WI0600062_Well Records_20100519

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'RE­S&E­N'-TML
� ELL CONSTRUCTION RECORD �-. Rq
I IM
61 North Carolina 5di�Hh6nV.bk8.Vi'ro=ehi'-and'4atuial-Resources-'Division,of.Watei
% Quality
WELL CONTRACTOR CERTIFICATION 402901
1-. WELL CONTRACTOR:.
-
.d. TOP OF:CASING'IS AboveLand'�-Surface*
FT..
Mark A. -Creel
'Top_ of.casing terminated. at/or below land "surface may requir6,,
Well.Contractor (Individual). Name 7.
a variarice in accordance with I 5A.NCAC'2C :O 118•.
E 1hb. or Environmental.
:e;.. YIELD (go' -N/A � METHOD T
OF N/A.
Well, Contractor Company Name
1517 01d 866xRoad'
f.. DISINFECTION:; � mount NIA'-
a �Street -Addr6ss -
.g.*- WATER ZONES (depth)
ary NQ 27513'
.:T 0 4.5
0 B6tt6 -.7rop Bottom
-
City or Town State Zip Code
..Top. 'Bottom Top Bottom,"
(91,9' ) 858-5350
.Top Bottom -TOIJ Bottom'
a -Area code., Phone number.
Thi6kness/
2f.WE'LL'INFORMAT ON:
.7.'G: a ria 'M
.CASIN- Depth: - Di'ametier ';Weight Material.''
WELL CONSTRUCTION 'PERWT# N/A'-
T60' 0' .'BottdITI 3 Ft. 2 sch.4b.PVC
- '- -
OTHER ASSOCIATED'PERMIT#(if applicable)- N/A -
-Top :-:Bottom Ft.
SITE WELL'ID'#('rf applicable)_.
Top _-Bottom
-_3 11 WE L , L USE (check 0
One Box) M6nii6rih'' 9,' uni'alIPLiblic g: M Cip -0.
8 %. GROUTil: D . eOth Material Method'
Industrial/Commerciail,b Agr icultu(al[]..Rkovery Ei. Injection ci.
;.:' ''
Top. IBottom. 2 -Ft. Beritonite 'Tre.mie
'p'O
lrrig'ati ono, Other 0 (list use .: . .. .
T 0 1 Q
Bottom. Ft. Grout
i . — - Tremie
DATE DRILLED 51611-0
..Top Bottom 'Ft.'
4. WELL LOCATION: -
S.- SCREEN:: Depth Diameter'. Slot Size':.' Material -
Corner HiahW�iv (US Hwv 421)""
Top 3 P,
Bottom M Ft' 2' in. 0.'01 'in'. VIC
(Street Name, Numbers, Community,Subdivision, Lot No., -Parcel, Zpd -Coe)
Top Bottom -Ft. in. In:.
..
CITY: Midway' COUNTY Sampson:
-Top Bottom Ft. in'.. in.
TOPOGRAPHIC I LAND SETTTING:."(Oie ck appropriate box)
[]Slope E] Valley flat 'Dkidge E30tffef.'
10. SANDIGRAVEL:PACK6
..Kof$TCD 36 �':AAAA&JVA.AAAAAAI CL R OR 3& .4&&26&AA CC
. . Depth. .. I size Material
Bottom Ft. 'Sand'.
me
AA&A,�AAAAAAI
...M MF IST CD 75. tL R OR MAISMI9A" 6C
0 ft6 Top rn Ft. -
'Latitude/16nigitude sourd6- 'WPS.'.OT6pograp ic map
Too. Bottom Ft:
(Iocbtioh of well must be shown on 6.USGS topomap .andattachedto" .`1-.
,th4sfbrmifnot,usingGPS)'-
11..-DRILLING•
-LOG-
Z S. FACILITY.(Nam6'of the6usiness where'the well is located.)
p ottom
...To F6rmation Description
-Lila Jackson Prn�prf�
_0' /'10'- `M666m Sand
!:Facility Name. Facilityappliczible)
I;riivpv'-,-C.'hrnp-r'Hihhw;*4v (0,1; Hwy '421
Street Address
City,or Town - State Zip Code
T.
Contact Name
ANY. Q
N/
Mailing Address..
H(c)("Ssinq unif
City or Town t.,'State Zip Code
12.REMARKS:
Area code Phone number
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
F THIS
a. TOTAL:DEPTH: 10'
RECORD HAS BEtNYQQV D TO THE WELL OWNER
tPE_
b..DOES WELL REPLACE EXISTING WELL? YES E&/- NO Lj
SIGNATURE OF CERTIFIED WELL TRACTOR DATE:
*c. WATER LEVEL Below Top -of Casing:. FT.
a
C, r, /7. r r
(Use if Above:Top.of Casing)..'
PRINTED NAME OF PERSON CONSTRUCTING THE:WELL
....... ....
Form*.
dbiiift'within -30:d6ys',of t ­omp etion to: ivision of Witik QbMity Information Processing,GW-1 b
16'161.',Pfioh
�-..17'Mail In Raleigh, N1,C72,7 6,9 9

NONRESIDENTIALWELL'CONSTRUCTIONBECORD
P''a
.
t� North'Carolina Department of Environment
and Natural Resources -Division of Water., uality :. e ,u
:
# 4029-g `
WELL CONTRACTOR CERTIFICATION6.
