NC0003433_Final Well Records_20150902

WELL CONSTRUCTrON RECORD
This form con ba used ror;ingle or multiple wells
1, Well Contractor informntlun;
�o +hr,n -FOCAd A i t TA�-
Well ContruelarNoma
-� j& 1 3 A
NC Well ConinctarCtdllicalion Number
CascEide Drilling, •L,P.
Company Name
2. Well Construction Permit #: - -
Wrall npplicaNe well permits (I,r. Canary, Sfatc; Yarfanee,"7nfddlun, rle)
J. Well Use (elleelt well use):
For lnremnE Ura pN[.4': •
'la; %VATi nZONES."_ ...
fL rt.
fl, fL
TGIIU sf G: fat
- Tn
rl. lt,
Th.,cAS1NG131V
Ttf
ft. Z� fL
fi. rb
f]Agliwltulnl
G30cothermat (1{eatinglCooling Supply)
OindusirlaVCammetcial
fllrri .At(on
an Dal;u c n c6rees in I autosI d
❑MtwicipaVpublic
' ClResidential Water Supply (single)
❑Residential Water Supply (sbared)
.. .
ft
gig' cR U
FROM
rt,
Non-WaturSupply Well:
rdhkanilaring
C3Recovery
[n j rctlo n.:Ei'cl 1. `
❑AquifcrRecharge
❑Aquifer Storage and Recovery
t7Aquifcr Test
ElExperimcntat Tcclmology
COcodlermai (Closed Loop)
C10rAllltrsrtal'iliCaFfn Cool(n ltelnrnl
130mundwolorRemedlodDri
❑SolinlfyBarrier
❑Slotmwatcr Drainage
❑Subsldeoce Control
❑Tracer
00111ellert lain.uudertf7)'Rcmntpsy
R,
14:f1hPVl1!
Fltr711
3�fL
n.
:20i.nn1LL
FFtunr
n,
4, Dale Weil(s) Completed:VC yYel.l ID11.� n
So. WellLocationtt� �
FeeEliSylgwnerNn- � ync3GiylOH(ifnpplieable)
ft.
fL
It.
Physical Addrev, Chy, and ZIP
County parccildendGcnifon No. CNN)
Sb I otltudc d L 1t d i d / ! d f
77:i7£M17 11
sccon s or dcc nun egrees.
('irwell field, one ladlong is cufiiclent)
G. Is (are) the well(s)t XPcrmaaent or 07empnrary
7. Is lbfa a repair to an existing well: ❑Yes or *a
ji(W tr a mpair, fill our kno,rn welf earth cilan ltrfam.ni ion and expfaiu die nature
of the
r'rpoir undar 4'Il ramon6 srcrlon or on the bock pfau jorai.
[I. Nutabor of well; constructed:
Form0lplc frtIcclfon or non-watersupply,valls ON4Y Wilk 1ha ruma contraction, you eon
submli onefann.
36
9. Total well depth below land surface;
(ft,)
Poe muldple Kwitr 161 ali deprhr Ifddarenl (crumple- JW110' and7©f_00)
10, Static water level below top or easing: • .). T
(ft.)
t+r.70arYOV91 U abo Ve canna, ura ",
�!
It.Bordroledlamcterr
17, Well construction method: con1 L
(l.c au0cr, mlary, cob)c, direct push, etc,)
f Olt WllTSft..9U1'PLY WELLS ONLY:.
131t. Yield (gptn) Method of test:
13b.Disinfeelioa type:—_- Amouat;
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ilieels•ii�niroir,nrx)-•, _.?_'.- _
(IN ([.Tor, iirn(nnr, mlV:act irm. rnrn raw. eie.1
22. Ccrtillantion;
signrlwe OrCenlfird Well CoromaDr wale
Nv i(rning ddr form, f hereby Cm'11y,6 Mal Ida nrllf) wr (were) rwurrurietl In accaTrnnce
Wilt l5d NCAC u7C.01o0 or l5A NCAC 03C.0700 hell Cmairveliun,Crnadantr and thal a
copy of rhtr retard tsar been pravidcrl ro the I,•cll a+uner.
D. Site dlagmul or additional well detuils:
You may use the back of Chia page to provide addidonal well site details ar well
construction dcloils. You may also attach addidanal pagm irnoeessmy.
SUBMITTALINSTIiCTiONS
241L ror All Walls: Submit tills form wldlin 30 days of completion of well
construction to (be following:
Division of Walor Refourecs, Information Proccishtg Unit,
1617 D&V Scrv[cc Confer, Raleigh, NC 27699-1617
24b. FWr injactlon Wells ONLY: In addition to sending the ratio in the address in
24o abavc, also submit it copy of this form within 30 days of completion or well
consWetlort to Ilte following:
Dlvlslon of Water Resaurcus, Underground Injection Contra[ Prugram,
1636 Mail Service Center, Raleigh, NC 27699-1636
34e. ror Water Sitpto] y & IitIectiau WelLT:
Also submit uric copy or this form widoin 30 daysafcompiclion of
wall construction to floe county health department of the County Witere
000sirucied.
porn ow -I North Carolina ocpariment afEnvlmnment and Naiunl Resources—Dlvelon or Waterliceaumcs Rcvised AuguaT 2913

WELL CONSTIMCTIt)N RECORD
This Patna ran he used rar sinyllc or inalsiliIa:wclLs
1, Well Contractor Inrurmadon:
hart -loci E A t I n
Well Corumiur Nurna
3913-A__
NC Well Contractor Ccntrieallon Number
Cascade Drilling, L.P.
Company Nome
2. Well Construction Permit fl:
Uri all appficoble hell permlix (1.e. Carmly, Swic. Yar•lanar, fnfedfon. a10
3. Well Use (cheep well use);
Water Supply Well:
DAgricultutul ❑Municipol/Public
❑Gcotherunal (HcatinglCooHng Supply) Oltcsidential Water Supply (singlo)
❑lnduatriaf/Commercial L7Ilasidendol Water Supply (shared)
Non-WalcrSupply'
f:7Manharing
❑Aquifer Rcahargc
❑Groundwater Rcmcdiotion
MAquirerStorageand Recovery
❑SolinitylJwTlcr
IlA.quifiar Tesr
❑Stormwaiar Drainage
❑flxptrimentni Technology
❑Subsidmee Control
E1GCDlh Crmal (CI07Cd reap)
QTmaer
013uulllcniial McutntJCco)int,Return)
❑Othcrfaxnlnln uuderN21 ]i
4, Data Well(s) Completed: Well lnfI V) 6
Sa. Well Location:
FacitilplQwncrttitg6{{l,r��: 11� '- rr rocilityiDN(}ifopplir��{bleJ
PbyslcsllAdd`�dr[rcsa C��ily'',.rannd�dZJp
Caupry cr. PanoelIdeali0eallnnNo, (PIN)
5b, Latitude and Longitude In dog rcasfmloutcalseconds or daclutol degrees:
(rrweli field, one laUlana is suMcient)
6,Is(arc)lhawell(s)iXprrmanenl or ❑Temporary
7, Is 1144 a repair to an existing wall; OYrs or ;r 0
1flhb tr a repair, /Ill aui Im url ivell cairtructrun injarmatlan and erpfahi the nature of the
rrpafr under 921 vamarkr icciian or an the beet,* ojihujarm.
H. Number ofwella constructed: 1.
Far multiple fq/eetlon oraomaviusupprJi well; ONLYWth the lamrsanxrnrerlon, Jva can
submfl anc/ann.
9, Total well depth below land surface: J (ft.)
For multiple v*YlLr 141 all depihs ((different (rroWle- 3@20r0'�an+d 2@J00 j
10. Static walrr ravel below tap of casing: (ft.)
rfuulcrlevel lxabai'acwfng, we "t•"
I Borehole dinnietar: iY (In.)
12. Well constr ucton method:
(La auger, rotary, cabla, direct push, ctc.)
FOR NVATEk SUPPLY IYELLS ONLY;
13a. Yield (gpm) Method of test:
13b.,I)Wnfoctinn type: Amount:
Fnr mlamii uae'orri.v;
-'TC tYA,TEtt Z0NFS - • .• • • '
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22, Certification-.
7.mcat&-ut T a" CI.ffied �5pq1
Slgnatuio orCentned Well Conlncinr Aare .
➢y x(gnfng fhLr jEvm r hardy certV. Char the nrll(r) itw llkvre) cuwrnrrled In aecw`dnnca
with 1SA NCAC 02C .0100 or 1 SA NC4C 03C,0200 Mall Canstrvulnn Slandardr and dial a
copy ethb retard has been pravldcd to the will nivner.
23, Site diagram Or nddlllonal troll detalLs;
You may use the back of this page to provide additional well silo dclails or well
construction delailc. You may also attach addilional pages irnecessary.
SUBMLTT'AL INSTUCTIONS
24a ear AIL 'We ls: Submit this farm within 30 days of eomplel(an of well
construction to the following:
DIVlslon of IVoier R(isuurccs, informatluu Processing Unit,
1617 Mnll Sarvica Center, l3:ticigh, NC 27699-1617
24b. FctE In)acilun Wells ONLYr In addition to sanding the form to the address In
24a above, also submit a copy of this farm within 30 days of ComplCllon or wall
construction to the rollowhig:
DlvIlion of Water RCsourcrs, Underground Injection Cuntrol Program,
1636 MnU Service Center, Rldalgh, NC 27699 1636
24c. For Water Sul)ltly S;,YPiccliunr Wells:
Also submit one copy or this form within 30 days Of COmpICllan or
well construction to Lhc. county health depurtmcnL of the County where
construaiad.
Form Ow -I North Cornllna Depanmant of Environment and Natoml Itesnurtes—Divlsfon urwoLer nesouicas Ravised Augurs 2013

WELL COS STRUCTIOI .RECORD
This fam, can Relined fur slnulc or mul rip lc wcl Is
1. Well Contractor Informudon:.
-Lnomonlr� I A 1�r1
Well CbntmotorName
3a13.-A
NC Well Contractor Certification Number
Cascade Dril[Ing,,L.P,,
Company Name
2- Well Construction Permit it:
Llrl all applicable well permits (1:e. Caurtry-, Stare, PmYunee, Injecilan, etc.)
3. Well Use (check well use):
wnserSupply Wall:
MAeculturul C1 iriun iclpaUPub iic
❑Geothermal CHeatinglCooling Supply) ❑Residendal Water Supply (single)
01ndustrioVCommerc111l l7Residcntial Water Supply (sliamd)
❑Aquifer Recharge
C30mundwalc.-Rcmcdiatlou
❑Aquffcr Storage and Recovery
[]Salinity Harrier
❑Aqulfu Test
❑SiormwuterDminage
uExperimentul Technology
❑Subuldcnce Control
❑Geothermal (Closed Poop)
❑Tracer
Far 3eternal Use ONLY:
14:.AVATE n ZONES ' • - - ..
a IL
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r. J' IL J' 6 n, � I fJ in. r l.CD I p `I C� I
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'-l9:SANplptt.tiVE1iPACti
lfd ircatlr :
1,R214 .-I
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gntrr.,t[I;ntl;,vratL-erica
ft.
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to:,ntxrLtar�t:
sac r«�tlra�luhld„sl
sirrpts SFiitff3S8tYt
_•° i i Y. �. v,., ... .
C1Gcol (explain undcrir?) Remarks)'
___hcruml'illcnlinplCaalintillalurst)' . ❑t7lhcr
n,
4, Date Well(l) Cnmpleted: J/a- �4Veii MA. A -Alm W ~
_�1t
5a..�Wall Location:
R fL
1) LA ei fa_0 le—�� Ci ar
�atlrty— rtt `: ^t. >.aittiy tkll (irtiPpiliahl.)
n. «.
e� e_.
Physical Addrus, City, and Zip
' R15RE1L7AtUS" -`
County Faucet ldeall0eadan No. (PlN)
5b. Latitude and Longitude In degreeslndnuteslseconds or decimal degrees:
27- Certification;
(rwctl raid, one lalftng b sutnelent)
r � 1 1. �-/_ °� _W
��t. go" ae�
6. 1s (are) tie 1vall(s)tXPermanant or OTamporury
Signature ofCentGcd Wc11 Commuter paid
By signing thfe jorm. I hereby eartUy that the ,veli(,) Mtn (ivwe) enwrrrrrtcrr in accordance
`
rvllh IJA NCAC 01C,0100 or 15A NCAC 02C.12R0 II41I Corutruelion Standarrir and that a
7. is this a repair to on existing vvell: ❑Yes or No
copy ofthlt retard har been provided on the well owner.
if dike Era repoir, fill ors fmoHn n rJl conarnedon Information and erpleila the nalar: ojlhe
reporrunder6'.I1 rumarFrseetlan bran the backajtldr fare,.
23. Site diagram or additional well details;
You may use the back of Ibis page to provide additional well silo details or welt
R. Number of wells eonslrueteds
construction details. You may ulso attach additional popca if necessary.
Far multrpfe lnjeciran or non-isxtlarsupply svd4 ONLY Wrh ilia sonic consirnrrron, you can
sabrnR farm
SUDKITTAL INSTUCT1 ONS
one
51
9. Total well depth below land surface• (R,)
14n, All W01a: Submit this Corm within 30 days or temptation or wall
For multiple writs ArI all depthr Udj(je-rent (example-3Q1R0' and J(si 1RU1
eunatmolon to the following:
10. Static water Leval below tap of casing, ((L)
Division of Water Resources, Information Processing Unit,
ffiratcr lavc] it above caring. we "+"
1617 Mail Scrvrca Center, Raleigh, NC 27499.16I7
11. Borehole dlnmaten j Q to (In.)
24b. for LtlecdonWO ONLY: In addition to sending ilia form to the addre,s in
scn
24a above, also submit a copy or this (otm within 30 duys of c0mpl0don or well
12. WcU construction methodl l L
construction to the following:
fl.e, auger, rotary, critic, direct push. etc.)
Alvlslon orWatar-Rasuurcus, Underground Infection Contrnl Pragram,
FOR WATER SUPPLY WELLS ONLY;
1636 Mall Service Canter, Raleigh, NC 27699-1636
13a. Yield (gpm) Method of test;
24c. CorWater Snptily & injection Wells:
Also submit one copy of this funs within 3o days orcomplcdon or
13b- Disinfection type Amount:
well construction to the County bcoldi department of the county where
constructed.
Form OW-1 Nnrtl, Carolina Department of Cnvlmnmcnl atul Nutumt Resources—Aivicton orWater lleanurccs nevLcd Aagusi 21113

WELL CONSTRUCTION RECORD
This farm can be used for singla or rout Uple wells
1. Well Cantractor Information;
Son��hcl1.1� 11 rLJ
Well Corumclor Noma
NC Welf Cohlrooior•denlncadon Number
Cascade. Drilling, L,P.
Company Nome
2. Well Construction Permit III
List nli opplfzuble w ll permltl rl.e. Ckumfy, SIWc, Yorfance Nathan, dc:4
3. Well Use (clieckwall use):
❑Agricultural ❑Miiniclpal/Publlc
❑Gcotbermai (Heatirig/Cooling Supply) ❑RcsldcnL(al WatarSupply (siaulc)
❑Industrio VCDminercial ❑ftasidtrntial Water Supply (shared)
Non-Wo ter Supply Wclla
❑Aquifer Recharge
00rv=dwatcr Remediatlon
❑Aquifer Starabc and Recovery
❑Salinity Bottler
❑Aquifer Test
❑SIOMMUter Drainage
❑Eaperinicntal Technology
❑Subsidcoce Control
[]Geothermal (Closed loop)
❑rmapr
A. Date Wcll(s) Completed: --!>12r, /Cwcai mi -A b mW - L,
So. Well Location:
Fnclnfy/AwncrNalns" Fudliry Wfi (roppucnhio
PhyylsitO Address, Clly, rind Zip
Counly Pilcel IdandfirattoaNa, (FIN')
5b. Latiludeund Longitude In degrees/minuluslracurids or decimal dogreei:
(lrwcil maid, aua inviong is suilictent)
6, Is (arc) the wcll[x):xVcrmnncnt or ❑Tempnrary
7. Is this a repair to an existing wall: QYcs or *0
111ALr 0 a rrpalr, J1l! oar knalm we/1 eatulrurdan fnfurmmlon and rrplaiit tilt nutury aflhe
rrpalr i order 1121 ramurkr secrfan or as the back of this form•
9. Number of wells constructed: . 1 •
For enulllpte injeelian arnon-iwlrrsupply wdlr ONLY iptih the sume conrlrurdun, you can
.tubmll ono fan".
9. Tolal well depth bulorf land surface: 3 o (ft.)
For mulOpla wells 11r1 oil depths if rigccnl (trample-J fuj200' and jQI001
10. Static water, level below top or casing: CO [r! )
ff1mier ievei (s abovreall"L, use ' +„
11. Borehole diameter:
12. Well construction mclhndt �xifl l ti
(Le, auger, rotary, calrie, direct push, ite:)
FOR WATER SUPPLY WELLS ONLY:
1311, Yield (upul) McOlod of test:
13b. Disinfection type; Amount:
For Internal Use ONLY:
-I1: WKC1irt,WNFs
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22. Certincutloni
7wiaMmt 5 add a iced 3 (a
Slgaaeure OrCoolGul Well Canlnclor Date
Iry rfbming Uifr form, I herrby rerli/,Y rAar the )eell(T) ipar llsrre) cuwaurred In acrurdance
irllh 1JA NCAC 07C.0100 or IJAYCAC 02C,0700 IVad Constnrdlan Stundaral need thar a
copy of thLrreeard hor been pruyldcd in Iht Kell oirner.
23, Site diagram or additional well details:
You may use the back of this page to provide mlditinnal wall s(ic det alls or well
construction details, You may also attach additional pages ifnecessary,
SUBMITTAL INSTUCTIONS
24v- Iror All WOIs: Submit this farm within 3o days or completion or well
construction iota the %llawillg:
Dlvtslon of Walur Resources, Iararmotian Processing Unit,
1417 Mull Service Center, Raleigh, NC 27699-1617
24b. 'n to rclfon iYolfs ONLYi in addition to &coding the farm to the address in
24a above, atsa &ubmit a copy of this form within 30 days or completion of well
wrisiruction to the fallowing:
Division ofWntar Resuurces, Underground Injacdon Central Pragrom,
1636 Mnil Service Center, M ilelgh, NC 27699-1636
24c, Car Wnfcr Sunuly & Iujactloa Welty:
Also submit one copy of this form within 30 dayuofaomplctianof
well eonstrucliun to the county health deportment of the cuunlywhere
constructed.
Farm Gw- I N"nh Carolina Dcpattrnent of Bnvltonmenl and Natural Rereurma -Division of Water Itsaourcet Rcvlud Aulpul 2013

WELL CONSTRUCTION RECORD
This i'umi can be ured fordngla nr multiple wells
1. Well Contractor Information:
Ja rm-1+Au>- --i-ry-O A O vgad
Well Comraclor Name
cai 3- A
NC Well Coelraetor CcAficolioa Number
Cascade QrURng, L.P.
Company Name
2. Well Construction Permit11.
Lorna applicable weft permlu Q.a Cniudy;'5lare. lrarlunce. Iryccliaa. eec.J
3. Well Use (ch oClt well flee):
WnterSuPi't7
MAgricultural
OMunlcipaypublic
00rodicrrnal (UmiinglCouling Supply3 ❑Rrsidendal Water Supply (single.)
❑Indae[rial/Commcrclal QRrsldentlul Water Supply (shared)
❑Aquifer Recharge,
❑Aquircr Storage and Rncavcry
MAquircrTest
❑Expednicautl Technology
00codiermal (Closed Loop)
00ocahermnl fIicetlnhtlCaulfnr. I
OOraundwalcr Rcmcdindvn
❑5ulinity Sorrier
❑S lormwater Drainage
❑Subsidence Control
OTrac=r
17011wr frxnl34i under 021 Remari:s
4, Date Wells) Coluplated: 2� 1YeII fllFf � aC J
5a. WdILowtion:
0(3
Facllity101ywncrNa+tad-e} FacililyIDlt(ifapptlrable)
PltyslcalAddrus, Clhy, and Zip
Caunly Parcel tdendticatlan No. (PIN)
Sb. Latitude and Longitude In degraeslm(nutcslseconds or decimal degrees:
(Ifwoil acid, ans IaUlanif it surflcical)
6.In (Arc) thowell(s):xPcrmonont or ❑Temporary
7. Is this n repair to an existing wall; QYcs or *-
Ijrhia 4 a repate Jill out bimm well enrulntetiart Infarmallnn and erplato the ndilva pjiho
reparr wdar 1I11 rumarb reerlan or on (he back ulthlrjorm.
S. Number of wells caustructad:
For moillpfe lriJrcfion nr nan•wrttcrsul,piy ivclfr ©N41` with Ihesame canairardon. yae can
sub,nlr onejprm. 4
9. T'otel +Well deptit below land surface. ` (It.)
Far mahtplo event ILastil depllu yrdif%rear (uaroplc-J 2rlp' anri 71Ja 1Q0�
10. StaNc water level below top of casing: - A)
1/,ro(W IEVO is alhow M flng, ore "1-"
11.11arabola dinumtar: CO (in,)
12. Well construction melltudt
(Le. aulcr, rotary, cabla, direct push, eta,)
F011 WAtTM SUPPLY WELLS ONLY:
13a. 'Auld (gpm) Metknd of test:
13b.Illslnfcction type: Amount;
22. Certtiicutioni
jz4i fiv a .T mU xed
SISTmaua afCertlfled Well Cantraetar DMIC.
DvsegnlaN rht,r frirrn. I hereby errr(1<4 char the tNrff(SJ was (nereJ carrarnrrtaf [a occadanee
wlth 114 N=61C.0160 or Is.e NUC 62C.020 Mail Calutrv;,lan swmtardr and dioh a
copy of thir record has been provided to the mll owner.
23, Silo dlagran: or nddltional well details:
You inay um the back of this page to provide additionnl well siie details or well
construction details. You may also altarh additional pages if necessary.
SUBM1717AL INSTUCTIONS
24a. Far All 'IYells; Submit this form within 30 days of completion of well
construction to the Mowing -
Division of Wuler Itesourccs, InrurmaHun Praccssing Unit,
1617 Mall Service Center, Raleigh, NC Z7699-1617
24h, I'nr Inleetimi Wails ONLY: In addition to sending die farm to the address in
24a above, also submit a copy of this farm within 30 days of cuinplction of well
consuuctiaa to the fallowing:
Division of WntwRosnurcrs, Undurground Injection Control Program,
1636 MU Service Center, Raleigh, NC 276994636
24a. For Woler Supply cG Inlectlou Wills:
Also submit one cnpy of thin form within 30 daysofeomplction of
well construction to the county huallh department of ilia county whera
construatcd,
Fonn OW.I North Catullno Deparimcntofitnvlronmcm and NAluml Resowces—DIVlrian of watorile owres Modsed Auourt 7013

