georgia Rd
Street Address
Franklin NC 28734
City or Town State Zip Code
8c 28 ) 369-0740
Area code Phone number
2. WELL INFORMATION:
WELL CONSTRUCTION PERMIT# W10100141
d. TOP OF CASING IS 0 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): 1 n METHOD OF TEST A Llft
f. DISINFECTION: Type HTC: Amount 1 /4 Clm
g. WATER ZONES (depth):
Top 340 Bottom 342 Top Bottom
Top Bottom Top Bottom
Top Bottom Top Bottom
Thickness/
7. CASING: Depth Diameter Weight Material
: Top0 Bottom 90 Ft
OTHER ASSOCIATED PERMIT#(if applicable) :Top Bottom Ft.
SITE WELL ID #(if applicable) F-5 Top Bottom Ft.
3. WELL USE (Check One Box) Monitoring ❑ Municipal/Public ❑ . 8. GROUT: Depth Material Method
Industrial/Commercial ❑ Agricultural ❑ Recovery ❑ Injection ❑ : Top_Q_ Bottom 95 Ft. bentonite pumped
Irrigation[] Other N((list use) Closed LooD Geother© Top 95 Bottom 450 po Ft. washed stone ured
DATE DRILLED 10-26-11 ; Top Bottom Ft.
4. WELL LOCATION:
1166 lotla Church Rd
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
CITY: Franklin COUNTY Macon
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
[]Slope ❑Valley i/Flat ❑Ridge ❑Other
KOISTCD 36 iAAAA&AAAAAAAAI CL R OR 3X^XMX00fXXX CC
KNKFKTCD75 iAAAA&AAAAAAAAI CLROR 7)c"lkXX0WCC
Latitudeflongitude source: DGPS ❑ropographic map
(location of well must be shown on a USGS topo map andattached to
this form if not using GPS)
S. FACILITY (Name of the business where the well is located.)
M,sicon Flomcntani Schnnl
Facility Name Facility ID# (if applicable)
1166 Intla Church Rd
Street Address
Franklin NC 28734
City or Town State Zip Code
Macnn Count Government _
Contact Name
Mailing Address
Franklin NC 28734
City or Town State Zip Code
Area code Phone number
6. WELL DETAILS:
a. TOTAL DEPTH: 450'
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO d
9. SCREEN: Depth Diameter Slot Size Material
Top Bottom Ft. in. in.
Top Bottom Ft. in. in.
Top Bottom Ft. in. in.
: 10. SAND/GRAVEL PACK:
Depth Size
Top
Bottom Ft.
Top
Bottom Ft.
Top
Bottom Ft.
11. DRILLING LOG
Top
Bottom
0
/ 85
85
190
90
/ 450
12. REMARKS:
Material
Formation Description
Sand and Clay
Granite Casinfa set
Granite
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
• 15A NCAC 2C, WELL CONSTRUCTION SJANDARDS, AND THAT A COPY OF THIS
RECORD UASWEN PROVVTO W WNER.
10-28-1'
SI NAT RE OF CERTIFIED WELL CONTRACTOR DATE
c. WATER LEVEL Below Top of Casing: 0 FT. ; Roger L willlarris
(Use "+" if Above Top of Casing) : PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Form GW-1b
Submit within 30 days of completion to: Division of Water Quality - Information Processing, Rev.1/08
1617 Mail Service Center, Raleigh, NC 27699-161, Phone : [phone]

•rF °� NONRESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
`s?V 3065 A
^a ^' • WELL CONTRACTOR CERTIFICATION #
1. WELL CONTRACTOR:
Roder L Williams
Well Contractor (Individual) Name
Tarheel Water Treatmant
Well Contractor Company Name
3494 Georoia Rd
Street Address
Franklin NC 28734
City or Town State Zip Code
8c 28 ) 369-0740
Area code Phone number
2. WELL INFORMATION:
WELL CONSTRUCTION PERMIT# W10100141
OTHER ASSOCIATED PERMIT#(if applicable)
SITE WELL ID #(if applicable) F-6
3. WELL USE (Check One Box) Monitoring ❑ Municipal/Public ❑
Industrial/Commercial ❑ Agricultural ❑ Recovery ❑ Injection ❑
Irrigation❑ Other N(Ost use) Closed LoOD Geotherey
DATE DRILLED 10-26-11
4. WELL LOCATION:
1166 lotla Church Rd
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
CITY: Franklin COUNTY Macon
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
❑Slope ❑Valley Flat []Ridge []Other
K01$TCD 36 iAAAA&AAAAAAAAI CL ROR 3X^XXXXI XWXX CC
KNMFI$TCD75 iAAAA&AAAAAAAA! CLROR 7ll'9(9@k7t!(9()W CC
Latitude/longitude source: OGPS (]topographic map
(location of well must be shown on a USGS topo map andatteched to
this form if not using GPS)
S. FACILITY (Name of the business where the well is located.)
Macon Flementary School
Facility Name Facility ID# (If applicable)
1166 Intla Church Rd
Street Address
Franklin NC 28734
City or Town State Zip Code
Mar -on Cminty Gnyernmpnt
Contact Name
Mailing Address
Franklen NCB
City or Town State Zip Code
Area code
Phone number
6. WELL DETAILS:
a. TOTAL DEPTH: 450'
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO qI
d. TOP OF CASING IS 0 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): 10 METHOD OF TEST Air Left
f. DISINFECTION: Type HTr Amount 1 /4 11)
g. WATER ZONES (depth):
Top a40 Bottom 342 Top Bottom
Top Bottom Top Bottom
Top Bottom Top Bottom
Thickness/
7. CASING: Depth Diameter Weight Material
Top 0 Bottom�90 Ft.
Top Bottom Ft.
Top Bottom Ft.
8. GROUT: Depth Material Method
Top. 0_ Bottom 95 Ft. bentonite pumped
Top 9._ Bottom 450 Ft. washed stone poured
Top Bottom Ft.
9. SCREEN: Depth Diameter Slot Size Material
Top Bottom Ft. in. in.
: Top Bottom Ft. in. in.
Top Bottom Ft. in. in.
: 10. SAND/GRAVEL PACK:
Depth Size
Top Bottom Ft.
Top Bottom Ft.
Top Bottom Ft.
11. DRILLING LOG
Top Bottom
0 / 85
85 / 90
90 / 450
' 12. REMARKS:
Material
Formation Description
Sand and Clay
Granite Casing set
Granite
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
• 15A NCAC 2C, WELL CONSTRUCTION STA DARDS, AND THAT A COPY OF THIS
: RECORD EN PROVI TO THE EL
v 10-26-11
SIGNATU E OF CERTIFIED WELL CONTRACTOR DATE
c. WATER LEVEL Below Top of Casing: 0 FT. ; Rnger L willeams
(Use "+" if Above Top of Casing) : PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Form GW-1b
Submit within 30 days of completion to: Division of Water Quality - Information Processing, Rev.1/08
1617 Mail Service Center, Raleigh, NC 27699-161, Phone : [phone]

NONRESIDENTIAL ONRESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
�4f A
WELL CONTRACTOR CERTIFICATION # 3065
1. WELL CONTRACTOR:
Roaer L Williams
Well Contractor (Individual) Name
Tarheel Water Treatmant
Well Contractor Company Name
3494 Georaia Rd
Street Address
Franklin NC 28734
City or Town State Z!p Code
8t 28 ) 369-0740
Area code Phone number
2. WELL INFORMATION:
WELL CONSTRUCTION PERMIT# Wl0100141
OTHER ASSOCIATED PERMIT#(if applicable)
SITE WELL ID #(if applicable) F-7
3. WELL USE (Check One Box) Monitoring ❑ Municipal/Public ❑
Industrial/Commercial ❑ Agricultural ❑ Recovery ❑ Injection ❑
Irrigation❑ Other ffl6ist use) Closed LoOD Geothern
DATE DRILLED-1 0-24-11
4. WELL LOCATION:
1166 lotla Church Rd
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
CITY: Franklin COUNTY Macon
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
❑ Slope [:]Valley prFlat []Ridge ❑ Other
KOISTCD 36 1AAAA&AAAAAAAA! CL R OR 3X0XnX00 XWX CC
KNMFMTCD75 iAAAA&AAAAAAAA! CL ROR 7X."XXXOW CC
Latitude/longitude source: OGPS Oropographic map
(location of well must be shown on a USGS topo map andattached to
this form if not using GPS)
5. FACILITY (Name of the business where the well is located.)
Macon Elementary School
Facility Name Facility ID# (if applicable)
1166 lotla Church Rd
Street Address
Franklin NC 28734
City or Town State Zip Code
Macon County Government
Contact Name
Mailing Address
Franklin NC 28734
City or Town State Zip Code
Area code Phone number
6. WELL DETAILS:
a. TOTAL DEPTH: 450'
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO pI
d. TOP OF CASING IS 0 FT. Above Land Surface*
'Top of casing terminated attor below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
: e. YIELD (gpm): 0 METHOD OF TEST Air Litt
f. DISINFECTION: Type HTC Amount 1 /4 Ctip
g. WATER ZONES (depth):
Top Bottom Top Bottom
Top Bottom Top Bottom
Top Bottom Top Bottom
Thickness/
7. CASING: Depth Diameter Weight Material
: Top 0 Bottom 84 Ft.
Top Bottom Ft.
Top Bottom Ft.
8. GROUT: Depth Material Method
Top 0 Bottom. 89 Ft. bentonite _Rum eg_d
Top 89 Bottom 450 Ft. washed stone loured
Top Bottom Ft.
9. SCREEN: Depth Diameter Slot Size Material
Top Bottom Ft. in. in.
Top Bottom Ft. in. in.
Top Bottom Ft. in. in.
: 10. SAND/GRAVEL PACK:
Depth Size
Top Bottom Ft.
Top Bottom Ft.
Top Bottom Ft.
11. DRILLING LOG
Top Bottom
0 / 85
85 / 90
0 / 450
12. REMARKS:
Material
Formation Description
Sand and Clay
Granite Casing set
Granite
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
• 15A NCAC 2C, L CONSTRUCTION ST NDARDS, AND THAT A COPY OF THIS
: RECORD B N PROVI D TO TH O NER.
v ` 10-24-11
S104ATUAE OF CERTIFIED WELL CONTRACTOR DATE
c. WATER LEVEL Below Top of Casing: 0 FT. Roger L Williams
(Use "+" if Above Top of Casing) : PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Form GW-1b
Submit within 30 days of completion to: Division of Water Quality - Information Processing, Rev.1/08
1617 Mail Service Center, Raleigh, NC 27699-161, Phone : [phone]

NONRESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 3065-A
1. WELL CONTRACTOR:
Roaer L Williams
Well Contractor (Individual) Name
Tarheel. Water Treatmant
Well Contractor Company Name
3494 Georgia Rd
Street Address
Franklin NC 28734
City or Town State Zip Code
8( 28 ) 369-0740
Area code Phone number
2. WELL INFORMATION:
WELL CONSTRUCTION PERMIT# W10100141
OTHER ASSOCIATED PERMIT#(if applicable)
SITE WELL ID #(if applicable) F-8
3. WELL USE (Check One Box) Monitoring ❑ Municipal/Public ❑
Industrial/Commercial ❑ Agricultural ❑ Recovery ❑ Injection ❑
Irrigation❑ Other N((Iist use) Closed LoOD Geotherld
DATE DRILLED 10-21 -11
4. WELL LOCATION:
1166 lotla Church Rd
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
CITY: Franklin COUNTY Macon
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
❑Slope ❑Valley UlFlat ❑Ridge ❑Other
K,g3MTCD 36 iAAAA&AAAAAAAA! CL ROR 3X^XXXXIA)9PXXX CC
KNMF ISTCD 75 iAAAA&AAAAAAAA! CL R OR 7XXXXXX'X0W CC
Latitude/longitude source: ❑GPS aopographic map
(location of well must be shown on a USGS topo map andattached to
this form if not using GPS)
5. FACILITY (Name of the business where the well is located.)
Macon Elem rItary School
Facility Name Facility ID# (if applicable)
1166 lotla Church Rd
Street Address
Franklin NC 28734
City or Town State Zip Code
Macon County Government
Contact Name
Mailing Address
Franklin NC 28734
City or Town State Zip Code
c)
Area code Phone number
6. WELL DETAILS:
a. TOTAL DEPTH: 450'
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO q/
d. TOP OF CASING IS n 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): 0 METHOD OF TEST Aar Left
f. DISINFECTION: Type HTC Amount 1 /4 Ctjl3
g. WATER ZONES (depth):
Top Bottom Top Bottom
: Top Bottom Top Bottom
;Top Bottom Top Bottom
Thickness/
7. CASING: Depth Diameter Weight Material
Top_0 Bottom 84 Ft.
Top Bottom Ft.
Top Bottom Ft.
8. GROUT: Depth Material Method
Top 0 Bottom 89_ Ft. bentonite Dumped
Top 89 _ Bottom 450 Ft. washed stone poured
Top Bottom Ft.
9. SCREEN: Depth Diameter Slot Size Material
Top Bottom Ft. in. in.
Top Bottom Ft. in. in.
Top Bottom Ft. in. in.
10. SAND/GRAVEL PACK:
Depth Size
Top Bottom Ft.
Top Bottom Ft.
Top Bottom Ft.
11. DRILLING LOG
Top Bottom
0 / 82
82 / 88
88 450
12. REMARKS:
easing Rernoved
Material
Formation Description
Sand and Clay
Granite Casino set
Granite
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
• 15A NCAC 2C, OftCONSTRUCTION ST NDARDS, AND THAT A COPY OF THIS
RECORD KAS BEEN PROVIO TO L 1 NER.
10-21-11
Sl(gNATUAE OF CERTIFIED WELL CONTRACTOR DATE
c. WATER LEVEL Below Top of Casing: 0 FT. Roger L walleams
(Use "+" if Above Top of Casing) : PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Form GW-1b
Submit within 30 days of completion to: Division of Water Quality - Information Processing, Rev. 1108
1617 Mail Service Center, Raleigh, NC 27699-161, Phone : [phone]

NONRESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 3065 A
1. WELL CONTRACTOR:
Roper L Williams
Well Contractor (Individual) Name
Tarheel Water Treatmant
Well Contractor Company Name
3494 Georaia Rd
Street Address
Franklin NC 28734
City or Town State Zip Code
8r 28 ) 369-0740
Area code Phone number
d. TOP OF CASING IS FT. Above Land Surface'
'Top of casing terminated attor below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): 30 METHOD OF TEST BIOW Down
f. DISINFECTION: Type_ HTC Amount 12 07
g. WATER ZONES (depth):
Top_ 140 Bottom 142 Top Bottom
:Top Bottom Top Bottom
Top Bottom Top Bottom
2. WELL INFORMATION: : 7. CASING: Depth Diameter
WELL CONSTRUCTION PERMIT# WI0100141 : TopQ_ Bottom�4 Ft.
Thickness/
Weight Material
OTHER ASSOCIATED PERMIT#(if applicable) Top Bottom Ft. _
SITE WELL ID #(if applicable) G-1 Top Bottom Ft. _
3. WELL USE (Check One Box) Monitoring ❑ Municipal/Public ❑ : 8. GROUT: Depth Material
Industrial/Commercial ❑ Agricultural ❑ Recovery ❑ Injection ❑ : Top 0 Bottom_89 Ft. bentonite
Irrigation[] Other W(list use) Closed LoOD Geother© Top 89 Bottom 450 Ft. washed StOf1E
DATE DRILLED 1 1-07-1 1 Top Bottom Ft.
4. WELL LOCATION:
1166 lotla Church Rd
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
CITY: Franklin COUNTY Macon
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
❑Slope ❑Valley 91FIat []Ridge ❑Other
K(gMTCD 36 iAAAA&AAAAAAAAI CL R OR 30XXXX90t9P X CC
KNMFISTCD75 iAAAA&AAAAAAAA! CLROR 7`k! )tytX9(ow CC
LatitudeAongitude source: ❑GPS Dropographic map
(location of well must be shown on a USGS topo map andattached to
this form if not using GPS)
5. FACILITY (Name of the business where the well is located.)
_ Macon Flementary School
Facility Name Facility ID# (if applicable)
1166 lotla Churrh Rd
Street Address
Franklin NC 28734
City or Town State Zip Code
_Macon County Gov .rnm nt
Contact Name
Mailing Address
Franklin NG 28734
City or Town State Zip Code
()
Area code Phone number
Method
pumped
poured
9. SCREEN: Depth Diameter Slot Size Material
Top Bottom Ft. in. in.
Top Bottom Ft. in. in.
Top Bottom Ft. in. in.
10. SAND/GRAVEL PACK:
Depth Size
Top Bottom Ft.
Top Bottom Ft.
Top Bottom Ft.
11. DRILLING LOG
Top Bottom
0 / 78
78 / 84
84 / 450
/
12. REMARKS:
leasing Removed
Material
Formation Description
Sand and Clay
Granite Casing Set
Granite
S. WELL DETAILS: ; 100 HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
• 15A NCAC 2C,_.W4L CONSTRUCTION ST NDARDS, AND THAT A COPY OF THIS
a. TOTAL DEPTH: 450' : RECORD H B N PROVI D TO THE R.
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO qI 11-07-11
SIGNATURE CERTIFIED WELL CONTRACTOR DATE
c. WATER LEVEL Below Top of Casing: _50 FT. R00PLL WIIIIamS
(Use "+^ if Above Top of Casing) :PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit within 30 days of completion to: Division of Water Quality Form /08
Y P ty - Information Processing, Rev. 1/OS
1617 Mail Service Center, Raleigh, NC 27699-161, Phone : [phone]

NONRESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 3065-A
1. WELL CONTRACTOR:
Roger L Williams
Well Contractor (Individual) Name
Tarheel Water Treatmant
Well Contractor Company Name
3494 Georgia Rd
Street Address
Franklin NC 28734
City or Town State Zip Code
8t 28 ) 369-0740
Area code Phone number
2. WELL INFORMATION:
d. TOP OF CASING IS FT. Above Land Surface'
'Top of casing terminated attor below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): 30 METHOD OF TEST BIOW Down
f. DISINFECTION: Type HTr: Amount 12 nz
g. WATER ZONES (depth):
:Top 140 Bottom 142 Top Bottom
Top Bottom Top Bottom
Top Bottom Top Bottom
Thickness/
7. CASING: Depth Diameter Weight Material
WELL CONSTRUCTION PERMIT# W10100141 : Top 0 Bottom 84 Ft.
Top Bottom Ft.
OTHER ASSOCIATED PERMIT#(if applicable)
Top Bottom Ft.
SITE WELL ID #(if applicable) G-2
3. WELL USE (Check One Box) Monitoring ❑ Municipal/Public ❑ : 8. GROUT: Depth Material Method
Industrial/Commercial ❑ Agricultural ❑ Recovery [I Injection [I:Topes_ Bottom _ Ft. bentOnite pumped
Irrigation❑ Other !(list use) Closed LOOD Geotherla Top 89 Bottom 450 Ft. Washed StOnE poured
DATE DRILLED 11-09-11 ;Top Bottom Ft.
4. WELL LOCATION:
1166 lotla Church Rd
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
CITY: Franklin COUNTY Macon
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
❑ Slope ❑ Valley Flat []Ridge ❑ Other
K@3t$TCD 36 1AAAA&AAAAAAAA! CL R OR 3mX'XXX00M)t CC
KNMFISTCD75 1AAAA&AAAAAAAA! CL ROR -`X. X`X'Xxy—1 m CC
LatitudeAongitude source: j)GPS E]ropographic map
(location of well must be shown on a USGS topo map andattached to
this form if not using GPS)
5. FACILITY (Name of the business where the well is located.)
Macon Elementary School
Facility Name Facility ID# (if applicable)
1 166 Intla Ghi arch Rd
Street Address
Franklin NC 28734
City or Town State Zip Code
M,qrnn (`ni inty Government
Contact Name
9. SCREEN: Depth Diameter Slot Size Material
Top Bottom Ft. in. in.
Top Bottom Ft. in. in.
Top Bottom Ft. in. in.
: 10. SAND/GRAVEL PACK:
Depth Size
Top
Bottom Ft.
Top
Bottom Ft.
Top
Bottom Ft.
11. DRILLING LOG
Top Bottom
0 / 82
82 / 89
99 450
/
/
Mailing Address
Franklin NC 28734_
City or Town State Zip Code ; 12. REMARKS:
U
Area code
Phone number
S. WELL DETAILS:
a. TOTAL DEPTH: 450'
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO LV
Material
Formation Description
Sand and Clay
Granite Casing Set
Granite
100 HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
• 16A NCAC 2SWfLL CONSTRUCTION ST NDARDS, AND THAT A COPY OF THIS
RECORDjKs,N PRO D TO ER
11-09-11
SIGNAT E OF CERTIFIED WELL CONTRACTOR DATE
c. WATER LEVEL Below Top of Casing: 50 FT. ; RQger L wil l la ms -
(Use "+" if Above Top of Casing) : PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Form GW-1b
Submit within 30 days of completion to: Division of Water Quality - Information Processing, Rev.1/08
1617 Mail Service Center, Raleigh, NC 27699-161, Phone : [phone]

r'O ;,: STATE a`••, NONRESIDENTIAL j�
1 r ESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 3118-A
1. WELL CONTRACTOR:
Timothv R Hamb
Well Contractor (Individual) Name
Midsouth Geothermal
Well Contractor Company Name
8275 Tournament Dr Suite 185
Street Address
Memphis TN 38125
City or Town State Zip Code
d. TOP OF CASING IS 2 FT. Above Land Surface'
*Top of casing terminated attor below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm):. SO METHOD OF TEST BIOW Down
f. DISINFECTION: Type HTC: Amount 1212 n7
g. WATER ZONES (depth):
Top Bottom Top Bottom
Top Bottom Top Bottom
9c 01 ) 748-9095 ; Top Bottom Top Bottom
Area code Phone number Thickness/
2. WELL INFORMATION: : 7. CASING: Depth Diameter Weight Material
WELL CONSTRUCTION PERMIT# W 10100141 : Top 0 Bottom- : Ft. 6 1 /8 .188
OTHER ASSOCIATED PERMIT#(if applicable)
SITE WELL ID #(if applicable) G3
3. WELL USE (Check One Box) Monitoring ❑ Municipal/Public ❑
Industrial/Commercial ❑ Agricultural ❑ Recovery ❑ Injection ❑
Irrigation❑ Other S((list use) Closed low Geotherne
DATE DRILLED (Z - 13 -11
4. WELL LOCATION:
1166 Lotla Church Rd
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
CITY: Franklin COUNTY Macon
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
[]Slope []Valley @(Flat []Ridge []Other
LATITUDE 36 " DMS OR 3X.XXXXXXXXX DO
LONGITUDE 75 " DMS OR 7X.XXXXXXXXX DO
Latitude/longitude source: OGPS Oropcgraphic map
(location of well must be shown on a USGS topo map andattached to
this form if not using GPS)
5. FACILITY (Name of the business where the well is located.)
Macon Flementary
Facility Name Facility ID# (if applicable)
1166 Lotla Church Rd
Street Address
Franklin NC 28734
City or Town State Zip Code
Macon County Government
Contact Name
Mailing Address
Franklin NC 28743
City or Town State Zip Code
Area code
Phone number
6. WELL DETAILS: j �'J
a. TOTAL DEPTH: t L/
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO qI
c. WATER LEVEL Below Top of Casing: � o
(Use "+" if Above Top of Casing)
Top Bottom Ft.
Top Bottom Ft.
8. GROUT: Depth Material Method
Top 0 Bottom Ft. Bentonite Pumped —
: Top 1 & 0 Bottom O Ft. washed stonE poured
Top Bottom Ft.
9. SCREEN: Depth Diameter Slot Size Material
Top Bottom Ft. in.
Top Bottom Ft. in.
Top Bottom Ft. in.
: 10. SAND/GRAVEL PACK:
Depth Size
Top Bottom Ft.
Top Bottom Ft.
Top Bottom Ft.
11. DRILLING LOG
Top Bottom
O
1�i Zl 4�SC'
/
12. REMARKS:
in.
in.
in.
Material
Formation Description Qp )J jr
Llt
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 PRO IDED TO THE WELL OWNER
f2�3-�1
SI NAY E OF CERTIFIED WELL CONTRACTOR DATE
: PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Form GW-1 b
Submit within 30 days of completion to: Division of Water Quality - Information Processing, Rev. 2/09
1617 Mail Service Center, Raleigh, NC 27699-161, Phone : [phone]

NONRESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 3065 A
1. WELL CONTRACTOR:
Roaer L Williams
Well Contractor (Individual) Name
Tarheel Water Treatmant
Well Contractor Company Name
3494 Georaia Rd
Street Address
Franklin NC 28734
City or Town State Zip Code
8f 28 ) 369-0740
Area code Phone number
2. WELL INFORMATION:
WELL CONSTRUCTION PERMIT# W10 100 141
OTHER ASSOCIATED PERMIT#(if applicable)
SITE WELL ID #(if applicable) GA
3. WELL USE (Check One Box) Monitoring ❑ MunicipallPublic ❑
Industrial/Commercial ❑ Agricultural ❑ Recovery ❑ Injection ❑
Irrigation[] Other W(list use) Closed LoCID Geothere
DATE DRILLED 12-7-1 1
4. WELL LOCATION:
1166 lotla Church Rd
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
d. TOP OF CASING IS FT. Above Land Surface'
'Top of casing terminated attor below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): 30 METHOD OF TEST Blow Down
f. DISINFECTION: Type I -ITC Amount 12 t77
g. WATER ZONES (depth):
Top Bottom Top Bottom
Top Bottom Top Bottom
Top Bottom Top Bottom
Thickness/
7. CASING: Depth Diameter Weight Material
Top 0 Bottom 162 Ft.
Top Bottom Ft.
Top Bottom Ft.
8. GROUT: Depth Material Method
Top 0 Bottom 167 Ft. bentonite pumped
: Top 167 Bottom 450 Ft. washed stone poured
Top Bottom Ft.
9. SCREEN: Depth Diameter Slot Size Material
Top Bottom Ft. in. in.
Top Bottom Ft. in.
CITY: Franklin COUNTY Macon ; Top Bottom Ft. in.
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
[]Slope ❑ Valley Flat ❑ Ridge ❑ Other : 10. SAND/GRAVEL PACK:
6 3nnnnnnnn n Depth Size
Kt9MTCD _ I nnnn & I CL R OR 3IKMXR�I(90(9 X CC ; Top Bottom Ft.
K W[$TCD75 I AAAA&AAAAAAAAI CL R OR CC
Latitude/longitude source: ❑GPS Oropographic map
(location of well must be shown on a USGS topo map andattached to
this form if not using GPS)
5. FACILITY (Name of the business where the well is located.)
Macon Elementary School
Facility Name Facility ID# (if applicable)
1166 Intla Church Rd
Street Address
Franklin NC 28734
City or Town State Zip Code
Macon County Government
Contact Name
Mailing Address
Franklin NC 28734
City or Town State Zip Code
Area code Phone number
6. WELL DETAILS:
a. TOTAL DEPTH: 450'
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
Top Bottom Ft.
: Top Bottom Ft.
11. DRILLING LOG
Top Bottom
0 / 162
162 / 450
12. REMARKS:
in.
in.
Material
Formation Description
Sand and Clay
Granite 30gDm
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
• 15A NCAC 2C, ELL CONSTRUCTION ST NDARDS, AND THAT A COPY OF THIS
RECORD EN PROV TO TH W IER
12-7-11
SIGNAT E OF CERTIFIED WELL CONTRACTOR DATE
c. WATER LEVEL Below Top of Casing: .r]O -FT. : Rngpr L williams
(Use "+" if Above Top of Casing) : PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Form GWAb
Submit within 30 days of completion to: Division of Water Quality - Information Processing, Rev.1/08
1617 Mail Service Center, Raleigh, NC 27699-161, Phone : [phone]

STATE
NONRESIDENTIAL WELL CONSTRUCTION RECORD
i North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 3065-A
1. WELL CONTRACTOR:
Roaer L Williams
Well Contractor (Individual) Name
Tarheel Water Treatmant
Well Contractor Company Name
3494 Georaia Rd
Street Address
Franklin NC 28734
City or Town State Zip Code
8( 28 ) 369-0740
Area code Phone number
2. WELL INFORMATION:
d. TOP OF CASING IS FT. Above Land Surface'
'Top of casing terminated aVor below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
: e. YIELD (gpm): 30 METHOD OF TEST Rlnw Down
f. DISINFECTION: Type HTC —Amount 1212n7
g. WATER ZONES (depth):
:Top Bottom Top Bottom
:Top Bottom Top Bottom
Top Bottom Top Bottom
Thickness/
7. CASING: Depth Diameter Weight Material
WELL CONSTRUCTION PERMIT# W10100141 : Topes_ Bottom 162 Ft.
OTHER ASSOCIATED PERMIT#(if applicable) Top Bottom Ft.
SITE WELL ID #(if applicable) G-5 ;Top Bottom Ft.
3. WELL USE (Check One Box) Monitoring ❑ Municipal/Public ❑
Industrial/Commercial ❑ Agricultural ❑ Recovery ❑ Injection ❑
Irrigation❑ Other t((list use) Closed LoOD Geothern
DATE DRILLED 12-5-1 1
4. WELL LOCATION:
1166 lotla Church Rd
(Street Name, Numbers, Community. Subdivision, Lot No., Parcel, Zip Code)
CITY: Franklin COUNTY Macon
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
❑ Slope ❑ Valley Flat ❑ Ridge ❑ Other
KOISTCD 36 iAAAA&AAAAAAAAI CL R OR 3mXXXXtAX *XX CC
KNWF $TCD75 iAAAA&AAAAAAAAI CLROR 7A."XX9IAW CC
Latitude/longitude source: ❑GPS Oropographic map
(location of well must be shown on a USGS topo map andattached to
this form if not using GPS)
5. FACILITY (Name of the business where the well is located.)
Macon Elementary School
Facility Name Facility ID# (if applicable)
118E Intla C'htirch Rd
Street Address
Franklin NC 28734
City or Town State Zip Code
Mnr.nn Cotinty Government
Contact Name
Mailing Address
Franklin NC 28734
City or Town State Zip Code
Area code
Phone number
S. WELL DETAILS:
a. TOTAL DEPTH: 450'
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO qI
8. GROUT: Depth Material Method
Top_Q Bottom 167 Ft. bentonite pumped
Top 1—Z_ Bottom 450 Ft. washed stone poured
Top Bottom Ft.
9. SCREEN: Depth Diameter Slot Size Material
Top Bottom Ft. in. in.
Top Bottom Ft. in. in.
Top Bottom Ft. in. in.
10. SAND/GRAVEL PACK:
Depth Size
: Top Bottom Ft.
Top Bottom Ft.
Top Bottom Ft.
11. DRILLING LOG
Top Bottom
0 / 162
162 / 450
/
12. REMARKS:
Material
Formation Description
Sand and Clay
Granite 30aom
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
• 15A NCAC 2C ELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
RECORD EN PRO D TO TH E O ER.
0 12-5-11
S16NATURE OF CERTIFIED WELL CONTRACTOR DATE
c. WATER LEVEL Below Top of Casing: 50 -FT. ; ngpr I willinmSl wllliamS
(Use "+^ if Above Top of Casing) : PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Form GW-1 b
Submit within 30 days of completion to: Division of Water Quality - Information Processing, Rev. 1/08
1617 Mail Service Center, Raleigh, NC 27699-161, Phone : [phone]

X.
1 r ONRESIDENTM WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 3065-A
1. WELL CONTRACTOR:
Rooer L Williams
Well Contractor (Individual) Name
Tarheel Water Treatmant
Well Contractor Company Name
3494 Georgia Rd
Street Address
Franklin NC 28734
City or Town State Zip Code
8r 28 ) 369-0740
Area code Phone number
2. WELL INFORMATION:
WELL CONSTRUCTION PERMIT# Wl0100141
OTHER ASSOCIATED PERMIT#(if applicable)
SITE WELL ID Of applicable) G-6
3. WELL USE (Check One Box) Monitoring ❑ Municipal/Public ❑
Industrial/Commercial ❑ Agricultural ❑ Recovery ❑ Injection ❑
Irrigation❑ Other !,{(list use) Closed LOOD Geotherd
DATE DRILLED-1 1 -21 -11
4. WELL LOCATION:
1166 lotla Church Rd
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
CITY: Franklin COUNTY Macon
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
❑ Slope ❑ Valley p(Flat ❑ Ridge ❑ Other
KtOf STCD 36 iAAAA&AAAAAAAA! CL R OR 3X4R9 XXPA t)W CC
KNMFATCD75 iAAAABAAAAAAAA! CLROR 7X!X9Qx`7f9(XOW CC
d. TOP OF CASINO 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): 30 METHOD OF TEST Blow Down
f. DISINFECTION: Type I -ITC: Amount 12 n7
g. WATER ZONES (depth):
:Top Bottom Top Bottom
Top Bottom Top Bottom
Top Bottom Top Bottom
Thickness/
7. CASING: Depth Diameter Weight Material
: Topes_ Bottom 1_�_ Ft.
Top Bottom Ft.
Top Bottom Ft.
8. GROUT: Depth Material Method
Top 0 Bottom. 167 Ft. bentonite pumped _
Top 167 Bottom 450 Ft. washed stone poured
Top Bottom Ft.
9. SCREEN: Depth Diameter Slot Size Material
Top Bottom Ft. in. in.
Top Bottom Ft. in. in.
Top Bottom Ft. in. in.
10. SAND/GRAVEL PACK:
Depth Size Material
Top Bottom Ft.
Top Bottom Ft.
Latitude/longitude source: E]GPS ❑Topographic map ; Top Bottom Ft.
(location of well must be shown on a USGS topo map andattached to
this form if not using GPS) ; 11. DRILLING LOG
5. FACILITY (Name of the business where the well is located.) Top Bottom Formation Description
Macon Flementary School
Facility Name Facility ID# (if applicable)
1166 lotla Church Rd
Street Address
_ Franklin NC 28734
City or Town State Zip Code
AAacnn County Government
Contact Name
Mailing Address
Franklin NC 28734
City or Town State Zip Code
Area code
Phone number
0 / 162
162 / 450
12. REMARKS:
Sand and Clay
Granite 30apm
6. WELL DETAILS: ; I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
• 15A NCAC 2C ELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
a. TOTAL DEPTH: 450� : RECORD S BEEN PRO DED TO TH EL ER.
b. DOES WELL REPLACE EXISTING WELL? YES El NO NO 0 d� 11-
SI NA RE OF CERTIFIED WELL CONTRAC21-1
TOR DATEATE
c. WATER LEVEL Below Top of Casing: 50 FT. ; Rnr L Williams
(Use "+" if Above Top of Casing) : PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Form GW-1b
Submit within 30 days of completion to: Division of Water Quality - Information Processing, Rev. 1/08
1617 Mail Service Center, Raleigh, NC 27699-161, Phone : [phone]

NUN RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 3065 A
1. WELL CONTRACTOR:
Roaer L Williams
Well Contractor (Individual) Name
Tarheel Water Treatmant
Well Contractor Company Name
3494 Georaia Rd
Street Address
Franklin NC 28734
City or Town State Zip Code
8( 28 ) 369-0740
Area code Phone number
d. TOP OF CASING IS FT. Above Land Surface*
'Top of casing terminated attor below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): 30 METHOD OF TEST Blow Down
f. DISINFECTION: Type HTC Amount 12 n7
g. WATER ZONES (depth):
Top Bottom Top Bottom
Top Bottom Top Bottom
Top Bottom Top Bottom
2. WELL INFORMATION: ; 7. CASING: Depth Diameter
WELL CONSTRUCTION PERMIT# WI0100141 : Tops_ Bottom 172 Ft.
OTHER ASSOCIATED PERMIT#(if applicable) Top Bottom Ft.
SITE WELL ID #(ifapplicable) G-7 ; Top Bottom Ft.
3. WELL USE (Check One Box) Monitoring ❑ Municipal/Public ❑
Industrial/Commercial ❑ Agricultural ❑ Recovery ❑ Injection ❑
Irrigation[] Other 31(list use) Closed LoCID Geother©
DATE DRILLED 1 1-22-1 1
4. WELL LOCATION:
1166 lotla Church Rd
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
CITY: Franklin COUNTY Macon
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
[]Slope ❑Valley 6(Flat ❑Ridge ❑Other
Kot$TCD 36 iAAAA&AAAAAAAA! CL ROR 3XoXXXX9)t9@ x CC
KNWKTCD75 iAAAA&AAAAAAAA! CLROR 7A."X9(900M CC
Latitude/longitude source: ❑GPS Oropographic map
(location of well must be shown on a USGS topo map andattached to
this form if not using GPS)
5. FACILITY (Name of the business where the well is located.)
Macon Elementary School
Facility Name Facility ID# (if applicable)
1166 lotla Church Rd
Street Address
_Franklin NC 28734
City or Town State Zip Code
Macon County Government
Contact Name
Mailing Address
Franklin NG 28734
City or Town State Zip Code
Area code
Phone number
Thickness/
Weight Material
8. GROUT: Depth
Material
Method
Top_0 Bottom 177
Ft. bentonite
pumped
:Top 177 Bottom 450 Ft. washed stone
poured
Top Bottom
Ft.
9. SCREEN: Depth
Diameter Slot Size Material
Top Bottom
Ft. in.
in.
Top Bottom
Ft. in.
in.
Top Bottom
Ft. in.
in.
10. SAND/GRAVEL PACK:
Depth
Size Material
Top Bottom
Ft.
Top Bottom
Ft.
Top Bottom
Ft.
11. DRILLING LOG
Top Bottom
0 / 172
172 / 450
12. REMARKS:
Formation Description
Sand and Clay
Granite 30aDm
6. WELL DETAILS: I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
• 15A NCAC 2C, WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
a. TOTAL DEPTH:. 450' RECORD EN PRO EDTO HEW L CNNER
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO EJ ' `511-22-11
SIGNATURE OF CERTIFIED WELL CONTRACTOR DATE
c. WATER LEVEL Below Top of Casing: 50 FT. Ro)7er L wllllamS
(Use "+" if Above Top of Casing) : PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit within 30 days of completion to: Division of Water Quality Form /08
y p ty - Information Processing, Rev. 1/08
1617 Mail Service Center, Raleigh, NC 27699-161, Phone : [phone]

NONRESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 3065-A
1. WELL CONTRACTOR:
Roger L Williams
Well Contractor (Individual) Name
Tarheel Water Treatmant
Well Contractor Company Name
3494 Georgia Rd
Street Address
Franklin NC 28734
City or Town State Zip Code
: 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 15A NCAC 2C .0118.
e. YIELD (gpm): 60 METHOD OF TEST Air Lift
f. DISINFECTION: Type HTC Amount 1 /41 /4 C;ue
: g. WATER ZONES (depth):
Top Bottom Top Bottom
Top Bottom Top Bottom
8( 28 ) 369-0740 ; Top Bottom Top Bottom
Area code Phone number Thickness/
2. WELL INFORMATION: ; 7. CASING: Depth Diameter Weight Material
WELL CONSTRUCTION PERMIT# W10 100 141 : Top 0 Bottom 95 Ft.
OTHER ASSOCIATED PERMIT#(if applicable) Top Bottom Ft.
SITE WELL ID #(ifapplicable) G-8 : Top Bottom Ft.
3. WELL USE (Check One Box) Monitoring ❑ Municipal/Public ❑
Industrial/Commercial ❑ Agricultural ❑ Recovery ❑ Injection ❑
Irrigation❑ Other !(list use) Closed LooD Geotherey
DATE DRILLED-1 0-26-11
4. WELL LOCATION:
1166 lotla Church Rd
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
CITY: Franklin COUNTY Macon
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
❑Slope ❑Valley Flat []Ridge ❑Other
KOISTCD 36 IAAAA&AAAAAAAA! CL R OR &,NXXXXIA)WX CC
KNMFPST CD75 1AAAA&AAAAAAAA! CLROR 7)V'AW1RXX)W CC
Latitude/longitude source: (]GPS Oropographic map
(location of well must be shown on a USGS topo map andattached to
this form if not using GPS)
S. FACILITY (Name of the business where the well is located.)
Macon Elementary School
Facility Name Facility ID# (if applicable)
1166 lotla Chur .h Rd
Street Address
Franklin NC 28734
City or Town State Zip Code
Macnn County Government
Contact Name
Mailing Address
Franklin NC 28734
City or Town State Zip Code
Area code
Phone number
S. WELL DETAILS:
a. TOTAL DEPTH: 450'
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO qI
8. GROUT: Depth Material Method
Top_Q_ Bottom 100 Ft. bentonite Dumped
: Top 100 Bottom 450 Ft. washed stone loured
Top Bottom Ft.
9. SCREEN: Depth Diameter Slot Size Material
Top Bottom Ft. in. in.
Top Bottom Ft. in. in.
Top Bottom Ft. in. in.
10. SAND/GRAVEL PACK:
Depth Size
: Top Bottom Ft.
Top Bottom Ft.
Top Bottom Ft.
11. DRILLING LOG
Top Bottom
0 / 95
95 / 125
125 / 450
/
12. REMARKS:
leasing Removed
Material
Formation Description
Sand and Clay
Loose Granite Gravel
Hard Granite
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
• 15A NCAC 2C, WELL CONSTRUCTION STANDARDS. AND THAT A COPY OF THIS
RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
10-26-11
SIGNATURE OF CERTIFIED WELL CONTRACTOR DATE
c. WATER LEVEL Below Top of Casing: 60 FT. Rnqer L Williams
(Use "+" if Above Top of Casing) : PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Form GW-1b
Submit within 30 days of completion to: Division of Water Quality - Information Processing, Rev. 1/08
1617 Mail Service Center, Raleigh, NC 27699-161, Phone : [phone]

NONRESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 3065-A
1. WELL CONTRACTOR:
Roger L Williams
Well Contractor (Individual) Name
Tarheel Water Treatment
Well Contractor Company Name
3494 Georgia RD
Street Address
Franklin NC 28734
City or Town State Zip Code
8( 28 ) 369-0740
Area code Phone number
2. WELL INFORMATION:
WELL CONSTRUCTION PERMIT# W 10100141
OTHER ASSOCIATED PERMIT#(if applicable)
SITE WELL ID #(if applicable) H-1
3. WELL USE (Check One Box) Monitoring ❑ Municipal/Public ❑
Industrial/Commercial ❑ Agricultural ❑ Recovery ❑ Injection ❑
Irrigation❑ Other l((Ilst use) Closed IOgD Geotherna
DATE DRILLED 1 1-17-11
4. WELL LOCATION:
1166 Lotla Church Rd
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
CITY: Franklin COUNTY Macon
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
❑Slope ❑Valley Flat ❑Ridge ❑Other
K(OISTCD 36 iAAAA&AAAAAAAA! CL R OR 3XeXxR?IPf XWXX CC
KNMFKTCD75 iAAAA&AAAAAAAA! CL R OR 7X..WX)kXX MMCC
Latitudefiongitude source: ❑GPS (]topographic map
(location of well must be shown on a USGS topo map andattached to
this form if not using GPS)
5. FACILITY (Name of the business where the well is located.)
Macon Elementary
Facility Name Facility ID# (if applicable)
1166 Lotla Church Rd
Street Address
Franklin NC 28734
City or Town State Zip Code
Macon County Government
Contact Name
Mailing Address
Franklin NC 28743
City or Town State Zip Code
U
Area code
Phone number
S. WELL DETAILS:
a. TOTAL DEPTH: 450
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO q/
d. TOP OF CASING IS FT. Above Land Surface*
'Top of casing terminated atior below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): 30 METHOD OF TEST BIOW Down
f. DISINFECTION: Type I i C Amount 1212 0�
g. WATER ZONES (depth):
:Top Bottom Top Bottom
Top Bottom Top Bottom
Top Bottom Top Bottom
Thickness/
7. CASING: Depth Diameter Weight Material
Top 0 Bottom 162 Ft.
Top Bottom Ft.
Top Bottom Ft.
: 8. GROUT: Depth Material Method
To Bottom 167 Ft. Bentonite Pumped
Top 167 Bottom 450 Ft._ Washed stone poured
Top Bottom Ft.
9. SCREEN: Depth Diameter Slot Size Material
Top Bottom Ft. in. in.
Top Bottom Ft. in. in.
Top Bottom Ft. in. in.
: 10. SAND/GRAVEL PACK:
Depth Size
Top
Bottom Ft.
Top
Bottom Ft.
Top
Bottom Ft.
11. DRILLING LOG
Top Bottom
0 / 82
82 / 162
162 / 450
12. REMARKS:
leasing Removed
Material
Formation Description
Sand Clay
Broken Rock
Granite 30 GPM
100 HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
• 15A NCAC 2C, WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
RECORD NN P�D TO THE EL ER.
11-17-11
SIG ATU E OF CERTIFIED WELL CONTRACTOR DATE
c. WATER LEVEL Below Top of Casing: FT. Roger L_ Williams
(Use "+" if Above Top of Casing) : PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Form GW-1 b
Submit within 30 days of completion to: Division of Water Quality - Information Processing, Rev.1/08
1617 Mail Service Center, Raleigh, NC 27699-161, Phone : [phone]

AATF ��
NONRESIDENTIAL ONRESIDENTIAL WELL CONSTRUCTION RECORD
3_
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 3065-A
1. WELL CONTRACTOR:
Roaer L Williams
Well Contractor (Individual) Name
Tarheel Water Treatment
Well Contractor Company Name
3494 Georaia RD
Street Address
Franklin NC 28734
City or Town State Zip Code
8( 28 ) 369-0740
Area code Phone number
2. WELL INFORMATION:
d. TOP OF CASING IS FT. Above Land Surface -
*Top of casing terminated attor below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e.
YIELD (gpm): 30 METHOD OF TEST glow Down
f. DISINFECTION: Type HTC Amount 12 n7
g. WATER ZONES (depth):
Top Bottom Top Bottom
Top Bottom Top Bottom
Top Bottom Top Bottom
Thickness/
7. CASING: Depth Diameter Weight Material
WELL CONSTRUCTION PERMIT# W10100141 : Top 0 Bottom 162 Ft.
OTHER ASSOCIATED PERMIT#(if applicable) Top Bottom Ft.
SITE WELL ID #(if applicable) H-2 ; Top Bottom Ft.
3. WELL USE (Check One Box) Monitoring ❑ Municipal/Public ❑
Industrial/Commercial ❑ Agricultural ❑ Recovery ❑ Injection ❑
Irrigation❑ Other td(list use) Closed IooD Geotherre
DATE DRILLED 1 1-15-11
4. WELL LOCATION:
1166 Lotla Church Rd
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
CITY: Franklin COUNTY Macon
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
❑Slope []Valley elat []Ridge ❑Other
K(W,ISTCD 36 iAAAA&AAAAAAAAI CL R OR 3X^XXXXrQ)W)( CC
KNNF ISTCD 75 iAAAA&AAAAAAAA! CL R OR 7)I!."XXXAXX* CC
Latitude/longitude source: ❑GPS []Topographic map
(location of well must be shown on a USGS topo map andattached to
this form if not using GPS)
5. FACILITY (Name of the business where the well is located.)
Macon Elementary
Facility Name Facility ID# (if applicable)
1166 Lotla Church Rd
Street Address
Franklin NC 28734
City or Town State Zip Code
Macon County Government
Contact Name
Mailing Address
Franklin NC 28743
City or Town State Zip Code
Area code
Phone number
6. WELL DETAILS:
a. TOTAL DEPTH: 450
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO 0 /
:8. GROUT: Depth Material Method
Top 0 Bottom 167 Ft. Bentonite Pumped
:Top 167. Bottom 450 Ft. washed stone loured
Top Bottom Ft.
9. SCREEN: Depth Diameter Slot Size Material
Top Bottom Ft. in. in.
Top Bottom Ft. in. in.
Top Bottom Ft. in. in.
10. SAND/GRAVEL PACK:
Depth Size
Top Bottom Ft.
: Top Bottom Ft.
Top Bottom Ft.
11. DRILLING LOG
Top Bottom
0 / 82
82 / 162
162 1450
/
12. REMARKS:
Material
Formation Description
Sand Clay
Broken Rock
Granite 30 GPM
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
16A NCAC 2C L CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
RECORD B N PROVIDED TO THE LL W R.
d� L� 11-15-11
SIGNATURE OF CERTIFIED WELL CONTRACTOR DATE
c. WATER LEVEL Below Top of Casing: FT. : Roger L. WllllamS
(Use "+" if Above Top of Casing) : PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Form GW-1b
Submit within 30 days of completion to: Division of Water Quality - information Processing, Rev.1/08
1617 Mail Service Center, Raleigh, NC 27699-161, Phone : [phone]

