NC0038377_2-Driller Well Const Records_20150902

WELL CONSTRUCTION RECORD
This form can be used for single or multiple wells
For Internal Use ONLY:
1. Well Contractor Information:
David Wilcox
Well Contractor Name
3223-A
NC Well Contractor Certification Number
Cascade Drilling, L.P.
Company Name
2. Well Construction Permit #:
List all applicable well permits (i.e. Count),, State, Variance, Injection, etc.)
3. Well Use (check well use):
Water Supply Well:
❑Agricultural
❑Geothermal (Heating/Cooling Supply)
❑ hidustrial/Commercial
❑ Irrigation
Non -Water Supply Well:
El Aquifer Recharge
El 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
❑ Stormwater Drainage
❑Subsidence Control
❑Tracer
❑Other (explain under #21 F
4. Date Well(s) Completed: 06/02/2015well ID#ABMW-01
5a. Well Location:
Mayo
Facility/Owner Name Facility ID# (if applicable)
10660 Boston Road, Roxboro, NC 27574
Physical Address, City, and Zip
Person
County Parcel Identification No. (PIN)
5b. Latitude and Longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one tat/long is sufficient)
N W
6. Is (are) the well(s): Z Permanent or ❑Temporary
7. Is this a repair to an existing well: ❑Yes or FIND
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 multiple injection or non -water supply wells ONLY with the same construction, you can
submit one form.
9. Total well depth below land surface: 13.3
For multiple wells list all depths if different (example- 3@200' and 2@100')
10. Static water level below top of casing: 6' 0
If water level is above casing, use "+ "
11. Borehole diameter: 6 (in.)
12. Well construction method: Hand Auger
(i.e. auger, rotary, cable, direct push, etc.)
14. WATER ZONES
FROM
TO
DESCRIPTION
rt.
rt.
ft.
ft.
15. OUTER CASING for multi -cased wells OR LINER if applicable)
FROM
TO
DIAMETER
THICKNESS
MATERIAL
ft.
ft.
I in.
16. INNER CASING OR TUBING(geothermal closed -loop)
FROM
TO
I DIAMETER
THICKNESS
MATERIAL
0 tt•
2 8 rt.
2 in'
SCH 40
PVC
ft
fL
in.
17. SCREEN
FROM
TO
DIAMETER
SLOT SIZE
THICKNESS
MATERIAL
2.8 ft'
13.3 ft.
2 in'
010
SCH 40
PVC
ft.
ft.
in.
18. GROUT
FROM
TO
MATERIAL
EMPLACEMENT METHOD & AMOUNT
0 rt•
0.5 tt•
Cemt./Bent.
Pour
ft.
rt.
rt.
ft.
19. SAND/GRAVEL PACK (if applicable)
FROM
TO
MATERIAL
EMPLACEMENT METHOD
2 tL
13.3 tt•
Sand
Pour
tt,
ft.
20. DRILLING LOG (attach additional sheets if necessary)
FROM
TO
DESCRIPTION (color, hardness, soil/rock type, grain size, etc.)
ft.
ft.
rL
ft.
rt.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
rL
et.
21. REMARKS
Bentonite seal from 0.5 to 2.0
2" U-Pack Screen
22. Certification:
Signature of Certified Well Contractor
Date
By signing this form, I hereby certify that the well(s) was (were) constructed in accordance
with 1 SA 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
(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 Inieetion 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 m Method of test: 24c. For Water Supply & Injection Wells:
(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.
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
For Internal Use ONLY:
1. Well Contractor Information:
David Wilcox
Well Contractor Name
3223-A
NC Well Contractor Certification Number
Cascade Drilling, L.P.
Company Name
2. Well Construction Permit #:
List all applicable well permits (i.e. Count),, State, Variance, Injection, etc.)
3. Well Use (check well use):
Water Supply Well:
❑Agricultural
❑Geothermal (Heating/Cooling Supply)
❑ hidustrial/Commercial
❑ Irrigation
Non -Water Supply Well:
El Aquifer Recharge
El 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
❑ Stormwater Drainage
❑Subsidence Control
❑Tracer
❑Other (explain under #21 F
4. Date Well(s) Completed: 05/31 /2015 well ID# AB M W-02
5a. Well Location:
Mayo
Facility/Owner Name Facility ID# (if applicable)
10660 Boston Road, Roxboro, NC 27574
Physical Address, City, and Zip
Person
County Parcel Identification No. (PIN)
5b. Latitude and Longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one tat/long is sufficient)
N W
6. Is (are) the well(s): Z Permanent or ❑Temporary
7. Is this a repair to an existing well: ❑Yes or FIND
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 multiple injection or non -water supply wells ONLY with the same construction, you can
submit one form.
9. Total well depth below land surface: 39.2
For multiple wells list all depths if different (example- 3@200' and 2@100')
10. Static water level below top of casing: 12
If water level is above casing, use "+ "
11. Borehole diameter: 6
12. Well construction method: Sonic
(i.e. auger, rotary, cable, direct push, etc.)
14. WATER ZONES
FROM
TO
DESCRIPTION
rt.
rt.
ft.
ft.
15. OUTER CASING for multi -cased wells OR LINER if applicable)
FROM
TO
DIAMETER
THICKNESS
MATERIAL
ft.
ft.
I in.
16. INNER CASING OR TUBING(geothermal closed -loop)
FROM
I TO
I DIAMETER
THICKNESS
MATERIAL
0 ft•
34.0 ft•
2 '"'
SCH 40
PVC
fL
fL
in.
17. SCREEN
FROM
TO
DIAMETER
SLOT SIZE
THICKNESS
MATERIAL
34 ft'
39.2 ft.
2 in'
010
SCH 40
PVC
ft.
ft.
in.
18. GROUT
FROM
TO
MATERIAL
EMPLACEMENT METHOD & AMOUNT
0 ft'
28.8 ft.
Cemt./Bent.
Tremie
ft.
ft.
rt.
ft.
19. SAND/GRAVEL PACK (if applicable)
FROM
TO
MATERIAL
EMPLACEMENT METHOD
32.6 fL
39.2 ft•
Sand
Pour
tt,
ft.
20. DRILLING LOG (attach additional sheets if necessary)
FROM
TO
DESCRIPTION (color, hardness, soil/rock type, grain size, etc.)
ft.
ft.
fL
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
rL
et.
21. REMARKS
Bentonite seal from 28.8 to 32.6
2" U-Pack Screen
22. Certification:
Signature of Certified Well Contractor
Date
By signing this form, I hereby certify that the well(s) was (were) constructed in accordance
with 1 SA 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
(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 Inieetion 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 m Method of test: 24c. For Water Supply & Injection Wells:
(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.
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
For Internal Use ONLY:
1. Well Contractor Information:
David Wilcox
Well Contractor Name
3223-A
NC Well Contractor Certification Number
Cascade Drilling, L.P.
Company Name
2. Well Construction Permit #:
List all applicable well permits (i.e. Count),, State, Variance, Injection, etc.)
3. Well Use (check well use):
Water Supply Well:
❑Agricultural
❑Geothermal (Heating/Cooling Supply)
❑ hidustrial/Commercial
❑ Irrigation
Non -Water Supply Well:
El Aquifer Recharge
El 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
❑ Stormwater Drainage
❑Subsidence Control
❑Tracer
❑Other (explain under #21 F
4. Date Well(s) Completed: 06/03/2015 Well ID#ABMW-02BR
5a. Well Location:
Mayo
Facility/Owner Name Facility ID# (if applicable)
10660 Boston Road, Roxboro, NC 27574
Physical Address, City, and Zip
Person
County Parcel Identification No. (PIN)
5b. Latitude and Longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one tat/long is sufficient)
N W
6. Is (are) the well(s): Z Permanent or ❑Temporary
7. Is this a repair to an existing well: ❑Yes or FIND
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 multiple injection or non -water supply wells ONLY with the same construction, you can
submit one form. 9. Total well depth below land surface: 106.0
For multiple wells list all depths if different (example- 3@200' and 2@100')
10. Static water level below top of casing: 11 .0
If water level is above casing, use "+ "
11. Borehole diameter: 6/1 0
12. Well construction method: Sonic
(i.e. auger, rotary, cable, direct push, etc.)
14. WATER ZONES
FROM
TO
DESCRIPTION
rt.
rt.
ft.
ft.
15. OUTER CASING for multi -cased wells OLINER if applicable)
FROM
TO
DIAMETER
THICKNESSR
MATERIAL
0 ft-41.0
ft-6
in.SCH
40
PVC
16. INNER CASING OR TUBING(geothermal closed -loop)
FROM
I TO
I DIAMETER
THICKNESS
MATERIAL
0 ft•
94.0 ft•
2 '"'
SCH 40
PVC
fL
fL
in.
17. SCREEN
FROM
TO
DIAMETER
SLOT SIZE
THICKNESS
MATERIAL
94.0 ft'
104.0 ft.
2 in'
010
SCH 40
PVC
ft.
ft.
in.
18. GROUT
FROM
TO
MATERIAL
EMPLACEMENT METHOD & AMOUNT
0 ff
86.5 ft.
Cemt./Bent.
Tremie
0 ft.
41.0 ft.
Cemt./Bent.
Tremie
rt
ft.
19. SAND/GRAVEL PACK (if applicable)
FROM
TO
MATERIAL
EMPLACEMENT METHOD
92.0 ft
106.0 ft
Sand
Pour
tt,
ft.
20. DRILLING LOG (attach additional sheets if necessary)
FROM
TO
DESCRIPTION (color, hardness, soil/rock type, grain size, etc.)
ft.
ft.
fL
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
rL
et.
21. REMARKS
Bentonite seal from 86.5 to 92.0
2" U-Pack Screen
22. Certification:
Signature of Certified Well Contractor
Date
By signing this form, I hereby certify that the well(s) was (were) constructed in accordance
with 1 SA 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
(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 Inieetion 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 m Method of test: 24c. For Water Supply & Injection Wells:
(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.
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
For Internal Use ONLY:
1. Well Contractor Information:
David Wilcox
Well Contractor Name
3223-A
NC Well Contractor Certification Number
Cascade Drilling, L.P.
Company Name
2. Well Construction Permit #:
List all applicable well permits (i.e. Count),, State, Variance, Injection, etc.)
3. Well Use (check well use):
Water Supply Well:
❑Agricultural
❑Geothermal (Heating/Cooling Supply)
❑ hidustrial/Commercial
❑ Irrigation
Non -Water Supply Well:
El Aquifer Recharge
El 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
❑ Stormwater Drainage
❑Subsidence Control
❑Tracer
❑Other (explain under #21 F
4. Date Well(s) Completed: 05/20/2015well ID#ABMW-03
5a. Well Location:
Mayo
Facility/Owner Name Facility ID# (if applicable)
10660 Boston Road, Roxboro, NC 27574
Physical Address, City, and Zip
Person
County Parcel Identification No. (PIN)
5b. Latitude and Longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one tat/long is sufficient)
N W
6. Is (are) the well(s): Z Permanent or ❑Temporary
7. Is this a repair to an existing well: ❑Yes or FIND
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 multiple injection or non -water supply wells ONLY with the same construction, you can
submit one form.