WELL CONSTRUCTION RECORD For Internal Use ONLY:
This form can be used for siaglc or muliple wells
1. Well Contractor Information:
Nathan D. Oldham
Well Contractor Name
2889 - A
NC Well Contractor Certification Number
CASCADE Drilling - Pyramid
Company Name
REVISED II I
2. Well Construction Permit#:
List all applicable xell permits (ix, County, State, Variance, Injection, etc.)
3. Well Use (check well use):
Water Supply Well:
❑Agricultural ❑Municipal/PubIic
❑Geothermal (Heating/Cooling Supply) ❑Residential Water Supply (single)
❑lndustriaVCommercial ❑Residential Water Supply (shared)
❑lrri ation
Non -Water Supply Well:
❑Monitoring ❑Recovery
❑Aquifer Recharge
❑Aquifer Storage and Recovery
❑Aquifer Test
❑Experimental Technology
❑Geothermal (Closed Loop)
❑Geothermal (Heatinp/Coolina
❑Groundwater Remediation
❑Salinity Barrier
❑Stormwater Drainage
❑Subsidence Control
❑Tracer
❑Other fexnlain under #21 Rem
4. Date Well(s) Completed: 04-22-15 Well ID#
5a. Well Location:
Duke Energy - Cape Fear
Facility/Owner Name Facility ID# (ifapplicable)
500 CP&L Road, Moncure, 27559
Physical Address, City, and Zip
CHATHAM
Cowity
Parcel Identification No. (PIN)
5b. Latitude and Longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one lat/long is sufficient)
35.58369988 N 79.04928277 W
6. is (are) the well(s): ©Permanent or ❑Temporary
7. Is this a repair to an existing well: ❑Yes or ❑No
lfthis is a repair, ill out known well construction information and explain the nature of the
repair under #21 remarks section or on the back of this form.
8. Number of wells constructed: 1
For multiple injection or non -water supply wells ONLY with the same construction, )+on can
submit one form.
9. Total well depth below land surface: 20
For multiple wells list all depths if diffevenI (example- 3(e 200' and 2@1001
10 Static water level below top of casino: 15 fft.l
Ifhaterlevel is above oraing, use +„
11. Borehole diameter: 6 (in.)
SONIC
12, Well construction method: _
(i.e. auger, rotary, cable, direct push, etc
FOR WATER SUPPLY WELLS ONLY:
13a. Yield (gpm)
Method of test:
13b. Disinfection type: Amount:
14. WATER ZONES
FROA1
TO
DESCRIPTION
ft.
ft.
rc.
rt.
15. OUTER CASING for multi cased wells OR LINER tf a licable
FROM
To
DIAMETER
7`HICKNESS MATERIAL
ft.
fa
I in.
16, INNER CASING OR TUBING ftreathermai closed-loo
FROM
TO
DIAMETER
THICKNESS
MATERIAL
0 ft,
15 ft.
2" 1".
0.154
PVC
ft.
ft.
in.
17. SCREEN
FROM I
TO
DIAMETER
SLOTSiZE
THICKNESS
MATERIAL
15 ft.
20 «•
2" I"'
0.010
0.154
PVC
ft
ft.
in.
18. GROUT
FROM
To
MATERIAI.
E1,1PLACEh1E14T METHOD & AMOUNT
11 ft-
0 ft.
grout
Tremie / Pressure
13 ft-
11 ft-
bentonite
Gravity
ft.
ft.
19.SANDIG RAVEL PAC KWa licable.
FROM
TO
MATERIAL
EMPLACEMENT METHOD
20 ft.
13 ft.
1-A Silica Sand
Gravity
rt.
rr.
20. DRILLIN43
LOG attach additional shcetti if necessary
FROM _
TO
DESCRIPTION egfor. hardnesx. sa0ruck type, wvin du._ etc.
rt.
rt.
See Boring Logs
ft,
ft.
-
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
21. REMARKS
22, Co J cation:
Siguaawre ofGertiCe Well Contractor Date
By signing this form. I hereby certify that the wel(s) was (were) constructed in accordance
with iSA NCAC 02C .0100 or 15A NCAC 01C .0200 Well Construction Standards and that a
copy ofihis record has been provided to the well owner.
23. Site diagram or additional well details:
You may use the back of this page to provide additional well site details or well
construction details. You may also attach additional pages if necessary.
SUBMITTAL INSTUCTIONS
24a. For All Wells: Submit this form within 30 days of completion of well
construction to the following:
Division of Water Resources, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
24b. joor injection Wells ONLY: In addition to sending the form to the address in
24a above, also submit a copy of this form within 30 days of completion of well
construction to the following:
Division of Water Resources, Underground Injection Control Program,
1636 Mail Service Center, Raleigh, NC 27699-1636
24c. For Water Supply & injection Wells:
Alsosubmitone copy of this form within 30 days of completion of
well construction to the county health department of the county where
nnn ctn i nterl

WELL CONSTRUCTION RECORD
This form can be used for single or multiple wells )G'VISISP
1, Well Contractor Information:
Nathan D. Oldham
Well Commetor Name
2889 - A
NC well Contractor Certification Number
CASCADE Drilling - Pyramid
Company Name
2. Well Construction Permit#:
Llst all applicable well permits (i.e. County, Stoic, Variance, lnjecdon, etc.)
3• Well Use (check well use):
Water Supply Well:
❑Agricultural
❑Geothermal (Heating/Cooling Supply)
❑ Ind ustrial/Conunercial
❑MunicipaUPublic
❑Residential Water Supply (single)
❑Residential Water Supply (shared)
Non -Water Supply Well:
loMonitoring ❑Recovery
❑Aquifer Recharge
El Aquifer Storage and Recovery
❑Aquifer Test
❑Experimental Technology
❑Geothennal(Closed Loop)
❑Geothermal (I-Iealing/Cooling Return
❑Groundwater Remediation
❑Salinity Barrier
❑Stortnwater Drainage
❑Subsidence Control
❑Tracer
❑Other (explain tinder #21 ):
4. Date Well(s) Completed: 04-21-15 well iD# AB MW-03 BR
5a. Well Location:
Duke Energy - Cape Fear
Facility/Owner Name Facility ID# (if applicable)
500 CP&L Road, Moncure, 27559
Physical Address, City, and Zip
CHATHAM
County Parcel identitication No. (PIN)
5b. Latitude and Longitude in degrees/minutes/seconds or decimal degrees:
(if well field. one lot/long is sufficient)
35deg, 35 min, 2 sec N 79deg, 2 min, 57sec W
6. Is (are) the well(s): OPermanent or ❑Temporary
7. Is this a repair to an existing well: ❑Yes or ElNo
6(this is a repair, fill out known well construction information and explain the nature of the
repair tinder #21 remarks .section or on the back of this form.
S. Number of wells constructed: 1
For• multiple byection or non -water supply wells ONLY with the sante construction, you can
submir one form.
9. Total well depth below land surface: 66 (ft.)
For multiple wells list all depths ifd ereni (example- 3 a1200' and 1 a 100')
10. Static water level below top of casing: 15
If water Jere/ is above casing. use "+"
11, Borehole diameter: 1 0 / 9 / 6 (in.)
SONIC
For internal Use ONLY:
14. wxr[ R 70NES
FRO*I
TO
I I)ESCRIPTIU,ti
ft,
ft.
ft.
%
IS. OUTER CASING for muitl-cased wells UR
LINER If a
lieablc
FRUM TU DIAMETER
'ritICNA ;
MATERIAL
0 R• 42 ft 6n In•
0.280I
PVC
16. INNER CASING OR TUDING Qcotlicrii
nl closed -loop)
FROM
TO
DIAMETER
TIIICKtiFSS
MATERIAL.
0 "'
61 rt-
2" In.
0.154
PVC
ft.
I ft.
in.
11, SCREFN
FROM I
TO
❑L'tMETER
SLAT SIZE
l7iLCKNnS
MATERIAL
66 B' 161
ft-
2" In,
0.010
0.154
PVC
ft. I
ft.
in•
18. GROUT
FROM
TO
AIATENAL
FRIEPL.ACEMENTMETiLOD&AMOUNT
56 ft.
0 ft.
grout
Tremie / Pressure
59 rt•
56 rt•
bentonite
Gravity
ft.
ft,
19. SANDIGRAYEf, PACK if applicable)
FROM
TO
MATERIAL I EMPLACFMENTMErROD
66 ft-
59 ft.
1-A Silica Sand Gravity
ft,
ft.
20. DRILLING
LOG utta¢It
addit€iliac sheets if necessu
FROM
I To
DESCRIPTION 1volor. hutdncss, solltruck t1po, grain size, etc.
ft.
ft.
See Boring Logs
ft,
ft,
ft.
ft.
ft.
ft.
ft.
ft.
ft,
ft.
ft.
21. REMARM
22. Ccrtific on:
t N��tS -lS
111nau re nfCer:iftc well Contractor Date
By signing this form, 1 hereby certify that the well(s) was (were) comeructed in accordance
with 15A NCAC 02C.0100 or 15A NCAC 02C.0200 Well Construction Standards and that a
copy of'this record has been provided to the well owner.
23. Site diagram or additional well details:
You may use the back of this page to provide additional well site details or well
construction details. You may also attach additional pages if necessary.
SUBMITTAL INSTUCTIONS
24a. For All Wells: Submit this form within 30 days of completion of well
construction to the following:
Division of Water Resources, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
24b. For Inlection Wells ONLY: In addition to sending the form to the address in
24a above, also submit a copy of this form within 30 days of completion of well
12. Well construction method: construction to the following:
(Ix. auger, tvtury. cable, direct push, ctc.)
Division of Water Resources, Underground Injection Control Program,
FOR WATER SUPPLY WELLS ONLY: 1636 Mail Service Center, Raleigh, NC 27699-1636
13a. Yield (gpm) Method of test: 24c. For Water Supply & Injection Wells;
Also submit one copy of this form within 30 days of completion of
13b, Disinfection type: Amount: well construction to the county health department of the county where
constructed.

WELL CONSTRUCTION RECORD For Internal Use ONLY:
This form can be used for single or multiple wells
1, Well Contractor Information:
Nathan D. Oldham
Well Contractor Name
2889 - A
NC Well Contractor Certification Number
CASCADE Drilling - Pyramid
ggVTSJPv I I
Company Name
2. Well Construction Permit #:
List all applicable well permits (i.e. County, State, Variance, Injection, etc.,)
3, Well Use (check well use):
Water Supply Well:
❑Agricultural
❑Geothermal (Heating/Cooling Supply)
❑lndustrial/Commercial
Non -Water Supply Well:
❑Aquifer Recharge
❑Aquifer Storage and Recovery
❑Aquifer Test
❑Experimental Technology
❑Geothermal (Closed Loop)
❑Geothermal (Heat ing/Cooling
❑Municipal/Public
❑Residential Water Supply (single)
❑Residential Water Supply (shared)
❑Recovery
❑GreLrndwater Remediation
❑Salinity Barrier
❑Stonmwater Drainage
❑Subsidence Control
❑Tracer
❑Other (explain under #21 1
4, Date Well(s) Completed: 04-22-15 Well IN AB MW-03 S
5a, Well Location:
Duke Energy - Cape Fear
Facility/Owner Name Facility ID# (if applicable)
500 CP&L Road, Moncure, 27559
Physical Address, City, and Zip
CHATHAM
County Parcel Identification No. (PIN)
5b, Latitude and Longitude in degrees/minutes/seconds or decimal degrees:
(ifwell field, one lot/long is sufficient)
35.58365266 N 79.04922482 W
6. Is (are) the well(s): OPermanent or ❑Temporary
7. Is this a repair to an existing well: ❑Yes or ONo
If ills is a repair, fill out known well construction information and explain rite naiure of due
repair under #21 remarks section ov on the back of this form.
S. Number of vvelis constructed:
For multiple Injection or non -wafer supply wells ONLY with the same constructlnn, you can
submit one form,
9. Total well depth below land surface: 37 (ft.)
For nndliple wells list all depths ildifferent (eraniple- 3@200' and 2C!100')
10, Static water level below top of casing; 15 (ft.)
If waicr level is above casing. use "+"
11, Borehole diameter: 10 / 6 (in.)
SONIC
ATEp'LON6S 14. WA7'Efl'/_gNF5
FRO,41
TO
DF.SCR1PlTON
ft.
ft.
rased wells OR LINER tf a Ileahlc
15. OUTFR CASING (for '"0'
FROM
TO DIAM", TIk1 117,SS MATERIAL
0 ft'
30 ft- 6" in. 0.280 PVC
16. INNER CASING OR TUBING cothen
at closed -too
FROM
TO
DIAMETER
1'RICKNF4S
MATERIAL
0 ft.
32 rt
2" la'
0.154
PVC
ft.
ft
In.
17. SCREEN
FROM
TO
DIAMETER
SLOTSIZE
THICKNESS
MATERIAL
32 ft.
37 tr.
2" in,
0.010
0.154
PVC
[t
ft.
in,
18. GROUT
FROM
TO
MATERIAL
EI PI ACEAIENTAIETHiDD & AMOUNT
27 rt
0 ft,
grout
Tremie / Pressure
30 ft•
27 ft
bentonite
Gravity
R.
ft.
19. SANDIGRAVEL
PACK
If applicable)
FROM
TO
MATERIAL I
Et1IF1.ACEMENTMET1101)
37 ft•
30 rt•
1-A Silica Sand
Gravity
ft,
ft.
20, DRIIAANG
LOG rattachaddlitlonutzLccrs If neccssnr
FROM
TO
DESCRIPTION color. hardnvsr v011rock type, grain size, etc.
rt.
A.
See Boring Logs
rt
ft.
ft,
ft
ft.
ft
rr,
rt.
ft.
ft.
ft.
ft.
21. REMARKS
22. Certification:
A
Signuzarc of Certified Well Contractor Date
By signing this form, I hereby certify that the weli(.$) was (were) constructed in accordance
with 15A NCAC 02C .0100 or 15A NCAC 02C .0200 Well Construction Standards and that a
copy of this record has been provided to the well owner.
23. Site diagram or additional well details:
You may use the back of this page to provide additional well site details or well
construction details. You may also attach additional pages if necessary.
SUBMITTAL INSTUCTIONS
24a. For All Wells: Submit this form within 30 days of completion of well
construction to the following;
Division of Water Resources, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
24b. Eor [election W lls ONLY: In addition to sending the form to the address in
24a above, also submit a copy of this form within 30 days of completion of well
12. Well construction method: construction to the following:
(i.c. auger, rotary, cable, direct push, etc.)
Division of Water Resources, Underground Injection Control Program,
FOR WATER SUPPLY WELLS ONLY: 1636 Mail Service Center, Raleigh, NC 27699-1636
13a. Yield (gpm) Method of test: 24c. For Water Supply & Injection Wells:
Also submit one copy of this form within 30 days of completion of
13b. Disinfection type: Amount: well construction to the county health department of the county where
constructed.

WELL CONSTRUCTION RE C01W
This form can be used for single or multiple wells
1. Well Contractor Information:
�hcln 'TC)66 ail tT
Well Contractor Name
'3a13-A
NC Well Contractor Certification Number
Cascade Drilling, L.P.
Company Narnc
2. Well Construction Permit #:
List all applicable well permits (i.e. Counry, State, 1 arlance, L fectiot, inc)
3. Well Use (check well use):
Water Supply Well:
❑Agricultural ❑Municipal/Public
❑Geothermal (-Heating/Cooling Supply) ❑Residential Water Supply (single)
❑Industrial/Commercial ❑Residential Water Supply (shared)
Non -Water Supply Well:
[R]Monitoring
Injection Well:
❑Aquifer Recharge
❑Aquifer Storage and Recovery
❑Aquifer Test
❑Experimental Technology
❑Geothermal (Closed loop)
❑GcathctmaI Meadne/Coolinu
❑Groundwater Remedial -ion
❑Salinity Barrier
ElStormwater Drainage
❑Subsidence Control
❑Tracer
❑Other (explain under 1121 Remurks)
4. Date Well(g) Completed: I Well Ing
5a. Well Location:
Fac iliLy/Owner Nomc Facility f D# (if applicubla)
Sig 0 C; P 4 L
Physical Address, City, and Zip
Counry Parcel Identification No. (PIN)
5b, Latitude and Longitude in degrees/utinutes/seconds or decimal degrees:
(ifwetl field, one Ini/Inng is sufficient)
For lnternnl Use ONLY:
- 14,►VATERZONES -
Fnt3hs
To
pFMr;lut•TION
13 1f.
Q6 rt•
_
Ash •R . wo i r-c
ft.
rt.
15.OUTER CASING MrTtllti•cascd well3l Oil
LINER firtsopucabio
FROM
TO
MAh UCH.
Tt 11CI{NFS5
MATERIAL
rl.
ft.
in,
16, INNER CASINGOlt
TUDING Mollierturd
closed-loo i
FlioN
TO
I 111ANICT-Crl I
Ti IICICNESS
I MATERIA1,
3 rl.
91 u.
a In.
ft,
ft.
l�
FROM
TO
DIAMETER
SLOTSIM
Till Ci NF75I
-MATERIAL
«.
"2(, ft.
a in.
ws-
ft.
fL
in.
r8. GIIOUT1 -.....;. .: :..:.. •
Friam
TO
MATERIAL
E:1ti'c.ACEhtENThMEI'LIO:nffi AI1f0UNT
U fl.
1 ft,
tcrou,t lxnit.,yk
[. b5
l rCrrnit C-.15wG I �ta41
f1.
I q fit.
Chip bm4rnit2
0 rC,v(i
ft.
fit.
I9. SANI11tRAVFL: PACK4$f a ilcnl)le
FROM
TO
MATERIAL.
EhIVIACEM0V'rn1ET1101r
f Cl IL
ft.
JIyi CG .5 fity�
'rn Y1•
ft.
ft.
tin nmur.srar:
I fir-, (,mri
sir naili.i ,1 1,-k1fe,er..ea:4j)
rl' - y
-�<I «. _ � rL M; � oe f;5h cartel tic,l iJP C ICtJ s
ft, ft.
ft. ft.
ft. ft.
ft.
M MAIARKS
prc�rt-+;vzti c"c,�trsr ;r15'�'c'11itCj
22. Certification:
it
tCtfuut, J fund Cl bxd
Signature of Certn lied Well Contractor Date
6. Is (are) the well(s): {Permanent or ❑Temporary
By signing this form, I Hereby terrify that the wells) was (were) ca+urnrcied !it accordance
rvidi ISA NCAC 02C.0100 or 15A NCAC 02C ,0200 Well Canrrmcrion Srondards and that a
7, is this a repair to an existing well: ❑Yes or ISNo
copy ofilits record has been provided to the uell owner.
lfdnis is a repair, fill out known well construction horniation and explain the nature of the
repair under 421 remarks section or on the back gfthis form.
23. Site diagram or additional well details:
!
You may use the bath of this page to provide additional well site details or well
8. Number ofwells constructed: -
construction details. You may also attach ndditional pages ifnecessary.
For multiple injection or non -hater supply uwlls ONL I' Ivldt the same cans-tructlon, you can
SUBMITTAL TNSTUCTIONS
submit one form.
/
9. Total well depth below land surface: J� (fit.)
24a, For All Wells: Submit this farm within 30 days or completion or well
For multiple ,tells list all depths Ifd perent (example- 34a ?00' and 2@a 100')
construction to the following:
10. Static water level below top or casing: I r Ii 1 (fL)
Division of Water Resources, Information Processing Unit,
lfrvater level is above casing, use "+"
1617 Mail Service Center, Raleigh, NC 27699-1617
11. Borehole diameter: Gl (in.)
24b. For Inicetlnu Wells ONLY: In addition to sending die form to the address in
24a above, also submit a copy or this forth within 30 days or completion of well
12. Well construction method: �r 1�t�
construction to the following:
(i.e. auger, rotary, cable, direct push, etc,)
Division of Water Resources, Underground Injection Control Program,
FOR WATER SUPPLY WELLS ONLY:
1636 Mail Service Center, Raleigh, NC 27699-1636
13a. Yield (gpm) Method of test:
24c. FurWtner Supply & Inice0oa Wells:
Also submit one copy of this form within 30 days orcompletion of
13b. Disinfection type: Amount:
well construction to die county health department or the county where
constructed,
Form GW-1 North Carolina Dcpartmou of Environment and
Natural Resources --Division or Water Resources Revised August 2013

