Hy CY2003

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and manual Resources
WELL CONTRACTOR (INDIVIDUAL) NAM: (print)
WELL CONTRACTOR COMPANY NAME_REUBEN CALDWELL
284364
^ Q
- DixiNsion of Water Quality
Quality - Groundwater Section
tll �5"�
( CERTIFICATION a27.7-/
DRILLING, INC. (��8 )254.-3581
PHONE
STATE WELL CONSTRUCTION PERMIT/ ASSOCIATED WQ PERMITS
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential Q' MunicipaVPublic 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: C t fD
County NIX (DoD
(Street Name, Numben, Community, Su vision, tot No., Zip Code)
3. OWNER: 4 W1��Dr�
Address \ 1 O -5 IrYtte `:1e-7/ (LcA
(street or Route No.)
C-LI e IJ C-
City & Town State Zip Code
(6,9K)- b 9-1 - 3 3 6 a
Area coda Phone number _ G
4. DATE DRILLED (a -1 1
5. TOTAL DEPTH: SC /
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 19
7. STATIC WATER LEVEL Below Top of Casing: ZC FT.
(Use's' if Above Top of Cuing)
8. TOP OF CASING IS - FT. Above Land Surface•
*Top of eulug terminated at/or below Ind surface requires •
variance la sccordmce with ISA NCAC 7C.0111.
9. YIELD (gpm): L b METHOD F TEST 0.-t(T - A t12-
10. WATER ZONES (depth): 1 i 0 C e
11. DISINFECTION: Type N t o Amount
12. CASING Wall Thickness
1 Depth �etcr or Wq' t/Ft. Material
From 1 - To I �0 Ft. �% i I i� St(ae L-
From To Ft.
From______ To Ft.
13. GROUT:, Depth Material /nMethod
From ,1- To 1) Ft. C-6 meSN l V0 u O
From To Ft.
14. SCREEN: Depth Diameter Slot Size . Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
Topographic/Lan etting
❑Ridge ❑Slope alley ❑Flat
(check epprcpriss box)
Latitudr/longitude of well location
(degtenhoinut daecooda) .-._-
LatitudeAongitude source:❑GPS❑Topogmmpblc_maji..:. -:
(check box)
DEPTH DRILLING LOQ
From To / Formation D_escnwp(io
ta5/- 1456-f4(t-re)
(tE�' r k
Or — a 3 o r (24 l C-
i
r^.
T•s
Sm
Cc>
-s m
CD
LOCATION SKETCH
Show direction and distance in miles fror t le6
two State Roads or County Roads. Includthc'»3
numbersand common road names. cmi ;tr.
U 1
G
It-
4-�
*0/ 207
tilt
a4 ? MILES
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THA COPY OF TIIIS RECORD HAS BEEN PROVIDED TO THE WELL WNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL
DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mali Service Center - Raleigh, NC
27699-1636 Phone No. [phone], Within 30 days. GW-I REV. 07/2001

284115
'1.
1(1.
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Nautml Resources - Division of Water Quality - Groundwater Section /((
cI:ItFIFICAT��I[ONp /C'
PHONE it 6J7-R59S
wi:1.1, CONTRACTOR (INDIVIUUAI.) NAME y�rint)�
1(IJ.L CON'rllA("rott COMPANY N.k)IE _
s r.ur1: WELL CONSTRUCTION PERM' Fru ASsOCIA'IEU WQ I'ERNIITP
(if applicablc)___
I i 'applicable I
1 WELL USE (Check Applicable 13ox): Residential Er-Municipal/Public 0 Industrial ❑ Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Winer Injection 0 Other 0 IIothcr, List Use
2. WELL. LOCATION: 1 Ligon/
Nears) 'fotvn: ... A ,4t1/. C•olon•._
I Sneer Nance. Nmnhas. Community. Subdivision. Lou No.. Zip C\rlel
3. (IV
:\ddlrss .la.
/, Atircerl o' Ituutc No.)
ne or '1 own ' $lac Zip Code
(gi)- (oYs.-f ,5
:\n•a c. lc. Plume number
.1. DATE DRILLED 7a -6-03
Topographic/Land setting
❑Ridge ❑Slope Eflaey ❑Plat
'check appropriate hos 1
Latitude/longitude nrwcll location
i degrees. tninules/sennnis)
Latitude/longitude souree:OGPSOTopographic map
• (cheek honl
DEPTH . DRILLING LOG
From Totpl)walipn Description
4
dD
DOES WELL 'REPLACE EXISTING WELL? YES 0 NO 0�
/Q5
7. STATIC WA TER L.EVEI. I3elow Top of Casio": p7 / FT.
(llse "T" it Above Top or Casing)
S. TOP OF CASING IS FT. Above Land Surface`
'Toil or caning terminated attar below land surface requires a
variance in uecor.luncyp'Ith I5:\ NC:%C '_C :011N. \
YIELD (gpnp; 70 METHOD OF TEST A'/
WATER "J.ONI S (depth):
1 I. DISINFECTION: Type /17*
I'. CASINO:
cnp_th/I� J FL P2
ter
Till yy_TU
•PrFt.
to Pt.
13. (;It OUT: Depth NIclteritl
from d Tn-2.0 Ft.
1110
I-1. SCRNIiN: Depth Diet peter Slut Size Material
Pmnl .__ 'ro.__..._.._ 11-_ _iu. ___._._ in.
15. SANIN(GRAVE.I. PACK:
DepthSize ivlaleria
Atm tint •
\Vail Thickness
or V ,'t,E'ht/1=t. fee/
From _ To FI.
I'luul_.-----f
In. RF\IAI:KS:
.Method
t �
"a
LOCATION SKIEI'C'tl y cm
Show direction and distance in miles Boni at Ieasi-c
r
two State Roads or County Roads. Inclu(troi tlm ry�a(}3
numbers and common road names":10 rno
z �r
O m�
yLt, 27k
Ut) IlliltFBY CERTIFY THAT TH IS WELL WAS CONSTRUCTED IN ACCORDANCE \VITI I I5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO TIlI! WELLflWNER--
w
--tV-et4" SIGNATUREOF PEi:SON CONSTRUCTING THE \VIiLL. DATE
Submit the original to the Division of Water Quclily, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 dies. OW-1 ItEV. 07/2001

284114
-t. ITVIIi DISII_I.hL d .' O3
e_ DOES
7. S h,Al1C \FATE(: I.E:VI?I. Below Top orCasir
t Ilse "-" it Ahore
TOP OF CASING IS FT. Above
ip of casing Icnnia:ned altar briny, Lind si rLnc re:;
variance in aceordanuc with I5.\:NC:\C 2C.(1118.
'1. YIELD Ippml: 3 NI LEI IODOPTES.
U WATER ZONES (depth):
II. DISINFECTION. Type T
71t-
1 2_ CASING:
I6 I(li\I:\RI' S':
\FELL CONSTRUCTION RECORD
Noah (iioI nu - Department or Environment and Natural Resources -`Div/)lion of Water Quality - Groundwater Section
�/(/
(O\ i I t(' 1 Olt (l\IllVltit '.\t.) N.\\IP:/('yriuti_kei )�'7 leak 2/e CERTIFICATION #121/ /
Nl-:LL('(1AIIACI'(11: (oAI I'.AAA'\.AAII'. �j rC� �e����•�"7� III 14 r(- }672
S I.\l p \\ 1.l.l. tO\SrRC ("I ION I'ER\IiT# .\SSOC'I..\'I'EID \\O PLR)llT#
I i(uplthcahlei (if api licahlc)
I AA'LI_I. USE tChcck Applicable 13ox): Rcsidcndal lunicip;dll'ublic O Industrial 0 A cricultmul O
VIunilorin ❑ Recovery 0 Heat Pump Aker Injection 0 Other 0 II Other, List Usc
VA IiI I. LOC:A 1101 Wx1 Ut)�
Nc rr )I �futcn' _ Count (9s o
✓7Y1) �Yn h� .:5€441e �Ja�p �i
Ill cl A uu nl a>. ('ou 1 1 uav Slh,b u. T in No.. Lip Code)
OAVNI:I::
\ (MIi»
/ .G/ Dil'hII
lc •'lmrn Slily /.ip Code From to
(s'C1 L Tile - C1, o
\Ice a.nlr I'a•,ue n„niha, -gO b
I tT:AI. DLLI'TI I: .39� / Q ,y�
)l \1'I!I_I_ REPLACE EXISTING WELL? VIiS 0 NO C
„iar 7
1 ' �L 4„' cf Dr -
/00 FT.
'I op ulLaSulgl
.and Surracs'
.hires a
/Tope I )hic I ncl setting
f7J lti(Igc ❑Vlolls OV tllcy ❑Flat
(cheek appropriate lost
Lulitudc.lon!hate or wen locution
Ides reesmiaaM ts%xeond.:)
L:uinulalun! Thule sourrc'.00IPSOTopu_mphic map
(check (Nix
DRILLING LOG
I-'\thl alsv01 I)cscriplion.
6�'NQ
O
{
B
L
L epth Ui.t tcI
gy :t. Y
Ucptll Nktterial,y
/ o Fl. _an.e^
fo PI.
I'
I1.
Diameter Slot Hze
S Tie
m•. mit
\\all iilckucss
or A'. •. III if t, Nita
(\vo State Roads or County Roads. Inds
t� v numbers mid conlnwn road names.
\Tart eri:d
Nlat. Fiat
/53/
m
LOCATION SKITC'I I co or,
Show direction and distance in miles from al ILttt�
is&big
O
w
!ix I IltKlilil' Lfli II FY II I.\ r TI I IS WELL \\'AS C't.'NST RUCTED IN ACCORDANCE \VITI I 1 S:\ NCAC 2C, \VELI.
CONS I RLCIION STANDARDS, ANDTIIAT :A COPY" OF THIS RECORD I1AS BEEN PROVIDED TO TIIH WELL OWNER
il-ga-'o3
SIGNATURE OF I'LHISO,N CONSTRUCTING II IF AWELT.. DATE
cn tt
rf
G
Submit the (original to the Division of Water Qu:lity, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
276'19-1636 I'Imnc .No. (919) 733-322I. a ithiu 31) (Int. ;. ( iW-I REV. 07/2001

284113
\'ELL CONSTRUCTION RECORI)
No, olino - Department of Environment and Natural Resources - Division of Water Quality Groundwater Section r. ----._.__—.------.--CERTIFIC\TION k€Y/
�
\\II.1.(1INI \C I'OI: COOP NANO: Ce_/1WAL%/rlONEk ff (,2>-0.
(IT
\(b.1.1- CO\SI I(t CI ION I'EIU11TIt :\SS OCI:VIED \V(2 rFR\IFr#
I II applicublei (il aI l Iie:lblc)
w('O\'I lt\('IV)R (I\DI\'till'\L) \:\\Ili: (pri:n)L?l / ir�(,�}
1 AVI:LI. LSE. (Check Applicable 130.y): Resider:lid 14<atinicipttliPtiblic ❑ Industrial ❑ Agricultural ❑
\ioniloring ❑ Recovery ❑ Heat Pump AVa'.cr Injection ❑ Oilier ❑ If Otlicr, I-ist Usc
VVELI. LOC:A'II(2N:
Ne sl Town ,9-n/ r-'' Count
62g
Voccl N.nu:. Nni 1,01 ('ommunlnr. Stli1L11 V1,1L111. 1t:1 NO Zip Caac)
11\V NI R:1UM /�� %QrJ''Y4'/1
:Add; esz `�'1 3_j emi) ercj,.,
1Sa. en :�t Ra ne N„.1
(ln or lour Idle hip Cade
g., )-6`19-oc1r
.Aicy.„kr, 1'h:nm,,„mbar
D:A IT'. Diu' .I.euLaZ- E-v
f1 )[\I_ I)I!I'TN: off_-___-
DOHS WELL REPLACE EXISTING AV'L'.LL7
Si:\TIC \VA'I LR TEVEI. Below Top or Casir
i OP OF CASINO IS FT. Abovc I
*lop urea sing icrmin.ilcd alfor brbm land surface re:;
cari.wc: in accord ate uu ith I5.k NC:\C 212.011H.
1'liiLD (upniC 7 NIPflIOl) OFTES
\V:\Tlilt ZONES Depth):
YIiS ❑ NO E
;?-3 FT.
Top otGusing)
.and Sur1'.1ce
tires a
Topographic./Land setting
riafil4c :Hittite ❑Valley ❑PINT
Ieiicck ageteg ithe hocl
Latitude/longitude of well location
tdegreesh„ IL„ICSlseeVndsl
Lluinule/longiludc source:❑GPS❑Topographic map
h«k has)
DEPTI I DRILLING LOG
From To
1=ur1 olio Description
020
tic 35 S N�,,J✓/
T � I ? fr -
I)ISI N F I'.CION_ Typc}/77
\SING:
neplb DI:yi to
nnu l) 3 o��
n-_--- 11.
Iwo Tt, --- rt,--
13 (iI<O . 1: Depth Nlalcl'ial / _
I - tom 0 T, C` 1=1. �evu6',117- _...
Ilt,n, Ttt I t
t-1 SCIZI. I:N: 1/cp1h Di:uneler Slu(':izc
Raoul To. _.. _ ILL
Dint It) I ii)
IvANI)GIAll.l. PACK.
Depth tiize FLilo
Ain. ant
VVail hickiicss
or\;Fit it Ft_
I In1u It)__
into i) FI.
1 (� I: I)\I:\ItKS:
tei Lai/
et
'tint
VIatc1'inl
O cp
p
L.r
N?
D c
1 0<
LOCATION SKNF(IT
Show direction and distance in miles Itttt3 tat Ie.Ri'a�
two State Roads or County Roads. Indudyyte
numbers and common road nnntes. reii�
c4
I I )1) I LR1 13Y CI'ICI II'Y'IT I:AT "D-I IS WELL WAS C(:,NSTRL'CTED IN ACCORDANCE WITI 115A NCAC 2C, AVi:LL---_
C ONSTRUC DON STANDARDS. AND THAT A COPY OF THIS RECORD HAS GLEN PROVIDED TO 'HIE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELT
DATE
.Submit Illy original to the Division of Water Go: lily, Groundwater Section, 1636 Mail Serriev (ender- Raleigh, NC
27699-1616 l'Imne :No. 191'91 733-32_21, within 31) (lay s. Ci AV' -I REV. 07/2001

WELL CONSTRUCTION RECORD
North 1:onlina - Deportment of Environment and Natural
(7�'esottIrccs - Division
1)E1.I.('l)\'II4.U"I012 (INUIVlIt'Al.) NAt111•: (win() ` P/!'l ( J itui ice
R11.1.('(IN'1 It.('IOU ('O]I ANY N.\\Ili_ ✓"(. C
I'.\'ft: writ. (-UNS'IICC C'I'ION 1'I•:Ittrl1'1'a ASSOCIATED IV() I'ERMrrn
I il'applicahlcl (if applicable)
284112
of Water Quality - Groundwater Section
,,///C�
CEtEr1FICA'rcoN n 077(9/
I'IIONE n / 17-kS'W
I WELT. USE (Check Applicable Box): Rcsiden'Jal la"--Municipal/Public 0 Industrial 0 Agricultural O
Nloniturine ❑ Recovery O Heat Pump \Voter Injection O Other O I[Othcr, List Use
2. WELL LOCATION: '✓/
Nearest Town: n rO/ runup, SAilee L�
Aga✓,yet Lev-.
Sgccl N:uue(L Linnbeit,Contintintly. Subdivision, Ltd No.. Zip Code)
1. OWNER: n'Ui
\ddtes.s w�9Lf of
W6 �y cellr Route N n.l
�L✓i/ze Aid e,
City w'lot'n Sidle
(9)g)- �' (o97
:\n•.t oodc Phone number
I. D:\'ili DRII.LIiL/o?—/c--
Zip Code
-
5. ItYrAl. DEPTH: 1a7C-
6. DOES \\'IiLL- REPLACE EXISTING WELL? 1'IiS O NO
7. STATIC \WATER LEVEL IiclowTop orCasiig:
Use "+" i f Above Top of Casing)
S. IT)I' GP CASING IS FT. Above Land Surface*
'Top of casing terminated alnr below land surface rer,':ires a
variance In accordance with ISA NCAC 2C .0118. L
0. YIELD (gpni): 7 METHOD OF TEST/i-,�
10. WATER ZONES (depth):
I. I)ISINFEC'TION. Type / -, Am('tutr_
12. CASI N(i: \Vall hickness
Depth Do wder or \` ere iPr Material
From e^ To ti t.c,// S/teri/
lout -__ T"------ fl"----'--
Prut To
I1. (11(01.iT: Deprlt, //?Material L Nathnd
From_ %..__._ rot «�
flow Tu
1.1. 1C 11.1.1LN: [typo) I)ianteter Slut size �iuicrial
1)uut To I1. in.
root ... __--_ I°_—..____ I1 in.
15. S:ANUJ(iItAVEF- PACK:
Depth Size ;vIiierial
From.._.._____...
Iv�nn To Et. --- — —_
I6. RI-:I;ARKS:
Topographic/Land setting
❑Itidee ❑Slope ❑Volley
wheck appropriate box
Latitude/longitude of well locution
IIcgrecsh 11etesisccundsl
Latitude/longitude souree:OGPSOTopographic map
rclteck has)
DGPTII - DRILLING LOG
from -10 Porn tliot Description
0 r20
9,
0
O
C_
0
C'0•
C „
CD
LOCATION SKFTC'll =tom
ss me
Show direction anti (list nee in miles lroitIW teat -Mr-,
Iwo Stole Roads or County Roads. I nebulae e r(4N
numbers and common road names.
O
T /,J
I Do I IERE13Y CERTIFY TIIAT THIS WELL WAS-C('NSTRUCTED IN ACCORDANCE \VITI I I5A NCAC 2C, WELL
CONSTRUCTION STANDARDS. AND THAT A COP',' OF TFIIS RECORD I1AS BEEN PROVIDED TO TI-IE WELL OWNER
SIGNATURE OF PEI:SON CONSTRUCTING THE WELL.
DATE
Submit the original to the Division of Water (jollity, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 31) do's. - OW -I REV. 07/2001

284111
WELL CONSTRUCTION RECORD
North Carolina - Department or Environment and Natural uResources - Division or Water Quality - Groundwater Section/ Cj
\,III CO\T lt.\(' I Olt I END! \ IIL..\I.) N.\\II (I rint)/ / 'X 6t,4J/45 e- CERTIFICATION IONN 7 7t,
\\Ill. (II\l It CI OIt ('O\I I' \\1' NAME7/ (e _ 'E/it MONK /i M1.( 2:217
Clr
\ 1 \ll( \\ba.l. ('O\Slltl'.CIION I'EIt\I ITN .\SSOCIA FL:D \\ Q 1'I(12\IITN
rl npltlic.thle) (ifap uhle)
WELL USE (Cheek Applicable Box): Reside lr ial Municipal Public 0 Industrial O Agricultural D
Monitoring ❑ Recovery 0 Beat Pump 1'v'a'lcr Injection ❑ Other 0 ILOthcr, List Use
2. V6 NIA. . LO( \ I ION:
Nu;i est Town: W)`%�'65e (buN'. �i✓4 cG -
(>imet N.mio. Nnmbc n. (bnmmmlr. Subdivisiml. 1_m hb_. Zip Code)
Mr /,45
Ill I�IRuil[ )
1 n i lat,n Scile / Lip (tide
\ re! :isk hide,. mmlhs
>. IIOr'11I. I)l Vi�Il: ,7 �N
/f2C 3
6. DOES WELL REPLACE EXISTING WELL? 1'IiS O NO
7. S r,\TIC WATER I.LNV FL Below Top or Cask 38 Fr.
(Use "V" it Above Top or Casing)
M. TOP OF CASING IS ET. Above Land Surface*
'lop of caving Irnninaled nl/ur hell,, land surface requiros a
variance in accordance with 15.\ NC:\C 2C MI IN. \
'). 1.IELD lepml: 1/4iNB:ElIOD OPTr(sr 4%'—
U). AA'ATI R ZONES (depth):
11 DISINI('IION. Type
'. C':ASIN(.i
Depth,
I lellt to y tt
nt Tn
-Tu -_----- I
(i1UUT Depth
I7om
Ilnt1t - . -I ti I t.
'-1 NaItli liN: Ucpih
I Tin I
Sr\NI)'OKAV1il. I'ALK:
Depth
I tom I o
I tool l u
Topographic L tnd etting
❑Rill c ❑Slope !Walk), ❑FIa1
1,1)eckaq,r tteh,v)
Lot itude!lonei mde or well locution
I11 erc,/min a eund.v)
Lmimde(loltgitude sourer OCrPSOTopo_raphic map
relied. bus)
0I:PII1 DIRILLING I.OG
Ilnut "To lion description
0
5:2_ S__
Sc /off
t, R. ENJAREN.
A im..mt
Wall hickucss
Or V. ill \ tteri:/
/763
NId ItotI
I)i:mtoler Slur >...c Material
Si'c
ial
ry
?T
� Cm
_
C C • Cam,
LOCATION SKI'TCIi Do
Show direction and distance itt miles Ihll>i Icahn
two State Roads or County Itoa(Is. Includeel11 r(ertt�
rna
numbers and common road names. 0) -
✓ z
11)1) IILREIV C'L'I:I IFS T ITAT TIIIS WELL WAS C( •NSIItUCTED IN ACCORDANCE AVIIII ISA NCAC 2C, WELL
CUNSTRli(IION STANDARDS. AND TI TAT A COP'." OF THIS RECORD HAS BEEN PROVIDED TO 1IL WELL OWNER
SIGNATURE OF PE1CSON CONSTRUCTING T I -IL: WELL DATE
Suhmil the original to the Division or water Qurlily, Groundwater Section, 1636 Mail Service (enter- Raleigh, NC
227699-1636 Phone No. 1910) 733-3221, within 31) day;. - GW-I REV. 0712001

284110
WELL CONSTRUCTION RECORI)
.Nonh Carolina - DLI':vuuau or1 iiyironment ❑nd `+atural Resources1- Division or Water Quality - Ciroundwatcr Section
[�J�J
\NELL('O\IIt.\(-IOR(INDIVIDt':\I.) NAME /prhlt)1?N'g,L ^g1tSe CERTIFICATION IP:9 N/�.-�/
\\ILl. ('ON "I R \(' UDR (-O\II' \NP C\\IF �[ ii��`�/X-121.44, I'IU)NE a VSKB)(2;22. 43:3
S I \ I I. \\1(I. I_ ('UNsrltC Cr ION rElt}LIT# \SsoCI: fr:l) \\'Q I'EIUIITn
1 Tapplicalnel (itap ucablc)
VAl.I.I. LSE. IClicck Applicable Box): Residen.lul [d" V'lunlcipal%I'uhlie D Industrial 0 Agricultural ❑
Monitoring ❑ Recoacry 0 I-Icat Pump W:l:cr Injection ❑ Oilier ❑ Il'ther, List lise
VVEl. I. LOC:A [10N
Nc:ucsi Io\\n:C�Jy/!� ('annl
IKIICcl Vawe. Nnnihm:. Conlin mdra. .Suh.li elyn uI, Lm No Zip, C
)]heel01 RO01e NO.)
/eesv L//e Ste- o
1 u) 'I l::nn SI.n) hip Code
Sc3 )- S7 . - ao��
Ares :ode I'lmmclouuhs
DAM
IOFAI. 1)00FI1:
C. DUES WELL REPLACE EXISTING \VLLL? VIES ❑ NO ECK
7 S VATIC WATER LNVIU. Below Top o[Casir IOC I'T.
i Oso's-- it Atsn e Top o(Casing)
( HP or CASING IS FT. Above I.and Sur(tce*
"lop ul caning Irrnlln:llpll al/or beln'\ lanll surrae_ rer,':ires a
variance in uccordunec rich 15:\ NCAC 2C .11118.
u. YIELD(=)pnl): `'l AlETI OD OF TIisr
10. WATER ZONES (depth):
I
Topographic Land setting
❑ILiduc ❑Slope ❑Valley DELit
Ldmck ap pnipuate ho.1
Latiludc lungiwdc ofwcll lucollon
hlegreeellupwIcxbeconI91
I.nlilude/lon_1ituvle source:❑GPS❑Topographic map
(check box)
U I'I'TII DRILLING LOG
From To Pnrt17atioll Description
L2C
,s7
575 Harp 5-4-&15y4'6'
yam ngv,Ye
� u
L
m
1
-ar
I UCA'IIUN SKETCH rn
Show direction ,ind distance in wiles Irot1 Ica m'
UICI,JI�IiC'l�101J
n ."hypc�T(� Aln�.ull i'hz
12 CASINO: AVolt Thickness two Stile Roads or County Roads. Ineluck is nOF
Depth ^ Ui:u inter or V. eightH. pl Icriul numbers and common road n;uncs. CA --I
To ,") e� ft. � �q$�l�
1-1,111 TO
(.RUGI: Ueplh / Nu liul y) Method
ezy
I law
-I. 1('RII I!N' Ucplh Diameter Slut ,_ic Material
I loin To
I tom fn 11. ln. ill.
13 SANOTGR AVEL PACK:
Depth
Size vl:a trial
Ilnm Tn -#/3%/
Il ()in Io
nn To
Ii liA 1AR 0.5
UI I HEREBY Y CFR I lFY TILAf THIS WELL WAS GUNSIRUCTED IN ACCORDANCE WITH II Is:A NCAC 2C., WELL
1'ONS I RUCTION STANDARDS. ANDTIIAT A COPY OF THIS RECORD I LAS BEEN PROVIDED To IIIE WELL OWNER
%-Ia,-&-Os
SIGNATURE OF I'bsON CONSTRUCTING THE WELL DATE
Submit the original to the Division of AA'titer Qu: lily, Groundwater Section, 1636 Mail Scnice Center- Raleigh, NC
27699-16 t6 I'hnne No. [phone], within 311 d:n s. G W-I REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Rpou ces - Div'sion or Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NANO.: rint)/1(2,- / 4 „ A /1/ .7 e cricriricATum
PlIONT: N
ide/../2
284109
S f ATE WELL. CONSTRUCTION PERMIT/I ASSOCR'TED WQ PERMrim
Hfa
WELL USE (Check Applicable /lox): Residem int erilunicipal/Public 0 Industrial 0 Aericultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection El Other 0 110ther, List Use
2. WELL LOCATIQN:
_
Neirest IleVIE.i.„.9
AV id;/‘',Ae 4/7eL:k/
Subdivision, Tut No.. Zip CillIt!)
/
Comm, _rity4WiT2T3t___
ov Niiit:11 h.i cl.‘" -5
Atith,„ 0 7 g r/ L
t Sifect oi Route No.)
City or 'Iowa MU: Zip Code
6.CsL)S - (;) 773-5—
Are., „Ric. Phone norther
1. DATE DRILLED /..•2 -C)
5. It I. 1) NPTII jt2 6-
(i. DOES WELL R 12:PLACE EXISTING WELL? YES 0
7. STATIC WATER LEVEL 13elow Top olCasino: 3 e
(use "+" irAINAV Top orCasing,
N. TOP 01: CASING IS '- yr. Above I .and Surface*
'Ton of easing terminated athir below land surritee requires a
rut:ince in arciirilanct.with I5:\ NCAC 2C .1/11/1.
YIELD (v.pni): Cs, METHOD OF TEST /9- -C-
IO. WATER ZONES (depth):
I I. DISINFECTION. Type
12. C ASINC.i:
1- rolil
TopographiciLansl setting
Ititiee OSIttpe Valley I:la
Wheel; appropriate bus
Latitude/longitude of well location
'degrees/mimeo/seconds}
I.aiiiudc/IongitutIcsource:DGPSOTopographic map
relied: host
DRILLING 1.0(1
To Fornjation Description
DEPTH .
From
/
NO
5 0
/cals
Attic Litt
Wall Thickness
Depth Diameter or V cieholt. Materhdr
To oZ / Ft -'/, VA/ Or —<1 62& /
- c_
. From To Ft. —
From to
lil<01.11.: Depth . Ntaterial , hlethod
From_ 0 To C.91\ Fite.)^4‘-f.” 1
how It,
1.1 SCREEN: Depth Diameter Sloi Size Material
Front, To in.
15. SANIMAR.AVEI. PACK:
Depth Size ivlateritil
From To H.
It.REMARKS:
r-'
1 O-t
LOCATION SKETC1- I
.--1--....
Show direction and distance in miles thing Icaic_74
two State Roads or County Roads. Include rond17---
rn.7..,
numbers and common road names. •• n
ta --,
.c• 0
=
yyw 0276
I Do I ILREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH15A NCAC 2C, WELL
(DNS] RUCTION STANDARDS. AND THAT A COM' OF THIS RECORD HAS 1311EN PROVIDED TO TIIE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL
DATE
Submit i he original to the Division of Water Qur lily. Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 OW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department or Environment and N�//fp��,)ura/l Resouu cos
/- Division of Water Quality - Groundwater Section
�/�J
\\'ha.Ll'UN'I'R:\("f(IR (INUI\'IDUAL)N:\AIF: (print) •((�.`L AAA"//fQ CERTIFICATION IF�gl(4J/q�
,) F:I.I. coy! u.t.rpop ('O\I I'AN\' NANII: _ t�_(tc_ (-tie_ 1 telt./ --P -----. .— PHONE # [�(. rID7/ " S/ ✓
284108
S FATE WF:l.l. CONSTRUCTION !PERMIT(' :%ssoclATED WQ PEILMrr#
i i l'•Ipplirlbl•I - _ (if apphcable)
\\'EI_I. USE (Check Applicable Box): Residemial O �Er- Municipal/Public ❑ Industrial 0 Agricultural 0
4lonitoring 0 Recovery 0 . Heat Pump \Vncr Injection 0 Other ❑ I r Other, List Use
/
2. WELL LOCATI N: /
Nearest: �Town: / -r /
%4.n Mf't i'.
rt
tlne¢I Name.
//N��nnthn z. Cunnu �,nily. SuhaliviSimL Lot No.. Zip CCode)OWNIilt:l/gUi/ n'l
Address j__7/7-
-
Steel ar I(Itutie No.)
TOTAL
('1I(.. "'Mt_Si
Ig57)- 2 Ls- y -
:\rea axle- Mime number _
.I. D:\TIi DRILLED /(2- (2Y -o
C'minl' '-
t
53 %C-1
Zip Code
,oi
DOES W'I. LL RLI'LAC'L' EXISTING WELL? YIiS D NO
7. STATIC WATEIt LEVEL 13clowTop ol'Casiwa: 'S''-? rr.
7 (use "r' it Above Top nr Casing)
S. TOP OP CASING IS :-•., rr. Above Land Surface'
'foil of casing ienninaled atfor below land surface retotwes a
variance in accoritance/with 15A NCAC '_C UI18.
'i. YIELI)(grunt: /-, METLIODOF-FEST/I-'
n). WATER zoNES (depth):
D .90
75 5
"SC
11. DISINFECTION: A/g
12. CASING:
• Depth Diao4er
/i
from_ _ To IrL (.�/ i
,,�_,��.topngraphic/Land setting
(yxldec ❑Slope ❑Valley ❑FI.I
(cheek appropriate box)
Lad ittide/longitude of well location
l dcgrecsatinelcs/seconds)
Latitude/longitude souree:❑GPS❑Topographic map
• . (cheek host
DNI'TII . - DRILLING I,OG
Front TO lypn}tion4)cscriplinn
/.4.')
-c
0
LOC'ATION SKlfl'('fl
CO
Arne tun Show direction and distance in miles From
Wall Thickness two State Roads or County Roads. Include
or C. eight/Ft. vlaicrial .. numbers and common road names.
fro)❑ To r1.
13. GROUT: Depth / Material �.
frtm�.•� _ ro_( f� :tJ F.%'.u.G�.,.r/
method
Id. SCI1.I1 N: Depth Diameter Slot Size Vknerial
M. ___...._ in.
From _______ im'__I'I.—_in. — in.
15. SAND;(ilti\VEI. I'ACK:
Depth Size NI;dcrial
Front__ _ -- 'it - F1.
fnml To Pt.
16. RE.RIt\RKS:
I Di) 1IEItFHV CER T IPY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE \VITI I I5A NCAC 2C, WELL_
-
(UNS IRUC'I'ION STANDARDS. AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
I a- Q-03
SIGNATURE OF I'EitSON CONSTRUCTING THE WELL. DATE
Submit the original to the Division of Water ()wilily, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 this. - GW-1 REV. 07/2001

12. CASING:
Depth
Flont
Frm__ To
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and N
%Ntill. elIN'rRAUTOlt (INDIVIDUAL) NAME whit/%(f:LL. ('ONT le trIOR (()MI'%NV NAME riCP._ L./
tural Rysour/ecs
friif
S FATE wa.t. CONSTRUCTION rE6htrra
1 il'a;)j'hc;lhIcl wr
284107
- Diviitnl of Water Quality - Groundwater Section
CERTIFICATION n.47
PHONE s ) (a <7<359, -
ASSOCIA I Eu WQ PER atrrn
(if ap,licable)
i W ELI_ USE (Check Applicable Box): Residun:ial 0 Municipal/Public ❑ Industrial 0 Agricultural 0
:\Ionitoriug ❑ Recovery 0 Heat Pump \Vaicr Injection ❑ Other 0 if other, List Use
2. WELL. L.00'ATION: / + // /
Nei Sl Town:AV.': ,y>u,/4 C•ounR4AkWo C
Simei Nmuc, Numha s, ('ouunuaily, Subdivision, Lot No.. Zip C'udel
Addle ;, 717 %vn✓�lC: u/9/-
ISliyel of Route No.)
tar//olf/Uc'Jrl,,r"P 4((
(pkilnarl',nu-/�O7 5-o Zip (.tole
-.^i
:\me code- l'hene mother
•1. I.):VI'li DRILLED 1
S. TOTAI. Dlil''I'11: Y04--
n. DOES WELL Rlil'LACII EXISTING WELL? 1'IiS ❑ NO GY
7. STATIC \VArEItLEVEL I3clowTop ofCasin : CcJ yr.
(Ilse "+' if Above -Top ol'Casing)
TOP OF CASING IS Ff. Above Lend Surface*
•'fni, of casing terminated attar below land surface requires a
variance in uccordan, with I5:\ NG\C 2C All IN.
Yn:1-D (grin). 0 METHOD or -nisi- Fl,,r
R3. \VA"l l 1< ZONES (depth):
Topographic/Land setting
❑Ridge IHSlope ❑Valley ❑Flat
(check appropriate hos )
Latitude/longitude nl'well location
I degmcs rninules/secunds )
Latitude/longitude source:❑GPS❑Topocraphic map
khcck bor.)
DEPTII . - DRILLING LOG
Fruut To Fpvniption/llescriplion
0 7C) (_ ' . /
�0 I G3
11. DISINFECTION. Type ,7/% Amt'unt
\valI riuckness
' Diameter or '. •'Chti Ft. {[v_latcria)
f'r , -5"tee t I
11 GRCw'r: Depth material •
From-.() --'roT n LL
Fnuu
Method
I I. SCRLk.N: Depth Diameter Slot Size Material
I7nm _ 'fu PI. in.
15. SANDr(iRAVIU.I'ACK:
Depth Size i�'I:ucrial
From _
I vom .re- 11.
16. Itl'\I;\RKS:
LOCATION sm.::I'C'LI
Show direction and distance in miles from a:Stasi m;
two State Roads or County Roads. Include tft roaCcc
numbers and common road names. rri'r'.
t
LComm 71,1r”
2 m
1 CD-C
CO qc
r'
I Uu I II:RIil3V CERTIFY Tli,vr rliiS WELL WASCONSTRUCTED IN ACCORDANCE \VITI I ISA NCAC 2C, WELL
CONS (RUC l IUN STANDARDS, AND TI-I AT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
Ia-c13-0 -1
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Qua.lily, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 PI • No. [phone], within 30 tia''s. - GW-1 REV. 07/2001

284106
WELL CONSTRUCTION RECORD
NorthCarolina - Department or Environment and Na oral Resources - Eiviil a Water Quality - Ciroundwater Section
DI.11,t ON'S It tt I Olt (INDIVIDUAL) NASD,: ript)
)) h LI. CON I It ‘C mit ( ow % NV NANIE _ n(e
s Lyn.: (ONSTItUCTI()N ['Eli:111TH
iltyplicable)
Z/IA. e
dfri PI IONE H ra-5 ) g_n:05-cir
mainavrioN#0A7
ASSOCIATED WQ PERSIITH
WI:LI. IMF Applicable 130s): Residential SI-VivitinicipaBlitiblie 0 Industrial 0 Agricultural LUILT
N-loniloring 0 Recovery 0 Heat Pump Winer Injection D Oilier 0 I I. 011icr, List Use
(ilapplicable)
INt;';ires1 twit:
e eC e .
riled Mow. 'umbels. Comionntly, Subdivision, Lot No., Zip codv)
oWNIi1::
:\ Lidless
los tireAsael
.1 tint Sloe lip Code
,51.,_ -5 /07
A e.t cotle• Plane
DATE !Atli tauli /Tog
5. TOTAL DEPTH: Thick
(1. DUES WELL REPLACE EXISTING WELL? YES D NO 127
7. S CATIC WATER LEVEL Below Top oltasine,: 110
Oise "+- ir Above Top orCasing)
N. TOP OF CASING IS FT. Above .and Surface*
'Top of casing iconiunletlattor below land surface requires a
variance in accordance with I5A NCAC 2C A1118.
‘J. Y IELD NIF.THOD OF TEST
in. \A, NTH( ZONES (depth):
LOCATION SKETCH 34 rric
Show direction and distance in miles froisi-ai
DWI State Roads or County Roads. Incligthe iitY
CJ
numbers and common road names.
c
ELT_-
Topogricillic11...and sett iog
0 Ridee ad Slope OValley
icheck appropriate host
L.alit tide/longitude t)1.‘vell lodaihml
I degreesitionuiestseconth I ' '
Latitude/longitude ra source:DGPSOTopoePtri-utpt - - • -
1
Ktio‘k box) ,
t) turn I DR! tiliNn I
Iron] -ro Formalon Description
1
▪ L▪ J
I I. I IISINFECTION. Type ft Aincuril
12. CASIN(i: Wall •! Inekness
c. Depth giA:yr or \\eight/Ft. Ivi."terial
Fromi--aTo6i Ft.
From To
!Tow To
I ili (.:ROUT: Deptlh Maleria.LI Nleihod
From 0 To 9i-ID Ft •Ci. ^-4-eni_T-
I 10111 ll
IT SCREEN: Ovp111 Diameter Slot I.,ize Material
01111 .1.0
15. Si \ Ni/r(ili/‘ VU. I)/ \ LK:
Depth Size ;Ylaierial
Flom. To 1:1.
I tom To
16. 0FNI/\
IEREBY CERTIFY Ti byrrws WELL WASCCNSTRUCTED IN ACCORDANCE WITI I ISA NCAC 2C, WELL
coNSTRUCTION STANDARDS. AND THAT A COPT OF THIS RECORD HAS BEEN PROVIDED TO TILE WELL OWNER
1)-17-03
SIGNATURE OF PEKSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water ()wilily, Groundwater Section, 1636 Mai! Service Center - Raleigh, NC
27699-1636 Phone No. ()19)733-322f, Within 30 day G W-1 REV. 07/2001

283925
WELL CONSTRUCTION RECORD
North CCa-olina - Department of Environment and N Iral Resources - I)i' Nam of \\ ater Oualitc - Ground vyater Section
// LA( Milt I( cDON= D
3/9
a+ra,1.(oxfaAcToagslnvuro,u,)N:Aa (print}Db1 n ' a�L ��,
�e qros . Vie- // 4 Pa hp PtIONf, u
of applicable) -� JY`�—o2 cif applicable)
STATE: \vE,Lt ( ONSTROCI ION PEIi\IErd
ASSO( 1.1'FED AA (J I'EI0,I1'1-4
I. WEL1. USE (Check Applicable Boxy. Residential 12 '.blunicipul Public ❑ Industrial ❑ Agricultural ❑
Monitoring 0 Itecoyery 0 Heat Pump Water Injection 0 Other Itother, List lIse
Fern- C5 CuuntytOo0at Topographic. L
upoiruphicLand sett
ing 2 WELLLOC. A 11(
ISm:a Name Nu 1 .....,-1,.1,l..6.„t ,ell hoh
t
� / dge ❑Slope ❑Valley
idi.frnq,naie hewNcurcst Tow?:
3. OWNIA: RJ:i , _(Y/
Address __q 0 .Cr1,Cs.N/s`--e64 a . Iaute 1,,ii iudc occun:D(1I SOl
opograploo map
Id menu. t,:con.lr
I,ha:k bov
met of Ruu�1e �Nu�-. � p
o /��Il 7� I DI pill DRILLING LO(,
( n 1 si.,iC- /lp ( .let. I rum fo Forman ni Description
I )-
\ iccolic- Dann; nnnher
4. DALE DRILLED S-/ a - 0 3
5.'ICI ALDI PIII: SOS'
6. DOLS W LL L REPLACE EXISTING WELL? YES ❑ NO
7. S I Al I(' WATER LEVEL I3elow Top or Casing: "to FL.
fUw "I- d:Abocc'ttip of Cuan_I
8. TOP OF CASING IS I I-"t-. Above Land Surface`
Top of casing terminated at/or below land surface requires a
suriance in accordance with I5A N( A( 2( .III18. O�
9. YIELD (gpm): .J H METOD OP TFSF rV, r5 -
WU. WATT-. R ZONI.S (depth)' 405 ' - 6rpm _ --. ----- -- LOC. AI ION SKLFC Ii 6
II. DISIN I -Et II ( IN: Tvpe R / f-J .Amount tan f,,J%S- Sht (t dircclion and di,tancc in mile:, tloCit Ie6i
12. C:\SING: Av`all I I ickne>s I Ao Suite Roads or ( aunty Roads- IneIti the &yid
Deinh Diameter or AV el_ht Ft. A/I�mar.d numbers and common road mmnes. cn
From Q l lo �� LL (� ' /� V� I zrn
cr
Prom I o It. __ - _. Dc
11om To Pt. _ -10. —I"-,
13. GROW ` Depth rn
Vtal..•lial Method S �rn
zi
I'rolu 0 Tu (20 Ft. C.. NNM
Frm o T o aa--
I t. _ _ _ CS -a I-7
14. S( RLLN: Depth Diameter Slot Site Alaterial N) 5
Z
I:-om To 1 t.__- in. in _..
d ,J
.5 D ' 2/Q.5T'
L.
om Tu Ft. In.
15. SAND (iRAWEL PACK(
Depth time
From To Pl.
From To Pt.
16. REMARKS:
\Itocrial
II)OII1/.'1(EIiY(I:ICI1F11l11A1 IIIISVALEI.IA. AS(UNSIRC(. II-I)INAC( UILDANC I. PI I II IS \ N( \( ,(-. AVID -I
(ON%TRI )N SIANDAf DS AND IIIA1 A( UP1 OFIIIIS RCC(�li1INI'ILUAIDI.0 TO IIIL AAI L1 nAl N4.It"_
SIUN,AILI(L OP PEIth()N( UNS IU IIN(I IIIi AAI1I. D:AII
Submit the original to the Division (JINN atcr Quality. Groundwater Section. 163n alai) Senice (enter- Raleigh_ N(
27699-1636 Phone No. [phone]. within 30 days. GAW-I RI \ . , 2Ut) I

283924
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - (iroundrvnter Section ���
NAME RpLtn Lip e.rb6 k cEl:ntu'.cnuNg_,3/,74
Wt:LLCUN"r R,A(' 1'UR(INOIA'IU(U.) NA. 1prin0 _ _
WELL (ONlRA( FmR(s»IPAN\ NA\IEG B%Y�JoS. VJ ciI 4 P.x..+Q;�-K .rl'PHONEr e
STATE\\EI.t. ('oNSTRUCI'ION t'ERMI"Ik _.. / //�/ .V 2--\sSO(- IA I F.U\\ Q I'?.R\II' Ia
Iit applicable)
(i t applicable)
I. WELL. USG (Check Applicable Box): Residential �Municilml Public ❑ Industrial 0 -Agricultural 0
Monnorin g 0 Recovery 0 Eleat Pump Water Injection ❑ Other 0 I1Othcr. List I ise_
2. WL[.I. LOCAl I( Topographic. Land setting
Nyr.�Tuvcn:( LL9� e etounty y)Otld— ❑Ridge ❑Slope ❑Valley Ilat
: r ki t i...l.ltupmpofAtc hll
I,L'Jel Nome, Nu an. Cumnumirc. subdni. loll- I to N„-lip [ ndel LuI llUtld I n1JILIdC of UCI oGln on
3. O\A NE.R: _ 0—I eYN. Q. is nmm enJ,t
Address p D t%. I.alIIUdc luneitudv uurc a:❑GI S❑Topugrrphrc mop
isrtcct 0I ioutc 10 t 1,1,,k husl
m&_ct9, I_�OJ-«t1 A_ .? %' I)I-PI-II DRILLING LUG
( Jq of t ,rare 4 )hip (,ode I'nnn To Fes -coati t i umergvu011
t
D. 94_
9 t ' SS5'
I_. J-_
Arta nalc- Phuuc ncnth.r 4. DATE 'WILLED - 2 i —b
5. "[UTAL DEPTH: 2S
6. DUES WELL RLPLACL LAISTIN(i WELL'. YES ❑ NO L�
7. STATIC I( WATER LLVEL 13,10, "fop of Casing: (Q,Q-_ET.
Aline Tins t t
8. TOP OF CASIN(i IS 1 IT. Above (.and SurIica'
'Top of asing terminated atlor below (and surface requires a
ra ri nee in accordance with 15A NCA( 2(. .0118.
9. YIELD ILTm): ,20 METHOD OE TEST r S •
11). WATIIR ZONES (depth): 405 — 241.42m
S/o51— / pm
I1. DISINIILIION: Type 14711q__ Amount jf i61-Es_
12. CASIN(i: Wail I lnckne>s
Depth Diameter ur Weight Et. Alarenal
Prom f) to 9(o It IP it PVC,
From to
Front I I't.
13. GR.01 l Depth /� (S4quteri;il _ --- iUetlt i t
Eruni b 7o _aD Fi. . _Qa»__.d-
Frnt To
14. S(IZLI-N: Depth Diameter Slut Siie Vlateral
From to Pt- in. in.
From 7u It.
15. SAND (iRAVLI. PACK:
I)cptlt ti''e Vlaterml
Prnnr Tn t-t
Dorn I Pt
16. REMARKS:
v
O -0
0
c_ 273
» c-m
LUC:A11'N SKL I tI I zm
Sh(vv vliroetiun and distance in miles from lit leu,m<
itt.o State ILtac6 or ('Lunn' Roads- Include the rt§u
nundvcr> and common road Humes. 3 Ao
W rn�
Q -
N
II)O IILRh.1iV (L.Itit YHMI 'IIIIS WILLAA;AS ( ()NS1RUCII'.I)IA A( ( ORDANC P \\IIII 13 VA(:A( 2(.AA'III . I
CUNSTR1 (TION STANDAI2 S. AND I I IA I OI') 01 1'IIIS RL(1) S 1)1 I N PILOA-IDI""-I) I I III AIT.LL UR'$.1-It
ylLL
: J 4 4
/.z-3/-b3
sIGNA I I. Or PI`RSI)N (t)NsTRI.( I INt, 1111 AAI -I I- D All_
Submit the original to the Division of V\ ater Quality. Groundwater Section. 1630 Mail Sen ice Cemer - 12nleigh. NC
27699-1636 )'hone No. [phone], within 30 da>s. CiAA'-I RF.V- II % '_OII

283923
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and NAuural Resources - D{ivision or Abater Quality
\VELL ( RA( -FOR (INDIVIDUAL) NAM `
E (print) Y_L1 MtiC. I�Yr LL'�'"
WEI.I.(1» I R:\(TOR coMr,VN\ NA\IFGir c_ne— Bros . NZ- I I `+- PowO,
STATE\\ Ft.t. (oNSTRUCFION rER\lIl#__
I f applicable) fif applicable)
tsso( I.\ l E1)\\ O
I. WELL. ESE ((:heck .Applicable Boy)- Residential Municipal Public ❑
Monitoring ❑ Recovery 0 I Ica Pump Water Injection 0 Other 0 I
2. AVF.LL LOCATION:
Nearest Trwamn.:"U2n1Ui I4. County
ltrcet A..I1IC. (Numbers. t (immunity. Subdn loon. t. t No_!Ip ( oriel
3. OAVNI.R: .L lrS_CIA
Add re,, qL 3r) Elite htl-k- )A t
/1 n e {street v 1 Runm MI.
t ,. of l ovv I Stale -� lql („de
wA .. I'hur. w nhcr
J. DAl E DRILLED 1 D 1 —O 3
5. TOTAL L)EPTII: 4in 5 '
6. DOES VVLI_L REPLACE EUJnN(i AVEIL.? YES 0 NO ffr'
7. STAIIC AVATF:R LEVEL Below Top or Casing: 'VD ET.
((lse II Abme lip ul ('axing)
N. TOP Oh CASING IS 1 ET.:Above Land Surface:`
`'eon or casing terminated at/or below land surface requires a
variance in accords •ce with 15A NCAC 2C .0118.
0. YIELD Igprn): iS METHOD OF FIST Lrs •
I (I. V. ATLR LONGS (.Icpth):
- Groundwater Section
('t;ItIIFIC.CrIOAh 31
•rIlO\E # (gra f (� �8 — 3 ! '7 0
Industrial ❑ Agricultural ❑
Oilier. List Use
Topoira)hicLand setting
❑Ridge Eclope 0 Valley ❑Pat
adleeA dissuprintd host
Latitude longitude or well location
1(I l'L'I c> minnK..:condo
Laiitudr Ion^_ituda sourcc:❑(il'S❑l upngraphlc nap
wb<ck host
1)1 '1 II DRILLING LOG
Fein � Pornta io I e ,nptioi
66 J�rxl.. t. -
So( 4{6S'
LOC:VI ION SKLF(II z cm
I I. DISIN'I I:C I ION: i vpc� 1-1--):Amount '1 f #1, . Shoo dircction and Lint., in miles from :E Ica%�
12. CASING: AJill Iluckncs> Iwo 1/4,1atc Roads or t ou nt) Rudds. 1nclud.Oc 1(12
Uepth Diameter up AA ciohl. I-t- Aid)crial ) nuluhcrs and common rout) 11at111S.5. 'V rn�
Z p
CJ tn2
ma
0 El)
N) o
2
t
1-rorn 1 o
I I0111 1 ))
13. OROI 1 Depth Metcrwl Method
From P Io a O L
1-run, TO I`.
14. SCl(E1. N: Depth )iuiuctcr
from To
I ruin To Ft. In.
15. SAND (iRAVI-.L PACK:
Dcpih ‘-no:
From fu_
From l0
16. RIIAIARKS:
Slat NIA: \latcrut
in.
I DO I ILRf.IsV (I I.P. I Ill I I IA I IIlls Vk i I I AA AS (UNS I RUC H l) IN ACC ORRI)iD VN( 1 1AI III 15 \ 1C A( 2C. AVI.I.I.
(UNSIRt;( 11(1 N ANDARDS.1 IIILAI ACOP DI IIIIS RI-.CORD�_ N I'ROAIDI.I) II) IIILAkI.I.I (AI.NI.It _ ____
h� /.z - 3 / — 4 3
sIGAA'[Liu tr)1 I'1-.RSON(°NsIltl( IINti 11(1 \A1-11. D.AII
Submit the original to the Division of Water Quality. (:rounds\ atcr Section. I63n Mail Series Center - Raleigh- NC
27699-1636 Phone Nu. [phone]. vv i[hin 31) days. CiAV-I REV. 07 '-obi

283922
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natu/rall Resources - t)iiv (doom{ of Water Ouulit
\\'FLI. ( ON I' RA(101t (INDRibUAL.) N:\\It (print) Ia /�rL.�-C .QY , far u-w
•
WEI.I.(()VERA( TOR COMP"\NA\IECYtZ✓)Z 1371"Wt)) 4Pnrap`1-c-
STATE:\\F:I.L CU]S'FRUCI I()N PER\IIr#__ \SSO(l:\fEU\\OYF.It\lb
t if applicahlel
01 applicable)
- (iruundwatcr Section �
(C ER IFl('Arm tCON # 3b(•
PHONE/
PnNF: # I()dla S' - 1
1. WELL LSE (Check .Applicable Box): Residential IAl unicipal Public ❑ Industrial 0 Agricultural ❑
Monitoring ❑ Recovery 0 Eleat Pump \\ Injection 0 tither 0 It Other. List Use_. __-
2. WLI.L LOGA110
Nearest Tolyn:
CouCLkY)et
(Shea Name. Sumba(. (bi%mm�ue Subdn oum. l 01 No /q, (bJcl
3. OWNI R eSn-1)��/,,F{.., '�v\aeLLA A--i p7 _ �
Address '.3 LLP L-t), FPOI..i
/ ie.4.4) rcct ur It out No
tl I h \
tlry,n Hun State
t
,Area cod.- Fhunc number
4. DAI E' WILLED I D — 9 - D
'r( 1 AL DLPTu 4;1p51
LJ= 53 )51
:om Eo
//a l
//ata $O51
kopoeniphic, Land selling
❑Ridge 'Slope ❑ValleV 01-1st
tdmaA aPpn,pnatc b„vt
Lwnude H ui:Mode o[vyell location
id r �. namt ',ndnl
ude Ion -irate :mace: ❑( ,PS❑T opographlc neap
hov1
UI•PIII DRILLING LOG
Pornr ioAMn Dcscript i,on
e
•
J.
6. DOE'S WELL REPLACE EXISTING WLI.L7 YES, ❑ NO _.
7. STATIC WATI:R LEVEL Below Top ofCasing: LT. - - --
Aisne rip 01( amligi
S. TOP ON CASING IS 11I. Above [and Surfhee*
.---
op of casing terminated rat/or below land ea rluee requires a --- -- _ _
variance in accordanc • wilh ISA SCAC 2( .0118. --
9. YIELD lepm). METHOD OE TEST rZr,$ --�-
10. WATER ZONCS (depth):
I2. CASING: AA'all Ihwkne„
Ucpih Di;unacr nr AAei_ht ft- Atu erial nun -en and ionunon road names. CA gm
>O
from & to / / 2 it /n " _- PU C_. 3 �o
E-rum Fo Et.rrl
1-I011l Ill I'l. _ �'i3
Wr
13(iRrn�
. Ull I Ucpth Alutenai l , ah,ml aBP
O �t
Prom / _ [o _r�0.1-t a"ti _ r �-
_
1 e0111 I0 It
14. S(RI I : Depth Ihwneter ',lot Sve Alatcri 11
1r0111 10 11. in. _-- 111-
I rum To I t. in. in
A L. L.
1S. SND ()RA I'lA( IN
Depth NIA. ALatanal
1 O<.Al ION SKETCH C..•c0a
/--1- I. DISINII`(l ION: Type �-1 H \inonnt ��3 )'I'S Jveaiiun .uud Ji,t.tnca in miles tio, Rt letmn
tvvo State Roach or (omit} Roads. Inclui. rovu
I bin, I rt
Prom I o Pt
16. REMARKS:
1 DO III ICI In (LI l IFV' II IAI I I IIS \\ i:LI. ACAS (UNS IRU( 1 I U IN ACCORD AN( 1 AA (III I SV N( \( 2(. WI III'
CONSTRUC ION tiI AND RI S. AND I IIA I ;A (OI'V Oi' I I(S RECUR ) II AS ail 1 N I'l(OAIDI I) Tit I III A'I.I-I 1)AVNI.R
/a —aye
SION \ 111(1 Or 11 RSON ( UNSn(t. (i I III AA I.II. D \ IP.
Submit the original to the Division ul AA ater Quality. Groundnater Section. 163o (Mail Ser, ice Center - R:deigh. A(
27699-1636 Phone No. [phone]. within 31) das s. (iAA'-I RE \ - 0- 2001

283921
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division or Water Quality - Groundwater Section
_ ( _�D NI(,I,LCON'1'RA(rpli (INDIVIDUAL) V:yAt F' IPrinq .Y_L. `, 1 Pump rue-Z- p
LRIIFIC.ytIO\ D /
WELL CONFI2A(T0R C(nIPAN\ NAME� 1`«rbeiaJJ�Y" �'• well * " Um(-�CO
STATE \WELT. CONSTRUCTION PERMIT# )U� \SSO( L\r ED\\C)I'LI( Ii#
(if applicable) Iii applicable)
I. WELL. USE (Check Applicable Boy): Residential Cil4unicipal Public ❑ Industrial ❑ A grieultoral ❑
Monitoring ❑ Recovery ❑ Heat Pump AVater Injection ❑ Other ❑ II Other. List Use
2. \VIiA.I. LOCATIO
Nearest I otvn:County
\/JI11ts
ISUC<I N.un.. Ne1116cn. ( umnmmrv_ SIA (Nun. Lul Ao_ CIp CUda I
1(L.
110__'
6. DONS WELL REPLACE EXISTING WELL'_ YES ❑ NO
7. STATIC WATER LEVEL Below Top or Casing: 4D FT.
IUs Ir-Ahutc tup or c asnlel
N. TOP
ra t ,dcasiterminated at/or below land ut (ace Irequi Urlace*
es a
variance in accordance with I5A NCAC 2C .6118.
9. YIELD (gpni): to O METHOD OP VLSI r$ In. WATER ZONES (depth): 1q S' - (op v+-N. ----
LOC HA I ION' SKE C I I o
I I. DISINFECT ION: Type iv _ri-/— AI I0LI t .aa-_-+� __ Sht tv lirceuuu .Ind durmLL in miles rron1 Ien D
12. CASINO: Wall 'thickness t\vo State Roads or ( thin) Roads. InclucI is rtt l.L�
Depth Diameter uI AVcieht I I. A)alma) numbers athl CPn1111Un road mates. i cn
Zm
cp
From To Ft. UI m
no
brow To Pt. —cp r�*t�
0
13. GROUT: Depth
�'yIatellal v( thy ud 3 rnz
From b Co .2/9 Ft. ii;I:e.Q ��^_�^%"/_ Ca ma
From To Pt. SO —4 r ,p 4
14. SLICE I.N: Depth Diameter Slot Svc vIdlaml IN t _i�
rtr�
Topmz_raphieLand setting
❑Ridge f11ope ❑Valley ❑flat
11aa1 im opi i.nc hall
I.atirtldd lnnglnlde ni ‘cell location
Id.rotes aorta., seaaatt t
Latitude loneitude source:❑(iPS❑Topographic map
Ich::k boy)
DC11111 DRILLIN(i LOO
From I u ' Curnr II Hi
0 74. _ ,
79 ' /4.5 ' - -
3. OWNI.R: wv�P S ag`n
AddreSS Ja5O AN, iit's Ctv.e Pam_
its 1 \l L oS- O '7 1 lD
1 ut.,r t t,II scv zIp(.�da
\I LI L ale- I'hni nrmher
4. DA-IF. DRILL(:D./ 1 - 1_9 --Da
5. TOT AL DEVIL 1:
From n To r]t/ rt 6 2
110111__ 10 It. 111 _ _ in.
11(1111 CU 1-t. 111 _ _ In.
15. SAND (IRA V TT PAC Is
Depth slie ))tame)
I- row lu II.
1'-ruin l o 1-(_
16. REMARKS.
PVO,
I DU 110(1.ItV 11.1211E 1' TI IAl 1111S N1L1. W. ( ()NS I RUC -11'1) IN ACC OI(D.AN( I AV I111 1 A N( AC 7C, AV61 I L
CONST Rli(,I ION SI AND41;DS. ANDl111T A ( 1)P1 01-I111,S 121-:( ( 121 1 N I'KUAII)PI) I() t111: AVFLI OAE NI. l( j r
�t`21 h eeid Q
SI(IN,A IHaL 01 PPRsl )N (()NS1121 I INt, 1111 N II I. I) ATP.
/ 3%fib..
Submit the original to the Division of Water Quality. Groundwater Section. 163o ;Mail Sea ice Center - Raleigh, N(
27699-1636 Phone No. t919) 733-3221. within 30 days. (AV-1 REV. 117 201) 1

283920
i. "I UTAL D11Flll: r7r)5 t-c-r ' I leel- 5� J�-
e
DOES WLLL. RLPLC'L L'GLI_'
STATIC WAFER LL.VAL(. HAISTIN(t Aelow Top of Casing: 1'ES ❑ NO 4 b PI-.
IOec " it ,Aburr fop of (it-.mui
S. .FOR OF CASING IS 1 I -"f. Abuce Land Surface*
*'ILp orcasing terminated at/or helots land surface requires a
s ariance in accordance with ISA N('AC 2( .I1118.
9. YIELD Igpm). 15 METHOD OF-rFST r2 hLs
Io. AVAT1-1RZONES (depth): to 25 1 - I p•"YN _.
11 DISINI- ITT ION: Tvpc I4 7Iij \mount (z+kU-}s
6
7
12. ( ASIN(i: AA`,ill lhicknes>
Dept),�[[ Di imaer nr \\'emht I t
Prom L.)7 To ( Pt_ t!
Prom To Ft.
fMill lo I1.
13. ('ROIJ 1 Depth�1/1 \q.tteri.d
1 runt © To_ ? Ft.
prom lc) I t.
14. hi( REI-.N: Ucpth I)1 unhier NI Sva
brunt Iu FL__. In.
Dona Fo I . in _..
•
\i utcr al
PVC.
\l et hod
Depth Stze AIuleri.d
17ulit To Ft.
Prom To Ft.
16.REMARKS:
latcri.d
(m rn oe n State /qr 1 I foal1)111
l 49
/
:\r:a soil.> one number r I VH F. T /__ �—
a D�TF DItILuD l 1—1 7 3 65
I4. ' �er�
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - (iroundwatcr SectTo
WELL CONTRACTOR (INDIVIDUAL) NAME (print) -dY E $Y(.4-LPI (tRT IF ItCFON r
o�
WELL CONTRACTOR CU)1PAN1 NANFG)(ac)(acne- Prvs. V/LI14 PuY11r'C-rnuS4k (8�p 48
—�
)
STATE\VELECONSTRUCTION PFI(MVT# _— / �/).2 \SSO( IATEl1 WO PERNIFrp
li Fapplicahlc) Of applicable)
I. WELL LSE I(heck Applicable Box): Residential EKCItinteipal Public 0 Industrial ❑ .Agricultural ❑
Monitoring 0 Itecocery 0 I feat Pump Water Injection ❑ Other ❑ I liOther. List the
2 WELL LOCAI ION: ) 9 ,.y1 Topu2 iuphic:Land selling
Nearest Totwy'n: Inp I ti tillCounty L CL4 "` ❑Ridge 1Slope ❑Valley ❑flat
Strari Nam...
Numbers.
( omnwnac. lubdn Ginn. Lot No /
3. (\\' N' I It V C) YlC1 Y'P 1
oche.' L u prropnutc hors
q, <..1.- Luliinsc longitude or vveil locution
itmn
Adzes, S9 1 1 .k )b tt4 .�
ISircct or ILnilc Na
t h»te:> !Truth, .eonnt. �
Latitudalour-itudc soured:❑GPS01 upo umpht: nap
((heck hoa
DRILI_IN(t Lu(i
formalin Description
_--
O
I.00:A 110N SKETCH L a73
Shots direction and distance in miles Gunnlea��
two St,tte Road; or ( owtty Roads. IncludeOle rt>o<
nunthers and common road names. C.l1 �r+t
-m
>0 o
1 DO IILRRti1 ( LICIIFI' llIA1' IIIIS V ILI AAAS( ONSI16A11:12 IN :Al CORDANI 1 \VrflI I.A N( AC _(.AA1.1I
( ()NS I ILU(IIUN NI AND: Ill 5. AND 'I I laA f A COPI OI- I'I IS 1(L( U -AN WI .N I'110A ID? 1) 10 1111. A11LI- UAAtN'I.R
G 2% .-i'� UI. 1'1 [(NON( )1NN1RI ( 11111. AT11. \ 11
Subunit the original to the Division of NN ater Quality. Groundwater Section. 16341 Afail Seniec ( eater- Italeigh. NC
27699-1636 Phone No. [phone]. within 31) (la) s. (iAA -1 RFA- ti- 10111
I7co

WELL CONSTRUCTION RECORD
(t Division ,fAA Water Quality - Ciroundwntei Section
283919
North Carolina - Department of Environment and Natural Resources - Iy hla t 3
I-%�, �w��y_,
VAt:LLCON'I'RACTOR (INDIVIDUAL) N.AA11� (prim) r r( t:RltFI(A'IIONn
WELLa.CON') IfA( TOR COMPANY NAVEL
STATE VAFil.l. CONS EDUCTION I'ERMII I
t irapplicable}
7
tive— 3Ie
reeve, s - vOEI I -4 warp PIR,Nt, p i 'fl LP'{g
/ lit I) _ \ssOC1.\TEl) \\QP :R>Ittd
tit applicable)
I. WELL. USII (Check Applicable lox): Residential
Monitoring_ 0 Recovery 0 Ilea! Pump Waterlttjce
2. WELL LOCA ILO ropost aphic,Land setting
Nearest Town: fl y�.�(minty Filly W ❑Ridge twPSlopc ❑Valley ❑liar
ulicipal Public 0 Industrial ❑ \gricultural ❑
n ❑ Other ❑ It Other. List tIse
tdmd appropt roue host
I strew Awing. Nwnhcm. ( nnnumits Saban i.+um_ Lot Ko.. /q, ( onlei
I-:nituda longitude of well location
3. ►- --' Prf� ' Bes_ir „- Job
uiRgrce
OW N1.R'. n �!2' pg ,cimuto.em,nobt
Address _-a-n/S� Vck_ts_�'+�-ga, • Lautudc lon_nude source.D(iPSlaT opogctphic map
tds Lkhost
(sue.a.'Raute N,rl In-Ii nRILL.IN(i LU(i
neAV 1' 11 NC �87 VO
( as on ttn state —1- /as („d.' None To I omlauon Description
^ t _ — ctxm,y-
vca.nda-Phouc numb, -aD 1 _af ?1.M
LJ/vitz,
A. DAI F. DRILLED i % - ,..qj -b 3 _ -
5.TO1ALDE.PTIl: .IDS' — —___ __.
6. DOES WELL REPLACE LXISTIN(i WELL? YES 0 NO
7. STAII( WATER LEVEL Below 'roil of ('using: QC) FT
i.. tl .-Aboc. Tap of (asinel
C. TOP O1 CASING IS _ FT. .Above I.and Surface-"
" rnp of casing terminated at/or below land surface requires a
variance in accordance with 15A NC.A( 2( .0118. .� /
n
9. YIELD I gpna}. J 5 METHOD OF I EST of rS
10.AVATEI<ZONES (depth): _ 1p1% - i pm----
I I. DISINI1 ( IION: Type H TIj-_ :Anxnna +45-1-15
12. CASIN(i: Wall Thickness
I)cpth Di:uncter or Weight li. AIalend'
From _EL To FI. b tt
From I o Et.—
Front To Ft-
13. GROL!Il Depth
PVr
\latcri;d Method
Prom fj_ To QC) it. t
Fenn to PI.
p
14. SCRP.I-N. Depth Diameter Slot Svc
Front To _..__ IT.._ in. in.
Prone to Ft. iII in.
U. SAND (iRAVLL PACK•
Depth Svc ALutenal
I rota- fn Ft. — -
I coin To D. _ -- -
16. RLVIARKS:
I ate n al
— — ▪ fl
LOCAL I ION SKETCH
.Show dircclion and dl•r.mcc in melee Irons ticapm
two State Read., or llulnty Roads. Ineludczte rozm
numbers and common road names. I o<
Cll
➢0
—.(
rno
zm
ulz
rnz
I DO IILRFI51 (tIts IF1 ALAI tIIIS\AI.LI WA5( ONSIRLcII-DIN AC(ORDAIts( L AUlfI I ANIA( 2(-_WI11
CONS I FtliC- I ION SIANI A DS. AM) IIIAI,A(OPl OF IIIISR6( OIts)IIAs Ii1I \ PILUAII)1 I) IO IIII:Aa I II OA1Y,il
slaNAruxl. t)1- PI RSt)N ( ()NSTILI (FINt, 1111 AA 111. l) AIli
r
—o
S
C0
O
—1
s
Submit the original to the Division of ater Quality. Groundnater Section. 163n Mail Ser' ice Center - Raleigh. NC
27699-1636 Phone No. (919) 733-32221, within 30 days. OW -I REV. 07 "20I11

3 OW'NI.R- t� 1-.-1p ��� T� NYC t t l,O„11 «.ind,l
Ad(Iress ��l.DI )lT s ?r .— 1 miluJ:. lonsnude tare_❑(iPSO I opogrgihie malt
t:h.c6 Liu()
151rcct or ILomc Vu.l DRI I.LI N(i I.t)( i
/gyp ( ul /� p form, dot De8cnption
Ar a 'do- I'han : number
4. DAL DRILLED i1 -a5-03
5. TUT AL DEPIl1. -3 4 '
6. DOI[S WELL REPLACE EXISTING WELL'. 1/ES ❑ NO
7. S FA WATER LEVEL Below Top of Casing: (n Q IT.
ICac iiAhorc'fop ol(:cmcl
R. TOP OP CASING IS i IT. Above Land Surface*
*'I'np n1' casing terminated at/or helots land surface requires a
variance in accordance with I>A N(' A( 2( .0118.
9. YIELDlepm), �D METHOD UP TL:SI-_ rt__
daz ksnnvi--/1e F1-- �taa3
Celt nt f tat( Slate
DI I' 1
Tom la /
.2. 3)15i'
h - --
ID.WATER /ONES(depd)) 3 a 5 ' - 3bc Pm_ et—
al�
I OC,Al ION SKLTCl l F O
I /Y/� I" Shovr Jtrcalon and diilLe in miles IFor
II. DISINhLC IIUN: Fype--�7 :Alit°our arJ_-�.�.5'nso Sr,lte RttutL, orlaunt)Rvads. lnclue
12. ('ASINu \\'all lhickne»
Depth Dranluc( or AAeiJll I-t. Alatunal nunthels and common road ❑dnu4.
From c 10 It is 11
I ronl I o _._ I-1 _.--
1rtmt Lo I-t.
13. I:mti TDepth ,+� uwrial 1 Merl, toll
I rout 0 To �tJ Ft_ _ �Y. y`—
I-rom To 1-t.
283918
WELL CONSTRUCTION RECORD
North Carolina -Department of Environment and Natural Resources - DP �II ul Water Oualttc - Groundwater Section g
CAL/1
WELL.( ONIRACFOR (INDIVIDUAL) NA)fft (prim) KPH). tl ,
C kirDS . Wei f -4 �#0111(s".te. i'IIONE n (.02 L
��t:Ll,coxrlLA('roacuatrAN1 NAME �(C � ,/O�
STATE rcr:Ll, cuNsraccrtoN rr.a\Irrro ___
T VSSO( 1.V I El) AA Q rk:a?Irra - — -
I if tgtpli<ahlcl
i r upplicablel
c raurlc:vnU ✓: _ LiV - / 70
1. WELL USE (Check Applicable I3ox): Residential Municipal Public 0 Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other 0 (1 Other. fist Iisc.
2. W'hl.L. LOC ALIIONN: v' 1�_'' },
Nearest Towil'. I r rCa S3AL- y4l )s aunty I�r�a tog _.
)J D
Land settin__
❑Ridge ❑Slope ❑Valle 'glut
Cs..S n9 s t lcck,ippr.Iri is hull
1ltrcvl Kainc. Nwnbcr.. Camnunurv. 0u66n i. n. I �n >a_ hip c .�J.1
I ;mtudc tun •uutk of (cell locauun
Fopographle.
PVC
14. SCR4P.N- Depth lhameter blot iiie
Prom Ib..
How To Ft.
15_ SAND (1IL:AVL.L I'ACIV.
Depth St'e 81:11e114
1-runt I a I t_
I rot 1 i El. . _
16. REMARKS:
\Iulcnal
i
I D) III -RE -NV ( LILT nil i ILAT II IIS \- LLL AA AAS ( ONSI RUC-1 PD IN A((1)RD:AN(F NTfI l I;_ A A( \( .2( \VU.l.l. L
C'UNS I RUCI ION STANDARDS, AND 1I IAT A l OM 01 TI IIS Rl:( ()ILI) ti IiFI-N PittII)1.1) l t) I Ill: Av I UV, NL L
/.2-.3 3
SI(iNAT URI.OF I'I RSI)N ( ()NNIRth IN( i 1I11 AVI I L D.AII:
Submit (he original to the Division of Water Quality, Groundwater Section. 163o iAlail Serf ice ( enter
I RI Raleigh.
g11 St
27699-1636 Rhone No. [phone]. within 30 days. _
r--

283917
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and al R}'sources - Division of Water Qualttc - Groundwater Section
DO 1.11 G��1 % ( T:RTIFR Al ION » 2�/
oPS • W ei l 4 Punt, 74 1`c.. !mom: e (gay 6 1�8 - 3 / �7 d
Assoc [Al F:D \FQ PER\IIT4
(it )ipplicahlel
WELL CONTRA( 1011 (INDIVIDUAL) N.-AAIE Winn
VVEI.1. CONTRA( TOR COMPANY NAME rattle -.
STATE NEI.t. ('O\SFRUCTION PERMIT# _ 171 z -.-_
(if applicable)
I. WELL L. USG (Check Applicable Bray): Residential Municipal Public 0 Industrial 0 -Agricultural 0
(Monitoring ❑ Reim yery 0 I leaf Pump Waternlection 0 Other ❑ 11 Other_ List l=ae__
2 W LI.I. L.00 AIIONi ropo I Iphic Land satin,
l I oLinty l�v11k. ❑Kidge ❑Slope ❑Valley
Nc uv R'"`11GJ�1�� t:tii J �''�"777
-1�s,L LT -- L ahpnliia hat)
tihul nJme �' Wnbe P. (blllma 11I�.In 1,11111. I i t ho_ /q l oJel
Latitude I I1ejtudc of well location
3 ( )WNI-.R:csi-.24-44-1SAG
Address 0 ( A a
Ltsiccet r Rowe No l '
r ncn IutrnSlate /lpr„Jd
( )-
Are u aril, Thane wmher
4. DALE DRILLED f J - 4,AP —b 3
_t
i. 101ALDI('III: /e'er
6. DOES WELL REPLACE EXISTING WILL? YES 0 NO 1 ..
7. S TAIIC WATER LEVEL Below Top tit Casing: LP 0 FT .
(Use" i(Ahove loc 01 Cu.,ici6
S. TOP OF CASIIN(i IS 1 I T. Aboye Land Surluce'r
"Top ulcasing terminated at/or below land surface requires a
variance in accmdance with I SA N(' A( 2( .0118.
9 YIELD I!npnp
l): O METHOD OF I LST alyr5
1(I. WATER /ONES (depth):
3 4 s - s •Fm
11. DISINI-1.0 (ION: I pc )'T _ .-AIuounl S/.p-+1,11s
I22. ( \SING: \\ltll llnekneoe
Diieh Diameter nr AAccht 19. A sd id
from © To a FL II
From
1-rolls to Ft.
Iec,a..-. nnoute_ .:Jnn.L I
Lwitude lom_itude source:❑(iPS❑'I opoeraphic nap
tdwcl.bml
DI. P Ill DRII.LIN(i LO(i
1 row To I-ornrtli 111 Dmcripiton
0 .23 ;y �._
23 ' _ sue1
• i — � �dQ�4 t.
13_ GROEI: Depth Atmerlal .} llethOJ
From Q I u 0 Ft. eAd -iY _ ---
From To Pt.
11 SCREI-.N: Depth Diameter Sloi slip AIatenal
From T o I'L in.
Prone T(1 - IT in_
15. SANI) (iRAVLI. PACK:
Depth Sv,c Vluteri'aI
11,111
I -row l o Ft_
111
c
Q C
LOGAI ION SKE'FCII i (go
Shuts direction and 111?I,t IICC in mik, tromlal Ic:om
I�ul Scue Roads or Ckwnty Roads. InclusUlhe rne•A
numbers and common road 111n➢es. -p m."'
2 =m
(nz
Carna
O --(
tV o
16. RLVIARICS: - - - - -
IDOI[ERE BI((Ai IFV'TIIATIIIIS\VILI.AA'AS (ONSI I(G():Il{D IN A(( ORDA)\,E'. AAIIII 15.AN(\C'-C. AYIhI
CONS(I ION S I ANDAI D.'. AND I IIA I A C UP( t )I II IIS RI.( 012D AS 1f1 I PILOA IDI_D I n I III i AA I.I 1 )AA];j;Ji_ __
d? - - - J�-.3/-03
till \VI 1 t. D:CII
SI(ONA'I URL OI- PIIRSi)N ( ONN Iltt'.( I IN(
Submit the original to [he Division of ater Quality. Groundwater Section. 163o (Mail Non ire ( enter l REV leigh' NU
I(1
27699-1636 Phone No. (9I9) 733-3221, within 30 day.

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources- D�<� tf Water Quality
w'ELI. ( ONTRACTUR (INDIVIDUAL) NAME (print) { A 6 1 rs b
WEI.I. CUNT RA(TUR COMPANV NAMED ruche' Bras. \NeiI at Pa'r14�
0.2 \SSO( IAI EII\\Q PER)Ilr3
tiTATF:\\F;Lt. CONSTRUCTION PER\Ill#__.. /�_._---
Iirapplicahle) Iit applicable)
283916
- Cinnmdvvatcr Seaton /(
( ERTIFIC.A'LION = 2 /
PHONE 4(an 4,/
$_3I `7d
I. WFl f LISP IC'heck Applicable Box): Residential I)5L. Municipal Public 0 Industrial 0 :Agricultural 0
nc
Monitoring ❑ Recovery ❑ Hcat Pump Water j ction 0 Other 0 11 1 )ther, List U.,c
2. WELL 1.0C AIIUI)l;t
Nearest F .\an: L'�(l,y`. County' �Q-i/ ll
c4-rr
Islrccl Nuns. Number,. (Cunnauntiv. Suhdivmmn_ Ian No _!ip (udci
3. OWNER: I 0 nv- e' 11
Address t3SD"1 -k- nis)t9c_4 ..-
�t�L C �8_a.73
I Su1c.jt or It I NO I
rl, ID
(Lc of rm.II State hip (oJ:
Amu curie- Phone numhcr —
4. DATE: DRILLED 1 a
i. TOTAL DliPll l:
6. DOES WELL REPLACE EXISTING WELL? V'ES 0 NO
7. ST All(' WA ER LEVEL Helov,' Top of Casing: �-O • I
Ills'-. ' d.-Ahovc rnp ul ( asnrt)
N. TOP OF CASING IS ( _ I'1-. Ahove land Surlhcc*
*q'op or casing terminated at/or below land sorl'acc requires a
A N(A(2( .o118. - -- -- l7
Penance in accordance with 15, �y
9. YIELD L%D METHOD_ OF T EST LQ YS --- —0 -p
10. WATER ZONES (depth): _Z �3 I - �-r) Q.p ci
.� LOC:AI ION SKETC l 1 C_ a�
I. DISINI LC ll(IV: Tvpe_T i-� _ Aiuuunt / Z. 4.1`I {_1 Sh0vv ,lireLtion and dblducc in miles lion le(r m
VA11I111 i kne>, tvvu State Roads or ( oust)' Roads. Include Iltc n>�1rn
C71
-v mo
3 =m
tn2
Topographic/Land setting
❑ILidgc ❑Slope ❑Valley AIlat
Khcck aopropnutt box
L.Itltude longitude of well location
Lanced: loncitude t ur-c❑( IPS❑Topo�'raphr in;q)
iJILLk ca.)
DRILLING LO(i
Pormatign De criptian
1)1 P 111
I7rnn To
r 3t
31.0 105_ _
_. L . Depth p Diameterr oAAeichl FI_ Alaterinl numbers and common road names.
From /D To 3 Ct Pt. LO l
From 1 Ft.
Prom _ -fo 11.
13. 'ROW r Depth A'Ll
Menial
Erm o .a%& }'
rom To Pt.
14. SC REIN: Depth Diameter slot slic Alatnrial
Drum_
Front To Ft.
15. SAND OKAVFL PA(
Dcp;h Site Mat<ri
1-runt fo t I.
Trots-- - I
Pve
16. RL:V-ARKS:
11
0 ---I
IN a
I DU I IhILFaiY CLICIIFl ' I IAI '1 I its WELL AVAS ( ()N� I Rue D IN A(. (()RDAN( F. AVIfI I 5.A ;‘,( AC 2(. AA t,Ll.
CONS IILIA CQION S'I,AND AIL I)S. A ND I IIAT A CI)Pl 01 IIIIS RL(0IjJd-I-t IirtNpl(()VIDF.D10)IIILACL_LLiVANrLZ-
/a -3/-63
sl(;NA II.ILI OI PI RSI )N ( ()Ns'IILI CTIN C 1111 AVi I I. _--
Submit the original to the Division of VAtiter Quality. (:roundvv ater Section. 163i) Nlail Sery ice Center- Raleigh, N(.
27699-1636 Phone No. [phone]. within 31) clays. OW-1 REV_ 117 20(11

283915
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources Di"' ,+ion of AA ater (iuuhc
ty - (iruuud�ater Section
11'ELL (OFIRAC TOR (INDIVIDUAL) N 1NW (prI I Uint) D 1 1l c� _� b
WELL (OSII(A(TOR(OMMPANVNAME Grc-ce i3.•os.L(.�11 P.- p)d iri<)Sv.#1'22' LLI8 - 3) r7
STATE\\ELL (ONSFRIJCrION PERMJ1NIT#___ I TD D.. 1sS0( IA I EI) WQ I'EI2\Irr#
( It apphcable) lit applicable)
. WELL USE (:heck .Applicable Box): Residential Municipal Public ❑ Industrial ❑ A'_ritultural 0
Monitoring 0 Recurery 0 I feat Pump Water Injection 0 Other 0 I I Other. List (lse_—.
2. WEI.1. LOCA LION:
Nearest Tov. n: L51L4JI c aunty_i_4g_9_i/?_0
GS 'I" Ye, I�(K
I1acc1 S,n nag Aulnhcm_ (.Immunilc. at No . !ql ( tole,
3. OW NI-.R- 1,%a.n4•1 A _. Crct..�
>,
Addle
'7
(i —LDS
I SIrcct Ol nulltC NO_I
A L _1�l _028_% .2-
n 4,,C hp(,Ide
1 1-
Alec code- mum,: uumhcr
4. UAIR DIRILLI D 1 a - q -0
5. TOTAL DLPTl1: �./
6. DUES WLLL REPLACE EXISTING WICLL7 YES 0 NO ory
7. STAIIC WAII[R LL'.V GL Below'Cop of Cluing: �.D 1-T.
(hw d,Abocc 'Cop of Cuslm_)
R. TOP OF CASING IS _ 'p' _ V .:Above Land Surface"
*Top of casing terminated atlor below land surface requires a
variance in accordance with ISA A(AC 2( .0118.
9. YIELD Igpnt): i D METHOD OF TESTlel r-_S
10. WAIP.RZONI.S(depth): _,$' — (Dr)
345
Tupogruphie Land setting
❑RiJee ❑Slope ❑Valley L-lut
check applopi hooc bold
I. alitude longitude of 1vell location
lal �I�III t eandnl
LWitude 10112 ode nurse. O(OPSOIupueraphic n1a11
1d.erhov
DI 1'Ill
1 nan l o
0 I
DRILLING I.()(1
Formation Description
0
`P I0 nnON SKLIcn C)
II DISINI -E(I ION. Ivpe 1-41-- Ftr\ulount (E, D-f I+s',h.t direction and dimllI t1ee In miles l ion ILlcn
11_.(_.ASIN(I VS. alIill cl.nc+s tvvIlilr'IL RUad]01(\Wilt )Roads.IncIudejlenoCt
Dlp i Di:uuetcr or AA ciJtt I t. Al:tertcl ❑unlhers und comm01) raid names. CII Do
s �
N0Z
CA)
0
I:elan p io at) Ft ID I 1 PVC_.
Prom_ 1 t
I rom To Ft.
13. (iRO[ 1 - Depth V(,aerial vIcthod
Prone Q TO „� (� I I_ U_n_*--l. . if
From To Pt_
14_ Se RCI.N': Dcpth 120111 lcr slot Site ylutcnal
1-nml 1 0 _._ Pt.-
1-run( to I1.
15_ SAND ( ;RA VLI_ PACK:
Uepth Si/2 Al.Itcrlar
11.11 To It
1'-rum I0 1-1.
16. ILL:M.AI<KS:
I I)O I IEILF3iY (t RIIFY T I IAI ll IIS VA 1 I I ACAS ( ON5 1 ILL( l I D IN AC ( ORIL\S( 1' VA fI I I I3_A S( \( _(. AV I LIJ
CONSIILL( "IION STAND CI)', AND 1II A 1 -A (01'1 01I I IIS RIC 012011 AS RI IN 1'ROA IDU.I) Tit I I IE VCP.LL O}\ NI.12
iZe)2QL � / —3 / —6 3
SI(,N;AI LRI OI 1'112S0N ( 011.111(I („NI 1111 11I-I I_ I) A Ili
Submit We original to the Division of eater Quality. Groundwater Section. 163o Mail Senice (-enter - Raleigh. M(
27699-1636 Phone No. [phone]. nithin 31) da's.
(AV -I RI.V. O T 2IIII I

Q
CERTIFICATION 4-297.
M
WELL CONTRACTOR COMPANY NAEda.4 1���
OCIATED WQ PERMIT#
(if applicable)
STATE WELL CONSTRUCTION PERMIT#
(if applicable
1. WELL USE (Check Applicable Box): Residential IL Municipal/Public ❑ Industrial 0 Agricultural ❑
Monitoring 0 Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural
WELL CONTRACTOR (INDIVIDUAL) NAME (print)
283t40.0
ources - Division of Water Quality - Grotmdwater Section
I .LAY z 4 PHONE agi G l 1It
2. WELL LOCATIO
Neare,5t Town:
County.
(Street Name, Numbers, Community, Subdivision, La No., Zip Code)
2
3. OWNER
Address
•
e�r_•�6Id
(Street or Route No.)
City or Town State Zip Code
( )-
Area code- Phone number
4. DATE DRILLED /JAZ/ b 3
5. TOTAL DEPTH: / 1
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 0
7. STATIC WATER LEVEL Below Top of Casing: /S FT.
Use "+" if Above Top of Casing)
8. TOP OF CASING IS /i a FT. Above Land Surface`
"Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): Na. 0 METHOD OF TEST-77..entP
10. WATER ZONES (depth): /D©'
11. DISINFECTION: Type rlr%0". —
12. CASING: (
Depth Diameter
Frorn-.Q Tosa Ft. (j 17
From _._ To Ft
From To Ft.
13. GROUT: Depth Material Me od —
From Q Ttb'Z_j)._Ft. /ai-a?t
From To Ft.
14. SCREEN: Depth Diameter Slot Size
From_ To Ft. in. is
From To Ft._ in. in.
15. SAN /GRAVEL PACK:
Depth Size Material
Amount �.5 En
Wall Thickness
or Weight/Ft. Material
.21C
From To
From__Y To
16. REMARKS.
Ft.
Ft.
Material
Topographic/Land setting
❑Ridge ikS1ope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/sccoods)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRITLLING LOrr
From To Formation Dili
CATIO
Show direction and distance in mi es from at least
two State Roads or County Roads Incl*ude the road
numbers and common road name
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUC IbD IN ACCORDANCE WITH ISA NCAC 2C, WELL
CONSTRUCTION STANDARDS, A THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL
�OWNER
SIGI A TUBE OF PERSON CONSTRUCTING THE WELL DATE
1
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days.
GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and
WELL CONTRACTOR (INDIVIDUAL) NAME (print)
WELL CONTRACTOR COMPANY NAME
STATE WELL CONSTRUCTION PERMIT# /Y7/! ASSOCIATED WQ PERMIT#
of applicable)
(f applicable)
283389
Resources -.Division of Water Quality - Groundwater Section
/ G ,Q iVI L CERTIFICATION 4177
ONE # N6ap': G O.-oVY)
l7L/1
1. WELL USE ((Check Applicable Box): Residential IX MunicipaliPublic ❑ Industrial 0 Awicul
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCATIO1i4f�--
N est Town:Q-tc County #
�� 8?/�
(Street Name, No C unity, Subdivision, Lot No., Zip Code)
3.fiO WNERCLifl'-t� e I .Set
Address
C�� I' � (Stroet(or Roe4Tlo.) "
/tea,
e2S7/G
City or Town State Zip Cndr
/-
.Ama cmiu- Phone number
4. DATE DRILLED //ti0 / P 3
5. TOTAL DEPTH:_ 4/
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO DZ
7. STATIC WATER LEVEL Below Top of Casing: yS Fr.
(Use "+" if Above Top of Casing)
g. TOP OF CASING IS /..2 FT. Above Land Surface`
""Cop of casing terminated atior below land surface requlraa a
variance in accordance witb ISA NCAC 2C .011S.
9. YIELD (gpm): _,,/r7 METHOD OFTESTrre4w
10. WATER ZONES (depth) cal /D
11. DISINFECTION: Type - Amount
12. CASING: _�. Wall Thickness
Depth Di, meter or Weien'Ft. Material
From 9 To yo Ft. 44_ #�2J P C-
From To Ft.
From To___ Ft.._--__.--
13. GROUT: Depth Material Method
Fr in__Q___ Toes2O Ft. __._. Lalifiley
From '1'o
14. SCREEN Depth Diameter Slot Size Material
From____ To FL_ in
From 'fo in
15. SAND GEL PACK.
Depth
From_ To
From TO
16. REMARKS:
Size
Ft.
ie.
Material
al EJ
Topographic/Land setting
❑Ridge 00S1ope [Walley ['Flat
(check epprcpciatc bex;
Latitude/longitude of well location
(degree iminutesisto nd::)
Latitude/longitude source❑GPS❑Topographic map
(check bolt;-
DEPTH pLING Loin--_ _P
From To Formaltion Description''
Show directio
two State Roar
numbers and c
TION SKETCH
d distance in miles from at least
or County Roads. include tkc
moron road nine:, o I°
= A 54p
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUC, IED IN ACCORDANCE WITH 15A NCAC 2C, WELL.
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO WELL OWNER
c4 ///i L
NATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mali Service Center - Raleigh NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001
3

283388
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and N tural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME
(print) 6D /12(/G' _n5t2i. L. CERTIFICATION #tit%7
WELL CONTRACTOR COMPANY NAME,R.Gt1-PL C4sl n L CatE. 'i � 4M4y � PHONE # �i' el 09-age-a
STATE WELL CONSTRUCTION PERMIT# `� (/
(if applicable) (if applicable)
N/F'
ASSOCIATED WQ PERMITS d//J
I. WELL USE (Check Applicable Box): Residential QI,' Municipal/Public 0 industrial 0 Agricultural ❑
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATIO
Neares Town: County #G
.2/7/
(Street Name, Nmnbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER
Address
1 (StreetN or )No)
City or Town State Zip Code
(
Area code- Phone number
4. DATE DRILLED //////D 3
5. TOTAL DEPTH: .3 9S
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO El
7. STATIC WATER LEVEL Below Top of Casing: gA FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / s FT. Above Land Surface"
'Top of casing terminated at/or below land surface requires a
variance In accordance with ISA NCAC 2C .0118.
9. YIELD (gpm)• . WTHOD OF TESTT.ese_o
10. WATER ZONES (depth):
11. DISINFECTION: Typ Amount // a
12. CASING: Wall Thickness
Depth ameter or Weight/Ft. Material
From 0 To / D Ft. _ it /
From_ To Ft,
From To Ft.
l3. GROUT: Depth Material pMethod_
From 0 To� 0 Ft. / fA.l� _
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From o Ft. in. in.
From T
-!/ o FL. in. In.
15. SAND/GRAVEL PACK:
De
From To Ft.
Ft.
From
16. REMARKS:
To
Sire Material
Topographic/Land setting
[Midge ($Slope Malley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/mimics/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(chock box)
DI'�M1f�LIWG LOG--_- - 1
Fornianbn Description
DEPTH
From To
O •TIO
Show direction and distance 't miles from at )east
two State Roads or County ',oads. InciSe toad
numbers and common roa ' . tes.
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRULIED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, N.j THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
I
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

283383
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) /t/ J Cp ,n 1.--PCERTIFICATION 2O /7/
WELL CONTRACTOR COMPANY NAME L 2C& W _PHONE HONE # a k- ‘ f%7—O9.fra
STATE WELL CONSTRUCTION PERMIT# AVir ASSOCIATED WQ PERMIT#
(if applicable)
(if applicable)
42'I
1. WELL USE (Check Applicable Box): Residential Cil Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATIOOX3: a
Near t Toi
Sa•v, e_
(Street Name, Numbers, Community, ity, Subdivision, Lot No., hip Code)
3. OWNER n
Address /3 D L� d
mctN r No.) a IT �0
City or Town State Zip Code
Area code- Phone number
4. DATE DRILLED e.L/%/b 3
5. TOTAL DEPTH: ej /v T�
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: /0 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS . S FT Above Land Surface*
'Top of casing terminated at/or below land surface requires •
variance in accordance with ISA NCAC 2C .0118. •
9. YIELD (gpm): /0 METHOD OF TEST /_.—Gm/
10. WATER ZONES (depth): lv_ of t ..2 9-5'
1 I. DISINFECTION: Type Amount 1/ '
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From /i To SO' Ft. /O �i .1t J..-/ f t/
From To Ft 7
CoJ 4 7/1 .
Topographic/Land setting
ORidge (]Slope OValley KFlat
(check appropriate beet)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:OGPSOTopographic map
(check boy)
DEPTH D'• LING LOG
From To Fo .. tipn Desalt -peon, ,
From To Ft.
13. GROUT: Depth'aoZMaterial Method
`y
From 0 To � Ft. 6Ltd i
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From__ /To Ft. in. in.
From - To Ft. in. in.
15. SAND/GRAVEL PACK:
h
From__. To Ft.
From / To Ft.
16. REMARKS:
LOCATION SKETC
Show direction and distance in miles from -at least
two State Roads or County Roads. Inclu. e -road
numbers and common road names. -. ;
Size Material
1 DO HEREBY CERTIFY THAT THIS WFI I WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
UCH
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2003

283382
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater
Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print)1..-- CERTIFICATION 0,2877
WELL CONTRACTOR COMPANY NAMEQ,iCLeo .Mpa ttLt4/IPPHONE # arn)— Z 7 erra
STATE WELL CONSTRUCTION PERMIT#PP ASSOCIATED WQ RMIT# N/%f
(if applicable)
(if applicable)
1. WELL USE (Check Applicable Box): Residential 9 MutnicipalfPublic 0 Industrial 0 Agricultural 0
Monitoring ❑ Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nears t Town: County
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER:_�?� r[OT.W
. .t s-.1 Address / 3 J��..aed
_. Otter or Route No.) 7
City or Town State Zip Code
(—
Area code- Phooe number
4. DATE DRILLED /D/g / b 3
5. TOTAL DEPTH: cep?
6. DOES WELL REPLACE EXISTING WF) T ? YES 0 NO 0
7. STATIC WATER LEVEL Below Top of Casing: S FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1. S FT. Above Land Surface*
'Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118. •
9. YIELD (gpm):METHOD OF TESTT.G.ILJ
10. WATER ZONES (depth): /4,01
11. DISINFECTION: Type ,Qrq"�r+ Amount
12. CASING: UU Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To y 1 Ft /O �i #'.t' ®!/
From To Ft. 7
From To
13. GROUT: Depth Method •
From D To ea7 D (_r tat Pit- y
From To
14. SCREEN: Depth Material
Topographic/Land setting
❑Ridge ❑Slope ❑Valley I1Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH
From To Formatio Description )
Ft
Material
Ft.
Ft.
Diameter Slot Size
Ft. in. in.
Ft. in. in.
From /To
From / To
15. SAND/GRAVEL PACK:
From To
From To
16. REMARKS:
Ft.
Ft.
Size Material
LOCATION SKETCH
Show direction and distance in mile
two State Roads or County Roads.
numbers and common road n
3
m yeast
de tie _load
nr
I DO HEREBY CERTIFY THAT THIS WFI 1 WAS CONSTRUCTED TN ACCORDANCE WITH 15A NCAC 2C, WELL.
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
enieict, 6abT
SIGNATURE OF PERSON CONSTRUCTING THE WELL
/ca ° 3
DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