_ya.:a pATFo ��
' NONRESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
�,•.l a~�';,,• r� WELL CONTRACTOR CERTIFICATION # 3065 A
1. WELL CONTRACTOR:
Roaer L Williams
Well Contractor (Individual) Name
Tarheel Water Treatment
Well Contractor Company Name
3494 Georoia RD
Street Address
Franklin NC 28734
City or Town State Zip Code
8( 28 ) 369-0740
Area code Phone number
2. WELL INFORMATION:
d. TOP OF CASING IS FT. Above Land Surface*
'Top of casing terminated attor below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): 30 METHOD OF TEST Blow Down
f. DISINFECTION: Type HTC Amount 12 Q7
g. WATER ZONES (depth):
:Top Bottom Top Bottom
Top Bottom Top Bottom
Top Bottom Top Bottom
Thickness/
7. CASING: Depth Diameter Weight Material
WELL CONSTRUCTION PERMIT# W101 00 141 : Top 0 Bottom 162 Ft.
OTHER ASSOCIATED PERMIT#(if applicable) Top Bottom Ft.
SITE WELL ID #(if applicable) H-3 ' Top Bottom Ft.
3. WELL USE (Check One Box) Monitoring ❑ Municipal/Public ❑ ; 8. GROUT: Depth Material Method
Industrial/Commercial ❑ Agricultural Cl Recovery ❑ Injection ❑ : Top_ Bottom 167 Ft. Bentonite Pumped
Irrigation❑ Other N((list use) Closed 100D Geotherra : Top 167 Bottom 450 Ft. washed stone loured
DATE DRILLED 11-10-11 ; Top Bottom Ft.
4. WELL LOCATION:
1166 Lotla Church Rd
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
cITY: Franklin COUNTY Macon
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
❑Slope ❑Valley Flat ❑Ridge ❑Other
KOMTCD 36 iAAAA&AAAAAAAAI CL ROR 3X^XXXXNX)= CC
MIVFMTCD75 IAAAA&AAAAAAAAI CLROR 7kJCXk7fX7ck'X7f CC
Latitude/longitude source: ❑GPS []Topographic map
(location of well must be shown on a USGS topo map andattached to
this form if not using GPS)
5. FACILITY (Name of the business where the well is located.)
Macon Elementary
Facility Name Facility ID# (if applicable)
1166 Lotla Church Rd
Street Address
Franklin NC 28734
City or Town State Zip Code
Macon County Government
Contact Name
Mailing Address
Franklin NC 28743
City or Town State Zip Code
Area code Phone number
6. WELL DETAILS:
a. TOTAL DEPTH: 450
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO q/
9. SCREEN: Depth Diameter Slot Size Material
Top Bottom Ft. in. in.
Top Bottom Ft. in.
Top Bottom Ft. in.
10. SAND/GRAVEL PACK:
Depth Size
Top Bottom Ft.
: Top Bottom Ft.
Top Bottom Ft.
11. DRILLING LOG
Top Bottom
0 / 82
82 / 162
162 / 450
12. REMARKS:
in.
in.
Material
Formation Description
Sand Clay
Broken Rock
Granite 30 GPM
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 EN PROVI D TO THE ELL N R.
d 11-10-11
SIGNATURE OF CERTIFIED WELL CONTRACTOR DATE
c. WATER LEVEL Below Top of Casing: FT.
(Use "+" if Above Top of Casing) Roaer L_ Williams
: PRINTED NAME OF PERSON CONSTRUCTING THE WELL
-1 b
Submit within 30 days of completion to: Division of Water Quality - Information Processing, Rev. Form GW GW
1617 Mail Service Center, Raleigh, NC 27699-161, Phone : [phone]

NONRESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 3065 A
1. WELL CONTRACTOR:
Roger L Williams
Well Contractor (Individual) Name
Tarheel Water Treatment
Well Contractor Company Name
3494 Georgia RD
Street Address
Franklin NC 28734
City or Town State Zip Code
8( 28 ) 369-0740
Area code Phone number
2. WELL INFORMATION:
d. TOP OF CASING IS FT. Above Land Surface -
'Top of casing terminated attor below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): 30 METHOD OF TEST Blow Down
f. DISINFECTION: Type HTC Amount 12 n7
g. WATER ZONES (depth):
:Top Bottom Top Bottom
Top Bottom Top Bottom
;Top Bottom Top Bottom
Thickness/
: 7. CASING: Depth Diameter Weight Material
WELL CONSTRUCTION PERMIT# W10100141 : Top 0 Bottom 152 Ft.
OTHER ASSOCIATED PERMIT#(if applicable) : Top Bottom Ft.
SITE WELL ID #(if applicable) H-4 Top Bottom Ft.
3. WELL USE (Check One Box) Monitoring ❑ Municipal/Public ❑ : 8. GROUT: Depth Material Method
Industrial/Commercial ❑ Agricultural ❑ Recovery ❑ Injection Cl
Irrigation❑ Other N((Iist use) Closed 100D Geotherre
DATE DRILLED 11-9-11
4. WELL LOCATION:
1166 Lotla Church Rd
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
CITY: Franklin COUNTY Macon
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
❑ Slope ❑ Valley elat ❑ Ridge []Other
K@St$TCD 36 iAAAA&AAAAAAAA! CLROR 3XoXxxxxxMX CC
KNWBTC075 IAAAA&AAAAAAAA! CLROR T>t."XXXIOM CC
Latitude/longitude source: ❑GPS Oropographic map
(location of well must be shown on a USGS topo map andattached to
this form if not using GPS)
5. FACILITY (Name of the business where the well is located.)
Macon Elementary
Facility Name Facility ID# (if applicable)
1166 Lotla Church Rd
Street Address
Franklin NC 28734
City or Town State Zip Code
Macon County Government
Contact Name
Mailing Address
Franklin NC 28743
City or Town State Zip Code
Area code
Phone number
Top 0 Bottom 157 Ft. Bentonite Pumped
:Top 157 Bottom 450 Ft. washed stone poured
Top Bottom Ft.
9. SCREEN: Depth Diameter Slot Size Material
Top Bottom Ft. in. in.
Top Bottom Ft. in
Top Bottom Ft. in
10. SAND/GRAVEL PACK:
Depth Size
Top Bottom Ft.
Top Bottom Ft.
Top Bottom Ft.
11. DRILLING LOG
Top Bottom
0 / 82
82 / 155
155 / 450
12. REMARKS:
in.
in.
Material
Formation Description
Sand Clay
Broken Rock
Granite 30 GPM
6. WELL DETAILS: 100 HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
• 15A NCAC 2C ELL CONSTRUCTION ST ARDS, AND THAT A COPY OF THIS
a. TOTAL DEPTH: 450 : RECORD EN PROVI TO THEWELOWNER.
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO 5/ : SIGNATURE OF CERTIFIED WELL CONTRACTOR DATE
c. WATER LEVEL Below Top of Casing: FT. : Roger L- Williams
(Use "+" if Above Top of Casing) : PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit within 30 days of completion to: Division of Water Quality information Processing, Form
y P y - g+ Rev. 1//OS08
1617 Mail Service Center, Raleigh, NC 27699-161, Phone : [phone]

NONRESIDENTIAL ONRESIDENTIAL WELL CONSTRUCTION RECORD
` '! _ North Carolina Department of Environment and Natural Resources- Division of Water Quality
f WELL CONTRACTOR CERTIFICATION # 2185 A
1. WELL CONTRACTOR:
Stanlev K. Setzer
Well Contractor (Individual) Name
Mid South Geothermal
Well Contractor Company Name
8275 Tournament Dr.
Street Address
Memphis Tn 38125
City or Town State Zip Code
9( 01 ) 748-9095
A d Ph b
d. TOP OF CASING IS RpMf)Ved 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): 150 METHOD OF TEST Air BIOW
f. DISINFECTION: Type
Amount
g. WATER ZONES (depth):
Top Bottom
Top
Bottom
Top Bottom
Top
Bottom
Top Bottom
Top
Bottom
rea co a one num er Thickness/
2. WELL INFORMATION: : 7. CASING: Depth Diameter Weight Material
WELL CONSTRUCTION PERMIT# W10 100 141 : Top 0 Bottom 96 Ft. 6 5/8 .250 steel
OTHER ASSOCIATED PERMIT#(if applicable) Top Bottom Ft.
SITE WELL ID #(if applicable) H-5 ;Top Bottom Ft.
3. WELL USE (Check One Box) Monitoring ❑ Municipal/Public ❑
Industrial/Commercial ❑ Agricultural ❑ Recovery ❑ Injection ❑
Irrigation❑ Other ((list use) Closed LoOD Geothern
DATE DRILLED 1 1-4-1 1
4. WELL LOCATION:
1166 lotla Church Rd
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
CITY: Franklin COUNTY Macon
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
❑Slope ❑Valley iiFlat ❑Ridge ❑Other
LATITUDE 36 " DMS OR 3X.XXXXXXXXX DID
LONGITUDE 75 " DMS OR 7X.XXXXXXXXX DID
Latitude/longitude source: QGPS Oropographic map
(location of well must be shown on a USGS topo map andattached to
this form if not using GPS)
5. FACILITY (Name of the business where the well is located.)
Macon Flementary School
Facility Name Facility ID# (if applicable)
1166 lotla Church Rd
Street Address
Franklin NC 28734
City or Town State Zip Code
_Macon County Government
Contact Name
Mailing Address
Franklin NC 28734
City or Town State Zip Code
U
Area code
Phone number
S. WELL DETAILS:
a. TOTAL DEPTH: 451
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO qI
8. GROUT: Depth Material Method
Top 0 Bottom 101 Ft. Bentonite Pumped
Top 101 Bottom 451 Ft. washed stone Poured
Top Bottom
Ft.
9. SCREEN: Depth
Diameter Slot Size Material
Top Bottom
Ft. in. in.
Top Bottom
Ft. in. in.
Top Bottom
Ft. in. in.
10. SAND/GRAVEL PACK:
Depth
Size Material
Top Bottom
Ft.
Top Bottom
Ft.
Top Bottom
Ft.
11. DRILLING LOG
Top Bottom
Formation Description
0 / 20
Red Clay
20 / 65
Brown Clay
65 / 92
sandy Soil
2/ 100
Sand Rock
100 / 142
Granite
142 / 150
Broken Rock
150 / 280
Granite
280 1320
Soft Granite
320 1451
Granite
12. 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.
SIGNArURE OF CERTIFIED
WELL CONTRACTOR DATE
c. WATER LEVEL Below Top of Casing: FT. Stanley K_ SP_tzer
(Use "+" if Above Top of Casing) : PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit within 30 days of completion to: Division of Water Quality Information Processing, Form /09
y P ry - 9� Rev. 2/09
1617 Mail Service Center, Raleigh, NC 27699-161, Phone : [phone]

NONRESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 2185-A
1. WELL CONTRACTOR:
Stanley K. Setzer
Well Contractor (Individual) Name
Mid South Geothermal
Well Contractor Company Name
8275 Tournament Dr.
Street Address
Memphis Tn 38125
City or Town State Zip Code
9( 01 ) 748-9095
Area code Phone number
d. TOP OF CASING IS RPmOVPd 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): _ 100+ METHOD OF TEST Air BIGW
f. DISINFECTION: Type Amount
g. WATER ZONES (depth):
Top Bottom Top Bottom
Top Bottom Top Bottom
Top Bottom Top Bottom
2. WELL INFORMATION: : 7. CASING: Depth Diameter
WELL CONSTRUCTION PERMIT# W101 00 141 : Top 0 Bottom 87 Ft. 6 5/8
OTHER ASSOCIATED PERMIT#(if applicable) : Top Bottom Ft.
SITE WELL ID #(if applicable) H-6A Top Bottom Ft.
3. WELL USE (Check One Box) Monitoring ❑ Municipal/Public ❑
Industrial/Commercial ❑ Agricultural ❑ Recovery ❑ Injection ❑
Irrigation❑ Other N((iist use) Closed Loop Geothero
DATE DRILLED 10-31 -11
4. WELL LOCATION:
1166 lotla Church Rd
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
CITY: Franklin COUNTY Macon
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
❑ Slope ❑ Valley Flat ❑ Ridge ❑ Other
KOI$TCD 36 iAAAA&AAAAAAAAI CL ROR 3mXXX90t)MX CC
KNWBTCD75 iAAAA&AAAAAAAAI CLROR 71)vxw)kxxoXX` CC
Latitude/longitude source: E]GPS I]ropographic map
(location of well must be shown on a USGS topo map andattached to
this form if not using GPS)
S. FACILITY (Name of the business where the well is located.)
Macon Flementary School
Facility Name Facility ID# (if applicable)
1166 lotla Church Rd
Street Address
Franklin N . 28734
City or Town State Zip Code
Macon County Government
Contact Name
Mailing Address
Franklin NC 98734
City or Town State Zip Code
U
Area code
Phone number
Thickness/
Weight Material
.250 steel
: 8. GROUT: Depth Material
Top 0 Bottom 92 Ft._Sentonite
Top 2 Bottom 366 Ft. Washed stone
Top Bottom Ft.
9. SCREEN: Depth Diameter Slot Size
Top Bottom Ft. in.
Top Bottom Ft. in.
Top Bottom Ft. in.
: 10. SAND/GRAVEL PACK:
Depth Size
Top Bottom Ft.
Top Bottom Ft.
Top Bottom Ft.
: 11. DRILLING LOG
Top Bottom
0 / 20
20 / 71
70 85
85 150
150 / 157
157 / 345
345 / 366
12. REMARKS:
in.
in.
in.
Method
Pumped
Poured
Material
Material
Formation Description
Red Cla
Brown Clay
sandy Soil
Granite
Broken Granite
Granite
Granite Gravel
6. WELL DETAILS: 100 HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
15A NCAC 2C, WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
a. TOTAL DEPTH:_ 366
RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO [)}I" ' 10-31-11
SIGNATURE OF CERTIFIED WELL CONTRACTOR DATE
c. WATER LEVEL Below Top of Casing: FT. ; Manley K. SetZer
(Use "+" if Above Top of Casing) : PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit within 30 days of completion to: Division of Water Quality Form /08
y p ty - Information Processing, Rev. 1/os
1617 Mail Service Center, Raleigh, NC 27699-161, Phone : [phone]

NONRESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 2185 A
1. WELL CONTRACTOR:
Stanley K. Setzer
Well Contractor (Individual) Name
Mid South Geothermal
Well Contractor Company Name
8275 Tournament Dr.
Street Address
Memphis Tn 38125
City or Town State Zip Code
d. TOP OF CASING IS RPmoVPd FT. Above Land Surface*
'Top of casing terminated atior below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): METHOD OF TEST_ Alr Blow
f. DISINFECTION: Type Amount
g. WATER ZONES (depth):
Top Bottom Top Bottom
Top Bottom Top Bottom
9r 01 ) 748-9095 ' Top Bottom Top Bottom
Area code Phone number
Thickness/
2. WELL INFORMATION: ; 7. CASING: Depth Diameter Weight Material
WELL CONSTRUCTION PERMIT# WI0100141 : Top 0 Bottom Ft. 6 5/8 .250 steel
OTHER ASSOCIATED PERMIT#(if applicable)
SITE WELL ID #(if applicable) H-6B
3. WELL USE (Check One Box) Monitoring ❑ Municipal/Public ❑
Industrial/Commercial ❑ Agricultural ❑ Recovery ❑ Injection ❑
Irrigation❑ Other Iti((list use) Closed Loop Geotherla
DATE DRILLED 11-1-11
4. WELL LOCATION:
1166 lotla Church Rd
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
CITY: Franklin COUNTY Macon
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
❑Slope ❑Valley elat ❑Ridge [3Other
KgI$TCD 36 iAAAA&AAAAAAAA! CLROR 3X^XXX9C90(9tXX CC
KNMF ISTCD 75 iAAAA&AAAAAAAA! CL R OR 7k!XXkXX9(kX9@ CC
Latitude/longitude source: (]GPS Elropographic map
(location of well must be shown on a USGS topo map andattached to
this form if not using GPS)
S. FACILITY (Name of the business where the well is located.)
Macon Elementary School
Facility Name Facility ID# (if applicable)
1166 lotla Church Rd
Street Address
_ Franklin NC 28734
City or Town State Zip Code
Macon County Government
Contact Name
Mailing Address
Franklin NC 28734
City or Town State Zip Code
U
Area code
Phone number
6. WELL DETAILS:
a. TOTAL DEPTH: 89
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
Top Bottom Ft.
Top Bottom Ft.
8. GROUT: Depth Material Method
Topes_ Bottom 89 Ft._ Bentonite Pumped
Top Bottom Ft.
Top Bottom Ft.
9. SCREEN: Depth Diameter Slot Size Material
Top Bottom Ft. in. in.
Top Bottom Ft. in. in.
Top Bottom Ft. in. in.
10. SAND/GRAVEL PACK:
Depth Size
Top Bottom Ft.
Top Bottom Ft.
Top Bottom Ft.
11. DRILLING LOG
Top Bottom
0 / 20
20 / 70
70 1 89
12. REMARKS:
Material
Formation Description
Red Clay
Brown Clay
sandy Soil
100 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.
SIGNATTRE OF CE -WELL CONTRACTOR DATE
c. WATER LEVEL Below Top of Casing: 7Q YT. Stanley K. Set7er
(Use "+'• if Above Top of Casing) : PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit within 30 days of completion to: Division of Water Quality - Information Processing, Form Rev. 1 /08 /OS
1617 Mail Service Center, Raleigh, NC 27699-161, Phone : [phone]

STATE o
NONRESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 2185-A
1. WELL CONTRACTOR:
Stanley K. Setzer
Well Contractor (Individual) Name
Mid South Geothermal
Well Contractor Company Name
8275 Tournament Dr.
Street Address
Memphis Tn 38125
City or Town State Zip Code
9( 01 ) 748-9095
Area code Phone number
2. WELL INFORMATION:
WELL CONSTRUCTION PERMIT# Q100141
OTHER ASSOCIATED PERMIT#(if applicable)
SITE WELL ID #(if applicable) H-7A
3. WELL USE (Check One Box) Monitoring ❑ Municipal/Public ❑
Industrial/Commercial ❑ Agricultural ❑ Recovery ❑ Injection ❑
Irrigation[] Other M((list use) Closed Loop Geother©
DATE DRILLED-1 0-26-11
4. WELL LOCATION:
1166 lotla Church Rd
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
CITY: Franklin COUNTY Macon
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
[]Slope ❑ Valley 91FIat ❑ Ridge ❑ Other
KOATCD 36 iAAAA&AAAAAAAAI CL R OR 3i( xXxx90t9 x CC
MMFMTCD75 iAAAA&AAAAAAAAI CLROR 71k9('X9Q)tX9(W* CC
Latitude/longitude source: OGPS []topographic map
(location of well must be shown on a USGS topo map andattached to
this form if not using GPS)
5. FACILITY (Name of the business where the well is located.)
Macon Elementary School
Facility Name Facility ID# (if applicable)
1166 lotla Church Rd
Street Address
Franklin NC 28734
City or Town State Zip Code
Macon County Government
Contact Name
Mailing Address
Franklin NC 98734
City or Town State Zip Code
Area code
Phone number
6. WELL DETAILS:
a. TOTAL DEPTH: 330'
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO q/
: d. TOP OF CASING IS Removed FT. Above Land Surface*
'Top of casing terminated attor below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm):
METHOD OF TEST Aar Blow
f. DISINFECTION: Type
Amount
g. WATER ZONES (depth):
:Top Bottom
Top Bottom
Top Bottom
Top Bottom
Top Bottom
Top Bottom
Thickness/
7. CASING: Depth
Diameter Weight Material
Top 0 Bottom_
Ft. 6 5/8 .250 steel
Top Bottom
Ft.
Top Bottom
Ft.
8. GROUT: Depth
Material Method
Top 0 Bottom 88 Ft. bentonite
Top 88 Bottom 330 Ft. Washed stong
Top Bottom Ft.
; 9. SCREEN: Depth Diameter Slot Size Material
Top Bottom Ft. in. in.
Top Bottom Ft. in. in.
Top Bottom Ft. in. in.
10. SAND/GRAVEL PACK:
Depth Size
: Top Bottom Ft.
Top Bottom Ft.
: Top Bottom Ft.
: 11. DRILLING LOG
Top Bottom
12. REMARKS:
Material
Formation Description
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
15A NCAC 2C, WELL CONSTRUCTION STANDARDS, AND THAT COPY OF THIS
RECORD HAS BEEN PROVIDED TO THE WELL OWNER
10-26-11
SIGNATURE OF CERTIFIED WELL CONTRACTOR DATE
c. WATER LEVEL Below Top of Casing: FT. : Stanley_K. Sauer
(Use "+" if Above Top of Casing) : PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit within 30 days of completion to: Division of Water Quality Information Processing, Form /08
y P � " g� Rev. 1/OS
1617 Mail Service Center, Raleigh, NC 27699-161, Phone : [phone]

STAl o
NONRESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 2185 A
1. WELL CONTRACTOR:
Stanley K. Setzer
Well Contractor (Individual) Name
Mid South Geothermal
Well Contractor Company Name
8275 Tournament Dr.
Street Address
Memphis Tn 38125
City or Town State Zip Code
9( 01 ) 748-9095
Area code Phone number
d. TOP OF CASING IS RPMQVPd 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 Air Blow
f. DISINFECTION: Type Amount
g. WATER ZONES (depth):
Top Bottom Top Bottom
Top Bottom Top Bottom
Top Bottom Top Bottom
Thickness/
2. WELL INFORMATION: : 7. CASING: Depth Diameter Weight Material
WELL CONSTRUCTION PERMIT# W10100141 : Top 0 Bottom 87 Ft. 6 5/8 .250 steel
OTHER ASSOCIATED PERMIT#(if applicable) Top Bottom Ft.
SITE WELL ID #(ifapplicable) H-713 Top Bottom Ft.
3. WELL USE (Check One Box) Monitoring ❑ Municipal/Public ❑ : 8. GROUT: Depth Material Method
Industrial/Commercial ❑ Agricultural ❑ Recovery ❑ Injection ❑
Irrigation❑ Other (J((list use) Closed Loop Geother©
DATE DRILLED-1 1 -2-11
4. WELL LOCATION:
1166 lotla Church Rd
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
CITY: Franklin COUNTY Macon
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
❑ Slope []Valley Flat ❑ Ridge ❑ Other
K@3MTCD 36 iAAAA&AAAAAAAA! CL R OR 3&XXXX00W)( CC
KNMF MTCD 75 1AAAA&AAAAAAAA! CL R OR 7IJ1.'X'Xxxxxvix CC
Latitude/longitude source: DGPS aopographic map
(location of well must be shown on a USGS topo map andattached to
this form if not using GPS)
5. FACILITY (Name of the business where the well is located.)
Macon Flementary School
Facility Name Facility ID# (if applicable)
1166 lotla Church Rd
Street Address
Franklin NC 28734
City or Town State Zip Code
Macon County Government
Contact Name
Mailing Address
Franklin N . 28734
City or Town State Zip Code
U
Area code
Phone number
6. WELL DETAILS:
a. TOTAL DEPTH:_ 120
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO qI
Topes_ Bottom 87 Ft. Sentonite Pumped
Top$L Bottom 120 Ft. washed stone poured
Top Bottom Ft.
9. SCREEN: Depth Diameter Slot Size Material
Top Bottom Ft. in.
Top Bottom Ft. in.
Top Bottom Ft. in.
10. SAND/GRAVEL PACK:
Depth Size
Top Bottom Ft.
Top Bottom Ft.
Top Bottom Ft.
: 11. DRILLING LOG
Top Bottom
0 / 20
20 / 70
70 / 90
go / 120
12. REMARKS:
in.
in.
in.
Material
Formation Description
Red Clay
Brown Clay
sandy Soil
_Granite
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
15A NCAC 2C. WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
11-2-11
SIGNATURE OF CERTIFIED WELL CONTRACTOR DATE
c. WATER LEVEL Below Top of Casing: 70 FT. : Manley K. Setzer
(Use "+" if Above Top of Casing) : PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit within 30 days of completion to: Division of Water Quality Form /08
y p ty - Information Processing, Rev. 1/08
1617 Mail Service Center, Raleigh, NC 27699-161, Phone : [phone]

NONRESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 2185 A
1. WELL CONTRACTOR:
Stanley K. Setzer
Well Contractor (Individual) Name
Mid South Geothermal
Well Contractor Company Name
8275 Tournament Dr.
Street Address
Memphis Tn 38125
City or Town State Zip Code
9( 01 ) 748-9095
Area code Phone number
d. TOP OF CASING IS RPMOVP.d 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): 100 METHOD OF TEST Alr Blow
f. DISINFECTION: Type Amount
g. WATER ZONES (depth):
Top 70 Bottom 450 Top Bottom
Top Bottom Top Bottom
;Top Bottom Top Bottom
2. WELL INFORMATION: ; 7. CASING: Depth Diameter
WELL CONSTRUCTION PERMIT# W 10100141 : Top 0 Bottom 82 Ft._ 6 5/8
OTHER ASSOCIATED PERMIT#(if applicable)
SITE WELL ID #(if applicable) H-8
3. WELL USE (Check One Box) Monitoring ❑ Municipal/Public ❑
Industrial/Commercial ❑ Agricultural ❑ Recovery ❑ Injection ❑
Irrigation❑ Other S((list use) Closed LoOD Geother©
DATE DRILLED 10-24-1 1
4. WELL LOCATION:
1166 lotla Church Rd
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
CITY: Franklin COUNTY Macon
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
❑ Slope []Valley Flat []Ridge ❑ Other
KOBTCD 36 iAAAA&^^^^^^^^! CL R OR 3mXX)PI(9t)tWX CC
KNWISTCD75 iAAAA&AAAAAAAA! CLROR 7X.'X9f )kXX'kW CC
Latitudellongitude source: [-IGPS ElTopographic map
(location of well must be shown on a USGS topo map andattached to
this form if not using GPS)
5. FACILITY (Name of the business where the well is located.)
Thickness/
Weight Material
.250 steel
Top Bottom
Ft.
Top Bottom
Ft.
8. GROUT: Depth
Material Method
TopQ_ Bottom 87
Ft. bentonite pumped
Topes_ Bottom 450 Ft. washed stone poured
Top Bottom
Ft.
9. SCREEN: Depth
Diameter Slot Size Material
Top Bottom
Ft. in. in.
Top Bottom
Ft. in. in.
Top Bottom
Ft. in. in.
10. SAND/GRAVEL PACK:
Depth
Size Material
: Top Bottom
Ft.
Top Bottom
Ft.
Top Bottom
Ft.
11. DRILLING LOG
Top Bottom
Formation Description
Macon Elementary School 0 / 30
Facility Name Facility ID# (if applicable) 30 / 78
1166 Intla Church Rd 78 195
Street Address 195 450
Franklin NC 28734 /
City or Town State Zip Code /
Macon County Government
Contact Name
Mailing Address
Franklin NC 28734
City or Town State Zip Code
U
Area code
Phone number
S. WELL DETAILS:
a. TOTAL DEPTH: 450'
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
c. WATER LEVEL Below Top of Casing: 70 FT
(Use "+" if Above Top of Casing)
Red Clay
Brown Clay
Mixture of soft and hard granite
Blue granite
12. REMARKS:
water with broken rock @145' to 155'
100 HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
• 15A NCAC 2C, WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
RECORD HAS BEEN PROVIDED TO THE WELL OWNER
1, 10-24-11
SIGNATURE OF CERTIFIED WELL CONTRACTOR DATE
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Form GW-1b
Submit within 30 days of completion to: Division of Water Quality - Information Processing, Rev. 1/08
1617 Mail Service Center, Raleigh, NC 27699-161, Phone : [phone]

NONRESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 3065-A
1. WELL CONTRACTOR:
Roaer L Williams
Well Contractor (Individual) Name
Tarheel Water Treatment
Well Contractor Company Name
3494 Georaia RD
Street Address
Franklin NC 28734
City or Town State Zip Code
8( 28 ) 369-0740
Area code Phone number
2. WELL INFORMATION:
d. TOP OF CASING IS FT. Above Land Surface'
*Top of casing terminated atior below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): 70 METHOD OF TEST Rlnw Down
f. DISINFECTION: Type HT - Amount 12 n7
g. WATER ZONES (depth):
Top Bottom Top Bottom
Top Bottom Top Bottom
Top Bottom Top Bottom
Thickness/
7. CASING: Depth Diameter Weight Material
WELL CONSTRUCTION PERMIT# W I0100141
: Top-- Bottom 110 Ft.
ToP Bottom
Ft.
OTHER ASSOCIATED PERMIT#(if applicable)
SITE WELL ID #(if applicable) I-1 A
TopBottom
Ft.
3. WELL USE (Check One Box) Monitoring ❑ Municipal/Public ❑
: 8. GROUT: Depth _ —
Material Method
: Topes Bottom 115
Ft.-RentOrtite Pumped
Industrial/Commercial ❑ Agricultural ❑ Recovery ❑ Injection ❑
Irrigation❑ Other 5((list use) Closed IooD Geotherre
Top 115 Bottom 383
Ft. washed stone poured
DATE DRILLED 1 1-10-11
; Top Bottom
Ft.
4. WELL LOCATION:
; 9. SCREEN: Depth
Diameter Slot Size Material
1166 Lotla Church Rd
: Top Bottom
Ft. in. in.
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
: Top Bottom
Ft. in. in.
CITY: Franklin COUNTY Macon
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
[]slope []Valley Flat ❑ Ridge ❑ Other
KOISTCD 36 iAAAA&AAAAAAAA! CL ROR 3X^AXXit(9&WX CC
KNMiF ISTCD 75 iAAAA&AAAAAAAA! CL R OR 7k9('><`J ]kXA W CC
Latitude/longitude source: DGPS Oropographic map
(location of well must be shown on a USGS topo map andattached to
this form if not using GPS)
5. FACILITY (Name of the business where the well is located.)
Macon FlPmentary
Facility Name Facility ID# (if applicable)
11 66 I otla Church Rd
Street Address
Franklin NC 28734
City or Town State Zip Code
Marnn County (,nvernment
Contact Name
Mailing Address
Franklin NC 28743
City or Town State Zip Code
c.U)
Area code
Phone number
6. WELL DETAILS:
a. TOTAL DEPTH: 383
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO CV
Top Bottom Ft. in.
10. SAND/GRAVEL PACK:
Depth Size
Top Bottom Ft.
Top Bottom Ft.
Top Bottom Ft.
: 11. DRILLING LOG
in.
Material
Top Bottom Formation Description
0 / 82 Sand Clay
82 / 110 Broken Rock
110 / 375 Granite
375 / 383 Broken rock 70 GPM
12. REMARKS:
I DO HEREBY TIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
• 15A NCAC 2 , W L CONSTRUCTION STANDARD , AND THAT A COPY OF THIS
RECORD' S EN PROVID THE ER
11-10-11
SIGF4ATUME OF CERTIFIED WELL CONTRACTOR DATE
C. WATER LEVEL Below Top of Casing: `{�% FT. ; ��r I Williams
(Use "+" if Above Top of Casing) : PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Form GW-1b
Submit within 30 days of completion to: Division of Water Quality - Information Processing, Rev.1/08
1617 Mail Service Center, Raleigh, NC 27699-161, Phone: [phone]

NONRESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 3065-A
1. WELL CONTRACTOR:
Roaer L Williams
Well Contractor (Individual) Name
Tarheel Water Treatment
Well Contractor Company Name
3494 Georaia RD
Street Address
Franklin NC 28734
City or Town State Zip Code
8( 28 ) 369-0740
Area code Phone number
2. WELL INFORMATION:
d. TOP OF CASING IS FT. Above Land Surface'
'Top of casing terminated attor below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): 0 METHOD OF TEST BIOW Down
f. DISINFECTION: Type HT . Amount 19 nz
g. WATER ZONES (depth):
;Top Bottom Top Bottom
Top Bottom Top Bottom
;Top Bottom Top Bottom
Thickness/
7. CASING: Depth Diameter Weight Material
WELL CONSTRUCTION PERMIT# W 10100141 : Top 0 Bottom 67 Ft. _
OTHER ASSOCIATED PERMIT#(if applicable) Top Bottom Ft. _
SITE WELL ID #(if applicable) 1-1 B Top Bottom Ft. _
3. WELL USE (Check One Box) Monitoring ❑ Municipal/Public ❑ : 8. GROUT: Depth Material
Industrial/Commercial ❑ Agricultural ❑ Recovery ❑ Injection ❑ Top 0 Bottom 67 Ft. Bentonite
Irrigation❑ Other N((list use) Closed loop Geotherne Top Bottom Ft.
DATE DRILLED 1 1-10-1 1 ;Top Bottom Ft.
4. WELL LOCATION:
1166 Lotla Church Rd
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
CITY: Franklin COUNTY Macon
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
[]Slope []Valley Flat ❑ Ridge ❑ Other
KOISTCD 36 iAAAA&AAAAAAAA! CL R OR 31(mXXXX90MX CC
KNMFI$TCD75 iAAAABAAAAAAAA! CLROR 7X!XX7tXXX90(9@ CC
Latitude/longitude source: E)GPS aopographic map
(location of well must be shown on a USGS topo map andattached to
this form if not using GPS)
5. FACILITY (Name of the business where the well is located.)
Marnn Elementary
Facility Name Facility ID# (if applicable)
1166 1 ntla Church Rd
Street Address
Franklin NC 28734
City or Town State Zip Code
Macon County Government
Contact Name
Mailing Address
Franklin NC 28743
City or Town State Zip Code
Area code Phone number
6. WELL DETAILS:
a. TOTAL DEPTH: 67
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO q/
c. WATER LEVEL Below Top of Casing: i0 e/1-01 FT.
(Use "+" if Above Top of Casing)
Method
Pumped
9. SCREEN: Depth Diameter Slot Size Material
Top Bottom Ft. in. in.
Top Bottom Ft. in. in.
Top Bottom Ft. in. in.
10. SAND/GRAVEL PACK:
Depth Size
Top Bottom Ft.
Top Bottom Ft.
Top Bottom Ft.
: 11. DRILLING LOG
Top Bottom
0 / 67
/
/
12. REMARKS:
leasing Removed
Material
Formation Description
Sand Clay
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
15A NCAC O,- ELL CONSTRUCTION TANDARDS, AND THAT A COPY OF THIS
RECOR A EEN PR ID D TO T lei.
n� \ 11-10-11
SIGNATU E OF CERTIFIED WELL CONTRACTOR DATE
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Form GW-1b
Submit within 30 days of completion to: Division of Water Quality - Information Processing, Rev. 1108
1617 Mail Service Center, Raleigh, NC 27699-161, Phone : [phone]

NONRESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 2185 A
1. WELL CONTRACTOR:
Stanley K. Setzer
Well Contractor (Individual) Name
Mid South Geothermal
Well Contractor Company Name
8275 Tournament Dr.
Street Address
Memphis Tn 38125
City or Town State Zip Code
9c 01 ) 748-9095
Area code Phone number
2. WELL INFORMATION:
WELL CONSTRUCTION PERMIT# W101 00 141
d. TOP OF CASING IS R�mAVPfi FT. Above Land Surface'
'Top of casing terminated attor below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
: e. YIELD (gpm): �_ METHOD OF TEST Air BIoW
If. DISINFECTION: Type Amount
g. WATER ZONES (depth):
Top Bottom Top Bottom
Top Bottom Top Bottom
'Top Bottom Top Bottom
Thickness/
7. CASING: Depth Diameter Weight Material
: Top 0 Bottom,_ Ft. 6 5/8 .25
OTHER ASSOCIATED PERMIT#(if applicable) Top Bottom Ft.
SITE WELL ID #(if applicable) 1-7 ; Top Bottom Ft.
3. WELL USE (Check One Box) Monitoring ❑ Municipal/Public ❑
Industrial/Commercial ❑ Agricultural ❑ Recovery ❑ Injection ❑
Irrigation[] Other [tj((list use) Closed Loop Geother©
DATE DRILLED-1 0-28-11
4. WELL LOCATION:
1166 lotla Church Rd
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
CITY: Franklin COUNTY Macon
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
❑Slope ❑Valley UrFlat []Ridge []Other
KOl$TCD 36 IAAAA&AAAAAAAA! CL R OR 3X0XX1KXPA)WX CC
KNMFI$TCD75 iAAAA&AAAAAAAA!CLROR7k.'X'k`X7U(9()WCC
Latitude/longitude source: [JGPS ❑Topographic map
(location of well must be shown on a USGS topo map andattached to
this form if not using GPS)
5. FACILITY (Name of the business where the well is located.)
Macon Elementary School
Facility Name Facility ID# (if applicable)
1166 lotla Church Rd
Street Address
Franklin NC 28734
City or Town State Zip Code
Macon County Government _
Contact Name
8. GROUT: Depth Material Method
Topes_ Bottom 70 Ft. Bentonite Pumped
Topes_ Bottom 450 Ft. washed stone poured
Top Bottom Ft.
S. SCREEN: Depth Diameter Slot Size Material
Top Bottom Ft. in. in.
Top Bottom Ft. in. in.
Top Bottom Ft. in. in.
10. SAND/GRAVEL PACK:
Depth Size
: Top Bottom Ft.
Top Bottom Ft.
Top Bottom Ft.
11. DRILLING LOG
Top Bottom
0 / 20
20 / 69
69 82
82 152
152 / 162
162 / 450
Mailing Address
Franklin NC 28734
City or Town State Zip Code : 12 REMARKS:
Area code
Phone number
6. WELL DETAILS:
a. TOTAL DEPTH: 450
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO 5 /
Material
Formation Description
Red Cla
Brown Clay
sandy Soil
Granite
Broken Granite
Granite
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
• 15A NCAC 2C, WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
RECORD HAS BEEN PROVIDED TO THE WELL OWNER
10-28-11
: SIGNATURE OF CERTIFIED WELL CONTRACTOR DATE
c. WATER LEVEL Below Top of Casing: FT. Stanley K. S -t7er
(Use "+" if Above Top of Casing) : PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Form GW-1b
Submit within 30 days of completion to: Division of Water Quality - Information Processing, Rev. 1/08
1617 Mail Service Center, Raleigh, NC 27699-161, Phone : [phone]

NONRESIDENTIAL WELL CONSTRUCTION RECORD
' North Carolina Department of Environment and Natural Resources- Division of Water Quality
�"••^ • f WELL CONTRACTOR CERTIFICATION # 3065 A
1. WELL CONTRACTOR:
Roaer L Williams
Well Contractor (Individual) Name
Tarheel Water Treatment
Well Contractor Company Name
3494 Georaia RD
Street Address
Franklin NC 28734
City or Town State Zip Code
8r 28 ) 369-0740
Area code Phone number
2. WELL INFORMATION:
WELL CONSTRUCTION PERMIT# WIO100141
OTHER ASSOCIATED PERMIT#(if applicable)
SITE WELL ID #(if applicable) J-1
3. WELL USE (Check One Box) Monitoring ❑ Municipal/Public ❑
Industrial/Commercial ❑ Agricultural ❑ Recovery ❑ Injection ❑
Irrigation❑ Other N (list use) Closed IDDD Geotherre
DATE DRILLED 11-11-11
4. WELL LOCATION:
1166 Lotla Church Rd
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
CITY: Franklin COUNTY Macon
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
❑Slope ❑Valley jiFlat ❑Ridge ❑Other
K@3f$TCD 36
KN MF MT CD 75
IAAAA&AAAAAAAAI CL R OR 3xoxxxxX40t9 x CC
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): Sn METHOD OF TEST BIOW 2Q=
f. DISINFECTION: Type Fire: Amount 1 07
g. WATER ZONES (depth):
;Top Bottom Top Bottom
:Top Bottom Top Bottom
Top Bottom Top Bottom
Thickness/
7. CASING: Depth Diameter Weight Material
Topes_ Bottom 110 Ft.
Top Bottom Ft.
Top Bottom Ft.
8. GROUT: Depth Material Method
Topes_ Bottom 115 Ft. BentOnite Pumped
Top 1L_ Bottom 450 Ft. washed stone poured
Top Bottom Ft.
: 9. SCREEN: Depth Diameter Slot Size Material
Top Bottom Ft. in. in.
Top Bottom Ft. in. in.
Top Bottom Ft, in. in.
10. SAND/GRAVEL PACK:
Depth Size
Top Bottom Ft.
jAAAA&AAAAAAAA! CL ROR 71x.."XX9('kW CC : Top Bottom Ft.
Latitudeflongitude source: ❑GPS ❑topographic map
(location of well must be shown on a USGS topo map andattached to
this form if not using GPS)
5. FACILITY (Name of the business where the well is located.)
Macon Elementary
Facility Name Facility ID# (if applicable)
1168 I ntla r'`hI Irnh Rd
Street Address
Franklin NC 28734
City or Town State Zip Code
I\A.+ron ('niInty Government
Contact Name
Mailing Address
Franklin NC' 28M
City or Town State Zip Code
Area code Phone number
6. WELL DETAILS:
a. TOTAL DEPTH: 4550
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO EV c-
c. WATER LEVEL Below Top of Casing: Jy FT.
(Use "+" if Above Top of Casing)
Top Bottom Ft.
Material
11. DRILLING LOG
Top Bottom Formation Description
0 / 67
67 / 110
110 / 450
/
/
/
/
/
12. REMARKS:
Sand Clav
Broken Granite
Granite -
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
• 15A NCAC LL CONSTRUCTION ST AR D THAT A COPY OF THIS
RECOR H EEN PROVIDED O THE
31 NATO E OF CERTIFIED WELL CONTRACTOR DATE
: PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Form GW-1b
Submit within 30 days of completion to: Division of Water Quality - Information Processing, Rev.1/08
1617 Mail Service Center, Raleigh, NC 27699-161, Phone : [phone]

NONRESIDENTIAL ONRESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 3065-A
1. WELL CONTRACTOR:
Rooer L Williams
Well Contractor (Individual) Name
Tarheel Water Treatment
Well Contractor Company Name
3494 Georoia RD
Street Address
Franklin NC 28734
City or Town State Zip Code
8( 28 ) 369-0740
Area code Phone number
2. WELL INFORMATION:
d. TOP OF CASING IS FT. Above Land Surface -
'Top of casing terminated attor below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): 30 METHOD OF TEST Blow Down
: f. DISINFECTION: Type_ HTC Amount 19 07
g. WATER ZONES (depth):
Top Bottom Top Bottom
:Top Bottom Top Bottom
Top Bottom Top Bottom
Thickness/
7. CASING: Depth Diameter Weight Material
WELL CONSTRUCTION PERMIT# W 10100141 : Topes_ Bottom 195 Ft.
OTHER ASSOCIATED PERMIT#(if applicable) : Top Bottom Ft.
SITE WELL ID #(if applicable) K-5 ; Top Bottom Ft.
3. WELL USE (Check One Box) Monitoring ❑ Municipal/Public ❑ : 8. GROUT: Depth Material Method
Industrial/Commercial ❑ Agricultural ❑ Recovery ❑ Injection ❑
Irrigation❑ Other !((list use) Closed IooD Geotherre
DATE DRILLED 1 1-8-1 1
4. WELL LOCATION:
1166 Lotla Church Rd
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
CITY: Franklin COUNTY Macon
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
❑ Slope []Valley Flat ❑ Ridge ❑ Other
KI3ISTCD 36 iAAAA&AAAAAAAA! CL R OR 3&XXXXfAXMX CC
KNMFISTCD75 1AAAA&AAAAAAAAI CLROR 7k)t. XXXXOW CC
Latitude/longitude source: ❑GPS []Topographic map
(location of well must be shown on a USGS topo map andattached to
this form if not using GPS)
5. FACILITY (Name of the business where the well is located.)
Macon Flem .ntary
Facility Name Facility ID# (if applicable)
1166 Lotla Church Rd
Street Address
Franklin NG 28734
City or Town State Zip Code
_Macon County GoyPmm .nt
Contact Name
Mailing Address
Franklin NC' 28741
City or Town State Zip Code
Area code
Phone number
6. WELL DETAILS:
a. TOTAL DEPTH:_ 450
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO q/
Top 0 Bottom 200 Ft. Bentonite Pumoed
Top 200 Bottom 450 Ft. washed stone poured
Top Bottom
Ft.
9. SCREEN: Depth
Diameter Slot Size Material
Top Bottom
Ft. in. in.
Top Bottom
Ft. in. in.
Top Bottom
Ft. in. in.
10. SAND/GRAVEL PACK:
Depth
Size Material
Top Bottom
Ft.
Top Bottom
Ft.
Top Bottom
Ft.
11. DRILLING LOG
Top Bottom
0 / 82
82 / 185
185 / 450
12. REMARKS:
easing Removed
Formation Description
Sand Clay
Broken Rock
Granite 30 GPM
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
15A NCAC 2C WfLL CONSTRUCTIONS ANDARDS, AND THAT A COPY OF THIS
RECORD S EN PROVI ED TOT E W IEl.
S16NAT RE OF CERTIFIED WELL CONTRACTOR DATE
c. WATER LEVEL Below Top of Casing: FT. Roder L_ Williams
(Use "+" if Above Top of Casing) : PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit within 30 days of completion to: Division of Water Quality Form /08
Y p ty - Information Processing, Rev. 1/08
1617 Mail Service Center, Raleigh, NC 27699-161, Phone : [phone]

NONRESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 3065-A
1. WELL CONTRACTOR:
Roaer L Williams
Well Contractor (Individual) Name
Tarheel Water Treatment
Well Contractor Company Name
3494 Georaia RD
Street Address
Franklin NC 28734
City or Town State Zip Code
8t 28 ) 369-0740
Area code Phone number
2. WELL INFORMATION:
WELL CONSTRUCTION PERMIT# W 10100141
OTHER ASSOCIATED PERMIT#(if applicable)
SITE WELL ID #(if applicable) K-6A
3. WELL USE (Check One Box) Monitoring ❑ Municipal/Public ❑
Industrial/Commercial ❑ Agricultural ❑ Recovery ❑ Injection ❑
Irrigation❑ Other !N((list use) Closed 100D Geothernd
DATE DRILLED 1 1-3-1 1
4. WELL LOCATION:
1166 Lotla Church Rd
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
CITY: Franklin COUNTY Macon
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
[]Slope ❑Valley `(Flat ❑Ridge ❑Other
KOISTCD 36 1AAAA&AAAAAAAA! CL R OR 31(^xXxx9019 x CC
KNWMTCD75 iAAAA&AAAAAAAA! CLROR %tJQ70(k7fXxNt)tX` CC
Latitude/longitude source: ❑GPS ❑Topographic map
(location of well must be shown on a USGS topo map andattached to
this form if not using GPS)
5. FACILITY (Name of the business where the well is located.)
Macon Elementary
Facility Name Facility ID# (if applicable)
1166 Lotla Church Rd
Street Address
Franklin N 8734
City or Town State Zip Code
Macon County Government
Contact Name
Mailing Address
Franklin NC 2874.3
City or Town State Zip Code
U
Area code
Phone number
d. TOP OF CASING IS FT. Above Land Surface*
'Top of casing terminated attor below land surface may require
a variance in accordance with 15A NCAC 2C..0118.
e. YIELD (gpm): 50 METHOD OF TEST BIOW Down
f. DISINFECTION: Type HTC Amount 12 oZ
g. WATER ZONES (depth):
Top Bottom Top Bottom
Top Bottom Top Bottom
Top Bottom Top Bottom
Thickness/
7. CASING: Depth Diameter Weight Material
Top 0 Bottom 165 Ft.
Top Bottom Ft.
Top Bottom Ft.
8. GROUT: Depth Material Method
Top 0 Bottom 170' Ft. Bentonite Pumped
Top 170 Bottom 200 Ft. washed stonE poured
Top Bottom Ft.
9. SCREEN: Depth
Diameter Slot Size Material
Top Bottom
Ft. in. in.
Top Bottom
Ft. in. in.
Top Bottom
Ft. in. in.
10. SAND/GRAVEL PACK:
Depth
Size Material
Top Bottom
Ft.
Top Bottom
Ft.
: Top Bottom
Ft.
11. DRILLING LOG
Top Bottom
0 / 82
: 82 / 165
165 / 200
/
12. REMARKS:
leasing Removed
Formation Description
Sand Clay
Broken Rock
Loose Gravel 50 GPM
6. WELL DETAILS: : I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
• 15A NCAC 2C, WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
a. TOTAL DEPTH:_ ZOO RECORD H EN PROVI TO TH EL NER.
11-03-11
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO G/ : SIGNAT E OF CERTIFIED WELL CONTRACTOR DATE
c. WATER LEVEL Below Top of Casing: FT. j�O�er L. WIIII��S
(Use "+" if Above Top of Casing) : PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit within 30 days of completion to: Division of Water Quality Form /08
Y P ty - Information Processing, Rev. 1/08
1617 Mail Service Center, Raleigh, NC 27699-161, Phone : [phone]