WELL CONSTRUCTION RECORD
This form can be used for single or multiple wells
For Internal Use ONLY:
1. Well Contractor Information:
Arthur E. Becker
Well Contractor Name
2201-A
NC Well Contractor Certification Number
Cascade Drilling LP Aiken S. C.
Company Name
2. Well Construction Permit #: on site
List all applicable well permits (i. e. County, State, Variance, Injection, etc,)
3. Well Use (check well use):
Water Supply Well:
❑Agricultural
❑Geothermal (Heating/Cooling Supply)
❑ Ind ustrial/Commercial
Non -Water Supply Well:.
R Monitori ng
in,jeetion Well.
❑Aquifer Recharge
❑Aquifer Storage and Recovery
❑Aquifer Test
❑Experimental Technology
❑Geothermal (Closed Loop)
❑Geothermal (I leafing/Cooling
❑Municipal/Public
❑Residential Water Supply (single)
❑Residential Water Supply (shared)
❑Groundwater Remediation
❑Salinity Barrier
❑Stormwater Drainage
❑Subsidence Control
❑Tracer
❑Other (explain under #21
4. Date Well(s) Completed: 5/1 5/15 Well ID# ABMW-04S
5a. Well Location:
Duke Energy Cape Fear Plant
Facility/Owner Name Facility ID# (if applicable)
500 CP&L Rd Moncure NC 27559
Physical Address, City, and Zip
Chatham
County
Parcel Identification No. (PIN)
5b. Latitude and Longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one lat/long is sufficient)
35 35' 16.3248" N 79 2' 59.208" W
6. Is (are) the well(s): ©Permanent or ❑Temporary
7. Is this a repair to an existing well: ❑Yes or FlNo
If this is a repair, fill out known well construction information and explain the nalure of the
repair under #21 remarks section or on the back of this form.
8. Number of wells constructed: 1
For multiple injection or non -water supply wells ONLY with the same construction, ),on can
submit one form.
9. Total well depth below land surface: 45
For multiple wells list all depths ifd&reni (example- 3(a,)200' and 2@000')
10. Static water level below top of casing: 18.01
1f water level is above casing, use "+"
I L Borehole diameter: 6 (in.)
14, WATER ZONES
FROM
TO
DESCR1P37UN
- 40 ft.
- 45 ft.
gray f-c silty sand
ft.
ft.
15. OUTER CASING far
multi -cased wc1Ls OR LINER if a Ilicable
FROM
'rO
DIAM F.TER
THICKNESS MATERIAL
0 ft.
-31 ft.
6 in. 1
280 PVC
16, INNER CASING OR
TUBING; (toot hernral elascd•loo
FROM
TO
DIAMETER
'171ICKNF,S I ,i lATFWAL
+ 3 ft.
- 40 ft,
2
154Pvc
ft.
ft.
+n.
17. SCREEN
FROM
TO
mAMETF.R
SLOT SIZE
THICKNESS
MATERIAL
- 40 ft'
- 45 fc.
2 In.
.010
.154
PVC u pack
rt.
ft.
in.
18. GROUT
FROM
-1`0
MATERIAL
FIMPLAC'E+111:,NT METF]On & AMOUNT
0 ft'
- 36 ft.
cementbentonit
I tremie pressure 1504 Ibs
- 36 ft.
-38 ft.
chip bentonite
gravity
ft.
ft.
19. SANDIGRAVEL PACK
Irapplicable)
FROM
TO
1LITERIAL
EMFLACF_MENTMETHOD
- 38 ft.
- 45 ft.
Silica sand
gravity
ft.
ft.
20. DRILLING
LOG NitsCh
additional sheets it necessary)
FROM
T TO
DEsciurriON (color. hardnm. iu1Vrock rv, le, grairk sixt, etc.
ft.
- 24 ft
Ash
-24ft•
- 25 ft.
Mix of ash and native clays
-25tt•
-30 ftgray
silty clay stiff
-30 ft'
- 41 ft'
- 41 ft.
-44 ft'
gray f-c silty sand
- 44ft'
- 45ft'
, gray weathered mudstone/shale
ft.
ft'
21. REMARKS
Protective casing installed
22. Certification:
Art Nether
Signature of Certified Well Contractor
May 18, 2015
URIC,
By signing this form. I hereby cerab- float the well(s) was (were) caustracted in accordance
with 15r1 NCAC 02C.0100 or 15A 1dCAC 02C.0200 Well Construction Standards and float a
copy ofthis record has been provided to the well owner.
23. Site diagram or additional well details:
You may use the back of this page to provide additional well site details or well
construction details. You may also attach additional pages if necessary.
SUBMITTAL INSTUCTIONS
(ft.) 24a. For All Wells: Submit this form within 30 days of completion of well
construction to the following:
(ft.) Division of Water Resources, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
24b. For In ection Wells ONLY: In addition to sending the form to the address in
Sonic 24a above, also submit a copy of this form within 30 days of completion of well
12. Well construction method: construction to the following:
(i.e. auger, rotary, cable, direct push, etc.)
Division of Water Resources, Underground Injection Control Program,
FOR WATER SUPPLY WELLS ONLY: 1636 Mail Service Center, Raleigh, NC 27699-1636
13a. Yield (gpm) Method of test: 24c. For Witter Supply & Injection Wells:
Also submit one copy of this form within 30 days of completion of
13b. Disinfection type: Amount: well construction to the county health department of the county where
constructed.
Form GW-1 North Carolina Department of Environment and Natural Resources -Division of Water Resources Revised August 2013

WELL CONSTRUCTION RECORD
This form can be used for single or multiple wells n
1. Well Contractor Information: V
Nathan D. Oldham
Well Contractor Name
2889 - A
NC Well Contractor Certification Number
CASCADE Drilling - Pyramid
Company Name
2. Well Construction Permit #:
List all applicable H+rll permlls (i.e. County, State, Variance, Injection, ere.)
3. Well Use (check well use):
Water Supply Well:
❑Agricultural ❑MunicipaVPublic
❑Geothermal (Rcating/Cooling Supply) ❑Residential Water Supply (single)
❑IndustriaVConutlercial ❑Residential Water Supply (shared)
❑bri ation
Non -Water Supply Well:
OMonitoring ❑Recovery
❑Aquifer Recharge
❑Groundwater Remediation
❑Aquifer Storage and Recovery
❑Salinity Barrier
❑Aquifer Test
❑Stonnwater Drainage
❑Experimental Technology
❑Subsidence Control
❑Geothermal (Closed Loop)
❑Tracer
❑Geothermal (fleating/Cooling Return.)
❑Other (explain under #21 Ren
4. Date Well(s) Completed: 05-08-15 Well iD# AB MW-05
5a. Well Location:
Duke Energy - Cape Fear
Facility/Owner Name Facility ID# (if applicable)
500 CP&L Road, Moncure, 27559
Physical Address, City, and Zip
CHATHAM
County
Parcel identification No. (PIN)
5b. Latitude and Longitude in degrees/minutes/seconds or decimal degrees:
(ifwcll field, one lat/long is sufficient)
35deg, 35min, 5sec N 79deg, 3min, 2sec W
6, Is (are) the weU(s): OPermanent or ❑Temporary
7, Is this a repair to an existing well: ❑Yes or END
If this is a repair, fill our known well construction information and explain the nature of the
repair under 1121 remarks section or on the back of this form.
1
For internal Use ONLY:
14. WATER ZONES
FROM 110 DESCRIPTION
ft. ft,
ft. ft.
15, OUTER CASING for multi -cased wells OR LINER, B a licablc
FROM TO DIAMETER THkCKNE.ti3 MATERIAL
ft. ft. in.
16, INNER CASING OR TUBING cathcrtnal closed -too
FROM TO DIAMETER THICK.NME (MATERIAL
0 rt. 12 ft• 2" ln. 0.154 PVC
ft. fr. In.
17. SCREEN
FROM TO DIAMETER SLOT SIZE THICKNESS MATERIAL
17 f`• 12 f`• 2" in' 0.010 0.154 PVC
ft, ft. in.
I& GROUT
FROM TO MATERIAL EntPI.ACENtENTItIF.TitOD & A1iOUNT
8 f`• 0 t' grout Tremie / Pressure
10 It. 8 fl• bentonite Gravity
ft. ft.
19. SANDIGRAVE1, PACK if app Ilea ble
FROM TO 11,'1Ti•:RIAI. EMPLACEhtENTME!HOD
17 f` 10 f`- 1-A Silica Sand Gravity
ft, ft.
20. DRILLING, LOG mttaclt addttianul sheets if necessary)
FROM TO DESCRIPTION Icolar, hardness, sollfrotk type mlo size, eta
rr. rr• See Boring Logs
ft. ft.
ft. ft.
ft. ft.
ft. ft.
rt. ft.
21. REit1ARKS
22. Certification:
az .�
rignatum orcenifstd Well Contractor Date
By signing this form, I hereby certify that the ivell(v) ivas (were) cousnvcied in accordance
ivith 15A NCAC 02C .0100 or I SA NCAC 02C .0200 Wert Construction Standardv and that a
copy of this record has been provided to the well owner.
23. Site diagram or additional well details:
You may use the back of this page to provide additional well site details or well
8, Number of wells constructed: construction details, You may also attach additional pages if necessary.
For multiple injection or non -water supply wells ONLY with the same construction, you can
submir one form. SUBMITTAL INSTUCTIONS
9. Total well depth below land surface: 17
For multiple wells list all depths if d(fterent (eruiuple- 3@200' and 1(a)100')
10. Static water level below top of casing: 15
!f mitw, levu1 is above casing, use "+"
11. Borehole diameter: , 6 (in.)
12. Well construction method: SONIC
(i.e. auger, rotary, cable, direct push, etc.)
24a. For All Wells: Submit this form within 30 days of completion of well
construction to the following:
Division of Water Resources, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
24b, For In€echo" Wells ONLY: In addition to sending the form to the address in
24a above, also submit a copy of this form within 30 days of completion of well
construction to the following:
Division of Water Resources, Underground Injection Control Program,
FOR WATER SUPPLY WELLS ONLY: 1636 Mail Service Center, Raleigh, NC 27699-1636
13a, Yield (gpm) Method of test: 24c. For Water Supply &c Injection Wells:
Also submit one copy of this form within 30 days of completion of
13b, Disinfection type: Amount: well construction to the county health department of the county where
constructed.

WELL CONSTRUCTION RECORD For Internal Use ONLY:
This form can be used for single or multiple wells VI)
1. Well Contractor Information:
Nathan D. Oldham
Well Contactor Name
2889 - A
NC Well Contractor Certification Number
CASCADE Drilling - Pyramid
Company Name
2. Well Construction Permit #:
List all applicable "vcll permlis (i.e. County, State, Variance, Injection, etc.)
3. Well Use (check well use):
Water Supply Well:
❑Agricultural
❑Geothermal (Heating/Cooling Supply)
❑ Ind ustrial/Commercial
Non -Water Supply Well:
❑Aquifer Recharge
❑Aquifer Storage and Recovery
❑ Aquifer Test
❑Experimental Technology
❑Geothermal (Closed Loop)
❑Geothernmal (Heating/Cooling
❑MunicipaVPublic
❑Residential Water Supply (single)
❑Residential Water Supply (shared)
❑Groundwater Remediation
❑Salinity Barrier
❑Stormwater Drainage
❑Subsidence Control
❑Tracer
❑Other (explain under #21 1
4. Date Well(s) Completed: 05-09-15 Well iD# AB MW-05 BR
5a. Well Location:
Duke Energy - Cape Fear
Facility/Owner Name Facility iDO (if applicable)
500 CP&L Road, Moncure, 27559
Physical Address, City, and Zip
CHATHAM
County Parcel Identification No. (PIN)
5b. Latitude and Longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one lat/long is sufficient)
35deg, 35 min, 5 secs N 79deg, 3mins, 2secs. W
6. Is (are) the well(s): OPermanent or ❑Temporary
7, Is this a repair to an existing well: ❑Yes or EINo
If this is a repair, fill out known well construction information and explain the nature of the
repair under #21 rentarks section or on the back of this form.
S. Number of wells constructed: 1
For multiple injection or non -water supply wells ONLY with the same construction, you can
submit one,form.
9. Total well depth below land surface: 60 (ft,)
For multiple wells list all depths if different (example- 3 n 200' and 2 n?100)
10. Static water level below top of casing: 23
If Hafer level is above casing, use "+"
11. Borehole diameter: 10 / 9 / 6 _(in.)
12. Well construction method: SONIC
(i.e. auger, rotary, cable, direct push, etc.)
FOR WATER SUPPLY WELLS ONLY:
13a. Yield (gpm) Method of test:
13b. Disinfection type: Amount:
Ii. WATER
_ 14.1yATERLONES
FROM TO I DESCRIPTION
ft. ft.
ft. ft.
IS. OUTER CASING for multi -coxed wefts) OR Lf1NER if a lleahle
1'RO:M TO D[AAfETER TMLC1:hL7SS MATEulA1,
0 40 rt 6" In, 0.280 PVC
16. INNER CASING OR TUBING feuthermul clusedl-loop)
FROM TO OIANIETER THLCHNESS MATEIIIAI.
55 r1• 0 ft- 2" In. 0.154 PVC
ft. ft. in.
17. SCREEN
FROM - - TO DIAMETER SLOTSIZE TI]ICKNESS MATERIAL
60 ft 55 f1 2" i"' 1 0.010 0.154 PVC
ft. ff. in.
is. GROi t
FRtt11 TO MATERIAL. EMPLACEMENTMET1161) & AMOtlN
51 rt. 0 et• grout Tremie / Pressure
53 n 51 ft. bentonite Gravity
ft. ft.
19. SANDIGRAVEL PACK if applicable
FROM To MATERIAL. BMPLACEMENTMETHOD
60 f1 53 ft- 1-A Silica Sand Gravity
ft. fl.
20. DRILLING LOG attach additional sheets if necesse
FROM TO DESCRIPTION tcDlor, herdncas, millrork type. ruin sin, etc.
See Boring Logs
ft. ft.
ft. ft.
R. ft.
ft. ft.
ft, ft.
f4 R.
21. REMARKS
90 to 60 feet was backfilledwith bentonite pellets
ZONES
22. Certification:
AU"
..�
ltract r Date
By signing this form, I hereby certih, that the tvell(.c) was (ivere) construcled in accordance
with I5A NCAC 02C .0100 or 1 SA NCAC 02C .0200 Well Construction Standards and that a
copy of this record has been provided to the well owner.
23. Site diagram or additional well details:
You may use the back of this page to provide additional well site details or well
construction details. You may also attach additional pages if necessary.
SUBMITTAL INSTUCTIONS
24a. For All Wells: Submit this form within 30 days of completion of well
construction to the following:
Division of Water Resources, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
24b. For Injection Wells ONLY: In addition to sending the form to the address in
24a above, also submit a copy of this form within 30 days of completion of well
construction to the following:
Division of Water Resources, Underground injection Control Program,
1636 Mail Service Center, Raleigh, NC 27699-1636
24c. For Water Supply & ISlection Wells:
Also submit one copy of this form within 30 days of completion of
well construction to the county health department of the county where
constructed.
ZONES
22. Certification:
AU"
..�
ltract r Date
By signing this form, I hereby certih, that the tvell(.c) was (ivere) construcled in accordance
with I5A NCAC 02C .0100 or 1 SA NCAC 02C .0200 Well Construction Standards and that a
copy of this record has been provided to the well owner.
23. Site diagram or additional well details:
You may use the back of this page to provide additional well site details or well
construction details. You may also attach additional pages if necessary.
SUBMITTAL INSTUCTIONS
24a. For All Wells: Submit this form within 30 days of completion of well
construction to the following:
Division of Water Resources, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
24b. For Injection Wells ONLY: In addition to sending the form to the address in
24a above, also submit a copy of this form within 30 days of completion of well
construction to the following:
Division of Water Resources, Underground injection Control Program,
1636 Mail Service Center, Raleigh, NC 27699-1636
24c. For Water Supply & ISlection Wells:
Also submit one copy of this form within 30 days of completion of
well construction to the county health department of the county where
constructed.

WELL CONSTRUCTION RECORD
For Internal Use ONLY:
This form can be used for single or multiple wells
1, Well Contractor Information:
Nathan D. Oldham
Well Contractor Name
2889 - A
NC Well Contractor Certification Number
CASCADE Drilling - Pyramid
Company Name
'Vx�i�
14, WATER ZONES
2. Well Construction Permit #:
List all oplAcahle, well permits (i.e. Comply, State, Variance, Injection, etc.)
3. Well Use (check well use):
Water Supply Well:
❑Agricultural
❑Geothermal (Heating/Cooling Supply)
❑ Ind ustrial/Commercial
❑lrt'izalion
Nun -Water Supply Well:
OMonitoring
Injection Well:
❑Aquifer Recharge
❑Aquifer Storage and Recovery
❑Aquifer Test
❑Experimental Technology
❑Geothermal (Closed Loop)
❑Geothenmal (I-Ieatina/Coolina Return)
❑Municipal/Public
❑Residential Water Supply (single)
❑Residential Water Supply (shared)
R ccovC'r]+
❑Groundwater Remediation
❑Salinity Barrier
❑Stormwater Drainage
❑Subsidence Control
❑Tracer
❑Other t
4. Date Well(s) Completed: 05-08-15 Well
ain tinder #21 Remarl
AB MW-05 S
5a, Well Location:
Duke Energy - Cape Fear
Facility/Owner Name Facility IDN (if applicable)
500 CP&L Road, Moncure, 27559
Physical Address, City, and Zip
CHATHAM
County
Parcel Identification No. (PIN)
5b, Latitude and Longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one Iat/long is sufficient)
35deg, 35min, 5sec N 79deg, 3min, 2sec W
6. Is (are) the well(s): l2lPermanent or ❑Temporary
7, is this a repair to an existing well: ❑Yes or ❑No
If this is a repair, fill out known well construction information and explain the nature ofthe
repair under N21 remarks section or on the back of this form.
8. Number of wells constructed:
For multiple injection or non -water supply wells ONLY with the same construction, you can
submit one fornt.
9. Total well depth below land surface: 33 (ft.)
For multiple wells list all depths ifdierent (ewanrple- 3©200' and 2C100')
10. Static water level below top of casing: 15
If awter level is above casing, use " + "
11. Borehole diameter: 10 / 6 (in.)
12. Well construction method: SONIC
(i.e. auger, rotary, cable, direct push, etc.)
FROM
TO
J DESCRIPTION
ft,
ft.
rL
rL
15. OUTER Ch511VG for ulultb•cased tvclls DR
LINER if a
1[tablc
FROm1
TO
DIAMETER
9'YHCKri}:SS
MATERIAL
0 ft.
125 ft-
1 Err In.
0.280
PVC
16. INNER
CASING OR
TUBING(geothermal
dosed -too
FROM
To
DIAMETER
'I'UICKNES3
I MATERIAL
28 f1'
0 «•
2' In.
0.154
PVC
fl.
ft.
In,
17. SCREEN
FROM
TO
DIAMETER
SLOTSIZE
THICKNESS
MATERIAL
33 ft,
28 n•
2' I"
0.010
0.154
PVC
ft.
ft.
In,
18. GROUT
FROM
I TO
MATERIAL
EI%IPLACENIENI' AIE'I'IIOD & AMOl1NT
24 ft-
0 ft•
grout
Tremie / Pressure
26 I't.
24 ft-
bentonite
Gravity
19. SANDIGRAYEL PAC If a Ilrablc
FROM
TO
MATERIAL
EMI't.ACEMENT METHOD
33 ft,
26 fr•
1-A Silica Sand
Gravity
ft.
ft.
24. DRILLING
LOG altneli
addhionai ot"m if neeessa
FROM
TO
DESCRIPTION teolor, hrsdnen soltlraek t - e, rnla shre, etc,
ft.
ft.
See Boring Logs
ft.
ft.
ft.
ft.
ft.
ft
ft.
ft.
ft.
ft.
ft.
ft.
21. REMARKS
22. Certill tin: —W- /f�[� [�
s .5
Signature n Ccniftcd Wctl Comractur Date
BY signing this form, I hereby certify that the well(s) was (were) constructed in accordance
with 1 SA NCAC 02C.0100 or 15.4 NCAC 02C .0200 [fell Construction Standards and that a
copy of this record has been provided to the well owner.
23. Site diagram or additional well details:
You may use the back of this page to provide additional well site details or well
construction details, You may also attach additional pages if necessary,
SUBMITTAL iNSTUCTIONS
24a. For All Wells: Submit this form within 30 days of completion of well
construction to the following:
Division of Water Resources, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
24b. For lnjertion Wells ONLY: In addition to sending the form to the address in
24a above, also submit a copy of this form within 30 days of completion of well
construction to the following:
Division of Water Resources, Underground Injection Control Program,
FOR WATER SUPPLY WELLS ONLY: 1636 Mail Service Center, Raleigh, NC 27699-1636
13a. Yield (gpm) Method of test: 24c. For Water Supply & Injection Wells:
Also submit one copy of this form within 30 days of completion of
13b. Disinfection type: Amount: well construction to the county health department of the county where
constructed.