283379
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
/ �/
�� p_ ,(� L. CERTIFICATION O / /
WELL CONTRACTOR COMPANY NAME s/ �} µ..erg {U'�wG�.�o IHONE a (rErn) - G V9-Ired
STATE WELL CONSTRUCTION PERMITa /Y//J ASSOCIATED WQ FERMITa /1/1/
(if applicable)
WELL CONTRACTOR (INDIVIDUAL) NAME (print)
(if applicable)
1. WELL USE (Check Applicable Box): Residential a MunicipaUPublic 0 Industrial 0 Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATIO h :
Near Town:
..saw
ArieV a.. e COlm 87/
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNE
Address >0
(Street a Route No.)
r1/• C
City or Town State
-217/G
Zip Code
Arca code- Phone number
4. DATE DRILLED J0//S/0 3
5. TOTAL DEPTH: 3 aS'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO IV
7. STATIC WATER LEVEL Below Top of Casing: 7t> FT.
(Use ••+" if Above Top of Casing)
8. TOP OF CASING IS rr FT. Above Land Surface"
'Top of using terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): . C THOD OF TEST�-lsst s
10. WATER ZONES (depth): //9 t
11. DISINFECTION: Type
12. CASING:
Depth Diameter
D To _ Ft.J
�
To Ft
To Ft.
Depth
To rat b Ft.
From
From
From
13. GROUT:
From D
From To FL
14. SCREEN: Depth Diameter
From ...To
Ft. in.
From / To Ft. in.
15. SAND/GRAVEL PACK:
th Size Material
From To Ft.
From To Ft.
Amount /O.,4 W.
Wa11 Thiclmess
or Weight/Ft. Material
Material Method •
10.-e
Slot Size Material
in.
in.
16. REMARKS:
two State Roads or County Ro ds. Inre the road
numbers and common road es. w
O _
LO
Topographic/Land setting
❑Ridge %Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Dt.. L yGurrl
,0
OC • TIO S H
Show direction and distance ' miles fro at -least
tl
0
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WFT
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
Serirrr_; d32e, /0//61D2
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
;J3
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD 293061
North Carolina - Department of Environment a I Resources - Division of Water Quality - Groundwater Section /
W'F,LI.C'ONTRA('TOR(INDIVIDUAL)N;\��SII,,''FF}}:'f�print)
t0 )/ )n-.—thneek>h. CF.RTIFICAATIION#'/a I
WELL CONTRACTOR COMPANY NAMF 14h_Q�C .3k641- /T'LLLail r / ' PHONE # fa CR4g 731 7O
STATE. WELL CONSTRUCTION PERMIT#
(if applicable) (if applicable)
ASSOCIATED WO PERMIT#
WELL USE (Cheek Applicable I3os): ResidentiaVSJ Municipal Public 0 Industrial ❑ AC_ricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other 0 I COther, List Use
WELL I.00ATIO
Nearee''ttTown:
(Street Name. �J\
Nlyr�/ay.
County
Lo
t nt N u.. Zip
OWNER:
3.t 071+La
Address i / U-112.4--e-A_
�.ucct or Rtut CI r)?K 7. . 1
City or mn
State
)-
Area code- Phone number
4. DATE DRILLED
Zip (
5. TOTAL. DEPTH: _38S'
6. DOES WELL. REPLACE EXISTING WELL? YF''ds�n NO
7. STATIC WATER LEVEL Below Top of Casing: _ FT.
(Cleo"(.' it -Above 'Fup of Casing)
S. TOP OF CASING IS FT. Above Land Surface*
*Tap ot'casing terminated atror below land surface requires a
variance in accordance with 15A NCAC 2C .0111. f
9. YIELD (gpm): LOD 1-
10. WATER ZONES (depth):
Topographic/Land setting
❑Ridge ❑Slope ❑Valley at
(cheek appropriate hos)
I .atitudelongitude of well location
Idcpre' m loom, sacotidi
Latitude. lon_itude source:❑CPS❑Topographic map
(checkbox)
DRILLING LU(i
Forma)escri ption
Dl.lrl'I1
1`rom_
3E '
36s' -.a N. 1 `�'-`
m
�- (p� pLUCi\(ION SKETCH
l I. DISINFECTION: Type /-f %R Amount Low -)- 'L i-5 Show direction and distance in miles from at least
13. CASING: Wall Thickness two State Roads or County Roads. Include the road
/� Depth Diameter or Weight Et. \F ter at numbers and common road names.
From To Ft. 6 it -VV (A
From To Ft. _
From To Ft.
13. GROUT: Depth /Alater�ial,. .�rL1 Method
From D To Qt Ft. (11,�p-`n -- l c r
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From 'Co Ft. in. in.
From To Ft. in. in. 0
t5. SAND/(TRAVEL PACK:
Depth Size Nlaterial
From To Ft.
From 'Co Ft.
16. REMARKS:
O -
c— o
rn
='a
to cm
om
W C
3s —IO
ZIC
9 n2
N -
a O
I DO IIEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE \WIN 15A NCAC 2C. WELL
CONSfRL1CITON STAND ARIJS, AND TIIA I A COPY OE THIS RECORD JI.A.S BFF.N PROVIDED TO TI IE WELL. OWNER
`7f /-37-6
DATE
SIGNATURE OF PFILSON CONS' IRUC'TIN(i (III.. A EEI I.
Submit the original to the Division of Water Quality, Groundwater Section, 1.63n Mail Sers ice Center - Raleigh, N('
27699-1636 Phone No. [phone], within 30 days. (iW-I REV. 07 2001

293062
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Nat al Resources - Divisi of Water Quality - Groundwater Section ' 1 /
WELT. CONTRACTOR (INDIVIDUAL.) NAM ' (print) C+i.`V��-�E - �� _ CERTIFICATION # -�d i r
W 1
- -- 'M� cv/�^1 11�� c�
WELT. CONTRACTOR COMPANY NA\IF.t\L. . _ p "i I IP IE ONE. # fOd� Lo..T 0 3 1 G
STATE. WELL. CONSTRUCTION PERMIT# T"a
(if applicable) (if applicable)
l
ASSOCIATED WQ PERMrr#
WELL USE (Check Applicable I3ox): Residentiahb Municipal. Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other ❑ If Other. List Use
WELL LOCATIO
Near uQ Town:
(Street Nam
3. OWNER:
Address
Cink
IStree er Rome No. C 02 2' 7 a l
( lay or'tottvtt Swt6 Lip Code
( )-
Area code- Phone number
4. DATE DRILLED / % - / 3 -0 .3
5. TOTAL. DEPTH: 90S I
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: to t F
ounty.
ers, Community. 5ubdivisio Lot No., Zip
le I
(tlse"t' it.Ahtt e Top of C'asinal
S. TOP OF CASING IS / FT. Above Land Surface*
"Top of casing terminated at/or below land surface requires a
variance in accordatiwith 15A NCAC 2C .111 IS.
9. YIELD (gpm): _ j,_`_ METHOD OF TEST ol. A f
10. WATER ZONES (depth):
1 I. DISINFECTION: Type
12. CASING:
/7 / Amount _s7 011
Depth Diameter
From G To .5 iS Ft. Ln t t
From To Ft.
From To Ft.
13. CIROUI` Dept j� atcrial IV ithod
From L/ Tor-,(( ) Ft. ..
From 'Er) Ft.
14. SCREEN: Depth Diameter Slot Size Material
From 'I-o Ft. in. in.
From 'ro Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Et.
From To Et.
Wall Thickness
or Weight Ft. Material
IP V C
Tupo raphic/Land setting
❑Ridge opc ❑Valley ❑Flat
,,••((((chuck appropriate boa 1
.at itude. longitude of well location
deerees amaite..secunds
Latitude- longitude source:❑GPS❑Topographic map
(check boa)
DIP TI1 DRILLING LOG
From In Font i(t Description
' 9n5 ,
0 5g'
LOCATION SKETCH
Shun direction and distance in stiles From at least
two State Roads or County Roads. Include the road
numbers and common road names.
16. REMARKS:
N
CO
0
0
0
m
O
—n
rn
GJ
1 DO HEREBY CERTIFY IIIAT TI IIS WELI. WAS CONSTRUCTED IN ACCORDANCE WIIII I5:\ NCAC 2C. WELI-
CONSTRUCTION STAND R S, AND IAT A COPY OF II IIS RECO IL ' BEEN PROVIDED TO T I IE WELL. OWNEI(
SIGNATURE OF PERSON C'ONSTRIICTINti TI II- AAIII I. DATE
Submit the original to the Division of Water Quality, Groundwater Section, 163o Mail Sera ice ('enter- Raleigh, NC
27699-1636 Phone No. [phone], within 30 days.
(iW-1 REV. 07 2001

293063
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resource..ys..,,- Divi don or Water Quality - Groundwater Section 30 LPWELT. CONTRACTOR(INDIVIDUAL) NAME (print)._ CERTIFICATION it
WELL CONTRA(TORCONIPANY NAME.-re_P—YS1)Tf_ t =�. �e_k -A-u..mp NE # (— Ci (I - 31
"
STATE WEI.I. CONSTRUCTION PERMIT# I D a ASSOCIATED WO PERMIT#
(if applicable) (if applicable)
1. WELL USE (('heck Applicable Box): Residential Municipal: Public 0 Industrial 0 :1 �ricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water nlection 0 -Other ❑ IIOther, List Use
2. WELL LOCATIO
Nea est "T Count
(Street Name. Numbers. C(tmmuniry. Subdi ei+i)m.)_ut No.. Lip ( ode)
(
Topographic/Land setting
❑Ridge VSlope ❑Valley ❑Flat
I cheek appropriate box)
Lat itude: longitude or well location
3. OAdd •ssWNER: f Qi % ) (denim minutes secon+(
1) taJLCL (_ •.)L4L 1/ , Latitude lon_titude source:❑CiPSDTopographic map
(Street or>1 o 8 7 / � (check NA
ACLit., 6 h JJJ DEPTH DRILLING LUG
City or Town f State Zip ( From o ) Format 1 )escription
( )_ 3
Arce code- Phone number
4. DATE DRILLED // -I % -1--)3
5. TOTAL DEPTH: 4&S 1
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: 1 2,0 ET.
(Use"." it'Ahura Top of Casing)
H. TOP OF CASING IS / FT. Above Land Surfltce*
"Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCA(' 2C .0118.
9. YIELD (gpm): Lp METHOD OF'FEST t. TS •
10. WATER ZONES (depth): .2 an r - a 4-S t
_3-r Qj51
11. DISINFECTION: Type
12. CASING:
Depth"? Diameter
Fronn�'lo 1$ Ft. 4o it
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From To .an Ft. " oa jto
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From _ "Fo Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From 'l o It
From To Ft.
LUC/VIION SKETCH
Amount _,2aL) -L5 .Shorn. direction and distance in miles Front at least
Wall "thickness, two State Roads or County Roads. Include the road
or Weight Ft. AtUa numbers and common road names.
('e
16. REMARKS:
I
C c
G'
n�
CO0r
c
c
o<
CO
*a
a —1�
3 �o
O cnz
N
Ct
I DO I IEREt1Y CERTIFY THAT WELL. WAS CONSTRUCTED IN ACCORDANCE WIII I I5A NCAC 2C. WELL
CONSTRUCTION S'TANS,AND TACOPY OF"II 115 I2EC0 FEN PROVIDED TO TIIE W[L1.OW'NFR
,raw/l SIGNATURE OF PERSON CONSTR(UCTING'1111- WEI E. Waft
j-37-a
Submit the original to the Division of \Cater Quality, Groundwater Section, 163n Mail Sers ice Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-I REV. 07. 2001

293064
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Nat al Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAN E (print) .1.-(Cum_t Or/le-CIL CERTIFICATION # b
— / 1 Q
WELL CONTRACTOR COMPANY NAM re Epp Yb} /Jo 1— c+ rat1` IONF. # �oarm 9T g-
STATE WELL CONSTRUCTION PERMITS / Yo 2 ASSOCIATED WQ PERMIT#
• - lif applicable)
(if applicable)
I. WELL USE (Check Applicable 13ox): Residential Municipal Public 0 Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL. 1.00ATIO, :
Neareft Town: (( '
Colin y P/C?L4 i 1XX.:1C
(Street Name. Numbers. Community. Subdivision. 1.
3. OWNER:
Address
(Simc(or Rutc No )
F(_3JLLJ 1 P_l .I )
Cny or iossn State
Zipt
( )-
Area code- Phone number
4. DATE DRII.LED / / ' el Li —63
5. TO'TAI. DEPTH: rjLS
6. DOES WELL. REPLACE EXISTING WELL? YES ❑ NO 1/3
7. STATIC WATER LEVEL Below Top of Casino: % 41-O FT.
(Use"." Above 'fop of Casingl
8. TOP OF CASING IS / FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance nh 15A NCAC 2C .Ill It✓) I
9. YIELD (gpm): METH( D OF TEST_,
10. WATER ZONES (depth): �4 5-(— / e 10 VYa
& S'LS / w
T/� nounu
11. DISINFECTION: Type
12. CASING:
,2n73(")
t.
Topot>raphic/Land setting
❑Ridge lope ❑Valley ❑flat
(check appropriate box)
Latitude longitude of well location
(degrees mutates. second+)
Latitude lon_itude source:❑C,PS❑Topographie map
(check box}
DEPTH DRILLING LUG
From To [[/J�^ 1 Funuatju( Description
LOCATION SKETCH
• +las Short direction and distance in miles (lout at (east
Wall Thie kness two State Roads or County Roads. Include the oud
Depth Diameter or Weight Et. Material number -roll romntun MildJ>19es,
From To
�� Ft . 0
From To Ft. • -. Fr-- W cn
From To Ft. I.; - z"'
cnm
13. (jRO(IT: Depth /Material 1 e_ W oat
From To c�[r*) Ft. l_R.l' -i(-7 1 a mo
_ =o
NZ
C.? rba
N --
U1 G
Z
From To Et.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/(TRAVEL PACK:
Depth Size Material
Method
is
Slot Size Slaterial
in.
in.
From I'o Ft.
From To Ft.
16. REMARKS:
c
r-�
CO
I DO I IEREI3Y CERTIFY TIIAT TI IIS WELL WAS CONSTRUCTED IN ACCORDANCE WTI I! 15A NCAC 2C, WELL.
CONSFR(1CjION STAND ,PRI9S, AND T1IAT A COPY OF MIS RECORD IL-Nf 1T'r I'ROVIDEI) IU TI IE WEL.I. UWNER
SIGNATURE oI PERSON C'ONSTRUCTIN( ifi 11
Will I. DATE
Submit the original to the Division of Water Quality, Groundwater Section. 163u Mail sen ice Center - Raleigh, NC
27699-1636 Phone No. (9I9) 733-3221, within 30 days. (W-I REV. 07 2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment an al }resources -
WE.I.I. CONTRACTOR (INDIVIDUAL) NAN . (print
WELL CONTRACTOR COMPANY NAME �rQntQ-'
STATE WELL. CONSTRUCTION PERMIT#
(if applicable)
293065
ivision of Water Quality - Groundwater Section
CERTIFICATION # o/a L%
/ / /
PHONE. # ( 4/¢ ''3 % �46
ASSOCIATED W'Q PERMrr#
lit applicable)
1. WELL USE (Check Applicable Box): Residential Municipal Public 0 Industrial 0 Agricultural ❑
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 other 0 It Other, List Use
2. WELL LOCATIO
Nearer Town: :_-ct Aa -(s71 , Coun
Llff ri/5
(Street Name. Numbers, Community. Suhdivlsi(nn.Let Se.. Lip (ode)
3. OWNER: Gt a/l'Ca.
Address 115.61 iA/tt / /s
(S cctn Route C2 O 7 2
City or To, i State
hip (bdc
I
Area code- Phone number
4. DATE DRILLED / / - (a. 7 -v3
Topographic/Land setting
❑Ridge I ,jlope ❑Valley ❑Flat
lchcck appropriate box)
I.atitude.longitude of well location
I deema. m mutes. secondnl
Latitutla: lumtitude source:❑CIPS❑Topographic map
(cheek box)
MATH( DRILLING LUG
Prom To Fonnation 1)escription
K{r
900
T
5. TOTAL DEPTH: a ? S t ..
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 15-
7. STATIC WATER LEVEL Below Top of Casing: +n FT.
(Use "(" if .Ahme Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surface*
*Top of casing terminated atlor below land surface requires a
variance in accordance with 15A NCA(' 2C .o11N.
9. YIELD (rpm): 7 METHOD OF'FEST 02 ties • 10. WATER ZONES (depth):
1l. DISINFECTION:'rype
12.
C'ASIN(i:
Depth
From /) 'ro Ft
From To Ft
From To Ft.
13. GROUT: Depth /r'vlateri
From_p_To (90 Ft. l t
From To Ft.
— LOCATION SKETCH
:13+-la 1 }5 . Shoo.direction and distance in miles rum) at least
Wall Thickness Iwo State Roads or County Roads. Include the red
Diameter or Weight FL M I numbers and common road names.0 `<
Material
aorl - 75p
I t
- F o
PV! -n G22a
COrn rn
cn
zm
- 0
W rem
o
a m�
3 am
O - tn=
ma
C,J1
Method
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK
:
Depth Size Material
From To Ft.
From 'To Ft.
16. REMARKS:
1 DO HEREBY CERTIFY TIIAT TIIIS WELL. WAS CONSTRUCTED IN ACCORDANCE \\lilt I5A NCAC 2C. WELI.
CONSTRUCTION STAND R S, AND "MAT A COPY OF Tl IIS REC AS BEEN PROVIDED 10 TI IE WELL OWNER
DATE
SIGNATURE OF PERSON CUNSTRUCrIN(i TIII- AAlil I.
Submit the original to the Division of Water Quality, Groundwater Section, 163o Mail Ser. ice Center - Raleigh. NC
27699-1636 Phone No. [phone], within 31) days. (iW-1 REV. 07 2001

293066
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
i-J
//�,..j(' t-� ru-c-(- (ERTivic.vrION# 3b� 1
WELL. CONTRACTOR CONIPAA( TOR IN\ NA\IE\v rcChE. �r 1 f L7 Lf..H) (°!'''-hioNF a taxi ED i ' 3 1 r7 b
STATE W EI L. coNSTRU(.TION PERMIT# __ . I 14 D. a - \SM)( IA I FD WQ PERM rf#
tirapplicablel tit applicable)
1. WELL USE (Check Applicable Bus): Residential CZ( Municipal Public ❑ Industrial 0 Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 It -Other. List Ilse
2. WEI.I. LOCATION:
Near t • own:
t Sireet Name Kumhan. ( onion(
P.S v 1 /itL ounty
[Flee
Suhdn faun. Ln M1a.. h p Cotcl
3. OWN1-1„
F,5
Address 321 1 Tht 1 hoz)ociL
Street p p
CS1/lt�rK�II._ute IC a�O O
State hip („de
tm ut 4,iii n
Area code- Phone number 4. DATE DRILLED t a - 1 -
01
5. TOTALDEPIIC 3 4
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO igs
7. STATIC WATER LEVE[. Below Top ofC:tsing: a 0 IT.
(Use 'l,Abine rap ol( luing)
R. TOP OF CASING IS I El. Above Land Surface*
'Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2( .0118.
9. YIELD gpm): METHOD OI TEST a 1-,as
10. WATER ZONES (depth): 3DO ( - 3 c43 Ltrg 1 ---
Topog aphic.Land setting
❑Ridge lope CD/alley DElat
t chcd. appropnete boil
I.ulitude longitude of Well locution
Id¢rcc, nunutes aee,n„lo)
I.atitudc longitude source:❑(iPS❑Topognylhic map
I dick so.)
DI. PTII ()RH.LI N( LU(i
From Io Porl11$ I)Nn Description
� 4 ) 341 -
1 LOC:A I ION SKETCH
I I. DISINl i:c iION: Type 14�I
Amount loj -1-4) 4- .Shutt direction tn) and distance in miles from at (cast
Amount l_
12. CASING:
Nall l Meknes. ttvo State Road, or t ounty- Roads. Include the road
Depth Diameter or Kei_ht Pt. Material nunihers tunl col lnam road names.
From b To 1 a 1 t. b 1' P\!G
From Io Ft._.---- -
rI
From To ti
:t1Ii Method r r- tar. ooFo
13. GR(nr: Depth
From �_ to ��Ft.
I7 �n,
From To Ft. j
Cp
rn
cc"
14. S(C ELLI:.N: Dcple Diameter slot Sue Material t -- Pi
i7
Froeee.. .._ To_—. _.— I t..._. in. in. W Sm
From 'Ft) Ft. in ... in. ! I rno
15. SAND GRAVEL PACK: ",;' ! am
(nx
Depth Svc Material I�_ 1.71
PIT)
Pr(rnt co FL ___
fV -fi
From lb It. CA i
16. REMARKS:
DU I IEILI'.BY ( Lit I IFS II IA T I111S NYLI. WAS CONS 1 RUCTI'.I) IN ACCORD Vs( I( \\ I II 115.\ N( V. 2( . \\ Et I.
CONSTR(i( II,ON STANDARDS. TND 111A f A COI'( ()I- 11115 RECORD S liI I N 1'1(OA1DI.D 1 ) T IIL AA h.LI. OWNI-.It
/-0/_0
SIGNAlUl&F ()I I'FItSON ( ()NS(Rtx IIN(.i Illl AA111
Submit the original to the Division of Water Quality, Groundwater Section. 163n\la[I tier' ire Center - Raleigh. NC
27699-1636 Phone No. [phone], within 30 days. OW -I REV. 117 21)1)1

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natu
WELL CONTRACTOR (INDIVIDUAL) NAME s ( nt)
WELL CONTRACTOR COMPANY' NAME
STATE WELT. CONSTRUCTION PERMIT#
(if applicable)
293000
Resources - Division f Water Quality - Groundwater Section
CERTIFICiA ION # u31.)
ASSOCIATED WQ PERMIT#
(if applicable)
I. WELL USE (Check Applicable I3ox): ResidentialA Municipal Public ❑ Industrial 0 Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 other 0 If other, List Use
2. WELL LOCATI )N
NearpT,gwn
(Street Nance. Numbers. C
r
County.
Topo'r aphieiLand setting
❑Ridge S ope ❑Valley ❑Flat
(check appropriate has)
I.dt hods. longitude of well location
rrg
3. OWNER: r a ide ls:c. ninnies. seconds)Addn.y.5 �ei�5'!������ L.: titude longitude source:❑(iPS❑Tupueraphic map
Cry/[�� �t (check
DRILLING LUG
T. Form Description
Street or Route
0 It
City or Town Snits
lip Code
( )-
.A
rea code- Phone number q
4. DATE DRILLED b -
3
5. TOTAL DEPTH: rRl I I
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO VI
7. STATIC WATER LEVEL Below Top of Casing: �lri FT.
(use "." ((Allow 'Fop of Caring)
K. TOP OF CASING IS / FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): ,2O METHOD OF'VLSNCACh rS
10. WATTER ZONES (depth): % QS / — 1 Cj p rn
Op M
t)I..I'III
Frog
;3T.s
) '7i)/
— I()CATION SKETCH
t I. DISINFECTION: Type Amount I a 4 4-Lit ,Show direction and distance in mile
12. CASING: Wall Thickness two State Roads or County Roads. I
Diameter or Weieht Ft. N'lip numbers and common road names.
Depth
From 'Ft)/ S Ft.
From To Ft.
/a I
From To Ft.
13. GROUT Depth Material N ethod
From To a� Ft. /3
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From "to Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size :Material
From 'Tu Ft.
From To Ft.
16. REMARKS:
c
c
at le
the Weld
O
rn CO o�
c
_ Zm
CO C)m
>0
a -4
MC A O
m
O VI Z
m,:7
N C/
rn c
Z
1 DO HEREBY CERTIFY MAT TIIIS WELL WAS CONSTRUCTED IN ACCORDANCE WIT II 15.A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND TIIAT rA COPY OF TIIIS RECO)ktH-3AS BIIFN I'ROVIDFI) TO 'THE WELL OWNER
DATE
SIGNATURE, OF PERSON CONSTRUCTING TIII. AA I1I I.
Submit the original to the Division of Water Quality, Groundwater Section, I63o Mail Sen ice Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-I REV. 07 2001

WELL CONTRACTOR (INDIVIDUAL) NAM ; printtt)7,04 pp� qq ./LI D2 --4- rL( ,'}'"'PHONE. # (�/ �6,4 g-3I %o
WELL CONSTRUCTION RECORD 293059
North C.arolina - Department of Environment a 'oral esources - Division of Water Quality - Groundwater Section C'
(TATMcA71ON # 4 4 1 a
WELL CONTRACTOR COMPANY NAME
STATE WELL CONSTRUCTION PERMIT# j `t ASSOCIATED WC) PERMIT
lif applicable) lif applicable)
I. WELL USE (Cheek Applicable Box): Residential yL Municipals Public 0 Industrial ❑ Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL, LOCATIO
Ncarent'
I Street Name. Nunmhpmmunity.. Subdivisu,p Lot Nu.. Lilt ( Ldel
3. OWNER:
Address
City. or T n Ste
w.._U �,.��
Area code- Phone number �% r ) l teit
4. DATE DRILLED / v�q —D air pq�] rr
5. TOTAL DEPTH: iI 2L t �e-�
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: FT.
(Ilse-,., if Above 'Top ofCasineI
5. TOP OF CASING IS f FT. Above Land Surface*
"Top of casing terminated at/ur below land surface requires a
variance in accnra with ISA NCAC 2C .0118.
9. YIELD (gpm' _3 & METHOD OF )-EST ea ti rS
10. WATER ZONES (depth): ! L $ r - _3.) -�_ LOCATION SKEIC"r c? o �'
1 I. DISINFECTION: Type 1--�% Amount Show direction and distance in nti y', _ m at k'�rist
YP' f-1 ess -i-�lis :
12. CASING: Wall Thickness two State Roads or County Roads c ' the road VIM
Depth Diameter or Weight Pt. Material numbers and common road name. 2 9
Frotn�'lo it 1 Ft. Lo It �.��
Topographie;Land setting
❑Ridge ❑Slope ❑Valley ,Flat
(cheek appropriate hex)
Laiitude.longitude of well location
(degree> minute.. seconds)
Latitude. loncitide ounce:❑GPS❑Topographic mop
(check box)
UF. P 111 DRILLING LOG
From To Forntatic n Description
/Di I JJ L n
n
L
(3trect or Roe pica/ /V( j g.7 g f
-:e Lip[n'—I — O(j
From To Ft.
From To Ft.
13. (TROUT: Depth _ Material Nlethod
From 0 To ,v1) Ft.l0--r
From 'to Ft.
14. SCREEN: Depth Diameter Sint Svc Material
From To Et. in. in.
From To Ft. in. in.
15. SAND/(TRAVEL PACK:
Depth Site Material
From To Ft.
From To Ft.
16. REMARKS:
1 DO I[EREHY C'ERTIFY'TIIAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE wait 15.A ACAC' 2C. WELL
CONSTRUCTION STANDAR>I). , AND ll IAT A COPY OF 11115 I(ECORU 1 EN PROVIDED 'I O TI IE WELL OWNER
SIGNATURE OF PERSON CO NSTRUC'TIN(I TI IL- AA El I. DATE
Submit the original to the Division of Water Quality, Groundwater Section, 163n Mail Ser%ice Center - Raleigh, St
27699-1636 Phone No. [phone], within 30 days. (iW-1 REV. 1)7 2001
CSZ
f

293719
WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources - Division or AVatcr Oualit_> - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAA/t/,}1�(Piino. _. ID 1 ✓1 12. Q--L )j CERTIFICATION k/a4(//ed
111 -. --/_ b)?� IONt: # (S:Qj CO 4/8 - 3
\ss0c'1:\IT:n \\Q PERal rru
(if applicable)
WELT. CONTRACTOR COMPANY NAND: _ruin L. ='
STATE WEI.1. CONSTRUCTION PERMIT#
(if applicable)
j'71)
!a-
l. WELL USE (Check Applicable Box): Residential*, :Municipal Public 0 Industrial 0 .-Agricuhural 0 1 -
Monitoring❑ Recovery ❑ i feat Pump Water Injection 0 Other ❑ I f Other. List Use
2. WEL.L. LOC'A"1 0
Near °tit Town:
e-rt 8I l •
(Strwt Mine. Numb) - m tunity, Subdis i:iun- isLdd,r1_Ip ( kick')
3. OW NI[R:
Address
County,�[
TDhha.t )� ).l r)
Street or Ron e huh.,
S(
/to ( ode
.Arcs code- Phone number
4. DATE DRILLED LP -/2 -0 a
5. TOTAL DEPTH: 1 4S 1
6. DOES WEL.I. REPLACE EXISTING WELL? YES 0 NO Xl
7. STATIC' WATER LEVEL Below Top ofCasine: 4 I'T.
(Csc-. if.Above Top of (using)
8. TOP OF CASING 1S I IT. Above Land Surface*
'Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (spur. 4 0 METHOD OE TEST at rs
10. WATER ZONES (depth): 1 sL5 ± - 4 O C1 `?.rn
I L DISINFECTION: Type
12. CASING:
DepthDi, iItCtCj
From D___ to 3 Et. Co
From 'Ft) Ft.
From _---_.lo Ft.
13. GROUT: Depth lateral
From �%To D Et.
Prom To It.
14. SCREEN: Depth Dianmter Slot Size
Front To Ft. in.
From -- to Ft. in. in.
15. SAND:GRAVE(- PACK:
Depth Size Mates(
l.at
Topographic/Land setting
❑Ridge OSlope ❑Valley Al Tat..
I disk appropriate box,
L:uitude Ioiigitude of well Ioeatibn
Id re, minutes scmnd.)
Lithe l oneitucld source.❑(iPS❑lopotnnph'k=+I P _.
l check bt,x} i
DUFF' I DRILLID(i LO(i
m To Forman(n Description
ion
0
SKETCH
:Amou)t a5-1-J)-ts Show direction and distance in miles from at leas(
\Vail Thickness two State Roads or C ounty Roads. Include the road
or Weight It AIanarja_ numbers and common read names.
L1 _L_L7
From To It.
From To Ft.
16. REMARKS:
Method
� 7y
Lite! ial
[ DO IIEREBY CERTIFY TIIA'f THIS WELL \VAS CONSTRUCTED IN A( CORDANCE: AVITII 15.A N(AC 2C. AVEI 1.
CONSTRUCTION S t.NTDARDS, AND Il IA'f rA CUP(. Uh 1I ITS RL'CORD Ip. MTN PROVIDED l O l I IP. ACEI.I- OWNER
SIGNATURE DI Pi[RSON (ONSIRL( HMI Tilt. WTI I. DA I E.
Submit the original to the Division of Water Qualit). Groundwater Section, 1631) mail Sort ice Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. OW -I RI:A. 07 2001

Hitti wa_
WELL CONSTRUCTION RECORD
295747
North Carolina - Department of Environment and
Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (((ppriintf -SSC 4t /✓r CERTIFICATION # �j ¢7
WELL CONTRACTOR COMPANY NAME /tt-tR Gre ent PHONE # 0424 SSA-es-3-4-0
STATE WELL CONSTRUCTION PERMIT#
ASSOCIATED WQ PERMIT#
(if applicable) (if applicable) -. --- ----
1. WELL USE (Check Applicable Box): Residential Municipal/Public ❑ Industrial 0 Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town:] (A)11-4 CI CAS oCounty1'1 l'-
'') L.rBeJCI "1,. r1.. ,t In ,el—rrn
(Street Name, Numbers, Comrrlunity, Subdivision, Lot No., Zip Code)
3. OWNER: % /hhp}Y U7 • 81ePJ- ` aco,
Address Ha 10CV 7VL%
(Street or Route )
A /ls 60r�, � 2 72
r City or 3�wnp — 0'State O O Zip Code
(pv2�- ! (p11/
Area code- Phone number
4. DATE DRILLED "7 — t" -0-3
5. TOTAL DEPTH: S
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO err
7. STATIC WATER LEVEL Below Top of Casing: To FT.
(Use "+" if Above Top of Casing)
S. TOP OF CASING IS FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accords nee witb l5.\NCAC 2C .0118. '
9. YIELD (gpm): 0 1ETHOD OF -EST kt 1 r
10. WATER ZONES (depth):(3') I QS- (.2) a o
a ' o � ��
11. DISINFECTION: Type 1.1'-r 4Amount / z/oY 3 n2
12. CASING: Wall Thickness
Depth Diameter orq�Weight/Ft. Ma rial
From 0 To / 0 g Ft. (� /j' 1.4 W _
From To Ft.
From To Ft.
13. GROUT: Depth Material
From To Ft. ,Material
d
E-
From 3 To Ft. a1V-%I.z r,/
14. SCREEN: Depth Diameter Slot Size 1 htatNr'al
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
To Ft.
To Ft.
From
From
Topographic/Land setting
[Midge gSlope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box) -'
DEPTH DRILLING LOG
From To Formation Description -
-7S
'75- ids
/cS-!f8
)07 --07(lo
--a 442
a:es4-9 ago cu v
vi %o --� y'�
e29a -ads
J4
LOCATION SKETCH c
c -.
Show direction and distance in miles fromalleast;:;_
two State Roads or County Roads. IncludecShe road
numbers and common road names.
/o v
oh Eli,-
Tkim P'PE v rh w40
(K� pet,
we 1
�kiic.` N,
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
CONST&EfCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNA
TU
OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-I REV. 07/2001

Sl'.1 PC BELL CONSTRUCTION PER11IT0 ASSOCIATED WQ PgRrrllTu
(itanplicoblei
WELL. CONSTRUCTION RECORD 2 9 8 6 90
Norm Caroline - Dcpaivncnrof Environment and Na/j(�iral Resources - Division of Waccr Quality - Groundwarcr Section
1\ ELL CONTRaC1'OI'.(INDIVIDU.AL) NAME ( ring Nri Ci J�leS CERTIFICATION N 1w°
WELL CONTRACTOR CUi\IP.aNV N.xt1E to' -a S t-tJJ //i.'��iw� PHONfi gz)ilit-f6
WELL USE (.Chezlr :Applioable Box): Residential Li IviunicipaliPubtic 0 Industrial 0
Monuarii g ❑ Recovery 0 Hear Pump Water lnjcccion 0 Oncor 0 If Orher, List Use
2. WELL LOC.ATNN: �
NcitesyTown Yf ✓ Limy i �( Co Line✓os /
o•W lieik a�,NesdlY/ge—
'�.
t3�ri Nanm, Nun ocn, Cannn un try, Subdtv smn , Ls Plo., _Ip Cud.)
3. O\1'NER. �,o c-ressIc.
tt
.Adiicsa zc7q (-hi j e u 7J0_,'? sir r- lie jic
(Sneer or Rourc No.)
AShe✓,Y/e_ ne A88Dfo
Cry ar Town Sratc Zip C„dc
Pre cod;- Phan numcr
4, DATE DRILLED c! ' /D
5. 'TOTAL DEPTH: rbror /
o. DOES WELL REPLACE EXISTING WELL? YES 0 NO e
7. STATIC WATER LEVEL Below Top of Casing: /CCv FT.
/ (U;e ''i-')i.lbovc Top of Cismy)
3. 1'OP OF CASING G FT. ..Above Land Surface,'
"Lap or. ism; eerm,iaad aver bcluw land surface rcq uires a
varisna m a::oraanu wire I5,A NCAC 2C .O110. p
9. YIELD (spin): METHOD OFTESJOOS""J_�Jj
10. WATER ZONES (depth): ii4 y
I I. DISINFECTION: TypeC/Pe/0)G
12. O :SING:
Dtpch Diamcrcr
From 0 To ZY Fr4.ne
From To Fc.
From To Fr,
13. GROUT: Deprh Material
From D To 25 Fr. CwicnJ
From To Fr.
14. SCREEN, D.prh Diameter Slor Size
From To Ft. in.
In.
From To
Fr in. In
l5. S>.ND/GR-iVELPACK:
Dcprh Size Marcrial
From To Fr.
From To Fr.
?.mount i2 foe
Wall Thickness
or Weighr/Ft. cnnl
to. REML=,RKS:
Mcrhod
Onet
Ntarcrial
Agrin:Mural 0
Topo�graphic/Land setting
❑Ridge L7SIope ❑Valley ❑Flat
(check appropriarc box)
Latitude/Ionginrde of well location
N7r°Lr.674'idore.r e'o
(degrees/ m inmuncconds)
Latinldeilongirude source: F1GPS❑Topographic map
DEPTH (cncck box)
DRILLING LOG
From To Fo anion Description
D - 23,y�
Z1-ZY
Lr- tor
v
O o
c)
71
LOCATION SKETCH A c^
Show direction and distance in miles from leasE-2
two State Roads or County Roads. IncludeNk ro9;1
numbers and common road names. -0 mo
—o
"m
cm Z
n? m 7a
CA --4
fJ1 c
z
7(rd Cre
CAnito ,ir.C.
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit Eric original to rho Division of Warer Quality, Groundwater Section, 1636 Mail Service Center- Raleigh, NC
27699-163o Phony No. (919) 733.32:1, within 30 days.
GW-I REV. 07/2001

293687
WELL CONSTRUCTION RECORD
Norm Carolina - Dcpaiiment of Environment and Natural Resources,- Division of Water Qualiry - Groundwater Section
\\ ELL CONTRACTOR. (INnlY1DUAL) NANIE�(('p'rim) tt,.w ' L(/.>.6! CERTIFICATION a.J h/J
w ELL CONTRACTOR COMPANY NAh1e le;,.a.J°w $ hG»' .�A•2��If yr PHONE rW}ZJ"'r—Mi
STATE \YELL CONSTRUCTION FERhIITh ASSOCIATED`WQ PtRIYl1Tn
:r.::plla.,bl:1 /irepplicablel
I. WELL USE rCheed Applicable Box): Residential ffr'lvlunicipaUPublic 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water lnjccrion 0 Other 0 If Other, List Use
2. WELL LOC.AT ON:
Neare Tow➢:Lew Ir. County
ii C tie. -e &a . zrhs ,i
tSoccr N.,,„‘,:Number, Cmnm unity Subdivision, Lor No., Zip Code)
_. OWNER: ) ca en az.
Adores /8/Mee nre-4 ,Ct.
� LSncerorRoutcNo.)
( Riofoir (YC .2S7/4.
C:ry a Town Sutc Zip Cock
(C J.81- c2,14_R -. 00 'i 5
Aida Cods- Phone number
+. DATE DRILLED SThe7 —03
5 TOTAL DEPTH: yore
a. DOES WELL REPLACE EXISTING WELL? YES ❑ NO V
1. STATIC WATER LEVEL Below Top of Casing: TO FT.
(Use "*"'if Above Top of Casing)
S. TOP OF CASING IS FT. Above Land Surface'
'NO or e4sm; rcrminare:l aver bcluiv land surface requires a
variance in aceurdauce irh l$A NCAC 2C.0118. /�
9. YIELD (gpm): / METHOD OF TEST//Q.�%1r - of
o'
WATEr.zoivES (deEa pth): ): lam' 2 Vol
I I. DISINFECTION: Type eh. .en— Amount /( kei.
11. CASING: Wall Thickness.
Depth Diameter or WeighrFr. Nlarcrial
From 0 To IOY RigMtSD2zs /cf -
From To F.
From To Fr.
13. GROUT: 0oprh Ndarerial Method
a jc %�o✓r'ni
From 0 To ZO Er. ak,c
From To
I4. SCREEN: Depth
Diamcrer Slor Size Material
From To Ft. in. in.
From To Fr in. in.
U- SAND/GRAVEL PACK:
Depth Sizd Marerial
From To Fr.
From To Fr.
DEPTH
From
To
43
l3�-GY ,c,/Alert
br• vat
-.w>ac
Topographic/Land sewing
❑Ridge dope ❑Valley ❑Flat
(cheek appropriate box)
Latitude/longitude of weldlocarion
Mr °?r.3-► jorz.s6.777
(degrees/minutes/seconds)
LariwPS deilongirude source: a ❑Topographic map
(check. box))
DRILLING LOG
Fq�rma n Description
O
LOCATION SKETCH rra
rn
Show direction and distance in miles from at IftLtr o`
two State Roads or County Roads. Include the?'iad w
numbers and common road names.
Cadn-4N, N.0 .
C!1
01
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C WELL
CONSTRUCTIIyjN STANDARDS AND TH.AT1.A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of 3Vater Quality, Groundwater Section, 1636 Mail Service Center- Raleigh, NC
27699-163o Phone No. [phone], within 30 days. GW-I REV. 07/200I

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Na ural Resources - Division of Water Quality -
WELL CONTRACTOR (INDIVIDUAL) NAME (prior) 41'I441
WELL CONTRACTOR COMPANY NAME AClf4 fans I-e// `%s•/��r
WAies
298663
Groundwater Section
CERTIFICATION #
PHONE 'en al-5✓` r
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMITS
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential Cr-Municipal/Public ❑ Industrial ❑ Agricultural 0
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearesro sqv •
ern
{4 County /lleywf� ve
e^ In
(Soca Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER. T � US,
Address la rnLLl hrf'r1 *
As he-u.11r n c a88oti
(Sires( or Route No.)
City or Town Sam
f6alo- 45 w- 11134
Area code- Phone number
4. DATE DRILLED S.-ZS-03
Zip Code
S. TOTAL DEPTH: ;Yr
6. DOES WELL REPLACE EXISTING WELL') YES ❑ NO Er-
7. STATIC WATER LEVEL Below Top of Casing: YD FT.
(Use "+"'if .Above Top of Casing)
S. TOP OF CASING IS / FT. Above Land Surface*
`Top or casing terminated actor below land surface requires a
variance in accordyy}}nce with I5A NCAC 2C .0118.
9. YIELD (gpm): S O METHOD OF TEST
10. WATER ZONES (depth): .2/0'
Topographic/Land setting
Ridge ❑Slope ❑Valley ❑Elat
(check appropriate box)
4tityde/lon'itude'ofwell location ,
dsi3l,305Wct,Lir,00
(degrees/mintnes/seconds)
Latitude/longitude source: ❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
0 - /ON F j
log — l dY
11. DISINFECTION: Type G/i,-ne Amount % %So
12. CASING:
Depth Diameter
From 0 To /De Fr. %%N
From To Ft.
From To Pc
13. GROUT: Depth Material Method
From 0 To to FL ion erelc ,An-- •Cy
From To Pc
I4. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ftin. in.
15. SAND/GRAVEL PACK:
Depth Size ivlaterial
From To Ft.
From To Pc
Wall Thickness
or Weight/Ft. Material
/'P "C
N grn
?t—
LOCATION SKETCH �?o
Show direction and distance in miles from at least N
two State Roads or County Roads. Include the road
numbers and common road names.
S�r.k:A-5 124L,
Ca n +.5,u 1-2 .
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
CONSTjtUCT10N STANDARDS, ANQ THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
'-✓.,.-b22 c- zS-0:3
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center- Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

298644
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resourcesr- Division of Water Quality- Groundwater Section
(INDIVIDUAL) CONTRACTOR (INDIVIDUL) NAME //Y(p�rint).L"A'% it Welt( ! CERTIFICATION NaPiie
\FELL CONTRACTOR COMPANY NAME /afitt.T°'l i s-t / 12-//J.i7 PHONE ji lrl ?rj--,j/f/
STATE WELL CONSTRUCTION PERMITS ASSOCIATED WQ PERMIT/
(ir applicable)
lif.tppliablel
1. WELL USE (Che.cic Applicable Box): Residential e NlunicipaliPublic ❑ Industrial ❑ Agricultural 0
Monitoring Recovery 0 Hear Pump Water Injection 0 Other 0 It' Other, List Use
2. WELL LOCATIQN:
pcaresLToWIT Counry
ahe. Loga,v-42,f/e E' fiiirz,t
(Sate( Nanm, uunbcrs, Caminuniry, Subdivision, Lot No., Zip Code)
- 3. OWNER. .... • I "nettCa. + _%ngh tt/°/atO
Addres> SQ/O ' i-eu.%/2- J
(Street ar Route No.)
Alen drr&oivu.//e A' C a 8.79 /
�City ar Tot n Suae Zip Coda
(ap i^,1- (e%7— ` 9'/
.iies cod:- Phone nu is
4. DATE DRILLED ire— el- ear
5. TOT.ALDEPTH: rot"
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO '
7. STATIC WATER LEVEL Below Top of Casing:490 FT.
(Use "t"le Above Top of Casing)
S. TOP OF CASING 13 FT. Above Land Surface' r,
"Top creating terminated aVor bduw land surface requires a
variance in aeoorclaiy5 with ISA NCAC 2C Awls. {'^
9. YIELD (gpm): /L METHOD OF TESTAce• 1P'/1:f
I0. WATER ZONES (depth): •260' 4O
Topographic/Land setting
'Midge ❑Slope ❑Valley °Flat
(check uppropriatc box)
La irude/longitude of well location
(degreesiminmes�n conds)
Larirudeilongirude source: l3GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
D - A 4G- 7/
a
e„�Sl�. e o
7! - 1 o r 6�..., fie52
.
iGG
c
I I. DISINFECTION: Typi4.-.
12. CASING:
G
Doprh pi/2eJr
From 0 To �/ Fr. `.
From To Ft.
From To Fr.
13. GROUT: Dcpnt
From O To20 FL
Amount /2 /io
Wall Thickness
or Weight/Fr. pMareriel
crifeii _et
Marerial
C/-Ifeeite
From To Fr.
13. SCREEN: Depth Diameter
From To Ft. in.
From To Fr. in.
15. SAND,OR-FVEL PACK:
Depth Size Marerial
Peak,
Method
ornf
Slot Sizc Material
in.
in.
From To Fr.
LOCATION SKETCH
Show direction and distance in miles from ar least
two Stair: Roads or County Roads. Include the road
numbers and common road names.
C�he. ter — L;fie- C. Foe*
CititiftN. C.
From To Pr.
lo. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C: WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
r z/-pj
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Warer Quality, Groundwater Section, 1636Mail Service Center - Raleigh, NC
27699-163o Phone No. [phone], within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
Norm Csrotina - Department of Environment and Natural Resources - Division of Warer Quality - Groundwarer Section
\S ELL CONTRACFOLi(INDI\9DU.:J.) NAhLE/ —(print) ditto, .tt /7�.°,e CERTIFICATION Lip
\1 ELL CONTR+CTOR COMPANY NA.NE rL ies//Oa/ I2// /I�cc//t PRONE }I7 h C/ %NS(j
STATE WELL CONSTRUCTION PERMITA ASSOCIATED WQ PERMIT,/
if _cfa.blcl (if applicable)
298640
1. WELL USE (Check .Applicable Box): Residential Pf MunicipaUPublie 0 Industrial 0 Agricuhural 0
Monuoring 0 Recovery 0 Hear Pump Warer Injection 0 Other 0 If Other. Lisr Use
2. WELL LOCATIQN
NcaresLTown Lam--t (LG Countyte4ey�-'o�r�
353 CrcWF uutsc IZd.
(Sa.:r Nanm, Nwnbcn, Communiry, Subdivision, Lot No., Zip Code)
3. OWNER: Ni: ke,
Address 353 Go1r Ccu...rsc t
CI(Sacet or Route No.)
Jae hC
city or Town State Zip Code
PS1 a.
Kea)- 2 3 3 L+a9
.A,'te cooe- Pliono number
4. DATE DRILLED r'Z.fr-03
5. TOTAL DEPTH: goer
o. DOES WELL REPLACE EXISTING WELL YES 0 NO Q
7. STATIC WATER LEVEL Below Top of Casing: VD FT.
(Die "."'ir above Top or Casing)
3. TOP OF CASING IS FT. Above Land Surface.
'Top of casing re rmin Aced acrur below land surface requires u
variance in Ac eo roA nee with ISA NCAC aC .011 S. pp
9. YIELD tgpm): /D IvIEI-;OD OF TEST "Atha,—Klf
10. WATER ZONES (depth): Liu
Topographic/La9.2 setting
❑Ridge ❑Slope OValley OFlac
(check uppropriata box)
4citwrde/longitude of well locarion
Pis
(degrees/minuteyytiseconds)
Lati(udeilongirude source: ir' GPS❑Topographic map
(cheek box)
DRILLING LOG
Foanati n Description
AI •
tic.,/,f/r., C
DEPTH
From To
o—r
`r- 70
D-/,/or
11. DISINFECTION: Type Chi -%1C Amount /r /M.
12. CASING: Wall Thickness
Depm Diamerer or WeighciFt. qla�rerial
From 0 To 70 Fr. 4.ar (nuervc
From to Fr.
From To Ft.
13, GROUT' Depth Material tvl � cmd o
From V To 20 Fr. COnc/6lc /o.s'1nT
From To Fr.
14. SCREEN: Depth Diamater Sior Size tyiarerial
From To FL in. in.
From To Fr. in. in,
15. SAND/GRAVEL PACK:
Depth Size Material
From To Pc,
From To Fr.
73
G -,
rn
x�
N r_
LOCATION SKETCH 'a O m
Show clirecrion and durance in miles from at leas[ t,-,�
two Scare Roads or County Roads. Include Lhe roan
numbers and common road names. cri
Q,To(f Co rs ¢ lad.
Clydc_ rC
lb. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STANDARg3, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
(A/J.�"`' d' 2a-- o
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwarer Section, 1636 Mall Service Center- Raleigh, NC
GW-I REV.07/2_001
27699.163o Phone No. [phone], within 30 days.

298571
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section r�
WELL CONTRACTOR (INDIVIDUAL) NAME (print) d0 66y jf(/, / 7). CERTIFICATION #2.0 �/(q AS
WELL CONTRACTOR COMPANY NAME Fri
rKV S O/We,/ �/�//i u Ce, PHONE dFB.LF) 6W -9 Pr?
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential D Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: ft__/' County
Fratc#- �dt m /a/(r #d .1
(Street Name, Numbers, Community, Subdivision, Lot No., Tin Code)
3. OWNER: Kr// U/att. eaL/
Address 1 (P(0 I Cann? I Vhd •
(Street or Route No.)
tdopographic/Land setting
tge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitudy of well location
N SS°26.377 /Idea°SY.%y3
(degree mute econds)
Latitude/longitude source: GPS❑Topographic map
(check box)
Camay( n( a,'-] } (p DEPTH DRILLING LOG
City or Town State Zip Code From To Formation Description
(S.-(o&IS'`1ta02-- 0 - 3xr Dr'rf
Area code- Phone number ,51. — S'OS . 6ta stt f t
4. DATE DRILLED 5/°J7o3
5. TOTAL DEPTH: SO S
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO QK-
7. STATIC WATER LEVEL Below Top of Casing: S D FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface* Q p
"Top of casing terminated at/or below land surface requires a .0 C'
variance in accordance with 15A NCAC 2C .0118. �t '-A
9. YIELD (gpm): 310 METHOD OF TEST /YOwri//C0 o*r` te
10. WATER ZONES (depth): //,7I1 N
o
LOCATION SKETCH N -70
Amount 194 2 S Show direction and distance in miles from at leastp r0
Wall Thickness two State Roads or County Roads. Include the roams tic-
-Diameter or Weight/Ft. Material numbers and common road names. W n
6,xS a/itr/z5 pvcsna2/ o
I . DISINFECTION: Type )ho hit1S
12. CASING:
Depth
From 0 To_ia, Ft
From To Ft.
From To Ft.
13. GROUT: Depth Method
From 0 To 20 Ft. PeU/`iey
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in. _
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Material CA Al Pelt
Etna( set R d. ' Lake Le�c�n
Coal -Lan, lie
16. REMARKS:
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A C PY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
l///r SA(03
SIGNATU E OF PERSON CONSTRUCTING THE WELL ATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-I REV. 07/2001

en tinier
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and • tural Resources - Division of Water Quality - Groundwater Section
A '-_ �, _ (F,RTIFIC.VtiON a T'/ g
WELL CONTRACTOR (INDIVIDUAL) N:\SIE: print) n�{m I �/ rr// ,/
Wfa.l- CONTRACTORCOMPANY NAME /� t aea—Ca_ ?d 1/' Q M.LF(OSE a (po'i P. 6'ef?
STATE. WELL CONSTRUCTION PERMIT# / 4L 2' ASSOCIATED WQ PERM(!# ii
l
2
(if applicable) lit. applicable)
WELL USE (Check Applicable Box): Residential Municipal Public O Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 I [Other, List Use
WELL LOCATION•
Nearest Town:
DI�IvLJY tJ1at�
I Strce cro Name. unbars, Co nunity, Suhdivisiun. Lot No.. Lip ode)
3. OWNER: KC .y)Y1 10 / t-
Address P alb
p(jcet or Rout: No.)
QV) ad
� r /) 0
�°7
ab"7& /
Fawn State Lip Cudc
( )-
Arca code- Phone number
4. DATE DRILLED // - /-b.3
5, TOTAI, DEPTH: 6 4 .c , �../
6, DOES WELL REPLACE EXISTING WELL? YES 0 NO (ad.
7, STATIC WATER LEVEL Below Top of Casing: / GG ET.
(Use "i"it Alm). 'Fop of Casing)
8. TOP OF CASING 1S I FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C IH,
9. YIELD (gptn): METHOD OF TEST c r5 -
I0. WAFER ZONES (depth): s51Q5 ' - rvm.
O LOCATION SKETCH
CH
11, DISINFECTION: Type /4 T11 Amount QQ' .-1,6/71-s-Show direction and distance in smiles from at (east
12. CASING: Wall Thickness two State Roads or County Roads. Include thcgmad
Diameter or Weight H. ,material numbers and common road names. F
Topographic/Land setting
❑Ridge ❑Slope ❑Valley `�19ut
i ghee), appropriate hos)
Latitudelongitude of well location
degrees in inutev,ieetiudsi
Latitudelongitude source:❑CiPSOT opographic map
'check box)
1)l I'LI1 DRL1.t,IN(i LOG
From fo Formation Description
92. -y
_92_' Gjs'
_., . _.
Depth
From C ToS Ft.
From To Ft.
From To Ft.
(.G / /
YVC in
A c C`
70 zm
o<
ut S_ rm
O
a mo
3r usrn
m`
C.71
Z
13. GROUT: Depth :ulster_ ial y N ethod
From C./ To aU Ft. (-'2�✓nQ -��
From To Ft.
14. SCREEN: Depth Diameter Slot Size )laterial
From To Ft. in, in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From 'fo FL
From 'fo Ft.
16. REMARKS:
I DO IIEREBY CERTIFY TIIAT TIIIS WELL WAS CONSTRUCTED IN ACCORDANCE Wll ll I SA NCAC 2C. WELL
CONSTRUCTION STANDAR , AND THAT A COPY Olt 'CI ITS RECORD IAS L3F_EN PROVIDED TO TIIEE WELL OWNER
SIGNATURE OF PERSON CONSTRt(' I IN i'II IF AVI.I I. D,VFI.
Submit the original to the Division of Water Quality, Groundwater Section, 163o Mail Semite ('enter - Raleigh, N('
27699-1636 Phone No. [phone], within 30 days. (iW-1 REV. 07 2001

WELL CONSTRUCTION RECORD 298222
North Carolina - Department of Environment and Natural Resources - Division of Water Quality
WELL CONTRACTOR (INDIVIDUAL) NAME (print) /) �.t lei.,
WELL CONTRACTOR COMPANY NAME. �TCP °J'CI. 13-nos. , I 1 9-C4477 p
STATE WELT. CONSTRUCTION PERMIT# / 7 D a ASSOCIATED WO PERMIT#
(if applicable) (if appticahle)
-PCOrNaFundwvAteSection
CERTIFICATION a 30//
rNloY/g - 3/'7 6
I. WELL USE (Check Applicable Bo.x): Residential Municipal Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery ❑ Heat Pump Water ejection 0 Other 0 [(Other, List Esc
2. WELL I.00ATION•,th_ Topo( aphis/Land setting
Nearest To�7:
)l ) County ❑Ridgelope ❑Valley ❑Flat
/ tc�`rG( (cheek appropriate huxl
(Sued Name. Numbers. Community. 5u digs eon. Lot Nu.. Yip (i del
S lt,s
Latitude. longitude of well location
r lc (4.tt<t
3. OWNER: Dr
4
5. TOTAL DEPTH: 4OS
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO.
7. STATIC WATER LEVEL Below Top of Casing: 4 0 FT.
llsc"." if Ahose Top of Casing)
rig TOP OF CASING IS / FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCA(' 2C .a I18.
9. YIELD (gpm): 3b METHOD OF TEST A rs
10. WATER ZONES (depth): / 00
3
11. DISINFECTION: Type /-4T1—/ Amount l '7 21-h/2.
12. CASINO: Wall Thickness
Depth Diameter or Weight Ft. Material
Prom Chi To 7 / Ft. (o t/ P U c
From To Ft.
From To Ft.
Address 6-4-
I degree. aunu4-s. second,. I
Latitude longitude source:❑(iPS❑Topographic map
(check bag)
287VS4 DI PFI I DRILLING LO(i
Formation Description
(Street or Route No.)
/h keg AJL Ftei his 44L /"
City or Toss State Gp (odc
1 )-
Area code- Phone number
DATE DRILLED 16 — a 3 - -3
13. GROUT: Depthmerial +
From [J To aD Ft. z.C..
From To Ft.
14. SCREEN: Depth Diameter Slut Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Aiaterial
From To Ft.
From To Ft.
iethud
16. REMARKS:
Ertnii
e3
7/'
Io
2 t
SQ.S
LOCATION SKETCH
Shore direction and distance in smiles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WI l i I I5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, tND 'II IAT A COPY OF THIS RECUR ) I IAS BEEN PROVIDED TO 'ME WELL OWNERCl a9-d
DATE:
SIGNATURE OF PERSON CONSTRUCTING II11-. WIEI 1.
Submit the original to the Division of Water Quality, Groundwater Section, 1636 NI ail Sen ice Center - Raleigh, N('
27699-1636 Phone No. [phone], within 30 days. (iW-I REV. 07. 200 I

298221
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
fJ )-Il- CE:RTIFIC.ATION; 3D�/
WELL CONTRACTOR (INDIVIDUAL) NAM : ( rims r 1 �J�j p - C� p 3 / %G
WEI.1. CONTRACTOR COMPANY NAMEp-g_,_ L�.�./ 'F t[j PHONE # fIJoS I� `�' ` o '
STATE. WE.L1. CONSTRUCTION PERMIT# /1/4) a ASSOC[ATEI) WQ PERMED*
(if applicable) Of applicable)
I. WELL USE (Check Applicable Box): Residential Municipal Public 0 Industrial 0 Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 IFOther, List Use
2. WELL LOCATION: ��
Nearest Town: et (' my V YLl1l/�
I Strcct N. sc. Nun ca. Community. Su ivision. Lot No.. Zip Code
3. OWNER:
Address
•' 2.)7P) Ens/ to
(Street or Route No.l
�ne-SV/ / /P. i✓C- , &' /&
t State / hip ( ode
( )-
Area code- Phone number
4. DATE DRILLED /C -.7a -6 3
5. TOTAL DEPTH: 6E)5-'
6. DOES WELL. REPLACE EXISTING WELL? YES 0 NOX-
7. STATIC WATER LEVEL Below Top of Casing: //6 ET.
(tlse''' i(Abutc Fopercituue)
K. 'l0P OF CASING IS � FT. Above land Surface"
*lop of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2(' .0118.
9. YIELD (PM): 6 METHOD OF TEST
W.,....
10. WATER ZONES (depth): -32S' - 6 ,--,_
LOCATION SKETCH
IL DISINFECTION: Type_" . _ Amount 2 / _Ll /3 Show direction and distance in stiles from at least
Th
12. CASING: Wall ickness 'two State Roads or County Roads. Include the road
Depth Diameter or Weight Pt. Material numbers and common ii road names.
From (7 to to 2 Et. 6 " Jj/(' c
From To Ft. O o
..4-
From Tu Ft. Z �n
13. GROUT: Depdt Material cthud a c`-�
m
From Tu�QFt. ��,f-tt oaf / v et<
From To Ft. c) ��
[4. SCREEN: Depth Diameter Slot Size Material p r-no
From 'lo Ft. in. in. S am
From 'F0 Ft. in. in - 1D tr'l
15. SAND/GRAVEL PACK: _
Depth Size 'taterial - 0 Z
From To FL From l'o Ft.
Topot raphiciLand settitig
❑RidgeSlope ❑Valley ❑flat
heck appropriate hot
Latitude longitude of well location
( decrees nunutes seconds)
Latitude loneitu(le source:❑GPS❑Topographic map
(cheek host
DI .['ll I DRILLING LOG
from To Formation Description
/Dp /to 2
16. REMARKS:
I DO HEREBY CERTIFY ILIA( THIS WELL \VAS CONSTRUCTED IN ACCORDANCE. WITH 15,\ NCAC 2C. W1I"1.
CONSTRUCTION STANDARD. , A D'IIIAI rA CUP}" UP IIIIS RECORD II:AS BEEN PROVIDED It) TIIE WELL OWNER
- , ( - .2 9 —
S[(iNA UR[OF PERSON CONSTRUCT! NCi'll Ifl 1. DAIF
Submit the original to the Division of \ ater Quality. Groundwater Section. 1630 Mali Sunice Center - Raleigh, NC
27699-1636 Phone No. [phone]. within 30 days. (iW-I RIIV. (17 2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and N
WEL.l. CONTRACTOR (INDIVIDUAL) NAME t, yrint)-_____I
WELL CONTRACTOR COMPANY NAME
i you
STATE: WELL CONSTRUCTION PERMIT#
(if applicable)
298219
al Resources -,D.iv }siun ,f Water Quality - Groundwater Section
,o/1�ij J - U/ /D// (E:RTIFIC \ ION
# a'1/
a / PIIONE # IV N4& -3/ /6
_ASSOCIATED WO PERM ET#
(if applicable)
I. WELL USE (Check Applicable Laos): Residential$. Municipal Public ❑ Industrial ❑ Agricultural 0
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other 0 I( Other. List Ilse
2. WELT. LOCATION'
NCit est//Town: County
U T
3. OWNER:
Address
/) /I (rei or Ruurc Na(
/4�r//./1(nL/e �
C !iW it) or row tc
.Area code- Phone number
4. DATE DRILLED 6 -1 r% -6 3
5. TOTAL DEPTH: 3DS
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below 'Top of Casing: lo Q FT.
(tlse" I"' it'Abucc Top at Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCA(' 2C .0118.
9. YIELD (gpm): J S METHOD OF TESr ArS
W. WATER ZONES (depth): c (%S) - 1 5—sp.-vs?,
Toporr aphis/Land setting
❑Ridge 'lope ❑Valley ❑Plat
Icheek apprnpriaie ho 1
Latitude longitude of well location
I dc}'rces minutes -4\oods l
Latitudes luneituda source:D(iPS❑Topographic map
idled: box)
a8'7a 1 DI PT II DRILLENC, LUG
/lit -o,le From To t Form: o Description
or-2 / SL el.t^-e�LeJ
l I. DISINFECTION: Type
12
CASING:
Depth
From To Sa Et.
FrFrom'To Et.
From 1 o Ft.
[3. GROUT: Depth
From D To 2U Ft
LOC:A LION SKETCI I c
/--/T--) Amount 193 i-b)-fs . Shoo direction and distance in miles front" Ie:L
Wall Thickness two State Roads or County Roads. Includi i c reMd_,
or Weight Pt. \tateri: numbers and common road names.
Diameter
From To Pt.
l4. SCREEN: Depth Diameter Slot Size
From _'to Et. in
From To Ft. in
l5.SAND•GRAVELPACK
:
Depth Size \latcrial
p_c
NIethod
»
Prom To Ft.
From to Ft.
in
Nlate ial
[6. REMARKS:
1 DO I IEREBY CERTIFY TI IAT '11115 WELL WAS (ONSERUCFED IN ACC ORDAN(1( \\TI I l 1 i,\ N('AC 2C'. \i'FLI.
C'ONSTRU. TION S'1'A D RDS, AND 'TIIAT A COPY UP I I [IS RD 11:AS 131.FN PROVIDEDTO THE WEI.I. OWNER
vj AiLie-e,(u2- a -625 , 8 S
SICiNATUR.E OF PERSON CONS rRU(TINt i 11II- U EI I. DA'I It
Submit the original to the Division of Water Quality, Groundwater Section, I63o Mail Ser% ice ('enter - Raleigh. N(
27699-1636 Phone No. [phone], within 31) days. GW-I REV. 07 2001

From ( To lv D Ft. 6
Front To Ft.
From "To Ft.
13. (TROUT: Depth�y Material
From D To 4o Ft.�
From To Pt.
l4. SCREEN: Depth Diameter Slot Si/c Material
From To Ft. in. in.
From To Ft. in. in. —_----
15. SAND/GRAVEL PACK:
Depth Size Matenal
From To Ft.
WELL CONSTRUCTION RECORD 298220
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section If
WE:LI. CONTRACTOR (INDIVIDUAL) NAIMIE (print)
CE:RTIFInT�iQoN# d �/
WELT. CONTRACTOR COMPANY NAME ,(LJy1/L'.�ION F. IV
#f�(.0 ��3/?�
STATE WELL CONSTRUCTION PERMIT#
02
ASSOCIATED WO PERMIT#
(if applicable) (if appl icable )
1. WELL USE (Check Applicable Box): Residential [X Municipal Public ❑ Industrial 0 Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 1 LOther, List We
WELL. LO('A"LION
Nears' Town
/ ����yy�/ Topographic/Land settilig
//�,----��//yy�am---�r-���.�-�� County " DRidge ❑Slope ❑ValleyIlat
[/ o vid J
Idtcck appropriate box
(Streetante. Nwnhers,Community. Subdivision. Lot No.. Zip C ((Co Latitude longitude o[ well location
3. OWNER:
Address
Area code- Phone number 9
4. DATE. DRILLED /
I deices nn notes seconds)
. Latitude. lomtitude ..sourer:❑OPSDTopographic map
(Street or Roe N ) Tel check box
v Ptt J i Route
Aas
zit� DFPT I I DRILLING LOG
avnrlettn State hp, ( ode From -co Formation Description
)- D 6_0 0Dn..7 •
e o aster yl,(2.rtit)
- zit -U3
5. 'TOTAL DEPTH: a R S )
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO g
7. STATIC WATER LEVEL Below Top of Casing: / 0 FT.
(tlsc'-." iI Abuse Top of Casing)
R. TOP OF CASING IS / FT. Above Land Surfaces
*Top of casing terminated at/or below land surface requires a -
cariance in accordance with ISA NCAC 2C .1)118.
9. YIELD (gpm): LSO METHOD OF TEST c.9 A rS •
10. WATER ZONES (depth): aA '- g pry-,.
I I. DISINFECTION: Type Amount
[2. CASING: Wall Thickness
sfii_1212;
LOC:A rHON SKETCH
Shots direction and distance in stiles from at least
two State Roads or County Roads. Include the road
Depth Diameter or Weight Ft. \Iaterial numbers and common road names.
p ve-
•thud
From To Ft.
16. REMARKS:
01
O'
c
0
CD
Cri
o-c
r".
—n'1
me
Gs=
r rl
0
C-�
G
I DO IIEREBY CERTIFY TIIAI''[I[IS WELL. WAS CONSTRUCTED IN ACCORDANCE \LTFII 15.\ NCAC 22C. WE1.1.
CONSTRUCTION STANDARDS. AND'THAT A COPY OF ruts RECORD S BFFN PROVIDED TO TI IF. WELL OWNER
L.(/ �l �fjLf A .. —29-6Y
SIGNATURE: OF PERSON CONS'I IR:( TIN( II U'EI I. DAIl.
Submit the original to the Division of Water Qual[ty, Groundwater Section, 163o Mail Sentry ('enter - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. (iW-I REA'. 07'2991

WELL CONSTRUCTION RECORD
;pzast2mentgf Environment and Natural Resources/-
(te�CTOR (INpIYIDUAL) NAME (print) D- h nu
( CT91t.fiMPANY NAME �Y text_ .BFps • tNt )1
i', * Q ci
�(trFQHlicablCC10I'( PERMIT# S/ 0.�• ASSOCIATED WQ PERMIT#
<6fapplicable) - : -
if applicable)
268148
Divisi n of Water Quality - Groundwater Section
L.�e.d
CERTIFICATION # .24 / &
4 Pm hp,-..r • PHONE. #(8.?SI/>O'317A
.17,$ (check Applicable Box): Residential I 'Municipal/Public ❑ Industrial 0 Agricultural ❑
pitoring p ''Recovery ❑ Heat Pump Water Injection ❑ Other 0 If Other, List Use
.QCATION;
`Ektil rr✓ /)1t-_ County PCIA.., t»7d0el
r ya t Yee_k O tJ.ia
`(SUcct Ner2e,, u bees, Community, Subdivision, Lot No., Zip Codc)
'QkVNirR;;
!I4- :S-faymen KGC•
(Street or Route N ,)
$ri$L,
OFTeivim `l State Zip Codc
Ig alpgne nutpber
;Qid,II,L. D; i- 3— 0 3 S cf P" LOS 4
PrpTH SAS wcu dr. n �d d
FLIIIEPLACE EXISTING WELL? YES 0 NO
DETER LVEL Below Top of Casing: F DO FT.
' . (Use'•+•• if Above Top of Casing)
43ASI110 IS 1 FT. Above Land Surface*
1541ln; I@rminated at/or below land surface requires a
,f(pftisP peg4rdgtl%)ylth IAA NCAC 2C .0118.
I;j? (gpiTi 1.'D 'METHOD OF TEST b Y
Topographic/Land setting
❑Ridge ❑Slope ❑Valley Ginat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
T $ 7QNFS (depth): 5DS 1 - Lo D , p
NFECTION; Type hit Pi g H Amount 1
G4; ^,r: Wall Thickness
;.Diameter or Weight/Ft. Material
To Ft.
Depth Material Method
�TOaD.�. Ft.` Co ...tat ti., p
Ton)
YE, PACK
Depth Size
Ft.
Diameter
Ft. in.
in.
Slot Size Material
in.
in.
Material
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
c
0
c
r.J
O
FRT(FYTHHAT.THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
TANDARR$$ D THAT A COPY OF THIS RECORD PROVIDED TO THE WELL OWNER
- ---4
d 3
QNATURE OF PERSON CONSTRUCIINQ E WELL DATE- ,,,.'
is t i
vg tI}ertPtyjsion of Water Quality, Groundwater Section, 1636 NI ail Service Center I• a(eigh, NC
qg)..7.0, ,b1; within 30 days. GM/4i . 07/2001
I

268145
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) I-�Yl (!i 4,1 d RN' CD A CERTIFICATION�A# 36� / n
WELL CONTRACTOR COMPANY NAME C re. P..pt.�' 3v"�). t')�(C `'/ Pit r,.,�1,�(1-''-c--PHONE #0,4l zl-k -3/7
I//
STATE WELL CONSTRUCTION PERMIT#
(if applicable) (if applicable)
ASSOCIATED WQ PERMIT#
1. WELL USE (Check Applicable Box): Residential Lt-Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATIOIspi'
Neare t Town: (L .L t--vim- County 9l'r-11 te)l.✓
h - e kc_t1
(Street Name, Numbers, Community, Subdivision, Lot No., Zi Code)
•
3. OWNER: l ) ry i In )e +r-
ct
Address %� ' 1�nK-�
(Street or Route No.)
( Ad 4 A/ C 8 7 /
City or Town State - Zip Code
Arca code- Phone number
4. DATE DRILLED 1 - Ln - C' 3
5. TOTAL DEPTH: to S{5'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO EV
7. STATIC WATER LEVEL Below Top of Casing: 1 LV) FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS J FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance In accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): / a METHOD OF TEST k r_S
10. WATER ZONES (depth): '3t/ t ' - 1
11. DISINFECTION: Type I-4 1 H
12. CASING:
Dept Diameter
From C) To LID Ft. /p 1'
From To Ft.
From To Ft.
Amount In '7
Wall Thickness
or Weight/Ft.
Material
A l'
13. GROUT: Depth M�aterial I Method
(5 From To c/
QO FL 4 °Aix a u fa
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
Topogra hic/Land setting
❑Ridge lope ❑Valley DFlat
(cheek appropriate box)
Latitude/longitude of well location
(degrees minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(cheek box)
DEPTH DRILLING LOG
From To Formation Description
n 6) 1 (7/(p4.-4
9c,1 L gs' tiLIt(-
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
h0 :£ Wd £— 83.1 CO
O<
•
(-4"'
truer
rta
G
tt,Q HERtBY CbK11tY-I-HAf THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I 5A NCAC 2C, WELL
� CONSTRUCTION STAN S, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
--1/ , i / 1,,�
I ) ; �l� SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original tolthe D vision of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
�,I
27699-1636 Phone Nd. (r l9) 73 -3221, within 30 days. GW-I REV. 07/2001
1
L—

268144
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAMES (print) -.8 )-1 —1ti+ -I,YtI PipCERTIFICATION# 3GT/
WELL CONTRACTOR COMPANY NAME (.-Y V t'PAF.7 ))1-US. 1-e_)d-t`d 7") Lt by. rillONE#(g::2k�c"r��--3y
STATE WELL CONSTRUCTION PERMIT# / 4 n 1.
(if applicable)
1. WELL USE (Check Applicable Box): Residential al---"Municipal/Public 0 Industrial 0 Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other 0 I(Other, List Use
ASSOCIATED WQ PERMIT#
(if applicable)
2. WELL LOCATION
Nearest�fTown: ! L ' Count — t- .X_'�
(Street Name, Numbers, Community, Subdivision, Lot No., Zip C
3. OWNER:1APs f'l n4 SliF)Y/ Ti"tks
Address � .� / a _Fi Dn/-/i nl2. jTf- ,
(Street ar Route No.)
biz • 5;,/g , A/C e 7 G
City Town State Zip Code
(—)-
Area code- Phone number
4. DATE DRILLED 1 - c —
5, TOTAL DEPTH: 1 0C) '
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 13--7
7. STATIC WATER LEVEL Below Top of Casing: 4 c FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS I FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 1SA NCAC 2C .0118.
9. YIELD (gpm): 2 METHOD OF TEST c L r S
10. WATER ZONES (depth): Si'' - i�M
)
11. DISINFECTION: Type H rN
12. CASING:
Depth Diameter
From LI To 4 T) Ft. in l t P I/ c
From To Ft.
From To Ft.
13. GROUT: Depth Prtatp-iMethod
From r% Too�` Ft. (�C_�i'r-P-/E-t
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From . To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
Amount 1 DCe
From To Ft.
From To Ft.
16. REMARKS:
Wall Thickness
or Weight/Ft.
Topogr�a is/Land setting
❑Ridge I9Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees. minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Forma 'on Description
(40 ' �/) ILff /
i 7>O�
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the roast
Material numbers and common road names. O o
co
1 r
w
1 DO HEWER THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION ST N , AND THAT A COPY OF THIS RECORD HAS BEOV IDED TO THE WELL OWNER
/ /-
Submit the original to he D
27699-3636 PhoneNo, (2 9) 73
SIGNATURE OF PERSON CONSTRUCTING THE µ ELL
DATE
ision of Water Quality, Groundwater Section, 1636 Mali Service Center - Raleigh, NC
3221, within 30 days. GW- I REV. 07/200
71)
Ot

268143
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section ,/
WELL CONTRACTOR (INDIVIDUAL) NAME (print) t CERTIFICATION # �C ` /
C ) // Ci 111rprj/)/'PHONE # 3/ 9a
WELL CONTRACTOR COMPANY NAME 3YePJ1f� �✓Z�S • Li l(�
STATE WELL CONSTRUCTION PERMIT# / 1/47 a
(if applicable)
ASSOCIATED WQ PERMIT#
(if applicable)
1, WELL USE (Check Applicable Box): Residential 0d' Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water injection 0 Other If Other, List Use
2. WELL LOCATION.
Nearegl.tTown: C i/im. tit County 4! 1r }i
b.") ( Fr tt) t LL1 E_ /
(Street Name, Numbers,, Community, Subdivision, Lot No., Zip Code)
3. OWNER: f-SGi,t ..11c,4t /is
Address S{ /) het f+w _n
(Street qr Route No.)
�rzt ne.5v,//e, g2ig4-e
City or town State Zip Code
Area code- Phone number
4. DATE DRILLED I - 1 3 - L5 3
5. TOTAL DEPTH: SP-S
6, DOES WELL REPLACE EXISTING WELL? YES ❑ NO Ir.
7. STATIC WATER LEVEL Below Top of Casing: 140 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surface*
*Top of casing terminated actor below land surface requires a
variance In accordance Rh l5A NCAC 2C .0118.
9. YIELD (gpm): METHOD OF TEST 3, {, rs
10. WATER ZONES (depth): C 1— 2; T
11. DISINFECTION: Type
12. CASING:
From 0
From To
From To
13. GROUT: Depth
From () To iD
From To
14. SCREEN: Depth
From . To
From To
15. SAND/GRAVEL PACK:
Depth
From To Ft.
From To Ft.
}-) TI-I Amount Ln r
Depth Diameter
To L]-Cq Ft. to tt
Ft.
Ft.
Wall Thickness
or Weight/Ft.
Material
Ft. C
Ft.
Diameter
Ft. in.
Ft. in.
16. REMARKS:
Material
P u
Method
Slot Size Material
in.
in.
Size Material
Topograa is/Land setting
❑Ridge [HSlope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees; minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To I Formation Description
1 )1 t/4-' (L, 1>-�
t}-
t} S Ds ' -L 1 b_pt M: t e.
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
DC
DC
w
0
0
:CD
rn "
G
:I Uti tteREBy C>-RTIFY T THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
I'.. Tl CONSTRUCTION ST}ANDARe, D THAT A COPY OF THIS RECORD HAS BEEN P QVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the D vision of Water Quality, Groundwater Section, 1636 Mail Service Ceenter, RaleiREVgh, NC 1
27699-1636 PhoneNo.(9. 9) 736-3221, within 30 days.

268142
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section (,
WELL CONTRACTOR (INDIVIDUAL) NAME (print) - 3Y 1.1 !»r'�L , Kt'Lr-(dC.-t- fpt CERTIFICATION # :.�5l!CY'/ /
WELL CONTRACTOR COMPANY NAME CK rP. e-L>f- -Ri'✓S • t3 1 `d- 211 n-p, ;[ILC PHONE # ,qli v^7 g - ' L
STATE WELL CONSTRUCTION PERMIT# / V/ -%Z ASSOCIATED WQ PERMIT# v
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential C9rMunicipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2, WELL LOCATION: / y
Nearest Town: //e)t(/f/FSvs lie. County$/QC &&CrX
(•rrflp-{/,t Di,ok C ,-- - rr.h ted l cjj 1P noa
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
Topogra uc/Land setting
❑Ridge lope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
1 e 3. OWNER: (degrees minutes/seconds)
DX._ J`
Address r'. O e- I' 4 .4' t rk l _ !% n�� 8 Latitude/longitude source:❑GPS❑Topographic map
eet or1{oute No.) (check box)
tic lcr U u.fuclus1,0, JIC. c287`i-S- DRILLING LOG
City or Town State Zip Code ForTtn Description
he,-c--o__E
Area code -Phone number 1 DLl L>
4. DATE DRILLED / — / 5 - 0 3
5. TOTAL DEPTH: -CI .0 t
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO Q�
7, STATIC WATER LEVEL Below Top of Casing: I D FT.
• (Use "+" if Above Top of Casing)
8. TOP OF CASING IS II FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): METHOD OF TEST .2 11 r
10. WATER ZONES (depth): 1 I L't t - 17.-S prn
S&L c1-a3 rk Nr--
11. DISINFECTION: Type /-/7—/-1 Amoutit ! bI -I-At
12. CASING:
DEPTH
From To
tr) I bCt
SC r
II Thickness
Depth Diameter or Weight/Ft. Material
From ( To I TiO Ft. & 11 64-te L
From To Ft
From To Ft.
13. GROUT: Depth Material Method
From (3 To a1' Ft. i'u—+-v t.4 '0i
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From . To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
(/// 2
""/
1
l I
1 _ _.Submit the frigiital to the Division of Water Quality, Groundwater Section, 1636 Mail Service Ceenterl REVgh,0NC 1
2769,9-1636 PintaerNo. (9 9) 733-3221, within 30 days.
GW-
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
0
W
-rt
CC1
)
0
(0
O
(-4
16.. REMARKS:
!DO HEBY=F&IftJ THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISANCAC 2C, WELL
CONSTRUCTION TA�IDARDS, AND THAT A COPY OF THIS RECORD HAS BEENPROVIDEDTO THE WELL OWNER 3 IIIIII JJ �� �� - 3 / - /)
DATE
e
SIGNATURE OF PERSON CONSTRUCTING THE W
l__,
EL
.d

268141
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural�Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME
'+' (print) i1 D b r Y) Li / ei> iD CERTIFICATION # 4241 S
WELL CONTRACTOR COMPANY NAME (-rr r_r,.-r- TRfnr.. I.J t- ll 4 IA -re . PHONE if (oar G Q Y' 3/ %I)
STATE WELL CONSTRUCTION PERMIT# 14- b a ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential] Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION: I
Nearest Town: l .tl.,,-1-trfc County /42) (t'vt
res 4 Yn 11 6e1-. - (r,.k ��5 R m
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: lake- l.t>ccun E )'Go n ( C=h'.
Address /54 Sutl Orrs4c-11'1If1 2 •
/t (Street or Route No.)
l ,G -tn 4tn4_ lk/ C,
City or Town 'State Zip Code
(—)-
Area code- Phone number
4. DATE DRILLED I - I (o - D 3
5. TOTAL DEPTH: SUS '
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: 5 FT.
• (Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance In accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): LAO METHOD OF TEST . 2 1-, rS
10. WATER ZONES (depth): 3 PS' I LI pm
LH; ' - 3D 9p
11. DISINFECTION: Type I -I TI-I Amount q /
12. CASING: - Wall Thickness
Depth Diameter or Weight/Ft. Material
From f1 To /OZ Ft. La" PVC,
From Ft.
From Ft.
Material 1_ Method
e +0 P
To
To
13. GROUT: Depth
From 1) To D Ft.
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From . To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Material
S '7 I In
Depth
From To Ft.
From To Ft.
--T DOHEREBY CERTIFY
CONSTRUCTION STAR
ri J,1
Submit the original to the
27699-1636 Phone No.'(919)
Size
Topographic/Land settin
ORidge ❑Slope ❑Valley Flat
(check appropriate box)
Latitude/longitude of well location
(degrees: minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
Formation Description
i� �QILk-z� J-
CJ t c
DEPTH
From To
n loll
'pc;' SIDS '
LOCATION SKETCH
Show Direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
S, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
.k( ) /-3/:tJ
SIGNATURE OF PERSON CONSTRUCTING TI 'ELL DATE
vivision of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
33-3221, within 30 days. GW-I REV. 07/2001
w
0
w

2681.1`1
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAMF, (print) 415 LA-1-VItc% CERTIFICATION //0251 '
WELL. CO.\'TRACI'Oit COMPANY NAME /CC Lee/l Q""VostiPRONE#ICS) t 7sJ'/'-4
STATE WELL CONSTItUCF1ON rERni1T# ASSOCIATED WQ PERMFr#
(i f applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential 2 Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other 0 IfOther, List Use
2. WELL LOCATION:: 1
Nearest Town: (,J4/Nt v /(c-
(SnttWNatne, Numbers. Community. Subdivision, Lot No.. Zip Code)
Count•: faN7C
3. O\VNEI2:.1•// 7..an7464m i7
Address 55S ,e%�y ('r✓c'
'Su -cc or Rome No.)
wnyireS ii, / - N, e - a 7s
City or Town State Zip Code
)-
Area code- Plume number
4. DATE DRILLED j-*22q- 03
5. TOTAL DEPTH: t.202.‘
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO Er
7. STATIC WATER LEVEL Below Top of Casing: a2 0 FT.
(Use "+•• if Above Top of Casing)
8. TOP OF CASING IS t� FT. Above Land Surface`
'Top of casing tertninated at/or below land surface requires a
variance in accordant vith 15A NCAC 2C .0118.
9. YIELD (gpm): 7 METHOD OF TEST ft'
10. WATER ZONES (depth):
I . DISINFECTION: Type ,%/7 Amount
12. CASING: Wall Thickness
Depth Diameter or R'cighVEt Material
To 7 S Ft. 6, JS/
Ft.
Ft.
topographic/Land setting
2idge DSlope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
( degreeshninuies/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(cheek box)
DEPTH DRILLING LOG
From �a Fgrmation( e. 'rip ion
do 77 S}q4 �h
77 / vS .$$per -e0-5?tr, sz
/n s s io. ,--
From T52
From To
Front To
13. GROUT:
From I-0
From To
14. SCREEN: Depth
From To
From To
15. SAND/GRAVEL PACK:
Depth
From To Ft.
From To Ft.
/BC? See/
# //a`i
Depth Material
fo_420__ Ft. Cr" e,^�
Method
Diameter Slot Size Material
Ft. in. in.
Ft. in. in.
16. REMARKS:
�1 "�
) I.DO HERE13 C. I2 Iil
i CONSTRUCTION $
J
Submit Ibeiotiiginal t) the Division of Water Quality, Groundwater Section, 1636 Mail Service Center- Raleigh, NC
AS i1769916i6 Ph(ith• No 919) 733-3221, within 30 days, GW-I REV. 07/2001
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
•
Size Material
Y THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
N DARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
DATE
SIG
ATUILE OF PERSON CONSTRUCTING THE WELL

268139
\VL:1,1., CONSTRUCTION RECORI)
North Cal Mina - Deparunent of Environment and Natural Res irces - Divvii. ion ;re Water Quality - Groundwater Section
\\fa.l. (U\vl n.\CrOIt (ISIII\III( \I.) NANII. I lrinl)S%�fC Jf roe 5ii1/ e CERTIFICATION r['
WEI.1 COO N.WIO R C(llll'AS\ NAME: »ite we//r�jvnf ['HONE a (swat 6�/'
ST AT \\r:LL CONS I Rrc r ION VEIL\( I -I # __. ASSOCIA rr:D Pl1I \IIT#
O1 :n 11ir.Ihle) 111 ;n 1liezhlc1
6b
I. AV'EI.I, USI1 (Check Applicable 13os). Residential ❑ Industrial ❑ Agricultural 0
NIoniloring ❑ Recovery ❑ I lea( Pump AAlater Injection ❑ Other ❑ I rOther, List Use
2. WELL LOCATIQN
Nearest Town:
S�lzo yci (ire K'
County /174�Gv06
ICnticl Name. Nnn]E ei s, Common Subdivision, Lel No.. Zip Code)
J%/
3. OWNER h/i//C2 ` d
Addressf)0 ✓e/(vet Pat —
eel or Bol: oNo.)
I�1�N0L J% /it C , c>?87�
ny or l'mcn Stale Lip Cade
Area cede- Phone ncnbcr
4. I)\TI: DRILLED/'Q-03
5. "TOTAL DEI'TI I: / 9%rj Tlf
6. DOES WELT. REPLACE EXISTING WELL? YES ❑ NO N9'
7. STATIC AAPATER LEVEL I3clow Top of Casing: /0 FT.
IL)se "l if Ahmc Top ur Casing',
8. TOP or CASING IS PT. Above Land Surface*
lql or casing terminated ;it/or below laud surface requires a
variance in accordance�rc✓ilh I5:\ NCAC 2C .01IN.
9. YIELD tom): /c7 METHOD OP TEST j4'r7—
10. AV ATER ZONES (deplliC
Topographic/Land setting y..--
❑Ridge ❑Slope ❑Valley Ehlat
(check :1ppropria1e box)
Latitude/longitude of dveI1 Jucalion
(degrees nilWLL•J: vends
L:ii iodc/Ioi gitude souree:❑GPS ❑TopOgdOphie 111ap
(check has)
DFI'f1I DRILLING LOG
Front n )ID(io 1 Description
lL
91/
//0
e
I.00ATION SKNTCII
1 I. DISINFI?C 1 ION. Type _ Amount Show direction and distance in miles from at least
12. CASING: AVall thickness two State Roads or County Roads. Include the road
Depth 'Violatenr AAal ht/Fi. pL crlul numbers and conmtnn Iz)ad names.
/ P C.:Prom fr� To ya it z_ mac p
From To Ft CO L
Ft ont To l l # //' (je
m
13, G1202.11 : Depth Maki it it Method W
PWin 0 1 QO Ft.(120-'"yfe^.71— __— I
C0
Farm to 17.
14_ SCREEN- I N'- Depth Diameter She, Sits Material
I•ront TO Ft. in. in.
From To Et. in. in.
Dcp:h
From To
From To
16.RHMARKS :
Size
' 1 awl hit
0
CJ
O
W
I DO 111112E131' CERTIFY T DA f TI ITS WELL \VAS CONSTRUCTED IN ACCORDANCE WITI1 15A NCAC 2C, WELL
)r+}' :ADN ST \N14RDSNI) TI IAT A COPY OFT 11IS RIiC012D I1AS BEEN PROVIDED TO THE IE WELL 0\VNER
Id
I
mil the Original to the I)id
276.0-1636 Thane AN. (91')) 733
I LRI? OP PERSON CONSTRUCTING TI Ili AVIi11,
DATE
f \Yale" Quality, Groundwater Section, 1536 Mail Service ('eater- Raleigh, NC
3221, vithin 30 Flays. GW-I REV. 07/2001

268138
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and N turaal Resources /- Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAM/E�(print) �/r TA 4�AiJt,% e CERTIFICATION 49
WELL CON'( RACTOIt COMPANY NAME//miLe Ole //i-- !VMf PHONE is
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ I'EIt\IIT#
if applicable)
(if applicable)
1. WELL USE (Check Applicable Box): Residential ec lunicipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATIQ
Nearest Town: C 'Y0
414r),'5 ret"
(Street Name,
Numbers, Community, Subdivision, Lot No.. Zip Code)
3. OWNER: rig ri r; .11
Address 4/07 en tqlont gJI e
/� (Sire ter Route No.)
&l ef-501f%
City or Town State
County gralicJcti
ag79
Zip Code
( )-
Area rode- Phone number
4. DATE DRILLED /-1C-03
5. To'rAL DEPTH: 3os
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO. V
7. STATIC WATER LEVEL Below Top of Casing: .7i.3 FT.
(Use "+" if Above Top of Casing)
3. TOP OF CASING IS FT. Above Land Surface*
*'Fop of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): c9C METHOD OFTEST»/i
10. WATER ZONES (depth):
11. DISINFECTION: Type
12. CASING:
Depth Diameter
From fd To /C ? Ft. �y
Topographie/Land setting
❑Ridge t3Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:OGPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To F in'ttio Description
0 as
Tf/
From To Ft.
From To Ft.
13. GROUT: Depth Material
From 0 To 020 Ft.(./� e^"c'^'f
Amount
Wall Thickness
or \' eight/Ft.
From To
14. SCREEN: Depth Diameter Slot Size
From To Ft. in. in.
From To Ft. in. _ in.
15. SAND/GRAVEL PACK:
Depth
From To Ft
From To Ft.
Ft.
Material
4s
see
LOCATION SKETCH
Show direction and distance in miles from at (east
two State Roads or County Roads. Include the road
numbers and common road names.
4041
Method
Size Material
Nlmcrial
ra :-
0
16. REMARKS:
I DO HEREBY CEI2 LITYI FIAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION51010 RDS AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
I-10-03
jt SIGNA 12E OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to te Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
274094636 Pliant.' 'MLA()1
) 733-3221, within 30 (la) s. GW-1 REV. 07/2001

268136
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Najoral R4sourrces-jDivision of Water Quality - Groundwater Section
WELL CONTRACTORa I(INDIVIDUAL) NAME nt) E�/)/ "'a7U/�D e CERTIFICATION/tat6y
WELL CONTRACTOR CO:MPANV NAME, NAME
Meg a A'mI PHONE 6a7 7Yt�
S"FATE. \YELL CONSTI(LCTION PERMIT#
(if applicable)
ASSOCIATED WQ PERMIT#
(if applicable)
I. WELL USE (Check Applicable Box): Residential P' Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION./
C.N://
Nearest Town: /Y'P/ e County -9yivi,00
OP,S/ey ('rPe.C�
(Street N. ,te Numbers, Community, Subdivision, Lot No. Zip Code)
3. OWNER:
J/9-1/e 6to /i//7
Address �.O.BO/ 6
V (Streettg Route No.)
Ur�avS74. /•
City nr Town State
( )-
Zip Code
Area code- Phone number n
4. DATE DRILLED /- - eS
5. TOTAL DEPTH: c 4 C
6. DOES WELL REPLACE EXISTING WELL? YES fl NO P
7. STATIC WATER LEVEL Below Top of Casing: _ 5/3 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS FT. Above Land Surface*
`Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): C, METHOD OF TEST .i-')."
10. WATER ZONES (depth):
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
pograpliic/Land setting
Idge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
Fo matioi Description
DEPTH
From To
(D c ? V
—3 3
1 I. DISINFECTION: Type
12. CASING:
Depth Diameter
From K To .3 / Et. (C
From To Et.
From To Pt.
Depth Material
Amount
Wall Thickness
or W'eightlFt. M terial
y/L1.9
13. GROUT: Method
From J
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From 'Co Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
numbers and common road names.
CO
C
r'n
—n
'O
—Jr
0
0
16. REMARKS:
I DO HEREBY.CER'TII
)2 r CONSSTTRRUCT I ON. .
Il
ii
L'
L. --Submit.lbe-originaLti the
27699-1636 Phone Nti4919)
IT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
3S, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
4--
SIGN
1-9-03
LIRE OF PEE:SON CONSTRUCTING THE WELL DATE
)ivision of Water Quality, Groundwater Section, 1636 Mail Service Center- Raleigh, NC
33-3221, within 30 days. GW-I REV. 07/2001

268135
u
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Nitural •p/iesour/Qes - Division of Water Quality - Groundwater Section f
WELL CONTRACTOR (INDIVIDUAL) NAME (Virint) Je, T{i /.sr/V 40e CERTIFICATION p C?4
/CCe we//ce/r,,yP PHONE 11 )6Rr-
VVEI.I. CONTRACTOR COMPANY NAME
STATE WELL CONSTRUCTION miti\IITN ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential (Municipal/Public 0 Industrial 0 Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCATIO :
Nearest Town: `t� V l� CCountyill Vre/ y
(Street Nana, Numbers, Col tiothy', Subdivision, Lot No.. Zip Code)
re
3
. OWNER:Ge. 107 vt7ee f
Address -8171C�✓ O CfPS7` /O/-
SI t r Route Nth
/0Alii e 1/.�rl N' �_ $' 757
ty or Town State Zip Code
( )-
Arco code- Phone number, ��
4. DATE DRILLED ,'
5. TOTAL DEPTH: QO5 {-r-
6. DOES WELL REPLACE EXISTING WELL? YES❑ NO Er
7. STATIC WATER LEVEL Below Top of Casing: c- 100 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS a FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in aceortancSS..gitlr I5A NCAC 2C.0118. _
9. YIELD (gpm): oC METHOD OF TEST /%'�
10. WATER ZONES (depth):
1/ >>,//Y/ LOCATION SKETCH
I. DISINFECTION: Type I7 Arneunt Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads. Include the road
Diameter or R cigh UEt. M serial numbers and common road names.
tLidopographic/Land setting
ge 0Slope ❑Valley ❑Plat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOCI
From To Forrpatio. Description
0 /0 ny.
-
c2' bus
S� SOS
"4O
Depth
From fa To 076 Ft.
From To Ft.
From To Et.
13. GROUT: Depth
From /7 To 041 Ft. cJ2i C.> /
From To Fl.
Material Method
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
14/30 7
CO .£ E;d 0— 8Bd CO
16. REMARKS:
Lop LIFR FRY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITI-1 15A NCAC 2C, WELL
C6NSTRUCTtON STANIYF43315� D THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
, ' `1 s#. / g- 03
Submit the original to the 1
24699-1636 Phone No. (919)_.
)ivisi
33-32
URE OF PERSON CONSTRUCTING THE WELL DATE
n of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
I, within 30 days. GW-I REV. 07/2001

IL
L5
Canton
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources • Division of Water Quality • Oroundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print Jeregly H. Bowman'
268632
CERTIFICATION Y 2 8 0 9
W ELL CONTRACTOR COMPANY NAME D RnwmAn Wel 1 Dr1111 ng, Tnr PHONEY H7A 252 — 7779
STATE WELL CONSTRUCTION PERMITS - ASSOCIATED WQ PERMITS/
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential CZ Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2 WELL LOCATION:
Nearest Town: Canton County Haywood
220 Rice Cove Road, Canton 28716
(Siren Name, Numbers, Community, Subdivision, Lol No„ Zip Code)
3 OWNER.
Address 220 Rice cove Road
(Street or Route No.)
NC 28716
City or Town State Zip Code
( Area codc' Phone number
s. DATE DRILLED 1 0/1 4/02
5.TOTAL DEPTH: 740e
6 DOES WELL REPLACE EXISTING WELL? YES 0 NO IX
7 STATIC WATER LEVEL Below Top of Casing: 1 0 FT.
(Use "+" i( Above Top of Cuing)
8. TOP OF CASINO IS 1 • 4 FT. Above Land Surface'
'Top of casing terminated at/or below land surface requires a
variance In accordance with I5A NCAC IC.0111.
9 YIELD(gpm): 12 METHOD OF TEST rotary air
10 WATER ZONES (depth): 1 7n'
230'
I. DISINFECTION: Type tablet Amount 6
12. CASINO:
Topographic/Land setting
ORidge DSlope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:OGPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
Tammy Deweese
Depth
From 0 To 83
From To
From To
I3 GROUT: Depth
From 0 To 20
From
14. SCREEN:
From
From
To
Depth
To
To
15 SAND/GRAVEL PACK:
Depth Size Material
To Ft.
From
From
Wall Thickness
Diameter or Weight/Ft.
Ft.61/8 Erb 80
Ft.
Ft.
Material Method
Ftconcrete gravity flow
Ft.
Diameter Slot Size Material
Ft. in. in,
Ft. in. in.
Material
PVC'
To Ft.
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the Egad
numbers and common road names. c
m
p
—a
tV
tV
rn
16. REMARKS:
�
ItiO trctror�T ?OfjNSTRIA101J
Submit the original to
27699.1636-PhozTe No. (9
THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
JARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OP PERSON CONSTRUCTING THE WELL DATE
the Division of Water Quality, Groundwater Section, 1636 Mall Service Center - Raleigh, NC
19) 733-3221, within 30 days. OW- REV. 07/2001
e.