NONRESIDENTIAL WELL CONSTRUCTION RECORD
17 North Carolina Department of Environment and Natural Resources- Division of Water Quality
3II8 A
;.•� WELL CONTRACTOR CERTIFICATION #
1. WELL CONTRACTOR:
Timothy R Hamby
Well Contractor (Ind•Ividuaq Name
Midsouth Geothermal
Well Contractor Company Name
8275 Toumament Dr STE 5
Street Address
Memphis TN 38125
City or Town State Zip Code
d TOP OF CASING IS -' FT. Above Land Surface*
`Top of casing terminated atfor below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): 100 METHOD OF TEST BIOW Down
: E DISINFECTION: Type I -ITC Amount 'I 2A2
g. WATER ZONES (depth):
;Topjff Bottom
: Top %�Q Bottom A'
Top Bottom
Top Bottom
9( 01 ). 748-9095
; Top
Bottom
Top Bottom
Area code Phone number
Thickness/
2 WELL INFORMATION:
: 7. CASING:
Depth
Diameter Weight Material
WELL CONSTRUCTION PERMIT# W10100141
: Top 40
Bottom *
Ft. 61 8 .188 Steel
OTHER ASSOCIATED PEDMIT#(if appi,
:Topes_
Bottom 0
Ft.
SITE WELL ID #(if applicable)_ b�
Top
Bottom
Ft.
3. WELL USE (Check One Box) Monitoring ❑ Municipal/Public ❑
: 8. GROUT:
Depth
Material Me�thJod
Industrial(Commercial ❑ Agricultural ❑ Recovery (I Injection ❑
: Top
Bottom_ FL�3eh ! C !
Irrigation❑ Other N(pi(st use) Closed LOOD Geothere
; Top
Bottom
FL
DATE DRILLEE_ F".
: Top
Bottom
FL
4. WELL LOCATION:
; 9. SCREEN: Depth
Diameter Slot Size Material
1166 Lotla Church Rd
: Top
Bottom -Ft.
-In. In.
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
CITY: Franklin COUNTY Macon
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
[]Slope []Valley (Flat ❑Ridge ❑Other
LATITUDE 36 " DMS OR 3X.XDD XM DD
LONGITUDE 75 " DMS OR 7X.XXXXXXX X DD
Latitudenongitude source: [33PS Qropographic map
(location of well must be shown on a USGS topo map andattached to
this form if not using GPS)
S. FACILITY (Name of the business where the well is located.)
Macon Elt?mentry School
Facility Name Facility ID# (if applicable)
1166 Loth Church Rd
Street Address
Franklin NC 28734
City or Town State Zip Code
Contact Name
Mailing Address
Franklin NC 28743
City or Town State Zip Code
U
Area code
Phone number
6. WELL DETAILS:
a TOTAL DEPTH: ,� O
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO ❑
= Top
Bottom
Ft. in.
Top
Bottom
Ft. in.
10. SAND/GRAVEL PACK:
Depth
Size
= Top
Bottom
FL
Top
Bottom
Ft.
Top
Bottom
Ft.
: 11. DRILLING LOG
in.
in.
Material
Top Bottom Formation Description
I/de
Jr
O /
6-y4- A
: 12. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
ISA NCAC 2C, WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
: RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
: SIGNAcWRE OF CERTIF1129 YELL CONTRACTOR DATE
c. WATER LEVEL Below Top of Casing: 60 -FT. : Timothy R Hamby
(Use "+" if Above Top of Casing) : PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Sub mit.Within 30�days of completion to Division of Water Quality. = Information Processing;. Form GW-1b
1617 Mail Service.Conter;.Raleigh NC 27699 167 Phone : (9. f9) 807-6300:

NONRESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 3065-A
1. WELL CONTRACTOR:
Roaer L Williams
Well Contractor (Individual) Name
Tarheel Water Treatment
Well Contractor Company Name
3494 Georgia RD
Street Address
Franklin NC 28734
City or Town State Zip Code
8c 28 ) 369-0740
Area code Phone number
2. WELL INFORMATION:
WELL CONSTRUCTION PERMIT# WIO100141
OTHER ASSOCIATED PERMIT#(if applicable)
SITE WELL ID #(if applicable) K-7
3. WELL USE (Check One Box) Monitoring ❑ Municipal/Public ❑
Industrial/Commercial ❑ Agricultural ❑ Recovery ❑ Injection ❑
Irrigation❑ Other I((Iist use) Closed IooD Geotherre
DATE DRILLED 10-31-1 1
4. WELL LOCATION:
1166 Lotla Church Rd
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
CITY: Franklin COUNTY Macon
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
❑ Slope []Valley Flat []Ridge ❑ Other
KOISTCD 36 IAAAA&AAAAAAAA! CL R OR 3mxxxxPowx CC
KNMFISTCD75 1AAAA&^^^^^^^"I CLROR 7`X'3Ck XX'X)OM CC
LatitudeAongitude source: ❑GPS Oropographic map
(location of well must be shown on a USGS topo map andattached to
this form if not using GPS)
5. FACILITY (Name of the business where the well is located.)
Macon Elementary
Facility Name Facility ID# (if applicable)
1166 Lotla Church Rd
Street Address
Franklin NC 28734
City or Town State Zip Code
nnar nn County Government
Contact Name
Mailing Address
Franklin NG 98743
City or Town State Zip Code
U
Area code Phone number
S. WELL DETAILS:
a. TOTAL DEPTH: 45O
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO !�
d. TOP OF CASING IS FT. Above Land Surface`
'Top of casing terminated attor below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): 50 METHOD OF TEST glow Down
f. DISINFECTION: Type HT Amount 19 07
g. WATER ZONES (depth):
Top Bottom Top Bottom
Top Bottom Top Bottom
;Top Bottom Top Bottom
Thickness/
7. CASING: Depth Diameter Weight Material
Top_ Bottom_ 82 Ft.
Top Bottom Ft.
Top Bottom Ft.
8. GROUT: Depth Material Method
Top 0 Bottom 887 Ft. Bentonite Pumped
Top3L_Bottom _450 Ft. washed stony loured
Top Bottom
Ft.
9. SCREEN: Depth
Diameter Slot Size Material
Top Bottom
Ft. in. in.
Top Bottom
Ft. in. in.
Top Bottom
Ft. in. in,
: 10. SAND/GRAVEL PACK:
Depth
Size Material
Top Bottom
Ft.
Top Bottom
Ft.
Top Bottom
Ft.
11. DRILLING LOG
Top Bottom
0 / 82
82 / 200
300 1450
/
12. REMARKS:
Formation Description
Sand Clay
Water (@192 50 cipm
Granite
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
• 15A NCAC 2C, AELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
RECORD EN PROVID TO TH ELL W ER
� r_ 10-31-11
: S16NATLAE OF CERTIFIED WELL CONTRACTOR DATE
c. WATER LEVEL Below Top of Casing: FT. Rnapr L. Williams
(Use "+" if Above Top of Casing) : PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Form GW-1b
Submit within 30 days of completion to: Division of Water Quality - Information Processing, Rev.1/08
1617 Mail Service Center, Raleigh, NC 27699-161, Phone : [phone]

NONRESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 3065 A
1. WELL CONTRACTOR:
Roaer L Williams
Well Contractor (Individual) Name
Tarheel Water Treatment
Well Contractor Company Name
3494 Georaia RD
Street Address
Franklin NC 28734
City or Town State Zip Code
8( 28 ) 369-0740
Area code Phone number
2. WELL INFORMATION:
WELL CONSTRUCTION PERMIT# WI0100141
d. TOP OF CASING IS
FT. Above Land Surface`
'Top of casing terminated atior below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm):
METHOD OF TEST Rlnw Down
f. DISINFECTION: Type HTC Amount 12 07
: g. WATER ZONES (depth):
Top Bottom
Top Bottom
Top Bottom
Top Bottom
Top Bottom
Top Bottom
Thickness/
7. CASING: Depth
Diameter Weight Material
: Topes(_ Bottom84 Ft
OTHER ASSOCIATED PERMIT#(if applicable) : Top Bottom Ft.
SITE WELL ID #(if applicable) K-8 : Top Bottom Ft.
3. WELL USE (Check One Box) Monitoring ❑ Municipal/Public ❑
Industrial/Commercial ❑ Agricultural ❑ Recovery ❑ Injection ❑
Irrigation❑ Other (((Iist use) Closed IooD Geothernd
DATE DRILLED-1 0-27-11
4. WELL LOCATION:
1166 Lotla Church Rd
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
CITY: Franklin COUNTY Macon
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
❑Slope ❑Valley prFlat ❑Ridge ❑Other
KOISTCD 36 1AAAA&AAAAAAAA! CL R OR 3X0XXXXPA (D= CC
KNMFI$TCD75 IAAAA&AAAAAAAA! CLROR 7)t!X`X`kXi(9POW CC
Latitude/longitude source: ❑GPS Oropographic map
(location of well must be shown on a USGS topo map andattached to
this form if not using GPS)
5. FACILITY (Name of the business where the well is located.)
Macon Elementary
Facility Name Facility ID# (if applicable)
1166 Lotln Church Rd
Street Address
Franklin NC 28734
City or Town State Zip Code
Macon County Government
Contact Name
Mailing Address
Franklin NC 28743
City or Town State Zip Code
U
Area code Phone number
6. WELL DETAILS:
a. TOTAL DEPTH: 450
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO qI
: 8. GROUT: Depth Material Method
Topes_ Bottom 89 Ft. Bentonite Pumaed
Top, 8g _ Bottom 450 Ft. Washed stonE poured
Top Bottom Ft.
9. SCREEN: Depth Diameter Slot Size Material
Top Bottom Ft. in. in.
Top Bottom Ft. in. in.
Top Bottom Ft. in. in.
10. SAND/GRAVEL PACK:
Depth Size
Top Bottom Ft.
Top Bottom Ft.
: Top Bottom Ft.
11. DRILLING LOG
Top Bottom
0 / 84
84 / 300
300 / 450
/
12. REMARKS:
Material
Formation Description
Sand Clay
Dry
_Dry
100 HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
16A NCAC 2C, WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
RECORD HAS BEEN PROVIDED TO THE WELL OWNER
10-27-11
: SIGNATURE OF CERTIFIED WELL CONTRACTOR DATE
c. WATER LEVEL Below Top of Casing: FT. : Roaer L_ Williams
(Use "+" if Above Top of Casing) : PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit within 30 days of completion to: Division of Water Quality information Processing, Form /08
y P ty " g+ Rev. 1/08
1617 Mail Service Center, Raleigh, NC 27699-161, Phone : [phone]

NONRESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 3065 A
1. WELL CONTRACTOR:
Roaer L Williams
Well Contractor (Individual) Name
Tarheel Water Treatment
Well Contractor Company Name
3494 Georaia RD
Street Address
Franklin NC 28734
City or Town State Zip Code
8( 28 ) 369-0740
Area code Phone number
2. WELL INFORMATION:
WELL CONSTRUCTION PERMIT# W l0100141
OTHER ASSOCIATED PERMIT#(if applicable)
SITE WELL ID #(if applicable) J-1
3. WELL USE (Check One Box) Monitoring ❑ Municipal/Public ❑
Industrial/Commercial ❑ Agricultural ❑ Recovery ❑ Injection ❑
Irrigation[] Other ly((list use) Closed loop Geotherre
DATE DRILLED-1 1 - 11 - 11
4. WELL LOCATION:
1166 Lotla Church Rd
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
CITY: Franklin COUNTY Macon
TOPOGRAPHIC / LAND SETTING; (check appropriate box)
[]Slope []Valley prFlat ❑ Ridge ❑ Other
KI31$TCD 36 1AAA A&AAA AAAAA! CL ROR 3XmXXX90t9P X CC
KNMFI$TCD75 iAAAA&AAAAAAAAI CLROR 7A.'X/C XX7cXW CC
Latitude/longitude source: ❑GPS []Topographic map
(location of well must be shown on a USGS topo map andattached to
this form if not using GPS)
5. FACILITY (Name of the business where the well is located.)
Macon Elementary
Facility Name Facility ID# (if applicable)
1166 Lotla Church Rd
Street Address
Franklin NC 28734
City or Town State Zip Code
Macon County Government
Contact Name
Mailing Address
Franklin NC 28743
City or Town State Zip Code
Area code Phone number
6. WELL DETAILS:
a. TOTAL DEPTH: 450
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO q�
c. WATER LEVEL Below Top of Casing: Sy FT.
(Use "+^ if Above Top of Casing)
d. TOP OF CASING IS FT. Above Land Surface'
'Top of casing terminated attor below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): 50 METHOD OF TEST BIOW Dovvn
f. DISINFECTION: Type HTC Amount 'I%-
g. WATER ZONES (depth):
Top Bottom Top Bottom
Top Bottom Top Bottom
Top Bottom Top Bottom
Thickness/
7. CASING: Depth Diameter Weight Material
Top 0 Bottom 110 Ft.
Top Bottom Ft.
Top Bottom Ft.
. 8. GROUT: Depth Material Method
Top 0 Bottom 115 Ft. Bentonite Pumped
: Top 115 Bottom 450 Ft. washed stone poured
Top Bottom Ft.
9. SCREEN:
Depth
Diameter Slot Size Material
Top
Bottom
Ft. in. in.
Top
Bottom
Ft. in. in.
Top
Bottom
Ft. in. in.
10. SAND/GRAVEL
PACK:
Depth
Size
Top
Bottom
Ft.
Top
Bottom
Ft.
: Top
Bottom
Ft.
11. DRILLING LOG
Top Bottom
0 / 67
67 / 110
110 / 450
/
12. REMARKS:
Material
Formation Description
Sand Clay
Broken Granite
Granite
: 100 HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
• 15ANCAC.2GrWELL CONSTRUCTION STA AR , D THAT A COPY OF THIS
REC DR H EEN PROVIDED O THE
Lr.
SIGNATURE OF CERTIFIED WELL CONTRACTOR DATE
Roger L. Williams
PRINTED NAME ORPERSON CONSTRUCTING THE.WELL
i,
Submit within 30 days of completion to: Division of Water Quality - Information ProcesMtrg; g N Form /08
Rev. 1 /08
1617 Mail Service Center, Raleigh, NC 27699-161, Phone : [phone] ;I i

NONRESIDENTIAL
WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 3065 A
1. WELL CONTRACTOR:
Roper L Williams
Well Contractor (Individual) Name
Tarheel Water Treatment
Well Contractor Company Name
3494 Georaia RD
Street Address
Franklin NC 28734
City or Town State Zip Code
8( 28 ) 369-0740
Area code Phone number
2. WELL INFORMATION:
WELL CONSTRUCTION PERMIT# W 10100141
OTHER ASSOCIATED PERMIT#(if applicable)
SITE WELL ID #(if applicable) 1-1 B
3. WELL USE (Check One Box) Monitoring ❑ Municipal/Public ❑
Industrial/Commercial ❑ Agricultural ❑ Recovery ❑ Injection ❑
Irrigation❑ Other It((list use) Closed IOOD Geotherra
DATE DRILLED 1 1-10-1 1
4. WELL LOCATION:
1166 Lotla Church Rd
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
CITY: Franklin COUNTY Macon
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
❑Slope []Valley VFW []Ridge ❑Other
K0I$TCD 36 iAAAA&AAAAAAAAI CL R OR 3X^XXXX90WX CC
KNMFI$TCD75 iAAAA&AAAAAAAA! CL ROR 7k:X'klQ7tXX1AW CC
Latitude/longitude source: ❑GPS aopographic map
(location of well must be shown on a USGS topo map andattached to
this form if not using GPS)
5. FACILITY (Name of the business where the well is located.)
Macon Elementary
Facility Name Facility ID# (if applicable)
1166 Lotla Church Rd
Street Address
Franklin NC 28734
City or Town State Zip Code
Macon County Government
Contact Name
Mailing Address
Franklin N . 29743
City or Town State Zip Code
Area code Phone number
6. WELL DETAILS:
a. TOTAL DEPTH: 67
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO W
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 attor below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): 0 METHOD OF TEST BIoW o=
f. DISINFECTION: Type I -ITC Amount i n7
g. WATER ZONES (depth):
Top Bottom Top Bottom
Top Bottom Top Bottom
Top Bottom Top Bottom
Thickness/
7. CASING: Depth Diameter Weight Material
Top 0 Bottom 67 Ft.
Top Bottom Ft.
Top Bottom Ft.
8. GROUT:. Depth Material Method
Top O Bottom 67 Ft. Bentonite —Pumped
Top Bottom Ft.
Top Bottom Ft.
9. SCREEN: Depth Diameter Slot Size Material
Top Bottom Ft. in.
Top Bottom Ft. in.
Top Bottom Ft. in.
10. SAND/GRAVEL PACK:
Depth Size
Top Bottom Ft.
Top Bottom Ft.
in.
in.
in.
Material
Top Bottom Ft.
11. DRILLING LOG
Top Bottom Formation Description
0 / 67
/
/
12. REMARKS:
Sand Clay
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
• 16A NC ELL CONSTRUCTION TANDARDS, AND THAT A COPY OF THIS
RECOR A .EN
PR IDED TO T-10-11
!A
Oc
SIGNATURE OF CERTIFIED WELL CONTRACTOR D� ATE
Roger L. Williams
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit within 30 days of completion to: Division of Water Quality - Information Processing, Form Rev. 1 /08 /08
1617 Mail Service Center, Raleigh, NC 27699-161, Phone : [phone]

NONRESIDENTIAL
WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
-•,�,a„Q,,,��„�<=
WELL CONTRACTOR CERTIFICATION # 3065 A
1. WELL CONTRACTOR:
Roger L Williams
Well Contractor (Individual) Name
Tarheel Water Treatment
Well Contractor Company Name
3494 Georgia RD
Street Address
Franklin NC 28734
City or Town State Zip Code
8( 28 ) 369-0740
Area code Phone number
2. WELL INFORMATION:
WELL CONSTRUCTION PERMIT# W10 100 141
d. TOP OF CASING IS FT. Above Land Surface -
'Top of casing terminated attor below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
: e. YIELD (gpm): 70 METHOD OF TEST aLQM QD=
f. DISINFECTION: Type HTC Amount 1 2 az
g. WATER ZONES (depth):
Top Bottom Top Bottom
Top Bottom Top Bottom
Top Bottom Top Bottom
Thickness/
7. CASING: Depth Diameter Weight Material
Top-0 Bottom 110 Ft
OTHER ASSOCIATED PERMIT#(if applicable)
Top
Bottom.
Ft.
SITE WELL ID #(if applicable) 1-1 A
Top
Bottom
Ft.
3. WELL USE (Check One Box) Monitoring ❑ Municipal/Public ❑
: S. GROUT:
Depth
Material Method
Industrial/Commercial ❑ Agricultural ❑ Recovery ❑ Injection ❑
: Top 0 Bottom 115
Ft. Bentonite _Pumped
Irrigation❑ Other [t((list use) Closed loon Geotherre
:Top 115
Bottom 383
Ft. washed stone poured
DATE DRILLED 1 1-10-1 1
;Top
Bottom
Ft.
4. WELL LOCATION:
1166 Lotla Church Rd
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
CITY: Franklin COUNTY Macon
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
❑Slope ❑Valley kiFlat ❑Ridge ❑Other
K@31STCD 36 iAAAA&AAAAAAAA! CL R OR 3X0AXD XfAXMX CC
KNMFI$TCD75 iAAAA&AAAAAAAA! CLROR 7X9(°XJC7f1C7(90(`( CC
Latitude/longitude source: ❑GPS Qropographic map
(location of well must be shown on a USGS topo map andattached to
this form if not using GPS)
5. FACILITY (Name of the business where the well is located.)
Macon Elementary
Facility Name Facility ID# (if applicable)
1166 Lotla Church Rd
Street Address
Franklin NC 28734
City or Town State Zip Code
Macon County Government
Contact Name
Mailing Address
Franklin NC 28743
City or Town State Zip Code
Area code
Phone number
S. WELL DETAILS:
a. TOTAL DEPTH: 383
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO q�
c. WATER LEVEL Below Top of Casing: ,`) FT.
(Use "+" if Above Top of Casing)
9. SCREEN: Depth Diameter Slot Size Material
Top Bottom Ft. in. in.
Top Bottom Ft. in. in.
Top Bottom Ft. in. in.
10. SAND/GRAVEL PACK:
Depth Size
Top Bottom Ft.
Top Bottom Ft.
Top Bottom Ft.
11. DRILLING LOG
Top
Bottom
0
/ 82
82
/ 110
: 110
/ 375
375
/ 383
/
: 12. REMARKS:
Material
Formation Description
Sand Clay
Broken Rock
Granite
Broken rock 70 GPM
I DO HEREBY TIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
• 15A NCAC W L CONSTRUCTION STANDARD , AND THAT A COPY OF THIS
: RECORD SSENPROVID�TPTHE ER.
SIGNATURE OF CERTIFIED WELL CONTRACTOR DATE
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit within 30 days of completion to: Division of Water Quality Form /08
y p ty - Information Processing, Rev. 1/08
1617 Mail Service Center, Raleigh, NC 27699-161, Phone : [phone]

NONRESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 3118 A
1. WELL CONTRACTOR:
Timothy R Hamby
Well Contractor (Individual) Name
Midsouth Geothermal
Well Contractor Company Name
8275 Tournament Dr Suite 185
Street Address
Memphis TN 38125
City or Town State Zip Code
9( 01 ) 748-9095
Area code Phone number
2. WELL INFORMATION:
WELL CONSTRUCTION PERMIT# Wl0100141
: d. TOP OF CASING IS 2 FT. Above Land Surface -
'Top of casing terminated attor below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
: e. YIELD (gpm): 40 METHOD OF TEST 3IOW DQM
f. DISINFECTION: Type HTC: Amount 12 o7
g. WATER ZONES (depth):
Top 250' Bottom_254'- Top Bottom
Top Bottom Top Bottom
Top Bottom Top Bottom
Thickness/
7. CASING: Depth Diameter Weight Material
Top +2 Bottom 67' Ft. 6 1 /8 .188 steel
OTHER ASSOCIATED PERMIT#(if applicable)
Top
Bottom
Ft.
SITE WELL ID #(if applicable) A-1
Top
Bottom
Ft.
3. WELL USE (Check One Box) Monitoring ❑ Municipal/Public ❑
: 8• GROUT:
Depth
Material
Method
Industrial/Commercial ❑ Agricultural ❑ Recovery❑ Injection ❑
: Top 0
Bottom 72
Ft. Bentonite
Pumped
Irrigation❑ Other (list use) Closed iooD Geotherrin
Top 72
Bottom 450
Ft._ washed stonE
poured
DATE DRILLED 9-29-1 1
Top
Bottom
Ft.
4. WELL LOCATION:
9. SCREEN:
Depth
Diameter Slot Size
Material
1166 Lotla Church Rd
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
CITY: Franklin COUNTY Macon
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
❑ Slope ❑ Valley p(Flat ❑ Ridge ❑ Other
p(gMTCD 36 1AAAA&AAAAAAAAI CL R OR 3mXXXt O&WX CC
KNMFISTCID 75 1AAAA&AAAAAAAA! CL ROR 7kx. )kX9C)W CC
Latitude/longitude source: ❑GPS aopographic map
(location of well must be shown on a USGS topo map andattached to
this form if not using GPS)
5. FACILITY (Name of the business where the well is located.)
Macon Flementary
Facility Name Facility ID# (if applicable)
1166 Lotla Church Rd
Street Address
Franklin NC 28734
City or Town State Zip Code
Macon County Government
Contact Name
Mailing Address
Franklin NC 28743
City or Town State Zip Code
Area code
Phone number
6. WELL DETAILS:
a. TOTAL DEPTH: 450'
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO q�
Top Bottom Ft. in
Top Bottom Ft. in
Top Bottom Ft. in
10. SAND/GRAVEL PACK:
Depth Size
Top Bottom Ft.
Top Bottom Ft.
Top Bottom Ft.
: 11. DRILLING LOG
Top Bottom
0 / 61
61 / 67
72 250
250 / 254
254 / 450
/
12. REMARKS:
easing Removed
in.
in.
in.
Material
Formation Description
Overburden
Granite
Granite
Broken Granite 40 GPM
Granite
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
15A NCAC 2C, WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
✓n< "� _9-29-11
SIGNA TR
RE OF CERTIFIED WELL CONACTOR DATE
c. WATER LEVEL Below Top of Casing: 60 FT. ; Jlmothy R Hamhy
(Use "+" if Above Top of Casing) : PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit within 30 days of completion to: Division of Water Quality - Information Processing, Form Rev. 1 /08 /08
1617 Mail Service Center, Raleigh, NC 27699-161, Phone : [phone]

NONRESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 3118 A
1. WELL CONTRACTOR:
Timothy R Hamby
Well Contractor (Individual) Name
Midsouth Geothermal
Well Contractor Company Name
8275 Tournament Dr Suite 185
Street Address
Memphis TN 38125
City or Town State Zip Code
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 15A NCAC 2C .0118.
: e. YIELD (gpm): 40 METHOD OF TEST aIOW DOWn
f. DISINFECTION: Type_HTC Amount 1 i Q
g. WATER ZONES (depth):
Top_250' Bottom 254' Top Bottom
:Top Bottom Top Bottom
9( 01 ) 748-9095
; Top
Bottom
Top Bottom
Area code Phone number
Thickness/
2. WELL INFORMATION:
: 7. CASING:
Depth
Diameter Weight Material
WELL CONSTRUCTION PERMIT# W10100141
: Top +2
Bottom 67'
Ft. 6 1 8 .188 steel
OTHER ASSOCIATED PERMIT#(if applicable)
Top
Bottom
Ft.
SITE WELL ID #(if applicable) A-2
' Top
Bottom
Ft.
3. WELL USE (Check One Box) Monitoring ❑ Municipal/Public ❑
: 8. GROUT:
Depth
Material Method
Industrial/Commercial ❑ Agricultural ❑ Recovery ❑ Injection ❑
: Top 0
Bottom_ 2
Ft. Bentonite Pumped
Irrigation[] Other r((listuse) Closed loop Geotherre
Top 72
Bottom 450
Ft. washed stone poured
DATE DRILLED 9-28-11
; Top
Bottom
Ft.
4. WELL LOCATION:
9. SCREEN:
Depth
Diameter Slot Size Material
1166 Lotla Church Rd : Top Bottom Ft. in.
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code) :Top Bottom Ft. in.
CITY: Franklin COUNTY Macon
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
❑ Slope []Valley Flat ❑ Ridge ❑ Other
KOI$TCD 36 iAAAA&AAAAAAAAI CL R OR 3X^XXXXP)OMX CC
KNMFI$TCD75 iAAAA&AAAAAAAAI CL ROR 7X'3C)fX'7E1(Xxxx CC
Latitude/longitude source: ❑GPS Qropographic map
(location of well must be shown on a USGS topo map andattached to
this form if not using GPS)
5. FACILITY (Name of the business where the well is located.)
Macon Flementary
Facility Name Facility ID# (if applicable)
1166 Lotla Church Rd
Street Address
Franklin NC 28734
City or Town State Zip Code
Macon County Government
Contact Name
Mailing Address
Franklin Nf 8743
City or Town State Zip Code
Area code
Phone number
6. WELL DETAILS:
a. TOTAL DEPTH: 450'
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO p�
: Top Bottom Ft. in.
10. SAND/GRAVEL PACK:
Depth Size
Top Bottom Ft.
Top Bottom Ft.
Top Bottom Ft.
: 11. DRILLING LOG
Top Bottom
0 /61
: 61 / 67
72_/ 250
250 / 254
254 / 450
/
: 12. REMARKS:
in.
in.
in.
Material
Formation Description
Overburden
Granite
Granite
Broken Granite 40 GPM
Granite
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
15A NCAC 2C, WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
1-4me 9-28-1
SIGNA RE OF CERTIFIED WELL CONTRACTOR DATE
c. WATER LEVEL Below Top of Casing: 60 FT. Timothy R Hamby
(Use "+" if Above Top of Casing) : PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit within 30 days of completion to: Division of Water Quality - Information Processing, Form Rev. 1 /08 /08
1617 Mail Service Center, Raleigh, NC 27699-161, Phone : [phone]

NONRESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 3118-A
1. WELL CONTRACTOR:
Timothy R Hamby
Well Contractor (Individual) Name
Midsouth Geothermal
Well Contractor Company Name
8275 Tournament Dr Suite 185
Street Address
MemOhis TN 38125
City or Town State Zip Code
9( 01 ) 748-9095
Area code Phone number
2. WELL INFORMATION:
WELL CONSTRUCTION PERMIT# W10100141
OTHER ASSOCIATED PERMIT#(if applicable)
SITE WELL ID #(if applicable) A-3
3. WELL USE (Check One Box) Monitoring ❑ Municipal/Public ❑
Industrial/Commercial ❑ Agricultural ❑ Recovery Injection ❑
Irrigation❑ Other ld(list use) Closed loop Geotherra
DATE DRILLED 9-27-1 1
4. WELL LOCATION:
1166 Lotla Church Rd
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
CITY: Franklin COUNTY Macon
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
❑Slope []Valley UrFlat ❑Ridge ❑Other
K4g3l$TCD 36 iAAAA&AAAAAAAAI CL R OR 3mX7(xxoomx CC
KNMFI$TCD75 IAAAA&AAAAAAAAI CLROR 7*w)Cxxxow CC
Latitude/longitude source: BPS Oropographic map
(location of well must be shown on a USGS topo map andattached to
this form if not using GPS)
S. FACILITY (Name of the business where the well is located.)
Macon Flementary
Facility Name Facility ID# (if applicable)
1166 Lotla Church Rd
Street Address
Franklin NC28734
City or Town State ' Zip Code
Macon County Government
Contact Name
Mailing Address
Franklin NG 28743
City or Town State Zip Code
Area code
Phone number
6. WELL DETAILS:
a. TOTAL DEPTH: 450'
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
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 15A NCAC 2C .0118.
e. YIELD (gpm): 4— METHOD OF TEST 3 QMu DoM
f. DISINFECTION: Type HTC Amount 'I 2--Z—
g. WATER ZONES (depth):
Top 250, Bottom 254 Top Bottom
Top Bottom Top Bottom
Top Bottom Top Bottom
Thickness/
7. CASING: Depth Diameter Weight Material
Top +2 Bottom 72' Ft. 6 1 /8 .188 Steel
: Top Bottom Ft.
Top Bottom Ft.
8. GROUT Depth Material Method
Top 0 Bottom 7T Ft._Bentonite Pumped _
Top 77 Bottom 450 Ft. washed stone poured
Top Bottom Ft.
9. SCREEN: Depth Diameter Slot Size Material
Top Bottom Ft.
Top Bottom Ft. in.
Top Bottom Ft. in.
10. SANDIGRAVEL PACK:
Depth Size
Top Bottom Ft.
Top Bottom Ft.
Top Bottom Ft.
: 11. DRILLING LOG
in.
in.
in.
Material
Top Bottom Formation Description
0
/ 55
55
/ 72
72
/ 250
250 / 254
254
/ 450
/
: 12. REMARKS:
leasing Removed
Overburden
Granite
Granite
Broken Granite 40 GPM
Granite
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
_9-27-1
SIgNATURE OF CERTIFIED WELL CONTRACTOR DATE
c. WATER LEVEL Below Top of Casing: _60 FT. Timothy R Hamby
(Use "+" if Above Top of Casing) : PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit within 30 days of completion to: Division of Water. Quality Form /08
Y p ty - Information Processing, Rev. 1/08
1617 Mail Service Center, Raleigh, NC 27699-161, Phone : [phone]

NONRESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 3118 A
1. WELL CONTRACTOR:
Timothy R Hamby
Well Contractor (Individual) Name
Midsouth Geothermal
Well Contractor Company Name
8275 Tournament Dr Suite 185
Street Address
Memohis TN 38125
City or Town State Zip Code
9( 01 ) 748-9095
Area code Phone number
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 15A NCAC 2C .0118.
: e, YIELD (gpm): 40 . METHOD OF TEST gIOW f�Q=
f. DISINFECTION: Type HTC; Amountl2—_z—
g. WATER ZONES (depth):
Top_ 250, Bottom 254, Top Bottom
: Top Bottom Top Bottom
Top Bottom Top Bottom
Thickness/
2. WELL INFORMATION:
' 7. CASING:
Depth
Diameter Weight Material
WELL CONSTRUCTION PERMIT# W 10100141
: Top +2
Bottom 72'
Ft. 6 1 /8 .188 steel
OTHER ASSOCIATED PERMIT#(it applicable)
: Top
Bottom
Ft.
SITE WELL ID #(if applicable) A-4
Top
Bottom
Ft.
3. WELL USE (Check One Box) Monitoring ❑ Municipal/Public ❑
: 8. GROUT:
Depth
Material Method
Industrial/Commercial ❑ Agricultural ❑ Recovery ❑ Injection[]
: Top 0
Bottom 77'
Ft. Bentonite Pumped _
Irrigation[] Other ffl((list use) Closed loon Geotherre
: Top 77
Bottom 450
Ft. washed stone poured
DATE DRILLED 9-23-1 1
; Top
Bottom
Ft.
4. WELL LOCATION:
1166 Lotla Church Rd
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
CITY: Franklin COUNTYMacon
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
❑ Slope ❑ Valley Flat ❑ Ridge ❑ Other
K@3ATCD 36 i AAAA&AAAAAAAAI CL R OR 3XK XXi XOOCk X CC
KNMFISTCD75 1AAAA&AAAAAAAAI CL ROR 7xh@kx7t!(M(" CC
Latitude/longitude source: DGPS aopographic map
(location of well must be shown on a USGS topo map andattached to
this form if not using GPS)
6. FACILITY (Name of the business where the well is located.)
Macon Flernentary
Facility Name Facility ID# (if applicable)
1166 Lotla Church Rd
Street Address
Franklin NC 28734
City or Town State Zip Code
Macon County Government
Contact Name
Mailing Address
Franklin NG 28743
City or Town State Zip Code
Area code
Phone number
6. WELL DETAILS:
a. TOTAL DEPTH: 450'
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO qI
9. SCREEN: Depth Diameter Slot Size Material
Top Bottom Ft. in. in.
Top Bottom Ft. in. in.
Top Bottom Ft. in. in.
10. SAND/GRAVEL PACK:
Depth Size
Top Bottom Ft.
Top Bottom Ft.
Top Bottom Ft.
11. DRILLING LOG
Top Bottom
0
/ 75
75
/ 77
77
/ 250
250
/ 254
254
/ 450
12. REMARKS:
easing Reinoved
Material
Formation Description
Overburden
Granite
Granite
Broken Granite 40 GPM
Granite
100 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 PRRO�V�IDED TO THE WELL OWNER.
' /
SIGNATURE OF CERTIFIED WELL CONTRACTOR DATE
c. WATER LEVEL Below Top of Casing: 60 FT. ; -j jmoth)( R Hamhy
(Use "+" if Above Top of Casing) : PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit within 30 days of completion to: Division of Water Quality - Information Processing, Form Rev. 1 /08 /08
1617 Mail Service Center, Raleigh, NC 27699-161, Phone : [phone]

;a STAr£
NONRESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Diiision of Water Quality
WELL CONTRACTOR CERTIFICATION # 3118 A
1. WELL CONTRACTOR:
Timothv R Hamb
Well Contractor (Individual) Name
Midsouth Geothermal
Well Contractor Company Name
8275 Tournament Dr Suite 185
Street Address
Memphis TN 38125
City or Town State Zip Code
9( 01 ) 748-9095
Area code Phone number
2. WELL INFORMATION:
WELL CONSTRUCTION PERMIT# W10100141
OTHER ASSOCIATED PERMIT#(if applicable)
SITE WELL ID #(if applicable) A-5
3. WELL USE (Check One Box) Monitoring ❑ Municipal/Public ❑
Industrial/Commercial ❑ Agricultural ❑ Recovery ❑ Injection ❑
Irrigation[-] Other (list use) Closed Ioor) Geotherre
DATE DRILLED 9-22-1 1
4. WELL LOCATION:
1166 Lotla Church Rd
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
CITY: Franklin COUNTY Macon
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
❑ Slope ❑ Valley Flat ❑ Ridge ❑ Other
K0F$TCD 36 iAAAA&AAAAAAAAI CL R OR 3mxXxxoamx CC
KNMFF$TCD75 iAAAA&AAAAAAAAI CLROR 7A.') XXXAAW CC
Latitude/longitude source: ❑GPS i lropographic map
(location of well must be shown on a USGS topo map andattached to
this form if not using GPS)
6. FACILITY (Name of the business where the well is located.)
Macon Elementary
Facility Name Facility ID# (if applicable)
1166 Lotla Church Rd
Street Address
Franklin NC 28734
City or Town State Zip Code
Macon County Government
Contact Name
Mailing Address
Franklin NC 28743
City or Town State Zip Code
Area code Phone number
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 15A NCAC 2C .0118.
e. YIELD (gpm): 40 ^ METHOD OF TEST Bk]W DO=
f. DISINFECTION: Type HTC Amount_
g. WATER ZONES (depth):
Top 250' Bottom 254' Top Bottom
Top Bottom Top Bottom
Top Bottom Top Bottom
Thickness/
7. CASING: Depth Diameter Weight Material
Top +2 Bottom 72' Ft. 6 1 /8 .188 steel
Top Bottom Ft.
Top Bottom Ft.
8. GROUT: Depth Material Method
Top 0 Bottom 77' Ft. Bentonite Pumped
Top 77 Bottom 450 Ft. washed stone poured
Top Bottom Ft.
9. SCREEN: Depth Diameter Slot Size Material
Top Bottom Ft. in. in.
Top Bottom Ft. in. in.
Top Bottom Ft. in. in.
10. SAND/GRAVEL PACK:
Depth Size
Top Bottom Ft.
Top Bottom Ft.
Top Bottom Ft.
11. DRILLING LOG
Top Bottom
0
/ 75
75
/ 77
77 250
250
/ 254
254
/ 450
/
12. REMARKS:
Material
Formation Description
Overburden
Granite
Granite
Broken Granite 40 GPM
Granite
6. WELL DETAILS: I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
• 15A NCAC 2C, WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
a. TOTAL DEPTH: 450' RECORD
.HAS BEEN PROVID DTOTHEWELLOWNER.
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO q/ ""�-22-11
SIGN RE OF CERTIFIED WELL CONTRACTOR DATE
c. WATER LEVEL Below Top of Casing: _60 FT. ; Tmoft R Hamby
(Use '•+" if Above Top of Casing) : PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit within 30 days of completion to: Division of Water Quality - Information Processing, Form Rev. 1/08l08
1617 Mail Service Center, Raleigh, NC 27699-161, Phone : [phone]

NONRESIDENTIAL ONRESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
31I8 A
WELL CONTRACTOR CERTIFICATION #
1. WELL CONTRACTOR:
Timothv R Hamb
Well Contractor (Individual) Name
Midsouth Geothermal
Well Contractor Company Name
8275 Tournament Dr Suite 185
Street Address
_ _Memphis TN 38125
City or Town State Zip Code
9( 01 ) 748-9095
Area code Phone number
2. WELL INFORMATION:
WELL CONSTRUCTION PERMIT# Wl0100141
OTHER ASSOCIATED PERMIT#(if applicable)
SITE WELL ID #(if applicable) A-6
3. WELL USE (Check One Box) Monitoring ❑ Municipal/Public ❑
Industrial/Commercial ❑ Agricultural ❑ Recovery ❑ Injection ❑
Irrigation❑ Other (((Ilst use) Closed loop Geotherre
DATE DRILLED 9-20-11
4. WELL LOCATION:
1166 Lotla Church Rd
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
CITY: Franklin COUNTY Macon
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
❑Slope []Valley Flat ❑Ridge []Other----
KOISTCD 36 iAAAA&AAAAAAAAI CL R OR 3XK XJV(XIAX9M CC
KNMFMTCD75 iAAAA&AAAAAAAAI CL ROR ' `*. kk7fD(9(9W CC
Latitude/longitude source: [GPS ❑Topographic map
(location of well must be shown on a USGS topo map andattached to
this form if not using GPS)
5. FACILITY (Name of the business where the well is located.)
Macon Elementary
Facility Name Facility ID# (if applicable)
1166 Lotla Church Rd
Street Address
Franklin NC 28734
City or Town State Zip Code
Macon County Government
Contact Name
Mailing Address
Franklin NC 28743
City or Town State Zip Code
Area code
Phone number
6. WELL DETAILS:
a. TOTAL DEPTH: 450'
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO q/
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 15A NCAC 2C ,0118.
e. YIELD (gpm): 40 METHOD OF TEST BIQW DOWn
f. DISINFECTION: Type HTC: Amount 12 oz
g. WATER ZONES (depth):
Top 250' Bottom 254' Top Bottom
Top Bottom Top Bottom
Top Bottom Top Bottom
Thickness/
7. CASING: Depth Diameter Weight Material
Top +2 Bottom 72' Ft. 6 1 /8 .188 steel
Top Bottom Ft.
Top Bottom Ft.
8. GROUT: Depth Material Method
Top 0 Bottom 77' Ft. Bentonite Pumped
Top 77 Bottom 450 Ft. washed stone poured
Top Bottom Ft.
9. SCREEN: Depth Diameter Slot Size Material
Top Bottom Ft. in. in.
Top Bottom Ft. in. in.
Top Bottom Ft. in. in.
10. SAND/GRAVEL PACK:
Depth Size Material
Top Bottom Ft.
Top Bottom Ft.
Top Bottom Ft.
11. DRILLING LOG
Top Bottom
0
/ 75
75
/ 77
77
/ 250
250
/ 254
254
/ 450
12. REMARKS:
Formation Description
Overburden
Granite
Granite
Broken Granite 40 GPM
Granite
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
15A NCAC 2C, WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
�-2 9 20 1
SIGN URE OF CERTIFIED WELL CONTRACTOR DATE
c. WATER LEVEL Below Top of Casing: 60 FT. : _ Timothy R Hamby
(Use "+" if Above Top of Casing) : PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit within 30 days of completion to: Division of Water Quality Form /08
Y p ty - Information Processing, Rev. 1/08
1617 Mail Service Center, Raleigh, NC 27699-161, Phone : [phone]

NONRESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 3118-A
1. WELL CONTRACTOR:
Timothy R Hamby
Well Contractor (Individual) Name
Midsouth Geothermal
Well Contractor Company Name
8275 Tournament Dr Suite 185
Street Address
Memphis TN 38125
City or Town State Zip Code
9( -01 ) 748-9095
Area code Phone number
2. WELL INFORMATION:
WELL CONSTRUCTION PERMIT# W10100141
OTHER ASSOCIATED PERMIT#(if applicable)
SITE WELL ID #(if applicable) A-7
3. WELL USE (Check One Box) Monitoring ❑ Municipal/Public ❑
Industrial/Commercial ❑ Agricultural ❑ Recovery ❑ Injection ❑
Irrigation❑ Other ffl6ist Use) Closed loop Geotherre
DATE DRILLED 9-20-11
4. WELL LOCATION:
1166 Lotla Church Rd
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
CITY. Franklin COUNTY Macon
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
❑Slope []Valley (Flat ❑Ridge ❑Other
K,of$TCD 36 IAAAA&AAAAAAAA! CL R OR 3X^XXXXAA) X CC
KNMFISTCID 75 iAAAA&AAAAAAAA! CLROR 7A..WX')tX9C)W CC
Latitudellongitude source: ❑GPS i]ropographic map
(location of well must be shown on a USGS topo map andaftached to
this form if not using GPS)
5. FACILITY (Name of the business where the well is located.)
Macon Flementary
Facility Name Facility ID# (if applicable)
1166 Lotla Church Rd
Street Address
Franklin NC 28734
City or Town State Zip Code
Macon County Government
Contact Name
Mailing Address
Franklin NC 28743
City or Town State Zip Code
Area code Phone number
6. WELL DETAILS:
a. TOTAL DEPTH: 4Ei0'
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO qV
d. TOP OF CASING IS 2 FT. Above Land Surface -
*Top of casing terminated attor below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e.
YIELD (gpm): 40 METHOD OF TEST aJQM DOWn
f. DISINFECTION: Type HTC; Amount 1 ? f)7
g. WATER ZONES (depth):
Top- 250, Bottom 254, Top
Bottom
Top
Bottom
Top
Bottom
Top
Bottom
Top
Bottom
Thickness/
7. CASING:
Depth
Diameter
Weight Material
Top +2
Bottom 77'
Ft. 6 1/8
.188 steel
Top
Bottom
Ft.
Top
Bottom
Ft.
8. GROUT:
Depth
Material
Method
Top 0
Bottom 82,
Ft. Bentonite _Pumped
Top 82 _ Bottom 450 Ft. washed stone poure
Top Bottom Ft.
; 9. SCREEN: Depth Diameter Slot Size Material
Top Bottom Ft. in. in.
Top Bottom Ft. in. in.
Top Bottom Ft. in. in.
10. SAND/GRAVEL PACK:
Depth Size
Top Bottom Ft.
Top Bottom Ft.
Top Bottom Ft.
11. DRILLING LOG
Material
: Top Bottom Formation Description
0 / 77
77 / 250
250 / 254
254 / 450
: 12. REMARKS:
Overburden
Granite
Broken Granite 40 GPM
Granite
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.
/? 9-20-11
SIGNA E OF CERTIFIED WELL CONTRACTOR DATE
c. WATER LEVEL Below Top of Casing: 60 FT.
Timothy R Hamby
(Use "+" if Above Top of Casing) :'PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit within 30 days of completion to: Division of Water Quality - Information Processing, Form Rev. 1 /08 /08
1617'Mail Service Center, Raleigh, NC 27699-161, Phone [phone]

NONRESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 3118 A
1. WELL CONTRACTOR:
Timothy R Hamby
Well Contractor (Individual) Name
Midsouth Geothermal
Well Contractor Company Name
8275 Tournament Dr Suite 185
Street Address
Memphis TN 38125
City or Town State Zip Code
9c 01 ) 748-9095
Area code Phone number
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 15A NCAC 2C .0118.
e. YIELD (gpm): 40 METHOD OF TEST 3IOW f)Q ein
f. DISINFECTION: TypeHTC Amount 12 n7
g. WATER ZONES (depth):
Top 250' Bottom 254' Top Bottom
Top Bottom Top Bottom
Top Bottom Top Bottom
Thickness/
2. WELL INFORMATION: ; 7. CASING: Depth Diameter Weight Material
WELL CONSTRUCTION PERMIT# W 10100141 : Top +2 Bottom 80' Ft. 6 1 /8 .188 steel
OTHER ASSOCIATED PERMIT#(if applicable)
SITE WELL ID #(if applicable)14-8
3. WELL USE (Check One Box) Monitoring ❑ Municipal/Public ❑
Industrial/Commercial ❑ Agricultural ❑ Recovery ❑ Injection ❑
Irrigation❑ Other W(list use) Closed IOOI) Geotherra
DATE DRILLED-9-1 5-11
4. WELL LOCATION:
1166 Lotla Church Rd
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
CITY: Franklin COUNTY Macon
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
❑ Slope []Valley Flat ❑ Ridge ❑ Other
KOISTCD 36 iAAAA&AAAAAAAA! CL R OR 3D(^x9[)(9C9 xwx CC
KNMFISTCD75 iAAAABAAAAAAAA! CLROR 7A..fAW YANXX CC
Latitude/longitude source: ❑GPS aopographic map
(location of well must be shown on a USGS topo map andattached to
this form if not using GPS)
5. FACILITY (Name of the business where the well is located.)
Macon Flementary
Facility Name Facility ID# (if applicable)
1166 Lotla Church Rd
Street Address
Franklin NC 28734
City or Town State Zip Code
Macon County Goyernm nt
Contact Name
Mailing Address
Franklin NC 2874.3
City or Town State Zip Code
Area code
Phone number
6. WELL DETAILS:
a. TOTAL DEPTH:_ 450'
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO BY(
Top Bottom Ft.
Top Bottom Ft.
8. GROUT: Depth Material Method
Top 0 Bottom 85' Ft. Bentonite _Pumped
Top 85 Bottom 450 Ft. washed stone poured
Top Bottom Ft.
9. SCREEN: Depth Diameter Slot Size Material
Top Bottom Ft. in. in.
Top Bottom Ft. in. in.
Top Bottom Ft. in. in.
10. SAND/GRAVEL PACK:
Depth Size
Top Bottom Ft.
Top Bottom Ft.
Top Bottom Ft.
11. DRILLING LOG
Top Bottom
0 / 80
80 / 250
250 / 254
254 / 450
/
12. REMARKS:
Material
Formation Description
Overburden
Granite
Broken Granite 40 GPM
Granite
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.
SIGNATVRE OF CERTIFIED WELL CONTRACTOR DATE
c. WATER LEVEL Below Top of Casing: 60 FT. : Timothy R Hamby/
(Use "+" if Above Top of Casing) ; PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit within 30 days of completion to: Division of Water Quality Form /08
Y P ty - Information Processing, Rev. 1108
1617 Mail Service Center, Raleigh, INC 27699-161, Phone : [phone]

NONRESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 3118 A
1. WELL CONTRACTOR:
Timothy R Hamby
Well Contractor (Individual) Name
Midsouth Geothermal
Well Contractor Company Name
8275 Tournament Dr Suite 185
Street Address
_ Memphis TN 38125
City or Town State Zip Code
9( 01 ) 748-9095
Area code Phone number
2. WELL INFORMATION:
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 15A NCAC 2C .0118.
e. YIELD (gpm): 40 METHOD OF TEST_B1oyv DOWn
If. DISINFECTION: Type HTC Amount 12 Q
: g. WATER ZONES (depth):
Top 250 Bottom254 Top Bottom
Top Bottom Top Bottom
Top Bottom Top Bottom
Thickness/
7. CASING: Depth Diameter Weight Material
WELL CONSTRUCTION PERMIT# W101 00 141 : Top +2 Bottom 74 Ft.
OTHER ASSOCIATED PERMIT#(if applicable) : Top Bottom Ft.
SITE WELL ID #(if applicable) B-1 ; Top Bottom Ft.
3. WELL USE (Check One Box) Monitoring ❑ Municipal/Public ❑ : 8. GROUT: Depth Material Method
Industrial/Commercial ❑ Agricultural ❑ Recovery ❑ Injection ❑
Irrigation❑ Other S((list use) Closed IooD Geotherre
DATE DRILLED-1 0- 12-11
4. WELL LOCATION:
1166 Lotla Church Rd
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
CITY: Franklin COUNTY Macon
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
[]Slope ❑Valley VFlat ❑Ridge ❑Other
KOISTCD 36 iAAAA&AAAAAAAAI CL R OR 3X^XXXrlC90(k X CC
KNMF FSTCD 75 1AAAA&AAAAAAAAI CL R OR 7x..WXRXX'kW CC
Latitude/longitude source: ❑GPS aopographic map
(location of well must be shown on a USGS topo map andattached to
this form if not using GPS)
S. FACILITY (Name of the business where the well is located.)
Macon Flementary
Facility Name Facility ID# (if applicable)
1166 Lotla Church Rd
Street Address
Franklin NC 28734
City or Town State Zip Code
Macon County Government
Contact Name
Mailing Address
Franklin NG 28743
City or Town State Zip Code
Area code
Phone number
6. WELL DETAILS:
a. TOTAL DEPTH: 450'
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO q/
Top_0 Bottom 79 Ft. bentonite pumped
Top 79 Bottom 450 Ft. washed stone poured
Top Bottom Ft.
9. SCREEN: Depth Diameter Slot Size Material
Top Bottom Ft. in. in.
Top Bottom Ft, in. in.
: Top Bottom Ft. in.
10. SAND/GRAVEL PACK:
Depth Size
: Top Bottom Ft.
Top Bottom Ft.
Top Bottom Ft.
11. DRILLING LOG
in.
Material
Top Bottom Formation Description
0 / 70
70 / 75
5 1 250
250 / 254
254 / 450
12. REMARKS:
Dirt
Granite
Granite
Broken Granite
Granite
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 ROVIDEO TO THE WELL OWNER.
10-12-1
SIGWATURE OF CERTIFIED WELL CONTRACTOR DATE
c. WATER LEVEL Below Top of Casing: _60 FT. Timothy R Hamby
(Use "+" if Above Top of Casing) : PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit within 30 days of completion to: Division of Water Quality Form /08
y p ty - Information Processing, Rev. 1/08
1617 Mail Service Center, Raleigh, NC 27699-161, Phone : [phone]

NONRESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 3118 A
1. WELL CONTRACTOR:
Timothy R Hamby
Well Contractor (Individual) Name
Midsouth Geothermal
Well Contractor Company Name
8275 Tournament Dr Suite 185
Street Address
Memphis TN 38125
City or Town State Zip Code
9( 01 ) 748-9095
Area code Phone number
2. WELL INFORMATION:
WELL CONSTRUCTION PERMIT# W10100141
OTHER ASSOCIATED PERMIT#(if applicable)
SITE WELL ID #(if applicable) B-2
3. WELL USE (Check One Box) Monitoring ❑ Municipal/Public ❑
Industrial/Commercial ❑ Agricultural ❑ Recovery ❑ Injection ❑
Irrigation❑ Other 56list use) Closed loop Geotherra
DATE DRILLED 10-11-1 1
4. WELL LOCATION:
1166 Lotla Church Rd
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
CITY: Franklin COUNTY Macon
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
❑Slope ❑Valley Jill ❑Ridge ❑Other
KI31$TCD 36 IAAAA&AAAAAAAA! CL R OR 3l(0XDPiC00WX CC
KNMF 1$TCD 75 iAAAABAAAAAAAA! CL R OR 7X..IXWXXXWX1 CC
Latitude/longitude source: ❑GPS Qropographic map
(location of well must be shown on a USGS topo map andattached to
this form if not using GPS)
5. FACILITY (Name of the business where the well is located.)
Macon Elementary
Facility Name Facility ID# (if applicable)
1166 Lotla Church Rd
Street Address
Franklin NC 28734
City or Town State Zip Code
Macon County Government
Contact Name
Mailing Address
Franklin NC 28743
City or Town State Zip Code
Area code Phone number
6. WELL DETAILS:
a. TOTAL DEPTH:_450'
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
d. TOP OF CASING IS _ 2 FT. Above Land Surface'
'Top of casing terminated attor below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): 40 METHOD OF TEST B QM D(]Wn
f. DISINFECTION: Type HTC Amount 12 n7
g. WATER ZONES (depth):
Top 250 Bottom 254 Top Bottom
: Top Bottom Top Bottom
Top Bottom Top Bottom
Thickness/
7. CASING: Depth Diameter Weight Material
Top +2 Bottoms Ft.
Top Bottom Ft.
Top Bottom Ft.
8. GROUT: Depth Material Method
Top 0 Bottoms Ft. bentonite pumped
Top 75 Bottom 450 Ft. washed stone poured
Top Bottom Ft.
: 9. SCREEN: Depth Diameter Slot Size Material
Top Bottom Ft. in. in.
: Top Bottom Ft. in. in.
Top Bottom Ft. in. in.
10. SAND/GRAVEL PACK:
Depth Size Material
Top Bottom Ft,
Top Bottom Ft.
Top Bottom Ft.
11. DRILLING LOG
Top
Bottom
0
/ 70
70
% 75
250
75 250
250
/ 254
254
/ 450
: 12. REMARKS:
Formation Description
Granite
Granite
Broken Granite
Granite
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.
2l d1? IdL _ 10-11-11
SIGN RE OF CERTIFIED WELL CONTRACTOR DATE
c. WATER LEVEL Below Top of Casing: 60 FT. Timothy R HamhV
(Use "+" if Above Top of Casing) : PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit within 30 days of completion to: Division of Water Quality - Information Processing, Farm Rev. 1 /08 /08
1617 Mail Service Center, Raleigh, NC 27699-161, Phone : [phone]

61a5rA7F"v
NONRESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 3118 A
1. WELL CONTRACTOR:
Timothy R Hamby
Well Contractor (Individual) Name
Midsouth Geothermal
Well Contractor Company Name
8275 Tournament Dr Suite 185
Street Address
Memahis TN 38125
City or Town State Zip Code
9( 01 ) 748-9095
Area code Phone number
2. WELL INFORMATION:
d. TOP OF CASING IS i FT. Above Land Surface`
'Top of casing terminated atior below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): _40 METHOD OF TEST_BjQW ❑ =
f. DISINFECTION: Type HTC Amount 12 07
g. WATER ZONES (depth):
Top.250 Bottom 254 Top Bottom
Top Bottom Top Bottom
Top Bottom Top Bottom
Thickness/
7. CASING: Depth Diameter Weight Material
WELL CONSTRUCTION PERMIT# W101 00 141 : Top +2 Bottom 73 Ft.
OTHER ASSOCIATED PERMIT#(if applicable) : Top Bottom Ft.
SITE WELL ID #(if applicable) B-3 ; Top Bottom Ft.
3. WELL USE (Check One Box) Monitoring ❑ Municipal/Public ❑ : 8. GROUT: Depth Material Method
Industrial/Commercial ❑ Agricultural ❑ Recovery ❑ Injection ❑
Irrigation[] Other l((Ilst use) Closed IOOD Geotherr>al
DATE DRILLED 10-10-1 1
4. WELL LOCATION:
1166 Lotla Church Rd
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
CITY: Franklin COUNTY Macon
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
❑Slope []Valley Flat ❑Ridge []Other
Ko[$TCD 36 iAAAA&AAAAAAAAI CL R OR 3X^XXXX90t9( X CC
KNMFMTCD 75 iAAAA&AAAAAAAA! CL R OR 7k' A)kXX'k M CC
Latitude/longitude source: OGPS Qropographic map
(location of well must be shown on a USGS topo map andattached to
this form if not using GPS)
5. FACILITY (Name of the business where the well is located.)
Macon Flementary
Facility Name Facility ID# (if applicable)
1166 Lotla Church Rd
Street Address
Franklin NC 2 8734
City or Town State Zip Code
Macon County Government
Contact Name
Mailing Address
Franklin N , 28743
City or Town State Zip Code
Area code
Phone number
6. WELL DETAILS:
a. TOTAL DEPTH: 450'
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO qI
Top 0 Bottom 78 Ft. bentonite primped
Top_ 78 Bottom 450 Ft. washed stone poured
Top Bottom Ft.
9. SCREEN: Depth Diameter Slot Size Material
Top Bottom Ft. in. in.
Top Bottom Ft. in. in.
Top Bottom Ft. in. in.
10. SAND/GRAVEL PACK:
Depth Size
Top Bottom Ft.
Top Bottom Ft.
Top Bottom Ft.
11. DRILLING LOG
Top Bottom
0
/ 70
70
/ 75
75 1 250
250
/ 254
254
/ 450
/
/
12. REMARKS:
leasing Removed
Material
Formation Description
Granite
Granite
Broken Granite
Granite
100 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 CERTIFIED WELL CONTRACTOR 10DA E
c. WATER LEVEL Below Top of Casing: 60 FT. Timothy R Hamby
(Use "+^ if Above Top of Casing) : PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit within 30 days of completion to: Division of Water Quality - Information Processing, Form Rev. 1 /08 /08
1617 Mail Service Center, Raleigh, NC 27699-161, Phone : [phone]

�7y� „-oc STA7Evti�R.
off., {f AL
1 r ONRESIDENTLQL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 3118 A
1. WELL CONTRACTOR:
Timothy R Hamby
Well Contractor (Individual) Name
Midsouth Geothermal
Well Contractor Company Name
8275 Tournament Dr Suite 185
Street Address
Memphis TN 38125
City or Town State Zip Code
9( 01 ) 748-9095
Area code Phone number
d. TOP OF CASING IS 2 FT. Above Land Surface -
*Top of casing terminated attor below land surface may require
a variance in accordance With 15A NCAC 2C .0118.
: e. YIELD (gpm): 40 METHOD OF TEST
f. DISINFECTION: Type HT(: Amount 1 ? 0
g. WATER ZONES (depth):
:Top 250 Bottom 254 Top Bottom
Top Bottom Top Bottom
Top Bottom Top Bottom
Thickness/
2. WELL INFORMATION: 7. CASING: Depth Diameter Weight Material
WELL CONSTRUCTION PERMIT# W10100141 : Top +2 Bottom_ 73 Ft. _
OTHER ASSOCIATED PERMIT#(if applicable) Top Bottom Ft.
SITE WELL ID #(if applicable) B-4 ; Top Bottom Ft.
3. WELL USE (Check One Box) Monitoring ❑ Municipal/Public ❑
Industrial/Commercial ❑ Agricultural ❑ Recovery ❑ Injection ❑
Irrigation❑ Other N((list use) Closed 100D Geotherra
DATE DRILLED-1 0-6-11
4. WELL LOCATION:
1166 Lotla Church Rd
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
CITY. Franklin COUNTY Macon
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
❑ Slope []Valley p(Flat ❑ Ridge ❑ Other
K9lSTCD 36 IAAAA&AAAAAAAAI CL R OR 21X^XXXX90MX CC
KNMFI$TCD75 IAAAA&AAAAAAAAI CLROR 7�x.'X`k)F7E9t7( 50 CC
Latitudeflongitude source: ❑GPS []Topographic map
(location of well must be shown on a USGS topo map andattached to
this form if not using GPS)
5. FACILITY (Name of the business where the well is located.)
_ Macon Elementary
Facility Name Facility ID# (if applicable)
_1166 Lotla Church Rd
Street Address
_Franklin NC 28734
City or Town State Zip Code
Macon County Government
Contact Name
Mailing Address
Franklin NG 29743
City or Town State Zip Code
Area code
Phone number
6. WELL DETAILS:
a. TOTAL DEPTH: 450'
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO [�
: 8. GROUT:
Depth
Material
Method
Top 0
Bottoms
Ft. bentonite
pumped
Top 78
Bottom 450
Ft. washed stone
poured
Top
Bottom
Ft.
9. SCREEN:
Depth
Diameter Slot Size Material
Top
Bottom
Ft. in.
in.
Top
Bottom
Ft. in.
in.
Top
Bottom
Ft. in.
in.
10. SAND/GRAVEL PACK:
Depth
Size Material
Top
Bottom
Ft.
TOP
Bottom
Ft.
Top
Bottom
Ft.
: 11. DRILLING LOG
Top Bottom
0 / 70
70 / 75
75/ 250
250 / 254
254 / 450
/
/
12. REMARKS:
easing Removed
Formation Description
Granite
Granite
Broken Granite
Granite
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
• 15A NCAC 2C, WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
10-6-11
SIGN RE OF CERTIFIED WELL CONTRACTOR DATE
c. WATER LEVEL Below Top of Casing: 60 FT. Timothy R Hamby
(Use "+^ if Above Top of Casing) : PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit within 30 days of completion to: Division of Water Quality - Information Processing, Form Rev. 1 /08 /08
1617 Mail Service Center, Raleigh, NC 27699-161, Phone: [phone]

NONRESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 3118 A
1. WELL CONTRACTOR:
Timothy R Hamby
Well Contractor (individual) Name
Midsouth Geothermal
Well Contractor Company Name
8275 Tournament Dr Suite 185
Street Address
Memphis TN 38125
City or Town State Zip Code
9� 01 ) 748-9095
Area code Phone number
2. WELL INFORMATION:
WELL CONSTRUCTION PERMIT# W10100141
OTHER ASSOCIATED PERMIT#(if applicable)
SITE WELL ID #(if applicable) B-5
3. WELL USE (Check One Box) Monitoring ❑ Municipal/Public ❑
Industrial/Commercial ❑ Agricultural ❑ Recovery ❑ Injection ❑
Irrigation❑ Other u{(list use) Closed loop Geotherre
DATE DRILLED 10-6-1 1
4. WELL LOCATION:
1166 Lotla Church Rd
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
CITY: Franklin COUNTY Macon
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
❑Slope ❑Valley Flat ❑Ridge ❑Other
KOISTCD 36 IAAAA&AAAAAAAAI CL R OR 3i0XX)(X00Cf(hX CC
MMFMTCD75 IAAAA&AAAAAAAAl CLROR 7`X.WXXX9(hM CC
Latitude/longitude source: ❑GPS ❑Topographic map
(location of well must be shown on a USGS topo map andattached to
this form if not using GPS)
S. FACILITY (Name of the business where the well is located.)
Macon Elementary
Facility Name Facility ID# (if applicable)
1166 Lotla Church Rd
Street Address
Franklin N . 28734
City or Town State Zip Code
Mammon County Government
Contact Name
Mailing Address
Franklin NC 28743
City or Town State Zip Code
Area code
Phone number
6. WELL DETAILS:
a. TOTAL DEPTH: 4501
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO qI
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 15A NCAC 2C .0118.
e. YIELD (gpm): 40 METHOD OF TEST 3J0M Down
f. DISINFECTION: Type HTC; Amount 12 n7
g. WATER ZONES (depth):
:Top 250 Bottom 254 Top Bottom
Top Bottom Top Bottom
Top Bottom Top Bottom
Thickness/
7. CASING: Depth Diameter Weight Material
Top +2 Bottom 73 Ft.
Top Bottom Ft.
Top Bottom Ft.
8. GROUT: Depth Material Method
Top 0 Bottom 78 Ft. bentonite pumped
Top 78 Bottom 450 Ft. washed stone poured
Top Bottom Ft.
S. SCREEN: Depth Diameter Slot Size Material
Top Bottom Ft. in. in.
Top Bottom Ft. in. in.
Top Bottom Ft. in. in.
10. SAND/GRAVEL PACK:
Depth Size
Top Bottom Ft.
Top Bottom Ft.
Material
Top Bottom Ft.
: 11. DRILLING LOG
Top Bottom Formation Description
0
/ 70
70
/ 75
75 250
250
/ 254
254
/ 450
/
12. REMARKS:
1• a
Granite
Granite
Broken Granite
Granite
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 PROVI ED TO THE WELL OWNER
SIGNAILtkE OF CERTIFIED WELL CONTRACTOR DATE
c. WATER LEVEL Below Top of Casing: 60 FT. Imothy R Hamby
(Use "+" if Above Top of Casing) :PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit within 30 days of completion to: Division of Water Quality - Information Processing, Form Rev. 1/OS/08
1617 Mail Service Center, Raleigh, NC 27699-161, Phone : [phone]

a SinTi 4 v .
1 r ONRESIDENTIAL WELL CONSTRUCTION RECORD
'
A
o North Carolina Department of Environment and Natural Resources- Division of Water Quality
•4'"`°"" • WELL CONTRACTOR CERTIFICATION # 3118 A
1. WELL CONTRACTOR:
Timothv R Hamb
Well Contractor (Individual) Name
Midsouth Geothermal
Well Contractor Company Name
8275 Tournament Dr Suite 185
Street Address
Memohis TN 38125
City or Town State Zip Code
9c 01 ) 748-9095
Area code Phone number
2. WELL INFORMATION:
WELL CONSTRUCTION PERMIT# Q100141
OTHER ASSOCIATED PERMIT#(if applicable)
SITE WELL ID #(if applicable)B-6
3. WELL USE (Check One Box) Monitoring ❑ Municipal/Public ❑
Industrial/Commercial ❑ Agricultural ❑ Recovery ❑ Injection ❑
Irrigation❑ Other N((list use) Closed loop Geotherna
DATE DRILLED 10-5-1 1
4. WELL LOCATION:
1166 Lotla Church Rd
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
CITY: Franklin COUNTY Macon
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
[]Slope []Valley Flat ❑ Ridge ❑ Other
K(c MTCD 36 iAAAA&AAAAAAAA! CL R OR 3)0XXXX00MX CC
KNMF I$TCD 75 iAAAA&AAAAAAAA! CL R OR 7)VA- kXX9( 6M CC
Latitude/longitude source: [JGPS aopographic map
(location of well must be shown on a USGS topo map andattached to
this form if not using GPS)
5. FACILITY (Name of the business where the well is located.)
Macon Flementary
Facility Name Facility ID# (if applicable)
1166 Lotla Church Rd
Street Address
Franklin NC 28734
City or Town State Zip Code
Macon County Government
Contact Name
Mailing Address
Franklin NC: 28743
City or Town State Zip Code
Area code
Phone number
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): 40 METHOD OF TEST_B1oW DpWn
f. DISINFECTION: Type HTC Amount 1 i Q
g. WATER ZONES (depth):
Top 250' Bottom 254, Top Bottom
Top Bottom Top Bottom
Top Bottom Top Bottom
Thickness/
7. CASING: Depth Diameter Weight Material
Top Bottom 65, Ft, 6 1 /8 ' 188 steel
Top Bottom Ft.
Top Bottom Ft.
8. GROUT: Depth Material Method
Top 0 Bottoms Ft. Bentonite Pumped
Top 70 Bottom 450 Ft. washed stone poured
Top Bottom Ft.
9. SCREEN: Depth Diameter Slot Size Material
Top Bottom Ft. in.
: Top Bottom Ft. in.
Top Bottom Ft. in.
10. SAND/GRAVEL PACK:
Depth Size
Top Bottom Ft.
Top Bottom_ Ft.
Top Bottom Ft.
11. DRILLING LOG
Top Bottom
0 / 65
65 / 250
250 / 254
254 / 450
12. REMARKS:
easing Removed
in.
in.
in.
Material
Formation Description
Overburden
Granite
Broken Granite 406PM
Granite
6. WELL DETAILS: I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
• 15A NCAC 2C, WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
a. TOTAL DEPTH: 4501 : RECORD HAS BEEN PROVIDED TO THE WELL OWNER
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO / �' 10-5-11
SIGNAVRE OF CERTIFIED WELL CONTRACTOR DATE
c. WATER LEVEL Below Top of Casing: 60 -FT. Timothy R Hamby
(Use "+" if Above Top of Casing) : PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit within 30 days of completion to: Division of Water Quality - Information Processing, Form Rev. 1 /08 /08
1617 Mail Service Center, Raleigh, NC 27699-161, Phone : [phone]

_; d� STA7� 6 •,, _
1 r ONRESIDENTM WELL CONSTRUCTION RECORD
f A'
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 3118 A
1. WELL CONTRACTOR:
Timothv R Hamb
Well Contractor (Individual) Name
Midsouth Geothermal
Well Contractor Company Name
8275 Tournament Dr Suite 185
Street Address
Memphis TN 38125
City or Town State Zip Code
9( 01 ) 748-9095
Area code Phone number
2. WELL INFORMATION:
WELL CONSTRUCTION PERMIT# W 10100141
OTHER ASSOCIATED PERMIT#(if applicable)
SITE WELL ID #(if applicable) B-7A
3. WELL USE (Check One Box) Monitoring ❑ Municipal/Public ❑
Industrial/Commercial ❑ Agricultural ❑ Recovery ❑ Injection ❑
Irrigation❑ Other I§((Iist use) Closed loop Geotherre
DATE DRILLED 10-3-1 1
4. WELL LOCATION:
1166 Lotla Church Rd
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
CITY: Franklin COUNTY Macon
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
❑ Slope ❑ Valley Flat ❑ Ridge [] Other
K01$TCD 36 iAAAA&AAAAAAAAI CL ROR 3X0XXD(X1A* X CC
KNMFMTCD75 iAAAA8IAAAAAAAA! CL ROR 7A.WAXXXXXX0 CC
Latitudeflongitude source: OGPS Qropographic map
(location of well must be shown on a USGS topo map andattached to
this form if not using GPS)
5. FACILITY (Name of the business where the well is located.)
Macon Flementary
Facility Name Facility ID# (if applicable)
1166 Lotla Church Rd
Street Address
Franklin NC 28734
City or Town State Zip Code
Macon County Government
Contact Name
Mailing Address
Franklin NC 28743
City or Town State Zip Code
Area code Phone number
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 15A NCAC 2C .0118.
e. YIELD (gpm): 40 METHOD OF TEST akn DO e n
f. DISINFECTION: Type HTC: Amount l 2 Q7
g. WATER ZONES (depth):
Top 250' Bottom 254' Top Bottom
Top Bottom Top Bottom
Top Bottom Top Bottom
Thickness/
7. CASING: Depth Diameter Weight Material
Top +2 Bottom 65' Ft. 6 1 .18_ steel
Top Bottom Ft.
Top Bottom Ft.
8. GROUT: Depth Material Method
Top 0 Bottom 70 Ft. Bentonite _Pumped
Top 70 Bottom 254 Ft. washed stone poured
Top Bottom Ft.
9. SCREEN: Depth Diameter Slot Size Material
Top Bottom Ft. in. in.
Top Bottom Ft. in. in.
Top Bottom Ft. in. in.
10. SAND/GRAVEL PACK:
Depth Size Material
Top Bottom Ft.
Top Bottom Ft.
Top Bottom Ft.
11. DRILLING LOG
Top Bottom Formation Description
0 / 65 Overburden
65 / 250 Granite
250 / 254 Broken Granite 40 GPM
2_4
12. REMARKS:
6aSing Ref I loved
6. WELL DETAILS: : I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
• 15A NCAC 2C, WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
a. TOTAL DEPTH:254' RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
10-3-11
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO G/ : SIGNS RE OF CERTIFIED WELL CONTRACTOR DATE
c. WATER LEVEL Below Top of Casing: 60 FT. Timothy R Hamby
(Use "+" if Above Top of Casing) : PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit within 30 days of completion to: Division of Water Quality - Information Processing, Form Rev. 1 /08 /08
1617 Mail Service Center, Raleigh, NC 27699-161, Phone : [phone]

�a SrATE' 4i`e
1 r ONRESIDENTL4L WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 3118 A
1. WELL CONTRACTOR:
Timothv R Hamb
Well Contractor (Individual) Name
Midsouth Geothermal
Well Contractor Company Name
8275 Tournament Dr Suite 185
Street Address
Memohis TN 38125
City or Town State Zip Code
d. TOP OF CASING IS i 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): 40 METHOD OF TEST 3JQM Down
f. DISINFECTION: Type HTC Amount 1 i Qz
g. WATER ZONES (depth):
Top_ 250, Bottom 254, Top Bottom
Top Bottom Top Bottom
9( 01 ) 748-9095 : Tap Bottom Top Bottom
Area code Phone number Thickness/
2. WELL INFORMATION: ; 7. CASING: Depth Diameter Weight Material
WELL CONSTRUCTION PERMIT# W 10100141 : Top +_ Bottom 65' Ft. 6 1 /8 .188 steel
OTHER ASSOCIATED PERMIT#(if applicable) : Top Bottom Ft.
SITE WELL ID #(if applicable) B-7B ; Top Bottom Ft.
3. WELL USE (Check One Box) Monitoring ❑ Municipal/Public ❑ : 8. GROUT: Depth Material Method
Industrial/Commercial ❑ Agricultural ❑ Recovery ❑ Injection ❑
Irrigation❑ Other iSi((list use) Closed IOOD Geotherra
DATE DRILLED-1 0-3-11
4. WELL LOCATION:
1166 Lotla Church Rd
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
CITY: Franklin COUNTY Macon
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
❑ Slope ❑ Valley g(Flat ❑ Ridge ❑ Other
K,O[$TCD 36 IAAAA&AAAAAAAAI CL R OR 3X( XXXX1QfWX CC
KNMFBTCID 75 iAAAA&AAAAAAAAI CLROR CC
Latitude/longitude source: ❑GPS ❑Topographic map
(location of well must be shown on a USGS topo map andattached to
this form if not using GPS)
5. FACILITY (Name of the business where the well is located.)
Macon Flementary
Facility Name Facility ID# (if applicable)
1166 Lotla Church Rd
Street Address
Franklin NC 28734
City or Town State Zip Code
Macon County Government
Contact Name
Mailing Address
Franklin N , 28748
City or Town State Zip Code
Area code
Phone number
6. WELL DETAILS:
a. TOTAL DEPTH:_ 196'
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO qI
Top 0 Bottom 70 Ft. Bentonite Pumped
Top 70 Bottom 196 Ft. washed stone poured
Top Bottom Ft.
9. SCREEN: Depth Diameter Slot Size Material
Top Bottom Ft. in. in.
Top Bottom Ft. in. in.
Top Bottom Ft. in. in.
10. SAND/GRAVEL PACK:
Depth Size
Top Bottom Ft.
Top Bottom Ft.
Top Bottom Ft.
11. DRILLING LOG
Top Bottom
0 / 65
65 / 196
/
12. REMARKS:
Material
Formation Description
Overburden
Granite
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
• 15A NCAC 2C, WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
wn n AA
SIGIAATURE OF CERTIFIED WELL CONTRACTOR DATE
c. WATER LEVEL Below Top of Casing: _ 60 FT. Timothy R Hamby
(Use "+" if Above Top of Casing) : PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit within 30 days of completion to: Division of Water Quality - Information Processing, Form Rev. 1 /08 /08
1617 Mail Service Center, Raleigh, NC 27699-161, Phone : [phone]

�Q;mo-d W A o
', r
.
1 r ONRESIDENTIAL
-T
WELL CONSTRUCTION RECORD
>`'�Bc ••
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 3118 A
1. WELL CONTRACTOR:
Timothv R Hamb
Well Contractor (Individual) Name
Midsouth -Geothermal
Well Contractor Company Name
8275 Tournament Dr Suite 185
Street Address
Memphis TN 38125
City or Town State Zip Code
9( 01 ) 748-9095
Area code Phone number
2. WELL INFORMATION:
WELL CONSTRUCTION PERMIT# W10100141
OTHER ASSOCIATED PERMIT#(if applicable)
SITE WELL ID #(if applicable) B-8
3. WELL USE (Check One Box) Monitoring ❑ Municipal/Public ❑
Industrial/Commercial ❑ Agricultural ❑ Recovery Injection ❑
Irrigation❑ Other S((listuse) Closed loop Geotherna
DATE DRILLED 9-30-1 1
4. WELL LOCATION:
1166 Lotla Church Rd
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
CITY: Franklin COUNTY Macon
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
❑ Slope ❑ Valley p(Flat ❑ Ridge ❑ Other
KOISTCD 36 iAAAA&AAAAAAAAI CL R OR 3XmXXXo0WX CC
KNMFKTCD75 IAAAA&AAAAAAAA! CLROR 7)V)MX7A)9(9(` CC
Latitude/longitude source: ❑GPS []topographic map
(location of well must be shown on a USGS topo map andattached to
this form if not using GPS)
5. FACILITY (Name of the business where the well is located.)
Macon Elementary
Facility Name Facility ID# (if applicable)
1166 Lotla Church Rd
Street Address
Franklin N 8734
City or Town State Zip Code
Macon County Government
Contact Name
Mailing Address
Franklin NO 28743
City or Town State Zip Code
U
Area code Phone number
6. WELL DETAILS:
a. TOTAL DEPTH: -450'
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO [�
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 15A NCAC 2C .0118.
: e. YIELD (gpm): - 40 METHOD OF TESTJaJQtn/ )n=
f. DISINFECTION: Type HTC: Amount 12 Qz
g. WATER ZONES (depth):
Top 250' Bottom 254,
Top Bottom
Top Bottom
Top Bottom
Top Bottom
Top Bottom
Thickness/
:7. CASING: Depth Diameter Weight Material
Top +2 Bottom 80' Ft. 6 1 /8 .188 steel
Top Bottom Ft.
Top Bottom Ft.
8. GROUT: Depth Material Method
Top 0 Bottom 85 Ft. Bentonite _Pum e� d
Top 85 Bottom 450 Ft. washed stone poured
Top Bottom Ft.
S. SCREEN: Depth Diameter Slot Size Material
Top Bottom Ft. in. in.
Top Bottom Ft. in. in.
Top Bottom Ft. in. in.
10. SANDIGRAVEL PACK:
Depth Size
Top Bottom Ft.
Top Bottom Ft.
Top Bottom Ft.
11. DRILLING LOG
Top
Bottom
0
/ 80
80
/ 250
250
/ 254
254
/ 450
/
12. REMARKS:
Material
Formation Description
Overburden
Granite
Broken Granite 40 GPM
Granite
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 BEI;t'/PROVIDED TO THE WELL OWNER.
" _9-30-11
fATURE OF CERTIFIED WELL CONTRACTOR DATE
c. WATER LEVEL Below Top of Casing: 60 FT. ; T'mothy R Hamby
(Use "+•' if Above Top of Casing) : PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit within 30 days of completion to: Division of Water Quality - Information Processing, Form Rev. 1 /08 /OS
1617 Mail Service Center, Raleigh, NC 27699-161, Phone : [phone]

NONRESIDENTLQL WELL
CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 3118 A
1. WELL CONTRACTOR:
Timothv R Hamb
Well Contractor (Individual) Name
Midsouth Geothermal
Well Contractor Company Name
8275 Tournament Dr Suite 185
Street Address
Memphis TN 38125
City or Town State Zip Code
9( 01 ) 748-9095
Area code Phone number
2. WELL INFORMATION:
WELL CONSTRUCTION PERMIT# W l0100141
OTHER ASSOCIATED PERMIT#(if applicable)
SITE WELL ID #(if applicable) C-1
3. WELL USE (Check One Box) Monitoring ❑ Municipal/Public ❑
Industrial/Commercial ❑ Agricultural ❑ Recovery ❑ Injection ❑
Irrigation❑ Other W(llst Use) Closed IooD Geothernd
DATE DRILLED 10-25-1 1
4. WELL LOCATION:
1166 Lotla Church Rd
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
CITY: Franklin COUNTY Macon
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
❑Slope []Valley Flat ❑Ridge []Other
Ktr�l$TCD 36 IAAAA&AAAAAAAAI CL R OR 3rc^XMX90QXXXX CC
MPVFKTCD75 iAAAA&AAAAAAAAI CLROR 71k.'X' xXX90tX CC
Latitude/longitude source: 0GPS Dropographic map
(location of well must be shown on a USGS topo map andattached to
this form if not using GPS)
6. FACILITY (Name of the business where the well is located.)
Macon Elementary
Facility Name Facility ID# (if applicable)
_1166 Lotla Church Rd
Street Address
Franklin NC 28734
City or Town State Zip Code
Macon County Government
Contact Name
Mailing Address
Franklin NC 28743
City or Town State Zip Code
U
Area code Phone number
6. WELL DETAILS:
a. TOTAL DEPTH: 450'
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO 0 /
c. WATER LEVEL Below Top of Casing: 60 FT.
(Use °+^ if Above Top of Casing)
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 15A NCAC 2C .0118.
e. YIELD (gpm): 100 METHOD OF TEST J0M Down
f. DISINFECTION: Type HTC; Amount 1 07
g. WATER ZONES (depth):
Top_ 250 Bottom 254 . Top Bottom
Top Bottom Top Bottom
Top Bottom Top Bottom
Thickness/
7. CASING: Depth Diameter Weight Material
Top +2 Bottom__ Ft. 6 1 /8 .188 steel
Top Bottom Ft.
Top Bottom Ft.
8. GROUT: Depth Material Method
Top 0 Bottoms Ft. Sentonite pumped
Top 87 Bottom 450 Ft. Washed stone poured
Top Bottom Ft,
9. SCREEN: Depth Diameter Slot Size Material
Top Bottom Ft. in. in.
Top Bottom Ft. in. in.
Top Bottom Ft. in. in.
10. SAND/GRAVEL PACK:
Depth Size
Top Bottom Ft.
Top Bottom Ft.
Top Bottom Ft.
11. DRILLING LOG
Top
Bottom
0
/ 77
77
/ 82
82
/ 250
250 / 254
254
1450
12. REMARKS:
Material
Formation Description
Granite
_Granite
Broken Granite 40 GPM
Granite
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.
,02 q4-y 10-25
SIGN RE OF CERTIFIED WELL CONTRACTOR DATE
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit within 30 days of completion to: Division of Water Quality Form /08
Y p ty - Information Processing, Rev. 1/08
1617 Mail Service Center, Raleigh, NC 27699-161, Phone: [phone]

NONRESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 3118 A
1. WELL CONTRACTOR:
Timothy R Hamby
Well Contractor (Individual) Name
Midsouth Geothermal
Well Contractor Company Name
8275 Tournament Dr Suite 185
Street Address
Memphis TN 38125
City or Town State Zip Code
9( 01 ) 748-9095
Area code Phone number
2. WELL INFORMATION:
WELL CONSTRUCTION PERMIT# W10100141
OTHER ASSOCIATED PERMIT#(if applicable)
SITE WELL ID #(if applicable) C-2
3. WELL USE (Check One Box) Monitoring ❑ Municipal/Public ❑
Industrial/Commercial ❑ Agricultural ❑ Recovery ❑ Injection ❑
Irrigation[] Other W(list use) Closed 100D Geothernd
DATE DRILLED 10-24-1 1
4. WELL LOCATION:
1166 Lotla Church Rd
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
CITY: Franklin COUNTY Macon
TOPOGRAPHIC ! LAND SETTING: (check appropriate box)
❑ Slope ❑ Valley Flat ❑ Ridge []Other
Kg3BTCD 36 iAAAA&AAAAAAAAI CL R OR 3X^XXXXNXXXX CC
KNMFKTCD75 IAAAA&AAAAAAAAI CLROR 71)t. Rit"'kXriQ CC
Latitude/longitude source: ❑GPS Qropographic map
(location of well must be shown on a USGS topo map andattached to
this form if not using GPS)
5. FACILITY (Name of the business where the well is located.)
Macon Elementary
Facility Name Facility ID# (if applicable)
1166 Lotla Church Rd
Street Address
Franklin N C 28734
City or Town State Zip Code
Macon County Goyernm .nt
Contact Name
Mailing Address
Franklin NC 28743
City or Town State Zip Code
Area code
Phone number
6. WELL DETAILS:
a. TOTAL DEPTH: 4501
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO qI
d. TOP OF CASING IS ? FT. Above Land Surface`
'Top of casing terminated attor below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
: e. YIELD (gpm): 100 METHOD OF TEST BIDW Down
f. DISINFECTION: Type HTC Amount 17 07
g. WATER ZONES (depth):
Top 250 Bottom 254 Top Bottom
: Top Bottom Top Bottom
Top Bottom Top Bottom
Thickness/
7. CASING: Depth Diameter Weight Material
Top +2 Bottom 82 Ft. 6 1 /8 .188 steel
Top
Bottom
Ft.
Top
Bottom
Ft.
8. GROUT:
Depth
Material
Method
Top 0
Bottom 87
Ft.SentOnite
pumped
Top 87
Bottom 450
Ft. washed stone
poured
Top
Bottom
Ft.
9. SCREEN:
Depth
Diameter Slot Size Material
Top
Bottom
Ft. in.
in.
Top
Bottom
Ft. in.
in.
Top
Bottom
Ft, in.
in.
10. SAND/GRAVEL PACK:
Depth
Size Material
Top
Bottom
Ft.
Top
Bottom
Ft.
Top
Bottom
Ft.
11. DRILLING LOG
Top Bottom
0
/ 77
77
/ 82
82
/ 250
250
/ 254
254
/ 450
!
: 12. REMARKS:
Formation Description
71i1
Granite
Granite
Broken Granite 40 GPM
Granite
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
15A NCAC 2C, WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
C /e 10-24-11
SIGN RE OF CERTIFIED WELL CONTRACTOR ' DATE
c. WATER LEVEL Below Top of Casing: 60 FT. Timothy R Hamby
(Use "+" if Above Top of Casing) :PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit within 30 days of completion to: Division of Water Quality - Information Processing, Form Rev. 1/08lOB
1617 Mail Service Center, Raleigh, NC 27699-161, Phone : [phone]

NONRESIDENTL4L
WELL CONSTRUCTION RECORD
4„a i1.
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 3118 A
1. WELL CONTRACTOR:
Timothv R Hamb
Well Contractor (Individual) Name
Midsouth Geothermal
Well Contractor Company Name
8275 Toumament Dr Suite 185
Street Address
Memphis TN 38125
City or Town State Zip Code
9( 01 ) 748-9095
Area code Phone number
2. WELL INFORMATION:
WELL CONSTRUCTION PERMIT# W 10100141
OTHER ASSOCIATED PERMIT#(if applicable)
SITE WELL ID #(if applicable) C.-3
3. WELL USE (Check One Box) Monitoring ❑ Municipal/Public ❑
Industrial/Commercial ❑ Agricultural ❑ Recovery ❑ Injection ❑
Irrigation❑ Other Ir!(list use) Closed IOOD Geotherra
DATE DRILLED-1 0-20-11
4. WELL LOCATION:
1166 Lotla Church Rd
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
CITY. Franklin COUNTY Macon
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
❑Slope ❑Valley QrFlat ❑Ridge ❑Other
K@39TCD 36 iAAAA&AAAAAAAA! CL R OR 3&X'Xi('X%X)WX CC
KNMFISTCD75 !AAAA&AAAAAAAA! CLROR 71)k:) X'RiAWX CC
Latitude/longitude source: ASPS aopographic map
(location of well must be shown on a USGS topo map andattached to
this form if not using GPS)
5. FACILITY (Name of the business where the well is located.)
Macon Elementary
Facility Name Facility ID# (if applicable)
1166 Lotla Church Rd
Street Address
Franklin NC— 28734
City or Town State Zip Code
Macon County Government
Contact Name
Mailing Address
Franklin N(" 28743
City or Town State Zip Code
Area code
Phone number
S. WELL DETAILS:
a. TOTAL DEPTH: 4501
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO C/
d. TOP OF CASING IS 2 FT. Above Land Surface`
'Top of casing terminated attor below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): 40 METHOD OF TEST 3JQW D0=
f. DISINFECTION: Type HTC Amount 1 ?�
g. WATER ZONES (depth):
:Top 250 Bottom 254 Top Bottom
Top Bottom Top Bottom
;Top Bottom Top Bottom
Thickness/
7. CASING: Depth Diameter Weight Material
Top +2 _ Bottom 82 Ft. 6 1 /8 .188 steel
Top Bottom Ft.
Top Bottom Ft.
• 8. GROUT: Depth Material Method
Top 0 Bottom 87 Ft. Bentonite-pumped
Topes Bottom 450 Ft. washed stone poured
Top Bottom Ft.
: 9. SCREEN: Depth Diameter Slot Size Material
Top Bottom Ft. in. in.
Top Bottom Ft. in. in.
Top Bottom Ft. In. in.
10. SAND/GRAVEL PACK:
Depth Size Material
Top Bottom Ft.
Top Bottom Ft.
Top Bottom Ft.
11. DRILLING LOG
Top Bottom
0 / 77
77 / 82
82 _/ 250
250/ 254
254 / 450
/
12. REMARKS:
Formation Description
Dirt
Granite
Granite
Broken Granite 40 GPM
Granite
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
&Z-, n -34-� 10_20
SIGN URE OF CERTIFIED WELL CONTRACTOR DATE
c. WATER LEVEL Below Top of Casing: 60 FT. Timofhy R HamhV
(Use "+" if Above Top of Casing) : PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit within 30 days of completion to: Division of Water Quality - Information Processing, Form GW-1b
Rev. 1 /08
1617 Mail Service Center, Raleigh, NC 27699-161, Phone : [phone]

NONRESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 3118 A
1. WELL CONTRACTOR:
Timothy R Hamby
Well Contractor (Individual) Name
Midsouth Geothermal
Well Contractor Company Name
8275 Tournament Dr Suite 185
Street Address
Memphis TN 38125
City or Town State Zip Code
9( 01 ) 748-9095
Area code Phone number
2. WELL INFORMATION:
WELL CONSTRUCTION PERMIT# W 10100141
OTHER ASSOCIATED PERMIT#(if applicable)
SITE WELL ID #(if applicable) CA
3. WELL USE (Check One Box) Monitoring ❑ Municipal/Public ❑
: d. TOP OF CASING IS 2 FT. Above Land Surface'
'Top of casing terminated attor below land surface may require .
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): 40 METHOD OF TEST BIOW DOWn
f. DISINFECTION: Type HTC Amount 12 07
g. WATER ZONES (depth):
Top 250 Bottom 254 Top Bottom
Top Bottom Top Bottom
Top Bottom Top Bottom
Thickness/
7. CASING: Depth Diameter Weight Material
Top +2 Bottom 82 Ft. 6 1/8 .188 steel
Top Bottom Ft.
Top Bottom Ft.
: 8. GROUT: Depth Material Method
Industrial/Commercial ❑ Agricultural ❑ Recovery ❑ Injection ❑
: Top 0
Bottom 87
Ft. Bentonite pumped
Irrigation[] Other V(list use) Closed 100D Geotherra
Top 87
Bottom 450
Ft. washed stone poured
DATE DRILLED 10-19-1 1
; Top
Bottom
Ft.
C11IL'•r441S�7ajiL�7:F
1166 Lotia Church Rd
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
CITY: Franklin COUNTYMacon
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
❑Slope ❑Valley Flat ❑Ridge []Other
KI(§I$TCD 36 iAAAA&AAAAAAAAI CL R OR 3J0X7 XX00MX CC
KNMFKTCD75 iAAAA&AAAAAAAAI CL ROR 7k!t(9cxlOc9t'l M CC
Latitude/longitude source: ❑GPS ❑topographic map
(location of well must be shown on a USGS topo map andattached to
this torm if not using GPS)
5. FACILITY (Name of the business where the well is located.)
Macon Elementary
Facility Name Facility ID# (if applicable)
1166 Lotla Church Rd
Street Address
Franklin NC 28734
City or Town State Zip Code
Macon County Government
Contact Name
Mailing Address
Franklin NC 28743
City or Town State Zip Code
Area code Phone number
6. WELL DETAILS:
a. TOTAL DEPTH: 450'
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO d
9. SCREEN: Depth Diameter Slot Size Material
Top Bottom Ft. in. in.
Top Bottom Ft. in. in.
Top Bottom Ft. in. in.
10. SAND/GRAVEL PACK:
Depth Size
Top Bottom Ft.
Top Bottom Ft.
Top Bottom Ft.
11. DRILLING LOG
Top Bottom
0
/ 77
77
/ 82
82 _/ 250
250
/ 254
254
/ 450
/
12. REMARKS:
Dirt
Material
Formation Description
Granite
Granite
Broken Granite 40 GPM
Granite
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
• 15A NCAC 2C, WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
SIGN RE OF CERTIFIED WELL CONTRACTOR DATE
C. WATER LEVEL Below Top of Casing: 60 FT. Timothy R Hamby
(Use "+" if Above Top of Casing) : PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit within 30 days of completion to: Division of Water Quality - Information Processing, Form Rev. 1 /08 /08
1617 Mail Service Center, Raleigh, NC 27699-161, Phone : [phone]