9. Total well depth below land surface: 40.5
For multiple wells list all depths if different (example- 3@200' and 2@100')
10. Static water level below top of casing: 17.0
If water level is above casing, use "+ "
11. Borehole diameter: 6
12. Well construction method: Sonic
(i.e. auger, rotary, cable, direct push, etc.)
14. WATER ZONES
FROM
TO
DESCRIPTION
rt.
rt.
ft.
ft.
15. OUTER CASING for multi -cased wells OR LINER if applicable)
FROM
TO
DIAMETER
THICKNESS
MATERIAL
ft.
ft.
I in.
16. INNER CASING OR TUBING(geothermal closed -loop)
FROM
TO
I DIAMETER
THICKNESS
MATERIAL
0 ft
35.3
12 '"'
SCH 40
PVC
fL
fL
in.
17. SCREEN
FROM
TO
DIAMETER
SLOT SIZE
THICKNESS
MATERIAL
35.3 ft'
40.5 ft.
2 in'
010
SCH 40
PVC
ft.
ft.
in.
18. GROUT
FROM
TO
MATERIAL
EMPLACEMENT METHOD & AMOUNT
0 IL
29.2 ft.
Cemt./Bent.
Tremie (80 gallons)
ft.
ft.
rt.
ft.
19. SAND/GRAVEL PACK (if applicable)
FROM
TO
MATERIAL
EMPLACEMENT METHOD
33.2 fL
40.5 ft•
Sand
Pour
tt,
ft.
20. DRILLING LOG (attach additional sheets if necessary)
FROM
TO
DESCRIPTION (color, hardness, soil/rock type, grain size, etc.)
ft.
ft.
fL
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
rL
et.
21. REMARKS
Bentonite seal from 29.2 to 33.2
2" U-Pack Screen
22. Certification:
Signature of Certified Well Contractor
Date
By signing this form, I hereby certify that the well(s) was (were) constructed in accordance
with 1 SA 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
(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 Inieetion 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 m Method of test: 24c. For Water Supply & Injection Wells:
(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.
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
For Internal Use ONLY:
1. Well Contractor Information:
David Wilcox
Well Contractor Name
3223-A
NC Well Contractor Certification Number
Cascade Drilling, L.P.
Company Name
2. Well Construction Permit #:
List all applicable well permits (i.e. Count),, State, Variance, Injection, etc.)
3. Well Use (check well use):
Water Supply Well:
❑Agricultural
❑Geothermal (Heating/Cooling Supply)
❑ hidustrial/Commercial
❑ Irrigation
Non -Water Supply Well:
El Aquifer Recharge
El 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
❑ Stormwater Drainage
❑Subsidence Control
❑Tracer
❑Other (explain under #21 F
4. Date Well(s) Completed: 05/27/2015well ID#ABMW-03S
5a. Well Location:
Mayo
Facility/Owner Name Facility ID# (if applicable)
10660 Boston Road, Roxboro, NC 27574
Physical Address, City, and Zip
Person
County Parcel Identification No. (PIN)
5b. Latitude and Longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one tat/long is sufficient)
N W
6. Is (are) the well(s): Z Permanent or ❑Temporary
7. Is this a repair to an existing well: ❑Yes or FIND
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 multiple injection or non -water supply wells ONLY with the same construction, you can
submit one form.
9. Total well depth below land surface: 61.0
For multiple wells list all depths if different (example- 3@200' and 2@100')
10. Static water level below top of casing: 17.0
If water level is above casing, use "+ "
11. Borehole diameter: 6/1 0
12. Well construction method: Sonic
(i.e. auger, rotary, cable, direct push, etc.)
14. WATER ZONES
FROM
TO
DESCRIPTION
rt.
rt.
ft.
ft.
15. OUTER CASING for multi -cased wells OLINER if applicable)
FROM
TO
DIAMETER
THICKNESSR
MATERIAL
0 ft-43.0
ft-6
in.SCH
40
PVC
16. INNER CASING OR TUBING(geothermal closed -loop)
FROM
I TO
I DIAMETER
THICKNESS
MATERIAL
0 It•
50.0 It•
2 '"'
SCH 40
PVC
fL
fL
in.
17. SCREEN
FROM
TO
DIAMETER
SLOT SIZE
THICKNESS
MATERIAL
50 ft'
60.0 ft.
2 in'
010
SCH 40
PVC
ft.
ft.
in.
18. GROUT
FROM
TO
MATERIAL
EMPLACEMENT METHOD & AMOUNT
0 IL
46.0 ft.
Cemt./Bent.
Tremie (100 gallons)
0 rt.
43.0 ft.
Cemt./Bent.
Tremie (80 gallons)
rt.
ft.
19. SAND/GRAVEL PACK (if applicable)
FROM
TO
MATERIAL
EMPLACEMENT METHOD
48.0 ft
61.0 ft•
Sand
Pour
tt,
ft.
20. DRILLING LOG (attach additional sheets if necessary)
FROM
TO
DESCRIPTION (color, hardness, soil/rock type, grain size, etc.)
ft.
ft.
fL
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
rL
et.
21. REMARKS
Bentonite seal from 46.0 to 48.0
2" U-Pack Screen
22. Certification:
Signature of Certified Well Contractor
Date
By signing this form, I hereby certify that the well(s) was (were) constructed in accordance
with 1 SA 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
(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 Inieetion 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 m Method of test: 24c. For Water Supply & Injection Wells:
(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.
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
For Internal Use ONLY:
1. Well Contractor Information:
David Wilcox
Well Contractor Name
3223-A
NC Well Contractor Certification Number
Cascade Drilling, L.P.
Company Name
2. Well Construction Permit #:
List all applicable well permits (i.e. Count),, State, Variance, Injection, etc.)
3. Well Use (check well use):
Water Supply Well:
❑Agricultural
❑Geothermal (Heating/Cooling Supply)
❑ hidustrial/Commercial
❑ Irrigation
Non -Water Supply Well:
El Aquifer Recharge
El 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
❑ Stormwater Drainage
❑Subsidence Control
❑Tracer
❑Other (explain under #21 F
4. Date Well(s) Completed: 05/31 /2015 well ID# AB M W-04
5a. Well Location:
Mayo
Facility/Owner Name Facility ID# (if applicable)
10660 Boston Road, Roxboro, NC 27574
Physical Address, City, and Zip
Person
County Parcel Identification No. (PIN)
5b. Latitude and Longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one tat/long is sufficient)
N W
6. Is (are) the well(s): Z Permanent or ❑Temporary
7. Is this a repair to an existing well: ❑Yes or FIND
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 multiple injection or non -water supply wells ONLY with the same construction, you can
submit one form.
9. Total well depth below land surface: 53.2
For multiple wells list all depths if different (example- 3@200' and 2@100')
10. Static water level below top of casing: 6' 0
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.)
14. WATER ZONES
FROM
TO
DESCRIPTION
rt.
rt.
ft.
ft.
15. OUTER CASING for multi -cased wells OR LINER if applicable)
FROM
TO
DIAMETER
THICKNESS
MATERIAL
ft.
ft.
I in.
16. INNER CASING OR TUBING(geothermal closed -loop)
FROM
I TO
I DIAMETER
THICKNESS
MATERIAL
0 tt•
48.0 tt•
2 '"'
SCH 40
PVC
fL
fL
in.
17. SCREEN
FROM
TO
DIAMETER
SLOT SIZE
THICKNESS
MATERIAL
48.0 ft'
53.2 ft.
2 in'
010
SCH 40
PVC
ft.
ft.
in.
18. GROUT
FROM
TO
MATERIAL
EMPLACEMENT METHOD & AMOUNT
0 ff
40.5 rt•
Cemt./Bent.
Tremie
ft.
ft.
rt.
ft.
19. SAND/GRAVEL PACK (if applicable)
FROM
TO
MATERIAL
EMPLACEMENT METHOD
45.7 tL
53.2 tt•
Sand
Pour
tt,
ft.
20. DRILLING LOG (attach additional sheets if necessary)
FROM
TO
DESCRIPTION (color, hardness, soil/rock type, grain size, etc.)
ft.
ft.
fL
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
rL
et.
21. REMARKS
Bentonite seal from 40.5 to 45.7
2" U-Pack Screen
22. Certification:
Signature of Certified Well Contractor
Date
By signing this form, I hereby certify that the well(s) was (were) constructed in accordance
with 1 SA 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
(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 Inieetion 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 m Method of test: 24c. For Water Supply & Injection Wells:
(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.
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
For Internal Use ONLY:
1. Well Contractor Information:
David Wilcox
Well Contractor Name
3223-A
NC Well Contractor Certification Number
Cascade Drilling, L.P.
Company Name
2. Well Construction Permit #:
List all applicable well permits (i.e. Count),, State, Variance, Injection, etc.)
3. Well Use (check well use):
Water Supply Well:
❑Agricultural
❑Geothermal (Heating/Cooling Supply)
❑ hidustrial/Commercial
❑ Irrigation
Non -Water Supply Well:
El Aquifer Recharge
El 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
❑ Stormwater Drainage
❑Subsidence Control
❑Tracer
❑Other (explain under #21 F
4. Date Well(s) Completed: 06/04/2015 Well ID#ABMW-04BR
5a. Well Location:
Mayo
Facility/Owner Name Facility ID# (if applicable)
10660 Boston Road, Roxboro, NC 27574
Physical Address, City, and Zip
Person
County Parcel Identification No. (PIN)
5b. Latitude and Longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one tat/long is sufficient)
N W
6. Is (are) the well(s): Z Permanent or ❑Temporary
7. Is this a repair to an existing well: ❑Yes or FIND
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 multiple injection or non -water supply wells ONLY with the same construction, you can
submit one form. 9. Total well depth below land surface: 1 08. 5
For multiple wells list all depths if different (example- 3@200' and 2@100')
10. Static water level below top of casing: 8' 0
If water level is above casing, use "+ "
11. Borehole diameter: 6/1 0 (in.)
12. Well construction method: Sonic
(i.e. auger, rotary, cable, direct push, etc.)
14. WATER ZONES
FROM
TO
DESCRIPTION
rt.
rt.
ft.
ft.
15. OUTER CASING for multi -cased wells OLINER if applicable)
FROM
TO
DIAMETER
THICKNESSR
MATERIAL
0 IL60.0
ft-2
in.SCH
40
PVC
16. INNER CASING OR TUBING(geothermal closed -loop)
FROM
TO
I DIAMETER
THICKNESS
MATERIAL
0 tt.