WELL CONSTRUCTION RECORD
269399
North Carolina - Department of Environment and tural Resources - Division of Water Quality - Groundwater Section
) �J
WELL CONTRACTOR (INDIVIDUAL) NAMF��(, (print) , CERTIFICATION q.c a
WELL CONTRACTOR COMPANY NAME . r L-41 KY i d! PHONE 8 KGiET G y%O ySfz
y/v
STATE WELL CONSTRUCTION PERMITS /V/i� ASSOCIATED WQ PERMIT('
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ® Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Neares own: arty
d d
(Street Name�p,Nu�m�ber, Community, Subbdivision, No., TaP Code)
3. OWNERP.C1 .s
Address / a a • Ge<sit.P
(Street or RomeNo.) `r• .177/G
City or Town State Zip Code
�)-
Area code- Phone number
4. DATE DRILLED of —A S/D 3
5. TOTAL DEPTH: 3 .2S
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: 4s FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / -S FT. Above Land Surface*
'Top of casing terminated at/or below land surface requires ■
variance In accordance with 15A NCAC 2C .0118. •
9. YIELD (gpm): /2 METHOD OF TEST"f-tnri
10. WATER ZONES (depth): 4.S'
11. DISINFECTION: Type oatiellZ
12. CASING:
Depth Diameter
From To •IC) Ft. to
From To Ft /
From To Ft.
13. GROUT: Depth
From 0 To.:::. Et
From To Ft
14. SCREEN: Depth Diameter Slot Size Material
From o Ft in. in.
T
From / To Ft in. in.
15. SAND/GRAVEL PACK
Depth Size Material
From / o Ft.
From / To Ft.
Amount /.2 °Z
Wall Thiclmess
or Weight/Ft Material
#`.2/ fr/C
Material
Cente-aet
Ivje hod
16. REMARKS:
r
joc4iEi
7`
B y CI )tTiFy 7
I CONS I lON-STANit
MAR
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degees/miwoes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. IncludSe raid
numbers and common road names. /Sec --
THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
�19-71-de,r , &a40 ,2,2 it t 3
SIGNATURE OF PERSON CONSTRUCTING THE WEI f DATE
U pf�ti _di!!!PIO.gittidt he D sion of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
AS,tINI/9 tRit JPipae No. 9) 73 3221, within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and N tural�$esources
WELL. CONTRACTOR (INDIVIDUAL) NAME,( print) /��e ,'— �4.
W'EI.I. CONTRACTOR COMPANY NAME r/J7•L e le
1-
�p
269364
- Division of Water Quality - Groundwater Section
e CERTIFICATION
g^a/6?
PHONE # ( )✓
SPATE \VEI.L CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
I. WELL USE (Check Applicable 13ox): Residential 0'unicipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery 0 Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. \VELL LOCATION: /
Ne %res�/t Town: tiY_ 47 County �Yii✓OJG*'
/*zee /Of A'✓ •
4Street Name, Nuifibers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: jAfe, feee_
LLC�f4, twit
Address 77 7 _Ls
(Street or Route N
((.44a n,
City or Town State
Zip Code
( Area code- ('hone number,
4. DATE DRILLED /-3o ' O 3
5. TOTAL DEPTH: cR.05�-Y
6. DOES WELL REPLACE EXISTING WELL? YES❑ NO Er
7. STATIC WATER LEVEL Below Top of Casing: FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with I5A NCAC 2C .0118.
9. YIELD (gpm): cR METHOD OF TEST /a 1 V
10. WATER ZONES (depth):
11. DISINFECTION: Type n T r1 Amount
12. CASING: Wall Thickness
Depth Diat%)tgter or Wct'htiFt. ateri.}l
Fromf02 To .) Ft. [r7% /n. -,Teel
From To Ft.
Front To Ft.
Topographic/Land setting
❑Ridge ❑Slope DValley
(check appropriate box)
Latitude/longitude of well location
(degreeshninutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
To For -ratio Description
DEPTH
From
0 /n
/0
36
56
13. GROUT: Depth Material Method
From 0 To (90 Ft-Ceati +e
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size .Material
From To Ft.
From To Et.
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
r ( 161 12 MARKS:
` I�
I DO HEREBY Ca(T Ih THAT ThIIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION SITIANDARD�S, AN AN THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
Ma.r — 30— 03
SIGNAVFURE OF PERSON CONSTRUCTING THE WELL DATE
N 272
o
P1
O
ASH:VI Submit the origiiftl to he Division of Water Quality, Groundwater Section, 1636 Mail Service Center- Raleigh, NC
27699-1636 Phone Na. (9 9) 733-3221, within 30 days, GW-I REV. 07/2001

WELL CONSTRUCTION RECORD 2 6 9 3 6 3
North Carolina - Department of Environment and //N{{��turall Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print)/-iiJ+L (um
4-d I) �'e CERTIFICATION/#�y6n�9. ,/
WELL CONTRACTOR COMPANY NAME /P`I(F U)iI h / u,nP PHONE # h-7�S) (_e2� ✓ �a
STATE VE1.I. CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable)
(if applicable)
I. WELL USE (Check Applicable Box): Residential W Municipal/Public ❑ Industrial ❑ Agricultural 0
Monitoring 0 Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
7,
WELL LOCATION:
Nearest Town: (qN) /A/
C 11 Al&oarr 2r4•
(Street Namc,N cumbers, Community, Subdivision, Lot No.. Zip Code)
3. OWNER: 1 /,t}Ie f C).340 wP
Address Y Ot.9/ �a��./04tiocc>� �ro/Y/1
(Street or Route No.)
City or Town State Zip Code
County1/10vnnC
( )-
Area code- Phone number
4. DATE DRILLED a-3'o3
5. TOTAL DEPTH: //'$_-F*
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO Ere
7. STATIC WATER LEVEL Below Top of Casing: /(J FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING 1S 02 FT. Above Land Surface*
•Top of casing Terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): / 0 METHOD OF TEST 4 / r
10. WATER ZONES (depth):
11 DISINFECTION: Type
12. CASING:
Depth Dia Teter
From *01. __ To74/ Ft. l /*'
From To Ft.
From To
13. GROUT: Depth�T�,
From f To tw
From rl o
14. SCREEN: Depth
From To
From To
15. SAND/GRAVEL PACK:
Depth
From To
To
From
In-) r II
Iti tl
MO HEREBY BYt-m, IfI' THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
I.\ -
CONSTRUCTION,ASTr NiI ARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
I r:-, ///ff
Amount
Wall Thickness
or g ht/Ft. b aleri4I
S7ee/
Ft.
Material
Ft. (le—cw
Topographic/Land setting
DRidge ❑Slope DValley L9fiat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To For atio Description
Q
do 76,
9/
1/
//5`
Method
Ft.
Diameter Slot Size Material
Ft. in. in.
Ft. in. in.
Size
Ft.
FI.
Material
LOCATION SKETCH
Show direction and distance in miles from al least
two State Roads or County Roads. Include the road
numbers and common road names.
SIGNATURE OF PERSON CONSTRUCTING THE WELL
DATE
Submit the origil)al to
27699-1636 Phone No. (�
he Division of Water Quality, Groundwater Section, 1636 Mail Service Center- Raleigh, NC
9) 733-3221, within 30 days. GW-I REV. 07/2001

269362
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment ands: tur/aliRessourcees - Division of Water Quality - Groundwater Section
WELL CONTItACrOR (INDIVIDUAL) NAME (print)/� top 7l A9'i)/�e' CERTIFICATION # 0249
WWELLCONTILVCTOR COMPANY NAME ?rite Wet! �A(%'MP PHpp
ONE # t �) 6071-9
SPATE WELL CONSTRUCTION PERMIT# ASSOCIATED \VQ PERMIT#
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential K.—Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATIQ
Nearest T,own:g Ydd``
�"tle fntl e'-
(Streel Nana, Numbers, Community, Subdivision, Lot No.. Zip Code)
3. OWNER:,fi//en/ /U& n
Address/(/o % dlerey/Nr-stock 809
yy (Street or out No.)
/ U / Z /79. .733--S
County 1,40000
City or Town State Zip Code
( )-
Area code- Phone number
4. DATE DRILLED a'a9S---/U3
5. TOTAL DEPTH: /94-
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO Er-
7. STATIC WATER LEVEL Below Top of Casing: 3o FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS FT. Above Land Surface*
*Top of easing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118. \
9. YIELD (gpm): [90 METHOD OF TEST 4'
10. WATER ZONES (depth):
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
u
„�Topographic/Land setting
PRidge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From d() F;9rr�a tio� Description
S--pot/
I I. DISINFECTION: Type %7.47/f Amount
12. CASING: Wall Thickness
Depth Diar�tctc or W'cighUPt. M, serial
FromlvZ To L'-7 Ft. 6 A
From To Ft.
From To Ft.
13. GROUT: Depth Material
f Method
From 0 To c O Ft. CP-'^ PN
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
Slot Size Material
in.
n.
numbers and common road names.
From To Ft.
16. REMARKS:
I DO HFREI3Y CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONST$1 ICTION STANDkRDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
MARI]b tu'Uiy.auigin4j.
27699-1636 Phone No. (9
IGNATURE OF PERSON CONSTRUCTING THE WELL
DATE
e Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
) 733-3221, within 30 days. GW-I REV. 07/2001
ASPr` IhE

269361
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural esources - Division of Water Quality - Groundwater Section
ff , e CERTIFICATION q a 1
Countys l/if/OpC
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: e"OO FT.
^� (Use "+" if Above Top of Casing)
A. TOP OF CASING IS oC FT. Above Land Surface*
`Top of casing terminated al/or below land surface requires a
variance in accordanse)vith I5A NCAC 2C .OI IH.
9. YIELD (gpm): 7J� METHOD OFTEST_4T*--
10. WATER ZONES (depth):
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(Degrees/minuses/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
DEPTH
Frown
6,2
II. DISINFECTION: Type
12. CASING:
WELL CONTRACTOR (INDIVIDUAL) NAMEn (print) Ale/ L
WELL. CON'rRAcrOR COMPANY NAME i/`�`C e we/. * Rc47, PHONE a (' tb77-S5S3
STATE WELL CONSTRUCTION PERMITS/ ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential Municipal/Public 0 Industrial 0 Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCAT
New�est Town:�r4�,r�%L�
t4t
(StreeWiSlaine, Numbers, Connnunity, Subdivision, Lot No., Zip Code)
3. OWNER: feu /! ✓l
Address A/ •
(Street or Route Ko.)
(741-1/1 /• (. d07)4
City or Town State Zip Code
Area code- Phone number //
4. DATE DRILLED ,-�/�S
5. TOTAL DEPTH: WC ✓ /rip
To
oO
Depth Dia peter
From *'Z _g To O _ Pt. -i Z
1=r0111 To Ft.
From To Ft.
13. GROUT: Depth nMaterial
From 0 To cs20 Ft. !Pam^ e.-..., 7
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
Amount
F• 'atio Description
LOCATION SKETCH
Show direction and distance in miles from at least
Wall Thickness two State Roads or County Roads. Include the road
or Weight/Ft. Ma -nal numbers and common road names.
Method
From To Pt.
From To Ft.
0
CO
0
16. REMARKS:
Y THAT TI IIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
NDARDS, AND THAT, COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATUR
OF PERSON CONSTRUCTING THE WELL DATE
-03
... Submit the orrttinal t) the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699.1636 Pharr• No. 919) 733-3221, within 30 day s, G W-1 REV. 07/2001

I I. DISINFECTION: Type //9/7 Amount
12. CASING: Wall Thickness
Depth is tetcr or W ciyht/Ft. M, tcrial
From To . FL /% // ./e-SZtt'/
From To Ft.
Front To Ft.
Depth_) , Material Method
To ,'x✓ Ft. Ce-'re.✓f
13. GROUT:
From 0
From To Ft.
14 SCREEN: Depth Diameter
From To Ft. in.
From To Pt. in.
15. SAND/GRAVEL PACK:
Depth Size
From To Ft.
From To Ft.
Slot Size Material
in.
in.
Material
269360
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural esources - Division of Water Quality - Groundwater Section WELL CONTRACTOR (INDIVIDUAL) NAMEjprint)L''J- /\h'y"J/e CERTIFICATION# //t/?
\VE1.1. CONTRACTOR COMI'ANV NAME
tc'i //gL%M
PII ONE -Trea
S'rAI E WELT. CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Net-estTown' 7/y,0 County'�YYbtrrG'C/
(Street Name, Numbers, Community, Subdivision, Lot No.. Zip Code)
3. `NNER:/1i 6 Cel � �✓ .
Address C 6�. i /\.2,Atorte
(Street or Route No.)
City or Town State Zip Code
( )-
Area code- Phone number
4. DATE DRILLED -`NO3
5. TOTAL DEPTH: 3rs-
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO la-
7. STATIC WATER LEVEL Below Top ofCasing: ,S 3 FT.
^7 (Use "+" if Above Top of Casing)
8. TOP OF CASING IS FT. Above Land Surface*
'Top of casing terminated at/or below land surface requires a
variance in accordance with I SA NCAC 2C .01 IR.
9. YIELD (gpm): 4,9 6- METHOD OF TEST 1
10. WATER ZONES (depth):
LOCATION SKETCH
Show direction and distance in miles from at (east
two State Roads or County Roads. Include the road
numbers and common road names.
4's
Topographic/Land setting
Tdge 0Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
Fo,r atiop Description
Nam/
DEPTH
From To
0
//2 gs
3c:.s
4 t10-5
W
J
16. REMARKS:
(� rV rh DQ 1-14.E r CLi62Tl
1l ----C ST1k TFal4-61N
1
HAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I SA NCAC 2C, WELL
\RDDSS,,, AND TI IAT A COPY OFTHIS RECORD I-IAS BEEN PROVIDED TO TI-IE WELL OWNER
SIGNATURE OF PEIL
ON CONSTRUCTING THE WELL
DATE
—Submit theoriginalto the Division of Water Quality, Groundwater Section, 1636 Nlail Service Center - Raleigh, NC
27699-1636 Plume No. (919 733-3221, within 30 days. GW-I REV. 07/2001

269359
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and N tur�//al/Resources.- Division of Water Quality - Groundwater Section
\YELL CO\IItACTOR (INDIVIDUAL) NAME rint) e ,/-/I /a�v%e CERTIFICATION/d�F79
\VELI. CONIRR\CTOIt COMPANY NAME 7/ vr/��M/-�C/.1h� PHONE 11 (-n(7"g5/Oi
STATE WELL CONSTRUCTION PERMIT ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
WELL USE (Check Applicable Box): Residential UV-Municipal/Public 0 Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery 0 Heat Pump Water Injection ❑ Other 0 IfOther, List Use
2. WELL LOCATION:�
Nearest To
y Conn
3. OWNER
(Street Name, Numbers, Community, Subdivision, Lot No.. Zip Code)
Address /%�� r�� +-✓ /¢�Je
(Street or Route No.)
City or Town State Zip Code
( Area code- Phone number.
4. DATE DRILLED 7-_ 6
3
5. TOTAL DEPTH: /Psr
6. DONS WELL REPLACE EXISTING WELL? YES 0 NO 421'
7. STATIC WATER LEVEL Below Top of Casing: 1/4> FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING 1S FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance wjth 15A NCAC 2C .0118.
9. YIELD (gpm): 3 METHOD OF TEST•(-
10. WATER ZONES (depth):
II. DISINFECTION: Type
12. CASING:
Depth el
From ±,2 To
From To
From To
13. GROUT: Depth
From 0 To P70
Topographic/Land setting
FfRidge DSlope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To F. m lion Description
0 o?))'O 49-
2/
6 < R6r
Amount
Wall Thickness
R. Diann r or Weight/Ft. Miite±riAl
Ft.
Ft.
Material
Ft. rem e"4T
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Size Material
Method
From
From
Depth
To FL
To Ft.
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
4 i3o3
16.REMARKS:
F iiitOy
SIIRUC'rieim
✓ALL
Submit the original to
27699-1636 Phone No. (9
THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
t ARDS, A THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
(t.;-ITC3
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
he Division of Water Quality, Groundwater Section, 1636 Mail Service Center- Raleigh, NC
9) 733-3221, within 30 days. GW-I REV. 07/2001

I I. DISINFECTION: Type
12. CASING:
Depth
From±R To l7/
From To
From To
13. GROUT: Depth O
From 5 To
From To
14. SCREEN: Depth
From To
From To
15. SAND/GRAVEL PACK:
Depth
From To
From To
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and N
WELL CONTRACTOR (INDIVIDUAL) NAMES (print)
WELL cONTRACrOR COMPANY N'AMF,JOf,I?P Wei/ �yic,„f
269358
ces - Divi ion of Water Quality - Groundwater Section /
"x (] e- CERTIFICATION #07h 9.
PHONE II 07Q )Exa')—$'SS'�
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED \VQ PERMIT#
(if applicable)
(if applicable)
1. WELL USE (Check Applicable Box): Residential Ib1unicipal/Public 0 Industrial 0 Agricultural ❑
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. \VELL LOCATIO :
Nearest Town: �^i�/✓ County�LL'ao/
,rr4Z,cr
(Street Name, Numbers, Community, Subdivision, Lot No Zip Code)
3. OWNER
Address
AvySw
(Street or Route No.)
4/, (.
City or 'No m State
( )-
Area code- Phone number
4. DATE DRILLED 0.20-0.3
5. TOTAL DEPTH:/
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO L7
7. STATIC WATER LEVEL Below Top of Casing: 6 S` FT.
(Use "+" i f Above Top of Casing)
8. TOP OF CASING IS FT. Above Land Surface*
"Top of casing terminated at/or below land surface requires a
variance in accord sac with 15A NCAC 2C .0118.
9. YIELD (gpm): J. METHOD OF TEST /9'1
10. WATER ZONES (depth):
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
Topographic/Land setting
E3�2irlge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
a���
From To F t itio Description
o
av l/73
Zip Code
Amount
Wall Thickness
FL J8
Dnn ete or V'ei'h t/Ft. Material
f el
Ft.
Ft.
1aterial Method
Fl.
Diameter Slot Size Material
Ft. in. in.
Ft. in. in.
Ft.
Size Material
0
16. REMARKS:
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITI-1 I5A NCAC 2C, WELL
RDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
ATURE OF PERSON CONSTRUCTING TI IE WELL
) ` I, /
J�: Mauimiit the -original be-fh n Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No� [phone], within 30 day. GW-I REV. 07/2001
J
-(;0-03
DATE

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and N tural Resources - Division of Water Quality - Groundwater Section
�//J
WELL CONTRACTOR (INDIVIDUAL) NAM riot) p A/,f/�[1 e old,
L L CERTIFICATION �r7t ! ,7
WELL CONTRACTOR COMPANY NAME�L )OS o1 LLGr' PHONE# gal L 0- ogre)
STATE WELL CONSTRUCTION PERMIT# `YPit ASSOCIATED WQ PERMIT# '✓/if
(if applicable) (if applicable)
269878
1. WELL USE (Check Applicable Box): Residential 14 Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION.
Nearest Town: iCounty /YL2y.tt,3Os,
21/
I
(Street Nanjij$umben, Community, Subdion, Lot No., Zip Code)
3. OWNER dt2ca � >C PiLILGCi
Address,* a
, (Street or Route No.) e
f ,
C' Town S Zip Code
(S 3)- tS9- *64 -
Area code- Phone number
4. DATE DRILLED //G /D 3
5. TOTAL DEPTH: r4,7 .'
6. DOES WELL REPLACE EXISTING WELL? YES,❑ O $
7. STATIC WATER LEVEL Below Top of Casing: FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS /ti FT. Above Land Surface'
*Top of casing terminated at/or below land surface requires a
variance In accordance with 15A NCAC 2C .0I18.
9. YIELD (gpm)• � METHOD OF TEST
10. WATER ZONES (depth): 7 t
,
11. DISINFECTION: Type /�d Amount 6. ° Z
12. CASING: 1 Wall Thickness
Depth Diameter or Weight/Ft. ater aal
From Tom Ft. 62 1: .t / �!i C
From To Ft./
From To Ft.
13. GROUT: Depth Material Me od ,
From_f To a%!') Ft. fSvi4.
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From �To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From o Ft.
From To Ft.
ee Q[.Ga1.s0 it.: a4-C.
16. REMARKS:
I DO HEREBY CERTIFY
! rCONSTRUCTION
Topographic/Land setting
❑Ridge XSlope ❑Valley ['Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
LOCATION SKETCI-[
Show direction and distance in miles from at (east
two State Roads or County Roads. Include the road
numbers and common road names.
r.tolp
0
J
IS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
W
1'/i�/r> 3
GNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Divi on of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. (919)733-3 21, within 30 days. GW-1 REV. 07/2001

270625
WELL CONSTRUCTION RECORD
IkrtitDepyttnent of nvironment and Natural Resources - Divisioni�of Water Quality - Groundwater Section
T CTQP((INpIVIDUAL) NAME (print) �J rt \c �1 t sr Jr to C3- CERTIFICATION # �P41 /
; c�-31'7L
Cf479MPANYNAMEk`TYee c Let' 11 4 f1 n� j'ac . PHONE k S) �c)�
6
CONSTRUCI'IQN PERMIT# I`I"ID%. ASSOCIATED WQ PERMITk
'(if a..licabte) (if at r licable)
E LISE'(Check Applicable Box): Residential t! Municipal/Public ❑ Industrial 0 Agricultural O
4Qn(tonng 0, Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
f,f. pCATIO{N
Tq}yn: /.L/a //he f u r lit- County lin.1/rt.loCri
r N,kS r Q, li'. — t!-J- .
Strpei Name, Numbers, Community, Subdivision, Lot No., Zip Code)
Topogr�aphic/Land setting
❑Ridge QSlope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
QyVNER4')+S-YIr1C:t+ l/. - ' 4C-L -� (degrees: minutes/seconds)
} 4drrss, ' ) 4 S a -Pi./ 5 c.n . Latitude/longitude source:OGPSOTopographic map
(Street or Route No.) (check box)
u-1-'v1fStG,I%t 'VC DEPTH DRILLING LOG
Town L State Zip Code From To Formation Description
ac Pboo9 number
lT iPRILLED A S, 3
DEPTH:
Q H �Lj REPLACE EXISTING WELL? YES ❑ NO 1
MVP LV, 4TER L VEL aglow Top of Casing: `d D FT.
(Use "+" if Above Top of Casing)
Tpg„QF CASING IS FT. Above Land Surface*
ilT9lagrFa#ing terminated at/or below land surface requires a
1099lD accofdaicp with 15A NCAC 2C .0118.
J I,p 1ptn): / Q_ METHOD OF TEST I1 r.c •
' I;•gONES (depth): `I01 t - I J J P rvl
bISI1IFECTION: Type f4 y / i Amount f2 et
ASING: Wall Thickness
' r Depth - Diameter or Weight/Ft. Material
yPNpl D To a / Ft, /p /' PVC -
I$•. ,• To Ft.
Tom,a, To Ft.
GROUT Depth renal / Method
r9p - TP i Ft. +-L'-st T -+ —t
aFStn% . r r7" r Tv Ft.
§g EN 1 Depth Diameter Slot Size Material
'F ',To Ft. in. in.
p/ RAVEL PACK: -
+ ' Depth Size Material
%JD
To Ft.
n al
�I' fits'
Cy_�Q y
A.xa LA
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
0
rr
Qfig$F,rpy- RTIFy THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
-- 'C'TIQN,STANDAIW5S AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
- f '13
SIGNATURE OF PERSON CONST t#1ING THE WELL jj�T'E
-tiroripatnraI tq the Division of Water Quality, Groundwatet(Section, 1636 Mail Service I
I gpe,IVg, (90) 733.3221, within 30 days.
- Raleigh, NC
I REV. 07/2001
•

WELL CONSTRUCTION RECORD . 270626
n,3lula Dypattment of Environment and Natural Resources - Division of Water Quality - Groundwater Section
]
(Q'I'aRACTOR(INDIYIDUAL)NAME (print) }�La- uw� � '��(/�� / CERTIFICATION q aye y
I'R,�X"z1'?RWCrOMPAI1Y NAME Rrex.l�e 13r rc II )PJP q- Pzi.i. c,/f PHONE a Ip.:.t� � zi/� — 3 Z
` A.
t CQMTRUCTION PERMITN % /f Li) -2 ASSOCIATED WQ PERMITN
(if a.. licable)`
(ifap4licable)
IyEL, USE (Check Applicable Box): Residential Ci}----Municipal/Public 0 Industrial ❑ Agricultural 0
Mgnl{tiring 0 Recovery 0 Heat Pump Water Injection O Other 0 If Other, List Use
'tWy414. i,QCATION:
�pt To1YIil1 /»azfr eSu11� 1 )e. County 1-ia-tLiilnnrt
nh DIt)e-)41 ate— .rnt,A /,,i,•/z-t
($aopt Name, Numbers, Community, Subdivision, Lot No., Zip Codc)
OWNER: La ✓rc
1.4,oryss .�.�S zit Men )-.J -..- l-(Jrt.cj
(Street or Route No.)
ity pr Town - State Zip Codc
Phone number es Li-
_ D
T ,DRILLED
T4L DEPTH: ` ' co xs
}>1{g14:REPLACEEXISTIN0 WELL? YES 0 NO La-
QyATER LEVEL Below Top of Casing: 1 OG FT.
(Use "+" if Above Top of Casing)
)? QF CASINO ISs 1 FT Above Land Surface*
;DR 9(paq ; termlaated at/or below land surface requires a
prliggein acoorllagpp with 15A NCAC 2C .0118.
Ei A (gpm):' 7 METHOD OF TEST 3 h r
giLts. ZQT' ES (depth). 'i� S -
CPto-J - 3pr}'1
I11SII4FECTION: Type N T" 1-1 Amount 1 C)'7
ASPtP, Wall Thickness
t Depth /�� Diameter or Weight/Ft. MaterialFront. _. To r_tvh Ft. j /, „
rorrl To " Ft.
Ipm To - -Ft.
QUT;'I Depth Material Method
To e Ft r c-s n.1 1
ckr: To Ft,
RN_,, Depth Diameter
Topographic/Land setting
/� ORidge 0Slope ❑Valley Qflat
/C. r�" (check appropriate box)
Latitude/longitude of well location
(degrees.' minutes/seconds)
Latitude/longitude source:OGPSOTopographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
101� b '
9iT s To Ftin.
p5/.('.,RAVEL PACK:
Depth Size Material
rQtnka. ' To Ft.
{gym=F
` To Ft
' e
Slot Size Material
in.
in.
cia< X
SIGNATURE OF PERSON CO4TRUTING THE WELL
ubnuitl�I origiool to the Division of Water Quality, Groundwater Section, 163644 id 5er5ft$
2 6 6 6-PRI/ N. [phone], within 30 days.
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
AT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I 5A NCAC 2C, WELL
(AND THAT -A COPY OF THIS RECO S BEEN PROVIDED TO THE WELL OWNER
/0--t9 2-3
TE
r - Raleigh, NC
-I REV. 07/2001
j D

270627
WELL CONSTRUCTION RECORD
. ,
Ql;na,09 rlQgpaRn;ent of Environment and Naruu�ral Resources - Division of Water Quality - Groundwater Section , /
T CT I;UINDIYtDUAI.) NAME � (print) fy7.Zf av+-k £h3DY"
Aft- CERTIFICATION# !
MR COMPANY NAME Are P-NY -13 r[,; I, )n 1I d at imp, PHONE N JY,.?A LUcc' - 3 I 91)
xc CANSTR{1CTIgl�I,PERMITk a' �- ASSOCIATED WQ PERMITl
Y'
(if aglicable)
{JeyEr(Qheek tjpplicable Box): Residential Fd' Municipal/Public ❑ Industrial ❑ Agricultural ❑
onnp Q4 Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
WELL LOCATION:
' t TQww ' County /--)a I/ a,)tnc{
as Naple, Numbers,11Cornmuniry, Subdivision, Lot No., Zip Code)
PWNER. im 0 0 I P, Y n h) r`., F)
PfAA�TGSS� ,1�Sl? �/t j�n 'C [.L �'^�-Ck.
(Street or Route No.)
/✓C .2?7J6
sty Q; Tow , State Zip Code
($B
Arr94de•'Phogc number
AT?RILLED I -
DEPTH; 305'
Igtij.?tcEEXISTING WELL? YES 0 NO G-
TER LEVEL Below Top of Casing: ) 5 FT.
-II. . (Use "+" if Above Top of Casing)
pi0E,F-CAING IS 1 • FT. Above Land Surface*
pit of itairIg terminated atlor below land surface requires a
4449,11t,4cc91112gee with, )SA NCAC 2C .e118.
jn) 37.S METHOD OF TEST 2 h r
NES (depth) ) OC ' - Cj p tom, r
�':.7 - 5..cipm
fIJ�I:ECTION: Type,' HT I-1 Amount 7 .S-i
4S11.19• Wall Thickness
vst.`r Depth - Diameter or Weight/Ft. Material
t �i" To (a 19 Ft.. /� t, p tic
ElgGrh , To • Ft
fgfrt To Ft,
QRQyT; Depth Material
iFtglrl f TO ? L I Ft. (o 4.-0. + L t
tom To Ft.
n Depth Diameter Slot Size Material
Fi xllt . FL in. in.
c1°{' ,, To Ft. in. in.
(1VEI. PACK:
, ➢epth Size Material
To` Ft.
Method
p
KS;
Topographic/Land setting
❑Ridge 23%pe ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees:minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
F� ton I �1� <<t�.
inn' 305' 2-1 rzet.,.,, .t.
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
Y CERTIFyTHAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I SA NCAC 2C, WELL
4N S170DARp$ ID THAT A COPY OF THIS RECORD HA r EN PROVIDED TO THE WELL OWNER
- 0 3
SIGNATURE OF PERSON CONSTRUCT('#ELL :'➢AT-6
r `
oFjg;Dal to the Dtviston of Water Quality, Groundwaler Section, 1636 Mail Service Cent ti YLeigh, NC
(rhino Ne. (919) 733-32;1, within 30 days.
O
•

WELL CONSTRUCTION RECORD
j$orth Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
EL1:. CONTRACTOR (INDIVIDUAL) NAME (print) 0 1 IU i J e Pt
fG, CERTIFICATION # 3 µ l 4
,1 'EEL CONTRACTOR COMPANY NAME �'T✓P ('_�x,c, a ✓ c"= - Lt.l&LX r)- -I_ t -✓ sv'4-r PHONE # (TIC) L. z/ k - 3 1 'I o
STATE WELL CONSTRUCTION PERMIT# 4-D a ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
270632
1;+-WELL USE (Check Applicable Box): Residential 2' Municipal/Public 0 Industrial 0 Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: MC, ri t z lIG ) )e j County 1-� E, a j t r -or'd.
Lo-h -v �1 F, C e K1riO�
- (Street Name, Numbers, Community, Subdivision, Lot No., Zip C' de)
.. OWNER: 'J ( on 6 1 Li-I�, e
'. Address P e Cam, e` t I `, 9 E
(Strce,t or Rn to No.) -r ) _
C(C-A/J�,11 e L in'XCrif A)C .2R 1.-]J 1
City drjfeAvn State J r Zip Code
^_ Area code- Phone number
:`DATE DRILLED i — 14 - c' 3
5. TOTAL DEPTH: 1 a C' `i '
6y DOES WELL REPLACE EXISTING WELL? YES 0 NO 0"--'
7' STATIC WATER LEVEL Below Top of Casing: 3C'o FT.
(Use "+" if Above Top of Casing)
TOP OF CASING IS 1 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. , YIELD (gpm): 1 METHOD OF TEST e k r S
IP, WATER ZONES (depth): Q C5 ' - ' 1 e c\P .,-x
1 I. DISINFECTION: Type_ (-1 TI-i Amount ci i lr
12, CASING: Wall Thick less
Depth Diameter or Weight/ Ft. Material
From f To (2ti Ft. (, '1 P1)0
From To Ft. _ From To Ft.
15.`GROUT: Depth Material Method
From C _ To ") G' Ft. r c v,, c-r, —}�_-1�
-'' -'From To Ft.
4 ,SCREEN: Depth Diameter Slot Size Material
.From To Ft. in. in.
,.(, From > To Ft. in. in.
1$ SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
.From To Ft.
) 6. , REMARKS:
'1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STANDARDS/5 THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CON(STR LINdn1E W ELL .
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mad Ser.ilelC
Topographic/Land setting
❑Ridge Ill/Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrccs m'inutcsiscconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
Formatign Description
DEPTH
From To
(,G
'
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
27699-1636 Phone No. [phone], within 30 days.
er - Raleigh, NC
N-1 REV. 07/2001

WELL CONSTRUCTION CONSTRUCTION RECORD
,.rth Carolina -.Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
r5 rr p CERTIFICATION# jell
... L //�� CONTRACTOR COMPANY NAME ('Lrc l'-i+.c I�rC%', . Lc l e. c4 ] u PHONE k (A. ' L-'rI E - 3 1 7C
rE WELL CONSTRUCTION PERMIT# ( 4-):.I. ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
a — v
r.l I.CQNTRACTOR (INDIVIDUAL) NAME (print)
270633
t'ELL USE (Check Applicable Box): Residential Er-Municipal/Public 0 Industrial 0 Agricultural 0
i.tonitoring 0 Recovery 0 Heat Pump Water Injection 0 Other ❑ If Other, List Use
YELL LOCATION
:earest Toygn:
O11 t of
rcet Name, Numbers, Community, Subdivision, Lot No., Zip Code)
::WNER: �lJG�r� —rim°rem c
.'',.idress S SS , k 2--L. 0 A.
(Street or Route No.)
-LA B 1 L ion
City oclfown State Zip Code
code- Phone number
GATE DRILLED .2 - 4 - C _3
JTAL DEPTH: 1 ca d- '
)OES WELL REPLACE EXISTING WELL? YES 0 NO EL"
' (1'ATIC WATER LEVEL Below Top of Casing: FT.
(Use "+" if Above Top of Casing)
' OP OF CASING IS / FT. Above Land Surface*
lop of casing terminated at/or below land surface requires a
, arlance in accordance with ISA NCAC 2C .0118. �(�
r I ELD (gpm): f METHOD OF TEST .2 `k.)--1 •
"ATER ZONES (depth): Yl C n L
ISINFECTION: Type HT N
• ASING:
Depth Diameter
From r) To t{ q Ft. Cr ' t
Torn To Ft.
:om To Ft.
:ROUT: Depth
:'rom To r-Ir Ft.
Amount n _
Wall Thickness
or Weight/Ft. Material
PIIC
Material
CeAr ti
r'om To Ft.
:CREEN: Depth Diameter
:tom To Ft. in.
FromTo Ft. in.
SAND/GRAVEL PACK:
Depth Size Material
Method
Slot Size Material
in.
in.
From To Ft.
From To Ft.
16. REMARKS:
p0 HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
oNSTR�IONIST�DARDS, A T AT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
JJ �ZS�
SIGNATURE OF PERSON CONSFi'RUdj111��'ij`1-1FWELL
,I r T�
,fi sybinit the original to the Division of Water Quality, Grouidwater Section, 1636 Mail Sen ice deli r - Raleigh, NC
'ph99;1636 Phone No. [phone], within 30 days. --C'tvFI REV. 07/2001
County QJ�i(/CL
Topographic/Land setting
❑Ridge hope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
Formation Description
DEPTH
From To
4-4 '
-4-
5 �Aa,1 U
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
3

iin
270838
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division!,of Water Quality - Groundwater Section
WELL CO:YFRACTOR (INDIVIDUAL) NAME (print) i O'jj.k.)C lfsx{.r J A...1QYrLl CERTIFICATION# 243Ic
WELL CONTRACTOR COMPANY NAME +d ti'kV o`er 1.4 PHONE # (ii29 (CC'S'��C�2
STATE: WELL CONSTRUCTION PERMIT'?
(if applicable)
ASSOCIATED WQ PERMIT#
(if applicable)
I. WELL USE (Check Applicable I3ox): Residential.. Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection ❑ Other 0 IrOther, List Use
2. WELL LOCATION: a
Nearest Town: l.Jciltak5 0 i 1 County �y r4W 00c�
C!sYi t +nc n f-n t ika
(Street Name. Numbers. Community. Subdivision, Lot No., Zip Code)
3. OWNER: t3a-N'.8 pkg. ,nrnon4
Address aGn Kos.c\a P1aC e
(Street or ntic No.)
�aik -rie 1V ake nc
city or lbwn Stale Zip Code
(&as)- a'a'0 t3a53-
0B"!Rv
Area code -Phone number
4. DATE DRILLED 316103
5. TOTAL DEPTH: 62&5
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO N
7. STATIC WATER LEVEL Below Top of Casing: 0 fi FT.
(Use "+" if Above Top of Casing)
S. TOP OF CASING IS 1 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): 15 METHOD OF TEST_�»�
10. WATER ZONES (depth):
II. DISINFECTION: Type P' ... Amount g
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From t=/ To 89 Ft. /-. it Ri iCC-
/
To Ft.
To FL
Depth
To .;(D
From
From
13. GROUT:
From 0)
Material Method
Ft. CP il7era 4 C nos
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To FL in.
15. SAND/GRAVEL PACK:
Depth
From To
From To
I d' RE M ARKS:
I DO HEREBY CER
CONSTRUCTION S
Ft.
Ft.
Slot Size Material
in.
in.
Size Material
Topograp Land setting
DRidge ope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
(W)e & Cj)eCAava
'-I-) In 29
29 i n asrC.e_
LOCATION SKETCH 144,7 .. _.
Show direction and distance in miles frofVat
two State Roads or County Roads. Inclu '4 the road
numbers and common road names.
c;
HAT THIS WELL WAS CONSTRUCTED 1N ACCORDANCE WITH I5A NCAC 2C, WELL
ARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
12443--- 315Ie3
S GNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center- Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-I REV. 07/2001

271834
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
\VE4L CONTRACTOR (INDIVIDUAL) NAME (print) JTrt� * �rt., CERTIFICATION# 304/
-3
I3 l<J� td �.�bt8
WELL CONTRACTOR COMPANY NAME Gvr e..r row C—[I � Pww.pPHONE It(Si,r1
STATE WELL CONSTRUCTION PERMIT# 1 4-C' a ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential 19' Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION: I '
Nearest Town: County F-t r>..c.4;e n �a
f- I R . n o i I o--4) G` S-I---E,,
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: l J r '
Address 5 3-S \ n )Wn.LL
(Street or Route No.)
0a,t., -A L (.0n1 78
ty or Town State Zip Code
Area code- Phone number a / D 3
4: `DATE DRILLED
5. TOTAL DEPTH: > CJ S '
DOES WELL REPLACE EXISTING WELL? YES 0 NO C'
7,' STATIC WATER LEVEL Below Top of Casing: FT.
(Use "+" if Above Top of Casing)
$, TOP OF CASING IS i FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
'.i variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm). 0 METHOD OF TEST n hrs .
110. WATER ZONES (depth):
11. `DISINFECTION: Type
12, CASING:
Topographic/Land setting
❑Ridge C'tSlope ❑Valley ❑Flat
(check appropriate box)
Latitude/loneitude of well location
(degrees. minutes/seconds)
Latitude/longitude source:OGPSOTopographic map
(check box)
DEPTH DRILLING LOG
From To //// Formation Description
D 5 Y- 1
54 ' q o'
Depth Diameter
From O To 5 `f Ft. Lc ''
From To Ft.
From To Ft.
13. GROUT; Depth Material Method
.From L To a D Ft. Co-vva-k-+ ±e j'
• From To Ft
,;. SCREEN: Depth Diameter Slot Size Material
'''From To Ft. in. in.
From To Ft. in. in.
SAND/GRAVEL PACK:
Depth Size Material
Amount
Wall Thickness
or Weight/Ft. Material
P t/ C
From To Ft.
From To Ft.
14 (REMARKS;
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
Q
7
23
1
0
0
'G4NSTRU(tigN STAN ,A
,Submit the original to the Divi!
27699-1636 Phone No (91p) 733-3
1S WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
ND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
S-3/—D,3
GNATURE OF PERSON CONSTRUCTING THE WELL DATE
ion of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
!21, within 30 days. GW-I REV. 07/2001
•
r.

271833
:.WELL CONSTRUCTION RECORD
paroling -Department of Environment and Natural Resources'' - ``Division of Water Quality - Groundwater Section
CQNTRACTOR (INDIVIDUAL) NAME (print) %" "D b 1 L N LYs $ (3 CERTIFICATION # a S//9
*E(LCONTRACTOR COMPANY NAME B/Os- IAIEI) Y PLIr1)IZS& PHONE # (gen 116-'3
TATE.WELL CONSTRUCTION PERMIT# /2- ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1:WELL' USE (Check Applicable Box): Residential'j6 Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL -LOCATION:
Neares/t&Town: A,e._ • r County 144y).)eoa`
l 11 r, P_v�P CL Ra
(Street Name, N bers, Community, Subdivision, Lot No., Zip Codc)
OWNER: rne,i 55a Anti ArSgQ�t'k
Address 9q Co p (\er k# rA. A K04. •
o141011re No.)
City or Talon State Zip Code
Area code- Phone number
4, RATE DRILLED 3 -1 I - 0 3
r5. TOTAL DEPTH: Q a S t �t
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO IttL
STATIC WATER LEVEL Below Top of Casing: (e 0 FT.
(Use" h" if Above Top of Casing)
. TOP OF CASING IS 1 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
.variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm):: ` 1 ri METHOD OF TEST
Q: WATER ZONES (depth): 1 8 S'— 1 0 gp
..I I. DISINFECTION: Type f--i t -4 Amount aq
'13. CASING: - Wall Thickness
Depth Diameter or Weight/Ft. Material
From D To 0 Ft. /o I t PVC.
From To Ft.
From To Ft.
. GROUT: Depth Material Method
' From 0 _ To ,I.17 Ft it 6 ,.,.. •, 4- -1-0-F,
From "' To Ft.
4. SCREEN: Depth Diameter Material
From To Ft.
in.
i.I From To Ft. in.
1 , SAND/GRAVEL PACK:
Depth Size Material
From To Ft,
From To Ft
Slot Size
in.
in.
14. REMARKS
Topographic/Land setting
❑Ridge ❑Slope ❑Valley '0flat
(check appropriate box)
Latitude/longitude of well location
(degrees, minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
.0 a D I NCQ-r+
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
I DO FIgREBY CERTIFY THAT
4 CQN TRUCTION STANDAI93SI
u 1Ist the Original to She Derision of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
fi9?1!636Phone No. [phone] within 30 days. GW-I REV. 07/2001
ELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
3-3/ —03
TURE OF PERSON CONSTRUCTING THE WELL DATE

271832
WELL CONSTRUCTION RECORD
9,01 Carohna.AFpaftment of Environment and Natural Resources - Division`nof Water Quality - Groundwater Section
t• PONTRACTOR (INDIVIDUAL) NAME/++ (print) �D 6 I. r% 1 t)e b a CERTIFICATION # 24/ g
` {.►.CQNTRACTQR COMPANY NAME LYYL2Nt- L7'',//a'S �fW a 11 Y iu Hip, ia+c- PHONE # (15.(m6jALQ 3/7r.0
STATE WELL CONSTRUCTION PERMIT# /y0 2 ASSOCIATED WQ PERMIT#
(ifapplicable) (if applicable)
WELL USE (Check Applicable Box): Residential (Municipal/Public ❑ Industrial 0 Agricultural 0
:'Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other ❑ If Other, List Use
2 'WELL LOCATIRN:
Nearest Town: ( County oat.
%-h / L1 Pond e. asp 1 i. 11
(Street Name, Name, Numbers, Community, Subdivision, Lot No., Zip Codc)
-3. OWNER: ?one)ty OSO- 1-41i,t3 He � Jul (degrees-m inures/seconds)
.Address 211 .P 1) Latta_ /2a-i Latitude/longitude source:OGPSOTopographic map
Topographic/Land setting
0Ridge ❑Slope ❑Valley lariat
(check appropriate box)
Latitude/longitude of well location
(Street or Route No.)
L� nesvr 11. NG a s"fl6
CI or Town State
+)-
Area code- Phone number
4.aDATE DRILLED 2
$. ':TOTAL DEPTH: SO 5—
Pc DOES WELL REPLACE EXISTING WELL? YES ❑ NO lY
7;' STATIC WATER LEVEL Below Top of Casing: a DO FT.
`- - (Use "+" if Above Top of Casing)
$.;TOP OF CASING IS 1 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
;variance In accordance with ISA NCAC 2C .0118. 1
9..YIELD (gpm)' / .20 METHOD OF TEST ol hrs •
0..WATER ZONES (depth): yes r 12D 5 p r
Zip Code
11.':DISINFECTION: Type
P. CASING:
Depth
From_t To Q D Ft.
From To Ft.
~Front To Ft.
:`GROUT: Depth
.',From 0 To Ft.
From To Ft.
4.'$CREEN; Depth
p;From To
+From ' To
?'(SAND/GRAVEL PACK:
Depth
From' To Ft
From To Ft.
NTH
Amount 5 /b
Wall Thickness
Diameter or Weight/Ft.
Gaf
Material
P v&
Material Method
Diameter Slot Size Material
Ft. in. in.
Ft. in. in.
Size Material
(check box)
DEPTH DRILLING LOG
From To Formation Description
0 a0' CAok-
a D 5 b.5 ' G r n..,. n
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
MARKS:
'I OD HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
G�j33�RU4 t i N S,TANDAjW , AN .T A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGN
the otlginal to the Divisio
6, 9-1636 ?hone No. (919) 733-322i, witl
3 3/— 0 3
E OF PERSON CONSTRUCTING THE WELL DATE
ater Quality, Groundwater Section, 1636 Ntail Service Center - Raleigh, NC
in 30 days. GW-I REV. 07/2001
0

271831
;'::-WELL CONSTRUCTION RECORD
�pfth C!oltna ,,Department of Environment and Natural LResources-�D�ivJision of Water Quality - Groundwater Section
• WELI, CQisTRACTOR (INDIVIDUAL) NAME (print) Dbi �t ✓tAA CERTIFICATION #i4i./9
LLCQNTRACTOR COMPANY NAME eat.
,e e'/ YOS. VI/r_)) tL r fjIMP e Z" I*. PHONE kin Gi1S'3/ It
STATEWE4.L CONSTRUCTION PERMIT# /70 a ASSOCIATED WQ PERMIT#
'` - (if applicable) Of applicable)
WELL USE (Check Applicable Box): Residential kii Municipal/Public El Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other U If Other, List Use
2. WELL LOCATION:
Nearest To LOci.i pes vl /fit . County //A y &Jncd
it)r) nth 1?d
(Street Name, Numbers, ommunity, Subdivision, Lot No., Zip Codc)
3. owNER: •S Ake .. le s Lett�.< Address 3n9 /-leron Oct
- // (Street or Route No.)
neA (iSi / J/i4 ySo,
ay or Town _jtate Zip Code
Area code- one number
4,SDATEDRILLED .5-7'1)3
5., TOTAL DEPTH: / SS '
6 DOES WELL REPLACE EXISTING WELL? YES ❑ NO Er
7; STATIC WATER LEVEL Below Top of Casing: 8D FT.
(Use "+" if Above Top of Casing)
S,•;TOP OF CASING IS i FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): .2n METHOD OF TEST cQ rc
JO,`WATER ZONES (depth): /LS r - 5p•..
11Y`.DISINFECTION;Type I- r4-t Amount
12,; CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From D Tole 21 Ft. L. "
From ` To Ft.
From To Ft.
3 ,, GROUT: Depth Material Method
"-'.: From D To ) O Ft C4.v au r I ..
From To Ft.
14.' SCREEN:Depth Diameter Slot Size Material
in.
in.
P vc
s'"From' To Ft. in.
.f• From ' TO Ft. in.
IS.' SAND/GRAVEL PACK:
Depth
From To Ft.
From To Ft.
Size Material
Topographic/Land setting
❑Ridge ❑Slope ❑Valley BFrt
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source: OGPSOTopographic map
(check box)
DRILLING LOG
Formation Description
DEPTH
From To
p Ga
ea ' i2s2
• ;lc-.
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
0
w
ray
0
0
REMARKS:
[d)AT NS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
ST CTICN STAND ?,'AP'D THAT A COPY OF THIS RECORD EEN PROVIDED TO THE WELL OWNER
ATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Divis of
274994636.Phone No. [phone]
of Water Quality, Groundwater Section, 1636 Mail Service Center- Raleigh, NC
within 30 days. GW-I REV. 07/2001

Size Material
271828
WELL CONSTRUCTION RECORD
r ,.
ot-tii Carolina -Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
ELL. (INDIVIDUAL) NAME
� (print) D 6 ! N LJe- b I CERTIFICATION # 2 , / 9
s I li&CQNTRACTORCOMPANY NAME LTVte Kb YOS . WA 1? '4 Pump 77..r .PHONE # (Oak le 418 -3) 7 D
km WELL CONSTRUCTION PERMIT# /4 0 2 ASSOCIATED WQ PERMIT
"s ' (if applicable) (if applicable)
WELL USE (Check Applicable Box): Residential &Municipal/Public 0 Industrial 0 Agricultural ❑
Monitoring ❑, Recovery 0 Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest o be to /,i' li _.0v!
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER:13
a
Address ((J K%J £ k r / clAd -
--• or Route No.) p
%JC. �D%J
7‘ CI Town
era code- Phone number
: DATE DRILLED of -
5. TOTAL DEPTH:.305'
DOES WELL REPLACE EXISTING WELL? YES ❑ NO
f.ATIC WATER LEVEL Below Top of Casing: 1 Db FT.
(Use "+" if Above Top of Casing)
i OP OF CASING IS I FT. Above Land Surface*
Top of casing terminated at/or below land surface requires a
II lance in accordance with ISA NCAC 2C .0118.
. IUD (gpm) .40 METHOD OF TEST a }� r
%TER ZONES (depth): .3 2 5 ' - µ0 r+.
Str
State
Zip Code
44SINFECTION:Type I-4T(-1 Amount
:. � "+SING: Wall Thickness
Depth Diameter or Weight/Ft. Material
tom To �LP Ft. /i is
Pve
from To Ft
'rrorp To Ft.
. ROUT -Depth " Material Method
From. O To aD l' ww Ft. Y.�-� -1-o r
From:' — To Ft.
Diameter Slot Size Material
Ft. in. in.
Ft. in. in.
SCREEN: Depth
From To
From ' To
SAND/GRAVEL PACK:
Depth
From` To
From To
Y f[D19.STIFY HAT
,a
Ft.
Ft.
S: )lunjt the original to theDilision
/,,99 1,010 Phone No. (919).7i3-3221,
Topographic/Land setting
County_thlapaVad ❑Ridge ❑Slope ❑Valley 131 fat
(check appropriate box)
Latitude/longitude of well location
(degrecs/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
Formation Description
DEPTH
From To
s's/o ,3DS
&ea-a7: -e-
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road-
numbers and common road names. o .
c.�
0
0
YELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
ye- 3-3/-03
TURE OF PERSON CONSTRUCT
E
WELL DATE
f Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
ithin 30 days. GW-I REV. 07/2001
ez

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME/'``(print) p bi i1 Lc) .Dotfb CERTIFICATION #44//x
WELL CONTRACTOR COMPANY NAMEG5relnt. 'BC DS . L.)e_1 I —E 7�w,041:41M.PHONE # /12S'
STATE WELL CONSTRUCTION PERMIT# ) 410g ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
271827
1. WELL USE (Check Applicable Box): Residential F"Municipal/Public 0 Industrial ❑ Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other ❑ IfOther, List Use
2. WELL LOCATION: ``
Nearest Tgen: Waa y fl t:- v i / / e_ County t.a.)OOC
(Street Name, Numbers, Community, Subdivision, Lot ., Zip Code)
3. OWNER: 1 L })b
Address rj
(Street or
State
YYl
City
( )-
Area code- Phone number O 3 t n 4 (�S r
4. -DATE DRILLED 'IY 't I [e D epW
5. TOTAL DEPTH: tuts n �X,3'i��y Wt l)
6. DOES WELL REPLACE EXISTING WELL? YES 0 Ni f9"--
-7. STATIC WATER LEVEL Below Top of Casing: a D D FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): cQ . S METHOD OF TEST � hrs
10. WATER ZONES (depth): z y bS I t e, p w
q 5- - alp -
l1. DISINFECTION: Type k—f ri-1 Amount St'?
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To alp Ft. i., i'
I c s
e No.)
f NCodc
Topographic/Land setting
❑Ridge ❑Slope ❑Valley Etrcit
(check appropriate box)
Latitude/longitude of well location
From To Ft.
From To Ft.
13. GROUT: Depth
From 0 To,AD
From To
14. SCREEN: Depth
From To
From To
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Pvc,
Material e M_ thud
—t-
Ft. CO.w..LwT-._7-e
Ft.
Diameter Slot Size Material
Ft. in. in.
Ft. in. in.
( 16-REMtttRi(3 -
1
I ; �ItDf}H-EREBYCERTIT THa
- CONSTIi,UCTIQN STAN
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formatiop Description
0 apt
bt.fact
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
r
0
O
S WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
JD THAT A COPY OF THISR'ECORQ HAS BEEN PROVIDED TO THE WELL OWNER
3'3/—t 3
.11 SI ATURE OF PERSON CONSTRUCTING THE WELL DATE
LSphmit the original to the ITvisio of Water Quality, Groundwater Section, 163o Mail Sen ice Center - Raleigh, NC
-27699-1636 Phone No, [phone], within 30 days. GW-I REV. 07/2001
tr
C

/� ,fN
WELL CONTRACTOR COMPANY NAME&et tale— 8Y DS . La t 11 �! rta-rnp.HONE #
) 4 0 .� ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
STATE WELL CONSTRUCTION PERMIT#
271826
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural ResourcesR- Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) D / In � P b Ll CERTIFICATION # a 7 / 8
(sag L4IS-3°
1. WELL USE (Check Applicable Box): Residential 1 ' Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:\1 '
Nearest Town.) a .Yr 4 i nr l i r County )401._t.'t-r� eck
(Street Name, Numbers, Community, Sunon, Lot No., Zip Code)
3.OWNER: 6�r-�. J1t
Address .� '] 111?t S Lt,�A.t.,
(Scree or oute No.)
City n State s Zip Code
Ma gcAt_ V&J `L1 Nc a$i s-t
Area code- Phone number
4. DATE DRILLED a - % ' 0 3
5. TOTAL DEPTH: Lo 2S t
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 12r
7. STATIC WATER LEVEL Below Top of Casing. — FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surface*
*Top of casing terminated aUor below land surface requires a
variance In accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): n MOD OF TEST
• -10, WATER ZONES (depth): J�-
11. DISINFECTION: Type
12. CASING:
5
Depth Diameter
From D To ac Ft, t o t I
From To Ft.
From To Ft.
Amount ---'-'
Wall Thickness
or Weight/Ft. Material
pvc
13. GROUT: Depth Material 1 Method
From To AD Ft. ('
From To Ft.
15
.SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16, REMARKS:
Topographic/Land setting
❑Ridge ❑Slope ❑Valley L4FIat
(check appropriate box)
Latitude/longitude of well location
(degrees m'notes'seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
o Q. c S�
aD r Lois'
brs•
LOCATION SKETCH
Show direction and distance in miles from at least-
two State Roads or County Roads. Include the road
numbers and common road names. w _
c
0
MDO 1, gREBY CERTIF
CIQNSTRUCTION
2/
Submit the original jo the
27699-1636 Phone N6. (919) -
T THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
DS, AND THAT A COPY OF TI-IIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
3
SIGNATURE OF PERSON CONSTRUCTI
1E WELL DATE
Division of Water Quality, Groundwater Section, 163ti Nlail Sun ice Center- Raleigh, NC
33-3221, within 30 days. G\V-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) D 1 ' 11 CERTIFICATION # 1 4) it
%/1� L.J 1) # .%t/a) Le- PHONE # (60/8 41 g .3) '7
WELL CONTRACTOR COMPANY NAMEa r'G an fa. ioS .
STATE WELL CONSTRUCTION PERMIT# /? D Z+ ASSOCIATED WQ PERMIT#
(if applicable)
(if applicable)
271824
1. WELL USE (Check Applicable Box): Residential 12/Municipal/Public 0 industrial 0 Agricultural 0
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATIO
Nearest Town:/1 .1 nesVt it. Cokunty i/A.t�L.�bdrL
o F'-/1 c 3. 7 4 a at spa sec
(Street Name, Numbers, Community Subdivision, Lot Mo., Zip Code)
3. OWNERT3LLGL I i 1P .���
Address PD Q / '7.? to
C/1A/ t (Street or Route CNJo.) ^ /
City or TowwnnState Zip Code
Area code- Phone number
4. DATE DRILLED 3 -/ l -d 3
5. TOTAL DEPTH: .3b:C 1
6. • DOES WELL REPLACE EXISTING WELL? YES 0 NO EJ.'
7. STATIC WATER LEVEL Below Top of Casing: ) 0 O FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS I FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): i b METHOD OF TEST . kr1
10. WATER ZONES (depth): .2 25 t - 2-o q p m
11. DISINFECTION: Type Ft
12. CASING:
Depth
From D To Los Ft.
From To Ft.
From To Ft.
13. GROUT: Depth
From To 'ei D
Diameter
to t
Amount (MID'
Wall Thickness
or Weight/Ft. Material
PVC
Material
Ft. CJ. w er
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size
From To Ft.
From To Ft.
16. REMARKS:
Method
ivP
Slot Size Material
in.
in.
Material
Topographic/Land setting
❑Ridge gSlope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes. seconds)
Latitude/longitude source:❑GPSOTopographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
305 }e
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
0- `
CO.77
1,DO HEREBY CERTIFY'�HA"�
CONSTRUCTION STAN;1MD
Submit the original to. the Dis
27699-1636 Phone No. (919) 733-
THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
AND THAT A COPY OF THIS RECORD H.3S-)3FN PROVIDED TO THE WELL OWNER
3-3/,)3
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
ision of Water Quality, Groundwater Section, 1636 Nlail Sen ice Center - Raleigh, NC
3221, within 30 days. GW-I REV. 07/200I

WELL CONSTRUCTION RECORD 271708
North Carolina - Department of Environm
WELL CONTRACTOR (INDIVIDUAL) NAME
WELL CONTRACTOR COMPANY NAME
ent and Naura` Re urces - Division of Water Quality - Groundwater Section 0
rint) r/'�� t� /x +/Q��%(J//1� CERTIFICATION /#7,t 7Y'bp,��p
' �.e 2-0977 v / //M� PHONE # yrr'w1 Cam',- 6//O
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable)
(if applicable)
1. WELL USE (Check Applicable Box): Residential Municipal/Public ❑ Industrial ❑ Agricultural ❑
• Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑. If Other, List Use
2. WELL LOCATIO
Near‘stTowry. '4' /� County �� (1C'
�' ro Tow/
(Street N;r, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER:
Address _ 7S7 SurN67,61e eCtie /ZFY,
E/ 09 v:4 )ter -
(Street or Route No.)
(4lj/19 V N. C
�R 7/(ter
Zip Code
NO Q'
FT.
8. TOP OF CASING IS FT. Above Land Surface*
'Top of casing terminated at/or below land surface req
variance in accordance ith I5A NCAC 2C .0118.
9. YIELD (gpm): METHOD OF TES1
WATER ZONES (depth):
11. DISINFEC[ION: Type__ ___ Amount
12. CASING: Wall Thickness
City or Town State
( )-
Arm code- Phone number7
4. DATE DRILLED J'7'DJ
5. TOTAL DEPTH: A-70,5"
6. DOES WELL REPLACE EXISTING WELL? YES
7. STATIC WATER LEVEL Below Top of Casing:
(Use "+" if Above Top of Casing)
wires a
T P
Depth Diam`�eter
From C . To 81 Ft. 6.7 °/h/
From To Ft.
From To Ft.
DEPTH
From To
0
,Qom
Topographic/Land setting
'Midge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
Fprnptiop Description
Or VittiFt.Atktl
13. GROUT: Depth n Material Method
From 0 _ To �(� Ft. (F ^dC��
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
/3 If
0
C)
v
C
0
Cfl
tV
16. REMARKS:
tpo 1t BY fcERTIFvr
1 6ONSTRUCIL N.STAj11.)4
T THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
)S, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
.3-fl-03
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-I636 Phone No:(919) 7t3-3221, within 30 days. GW-1 REV. 07/2001
17.

271707
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section 9
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Ale. y/ 2SC)//€ CERTIFICATIOiVN���/
/dip kqf//Q 4/17/ PHONE # (ge3) i8398
VVEIL CO.NT R.Acfol( COMPANY NAME
STATE VVELI. CONSTRUCTION PERMIT# ASSOCIATED WQ PERMITS/
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential E' Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION:
Nca�sVTowrili (1,4/1/[ z✓
munit
Countv a _D_D�
(Street Name N Hers, Cont
(SCommunity, Subdivision, Lot No., Zip Code)
3. OWNER: V - 'b /1 i1/ %6�1:'7"�
Address l Lo urn »r
(Street or Route No.)
A rs/4I /v /✓. C
City or Town State Zip Code
,a28 7/6
( Area code- Phone number
4. DATE DRILLED ,Tii3
5.TOTAL DEPTH:
,�
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO 421---
7. STATIC WATER LEVEL Below Top of Casing: 7" / FT.
(Use "+" if Above lop of Casing)
8. TOP OF CASING IS FT. Above Land Surface*
`Top of casing terminated at/or below land surface requires a
variance in accordanc,e syitith 15A NCAC 2C .0118.
9. YIELD (epm): n/ METHOD OF TEST / r2
10. WATER ZONES (depth):
II. DISINFECTION: Type
12. CASING:
Depth/ Dian r
From y,�. To %-2 Ft. U/1- /
From To Ft.
From
13. GROUT:
From (7
From
14. SCREEN:
From To
From To
15. SAND/GRAVEL PACK
Depth
From To
From To
Topographic/Land setting
DRidge ❑Slope fecallcy ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/mi nu testseconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To F.rrpati. Description
0 02n
Amount
Wall Thickness
or Weight/Ft. /
teriali
lL�j . l,5 i 3
To Ft.
Depth Material / Method
2o To , Ft. �er gN/-
To Ft.
Depth Diameter Slot Size Material
Ft. in. in.
Ft. in. in.
Size Material
FL
Ft.
16.REMARKS:
LOCATION SKETCH
Show direction and distance in miles from at e�st =-
two State Roads or County Roads. Include th6.43)ad
numbers and common macl names.
J
i1D451EREB)'j CERTIFY
.1C019STlthriCTiON STAND
r—
TFIIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
P
SIGNATURE OF PERSON CONSTRUCTING THE WELL
�J -au -03
DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center- Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-I REV. 07/2001
1

From
From
17.REMARKS
North Carolina - Department of Environment and Natural Resources • Division of Water Duality - Groundwater Section
1636 Mail Service Center - Raleigh. N.C. 27699.1636-Phone [phone]
271'l06
WELL CONSTRUCTION RECORD WELLCONTRACTOR• once%%lQ /M�
WELL CONTRACTOR CERTIFICATION it: a rb /
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE (Check Applicable Box): Residential V Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery n Heat Pump Water Injection ❑ Other n If Other, List Use:
2. WELL LOCATION,- (Show sketch of the location below) /
Nearest Town:.l'%/D € County gAVO
W4et v/ep/ goVe-
(Road Name anu/ Numbers Communily, or Subdivision and Lot No.)
/
3. OWNER ` Cgr%� /i!/A/ /t°
Address &oi- (�/y. rh,&) /�V7
r//A, /2/, r ic3i702/
(Street or •outo No.)
City or Town Stale Zip Code
4, DATE DRILLEDayO.2
5. TOTAL DEPTH . fyC
6. CUTTINGS COLLECTED YES [ I NOn
7. DOES WELL REPLACE EXISTING WELL? YES (1/ NO
8. STATIC WATER LEVEL Below Top of Casing:
o FT.
II
(Use'.' it Above Top of Casing)
9. TOP OF CASING IS FT. Above Land Surface•
'Top of casing terminated atfor below land surace requires a variance In accor-
dance with 15A NCAC 2C .0110
10. YIELD (gpm)' / METHOD OF TEST /7'7
11. WATER ZONES (depth): --�-�-
12. CHLORINATION: Type 17/i Amount
13. CASING:
Wall Thickness
Depthp ' /D_ia `ler or Weight/Ft. erial
From To 0 —_ Ft. W
From To Ft.
From To Ft.
14. GROUT:
Depth //''r Material Method
From 0 To o(J Ft t-EMe.ir
From To Ft
15.SCREEN:
Depth Diameter Slot Size Material
From To Ft in in
From To Ft in in
From To Ftin in.
16. SAND/GRAVEL PACK:
Depth Size Material
To Ft
To Ft
DRILLING LOG
From To
DEPTH
Fo actaryDescnpticn
'7 Y
,ve
If additional space is needed use back of form
LOCATION SKETCH
0
CO
(Show direction and distance from at least two State
Roads, or other map reference points)
i3ss
0
cIl
N
CONSTRUCTED IN ACCORDANCE WITH 1SA NCAC 2C, WELL
OPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
c3-ay-o3
SIGNATURE OF PERSON'tONSTRUCTING THE WELL
Omit o'ginal to Division of Water Duality. Groundwater Seciion within 30 days
DATE
GW-1 REV. 12199

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and N, tural
WELL CONTRACTOR (INDIVIDUAL) NAME(print) - I
WELL CONTRACTOR COMPANY NAME r 'Le
271705
esources - Division oof Water Quality - Groundwater Section
e // CERTIFICATION fC
PHONE # ( o) (°'^^ .7- as Tie
T
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT
(if applicable)
(if applicable)
1. WELL USE (Chcck Applicable Box): Residential ty' Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other O. If Other, List Use
2. WELL LOCATION:
Nearest Tpwn:
M
yr
County
(Street Name. Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER Sy / /r) /�
Address d798 £ 7 / 'T,/, eiv
I4
(Street or Rope No.)
C
r 70
City or Town State Zip Code
( )-
Area code- Phone numb
4. DATE DRILLED5i/)- 0 3
5. TOTAL DEPTH: C ys--
6. DOES WELL REPLACE EXISTING WELL? YES O NO Er
7. STATIC WATER LEVEL Below Top of Casing: (90O FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS O FT. Above Land Surface*
`Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118. ,/
9. YIELD (gpm): �/Y
R METHOD OF TEST Y/`
10. WATER ZONES (depth):
topographic/Land setting
dge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitudc of well location
(degrees/minutes/seconds)
Latitude/longitude source:OGPSOTopographic map
(check box)
DEPTH DRILLING LOG
From To
o aD
Fs t o Description
/CL
W
LOCATION SKETCH
11. DISINFECTION: Type )47 Amount Show direction and distance in miles frontal least
2. CASING:, /Q� PJ Wall Thickness two State Roads or County Roads. Include the mast:;-
HOC To th�� t� Ft. (!J i �er or Weight/Ft. �/ e� j. numbers and common road names. "t _
From/fl-
4l2)11
From To Ft.
From To Ft.
13. GROUT: Depth1 Material _ / Method
From 0 To �'YD FL.(2 P m &/.`'7
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
O
to
Iv
16. REMARKS:
VI O MERI4B`\ CEl TIF
ICONSTRUCTION STA
T THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
DS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
3-io-03
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original `P the 1 'vision of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No.(919)
3-3221, within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and
WELL CONTRACTOR (INDIVIDUAL) NAME)(Print)
WELL CONTRACTOR COMPANY NAMEtat
272363
tural Resources - Division of Water Quality - Groundwater Section
L. �/J .CERTIFICATIION#4 �9 7
7
L1 .PHONE # 419—a/82
ASSOCIATED WQ PERMIT# N/
(if applicable)
STATE WELL CONSTRUCTION PERMIT#
(if applicable)
1.41
1. WELL USE (Check Applicable Box): Residential * Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATIO
Nearest Town:
LA
(Street Name, Numbers, Camm,mity, Subdivision, Lot No., Tip Code)
3. OWNER:( It Glr%ta+tom a
Address
fir/ �.4 2/ (.( Led
(Street or Route No.)
County
City or Town State Zip Code
—)
Area code- Phone number
4. DATE DRILLED ....
/./h %63
5. TOTAL DEPTH: ..2 4 ' t
6. DOES WELL REPLACE EXISTING WELL? YES/ /❑ NO is.7 7. STATIC WATER LEVEL Below Top of Casing: d FT.
(Use -r" if Above Top of Casing)
8. TOP OF CASING IS 1.e I— FT. Above Land Surface*
'Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): ..-1-- METHOD OF TEST7ece./
10. WATER ZONES (depth): Th t / 'o t
11. DISINFECTION: Type Amount /C) oL
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
�l
From P / To y� Ft ,mac ! Oar_
From To Ft.
From To Ft.
13. GROUT: Depth
From To e2 0 Ft
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From o Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From o TFt.
From f To Ft.
16. REMARKS:
Material
eerlLtce
clei
Topographic/Land setting
[Midge slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minuteslseconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
LOCATION SKETCH
Show direction and distance in miles from Tt least
two State Roads or County Roads. InclucIa ie road -
numbers and common road names.
w
:a
THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
AND TEAT COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
Submit tht.9.7Jginal_tothe D
G T,t495-Tit96(?h6fiena,Y'919) 73
PS'LVI 4E,. 0" HuE
SIGNATURE OFPERSONCONSTRUCTING THE WELL DA
[vision of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
3 3221, within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD 272184
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Jeremy H. Bowman' CERTIFICATION Y 2809
WELL CONTRACTOR COMPANY NAME D Rnwman Wel 1 Dri 11 I. ng, Tnr PHONEY 87A 252— 7779
STATE \VELL CONSTRUCTION PERMITY ASSOCIATED WQ PERMITY
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential Ix Municipal/Public 0 Industrial 0 Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town:Canton County Haywood
131 ancpin Drive 28716
(Street Name, tFembcrs, Community, Subdivision, Lot No., Zip Code)
3.OWNER: Claudio Fuentes
Address 131 Bespin Drive
(Street or Route No.)
rend- n NC 28716
City or Town State
)-
Area code. Phone number
4. DATE DRILLED 1 /1 5/03
Zip Code
5.TOTAL DEPTH: 400'
6 DOES WELL REPLACE EXISTING WELL? YES 0 NO Ca
7. STATIC WATER LEVEL Below Top of Casing: 1 00FT.
(Use "+" if Above Top of Cuing)
8. TOP OF CASING IS 1 ' 4 FT. Above Land Surface"
'Top of cuing terminated at/or below land surface requires a
variance In accordance with 15A NCAC 2C .0118.
9 YIELD (gpm): 2 METHOD OFTEST- rotary
(0. WATER ZONES (depth): 200'
300'
11. DISINFECTION: Type tablet Amount 6
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 40 Ft.61 /8 Srh RQ PVC'
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From 0 To 20 Ft. concrete gravity flow
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15 SAND/GRAVEL PACK:
Depth Size Material
From To Ft
From To Ft
Topographic/Land setting
❑Ridge ❑Slope ❑Valley OFIat
(check appropriate box)
Latitude/longitude of well location
(degrees/minu ies/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
PEPTH DRILLING LOG
From To Formation Description
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
0
7'3
6.14
0
16. REMARKS:
r, IT'1 Dpp f\IgRE
'SCdNSTRU
FY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
NDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
�t �l //-1s /w."
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
l/l.3 it;
-
Submit the_oliginal lto the Division of Water Quality, Groundwater Section, 1636 Mall Service Center -Raleigh, NC
27699-I636 PVFone No.1(919) 733-3221, within 30 days. OW -I REV. 07/2001
air

WELL CONSTRUCTION RECORD 274221
North Carolina - Department of Environment and Natural Resources - DivisionLof Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) [3 1 I ( u'Ar5 ' 1 CERTIFICATION # _
WELL CONTRACTOR COMPANY NAME Fnfbtn (�. LJvt\\ c'Mt'n'fl c • PHONE #
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential lE Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring 0 Recovery ❑ Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town:l/estmostitllr Countyt-t4ytaletb
®(Street Name, yyarn
UTerk. 4ktct
3. O WNER:pm
Address / 9 3 /
(Street or Route No.)
(�pL*SW tfiA .se
bejjs��``Comm ity, Subdivision, Lot No., Zip Code)
�tP'Li706 Air root
ij u Sae //
A-ssea �Ly sT
City or Town State Zip Code
(&aB)- Y52 - 4c9s r
Arca code- Phonc number
4. DATE DRILLED «/23/03
5. TOTAL DEPTH: nt,'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 0
7. STATIC WATER LEVEL Below Top of Casing: ytoe FT
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
'Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
10 WATER ZONES (depth):
9. YIELD (gpm): 2 METHOD OF TEST R Il:. C' es ire
re
_ . re� C Cc.
LOCATION SKETCH -'I CS
r=
Show direction and distance in miles from 6lleas
two State Roads or County Roads. Include dey ro
numbers and common road names.
/Topographic/Land setting
LM idge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
Formation Description
j eletaaertmaieL
a
DEPTI I
From To
— 2. 2
2-7
- .ro
79 T z ti rr-fr..
c
o-
11 DISINFECTION: Type (t kF Qp Amount Ik O Z.
12. CASING: Wall Thickness
Depth Diyne pr or Weight/Ft. Material
From */ To 8'd• Ft I' *-4kit PVC_
From To Ft.
From To Ft.
13. GROUT: Depth Material
From a To Z. / Ft. P.tirt.aa'
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK
Depth
To
From
From
16. REMAR9CS:
I If0 HE
s 1 CONSTRUCTION ST
I L
Ft.
To Ft.
Metho
PMlaa•
Size Material
/7
2 h¥A-& . ,P� Scific9 ADAt2 - ,-4 i GPn{
THIS WELL WAS CON TRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
5, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
O o
A Aar, 5 0 frothht-Tr Q I-e
37, � /"4 / / / 3 /n
SIGNATURE OF PERSON CONSTRUCTING THE WWWCCCLL ATE
Sttbmit the grtginal to thejDivision of Water Quality, Groundwater Section, 1636 Mall Service Center - Raleigh, NC
27699-1636 Phone Nti, 33-3221, within 30 days. GW-1 REV. 07/2001
,I04UL5gr:o

WELL CONSTRUCTION RECORD
Carolina - Department of Environment and Nan.y{'al Resources
FI.CONTRACroR(INDIVIDUAL) NA. (print) t,-r•'r
gpk CONTRACTOR COMPANY NAM
STATE WELL CONSTRUCTION PERMIT#
(if applicable)
274J7
Division of Water Quality - Groundwater Section
CERTIFICATION #364
PHONE # &!J) �; y6 • 3I 71)
ASSOCIATED WQ PERMIT#
(if applicable)
1, -WELL USE (Check Applicable Box): Residential* Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 I ['Other, List Use
2. WELL LOCATI.01)1:
Nearest Town: tilettineS V I / )e_ County L) L
. Fa I l C,, .a I La
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: JUhn Ca e jo V/r.u4D
'Address 361 1 —.TIP ikJ 1 LOAne-4 )<r1 •
(Street or Route No.)
rIesv.liti NC a$I-]gfo
City or To n State Zip Code
Area code- Phone number
4: DATE DRILLED S- 13 -0 3
S. TOTAL DEPTH: / $$
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7.'STATIC WATER LEVEL Below Top of Casing: (e D FT.
(Use "+" if Above Top of Casing)
,TOP OF CASING IS FT. Above Land Surface*
*TN) of easing terminated at/or below land surface requires a
varignee in accordance with ISA NCAC 2C .0118.
9 )YIELD (gpm): .20 METHOD OF TEST Yr r—S •
' 14: WATER ZONES (depth):
i 475-' ' r2.0 q p /v)
11.'DISINFECTION: Type 1—i77/ Amount a2
I2: CASING: Wall Thickness
Depth //n Diameter
From © To Y'7 Ft. t rr
From To Ft.
From To Ft.
.GROUT,,,,' ,Depth Material Method
From ^ Li To Ft. (it an&2 .A.Ll `f}
From To Ft
SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
`. From `To Ft. in. in.
r1.:SAND/GRAVEL PACK:
Depth Size Material
or Weight/Ft. aterial
i From To Ft.
From ' To Ft.
Topo ,raphic/Land setting
❑Ridge Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
8(e-I •
(deerees:'m inures/seconds)
Latitude/longitude source:OGPSOTopographic map
(check box)
DRILLING LOG
Form tiin Description
DEPTH
From
qq
To
L/9 /
/85'
hC�e
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
—o
CO
16. REMARKS:
—THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
S, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
tdac C 1/45`_3i_03
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
V Subiic the original to the D vision of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
CF27699 694 phaniiN61(919) 733-3221, within 30 days. GW-I REV. 07/2001
hr EVILt £:T,Ers/' '44l OFFICE

271171
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - `Divisionn of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME(print) ph.//Y I-3C.G A CERTIFICATION #.7V/2
l?i- l j� mil
WELL CONTRACTOR COMPANY NAME f'N ein/e. Bras Lz2) Jj �F 4'ra / i ut.PHONE # jj kA fr'3/ 7 p
STATE WELL CONSTRUCTION PERMIT# /'y 0:A ASSOCIATED WQ PERMIT#/
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential CC-Municipal/Public 0 Industrial 0 Agricultural ❑
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
NearestTown: Ls*Wilt S v. l i c County y-Jp a r.ey? r
r I•I tov I+ts c/ Plu}1 C,�•..Mc..
(Street Name, fMmbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: C.>✓ h r r 5 /3 e CA.
Address 9 '7 r7 P/ . rYl rL.i,.u.. S 4
l� (Routo Np.)
e)4_
neStreet5or
City or To2 State Zip Code
Area code- Phone number
4, • DATE DRILLED .3 - b 3
5. TOTAL DEPTH: 305 '
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO lir
7. STATIC WATER LEVEL Below Top of Casing: i DO FT.
(Use "+" if Above Top of Casing)
8, TOP OF CASING IS 1 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance In accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): a0 METHOD OF TEST a h rS
10. WATER ZONES (depth): v2 D $ ' - 1 2 c2p„wx
2'VS '- S?r�yn
11. DISINFECTION: Type i-i 1-1-1 Amount 3CD
12. CASING: Wall Thickness
or Weight/Ft. Material
#e.t1
Depth
From 1') To /I'L Ft.
From To Ft
From To Ft.
13. GROUT: Depth Material
From 0 To a0 Ft.
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
Diameter
i ft
C3vvs.-L-vs-1
Method
From To Ft.
From To Ft.
Topographic/Land setting
❑Ridge ❑Slope ❑Valley 0£lat
(check appropriate box)
Latitude/longitude of well location
(degrees:minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(ebec&box)
DEPTH DRILLING LOG
From To
D %
'7a'
Form ti9n Description
ifre
I -^a-1 l L
0
r_
L7
.T.
Q1
0<
o -
m
LOCATION SKETCH Wc-)
n
Show direction and distance in miles from aP ast0
--s
two State Roads or County Roads. Include the road
numbers and common road names.
16. REMARKS:
1Dq'HE BY;'CERT
i_ CAN CtCI
;.1.
Submit the origivRhio the
27699-1636 PhoneNo.(919)
(AT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
jLDS, AND THAT A COPY OF THIS RECORD HA�HEEN PROVIDED TO THE WELL OWNER
z eat
SIGNATURE OF PERSON CONSTRUCTING THE WELL
DATE
Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
733-3221, within 30 days. GW-I REV. 07/2001

WELL CONSTRUCTION RECORD
274167
Carolina .Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME ll (print) i-G0/�b I rl 1.J c .lf.�./.(�) n. A CERTIFICATION # a V/>
WELL CONTRACTOR COMPANY NAME Gr -P_AAL 1_'1YOS. (.C/211 . r uiwsp NI -CRONE # (gag 4/9" 3 / 71"
r )
;'STATE WELL CONSTRUCTION PERMIT# / VD A ASSOCIATED w'Q PERMIT#
Oran tieable) (if applicable)
1,' WELL USE (Check Applicable Box): Residential Municipal/Public 0 Industrial 0 Agricultural 0
,.Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2, WELL LOCATION.
rest To n: A County2liLe YYX�
� ([ �u t- T
(Street Name, Numbers Co munity, Subdivision, Lot No., Zip Code)
3. OWNER: yi/, 1 At 44/ yr/JJ J2
• Address DWI/ /A-1 lu<'.i�. Pd
(Street or Route No.) ()
r2a r eSth i /4 j 7'1-e, on 17:6
(—)'
City o own State Zip Code
Area code- Phone number
4 DATE DRILLED 1/ - /d - O3
IC TOTAL DEPTH: ! g-S
6 DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7y'STATIC WATER LEVEL Below Top of Casing: G /) FT.
(Use "+" if Above Top of Casing)
,8. -TOP OF CASING IS I FT. Above Land Surface*
',-*Top of casing terminated at/or below land surface requires a
j. variance in acenrdanee with 15A NCAC 2C .0118.
9.;YIELD (gpm): 30 METHOD OF TEST r s
0:WATER ZONES (depth): /(n S' - 3(') yr)
i:11: DISINFECTION: Type /-IT/-!
`'_ 12. CASING:
... .. Depth
From D To 4 / Ft.
From To - Ft.
From To Ft.
GROUT:+� 'Depth Material -e- Method
/
From ■ s To j./) Ft. 1 D4ntn ss.± l tp
from To Ft.
4.,ISCREEN: Depth Diameter
From To Ft. in.
From To Ft in.
15.' SAND/GRAVEL PACK:
Depth Size Material
rom To Ft. "
Tom'' To FL
Diameter
to it
Amount / 2
Wall Thickness
or Weight/Ft. Material
PVC,
Slot Size Material
in.
in.
Topographic/Land setting
❑Ridge ❑Slope -OValley `Flat
(check appropriate box)
Latitude/longitude of well location
(d ur esntinutes/seconds)
Latitude/longitude source:OGPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To/ FormQn Description
deed -/
' /SY .L�
ui
0
c
CM
c
0
LOCATION SKETCH t rno
Show direction and distance in miles from at least 3 m
tn.
two State Roads or County Roads. Include the road
numbers and common road names.
0
:REMARKS.
FRFRV ('FRTIFV THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
Submit the original to the 1
277699.1616 Phone No. (f19) 7
( 01-1h'0,AlFRSEc1r5/
aSHf94C ^{GCam;-OFFlcE
S, AND THAT A COPY OF THIS RECORD J,[AS-r}EEN PROVIDED TO THE WELL OWNER
S-3/-D3
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
ivision of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
3-3221, within 30 days. P GW-I REV. 07/2001
t7
G
z

274166
WELL CONSTRUCTION RECORD
rah Carolina Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOP(INDIVIDUAL) NA E 1)_ t) bp _ CERTIFICATION L i ,,./:
WELL CONTRACTOR COMPANY NAME &rreLt_. L 1Jr" L.c)e-i..i -?- Yl. w.x,pk+ntNE # (znj1 GYS - / %v
*STATE WELL CONSTRUCTION PERMIT# / 7 V 2 ASSOCIATED WQ PER:\IIT#
(ifapplicable) (if applicable)
Al
..WELL USE (Check Applicable Box): Residential MunicipaliPublic 0 Industrial 0 Agricultural 0
-!Monitoring ❑ Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION Ala
" Nearest own: - / _ i . County Ft/a 7/31)e.) CL
Community,
•S 7/4-
(Street Name, Numbers, Subdivision, Lot No., Zip Code)
3. OWNER: a-l-P4 PA-)Cle-r
Address 1 .2 b 9 P raj z ,t 4i'
(Street or Rout No.)
i?eSu/ Jle, .A/c- [Si7W LA
City or ?own State Zip Code
Area code- Phonc number
'Lk DATE DRILLED 'S/ / '7 - .' 3
5, TOTAL DEPTH: /
.b:' DOES WELL REPLACE EXISTING WELL? YES ❑ NO lX
7._ STATIC WATER LEVEL Below Top of Casing: 410 FT.
• (Use "+" if Above Top of Casing)
TOP OF CASING IS 1 FT. Above Land Surface*
'rTpp of casing terminated atlor below land surface requires a
variance In accordance with 15A NCAC 2C .0118.
9., YIELD (gpm): 40 METHOD OF TEST o. h r5
(4..WATER ZONES (depth): / 6 5 r - 40 cjpm
1I. DISINFECTION: Type 1-i rig 23
12. CASING:
Depth
From 1)' To /69 Ft.
From To Ft
From "- To Ft.
Diameter
G"
Amount
Topo aphic/Land setting
❑Ridge lope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degucs m inwcsiscconds)
Latitude/longitude source:OGPSOTopographic map
(check box)
DEPTH DRILLING LOG
From To Fo a ion Description/
/Lt 9 UJ_C
/i /� ' / ST -1 A,,,, .1'1
CO
L
C
Ur
LOCATION SKETCH "0
Show direction and distance in miles from at least
Wall Thickness two State Roads or County Roads. Include the road W
or Weight/Ft. In numbers and common road names. t
O
131; GROUT: Depth Material Method
Frpm fi To ojD Ft. C12-4-sLa I C /O
From To Ft.
14...SCREEN:-- Depth Diameter Slot Size Material
From To Ft. in. in.
'''.From To Ft in. in.
15. SAND/GRAVEL' PACK:
a Depth Size Material
From To Ft.
From To Ft
14' REMARKS:
S WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
ND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
3`-3/-O3
ATURE OF PERSON CONSTRUCTING THE WELL DATE
Sr41nit the original to the 'Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
2749 143f FheeeAu} 3-3221, within 30 days. GW-I REV. 07/3001
ASvE'vi4LE. IA OFFICE ..
c
O

WELL CONSTRUCTION RECORD
;North Carolina- Department of Environment and
WELL CONTRACTOR (INDIVIDUAL) NAM/E, (print)
tyFcLL CONTRACTOR COMPANY NAME (irtea
' !STATE WELL CONSTRUCTION PERMIT#
(if applicable)' (if applicable)
d L
•
1. `WELL USE (Check Applicable Box): Residential Municipal!Public 0
Monitoring 0 Recovery 0 Heat Pump Water njection 0 Other 0 1
2. WELL LOCATIO
Neare$ Town:
olt
(Street Name, Nu
.So
County 54u b),wt
Community, Su % p )
OWNER: h�'It, CiH-e°.CC-t/ I
Address ?2/7 D A.A ✓,i . /,- •
(St= or Rou%e o.)
�iVl /t /V`
vision, Lot No., Zi ode
City or own State Zip Code
Area yode- Phone number , /
4i`DATEDRILLED Y -3
,5;'TOTAL DEPTH: ,j— "C ✓
;`ROS WELL REPLACE EXISTING WELL? YES 0 NO O.
'STATIC WATER LEVEL Below Top of Casing: / ( FT.
(Use "+" if Above Top of Casing)
TOP OF CASING IS I FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
Variance In accordangewith ISA NCAC 2C .0118.
9: (YIELD (gpm): Lie METHOD OF TEST .2. h r5 •
IQ: WATER ZONES (depth): 5,2 7 z{t' n p -,
1 I' DISINFECTION: Type
,12:. CASING:
Depth
:From ID To a
From To
From To
134 GROUT: : Depth
From /) TO_c2Q_
From To
% i{-/ Amount g/
Diameter
Ft. 7, �✓
Ft.
Ft
Ft.
Ft.
14. SCREEN: i,;Depth Diameter
Ft in.
From To Ft in.
5,SAND/GRAVEL PACK:
Depth
From To
From To
Wall Thickness
or Weight/Ft. Material
Pv�
Material Method
Ft.
Ft.
Size
Slot Size Material
in.
in.
Material
274165
ral Resources - Divi ion of Water Quality - Groundwater Section
7 CERTIFICATION # .IS/./18
/.�•C W ✓.j'yf • r CF-PHONE # isa C 5a • 3/ 715
ASSOCIATED WQ PERMIT#
Industrial 0 Agricultural 0
Other, List Use
Topographic/Land setting
❑Ridge ❑Slope ❑Valley Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:OGPSOTopographic map
(check box)
DEPTH DRILLING LOG
From To Formatiodg escription
x2_4. 4. wit . t
w
C
LOCATION SKETCH z �"
rnt
Show direction and distance in miles from attleast 0<
two State Roads or County Roads. Include t e road` o
numbers and common roacFnames. -a mr..
O
O
16. REMARKS:
HIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
S-3/--oj
t. c,
1GNATURE OF PERSON CONSTRUCTING THE \WELL DATE
SNg4ut the original to the Div f lion of Water Quality, Groundwater Section, 163o Mail Service Center - Raleigh, NC
4434 PhoarNg19p) 733-
221, within 30 days. GW-I REV. 07/2001

3; OWNER:
WELL CONSTRUCTION RECORD
NPrth Caroltrta - Department of Environment and Natural Resources - Divisi of Water Quality - Groundwater Section
WELL CON R(print)
ACTOR (INDIVIDUAL) NAME iLL I r
T f 4 f' CERTIFICATION q 3v4/
\YELLCONTRACTOR COMPANY NAME t rre.2Jnlc VT (//d) '-("p�{ONE # j$rL y�-3/ %a
STATE WELL CONSTRUCTION PERMIT# /1 n2 ASSOCIATED WQ PERMIT#
`(ifapplicabte)' (if applicable)
c.rT4 t+ W'd?r.. '
WELL USE (Check Applicable Box): Residential*. Municipal/Public 0 Industrial 0 Agricultural ❑
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 I f Other, List Use
274164
, WELL LOCATIO
Netrest
yuntyAdtbed
YDtilt/
(Street Name, Nmn6ers, Community, Subdivision, Lot No., Zip Code)
Address V / 3,r, r1 (Y)t'ryin_;2._ ('snit
/a/p (Street or Route No.) 341//6,
City o Town � F[
State Zip Code
Area code- Phone number
DATE,DRILLED 4- 3 D — 6.3
S TOTAL DEPTH: % aOS
46 `DOES WELL REPLACE EXISTING WELL? YES ❑ NO .[
9:`:: STATIC WATER LEVEL Below Top of Casing: / MC FT.
• (Use "+" if Above Top of Casing)
8r'TOP OF CASING IS / FT. Above Land Surface*
.'Top of casing terminated actor below land surface requires a
t:variance In accordau a ith ISA NCAC 2C .0118. /
9' YIELD (gpm): /2 METHOD OF TEST a h rS
1 R j WATER ZONES (depth):
Topographic/Land setting
(�Zidge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
)degrecsiminutes/seconds)
Latitude/longitude source:OGPSOTopographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
/) s «a
kJ A
I I. DISINFECTION: Type
12. CASING:
Depth
From 0 To /n s5 Ft.
c From To Ft.
`;From To Ft.
3 'GROUT: ` -. Depth Material 1
From 0 To VD FL C p
,F;rom To Ft.
Diameter
6 ./
Amount //i/
Wall Thickness
or Weight/Ft.Material
Method
�o / l
4;';SCREEN: Depth Diameter Slot Size Material
~`From To Ft. in in.
From" ' To Ft. in. in.
5:'``SAND/GRAVEL PACK:
Depth Size Material
From * To Ft.
From To Ft.
16. REMARKS:
w
LOCATION SKETCH C o��'
Show direction and distance in miles from at last .._
two State Roads or County Roads. Include thicread r
numbers and common road names.
-o
r.J
r
O
3I11-1
it the original to the Div ion o
!MI et(9})..;.., 221, w
ELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
HAT A COPY OF THIS RECORD HAS t3E,E 4 PROVIDED TO THE WELL OWNER
FURS OF PERSON CONSTRUCTING THE WELL
.f-3/-n 3
DATE
Water Quality, Groundwater Section, 1630 Mail Service Center - Raleigh, NC
ithin 30 days. GW-I REV. 07/2001
2 f
CI
0

Sc
WELL CONSTRUCTION RECORD
,North Carolina Department of Environment and Nat iral Resources - Division of Water Quality - Groundwater Section11'/
1* WELL CONTRACTOR (INDIVIDUAL) NAME (print) t. CERTIFICATION #✓, 4 /
iW&LE. CONTRACTOR COMPANY NAME C; l-L't',Y1c . /'Yr5 t l.(JP-LL, �i Ktpd "'E+IONE k
'‘WE
LE.
WQ PERMIT#
Of applicable)
STATE WELL CONSTRUCTION PERMIT#
'`--`` (ifapplicable)
L. 'WELL USE (Check Applicable Box): Residential(, Municipal/Public 0 Industrial ❑ Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION;
Nearest Town:
�h
County At/layle.Y Z.
(Street Name, Numbers, CommuJy, Subdivision, Lot No., Zip Code)
- 3. OWNER: erredel, /_P-hL.z�'r
Address 3 / C�9' WIt c� ke ,/ ,edi
d�treet or Rome No.) 9 7 t
Cary or own - Z State V l~ Zip Code
7' Area code- Phone number
'4. DATEDRILLED .J -/ _03
-5. TOTAL DEPTH: /(o,5z 11
6,',DOES WELL REPLACE EXISTING WELL? YES CINO ,cam
Z. >STATIC WATER LEVEL Below Top of Casing: 6 U FT.
(Use "-Si" if Above Top of Casing)
TOP OF CASING IS / FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance In accordance with ISA NCAC 2C .0118.
9. ;YIELD (gpm): 2 0 METHOD OF TEST a 6t v5 .
jct. WATER ZONES (depth): 95-' - 4et) p
/673 r - / Apr
11i.D1SINFECTION: Type HT'/-/ Amount / $
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From .t To /p R Ft 1a ie p vc_
From To Ft
From To Ft.
GROUT:^ - Depth }�1aterial Method
From 60-: To iD Ft. (.P4ittiLf /t*p
',. FromTo Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From - To Ft in. in.
15.. SAND/GRAVEL PACK:
Depth Size Material
From ' To Ft. From To Ft.
274163
aunt ,Y8.3/10
Topo raphic/Land setting
❑Ridgelppe ❑Valley ❑Flat
//////(check appropriate box)
Latitude/longitude of well location
(degrees:minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
Forma jipp Description
DEPTH
From To
i0
c
O
LOCATION SKETCH
Show direction and distance in miles from atgst
r:
two State Roads or County Roads. Include the(road
numbers and common road names.
-v rn2
REMARKS:
h(1 HFRFRV f FBTIFV TF(pT"
,. NT
Su mj( the original to the Divisio
Gi'VCZ7, henP1?la T'ci 33-322.
y`�t^t r
t k� �fd
ASH01r LT = J LEICE
WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
%ram .5-3/-n3
ATURE OF PERSON CONSTRUCTING THE WELL DATE
of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
within 30 days. 4 GW-I REV. 07/2001

274161
WELL CONSTRUCTION RECORD
North Carolina -.Department of Environment and.elan al Resources - Di ision of Water Quality - Groundwater Section
WFLLCONTRACTOR(INDIVIDUAL)NAME/t(print) I !�1A/ /� t U CERTIFICATION#a 9/g
Wg,L CONTRACTOR COMPANY NAME rese EIVL- BLS. I<FIL NM/ //✓CPHONE#
�,§TATE WELL CONSTRUCTION PERMIT#
. . (if applicable)
414-3/I6
/71L/2 ASSOCIATED WQ PERMIT#
(if applicable)
1."WELT, USE (Check Applicable Box): Residential
"Monitoring 0 Recovery 0 Heat Pump Wated
2, WELL LOCATION
Nearest T wn: ounty 4 )r _
Aft
(Street Name, Numbers, Community, Subdivisio,yLot No., Zip Code)
3. OWNER: lI /id (n,"a
Address /t/ C t1 ue, fir<l/�
k;J/ /11 (Street or Route,No.) Ale 7 (� y �} /
a41'eSI//�/e, A e UC0/66
City or To/On State Zip Code
Area code- Phone number
4:;DATE DRILLED S-/2 -v3
TOTAL DEPTH: . q </S
6 DOES WELL REPLACE EXISTING WELL? YES 0 NO�SI
7 STATIC WATER LEVEL Below Top of Casing: 40 FT.
(Use'•+" if Above Top of Casing)
$, TOP OF CASING IS / FT. Above Land Surface*
'Top of casing terminated at/or below land surface requires a
variance In accordance with 15A NCAC 2C .0118. //
9.;YIELD .(gpm): 16 METHOD OF TEST c2 )1rS
10: WATER ZONES (depth)• .3 d 6 / - / 51 t� jo
p m
II. DISINFECTION: Type f•-! 7-7-/ Amount Set
92 'CASING;. Wall Thickness
Depth Diameter or Weight/Ft. M serial
:From. 0" To % / (3 Ft. 6 t /
From To Ft.
-.i-From To Ft.
13.-..GROUT: Depth , 1aterial ._/. Method
From © To 2 D Ft (-il,YniAc.0 -•-inp
From To Ft.
16.- SCREEN; Depth Diameter Slot Size Material
'''..Frptp'' `'To Ft. in. in.
I From `' To Ft. in. in.
15, SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft
Municipal/Public 0 Industrial 0 Agricultural 0
tjection 0 Other 0 I ( Other, List Use
Topographic/Land setting
❑Ridge ❑Slope OValley lot
(check appropriate box)
Latitude/longitude of well location
( degrees in Inutes/seconds)
Latitude/longitude source:OGPSOTopographic map
(check box)
DEPTH DRILLING LOG
From To Fomia 'o Descripticyn
O i/D' cnQ
//0 ' 3Alems
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
0
CO
16.REMARKS:
�I ➢QHEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
AND THAT A COPY OF THIS RECORD • S BEEN PROVIDED TO THE WELL OWNER
Spbmit the original to Ili
27699-1636 Phone No. (91) 733-
GNATURE OF PERSON CONSTRUCTING THE WELL
31-D3
DATE
sion of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
221, within 30 days. GW-I REV. 07/2001

NORTH CAROLINA DEPARTMENT OF NATURAL RESOURCES AND COMMUNITY DEVELOPMENT FOR OFFICE USE ONLY
DIVISION OF ENVIRONMENTAL MANAGEMENT - GROUNDWATER SECTION
P.O. BOX 27887 - RALEIGH,N.C. 27811, PHONE [phone] Quad. No. Serial No.
2 7 5 7 5 1 Lat Long. Pc
Minor Basin
WELL CONSTRUCTION RECORD Basin Code
Header Ent GW-1 Ent
DRILLING CONTRACTOR R O U I n rcty, e- �- - ' L LU "--vn-P
STATE WELL CONSTRUCTION
DRILLER REGISTRATION NUMBER y 18 PERMIT NUMBER: / o 2-
C� .
1. WELL LOCATION: (Sho ketch of, the location below)
at
Nearest Town. (Ak
S-4-e_v L.." 5 in -,(Co V e -
(Road, Community, or Subdivision and Lot No.)
2. OWNER 1 . INN ae-LL.
ADDRESS c13 kC -
(Street or Route No.)
C1--�r�LI JC. r.237 Al
Cit or Town State Zip Code
3. DATE DRILLED L0 -a 3 -D3 USE OF WELL re431clt41--i4-L
4. TOTAL DEPTH 10-C ) CUTTINGS COLLECTED ❑ Yes InNo
,
5. DOES WELL REPLACE EXISTING WELL? ❑ Yes LrJ.No
6. STATIC WATER LEVEL: LAC) FT E above TOP OF CASING.
below
TOP OF CASING IS 1 FT ABOVE LAND SURFACE.
7. YIELD (gpm): '/ra2 METHOD OF TEST of {l rS
8. WATER ZONES (depth): II b ) - Z/ a. 3 pIY>
9. CHLORINATION: Type I'i Y t-T Amount 1 3 ri "i-u) -
10. CASING:
Wall Thickness
F� LD Depth Diameter or Weight/Ft. Material
ti From To SIP Ft 'r Yvl.-
From To Ft
From To Ft
11. GROUT:
Depth �I/1��\ //11Material Method
From D To r. L/ Ft. l_t_4n
From To Ft.
12. SCREEN:
Depth
From To Ft.
From To Ft.
From To Ft
13. GRAVEL PACK:
Diameter
Slot Size Material
in. in.
in. in.
in. in.
Depth Size Material
Fro rdl I Ll I 'r To Ft
r(I •(C To �Ft.
Fro
is j
I 0 H REBY CERTIFY THAT THI vvfL WAS CONSTRUCTED IN ACCORDANCE WITH 15 NCAC 2C, WELL CONSTRUCTION
S AND DS, AND THAT A COPY F THI RECORDWEE PROVI D 0 THE WELL OWNER.
ASSIEVILI E RHyc11.1AL ouicE SIGNATURE OF CONTRACTOR OR AGENT DATE
Submit original to Division of Environmental Management and copy to well owner.
14. REMARK
County:
Depth DRILLING LOG
From To
/
n '7 t0'
FR rwnation Description
tg
If additional space is needed use back of form.
LOCATION SKETCH
(Show direction and distance from at least two State Roads,
or other map reference points)
0
GW-1 Revised 6/88

NORTH CAROLINA DEPARTMENT OF NATURAL RESOURCES AND COMMUNITY DEVELOPMENT FOR OFFICE USE ONLY
DIVISION OF ENVIRONMENTAL MANAGEMENT - GROUNDWATER SECTION
P.O. BOX 27687 - RALEIGH.N.C. 27811, PHONE [phone] Quad. No. Serial No.
27575(Lat. Long. Pc
Minor Basin
WELL CONSTRUCTION RECORD Basin Code
Header Ent. GW-1 Ent
t��,bb- C �i 'LLWt STATE WELL CO
-�.
DRILLING CONTRACTOR -Robin .-YP ',no �✓dam
DRILLER REGISTRATION NUMBER a 4/ / 8 PERMIT NUM ERNSTRUCTION' ya
1. WELL LOCATION: (Show sketch of the location below)
Nearest Town: 042// /l/'
Lod- 1 C'Ylens, o ironc u.b_e)
(Road, Comrpup ity, or Subdivision and Lot No.)
2. OWNER / I
ADDRESS
County:
d
Depth
From To )
�1 S?
c '� PaA.,le r1,_., Q- . ,57 /4S
/) � (Street o�l-Rof oute No.) 9 72 )
(- City/or Town( State Zip Code
3. DATE DRILLED - 62 ri •d :1 USE OF WELL re iL
DRILLING LOG
F. arp tion De scrjp tion
.24.-41L44..t tr
4. TOTAL DEPTH I LDS I CUTTINGS COLLECTED ❑ Yes tom. No
5. DOES WELL REPLACE EXISTING WELL? ❑ Vest No
6. STATIC WATER LEVEL: 102D FT ❑ above TOP OF CASING,
TOP OF CASING IS below
FT ABO E LAND SURFACE.
7. YIELD (gpm): a5 METHOD OF TEST .L hrs
8. WATER ZONES (depth):
1LI5' - a53 cYN
9. CHLORINATION: Type I-� rN Amount 1 D 44) I •
10. CASING:
Wall Thickness
//��
Depth / Diameter or Weight/Ft. Material
From a _To �/ Ft L " Pt%`,
From To
From To
11. GROUT:
Ft
Ft
Depth '�ll Material Method
From To tQO Ft. l 0_00 9.N±
From To Ft.
12. SCREEN:
From
From
From
13. GRAVEL PACK:
Fr
14. REMAR
If additional space is needed use back of form.
LOCATION SKETCH
(Show direction and distance from at least two State Roads,
or other map reference points)
L n__
r
r -
t = _
LT
-li m c
=-
1V n�
C.J
Depth Diameter Slot Size Material crs
To Ft. in. in.
To Ft. in in.
To Ft in in.
To Ft.l'`"
To Ft.
Material
I DO IIIEREBY CERTIFY THAT TIfilS W LL WAS CONSTRUCTED IN AC ORDANCE WITH 15 NCAC O, WELL CONSTRUCTION
STAN ARDS,AND THAT A COPYIOF T IS RECORD HAS EEN PR VI TO THE WELL OWNER
o I ; `2-1.2 ✓ . )i-rLL �l< G -3 0 •- 0 3
'+° l J r-E SIGNATURE OF CONTRACTOR OR AGENT DATE
GW-1 Revised 6/88
Submit original to Division of Environmental Management and copy to well owner.