NQNRESIDENTLQL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 3118-A
1. WELL CONTRACTOR:
Timothy R Hamby
Well Contractor (Individual) Name
Midsouth Geothermal
Well Contractor Company Name
8275 Tournament Dr Suite 185
Street Address
Memphis TN 38125
City or Town State Zip Code
9(_ 01 ) 748-9095
Area code Phone number
2. WELL INFORMATION:
WELL CONSTRUCTION PERMIT# W10100141
OTHER ASSOCIATED PERMIT#(if applicable)
SITE WELL ID #(if applicable) C-5
3. WELL USE (Check One Box) Monitoring ❑ Municipal/Public ❑
Industrial/Commercial ❑ Agricultural ❑ Recovery ❑ Injection ❑
Irrigation❑ Other [,((list use) Closed 100D Geotherre
DATE DRILLED 10-18-1 1
4. WELL LOCATION:
1166 Lotla Church Rd
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
CITY: Franklin COUNTY Macon
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
❑Slope ❑Valley OfFlat ❑Ridge ❑Other
K@3F$TCD 36 iAAAA&AAAAAAAA! CL ROR 30X'RX'XPA)WX CC
KNMFI$TCD751AAAA&AAAAAAAA!CLROR71k.'X`kX'7xxxiftCC
Latitude/longitude source: (GPS aopographic map
(location of well must be shown on a USGS topo map andattached to
this form if not using GPS)
5. FACILITY (Name of the business where the well is located.)
Macon Flementary
Facility Name Facility ID# (if applicable)
1166 Lotla Church Rd
Street Address
Franklin N . 28734
City or Town State Zip Code
Macon County Government
Contact Name
Mailing Address
Franklin NC 2874*1
City or Town State Zip Code
Area code Phone number
6. WELL DETAILS:
a. TOTAL DEPTH: 4501
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO Cii(
d. TOP OF CASING IS 2 FT. Above Land Surface*
`Top of casing terminated attor below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): 40 METHOD OF TEST 3J W Down
f. DISINFECTION: Type HTC: Amount 1 n7
g. WATER ZONES (depth):
Top 250 Bottom 254 Top Bottom
Top Bottom Top Bottom
Top Bottom Top Bottom
Thickness/
7. CASING: Depth Diameter Weight Material
Top +2 Bottom_ 2 Ft. 6 1 /8 .188 steel
Top
Bottom
Ft.
Top
Bottom
Ft.
8. GROUT:
Depth
Material
Method
Top 0
Bottoms Ft.
Bentonite
pumped
Top 87
Bottom 450
Ft, washed stone
poured
Top
Bottom
Ft.
9. SCREEN:
Depth
Diameter Slot Size Material
Top
Bottom
Ft.
in.
in.
Top
Bottom
Ft.
in.
in.
Top
Bottom
Ft.
in.
in.
10. SAND/GRAVEL PACK:
Depth
Size Material
Top
Bottom
Ft.
: Top
Bottom
Ft.
Top
Bottom
Ft.
11. DRILLING LOG
TopBottom
0 / 77
77 / 82
82 •—/ 250 _
250 / 254
254 / 450
12. REMARKS:
Formation Description
Granite
_Granite
Broken Granite 40 GPM
Granite
easing Removed
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
=-� ,.12
SIGNIATURE OF CERTIFIED WELL CONTRACTOR DATE
c. WATER LEVEL Below Top of Casing: 60 FT. 111Tloth�/ R Haml]y
(Use "+" if Above Top of Casing) : PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit within 30 days of completion to: Division of Water Quality - Information Processing, Form Rev. 1 /08 /08
1617 Mail Service Center, Raleigh, NC 27699-161, Phone : [phone]

a srAi�'a .
NONRESIDENTIAL WELL CONSTRUCTION RECORD
0'
North Carolina Department of Environment and Natural Resources- Division of Water Quality WELL CONTRACTOR CERTIFICATION # 3118 A
1. WELL CONTRACTOR:
Timothy R Hamby
Well Contractor (Individual) Name
Midsouth Geothermal
Well Contractor Company Name
8275 Tournament Dr Suite 185
Street Address
Memphis TN 38125
City or Town State Zip Code
9( 01 ) 748-9095
Area code Phone number
2. WELL INFORMATION:
WELL CONSTRUCTION PERMIT# W10100141
OTHER ASSOCIATED PERMIT#(if applicable)
SITE WELL ID #(ifapplicable) C-6
3. WELL USE (Check One Box) Monitoring ❑ Municipal/Public ❑
Industrial/Commercial ❑ Agricultural ❑ Recovery ❑ Injection ❑
Irrigation❑ Other (((list use) Closed loop Geotherra
DATE DRILLED 10-17-1 1
4. WELL LOCATION:
1166 Lotla Church Rd
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
CITY: Franklin COUNTY Macon
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
[]Slope ❑ Valley Ii(Flat ❑ Ridge ❑ Other
KOBTCD 36 iAAAA&AAAAAAAA! CL R OR 3X^XXXXO0t91XX CC
KNMFKTCD75 iAAAA&AAAAAAAA! CL ROR 7X.'X XxXX)m CC
Latitude/longitude source: ❑GPS Elropographic map
(location of well must be shown on a USGS topo map andattached to
this form if not using GPS)
5. FACILITY (Name of the business where the well is located.)
Macon Elementary
Facility Name Facility ID# (if applicable)
1166 Lotla Church Rd
Street Address
Franklin NC 28734
City or Town State Zip Code
Macon County Government
Contact Name
Mailing Address
Franklin NC 28743
City or Town State Zip Code
U
Area code
Phone number
6. WELL DETAILS:
a. TOTAL DEPTH: 450'
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO qI
c. WATER LEVEL Below Top of Casing: 60 FT
(Use "+" if Above Top of Casing)
d. TOP OF CASING IS 2 FT. Above Land Surface`
'Top of casing terminated attor below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): 40 METHOD OF TEST BIQW JDDM
f. DISINFECTION: Type HTG Amount 12 oz_
g. WATER ZONES (depth):
Top 250 Bottom 254 Top Bottom
Top Bottom Top Bottom
Top Bottom Top Bottom
Thickness/
7. CASING: Depth Diameter Weight Material
Top +2 Bottom_ 2 Ft. 6 1 /8 .188 Steel
Top Bottom Ft.
Top Bottom Ft.
8. GROUT: Depth Material Method
Top 0 Bottom 87 Ft. Bentonite pumped
Top 87 Bottom 450 Ft. washed stone poured
Top Bottom Ft.
9. SCREEN: Depth Diameter Slot Size Material
Top Bottom Ft. in. in.
Top Bottom Ft. in. in.
Top Bottom Ft. in. in
10. SAND/GRAVEL PACK:
Depth Size Material
Top Bottom Ft.
Top Bottom Ft.
Top Bottom Ft.
11. DRILLING LOG
Top Bottom
0 / 77
77 / 82
82 / 250
250 / 254
254 / 450
/
: 12. REMARKS:
Formation Description
Dirt
Granite
Granite
Broken Granite 40 GPM
Granite
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
SIGDATE 1 CERTIFIED WELL CONTRACTOR 1 O1
. PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit within 30 days of completion to: Division of Water Quality Form /08
y p ty - Information Processing, Rev. 1/O8
1617 Mail Service Center, Raleigh, NC 27699-161, Phone: [phone]

NONRESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 3118 A
1. WELL CONTRACTOR:
Timothy R Hamby
Well Contractor (Individual) Name
Midsouth Geothermal
Well Contractor Company Name
8275 Tournament Dr Suite 185
Street Address
Memohis TN 38125
City or Town State Zip Code
9r 01 ) 748-9095
Area code Phone number
d. TOP OF CASING IS 2 FT. Above Land Surface*
'Top of casing terminated attor below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
: e. YIELD (gpm): 40 METHOD OF TEST gIOW Down
f. DISINFECTION: Type HTC; Amount- 2 QZ
g. WATER ZONES (depth):
Top 250 Bottom 254 Top Bottom
Top Bottom Top Bottom
Top Bottom Top Bottom
Thickness/
2. WELL INFORMATION: ; 7. CASING: Depth Diameter Weight Material
WELL CONSTRUCTION PERMIT#WI0100141 : Top +2 Bottom 92 Ft. 6 1/8 .188 steel
OTHER ASSOCIATED PERMIT#(if applicable) Top Bottom Ft.
SITE WELL ID #(ifapplicable) C-7 ; Top Bottom Ft.
3. WELL USE (Check One Box) Monitoring ❑ Municipal/Public ❑ ; 8. GROUT: Depth Material Method
Industrial/Commercial ❑ Agricultural ❑ Recovery ❑ Injection ❑
Irrigation❑ Other [((list use) Closed IOOD Geotherre
DATE DRILLED 10-14-1 1
4. WELL LOCATION:
1166 Lotla Church Rd
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
CITY: Franklin COUNTY Macon
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
❑Slope []Valley VFW ❑Ridge []Other
Kra�ATCD 36 IAAAA&AAAAAAAA! CL ROR 33C4xXxx 0(xxx CC
KNMFI'5TCD75 IAAAA&AAAAAAAA! CLROR 7`)k.WXX"1(9C'AW CC
Latitudenongitude source: [JGPS propographic map
(location of well must be shown on a USGS topo map andattached to
this form if not using GPS)
5. FACILITY (Name of the business where the well is located.)
Macon Elementary
Facility Name Facility ID# (if applicable)
1166 Lotla Church Rd
Street Address
Franklin NC 28734
City or Town State Zip Code
Macon County Government
Contact Name
Mailing Address
Franklin NC 28743.
City or Town State Zip Code
Area code Phone number
Top 0
Bottom 97
Ft. Bentonite pumped
Top 97
Bottom 450
Ft. washed stone poured
Top
Bottom
Ft.
9. SCREEN:
Depth
Diameter Slot Size Material
Top
Bottom
Ft. in. in.
Top
Bottom
Ft. in. in.
Top
Bottom
Ft. in. in.
10. SAND/GRAVEL PACK:
Depth
Size Material
Top
Bottom
Ft.
Top
Bottom
Ft.
: Top
Bottom
Ft.
11. DRILLING LOG
Top
Bottom
0
/ 90
90
/ 92
92 250
250
/ 254
254
/ 450
/
12. REMARKS:
easing Rernoved
Formation Description
Granite
Granite
Broken Granite 40 GPM
Granite
6. WELL DETAILS: I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
15A NCAC 2C, WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
a. TOTAL DEPTH: 4501 : RECORD HAS BEEN PROVIDED TO THE WELL OWNER-
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO 1 D-14-11
SlGkCERTIFIED WELL CONTRACTOR DATE
c. WATER LEVEL Below Top of Casing: 60 FT.
(Use "+^ if Above Top of Casing) Timothy R Hamby
:PRINTED NAME OF PERSON CONSTRUCTING THE WELL
s of completion to: Division of Water Quality Form GW 1b
Submit within 30 days p ty - Information Processing, Rev. 1/08
1617 Mail Service Center, Raleigh, NC 27699-161, Phone : [phone]

NONRESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 3118 A
1. WELL CONTRACTOR:
Timothy R Hamby
Well Contractor (Individual) Name
Midsouth Geothermal
Well Contractor Company Name
8275 Tournament Dr Suite 185
Street Address
Memphis TN 38125
City or Town State Zip Code
9t 01 ) 748-9095
Area code Phone number
2. WELL INFORMATION:
WELL CONSTRUCTION PERMIT# W101 00 141
OTHER ASSOCIATED PERMIT#(if applicable)
SITE WELL ID #(if applicable) C-8
3. WELL USE (Check One Box) Monitoring ❑ Municipal/Public ❑
Industrial/Commercial ❑ Agricultural ❑ Recovery ❑ Injection ❑
Irrigation❑ Other [d(list use) Closed 100D Geotherre
DATE DRILLED 10-13-1 1
4. WELL LOCATION:
1166 Lotla Church Rd
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
CITY: Franklin COUNTY Macon
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
❑ Slope ❑ Valley g(Flat ❑ Ridge []Other
K(01$TCD 36 iAAAA&AAAAAAAAI CL ROR 3X^XXXXOO(9 X CC
KNMFI$TCD75 iAAAA&AAAAAAAA! CLROR 7`*.Wx'llf'J(mom CC
Latitude/longitude source: ❑GPS OT'opographic map
(location of well must be shown on a USGS topo map andattached to
this form if not using GPS)
5. FACILITY (Name of the business where the well is located.)
Macon Elementary
Facility Name Facility ID# (if applicable)
1166 Lotla Church Rd
Street Address
Franklin NC 28734
City or Town State ,Zip Code
Macon County Goyernm .nt
Contact Name
Mailing Address
Franklin N C, 28743
City or Town State Zip Code
Area code Phone number
6. WELL DETAILS:
a. TOTAL DEPTH:4501
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NOG/
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 15A NCAC 2C .0118.
e. YIELD (gpm): 40 METHOD OF TEST BIOW DOWn
f. DISINFECTION: Type HTC Amount 12 o7
g. WATER ZONES (depth):
Top,250 Bottom 254 Top Bottom
:Top Bottom Top Bottom
Top Bottom Top Bottom
Thickness/
7. CASING: Depth Diameter Weight Material
Top +2 Bottom 94 Ft. 6 1 /8 .188 steel
: Top Bottom Ft.
Top Bottom Ft.
8. GROUT: Depth Material Method
Top 0 Bottom 99 Ft. Bentonite pumped
Top 99 Bottom 450 Ft. washed stone poured
Top Bottom Ft.
9. SCREEN: Depth Diameter Slot Size Material
Top Bottom Ft. in. in.
Top Bottom Ft. in. in.
Top Bottom Ft. in. in.
10. SAND/GRAVEL PACK:
Depth Size
Top Bottom Ft.
Top Bottom - Ft.
Top Bottom Ft.
11. DRILLING LOG
Top Bottom
0 / 90
90 / 94
94 250
250 254
254 / 450
12. REMARKS:
easing Ren loved
Material
Formation Description
Granite
Granite
Broken Granite 40 GPM
Granite
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
• 15A NCAC 2C, WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
I/A � � 10-13-11
SI ATURE OF C TIFIED WELL CONTRACTOR DATE
c. WATER LEVEL Below Top of Casing: 60 FT. Timothy R Hamhy
(Use "+" if Above Top of Casing) : PRINTED NAME OF PERSON CONSTRUCTING THE WELL
s of completion to: Division of Water Quality Form
Submit within 30 days p ty - Information Processing, Rev. 1/0808
1617 Mail Service Center, Raleigh, INC 27699-161, Phone : [phone]

v;;asurEo
=M1��`' NONRESIDENTIAL WELL CONSTRUCTION RECORD
F.
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 3065 A
- Yh eQIIA,M<4�f--.
1. WELL CONTRACTOR:
Roger L Williams
Well Contractor (Individual) Name
Tarheel Water Treatmant
Well Contractor Company Name
3494 Georaia Rd
Street Address
Franklin NC 28734
City or Town State Zip Code
8( 28 ) 369-0740
Area code Phone number
2. WELL INFORMATION:
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 15A NCAC 2C ,0118.
e. YIELD (gpm): 10 METHOD OF TEST_ %fir Ift
f. DISINFECTION: Type /-ITC Amount 1 /4 .11ll—
g. WATER ZONES (depth):
Top 303 Bottom 304 Top Bottom
: Top Bottom Top Bottom
Top Bottom Top Bottom
Thickness/
7. CASING: Depth Diameter Weight Material
WELL CONSTRUCTION PERMIT# WI0100141 : Top 0 Bottom 84 Ft.
OTHER ASSOCIATED PERMIT#(if applicable) :Top Bottom Ft.
SITE WELL ID #(if applicable) D-1 ; Top Bottom Ft.
3. WELL USE (Check One Box) Monitoring ❑ Municipal/Public ❑ : 8. GROUT: Depth 'Material
Industrial/Commercial ❑ Agricultural ❑ Recovery ❑ Injection ❑ : Top 0 Bottom_ 89 Ft._bentOnite
Irrigation[] Other W(list use) Closed LOOD Geothere : Top 89 Bottom 450 Ft. washed stone
DATE DRILLED 9-29-1 1 ; Top Bottom Ft.
4. WELL LOCATION: ; 9. SCREEN: Depth Diameter Slot Size
1166 lotla Church Rd
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
CITY: Franklin COUNTY Macon
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
❑Slope ❑Valley prFlat ❑Ridge ❑Other
K0MTCD 36 IAAAA&AAAAAAAAI CL ROR 3mXnX00MX CC
KNMFI'STCD75 iAAAA&AAAAAAAA! CLROR 7'X.)MXXX1C'X9@ CC
Latitude/longitude source: DGPS Qropographie map
(location of wet/ must be shown on a USGS topo map andattached to
this form if not using GPS)
5. FACILITY (Name of the business where the well is located.)
Macon Flementary School
Facility Name Facility ID# (if applicable)
1166 lotla Church Rd
Street Address
Franklin NC 28734
City or Town State Zip Code
Macon County Government
Contact Name
Mailing Address
Franklin NC 28734
City or Town State Zip Code -
Area code
Phone number
6. WELL DETAILS:
a. TOTAL DEPTH: 4501
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO qI
Top Bottom Ft. in.
Top Bottom Ft. in.
Top Bottom Ft. in.
: 10. SAND/GRAVEL PACK:
Depth Size
Top Bottom Ft.
Top Bottom Ft.
Top Bottom Ft.
11. DRILLING LOG
Top Bottom
0 / 75
75 / 84
84 / 450
12. REMARKS:
easing Removed
in.
in.
in.
Method
pumped
Doured
Material
Material
Formation Description
Sand and Clay
Granite Casing set
Granite
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
• 15A NCAC L CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
RECO AS B N PROVIDED TO THE NER.
SIGNATURE OF CERTIFIED WELL CONTRACTOR DATE
c. WATER LEVEL Below Top of Casing: 60 FT. : Roger L Williams
(Use "+" if Above Top of Casing) : PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit within 30 days of completion to: Division of Water Quality Form /08
Y P ty - Information Processing, Rev. 1/08
1617 Mail Service Center, Raleigh, NC 27699-161, Phone : [phone]

1 :ONRESIDENTL4L WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
•w�a„;;.F
WELL CONTRACTOR CERTIFICATION # 3065 A
1. WELL CONTRACTOR:
Roaer L Williams
Well Contractor (Individual) Name
Tarheel Water Treatmant
Well Contractor Company Name
3494 Georaia Rd
Street Address
Franklin NC 28734
City or Town State Zip Code
8( 28 ) 369-0740
Area code Phone number
2. WELL INFORMATION:
WELL CONSTRUCTION PERMIT# W 10100141
OTHER ASSOCIATED PERMIT#(if applicable)
SITE WELL ID #(if applicable) Q-2
3. WELL USE (Check One Box) Monitoring ❑ Municipal/Public ❑
Industrial/Commercial ❑ Agricultural ❑ Recovery ❑ Injection ❑
Irrigation❑ Other W(list use) Closed Loop Geothern
DATE DRILLED 9-28-1 1
4. WELL LOCATION:
1166 lotla Church Rd
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
CITY: Franklin COUNTY Macon
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
❑Slope []Valley p(Flat ❑Ridge ❑Other
K01$TCD 36 iAAAA&AAAAAAAAI CL ROR 3X^XXXXOOMMX CC
KNMFI$TCD75 iAAAA&AAAAAAAAI CLROR 7x.WX'XXX00M CC
Latitude/longitude source: ❑GPS Cropographic map
(location of well must be shown on a USGS topo map andattached to
this form if not using GPS)
5. FACILITY (Name of the business where the well is located.)
Macon Elementary School
Facility Name Facility ID# (if applicable)
1166 lotla Church Rd
Street Address
Franklin NC 28734
City or Town State Zip Code
Macon County Government
Contact Name
Mailing Address
Franklin NC 28734
City or Town State Zip Code
Area code
Phone number
6. WELL DETAILS:
a. TOTAL DEPTH: 4501
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO qI
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 15A NCAC 2C .0118.
e. YIELD (gpm): 40 METHOD OF TEST Air I
f. DISINFECTION: Type HTC: Amount 1 /4 is I-
g. WATER ZONES (depth):
Top_ 5�0 Bottom 252 Top Bottom
Top Bottom Top Bottom
Top Bottom Top Bottom
Thickness/
7. CASING: Depth Diameter Weight Material
Top 0 Bottom 84 Ft.
Top Bottom Ft.
Top Bottom Ft.
: 8. GROUT: Depth Material Method
Top 0 Bottom 89 Ft. bentonite pumped
Top 89 Bottom 450 Ft. washed stone poured
Top Bottom Ft.
: 9. SCREEN: Depth Diameter Slot Size Material
Top Bottom Ft. in. in.
Top Bottom Ft. in. in.
Top Bottom Ft. in. in.
: 10. SAND/GRAVEL PACK:
Depth Size Material
Top Bottom Ft.
Top Bottom Ft.
Top Bottom Ft.
11. DRILLING LOG
Top Bottom
0
/ 51
51
/ 64
64 77
77
/ 84
84
/ 450
/
12. REMARKS:
easing Re[ noved
Formation Description
Sand and Cla
Granite
Brown Sand
Granite Casing Set
Granite
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
15A NCAC 2C LL CONSTRUCTION ST NDARDS, AND THAT A COPY OF THIS
RECORD B N PROVIDED TO TH E WNER.
O G _9-28-11
SIGNATU E OF CERTIFIED WELL CONTRACTOR DATE
c. WATER LEVEL Below Top of Casing: _50 FT. : _R_ oiler L Williams
(Use •'+" if Above Top of Casing) : PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit within 30 days of completion to: Division of Water Quality Form /08
y p ty - Information Processing, Rev. 1/08
1617 Mail Service Center, Raleigh, NC 27699-161, Phone : [phone]

;a ; SiA4"2o�y4
NONRESIDENTLQL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 3065 A
1. WELL CONTRACTOR:
Roaer L Williams
Well Contractor (Individual) Name
Tarheel Water Treatmant
Well Contractor Company Name
3494 Georaia Rd
Street Address
Franklin NC 28734
City or Town State Zip Code
8( 28 ) 369-0740
Area code Phone number
2. WELL INFORMATION:
WELL CONSTRUCTION PERMIT# W 10100141
OTHER ASSOCIATED PERMIT#(if applicable)
SITE WELL ID #(if applicable) D-3
3. WELL USE (Check One Box) Monitoring ❑ Municipal/Public ❑
Industrial/Commercial ❑ Agricultural ❑ Recovery ❑ Injection ❑
Irrigation❑ Other N((,Iist use) Closed Loot) Geotherd
DATE DRILLED 9-26-11
4. WELL LOCATION:
1166 lotla Church Rd
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
CITY: Franklin COUNTY Macon
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
❑Slope ❑Valley Flat ❑Ridge []Other
KfI$TCD 36 1AAAA&AAAAAAAAI CL R OR 3X^XXXXIAXMX CC
KNMFI$TCD75 iAAAA@AAAAAAAAI CLROR 79 .WX1kXX"'W CC
Latitudenongitude source: ❑GPS aopographic map
(location of well must be shown on a USGS topo map andattached to
this form if not using GPS)
5. FACILITY (Name of the business where the well is located.)
Macon Elementary School
Facility Name Facility ID# (if applicable)
1166 lotla Church Rd
Street Address
Franklin N 82_734
City or Town State Zip Code
Macon County Government
Contact Name
Mailing Address
Franklin NG 28734
City or Town State Zip Code
U
Area code Phone number
6. WELL DETAILS:
a. TOTAL DEPTH:_ 450'
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO qI
d. TOP OF CASING IS _ 2 FT. Above Land Surface -
*Top of casing terminated attor below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): 20 METHOD OF TEST Air I Ift
f. DISINFECTION: Type HTC Amount 1 /4 C;l t -
g. WATER ZONES (depth):
:Top 230 Bottom 232 Top Bottom
:Top Bottom Top Bottom
Top Bottom Top Bottom
Thickness/
7. CASING: Depth Diameter Weight Material
Top 0 Bottom 84 Ft.
Top Bottom Ft.
Top Bottom Ft.
: 8. GROUT:
Depth
Material Method
Top 0
Bottoms
Ft. bentOnite pumped
Topes
Bottom 450
Ft. washed stone poured
Top
Bottom
Ft.
9. SCREEN:
Depth
Diameter Slot Size Material
Top
Bottom
Ft. in. in.
Top
Bottom
Ft. in. in.
Top
Bottom
Ft. in. in.
: 10. SAND/GRAVEL PACK:
Depth
Size Material
Top
Bottom
Ft.
Top
Bottom
Ft.
Top
Bottom
Ft.
11. DRILLING LOG
Top Bottom
0 / 78
78 / 84
84 450
12. REMARKS:
Formation Description
Sand and Clay
Granite Casing Set
Granite
easing Removed
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
• 15A NCAC 2C, WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
RECORD H •EN PROVIDE TO THE ELL O NN R.
9-26-11
SIGNATURE OF CERTIFIED WELL CONTRACTOR DATE
c. WATER LEVEL Below Top of Casing: 50 FT.
RoDer L Williams
(Use "+" if Above Top of Casing) : PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit within 30 days of completion to: Division of Water Quality Form /08
y p ty - Information Processing, Rev. 1108
1617 Mail Service Center, Raleigh, NC 27699-161, Phone: [phone]

LwA `4
1 r ONRESIDENTL4L WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 3065 A
1. WELL CONTRACTOR:
Roaer L Williams
Well Contractor (Individual) Name
Tarheel Water Treatmant
Well Contractor Company Name
3494 Georaia Rd
Street Address
Franklin NC 28734
City or Town State Zip Code
8( 28 369-0740
Area code Phone number
2. WELL INFORMATION:
WELL CONSTRUCTION PERMIT# Wl0100141
OTHER ASSOCIATED PERMIT#(if applicable)
SITE WELL ID #(if applicable) Q-4
3. WELL USE (Check One Box) Monitoring ❑ Municipal/Public ❑
Industrial/Commercial ❑ Agricultural ❑ Recovery ❑ Injection ❑
Irrigation❑ Other t((list use) Closed Loop Geothere
DATE DRILLED 9-23-1 1
4. WELL LOCATION:
1166 lotla Church Rd
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
CITY: Franklin COUNTY Macon
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
❑Slope []Valley Flat []Ridge []Other
K0ISTCD 36 iAAAA&AAAAAAAAI CL R OR 3X^XXXXIAXMX CC
KNWBTCD75 iAAAA&AAAAAAAAI CL ROR 71)t. UC7fX1( om CC
Latitude/Iongitude source: ❑GPS Qropographic map
(location of well must be shown on a USGS topo map andattached to
this form if not using GPS)
5. FACILITY (Name of the business where the well is located.)
Macon Elementary School
Facility Name Facility ID# (if applicable)
1166 lotla Church Rd
Street Address
Franklin NC 28734
City or Town State Zip Code
Macon County Government
Contact Name
Mailing Address
Franklin NC 28734
City or Town State Zip Code
Area code
Phone number
6. WELL DETAILS:
a. TOTAL DEPTH: 450'
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO q/
d. TOP OF CASING IS 2 FT. Above Land Surface'
"Top of casing terminated atfor below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
: e. YIELD (gpm): 0 METHOD OF TEST Air L itt
f. DISINFECTION: Type HTC, Amount 1 L4 G t1--
g. WATER ZONES (depth):
TopQ_ Bottom_ Top Bottom
Top Bottom Top Bottom
Top Bottom Top Bottom
Thickness/
7. CASING: Depth Diameter Weight Material
Top 0 Bottom 84 Ft.
Top Bottom Ft.
Top Bottom Ft.
8..GROUT: Depth Material Method
Top 0 Bottom 89 Ft. bentonite pumped
Top-E Bottom 450 Ft. washed stone o red
Top Bottom Ft.
S. SCREEN: Depth Diameter Slot Size Material
Top Bottom Ft. in. in.
Top Bottom Ft. in. in.
Top Bottom Ft. in. in.
10. SAND/GRAVEL PACK:
Depth Size
Top Bottom Ft.
Top Bottom Ft.
Top Bottom Ft.
11. DRILLING LOG
Top Bottom
0 / 77
77 / 87
87 1450
/
12. REMARKS:
Material
Formation Description
Sand and Clay
Granite Casing Set
Granite
I DO HEREBY CERT FY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
• 15A NCAC 2C CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
: RECORD B N PROVID TO THEXL ER.
`t 9-23-11
SIGNATURE OF CERTIFIED WELL CONTRACTOR DATE
c. WATER LEVEL Below Top of Casing: _0 FT. : _Roger L Williams
(Use •'+^ if Above Top of Casing) : PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit within 30 days of completion to: Division of Water Quality - Information Processing, Form Rev. 1/08 b
08
1617 Mail Service Center, Raleigh, NC 27699-161, Phone: [phone]

SfATS4+.`c.
NONRES`IDENTIAL WELL CONSTRUCTION RECORD
o North Carolina Department of Environment and Natural Resources- Division of Water Quality WELL CONTRACTOR CERTIFICATION # 3065 A
1. WELL CONTRACTOR:
Roaer L Williams
Well Contractor (Individual) Name
Tarheel Water Treatmant
Well Contractor Company Name
3494 Georgia Rd
Street Address
Franklin NC 28734
City or Town State Zip Code
8( 28 ) 369-0740
Area code Phone number
2. WELL INFORMATION:
WELL CONSTRUCTION PERMIT# W 10100141
OTHER ASSOCIATED PERMIT#(if applicable)
SITE WELL ID #(if applicable) D-5
3. WELL USE (Check One Box) Monitoring ❑ Municipal/Public ❑
Industrial/Commercial ❑ Agricultural ❑ Recovery ❑ Injection ❑
Irrigation[] Other t9((list use) Closed LoOD Geothere
DATE DRILLED 9-22-1 1
4. WELL LOCATION:
1166 lotla Church Rd
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
CITY: Franklin COUNTY Macon
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
❑ Slope ❑ Valley JiFlat ❑ Ridge []Other
K@311STCD 36 IAAAA&AAAAAAAAI CL R OR 3R0XXD(90009@ X CC
KNMF[STCD75 IAAAA&AAAAAAAAI CLROR-9X.'X`kX`Jlf'1(7Cw CC
Latitude/longitude source: ❑GPS aopographic map
(location of well must be shown on a USGS topo map andattached to
this form if not using GPS)
5. FACILITY (Name of the business where the well is located.)
Macon Flementary School
Facility Name Facility ID# (if applicable)
1166 lotla Church Rd
Street Address
Franklin NG 28734
City or Town State Zip Code
Macon County Government
Contact Name
Mailing Address
Franklin NC 28734
City or Town State Zip Code
Area code
Phone number
6. WELL DETAILS:
a. TOTAL DEPTH: 450'
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO qI
d. TOP OF CASING IS i 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): 0 METHOD OF TEST Air I ift
f. DISINFECTION: Type HTC Amount 1 /4 CI to-
: g. WATER ZONES (depth):
Top_0 Bottom,Q_ Top Bottom
Top Bottom Top Bottom
Top Bottom Top Bottom
Thickness/
7. CASING: Depth Diameter Weight Material
Top 0 Bottom 84 Ft.
Top Bottom Ft.
Top Bottom Ft.
8. GROUT: Depth Material Method
Top 0 Bottom 89 Ft. bentonite pumped
Top 89 Bottom 450 Ft. washed stone poured
Top Bottom Ft.
9. SCREEN: Depth Diameter Slot Size Material
Top Bottom Ft. in.
: Top Bottom Ft. in.
Top Bottom Ft. in.
10. SAND/GRAVEL PACK:
Depth Size
Top Bottom Ft.
Top Bottom Ft.
Top Bottom Ft.
: 11. DRILLING LOG
in.
in.
in.
Material
Top Bottom Formation Description
0 / 77
77 / 87
87 _/ 450
12. REMARKS:
Sand and Clay
Granite Casing Set
Granite
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
• 15A NCAC 2C, WELL CONSTRUCTION STANDARDS, AND THAT COPY OF THIS
RECORD HASIE*M PROVIDED TO THE WELL OWNER.
; SIGWATURE OF CERTIFIED WELL CONTRACTOR DATE
c. WATER LEVEL Below Top of Casing: _0 FT.
RoDQr L Williams
(Use "+" if Above Top of Casing) : PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit Within 30 days of completion to: Division of Water Quality Form GW-1b
y p ty - Information Processing, Rev. 1/08
1617 Mail Service Center, Raleigh, NC 27699-161, Phone : [phone]

NONRESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 3065 A
1. WELL CONTRACTOR:
Roger L Williams
Well Contractor (Individual) Name
Tarheel Water Treatmant
Well Contractor Company Name
3494 Georoia Rd
Street Address
Franklin NC 28734
City or Town State Zip Code
8( 28 ) 369-0740
Area code Phone number
2. WELL INFORMATION:
WELL CONSTRUCTION PERMIT# Wl0100141
OTHER ASSOCIATED PERMIT#(if applicable)
SITE WELL ID #(if applicable) D-6
3. WELL USE (Check One Box) Monitoring ❑ Municipal/Public ❑
Industrial/Commercial ❑ Agricultural ❑ Recovery ❑ Injection ❑
Irrigation❑ Other N((list use) Closed Loop Geothern
DATE DRILLED 9-21 -11
4. WELL LOCATION:
1166 lotla Church Rd
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
CITY: Franklin COUNTY Macon
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
❑Slope ❑Valley Flat []Ridge []Other
KoI$TCD 36 inAAA&AAAAAAAAI CL R OR 3XK XXXX9®WX CC
KNMFI$TCD75 iAAAA&AAAAAAAAI CL ROR 7X."7f1(X' oom CC
Latitude/longitude source: ❑GPS aopographic map
(location of well must be shown on a USGS topo map andattached to
this form if not using GPS)
5. FACILITY (Name of the business where the well is located.)
Macon Flementnry School
Facility Name Facility ID# (if applicable)
1166 lotla Church Rd
Street Address
Franklin NC 28734
City or Town State Zip Code
Macon County Government
Contact Name
Mailing Address
Franklin NC 28734
City or Town State Zip Code
Area code
Phone number
6. WELL DETAILS:
a. TOTAL DEPTH:_ 450'
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
d. TOP OF CASING IS i 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 Am Lift
f. DISINFECTION: Type HTC: Amount � /4 ca W--
: g. WATER ZONES (depth):
Topes_ Bottom_ Top Bottom
Top Bottom Top Bottom
Top Bottom Top Bottom
Thickness/
7. CASING: Depth Diameter Weight Material
Top 0 Bottoms Ft.
Top Bottom Ft.
Top Bottom Ft.
8. GROUT: Depth Material Method
Top 0 Bottom 89 Ft. bentonite pumped
Top 89 Bottom 450 Ft. washed stone poured
Top Bottom Ft.
9. SCREEN: Depth Diameter Slot Size Material
Top Bottom Ft. in. in.
Top Bottom Ft. in. in.
Top Bottom Ft. in. in.
10. SAND/GRAVEL PACK:
Depth Size
Top Bottom Ft.
Top Bottom Ft.
Top Bottom Ft.
11. DRILLING LOG
Material
: Top Bottom Formation Description
0 / 77
77 / 87
7 / 450
/
12. REMARKS:
easing Removed
Sand and Clay
Granite Casing Set
Granite
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
15A NCAC 2C, CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
RECORD PROVDEDTO E OWNER.
oc _9-21-11
SIGflATURE OF CERTIFIED WELL CONTRACTOR DATE
c. WATER LEVEL Below Top of Casing: 0 FT.
(Use "+" if Above Top of Casing) : RoDer L Williams
PER
: PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit within 30 days of completion to: Division of Water Quality Form /08
y p ty - Information Processing, Rev. 1/08
1617 Mail Service Center, Raleigh, NC 27699-161, Phone: [phone]

NONRESIDENTL4L
WELL CONSTRUCTION RECORD
44
North Carolina Department of Environment and Natural Resources- Division of Water Quality
`°•\`hY p,4k;,a '. -'
WELL CONTRACTOR CERTIFICATION # 3065 A
1. WELL CONTRACTOR:
Roaer L Williams
Well Contractor (Individual) Name
Tarheel Water Treatmant
Well Contractor Company Name
3494 Georaia Rd
Street Address
Franklin NC 28734
City or Town State Zip Code
8( 28 ) 369-0740
Area code Phone number
2. WELL INFORMATION:
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): 0 METHOD OF TEST Ai I lft
f. DISINFECTION: Type HT(' Amount— /Q c;
g. WATER ZONES (depth):
Top_0 Bottoms Top Bottom
Top Bottom Top Bottom
Top Bottom Top Bottom
Thickness/
7. CASING: Depth Diameter Weight Material
WELL CONSTRUCTION PERMIT# W 10100141 : Top O Bottom_ Ft.
OTHER ASSOCIATED PERMIT#(if applicable) Top Bottom Ft.
SITE WELL ID #(ifapplicable) D-7 Top Bottom Ft.
3. WELL USE (Check One Box) Monitoring ❑ Municipal/Public ❑ : 8. GROUT: Depth Material Method
Industrial/Commercial ❑ Agricultural ❑ Recovery ❑ Injection ❑
Irrigation❑ Other M((list use) Closed Loon Geotherd
DATE DRILLED 9-20-1 1
4. WELL LOCATION:
1166 lotla Church Rd
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
CITY: Franklin COUNTY Macon
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
❑ Slope ❑ Valley Flat ❑ Ridge ❑ Other -
Ktgt$TCD 36 Ii�AAA&AAAAAAAAI CL R OR 3X0XXXX00N X CC
KNMFI$TCD75 1AAAA&AAAAAAAAI CLROR 71X!X'X'kXxxxxx CC
Latitude/longitude source: ❑GPS Oropographic map
(location of well must be shown on a USGS topo map andattached to
this form if not using GPS)
S. FACILITY (Name of the business where the well is located.)
Macon Elementary School
Facility Name Facility ID# (if applicable)
1166 lotla Church Rd
Street Address
Franklin NC 28734
City or Town State Zip Code
Macon County Government
Contact Name
Mailing Address
Franklin NC 28794
City or Town State Zip Code
Area code
Phone number
6. WELL DETAILS:
a. TOTAL DEPTH:-450'
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO q/
Topes( _ Bottom 82_ Ft. bentonite pumped
Top 89 Bottom 450 Ft. washed stone poured
Top Bottom Ft.
9. SCREEN: Depth Diameter Slot Size Material
Top Bottom Ft. in
Top Bottom Ft. in
Top Bottom Ft. in
10. SAND/GRAVEL PACK:
Depth Size
Top Bottom Ft.
• Top Bottom Ft.
: Top Bottom Ft.
11. DRILLING LOG
in.
in.
in.
Material
Top Bottom Formation Description
0 / 74
74 / 87
87 / 450
12. REMARKS:
Sand and Clay
Granite Casing Set
Granite
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
15A NCAC 2C L CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
RECORD B N PROVID TO THE ELL OW ER.
SI NAT E O CERTIFIED WELL CONTRACTOR ��
c. WATER LEVEL Below Top of Casing: 0 FT. Roder L Williams
(Use "+^ if Above Top of Casing) : PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit within 30. days of completion to: Division of Water Quality - Information Processing, Form Rev. 1 /08 /08
1617 Mail Service Center, Raleigh, NC 27699-161, Phone : [phone]

=yam STA1Fo+.i`M'A NONRESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- DiNrision of Water Quality
WELL CONTRACTOR CERTIFICATION # 3065 A
1. WELL CONTRACTOR:
Roger L Williams
Well Contractor (Individual) Name
Tarheel Water Treatmant
Well Contractor Company Name
3494 Georgia Rd
Street Address
Franklin NC 28734
City or Town State Zip Code
8( 28 ) 369-0740
Area code Phone number
2. WELL INFORMATION:
WELL CONSTRUCTION PERMIT# W 10100141
OTHER ASSOCIATED PERMIT#(if applicable)
SITE WELL ID #(if applicable) D-8
3. WELL USE (Check One Box) Monitoring ❑ Municipal/Public ❑
Industrial/Commercial ❑ Agricultural ❑ Recovery ❑ Injection ❑
Irrigation❑ Other t((list use) Closed LooD Geotherld
DATE DRILLED 9-16-1 1
4. WELL LOCATION:
1166 lotla Church Rd
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
CITY:.Franklin COUNTY Macon
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
❑Slope ❑Valley JJFlat ❑R!dge []Other
K0I$TCD 36 IAAAA&AAAAAAAA! CL R OR 3X( Xl[D('X100= CC
KNMFBTCD75 1AAAA&AAAAAAAA! CL ROR 7Tk.)kx7fX9(90t'X` CC
Latitudeflongitude source: DGPS Oropographic map
(location of well must be shown on a USGS topo map andattached to
this form if not using GPS)
5. FACILITY (Name of the business where the well is located.)
Macon Flementnry School
Facility Name Facility ID# (if applicable)
_1166 lotla Church Rd
Street Address
Franklin NC 28734
City or Town State Zip Code
Macon County GovPrnm .nt
Contact Name
Mailing Address
Franklin NC 98734
City or Town State Zip Code
Area code
Phone number
6. WELL DETAILS:
a. TOTAL DEPTH: 4501
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO B/
d. TOP OF CASING IS 2 FT. Above Land Surface*
'Top of casing terminated attor below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): 100 METHOD OF TEST_Alr Llft
f. DISINFECTION: Type HTC; Amount 1 /_4 Ct to
: g. WATER ZONES (depth):
Top 260•_ Bottom 261 Top Bottom
Top Bottom Top Bottom
;Top Bottom Top Bottom
Thickness/
7. CASING: Depth Diameter Weight Material
Top 0 Bottom 84 Ft.
Top Bottom Ft.
Top Bottom Ft.
: 8. GROUT: Depth Material Method
Top O Bottom 59 Ft. bentonite pumped
Top_Bg _ Bottom 450 Ft. washed stone poured
Top Bottom Ft.
9. SCREEN: Depth Diameter Slot Size Material
Top Bottom Ft. in.
Top Bottom Ft. in.
Top Bottom Ft. in.
10. SAND/GRAVEL PACK:
Depth Size
Top Bottom Ft.
Top Bottom Ft.
Top Bottom Ft.
: 11. DRILLING LOG
in.
in.
in.
Material
: Top Bottom Formation Description
0 / 80
80 / 87
87 / 450
12. REMARKS:
Sand and Clay
Granite Casino Set
Granite
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
15A NCAC 2C, CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
RECORD HA E PROVIDED TO TH E OWNER.
D� _9-16-11
SIGRATUREE OF CERTIFIED WELL CONTRACTOR DATE
c. WATER LEVEL Below Top of Casing: 50 FT. : _ ROsjer L WIIIIamS
(Use "+" if Above Top of Casing) : PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit within 30 days of completion to: Division of Water Quality Form /08
Y P ty : Information Processing, Rev. 1/08
1617 Mail Service Center, Raleigh, NC 27699-161, Phone: [phone]

NONRESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 3065 A
1. WELL CONTRACTOR:
Roaer L Williams
Well Contractor (Individual) Name
Tarheel Water Treatmant
Well Contractor Company Name
3494 Georgia Rd
Street Address
Franklin NC 28734
City or Town State Zip Code
8c 28 ) 369-0740
Area code Phone number
2. WELL INFORMATION:
WELL CONSTRUCTION PERMIT# WI0100141
OTHER ASSOCIATED PERMIT#(if applicable)
SITE WELL ID #(if applicable) E-1
3. WELL USE (Check One Box) Monitoring ❑ Municipal/Public ❑
Industrial/Commercial ❑ Agricultural ❑ Recovery ❑ Injection ❑
Irrigation❑ Other p{(Iist use) Closed LoOD Geothere
DATE DRILLED 10-18-1 1
4. WELL LOCATION:
1166 lotla Church Rd
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
CITY: Franklin COUNTY Macon
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
❑Slope []Valley VFW ❑Ridge ❑Other
KNISTCD 36 IAAAA&AAAAAAAAI CL R OR 3XOXXXX90MX CC
KNIv1FISTCD75 1AAAA&AAAAAAAAI CLROR 7X.Wkxn10ft CC
Latitudefiongitude source: ❑GPS aopographic map
(location of well must be shown on a USGS topo map andattached to
this form if not using GPS)
5. FACILITY (Name of the business where the well is located.)
_ Macon Flementary School
Facility Name Facility ID# (if applicable)
1166 lotla Church Rd
Street Address
Franklin NQ 28734
City or Town State Zip Code
Macon County Government
Contact Name
Mailing Address
Franklin NC' 28734
City or Town State Zip Code
Area code Phone number
6. WELL DETAILS:
a. TOTAL DEPTH: 4501
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO q/
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 15A NCAC 2C .0118.
e. YIELD (gpm): 10 METHOD OF TEST_Air I ift
f. DISINFECTION: Type HTC Amount, 1 /4 �
g. WATER ZONES (depth):
Top 210 Bottom 212 Top Bottom
Top Bottom Top Bottom
Top Bottom Top Bottom
Thickness/
: 7. CASING: Depth Diameter Weight Material
Top 0 Bottom 84 Ft.
Top Bottom Ft.
Top Bottom Ft.
8. GROUT:
Depth
Material Method
Top 0
Bottom.$9
Ft. bentonite pumped
Top 89
Bottom 450
Ft,
washed stone poured
Top
Bottom
Ft.
9. SCREEN:
Depth
Diameter
Slot Size Material
Top
Bottom
Ft.
in. in.
Top
Bottom
Ft.
in. in. T_
Top
Bottom
Ft.
in. in.
10. SAND/GRAVEL PACK:
Depth
Size Material
: Top
Bottom
Ft.
Top
Bottom
Ft.
Top
Bottom
Ft.
: 11. DRILLING LOG
: Top Bottom Formation Description
0 / 79
79 / 84
84 / 450
12. REMARKS:
Sand and Clay
Granite Casino Set
Granite
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
• 15A NCAC 2C ILL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
RECORD VKS W EN PRO IDED TO T 1`W .k NER.
c 10-18-11
SI AT E 6F CERTIFIED WELL CONTRACTOR DATE
c. WATER LEVEL Below Top of Casing: -50 FT. : __Roger L Williams
(Use "+" if Above Top of Casing) : PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit within 30 days of completion to: Division of Water Quality Form /08
Y p ty - Information Processing, Rev. 1108
1617 Mail Service Center, Raleigh, NC 27699-161, Phone : [phone]

NONRESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 3065 A
1. WELL CONTRACTOR:
Roger L Williams
Well Contractor (Individual) Name
Tarheel Water Treatmant
Well Contractor Company Name
3494 Georaia Rd
Street Address
Franklin NC 28734
City or Town State Zip Code
8r 28 369-0740
Area code Phone number
2. WELL INFORMATION:
WELL CONSTRUCTION PERMIT# W101 00 141
OTHER ASSOCIATED PERMIT#(if applicable)
SITE WELL ID #(if applicable) E-2
3. WELL USE (Check One Box) Monitoring ❑ Municipal/Public ❑
Industrial/Commercial ❑ Agricultural ❑ Recovery ❑ Injection ❑
Irrigation[:] Other W(list use) Closed LooD Geotherd
DATE DRILLED 10-17-1 1
4. WELL LOCATION:
1166 lotla Church Rd
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
CITY: Franklin COUNTY Macon
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
❑Slope ❑Valley Flat ❑Ridge ❑Other
K,of$TCD 36 iAAAA&AAAAAAAAI CL ROR 3&X7t X00WX CC
KNMFI$TCD75 1AAAA&AAAAAAAAI CLROR 7X!X'X`XMmft CC
Latitudegongitude source: ❑3PS aopographic map
(location of well must be shown on a USGS topo map andattached to
this form if not using GPS)
5. FACILITY (Name of the business where the well is located.)
Macon Flementary School
Facility Name Facility ID# (if applicable)
1166 lotla Church Rd
Street Address
Franklin NC 28734
City or Town State Zip Code
Macon County Government
Contact Name
Mailing Address
Franklin NC 28734
City or Town State Zip Code
Area code
Phone number
6. WELL DETAILS:
a. TOTAL DEPTH: 450'
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO q/
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 15A NCAC 2C .0118.
e. YIELD (gpm): 60 METHOD OF TEST_Alr Lift
f. DISINFECTION: Type HTC Amount- /4 CI t —
g. WATER ZONES (depth):
:Top 210 Bottom 212 Top Bottom
Top 330 Bottom 332 Top Bottom
Top Bottom Top Bottom
Thickness/
7. CASING: Depth Diameter Weight Material
Top 0 Bottom 84 Ft.
Top Bottom Ft.
Top Bottom Ft.
8. GROUT: Depth Material Method
Top 0 Bottom 89 Ft. bentonite pumped
Top,$2_ Bottom 450 Ft. washed stonE poured
Top Bottom Ft.
9. SCREEN: Depth Diameter Slot Size Material
Top Bottom Ft. in. in.
Top
Bottom
Ft. in.
Top
Bottom
Ft. in.
10. SAND/GRAVEL PACK:
Depth
Size
Top
Bottom
Ft.
: Top
Bottom
Ft.
: Top
Bottom
Ft.
: 11. DRILLING LOG
Top
Bottom
0
/ 75
75
181
81
/ 450
12. REMARKS:
in.
in.
Material
Formation Description
Sand and Clay
Granite Casing Set
Granite
easing Removed
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
15A NCAC 2C, W CONSTRUCTION S ANDARDS, AND THAT A COPY OF THIS
RECORD H E ! PROVI ED TO T E NER.
0 10-17-11
SIGNATUAE OF CERTIFIED WELL CONTRACTOR DATE
c. WATER LEVEL Below Top of Casing: 50 FT. : Rosjer L Williams
(Use "+" if Above Top of Casing) : PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit within 30 days of completion to: Division of Water Quality Form GW-1 b
y p ty - Information Processing, Rev. 1/08
1617 Mail Service Center, Raleigh, NC 27699-161, Phone : [phone]