98 7 ft•
2 in'
SCH 40
PVC
fL
fL
in.
17. SCREEN
FROM
TO
DIAMETER
SLOT SIZE
THICKNESS
MATERIAL
98.7 ft'
108.2 ft.
2 in'
010
SCH 40
PVC
ft.
ft.
in.
18. GROUT
FROM
TO
MATERIAL
EMPLACEMENT METHOD & AMOUNT
0 ft.
88.0 ft.
Cemt./Bent.
Tremie
0 ft.
60.0 ft-
Cemt./Bent.
Tremie
rt
ft.
19. SAND/GRAVEL PACK (if applicable)
FROM
TO
MATERIAL
EMPLACEMENT METHOD
96.5 ft
108.5 ft
Sand
Pour
tt,
ft.
20. DRILLING LOG (attach additional sheets if necessary)
FROM
TO
DESCRIPTION (color, hardness, soil/rock type, grain size, etc.)
ft.
ft.
fL
ft.
rt.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
rL
et.
21. REMARKS
Bentonite seal from 88.0 to 96.5
2" U-Pack Screen
22. Certification:
Signature of Certified Well Contractor
Date
By signing this form, I hereby certify that the well(s) was (were) constructed in accordance
with 1 SA 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
(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 Inieetion 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 m Method of test: 24c. For Water Supply & Injection Wells:
(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.
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
For Internal Use ONLY:
1. Well Contractor Information:
David Wilcox
Well Contractor Name
3223-A
NC Well Contractor Certification Number
Cascade Drilling, L.P.
Company Name
2. Well Construction Permit #:
List all applicable well permits (i.e. Count),, State, Variance, Injection, etc.)
3. Well Use (check well use):
Water Supply Well:
❑Agricultural
❑Geothermal (Heating/Cooling Supply)
❑ hidustrial/Commercial
❑ Irrigation
Non -Water Supply Well:
El Aquifer Recharge
El 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
❑ Stormwater Drainage
❑Subsidence Control
❑Tracer
❑Other (explain under #21 F
4. Date Well(s) Completed: 05/31 /2015 well ID# AB M W-04 D
5a. Well Location:
Mayo
Facility/Owner Name Facility ID# (if applicable)
10660 Boston Road, Roxboro, NC 27574
Physical Address, City, and Zip
Person
County Parcel Identification No. (PIN)
5b. Latitude and Longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one tat/long is sufficient)
N W
6. Is (are) the well(s): Z Permanent or ❑Temporary
7. Is this a repair to an existing well: ❑Yes or FIND
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 multiple injection or non -water supply wells ONLY with the same construction, you can
submit one form.
9. Total well depth below land surface: 64.5
For multiple wells list all depths if different (example- 3@200' and 2@100')
10. Static water level below top of casing: 6' 0
If water level is above casing, use "+ "
11. Borehole diameter: 6/1 0 (in.)
12. Well construction method: Sonic
(i.e. auger, rotary, cable, direct push, etc.)
14. WATER ZONES
FROM
TO
DESCRIPTION
rt.
rt.
ft.
ft.
15. OUTER CASING for multi -cased wells OLINER if applicable)
FROM
TO
DIAMETER
THICKNESSR
MATERIAL
0 IL54.5
ft-6
in.SCH
40
PVC
16. INNER CASING OR TUBING(geothermal closed -loop)
FROM
TO
I DIAMETER
THICKNESS
MATERIAL
0 ft•
55.8 ft•
2 '"'
SCH 40
PVC
fL
fL
in.
17. SCREEN
FROM
TO
DIAMETER
SLOT SIZE
THICKNESS
MATERIAL
55.8 ft'
61.0 ft.
2 in'
010
SCH 40
PVC
ft.
ft.
in.
18. GROUT
FROM
TO
MATERIAL
EMPLACEMENT METHOD & AMOUNT
0 ff
48.5 ft.
Cemt./Bent.
Tremie
0 ft.
54.5 ft-
Cemt./Bent.
Tremie
rt
rt.
19. SAND/GRAVEL PACK (if applicable)
FROM
TO
MATERIAL
EMPLACEMENT METHOD
54.9 ft
64.5 ft•
Sand
Pour
tt,
ft.
20. DRILLING LOG (attach additional sheets if necessary)
FROM
TO
DESCRIPTION (color, hardness, soil/rock type, grain size, etc.)
ft.
ft.
fL
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
rL
et.
21. REMARKS
Bentonite seal from 48.5 to 54.9
2" U-Pack Screen
22. Certification:
Signature of Certified Well Contractor
Date
By signing this form, I hereby certify that the well(s) was (were) constructed in accordance
with 1 SA 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
(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 Inieetion 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 m Method of test: 24c. For Water Supply & Injection Wells:
(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.
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
For Internal Use ONLY:
1. Well Contractor Information:
David Wilcox
Well Contractor Name
3223-A
NC Well Contractor Certification Number
Cascade Drilling, L.P.
Company Name
2. Well Construction Permit #:
List all applicable well permits (i.e. Count),, State, Variance, Injection, etc.)
3. Well Use (check well use):
Water Supply Well:
❑Agricultural
❑Geothermal (Heating/Cooling Supply)
❑ hidustrial/Commercial
❑ Irrigation
Non -Water Supply Well:
El Aquifer Recharge
El 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
❑ Stormwater Drainage
❑Subsidence Control
❑Tracer
❑Other (explain under #21 F
4. Date well(s) Completed: 02/10/2015 Well ID# MW-03BR
5a. Well Location:
Mayo
Facility/Owner Name Facility ID# (if applicable)
10660 Boston Road, Roxboro, NC 27574
Physical Address, City, and Zip
Person
County Parcel Identification No. (PIN)
5b. Latitude and Longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one tat/long is sufficient)
N W
6. Is (are) the well(s): Z Permanent or ❑Temporary
7. Is this a repair to an existing well: ❑Yes or FIND
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 multiple injection or non -water supply wells ONLY with the same construction, you can
submit one form.
9. Total well depth below land surface: 75.1
For multiple wells list all depths if different (example- 3@200' and 2@100')
10. Static water level below top of casing: 16.0
If water level is above casing, use "+ "
11. Borehole diameter: 6
12. Well construction method: Sonic
(i.e. auger, rotary, cable, direct push, etc.)
14. WATER ZONES
FROM
TO
DESCRIPTION
rt.
rt.
ft.
ft.
15. OUTER CASING for multi -cased wells OR LINER if applicable)
FROM
TO
DIAMETER
THICKNESS
MATERIAL
ft.
ft.
I in.
16. INNER CASING OR TUBING(geothermal closed -loop)
FROM
TO
I DIAMETER
THICKNESS
MATERIAL
0 ft
68.8
12 '"'
SCH 40
PVC
fL
fL
in.
17. SCREEN
FROM
TO
DIAMETER
SLOT SIZE
THICKNESS
MATERIAL
68.8 ft'
74.0 ft-
2 in'
010
SCH 40
PVC
ft.
ft.
in.
18. GROUT
FROM
TO
MATERIAL
EMPLACEMENT METHOD & AMOUNT
0 ff
6 1. 0 ft
Cemt./Bent.
Tremie
ft.
ft.
rt.
ft.
19. SAND/GRAVEL PACK (if applicable)
FROM
TO
MATERIAL
EMPLACEMENT METHOD
66.2 fL
75.1 ft
Sand
Pour
tt,
ft.
20. DRILLING LOG (attach additional sheets if necessary)
FROM
TO
DESCRIPTION (color, hardness, soil/rock type, grain size, etc.)
ft.
ft.
fL
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
rL
et.
21. REMARKS
Bentonite seal from 61.0 to 66.2
2" U-Pack Screen
22. Certification:
Signature of Certified Well Contractor
Date
By signing this form, I hereby certify that the well(s) was (were) constructed in accordance
with 1 SA 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
(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 Inieetion 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 m Method of test: 24c. For Water Supply & Injection Wells:
(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.
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
For Internal Use ONLY:
1. Well Contractor Information:
David Wilcox
Well Contractor Name
3223-A
NC Well Contractor Certification Number
Cascade Drilling, L.P.
Company Name
2. Well Construction Permit #:
List all applicable well permits (i.e. Count),, State, Variance, Injection, etc.)
3. Well Use (check well use):
Water Supply Well:
❑Agricultural
❑Geothermal (Heating/Cooling Supply)
❑ hidustrial/Commercial
❑ Irrigation
Non -Water Supply Well:
El Aquifer Recharge
El 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
❑ Stormwater Drainage
❑Subsidence Control
❑Tracer
❑Other (explain under #21 F
4. Date well(s) Completed: 01 /30/2015 Well ID# M W-05 B R
5a. Well Location:
Mayo
Facility/Owner Name Facility ID# (if applicable)
10660 Boston Road, Roxboro, NC 27574
Physical Address, City, and Zip
Person
County Parcel Identification No. (PIN)
5b. Latitude and Longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one tat/long is sufficient)
N W
6. Is (are) the well(s): Z Permanent or ❑Temporary
7. Is this a repair to an existing well: ❑Yes or FIND
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 multiple injection or non -water supply wells ONLY with the same construction, you can
submit one form.
9. Total well depth below land surface: 65.0
For multiple wells list all depths if different (example- 3@200' and 2@100')
10. Static water level below top of casing: 9' 0
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.)
14. WATER ZONES
FROM
TO
DESCRIPTION
rt.
rt.
ft.
ft.
15. OUTER CASING for multi -cased wells OR LINER if applicable)
FROM
TO
DIAMETER
THICKNESS
MATERIAL
ft.
ft.
I in.
16. INNER CASING OR TUBING(geothermal closed -loop)
FROM
I TO
I DIAMETER
THICKNESS
MATERIAL
0 tt•
58.0 tt•
2 '"'
SCH 40
PVC
fL
fL
in.
17. SCREEN
FROM
TO
DIAMETER
SLOT SIZE
THICKNESS
MATERIAL
58.0 ft'
63.0 ft.
2 in'
010
SCH 40
PVC
ft.
ft.
in.
18. GROUT
FROM
TO
MATERIAL
EMPLACEMENT METHOD & AMOUNT
0 ff
51.3 tt•
Cemt./Bent.
Tremie
ft.
ft.
rt.
ft.
19. SAND/GRAVEL PACK (if applicable)
FROM
TO
MATERIAL
EMPLACEMENT METHOD
55.8 tL
65.0 tt•
Sand
Pour
tt,
ft.
20. DRILLING LOG (attach additional sheets if necessary)
FROM
TO
DESCRIPTION (color, hardness, soil/rock type, grain size, etc.)
ft.
ft.
fL
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
rL
et.