1. WELL CONTRACTOR:.a
,.d:.TOP OF CASING IS .Q ``' FT. Above,Land Surface*„
Mark A. Creel -
'Top of,'asing,terrninated at/or below land surface may require
-Well Contractor (Individual) Name.
ayariance in:accordance with 15A.NCAC 2C .0118.-.
AQEnvironme
rantal- InC.
e. YIELD (gpm): N/A METHOD OF TEST' N/A
Well Contractor Company'Name . " „
1517 �Id.ADeX ROad
f. •DISINFECTION: Type_N/A Amount_ N/A
Street Address
g. WATER ZONES (depth)-:,
Cani ' NC: 27513
Top 4 5 Bottom 10 Top ' Bottom '
City or Town State Zip Code
: Top Bottom Top Bottom '
9( 19 --) :858-5350
:. :Top' Bottom' Top Bottom
Area.code'' Phone.number ..
:•Thicknessl..::
2. WELL INFORMATION:
7. CASING Depth Diameter Weight ' ' . Material
EL
WELL CONSTRUCTION PERMIT# N/A `
Top 0 Bottom 5 .---':Ft.*-SCh.40- -PVC
''OTHER ASS.00IATED'PERMIT#(if applicable) N/A,'
.Top Bottom ' Ft.
SIT ID #(if applicable) I NJ-6 '
Top
Top ' Bottom • Ft:
,.
; 3: WELL.USE.(Check.One- BDx) Monitoring ❑ :Municipal/Public p . , ,'
Depth: Material. „ Method -
Ind ustrial/Commercial ❑.' Agriculturafp- Recovery ❑ Injection❑
... `Top 2 Bottom 4 "Ft. Bentonite Trerriie,
Irrigationp Other (list use) Inid6tion'
TO 0 •:. Bottom 2 Ft: Grout Tremie`: "
DATE DRILLED 5/6/19
Top . .' . Bottom . Ft:
4. WELL LOCATION::
9:.,SCREEN:` Depth Diameter Slot Size Material' i
` Sivey's Corner HiahvVav (US Hwy.421 l
ToP' S Bottom 10 ` Ft 2 in.: 0.01 in.. PVC :
'(Street;Name, Numbers, .Community; Subdivision, Lot No., Parcel, Zip Code)
Top Bottom Ft. in;
CITY: Midway COUNTY SamDSon .'
in.
~. Top Bottom '• . Ft. in_ . in.
TOPOGRAPHIC/ LAND SETTING: (check appropriate box):.`
❑Slope : ❑Valley elat ❑ Ridge `.p Other
10.'SAND/GRAVEL PACK:
K(d tSTCD 36• .�AAAe&AAAAnAAAi CL ROR 3b^16�26&A^
_ Cc
-.Depth.Size.. Material. .
'-Top -4 Bottom'-10- - Ft. 2 med Sand
KNrvFFsTCD75' .jAAAA&AAAnAA"! CLROR •(D�VOJOT:AA CC
Top' Bottom .: Ft.'
Latitude/Iongitude source:" OPS : Diopographic'map' '
Top Bottom Fti
(location of well must be shown on-5 USGS topo,map andattached to ..,
.. .
this form if not using. GPS).
1.1: DRILLING LOG
5 FACILITY (Name of the business where the well,is Iodated.),.
Top. . `, Bottom. Formati(onDescription
ila .lacksclri PrnnPrty
0' ` L 10' Medium Sand
Facility. Name Facility. ID#.(if applicable)
;n'iVPVtS ('nrnPr Hinhway (U'S Hine `4211
/
:Street Address
City or Town . State % ' .Zip Code
N/A
/.
Contact'Name
N/A
Mailing Address
,
City or -Town State ." Zip Code
12. REMARKS:-'n)o;,
7)alfG`t r 7(l( :3&in g unit
Area code. Phone number
' 6. WELL DETAILS: -
IDOHEREBYCERTIFYTHATTHISWELLWASCONSTRUCTED INACCORDANCEWITH
15A NCAC 2C,WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
a. TOTAL DEPTH: 1 O'
RECORD HAS BEEN P ED TO THE WELL OWNER. 0.
b. DOES,WELL REPLACE EXISTING WELL? YES ❑/. N0.❑
SI ATUR OF CERTIFIED W NTRACTOR DATE
c. WATER LEVEL Below Top of Casing: 4 5 FT.
" C
(Use "+" if Above Top of Casing)
..PRINT ED NAME OF. PERSON CONSTRUCTING THE WELL
Submit within 30 clays of completion to Division of Water
Form Gw-lb'.
Quality Information
1617 Mail Sennce Center, Raleigh, IN 27699-161, Phone ;(919)
Processing,
807:6300 f Rev 1/08 .

ENRAL'WjEL'L
kE66kjy-,::
CONSTRUCTION
-N Caroliria-peparb:Ij& -t of Eriviroiria-rien'tlian-
d Natural sources- Division.of Water. Quality'
,'� CERTIFICATION
_4
1. WELL CONTRACTOR:
-TOP OF -FT. A"'
d. CASING is Above Land '
Surface
Mark"k Cre6l.