''era STATf�
NONRESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 3065 A
1. WELL CONTRACTOR:
Roger L Williams
Well Contractor (Individual) Name .
Tarheel Water Treatmant
Well Contractor Company Name
3494 Georaia Rd
Street Address
Franklin NC 28734
City or Town State Zip Code
8( 28 ) 369-0740
Area code Phone number
2. WELL INFORMATION:
WELL CONSTRUCTION PERMIT# W101 00 141
OTHER ASSOCIATED PERMIT#(if applicable)
SITE WELL ID #(if applicable) E-3
3. WELL USE (Check One Box) Monitoring ❑ Municipal/Public ❑
Industrial/Commercial ❑ Agricultural ❑ Recovery ❑ Injection ❑
Irrigation❑ Other It((list use) Closed Loon Geothern
DATE DRILLED 10-14-1 1
4. WELL LOCATION:
1166 lotla Church Rd
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
CITY: Franklin COUNTY Macon
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
❑Slope []Valley Flat ❑Ridge ❑Other
K01$TCD 36 iAAAA&AAAAAAAAI CL R OR 3X( XXX P101XXX CC
KNMFI$TCD75 iAAAABAAAAAAAAI CLROR 7&")tD(X)W CC
Latitude/longitude source: ❑GPS Qropographic map
(location of well must be shown on a USGS topo map andattached to
this form if not using GPS)
5. FACILITY (Name of the business where the well is located.)
Macon Elementary School
Facility Name Facility ID# (if applicable)
1166 lotla Church Rd
Street Address
Franklin NC 28734
City or Town State Zip Code
Macon County Government
Contact Name
Mailing Address
Franklin NC 28734
City or Town State Zip Code
Area code Phone number
6. WELL DETAILS:
a. TOTAL DEPTH:—450'
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO qI
d. TOP OF CASING IS 2 FT. Above Land Surface`
'Top of casing terminated atior below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): 60 METHOD OF TEST Air Ift
f. DISINFECTION: Type HTC: Amount I /4 CaW—
g. WATER ZONES (depth):
Top 332 Bottom- 334 Top Bottom
Top Bottom Top Bottom
Top Bottom Top Bottom
Thickness/
7. CASING: Depth Diameter Weight Material
Top 0 Bottom$_ Ft.
Top Bottom Ft.
Top Bottom Ft.
8. GROUT: Depth Material Method
Top 0 Bottom. 89 Ft. bentonite pumped
Top 89 Bottom 450 Ft. washed stone poured
Top Bottom Ft.
9. SCREEN: Depth Diameter Slot Size Material
Top Bottom Ft. in. in.
Top Bottom Ft. in. in.
Top Bottom Ft. in. in.
10. SAND/GRAVEL PACK:
Depth Size
Top Bottom Ft.
Top Bottom Ft.
: Top Bottom Ft.
11. DRILLING LOG
Material
: Top Bottom Formation Description
0 / 75
75 / 81
8181 / 450
/
/
12. REMARKS:
Sand and Clay
Granite Casing Set
Granite
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
• 15A NCAC 29L CONSTRUCTIOpI STANDARDS, AND THAT A COPY OF THIS
RECORDHAS BEEN PROYJDED TO HE WE14. OWNER.
10-1.4
SIGNATORE OF CERTIFIED WELL CONTRACTOR DATE
C. WATER LEVEL Below Top of Casing: 5n FT. : ROCJer L WIIIIamS
(Use "+" if Above Top of Casing) : PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit within 30 days of completion to: Division of Water Quality Form /08
y p ty - Information Processing, . Rev. 1/08
1617 Mail Service Center, Raleigh, NC 27699-161, Phone: [phone]

NONRESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 3065 A
1. WELL CONTRACTOR:
Roger L Williams
Well Contractor (Individual) Name
Tarheel Water Treatmant
Well Contractor Company Name
3494 Georaia Rd
Street Address
Franklin NC 28734
City or Town State Zip Code
8( 28 1 369-0740
Area code Phone number
2. WELL INFORMATION:
WELL CONSTRUCTION PERMIT# W 10100141
OTHER ASSOCIATED PERMIT#(ifapplicable)
SITE WELL ID #(if applicable) E-4
3. WELL USE (Check One Box) Monitoring ❑ Municipal/Public ❑
Industrial/Commercial ❑ Agricultural ❑ Recovery ❑ Injection ❑
Irrigation❑ Other [+(list use) Closed LoOD Geothero
DATE DRILLED-1 0-6-11
4. WELL LOCATION:
1166 lotla Church Rd
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
CITY: Franklin COUNTY Macon
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
❑Slope ❑Valley VFW ❑Ridge ❑Other
K01$TCD 36 iAAAA&AAAAAAAAI CL R OR.3mXXXX90(9PkX CC
KNMF BTCD 75 1AAAA&AAAAAAAA! CL R OR 7`x.')cx xxxooty CC
Latitude/longitude source: ❑GPS []Topographic map
(location of well must be shown on a USGS topo map andattached to
this form if not using GPS)
5. FACILITY (Name of the business where the well is located.)
Macon Flementary School
Facility Name Facility ID# (if applicable)
1166 lotla Church Rd
Street Address
Franklin NC 28734
City or Town State Zip Code
Macon County Government
Contact Name
Mailing Address
Franklin NC 28734
City or Town State Zip Code
Area code
Phone number
6. WELL DETAILS:
a. TOTAL DEPTH: 4501
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO qI
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 15A NCAC 2C .0118.
e. YIELD (gpm): 0 METHOD OF TEST Alr Ift
f. DISINFECTION: Type HTC Amount 1/4 G112
g. WATER ZONES (depth):
Top 0 Bottom_ Top Bottom
Top Bottom Top Bottom
Top Bottom Top Bottom
Thickness/
7. CASING: Depth Diameter Weight Material
TopQ_ Bottom 84 Ft.
Top Bottom Ft.
Top Bottom Ft.
8. GROUT: Depth Material Method
Top 0 Bottom- 89 _ Ft. bentonite pumped
Top 89 Bottom 450 Ft. washed stone poured
Top Bottom Ft.
9. SCREEN: Depth Diameter Slot Size Material
Top Bottom Ft. in. in.
Top Bottom Ft. in. in.
Top Bottom Ft. in. in.
10. SAND/GRAVEL PACK:
Depth Size
Top Bottom Ft.
Top Bottom Ft.
Material
Top Bottom Ft.
11. DRILLING LOG
Top Bottom Formation Description
0 / 80
80 / 87
8/ 450
Sand and Clay
Granite Casing Set
Granite
12. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
• 15A NCAC 2C_W4LL CONSTRUCTION ST DARDS, AND THAT A COPY OF THIS
RECORD Pt BAN PROVID TO THE EL ER
10-6-11
SI AT RE OF CERTIFIED WELL CONTRACTOR DATE
c. WATER LEVEL Below Top of Casing: 0 FT. ; Roger L Wlllla ms
(Use "+" if Above Top of Casing) : PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit within 30 days of completion to: Division of Water Quality - Information Processing, Form GW-1b
Rev. 1 /08
1617 Mail Service Center, Raleigh, NC 27699-161, Phone : [phone]

NONRESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 3065 A
1. WELL CONTRACTOR:
Roger L Williams
Well Contractor (Individual) Name
Tarheel Water Treatmant
Well Contractor Company Name
3494 Georaia Rd
Street Address
Franklin NC 28734
City or Town State Zip Code
8( 28 ) 369-0740
Area code Phone number
2. WELL INFORMATION:
WELL CONSTRUCTION PERMIT# W 10100141
OTHER ASSOCIATED PERMIT#(if applicable)
SITE WELL ID #(if applicable) E-5
3. WELL USE (Check One Box) Monitoring ❑ Municipal/Public ❑
Industrial/Commercial ❑ Agricultural ❑ Recovery ❑ Injection ❑
Irrigation❑ Other N((list use) Closed Loop Geotherd
DATE DRILLED 10-5-1 1
4. WELL LOCATION:
1166 lotla Church Rd
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
CITY: Franklin COUNTY Macon
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
❑Slope []Valley I(Flat ❑Ridge []Other
KOBTCD 36 1AAAA&AAAAAAAAI CL R OR 3X( XXXrXOOrXJl9Q CC
KNMFMTCD75 1AAAA&AAAAAAAAI CL ROR 71X.,)=Jt3C9C9w CC
Latitude/longitude source: OGPS Qropographic map
(location of well must be shown on a USGS topo map andattached to
this form if not using GPS)
5. FACILITY (Name of the business where the well is located.)
Macon Elementary School
Facility Name Facility ID# (if applicable)
1166 lotla ChLlrch Rd
Street Address
Franklin NC 28734
City or Town State Zip Code
Macon County Government
Contact Name
Mailing Address
Franklin NC 28734
City or Town State Zip Code
I-)
Area code
Phone number
6. WELL DETAILS:
a. TOTAL DEPTH: 450'
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO qI
c. WATER LEVEL Below Top of Casing: 0 FT
(Use"+^ if Above Top of Casing)
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 15A NCAC 2C .0118.
e. YIELD (gpm): 0 METHOD OF TEST Air ff
f. DISINFECTION: Type HTC Amount 1 /4 "Ito
g. WATER ZONES (depth):
TopQ_ Bottom_ Top Bottom
Top Bottom Top Bottom
Top Bottom Top Bottom
Thickness/
7. CASING: Depth Diameter Weight Material
Top 0 Bottom Ft.
Top Bottom Ft._
Top Bottom Ft.
: 8. GROUT:
Depth
Material Method
Top 0
Bottom 89
Ft. bentonite pumped
Top 89
Bottom 450
Ft. washed stone poured
Top
Bottom
Ft.
9. SCREEN:
Depth
Diameter Slot Size Material
Top
Bottom
Ft. in. in.
Top
Bottom
Ft. in. in.
Top
Bottom
Ft. in. in.
10. SAND/GRAVEL PACK:
Depth
Size Material
Top
Bottom
Ft.
Top
Bottom
Ft.
Top
Bottom
Ft.
11, DRILLING LOG
Top Bottom
0 / 77
77 / 84
_ 4 / 450
Formation Description
Sand and Clay
Granite Casing Set
Granite
12. REMARKS:
I DO HEREBY CERTIFYTHAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
75A NCAC 2C, L CONSTRUCTION
EL RDS, AND THAT A COPY OF THIS
TO
: RECORD B N PRO DED TO TH EL O NER.
SI NA RE OF CERTIFIED WELL CONTRACTOR ,0D E
: PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit within 30 days of completion to: Division of Water Quality - Information Processing, Form GW-1b
Rev. 1l08
1617 Mail Service Center, Raleigh, NC 27699-161, Phone: [phone]

�`ra 51'ArFo�y,
3
NONRESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 3065 A
1. WELL CONTRACTOR:
Roger L Williams
Well Contractor (Individual) Name
Tarheel Water Treatmant
Well Contractor Company Name
3494 Georgia Rd -
Street Address
Franklin NC 28734
City or Town State Zip Code
8c 28 ) 369-0740
Area code Phone number
2. WELL INFORMATION:
WELL CONSTRUCTION PERMIT# WI0100141
OTHER ASSOCIATED PERMIT#(if applicable)
SITE WELL ID #(if applicable) E-6
3. WELL USE (Check One Box) Monitoring ❑ Municipal/Public ❑
Industrial/Commercial ❑ Agricultural ❑ Recovery ❑ Injection ❑
Irrigation❑ Other N((list use) Closed Loop Geotherd
DATE DRILLED-1 0-4-11
4. WELL LOCATION:
1166 lotla Church Rd
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
CITY: Franklin COUNTY Macon
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
[]Slope []Valley prFlat []Ridge []Other
KI3I$TCD 36 innnA&AAAAAAAAI CL ROR 3X^XI XXOOWX CC
KNMFI$TCD75 iAAAA&AAAAAAAA! CLROR CC
Latitude/longitude source: ❑GPS aopographic map
(location of well must be shown on a USGS topo map andattached to
this form if not using GPS)
5. FACILITY (Name of the business where the well is located.)
Macon FI m n ary Srhnni
Facility Name Facility ID# (if applicable)
1166 lotla Church Rd
Street Address
Franklin N C, 28734
City or Town State Zip Code
Macon County Government
Contact Name
Mailing Address
Franklin NC 28734
City or Town State Zip Code
�1
Area code
Phone number
6. WELL DETAILS:
a. TOTAL DEPTH:. 4501
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO pI
d. TOP OF CASING IS i 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): Q METHOD OF TEST_ ®Ir Lift
f. DISINFECTION: Type HTC: Amount 1 /4 CIM—
g. WATER ZONES (depth):
Top 0 Bottoms Top Bottom
Top Bottom Top Bottom
Top Bottom Top Bottom
Thickness/
7. CASING: Depth Diameter Weight Material
Top_ Bottom 84 Ft.
Top Bottom Ft.
Top Bottom Ft.
8. GROUT:
Depth
Material Method
Top 0
Bottom 89
Ft. bentonite pumped
Top 89
Bottom 450
Ft. washed stone poured
• Top
Bottom
Ft.
9. SCREEN:
Depth
Diameter Slot Size Material
Top
Bottom
Ft. in. in.
Top
Bottom
Ft. in. in.
Top
Bottom
Ft. in. in.
10. SAND/GRAVEL PACK:
Depth Size
Top
Bottom Ft.
Top
Bottom Ft.
Top
Bottom Ft.
11. DRILLING LOG
Top Bottom
0 180
80 / 87
87 / 450
/
: 12. REMARKS:
Material
Formation Description
Sand and Clay
Granite Casing Set
Granite
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
15A NCAC 2C ELL CONSTRUCTION ANDARDS, AND THAT A COPY OF THIS
RECORD 8 EN PRO DED TOT W WNER
10-4-11
SIGNATLIRE OF CERTIFIED WELL CONTRACTOR DATE
c. WATER LEVEL Below Top of Casing: 0 FT. Roger L williams
(Use "+" if Above Top of Casing) : PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit within 30 days of completion to: Division of Water Quality Form GW-1b
y p ty - Information Processing, Rev. 1/08
1617 Mail Service Center, Raleigh, NC 27699-161, Phone : (919) 807=6300

„s�'� SfATFpGy
�,ihk iwN VM1�:=A
NONRESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 3065 A
1. WELL CONTRACTOR:
Roger L Williams
Well Contractor (Individual) Name
Tarheel Water Treatmant
Well Contractor Company Name
3494 Georaia Rd
Street Address
Franklin NC 28734
City or Town State Zip Code
8t 28_) 369-0740
Area code Phone number
2. WELL INFORMATION:
WELL CONSTRUCTION PERMIT# W10100141
OTHER ASSOCIATED PERMIT#(if applicable)
SITE WELL ID #(if applicable) E-7
3. WELL USE (Check One Box) Monitoring ❑ Municipal/Public ❑
Industrial/Commercial ❑ Agricultural ❑ Recovery ❑ Injection ❑
Irrigation❑ Other N((list use) Closed LoOD Geothere
DATE DRILLED 10-3-1 1
4. WELL LOCATION:
1166 lotla Church Rd
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
cITY: Franklin COUNTY Macon
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
❑Slope ❑Valley Flat ❑Ridge []Other
K0I$TCD 36 iAAAA&AAAAAAAA! CL R OR 3)0X9 XX)0t9@ X CC
KNMFI$TCD75 iAAAA&AAAAAAAA! CL ROR 7x.WA)FX9(0W CC
Latitude/longitude source: i]GPS Qropographic map
(location of well must be shown on a USGS topo map andattached to
this form if not using GPS)
5. FACILITY (Name of the business where the well is located.)
_ Macon Elementary School
Facility Name Facility ID# (if applicable)
1166 lotla Church Rd
Street Address
Franklin NC 28734
City or Town State Zip Code
Macon County Government
Contact Name
Mailing Address
Franklin NG 28734
City or Town State Zip Code
Area code Phone number
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 15A NCAC 2C .0118.
e. YIELD (gpm): 2n METHOD OF TEST Air L Ift
f. DISINFECTION: Type HTC Amount
g. WATER ZONES (depth):
Top_250 Bottom252 Top Bottom
:Top Bottom Top Bottom
Top Bottom Top Bottom
Thickness/
7. CASING: Depth Diameter Weight Material
Top 0 Bottom 84 Ft.
Top Bottom Ft.
Top Bottom Ft.
: 8. GROUT: Depth Material Method
Top2_ Bottom 89 Ft. bentonite pumped
Top 899 Bottom 450 Ft. washed stone poured
Top Bottom Ft.
9. SCREEN: Depth Diameter Slot Size Material
Top Bottom Ft. in. in.
Top Bottom Ft. in. in.
Top Bottom Fte in. in.
: 10. SAND/GRAVEL PACK:
Depth Size
Top Bottom Ft.
Top Bottom Ft.
Top Bottom Ft.
11. DRILLING LOG
Top Bottom
0 / 80
80 / 87
_ 7 / 450
12. REMARKS:
leasing Removed
Material
Formation Description
Sand and Clay_
Granite Casing Set _
Granite
6. WELL DETAILS: ; I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
• 15A NCAC 2C LL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
a. TOTAL DEPTH: 450' -RECORD EN PROV ED EW WNER.
�c
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO : SIGNAT RE OF CERTIFIED WELL CONTRACTOR D1 ATE 1
c. WATER LEVEL Below Top of Casing: 50 FT. Roger L williams
(Use "+” if Above Top of Casing) : PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit within 30 days of completion to: Division of Water Quality - Information Processing, Form Rev. 1 /08 /08
1617 Mail Service Center, Raleigh, NC 27699-161, Phone : [phone]

NONRESIDENTL4L WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 3065 A
1. WELL CONTRACTOR:
Roger L Williams
Well Contractor (Individual) Name
Tarheel Water Treatmant
Well Contractor Company Name
.3494 Georgia Rd
Street Address
Franklin NC 28734
City or Town State Zip Code
8( 28 ) 369-0740
Area code Phone number
2. WELL INFORMATION:
WELL CONSTRUCTION PERMIT# W 10100141
OTHER ASSOCIATED PERMIT#(if applicable)
SITE WELL ID #(if applicable) E-8A
3. WELL USE (Check One Box) Monitoring ❑ Municipal/Public ❑
Industrial/Commercial ❑ Agricultural ❑ Recovery ❑ Injection ❑
Irrigation❑ Other W(Iist use) Closed Loop Geothero
DATE DRILLED 9-30-1 1
4. WELL LOCATION:
1166 lotla Church Rd
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
CITY: Franklin COUNTY Macon
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
❑ Slope ❑ Valley elat []Ridge []Other
K0ISTCD 36 IAAAA&AAAAAAAAI CL R OR 3X^X)ri(XNXXXX CC
KNMFPBTCD75 iAAAA&AAAAAAAAI CL ROR 7`X..WX>tXA0W CC
Latitude/longitude source: ❑GPS Qropographic map
(location of well must be shown on a USGS topo map andattached to
this form if not using GPS)
5. FACILITY (Name of the business where the well is located.)
Macon Elementary School
Facility Name Facility ID# (if applicable)
1166 lotla Church Rd
Street Address
Franklin NQ 28734
City or Town State Zip Code
Macon County Govemment
Contact Name
Mailing Address
Franklin NC 28724
City or Town State Zip Code
Area code Phone number
6. WELL DETAILS:
a. TOTAL DEPTH:_2701
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO q/
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 15A NCAC 2C .0118.
e. YIELD (gpm): 200 METHOD OF TEST Alr I Ift
f. DISINFECTION: Type {-ITC Amount 'I 4 CIW­
g. WATER ZONES (depth):
Topes Bottom 262 Top Bottom
Top Bottom Top Bottom
Top Bottom Top Bottom
Thickness/
7. CASING: Depth Diameter Weight Material
Top 0 Bottom_ Ft.
Top Bottom Ft.
Top Bottom Ft.
:8. GROUT: Depth Material Method
Top 0 Bottom-89 Ft. bentonite pumped
Top 89 Bottom _2Z9 Ft. washed stone poured
Top Bottom Ft.
: 9. SCREEN: Depth Diameter Slot Size Material
Top Bottom Ft. in. in.
Top Bottom Ft. in. in.
Top Bottom Ft. in. in.
10. SAND/GRAVEL PACK:
Depth Size
: Top Bottom Ft.
Top Bottom Ft.
Top Bottom Ft.
11. DRILLING LOG
Top Bottom
0 / 82
82 / 87
87 450
12. REMARKS:
Material
Formation Description
Sand and Clay
Granite Casing Set
Granite
easing Removed
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
• 15A NCAC 2C LL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
RECORD S EN PIRPOPED TOT E OWNER.
9-30-11
SIGNA110RE OF CERTIFIED WELL CONTRACTOR DATE
c. WATER LEVEL Below Top of Casing: 50 FT.
Ro6er L Williams
(Use "+•• if Above Top of Casing) : PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit within 30 days of completion to: Division of Water Form
y p Quality - Information Processing, Rev. 1/0808
1617 Mail Service Center, Raleigh, NC 27699-161, Phone : [phone]

-, raSrAlFn 4.
r�
1 r ONRESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 3065 A
1. WELL CONTRACTOR:
Roger L Williams
Well Contractor (Individual) Name
Tarheel Water Treatment
Well Contractor Company Name
3494 Georaia RD
Street Address
Franklin NC 28734
City or Town State Zip Code
8( 28 ) 369-0740
Area code Phone number
2. WELL INFORMATION:
WELL CONSTRUCTION PERMIT# W l0100141
OTHER ASSOCIATED PERMIT#(if applicable)
SITE WELL ID #(if applicable) E-813
3. WELL USE (Check One Box) Monitoring ❑ Municipal/Public ❑
Industrial/Commercial ❑ Agricultural ❑ Recovery ❑ Injection ❑
Irrigation❑ Other M((list use) Closed IOOD Geotherre
DATE DRILLED 10-25-11
4. WELL LOCATION:
1166 Lotla Church Rd
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
CITY: Franklin COUNTYMacon
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
❑Slope []Valley Flat ❑Ridge ❑Other
KOISTCD 36 IAAAA&AAAAAAAAI CL R OR 3X^Xxxxoamx CC
KNMFI$TCD 75 iAAAABAAAAAAAAI CL R OR 71xxxxxXXA Xx CC
Latitude/longitude source: ❑GPS OTopographic map
(location of well must be shown on a USGS topo map andattached to
this form if not using GPS)
S. FACILITY (Name of the business where the well is located.)
Macon Elementary
Facility Name Facility ID# (if applicable)
1166 Lotla Church Rd
Street Address
Franklin NC 28734
City or Town State Zip Code
Macon County Government
Contact Name
Mailing Address
Franklin NC
28743
City or Town State
Zip Code
L-)
Area code Phone number
S. WELL DETAILS:
a. TOTAL DEPTH: 165
b. DOES WELL REPLACE EXISTING WELL? YES ❑
NO qI
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.
: e. YIELD (gpm): METHOD OF TEST l3kW DOWn
f. DISINFECTION: Type HTC Amount 1 i o7
g. WATER ZONES (depth):
Top Bottom Top Bottom
Top Bottom Top Bottom
Top Bottom Top Bottom
Thickness/
7. CASING: Depth Diameter Weight Material
Top 0 Bottom 95 Ft.
Top Bottom Ft.
Top Bottom Ft.
8. GROUT: Depth - Material Method
Top 0 Bottom 100 Ft. Bentonite Pumped
:Top 100 Bottom 165 Ft. washed stone poured
Top Bottom Ft,
9. SCREEN: Depth Diameter Slot Size Material
Top Bottom Ft. in. in.
Top Bottom Ft. in. in.
Top Bottom Ft. in. in.
10. SAND/GRAVEL PACK:
Depth Size Material
Top Bottom Ft.
Top Bottom Ft.
Top Bottom Ft.
11. DRILLING LOG
Top Bottom
0 / 95
95 / 165
/
Formation Description
Sand Clay
Soft Granite
12. REMARKS:
easing Removed
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
15A NCAC 2C, LL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
RECORD NPRO DTOT OWNER.
d 10-26-11
SI NAT RE OF CERTIFIED WELL CONTRACTOR DATE
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit within 30 days of completion to: Division of Water Quality = Information Processing, Form Rev. 1 /08 /08
1617 Mail Service Center, Raleigh, NC 27699-161, Phone: [phone]

NONRESIDENTIAL
WELL CONSTRUCTION RECORD
North Carolina Department Environment Natural Resources-
f
of and Division of Water Quality
ry
WELL CONTRACTOR CERTIFICATION # 3065 A
1. WELL CONTRACTOR:
Roger L Williams
Well Contractor (Individual) Name
Tarheel Water Treatmant
Well Contractor Company Name
3494 Georaia Rd
Street Address
Franklin NC 28734
City or Town State Zip Code
8( 28 ) 369-0740
Area code Phone number
2. WELL INFORMATION:
: d. TOP OF CASING IS 0 FT. Above Land Surface -
*Top of casing terminated attor below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): 20 - METHOD OF TEST Alr Ift
f. DISINFECTION: Type HTC; Amount 1 /4 [:Its
: g. WATER ZONES (depth):
Top 240 Bottom 242 Top Bottom
Top Bottom Top Bottom
;Top Bottom Top Bottom
Thickness/
7. CASING: Depth Diameter Weight Material
WELL CONSTRUCTION PERMIT# W 10100141
: Top 0
Bottom 89
Ft. _
OTHER ASSOCIATED PERMIT#(if applicable)
Top
Bottom
Ft.
SITE WELL ID #(if applicable) F-1
; Top
Bottom
Ft. _
3. WELL USE (Check One Box) Monitoring ❑ Municipal/Public ❑
: 8. GROUT:
Depth
Material
Industrial/Commercial ❑ Agricultural ❑ Recovery [I Injection ❑
: Top 0
Bottom 94
Ft. bentonite
Irrigation❑ Other ii(rst use) Closed LOOD Geothere
Top 94
Bottom 450
Ft._ washed stone
DATE DRILLED 1 1-3-1 1
; Top
Bottom
Ft.
4. WELL LOCATION:
1166 lotla Church Rd
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
CITY: Franklin COUNTY Macon
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
❑Slope ❑Valley VFW ❑Ridge ❑Other
K0I$TCD 36 iAAAA&AAAAAAAAI CL R OR 3)(^XXX'X90(9 X CC
KNMFI$TCD75 1AAAA&AAAAAAAAI CL ROR 71)uAw)F7(9Cow CC
Latitude/longitude source: (]GPS ❑topographic map
(location of well must be shown on a USGS topo map andattached to
this form if not using GPS)
5. FACILITY (Name of the business where the well is located.)
_ Macon Elementary School
Facility Name Facility ID# (if applicable)
1166 lotla Church Rd
Street Address
Franklin NC 28714
City or Town State Zip Code
Macon County Government
Contact Name
Mailing Address
Franklin NC 28734
City or Town State Zip Code
U
Area code Phone number
6. WELL DETAILS:
a. TOTAL DEPTH: 450'
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO qI
c. WATER LEVEL Below Top of Casing: 50 FT.
(Use "+^ if Above Top of Casing)
Method
umoed
poured
9. SCREEN: Depth Diameter Slot Size Material
Top Bottom Ft. in. in.
Top Bottom Ft. in. in.
Top Bottom Ft. in. in.
10. SAND/GRAVEL PACK:
Depth Size
Top Bottom Ft.
Top Bottom Ft.
Top Bottom Ft.
11. DRILLING LOG
Top Bottom
0 / 84
84 / 89
_89/ 450
/
: 12. REMARKS:
Material
Formation Description
Sand and Clay
Granite Casina set
Granite
easing Removed
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
• 15A NCAC 2C, L CONSTRUCTION STPINDARDS, AND THAT A COPY OF THIS
RECORD BfIN PR OV O TO TH E NER
SIONATYRE OF CERTIFIED WELL CONTRACTOR 1 DATE
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit within 30 days of completion to: Division of Water Quality - Information Processing, Form Rev. 1/OS/08
1617 Mail Service Center, Raleigh, NC 27699-161, Phone : [phone]

=-_-�ou SrATp44�
NONRESIDENTIAL
S
WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
^�
WELL CONTRACTOR CERTIFICATION # 30tS5 A
1. WELL CONTRACTOR:
Roaer L Williams
Well Contractor (Individual) Name
Tarheel Water Treatmant
Well Contractor Company Name
3494 Georaia Rd
Street Address
Franklin NC 28734
City or Town State Zip Code
8t 28 ) 369-0740
Area code Phone number
2. WELL INFORMATION:
WELL CONSTRUCTION PERMIT# Wl0100141
OTHER ASSOCIATED PERMIT#(if applicable)
SITE WELL ID #(if applicable) F-2
3. WELL USE (Check One Box) Monitoring ❑ Municipal/Public ❑
Industrial/Commercial ❑ Agricultural ❑ Recovery ❑ Injection ❑
Irrigation❑ Other I41ist use) Closed Loop Geother©
DATE DRILLED 1 1-1-1 1
4. WELL LOCATION:
1166 lotla Church Rd
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
CITY: Franklin COUNTY Macon
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
pSlope ❑Valley VFW []Ridge ❑Other
KOISTCD 36 IAAAA&AAAAAAAA! CL ROR 3X^XXDXX*) 7i CC
KNMF I$TCD 75 jAAAA&AAAAAAAA! CL R OR - 9A. X`XXD(9C)w CC
Latitude/longitude source: ❑GPS Qropographic map
(location of well must be shown on a USGS topo map andattached to
this form if not using GPS)
5. FACILITY (Name of the business where the well is located.)
Macon Elementary School
Facility Name Facility ID# (if applicable)
1166 lotla Church Rd
Street Address
Franklin NC; 28734
City or Town State Zip Code
Macon County Government
Contact Name
Mailing Address
Franklin NG 28734
City or Town State Zip Code
Area code
Phone number
6. WELL DETAILS:
a. TOTAL DEPTH:_ 450'
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO LTA
d. TOP OF CASING IS 0 FT. Above Land Surface -
'Top of casing terminated attor below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): 20 METHOD -OF TEST_Air l ift
L DISINFECTION: Type I -ITC; Amount /_ 4, (�� Irt
g. WATER ZONES (depth):
:Top 240 — Bottom 242 Top Bottom
: Top Bottom Top Bottom
Top Bottom Top Bottom
Thickness/
7. CASING: Depth Diameter Weight Material
Top 0 Bottom 89 Ft.
Top Bottom Ft.
Top Bottom Ft.
8. GROUT: Depth Material Method
Top 0 Bottom 94 Ft. bentonite -pumped
Top 94 Bottom 450 Ft. washed stont poured
Top Bottom Ft.
; 9. SCREEN: Depth Diameter Slot Size Material
Top Bottom Ft. in. in.
Top Bottom Ft. in. in.
Top Bottom Ft. in. in.
: 10. SAND/GRAVEL PACK:
Depth Size
Top
Bottom Ft.
Top
Bottom Ft.
: Top
Bottom Ft.
11. DRILLING LOG
Top Bottom
0 / 84
84
/ 89
89
1450
/
12. REMARKS:
Material
Formation Description
Sand and Clay
Granite Casino set
Granite
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
• 15A NCAC LL CONSTRUCTION ST DARDS, AND THAT A COPY OF THIS
: RECORD AS PROV D TO TH NER.
d� 11-1-11
SIGNAT E OF CERTIFIED WELL CONTRACTOR DATE
c. WATER LEVEL Below Top of Casing: _50 FT. ; RO{jer L WIIIIamS
(Use "+^ if Above Top of Casing) : PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit within 30 days of completion to: Division of Water Quality Form /08
y p ty - Information Processing, Rev. 1/08
1617 Mail Service Center, Raleigh, NC 27699-161, Phone : [phone]

•ate SrAt;va,�.
NONRESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 3065 A
1. WELL CONTRACTOR:
Roger L Williams
Well Contractor (Individual) Name
Tarheel Water Treatmant
Well Contractor Company Name
3494 Georoia Rd
Street Address
Franklin NC 28734
City or Town State Zip Code
8( 28 ) 369-0740
Area code Phone number
2. WELL INFORMATION:
d. TOP OF CASING IS n FT. Above Land Surface`
'Top of casing terminated attor below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): 10 METHOD OF TEST Air) Ift
f. DISINFECTION: Type HTC Amount 1 /4 CI1-
g. WATER ZONES (depth):
:Top 240 Bottom 242 Top Bottom
Top Bottom Top Bottom
Top Bottom Top Bottom
Thickness/
7. CASING: Depth Diameter Weight Material
WELL CONSTRUCTION PERMIT# W10100141
: Top 0
Bottom 89
Ft.
OTHER ASSOCIATED PERMIT#(if applicable)
Top
Bottom
Ft.
SITE WELL ID #(if applicable) F-3
; Top
Bottom
Ft.
3. WELL USE (Check One Box) Monitoring ❑ Municipal/Public ❑
; 8. GROUT:
Depth
Material Method
Industrial/Commercial ❑ Agricultural ❑ Recovery ❑ Injection ❑
: Top 0
Bottoms
Ft._bentonite pumped
Irrigation[] Other [d(list use) Closed Loop Geothere
Top_ 94
Bottom 450
Ft. Washed stonE _poured
DATE DRILLED-1 0-31 -11
;Top
Bottom
Ft.
4. WELL LOCATION:
1166 lotla Church Rd
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
CITY: Franklin COUNTY Macon
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
❑ Slope ❑ Valley 91Flat ❑ Ridge ❑ Other
K@3MTCD 36 IAAAA&AAAAAAAAI CL R OR 3X^XXiPi00WX CC
KNMFMTCD75 iAAAA&AAAAAAAA! CL ROR 7X3(9Ck)kXX)W CC
Latitude/longitude source: ❑GPS Qfopographic map
(location of well must be shown on a USGS topo map andaftached to
this form if not using GPS)
5. FACILITY (Name of the business where the well is located.)
Macon Elementary School
Facility Name Facility ID# (if applicable)
1166 lotla Church Rd
Street Address
Franklin NC 28734
City or Town State Zip Code
Macon County Government
Contact Name
Mailing Address
Franklin NC 287M
City or Town State Zip Code
Area code
Phone number
6. WELL DETAILS:
a. TOTAL DEPTH: 450'
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO qI
c. WATER LEVEL Below Top of Casing: _ 50 FT
(Use "+" if Above Top of Casing)
9. SCREEN: Depth
Diameter Slot Size Material
Top Bottom
Ft.
in. in.
Top Bottom
Ft.
in. in.
Top Bottom
Ft.
in. in.
10. SAND/GRAVEL PACK:
Depth
Size Material
Top Bottom
Ft.
Top Bottom
Ft.
Top Bottom
Ft.
11. DRILLING LOG
Top Bottom
Formation Description
0 182
Sand and Clay
82 / 89
Granite Casina set
89 1450
Granite
/
: 12. REMARKS:
easing Removed
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
• 15A NCAC 2,C,4VfLL CONSTRUCTION ST DARDS, AND THAT A COPY OF THIS
REC;61-
S EN PROM TO TH E NER.
- 10-31-11
SIGNATI ME OF CERTIFIED WELL CONTRACTOR DATE
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit within 30 days of completion.to: Division of Water Quality Form GW-1b
yty Information Processing, Rev. 1/08
1617 Mail Service Center, Raleigh, NC 27699-161, Phone : [phone]

��a nSrAT�o
NONRESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 3065 A
1. WELL CONTRACTOR:
Roger L Williams
Well Contractor (Individual) Name
Tarheel Water Treatmant
Well Contractor Company Name
3494 Georgia Rd
Street Address
Franklin NC 28734
City or Town State Zip Code
8( 28 ) 369-0740
Area code Phone number
2. WELL INFORMATION:
d. TOP OF CASING IS .0 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): 20 METHOD OF TEST_Ai I Ift
If. DISINFECTION: Type HTQ Amount 1 /4 GatP—
g. WATER ZONES (depth):
:Top 340 Bottom 342 Top Bottom
: Top Bottom Top Bottom
Top Bottom Top Bottom
Thickness/
7. CASING: Depth Diameter Weight . Material
WELL CONSTRUCTION PERMIT# WI0100141 : Topes_ Bottom -a— Ft.
OTHER ASSOCIATED PERMIT#(if applicable) Top Bottom Ft.
SITE WELL ID #(if applicable) F-4 Top Bottom Ft.
3. WELL USE (Check One Box) Monitoring ❑ Municipal/Public ❑ : 8. GROUT: Depth Material Method
Industrial/Commercial ❑ Agricultural ❑ Recovery ❑ Injection ❑
Irrigationo Other S((list use) Closed Loop Geothern
DATE DRILLED-1 0-27-11
4. WELL LOCATION:
1166 lotla Church Rd
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
CITY: Franklin COUNTY Macon
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
❑Slope ❑Valley liftlat ❑Ridge ❑Other
K@3KTCD 36 iAAAA&AAAAAAAAI CL ROR 3R0WAP10WX CC
KNMFISTCD 75 iAAAA&AAAAAAAAI CL R OR 71x."xxxooix CC
Latitude/longitude source: ❑GPS []Topographic map
(location of well must be shown on a USGS topo map andattached to
this form if not using GPS)
5. FACILITY (Name of the business where the well is located.)
Macon Flementary School
Facility Name Facility ID# (if applicable)
1166 lotla Church Rd
Street Address
Franklin N 8734
City or Town State Zip Code
Macon County Government
Contact Name
Mailing Address
Franklin NC 29734
City or Town State. Zip Code
L-)
Area code
Phone number
6. WELL DETAILS:
a. TOTAL DEPTH: 450'
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
Top 0 Bottom 94 Ft. bentonite pumped
Top 94 Bottom 450-- Ft. washed stone Doured
Top Bottom Ft.
9. SCREEN: Depth Diameter Slot Size Material
Top Bottom Ft. in
Top Bottom Ft. in
Top Bottom Ft, in
10. SAND/GRAVEL PACK:
Depth Size
Top Bottom Ft.
Top Bottom Ft.
Top Bottom Ft.
11. DRILLING LOG
Top Bottom
0 / 84
84 / 89
89 / 450
/
12. REMARKS:
easing Removed
in.
in.
in.
Material
Formation Description
Sand and Clay
Granite Casing set
Granite
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN�ACCORDANCE WITH
• 15A NCAC 2C, WELL CONSTRUCTION STANDA , AND THAT A COPY OF THIS
RECORD HA N PROM TO THE WE E
G' 10-27-11
SIG ATU E OF CERTIFIED WELL CONTRACTOR DATE
c. WATER LEVEL Below Top of Casing: 50 FT. : _Roger L Williams
(Use "+" if Above Top of Casing) : PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit within 30 days -of com completion to: Division of Water Quality Form GW-1b
p ty - Information Processing, Rev. 1/08
1617 Mail Service Center, Raleigh, NC 27699-161, Phone: [phone]

NONRESIDENTML WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 3065 A
1. WELL CONTRACTOR:
Roger L Williams
Well Contractor (Individual) Name
Tarheel Water Treatmant
Well Contractor Company Name
3494 Georgia Rd
Street Address
Franklin NC 28734
City or Town State Zip Code
8( 28 ) 369-0740
Area code Phone number
2. WELL INFORMATION:
d. TOP OF CASING IS O FT. Above Land Surface`
*Top of casing terminated attor below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gprn): 10 METHOD OF TEST_Alr Llft
f. DISINFECTION: Type HTC Amount /4 (I IJ]_
g. WATER ZONES (depth):
:Top 340 Bottom 342 Top Bottom
Top Bottom Top Bottom
Top Bottom Top Bottom
Thickness/
7. CASING: Depth Diameter Weight Material
WELL CONSTRUCTION PERMIT# WI0100141 : Top 0 Bottom 90 Ft.
OTHER ASSOCIATED PERMIT#(if applicable)
SITE WELL ID #(if applicable) F-rJ'
3. WELL USE (Check One Box) Monitoring ❑ Municipal/Public ❑
Industrial/Commercial ❑ Agricultural ❑ Recovery❑ Injection ❑
Irrigation❑ Other lt((list use) Closed Loop Geotherd
DATE DRILLED 10-26-1 1
4. WELL LOCATION:
1166 lotla Church Rd
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
CITY: Franklin COUNTY Macon
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
❑Slope []Valley VFW ❑Ridge ❑Other
I,gf$TCD 36 IAAAA&AAAAAAAAI CL R OR 3mXXXX*)mx CC
KNMFI$TCD75 iAAAA&AAAAAAAAI CLROR 7`k.WXXXXW* CC
Latitude/longitude source: OGPS Oropographic map
(location of well must be shown on a USGS topo map andattached to
this form if not using GPS)
5. FACILITY (Name of the business where the well is located.)
Macon Flementary School
Facility Name Facility ID# (if applicable)
1166 lotla Church Rd
Street Address
Franklin NC 28734
City or Town State Zip Code
Macon County Goyernm .nt
Contact Name
Mailing Address
Franklin NC 28734
City or Town State Zip Code
Area code Phone number
Top Bottom Ft.
Top Bottom Ft.
: 8. GROUT: Depth Material Method
Topes_ Bottom 9� Ft. bentOrllte—Pumped
Top 9L Bottom 450 Ft. washed stone poured
Top Bottom Ft.
9. SCREEN: Depth
Diameter Slot Size Material
Top Bottom
Ft. in. in.
Top Bottom
Ft. ' in. in.
Top Bottom
Ft. in. in.
10. SAND/GRAVEL PACK:
Depth
Size Material
Top Bottom
Ft.
Top Bottom
Ft.
Top Bottom
Ft.
11. DRILLING LOG
Top Bottom
0 / 85
85 / 90
90 / 450
: 12. REMARKS:
Formation Description
Sand and Clay
Granite Casino set
Granite
6. WELL DETAILS: : I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
• 15A NCAC 2C, WELL CONSTRUCTION SJANDARDS, AND THAT A COPY OF THIS
a. TOTAL DEPTH: 450' RECORD EN PROV D TO T W WNER.
a 10-6-1
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO pI : SIGNATLTRE OF CERTIFIED WELL CONTRACTOR DATE
C. WATER LEVEL Below Top of Casing: O FT. : Roder L Williams
(Use "+^ if Above Top of Casing) : PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit within 30 days of completion to: Division of Water Quality Form /08
y P ty - Information Processing, Rev. 1/08
1617 Mail Service Center, Raleigh, NC 27699-161, Phone : [phone]

ryd SfAi;''
V 1 r ONRESIDENTL4L WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
-s WEI L CONTRACTOR CERTIFICATION # 3065 A
1. WELL CONTRACTOR:
Row L Williams
Well Contractor (Individual) Name
Tarheel Water Treatmant
Well Contractor Company Name
3494 Georaia Rd
Street Address
Franklin NC 28734
.City or Town State Zip Code
8t 28 ) 369-0740
Area code Phone number
d. TOP OF CASING IS n 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): 10 METHOD OF TEST_Ak Lift
f. DISINFECTION: Type HT(' Amount _ 1 /4 CI1P--
g. WATER ZONES (depth):
Top 340 Bottom 342
Top Bottom
Top Bottom
Top
Bottom
Top
Bottom
Top
Bottom
Thickness/
2. WELL INFORMATION: : 7. CASING: Depth Diameter Weight Material
WELL CONSTRUCTION PERMIT#W10100141 :Top 0 Bottom 90 Ft.
OTHER ASSOCIATED PERMIT#(ifapplicable) Top Bottom Ft.
SITE WELL ID #(if applicable) F-6 Top Bottom Ft.
3. WELL USE (Check One Box) Monitoring ❑ Municipal/Public ❑ : 8. GROUT: Depth Material Method
Industrial/Commercial ❑ Agricultural ❑ Recovery ❑ Injection ❑ : TopQQ _ Bottom 95. Ft. bentonite pumped
Irrigation❑ Other !9((list use) Closed Loop Geothern ; Top 95 Bottom 450 Ft. Washed Stone poured
DATE DRILLED 10-26-1 1 ;Top Bottom Ft.
4. WELL LOCATION:
1166 lotla Church Rd
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
CITY: Franklin COUNTY Macon
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
❑Slope ❑Valley prFlat ❑Ridge ❑Other
KOISTCD 36 iAAAA&AAAAAAAA! CL R OR 3X^XXD(XIAWOW CC
KNMFI$TCD75 1AAAA&AAAAAAAA! CL ROR 7X.1XhNXJf3(X0W CC
Latitude/longitude source: ❑GPS E]ropographic map
(location of well must be shown on a USGS topo map andattached to
this form if not using GPS)
5. FACILITY (Name of the business where the well is located.)
Macon Flementary School
Facility Name Facility ID# (if applicable)
1166 lotla Church Rd
Street Address
Franklin NC 28734
City or Town State Zip Code
Macon County Government
Contact Name
Mailing Address
Franklin NG 287'14
City or Town State Zip Code
Area code Phone number
6. WELL DETAILS:
a. TOTAL DEPTH:. 4550'
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO qI
9. SCREEN:
Depth
Diameter
Top
Bottom
Ft. in.
Top
Bottom
Ft. in.
Top
Bottom
Ft. in.
10. SAND/GRAVEL PACK:
Depth
Size
Top
Bottom
Ft.
Top
Bottom
Ft.
: Top
Bottom
Ft.
11. DRILLING LOG
Top
Bottom
0
/ 85
85
/ 90
90
/ 450
: 12. REMARKS:
leasing Removed
Slot Size Material
in.
in.
in.
Material
Formation Description
Sand and Clay
Granite Casing set
Granite
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
15A NCAC 2C, WELL CONSTRUCTION STA DARDS, AND THAT A COPY OF THIS
RECORD EN PROM TO THE EL R.
U 10-26-11
SIGNATURE OF CERTIFIED WELL CONTRACTOR DATE
c. WATER LEVEL Below Top of Casing: _ 0 FT. : Roger L WllllanlS
(Use "+^ if Above Top of Casing) : PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit within 30 days of completion to: Division of Water Quality - Information Processing, Rev. 1/08 Form b
OS
1617 Mail Service Center, Raleigh, NC 27699-161, Phone: [phone]