21. REMARKS
Bentonite seal from 51.3 to 55.8
2" U-Pack Screen
22. Certification:
Signature of Certified Well Contractor
Date
By signing this form, I hereby certify that the well(s) was (were) constructed in accordance
with 1 SA 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
(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 Inieetion 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 m Method of test: 24c. For Water Supply & Injection Wells:
(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.
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
For Internal Use ONLY:
1. Well Contractor Information:
Donald Warren
Well Contractor Name
3581-A
NC Well Contractor Certification Number
Cascade Drilling, L.P.
Company Name
2. Well Construction Permit #:
List all applicable well permits (i.e. Count),, State, Variance, Injection, etc.)
3. Well Use (check well use):
Water Supply Well:
❑Agricultural
❑Geothermal (Heating/Cooling Supply)
❑ hidustrial/Commercial
❑ Irrigation
Non -Water Supply Well:
El Aquifer Recharge
El 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
❑ Stormwater Drainage
❑Subsidence Control
❑Tracer
❑Other (explain under #21 F
4. Date well(s) Completed: 04/13/2015 Well ID# MW-06BR
5a. Well Location:
Mayo
Facility/Owner Name Facility ID# (if applicable)
10660 Boston Road, Roxboro, NC 27574
Physical Address, City, and Zip
Person
County Parcel Identification No. (PIN)
5b. Latitude and Longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one tat/long is sufficient)
N W
6. Is (are) the well(s): Z Permanent or ❑Temporary
7. Is this a repair to an existing well: ❑Yes or FIND
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 multiple injection or non -water supply wells ONLY with the same construction, you can
submit one form.
9. Total well depth below land surface: 1 00.0
For multiple wells list all depths if different (example- 3@200' and 2@100')
10. Static water level below top of casing:
If water level is above casing, use "+ "
11. Borehole diameter: 6
12. Well construction method: Sonic
(i.e. auger, rotary, cable, direct push, etc.)
14. WATER ZONES
FROM
TO
DESCRIPTION
rt.
rt.
ft.
ft.
15.0UTER CASING for multi -cased wells OR LINER if a Gcable
FROM
TO
DIAMETER
THICKNESS
MATERIAL
ft.
ft.
in.
16. INNER CASING OR TUBING(geothermal closed -loop)
FROM
I TO
I DIAMETER
THICKNESS
MATERIAL
0 ft•
90.0 ft-
12 '"'
SCH 40
PVC
fL
I ft.
I in.
17. SCREEN
FROM
TO
DIAMETER
SLOT SIZE
THICKNESS
MATERIAL
90.0 ft'
100.0 ft.
2 in.
010
SCH 40
PVC
ft.
ft.
in.
18. GROUT
FROM
TO
MATERIAL
EMPLACEMENT METHOD & AMOUNT
0 ff
8 1. 0 ft•
Cemt./Bent.
Tremie
ft.
ft.
rt.
ft.
19. SAND/GRAVEL PACK (if applicable)
FROM
TO
MATERIAL
EMPLACEMENT METHOD
84.0 ft
100.0 ft
Sand
Pour
tt,
ft.
20. DRILLING LOG (attach additional sheets if necessary)
FROM
TO
DESCRIPTION (color, hardness, soil/rock type, grain size, etc.)
0 ft-
17.0 ft•
Orange/Brown silt and saprolite
17.0 ft.
100.0 ft.
Green phyllite and granite with quartz
ft.
rt.
rt.
rL
ft.
rt.
ft.
ft.
rL
ft.
21. REMARKS
Bentonite seal from 81.0 to 84.0
2" U-Pack Screen
22. Certification:
Signature of Certified Well Contractor
Date
By signing this form, I hereby certify that the well(s) was (were) constructed in accordance
with 1 SA 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
(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 Inieetion 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 m Method of test: 24c. For Water Supply & Injection Wells:
(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.
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
For Internal Use ONLY:
1. Well Contractor Information:
Jonathan Todd Allred
Well Contractor Name
3213-A
NC Well Contractor Certification Number
Cascade Drilling, L.P.
Company Name
2. Well Construction Permit #:
List all applicable well permits (i.e. Count),, State, Variance, Injection, etc.)
3. Well Use (check well use):
Water Supply Well:
❑Agricultural
❑Geothermal (Heating/Cooling Supply)
❑ Industrial/Commercial
❑ Irrigation
Non -Water Supply Well:
El Aquifer Recharge
El 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
❑ Stormwater Drainage
❑Subsidence Control
❑Tracer
❑Other (explain under #21 F
4. Date well(s) Completed: 04/24/2015 Well ID# MW-07BR
5a. Well Location:
Mayo
Facility/Owner Name Facility ID# (if applicable)
10660 Boston Road, Roxboro, NC 27574
Physical Address, City, and Zip
Person
County Parcel Identification No. (PIN)
5b. Latitude and Longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one tat/long is sufficient)
N W
6. Is (are) the well(s): Z Permanent or ❑Temporary
7. Is this a repair to an existing well: ❑Yes or FIND
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 multiple injection or non -water supply wells ONLY with the same construction, you can
submit one form.
9. Total well depth below land surface: 77.5
For multiple wells list all depths if different (example- 3@200' and 2@100')
10. Static water level below top of casing: 8' 0
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.)
14. WATER ZONES
FROM
TO
DESCRIPTION
rt.
rt.
ft.
ft.
15.0UTER CASING for multi -cased wells OR LINER if a Gcable
FROM
TO
DIAMETER
THICKNESS
MATERIAL
ft.
ft.
in.
16. INNER CASING OR TUBING(geothermal closed -loop)
FROM
TO
I DIAMETER
THICKNESS
MATERIAL
0 ft•
66.8 It•
2 '"'
SCH 40
PVC
fL
fL
in.
17. SCREEN
FROM
TO
DIAMETER
SLOT SIZE
THICKNESS
MATERIAL
66.8 It•
77.5 ft•
2 "
1 1 010
SCH 40
PVC
ft.
ft.
in.
18. GROUT
FROM
TO
MATERIAL
EMPLACEMENT METHOD & AMOUNT
0 If
61.8 ft.
Cemt./Bent.
Tremie (75.6 gallons)
ft.
ft.
rt.
ft.
19. SAND/GRAVEL PACK (if applicable)
FROM
TO
MATERIAL
EMPLACEMENT METHOD
65.0 fL
77.5 ft•
Sand
Pour
tt,
ft.
20. DRILLING LOG (attach additional sheets if necessary)
FROM
TO
DESCRIPTION (color, hardness, soil/rock type, grain size, etc.)
ft.
ft.
fL
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
rL
et.
21. REMARKS
Bentonite seal from 61.8 to 65.0
2" U-Pack Screen
22. Certification:
Signature of Certified Well Contractor
Date
By signing this form, I hereby certify that the well(s) was (were) constructed in accordance
with 1 SA 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
(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 Inieetion 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 m Method of test: 24c. For Water Supply & Injection Wells:
(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.
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
For Internal Use ONLY:
1. Well Contractor Information:
Jonathan Todd Allred
Well Contractor Name
3213-A
NC Well Contractor Certification Number
Cascade Drilling, L.P.
Company Name
2. Well Construction Permit #:
List all applicable well permits (i.e. Count),, State, Variance, Injection, etc.)
3. Well Use (check well use):
Water Supply Well:
❑Agricultural
❑Geothermal (Heating/Cooling Supply)
❑ Industrial/Commercial
❑ Irrigation
Non -Water Supply Well:
El Aquifer Recharge
El 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
❑ Stormwater Drainage
❑Subsidence Control
❑Tracer
❑Other (explain under #21 F
4. Date Well(s) Completed: 04/25/2015well ID# MW-07D
5a. Well Location:
Mayo
Facility/Owner Name Facility ID# (if applicable)
10660 Boston Road, Roxboro, NC 27574
Physical Address, City, and Zip
Person
County Parcel Identification No. (PIN)
5b. Latitude and Longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one tat/long is sufficient)
N W
6. Is (are) the well(s): Z Permanent or ❑Temporary
7. Is this a repair to an existing well: ❑Yes or FIND
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 multiple injection or non -water supply wells ONLY with the same construction, you can
submit one form.
9. Total well depth below land surface: 32.5
For multiple wells list all depths if different (example- 3@200' and 2@100')
10. Static water level below top of casing: 9' 0
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.)
14. WATER ZONES
FROM
TO
DESCRIPTION
rt.
rt.
ft.
ft.
15.0UTER CASING for multi -cased wells OR LINER if a Gcable
FROM
TO
DIAMETER
THICKNESS
MATERIAL
ft.
ft.
in.
16. INNER CASING OR TUBING(geothermal closed -loop)
FROM
TO
I DIAMETER
THICKNESS
MATERIAL
0 ft•
19.5 It•
2 '"'
SCH 40
PVC
fL
fL
in.
17. SCREEN
FROM
TO
DIAMETER
SLOT SIZE
THICKNESS
MATERIAL
19.5 It•
30.5 ft•
2 "
1 1 010
SCH 40
PVC
ft.
ft.
in.
18. GROUT
FROM
TO
MATERIAL
EMPLACEMENT METHOD & AMOUNT
0 If
13.6 ft.
Cemt./Bent.
Tremie (19.2 gallons)
ft.
ft.
rt.
ft.
19. SAND/GRAVEL PACK (if applicable)
FROM
TO
MATERIAL
EMPLACEMENT METHOD
17.5 fL
32.5 ft•
Sand
Pour
tt,
ft.
20. DRILLING LOG (attach additional sheets if necessary)
FROM
TO
DESCRIPTION (color, hardness, soil rock type, grain size, etc.)
ft.
ft.
fL
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
rL
et.
21. REMARKS
Bentonite seal from 13.6 to 17.5
2" U-Pack Screen
22. Certification:
Signature of Certified Well Contractor
Date
By signing this form, I hereby certify that the well(s) was (were) constructed in accordance
with 1 SA 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
(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 Inieetion 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 m Method of test: 24c. For Water Supply & Injection Wells:
(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.
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
For Internal Use ONLY:
1. Well Contractor Information:
David Wilcox
Well Contractor Name
3223-A
NC Well Contractor Certification Number
Cascade Drilling, L.P.
Company Name
2. Well Construction Permit #:
List all applicable well permits (i.e. Count),, State, Variance, Injection, etc.)
3. Well Use (check well use):
Water Supply Well:
❑Agricultural
❑Geothermal (Heating/Cooling Supply)
❑ hidustrial/Commercial
❑ Irrigation
Non -Water Supply Well:
El Aquifer Recharge
El 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
❑ Stormwater Drainage
❑Subsidence Control
❑Tracer
❑Other (explain under #21 F
4. Date well(s) Completed: 02/14/2015 Well ID# MW-08BR
5a. Well Location:
Mayo
Facility/Owner Name Facility ID# (if applicable)
10660 Boston Road, Roxboro, NC 27574
Physical Address, City, and Zip
Person
County Parcel Identification No. (PIN)
5b. Latitude and Longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one tat/long is sufficient)
N W
6. Is (are) the well(s): Z Permanent or ❑Temporary
7. Is this a repair to an existing well: ❑Yes or FIND
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 multiple injection or non -water supply wells ONLY with the same construction, you can
submit one form.