Plo
"T ' f - 'terminated at/dr-h w Inrid'surface may require
pp o. casing
Well Contractor (19divid1u.a1)-NaFne'
...a variance in accordance wifti. 1 5A.NCAC 2C'.0118
Aara Envit�bnmeht6llhc.'
e.'YIELD METH'dD.OF-TEST.N/A
9p
-Well Contractor Company. Name. -
1 517:01d: Abox Road
f. DISINFECTION: Type 'NW Amount N/A
Street Address
9 .,WATER ZONES (depth)*
Ca*rv* '.NC 2751
Top 4.5 Bottom10. op, T, Bottom
City.. or Town State - . Zip Code
Top Bottom Top Bottom
919 :858-53-56
Bottom
top Top Bottom
Area code Phone number
-Thicknesst. .
2. WELL INFORMATION:
Diameter Weight CASING: Depth I
* Materia
WELL CONSTRUCTION PERMIT# NIA`
-Top & Bottom -:Ft 2 PVC'.
s ch.4
-OTHER ASSOCIATED PERMIT#(if mapplicable)'Ft.'
NIX
T
Top Bottom
SITE W L INJ=5 EL ID. #(if applicable,
a
m Top Boft6* Ft:
3; WELC USE (Check One Box) Monitoring 0 Munidipal/Pbblic Dm m
8.'*GROUT:, Depth' `Material Method.
Industrial/Commercial p Agriculturalo Recovery 0- 1 n"jection. D
Bottom 4
Top 2 behtohitd TreHe
irrigationD Other jV(Iist -use) -1 ilectibn
..
-M Ft.m Grout" Tr�e­rfiie
�Top 0 Bottom- Q
MM . _. M
.. .
DATE DRILLED 5/6/1 G
I . . . 0'.
Top Bottom,- :Ft
4. WELL, LOCATION:
..-9.m*SCREEN: Depth - Diameter SlotSize'. Material
e V Comer
'Siv' '.s Co ne HiahVvav'(U8 HW.V 421
..
p- 5 'Bottom 10 Ft 2 in. 0.01 1 PVC, -
Name; Numbers,:Community. Subdivision, Lot No., Parcel, Zip Code)
:`Top Bottom a in. In:
C ITYi' Midway COUNTY Sampson
Top'. - Bottom Ft. in.. in.
a .'TO. PO.GRAPHIC /LAND SETTING... (check'appropriateb.o4a.
DSlope IDValleV Flat. oRidge. 00ther,
A 0.' SAND/GRAVEL,PACK:"
-I$T.CD CL R OR 3&
K(g, 36 �^AkA&AAAAAAAA! A&&266AA • CC.
Depth
D 'Size Material:
:.Top 4- Bottom. 10- Pt. #2 med Sand'
75 6C
KNiIVF1$TCD )AAA:�&AAAXAAAA1 CL R OR m7,84
Topm,. 'Bottom" Ft.
Lati , tudeAongitude:sour6e::. V�,Ps* E]Top6graphic map
Bottom BotfoFf.
(location of well m6st-be 'shownrbn a USGS topo' map andattached to..
this form if. bt usin CPS)
n g
11. DRILLING.LOG
.5. FACILITY (Name of the .business -where'the well is -located.)'
Top Bottom Formation Description.
Pronpi1v
10 - Medium Sand
Name ..Faci lity Facility I Ej# (if applicable).::
Snivey's' Cornpr H&nhWay(US -Hwy :421)
Street Address
Midway
City or Town State Zip Code
Contact Name
Mailing Address
City or Town. State Zip, Code
-REM ARKS:
Area code Phone number..
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 '
TH: 1:0'
a. TOTAL DEPTH:
RECORD HAS BEEN PRO OWNER.
-VMED TO-TEEWEIL
-b. DOES WELL REPLACE EXISTING'VkLL YES bV NOD
SIG ATURE OF CERTIFIED WELL DMITRACTOR DATE
WATER LEVEL Below Top of Casing:
n -4 -FT.
7
'(Use "+P if Above.Top of Casing)
7
PRINTED NAME OF PERSON CONSTRUCTING THE WELL:
Librhi.twithin 3b:'days ­'W 'ti6m...I)ivisi-c;h�-�6,iWati)r
Form-GW-lb.
QLialmimt-...-�,f�':Inforinzitioh'Pr6d6�siiig
completion
1617 Mail ervic�e C6fiter..,Ra IN Phone
y'.-Rev.1/0
T'6300. 8

STAre {. '
NONRESIDENTIAL WELL'CONSTRUCTION RECORD J.
ss� z
t z North Carolina Dppaitrnent of Environment and Natural Resources- Dry stori of Water Qualaty. ek '.
WELL CONTRACTOR CERTIFICATION #:'4029-B „ ,..
1. WELL CONTRACTOR
d. TOP OF CASING IS n = FT. Above. Land Surface
Mark A. Creel ' *Top of casing terminated at/or below land surface may require
Well Contractor (Individual). Name 'a variance in accordance with T5A NCAC 2C :0118: ,
Apra Environmental 16c..e, YIELD(gpm): NIA METHOD OF"TEST N/A
Well Contractor Company Name
1.517 aCi Old Abd RO; f. -bI INFECTION: Type N/A Amount N/A
Street Address' g:•. WATER ZONES (depth):..