WELL CONSTRUCTION RECORD
This form can be used for single or multiple wells �VISFP
1. Well Contractor Information:.
Nathan D. Oldham
Well Contractor Name
2889 - A
NC WclI Connector Certification Number
CASCADE Drilling - Pyramid
Company Name
2, Well Construction Permit #:
List all applicable well permits (i, e. Counl, State, Variance, Injection, etc.)
3. Well Use (check well use):
Water Supply Well:
❑Agricultural
❑Geothermal (Heating/Cooling Supply)
❑ Industrial/Commercial
❑Municipal/Public
❑Residential Water Supply (single)
❑Residential Water Supply (shared)
Non -Water Supply Well:
mlvlonitoring
❑Recovery
Injection Well:
❑Aquifer Recharge
❑Groundwater Remediation
❑Aquifer Storage and Recovery
❑Salinity Barrier
❑Aquifer Test
❑Stonnwater Drainage
❑Experimental Technology
❑Subsidence Control
❑Geothermal (Closed Loop)
❑Tracer
❑Geothermal (Heating/Cooling Return)
❑Other (explain under #21 Remarks)
4, Date Well(s) Completed: 04-24-15 Well ID# MW-fly BR
5a. Well Location:
Duke Energy - Cape Fear
Facility/Owner Name Facility ID# (if applicable)
500 CP&L Road, Moncure, 27559
Physical Address, City, and Zip
CHATHAM
County Parcel Identification No. (PIN)
5b. Latitude and Longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one lot/long is sufficient)
35deg, 35min, 33sec N 79deg, 2mins, 24secs W
6, Is (are) the well(s): OPermanent or ❑Temporary
7. Is this a repair to an existing well: ❑Yes or ONo
/f lhis is a repair, fill out known well construction information and explain the nature of the
repair under 0I remarks section or on the back of this form.
8. Number of wells constructed: 1
For multiple injection or non -water supply wells ONLY with the scone construction, you can
submit one franc
9. Total well depth below land surface: 50 (ft.)
For multiple wells list all depths Ifd&rent (example- 3 04200' and 2((y100')
10, Static water level below top of casing: 43
If water level is above casing, use " + "
11. Borehole diameter: 10 / 6 (in.)
SONIC
For Intemal Use ONLY:
14. WATER ZONES
FROM
TO
DESCRIPTION
ft.
ft.
ft.
ft.
15, OUTER C^ SINE far
mutll-cased rrclts OR
LINER if a Slcablr
1•-Ittsw
'1.0
"Ll IETER
l FINI' E85 MATEIAL
0 rt,
30 fL1
6 n In. 1
0.280 PVC
16. INNER CASING OR TUBING cothermal
closed -Ion
RUM
TO
DIAMETER I
THICKNESS
3ATERIAL
45 rt'
0 f0
2" I"' 1
0.154
PVC
ft.
ft.
In.
17, SCREEN
FROM
TO
DIAAIETER
SLOTSIZE
THICKNESS
MATERIAL
50 ft
45 rt•
2" t"
0.010
0.154
PVC
ft,
ft
In,
18. GROUT
FROM
I TO
MATERIAL.
EMPIACEMENT METROD & AMOUNT '
39 ft
0 fL
grout
Tremie / Pressure
43 rt.
39 ft-
bentonite
Gravity
ft.
ft,
19. SANDIGRA1'EL PACK If a rllcable
FROM
TO
MATERIAL I
EMPLACEMENTMET1101)
50 ft'
43 ft,
1-A Silica Sand
Gravity
ft,
ft,
20. DRILLING
LOG attach addltianul tltects If nrcctsar
FROM
TO
DESCRIPTION colur. hardncas, ralltrack l o .rain size. etc.
rt.
rr,
See Boring Logs
ft.
rt.
ft.
ft.
ft.
ft.
ft,
ft,
ft.
ft,
ft
ft.
21. RrNIARKS
22. Cert' cation:
A69M
Signature ofCertifred Well CrintracCor Date
By signing this form. I hereby certify that the well(s) was (were) constructed ht accordance
with 1 SA NCAC 02C .0100 or 15A NCAC 02C .0200 Well Construction Slandards and that a
colry• of this record has been provided to the well owner.
23. Site diagram or additional well details:
You may use the back of this page to provide additional well site details or well
construction details. You may also attach additional pages if necessary.
SUBMITTAL 1NSTUCTIONS
24a, For All Wells: Submit this font within 30 days of completion of well
construction to the following:
Division of Water Resources, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
24b. For Inlection Well ONLY: In addition to sending the form to the address in
24a above, also submit a copy of this form within 30 days of completion of well
12. Well construction method: construction to the following:
(i.e. auger, rotary, cable, direct push, etc.)
Division of Water Resources, Underground Injection Control Program,
FOR WATER SUPPLY WELLS ONLY: 1636 Mail Service Center, Raleigh, NC 27699-1636
13a, Yield (gpm) Method of test: 24c. For Water Supply & injection Wells:
Also submit one copy of this form within 30 days of completion of
13b. Disinfection type: Amount: well construction to the county health department of the county where
constructed,

WELL CONSTRUCTIO R C01W
This form can be used leer single or Multiple wells
1, Well Contractor Information.
Well Contractor Name
z-9 2 -�, -
NC Wc11 Contractor Cartificaiian Number
Cascade Drilling, L.P.
Company Name
2. Well Construction Permit#:
Llrl all applicable wall permits fi.e, Canary Statc, Variance, Injection, etc)
3. Well Use (check well use):
Wotcr Supply Well.,
❑Agricultural
❑Geothermal (Heating/Cooling Supply)
❑lndustriaVCommarcial
Non -Water Supply Well.
❑Aquifer Recharge
❑Agblfcr Storage and Recovery
❑Aquifer Test
❑Experimontal Technology
❑Oeotherinal (Clascd Loop)
❑Geothermal (Brain;/Cooling
4. Date Wcll(s) Completed;
5u. Well Location:
C,Q. e e—
Facilitylt7wncr NAie
❑Municipal/Public
❑Residential Water Supply (single)
❑Residential Water Supply (shared)
A
DGmundwater Remediation
❑Salinity Barrier
❑Stormwater Drainage
❑Subsidence Control
f3Traccr
t70tltttr (cx lain undar 1121 Ranrntks)
.Well II10 1� , i D
Facility ID9 (ifapplicable)
Physic`all Address. City, and Zip
trl 01
County Parcel Identification No. (PIN)
5b. Latitude and Longitude in degrees/minutes/seconds or decimal degrees:
(Ifwcll fictd, one Iat tone is rufricient)
11_ ,S"isS 3 � N � � , O 0I W
6, Is (are) the well(s); XFermanent or ❑Temporary
7. Is tlds a rcpalr to un existing ~veil: ❑Ycs or o
iJthfr tr rr repair-, jiff ma krrann well eanitrvetion ittfarmallon and explain the nature ofthe
repo& under 021 remarks seerlanor an the barck of (Isis form.
8. Number of wells constructed:
Far multiple injection ar non -water supply wells ONLY with the same! runsfructloo. you can
submit one furtn.
9. Total wail depth below land surface:
For multiple wally tilt all depths IIrdippepr (example- 3Qu 200' atu12(@/00q
10. Static water level below top of casing: (ft.)
Ijivnterlovel is above casing, use
11. Borehole diameter. A Qn,)
12, Well construction method:
(i.e. auger, rotary, cable, disco push, etc.)
Far lairmol Ilia ONLY'
l-. WA` FILLONIUS
FRONT To loos um n a N
ft.
rt.
IS, t]V1 ER'CA5113G, fd'r niirltl'caseiiVIM `ORLLNER,
I[.li" leablc
Ftxtr;it Tn - ntAaf"ER
TniCtcNF.Ss o-tA•n!ntAL
Qft.
z ( ft,
In.
<•:76NNEl2
:TJ.N
C+lS1NCr4ll tl'lSB1l�iG
'ratliermat
^
elaicd-Ian' ''-' '� "' ' -
Fit
TO
11 LtA1Lr7Ftt
Ttil[:t(k]i,yS MATFAUAL
ft.
ft,
In.
It.
ft,
In.
'--MATMIL
FROM I
TO I nlANMT$R 0.67 SI7.Lr Tlil IKhSS
41t.
.)!! ft
D
P �..
fl.
ft,
I•'nrlat
TO
MATERIA1.
F.A1PLAi:kMt:NTtttF�771nn dr AhtOVYr
ft,
i> ft.
C.Qecess
UI
G fl.
ez ft.
Q
i C
it.
R,
l
To
atA'trAtAl- F,A1KACf:athrrrhIETIIQD
r
ft,
NC IM ouarh
a0dllhinatsTo
n&MMITlntrt calnr, lrardnrlt �nllrreeL rYiu, ruin star, ere.1
n.
ft,
U1.fr_
ft.
f l n !
ft.
ft.
ft.
iL
ft.
fl.
ft.
fL
ft.
ft.
22. Certification:
15'—
Signature of Ccaified Well Contractor Date
By signing this farm. I herehy eertf(,v that the well(1) ivus (were) constructed lit accordance
with i7A NC4C 02C .0100 or isA NCAC 02C .0200 irell Can iniction Slandards and that a
copy Pf rhlr record has been provided to the well owner.
23. Site diagram or additional well details:
You may use (tic back of this page to provide additional well site details or Well
construction details, You may 01so attach additional pages if necessary.
SUBMI'iTAL INSTUCTIONS
24u. 1-or All Wells: Submit this form within 30 days of completion of well
cnnstrucliou to the following:
Divislou of Water ReSeurces, Information Processing Unit,
1617 Mail Service Ccnlcri Raleigh, NC 27699-1617
24b, Ivor IPljactinn We ONLY: In addition to sending the form to the address in
24a above, also submit a copy of this form within 30 days of completion of well
construction to the following:
Division of Water Resources, Underground Injection Control Program,
FOR WATlsit SUPPLY WELLS ONLY: 1636 Mall Service Canter, Raleigh, NC 27699-1636
24c. For Water Supply & In ection Wells:
13a. Yield (gpm) Method of test: Also submit one copy of this form within 30 days of completion of
13b. Disinfection Amount: well construction to the county health department of the county where
type: construuted.
Form OW-1 North Carolina Department of Environment and Natural Resources— Division of Water Rcsaurcas Revised Auinut 2013

WELL CONSTRUCTION RECORD For Internal use ONLY:
This form can be used for single or multiple wells VISEP
1. Well Contractor Information: IR
14. WATER ZONES
WclI Contractor Name
2889 - A
NC Well Contractor Certificution Number
CASCADE Drilling - Pyramid
Company Name
2. Well Construction Permit #:
List all applicable well permits (i.e. County, State, luriance, Injection, etc.)
3. Well Use (check well use):
❑Agricultural ❑Municipal/Public
❑Geothermal (Heating/Cooling Supply) ❑Residential Water Supply (single)
❑lndustriaUCommercial ❑Residential Water Supply (shared)
❑ Ti ation
Non -Water Supply Well:
IJMonitoring ❑Recovery
4. Date Well(s) Completed: 04-27-15 Well ID# MW-09 BR
5a. Well Location:
Duke Energy - Cape Fear
Facility/Owner Name Facility 1D1i (if applicable)
500 CP&L Road, Moncure, 27559
Physical Address, City, and Zip
CHATHAM
County
Parcel Identification No. (PIN)
5b. Latitude and Longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one latlong is sufcicnt)
35.58481233 N 79.03189120 IV6, Is (are) the well(s): ©Permanent or ❑Temporary
7. Is this a repair to an existing well: ❑Yes or ONo
Ifthis is a repair, fill out known well construction Information and explain the nature of the
repair under H21 remarks section or on the back oj'ihis fora.
8, Number of wells constructed: 1
For multiple injection or non -water supply wells ONLY with the some construction, ,Vint can
submir one form.
9, Total well depth below land surface: 40
For multiple wells lixi all depths if different (ecample- 3Qa 200' and 2(a 100')
10, Static water level below top of casing: 12 (ft.)
If uvter level is above casing, use "+"
11. Borehole diameter: 10 / 6 (in.)
SONIC
12. Well construction method: _
(i.e. auger, rotary, cable, direct push, etc.
Nathan D. Oldham
WclI Contractor Name
2889 - A
NC Well Contractor Certificution Number
CASCADE Drilling - Pyramid
Company Name
2. Well Construction Permit #:
List all applicable well permits (i.e. County, State, luriance, Injection, etc.)
3. Well Use (check well use):
❑Agricultural ❑Municipal/Public
❑Geothermal (Heating/Cooling Supply) ❑Residential Water Supply (single)
❑lndustriaUCommercial ❑Residential Water Supply (shared)
❑ Ti ation
Non -Water Supply Well:
IJMonitoring ❑Recovery
❑Aquifer Recharge ❑Groundwater Remediation
❑Aquifer Storage and Recovery ❑Salinity Barrier
❑Aquifer Test ❑Stormwater Drainage
❑Experimental Technology ❑Subsidence Control
❑Geothermal (Closed Loop) ❑Tracerm ❑Geotheral (Heating/Cooling Return) ❑Other (explain under #21 Ren
4. Date Well(s) Completed: 04-27-15 Well ID# MW-09 BR
5a. Well Location:
Duke Energy - Cape Fear
Facility/Owner Name Facility 1D1i (if applicable)
500 CP&L Road, Moncure, 27559
Physical Address, City, and Zip
CHATHAM
County
Parcel Identification No. (PIN)
5b. Latitude and Longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one latlong is sufcicnt)
35.58481233 N 79.03189120 IV6, Is (are) the well(s): ©Permanent or ❑Temporary
7. Is this a repair to an existing well: ❑Yes or ONo
Ifthis is a repair, fill out known well construction Information and explain the nature of the
repair under H21 remarks section or on the back oj'ihis fora.
8, Number of wells constructed: 1
For multiple injection or non -water supply wells ONLY with the some construction, ,Vint can
submir one form.
9, Total well depth below land surface: 40
For multiple wells lixi all depths if different (ecample- 3Qa 200' and 2(a 100')
10, Static water level below top of casing: 12 (ft.)
If uvter level is above casing, use "+"
11. Borehole diameter: 10 / 6 (in.)
SONIC
12. Well construction method: _
(i.e. auger, rotary, cable, direct push, etc.
FROM TO K--SCRIPTION
ft, ft,
ft. ft.
15. OUTER CASING far nt!11 -cased trolls OR LINER B a t licable
FROM To D1A11ETER TRICI{;tiE.RS MATERIAL
0 Pt, 17 ft. 1 6" In, 0.280 PVC
16. INNER CASING OR'rUBING cothermal clascd-loo
FROM TO DIAMETER THICKNESS NIA7THIAL
0 rL 35 rt. 2" In, 0.154 PVC
ft. ft. In.
M SCREEN
FROM TO DIANiFFER SI.OTsizE _THICKNESS NATLRIAL
35 ft, 40 ft- 2" In. 0.010 0,154 PVC
ft. ft. In.
18. GROUT
1'RO.T 1 TO _ _ MATERIAL EMPI.ACFNIENT 51ETHOt7&AMOUNT
31 ft, 0 ft. grout Tremie / Pressure
33 ft. 31 t<• bentonite Gravity
ft. ft.
19. SANDIGRAVEL PACT{(if nppllcablc
11,110A1 TO MATERIAL F.MPLACEMENTAfETHOD
40 ft- 33 ft. 1-A Silica Sand Gravity
ft. ft.
20, DRILLING LOG ntw It addlilonal shceu if necesse
FROM I TO DESCRIPTION tcalor, hardnno, W11mck t' •, M rate stu, ate.
ft, ft. See Boring Logs
ft. ft.
ft. ft,
ft. ft.
ft. ft.
ft. ft.
R, ft.
21. RF.MARIC,Y
22, Certlfi o :.
Signature of Certified Well Contractor Date
Br signing this form. I hereby cerittry that the wells) was (were) constructed in accordance
with 114 NCAC 02C .0100 or 1 SA NCAC 02C .0200 Well Construction Standards and that a
copy of this record has been provided to the well owner.
23. Site diagram or additional well details:
You may use the back of this page to provide additional well site details or well
construction details. You may also attach additional pages if necessary.
SUBMITTAL INSTUCTIONS.
24a. For All Wells: Submit this form within 30 days of completion of well
construction to the following:
Division of Water Resources, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
24b. For Inlection Wells ONLY: In addition to sending the font to the address in
24a above, also submit a copy of this form within 30 days of completion of well
construction to the following:
Division of Water Resources, Underground Injection Control Program,
FOR WATER SUPPLY WELLS ONLY: 1636 Mail Service Center, Raleigh, NC 27699-1636
13a, Yield (gpm) Method of test: 24c. For Water Supply & Injection Wells:
Also submit one copy of this form within 30 days of completion of
13b. Disinfection type: Amount: well construction to the county health department of the county where
constructed.
22, Certlfi o :.
Signature of Certified Well Contractor Date
Br signing this form. I hereby cerittry that the wells) was (were) constructed in accordance
with 114 NCAC 02C .0100 or 1 SA NCAC 02C .0200 Well Construction Standards and that a
copy of this record has been provided to the well owner.
23. Site diagram or additional well details:
You may use the back of this page to provide additional well site details or well
construction details. You may also attach additional pages if necessary.
SUBMITTAL INSTUCTIONS.
24a. For All Wells: Submit this form within 30 days of completion of well
construction to the following:
Division of Water Resources, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
24b. For Inlection Wells ONLY: In addition to sending the font to the address in
24a above, also submit a copy of this form within 30 days of completion of well
construction to the following:
Division of Water Resources, Underground Injection Control Program,
FOR WATER SUPPLY WELLS ONLY: 1636 Mail Service Center, Raleigh, NC 27699-1636
13a, Yield (gpm) Method of test: 24c. For Water Supply & Injection Wells:
Also submit one copy of this form within 30 days of completion of
13b. Disinfection type: Amount: well construction to the county health department of the county where
constructed.

WELL CONSTRUCTION RECORD
This fort can be used far sinsie or multiple wells
1. Well Contractor Information:
Well Conti,clarNomc
NC Well Controeiar Cenlflcalion Number
Cascade OrNling, L.P.
Company ldarne f
2, Well Construction Permit Ne
Ltrl air appllcable,ud/perrrifu (r.e. Cauaey. Slate, Yortance, lnjeeafoa, ale)
J. Well Use (aheclt well use):
1Viltersupply Weal;
OAgricullurul ❑Plunielpol/Public
❑Ocotlienriul (Heating/Cooling Supply) ❑Resldandal Water Supply (aingia)
Dladunm rfal/Cumercial❑RasldentialWatorSupply[sltarcd)
,rW - -
Nun- Vnte'rSuPplyWellt
For lnlereal Litt ONLY: -
:.. .,
tntom
TO
cluvrru,e
n,
ra
+:15:OUTF,.rtCAsLNG,, rai•,
unt:.r:std wtill :t?Si 1:tHir.lt'(If n t llr.51c 7
-moat to
m,#nlrl'rl:u rutcitNF_ss nt,tr�o-ysu.tu
rt,
Th
l 'In
r. CS t' VC-
fNNl:lit'ASINO'OR:TOnING'jpt,,-c,_ilici'ipat:'ctiit2alo`o
1+nt7l1
TO
111,tAi L"f F.I#'
Tlltt:ISMwS
417.'sCltf,6Ni_
:f�,t�: Y„ni,%AiOn:ti.
.�y,. •.-�=
•}'
.�Lr•:
_ --
,
•vaor
n
I.sr.orrsiA
•
I �ntteursn s
a! <TrIuAr.
LEl
rrtaat ti"o
..+errnrnt,
� r„.srtaa:r`:�trxrnu;rilaus.,narryr+t
41q IG
fG
-rr ay q4r
rDm iO
nro �Cr]M
t7AqulrcrRecharge
❑GroundwatcrAcmodfolion
l'•
❑AqutrcrStomgeand Recovery
❑Sal#nlryBarrier
❑A.quifar Tcst
❑StormwatrxDrainage
[]Experimental Technology
❑Subsfdcnee Cotuml
_.21
❑Geothermal (Closed Loop)
❑Tracer
U
ra �
Drcltnvl i frnar. Ira iticsh
o 141ATEJUAI
n, ft,
t717eotlrertrtnl fl%eatinglCanl#nit 1Lanim7' ❑Other (explain uader1f21 Rcmcdx) _� : n'
(L
4.DoteWalls)Completed: wonMf1
r,
So, Well Locol.ion; tt.
Faciliiyll)wrsci Na %a Facility IDlt (irapplicabtc)
n.
Plryifcalhddreas, Ciiy, and'Iip st .t ntltrtl
County Fumcl ldentlncol lea No_ (M)
Sb. Le Rude and Longitude In deg reosinuouteshecunds or decimal degrees:
ftfwcll field, ano latllong is sutGcieot)
W
6.1s (are) ilia wc11(s):'Xlrarmnnent or ❑Tampnrary
7. Is this a repair to an esislltig well: 01'es or *0
(f th lr rs a repot , fill on t kno as sell caruinic ion bl/oraiallan and crpl abl the oalurr of th r
rrpalr atader 921 ramurkr zaciton at an (he back of drlr farm.
S. Number of wells constructed; l -
Form wiilplc bijectian or noa.xnrrr i apgiy vWlz RNLY w1th tha Jame eu+uararrian, you ran
atrlunir Mayan&
9. Total well dnplti below laud surface:
For muhiplautiItsIrsia0eeplhs(jd crcu{trample•3(o]IOti`alWf1[n])ji0)
10. Static venter level below trap of easing: . .� (M)
ifuulerleraltrabove cmlog,U.Vd
ILUorchaladlametert�
jT�
12. Well construction method, � i, t-r
[Lr. vup, Miary. cable, dbccl push, tic.)
FOR IYATER SUPPLY WELLS ONLY:
130. Yield (gpm) Method of testl
131b. Disinfection types Amount:
112. Cortlficutfant
3anaf Wll. J add al& d 14 t o S"
SlgtmtvrcafCutlncd Well Contractor Data
Dv 7fgning thG forma J'Auvby centfv char the tvellfs) war llokwe,1rdluariried In accarsduace
trlth 1J,t NCAC 02C.0100 ar 15.4 NGfC 02C.0I00 IYnO Corard,rctlan Srdattarttr add thni a
copy ofthir record hot beenpravided to the well nw'ner.
23, Site diagram or additional well dolciM;
You may use the back of this poge to provide oddillonnl wall site details or well
cowltueliondetails, You may also attach nddltional pages irncccssary.
SUBMITTA.LINSTUCTIONs .
24a. Far All Welty. Submit this fbnn within 30 days or completion of well
construction la the fallowing:
Dlvlslon of Water Resources, Information Processing Unit,
1617 Mall Service Center, Ralalgh, NC 27697-1617
24b. For N .tfnn Walls ONLY: In eddlffart to sending the form to the address In
24aabove, afsa submit a copy of this fatten within 30 days of completion of well
construction to the following:
D1vh[on of Water Resources, Underground Injudlon Cantral Prograat,
1636 Mall Service Center, Ralulgh, NC 27699-1636
24c. For Water Sattlrly & Injection Wclfs:
Also submit one copy of this farm within 30 duys orcumplction of
well construction to the county health department el' the county where
constructed.
Form GW-I Nosh Camuna Depanmcni aranvlranmcnt and Natural Resource—Dlvision of Warar lutiourca lkvlsed Auttwt 2013