9. Total well depth below land surface: 67.7
For multiple wells list all depths if different (example- 3@200' and 2@100')
10. Static water level below top of casing: 34.0
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.)
14. WATER ZONES
FROM
TO
DESCRIPTION
rt.
rt.
ft.
ft.
15. OUTER CASING for multi -cased wells OLINER if applicable)
FROM
TO
DIAMETER
THICKNESSR
MATERIAL
0 ft-46.5
ft-6
in.SCH
40
PVC
16. INNER CASING OR TUBING(geothermal closed -loop)
FROM
TO
I DIAMETER
THICKNESS
MATERIAL
0 ft•
61.8 ft•
2 '"'
SCH 40
PVC
ft
fL
in.
17. SCREEN
FROM
TO
DIAMETER
SLOT SIZE
THICKNESS
MATERIAL
61.8 ft'
67.0 ft.
2 in'
010
SCH 40
PVC
ft.
ft.
in.
18. GROUT
FROM
TO
MATERIAL
EMPLACEMENT METHOD & AMOUNT
0 ff
55.5 ft.
Cemt./Bent.
Tremie
0 ft.
46.5 ft.
Cemt./Bent.
Tremie
rt
ft.
19. SAND/GRAVEL PACK (if applicable)
FROM
TO
MATERIAL
EMPLACEMENT METHOD
60.2 ft
67.7 ft•
Sand
Pour
tt,
ft.
20. DRILLING LOG (attach additional sheets if necessary)
FROM
TO
DESCRIPTION (color, hardness, soil/rock type, grain size, etc.)
ft.
ft.
fL
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
rL
et.
21. REMARKS
Bentonite seal from 55.5 to 60.2
2" U-Pack Screen
22. Certification:
Signature of Certified Well Contractor
Date
By signing this form, I hereby certify that the well(s) was (were) constructed in accordance
with 1 SA 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
(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 Inieetion 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 m Method of test: 24c. For Water Supply & Injection Wells:
(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.
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
For Internal Use ONLY:
1. Well Contractor Information:
David Wilcox
Well Contractor Name
3223-A
NC Well Contractor Certification Number
Cascade Drilling, L.P.
Company Name
2. Well Construction Permit #:
List all applicable well permits (i.e. Count),, State, Variance, Injection, etc.)
3. Well Use (check well use):
Water Supply Well:
❑Agricultural
❑Geothermal (Heating/Cooling Supply)
❑ hidustrial/Commercial
❑ Irrigation
Non -Water Supply Well:
El Aquifer Recharge
El 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
❑ Stormwater Drainage
❑Subsidence Control
❑Tracer
❑Other (explain under #21 F
4. Date Well(s) Completed: 02/16/2015 Well ID# MW-08D
5a. Well Location:
Mayo
Facility/Owner Name Facility ID# (if applicable)
10660 Boston Road, Roxboro, NC 27574
Physical Address, City, and Zip
Person
County Parcel Identification No. (PIN)
5b. Latitude and Longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one tat/long is sufficient)
N W
6. Is (are) the well(s): Z Permanent or ❑Temporary
7. Is this a repair to an existing well: ❑Yes or FIND
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 multiple injection or non -water supply wells ONLY with the same construction, you can
submit one form.
9. Total well depth below land surface: 41 .0
For multiple wells list all depths if different (example- 3@200' and 2@100')
10. Static water level below top of casing: 33.0
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.)
14. WATER ZONES
FROM
TO
DESCRIPTION
rt.
rt.
ft.
ft.
15. OUTER CASING for multi -cased wells OR LINER if applicable)
FROM
TO
DIAMETER
THICKNESS
MATERIAL
ft.
ft.
I in.
16. INNER CASING OR TUBING(geothermal closed -loop)
FROM
TO
I DIAMETER
THICKNESS
MATERIAL
0 ft
33.3
12 '"'
SCH 40
PVC
fL
fL
in.
17. SCREEN
FROM
TO
DIAMETER
SLOT SIZE
THICKNESS
MATERIAL
33.3 ft'
38.5 ft-
2 in'
010
SCH 40
PVC
ft.
ft.
in.
18. GROUT
FROM
TO
MATERIAL
EMPLACEMENT METHOD & AMOUNT
0 ft
28.5 ft
Cemt./Bent.
Tremie
ft.
ft.
rt.
ft.
19. SAND/GRAVEL PACK (if applicable)
FROM
TO
MATERIAL
EMPLACEMENT METHOD
31.4 fL
41.0 ft
Sand
Pour
tt,
ft.
20. DRILLING LOG (attach additional sheets if necessary)
FROM
TO
DESCRIPTION (color, hardness, soil/rock type, grain size, etc.)
ft.
ft.
fL
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
rL
et.
21. REMARKS
Bentonite seal from 28.5 to 31.4
2" U-Pack Screen
22. Certification:
Signature of Certified Well Contractor
Date
By signing this form, I hereby certify that the well(s) was (were) constructed in accordance
with 1 SA 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
(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 Inieetion 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 m Method of test: 24c. For Water Supply & Injection Wells:
(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.
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
For Internal Use ONLY:
1. Well Contractor Information:
David Wilcox
Well Contractor Name
3223-A
NC Well Contractor Certification Number
Cascade Drilling, L.P.
Company Name
2. Well Construction Permit #:
List all applicable well permits (i.e. Count),, State, Variance, Injection, etc.)
3. Well Use (check well use):
Water Supply Well:
❑Agricultural
❑Geothermal (Heating/Cooling Supply)
❑ hidustrial/Commercial
❑ Irrigation
Non -Water Supply Well:
El Aquifer Recharge
El 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
❑ Stormwater Drainage
❑Subsidence Control
❑Tracer
❑Other (explain under #21 F
4. Date Well(s) Completed: 02/16/2015 Well ID# M W-08S
5a. Well Location:
Mayo
Facility/Owner Name Facility ID# (if applicable)
10660 Boston Road, Roxboro, NC 27574
Physical Address, City, and Zip
Person
County Parcel Identification No. (PIN)
5b. Latitude and Longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one tat/long is sufficient)
N W
6. Is (are) the well(s): Z Permanent or ❑Temporary
7. Is this a repair to an existing well: ❑Yes or FIND
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 multiple injection or non -water supply wells ONLY with the same construction, you can
submit one form.
9. Total well depth below land surface: 30.1
For multiple wells list all depths if different (example- 3@200' and 2@100')
10. Static water level below top of casing: 30.0
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.)
14. WATER ZONES
FROM
TO
DESCRIPTION
rt.
rt.
ft.
ft.
15. OUTER CASING for multi -cased wells OR LINER if applicable)
FROM
TO
DIAMETER
THICKNESS
MATERIAL
ft.
ft.
I in.
16. INNER CASING OR TUBING(geothermal closed -loop)
FROM
I TO
I DIAMETER
THICKNESS
MATERIAL
0 tt•
25.0 tt•
2 '"'
SCH 40
PVC
fL
fL
in.
17. SCREEN
FROM
TO
DIAMETER
SLOT SIZE
THICKNESS
MATERIAL
25.0 ft'
30.0 ft.
2 in'
010
SCH 40
PVC
ft.
ft.
in.
18. GROUT
FROM
TO
MATERIAL
EMPLACEMENT METHOD & AMOUNT
0 ff
19.0 tt•
Cemt./Bent.
Tremie
ft.
ft.
rt.
ft.
19. SAND/GRAVEL PACK (if applicable)
FROM
TO
MATERIAL
EMPLACEMENT METHOD
23.3 tL
30.1 tt•
Sand
Pour
tt,
ft.
20. DRILLING LOG (attach additional sheets if necessary)
FROM
TO
DESCRIPTION (color, hardness, soil/rock type, grain size, etc.)
ft.
ft.
fL
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
rL
et.
21. REMARKS
Bentonite seal from 19.0 to 23.3
2" U-Pack Screen
22. Certification:
Signature of Certified Well Contractor
Date
By signing this form, I hereby certify that the well(s) was (were) constructed in accordance
with 1 SA 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
(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 Inieetion 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 m Method of test: 24c. For Water Supply & Injection Wells:
(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.
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
For Internal Use ONLY:
1. Well Contractor Information:
Donald Warren
Well Contractor Name
3581-A
NC Well Contractor Certification Number
Cascade Drilling, L.P.
Company Name
2. Well Construction Permit #:
List all applicable well permits (i.e. Count),, State, Variance, Injection, etc.)
3. Well Use (check well use):
Water Supply Well:
❑Agricultural
❑Geothermal (Heating/Cooling Supply)
❑ hidustrial/Commercial
❑ Irrigation
Non -Water Supply Well:
El Aquifer Recharge
El 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
❑ Stormwater Drainage
❑Subsidence Control
❑Tracer
❑Other (explain under #21 F
4. Date well(s) Completed: 04/11 /2015 Well ID# M W-09 B R
5a. Well Location:
Mayo
Facility/Owner Name Facility ID# (if applicable)
10660 Boston Road, Roxboro, NC 27574
Physical Address, City, and Zip
Person
County Parcel Identification No. (PIN)
5b. Latitude and Longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one tat/long is sufficient)
N W
6. Is (are) the well(s): Z Permanent or ❑Temporary
7. Is this a repair to an existing well: ❑Yes or FIND
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 multiple injection or non -water supply wells ONLY with the same construction, you can
submit one form.
9. Total well depth below land surface: 61.0
For multiple wells list all depths if dii fereni (example- 3@200' and 2@100')
10. Static water level below top of casing: 25.0
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.)
14. WATER ZONES
FROM
TO
DESCRIPTION
rt.
rt.
ft.
ft.
15.0UTER CASING for multi -cased wells OR LINER if a Gcable
FROM
TO
DIAMETER
THICKNESS
MATERIAL
ft.
ft.
in.
16. INNER CASING OR TUBING(geothermal closed -loop)
FROM
I TO
I DIAMETER
THICKNESS
MATERIAL
0 ft•
48.0 ft•
2 '"'
SCH 40
PVC
fL
fL
in.
17. SCREEN
FROM
TO
DIAMETER
SLOT SIZE
THICKNESS
MATERIAL
48.0 ft'
58.0 ft.
2 in.
010
SCH 40
PVC
ft.
ft.
in.
18. GROUT
FROM
TO
MATERIAL
EMPLACEMENT METHOD & AMOUNT
0 ff
43.0 ft•
Cemt./Bent.
Tremie
ft.
ft.
rt.
ft.
