NC0001422_Sutton Final Well Construction Records_20150805

WELL CiiN UCTIO RECORD
T1tis ibrm can be used for Bingle of multiple wells
1.Well Contractor In4formation:
}/CSMA ��t 1�y&
Well ConfUaaclorName]
NC Well Contractor Cenificulien Number
Company Nwne
2. Well Construction Permtt N:
Lin all opphcadle well perinAr (,c. County, Slate, Yarimtce, hi ecrlun, etc.)
3. Well Use (check well use):
ClAgricullural
❑Geoiltennal (Hcoting/Cooling Supply)
❑ Industrial/Commercial
Non -Water Supply Well:
❑Aquifer Recharge
❑Aquifer Storage and Recovery
❑Aqu i fcr Tot
❑Experimental Technology
❑Geothermal (Closed Loop)
❑Chcolhcnnnl (I lealinp)Coolim
❑Municipal/Public
❑Residential Water Supply (single)
❑Residential Water Supply (shared)
❑Recovery
❑Groundwater Remediation
❑Salinity Barrier
OStormwnler Drainage
❑Subsidence Control
❑Tracer
❑Other (explain under P21
4. Date Well(s) Conlpleled: 3-30'15 Well IDN .r7UP) V-�
5a. Well Location:
j;.N,LTica�'le"Y�1'i�c'i5 uric..
FnciIitylOwucr Nal
Futility IDA (ifnpplicnble)
lif", 6zi n Pictfr 0.
Physical Address, Cily, and Zip
r
lYtm,.-i ; PVC err
County parcel Identification No, (PIN)
5b. Latitude and Longitude In degrees/minutes/seconds or decimal degrees:
(ifwell Geld, one lat/long is sufieietd)
N
W
G. Is (are) the well(s): Apermmnent or ❑Temporary
7. Is this a repair to an existing well: ❑Ycs or C3No
(f liar Is a rupafr, flit. on( known well colatrnciiow hyivawlifin and explain rite namre ofrhe
repair urrdhr 971 reniurka xecllon or on the hack rfihls ynan.
8. Number of wells constructed:
For nwldple iajecliun or non-walcr,rnpply wells ONI.P wah Nte.rame conorucrlon, you van
sublon one fomr.
9. Total well depth below land surfare: log (ft.)
lroroudapla trails list A rh:pou;I'll((forenr risanV*l J[+ 200'Imd 2@ fnfl')
10, Stalicwater level below top of casing: (fL)
lfwarerlocl A abort erring, are i „
11. Borehole diameter: f f3` (in.)
12. Well construction method: _ [T fry" 5oiei L
(im. auger, rotary, cable, direct push, etc,)
r= Usc ONLY:
FRONT To DESCRIPTIGpi
ft. ft.
It. fl.
71Lt7117LYR; .A NC: rnr iriulli ca nd irafs vrl I INRI[: if it r ellciililc
FROMT{1 aIADYETFa THICKNESS N1ATL'RtAL
ft. rt. Irr
.:I&LINNElt CASli4C 011'1 li 1AG mtheriii4l thimd-lau r . —
FItONT i"[Y41)LOIE-Trit 1'1I1C1iNk.S5 ARATEIRIAI.In. . G
rT ia,
17.$G111E
MOAT aLAAMM I RLOT5I7.1- I Tiiir-KNr-48 I Nm TTr.. AT,
i0 ft. D fr' In.
4
ff. fl. In.
FRONT T(t NMTF:IIIAL EM1TPGt r;01 ENT al F,TnOn & ANIOUNT
L) tt.,_& R• Ctowal ii1i91IC
rt. ft.
0. ft,
1yt:i;SNruCR'tl ": 7. iCK frrr t eaLle s.= :: , .
MOAT to mAIcltlm. s.N1m-%cENU:Nrmt7rnou ..__
30, 101S in, i,A 5a E
ft, ft.
?a,°Il1ZI 'T:1hC9 E"OLS rsrl'nclti�oililtilarinf•ailivrla lrelrces:ru _ ''= s!_
rRaAI TO 00501F71RON LoAmr, 1,. nlaesr. reNrvc.k l•.•e. AMIA Ilrz sit
ft. fl.
ft. ft.
fl. ft.
ft. ft,
A fl.
ft. ft.
n. fL�
a21 SElLtklr►it[+9 ';� Vii.-$..�. �''r=' .. _. ..... ---
22.C rtlficaliut ray
y.
Signature nFCcrtlficd ell Cat Dale
By,sfgullrg 110tr faro" I "'Al' "atfj, Nun rhe urll(.0 Inas lucre) c-wnwrrd Ill arrorrla+np
u'ilh 1A4 NCAt: 02C,1)101l or 15ANC',lC 02C. 0200 1Kell Cou.nnrrda, r Stundardr and rhar o
copy ofthis recordlrar hcan provided io the rrcll owner.
23. Site diagram ur udditionnl well details:
You may use. the back of this page to provide additional well site deluils or well
construction details. You may also allach additional pages if necessary
SUBivii, "1'AL 1NSTUC-rIONS
24a. far All WelLs: Submit this form within 30 days of completion of well
constniclion to the fallowing:
Division ofWaler Resources, Informallon Processing Unit,
1617 Mall Service Center, Raleigh, NC 27699-1617
241y. For Injccljml_Wells ONLY: In addition to sending die 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. field (gpm) Method of test: 24c. For Wascr Suptdl_ S: lajti tdvu Wells:
Also submit one copy of this fort within 30 days of completion of
13b. Disinfection type: Amuullt• well construction to the county health department of the county where
-- constructed.
Form G W -I North Carol inn Department of Environment and Natural Res oulets — Division of Water Resources Revised August 2013

WELL CONSTRUCTION RECORD
Tliis fomi can ho used for sinala or incl Iiplo wells
1. Well Contractor Information:
Q t
Well Conlr!lelor Nmao
'3A A 3...
NC Well Contructor Certificalion Number
Cc
Company Nanie ej
2. Well Construction Permit th _
Lit all applicable mullpermils (Le. Coulu), State, Yariauce, byeeilo , eta)
3. Well Use (check well use):
❑Agricultural
❑Geothermal (lientinglcooling Supply)
❑ Industrial/Commercial
Non-Water5upply Well:
U&Ionilorin,g
❑Aquifer Recharge
QAquirer Storage and Recovery
❑Aquifer Test
❑Experimental Technology
❑Geothermal (Closed Loop)
17Gcothcrmai (HeatinvICutrlinn
❑Municipal/Public
❑Residential Water Supply (single)
❑Residential Water Supply (shared)
❑Recovery
❑Groundwalcr Remediation
QSniinity Barrier
❑Stomrwater Drainage
❑Subsidence Control
❑Tracer
under -#21
4. Date Well(s) Completed: -,�q'15 Well IDH '491' lu' F i
So. Well Location:
-RIV e 6104t,3r
Fociliryi0wnttr Nanta v Facility IDs (if applicablo)
Physical Address, City, and Zip -
_v't1tocL > 1ictl'lG Vey
County Porcel Identification No (PIN)
5b. Latilude and Longltude in degrees/mlautes/seconds or decimal degrees:
(if WUII field, one lot/long is sufficient)
W
6. Is (tire) thewell(s): 0ermnnent or ❑Temporary
7, Is (his a repair to an existing well: ❑Yes or Richie
lflhls is a repair, Jlll out knolrr well cmulnmrirni Information and explain the nurture (y'rhe
repair under k21 remarks section or art the back afthis forni..
8, Number of wells constructed:
Ear mulllple It fecilon or ncuwvwdr supply 10-0111 ONLY Irish the ,same construction, you can
submit one farm.
9. Total well depth below land surface: 76 (ft,)
Far multiple "•ells list till deprlu tfdiffnun (example- 3 a 200' and 2nq 100')
10. Static water level below lop of coshig:
Ifivaur level Is above casing, five
11. Borehole diameter:
12, Well construction method: Scut
(i.e, auger, rotary, cubic, direct push, ale.) -
[7mn
I Use ONLY:
14.lyd,Y C .ft=2f7i�F377
u�.:=1
FnDZ To IYFSCTIII"rTpN
ft. ft,
ft. ft.
lf;;il':'�ii>'i1SENC.`_irsti'muit3-ciNictl:wtlls�flfGTJ l:li'if,ui ilctiha ..: >_
FROM 'rfr nIAM1IETEIL THICIcnrss bl 1'i:ttltl.
ft to. i!u
16.[NNE 11.CA'SINC.'AEt=I'[intNL't � tiuthcnndl-eriisivf-tiro- rl
Fnt]M Trl niAMeTt.n. TnICKNr55 I mm-rT .w.'a
In, )t Hb Pu L -
ft. f,. in.
17.`�SClRfiE11t ..;
FROM I To w WAN Mit 91, SIZV. TU1rwNFSti r X-1-ERIMI.��
ft. 76 ft.
r
f6 fl,in.
FROM DIATFRIAI. kAI P'L.At',J"hIEYT 1.1 M DD 4AMOUNT
rr. fit, rt. ,Cew1�r7 F re�41f ie
ft. n.
r, f4
r9 SSA'N1ilGrtlll'Z'<•1,.``i'liCl{ iftt i itiiinble ':..,_...,17z ..
RIIO,�r Thy MATTRIAL kAI '1,A C"k:M1l lifiF h l f:'rii ao
ft, ff.
�/1�flii�alN4 f-fjli nilaL't141iitilTni441{3I1CCI]r��ICCtY6: 4=.r- ._ - ii :
Faoar 'rO ntwlr_IOrrltrN toter liorrinas, rafarrrhl IR. fain li3l°, cit.
ft, rt.
ft, ft.
ft, ft.
Ft. fl.
fl, ft.
fl. ft.
ft, rt.
22, Cllr`-
`reotLcmn,=u ..,.._. Dare
.y stgniti Ilri.r firms, l hereby cerufy dam the well(r) was (ware) ca ninicierl in accardnurc
avth ISA NCAC 02C,0100 or 15:1 NCAC 020.0200 )fell Coirrinicilon Standarilr and than a
copy of this reeard hay heen provided to Elie uxll owner,
23. Site dingrmn or udditinnul well details:
You may use the back of this page to provide additional well site details or well
construction details. You may ulso attach additional pages if necessary,
SUBMITTAL INSTUCI'IONS
24a, FnEAll WETIs: Submit this form within 30 days of completion of well
construction to the following:
Division of WnlerResourees, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
24b. F" lnlectlo3( 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 or Water Resources, Underground Injection Control Program,
FOR WATER SUPPLY WELLS ONLY: 1636 Mail Service Center, Raleigh, NC 27699-1636
13a. Yield 24c. For Yale Su1lrrly rk litjcclitur ►Yetls:
(gym) _ Method of Ies(:
Also submit one copy of this form within 30 days of completion of
136. Disinfection type: Amount: well construction to die county health department of the county where
-- - constructed.
Fenn GW -I North Carolina Deprrtmoal of linvironmont and Natural Resources - Division ofWamrHesources Revised August 2013

WELL CONSTRUCTION REiCORD
Tllis form can he used for single or multiple wells
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 th
List all applicable ivellpermits (i.e. Conroy, Slate, Variance. bjeclipn, eta)
3. Well Use (cheek wail use);
❑Agricultural ❑Municipal/Public
❑Geothermal (Heating/Cooling Supply) OResidenlial Water Supply (single)
❑lndusirial/Commercial ❑Residential Water Supply (shared)
Nun -Witter Supply Well:
©Monitoring ❑Recovery
❑Aquifer Recharge
❑Groundwater Remediation
❑Aquifer Storage and Recovery
❑Salinity Barrier
❑Aquifer Test
OSlormwater Drainage
❑Experimental Technology
❑Subsidence Control
❑Geothermal (Closed Loop)
OTracer
❑Geothermal (Hensing/Cooling Return)
❑Other (explain under #211
4. Dale Wcll(s) Completed:
3-28-15 Well Inn ABMW-2D
Sa. Well Location:
Duke Energy Progress -Sutton
Fnetliiy/Owner Name Facility ID# (ifupplienble)
801 Sutton Steam Plant Road, Wilmington, NC 28401
Physical Addzess, City, and Zip
New Hanover County
County
Parcel Identification No. (PIN)
5b. Lntitude and Longitude in degreeshninules/seconds or decimal degrees:
(ihvcll field, ono lut/long is sufficient)
W
6.Is(are)thcwell(s): OPermanent or ❑Temporary
W
7. Is this a repair to an existing well: ❑Yes or E]Ko
If tris is a repair, fill out laiovn wall cansinrction b fortnation and csplarn the nature of dm
repair under 021 remarks secrion or an the back oflhisforrn.
8. Number of wells constructed: 1
For multiple injection or non•ivater supply wells ONLY with the sante construction, you can
Submit oneform.
9. Total well depth below land surface: 46 (CL)
For muhiple [cells list all depths (f d(fferetnt (example. 3@ 300' and 29100')
100')
10. Static water level below lap urensing: n/a (It.)
If+rwter level It above casing, use "+"
11, Borehole diameter; 6 (in,)
For intcmal Use ONLY'
1°I: WATER ZOO
FROM TO P SCUir7JUN
rt. n,
ft. ft.
15, f1l1 MI ARING rW indii-ourd wrlkl OIY'LINKIR ifu ]Icahte
TRONT Th aIAMETFl4 I TITICIMFSS nr.1TEn€AL
ft. ft. in.
16.INNFitCLtiiNGOtt 7UDINGeatharmalclnnnd-Ian, .
711MIT iii MAPS M. 3 'r1RCIMF55 I1rATETUX1,
0 ft. 14 rt. 12 ±JnScl. 40 PVC
14 ft. 4
17 SCREE N
ITli751[ °t 111AM11c'ra*n :SI.r1TsI71' TMCKN tis HLA1'F.LY
41 r` 46 n 2 l" 1 .10 40 PVC
ft, ft. [n,
Fafnir TO 7kIAT'81lIAL rT7pL AS'GM FN'r a1L71lfSn 4 AAtranNr
0 ft 35 f` Neat Cement Tremle
ft. ft.
fA ft.
A9.SANDiG7tAVFl;P.ACTC Ifo n uctahle .'. _:. ... .
FROMTO nIATE_ MAL F:M1II'tACI:M11F.NT•51&',Tllnn
38 fl 46 f`• 1A Sand Pour
ft. ft.
:?a:[StY11,LC{4"ti.L.CFGudaclr
ccsdtllilimut' "tSiftticefAur -�
rnnt+l n limall fuer DM(calm, Infill rim. 50111-6 !Alf., si-, em)
ft. rt,
n. ft.
rt, rt.
ft. ft.
ft, ft.
ft, fl.
rt. ft.
.L tsl:nlnl�ls •..: ,
22. Certification:
3-2-15
Signauou arCertified Well Contractor Dale
By signing this form, i hereby certify dmt the nwll(s,) it -as (usre) conjimcred in acranhince
nvlth 15A NC:AC 02C .0/00 or ISA NC1C 02C,066 Nell Consrnrcriau Siandnrds and that a
copy ofthis record has been provided to the well aivner•
23. Site dingrarn or additional well details:
You may use the back of this page to provide udditional well site details or well
construction details. You may also attach additional pages if necessary.
SUBMITTAL INSTUCTCONS
tau. For All Wells: Submit this form within 30 days of completion of well
construction to the fallowing:
Division of Water Resources, Infortnntimt Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1(17
24b. Fur Inieclion Wells ONLY: In addition to sending the form to the address in
Sonic24a above, niso submit a copy of this form within 30 days of completion of well
12. Well construction method: construction to the following;
(i.e. auger, rotary, cable, direct push, etc.)
Division ofWater Resources, Underground Injection Control Program,
FOR WATER SUPPLY WELIS ONLY: 1636 Mail Service Center, Raleigh, NC 27699-1636
24c, Far Water Su I & Injection \yells:
13x. Yield (gpnt) - Method of test:
Also submit one copy of this form within 30 days tifcomplelionof
13b. Disinfection type: Amount: well construction to Uie county health department or the county where
constructed.
Form Gw-I North Carolina Department of Environment and Natural Resources —Division of water Resources Revised August 2017

WIIII-1-1 TJIL(Jfi, i 1"fN 1kl111,A_PlCif
This form can be used for single or multiple tuella
1. Wall Contractor Information:
1
�7 r2r1'1e� LL�C
For Internal Use ONLY:
1 1i ►�rii1'h,lk >r,4 '
26N
FACIM TO
_ .... :
11 F.Sl 111111 Ills
Well ContractorNamc
NC Well Coninclar CertificalionNumber
�i
1-5ce,21.2 l� ; ) i
75t-.f7t11iSlI HfilfrC fu r. tuvlli:ca
rcd'irnlla .`O11fl,tlr EW f'If IIephle _-L a
FROM Th
MAMMA T1f1CYKVPNM 1HATEkIAi,
rt. n.
111.
Company Nnme
2, Well Construction Permit 4:
Liss all applicable well peraiMi (1.e. Cmar)5 Stare, 1§rrlance, GJeclion, etc.)
3, Well Use (check well use):
7lisINNIvI:C.iS11aG:Cgt::'3'S711fNG'-criiftt'rrilill iliised-Til r • -
FRCUI T¢
RlAn11q'ITIt TiIICXNFS5
MATERIAL
� rt 3 0. e2 In, w O
�
fl, ft. he.
Willer Supply Well.
❑Agricultural ❑Municipal/Public
❑Geothermal (Heating/Cooling Supply) ❑Residential Water Supply (single)
❑Industrial/Commercial ❑Restdt nlial Water Supply I (shined )
n
❑[rr-NonWotiir'a
Fnom TO
RIAMTER ET-i1TS1717 TIIIMNE55
AIAt'F lfl lr.
3 n• i<• In I l7 5ch Y(a
U
fi, ft. 1r
Ilk>:Ost[lirr
Vileml
I to MATL1UTA1. EMPLt MAIRNI'1tF.rllllll& An106{;,i
fr.
ft.
C' 1 1eo revAfe1ir<
ter Supply Well:
IYl MUrlittlring I�RLeCVCI]+
ft.
fl.
_
Injection Well: _
❑Aquiver Recharge ❑Groundwater Remediation
[]Aquifer Storage and Recovery ❑Salinity Barrier
❑Aquifer Test ❑Slormwater Drainage
❑Experimental Technology ❑Subsidence Control
❑Geothermal (Closed [.cop) ❑Tracer
❑Gi:odlcralal (1 icahn iCoolilt Reniml 001her 1"plain under 021 Remurks)
f6
ft.
__ _-
`:39:�4ANi>EG1Utultsrelidli''Irri `lielibla :c.
FROM To niA'renlAl, elltrtA+rnr�nrnterne7u
3 rt S{ rt
./::�tNe�
❑. rr.
7spf:.' auunli udititlaiidf [i'eela.rftrs vela" = --
€20�DRIG�j -
Fno)11 I'D f7GSCRIAT1C7N fralnr, I,nnlnc,l, ralVn el, t rr iu �lze etch
fr. ft.
r7 �.
4. Dale Wells) Completed: J" S Well iDN.Afla'�Wd— 5
5a, Well (ocation:
Fucilily/Dwacr Nd4V
#� tFacility IDA (if applicable)
A 7 fit {rte 1 3`�t4YIn 1��(#fl 1�Cx •
ff.
ft.
r�. ft.
ft. ft.
ft, fl.
ft,
ft.
T__
Physical Address, City, and zip
�?Ca;c?'u'
County parcel idenliftcoiion No. (PiN)
_xxl►fnxs
5b. Latitude and Longitude in degrecsfminutes/seconds or decimal degrees:
(if well field, one IaUlong is sufficient)
`lt
6. Is (arc) the well(s): Qfl' rmancnt or OTeniporary
7. Is this a repair to an existing well: ❑Yes or M4o
!f fhls is a -pair, Jill out knavn wall constnicnon h fornanlan and explaru the nature ofdi0
repair under 921 renrarkv recrlon or art the back oflhis form.
8. Number of wells constructed: _
For aalflple h jac0on or nmt-ivarer supply bells ONLY 07th the same construction, ,Tau can
suhnrll 0110 form.
9. Total well depth below land surface: {y.)
rur m„llolA leells lost all rliyrtlxr rflr�crctrt (er;rrrrinlr= 3x110' and 2{e)144')
10, Static water level below lop of rinsing:
(f wafer level Lr above casing, tair " I "
11. Borehole diameter: (in,)
12, Well construction method:"
(i.e. auger, rotary, cable, direct push, etc.)
(fl.)
304
"U,i , telata aft1en LL'Cdl E.{7i1Ra Dnlc
By signing this Jbrut, 1 ltarohr cerdJjo float the rvell(s) eras (wore) cmmmIcl0rl res accordance
whij15A NCAC 070,11100 or 15d NCAC 02C, 0200 Well C'onortction Siaudurdr mud that a
cop), of thls record bar been provided to the well owner,
23. Site diagraut 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 addilionol pages ifneccssary.
SUBMITTAL iNSTCICTIONS
24x. For All WON Submit this form within 30 days of completion of Avell
consti' ctiun to die foHowing;
Division of Water Resources, Information Processing Unit,
1617 Mall Service Calder, Ruielgh, NC 27699-107
24b. FuTlnirction 14'ells ONLY; In addition to sending die form to the address in
24aribove, also submit a copy of this form within 30 days of completion of well
constriction to die fallowing:
Division of Water Resources, Underground Injection Control Program,
FOR WATER SUPPLY WELLS ONLY: 1636 Mail Service Cenlcr, Raleigh, NC 27699-1636
13a. Yield (gpm) Method of test: 24c. For Waller Supply & In action WoILA:
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.
Four, GW -I North Caruliun Department of Environment and Natural Ra9onrccs —Division of Wnler Resources Revised August 2013

WELL CONSTRUCTION RECORD
11ua rom+cnn be used fpr single or mullipic wells
1. Well Contractor Information:
1 'til L� QLif-' r
WellControetorN, n:
.N9'L- AA
NC Well Contractor Certification Number
Company Name }
2. Well Construction Perot[( th _
List all applicable tvellpermils (i.e. County. Stole, Varlance, hVection, etc.)
3. Well Use (check well use):
❑Agricultural ❑Munieipal/Public
❑Geothermal (Heating/Cooling Supply) ❑Residential Water Supply (single)
❑Industrial/Commercial ❑Residential Water Supply (shared)
❑ Irrigali on
Non -Water Supply Well:
❑Aquifer Recharge
❑Aquifer Storage and Recovery
❑Aquit'er Test
[]Experimental Technology
❑Geothermal (Closed Loop)
❑Geothermal t l leadnlffl~tru)inr
OGroundwater Remediation
OSalinity Barrier
❑Stormwaler Drainage
❑Subsidence Control
❑Tracer
❑Other (ttxnlnn under #211
4. Date Well(s) Completed: 1'") IL Well IDtI 4- •r,
So, Well Locution:
lief htYZtU,f�I•Pyr,�1,�7-
P'ncihIy/Owner Name
FacilitylDll (ifapplicable)
ED )' l .rGt �w ail ELImtEr; i(J 0
Physical Address, City, and Zip y
County Parcel ldentifiruion No. (PIN)
Sb. Latitude and Longitude in degrees/minutes/seconds or decimal degrees:
(ifwell field, one lat/long is sufficient)
+t.�b%yLla't —N - �i (ol�'2.�IW
6. Is (arc) the well(s): ❑Permanent or []Temporary
7, Is this a repair to an existing well: ❑Yes or 14No
Ifdtis is a repair, fill out known well constniction ll formation an plait dm none afthu
repair under #21 remarks section or on the back of this form.
8. Number Rf wells constructed:
For multiple infection or non-watersrtppl3 ii clfs ONLY+rhh the same construction, you car
subinit one form.
9. Total well depth below land surface: L J (ft.)
For multiple wells list all depdrs lfdierent (example- 3@200' and 1 a 100')
For Internal Use ONLY:
,:y �.��hamtslt: •ro rlr s
FROM To aE.SCRI r't'[ON
ft. rt.
ft. rt.
1S. OTITEIVCASiNG' rar multi•cIa cd wrlla Ci1t't tNrir tf u l ftcuhie "
FRONT To nr,hntr�rm TIIICH[i.ES;1 MATERIAL
ft. ft. tn.
' 16,zTNNElt CASriti Olt"I'Un1NC fpcolherrrsat ehised-lint+
rhoitl TO DIAMETER I 1711cxN£SS i arATEnrAL
r"ti rt. fL
V t i V
fl.
I7,SCIWEW: _::-::.r :-_
FROM TO nl AItIETEIt S1.t ITSr7.P. THICICN,�­45 NtATER1A1,
.7~ b ft. rl. V V
cfl. rt. L
IAi Gil011 ...:
FROM 'ri} MATERIAL V511'1Af.nIEN-r MC.'rH(m & AMOUNT
ft. I fl. �.1r.'_ O ' 1^.
ft. a,
ft. fr.
19: SANDICRAYCLI',teI{{inn Ikollir
FROM TO SfATt:lu,tt.En11�r,nCKNTi'Nr.�t:t`.T'lIon ..
ft. ft.
`20:BIlIt;L2I41[':LOf: riltudli'iidelidiinritshectsifiiol.eaeu�':.FROM TO OSCRIPTION(c htr. bdrdnus, solVivA lyti,, Xolutirc clot
ft. rr.
fl. ft.
ft, rt.
ft. ft. Nt ]
rL ft.
rt. Ft. —
ft. ft.
KS
22, Certification:
Signature ofCertificd Well Contractor Dow
By signing this form, I hereby cerdfy� that the nrll(s) nws (were) constnicted in accordance
with 15A NCAC 02C 0100 or 15A NGIC 0117.0700 IVel/ Commiction 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
constniclion details. You may also attach additional pages if necessary.
SUBMITTAL rNSTUCTIONS
24a. Far All Wells: Submit this form within 30 days or completion or Weil
construction to the following:
10, Static water level below top of casing: (fL) Division of Water Resources, Information Processing Unit,
Ifvraerlevel is above casing, we "r+" 1617 Mail Service Center, Raleigh, NC 27699-1617
11. Borehole diameter: l¢ (in.) 24b. For hilgeilotl Wells ONLY: In addition to sending the Ibtm to the address in
f. 24a above, also submit a copy or this form within 30 days of completion of well
12, Well construction method: LNf) [J construction to the following:
(i.e. auger, rotary, cable, direct posh, etc,)
Division ofWnter Resources, Underground Injection Control Program,
FOR WATER SUPPLY WELLS ONLY: 1636 Mail Service Center, Raleigh, NC 27699-1636
13a. Yield 24c, For Wu ter Su 1 11 St' In vction 4Yeltt:
(gpnt) _ Method —
Also submit one copy of this form within 30 days or completion of
13b. Disinfection type: ___ Amount: well construction to the county health department of the county where
constructed
Farm OW -1 North Carolina Department orEnvironmem and Natural Resources -Division or Water Resources Revised August 2013