NORTH CAROLINA DEPARTMENT OF NATURAL RESOURCES AND COMMUNITY DEVELOPMENT
DIVISION OF ENVIRONMENTAL MANAGEMENT - GROUNDWATER SECTION
P.O. BOX 27687 - RALEIGH.N.C. 27811, PHONE [phone] 750
WELL CONSTRUCTION RECORD
FOR OFFICE USE ONLY
Quad. No. Serial No.
Lat. Long. Pc
Minor Basin
Basin Code
Header Ent GW-1 Ent
DRILLING CONTRACTOR --RD h 1 n La ) t 1> _ &vctne.. &rr, 1.u)441 4 P u.rnr 1 •2-11/4-r-- •
STATE WELL CONSTRUCTION
`2 it/ 8 PERMIT NUMBER: % *KD -Z
DRILLER REGISTRATION NUMBER
1. WELL LOCATION: (Show sketch of the location below)
Nearest Town:
SI !�
bnfn� �t1 r - ofhet p I) Depth DRILLING LOG
(Road. Community, or Subdivisions and Lot No.)
2. OWNER MUkn eT-hnSlNfl
'J ADDRESS 3 l CYIec /JL3 e-,
Street or Route No.) b
t1ESu1IIe AJC. o�0%2d
Cit or Town State Zip Code
3. DATE DRILLED 4,-/ % -cS USE OF WELL r PSIck-rd�/t'si-C
. 4. TOTAL DEPTH 35 Ip.
1 CUTTINGS COLLECTED ❑ Yes No
5. DOES WELL REPLACE EXISTING WELL? ❑ Yes No
6. STATIC WATER LEVEL: 7 FT ❑ above TOP OF CASING,
TOP OF CASING IS Crbelow
FT. ABOVE LAND SURFACE.
7. YIELD (gpm): CO b METHOD OF TEST
aArs
8. WATER ZONES (depth): 305 ) - 0, p irr
9. CHLORINATION: Type i'}T/-1 Amount Si 1-i'MS •
10. CASING:
Wall Thickness
Depth 1 Diameter or Weight/Ft. Material
From C.)n To Ft ZD )( Si't'P1
From To Ft
From To Ft
11. GROUT:
Depth �1 Material Method
From 0 To o7/5 Ft. L Qi9'1tP.11--tom-*-"F%
From To Ft.
12. SCREEN:
Depth
From To Ft.
From To Ft.
From To Ft
13. GRAVEL PACK:
Diameter
Depth Size
I , rR
14. R MP. GCS:
- I: DO HEREBY CERTIFY TH H
STANDARDS, AND THAT A OPY
ICE
GW-1 evsed 6/88
Slot Size Material
in. in.
in in.
in in.
i
Material
County:
From To Formation Description
hn la)
32 Jac hn4i*It/
If additional space is needed use back of form.
LOCATION SKETCH
(Show direction and distance from at least two State Roads,
or other map reference points)
IS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15 NCAC 2C, WELL CONSTRUCTION
OF THIS RECORD HWEN_PROVIQEat TO THE OWNEX� ` - se
. ct3
SIGNATURE OF CONTRACTOR OR AGENT DATE
Submit original to Division of Environmental Management and copy to well owner.

WELL CONSTRUCTION RECORD
275749
North Carolina Department of Environment and Naa) zral Resources - Di /'(�sion of Water Quality - Groundwater Section '/
'WELT. CONTRACTOR (INDIVIDUAL) NAh/y (print) hi.a-t /V"-a CERTIFICATION #,3.0V/
Wf4LcoNTRACfoR COMPANY NAME, 7rf Plic,,/ErA to e/? H mZt JP PHONE # ��g In Aar Jam/ 70
STATp WE{,L CONSTRUCTION PERMIT# 1 i` e Z ASSOCIATED WQ�_PEERMIT#
(if applicable) (if applicable)
1: -WELL USE (Check Applicable Box): Residential�j Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring 0 Recovery El Heat Pump Water njection 0 Other 0 I f Other, List Use
2.WELL LOCATION: I / ) e Topographic/Land setting
Neare Tyowr 7 r/Ge4L}-I E, UQI/e./ CcAinty kf0(�. ❑Ridge ®Slope ❑Valley ❑flat
rS+,T[L //i�i hla F L /L �f/1Cr J (cheek appropriate box)
(Street Name, Numbers, Community, Subdivision, Lot No.. Zip Code) Latitude/longitude of well location
3. <OWNER:
(Street or Rome No we
City Town State Zip Code
( ) •
Area code- Phone number , / J a
4rDATE DRILLED `f V
5. TOTAL DEPTH: SOS
'6- DOES WELL REPLACE EXISTING WELL? YES 0 NO .
7. STATIC; WATER LEVEL Below Top of Casing: SD FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS FT. Above Land Surface*
• *Top of casing terminated at/or below land surface requires a
variance in accordance with I5A NCAC 2C .0118.
9. YIELD (gpm): It METHOD OF TEST o< h r5 -
IQ. `WATR ZONES (depth): c265i - /5 firm
DISINFECTION: Type N%/4
12. CASING:
Depth
From To 40 Ft.
From To Ft.
From To Ft.
13. GROUT' Depth Material ethod
From To�� Ft. (2� )t Li
From To Ft.
14.^SCREEN: Depth Diameter Slot Size Material
'.iFrom To Ft. in. in.
`From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Material
To
To
Diameter
6,
(degrees. minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Fom ti n Description
9'0 ' SO� Al .t .v,t a
LOCATION SKETCH
Amount "r? Show direction and distance in miles from at least
Wall Thickness two State Roads or County Roads. Include the road,
or Weight/Ft. Material numbers and common road names. W �_-
c
r—
From •
From
Size
Ft.
Ft.
J
-o
rV
ca
4v
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
Q1�7•.SIimUCl`ION[pTAD THAT A COPY OF THIS REC I1: BEEN PROVIDED TO THE WELL OWNER
tl=' Gn iIVi c,
-3D 63
I S QNATURE OF PERSON CONSTRUCTING -THE WELL DATE
•�)
_I
Submit the original to the L 10.1 of Water Quality, Groundwater Section, 1636 Mail Seniee Center - Raleigh, NC
27 99-i636 Phone No. [phone], within 30 days. G W-I REV. 07/2001
i c Ok�

WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources
WELL CONTRACTOR (INDIVIDUAL) NAME (print)
WELL CONTRACTOR COMPANY NAME Ic-r E E- t e- /O ✓Z.5 .
STATE WELL CONSTRUCTION PERh1IT#
- (if applicable)
0
275748
Diyjsion of Water Quality - Groundwater Section
ooCERTIFICATION # .5/,6
9' TK iryWTHONE #flu ��7/8'-3/r%D
ASSOCIATED WQ PERMIT#
(if applicable)
1.".WELL'USE'(Check Applicable Box): Residential Municipal/Public 0 Industrial 0 Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water njeetion 0 Other 0 If Other, List Use
2: `WELLLOCATION:
Nearest
County fil/J1,
L -- P/4e.res
(Street Name, Numbers,
Community, Subdivision, 1Lot/jNo.. Zip Code) f=✓.. OWNER: /�I��LP S P
Address. to ID 71t'Ynp. ervt v
`(Street or_Rpu`q No.) 8 7 z /
,- City dr Town ' State Zip Code
Area code- Phone number
4: DATE DRILLED
-5r TOTAL DEPTH: 595 '
6, DOES WELL REPLACE EXISTING WELL? YES 0 NO L
7, STATIC WATER LEVEL Below Top of Casing: 1 DO FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance In accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): A METHOD OF TEST c ? h rS
10. WATER ZONES (depth):
11. DISINFECTION: Type I -IT N Amount 7g
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From To 'V5 Ft. 4,
From To Ft.
From To - Ft.
GROUT: - - Depth .c1
From a To o2D Ft. ,i,L4./ +71
From - To Ft.
SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From "' To Ft. in. in.
SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
4/-.23 -a,3
tJPi
Topographic/Land setting
❑Ridge 0Slope ❑Valley ,Flat
(check appropriate box)
Latitude/longitude of well location
(degrees. minutes/sceonds)
Latitude/Ion gitude source:DGPSDTopographic map
(check box)
DEPTH (check
LOG
From Tos , Form tion Description
C% �etti •
y5"
PG el
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
16. REMARKS:
FB9-714g i . RTt
-
So{fMSTRUCtIONlSTANp
Submit the original to the
{ WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
D THAT A COPY OF THIS RECO S BEEN PROVIDED TO TIIE WELL OWNER
enuLt?JiP:";rhl
Acuf iii.ic rf
ATURE OF PERSON CONSTRUCTING THE WELL .DATE
of Water Quality, Groundwater Section, 1636 Mail Serr ice Center - Raleigh, NC
within 30 days. GW-I REV. 07/2001
aterial Method

'STATEWELL CONSTRUCTION PERMIT#
WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources - Division of' Water Quality - Groundwater Section /
WELLCONTRACTOR(INDIVIDUAL)N21•, .,(print) ) £r CERTIFICAAJTION# .301i/
WELL CONTRACTOR COMPANY NAME lJ YL'L: ne %/ S . LC}e' // �F UYYJ ) kr - PHONE # (Lzg L0 q - 3 / 7 n
ASSOCIATED WQ/PERMIT#
(if applicable)
(if applicable)
I. WELL USE (Check Applicable Box): Residential Municipal/Public 0 Industrial 0 Agricultural O
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2."WELL'LOCATION:
Nea st Totwni C C ounty
(Street Name, Numberss Community, Subdivision, Lot No, tip Code)
11 _j
3. OWNER:
Address
1�a
2757 4 6
Topog aphic/Land setting
❑RidgeSlope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees minutes/seconds)
Latitude/Ion zitude source:OGPSOTopographic map
(check box)
DEPTH DRILLING LOG
From To Forman n Description
%J� Z Ch
LOCATION SKETCH
11.' DISINFECTION: Type /-T % I -I Amount .2 9 Show direction and distance in miles from at least
12r CASING: Wall Thickness two State Roads orCountyRoads. Include the road
Depth Diameter or Weight/Ft. aterial numbers and common road names. From n To 75 Ft. 6') PZC
From To Ft
From To - Ft. o
13. GROUT: : Depth n Material Method L
From 0 To ,2 0 Ft. (.P n�E�t�
From To Ft. 4 C
14:":SCREEN: Depth Diameter Slot Size 'Material I
From To FL in. in. J
From To Ft. in. in. v
15, SAND/GRAVEL PACK: y
Depth
From - To Ft.
ieeeizoux.)
it a?g !S /
City orailln State Ji Zip Codc
;Area Code- Phone number
`4.' DATE DRILLED 5- 1 -0.3i
5.TOTAL DEPTH: /25
6, DOES WELL REPLACE EXISTING WELL? YES 0 NO IL
7: STATIC WATER LEVEL Below Top of Casing: ad FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS r FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance In accordance with ISA NCAC 2C .011g. 9. YIELD (gpm): /(Y) f METHOD OF TEST o2 A rs •
10. WATER ZONES (depth): /OLD ' - /nO f 5 7
From To Ft.
Size Material
IV
Cal
16. REMARKS:
I DO HEREBY CERTIFY THAT THIc WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
CQNST1WcTION STANDAR S, ND THA-eAl COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
1tile]) , cif, ,emu 36 ' 3
SIGNATURE OF PERSON CONSTRUCTING TTHH WELL DATE
I .-..
Submit fhe Original to the Division oflWate - Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699+636 PAmneNo. (919).7333221,4hin 3) days. GW-I REV. 07/2001

3. OWNER:
Address
City or
Area code- Phone number
4:>DATE DRILLED 5- -2U -D3
5.7TOTAL DEPTH: /!, S r
6.DOES WELL REPLACE EXISTING WELL? YES ❑ NO ift,,
7.'STATIC WATER LEVEL Below Top of Casing: .?/) FT.
(Usc "+" if Above Top of Casing)
$. `TOP OF CASING IS / FT. Above Land Surface*
*Top of casing terminated odor below land surface requires a
variance In accordant with ISA NCAC 2C .0118. /
9.: YIELD (gpm): METHOD OF TEST o2 /j / S .
I0.WATER ZONES (depth): /'S/s' - / 9P^-+
WELL CONSTRUCTION RECORD
North Carolina"- Department of Environment and
ELL CONTRACTOR (INDIVIDUAL) NA/N " (print)
-WELL CONTRACTOR COMPANY NAME YYPPM ,/
STATE WELL CONSTRUCTION PERMIT# /4'd.z
(if applicable)
275744
al Resources - Division of Water Quality - Groundwater Section
a CERTIFICATION # a 4//
le PHONE # (
ASSOCIATED WQ PERMIT#
(if applicable)
1. WELL'USE (Check Applicable Box): Residentia', Municipal/Public 0 Industrial ❑ Agricultural ❑
Monitoring 0 Recovery ❑ Heat Pump Water Injection ❑ Other 0 I [Other, List Use
2. WELL LOCATION:
Nearest To'tyr
as
(Street Name, Numbe, Community, S bdi
(aS I2j
ision, Lot No., Zip Codc)
t2 ttG%t
of LA.
(Street a jti�a Np.)a2/" ��)
State / Zip Code
Topog aphic/Land setting
❑Ridge LS(S,lope ❑Valley ❑Flat
t heck appropriate box)
Latitude/longitude of well location
( degrces.nunutcs/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To / Fomiar on Description
G
/is Mt,* -
11. DISINFECTION: Type /--7 777' Amount ,Q 5
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From tO To X Ft. /r t V C
, From To Ft.
''From To Ft.
13.,GROUT: Depth �,y aterial ethod
, From To .0 FL (Thin,
`From To Ft.
4. SCREEN: Depth Diameter Slot Size Material
From - To Ft. in. in.
`From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
_.From To Ft.
-From To Ft.
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names. o
c.�
c
c
t—
I
J
N
W
/T
t6. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
A COPY OF T}IIS RECO BEEN PROVIDED TO THE WELL OWNER
SIGNATOE OF PERSON CONSTRUCTING THE WELL DATE
Su
'127(
1411D the original to the Division ot-W
9 16 16 Phone No. (919) 733-32211jj withi
ter Quality, Groundwater Section, 163ti Mail Service Center - Raleigh, NC
30 days. GW-I REV. 07/2001

275743
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and N ural Resources - Doi 'ion of Water Quality
,WELL CONTRACTOR (INDIVIDUAL) NAME rint) ra.et-
WBLL CONTRACTOR COMPANY NAME NAME/print)
p /O S . 1I P // 9r P
-STATE WELL CONSTRUCTION PERMITh li'l 7 ASSOCIATED WQ PERNIIT#
"' (if applicable) (if applicable)
- Groundwater Section '/
CERTIFICATION a 36Y
/
PHONE N
1, WELLUSE (Check Applicable Box): Residential kY MunicipaliPublic 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water injection 0 Other 0 If Other, List Use
WELL LOCATION: 7 I /
Nearest Town' riif {{t8l e- .L-ii ek County 1! c-yb)n(ol
tit 1 lr s �,; Lie,
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
OWNER:' nna� IBOLTYL .�
Address a .S D YYl o cl±.j..e
(S eat or Route No.)
�_c1,t A� n L e 1 Z No sea
a 3 a a.
City or own State Zip Codc
Arca code- Phone number
4.'DATE DRILLED 5 ` a — D 3
TOTAL DEPTH: 9 //3 ' •
6. DOES WELL REPLACE EXISTING WELL? YES, /0 NO yQ
7.' STATIC WATER LEVEL Below Top of Casing: T 0 FT.
(Use "+" if Above Top of Casing)
TOP OF CASING IS FT. Above Land Surface*
'Top of casing terminated at/or below land surface requires a
variance In accordance with 15A NCAC 2C .0118.
9, YIELD (gpm): L'3 METHOD OF TEST a A es
10. WATER ZONES (depth): ODD ' — 3 m
Ili DISINFECTION: Type
12, CASING:
Depth
From ToT4 Et.
From To Ft.
From To Ft.
GROUT;^ Depth
From ,A/ To ag, Ft.
. --:.From To Ft.
/4TH
Diameter
Amount ) Los
Wall Thickness
or Weight/Ft. Material
aterial tAti
Method
14.``SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
SAND/GRAVEL PACK:
Depth Size Material
From - To Ft.
•(.From To Ft.
Topographic/Land settin"
❑Ridge ❑Slope OValleyDIbklat
(check appropriate box)
Latitude/longitude of well location
(degrees:minutes/seconds)
Latitude/longitude source:OGPSOTopographic map
(check box)
DEPTH DRILLING LOG
From To Form�ti n Description
n 74/
7S"9ij ''
•
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. include the road
numbers and common road names.
9C :3 Wd L- ¶1(' CO
16. REMARKS:.
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
COMM-1,lLLION-$1ANDARD 'MAT �4 COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
3v -a3
y
SIGNATURE OF PERSON CONSTRUCT
I J;
Saud ttfp original to the Division Water Quality, Groundwater Section, 163n Mail Ser ice Center- Raleigh, NC
2769-1636il'hone No. [phone], v 'thin 30 days.
IHE WELL DATE
GW-I REV. 07/2001
L-3
-26

WELL CONSTRUCTION RECORD
North Carolina • Department of Environment and Natur I Resources - Division of Water Quality - Groundwater Section
275742
WELL CONTRACTOR (INDIVIDUAL) NAMA (print)
/
WELL CONTRACTOR COMPANY NAME S, teem
}STATE WELL CONSTRUCTION PERMIT#
i410
pn � ^ CERTIFICATION # /.3o 4 /
)2// /QnY7 " PHONE it(2p . -317V
ASSOCIATED WQ PERMMIT#
(if applicable)
'1. WELL USE (Check Applicable Box): Residential Municipal/Public 0 Industrial 0 Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 I Miller, List Use
2. WELL LOCATION.
Nearest, Tpwn:
County a3ed
(Street Name, t• misers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: ��9 �7 fY7a4i� y
Address 3SD Nu c(( e o 21.c .
(Street or Route Noe))
//t, NC 2g786
City 9f Town State Zip Code
Area cede- Phone number
4.. DATE DRILLED S- a '7 -" 3
5 . TOTAL DEPTH: 5/ 25 '
6 'DOES WELL REPLACE EXISTING WELL? YES 0 NO Ili
7. STATIC WATER LEVEL Below Top of Casing: /0 FT
(Use"+" if Above Top of Casing)
8. ;TOP OF CASING IS / FT. Above Land Surface*
"TOP of casing terminated at/or below land surface requires a
variance In accordance with ISA NCAC 2C.0118.
9 ,YIELD (gpm): 1Gb -i- METHOD OF TEST .2 A rS
10 WATER ZONES (depth): h) 07D S g it
z
'//
516U- //)O-Ora-
1 1, DISINFECTION: Type H77-/
12. CASING:
From C Y ita
Depth Diameter
To /pi)' Ft. t' 'r
From To Ft.
From To Ft.
13.`"GROUT: Depth Material
From b To QD Ft Co ''
1;''From To Ft.
}..1,SCREEN: Depth Diameter
"-':Frorn To Ft. in.
-;`-;From'' To Ft. in.
5. SAND/GRAVEL PACK:
Depth Size Material
From ' To Ft.
From To Ft.
Amount 27
Wall Thickness
or Weight/Ft. Material
Me od
Slot Size Alarm -jai
in.
in.
Topogr phic/Land setting
❑Ridgelype ❑Valley ❑Flat
heck appropriate box)
Latitude/longitude of well location
(degrees- in inures/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
Form,ti9p Description
DEPTI-t
From To
A Co d
D , SIRS
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
REMARKS:
1 DQ Sif FRY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CON ' JON'STAN S, AND TRAY ik COPY OF THIS RECOII-(\AS BEEN PROVIDED TO THE WELL OWNER
itE,tt-AL Lt.
SIGNATURE OF PERSON CONSTRUCTING THE WELL
Suhi it (he original to the Division oFWai
2269 1636LPhoTe No. [phone]_% ithin
6 -3d I3
DATE
r Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
0 days. GW-I REV. 07/2001

1: Monitoring ❑ Recovery ❑ Heat Pump Water Injection 0 Other 0
WELL LOCATION:
Nearest Town: itialAesv.
G)anct-. CL ve_ RA
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
`3. OWNER: II al
GIb GtI net Cave-
(Strcet or Rau No.)
County /-! &y Lead
CI 78 7.1(
City or Ttiwn 1 State Zip Code
( )
Area code- Phone number
4,DATE DRILLED 5 - .2 7 -0 3
1;1TOTAL DEPTH: :7LD S ' �(
6. -DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7.STATIC WATER LEVEL Below Top of Casing: 40 FT.
j (Use"+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance In accordance with ISA NCAC 2C .0118.
9,, YIELD (gpm): 25 METHOD OF TEST « /7 rS
1SinWATER ZONES (depth): / r n
1I1 DISINFECTION: Type /-/T/-J Amount 41[)
12. CASING: Wall Thickness
From , p 3 Diameter or Weight/Ft. Material
''
Depth
To o . Ft.
:.From To Ft
From To . Ft.
13.:GROUT: Depth Material Method
From a To JO Ft. LO--vni.i.wt 417
, .From - To Ft.
.t 14.'SCREEN: Depth Diameter Slot Size Material
;':From ` To Ft. in. in.
/Froin To Ft. in. in.
,!.SAND/GRAVEL PACK:
Depth Size Material
::From' To Ft. -
From - To Ft.
P vr_
275'741
WELL CONSTRUCTION RECORD
orth Carolina - Department of Environment and ural/Resources - Division5of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME(print)(print) np h i n, '1 I!I/L / h t CERTIFICATION #dt'/b'
WELL. CONTRACTOR COMPANY NAME G ,Leta- /31'05 • 1-c�P j i 9t l'u-sly) l/�}I,t' PHONE- # t7 c 4R -3 / 7O
STATE WELL CONSTRUCTION PERMIT# / 7 6 i ASSOCIATED WQ /PERMIT#
"` (ifapplicable) (if applicable)
1.` WELL USE (Check Applicable Box): Residential Municipal/Public 0 Industrial 0 Agricultural 0
If Other, List Use
Topographic/Land setting.
❑Ridge ❑Slope ❑Valley lot
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:OGPSOTopographic map
(check box)
DEPTH DRILLING LOG
From To
6 3 FormatioZscription
G tt.j 1)
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names. cnt
0
Ce
C—
c ..,.
c
C
IV
w
41
16: REMARKS:
I Dip HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
A jlW A COPY OF THIS RECORD MS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTI
,Ltsu rt1!e original to the Division 44
• /27699463tPhone No. (919) 733-32212jwithi
-30-63
HE WELL DATE
ter Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
30 days. GW-I REV. 07/2001

275710
WELL CONSTRUCTION RECORD
North Carolina Department of Environment and N.at ral Resources - Divici of Water Quality - Groundwater Section /
;WELL CONTRACTOR (INDIVIDUAL) NAM (print) -N.LJ%'/A �LJY•LL It Q . CERTIFICATION # 3D//'
(j�dl eo 7b 3 ! '7 0
WELL CONMACCOR COMPANY NAME "jae,C)1,9-/ t `S• 2�� d Um�O�tt@HONE # (i
• STATE WELL, "i
CONSTRUCTION PERMIT# / 6 2 ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. , WELL USE (Check Applicable Box): Residential k Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCATION: I
Nearest Town: YY\A Hie
r1 e ic t/4. OP / (County /4LLi r t, ICy;+pk
b j. /oj ...—P 1 LI,
(StreetNwte, Numbers, Community, Subdivision, Lot No., Zip Codc)
3. OWNER:9 )te( L, J 1�/Luc
Address i(Q �Lt_/ldf< BTO—A- . e-e
(Street ortie No.)
�~�-t-/r 1a
A/C .2o 8 (0
City or Town State Zip Code
Area code" Phone number OP b
4. i. DATE DRILLED � o
$ `TOTAL DEPTH: a Q S
6' DOES WELL REPLACE EXISTING WELL? YES �❑-7//N�O ,
7 , STATIC WATER LEVEL Below Top of Casing: o((FT.
(Use "+" if Above Top of Casing)
8 TOP OF CASING IS J FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): METHOQ QF-T5ST a h rS
10. WATER ZONES (depth): / 1S �I
11:'DISINFECTION: Type
To setting
0Ridge Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrces,minwos/seconds)
Latitude/longitude source:❑GPSOTopographie map
(check box)
DRILLING LOG
Formatio Description
DEPTH
From To (
0 28
fie' 2.2, '
4
1
LOCATION SKETCH
Amount Show direction and distance in miles from at least
12, CASING: Wall Thickness two State Roads or County Roads. Include the road
• Diameter or Weight/Ft. Material numbers and common road names.
�
Frorn To 2 . - Ft.
A. From To Ft.
From To Ft.
13. GROUT: Depth
From C To a D Ft.
Material
(V / ,
From To Ft.
14."SCREEN: Depth Diameter
'.> From To Ft. in.
':From:`' To Ft. in.
15,"SAND/GRAVEL PACK:
Depth Size
' From ' To Ft.
From To Ft.
PVC
Slot Size Material
in.
in.
Material
"..16., REMARKS:
1 DO HEREBY CERTIFY THAT THIS WEI L tyAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CON TA, C4'ION STAN3)AJRDS, AND TikkAli }1 COPY OF THIS REC
Sub
`2769
HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATUREIOF PERSON CONSTRUCTING THE WELL DATE
t tEe original to the Division of Water Quality, Groundwater Section, 1636 Mall Service Center - Raleigh, NC
-MO 'none No..1919j733-3221rijithin30days. GW-I REV. 07/2001

O
.f Frpfn To Ft. c.o
3. GROUT: Depth c n
From D To An Ft.
i. From To Ft, t
J
14, SCREEN:. Depth Diameter Slot Size Material
—17
Frpm To Ft in. in. 3
From To Ft. in. n. N
I5., SAND/GRAVEL PACK:
Depth Size Material - e''�
From ` To Ft.
From To Ft.
16. REMARKS:
frilig47010ERTIFt T
WELL CONSTRUCTION RECORD
:North Carolina Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
275734
)VELI. CONTRACTOR (INDIVIDUAL) NAME/' (print)�') �t
lj'FLLCONTRACFORCOMPANY NAME ITre-e. 1P /Zl'7$,l/h-1( 4 &MPAi-Jr PRONE # Jpe&Yff'-3/7v
.;STATE WELL CONSTRUCTION PERMIT# / 7 O ASSOCIATED WQ PERMIT#
(if applicable)
•(ifapplicable)
WELL USE (Check Applicable Box): Residential Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
WELL LOCATIO
Nearest, own_
County /Q,1�zaz.,
(Street Name, Numbers, Community, Subdivision, Lot No.. Zip Codc)
' 3. OWNER: C aJP 6-00
Adcjress /'I / p/u/5Owl, V/te. alibr
(Sttrcetor R%/ P 75NL2Jge. 02U / U o
Crty oriTown State Zip Codc
t; Arca code- Phone number
•4/ Q `D3 . i DATE DRILLED
'Si, TOTAL DEPTH: / iS
6, DOES WELL REPLACE EXISTING WELL? YES 0 NO 14
7.t STATIC WATER LEVEL Below Top of Casing: / 0 FT.
(Use "+" if Above Top of Casing)
FT Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance In accordanwith ISA NCAC 2C .0118.
9. YIELD (gpm): .! (./_ METHOD OF TEST Q h i'S
10, WATER ZONES (depth): jO s - p rte,
8.'=TOP OF CASING IS
•r 11+'DISINFECTION: Type
l;.i': CASING:
14 1-1
D Depth Diameter
From To o / Ft. to r f
From To Ft.
Amount /2n
Wall Thickness
or Weight/Ft, late iiol
Topographic/Land setting
Midge ❑Slope ❑Valley 'Fla
(cheek appropriate box)
Latitude/longitude of well location
tdegtees,nt mutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
icheck box)
DEPTH DRILLING LOG
From T Form' io Description
/ / ' / „1 S' et
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
aterial Method
CERTIFICATION #�'S/g
HIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
�I'rf.014. 'TANI) # `I IAND THAT A COPY OF THIS RECORD HAS.l3F EN PROVIDED TO THE WELL OWNER
IGNATURE OF PERSON CONSTRUCTIN
WELL
co -3e -e 3
DATE
t$pbpDt ttrCer-1�ginaL{4{hie Divion of Water Quality, Groundwater Section, 163o Mail Service Center -Raleigh, NC
176�9 1610 Phonk-No.'(9191733-1221, within 30 days. G W-I REV. 07/2001

t,it;ttc NspU T1AN TAN
275735
WELL CONSTRUCTION RECORD
orth caro4tna n,geparlment of Environment and Natural Resources - Division of Water Quality - Groundwater Section
k.L , . b Wel b 7 `/
WELL CONTRACTOR (INDIVIDUAL) NAME�(�prin() A / el CERTIFICATION q A 7i
fp. CONTRACTOR COMPANY NAME (i.ree r e__ L2 ros . De.11 4 PGn1� PHONE E a {mg 6 9 — 3 / 4749
TATE WELL CONSTRUCTION PERMIT# /1/40 ASSOCIATED WQ PERSIITa
(if applicable) (if applicable)
WELL USE (Check Applicable Box): Residential i Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use
•
WELL LOCATI ,.
Nearestjoty " f A. County
(Street Name, Numbers, Community, Subdivision, Lot No., Zi Code)
3. OWNER: 1 r au-0 ivrI,�y �
Address , -? 5 / .>SJP
(Street or Route No.)
�CL1nesuf l/i, NC _n7g6
City or Tovfn State Zip Cade
(_)-
...'"Area code. Phone number
4, i PATE DRILLED 6 9 "03
5, i TOTAL DEPTH: l.2 S '
6, DOES WELL REPLACE EXISTING WELL? YES ❑ NO Ili.
7.;STATIC WATER LEVEL Below Top of Casing: .7O FT.
(Use "+" if Above Top of Casing)
4. TOP OF CASING IS / FT. Above Land Surface*
`.,. *Top of casing terminated at/or below land surface requires a
yarlance In accordance 1th ISA NCAC 2C .0118. d / i`S
9.;YIELD (gpm): 1 2 n METHOD OF TEST n •
10. WATER ZONES (depth): le 5 t - 1= 0 )x
105r - ioD�pr
11. DISINFECTION: Type H T-71 Amount / 8
12, CASING: Wall Thickness
Depth Di meter or Weight/Ft. Material
From ID To �� Ft. t i PVC
-.From To Ft.
' From To Ft.
�
3,; ORmIIT: Depth -renal M�thod
From_ Too oZ Ft. l 0 m OM�
'. From_ To Ft.
14.t SCREEN: Depth Diameter Slot Size Material
To Ft. in. in.
' From To Ft. in. in.
15, SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Topoc, aphic/Land setting
❑Ridge ope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
O g r•
7�! /:151
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
add L— lflr CO
IV
CO
cn
:.' REMARKS:
FPQ HFRFBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
30 cD 3
ELL DATE
t1
SIGNATURE OF PERSON CONSTRUCTING TH
Submit the original iolhe Division of Water Quality, Groundwater Section, 163o Mail Service Center- Raleigh, NC
—_j°i762.9:1636 Done No:(919) 33-3221, IAithin 30 days. GW-I REV. 07/2001
h ,., cirr.-
I � iCF
rr:rFJ
O

11:.DISINFECTION: Type
12. CASING:
Depth 99
Wm 10 To iJ `'L" Ft.
FroriTo Ft
From To Ft.
13,1GROUT6,-Depth ,Material
"From /) To aD Ft. G.
275736
WELL CONSTRUCTION RECORD
J'Iorth Caroima - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section '/
WELL CONTRACTOR (INDIVIDUAL) NAM• (print) rI t fSril L'1 CERTIFICATION # 201/
WELL CONTRACTORCOMPANY NAME rterte. J 5 We- l! Fors' PHONE s 02g6Vg -3 L 70
• # STATE WELL CONSTRUCTION PERMIT
(if applicable) (if applicable)
11i O.2 ASSOCIATED WQ PERM
1. WELL'USE (Check Applicable Box): Residential Municipal/Public❑ Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water njection 0 Other 0 IFOther, List Use
2. WELL LOCATIO
.Ne tTowa: Coun
/ ArrP / L ! J /
(Sncer3' me, Numbers, Community, Subddision, Lot No., Zip Code)
Wdr-S-ue...
;Vie, c2g7/6
code
OWNER:
Address
City or Town Sat
e Zip
'Area code- Phone number - 0
4: DATE DRILLED 10 — EC
5. TOTAL DEPTH: .3C1S
6. DOES WELL REPLACE EXISTING WELL? YES U NO
7.i,STATIC WATER LEVEL Below Top of Casing: . n FT.
(Use "t" if Above Top of Casing)
TOP QF CASING IS I FT. Above Land Surface*
`'T9p of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): ` .% METHOD OF TEST Q h!S
10. WATER ZONES (depth): ,36/ 1 - / .k q p Y1 Y
Amount `-) '7 Show direction and distance in miles from at least
Wall Thickness two State Roads or County Roads. Include the road
or Weight/Ft. teriat>! numbers and common road names.
Topogfjaphic/Land setting
❑Ridge¢4Slope ❑Valley ❑Flat
rcheek appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From 3ToS / Formation Description
.34' 3DS' � .t-
Diameter
6if
From To Ft.
4:'SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
i From To Ft. in, in.
15. ;SAND/GRAVEL PACK:
ethod
Pic
Size Material
From " To Ft.
From To Ft.
LOCATION SKETCH
N
01
il:, REMARKS:
eNS 'I?. OoJit, STANi
IS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
p$, f(ND THAT A COPY OF THIS RECORD HASBEEN PROVIDED TO THE WELL OWNER
11PNATURE OF PERSON CONSTRUCTIN
E WELL
6 3-63
DATE
is; Saudi the original to th Divis on of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
t17:699406 Phone -No. (9 33-3 21, within 30 days. GW-I REV. 07/2001
c>_

WELL CONSTRUCTION RECORD
n7r'"'3fl
forth Carojina - Department of Environment an. ...1 Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAr. (print) 2>1 CERTIFICATIONAJy#.( 7' g
L(. CONTRACTOR COMPANY NAMEr 7/'PP/'l E,,/ £ /1S- ({ •_II 'any,A4IC PHONE # (g{X Z6L -3I 7D
STATE WELL CONSTRUCTION PERMIT# ATe ASSOCIATED WQ PERMIT#
(ifapplicable) (if applicable)
WELTUSE (Check Applicable Box): Residential l- Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2, WELL LOCATIO
Near@stTgwtt /leSY# //t- County /-/q. 22,ota
1CL,4C i✓e
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Codc)
3; OWNER: A./ l f G/CLL2 (�L
Address 3440 trio hit- CPI"e /ice
(EL (Z" RoueN 02g7 /
,.::City or Toll State Zip Code
Area code- Phone number _ ��
4-DATE DRILLED 5 — 30 _
5 TOTAL DEPTH: 1 1 ri
6,,ROES WELL REPLACE EXISTING WELL? YES ❑ NO)11...
STATIC WATER LEVEL Below Top of Casing: ao FT.
- (Use "+" if Above Top of Casing)
8';TOP OF CASING IS FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance In accordance with ISA NCAC 2C .0118. 9.;YIELD (gpm): of METHOD OF TEST ? A r5 •
10. WATER ZONES (depth): 851 - / rJc pon
a$ ' — 8 `. -(v-\
II. DISINFECTION: Type hi Tf"/ Amount p Show direction and distance in miles from at least
12.''CASING: Wall Thickness two State Roads or County Roads. Include the road
Topographic/Land setting
DRidge ❑Slope ❑Valley ilat
(check appropriate box)
Latitude/longitude of well location
(dcgrces minutes/seconds)
Latitude/Ion_itude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Form ' Description
?D' 22c' ,i nn vtitt
Depth
From 0 To� Ft.
;From To Ft.
Diameter
b Il
From To Ft.
,.GROUT: Depth,�f�n /,4�'laterial j
, IFrom © To oSL� Ft. (D.Yu 0 At T
frog' To Ft.
14. SCREEN: Depth Diameter Slot Size
':From To Ft. in. in.
f From - To Ft. in. in.
15. 'SAND/GRAVEL PACK:
Depth Size Material
From ` To Ft.
From To Ft.
6.)REMARKS•
LOCATION SKETCH
or Weight/Ft. terial numbers and common road names.
Met od
Material
Y THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
ST4t 1CT1ON STAN 'AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
0
0
r
..I
' ; SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
4m[t the original to the Divis'on of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
4 j'bnne No. (919j ,33-32: 1, within 30 days. GW-I REV. 07/200I
,"0,;-ER Sl0, i01N..
1E1.1C tr=ICE

WELL CONSTRUCTION RECORD
orth Carolina - Department of Environment and
W.ELL CONTRACTOR (INDIVIDUAL) NAME (print)
WELL CONTRACTOR COMPANY NAME Cr gee
STATE WELL CONSTRUCTION PERMIT*/
(ifapplicable)
2~i3 738
Resources - Division of Water Quality - Groundwater Section /
/I CERTIFICATION a '7 o2 / Z
hL. Yo3 . LhJW + Y�,Jt.truONE a (8.'Lk S_ 3I "2b
ASSOCIATED WQ PERMIT*/
obI"n LJeJL
YeD
Cif applicable)
WELL USE (Check Applicable Box): Residential Il, Municipal/Public 0 Industrial ❑ Agricultural 0
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other 0 It Other, List Use
2,'WELL/LOCATION: // // JJ
Nearest Town: County /`'t {.✓c1Oe"
(Street Name, Numbers, Commultity, Subdivision; Lot No., Zip Codc)
3.-OWNER: -----n her: K l e: --
Address 4.2.2Ca!o L` Sleif.. fires E Gf,
.,. (street or Rou o) ..
.': City or Town State Zip Code
Area code. Phone number
$,;DATE DRILLED Jr' 2 9 03
5 'TOTAL DEPTH: / a 51
DOES WELL REPLACE EXISTING WELL? YES 0 NO 1
-.STATIC WATER LEVEL Below Top of Casing: Le iO FT.
(Use' *' if Above Top of Casing)
OP OF CASING IS 1 FT. Above Land Surface*
tTpp of caning terminated at/or below land surface requires a
: variance in accordance with ISA NCAC 2C .0118.
9, ;YIELD (Rpm): ) 2. METHOD OF TEST ol/l rS
O, WATER'ONS (depth): 105.- 17 3p cr.
1., DISINFECTION: Type fi-ra
CASING:
Depth /
From To Syi Ft.
From, To Ft.
From To `Ft.
GROUT, Depth
From / / To a° Ft.
From To
4,'SCREEN:';, Depth Diameter
To Ft. in.
» From To Ft. in.
1.5. ;SAND/GRAVEL PACK:
Depth
From r To
From To
Diameter
Size
Material
Amount
Wall Thickness
or WeightFt.
/i)
Ft
Sior Size Material
in.
in.
Material
P VC.
ethod
Material
Topog aphic/Land setting
❑Ridge lySlope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(d grccs.minwcsiscconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To'/ / Formation Description
52/ /
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
9 rn
://d::,
W 0^
C71 i
14: REMARKS:
A{j?'HEREBY,CE.I2TIFY THA LP WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
pNkTRUCTION STAN a ; ' I$,ht4D THAT A COPY OF THIS RECORD/HAS BEEN PROVIDED TO THE WELL OWNER
t ., rbf k (n. ) 6-30-D3
Sj ATURE OF PERSON CONSTRUC Igo THE WELL
DATE
i Ile Qrjglnal tqthetl ivisio i of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
4fi 636 Phdne NO; (9I')y733-322 , within 30 days.
GW-I REV. 07/2001

WELL CONSTRUCTION RECORD
•
grM
tMCarolina = Department of Environment and Natural Resources - Division,of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME(print)2.r /�y�ytt IJ Y ktt CERTIFICATION k 3041/
WCr/
WELL CONTRACTOR COMPANY NAME I re. e.Ike "ETa ' LI )4, j) 41111T 1PJ'-'PHONE k1rYg 1p VE/ 3 116
STATE WELL FQNSTRUCTION PERMIT# / `Y' -L- ASSOCIATED WQ PER,MIT#
(ifapplicable) (if applicable)
275739
1. WELLUSE (Check Applicable Box): Residential Municipal/Public ❑ Industrial ❑ Agricultural 0
�Mogitoring 0 Recovery 0 Heat Pump Water njection ❑ Other 0 IFOther, List Use
1. WELL LOCATION: N�l
Nearest Town: t Q County
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code), I / /
i. OWNER: SYvI[� y pelt. era c w-e.rf11� e
,Y +< n 0 i I b (degrees minutes/seconds)
Address R & >!) OGPS
�$/�cet or Route No.)
l i. M �. l �♦'.
(check box)
DEPTH DRILLING LOG
Topo¢nr�a�phic/Land setting
DRidge "�'ope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
Ci own State Zip Code Fron To Form Descriptipn
. I Area code -Phone numberp t 5/s'
`J�—�rX 3
4: DATE DRILLED D
5 TOTAL DEPTH: �'/5 1 `/
6; DOES WELL REPLACE EXISTING WELL? YES 9 NO �6
7. STATIC WATER LEVEL Below Top of Casing: Lit) FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
`.*Top of casing terminated at/or below land surface requires a
' variance In accordance with ISA NCAC 2C .0118. //
...I 9. YIELD (gpm): )1 f METH_O OF TEST a AYS IQ WATER ZONES (depth): ado
11.�';DISINFECTION:Type t'-/- 7/ Amount vet
Ili CASING: Wall Thickness
/� Depth Diameter or Weight/Ft. Marc ial
From . V To SK Ft a t' sl c
From To Ft.
From To Ft.
13., GROUT: Depth Material
From 4 To 20 Ft. 1 -0�w PA,
:From To FL _
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15.' SAND/GRAVEL PACK:
• Depth Size Material
From " To Ft.
From To Ft.
M thod
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
0
w
L
—o
r)
tT
6. `REMARKS:
1 DQ HEREBY CERTIFY LL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
C TRU ON STAND S, AANP` AT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
TL) �ff�•
-30 -es
r-.t - - SIGNN URE OF PERSON CONSTRUCTIN-G THE WELL
ubmit the original to the Division of
7699�636 Phone No. (919) 733-3j21, w
DATE
Water Quality, Groundwater Section, i636 Mail Service Center - Raleigh, NC
thin 30 days. GW-I REV. 07/2001
metal )a/C dc7s /

274801
,
\ \U, co
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and
s� Naturaly��Reso ces - Division o Wat-r Qua't - Groundwater Secti0�3a
rlat)65L�. CERTIFICATIONS*, 1�n?
YW'ELI. CONTRACTOR (INDIVIDUAL) AL) NAME (p PHONE # �2
1YE1.1. CONTRACTOR COMPANY NAME
ASSOCIATED WQ PERMI
S fA'IE w''At la licable) ON PERMITN ___— (ifa licabie
l ifa licablel
I. WELL USE (Check Applicable Box): Residential I(!r Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 if Other, List Use
2. WELL LOCATIPN
Nearest Town:
1., • 3
Svcci Name. Numbers. Community, Subdivision, Lot No., Zip Code)
3 OWNER:
Add' e.s
County
1aQYl i jeor R, CVNln)
300 15
City or Town Sta a Zip Code
(_.-.—)-
Area code- Phone number h p _ 3
4. DATE DRILLED �o_�._. K -�-
5. TOTAL DEPTH:
6. DOES WELL REPLACE EXISTING WELL? YES NO FP'
7. STATIC WATER LEVEL Below Top of Casing:
T.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS ___I__.- FT. Above Land Surface'
flop of casing terminated atlur below land surface requires a
variance in aceordanceStb ISA NCAC 2C .0118. TC-a•""G--
>swl*
9. YIELD (gpm): ___a__ METHOD OF -'[ES
10. WATER ZONES (depth): ___4 - ---- —" kOCATION SKETCH
Amount -_3.._— Show direction and distance in miles from at least
1 1. DISINFECTION: Type Wall Thickness two Statc Roads or County Roads. Include the road
2. CASING: numbers and common road names.
arN
Depth Diameter or 1VcighUFt" Material � a __
To Ft — —. ( I w
c
•
From _ C1
From _ To_—_ FL_-- .�� �.�.� �-
From__- To Ft. _ - Method �C Y��-",
I3. GROUT: Depth Mate "'��' -�Y— »t�qOU�zic
Front__ _ To.Ft. tT ,- _
Fronl_ To Ft. — —"—
iT
Material r'
14. SCREEN: Depth Diameter Slot Size y ,.. r+.
From_ To Ft_ in. in. — m
Pt. in. _ in.
From__._ To _ — _
re
15 SAND/GRAVEL PACK: — c
DepthSize •Material z
From ,-.__To Ft.
From To__ Ft. _
Topographic/Land setting
❑Ridge ❑Slope ❑Valley L lat
s _ (check appropriate box)
t%1 I CD Latitude/longitude of well location
1 (degrees/minutes'seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LO ,
From To Formation Description
16. REMARKS:- --
RDANCE WITH I 5A NCAC 2C, WELL
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN
RIDS, AND THAT A COPY OF THIS RECORD HOAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL
DATE
i 636 Mail Service Center - Raleigh, NC
Submit the original -to the Division of Water Quality, Groundwater Section, Center
REV. h,NC 07/2001
27699.1636 Pliant yin. (91'}9) 733-3221, within 30 days.

WELL CONTRACTOR (INDIVIDUAL) NAME (print) 1]ex r' Ctt l-l. 'S cow 44r3
WELL CONTRACTOR COMPANY NAME f 'S¢_ 4 Q San (ar L M? T et .
STATE WELL CONSTRUCTION PERMIT/ ASSOCIATED WQ PERMIT#
(if applicable) _ (if a.. Fcable)
274612
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
CERTIFICATION # a4310
PHONE # (Sits) a 55,. Z6ST
1. WELL USE (Check Applicable Bo:r): Residential QI Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heal Pump Water Injection 0 Other ❑ If Other, List,Use
2. WELL LOCATION:
Nearest Town: WcO�n¢t v Ile County 11a'+Jweod
-fr. ("AT lQP
(Street Name, Numbers. Community, Subdi, ision, Lot No., Zip Code)
3. OWNER: ia-ct Q 'Ho.nq,
Address ConSrn4,.%1,¢.Cy S1 a
(Street or Route No.)
ro �nas� 11� (lc. a9 -rive
City or Town State Zip Code
( )-
Area code- Phone number
4. DATE DRILLED 3" $ - 33
5. -TOTAL DEPTH: 105
6. DOES WELL REPLACE -EXISTING WELL? YES 0 NO in
7. STATIC WATER LEVEL Below Top of Casing: 2.t FT.
(Us: "+" if Above Top of Casing)
8. TOP OF CASING IS 1 IT. Above Land Surface*
*Top of casing terminated at/or below lard surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): .5o METHCD OF TEST al
10, WATER ZONES (depth): d'
11. DISINFECTION: Type 1:11 S Amount
12. CASING: Wall Thickness
Depth Dian eta or Weight/Ft. Material
From -V1 To ID Ft. 6-I t1 r"tl rie,3tC
From To Ft. !+
From To Ft.
13. GROUT: Depth M.itcrial Method
From 0 To ao Ft. C.'_ment OUCasi
From To Ft.
14. SCREEN: Depth Diamet:r Slot Size Material
From To Ft. in. in.
From To Ft. _in. in,
15. SAND/GRAVEL PACK:
Depth Sizc Material
From To Ft.
From To Ft.
Tdpoggra hic/Land setting
❑Ridge IdSlope ❑Valley OFIat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:OGPS❑Topographic rrap
(check box)
DEPTH DRILLING LOG
From TT�nTo Formation Description�`
TD 3 ova( �J@t06T
3t5 'T /OS (re e."lit
CO
c
C_
a
c
rm
t> - 7
LOCATION SKETCH PO--'
Show direction and distance in miles fro le- --
two State Roads or County Roads. Inclu e r�
numbers and common road names. m
c
0
C rl
16. REMARKS:
HE8,EEY dERilthY Tom'
CONSTRUC I ION S I ANQ
THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
S, AN TEAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATI RE F PERSON CONSTRUCTING THE WELL
5.3-cdz
DATE
—_._.
Gpsitmrt oFfp5 4ffdo the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
ASH t?' 1k9' ft i61RhAneN4Jell9) 723-3221, within 30 days. GW-I REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
K a...neC % CERTIFICATION # a-y 3LO
WELL CONTRACTOR COMPANY NAME a Ci.it y+ji d' 'S lr 11'QO>MD in PHONE # (la a 56- ]ScSS
WELL CONTRACTOR (INDIVIDUAL) NAME (print) l%ttr: Cat i4
STATE WELL CONSTRUCTION PERMITS
(if applicable) (if applicable)
r
2'74608
ASSOCIATED WQ PERMIT#
I. WELL USE (Check Applicable Box): Residential RI Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Hea: Pump Water Injection 0 Other 0 If Other, LisUUse
2. WELL LOCATION:
Nearest Town: 1;ra�NV aJ. \1Q
s Rd.
County 1•\sywoe d
(Street Name. Numbers, Community, Subdi.ision, Lot No., Zip Code)
3. OWNER: .1-S4zv:n SNStIce
Address Mc.}\-: S Rcr
(Street or Route No.)
\ t�z ate
Cit orTown State
Zip Code
( 5L)- (.,ra7- sa,i
Area code- Phone number
4. DATE DRILLED `A' 3o. 03
5. TOTAL DEPTH: V-15
6. DOES WELL REPLACEEXISTING WELL? YES 0 NO ZFl
7. STATIC WATER LEVEL Below Top of Casing: en FT.
(Us t "+" if Above Top of Casing)
8. TOP OF CASING IS 1 I T. Above Land Surface*
*Top of casing terminated at/or below lard surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): i D METHOD OF TEST la:),
10. WATER ZONES (depth):
Tdpographic/Landtting
[Midge 0Slope i3Valley DFlat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
onC t, ecacr
:3 L
G- ea.r, t * C
tr.
CZ o
CO
1 I . DISINFECTION: Type 1: tII5 Amount °b
12. CASING: Wall Thickness
Depth Diarr e'er or Weight/Ft. Material
From '41 To 3� Ft_ L- +4.21 r1e.st1,,,
From To Ft.
From To Ft.
13. GROUT: Depth M aerial Method
From 0 To ab Ft. C':m¢nt _ I�,. 42i_
From To Ft.
14. SCREEN: Depth Diamet:r Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Sizi Material
From To Ft.
From To Ft.
16. REMARKS:
kJ, pp RE YCE
�R +FY?
co -Ns -MI I( TI6N S'tA' to r I
1
LOCATION SKETCH
Sb
� m _
Show direction and distance in miles froat legs
de
two State Roads or County Roads. Incluthe
numbers and common road names. erl
o
T THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
JS, AND TEAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
1
1 30 03
L ' anaLtL the
—Submrt�tte.orrg_
�%69�9-1636 Phon NA.(?I9) 7
SIGNATURE OF PIJtSON CONSTRUCTING THE WELL DATE
ivision of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
3-3221, within 30 days. F GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality
WELL CONTRACTOR (INDIVIDUAL) NAPIE (print) Ck li. ticw 44-ri
WELL CONTRACTOR COMPANY NAME el-Ifie S4tarld SL^NC11t1 LTwa.
STATE WELL CONSTRUCTION PERMITk ASSOCIATED WQ PERMIT#
(if applicable) (ifa..Ilcable)
I. WELL. USE (Check Applicable Bo::): Residential RI Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Hea- Pump Water Injection ❑ Other ❑ If Other, List:Use
274601
- Groundwater Section
CERTIFICATION # 62.431.0
PHONE # fYL9 a 55- 7_45 '
WELL LOCATION:
Nearest Town: Wa74e9-stt42l le
2\og+ntnt
(Street Name. Numbers. Community. Subdis ision, Lot No-. Zip Code)
County ` 1s-tao a
3. OWNER: 'Snv, $ ?awl. W 4-1-
K:nS
Address 1(09 wt+tte e. a4
(Street or Route No.) ']
—I-1.6 04ton (.Y4 30a870
City or Town State Zip Code
()- 4&4 es(0s
Area code- Phone number `��
4. DATE DRILLED 5'r1
5.'TOTAL DEPTH: 4%s5
6. DOES WELL REPLACE.EXISTING WELL? YES ❑ NO S
7. STATIC WATER LEVEL Below Top of Casing: 90 FT.
(Ur= "+" if Above Top of Casing)
8. TOP OF CASING IS i I T. Above Land Surface*
*'fop of casing terminated at/or below lard surface requires a
variance in accordance with I SA NCAC : C .0118.
9. YIELD (gpm): Sl; METHCD OF TEST Rl4
10. WATER ZONES (depth): o
11. DISINFECTION: Type
12. CASING:
From 'R1
From
From
13. GROUT: Depth
From 0 To 90
From To
14. SCREEN: Depth
From To
Frorn To
15. SAND/GRAVEL PACK
Depth
From To
Depth
To q?
To
To
Diameter
_
Ft.
Ft.
From To
16.REMARKS:
Amount
Wall Thickness
or Weight/Ft. Material
i3 02 I _F _i_5tt S
M aerial
Ft. C'_ntent
FL
Diamet :r
Ft. in.
Ft. in.
Ft.
Ft.
Size
Slot Six
�dpographic/Land setting
£ idge DSlope DValley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic nap
(check box)
DEPTH DRILLING LOG
From To Formation DDescriptio
pn
'TO VT trot( 1Jecasn
G- ren1
C,]
LOCATION SKETCH
Show direction and distance in miles from aaleasta_r
two State Roads or County Roads. Include he rook
numbers and common road names.
1460 lac
Method
is SA,
01e\V
in.
in.
Material
la
C_
2 ^r
Sri
--
GrabTssa. ,tn
CJ1
Ca G
�u�b,�,rn t the Original tnithe D
P SG 49hr4n Y 6 rhrihl (�(.19) 73
THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
, AND TEAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
Uy S 9- �3
SIGNATURE OF i .R ON CONSTRUCTING THE WELL DATE
vision of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
-3221, within 30 days. GW-1 REV. 07/2001

274449
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and N tu��ra�ll Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAMlE(print)'al Aseriv/l//e- CERTIFICATION #`*io///71I
WELL CONT R:ACI OR COMPANY NAME // �Ct we * PHONE # rc() 43.77-
STATE \VE.LI. CONSTRUCTION PERMIT# ASSOCIATED \VQ PERMED(
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): ResidentialMunicipal/Public 0 Industrial ❑ Agricultural 0
D9onitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 IFOther, List Use
2. WELL LOCATION'
Nearest Town: 14/7 e County.
2aN M/J
(Street Nmne. Numbers, Community, Subdivision. Lot No.. Zip Code)
3. OWNER: 054 4- ((�' (degrees/minutes/seconds)
Address ,41/ t Latitude/longitude source:❑GPSOTopographie map
(Street or Roo(.: Na) (check box)
// e �' (.. (��Z/ DEPTH DRILLING LOG
City or Town State Zip Code From To Fr I alin Description
( )- 0 /0/
Area code- Phone numbers /0 C
5. TTDDEPTH: j' 63 � s� . 5-
5. TOTAL DEPTH: /��
6. DOES WELL REPLACE EXISTING WELL? YES.S NO i2r.---
7- STATIC WATER LEVEL Below Top of Casing JQ7 FT.
(Use "+" if Above Top of Casing)
8. 'lOP OF CASING IS cc FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm)• /0 METHOD OF TEST ,if°
10. WATER ZONES (depth): c
LOCATION SKETCH o
I I. DISINFECTION: Type 7;7 Amount Show direction and distance in miles fronlia leaet,
12. CASING: Wall Thickness two State Roads or County Roads. Include r— }
Depth // Djamelc( or Weight/Ft. to °iial _ numbers and common road names. Z z^,
From jr� To a7 Ft. �p %y � 1�iC_
From To Ft. -t
From To Ft. #/5:li -0 �m
13. GROUT: Depth Material Method JJ rnt
From d To r�© Ft. ��.,.vle ' 0-
From To Ft. o a
lD a
14. SCREEN: Depth Diameter Slot Size Material Z
From To Ft in. in.
Topoggraa hie/Land setting
❑Ridge lope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16.REMARKS:
WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
D THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE \VELL OWNER
�II NATURE OF PERSON CONSTRUCTING THE WELL DATE
nhmit the original to the'Divis on of Water Quality, Groundwater Section, 1636 Mail Service Center- Raleigh, NC
2lia9-9 16;6 I'hiiiicdS *frt, 33-3121, within 30 days. GW-I REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Deparunent of Environment and Nptur tural eso}aon
trees - Division of Water Quality - Groundwater Section
\\'ELL CONTRACTOR (INDIVIDUAL) NANIE (print) / .4-41.1
/, C CERTIFICATION'#
WELL CONTRACTORCOSIPANY NA NIE /✓ /(C /pie//` 4'tvA PHONE N 6.2%6,2iy-C�8Jt
9g
STATE \VEL1. COSST RUCTION PER\IIT#
t if applicable)
2
3
ASSOCIATED \VQ PERMIT*/
(if applicable)
WELL USE (Check Applicable Box): Residential Pr Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other ❑ If Other, List Use
WELL LOCATION:
Ne tr\p-t Town: County
�//° ,/ it
(Street Name, Numbs, Community, Subdivision, Lot No.. Zip Code)
14w (1e5SSr
% y
(Strceto f,
OWNER:
Address
DEPTH
Cit) ossn State Zip Code Fi i
Area code- Phone number
4 DATE DRILLED,. S -2 - 0 3
From
13. GROUT: Depth Material Method
Prom 0 To •70 FL�e^('-^'t
From To • Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in,
From To Pt. in. In.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
GH
070
5. TOTAL DEPTH: 3 (n 5 de
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO L9-'
7. STATIC WATER LEVEL Below Top of Casing: 75- FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance wittlfi ISA NCAC 2C.0118.
9. YIELD(gpm): METHOD OF TEST 4/7
10. WATER ZONES (depth)
11. DISINFECTION: Type
LOCATION SKETCH
Amount Show directi
/ two State Roads or County Roads.
12. CASING: Wall Thickness
274448
/Topographic/Land setting
Midge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
For atio Description
O G
W
C� ti7—
on and distance in mil
C r
cam'
es from feas t2--'
IncIudeIt1 roajr
Depth'? Diane ter or Wcieht/Ft. M1 terial numbers and common road names. coo
To ! � FL /� �5`fil i �m
N--
"O
3
From �.�C
From To Ft. •• m.v
To Ft. --I
From To Ft.
16. REMARKS:
ti -
W
W
o G
I no HFRFRY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
NrRUC 9N $TAFMAI AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
xL z _ !. 42, S- 13 c3
DATE
Submit the original to th
1 )7699-16361thmtc i'o. (919
IGNATUItE OF PERSON CONSTRUCTING THE WELL
D11,151011 of Water Quality
733-2 2J 1, within 30 days.
Groundwater Section, 1636 Mail Service Center - Raleigh, NC
GW-1 REV. 07/2001
Cii i

274445
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural R sour es - Division of Water Quality - Groundwater Section /
CERTIFICATION #���/
u 4� ' �
WELL COSrtrACroR (INDIVIDUAL) NAME (print) * J{nl PHONE # +K�%'�
WELL CONTRACTOR COMPANY NAME n We�/k" "'7P
ASSOCIATED WQ 1'ERMLT#
STATE WELL CONSTRUCTION PER?Ill'# (if applicable)
(if applicable)
USE (CeckApplicaableox):Rednl-d pal/Public Industrial
Agricultural
Monitoring0overy El Beat ox): Residential
If r, Lie
2. WELL LOCATION:
Ltd/NJe SV// E-
Ncares't Town: �J
(Street Name. Numbers, Community, Subdivision. Lot No.. Zip Code)
3. OWNER:-���C
Address hQ
(;' L /1:I
t;:l:
street r RouteNI() (-
d 7/o>
City or Town State Zip Code
Area code Phone number g J
4. DATE DRILLED ��' .J
DEPTH Q
5. TOTAL '
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO E>'
7. STATIC WATER LEVEL Below Top of Casing LSD FT.
(Use"+" if Above Top of Casing)
8. TOP OF CASING IS FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
vIELD g m)rd:rntafwith ISAMETHOD .0OFBTEST _'�
9. YIELD (gpm): fX
10. WATER ZONES (depth):
opographic/Land setting
iRidge ❑Slope [Walley DFlat
(check appropriate box)
Latitude/longitude of well location
(degreesani nutes/seconds)
Latitude/longitude source:OGPSOTopographic map
(check box)
DRILLING LOG
F
DEPTH
From
To
rt atio 1 Description
LOCATION SKETCH
��yy Show direction and distance in miles from at least
1 I. DISINFECTION: TypeI� Amount two State Roads or County Roads. Include the road
12. CASING: WalWeil ihnFss
llia� ter or N('ei 'hVFt ten 1 numbers and common road names.
Depth '/ /d 'et
From 02 To_�_. Ft. ii7 i d
From To Ft.
From To Ft.
13. GROUT: Depth
Material Method
From 0 To 0?-0Ft. e%He✓
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To
Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK: Material
Depth Size
From To _ Ft.
From To Ft.
I6. REMARKS:
lal Elf(BN1gE1
v
do iv j N
1.1
TI4'AT
coLin tyA/tvdcc/
thaq
1 • WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
A' ► THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
✓i; 5 ATURE OF PERSON CONSTRUCTING THE WELL DATE
1
SulLusit-t-14y.9414xal to the-pivisio of Water Quality, Groundwater Section, 1636 Mail Service Center - REVgh, C
27016,1Kljninnc No: (919) Tt3-3221 within 30 days.

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and N9tural Rersoureps - Divisjon of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME rint)
WELL CONTRACTOR CONIPANY N:A\IE iil- e %ve// e: /'V-^I/ PHONE #
SPATE WELL CONSTRUCTION PERMIT/4ASSOOCIATED \\'Q # PERMIT
(if applicable)
274444
CERTIFICATION 8Q%/
Sn's%':S'S`ir
(if applicable)
WELL USE (Check Applicable Box): Residential G -Municipal/Public 0 Industrial ❑ Agricultural ❑
INionitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other 0 If Other, List Use
WELL LOCATION:
M
(Street Name. Numbers, C
e_ dal county
ty, Subdivision, Lot No
3 OWNER:, I/JN/y JY°D
Address Cs'— v *11 Dr)
(S eet or Route No.)
lil1 ty or low n State
Zip Code)
73/
hip Code
Topographic/Land setting
fUTdge DSlope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source.❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Fgrrpatiop Description
L ;?D
Area code- Phone number
4. DATE DRILLED -",� 7-- 0 g 6(4
5. TOTAL DEPTH: �t2 S 7
6. DOES WELL REPLACE EXISTING WELL? YEs�j� N0 g
7. STATIC WATER LEVEL Below Top of Casing:: >3
FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS t( FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordan‘ wRh 15A NCAC 2C .0118.
9. YIELD (gpm): Q-2) METHOD OF TEST n'�
10. WATER ZONES (depth):
I I. DISINFECTION: Type f%TAmount
12. CASING: Wall Thickness
Depth /� DiapStc or Weight/Ft.
From To U/fv' Ft. /
From To Ft.
From To Ft.
13. GROUT: Depth Material
From G To "90 Et. Le•-•••
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
5. SAND/GRAVEL PACK:
Depth Size Material
To Ft.
To Ft.
SJ�
c
LOCATION SKETCH C:)`o
Show direction and distance in miles frole At lq.sxt
two State Roads or County Roads. Incluhe rtt "h
terial - numbers and common road names. 2 e T,
)4(C , j/Gl/ %y -
Method
From
From
16. REMARKS:
Submit the original to he 1)i
It 9)73
CPOULD + Ef 10[1
ASNEVILLE PICIC,,II_EFE-10E
THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITFI ISA NCAC 2C, WELL
AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATL (E OF PERSON CONSTRUCTING THE WELL
DATE
ision of Water Quality, Groundwater Section, 1636 Nlail Service Center- Raleigh, NC
3221, within 30 days. GW-1 REV. 07/2001

272777
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Reso
WELL CONTRACTOR (INDIVIDUAL) NAME (print)
\WELL CONTRACTOR COM PAN(' NAME
SLATE WELL CONSTRUCTION PERMIT#
(if applicable) //
I. WELL USE (Check Applicable Box): Residential ILL Municipal/Public 0 Industrial ❑ Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELLLOCATI-
Nearest Town: t+l40
153
ces - Division o
Water Qua
ASSOCIATED WQ PERMIT
(if applicable)
County = LZ0l,e (.
CA. Cgil(.1
(Street Name, Numbers, Community. Subdivision, Lot No.. Zip Code)
3. OWNER:
Address
City or Town
Area code- Phone number 2
4. DATE DRILLED �J
5.TOTAL DEPTH:
6 DOES WELL REPLACE EXISTING WELL? YES 0 NO P'
7. STATIC WATER LEVEL Below Top of Casing:
FT.
(Use "+"if Above Top ofCasing)
8. TOP OF CASING IS ____L_ FT. Above Land Surface*
'Top of casing terminated at/or below land surface requires a
variance in accordaneS with 15A NCAC 2C .0118. icotherb4y,
9. YIELD (gpm): __ tc__ MET4OD OF TES
10. WATER ZONES (depth): 2- O
I1. DISINFECTION: Type Amount 10
12. CASING: Wall Thickness
Depth D met I. or Weight/Et. Material
From Tot F LCJ
From To Ft.
From To Ft.
Material Method
th°d
13. GROUT: Depth //��-��-� �'�--
From To FL�„Q�A
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
Frmn To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK: Depth Size Material
Groundwater Sectt93
CERTIFICATION�#t�Li.Gpp.
PHONE # ,?.� igtetay
_�C1BE.
Topographic/Land setting
❑Ridge QS(ope ID Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
From To Ft.
From To Ft.
16.REMARKS:
r-
IZUCTION ST ! Al S
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
jf_z 3
fro
2,74
0
0
a
l
J,S WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
- THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
original to the D v sio
tmlletjn- (? �)
173 -322
9CF
ATURE OF PERSON CONSTRUCTING THE WELL
DATE
of Water Quality, Groundwater Section, 1636 Mail Service Center
�vg07/2001
within 30 days.

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section Q
WELL CONTI2.AC'I'OR(INDIVIDUAL) NAME )print) I 141V1/e CERTIFICATION tF'J/6/
WELL CONTRACTOR COA1PANY NAME
PHONE #
272763
STATE \\'ELL CONSTRUCTION PER\IIT# ASSOCIATED \\'Q PERMIT#
(if applicable)
(if applicable)
1. WELL USE (Check Applicable Box): Residential EI Municipal/Public ❑ Industrial 0 Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATI
Nearest Town: /,VQ
41e-s(0
treet Name. Nu others. Community, Subdivision, Lot No., Zip Code)
3. OWNER:,ees+^i ypric /e-
Address 90 o/il✓- e. V.61.rar c.i
or Route No.)
or Towi
County ✓i CVOC/
a /5/
State Zip Code
( )-
Area code- Phone numbe ^7
4. DATE DRILLED /5-22r"3
5. TOTAL DEPTH: jcs f-f
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO ga--
7. STATIC WATER LEVEL Below Top of Casing: ge FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance vitlt 15A NCAC 2C .0118.
9. YIELD (gpm): METHOD OF TEST %}"zr
10. WATER ZONES (depth):
11 DISINFECTION: Type r/91- Amount
12. CASING: Wall Thickness
Depth Di7gaiter or �Wtefie-ht/Ft. Material
`
From -o2- To 70.3 Ft. 62 ' J ,
From To Ft.
From "fo Ft.
13. GROUT: Depth, Material 1_,.From 0 To do Ft. Le -,,,,
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Topogra hic/Land setting
❑Ridge L'3'Slope 0Valley 0Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Fgrryatign Description
"C /3c
/ry 3Gnc"
16. REMARKS:
Method
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
431
0
-t
1
AD
N
0
C•
CC'
rn tic
o
rn
.r1 !r.
u)
0A
—'I
G
I D0 HEREI3Y CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
C(SP($TRUCTION STANDARDS, AND ThkT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
4-as-O3
../,v�7 AI RE OF PERSON CONSTRUCTING THE WELL DATE
P;N
St bn ij the original to the Divisil of
276)9-1636 PluTinc-No_(9l9) 733-32 I wit
Later Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
in 30 days. GW-1 REV. 07/2001

North Carolina • Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mal Service Center - Raleigh. N.C. 27699-1636-Phone [phone] yn �� /,, J�1/./�,
WELL CONTRACTOR: ! r'CN- bK�// T / '�M1) ,/ j/
WELL CONTRACTOR CERTIFICATION #: a�'69 / ttX /,r/y/zre
STATE WELL CONSTRUCTION PERMIT#:
WELL CONSTRUCTION RECORD
1. WELL USE (Check Applicable Box): Residential Er Municipal ❑ Industrial E Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below) / /
Nearest Town: 1/11 Ne�✓" fie County: '4-jz^I/t9L[>p/
(Road N me an Numbers. Community, or Subdivision and Lot No.)
3. OWNER ,5Ar% Ve'-heV`�_'y N i
Address /17 4 or lan.5i, Ea/
«eel or oulo
VCo�wn 7 Stale Zip Code
4. DATE DRILLED / �L—U7
5. TOTAL DEPTH 3.74"
6. CUTTINGS COLLECTED YES n NO
7. DOES WELL REPLACE EXISTING WELL? YES ❑ NOP"-
8. STATIC WATER LEVEL Below Top of Casing: e FT.
(Use'+' if Above Top of Casing)
9. TOP OF CASING IS FT. Above Land Surface'
-Top of casing terminated aVor below land surface requires a variance In accor-
dance with 15A NCAC 2C .Q0,.110
10. YIELD (gpm). or r METHOD OF TEST A'I
11. WATER ZONES (depth):
DRILLING LOG
From To
0 a�
3-3
3 5-
12. CHLORINATION: Type
13. CASING:
Ail if
Amount
Wall Thickness
*2 Depth j Di wiper or Weight/Ft.
From - To IC/ Ft
From To Ft
From To Ft
14. GROUT:
Depth
From _S1— To ot.)
From To
15.SCREEN:
Depth
From To Ft
From To Ft
From To Ft
16.SAND/GRAVEL PACK
Depth
From To Ft
From To Ft.
17. REMARK,._.
I DO HER
CONSTR
&g75Y0
Material
Ft CF'AL eAcr
Ft
272762
DEPTH
atio Description
If additional space is needed use back of form
LOCATION SKETCH
rial (Show direction and distance from at least two Stale
Roads, or other map reference points)
Method
Diameter Slot Size Material
in in
in in
in in
Size Material
O
W
a
to
3
IV
� ,,Y_h7R€,_T1lATIu WELL -WA
qTr N STANDARDS AND THAT
II 1
FOR 0FFIq&"USE ONLY
Quad No'
f.
Serial No. 1
Sub
origi
NSTRUCTED IN ACCORDANCE WITH 1SA NCAC 2C, WELL
OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
z�! 1 9_ 3_ 023
GNATUREIOF PERSO ONSTRUCTING THE WELL DATE
I to Division of Water Duality. Groundwater Section within 30 days
GW-1 REV. 12/99

WELL CONS'T'RUCTTON RECORD
Nor., (1iulliu - )cpir'Ittcnt of Ln.;ranntent and Natural Resooutrc les - Di,t on of AVater Quality
aF Et1 { ;IN 11UC lOk11\{A1 lot' Ni i N:\NF: (print) Latch( 1
. . to 1rr\PC\}-`_( 1 t
•
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-
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GW-1 Revised 6/88
Z Code
3. DATE DRILLED (/) � �F F�'`� USE OF WELL J�-Full' u'�/ � 4. TOTAL DEPTH /nC / CUTTINGS COLLECTED ❑ Yes gNo
5. DOES WELL REPLACE EXISTING WELL? ❑ Yes ® No
6. STATIC WATER LEVEL: CJ FT. El above TOP OF CASING,
below
TOP OF CASING IScc,, / FT ABOVE LAND SURFACE.
7. YIELD (gpm): /.J METHOD OF TEST -2 /1.ekS
2
8. WATER ZONES (depth): c2
�OM
9. CHLORINATION: Type /'a 1 / I Amount ft/ JL/TS
10. CASING:
Wall Thickness
Depths Diameter or Weight/Ft. Material
From To i Ft PV e_
From To Ft
From To Ft.
11. GROUT:
// Depth �f 7� /t Material / Method
From L To .�f C Ft. ( t/"11 LAi _T- +'..
From To Ft.
12. SCREEN:
Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
From To Ft in. in.
13. GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
14. REMARKS:
NORTH CAROLINA DEPARTMENT OF NATURAL RESOURCES AND COMMUNITY DEVELOPMENT
DIVISION OF ENVIRONMENTAL MANAGEMENT - GROUNDWATER SECTION
P.O. BOX 27687 - RALEIGH,N.C. 27611, PHONE [phone] n ry �� l7 n Quad. No. Serial No.
Lat. Long Pc
Minor Basin
Basin Code
Header Ent. GW-1 Ent
FOR OFFICE USE ONLY
WELL CONSTRUCTION RECORD
DRILLING CONTRACTOR ///Z-)L- (27 re-E-LLE-
(`// STATE WELL CONSTRUCTION II //
DRILLER REGISTRATION NUMBER d PERMIT NUMBER: / `7 D '2
1. WELL LOCATION: (Show sketch of the location below)
/1
Neare t Town: C- ( /
he ��i �l >()ck 1 - Tcutcf /e_ LJOO
County:
C21� /1 )!)OC)
Depth DRILLING LOG
(Road, Commu ity, or Suh rvisio and Lot .7 t
From,To / F��iirmlation Description
2. OWNER i) all ��• �f. — ��������' a7 �� c)
ADDRESS K(/ Cry Cr;
r, V et C�.. i��Ar :�D I 2iD� / hCt.41 LLC,
(Scree or Route No 7,72
rp.t talk II C,k % i
C y or Tov/n State p
I (-7
0
W
If additional space is needed use back forte
r7
LOCATION SKETCH -L_
IV o
(Show direction and distance from at least tv‘c•Stati4iikaads,
or other map reference points) -Q
.73
N co
Fri=�
ri
IV
cn
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15 NCAC 2C, WELL CONSTRUCTION
STANDARDS, AND THAT A COPY OF THIS RECORD HAS PROVID D 0 THE WELL OWNER. /
/�1k4L<
SIGNATURE OF CONTRACTOR OR AGENT DATE
Submit original to Division of Environmental Management and copy to well owner.

NORTH CAROLINA DEPARTMENT OF NATURAL RESOURCES AND COMMUNITY DEVELOPMENT
DIVISION OF ENVIRONMENTAL MANAGEMENT - GROUNDWATER SECTION
P.O. BOX 27887 - RALEIGH.N.C. 27811, PHONE [phone]
WELL CONSTRUCTION RECORD
DRILLING CONTRACTOR
280829
DRILLER REGISTRATION NUMBER
FOR OFFICE USE ONLY
Quad. No. Serial No.
Lat. Long. Pc
Minor Basin
Basin Code
Header Ent GW-1 Ent
STATE WELL CONSTRUCTION
PERMIT NUMBER: / 9 c =Z
1. WELL LOCATION: (Show J?$ketch of the location below)
Nearest wn: • /l E .Si/ / /it' .
( L1.Ati- l),-cz_e_)
(Roammunity, or Subdivision and Lot No.)
2. OWNER kJ../ e ti ,lt.t t'i__-
P& /_3ot Liol
(Street or Route No.)
ity or Town ) State ip Code r'
3. DATE DRILLED - 3 - D J USE OF WELL --LC-1-ta i c - '
4. TOTAL DEPTH LP Li b I CUTTINGS COLLECTED El Yes g, No
5. DOES WELL REPLACE EXISTING WELL? Ill Yes ILu No
ADDRESS
GW-1 Revised 6/88
6. STATIC WATER LEVEL: O FT. 0 above TOP OF CASING,
TOP OF CASING IS FT ABbelow
ABOVE LAND SURFACE..�
7. YtELD (Wpm): METHOD OF TEST -�( A K'S
8. WATER ZONES (depth): S 1 _ Cj fDfl
9. CHLORINATION: Type /-! %// Amount ) b 3 4-) 1+3
10. CASING:
Wall Thickness
Depth Diameter or Weight/Ft. Material LOCATION SKETCH W a
From To °1 Ft tl t/�� (Show direction and distance from at least tvc9Stat Roads,
From To Ft or other map reference points) —'f c"{
113 c
From To Ft. 0 -
--.
Dc
11. GROUT: 'iD N--
Depth m Material Method '
)
IV
From 1) To Ea FL -Chest bl- N
From To Ft. 01 o
County: Nat ltl�JO i�
Depth DRILLING LOG
From To / 5prrpation Description
a G' Liy9l hnAt7.t�
If additional space is needed use back of for...
12. SCREEN:
Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
From To Ft in in.
13. GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
14. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15 NC 7C, WELL CONSTRUCTION
STANDARDS, AND THAT A COPY OF THIS RECORD HASB/� Ef� PRO ID TO THE WELL OWNER. \\
SIGNATURE OF CONTRACTOR OR AGENT DATE
Submit original to Division of Environmental Management and copy to well owner.

GW-1 Revised 6/88
NORTH CAROLINA DEPARTMENT OF NATURAL RESOURCES AND COMMUNITY DEVELOPMENT
DIVISION OF ENVIRONMENTAL MANAGEMENT - GROUNDWATER SECTION
P.O. BOX 27667 - RALEIGH,N.C. 27611, PHONE [phone]
WELL CONSTRUCTION RECORD
DRILLING CONTRACTOR
DRILLER REGISTRATION NUMBER '30 �� I
280830
62.L-/t—t 4-11.-LLi_L-
FOR OFFICE USE ONLY
Quad. No. Serial No.
Lat. Long. Pc
Minor Basin
Basin Code
Header Ent. GW-1 Ent
STATE WELL CONSTRUCTION /
PERMIT NUMBER: �</G
1. WELL LOCATION. (Show slyelch of the location below)
Nearest Tr n: -/X_)LC_L/4 L.5 v, //L County:
/4fC.
(Road. Commungy or Subdivision an Lqt No.)
�{ / From To Formation Description
�_l� ( / ��
2. OWNER ei 4' h--L IL; /
ADDRESS /S %JTL�St�Yt. NT.S /C1�� L) UC9
(Stye t r Route NoJ /
Yt�a��r�rs�l ",_mac ��7�� L�c� �bS �G��—
City r Town State J Zip Code
3. DATE DRILLED Cj _/ 7-03 USE OF WELL hei11(LCAt*lle.(-
4. TOTAL DEPTH 7h3 t CUTTINGS COLLECTED ❑ Yes )SJ No
5. DOES WELL REPLACE EXISTING WELL? ❑ Yes $ No
6. STATIC WATER LEVEL: 50 FT. ❑ above TOP OF CASING,
of below
TOP OF CASING I5 / FT ABOVE LAND SURFACE.
7. YIELD (gpm): k.�� METHOD OF TEST (. A/�S
/
8. WATER ZONES (depth): 4P S)C) / .5O p )�
J
9. CHLORINATION: Type N7 7?! Amount / /<C? 4/>//5 .
10. CASING'.
Wall Thickness
Depth / Diameter or Weight/Ft. Material(
/
From A l To 6) L' Ft C' t t / n`-'
From To Ft
From To Ft
11. GROUT:
ff Depth Material Method
From 6 To )L Ft. CQ. 'b yL1'_AL1—
From To Ft.
12. SCREEN:
Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
From To Ft in in.
13. GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
14. REMARKS:
Depth DRILLING LOG
If additional space is needed use back of form..
LOCATION SKETCH W c
(Show direction and distance from at least twDCEtat9 ?cads,
or other map reference points)'
IV
O
i
'D r1
r1
IV rr.
0
N -
Q1 0
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15 NCAC 2C. WELL CONSTRUCTION
STANDARDS, AND THAT A COPY OF THIS RECORD?
HAS'BEEN PROVI E TO THE WELL OWNER(
Lit
lV L�
SIGNATURE OF CONTRACTOR OR AGENT DATE
Submit original to Division of Environmental Management and copy to well owner.

City r Town tate ZipCode
9-/2 -0.3 USE OF WELL/7CJi1 el eat �,Act(
(YD / COLLECTED ❑ Yes 124-No
CUTTINGS
C)
FT
STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVI E TO THE WELL OWNER.
GW-1 Revised 6/88
NORTH CAROLINA DEPARTMENT OF NATURAL RESOURCES AND COMMUNITY DEVELOPMENT
DIVISION OF ENVIRONMENTAL MANAGEMENT - GROUNDWATER SECTION
P.O. BOX 27687 - RALEIGH,N.C. 27811, PHONE [phone]
WELL CONSTRUCTION RECORD 28031
DRILLING CONTRACTOR 71 A-21 et-(L.-1- r ,"/"'"Le 't
DRILLER REGISTRATION NUMBER 3 7
FOR OFFICE USE ONLY
Quad. No. Serial No.
Lat. Long. Pc
Minor Basin
Basin Code
Header Ent. GW-1 Ent
STATE WELL CONSTRUCTION ' /
PERMIT NUMBER: / U ^'
1. WELL LOCATION. (Show /,sketch of the location below)
Nearest Town: fLGL-C/ inl h
) h� LE-idid u) J-)
(Road, Commu r Subdivision and Lot o.)
2. OWNER 1 ILr//-y1--.a-er/1 //77 11
ADDRESS C; L . lL.`L 2.C- )!✓ h.""" /c.fC-
/ (Stre,et or Route No.) % g J
`L / ft //ir V 1 � 5�- lL
3. DATE DRILLED
4. TOTAL DEPTH ��II
5. DOES WELL REPLACE EXISTING WELL? ❑ Yes L7g No
6. STATIC WATER LEVEL: IX
❑,above TOP OF CASING,
below
TOP OF CASING S / FT. ABOVE LAND SURFACE,
7. YIELD (gPm): / METHOD OF TEST 02 1712S
8. WATER ZONES (depth): I 3 g 5 p/O7 / 1�Q y
9. CHLORINATION: Type /e-T Tit Amount /V'(7 T/L /TS .
10. CASING:
Depth
From Ci To i2I
From To
From
11. GROUT:
From
From
12. SCREEN:
To
Depth
To Ll
Ft
Ft
Ft
Wall Thickness
Diameter or Weight/Ft. Material
6 1/
,sue_
Material Method
FL er-111 r.11
To Ft.
Depth
From To
From To
From To
13. GRAVEL PACK:
Depth
From To
From To
14. REMARKS:
Ft.
Ft.
Ft
Diameter
Slot Size Material
in. in.
in. in.
in. in.
Size Material
Ft.
Ft.
County:
Depth
From
DRILLING LOG
To Formation Description
n /r
;i' 9eS'
Cie
A CLn1LC,(
If additional space is needed u=
e back of twin._
LOCATION SKETCH
(Show direction and distance from at least two State Roads,
or other map reference points)
O
CO
O
r7
N)
O
-D
tV
IV
?1
c
0
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15 NCAC 2C, WELL CONSTRUCTION
9-30-D
SIGNATURE OF CONTRACTOR OR AGENT DATE
Submit original to Division of Environmental Management and copy to well owner.

GW-1 Revised 6/88
NORTH CAROLINA DEPARTMENT OF NATURAL RESOURCES AND COMMUNITY DEVELOPMENT
DIVISION OF ENVIRONMENTAL MANAGEMENT - GROUNDWATER SECTION
P.O. BOX 27687 - RALEIGH.N.C. 27611, PHONE [phone]
WELL CONSTRUCTION RECORD
DRILLING CONTRACTOR )U 6 n
DRILLER REGISTRATION NUMBER
)
280817
FOR OFFICE USE ONLY
Quad. No. Serial No.
Lat. Long. Pc
Minor Basin
Basin Code
Header Ent. GW-1 Ent
STATE WELL CONSTRUCTION /
PERMIT NUMBER:
1. WELL LOCATION: (Show sk tch of the location_below)
Nearest Town: L ie-C L 4 - 1/ l L County:
k. Depth
(Road, Corn nity, or Subdivision a%4 Lot No.) y� / I From To
2. OWNER %Li !C id e 1 ell- °q �1FCVn2 - nal J�.�
,,� t) / 3 9 ),;.taLt I Door Id (1 , 0 'f
„LiJa(Street kr RouY �N400.) n/ 7 p) Li /7 ' 67 j
L//iiE-��I �-� � b 0�0
City/or Town ' tate Zip Code
ADDRESS
3. DATE DRILLED
4 TOTAL DEPTH
�C - / -6) 3 USE OF WELL %1-L-ri i L7'--,/(C
Ly �� I CUTTINGS COLLECTED El Yes L7i-No
5. DOES WELL REPLACE EXISTING WELL? ElYes 21LNo
6. STATIC WATER LEVEL IO FT. ❑ above TOP OF CASING,
gL below
1 FT. ABOVE LAND SURFACE.
METHOD OF TEST
TOP OF CASING ISL,
7. YIELD (gpm}.
8. WATER ZONES (depth): O 5 I '� ) c;\ m
9. CHLORINATION: Type
10. CASING:
2Re .
rl Tl- Amount
/� [ Depth �7
From C ) To �` ( Ft
From To Ft
From
11. GROUT:
To Ft
Wall Thickness
Diameter or Weight/Ft.
6. I I
Depth Material
From 0 To L) FL (t4 L.E.AL+
From To Ft.
12. SCREEN:
Depth
From To Ft,
From To Ft.
From To Ft.
13. GRAVEL PACK:
Material
j)C_
Method
-711)13
Diameter Slot Size Material
in. in.
tn. in.
in. in.
Depth Size Material
From To Ft.
From To Ft.
14. REMARKS.
DRILLING LOG
Formation Description
�nQ.tLr�
If additional space is needed
use back Sf_iofri2.'-
LOCATION SKETCH
(Show direction and distance from at least two State Roads,
or other map reference points)
O
W
O
n
N
O
-b
IV
rV
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15 NCAC 2C, WELL CONSTRUCTION
STANDARDS, AND THAT A COPY OF THIS RECORD IiA BFtEN ROVID)E 0 THE WELL OWNER. (, (, _ \
SIGNATURE OF CONTRACTOR OR AGENT DATE
Submit original to Division of Environmental Management and copy to well owner.