19. SAND/GRAVEL PACK (if applicable)
FROM
TO
MATERIAL
EMPLACEMENT METHOD
46.0 ft
61.0 ft•
Sand
Pour
tt,
ft.
20. DRILLING LOG (attach additional sheets if necessary)
FROM
TO
DESCRIPTION (color, hardness, soil/rock type, grain size, etc.)
0 ft-
46.0 ft.
Orang
46.0 ft.
58.0 ft.
Granite bedrock
ft.
fr.
rt.
et.
ft.
ft.
ft.
ft.
rt.
ft.
21. REMARKS
Bentonite seal from 43.0 to 46.0
2" U-Pack Screen
22. Certification:
Signature of Certified Well Contractor
Date
By signing this form, I hereby certify that the well(s) was (were) constructed in accordance
with 1 SA 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
(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 Inieetion 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 m Method of test: 24c. For Water Supply & Injection Wells:
(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.
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
For Internal Use ONLY:
1. Well Contractor Information:
David Wilcox
Well Contractor Name
3223-A
NC Well Contractor Certification Number
Cascade Drilling, L.P.
Company Name
2. Well Construction Permit #:
List all applicable well permits (i.e. Count),, State, Variance, Injection, etc.)
3. Well Use (check well use):
Water Supply Well:
❑Agricultural
❑Geothermal (Heating/Cooling Supply)
❑ hidustrial/Commercial
❑ Irrigation
Non -Water Supply Well:
El Aquifer Recharge
El 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
❑ Stormwater Drainage
❑Subsidence Control
❑Tracer
❑Other (explain under #21 F
4. Date Well(s) Completed: 02/25/2015 well ID# M W-10 B R
5a. Well Location:
Mayo
Facility/Owner Name Facility ID# (if applicable)
10660 Boston Road, Roxboro, NC 27574
Physical Address, City, and Zip
Person
County Parcel Identification No. (PIN)
5b. Latitude and Longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one tat/long is sufficient)
N W
6. Is (are) the well(s): Z Permanent or ❑Temporary
7. Is this a repair to an existing well: ❑Yes or FIND
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 multiple injection or non -water supply wells ONLY with the same construction, you can
submit one form.
9. Total well depth below land surface: 65.5
For multiple wells list all depths if different (example- 3@200' and 2@100')
10. Static water level below top of casing: 14.0
If water level is above casing, use "+ "
11. Borehole diameter: 6
12. Well construction method: Sonic
(i.e. auger, rotary, cable, direct push, etc.)
14. WATER ZONES
FROM
TO
DESCRIPTION
rt.
rt.
ft.
ft.
15. OUTER CASING for multi -cased wells OR LINER if applicable)
FROM
TO
DIAMETER
THICKNESS
MATERIAL
ft.
ft.
I in.
16. INNER CASING OR TUBING(geothermal closed -loop)
FROM
I TO
I DIAMETER
THICKNESS
MATERIAL
0 ft
48.0
12 '"'
SCH 40
PVC
fL
fL
in.
17. SCREEN
FROM
TO
DIAMETER
SLOT SIZE
THICKNESS
MATERIAL
48.0 ft'
58.0 ft-
2 in'
010
SCH 40
PVC
ft.
ft.
in.
18. GROUT
FROM
TO
MATERIAL
EMPLACEMENT METHOD & AMOUNT
0 ff
42.5 ft
Cemt./Bent.
Tremie
ft.
ft.
rt.
ft.
19. SAND/GRAVEL PACK (if applicable)
FROM
TO
MATERIAL
EMPLACEMENT METHOD
46.1 fL
65.5 ft
Sand
Pour
tt,
ft.
20. DRILLING LOG (attach additional sheets if necessary)
FROM
TO
DESCRIPTION (color, hardness, soil/rock type, grain size, etc.)
ft.
ft.
fL
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
rL
et.
21. REMARKS
Bentonite seal from 42.5 to 46.1
2" U-Pack Screen
22. Certification:
Signature of Certified Well Contractor
Date
By signing this form, I hereby certify that the well(s) was (were) constructed in accordance
with 1 SA 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
(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 Inieetion 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 m Method of test: 24c. For Water Supply & Injection Wells:
(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.
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
For Internal Use ONLY:
1. Well Contractor Information:
Jonathan Todd Allred
Well Contractor Name
3213-A
NC Well Contractor Certification Number
Cascade Drilling, L.P.
Company Name
2. Well Construction Permit #:
List all applicable well permits (i.e. Count),, State, Variance, Injection, etc.)
3. Well Use (check well use):
Water Supply Well:
❑Agricultural
❑Geothermal (Heating/Cooling Supply)
❑ Industrial/Commercial
❑ Irrigation
Non -Water Supply Well:
El Aquifer Recharge
El 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
❑ Stormwater Drainage
❑Subsidence Control
❑Tracer
❑Other (explain under #21 F
4. Date Well(s) Completed: 04/24/2015 Well ID# MW-1 1 BR
5a. Well Location:
Mayo
Facility/Owner Name Facility ID# (if applicable)
10660 Boston Road, Roxboro, NC 27574
Physical Address, City, and Zip
Person
County Parcel Identification No. (PIN)
5b. Latitude and Longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one tat/long is sufficient)
N W
6. Is (are) the well(s): Z Permanent or ❑Temporary
7. Is this a repair to an existing well: ❑Yes or FIND
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 multiple injection or non -water supply wells ONLY with the same construction, you can
submit one form.
9. Total well depth below land surface: 95
For multiple wells list all depths if different (example- 3@200' and 2@100')
10. Static water level below top of casing: 39.0
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.)
14. WATER ZONES
FROM
TO
DESCRIPTION
rt.
rt.
ft.
ft.
15.0UTER CASING for multi -cased wells OR LINER if a Gcable
FROM
TO
DIAMETER
THICKNESS
MATERIAL
ft.
ft.
in.
16. INNER CASING OR TUBING(geothermal closed -loop)
FROM
TO
I DIAMETER
THICKNESS
MATERIAL
0 ft
84.3
12 '"'
SCH 40
PVC
fL
fL
in.
17. SCREEN
FROM
TO
DIAMETER
SLOT SIZE
THICKNESS
MATERIAL
84.3 ft
94.4 ft
2 "
1 1 010
SCH 40
PVC
ft.
ft.
in.
18. GROUT
FROM
TO
MATERIAL
EMPLACEMENT METHOD & AMOUNT
0 ft.
77.5 ft.
Cemt./Bent.
Tremie
ft.
ft.
rt.
ft.
19. SAND/GRAVEL PACK (if applicable)
FROM
TO
MATERIAL
EMPLACEMENT METHOD
82.5 fL
95.0 ft
Sand
Pour
tt,
ft.
20. DRILLING LOG (attach additional sheets if necessary)
FROM
TO
DESCRIPTION (color, hardness, soil/rock type, grain size, etc.)
ft.
ft.
fL
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
rL
et.
21. REMARKS
Bentonite seal from 77.5 to 82.5
2" U-Pack Screen
22. Certification:
Signature of Certified Well Contractor
Date
By signing this form, I hereby certify that the well(s) was (were) constructed in accordance
with 1 SA 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
(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 Inieetion 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 m Method of test: 24c. For Water Supply & Injection Wells:
(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.
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
For Internal Use ONLY:
1. Well Contractor Information:
Jonathan Todd Allred
Well Contractor Name
3213-A
NC Well Contractor Certification Number
Cascade Drilling, L.P.
Company Name
2. Well Construction Permit #:
List all applicable well permits (i.e. Count),, State, Variance, Injection, etc.)
3. Well Use (check well use):
Water Supply Well:
❑Agricultural
❑Geothermal (Heating/Cooling Supply)
❑ Industrial/Commercial
❑ Irrigation
Non -Water Supply Well:
El Aquifer Recharge
El 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
❑ Stormwater Drainage
❑Subsidence Control
❑Tracer
❑Other (explain under #21 F
4. Date Well(s) Completed: 04/28/2015 Well ID# MW-12D
5a. Well Location:
Mayo
Facility/Owner Name Facility ID# (if applicable)
10660 Boston Road, Roxboro, NC 27574
Physical Address, City, and Zip
Person
County Parcel Identification No. (PIN)
5b. Latitude and Longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one tat/long is sufficient)
N W
6. Is (are) the well(s): Z Permanent or ❑Temporary
7. Is this a repair to an existing well: ❑Yes or FIND
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 multiple injection or non -water supply wells ONLY with the same construction, you can
submit one form.
9. Total well depth below land surface: 97.5
For multiple wells list all depths if different (example- 3@200' and 2@100')
10. Static water level below top of casing: 31.0
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.)
14. WATER ZONES
FROM
TO
DESCRIPTION
rt.
rt.
ft.
ft.
15.0UTER CASING for multi -cased wells OR LINER if a Gcable
FROM
TO
DIAMETER
THICKNESS
MATERIAL
ft.
ft.
in.
16. INNER CASING OR TUBING(geothermal closed -loop)
FROM
I TO
I DIAMETER
THICKNESS
MATERIAL
0 ft
87.0
12 '"'
SCH 40
PVC
fL
fL
in.
17. SCREEN
FROM
TO
DIAMETER
SLOT SIZE
THICKNESS
MATERIAL
87.0 ft
97.0 ft
2 "
1 1 010
SCH 40
PVC
ft.
ft.
in.
18. GROUT
FROM
TO
MATERIAL
EMPLACEMENT METHOD & AMOUNT
0 ft.
79.0 ft.
Cemt./Bent.
Tremie
ft.
ft.
rt.
ft.
19. SAND/GRAVEL PACK (if applicable)
FROM
TO
MATERIAL
EMPLACEMENT METHOD
84.8 fL
97.5 ft
Sand
Pour
tt,
ft.
20. DRILLING LOG (attach additional sheets if necessary)
FROM
TO
DESCRIPTION (color, hardness, soil/rock type, grain size, etc.)
ft.
ft.
fL
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
rL
et.
21. REMARKS
Bentonite seal from 79.0 to 84.8
2" U-Pack Screen
22. Certification:
Signature of Certified Well Contractor
Date
By signing this form, I hereby certify that the well(s) was (were) constructed in accordance
with 1 SA 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
(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 Inieetion 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 m Method of test: 24c. For Water Supply & Injection Wells:
(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.
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
For Internal Use ONLY:
1. Well Contractor Information:
Jonathan Todd Allred
Well Contractor Name
3213-A
NC Well Contractor Certification Number
Cascade Drilling, L.P.
Company Name
2. Well Construction Permit #:
List all applicable well permits (i.e. Count),, State, Variance, Injection, etc.)