CBrV' " ' NC 27513 Top 4.5 - - - 1 6ttom'10 Top Bottom
City or Town State Zip.Code - .
Top. Bottom :.Top .. Bottom:.
919 858-5350 :Top Bottom . Top_" Bottom '
Area Code Phone number
2r WELL INFORMATION:' Thickness/ .
7. CASING:: Depth Diameter". -'-Weight., . Material
WELL CONSTRUCTION PERMIT# NSA Top 0 Bottom 5 Ft.,2" SCh.40'' PVC
:. OTHER ASSOCIATED:PERMIT#(if"applicable) NIA. ToP Bottom Ft.
SITE WELL ID #(ff applicable) I N.I-3 Top. Bottom' Ft.
3. WELL USE (Check One Box) Monitoring ❑.. Municipal/Public. 8< GROUT: Depth , ' .`Material '.Method"
IndustriaUCommercial ❑ Agricultural ❑ Recovery Injection ❑ Top 2 :Bottom; 4. Ft Bentonite Tremie'
Imgation❑..Other e(list use) InleCtibnT Top 0 Bottom 2 Ft. Grout 7remie `
-,DATE-DRILLED 516110 Top______Bottom Ft.
4..WELL LOCATION:
' 9 . SCREEN: Depth Diameter Slot Size - Material-
. Sivev's Corner Hioh'wav (US Hwv'421) Top 5 Bottom 10 Ft. 2 in.. 0.01 1' PVC.
(Street Name; Numbers, Community; Subdivision, Lot No., Parcel; Zip Code),
Top Bottom Ft. in.. in.
CITY: MIdWAV ".COUNTY SamDSOn' Top Bottom Ft." in. in. .
TOPOGRAPHIC / LAND SETTING: (cfieck'appropriate box),.
-.I* 0Slope ❑Valley elat• pRidge ❑Ottfer 10.SAND/GRAVEL PACK:
K(a�l'&TCD 36. I,..,1&AAA'AAAAAI CL R OR 3b�1bfr266 �� CC Depth Size Material
Top 4 Bottom 10 Ft. #2
1WIvFISTCD75 nn116nnnnnnnnl::CLR.OR.718.461�9AAACC Top Bottom Ft. :.
Latitude/longitude source: BPS' []Topographic map Top Bottom. ` Ff. '
(lobation; of well must be shown on 6'USGS topo map andattached to
this'
form if not using GPS) 11.DRILLING LOG
5. FACILITY (Name of the business where thewell is located.), Top .Bottom Formatiori Description
HA 'Janksrin PrnnPrt r 01./ 10' . Medium Sand -
Facility Name Facility ID#.(if applicable)
Sdivey s, CornPr S Hiah nr��i (l 1HwA 421.�.. ' . /.
Street Address /77
Mirfvva i
City or Town - State Zip Code ' /
N/A
Contact Name 7/
NIA
Mailing Address / r n
City or Town State Zip Code ( q
12. REMARKS:.
Area code Phone number
6. WELL DETAILS:' . ' ' . I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRV6-FiD'(N'ACCORDANCE WITH.
154 NCAC,2C, WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
a. TOTAL DEPTH: "1 O' - '
' RECORDNAS 'VIDEDTOTHE WELL OWNER.. '
b..DOES WELL'REPLACE EXISTING WELL? • YES OV. NO ❑ _ S� S' " �0
e--SIGNAfE71`2E OF CERTIFIED WELL CONTRACTOR DATE
c. WATER_ LEVEL Below Top of Casing: /� -!j FT
(Use "+° if'Above Top of Casing) ' C[ r (t y-l' / e j'
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit within 30 days of completion to Divislon:of Water Qua(Ity Information Processing,
Form GW 1b
1617 Mail Service Ceriter, Raleigh, NC.27699 161, Phone {919) 807 6300 Rev. 1/08

Form GW-1b
. Rev. 1/08.

aw.
1. WELL CONTRACTOR:
Tommy Bolvard
Well Contractor (Individual) Name
Environmental Drilling & Probing Services LLC
Well Contractor Company, Name
17538 Greenhill Road `
Street Address
Charlotte NC 28278
City or Town State Zip Code
7(_ 04 ) 607-7529
Area code Phone number
2. WELL INFORMATION:
WELL CONSTRUCTION PERMI
NONRESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 3307 `
6 6 1 c.
OTHER ASSOCIATED PERMIT#(if applicable)
SITE WELL ID #(ifapplicable) MW-4
3. WELL USE (Check One Box) Monitoring V Municipal/Public ❑
Industrial/Commercial ❑ Agricultural ❑ Recovery ❑ Injection ❑
Irrigation❑ Other ❑ (list use)
DATE DRILLED-3/8/1 0 - 319110
4. WELL LOCATION:
13931 SDivey's Corner Hwv
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip ode)
CITY: Newton Grove COUNTYAr=m. _"
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
❑Slope []Valley ❑Flat ❑Ridge ❑Other
LATITUDE 36 " DMS OR 3x.XXXXXXXXX DID
LONGITUDE 75 " DIMS OR 7X.XXXXXxxxx DD
Latitude/longitude source: 03PS 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.)