WELL CONSTRUCTION RECORD
'Chis form eau tae ileal rat stain& nr nnllIiple %veils
1. Well Contractor Information: I
Y tl
Well Contractor Name
2(( �T- rI
NC WellCaniniciar CenificationNumLer
Company Name �-
2, Well Construction Permit 4:
List all applicable ,vell permits C1. e. County, State, Variance, byection, etc.)
3. Well Use (check well use):
VVulcr Supp3y Weil;
❑Agricultural ❑Municipal/Public
❑Geothermal (Heating/Cooling Supply) ❑Residential Water Supply (single)
❑Industrial/Commercial ❑Residential Water Supply (shared)
Nun -Water Supply Well:
Injectlml Well:
fl.
❑Aquifer Recharge
❑Groundwater Remediation
❑Aquifer Storage and Recovery
[]Salinity Barrier
❑Aquifer Test
❑Stormwater Drainage
❑Experimental Technology
❑Subsidence Control
❑Geothermal (Closed Loop)
❑Tracer
130colhcrmal (fleatin actin Return)
❑O(her{explain under 1121 Remarks)
4. Date Well(s) Completed:"'75J
W1.11 11111 — L
a. Well Locution:
1�5�,
T� ill �{moi V11[9� b
FocitilytOwncr Name
Facility IM (irepplicable)
Physical Address, City, and Zip y 1
County Parcel Identification No (PIN)
Sb, Latitude and Longitude in degrees/minutes/seconds or decimal degrees:
(il'wctl field, one lotllong is sufficient)
For Internal Use ONLY:
ft. I rt. I In.
.4&JNNF,R0A5FNG7.01r:'7'UIIING nuhcrnrol'clmcd-tun 1
FIID&I 1 TO I I11.AM r,Mn I T111rKNL55 Di,1'rLIIIAL
O ft. ft.
1 2 -
ft. I ft. I In.
REEN .. . _. .. .
7 D IIIAaI EMIL st-11T Si7,E TRICl.7til SS MATERIAL
in. . 1�), t)I= IN&
ft. ft. In
rr. rr, CI r �i1 tri
l
fl, fl.
Ctd fr.
I , 19. NANDIG RAYha. PACK 6IFitnn1tenld0
Irk• ft, ft.
fl. ft.
ft,
fl.
ft.
fr.
rt,
ft.
n.
ft.
ft.
ft.
ft,
ft.
fl.
ft.
22. Certification:
6. Is (are) the well(s): ❑Permanent or ❑Tcnnpnrary
7. Is this a repair to an existing well: ❑Yrs or Via
If this is a repair, fill out iarmnvt spell construction information and explain the naive of the
repair under 021 reniarks section or on the back ofthisform.
8. Number ofwclls constructed:
For nuddllle lidecifon fir tion-miler.rupply u'a1h ONf,Y ildtb rl+a lanae ronstroclion, you rou
,vull,nk aneform.
9. Tutnl well depot hclowinrld surfacer iJ (170
For naddFle writs list aI! depNfs lV'df ffererrt (ea'atnple- 3( 700, told 2@100')
10, Static water level below top ofcusing: M)
If mater level Lr above casbrg, use
11. Borehole diameter:
r, .
12. Well construction method: 36 fj jL
0-C auger, rotary, cable, direct push, etc.)
FOR WATER SUPPLY WELLS ONLY:
130. Yield (gpm) Method of lest:
13b. Disinfection type: Amount:
Signonucur -crllfi ml Wall Commclor – Date
By signing this farm, I hereby certify that the well(s) uyis (here) consoveod in accordance
frith ISA NCAC 02C. 0I00 or 15A NCAC 03C, 0200 IVell Construction Standards and that a
copy ofillis record bas been provided to the Nell owner.
23. Site diagram or additional well details:
You may use the back of this page to provide additional well site details or well
construction details. You may also attach additional pages if necessary.
SUBMITTAL INSTUCTIONS
24a. For All Wells: Submit this farm within 30 days of completion or well
construction to the following:
Division of WaterRrsources, Informulion Processing Unit,
1617 Mad Service Center, Raleigh, NC 27699-1617
24b, For Tailection We11s ONLY: In addition to sending die firm to the address in
24a above, also submit a copy of this form within 30 days of completion or well
construction to the fallowing:
Division of Water Resources, Underground Injection Control Program,
1636 Mail Service Center, Raleigh, NC 27699-1636
24c. For Waict Supply & likicelltin lyvjils:
Also submit one copy of this form within 30 days ofcompletion of
well construction to die county health department of the county where
constructed,
Form GW -1 North Carolina Depunmenl of Environment and Natural Resources – Division orWoler Resources Revised August 2013

WELL CONSTRUCTION RECORD
This farm can be used for single or multiple wells
1. Well Contractor Information:
1 �.hurl
Well Contractor Name
NC Well Contractor Certification Number
Company Narno
2. Well Construction Permit 1t:
List all applicable hell permits (f,e. Cmu ly, State, Variance, lidecilon, etc.)
3. Well Use (check well use):
Water Supply Well:
❑Agricultural ❑Municipal/Public
❑Geothermal (Heating/Cooling Supply) ❑Residential Water Supply (single)
❑Industrial/Commercial DResidential Water Supply (shared)
Nun -Water Supply Well:
❑Recovery
❑Aquifer Recharge ❑Groundwater Remediation
❑Aquifer Storage and Recovery ❑Salinity Harrier
❑Aquifer Test ❑Stormwater Drainage
❑Experimental Technology ❑Subsidence Control
❑Gcothermal (Closed Loop) ❑Tracer
❑Geothermal (Hcat{nglCoahn{g Reim) 00ther(explain under 421 R(=rks)
4. Dale Well(s) Completed: t'3�- }�l Well lob -_ c
So. Well Localion:
1%. n t.
FacilitylOwner Name Facility ID# (ifapplicoblo)
Physical Address, City, and Zip 3
r\co)tw�'t _
County Parcel identification No. (PiN)
Sb. Latitude and Longitude in degrems/minutes/seconds or decimal degrees:
(i(well field, one inlAong is sufficient)
W
For Internal Us c ONLY:
44,")VATCR LGNFS — - - —
ti ou To DFSCRIPIRIN
ft. ft.
ft, ft.
IR,fm nT.H.CA.SINC. I rir a,.,ro,41r1 nil F.YNF.rl iffo,;nfireihi.l....:. ..
22. Certification:
7'O
1111ANIF37.R
TIIICHNESS aIATEnihl.
VER
CASINC1011. RINGenui mud
t tiracd•1iiu 1 '
copy ofthis record has been provided to the well ❑weer,
TO I1g'%METEII
I 'rtnt. arms MATERIA
repair under 021 remarks section or on the back ofrhiafornt.
In.
You may use the back of this page to provide additinna( well site details or well
8. Number ufwells constructed:
construction details. You may also Witch additional pages if necessary.
Ithl c._
submit onefrinn.
TO
DIAMETER SLOTSIZE -
Tl11CKNFS5
MITE IAL
ff.
/� ft.
1- in.fc,
Ifwalerlevel is above casing, tete "+"
1617 Mail Service Center, Raleigh, NC 27699-1017
11. Borehole diameter: (in.)
ft.
ft.
in.
12. Well construction method: Sl'rl i
construction to the following:
(i.e. auger, rotary, cable, direct push, etc,)
Division ofwuterResourems, Underground infection Control Program,
To I MATERIAL
EMPLACF.W.HT nll-:Ttuou s AnfouNI
ft.
'C ft.
l•
ft.
_ fr.
well construction to the county health department of the county where
ft,
rl.
Form GW -I North Carolina Department of Environment tad
Yt11QItAV1� CMAC[.' fit rlle8idu
TO Rl-VITRIA1.
E1%1 PLA FINT L NT INI f.77 iC1O
rt.
fr-
ILLI t c1 gitaelr itdtlidui,rd sl,ceu if ucceisn
TO nF4Clt11"f'n)N Jt al ar, burr nn., tut0rue4 type. grab, sire, elr.l.
ft.
fr.
fG
fL
ft.
ft.
ff.
ft,
ff.
ft.
ft.
ft,
ft,
R.
dAW,9
22. Certification:
Signature ofCcriified Well Contractor Date
6. Is (are) the wcll(s): ❑Permanent or ❑Temptlrary
By signing this form, I hereby eerf fy that the well(s) ivas (were) constructed in accordance
with 1511 NCAC 02C.0100 or /5A NC IC 02C,0200 Well Conslniction Standards and dial a
7, Is this a repair to an existing well: ❑Yes or 151,No
copy ofthis record has been provided to the well ❑weer,
{films is a repair, fill oul known ,yell construction information and "plain flue nature ofthe
repair under 021 remarks section or on the back ofrhiafornt.
23. Site diagram or additional well details:
You may use the back of this page to provide additinna( well site details or well
8. Number ufwells constructed:
construction details. You may also Witch additional pages if necessary.
For muldple fgjection or not -nater supply wells ONLY mth doe sante canoraction, you call
submit onefrinn.
SUBMITTAL INSTUMONS
9. Taint well depth below hand surface: (ft,)
240. For All Wells: Submit this form within 30 days of completion of well
For naulllple tralls list atl dept(r_t tfd(yrrc,u rcrample- 3Qa 300' mrd?Qa )00')
construction to the following:
10, Static water level below top of casing: ({{)
Division of Water Resources, Information Processing Unit,
Ifwalerlevel is above casing, tete "+"
1617 Mail Service Center, Raleigh, NC 27699-1017
11. Borehole diameter: (in.)
24b. f tit' Injection Wglis ONLY: In addition to sending the form to the address in
qy�
24a above, also submit a copy of this form within 30 days of completion of well
12. Well construction method: Sl'rl i
construction to the following:
(i.e. auger, rotary, cable, direct push, etc,)
Division ofwuterResourems, Underground infection Control Program,
FOR WATER SUPPLY WELLS ONLY:
1636 Mail Service Center, Raleigh, NC 27699-1636
13a. Yield (gpm) Method of list:
24e, For Willer Supply Yr. Iniccsinn lYclls:
_
Also submit one copy of this form within 30 daysofcompledon or
13b. Dislnfecdon type: Amount:
well construction to the county health department of the county where
constructed.
Form GW -I North Carolina Department of Environment tad
Natural Resources -Division of Water Resources Reviscd August 200

WELL CONSTRUCTION .RECORD
This farm can be used for single or multiple wells
1. Well Contractor Information:
Well Contractor Name
2'11"1-n
NC Well Contractor CCrlltieatian Namber
r f' L�r` (.,A f, l I III)o.
Company Name J
2. Well Constructiou Permit 11:
41st all applicable well permits (i. e. County. Stare, I'ariance, Injection, etc.)
3, Well Use (check well use):
❑Agricultural ❑Municipal/Pubde
❑Geothermal (Wcating/Cooling Supply) ❑Residential Water Supply (single)
❑Industrial/Commercial ❑Residential Water Supply (shared)
Non -Nater Supply
❑Aquifer Recharge
❑Groundwater Remediation
❑Aquifer Storage and Recovery
❑Salinity Barrier
❑Aquifer Test
❑Stormwater Drainage
❑Experimental Technology
❑Subsidence Control
❑Geothermal (Closed Loop)
❑Tracer
❑Geothermal (Heating/Cooling Return)
❑Other (explain under 931 F
4, Date WLII(s) Compleled: -SI- Is Well ml Vi
5a. Well Locution:
-1iY1C,
Faciltlyl[hvner Nmin Facility IDN (ifopplicoble)
Physical Address, City, and Zip d
County Parcel ldealificutionNo (PIN)
5b. Latitude and Longitude in degrees/minutes/seconds or decimal degrees:
(ifwell fickl, one lotlong is sufficient)
�}L! 4N -I J (M)1) MR
6. Is (arc) the well(s): ❑Permanent or ❑Temporary
7. is this a repair to an existing well: ❑Yes or 1R ND
If ilds is a repair, fill out known well construction information and itrphiin the natrre ofncr
repair under 1131 remarks section or on the back oftlds farm.
8. Number of wells constructed.-
For
onstructed:For nadriple itliection or non-rvarersupply wells ONLY with the sante coastructian, you can
subml(oneform.
For Intcnhal Use ONLY:
I' I:L:wATTR,Y.f -4vs
ft. I ft.
fi. f ft.
15 -OUTER CASING (for tnuld-cased tvelis) OIt1aNER if n o-licnlhte
V'RM1 'rq DIAMET£lt T1iILiti'1NFSs M1IAi'AIUM..
ft. ft. in.
16::1NNER CjW NG 0 I TV11ING to eodhe rhunl Ous ed -€nu ul .
C) ft.
V
ft.
fn.
ft,
ft.
ft.
ft.
ft.
R.
rt.
FROM r0
ft.
1111AMYTER
SLOrsrr.V.
T1UVKNfrs M.+7'emAt
..,..
ft,
rt.
irw
; llyGROU7..
MOhI TO
M.1TF.R€AL EMPLACEMENTMETIIOII& AMODN'r
It -
fl. L1
nd
ft.
ft.
ft.
ft.
�. TO
fr:` q I I I
ft. I ft.
DIl[LL]TJC�I:OC-(iitlt5lfaflslldtirittfsher;lslfeircesfrirj`T
FROAI TO nFS CRI PTI ONtcolar.lhnrd—t snlllrvclt tune. v-1 nibs rre.l
ft.
ft.
ft,
ft.
ft.
ft.
ft.
ft.
R.
rt.
ft.
ft.
rt,
ft.
IA RKS ..:,..
..,..
22. Certification:
✓ y , / `
Signalure ofCertifiud Well Cuntraclor Date
By signing this form, I hereby cerlify that the wells) nus (mere) consinhcied in accordance
with 15A NCAC 03C.0100 or iM NCAC 03C.0200 Well Construction Standards and that a
copy gfthis record has been provided to Hie well owner.
23. Site diagram or additional well details:
You may use the bacic of [his page to provide additional well site details or well
construction details. You may also attach additional pages if necessary.
[[ } SUBMiTTAL TNSTUMONS
9. Total well depth below land surface; , e - (ft,) 24u, Fnr All Well : Submit this form within 30 days of completion of well
For multiple wells list ail depths (fdiffereut (esnnhple- 3 200 amt. 100). construction to the Following:
10. Static water level below lop of cusing: (ft.) Division of Water Resources, Information Processing Unit,
IfuRfer kiwrt tt above rasing, use "+" I617 ]Mall Service Center, Raleigh, NC 27699-1617
m
11, Borehole diameter:. ( W0 (in.) 24h. For Inlewlun Wvlhi ONLY; In addition to sending the tiurm to the address in
(�I� 24a above, also submit, a copy of this farm within 30 days of completion of well
12, Well construction method: 1t, ti y C! construction to the,following:
(i.e. auger, rotary, cable, direct pnstl, etc.)
Division ofWater RLsunrcLs, Underground injection Control Program,
FOR WATER SUPPLY WELLS ONLY; 1636 Mail Service Center, Raleigh, NC 27699-1636
13a, Yield (gpm) Alethud of test: 24c. For Mier Supply & InjcL'ri11rl Wells;
Also submit one copy of this form within 30 days of completion of
13b. Disinfection type:., Atnuunt- T well construction to die county health department of the county where
constructed.
Form GW -I Noah Carolina Department of Environment and Natural Resources- Division of Wuler itesources Revised August 2013

WELL CONSTRUCTION REC(]I�.
This form can be urui lbr single or mulrlplc wells,
1. Well Contractor Inrormalion;
Arthur Becker
WellContraelorName -
2201-A
NC Well Commctor Certification Number
Cascade Drilling LP Aiken SC
Company Name
2. Well Construction Permit N: on site
List all applicable rvell permits (lc, County, State, Variance, Iglection,
3, Well Use (check well use):
Water Supply Well;
❑Agricultural
❑Geothermal (Heating/Cooling Supply)
❑industrial/Commercinl
Non -Water Supply W03:
❑Aquifer Recharge
❑Aquifer Storage and Recovery
❑Aquifer Test
❑Experimental Technology
❑Geothermal (Closed Loop)
❑ Geothermal (Hen tin eleDol i n n 1
❑Municipal/Public
❑Residential Water Supply (single)
❑Residential Water Supply (shared)
EIRecuvery
❑Groundwater Remediation
❑Sulinity Barrier
❑Stormwater Drainage
❑Subsidence Control
❑Truevr
alnin under 421 I{emurks)
4, Dale Weil(s) Completed: May 15' 2015 Well IDM AW -2D
5u. Well Location:
Duke Energy Sutton Plant
Focilily/Owner Name Facility IDN (ifapplicoblc)
801 Sutton Plant Road Wilmington NC 28401
Physical Address, City, and Zip
New Hanover
Cnanty _ -.vLLJ
Parcel Id-fiftcadon No. (PIN)
5b. Latitude and Longitude in degrees/minules/seconds or decimal degrees:
(ifwell field, one lat9ong is sutlicicnt)
34 18'3.8988" N 74 59'7.2528" W
6. I9 (arc) the well(s): rAPernmrtent or ❑Temporary
7. Is this a repair to nn existing well; ❑Yes or ElNo
{jt/ds /s a repolr, fill out known well construction h formation and explain rbc nature of the
repair under N21 remark section or an the back of dds form,
S. Number ofwclls constructed: 1
For muhlple Iq/eciian or non-watersupply wells ONLY with rhe surae cmistructian, l ou can
submit one form.
9. Total well depth below land surface: 100
For muhiple urns list all dept!, rfdl fjerent (example,- 31rr 00' and 2@100)
10. Static water level below top of casing: 18.69
lfineter level is above casing, use
11. Derchole dlaulcter: 6 (in.)
For Internal Use ONLY:
-58 rr' -59
r' Brn - Gray F -C gravel
-100
rt Dk Gray fine silty sand
tt.
re,
ra
rr.
ft.
fl
fr.
rt.
RL,N3 [33ltih+J::
Protective: casing installed
22, Certification:
Art Meeker May 18, 2015
SipnalureafCenific Wellcontmcaar Date
By s/gnrag this farm, I hereby errl( that the WHO ntus (were) coartructed In accordance
udth ISA NC.4 VIC.0100 or 15.4 NCAC 02C,R?Q0 bili Constrnulon Standards and that a
copy oftdls record has been provided to the Weil 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 ifoccessary.
SUBMrf7AL INSTUCrIONS
24a, For All NVclis: Submit this fort within 30 days of completion of well
consiniclion to die 1'(lllowing:
(ft.) Division of Water Resourced, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
tab, par rt eejft Yc ONLY; In addition to sending die form to the address in
12. Well construction method:
Sonic 24a above, also submit a copy of this form within 30 days of completion of well
construction In the following:
(i.e. auger, rotary, cable, direct posit, etc,)
Division orWuler Resources, Underground lnjectiou Control Program,
FUR WA'rER SUPPLY WELLS ONLY: 1636 Mall Service Center, Raleigh, NC 27699-1 63h
13o. Yield (gpm) Method of test: 24c, For WuIcr Supply & Injection Wells:
Also sllltmit one copy of Otis form wilhin 30 days of completion of
13b. Disinfection type; Amount; well eoaMuction to the cu iFly health department of the county where
corulrtrctcd,
Form GW -I North Carolina Department ofEnvironmcnt and Natural Resources -Division of Water Resources Revised August 2013

WELL CONSTRUCTION RECORD
'This farm call be used for single or multiple wells
1. Well Contractor Infonnation:
((A e w, % c,
Well Contractor Name
20617- '
NC Well Contractor CertifacationNumber
tc1(�t(�6t, 6'rt
Company Nnmc
2. Well Construction Permit p:
List all applicable ivell permits (i.e. Coway. Stare, I urlance, Ejection, etc.)
3. Well Use (check well use):
Water Supply Well:
❑Agricultural
❑Geothermal (T-ieating/Cooling Supply)
❑Industrial/Commercial
❑ lrrication
Nun -Water Supply Well:
❑Municipal/Public
❑Residential Water Supply (single)
❑Residentinl Water Supply (shared)
]s"'(`Monituring
❑Recovery
injection) ell:
OAquifer Recharge
❑GrounN%ter Remediation
❑Aquifer Storage and Recovery
❑Salinity Barrier
❑Aquifer Test
❑Starmwater Drainage
[]Experimental Technology
❑Subsidence Control
❑Geothermal (Closed Loop)
❑Tracer
❑Geothermal (Heating/Cooling Rclum)
❑Other (explain under 921 Remarks)
A. DateWell(s) Completed: - �S Well ID4
So. Well Location:
DAU
Facility/Ownc r Name Facility iD+ (i (applicahlc)
t6X 1C'u'khYl l�l�(]tRC1 lckln L{.�r1elYlrtlUlfiklidl ��t1
Physical Address, City, and Zip J 9�+LJ61
X14"m
County Parcel Identification No. (PIN)
5b, Latitude find Longitude in degreWminuics/seconds or decimal degrees:
(ifwcll iicid, one ta(/long is sufficient)
N 1�1 �iaLIJV IL W
6. Is (are) the wcll(s): ❑Permanent or ❑Temporary
7. Is this a repair to an existing well: ❑Yes or P�tNn
If this is a repair, Jill out /aimrn ivell consmiction information and arplain the nature of due
repair under U?I remarla section or an the back of this form.
H. Number of wells constructed:
For multlplc hVection or non-warer supply ivells ONLY with the some construcilnn, you Cali
submit one farm %
9. Total well depth below bind surface: L'2 (ft.)
For multiple ,Yells list all depihs ifri /ferent (exaaiple- 3 a 200' am!? a 100')
10, Static water level below top of easing:
If warer level iss above casing, eve "
11. Borehole din meter:
(in.)
12, Well construction method: U_yl�[ F
(i.e. auger, rotary, Cable, direct push, etc.) -
Por Internal Use ONLY:
14:AVATIM 2t'1N1`S
FROM TO
fl.
ft.
15llt711'i'f.ii-t;a5iNG: for'iilaltl-en.scd wellsr3ftLttVIWR if u 1 iGcnMa
-
IOal TO
OIAhTF:Tr•.R TIIECIiTPL'45
MATERIAL
16JWrr4NMR:CASlT4G DR-'a13t;lRG Ig cu711rrmLit atv%ml-Inap)
irlioNt To
nlAMTERTrflCittti.4_NS MATERIAL
a,- ll
ft. :n.
Fu
ft.
17, SCREEN
FoOM
TO
ni,1;1iFTF.n 51.0'r si zz 7ani'ttti L`�.w at.r.a"I!nIAL
rt,
ft.
f4
rt.
1n,
niom TO
ASAYMAL Ean'L%CFM ENT METtlrlR ,s, .USIOUNTr
p rt. ed E
ft.
fl.
ft.
ft.
ft.
19::SAND/r. AVIS, VA(.•t: ({rlilll-liealllr
1111ON TO
MAIVRIA1. t:a11'11.A 0-AI1':NT IVET1TO11
C'
a
ft.
ft,
fl.
.'2LI—DRILLING, I,(%r 11tIk4L'IS IId11111111171I: }YI('•eIS If 51 tek9' In
FROM TO
nF-ti r:lt.11"TrIIN (rata P, I11r111n G1,.f41aRlrlt {y lC. YIII IF a/G, cl raj
ft.
rt.
ft.
ft.
ft.
fi.
ft.
ft,
ft.
rt.
ft,
ft.
ft.
k
ft,
-11i MARKS
22, Certification:
Signature nfCenificd Well Contractor pale
By signing this form, i hereby certifj, that life well(s) was (were) ConsfMiCled in accordmrce
with 15A NCAC 02C,0100 or 15A NCAC 02C .0200 Nell Consirriction Standards and that a
copy afthis record has been pro4ded to life well owner.
23. Site diagram or additional well details:
You may use (he back or this page to provide additional well site details or well
construction details You may also attach additional pages if necessary.
SUBMITTAL iNSTUCTIONS
24a. For All Wells: Submit this fomi 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
tab. Fpr Tn eviinn Wclls ONLY: In addition to sending dao form to the address in
24a above, also submit a copy of this foot within 3D days of completion of well
construction to the following:
Division of Wuler Resources, Underground Injection Control Program,
FOR WATER SUPPLY NVE LLS ONLY: 1636 Niall Service Center, Ralcigb, NC 27699-1636
13x, Yield (gpm) Mclbod of test: 24c. For Waller Supply & ltilectlon Wells:
Also submit one copy of this form within 30 days of completion or
13b. Disinfection type: _ ._ Amount: _ well construction to the county health department of the county where
—_ constructed.
Form GW -1 Norm Carolina Department ofEnvirmlment and Natural Resources— Division of Water Resources Revised August 2019