3. Well Use (check well use):
Water Supply Well:
❑Agricultural
❑Geothermal (Heating/Cooling Supply)
❑ Industrial/Commercial
❑ Irrigation
Non -Water Supply Well:
El Aquifer Recharge
El 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
❑ Stormwater Drainage
❑Subsidence Control
❑Tracer
❑Other (explain under #21 F
4. Date Well(s) Completed: 04/29/2015well ID# MW-12S
5a. Well Location:
Mayo
Facility/Owner Name Facility ID# (if applicable)
10660 Boston Road, Roxboro, NC 27574
Physical Address, City, and Zip
Person
County Parcel Identification No. (PIN)
5b. Latitude and Longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one tat/long is sufficient)
N W
6. Is (are) the well(s): Z Permanent or ❑Temporary
7. Is this a repair to an existing well: ❑Yes or FIND
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 multiple injection or non -water supply wells ONLY with the same construction, you can
submit one form.
9. Total well depth below land surface: 51.0
For multiple wells list all depths if different (example- 3@200' and 2@100')
10. Static water level below top of casing: 31.0
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.)
14. WATER ZONES
FROM
TO
DESCRIPTION
rt.
rt.
ft.
ft.
15.0UTER CASING for multi -cased wells OR LINER if a Gcable
FROM
TO
DIAMETER
THICKNESS
MATERIAL
ft.
ft.
in.
16. INNER CASING OR TUBING(geothermal closed -loop)
FROM
TO
I DIAMETER
THICKNESS
MATERIAL
0 ft
39.5
12 '"'
SCH 40
PVC
fL
fL
in.
17. SCREEN
FROM
TO
DIAMETER
SLOT SIZE
THICKNESS
MATERIAL
39.5 ft
49.5 ft
2 "
1 1 010
SCH 40
PVC
ft.
ft.
in.
18. GROUT
FROM
TO
MATERIAL
EMPLACEMENT METHOD & AMOUNT
0 ft.
32.7 ft.
Cemt./Bent.
Tremie
ft.
ft.
rt.
ft.
19. SAND/GRAVEL PACK (if applicable)
FROM
TO
MATERIAL
EMPLACEMENT METHOD
38.0 fL
51.0 ft
Sand
Pour
tt,
ft.
20. DRILLING LOG (attach additional sheets if necessary)
FROM
TO
DESCRIPTION (color, hardness, soil/rock type, grain size, etc.)
ft.
ft.
fL
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
rL
et.
21. REMARKS
Bentonite seal from 32.7 to 38.0
2" U-Pack Screen
22. Certification:
Signature of Certified Well Contractor
Date
By signing this form, I hereby certify that the well(s) was (were) constructed in accordance
with 1 SA 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
(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 Inieetion 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 m Method of test: 24c. For Water Supply & Injection Wells:
(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.
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
For Internal Use ONLY:
1. Well Contractor Information:
Donald Warren
Well Contractor Name
3581-A
NC Well Contractor Certification Number
Cascade Drilling, L.P.
Company Name
2. Well Construction Permit #:
List all applicable well permits (i.e. Count),, State, Variance, Injection, etc.)
3. Well Use (check well use):
Water Supply Well:
❑Agricultural
❑Geothermal (Heating/Cooling Supply)
❑ hidustrial/Commercial
❑ Irrigation
Non -Water Supply Well:
El Aquifer Recharge
El 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
❑ Stormwater Drainage
❑Subsidence Control
❑Tracer
❑Other (explain under #21 F
4. Date Well(s) Completed: 04/15/2015 well ID# M W-13 B R
5a. Well Location:
Mayo
Facility/Owner Name Facility ID# (if applicable)
10660 Boston Road, Roxboro, NC 27574
Physical Address, City, and Zip
Person
County Parcel Identification No. (PIN)
5b. Latitude and Longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one tat/long is sufficient)
N W
6. Is (are) the well(s): Z Permanent or ❑Temporary
7. Is this a repair to an existing well: ❑Yes or FIND
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 multiple injection or non -water supply wells ONLY with the same construction, you can
submit one form.
9. Total well depth below land surface: 1 00.0
For multiple wells list all depths if different (example- 3@200' and 2@100')
10. Static water level below top of casing: 33.0
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.)
14. WATER ZONES
FROM
TO
DESCRIPTION
rt.
rt.
ft.
ft.
15.0UTER CASING for multi -cased wells OR LINER if a Gcable
FROM
TO
DIAMETER
THICKNESS
MATERIAL
ft.
rt.
in.
16. INNER CASING OR TUBING(geothermal closed -loop)
FROM
TO
I DIAMETER
THICKNESS
MATERIAL
0 ft•
88 8 ft•
2 in'
SCH 40
PVC
rL
rL
in.
17. SCREEN
FROM
TO
DIAMETER
SLOT SIZE
THICKNESS
MATERIAL
88.8 ft'
98.7 ft.
2 in.
010
SCH 40
PVC
ft.
ft.
in.
18. GROUT
FROM
TO
MATERIAL
EMPLACEMENT METHOD & AMOUNT
0 ff
83.4 ft•
Portland
Tremie
ft.
rt.
rt.
ft.
19. SAND/GRAVEL PACK (if applicable)
FROM
TO
MATERIAL
EMPLACEMENT METHOD
86.9 fL
100.0 fL
Sand
Pour
tt,
ft.
20. DRILLING LOG (attach additional sheets if necessary)
FROM
TO
DESCRIPTION (color, hardness, soil/rock type, grain size, etc.)
0 ft•
0.0 ft•
Orange/Brown silt and clay
40.0 ft•
52.0 ft
Saprolite
52.0 ft.
99.0 ft.
Granite Bedrock
rt.
ft.
ft.
ft.
ft.
f't.
rt.
ft.
21. REMARKS
Bentonite seal from 83.4 to 86.9
2" U-Pack Screen
22. Certification:
Signature of Certified Well Contractor
Date
By signing this form, I hereby certify that the well(s) was (were) constructed in accordance
with 1 SA 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
(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 Inieetion 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 m Method of test: 24c. For Water Supply & Injection Wells:
(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.
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
For Internal Use ONLY:
1. Well Contractor Information:
Donald Warren
Well Contractor Name
3581-A
NC Well Contractor Certification Number
Cascade Drilling, L.P.
Company Name
2. Well Construction Permit #:
List all applicable well permits (i.e. Count),, State, Variance, Injection, etc.)
3. Well Use (check well use):
Water Supply Well:
❑Agricultural
❑Geothermal (Heating/Cooling Supply)
❑ hidustrial/Commercial
❑ Irrigation
Non -Water Supply Well:
El Aquifer Recharge
El 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
❑ Stormwater Drainage
❑Subsidence Control
❑Tracer
❑Other (explain under #21 F
4. Date Well(s) Completed: 02/05/2015 Well ID# MW-14BR
5a. Well Location:
Mayo
Facility/Owner Name Facility ID# (if applicable)
10660 Boston Road, Roxboro, NC 27574
Physical Address, City, and Zip
Person
County Parcel Identification No. (PIN)
5b. Latitude and Longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one tat/long is sufficient)
N W
6. Is (are) the well(s): Z Permanent or ❑Temporary
7. Is this a repair to an existing well: ❑Yes or FIND
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 multiple injection or non -water supply wells ONLY with the same construction, you can
submit one form.
9. Total well depth below land surface: 35.4
For multiple wells list all depths if different (example- 3@200' and 2@100')
10. Static water level below top of casing: 16.0
If water level is above casing, use "+ "
11. Borehole diameter: 6
12. Well construction method: Sonic
(i.e. auger, rotary, cable, direct push, etc.)
14. WATER ZONES
FROM
TO
DESCRIPTION
rt.
rt.
ft.
ft.
15.0UTER CASING for multi -cased wells OR LINER if a Gcable
FROM
TO
DIAMETER
THICKNESS
MATERIAL
ft.
ft.
in.
16. INNER CASING OR TUBING(geothermal closed -loop)
FROM
I TO
I DIAMETER
THICKNESS
MATERIAL
0 ft•
29.0 ft•
2 '"'
SCH 40
PVC
fL
fL
in.
17. SCREEN
FROM
TO
DIAMETER
SLOT SIZE
THICKNESS
MATERIAL
29.0 ft'
34.0 ft.
2 in.
010
SCH 40
PVC
ft.
ft.
in.
18. GROUT
FROM
TO
MATERIAL
EMPLACEMENT METHOD & AMOUNT
0 ff
21.3 ft•
Cemt./Bent.
Tremie
ft.
ft.
rt.
ft.
19. SAND/GRAVEL PACK (if applicable)
FROM
TO
MATERIAL
EMPLACEMENT METHOD
26.4 ft
35.4 ft•
Sand
Pour
tt,
ft.
20. DRILLING LOG (attach additional sheets if necessary)
FROM
TO
DESCRIPTION (color, hardness, soil/rock type, grain size, etc.)
ft.
ft.
fL
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
rL
et.
21. REMARKS
Bentonite seal from 21.3 to 26.4
2" U-Pack Screen
22. Certification:
Signature of Certified Well Contractor
Date
By signing this form, I hereby certify that the well(s) was (were) constructed in accordance
with 1 SA 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
(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 Inieetion 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 m Method of test: 24c. For Water Supply & Injection Wells:
(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.
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
For Internal Use ONLY:
1. Well Contractor Information:
David Wilcox
Well Contractor Name
3223-A
NC Well Contractor Certification Number
Cascade Drilling, L.P.
Company Name
2. Well Construction Permit #:
List all applicable well permits (i.e. Count),, State, Variance, Injection, etc.)
3. Well Use (check well use):
Water Supply Well:
❑Agricultural
❑Geothermal (Heating/Cooling Supply)
❑ hidustrial/Commercial
❑ Irrigation
Non -Water Supply Well:
El Aquifer Recharge
El 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
❑ Stormwater Drainage
❑Subsidence Control
❑Tracer
❑Other (explain under #21 F
4. Date Well(s) Completed: 05/12/2015 well ID# M W-15 B R
5a. Well Location:
Mayo
Facility/Owner Name Facility ID# (if applicable)
10660 Boston Road, Roxboro, NC 27574
Physical Address, City, and Zip
Person
County Parcel Identification No. (PIN)
5b. Latitude and Longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one tat/long is sufficient)
N W
6. Is (are) the well(s): Z Permanent or ❑Temporary
7. Is this a repair to an existing well: ❑Yes or FIND
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 multiple injection or non -water supply wells ONLY with the same construction, you can
submit one form.
9. Total well depth below land surface: 64.0
For multiple wells list all depths if different (example- 3@200' and 2@100')
10. Static water level below top of casing: 58' 0
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.)
14. WATER ZONES
FROM
TO
DESCRIPTION
rt.
rt.
ft.
ft.
15. OUTER CASING for multi -cased wells OR LINER if applicable)
FROM
TO
DIAMETER
THICKNESS
MATERIAL
ft.
ft.
I in.