WELL CONSTRUCTION[ RECORD
Tlds farm can be used fors Ingle or multiple welli
1, Well Contractor Information:
AA 1
Fa�IriinmaluteoNLr:
'34. WATURZON7: C' .. ,.. :}'..; :-• � --.. ,, ;.. ,�...'. _..
MOM
I To
nF.417 r41nor
Well Contractor Nam -
<3 9.13 - A,
NC Well Contractor CcrgAcoi[on Number
Cascade Drilling, L.P.
r.
7L
A.
: " A.
IS::OLllrrjLCA5jNG..:
foFmdtllsoScd:irelti
'p1LTiNISiL'
is t'Itreb r '. 4..t.: • :.:
Pnndl
TO
tlrtatr:TER
'IMICICNP:%5 AIA7f:nlAf
n.:
Company Name
2. Well Construction Permit fl:-
Lirt all oppllW Gle todil permtls (l.r. Caunry, Siare l ArioncK lnfecflan, rr�1
3. Well Ifsa (check well use);
'l6ltNNEI'CrLSIN{IitiUIiCHQ`
calhi'rmaiiIhica:[oc
t:l.l:••t:7r:°� :".
-�h
'rlioht
TO
DIAAILT-F:n _
• TTnCKFF:55 IAT:'.n_P. L
R.
,s
fl.
In.
717:scrtz
Tr 3
_
'1SL41T61lr.
^-+
^'TIIti
- I'+!
MOM
T1 NI.rf,iCM1
1d1rTSS _
MAT�n A
Watcr Supply Wall:
❑Agricultural ❑Municipal/Public
❑Gaolhermol (Heating/Cooling Supply) ❑Rcs)drnt)al Watcr Supply (single)
❑ Ind List rial/Commerclol ❑Residential Water Supply (sllorcd)
Cl Irri ,lion -
.lt .
r;�7 1L tl In
p j D
M IJr
li
1l. In.
'ts: cttOtrr-d:w:
Sr°; s ' +•._'° ,' I - ,.-..'•r
; ::!
;';':;:' ,_, ..:;
:. :, •>, .' .
FROM
Tn
WATEaIAI.'
ErPL,LCCnrI!hT alrriilia LAhiD%INT
p rt:
n,
-}')'C� C1L(�
Naar-WalcrSupply Well:
10-Manhnring. CIRteuvcry.
{.
I n'
1
i]R {
%- L
I[lfoction
❑Aquifer Recharge ❑Gmundvmlcr Remcdlarion
❑AqulfrrStorage and Rccavrry ❑SnllnItyDafricr
❑Aqu)fcrTc5l ❑Starmwatarprninoge
❑Experimental TechnDIG&Y ❑Subsldcnca Control
00cothcrmal (Closed Loop) OTracer
19: SnKttlt
itAV1;VP;Lt [
ff d rkiealsle i=',
'-:.='r-a. "•.::.^! +`sir," • •:, '.'
Fn4ht:
TO "'
i,1A F7tl L
S:hFi'L.iCr:ali:YT r,i Er'3F D[F
n
rL
++
I A iFl
7 Y
P.
rr
.-10.'DRIRLLING
LR7C. ,il:�`rh'eddfaortilSetncu
tf mitrtse
-
`PIt DSI
- TD
ALS Clltlrrlo ";ar, luNn,g; rntV ec44gpr, lain sit- rl�
❑0cathenllai -Icailu ;1Coulin Rciurn) ❑Dthcr cx laih under /121 Remar&x)-
R
rt
�oOr in i
4, Data Well(s) Completed: Af % Well ID# MW - t o D
•
'
R,
fL
5a. Well Location:
tt
It.
`
rL
rL
Fatilliyhlwacr N061a Fschtly lea prnppucabtr:l
500
n.
n,
Pla cdtal Address, City, and Zip
17:Itih1AR1:5-
; .
.purity " "' Parcclldcndfiwlion No. (PIN)
51j. Lalltlttle unit Longitude In dcgreWculnulcrlsecuntll or decimal degrees:
22. Cardlicutlon;
(irwctl field, one lWlony Issufilclent)
-N. Q'�� Wtat/tart
5`add QCPited
"" •
6. Is (are) pin ❑Tetnporary
Signature orCcniGid Well Conlraclor 17a o
well(s):XParmanaat or
By signing 1hirfarm, rherehy rertiF+ that the wdl(s) was (it -ere) conrlruried in ucre!alance
frith 114 NC.IC 02C,0/00 or 1Sd NCAC 0:0.0200 11rea Cowliuction Slan lards and that a
7. Is 11111s a repair lu an existing well: ❑Yes or *11
ropy aflhir pedant has beat prvvidrd to 1ha well mvncr,
!f lius is a rnptur fell out binim spsll cwtstruclion Igformation nod csplafa Ilie rurturr of the
rrpalr tmddr 021 rrmorkt aaeuon or on the back afdilrform.
23. Site dla(;rum ur addillunal well dat2ils:
You may use the bade of this page to provide additional well site details or well
8. Number of wcW construetedi `V -
cunsuuetion detu(1s, You may nlse uttach additional pages if necuoutay.
Form utlfplehJectianornon•wotersulrp(i•svcllsONLY Meh?he jWvu e'unsirr•dinn,you can
SUBMITTALINSTUCTIONS
xubmli one faun
9.Toln1 well depth below land surfacer (it.)
2de, T+or All Wells: Subm)l this form within 30 days of comptclian of weil
Farmuldple wells Ilrl all depths
constriction to the following:
^ I0. Static water level below top of casing: � 2— (ft.)
Division of Wuler Resources, information Procesting Unlit
_ -
piwrerlevol U abovocating, ups"'+"
1617 MnO Service Century Rulclgh, NC 27699-1617
13. llorobole dlarnular:
20. iPr ]nlectlon Wells ONLY: In addition to sending, tha fort to the address in
"
�
24o above, also wbinit n copy of d115 romt Within 30 days or comptclian or well
IL Wet! construction metliod; 1 tr
consttuctian to the F011DWing;
(Le. auger, rnrary, rabic, dlract pusli, rlc.)
Division or Water Resources, Underground Injection Control Program,
FOR WATER SUPPLY WELTS ONLY-
1636 Mail Semler. Center, Raleigh, NC 27699-1636
24c. For Wolcr Sunnly & iniaction Wellsl
33o. Yicld (gpm) Method of test:
Also sultmit one copy of this fort whilin 30 days orearnplction of
I3G, Disinfection type: .._. Amount;
well construction to the county health department of lite county where
constructed,
Form QW-I North Caroltou Mparimcni or8nvirnntncnt and Natural Resources - DlvITIon or Water ftesaurces Ttevlsed August 2013

WELL CONSTRUCTION RE, CORD
Thu 6or211can he urcd fnr rringlo oraiwilpia wails
L Well Contractor Inrarmadon:
Jonathan Todd Allred
,Val] Convautor Name
3213-A
NC Wcll ContraeturCcrrlfmalloaNurober
Cascade Drilling, LP.
Company Name-
2, Well Construction Permit f1:
441 ull oppffcahlo nrll pennlis (I.E. Cmrnry, 51a1c paiianee, irdaulan, elzj
J. Well Ure (Chock Weit uae):
❑Atiricultural DMuniclpoUPublic
❑Gcolhumol (Hcating/Caofing Supply) ❑Rlsidcritial Water Supply (single)
❑lndus[riat/Cnmmorcinl 011csidcntial WolerSupply (shercd)
In ucsloii kYctL
❑Aquifer RecharUc
❑Groundwater 11cmediuliun
❑AquirerSw. andRcr:ovcry
❑SallnlryDurder
❑Agtdrer Tcai
❑Slormwaux Drainage
dBxperimuntul Technology
❑Subeidcnce Control
❑Geothermal (Closed coop)
❑Trucer
17Ge0111erinal (FIcvfln;JCao)in I;cttirh)
00thor(ra 'laid under 1121 Reniri trsf
4. Date Wcll(s) Complatedi all% lWell IDO
50, Well Locauan:
7vke- c `rfO +^
Faaillty/t7rvmr am¢
Facility WN (Ifnpplicablc)
Physical Addeeir, City, and Lip
rnrinrarnal'Usa D14LY:
leaner 7u aescltrr7rnl;
rl. fl.
- .:TS.�OUTLR- Wrils
Oft LIMIt 1[.n r YllrrlYla
"-: ,•::�'.:._•.
nli Qhl Tn nln AlrTF.n
7'I }CifN ISS
S1,i71;lthti.
-t6.TNNlt1'GtSTNr;fslt7[]1tIi4C CeflYTrkdntCtarrd•19n
.t:%
-
t+nfSaf -. - 1i1.
nfAAT6Ti<tt
Tftlr:nli FS� n4A7'�rrtA4
a 7 11. L! 0 rr,
it. ft,
In.
FirOhS -
Tn - --
a1,5 SE'rt:n-St,tl751'lJ: TmRClrrSS Sf AI"L'I 1hL
tjef it.
�.� In, , 010 , I,"• Cl rt/G
ft,
It.
ln,
rr1t111 7n 1r,\TCIIIt4 �•• -r.511'l..iCb_41 F.Yr AlFTlrnn Rr Ahrellr.`r
q d it. n,
t �'•5- l •leis f ,!C- �f Cv .
_ —
ko �.a rr.' ill,.: a•� .; �.�'�,� '.�,
49: A'.Vt11C1tnvLn-PACK if d ncntrrc '. C ,.:.:• :.... .-:... .
:tnuar as 7.1 T>:nW. FhrrLZ7-%u-;.Yfllmitiri
l l fl, LI R. ;� Si �lCa :ar.'I.r. p:r!•r'•I,
IF. n.
� 70.17n1Lt,1NC LIlG onaeh aiidlllahci'rinu+:ttitfrreeersa -
Minim -ro - i1FSG}til'7i4trrmhir. fi+u,}aau rutlrr.rl e, ,:, 1•rarn eLr rrr,r
rl, 5t c n.f:10 r l to S
fr. ` w
rh n,
n. s.
ft. rr
Il ft.
7L 1tFhfdltl:S- _,:, _-- • '
County Puccl ldendfeotlon No. (P"
- - • • •- -
SIP. Lutilude and Longitude In degrees/minutes/seconds or declmul degrees[
"
(i(wcll flcld, on¢ laulnng ivaulrclenc)
22, Certlficailort:
�s,r(ri:'+!`f !�0t[dGftlYf FY
j�rirealr7CIfL,luclriaE'!ired
6. 19 (ura) the well(s)l XPermoncnt or ❑Tantporury
Slgtutuxta(CntlttcdWell Coln naotar ga1v
7.Is this a repair to an existing well: OVas or YNa
ay slgnlnf; lT,L�rnrm, r I rxsby crrf�a line fire wnrlf(r) freer f+verrJ mrerarrrrcl in acnrnrtanre
+ulfh i3A Ni tC 03G .0I0d ar rs t NrrlC oaC .d:na Ireil Cnarrructlmi $ranrlanis and rhea n
hvx
trrhtr fra rrpaer. Jill will known wale ctiml-criovn k(ormallan mid explabt the natlrrr of Air
cape afthir rCcard bratprovided no rhr well owacr.
reprur under#J1 rr,n¢rirreerran oraa rhr back ofrhta fern[.
23• Site diagram or additional well dalnils:
8. Number ofwalts egnstructed: if
You may use the Illicit of this page to provddo additional well situ details or wcll
Furatuhlpler injlxllan or[ton-rwlerJgppt} wcllr ONLY wrlh the sonic eonstra+nloa,
canslructitan de(ails. You may ulsonnoclt alldltional pagca irnccessory.
),oilcan
subinfr ana fnnra
SUBMITTAL INSTUCTIONS
�if .
�•
9, Total well depill below lltad s•urfaee:• (tin}
Formtrltfpie nclls Its# ail d,,pilu(rdVercar(exaln'Ple.33(c)700'una`2@1AWj
it t
Ida, 1?ur All WnlCi; Subpaii This farm within 30 days of cnlnplclian of well
eatutructian io lha rollDwing:
10, Sttilic Water level balnw lap arcosingi -! (fL)
Divislun a Wilier ReSgarces, Tn rorma don Prnccsfinl; Ulrif,
lJugtulavcl truhaVe casing, use "+"
1617 MitU Service Cc11ter,11ulelgh, NC 27499-1617
16
11. Durchulc dlamctar: __IO (In,)
246. I•at Irricerinn 1Vclls ONLY: In ndditlon to sanding the form to the address In
12, Well construction method: ' m el..e C—
144 above, -Oso submit a C4f3y or this £anal within 30 clays or cnmplctlon of wall
_
G.e. auger, rotary. cubic, direct pwh, etc.)
construalion to rho 11011Dw(ng:
DlvLslon of Walur Reseitrcu, Underground lnJuctlon Cnntral Program,
1636 Mall Service Conter, Ralalgh, NC 27699-1.636
17OR WATER SUPPLY WELLS ONLY;
13e. Yield (gpm) Muthad of testy
I4r. Yur Water Sun !y & lnlealian Wails;
,
Also submit one copy of oils form within 30 days orcomplctian or
I3h.Dlrinfuctlorr type: Amount;
well conslniclion to lltu county health dupnriment ortlic countywllerc
- ........ - .. -'
construalcol.
Fnrm CAP-1 North Crrniina Department of finvlrunm.nl and Nniurul ltaaourves-1xviiiian or Water ltasoarccs Itevised Augur 2n13

WELL CONSTRUCTTONIZECOR'D
Tbls (urtri can be used For Sins19 or MIL hlpIC well
1. Well Contractor furorrn ition:
a MA-hgYN mid A C Iyt d
Well Ccmraator Name
3cgQ- X
NC Well Contractor CerilGcauan Number
Cascade Drilling, l .P.
Company Name, —
2. Well Construction Permit th
4W all appficable well permlu (fa (7uiwry, Stara r urinnce.Injecllan, etc)
3. Well Use (clseck well use):
Mgdcultuml
❑Gaotbcrmol (Hcating/Coo(ingSupply)
❑ Lid ustria 11Ca mmercia l
nrmnaltna ...
❑Aquifer Recharge
❑Aquifer Storage, and Recovery
❑Aquifer TeML
❑Exitcrirricatal Technology
❑Geothermal (Closed loop)
4. Date Well(s) Completed;
❑MunicipaliPublic
OResidcatial Water Supply (single)
❑Rcsidcndnl WatcrSupply (shnrcd)
❑Groundwater Remcdlation
❑Sal Inity'Rarrier
❑Stormwaler Drainogo
❑Subsidence Contral
OTraccr
000tcrfcx6lain undertr2l
57Wall]Blii-�.�� }-
5a. Well iLocation-
1]k`1 e
paol4llylOwrtatNaitie ` 'FeciiityiDrr(irappiicable)
Physimi Address, City, and Zip
County Parcel IdcruiGCatlon No, (PIN)
For Interval Use ONLY;
Sn, Lnutude and Longitude, to degre"Iminutesrseconas or ucelrnal aegrecs: 12. Certification-
(ifwull Gold, anti Iadlmig is rufAcicnr)
t d." affAm
." .r+ ! W LafFtClit J add
6,fs(orc)thawell(s):XPormancat or ❑Temparary
7. Is this a repair to on existing tvelli ❑Ycs or )�Wo
OrUds if a repair, flit mu brawn well eortrinirrIon it jormanon and erplaht the natare ajdte
repair under 1111 /YmUrhr redrUn ar on the bock Vflhlr farm
S, Number orvveils constructed; 1
Farmuldple Injection or nun-watcrrrrppfy welLr ONLYtv11h the rams CalUtnletlUrt. you can
Slpnatura of Cinllled Well Caniractar
tq Z FE:�
Osta
Hy rlgning thlr form, f herebp cerlLry that she welIN wru (here) tonsmirsed to aeroj-danet
with /11 11CdC01C,000 or 15d NrAC 02C.0300 fruli Canrnucifun Slandardrand that a
copy aJthir record has been provided to the nvell owner.
23. Site dlagram or additional well details:
You may use flit: back of this page to provide additional well cite details or well
construction detalta. You may also nuach additional pages if ncccsory.
rubtnfl one farm, %
SUBMITTAL INSTULMONS
n
9, Tutu[ well depth W th below Innd surface:
(ft,) 24a, For All Wetis; Submit this Corm within 30 dayt or completion of Well
For multiple neNs 101 all depths (fd&Tnt (trample-3Q1011 and J@)001
eonitnsetlon to the following:
ltl. Stade voter level below trip arcasing,. �4: _
(It.) Division of Water Resources, Information Processing Unit,
frvarw level & about casing, ute '14-
1617 Moll Sarvlcc Center, Raleigh, NC 27699-1617
11, Borehole diameter:, �t' (In,)
24b, frnrjnjqctlnn Wrtil ONLY; In addition to sending the Torm to the address in
24o above, also submit a copy of this Conn within 30 days or complcdon of well
iZ Well construction niethud:. n_�_ L _
eonstruFtion to die following:
(Lc. outer, rotary, tmblc, rlfrcrr push, ctc.)
Division of Water Resources, Underground Injection Control Program,
FOR WATER SUPPLY WELLS ONLY:
1636 Mall Service Center, Ralclgli, NC 27699.163fr
13a. Yield (gpin) Method of test:
24c, For Witter Supply & Injection Wells:
Also submit one copy of this farm within 30 the sofeomplcdnn or
I3b. Dlsinroedon type; Amount:•
well ions[mction to die county health department of the county Where
constructed.
Form OW-1 North Camll na Mpanment of &nviroralwnt and Natural Itcrourecs — Dlvlsfan n rwotu llcsoutce , Revised Aa6usl 20I I

LL.CQNSTRU+CTI.ON RECORD
Thin Corn[ can be teed far stnil(e or multiple wclLs
1. Well Contractor Taformatlon:
eta 4ftic,�, T Il reel
Well Conuaclor-Numc
3�1
NC'Well Coolracror Ccrtlficalion Number
Cascade-. Drilling, L.P.,
Ca mpdny Name
WCII Construction Permit 11,
L"allopplicablaWell Fermin(I,d.County, Store- lur;ldrieGfnfdclion,'etcf" '
3. Well Me (cheelttvell use),.
❑ Agricu Ituro l ❑ Municipal/Publlc
❑Geotharmal (Hooting/Cooling Supply) ❑Ruidcrrtlal Water Supply (single)
QIndus trioUCDmmerclnI ❑Residential Water Supply(sltnred)
❑Aquifer Recharge gGroundwater Remedintion
❑Aquifer Starage and Reeavery ❑Salinity Brinier
❑Aqulfcr Test ❑Stormvwer Drainage
Mxperimenial Technology ❑Subsidence CDnlrul
❑Gcothermol (Closed Loop) ❑Tracer
Fnr Interrmt Lim ONLY:
-•lf?1vA7C.rr lflNl.5 r. ... ..
n. rL
1"'' • ft. I fl. I la. I I I
ft.
�t
I 1 ft.
.,,rf
t�
"
- __C"-[,
J.
fl.
tn.
• � _
n.Tntt<i;N"SS
,
MUNI•
l}
Ulr�nit-Tt:I �
5Lf14517.R
MA�Tenlnt.
a rS-r
F." V—C
l ft.
O fLCLA—mi
O-ss ►rG
rr.
iL
fL
fL
::lsraxlmlartavta:r.A_tr.•
lrm,rne�bte �
;�.I:.:,:., �..,�.:::�:.,,:._�,�-:�;• -.
FliDbl
TD
MATEWAL I sat rL«4COT17rr.IcrlIUD
2� nI
n:
IL
I fL
❑Gcodttrmnl liaotitglCanUn , Ralttm) . DMICs (wt laln underIM Romans
R'
n
ar l en
Ah�} 1 _
Date Well(s) Completed: , WCII IDI1 I Y�i ��5 5 T
It.
ft.4,
M
ft.
Sa. Well Locotlatty
fL
..' fL
Fsdlity/Owncrr'utrw�', 5"'""� F.cilityIDa[ifop0lubllrc)
fL
rl.,
�{
IL-
Phyri Address, Chy, and Zip
='REMATlKS',-
{w_i
Caantp • - - .. 7.7.1ld d ei"' tid'o No. (PIN)
'. ... .... - . . .
5b. Latihide and f oagtfude In dagraeslminutes/seconds or decimal degrees:
22, Certllicutlon:
(ifwctt field, ono 4+t71onG lssvfficlentl
�r
'
YmutfFuut J acid aff wd L41ji-I
,
SiEnalumofCetdfiad Well Conuaclor Date
6, Is (oru) the lvtll(s): *crmancnt or []Temporary
By r/gning MEr farm, thereby rerrLry /hat the uvll(J) %An (erercf to-u+nuled In aecunfame
evlth tSd NCAC 07C .0I00 or 1SA NGC oic RI00 IWI Comiructran Srandordi nad AW u
7. Is this n repair Iv an existing well: ❑Yes or *a
copy gfthU record Aar been provided to the +volt owarr.
(fihtr Ira repair. fill atu Jo,awn well cotrrrrsixilan (+tfarmallan and explain thrnarun ofthe
repair under 031 renoorLy aeerran ar an rho hack nfrhtr fast
23. Site dingrnm or additional well dclalis:
You may use Use back of this page w provide additional wolf site details or well
8, Number of wells constructed.*
construction details, You rosy also altach uddillonal pages ifnecossary.
Formulripte Injecrlon ur non-wWorrup/dy u•elLr Mrtrilh the raise caailruufan, you can
SLMMITTAL INS"rUCTIONS
rubrnlranefanm
9. Total well depth below landaurfatc: +
24a. T'n_r All Wetlxr Submit This form within 30 days or comple0on of well
Fdrmulllpld wrlk till all dapthr Ifdjfferanl [rsampie J(�}7Q0'y'arxrd7{u�'10-y.
eonsttuclion to the following:
10. Static Water level below lop pirtoting:
I _ _ (El)
--�
Divlslon of Walcr Resources, information Ptucessing Unit,
f(wwerlevelrr oba,v owing, are.-"4--'- - - - -- '"
1617 Mail Service Center, Raielgh, NC Z7699-1617
11. Borehole diamelar' (la,)
24b. Vnr lnitetinn Wall1 ONLY: In addition to sending the form to the addruss In
,
24aahovc, also submit a copy of this farm within 30 days of completion of well
M Well construction method: �Q11111
construction. to ate following:
(te- auger, rosary, Gble, dlreat pub, cic:) ' -
DIVI9lan of Water Resources, Underground InjCCpun CanIIDI Program,
FOR WATMi SUPPLY WELLS dNLYi
1636 MoU Service Center, Raleigh, NC Z7699-1636
24e,'For Writer Supply & WLcllon Wells
13a. Yield (gpin) Method of test:
Also oubmil one copy of this foam within 30 days of completion of
I3h. Disinfection typo: Amount:
well construction to the county health department of the county where
constructed
Form pW-I North Camllnl Depanm:nt orllrtvlmunwnt and Nataral Rctouruu- Dlvisloit of Water Ilesaumes Revlred August 2013