WELL CONSTRUCTTON RECORD
'fids Gam can he used for Oiltle at nathiple wc1la
1. Well Contractor Information:
Lie o` F..l
Well Contractor Name
q('
NC Well Contract,,( Certification Number
o
Compmry Nana:
2. Well Construction Pcrnitt #:
List all applicable well permits (i.e. County, ym1r. Variance, Ljecdon, ale,)
3. Well Use (check well use):
Water Supply Well:
❑Agricultural
❑Gcolhermal (licating/Cooling Supply)
❑Industrial/Commercial
Non -Water Supply Well:
In)eclian AVoll:
❑Aquifer Recharge
❑Aquifer Storage and Recovery
❑Aquifer Test
❑Experimental Technology
❑Geothermal (Closed Loop)
❑Municipul/Public
❑Residential Water Supply (single)
❑Residential Water Supply (shared)
Q
❑Groundwater Remediation
❑Salinity Bonier
❑Slormwater Drainage
❑Subsidence Control
❑Tracer
110ther (explain under,121 F
4. Date Wcll(s) Completed: —�3 4 ; Well M# Y IN - J[ ,s
5a. Well Location:
`` �r ' l
� L� S Z^»Q MM ►-a.^C (W Liv
I^ucslity?OwnarNama i f Fnc6[ity ID# (ifnpplicnble)
Physical Address, City, and Zip
County Parcel Tdentificalion No" (PIN)
5b. Latitude and Longitude in degrees/minutes/seconds or decimal degrees:
Ofwell field, one Int/inng is su113clent)
6. Is (are) the well(s): ❑Permanent or ❑Temporary
7. is this a repair to an existing well: ❑Yrs or ln
lfthtr Is it rekmir, fill mit known av11 cousrracxeirr in
Jrrmuffna am plain the nature of the
repair under #2! remarks section or on the bark ofilaxform.
8. Number of wells constructed:
For multiple iti/eciion or non -water supply wells ONLF with the same cana7rrtctian, ymr can
submit one form,
9. Total well depth below land surface:
For nwhiple wells list all deptts (f different (example- J 11 .00' and 2@100')
100')
10, Stntic water level below top of casing: A)
lfinter level Is above easing, ase "+"
IL Borehole diameter: lS (in.)
12. Well construction 1110110d:
(i c. eager, rotary, cable, direct push, etc.)
For Internal Use ONLY:
T,
To rRaM1t To
DESCHIMMN
ft.
Q.
ft, ft,
. IS 011-TEX:CASINGfRr�moiti siredtycltx Oluix-tEd1 1r. rMacatilo
t•`It 0145 `r0
MAMETEIt TIMIttHFM I MATERIAL
fl. fl.
in.
16-fNNE11:i^_ASINC 011"I'1tBiNG-anllte�lrtaset! fort I
PH(M TO
nFAMETEti
TfrlCltiYFSS MATERtAt,
ft. /
y ft,
V'
'7 ln'
L
ft. ft,
in.
M'MEEiSN`.._
SLOT BrLF:
"Clnt`t -NESS MAyT�E/+RIIAL
Lis
iT��M
-, c ri
r fl , Vyrv.l
1tlaCEirJiff ::::
"�
K110?il TO
I MATERIAL !':M I'tJ1Cf-1�f F.tiT h trTISOn.X AAIOIINT
ft. � ft.
I
ft. ft.
ft. ft
19. SAt4 YGRAVEr I'e1C1C: If'li Ilcielhla .
FROMTo
1nArEltIAL VMPI.ACEM> N'rMF-ntpn
Q rt-
It-
(0, nL
ft,
ft,
E0'.nfrr4lilNGG(]G111hiclioiltlitiuuulsliectslfnece
a77.
FROM
TO
timiccn,I "10.Y tmlar, I_nmtnrsx, ln1t11'nefc t rnln�irx, etc.!
rl,
ft.
ft.
ft.
ft.
ft.
fl.
ft.
ft,
ft.
ft.
ft.
ft.
ft.
-
...w1.11FAIARK5
"._. ....: .: ... -•
22. Certification:
C-
Signature orceiliflod. Well Contractor Dale
By signing this form, l hereby earth that the u'ell(s) utas (were) cmhsitacud GI accordance
withISA NCC 0?C .0100 or 1St NCAC 03C.0200 iVell Construction Standards and that a
copy ofthis record has been provided io 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. 1'ou may also attach additional pages ifneeessary
SUBMITTAL iNSTUCTIONS
24a. For All Wells: Submit this form within 30 days of completion of well
constluclion to the following:
Division of Wulcr Resources, information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27499-1617
24b. For fn cation iyah ONLY: In addition to sending the Conn to the address in
24a above, also submit a copy of this form wiUtin 30 days of completion of well
construction to the following:
Division of Water Resou rccs, Underground injection Control Program,
FOR WATER SUPPLY WELLS ONLY: 1636 Mail Servlcc Center, Raleigh, NC 27699-1636
13a. Yield m 24c. Frlr 1Water Su t 1 ul't Itl cetiun Wells:
Qpm) Method ortesit:
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.
Farm GW -1 North Carolina Department of FAivironment and Natural Resources —Division of Water Resources Revised August 2013

WELL CONSTRUCTION RECORD
This form can be used far single or multiple wells
1. Well Cuutrnctur Information;
Well Contractor Na ne
NC Well Contractor Gmv)� codon Number
c�cats���.��r��,
Company Name
2. Well Construction Permit H:
List all applicable well permits (U. Comp, Stale, Variance, byeclion, arc.)
3. Well Use (check Well use):
Water Supply Well;
❑Agricultural ❑Municipal/Public
OGeothermal (lieating/Cooling Supply) ❑Residential Water Supply (single)
❑Industrinl/Commercial OResidenlial Water Supply (shared)
Non -Water Supply Well:
❑Rectivery
❑Aquifer Recharge ❑Groundwater Remediation
❑Aquifer Storage and Recovery ❑Salinity Harrier
OAquifer Test ❑Stormwater Drainage
❑Experimenlal Technology ❑Subsidence Control
OGeolhctmal (Closed Loop) ❑Tracer
❑Geothermal (Healing/Cooling Return) ❑Other (explain under 421 Remarks
4. Dale Well(s) Completed: ~ J� f Well IDI[
Sa. Well Location:
v
Facility/OwncrNamo'3 Facility Mil (ifapplicablc)
Physical Address, City, and Zip
Wys Itkt;C'ge.�r.
County
Parcel Identification No, (PfN)
5b, Latitude and Longitude in degrees/minutes/seconds
or decimal degrees:
(lr Weii one laulonb is sufficient)
4Held,
�L't
1"i L,{2
Lt1��14 N
W
6, Is (are) the well(s): ❑Permanent
or ❑Temporary
7. Is this a repair to an existing well:
❑Yes or u
If this is a repair, fill out kno vi ivell construction
information and oxplithu the nature of ilia -
repair under 621 remarks section or an the backafthfsform.
S. Number orwens constructed:
For multiple iq/ectlon or non-uwtersupply wells ONLY trirh the same construction, you call
submit oneform,
9. Total well depth below land surface:
For multiple atolls list all depths fl diYerew (example. 3@200' and 2@100')
100')
For Internal Use ONLY:
.14: WATRit 7ON4p_fi .. _.. .. :. ;.
rt. I fl,
ft. I ft.
I rt, i rt. I In, I I I
6 ft, ft. I In, L 1 V V Cy
fl. ft. in.
ft. I
t.
&'qft. 7 ' C- rt. I a. 01("1 VC
i ts_runrrr - a
Q ft. i '/ r ft. 04 1 J /J v
rh i fl. 1 1
9rSA"IGII'MI:-i'ACiC tfn!ilfcublc
FROMTO 61ATtdRi I. I:htf t.A Na•:ntl'.N-r'M1lr{TIII}]1
1.7 z �, ft.
ft. ft.
• 20-:DCtII.'I:fPMLOG (ulinshudilidon a ticcts frficccmary
FnOril Tn nFSCI1Sl'77UNIrular. huranear,wullr+acin lune. ora€en tfrz. r.le.Y
22, Cerlificaliun;
Sigrrature ofCettificd Well Contractor Date
By signing this form. 1 hereby certffy that the u•ell(s) ivas (here) cansiniered M accordance
with ISR NCAC 02C.0100 or 15A NCAC 01C.02017 Well Construction Standards and that a
copy ofthis recard has been provided to the ivell aivner.
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.
SUIIMITTAL INSTUCTIONS
24u. Far All Wells: Submit this form within 30 days of completion of well
construction to the following;
lo, Sialic water level below top of casing: (ft.) Division of Water Resuurces, In tormntinn Processing Unit,
if comer level Is above casing, we /+" 1617 Mail Service Center, Ralcigh, NC 27699-1617
11. l9orchule diameter: l.(1 {in.) 246. For luicefinu Wells ONLY: In addition to sending die foot to the address in
24a above, also submit a copy of this form within 30 days of completion of well
12. Well construction method: �]� l.r construction to the following:
(i e. auger, rouuy, cable, direct push, elc.)
Division of Water Resources, Underground Injection Control I'rugrntn,
FOR WATER SUPPLY WELLS ONLY: 1636 Mail Service Center, Raleigh, NC 276994636
13a. field (gpm) Method of test: 24c. For Water Supply & fnjcction Wells:
Also submit one copy of this form within 3D daysofcompletion or
13b. Disinfection type:, Amount; well construction to the county health department of Clio county where
constructed.
Form GW -1 Nardi Catalina Department of Envimnmcnt and Natural Resources — Division of Water Resnurccs Revised August 2013

WELL CONSTRUCTION RE, CORD
This form can be used far single or multiple wells
1. Well Contractor Tnfurmation:
Well Contractor Name
L
NC Weil Con molar Certification Number
Its SU&
Company Name
2. Well Construction Permit #:
List all applicable well perndls (l.e. County, State, Variance, Injection, etc.)
3. Well Use (check well use):
Water Supply Well:
❑Agricultural ❑Municipal/Public
❑Geothermal (Heating/Coaling Supply) ❑Residential Witter Supply (single)
❑Industrial/Commercial OResidential Water Supply (shared)
❑Irrigation _
Nun -Witter Supply Well:
❑Recovery
Injection Well:
❑Aquifer Recharge
OGroundivaler Remediation
OAquifer Storage and Recovery
❑Salinity Barrier
❑Aquifer Test
❑Stormwaler Drainage
❑L-xperimenlul Technology
❑Subsidence Control
❑Geothermal (Closed Loop)
❑Tracer
❑Geothermal (Fleating/Gaoling Ree7cimt)
❑Other (uN Ruin under 921 Remarks)
4. Date Well(s) Completed: lam(' G) Well IDN
Sa. WeIl Locution:
TMATERIAL
/
Le,She-�i('t����i—ii�I•
Fueilily/Owner Name J V
IW ' �
Fneility IDs (irnpplicuble)
Physical Address, City, and ?1p
7fii INNER t:Ati18TG OR 3'iiBING: enlhr
_��Q�) i�fkYlilY•i'i�
FROM _- - TO
Courtly
Parcel Identification No. (PIN)
5b. Latitude and Longiiude in degrees/minutes/seconds or decimal degrees:
(ifwell field, one tat/long is sufficient)
til i Y� 14 , N 1'1- 4i6440 q w
6. Is (arc) the Wcll(s): OPermonent or OTempornry
7, is this a repair to an existing well: ❑Yes or No
(%this is a repair, fill out known well constrr¢ripn itrfarnratfnn anft ixplahr the nature of rbc
repair under 1111 remart r section or on tire back of this form.
8. Number ofwells constructed:
For mulriple injection or iron -water supply wells ONLY udlh tire same carurracllon, you can
submit one form.
9. Total well depth below land surface: C16 (ft.)
For multiple wells list all depilu !f di,(jerene (example- 3 a 200' and 2@100')
100')
For Internal Use ONLY:
FROM 7[7
17FSC_a I?Tt0'r
Fl, ri.
rt. rt.
:•IS..DtFI'Elt� CASING farlrialtl•rasFd wettlr t31t.LlMI•., lf' ir4 I 11 CI11JIF : ': �'-:':-'..:_:
rnOM11
T{]
nlAdtl:Tl:li
TMATERIAL
ft.
fl,
in,
7fii INNER t:Ati18TG OR 3'iiBING: enlhr
_.-
-rmubclnsed-Iuo r
FROM _- - TO
DIAM1l£TE.R
TFI1CKNFss Z�YA I rtk L..._.
ft.� S rl.
4 �1 in.
It.
TMM 'ro
lnAalETEn
I0T41 J.F_
1i 111 -It N r_45
MATY111At.
ft
FRMI RP
MATERIAL EMP ACF.HRINTlM1 ETIMI)&AMOUNT
ft. 117 L rt.
l .
fl. ft.
A. ff.
19. SANDiGRAVI?L YACIi if ti i ilieahlr
FltOnI To
M1IATEh1A1.
E1%lVt.ACEA11;`7TA1ETn0n
J1 `. rt. �,1� ft.
1
� �.4
..
fl. ft,
10. ]MILLING 'LOC: litlncll'uddid$60l sheet.i lfbiekcMll
•t•
Fnf$11 TO
PESCItII'a'ptlN irnln r. iim7laest mlffroch r, -rain t[.n, e1F.t
ft. ft
ft. ft.
ft, it.
ft, rt.
ft. I'L
ft, ft.
ft ft.
a1: ftehfARls
22. Certification:
Silpinture of Ccrliked Well Controclor Dale
Ay signing this form, i hereby certify that Bre rvell(s) was (were) corutnrcted In accordance
with 15.1 NC.I C 02C 0100 or 15A MC IC 0X,0300 Nall Construction Standards and that a
copy oflhis record has been provided to the well owiror,
23, Site diugrnm 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 TNSTUCTIONS
24a. For All Wells: Submit this fort widiin 30 days of completion of well
construction to the following:
10. Static water level below lop of casing: (ft.) Division of Water Resources, informatfon Processing Unit,
Ifwater level is above casing, use,,^+" _- 1617 Mail Service Center, Raleigh, NC 27699-1617
11. Borehole diameter: UJ _ (in.) tab. Fttr lnjectinn 3Yc[iS ONLY: int addition to sending the form to the uddress in
++ 24a above, also submit a copy of this fort wigtin 30 days of completion of well
12. Well construction method: 4.A construction to the following:
(i.e. auger, rotary, cable, direct push, cic.)
Division of Wutcr Resources, Underground Injection Control Prugram,
FOR WATER SUPPLY WELLS ONLY: 1636 Mail Service Center, Raleigh, NC 27699-1636
13a. Yieldm 24c. For Wu ter Supply & Injection Weill;
(gp )� Method of lest: Also submit one copy of this form within 30 days of completion of
13b. Disinfection type: Amount: well construction to die county health department or the county where
constructed.
Form GW -I North Carolina Department ofCnviroumcnl and Natural Resources — Division of Walcr Resources Revised August 2013

WELL CONSTRUCTION RECORD
This form can be used for single or multiple wells
1. Well Contractor Information:
K AMI A
Well Contraciar N unc
NC Well ContraciorCenilIcndpn Number
Company Name
2. Well Construction Permit #: _
List all applicable well permits (i.e. County, Slate, Variance, Irp'ection, etc.)
3. Well Use (check well use):
Water Supply Well:
❑Agricultural
❑Geothermal (Heating/Cooling Supply)
❑ industrial/Com mere ial
Non-WuterSupply Well:
❑Aquifer Recharge
❑Aquifer Storage and Recover),
❑Aquifer Test
❑Experimental Technology
❑Geothermal (Closed Loop)
❑Municipal/Public
❑Residential Water Supply (single)
❑Residential Water Supply (shared)
❑Recovcfy
❑Groundwater Remediation
❑Salinity, Barrier
❑Slormwater Drainage
❑Subsidence Control
❑Tracer
❑Geothermal (Ilcating/Coaling Return) ❑Other (explain under #21 Remarks)
4
4. Date Well(s) Completed: L �- i Well 1D:1 ' 6
5a. Well Location:
facility/OwncrNume ' Q p� rocilityWit (ifapplicuble)
s )o� &kn fe a M i �aq VA- 0,tM I lid h .n
Physical Address, City, and Zip 26go I
A Y o��d. fr '-�
County Parcel Identification No. (PiN)
5b. Latitude and Longitude in degreeshninu I es/seconds or decimal degrees:
(ifwcll field, one latlong is sufficient)
5'-1 X,) � N �1'1•ri 7tfCj W
b. is (are) thewell(s): OPermunent or ❑Temporary
7. Is this a repair to an existing well: ❑Yes or VNa
If this Is a repair. Jilt out Anmwn wed construction tuJormation rt rl exphhin the nature of ilia
repair under R21 remark section or rat the back of its fornh.
S. Number orwells constructed:
For multiple infection or non -water supply wells ONL1'v.fill the same construction, you can
subndtonefarm. q/
9. Total well depth below land surface: (ft.)
For multiple wells list all depths ifd✓f Brent (esaniple- 3@200' and 2©100')
10. Static water level below top of casing:
{fwaler level Is above casing, use "+"
11, Borehole diameter; (in.)
12, Well construction method: M� _
(i.e, nuger, rotary, cable, direct push, dc.)
far inlemal Use ONLY:
14 -WATER ZONES
MOM TO
nE.SCIt II'TION
fl. ft.
ft. ft.
15 CIlfTF1R 11e1.51,10 for mnldKuceett welts 'i1R i.fNt)I�ira ! liieulile
FROdi Tfl n1AA1F.4" TI{ICriNfS5 MATI?«IAL
ft. ft.
7fi:71VT7)wR:t.'.ASTiYG f]li 7'[ii]INC, eulltermul rtnMh'II-ltfa r
FROM 'rt) DIA ATETF_n
TITICICNrS". '14A7'rnIAL
17: SCREEN
FROM TO DIAMETER st,urstLf' rPl tt_3.NrS5 �At,t Tltrtl,lf..
. C ft. •�( ff.
v
IFR' • 1J 0
ft. rt.
tn.
FRONT TO MATERIAL EMI'LACEAIIt NTA11?'rl]DD&AMODN7'
ft. ft, t
ft. ft.
ft. ft.
19. SANIM'MAVELPr1i'YFC 0r'a ti IIIleuhk - -
FROM 'ro
MATEREll. n-1 171ACLI61 ENT n I E'f l 10 a _
ft. S ft.
SII, D11I1 LING LOG alta Cli'gdllltton3fl. 6tle[tE ifnbL' if
Fnt7,7f TO
11r%CnI PTI ON I colo r. It unarm, ranhu di typz, prain aea. el r.
ft. rt.
fl. ft.
rt. rt.
«, rt.
ft. ft.
R. ft.
ft. «.
Lf HFIIfAtli�'
22. Certiftcution:
Signature afCcrtifned Well Contractor Dole
by signing this farm• I hereby cerrU- that the u'ell(s) was (were) constructed in accordance
with 15A NCAC 02C.0100 or 15A NCAC 0217 .0200 Hell Conslrrction Standards and that a
copy of this record has been provided m the ivell 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 BYSTUCTIONS
24a. For All 8111911 : Submit this form within 34 days of completion of well
construction to the following;
Division of Water Resources, Infonnation Processing Unit,
1617 Muil Service Center, Raleigh, NC 27499-1617
24b. t'nr Inlrs'.tbtn Walls ONLY: In addition to sending the form to the address in
Zia above, also submit a copy of this form within 30 days of completion of well
construction to die following:
Division orWuter Resources, Underground Injection Control Program,
FOR WATER SUPPLY WELLS ONLY: 1636 Mail Service Center, Raleigh, NC 27699-1636
13a, Yieldm Method of test: 24c. For Water Supply S luleelton Wells:
(gP ) Also submit one copy of this form within 30 daysafcompletion or
13b. Disinfection type:_ Amount: _ well construction to die county health department of the county where
constructed.
Form OW -t Nonh Carolina Department of Envirmtmem and Natural Resources - Division of Wriler Resources Revised August 2013

WELL CONSTRUCTION RECORD
This form can he used for singic or multiple wells
1. Well Contruclor lnfurmation:
1 ['_1
Well Conunclor Nmnc
leigE-
NC Well Cunlractor Ccrli cutian Number
no
Company Name
2, Well Construction Permit M
List all applicable well permhs (i.e. County, Stare, Variance, lyectlon, etc.)
3, Well Use (check well use):
Witter Supply 1Yc11:
❑Agricultural ❑Municipal/Public
❑Geothermal (Heating/Cooling Supply) ❑Residential Water Supply (single)
Clindustrial/Commercial ❑Residential Water Supply (shared)
Non-Wutcr Supply Well;
h+lrnliinrior,
DR=very
jecdou Wrn:
fl.
❑Aquifer Recharge
❑Groundwater Remediation
❑Aquifer Storage and Recovery
❑Salinity Barrier
❑Aquifer Test
CIStonnwater Drainage
ClExperimenlal Technology
❑Subsidence Control
❑Geothermal (Closed Loop)
❑Tracer
under 1121 Rcmnrks)
4, Date Well(s) Completed: Z' ' i'a Well IDN ��� JV'
5a, Well Location:
• ed{lylOwncr Namu�— Facility IM (ifnpplicabla)
.+,. rr —r 1 ,r .u—1,,til -E JkJ1 I I It I L,r
Physical Address. City, and Zip
County �^ Parcel identification No. (PIN)
5h. Lptitude and Longitude in degrees/minutes/secunds or decimal degrees:
(ifwcll field, uric lsl/long is sufficient)
0-) !' f ' �� �fl � N n f �� 7 r1 � ,2 `i rt? � W
6. Is (are) the well(s): ❑Pernlancnt or ❑Temporary
7. Is (his a repair to an existing well: ❑Yes uro
Ifthts is a repair, fill out Amau•n well eonstnicifon it formation at 1r:rpluUt the to iurc of due
repair under 021 remarks section or an the back of this form.
9. Number ofwells constructed:
Far multiple injection or non -water supply wells ONLY whif the santc construction, you con
submit aneform.
LC
9. Total well depth below land surface: '� (rt.) 24a. For All Wells: Submit this form within 30 days of completion of well
For multiple wells list all depths ifd((1'erent (example- J@ 100' mrd 2@1001 1001 construction to the following:
10. Static water level below top of casing: M.) Division or Water Resources, Infurutation Processing Unit,
Ifwater level it above casing, use "�+" 1617 Mail Service Center, Raleigh, NC 2 7699-1 61 7
11. Borehole diameter: l5J (in.) 24b, ror liljeellon '!Yells ONLY: In addition to sending the form to the address in
24a above, also submit a copy of this form within 30 days of completion of well
12. Well construction method: n ib
construction to the following:
(i.e. nugcr, rotary, cable, direct push, etc,)
Division ofWn(crResources, Underground injec(ion Control Program,
FOR WATER SUPPLY WELLS ONLY: 1636 N1a11 Service Center, Raleigh, NC 27699-1636
13a. Yield Qpm) Method of test' 24c, Ivor Water Su )lv & lutLi:6un WeIN:
Also submit one copy of this form within 30 days of completion of
13b. Disinfection type: Amount: well construction to the county health department or the county where
constructed.
For Internal Use ONLY:
fl. ft. I In. I
AS]NG
I ii.:rn�t�firlectin-•rrinrxr.�rr.ennr�.,;rae,•lmRril_I,,,,,,t .�
1•
U
I'll
/5 C
i
fl.
fl. tn.
�r�ftt
n1AlkirTrit
SWIF 5Tzr
'r1llCG1JE 4$
AIATERIAL
ft. 4
! ft.
?
2 In.–
. GI
ft, fl.
in,
OT
_
To
NiA1 rctn.rt. t:M1,s4.a11cuminNTn1&'t'nif?r.hntaur,I
ft.
fl.
A.
ft.
Y(NC;rtAVEL'PACK Ira It illeolde)'
Tea
MATERIAL
1:1ot1'1A1.1.11FNTAtrrrmn
fr.
ft, rt.
12D;➢73fI.[:1N{i I.f3f;'Cui6ecic'adilitFisbtil aLeets lr irecrsinrvl
FROM Ta nFS4RIPT1ONk.7ar uurdnrat tulUruukl c, ruler t•te,1
ft. ft.
tt. rt.
ft. rt.
ft. fL
ff
ft.
ft,
ft.
`21rii1.Ufu'lrtts - -.. ,:
22, Certification:
Signature ofCcrtiticd Well Colnnlator Dow
4y signing this form, I hereby cerilfy that the well(s) was (here) constructed In accordance
with IJA NCsIC 02C.0100 or ISA NCAC 02C,0200 11 ell Consinmtion Standards and that a
copy ofthis record has been provided to the well owner.
23. Site diagram or additional well details:
You may use the back of this page to provide additional well site details or well
construction details. You may also attach additional pages if necessary.
SUBNIITTAL INSTUCTIONS
Form GW -1 North Carolina Department of"Environmcnt mud Natural Resources — Division ofWncer Resources Reviscd August 2013

WELL CQNSTRUCTION RRC©i
This form call In: naed rot single or muitiple wells
I. Well Contractor Infornmtion:
Arthur Becker
Well ConvociorNarne
2201-A
NC Well Conloctor Certification Number
Cascade Drilling LP Aiken SC
Company Namc
2. Well Construction Permit q: on site
List all applicable well perntitr ri:r. Cauno,, Stale, Parlanee, hyeclian, etc.)
3, Well Use (check Well usc):
Witter Supply well:
❑Agricultural ❑Municipal/Public
❑Geothemml(Heating/Cool ing Supply) ❑Residential Water Supply (single)
❑Industrial/Commercial ❑Residential Water Supply (shared)
Non -Water Supply
❑Aquifer Recharge
❑Aquifer Storage and ltecovery
❑Aquifer Test
❑Experimental Technology
❑Geothermal(Closed Loop)
❑Recovery
❑Groundwater Remediation
❑Salinity Harrier
❑Stormwaler Drainage
❑Subsidence Control
❑Tracer
"J IQUMVIIJI U trleatin .4..001111 r 1Cea ❑tither [ex loin under 1:21
4. Date Well(s) Completed: May 15, 2015 Well Illy AW -5D
5a. Wall Location:
Duke Energy Sutton Plant
Facility/OwncrName Facility IDN(ifapplicoblc)
801 Sutton Plant Road, Wilmington NC 28401
physical Address, City, and Zip
New Hanover
Cnunly Pacel IdentiticadonNo. (PIN)
5h. Latitude and Longitude in degrees/minutes/seconds or decimal degrees:
017well field, all; ladlong Is sufficient)
34 17'22.3152" N 77 58'47.4384" W
6, Is (are) lila well(s): 1OPerrnanent or ❑Temporary
7, Is this a repair tit an existing ►veil. LlYes or fallo
,lf fids ho repair, fill out kna5rn walleonvroodon hfamitflan and arplain rhe nalure ofthe
repalr undar flai rrtnark" Alrlian or wt the bark aflitls fbrnc
S. Number ofwells constructed: 1
F'nr ttrnlfllria m)eerlan or non•warcrsupply u'r:lfs {1NGYmf1h life setmn consa•ucllan, you cot
aribnill ane fast
9, Total Well depth balow land surface: 100 VQ
For ninfiVe lvel's list all doptics i chgereni (rarrtulrin- d .200' and 2 100')
10. Stehle wuterlevcl below top of casing: 15.65 (fG)
lfaxrrer level Lr above taring, use
11.13archole dlinneter: 6
12. Well coustruction method: Sonic
(i.e. auger, rawy, cable, direct push, cle)
FOR WATER SUPPLY WELLS ONLY:
134, Yield (L -PRI) Method of lest:
13b, Disinfection type: Amount:
For Inlcmal Use ONLY: :7:�
1,1rVAiIt :7rI VIlS
- 60 f'' -100 IL
rr. fL
�I.f:'(71''1'1•L•litiC`.ri$tI�IC..: turiiinlfi=�i9csE" rrci[a
FROAS TO _ utAArr3��1
fl, fl. _ m.
sand
+ 3 rt -90 fl 2 In- ,154 PVC
n,
TA'io3rilR)rFIV _
FROM I TO MAN i -vu Ki OT sM'- T11ICI NF -4,4 MATERIAL
-90 ft -100 f'• 2 I" .010 .154 U pack
ft, ft. fn,
fROM .1'1 tln'l7.RIAt. Erv1rLACF,i11-fi-r iter rinan eY. nufdr
rc. -$5 n, cement benlonterremle pressure 1100 lbs
-83 ff• -88 r' bentonite chi gravity 160 lbs
ft. rt.
88 fr• -100 "I silica sand # 2 gravity
n. ft—.F—
[0
t.
i6 ft. i-5 ft. i ht_nA-_r,rnsr eon.a
-5 rc' -56
rc' white m -c send
-56 r' -57
f' tan/orange m -c sand some f gravel
-57 f° -60
«, gr
f-m sand
-60 r' -100
r' gray silty clayey sand
R.
ft,
ft.
ft.
Protective casing installed
22. Certification:
r[I" � xeckef- May 18, 2015
Signaltno OrcenifedNvcll Cantroetor Data
By signing tit's form, 1 hetrby cerlify that the arzllfs) ryas (were) constructed in arcardance
ividt lSA NCrfC 0X .0100 ar 1st 11CrlC 03C ,02VQ frell Constmalian Standards rind that a
copy of ihls record has been provided to the ivell owner.
23. Site diagram or additional well details:
You may use the back of this page to provide addi4nual well site details or well
construction details. You may also attach additional pages if necessary.
SU`FlMfl"f'AL,INSTUM- ONS
24a. Far AllWells: Submit t1iis form within 30 days of completion of well
consLructlon to the following;
Division of Water Resourees, Information Processing Unit,
1617 Mail Service Ccutcr, Raleigh, NC 27699-1617
24b. rnr In'cclion Wol.a ONLY: In addition to sending dte form to the address in
24a above, also aullmlt a copy of (itis furor within 30 days of completion of well
cnfrstnlettrul to the rallowing:
Division orWa(er Resources, Underground Injection Control Program,
1636 Mail Service Center, Raleigh, NC 276994636
24c, Irar W41er Supplj^ .� 1n1eeMan'4irclls:
Also submit one copy of this form within 30 days of completion of
well consLniction to the county health department of the county where
consvuwed,
Form GW -I Nordt Carolina Deparlmcltl of Gnvirunment and Naluml Resources —Division of Water Resources
Revised August 2013