NORTH CAROLINA DEPARTMENT OF NATURAL RESOURCES AND COMMUNITY DEVELOPMENT
DIVISION OF ENVIRONMENTAL MANAGEMENT - GROUNDWATER SECTION P.O. BOX 27687 - RALEIGH.N.C. 27811, PHONE [phone] C
WELL CONSTRUCTION RECORD
DRILLING CONTRACTOR
DRILLER REGISTRATION NUMBER U q /
FOR OFFICE USE ONLY
Quad. No. Serial No.
Lat. Long. Pc
Minor Basin
Basin Code
Header Ent. GW-1 Ent
STATE WELL CONSTRUCTION f
PERMIT NUMBER: 4-1
1. WELL LOCATION' (Show sketch of the location below)
Nearest Towrt; ,
ti
(Road. Community, Suhdivis
County:
Vial el )60d_
Depth DRILLING LOG
From To Formation Description
2. OWNER Pi 9
(Street or R to No) ��,� -3 j z �All �ti-Ll-1
tittx)- C7/L� '
Zip Code
City or Town
STANDARDS, AND THAT A COPY OF THIS RECORD ASBVEN PROVI D TO THE WWELLOWNER.
S
SIGNATURE OF CONTRACTOR OR AGENT
Submit original to Division of Environmental Management and copy to well owner.
State
3. DATE DRILLED Cl - -L 3 USE OF WELL YULA.r[1.191�/4-t.
4. TOTAL DEPTH .385 I CUTTINGS COLLECTED D Yes NINo
5. DOES WELL REPLACE EXISTING WELL? ❑ Yes No
6. STATIC WATER LEVEL: `TCt FT. ❑ above TOP OF CASING,
ca below
TOP OF CASING I5 I FT ABOVE LAND SURFACE.
7. YIELD (gpm): 3(METHOD OF TEST /1 laCz
3
8. WATER ZONES (depth): `Z 5 I J .5 ID p m
9. CHLORINATION: Type TH Amount V-' +L / 1
10. CASING:
From
From
From
11. GROUT:
Wall Thickness
Depth Diameter or Weight/Ft. Materialtr
7D To J � Ft 6,n
'/ 1'VC--
To
To
Ft
Ft
Depth� Material
� From ) To ✓1 0 Ft. k1 -i"kt--e .1i .Y
From To Ft.
12. SCREEN:
Depth
From To Ft
From To Ft
From To Ft
13. GRAVEL PACK:
Diameter
Method
-72 et
Slot Size Material
in. in.
in. in.
in. in
Depth Size Material
From To Ft.
From To Ft.
14. REMARKS'.
)71
If additional space is needed tise back o'Yorm:. ..
LOCATION SKETCH
(Show direction and distance from at least two State Roads,
or other map reference points)
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15 NCAC 2C, WELL CONSTRUCTION
Le' q-30.6
DATE
GW-1 Revised 6/88

NORTH CAROLINA DEPARTMENT OF NATURAL RESOURCES AND COMMUNITY DEVELOPMENT
DIVISION OF ENVIRONMENTAL MANAGEMENT - GROUNDWATER SECTION
P.O. BOX 27687 - RALEIGH.N.C. 27611, PHONE [phone]
WELL CONSTRUCTION RECORD
DRILLING CONTRACTOR ✓ l LIC1 1�J
DRILLER REGISTRATION NUMBER -IL/ / S
280817
FOR OFFICE USE ONLY
Quad. No. Serial No.
Lat. Long. Pc
Minor Basin
Basin Code
Header Ent. GW-1 Ent
STATE WELL CONSTRUCTION / /Q
PERMIT NUMBER: 27
1 WELL LOCATION: (Show ketch of the locationbelow) 1
Nearest To / /
2t- S 1// / /t- County: 7f 11 'DD��I.
F L k. Depth ( DRILLING LOG
(Road, Community, or Subdivision an Lot No.) From To Formation Description
2. OWNER (PA LL./.-1 `kML- 1 (l /�•
� �Lti�-/�1/C,
ADDRESS J )Y 'i q�e+�LA. - P " Buy_ ) a t ,5Z�
LJ (Stre t or Rout J /-%T' 7�j,c /
`it cu/i1d vt %It s. �x 78Z�
City or Town State , Zip CQde
3. DATE DRILLED q-c2't�3 USE OF WELL hDll}
/41.1"/<'2_
4. TOTAL DEPTH I a- / CUTTINGS COLLECTED + ❑ Yes I -No
5. DOES WELL REPLACE EXISTING WELL? ❑ Yes L73- No
6. STATIC WATER LEVEL: J C ET. 0 above below TOP OF CASING,
TOP OF CASING IS � I FT. ABOVE LAND SURFACE.
In
7. YIELD (Wm): ( /) METHOD OF TEST .0 I� P
n, L- )
8. WATER ZONES (depth): / C w - �� ' fAf (Yl
9. CHLORINATION: Type k Amount d
10. CASING:
Wall Thickness
Depth Diameter or Weight/Ft. Material
ial
From A To aFt (L __L.
From To Ft
From To Ft.
11. GROUT:
Depth A Material
From CrTo �� Ft. ±_Yll.i,lLi
From To Ft.
12. SCREEN:
M@thod
LT
Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
From To Ft. in. in.
13. GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
(
r -
su
L
If additional space is needed use back of form
LOCATION SKETCH
(Show direction and distance from at least two State Roads,
or other map reference points)sico
W 0
O
o c
N
m�
cn's.
0
N -+
Ir-
Ql
14. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15 NCAC 2C. WELL CONSTRUCTION
STANDARDS, AND THAT A COPY OF THIS RECORD HAS EEN PROV��IgqEEp TO THE WELL OWNER.
L-tA ��ltiJ%�J'.-G�
SIGNATURE OF CONTRACTOR OR AGENT DATE
Submit original to Division of Environmental Management and copy to web owner.
GW-1 Revised 6/88

NORTH CAROLINA DEPARTMENT OF NATURAL RESOURCES AND COMMUNITY DEVELOPMENT
DIVISION OF ENVIRONMENTAL MANAGEMENT - GROUNDWATER SECTION
P.O. BOX 27887 - RALEIGH,N.C. 27811. PHONE [phone] M 8 f1 8 18
WELL CONSTRUCTION RECORD
DRILLING CONTRACTOR 1 ).R
DRILLER REGISTRATION NUMBER a
FOR OFFICE USE ONLY
Quad. No. Serial No.
Lat. Long. Pc
Minor Basin
Basin Code
Header Ent. GW-1 Ent
STATE WELL CONSTRUCTION / l/
PERMIT NUMBER:
1. WELL LOCATION: (Show sk ch of the location below)
L' j/Cat11e 3)112//
on and Lot
Subdi - i
Nearest Town()
No.
(Road, Community, '/�
2. OWNER AJ i1.CAV1'Li/Lv�1-1 L,1 k--t-,) o
p G l3 D,L- / :3 Lo .,
(Street or Route No )
Lie-)(11--time ,5 vi le , rk(C �?& 78�C
City orC, ow`n State - (le Code 7
3. DATE DRILLED 8 - 2 b -0 3 USE OF WELL h.ed.tG�"..�r c —
4. TOTAL DEPTH rQ±l CUTTINGS COLLECTED Ell Yes Yes No
5. DOES WELL REPLACE EXISTING WELL? El Yes LXLNo
6. STATIC WATER LEVEL Lit) FT. 0� a�above TOP OF CASING,
TOP OF CASING IS / FT A$OVbE LAND SURFACE.
7. YIELD (gpm): Ct METHOD OF TEST (2 /11-S
8. WATER ZONES (depth): / Y CD) y P r n
ADDRESS
GW-1 Revised 6/88
County'. Y/CkM Z2/00(1
Depth DRILLING LOG
From To Formation Description
30' °WS'
0
� 1
9. CHLORINATION: Type T// Amount 3 3 '� LiL)T.'----
10. CASING:
Wall Thickness If additional space is needed use tack of forF{ry�_
nn Depth // �1 Diameter or Weight/Ft. Material LOCATION SKETCH
From C� To il / Ft )' P� `- (Show direction and distance from at least two State Roads,
From To Ft or other map reference points) c
O 0
From To Ft COO
11. GROUT: C')
Material Method -VC'
Depth 00
From Tot' Ft. (1-:471r'-1T O
From To Ft. 3
12. SCREEN: IV
a
0
Depth Diameter Slot Size Material IN.)-.
01 r
From To Et. in. in. `
From To Ft. in. in.
From To Ft. in in.
13. GRAVEL PACK:
Depth
From To Ft.
From To Ft.
14. REMARKS:
Size Material
is
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15 NC 2C, WELL CONSTRUCTION
STANDARDS, AND THAT A COPY OF THIS RECORD EIASIBEJN PRO I D TOTHEWELL OWNER
• %g _ 3 b , �]
SIGNATURE OF CONTRACTOR OR AGENT (\! DATE
Submit original to Division of Environmental Management and copy to well owner.

NORTH CAROLINA DEPARTMENT OF NATURAL RESOURCES AND COMMUNITY DEVELOPMENT
DIVISION OF ENVIRONMENTAL MANAGEMENT - GROUNDWATER SECTION
P.O. BOX 27687 - RALEIGH,N.C. 27611, PHONE [phone]
280819
WELL CONSTRUCTION RECORD
DRILLING CONTRACTOR 01)-r4� `-'I/`^jJ'�
DRILLER REGISTRATION NUMBER ` in
FOR OFFICE USE ONLY
Quad No. Serial No.
Lat. Long. Pc
Minor Basin
Basin Code
Header Ent. GW-1 Ent
STATE WELL CONSTRUCTION / i //)
PERMIT NUMBER: 7"
1. WELL LOCATION: (Show
//sske ch of the location below
L�C.��-�' ill-�� 1 /� 1 7��
Nearest Tow E' County: 1 LOC e.
%t�/" .I l
(Road, nity, or
Suhdiv nd Lot No) f� From To Formation Description
2. OWNER ( CommjLl�',4 ii...1. c�L acri� D I L�71C�LL6S�� , .
ADDRESS r'I
am' 2 1 I _J.—LLLunn-7)i %cL . (')i /PC 1 (�l�EOr.' .
�II (Street 9r Route No 1n/,1 ,(p� / �JhCIAvr-Lb
!/Q.c��le'.Si�//le /��C_8781c
City o Town Slate ZJ,ip Code I
3. DATE DRILLED a -L28 63 USE OF WELL -)1C(2 If ilLi-
4. TOTAL DEPTH 6(17S I CUTTINGS COLLECTED�J❑ Yes VNo
5. DOES WELL REPLACE EXISTING WELL? D Yes it No
`'
/
Depth DRILLING LOG
6. STATIC WATER LEVEL:
TOP OF CASING
IS
7. YIELD (gpm): �1
8. WATER ZONES (depth):
FT. C above TOP OF CASING,
8C below
FT. A OVE LAND SURFACE.7
�
METHOD OF TEST �t /D/C.C•s
qs I — ey_7 rrA
9. CHLORINATION: Type I 1T1( Amount Jr 1 'i E> 17Ls
10. CASING:
Wall Thickness
Depth Diameter or Weight/Ft. Material
From 4-) To & ( II p Ft. �C U �-"
From To Ft
From To Ft
11. GROUT:
Depth Material Method
From To aO Ft. C-C---61LL,4C/ y
From To Ft
12. SCREEN:
Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in, in.
From To Ft in. in.
13. GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
t, c
0
Fr -
If additional space is needed use bet,), ul luuy.
LOCATION SKETCH W —
(Show direction and distance from at least tiState'$oads,
or other map reference points) --I c m
N
D rr'i�
3 ".
14. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15 NCAC 2C, WELL CONSTRUCTION
STANDARDS, AND THAT A COPY OF THIS RECORDv{iSIBE�,N PROVI THEWE— OWNE (t 3 _ 1) .7
7
•
SIGNATURE OF CONTRACTOR OR AGENT DATE
Submit original to Division of Environmental Management and copy to well owner.
GW-1 Revised 6/88

1. WELL LOCATION-. (Show sk tch of the location below)
Nearest Tow : �a_ n E 5 V 1 / /e-
tt ("i'ru
Subdivision
./l and Lot N /� 1,
2. OWNER lAl%(.�-4I�L/C�GV -Ci LA.
I l 4 ants 1 ELL 1 2CI .
(Streets r oute Nits? G >7 x 1
City or Town State 11 Zip Code l
3. DATE DRILLED '-2h-�3 USE OF WELL) ICI. 4Na, “--
4. TOTAL DEPTH In (C CUTTINGS COLLECTED El Yes >eNo
5. DOES WELL REPLACE EXISTING WELL? ❑ Yes 04 No
6. STATIC WATER LEVEL: 2 D ET.Ij0� above TOP OF CASING,
TOP OF CASING IS / FT. A80VE LAND SURFACE.
7. YIELD (gpm)'. r.-. METHOD OF TEST A rf,
8. WATER ZONES (depth): t--3 C j y cj rr0
/�T/ - l3 v Sari,
9. CHLORINATION: Type /-/ T/l Amount / 0 3 A- I / -is
ADDRESS
NORTH CAROLINA DEPARTMENT OF NATURAL RESOURCES AND COMMUNITY DEVELOPMENT
DIVISION OF ENVIRONMENTAL MANAGEMENT - GROUNDWATER SECTION
P.O. BOX 27687 - RALEIGH,N.C. 27811, PHONE [phone]
WELL CONSTRUCTION RECORD
DRILLING CONTRACTOR
DC�1,J
DRILLER REGISTRATION NUMBER
L-OE BR
,2'/ / g
28
FOR OFFICE USE ONLY
Quad No. Serial No.
Lat. Long. Pc
Minor Basin
Basin Code
Header Ent GW-1 Ent
STATE WELL CONSTRUCTION / L / z
PERMIT NUMBER:
(Road, Community,
County: �C-t_.C/t,CJOCr)
Depth DRILLING LOG
From
To Formation Description
aU' G /s' 2\etssut�
,r,
10. CASING' If additional space is needed us o orm.
Wall Thickness
Depth Diameter or Weight/Ft. Material
LOCATION SKETCH O G
From t To2 Ft r Pv �, (Show direction and distance from at least tvb Statal Ploads,
or other map reference points) CD "-
From To Ft _r-1
From To Ft N -
O
Dco
11. GROUT:
Material Method "O `"-
/� Depth .J1 —s ^'r.
Cl To :R Lt Ft. CL' M'lLw.( 4 v:
721
From N r '''"
co
From To Ft. 1 -a
Q1 G
'L
12. SCREEN:
Depth Diameter Slot Size Material
From To Ft. in. . in.
From To Ft. in. in.
From To Ft in. In
13. GRAVEL PACK'.
Depth Size Material
From To Ft.
From To Ft.
14. REMARKS'
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15 NCAC 2C, WELL CONSTRUCTION
STANDARDS, AND THAT A COPY OF THIS RECORD HA$ BEEN PR I ED TO THE WELL OWNER. J 93�_ G(3
SIGNATURE OF CONTRACTOR OR AGENT DATE
Submit original to Division of Environmental Management and copy to web owner.
GW-1 Revised 6/88

NORTH CAROLINA DEPARTMENT OF NATURAL RESOURCES AND COMMUNITY DEVELOPMENT
DIVISION OF ENVIRONMENTAL MANAGEMENT - GROUNDWATER SECTION
P.O. BOX 27687 - RALEIGH.N.C. 27611, PHONE [phone]
280821
WELL CONSTRUCTION RECORD
DRILLING CONTRACTOR h L Le I
3 Dtf
DRILLER REGISTRATION NUMBER
FOR OFFICE USE ONLY
Quad. No. Serial No.
Lat Long. Pc
Minor Basin
Basin Code
Header Ent. GW-1 Ent
STATE WELL CONSTRUCTION L/G
PERMIT NUMBER:
1. WELL LOCATION: (Show s tch of the location below)
Nearest Tgwg: a "f t -1-671....-
�CGZ
(Road. G%1Gsrt unity, or Subdivision a Lot No )
2. OWNER
ADDRESS
16114 G �l dip L/D`. 4 F rAnt - Ark
4 1 L C L , ;,�Lta (*I -
if )(Li/)1e>D(Str1
3. DATE DRILLED
4. TOTAL DEPTH
eet r Route . n�
City o Town State , Zip Code
B . 7 "4'3 USE OF WELD -UAL!:
1/
17L5J CUTTINGS COLLECTED D Yes
5. DOES WELL REPLACE EXISTING WELL? ❑ Yes
6. STATIC WATER LEVEL. FT. I, above
No
TOP OF CASING,
below
TOP OF CASING IS / FT. A OVE LAND SURFACE.
7. YIELD (gem): METHOD OF TEST
8. WATER ZONES (depth): Ll- /
9. CHLORINATION.
10. CASING:
Type
e..ntvelt:ct
Amount ) �C% T IJ I 'IS
Wall Thickness
Depth Diameter or Weight/Ft. Material
From 7) To Ft. b
From To Ft
From To —Ft.
11. GROUT:
Depth
From To of C)
From To
12. SCREEN:
II
P U c
Material /1 }}
Ft. Oil
Ft.
Depth
From To Ft.
From To Ft.
From To Ft
13. GRAVEL PACK:
Depth
From To Ft.
From To Ft.
Method
Diameter Slot Size Material
Size
in.
in.
in
in.
in.
in.
Material
County:
.17/6/.1 C I )(:C_YL
Depth DRILLING LOG
From To Formation Description
L
If additional space is needed use back of ..:
LOCATION SKETCH CO
(Show direction and distance from at least t5,3 StaLg-Roads,
or other map reference points) :r
N uc
O
t r1,
- Nr:
N Cr; -A:
0
14. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN AC ORDANCE WITH 15 NCAC 2C, WELL CONSTRUCTION
STANDARDS, AND THAT A COPY OF THIS RECORD RI BEN. ROVI TO THE WELL OWNER. yLi - 3E2 , 6
SIGNATURE OF CONTRACTOR OR AGENT DATE
Submit original to Division of Environmental Management and copy to well owner.
GW-1 Revised 6/88

NORTH CAROLINA DEPARTMENT OF NATURAL RESOURCES AND COMMUNITY DEVELOPMENT
DIVISION OF ENVIRONMENTAL MANAGEMENT - GROUNDWATER SECTION
P.O. BOX 27667 - RALEIGH,N.C. 27611, PHONE [phone]
280822
WELL CONSTRUCTION RECORD
DRILLING CONTRACTOR 4- &4i /N/1-LLL L
DRILLER REGISTRATION NUMBER 3C'Y
FOR OFFICE USE ONLY
Quad. No. Serial No.
Lat. Long. Pc
Minor Basin
Basin Code
Header Ent GW-1 Ent
STATE WELL CONSTRUCTION / PERMIT NUMBER: / /6
1. WELL LOCATION. (Show sketch of the location below)
Nearest Towne-���/a1-C.11 P 5'.fn / �e- County. WOO !+.%D<7(1_
) ,f) H ! Cc_Q-r-K- Depth DRILLING LOG
(Road, Commu�n,14y, or Suhd-J{-vision and Lot N .) From To Formation Description
7a
2. OWNER La) 1) 41-tit a-2_ p1}�fYl2e
ADDRESS �.L! L' U I &LLL. / %7 L° % z Of
�C+.� 1
StF et or R u e NoJ (�,� t t� (�,� �--1 A Cr AA[ (e ,
/,(,(eLjn v)7/e k/C_ s/%g i.
City or Town State Zip Code -1
3. DATE DRILLED X -//S'V USE OF WELL %tt!'iLAttC'_�-
4. TOTAL DEPTH 7'7 J i CUTTINGS COLLECTED ❑ Yes ITV No
5. DOES WELL REPLACE EXISTING WELL? El Yes `T No
6. STATIC WATER LEVEL: Lin FT. ❑.above TOP OF CASING,
[�y below
TOP OF CASING
GGcIIS / ET. ABOVE LAND SURF/ACE.
7. YIELD (glom): ,2L-t METHOD OF TEST �( h Z2-S .
8. WATER ZONES (depth). :7 t - d - 1 p YYI I'
9. CHLORINATION: Type /7 T/-/ Amount % C/ 4 ! ) H S
10. CASING:
Wall Thickness
Depth Diameter or Weight/Ft. Material
From From To Li Ft (L t t I "Jt/C
From To Ft
From To Ft
11. GROUT:
Depth Material Method
From �' To o/i Ft. -Fite mot? -fS
7-Crip
From To Ft.
12. SCREEN:
Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
From To Ft in in.
13. GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
It additional space is needecalsej2a,cR-1P: form..
LOCATION SKETCH
(Show direction and distance from at least twowoSta Roads,
or other map reference points) cz
CD o
CD
—1 c c
N a:
O ,<r
N rt.
r1cn
17
E
rn
14. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15 NCAC WELL CONSTRUCTION
STANDARDS, AND THAT A COPY OF THIS RECORD HAS ID B EN,PROVO THE WELL OWNER. / \9 _ 3 0 - 0_3
Ai Alt �. �YL ei
7
SIGNATURE OF CONTRACTOR OR AGENT DATE
GW-1 Revised 6/88 Submit original to Division of Environmental Management and copy to well owner.

GW-1 Revised 6/88
NORTH CAROLINA DEPARTMENT OF NATURAL RESOURCES AND COMMUNITY DEVELOPMENT FOR OFFICE USE ONLY
DIVISION OF ENVIRONMENTAL MANAGEMENT - GROUNDWATER SECTION
P.O. BOX 27887 - RALEIGH,N.C. 27811, PHONE [phone] Quad. No. Serial No.
2 O r7 Lat. Long. Pc
<. t Minor Basin
WELL CONSTRUCTION RECORD Basin Code
Header Ent. GW-1 Ent
DRILLING CONTRACTOR .n h n /t, c g!>
DRILLER REGISTRATION NUMBER
:2L./2
STATE WELL CONSTRUCTION /4/U .
PERMIT NUMBER:
1. WELL LOCATION: (Show sketch of the location below)
Nearest Town - /i ' t e-- County:-Gi-L,/ C1/O6
•
1- -'1U clS' % rr rteS k 4' , -P ✓ t
(Road, Comm or Suddivision and9cL1nEs
o.)
2. OWNER G44r/C' ADDRESS / -�J 3 h CLLA1v�/r -
/I (Street or Route No.) g go,
I a, �6
/i, Cugnr cut llL1 VC_
City or Town State Zip`NCode
3. DATE DRILLED R --QQ _6-3 USE OF WELL lt-Qfl IGIP.- ��1
C/
4. TOTAL DEPTH LOOL I CUTTINGS COLLECTED El((
Yes LrJ-No
5. DOES WELL REPLACE EXISTING WELL? ❑ Yes it No
6. STATIC WATER LEVEL: t/0 FT above TOP OF CASING,
E below
TOP OF CASING/)S / FT. ABOVE LAND SURFACE.
7. YIELD (gpm): // ;9_ METHODHOF TEST Ade6
•
`f
8. WATER ZONES (depth): Gl f.7 I ` //a 1 p M
9. CHLORINATION: Type /-1 7/ / Amount 7 *A/J5
•
10. CASING: Wall Thickness
DepthDiameter or Weight/Ft. Material/�
From /9 To O q Ft Ir Y
/ V ct'
From To Ft
From To Ft
11. GROUT:
Depth /1 Material Method
(From To c2/:" Ft. EL {1'LL' /8j-
From To Ft
12. SCREEN:
Depth Diameter Slot Size Material
From To Ft. in. In.
From To Ft. in. In.
From To Ft in. in.
13. GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
14. REMARKS'
Depth DRILLING LOG
From To Formation Description
((e«
I,tCI It / t
if additional space is needed use bacRf fois@;
LOCATION SKETCH N oc_
(Show direction and distance from at least tvlIDStatir.Flgads,
or other map reference points)
"O rn
tV 0
c
N -'
Ql
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15 NCAC 2C, WELL CONSTRUCTION
STANDARDS, AND THAT A COPY OF THIS RECORD HASf3.ENPROVID D Q.O THE WELL OWNER. .3n , U
SIGNATURE OF CONTRACTOR OR AGENT DATE
Submit original to Division of Environmental Management and copy to well owner.

NORTH CAROLINA DEPARTMENT OF NATURAL RESOURCES AND COMMUNITY DEVELOPMENT
DIVISION OF ENVIRONMENTAL MANAGEMENT - GROUNDWATER SECTION
P.O. BOX 27687 - RALEIGH,N.C. 27611, PHONE [phone]
WELL CONSTRUCTION RECORD
280824
FOR OFFICE USE ONLY
Quad. No. Serial No.
Lat. Long. Pc
Minor Basin
Basin Code
Header Ent GW-1 Ent
DRILLING CONTRACTOR 1-AD b 1 n e-)F_ 8 3
a g STATE WELL CONSTRUCTION
DRILLER REGISTRATION NUMBER 7' PERMIT NUMBER:
1. WELL LOCATION: (Show sketch of tpe location below)
Nearest Ton
G1�
(Road, C nity, or Subdivision and Lot No.)w,.
2. OWNER / 11 ('.k C�it CLLLaci J
ADDRESS 1' o 87 /
1 (S reef or Route No.)
EL/CLK 1 tryC, 07 g `7 L i
City br Towrf State Zip Code
3. DATE DRILLED ? -) 5 "03 USE OF WELL Rk314 n,,)_'rrc1,/''4--Z
4. TOTAL DEPTH / �-f 1 CUTTINGS COLLECTED��{1 11El Yes L�..No
5. DOES WELL REPLACE EXISTIEltA NG WELL? Yes No
6. STATIC WATER LEVEL: /40 FT. ❑ above TOP OF CASING,
M. below
TOP OF CASING IS / FT. ABOVE LAND SURFACE.
7. YIELD (gpm): /n METHOD OF TEST /7 /2.S
8. WATER ZONES (depth): ///1 .`J 1 — /Or-� m
9. CHLORINATION: Type i-' %I-1 Amount O')
10. CASING:
Wall Thickness
Depth Diameter or Weight/Ft. Material c-) -:;
LOCATION SKETCH C)
From (.l To `! Ft In V `- (Show direction and distance from at least IwtatBc�toads,
From To Ft or other map reference points) p __
From To Ft. r- c
11. GROUT: N clr
Depth /1 Material Method N
From t To Jr) Ft. e,..„. „_:„_( l / Z
From To Ft.
12. SCREEN:
Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
From To Ft in in.
13. GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
14. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15 NCAC 2C, WELL CONSTRUCTION
STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PRO ID D TO THE WELL OWN 3 (j ,Q 3
yf) ir)124� .
SIGNATURE OF CONTRACTOR OR AGENT DATE
Submit original to Division of Environmental Management and copy to well owner.
County:
Depth
DRILLING LOG
From To Formation Description
GW-1 Revised 6/88
If additional space is needed use backai torn

GW-1 Revised 6/88
NORTH CAROLINA DEPARTMENT OF NATURAL RESOURCES AND COMMUNITY DEVELOPMENT
DIVISION OF ENVIRONMENTAL MANAGEMENT - GROUNDWATER SECTION
P.O. BOX 27687 - RALEIGH,N.C. 27611, PHONE [phone]
2025
WELL CONSTRUCTION RECORD
DRILLING CONTRACTOR 6b h / N LL/£ R R
DRILLER REGISTRATION NUMBER a /
FOR OFFICE USE ONLY
Quad. No. Serial No.
Lat. Long. Pc
Minor Basin
Basin Code
Header Ent GW-1 Ent
STATE WELL CONSTRUCTION
PERMIT NUMBER: / .4' "
1. WELL LOCATION: (Show ketch of the location below)
Neares Town: - CT-14_1
usA/0 Vt-
laer
(Road, C6mmunity, or Subdivision Lot No.) j�
2. OWNER c nI 1 )t r 41 + J,_J'bl'1C.1, t C7US ern
ADDRESS I" DK" a 756
(Street or Route No.) v /
0 _ c���-� ) /X/ C -2 5
City or Town State Zip Code
_ 1
3. DATE DRILLED O " ) 3 - v3 USE OF WELL 1`tC-d -4 C'i 1�1a,,��11Y,, / et(
4. TOTAL DEPTH 71)L v CUTTINGS COLLECTED��/,,❑ Yes .LJ No
5. DOES WELL REPLACE EXISTING WELL? D Yes 1 No
County: fry LC)GGC,l
Depth DRILLING LOG
From To Formation Description
7f1%si ftt
6. STATIC WATER LEVEL: I cC) FT. Di above below TOP OF CASING,
TOP OF CASINGIS FT ABOVE LAND SURFACE.
{ re
7. YIELD (gpm): 71L METHOD OF TEST - Iv� A as
8. WATER ZONES (depth): `-� B v i/C pry-,c
9. CHLORINATION: Type H hl Amount SZ' FL.f5 .
10. CASING:
Wall Thickness
Depth 1 / Diameter or Weight/Ft. Material
From To / / Ft /t' if 1.)
From To Ft
From To Ft.
11. GROUT:
Depth Material Method
From To 2- Ft. Ott ) T.0 0- 1-673
From To Ft.
12. SCREEN:
Depth
From To Ft.
From To Ft.
From To Ft
13. GRAVEL PACK:
Diameter
Slot Size Material
in. in.
in. in.
in. in.
Depth Size Material
From To Ft.
From To Ft.
14. REMARKS.
If additional space is needed use tack ortorm.
LOCATION SKETCH
(Show direction and distance from at least two Sta Roads,
or other map reference points) W
O c' —
n
N E
O 5'
�C r;
n-'
N m
0
Q1 G
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN A CORDANCE WITH 15 NCAC 2C. WELL CONSTRUCTION
STANDARDS, AND THAT A COPY OF THIS RECORD HAS EEN PROV TO THE WELL OWNER. 2� y 3n
SIGNATURE OF CONTRACTOR OR AGENT DATE
Submit original to Division of Environmental Management and copy to well owner.

NORTH CAROLINA DEPARTMENT OF NATURAL RESOURCES AND COMMUNITY DEVELOPMENT
DIVISION OF ENVIRONMENTAL MANAGEMENT - GROUNDWATER SECTION
P.O. BOX 27887 - RALEIGH.N.C. 27811, PHONE [phone]
WELL CONSTRUCTION RECORD 280826
DRILLING CONTRACTOR ---RD L / iV /-0C- L. A
DRILLER REGISTRATION NUMBER
FOR OFFICE USE ONLY
Quad. No. Serial No.
Lat. Long. Pc
Minor Basin
Basin Code
Header Ent. GW-1 Ent
STATE WELL CONSTRUCTION
PERMIT NUMBER:
7 /'
1. WELL LOCATION: (Show sketch of the location below) Nearest Town: lJC✓E S�County: Lc()A_
a -)j) k_ 1O(,J
S Depth DRILLING LOG
(Road, Commu tyr r Subdivision and L2t)No.)
2. OWNER -C'%O'_,lx-- L-U-t- L 0 '• 1
f-' 13 COBS
(Street or oute No.)
ADDRESS
(.C.0
City or Town State Zip Code
3. DATE DRILLED �-( / - 0-3 LRJ&
USE OF WELL ))A_Un l�Li1;,..Z
r¥
4. TOTAL DEPTH / / `1. CUTTINGS COLLECTED�x,El Yes t4I. No
5. DOES WELL REPLACE EXISTING WELL? ❑ Yes IZJ No
6. STATIC WATER LEVEL: FT. 0 above below TOP OF CASING,
TOP OF CASING/ 'IS/ Co FT ABOVE LAND SURFACE.
7. YIELD (gpm): (! T METHOD OF TEST -,. iR r5
8. WATER ZONES (depth):
9. CHLORINATION: Type /4 -17-/ Amount <714-s
10. CASING:
From To / For ation Description
11 Y /C.4 l
If additional space is needed use back of form.
' / I �1 r LOCATION SKETCH c
From Q To _u' `t Ft LP I t v �� (Show direction and distance from at least t�Sta�Roads,
From To Ft or other map reference points) CO n_
C) ^r
From To Ft (--r-i
11. GROUT: IN) o<O
Depth Material Method =+cam
From To 2 D �1 Ft. C 0-14_Fsi -I �t p 3 -^'r,
N
From To Ft. IV rn..;
cT
N
12. SCREEN: cn a
Wall Thickness
Depth Diameter or Weight/Ft. Material
Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
From To Ft in. in.
13. GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
14. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15 NCAC 2C, WELL CONSTRUCTION
STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDE T THE WELL OWNER.
(-Cl y 02 h ALL NL�,
-3z, 3
GW-1 Revised 6/88
SIGNATURE OF CONTRACTOR OR AGENT DATE
Submit original to Division of Environmental Management and copy to well owner.

NORTH CAROLINA DEPARTMENT OF NATURAL RESOURCES AND COMMUNITY DEVELOPMENT
DIVISION OF ENVIRONMENTAL MANAGEMENT - GROUNDWATER SECTION
P.O. BOX 27687 - RALEIGH.N.C. 27611, PHONE [phone]
WELL CONSTRUCTION RECORD
DRILLING CONTRACTOR t S..
DRILLER REGISTRATION NUMBER
280813
FOR OFFICE USE ONLY
Clued No. Serial No.
Lat. Long. Pc
Minor Basin
Basin Code
Header Ent. GW-1 Ent
STATE WELL CONSTRUCTION / �U 2
PERMIT NUMBER:
1. WELL LOCATION: (Show sketch of the locafion below)
Nearest To
(Road, Comr a or Subdivision and t No.)
2. OWNER (11..41A--a- '^' %�V{r .0
/
ADDRESS I ri L. (-^if-)A
$. (Streakier Route N,o.) le
Gjitior Town tate ppZip Code
3. DATE DRILLED �/ /-/6 _t 3 USE OF WELL 1?LAtLAP-8.3//t{
4. TOTAL DEPTH 'Y6.5 CUTTINGS COLLECTED ❑ Yes VI-No5. DOES WELL REPLACE EXISTING WELL ElYes 54 No
County: !-la -(f 1.01000'1
Depth DRILLING LOG
6. STATIC WATER LEVEL:
TOP OF CASING IS /
7. YIELD (gpm): zl/METHOD OF TEST _ /0�s'.
8. WATER ZONES (depth): 3('d c pn-
C/GD.S / - prn / [/
9. CHLORINATION: Type 1 H Amount (nl% 4A t4
so
1
10. CASING.
FT ❑ above TOP OF CASING,
below
FT. ABOVE LAND SURFACE.
Wall Thickness
Depth
/ 7 Diameter or Weight/Ft. Material
From To `Z r/ Ft 4.. r/ » V ( (Show direction and distance from at least two State Roads,
or other map reference points)
From To Et
From To Ft
11. GROUT:
Depth �J Material Method
From From a To xl� Ft. (i�_.i cd-tt 1 �t-
From To Ft. v
12. SCREEN:
From
To Formation Description
n
0
r1
If additional space is needed Use back
(1 Tm.._.._.t
Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
From To Ft in. in.
13. GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
LOCATION SKE
9Z:Z idd 03130E0
14. REMARKS.
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15 NCAC 2C, WELL CONSTRUCTION
STANDARDS, AND THAT A COPY OF THIS RECORD HAKEPROVIDE _rq THE WELL OWNER. , �J-) _ 3 D - O
SIGNATURE OF CONTRACTOR OR AGENT DATE
Submit original to Division of Environmental Management and copy to well owner.
GW-1 Revised 6/88

3 DATE DRILLED
NORTH CAROLINA DEPARTMENT OF NATURAL RESOURCES AND COMMUNITY DEVELOPMENT
DIVISION OF ENVIRONMENTAL MANAGEMENT - GROUNDWATER SECTION
P.O. BOX 27687 - RALEIGH,N.C. 27611, PHONE [phone]
280812
WELL CONSTRUCTION RECORD
DRILLING CONTRACTOR s
DRILLER REGISTRATION NUMBER a ` / "/
FOR OFFICE USE ONLY
Quad. No. Serial No.
Lat. Long. Pc
Minor Basin
Basin Code
Header Ent. GW-1 Ent
STATE WELL CONSTRUCTION z/z)
PERMIT NUMBER:
1. WELL LOCATION: (St'.
Nearest Town.
-h of the location below)
7/- a.--gn6S I/ r /4-'
`oAzbi{1 x 2
(Road, Commeni • Subdivision and L' t No ))
2. OWNER —
ADDRESS /377 _L.L.Lbt,.' , pd
County:
Depth
From
/IQ C/ Lc)0 0 4_
DRILLING LOG
To
'
Formation Description
(Street or. R ute No) �Cr 7 L'� i
L��%L h,F.6u) r9E, tic_ .,2786
City or town State Zip Code
4?-I q -1T3 USE OF WELL n.Ca, Cl P At_19-r�-1-
4. TOTAL DEPTH ,�S/.}� / CUTTINGS COLLECTED ❑ Yes 1 f No
❑ Yes L19�No
PI above TOP OF CASING,
below
ABOVE LAND SURFACE.
5. DOES WELL REPLACE EXISTING WELL?
6. STATIC WATER LEVEL: 40 FT.
TOP OF CASING IS
IIS^S FT II
7. YIELD (gm):): C-(�f METHOD OF TEST . 4l wn-5
8. WATER ZONES (depth)
9. CHLORINATION:
10. CASING.
I8S' InL>t
Type /g /
Amount 2 7 b i#S
Wall Thickness
Depth 77 Diameter or Weight/Ft. Material
From I)Too4 �-' Ft r 1 p U c
From To Ft
From To Ft
11. GROUT:
Depth
From 0 To ,(2- Ft
From To Ft
12. SCREEN:
Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
From To Ft in. in.
13. GRAVEL PACK:
Material
Method
Depth
From To Ft.
From To Ft.
14. REMARKS:
Size Material
r l) �h-ll
[FILL
0
If additional space is needed u9e' bark of form
LOCATION SKETCH
(Show direction and distance from at least two STBte.RDadsf
or other map reference points)
O
W
O
—i
O
"O
N
0'
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15 NCAC 2C, WELL CONSTRUCTION
STANDARDS, AND THAT A COPY OF THIS RECORD JHAS BEEN PROVI JEJ TO THE WELL OWNER. �L� �� 3L� j
SIGNATURE OF CONTRACTOR OR AGENT DATE
GW-1 Revised 6/88 Submit original to Division of Environmental Management and copy to well owner.

281433
WELL CONSTRUCTION RECORD
Nonh (':uolina - Dep:lruuunt of l]nvironmenl and itural Resources - Division of Water Quality - Groundwater Section /��/
\\1(t.I, CUNT I(1(L 1011 IINOIVIDt'AII N.\\IE (print) )�5 A('-[, l)Q �� CERTIFICATION �q�/K//M
,\I LL l'ON R.\('I'OI: COyII' .\S1'N.UII' ,1,0(2/
I.\lT1 \\ I-.I,1. (ONSIl(C ("I'ION 1'I(IRNII'ra
ili ahp!ieablel
i
ASSOCIATED \\ Q 1'E1<'11 f6
(seal),I licubie)
I AA'LI.I. USN (Chock Applicable Ho.N): Residential R.—Municipal( Public 0 Industrial D Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump \'v'a'::r Injection 0 Other 0 I[Other, List Use
\\LLL LOC:\ I ION:: /
Neal csi.1,w11 UTAVNC;
n
NI ea, Alan:. Numbers
kfe
VI it __,_ Cu11n1 f /Vero
/
Ile. Snb,IIcF>i:al- Ln1 No Zip Coda
\ddlc,
ISrccl of Rowe No.) S�
�"� I, el u,rn Stale Zlp Co& I-IUIII f0
SS' )- 5-316 — S/72 G /o
is I,,,n nnlllh:ii, g o 3 /o 021
t I).\Il ()I:II LI,t) L/
DlEALDEPTH) 0.. Lye.- 305-•
7 S lAIIC AVATCI. LEVEL Below Top ol-Casing: (00 ET.
(Ilse "*' it Abouc Top or Casinpl
S. TOT' OE CASING IS •• Pr. Above '.anll Surface*
-alp ul casiu„ It'I'n,lllall'd al/or Inlay, I:uul surface re;;:tires a
c,,riance in accordance with 15A NCAC '_C J)I18.
YIELD leplu): 3 MET' KM Of TEST Air -
I{) VATER ZONES (depth):
I. I HSINEECIION. 'Fyne _((� Ain) tint
12 CASING: Wall dhickitcss
I tenth Diameter or V. ciuht
^^�� ll_ :blatclra
I rout 71-1 To ,x� I-t. �V e/fl c5Yrs&
lain _._ ri,------ PL- ---._ __ -.- ---.-- -
( Itl )l'l' Dchlb��/l CN cri VIcthad
Horn 11, 25 - :L
h DOES VVEI I REPLACE EXISTING WELL? YES ❑ NO
✓M�
11111E _-__- I10
I -I NIILI. I)N'. Ucplh Dcmlcler Slut:-.ic .AIaleli,11
I 11*111 Tu _I1.
I I0111 To it
DepthSim
17on1 In El. _--
I l,n..
r,. ItI:AI:ARICS:
I:J trial
opographic-[_and setting
ILidge ❑Slope ❑Valley ❑Plat
I; h.ck appn p, aIc h, x l
L:uitudc'loneitudc oli well locution
(ICgrecs, lainulesisccouds)
udcilonoitude sourcc:0GPS01 opourupllic niap
Ickeck hall
DRILLING LOG
IiiAniation,Description
sseriplV 'm�a��
4-TSi4w�
CD G;
rn
n
I
G)
_.
LOCATION SKETCH N V m..,:
Show direction :nut (II51tince in mules Rural IC 1:1
(wo stale Roads or County Roads, Inc!,Elio r��gfad
numbers :Hid common road names.
I I )11 IIliltIliY CLK I IPY'NIA TTHIS WELL \VAS 0 NSTItUC'TED IN ACCORDANCE \VITI1 1SA NCAC 2C, WELL
-UNS EUCil ION STANDARDS. AND TIIAT A COPY OF THIS RECORD I IAS HENN PROVIDED TO T IIE WELL OWNER
2 1
I o3
SIGNATURE OF PERSON CONSTRUCTING TILE WELL, DATE
Submit (he original to the Division of \V;iler Qu:.lity, Groundwater Section, 1636 Mail Service Center- Raleigh, NC
7609-16161'Iumc Nu. (919) 7}I-tI'_1, \vithin 30 days-IG.Ib Mimic Nu. 1919) 7}I-i721. Ivithin }LI (lays. CM -I REV. 07/2001

281432
WELL CONSTRUCTION RECORD
.North ('nrolinu - Department ni Environment and /�(`")JMarla/}'IRresources-IDivi1sion orVAlater Quality - Groundwater Section 4
\\ FIT ('ONl It.((' IOlt tl\UI\Illh\t.) N.\\lE (Vriut)"/( )TI'\rr,, {/k g}LO/Lee CERTIFICy\�TIONN-#`741�/
\\III.( )%-iu\(,l)lt( MI l'\N\' NAME Brie-(.\Jell-J-1�/11 -. ------ ---.IIIONL: H f�Ss) 627-5:vg
S I CET; \\(.I.I. ('ONSI'Itt'CI'ION ri...i \l rut .\SSOCI:V! EI) \\Q 1'EIt\II't1
I irapplicahlc) (ir.pplicahle)
I AVli.I_ LSE {(heck Applicable 13ox): Resider: '.:d E IA luniripul)I'ublic 0 Industrial 0 ACgricullural ❑
,Vlonitto inu ❑ Recovery 0 Heat Pump AVa:cr Injection ❑ Other ❑ II Other, List Use
it)
VAIiI.I.. I OC VIION: v/
N u •st Iowa ClkP� _. (loner//Q »JIJ
ass _Gve_
I�Oae1 Nmua. ".wnbo:. (l. int:: ),. Subdleisi.nl- 1oi N., lip C.nlet
1 )Ab NI1(TR.9/vl OC
JL
:\tldi cis.; f fi ELJ
C1/Oe ISn.cI nI I:awc
l I,vnr tune} `a,1: /q,(„dc
) az� 0776?
\ie:. code- I'lemc mm�hs
D:ATI. DRII.I .h.D -G 3
rOTAI. DPI' III: SOS
DOTS WILE_ I:GI'LACIi EXISTING WELL:'
S VATIC WATLl( LEVEL I3clow Top or Casir
it/se I .vanc
I OI Or C \SIN(, IS I f Above
T 1 illcave R wi,rtlul ,II r berm 1 m I. urF,c • re:;
vuruuu, iu accordance a with I5:\ \CAC 2C .I)113.
11[LD tytini): /e 1\MNI I I0D 01' TES
WATER ZONES (depth):
YIiS ❑ NO ri
3 7 I- I.
lop or Casing}
.and Surface-`
!drum,
I I. DISINFECTIONTypeT Atiic uit
12. C:ASIN(i: AVall hic-;iic.9
Ucpth Dlµmder or V. ci gill I t. :Nt; teri;d
Hum 02 To jest/ IT. 6 //y , i8 a�ee /
heat _ _lI, _____._
Drum -- ro 1_I,_—_
I7 (I1(IL' 1_r'
1 Depth // Material NIethnd
I Intl I.
-I-n-._p2U IEl'CNT/
1101.1 rt'- ___ . _ I.1. --- -- --- _..---- ---
I-I. SCKI. ITS Depth Ilt:unaler Slot tore NI.ecr'inl
Reel l0 It _._ iII. in
I lone I,, H. 1
S:ANI) (dLVVo.l. I 'ACIK'.
Depth Size Al::(cant
I -tom llo --_— PL_
Iti. ItF:AI:ARKS:
opoti,rttpltieltand setting
Lit! c ❑slope ❑V Ilcy ❑19at
I h ck ;trproptulic ho sl
Lull ludo longitude 01' well Iocalion
I dcgrccs:Iu ln,,lcsixconds)
Linittidelomtitude sourcc:DGPSOTopogrnphic map
(check Ise s1
DEPTH DRILLING LOG
From To I: I ati 1 Description
0 ao 10-
/3S
�— 07CC
4W
a(OS<r-e
ray%f
O
(-1
1
LOC'AIION SKIfrC'If CO
Show direction and distance in miles Iror.Uit Icp t—
two Slate (toads or County Roads. Include -the rx)21=
numbers and common road names. tV rri
na
/33
I OD l IIfl1Nl1A C'IAc III'Y TI IA"r THIS WELL WAS CT.'NS"IRUCTED IN ACCORDANCE \VITI I ESA NCAC 2C,
l ONSTRUCI ION STANDARDS. AND THAT A COP' 01: THIS RECORD I IAS BEEN PROVIDED TO 1I IE WELL OWNER
11%
V SIGNATURE Or PERSON CONSTRLCTINC THE WELL. DATE
.Submit the original to the Division of \\later Qu: lily, Groundwater Section, 1636 Mail Service Center- Raleigh, NC
27699-1616 I'hunc No. (919) 733_3221, ss ithin 30 do's. - Ci1V-I REV. 07/2001

WELL CONSTRUCTION RECORD
Noah rmolin:l - Deoartmeni of Environment and Natural ill,
- Division or Water Quality - Groundwater Section,/
\t I I I. l-(/\I II O I OR(I\11I\ 111t'.\I.) N (print)Xe r �' I. I4-4O%I/ e- CERTIFICATION # �Y�
\\LI.I.(ll\'Ilt\('1'I OR (C(1\II'.\\\-\.\\II f'r/ce_we/l tit'l, _ _---._--_-. --_-- PHONE It (52g) Na7'1e,5W
\ I A.111 \\ t.1.L CO\ STRICII0N PERM it# ASSOCI.\'t El) \\Q 1'EIUIIT#
(il:gaplie Ihlel tit up vl licnhle)
alma
281431
VA'I.I.I. USE (Check Applicable 13ox): ResideiLOI 07 6funicip:lil'ublic ❑ Industrial 0 Agricultural ❑
Monitoring ❑ Recovery ❑ Beat Pump AVu:..r Injection 0 Other 0 If Other, List Use
_ \\'till. LOCATION: I/'p
NCllresl Town. �q1 /�/`s✓ / ('Pllnl
01
I1M1eel A.Inle. Number.. (mnnanuv, Suhdk l s tun. I of No
(1\ANII.It:,1`i3-µV%�/� !/ ne_
.\\Idle„ 3— eo -. f'f
hIca ul Rom: Nu.l
wd�/Nest///, fILC s
(lls,''Io„II MAR: /tp ('wte
- Q__93g
/Ip C,de
Vm :isle Photo amnb:r
-I_ ()AA h
fOTAI.I)N:PTLE. 3Qs �
DOES VAIlLI_ I:EW
PLACE EXISTING L!LL? 1'IiS �'NO ❑
7. S I':ATIC AVATBR I.IEVHI. 13clow Top u[Casin /cc ET.
(IJse.. "it nhoce Top o!Casinpt
1'(11' OP CASING IS 2 FT. Above !.and Surface'
'lop incasing iernliu.ne,l a1/ur belle\ land surface rer•:ires a
variance in accordance vith 15.k \C;\C 2C.1111X.
'1. I.IFLU (epnt): �,` VML!TIIOD OF TESTi'i/
u vVATI'.lt ZONES (depth):
I I. DISINIIICT ION. Type // 4 Anl :1n1
�opographie Lan(( setting
Ittduue ❑slope ❑Valley ❑Flat
(cheek appnipnate buy,
Latitude'Iuneimde of well location
t degrceilni uule,sLseewtts)
L:(thole:loncilwle sourccDGPS❑Topu__raphic map
{cheek hull
DEPTH DRILLING LOG
I -rum To Hint t Deseriplion
0 ICJ ��
—20 1C. o—___
/C5- /as /41v +/
/Js 32r ✓n�
CASING: 'Wall ;licitness
Depth D�i":uydcr or V. cichtll_ :Afaleri:tl
Flom �'� Tu / L 3 PE 4' /� / /f Xke/
I oot Tu----- -- EL—_...--
Enmt_._
)CT : Depth Maleri;d Method
hen Q To 020. - Il._.-:
I tom lit
I S( I.I.EN Depth Di:uneter Slut.', /c ,Material
Itom fo It...
I min
IS S:\NI)'(iKAV I i!.I'A('K:
Depth Size .\LOCIlal
role
(hint To__
t 11AI:\RI:S:
O '
Ca)L
n
t - —
LOCATION SKETCH W
Show direction and distance in miles from\t)t Ie:rt,
tAAU State Roads or County (toads. Inclu(le=+he I-0*E
ttutnbei s and common mad names. N m ra t
rt
no a-
/3c
1 I'(1111110 IlY CERTIFY IFY TII Af THIS WELL WAS C(NSTRUCTED IN ACCORDANCE AVITA I5A NC AC 2C, WE
(it iNA I RUCTION STANDARDS. AND THAT A COPY OF PHIS RECORD I I AS BEEN PROVIDED TO I I IE AVELL
—tom 03
�SI(1NAI'URE OF I'ESSON CONSTRUCTING THE WELL.
DATE
Submit the original to the Division of Water Qv:: lily, Groundwater Section, 1636 Atail Service Center - Raleigh, NC
27699-1636 Plume No. [phone], within 30 day s. . GW-I REV. 07/2001

WELL CONSTRUCTION RECORI)
North Carolina - Department or Environment )ind dIti al Rcc)'ources - Division or Water Quality -
w i.LL CON II (' (Olt (INDIVIDUAL) NAME (print)[L/Cl '.71i "HIVi?e'
\\l:1.I.C(1\lN (-t'OII CO\II'\SS\.UIh:jLJae-es/elf 117b71 /:--____---------I•
5I All-: w kit CONSTRUCTION PERMED: ASSOCIATED wQ I'ER)II'rn
I iY ahplit.!I)le) (if )tp:l lOivable)
28143�1
Groundwater Section 2Ye(�
E R'rl I: ICAN 11
IICU\l:, n 1Z'llO6a ;g.
I AVLI.I_ USE (Check Applicable 13os): Resider :aI L9' tllunicipuDI tlhI c ❑ Industrial 0 A2riculturul 0
:Atom loving 0 Recover)' 0 I leat Pump Wa:er Injection 0 Other 0 IfOther, List Use
VA LI.I_ LUC'ATIONi,
N C �sl . /De co,„,, 9�Lg,J
Lo: No hip Coilco
(l\\NI::R:_/f}$1i/ Ysfir,"-PW7
/ ,/ (SIwct of iserpcNu.)
(VIA)
L /IA)e /1/ �- o2q_7.2 /
Topogra lhicl-ancl setting
❑Rid c L \lope ❑b lley ❑Elul
(check apt r I -a hu,)
Lalimdr. luneitudc or well location
I dcgrecs:uduule ;seconded
I itiuudJl umsi rude sourc¢OGPSDToporaphic map
(check hall
DRII.I-ING LOG
I:orn'ttiot Description
a /-O cic:q/VJ> 2' e
1-4NJ,1P
1)1-I'TII
(it‘ or Ion)) -L I- /ipCud, horn ru
) 627-lti%1V ozo
le)oste Ohms. nnmhs
.JF) /no
I) \II. DISH I I U- .20 -0 3 & /0/5
rOI\! UI'I'l-IL(-ROc"
DOES VATI_1_ REPLACE EXISTING WELL:' YES D NO
S VATIC VWATER I.I'.VEI. Below Top orCasinr): (o FT.
Ilisu"r" it Ahow l op of Casincl
'1 1' OF CASING IS FT. Above I-:md Surface'
`lop of cn•ing termini: (1 actor brlo't land surface rem •.:ires a
variance in accorilaIIC' %cith I5.\ NCAC 2C .III IN. _
VI1'LU (opnth ClNII:TI IOD OF TEST /4.r
\\' ATIiR 7.ONI!S (depth):
II. DISINFECT ION. Type Al_/27# Alo :Int
12- C:ASIN( \Vzll hiekne,ss
71-� Depth I)iaumtdi or\'. _iehl. Et. leri:d
Iltn t
Et 1.1111 _...--_ In"------ I:t.-- ---'------___" -__. —
--
Imnu lu PI. - - -------...
I CI Ri iL 1 - Ilepllt hletainl Alcthod
I tarn6 T„ -- Q-- 1'I.a67,.,c.✓rI _----_—_—
I UI!1 it,---.--i:t_------ ----------------
I I m.T.! iN Depth Diameter Slut �.lir \I:uerinl
I?. S:ANI) (II ,VA'IiI. PACK:
Ueptl) Size '\Ial eri:l
Ir, R. li\IARKS
CO ro
--pet
LOCATION SKE.TCI I W r__
Show direction and distance in miles Iron at ICa5K,"
tov) State Roads or County Roads. Include-1M
numbers and common road panics.
N f?.._
c
# /33y
111(1 I II)RNHY CEK Il ly 11 I:A r TIiBS WELL WAS C'1. NSII(UCTED IN ACCORDANCE AVITI I ISA NCAC 2C, AVE
INSII<(L I ION STANDARDS. AND THAT A COPY ()I: THIS RECORD I IAS BEEN PROVIDED TO TIIE WELL
SIGNATURE OF PEKSON CONSTRUCTING THE AA'ELI. DATE
r
1V
Submit the original to the Division of Water ()unity, Groundwater Section, I1\36 IAlail Service Center- Raleigh, NC
27699-1636 Phony No. (919) 733_3221, within 30 dads. CiW-I REV . 07/2001

WELL CONSTRUCTION RECORD
Nnt3h (.rolina - Dcpart!uent of Environment and N plural jtest) irces - Division of Water Quality
VA 1.1.1. COVE I .AC I OR (INDIVIDUAL) NAME riiI0X_//111 p n
N III ((p\I I(AC FOR CI)\ll CST N.\\II r' ce wed frili" '
\I\,I:"1.I.I. CU\SIRCCrION rI•:R\lIr# ASSOCIATED \\Q rh:i iIr
I!I:Ipl,lic:%l,lei - (iCapplicahlei
411J1fe.
I AVIII I. LSE (Check Applicable 'lox). I:csi(lcv.... VNlunlcipat !'tblic O
N !oni!nrinu ❑ ILecovery O Heat Pump Ab'u'.er Injection ❑ Other El11
Coon! g. y,,,opr/l.
Lot No.. Zip Cohlel
0 Ai
LO( \II(1N
Net sl rnttll ( yz).
�-
IA) of• Q j2
I1h'. el A.IIPIC. M1hhhnbcI<. Couanuuily. Subdnisi
OAA NIII::_.c4fiCt Ke-5
\,Idles /23 LIJL/CFlN
Stwei or Runic Na.l
,r"g/N Vi/t < • a 6
n .r lo„II r I�,n'�c�j /Ip Cvtc
vz)- 739'_ �3_6_L [
:Ate: cwlc Phone uuhnhehj
1. ILA 1 I! DI<11.1.LU // o2 03
IO"[Al. I)I'.I'TII:
(I. DOES VVELL I<LI'LACL EXISTING WELL? YI'�S 0 NO Et"'7. S VATIC AVA fL:R LEVI'.I. Below Top or Casir _72J FT.
IUsc'-*" it Abu,; Top olC wind
CASING IS FT. ,'Above Land Surface*
"I up nl vesil„ Ianhhin.n rt al/nr brlu„ laud surface requires a
variance is accordance with I5'. NCAC 2C MI IN. ,-
'I. YIELDI pui). DNIE IIOD OE TESr/9i
(!. \AAI Ills ZONES (depth):
L. DISINI:IICT ION. Type ,/v
C:ASING:
Di:pm:ter
-RIIla*oZ d o "jam FL to 41
I lood To
I tom
1. ICI : -_. Depth
Ilout fo
!-1 St RI I:N: Ogvh
I loth Ill_
S:A ND Y GKAVH.''AUK:
Ueplh Sits
Frond 1 _ hI.
Ilow fu
!II. ItI \ TARES S.
t.
Material al Nlethnd
AM! tall
281429
- Groundwater Section
CrIt FI IC:\Tl0N p a%b/
l•11()\r: # eiggi6d7i9<SSg
Industrial O Agricultural ❑
Other, I_ist Use
Topographic:I tit! setting
_ 12id c CJtilupe ❑V lacy ❑I:I:It
(cheek appnp a0. beta
Latitudelloneitude of well location
ttc yrceNminetes >ecun tsl
tilt Ic/lonn •itoite sourecO IPSOTopog rapllic map
'check ho>t
DRILLING LOG
I' rl atiu n Description
Noy
v e
r�r -fie
c
V D
Cs)
I11
r-D
I.00A I ION SKI•:T('l I 1 cr.-
-Show direction and distance in miles Irol4i'?u lei siI`�:
VVail hickness Lwo Slate Roads or County Road* Inclu(hrihc rEtarl-
or V. eight. Lt. N aerial numbers and common road names
Diameter Slot
in.
c \Race':it
I I11 1111!I![IiY CERTIFY TI TAT 1I11S WELT \VAS C( NSII<UCTED IN ACCORDANCE WIT 1115A NCAC 2C, W
(();NSIRLCIION STANDARDS. AND THAT A COPY OF THIS RECORD I IAS L31/EN PROVIDED TO II IL WEL
/N/9-03
DATE
ezt*-
50 NA FORE OF I'E=.SON CONSTRUCTING 111f. WELI.
Submit (he original to the Division of Water Quality, Groundwater Section, 1636 AI
27G99-16 6 Plume No. [phone], within 311 clan s.
N
c_o air
0
I Service Center - Raleigh, NC
OW -I REV.07/2001
i-7

281110
WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
CERTIFICATION #_t t3to
WELL CONTRACTOR(INDIVIDUAL)NAME (print) pests0( -IAnC•-g-k Gn se.
WELL CONTRACTOR COMPANY NAME Q--N`aae "tVb ca)q4A p:.ne PHONE s Bid (.042S- "GZ''
STATE WELL CONSTRUCTION PERMIT- ASSOCIATED WQ PERMIT#
(if applicable) (if appf le=�
I. WELL USE (Check Applicable Bo:): Residential Q' Municipal/Public ❑ Industrial 0 Agricutur
Monitoring 0 Recovery ❑ Hea' Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: i � wR• 5 Or: '1/4\c
wr Ric
(Street Name, Numbers, Community, Subdi ision, Lot No.. Zip Code)
3. OWNER: Q.avco 14,5rne.5
Address tS 1 Pak 1-con nV2'^"'t
County i-4tt-)/uJoot
(Street or Route No.)
{io\rnearA 199a0t..
\
City or Town State Zip Code
( )-
Area code- Phone number
4. DATE DRILLED \t-•o3
5. -TOTAL DEPTH: 305
6. DOES WELL REPLACE EXISTIN
7. STATIC WATER LEVEL Below 1
(Us
8. TOP OF CASING IS .1
*Top of casing terminated at/or below Iai
variance in accordance with 15A NCAC
9. YIELD (gpm): B METH(
10. WATER ZONES (depth):
G WELL? YES 0 NO d
op of Casing: e0 FT.
"+" if Above Top of Casing)
'T. Above Land Surface*
d surface requires a
'C .Ot18.
'D OF TEST R-)
Topogra�phic/Land se
[7Ridge E'Slope ❑Va'le
(check appropriate to
Latitude/longitude of well
(degrees/minutes/secend
Latitude, longitude source:❑GPS0
(check to
DEPTH ER
From To Forma
4\
1)1
305
11. DISINFECTION: Type I). t\ o
12.
CASING:
Depth Dianeter
From it To it Ft. toIII__
From To Ft.
From To Ft.
13. GROUT: Depth Material
From 0 To a0 Ft. C.ernert t
Amount a
Wall Thickness
or Weight/Ft. Material
Method
-etas-Leta
From To Ft.
14. SCREEN: Depth Diame'i:r Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Siz . Material
From To Ft.
From To Ft.
16. REMARKS:
- -
OvEL* (d.acde .-
LOCATION SKETCH
Show di ection and distance in roles from at least
two Stat ; Roads or Courty Road:. Include the t oa 1
numbers and common road name 3,
81:11 I1V 01 030 £0
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,'NELL
CONSTRUCTION STANDARDS, AND TEAT A COPY OF THIS RECORD HAS BEEI I PROVIDED TO THE WELL OWNER
SIGNATAE OF PERSON CONSTRUCTING THE V. ELL DATE
Submit the original to the Division of Nater Quality, Groundwater Section, 1636 Mail Service Center- Raleigh, NC
27699-1636 Phone No. [phone], wit hin 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Divisionryof Water Quality
WELL CONTRACTOR (INDIVIDUAL) NAME (print) DeCCve-x ..E]0.ojeca
WELL CONTRACTOR COMPANY NAME C-St- SaJ�eCA Scnto e�sa Pine
STATE WELL CONSTRUCTION PERMIT- ASSOCIATED WQ PERMIT#
(if applicable) - (if a Pcable
I. WELL USE (Check Applicable Bo c): Residential d Municipal/Public ❑ Industrial 0 Agricul
Monitoring ❑ Recovery 0 Hes: Pump Water Injection 0 Other ❑ If Other, List Use
281100
- Groundwater Section
CERTI'ICATION
PHONE # (Bra) Caro S
2. WELL LOCATION:
Nearest Town: rzsasc t Va1te15- County 1-iat.Jcod
(Street Name. Numbers, Community, Subdi ision, Lot No., Zip Code)
3. OWNER: i3;•bb‘.5 M,-.ne V.:. r+v
Address t"'to-gh J:+-.�-+p 'Ac-d
(Street or Route No.)
rnn.c f ,e- Va\ey . Ina
City or Town . to
(+aF )- G afn :3Y t s
Arca code- Phone number
4. DATE DRILLED 1t•.t't--o's
5. -TOTAL DEPTH: .3aaa
6. DOES WELL REPLACE EXISTIE G WELL? YES 0 NO Ed'
7. STATIC WATER LEVEL Below] op of Casing: !n'D FT.
(lit : "+" if Above Top of Casing)
8. TOP OF CASING IS .1 :'T. Above Land Surface*
*Top of casing terminated atlar below lard surface requires a
variance in accordance with 15A NCAC "C .0118.
9. YIELD (gpm): niO METH( D OF TEST R;q
10. WATER ZONES (depth): d
s17st
Zip Code
Topogr3.ph:.c/Land
[]Ridge C1SIope DV2
(check appropriate t
Latitude/longitude of w
(degrees/minutes/sec
Latitude, longitude source:❑GPSo
(check ox)
DEPTH • RILLING
From To Formation Descriptic
seii hg
❑Flat
am)�'
IE �< ation
r r
}(
7 L
3aa
1 I. DISINFECTION: Type D .11t Amount to
12. CASING:
Depth
From 4 t To 'l i
From To
From To
13. GROUT: Depth
From O To o2C Ft.
From To Ft.
14. SCREEN: Depth Diame: er Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Siz • Material
Wall Thickness
Dian eter or Weight/Ft. Material
Ft. (cy -eat pocsF'c
Ft.
Ft.
K rterial
Cef,ent
Method
v oycea
From To Ft.
From To Ft.
0VQ.L', a ioCol o'-+
&Ca-+s; he.
LOCATION SKETI )H
Show di 'ection and distance in ¢Iles from at least
two Stat Roads or County Road.. Include the Boa I
number: and common road name:.
r_.
cn :
0
0
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WE'.L WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND TY AT A COPY OF THIS RECORD HAS BEET! PROVIDED TO THE WILL OWNER
SIGNATI I OF PERSON CONSTRUCTING THE VELL DATE
Submit the original to the Division of ')Pater Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. (9I9) 733-3221, wit hin 30 days.
GW-1 REV. 07/2001

281726
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
R ELL CONTRACTOR (INDIVIDUAL) NAME (print) Mitchell D. Cook
WELL CON.' RACTOR COMPANY NAME P atItIn'S I'll Erini i, $L^ PHONE P ers) 369-9591
STATE WELL CONSTRUCTION PERMIT: ASSOCIATED 1VQ PERMIT
(if applicable) (ifapolicable)
CERTIFICATION 0 2043
I. WELL USE (Check Applicable Box): Residential L Ntunicipal/Public ❑ Industrial ❑ Aericultural D
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town. Waynesville County Haywnrxl
659 Orion Davis Rrl EBCI well
(Street Na:ne, Nu:nbe's, Comcorhy, Subdivision, Lot No., Zip Code)
3. owNpR,Samuel G. Ball Jr.
Address 659 Orion David Rd La
:Street or Roue No.)
Waynesville, NC 28786
City cr Town State
(828)- 452-4973
Zip Code
Area code Phone number
4. DATE DRILLED 10-8-03
5. TOTAL DEPTH: 525'
6. DOES WELL REPLACE EXISTING WELL? YES D NO [
7. STATIC WATER LEVEL Below Top of Casino: 90 FT.
(Use "-" if Above Top of Casing)
8. TOP OF CASING IS 2 FT. Above Land Surface'
'Top of casing terminated at/or below land surface requires a
variance In accordance with 15A NCAC 2C .0118,
9. YIELD (gpm): 30 NIETHOD OF TEST blow
10. WATER ZONES (depth): 95' & 490'
11. DISINFECTION: Type H T H Amount 16oz
12. CASING: Wall Thickness
Depth Diameter or AV'eight'Ft. Material
From 0 To 79 Ft. 6" pvc
From 79'To 83 Ft. 6 .188 steel
From To Ft.
13. GROUT: Depth Material Method
From 0 To 20 Ftb3rnite & caret pried
From To Ft.
14, SCREEN: Depth Diameter Slot Size tMateriai
From To Ft. in. in.
From To Ft. in. ir..
15. SAND.'GR.AVELPACK:
Depth Size Material
From To F:,
From To Ft.
16. REMARKS:
DEPTH
Front To
0 81'
81' 525'
Topo_raphic'Land settine
❑Ridge ❑Slope ❑Valley DFlat
(check appropriate box)
Latitude,'longitude of well location
(degrees%mi n::I s'secopes)
tudelontitude source.DGPSO T opograpchic map
„beck box)
DRILLING LOG
Formation Description
clay & ssrd
granite
LOCATION SKETCH
Show direction and distance in miles from a; least p
two State Roads or County Roads. Include the road (-0numbers and common road names. Cm
r ' !`
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
-e" .12 )5/P /o
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Nail Service Center - Raleigh, NC
27699-1636 Phone No. (919) 733-3J21, within 30 days. GW-1 REV. 07/2001
N lod.

281691
WELL CONSTRUCTION RECORD
North C arolina - Department of Environment and Natural - Di‘ 'stun of Water QualU.m - (:Ioundh‘uter Seel
/
NAME (print) ____ l/�1h.t.t11� ( F R'FI1 I( I IOv n
\\r;LL(ON'I'RACIi)R (INDIVIDUAL) f f1n\' /� ���� '/g -.'3/
N 1C O J 9_ `} -r Lt_7\. W - I'rioNF: N 1(k+(d 6
\\F:LL(Ov'llt:\C'T012 CO)i P,AN\\:\\IF;�--4�--���' - �1 -
\SSO(I.\'I ED \\ (J I'ER\IITa-
ST.ATF,AAF.1,1.picale) CONSTRUCTION PFaiVIITp - -- Irt applicable)
fit applicable) '
I. WELL USE (Check Applicable Box): Residential . Municipal Public 0 Industrial 0 Ag riculturul ❑
Monitorirc ❑ Recovery ❑ ilea[ Pump Hater Injection 0 Other ❑ II Uther. I ist I: >c__
•
2. WL1.I. 1.0C ARON
Nearest 'town: //e Court
-�l� 'Pam, evve,
1St ct�N,nna.Numhyr.youm,nunln, luhJiv>nn_fattlp ode)
3. OWNER:
Address
' (Street a Raul. No .)
1Q , t1C X 7 5 l
St.ua
Vrcu coda I'h,•nc number
d. DAI F. DRILLED 9 -9 -t 3
5. TOTAL 1)0'11e to /)S !
6. DOES W ELL REPLACE EXISTINGAAIL.L? V ES 0 NO
7_ STAIR.' WATER LEVEL Below 'Hp oi(Crising: 40 lit
il'.c _ ir-A6cyc lap of Coolie)
S 'FOP' OP CASING IS 1 1- 1 . Aboyc Land Surface`
*Top or casing terminated at/or below land surface requires a
Aariance in accordance with I A M AC 2( II1I8.
9. YIELD D lgpm)- 010 METHOD IES1 r2 kEsS
10. WATER ZONES (depth): 3.z5 ' — P --_ - --- 'S4C ln4 '1,F SE��i �}CICE
_595' Ji 5pm OC.vlIt)NS LICbet
%-L4_ iit.3_rbl.is . ',how dlr.:Limn old Jicianee c ium -u Ic.:,t
1I_ (ANIDISiLLC LION: Type 1ino.nu ttvn St,u: Roads or County Roach. InluJ HE: Toad
12. C,ASI A'C i_ Wall II icAno>
Uepth/ r, Di:uncicr nr AA i_ht la r.
_ AImm�al numbeand common road nark>.
from 7 ro d 1t. to /r _P vC
Itrunl To Ft.
1 roil To Ft_ -_. - _
(3. GROW 1 Depth nAiaterml Method
I rum tO r o ) FL -L-P-- 14-"1� 4 —
1 row l o Pr
14. SCRI.I.N_ Depth Diameter Slol Svc vLoma) "D __
Prom l o _. -._ Et. in. in. - �L __ _
Irom Tu It. in. __. in. ,G- c __
PI 7-;
I. SAND (,RAVE.[. I'AC k: O C'
Lend) Siic AIatstal F o
From fo Ft. ..
Iron] Tn
[(Tog aphic Land sett-1
❑RIJae Sl:lpe ❑Valley. ❑I- lat
(d,:J..:r;.:orisIIL hos
I .:node Ioneilude ul yell location
AI Le:
,�rnnW .:o,n.61
L.nitute lun^_Itudc storm.❑( IPS❑ I opts mpluc 1110E
� ,.A host
DRII.I_IN( i [(Ai
DI P1
min 11, I unnalitm Dcncnpn„n
6 ge —__ _
68 6l?�'
'7 a
16. RANI:ARKS:
I DU I16Rf;iil C 1,1(1111- IlI,A I l (IIS W LEI_ AA'AS ( ONS IRLC"I ID IN tA( (ORD AN( F. AA Ill) U.A NC AC 2C. AA LI.I.
CONS IRLC-IION ti FANDARDS. AND II IAT A ( ()I') (iITHIS RFCORI) I I AS Ili I N I'ROA-IDI-. I) IO 1 I11: AV I I_I. OU NI.R
4ZA
7/_ 3n -G 3
SIGNA'I BILL OL I'f RSON (r)NNTR(:( -I oft 11if AVl i 1. I) AI E:
Submit the original to the Division of VA ater Quality, Groundwater Section. 1631, AIail Service Center - Raleigh. y(
27699-I636 Rhone No. [phone]. vy ithio 30 days. (IAA' -I R6.V. 07 21101

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources- Division of Water Quoln>
WELL CONTRACTOR (INDIVIDUAL) NA(print) (print) _/` rtt, (TYMPANYWEI.I,CONTRACTOR COPANV NAND.l7CtL17� QY ._. ldct_11 `1 Pam
5'TA'fE WELL CONSTRUCTION PERMIT
tO
( if applicable) I if applicable)
281600
- Groundwater Section ('ERIIFI('tiTtONN 36'/ /
PHONE # — 617/8 - 3/ 7°
a550('1.\TED\AQ PER\II'rx
I. WELL USE (('heck Applicable I3ox): Residential I Municipal. Public 0 Industrial ❑ Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other ❑ I[Othcr. List Use
2. WELL LOCATION
Nearest Town: ��«i £<T77 2I2L County
Topoyphic/Land setting
❑Ridge Slope ❑Valley ❑flat
Ichcck appropriate box)
[Su cct N.unc. Numbers, Community. Suhdn a+am Lot 'xo..hip l'odc)
Latitude. longitude of well location
3. OWNER: / / /4Q ��jj� i-ID M �-th 7,, Pf Dj o' C� - --11 minus _ : ccond.)
Addr'ss i SL� p2 /1 Cm .L?., �' L.mtudc loneuu,1 source:O(JPS❑ topographic map
',beck boy)
(Street of ouK Na )
nFy l" // �
la
C .�. k inet OltI'l 1 DRILLING LOG
i
From 1h Ponnat on Description
in re, a State Zip11 3J
( / [j—C
( l-
Area coda Phone number
4. DATE DRILLED JO—/3-63
5. TOTAL DEPTH: _R!)..S'
6. DOES WELL REPLACE EXISTING WELL? 1'ES 0 NO X,
7- STATIC WATER LEVEL Below Top of Casing: / a 0 ET.
(U.c ,'' iL\hot lop of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
i .
"Top of casing terminated at/or below land surface requires a -_.- -.
canance in accordance with 15 \ NCAC 2(' MID( -'--- -- -
9. YIELD (grimy,3 METHOD 01 TEST �% C C - -
to. WATER ZONES (depth): / PS ' - Las ' .S1 p'"' . _ _ `. -.--
Loci Tic.) SKI T
t�l CF1
_ 'hype /�-�-3 Shoev nucction and di,tahca rfYuiies. from ,u IL tst
1 I. DISINFECTION: f e t Amount itc s '%S- too Sratc Roads or County Roads. Include the road
12. CASING: Wall llneknes., o
Depth Diameter or Al eight 1:1 Material numbers and common road moues.
2 0
From-D To .1 � ft.i_li_ -- QUC- O c,
From To Et. CI
From To Pt. CD
13. GROUT: Depth aMatcrial IAlethod 1 •
-�
From _ f; To „QS' Ft. (_P-41
From To Ft.
14. SCREEN: Depth Diameter Slot Size
FromTo Ft. in- in
From -_� fo _- Pt._ _in. - in
15. SAND'GRAVEL PACK:
Depth Size Material
Prom To Ft
Prom --.fo Ft
CD
16. REMARKS: -
1 DO IIERIADI CERTIFY THAT TIIIS WEI1. WAS COW RUCIED IN ACCORDANCE AFI II I5.1 N(Al'_(, WLLI.
('ONSTRDCIION S'I'ANDA D., AND IIIAF A COPS OF TIIIS RICO SBEEN PROVIDED l0II1E \tEI.I OWNER
ke_a2 . . __ // 3� ,63
SIGNATURE OF I'I.RSON CONSIRLA' 1111• UT11 DAZE
Submit the original to the Division of Water Quality, Ground'ater Section. 163o Nlail Service C eiWr I RI Raleigh,
St
DU I
27699-1636 Phone No. [phone], within 30 da)s.

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and al Resources - Uiv�isio�l ofAWater Qualit\ - Groundwater Section
1a1/s
c1:R�r1Eu�:v noN #
WELL CONTRACTOR (INDIVIDUAL) NAND, (Print)
WELL. CONTRACTOR COMPANY NAM
STATE WELL CONSTRUCTION PERMIT# _
lit applicable)
281689
'-G'TDONE # 1e.vn o L4J k - -3 / %C
L(-) __ _thso('I:CFED MO PER\II'rk
lit applicable)
1. WELL USE (Check Applicable Box): Residential Municipal Public 0 Industrial O :Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water election 0 Other ❑ If Other. List lice
2. WELL LOCATION
Nearest twit:
L
Stay -
County Lt-1/717
te. Numbers. Community. Suhdniston. 1 it No.. Lip ('del
3 OWNER: /i<L'O
Address 3 �iJr �p �C
r l h (StreetRoute No_1 o 7
ie
r „tit,'too noon State lip loJ:
)-
Area cola- I'honc ntnnhcrcoda- I'ho ie ntnnhcr
4. DATE DRILLED /L - 'J "Z)3
5 TOTAL DEPTH-
to. WATER. ZONES (depth): ,5/)6-/- 66,5-) 1/4/ - e---...-.- ---- ^� ``•'
��n LOCATION SKLT?l'H
11. DISINI'FC LION: Type ,11/-/ Amount / F..--i-b_1 .Shoo direction and distance in miles from at least
CASING: _ -VAall Thickness ttso State Roads or County Roads. Include the road
Depth Diameter or \\ eight It .Material numbers alibi common road II:utDOS.
From Q "Fo_, Pt. 4 //
From To Pt.
From To
13. GROUT Depth Almeria' Alc hod
From 7) To div Pt.
From To Ft.
14_ SCREEN: Depth Diameter Slot Si'c materiel
From To Ft. in. M. - —
1'Rll11 "Co Ft. in_ in_
15. SAND'CiRAVP.I. PACK:
Depth Size NIatcrid!
PL/c
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. SYNC((' WATER LEVEL Below lop of Casing: LT.
8. TOP OP CASING IS l ET. Above Land Surface' - - - --- i 1 ,
"Top of casing terminated at/or below land surf tee requiteO
a - - --_ - -__ t L`'- M _
variance in accordance s))'ith 15A. N('A(' 2C.111111. J
9. YIELD Iepm): /4Z METHOD oP THS"h rS
Topographic/Land setting,
❑Ridge ❑Slope OValkw Tat
tehack .tpproprrtte has)
Lutimde longinide ofvVeil location
I.atiiude. longitude sourec:OGPS❑ Copographic map
Noce). hox)
DE.PIII DRILI_INO LOG
I ront To Forman pn Description
3e:,-- ,aL
Front To Ft.
1'10111 lb Ft.
L P��
16. REMARKS:
h0:h lid I-330£0
I DO IIERFI3Y ('IUYrHEY TnA"r TIUS WELL AA AS CONSTRUCTED IN ACCORD ANC!- WIT' I5.A NC AC 2C. WELL
CONSTRUCTION SrANDAR! S. AND ir1InF A COP( OP TIUS RECORD II:AS KEEN PROVIDED 11) THE AALI.I. OWNER
C( -30 -3
`-//i.2
SIONATURI'. OF PERSON CONS l RECIINS i'rIII- WEI I. UAl i
Submit the original to the Division of Water Quality-, Groundwater Section. 163n Mail Sec ice ('enter - Raleigh. N(
27699-1636 Phone No. [phone]. within 30 day. OW-1 REV. 07 2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division ofAAater Oual11>
WELL CONTRACTOR (INDIVIDUAL) NAME Iprinq
WELL CONTRACTOR CO)IPAN
STATE WELL CONSTRUCTION PER\TIT# / 4 U ASSOCIATED WQ PERMIFF# _ _
IJf
NAME GYC.�PIt pis • Loth -4-Pump,
Y
of applicable) (if applicable)
WELL USE (Check Applicable Box): RcsidentialN5. Municipal Public 0 Industrial 0 :Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 I I Other, List l ise
2. WELL LUCATIO
Nearest To
,Lren Name Numbc
3. OWNER: /irp, ' inen
Address 8 - '( ]1_ LU SJC
Strect or Route No. t
�_%J_C a72/ ,1
Lary ( Too state /ip rode
( )-
Ar c'a code- Phone number , /
4. DATE DRILLED /o - a Y' -d.3
5. TOTAL DEPTH: Vas '
6. DOTS WELL REPLACE EXISTING WELL? YES 0 NO Ai.
7. s LATIC WATER LEVEL Below Top of Casing: /4 0 ET.
(use "i" ifAisne-I op of Casing)
S. TOP OF CASING IS ( FT. Above Land Surtlicc*
"Top of casing terminated at/or below land surface requires a
.ariance in accordance with 15A NCAC 2C.0118.
9. AIEI.D(gpm): 1R METHOD OFTFS1 ,..2JrS
Ill. W'A"TIiR ZONES (depth): LS - LS1Lp.Ln
11_ DISIN FPC 1ioN: Iypc - ..Y - Amount _.h./. +17)L
12. ( ASING: AA all Thicknes.,
Depth L f iantctor or AA eight Pt. :Material
7 From 9 To %Ft. _6_'I PVC
From To Ft.
From To Ft.
13. GROUTDepth I//}i,lMa'_terial yy Method
From O To r) Et. & _anitiC,±ti 11)-"( —
Fronl Fog
14. SC REF.N: Depth Diameter Slot Stie Vlatcrial
From To Ft- in. in.
From To Pt. - ill 111
281688
- Ciro undwater Section CERTIFICATION fft 3U L(l
/
''HONE p )o..te G - 3/ %D
Topot'mphictLand setting,
❑Ridge »Slope ❑Valley 01rlat
Ichcc6 appropriate box)
Latitude longitude t 1'cell location
IdC11-:J, miml1C SCCond+l
Latitude longitude sourec:❑GPS❑Topographic map
Khaa6 box)
DI-I'lll DRILLING LUIi
From To ± I Form: ti m Descriptit)n
15. SANI)'GRAVFI. PACK:
Depth Size
From To Ft.
From To It.
l6. RP.MARKS:
tlatori,l
LOT.. -A [ION
Slum direction and distancen i u es trom to bast
e State Roads or County Roads. Include the road
numbers and common road n;una,.
SKI:
h0:h fld I-330£0
I DU I IEREIIY LER7IFY THAT TIIIS WELT. AA AS C ONS Il(I IC I 1::D IN ACCORD ANCI VCFFI 115-A NC AC 21. AVLI.I.
CONS11211(TION SFANDARAND.DIAT A COPY OF THIS RECU ) II BI F.N PROVIDED 0) I IIF. AA 11.I. UWNI-R
//_30 r C 3
--D:\Ili ----
SI(iNAIUI{L UP PERSON CONS TIt14 IING Illy AA I I.
Submit the original to the Division of N ater Quality, Groundwater Section. 1630 ALul Ser'ice Center(]Wr1 RI Raleigh,
:Intl
27699-1636 Phone No. [phone], within 30 days.

WELL CONSTRUCTION RECORD 281687
North Carolina - Department of Environment and Natural Resources - Division of Water Ounlit). - Groundwater Section
VA Eli, CONTRACTOR (INDIVIDUAL) NAME tPrint}__.�7ppr 1.f�—_!�2'ri.t-�- - �(1 Ch:R'I IF'1('.U'ION#
WELT CONTRACTOR COMPtNVN%MF are e_nt / -- 5-. Lor%1 / a ParnpAtte •Pn0SE # 6 Vg --3/ 16
STATE WELL CONtiI'RUC'TION PERMIT#_ -_ /']`-(-' __._ASSO(tArED\AQ PLR?TIT# -
-----
Iifapplicablel I if applicable)
I. WELL USE (Check Applicable l3ox): Residential Municipal Public 0 Industrial 0 .Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water nlection 0 Other 0 'Wilier. List Ilse•-
3 WELL LOCATION
Neatest Town: A L'-"✓•lam (.o(Inty id() act_
C�'n rrri)5 Lnvf,
(Sired Name, Numbers. Community. Sobdn ri n. Ipi No.. Lin l �tde l
I CL 3 OWNER: 1t v� -'-rF
Address aac 0)ri 2 Lsa.-IAL
(Sucet ar Route No.l
1ACA I_ )VC a87SLb
1usor-it un Sta:c / Lip Lode
_I -
Area ethic- Phone number
4. DALE DRILLED I D- 2 r -D
5- TOTAL DEPTIC a D S '
6. DOES WELL REPLACE EXISTING WELL? AIS 0 NO y,
7. STATIC WATER LEVEL Below' op ofCasing: D LT.
(Usc"Top of Casing)
S. TOP OE CASING IS
L
ET. Above Land Surface*
`Top of casing terminated at/or below land surface requires a
variance in accordance with 15A :ACM- 2C .0118.
9. YIELD (epm): _I Jr b METHOD OF TEST rS -
ID.WATER ZONES (depd): /5pm (p5'-3iS pin
� Amount 33�-j ��-Sut J
Shoiroan lioand disco
Topo��gJraphic/Land setting
❑Ridge /�\JSlope ❑Valley ❑Plat
CIICA appropriate box)
Latitudelongitude of well locution
mama: it -Kin Z Latitude Ion--_il ode source:0(01)S❑Topographic map
(chock box)
DI.PTn DRILLING LOG
Prom r Formation Description
QnS-
. `"
12. CASING: Acall Ihicknes. tut) Slate Roads or bounty Roads. Include the road
Depth Di:linen:1 or AAbiglu Ft. AIatcri I numhcrs and common road names.
from tO I o.� 1/ Ft to 11 �t Ni
From to Et.
Froth To Ft.
13. GROUT: Depth Material
From f (-2,-)1-0(-2,-)f=t.
Erom To I-t.
IT SC'RF:1-,N: Depth Diameter Slot Svc
From_ To ET. in. - in-
Erom To Irt. in. in.
13 SAND/GRAVIiL PACK:
Depth Size Material
l IDISINILCI ION: 1'ypc / / -
9) I}_]
lAi
I OC.-\TION
\Iethod
7i
Prom To Et
From To Ft
Id. RI -:MARKS:
MaterialMaterial
c
1 DO IIiflald 1' (id( r IT I'IIA'LTIIIS Wlil-I. ACAS C'ONSIRUC-IT:D IN AlC ORI).ANCI. AA I Ill .A NC AC 2C. AAL'LI.
CONS I RUCTION S T ANDARDS, AND T I IA I A COI') OF THIS RECORD II AS lih-EN TIROA IDl.I) 11) I I II- WI:I.I OAA'NHL
//- 3 3
SIONATURIi U h 1'VRSON CONS TRLI IINt i 1111. WEI I. DAIT
Submit the original to the Division of Rater Quality, Groundwater Section, 1630 Mall Son Ice ('enter - Raleigh, N('
27699-1636 Phone No. [phone], within 30 days OW-1 RIEV. 07 2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division or Water Oualitc - Groundwater Section
CERTIFICATION # a `>< / 8
well, CONTRACTOR (INDIVIDUAL) NAME (print) �{]D � 1 n �-Je-� �f� f7 � (� � �
&fl fC 12)rQ3.✓� !i -4 Put1'1aO)�iIvC PII0Nt;# $ LP
WELL. CONTRACTOR COMPANY NAME
slA IT: WELL CONSTRUCTION PER\IIT# .-
1 if applicable)
1' D -__ AssoctATE0 W Q PERM tl Of applicable)
I. WELL USE tCheck Applicable 13ox): Residential 1. Municipal Public ❑ Industrial O Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Winer Injection 0 other ❑ I Iother, List Use
2. WELL LOC'Atio
Nearest I own: _ L C ninty
(Street Nantc. Numbers, Community, Subdl. ision. Lot No.. hip yodel
3. OWNER: L---r--z1 L--------
Address 64-rA)1)e -r-
/ 1)cad n tsv I I I ±l C. .2 g� $
)cat
(Street or Roue No
its
n State hipId
Arca code- ('hone number
4. DATE DRILLED 1D-3D-03
5. DOTAL DEPTH: 1
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 'it1
7. STATIC WATER LEVEL Below 'Top ofCasing. a D ET.
DE):"N"if Ahtn Top or Casim_1
8. TOP OF CASING IS
PT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance . th 15A NCAC 2C .0118.
9. YIELD (gpm): ) METHOD OF TEST rs
ID. WATER ZONES (depth): Cob t -
I
11. DISINFECTION: "Type /-1T1-1
12. CASING:
11
Depth Diameter
Prone D To A1 Et. /D _
From To Pt.
From To Pt
GROUT: Depth Nhtterial i
Groat Q To it a Ft. l htA___A0-
Prom_-- - To Pt.
14. SCREEN: Depth Diameter SlotSize
From To Ft. in. in.
From 'Eo lit. in. in.
15. SAND:GRAVI:I. PACK:
Depth
From _ To Ft
From To Pt
Amount 1 (._}aims
Wall Thickness
or Weight Ft. AMaterial
P QcL
281685
Topugraphie/Land setting
❑Ridge 1LSlope ❑Valley ❑Flat
'check appropriate box 1
Latitude. Ion ghude olvvell location
iiRiti,•3, stout ondJ
Latitude . longitude saurcc:❑CTPSOTopogiaphic map
(elided hog
DRILLING LOG
Format on Description
Method
Site
Nl ate rial
\latcri,t
DI P111
From 10
01`
al'_ IG&I
nt
(
j1-14AY 2004
r- 5L+NNC r'3-SEGTION
c__117,,,„ �N LllIIICE
i 0( -A iTi)11 SKI I C I[
Short direction and distance in miles from at leas(
too State R.tads or County Roads. Include the road
n umbc rs and common road Milne:: O c
W
O n
m =5_i
o
.c'
O
16. REMARKS: --
I DO 11ERE13V C ERTIPY THAT TIIIS W P.LI. WAS CONSTRUCTED I I D IN ACCORDANCE WITH 15.A NC AC " C, WELL
CONSTRUCTION S EANDAI DS, AND I IIAT A CORN OF HITS RECORD AS BEEN PROVIDED l0 1111 WELL OWNER
2/ 3z)
SICiNATURII 01: PERSON CONS t NL'iLllNt i 11II. AV 17 I.
Submit the original to the Division of Water Quality, Groundwater Section, 163o ATail Scr. ice Center - Raleigh, NC
27699-1636 Phone No. (919) 733-3?21, within 30 days.
OW -I REV. 1)7 2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resourc'es-\ Division ,,
on of Water Quality - Groundwater Secuon
WELL CONTRACTOR (INDIVIDUAL) NA11E (print) KOEj/rl i.l�e. bU CERTIFICATION # �9//ig
WELL CONTRACTOR COMPANY NAME
STATE WELL CONSTRUCTION PERM TT# / L/Z),# ASSOCIATED WQ PERMrr#
Of applicable) (if applicable)
1
WELL USE (Check Applicable I3ox): Residential3. Municipal Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ It other List Use
2. WELL LOCATIO
Nearest II n:
t.)3)lF4
(Street Name. Nunthcn. (onununity, Subdit icon. I zii No.. /q, (-adci
3. OWNE) _\3 e-r nALA E- Ci_Y S
Address 1 '1 Fos-)- 5.A-c r 1-"
( trc i or Route No
nat
( nr rot, Sr. Llp r ode
( )-
:Aron code- Phone number
4. DATE DRILLED 1 - 4 - D 3
5. "TOTAL DEPTH: 4 4-5 '
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO 14
7. STATIC WATER LEVEL Below Top ofCasing: QiL7 FI
(Ilse "'."if Abu'e Top o(Casinel
8. TOP OF CASING IS
FT. Above Land Surface'
"Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): .J METHOD ITS T s h rs
•
lug wATEER ZONES (depth): 3D5 ' - srn
1
281684
r_eeae Ti S,Le:ell 4 Pumpi PHONE #(B,gR/oig-3/26
Topographic/Land setting
❑Ridge ❑Slope ❑Valley 1rIat
(cheek appropriate box)
Latitude longitude of well location
W.(ees minutes seconds)
Latitude, longitude source:❑(IPS❑Topographic map
telie k host
DEP 1'1I 1)RILLIN(i IO(i
Formation Description
_�ht t±t.
11. UISINH:(IION:Type J---47-/-) Amount to'Z rli"s_.
12. CASING: Wall Thickness
Depth Diameter or \\eight Ft. Material
front D To 3 2 Ft. Lp " _L'
From 'To It -_
From To
13. GROUT: Depth Material V Method
From D To 2D Ft.- _ —
Front To Ft.
14. SCRET:N: Depth Diameter Slot Size ylaterral
From _ To Ft. in. in.
From 'To Ft. in. in.
15. SANDIGRAVITI. PACK:
Depth Size Nl:aerial
Front To Ft.
1:ron1 l o Ft.
16. REMARKS.
Irom To
D 08 _
32 44S'
v- cUNr rR SECTION
Shoot direction and disknee u�ntnIlts.,�itlltn) ttVl OFFIPE
ttoo State Roads or ( out ly Aoatli rittli 4 1c roil—
nuinhcrs and conunon road names. W
O
r-I
O
I DO IIERIlBY CF.RT IFY TIIA"r TIIIS WEI I. \VAS (ONS112UCT1{D IN ACCORD ANTE AA9Tl 115.A NUM 2C, W Ell.
CONSTRUCTION STANDAR )S, AND T IIA'I A COPS O1- TIIIS RECORD I I.AS 131 EN PROVIDED TO El IC WEI.I. OWNER
`L.c)o? //-3D-D3
SIGNATURE Of PERSON CONSTRUCT INti FI II AC EL 11 DALE
Submit the original to the Division of %rater Quality, Groundwater Section, 1630 NI ail See ice ('enter - Raleigh, NC
27699-1636 ('hone No. [phone], within 30 (lays. OW-1 REV. 07 2001

WELL CONSTRUCTION RECORD
North Cantina - Department of Environment and Natural Resources - D�ivision of Water (,)unhlc
WELL (ON'I RACI OR !INDIVIDUAL) NAME (prim) 40wh1 n =I-�-1C" 1
reeme-
/�(/ _ __ \SSO(1.1i En\\ I'tat\II'I'-
STATE WELL CONSTRUCTION PERyIlla _. - li(;ipplicuhlc)
t i tapplicable)
281682
- Groundwater Sections g
( ERIIEI(, \ FION a 17 /
Pn ONI, a b2 [n `ti " 3/ , n
I. WELL USE (Check Applicable Box) Residential Municipal Public O
Monitoring ❑ Recovery ❑ I-lcat Pump Water injection ❑ Other ❑ it
Z. WELL CA rI(N
Neatcs
4_11a
I Street N, re. NN t ibe ( bnmr n itv. So
3 UWNE.R- _ . .`:C'A
Address 3ai I l`
(Streit ur Rom,Nb,,I /
Mts\/1 Le /`C C
( it, 1 Is oun ere lip (ode'
Area \toile- Phone nwnh.r
4. DA1 f DRILLED / I — / a — 6 3
s 1(11Al DEPTII:
I-n No _ /np I.sIcI
LIMA
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO.'S-
7. SI.AII( W AILR LEVEL Below Top of ( using:to 1'l-.
Lac .. of:Above hp
of (uolnJ
S. TOP UP CASING IS I. Abo' e land Surface*
"lop or casing terminated al/or below land surface requires a
variance in aut urdance with I5A N('A( 2( .nl Iri.
9. YIELD (gpini IDD METIIOD OF T[[SI_cik CS •
ID. AAILI( LONLS (depth): Q1n5 —�D ccp
I I. DISINI-l.(.IION. Type NTO _ :Amount 4Te]fifii-_
12_. CASING: AAall l hiekncan
or AAcigin 1-L
110111 J
DepthDi:untter
Io / �-7 '7 It lc i'
Irom__
I ram Iu Pt.
13. (iROtll1 Ucpth /lA4:ucnul �}
Isom D io aD Et. (o nluy
Prune Tu 1t.
14 SC RLI. N. Depth Deuncicr
Prone_ lu___-- 1't--._III
.
Pruitt TU II. In.
15 SANI) (1RAVI.L I'A(lff.-
I)cpth time \ I'etenul
I role Tu
From .I o
16. RI.AI:ARIi
Slot Sve
PVC
tel
Industrial ❑ Aerlrrdtural O
)thcr. List Loe. ._
Topographic and setti112
❑Ridge ❑Shope ❑Valley Plat
-I...k appr,it rro , b,. 1
I_.ultad)! lonsnudc of Well loeatiun
Latitude lemaitudc ' 'ogee.❑GPSO I opogr.Iphie Help
TA eel. bon)
DI. PIII DRILLING II)(i
1 mm Io Form:tl n Description
0 72'
77 ' 85' — ___..
arm
LUC:A I ION SLL I (T`
Shoe dircelion and distance in mi
teat Si ite Road, or County Roads.lAd
numbers and common mad Hume,
I DU IILRItDY 1 LR I IFV TI IAF I I I(S N LLI- AVAS (()NS IRD( I IL) Ih V(( ORD AN( I. AV 1111 I A A A( \( 2C. \\, P.LI.
CONS IRILIION SIANDAI DDS/ AND LIT ,ALOPA UI-TIIISIRI( ()I AS II. IN PIO)AIDIDl') 1u1 AA I. I.. 0AV NC It
CZ()
D
SI(ONATIIR6OI PLRSI-)N (O�NSIRt CIIN(t 1III
Submit the original to the Division of Water Quality. Groundvy ater Section. 163u Mail Syr ice Center - Raleigh. NC
27699-1636 Phone No. [phone]. Within 30 (lays. (AA -I REV. 07 201)1

North Carolina - Department of Environment and Nat
WELL ( ONC1'RACIOR(INI)IVIDUAL) NAA whit)W EILL (ON"I RA(TOR COMPANY NAME ram"
STATE WELL ('ONS'TRUC RUTION PERAII'I4 _
l it a't licahlc)
I. WP.1-t. USE (Check Applicable Bog): Rcaident
Monitoring 0 Recovery 0 I -(cat Pump AA'al
2. A>v Il.L LOCATION:
NIJah .; _t;TON rt : County _ _
r)-)J _ )-
IAu( 1 ti:u�c. 'tin bc> ion "IIto No hip( oilsi
3. OWN1IC ../ VJ_Il'-lam
Address 1 °11
e
t : law
�t\._,_mil _ 8 7 / C�
Suns hip (pdc
C/-3-03
6. DOES WELL REPLACE EXISTING WL:LL? 1 ES 0 NO
7. S I A [IC WALI1R LEVEL Below Cop of(using: SD 1:I..
(LS it.-\bt'‘c 1-np or (a ilI,_I
8. TOP rim IS 1 1 I those Land Surface„
*'1'up of casing terminated at/or belur land surface requires a
eariance in accordance j`'ith I5A V(.A( 2( . 11118. --
9. YIEI.1) tgpl»Y—�..a__ MELl1OD OE I11S1_- _S _—
10. WAILL:IL ZONIIS (depth).
II. DISINI I. I ION. Lvpc -1/7 _ Auwuln i & +1,14s. in , dii,iiiiiii and llbtillte in a
VAall IInc'knc» 1(to Stine Roads or( aunt\ Roa 'vEt
�. C ,ASING: lateta nunlhcrs and common road nun >.
/� Uio D6iilc'r arAAcichll t. Aii PVl)
I1un1 / T1) �g Ic
Lion, To Ft. --- -
I role Tu
13. GROUT. Dcpth Vlatenal Nit/Plod
Front Q To I t LI ant s_+
Prom ro Ft_ V
14. SCRF.I.N. Depth t)iamcicr 11u1 Svc Almcri.d
I run) 1 u 1 t in _ is
From I Pt.
15. SAND (iRAVLL PAC K
Ucplh Su'c AIutcrla1
Prom I o Et. _ _ _ .....
1--ram l 0 Pt. ---_-
Milli?IL;
( in ,i Ib.n
1 )-
Ansa coda- I'hune uumher
3. 1)A I E DI(ILLEI)
5. IrYIALDI'P"Ill: t70c
WELL CONSTRUCTION RECORD
1 Resources - Div isi n oy I Water ( )ual)ty - (iruundrsater Section D i I
�t('IIIO\E a O (U$
\SS()( IA'I Ell \\ O PER\II'fa
l itapplicati i
281681
1 Municipal Public ❑ Industrial 0 Aorlculturnl 0
Injection 0 Other ❑ I I Othar. I I t I . c
Fopot�rapluc. Land setting
❑Rides 11opc ❑Valley ❑flat
l —f ippnip I host
I.❑l iudc longitude of %yell location
i ��nuntn �onJ;I
abed I ncinldc ,t urea.❑GI S❑l opo_raphn ni.Ip
(slice) bt,v
DI(ILLIN(i I tRi
I Until )csei plloll
C
1)1 Pill
From 79
%9 ' 7Dr-!
Craii
°t.
— 1a.i p •- N
qofp"�
10111 :!F(QLSt
lode the roa.
o
m
n
'D
O
W
th,
0
16. RI: YLARICS:
II)O II Nil 131 ( LI(IIPSTIIA 111115 WILT AAAS( ON", RE "161) I N A( t0I<D.Ay( I AALFI1I 1A 1( a.RI-.LI.
CONSFR11( l ION S IANDARD., AND IIIA I A( OP 1 OI II IIS RE( ()I( SIiIF5'PILUA-ID1D-Il)IIIIVill.(MN'R
3b
Y�� ,_ _
- =0 3
- - SI(,NATU R6 Uf PI RS)N(ONSIILCC LIS(� (III KII I UAIIL
Submit the original to the Division of yA ater Qualitc. Grom)dvAater Section. 163o ?tail Se) ice ('enter - Raleigh. M.
27699-I636 Phone No. (919) 733-3__I, vAithin 30 days. (iAA'-I I{F.5 97 2001

WELL CONSTRUCTION RECORD
281680
North (arolina - Department of Environment and Natural Resource. - Division of Water ()tualit> - (iroundhrutcr Section
( [WI Ill(.\ FIU\ 4G
vWELLa,( uNTRnrroR (INDIVIDUAL) A_ I6 Iprinn Y ���j�( ✓, q. - 3 1
7
U.VYIP 1,110Ni N i��
wi:t.i.(ONIILV(TC)R COMPvAANAVlt. ZJ o2
SIAfl: WELL CONSTRUCTIONPLR\IIIN —_ —
it oppllcablcl
L WELL LSL ((Keck Applicable Boy): Residential Municipal Public ❑ Industrial ❑ Agricultural 0
Monitoring ❑ Recovery ❑ Ilex Pump Water Injection ❑ Other ❑ I I Other. List l'se _ _.--
\»p( 1.\l I❑ \\ () PI.R\I11
lit applicable)
2. W GLL LO('AII(
Nc(u st Tu (n' nr SV% t 1 �� County'
t'berg-Int I� 2c
Itiu aA.nnc kurnhco_( onnlnn /ip caul
1. (1\>r N I'. IL. IJ_ .• 'k'1'
Addres 1 -A L ai C}}li--`T �t-
,SIcL„, kua:N'V J"
ifla ctt e- Qai It I ,LJ �2 1
(u 1` n .State tip (.,d:
Arco cod.- I'hon:
d. DALE DRILLLD -I - si
5. TOIAL DP.P111:
6. DOI S WF,LL REP' ACL EXISTING WILL? YES
N 0 ,
7_ SIAII( WALCRLLVP:1.ktelo I)opot(:sinu l'T.
I L'.c -d.h.nc Tnpol Cu_sinul
R. TUP OP CASING IS t "f. ,Abocc Land Sur face'
*lop otauing terminated ',.Ilan below land surface requires a
variance in atcurdan'e with 15A NC:\C 2( .1>11S.
9. YILLDIgpmp._Jain _N1P.IHIODO1' IL_s1 _. � Lt4
11). WA I I IL ZONI:S (depth): QS - q :ZS r - -
I. DISINI-I.( IION: Tvpc /- � -A mount lob tb I)-5.
12. (ASIN(1 AA,Ill lhieknene
Uep,h _ 'i.aneler or \\'nuht f-t_ \,Itevrla
I?on) 0 TLS I't_ (4, �J
Form ) I _ Pt.
From fo Pt.
11 (IROI.'L: Depth I\la .reel
Prom T IIFt.
I'rum to Pt.
14_ S(-RF.1 Nt Dept) Dmincicr slot situ
I:tomIo_--- Il.--_-_In. —.._
t tom To 19. in. _.
nI
D:pol Sv,c AIutcnal
Drum _ to Ft - -
From to
Togo'r phic.Land setting
j_ ❑Ridgelopc ❑Valley ❑lint
aliaJ appiapiialaI .I
;nnudc I m Rude of Nell location
1 auto. I.)
L;uiulJe lon'_itudc .oursI opo r Iph1L kid')
cicccI.I
Di Pill NthLI INC, I MG
Irvin t o I initiation Itesctiption
t-5_
85445'
1 O(\ IION SKL
Sho.. direction and (lulance in
I..o Stine Roa(6 or (aunt), Ro
numbers and cxnnmon road n'al
o
MP; I}o In le;ml
�.' elude
16. Rd, \IARKS
I DO Wild .Iil (L RI IFV 11IAI ll IIS VV(1LI. WAS Cl )NS I R(ic DIN A((ORD A I 1113.A A(
CONS1RI"1 IION si AN1 ARDS, AND I ILA I ,A (OP1 01 1111 (1( ORD II AS lit1A1'ROA 11)11) II) 1111 Nh. 11. MA
Le?)
// 6 03
{� SIGAA"I URL (>I I'F.ItSON l I)NS Rl l list r 11II AAIII. D.AI
Submit the original to the Division of N ater (2ualitc. Groundvcatcr Section. 163n Mail Service ( enter( Ri leigi. y(21
27699-1636 Phone No. [phone]..y ithin 30 da)'s.