1 r ONRESIDENTL4L
r•
' '
WELL CONSTRUCTION RECORD
'''
I o;"
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 3065 A
1. WELL CONTRACTOR:
Roaer L Williams
Well Contractor (Individual) Name
Tarheel Water Treatmant
Well Contractor Company Name
3494 Georaia Rd
Street Address
Franklin NC 28734
City or Town State Zip Code
8( 28—) 369-0740
Area code Phone number
2. WELL INFORMATION:
WELL, CONSTRUCTION PERMIT# Wl0100141
OTHER ASSOCIATED PERMIT#(if applicable)
SITE WELL ID #(if applicable) F-7
3. WELL USE (Check One Box) Monitoring ❑ Municipal/Public ❑
Industrial/Commercial ❑ Agricultural ❑ Recovery ❑ Injection ❑
Irrigation❑ Other S((list use) Closed Loop Geother©
DATE DRILLED 10-24-11
4. WELL LOCATION:
1166 lotla Church Rd
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
CITY: Franklin COUNTY Macon
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
❑ Slope ❑ Valley Ii(Flat ❑ Ridge ❑ Other
KOATCD 36 iAAAA&AAAAAAAA! CL R OR arc^XXD(XOOMX CC
KNMF!STCD 75 IAAAA&AAAAAAAA! CL R OR 7�k!XkXX3C/(k)(9C CC
Latitude/longitude source: ❑GPS Oropographic map
(location of well must be shown on a USGS topo map andattached to
this form if not using GPS)
5. FACILITY (Name of the business where the well is located.)
Macon Elementary School
Facility Name Facility ID# (if applicable)
1166 lotla Church Rd
Street Address
Franklin N C 28734
City or Town State Zip Code
Macon County Government
Contact Name
Mailing Address
Franklin NG 28734
City or Town State Zip Code
Area code
Phone number
S. WELL DETAILS:
a. TOTAL DEPTH:_ 4501
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO qI
: d. TOP OF CASING IS 0 FT. Above Land Surface`
'Top of casing terminated attor below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): 0 METHOD OF TEST Air Lift
f. DISINFECTION: Type HTC Amount U4 Cla—
g. WATER ZONES (depth):
Top Bottom Top Bottom
Top Bottom Top Bottom
Top Bottom Top Bottom
Thickness/
7. CASING: Depth Diameter Weight Material
Topes_ Bottom844 _ Ft.
Top Bottom Ft.
Top Bottom Ft.
8. GROUT: Depth Material Method
Top 0 Bottoms Ft. bentonite -pumped
Top eR _ Bottom 450 Ft. washed stone poured
Top Bottom Ft.
9. SCREEN: Depth Diameter Slot Size Material
Top Bottom Ft. in. in.
Top Bottom Ft. in. in.
Top Bottom Ft. in. in.
10. SAND/GRAVEL PACK:
Depth Size
Top Bottom Ft.
Top Bottom Ft.
Top Bottom Ft.
11. DRILLING LOG
Top Bottom
0 / 85
85 / 90
90/ 450
/
I
Material
Formation Description
Sand and Clay
Granite Casing set
Granite
12. REMARKS:
easing Re, noved
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
15A NCAC 2C, L CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
RECORD B N PROVIPED TO TH O NEP,
U 10-24-11
SIGfiATURE OF CERTIFIED WELL CONTRACTOR DATE
c. WATER LEVEL Below Top of Casing: 0 FT. ; _Roger L Williams
(Use "+° if Above Top of Casing) : PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit within 30 days of completion to: Division of Water Quality - Information Processing, Form Rev. 1 /08 /08
1617 Mail Service Center, Raleigh, NC 27699-161, Phone: [phone]

NONRESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 3065 A
1. WELL CONTRACTOR:
Roaer L Williams
Well Contractor (Individual) Name
Tarheel Water Treatmant
Well Contractor Company Name
3494 Georaia Rd
Street Address
Franklin NC 28734
City or Town State Zip Code
d. TOP OF CASING IS 0 FT. Above Land Surface"
'Top of casing terminated attor below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): 0 METHOD OF TEST Air ift
f. DISINFECTION: Type HTC. Amount 1 /4 Cum
g. WATER ZONES (depth):
Top Bottom Top Bottom
Top Bottom Top Bottom
8( 28 ) 369-0740 : Top Bottom Top Bottom
Area code Phone number
Thickness!
2. WELL INFORMATION: ; 7. CASING: Depth Diameter Weight Material
WELL CONSTRUCTION PERMIT# W 10100141 : Top 0 Bottom 84 Ft
OTHER ASSOCIATED PERMIT#(if applicable) Top Bottom Ft.
SITE WELL ID #(if applicable)F-8 Top Bottom Ft.
3. WELL USE (Check One Box) Monitoring p Municipal/Public ❑
Industrial/Commercial ❑ Agricultural ❑ Recovery ❑ Injection ❑
Irrigation❑ Other ti((list use) Closed Loop Geothern
DATE DRILLED 10-21 -11
4. WELL LOCATION:
1166 lotla Church Rd
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
CITY: Franklin COUNTY Macon
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
❑Slope ❑Valley Flat ❑Ridge ❑Other
KOISTCD 36 1AAA A&AAAAAAAAI CL R OR 3X( XXXXN)WX CC
KNMFI$TCD75 _ iAAAA&AAAAAA^AI CL ROR 7x."XYA0W CC
Latitude/longitude source: E]GPS ❑topographic map
(location of well must be shown on a USGS topo map andattached to
this form if not using GPS)
5. FACILITY (Name of the business where the well is located.)
Macon Elementary School
Facility Name Facility ID# (if applicable)
1166 lotla Church Rd
Street Address
Franklin NC 28734
City or Town State Zip Code
Macon County Government
Contact Name
Mailing Address
Franklin NC 28734
City or Town State Zip Code
Area code Phone number
6. WELL DETAILS:
a. TOTAL DEPTH: 450'
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO 5
8. GROUT: Depth Material Method
Top 0 Bottom 89_ Ft. bentonite pumped
Top 8q_ Bottom 450 Ft. washed stone poured
Top Bottom Ft.
9. SCREEN: Depth Diameter Slot Size Material
Top Bottom Ft. in. in.
Top Bottom Ft. in. in.
Top Bottom Ft. in. in.
10. SAND/GRAVEL PACK:
Depth Size
Top Bottom Ft.
Top Bottom Ft.
Top Bottom Ft.
11. DRILLING LOG
Top Bottom
0 / 82
82 / 88
88 / 450
12. REMARKS:
easing Removed
Material
Formation Description
Sand and Clay
Granite Casing set
Granite
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
15A NCAC 2C, CONSTRUCTION ST NDARDS, AND THAT A COPY OF THIS
: RECORD 9 PROVID TO L ER.
10-21-11
Sl(ffNATVRE OF CERTIFIED WELL CONTRACTOR DATE
c. WATER LEVEL Below Top of Casing: 0 FT. Roper L Wiiliams� Williams
(Use "+" if Above Top of Casing) : PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit within 30 days of completion to: Division of Water Quality - Information Processing, Form GW-1b
Rev. 1/08
1617 Mail Service Center, Raleigh, NC 27699-161, Phone : [phone]

NONRESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 3065 A
1. WELL CONTRACTOR:
Roaer L Williams
Well Contractor (Individual) Name
Tarheel Water Treatmant
Well Contractor Company Name
3494 Georaia Rd
Street Address
Franklin NC 28734
City or Town State Zip Code
St 28 ) 369-0740
Area code Phone number
2. WELL INFORMATION:
WELL CONSTRUCTION PERMIT# W 10100141
OTHER ASSOCIATED PERMIT#(ifapplicable)
SITE WELL ID #(if applicable) G-1
3. WELL USE (Check One Box) Monitoring ❑ Municipal/Public ❑
Industrial/Commercial ❑ Agricultural ❑ Recovery ❑ Injection ❑
Irrigation[] Other W(list use) Closed LoOD Geothero
DATE DRILLED 1 1-07-1 1
4. WELL LOCATION:
1166 lotla Church Rd
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
CITY: Franklin COUNTY Macon
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
❑ Slope ❑ Valley VFW []Ridge ❑ Other
KOMTCD 36 iAAAA&AAAAAAAAI CL R OR 3X0XXi(X%)tt X CC
KNMFI$TCD75 iAAAA&AAAAAAAAI CLROR 7k3(9CX'7PXX1XXX CC
Latitude/longitude source: ❑GPS ❑topographic map
(location of well must be shown on a USGS topo map endattached to
this form if not using GPS)
5. FACILITY (Name of the business where the well is located.)
Macon Elementary School
Facility Name Facility ID# (if applicable)
1166 lotla Church Rd
Street Address
_ Franklin NC 28734
City or Town State Zip Code
Macon County GoyPrnm nt
Contact Name
Mailing Address
Franklin NG 28734
City or Town State Zip Code
U
Area code
Phone number
6. WELL DETAILS:
a. TOTAL DEPTH:_ 450'
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO qI
c. WATER LEVEL Below Top of Casing: 50 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.
: e. YIELD (gpm): 30 METHOD OF TEST BIDW Down
: f. DISINFECTION: Type HTC: Amount 12 QZ
g. WATER ZONES (depth):
Top 140 Bottom 142,_ Top Bottom
:Top Bottom Top Bottom
Top Bottom Top Bottom
Thickness/
7. CASING: Depth Diameter Weight Material
Top 0 Bottom 84 Ft.
Top Bottom Ft.
Top Bottom Ft.
8. GROUT: Depth Material Method
Top 0 Bottom39 Ft. bentonite pumped
Topes Bottom 450 Ft. washed stone. poured
Top Bottom Ft.
9. SCREEN: Depth Diameter Slot Size Material
Top Bottom Ft. in. in.
Top Bottom Ft. in. in.
Top Bottom Ft. in. in.
10. SAND/GRAVEL PACK:
Depth Size
Top Bottom Ft.
Top Bottom Ft.
Top Bottom Ft.
: 11. DRILLING LOG
Top Bottom
0 / 78
78 / 84
_ 44 1 450
/
12. REMARKS:
easing Ren loved
Material
Formation Description
Sand and Clay
Granite Casino Set
Granite
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
15A NCAC 2C, LL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
RECORD HXBE4N PROVI D TO THE J✓ ER.
L-1j
SIGNATURE CERTIFIED WELL CONTRACTOR D4 E 11
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit Rev. 1/08
within 30 days of Completion to: Division of Water Quality - Information Processing, Form b
08
1617 Mail Service Center, Raleigh, NC 27699-161, Phone : [phone]

NONRESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 3065 A
1. WELL CONTRACTOR:
Roaer L Williams
Well Contractor (Individual) Name
Tarheel Water Treatmant
Well Contractor Company Name
3494 Georaia Rd
Street Address
Franklin NC 28734
City or Town State Zip Code
8r 28 ) 369-0740
Area code Phone number
d. TOP OF CASING IS FT. Above Land Surface -
'Top of casing terminated attor below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): 30 METHOD OF TEST aJQM Down
f. DISINFECTION: Type_HTC Amount 112--z—
g. WATER ZONES (depth):
:Top 140 Bottom 142 Top Bottom
Top Bottom Top Bottom
Top Bottom Top Bottom
Thickness!
2. WELL INFORMATION: ; 7. CASING: Depth Diameter Weight Material
WELL CONSTRUCTION PERMIT# W 10100141 : Top O Bottom 84 Ft.
OTHER ASSOCIATED PERMIT#(ff applicable)
SITE WELL ID #(if applicable) G-2
3. WELL USE (Check One Box) Monitoring ❑ Municipal/Public ❑
Industrial/Commercial ❑ Agricultural ❑ Recovery❑ Injection ❑
Irrigation❑ Other W(list use) Closed Loop Geotherd
DATE DRILLED 1 1 -09-11
4. WELL LOCATION:
1166 lotla Church Rd
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
CITY: Franklin COUNTY Macon
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
❑ Slope ❑ Valley Flat []Ridge ❑ Other
KOISTCD 36 iAAAA&AAAAAAAA! CL ROR 3D(MXXi00MX CC
MWKTCD75 IAAAA&AAAAAAAAI CLROR 71X.")t900W CC
Latitude/longitude source: E]GPS Dropographic map
(location of well must be shown on a USGS topo map andattached to
this form if not using GPS)
5. FACILITY (Name of the business where the well is located.)
Macon FI m ntary Rrhoni
Facility Name Facility ID# (if applicable)
1166 lotla Ch Ir .h Rd
Street Address
Franklin NQ 28734
City or Town State Zip Code
Macon County Government
Contact Name
Mailing Address
Franklin NG 9873
City or Town State Zip Code
Area code
Phone number
6. WELL DETAILS:
a. TOTAL DEPTH: 450'
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO q/
Top
Bottom
Ft.
Top
Bottom
Ft.
8. GROUT:
. Depth
Material
Method
Topes_
Bottom 89
Ft. bentonite
pumped
Top 89
Bottom 450
Ft. washed stone
poured
Top
Bottom
Ft.
9. SCREEN:
Depth
Diameter Slot Size Material
Top
Bottom
Ft. in.
in.
Top
Bottom
Ft. in.
in.
Top
Bottom
Ft. in.
in.
10. SAND/GRAVEL PACK:
Depth
Size
Material
Top
Bottom
Ft.
Top
Bottom
Ft.
Top
Bottom
Ft.
11. DRILLING LOG
Top Bottom
0 / 82
82 / 89
89 / 450
12. REMARKS:
Formation Description
Sand and Clay
Granite Casing Set
Granite
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
15A NCAC 2C LL CONSTRUCTION ST NDARDS, AND THAT A COPY OF THIS
: RECORD S EN PRO D TO T NER
SIGNATURE OF CERTIFIED WELL CONTRACTOR DATE
c. WATER LEVEL Below Top of Casing: _50 FT. Roaer L william�
(Use "+" if Above Top of Casing) : PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit within 30 days of completion to: Division of Water Quality - Information Processing, Form GW-1b
Rev. 1/08
1617 Mail Service Center, Raleigh, NC 27699-161, Phone,: [phone]

4
NONRESIDENTL4L WELL CONSTRUCTION RECORD
ti e yt 3.r�
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 3065 A
1. WELL CONTRACTOR:
Roger L Williams
Well Contractor (Individual) Name
Tarheel Water Treatmant
Well Contractor Company Name
3494 Georgia Rd
Street Address
Franklin NC 28734
City or Town State Zip Code
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): 30 METHOD OF TEST BLOW Down
f. DISINFECTION: Type L-ITC Amount 12 nz_
g. WATER ZONES (depth):
:Top Bottom Top Bottom
: Top Bottom Top Bottom
8( 28 ) 369-0740 ; Top Bottom Top Bottom
Area code Phone number Thickness]
2. WELL INFORMATION: ; 7. CASING: Depth Diameter Weight Material
WELL CONSTRUCTION PERMIT# W10100141 : Top 0 Bottom 1162 Ft.
OTHER ASSOCIATED PERMIT#(if applicable) Top Bottom Ft.
SITE WELL ID #(if applicable) G-4 : Top Bottom Ft.
3. WELL USE (Check One Box) Monitoring ❑ Municipal/Public ❑
Industrial/Commercial ❑ Agricultural ❑ Recovery ❑ Injection ❑
Irrigation❑ Other p{(list use) Closed LoOD Geotherla
DATE DRILLED 12-7-1 1
4. WELL LOCATION:
1166 lotla Church Rd
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
CITY: Franklin COUNTY Macon
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
❑ $lope ❑ Valley p(Flat []Ridge []Other
KOI$TCD 36 IAAAA&AAAAAAAA! CL ROR 3X^XXXXOOMX CC
KNMFI$TCD75 iAAAA&AAAAAAAA! CL ROR 7ll'."XXX90 * CC
Latitude/longitude source: []GPS Oropographic map
(location of well must be shown on a USGS topo map andattached to
this form if not using GPS)
5. FACILITY (Name of the business where the well is located.)
Macon Elementary School
Facility Name Facility ID# (if applicable)
1166 IOUs Church Rd _
Street Address
Franklin NC 28734
City or Town State Zip Code
_Macon County Government
Contact Name
Mailing Address
Franklin NC 28734
City or Town State Zip Code
Area code
Phone number
6. WELL DETAILS:
a. TOTAL DEPTH:_450'
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO qI
8. GROUT: Depth Material Method
Top 0 Bottom 167 Ft. bentonite pumped
Top 167 Bottom 450 Ft. washed stone poured
Top Bottom Ft.
9. SCREEN: Depth Diameter Slot Size Material
Top Bottom Ft. in.
Top Bottom Ft. in.
Top Bottom Ft. in.
10. SAND/GRAVEL PACK:
Depth Size
Top Bottom Ft.
Top Bottom Ft.
Top Bottom Ft.
11. DRILLING LOG
Top Bottom
0 / 162
162 / 450
12. REMARKS:
in.
in.
in.
Material
Formation Description
Sand and Clay
Granite 30apm
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
15A NCAC 2C, ELL CONSTRUCTION ST DARDS, AND THAT A COPY OF THIS
RECORD EN PROV D TO TH E W ER.
12-7-11
S16NATLYkE OF CERTIFIED WELL CONTRACTOR DATE
c. WATER LEVEL Below Top of Casing: _ 5n YT. Roger I_ Williams
(Use "+" if Above Top of Casing) : PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit within 30 days of completion to: Division of Water Quality Form GW-1b
Y p ty - Information Processing, 1617 Mail Service Center, Raleigh, NC 27699-161, Phone : [phone] Rev. 1/08

NONRESIDENTIAL WELL CONSTRUCTION RECORD
l Sy
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 3065 A
1. WELL CONTRACTOR:
Roger L Williams
Well Contractor (Individual) Name
Tarheel Water Treatmant
Well Contractor Company Name
3494 Georaia Rd
Street Address
Franklin NC 28734
City or Town State Zip Code
8( 28 ) 369-0740
Area code Phone number
2. WELL INFORMATION:
WELL CONSTRUCTION PERMIT# W10100141
OTHER ASSOCIATED PERMIT#(if applicable)
SITE WELL ID #(if applicable) G-5
3. WELL USE (Check One Box) Monitoring ❑ Municipal/Public ❑
Industrial/Commercial ❑ Agricultural ❑ Recovery ❑ Injection ❑
Irrigation❑ Other [i((list use) Closed LooD Geotherd
DATE DRILLED-1 2-5-11
4. WELL LOCATION:
1166 lotla Church Rd
(Street Name, Numbers, Community, Subdivision, Lot No_, Parcel, Zip Code)
CITY: Franklin COUNTY Macon
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
❑Slope ❑Valley Flat ❑Ridge ❑Other
K0I$TCD 36 IAAAA&AAAAAAAAI CL ROR 3WkXXXX')0(9(` X CC
KNMFI$TCD75 IAAAA&AAAAAAAAI CL ROR 7x.'!CX`X'xXX)C)C9C CC
Latitude/longitude source: ❑GPS ❑topographic map
(location of well must be shown on a USGS topo map andaffached to
this form if not using GPS)
5. FACILITY (Name of the business where the well is located.)
Macon Flementary School
Facility Name Facility ID# (if applicable)
1166 lotla Church Rd
Street Address
Franklin NC 28734
City or Town State Zip Code
_Macon County Govprnment
Contact Name
Mailing Address
Franklin NC 28734
City or Town State Zip Code
Area code
Phone number
6. WELL DETAILS:
a. TOTAL DEPTH: 450'
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO qI
c. WATER LEVEL Below Top of Casing: 50 FT
(Use "+" if Above Top of Casing)
d. TOP OF CASING IS FT. Above Land Surface'
'Top of casing terminated attor below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
: e. YIELD (gpm): 30 METHOD OF TEST BIOW Down
f. DISINFECTION: Type HTC Amount 117�_
g. WATER ZONES (depth):
Top Bottom Top Bottom
Top Bottom Top Bottom
Top Bottom Top Bottom
Thickness/
7. CASING: Depth Diameter Weight Material
Top 0 Bottom 162 Ft. .
Top Bottom Ft.
Top Bottom Ft.
8. GROUT: Depth Material Method
Top 0 Bottom 167 Ft: bentonite pumped
Top 1—Z_ Bottom 450 Ft. washed stone poured
Top Bottom Ft.
: 9. SCREEN: Depth Diameter Slot Size Material
Top Bottom Ft. in. in.
Top Bottom Ft. in. in.
Top Bottom Ft. in. in.
10. SAND/GRAVEL PACK:
Depth Size
Top Bottom Ft.
Top Bottom Ft.
Top Bottom Ft.
11. DRILLING LOG
Top Bottom
0 / 162
162 / 450
/
: 12. REMARKS:
6asing Removed
Material
Formation Description
Sand and Clay
Granite 30aom
: 100 HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
15A NCAC 2C,ONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
: RECORD EN PRO D TO TH E O ER.
SI NA RE OF CERTIFIED WELL CONTRACTOR DATE�
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit within 30 days of completion to: Division of Water Quality Form /08
Y p ty - Information Processing, Rev. 1/08
1617 Mail Service Center, Raleigh, NC 27699-161, Phone: [phone]

NONRESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 3065 A
1. WELL CONTRACTOR:
Roger L Williams
Well Contractor (Individual) Name
Tarheel Water Treatmant
Well Contractor Company Name
3494 Georgia Rd
Street Address
Franklin NC 28734
City or Town State Zip Code
8r 28 ) 369-0740
Area code Phone number
2. WELL INFORMATION:
WELL CONSTRUCTION PERMIT# Q100141
OTHER ASSOCIATED PERMIT#(if applicable)
SITE WELL ID #(if applicable) G-6
d. TOP OF CASING IS 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): 30 METHOD OF TEST BIQW JJQM
f. DISINFECTION: Type HTC Amount 1207
g. WATER ZONES (depth):
Top Bottom Top Bottom
Top Bottom Top Bottom
Top Bottom Top Bottom
Thickness/
7. CASING: Depth Diameter Weight Material
Top 0 Bottom 1QL_ Ft.
Top Bottom Ft.
Top Bottom Ft.
3. WELL USE (Check One Box) Monitoring ❑ Municipal/Public ❑ : 8. GROUT: 'Depth Material Method
Industrial/Commercial ❑ Agricultural ❑ Recovery ❑ Injection ❑ : Top 0 Bottom 167 Ft. bentonite pumped
Irrigation[] Other 11i6ist use) Closed LoOD Geotherd :Top 167 Bottom 450 Ft. washed stone floured
DATE DRILLED 1 1 -21 -11 ; Top Bottom Ft.
4. WELL LOCATION:
1166 lotla Church Rd
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
CITY: Franklin COUNTY Macon
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
❑ Slope ❑ Valley Flat ❑ Ridge ❑ Other
K?43KTCD 36 IAAAA&AAAAAAAA! CL R OR 3X^XXXX9®f9@XX CC
KNMFI$TCC) 75 1AAAA&AAAAAAAA! CLROR 7X.WA'Ri(7C'XW CC
Latitude/longitude source: OGPS ❑topographic map
(location of well must be shown on a USGS topo map andattached to
this form if not using GPS)
5. FACILITY (Name of the business where the well is located.)
Macon Flementary S .hool
Facility Name Facility ID# (if applicable)
1166 lotla Church Rd
Street Address
Franklin NC 28734
City or Town State Zip Code
Macon County Gov .rnm nt
Contact Name
Mailing Address
City or Town State Zip Code
Area code
Phone number
6. WELL DETAILS:
a. TOTAL DEPTH: 45501
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO q/
9. SCREEN:. Depth Diameter Slot Size Material
Top Bottom Ft. in. in.
Top Bottom Ft. in. in.
Top Bottom Ft. in. in.
10. SAND/GRAVEL PACK:
Depth Size
Top Bottom Ft.
Top Bottom Ft.
: Top Bottom Ft.
11. DRILLING LOG
Top Bottom
0 / 162
162 / 450
12. REMARKS:
easing Removed
Material
Formation Description
Sand and Clay
Granite 30apm
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
15A NCAC 2C ELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
: RECORD S EN PRR0 DEO TO TH EL NER.
SIGNATURE OF CERTIFIED WELL CONTRACTOR DATE
c. WATER LEVEL Below Top of Casing: _ 50 FT. ; __ Roger L Wllllams
(Use "+" if Above Top of Casing) : PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit within 30 days of completion to: Division of Water Quality Form /08
Y P ty - Information Processing, Rev. 1/08
1617 Mail Service Center, Raleigh, NC 27699-161, Phone : [phone]

c � STATEv�
,rG 1 r ONRESIDENTL4L WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
4, La4yyn" .� WELL CONTRACTOR CERTIFICATION # 3065 A
r.` Vacn`
1. WELL CONTRACTOR:
Roaer L Williams
Well Contractor (Individual) Name
Tarheel Water Treatmant
Well Contractor Company Name
3494 Georaia Rd
Street Address
Franklin NC 28734
City or Town State Zip Code
8( 28 ) 369-0740
Area code Phone number
2. WELL INFORMATION:
WELL CONSTRUCTION PERMIT# W 10100141
OTHER ASSOCIATED PERMIT#(if applicable)
SITE WELL ID #(if applicable) G-7
3. WELL USE (Check One Box) Monitoring ❑ Municipal/Public ❑
Industrial/Commercial ❑ Agricultural ❑ Recovery ❑ Injection ❑
Irrigation❑ Other (list use) Closed LODD Geotherd
DATE DRILLED 1 1-22-1 1
4. WELL LOCATION:
1166 lotla Church Rd
(Street Name, Numbers, Community, Subdivision, Lot No.,Parcel, Zip Code)
CITY: Franklin COUNTY Macon
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
❑ Slope ❑ Valley Flat ❑ Ridge ❑ Other
KOISTCD 36 iAAAA&AAAAAAAAI CL ROR 3X^)F7t?PJP10f9 x CC
KNMFI$TCD75 jAAAA&AAAAAAAAI CLROR 7`X.9PkkXxxoom CC
Latitude/longitude source: [33PS aopographic map
(location of well must be shown on a USGS topo map andattached to
this form if not using GPS)
5. FACILITY (Name of the business where the well is located.)
Macon Flem _ntary School
Facility Name Facility ID# (if applicable)
1166 lotla Church Rd
Street Address
Franklin NC 28734
City or Town State Zip Code
Macon County Gov .rnm .nt
Contact Name
Mailing Address
Franklin NC: 28734
City or Town State Zip Code
Area code
Phone number
S. WELL DETAILS:
a. TOTAL DEPTH:450'
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO qI
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): 80 METHOD OF TEST BIOW Down
f. DISINFECTION: Type HTC: Amount 'I o7
g. WATER ZONES (depth):
:Top Bottom Top Bottom
:Top Bottom Top Bottom
Top Bottom Top Bottom
Thickness/
7, CASING: Depth Diameter Weight Material
Top 0 Bottom 172 Ft.
Top Bottom Ft.
Top Bottom Ft.
8. GROUT: Depth Material Method
Top 0 Bottom 177 Ft. bentonite pumped
:Top 177 Bottom 450 Ft. washed stone poured
Top Bottom Ft.
9. SCREEN: Depth Diameter Slot Size Material
Top Bottom Ft. in. in.
Top Bottom Ft. in. in.
Top Bottom Ft, in. in.
10. SAND/GRAVEL PACK:
Depth Size
Top Bottom Ft.
Top Bottom Ft.
Top Bottom Ft.
11. DRILLING LOG
Top Bottom
0 / 172
172 / 450
/
12. REMARKS:
easing Removed
Material
Formation Description
Sand and Clay
Granite 30ppm
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 VkSVEN PRO ED TO HE W INNER.
/> 1111-22-11
SIGNATtAE OF CERTIFIED WELL CONTRACTOR DATE
C. WATER LEVEL Below Top of Casing: _50 FT. _ROsjer L Williams
(Use "+" if Above Top of Casing) : PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit within 30 days of completion to: Division of Water Quality Form /08
Y P ty - Information Processing, Rev. 1/08
1617 Mail Service Center, Raleigh, NC 27699-161, Phone : [phone]

NONRESIDENTL4L WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 3065 A
1. WELL CONTRACTOR:
Row L Williams
Well Contractor (Individual) Name
Tarheel Water Treatmant
Well Contractor Company Name
3494 Georaia Rd
Street Address
Franklin NC 28734
City or Town State Zip Code
8( 28 ) 369-0740
Area code Phone number
2. WELL INFORMATION:
d. TOP OF CASING IS 2 FT. Above Land Surface*
'Top of casing terminated attor below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): 60 METHOD OF TEST_Air Lift
f. DISINFECTION: Type HTC Amount 1 /_4 G to
g. WATER ZONES (depth):
Top Bottom Top Bottom
Top Bottom Top Bottom
Top Bottom Top Bottom
Thickness/
7. CASING: Depth Diameter Weight Material
WELL CONSTRUCTION PERMIT#W10100141 :Top 0 Bottom 95 Ft.
OTHER ASSOCIATED PERMIT#(if applicable)
SITE WELL ID #(ifapplicable) G-8
3. WELL USE (Check One Box) Monitoring ❑ Municipal/Public ❑
Industrial/Commercial ❑ Agricultural ❑ Recovery ❑ Injection ❑
Irrigation❑ Other 5((list use) Closed Loop Geotherd
DATE DRILLED-1 0-26-11
4. WELL LOCATION:
1166 lotla Church Rd
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
CITY: Franklin COUNTY Macon
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
❑Slope ❑Valley Flat []Ridge ❑Other
KOISTCD 36 iAAAA&AAAAAAAAICLROR3X^XXXX70f9(•XXCC
KNMFI$TCD 75 iAAAA&AAAAAAAA! CL R OR 7k."X'1(7(0W CC
Latitude/longitude source: (]GPS I]ropographic map
(location of well must be shown on a USGS topo map andattached to
this form if not using GPS)
6. FACILITY (Name of the business where the well is located.)
Macon Flem .ntary S .hool
Facility Name Facility ID# (if applicable)
1166 lotla Church Rd
Street Address
Franklin NC 287*14
City or Town State Zip Code
_Macon County Government_
Contact Name
Mailing Address
Franklin NC 28734
City or Town State Zip Code
U
Area code Phone number
6. WELL DETAILS:
a. TOTAL DEPTH:_ 450'
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
Top Bottom Ft.
Top Bottom Ft.
8. GROUT: Depth Material
Top 0 Bottom 100 Ft. bentonite
:Top 100 Bottom 450 Ft. Washed stone
Top Bottom Ft.
Method
-pumped
-poured
: 9. SCREEN: Depth Diameter Slot Size Material
Top Bottom Ft. in. in.
Top Bottom Ft. in. in.
Top Bottom Ft. in. in.
10. SAND/GRAVEL PACK:
Depth Size
: Top Bottom Ft.
Top Bottom Ft.
Top Bottom Ft.
11. DRILLING LOG
Top Bottom
: 0 / 95
95 / 125
125 / 450
12. REMARKS:
easing Ren loved
Material
Formation Description
Sand and Clay
Loose Granite Gravel
Hard Granite
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
15A NCAC 2C, WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
10-26-11
SIGNATURE OF CERTIFIED WELL CONTRACTOR DATE
c. WATER LEVEL Below Top of Casing: 60 FT. Ro('jer L Williams
(Use "+" if Above Top of Casing) : PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit within 30 days of completion to: Division of Water Quality Form /08
Y p ty - Information Processing, Rev. 1/08
1617 Mail Service Center, Raleigh, INC 27699-161, Phone : [phone]

SrA1Fo'L4
ONRESIDENTIAL
WELL CONSTRUCTION RECORD
3 o
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 3065 A
1. WELL CONTRACTOR:
Roger L Williams
Well Contractor (Individual) Name
Tarheel Water Treatment
Well Contractor Company Name
3494 Georgia RD
Street Address
Franklin NC 28734
City or Town State Zip Code
8( 28 369-0740
Area code Phone number
2. WELL INFORMATION:
WELL CONSTRUCTION PERMIT# W10100141
OTHER ASSOCIATED PERMIT#(if applicable)
SITE WELL ID #(if applicable) H-1
3. WELL USE (Check One Box) Monitoring ❑ Municipal/Public ❑
Industrial/Commercial ❑ Agricultural ❑ Recovery ❑ Injection ❑
Irrigation❑ Other N(Vist use) Closed IooD Geotherre
DATE DRILLED 1 1-17-1 1
4. WELL LOCATION:
1166 Lotla Church Rd
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
CITY: Franklin COUNTY Macon
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
❑ Slope []Valley Flat ❑ Ridge ❑ Other
K,0MTCD 36 IAAAA&AAAAAAAAI CL ROR 3X^XXXXOOWXX CC
KNMFI$TCD75 IAAAA&AAAAAAAAI CL ROR 7X'."X"XXO('X9( CC
Latitude/longitude source: BPS ❑Topographic map
(location of well must be shown on a USGS topo map andattached to
this form if not using GPS)
5. FACILITY (Name of the business where the well is located.)
Macon Flementary
Facility Name Facility ID# (if applicable)
1166 Lotla Church Rd
Street Address
Franklin NC 28734
City or Town State Zip Code
Macon County Government
Contact Name
Mailing Address
Franklin NC 28743
City or Town State Zip Code
Area code
Phone number
6. WELL DETAILS:
a. TOTAL DEPTH:_450
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO G/
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): 3_ METHOD OF TESTJ3JQW DOWn
f. DISINFECTION: Type HTC Amount 1i o7
g. WATER ZONES (depth):
Top Bottom Top Bottom
Top Bottom Top Bottom
Top Bottom Top Bottom
Thickness/
7. CASING: Depth Diameter Weight Material
Top 0 Bottom 1 22 Ft.
Top Bottom Ft.
Top Bottom Ft.
: 8. GROUT: Depth Material Method
: Top 0 Bottom 167 Ft.Bentonite Pumped
:Top 167 Bottom 4�_ Ft. washed stonE poured
Top Bottom Ft.
: 9. SCREEN: Depth Diameter Slot Size Material
Top Bottom Ft. in. in.
Top Bottom Ft, in. in.
Top Bottom Ft. in. in.
10. SAND/GRAVEL PACK:
Depth Size
Top Bottom Ft.
Top Bottom Ft.
Top • Bottom Ft.
11. DRILLING LOG
Top Bottom
0 / 82
82 / 162
162 1450
/
: 12. REMARKS:
Material
Formation Description
Sand Clay
Broken Rock
Granite 30 GPM
100 HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
15A NCAC 2C, WELL CONSTgggRfffUCTVS!TAARDS, AND THAT A COPY OF THIS
RECORD ENEN PD TO NER.
11-17-11
SIGNATURE OF CERTIFIED WELL CONTRACTOR DATE
c. WATER LEVEL Below Top of Casing: FT. RO�er L_ William. -,(Use "+" if Above Top of Casing) : PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit within 30 days of completion to: Division of Water Quality.- Form GW-1b
Y p ty_- Information Processing, Rev. 1108
1617 Mail Service Center, Raleigh, NC 27699-161, Phone : [phone]

a'o STATE4''�
'' I; `
NONRESIDENTL4L WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
�: •
WELL CONTRACTOR CERTIFICATION # 3065 A
1. WELL CONTRACTOR:
Roger L Williams
Well Contractor (Individual) Name
Tarheel Water Treatment
Well Contractor Company Name
3494 Georgia RD
Street Address
Franklin NC 28734
City or Town State Zip Code
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): 30 METHOD OF TEST BIOW Down
: If. DISINFECTION: Type HTC Amount 7 n7
g. WATER ZONES (depth):
Top Bottom Top Bottom
Top Bottom Top Bottom
8( 28 ) 369-0740 Top Bottom Top Bottom
Area code Phone number Thickness/
2. WELL INFORMATION: : 7. CASING: Depth Diameter Weight Material
WELL CONSTRUCTION PERMIT# W 10100141 : Top 0 Bottom 162 Ft.
OTHER ASSOCIATED PERMIT#(if applicable) Top Bottom Ft
SITE WELL ID #(if applicable) H-2 ; Top Bottom Ft
3. WELL USE (Check One Box) Monitoring ❑ Municipal/Public ❑ : 8. GROUT: Depth Material Method
Industrial/Commercial ❑ Agricultural ❑ Recovery ❑ Injection ❑
Irrigation❑ Other IN((list use) Closed IooD Geotherra
DATE DRILLED 1 1-15-1 1
4. WELL LOCATION:
Top 0 Bottom 167 Ft. Bentonite Pumped
Top 167 Bottom 450 Ft. washed stone _ooured
Top Bottom Ft.
9. SCREEN: Depth Diameter Slot Size Material
1166 Lotla Church Rd : Top Bottom Ft. in.
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code) :Top Bottom Ft. in.
CITY: Franklin COUNTY Macon
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
❑Slope ❑Valley VFW ❑Ridge ❑Other
KOMTCD 36 iAAAA&AAAAAAAA! CL ROR 3X0X7CDP100(MX CC
KNMFI'$TCD75 iAAAA&AAAAAAAA! CLROR 71x.WAX'J(9W)0 CC
Latitude/longitude source: EIGPS OTopographic map
(location of well must be shown on a USGS topo map andattached to
this form if not using GPS)
5. FACILITY (Name of the business where the well is located.)
Macon Flementary
Facility Name Facility ID# (if applicable)
1166 Lotla Church Rd
Street Address
Franklin N 8734
City or Town State Zip Code
Macon County Government
Contact Name
Mailing Address
Franklin NC 28743
City or Town State Zip Code
Area code Phone number
: Top Bottom Ft. in.
10. SAND/GRAVEL PACK:
Depth Size
Top Bottom Ft.
Top Bottom Ft.
Top Bottom Ft.
in.
in.
in.
Material
11. DRILLING LOG
Top Bottom Formation Description
0 / 82 Sand Clay
82 / 162 Broken Rock
162 1450 Granite 30 GPM
12. REMARKS:
easing Removed
S. WELL DETAILS: ; I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
• 15A NCAC 2C L CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
a. TOTAL DEPTH: 450 : RECORD W B N PROVIDED TO THE%ELL W R.
d� G�
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO G/ : SIGNATLAE OF CERTIFIED WELL CONTRACTOR DATE �1
c. WATER LEVEL Below Top of Casing: FT. : Ro,6er L. Williams
(Use "+" if Above Top of Casing) :PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit within 30 days of completion to: Division of Water Quality - Information Processing, Form Rev. 1 /08 /08
1617 Mail Service Center, Raleigh, NC 27699-161, Phone : [phone]

4 NONRESIDENTIAL WELL CONSTRUCTION RECORD
h o North Carolina Department of Environment and Natural Resources- Division of Water Quality
^�-""""„,•; WELL CONTRACTOR CERTIFICATION # 3065 A
1. WELL CONTRACTOR:
Roper L Williams
Well Contractor (Individual) Name
Tarheel Water Treatment
Well Contractor Company Name
3494 Georaia RD
Street Address
Franklin NC 28734
City or Town State Zip Code
8( 28 ) 369-0740
Area code Phone number
2. WELL INFORMATION:
WELL CONSTRUCTION PERMIT# W 10100141
OTHER ASSOCIATED PERMIT#(if applicable)
SITE WELL ID #(ifapplicable) H-3
3. WELL USE (Check One Box) Monitoring ❑ Municipal/Public ❑
Industrial/Commercial ❑ Agricultural ❑ Recovery ❑ Injection ❑
Irrigation❑ Other t9((list Use) Closed loon Geotherna
DATE DRILLED 1 1-10-1 1
4. WELL LOCATION:
1166 Lotla Church Rd
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
CITY. Franklin COUNTY Macon
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
❑Slope ❑Valley Flat ❑Ridge ❑Other
K@31$TCD 36 1AAAA&AAAAAAAA! CL R OR 3X^XX PXNO" CC
KNMFKTCD 75 1AAAA&AAAAAAAA! CL R OR 7A' WXXX'XW CC
Latitude/longitude source: BPS aopographic map
(location of well must be shown on a USGS topo map andattached to
this form if not using GPS)
5. FACILITY (Name of the business where the well is located.)
Macon Elementary
Facility Name Facility ID# (if applicable)
1166 Lotla Church Rd
Street Address
Franklin NC 28734
City or Town State Zip Code
Macon County Government
Contact Name
Mailing Address
Franklin NC 28743
City or Town State Zip Code
Area code Phone number
6. WELL DETAILS:
a. TOTAL DEPTH: 450
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO Gl�
d. TOP OF CASING IS
FT. Above Land Surface'
'Top of casing terminated attor below land surface may require
a variance in accordance
with 15A NCAC 2C .0118.
e. YIELD (gpm): _ 30 METHOD OF TEST BIDW Down
If. DISINFECTION: Type HTC: Amount 17 Qz
g. WATER ZONES (depth):
Top Bottom
Top Bottom
Top Bottom
Top Bottom
Top Bottom
Top Bottom
Thickness/
7. CASING: Depth
Diameter Weight Material
TOP 0 Bottom 162
Ft.
Top Bottom
Ft.
Top Bottom
Ft.
8. GROUT: Depth
Material Method
Top 0 Bottom 167
Ft. Bentonite Pumped
Top 167 Bottom 45Q_
Ft. washed stone poured
Top Bottom
Ft.
9. SCREEN: Depth
Diameter Slot Size Material
Top Bottom
Ft. in. in.
Top Bottom
Ft. in. in.
Top Bottom
Ft. in. in.
10. SAND/GRAVEL PACK:
Depth
Size Material
Top Bottom
Ft.
Top Bottom
Ft.
Top Bottom
Ft.
11. DRILLING LOG
Top Bottom
0 / 82
: 82 / 162
162 / 450
/
: 12. REMARKS:
Formation Description
Sand Clay
Broken Rock
Granite 30 GPM
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
15A NCAC 2C, WELL CONSTRUCTION ST CDARDS, AND THAT A COPY OF THIS
RECORD�ENPROVID TO T HE E�NP-
11-10-11
SIGNATURE OF CERTIFIED WELL CONTRACTOR DATE
c. WATER LEVEL Below Top of Casing: FT. : _ RODer L _ WI IIIamS
(Use "+^ if Above Top of Casing) : PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit within 30 days of completion to: Division of Water Quality - information Processing, Form GW-1b
1617 Mail Service Center, Raleigh, NC 27699-161, Phone :Rev. 1 /06
(919) 807-1i300

1 r ONRESIDENTL4L WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
?'�` """"" • 7. WELL CONTRACTOR CERTIFICATION # 3065 A
1. WELL CONTRACTOR:
Roaer L Williams
Well Contractor (Individual) Name
Tarheel Water Treatment
Well Contractor Company Name
3494 Georgia RD
Street Address
Franklin NC 28734
City or Town State Zip Code
8(_ 28 _) 369-0740
Area code Phone number
2. WELL INFORMATION:
WELL CONSTRUCTION PERMIT# W10100141
OTHER ASSOCIATED PERMIT#(if applicable)
SITE WELL ID #(ifapplicable) H-4
3. WELL USE (Check One Box) Monitoring ❑ Municipal/Public ❑
Industrial/Commercial ❑ Agricultural ❑ Recovery ❑ Injection ❑
Irrigation❑ Other I((!ist use) Closed looD Geotherra
DATE DRILLED 1 1-9-1 1
4. WELL LOCATION:
1166 Lotla Church Rd
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
CITY: Franklin COUNTY Macon
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
[]Slope []Valley &(Flat ❑Ridge ❑Other
Kol$TCD 36 iAAAA&AAAAAAAAI CL R OR 3X4XMX00MX CC
KNMFI$TCD75 iAAAA&AAAAAAAA! CLROR 7A.'f(`kkXXXOM CC
Latitude/longitude source: ❑GPS Oropographic map
(location of well must be shown on a USGS topo map andattached to
this form if not using GPS)
5. FACILITY (Name of the business where the well is located.)
Macon Elementary
Facility Name Facility ID# (if applicable)
1166 Lotla Church Rd
Street Address
Franklin NC 28734
City or Town State Zip Code
Macon County Government
Contact Name
Mailing Address
Franklin NC 28743
City or Town State Zip Code
U
Area code Phone number
6. WELL DETAILS:
a. TOTAL DEPTH: 450
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO q/
d. TOP OF CASING IS FT. Above Land Surface -
'Top of casing terminated atior below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
: e. YIELD (gpm): 30 METHOD OF TEST abw Down
f. DISINFECTION: Type I -ITC Amount 11 —Qz —
: g. WATER ZONES (depth):
Top Bottom Top Bottom
Top Bottom Top Bottom
Top Bottom Top Bottom
Thickness/
7. CASING: Depth Diameter Weight Material
Top 0 Bottom 152 Ft.
Top Bottom Ft.
Top Bottom Ft.
8. GROUT:
Depth
Material Method
Top 0
Bottom 157
Ft. Bentonite Pumped
Top 157
Bottom 450
Ft._ washed stone poured
Top
Bottom
Ft.
9. SCREEN:
Depth
Diameter Slot Size Material
Top
Bottom
Ft. in. in.
Top
Bottom
Ft. in. in.
Top
Bottom
Ft. in. in.
10. SAND/GRAVEL PACK:
Depth
Size Material
Top
Bottom
Ft.
Top
Bottom
Ft.
Top
Bottom
Ft.
11. DRILLING LOG
Top Bottom
0 / 82
82 1 155
155 / 450
/
12. REMARKS:
Formation Description
Sand Clay
Broken Rock
Granite 30 GPM
100 HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
15A NCAC 2C,yyELL CONSTRUCTION ST ARDS, AND THAT A COPY OF THIS
RECORD :KS` EEN PROVI TO THE EL NER.
d
SIGNAT E OF CERTIFIED WELL CONTRACTOR DATE1—�
c. WATER LEVEL Below Top of Casing: FT. }�o�P.r L. WIIIIamS
(Use "+" if Above Top of Casing) : PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit within 30 days of completion to: Division of Water Quality - Information Processing, Form GW-1b
Rev. 1 /08
1617 Mail Service Center, Raleigh, NC 27699-161, Phone : [phone]

d �
1 r ONRESIDENTLQL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 2185 A
1. WELL CONTRACTOR:
Stanlev K. Setzer
Well Contractor (Individual) Name
Mid South Geothermal
Well Contractor Company Name
8275 Tournament Dr.
Street Address
Memphis Tn 38125
City or Town State Zip Code
9( 01�) 748-9095
Area code Phone number
2. WELL INFORMATION:
d. TOP OF CASING IS RRMnVPd 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): 150 METHOD OF TEST Air BIOW
f. DISINFECTION: Type Amount
g. WATER ZONES (depth):
Top Bottom Top Bottom
:Top Bottom Top Bottom
Top Bottom .Top Bottom
CASING: Depth Diameter
WELL CONSTRUCTION PERMIT# WI0100141 : Top 0 Bottom 96 Ft. 6 5/8
OTHER ASSOCIATED PERMIT#(if applicable) Top Bottom Ft.
SITE WELL ID #(if applicable) H-5 Top Bottom Ft.
3. WELL USE (Check One Box) Monitoring ❑ Municipal/Public ❑ : 8. GROUT: Depth Material
Industrial/Commercial ❑ Agricultural ❑ Recovery ❑ Injection ❑
Irrigation[] Other W(iist use) Closed LoCID Geothere
DATE DRILLED 1 1-4-1 1
4. WELL LOCATION:
1166 lotla Church Rd
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
CITY: Franklin COUNTY Macon
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
❑Slope ❑Valley U'Flat ❑Ridge ❑Other
LATITUDE 36 �' " DMS OR 3X.XXXXXXXXX DID
LONGITUDE 75 " DMS OR 7X.XXXXXXXXX DID
Latitudellongitude source: ❑GPS []Topographic map
(location of well must be shown on a USGS topo map andettached to
this form if not using GPS)
5. FACILITY (Name of the business where the well is located.)
Macon Flementary School _
Facility Name Facility ID# (if applicable)
1166 lotla Church Rd
Street Address
Franklin NC 28734
City or Town State Zip Code
Macon County Government
Contact Name
Mailing Address
Franklin NCB 28734
City or Town State Zip Code
Area code
Phone number
S. WELL DETAILS:
a. TOTAL DEPTH: 451
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO qI
Thickness/
Weight Material.
.250 steel
Method
Top 0 Bottom 101
Ft. BentOnite Pumped
: Top 101 Bottom 451
Ft. Washed StonE Poured
Top Bottom
Ft.
9. SCREEN: Depth
Diameter Slot Size Material
Top Bottom
Ft. in. in.
Top Bottom
Ft. in. in.
Top Bottom
Ft. in. in.
10. SAND/GRAVEL PACK:
Depth
Size Material
Top Bottom
Ft.
Top Bottom
Ft.
Top Bottom
Ft.
11. DRILLING LOG
Top Bottom
Formation Description
0 / 20
Red Clay
20 / 65
Brown Clay
65 / 92
sandy Soil
92 —/ 100
Sand Rock
100 / 142
Granite
142 / 150
Broken Rock
150 / 280
Granite
280 /_ 320
Soft Granite
320 / 451
Granite
/
/
: 12. 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
11-4-11
SIG URE OF CERTIFIED WELL CONTRACTOR DATE
c. WATER LEVEL Below Top of Casing: FT. : Manley K_ SPt7pr
(Use "+" if Above Top of Casing) : PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit within 30 days of completion to: Division of Water Quality - Information Processing, Form Rev. 2109/09
1617 Mail Service Center, Raleigh, NC 27699-161, Phone : [phone]