WELL CONSTRUCTION RL- CO RM
1"1111 farm can be nscd for single er maltiple wells
1. Well Contractor Information:
Arthur Becker
Well Contractor Name
2201-A
NC Well Contmclor Certificnion Number
Cascade Drilling LP Aiken SC
Canrpaay Name
2. We]] Construction Permit,, On site
List all applicable welt permos p.e. Coun01, State, Variance, ftfeciian, eir')
3, Well Use (check well use):
Water Supply 1Vell:
❑Agricultural
[]Geothermal (Heating/Cooling Supply)
❑Indus trial/Comm erciul
Nun -Water Supply Well:
MMoniloring
❑Aquifer Recharge
OAquifer Storage and Recovery
❑Aquifer Test -
❑Experimental Technology
❑Geothermal (Closed Loop)
❑Municipal/Public
OResidential Water Supply (single)
❑Residential Water Supply (shared)
❑Groundwater Remediation
❑Salinity Barrier
❑Slormvrnter Drainage
[]Subsidence Control
❑Tmcer
Motherfexnlain under:! -)1 A
4. Date Walls) Completed: May 15, 2015 Well Jul AW -5E
5a. Well Location:
Duke Energy - Sutton Plant
Facility/Owacr Name Facility fD9 (irapplicoble)
801 Sutton Plant Road Wilmington NC 28401
Physical Address, City, and Zip
New Hanover
County Parcel identification No. (PIN)
5b. Latitude. and Longitude In degrees/minutes/seconds or decimal degrees:
(ifwcll field, one lin/long is sutfiieirnt)
34 17'22.3152" N 77 58'47,4384" W
6, Is (arc) the well(s): ©Permanent or ❑Temporary
7, Is this u repair to an existing well: OYes or ElNo
Ifthis Is a repair, fill aid knmvn well conshuctii n h farnlation and explabr rile nanrre ofthe
repair under 021 remark section or on the back aftbbx form.
8. Number of wells constructed; 1
For multiple irtjectlon or tion• loner aupply veils ONLY evnh the sonic construction, yore can
submit one form,
9. Total well depth below land surface: 150 {ft.)
Far mulfiplo wells Usl all dcpliv !f rft/jerent (example- 3{ r/�?f10' a+tdTt17j1p0')
10. Static water level below top of casing: 9.62 (ft )
(f water level is above casing, use "+"
I1, Borehole dlamcter: 6 _ (in,)
Pur Internal Use ONLY:
-56f1
-57
r'' tan -orange M -C sand some F gravel
-57
f' -82
r' Gray F silty sand
-82
f' -83
6t Gray cemented F sand
-83
° -117
f' Dk Gray F silty sand
-117
f' -150
ft Dk Gray F sandy silt
ft.
ft.
Prolective casing Installed
22, Cerdficalion:
Arc 13acker-
Signnturcurcen}i6cd WellComruclor
May 18, 2015
Date
83' Xj9;JitJ2 thisfarnk f l+Mc4V cerlOP Flat rhe 1vc11(s) ivty flier¢) consrl Oed in aeeorrintire
with 13,( NCAC. 030.0100 or 15d NC iC 03C,o3o0 Iretl C6ns+rucliml Standards and iliar a
copy of 1hCsrecord has been provided to 11au %W41 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 irnecessary.
SUIIMTTTAL INSTUCTIONS
24a, )'i LII Welts: Submit this form within 30 days of completion of well
consttuotion to the i'allowing:
Division of Water Resources, Infortantiou Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
gals. Far_ln(cetitim Wellg ONLY: In addition to sending the fort to the address in
Sonic 24n above, also submil a copy of this form within 30 days or roropletion of well
12, Well construction cable,
method: conS"ctioll to the following:
(i e. auger, rainy, cable, duecl push, etc.)
Division of Waterftmources, Underground Injection Control Program,
IiOR WATER SUPPLY WELLS ONLY: 1636 Mall Service Center, Rulciglr, NC 27699-1636
13a, Yield (gprn) hlcthod of test: 24c, For Water Supply d'e Injcednn Wells:
Also submit one copy of this form within 30 days of completion of
13b. Disinfection type: �_. Amount: wall roaslruction to the county health department of the county where
conalructed,
Form GW -1 North Carolina Deportment of Envirunment and Natural Resources— Division of Wnlcr Resources Revised August 2013

WELL. CONSTRUCTION RECORD
This form con be used far single or multiple wells
1. Well Contractor Int grnuttfun:
M v, b (�t 1 Cbi-c"
Well Contractor Nome
NCfWell
{Cofntruclo�rC./caiTicalit Number
Company Name v
2. Well Construction Permit ff:
List all applicable well permits (Le. County, Srate, Variance, lr Vection, etc.)
3. Well Use (check well use):
Water Supply Well:
❑Agricultural ❑Municipal/Public
❑Geothermal (Heating/Cooling Supply) ❑Residential Water Supply (single)
❑Industrial/Commercial ❑Residenliul Water Supply (shared)
Non -Water Supply Well:
❑Aquifer Recharge
❑Groundtvaler Remediation
❑Aquifer Storage and Recovery
❑Salinity Barrier
❑Aquifer Test
❑Stormwater Drainage
❑Experimenlul Technology
❑Subsidence Control
❑Gcotlicrmal (Closed Loop)
❑Tracer
❑Geothermal (hleuting/Cooling Relum)
❑Other (explain under t121 Remarks)
4. Dale Well(s) Completed: 0 - I5W.1i IDO L_1]
Su. Well Location:
us Ir n..r�
Fuciiityl�WOcrNaml` �y Facility
(��I
Physical Address, City, and lip
1 ��i?
_f'1'w e "� IL 11
County Parcel Idenlifrcation No (PIN)
5h. Latitude and Longitude in degrees/minutes/secunds or decimal degrees:
(irwell field, one laulong is sufficient)
(. Z:—y rt
J'�' �L _ N I .Cal `''), LJ:7 � W
6. Is (arc) the wcll(s): ❑Permanent or ❑Temporary
7. Is this a repair to an existing well: ❑Yes or u
Ifthis is a repair, fill out known well canstruction information a plain the nature of the
repair under t;2d remarks section or on the back of thlsform.
3. Number ufwells constructed:
For nuthiple Injection or nnn-water supply svells ONLY iv1Ni the same canaructiun, you cou
s+rbmlr one form, %�
9, Tottlwell depth below land surface: [_.✓ (fL)
For multiple tsrlls list all depths f different (example. 3 a 200' and ? 0 100
Pur Internal Use ONLY:
S71'4-AVATRR 3.ON C5...
fL ft.
Tt. fl.
t5. OII'rN:R Ci�SiNC Ifnr amid-cttacJ ivellsl4Tt LINuII.tlf uutrlleutile3
ft.
I
ft.
in.
16. TNN'l::11 CASiNC,fDii"ft1IiINL Lcathernnd elf+aod-Inti r
.
FROM TO
MA:NIF.Mih
TIUCKNEss
IIrATCRIAL
ft.
ft.
to, r `
O
J
LayCil
ft.
17. SrREEN
Imnm I TO
I 151ANIP5r.n I
la -CI NUT' I THICKNESS I MATERIAL
I n(c,
r fL I in.
I IA_ Glint I'll ,:•a . • .... I ... .. . . � . . .. 1
HI -19. sA�N01GRAVV.L l,AC[{ IL ryrrllcutrtC7.. .. _.__
ji RAiam I –In TMATERIAL 'T"� iAn'I.AC_LhSLPo,hi LTnon
I: 21L.13H ILLINI.' 1 OG. in t ILL CIL llfldltinnnl slrrete if rtecessttM '�'�'.::' ." . I
ft. ft.
ft. ft.
ft. ft.
11 2r.�rttenlxtrrcc� _ .. I
22, Certification:
Signature ol'Cur ified Well Contractor Date
By signing this form, I hereby cert that the well(s) was (were) cotrstnmted In accordance
with lSd NCAC 02C,0100 or ISA NCAC (12C.0200 Well Cansnvettmt Standards and that a
copy of this record has been provided to the well owner,
23. Site diagram or additional well detuils:
You may use the back of this page to provide additional well site details or well
construction dc4gil5. You may also attach oddidunal pages if necessary.
SUBMITTAL INSTUCYIONS
24a. For All Wells: Submit this Form widiin 30 days of completion of well
construction to the following:
10. Static water level below top of casing, (ft,) Division of Wulcr Resources, Inronnalion Processing Unit,
lfwarer level is above casing, use "ll+" 1617 Mail Service Center, Raleigh, NC 27699-1617
11, Borehole dtumcicr: _LQ_. (in.) 24b. Fur Inlceltntl Wells ONLY: In addition to sending the farm to the address in
24a above, also submit a copy or this form within 30 days of completion of well
12. Well construction method: IAV U c I construction to the following:
(i.e. auger, rotary, cable, direct push, etc..)
Division ofWutcr Resources, Underground trljccl[on Control Program,
FOR WATER SUPPLY WELLS ONLY: 1636 Mall Service Center, Raleigh, NC 27699-1636
13u. Yield (gpm) Method of test: 24c. for Water Supply b_ln'ectiun Wells;
Also submit one copy of this form within 30 days of completion of
13b. Disinfection type: Amount: well construction to the county bculdi department of the county where
constructed -
Form GW -1 North Carolina Department of Environment aid Natural Resources - Division of Water Resources Revised August 2013

WELL CONSTRUCTION RECORD
71,is form can be used for single or multiple wells
1. Well Contractor InrurTrtution:
Well
1
ellll Contractor
Name
NC Well Contractor Certification Number
�f�tS�odc_
Company Name J
2. Well Construction Permit #:.,_
List all applicable hell permits (i.e. County, State, Variance, hJeerion, vie.)
3, Well Use (check well use):
Water Supply Well:
❑Agricultural ❑Municipal/Public
❑Geothermal (Henting/Cooling Supply) ❑Rcsidcntiul Water Supply (single)
❑Induslrial/Commercial ❑Residential Water Supply (shared)
Nan -Water Supply Well:
injection 1VOI:
[]Aquifer Recharge
❑Groundwater Remediation
❑Aquifer Storage and Recovery
❑Salinity Barrier
❑Aquifer Test
❑Stormwater Drainage
❑Experimental Technology
❑Subsidence Control
❑Geothermal (Closed Loop)
❑Tracer
❑Geothermal (lleating/Coolin' Return)
❑Olher(t:x luin under #11 Remark.()
4. Dale Well(s) Completed: is Well IDH , `ir 1✓
5n. Well Location:
Faeiltly/GwnerName �, S.- F,J Facility [bN (iCapplicuble)
Pfpl sleal Address, City, and Zip r J 4cf
I `► C'\N Aa -i l () 4i c
County Parcel Identification No. (PTN)
5b. Latitude and Longitude in degrceshninutes/seconds or decimal degrees:
(iCwell field, one loUlang is sufTiicient)
4 �1Ll i C c;�7 N �I 1-7 7. w
6. Is (are) the well(s): ❑Permanent or ❑Temporary
7, Is this a repair to an existing well: ❑l'es or qAO
If this Is a repair, fill out Iatown ivell consenietimi Information anofm#rxin the nature oftlia
repair under #21 remarry section or an die back ofdis form,
8, Number of wells constructed:
For multiple infection or non -water supply wells ONLY with the some consintction, you can
submit one form,
For Internal Use ONLY;
- 14:1%'ATGIt 7.ON6:5.
FL rt.
rt. I 11-1
In.
fti. TNMFt CASING Olt"' euthertawl closed=lpd i
MUM TO nth M1TETZIT lltlCxr4r.55 I
in. �I
fl. rt. in.
`•oi
V6
ft.
For multiple wells list all depths ((different (example. 3 u X00' and : n 100')
construction to the fallowing:
IN. GILOUT
(fL) Division of \Vater Resources, Information Processing Unit,
FROM
TO nr ITrRt,1L snts�t.,tc,ensrnr nto:rfsnn es: hnrrrurrr
ft,
9 1"A
.
n,
ft.
ft.
ft.
11).SANllICRAVC1:PACh ifu dimble
(nom
14_ rt'
rft. }
Tn MAIrattnL ehirthcr=ntr_NTnrsruou
A -
ft. I
t:'zn.nurr:ralvr.r:nr.r„Iragaaadta,eaid.neer.-rr>e�e,.ar.+t, __ t
ft. ft,
ft. ft.
ft. ft.
ft, ft.
ft. rt.
ft. ft.
ft. ft.
t�tar!�wantnrs
22. Certification:
Signataru of Certified Well Conuvelor Dale
By signing this form, I hereby certify that the well(s) was (were) consinicied hi accordance
with ISA NCAC 02C.0100 or 15A NCAC 02C.0200 Well Constnection Standards and that a
copy of ills record has been provided to rhe well nwner.
23. Site diagram or additional well details:
You may use the back of this rouge to provide additional well site details or well
construction details You may also attach additional pages if necessary.
SUBMITTAL INSTUCFIONS
9. Total well depth below land surface:_ ! I
(CL) 24a. For All Wells: Submit this form widiin 30 days of completion of well
For multiple wells list all depths ((different (example. 3 u X00' and : n 100')
construction to the fallowing:
10. Static water level below lap of easing:
(fL) Division of \Vater Resources, Information Processing Unit,
Ifivater level Is above casing, use ”+"
1617 Mail Service Center, Raleigh, NC 27699-1617
11. Borehole diameter: Q on.)
246, For Iniscffon Wells ONLY: In addition to sending the form m the address in
y
14a above, also submit a copy or this form within 30 days of completion of well
12. Well construction method: _ ;1 ti 1 J
construction to die following:
(i.e. auger, rotary, cable, direct push, etc,)
Division ofWuterRcsourcls, Underground Injection Control Program,
FOR WATER SUPPLY WELLS ONLY:
1636 Mail Service Center, Raleigh, NC 27699-1636
24" [fur Walter Supply & Trijcc'tion Wc[6
13a. Yield (gpm) Method of test:
Also submit one copy of this form within 30 days of completion of
13b. Disinfection type: Amount:
well construction to Ile county hcaltli department of the county where
cunstrucled
Form GW -1 North Carolina Department ofhnvironment
and Natural Resources -Division of Winer Resources Revised August 2013

_WELT.. CQnTRUCTIQN REC01,-
171by form can he used for sinsic or multiple wells
1. Well Contractor Information:
Arthur Becker
Well Contractor Natne
2201-A
NC Well Contractor C-65cation Number
Cascade Drilling LP Aiken SC
Company Name
2. Well Construction Permit A: on Site
List all applicable well permits (i.e. County, State, Variance, Infection, etc.)
3, Well Use (check well use):
r-rsru r auppry vv en:
❑Agricultural
013cothermal (Heating/Cooling Supply)
❑lndustri al/Commercio l
trust-%Yntcr ciappiy 1ven:
OMonlloring
❑Aquifer Recharge
❑Aquifer Storage and Recovery
OAquifer Test
❑)experimental Technology
❑Geothermal (Closed Laop)
❑Llcuthumal (HeatinUCculine I
❑Municipal/Public
ORcsidenlial Water Supply (single)
[]Residential Water Supply (shared)
[]Groundwater Remediation
❑Salinity Barrier
❑Stormwatcr Drainage
❑Subsidence Control
[]Tracer
❑OthcrreRnlakn under -821 12
4. Date Well(s) Completed: May i5' 20,15 Well IDH AW -6E
Sa. Well Location;
Duke Energy Sutton Plant
Facility/Owner Name Facility ]DO (ifopplicable)
801 Sutton Plant Road Wilmington NC 28401
Physical Address, City, and Zip
New Hanover
County Postal Identification No. (PIN)
5b. Latitude and Longitude in dcgrces1minuics/seconds or decimal degrem
bfwell field, ono lat/lun6 is sufGcicnt)
34 17'39.7176" N 77 58' 54.8832"
G. Is (ure) the well(s): I231'ermanerd or ❑Temporary
Internal Use ONLY; �^ -�
22, Certification:
W Artl3"ker
Signature orCertified
7. Is this a repair to an existing well: OYcs or 91No
lfdris tri rapnfr, fit! out ,Mown melt corurrunilun 1+tfurmwian and explain the nunrra q -the
repair under 1l:1 remar47• seciton ar an tlra bael; ajthi3 form.
S. Number of wells constructed: 1
For tnulripin iryecilon or naimmier supply w•elLs ONLY whlt thesante conitrrtction, you can
srlirmif ane frnn-
9. Total well depth below laud surface: 150 (ft)
For mulrlple ii -ells !!st all depths (jdlQ'Erent (erntnpie-3@200' and ? a OO)
Io. Smite venter level below top orcasing: 6.34 (A-)lfcwairrlaualIs above cming, nue "+"
11. Borehole diameter: 6 ftn_1
Contractor
May 18, 2015
Dale
By signing 1111r form• I hereby terrify that the ivell(r) was (inure) constntcred in accordance.
with 15A NCAC wC.0I00 ar 114 NCAC wc'020fl 11 ell cunslructirnp Slanderds and thin a
copy ofthis record hos been provided io ilia well owner.
23, Site diagram or additional well details:
You may use the back of Ihis ;mgt; to provide udditicnul well site details or well
construction details. You may also attach additional magus irinecessary,
SU11Mi'I-rAL INSTUGTIONS
24a. True All Wells: Submit this form within 30 days of completion or well
construction to the following:
Division of Water Resources, information Processing Unit,
1617 Alail Service Center, Raleigh, NC 2 76 99-1 61 7
24b. For I11'i0lon W •lls ONLY: In addition to sending the form to the address in
Sonic 24a above, also submit a copy of this farm within 30 days of completion of well
12. Well conty, roble, method: h, construction to the fallowing:
(i. c. auger, rotary, cnhlc, direct push, etc.)
Division of WaterResourees, Underground Injection Control Prugratn,
FOR WATER SUPPLY WELLS ONLY: 1636 A1ail Service Center, Raleigh, NC 2 769 9-1 63 6
13a, Yield (gplu)Method of test 24c. Far Wit ler Supniy & ]n eetfuu lyclis:.
Also submit one copy of this forrn within 30 days of completion of
13b, Disinfection type: Amuuot; _ well construction to the county health department of the county where
-. constructed.
Form GW -1 Nunh Carolina Department o(Environmmi and Natural Resources -Division of Waler Resources Revised August 2013
For

WELL CONSTRUCTION RECORD
'Mix form can be used for single or multiple wells
1. Well Con�t�nlctto�r�Inrurmntiun:
cueman
Well Contractor Nome
I������-
NC Well Cantor or Cert r. tion Number
`5
Company Name
2. Well Construction Permit t!:
List all applicable ivell pernrOs (i.e. Couno', Stare, Variance, Lyeedon, etc.)
3. Well Use (check well use):
water supply well:
❑Agricultural
❑Geothermal (Henting/Cooling Supply)
❑ Industrial/Commercial
Nun-Wutcr Supply Well:
❑Municipal/Public
0RcsidcnLint Water Supply (single)
OResidentiat Water Supply (shared)
❑Aquifer Recharge
❑Groundwalcr Remediation
❑Aquifer Storage and Recovery
❑Salinity Barrier
OAquifer Test
❑Slurmwalcr Drainage
❑Experimental Technology
❑Subsidence Control
❑Geothermal (Closed Loop)
❑Tracer
❑Geothermal fl-leallnpJCcolinp_ Reiurn)
❑Othtr fek-oit in under #21 Ti
4. Dulc WCIi(s) Completer]: 1 N ft1 Wcll iD# AW— 1 1.J
5a. Well Location:
1
-aik j nev(l ttr secs t % i =
FacilitylOwncrNnma J Facility IDN (ifapplicable)
C]l s'(3 t��'t it�llt�C Vii' IUl
Physical Address, City, and Zip
County
Parcel identification No. (FIN)
Sh. Latitude and Longitude in degrees/minutes/seconds or decimal degrees:
(ifwcll rich], one ludlung is suffiuicuo
6, Is (are) thewcll(s): ❑Permanent or ❑Temporary
7. is this a repair to on existing well: ❑Yes or I1u
Iflhis is a repair, fill out ]auto well consinicfion i fonlmllon ail,t"Plu in the imfura of the
repair under 1121 remarks section or on the backoflhisforin
8. Number ofwells constructed:
Fur multiple injection or aalr-water supply wells ONLY MM rhe sante construcliar, ymt can
submit oneform.
9. Total well depth below land surface: l V J (ft.)
For multiple wells list all depths tf d((Jereal (example- 3@200' and 2 a 100')
For Internal Use ONLY:
(fL) Division of Water Resources, Infllr'malinll i'rocessing Unit,
ifu•ater level it above casing, use "+"
1617 Mail Service Center, Raleigh, NC 27699-1617
11. Borehole diameter. (in.)
24b. For I)r cctiun WAs ONLY: In addition to sending the form to the address in
MON; TE)
I2. Well construction method; 1.
nFscrtmnan
ft.
rt.
ft.
R.
1s.IlurFli'Ci1SlNG inrttinlfi•ulscsl it {alis cskt > !l xr a tticuuie
M011l To
mA\IVATIr T TnICI{itiFr.S hLl'IY?4lI.AL --
ft.
----
Also submit one copy of this form within 30 days of completion of
16. INNER CANING t)it I'VIiING(entliern,al cinsed-Inn t -
MOM TO
well construction to the county health department of the county where
MAialET$It
T11101MESS
htATETUAL
ft. J
fl.
in.
[.,1+t IJt
1 V 41
ft,
ft
In
kat Ont 'lir
DIA MFTFIt SLOTS17E
T111CT12NF_SS hIATI'n.IAL
ft. 6�1� !°
Z In. (A lb��✓
ft. ft,
in.
rR6TT 'T [)
hIATEtnhL k:\ti+1.M1 CJ'.a1t•:NT M131 'r11Dnti AAlOnIVT
4 A.
rt.
fl.
Et.
11. SdNC)IC f{.►VEL E'ACK if ulr IIfC]A tie
FROM To
ar.1TEMAl,
E:T11'11 ck: hr CAI n)r_rl IUD
fl.
ft.
. },({, 1}1t1L1,1NG L[7f:- tiilnt)i �dditinriulslrerfs irnziisSu
Fltnhl TO
t)kSClill'1'fRtW culnr, hnrJnrsr, rulllrnrk t e rdn �i,r, et c,1
rt.
ft.
-
fl.
ft.
fl.
ft.
ft.
fl.
ft.
ft.
ft
fl.
ft.
rt.
22. Certification:
Signature ofCertllicd WOCmaractar Dale
By signing this farm, 1 hereby cerin, that Me well(s) was (+Vere) constructed in accordance
with JJA NCAC 02C 0/00 or 15,1 NCAC 02C.0200 I frell Consu-nerimt Standards and that a
copy ofihis record has been provided to rhe well owtior,
23. Site diagram nr additional well details:
You may use the back of this page to provide additional wall site details or well
construction details You may also attach additional pages if necessary.
SUBMITTAL INSTUCTIONS
240. Far All Wells: Submit this form within 30 days of completion of well
construction to the following;
10, Static water level below Iop of casing:
(fL) Division of Water Resources, Infllr'malinll i'rocessing Unit,
ifu•ater level it above casing, use "+"
1617 Mail Service Center, Raleigh, NC 27699-1617
11. Borehole diameter. (in.)
24b. For I)r cctiun WAs 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
I2. Well construction method; 1.
construction to the Ibllowing:
(ix, auger, rotary, cable, direct push, ele,)
Division of Witter Resources, Underground Injecliun Control Program,
FOR WATER SUPPLY WELLS ONLY: � — -
1636 Mail Service Center, Raleigh, NC 27699-1636
13n. Yieldm Method orlest:
(gp )
24c, l'ur Wawr Supply & Injuelllrn ]Yalta:
,..,
----
Also submit one copy of this form within 30 days of completion of
131). Disinfection type: Amount:
well construction to the county health department of the county where
constructed
Form GW -I Nordi Carolina Department afEavironment mid Natural Resources — Division of Water Resources Revised August 2013