281679
WELL CONSTRUCTION RECORD
NorthLarolina - Department of Environment and Natural RcourCes- I)ic i>i or Wuser ()tidbit- ( iruundfcutcr Section 8
�R0_b i n 11.) ( LI(111 I( 'l ION 4) 4 g J7 / 7 °
IL
\PHII.( U\FIACTOR( O\IPA\\ NANO.Grtt) B LISal y 4,M (O CI
e_ne. rDs �} urvA I Pno\r. a
/ ( b a__.— \11()( I. T ED \\O PF.R\tl14 —.
.ATA'F6AAt, l,1,CO3AScle) PPRVII'IN. - — iit applicable)
tit applicable)
I. WELL USE IC heck Applicable Boxy Residential* Municipal Public 0 Industrial ❑ Agricululral 0
n
V7unnuring�❑ Recovery ❑ Ileat Pump Afluter I'ction 0 (Nhcr 0 I( )ther. List l .c_
2. WELL t l I.(x ALIGN:
Nearest Town ille4,1(e._ r leaf uunty
c�_p1u1c UU, OO_Fo11 s
\t1 nbco.l nnnumitc NuhJnt nn.lan Ao. /,p t'uJci
)OO�
Adchcs, r k_ mo res '-_- -
sttcet 011(„nte Sa 1 D
C�i? �� p 1c r , EL. :3 4 r7
( In „, rtltn tiruc /,r
V rea wdo I'honm number
d DALE 'WILLED D.,Q q -U.
(. DOES WELL. REPLACE EXISTING WELL? YES 0 NO Tv
7. SI.AIIC' WATER LEVEL Below Top of Casing: 610 CIl- --.--_ Flax
o
fl .- 1t Vhot. T Ca.1n=) F...- — -'-C
S. TOP OI' CASING IS J 11. Above 1 and Su lace° - -- s— '<
*lop or cuing terminated at/or below land surface requires a "o
_ —.
.--._—C_)T
canance in accordance with 15A N( AC 2( .0118.
9. YIELD (gpm). METHOD OF I I S.I . )1 rS --. - . ,�' — —
II). \\ Al I;R ZONES 'depth):
-i
i �—�1 _ 9Z 1 1}5 Shovt J,rcdtion and dot.1ncc inn g om nt c;ol
-7 d
5. -IO"I AI_ DEPI 11: DS
FopugrapllicLand sellin_!
❑Ridge ❑Slope ❑Valley [Plat
appnq mtc bt,
1-unmde I i t(udc utvvcll location
utitud< Ion -nude t ur,c 0( tl SDl opu¢raphlc maw
kw,
DI PI11 DKII.LIN(i [AM
17tmt I o lorJ;tli to Description
lR
__ -- zm ._o --
�s 1 5i
- � M_. cia
LUC.AI IuN SKET(?lo
1I. DISIALEC IIOV: Tvpc f _ _ AIItt IWtt-_ __ ---
t AA dl I h,cl.nc,. IA State Road, or l A,unp� Road ;�nc tide Ihe rood
1_. (ASIN(i: >. l
Inns
Q
Depth Ihantccr nr AAccht Pt AIa na� mother ant' conunnn rood Illtttlt
LI D to E. 14' )
hunt To
7on1 Tu
Fl.
13. (i12OU L I )cpth ylatcn.tl 1 Alethod
lrt)Itt 1o42D ettAa
ftow t0 lt.
14 SC ICE I '. Depth D,:uncter Yel 5l/c vIr.anul
1 turn Io_-_ 1't. i1t.
will TU Ft. 111 in. --
U- S:ANI) (dKAA IL P.ACK:
Depth N,ic Alatcriol
I ion' Io I t- _ -- -. --
I --corn -- lu IL
0
CO
0
m
0
'O
O
CAD
6. KG.\LARKS: -------_
I DO iltdcr3I ( Lit lll' FIIArIIIIS\AEd_ I-AAAS(l)NS'1ILUCILDIN A((GILDAA'(I.AA'IIIIdAA1 AC 2C. At1I.I.
CONSIRLLIOASIANDAIANDII1ALA(UI'101 IIIISICF_(()LN-N.fANIilL N PILOAIUI -I) II) IIII .AAI I 0AANI-.It
SIGN AI UICI. OF PI RSt)N CONSI RL. ('I
Al l L DAI 1.
Submit the original to the Division of ‘N ater Quality. Groundsv Mee Section. 1(13o ,Afail S
27699-1636 Phone No. [phone]. within 31) days.
cc (-enter - Raleigh. \(
()\\-I RLV. 1)7211)1

283164
WELL CONSTRUCTION RECORD
North Carolina - Department of Envire nment and Natural Resources - pDivision .If Water Quality - Grout dwater Section
WELL CONTRACTOR (INDIVIDUAL) NA AE (print) Dere;cm. i-vsuzslh 1}0..5QCJ
WELL CONTRACTOR COMPANY NAME CY 4t. Sa.NVet 'd . 01`0fl4,8 P:.*,e PHONE (do S-'-CL'
CERTIFICATION #_at tl31.c
STATE WELL CONSTRUCTION PERMIT. ASSOCIATED
(if applicable) -_ (ifapp]
I. WELL USE (Check Applicable Bo ): Residential oMunicipal/Public ❑
Monitoring ❑ Recovery ❑ Her t Pump Water Injection ❑ Other ❑
2. WELL LOCATION:
Nearest Town: C.\ d% County Tku_.aUccd
t'a.a\ d Cove oCc Cco.bkwQ
(Street Name. Numbers. Community, Subdi pion, Lot No., Zip Code)
3. OWNER: '-:e) Nyza-szo
Address HN F.-,, A VI
(Street or Rout No.)
City or Town State Zip Code
Arca code- Phone number
4. DATE DRILLED to • 15 • z= 3
5.-TOTAL DEPTH: Jai; s
6. DOES WELL REPLACE EXISTID G WELL? YES ❑ NO
7. STATIC WATER LEVEL Below 7 op of Casing: (PO FT.
(Us "+" if Above Top of Casing)
8. TOP OF CASING IS \ 'T. Above Land Surface*
*Top of casing terminated at/or below lad surface requires a
variance in accordance with I5A NCAC C .0118.
9. YIELD (gpm): a METH( D OF TEST
10. WATER ZONES (depth):
WQ PERMIT#
cable)
If
tom-IR
Industrial ❑ Agricul ural ❑
Other, List Use
Topograph:c/Land setting
[]Ridge Slope ❑Valey ❑Flat
(check appropriate t rx)
Latitude/longitude of wt 11 location
(degrees/minutes/sect ads)
Latitude, longitude source:❑GPS.3Topographic n
(check I ox)
DE'TH C RILLING LOG
From To
Fon ration Descrir tic
p
•'r \ bi C)yes- fj,,.cds rt.
ra3 5t05
l 0.-Ca - c
0
U
era
_-rn
-n
11. DISINFECTION: Type Amount (o
12. CASING: I Wall Thickness
Depth Diar eter or Weight/Ft.
From It\ To (o% Ft. (off 4.
From To Ft.
From To Ft.
13. GROUT: Depth K aterial
From b To a0 Ft. merit
LOCATION SKETCH cJ
Show di -ection and distance in rr iles fry at last
two Stall Roads or County Road--. Inch thoa '
Material number( and common rcad name;.
Method
frc....Ctt
From To Ft.
14. SCREEN: Depth Diarne :r Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Siz: Material
From To Ft.
From To Ft.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WE WAS CONSTRUCTED IN ACCORDAN .E WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND TF AT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
7D�.in.cPJt it r,_.o., , Jn %3 D t5 - c S
SIGNAT )R F PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Nater Quality, Groundwater Section, ) 636 Mail Servict Center - Raleigh, NC
27699-1636 Phone No. [phone], wi hin 30 days. GW-1 REV. 07/2001

283160
WILL CONSTRUCTION RECORD
North Carolina - Department of Envin nment and Natural Resources-QDivi(sion if Water Quality - Grour dwater Section
WELL CONTRACTOR (INDIVIDUAL) NA'4E (print) Cle<. CM ?lRlOn 1QC, CERTI 7ICAT1ON at (VA,
WELL CONTRACTOR COMPANY NAME Q-N'tee S.V"deV 3 a . C• tall P; r%e PHONE # (Wet (OCoS• LCLr'
STATE WELL CONSTRUCTION PERMIT ASSOCIATED WQ PERMMIT#
(if applicable) gas- (ifappl.cable
11111•11111IM- It•
1. WELL USE (Check Applicable Bo c): Residential Er Municipal/Public 0 Industrial 0 Agricul ural 0
Monitoring ❑ Recovery 0 Hee t Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: Aest County 1-tau,,, aces
as i 2
(Street Name, Nuinbers, Community, Subdi ision, Lot No., Zip Code)
3. OWNER: tQ 3.ty Gees.'\
Address .2'- i.f nd5cn`-�
(Street or Routo.)
L.l--ci/ /J C
City or Town State
(S 2j)- tit -1st
Area code- Phone number
4. DATE DRILLED to - 7.1 c's
5. -TOTAL DEPTH: tb S
6. DOES WELL REPLACE EXISTIP
7. STATIC WATER LEVEL Below 1
(U,
8. TOP OF CASING IS i
*Top of casing terminated at/or below la.
variance in accordance with 15A NCAC
9. YIELD (gpm): Sc METH(
10. WATER ZONES (depth):
as72t
Zip Code
G WELL? YES 0 NO IN
op of Casing: 2 O FT.
"+" if Above Top of Casing)
'T. Above Land Surface`
d surface requires a
C .0118.
D OF TEST iZ
Topographic/Land setting
[]Ridge Eliot)! ❑Va ley ❑Flat
(check appropriate t ,x)
Latitude/longitude of wt 11 location
(degrees/minutes/sect ads)
Latitude. longitude source:❑GPS DTopographir: nap
(check I ox)
DE'TH E FULLING LCG
From To Formation Descrirtic
t t-10
QVfLC f3 .ncd on
O
W
T
0
Falr
11. DISINFECTION: Type
12. CASING:
Depth Diar eter
From t't To `-iLt Ft. (ci;
From To Ft.
From To Ft.
13. GROUT: Depth
From 0 To .ZC)
Amount 8
Wall Thickness
or Weight/Ft. Material
n.21
IV atcrial Method
Ft. Cetn.r.nr r::...yeA
From To Ft.
14. SCREEN: Depth Diame er
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Siz: Material
Slot Size Material
in.
in.
From To Ft.
From To Ft.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WE _,LWAS CONSTRUCTED IN ACCORDAN :E WITH 15A NCAC 2C, ,
itt—
CONSTRUCTION STANDARDS, AND T1 AT A COPY OF THIS RECORD HAS BEE] I PROVIDED TO THE WI-:LL OWNER
LOCATION SKETCH S
Show di 'ection and distance in n' iles frotniat 143rf.
two Stat Roads or County Road Includcjthe `2a'
numbers and common rcad name;. o ❑
-2:,x,l�h en-24-2( OF
SIGNAT IRE OF PE ON CONSTRUCTING THE V ELL DATE
Submit the original to the Division of Neter Quality, Groundwater Section, i 635 Mail Service Center Raleigh, NC
27699-1636 Phone No. [phone], wi hin 30 days. GW-1 REV. 07/2001
-2 ,-d.3

28315'7
WICIL CONSTRUCTION RECORD
North Carolina - Department of Envirc nment and Natural Resources - Division )f Water Quality - Grour dwater Section
WELL CONTRACTOR (INDIVIDUAL) NA HE (print) OeOCte-x T\»a (Iv-E]�y„.
WELL CONTRACTOR COMPANY NAME C\•ade S`•i`JQCO V l #2 ves Ptavit e
STATE WELL CONSTRUCTION PERMIT ASSOCIATED WQ PERMIT#
(if applicable) -mmes (ifappl cable
I. WELL USE (Check Applicable Bo 0: Residential al Municipal/Public 0 Industrial 0 Agricutural ❑
Monitoring ❑ Recovery 0 Her t Pump Water Injection ❑ Other 0 If Other, List Use
CERTIFICATION #_ at !_3LC
PHONE # (22% (doS- =0Z7
2. WELL LOCATION:
Nearest Town: CA i-taait County If W
R$9 Lam., ,3 anew 2a SI" u
(Street Name. Numbers, Canmunity, Subdi ision, Lot No., Zip Code)
3. OWNER: P0-144 t�v tt
Address 216 14tLS4- ^MG()'.vnt C:�e\e
(Street or Route No.)
1\oCCc\ K Vet
City or Town State
(75v)_ 8q3, 41se
Arca code- Phone number
4. DATE DRILLED 10-M-\-03
5.-TOTAL DEPTH: 02aS
6. DOES WELL REPLACE EXISTIP
7. STATIC WATER LEVEL Below 1
(Us
8. TOP OF CASING IS \
*Top of casing terminated at/or below lar
variance in accordance with ISA NCAC
9. YIELD (gpm): 30 METH(
10. WATER ZONES (depth):
Q3503.
Zip Code
G WELL? YES 0 NO ES
op of Casing: 2)0 FT.
"+" if Above Top of Casing)
'T. Above Land Surface*
d surface requires a
C Atls.
D OF TEST fks=\
Topographic/Land setting
[7Ridge f13Slopa [Wiley ❑Flat
(check appropriate t )x)
Latitude/longitude of wi 11 location
(degrees/minutes/sec( ads)
Latitude longitude source:DGPS 7Topographi: n ap
(check l ox)
DE'TH ERILLINGLCG
From To Forr ration Descrir tic
7_2S
11. DISINFECTION: Type ¶r\\5
12. CASING:
Depth
From i-\ To 14)`i
From To
From To
13. GROUT: Depth
From_a To a0
From To
14. SCREEN: Depth
From To
From To
15. SAND/GRAVEL PACK:
Depth
From To Ft.
From To Ft.
Diar eter
Ft. h y
Ft.
Ft.
Ft.
Ft.
Diame =r Slot Size Material
Ft. in. in.
Ft. in. in.
Amount i3
Wall Thickness
or Weight/Ft. Material
)rat\
N. ateriel
C P rsvevnk
Method
Siz : Material
ove< t3..<a.
in ante
-
-D
LOCATION SKETCH
C.?
-
ma
Show di -ection and distance in miles frA at least
two Stat Roads or County Road:. Inciaus theca i
number: and common rcad name..
16. REMARKS:
1 DO HEREBY CERTIFY THAT THIS WE £ WAS CONSTRUCTED IN ACCORDAN ;E WITH 15A NCAC 2C, `NELL
CONSTRUCTION STANDARDS, AND TI AT A COPY OF THIS RECORD HAS BEET ] PROVIDED TO THE WELL OWNER
SIGNAT IRE O ERSON CONSTRUCTING THE V'EL.L DATE
Submit the original to the Division of hater Quality, Groundwater Section, i 636 Mail Service Center- Raleigh, NC
27699-1636 Phone No. [phone], wig hin 30 days.
GW-1 REV. 07/2001

283156
WELL CONSTRUCTION RECORD
North Carolina - Department of Envirt nment and Natural Resources - Division if Water Quality - Groundwater Section
WELL COh'TRACTOR(INDIVIDUAL)NA'AE (p) tint Decc:�x -IA a,4rYs ,Q n..a 4C0 CERTIFICATION #:at C%1c
aJ
.a aa;. t8 Q.0a Son:Jer\P+" ' PHONE # ($<"59 (doS-:L0ZZ
WELL CON'f RACTOR COMPANY NAME CN � 5 STATE WELL CONSTRUCTION PERMIT ASSOCIATED WQ PERMIT#
(if applicable) - (ifa l cable
L WELL USE (Check Applicable Bo 0: Residential in Municipal/Public 0 Industrial ❑ Agricul:ural ❑
Monitoring ❑ Recovery 0 He21 Pump Water Injection 0 Other ❑ If Other, List Use
1111111MOIMINMi 11
2. WELL LOCATION:
Nearest Town: 4k'a:->etn SQ,AP., Count 'N°-`3 Oa
\(om AP R Qs7aco
(Street Name. Numbers. mmunity, Su won, Lot No., Zip Code)
3. OWNER:
Address
Scot\ '(1s..&Sinn nn
\O\ \Ae\\.rt `V1 C•& C\t
(Street or Rot No.) 0
wa�\\v\etiv,\\e h� .28'76b
Citt or Town State Zip Code
( �)- 50'1- (Da\o
Rcra-C�
Arca code- Phone number
4. DATE DRILLED \0-A3�O1
5. -TOTAL DEPTH: aa5
6. DOES WELL REPLACE EXISTID G WELL? YES 0 NO Gsl
7. STATIC WATER LEVEL Below] op of Casing: `\O FT.
(Us : "+" if Above Top of Casing)
8. TOP OF CASING IS \ :''T. Above Land Surface*
*Top of casing terminated at/or below la, d surface requires a
variance in accordance with 15A NCAC C .0118.
9. YIELD (gpm): 1c METHOD OF TEST
10. WATER ZONES (depth):
•rS•x�
Topographic/Land setting
[]Ridge "Slope ❑Va ley ❑Flat
(check appropriate E ix)
Latitude/longitude of wi 11 location
(degrees/minutes/seer ads)
Latitudelongitude source:❑GPS DTopographi; n ap
(check I ox)
DE'TH L RILLING LCG
From To Formation Descrip tic-.
11. DISINFECTION: Type.A 5
12. CASING:
Depth
From }v To %Ia Ft.
From To Ft.
From _ To Ft.
Amount B
Wall Thickness
Dior eter or Weight/Ft.
Lett
13. GROUT: Depth
From 0 To at) Ft.
From To Ft.
14. SCREEN: Depth Diame er Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Siz , Material
M aerial
CeN.evet
Material
Method
�LUrZ
From To Ft.
From To Ft.
16. REMARKS:
ui (,av Dn
&rants 0
;C-
C �r
"O mo
LOCATION SKETI:H 'c'_=
W
Show di -ection and distance in rr files fr'n atftast
two Stat : Roads or County Road . Inc8e them
numbers and common rcad name t. `
I DO HEREBY CERTIFY THAT THIS WE 1, WAS CONSTRUCTED IN ACCORDAN :E WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND TE AT A COPY OF THIS RECORD HAS BEET I PROVIDED TO THE WELL OWNER
Q.'vt-Wt %UNA A� 10- ‘7)-ea
SIGNAT IRE OF PERSO CONSTRUCTING THE V 'ELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Ceenteri RREVgh, C
27699-1636 Phone No. [phone], wi: hin 30 days.

283149
WELL CONSTRUCTION RECORD
North Carolina - Department of Envirt nment and Natural Resources - Division )f Water Quality - Grourdwater Section
CERTI ?ICATION # a, tab
PHONE 4 &Z'% Cocos- ;cc
WELL CONTRACTOR (INDIVIDUAL) NA 'LE (print) Deccxk ":\a.o.dh
‘YELL CONTRACTOR COMPANY NAME e-Vtle. S'ri.3-1"aeco v9iSo rk Pu-aie
STATE WELL CONSTRUCTION PERMITASSOCIATED WO PERMIT#
(if applicable) - (if appi .cable I_,.
. WV
1. WELL USE (Check Applicable Bo c): Residential 172 Municipal/Public ❑ Industrial 0
Monitoring 0 Recovery ❑ Hea : Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION: �/
Nearest Town: C I yV e
x'�"bkl puie
(Street Name, Numbers, Community, Subdi ision, Lot No., Zip Code)
County Nay4we' /
Topogra ,c/Land
CIRidgee ❑Va
(check appropriate t
Latitude/longitude of mu
3. OWNER:/4 Y17Eh/ C-t2 N r'l tee e taa Haines (degrees/minutes/sect
Address R4 AUX ,a/L Latitudelongitude source:❑GPS
(Street or Route No.) (check I
Mr$PP;P 172// A(C. 2875/ L
City or Town State Fora ation Descrif tic
Zip Code
(5.7. )- cq. - 3 y/1
Area code- Phone number
4. DATE DRILLED 10-43-a3
5.-TOTAL DEPTH: ,jam 5
6. DOES WELL REPLACE EXISTII• G WELL? YES 0 NO ❑
7. STATIC WATER LEVEL Below'] op of Casing: (Q,'i FT.
(Ut : "+" if Above Top of Casing)
/
8. TOP OF CASING IS / i'T. Above Land Surface*
*Top of casing terminated at/or below tag, d surface requires a
variance in accordance with 15A NCAC. C .0118.
9. YIELD (gpm): S METH( D OF TEST N l &
10. WATER ZONES (depth):
DE'TH
From To
-f/ -4 S °ref' I3'4;t
izS - l"aA/77-
11. DISINFECTION: Type Nr1//S
12. CASING:
Depth
From "--/ To GS
From To
From To
13. GROUT: Depth
From v To 2t
From To
14. SCREEN: Depth
From To
From To
15. SAND/GRAVEL PACK:
Depth
From To Ft.
From To Ft.
Ft
Ft.
Ft.
Amount
0
w
r1
LOCATION SKET{ 7H 3
r—,
Show di 'ection and distance in rr Iles fro n t least=
rn
Wall Thickness two Stat t Roads or Courty Road.. Inclu he :aa
CD
Diar eter or Weight/Ft. Material numbers and common read name;. o
Ft.
Ft.
ar Pras'rc
K atcrial Method
GemeNr Povra'
Diame ;r
Ft. in.
Ft. in.
Slot Size Material
in.
in.
Siz Material
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDAN :E WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND AT A COPY OF THIS RECORD HAS BEET 1 PROVIDED TO THE WILL OWNER
onntis3c '�/ Lace i . b /v - /3
SIGNAT' )RE OF PERSON 'oNST CTING THE V ELL DATE
Submit the original to the Division of JVater Quality, Groundwater Section, :636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], wi hin 30 days. GW-1 REV. 07/2001

282900
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources -^Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME(print)EO 6 ) Yl L )t? I ) CERTIFICATION # a
W41
ELL CONTRACTOR COMPANY NAME &reef SYUS Lia-1) + 1 u.f„-44-t PHONE # (O zY - 3 Inc
STATE WELL CONSTRUCTION PERMIT# / II- 7. ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1, WELL USE (Check Applicable Box): Residential 8-"Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring ❑ Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town;
County
rel
(Street Name, Numbers, Community, Subdivision, Lot No.. Zip Codc)
3. OWNER: Q.l( e.L.tJ Quo J,-
Address /a f' l jluk f Iaa 4 Q a U •
(Street o Route No.)
ve/%P, �C vDl
City or Town State Zip Code
( )-
Area code- Phone number
4. DATE DRILLED 3 -2 I —0 3
5. TOTAL DEPTH: ) 04-S '
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: I bbo' FT.
(Use "+" if Above Top of Casing)
8. ,TOP OF CASING IS i FT. Above Land Surface*
.*Top of casing terminated at/or below land surface requires a
' variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 1/4- METHOD OF TEST rs
' 10. WATER ZONES (depth): A S t - ' i Lk r�iN-m
II. DISINFECTION: Type Ft T E-1 Amount 1 to
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From n To (p (r) Ft. 6) i 1 pV l' .
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From 0 To .2t1 Ft. (r_P,wv.z,._-f �v_r
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
. From To Ft. in. in.
15: SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Topograa is/Land setting
DRidge Cr]Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees minutes/seconds)
Latitude/longitude source:OGPSOTopographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
n la D
ion ' i o 44S'
LOCATION SKETCH
Show direction and distance in miles frorh aFi Last
two State Roads or County Roads. Inclu4e,th2 road
numbers and common road names. ,''�
0
GO
1V
16. REMARKS:
, "I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STA/ND�/iRDS, AND THAT A COPY OF THIS RECORD HAS
.A�BEEN PROVIDED TO THE WELL OWNER
t+j
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Sen ice Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-I REV. 07 2001

282704
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and NaturaltuResources- Division of Water Quality - Groundwater Section , / /
WELT. CONTRACTOR (INDIVIDUAL) NAME (print) _- (3. r r lam_:--C� CERTIFICATION # .3 r% �r r
'i • �[
WELL CONTRACTOR COMPANY NAMEE,;r- (teP nL, 2.rG, 11 ---k-`+" ttv )UPHONE F 1:251?) (p4 j- air) C
STATE WELL CONSTRUCTION PERMIT# J 4-0a :ASSOCIATED\\Q PERMIT/4 -. -_ —_--.
(if applicable) ( if applicable)
1. WELL USE (Check Applicable Box): Residentiallb. Municipals Public ❑ Industrial ❑ :Agricultural 0
Monitoring ❑ Recovery ❑ Heat Pump Water Injection 0 Other ❑ II.Otlicr. List Use
2- WELL LOCATI N: "'R�
Nearest Town: County ( fa -Li LOOOCI
(Street Name. Numbers. Col6munity. Subdisision, Lot Nu.. /ip ('ndel
3. OWN fIlt: dr, k 4G_rc
Address r.I .,
Topographic/Land settin
❑Ridge *Slope ❑Valley ❑Plat
(check uppmpriata havl
Latitudelongitude of well location
(deuce. minute.. second.,}
-aJ lit IrA'C_A-}; Latitude. Ioneitudc source:❑GPSD 1opofgraphic (nap
,//--�� __ (Street or Route No.} �� Ichxk bowl
P ts j - . - 1 (t ),lM hee5vt i lc,.}JC. % Dlil'll I DRILLING LOG
Lie or'hoen State
7 (ode Pram lb
Arca code- Phone number SS r (O >5 / S h (1 M i 'f t.
4. DATE DRILLED J D -' 62 I - Dv�
5. 'roTAL DEPTH: COOS 1
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO A.
7. STATIC WATER LEVEL Below Top of Casing: 3%5 FT.
(Use".- if thove Top of C.esinsl
8. TOP OF CASING IS I FT. Above (,and Surfacer`
I'on :ion Desrripliun
*Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCA(' 2C .0118.
9. YIELD (gpm): 1 2 METHOD OF TEST '
10- WAI P.R ZONES (depth):__.- > - _3 `2
ll- DISINFE('1ION
12 CASING:
I
1 OC.AlION SKIT IIc I
:Amount i ✓ =14Y1E5 Shin, lileelion and distance in ill let i)om at le.ist i -
waitl ieknar bat} Slate Roads or County Road #t)s�,l�ule the toa I .
Depth Diameter or Weight. Ft- AiateriuI nunr lb S :uiJ i common road name -5 - L_____ - 1
Front t) 1'o_1i s Ft.
From 'co Ft.
From To
13. (TROUT: Depth Material Method
From I lb o`ICl Pt. -4- 4r fs—
from To Ft. �i
14- SCREEN: _-- Depth Diameter Slot Size Material
Front To Ft. in.
in.
I'ype_}{T 1-1
fa it
From To Pt. in-
15. SAND/GRAVEL. PACK:
Depth Size
From To Ft.
From To 1't.
laterial
16. RFNIARKS:
I Do IIERI:I3Y ('F.R11FY-HIKE THIS W1t1.1. \VAS CONS'IRUd TED IN ACCORD:ANCF AAlllI If.A NCAC 2(', AI.ELI.
CON' 1 (It('"11ON STAND/' !jS, AND TI1AT A COPY OF HATS RECORD I1:AS 13} -?-P44llV'IDLD 10 1111( \V EL.l. OWNER
c
o) � � /0 - 3/ —a 3
SIGNATURE OF PERSON CONsIRU('I INC 1111 A
Submit the original to the Division of Water Quality, Groundwater Section. 163o .Mail Syr) ice Center - Raleigh, NC
27699-1636 ('hone No. [phone], within 30 days. (iW-1 REV. 07 2001

282703
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - DA ision of Water Ounlit>
CONTRACTOR (INDIVIDUAL) N:\N7E (print) 3r(.� _� Al
_
well. CONTRACTOR CO\IPANY NAMEDr to .,. _B or 5 . ��'t"`r
STATE WELL CONSTRUCTION PERMIT#Ai:LP
(Ja ASSOCIATED \\Q PER:IIru__
of applicable) -t if applicable)
- Groundwater Section (�r
(I:REIFIC.\TION N - a 6 J
PHONE a ($, %L(1 `' —31 7 O
WELL USE (Check Applicable Box): Residential �Munieipal Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery 0 Heat Pump Water Injection ❑ Other ❑ 11 Other, List Use
WELL LOCATION:
Nearest Town:mc,4R 1 V/. /]F4I County 000j.,_41.00061-
/n 4-/ C3' re n AD-n. /7-r b. s +-
(Sven Nano. Numbers. (onuuanity. Subdit coon. I An No lode)
Topo n aaF)hic!Land setting
❑Ridge HSlope ❑Valley ❑Flat
chce6 appropriate boll
Latitude longitude of well location
3. OWNLR2 rcunncyryFcvesf Evefs. ,"+-e>.I t-v+S c-r- Id._m<. mmme..ee,m(t.)
Address P 0 t. o-v- 1 %OO Latitude longitude source:❑GPS❑Topographic malt
en� I Ircct o/'u�c1Nu_I �� {cheek bowl
V/_AejDRILLING LO<i
zip (-ode Fon )anon Description
A.nnv t I
4
6
7
5
l-in of ,A Sett
l )'
:Amu code- Phone number
DATE DRILLED '7 - / `d - O 3
'TOTAL DEPTH: 1 DOS
DOES WELL REPLACE EXISTING WELL' YES ❑ NO
STATIC WATER LEVEL Below 'Fop of Casino: ,gO ET.
Olse*i* if Mime Top of (using)
TOP OF CASING IS 1 ET. Above Land Surface*
"Top of casing terminated at/or below land surface requires a
variance in accordance with IS.A NCAC 2(' .11118. 1 1
9. YIELD (gpm): r7 METHOD OF FESTg_./1(5 •_ - -- ----
10. WAlTER ZONES (depth):
D1.PTI I
from To I
53
53_' 1eo'
LO(AIIONSKL. t(H 1
1 I. DISINFECTION: Tvpc /-171/ f Amount / r(ry -(- )) js Nhote direction and distance in miles IIcm7-tt least
12.
r
CASINOWanlhaAnes Itto Mate Roads or County Roads. Inc of the road
Depth Diameter or weight I t. Alaterial numbers and common road names. r .�
l
Prom 6 To sb 3 Et. ✓.0 1 1 } :, c. �� —1�
From _ To Et.
From To
13. GROW.: Depth Material 1 Method
From 9 " I o 22aO Ft. L—nt--t--
From To Pt.
14. SCREEN: Depth I) meter SIot Size ,Material
Prom_.. To ft. in. i11
From To Pt. in_ in.
15. SAND!GRAVF.I. PACK:
Depth Size Material
From.__ "Fo Ft.
From ' To It.
16. REMARKS:
0
U1
W
I DU I IERIi13Y CLI2I IF1''FIIAT TIIIS WE_'I_I. WAS (ONS'I RIJCrI:U IN ACCORDANCE W 111l 15 \ NCAC 2C, AA'ELT.
C'UNSFRIICIION STANDARDS, ANDIIIAT A COPY OE THIS RD.() S 131E:N PROVIDED 1011111 N E.L.I. OWNER
gl)a ,SzP , i. — 3 /- 6 3
SIGNATURE 01 PERSON (ONS'IRGCIIN(i ll IF. AAail I. DATE
E
Submit the original to the Division of Water Quality-, Groundwater Section. 1631, Afail Sereice ('enter - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. (iW-1 KIN. 07 2001

282702
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WEI.I. CONTRACTOR (INDIVIDUAL) NAME (print)__-'--1 C2-L'1_,LM.— 1 1 a D CERTIFICATION # -2 41g
n ' l * p p'
WELL 7.CONTRACTOR COMPANY NAMEC (Ge<lN'“:1 . GO 1 i 1 �I't'tr'N-P PANNE # (O S to q 8 - 3 1 r% U
STATE WELL CONSTRUCTION PERMIT# LIkT.., 13!)a ASSOCIATED WQ PERMIT#
(ifapplicable) !if applicable)
1. WELL USE, (Check Applicable Box): Residential YA, Municipal Public ❑ Industrial 0 .Agricultural 0
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ if Other, List Use
2. WELI. LOC'AT ONj
Nearest Town: /QJ� nP 5 ell 1 le .C'ounty 1Q.7foncet
FCL I Ltd n R-{ 1 q
tlttcet Name, Numbers, Community. Suhdro on. Int No.. hip l ode}
3. OWNER: n n '� ) ids
Address (_Il t-, -1 h n� Tr
(Street or Route No.)
esv)/ltLC 28
Cin or-n1i State hip Code
rS -
10. WATER ZONES (depth): ��5 " 4 5 Prn
Topographic/Land setting�/"
❑Ridge ❑Slope ❑ValleyIl&-lat
Ichee 1. appropriate box
Latitudelongitude or well location
tac_tett, minute. sea,nd.)
Latitude lon_itude souree:OUPS❑Topo_rhphic neap
(cheek box
01)PTI1 DRILLING LOG
From In I Formati$2n Description
D 4/
( 1-
Area code- Phone number
4. DATE DRILLED -."-03
5. TOTAL DEPTH: (o
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below "Cop of Casing: (OD
(Ur."I" ifAlto)c Top of Casing)
8. TOP OI' CASING IS / ET. Above Land Surfaces
*Top of casing terminated at/or below land surface requires a
variance in accordance))vith 15A NCA(' 2(' .0118.
9. YIELD (gpm): (n Mfg CHOD OF TEST
I I. DISINFECTION: Tvpe.__H-ni :Amount 9L_
12. CASING: AAall ilt ickne.ss
or Wem__ht. Pt.
Prom. 0
Depth Diameter
'Co L/-c Et. (
From To Ft.
From 'Co Pt.
) LOCATION SKE IC'l1
+[A1 ) 4-s_. Shim direction and distance in miles Ito f 1 jr:St
t(to Slane Roads or County Roads. Inch' e-thilroad
c'
nunhbcrs and common road names. , -L_ I_
\laterial
PIIC
13. GROUT: Depth Material Method
From 6J lo a 0 Ft. fn
From To Pt.
14. SCREEN. Depth Diameter Slot Size Material
From To Pt. in. in.
From 'Io Ft. in. in.
15. SANDtaRAVl31. PACK: — ----
Depth Site Material
Prom To
From To
16. REMARKS:
CD
CO
CD
O
O
1
3
0
u1
CO
1 DO HEREBY (LRIIFY ' IIAF TIIIS WELL \VAS CONS IRIICTED IN ACCORDANCI. WEED I SA NCAC 2C, WELL
CONS IEUC'TION S'IANDA}tI S, AND ll IAT A COPY OF HITS RI-i t) (D I I.AS 131 'iyROA'IDILD TO THE WEI.1. OWNER
/ 6 3/-63
SIGNA'HMI O1I PERSON CONS lit UCIINti 11 ll.AFI-.I L I)AIb.
Submit the original to the Division of Water Quality, Groundwater Section, 163u Atall SCO ice Center - Raleigh, N('
27699-1636 Phone No. [phone], within 30 days. tiw-1 REV. 1)7 200!
I

282701
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL.) NAME
(print)— Ca--.4* - CERTIFICATION # 13b4-I
%%Et.I. CONTRACTOR COMPANY NAME/ -w ±-+ . Ll-) -4--1-1--4--1-1- d. P"" it PHONE # ((1ocp to `( - l
STATE WELL CONSTRUCTION PERMIT#
ASSOCIATED \\Q PERNIT#
(if applicable) (if applicable)
I. WELL USE (Check Applicable 13ox): Residential j, :Municipal. Public 0 Industrial 0 Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 ((Others List (i>c_
2. WELL. LOCATION:
Nearest Town: mt.�et t \IG ) )e. �ounty kiA.L Wood._
�1�_Ed�itlerc Its
(SI ect Name. Numbers, Community. Subdn ision. botiTtA, Code}
3. OWNER: 1 ) 1 1), kf)OFI-�t AnD
Address 14 o :,)„ -J e L) L t2Ik
(Street or Route N.
ntstf1 IIt1 pJG aVi
Tin or Tt o n State Lip Code
I r
.Areacode-Phone number
4. DATE DRILLED F - fa -0 3
5. 'TOTAL DEPTH: 1 1 05
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below "lop of Casing: ?G PT.
(Use "(" if Abuse Tap u(Cast rig)
8. Top OF CASING IS IT. Above Land Surf ices
*Top of casing terminated atior below land surface requires a
variance in accordance with I5A NCAC 2C All18.
9. YIELD (gpnt): [o METHOD OF TEST cQ h rs•
10. WATER ZONES (depth): to 0Q t - ct P^'v
Topout.tphic/Land setting
❑Ridge,Slopc ❑valley OF
at'u
i h ck appropriate box)
Latitude. Mom=itudc Of well lorano t
b I inmut tiandcl 7;?-
Latitude longitude s ,urea:❑(TPS❑ 1 opo 4q)hie in:lp
(dlcck hex)
DRILLIN
DI I'TII
From 1 o
o L9 3-.
Loa' DSI
CITE
Fon aint Dv scri ptiou
(3P,cr. LOC,\ILION SKETCH
11- DISINFECTION: Typc I-1- Ti-{ Amount 1 v'7 fjJ Fs Show direction and distance in miles from at least
12 CASING: Wall Lhickncs; two Sratc Roads or County Roads. Include the road
Depth
9rst -
Diameter or AA eight I`t. Ntatetial numbers and common road names.
rrom r0 To /✓0 3 Ft. Co )1 PV C
Prom To Ft.
From To Pt.
13. GROUT: Depth Material Method
From 0 To a D Ft. CD—✓uo—w-'}_
From To Ft.
14. SCREE-.N: Depth Diameter Slot Size Nlatcnal
From To Ft. in. in.
From To Ft. in. in. _
15. SAND -(RAVEL, PACK:
Depth Size Alaterial
From To Ft.
Front To It.
16. REMARKS:
0
CO
0
0
C
0
0
ut
CO
0
n�
c▪ rn
ern
0
7
• 1
rn o
ma
r-)
0
1 DU 11ERL13Y CIfRTIFI' ILIA"L TIIIS Will. WAS CONSIR(IC'LND IN ACCORDANCE. AATIll 1>.A:CAC 2C. WELL.
CONSTRLiCHON STAND R S, AND Ti IAT A COPS OE THIS IIS ItI LORD I I,) ' Iit.EN PROA'II)I:O TO l I11. WF:L.I. t)AANEIL
Yi) /6-3/-63
SIGNATURI:01 PI`RSON CDNS] RIIt I LNG lllt. AA1i11.
DATL:
Submit the original to the Division of Water Quality, Groundwater Section. lain Nlail sort ice Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. (iW-1 RIiV. 07 2001

282700
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division or Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) w�•251 r,�}-�� CERTIFICATION f✓ 30
WELL CONTRACTOR COMPANY NAME Gr the. �r0S . yvc 11 4 Pa Yp PHONE # ja2J9 Z, 99-
STATE \\'EI.I. CONSTRUCTION PERMIT#
LT 1 +`+ ASSOCIATED WQ PERMIT#
(if applicable) ( if aplicable)
I. WELL USE (('heck Applicable 13ox): Residential Municipal Public 0 Industrial 0 Agricultural ❑
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other 0 ICOther. List Use
2. WELL LOCATION: Near ) cst Town: a.q [a'r- 4�t �� County
1.o f.3/S UU AL /is o /(-s+- nc e
tsirccl Nam:. Number's, community. sultan ision. Lot No., liipCodcl
3. OWNER: I J % /.)/t . oL Cnirt_vt%
Address / 43 j )p 4t,<i0Ca_ Q .
1 dal
IStrcct or Route ) 6 6
ne��.v/ ll� /VC � �' 7
(llv 1 (en State hip (-ode
:Area code- Phone number
4. DATE DRILLED R _ 11 —U3
5. TOTAL DEPTIL 9 Fes /
6. DOES WELL. REPLACE EXISTING WELL? YES 0 NO ti
7. STATIC' WATER LEVEL Below 'Lop of (Casing: FT.
(Use i(:1hot'c Top of Lasing)
S. TOP OF CASING IS 1 ET. Above Land Surface*
'lop of casing terminated at/or below land surface requires a
variance in accordance with ISA NC:\(' 2(' .0118.
9. YIELD (Tin): /017 + METHODOOP TEST o� 11 /5 •
10. WATER ZONES (depth): St( -
TOGA LION SKETCI1
11. DISINFECTION: Type /1 Tj—/ Amount - j(e 5 f li) FSSIhM tlireciion and distance in miles from at Icasi
12. CASING: Wall Thickness nvo Scud Roads or County Roads. Include the road
Depth Diameter or Weight 1'1. XI:terial numbers and common road names.
From D To 02-5 Et. ' 1 JJ V C—
Topoer)hic/Land Setting
❑Ridge .Slope ❑Valley 0 Tat'.
Idv�k uppn pmr box}
Latitude longitude orAcell locati
I I. an UMW), cendsl -n
I.:ultutic longitude sourCL:OGPSOIbprapine mai
Iehcck box)
DI111 DRILL(N(tl_iit
from To ) Formation 1 cscription
�nt [ate
/ r/c)
% �l
From To Pt.
From To
13. GROUT: Depth Material .1 --�- Method
From .0 To 026 It. 0t An 2_ie--7
From To F[.
14. SCREEN: Depth Diameter Slot Site Material
From To Ft. in. in.
From To I L in it.
15. SAND!'GRAVHI. PACK:
Depth Site Mumri al
From _ to Ft.
From to
16. REMARKS:
hS:01Nn 01 AONEO
I DO HEREBY CEI211P1' ll1AT THIS W'I11.I. WAS ('ONS I kliCFED IN ACCORDANCE AA TI I I 1 S.A #CAC 2C. WGLI.
CONSTRIJC"LION STANDARDS, AND TIIAI A COPY OF THIS RECORD IIAS BEEN PROVIDED 10 TIlll WEL.I. OWNER
Ler) -2 htAti 2
SIGNATURE OF PERSON CONS !RUC.] IN( IIlI
Submit the original to the Division of Plater Quality, Groundwater Section, 1630 Mail Seri ice ('enter - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. (iW-1 REV. 072001
3

282699
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) _arLjj - rJ i ,t a - CERTIFICATION # 3' I6 ¥ /
WELL CONTRA: TOR COMPANY N:A\IE.l3 iez-ne- _.CZ-rOS , 1��--� Pu-M PRONE "�IR)NE: a (W�lp /o y' - 3 1 7 Z%
STATE WELL CONSTRUCTION PERMIT#
(it applicable)
CI))
1. WELL USE (('heck Applicable 13ox): Residential e7 '.Municipal. Public 0 Industrial 0 Agricultural ❑ I ,
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2, WELL LOCATION:
Nearest /l own:
I Street Name. Natubers, Comma' ty, Subdnisiun. Lot No_ /ip ( ode}
/7_2
3. OWNER: /3I I 1 Lk)(c� o--t
Address I L D a , ]7 e I iTho oe . RL
, l (Street or Route No. )
1/Jam[-p e_sul Iir T//C,
4SQ t o
40
( in of lost) State
lip coat ---
A.a eodc- Phone number
4. DATE DRILLED 8 - 7 -0 3
5. "TOTAL DEPTH: /06 S '
6. DOES WELL REPLACE EXISTING WELL'? YES 0 NO C -
7. STATIC WATER LEVEL Below Top of Casing: /IIb FT.
((Etc t` il'Abotc Tap or C'u.me)
8. TOP OF CASING IS 1 FT. Above Land Surthce
'Top of casing terminated at/or below land surface requires a
variance in accordance with I5A NCA(' 2C .01IS.
9. YIELD (gpm):_2 METHOD of:-rlsr A rs
10. WATER ZONES (depth): / }�D ' /o e
9 e p - s LOCATION SKETCH
II. DISINFECTION: Type—/71±TZ-I Amouli (le 1th Shoo direction and distance in miles from at least
12. CASING: Wall Thickness Itto State Roads or County Roads. Include the road
I)cpth Dianlncr or Weight Pt. materinal numbers and common road names
ASSOCIATED WQ PER.AI rr# _
(if applicable)
Tupotpta htc/Land se
ountyy ❑Kidee .lope ❑Valley ❑Ilu-'
(.heck appwpn-ae boll p
Latitude longitude el well loeat ou
)deuces nnnutts seconds) '•
Im
I..uitudc longitude source❑(,PS❑Topogtaphic
(check Kos.
DIPTII DRILLING .O(i
From To Frnnt in Description
2 , /vLpS
From D To 4 A Et. i/
From To Pt.
From To Pt.
13. GROUT: Depth Material Method
From To a6 Ft. 4 -720p
From To Pt.
14. SCREI'.N: Depth Diameter Slot Site Alaterial
from To Ft. in. in.
Front To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Site \Imerial
Prom To Ft.
From To
16. REMARKS:
'IS :OI WV 0 I MN CO
I DO IIERE131" CERTIFY THAT TIIIS Witt I. WAS (DNS 1RLC'TLD IN A(CORDANT I. Will! I5.A NC AC'_C. WEI.1.
CONSI RUCTION.STANDARI)S, AND FHA I A COPS OF THIS 12ECORD ILA' 3I, FN PROVIDED ' 10 IIIE Wra.I. OWNLR
,3/-63
SI(iNA'TUltll OP PERSON ('ON'S II{U(i LNG ll lh. WIT I.
0
n_
rn
ern
0c
�t
-5�
T
rvt
V Z
n�
O
DATA
Submit the original to the Division of Water Quality-, Groundwater Section. I ban Mail Sen ice Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. OW-1 REV. 07 2001

9.
l ().
1I. DISINPEC'TION
3. OWNER:
Address
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment a oral Resources - Divisioi of Watc Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAN E print)-r�,("t-c14-__L "'J ( RTIFIC\iIONp
lln -6� L.c)-s--1-L' ^l P tut I'IIONE # (8.�S & Y 8' - 3 1 170
WELL CONTRACTOR COMPANY NAME �' /'
STATE WELL CONSTRUCTION PERMITN _ / V. (0. Q _ _ - _ASSOCIATED \\'Q PERMIT#
(if applicable)
(if applicable)
282697
I. WELL USE (Check Applicable 13ox): Residential lE Municipals Public ❑ Industrial ❑ .Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ IIOther, List U,c
2 WELL LOCATION
Ncart 1: Li j///) Ec (/ I //L-County
�C'i .)LJ1 t LL' -. �Y a
'rot Name 'uuthcrc Community. Suhdicis ion. I*n No.. lip ('nde)
(SIw
:T0. C k -_I / O V e i
%�
Len_ _C/C (Street in.,c No.) r( C- �S 7 , Cp
ov Tnvn Stale
Lip C„dc
•
Area code- Phone number
4. DATE DRILLED '9 - 1 b --0.3
5. TOTAL DEPTH: 5
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO V
7. STATIC WATER LEVEL Below 'Fop of Casing: e2L) ET.
(Use `I" it :Ouse Top of Casing)
8. TOP OF CASING IS 1 I'T. Above Land Surthces
*Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NC:\( 2C M.0118.
m): �'7 $
YIELD (gp'� E - lOD OP IESI_
WATER ZONES (depth): 'V 4t 3 ' - 41 p.vt
5b ' - I ` xr1
.1pe Amount 41_
12. CASING: Wall Thickness
Depth Diunetcr
From 'fo 4Ft. (p '
From To Ft.
From 'fo
13. GROUT: Depth /1 Material /Method
From %) 'fo j 0 Ft. ((/��( 7 "Cr
From To Et.
14. SCREEN: Depth Diameter Slot Size AI:acrial
From _ To Ft. in. in.
From Io It. in- in.
15. SAND/GRAVEL PACK
Depth Sitc Material
Front To
Y •
Topographic/Land setting
❑Ridge ❑Slope ❑Valley I Ftt
I cheek appropriate box)
Latitude longitudo of well locution
(d.eree. u»Innt.:.>x„ad,l
Latitude longitude source:❑GPS❑Topographic map
(check host
DRILLING LOG
formation Description
�� y2 ' .P,. .
. • . o ' _Am La
DI I) Id
FI'OIl1 To
LO('ATION SKETCH
1:44/1.5 Shots direction and distance in miles fro u-A-Ik•ast
two Sate Roads or County Roads. Inclu9t:t}b9 road
or Acicht. Pt- ,Material numbers and common road names. m0
P VCw
O
{
From To Ft.
16. REMARKS:
O
Z
O
Crl
I DO IIEREDY CERTIFY THAT TIIIS WI'.I.I, WAS CONS] RUC I LI) IN ACCORD ANCF. AVIII 113.3 MAC 2C'. WELL
CONSTRUCTION STANDAJ2DS, AND TI IAI A COPY O1: Il IIS RECORD 11 AS KEEN PROVIDED TO I I Ili WELL OWNER
/0,3/—d3
SRiNAruRL pi: PERSON CONSTRLC IING II II WP.t 1. DAIL
Submit the original to the Division of Water Quality, Groundwater Section, 163o Mail Serm ice ('enter- Raleigh, N('
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07 2001

282695
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and tymu'ralResource{- Division of Water Quality - Groundwater Section
- - . q
WELL CONTRACTOR (INDIVIDUAL) NAME (print) __/. _�) t3-Ui_.b_J"p ('ER tIFI('.I' ION a
(�/ 3
WELL. CONTRACTOR COMPANY NAME G i e 1/j` ..).-8/k • W "''" P &p PHONE e (n.2A 6
Sl':\'I'E WELL CONSTRUCTION PERMIT# /4 46 ✓S _ ASSOCIATED \\Q PERMIT l x
if applicable)
(if applicable)
WELL IISF: (Check Applicable I3ox): Residential VMunicipal. Public ❑ Industrial ❑ Agricultural 0
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other ❑ [(Other. List Use
2. WELL LOCATION
NearL'+{ town:
.rcok zk
County e)G(
(Street Name. Numbers,
llCommunity, Suhdniei<n_ I i i No.. lip code)
3. OWNER:
Address P 0 a cy (oS3
IStrcct Route No. .29-7�
r rtMll 1 Swig
p ( laic
:Aura code- Phone number 6-34. DATE DRILLED 9 —. y -
5. TOTAL DEPTH: tp OS r
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO Cr
7. STATIC WATER LEVEL Below Top of Casing: ET.
(Ilse " i .. it ,Abeer Top nt Casin,_1
S. TOP OF CASING IS FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C.1)118.
9. YIELD (gpm): 0 METHOD or TEST . hrs
ID. WATER ZONES (depth):
II. DISINFECTION: Type !i 771_/__ Amount—L_r
12.--
CASING: AVall Thickne s
Depth Dia meter or Weight. I't A aepa
(4)( I
From b To � Ft. V ,
From 're Pt,
From To- -.
13. GROUT: Depth Material Method
From 1)To &h Ft. CQ
From To Pt.
14. SCREEN: Depth Diameter Slut Size AI:umial
From To FT, in. in. From To Ft. in.
15. SAND/GRAVEL. PACK:
Depth Silo Material
From To FI.
From Tu Et.
16.REMARKS:
Topographic:Land setting
❑Rides L3'Iopc DValley ❑'lei;
,ppropi ate boll ..
Latitudelongitude of well locattan
tdasr.:. inuurtCs ssondol
Latitude.IomOitudc source:❑(1PS❑Topogarfii t,_tp_
(check ho>1
DRILLW i L( (i
Forma, n Descnl lion
DI I'll1
om To
,_.
LOCATION SKETCH
Shot) direction and distance in miles from at least
Itto State Roads or County Roads. Include the rtLod
numbers and common road names. O r
W
_
-c
O
Ul
`-1
I DO HEREBY CERTIFY 11111ATTIIIS WELL. WAS CONSTRUCTED IN ACCORDANCE AAill l I5.A NCAC 2C, AWELL.
CONSTRUCTION S'I'ANDARR S AND IIIAI. A COPY OF ll11S RECORD AS 13I EN PROVIDED I() III[ WL1.1. OWM..R
SIGNAIUR, 01- PERSON ('ONS I RL( 1 mu 1IIF. \\ L DA I I'
Submit the original to the Division of Water Quality. Groundwater Section. 163u Mail Sertice Center - Raleigh. N('
27699-1636 Phone No. [phone], within 31) (lays. (1W-I REV. 07. 2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Na iral Resources - DiviSI ,n of Water Qualit>
W'ta l (ON'l RA('1'OR (INDIVIDUAL) NAME (print) __ i it ei.+.V-±_._. rLA-,
\\ELI. CONTRACTOR COMPANI NAME i ee_xL&'/_ _ryry resL` � (", W 1 )I'1
SPATE WEE(. CONSTRUCTION PERMIT# / `1 D �C ___.—\sso('IA"I L:I) WQ 1'ER.\IITp
01 applicable) /if applicable)
I. WELL LISE (Check Applicable 13ox): Residential Er -Municipal Public 0 Industrial 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other ❑ IF Other, List Use
2. WELL LOCATION' )
Ncarest�row nn: C/ Countyc
o �- (� �
(SINCI Name Numbers. Community. Suhditi ion. Lot do , Zip (
3. OWNER: }�G'1�-�n ' �(-Lay %'t`nL243
Address �yi �,6�t� n�-r-' _. -
Sttyc",rRtt No.)
F L ,3 5/ 2 6 I
S ate /ip (ode
( (-
Area cock- Phone number p
4. DATE DRILLED ! " 3 t' - P 3
5. TOTAL DEPTH: �n )
6. DOES WILL REPLACE EXISTING WELL? YES 0 NO EV
7. STATIC WATER LEVEL Below "lop ofCasine: FT.
(Use"''' ilAbote Top ct (isiagi
5. TOP OF CASING Is 1 FT. Above Land Surfaces
*Top of casing terminated at/or below land surface requires a
variance in accordan a vith ISA NCAC 2C .11I18.
9. YIELD (pm): 'J t METHOD OF TEST v( rs -
10. WATER ZONES (depth): _ / 'Z Li ' /O two—,
282693
- Groundwater Section
(' RHFIC.\ITON#
PRONE: # (Kt% 1,2 `/5' - 3I 76
\grina wrtl
v
Topogr phis/Land setugg
❑Ridge 11Slope ❑Vallev ,pt:41
(check appmlua b+v) ! 22,
L:uitudelongitude of well lue:uwtl
Itlegiecs miao seconds)
Latitude 1011,2.1tlali2 nap
IcAcck boat
DEPTHDRII,I�ING LOGO
I'rt�1.
lails ) Porn)at`in1�lLDripUos:—
I.00All0
I I. DISINFECTION: Type fr_T—-- Amount (4C._ 4-1) s . Shots k lircaion and disemrc in miles From at least
12. CASING: Wall Thickness Itv0 Sate Roads or County Roads. Include the road
c
G
c
-
From D
Fran)
From
13. GROUT:
From
From
N SKETCH
Depth Diameter or Weight. at. Material numbers and common road names
,t)ag I:t.J 1i = a'Jc.
'fo It.
To Pt.
epth Material N1)cthoti
FDo f() It. 7L.-/- (t2.1
To Et.
14. SCREEN: Depth Diameter Slot Site Materiel
From To Ft. in. in.
From to Pt. in. _ in
15. SANDGRAVEI-PACK:
Depth Size Material
From
From
To Ft.
To Pt.
16. REMARKS:
0
O
C
0
I DU HEREBY ('ERCIFY THAT THIS WELL WAS EONS IRU("I ED IN ACCORDANCE WITH I5.A MAC 2C, WELL
CONSTRUCTION STANDA131S, ANDIIIAT A COP} OF THIS RECORD IIA .N PROVIDED TO -HIE WELL OWNER
SIGNATURE
)I: PERSON CONS IRti(`IINU T 1II
/p-3/_o-3
DAVF:
Submit the original to the Division of Water Quality- Groundwater Section, 163o NI ail Service Center- Raleigh, NC
27699-1636 Phone No. [phone], within 311 days. OW -I REV. (17 2001

282692
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and N'=t ird Resources - Division u(ffVLWater Quality - Groundwater Section /�
6 `d y n+ !CERTIFICATION # T/ 8
WF:LI.c CONTRACTOR (INDIVIDUAL) NAME 1ptinq—D / n+\1�a,_I(� ���y. "�'y�
(N -ll-� + 1.Ly1N[) 1I"'. # Lc 4Li & `� g 3 ) IC
WELL. CONTRACTOR (IONIPANI" NANIF: re_em e, _).. ir-pt. I t
STATE WELL CONSTRUCTION PERN1I"I'# _ _
D2.. -- ASSOCIATED \\Q PI.RMITk
(if applicable) (if epplicahlcl
)
w LLL USE (Check ApplIL Ible Box): Residential Municipal. Public ❑ Industrial ❑ Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL COCA 110
Nearest Town:
'
Istrcct Name.. NuNn]
Stahl) 'sand Lot No_ Lip ('ode)
Topograihic/Land setting
❑Riche LClope ❑Valley ❑tiir,
tchcck uppmpriutc hns)
Latitude longitude of well location
3 OWNER: �� II Tees m.o. nd,sl
Address ..2 q--q- T p•S 4-i11n tiN_�ll . Lautud: longitude source:❑(ilS❑Topo�,+iphl"ithiA ^,�•
� / 7 h 'kl uI
(Street nr ROM' No.I M L S � /
rev, IleDER 111 DRILLI/VG L At
Cm n ftl State i Gp (-ode Troll) To i 1. i•nn Descr Holt
J_-_
Area code- Phone number
T. DATE DRILLED i0 —'3`'1)3
5. TOTAL DEPTH: i LD_c 1
6. DOES WELL REPLACE EXISTING WELL? YES NO ER"
/
7. STATIC WATER LEVEL Below Top of Casing: 1 W FT.
(Ilse' I" a Ainn e Top ,It Casing)
)
R. TOP OF CASING IS / FT. Above band Surface"
'Top of casing terminated at/or below land surface requires a
variance in accordance with I5A NC.A(' 2(' .0118.
9. YIELD (gpm): s� 5 METHOD OF TEST r s
•
Ill. WATER ZONES (depth):
el 4�;_pM -
s - -� - LOC' V HON SKL FCI I
I L DISINFECTION: Type L-j T Amount (y')_. faits , Show direction and distance in stiles from at least
12. CASING: wall Thickness two State Roads or (booty Roads. Include the road
Depth/ Diameter or Weight. Ft- Maternal numbers and common road names.
From dJ To (C '1 Ft. (;. 't --- P✓(t_
Frllln To 1't.
From To
13. GROUT: Depth Material j Method
From %) To 1r)_Ft._f,4 Act. +LTA
From Co Fl.
14. SCREEN: Depth Diameter • Slot Size Material
From To I t. in. in.
front"co Pt. in. —.—_ in.
15. S.ANDI(iRAVEL PACK
Depth Size Nlaterial
From _Io Ft.
From TO Et
16. RI:N-(ARKS:
I DO IIERII131' CERTIFY TIIAT TIt1S WELL WAS CONSTRUCTED IN ACCORDANCE Wild l 15:A NC AC 2C. WELL
CONSTRUCTION STAND RDS, AND THAT A COP(. OF fills RELOl2D II AS BEEN PROVIDED I011113 WELL OWNER
SICiNAIURL Uh PERSON coNstiruct WLI L D:AII'.
Submit the original to the Division of Water Quality. Groundwater Section. 163o Mail Sen ice ('enter - Raleigh, St
27699-1636 Phone No. [phone], within 30 days. (iW-1 RI.V. 07 2001

282691
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
(LII FcArOv # JG
WELLCONTRACTOR (INDIVIDUAL) NA (print) ar1eP
%'/!i
_ 3/%0
WELLCONTRACTOR COMPANY NAM-�et>_lt �rp; _�W�2, d- Yl-fa/,V^�L.PIONE#i R67 "
STATE. WELL CONSTRUCTION PERMIT# /lin ASSOCIATED (\ Q PERM I T#--_._.
(if applicable) of applicable)
I. WELL USE ((Meck Applicable 13ox): Residential Municipal Public ❑ Industrial ❑ Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION'
Nearest Town:ryLt./
/ O�2 ~%
(Street Name. Numhcis, Cummunitv. Subdi
3. OWNER:
Address
4
6
7
o�ISutct or Route No.) /
� A/C z
Cnc or rt tt 1 tart Lip Coda
Area Code- Plume number
DATE DRILLED / —n 3
TOTAL DEPTH:
DOES WELL REPLACE EXISTING WELL? YES ❑ NO 6-
STATIC WATER LEVEL Below. Top of Casino: lie, FT.
(Use "'`if Above lop of Caangl
S. TOP OF CASING 1S / PT. Above I.and Surt:)cc*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NC A(' 2C .0118.
9. YIELD (apm): 30 METHOD DOE TEST a rc
ID. WATER ZONES (depth): 4/tit' / —
11. DISINFECTION: Type Ft- 7-7-4 Amount .25- f`›.)475
12. CASINO: Wall Thickness
Depth Diameter or Weight Ft. Maternal
From LA To 317/ H. 6_/ ( Pv
From 'T) Ft.
From -fo
13. GROUT: Depth „Material Method
From /> 'To „ 2C) Ft. ( D -r T
From To
14. SCREEN: Depth Diameter Slot Size Material
1-rom To Ft. in.
From To Pt. in. in.
15. SAND/GR.AVIEI. PACK:
Depth \luterial
!Ton) _ To
From To
Site
Fa.
16.REMARKS:
Iifs (}tt:A /
tit:ALL
Vs� i
isiou. Lei No. . hip ('ode)
Topographic/Land setting
❑Ridge ope ❑Valley ❑Flat
Ichock appropriate hovt
Latitude Ion^_itude vveil location
Cal c+.u)LCI 1 Neumc, ennetC� xnmd.t
I ID(j Net R) VC( .1 atituda lon_itudc source-❑GPS❑Topographic map
tdwek huxl
DKILLtN(i LOIi
DI I'll(
1- Ton) To /
Iormattio,(t Description
LOC:A110N SKETCH
Show direction and distance in miles 1mi>l: t le:
itvo State Roads or County Roads. Inclutk She rb�, d
numbers and Common road names. O
b o
t rn
l'IC
w r„
ma
o
r
I DO IIERP:I3Y CERTIFY THAT TIIIS WELL. WAS CONSTRUCTED IN ACCORDANCE Wit} I3.A NC AC 2C. WELL.
CONSTRUCTION SrANQARPS, AND TIIA't A COPY OF 1111S 12F.00121 S IiLF:N PROVIDED 1.0 lllE WEI-1. OWN ER
SIGNATURE OF PERSON CONS MEG
I III AAII1. D.AIT
Submit the original to the Division of Water Quality', Groundwater Section, 163u ail Sers ice Center - Raleigh, tit
27699-1636 Phone No. [phone], within 30 days. OW -I REV. 07 2001

282688
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Dia isi 1/m of A\later Vuulih - Groundwater Section,/
WELL CONTRACTOR INDIVIDUAL. NA)1 II _ -_. L ('hRIIFICATION#.. Y-/g
WELL CONTRACTOR COMPANYNAME _r tit 'ME_ E'rvj. Zkl N `Lfl Al
1 TIIONF: # toeta �• ,/ - 3 / 7
tiTATE WELL CONSTRUCTION PERM tr# ____ /SL)2_-_ ASSOCIATED)\'Q PERMIT
( it applicable) I if applicable)
I. WELL USE (Check Applicable Box): Residential Municipal Public ❑ Industrial ❑ Agricultural
g;In
Monitorin❑ Recovery D Heat Pump Water n)cction ❑ Other ❑ If Other, List Ilse
2. WELL LOCATION
Nearest 1'rlwn: 1d J
I( Count
eel M1`.uno. Numbers, Conummiiv. Subdn i%iau. Iva Nu.. hip lode
Topographic/Land sett!
❑Ridge »Slope DValley IJET;t
I�hcck appropt late box)
I.aIitudc. longitude oI\Nell roc luani
3. OWNER: -r t_T4 E✓eo S it c.inimt ondnl
Address / /7 Q 4 I LaineLC,_.— D,'.ILL I. alIUIIc lun_iluSL ourcc.❑([PS❑Tolpol i1hic map
/)/ I Stye[ or RoomNo.) a (cheek host 11
-QeTl TII DI.PDRILL WG LOIi
Cits or Toaan �datc hip( from To ( Punua, Uescnpu
Area code- Phone mmtber 7y$ a SLJ h!ia
4. DATE DRILLED '/ /� - / 0 " 6 3
3. ILOTAL DEPTH: R z/S /
6. DOES WELL. REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of C'asine: to j) PT.
IUt .- ifAbeie fop or Ciaim_I
R. TOP OF CASING IS ET. Above Land Surfaces
"Top of casing terminated at/or below land surface requires a
- __ -. - -----
variance in accordance jvith 15A NCA(' 2(' .t1118. -
9. YIELD (�=pnl): / METHOD OF TES; / /2 K��,
•
ID. WATER ZONES (depth): _ _ VLS- % Vs- '
LOCATION SKETCH
11. DISINFECTION: Type-}%/--J Amount / 'Ia f 1' Shim direction and distance in miles from at least
12. CASING: Wail Thickness teat) State Roads or County Roads. Include then;id
Depth Diameter or \\ eight. D. .At aerial numbers and common road nan)CS. W 0
From(,J To 7 rt. l " » V( ��
From "It) It. C cc1
From To H. - — tr.hcz
13. GROUT: Depth l�Mutcrial Method CD,c
From 0 To ,-//O It. ( (' dnLR.-a _tap— 3 coo
FromTo It. " r"
cn z
I4- SCREEN: Depth Diameter Slot Size NI:aerial CDr-ta
From To Ft. in. in. __. ___.. (J1 —)
From t o Ft. in- _ in. CO o
15. SAND/GRAVEL PACK:
Depth Size Material
front to Ft.
From To it.
16. REMARKS:
I DO IIEREBI" CERTIFY "I IIAI-THIS WEI I. WAS (ONS'IRUCI PD IN ACCORD AN(I WITH 15.A N( AC 22(. WELI.
CONSTRUCTION SFAND 2DS, AND THAT A COI'(' OF 1111S REC()RI) I IN PR0VIDbD l() HIE AA El OW,NI.R
J y/
SI(iNAT IRE ()IPERSON ONS 1 RN IINci 111I. AA'II I_ D.V1II
Submit the original to the Division of Nater Quality, Groundwater Section. 1630 ,Mail Nen ice ('enter- Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. (iW-I REV. 07. 2001

282687
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and N' iral Resources - Division of Water Quality - Groundwater Section
/r� / j ) CERTIFICATION k.� 1(e
R'F:1.1, CONTRACTOR (INDIVIDUAL) NAME/� (print) _ _ 6�-C1--}tom... __Le b /� - -
U1t x,e, Sr4s_.. Yye)) �- {dump, �,ti . PIRINE # 629 /,, •
S' - 3 / 7!,
WF:LI. CONTRACTOR COMPANY NAME
STATE WELL CONSTRUCTION PERMIT# _ / 7 D.2 —:\sso IAn') \\Q PERMIT#
lit applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential — Municipal Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection 0 Other ❑ [(Other, List Usa
2 WELL LOCAIIO : ,
Neat f'I(wt C S County �ewit)tond
jI
{Street Name. Numbers, 'ommunih/ Suhdn ri n Irn No.. /in Code
3. OWNER:C9i.�(� C Jr S 4G-�.L.L1
•
Address (' n .////I-0Fp SS)ran .l ALtl(ttLr'S
IStrcci �/) or Route Nu.) �.
a34' C- taw-, hiss h.,
(Lyor Ton n State hip ( ode “.287LI
l )-
Arca cods- Phone number
4. DATE DRILLED 9 - ? 2 - 03
5. TOTAL DEPTH: 62D S '
6. DOES WELL REPLACE EXISTING WELL". YES ❑ NO g
7. STATIC WATER LEVEL Below 'Fop of Casing: v(-)
(Use "." ifAbosc Top of (user)
8 'TOP OF CASING IS
ET. Above Land Stu -Mites
'Top of casing terminated at/or below land surface requires a
variance in accordance with 15A N('A(' 2(' .0118.
9. YIELD (gpm): 2 METHOD OF TEST a /-775
10. WATER ZONES (depth): 3 a 5 t - 52).
PT
11. DISINPECTEON: Typc_HTL( Amount gej #7/1_5_..
12 CASING: N all lltieknc,,s
Depth Diameter or AAeight. Ft. Nlaieriul
Cron) O To LL/O, Ft. G. Ptie
From TO Ft.
Front--- To
13. OROIJT: Depth /�Material pleihod
Front ,c) TO ..zit it. S U - 4173
From To Pt.
14. SCREEN: Depth Diameter Material
From To Ft. in.
From "To It. in.
15. SANDIURAVEI. PACK:
Depth Size Material
Slot Size
From Tn Ft.
From To Pt-
16.REMARKS:
in.
in.
Topographic/Land setting
❑Ridge DSlopc ❑Valley �Ltlat
check appropriate box)
Latitude longitude of well location
fdc_mc, nunmc,. seconds)
L.uitude. lomtitudc source:❑(IPS❑Topographic nwp
i,cck bo-x)
U P.P1-II DRILLING LOG
Irani 11) formation Description
LOC':VIION SKL'TCIIiti
Shots direction and distance in miles roil-4 it least
two Stine Roads or bounty Roads. In4ITn : head
numbers and common road names. lies
1 DO IIE12E133' ( EIS TIF1' TIIAT THIS WEI.I. 33 AS (DNS INI( I ED IN ACC( )RD ANCI. 331111 15.3 NC -AC 2(. WLLI.
CONS 'I P. iCION STANDS, AND l IIA'I A COI'1 OE ll EIS I2f C O 3S BEEN PROVIDED lO 111E AW EL.I OWNER
/D 3/ - ° 3
SEGNA FLIRP. OF PERSON CONS IRE( ITN(
Submit the original to the Division of Water Quality', Groundwater Section, 1630 flail Sers ice ('enter- Raleigh. NC
27699-1636 Phone No. [phone], within 30 days. (ib6-1 REV_ 07:.2001

282686
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - I)i‘ ision of Water O()Joins'
ual- Groundwater Section
/
WELL CONTRACTOR (INDIVIDUAL) NAA E (print) Y (1-�t._( KCi.4 C e_. - ('F:RI'1 FIC A 1 ION # ' L��
W ELL CONTRACTOR COMPANY NAME ( ay)&, -/ rtvs ..VTQ 1 ' -+ 1 1. rnpiJ ELa-
STATE WELL CONSTRUCTION PERMIT# / 41t.0 _._-- ASSOCIATED WQ rERMrr
1 d'applicable) lit. applicable)
PHONE #
WELL USE (Check Applicable 13ox): Residential CVMunicipal Public 0 Industrial ❑ Agricultural 0
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other ❑ IC Other, list lick
Neal'
2. WELL LOCATION
ounty LkA/U)LY>D
Q.ltvere iL4P -
(Suet Namc. Munk jS. Conlinunity_ Subdnl:i n Tot No.. tip Code'
3. OWNER:
Address / l) / L17
ISt cct or Route No.)
i2-t-1 Iof.l y �J C .
Cite or Town sttt(c Lip
,73
:\rca code- Phone number
4. DATE DRILLED 9- /(` -3
5. 'E6TAL DEPTH: 3 e a '
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: L') FT
(usc"'' i Above Top of Casing)
8. TOP OF CASING 1S / ET. Above Land Surface*
'Top of casing terminated atior below land surface requires a
variance in accordance with ISA NCAC 2C
9. YIELD (gpnl): ,,;(l) METHOD U1` TEST ftr5
10. WATER ZONES (depth): 31/J ' - -3 9-
7 C•
Topographic/Land setting
❑Ridge ptilope ❑Valley ❑t Yai
check appropriate riaa box} tI
Latitudelongitude of well loc 1 um�
11' nice, minutes . aonds)
I. abode loneitud . ourcc:❑GPS❑ I opt ,F}`;Ipic Wrap
(check hos)
DIPIII DRILL!
From To Formation
.3_s
LAJ
)it sClipuo�E )�
LOC:A1'ION SKETCH
11. e DISINFECTION: 'i'y - _ :Amount /„_„�_ f�j (i<3_. Show direction and distance in miles from at lo:ie
-e
P �— _— two Scats Roads or bounty Roads. Inclutbthe ad
12. CASING: Wall ciuln es> Ca"
or W�ciaht. Pt. 1 I numb �n and common road names.
Depth Dituncicr
From /i i o /7/3 Ft. U, rl
From 'Co Pt.
From _To Pt.
13. (TROUT: Depth /� Ntaterial
Prom L To .)/7 1`t. (f ;Eti-2ne-1-
from To Pt.
14. SCREEN: Depth Diameter
From To Ft. in.
From To
15. S\NI):GRAVEL PACK:
Depth Size
Pron1 1 o Et. _
From To It
16. REMARKS:
arena e ` .. o
z
PY �•' -CI C
c ,
Slot Size Alaterial
in.
in.
\I:nc vial
I DO IIEREI3Y CERTIFY 'III AT TIES WELL WAS C ONSI RUCHi) IN ACCORD ANC!, WII 1 15.A NC AC 2C. WEL1.
CONSTRUCTION STANDARD, AND IIIAT A COPY OF IIIIS RECORD II:AS BEEN PROVIDE!) TO IIIF WP.LI. OWNER
/) —3/ - 03
DATE
\ )'`JALi) ALL
SIGNATURE OE PERSON CONS IRl iCllNt i'1'1II
Submit the original to the Division of Water Quality. Groundwater Section. 163u NI ail Sen ice Center- Raleigh. NC
27699-1636 Phone No. [phone], within 30 days. ( iW-1 REV. 07 2001

282685
(11)01 FOtn State
(
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and
WELL CONTRACTOR (INDIVIDUAL) NA\IF. (print) _
WELL CONTRACTOR COMPANY NAME. G r-ces
STATE WELL CONSTRUCTION PERMIT# --
(if applicable)
Natural Resources- Division of Water (Alalitc
t - t,U cl t -I- PLO•wp,
4toa
ASSOCIATED WO PERMIT#
l if applicable)
- Groundwater Section ,/
CERTIFICATION # 3 L`f
PHONE # (S2 G.' $- 3' b
I. WELL USE ((luck Applicable Box): Residential Municipal Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, I.ist (ise
2. WELL I.0CAF/t0'J:
: Nearest'I'ownL.t }naL11FS VI //L County
{op r
ISircei Name. Numbers. Community, SubdL (Sloop. lie No.. hip (\nlci
3. OWNLR: /CC'��R—�v/tY' nC-/
Ad4lFess / n.
(Street or RouI te NO. A
!)tI 11 ,_5() 3
hip C otic
Area attic- Phone number
4. DATE DRILLED 8j -/3 - D3
5. TOTAL DEPTII:
/7/S'
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO �.
7. STATIC WATER LEVEL Below lop ofCasine: <% I T.
(Use - if Ahot : Top of C mutat
S. Top OF CASINO 1S / FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCA(' 2(' .MI18.
9. YIELD (gpn ): /( METHOD OF TEST .Q A es
•
10. WATER ZONES (depth):
11_ DISINFECTION: Type jai[
Amount 78_/2L5s_.
12- CASINO: wall Thickness
Depth Diameter or N eight. Pt. Atalenal
From To In S Lt. 1., " J-nVl.n
From 'Eo Ft.
From To
13. GROUT: Depth /i Material Method
From 0 'ro .2i) Et. ( O _GNLt1 '-[-Y,�
From To Pt.
14_ SCRII..N: Depth Diameter Slot Size ALncrial
From To Ft. in. in.
From To Ft. in. _ in
15. SANIIGRAVLL PACK:
Depth Size Material
From _ To Ft.
From 'Io Pt.
16. REMARKS:
Topographic/Land setting
❑RidgeSlope ❑Valley ❑'tat-�
IChei6 appropriate box} :.
Latitude longitude of well loeati m
1
11-11-117
IT -a
0
7
(dettieo, nllatl caadi 1
Latitude lonaitud source ❑(1PS❑"I oporyaphi map
(chefs has,
DI-.PTII DR11_1.1'1Ci 10(1 )jI
I ro Formatio 1 I ascription%l
_.__ o _&S./.
I.((rAIDON SKETCH
Shots direction and distance in miles from at least
two Stine Roads or County Roads. Include the road
numbers and common road names
0
w
O
C
0
a
t=P
Ul
w
I DO IIIREBY CERTIFY 111AT TIEIS W'1!1.1. AA'AS CONSTRUC I ED IN rACCORDANC IL AVIIIl I5.A NCAC 2C. AA'[I.1.
CONSTRUCTION STAND4RUS, AND IIEAT A COPS Oh THIS I2,F-tt14L2 II. - AS BFPN PROVIDED TO 111E AAILI OWNER
in ' 3 /- 63
SIGNATURE 01 PERSON CONSI RV(' IN(i lll1. \\ LI I_
Submit the original to the Division of Water Quality, Groundwater Section, 1630 Mail San ice Center - Raleigh. NC
27699-1636 Phone No. [phone], within 30 days. (4W-1 REV. 07 2001

282684
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and i' tura] Resources - Division of Water Qualltc - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) /•✓ C/K-i�/Q- _ . 8ra t - /,+�- PHONE # f5%?W V S' - 3 /
CERTIFICATION #
(�
WELL CONTRACTOR COMPANY N,1AIF.�Y_P.C3d P,—_ - I7J i y�() -4-- !' KY`sP , al
STATE WELL CONSTRUCTION PERMIT# _ / `Y/ /),.i. _- _..—ASSOCIATED WO PERMIT:
1 if applicable)
if tipplieable) - -
I. WELL L1S1: (Cheek Applicable 13ox): Residential lg.- Municipal. Public 0 Industrial ❑ Agricultural
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other 0 I(t )thcr, List tse
2. WELL LOC'AIION:
Neat -st I own: C / 2 / e County »(1 dt-
./nJ ,./I � --_ 1.
I Street Nana, Numbers, c omfnuuuv.. Subt�u tionCO) No.. lip lode)
/ 1{ 3. OWNER: _ 1 kC. -%�—O t_%L)—! i ) I .c, nuue - can,.)
Address -54-,R 3 TA, e Lb, Liers_ D 1 Latitude lon_itude source.❑CIPS❑T
�Route No l Ru'.6 hos)
--I�y�, I�D.(C(Sfr 1-( o,/9 F J �L .-3 "'� `j 3 UI.I'fIl DRII
iii ii> of to,,,, State hp Cod,/ [Roll l o /
Area mde-Phone cumber E%IS4, K.� , 53' .3/fs/
4. DATE DRILLED 1 D - 9 - o3 LJc? I - .2 q-5
5. "TOTAL DEPTH: 34`T' 7)/,'/)td )do' eie'pc'
6. DOES WELL REPLACE EXISTING WELL:' YES 0 NO lilt
7. STATIC WATER LEVEL Below "fop of Casing: J o0 FT.
It x -r'. it Ahovc Top of Lasing'
8. "TOP OF CASING IS ) ET. Above Land Surface*
"Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .11118.
9. YIELD (gpm): /6 METHOD OF 'TEST P /5) ,-s
10. WATER ZONES (depth): / R 5 ' - I cj U ' _--
Topou -aphici Land sett
❑Ridge Slopc ❑valley
)'heck appropriate boll
Latitude longitude of well It
Format( al Descript n- )3
11
phic nitp
I 00
i e.
Tin
LOC:A1 ION SKETCI1
11. DISINFECTION: Type 1-4-/-/-/ Amount M /is_ -Sho)) direction and distance in miles from at least
12. CASING. Null Thickness two State Roads or County Roads. Include the roar)
Depth Diameter or AA - eight . Ft. Material numbers anti common road names. c
From fri Co Et. (a, el f U ( W o
From, 1 o Ft. ZO -`-''-
Lro1n To hl. cc e.
13. GROUT` Depth aterial Method — o�
From � 'fo �n Et. � tt iCl -t- , en Wiz'
+
Prom_____ To ._._ Pt. macl
rn
14. SCREEN: Depth Diameter Slot Si/e VMaterial 3 c
From To Ft. in. in. O T
Cn
co
From To Ft. in. - in.
n --I
15. SANDIGRAVId. PACK: CO
Depth Slit: AMatorial
From to Ft.
Front To Et.
16. REMARKS:
I DO IIEILL'13Y CERIUM' IAT TIIIS WELL WAS CONSTRUCTED IN ACCORD ANCL AVIlll 15.A N(AC 2C. WELL
CONSTRUCTION S FANDARIa$, TND ll lAL A COPY Of 11115 RECORD HAS BEEN PROVIDED R) I TIE WELT OWNhalt
/P,3/ D3
.4 ,tz
SICiNA'FURL OI' PERSON CONS I RUC I ING llu\-Ilt I. DALE
Submit the original to the Division of Water Quality, Groundwater Section, 163trMail Sen ire Center - Raleigh. NC
27699-1636 Phone No. [phone], within 30 days. (1W-1 REV. 07 2001

WELL CONSTRUCTION RECORD
282390
.Not lh Carolina - Department of Environment and :)turall [Resources - Division or A1'aler Quality - Groundwater Sections j/
N T.I I CON \('I fll<{1\DIVlI)[.\L)\A\II trim) [L))����.5/ /� itlij/?e CERTIFICATION # �e9cam,
\\I'1II.O\a ItA(IDR (.O\II'\\1 S.\\II!rr•Ce `1/_Q//91 1/41f I Z2wJ-=v/�
rno\r: #
5 I.\ I r: \c 1.1.1. (-O\1 I'RC CT IO\ I'EI \lrru
(:I :gal+licuhlel
ASSOCLA"I FI) AAQ I•ERViIFH
(if upplictblet
VVLI.I. USL ((lheck Applicable Box): Resider. -II Er---NlunicipaI Public ❑ Industrial 0 Agricultural
VIonilorin" ❑ Recovery 0 Ileat Pump AVaxr Injection 0 Other 0 II Other, List Use
'. \\ I2I.I. LO(\ I ION:
Nr lc id Town!'✓4ttle,5
AziLbeic/DT
i al Nanm. Numb,. (''u m Yn. Subdi yin
OAA Nl-R:,C' / yO7—
//�-- count.. /Y-' woe/
Lit No.. Zip (ndct
vkires, O 1N�n•E fi_1-•
sae❑ . No
tIVC
ag
tto or Hutt l 1, /l (tttic
I o' )- G'(01 as
Topographic/Land settin
❑ILldee at —Slope ❑Valley CfII hu,l
tell k-Ip))n1..11 b,vi 1
Letitudc loneilude of well locatioh_`;j
I(leS rces. ulilullc:,. cconds)
Luliludcrlongilml vourcc:❑CII+S❑Topo ,apifi
idled, host
DRILI_IN
I'`+r1 )align U
CI sa-Y
DI PEll
front Tu
a -Do
.Arc.! auh- Phone nnlnhe
1. I) VII: DRII I.I:D -. 0 /38
*. II)I:AI. ukiviH 0r �/
(i. Dohs VAI[LI RI.A LAISI ING WELL? 1"IiS�07 NO Er
7. SAIICAVVIIRI_f:VF'.I.Below Top olCasin2: oC5— PT.
lUse' n Alyre nito1(:slopl
,. TlI' OP CASING IS FT. Above Land Surface'
"I up ul c •ina terminated al/in' bchi' land surface rettuires a
c.Iriancv in vunrtd:nice with ISA NCAC 2C .1)118.
v IIiLD(Lplll): 3 METIIOD OETIiST 4"•/
10. AAATI':R ZONES (depth):
I. I fSINFI:CIION. 'Type %2 Am- ant
C:\SIN(i: \\':JI : hickncss
Deitch Di:lnelel' orVp- eiuhl.'I t. AI ltei ial,
[tofu fu /�� Ft. �� .•/f 5/frf"
I nou fo FI
1 4KUG l : UchlI1 Maternal
I tom O Tn -I SCR(. I IN'. Deplll
Ilonl In I1.
I7 tit :ANI)'GRAVL:-. I'A( K:
Depth Site
17on1
I1i4�1 Tu
I It CALARI.S.ti:
/3d
ys
c
O
I)rllnelcr Slut o/e Malinri;d
Inc et i;tl
LOCATION SKETCH �
rn _
Show direction and distance in miles lira-Tai isi.
t v'o State Roads or County. (Loads. IneIrc11.)the VtiA
numbers and CO111111nll Nat 1111neS. CV 2
olJ iiVuj J? a3
F o
!Intl119tE131. C1:RTIFI THAT IAT THIS WELL WAS ('1 iNSTRUCTED IN ACCORDANCE WITH I I ISA NCAC 2C, WELL
I tNSTRCCI ION STANDARDS. AND THAT A COPY OE THIS RECORD IIAS HENN PROVIDED TO 'HIE WELL OWNER
teda
SIGNATURE OF PERSON CONSTRUCTING INE WELL. DATE
0U
Submit the original to the Division of \\'ater Qn:. city, Groundwater Section, 1636 Mail Service Center- Raleigh, NC
2761)9-1636 Phone No. [phone], within 30 (l))ws. • Ci\V-I REV. 07/2001