Lila Igrksnn Site
Facility Name Facility ID# (if applicable)
13P31 Seiv .v'G Cornpr Hwy
Street Address
Newton Grove NC
City or Town State Zip Code
_NA
Contact Name
same
Mailing Address
Same
City or Town State Zip Code
Area code
Phone number
6. WELL DETAILS:
a. TOTAL DEPTH: 11'
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO q/
c. WATER LEVEL Below Top of Casing:_
(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 TEf I �t���II
6
f. DISINFECTION: Type
Amol�-13
nt
g. WATER ZONES (depth):
%;� .i 2
:Top Bottom
Top__j Bottom
Top Bottom
rGpGi0NAL0IFiic
Top Bottom
Top Bottom4—
Thickness/
: 7. CASING: Depth
Diameter Weight Material
Top_ Bottoms
Ft._2 sch.40 PVC
Top Bottom
Ft.
Top Bottom
Ft.
: 8. GROUT: Depth
Material Method
Top 1 Bottom_5_
Ft. Bentonite _ Tremie
Top 5 Bottom 0
Ft. Grout Tremie
Top Bottom
Ft.
9. SCREEN: Depth
Diameter Slot Size Material
Top 11 Bottom 1
Ft. 2 in. 0.01 in. PVC
Top Bottom
Ft. in. in.
Top Bottom
Ft. in. in.
10. SAND/GRAVEL PACK:
Depth
Size Material
Top 11 Bottom 1
Ft. #2med Sand
Top Bottom
Ft.
Top Bottom
Ft.
11. DRILLING LOG
Top Bottom
12. REMARKS:
Formation Description
I DO HEREBY CERTIFY W THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
15A NCAC 2C, WELLQCNSTRUCTION STANDARDS, AND THAT AC.CRY OF THIS
RECORD HA OVIDED TO TH
3/22/10
SIGNAT F CERTOED&ELL001 C
; PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit Within 30 days of completion to: Division of Water Quality - Information Processing, Form GW-1 b
1617 Mail Service Center, Raleigh, NC 2769.9-161, Phone : [phone] Rev. 2/09

NONRESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 3307 1 >;
e3 L J; 0;
1. WELL CONTRACTOR:
Tommv Bolvard
Well Contractor (Individual) Name
Environmental Drillina & Probing Services, LLC
Well Contractor Company Name
17538 Greenhill Road
Street Address
Charlotte NC 28278
City or Town State Zip Code
7c 04 ) 607-7529
Area code Phone number
2. WELL INFORMATION:
WELL CONSTRUCTION PERMIT#
OTHER ASSOCIATED PERMIT#(if applicable)
SITE WELL ID #(if applicable) MW-8
3. WELL USE (Check One Box) Monitoring 3( Municipal/Public ❑
Industrial/Commercial ❑ Agricultural ❑ Recovery ❑ Injection ❑
Irrigation❑ Other ❑ (list use)
DATE DRILLED 3/8/10 - 3/9/10
4. WELL LOCATION:
13931 Soivev's Corner Hwv
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel Zip Code
CITY: Newton Grove COUNTY 1 '
TOPOGRAPHIC / LAND SETTING: (check appropriate
❑Slope []Valley ❑Flat ❑Ridge [I Other
LATITUDE 36 " DMS OR 3X.XXXXXXXXX DD
LONGITUDE 75 " DMS OR 7X.XXXXXXXXX DD
Latitude/longitude source: BPS QTopographic 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.)
_ Lila Jackson Site
Facility Name Facility ID# (if applicable)
13931 Sniv v's Corner Hwy
Street Address
Newbn Grove NC
City or Town State Zip Code
_NA
Contact Name
dame
Mailing Address
Same
City or Town State Zip Code
Area code Phone number
6. WELL DETAILS:
a. TOTAL DEPTH: 111
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO q�
c. WATER LEVEL Below Top of Casing: _
(Use'+' if Above Top of Casing)
d. TOP OF CASING IS ..FT -Above Land Surface -
*Top of casing terminated at/or " low la—d- nd 'rfakrnay-requir
1 IQ
a variance in accordance with 5A NCAC 2C` �011+8 p�' ii�
e. YIELD (gpm): METH D OF TEST r;
f. DISINFECTION: Tvpe Amo nt�`
: g. WATER ZONES (depth):
Top Bottom
Top Bottom
Top Bottom
l �F1VR-FAl� om REGI�!
To
Top Bottom
Top Bottom
Thickness/
: 7. CASING:
Depth
Diameter Weight
Material
Top 1
Bottoms_
Ft. 2 sch.4
PVC
Top
Bottom
Ft.
Top
Bottom
Ft.
: 8. GROUT:
Depth
Material
Method
Top 1
Bottom_5_
Ft. Bentonite
Tremie
Top .5
Bottom 0
Ft. Grout
Tremie
Top
Bottom
Ft.
9. SCREEN:
Depth
Diameter Slot Size
Material
:Top 11
Bottom 1
Ft. 2 in. 0.01 in.
PVC
:.Top -
Bottom
Ft. in. in.
Top
Bottom
Ft. in. in.