WELL CONSTRUCTION RECORD
'Mis form can be used for single or multiple wells
1. Well Cant' tractor Information:(� �+
riotyi .! Y l ?t� i 4 N� \ 1/
13. C)
Well Contractor Name
7 C1 Cil Z'
NC Well CantmctorCcrufeat{an Number
�_Gl�tryiud���-
Company Name
2. Well Construction Permit b:
List all applicable well pernths (i,e. Counry, Stare, Variance, injection, etc)
3. Well Use (check well use):
Wn ler Supply Well:
❑Agricultural ❑Municipal/Public
❑Geothermal (1-Ieating/Cooling Supply) ❑Residential Water Supply (single)
❑Industrial/Commercial ❑Residential Water Supply (shared)
Non -Water Supply Well:
oRecovery
❑Aquifer Recharge ❑Groundwater Remediation
❑Aquifer Storage and Recovery ❑Salinity Barrier
❑Aquifer Test ❑Stormwater Drainage
❑Experimental Technology OSubsidcnce Control
❑Geothermal (Closed Loop) ❑Tracer
❑Geothermal (f'ieatingiCooling Return) ❑Other (explain under 1121 Remark., I'
4. Dale Well(s) Completed; 'L-' S (e > Well iDll
Sa. Well Locution:
m",, i- " Yin- Jl SPI iii' Lei ,.
FacilitylOwncr Name Facility 1130 (ifupplicable)
m 3i _ ba I til o hu
—
Physical Address, City, and Zip
n} ELit IC_
County Parcel Identification No. (PIN)
Sh. Latitude and Longitude in dcgreeslminuhs/seconds or decimal degrees:
(ifwell field, one lnrllong is sufficient)
04 1-5 (jqX70` 3 N . � 7'�1�� 2.6` Zi 6q W
G, Is (are) the well(s): ❑Permanent or ❑Temporary
7. Is this a repair to an existing well: ❑Yes or Pq
If dds is a repair, fill out known well construction h formation ul esp/niu the nature of the
repair under 1121 remarks section or on the back ofthis form"
S. Number of wells constructed:
For multiple injection or non-umter supply n'elis ONLY with the same construction, you can
submit ane farm.
9. Total well depth below fund surface: (ft)
For nnddple wells list all depdu (f d ierem (esample- g a X00' mu! 2®100')
For Internal Use ONLY:
I J. NVATER 20N5'S
MOM Ta
DFSra:trTwN
ft.
fr.
fl,
ft.
15. f1U i'I li CrItitNG ftirnru ti atscd well, -f51t LIN AT" It W o i tlicalde},�
Fataam rn
UrAaIF.TF.It TIttCItVf5s nlnl,luAt.
ft.
MANNERCASINGOR'I'liBIN G' eotlaermal+:i6k&Iont
FRO51 'I'a
RIu4;1th`i4a 'TIIICICNNSS Rt A'C I!?r W. -
O ft.
a,
ft.
Al SCREEN,:;
FrioM
TO
DIAMETER SlAUSILr.. I 1111000Sti I MATF.RIAr,
ft.
r'C ft,
ft.
MOM M
MATCRIAL FMPLACEht ENT N16Tt1OD & ARIOUNT
ft. ` Ly
V t
ft.
11 1
ft.
fl.
ag. snNuft;R.�v rL PAc1c 1f it t i►ii:ublr :..:...: ,
FROM Tr)
1T,1'1'1:111AA�L ETiI'LAC£hwKrNs"llulr
i , ft. :��
ft.
t 1
ft.
ft.
't311;1f7il M& 3 G 1-t-)G(nitarli'midiliumita1mcf3lfneee_141rry
k{IO><I 1'0
DFS GTi1nT1{iN rnit,r, I:,uraueir •utllrveiulY pe, Arun, iErr, etc.,)
ft.
ft,
ft.
ft.
ft.
ft.
ft.
ft.
ft.
ft.
to.
ft.
22, Certification:
Signature orEctimed Wctl Conaaclar Date
Dy s(grung this fol ar. i Iren:bv cer j5, that the ivell(s) was (were) eanxhuered ht accordance
n•iih IJA NCAC 02C .0100 or 15A NCAC 02C .0200 IFcll Gansrrterinn Srmtdnrrls and that a
copy a(Mis record has been provided to the well oivuer.
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 TNS'llil„ rl ONS
24a. For All Wells: Submit this form within 30 days of completion of well
construction to the following:
10. Static water level below top of cusing, _ _ (Cl) Division of Water Resources, Information Processing Unit,
If water levet is above casing, use "+" 1617 ivlail Service Center, Raleigh, NC 27699-1617
11. Borehole diameter: (in,) 24h, For inieciiult Wells ONLY: in addition to sending die form to the address in
24a above, also submit a copy of this form within 30 days of completion of well
12. Well construction method: i 1_ U t conslructien to the following:
(i,e, auger, rotary, cable, direct push, etc.)
Division aflYatcrResources, Underground Injection Control Fragrant,
FOR WATER SUPPLY WELLS ONLY: I636 14Ini1 Service Center, Raleigh, NC 27699-1636
13a. Yield (gin), Method urtest: 24c. icorWuter Supply & injection Wells:
Also submit one copy of this form within 30 days of completion of
13h. Disinfection type: __.. _ Amount well construction to the county health deportment of the county where
constructed.
Porn GW -I Nonb Carolina Department of Environmcnl and Natural Resaiuces - Division of Waler Resources Revised August ?u 11

WELL CONSTRUCTION RECORD
This form can be used ror single or multiple wells
1, Well Contractor Information:
Well Contractor Nam.
Z_
NC Well Conlmcon-CaniffiealtalIn Number
t r( loL 1 l
Company Name
2, Well Construction Permit #:
List all applicable well permits (i.e. County, State. Variance, hjeetiaa, etc.)
3. Well Use (check well use):
WWWSupply Well:
CAgricultural
❑Geothermal (Heating/Cooling Supply)
❑industrial/Commercial
Nun -dialer Supply Well:
❑Aquifer Recharge
❑Aquifer Storage and Recovery
❑Aquifer Test
❑Experimental Technology
❑Geothermal (Closed Loop)
❑Geothermal O'leati na/Cuol In e
❑MunicipaUPublic
❑Residential Water Supply (single)
❑Residential Water Supply (shared)
OGroundwater Remediation
❑Snlinily Barrier
❑Stormwater Drainage
❑Subsidence Control
[]Tracer
❑Other (explain under #21
4. Date Well(s) Completed: L' J Well IDR Y r x
So. Well Locution: f
Facility/Owner Name 4 Facility IDN (ifapplicable)
Physical Address, City, and Zip J
h r1ue-C L
County Parcel Identification No. (PIN)
5h. Latitude and Longitude in degrees/m[nutes/seconds or decimal degrees:
(ifwell field, one latlong is sufficient)
6. is (are) the well(s): ❑Permanent or ❑Temporary
7. Is this a repair to an existing well: ❑Yes or opo
(frhis is a repair, fill our knoavh Nell constntcllan Information and explain the nature of tha
repair under #31 remarks section or on the back of this form.
S. Number ufwcils constructed:
For mulliple btlecilon or non -water supply wells ONLY with the sante cans-frucrlon, you can
submit one form.
9. Total well depth below land surface: r' (fl.)
For multiple wells list all depths (jd(ffereot (example- 3 a :00' and 2@100')
100')
For Intcmal Use ONLY:
W. WATER 7I ONRS
FROM TO
DESCRIPTION
ft,
ft.
ft.
A.
15.:OLf:1'EItL'A.514G frirmulti-eased wells
OR 1,[i`IElll' if a ficnhle '
1410NI -ro
n1ASff-TEII
TllFSS 1 MATERIAL
Irl,
rt. I in,
. Itl. INKFA CASING till Tt1R1Nth' ilddterinnl a med-inn 1 .
MONI To
"WILMN I 111117NFSS I AIAT1E/titAL
ft.f l
i
ff. in. Y
rt.
fl. im
rROht TO
DIAMETER SLOT SIZE
TiRCRNrss NIATEm AL
40 ft. s /t.
•2- in. o I
►J
�
fl. IG
in.
1S. GROUT
FROM TO
NIATERUII lih1M,%CI!V%%L1H'r hfE11;011 & AMOUNT
o
faflkal
fl.
n,
rt.
rt.
%M'SANDIG rpllrliht. .
FROMT4
NIATE.mAI.
I7A1P LACEMENTaIETnOD
zq ,� ft. J
rt.
fl.
ft.
2a. nlflLGlNti'l:QC AlWtltl'td111lIUnaISIICCLIIrneL"CSSa '
FRONT TO
DESCRIPTION fetilor. kanln .0fruck lypr, rain ibe, ete.l
ft.
ft,
ft.
rt.
ft.
rt.
fl.
fl,
ft.
ft.
Ct,
ft.
fl.
ft.
22. Certification:
Signature ofCanified Well Coutmclor Date
By signing this farm, I hereby certify that the wells) oras (ware) consimcmd in aceardance
with 154 NCAC 02C.0100 or IM NC.tC 02C.0200 1 Fell Consinmton Standards and that a
ropy ofthis record has been provided to the it -ell on•ner,
23. Site diagram ur additional well details:
You may use lie hack of this page to provide additional well site details or well
construction details. You may also attach additional pages if necessary.
SUBNfrrTAL TNSTUCTIONS
24a, For All `yells: Submit dtis form within 30 days of completion of well
construction to the following:
10. Slade water level below top orcasing- (fl} Division of Water Resources, lnrorinalion Processing Unit,
if water level is above casing, use "!!t•__" 1617 Mail Service Center, Raleigh, NC 27699-1617
11, Borehole diameter: liJ (in,) 24b. ror Inicctiun }Yells ONLY: In addition to sending die form to the address in
{{��
II
24a above, also submit a copy or this runn within 30 days or completion or well
12. Well construction method: &fl 1,C1. construction to the hollowing:
(i. a. auger, ratary, cable, direct push, cic.)
Division ofWater Resources, Undergrmmd Injection Control Program,
FOR WATER SUPPLY WELLS ONLY: 1636 Mail Service Center, Raleigh, NC 27699-1636
13a. Yield (gpm) Method of test 24c. Far►Yuter Suftpj_ 4 injection WON:
Also submit one copy of this form within 30 days orcomplelion of
13b. Disinfection type: Amount: well construction to die county health department of the county where
constructed.
Form OW -1 North Carolina Department orGnvimumcut and Natural Resources — Division orlVuier Resources Revised August 2013

WELL CONSTRUCTION RECORD
Tlnis form can be used for single or multiple wells
1, Well Contractor Information:
Mhki
Well ContractorNamc
IQG"li"L'_ A
NC Well Contractor CW11ficalion Number
6i�' 0 J C. (VIIIi 1
Company Name
2, Well Construction Permit 9.
List all applicable hell permhs (ie. Count)1, State, Parlance, liVection, ere,)
3. Well Use (check well use):
Water Supply Well:
❑Agricultural
❑Geothermal (Heating/Cooling Supply)
❑ Industrial/Commercial
Non -Water Supply Well:
injection Well:
❑Aquifer Recharge
❑Aquifer Storage and Recovery
❑Aquifer Test
❑Experimenuil Technology
❑Municipal/Public
❑Residential Water Supply (single)
❑Residential Water Supply (shared)
❑Recovery
❑Groundwaler Remediation
❑Salinity Barrier
❑Stormwater Drainage
❑Subsidence Control
❑Geothermal (Closed Loop) ❑Tracer
❑Geothermal (Heating/Cooling Return) ❑Other(cxpluin under #21 Remark
a. Date Well(s) Completed: ' J Well IDH AN—
So. Well Locution:
K)"Vboey_z th �rrsC (' LiS 11CI
Facility/OwncrNatn� — Facility lDli(ifupplicnble)
Physical Address, City, and Zip Orb )
County Parcel Identification No. (PIN)
5b. Latitude and Longitude in degrees/minutes/seconds or decimal degrees:
(ifwcll field, one [at/long is sulEcium)
N-28ilt. i2Z5 _ N T 7�7 I f � i W
G. Is (arc) the well(s): ❑Permanent or ❑Temporary
7. Is this a repair to an existing well: ❑Yes or ❑No
ff this is a repair fill out ,Uloun avec consiniction orforom0on and explain the nature of the
repair under 921 rennarA,s section or on the back of dais form.
8. Number orwens constructed:
For multiple infection or non -water supply hells ONLY with the sumo canstrtreflon, you can
submit one form.
9. Total well depth below land surface: `� (ft.)
For multiple wells Ilii all depihv lfdi-(%rent (example- 3 a ?00' and 7 rr 100
10. Static water level below lop of casing:
Iflvaher level is above casing, use "+"
11. Borehole diameter: �(i n.)
12. Well construction method:
(i.e. auger, rotary, cable, direct push etc.)
rr7nlcmal USe ONLY:
14 ]VATRII 7f)NLF
FILONI TO rn NDUPTTON
ft. ft.
fl. fl.
75::DUTE11f.i151NG Snirmulli•f•tlieelwctL,s 111t1SN1C11 if a llichilde
FROM TO DIAMETER T1FICKNFS5 aIATLnTAL
ft,
fr.
in.
16:INL4E CASIN0411t'1"l111IND +rulkrcrnlul'ciaied=Inn i - - _
f11OP1 TO 111Ah1ETFA TISICI{N E,Sti atATE11IAL
ft. in. ( n
fl. rl.
A7:SCRC1KN
FROMru
1�:7 it,
ft.
DIMMYTCIa ISLOTsI7,E Tgn7%'hr,^,s m,ki,EmAL
3 ' 2— In. PVC,
•9�
rt, in.
1S.GRD1L1' .
ladle To MATERIAL enol-+ctnlrNraFt¢TlronsAntouN7
n. 1-.3 1.
fl.
fl.
ft.
fl.
19. S;%M)IGnAVM PA CH' Ifn f llicunlel
MOM
TO MIA•ITnIAI_ EMPLACEMENT 111rTirou
1 fil.
i
fl.
fr.
ft,
zn; tntlUi rNc
l,Dt: 6111t01 ulldidnnai3bn a Irneelasu
FROM
TO
isb_5 i;R1Ir1'rnN{calor, llardacs, selllruelr Ir .+n1n rtrr. (vA
rr.
rt,
rf.
ff.
if.
ft.
rf.
rt.
fl.
ff.
il.
ft.
21:illEbiAltlC.S ' _ _ _
22, Certification:
Signature ofCertifaed Well Contractor Dale
By signing rhis fano, I hereby certt& that the wells) was (here) constructed in accordance
with 15A NCAC 02C.0100 or 15d NCAC 0X,0100 IVell Construction Standards and that a
copy ofilds record has been provided io the mall owner,
23. Site diagram or additional well details:
You may use the back of Oils page to provide additional well site details or well
construction details. You may also almeh additional pages if necessary.
SUBMITTAL iNSTUCTIONS
24a. For All Wells: Submit this form within 30 days or completion of well
construction to the following:
(f0) Division of Water Resources, information Processing Unit,
1017 Mail Service Center, Raleigh, NC 27699-1017
24b. Vor Inimlion Wells ONLY: In addition to sending die form to the address in
24a above, also submit n copy of this form widiin 30 days of completion or well
construction In the following:
Division of Water Resources, Underground Injection Control Program,
FOR WATER SUPPLY WELLS ONLY: I636 Mail Service Center, Raleigh, NC 27699-1630
13a. Yield (gpm) Method of test: 24c. For Wader Supply & injection Wells:
Also submit one copy of this form within 30 days of complclion of
13b, Disinfection type: Amount: well construction to Ole county health department of the county where
constructed.
Farm GW -1 North Carolina Depanment 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
1.Well Contractor Information:
�(
f`p (n(AeI
Well ContraetorNnme
2gg2- .
NC Well Cantraelnr Crrliffrslina Number
Company Name
2. Well Construction Permit M
List all applicable well permits (ix, County, State, t ariance, Injection, ote.)
3. Well Use (check well use):
Water Supply Well:
❑Agricultural
❑Geothermal (I[eating/Cooling Supply)
❑ industrial/Commercial
❑Municipal/Public
❑Residential Water Supply (single)
❑Residential Water Supply (shared)
Non -Water Supply Well:
oniloring
❑Recovery
9njection Well:
. ' ;: -
❑Aquifer Recharge
❑Groundwater Remediation
❑Aquirer Stomgc and Recovery
❑Salinity Harrier
❑Aquifer Test
❑Slormwaler Drainage
❑Experimental Technology
❑Subsidence Control
❑Geothermal (Closed Loop)
❑Tracer
❑Geothermal (Ideating/Conlin g Return)
❑Other (explain under 1121 Remarks)
4. Date Well(s) Completed; J ' I'S Well IDit1��'�
5a. Well
11�t[,Location: �n
21
ForaiVilityH.]wner Nluna Facility IDN (if tipplicnble)
11' �" IZa M ,�I�r Ifi llx)lon A o�G
Physical Address, City, and Zip
i ` 1.v O If
County parcel Identification No. (PiN)
5b. Latitude and Longitude in degrees/minutes/secunds or decimal degrees;
(ifwcll field, one livelong is sufficient)
` -�. -Z ',LILfc)-1 L N{�.._W
6, is (arc) the well(s): []Permanent or ❑Temporary
7. Is this u repair to an existing well: ❑Yes or No
Ifthis is a repair, fillout known well construction information mrl), gilabt the nature of the
repair under 0131 remark section or on the back of thisform,
8. Number of wells constructed;
For ntuhipre injection or non-uatersupply wells ONLY with the sonic construction, you can
submlr oneform. LC
9, Total well depth below land surface: J _ (ft-)
For multiple wells list all depibs (fdii ferent (example- 3 a 00' mid 3 n 100
10. Stu tic water level below top of casing:
If mater level is above casing, use "+"
11, Borehole diameter: [// _n (in.)
12. Well construction method:
(i.e. auger, rotary, tabic, direct push, etc.)
For Internal Use ONLY:
Ia:14A7=Jr,It:7.ONTtfi
. ' ;: -
FROM TO
nl•SCmPIION -_---- --
fL
fL
ft.
ft.
.. 05. OU'l t -Al CASING
llirnlilel:::: ....::....:.
FROM
TO
DIAriI ETI;II
T'I IICKNFS$
MATERIAL
fl.
fl. in.
16;1NNIM
CASING UR T11I1t1NGeothirnlnl'.
elided -111611 ..:. .: -
FROM
TO
DIAMFTiiR
TllTnMFSs RIA17--IAL
ft.
ft.
In.
h L
ll
ft.
rt.
in.
.17.:SCR.EEN.. �.:.. :..
..
FROM TO
DIAnIF rr'il ,LOT F17F.
1-1119-KNF.$5 MATERIAI.
(� ft. e4 S ft.
in. a i O
)
K)
ft. rt.
ln.
tS. [:r2M) T
FR Ont
TO
rNMITHIAL }:MPIACEMENT AiFTnOlt 1. AMOUNT
Ft.
SS
ft.
ft.
rt.
ff.
ft.
19. SANDICRAV ;LTACK. t Ira 14011K1t111e
FROM TO
"'ATERIA
1=rill-UCEML•'NTMETIIUD
^'t ft. G
1 J
fl.
ft.
ft.
an,'DRMLING 1AM atlucltlldds`llunul Ahceis if nctesiar
Yn0\t To
R£suftwTioti fcaiuriiardnwi,.runiruct,i strain sEae,ctc.)
fr.
ft.
Ft.
rt,
rt.
ft.
ft,
ft.
f!.
ft.
ft.
ft.
rt.
,!I. REMARKS_�
rt.
.. ..:.- .
22. Certification:
Signature ol'Cerliticil Well Contractor Dale
By signing ibis form, 1 hereby certify that the ivell(s) ryas (were) constructed in accordance
with 15.1 NCAC 1130.0100 or IS,4 NC.IC 02C.0200 Well Construction Standards and that a
copy afthis record has been provided to the well owner.
23. Site diagram or udditiumd 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 MSTUCfIONS
24a. Par All Wells: Submit this form within 30 days of completion of well
construction to the following:
Division ofWnter Resources, Informollon Processing Unit,
1617 Alail Service Center, Raleigh, NC 27699-1617
24b. For Inlretion Well; ONLY: In addition to sending Ole form to die address in
24a above, also submit a copy of (his form within 30 days of completion or well
construction to the following:
Division orWnter Resources, Underground injection Control Prugrom,
FOR WATER SUPPLY NVELLS ONLY: I636 Mail Soviet Center, Raleigh, NC 27699-1636
13n. l'icld (gpnt) Method of lest: 24c. For Minter Sultpi "d•. loicetlon Neils:
Also submit one copy of this form within 30 days of completion of
13b. Disinfection type: Amount: _ well construction to llse county health department of the county where
constructed.
Palm CiW-I Norh Carolina Department ofC•nvironment and Natural Resources — Division ofWutcr Resources Revised August 2013

WELL CONSTRUCTION RECORij
71ris form ciln be used for single or multiple wells
1. Well Conlruclor Information:
Arthur Becker
Well Contractor Name
2201-A
NC Well Contractor Cenificalion Number
Cascade Drilling LP Aiken SC
Company Name
2. Well Construction Permit 0: On site
List all applicable wall permlls (i.e. County, State, Variance, GUection, etc.)
3. Well Use (check well use):
Water Supply well:
❑Agricultural ❑Municipal/Public
❑Geothermal (Heating/Cooling Supply) ❑Residential Water Supply (single)
❑Industrial/Commercial ❑Residential WaterSupply (shared)
Nun -Water Supply
Injr:Cliutl Well;
❑Aquifer Recharge
❑Aquifer Storage and Recovery
❑Aquifer Test
❑Experimental Technology
❑Geolherrnal(Closed Loop)
❑Geothermul fI•lcatinr/Coolirm
❑Groundwater Remediation
❑Salinity Barrier
❑Stormwater Drainage
❑Subsidence Control
❑Tracer
❑Otherfcxolanl under #21 R
4. Date Well(s) Completed: May 15, 2015 Well mil AW -9D
Su. Well Location:
Duke Energy Sutton Plant
FacilitylOwnerName Facility iD9 (ifapplicable)
801 Sutton Plant Road, Wilmington NC 28401
Physical Address, City, and Zip
New Hanover
County Parcel Identification No. (PIN)
5b. Latitude and Longitude ht degrees/mloutes/seconds or decimal degrees:
(irwau Geld, one Int/long is sufficient)
34 17'3,8076" N 77 58'52.4496" W
6, Is (are) the well(s): pPennuncut or ❑Temporary
7, Is this a repair to as existing well: ❑Yes or allo
Ifrlds is a repair.fill out known well construction b jnrnlati"n and taplaln Ihr nature of the
repair under U.1 remarks section or on the back ofthis farm.
S. Number of wells constnieled: 1
For multiple iq/ection or non -water supply wells ONLY with ilia sante cousiracrion, you can
submit oneform.
9. Total well depth below land surface: 100 (ft.)
For muhlpla wells list all depths tfd117erent (asample- 3@200' and 3@1001
10. Static water level below top of casing: 5.2 (f6)
if wafer level is above casing. use '•+"
IL Borehole diameter: 6 (in.)
For Internal Use ONLY;
FROM To I DFSf_tllt'1'larl
-77 f'' -100 r'• gray silly/clayey sand
rt. n.
]S;13f1'I'CTtr(1151NC'rtrl:niiilll�e:rfed1+•olid:gkl,liYlsIt if4ieultle
FIt D]N TR MAMETFIt Tlnl:lfNPI
sS MATERIA4
ft, ft.
11VINNE]WCASING 1011.7'[1R1NG''•cnllrernrlii�elnscd.lnn r
PROM 14 1 LAkMCTart I TRICICNESs MATTn Ltt,
+3 rr, -90 rL 2 in. ,154 PVC
ft, fr. in.
YII nM 1'0 DIAbtH• 1 SLOTFIZ31 TIt1Cl NESS MATERIAL
-g0 ". -100 rt. 2 t" .010 .154 U pack
n. rr. Iry
FROM TO I AIATERIAL cnlrl,l C.EM t.hT tl1 E'r11O(I tr•AAInUNT
0 rr• -85 r'' cement bento Tremie pressure 1100 lbs
-85 n• -88 f1, bentonite chi: gravity 160 lbs
rr. rt.
1J;;S'Al\D1G11t1V.T;1.:PAfIFC'tiflr r Ilcinlrle :�I� .
FROM TO I MATFRIAl, EA11'Lt CE{11 EN.'I'a4L;'rtrr7n
-88r' -100 rt. silica sand # 2 gravity
ft. fr.
[r16f:L'1„[ra
•'2Oi:f)I111i1YNG'f:L1G 6r¢:relDie[Idirtannfslleals- - "`i
rnom Ta DrSCm FTtt1N koh,, 1 rarest �ulYhvlrla av min nine c, n.i
0 n. •.4 fl. black -gray sand
-4 fr. -49 rL white m -c sand
-49 n, -57 r'• gray silty clayey sand
-57 rr. -77 rt. gray silty f sand
-77 rr• -100 ft. gray silty clayey sand
ft. ft.
rr n.
�1:xillflldl�5 I i . 'I
Protective casing installed
22. Cerlllicntiow
Art reckel- May 16, 2015
SigtmntreofCcrtified Well Contractor Dole
By signing tlds form, i hereby certly that rhe nvell(s) was (were) constructed la accordance
with 1JA NCAC 02C.0100 or IJA NCAC O;C •0300 IVeli Construction Standards and dent a
copy of this record has been provided in ilia wall owner.
23. Site diagram or additional well detulls:
You may use the back of this page to provide additional well site details or well
wnsuucdon details, You may also attach additional pages if necessary.
SUBM177AL 1NSTCICTIONS
24a. P•or All Wells: Submit this form within 30 days or completion of well
construction to the Following:
Division of Water Resources, Information Processing thtit,
1617 Mail Service Center, Raleigh, NC 27(19)-1617
24b. For Inicci(nn Wella ONLY: In addition to sending the foml to the address in
Sonic 24a above., also submit a copy of this form within 30 days of completion of well
12, Well construction method: construction to die following:
(i.e. auger, rotary cable, direct push, etc.)
Division of Watcr Resources, Ulyderground Injection Control Program,
FOR WATER SUPPLY WELLS ONLY: 1636 Alail Service Center, Rnlelgh, NC 27699-1636
13a. Yield (gpm) Method oftest: 24c• For Writer Sappl ' Rte injection Neils:
Also submit one copy or 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 -I Nort11 Carolina Department ofEnvironmcnl and Natural Resources - Division arWaler Resources Revised August 2013

WELL CONSTRUCTION RECD
'nit;r, form can frc used rar single ar aml Iill lc wc.IL
1. Well Conlruclor Information:
Arthur Becker
Well Coutractor Nam.
2201-A
NC WCII Contractor Cenifleallan Number
Cascade Drilling LP Aiken SC
Company Natue
2. Well Construction Permit ll: on site
1.1st all applicable mvell permits (I.e. Cauaty. State, Variance, hVecdon, rtc,)
3. Well Use (check well use):
❑Agricultural ❑Municipal/Public
❑Geothermal (I•leuting/Cooling Supply) ❑Residential Water Supply (single)
❑industrial/Commercial ❑Residential Water Supply (shared)
Supply
❑Aquifer Recharge
❑Aquifor Storage and Recovery
❑Aquifer Test
❑Experimental Technology
❑Geothermal (Closed Loop)
❑GColllermnl f%fcatinulC"nntfnn 1
[]Groundwater Remediation
❑Salinity Barrier
OStomnvater Drainage
❑Subsidence Control
❑Tracer
❑Ritter (cxitlain under 1121 R
4. Date Well(s) Completed: May 15, 2015 Well ID11 MW -23E
5a. Well Location:
Duke Energy Sutton Plant
Facility/Owner Name Faeilily IDA (irappacable)
801 Sutton Plant Road Wilmington NC 28401
Physical Address, City, and Zip
New Hanover
County
Parcel Identification No, (PIN)
Sh. Latitude and Longitude In degrees/minutes/seconds or decimal degrees:
(ifwell field, ono IalAong is sufficient)
34 17'32.712" N 77 59'2.238"
W
6. Is (arc) the well(s): ©Permanent or ❑Temporary
7. Is tills a repair its an existing well: ❑Yes or YJ No
((this is a repair fill aur Awoh,7t wrll eonsrna Non Inun+ation and explain the nature of the
repair uuder 021 rcmardT seeNan or an the back gJihis fm'nr.
8. Number ofwells constructed: 1
For multiple injectron or nun -anter supply wells ONLY with dee same construetion, you can
submit one form.
9. Total well depth helu'v land surface: 150
FormuiNpfe eVU14 list all drplbr lfdoerdu (esample-J r�IIU' amt R(tjr Jv55
10. Stu tic water level lactow lop of casing: 2.88 (fL)
1f starer level Is above casing, use ,+"
11. llorchole diameter: 6 (it'.)
12, Well construction method: Sonic
(i.e. auger, rotary, cable, direct push, etc.)
For Internal Use ONLY:
22. Cerliliculion:
Art`BecLe'' May 16, 2015
Shgnnnuc DfCerti fieri Wal Contraclar Dato
'ay slgnrng "t"' form, I lrrreby eerlyy ihnr the W11(s) was (nan.+r) ennsinrcied in aceordmice
With ISA NG1C 02C .0100 at - 15r1 VC,4C.72C,g2a0 lYa/I Cnnstrnction Standards and rhnf n
copy ofthis record has been provided to the well owner,
23. Site diagram or additional well details:
You may use the back of this page to provide nddidonal well silo details or well
construction details, You may also attach additional pages if necessary.
EallIMI'AI. lN. ,gTUCPIONS.
24a. for All Wells: Submit this form within 30 days of completion of well
construction to the following:
Divlslon of Water Resources, Inronnatiou Pracessing Unit,
1617 Mail Service Cooter, Raleigh, NC.27699.1617
24b. Po ec[lttn SV f1s ONLY: In addition to sending the form to the address in
2"aabnve, also subrnit a Copy of this form within 3D days of completion of well
construction to tic fullowing'
[13a.
OR WATC Division of W;rtcr Resources, Underground Injection Control Program,
R SUPT LY WEDS ONLY: 1636 Mail Service Center, Raleigh, NC 27699-1436r
Yield (gprn) _iYfethod "rtes"• Zoe, ror Water Suptrh' de Eslieet(on iVe11xAlso summit one cagy of tills form widhin 30 days of completion of
h, Disinfecton type; Amount.- well catrstnlclinn in the county health department of the county where
— coaslnlctcd.
Form O W -I NDtdm Carolina Department of Environment and Natural Resources –Division of Wuler Resources
Revised August 2013