WELL CONSTRUCTION RECORI) 282389
.North (':Irolin:l - Department of Environment arid aural Resources - Division of Water Quality - Groundwater Section
VA Eli (11Ni It. A CIOlt (IAUTAII)l :Al.l NAME (print) 4, /f-e. CERTIFICAT„),Y..2v69
LL412 PHONE q J.CCnC+(7�
A) /-'Ui
\\ I II.cu\lit.\ulolt COMP \N\ N.\\II< Pryce Eve'/
r. Cin: \\ I.t.l. (0\SI It CI'IO\ I'1:lt\II'14
:t ❑la)dicahlel
ASSOCFA"I El) AAO I'EItVIITtt
li h:q,nl iell,lel
I AVII.I_ USE (Check Applicable Box): Resident:al VMunicipal/I'ublie D
Monitoring D Recovery ❑ Heat Pump Water Injection 0 Oilier 0 I
S/w'U f'
S..1 N inky . nl . s. Commune Subdiri u. I01 No 71p ( ode,
OAV NIR Ive OL
Vddl:cis
VA'LI.I. LOC VIION: / %/
Net \\ rest Fowl: WR')2'62:51/'le Co
1 I...,' I , ua T1
ur I ,./1' `.I tle
l l- �aY7 - ‘2,517
v:ea,ode-nuoictainth .,
J. D,ATli I)HII_I.GU_�
:. Nt)NAI.
p ('ode
DOES WELL REPLACE EXISTING WELL? YES Q NO
7 S lA11C WATER LEVEL Below Top olCasu -7,3 FT.
(use `+" it Ahoy,: Top olCasme)
X. l 01' OF CASING IS FT. Above Lund Santee'
''lop nl'casing terminated al/or below land .nrLIce rci; !fires a
variance iu accordance with I5:\ NCAC 2C.11118.
FILLD (='pin): s2 O� �METI IOD OF EST,4-i/
IU. AVAIIH( ZONES (depth): I. DISINFECTION ECTION. Type _X 1- %
I'. CASING:
Atle ant
\Vall Inekricsi.
I kpth a/.�� /Di.iucter or A.eSnr
INI11 (2 'It) / / It. (, %y ,i?_/
Front 111 I:I.
I runt Tu I'I. — — --
17 Cll<OCl//: Depth AI:ucl'iul
IroluL.)lu -CJ 1-I (1.'tee
1 Ilml 1 , Pt.___. _..
!-1 1C'I<IIIN: Depth Diameter Situ L e AilVcrr.11
I'II`ul To I i
.5. SAND GKAVI/L PACK:
Depth Si/I:
11111 To FI_
I lain Iu I't.
11d'i. :mil li(IltiNets and eUtimioti road navies
\I1thud
n. ItliALARKS
Lac I
1-)
Industrial ❑ Agricultural 0
)thcr, List Use
Topn l phic: Lund setting
❑Riduue ❑tilt l,e ❑ Val Icy ❑I IItL
I'I $ appluptiatc I'' 1
Lalitudeloneimde Orwell Iofelloll -„
1I uec..minutes<,ceond,l
L;uiul(I lon_iuld sourcc:O0[SOTopo r atttitilya
I Cheek bit
rrl [NTT!:DRII.I.ING LOG L:L_.__.
Inlm -I I nrnlnlioq Duaiplioil
O NE:
W
0
LOCATION SKETCH
Show direction and distanee in miles Gum al
two State Roadds or County. Roads. IncItt the jjJ t
cn
0
z
w
IV
I I u) I IIIRI/11A ChM IPA TI AlLTHIS WELL \VAS 0 .NSTRUCTED IN ACCORDANCE AVIT11 I SA NCAC 2C, WELL
Cl4NSTROCI ION STANDARDS. AND THAT A Cop':" OF THIS RECORD I1AS BEEN PROVIDED TO 'HIE WELL OWNER
jet*SI(iNA-FL:RI
G——DD
OF 11E3,SON CONSTRUCTING 11-0/ AVI/L!- DATE
Submit the original to the Division of VA';tter Qu: lily, Groundwater Section, 1636 ,ALail Service Center - Raleigh, NC
27690-I636 Phone Nu. (9191 733 3221, within 31) (la';. - Ci\V-I RGV. 07/2001

WELL CONSTRUCTION RECORD
.North ('nrol:nu - 1)eparuucm of Environment and Natural esources - Division of Water Quality - Groundwater Section
\\I II. CONIIt.\(CI Olt (INDIVIDUAL) NA\II. min° ke74-' L�4j U/ \\VI CERfIFICAIO\
I. CON (OM I\NN\\IF: CC �e,C-. 'h 1'I ION I.: if ,J[e)vqp )/BU,JQk S I.\II: \\T.LI. ('(INSIItUC'IION I'Elt\IIFN :\SSOCI:\'ITD \\O I'ER\Iffy
ifapplicahlel (il applicable)
282:18 at
I AA'LI.I. USE IUteck Applicable 13oN): Rcsi(Icn.ial I lunicipal%I'ublic 0 Industrial ❑ Agricultural 0
Monitoring 0 Recovery 0 Heat I'unap Wa'lirr Injection ❑ Other ❑ I(Other, List Use
_. W LI.I.. LOC:AIl03 N:
Ncuoal Torvn C4))/111)1Q^1.
____ ( ounl
I`.i ail N.anc 11. +. (ou (n. Suhdici',I n, I of No.. /.ip Code)
-n. �..— r
\cldl ce, 1:�_U
`t( y�-/v Tc
(Sri cart Irmo Nn
cR 7/
tlry Iona S!alc /ip(ode
&2.) a35 - got\
Vicy. mule- I'Imve nonL:r ,7
I. D:\"I li URII.I .Ii Li/Ly-F-C-
N. LO'I'AI. Ulil'lll:
Topographic -Land setting
Llrlec ❑Stoke ❑V.11cy ❑ 1.0
1'Irek spridairue boa _
Latltudc Ion chute of well lucatk n
Idcerrcruuuuushcet Ills)
Litu ut(Ic Ioncitulc source,❑GPS❑Topu_r[ Phitt map
Idmak hua
DEPTH 1)1211.1.1Np 1.0G j--_--
FlomTo •Form • it D'.scriptian
i>70
�\
gJJ
4)
DOES WId..I- REPLACE EXISTING WELL? YES ❑ NO L7
7_ SlA'IICAVATEI( I.INVI113elow Top kJ!' Cusi r': FT.
11)u• � it Abuvc "I op or('asing)
I01' OF (dASIN(i IS' FT. Above Land Surface"
-lip ul cu'ill„ terminated al/or brlue land surface require: a
variance in accordance with 15.\ NC:\C 2C .0118.
'!. YILLDIc'Pull: 1 FILCIIIOD OF TES 114/r
ICI_ AVATlild ZONES (depth):
W
I I. DISIN EEC] ION. Type 47,/ Alnr un1
I_. CASING: AA'ull I:ickness
or A:_ieht"11. AI recut
St D Depth
I cow --- Toth -2- I-L.
I -101ll fo
Ka
rup_ ___.Tu I.1.
I I (L(11 I Ucpth 6l a nal Nlathod
1 t l III 0 11 /�&_ 1_( 1 2^ (j✓�
I lull lt,__— I't
t-I. S( b l I..N'" I)cplh 1)i..imeter Sly,- _ e Nlaterial
Flom To 1 i __. in
11h1111 fu I 1
13 SANI)'(JRA '.'EL i'iACK:
Depth Size iddicrial
I tom To P1.
(,. kli,AI:ARICS:
Diameter
'Y
I_iC'(\II()N SKETCH p air
Shaw direction and distance in miles I'ui1 t Ie:Ciii
two Stale Roads or C'uunty Routh. Includl..thc rid„
Illlnlbers;Mil c0Ill111t0n road IlanleS.
i'47y
1 Ut I I ILRFIiY CERTIFY T I IAT TI IIS WELL WAS Cr. NSTRUCTED IN ACCORDANCE WITH 15,3 NCAC 2(2. WELL
O;NSI RUL II0N S'I:AND:ARDS. AND TIIAT :A COP'." OF THIS RECORD I IAS BEEN PROVIDED TO TI IL WELL OWNER
l0-Q-C3
SIGNATURE OF I'EF.SON CONSTRUCTING TI IL WELT.. DATE
Submit Ike original to the Division or Water Qu: lily, Groundwater Section, 1636 \tail Service Center- Raleigh, NC
27699-1616 Plume NO, (919) 733_3221, Within 31) day s. - OW -I REV. 07/2001

WELL CONSTRUCTION RECORD
28238'7
NMI ill C: l olin:1 - Dcparinte t of Environment and Natural Reso(rens - Di vision or Water Quality - Groundwater Section
\\IA I.('tl\ll<.\(I(II<(I\DI\IIII.\I.) N.\VV: (print) \l.
\ \ I I I.('n\l It.\(f(II<('O\t I'\\1 NANiv. i'!CC uil".d`
I.\ 1!: \\ LI.l. (I)\SI RI. ((ION rr:u\I I'rk
I II'appl.cahlcl
/J/l /� CL:IZFIFICA'I'ION aWpr✓�'
^49 I•IIONE p Oceelig -g6-ri
. SS(CIA'1 1) AA'Q 1'EItVIFFH
oil' i1 J IicaI Iel
A1'I:I_L LSE Kited, :Applicable 13os): Resider::al t3--,Nlunicipal0'ublie O Industrial D Agricultural 0
Monitoring ❑ Recovcry O I -leaf Pump AVa'cr Injection 0 Other 0 I(Other, List. Use
VA II.L Luc V IION: ,/
Neat!). Tow it i1t siatt/ Clnlnl: i4 O.D
rower Nan:. n:. 11 a. ('un 1 I suhanpipn. Lot :'o._ lip Cutlet
DV; liCte 4g,
Vdd1 S. / �7 /t4.1
ISnact ,r4(title
\I.)
LIP 1.1 I Linn .`Aaf Gp Code
)- &407 - 5355-
n, d nun, unmhs
5. ILVI 1)ICl1.1.eDj6 -/e-03
[HT.\I. UFI'li
n. Ut_)LS VA'ELI_ REPLACE EXISTING WELL? 1'IiS 0 NO
S VATIC \\';\ hliR LfVlil_ IA•luw Top ufCash.,: c_r7S Gl'.
(Use "T' it Above lop of :using,
P:. TOP Ol CASING IS FT. Above !.and SurCaee'
"llnr ul casing lermiunled aVur Irelnw land surface rer,'.:ires a
variance in araurilance with ISA NCAC 2C.1111 Y. _
YIELD )epitin /0 N!V[IIOD OF TES I! /Q,f/r
1!. AA A I I'.R ?.ONES {depth):
ti
I. DISINI:I!CTIO`i.'Fypc_- -7 Anr. ant
!2 (_:\SI N(i: Wall llickiloa.
Ucpth Variety! or V. dull:l:! A
I PPP r To � Pt. /
I rim'
I1 (11UG 1 . Itern1Malaita]
I row
Pt.
I-1. SCI+_I IiN: Depth
TopogruphicThan setting !TIE.i
❑ILid,c ❑.slope alley Ciao
Rhea k appr P lie hall 1 _.
Lalilodcauneitudc or well locatiiun
!degrees iiiiiititesSccoudS) 1 =
I,;n it ode' loncitta suurcc:OC PSOTopu r,Ipbic map —
check box!
1
Dlil'"I'Il I)RRli IIJ(1 Loci
Pnnn "fu Ft, 1 lt 1iu) Dcsc'ril tion �'
0 a0 `Q
nt`va-656,v
7;r-s- fe
6
4-1
[TI
O:-
1
LOCATION SKI:ICI-I -ice
Show direction and distance in miles lion ( Ieaalca
two State Roads or County Roads. IneludU le roturbl
r'1
!mai nulnbers and CW11111011 road names. v f0
z
Nlclhod
Di_wleler Slur `..ze \falerial
u //O
I loin ll1 FI. i11. in.
lit III FIE.._ PI.
S\NI)GRAVEL PACK:
Depth Site 'vlalerial
Ilon1 In II.
!win_
11 �. kl Ii\1:\RICS.
111III:RP:1h C'1`I<11 P\ TII:\I TINS WELL WAS 0 NSIRUCFED IN ACCORDANCE \VDT 115A NCAC 2C, WELL
C( INS' TRUST ION S'I ANI).ARDS. AND 1I LAT A COP'( ()I: THIS RECORD 1IAS BEEN PROVIDED TO THE WELL OWNER
I O- ICo-0-3
SIGNATURE OF PERSON CONSTRUCTING TI IE WELL. DATE
.Submit the original to the Division of Water Ot;: Iily, Groundwater Section, 1636 Vnail Service Center- Raleigh, NC
_'7699-I636 Thane .No. 1919) 733-3221, within 30 (IiI S. GW-I REV. 07/2001

WELL CONSTRUCTION RECORI) 2 8 2 3 8 6
North (.al'ohllu - Deparlmcnt or Environment and `:• lurid R c-sources - Division or Water Quality - Groundwater Section
\\III ("11\sit t(-l UI<(INDIVIDUAL)\.\\II pprint)/
A,6-11) e CERTIFIC.\'IIONk
fj._L iLL_G stt/AL IL•t �'Y'
\III t'(1\-IR.\('I(IRCO\II'kN1 \.\\II
\ I \ 1 \\ 11.1. ('O\STItt CFI()); rl:R\ I F# :\SSOCTVIT I) \\ Q 1'IEIt\I ITk
iCTrlicahlrl (ilapt icahlc)
Imo NE: a psZ3)
L—_.._�-•
VALI.I. LASE (L'hcck ;Applicable Box): Rcsiciclr.ial D" Iblunlcip iI'Public ❑ Industrial .
-7 —272❑
NIonilnriug ❑ Recovery ❑ Beat Pump Wa'.cr Injection O Other ICOther, List Use
'. \AI':I-I. LOC ATION:
NcuvsliJruvvn CANfr✓.C'ounl1.11L109(1
"..iic,1 N F:I,a+. (1.n I) r.. ',id/di Psli111. Lol NO 71 Code)
( )U // NIIR:{. ktif e� IANCk
wdlcs, l/37 Li4 lino-ej&
is,,,,,,, Rom N• 1
(?may#� iv± a
( in In is a Si.ite /ip ('ode
5G1 )-373-977?
Vmato& flume munha'
I. O,\ 1 I. I) II.I.1JD� -/ /0 e 3
1( )IAI. DNIIII: 71/42
n. 1)1)1:S \\'ELL ItLI'L.ACG LXISIING WELL?
PISS ❑ NO V
7. S VATIC VVATER LEVEL Below Top o[Casin 020O FT.
(Ilse":" i1 Ahusc Top of Casing)
N. -MP OF CASING IS FT. Above !-and Surlacc'
-inn ul casing lurmioated al/or hebn land surface rc:;.cires a
variance in acroril:mc with 15.\ \(';\(22C .1)1 IN.
`L Y Hip (cpnU: J' NII-:TI IOD OF TEST /4''
DEPT!I
Prink to
03
740
�Topn_l al)hie/ and settle
nl
012it1_c ❑Slope ❑Valley CTljo
t'h k a1,1,.,p,a4 hint -.
Luthud,: lun_ilude orvee11 locirlitm)
1 I ur es, wm Isvciasisi
'Lunde;longitude source: OGPSDIoritivgriphic nllp
lick Imp)
DRII_I N'G iTtT(
I in uti m Descri\IioH ..-(144
AvraS„v o5:4a
n yi" e
W
Cr)
r7T
II! AV:ATIR /ONIt:S (depth):
I I. DISINIIi C'IION -Type Ain (int
2 C'ASIIN(i: AVal) hiekues,e
Depth Di, rider orA`. iiuli Tl.
Fran) ` Tn Si I t.
Ilonl Tn
Irnrn ro I1.
l I l IL I: I tenth %t to i:d
I win � I O I'I.MLti� ,
I lull "rn ft.
1l PI IN. ()cplh Diamclu Sip; :-.'..c NLitei nl
Ii)C/AL ION SKI. TC'li C".
Shove direction and distance in miles ITotttpl Icet--
n
two Slate Roads or County Roads. Incud�lhe r(r;rch
\iaterial numbers and common road names.
N c-)
G
Ilan ro _ ICI.
Iloill lb II.
Depth Si,e 11:a erial
Ioil To PI.
innI o R.
Its I;EAI:ARES:
hallo!
W rn
rn_.
I DI l IIIiRr:HA (1/1(1II'1' 11IA l TII IS WELL WAS CC'NSTRUCTED IN .ACCORDANCE AVITI 115:A NCAC 2C, WELL
I. TiNS'I RUCTION STANDARDS, AND THAT A COP': OF THIS RECORD IIAS BEEN PROVIDED TO 111E WELL OWNER
'z I0-(G- 03
SIGNATURE OP 1'EI-SON CONSTRUCTING THE WELL. DATE
Submit the origiuul to the Division or \V;Uer Qu:.lity, Gruundw
27619-IGto Phone No. 1919) 733_1221, .within 31) days.
r Section, I(36 Nlail Service Center - Raleigh, NC
CGW-I RL•'V. 07/2001
tz

282384
\VELL CONSTRUCTION RECORD
North (Irolinu - Department of Environment and Natural Resources Division or Water Quality - Groundwater Section `��j%
\\PI Lt'ON'IIt. \('l(IIt (I\DI\IDI:Al.)N.\\II' (Print)-''''ff''Xg//I%F}u% CF:KrII'ICATIOSF.276/
\CFI)U C(1\I I'\NV N\\ IE iCTGC' r�'"�! I !-Lim --.— __--------------I•In)\t: k lgy546X75J/D
S 1 \. 11. ,\T.I.I. ('(INSTRUCTION 11I':101E14 ASSOCIATED \\ Q I'cI\II'rk
I Ir :flrlieshlcl Cr aPltlicablc)
1 AVLI.L 1.
VInn. Rni
VAIII LOCATION:
\ u sl I uts 11AI�L'�e C glint, 4frpeti
l �l l \ una. \ nl 9. C„ l l l l\. Subd lx u. Lot
NO _ !p Culcl
() NIfR: DeA/J�;D// -7� �I/d/r
/� �/' / DIi I'l'II
f 1" /IN rr 10nn 4rtr /ip C„de TrullA Nt
(9Q )- Sig - YH C o i2t2--
L DAIf I)lal_it/0 a".3
\l. I)I rill &S f v/05" 605"
(lI) )E
NO
S VA LL ItLLAC_ EXISTING WELL? YILS 0
7 ST:AIIC AVATER I.EVNI, Below Top orCashel: 3 FT.
1tJse "T' i( Above Top olC siny)
S. TC)I' ()I' CEASING tS FT. Above Land Sur!hce*
clip idcasing trnninated al/or !who. hind •arfae, re;t tires
e-.tri.mee in ueuoraancc Willi 15.\ NCAC 2C .0118.
'I. NIIiLD (y1'110: 2 NILI I 1013 OF TEST %51/%
11( \AAIER ZONES (depth):
1 I
DISINI I:CTION. Type ,_Zel Amr:mt
C:A$1N(i: AV;dl hickucss
Ucplh Dhtgtcier or A'-_i,hNI:t onal
I ion, fa : — ' Pt. (�o�=� S}%�
I lnm -- _ rt'------ I'I. -- -
I runt _ ___ it,I'I.
11 t,km 1 Helnh�\ �r--Ai:uerial Method---
I nnn-`J' I r�c0 I1. '1's•teiv 7
Ilum ' Ia it
I . 1( b.1 I N: Depth_—. (Carnets! Slot: ALoci id!
I lnnl Iit I . in. ill.
I 1 R:A NI)'GI(A VI.1. PACK:
Depth Site 'yImesia1
From To hI.
!I,. 1(1,AI:A I: S
Sri (Check ;Applicable Box): I:esiden,'.al VA lunicipalil'ublic 0 Industrial 0 :Agricultural
(4 0 'Secoyery 0 Beat Pump AVa'..:r Injection 0 Other 0 II Other, List Use
H z;
r r
_____Topographicitnikl settn
1 Rittke ❑5lohc ❑V Illey PI LI
(chock April -mate b.,rI -
L:nilude;lon_itudc of \veil loc. Crtir
'is
(cicgces, tiult _ Scaonds) -�1
L:Ilitudc:Iongitudc sourcc:OCiPS❑Top r+r tic map
I cltcck huel ;T
DRII-I, NC; LOG
For mltiol Description
7
e-
C
L—J
0
P
r,
O
LOCATION SKIffCll t 1'r
Shaw direction and distance in miles IroFPai Ic7LU=
two State Roads or County Roads, Incltiebthcrna`d
numbers and common road names.
I n I II`.R P.B1' CI!!t Ill'1" "III^A I TI IIS WELL \VAS CC'NSTRUCTED IN ACCORDANCE WITI I I SA NCAC 2C, WELL
CONS' RUCTION STANDARDS. AND THAT A COPY OF THIS RECOIL' I IAS BEEN PROVIDED TO II UV WELL OWNER
10-rpiL-1-D3
SIGNATURE OF rFOjON CONSTRUc1ING llt0. WELL. DATE
Submit the original to the Divisinu of Water Qu:. lily, Groundwater Section, 1631, I\ hit Service Center- Raleigh, NC
27699-I636 Phone Na. (9(9) 733-3221, vWithin 311 (1:(;. GVV-I REV. 07/2001

28238'3
WELL CONSTRUCTION RECORD
North ('nrolina - I )epnrtnlenl of Environment and NatyUral Resourcces-LDivision of Water Quality - Groundwater Section/'/
\\ 1..11. (u\i I1Ac Ink (INUI\it \I.) N.\\tE ( rrint)JJ im#4-- �, cFarn r[c:�noSa�YE'�
\\ r11.('u.] It \(' rim CO\I I'\N1 \.Uth: /.LC L�J//1—/�':':' -- - --- -- rnON It aWj) 7W.i7ir
r.\l h: \\ I -II. CUNs'I'Itt C i IUS PEI:\Irra
:f 'appliethlel
7
Iu
IL
12
.ASSUCLA FED AA Q 1'EltVI rl'a
(if applicable)
VA I:LI_ LSE (Check ,Applicable Hoy). Itesiden.lal [H' Municipal l'uhlic D Industrial 0 Nericulturtl C
VIonilorillg ❑ Recovery 0 teat I'ump Ave cr Injection ❑ Other I[Other, I.ist Use
WEI.I.. MCA] ION:
NeurcsI l \n a-- -✓
5erre/�
ISneel A,uuc. ^.muh. n. Cowm-�untl/c. Subdlvi.n 1. I_ul NoOAAN'IT' cJ�uC� `✓d--t..eS
Ca - c_d
Zip C'„del
Ct ve 1 )
ISt.el ni Ronk: No
(lr. nn loon ;Lnc hip ('uJL
t}t.IIee
I):\DRII.I.IsI y—c7�J�— 63
R)I.\I. I)1!I'lll:_._a-7 --- D
DOE'S VMILT_ REPLACE EXISTING WELL' YES 0 NO
S VATIC \b r\TIiR LEVEL, liclo\v "fop otC'asir ,: /i/ 1 .
(Ilse.. ir.Abocc Top orCrsn;gl
1 (11' OF CASINO IS F['. Above Land Surface*
211n, ur easing Ivnuin: n•tt al/or bebi,v land sin -face re ;t!ires a
variance in accurd:wce ,vilh I5A NCAC '-C.1)118.
1'I11L1) (upnr} /C M11111IOD OP ff[SC Arm
WAIN( VON(depth):
DRILI.
��_�LTopog aphic/and settin
IJ'Itldgv ❑Slope ❑Valley
(check a,q,r, 1, ate Ni,
Lai Of. oh well loci
IJegrecs mluule+: scLondS)
I.; Itiuulalonninnle sourrc:❑GPS❑Top
Idreck Null
DEPTI I
From I Port )ati m
0 CAD"
c57 %y
O 5;9^.410 SA' .V P
Ic map
o
0
DISINI.LCTION_ TYPc it%-# Ant :lnt
( \SING-
T I )epth
[Eras) � To y 1't.
1ton, Tn Pt.
(ih(,U T: Depth /�SlatcrLd Method
I'ion] �jIn di' I't- C e^^c...✓>I
I mut To Et
SCR[. I-:N: Depth Dometot Slot /c .AI:aartat
Dcm tet<r
\\':III hi kucs':
or At ightft_ NliteriaT numbers:nut common road names.
itSg/
111,111 _ la. I i
nil Ik, I I.
Dinh Sizc
Ivnn, To PI_
Ilonl I1'
It.. RIf\L\ItbS
's I al end
LOCATION SKETCH 1 0
Show direction ;Ind distance in miles Ern aile;++7
two Stale Roads or County. [toads. Incluv he rc+il1
ter-:
W
IV
<f_
I DO HEREBY CERTIFY 111A l THIS WELL WAS C( -NS1dtUCTED IN ACCORDANCE AAIII I I5A NCAC 2C, WELL
IONS HUTTION STANDARDS. AND THAT A COP OF THIS RECORD I IAS BEEN PROVIDED TO I IIE WELL OWNER
�? :D,-03
Ited
SI( ;NATURE Of I'EASOIN CONSTRUCTING TI IL WELL.
DATE
Submit the original to the Division of AAEater Qu:. lily, Groundwater Section, 1636 Mail Service Center- Raleigh, NC
27699-I636 Thane No. [phone], within 30 tl:n s. - OW-1 REV. 07/2001

282382
WELL CONSTRUCTION IZECORI)
Nutt!) ('arolin:t - Dcparinlcnl ol.hiivironment and tural Resour'es - Division of Water Quality - Groundwater Section
p /y/ ay
V�
\� r1 1 ('nN-n; \rent: (()\n• \Nr y\\t \\u p,rinrly ALL /11�- d 1 crl(n nc•cnou n ��P11 lU]IIt �(1n1t 11\UI\InL\IJ�
(/ iC('----1 hi -el/ el- A7./..,,o -__ I,iIONE a 1`Sd13V.„9J- Sy3
s 1 \ I I. \\ I. IA. (ONS IItt CI ION I'EIt\I ITN :\SSOC'IA'FED \\ O I'ER\IIll
I applicahle) (if;t) )1 ieahleI
I AVt I.I. LSE I('heek Applicable Box): Rcsiden,ial (�NI w)icipulrl'ublie ❑ Industrial 0 Aericulturat
Vlunilor in_ O I&eeti ery 0 I-leat Purim Wa:er Injection ❑ Other 0 I(Otlier, I-ist Use
win I.O(.A I I0N
Nearest Town f/ �%
1-2-0 l 004C c /Cc
1. omit
INneei Nita Niat T er, (',wnmmIl. Bakalv'RI„n. Lot No /.ip (TT.)
( IAA NI Rjtc2 9Y GQ -5 c�I
Wdiess 23 -c lA%�eVLnQ
IN aa,1 ut Nn.)
1A14 ,wile /1/ ( (QC? 7 6—
, i, 1i ,, srtic /''Code
)- 7�L - _RL2L5a__.
.� vrc:odd„ne louah:r
4C '
-3 InlAi.UEI'lll:
o. DOIIS VV'F.LL Rla'LALli EXISTING WLLL° 'IFS ❑ NO
7. S L:\IIC \VATL'R I.1;AT - Belo\Clop of Casiru:
I Ilse "'." it Aho.c rip of Casing/
S. l (N' OF CASING IS - - - - Above hand Stirlaec'
`)bp of caning trnuin:nea al/or helm land surface rewards a
variance in uc auntaove,sin, 19,\ NCAC 2C All IN.
YIELD (you'll 50 NILIIIOD OFTES ; ni
IU. WATER 7ONI/S (depth):
UISINI'LCIION . IV'pc is%�
LASING:
Topographic/Land setti
0Rid .e ❑SI, pe 12 dley
Ii k ipt iiin I,nl
Latiludc'luueitude el well to
ltlagFCCNI11111111121.101111,0
11 ulJrili,n_ilu 1 source:OGl'SOTc
heck h,isl
B1211
cl)�nyil
v
1)11 )1.11
utin T1)
r2o
A nr...1 nt
VA'all hicknes3
I.tenth Ui.tpdcr or V.oieht I1 A am la
14oui To �- Et. (r%)/4) , � '.
Dunn
Ilou
(iR(II I` Urplh Nlulerial
n,w 0 T„ —20 l-1. (,,,. tyr'
I loin 'to PI.
I . S('RI.EN: I)clnh It:Juicier Slut
11„In lu Il.
S;ANI) (ICAVI!LPACK
Depth Si/e
e
\lolcriu
aititH
TT)
am phis map
ci'
'TRIG LOc
,9-4D .5;74/A
vie
c;
O a
C c,
LOCATION SKI:11'I I 1 0`
r
Show direction and distance in miles from at Ieuffie
two Shoe Kurds or County Roads. Includable r 7t LL
numbers and eormnun road names e,at
r-.
2
4/36.3
c..)
IV
r
1-rum
Twin Ib Et
ITT . b:li\I:\R!CS:
I I To I II'_KFI3Y Chid IPl" Ti l.' I'fl lIS WELL \VAS C'C•;NSTRUCPED IN ACCORDANCE WITI I I5A NCAC 2C, WELL
O,NSIKLCIION STANDARDS. AND THAT ;ACOP! OF THIS RECORD I I AS BEEN PROVIDED TO II IF WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING TILE WELL
i 0-3-03
DALE
Submit the original to the Division of \\'ater Qu:. lily, Groundwater Section, 1636 Mail Service ('enter- Raleigh, NC
27699-1636 Pillow No. [phone], vw'thin 31) d:ns. GAV-I RBV. 07/2001

282381
WELL CONSTRUCTION RUCORI)
Not cal - I )cpai tmenl of Inivironmcnt ;Ind ` : turall Resources - Di 'kiwi or Water Quality - Groundwater Section
� // !�
v\ Eli. ( I ISI it \CIOIt (1),Divi UAL) NAVE (print) ��e/`i-L nt,- -ate CI<E'nrtCAIION N�Y�/
\\ IU1, co\"1 It.\crOlt Co\II'AN\' N.\\II! r�l C€' We// V/ L/Pt� PHONE # (S16'7-5151?
S I.\ I 1: \\ IAA. ('o\SI ucc'r ION I'h:R,\tl'I'p ASSOC': \T r:u \\'Q PERM 1'I't)
I it tIFIieuhlcl
l ifupplicable)
AA [I_I. OSE (Cheek Applicable Boxy Residential Ere—Municipal1'nblic ❑ Industrial ❑ Agricultural ❑
Monitoring 0 Recovery 0 kcal Pump AV;rar Injection ❑ Oilier ❑ I f Olhcr, List Use
Nearest Town:l='�'� Count.
a �33 zfran_/..,UFF /<
{sure' N..vue. Nulnho,s, Cuinnnmil}', SuhdiA idlo11, l of No /_Ip (1RIe)
0\\ NI IS 2r"" ,G1711,ail
\t,hc;, 2t513--r>c(o ;r/c/-
Ill tCl l l 1i11tlte Nt0,)
w4�/Ne 51-* /�% N
In Ililln til.w tip(
Y)-L 2— ,3 &03
'075
,Are.! curie- Phone Ilninhar,
I)ATIL DRILI.EDt-o
TOTAI. DEI'lli: 0205--
DOTS WIII.I. RII i. AC'li NXISTING VVlll.l.? YES ❑ NO
STATIC VVATIiI( LEVEL 13eIow Top o[Casicg: _,33 FT.
(Use "r" it Ahure lisp o(Casing)
ti_ 101' Ol: CASING IS PT. Above :.and Surface*
'inn a taking terminated in/or hela(v land surface requires a
s:viante in attunl:MCC pith 15.A A'CAC 2C .1)118.
0. YIELD IL'pltll: MKT! I01) OFTES r -7—
1(). AV*ATSR /ONTS (depth):
II
li
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ate
(check uIT:01, ms host
Lulitudcllongitude of well location
(degrees ininonds1 -'
I.:diludclonguilutl worce:❑(IPS❑Topographic limp
(dick haxl
DEPTH DRILLING I4CICI
from To Pen mlion Deslipliot
O do .9-
7 /05 - i,
7±- vn„
LOOS bS 4,, r0.-v ) re —
!ISI NEE( -1ION.1}pc /�%
LASING:
Depth I_1I r
171n `�� oTo �� Ft. 2/ /
1-1(111
Anmunt
\Vall ._hickncss
or V. cighl'll_ N ucrinl
PASit` _
17on1 To P(.
I (,l (_) I'. i)cplit NIa ri'a Ni dio(i
11on1 To it_
1-1. SCRI!1!N: Dtpllt Di:tnlcicl Slo: tic N'lalerial
11111 Ta1. in. _.._ in.
1 1010 To t. in_ in.
IS- S:ANI)GRAVN. I, PACK'
Delnll Svc .I;rtcriul
I row_ Ill 1
1-tomu Ib fl.
16 RL':AIAILIiS:
LOCATION SKr:ICII W '—
Show direction and distance in miles Iio tilt Ic4Si ,
t to Staie Roads or County Roads. Inch the FS;id
numbers and common road names. .._
i3b3
N
co
W
I DO I IFI(HiY CE.1(1 I'S 11IAT TI IIS WELL \VAS CI NS112UCfED IN ACCOI:D,ANCE AVI"Ill I5A NCAC 2C. WELL
['O,NSTRULFION STANDARDS. AND TI IAT A COP" 0111IIS RECORD I IAS BEEN PROVIDED TO THE WELL OWNER
_9/ce>� T HI'1-O"3
SIGNATU li OF PELSON CONSTRUCTING THE WELL, DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-163A Phone No. [phone], within 30 day s. GW-I ItEV. 07/2001
rn
ti
0
0
2

282149
WELL CONSTRUCTION RECORD
OCT 2 4 "2uJ1
GROUNDWATER SECTION
ASHEVILLE REGIONAL OFFICE
North Carolina - Department of Environment and Natural(�Resources - Division of Water Quality - Groundwater Section
VVEt.I. CON'TRACtOR (INDIVIDUAL) NAME (print) / 1e4 CrhfliCCERTIFICATION #' 24
WELLCO.N"I RACrOR COAIPANY NAME nk 4 Le1v/( s/�',/ /xAi/, c— PRONE # t❑z6)s-w-l%��
STATE \\ELL CONSTRUCTION PERMIT# ASSOCIATED \\'Q PERMIT#
Of applicable) (if applicable)
WELL USE (Check Applicable Box): Residential-0- Municipal/Public 0 Industrial 0 Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other ❑ If Other, List Use
?. WELL LOCATION:
NeaarQst Town: TVIX`/,-,( UW-I/(1 County RI `l tr F)J
'r L1,:o„+ /-ryr wxt loci
(Street Name. Numbers. Community. Subdivision. Lot Na. Zip Code)
3. OWNER:1l/IX %she
Address (. c. OIL
(Street or Route No.)
„kSU;lf< n/L a
Cit} or Togo State Zip Code
( Area code- Phone number
4. DATE DRILLED /Ca _ (a--03
5. TOTAL DEPTH: 3 WI)
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO ❑
7. STATIC WATER LEVEL Below Top of Casing: 451v FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
`Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 42—/ 5- METHOD OF TEST 1'
10. WATER ZONES (depth):
1 I. DISINFECTION: Type Amount
12. CASING: Wall Thickness
Depth,/ Diameter or Weight/Ft. Material
From /) To 7 3 Et. C- %y Ai} (-
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From To 2 t-. Ft._7','719ii77 /047/W7
From To Ft.
14. SCREEN. Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From) To Et.
Topographic/Land setting
❑Ridge ❑Slope DValley DFlat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Forman on Description
LOCATION S
Show direction and distancc in miles from at (east
two State Roads or County Roads. Include the road
numbers and common road names.
O o
O • 2-
-`'t
r1
N _E
tD roc
- .
S - r"c
rt
cn._
• mz
c-
W
0
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH IUA NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL
/0 7-&-2_V —03
DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 flays. GW-I REV. 07/2001

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section 2 7 2 i 6 1
1636 Mal Service Center - Raleigh, N.C. 27699.1636-Phone [phone]
WELL CONSTRUCTION RECORD WELLCONTRACTOR• f r tifP/Q '/HP
WELL CONTRACTOR CERTIFICATION It: cZ4 9 -Ad??/.isuk-e
STATE WELL CONSTRUCTION PERMITN:
1. WELL USE (Check Applicable Box): Residential Er Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ II Other, List Use:
2. WELL LOCATION: Show sketc of the location below
Nearest Town. 14 4 q.r2S(/t///e County �6r%E'L'-
N/ �<c f /#/ d�
(Rea ame and Num ers. �C�omlmu ty, pc Subdivision and Lol No.)
3. OWNER /'2/X1e the?r
Address 36 CZ,,/ At
(SI ecet or Roulo No,)
(,etfr u7/a 4/, .s>.‘
City r Town 1� State Zip Code
4. DATE DRILLED 0 7'0a'
TOTAL DEPTH /y.er
5.
6.
7.
8.
fl
DRILLING LOG
CUTTINGS COLLECTED YES NOE
DOES WELL REPLACE EXISTING WELL? YES in NO[L
STATIC WATER LEVEL Below Top of Casing: la FT.
^^)� (Use'.' it Above Top of Casing)
9. TOP OF CASING IS e< FT. Above Land Surface'
'Top of casing terminated at/or below land surface requires a variance In accor-
dance with 15A NCAC 2C . 18
10. YIELD (gpm)• METHOD OF TEST Air
11, WATER ZONES (depth)
12. CHLORINATION: Type j// Amount
13. CASING:
Wall Thickness
Depth
4 Dia1er or Tit.t. �M eal
� / From ,� To Ft 6,,'
From To Ft.
From To Ft
14.GROUT:
Dept Material Method
From 0 To p/0 Ft 1�"4ea'
From To FI
15. SCREEN:
Depth Diameter Slot Size Material
From To Ft in in
From To Ft in in
From To FI. in in
16. SAND/GRAVEL PACK:
Depth Size Material
From To
From To
17. REMARNS.,
ii I 1
I DO HEIk h)CERT+FY-THAT-Tk4l&UJ-E4.LWA!
CONSTIjc1Cj10N STANDARDS, AND THAtiA C
/
FOR OFFICE USE ONLY
Quad No -
Sena! No.
Ft
Ft
S,gpTnit orig
DEPTH
If additional space is needed use back of form
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other map reference points)
_ �z1
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•
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>0
b rn
me rnD
rn
(n:x
rn z
N —+
ONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
PY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
12 :11)( LI—`)—Q3
SIGNATURE OF PERSOV CONSTRUCTING THE WELL OATS
nal to Division of Water (Duality, Groundwater Section within 30 days
GW-1 REV. 12r99

North Carolina Department of Environment and Natural Resources Division of Water Ouahry - Groundwater Secbon
1636 Mal Service Center • Raleigh. N.C. 27699-1636-Phone [phone]
) 272760
WELL CONSTRUCTION RECORD WELLCONTRACTOR• Ate G%//71,J,?-4,yy
WELL CONTRACTOR CERTIFICATION N: �J� � %S��'�
STATE WELL CONSTRUCTION PERMITN:
1. WELL USE (Check Applicable Boa): Residential 2Municipat n Industrial ❑ Agricultural ❑ Monitoring D
Recovery ji Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATION: (Sho sketch oL the location below)
Nearest Town: 1/IS-
L in //C County'
,&ri - ' c c/4-r0
(Road Name and Numbers, Community, or Sub,on and Lot No.)
3. OWNER t4 tfr//f^/ / Y
4
5
6
Address
'rr'i
City or Town Stale
DATE DRILLED, O—.J'
TOTAL DEPTH 7cs
CUTTINGS COLLECTED YES I ) NOf
W72/
Zip Code
7. DOES WELL REPLACE EXISTING WELL? YES N0[✓
8. STATIC WATER LEVEL Below Top of Casing:. `/a FT.
i (Use it Above Top of Casing)
9. TOP OF CASING IS " FT. Above Land Surface'
-Top of casing terminated aVor below land surface requires a variance In accor-
dance with 15A NCAC 2C .,,qq�1
10. YIELD (gem). �5% METHOD OF TEST fly /"
11. WATER ZONES (depth):
12. CHLORINATION: Type r`f Amount
13. CASING:
Wall Thickness
't') Depth"-�. Oi eetter or W i n�Ft. M,a}edal
From ' To (C / Ft 6T/ 13 - tee
From To Ft.
From To Ft
14.GROUT:
Depth //,� Material- Method
From 0 To n�,D Ft [ .CAM f3'v
From To Ft
15.SCREEN:
Depth Diameter Slot Size Material
From To Ft in in
From To Ft in. in
From To Ft in in
16.SAND/GRAVEL PACK:
Depth Size Material
To Ft
To Ft
From
From
17. RELMARKS:
3
cq
DRILLING LOG
pFrom To
7/
12o 41s
/ /2O
DEPTH
If additional space is needed use back of form
LOCATION SKETCH
(Show direction and distance Irom at least two Slate
Roads, or other map reference points)
//s4
REBY CERTIFY THAT THIS Wri
I UCTION STANDARDS, ANbTFNWA ACOPY S NOF THIS RECORD HSTRUCTED IN ASBEENPROVIDED TO THE WELL OWNER.
'Jf %r x 4 d D3
FO
Oe
0 FICE,USE ONLY
No:
Serial No
Su
SIGNATURE OF PERS N CONSTRUCTING THE WELL DATE
mil original to Division of Water Duality, Groundwater Section Within 30 days
GW-1 REV. 12/99

272758
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) eFtX .t..I /»e CERTIFICATION#9,t%
\\ELI.CONTR.\CroRCO\IPANVNAME 4-7,c-C wP//s . PHONE
STATE: WELL CONSTRUCTION PERMITS/ ASSOCIATED AVQ PERMIT#
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential Er--Municipal/Public ❑ Industrial 0 Agricultural 0 -
Monitoring 0 Recovery D Heat Pump Water Injection 0 Other ❑ If Other, List Use
WELL LOCATION
Neaee �rt Town: C,0 e
a470,S fie) ye
( bet Name. Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER:_(Q31I0'77 17
Address 36% &0
'Street or Route No.)
i P
V/tuI /V(
ity or Town State
County/idp0 1
-54'7g6/
Zip Code
opographic/Land setting
edge ❑Slope DValley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degreeshninutesiseconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To For atio Description
( )- 0 /0
Area code- Phone numbe/r,r, // /0 da
4. DATE DRILLED 7-r2?*0 3 z,; 15-
5. TOTAL DEPTH: 3B,Sf-l' 6s- ,3pS
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO oe
7. STATIC WATER LEVEL Below Top of Casing: ys FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 3 METHOD OF TEST t-r
10. WATER ZONES (depth):
1 I. DISINFECTION: Type
12. CASING:
7/
Depth Diameter
Fro- ;� To 0)-0 Ft. 6 /29
From To Ft.
From To Ft.
err
r
�RN
LOCATION SKETCH
Amount Show direction and distance in miles from at least
Wall Thickness two State Roads or County Roads. Include the road
or Weight/Ft, aterial numbers and common road names.
13. GROUT: Depth Material Method
From 0 To 3 FFt.
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
To Ft.
To Ft.
From
From
0
ca
—C
—G
1
uzit
tV
F
16. REMARKS:
"� DO HE1EB1I1 CW.RT 1VY'1
CONST1 I tr` flO\+ STAN R
uL
Mrs THIS WELL WAS CONSTRUCTED 1N ACCORDANCE WITH I5A NCAC 2C, WELL
Rq AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
�{—a3—o3
SIE(NATURE OF PERSON CONSTRUCTING THE WELL DATE
,Stibntit th original tolhe Di 'ision of Water Quality, Groundwater Section, 1636 Mail Service Center- Raleigh, NC
27699-1636 Phone No.'(9 9) 7331-3221, within 30 days. GW-I REV. 07/2001
Sr

272757
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and N tural R sources - Division of Water Quality - Groundwater Section /y
WELL CONTRACTOR (INDIVIDUAL)NAN1EE (print) e) L ) A-4,i)I r CERTIFICATION #91�76/9
WELL CONTRACTOR COMPANY NAME /ter, Le )d/ iv/b, PHONE # ( 6!9?-gs9S
STATE WELL CONSTRUCTION PERMIT'S ASSOCIATED NVQ PERMIT'S
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential IV-Municipal/Public ❑ Industrial ❑ Agricultural 0
Monitoring 0 Recovery D Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATIO
Ne' rest Town:
County
et Name, Numbers, Community, Subdivision, Lot No.. Zip Code)
3. OWNER: (O 41 Li> one 1
Bed;
setting
edge DSlope DValley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Address ?rJ lO '"p-.✓o 09-7 72 ,/ Latitude/longitude source:❑GPS❑Topographic map
(Street or Ror No.)
Zip Code
City or Town State
( )-
Area code- Phone number
4. DATE DRILLED a3-0?
5. TOTAL DEPTH: _70S`F7-
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO L9�
7. STATIC WATER LEVEL Below Top of Casing: 242 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS QC FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): /0 METHOD OF TEST /51--
10. WATER ZONES (depth):
11. DISINFECTION: Type !/ /
12. CASING:
Depth Diameter
From 7kr2 To 91, ELL.,9y
From To Ft.
From To Ft.
13. GROUT: Depth /? Material /
From fl To 2G Ft. (- e,^4,-vii
From To Ft.
14. SCREEN: Depth Diameter Slot Size
From To Ft. in. in.
From To Ft. in. in.
I5. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Amount
Wall Thickness
or Weight/Ft. , serial.
Material
(check box)
DEPTH DRILLING LOG
From To For atio Description
0 -v
LOCATION SKETCH
Show direction and distance in miles from at (east
two State Roads or County Roads. Include the road
numbers and common road names.
/3 6 7
O
aas
tV
16. REMARKS:
REBY CERTIFY THAT
C(9NS(fRUC 'IOpN STAN( P.
i `'I I. n1
;Sub mit the original to tilt
27699 1636 Phone No. (919y733
THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
—AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
GNA RE OF PERSON CONSTRUCTING THE WELL DATE
ision of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
-3.21, within 30 clays. GW-I REV. 07/2001

273097
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and NaturalResources
s - Divijs�io I of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) )—(l) rli Yl Lt)(JI, 1 CERTIFICATION#.� Li/
1 WELL CONTRACTOR COMPANY NAhIEs 7/'r�pl�lr,)�y±pS• lit, µ RIM](J ,JA['PHONE #(Yj2Y to y-iS-31 7
STATE WELL CONSTRUCTION PERMIT# / 4 .9. ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential E--"Municipal/Public 0 Industrial 0 Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATIO(>IL
Neare t Town: J.ri )`D?n County
��•/ -7(n
(Street Nameimbers, Community, Subdivision, nLot No., Zip Code)
'3. OWNERS 1�!^A.L[vIJi )4t'l4,p'
Address 113 ti (ry v joy Pit
(StreetRoute No.)'
�� or A/C. on7/6
City or Town State Zip Code
Area code- Phone number
4. DATE DRILLED 3 -1 4- - 03
5. TOTAL DEPTH: iOS- I
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO V
7. STATIC WATER LEVEL Below Top of Casing: ow, FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS
i FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accords ce with 15A NCAC 2C .0118.
9. YIELD (gpm): �o0 METHOD OF TEST ra h r4
10. WATER ZONES (depth): l DS' - ;] L> P 1,3/4
asps ' - 4o vp>, _
11. DISINFECTION: Type 1.4-7—/—/ Amount 51
12. CASING:
Topographic/Land setting
DRidge ❑Slope ❑Valley C}Frt
(check appropriate box)
Latitude/longitude of well location
(degree.,. minutes4econds)
L.atitudzIongitude source:❑GPS❑Topographic map
(cheek box)
DEPTH DRILLING LOG
From To Forrkiation Description
SO' ,iDS' ha
Depth
From D To �O
From To Ft.
From To Ft.
13, GROUT: Depth
From D To .2b
From To
Ft.
Ft.
Material
LOCATION SKETCH
Show direction and distance in miles from at least
Wall Thickness two State Roads or County Roads. Include the roe
Diameter or Weight/Ft. Material numbers and common road names. 0
Ft. b i' "5 -- e 1 = o
pt cr.i
j
or
-4`
S n
se
r °
0
Method
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
' 16. REMARKS:
ip. P po BERgBYCE$.C1F (
r--CONSTRUCTION STAN
Of out The origioittothe
r,e (17644-1636 �hoee In�('l1A
T THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
S, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING f"C4'ELL DATE
ivision of Water Quality, Groundwater Section, 1636 Mail Senice Center- Raleigh, NC
3-3221, within 30 days. GW- I REV. 07/2001

From p
From Ft.
From Ft.
13. GROUT:
From Cl
From Ft.
14, SCREEN:
From
From
Ft.
-1 �-1— /-1 Amount / a LI
Wall Thickness
Depth Diameter or Weight/Ft. Material
To 40 Ft. %" PV C
To
To
Depth Material Method5 To �
To
Depth Diameter Slot Size Material
To Ft. in. in.
To Ft. in. in.
2'73096
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME ((print)• 2 rLL(��- CERTIFICATIONpp:O�`# 3)4.1
WEL
L. CONTRACTOR COMPANY NAME Ore tea Y.S L)PfY t `� :14,44,D1 en PHONE # o - 31'l 0
STATE WELL CONSTRUCTION PERMIT# 14 Dom-. ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
WELL USE (Check Applicable Box): Residential L " Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: • County W e...9 Lori
(Street Name, Numbersrtommuunity, Subdivision, Lot No., Zip Code)
3. OWNER: ijPflint Fes. SSra.P i
Address -1 S ` i2 lit psi. -
(Street or Route No.)
aci AAA f t4 C� �2 S' 1 i 5
City or Town State Zip Code
Area code- Phone number
4. DATE DRILLED s - /3 "- D 3
5. TOTAL DEPTH: ' W 5 '
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO t
7. STATIC WATER LEVEL Below Top of Casing: (5 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING 1S I FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): a METHOD OF TEST___________ k rS
10. WATER ZONES (depth): .5 S' ' :7. el p ry\
11. DISINFECTION: Type
12. CASING:
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Topographic/Land setting
❑Ridge d5lope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
Idegmes nun ucsnecands)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
fi ti-D
4 E> ' 9OS it
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
16. REMARKS:
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STAN DS AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
1Ii'�TURE OF PERSON CONSTRtpCIiIVG THE WELL DATE
l
Submit the original to the Disi�io of WLater Quality, Ground+vkk
27699-1636 Phone No. [phone], lvithin 30 days. I
G r 0 U—
ASHL, LE '
Section, 1636 Mail tiers ice Center - Raleigh, NC
GW-1 REV.07/2001

( )-
• Area code- Phone number
4: DATE DRILLED 3- / a - D 3
5. TOTAL DEPTH: .:?L'S
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO (ar
7. STATIC WATER LEVEL Below Top of Casing: %n() FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118. �l 1
9. YIELD (gpm): (n D METHOD OF TEST g) h r S
• 10. WATER ZONES (depth): /OS" - 41 pm .�ri5 - 6 yp ni
WELL CONTRACTOR (INDIVIDUAL) NAME (print)
WELL CONTRACTOR COMPANY NAME
STATE WELL CONSTRUCTION PERMIT#
(if applicable)
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
�1 1:). r<3t tv�
/ 1fD 2.
273095
CERTIFICATION # .2 7 i g
c_ PHONE # (1.2I.II O Y'Y - 3 % 7.0
ASSOCIATED WQ PERMIT#
(if applicable)
1. WELL USE (Check Applicable Box): Residential LZ MunicipaliPublic ❑ Industrial 0 Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest T/pwn: 0 A c-4 Countyjiatrthppd.,
l�21-t+ %tr- t1.44e
(Street Name, Numbers, Community, Subdi 4Lion, Lot No., Zip Code)
Topo_graaPhic/Land setting
DRidge Lr3'Slope DValley ❑Flat
(check appropriate box)
Latitude/longitude of well location
3. OWNER: 1114-n e Oc,n 4-rN l List - Rrt" I �l -1'5.5d Nn...q degrees minutes seconds)
Address 1 1 Cr t 6( , a q a.- .1—r,:..t i Latitude/Ionngitude source:❑GPS❑Topographic map
t (Street or Rbtlte Nb-1 �r (check box)
JY1LEtjCAiL Ila II tti i Air' , g t7 S i DEPTH DRILLING LOG
City n State Zip Code From To Formation Description
0 14 S 1 LP tt-i i'
Lt l I 2LAAS t Xt. - .tt.
42 IDS ' — J L 2 p
11. DISINFECTION: Type /-/'7""l-1 Amount 31:21
.,12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material 4 From n To -g Ft. L., tt PVC
From To Ft.
From To Ft.
13. GROUT: Depth +Material Method
From 1) To , D Ft. (�ors.a_..�t +rna
From To Ft.
1:14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
LOCATION SKETCH
Show direction and distance in miles from at least c
two State Roads or County Roads. Include tl e�oadg-
numbers and common road names.
3 ^ti
Dia c
oC
-4o
y me
= m_
r
t
N
16. REMARKS:
` t I DU I-f) tuY CERI lt1/ kCPTHIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
i J , CNS OTRt)CI"1ON STA D , AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
J
`t-3D—
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Nlail Senice Center - Raleigh, NC
6T 71636PhoneNo. (9119) 733-3221, within 30 days. GW-1 REV. 07/2001
ASHFPILL'_
03
c-a
--i

Address /d /3 2 -S (, to`ZL) .P�-u.Iw.wce. Ls,
(Street or Route No.)
�L /SD
State Zip Code
Area code- Phone number
4: DATE DRILLED J %
5. TOTAL DEPTH: $ t&&'
6.- DOES WELL REPLACE EXISTING WELL? YES /❑// NO EY
7. STATIC WATER LEVEL Below Top of Casing: '710 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS i FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): METHOD OF TEST
10. WATER ZONES (depth): 3 g S r
1 I. DISINFECTION: Type 14t
12. CASING:
Depth Diameter
From 0 To /,/ / Ft. (n " P I/ G
From To Ft
From To Ft.
;13. GROUT: Depth
'..'From (r) To .n.D Ft.
From To Ft.
.14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
Material 11
C D ,wdQµ;1
Method
From To Ft.
From To Ft.
Topogra is/Land setting
❑Ridge lope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(dc:Ives. ininutes/seconds)
. Latitudeilongitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
//
//4" gnC' , to
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
A
w
16. REMARKS:
1 DO HEREBY CERTIFY THATI+I-II
273093
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and NaturaluResources��1- Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME%(print) R' (it.{r.�/(,% 13 V /tar 1 CERTIFICATIONpG# 3t, �
WELL CONTRACTOR COMPANY NAME l.7'YPL'.�+L'- FIYGti LL/t/l T€M�IYJ/•PHONE# naB L.Z/p -3 /7D
STATE WELL CONSTRUCTION PERMIT#
ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
• 1. WELL USE (Check Applicable Box): Residential I/Municipal/Public 0 Industrial 0 Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 It'Other, List Use
2. WELL LOCATION
Nearest own:
ti Li-nt" I�%
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Cede))
3. OWNER: ,0442/l ,t �L
County
/iityo/Town
City or Town
Amount / 3 ¶
Wall Thickness
or Weight/Ft. Material
WL(VAS£ONSTK(1 E.LCtED
CONSTRUCTION STANDq.RD$, Y .a T
Gl A)
TURE OF PERSON CONS
Submit the original to the D vision g3IV';aTOWTEitST r,
27699-1636 Phone No. (919) 73-3220vifhiiLSOlik)i&;'ip.I OFFICE
CORDANCE WITH I5A NCAC 2C, WELL
HAS BEEN PROVIDED TO THE WELL OWNER
NG THE WELL DATE
Section, 1636 Mail Service Center - Raleigh, NC
GW-I REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural/�Resources - Division of Water Quality - Groundwater Section
'WELL CONTRACTOR (INDIVIDUAL) NAME (print) l-3/� Yl-t Li_iIJ ,eiV LL/i� CJ CERTIFICATION# -3D '//
WELL CONTRACTOR COMPANY NAME (ver ne //)YO i. &e�e// 4- Aim, jktC PHONE Si Va2�1/o//g"-3✓7e)
STATE WELL CONSTRUCTION PERMIT# / S -4 ASSOCIATED WQ PERIIIT#
(if applicable) (if applicable)
273092
1. WELL USE (Check Applicable Box): Residential RI—Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring ❑ Recovery ❑ Heat Pump Water Injection 0 Other 0 II'Other, List Use
2. WELL LOCATIO J/
4 .u. County AC
Nearest Town:
1i3O/c o/ n 2 SS/ .
(Street Name,
,NNumbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: t_/J/rY) / AnrnGS
Address S3 5 T e_ f_i )s a v e.
(Street or Route No.)
Sy f lLt1c 4)-t..e_/ . L L 60/ l c)
Cify or Town State Zip Code
(—)-
Area code- Phone number
4. DATE DRILLED 3 - y - n3
5.'TOTAL DEPTH:
6.'DOES WELL REPLACE EXISTING WELL? YES ❑ NO 2".."
7.'STATIC WATER LEVEL Below Top of Casing: 90O FT.
+ (Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): � METHOD OF TEST Ea rS
10. WATER ZONES (depth):
Topographic/Land setting
❑RidgeNSIope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(dcgreevininwesiseconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
Formation Description
DEPTH
From To
D .54/
S4/9RS'
i' •11: DISINFECTION: Type 14Ti-) Amount ) LP
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft.
From D To -4- Ft Lo t'
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From 0 To �C) Ft. Cc o,,__1- -4-e-p
From To Ft
14. SCREEN: Depth Diameter Slot Size Material
;`From To Ftin. in.
'.'From To Ft. in. in.
Material
PVC-.
15. SAND/GRAVEL PACK:
Depth
From To Ft.
From To Ft.
16. REMARKS:
I DO HEREBY CERTIFY THAT TH
',: CONSTRUCTION STANNND DS, A
Size Material
7.
LOCATION SKETCH
Show direction and distance in miles from at (east
two State Roads or County Roads. Include the road
numbers and common road names.
T A COPY OF THIS RECORiq H
ii
SICNATURE OF PERSON CONSTRU
a
3C
.r
RDANCE WITH I5A NCAC 2C, WELL
S BEEN PROVIDED TO THE WELL OWNER
-jL> - 0 3
TINGTHE WELL DATE
Submit the original to the Division of Water Quality, Greuydwattr Section, 1636 Mail Sers ice Center - Raleigh, NC
27699-1636 Phone No. [phone], wit
y5.
GW-I REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAM/E�� (print) �AJ LL n CERTIFICATION # .36 Si
WELL CONTRACTOR COMPANY NAME CrPen) RI[i5 . id St u mP J.AC PHONE # (ea GY-B -3Z ��
/ STATE WELL CONSTRUCTION PERMIT# '
/41U2 ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential (/Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION;,
Nearest Town: County Jnf�
In.s�ir nu 1'
(Street Name, N tubers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: R y a:--J m» 1 ! Cl 0 k' - &
Address ? 2' CALF M tti/ Y /(I.C.e L enip
Street or Route No.)4
AVe.
City or wn State Zip Code
( )-
Area code- Phone number
4. DATE DRILLED .2 - 3 - 0 3
5. TOTAL DEPTH: 3 4
6.`DOES WELL REPLACE EXISTING WELL? YES ❑ NO Q'
7. STATIC WATER LEVEL Below Top of Casing: 1 30 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS I FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance In accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 1 D METHOD OF TEST h r5 •
10. WATER ZONES (depth): 3 a 5 ' - 3 y-s
11. DISINFECTION: Type &1 YI-1 Amount 5/3
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From D To 9 0 Ft. LP " P U
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From 0 To Q p Ft. r Da.u-c.4t i- -I-'L-p
From To Ft,
} 14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
.r' From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
273091
Topoggraa uc/Land setting
❑Ridge 1ySlope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(decrees minutes/seconds)
Latitudeilon_itude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
De
scription
To Fomt t n
d �!O -
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
I If b
HpR I DO EBY CERTIFY THAT THffik aWAS CONS I RUC I EL)IN AC
CONSTRUCTION STAND DS, ANDSli
AT A COPY OF THIS RECORD
i ��:
RDANCE WITH 15A NCAC 2C, WELL
S BEEN PROVIDED TO THE WELL OWNER
viz)
-3n-63
SI5NATt)RE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division otia ater Quatipt, Grou$dwater Section, 163o Mail Sers
27699-1636 Phone No. [phone], within 30 days.
Center - Raleigh, NC
GW-I REV. 07/2001

273090
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print)
WELL CONTRACTOR COMPANY NAME i - rYVS
STATE WELL CONSTRUCTION PERMIT#
(if applicable)
CERTIFICATION # 346 4' /
HONE # gi La VIS"--1
ASSOCIATED WQ PERMIT#
(if applicable)
1. WELL USE (Check Applicable Box): Residential LsY Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring 0 Recovery ❑ Heat Pump Water Injection ❑ Other ❑ I f Other, List Use
2. WELL LOCATION:
Nearest -Town:
I Ver »D)rl.7P_ tvr-
(Street Name, Number Community, Subdivision, Lot No., ZipCode)
3. OWNER: / ), Q.,44 2 (4/r-40-L.P ../7__/
Address '7fj 7 -f )'v er Pt I'm )1 etd' .
neet or Route No.)
J
(1•272
City or Town
(—)-
cfl'7/ le
Stat
Zip Codc
Area code- Phone number
4. DATE DRILLED / 2 "/ 7 - e
5:TOTAL DEPTH: (n
6, DOES WELL REPLACE EXISTING WELL? YES 0 NO (ate
7. STATIC WATER LEVEL Below Top ofCasing: ILS- FT.
(Use"+" if Above Top of Casing)
$. TOP OF CASING IS 1 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance In accordant with 15A NCAC 2C .0118.
9. YIELD (gpm): METHOD OF TEST .2 I rS •
10. WATER ZONES (depth): 5 30
County - -//! l�
Topogr is/Land setting
❑Ridge Slope ❑Valley ❑Flat
(cheek appropriate box)
Latitude/longitude of well location
(degrees minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(cheek box)
DRILLING LOG
Formation Description
DEPTH
From To
0 34
34' L'e '
II. DISINFECTION: Type /-IYF-1
12, CASING:
Depth Diameter
From D To 3 14- Ft. f p' I
From To Ft.
From To Ft.
13. GROUT: Depth
From P To Jo Ft
From To Ft.
,
14..SCREEN: Depth Diameter
From To Ft. in.
From To Ft in.
15. SAND/GRAVEL PACK:
Depth Size
From To Ft.
From To Ft.
Amount 8D
Wall Thickness
or Weight/Ft. Material
PVC -
Material
l�l�rn.A-+cam
-' 16. REMARKS:
I DO HRREBY CERTIFY THAT T
CONSTRUCTION STANDS,
Led
SI
'Submit the original to the Divis
27699-1636 Phone No. (919) 733-32
Method
Slot Size Material
in.
in.
Material
51
ED I
AT A COPY OF THIS RECO
NATYRE OF PERSON CONSTRUCTIN
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
0
0
3
--C
tV
A
1
W
RDANCE WITH 15A NCAC 2C, WELL
S B PROVIDED TO THE WELL OWNER
Lte `f-3v'-°3
THE WELL DATE
n ofA1Y4tkui Quality, nOrturiMuillier Section, 16311 Mail Service Center - Raleigh, NC
1, whRn3u days: GW-I REV. 07/2001

273089
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) akDiambi ld Or- p (r-���. I CERTIFIC5ATION#'/.�ij/S
WELL CONTRACTOR COMPANYNAME l9'ree.he- Byc's. (..�'.>. 1) , i[nl/1 is.< PHONE # 0244.4L ' 3Z7C'
STATE WELL CONSTRUCTION PERMIT# /'70 a ASSOCIATED WQ PERMMIT#
(if applicable) (if applicable)
1.- WELL USE (Check Applicable Box): Residential C7 Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring 0 Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:�)
Nearest Town: f.Ul2u 17e s v. / It County 7
LP 4-3 t/ Fr z. -.)C )n V,�
G190o
ett .
(Street Name, Numbers Community, Subdivision, Lot No, Zip Codc)
3. OWNER: - 19( /-4-W -VV)e
Address 24' p.r.(< j p. ,.%)r
Street or Route No.)
yZG .28' 7 z I
City or Town / State Zip Code
(—)-
Area code- Phone number
4. DATE DRILLED //-.25-•4 L
5. TOTAL DEPTH: I
6.;DOES WELL REPLACE EXISTING WELL? YES ❑ NO l
7. STATIC WATER LEVEL Below Top of Casing: 1 0 FT.
(Use "*" if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance In accordance with ISA NCAC 2C .0118. iI
9. YIELD (gpm): I METHOD OF TEST YtrS
10. WATER ZONES (depth): 1 to S ' 1 S
11. DISINFECTION: Type
12, CASING:
Depth Diameter
From 4 To aD Ft. /n "
From To Ft
From To Ft
ar�
HTN
13. GROUT: Depth Material
From i) To ao Ft C.Qwti.e...--
tr:,From To Ft.
14.?.SCREEN: Depth Diameter Slot Size
''.',From To Ft. in. in.
From To Ft. in. in.
Amount ..3 )
Wall Thickness
or Weight/Ft. Material
15. SAND/GRAVEL PACK
Depth
From To
From To
Size Material
Ft.
Ft.
Method
Material
Topogra He/Land setting
❑Ridge lope ❑Valley ❑Flat
(cheek appropriate box)
Latitude/longitude of well location
(dcerces minutes/seconds)
Latitude/longitude source:OGPSDTopographic map
(check box)
DRILLING LOG
Fornyttp n Description ns
DEPTH
From To
v al)
-2p' its
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
16• REMARKS:
ry
' 1 DO HgREBY CERTIFY THAT THIS WILE i AS CONSTRUCTED IN ACCFItANCE WITH I5A NCAC 2C, WELL
.CONSTRUCTION STAND S, AND TLFIAM A COPY OF THIS RECORD I ASJ IE EN PROVIDED TO THE WELL OWNER
SIGNATURE RttrAttc/('i Cf1NSTg(ICTTfJG THIS WELL DATE
A HE\ILi.E REL
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center- Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-I REV. 07/2001

273087
WELL CONSTRUCTION RECORD
-North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME
(print) ll b 6 t n iiJ h 8
CERTIFICATION * Sly)
WELL CONTRACTOR COMPANY NAME &"re.c-he /3ra.. GJ: t) +- r-a-mp1Jtte •PHONE p 64/ - 31 9D
STATE WELL CONSTRUCTION PERMIT* / '''/ b ASSOCIATED WQ PERMIT*
(if applicable) (ifapplicable)
I. WELL USE (Check Applicable Box): Residential f3 Municipal/Public 0 industrial 0 Agricultural ❑
. Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: L..3al nest/ I /) a, County /4La-4('e)oe#
F-A-I tern Arlo - P1o1-
(Street Name, Numbers, Common ', Subdivision, Lot No., Zip Codc)
3. OWNER:
Address
eLvr try-
D f3 rrti 1 1 of +1-
Topographic/Land setting
❑Ridge ❑Slope ❑Valley flat
(ch rk appropriate box)
Latitude/longitude of well location
do Jet, -I r ieTa,‘„e
(Street or Route No.)
l2u esv, I its /t/ C. a 2 7S( LP
City of Town State Zip Codc
Area code- Phone number
4.'DATE DRILLED 5- I is -
5. TOTAL DEPTH: 705-
6`DOES WELL REPLACE EXISTING WELL? YES 0 NO
7.STATIC WATER LEVEL Below Top of Casing: i Da FT.
(Use "+" if Above Top of Casing)
8. ,TOP OF CASING IS 35 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
: variance In accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): Lo METHOD OF TEST a lm r S
10. WATER ZONES (depth): 4 La S ' - Lo rs p rv.
11. DISINFECTION: Type t-t t 14 Amount / 09
Wall Thickness
Depth Diameter or Weight/Ft. Material
To 3 S Ft. La 't Q C_
12. CASING:
From i
From To Ft.
From To Ft.
13.; GROUT:
From 0
From
14. SCREEN:
":From
From To Ft
i
1$%`SANplGRAVEL PACK:
Depth Size
From To Ft.
From To Ft.
Depth Material
To a D Ft. eDy.fleiu..
To Ft.
Depth Diameter
To Ft. in.
in.
MethodN
4.,
.- I)
Slot Size Material
in.
in.
Material
16. REMARKS:
l
I DQ HEREBY CERTIFY THAT THI iI
,CONSTRUCTION STANDARDS, AN
i.l
T
ONSIRULICUi
T A COPY OF THIS RECOd
SIQNATURE OF PERSON CONSTRUCT'
::. GR00 - --
Submit the original to the Divisi n of * h't r+Quahty, Grqundtyater
27699-1636 Phone No. [phone], within 30 days. _.—
(degrees. minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
35
35'
13 ' li 1N._.44- --il_.,
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
NO
Se
(.)
RDANCE WITH 15A NCAC 2C, WELL
S BEEN PROVIDED TO THE WELL OWNER
5� 3o a 3
THE WELL DATE
tion, 1636 Mail Sen ice Center - Raleigh, NC
GW-I REV. 07/2001

273076
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAM Sprint)
WELL CONTRACTOR COMPANY NAME Jai KO
STATE WELL CONSTRUCTION PERMIT*/
2
(if applicable)
nio
ASSOCIATED WQ PERMIT#
(ifapplicable)
CERTIFICATION*/ 361//
PHONE */ L vYfr'�3/n
1. WELL USE (Check Applicable Box): Residential.- Municipal/Public 0 Industrial 0 Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCATIOI)fp
Nearest Town: (-lr-/t--r�� County/h.ti,ii(ai
1 / l o_r b,.) La-r..P
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3, OWNER: L_ P_
Ph2 -)4-)
Address .0 7 fY7n r h . / -.)/
etrect or Route;oo.)
City or Town State)
Zip Code
Area code- Phone number ''/
4. DATE DRILLED 7 2 'D3
ix7/(a
Topographic/Land setting
Midge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
Idegnxs. mina( sIscmnds)
Latitude/longitude source:❑GPSDTopographic map
(check box)
DEPTH DRILLING LOG
From To Fomtation Description
D / 2'1 p¢
/i93Qs'
5. TOTAL DEPTH: 3 a 5
6, DOES WELL REPLACE EXISTING WELL? YES 0 NO-',
7. STATIC WATER LEVEL Below Top of Casing: 30 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS I FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): /n04- METHOD OF TEST < r5
10. WATER ZONES (depth): DS ' - (o() o _
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the roaL
numbers and common road names.
CJ
S
ste
11. DISINFECTION: Type 1--4 T}-( Amount ..i i
12. CASING:
Depth
From D To /.27 Ft.
From To Ft.
From To Ft.
13. GROUT: Depth
From /) To ,Q0 Ft.
From To
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size
From To Ft.
From To Ft.
16. REMARKS:
I DO HEREBY CERTIIFF2L4
Y THAT TWISAVFI I W'�ASCONSY
CONSTRU TION AND THAT A COPY OF THIS
Liz es)
i SIGNATURE OF PERSON CONSTRUCTING THE WELL
Diameter
r
Wall Thickness
or Weight/Ft, Material
Pvr.
aterial
(' CA-r.:,.,:4
Ft.
Slot Size Material
in.
in.
Method
F
Material
N
s
ACCORDANCE WITH 15A NCAC 2C, WELL
HAS BEEN PROVIDED TO THE WELL OWNER
-. 34 n
DATE
Submit the original to the Jb�ivisiottui� Water Quality, Groundwa er Section, 1636 Mail Sen ice Center - Raleigh, NC
27699-1636 Phone No. (919)733:3221rwithin 30 days. GW- I REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Divisionivof Water Quality - Groundwater Section /
WELL CONTRACTOR (INDIVIDUAL) NAME (print) /�1.YLi&4 &Y IA- E�� CERTIFICATION # apt/
WELL CONTRACTOR COMPANY NAME trP.P..it-6--,/A t t:)ti AI- kayo, .11 PHONE # f%L8' GYy- 3 / 76
7" STATE WELL CONSTRUCTION PERMIT# �D.1 ASSOCIATED wQ PERMMIT#
(if applicable) (if applicable)
273075
1. WELL USE (Check Applicable Box): Residential MunicipalVPublic 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATIO .. L/ /
Neares TowCounty 19/}
l r> t n / {i, �Q e k_ — //LL r/
(Street Name, Numbers, Coninuniiy, Subdivision, Lot No.. ip Code)
3. OWNER: Fel, /VO I P4-mLel
Address q w Roe _A t .<. k/1 t r Ln.ti:-
(Street or Route No.)
Lzia tits1. Alt .2$'794°
City or/Town State Zip Code
(—)-
Area code- Phone number
4. DATE DRILLED 4 - / - e 3
5. TOTAL DEPTH: c3D 5
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO VL
7. STATIC WATER LEVEL Below Top of Casing: SD FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS i FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance In accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): ..Z METHOD OF TEST r2 vs -
10. WATER ZONES (depth): / 2D I - 2 q rm
11. DISINFECTION: Type /-i- % f-1 Amount
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To IDS Ft. to et
From To Ft.
From To Ft.
13. GROUT: Depth pMaterial
From © To rW Ft. t Pwt+.-2.-43L
From To Ft.
14. SCREEN: Depth Diameter Slot Size
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size iNlatcrial
From To Ft.
From To Ft.
S-e.e
Method
Material
Topo raphic/Land setting
❑Ridge Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(decrees in inuiesiseconds)
Latitude:lon_itude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
Foimajt Description
DEPTH
From To
D i
/DS30S'
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the roaW
numbers and common ton road names.
W
7
IN)
S
16. REMARKS:
I DO HEREBY CERTIFY THAT 1111ScbrVELL WAS CO
CONSST/R4CTIIOON STAND/ 9StANDTIAT A COPY OF THIS 1
GC/ r L
TORDANCE WITH 15A NCAC 2C, WELL
AS BEEN PROVIDED TO TILE WELL OWNER
G THE WELL DATE
ATURE OF PERSON CONSTIi
Submit the original to the D' isioniaaKuter Quality Grount(w e
27699-1636 Phone No, (919) 73 -32214 iihIn 30 days.
Section, 163(1 Mail Sen ice Center - Raleigh, NC
GW-I REV. 07/2001

WELL CONSTRUCTION RECORD
273070
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) n is i n LI) Pih CERTIFICATION # 2 4,11
WELL CONTRACTOR COMPANY NAME GVZ. C-Nr n . L3e..1\ -1-1-
-sa,vvv4sTnc .PHONE ft fts-2Dl 4,`/cs - 3 i '7C'
STATE WELL CONSTRUCTION PERMIT# / Vo 2 ASSOCIATED WQ PER)IIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential, Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring Recovery ❑ Heat Pump Water Injection 0 Other 0 I (Other, List Use
2. WELL LOCATION• �� 1
Nearest T w _ County /'/irT
vr'
- (Street Name; Numbers, Co //munity, Subdivision, Lot No., Zip Codc)
3. OWNER: ) e.,j /J %—.
Address of i./etAl:
6//..�iAti o i /
1) (Street of Route jo.)
AJ1nrsvtIle Al ,2u%g6
City or town State Zip Code
Area code- Phone number
4.. DATE DRILLED 3-.24 -b 3
5. TOTAL DEPTH: d -'/ 5- '
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO Y,l
7. STATIC WATER LEVEL Below Top of Casing: W/) FT.
(Use "+" if Above Top of Casing)
8, TOP OF CASING 1S I FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 40 METHOD OF TEST it rs •
1O. WATER ZONES (depth): r2.2 S ' - Li.0 i r ,rs
11. DISINFECTION: Type /-f Y N Amount CY
-12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 6 To /) 3 Ft. 6 " /9VP
From To Ft.
From - To Ft.
13. GROUT: Depth Material Method
_ From O To ao Ft. C onn--r-sj "11
• From To Ft.
'I4. •SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Topographic/Land setting
❑Ridge ❑Slope ❑Valley Flat
(check appropriate box)
Latitude/longitude of well location
(degrees. minutes seeonds)
Latitude/longitude source:❑GPS❑Topographic map
(cheek box)
DEPTH DRILLING LOG
From To Forntation escription
//3 /�f.
//3' VS'
LOCATION SKETCH
Show direction and distance in miles from at (cast
two State Roads or County Roads. Include the road
numbers and common road names.
O
CO
N
r?
16. REMARKS:
1 DO HEREBY CERTIFY THAT HI
CONSTRUCTION STANDARDS AIN
ij
ELL (VAS IQ�»ISTIWCT E�
1 HA ACOn OFTIIISRL-L
l
it
NATURE OF PERSON CONST 3UF7I G THEW ELL DATE
i
Submit the original to the Division or%ater Quality, Grourrdlwater Section, 163o Mail Serslee Center - Raleigh, NC
27699-1636 Phone No. [phone],.Within 30 days. --- GW-1 REV. 07/2001
R
=oRDANCE WITH I5A NCAC 2C, WELL
LAS BEEN PROVIDED TO THE WELL OWNER
hzezz
3
c

Zip Code
Area code- Phonc number
4. DATE DRILLED 3 —•2 7 ' 03
5. TOTAL DEPTH: 31oSt
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO-,
7. STATIC WATER LEVEL Below Top of Casing: .5-T.
(Use'•+" if Above Top of Casing)
8, TOP OF CASING IS i FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance In accordance with 15A NCAC 2C .0118.
'.9. YIELD (gpm): 1 Ao i" METHOD OF TEST . 1, r5 -
IO. WATER ZONES (depth): 356 1 _ /.201- y,e
11. DISINFECTION: Type /-1 TN Amount 10 i n
Wall Thickness
Depth Diameter or Weight/Ft. Material
From . To 73 Ft. /n rt
From To Ft.
From To Ft.
From D To
13. GROUT: Depth /Material ethod
,2C2 Ft. ( dam)
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
12. CASING:
WELL CONSTRUCTION RECORD 2 7 3 07 2
North Carolina - Department of Environment and Natural,)Resources -'Divtision of Water Quality - Groundwater Section
' WELL CONTRACTOR (INDIVIDUAL) NAME
� (print) k /�o 6) n LClp ) /'\ e CERTIFICATION # _ 7 / b'
WELL CONTRACTOR COMPANY NAME ' rr.P )w'/ f NZ1 f, 2hjJ cv fumy, I PHONE # ez l S'S' - 3 / 7v
STATE WELL CONSTRUCTION PERMIT# /7D /.. ASSOCIATED NV() PERMIT#
(if applicable) (if applicable)
•
WELL USE (Check Applicable Box): Residential., Municipal/Public 0 Industrial 0 Agricultural ❑
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 It' Other, List Use
2. WELL LOCATIO
Nearest T
(Street Name, Num
3. OWNER:
Address
Coun
Community, Subdivision, of Noip Code)
7 Alf
7.14n11l ieze
n -(street rRoute No.)
.A �g7/b
City or Town Statd (C
Pvc
16. REMARKS:
I DO HFREBY CERTIFY THAT THI
CONSTRUCTION STANDARDS, A
/I Sti—f.
SIG
Submit the original to the Divisio
27699-1636 Phone No. [phone]wSlifri °t11 'ys
t
LLWAS CONSTPI Iria niJ ,t4
T A COPY OF THIS RECORC
Topographic/Land setting
❑Ridge ❑Slope ❑Valley
(check appropriate box)
Latitude/lonaintde of well location
a
(dcerces minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(cheek box)
DEPTH DRILLING LOG
From To Formaiiw Description
73
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
F
DANCE WITH I5A NCAC 2C, WELL
I3EEN3ROVIDED TO THE WELL OWNER
SL_3z)- c)3
TORLE OF PERSON CONSTRUCYING'tIIE WELL DATE
of W'ateK uatity, Ground4Wa errl
Secton, 1636 Mail Service Center- Raleigh, NC
GW-I REV. 07/2001
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273073
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural/�Resources - Divisionivof Water Quality - Groundwater Section !/
WELL CONTRACTOR (INDIVIDUAL) NAME (print) £t- (U.t /�-+l`-LL CL- p CERTIFICATION # 3Ory-/
WELL CONTRACTOR COMPANY NAME C-s YCC1AR., 1�6 e) Lp`I1 `-1- Pµynp rJ -PHONE#fgZ)C yg- 3/7 49
STATE WELL CONSTRUCTION PERMIT# /y4 J? ASSOCIATED WC) PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residentia)�j, Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION: Topou aphis/Land setting
Nearest Town:-z I B �o1-#s-e ❑Ridge ]$Jape ❑Valley ❑Flat
J Yl r N�j Lli^jj (check appropriate box)
(Street Nand, Numbers, ComAunity, Subdijsion, Lot No.. Zip Code) Latitude/longitude of well location
lrye. Lak iederAr
City r Town State z Zip Code
Arca code- Phone number
4. DATE DRILLED 3 - '1 CU 3
5. TOTAL DEPTH: I O O
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO �1
7. STATIC WATER LEVEL Below Top of Casing: —a-- FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118. /
9. YIELD (gpm): -'�— METHOD OF TEST c2 hrj
3. OWNER:
Address
10. WATER ZONES (depth):
(degrees. minuets/seconds)
Latitude/longitude source:OGPSOTopographic map
(check box)
DEPTH DRILLING LOG
From To ' Formation Description
Q teael�s t.
11. DISINFECTION: Type /-,<TH
12. CASING:
Depth Diameter
From (1 To of F) Ft.
From To Ft.
From To Ft.
Amount
Wall Thickness
or Weight/Ft. Material
Pve'
13. GROUT: Depth Material Method
From To 9/) Ft. %7,oe-x..4t# --/-ri2p
From To Ft.
_ 14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth
From To
From To
16. REMARKS:
Size Material
Ft.
Ft.
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
I
I DO HEREBY CERTIFY THAT THIS - WAS CONSTRUCTED A
CONSTRUC'ION STAND S, AND TfI-11YT A COPY OF THIS RECOR
Lc._) '1/4-2PP2a L
SIGNATURE OF PERSON CONSTRUC
w
DANCE WITH I5A NCAC 2C, WELL
SEEN PROVIDED TO THE WELL OWNER
NG T IE R'ELL DATE
Submit the original to the Divisiof{ of Water Quality, Groundwgger Sect on, 163o mail set-. ice Center - Raleigh, NC
27699-1636 Phone No. [phone] within 30 days. - GW- I REV. 07/2001
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W ELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Divisior of Water Quality - Groundwater Sectior
WELL CONTRACTOR (INDIVIDUAL) NAME (print) l�¢cr:CK li. �4wyQr'1 CERTIFICATION# &M3EO
PHONE#{Q% a56-2L*P
WELL CONTRACTOR COMPANY NAME C
An? inc.
?7rn97
STATE WELL CONSTRUCTION PERMIT? ASSOCIATED WQ PERMIT
(if applicable)inammomm
(if appLcable)
1. WELL USE (Check Applicable Bct): Residential S Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring ❑ Recovery 0 He r. Pump Water Injection 0 Other 0 If Other, List,Use
2. WELL LOCATION:
Nearest Town: Wah4esv:1 t P
bald Gr
County 1-ii-%wcon)
(Street Name. Numbers. Community. Subd ision, Lot No.. Zip Code)
3. OWNER: 24\e1- C \ccc u<
Address I % tc a?'a 7W
(Street or Rout o.)
Ctte.stac .5C a97c(o
City or Town State Zip Code
3-7Lio(s='
Area code- Phone number
4. DATE DRILLED 51029 103
5.-TOTAL DEPTH: a S
6. DOES WELL REPLACEEX1ST311G WELL? YES ❑ NQ Fl
7. STATIC WATER LEVEL Below 'Top of Casing: 00 FT.
(U o "+" if Above Top of Casing)
8. TOP OF CASING IS 1 IT. Above Land Surface'
*Top of casing terminated at/or below Is rd surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 5 METHCD OF TEST i2:,
10. WATER ZONES (depth):
11 DISINFECTION: Type 9:115 Amount I,
12. CASING: Wall Thickness
Depth Dia: retcr or Weight/Ft. Material
From -?1 To tsz Ft._ EL. M ?1 I1e.}:C
From To Ft.
From To Ft.
13. GROUT: Depth 6 !aerial Method
From 0 To at) Ft. e.':.men# 0%...4-441
From To Ft.
14. SCREEN: Depth Diami tsr Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Si: e Material
From To Ft.
From To Ft.
Tdpographic/Land setting
❑Ridge ifSlope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
NINE
(degrees/minutes/seconds)
Latitud ./longitude source:❑GPS❑Topographic rrap
(check box)
DEPTH DRILLING LOG
From To Formation Descript on
(./n tint( 3eta cn
(oo ay5 (r-re..a»t
LOCATION SKETCH C.) s-
Show drection and distance in miles $Qm at lea
two Str t. Roads or County Roads. IncRe theriai
numbers and common road names. -.
16. REMARKS:
ii 3 I I� '!
I DO HEREBY FiERTIFTIT T THIS WILL WAS CONSTRUCTED IN ACCORDM ICE WITH 15A NCAC 2C. WELL
it ,s f CONSTRUCTION STA DS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
I y
SIGNATURE
5j 29103
PERSON CONSTRUCTING THE WELL DATE
Submit tht+original to the 'vision of Water Quality, Groundwater Section, 1636 Mail Service Center- Raleigh, NC
27692 IY3h1'.hi11n:1yn-(919) 7 3-3221, wi thin 30 days. G W-1 REV. 07/2001

WELL CONSTRUCTION RECORD
276086
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) i ttr: ctt CERTIFICATION it ativo
PHONE # (Q29 a 55 75,5*g
WELL CONTRACTOR COMPANY NANTE C Swaieea . e� Sc^Ntll � � ewe
Nile
STATE WELL CONSTRUCTION PERMIT/ ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
WELL USE (Check Applicable Bo::): Residential RI Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring 0 Recovery ❑ Hea: Pump Water Injection 0 Other ❑ If Other, List.Use
l
2. WELL LOCATION:
Nearest Town: e.30.tgeIQ County 14a...ewcca
(.'50 ""S't - c C.cNIe.q eJ Qg7Cc
(Street Name, Numbers, Community, Subdi) isi on, Lot Na, Zip Code)
3. OWNER: tB430d
Address l SC) 3a 44 to-rv¢o Rd
(Street or Route No.)
uaca e.SY tie vie_ P153 7$G
City or Town State Zip Code
(8'.29)- 924o- 053s%
Area code- Phone number
4. DATE DRILLED Cc- ici • 0 3
5. TOTAL DEPTH: 1 6.5
6. DOES WELL REPLACEEXISTING WELL? YES 0 NO IC
7, STATIC WATER LEVEL Below Top of Casing: .J FT.
(Us v "+" if Above Top of Casing)
8. TOP OF CASING IS i 1 T. Above Land Surface*
*Top of casing terminated at/or below lar d surface requires a
variance in accordance with ISA NCAC :C .0118.
9. YIELD (gpm): O METHCD OF TEST IQ
10. WATER ZONES (depth):
To'pographic/Land setting
❑Ridge DSlope ,R1Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPSOTopographic rrap
(check box)
DEPTH DRILLING LOG
From To Formation Description
4-1. Li4 ()Net Paetdcr
N4 les G-fas'*e
1I. DISINFECTION: Type 9:14S
12. CASING:
Depth
From '41 To 14 4
From To
From To
13. GROUT: Dcpth
From 0 To 10 Ft.
14.
From To Ft.
Dian eter
Ft.
Ft,
Amount
Wall Thickness
or Weight/Ft. Material
it 2 t > e,a+: c
M uerial
C _ment
Method
cueO _
SCREEN: Dcpth Diamet tr Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From
From
To Ft.
To Ft.
16. REMARKS:
rr-�\ I RD HEREBY�CEF3TIF
i 1 C,pAISI
i1 -17
II
LOCATION SKETCH
Show direction and distance in miles from �at least
two Stag: Roads or County Roads. Inclu¢9,yhe roa i
numbers and common road names.
,T THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
DS. AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
2/evJ Ao^"4i2ztt2T (c - ! 9 . C:3
SIGNATURE OF PERSONOCONSTRUCTING THE WELL DATE
Submit the-einaltb the ivision of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
2'7619,163'6 R6nnc'$r(919) 7133-3221, within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
276084
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
O'ELL CONTRACTOR (INDIVIDUAL) NAME (print) %V.y y,wSt% r S CERTIFICATION # a Lil✓v
\%Ela.CONTRACrOR COMPANY NAME ctta ae 5gta r'�C*Sass weft vN.,;tdn. PRONE a t`3ZK167[2s2 3czz
STATE NELL CONSTRUCTION PER;AIITk ASSOCIATED WQ PERMIT)
(if applicable) (if a. licable)
1. WELL USE (Check Applicable Box): Residential St Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List -Use
2. WELL LOCATION:
Nearest Town: /Yc:Kcrj AO '23 County /f/w w t Ct`*-
___CO*t..tSG YLk. ()Itc 2'7
(Sneer Name. Numhcn. Community. SubdF islon. Lot No., Zip Code)
3. OWNER: ny 1Sts',tte \
Address 2n+t 373 8o". 9I
(Street or Rouen No.)
QCndite AC
City or To, n State
(12R)- 7i2 51 4,2
aS
Zip Code
Area code- Phone number
4. DATE DRILLED 31.28io3
5. TOTAL DEPTH: 'Ay5
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO 1
7. STATIC WATER LEVEL Below Top of Casing: _ %OFT.
(Us"(i" if Above Top of Casing)
S. TOP OF CASING IS 1 IT. Above Land Surface*
*Top of casing terminated at/or below lat d surface requires a
variance in accordance with I5:A NCAC :C .0118.
9. YIELD (gpm): 11 METHCD OF TEST fi.5
l0_ WATER ZONES (depth):
I I. DISINFECTION: Type D, it 5
12. CASING:
Depth Diannetcr
From t1 To '1' Ft._2_
Prom To Ft.
From To Ft.
GROUT_Depth
From ID To e20 Ft.
Topographic/Land setting
[Midge °Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
+1 ati ovzr & racn
49-Li 3t15 (rrewte.
Amount Si;
Wall 'Thickness
or Weight/Ft. Material
i & 3 Ftztij
M itcrial
Cerig tvl+
From To Ft.
14_ SCREEN: Depth Diamet_r
From To Ft
From To Ft
15. SAND/GRAVEL PACK:
Depth Size
From To Ft.
From ho Ft.
16.REMARKS:
in
in
Method
o used.
Slot Size Material
in.
in.
Material
LOCATION SKETCH _
Show direction and distance in miles from at Ieasf_
two State Roads or County Roads. lnclude road
numbers and common road names.
I DO HEREBY CERTIFY TIIAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C. WELL
;C(11NS LICjjIQNISLAN S AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
r — +IF Pea0- 51at) 03
1 t I SIGNATURE OF PERSO ' CONSTRUCTING THE WELL DATE
ti;
i Submit the original tot to Division of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
27699-1616 Phony_ 19) 7313-3221, within 30 days. GW-1 REV. 07/2001
l - 'I SEG11GN
Asiiiii it f a ..... OFFICE

27602'3
WELL CONSTRUCTION ItECORI)
Noe lh cal otin❑ - Dcp:iitnlenl oll Environment and NNaturallII esoureesfs Division or Water Quality- Groundwater Section y[�
\\ fat (1)\ I i.\C'li ll<II\III\'Il) AI NAM (1'ri"0_/ CL f n- k i V L-re CI7211 EIG\'I ION # �� '�
Nl(1t c11A'I ItV( I ONc(AIP,ANA N.ANIP: �f,Ci U1eilo- w-K I'lIONE # )( 7-Usw
SI.\IE\\lul.(()NSrltl'(I ION t'P:R\II'rn - _-_-___--. \SSI)('!ATE')\\'Q 1'EILNIITn
( i I :a,l,licahl.l l if applicable)
I. AVI(Chcck Applicable Box): Rcsidcn:t.al Nlunicipol Public ❑ Industrial 0 Auricular 0
Vluniloring ❑ I<ccovcry O I feat Puny Injection ❑ Other O II Other, List Use
WELL LI. LOCATION:
Nei nest Town: t 1/4- �1iv, le- Count:.»VOet
..-if --- 0r
itiiieci Nene. Nuu,bu.. t'ommunity. Subdl , mutt. 1 ei No.. /up CoLcl
(IAANl-I2: VQfj,,Vyl
\ddl ca j23-�
1)iiwel or Runic No )
W4lb
/ SIJ, j/C- ,A/C_ .2S'25 @
in, log, ii Sl.uc tip Code
I )
v ,,,,I.-
DATE Din LW)
TUTAL l)i-: vTIT:_--C----
h, DoIS VVlil.l. Rlil'1_ACI( EXISTING WELL:' YES 0 NO
SIATI( \VVVER. IiVlil. I Blow Top of C'nsil ET.
(I'u,"'"itAbur. rap of Casiu")
ti- TOP Or LASIN(G IS FT, Above :.mud Surface*
it Ey ul Glsiug terminated alfur below land surface Fs:ru res a
variance in nrcurd.iup will 15.\ NC:\( 2(' .111 IS. •
`). YIELD lopni):: /c. N1NT11O1) OETESC
III. AA',A'I Iflt TONGS (depth): -
I. 1)ISINIIICIION I)'pc Ainr dot
. _ ( ,ASING: AVall _Ilickncs,s
h'ldil // Ucu�ct/cr' nor V. itoli t I t. NI Icri:ll
opogralvhielLnnd setting
t idge ❑Slope ❑Valley ❑Plat
1-hck .ppngrid bus)
1.a111 udc'lonei lode of well loca11011
ILIsTiCes reunites samdel
La triode/longitude sourcc.OGPSO Topographic map
DIi P I- II
neMom To
jU
I cheek bull
DRILLING LOG
Ptgrn�tai op Description
/ -$ ..✓A�i-., e
LOCATION SKETCH
Show direction and distance in miles From at least
two State Roads or County Roads. Include the rtx+d
numbers and common road names. C�
1 ony [1 p 1.1010 / - / l yw //-23Q.7[/ L. c)
I:1nm To 1i --- - -------
I : (I(UL I . Depth NI tl n.11 A lelhod
I ltml Gl Ft, .._: .v- IL(p, eN
H uin Ib 1'1.—---_..--- --- __. -----
I -I S( tRI'.LN'. Utplh I hinnercr Slot `-lie Nlaleri:ll
Irrnn -_. --. lb I:L-.___-_
Tram To
SAND: GRAA'EI. 1'ACK:
Depth Sic ,IWeriul
Penn _ Io I
Tom 1,1 ___-- I
lo. tI-AI,ARFS.
I IA I IIIIS VVI: L \VAS C( NSIRUCIIEl) IN ACCOI DANC'L AMITI 15A N('AC 2C, WELL
IJNs I RI ( ION SIR \RUS. AND'TI IA I A CUT' OI' "I IIS RIiCOILD I IAS RLI(N I'RUVIDP:U'IUEI II WELT. OA1'NIiR
uIll
J L1
GncUldtA.n.)r PtIgOd ftIAL`".(')I
ASHEV.LI E RE11011:- OFFICE
1 ; Sl(NA I L tll 0I. iii:.1,SON cams I RUCrINa-I I lL \VULI. DATE
,Submit the orilgin: I to Il�c Division of Water QL:.lity, Groundwater Section, 1636 Mil Service Center- Raleigh, NC
) 733-3221, within 31) MIN OW -I REV. 072001

WELL CONSTRUCTION RECORD
VAL.I lUA'l li.A('IOIt (INDIVIDUAL) IfU1111 tlllld Nia111 It,1's1(Ill �� el -Water �uu it_v-(Iroundwntcr Section
Nollh (atolula - D'parllllclll of Isle\ /// // Y,/ C,
.NAME ( viral) e,t �_- ! �- _ CERTIFICATION pr�y4/
VAICI I CON -I RA(' I OR (O?I I'ANN NAND.: cIc to // 7
SI.VIVVAF.1.I_('(I,AS'IRr(IlO,N 1'L:RVIIi# ASSOC! ATEDAA'QI'IOtAItI#
Fit applicable) tit -applicable)
P u oN I: 1 0-?81 6a7-5.5p8
I. AV111_1. US11 (('heck :Applicable. !lox): 12csidcn
Aloniloring ❑ Rccuccry ❑ I feat I'utnp AVa
2. VA-EI.I. LOCATION:
Nc, stllnvn:e/e co. c,22/
I Fo NI N.uue. Numbe;, C'umnuuldv. Subdi sision. ut No. tip (Hick
II R IA9unicipalil'ublic 0 Industrial 0 Auricultural 0
r Injection ❑ other O Il Other, List Use
C1 Illwel ur I:nul: Nu_)
�Qe C
or Stele /Ip ('ode
7.2/
DNI'TI I
From To
I )- c c2V
// 3
-I. DAt F. URII.LPD rQ /g-03 / 7-?
I O VAL Dl1I'T11'. SK
DOHS VA'IiI L Rlil'LAC'I_ LXISPINC W1=1.1.? YES 0 NO L9-
STA i I( \A A"I LR 1.1'A l t. Below I op of
Itkc IrAhove lop or C-a.incl
TOI' ()I-CASIN( i IS FT. Above Land Surlacc*
'Top or ca.ing Ivr mingled :War bet %v hra land surface reuires
ra in ai truce.% ill. IS: \ N(1\(' _'('.II118.
`I. 1IIII I)(upnt)_-_ Nii,T1IOD Oh !Fs! / r
AA:AFAR 7oNI-S (depth):
. o code- Mimic tululi.:r
276022
Topographic/Land setting
❑12i(Igc ®�opc ❑Vullcy ❑Flat
(check upprorn:te box)
Lalitudc'loncinulc of well location
Pk:grecs mnun<iseamda
Luliludc; lonliitudc Suffix: O(GPSOl upon raphic map
IcbvcR box)
DRILLING LOG
Fn Jl n natiDescription
y�nS� & sire
ra- : >-c
10('AIION SKICI CI I
1 I. D ISINI'h.(TION. Tvpe // �>i (\nv antShow direction and distance in miles from at least
! 2 ( ASIN(i: AVtill "hickltess two Sitnte Roads or County Roads. Include the road
I)ehllt Diu ncler or Avc',9,4111 Fi Nlateria nulnhers and common road names
Moral? To )2/i:t /fr/ i /Yt5
Pun❑ To I'I. g /5o S
Flom __— Tu I'I.
( Ott it; T: Depth;
I -runt.__.?%.
17uln Tn
nlab-ri.d /� iNletbo,l
I I S(I:I.I:N'. ()ilia] Uianlnet Slut )lie Nloterial
Prom lb _._ II._-____-. in.
11om 1(1_ - --. FI..___.___ in. in.
IS S:A ND ( IR AVI:I. PACK:
()cplh Sire :'.toter MI
Ilon1 1i PI
I olm I tt
Rt-.NIAlt KS:
I I 1 V,A 1'I-
IkGI(
0
CO
f—
a
IV
0)
oo c
r-
0
0
III - III :AI 11I1SAVIfII AAAS('l-VSIRt3l"III) IN A(l'UI.UAN(ILAA'Illl IiA N(AC _C,AA'Iil.l.
-I U
.Submit Ike wit 1 at tJ) the Division ohAA'ater Qu: lit)', Groundwater Section, Ib36 flail Service Center- Raleigh, NC
'7 I t -FLU Phut • N1 . Q919) 7.33-3221, vyithin 31) (lax s. GW-I RIiV. 07/2001
GROUNDWATER. SECTION
ASHEVILLE REG!C'H3L 'IPTICE
'DAItDS. AND II IA I A COPV THIS RE C'UIgl IIAS BEEN PROVIDED IU II IE WELL OWNER
SIGN:AIURI-.- )I-- 1'LltSO' CONSIRUCTIN( T111 AVELA. DA"I I