10. SAND/GRAVEL PACK:
Depth
Size Material
Top 11
Bottom 1
Ft. #2med Sand
Top
Bottom
Ft.
Top
Bottom
Ft.
11. DRILLING LOG
Top Bottom
/
/
12. REMARKS:
Formation Description
Imo. Viz= 17 v r-
k: iTt�rf:fc�iOf1 i�rr�SSir;v iie'td!
tilrS�vi��V
I DO HEREBY CERTIFY_THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
15A NCAC 2C. L CONSTRUCTION STAND DS, AND THAT A COPY THIS
RECORD HAS PROVIDED TO THEW R.
SIGNATIJK OF CERWD WELt CO
PRINTED NAME OF PERSON
Submit within 30 days of completion to: Division of Water Quality - Information Processing, Form GW-1b
Rev. 2/09
1617 Mail .Service Center, Raleigh, NC 27699-161, Phone : [phone]

NONRESIDENT'IAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 3307 r ,�
eS �� L 4
1. WELL CONTRACTOR:
Tommv Bolvard
Well Contractor (Individual) Name
Environmental Drillina & Probina Services, LLC
Well Contractor Company Name
17538 Greenhill. Road
Street Address
Charlotte NC 28278
City or Town State Zip Code
7( 04 ) 607-7529
Area code Phone number
2. WELL INFORMATION:
WELL CONSTRUCTION PERMIT#
OTHER ASSOCIATED PERMIT#(if applicable)
SITE WELL ID #(ifapplicable) TW-6R
3. WELL USE (Check One Box) Monitoring 5( Municipal/Public ❑
Industrial/Commercial ❑ Agricultural ❑ Recovery ❑ Injection ❑
Irrigation❑ Other ❑ (list use)
DATE DRILLED 3/8/10 - 3/9/10
4. WELL LOCATION:
13931 SDivey's Corner Hwv
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
CITY: Newton Grove COUNTY v
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: BPS 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.)
Lila Jackson Site
Facility Name Facility ID# (if applicable)
13931 Soiv .v'G Corner Hwy
Street Address
Newton GrnvP N
City or Town State Zip Code
NA
Contact Name
Same
Mailing Address
Same
City or Town State Zip Code
Area code Phone number
6. WELL DETAILS:
a. TOTAL DEPTH: 111
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO q�
c. WATER LEVEL Below Top of Casing: FT
(Use'+° if Above Top of Casing)
d. TOP OF CASING IS FT. Above_LaDd SuiJac@' _
*Top of casing terminated at/or below lapd surface--maequirg t�
a variance in accordance with 15A NCI C 2C .011r8CR yrr C� �1 .,U
e. YIELD (gpm): METHOD OFT ST APR
9 )rley
!2 W:3
f. DISINFECTION: Type Amount
: g. WATER ZONES (depth):
Top Bottom
Top Bottom
Top Bottom
Top Bottom
Top Bottom
'ETfEMLLEREGIONAL OFFICE 1
Thickness/
7. CASING:
Depth
Diameter
Weight
Material
Top 1
Bottom_ Ft. 2
sch.40
PVC
Top
Bottom
Ft.
Top
Bottom
Ft.
: 8. GROUT:
Depth
Material
Method
Top 1
Bottom .5
Ft. Bentonite
Tremie
Top .5
Bottom 0
Ft. Grout
Tremie
Top
Bottom
Ft.
9. SCREEN:
Depth
Diameter
Slot Size
Material
Top 11
Bottom 1
Ft. 2 in.
0.01 in.
PVC
Top
Bottom
Ft. in.
in.
Top'
Bottom
Ft. in,
in.
10. SAND/GRAVEL PACK:
Depth
Size
Material
Top 11
Bottom 1
Ft. #2med
Sand
Top
Bottom
Ft.
Top
Bottom
Ft.
11. DRILLING LOG
Top Bottom Formation Description
n r �. E ir— Gam,
% G �V s- t_k
....w a ,ct eta s� t .' (rJCcbl."-,tll LJri iE
12. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
15A NCAC 2C, WE NSTRUCTION STANDARDS, AND THAT A COPY OF THIS
RECORD N ROVIDEDTOTHEWELL R.
• �3/22/10
: SIGNA E OF C'[ED W NT aeDATE
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit within 30 days of completion to: Division of Water Quality Form 109
Y p ty - Infon�nation 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 # 3307
1. WELL CONTRACTOR:
Tommy Bolvard
Well Contractor (Individual) Name
Environmental Drilling & Probing Services, LLC
Well Contractor Company Name
17538 Greenhill Road
Street Address
Charlotte NC 28278
City or Town State Zip Code
7( 04 ) 607-7529
Area code Phone number
2. WELL INFORMATION:
WELL CONSTRUCTION PERM
OTHER ASSOCIATED PERMIT#(If applicable)
SITE WELL ID #(if applicable) TW-4 R
3. WELL USE (Check One Box) Monitoring If Municipal/Public ❑
Industrial/Commercial ❑ Agricultural ❑ Recovery ❑ Injection ❑
Irrigation❑ Other ❑ (list use)
DATE DRILLED 3/8/10 - 3/9/10
4. WELL LOCATION:
13931 Soivev's Corner Hwy,
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
CITY: Newton Grove COUNTY
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
Latitudeflongitude source: (BPS Qropographic map
(location of well must be shown on a USGS topo map andattached to
this farm if not using GPS)