1 r ONRESIDENTM WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 2185 A
1. WELL CONTRACTOR:
Stanley K. Setzer
Well Contractor (Individual) Name
Mid South Geothermal
Well Contractor Company Name
8275 Tournament Dr.
Street Address
Memphis Tn 38125
City or Town State Zip Code
9( 01 ) 748-9095
Area code Phone number
2. WELL INFORMATION:
WELL CONSTRUCTION PERMIT# W 10100141
OTHER ASSOCIATED PERMIT#(if applicable)
SITE WELL ID #(if applicable) H-6A
3. WELL USE (Check One Box) Monitoring ❑ Municipal/Public ❑
Industrial/Commercial ❑ Agricultural ❑ Recovery ❑ Injection ❑
Irrigation❑ Other s6ist use) Closed Loop Geothere
DATE DRILLED 10-31-11
: d. TOP OF CASING IS RPmoVPd 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): 100+ METHOD OF TEST Air BIOW
f. DISINFECTION: Type
Amount
g. WATER ZONES (depth):
Top Bottom
Top Bottom
Top Bottom
Top Bottom
Top Bottom
Top Bottom
Thickness/
:7. CASING: Depth
Diameter Weight Material
Top 0 Bottom 87
Ft. 6 5/8 .250 steel
Top Bottom
Ft.
Top Bottom
Ft.
8. GROUT: Depth
Material Method
Top 0 Bottom 92
Ft. Bentonite Pumped
Top 92 Bottom 366
Ft. Washed stont Poured
j Top Bottom
Ft.
4. WELL LOCATION: ; 9. SCREEN: Depth Diameter Slot Size Material
1166 lotla Church Rd : Top Bottom Ft. in. in.
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code) ;Top Bottom Ft. in. in.
CITY: Franklin COUNTY Macon
TOPOGRAPHIC / LAND SETTING: (check appropriate box).
❑Slope ❑Valley VFlat ❑Ridge ❑Other
K@SKTCD 36 iAAAA&AAAAAAAAI CL ROR 3X( XXXX?AkWX CC
KNMFKTCD75 iAAAA&AAAAAAAA! CLROR 7k.'X'kk7t9U'(0ow CC
Latitude/Iongitude source: ❑GPS aopographic map
(location of well must be shown on a USGS topo map andattached to
this form if not using GPS)
5. FACILITY (Name of the business where the well is located.)
Macon Flementary School
Facility Name Facility ID# (if applicable)
1166 lotla Church Rd
Street Address
Franklin NC 28734
City or Town State Zip Code
Macon County Government
Contact Name
Mailing Address
Franklin NC 98734
City or Town State Zip Code
U
Area code
Phone number
6. WELL DETAILS:
a. TOTAL DEPTH:_ 366
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO IV
: Top Bottom Ft. in.
: 10. SAND/GRAVEL PACK:
Depth Size
Top Bottom Ft.
Top Bottom Ft.
in.
Material
Top Bottom Ft.
11. DRILLING LOG
Top Bottom Formation Description
0
/ 20
20
/ 71
70
/ 85
85
/ 150
150
/ 157
157
/ 345
345
/ 366
/
12. REMARKS:
Red Cla
Brown Clay
sandy Soil
Granite
Broken Granite
Granite
Granite Gravel
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 CERTIFIED WELL CONTRACTOR DATE
C. WATER LEVEL Below Top of Casing: FT. Stanley K_ Setzer
(Use "+" if Above Top of Casing) : PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit within 30 days of completion to: Division of Water Quality Form /08
Y p ty - Information Processing, Rev. 1/O8
1617`Mail Service Center, Raleigh, NC 27699-161, Phone: [phone]

J4V �V,,Y• AVh �V
�P F
]� �
ONRESIDENTL4L
,'
1 r WELL CONSTRUCTION RECORD
J. �.' c'
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 2185 A
1. WELL CONTRACTOR:
Stanlev K. Setzer
Well Contractor (Individual) Name
Mid South Geothermal
Well Contractor Company Name
8275 Tournament Dr.
Street Address
Memphis Tn 38125
City or Town State Zip Code
9( 01 ) 748-9095
Area code Phone number
2. WELL INFORMATION:
WELL CONSTRUCTION PERMIT# W10100141
OTHER ASSOCIATED PERMIT#(if applicable)
SITE WELL ID #(if applicable) H-6B
3. WELL USE (Check One Box) Monitoring ❑ Municipal/Public ❑
Industrial/Commercial ❑ Agricultural ❑ Recovery ❑ Injection ❑
Irrigation❑ Other t((list use) Closed Loop Geothero
DATE DRILLED 11-1-11
4. WELL LOCATION:
1166 lotla Church Rd
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
CITY: Franklin COUNTY Macon
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
❑ Slope ❑ Valley (Flat []Ridge [-]Other
KI@3ISTCD 36 1AAAA&AAAAAAAA! CL ROR 3X0X'XXX1AW&X CC
KNMFBTCD75 iAAAA&AAAAAAAA! CL ROR 7`kJbCXXYAXW CC
Latitude/longitude source: ❑GPS ❑ropographic map
(location of well must be shown on a USGS topo map andattached to
this form if not using GPS)
5. FACILITY (Name of the business where the well is located.)
Macon FlemPntary School
Facility Name Facility ID# (if applicable)
1166 lotla Church Rd
Street Address
Franklin NC 28734
City or Town State Zip Code
Macon County Government
Contact Name .
Mailing Address
Franklin NG 28734
City or Town State Zip Code
U
Area code Phone number
6. WELL DETAILS:
a. TOTAL DEPTH:_ 89
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO pI
d. TOP OF CASING IS RPMnVP.d 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_Air gIOW
f. DISINFECTION: Type Amount
g. WATER ZONES (depth):
Top Bottom
Top Bottom
Top Bottom
Top
Bottom
Top
Bottom
Top
Bottom
Thickness/
: 7. CASING:
Depth
Diameter Weight Material
: Top 0
Bottom
Ft. 6 5/8 .250 Steel
Top
Bottom
Ft.
Top
Bottom
Ft.
8. GROUT:
Depth
Material Method
Top 0
BottomB� Ft. Bentonite Pumped
Top
Bottom
Ft.
Top
Bottom
Ft.
9. SCREEN:
Depth
Diameter Slot Size Material
Top
Bottom
Ft. in. in.
Top
Bottom
Ft. in. in.
Top
Bottom
Ft. in. in.
10. SAND/GRAVEL PACK:
Depth
Size Material
Top
Bottom
Ft.
Top
Bottom
Ft.
Top
Bottom
Ft.
: 11. DRILLING LOG
Top Bottom Formation Description
0 / 20
20 / 70
70 89
1
12. REMARKS:
Red Clay
Brown Clay
sandy Soil
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
• 15A NCAC 2C, WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
RECORD HAS BEEN PROVIDED TO THE WELL OWNER
• �s � S�� 11_1_11
SIGNATURE OF CERTiFIE©-WELL CONTRACTOR DATE
c. WATER LEVEL Below Top of Casing: 70 FT. StanleyK. SPt7er
(Use "+" if Above Top of Casing) : PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit within 30 days of completion to: Division of Water Quality Form /08
Y P ty - Information Processing, Rev. 1/08
1617 Mail Service Center, Raleigh, NC 27699-161, Phone : [phone]

,;•6rn5TATo
NONRESIDENTL4L
WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 2185-A
1. WELL CONTRACTOR:
Stanlev K. Setzer
Well Contractor (individual) Name
Mid South Geothermal
Well Contractor Company Name
8275 Tournament Dr.
Street Address
Memohis Tn 38125
City or Town State Zip Code
9c 01 ) 748-9095
Area code Phone number
2. WELL INFORMATION:
WELL CONSTRUCTION PERMIT# W10100141
OTHER ASSOCIATED PERMIT#(if applicable)
SITE WELL ID #(if applicable) H-7A
3. WELL USE (Check One Box) Monitoring ❑ Municipal/Public ❑
Industrial/Commercial ❑ Agricultural ❑ Recovery ❑ Injection ❑
Irrigation❑ Other W(list use) Closed LOoO Geotherd
DATE DRILLED 10-26-1 1
4. WELL LOCATION:
1166 lotla Church Rd
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
CITY:Franklin COUNTY Macon
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
❑ Slope []Valley prFlat ❑ Ridge []Other
KOISTCD 36 iAAAA&AAAAAAAA! CL R OR 3iC4x7(X>tC9QX xx CC
KNMFISTCD75 iAAAA&AAAAAAAA! CL ROR 71k.'X'X` AXX'W CC
Latitude/longitude source: OGPS Dropographic map
(location of well must be shown on a USGS topo map andattached to
this form if not using GPS)
5. FACILITY (Name of the business where the well is located.)
Macon Elementary Schonl
Facility Name Facility ID# (if applicable)
1166 lotla Church Rd
Street Address
Franklin N 8734
City or Town State Zip Code
Macon County Government
Contact Name
Mailing Address
Franklin NC 28734
City or Town State Zip Code
Area code Phone number
6. WELL DETAILS:
a. TOTAL DEPTH:330'
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO [�
d. TOP OF CASING IS RemoVed 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 Air gIOW
f. DISINFECTION: Type Amount
: g. WATER ZONES (depth)
Top
Bottom
Top
Bottom
:Top
Bottom
Top
Bottom
Top
Bottom
Top
Bottom
Thickness/
7. CASING:
Depth
Diameter
Weight Material
Top 0
Bottom 83
Ft. 6 5 8
.250 steel
Top
Bottom
Ft.
Top
Bottom
Ft.
8. GROUT:
Depth
Material
Method
Top 0
Bottom 88
Ft. bentonite _pumped
Top 88 Bottom 330 Ft. washed stonF pourd
Top Bottom Ft.
9. SCREEN: Depth Diameter Slot Size Material
Top Bottom Ft. in. in.
Top Bottom Ft. in. in.
Top Bottom Ft. in. in.
10. SAND/GRAVEL PACK:
Depth Size Material
Top Bottom Ft.
Top Bottom Ft.
Top Bottom Ft.
11. DRILLING LOG
Top Bottom Formation Description
: 12. 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.
1426-
SIGNATURE OF CERTIFIED WELL CONTRACTOR DATE
c. WATER LEVEL Below Top of Casing: FT. : Stanley K. SP.tZer .
(Use "+^ if Above Top of Casing) : PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit within 30 days of completion to: Division of. Water Quality - Information Processing, Form GW-1b
Rev. 1 /08
1617 Mail Service Center, Raleigh, NC 27699-161; Phone : [phone]

y` 1 � ONRESIDENTIAL WELL CONSTRUCTION RECORD
+" _�; North Carolina Department of Environment and Natural Resources- Division of Water Quality
y J.
v� �,• 1 T I WELL CONTRACTOR CERTIFICATION # 2185 A
1. WELL CONTRACTOR:
Stanley K. Setzer
Well Contractor (Individual) Name
Mid South Geothermal
Well Contractor Company Name
8275 Tournament Dr.
Street Address
Memphis Tn 38125
City or Town State Zip Code
9( 01 ) 748-9095
Area code Phone number
2. WELL INFORMATION:
WELL CONSTRUCTION PERMIT# W10100141
OTHER ASSOCIATED PERMIT#(if applicable)
SITE WELL ID #(if applicable) H-7B
3. WELL USE (Check One Box) Monitoring ❑ Municipal/Public ❑
Industrial/Commercial ❑ Agricultural ❑ Recovery ❑ Injection ❑
Irrigation❑ Other [§((list use) Closed Loop Geotherd
DATE DRILLED 1 1-2-11
4. WELL LOCATION:
1166 lotla Church Rd
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
CITY: Franklin COUNTY Macon
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
[]Slope []Valley Flat ❑Ridge ❑Other
KIff3I$TCD 36 1AAAA&AAAAAAAA! CL ROR 3iCmx)XfA)WX CC
KNNTI$TCD75 iAAAA&AAAAAAAA! CL ROR 7'xlXkk7tD(9("m CC
Latitude/longitude source: []GPS Oropographic map
(location of well must be shown on a USGS topo map andattached to
this form if not using GPS)
5. FACILITY (Name of the business where the well is located.)
Macon Flementary School
Facility Name Facility ID# (if applicable)
1166 lotla Church Rd
Street Address
Franklin NC 28734
City or Town State Zip Code
Macon County Government
Contact Name
Mailing Address
Franklin NC 28734
City or Town State Zip Code
(---)
Area code Phone number
: d. TOP OF CASING IS RPMf)VP.d FT. Above Land Surface`
'Top of casing terminated attor below land surface may require
a variance in accordance
with 15A NCAC 2C .0118.
e. YIELD (gpm):
METHOD OF TEST Air Bloom_
f. DISINFECTION: Type
Amount
g. WATER ZONES (depth):
:Top Bottom
Top Bottom
:Top Bottom
Top Bottom
;Top Bottom
Top Bottom
Thickness/
7. CASING: Depth
Diameter Weight Material
Top 0 Bottom 87
Ft. 6_ 6/8 .250 steel
Top Bottom
Ft.
Top Bottom
Ft.
8. GROUT: Depth
Material Method
Top 0 Bottom 87
Ft. Bentonite Pumped
Top 87 Bottom 120
Ft. Washed stone poured
Top Bottom
Ft.
9. SCREEN: Depth
Diameter Slot Size Material
Top Bottom
Ft. in. in.
Top Bottom
Ft. in. in.
Top Bottom
Ft. In. in.
10. SAND/GRAVEL PACK:
Depth
Size Material
Top Bottom
Ft.
Top Bottom
Ft.
Top Bottom
Ft.
: 11. DRILLING LOG
Top Bottom
0
/ 20
20
/ 70
70
/ 90
90
/ 120
/
12. REMARKS:
Formation Description
Red Clay
Brown Clay
sandy Soil
Granite
6. WELL DETAILS: I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
• 15A NCAC 2C, WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
a. TOTAL DEPTH: 120 : RECORD HAS BEEN PROVIDED TO THE WELL OWNER
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO qI 11 : SIGN RE OF CERTIFIED WELL CONTRACTOR _ DATE
C. WATER LEVEL Below Top of Casing: 70 FT. ; Stanley K. Set7Pr
(Use "+" if Above Top of Casing) : PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit within 30 days of completion to: Division of Water Quality Form /08
Y P ty - Information Processing, Rev. 1/08
1617 Mail Service. Center, Raleigh, NC 27699-161, Phone : [phone]

NONREUDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 2185 A
1. WELL CONTRACTOR:
Stanley K. Setzer
Well Contractor (Individual) Name
Mid South Geothermal
Well Contractor Company Name
8275 Tournament Dr.
Street Address
Memphis Tn 38125
City or Town State Zip Code
9t 01 ) 748-9095
Area code Phone number
d. TOP OF CASING is RP-MOVPd 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): 100 METHOD OF TEST Air glow
f. DISINFECTION: Type Amount
g. WATER ZONES (depth):
Top_70 Bottom.450 Top Bottom
:Top Bottom Top Bottom
Top Bottom Top Bottom
2. WELL INFORMATION: ; 7. CASING: Depth Diameter
WELL CONSTRUCTION PERMIT# WI0100141 : Topes Bottom 82 Ft. 6 5/8
OTHER ASSOCIATED PERMIT#(if applicable) Top Bottom Ft.
SITE WELL ID #(if applicable) H-8 Top Bottom Ft.
3. WELL USE (Check One Box) Monitoring ❑ Municipal/Public ❑
Industrial/Commercial ❑ Agricultural ❑ Recovery ❑ Injection ❑
Irrigation[] Other [I((list use) Closed Loop Geotherd
DATE DRILLED 10-24-1 1
4. WELL LOCATION:
1166 lotla Church Rd
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
CITY. Franklin COUNTY Macon
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
❑Slope ❑Valley VFlat []Ridge ❑Other
K@3I$TCD 36 iAAAA&AAAAAAAA! CL ROR 3X^XXi(X9"X CC
KNIVIFI$TCD 75 iAAAA&AAAAAAAA! CL R OR N.'x5P)QX!(9t0'X9P CC
Latitude/longitude source: DOPS Qropographic map
(location of well must be shown on a USGS topo map andattached to
this form if not using GPS)
S. FACILITY (Name of the business where the well is located.)
Macon Flementary School
Facility Name Facility ID# (if applicable)
1166 lotla Church Rd
Street Address
Franklin NC 2873
City or Town State Zip Code
Macon County Gov _rnm .nt
Contact Name
Mailing Address
Franklin NC 28734
City or Town State Zip Code
Area code
Phone number
Thickness/
Weight Material
.250 steel
: 8. GROUT: Depth
Material
Method
TopBottom 87
Ft. bentonite pumped
Top 87 Bottom 450
Ft. washed stone _poured
Top Bottom
Ft.
9. SCREEN: Depth
Diameter Slot Size
Material
Top Bottom
Ft. in. in.
Top Bottom
Ft. in. in.
Top Bottom
Ft. in. in.
10. SAND/GRAVEL PACK:
Depth
Size Material
Top Bottom
Ft.
Top Bottom
Ft.
Top Bottom
Ft.
11. DRILLING LOG
Top Bottom
0 / 30
30 / 78
78 / 195
195 / 450
/
Formation Description
Red Clay
Brown Clay
Mixture of soft and hard granite
Blue granite
12. REMARKS:
11itwater with broken lock @145' to 155'
6. WELL DETAILS: I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
• 15A NCAC 2C, WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
a. TOTAL DEPTH:_ 450' RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NOW r�L � � �- � 10-24-11
SIGNATURE OF CERTIFIED WELL CONTRACTOR DATE
c. WATER LEVEL Below Top of Casing: 70 FT. ; _ Stanley K- SetZP_r
(Use "+•• if Above Top of Casing) : PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit within 30 days of completion to: Division of Water Quality - Information Processing, Form GW-1b
Rev. 1/08
1617 Mail Service Center, Raleigh, NC 27699-161, Phone : [phone]

NONRESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 2185-A
1. WELL CONTRACTOR:
Stanley K. Setzer
Well Contractor (Individual) Name
Mid South Geothermal
Well Contractor Company Name
8275 Tournament Dr.
Street Address
Memphis Tn 38125
City or Town State Zip Code
9( 01 ) 748-9095
Area code Phone number
2. WELL INFORMATION:
WELL CONSTRUCTION PERMIT# W10100141
d. TOP OF CASING IS Remt)ye(i 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): 2 METHOD OF TEST_Alr JQW
f. DISINFECTION: Type Amount
g. WATER ZONES (depth):
Top Bottom Top Bottom
Top Bottom Top Bottom
Top Bottom Top Bottom
Thickness/
7. CASING:. Depth Diameter Weight Material
Top 0 - Bottom 65 Ft. 6 5/8 .250 steel
OTHER ASSOCIATED PERMIT#(if applicable)
Top
Bottom
Ft.
SITE WELL ID #(if applicable) 1-7
; Top
Bottom
Ft.
3. WELL USE (Check One Box) Monitoring ❑ Municipal/Public ❑
: 8. GROUT:
Depth
Material Method
Industrial/Commercial ❑ Agricultural ❑ Recovery [I Injection ❑
: Top 0
Bottom 70
Ft. Bentonite Pumped
Irrigation❑ Other N((list use) Closed Loop Geothere
Top 70
Bottom 450
Ft. washed stone poured
DATE DRILLED 10-28-1 1
; Top
Bottom
Ft.
4. WELL LOCATION:
; 9. SCREEN:
Depth
Diameter Slot Size Material
1166 Iotla Church Rd : Top Bottom Ft. in.
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code) :Top Bottom Ft. in.
CITY: Franklin COUNTY Macon
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
❑Slope []Valley Flat ❑Ridge ❑Other
pqg�ISTCD 36 IAAAA&AAAAAAAAI CL R OR 3XC XXl(X9&WX CC
KNMFISTCD75 jAAAA8IAAAAAAAA!CLRORN.�(9CkRX9WDOCC
Latitude/longitude source: OGPS Qropographic map
(location of well must be shown on a USGS topo map andattached to
this form if not using GPS)
5. FACILITY (Name of the business where the well is located.)
Macon Flementary School
Facility Name Facility ID# (if applicable)
1166 lotla Church Rd
Street Address
Franklin NO 28734
City or Town State Zip Code
Macon County Government
Contact Name
Mailing Address
Franklin NC 28734
City or Town State Zip Code
U
Area code Phone number
6. WELL DETAILS:
a. TOTAL DEPTH: 450
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO I/
: Top Bottom Ft. in.
10. SAND/GRAVEL PACK:
Depth Size
Top Bottom Ft.
Top Bottom . Ft.
Top Bottom Ft.
11. DRILLING LOG
Top
Bottom
0
/ 20
20
/ 69
69_/ 82
82
/ 152
152
/ 162
162
/ 450
12. REMARKS:
in.
in.
in.
Material
Formation Description
Red Cla
Brown Clay
sandy Soil
Granite
Broken Granite
Granite
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 CERTIFIED WELL CONTRACTOR DATE
c. WATER LEVEL Below Top of Casing: FT. : _Stanle�K. Set7erSet7P_r
(Use "+" if Above Top of Casing) : PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit within 30 days of completion to: Division of Water Quality - Information Processing, Form GW 1b
Rev. 1 /08
1617 Mail Service Center, Raleigh, INC 27699-161, Phone : [phone]

re
NONRESIDENTIAL WELL CONSTRUCTION RECORD
i x North Carolina Department of Environment and Natural Resources- Division of Water Quality
P Qu tY -�y, WELL CONTRACTOR CERTIFICATION # 3065 A
1. WELL CONTRACTOR:
Roger L Williams
Well Contractor (Individual) Name
Tarheel Water Treatment
Well Contractor Company Name
3494 Georgia RD
Street Address
Franklin NC 28734
City or Town State Zip Code
8f 28 ) 369-0740
Area code Phone number
2. WELL INFORMATION:
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): 30 METHOD OF TEST 3tQW )n=
f. DISINFECTION: Type HTC Amount 2 07
g. WATER ZONES (depth):
Top Bottom Top Bottom
Top Bottom Top Bottom
Top Bottom Top Bottom
Thickness/
7. CASING: Depth Diameter Weight Material
WELL CONSTRUCTION PERMIT# W 10100141 : Top0_ Bottom 195 Ft.
OTHER ASSOCIATED PERMIT#(if applicable) Top Bottom Ft.
SITE WELL ID #(ifapplicable) K-5 ; Top Bottom Ft.
3. WELL USE (Check One Box) Monitoring ❑ Municipal/Public ❑ : 8. GROUT: Depth Material
Industrial/Commercial ❑ Agricultural ❑ Recovery❑ Injection ❑
Irrigation[] Other 4'(list use) Closed 100D Geotherre
DATE DRILLED 1 1-8-1 1
4. WELL LOCATION:
1166 Lotla Church Rd
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
CITY: Franklin COUNTY Macon
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
❑Slope ❑Valley pj`Flat ❑Ridge ❑Other
KI93f$TCD 36 iAAAA&AAAAAAAAI CL R OR 3X( XXXXPA)WX CC
KNMFf$TCD75 1AAAA&AAAAAAAAI CLROR 7'x.�Ck` xxxw* CC
Latitude/longitude source: E]GPS Qropographic map
(location of well must be shown on a USGS topo map andaftached to
this form if not using GPS)
5. FACILITY (Name of the business where the well is located.)
Macon Flementary
Facility Name Facility ID# (if applicable)
'1166 LOtla Church Rd
Street Address
Franklin N 8734
City or Town State Zip Code
Macon County Government
Contact Name
Mailing Address
Franklin NC' 28743
City or Town State Zip Code
Area code
Phone number
6. WELL DETAILS:
a. TOTAL DEPTH: 450
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO qI
c. WATER LEVEL Below Top of Casing: FT
(Use "+" if Above Top of Casing)
Method
Top 0 Bottom-200
Ft._ Bentonite
Pumped
Top 20Q_ Bottom 450
Ft. washed stone
poured
Top Bottom
Ft.
9. SCREEN: Depth
Diameter Slot Size Material
Top Bottom
Ft. in.
in.
Top Bottom
Ft. in.
in.
Top Bottom
Ft. in.
in.
10. SAND/GRAVEL PACK:
Depth
Size Material
Top Bottom
Ft.
Top Bottom
Ft.
Top Bottom
Ft.
11. DRILLING LOG
Top Bottom
0 / 82
82 / 185
185 450
12. REMARKS:
Formation Description
Sand Clay
Broken Rock
Granite 30 GPM
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
15A NCAC 2C:,IVLL CONSTRUCTION S ANDARDS, AND THAT A COPY OF THIS
RECORD S VEN PROV ED TO T E W l_ER.
SIGNAT RE OF CERTIFIED WELL CONTRACTOR DATE
1
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit within 30 days of completion to: Division of Water Quality - Information Processing, Form GW-1b
1617 Mail Service Center, Raleigh, NC 27699-161, Phone : [phone] Rev. 1 /08

1 r ONRESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 3065 A
1. WELL CONTRACTOR:
Roger L Williams
Well Contractor (Individual) Name
Tarheel Water Treatment
Well Contractor Company Name
3494 Georgia RD
Street Address
Franklin NC 28734
City or Town State Zip Code
8( 28 ) 369-0740
Area code Phone number
2. WELL INFORMATION:
WELL CONSTRUCTION PERMIT# W10100141
OTHER ASSOCIATED PERMIT#(if applicable)
SITE WELL ID #(if applicable) K-6A
3. WELL USE (Check One Box) Monitoring ❑ Municipal/Public ❑
Industrial/Commercial ❑ Agricultural ❑ Recovery ❑ Injection ❑
Irrigation❑ Other [(list use) Closed IooD Geotherre
DATE DRILLED 1 1-3-1 1
4. WELL LOCATION:
1166 Lotla Church Rd
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
CITY: Franklin COUNTY Macon
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
[]Slope ❑ Valley Flat ❑ Ridge ❑ Other
K0l$TCD 36 iAAAA&AAAAAAAAI CL R OR 3mX)1XXPA)Wx CC
KNMFI$TCD75 iAAAA&AAAAAAAAI CLROR 71x.'X' )tX'1()W cc
Latitude/longitude source: []GPS aopographic map
(location of well must be shown on a USGS topo map andattached to
this form if not using GPS)
5. FACILITY (Name of the business where the well is located.)
Macon Flementary
Facility Name Facility ID# (if applicable)
1166 Lotla Church Rd
Street Address
Franklin NO 28734
City or Town State Zip Code
Macon County Goyernm .nt
Contact Name
Mailing Address
Franklin NC 28743
City or Town State Zip Code
Area code
Phone number
6. WELL DETAILS:
a. TOTAL DEPTH: 200
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO qI
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): 50 METHOD OF TEST 3tQW Down
f. DISINFECTION: Type HIG Amount__12-07_
g. WATER ZONES (depth):
Top Bottom Top Bottom
:Top Bottom Top Bottom
;Top Bottom Top Bottom
Thickness/
7. CASING: Depth Diameter Weight Material
Top 0 Bottom 155 Ft.
Top Bottom Ft.
Top Bottom Ft.
8. GROUT: Depth Material Method
Top 0 Bottom 170' Ft. Sentonite Pumped
:Top 170 Bottom 200 Ft. washed stone poured
Top Bottom Ft.
9. SCREEN: Depth Diameter Slot Size Material
Top Bottom Ft. in. in.
Top Bottom Ft. in. in.
Top Bottom Ft. in. in.
10. SAND/GRAVEL PACK:
Depth Size
Top
Bottom Ft.
Top
Bottom Ft.
: Top
Bottom Ft.
11. DRILLING LOG
Top Bottom
0 / 82
82 / 165
165 / 200
/
12. REMARKS:
Material
Formation Description
Sand Clay
Broken Rock
Loose Gravel 50 GPM
easing Removed
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
• 15A NCAC 2C, WELL CONSTRUCTION ST NDARDS, AND THAT A COPY OF THIS
RECORD EN PROVI TO TH EL NER
a 11-03-11
SIGNAT E OF CERTIFIED WELL CONTRACTOR DATE
C. WATER LEVEL Below Top of Casing: FT. Roger L. Wllllams
(Use "+" if Above Top of Casing) : PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit within 30 days of completion to: Division of Water Quality - Information Processing, Form GW-1 b
Rev. 1 /08
1617 Mail Service Center, Raleigh, NC 27699-161, Phone : [phone]

:�' of STATE o�
rtp,
NONRESIDENTL4L
WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division Water
of Quality
„;Y«,,•�,�.*� _�•
WELL CONTRACTOR CERTIFICATION # 3065 A
1. WELL CONTRACTOR:
Roger L Williams
Well Contractor (Individual) Name
Tarheel Water Treatment
Well Contractor Company Name
3494 Georaia RD
Street Address
Franklin NC 28734
City or Town State Zip Code
8( 28 ) 369-0740
Area code Phone number
2. WELL INFORMATION:
WELL CONSTRUCTION PERMIT# W 10100141
OTHER ASSOCIATED PERMIT#(if applicable)
SITE WELL ID #(If applicable) K-7
3. WELL USE (Check One Box) Monitoring ❑ Municipal/Public ❑
Industrial/Commercial ❑ Agricultural ❑ Recovery ❑ Injection ❑
Irrigation❑ Other p{(list use) Closed 100D Geotherrm
DATE DRILLED 10-31-11
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): 50 METHOD OF TEST BIoW DOWn
f. DISINFECTION: Type HTC Amounty z
g. WATER ZONES (depth):
Top Bottom Top Bottom
Top Bottom Top Bottom
Top Bottom Top Bottom
Thickness/
7. CASING: Depth Diameter Weight Material
Top_0 Bottom 82 Ft.
Top Bottom Ft.
Top Bottom Ft.
8. GROUT: Depth Material Method
Top 0 Bottom 887 Ft. Bentonite Pumped
Top 87 Bottom 450 Ft. washed stone poured
Top Bottom Ft.
4. WELL LOCATION: ; 9. SCREEN: Depth Diameter Slot Size Material
1166 Lotla Church Rd : Top Bottom Ft. in.
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code) :Top Bottom Ft. in. in.
CITY: Franklin COUNTY Macon
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
[]Slope ❑ Valley Flat ❑ Ridge ❑ Other
KOISTCD 36 iAAAA&AAAAAAAA! CL R OR 3!K,%W"00MX CC
KNMFPST CD75 !AAAA&AAAAAAAA! CLROR 7A.'X' XXXWXX CC
Latitude/longitude source: OGPS aopographic map
(location of well must be shown on a USGS topo map andattached to
this form if not using GPS)
5. FACILITY (Name of the business where the well is located.)
Macon Flementary
Facility Name Facility ID# (if applicable)
1166 Lotla Church Rd
Street Address
Franklin NC 28734
City or Town State Zip Code
Macon County Government
Contact Name
Mailing Address
Franklin NC 28743
City or Town State Zip Code
U
Area code
Phone number
: Top Bottom Ft. in. in.
: 10. SAND/GRAVEL PACK:
Depth Size Material
Top Bottom Ft.
Top Bottom Ft.
Top Bottom Ft.
11. DRILLING LOG
Top Bottom Formation Description
0 / 82
: 82 / 200
300 / 450
12. REMARKS:
Sand Clay
Water 0.192 50 aDm
Granite
6. WELL DETAILS: I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
• 15A NCAC 2C, VELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
a. TOTAL DEPTH: 450 :RECORD EN PROVID TO TH ELL W ER.
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO L� : S16NATIJAE OF CERTIFIED WELL CONTRACTOR -1 DATE �1
c. WATER LEVEL Below Top of Casing: FT. Roger L. Wllllams
(Use "+" if Above Top of Casing) : PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit within 30 days of completion to: Division of Water Quality - Information Processing, Form Rev. 1 /08 /08
1617 Mail Service Center, Raleigh, NC 27699-161, Phone : [phone]

NONRESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 3065 A
1. WELL CONTRACTOR:
Roger L Williams
Well Contractor (Individual) Name
Tarheel Water Treatment
Well Contractor Company Name
3494 Georoia RD
Street Address
Franklin NC 28734
City or Town State Zip Code
8( 28 .) 369-0740
Area code Phone number
2. WELL INFORMATION:
WELL CONSTRUCTION PERMIT# W 10100141
OTHER ASSOCIATED PERMIT#(if applicable)
SITE WELL ID #(if applicable) K-8
3. WELL USE (Check One Box) Monitoring ❑ Municipal/Public ❑
Industrial/Commercial ❑ Agricultural ❑ Recovery ❑ Injection ❑
Irrigation❑ Other lt((listuse) Closed loot•) Geotherre
DATE DRILLED 10-27-11
4. WELL LOCATION:
1166 Lotla Church Rd
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
CITY: Franklin COUNTY Macon
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
❑Slope []Valley JjFlat ❑Ridge []Other
K(01$TCD 36 1AAAA&AAAAAAAA! CL R OR 3X^JFXXrR90(9t~R9[ CC
KNMFI$TCD75 !AAAA&AAAAAAAA! CLROR 7`X.WAXXXOW CC
Latitude/longitude source: ❑GPS ❑i opographic map
(location of well must be shown on a USGS topo map andattached to
this form if not using GPS)
5. FACILITY (Name of the business where the well is located.)
Macon Elementary
Facility Name Facility ID# (if applicable)
1166 Lotla Church Rd
Street Address
Franklin NC 28734
City or Town State Zip Code
Macon County GoVPrnment
Contact Name
Mailing Address
Franklin NO 8742
City or Town State Zip Code
Area code Phone number
6. WELL DETAILS:
a. TOTAL DEPTH:_ 450
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO qI
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 31QM Down
f. DISINFECTION: Type HTC Amount i 07
g. WATER ZONES (depth):
Top Bottom Top Bottom
Top Bottom Top Bottom
Top Bottom Top Bottom
Thickness/
7. CASING: Depth Diameter Weight Material
Top 0 Bottom 84 Ft.
Top Bottom Ft.
Top Bottom Ft.
: 8. GROUT: Depth Material Method
Top 0 Bottom 89 Ft. Bentonite Pumped
Top 89 Bottom 450 Ft. washed Stone poured
Top Bottom_ Ft.
9. SCREEN: Depth Diameter Slot Size Material
Top Bottom Ft. in. in,
Top Bottom Ft. in. in.
Top Bottom Ft. in. in.
10. SAND/GRAVEL PACK:
Depth Size
Top Bottom Ft.
Top Bottom Ft.
Top Bottom Ft.
11. DRILLING LOG
Top Bottom
0 / 84
84 / 300
300 / 450
/
/
12. REMARKS:
easing Rernoved
Material
Formation Description
Sand Clay
Dry
Dry
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
15A NCAC 2C, WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
10- 7-11
SIGNATURE OF CERTIFIED WELL CONTRACTOR DATE
c. WATER LEVEL Below Top of Casing: FT. : B0(jer L. WIIIIamS
(Use "+^ if Above Top of Casing) : PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit within 30 days of completion to: Division of Water'Quali Form GW-1b
Y P ty - Information Processing, Rev.1/o8
1617 Mail Service Center, Raleigh, NC 27699-161, Phone : [phone]

NONRESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 3065 A
1. WELL CONTRACTOR:.
Roaer L Williams
Well Contractor (Individual) Name
Tarheel Water Treatment
Well Contractor Company Name
3494 Georaia RD
Street Address
Franklin NC 28734
City or Town State Zip Code
8� 28 ) 369-0740
Area code Phone number
2. WELL INFORMATION:
WELL CONSTRUCTION PERMIT# W10100141
OTHER ASSOCIATED PERMIT#(if applicable)
SITE WELL ID #(if applicable) Al-5
3. WELL USE (Check One Box) Monitoring ❑ Municipal/Public ❑
Industrial/Commercial ❑ Agricultural ❑ Recovery ❑ Injection ❑
Irrigation[] Other N((,Ilst use) Closed IODD Geotherrie
DATE DRILLED 1 1-30-1 1
4. WELL LOCATION:
1166 Lotla Church Rd
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
CITY: Franklin COUNTY Macon
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
[]Slope ❑ Valley li(Flat ❑ Rldge ❑ Other
K,gMTCD 36 IAAAA&AAAAAAAAI CL ROR 3X^1tXXX9OWX CC
IWMFI$TCD75 1AAAA&AAAAAAAAI CLROR 7`x..WA)l`3YX)W CC
Latitude/longitude source: E]GPS ❑Topographic map
(location of well must be shown on a USGS topo map andaftached to
this form if not using GPS)
5. FACILITY (Name of the business where the well is located.)
Macon Flementary
Facility Name Facility ID# (if applicable)
1166 Lotla Church Rd
Street Address
Franklin NC 8784
City or Town State Zip Code
Macon County Goyernm .nt
Contact Name
Mailing Address
Franklin NG 28743
City or Town State Zip Code
Area code
Phone number
6. WELL DETAILS:
a. TOTAL DEPTH: 450
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO Wr
d. TOP OF CASING IS FT. Above Land Surface -
`Top of casing terminated attor below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): 5 METHOD OF TEST BIOW Down
If. DISINFECTION: Type HTC Amount
g. WATER ZONES (depth):
Top_ 340 Bottom• 342 Top Bottom
Top Bottom Top Bottom
Top Bottom Top Bottom
Thickness/
7. CASING: Depth Diameter Weight Material
Top 0 Bottom_84 Ft.
Top Bottom Ft.
Top Bottom Ft.
: 8. GROUT:
Depth
Material Method
Top 0
Bottom 89
Ft._ Bentonite Pumped
Top o_
Bottom 450
Ft. washed stone poured
Top
Bottom
Ft.
9. SCREEN:
Depth
Diameter Slot Size Material
Top
Bottom
Ft. in. in.
Top
Bottom
Ft. in. in.
Top
Bottom
Ft. in. in.
: 10. SAND/GRAVEL PACK:
Depth
Size Material
Top
Bottom
Ft.
Top
Bottom
Ft.
: Top
Bottom
Ft.
11. DRILLING LOG
Top Bottom
0 / 78
78 / 84
84 / 450
12. REMARKS:
easing Re, noved
Formation Description
Sand and clay
Granite casing set
Granite
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
• 15A NCAC L CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
RECOR AS B N PROVIDED TO TH/,I NER,
SlGr4ATURE OF CERTIFIED WELL CONTRACTOR DATE
c. WATER LEVEL Below Top of Casing: _ 50 FT. Rogp—r L_ Williams
(Use "+" if Above Top of Casing) : PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit within 30 days of completion to: Division of Water Quality - Information Processing, Form GW-1b
Rev. 1 /08
1617 Mail Service Center, Raleigh, NC 27699-161, Phone : [phone]

-.e A SrATF
f '
1 r ONRESIDENTM
WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division Water
;7 ,
of Quality
WELL CONTRACTOR CERTIFICATION #
1. WELL CONTRACTOR:
Roper L Williams
Well Contractor (Individual) Name
Tarheel Water Treatment
Well Contractor Company Name
3494 Georaia RD
Street Address
Franklin NC 28734
City or Town State Zip Code
8t 28 ) 369-0740
Area code Phone number
d. TOP OF CASING IS 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): 150 METHOD OF TEST BIoW Down
f. DISINFECTION: Type HTC; Amount
g. WATER ZONES (depth):
Top 260 Bottom 264 Top Bottom
Top Bottom Top Bottom
Top Bottom Top Bottom
Thickness/
2. WELL INFORMATION: : 7. CASING: Depth Diameter Weight Material
WELL CONSTRUCTION PERMIT# W 10100141 : Top 0 Bottom t�9 _ Ft.
OTHER ASSOCIATED PERMIT#(if applicable) :Top Bottom Ft.
SITE WELL ID #(if applicable) Al-6 : Top Bottom Ft.
3. WELL USE (Check One Box) Monitoring ❑ Municipal/Public ❑
Industrial/Commercial ❑ Agricultural ❑ Recovery ❑ Injection ❑
Irrigation❑ Other 56ist use) Closed IOOD Geotherra
DATE DRILLED 1 1-23-1 1
4. WELL LOCATION:
1166 Lotla Church Rd
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
CITY: Franklin COUNTY Macon
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
❑ Slope ❑ ValleyFlat ❑ Ridge []Other
Kt5I$TCD 36 iAAAA&AAAAAAAA! CL R OR 3&X90(X40OMX CC
KNMFI$TCD75 iAAAA&AAAAAAAA! CLROR 71X. WX)kX )0M CC
Latitude/longitude source: ❑GPS Dibpographic map
(location of well must be shown on a USGS topo map andattached to
this form if not using GPS)
5. FACILITY (Name of the business where the well is located.)
Macon Flementary
Facility Name Facility ID# (if applicable)
1166 Lotla Church Rd
Street Address
Franklin NC 287.34
City or Town State Zip Code
Macon County Government
Contact Name
Mailing Address
Franklin NG 28743
City or Town State Zip Code
Area code Phone number
8. GROUT:
Depth
Material Method
Top 0
Bottom 94
Ft. Bentonite Pumped
Top 94
Bottom 450
Ft._ washed stone poured
Top
Bottom
Ft.
: 9. SCREEN:
Depth
Diameter Slot Size Material
Top
Bottom
Ft. in. in.
Top
Bottom
Ft. in. in.
Top
Bottom
Ft. in. in.
10. SAND/GRAVEL PACK:
Depth
Size Material
Top
Bottom
Ft.
: Top
Bottom
Ft.
: Top
Bottom
Ft.
: 11. DRILLING LOG
Top Bottom
0 / 80
80 / 89
89/ 450
/
/
/
12. REMARKS:
Formation Description
Sand and clay
Granite casino set
Granite
6. WELL DETAILS: : I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
15A NCAC 2C, WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
a. TOTAL DEPTH:_450 : RECORD ENPROVI EDTOT WNER.
11-23-11
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO pI : SIGNATURE OF CERTIFIED WELL CONTRACTOR DATE
c. WATER LEVEL Below Top of Casing: 50 FT. ' -Roger L. Williams
(Use "+" if Above Top of Casing) : PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit within 30 days of completion to: Division of Water Quality - Information Processing, Form GW-1.b
Rev. 1 /08
1617 Mail Service Center, Raleigh, NC 27699-161, Phone : [phone]

NONRESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 3065 A
R�
1. WELL CONTRACTOR:
Roger L Williams
Well Contractor (Individual) Name
Tarheel Water Treatment
Well Contractor Company Name
3494 Georaia RD
Street Address
Franklin NC 28734
City or Town State Zip Code
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): _ 100 METHOD OF TEST 3tQM Down
f. DISINFECTION: Type HTC Amount _ 1 ? n7
g. WATER ZONES (depth):
Top_260 Bottom 264 Top Bottom
Top Bottom Top Bottom
8( 28 ) 369-0740 : Top Bottom Top Bottom
Area code Phone number Thickness/
2. WELL INFORMATION: ; 7. CASING: Depth Diameter Weight Material
WELL CONSTRUCTION PERMIT# W101 00 141 : Top 0 Bottom 89 Ft.
OTHER ASSOCIATED PERMIT#(if applicable) Top Bottom Ft.
SITE WELL ID #(if applicable) Al-7 ; Top Bottom Ft.
3. WELL USE (Check One Box) Monitoring ❑ Municipal/Public ❑
Industrial/Commercial ❑ Agricultural ❑ Recovery Injection ❑
Irrigation❑ Other IM (list use) Closed loon Geotherne
DATE DRILLED 1 1-18-1 1
4. WELL LOCATION:
1166 Lotla Church Rd
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
CITY: Franklin COUNTY Macon
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
[]Slope ❑ Valley Flat ❑ Ridge ❑ Other
KgMTCD 36 iAAAA&AAAAAAAAI CL ROR 3)(^X7CDX00M)t CC
KNMFI$TCD75 IAAAA&AAAAAAAAI CLROR 7x.W)`k7fXX-XX* CC
Latitude/longitude source: ❑GPS aopographic map
(location of well must be shown on a USGS topo map andattached to
this form if not using GPS)
5. FACILITY (Name of the business where the well is located.)
Macon Elementary
Facility Name Facility ID# (if applicable)
1166 Lotla Church Rd
Street Address
Franklin NG 28734
City or Town State Zip Code
Macon County Government
Contact Name
Mailing Address
Franklin NC 9874.'l
City or Town State Zip Code
Area code Phone number
6. WELL DETAILS:
a. TOTAL DEPTH: 450
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO IV
8. GROUT: Depth Material Method
Top 0 Bottom 94 Ft. Bentonite Pumped _
Top 94 Bottom 450 Ft. washed stone poured
• Top Bottom Ft.
9. SCREEN: Depth Diameter Slot Size Material
Top Bottom Ft. in.
Top Bottom Ft. in.
Top Bottom Ft. in.
10. SAND/GRAVEL PACK:
Depth Size
Top Bottom Ft.
Top Bottom Ft.
Top Bottom Ft.
11. DRILLING LOG
Top Bottom
0 / 80
80 / 89
89 �./ 450
12. REMARKS:
in.
in.
in.
Material
Formation Description
Sand and clay
Granite casing set
Granite
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
• 15A NCACELL CONSTRUCTION TANDARDS, AND THAT A COPY OF THIS
RECORD EEN PROVIDED WNER-
S16NATLTRE OF CERTIFIED WELL CONTRACTOR DATE
c. WATER LEVEL Below Top of Casing: 50 FT. Roger L_ Williams
(Use "+" if Above Top of Casing) : PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit within 30 days of completion to: Division of Water Quality - Information Processing, Form Rev. 1 /08 /08
1617 Mail Service Center, Raleigh, NC 27699-1.61, Phone : [phone]

1 1 ONRESIDENTM WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 3065 A
1. WELL CONTRACTOR:
Roger L Williams
Well Contractor (individual) Name
Tarheel Water Treatment
Well Contractor Company Name
3494 Georaia RD
Street Address
Franklin NC 28734
City or Town State Zip Code
8( 28 ) 369-0740
Area code Phone number
2. WELL INFORMATION:
WELL CONSTRUCTION PERMIT# W10100141
OTHER ASSOCIATED PERMIT#(if applicable)
SITE WELL ID #(if applicable) A1-8
3. WELL USE (Check One Box) Monitoring ❑ Municipal/Public ❑
Industrial/Commercial ❑ Agricultural ❑ Recovery ❑ Injection ❑
Irrigation❑ Other [1((list use) Closed IOOD Geotherra
DATE DRILLED 1 1-16-1 1
4. WELL LOCATION:
1166 Lotla Church Rd
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
CITY: Franklin COUNTY Macon
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
❑Slope ❑Valley Flat ❑Ridge []Other
KOI$TCD 36 IAAAA&AAAAAAAAI CL R OR 3X^X)[XXN)6(' X CC
KNMFI$TCD75 iAAAA&AAAAAAAA! CL ROR 71X'."XXXOOM CC
Latitude/longitude source: ❑GPS aopographic map
(location of well must be shown on a USGS topo map andaftached to
this form if not using GPS)
5. FACILITY (Name of the business where the well is located.)
Macon Elementary
Facility Name Facility ID# (if applicable)
1166 Lotla Church Rd
Street Address
Franklin NC 28734
City or Town State Zip Code
Macon County Goyprnm .nt
Contact Name
Mailing Address
Franklin NC 28743
City or Town State Zip Code
Area code Phone number
6. WELL DETAILS:
a. TOTAL DEPTH: 450
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO q/
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): I oo METHOD OF TEST aJQM Down
f. DISINFECTION: Type HTC Amount 19 o7
g. WATER ZONES (depth):
Top 260 Bottom 264 Top Bottom
Top Bottom Top Bottom
Top Bottom Top Bottom
Thickness/
7. CASING: Depth Diameter Weight Material
Topes_ Bottom 89 Ft.
Top Bottom
Ft.
Top Bottom
Ft.
8. GROUT: Depth
Material Method
Top 0 Bottom__Q4
Ft. bentonite Pumped
Topes Bottom 450
Ft. washed stone poured
Top Bottom
Ft.
9. SCREEN: Depth
Diameter Slot Size Material
Top Bottom
Ft. in. in.
Top Bottom
Ft. in. in.
Top Bottom
Ft. in. in.
10. SAND/GRAVEL PACK:
Depth
Size Material
Top Bottom
Ft.
• Top Bottom
Ft.
Top Bottom
Ft.
11. DRILLING LOG
Top
Bottom
0
/ 80
80
/ 89
89
/ 450
/
/
12. REMARKS:
Formation Description
Sand and clay
Granite casino set
Granite
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
• 15A NCAC 2C, W CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
RECORD PROVIDED TOTHE EL O ER.
SIGNATURE OF CERTIFIED WELL CONTRACTOR DATE
c. WATER LEVEL Below Top of Casing: _ 50 FT. : _ Ro6er L. Williams
(Use "+" if Above Top of Casing) : PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit within 30 days of completion to: Division of Water Quality - Information Processing, Form Rev. 1 /08 /08
1617 Mail Service Center, Raleigh, NC 27699-161, Phone: [phone]