16. INNER CASING OR TUBING(geothermal closed -loop)
FROM
I TO
I DIAMETER
THICKNESS
MATERIAL
0 tt•
53.0 tt•
2 '"'
SCH 40
PVC
fL
fL
in.
17. SCREEN
FROM
TO
DIAMETER
SLOT SIZE
THICKNESS
MATERIAL
53.0 ft'
63.0 ft.
2 in'
010
SCH 40
PVC
ft.
ft.
in.
18. GROUT
FROM
TO
MATERIAL
EMPLACEMENT METHOD & AMOUNT
0 ff
46.4 tt•
Cemt./Bent.
Tremie
ft.
ft.
rt.
ft.
19. SAND/GRAVEL PACK (if applicable)
FROM
TO
MATERIAL
EMPLACEMENT METHOD
50.8 tL
64.0 tt•
Sand
Pour
tt,
ft.
20. DRILLING LOG (attach additional sheets if necessary)
FROM
TO
DESCRIPTION (color, hardness, soil/rock type, grain size, etc.)
ft.
ft.
fL
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
rL
et.
21. REMARKS
Bentonite seal from 46.4 to 50.8
2" U-Pack Screen
22. Certification:
Signature of Certified Well Contractor
Date
By signing this form, I hereby certify that the well(s) was (were) constructed in accordance
with 1 SA 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
(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 Inieetion 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 m Method of test: 24c. For Water Supply & Injection Wells:
(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.
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
For Internal Use ONLY:
1. Well Contractor Information:
David Wilcox
Well Contractor Name
3223-A
NC Well Contractor Certification Number
Cascade Drilling, L.P.
Company Name
2. Well Construction Permit #:
List all applicable well permits (i.e. Count),, State, Variance, Injection, etc.)
3. Well Use (check well use):
Water Supply Well:
❑Agricultural
❑Geothermal (Heating/Cooling Supply)
❑ hidustrial/Commercial
❑ Irrigation
Non -Water Supply Well:
El Aquifer Recharge
El 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
❑ Stormwater Drainage
❑Subsidence Control
❑Tracer
❑Other (explain under #21 F
4. Date Well(s) Completed: 05/08/2015 Well ID# MW-16BR
5a. Well Location:
Mayo
Facility/Owner Name Facility ID# (if applicable)
10660 Boston Road, Roxboro, NC 27574
Physical Address, City, and Zip
Person
County Parcel Identification No. (PIN)
5b. Latitude and Longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one tat/long is sufficient)
N W
6. Is (are) the well(s): Z Permanent or ❑Temporary
7. Is this a repair to an existing well: ❑Yes or FIND
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 multiple injection or non -water supply wells ONLY with the same construction, you can
submit one form.
9. Total well depth below land surface: 59.5
For multiple wells list all depths if different (example- 3@200' and 2@100')
10. Static water level below top of casing: 6' 0
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.)
14. WATER ZONES
FROM
TO
DESCRIPTION
rt.
rt.
ft.
ft.
15. OUTER CASING for multi -cased wells OR LINER if applicable)
FROM
TO
DIAMETER
THICKNESS
MATERIAL
0 ft.
47.2 ft.
6 in.
S
PVC
16. INNER CASING OR TUBING(geothermal closed -loop)
FROM
I TO
I DIAMETER
THICKNESS
MATERIAL
0 ft•
48.7 ft•
2 '"'
SCH 40
PVC
ft
fL
in.
17. SCREEN
FROM
TO
DIAMETER
SLOT SIZE
THICKNESS
MATERIAL
48.7 ft'
59.0 ft.
2 in'
010
SCH 40
PVC
ft.
ft.
in.
18. GROUT
FROM
TO
MATERIAL
EMPLACEMENT METHOD & AMOUNT
0 ff
44.5 ft.
Cemt./Bent.
Tremie
0 ft
47.2 ft-
Cemt./Bent.
Tremie
rt
ft.
19. SAND/GRAVEL PACK (if applicable)
FROM
TO
MATERIAL
EMPLACEMENT METHOD
48.2 fL
59.5 ft•
Sand
Pour
tt,
ft.
20. DRILLING LOG (attach additional sheets if necessary)
FROM
TO
DESCRIPTION (color, hardness, soil/rock type, grain size, etc.)
ft.
ft.
fL
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
rL
et.
21. REMARKS
Bentonite seal from 44.5 to 48.2
2" U-Pack Screen
22. Certification:
Signature of Certified Well Contractor
Date
By signing this form, I hereby certify that the well(s) was (were) constructed in accordance
with 1 SA 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
(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 Inieetion 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 m Method of test: 24c. For Water Supply & Injection Wells:
(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.
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
For Internal Use ONLY:
1. Well Contractor Information:
David Wilcox
Well Contractor Name
3223-A
NC Well Contractor Certification Number
Cascade Drilling, L.P.
Company Name
2. Well Construction Permit #:
List all applicable well permits (i.e. Count),, State, Variance, Injection, etc.)
3. Well Use (check well use):
Water Supply Well:
❑Agricultural
❑Geothermal (Heating/Cooling Supply)
❑ hidustrial/Commercial
❑ Irrigation
Non -Water Supply Well:
El Aquifer Recharge
El 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
❑ Stormwater Drainage
❑Subsidence Control
❑Tracer
❑Other (explain under #21 F
4. Date Well(s) Completed: 05/08/2015 Well ID# MW-16D
5a. Well Location:
Mayo
Facility/Owner Name Facility ID# (if applicable)
10660 Boston Road, Roxboro, NC 27574
Physical Address, City, and Zip
Person
County Parcel Identification No. (PIN)
5b. Latitude and Longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one tat/long is sufficient)
N W
6. Is (are) the well(s): Z Permanent or ❑Temporary
7. Is this a repair to an existing well: ❑Yes or FIND
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 multiple injection or non -water supply wells ONLY with the same construction, you can
submit one form.
9. Total well depth below land surface: 39.0
For multiple wells list all depths if different (example- 3@200' and 2@100')
10. Static water level below top of casing: 6' 0
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.)
14. WATER ZONES
FROM
TO
DESCRIPTION
rt.
rt.
ft.
ft.
15. OUTER CASING for multi -cased wells OR LINER if applicable)
FROM
TO
DIAMETER
THICKNESS
MATERIAL
ft.
ft.
I in.
16. INNER CASING OR TUBING(geothermal closed -loop)
FROM
I TO
I DIAMETER
THICKNESS
MATERIAL
0 tt•
28 7 rt•
2 in'
SCH 40
PVC
rL
rL
in.
17. SCREEN
FROM
TO
DIAMETER
SLOT SIZE
THICKNESS
MATERIAL
28.7 ft'
38.9 ft.
2 in'
010
SCH 40
PVC
ft.
ft.
in.
18. GROUT
FROM
TO
MATERIAL
EMPLACEMENT METHOD & AMOUNT
0 rf
21.5 tf
Cemt./Bent.
Tremie
ft.
rt.
rt.
ft.
19. SAND/GRAVEL PACK (if applicable)
FROM
TO
MATERIAL
EMPLACEMENT METHOD
26.7 tL
39.0 tt•
Sand
Pour
ft,
ft.
20. DRILLING LOG (attach additional sheets if necessary)
FROM
TO
DESCRIPTION (color, hardness, soil/rock type, grain size, etc.)
ft.
ft.
rL
ft.
rt.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
rL
et.
21. REMARKS
Bentonite seal from 21.5 to 26.7
2" U-Pack Screen
22. Certification:
Signature of Certified Well Contractor
Date
By signing this form, I hereby certify that the well(s) was (were) constructed in accordance
with 1 SA 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
(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 Inieetion 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 m Method of test: 24c. For Water Supply & Injection Wells:
(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.
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
For Internal Use ONLY:
1. Well Contractor Information:
David Wilcox
Well Contractor Name
3223-A
NC Well Contractor Certification Number
Cascade Drilling, L.P.
Company Name
2. Well Construction Permit #:
List all applicable well permits (i.e. Count),, State, Variance, Injection, etc.)
3. Well Use (check well use):
Water Supply Well:
❑Agricultural
❑Geothermal (Heating/Cooling Supply)
❑ hidustrial/Commercial
❑ Irrigation
Non -Water Supply Well:
El Aquifer Recharge
El 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
❑ Stormwater Drainage
❑Subsidence Control
❑Tracer
❑Other (explain under #21 F
4. Date Well(s) Completed: 05/08/2015 Well ID# MW-16S
5a. Well Location:
Mayo
Facility/Owner Name Facility ID# (if applicable)
10660 Boston Road, Roxboro, NC 27574
Physical Address, City, and Zip
Person
County Parcel Identification No. (PIN)
5b. Latitude and Longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one tat/long is sufficient)
N W
6. Is (are) the well(s): Z Permanent or ❑Temporary
7. Is this a repair to an existing well: ❑Yes or FIND
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 multiple injection or non -water supply wells ONLY with the same construction, you can
submit one form. 9. Total well depth below land surface: 8.5
For multiple wells list all depths if different (example- 3@200' and 2@100')
10. Static water level below top of casing: 4' 0
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.)
14. WATER ZONES
FROM
TO
DESCRIPTION
rt.
rt.
ft.
ft.
15. OUTER CASING for multi -cased wells OR LINER if applicable)
FROM
TO
DIAMETER
THICKNESS
MATERIAL
ft.
ft.
I in.
16. INNER CASING OR TUBING(geothermal closed -loop)
FROM
I TO
I DIAMETER
THICKNESS
MATERIAL
0 ft•
4.9 ft•
2 '"'
SCH 40
PVC
fL
fL
in.
17. SCREEN
FROM
TO
DIAMETER
SLOT SIZE
THICKNESS
MATERIAL
4.9 ft'
7.6 ft.
2 in'
010
SCH 40
PVC
ft.
ft.
in.
18. GROUT
FROM
TO
MATERIAL
EMPLACEMENT METHOD & AMOUNT
0 ft.
2.3 ft.
Cemt./Bent.
Tremie
ft.
ft.
rt.
ft.
19. SAND/GRAVEL PACK (if applicable)
FROM
TO
MATERIAL
EMPLACEMENT METHOD
4.4 fL
8.5 ft•
Sand
Pour
tt,
ft.
20. DRILLING LOG (attach additional sheets if necessary)
FROM
TO
DESCRIPTION (color, hardness, soil/rock type, grain size, etc.)
ft.
ft.
fL
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
rL
et.
21. REMARKS
Bentonite seal from 2.3 to 4.4
2" U-Pack Screen
22. Certification:
Signature of Certified Well Contractor
Date
By signing this form, I hereby certify that the well(s) was (were) constructed in accordance
with 1 SA 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
(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 Inieetion 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 m Method of test: 24c. For Water Supply & Injection Wells:
(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.
Form GW-1 North Carolina Department of Environment and Natural Resources - Division of Water Resources Revised August 2013