WELL CONSTRUCTION RE, CORI)
This rurm ten be uaad for simple or multiple wells
I. Well Contractor Information:
-w A nfcffian IDA . _ A II i-rc
Well Conlmchnr Name
NC Well Conincmr Cerittestion Number
Cascade Drilling, L.P.
Company Name
2, Well Construction Permit 9:
Gut all opp(Imhle wril permltt ax Carry, Stale, Variance, Jnfretlart, ale.)
3. Well Use (ellock well usc)l
Watcr Supply Well:
❑Agricultural
❑Munlclpal/Public
❑C=thermal (Hcaiing/CoolingSupply)
❑Rc cIvridal Water Supply (single)
❑Lhduatrial/Commcrcial
❑Residential Water Supply (shored)
❑ln-i .orlon
Nan•Wa[or Supply Wollt;
MMoniloring
❑Reeauery. ,
hijJ citon 1Vcllr '-
❑Aquifer Reehnrgo
❑Groundwater Remedfotion
❑Aquifer Storage and Recovery
❑Salinity Barrier
DAquiferTest
❑SiormwaterDralnoZe
OExperimcntal Technology
❑Subsidence Control
40eothormal (Closed Coop)
❑Tracer
ClOcatharmal (I few InldCnuiIhir Routm)
❑otbcr(axpioin under 021 Itemark:a)
4, Data well(s) Camp]otud: LUII Weu ID11 1 + u-�- • ',: 0 .
So. Wall Loco don:
Facility/OwncrN FrcllhylDd{lfappllahtc)
5pb . ck-d L,
Pbyskal Addles, My, and ZIP
County - - Peri;d Idculifcutiiin No. (PIN)
Sb. Latitude and Longitude In degrecs/minuteslsceonds or dceltrtal degrees:
(;[well field, atm ratllnng is surficient)
6. Es (are) via wall(s):XPermaucnt or ❑Temporary
7. Is this n repair to on existing well: OYcs or XNo
ljthls b a rrpair,�Jl nut l Dawn unil rotwintriloa 6tfaramllon and erplaru the nature of fhe
Wait under P2I remarhr ruction or an she hark ajthtrjarm.
B. Number orwcus construcledl 1
For m ulthpla im1cction or non-twlerrupplj• Wdir Of+1G y with the ram a consirlledan, you ruff
Jnbrnll onojonrr,
9. Total well depth below land surfacre
Far muftlplr%vl►r tut oil dapfhr(jdjffarant frsampla-3,fejt 09'aanill(D)00)
Ia. Slatc water kvet below top of casings ✓ {Il_}
et.mrat level b above Carley, use "+"
11. Borehole diamolor. (In.)
It Well construction malhod: CNN C✓
(tie, 2uge6 rulary, cable, direct push. cir-) --
For Internal Me ONLY*,
22. Certification:
ywurtixwt ,7 add M44ul
Si&utura o(Cenirted Well Contractor Dale
➢v x1gafng lhlrjbrar, f hereby eer#Uy thul the avlift) war (vary) rawmircled In oecwdanee
with I.IA NCAC 02C.0100 or lit NGC 0117.0206 Well Cowtntdfan 5iundarrfi and Char a
copy ojthlt record har been provided to the well owner,
D. Site diagram or additional well details:
You may use the beck of dais page to provldo additional well site details or well
canatluotion delailu. Yea may also attach additional poses if necossory,
SUBMITTAL, INSTUCI'IONS
24a. fnr All Watts: Suhmit (his farm within 30 days of completion or well
construction to the following:
Dkvlslurl of Water Resources, Inronnatian Processing Unit,
1617 Mail Service Canter, Ralelrh, NC 27699-1617
24b. rnr Inlrectmn Watlm ONLY: In oddidea 10 sending 010 form to the address in
244 above, also submit a copy of this farm within 30 days of completion of well
construction to the following:
Divlsian of WaterResourcesr Underground Injection Control Prograttt,
IIOCt WA.TBR SU11?LY WELLS 0NFLYI 1 1636 Mall Sarvlce center, Iloicigh, NC 27699-16I6
24c, Far Water Seal& r• Injection Wells-,
13n. Yield (spun) Metbod of test:. _ Also submit one copy of this form within 30 days of completion of
13b. Disinfection type: Amounll well construction to the county health department of the county where
conakuoled.
Foram OW-1 North Catalina rleparmenl of Environment and Natural Resources --Division of Walcr ilciourcu favind Aut ul 2013

WELL CONSTRUCTION RECORD
This form can be used for single or multiple wells
1. Well Contractor Information:
Nathan D. Oldham
Well Contractor Name
2889 - A
NC Well Contractor Certification Number
CASCADE Drilling - Pyramid
Company Name
2. Well Construction Permit #:
List all ap➢licahle well permits (i.e. Counry. Store, Yanarcc,, lay,o on,
3. Well Use (check well use):
❑Agricultural
❑Geothermal (Heating/Cooling Supply)
❑ Industri al/Commercial
❑Aquifer Recharge
❑Aquifer Storage and Recovery
❑Aquifer Test
❑Experimental Technology
❑Geothenual(Closed Loop)
❑Geothermal (Heating/Cooling
[]Municipal/Public
[]Residential Water Supply (single)
❑Residential Water Supply (shared)
[]Groundwater Remediation
OSalinity Barrier
OStonmvater Drainage
❑Subsidence Control
[]Tracer
[]Other (explain under 421 F
4. Date Well(s) Completed: 05-05-15 Well ID# MW-16 BR
5a. Well Location:
Duke Energy - Cape Fear
Facility/Owner Name Facility ID# (ifapplicable)
500 CP&L Road, Moncure, 27559
Physical Address. City, and Zip
CHATHAM
County
Parcel Identification No, (PIN)
For Internal Use ONLY:
14. WATER ZONES
FROM
TO
DESCRIPTION
ft.
ft.
rt.
rt.
15. OUTER CASING IW multi-casedwells) OR LINER(ifa licahle
FROM
TO DIAMETER THICKNESS 31ATERIAL
0 ft'
20 f[. 1 6 In. 1 0.280 PVC
16. INNER
CASING OR TUBING eotbermal
closed -too
FROM
'r0
DIAMETER
THICKNESS
NIATERL4L
0 ft.
46 ft.
2" in.
0.154
PVC
ft.
ft.
I in.
17. SCREEN
FROM
TO
DIAMETER
SLOI'SIZE
TUCKNESS
MATERIAL
51 R•
46 f`•
2" in.
0.010
0.154
PVC
f[.
in.
18. GROUT
FROM
TO
MATERIAL
EMPLACEMENT METHOD&AMOUNT
40 ft.
0 rt.
grout
Tremie / Pressure
44 ft-
40 ft-
bentonite
Gravity
ft.
R.
19. SAND/GRAVEL
PACK
if a licahle
FROM
TO
MATERIAL
EMPLACEMENT METHOD
51 f1.
44 ff.
1-A Silica Sand
Gravity
ft.
ft.
20. DRILLING
LOG homch
additional sheets If necessary)
FROM
TO
DESCRIPTION acto, hoodocss, son/rock type, m ve, etc.
ft.
ft.
See Boring Logs
ft.
ft.
R.
ft.
ft.
ft.
a.
ft.
ft
ft.
ft.
ft.
21. REMARKS
90 to 60 feet was backfilledwith bentonite pellets
5b. Latitude and Longitude in degrees/minutes/seconds or decimal degrees: 22• Certification -
(if well field, one lat'long is sufficient)
35deg, 35min, 44sec N 79deg, 2min, 15sec W,
Signature of Cettificd Well Contractor Date
6. Is (are) the well(s): faPermanent or []Temporary g this ( I h b i r h i th 11 ) d ' d
7. Is this a repair to an existing well: ❑Yes or ONo
If this is a repair, fill o,a known well ,onvruoic, P �...iwion mad er➢lofn the tu nare of the
,-grtiv node,' #21 octson e.vectim m' o t the hack cy rhos fmwt.
S. Number of wells constructed: 1 m For u6ipte my,uroor n non -water supply cod is ONLY with the same cansrr."iion, yoz, can
'oh i, one t rm.
9. Total well depth below land surface: 51
F'o, an dripl, wells list all depths iyd o w /example- 3@200' and?11}700')
10. Static water level below top of casing: 0 (ft.)
Ifwoter level is above coring, .use"
t ugnmg e, e,e y "I , a e the (s oas (were) coa, rw a rn accol once
with 15A NCAC 02C .0100 or I SA NCAC 01C.0200 dell Construction Standen ds and that o
copy afthis recro d has been provided to the well timer
23. Site diagram or additional well details:
You may use the back of this page to provide additional well site details or well
construction details. You may also attach additional pages if necessary.
SUBMITTAL INSTUCTIONS
24a. For All Wells: Submit this form within 30 days of completion of well
construction to the following:
Division of Water Resources, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
11. Borehole diameter: 1 O / 6 (in.) 24b. For Infection Well ONLY: In addition to sending the form to the address in
SONIC 24a above, also submit a copy of this form within 30 days of completion of well
12. Well construction method: construction to the following:
(i.e. auger. rotary, cable, direct push, etc)
Division of Water Resources, Underground Injection Control Program,
FOR WATER SUPPLY WELLS ONLY: 1636 Mail Service Center, Raleigh, NC 27699-1636
13a. Yield (gpm) Method of test: 24c. For Water Supply & Injection Wells:
Also submit one copy of this forma within 30 days of completion of
13b. Disinfection type: Amount: well construction to the county health department of the county where
constructed.
Form GW-I North Carolina Department of Environment and Natural Resources- Division of Water Resources Revised August 2013

WELL CONSTRUCTION RECORD
This form can be used for single or multiple wells tr I SQD
1. Well Contractor Information: J12 Y
Nathan D. Oldham
Well Contractor Name
2889 - A
NC Well Contractor Certification Number
CASCADE Drilling - Pyramid
Company Name
2. Well Construction Permit #:
List all applicable r+pll permits (i.e. County, State, Variance, h jection. etc.)
3. Well Use (check well use):
❑Agricultural
❑Geothemtal (Ileating/Cooling Supply)
❑ Industrial/Commercial
❑Irrigation
Non -Water Supply Well:
injection Well:
❑Aquifer Recharge
❑Aquifer Storage and Recovery
[]Aquifer Test
❑Experimental Technology
❑Geothermal (Closed Loop)
❑Geothermal (Heating/Cooling
❑MunicipaUPublic
❑Residential Water Supply (single)
❑Residential Water Supply (shared)
❑Recovery
❑Groundwater Remediation
❑Salinity Barrier
❑Stonnwater Drainage
❑Subsidence Control
❑Tracer
❑Other (explain under #21 1
4, Date Well(s) Completed: 04-29-15 Well ID#
MW-16 S
5a. Well Location:
Duke Energy - Cape Fear
Facility/Owner Name Facility ID# (if applicable)
500 CP&L Road, Moncure, 27559
Physical Address, City, and Zip
CHATHAM
County
Parcel Identification No. (PiN)
5b. Latitude and Longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one lattlong is sufficient)
35deg, 35mins, 44 secs N 79deg, 2mins, 15secs W
6. Is (are) the well(s): OPermanent or ❑Temporary
7. Is this a repair to an existing well: ❑Yes or ❑No
if this is a repair, fill out known well construction information and ecplain the nature of the
repair under #21 remarks section or on the back of this form.
1
For internal Use ONLY:
la. WATER ZONES
FROXI TO DESCRIPTION
ft. ft.
ft. ft.
15.OUTER CASING for multi -cased swells OR LINER lIa Ilcable
FRU:Ir TO Emil T11tCKNFSS able)btATERtAL
f[. ft. in.
16. INNER CASING OR TUIIING ( votbermsl etwed-ion
FROM TO DIANILTER THICKNESS MATERIAL
6 ft 0 ft• 211 in. 0.154 PVC
ft. ft. In.
17. SCREEN
FROM TO DIAMETER SLOT SIZE THICKNESS MATERIAL
16 f[. 6 ft. 2n t°' 0.010 0.154 PVC
tn.
18, G[IOU T
FROM 'ro MATERIAL EMPLACEMENTMF.THODAtAMOUNT
2 ft. 0 rr. grout Tremie / Pressure
4 ft. 2 rc. bentonite Gravity
ft. f[.
10. SANDIC;RAI'EL PACE{ If a llcablc
FROM TO _ MATERIAL I EMPLACEME{VTMETHOD
17 l" 4 ft. 1-A Silica Sand Gravity
ft. ft.
20, DRILLING LOG attach additlonal sheets if necessary)
FROM To DESCRIPTION tcalor, hardness, suTrockl.. a ruln size, etc.
ft. ft. See Boring Logs
ft. ft.
fL ft.
ft. ft.
ft. ft.
ft. ft.
ft. ft.
21. RF.IIIARKS
22. Certifi tion:
Signature of Certified Well Cnnlruclor Date
Br signing this form, i hereby certif , that the wells) was (were) constructed in accordance
with I5A NCAC 02C .0100 or 15A NCAC 02C .0100 Well Construction Standards and that a
copy ofthis record has been provided to the well owner.
23. Site diagram or additional well details:
You may use the back of this page to provide additional well site details or well
8. Number of wells constructed: construction details. You may also attach additional pages if necessary.
For multiple injection or non -water supply wells ONLY with the sutne construction, you can
submit one form. SUBMITTAL INSTUCTIONS
9. Total well depth below land surface: 17 (ft.)
For multiple wells list all depths if different (erample- 3(a)200' and 2@100')
10. Static water level below top of casing: 0 (ft.)
If water level is above casing, use
11. Borehole diameter: 6 (in.)
SONIC
12. Well construction method: _
(i.e. auger, rotary, cable, direct push, etc.
24a. For All Wells: Submit this form within 30 days of completion of well
construction to the following:
Division of Water Resources, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
24b. For Infection Wells ONLY: in addition to sending the form to the address in
24a above, also submit a copy of this form within 30 days of completion of well
construction to the following:
Division of Water Resources, Underground Injection Control Program,
FOR WATER SUPPLY WELLS ONLY: 1636 Mail Service Center, Raleigh, NC 27699-1636
m Method of test: 24c• For Water Supply & Injection Wells:
13a. Yield (gp ) Also submit one copy of this form within 30 days of completion of
13b. Disinfection type: _ Amount: well construction to the county health department of the county where
constructed.

WELL CONSTRUCTION RETORD
Far lnlerrtil use ONV 5 i '
ThIs farm can be Cued fur rinaIt at multiple wa1L
1. Well Contractor Information:
: ta:wA'r�niatifs
J n ih(In 2h �
�� i�tf�l'��
�-/IRr,r•
7o
n€tcnrlittfHt:
Well Conlrnular Name
NC Well Contractor Ccrtilicauon Number
-IS:OUTf:R'C151YGt' fnr.nsult
Pro ttdnreEld)tilt
LTN€:R Erri s
lh:dllc ::-':::.`::•• r•-..-
FRUM "- Ta
IIIAxMilili
•iIIIC1C [l €:SS
'AIi�TEF2IAL
Cascade Drilling, L.P.
-
Company Name
=±tc:•tr+N�n.enSSNtratz
rtlltrl+t;" r urecriiafrlarrl=lPa
.. .,. . -.-, : � •. .
FROM
Ta
c(ANIt.m.n.
'19 xtr MESS 1 1I47ntm6L
2, Well Cunsiruellun Permit il-
ft.
r-f R,
In,
e.—e l
Lal oil appffcobld W tdlpermflr (La Caual)4 &atS Fyfi-IlRCr. fgjrrtlAR,, efG�
'.-v1
" ""
'
r4
fl,
IR,
3. Well Use (theca Weil ust)t
s7.6t ItE ,N
Watcr$up)1Iy Wtll:
Pltnhf
TU
[HAAM"A S[:nTS181:
rtllCVNP_CY
41A11?1U0L
❑Agrlculturul CIMunicipuUPubllc
(Hcatln lConlin Supply) ❑Reidential Water SuPPIY (sin6le)
R»
m
lip.
❑IndustriaVCommercial ❑Itrsiden[inlWater Supply (sharcd)
�BCflour, '='' :-••-!. = ! <- -- C:.:-:='.:..
�T1ln•IACF.,If-ST
Cllrri ntiva
Fnr.Yr
Jt.0
TV
I R,
a1A71:10AL
r
M1tl;771[In &.rtilll tl;rT
r,-
lilt P 7(<j
Nnn•WalerSuppiy vYrili`
r-4i7 {
t
tRIManiloring 01tccavcry
ft"I t to
111jur.111rll WWI,
❑Aquirer Rechnrge ❑Groundwatcriicrnedialion
17: "kNUtGIGtVL+L
1 ACrt ftf.n tllultda
ClAquirarStorageandRecovery ❑SalinityBarrie`r
vnnM1r
TO Iih77QSliAL EAIPL1CFllt'hTM1tllllhn
`t�
I
13A,guifer Test ❑Starmwater Drainage
`�
'•
`-'r� CA .r
f"•V' 3
ft.
IL
❑Experimontul Technology ❑Subsidence Control
❑Gealiermpl �CIUSLd IAop) ❑Tracy
rO,llrtll.LJl4f:
! l7G ullacll additton+I vhrela Irnecc:lxr
Fnoxl
TO
t1r_5CR11`Tfnli [Cuter h+tanr, 1. rulPrarl Ir ir. rala+lvc clr.
❑i]L'aIIIL'Crnnl (HLiIHn "'rraallll , IiGlurrll Y3Dll14r (e1i lain under N2] Ramnrksl
ft.
r7• n ii.
_- ... .. �r . -�.
4,Date Well(s) Completed: �D JS IVLII11)), A— ` i"'1�l /
ft.
,
5a. Wall Location:
4`
Facciil�lilylokyner hlanl7 a 1�
Forflily IDC(Irupplic�a�hle)
n,
Jl.
•" - • - - `
rt
Fhyifcdl Address, City, and 7.1p
:21::RFM1tdllt{S:=.,,
_. _„ ,._
. ,.. i. ,, . _ . _,-, , ,._. ., ,.:•> >,
_ tbil
County Farce l fdendRcotlan Nu. (PI14)
Sb. Lod ludeand Langitudc In degreeVrainutctgeeandl or decimal degrees:
Y2. Ccrtirtcatlon:
(ifwell Real, one InUlang h suirleicnt)
rtzI cILA
J la" Mal 1O —1
N , ;7\0(00 ty
j7imulffma
Le,
)(Permonerll
Sit3noture ofCcnified Well Cantradnr Date
6. Is (are) tie wall(s): or 09'empnrury
Av slgnfng Mixform. l hereby rallJv that fAe imilfrl was (ivera) ro,ulmeted In accordaaea
evlth UA NCAC 07C.11100 or l3rt NCAC 07C.0 170 IPcll Conrinrctrnn Slandanfr and that u
7. Is this a repair to an crlsdng we1L ❑Ycs or *a
enpv njlhtr raconthas been pravfded to the tall owner.
lfrhi.r tr a rcaair, Jlll mtt ,Gmnn nett carrslnratfan lnjarmarian and aspinbr die uuauv oftha
rapuirunder fill rvntartsxecdan or on the burn' ujddrJorur.
23. Site diagram or additional lvefl details:
``
You may use tic bock of this page to provide additional well slte dclnils or well
S. Number of wells cons(ructed:. 1..
construclinn details. You may also naach addidanal pages ifnecesaary,
Farmuhlpla Allgetfon or non-walersnpplp welt UNLI' wllll thr aurne eartslructfmr, you can
subinfl one fann..
SUBMITTAL INSTUCTIONS
9. Total well depth below land surfaec: (re.)
24a. For All Wellr: Submit this farm within 30 days or completion of well
For maltlpluwells fist all drpdvljdgercn/(rmmpir-.1@2IR'and2�Ca)IOU)
nan9lructiontothe following,
IU. Stadc water level below lop urcasiog: - J VQ
Dlvlsion aMut=Resources, Inrurtnution Processing Unit-,
ljwnlcr loval it abuvo casing, lug "*" r
1617 Muff Service Center, Ralelgh, NC 27699-I617
,,
11. Borehole dramclar- C) >,-t+ (1n.)
241j. Fnr_t Ices on Wells ONLYi In addition to sending the rurm to the address in
�,
2411 above, also submit A copy or this form within 30 days or completion of well
12. Well construction method: i i
constrction to the fallowing:
fl.c. aulier, rotary, cabtu, 44cct push atc.)
Division nrWnfcr Resources, Underground Injection Control Program,
r,OR WATER SUPPLY WELLS ONLY:-
163G MaUScrvieu Center, RuleIgh, NC 27699-LG36
1311, Y1eld I6Pr1) McUlad of Icsi
24r-Tar Water Suit(ily& InInrtino Wells:
; Also submit ono copy of (his foul within 30 days orcurnplation of
13b. BlslnfecNon type; Amount::
well curwiruclion to Ilro county health dcparimcnt of the county where
constructed,
Farm OW-1 Nortlt Carolina Depanment of fInvlranntenl and Natural Rernumes - divislau nrwaterltranurcri Itevracd Auwst 2013