WELL CONSTRUCTION RECORD
71is form can be used for single or multiple wells
1. Well Contractor Ififurmation:
Well Conlrnemr Name
2gg2- Ln
NC Well Contractor Ccrtiti aiinn Number
I( lb
o
Company Name
2. Well Construction Permit N:
List all applicable Nell permits (i.e County, Stale, Variance, Ity-lion, weJ
3. Well Use (check well use);
Water Supply Well:
❑Agricultural ❑Municipal/Public
❑Geothermal (Heating/Cooling Supply) ❑Residential Water Supply (single)
01ndustrial/Commercial OResidentiul Water Supply (shared)
❑Irrigation
Non -Wu [or Supply Well:
❑Aquifer Recharge
❑Groundwater Remediation
❑Aquifer Storage and Recovery
❑Salinity Barrier
❑Aquifer Test
❑Starmwuter Drainage
❑Experimental Technology
❑Subsidence Control
❑Geothermal (Closed Loop)
❑Tracer
❑Geathermltl (7-Ieadi1Caolid ?return)
❑011ier (explain undo 221 Remarks)
4. Date Well(s) Y)j
Completed:
-Well ID9 t
5n. Well Location:
rt.
Styr `dry(
V Li h �y 1 �- i'�G�
Facility/Owner Name
Facility iM (ifnpplicuble)
L' i Lsolm
lrA t 1 k m bv V,
Physical Address, City, and Zip
IC I
L1161 -1` UN -� � 0-rP r
rr.
County
Parcel ldenlificationNo. (PiN)
5b, Lulltudc and Longitude in degrees/minutes/seconds or decimal degrees
(ifwcll ticid, one latlong is sufficient)
"•)L1 4 -I1]1 &C 1 N 1° 1��i2�5 _W
6. is (are) (he well(s): ❑Permanent or ❑Temporary
7. is this a repair to on existing well: ❑Yes orNCO
Ifthis is a repair, fill out known well constructor r[rfarnta0nn and expla0r the nitre ofrhe
repair under f121 remarks seclian or on the back oflhis form,
B. Number ufwclls constructed:
For multiple Injection or non -water Supply wells P/VLY with the same construction, you can
submit one form.
9. Total well deptlt below land surface: V') (ft.)
For multiple wells list all depihs ifd fferent (example- 3 n 200' and 2 a 1001
For Inlernal Use ONLY:
f- AVATi'R -l.DNIt9
.
1mom TO
1H St'allP'Itt1N
ft.
ft.
rt.
—51.
rt.
tllirEfllcrlSr.NG I fIrnlunlrlA-cS,1aTrlls OTT"1kISii miFbATFRTAES,leRTC
FhildllF T4
rt.
ft.
in.
16. iNN1':I Vt SMG Oil TT1HiNG cutFlermnl cltl+rd fan I
FROM TO
RIAMElMn. I THICKNF-C$ I ru ATF.FIFAL
rt.
rr, L 1n. I
rr.
rt, in,
IVSC
tUMT TO
111AMETER I SLOTSTl.r.
I rant".1;Mf45 MAITRI L
r
i I1
ft. ft.
in
iK.GiMLf'r.. ,,,...._
1t1L0A1 TO
NIA'ITR A.L VAIP-AC0 1.NT METIl O11 & Aa1OUNT
b ft.
ft.
1 {• f� f,
rt.
ft.
rt,
rt.
la.'st+m icRAvEl. v.tcl, fir111111mide
FROM TO
IATF.mn1. cotta u'tntl7 'rnIF.T'luau
rt. Z j
ft.
fl.
ft.
�t1,-I7IIILiatiVGl-,tits' illraClt lltldlrt[In11I�pIICClS lr neGG3R.
nt[)I%T TO
OfSCarPTfOTd trnlnr (inrdnt6l.. rn11lrRel[r he, ratan fate, eiG.t
ft.
fl,
rt.
ft.
fl,
ft.
rt.
rt.
rt.
It.
ft.
ft,
ft,
n.
22, Certification:
Signature ofCenifted Welt Contractor Dale
Ry signing lois form, I hereby certify that the well(s) was (were) constructed in accordance
with 15d NC11C 02C.0100 or 1511 NCAC 03C,0200 Well Conslntciion Smndards and that a
copy gf1his record has been provided to the Tvell aivner.
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 INSTLICTIONS
24a. Far All Wrils: Submit this form within 30 days of completion of well
construction to the following:
10. Slake water level below top of erasing: A) Division of Water Resources, Information Processing Unit,
Ifunrer/eve/ is above casing, rise "r+ 1617 Mail Service Center, Raleigh, NC 27699-1617
11. Burcllole diameter: `til (in.) 24b. Icor 1 ectinn Well ONLY: In addition to sending the form m the address in
t 24a above, also submit a copy of this form within 30 days of completion of well
12. Well construction method: 1 L� construction to Ilse following:
(i.e. auger, rotary, tabic, direct push, Cie.)
Division of Water Resources, Underground Injection Control Prograut,
FOR WATER SUPPLY WELLS ONLY: 1636 Mail Service Center, Raleigh, NC 27699-1(1
13a. Yield (gpm) Method of test: 24c. icor Water Supply a1'i lo'cctluu 11 db:
Also submit one copy of this foul within 30 daysofcompleiion of
13b. Disinfection type: Amount: well construction la the county health department of the county where
constructed,
Farm QW -1 North Carolina Department of Envirournew mad Natural Rcsumccs — Division of Water Resources Revised Augusl'_013

WELL CONSTRidC' ON RE, CORD
'Mis form can be used for single or multiple wells
1, Well Conlruclor Information:
Well Contractor Name
_I 1 C17 --A
NCWcllContractor Cartirt tion Number
Company Name
2, Well Construction Permit H:
List all applicable ivell perinits (i, e. Coamy. State, Variance, hyeethon, etc.)
3. Well Use (check well use):
Water Supply Well:
❑Agricultural
❑Geothermal (Healing/Cooling Supply)
❑industrial/Commercial
Nan -Water Supply Well:
❑Aquifer Recharge
❑Aquifer Storage and Recovery
❑Aquifer Test
❑Experimental Technology
❑Geothermal (Closed Loop)
❑Gcolhernial (Headrig/Caoling
❑Municipal/Public
❑Residential Water Supply (single)
❑Residential Water Supply (shared)
❑Groundwater Remediation
❑Salinity Barrier
❑Stmmwaler Drainage
❑Subsidence Control
❑Tracer
❑Other (explain under 1121
4. Date Well(s) Completed:
Sri, Well Location:
Fucilily/Owner Name 0 J Facility IDI! (ifopplicable)
BY) uboa IMAMn I- All) I11(i 6nsic.,
Physical Address, City, and zip L Z 1 Q
(we r
County Parcel Idemi6calion No (PIN)
Sb. Latitude and Longitude in degrees/aduutes/seconds or decimal degrees:
(ifwcll field, one lat/long is sufficient)
6. Is (are) the well(s): ❑Permanent or ❑Temporary
7. Is this a repair to an existing well: ❑Yes or I
if lids is a repair, fill ad known nvell construction huforamoloir otn t, plain the nature of due
repair under 01 rennaH s section or wt the bark of dds forau.
S. Number of wells constructed:. w
Formultiple injection or iron -water supply wells ONLY with thesame canyrruciton, you can
submit oneform.
9. Tota) well depth below land surface: 95 (ft.)
For multiple wells list all depths tf dt ereal (example- 3 n 200' and 2@100')
100')
10. Static waierlcvcl below lop ofcusing: (ft,)
Ifwater level is above casing, use "+"
11, Borehole diameter: (in.)
12. Well construction method: Wo 9 I (./
(i.e auger, rotary, cable, direct push, ero.)
For Internal Use ONLY:
l4, MIATME 7,ONL5
Ir11ON1' TO DES CteIPT[ON
fl, rt.
ft. rt.
15J)UTERCASING t rur "Iutlk;ts 'd vc1T5 U1t. nit Ira dichldel
Inaom Tn THICICNE&I NA'YEmAL
ft. ft. in.
16..TT4NTR C!M;ING OR f lMING 90thc6nalctnied-0nn
i imm TO DIA\tMIt TMCKNESS MATERIAL
fl. L 10 '- ?_
fl. ft. in.
17 SC1ti T N
Flr flat J TL�[1J t11AN1 ETER SLOT SIF.t: TI WIL-iLSS ATEtmAL
3 1 " in' F_V(,
fl ft. Inn.
FROM TO MAI ERIAI. f1n'LtCEtS1ENT'Nii:'i llnD&.%NJ OIINT
fl. 3 ir. An n
ft. ft,
fr. rt.
'M SAND/GRAVEL TIACK tin tlraw r)—
izabru- TO NIATEHIAL Em m,6r-LM EN -rat -n Kio
rt. 1. rl r1
ft, ft.
-]at DRILIA to LOG tiltirch additional dllech irriecra ory
MOM TO Dr-SCIUM011 I[»Irir Is»nlnuc �niifrve.lr tp»c. grain tire, rrr p
ft. ft.
ft. a.
ft. ft.
m. ft,
ft. ft.
ft, rr.
21. RLNIAI{1LS .
22, Certification:
Si$rarlsue urCenified'W l Conlruclor Dile
0y signing Mix fora, 1 hereby certify that the nvel!(sJ it -as (were) eotalr ucted in accordance
with 15d NCAC 02C.0100 or lSrl NCAC 02C,020[) IVcll Consinielion S'tandnrds mud that a
copy oftltis retard 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
24u. Far All Wells: Submit this form widiin 30 days of completion of well
construction to the Ibllowing:
Division of Water Resources, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
24b. Icor Infecilou Well% ONLY: In addition to sending die form to (lie 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 Mall Service Center, Raleigh, NC 27099-1636
13a. Yield (gpm) Methnd of test: 24c. _FarWaier Supply & Inleetitm Welts:
Also submit one copy of this form within 30 days of completion of
13b. Disinfection type: Amount• well construction to the county health depurtment of the county where
constructed.
Form GW -I Nordl Carolinu Department of Environmcol aid Natur l Resources —Division of Wnter Resources Revised August 2013

"ReviSldi
WELL CONSTRUCTION RECORD
This thrm can lie used ror ainyle or multiple wells
L Well Contractor Information:
Timothy D. Leatherman
Well ContrnclorName
2888-A
NC Well Contractor Cutificalion Number
Cascade Drilling, L.P.
Company Name
2. Well Construction Permit #:
List all applicable well permits (te. County, Stale, Variance, hVection, e1c.)
3. Well Use (check well use):
Water Supply Wall...
❑ Agri cu I tura)
❑Geothermal (lfeating/Cooling Supply)
❑industrial/Commercial
Nun-Waicr Supply Well:
❑Municipal/Public
❑Residential Water Supply (single)
❑Residential Water Supply (shared)
❑Aquifer Recharge
❑Groundwater Remediation
❑Aquifer Storage and Recovery
❑Salinity Barrier
❑Aquifer Test
❑Slormwater Drainage
❑Experimental Technology
❑Subsidence Control
❑Geothermal (Closed hoop)
❑Tracer
❑Geothermal(Rcating/c-unlingUclom)
❑Olher(avplainunder #21I
4. Dale Well(s) Completed: 4-14-15 well iDir S M W 1 B
.in. Well Location:
Duke Energy Progress, Inc.
Facility/Owner Name Facility 1D/1(if opplicablu)
801 Sutton Steam Plant Road, Wilmington, NC 28401
Physical Address, City, and Zip
Hanover
County
Parcel Idenlificulion No. (PIN)
5b. Latitude and Longitude in degreeshninules/seconds or decimal degrees:
(if well Geld, one lut/long is sufficient)
341735.6 N 775840.5 W
6, 1s (arc) the wcl[(s): 67Permunent or ❑Temporary
7. is this a repair to an existing well: ❑Ycs or ©No
Ifildr Is a repair, f it out known well construction Ljumadon and erplain ehe nantre ofihe
repair under 021 remark section or on the bock ofdiis farm.
8. Number of wells construcled: 1
For multiple i4ectiaa or non-watersupply wells 01V4Yi drh die tame construction, you can
subndt one form.
9. Total well depth below land surface: 23'9 (ft,)
For multiple ivells list all depths {jdigrrent (arample• 3Qa 200' and 2@ 1001)
10, Static water level below top of easing:
ifuVicr level is above rasing, use "+ "(
11. Borehole dinlurier: V,1
(in.)
Vt.)
For Fnteroal Us. ONLY:
]-i:]VATk;H ZONRS:, -'
FROM To nrscrtn'Tni:s• _ - .
-
n. n.
-35.�4[1'ltiliCASINGfurinldli-ctucdtvells URt.lNEIR'ifnvf li Dille' .::::::.::.:::::::.::..:
FROht •rn OtAaln '1'ltlrJl{*tEssI MAT IrAL
ft. ft In.
1.FNNERCA.4ING:O1- ING.. ernthirinalc[nbed-lawn "•
�6.:.: ...
771TI8'3'.
mAriMM11 TFIIEKNV.% 7fA9 rt. 2 hSch. 40 PVC
ft, in.
MOM I TO nIAt1IFTRA I S:.0T,414 . T I I I I' iM1F58ai,ITE AUAL
18.9 it' 23.9 n• 2 !" .10 Sch. 40 PVC
ft. ft, in
l -R-0 t TO MATLNAL F:hIM% EMENT6-114THOU MOUNT
0 ft' 13,6 «• Portland Tremie
13.6 rl 16 rt' Bentonite
M SANDiGMVELrACK I riii, a 1161 pie)
Y9051 TO I MATERIAL I 1"at1'I,ACrA1CNTMETnDn
16 rr• 23,9 f1- Sand Sonic
CI. fl.
211:IM11di'MrvLQC. liMoctiaildhIamilalice"!rrinacssa ')
Fr1OM1l TO ne_ti C:lilPTiON cal an t,anlrrur suly-1; ry lie. UrAll rlxe, cic.I
fl, ft.
tr. A.
- rt. rr,
fit. rt.
ft. n.
fl. ft.
rr. ft.
`AliiiF.M1fAllFi5 '
22. Certification:
Sign�uture orccttificd Well Conlin— cluurr Dote
By signing Nds form, 1 hereby cert, that rite wells) ow (were) constructed In accordance
with ISA NCAC 02C.0100 or 15A NCAC 02C.0200 Kh' Cmrsinicilon Siandards and that a
copy ofthis record has been provided to the well owner.
23, Site dlugrarn or udditional well details:
You may use the back of this page to provide additional well site details or well
construction details. You may also attach additional pages if necessary.
SUBMITTAL 1NSTUCTIONS
24a. For All WON: Submit this form within 30 days of completion of well
construction to the following:
Division urWater Resources, Information Processing Unit,
1617 Dlail Service Center, Raleigh, NC 27699-1617
24h. Fnr lnit rihm ►Vella ONLY: In addition to sending die form to the address in
Sonic 24a above, also submit a copy of this form within 30 days of completion of well
12. Well construction method, _ construction to the following:
(i.e. auger, rotary, cable, direct push, cle.)
Division orWnlerResources, Underground injection Control Program,
FOR WATER SUPPLY WELLS ONLY: 1636 Mall Service Center, Raleigh, NC 2769.9-1636
13a. Yieldm 24c. [''or 11'nler Supply . leljeClitin �Ve1L:r
(6P ) Method of test; , Also submit one copy of this form within 30 days or completion of
13b. Disinfection type; Antounl: well construction to the county health department of life county where
constructed,
Fano GW -1 Nordr Carolina Department ol'Environnrcnl and Natural Resources - Division of Wmer Resources Revised August 2013

MLLCONSTRUCTiON RECORD
'Mis form can be used for single or multiple wells
1. Well Contractor Information:
Timothy D. Leatherman
Well Contractor Name
2888-A
NC Well Contractor Certification Number
Cascade Drillinq, L.P.
Company Name
2. Well Construction Permit N:
List all applicable well permits p,e. County, Stale, Variance, btecdon, etc.)
3, Well Use (check well use):
Water Supply Well:
❑Agriculturul
❑Geothermal (Heating/Cooling Supply)
❑industrial/Commercial
Nun -Water Supply Well:
Injection Well:
❑Aquifer Recharge
❑Aquifer Storage and Recovery
❑Aquifer Test
[]Experimental Technology
❑Geothermal (Closed Loop)
❑Geothermal (Heating/Cooling
❑Municipal/Public
❑Residential Water Supply (single)
❑Residential Water Supply (shared)
❑Recovery
❑Groundwater Remediation
❑Salinity Barrier
❑Stomtwater Dra(nagc
❑Subsidence Control
❑Tracer
❑Other (explain under 421 Remarks)
4. Dale Well(s) Completed: 4-14-15 Nve11 mN SMW 1 C
5a. Well Locution:
Duke Energy Progress, Inc.
Facility/Owner Name Facility 1D11 (ifopplicable)
801 Sutton Steam Plant Road, Wilmington, NC 28401
Physical Address, City, and Trp
Hanover
County
Parcel Identification No. (PiN)
Sb. Latitude and Longitude in dcgrecs/minutes/seconds or decimal degrees:
(ifwell field, one taUlong is sufficient)
341735.6 N 775840.6 W
6. Is (are) the wcll(s): OPermanenl or ❑Temporary
7. Is this a repair to an existing well: ❑Yes or CINo
1f this is a repair, fill out known ivell construction Information uxd explain the nature of the
repair under 1121 renrnrla section or on the back of this form.
8. Number of wells constructed: 1
hbr nmtriple injection or amt -water supply ivells ONLY wide die same cuasvructinn, yrm can
submit one forni.
9. Total well depth below land surface: 46 (fL)
For multiple ivells list all depths (f d(ffereni (example- 3@200' and 2@100)
100)
10. Slatic water level below lop orensing:
If ivarer level is above casing, use "+"
(ft.)
For internal Use ONLY:
_[�:iVA'P11R�ON1iS
FROM TO ot-grnlVT oK
ft, ft.
ft, ft.
16. 00TLR CASING frof ifs -Olt LINh;tt ifui Itrenble
FiIAhf Tn alAN1F"I'E;a 7T(FCIIMESS AIATEIGAL
rt. rt. In,
16. INNER CASING Olt Tu11tNG rcnlhermnt'r 461-ld i .
3,110111 To nrnntl 1,11 THIMMI:S MATERIAL
0 ft. 41 ft. 2 IM Sch.40 PVC
ft. ft, In.
pHONI Tn 11r,1.NlFTEIt 6Lr1TSIZE T:I«'RNrsrl NtAMiZAA
41 ft' 46 ft. 2 In. .10 Sch.40 PVC
R. ft. in.
lg. GRO U-1 - ::........
nal —' znMATERIAL _ eta I.sr.I:ntcwT NIIE'Trinn s AM(KNT
0 ft' 36,7 rr. Portland Tremie
36.7 ft• 38.5 ft. Bentonite
fl. ft.
yu. SAN171DRAVi(f:)' m fira dicubic
17l{INI To AIATERIAI. [_NSPI,A['t:,li};NTN1 Txrtn
38.5 ft' 46 ft. Sand Sonic
ft. ft.
7l].iD I1LL1Nt: l.;f]I; anncb ual+lislurird Elremlt'if neCGi6nn
mto,I ern Fia C1;ZPTtox tcol.r,l.aE•d„rs, lorthicil YY n% �n,la rlr:. ehe.9
ft. rt.
ft. It.
ft, ft.
ft. rt,
ft. ft.
It. ft.
ft. rt,
V. RMIAR1l5• ,. _ .. ... .
22. Certification:
-� d Ll s
Signature of carred Well Co +vactor Dae
By signing rids form. 1 hereby certify that the wells) ons (were) constructed in accordance
with ISA NCAC 02C.0100 or ISA NCAC 02C.0200 0tell Couuruction Standards and that a
copy ofthis record Inas been provided m the well oivner,
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 uttach additional pages if necessary.
SUBMITTAL INSTUCTFONS
24a. For All Wells: Submit this form within 30 days or completion of well
construction to the following:
Division orwater Resources, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
11. Borehole diameter: S (in.) 24b. Far infection Wells ONLY: In addition (o sending tie form to the address in
SORIC 24a above, also submit a copy of this form widtin 30 days of completion of well
12. Well construction method: construction to the fallowing:
(i.e. auger, rotary, cable, direct push, etc.)
Division of{VulerRrsourcrs, Underground injection Control Program,
FOR WATER SUPPLY WELLS ONLY: 1636 Mail Service Center, Raleigh, NC 27699-1636
13a, Yield (gpin) Method of test: ` _ 24e, For Water Supply & Inlecllon Wells-,
Also submit one copy or this form within 30 days or completion of
13b, Disinreetion type: Amount: well construction to the county health department of die county where
constructed.
Form GW -I North Carolina Department of Envirunment and Natural Resources —Division of Waier liesources Revised August 2013

WE'LL CONSTRUCTiCNV RE, CORD
This farm can be uscd for single or mulliplc wells
ff.
1, WellContractur information:
I& Ol TER CASING.' far�nwlH-rased lxs}is pR'[,INldlt Iru�r-Ilenblc ..
- `oawA Ctok M/n
DT,%riL F°R TIIILKNUSS AIATCMI.AL
Well Cuntruclor Name
rt. in.
% C
4I q 7 _:A
FROM I Tin
NC Well Contractor Certification Number
a ft.
�K(fule V�lllIno
rl.
Company Name
2. Well Construction Permit M _
Qiv TO
List all applicable hell perndls (i. e. County, State,
Ynriance, Injector, ere.)
3, Well Use (check well use):
ft.
Water Supply Well;
ft.
OAgricultural
OMunicipal/Public
❑Geothermal (licatinglCooling Supply)
❑Residential Water Supply (single)
❑Industrial/Commercial
❑Residential Water Supply (shared)
Olrri niton
[l rl, c:
Nun -tauter Supply Walb
w
Munituring
ORcenvery
Injcrilnn Well:
OAquifer Recharge
❑Groundwater Remediation
❑Aquifer Storage and Recovery
❑Salinity Barrier
❑Aqui for Test
OStormwaler Drainage
OExperimental Technology
❑Subsidence Control
OGeothermal(Closed Loop)
❑Tracer
1713aathemnal(ileating/CoolingRctuin)
❑Other(explain uncle 421 Remarks)
4. Dtllc Wcll(s) Completed; t Well TDN pz4
Su. Well Location;
PAW -Z3
Focilily/Owner Nnrnc
Facility IDN (ifopplicable)
,b1 (�it1---1st - 1b€'tlm ?1t.L'fi1„jj&%AMcrL
Physical Address, City, and Zip
County
Parcel identification No. (PIN)
5b. Latitude and Longitude in degrees/minutes/seconds or decimal degrees:
(if -well Relit, one inOong Is sufficient)
�ft N (°ii-�_r�c�t LT W
6. Is (are) tiicwell(s): 011crmmnent or ❑Temparary
7. is this a repair to an existing well: ❑Yes or'i(1No
Jfthls Is a repalr,� ll mat known Ive/i construction h forntailou a hd ehlrluin lire naitird afthe
repair under #21 remark section or on the back ofthis form.
S. Number of wells constructed:
For audilple hVecilon or non -a -alar sig+pii, ivells ONLY wish the sante construction, you con
subndtoneform.
9. Total well depth: below land surface: �_� (fl.)
For mtdilple wells list all depths if dVerent (eraniple• 3 200' mid 3Qo 100)
10. Static water level below lop of casing: (ft.)
lfnnter level is above casing, rise.
11. Burchole diameter:
12. Well construction method: S'oyl1 t
(i.e. auger, rotary, cable, direct push, etc.)
FOR WATER SUPPLY WELLS ONLY:
13u. l'Icld (gpm),--A.,_ Nfclhod of test:
13b, Disinfection type: _ Amount:
For Inleral Use ONLY:
ft.
ft.
ff.
ft,
I& Ol TER CASING.' far�nwlH-rased lxs}is pR'[,INldlt Iru�r-Ilenblc ..
rRoMTQ
DT,%riL F°R TIIILKNUSS AIATCMI.AL
>t.
rt. in.
16,.INNRR "INC OR TULING audlhernrnl clused luo
FROM I Tin
I DIAMETER I T1110i01ESS AIATERr.AL
a ft.
r1. la I C Aj
rl.
rr. In.
Qiv TO
niAMFT£n FLOT SIZE THICKNESS AIATERIAL
,7 fL
ft.
2.in.
ft.
fl.
In
lS.GROIIT
`
"- M To
nlATEMAL I FAIMACal MffAt>e'Trlpu&ANI0tlnT
[l rl, c:
rt.
r 1 r
fl.
fl.
a9, sdl+(I11t�R;t V> L PAC]: (I nip iucubm '
ntolll TO
MATERIAL EMPl.ACEINWNTMETWOD
fL
a
ft.
rt.
ft.
;,ao:ntt14L7Nc ]:r7t; rrivaali`addltlnnnt slicelsdraceess6rvl . ' ...
rt.
rt.
ft.
rL
fl,
ft.
ff.
ft.
fr,
fl.
fl.
ft.
rr,
rt
22. Certification:
sigrmuur rr Canificd Well Cuotracl uDale
By signing ibis form, I hereby rerl((y Ihat the well(s) was (were) cottrtnicted in accordance
wish 1511 NCAC 02C,0100 or 15A NCAC 02C.0200 IVell Constriction Standards and that a
copy of this record has been provided to the well owner,
23. Site diagram or additional well details:
You may use the back of this page to provide additional well site details or well
construction details. You may also attach additional pages if necessary
SUBMITTAL INSTUCTIONS
24a. W'Dr_All WelM Submit this form within 30 days of completion of well
construction to the following:
Division of Water Resources, information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
24h. 1 --or In(rclion_Wclls ONLY: In addition to sending lie 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 11rogrnm,
1636 Mail Service Center, Raleigh, NC 27699-1636
lac. For Witter Supply Ift in ectian Wells:
Also submit one copy of this form within 30 days of completion of
well construction to the county hcnllh department of the county where
constructed.
Form OW -1 North Carolina Department orLnvironmcul and Natural Resources — Division of -Water Resources Revised August 2013