5. FACILITY (Name of the business where the well is located.)
Lila Jackson Site
Facility Name Facility ID# (if applicable)
13931 Soivev's Corner Hwy
Street Address
Newton Grove NC
City or Town State Zip Code
_NA
Contact Name
Same
Mailing Address
Same
City or Town State Zip Code
Area code Phone number
6. WELL DETAILS:
a. TOTAL DEPTH: 111
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO (�
c. WATER LEVEL Below Top of Casing: FT
(Use °+" if Above Top of Casing)
d. TOP OF CASING IS
FT. Above Land SarfacE• --}}��—
To of casing terminated at/or below land su ace may re ulre' j�• gg
P 9 Y� NfL.JIEll.y
a variance in accordance
with 15A NCAC 2 .0118.
e. YIELD
(gpm):
p�
METHOD OF TEST III 2 A"In
f. DISINFECTION:
Type
Amounit
g. WATER ZONES (depth):
DE 'AI LLEREGIONAL OFi%
Top
Bottom
Top Bottom -- - - --
Top
Bottom
Top Bottom
Top
Bottom
Top Bottom
Thickness/
: 7. CASING: Depth
Diameter Weight Material
Top
1 Bottoms
Ft. 2 sch.40 PVC
Top
Bottom
Ft.
Top
Bottom
Ft.
8. GROUT: Depth
Material Method
Top
1 Bottom .5
Ft. Bentonite Tremie
Top
.5 Bottom 0
Ft. Grout Tremie
Top
Bottom
Ft.
9. SCREEN: Depth
Diameter Slot Size Material
Top
11 Bottom 1
Ft. 2 in. 0.01 in. PVC
: Top
Bottom
Ft. in. in.
Top
Bottom
Ft. in. in.
10. SAND/GRAVEL PACK:
Depth
Size Material .
Top
11 Bottom 1
Ft. #2med Sand
Top
Bottom
Ft.
Top
Bottom
Ft.
: 11. DRILLING LOG
Top Bottom Formation Description
/
/ Erc; t=rTnailOr; Y"F?�;cg9iir• ! tr��..
12. REMARKS:
I DO HEREBY CERTIFY,THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
15A NCAC 2C, WEWTONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
RECORD EN ,TO THE
NE.� _JRi ��:9�
22/10
SIGNA OF FIED L C� i/DATE
• PRINTED NAME OF PERSON CONSTRUCTING THE WELL
W-1 b
Submit within 30 days of completion to: Division of Water Quality - Information Processing, Rev. Form G
1617 Mail Service Center, Raleigh, NC 27699-161, Phone : [phone]

� „a STA7Z'v�
1. WELL CONTRACTOR:
Tommv Bolvard
NONRESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 3307 63 ' ��•
Well Contractor (Individual) Name
Environmental Drilling & Probina Services, LLC
Well Contractor Company Name
17538 Greenhill Road
Street Address
Charlotte NC 28278
City or Town State Zip Code
7( 04 ) 607-7529
Area code Phone number
2. WELL INFORMATION:
WELL CONSTRUCTION PERMIT#
OTHER ASSOCIATED PERMIT#(if applicable)
SITE WELL ID #(if applicable) MW-7D
3. WELL USE (Check One Box) Monitoring N( Municipal/Public ❑
Industrial/Commercial ❑ Agricultural ❑ Recovery ❑ Injection ❑
Irrigation[] Other ❑ (list use)
DATE DRILLED 3/9/10 & 3r'17/1
4. WELL LOCATION:
13931 Soivev's Corner Hwv
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel, Zip Code)
CITY: Newton Grove COUNTYMbb.
�
TOPOGRAPHIC / LAND SETTING: (check appropn
❑Slope ❑Valley ❑Flat ❑Ridge ❑Other
LATITUDE 36 " DMS OR 3X.XXXXXXXXX DID
LONGITUDE 75 " DMS OR 7X.XXXXXXXXX DID
Latftude/longRude source: BPS EDTopographic 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.)
Lila Jackson Site
Facility Name Facility ID# (if applicable)
13931 SDivey's Corner Hwy
Street Address
Newton Grove NC
City or Town State Zip Code
NA
Contact Name
Same
Mailing Address
Same
City or Town State Zip Code
Are code
ode
Phone number
6. WELL DETAILS:
a. TOTAL DEPTH: 40'
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO G
c. WATER LEVEL Below Top of Casing: FT.
(Use "+" if Above Top of Casing)
d. TOP OF CASING IS FT Above Land -Surface'— -
t y u� u � i� •iV
'Top of casing terminated attor Belo land suHICIL IL- -1
a variance in accordance with 15A! CAC 2C .0118.
e. YIELD (gpm): METHOD
f. DISINFECTION: Type
g. WATER ZONES (depth):
Top Bottom
:Top Bottom
Top Bottom
r TEST P? , 2 619
Amount
DENR-FR ►11MLLERF_GIONkOF(;0E
Top
Bottom
Top
Bottom
Top
Bottom
Thickness/
:7. CASING: Depth Diameter Weight Material
: Top " Bottom_ Ft. 6 sch.40 PVC
Top 2" Bottom__D Ft. 2 sch.40 PVC
Top Bottom Ft.