WE LL CONSTRUCTION -RE, CO BLD: farinlanalUeaQNIY:
This farm con be weal for tlllfgk ar multiple wens
1. Well Contractor Iararluution:
Jonathan Todd Allred
Well Con lmulor Nama
3213-A
NC well CuntroelarConlfioalion Number
Cascade Dr,
lifngr LP -
Company Nnmc
2, Well Construction Permit 9:
Lfrf all applicable tvetipermfir ff.e. Country, Sidtd, Variance,'hdocilon: a1a)
3, Well Use (check well use):
❑Agricultural ❑AlunieipaUPublic
[3Geothermal (Heating/Cooling Supply) ❑Ittwidmdo] Water Supply (single)
❑IndustriollCommcrcial ❑RcsidendalWater Supply (uharcd)
Non-1Watcr5uppty Well:
❑Aquircr Recharge
❑Groundwater Remediation
ClAgnifer Storage and Recovery
❑Salinity, Barrier
❑Aquifer Te.9t
❑Stormwatcr Draianga
DErperimenud Technology
❑Subsidence Control
00oalhermal (Closed Loop)
❑Tracer
4. Dille Wcll(s) Camplaled: cfr I IJ Well mlr l�
5a, Wall Locutlnn;
Freilily/Ic�. Facilltyl]?I(IfrPpllcablc)
50 - �"-lam r 'fin[' {�1 •?
Physical Address, City, and Zip
Courtly Parcel IdentifiCAlion No. (PIN)
Sb. Latitnsde and Longitude In ds or decimal degrees:
(irwa9 field, one Intllon;issufrrcicatl
6. is lure) the wcli(s): Pcrmonent or OTernporary
1.Is IttIs a ropal r to an ex10ag smell; OYcs ar No
!,/rhfs Fr a repair, Pit oaf knaarn rvaff ratrstrrrefia+r hl/armorfon anal eaplufit the no lure ajrhe
rrpal r under 021 r entarkr # mutua o r an fhe Lash of th tfurat.
8,Numhcrorwells constructedi I
Form wit title Ittlarfimr orltou-xuterrv*4- rvells Oft uQh the larrle sonrtracilun, you en
submit one jnrrn, }
9. Total well depth below land surface: LJ ! yi.
For maniple r.dGr list all dcpthy (rd yercnl fexompld• J@2000`'itud 2@100') '
10, Simile venter level below top orcasingt.
elirler level Lr above cut Ing, era "+" '•" ' " -
11.Bvrolrotediameter: a (in.)
13. "'ell canstructlon methadi � -S ' •'i_+f � ^ --
G&. ouger, ratnry, cubic, direst puull, rtc.)
FOR WATER SUPPLY WELLS -ONLY:. ... .
13a, Yield (gprn) 11lutllad of test;
13b, Dlslnfccbontypc: Amaunti
rr. I rt, I - / In,
S i rt' rx " r. 4-1,-7- {3l/I
7n' •- •j'UI,\\SF.T£n Sf.al^SI''r. t:• •r711'CKHE.CS FiA
oryC f R.
fl
-S GJ
1 ! ,,)( C
DC R,
ft
t'lC'r`rrt L fit.
..
tL
it.
�t7�.
L
,J!
LK SANti1C8.71VELtuCl
(if no riciblel
•t�nnrl
"ro
>lt.liF.R[ L
EhtPL\CEAn:rtThtCrilO[t••
-sic) n,
Z rt.
IFktS'
.. n:,ri
ft.
R
1 1)Ttllj fNG
Lf3C tftarh
�ddlllanal shiers tDnecsisn
Paoi[
Tn
11F_it:fttrTlft,Y frol.r iraNrrrn, ro4Vrn,ut rr,;,�yn rite., rfr.i
rL
r
�,•�, ''r'ie r7 'r'
fc
n,
ra
14
(t.
ft.
n.
rt,
ILS
22, Certiflcatlon;
fathast, 5 add CUAM
SlUtinture ofCenlfied 1VOI Cortimctur Dale
0y rlgaing Vitt form, I hereby ecrlkt ?hut the uW10) tror retire) runrlrucled hi accordance
u4th ISd JVCAC 9IC.0100 or ISrt NCAC OIC.0700 11'ofl Comtructian Srandurdr ,end lbal a
eopY4,irthir raeard har beat prutNdcd to lite owlt owner,
23. Site diagram oraddlflonal well details;
You may use the back of this page to provlde-addidonal well site details fir well
ConSUIletlan defail', YOU may also anach addifimtal pages ifnccessary,
SUBMITTAL INSTUCTIONS
2411. Far 61I Wtills: Submit this rann within 30 days of completion of well
construction to the following:
Division urWoter Resources, Information Processfng Unit,
1611 Mall Scrvlce Center, Italcigit, NC 27699-1617
tab. %,fin f0cellan W01s ONLY: In addition to Sending the tarn to the addres,9 in
24a ubove, also submit o copy or this rann within Ill days or completion of well
Conswcdan to the following;
Divlclon ofWater Rc9ourcas, Underground Injection CUnlrat Program,
1636 Mail Service Center, Raleigh, NC 27699-1636
24c, For Water Sup1JX & Injection Wells;
Also submit one Copy or Ihio rums within 30 days ofcompletion or
well cortsiructlan to the county hearth department of the county where
canulnlotcd.
Farm Cw-I North Catollaa DapanmenlarrnVImnmenl and Nmurol itcsmucrs-Division ofWutorlicsourciz Kcvlred August 2013

bir�L3L CC)NSTRilCTJ[li R CORD
Tids Mtntcan lic mad for Finnic orinawplc wells
I. Well Contractor information:
Well Contractor No me
v 1 -
NC Well Cantrauor Cchl«calion Number
Cascade Drilling, L.P.
CompanyNu+no
2. Well Construction Permit i
Glsr ollappJicahla »•!1 permits (ta. Caanq: S1glP, Vdrlonca, lryeerfon, dc1 "
3. Well UM (check $veil Usti):
CIALMcullurul l7MunicipaUPublic
I70uolhunnul (Heatln0/Cooling Supply) 011widenlinl Water Supply (single)
01ndustrial/Conimcrclal ❑Residential Water Supply (shared)
aIor supply Well:
OAquifcr Rcchurgc
❑Groundwater 1lcmediation
❑Aquifer Storage and Recovery
17S41inhy Border
❑Aquifer Tent
❑Slamswattr Drainage
CExpelimcnial Technology
0subsidence conuol
❑Geelllumal (Closed uup)
❑Tracer
4, pate Welf(s) Completed: 3/7 /S W011Bfi M I,n%'• i 7s�
So. Well Locution:
C)u i C-
Faeit{I}it]urnerNam facility Mel (irappllcable)
St7C) GPr an �r+e , /V G A756 7
Physical Addrus, Chy, and Yip
County Par=l ldcutificatinri No. (Phil
5b. Latituile and Longitude In degree3/mrnutW5acUnds pr dae)mol degrees:
(irwei 1 field, one Iat/lanA is suarpcienl)
'2- 1-71 6-1356.I3L N 7q,oy� r .[,"pIS. W
6.Is (ire) the tvall(s)l v'eirriulrenl or ❑Temporary
7.Is tbls is repair to on existing veil, ❑Yes or jkNo
y1hir it a repolr, fill Girl A7raun urflso+ulnirtion Itlfarnrddon and esnfain die aware of tha
repair sndrr Dill t'ttlntarks teerian or on (ha[LaekerflhGrfarur.
S. Nutabor of weUr, constructed.
For mailpie ftvecllon or non.uafer .rabmil oneforin, rvpp¢'tvofG ONLY Irish Jhesunir cunrrrt crJnn, you can
p
9. To $yell depth bel'OW land surface: II r (ft.)
For nine fple surllr Ati all dcplhs tf dreraa t ["ample- 3l[i}3011' and 101001
10. Scotia water swot beimv top creasing; 6 (fL)
(�nalerfcve! lr above coring, tire "f-" . .
11, Borehole diameter; . _ f� (in,)
12. Wta consirucdon method: ' tDrl i L
(i.e. nup_r rolnry cuble direel h i
For tnl I Ujc ONLY;
#rti7i.f �
Tn :lr t.3C11l1'rrn.Y
«.
to.
11.411TL•"ttCASINr.'inrn,ulli-eatediritlr
(IIGr.1tVE1t-ifa$ «r�hk .±.�.....,.- ..:
FRnitl -rn
IPIAAIETEIt THIC: iiN1?i4 1.t,sTF,n IAr.
'_lG.'( . S1LCrV51,ICrUR'1'IllllfyC
"e611trrniel'duscd.lbu
S - .
tIr ME70:rl
TrttCJrrl ESS •MA7r RIAL
ft. rr
rj In
r� Y� vF C-
n,
r17lTCIL,GH- -.I.
'inOAI' TO nIAA4L7xn SLiMMF iild•kni Ur MA EnrAr.'.:
rL Ili. r �� • 'f.l]tf.:
,
'
_ RIOAi TQ
tr.
MATrArAG &ttI 1.4C,}'1Ir;'iT 6IF:Tt`lon&e1,5inrfM1T
JL
5'
(:j f71J)r + p tJr
ni*l7
l9.'SANUMlAVLi.I�ACtCtlfa
annsr
ilcbbir'• -
ft.i ten• {7t]C f.t �r7Ft•�
R. pL
n, n.
rt. ft.
fL' fr.
" n. ri.
22. Ccrlifleation:
ymurduut J add QPPwd
Slgrurura gfCettlilcd Wall Cnnriacrur Date
By JI&nrng sou Juan, I f-6)• a rto that the nrJl(f) nVr Note) ronruurled in accardanee
WIA I3,1 NC1C 01"J00 nr l.rrf JVG1C 01C.0100 IibH Cnnslruelfoa Slant/ardr and /brit a
rnpy ofthft rueard har been provided io the Ived ou"arr.
23, Site dlogroin or additional well details:
You may use the baclt or this page to Pavlde addllinnat welt aite details ar well
cansuucliva dctotiv, You may Au allachaddiIlona[ pages Tneecssory.
SUHM11'TAL IINiTUC`YJ0NS
240, 1�ar Alt 4Vea1�; Submit this form within 30 days or completion of veil
Mllift Ilion to the following:
Division of Water Resources, Inform utlou Processing UllII,
1617 Mail Scrvlce Center, Raleigh, NC 27699.161.7
111b, Tar n u stria Wei ONLY: In addition to sanding the form to dte address in
24a abovc, also submit a copy of this form within 30 days or completion of well
pus collmuctlan to the fopowing:
- D(vlslon nfWater Resources, Underground InjecUan Control Program,
rOR WATER SUPPLY WE, LLS ONLY; 1636 Mall Service Cenlcr, (talclgh, NC 27699.1616
13n. YlcJd (glom) Methad ortest: 24e• For Water Su I ai to celiutl We14:
Also submit one copy of skis faun Within 30 days nfcoulplelton of
13b, bls)nfecdan type; — _-_, Amount; wail consiruct(on to the county health depnnment of the county Where
- • . , constructed.
Farm QW-I Noith Carolina Depanmenl of Cnvir antim and ilolural Rrsauxcii-• oivisinn or Waler Rcaaurec
Tlevlscd August 20 13

WELL CONSTRUCTION RECORD
This form can be used forsingle or mulliplewells
L Well Contractor Inform
ation:
Well Contractor Name
.ZQ L\,L-
NC Well Centimeter cnificatian Nutnbcr
Company Name
2. Well Construction PerndtNt.
List afl applicable Nell perntits (i.e. Counly, State, Variance, Infection, etc.)
3. Well Use (check well use):
❑Agricultural ❑Municipal/Public
❑Geothermal (Flealing/Cooling Supply) ❑Residential Water Supply (single)
❑industrial/Commercial ❑Rcsidentiol Water Supply (shared)
C lIrrivati on
❑Aquifer Recharge
❑Gidundwater Remedialion
❑Aquifer Storage and Recovery
❑Salinity Barrier
❑Aquifer Test,
❑Stormwater Drainage
❑) xperimental TechrmIogy
❑Subsidence Control
❑Geothermal (Closed Loop)
❑Tracer
❑Geothermal (llealingi'Cooling Return)
❑Olher(explain under #2l Remarks)
4. Date Well(s) Completed: V
Well 1139
Sit, Well Location: lr
�uye C, icxy �! � fit i (
Fr'wilily Owncr Name
Facility 1DH (ifapplienble)
��sSLI-
Physsicaall Address,City, and Zip
County
Parcel Identiftcotion No. (PIN)
5b. Latitude and Longitude in degreeshnlnutes/seconds or decimal degrees:
(irwell field, one laulong is sufficient)
N �- Yy 5-9
W
6. Is (are) the tvcll(s): ❑Permanent or ❑Temporary
7. Is this a repair to an existing well: ❑Yes or VNO
Ifthis is a repair, fill out known evil constntction information run usplain the nature ufthe
repair under'21 remarks seclion or out the back of this forrn.
8, Number of wells constructed: I
For multiple Infection or non-waler supply wells ONLY with the saute construction, you cal
submit wee form.
9. Totat well depth below land surface: (iL)
For multiple wells list all depths ifdii ferent (example-1 7020 and:©100')
ill. Static water level below top of easing: ]•� (fL)
lfwater hotel It abore casing, use "+"
11. Borehole diameter: ---6) ----� (In.)
12. Well construction method: Un IC)
(i.e. auger, rotary, cable, direct push, etc.)
FOR WATER SUPPLY WELLS ONLY:
13a. Yield (gpm) Method of test:
13b. Disinfection type: Amount:
For internal Usc ONLY:
14. W,LTF.III ZONES
VROAt
TO
nrSCRIPTiON
ft.
ft.
ft.
rl.
15.OUTER "SlNc ifor'mubf-escd,rn]is-clICLINI:R'ifv flrnbae.:- ......._.,
fTifyhl.
Tr]
DIAMETER TIHCHNESS M1fATEh L4L
Ft.
f6
in.
16. INNER
CASING OR
TUDING cotlrerirltrl cl"ed-ln2al=
MOM
TO _
MAMMA A T1 IC&NrNS
MATCRIAL
ft.
ft.
I.
in.
Fn0
'ro
t11AMETF,n
SLOT t2E
TIIICRNES.q
hIATMIAL
ft.
l7 ft.
`i
in.
(� �S
fl.
fr.
in.
-18, 'ROUT::
FIti1M
TO MA,T tIAL
EN1i'tACV1%FPPr T_A11:3`11Dt)&.Ar.T0UXT
-.
0� ft.
a ft.
rt.
ft.
fl.
ft.
tR. SAN[11GtiAYPI: f'hCiG tf it ltcaLfr -
FROA1
TO
MATEn1AL
EM1fPLACEJIJVNTh1ETI101t
f`
it.
-2D:.pRfL1.lNG
LOG' iiiniclt
ndditionul sheets Trin,crimal
Fltom
TO
I]ESCRIPT1ONl eniar. Urdnw. tulOracn type, Mimin sim enr.1
n.
if e
ft.
fl.
ft,
fl.
if •
ft.
fl.
ff.
ff.
rt.
21. HEt4fAlthS
': r
22. Certification:
Signature ol'Certiftud Well Coutrnclor Dale
By signing this form. I hereby certify that file wells) was (were) constnicted 1n accordance
wfth I5,1 NCAC 02C.01 i10 or 15A NCAC 02C.0200 Well Construction Standards and that a
copy ofthis record has been provided to the well ao ier.
23. Site diagram or additional well details:
You may use the back: or this page to provide additional Well site details or well
construction details. You may also attach addidunat pages ifnecessary.
SUBMITTALTNSTULTiONS
24u. Fur All Wells: Submit this form within 30 days of completion of Weil
construction to tite following:
Division of Water Resources, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
24b. For Infeellon Wells ONLY: In addition to sending die Corm to the address in
24aabove, also submit n copy of this farm within 30 days or completion or well
construction to the following:
Division ofWuler Resources, Underground Injection Control Program,
1636 Mail Service Center, Raleigh, NC 27699-1636
24c. For Water Supply & Tnjectiml Wells:
Also submit one copy or this form within 30 days of completion of
well construction to the county health department of the county where
constructed.
Farm GW I North Cnrolirut Department ofEnviroumeut and Natural Resources —Division of Water Resources Revised August 2013

WELL CONSTRUCTION RECORD
This form can be used for single or multiple wells
1. Well Contractor Information:
Well Contractor Name
2c1 cI Z-
NC Well Conauclor Cerificulion Number
um(- (:. o
Company Name il
2, Well Construction Pcrmit 4:
Gist all applicable well permits (i.e. Cmuugb State, Variance, injection, etc)
3. Well Use (check well use):
Water Supply Well:
❑Agricultural ❑Municipal/Public
❑GCDthcrmal (Heating/Cooling Supply) ❑Residential Water Supply (single)
❑Industrial/Commercial
Non -Water Supply Well:
❑Aquifer Recharge
❑Aquifer Storage and Recovery
❑Aquifer Test
ElExperimental Technology
❑Gcothermal(Closed Loop)
❑Geothermal flleatine/Coaline
❑Residential Water Supply (shared)
❑Groundwater Remedialion
❑Sulinity Barrier
❑Stormwater Drainage
❑Subsidence Control
❑Tracer
❑Other (explain under 421 Remarks)
4. Date Welts) Completed: ' I5 Well mil W11 N S
5a. Well Locution:
Wof C- rkr S E I�YT
Faci�waer Name Facility ]DO (if upplicuble)
� 6i, f e!�� L oUV C' i(i Qrb ti c.I ISSc
Physical Address, City, and Zip
��lfhk�'1t�lrY�
County Parcel Identification No. (PIN)
5b. Latitude and Longitude in degrees/minutes/seconds or decimal degrees:
(ifwell ticid, one lat/long issumclent) '^/
} f.'.. j ., r-- - r7 1. 1�.�l,1 I _ l�t'"I1' `� 1 �V
6, Is (are) the well(s): ❑Permanent or ❑Temporary
7. Is this a repair to an existing well: ❑Yes or `1 No
Ifthls is a repair, fill out knmvm well construction irjornmrionau,J�� No
tha uwnere ofthe
repair render 021 remarks section or on the back ojthis form.
8. Number of wells constructed: 1
For multiple irifeetion or non-watersupply wells ONLY Ivith dtesome construction, your can
submit one form.
9. Total well depth below land surrnee:. !" J _ _ (ft,)
For multiple wells list all depths 1(dierent (example- 3 a 200' and 2(@100')
For Internal Use ONLY:
14, WATi)ltZONES
FROM
TO
bFSC_lifi'770N
ft.
fl.
ft.
fl.
1s; OUTL'R CASING for
rlsatrt.casell Arens ostLINER Ira
firnble
raita5t
TO
iltAstt Tt [t T1110,Z E55
I MATERIAL
ft.
ft.
in.
FIGiTP1N6tfCA£ING-flltTl]St1NG
tcalltertnsslduscd-taut
FROM
TO
nrAMETVR -
T111Cr[t�trcc
t I �LI
MATERtAI.
ft.
IT 5 ft.
e7 In.
L�
ft.
ft.
in.
FROM
TO
nrAnts:TEst
SLOT517E
Ttt1CKNFSs
MATERIAL
7
in.
ft.
ft.
1F4G1i0UTt.,,•:....: ....... .., ..
FROM
TO
MATERIAI.
��-�
EIIPl.ilt:r.AIF:NT'.%IETli011&AMSQIPNT
fr.
ft.
ft.
ft.
v
19.SA1'RsrG1'1AVF:I:P.tC[i: ifa lir:nlrle "
FROM
„ -7 ft.
,j
TO
MATERIAL.
EMP[.ACEA16FT al GrnOP
I S ft.
ft.
fl.
20. DRILLl
G LOG nonch
a(Idltinnn) 71teels' Ifnee Lisa -. .. "
FROM
Tfl
0kcluprtON(calm. honbum ialllradrtype. crula d". eta
ft.
ft.
Qom_
ft.
ft.
J "
ft.
ri.
rt.
fr.
ft.
ff.
fl.
fl.
A.
il.
22, Certification:
Signature of -Certified Well Contmclor Dole
by signing this farm, I hereby eerllfy� that the tvell(s) was (were) constructed in accordance
❑friu ISA NCAC 02C.0i00 or iSA NGtC 02C.0200 Nell Construction Standards and that a
copy ofihis record has been provided to the well owner,
23. Site diagram or additional well details:
You may use the back of this page to provide additional well site details or well
construction details. You may also attach additional pages ifnecessary.
SUBMITTAL INSTUCi'IONS
24a. For All Wells: Submit this form within 30 days or completion or well
construction to the following:
10. Static water level below top of casing: Z_ (ft.) Division of Water Resources, Information Processing Unit,
if inter level is above casing, use "+" 1617 Mail Service Cell ter, Raleigh, NC 27699-1017
11. Borehole diameter ,• D (in.) 24b. Vor Injection WON ONLY: in uddilion to sending the farm to the address in
(� 24a above, also submit a copy of this form within 30 days of completion of well
12. Well construction method: 1� � U construction to the following:
(i.e. auger, rotary, cable, direct push, etc.)
Divisimr oC Water Resources, Underground Injection Control Program,
FOR WATER SUPPLY WELLS ONLY: 1636 Mail Service Center, Raleigh, NC 27699-1636
13a. Yield (gpm) Method of test: 24c. For Wlticr Supply St 1n Wfi n Wells:
Also submit one copy of this form within 30 days of completion of
13b. Disinfection type: Amount: well construction to the county health department of the county where
constructed.
Form OW-1 North Carolina Department of Environment and Natural Resources — Division of Waler Resources Revised August 2013