WELL, CONSTRUCTION RECORD
'Lis form can be used for single or multiple wells
1. Well Contractor informnlion;
1(_ (0 r W nn
Well contractor Name
?LGA (i 2 — A
NC Well Contractor Certifmalion Number
JUS C.[A6f, Ci ti i�iti fl
Company Name
2. Well Construction Permit ti:
List all applicable Nell permits (I,c. Counry, State, flariance, hyection, etc.)
3. Well Use (check well use):
wnter Supply well:
❑Agricultural ❑Municipal/Public
❑Geothermal (Heating/CoolIng Supply) ❑Residential Water Supply (single)
❑Industrial/Commercial ❑Residential Water Supply (shared)
Nun -Water Supply Well:
DAquifer Recharge
❑Aquifer Stnmge and Recovery
❑Aqu i fcr Test
❑Experimental Technology
❑Geothermal (Closed Loop)
❑Recovery
❑Groundwater Remediation
❑Salinity Barrier
❑Stormwater Drainage
❑Subsidence Control
❑Tracer
❑GeolhefrrlUl {FIE:atingJL".nUling S(eflll7i) ❑Odlcr (explain tinder A21 RCplurks) j
4, Dale Well(s) Completed: P 5Well iDM_
Su. Well Location:
1{ nL
Faeilily/Owner Namc Facility IDN (iruppiicnble)
t... & t4K u 11 knw!(, `
Physical Address, City, and Zip
County Pored identification No (PIN)
5b. Latitude and Longitude in degrees/minutes/secunds or decimal degrees:
(ifwell field, one Iat/long is sufficient)
611 261 n 6%� N 71 - CE �', �f i 1V
6. Is (tire) the well(s): 01'ermanenl or ❑Temporary
7, is this a repair in an existing well: ❑Yes or QDIG
Jfthis is a repuir, Jill out hatorvn well construction h formation and explain the nature of tha
repair under 921 rvnhar/ts section or an the back of Uds farm,
B. Number of wells constructed: _
For multiple injection or non-tvatersupply wells ONLY wish rhe same construction, you can
submit one form.
9. Toted well depth below land surface: D
For mulliple wells list all depths if different (example- 3 x(}1011' and 7@ 100'i
],'or Inlemnl Use ONLY:
`:1.1.1VA'fL11,SG1711G5:.: -
RIOM1l TO IMSCIUMUN
rt. R.
ft, ft.
i5: DEITiMCASING f+hrmuld wised tvc�t3R
14NM lra t licable
F1ri,A1 10 nIAbTMR
THICKNESS MATERIAL
rc
rt. la
.:15TN'{ RCi151Ni:.DR.ZTIII(NG f a eutlrcrnnatefmaed-luo- `
Fltom TO nIAHI£TEIt 1' IIi:1ffNxss a1ATEIum,
it , rt. 2 in.c , Ll e
ft, fl. In.
ImON
nrA1WTFr1 SLOT517dt
'ruicKxE55
r.IATF.RIAL
„ft.q!s 1
try _f� 0
v�
ft, fl.
In.
FROM TO al. TERIAL F:AI I'I:c1 CE hlcriTAICI-Ittnl ti A1ll OUNT
o rt. � fl c , r fn i
ft. ft.
rt. rt.
19. SANDiGRAVEL PACIi Ira 1 licablc
FROM To M1IATeRTAl., £M1t 1'L.AC£M1t Rf"rl-dfE771D 11
3-7 rt. 1115 fl. San [
ft. ft. -
2K.DR1LIJNG LOC. y4ch othlIII usoul iboeis II'm dsatsffl. Z-:'
1•`r ho TW
nFS C1tIPT10N cuter, ltnnntrrc, cu9irn�ekt r. r.Jn etre cnc.1
ft. fl.
fr. ft.
ft. ft.
a. ft.
fl. ft.
Ft. ft.
fr. rt.
21.lu?AlARKS
22. Certification:
Signaturu of Certified Well Contractor Dale
By signbrg this form, 1 hereby cerh, that the nrll(s) naw (were) constructed In accordance
adlh 15d NCAC 02C.0100 or !Sd NCAC 02C.0200 well Construction Standards and that a
copy of this record has been provided to the (veil owner,
23. Site diagram ur additional well details:
You may use the bock of this page to provide additional wolf site details or well
construction details You may also attach additional pages if necessary.
SUBMITTAL INSTUC IONS
24a. icor All Wells: Submit this form within 30 days of completion of well
construction to die following:
Ill. Static water level below top of casing: (ft-) Division of Water Resources, Infonnnliun Processing Unit,
Uwaier level is above casing, use "i " 1617 Mail Service Center, Raleigh, NC 27699-1617
11. Borehole diameter: 60 (in.) 24h. For In}erliwn Wells ONLY: In addition to sending the form to the address in
24a above, also submit a copy of this form within 30 days of completion of well
12. Well construction method: S )n I U construction to the following:
(i e. auger, rutary, cable, direct push, ale.)
_ Division ufWuter Resources, Underground Injection Control Program,
FOR WATER SUPPLY WELLS ONLY: 1636 Mail Service Center, Raleigh, NC 27699-1636
13a, Yield (gpm) Method or test: 24c. Par Water Supply St ltdcetian Wells;
Also submit one copy of this form within 30 duys efcomplelion of
13h. Disinfection type: _ Amount: well construction to Ulu county health department of Ole county where
constructed.
Form GW -1 Nortb Carolina Department ofEnvirCHIM-1 and Natural Resources - Division ofWuter Resources Revised August 2013

WELL CONSTRUCTION RECORD
This form can be used for single or multiple wells
1. Well Contrae(or Information:
1 0' t �-
Well Contractor Name
2(AL-:A -
NC Well Contractor Certification Numbrs
r` t. LL I Yl
Company Name
2. Well Construction Permit #:
List all applicable well permits (i.e. County, State, Vartance, Injection, ere.)
3. Well Use (check well use):
For Inlcrnul Use ONLY:
ft. I ft,
ft, j ft.
f74f7M11
7D nlAilrF:TEn
T1iIC7,'IYP59
a1,5T¢6Lf,AL
ft.
ft. En.
'.IE; idellYLli CASING 01VIVRING eothcI clikitird4ndtil
F7tr7R1
TO -
ntdrlTMM
Trr1C'K14M
t11ATEMAL
o
j7yb.
n.
to.
in
❑Agricullurul ❑MunicipaliPublic
❑Geothermal (I•icuting/Cooling Supply) ❑Residential Water Supply (single) fl.
❑Industrial/Commercial ❑Residential Water Supply (shared) kD
Nun-1Vuler Supply Well:
]. onituTing 011ccovery
Injection Nell:
❑Aquifer Recharge ❑Groundwater Remediation
❑Aquifer Storage and Recovery ❑Salinity Barrier
❑Aquifer Test ❑Stormwater Drdinuge
❑Experimental Technology ❑Subsidence Control
❑Geothermal (Closed Loup) ❑Tracer
EIGcolhcrmal HeatitiCoo iag�lReturn) ❑Other(explain under#21 R maria)
4. Date Well(s) Completed: J i' S Well I ft . - .� &
5a. Well Location: G KW — c":5 T3
Ag,'61F I�� aNI
FuciGtylChvner NTuneW Facility ID# (ifapplicnbio)
i r' k^rY�1)L'h, i
Physical Address, City, and Zip
f -"^j lAlAnoJEf
County Parcel identification No. (PIN)
5b. Latltude and Longitude in degrees/minutes/seconds or decimal degrees;
(i(well field, one laUlong is sufficient)
b. Is (ara) the well(s): ❑Permanent or []Temporary
7. Is this a repair to an existing well: ❑Yes or 11U
If this is a repair, fill Diff lanais well construction iri/armarlon and explain the nature of the
repair ander 031 remarla section or on the back ofthisform.
8. Number of wells constructed:
For mulliple. injection ortmn-nater supply wells ONGI' n'ifb the same eonstrucilon, you car
submit one fomi. �f I
9. Tntal wrll depth below lantl surfaA
ce: •C9 (ft.)
For muldlile rveils list all depths ff d(fjterent (example- 3 x@200' aid? 2@100')
10. Static water level below lop of cusin6:
lfwaterlevel is above casing, use "+"
11. Borehole diameter:
w
12. Well construction method:
(i.e auger, rotary, cable, direct push, ele.)
FOR WATER SUPPLY WELLS ONLY:
13a. 1'leld (gpm) Method of fes(:
136. Disinfection type; Amount:
ff.
t fr. in.
fl. En.
R1ATt'it Li L.
Ct, f
r
fl.
ft.
`SL PACK lura neuhie)
h1.i TEIITAL
� fl.
ft.
FROM TO DFS CIL I FT] ON frAur, Im rditrar "IV rntk! nun xire, ell.
ft. fL.
A. R.
fi. fl.
fr. ft.
n. ft.
ft. ft.
l n. R.
2L REMAIIIiS
22. Certification:
Sigttalurc of Cenificd Well Contractor Dale
By signing this form. I hereby cert(%y that the ivell(s) tvns (were) constructed in accordance
ndth 15A NCAC 02C.0100 or 15A NCAC 02C 0300 Well Consintcrion Standards and that a
copy Dfilds record has been provided to the well onvner.
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 fNSTUCTIONS
24a. For All Wells: Submit this form within 30 days of completion of well
construction to the following:
Division ttf Wu(cr Resources, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
24b, liar iniection Walls ONLY: In addition to sending die form W the address in
24a above, also submit a copy of this form within 30 days of completion of well
construction to the fallowing:
Division of Water Resources, Underground Injection Control Program,
1636 Mail Service Center, Raleigh, NC 27699-1636
lac. For Wa(cr SVrily& injection Wiens:
Also submit one copy of this form within 30 days ofcomplelionof
well construction to Ilie county health department of tate county where
construcled
Form GW -I Norio Carolinn Department ofEnviroumem and Nnlwal Resources—Division of Water Resources Revised August 2013

MLELL CONSTRUCTION RECORD
This form can be used for single or multiple wells
1. Well Conirnelur Infurmalton:
Well Contractor Name
NC Well Contractor Certifncelinn Number
S�\' Ac
Company Name
2, Well Construction Permit fl:
List all applicable +veil perinlis (i.e. Courtly, Stare, Variance, Igleclon, ere.)
3. Well Use (chcelt well usc):
Water Supply Well:
❑Agriculturul ❑Municipal/Public
❑Geolhertnal (Heating/Cooling Supply) ❑Residential Water Supply (single)
❑Industrial/Commerciul ❑Residential Water Supply (shared)
❑liri anon
Nun -Writer Supply Wcll:
❑Aquifer Recharge
OAquifur Storage and Recovery
❑Aquifer •rest
❑Experimental Technology
❑Geothermal(Closed Loop)
OGeothermal (1-Ieattn Coaling Ratan
❑Groundhvalcr Remediation
❑Salinity Barrier
❑Stormwatcr Drainage
❑Subsidence Control
❑Tracer
❑Other (explain under' 21 Remarks
-rrn.r
4. Dale Well(s) Completed: __ L`1 u l`1iVc11 IDft j
5a. Well Lachlan:
Faeility/Owner Wine Facility 1D# (iropplicabic)
• u s x+ t- r rs this ls- a w�.w. Ell
Physical Address, Cily, and 7Jp
County Parcel Identification No. (PM)
5b, Latitude and Longitude in degrees/minules/seconds or decimal degrees:
(ifwell Geld, cuts lat/long is sufficient)
For Internal Use ONLY;
aW- WA -11.11 Zn NJ-,';
ft fl,
ft. I rt.
HUM'rO
DWIF.TF.R
nnCKNFSS MAMIAL
fl.
fl. in.
By signing this form, I hereby cerilfy liar the u•ell(s) was (mere) consinicred in accordance
6ANNER:C,kSING DR 13ING culbcmtn] chmcd-lira
nom TO
TlticxKms TuATEWAL
GDIAMETER
lJ fl. 1'4f 1 • l
ft. .�f in. yJ
L r
fl.
ft. in.
a. scrlEEnt,: :.. .
ICOM TDDIAMETEII
8. Number al -wells cunstructed:
SLOTSt7.E TUIC K NE.S:i il[hTknIAL
-sj ft. IL' -'A.
IfZ In.
Pile
0. rt.
in
24a. Tar All Wells: Submit this form within 30 days of completion of well
For multiple ivells list all depolr (f d&rent (example- 3 a 200' and? a 1001
construction to the following:
Rohl TO
MATEMAL rnirl,Ar-eptl;'vT nI L'77iuu.a Ant 1
p ft.r
rt. ['t S C1
ft,
ft.
ft.
rt.
1- SAri YGRAVEL PACK irm -linable
'tool TO
ILMEFAL
I i'hll'LACEntLMrnun,nou
J ft. ! 5
r
Division of Water Resources, Underground Injection Control Program,
TOR WATER SUPPLY WELLS ONLY:
A.
rl.
Zoe, For (Vater Supply & In limethiis Wells:
I�DR1LLfNC,?iDG-(nalusli'tiildliiunulelreetsifueeessgr}1 -
tohi-TT O
DESCRIPTION (.0— 11-1. L...,niu rano Prov- —1n .Ire - .f e_1
1`111 REMAIMS :: - . .. I
22, Cerlificnlion:
�1` � i 3� Ce+(.1 � � ,.sur
� alClb N �_�,t
C. "
�.� � C
Aiguature urce^rtmeti Wall Entumetar Data
6. Is (are) the R'ell(s): 01'ermanent or ❑Temporary
By signing this form, I hereby cerilfy liar the u•ell(s) was (mere) consinicred in accordance
with 15.4 NCAC 02C.0100 or 15A NCAC 02C./1200 Well ConstrmNon Standards and char a
7. Is this u repair to an existing well: ❑Ycs or `RNu
copy oftlds record Ira, been provided la rhe well oirtter,
lfthis is a repair, Jill out knomu meli construction igfarmation and explain the name oftbe
repair under #21 remarks secdon or on the back ofthisform.
23. Site diagram or additional well details:
You may use the back of this puge to provide additional well site details or well
8. Number al -wells cunstructed:
construction details. You may also attach additional pages if necessury
For multiple injection or non -rater supply n'ells ONLY ivith the same construction, you can
submit one fans,
SUBMITTAL INSTUCTIONS
11 !! I _
9. Total well depth below land surface: ` 1 Lk C� (ft.)
24a. Tar All Wells: Submit this form within 30 days of completion of well
For multiple ivells list all depolr (f d&rent (example- 3 a 200' and? a 1001
construction to the following:
10. Slotle watL'r level below lop ol'casing: (rt)
Division of Water Resources, Information Processing Unit,
If water level is above casing, use " i•"
1617 Mall Service Center, Raleigh, NC 27699-1617
H. Borehole dinmcler: ,-_- Cl' (in.)
24b. l7nr Inieelhiri }Valls ONLY: In addition to sending the form to the address in
24a above, also submit a copy of this form within 30 days of completion of well
12. Well construction melhod: C lri
conswclion to the following:
(i.e• auger, rotary, cubic, direct pusli, etc )
Division of Water Resources, Underground Injection Control Program,
TOR WATER SUPPLY WELLS ONLY:
1636 Mall Service Center, Rulcigh, NC 27699-1636
13a. Yield (gpm) Method of test:
Zoe, For (Vater Supply & In limethiis Wells:
Also submit one copy of this form within 30 days ofcompletionof
136. Disinfectlon type: Amount:
well construction to the county health department of the county where
constructed,
Form GW -I North Carolina Department of Environrnctit said
Natural Resources — Division of Watcr Resources Revised August 2013

WELL CONSTRUCTION RECORD
This form can be used for single or multiple wells
L Well Contractor Information:
Timothy D. Leatherman
Well Contractor Name
2888-A
NC Well Contractor Certification Number
Cascade Drilling, L.P,
Company Nome
2. Well Construction Permit N:
List all applicable Nell pertn0s (r. e. Count), State, Fariance, bfection, ere.)
3. Well Use (check well use):
Water supply well:
❑Agricultural
❑Geothermal (Heating/CoolingSupply)
❑ industrial/Commercial
Nun-Wu(er Supply Well:
Injection Well:
❑Aquifer Recharge
❑Aquifer Storage and Recovery
❑Aquifer Test
❑Experimental Technology
❑Geothermal (Closed Loop)
❑Geothermal (Pleating.,/Cooling
❑Municipal/Public
❑Residcntial Water Supply (single)
❑Residential Water Supply (shared)
❑Groundwater Remediation
❑Salinity Barrier
❑Stormwater Dminagc
❑Subsidence Control
❑Tracer
❑Other (explain under /!21 V
4. Date Well(s) Completed: 4-14-15 well 1119 SMW4B
Su, Well Location:
Duke Energy Progress, Inc.
Facility/Owner Name Facility 1D4 (irupplieablc)
801 Sutton Steam Plant Road, Wilmington, NC 28401
Physical Address, City, and Zip
Hanover
County
Puree[ Identification No. (PM)
5b. Latitude and Longitude in degrees/minutes/seconds or decimal degrees:
Orwell field, one IaUlong is sufficient)
341808.1 N 775852.7 W
6, Is (arc) the wcll(s): COPermmnent or ❑Temporary
7. 1s this a repair to an existing well: ❑Yes or ©No
lfdds is a repair, fill our known well construction information and explain the nature ofthe
repair under #21 remarks section or an the back oflhis form,
S. Number of wells constructed: 1
For multiple Infection or non -water supply wells ONLY with the same cautstructlon, you can
submit one form.
For internal Use ONLY:
-14;11A"1'Ek JCSNFS
FROM To aescmPT101'4 -
ft. ft.
ft. ft,
i15, OUTER* CASING for inulti-cascdsvells f1R'L1NCitfifii 'ikrdila
Ft nsr T1 nunleTEu Trncrttvrss nuTE;•n1AL
In.
16. INNIU1 CASING OR:
_URING' .eutlrerrrinithiscd•luu
Cn 01 TO n1AA1F.TF.11 THIC1 NT9S hiATKnIAt. _
0 ft, 19 fL 2 (n• Soh. 40 PVC
ft, ft, im
FItr1,11 Tn ulAht ETER SLOTS= TIIICI.Nk1511' IATMJAL
19 «, 24 n. 2 in. .10 Sch.40 PVC
ft, rd,
78`R:r OIIT. ..._ .. _ . .
FROM TQ MATERIAL F;tilrLACEI11ENT MI'Al loft & AhIQl1NT
0 rt, 13.8 rl. Portland I Tremle
13.8 rt, 16,5 «. Bentonite 1 Gravity
1%.9ANil1GRAVELPACT: iro Iticnhlc
{7
....................
FHONI T_ %IAT1'n1Ai. t:ar Pl.A f: Ea51 :TYT h1t•,TIiQU
16.3 ft- 24 ft• Sand Sonic
ft. rt. ,.
.!.M-DlilLLrNGLOG atunalludnlitiiiinslaheers:ifnecesaa
1`103M To nESCR[I'7lQN feator. unrinra.rnFllrnekr ie, nln .Ise, ,t.1
0 f'• 8 ft. Brown, Tan, med.tg
rr, rt. fine sand saturated
8 ft, 24 ft. Tan, fine graln sand saturated
ft. rt.
ft. ft.
fl. rt.
2L lt1C41Afi KS_ -
5 -ft of U -pack prepack screen
22, Certification:
Sipaturcof Certified VCII iC'notn nr Dnte
Ay signing this form, 1 hereby certify thaf the ice/l(s) uas (were) constructed In accordance
with iSA NCAC 02C,0100 or 15,1 NCAC 112C.0200 )Fell Constriction Smndardr and that a
copy ofthis record has been provided to rhe well owner,
23. Site diagram or additional well details:
You may use the back or this page to provide additional well site details or well
construction details. You may also attach additional pages if necessary
SUBMITTAL INSTUCTIONS
9. Total well depth below land surface: 24 (ft.) 24a, Fur All Wells: Submit this form within 30 days of completion of well
For multiple wells list all depths fd('fferent (example- 3 a 200' and 2@100') 100') construction to [lie following:
10. Static water level below lop of casing;
If water level is above casing, use
11. Borehole diameter: 6
(in.)
(ft-) Division of Waler Resources, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
24b. nor iniecllon Welts ONLY: In addition to sending die form to rte address in
Sonne 24a above, ansa submit a copy pf [Itis forth within 30 days of completion of well
12. Well construction method: construction to the following:
(i.e, auger, roue y, cable, direct push, etc,)
Division o(Water Resources, Underground Injection Control 1'rograul,
FOR WATER SUPPLY WELLS ONLY: 1636 Mail Service Center, Raleigh, NC 2769 9-1 63 6
13a. Yicld (gpm) Method or test: 24c, rttrWlttcrSuplily ck Uaiectian Wells:
Also submil one copy or this form within 30 days ofcompletionof
13b. Disinfection type: Amount:. well construction to the county health department of the county where
constructed,
Form OW -I North Carolina Department of Environment and Natural Resources —Division ofWater Resources Revised August 2013

WELL CONSTRUCTION RECORD
Tltis form can be used for single or multiple wells
1. Well Contractor information:
Timothy D. Leatherman
Well Contractor Name
2888-A
NC Well Conuvclur Certification Number
Cascade Drilling, L.P.
Company Name
2. Well Construction Permit f:
List all applicable svell permits (t e. County, Stale, Variance, Necdan, etc.)
3. Well Use (check well use):
Well:
❑Agricultural ❑Municip il/Public
❑Geothermal (Heating/Cooling Supply) ❑Residential Water Supply (single)
❑Industrial/Commercial ❑Residential Water Supply (shared)
Nun-Wnler Supply Well;
injection well:
❑Aquifer Recharge
❑Aquifer Storage and Recovery
❑Aquifer Test
❑Experimental Technology
❑Geothermal (Closed Loop)
❑Geothermal (Heating/Cooling
❑ R eco very
❑Groundw'ater Remediation
❑Salinity Harrier
LlStormwater Drainage
❑Subsidence Control
❑Tracer
❑Other {explain under 421 T
4, Date Well(s) Completed: 4-13-15 Well Ina SMW4C
So. Well Locution;
Duke Energy Progress, Inc.
Facility/Owner Nnme Facility ID0 (if applicable)
801 Sutton Steam Plant Road, Wilmington, NC 28401
Physical Address, City, and Zip
Hanover
County
Parcel Identification No. (PIN)
Sb. Latitude and Longitude in degrees/minutWseconds or decimal degrees:
(irwcll field, one IntAung is sufficient)
341808.1 N 775852.7 W
6, Is (arc) the well(s): OPermmnent or ❑Temporary
7. Is this a repair to an existing well: ❑Yes or ONo
If this is a repair, fill our laiown ivell construction irformallon and aspluin die nature of the
repair under #21 remarks section or an the back of this form.
1
For internal Use ONLY:
FROM I1ri6Ci I iv.1-1 -,4
ft. ft.
ft. rt,
'15fUI1.TEkCA:i1Nl;:rurniiiltP-cuhealivells OR�I:iNER -itcGdticf-.
F11:01111 Tu DIAM1IETER 'nL10MEss AlA'ftileLtt,
rt, n. In.
Ib, INNY11 CASING OR.T1,IBTNG.f Cnlhertital:ctuvt&lo4 i
FIIOAI TO rnAAIFTM "11CIMM MATF'm'i1-
0 ft. 45 ft, 2 1" Sch.40 PVC
rl. I ft. In,
°'47: SCREEN
FROM] TO DMAI;FTt'.n NLOTSIT.Y 7Ti1CKNM MArF10A4.
40 ft. 45 R. 2 In. .10 SCh. 40 PVC
ft. ft. in,
1AiC13DI1'Y ` i ,. ,
F110,11 TO AIAiERIAL r..'.,rICEtifENI'alE.'rl1{all5ti5AlgtiNT
0 ft, 33.5 rl, Portland Tremie
33.5 it' 37 rt• Bentonite
ft. ft.
19:'iiRNI1JCRAVL+LPACK 'fil'appilcubleif.:
MOM To I 11IATMAL 1rt,Acc?,rENTAmmuD
37 ft- 45 ft' Sand Sonic
ft. rL
20 DRILI,IMGCOG' itttieli iidtllatunnl'hilcels irzlises[nin
FROM TO ni:Se:nCPTiON'frnlur, bnnlners, rnlurarlrt ala .lir, ett.l _
fl. rt,
ft. ft.
fl. ft.
ft, 1 A.
rt, rt.
ft. ft.
ft. n.
22, Certification:
QJ
Sil¢nalmm afrcrtlfied Wcll Comrnetur Date
By stgniug this form, 1 hereby certify that the ivell(s) was (were) cwstrrcled in accordance
with ISA NCI C 02C,0100 or 15A NCAC 02C.0200 (Fell Conwisction Standards and ilat a
copy of this record has been provided to the well owner.
23. Slic diagram or additional well details:
You may use the back or this page to provide additional well site details or well
S. Number ofwells constructed: _ construction details. You may, also attach additional pages irnecessary.
For multiple ityecirmn or non -water supply wells ONLY with (lie same cwnarrucllon, you can
submit oneform. SUBNIiTTAL INSTUCt-IONS
9. Total well depth below [land surface: 45 (ft.) 24a. For All Wells: Submit this form within 30 days or completion of wall
Par multiple wells list all depths if aftCerent (example- 3 a 00' and?Qa 2@10(y) construction to the following:
10. Static water level below top of casing:. _
if water level is above casing, use
11. Borehole diameter: 6 (in.)
(fL) Division ofWuterResources, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
24b. For Iniecthin Wells ONLY: In addition to sending the form to the address in
Soule 24a above, also submit a copy of this form tvilhin 30 days of complctien of well
12. Well construction method: ._.__ construction to tine rollowing;
(i.e. auger, rotary, cable, direct push, etc.)
Division oCWuter Resources, Underground Injection Control Program,
FOR WATER SUPPLY WELLS ONLY: 1636 Mall Service Center, Raleigh, NC 27699-1036
13a. Yield24c. For Water Supply & Injection Wells:
(gpm) Method of test: Also submit one copy of this forth within 30 days ofcompletion of
13b. Dlsinfeetion type; Amount: well construction to die county healdt department of the county where
constructed
Form OW -I North Carolina Department of[nvimnmenl mid Natural Resources— Division of Water Resources Revised August 2013