8. GROUT: Depth Material Method
Top 33 _ Bottoms_ Ft. Bentonite Tremie
Top_al Bottom 0 Ft. Grout Tremie
Top Bottom Ft.
9. SCREEN: Depth Diameter Slot Size Material
Top 40 Bottom 35 Ft. 2 in., 0.01 in. PVC
Top Bottom Ft. in. in.
Top Bottom Ft. in. in.
10. SAND/GRAVEL PACK:
Depth Size Material
:Top 40 Bottom 33 Ft. #2me Sand
Top Bottom Ft.
Top Bottom Ft.
11. DRILLING LOG
Top Bottom
Formation Description
/
M,AA 9, 4 7 010
/
�sn
: 12. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
15A NCAC 2C, CONSTRuc-nON STANDARDS, AND THAT A COPY OF THIS
:RECORD EN PROVIDED TO OWNER.
3/22/10
: SIGNP,WE OF C IFI EL CO OR DATE
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Form GW-1 b
Submit within 30 days of completion to: Division of Water Quality - Infonnation Processing, Rev. 2/09
1617 Mail Service Center, Raleigh, NC 27699-161, Phone : [phone]

1 r ONRESIDENTIAL"WELL CONSTRUCTION RECORD
�4 •' W`
'S `! r North Carolina Department of Environment and Natural Resources- Division of Water Quality
�'� . � •� �,
WELL CONTRACTOR CERTIFICATION # 3307
1. WELL CONTRACTOR:
Tommy Bolvard
Well Contractor (Individual) Name
Environmental.Drillina & Probina Services, LLC
Well Contractor Company Name
17538 Greenhill Road
Street Address
Charlotte NC 28278
City or Town State Zip Code
(704 ) 607-7529
Area code Phone number
2. WELL INFORMATION:
WELL CONSTRUCTION PERMIT#,
OTHER ASSOCIATED PERMIT#(if applicable)
SITE WELL ID #(if applicable) MW-8D
3. WELL USE (Check One Box) Monitoring I/ Municipal/Public ❑
Industrial/Commercial ❑ Agricultural ❑ Recovery ❑ Injection ❑
Irrigation❑ Other ❑ (list use)
DATE DRILLED 3/9/10 & 3/17/1 Qf
4. WELL LOCATION:
13931 SDivev's Corner Hwy
(Street Name, Numbers, Community, Subdivision, Lot No., Parcel Zip _Coded l
CITY: Newton Grove COLINT t �'
TOPOGRAPHIC / LAND SETTING: (check appropriate x)
❑Slope ❑Valley ❑Flat ❑Ridge ❑Other
LAT,ITUDE 36 " DMS OR 3X.XXXXXXXXX DD
LONGITUDE 75 "DMS OR 7X.XXXXXXXXX DD
Latitude/longitude source: BPS 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.)
Lila Jackson Site
Facility Name _ Facility ID# (if applicable)
13931 Sniyev's Corner Hwy
Street Address
Newton Grove NC
City or Town State Zip Code
NA
Contact Name
Sam P
Mailing Address
Same
City or Town State Zip Code
Area code
Phone number
6. WELL DETAILS:
a. TOTAL DEPTH: 40'
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
c. WATER LEVEL Below Top of Casing: FT.
(Use "+" if Above Top of Casing)
d. TOP OF CASING IS FT. Above Lan-d'Su'face�r �:�
'Top of casing terminated at/oTrsurf�ce?may regUT.
II
Thickness/
: 7. CASING: Depth Diameter Weight Material
: Top " Bottoms_ Ft. 6 sch.40 PVC
Top 2" Bottom_ Ft. 2 sch.40 PVC
Top Bottom Ft.
a variance in accordance with 15A CAC 2C.01
;
e. YIELD (gpm):
R18.
(u' � A T'!a
METHOD O TEST A� rti 1 2
: f. DISINFECTION: Type
g. WATER ZONES (depth):
Top Bottom
mount
h@�RFA
-EI LLFRrG ON�IL OrF;%� �
Bottom — •4
Top
Top Bottom
Top
Bottom
: Top Bottom
Top
Bottom
8. GROUT: Depth Material Method
Top 33 Bottom .. 31_ Ft. Bentonite Tremie
Top 31 Bottom 0 Ft. Grout Tremie
Top Bottom Ft.
9. SCREEN: Depth Diameter Slot Size Material
Top_ 0 Bottom 35 Ft. 2 in. 0.01 in. PVC
Top Bottom Ft. in. in.
Top Bottom Ft, in. .in.
: 10. SAND/GRAVEL PACK:
Depth Size Material
Top 40 Bottom 33 Ft. #2med Sand
Top Bottom Ft.
Top Bottom Ft.
11. DRILLING LOG
: Top Bottom Formation Description
/
/
/
i
/
: 12. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
15A NCAC 2C, WE ONSTRUCTION STANDARDS, AND THAT PY OF THIS
:RECORD 17 N PROVIDED T L OWNER.
1/22/10
SIGN RE OF W C TRAC R 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]