WELL CONSTRUCTION RECORD
This form can be used for single or multiple wells Vlsf p
1. Well Contractor Information: RE l%
Nathan D. Oldham
Well Contractor Name
2889 - A
NC Well Contractor Certification Number
CASCADE Drilling - Pyramid
Company Name
2. Well Construction Permit #:
List all applicable well permit., d.e. Comity, State, Valance. Infection, ete.J
3. Well Use (check well use):
Water Supply Well:
❑Agricultural
OGcothermal (Heating/Cooling Supply)
❑ lndustnal/Commercial
Non -Water Supply Well:
OAquifer Recharge
OAquifer Storage and Recovery
❑Aquifer Test
❑Experimental Technology
OGeothermal (Closed Loop)
OMunicipaUPublic
❑Residential Water Supply (single)
❑Residential Water Supply (shared)
OGroundwater Remediation
❑Salinity Barrier
❑Stonmvater Drainage
[]Subsidence Control
OTracer
OOther (explain under #21 F
4. Date Wells) Completed: 05-14-15 WeB ID# MW-20 BR
So. Well Location:
Duke Energy - Cape Fear
Facility/Owner Name
Facility IDk (ifapplicable)
500 CP&L Road, Moncure, 27559
Physical Address, City, and Zip
CHATHAM
County
Parcel Identification No. (PIN)
5b. Latitude and Longitude in degrees/minutes/seconds or decimal degrees:
(ifwell field, one IeUlong is sufficient)
35deg, 34mins, 52secs N 79deg, 2mins, 50secs
For Internal Use ONLY:
14. WATER ZONES
FROM
TO
DESCRIPTION
ft.
ft.
ft.
ft.
15. OUTER CASING formulfi-cased wells ORLINER ifa
licable)
FROM
TO DL\DIETER THICKNESS
NIATERLAL
0 tt.
27 ft. 6„ in. 0.280
PVC
16. INNER CASING OR TUBING eothermal
closed-loo
FROM TO
Dusir R
THICKNESS
MATERIAL
0 ff 56 FU
2" In.
0.154
PVC
ft. I ft.
in.
17. SCREEN
FROM
TO
D1AMEl'ER
SWTSILE
THICKNESS
MATERIAL
61 e•
56 ft•
2" '"'
0.010
0.154
PVC
ft. I
ft.
in.
18. GROUT
FROM
TO
MATERIAL
EMPLACEMENTMETHOD&AMOUNT
50 It.
0 D.
grout
Tremie / Pressure
54 f-
50 f-
bentonite
Gravity
ft.
ft.
19. SAND/GRAVEL
PACK(ifapplicable)
FROM
I TO
MATERIAL
EMPLACEMENT METHOD
61 fL
54 ft-
1-A Silica Sand
Gravity
ft.
ft.
20. DRILLING
LOG (attach
additional sheets if necessary)
FROM
TO
DESCRIPTON leolor, hnrtlness, soiVrock in alzq eM.
m
ft.
ft.
See Boring Logse
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft
ft.
ft.
Irt.
2L REMARKS
22. Certification:
Signature of Certified ell ContractorbDate
6. Is (are) the well(s): OPermanent or OTemporary
By signing this form, I hereby cerllfy that the well/) coos (vere) conan'ucted in ac"okmce
with 15A NCAC 01C.0100 or 15A NCAC 02C.0200 !Yell Construction Standards ason .. i a
7.15 this a repair to an existing well: ❑Yes or ONo
copy close, record has been provided to the well owner.
If this o a rpm,,fill ma knmvn a ell.,,action informarmes toed explain the astare of the
repair aide, 021 r,o mrk, section to on the back o)O:isform.
23. Site diagram or additional well details:
1
You may use the back of this page to provide additional well site details or well
8. Number of wells constructed:
construction details. You may also attach additional pages ifnecessary.
For multiple injection is non -wirer supply wells ONL I' with the stone eonshucrion, you ems
submit one firm.
SUBMITTAL INSTUCTIONS
61
9. Total well depth below land surface: (ft.)
24a. For All Wells: Submit this form within 30 days of completion of well
For mnitipleovIls lim,11depthslfdgh..of 0xrample-3@200'a,d2P'l00')
construction to the following:
10. Static water level below top of casing:
If water level is above casing, use "r
11. Borehole diameter: 10 / 6 (in.)
12. Well construction method: SONIC
(i.e. auger, notary, cable, direct push, etc.)
(ftd Division of Water Resources, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
24b. For Iniection Wells ONLY: In addition to sending the form to the address in
24a above, also submit a copy of this form within 30 days of completion of well
construction to the following:
Division of Water Resources, Underground Injection Control Program,
FOR WATER SUPPLY WELLS ONLY: 1636 Mail Service Center, Raleigh, NC 27699-1636
13a. Yield (gpm) Method of test: 24c. For Water Supply & Injection Wells:
Also submit one copy of this form within 30 days of completion of
tab. Disinfection [y, pe: Amount: well construction to the county health department of the county where
constructed.
Form GW-I North Carolina Derso mcnt of Environment and Natural Resources- Division of Water Resources Revised August 2013

WELL CONSTRUCTION RECORD
This form can be used for single or multiple wells i
1. Well Contractor Information:
r�
Nathan D. Oldham
Well Contractor Name
2889 - A
NC Well Contractor Certification Number
CASCADE Drilling - Pyramid
Company Nome
2. Well Construction Permit #:
List all applicable well permits (i.e. County, State, Variance, Injection, etc.)
3. Well Use (check well use):
Water Supply Well:
❑Agricultural ❑MunicipaVPublic
❑Geothermal (Heating/Cooling Supply) ❑Residential Water Supply (single)
❑IndustrialtContmercial ❑Residential Water Supply (shared)
Non -Water Supply Well:
❑Aquifer Recharge
[]Groundwater Remediation
❑Aquifer Storage and Recovery
❑Salinity Barrier
❑Aquifer Test
❑Stormwater Drainage
❑Experimental Technology
❑Subsidence Control
❑Geothermal (Closed Loop)
❑Tracer
❑Geothermal (1lcating/Cooling Return)
❑Other (explain under #21 Rcmarks)
4. Date Well(s) Completed: 05-13-15 Well iD# MW-20 S
5a. Well Location:
Duke Energy - Cape Fear
Facility/Owner Name Facility iD# (if applicable)
500 CP&L Road, Moncure, 27559
Physical Address, City, and Zip
CHATHAM
County Parcel Identification No. (PIN)
5b. Latitude and Longitude in degrees/minutes/seconds or decimal degrees -
(if well field, one hat/long is sufficient)
35deg, 34mins, 52secs N 79deg, 2min, 50seC
w
6. Is (are) the well(s): OPermanent or ❑Temporary
7. is this a repair to an existing well: ❑Yes or [?)No
If this is a repair, fill on known well construction information and explain the nature of the
repair under #21 remarks section or on the back of this form.
8. Number of wells constructed. 1
For multiple b jeelion or non -water supply wells ONLY with the same construction, you car
submit onP farm.
9. Total well depth below land surface; 25
For multiple wells list all depths lfdierew (evartple- 31_t�,200' and 2@I00')
10. Static water level below top of casing: 5 (ft.)
If water level is above casing. use "+"
11. Borehole diameter: 6 (in.)
12. Well construction method; SONIC
(i.e. auger, rotary, cable, direct push, etc.
For Internal Use ONLY:
14. WATER ZONES
FROM TO iwscit r[ON
ft, ft.
15.OUTER CASING Lor multi -eased wells UIR LINER if s liable
FROM TO DIAM1111 TH1CKriF55 MATEti'1AL
ft. ft. In.
16. INNER CASING OR TUBING eothernlal eloscd-loo
FROM to DIANIFITErt I THICKMESS MATERIAL
0 "' 15 rt. 2" In. 0.154 PVC
ft. ft. in.
17. SCREEN
FROM TO DIAMBTFR I SLOTS17X I TIiidwi viS MATERLI,L
15 fr. 25 fc' 2" Itl' 0.010 1 0.154 PVC
ft. ft. in.
18. GROUT
FROM TO nrATER1.%L _ FrOPIACE1[ENTMET110DAAMOUNT
11 ft. 0 ft. grout Tremie / Pressure
13 ft- 11 ft. bentonite Gravity
ft, ft.
19. SANDIGRA► EL PACK if a 1 Ilcable
FROM TO MATERIAL I Eaf1°[.ACED'1uN r METHOD
25 ft- 13 ft. 1-A Silica Sand Gravity
ft. ft.
20, DRILLING LOG fattaclt additional sheets it neecssn
FROM TO DESCRIPTION [solar, hardani, saf9lruak t • r, roln %1M. ete. _
ft. rr. See Boring Logs
ft. ft.
ft. ft.
ft. ft.
21. REMARKS
22. Certiflc Non:
ignature ofCenificd Well Contractor Date
By signing this form. I hereby certifi, that the Ivell(s) was (wwre) constructed in accordance
with iSA NCAC 02C.0100 or i5A NCAC 02C.0200 Well Construction Standards and that a
copy of this record has been provided to the well owner.
23. Site diagram or additional well details:
You may use the back of this page to provide additional well site details or well
construction details. You may also attach additional pages if necessary.
SUBMITTALINSTUCTiONS
24a. For All Wells: Submit this form within 30 days of completion of well
construction to the following:
Division of Water Resources, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
24b, EQr Iniection Wells ONLY: In addition to sending the form to the address in
24a above, also submit a copy of this form within 30 days of completion of well
construction to the following:
Division of Water Resources, Underground Injection Control Program,
FOR WATER SUPPLY WELLS ONLY: 1636 Mail Service Center, Raleigh, NC 27699-1636
13a, Yield (gpm) Method of test: 24c. For Water Supply & Injection Wellsa
Also submit one copy of this form Within 30 days of completion of
13b. Disinfection type: Amount well construction to the county health department of the county where
constructed.

WELL CONSTRUCTION RECORD
This form can be used for single or multiple wells T SF,
1. Well Contractor Information:
Nathan D. Oldham
Well Contractor Name
2889 - A
NC Well Contractor Cortifiication Number
CASCADE Drilling - Pyramid
Company Name
2. Well Construction Permit #:
List all applicable uvll permits (i.e. County, State, Variance, h jeetion, etc.)
3, Well Use (check well use):
Water Supply Well:
❑Agricultural
❑Municipal/Public
OGeothermal (Heating/Cooling Supply)
❑Residential Water Supply (single)
Dlndustrial/Commercial
❑Residential Water Supply (shared)
❑lrri ation
Non -Water Supply Well:
IZMonitoring
DRecovery
Injection Well:
❑Aquifer Recharge
❑Groundwater Remediation
❑Aquifer Storage and Recovery
❑Salinity Barrier
❑Aquifer Test
OStormwater Drainage
DExperimental Technology
❑Subsidence Control
❑Geothertmal (Closed Loop)
❑Tracer
❑Geothermal (Heating/Cooling Retum)
❑Other (explain under #21 Remarks)
4. Date Well(s) Completed: 04-23-15 well ID# MW-21 BR
5a. Well Location:
Duke Energy - Cape Fear
Facility/Owner Name Facility ID# (if applicable)
500 CP&L Road, Moncure, 27559
Physical Address, City, and Zip
CHATHAM
County Parcel Idcnti6cntion No. (PIN)
5b. Latitude and Longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one lat/long is sufficient)
35deg, 35min, 27sec. N 79deg, 3mins, 4secs W
6. Is (are) the well(s): ©Permanent or ❑Temporary
7. Is this a repair to an existing well: ❑Yes or [?)No
!)'this is a repair, fill out known well construction information and ecplain the nature ol'rhe
repair under #21 remarks section or art the back of this, form.
S. Number of wells constructed: 1
For multiple it jeetion or non -wafer supply wells ONLY with the sunte construction, you can
submit one form.
9, Total well depth below land surface: 60 (ft.)
For multiple wells list all depths ifdi/ferent (example- 3@200' and 2@L1100')
10. Static water level below top of casing: 6 (ft.)
lfwaler level is above casing, use "+"
11. Borehole diameter: 10 / 6 (in.)
12. Well construction method: SONIC
(i.e. anger, rotary, cable, direct push, etc.)
For Internal Use ONLY:
14. WATER ZONES
FROM
TO
DESCRIPTION
ft.
ft.
ft.
ft.
15. OUTER CASING ifor multi-mic1 welts OR
LINER if s licabla
FROM
TO DIAMETER
TFlICKKFS5 MATERIAL
0 ft.
32 ft. 6n In. 1.
0.280 PVC
16. INNER CASING OR TUBING eatharmal closed-lun
FROM
TO
DIAMETER I
THICKNESS
I MATERIAL
50 ft
0 ft.
2" In.
0.154
PVC
ft.
ft.
In.
17. SCREEN
FROM TO
DIAMETER
SLUT SIZE
THICKNESS
51ATERIAL
60 ft. 50 ft-
2,. In.
0.010
0.154
PVC
(t. ft.
In.
PRe-Pack,
18. GROUT
FROM
TO
MATERIAL
EMPLACEMENTAIETROD&AMOUNT
45 n.
0 ft,
grout
Tremie / Pressure
47 ft-
45 f•
bentonite
Gravity
ft.
ft.
19. SANINGRAVEl,
PACK If a llcabtc
FROM
TO
MA ERIAI. I
ENFLACEEMItiTMETHOD
62 rt.
47 ft.
1-A Silica Sand
Gravity
ft.
ft.
20. DRILLING
LOG tattach
addltiennl sheets If neecasa
FROM
I TO
DESCRIPTION: lector. herdnrlt, ial!lrack typo. ealn Am etc,
ft.
ft.
See Boring Logs
ft.
ft,
ft.
ft.
ft.
ft.
ft.
ft.
ft,
ft.
j
fL
Ct.
21. REMARKS
22. Certinc tion:
ignature ofccitlfred Wen Contractor Date
By signing this form, 1 hereby certify that the weR(v) was (were) consimcled in accordance
with 1 SA NCAC 02C.0100 or 15.4 NCAC 02C .0200 Well Construction Standards and that a
copy of this record has been provided to the well owner,
23, Site diagram or additional well details:
You may use the back of this page to provide additional well site details or well
construction details. You may also attach additional pages if necessary.
SUBMITTAL INSTUCTIONS
24a. For All (Yells: Submit this form within 30 days of completion of well
construction to the following:
Division of Water Resources, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
24b. For Irtlectlon Wells ONLY: In addition to sending the form to the address in
24a above, also submit a copy of this form within 30 days of completion of well
construction to the following:
Division of Water Resources, Underground ]Injection Control Program,
FOR WATER SUPPLY WELLS ONLY: 1636 Mail Service Center, Raleigh, NC 27699-1636
13a. Yield (gpm) Method of test: 24c. For Water Supply & fitjectlon Wells:
Also submit one copy of this form within 30 days of completion of
13b. Disinfection type: Amount: well construction to the county health department of the county where
constructed.

12, Well construction method: _
(i.e. auger, rotary, cable, direct push, etc.
WELL CONSTRUCTION RECORD_ For internal Use ONLY:
This form can be used for single or multiple wells a �.i'j.19
1. Well Contractor information:
Nathan D. Oldham
Well Contractor Name
2889 - A
NC Well Contractor Certification Number
CASCADE Drilling - Pyramid
Company Name
EVI
14, WATER ZONES
2. Well Construction Permit #:
List all applicable well permits (i.e. County, Slate, Variance, Injection, etc.)
3. Well Use (check well use):
Water' Supply Well:
❑Agricultural
❑Geolhermal (Heating/Cooling Supply)
❑ Ind ustrial/Conimercial
❑brigation
Non -Water Supply Well:
MMonitoring
Injectton Well:
❑Aquifer Recharge
❑Aquifer Storage and Recovery
[]Aquifer Test
❑Experimental Technology
❑Geothermal (Closed Loop)
❑Geothermal (HeatintdCooline, Return)
❑Municipal/Public
❑Residential Water Supply (single)
❑Residential Water Supply (shared)
C
❑Groundwater Remediation
❑Salinity Barrier
❑Slormwater Drainage
❑Subsidence Control
❑Tracer
❑Other (explain under #21 Remarks)
4. Date Well(s) Completed: 04-23-15 Well ID# MW-21 SL
5a. Well Location:
Duke Energy - Cape Fear
Facility/Owner Name Facility iD# (if applicable)
500 CP&L Road, Moncure, 27559
Physical Address, City, nnd Zip
CHATHAM
County
parcel Identification No. (PiN)
5b. Latitude and Longitude In degrees/minutes/seconds or decimal degrees:
(if well field, one let/long is sufficient)
35deg, 35min, 27sec. N 79deg, 3mins, 4secs W
6, Is (are) the well(s): ©Permanent or ❑Temporary
7. is this a repair to an existing well: ❑Yes or [?]No
Ifthis is a repair, fill out known well construction information and explain the nature of the
repair under #21 remarks section or an the back of this form.
8, Number of wells constructed: 1
For multiple injection or non -water supply a+e lls ONLY with the same construction, you can
submit one fora.
9. Total well depth below land surface: 28•5
For multiple wells list all depths ifdierent (example- 3 a 200' and 1L100')
10. Static water level below top of casing: 6
lfwater level is above casing, use
11. Borehole diameter: 6 (in.)
SONIC
FRUM
TO
I DESCRIPTION"
ft,
ff.
ft.
ft.
15. OUTER CASING for multi -cased w•etl, OR
LINER if a Ilcablc
FROM
TO DIAMETER
Tfl[CKNESS MATERIAL
ft.
ft. In.
16. INNER CASING OR TU81NG eothermal
closed-loo
FROM
TO
DIAMETER
TnICKNE,4S
MATERIAL
0 ft'
23.5 ft•
2" In'
0.154
PVC
ft.
ft.
In.
17. SCREEN
FROM
TO
DIAMETER
SLOT SIZE
THICKNESS MATERIAL
28.5 ff'
23.5 fL
2" in.
0.010
0.154 PVC
ft.
ft.
18. GROUT
FROM
TO
MATERIAL
E?MPLACEMENTMETRaD&A1110UNT
17 n
0 ft•
grout
Tremie / Pressure
19 rt.
17 ft,
bentonite
Gravity
ft.
ft.
19. SANDIGRAVEL PACK if applicable)
FROM
TO
MATERIAL
Ei1PLACEMEN'IMETHOD
28.5 ft-
19 ft.
1-A Silica Sand
Gravity
20. DRILLING
LOG (attach additlonal sheet, If necessa
FROM
TO
DESCRIPTION teulur, hardnm, wIVrwkts- c, -In Mu, etc.
rt,
rc.
See Boring Logs
-
ft.
ft.
fl.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
21. REMARKS
22. Certification:
.eSigrumne of Certified WclI Contractor Date
Br signing this form, I hereby cerli y that the tveNfs) ivas (were) constmic(ed in accordance
with 15A NCAC 02C .0100 or 15A NCAC 02C .0100 Well Construction Standards and than a
cow ofthis record has been provided ro the well owner.
23. Site diagram or additional well details:
You may use the back of this page to provide additional well site details or well
construction details. You may also attach additional pages if necessary.
SUBMITTAL INSTUCTIONS
24a. For All Weils: Submit this form within 30 days of completion of well
construction to the following:
Division of Water Resources, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
24b. For lniection Weill ONLY: In addition to sending the form to the address in
24a above, also submit a copy of this form within 30 days of completion of well
construction to the following:
Division of Water Resources, Underground Injection Control Program,
FOR WATER SUPPLY WELLS ONLY: 1636 Mail Service Center, Raleigh, NC 27699-1636
13a, Yield (gpm) Method of test: 24c. For Water Supply & Injection Wells:
Also submit one copy of this form within 30 days of completion of
13b. Disinfection type: Amount: well construction to the county health department of the countywhere
constructed.

WELL CONSTRUCTION RECORD
This form can be used for single or multiple wells 'VI s
1. Well Contractor Information: � �F 1
Nathan D. Oldham
Well Contractor Name
2889 - A
NC Well Contractor Certification Number
CASCADE_ Drilling - Pyramid
Company Name
2. Well Construction Permit #:
List all applicable urll permits (i.e. County, Slate, Variance, Injection, etc)
3, Well Use (check well use):
Water Supply Well:
❑Agricultural
❑Geothermal (Heating/Cooling Supply)
❑ Industrial/Commercial
Non -Water Supply Well:
❑Aquifer Recharge
❑Aquifer Storage and Recovery
❑Aquifer Test
❑Experimental Technology
❑Geothermal (Closed Loop)
❑Geothermal (Heating/Cooling
❑Municipal/Public
❑Residential Water Supply (single)
❑Residential Water Supply (shared)
❑Groundwater Remediation
❑Salinity Barrier
❑Slormwater Drainage
❑Subsidence Control
❑Tracer
❑Other (explain tinder #21 1
4. Date Well(s) Completed: 04-23-15 Well iD# MW-21 SU
5a. Well Location:
Duke Energy - Cape Fear
Facility/Owner Name Facility 1D# (if applicable)
500 CP&L Road, Moncure, 27559
Physical Address, City, and Lip
CHATHAM
County Parecl identification No. (PiN)
5b. Latitude and Longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one lat/long is sufficient)
35deg, 35min, 27sec. N 79deg, 3mins, 4secs W
6. Is (are) the well(s): OPermanent or ❑Temporary
7. is this a repair to an existing well: ❑Yes or [?]No
If this is a repair, fill out known well construction information and explain the nature of the
repair under #21 remarks section or on the back of this, form.
8. Number of wells constructed: 1
For nudtiple injection or non -water supply ur/1s ONLY with the some construction, you can
submit one.farnr.
9. Total well depth below land surface: 16 (ft.)
For multiple wells list all depths if derett (example- 3@200' and 1(a100')
10. Static water level below top of casing: 6 (ft.)
If writer level is above casing, use " + "
For Internal Use ONLY;
14. WATER ZONES
FROM
TO
I)PSCRiPTION
rr.
rr.
rr.
ft.
15. OUTER CASING for ntultl-eased wells OR LINER if a
Ileablc
PROM
TO DIAMETER
THICKNESS
MATERIAL,
ft.
I ft. I in,
16. INNER
CASING OR TUBING
eolhcrrttal
closed -loon)
FROM
TO
DIAMETER I
THICKNESS
MATERIAL
11 ft,
0 ft.
2" in.
0.154
PVC
ft.
ft.
In,
17. SCREEN
FROM
TO DIAMETER
91.0TSI7.E, THICKNESSI
MATER[Al,
16 fL
11 ft' 2" in.
0.010 0.1541
PVC
ft.
rt. In-
Pre -Pack well screen
19. GROUT
FROM
TO
NIATERiAL
EMPLACF.MENTMETHOD Ik AMOUNT
7 ft.
0 rt•
grout
Tremie / Pressure
9 I'L
7 rt.
bentonite
Gravity
rL
«.
19. S,kND/GnA%'EL PAC LC
if a Ilcablc
FROM
TO
I MATERIAL
EMPLACEMENT METHOD
16 ft.
9 ft-
1-A Silica Sand
Gravity
20. DRILLING
LOG altuch addillonal sheets If necessary)
FROM
TO
D&~CRIPTIO>v "toy, bardnvi.. totVrack qpeyLm1nsize.etc.
See Boring Logs
ft.
ft.
ft.
ft.
ft.
ft.
ft.
«.
ft.
ft.
ft.
ft,
21. REMARKS
22. Certi cation:
ignalure of Certified Wcll Contractor Date
By signing this form, i hereby certify that the rrell(s) was (were) constructed in accordance
with 15A NCAC 02C .0100 or iJA NCAC 02C .0200 Well Construction Standards and that a
copy of This record has been provided to the well owner.
23, Site diagram or additional well details:
You may use the back of this page to provide additional well site details or well
construction details. You may also attach additional pages if necessary.
SUBMITTAL 1NSTUCTIONS
24a. For All Wells: Submit this form within 30 days of completion of well
construction to the following:
Division of Water Resources, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
11. Borehole diameter: 6 (in.) 24b. For Iniection Wells ONLY: In addition to sending the form to the address in
SONIC 24a above, also submit a copy of this form within 30 days of completion of well
12, Well construction method: construction to the following:
(i.e. auger, rotary, cable, direct push, etc.)
Division of Water Resources, Underground Injection Control Program,
FOR WATER SUPPLY WELLS ONLY: 1636 Mail Service Center, Raleigh, NC 27699-1636
13a. Yield (gpm) Method of test: 24c. For Water Supply & Injection Wells:
Also submit one copy of this form within 30 days of completion of
13b. Disinfection type: Amount: well construction to the county health department of the county where
constructed.