•R Vi3trj
WELL CONSTRUCTION RECORD
This form can he used for single or multiple wells
1. Well Contractor Information:
Timothy D. Leatherman
Well Contractor Narne
2888-A
NC Well Contractor Ccrtifiicalion Number
Cascade Drilling, L.P.
Company Name
2. Well Construction Permit ft:
List all applicable well permits (i.e. County, State, Voriance, ltjection, etc.)
3. Well Use (check well use):
V4nter Supply \Vett:
❑Agricultural
❑Geothermal (1-leating/Cooling Supply)
MIndustrial/Commercial
Nowt-WittcrSupply Well:
❑Aquifer Recharge
❑Aquifer Storage and Recovery
❑Aquifer Test
❑Experimental Technology
EIGeothtrmal (Closed Loop)
❑Geothermal fliealinvXfjihna.
4. Dale Well(s) Completed: 4-13-15
5a, Well Location:
Duke: Energy Progress, Inc.
❑Municipal/Public
❑Residential Water Supply (single)
OResidential Water Supply (shared)
❑Rrcavery
❑Groundwater Remediation
❑Salinity Barrier
❑Stormwatcr Drainage
❑Subsidence Control
❑Tracer
Miller (exnfuinunder 421 i
WclI1Di1 SMW513
Facility/Owner Name Facility IDO (irupplicable)
801 Sutton Steam Plant Road, Wilmington, NC 28401
Physical Address, City, and Zip
Hanover
County
PueelIdentification No. (PIN)
5b. Latitude and Longitude in degrees/minutes/seconds or decimal degrees:
(irwell field, one lalftng is sufficient)
341752.8 N 775842.2 W
For Inlemnl Use ONLY:
IMOM TO
r1V517111rTION
ft. I
ft.
ft.
ft.
`15: O1I71':ti t,;.L Slitits fnY'miltl•[13ged Wmtl% .DFl C:111it;[r lIf A 1 Itl[n 1110
YO
IlltOati-0'
n1AMETEII TFIICKWss NIA-1'ERIAL
fl
fl.
16.INN7 it CASING OR TUMISIG rlmulh.rniat r1wed••Inn
FROM To
11MIEFF11 I 'FITPU NESS MATEWAL
p ft. 10.8rt•
2 "� 5ch.40 PVC
ft.
ft. ]ty
FROM T•O
01AM1ILI'M SLOI'MM 7T4! h7dFSS MATERIAL
19.8 ft' 24.8 rl-
2 t" 1 .10 SCh. 40 PVC
ft. ft.
in,
]FROM TO
MATERIA1.
isini+crnseNr+lr•:rno11. +MautvT
0 ft. i4.1
rr. Portland
iremie
ft.
ft.
ft.
ft.
X19.SANDIGRAVE1;1'•7Cii lfnbpT1rnh1e - -' -- '
TIMM TO
MATERIAL EAIPt.«10EMENT' MLTI3O11 -
16.5 rt. 24.8
rL Sand Sonic
ft.
rt,
' 3f1 IORI1A.1 �SNG'' II Itil ON addidu mil Al Icab.'Af nert4ivrt �'
LOnG
Flt"m TO
TI Sf1311PT1ON ]Felon._ Imvdnrar,. wll7enr]r. tr a• .rally s61e• ri[.}
ft.
ft.
ft
ft.
fl.
fl.
ft.
fl.
ft•
fl.
ff.
fd.
2U1FAI iRlts
22, Certification:
SignatureRMzcmrAdWeil C: nuaelnr Dale
G• Is (arc) the wcll(s): ❑Pcrntunent or ❑Tcmpolliry By signing thisform. 1 liorrb} cert(!y that the well(s) n'as c'u'be) consiruried Irl accordance
with 15x1 NGC 02C.1880 or 15A NCAC 02C.00 lVell Cansnixtion Sulndardx oral thol a
7. Is this a repair to an existing well: ❑Ycs or ❑Nu copy ofrhis record has been provided to the well owner.
Ifthis is a repair, fill our known well construction information and explain the nwum ofthe
repair wider #21 remarkxsection or on the back ofthisform. 23, Site diagram or additional wetl details:
You may use the back of alis page to provide additional well site details or well
8. Number of wells constructed: 1 construction details. You may also attach additional pages if necessary.
For multiple litjecifon or non -water supply wells ONLYwith thesame construction, you can
submit oneform. SUBMITTAL INSTUCYIONS
9, Total well depot below land surracet 24.8 (rt.) 24a, For All Wells: Submit this form within 34 days or completion of well
For multiple imlls list all depths !fd(Qerent (example- 3 a ?00' and 2@ 1001 construction to the following:
10. Static water level below top of casing:
If ❑Wier level is above casing, use
11, Borehole diameter: 6
(in.)
(ft.) Division DMiter Resources, Information Processing Unit,
1617 Mail Service Center, Ralcigh, NC 27699-1617
24b. For lniectitln WF -11,9 ONLV: In addition to sending die form to the address in
Sonic
above. uNo submit a copy of this form within 30 days or completion of well
12. Well construction method: _ construction to the rollowing:
(i.e. auger, rotary, cubic, direct pusli, elcJ
Division of Witter Resources, Underground Injection Control Program,
FOR WATER SUPPLY \VELL5 ONLY: 1636 Mail Service Center, Raleigh, NC 27699-1636
13a. Yield (gpm) -,,- Mellhud of les(•-- 24c. For Witter Supply St InJcctinn Wells;
Also submit one copy of this form within 30 days afcompleliunOr
13b. Disinfection type: Amount: well construction to die county health department of the county where
constructed.
Form G W-1 North Carolina Department orEnvironment mrd Natural Resources - Division of Water Resources Revised August 2013

�Rcvj 3Ld
WELL CONSTRUCTION RECORD
This farm can be used for single or multiple wells
1. Well Contractor Information:
Timothy D. Leatherman
Well Contractor Name
2888-A
NC WCII Contractor Certification Number
Cascade Drilling, L.P.
Company Name
2. Well Construction Permit t#:
List all applicable well permits (l.e. County, State, Parlance. Injection, etc.)
3. Well Use (checli well use):
Water Supply Well:
❑Agricultural
❑Municipal/Public
❑Geothermal (Heating/Cooling Supply)
❑Residential Water Supply (single)
❑Industrial/Commercial
❑Residential Water Supply (shared)
❑Irri ation
in,
Non -Water Supply Well,
FDOa1 1
MMon itori ng
❑ Recovery
❑Aquifer Recharge
❑Aquifer Storage and Recovery
❑Aquifer Test
❑E•xperimental 'technology
❑Geolhermal (Closed Loop)
❑Geothermal (Heating/Cooling Return)
❑GfDundlvalef Remediation
❑Salinity Barrier
❑Stormwawr Drainage
❑Subsidence Control
❑Tracer
❑Other (explain under f121 Remarks)
4. Date Well(s) Completed: 4-13`15 Well IDI# SMW5C
Su. Well Location:
Duke Energy Progress, Inc.
Facility/Owner Name Facility Mi (if upplicable)
801 Sutton Steam Plant Road, Wilmington, NC 28401
Physical Address, City. and Zip
Hanover
County Parcel Mend fieadonNo. (PrN)
Sh. Latitude and Longitude In degrees/rnlnules/seconds or decimal degrees
(ifwcll field, one IaUiong h sufficient)
341752.8 N 775842.2
6. Is (are) the well(s): [APermanent or ❑Temporary
For Internal Use ONLY:
14 WATE zQN
FROM TO PMC.'lIMON
rt. ft.
rr. fr.
.,15 OU'I'.E1i CNISING'(for, utts-tusCd sucl�s) Ciit t[NGt1 3f a t llirulrle ' ..... ....... ..... .
FROM TO nIA-ZIF t;n Tnt WNRISS I MATEMAL
ft, ft.
in,
16. INNER CASING ORTTi11?NG fiteallitnual ciased-tun i
FDOa1 1
Tel nIAME1 It
risin4NY-ss
M:{i-ruIAL
0 rt.
38.8 n• 2 1°'
Sch.40
PVC
ft.
CI, in.
FROM TO nwmr£n KWT SI2X 77 rtCKNFtiS MATERIAL
38,8 t. 43.8 rt• 2 in.. .10 SCh. 40 PVC
ft. ft.
rutom To 51ATralAL nt1,I.ACEm1FN'rhILT11O0& AMOUNT
0 rr' 33.5 ft. Portland Tremie
rr. fl.
fl. ft.
M1SAN L)1CRAVrhJ, PACK lrs ilicalslr
FR 0411 To
MATERIAL EMPLAC11NIEVT5IETROD
35.6 f1• 43.8 rr•
Sand Sonic
A. rt.
'2ii-'I71t11.1�tNC'-Lr)i: attncll ndiifilvnu4jlierra irnnxssa ... - -
FnoM TO
DmcfltrY'Ir11Y rotor, aanlncll s.fOnatsj rutmxlr tic
ft, ft.
ft. ff.
A. rt.
ft.
ft. R.
fl. ft.
fl, ft.
22, Certification:
W � nf.013-11-1 IT q11V I3;
signature of cenified Wtif-Coolractor Uatc
7. Is this a repair to an existing well: ❑Yrs or ONo
Ifshis is a repair, fill out.asown hell constniction ih fornmtiao and explain she nature of the
repair under IV21 remarks section or on the back of iUs form.
S. Number of wells constructed, 1
For multiple injection or non -water supply wells ONLY with the same consrraclion, yon can
submit one fon".
9. Total well depth below land surface: 43•8 (rt.)
For multiple wells list all depths ifdli ferem (erample- 3 a 2100' mnl2©100')
10. Stu tic water level below top Dressing:
If Darer level Is above casing, use
I1. Borehole diameter: 6
12. Well construction method: Sonic
(i,c auger, rolary, cable, direct pustti etc.)
By signing this form. 1 hereby certify that she wells) ons (were) constntcied In accordance
withISA NCAC 0X.0100 or ISA NCAC 02C.0200 Well Consintcrlan Standards and that a
coP1. ofthis record has beers provided to the well owner.
23. Site diagram or additional well details:
You may use the back of this page to provide additional well site details or well
construction details You may also attach additional pages ifnecessary,
SUBMITTAL INSTUCTIONS
24a. For All Wells: Submit this form within 30 days or completion of well
construction to the following:
{ft.) Division of Water Resources, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
24h. Fur lnicelimlyVAlg ONLY: In addition to sending the form to the address in
24a above, also submit a copy of this fonn within 30 days or 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. Yieldm 24c. F'arS'1 ow Supply & bileetlon Wells:
(gp ) 141ctltod of test:
Also submit one copy of this form within 30 daysofcompietion of
13b. Disinfection type: Amount: well construction to the county health department of dtc county where
constructed.
Form GW -1 Nonh Carolina Mpanmcm ofEnvironmcat and Natural Resources - Division of Water Resources Revised August 2013

't! i .00A `✓,
VM LL C®NSTRUMON RECORD
This form can be used for single or multiple wells
1. Well Contractor Information:
Timothy D. Leatherman
Well Contractor Name
2888-A
NC Well Conituclor Certifica[ion Number
Cascade Drilling, L.P.
Company Name
2, Well Constriction Permit 0:
List all applicable hell permits (i, e, County, State, Variance, Itycellon, etc.)
3. Well Use (check well use):
Wn ter Supply Well:
❑Agricultural
❑Geothermal (Ileating/Cooling Supply)
❑ Industrial/Commercial
Non -Witter Supply Well:
❑Aquifer Recharge
❑Aquifer Storage and Recovery
❑Aquifer Test
[]Experimental Technology
❑Geothermal (Closed Loop)
❑Geothermal (EleatinaJCocling Return)
4. Dale Well(s) Completed: 4-10-15
5u. well Locution:
Duke Energy Progress, Inc.
❑Municipul/Public
❑Residential Witter Supply (single)
❑Residential Water Supply (shared)
❑Il movery
❑Groundwater Remediation
❑Salinity Barrier
❑StormwalerDrainage
❑Subsidence Control
❑Tracer
❑Other (exnlain under#21 I
Well IDH SMW6B
Ftwility/Owner Name Facility ID# (if applicable)
801 Sutton Steam Plant Road, Wilmington, NC 28401
Physical Address, City, and Zip
Hanover
County
Parcel Identification No. (PiN)
Ste. Lutltude and Longitude in degrees/minutes/seconds or decimal degrees:
(i(wcll ftald, one ladlong is sufficium)
341744.6 N 775837.1 "
6. Is (are) the well(s): ©Permanent or ❑Temporary
7. Is this a repair to an existing well: ❑Ycs or ONo
Ifthfs Is a repair, fill out known well construction fti/brntadon and explain the nature ofthe
repair under a21 remarkr section or an the back c f this form.
1
For internal Use ONLY:
14. WATEII20NES
FROM TO _ M-SCRIPnoN
rt. ft.
n,
l$, 01,111'X C3ASiNG firmttllt-cusetl wrlls I I LINF.iI if o 1 rlkcal e
FRONT 'TO aIAAt F:Tftt 'rltiLT�NF.SS M1SATFY[l.1t.
fl. ft. in.
L.
1fi:sITVNGR C'_kS1NG Oli T[1FIIlYC; erillremanl ciusi it -la r
FROM TO mmar.rEtt 'rltl{_f: atitFSS MATERIAL
0 R, 19.4 rt. 2 In, SCh. 40 PVC
ft. fl. 1n
PROM TO nMNET'ER SLOTSrL1. TIIICk-NESS n1ATERIAF.
19.4 rl. 24.4 r` 2 in. .10 Sch.40 PVC
ft, ft. in.
t a, f=ltrtti'r ;
FROM To - MATERFAt. Eh1S'1.1 F.M11i:N1`AIEnlOYY k AM1IOUNT
0 rr• 13.2 r' Portland Tram ie
ft, rt.
R. rt.
'19:,8tL1111PiGItAVCLYACI:
Mum 1YF MT -DUAL UIPLACF:MEW irTitoo
16.4 r'• 24.4 ra Sand Sonic
ft, ft.
:�'30111r1I;L.lNCrLOG(tit lneli'ndill dotiitlgliae.ls'iriteeettstieyy�'
Films TO mFSCFtIPTION cnfpn lmnit,ut spl0ixtr.Etr c, rnta aim etc?
ft. ft,
ft. ft.
ft. rt•
rt. rt.
rt. ft.
ft. ft.
ft. ft.
22. Certification:
-J ah- 4t t t t;:, 4hSll�
Signature orCenilied Well Contraelor Datc
6y signing Phis farm, I hereby certify that the ivell(s) was (here) constructed in accordance
with 15.4 NCAC 02C Al flfl or 15.1 NCAC 02C,0200 frell Constmetion Standards and that a
copy ofthis record has been provided to the well onvier.
23. Site diagram or additlonal well details:
You may use the back of this page to provide additional well silo details or well
8. Number of wells constructed: construction details. You may also attach additional pages if necessary.
For noilrlple Igjection or non -[rater supply wells ONLY udth die sanne comyr action, you can
submit oneform. SUBMITTAL INSTUCTTONS
9. Total well depth below land surface: 24.4 (rt) 24a. For All Wells: Submit this form within 30 days of completion of well
For multiple Ivells list all depdts (fdfferent (example. 3@aa.700' and 2 n 100 construction to the following:
10. Slade water level below top of casing:
If mater level is above casing, use
11. i3omhole diameter: 6
(in.)
(ft) Division of Water Resources, Inrormation Processing Unit,
1617 Mull Service Center, Raleigh, NC 27699-1617
24h. nor Iniieflon Wells ONLY: in addition to sending the lbrin to the address in
Sonic 34a above, also submit o copy of this form within 30 days of completion of well
12, well construction method: construction to die following:
(i.e. auger, rotary, cubic, direct pusl4 ctc,)
_ Divlsiun ofwater Resources, Underground inJecNun Control Program,
FOR WATER SUPPLY WELLS ONLY: 1636 Atoll Service Center, Raleigh, NC 27699-1636
13u. Yield (gpm) Method of test: 24c. For Water Supply Sc Injection Wells:
Also submit one copy of this Corm within 30 days orcoluplelion of
13b. Disinfection type: - Amount: W_.___ well construction to lite county health department of the county where
constructed.
Form GW -1 Nardi Carolina Department orEnvironment and Nuluml Resources - Division of Water Resources Revised August 2013

WELL CONSTRUCTION RECORD
This farm can be used for single or multiple wells
1. Well Cuntraclur information:
Timothy D. Leatherman
Well Contractor Name
2888-A
NC Well Contractor Certification Number
Cascade Drilling, L.P.
Company Name
2, Well Construction Permit N:
List all applicable well perni is (i.e. County, State, Variance, Injection, etc.)
3. Well Use (check well use);
Water Supply Well:
❑Agricultural
❑Geothermal (I-leating/Cooling Supply)
❑ Industri nl/Commercial
Non -Water supply Well:
❑Aquirer Recharge
❑Aquifer Storage and Recovery
❑Aquifer Test
❑Experimental Technology
❑Geothermal (Closed Loop)
❑Geothermal (Heating/Cooling Return)
OMunicipal/Public
❑Residential Water Supply (single)
❑Residential Water Supply (shared)
❑Groundwater Remediation
❑Salinity Barrier
❑Stormwaler Drainage
❑Subsidence Control
❑Tracer
[]Other (explain under #21 Remarks)
4. Date Well(s) Completed: 4-10-15 Well IDN SMW6C
Su. Well Locution:
Duke Energy Progress, Inc.
Facility/Owner Name Fncility IAA (ifupplicable)
801 Sutton Steam Plant Road, Wilmington, NC 28401
Physical Address, City, and Zip
Hanover
County Parcel ldeutificntion No. (PtN)
Sb. Latitude and Longitude in degrees/minutes/seconds or decimal degrees:
(ifwell field, one latlang is sufficient)
341744.8 N 775836.9 W
6, Is (lire) the well(s): 01'ermanenl or ❑Temporary
7. Is this a repair to an existing well: ❑Yes or El No
Ifthis is a repair, fill mu lahosvn well canstnictiar i fnnnatcm and explain the nature ofihe
repair under #21 remarks section or on the back ofrhis form•
8. Number of wells constructed: 1
For multiple bUection or non -water supply wells ONL1'tvith the same Construction, you can
submit oneform.
9. Total well depth below land surface: 44
For multiple wells list all depths lfdllffereni (e ample- 3 x@200' mu! 2@100')
100')
10. Static water level below top of casing: (fl.)
Iftt'ater level is above casbhg, use "+'•
11, Borehole diameter: 6 _. (in.)
For Internal Use ONLY:
I4 'NATER ZONES
FROM Tn IrFSC'litl"'r1UN
ft. R.
ft. rt.
:']S; Il7'Ek L};{SINE^' foe nilu111-rnstJ weals OR L1NCA lf.0 1 illu�blc
PIt6Al TO alAritt'rili TIl1Cii8frS5 htAiFIIIAL
ft. ft, in.
I& INNER CAS1NG:OR TUIIING. "enllacrmul rlruserl but
InIOSr TO mAMP.TTFIR I THICKNESS iIh4TF.leIA.L _
0 ft. 39 rr. 2 in Sch.40 PVC
ft. fl.
.7, S0,RISN
FROM To n1AMTER 81101T' ST7.r. TIII1:KNP4N5 MATERIAL
39 «. 44 fi• 2 in, .10 SCh. 40 PVC
ft. ft. in.
Is. GROVII:
t'aclaf TO _ MATERIAL ft+lrtACEAirNTnitralnuxansolmT
0 fL 34 n Portland Tremle
ft. fL
ft. ft.
1'l S. NUIGRAVF 1;11AC1.' irp "licAbit
FROM TO MATERIAL EMM%CEa1GNTAILTHOn
36 ft. 144 ft, Sand I Sonic
n. rt.
xa; DRILIANG44G Olin ltsiddiriunnlsheets lrficceshia
FROM - TEF a£S'L`alf°'t7nN rcnror. hnnlnax. 6rhEltrnrlrs s. rulln 6174, E71
—
ft. ft.
fl, ft.
fL ft.
ft. rt.
ft. rt.
ft.ft.
ft. ft.
22. Certification:
Signature of Ccrtilicd Well Contractor Data
By signing this form, 1 hereby certify that the tvell(s) nus (were) constnecied fn nccordonce
with ISA NCAC 02C.0100 or 15A NCAC 02C.0200 Well Comintcrion Standards and that a
copy ofthis record has been provided to the svell 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
24u. For All Wells: Submit this form within 30 days of completion of well
construction to the following:
Division or Water Resources, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
24b. Tar Injection Wells ONLY: In addition to sending die form to the address in
Sonic —construction
also submit a copy of tits form within 30 days of completion of well
12. Well construction method: _ construction to die fallowing;
(Le auger, rotary, cable, direct push, etc.) --
Division of Water Resources, Underground Injection Control Program,
FOR WATER SUPPLY WELLS ONLY: 1636 Mall Service Center, Raleigh, NC 27699-1636
13u. Yield (gpm) Method of test: 24c, For Watar Suppiv & lujection Wells;
Also submit one copy of this form within 30 days afcompletionof
13b. Disinfection type: Amount:, well construction to die county health department of the county where
constructed,
Form GW -1 North Carolinn Department ofLnviroumcnl and Natuml Resources — Division of Water Resources Revised August 2013

WELL CONSTRUCTION RECORD
This form can be used for single or multiple wells
1. Well Contractor Information:
Timothy D. Leatherman
Well Conuuctnr Name
2888-A
NC Well Contmetar Certification Number
Cascade Drilling, L.P,
Comp uny Nantc
2. Well Construction Permit H:
List all applicable Nell permits (Le. Coungq State, rnriance, Iryleclion, etc.)
3. Well Use (check well use):
Water Supply Well:
❑Agricultural
❑Geothermal (Heating/Cooling Supply)
❑lndustrial/Commercial
Non -Water Supply Well:
❑Aquifer Recharge
❑Aquifer Storage and Recovery
❑Aquifer Test
❑Experimental Technology
❑Geothermal (Closed Loop)
❑Gtotherxnnt fflealineYcoolina
4. Date Well(s) Completed: 4-8-15
5u. Well Locution:
Duke Energy Progress, Inc,
❑Municipol(Public
❑Residcnlial Water Supply (single)
❑Residential Water Supply (shared)
❑Recovery
❑Groundwater Remediation
[]Salinity Barrier
❑Stormwater Drainage
❑Subsidence Control
❑Tracer
❑Other (extllnin under #21 1
Well [IV SMW6D
Facility/Owner Name raciuty 104 (if applicuble)
801 Sutton Steam Plant Road, Wilmington, NC 28401
Physical Address, City, and Zip
Hanover
County
Parcel Identification No. (PIN)
5b. Latitude and Longitude in degrees/minuics/seconds or decimal degrees:
(ifwcll field, one 141.1long is sufficient)
341744.7 N 775836.8 W
For Internal Use ONLY:
.14: WATIr.1t Y.OY 1:.4 - .... :..:.... . ..� _,.. . .
FROM
T'(} nFSMIPTI[IN
fY.
ft,
ft.
rt.
I ncublr .:
13: fltil'E;f! C,tSIwJC fnrrYiultl=rnsed Ivens)Olt LINI?TC 1r Lill
FtlOni
-TO
ntA ofrmn TIIFCYC:YFSS
MATEMAL
In.
Ir; INNEft 'C ASTNG OR Tt17tING lifenthern,ut einsorl Ina 1
Fhf)''11 TO nlrldlih"ii TIIICK14FSS nfAM, MAL
0 f,, 103 12 tn, SCh. 40 PVC
ft. A. fu.
17.SCREMN
mons To DlAA1F.T:n 4LIDT-tri TIIICI,-NESS M1tA•rsar.,1,
103 " 108 f' 2 '°' .10 Sch.40 PVC
ft. ft. in.
FROM Tit MATERM.
1'M1nlnulf:G,M111"h7 M1f 1077 erin .fe AAfOUNT
0 f'• gg f'- Portland
Trarnle
ft. ft.
ft. ft.
SANINGRAYG1.PACiC'
Ifo llcalalr
}rta"I I TO _
MATERIAL r•.t+tt�l.ACentF.hT'ntl:rnau
101 ° 108 f''
Sand Sonic
rr, ft.
20, IIt1Nf; t.f3{i ailarll'
rldlrinual slYarts.Ir l}rrrd5a
FROM TO
byscft 11MON(cc lar. Ilard11f3l. I ailirnalt i log,11 {n usr. rtel
ft. ft.
ft, FY.
ft. ft.
Ft. ft.
ft. «.
fl. rt.
ft, rr.
22, Certification:
ejL. gj. a _ S
t-S—
Signalure uIC0101rd Well Conlrnelur Dute
6. Is (are) the well(s): OPermanent or ❑Temporary By signing This form, I hereby certify that the u'ell(s) tuns (were) coralructed in accordance
with 15A NCAC 02C.0100 or 1 SR NCAC 02C.0200 [Yell Constntction Standards and that a
7. Is this a repair to an existing well: ❑Yrs or ONo copy ofthis record has been provided to die well owner.
If dds Is a repair, fill out known well construction information and explain the rurtura of ilia
repair taider 1121 remarks section or on the back ofihis farm, 23. Site diagrum or additional well details:
You may use the back or this page to provide additional well site details or well
S. Number of wells constructed: 1 construction details. You may also attach additional pages if necessary.
For multiple hl/eclion or non -water supply nvells ONLY Mill rha sunre construction, you can
submir onefornt. SUBMITTAL INSTUCTIONS
9. Total well depth below land surfnew 108 (ft.) 24a, hitt- All Wells: Submit this form within 30 days of completion of well
For mlrhiprc wells list all depths ifdieretir (example- 3402 2O0' and2 0V') construction to die following:
10. Static water level below top of casing:
Ywater level Ls above casing, tae
It. Borehole diameter: 6
(in.)
(ft) Division or Wuler Resources, luronnution Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
24b. For l,niecilqu Wells ONLY: in addition to sending the form to the address in
Sonic 24a above, also submit a copy of this form within 30 days of completion of well
12. Well construction method: construction to the following:
(i.e. auger, rotary, cable, direct push, etc )
Division ofWater Resources, Underground Injection Control Program,
FOR WATER SUPPLY WELLS ONLY: 1636 Mall Service Center, Raleigh, NC 27699-1636
13a, field (gpm) _ Method of test: 24c. Por Wnler Supply lu'r Injet:tlnn Wella:
Also submit one copy of this form within 30 days of completion or
13b. Disinfection type,, Amount: well construction to die county health department of die county where
._ constmeted
Form GW -1 North Carolina Department of Environment and Nattuul Resources — Division or Watcr Resources Revised August 2013