276021
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and N turall RResouurcess-- Division of Water Quality - Groundwater Section
WELLCONT RACT Old (INDIVIDUAL) NAMIF,(print) e !4 A 47//40 CERTIFICATION N
w FI.[, CON'( R ACTOR COMI I'A NY NA 1E Pit C e G(Je/,/ -- f'vn+`' PHONE a (rrM'.9j 440(71- S5'78
STATE WELL CONSTRUCTION PERMIT#
ASSOCIATED WQ PERMIIT#
( itappl icable) (if applicable)
2
WELL USE (Check Applicable Box): Residential 1g�Municipal/Public ❑ Industrial 0 Agricultural 0
Nlonitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
WELL LOCATION:
Newest Tovvn: / lie- /__ County
co4/Ot/ff IC2o v !'9✓:s
(Street Name. Numbers, Community, Subdivision, Lot No_ Zip Code)
3. OWNER:, 5G4Ni)f4 /4/4
Address /'/ 72;;'%riq'vti / ti•
S,Street or Rowe No.)
.tV.e e/o(e 376)3°
City or Ton n State Zip Code
( r
Area code- Phone mush_
4. DATE DRILLED `/ -O
Topographic/Land setting
2kidge ❑Slope ❑Valley DFlat
(check appropriate box)
Latitude'longitude of well location
(decrees/mum tes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To F n mtior) Description
a.o ()a
5. TOTAL DEPTH: r7' IC'f r,/ /90 0c
6. DOES WELL REPLACE EXISTING WELL? YES,VNO Igr \ T
7. STATIC WATER LEVEL Below Top of Casing: 7. ' FT.
(Use `+" if Above Top of Casing)
8. TOP OF CASING IS FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
/
9. YIELD (gpm): C METHOD OF TEST /i., r
I . WATER ZONES (depth):
[ LOCATION SKETCH
11. DISINFECTION: Type /7 %g Amount Show direction and distance in miles from at (cast
12. CASING: Wall Thickness two State Roads or County Roads. Include the road
Depth Diameter or AVeighUPt. M. erial numbers and common road names. o .
From �� To ? Filo �`� f%f . " • From 'I'o Ft.
From To Ft.
13. GROUT: Depth Material Method
From C To o2C Ft inrG.KPN7/-
From To FL
14_ SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
Front To Ft.
From To Ft.
r-
r
fV
co
16. REMARKS:
IJJo 1tPIkPIZY CFR.TiFA
r--� C1NT1RULTIGN $ :A.
�n
I I
I
It,
I j
l2)
Submit the original o the Jivision of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
1 77699_ (43r,1't, oto No 919)-33-3221, within 30 days. GW-I REV. 07/2001
GROUI"ONSEAfER, SECTION
ASHENAI LE f OFHCE
T TI11S WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
DS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
tly
�NATUI OOFF PERSON CONSTRUCTING THE WELL
DATE

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Na ural Resources - Division of Water Quality - Groundwater Section VAELL COSTIt.ACIOR (INDIVIDUAL) N:Ablr' (print) �T,y _pl�a�-o//e CERTIFICATION#02967J��j
\\EI.I, CONTRACTOR COMI':AN\' NANIEPT-0 to U'e)1 �'Y1.'cv 1'FIONE
STATE VVEI.I. CONSIItUCTION PERMIT#
276020
ASSOCIATED \\'Q PER:\TIT#
(if applicable) (if applicable)
WELL USE (Check Applicable Box): ResidentialMunicipal/Public ❑ Industrial 0 Agricultural 0
Nlonitoring 0 Recovery 0 Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Tovvn:_/
County
n dV(Street Name. Numberom-lily', C(ty. Subdivision, Lot No.. Zip Code)
a -
3. OWNER:
Address
�//
(Street or Route No.)
(14 41l All[.
City or Town State
)-
Aran code- Phone numbe�r. ,..�
4_ DATE DRILLED 0.3
oNwo
Zip Code
5. TOTAL DEPTH: eir
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: /PO FT.
(Use "+" if Above Top of Casing)
S. TOP OF CASING IS FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 1 5,A NCAC 2C .0118.
9. YIELD (gpm): / METHOD OF TEST ,r(
IQ WATER ZONES (depth):
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names. -_
Q
W
c
r-
ttdopographic/Land setting
ge ❑Slope ❑Valley 0Flat
(check appropriate box)
latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑G PS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To For ati n Description
1I. DISINFECTION: Type i Amount
12. CASING: Wall Thickness
�/. Depth Dia)neter or Weight/Ft. pMi cripL
From To 8/ Ft. In/5� y �'fC-
From To Ft.
Front To Ft.
13. GROUT Depth Material Method
From d To 02_Ft 't+e
(Tom 'fo Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Et. in. in.
15. SAND/GRAVEL PACK:
Depth Size -Material
Front To Ft.
From To Ft.
16. REMARKS:
ll08
N
CO
rl
1 UV Frptrry_dcitu
l� F :(�T THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL oNS i2Ut f1�1 A S IPA IS, AND THAT A COPY OP THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
�c lL—O�
SIGNA'' RE OF PERSON CONSTRUCTING TIIE WELL DATE
Submit the original tQ he Ittivision of Water Quality, Groundwater Section, 1636 Nlail Service Center - Raleigh, NC
L,,,Z1/101 ibidrPptytRtiNol-010)7r-3221,within30days. GW-1 REV.07/2001
OFFICE

WELL CONSTRUCTION RECORD .2 7 6 01
North Carolina • Department of Environment and Natural Resources • Division of Water Quality • Groundwater Section
WELL CONTRACTOR (INDIVIDUAL)- NAME (print) Jeremy H. Bowman ' CERTIFICATION S 2809
WELL CONTRACTOR COMPANY NAME n Rnwmen Wel 1 llri 111 ng, Tnr PHONE S 89R 952-7779
STATE WELL CONSTRUCTION PERMITS ASSOCIATED WQ PERMITS
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential Dt Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: Waynesville County Haywook
25 Parsonage Court
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER:
Address
Joseph Hughes
25 Parsonage Court
(Street or Route No,)
Waynesville NC 28786
City or Town State Zip Code
( )-
Area code- Phone number
4. DATE DRILLED 1 f 74 / 01
5. TOTAL DEPTH' 260'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO IX
7. STATIC WATER LEVEL Below Top of Casing: 60 FT,
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1 • 4 FT. Above Land Surface*
•Top of casing terminated at/or below land surface requires a
variance In accordance with 15A NCAC 2C .01131.
9. YIELD (gpm): 5 METHOD OF TEST'. rotary
10. WATER ZONES (depth): 1 80' , 220'
240'
II. DISINFECTION: Type tablet Amount 6
12. CASING: Wall Thickness
From 0
From To
From To
11. GROUT: Depth
From 0 To 20 Ft. concrete gravity flow
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in, in.
From To Ft in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
Depth
To 50
Diameter or Weight/Ft.
Ft.51 /8 Sch RO
Ft.
Ft.
Material
PVC
Topographic/Land setting
❑Ridge ❑Slope OValley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:OGPSOTopographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
air
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
From To Ft.
From To Ft.
Material Method
c,
16. REMARKS:
1 nO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
1 (CONSTRUCTION, ST S, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
Submit the original to th
21699 163K Phan I (919
'F U'.:`:'.n/ 1I5IY
THEY;;; A� (Puri
ttIS AL —
SIGNATURE OF PERSON CONSTRUCTING THE WELL
7/ DATED 3
Division of Water Quality, Groundwater Section, 1636 Mall Service Center • Raleigh, NC
733-3221, within 30 days. GW-1 REV. 07/2001

276018
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) / l/�?'? CERTIFICATION#���
M
\YELLCON'rltACrORCO\II'ASV NA\ lEflfCE', t e/// in.,49
PHONE #
STATE \\ iLL CONSTRUCTION PER\IIT# ASSOCIATED \VQ PER\IIT#
(if applicable) (if applicable)
2
WELL USE (Check Applicable Box): Residential ♦3" M unicipal.'Public 0 Industrial 0 Agricultural ❑
Ntonitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 IIOther, List Use
WELL LOCATION:
Ne rest Town: W4
rrys/ 77-eto
(Street Noma. Numbers, Community. Suhdivis
3. OWNER:
Address
County HJ tor✓
Lot No.. Zip Code)
Itt%W.I�/✓G*S✓/�%i�t or Route .2e
ity orTown State Zip Code
Area code- Plume number
4. DATE DRILLED , 5 7 30
5.TOTAL DEPTH: 37s--&-
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO la"--
7 STATIC WATER LEVEL Below Top of Casing: .3 3 FT.
(Use `+" if Above Top of -Casing)
8. TOP OF CASING IS FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): /0 METHOD OF TEST •
10. WATER ZONES (depth):
I I. DISINFECTION: Type
12. CASING:
Depth Dia ictcr
f
From 2 To 79 Ft. ( hi/
From To Ft.
From To Ft.
13. GROUT: Depth Material . Method
From 0 To <9� Ft. �eM,,v7
From To Ft.
14. SCREEN: Depth Diameter Slot Sizc Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
Amount
Wall Thickness
or WeighVPt. N tcrial
From To Ft.
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑G P S❑Topographic map
(check box)
DRILLING LOG
Forniati m Description
S.a Nd�
4 rz2�9ND<-5— 4.ef
DEPTH
From To
(90
/c r J9s -
C 4t
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
44 /318
0
CO
t_
C
r—
I
N
C0
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CPNSI RIC;TIPN STA.
-d
Submit the original t f ' IAivision of Water Quality, Groundwater Section, 1636 Nlail Service Center - Raleigh, NC
27699-1636 Plume No. ($19) 7'3-3221, within 30 days. GW-I REV. 07/2001
5s, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
5 O3
OF PERSON CONSTRUCTING THE WELL DATE
CRCL .Pr R _•.;TION.! C
Ac,. V' e t t __ H

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and N tural esou ccs - Division of Water Quality - Groundwater Section
WELLCOSTIt:ACfOR (INDIVIDUAL) NAME (print) J I et�� uZie CERTIFICATION
WELL CO.N TRtCrOR COMPANY NAME P%, vQe//k 7 D'l`f
27 ri019
PHONE # p(9)AA-875{J
SATE WELL CONSTRUCTION PERMIT# ASSOCIATED AVQ t'ER>nT#
(if applicable) (if applicable)
I. WELT USE (Check Applicable Box): Residential RV-Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection ❑ Other 0 1f Other, List Use
2. \VELL LOCATION:
Nearest Town:
/
�1fuure
ISt« ct Name Numbs
3. OWNER:
Address
County
Subdivision, Lot No., Zip Code)
• {Street or Roue No.)
City or Town Star Zip Code
Area code- ('hone numher-
4. DATE DRILLED/H -03
5. TOTAL DEPTH: �?////9
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO 6"
7. STATIC WATER LEVEL Below Top of Casing: CA7 FT.
(Use `+" it'Above Top of Casing)
S. TOP OF CASING IS FT. Above Land Surface*
`Top of casing terminated at/or below land surface requires a
variance in accordance, ith I5A NCAC 2C .0118.
9. YIELD (gpm): f0 METHOD OF TEST/9 'T
10. WATER ZONES (depth):
11. DISINFECTION: Type 7/4/ Amount
12. CASING: Wall Thickness
From .1-"Z
Deptl Diameter or Weight/Ft. M tenet.
To -5 Ft. �'i //y.$'{'J(
From To Ft.
Front To Ft.
13. GROUT: Depth Material
From 0 To cD Ft. tier, c''/
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
83722
Method
4opographic/Land setting
ge 0Slope ❑Valley ❑Flat
(check appropriate box)
Latitude'longilude of well location
(degrees/minutes 'seconds)
Latitude/longitude source:❑G PS❑ i opographic map
(check hot)
DEPTH DRILLING LOG
From To F t Lion Description
From To Ft.
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
/3c7
Q
W
16. REMARKS:
111(1 HP12FBV CFRTIFY 1, W
CoNSTRL I I(0t'
�vw r
..,) I,', i l
Li L =—
Submit the original t I the
` 77699-1616 Thum,' Nn �9 9)
GINCIISTOWITTESI SECTION
ASHIFICITLIE SLOINITIC.. OFFICE
T THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
)S, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
jetzi (C)
SIGNATURe OF PERSON CONSTRUCTING THE WELL DATE
(vision of Water Quality, Groundwater Section, 1636 Mail Service Center- Raleigh, NC
3-3221, within 30 days. GW-I REV. 07/2001

278347
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and N Resources - Division of Water Quality - Groundwater Section WELL CONTRACTOR (INDIVIDUAL) NAMI�i, (print) (h', A 4/1 C. 1 �/J CERTIFICATION ttf7.9
WELL CONTRACTOR COMPANY NAME ,CYGfQe e.te.t.01, basil (12 ;Le PHONE N fZ. /aY it p a
STATE WELL CONSTRUCTION PERMIT'S . ASSOCIATED WQ PERMTTN /�I?
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential I [ Municipal/Public ❑ Industrial ❑ Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town:.
(Street Nbers, Commonly, Su v/
3. OWNER: Z/41 /a .1.4-t t
Address /... 0 4e.c) Cebu, �6,
»fan Ll (S t ante& C 4 g%yl r—
Town
Zip Code
Area code- Phone number / �/�
4. DATE DRILLED S/ 3
5. TOTAL DEPTH: . f
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO181
7. STATIC WATER LEVEL Below Top of Casing: 6-6" FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS A S FT. Above Land Surface'
*Top of casing terminated at/or below land surface requires a
variance In accordance with 15A NCAC 2C .0I18.
9. YIELD (gpm): -3l'� METHOD OF TEST
10. WATER ZONES (depth): /..1.
11. DISINFECTION: Type Amount
jp ;-,
12. CASING: Wall Thickness
Ft 1. i 4et,2 / to
Depth//
FromL17 To (rO
From To
From To
13. GROUT: Depth
From F)
From To
meter or Weight/FL
Ft 7
Ft.
„ Material
Ft [�6H2te�r
Ft
14. SCREEN: Depth Diameter
o Ft. in.
To Ft. in.
%GRAVEL PACK:
tb
Fro
Fro
15. S
From
From
16. REMARKS:
0
M9thod •
r�t2c,y
Slot Size
in.
in.
Material
Size Material
Ft.
Ft.
Topographic/Land setting
❑Ridge titS1ope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
O CO
CO
rfie
0 T.c rn
--..,
LOCATION SKETCH
Show direction and distance in miles
two State Roads or County Roads.
numbers and common road names
3 m
at ast
ethgroad
I DO HEREBY CERTIFY THAT THIS WEI 1 WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT _ COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRU ''g3Jr' WELL
Submit the original to the Division of Water Quality, Groundwate a Ir n, 1636 Mail Service Cent
27699-1636 Phone No. [phone], within 30 days.
r
eigh, NC
V. 07/2001
cALIAI
0
G.2OUIV.O`:7
SECIic1!

\YELL CONSTRUCTION RECORD
Surdl Carolina - Derailment or Enyironnlent and Natural Resource. - Division or Water Quality - Groundwater Section
\\ I I.1. (-U\"1It.\(-)(a t (non !I)t'.\1.1 \A\II( (print) - L` i L� 142141/, 'e Ct:RTIPIC.\'I'10\k
\\rL1.ti) \-IR \("I"OI:('OW' \\\ •k\ 11.:/2/ri3Cebee// 4//v p ---------- rll0\Ic a to/t.--es
\ r II. N 1.1. 1. ('U\S 1Itt (LION l'Elti1"Ik . SSOC'IA'rr:u \\O 1'LR\TIT#
:( lPpli.ahlcl (irarpl icablc)
i WELL USE )Chsk .Applicable 130N): Rcsidcn.:al 6A' IAlunieipalil'uhlic 0 Industrial 0 Auricultural 0
Vlonitorill_ ❑ Itreocery 0 Heat I'ump War Injection ❑ Other 0 IfOther, List Use
W1:1.1, LOCATION. N\ e•1 Tu\vn lev9Y/V2 Ld>od/
ICCI aam. N Ibe (I nm i n .iubAia ni. Iul `lo.. /.111 C ticl
sNIsi ��A /'O C— �oU�c
\!ds 0/7—dle�.,/.�� �i— / S
\11e❑kli RnuV No.1
L(/A) ./ALos f //e
Lit%yr Imrn St.nc /ip (bJe
ViC. a�ne IIithe mo a hr;
DOES \\'I!I..I. RGI'L:\CE EXISTING \\'ELL" VI)S ❑
NO
7 S I':\IlC \VATER. LEVEL 13clow Top or Case' efria?o FT.
,Ise•.. 0 AI„I.e)„p„tCISiF„I
TOP OE (:ASING IS FT:Above Lanai SurEtcc'
`top ul cn\iug Iertnitrtlad Afar helim Dann \nrraee re: iret: a
cari:m<c III accordance with 1>.\ NCA(2 2C.11118.
'I. VIELD(epinU- .3` VINT IOD OFTI:SF /57/
R). AV AIIiIt /ONI':S (depth):
DISINI I;ClION. Type
12 C:ASI:N(i:
I'epth Diameter
inn
17on1 To fl_
Innis 111 Ft.
y-474/
2'78545
c/69
Topographic:land setting
❑ Itt&_e gclope ❑Nall..\ ❑Plat
a k appro to hovl
L,Il ilude'I(ng i ltidc or well locution
Wept -cc., wuurlcsnenaNsl
LuliludL It 11i iwdt source:❑GPS❑Topog rophic map
(check Novi
DEPTH DRILLING LOG
From To hprlp;Itiu t Description
0 a67 /
rS, NO y
4yrlro $4vo.S&ere
LOC.AII()N SRI[TC'H
CO
)Ana ant Show direction and distance in miles Fronde'lea. A
Wail -hickocss two Stale Roads or County Roads. Include the roo0
or V. 'i tht'FL :\ ile i:ll numbers and common road manes
( I<Ol Uynh VI:II riai Nletbod
Flout D In l__ I CP/mc t..._
I St.'KI. I : Dcinh D::undo Slot l i AI_ucriul
Flout Ill It
I)ull1 Ia -t. III. III.
S ANI) GRAV'IiI.I':ACIK:
peril] Si:e 'h iel is
11.111 Tn
Il�nn To FI.
lit I:If\I:\I:KS:
-9 ca'
z"t
1 D11 I II.ItIil3V CLICIII'V 11T:A"E 101S WELL WAS C'(-NSIRUCTED IN ACCORDANCE WITH firA NC'AC.2C, RTI L
I ONSTItt'i CI ION STANDARDS. AND TI TAT A COP`" (JF THIS RECORD I IAS HELN PROVIDED TO II IL WELL OWNER
SIGNATURE. OF I'E':SO.N CONSTRUCTING Tilt) WELL
DATE
Submit the original to the Division of Water Qu: lily, Croundrcater Section, 1636 \I:III Senile Center- Raleigh, NC
276'19.1616 Thane No.1919) 73?-i221,'vithill 311 do>;. GW-I REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
\YELL CONTRACTOR (INDIVIDUAL) NAME (print) /1(C Tr1 74,10 is?e CERTIFICATION ft + ram///Q
WEI.1. CON'TRACI'OR COMPANY NAME , CE 44'&//%e— AV^"f PHONE k fajaZ i�J /e
snit WELL CONSTRUCTION PERMIT# ASSOCIATED \VQ PERMIT#
(if applicable)
lifapplicable)
27834
I. WELL USE (Check Applicable Box): Residential l Municipal/Public 0 Industrial 0 Agricultural ❑
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest T wn:
rC eNn
t Simct Name, Numbers, Cot ninumyy /Suhdivisn, Lot Na. Zip Code)
3. OWNER:.!%RV/!D l h _e
Address O, 1So/ g(o
County git%Oo�
(Street or Route No.)
aYoe . 7,2 )
City or Town State
( )-
Area code- Phone numbs
4. DATE DRILLED
5.TOTAL DEPTH: _
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO QV
7. STATIC WATER LEVEL Below Top of Casing: /o'O FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 07 FT. Above Land Surface*
"Top of casing terminated at/or below hind surface requires a
variance in accmrdance 7wyt t ISA NCAC 2C .0118.
T
9. YIELD (gpm): METHOD OF TEST .74-zr
10. WATER ZONES (depth):
Zip Code
topographic/Land setting
tge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To F at* Description
SOY
/uS
/0,S
1'd
AN /
AC
LOCATION SKETCH
1 I. DISINFECTION: Type AC Amcunt Show direction and distance in miles from at IeaPO
12. CASING: Wall Thickness two State Roads or County Roads. Includ4e rd b
rrt
Depth Dia peter or V. eight/FI. nM/,ry1eria,rl \ numbers and common road names. Cr*? �zz
From �, To Sl: Ft. 6V</ .Y /QSI;C
From To Ft. Z /i)tv 19 - 2 J CO ~
or
Z ) L J i
O
ern
ern
From To It.
13. GROUT: Depth Material Method
From 6 To .4 Ft. CF'...ems✓i-
From "re Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To FI. in. _ in.
From To Ft. in. in.
15. SAND/GRAVEL PACK
Depth
From To
From To
Size Material
Ft.
Ft.
16. REMARKS:
0<
q m
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
(l) G _C 3
SIGNATUItE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of 6Vater Qu:Jity, Groundwater Section, 1636 Nlail Service Center- Raleigh, NC
27699-1636 Phone No. [phone], within 30 daxs. GW-I REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and N tural Resources/- Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME ((pprint) ( I)L J.dy(//20C CERTIFICATION#,XY1c.
WELL CONTRACTOR CO\IPANV NAME f/i(r /il%P///0- AG/M# p*� PHONE )rc/d2-8 7
STATE: \VEI.1. CONSTRUCTION PERMED! ASSOCIATED WQ I'ER\IIT#
(if appl icable) (if applicable)
I. WELL USE (Check Applicable Box): Residential ti/ Municipal/Public 0 Industrial 0 Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION: '/ /
Nearest Town: kiii �yj(JeC1 �/- Count'. V4/nv(Y
<111n/nn2r/tv J`L/
.Street Name, Nu,,,ui////uihhers. Community, Subdivision, Lot No-. Zip Code)
3. OWNER:4 4 %a ���•
Address re �,r,••�
(Street or Route No-)
W. tity Ifc /U. c. qt7g6
try or Town State Zip Code
\re:t code- Phone number
4. DATE DRILLED R�y/C'�
5. TOTAL DEPTH: 4' m6' 62// 7
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: (C' FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS `2 FT. Above Land Surface*
•'fop of casing terminated at/or below land surface requires a
variance in aceordnnce with ISA NCAC 2C .0118.
9. YIELD (gpm): _3 METHOD OF TEST .4(7
10. WATER ZONES (depth):
LOCATION SKETCH —fl r~n�
Show direction and distance in miles front Ieatirg
two State Roads or County Roads. Incluck91ie rOgg
numbers and common road names. —4
o
278543
Topographic/Land setting
I1Ige ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:OGPSOTopographic map
(check box)
DEPTH DRILLING LOG
From�Fo
C, rpatio� Description
)o / yr
7y"
ys
11. DISINFECTION: Type
t?. CASING:
Depth
From tc)i, To l- 3 , Ft.
From
Amount
Wall Thickness
D Arg,ir�ya%% nvFL tee
To Ft.
From To Ft.
13. GROUT: Depth Material
From G To )19 Ft. Cc re"7i-
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
Prom To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size 'vtaterial
Method
Slot :izc Material
in.
in.
From To Ft
From To Ft.
16. REMARKS:
0
O
w
rn
rrl
0
IT
10,0 /9- a3
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
t-cj SIGNATURE OFCLL
SON CONSTRUCTING THE WELL
DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center- Raleigh, NC
27699-1636 Phone No. [phone], within 30 da}s. GW-1 REV. 07/2001
1

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and N
WEI.I. CONTRACTOR (INDIVIDUAL) NAME (print)
\EI.I. CONTRACTOR RAC'TOR CO.IPANY NA\IE
S'I AT \\'fa.l. CONSTRUCTION PERMITS,
I if applicable)
rice to
nrr /j0
tural Resources - Divi -ion of Water Quality - Groundwater SecWoh� //tQ
V' e- CERTIFICATION # 92�6/
(/4^� PHONE # $03) ,7- 515,g.
ASSOCIATED WQ PER\IIT#
• (if applicable)
1. WELL. USE (Check Applicable Box): Residcmial EKvIunicipal/Public ❑ Industrial ❑ Agricultural ❑
'Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ IiOther, List Use
2. WELL LOCATION: //
Nearest Town:( ^- Kr2 n/ Count
r,9 77er r
(Sueel Name. Numbers, /Conmtun/ity, Subdivision, Lot No.. Zip Code)
3. OWNER--JAL/C 3'FQP
Address 1 ijtil B/U V A
(Street or Route No.)
Ca Y"J) O., 4/.
City orbown Stole Zip Code
)-
Area code- Phone number
4. DATE DRILLEDSA 0,3
5. TOTAL DEPTH: JDS--( t
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO EV-
7. STATIC WATER LEVEL Below Top of Casing: /dU FT.
(Use "+" if Above Top of Casing)
S. TOP OF CASING IS FT. Above Land Surface"
*trap of casing terminated at/ur below land surface requires a
variance in accordance )'ith 15A NCAC 2C .0118.
9. YIELD (gpm): / ..2 METHOD OF TEST
10. WATER ZONES (depth):
II. DISINFECTION: Type
12. CASING:
Fromi-2
From
From To
Depth
To 7-/
To
c9a 7Il2
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
DEPTH
From _To�,
0 JN
6 4is
gC5 O5
/17-
Formatiot Description
LOCATION SKETCH 1 0<
Ameunt Show direction and distance in miles from at le§o
Wall "thickness two State Roads or County Roads. Inclughe in
or Weight/Ft. MpteriaL numbers and common road names. n
N2
y� I- Ste L /!V :Q i$ CO.c
0
13. GROUT: Depth Nledtud
From O To .970
from To Pt.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Et. in. _ in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
Dia71\cter
Ft. 6 'Ay
Ft.
Ft.
Material
n
Ft. ` E/M f'N7
From To Ft.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I SA NCAC 2C, WELL' ---
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
�•CG%C'LL Je C-c
SIGNAT 12E OF PERSON CONSTRUCTING THE WIiLL
DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center- Raleigh, NC
27699-1636 Phone No.(919) 733-32221, within 30 da) s. G W-I REV. 07/2001

WELL CONSTRUCTION RECORD
278541
North Carolina - Department of Environment and Natural Resources - Divisi n of Water Quality - Groundwater Section
lA'ELL COSIIi:AC"1'Olc (INDIVIDUAL) NANIElprint) gel /L-N 4Sa 1() !i e CERTIFICATION W?
WWELLCON'fltACI'OR COMPANY NAME //w/�A7Ce' ��tni° PHONE # fgi^-1 &V— :�
STATE WELL CONSTRUCTION PERMIT#
(if applicable)
ASSOCIATED WQ PERMIT#
(if applicable)
I. WELL USE (Check Applicable Box): Residential L9" lunicipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ IfOther, List Use
2. WELL LOCATION
Nearest Town: C��f% e
o/(dr'r C K!/
�� pographiciLand setting
Count�/}w�1'U�oidge ❑Slope ❑Valley ❑Flat
• (check appropriate box)
(Street Name. Numbers, Community, Sufbddivision, Lot No.. Zip Code)
3. OWNER: e /;e/(4
Address �h. �r y' 70,S
(Street or Route No.)
44.q�s �c
City or Town S m le Zip Code
( )-
Area code- Phone num her
4. DATE DRILLED St-
5. TOTAL DEPTH: c C✓
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO L9�
7. STATIC WATER LEVEL Below Top of Casing: /*/6% FT.
(Use "+" if Above Top of Casing)
S. TOP OF CASING IS FT. Above i.and Surface*
*Toy of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): 6, METHOD OF TEST 4'C-
10. WATER ZONES (depth):
I . DISINFECTION: Type
12. CASING:
Depth
From To 7d
From To
Front To
13. GROUT: Depth
From t) To .-ZC
From To
14. SCR ENN: Depth
From To
From To
15. SAND/GRAVEL PACK:
Depth
From To Ft.
From To Ft.
/`7 727i Amount
Wall Thickness
Diameter or Weight/Ft.Al teriali
i.
hl.
Material . Method
Ft. ('FtMen/
Pt.
Diameter Slot Size Material
Pt. in. in.
Pt. in. in.
Size Material
16.REMARKS:
Latitude/longitude of well location
{degrees/Initiates/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Forrnttio Description
G o2a CA-
)r. %y
/cs-
5 jrS
n
LOCATION SKETCH tSo
Show direction and distance in miles frotugt lego
two State Roads or County Roads. Inclucc lie r©yW
numbers and common road names. mir e
w
r
//%W0.257
G
�`
I DO IIEREI3Y CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITII I5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
ac ss i ; -13-Q3
SIGNATUI E OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center- Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-I REV. 07/2001

278540
WELL CONSTRUCTION RECORD
North Carolina - Deparunent of Environment and Natural Resoircesr-,/D`ivision of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME �(print),�er rooF� 're CERTIFICATION q�Y�F
WELL CON'fIU\CFOIt COMPANY NAME A-- t e tuk-v/' /.M f PHONE if F+'�' 16'27- 83,9
sTA'rt: WELL CONSTRUCTION PERMIT*/ ASSOCIATED WQ PERMED/
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential LAY Mtmieipal/Publie ❑ Industrial ❑ Agricultural 0
Monitoring ❑ Recovery 0 1-teat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION: �// /
Nearest Town: ( y-0 Ai County 40-0Od
(;r(-50
4Strcel Nana, Numbers, Conmtunity, Subdivision, Lot No.. Zip Code)
3. OWNER:��4Y'/r, e ft-4L✓ICC°
Address 3S6 (a^y9er5 LN
n (Street or Route No.)
L,arret it i✓ /i�•
City or Town St/ate
07-4 7JYg
Zip Code
( )-
Area code- Phone number
4. DATE DRILLED « gS�0 3
5. TOTAL DEPTH: � S
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO f�
7. STATIC WATER LEVEL Below Top of Casing: &2- FT.
(Use "+" if Abovr Top of Casing)
8. TOP OF CASING IS FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 3 METHOD OF TEST Ljt/1/4-"
10. WATER ZONES (depth): /L
II. DISINFECTION: Type iir Amount
12. CASING: Wall Thickness
Depth , '7 Diameter or Weight/Ft. M erial
From f n, To l / Ft. (A /
From To Ft.
From To Ft.
Topograa is/Land setting
❑Ridge lWSlope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degreeshni naves/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
Fo tiop Description
DEPTH
From To
/) U
a
8'
a
le
LOCATION SKETCH
r ��G✓ a 7 � W
13. GROUT: Depth n Material Method
From . To D20 Ft.f F'M(QN 71--
From To Ft.
14. SCREEN: Depth Diameter Slot Sizc Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Sizc Material
From To Ft.
From To Ft.
16. REMARKS:
cn xiT
�O cm
z
Show direction and distance in miles fro' at legatic
:Ern
two State Roads or County Roads. Inch' e the
m
numbers and common road names. MC pair
r
C
I DO 11E12E131' CERTIFY THAT TI-IIS WELL WAS CONSTRUCTED IN ACCORDANCE WITII I5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD IIAS BEEN PROVIDED TO TIIE WELL OWNER
SIGNATURE OE I'1?'LSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 da) s. GW-I REV. 07/2001

NORTH CAROLINA DEPARTMENT OF NATURAL RESOURCES AND COMMUNITY DEVELOPMENT r.,
DIVISION OF ENVIRONMENTAL MANAGEMENT - GROUNDWATER SECTION .'
P.O. BOX 27687 - RALEIGH,N.C. 27611, PHONE [phone]
WELL CONSTRUCTION RECORD
DRILLING CONTRACTOR L'.c'.
DRILLER REGISTRATION NUMBER 'Y/%
/ g
n f FOR OFFICE USE ONLY
Quad. No. Serial No.
Lat. Long. Pc
Minor Basin
Basin Code
Header Ent GW-1 Ent
STATE WELL CONSTRUCTION
PERMIT NUMBER:
1. WELL LOCATION: (Show sketch of the location below)
»
Nearer Town:
County: Sky f Lc%CY2
1 LD 4 Depth // DRILLING LOG
(Road, Com aity, prr Su.: iv ision and Lot No,)
2. OWNER il�L�(,QJ/T �SOQ ('t.ti o From To Formation Description
VVVf /
ADDRESS G> L a� © U'6'
(Stye or Route o. �p/� / 25"' .�14 [tiv4-&—
y� re s J. nl2 77tC�
Cit or Town State , Zip Code
-// I
3. DATE DRILLED S/' 2S' �1` USE OF WELL �Ji 7/%�71u '>Z/4!
4. TOTAL DEPTH 6 a 5 ' CUTTINGS COLLECTED ❑ Yes
5. DOES WELL REPLACE EXISTING WELL? D Yes Lk(No
6. STATIC WATER LEVEL: `3od FT ❑ above TOP OF CASING,
TOP OF CASING 15 below
FT A VE LAND SURFACE.
. 7. YIELD (gpm): .S METHOD OF TEST c.2 dj!='S
8. WATER ZONES (depth): •30J / - \3Pm
9. CHLORINATION: Type Ai%k) Amount 6(1!I lit l/S
10. CASING:
Wall Thickness
Depth Diameter or Weight/Ft. Material
0 // /_C
From To � FtL . O (
From To Ft
From To Ft
11. GROUT:
Depth /I /1 Material Method
From L/ To dFt.fin•-Lint-e-Yl�l.j-
From To Ft.
12. SCREEN:
Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
From To Ft in in.
13. GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
14. REMARKS:
If additional space is needed use back of form.
LOCATION SKETCH
(Show direction and distance from at least two Se3te Roads,
or other map reference points) Q
W a,
c
�O Cm
( o<
co
qc
3 ri
o 110
n
N o
/
c^I
t'
J I FILE
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15 NCAC 2C, WELL CONSTRUCTION
STANDARDS, AND THAT A COPY OF THIS RECORD HA BEEN PROV 3E9 TO THE WELL OWNER.
410
D 3
GW-1 Revised 6/88
SIGNATURE OF CONTRACTOR OR AGENT DATE
Submit original to Division of Environmental Management and copy to well owner.

GW-1 Revised 6/88
NORTH CAROLINA DEPARTMENT OF NATURAL RESOURCES AND COMMUNITY DEVELOPMENT 9 1'7 r^51 FOR OFFICE USE ONLY
DIVISION OF ENVIRONMENTAL MANAGEMENT - GROUNDWATER SECTION (" 1) O 3
P.O. BOX 27887 - RALEIGH,N.C. 27811, PHONE [phone] Quad. No. Serial No.
Lat. Long. Pc
Minor Basin
WELL CONSTRUCTION RECORD Basin Code
Header Ent. GW-1 Ent
DRILLING CONTRACTOR >6
STATE WELL CONSTRUCTION / /� -2
DRILLER REGISTRATION NUMB SO 7 PERMIT NUMBER: 3
1. WELL LOCATION: (Show )$ketch of the location below)
.
LC/c2 tpn/-a// //.
Nearest Town:
'the
!i✓1d,t..L
(Road, Comity, or Subdivision and L No.) f
2. OWNER `� j'-r/r—d _A-i-�) / /� �/
ADDRESS S `7` --...4 -ti l tr-� ,c2d • 0 I /G 7 �iSc/�,,A.A �1
(Ji Route Fro.) / IG ' ?.,? r uC/�)h titer C C
V21.4 it,
ti NC e?pCoe
r Town'Male /Zip Code
3. DATE DRILLED 5--a(4'OS USE OF WELL JLo1.'/DAt1/ei
4. TOTAL DEPTH .a 2 s CUTTINGS COLLECTED ❑ Yes .No
5. DOES WELL REPLACE EXISTING��/�//� WELL? ❑ Yes yV No
6. STATIC WATER LEVEL: `Y(1 FT ❑ above TOP OF CASING,
below /'7
TOP OF CASING IS I FT A VE LAND SURFACE.UJ
7. YIELD (gpm): / a METHOD OF TEST r9 P
8. WATER ZONES (depth): .20 ' 7 ` / _2a pry-)
9. CHLORINATION: Type /`I / I7 Amount ,q 5 T b 14-s
10. CASING:
Wall Thickness
/� Depth / Diameter or Weight/Ft. ,,M-aat-eri'al / LOCATION SKETCH
From f / To _Lit l4 FI 40 (1 Aka_
O
(Show direction and distance from at Ieasto Stgte Roads,
From To Ft or other map reference points) 03 0
c'
N �: �
From To Ft. rn c�
O _,..rn
11. GROUT: 1 `pt
Depth Material Method CO .`-Er'
>0
From Lt J To / �1) Ft. eG'.-V+t..[-1t $ No
rn
From To Ft. z
12. SCREEN: (71 —1
N o
z
County: X/4 � Lc1/IC3/44
Depth DRILLING LOG
From To Formation Description
If additional space is needed use back of form.
Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
From To Ft in in.
13. GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
14. REMARKS:
3RO Yt`ER ' ECTI (i P1
ASHEViLI_E LFHGL
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED I ACCORDANCE WITH 15 NCAC 2C, WELL CONSTRUCTION
STANDARDS, AND THAT A COPY OF THIS RECORD HA4 BEEN PRO 1 D TO THE WELL OWNER. / a
SIGNATURE OF CONTRACTOR OR AGENT DATE
Submit original to Division of Environmental Management and copy to well owner.

GW-1 Revised 6/88
2. OWNER
NORTH CAROLINA DEPARTMENT OF NATURAL RESOURCES AND COMMUNITY DEVELOPMENT
DIVISION OF ENVIRONMENTAL MANAGEMENT - GROUNDWATER SECTION
P.O. BOX 27887 - RALEIGH,N.C. 27811, PHONE [phone]
WELL CONSTRUCTION RECORD
DRILLING CONTRACTOR
DRILLER REGISTRATION NUMBER
a a 8g
9
FOR OFFICE USE ONLY
Quad. No. Serial No.
Lat. Long. Pc
Minor Basin
Basin Code
Header Ent. GW-1 Ent
STATE WELL CONSTRUCTION
PERMIT NUMBER:
/VD?
1. WELL LOCATION: (Show sketch of the location below)
Nearegt Town:
I I lCr)
Comm it or
(Road.y, Subd Firs ion a. d of No,)
/.kt
929 /It
ADDRESS
(Stre or
City or Town
.'1
oute No.) 2 15> 7 16
State Zip Code
County.
Depth
From To
33'
3 ' yIDS
-7 Cr ),)(IC.L.
DRILLING LOG
Formation Description
3. DATE DRILLED W -o3 USE OF WELL h4.D/CiPin`F�/kL
4. TOTAL DEPTH 4 D 5 r CUTTINGS COLLECTED El Yes 'IT.No
5. DOES WELL REPLACE EXISTING WELL? ❑ Yes No
6. STATIC WATER LEVEL.
TOP OF CASING IS
lei
7. YIELD (glom):
8. WATER ZONES (depth):
9. CHLORINATION: Type
10. CASING:
From 6)
From
From
11. GROUT:
From
From
12. SCREEN:
FT 0 above TOP OF CASING,
below
FT ABOVE LAND SURFACE.
o� METHOD OF TEST /1 t -S
470 -% pnt
ate 5- - jort pm
, TN Amount (p r7
Wall Thickness
Depth Diameter or Weight/Ft. Material
To 3u Ft to " Pict
To
To
Ft
Ft
Depth Material Method
To -2 /`00M'1...'
/') Ft. ( _ki- 1/44)7n
From
From
From
13. GRAVEL PACK:
To
Ft.
Depth Diameter Slot Size Material
To Ft. in. in.
To Ft. in. in.
To Ft in in.
Depth
From To
From To
14. REMARKS'
Size Material
Ft.
Ft.
If additional space is needed use back of form.
LOCATION SKETCH
(Show direction and distance from at least two State Roads,
or other map reference points)
A
0
C.71
N
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15 NCAC 2C, WELL
STANDARDS, AND THAT A COPY OF THIS RECORD h_ZyEEN PROVJDD TO THE WELL OWNER. �l
SIGNATURE OF CONTRACTOR OR AGENT DATE
Submit original to Division of Environmental Management and copy to well owner.
CONSTRUCTION
17-3/- 6 3

276601
GW-1 Revised 6/88
NORTH CAROLINA DEPARTMENT OF NATURAL RESOURCES AND COMMUNITY DEVELOPMENT
DIVISION OF ENVIRONMENTAL MANAGEMENT - GROUNDWATER SECTION
P.O. BOX 27687 - RALEIGH,N.C. 27811, PHONE [phone]
WELL CONSTRUCTION RECORD
DRILLING CONTRACTOR
DRILLER REGISTRATION NUMBER
FOR OFFICE USE ONLY
Quad No. Serial No.
Lat. Long. Pc
Minor Basin
Basin Code
Header Ent GW-1 Ent
STATE WELL CONSTRUCTION /��'
PERMIT NUMBER:
1. WELL LOCATION: (Show ketch of the location below)
rtie
Near s Town: C. - aG.
(Road, Co unity. /�or S bdivision and Lot No.) /J�
2. OWNER lJ �(Q�Y_�(L�C2 .-1-C,4.---1-�r
ADDRESS 11/ 53 C-!�)4s-i /CM
(S eet or outs of
City or Town State Zip Code
3. DATE DRILLED
4. TOTAL DEPTH
5. DOES WELL REPLACE EXISTING WELL? [1] Yes 'allo
6. STATIC WATER LEVEL: '/D
TOP OF CASING IS
7. YIELD (gpm):
to -9-6.3 USE OF WELL .JW1,cb-44:7�;I 'L'
-. 05 ) CUTTINGS COLLECTED El Yes �uvo
8. WATER ZONES (depth):
9. CHLORINATION:
10. CASING:
From
From
From
11. GROUT:
FT. kabove TOP OF CASING,
below
FT ABOVE LAND SURFACE.
METHOD OF TEST
/. 57- /no c3Pr"
Type T{-1
Depth Diameter
l/ To g9 Ft 6, r)
To Ft
To Ft
Amount .71t 'f"b(is-•
Wall Thickness
or Weight/Ft. Material/l
Y
Depth
From EJ To_lr—Ft.
From To Ft.
12. SCREEN:
Material
(PSI-44 f
Depth Diameter
From To Ft.
From To Ft.
From To Ft
13. GRAVEL PACK:
Depth
From To Ft.
From To Ft.
14. REMARKS:
Method
/Op
Slot Size Material
in. in.
in. in.
in in
Size Material
County:
Depth
From
W' / / k)(7r)
DRILLING LOG
To Formation Description
LJ Off'
gg ' ADS/
A/Yl4_z / P'
If additional space is needed use back of form.
LOCATION SKETCH
(Show direction and distance from at least two Sfe Roads,
or other map reference points) 0 p
CO
- .
m
1 co--
CO ~rn
G
a ri
3 am
O mr
C7
rs -4
rV o
( iOUNi -H cc aQ.,";
ASHEV;LLI: RL: 9i:A'L UFFiCE
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15 NCAC 2C, WELL CONSTRUCTION
STANDARDS, AND THAT A COPY OF THIS RECORD HAS `E N PRO ID D TO THE WELL OWNER. J / - 03
SIGNATURE OF CONTRACTOR OR AGENT DATE
Submit original to Division of Environmental Management and copy to well owner.

NORTH CAROLINA DEPARTMENT OF NATURAL RESOURCES AND COMMUNITY DEVELOPMENT
DIVISION OF ENVIRONMENTAL MANAGEMENT - GROUNDWATER SECTION
P.O. BOX 27887 - RALEIGH,N.C. 27811, PHONE [phone]
WELL CONSTRUCTION RECORD
DRILLING CONTRACTOR
DRILLER REGISTRATION NUMBER
2 8 F`� 1n' FOR OFFICE USE ONLY
-ua'8. Y4o. Serial No.
Lat. Long Pc
Minor Basin
Basin Code
Header Ent. GW-1 Ent
STATE WELL CONSTRUCTION
PERMIT NUMBER:
Neat
1. WELL LOCATION: (Sho sketch of the location below)
Nearest Town:
(Road, Commun
County:
Depth
[Jvc2c
DRILLING LOG
_ From To Formation Description
2. OWNER �+ D DI/0-
ADDRESS /.3D a 4 ALYY (/ 4-) a Z.)g7 etc
(St(% tl / Ronu .) a g 7 e 6 �� r /emst , ja�,.,/.-t,,
Cit or Town State eZip Code /
aDATE DRILLED 7- / -e 3 USE OF WELL )t1-dl/71P /LL�
4. TOTAL DEPTH /UDS ' CUTTINGS COLLECTED,, - Ill Yes 'No
5. DOES WELL REPLACE EXISTING WELL? ❑ Yes allo
6. STATIC WATER LEVEL:
TOP OF CASING IS
7. YIELD (gpm):
8. WATER ZONES (depth):
/
FT 0 above TOP OF CASING,
Clkilooelow
FT A OVE LAND SURFACE.
METHOD OF TEST c. h /S
</D g ' - /J /'�'v1
9. CHLORINATION: Type I4l-F-} Amount )d3 fbI]S
10. CASING:
Wall Thickness
Depth , ,/ Diameter or Weight/Ft. Material
From L� To / I/ Ft 6 /1 i V e
From To Ft
From To Ft.
If additional space is needed use back of form.
LOCATION SKETCH
(Show direction and distance from at least two State Roads,
or other map reference points)
0
11. GROUT: O
Depth Material Method W 0
//�j 0
From ToL) Ft. l.1',h'YL.JMr� rn
• �r
From To Ft. I om
CO >0
12. SCREEN: a my
S d
VIZ
• m 7.,
c-,
Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
From To Ft in in.
13. GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.,
14. REMARKS:
GROUN!D'rIATH SECTION
ASHEViL_z REGiOF(.A.L OFFICE
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15 NCAC 2C, WELL CONSTRUCTION
STANDARDS, AND THAT A COPY OF THIS RECORD HAS EEN PR VI ED TO THE WELL OWNER.
%� I IL1.
SIGNATURE OF CONTRACTOR OR AGENT DATE
GW-1 Revised 6/88 Submit original to Division of Environmental Management and copy to well owner.

NORTH CAROLINA DEPARTMENT OF NATURAL RESOURCES AND COMMUNITY DEVELOPMENT
DIVISION OF ENVIRONMENTAL MANAGEMENT - GROUNDWATER SECTION
P.O. BOX 27687 - RALEIGH,N.C. 27811. PHONE [phone]
WELL CONSTRUCTION RECORD
DRILLING CONTRACTOR
-P L. A: &Lai _
DRILLER REGISTRATION NUMBER
4/2
FOR OFFICE USE ONLY
Quad. No. Serial No.
Lat. Long. Pc
Minor Basin
Basin Code
Header Ent GW-1 Ent
STATE WELL CONSTRUCTION i z/D
PERMIT NUMBER: %-
1. WELL LOCATION: (Sho
Nearest Town:
XIAaL©Gt
(Road, Community, or
2. OWNER (��G
ADDRESS
(S ree
or Route .)
W ZieS1Jt//? /1% 6'778Cc
City brT/own Mate) u,Zip Code
/7 3. DATE DRILLED /- -It) 3 USE OF WELL Fli enka-L
4. TOTAL DEPTH SD S CUTTINGS COLLECTED El' Yes No
5. DOES WELL REPLACE EXISTING WELL? ❑ Yes
6. STATIC WATER LEVEL:
TOP OF CASING IS
7. YIELD (gpm): �7
8. WATER ZONES (depth):
(n0 FT ❑ above TOP OF CASING,
FT A OVEelow LAND SURFACE.
9. CHLORINATION: Type
10. CASING:
From
From
From
11. GROUT:
6
METHOD OF TEST �Z Il %ZS. •
'3t 3 , _ 4-9 on,
14-rii Amount d j 4'b i -
Wall Thickness
Depth Diameter or Weight/Ft. Material
To YS Ft 6 r/ P ✓tL
To Ft
To Ft
Depth
From V To eqC)
From
12. SCREEN:
From
From
From
13. GRAVEL PACK:
From
From
14. REMARKS:
Material Method
Ft. Coa L .N faT
To Ft.
Depth Diameter Slot Size Material
To Ftin. in.
To Ft. in in.
To Ft in in
Depth
To
To
Size Material
Ft.
Ft.
County: �LY.C/t�n %n(,�
sketch of the locationbelow)
, 7
'[�rlr'•i �) — fir„ ^� Depth DRILLING LOG
hdivision and Lot No.
3� �.R- From To Formation Description
.:), LA- ' 4/s-
fs' 564
If additional space is needed use back of form.
LOCATION SKETCH
(Show direction and distance from at least two State Roads,
or other map reference points)
O
W
cn
m
0
co
a
O
N
GROUNDWATER SECTION
ASHEVILLE REGIONAL OFFICE
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15 NCAC 2C, WELL CONSTRUCTION
STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PFjOVDED TO THE WELL OWNERR�
Y
2-3/-03
SIGNATURE OF CONTRACTOR OR AGENT
DATE
GW-1 Revised 6/88 Submit original to Division of Environmental Management and copy to well owner.

GW-1 Revised 6/88
NORTH CAROLINA DEPARTMENT OF NATURAL RESOURCES AND COMMUNITY DEVELOPMENT
DIVISION OF ENVIRONMENTAL MANAGEMENT - GROUNDWATER SECTION
P.O. BOX 27687 - RALEIGH,N.C. 27811, PHONE [phone]
WELL CONSTRUCTION RECORD
DRILLING CONTRACTOR 1`-11r- Ct w• C r t ak
DRILLER REGISTRATION NUMBER) `' 5
A
S 98
Quad. No. Serial No.
Lat. Long. Pc
Minor Basin
Basin Code
Header Ent GW-1 Ent
FOR OFFICE USE ONLY
STATE WELL CONSTRUCTION
PERMIT NUMBER: rl T O a-
1. WELL LOCATION: (Show sketch of the location below)
//
Nearest Town: l" _0„L �cch_ County:
T/—.�v,r; ` I Y) — 1 Ar oo k WO 1. I o,.: Sid) .
(Road, Commnhity, o Subdivisio�di1T� and Lot .) .
2. OWNER 1d L. //ll
ADDRESS ) P_VYZ[ n C�BA.1 kit- •
/-tea ( trr1eg t, or Route No.) !' 7 /�
�Cii`ty. or Town tate�JD Zip Code
3. DATE DRILLED / -.2,-t3 USE OF WELL d 1G1 �YC�rI�
4. TOTAL DEPTH 1)5 / CUTTINGS COLLECTED ❑ Yes tg•No
5. DOES WELL REPLACE EXISTING WELL? ❑ Yes No
6. STATIC WATER LEVEL:
TOP OF CASING IS
7. YIELD (gpm): /
8. WATER ZONES (depth):
�<1 FT. 0 above TOP OF CASING,
St below
FT ABOVE LAND SURFACE.
9. CHLORINATION: Type
10. CASING:
From LJ
From
From
11. GROUT:
METHOD OF TEST
�l rs
e. 7'S Z / cj fD rn
H iH Amount 1.24 +b)h
Wall Thickness
Depth i-7
Diameterlor Weight/Ft. Material
i
To L/ t Ft Ct� y t i t[ l
To
To
Ft
Ft
/) Depth,n Material f Method
From _(11) To2//�� L_Ft. C CiVA-Q.AWI }_�`L2^
From To Ft.
12. SCREEN:
From
From
From
13. GRAVEL PACK:
Depth Diameter Slot Size Material
To Ft. in. in.
To Ft. in. in.
To Ft in in.
Depth
From To Ft.
From To Ft.
14. REMARKS:
Size Material
Depth
From
T ?
l tci
hi LeitCA
DRILLING LOG
To Formation Description
v7 ' (fat
If additional space is needed use back of form.
LOCATION SKETCH
(Show direction and distance from at least two State Roads,
or other map reference points) 0
O x
o
N
-0 cn
Tm
1 0<
m -1›.
cot
O cot
c-t
—4
6R.OUlNLSLATFR SECTION
ASHEVILLE REGIONAL OFFICE
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15 NCAC 2C, WELL CONSTRUCTION
STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PQO�/IDED TKO THE WELL
SIGNATURE OF CONTRACTOR OR AGENT DATE
Submit original to Division of Environmental Management and copy to well owner.

NORTH CAROLINA DEPARTMENT OF NATURAL RESOURCES AND COMMUNITY DEVELOPMENT
DIVISION OF ENVIRONMENTAL MANAGEMENT - GROUNDWATER SECTION
P.O. BOX 27687 - RALEIGH,N.C. 27611. PHONE [phone]
WELL CONSTRUCTION RECORD
DRILLING CONTRACTOR
DRILLER REGISTRATION NUMBER
FOR OFFICE USE ONLY
Quad. No. Serial No.
Lat. Long. Pc
Minor Basin
Basin Code
Header Ent GW-1 Ent
STATE WELL CONSTRUCTION
PERMIT NUMBER:
1. WELL LOCATION: (Show sketchkof the location below) l�
Nearest �To/wjn: 0X f,/ i //,�[� f, ^J_ /,,.,. `) County: /}/�///!V(iOt
jr1-4'4.4.40 - / ,a)-19 r Ick I/''"^-' Depth DRILLING LOG
(Road, Communit r Subdiv Sion and hot No.) ,
From To Formation Description
2. OWNER n_e`-6(-4---1-- �%� / /
ADDRESS � `% Ql� 477-0r7L) & ,CSJ./t _ 7) 4 D y ! i`.a�
/f' / f7�G beet or Rout No.) -7 t" ' /,t-DS /L�L.wr
zt
City or Town / State Zip Code
3. DATE DRILLED 7- 7-03 USE OF WELL Re Si Cl r:i-i-/{.L n
4. TOTAL DEPTH / SOS' CUTTINGS COLLECTED El Yes Zt No
5. DOES WELL REPLACE EXISTING WELL? ❑ Yes 14„No
6. STATIC WATER LEVEL: FT D above TOP OF CASING,
below
TOP OF CASING IS FT ABOVE LAND SURFACE.
7. YIELD (gpm): METHOD OF TEST c2 Ani -•
8. WATER ZONES (depth):
9. CHLORINATION: Type /-4 T M Amount
10. CASING:
Wall Thickness
Depth Diameter or Weight/Ft. Material
From Q To dar,L Ft 65
From To Ft
From To Ft
11. GROUT:
Depth(� Material ] -.1-7
Meetthod
From [% To //��lb Ft._/' 7 .1- 7
From To Ft. (/
12. SCREEN:
Depth
From To Ft.
From To Ft.
From To Ft
13. GRAVEL PACK:
Diameter
Slot Size Material
in. in.
in. in.
in in.
Depth Size Material
From To Ft.
From To Ft.
14. REMARKS:
If additional space is needed use back of form.
LOCATION SKETCH
(Show direction and distance from at least two State Roads,
or other map reference points)
0
O
GO0
n
CI)
I ca
rl :'�7
D cm
( o E
CO
re.>
MID 3 am
9m
n=
=
U7 -1
N p
2
s
1
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15 NCAC or,--lif CLL )f,"664S OFRCE
STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVI E TO THE WELL OWNER.
xe,/ 2-3/-03
GW-1 Revised 6/88
SIGNATURE OF CONTRACTOR OR AGENT DATE
Submit original to Division of Environmental Management and copy to well owner.

GW-1 Revised 6/88
NORTH CAROLINA DEPARTMENT OF NATURAL RESOURCES AND COMMUNITY DEVELOPMENT
DIVISION OF ENVIRONMENTAL MANAGEMENT - GROUNDWATER SECTION
P.O. BOX 27887 - RALEIGH.N.C. 27611, PHONE [phone]
WELL CONSTRUCTION RECORD
DRILLING CONTRACTOR 1 R'1 50 -C�--
DRILLER REGISTRATION NUMBER 3 0 14-
OR OFFICE USE ONLY
Quad. No. Serial No.
Lat. Long. Pc
Minor Basin
Basin Code
Header Ent GW-1 Ent
STATE WELL CONSTRUCTION
PERMIT NUMBER: 7
1. WELL LOCATION: (Show sketch of the location below)
Nearest Town Q.4y ncs V )
C/d
(Road, Community or Subdivision and Lotl�No�d
No.)
2. OWNER �(T71. -f'177i
ADDRESS .L4Pi /n •
(Street or Route No.)
73 /
LZ l)C,.$l/; //°L Zvi. 73 7ts
C y
3. DATE DRILLED
4. TOTAL DEPTH
5. DOES WELL REPLACE EXIST)IN^WELL?
6. STATIC WATER LEVEL: 'Y'[!
TOP OF CASING IS 1
7. YIELD (QM):
8. WATER ZONES (depth):
ii or own Slate Zip Code
17-1b -t j USE OF WELL -Re eIG"L
'%/•)S CUTTINGS COLLECTED ❑ s"
Yes y�rvo
❑ Yes 4..No
FT ❑ above TOP OF CASING,
be
FT A OVE LlowAND SURFACE.
METHOD OF TEST 2 hes
SSpm
(r,f5' - a . s p.^Y-‘
9. CHLORINATION: Type }-171-1 Amount .120 44,1 -c
10. CASING:
Depth
From h To SA
From To
From
11. GROUT:
To
Depth
From l' To -#0
From
12. SCREEN:
Wall Thickness
Diameter or Weight/Ft.
Ft CP "
Ft
Ft.
Material
FL
To Ft
Depth
From To
From To
From To
13. GRAVEL PACK:
Depth
From To
From To
14. REMARKS'.
Ft.
Ft.
Ft
Diameter
in.
in.
in
Material
PVL
Method
TM
Slot Size Material
in.
in.
in.
Size Material
Ft.
Ft.
County:
Depth
From
DRILLING LOG
To Formation Description
Saz qz s' a A /r itll Cis
If additional space is needed use back of form.
LOCATION SKETCH
(Show direction and distance from al least twec,Stato pads,
or other map reference points) W
N ��
rn o^
om
1 o:c
Op >CD
-4o
mo
r*1
(At
n7:1
n
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15 NCAC 2C. WELL CONSTRUCTION
STANDARDS, AND THAT A COPY OF THIS RECORD H S BEEN R VIDED TO THE WELL OWN
SIGNATURE OF CONTRACTOR OR AGENT DATE
Submit original to Division of Environmental Management and copy to well owner.

278593
NORTH CAROLINA DEPARTMENT OF NATURAL RESOURCES AND COMMUNITY DEVELOPMENT
DIVISION OF ENVIRONMENTAL MANAGEMENT - GROUNDWATER SECTION
P.O. BOX 27687 - RALEIGH.N.C. 27611, PHONE [phone]
WELL CONSTRUCTION RECORD
DRILLING CONTRACTOR kO k) n I D .1h
DRILLER REGISTRATION NUMBER
FOR OFFICE USE ONLY
Quad. No. Serial No.
Lat. Long. Pc
Minor Basin
Basin Code
Header Ent GW-1 Ent
STATE WELL CONSTRUCTION 1
PERMIT NUMBER: 4
} 3
1. WELL LOCATION: (Shovryketch of the location below)
/•Neavest Town: V 1 /e County: y'�'f (,� .(f r Q�"f-A
( -Q- 4--?'LL--_4 e, i.Yl' ! V( Depth DRILLING LOG
(Road, Commu y, or SuSdivision and Lot No.)
/9+�j j) From To Formation Description
2. OWNER l'/illa.Z)i_A- ( L.LCLIiI) OP
ADDRESS 7' i (L} 1') I? / !'X' r . Q 0 8/ ' l Y �2,u
(Street ornoute No.) 8/ d /4/5 i An_.a^Ltt.
(di alpits V 1 //e. b/c .? t 7 c'L
City br ,Town Itate Zip Code
3. DATE DRILLED 7- ZY -4 -3 USE OF WELL i'52PStri r,t, 1-d.42
4. TOTAL DEPTH 1 45 r CUTTINGS COLLECTED ❑ Yes ILFNo
5. DOES WELL REPLACE EXISTING WELL? ❑ Yes 1bL.No
6. STATIC WATER LEVEL: LOC) FT. 0 above TOP OF CASING,
TOP OF CASING ISigi below
FT ABOVE LAND SURFACE.
7. YIELD (gpm): 3. e..) METHOD OF TEST oR A r S
8. WATER ZONES (depth): 1 .( 5 / - ao (\pr'v\
9. CHLORINATION: Type
10. CASING:
HI-1 Amount
Wall Thickness
�!^-�a O Depth Diameter or Weight/Ft. Material
From FJ To !D / Ft (O /y !" (! e,
From To Ft
From To Ft
11. GROUT:
Depth Material Method
From i To 22 Li Ft. C 4I-t t.-. 4
From To Ft. �V1
12. SCREEN:
Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
From To Ft in. in.
13. GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
14. REMARKS.
If additional space is needed use back of form.
LOCATION SKETCH
(Show direction and distance from at least its Staid Roads,.
or other map reference points) W
[n e2
m 3rn
( O{
CO SIM
S>n
• --1
a CA
Cli -�
N o
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15 NCAC 2C, WELL CONSTRUCTION
STANDARDS, AND THAT A COPY OF THIS RECORD HAS liEEM PROV TO THE WELL OWNER. �\ _ / _
Lit/ LI v
SIGNATURE OF CONTRACTOR OR AGENT CrJ DATE
GW-1 Revised 6/88 Submit original to Division of Environmental Management and copy to well owner.

GW-1 Revised 6/88
NORTH CAROLINA DEPARTMENT OF NATURAL RESOURCES AND COMMUNITY DEVELOPMENT
DIVISION OF ENVIRONMENTAL MANAGEMENT - GROUNDWATER SECTION
P.O. BOX 27887 - RALEIGH,N.C. 27611, PHONE [phone]
WELL CONSTRUCTION RECORD
DRILLING CONTRACTOR
06 Eaa
DRILLER REGISTRATION NUMBER
a/g
1)
1
FOR OFFICE USE ONLY
Quad. No. Serial No.
Lat. Long Pc
Minor Basin
Basin Code
Header Ent. GW-1 Ent
STATE WELL CONSTRUCTION / / �O
PERMIT NUMBER: 7`
1. WELL LOCATION: (Show ¢ketch of the location below)
//
Nearest Town: �-C/ 19l ES 1/ / / a- County: /�j9 LOOP.j
( n✓1/ /I VL Depth ( DRILLING LOG
(Road, Community,l-amriSuhdivision and /Lot No.)
2. OWNER 1 ' I a.g- `, fj Q_L/[� e, From pTo Formation Description
ADDRESS . 8 L nnIi, rki/L. 0 74r idRKL^Q--e
(Street or Wu to NoJ 96 r 3l5 1 C
ctc/neSV l /Ir/ il/C e2 87£��
City 1r Town State I Zip Code
3. DATE DRILLED 7 - a 5. - v3 USE OF WELL YLSIr& PWV' ‘‘.. 1_
4. TOTAL DEPTH 3Os I CUTTINGS COLLECTED ❑ Yes IgNo
5. DOES WELL REPLACE EXISTING WELL? ❑ Yes X No
6. STATIC WATER LEVEL: I 0 0 FT ❑ above TOP OF CASING,
TOP OF CASING IS Q below
FT ABOVE LAND SURFACE.
7. YIELD (gpm): I a METHOD OF TEST a k rS
8. WATER ZONES (depth): .Z o5 ' - .3 otos . l
30s1-4Jgpm1
9. CHLORINATION: Type I4 TIA Amount 3to" +b ITS .
10. CASING:
Wall Thickness
Depth Diameter or Weight/Ft. Material
From /) To 96Ft to It o54-et_t
From To Ft
From To Ft
11. GROUT:
Depth n Material 1 TMethodI__
From t l To o�O Ft A _t�.0 i o p
From To Ft.
12. SCREEN:
Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
From To Ft in in.
13. GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
14. REMARKS:
If additional space is needed use back of form.
LOCATION SKETCH
(Show direction and distance from at least two St ▪ Roads,
or other map reference points) 0 • O
I1, \,I Ir
[' II;
I--
-F. N
A., _l L k h C'' 11:1C1-
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15 NCAC 2C, WELL CONSTRUCTION
STANDARDS, AND THAT A COPY OF THIS RECORD HAS B5ENP ROVIQEQ TO THE WELL OWNER. Y 2 3/-43
SIGNATURE OF CONTRACTOR OR AGENT DATE
Submit original to Division of Environmental Management and copy to well owner.

278591
1. WELL LOCATION: (Show sketch of the location below)
u
Sub ivision and Lo
0f /
I
/JJfinr,sV' /% Al
City of Town Sltate
DRILLED 7- 211 -r3 USE OF WELL
rg78G
Zip Code A
3. Rl
TOTAL DEPTH 3:25c 1 CUTTINGS COLLECTED El Yes
NORTH CAROLINA DEPARTMENT OF NATURAL RESOURCES AND COMMUNITY DEVELOPMENT
DIVISION OF ENVIRONMENTAL MANAGEMENT - GROUNDWATER SECTION
P.O. BOX 27687 - RALEIGH,N.C. 27811, PHONE [phone]
WELL CONSTRUCTION RECORD
DRILLING CONTRACTOR
DRILLER REGISTRATION NUMBER
ami,n.J k LLe i
3 4% Ili
FOR OFFICE USE ONLY
Quad No Serial No.
Lat. Long. Pc
Minor Basin
Basin Code
Header Ent. GW-1 Ent
STATE WELL CONSTRUCTION /
PERMIT NUMBER: / `�` U i.
Nearest Town?
/ edit 10 I�yz
(Road, Communj
2. OWNER
ADDRESS
DATE
4. �/
5. DOES WELL REPLACE EXISTING WELL? ❑ Yes ITJ-No
6. STATIC WATER LEVEL: f) FT ❑ above TOP OF CASING,
below
TOP OF CASING IS I FT ABOVE LAND SURFACE.
METHOD OF TEST .. hrs
8. WATER ZONES (depth): Et 5 I / c`� . pYYI
7. YIELD (gpm): I a
(Street or Riute N
9. CHLORINATION: Type
10. CASING:
'14T1-I
Amount s5/..s ¥ n 17'S •
Wall Thickness
/�
Depth Diameter or Weight/Ft. Material
From 0 // To `7�" U Ft (n r/
From To Ft
From To Ft
11. GROUT:
Depth Material 1
Method
e tthood�
From 7 To .r) Ft �,j
From To Ft.
12. SCREEN:
Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
From To Ft in in.
13. GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
14. REMARKS:
County:
Depth
/4
ne1/421
DRILLING LOG
From To Formation Description
If additional space is needed use back of form.
LOCATION SKETCH
(Show direction and distance from at least two State Roads,
or other map reference points)
0
CO
CO
m 5T
cm
COnil
S<
▪ rm
0 NZ
▪ rn�
(XI�
N c,
Z
0
co,
RD b.-
11-1 g
GF.c}
'I'�, r6:..
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15 NCAC 2C, WELL CONSTRUCTION
STANDARDS, AND THAT A COPY OF THIS RECORD HAEOS BEEN PR ONVIIDED O HE WELL OWNER.
SIGNATURE OF CONTRACTOR OR AGENT
g-3/-P3
DATE
GW-1 Revised 6/88
Submit original to Division of Environmental Management and copy to well owner.

27," r 0
NORTH CAROLINA DEPARTMENT OF NATURAL RESOURCES AND COMMUNITY DEVELOPMENT FOR OFFICE USE ONLY
DIVISION OF ENVIRONMENTAL MANAGEMENT - GROUNDWATER SECTION
P.O. BOX 27687 - RALEIGH,N.C. 27811, PHONE [phone] Quad. No. Serial No.
Lat Long. Pc
Minor Basin
WELL CONSTRUCTION RECORD Basin Code
Header Ent. GW-1 Ent
DRILLING CONTRACTOR BILLQ1
DRILLER REGISTRATION NUM R 30 T
/
STATE WELL CONSTRUCTION //
PERMIT NUMBER: / 7` d z
1. WELL LOCATION: (Show sketch of the location below)
,,
Nearest Town: 1 t hI``Ck € qt\l C\lnr I 1e
Grooksll)F..5{Ct{PC
(Road, Community, or Subdivision and1Lot No.) From To Formation Description
2. OWNER 0 7 I (dui, ' 1 / a_.4--Po ('C•�,
ADDRESS PTh Street or Route No.) `h Y z /Vs-' %"1 !tz).�� ti i
( t)nPsu, 11tNC', ��786
City or Town State !� Zip Code
3. DATE DRILLED 1-,36-O� USE OF WELL R+P` IC '�.L: t
4. TOTAL DEPTH I Li 4] I CUTTINGS COLLECTED ❑ Yes Itl.No
County: ka_I l GJ)t'Jti
Depth DRILLING LOG
5. DOES WELL REPLACE EXISTING((��WELL? ❑ Yes In No
6. STATIC WATER LEVEL: J.]tT_ -4./ a FT ❑ above TOP OF CASING,
la below
TOP OF CASING
IS____I FT A OVE LAND SURFACE.
7. YIELD (gpm): ih METHOD OF TESTI
nf5 •
Y
8. WATER ZONES (depth): p c - 7� lF% rzs_42,
9. CHLORINATION: Type 1-47-1-1 Amount a 4 h 1 4-s .
10. CASING:
Wall Thickness
Depth Diameter or Weight/Ft. Material
C To 50 Ft /e I From
From To Ft
From To Ft
11. GROUT:
Depth { Material Method
/
From frl To V) Ft. ( O_Pvr 0 Al 1
From To Ft.
12. SCREEN:
Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in, in.
From To Ft in in.
13. GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
14. REMARKS:
If additional space is needed use back of form.
LOCATION SKETCH
(Show direction and distance from at least two State Roads,
or other map reference points) c
O o
W
N v-,
rn c r"
O crn
o-
CO �m
:z-C
r ▪ 73o
rn
in
m�
n
V7 -f
N o
Lr1
ASP '.
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15 NCAC 2C, WELL CONSTRUCTION
STANDARDS, AND THAT A COPY OF THIS RECORD HAS VEEP PROVIF7E TO THE WELL OWNER
-3/-n 3
GW-1 Revised 6/88
SIGNATURE OF CONTRACTOR OR AGENT DATE
Submit original to Division of Environmental Management and copy to well owner.

NORTH CAROLINA DEPARTMENT OF NATURAL RESOURCES AND COMMUNITY DEVELOPMENT
DIVISION OF ENVIRONMENTAL MANAGEMENT - GROUNDWATER SECTION
P.O. BOX 27687 - RALEIGH,N.C. 27611, PHONE [phone]
WELL CONSTRUCTION RECORD
DRILLING CONTRACTOR P D/ a�
DRILLER REGISTRATION NUMBER
Id''e// 6
Quad. No. serial No.
Lat. Long. Pc
Minor Basin
Basin Code
Header Ent GW-1 Ent
STATE WELL CONSTRUCTION n
PERMIT NUMBER: / /4
1. WELL LOCATION: (Show sketch of the Iona on below)
Nearest Town.
(Road. Comrfiunity, or Subdivision and Lot No )
}�
From To i
2. OWNER I .0 0RI I/y1'1 ^ el'I.1 nr 5 /3s
/35-
ADDRESS
3
4
5. DOES WELL REPLACE EXISTING WELL?
6. STATIC WATER LEVEL: c
TOP OF CASING IS
7. YIELD (gpm): )Si)
8. WATER ZONES (depth):
PD facrk g
nn ote (Street of j to No.)
City or Tovin
State
DATE DRILLED -IV ' 0 3 USE OF WELL
p
TOTAL DEPTH .:/ .2 S
9, CHLORINATION: Type
10. CASING:
From
From
From
11. GROUT:
From
From
12. SCREEN:
CUTTINGS
Zip Code 1 `
.4 1).4-4 C-tt.H{ T c�Y
COLLECTEDT�//❑ Yes Ip-glo
❑ Yes A --No
FT. El above TOP OF CASING,
below
FT ABOVE LAND SURFACE.
METHOD OF TEST
ahps .
3/) S 7 - / SL) J r,-,
1-1
Amount T 3. --/61-h
Wall Thickness
Depth Diameter or Weight/Ft. Material LOCATION SKETCH
To /36 Ft /v r 1 9 V• C (Show direction and distance from at least two State Roads,
or other map reference points)
County:
Depth
DRILLING LOG
�Fo,(mation Description
�X-4-.r„
k3, r y
J1 f P
If additional space is needed use back of form.
To
To
Ft
Ft.
Depth Material g Method
/ Cr Ll
To
Depth
From To
From To
From To
13. GRAVEL PACK:
From
From
Depth
To
To
Ft.
Diameter
Slot Size Material
Ft. in. in.
Ft. in. in.
Ft in in.
Size Material
Ft.
Ft.
CO
CA
711
1
CO
cn
N
.o
0
0
cC1
m
o<
m
�o
m�
0O
rn
rnz
ma
c1
H
0
r
G=;CL.'flV»TER SECTIM'
14. REMARKS' , l bLCiLL:: HEGIU\4;L. OFFICE
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15 NCAC 2C, WELL CONSTRUCIIUN
STANDARDS, AND THAT A COPY OF THIS RECORD HAS EEN PRO ID D TO THE WELL OWNER.
Y.w) hti 14 p 8-3/- 03
SIGNATURE OF CONTRACTOR OR AGENT DATE
Submit original to Division of Environmental Management and copy to well owner.
GW-1 Revised 6/88

273539
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Nap`l urall/ R sources - Division of Water Quality - Groundwater Section
WELL; CONTRACTOR (INDIVIDUAL) NAM (print) 6t - A-721//O Q CERTIFICATION p f/.
WE.1.l. CONTRACTOR COMPANY NAME f/Cp .Ve//9Atinv PHONE N (' ) 6a7-8SS's
STATE \\'EI.I. CONSTRUCTION PERMIT# ASSOCIATED \\'Q PERMIT#
i f appl ieable)
(if applicable)
1. WELL USE (Check Applicable Box): Residemial Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearts✓t Town: flt /
/1/ f /j
County
(Street Name, Numbers, Community, Subdivision, Lot Na. Zip Code)
3. OWNER:
Address 02 fe l+rr
Sl ree(or Route No.)
4t4t�NesV/ /% 4, e. tRf �5
City or Town State Zip Code
(
Area code- Phone number
4. DATE DRILLED —/R— U -j
5. TOTAL DEPTH: •54/5--
Topographic/Land setting
21217.lge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
To F�,ft ati n Description
O ( /. y
�?o /ro/�, ✓
e.
/.1 7.v Toter ti�.ri�
DEPTH
From
—/7
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO Id/
7. STATIC WATER LEVEL Below Top of Casing: 4/0 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS a- FT. Above Land Surface*
"fop of casing terminated at/or hetnw Iand surface requires a
variance in accordance with IS\ NCAC 2C .1111N.
9. YIELD (gpm): 6 METHOD OF TEST /3 /•
10. WATER ZONES (depth):
II. DISINFECTION: Type /977%
12. CASING:
2 Depth `D_ia \eter
f
From T To / Cl4 Ft. U' l��
From To Ft.
From
13. GROU"f•
From
From
14. SCREEN:
From
To Ft.
Depth Material
Toi?) FL eeavCN71"
To Ft.
Amount
Wall Thickness
orVWcjgh t/Ft, latert
Depth Diameter
To Pt. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
Method
Slot Size Material
in.
in.
From To Ft.
0
ea
O
(1) La=
rill,m
Co
I L_
cA cr
LOCATION SKETCII S mo
Show direction and distance in miles frot t Ieas�Z
two State Roads or County Roads. Include regtFJ
numbers and common road names. t-4 _G
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAATIA COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
l �' - I l l .'3
SIGNATURE dF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center- Raleigh, NC
27699-1636 Phone Nn. [phone], within 30 da's. G W-I REV. 07/2001

WELL CONSTRUCTION RECORD
278 538
Noirh Carolina - Department or Lnviron:nem and Natural Resources - Division or Water Quality - Groundwater Section) [y
Li I. (-flAlI1A('IOlt 11AIllAInn AL1 ].AAI4: (print) Ate�4.✓1/C cEItrIPIc FIIoNN Yt/
IV 1 L CON 1It.\C1 OR C'O\I I' \N\ \A\Ih: ✓y �/r C� e// �` /1) ✓..'1/fi - - PHONE # �ple,
1,1 \ I F: \ p.l.l. ('O\ IItt CrIO\ rElntlT# .\SSOCI:cr ED \\ O I'Elt\Ir(7
Ira.)'!ir.lhle l lit avj pl'icablc)
VVCLi. ESL' tChccL Applicable 13ox): Rcsidcr.i;d I lunicipall'uhlic 0 Industrial 0 Aericultural 0
Vlonilorin� ❑ Recovery ❑ kcal Pump AVj''.:r Injection 0 Other 0 If Ulher, List Use
WELL LOCATION:
v
Nearest T-nou .g✓TG •\/ Coffin
Di.x (. ,L
4A✓f/r24J'
I.nea N.uu;. S'iuubcN. (',mfnIwlm..YubdIl I.1, 11 Lei N,l. Zip C',elel
uw,vl:R: CCa/6e jf/ 4,.-v/
f sfrca ROLIN ,,I t
CC ��>/
v. c- �/!p
(ln ,.r l,n,n Nl.ne ap code
Vicy. .,.de I'h,.m nnm hlr/
\II. IRII.I.h.D
r(rr:AL DFIl II: &CS
(,. DOES VV I!LL I<'.J'LACL' EXISTING WELL' YES ❑ NO Icl"
S VATIC \V:\TER. LF:VIf I. 13clow Top urCasicd: I.T.
I1"e `." it r\b,n._ T"p of (asfnp f
1 ()I'OF CASING IS _ FT. Above I. and Surrucc'
'lop ul caning lerluin:frcn al/or 6011e land .urraec rc:;•:ires a
variance iu accordance with 15 NCAC 2C .1111N.
'I. 1'!Dip I:'I'iu): mkt' too OP fl(S r Y91
IR. AVATLR ;:ONES {depth):
I. DISINFECTION. Type HT�� Am: tnu
f C:\tiINCi: „auhickness
)eplh Diaiycier or V. cieht'd. \I itcri
Pnmf 1; To FL
!; (iltO I: Depth
I rnfii U___ "It,.tJ_ 1`1.
I fort Tu PI.
!-I Sl'I±I.I'..' Ucpfh Dfaull'ter Slot'
11„111 ro IT.
Will I.n _.
:. I;ticrial
13
•
\Iclllorl
in
Depnl Si,'c 't I aerial
I rat)
It. G.I:\I:\It ICS'.
\.I.1 [1l
�Topngraph ic' Lan d setting
L7Rnhc ❑Slope ❑Vain) ❑Flan
icreck appn,p-,tc hoe)
Lalitudc:lonciwdc or well location
(Jcgre:s. minulcs seconds)
nlilud-a tom itilde source:OGL'SI:Topooraphic map
dick host
DRII.I-ING LOG
Fo l : It iyn Description
e
Ca
CO "a
rn :,m
"-O C c
I arc -
LOCATION SKETCH >o
Shots (lircution Imd distance in miles rror=d IcR0
to Slate Roads or County Roads. IncItid dta ant
numbers and common road names. ••
Ca
rc;1�
G
1
110 1 !TRH)). CFKI IPY TI I:AT THIS WELL WAS C'I.-,NSTRUCfED IN ACCORDANCE WITI I I5A NCAC 2C. WELL
(ONST RUCTION S LAND.ARDS. AND THAT :A COPY OF THIS RECORD I1AS BEEN PROVIDED TO TT IE. WELL OWNER
SIGNATURE OF PE'<SON CONSTRUCTING Tlil! WELL
- j S C 3
DATE
Submit the original to the Division of "Water Qu: lily, Groundwater Section, 1636 ;Mail Service Center- Raleigh, VC
2276994636 flans An.(910) 733_3221. Acithin 31) days. C W-I REV. 07/2001

278586
2. OWNER
NORTH CAROLINA DEPARTMENT OF NATURAL RESOURCES AND COMMUNITY DEVELOPMENT
DIVISION OF ENVIRONMENTAL MANAGEMENT - GROUNDWATER SECTION
P.O. BOX 27887 - RALEIGH,N.C. 27811, PHONE [phone]
WELL CONSTRUCTION RECORD
DRILLING CONTRACTOR
DRILLER REGISTRATION NUMBER
FOR OFFICE USE ONLY
Quad. No. Serial No.
Lat. Long. Pc
Minor Basin
Basin Code
Header Ent. GW-1 Ent
STATE WELL CONSTRUCTION
PERMIT NUMBER:
/ /1%�.�
1. WELL LOCATION: (Show sketch of the location below)
YC% .tea I;1
Nearest Town:
(Road, Communiti. or Subdivision and Lot o.)
ADDRESS ��
,AaJ SO a
../ (Streett r Route N J `'�j /i6 J� T 6'
L[Cit or own IJ//!�) Do 6
Cif or Town State Zip Code
County:
Depth
DRILLING LOG
From To Formation Description
3. DATE DRILLED r-JO-D3
4. TOTAL DEPTH 6,a
<3G '
USE OF WELL. n ,LD' 7; I
CUTTINGS COLLECTED ❑ Yes
5. DOES WELL REPLACE EXISTING WELL? ❑ Yes %No
6. STATIC WATER LEVEL:
TOP OF CASING IS
7. YIELD (gpm): -3 5
8. WATER ZONES (depth):
9. CHLORINATION: Type
10. CASING:
I n
1
FT ❑•above TOP OF CASING,
g below
FT ABOVE LAND SURFACE.
METHOD OF TEST oC J'1 Q 5 •
yes - /% pet.
Gas' - .33 stfli�fpm
re) Amount %I 'fb/rs.
Wall Thickness
Depth Diameter or Weight/Ft. Material
From
From
From
11. GROUT:
From
From
12. SCREEN:
To 3Lv Ft Cv r /
To Ft
To Ft
PVC
Depth nn Material Method
.( To CW Ft. rf��n+-a.kT p
To Ft.
Depth
From To Ft.
From To Ft.
From To Ft
13. GRAVEL PACK:
Diameter Slot Size Material
in.
in.
in.
in.
in.
in.
Depth Size Material
From To Ft.
From To Ft.
14. REMARKS'
If additional space is needed use back of form.
LOCATION SKETCH
(Show direction and distance from at least two State Roads,
or other map reference points) <a
0 0
c-t �
ni o n1
D cm
o_.c
co
D0
-1--
rn
no
_ (n
NZ
0 mz
(.11
tv o
1 II
GROLIIA'L':VATFR SFC'InN
ASHEVILLE 'i[Gh!NAL-"JFHCE
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15 NCAC 2C. WELL CONSTHUCI ION
STANDARDS, AND THAT A COPY OF THIS RECORD HAS p EEN PRO I D TO THE WELL OWNER.
SIGNATURE OF CONTRACTOR OR AGENT
-3/
DATE
GW-1 Revised 6/88
Submit original to Division of Environmental Management and copy to well owner.

277525
WELL CONSTRUCTION RECORD
N9rtb Carolina - Department of Environment and Nan. ral Resources - Diilvision of Water Quality - Groundwater Section
.WELL CONTRACTOR (INDIVIDUAL) (print) Jh�J�I-'/.{t'��t. l °-'f (_ext_i_ ^ CERTIFICATION #. a ES
:WELL CONTRACTOR COMPANY NAMELrQRNt�/I�1 ..4.2-, u)dJ - I—u.rw�.�l. V4�-"PHO.NE k (g g/, Lg.3)7C
STATE WELL CONSTRUCTION PERMIT# / �D 2 ASSOCIATED WQ PERMIT#
- (if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use
2.' WELL LOCATION: / / Topo raphic/Land setting
Nearest wn:L))92/YlES I //P Count �/QA/106Gd_ ❑Ridge Slope ❑Valley ❑Flat
\// iia es nCi 1 n-- elicit appropriate box)
(Street Name, N bets, Community, Subdivision, Lot No., Zip Code) Latitude/longitude of well location
3. OWNER: eT'Yt--f-, iJ1.Plfil ft ( decrees minutes/seconds)
Ad ess P 0 o f-t(. , / R `7 1 Z _ Latirudeilon_itude source:❑GPS❑Topographic map
hn (Street RNo. (check box)
,mil', ,.4,sor ,�oute, %�L %IC o��%%/ DEPTH DRILLING LOG
�ity or Town State / Zip Code From To Form ti n Description
( )- 6 '7O / i it)
Area code- Phone number 7) ' ; 3/) s" r � r "�
4. DATE DRILLED -.D -63
-5. TOTAL DEPTH: 3QS '
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: '�.,
FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
"Top of casing terminated at/or below land surface requires a
variance In accordant ith ISA NCAC 2C .0118.
II _a
9. YIELD (gpm): , i METHOD OF TEST 2 h r$ r -
9D �c,om 7(05' 9.bw
„cgs , _ .2 2 a p yvn LOCATION SKETCH _ ,,
11 ' DISINFECTION: Type /-I// 7 Amount ' 471 % Show direction and distance in miles from at lease
12. CASING: Wall Thickness two State Roads or County Roads. Include tlleoatl=
" Depth Diameter or Weight/Ft. Material numbers and common road names. W r
From / To 7D Ft. c 'r Seel o
From To Ft. — c
• From To Ft.
13.- GROUT: Depth Material Method
From £ To aU Ft. („P-4-r ti+J 7___
FromTo Ft. 7"
14." SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
`:From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From - To Ft.
From To Ft.
16:REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
J.. CONSTRUCTION STAND D , AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
�Q e�—L. Cod 7 3/ a 3
SIGNATURE OF PERSON CONSTRUCTING THE WELL
DATE
Submit the original to the Division of Water Quality, Groundtfrfte4' eetjoll I63ia Majl Seen it-• to r= Raleigh, NC
27699-1636 Phone No [phone], within 30 days. '1 -' � �. REV. 07/2001
�� S( — it
fr

277524
WELL CONSTRUCTION RECORD
'North Carolina. Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
7
WELL CONTRACTOR (INDIVIDUAL)NAM5 ((yriot)�J c� ) CERTIFLCATION# �.✓0�/
WELLCONTRACTOR COMPANY NAMEt1A PD-AL JLr `�(/LLG 92 /��m� Lan PHONE # fQias, �C 9- 3/ 7D
STATE WELL CONSTRUCTION PERMIT# 2
(if applicable)
ASSOCIATED WQ PERMIT#
(if applicable)
:.WELL USE (Check Applicable Box): Residential, Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATIO
Nearest Town: County
9 P Pi/ 7r ,
ir-.'I ne ,I IC ,2k 17 8U
Area code -.Phone number D�
PATE DRILLED to`
S
'
5.' TOTAL DEPTH: /1 4 - '
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO I
7. STATIC WATER LEVEL Below Top of Casing: `h3 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118. /
9.'YIELD (gpm): 4i) METHOD OF TEST r-� Are; .
10. WATER ZONES (depth): //S' — Or in
11''-DISINFECTION: Type
12. CASING:
Depth
From � To 3 � Ft.
From' To Ft.
From To Ft.
13.,' GROUT: " < Depth Material
From 1 To ri� Ft. /n
Frbm To Ft.
4. SCREEN: Depth Diameter • Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
5. SAND/GRAVEL PACK:
Depth Size Material
(Street Name, Numbers/Community, Subdivision, Lot No., Zip Code)
3. OWNER: 1 0.44r </ C` /TYVV , &ilJ •
Address 3 ? l /Opt P 004 /2n1 .
(Street.or oute No.)
Siri
City orown State Zip Code
Diameter
G"
Amount %
Wall Thickness
or Weight/Ft. Material
PVC
Method
From . To Ft.
From - To Ft.
Topo aphic/Land setting
❑Ridge Slope ❑Valley 0Flat
(check appropriate box)
Latitude/longitude of well location
(degrees lminutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To i Formation Qescription
0 -2
k_30251415'
An 4.„
0
LOCATION SKETCH _ -
-J
Show direction and distance in miles from atictst
-
two State Roads or County Roads. Include the6oadT,
numbers and common road names.
0
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
' CONSTRUCTION STAND S, AND THAT A COPY OF THIS RECORD I-IAS BEEN PROVIDED TO TFIE WELL OWNER
Led.9/t�L 7-J/ 3
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
rI i
Submit the original to the Division of Water Quality, Croun��� r,figcl(iotl, jGrib �1ail Sir(r7ce 1 r -Raleigh, NC
Phone No. [phone], within 30 days. I f— GI -I REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina -Department of Environment and N
WELL CONTRACTOR (INDIVIDUAL) NAME print) y11
WELL CONTRACTOR COMPANY NAME LflJfa.
STATE WELL CONSTRUCTION PERMIT#
(if applicable)
/ lo2
ural Resources - Division of Water Quality
ASSOCIATED WQ PERMIT#
(if applicable)
277520
- Groundwater Section /
CERTIFICATION # 3/0 5
.PHONE# ,7 6V -3/7d
WELL USE (Check Applicable Box): Residential Municipal/Public 0 Industrial ❑ Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 It Other, List Usc
2 WELL LOCATIO
Near
County ,L/a,,Li 0d
hJtQ Q Qe ;IDA.IL-
(Street Name, N crs, Community, Subdivision, Lot No., Zip Code)
3. OWNER: /914_ ,"
Address J . ) I A Jt h LL)A/n 41
YZIi (Street or e,No.) .( 0 �7 /
l! /nP.SUr%/ /�V/ CJ
City or own State / Zip Code
Area code- Phone number •
4::DATE DRILLED 6 - .5 - 0 3
"5.TOTAL DEPTH: a a 3 I
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7i STATIC WATER LEVEL Below Top of Casing: ,217 FT.
(Use "+" if Above Top of Casing)
8.. TOP OF CASING IS % FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance ith 15A NCAC 2C .0118. ^
9.>Y►ELD (gpm): .3 METHOD OF TEST of n
'. 1O, WATER ZONES (depth):
a9' - /f g ph-t
It. DISINFCTION: Type %/ % Amouni(
12. CASING:
TopogJaphic/Land setting
❑Ridge 'Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees, minutes/seconds)
Latitude/Ion_gitude source:DGPSI]Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
�4' e2 2S/ Pia ,44 , 70�
Wall Thickness
Depth '/ Diameter or Weight/Ft. Material
'From 0 To 4`7 Ft. to " Pvg
From To Ft.
From To Ft.
: 13. GROUT: - Depth AMaterial ,/ Method
:From tO To 02() Ft. U 0,444_10a, /./2-070
From To Ft.
t'.14.; SCREEN: Depth Diameter Slot Size Material
Fpom To Ft. in. in.
:From To Ft. in. in.
15.;SAND/GRAVEL PACK:
Depth Size Material
From ` To Ft,
'From_ To Ft.
4.a
r0
c�
LOCATION SKETCH -a
Show direction and distance in miles from at -least ^' -
two State Roads or County Roads. Include dieload,=-2
numbers and common road names. o
0 es
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION SETA DS, AND THAT A COPY OF THIS RECORD HAS BP PROVIDED TO THE WELL OWNER
27 P,ta, t 7 3/- 0 3
SIGNATURE OF PERSON CON .TRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Grou rdwater Section, 1636 Nlail Nervier Center - Raleigh, NC
27699.1636 Phone No. [phone], within 30 days. �(5*-1 REV. 07/2001
I
t::

277519
WELL CONSTRUCTION RECORD
North Carolina'- Department of Environment and al Resources - Divisio i of Water Quality - Groundwater Section
rl
WELL CONTRACTOR (INDIVIDUAL) NAM/E' (print) -I--JD ✓ CERTIFICCA7TI[ON # 02 /Q
LL CONTRACTOR COMPANY NAMES YYPE'hL'f al
GL �.LI /'.. PHONE q (lro�Ih Co Y-��.3
27699-1636 ?hope No. [phone], within 30 days.
:wL i /90
ASSOCIATED WQ PERMIT#
(if applicable)
STATE WELL CONSTRUCTION PERMIT#
(if applicable)
�02
1,. WELL. USE (Check Applicable Box): Residential Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Wate Injection 0 Other 0 IIOther, List Use
2:, WELL LOCATIO
Nears�sst�Town: nn --^
(Street Name, Numbers, Community, Subdivision, Lot No., Zip
Code)
3. OWNER: (2 it dJ Ct tla .L
Address Q /3 '7ep
(Street or Route No.)
Y./ 2//4esvt //I / A/C ..2I7
City r Town State Zip Code
Area code- Phone number
4: DATE DRILLED - .2 /
'5. %TOTAL DEPTH: 3 9 S '
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: Lo 60 T.
8:'TOP OF CASING IS / (Use"+" if Above Top of Casing)
FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with I5A NCAC 2C .0118. rj
9. YIELD (gpm): a b METHOD OF TEST /�
ern- County ?14///,d4 d1.
10. WATER ZONES (depth): aD5 ) - 1/a �iP >»
.305) — /4 OT aDm
I I. DISINFECTION: Type 1-1-7-1-1AmountSv`/
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
„ tom„7)To +� FT / /) P vL
r: 'From To Ft.
From To Ft.
13.-GROUT: Depth nMaterial
From 0 To�%ts Fo vr,.Lk t
From To Ft.
4.`SCREEN: Depth Diameter Slot Size Material
From To Ft, in. in.
From To Ft. in. in.
Method
15. SAND/GRAVEL PACK:
Depth
From - To
From To
Ft.
Ft.
Size Material
Topraphic/Land setting
❑Ridge 'Slope ❑Valley ❑Flat
check appropriate box)
Latitude/longitude of well location
(degrees minutes/seconds)
Latitude/longitude source:DGPSOTopographic map
(check box)
DEPTH DRILLING LOG
From To Fonnati. escription
/> lv -2 v
ag-
•
rfl
LOCATION SKETCH -o
Show direction and distance in miles from at Ic3st
two State Roads or County Roads. Include thcatsiad
numbers and common road names. o
0
16. " REMARKS:
'I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STADS, AND THAT A COPY OF THIS RECORD HA SEEN PROVIDED TO THE WELL OWNER
ALPdtI
SIGNATURE OF PERSON CONSTRUCTING THE WELL
%_3/-6 3
DATE
Submit the original to the Division of Water Quality, Oro lttr at Section 16 0 Mail bits yc; r}rter - Raleigh, NC
I I _ '" �! i OW -I REV. 07/2001
rn

3. OWNER:
Address a O
277517
WELL CONSTRUCTION RECORD
North Carolina �-;Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) ko / (l/ 1 b/� n n CERTIFICATION # . ,/
WELL CONTRACTOR COMPANY NAME �qre e ne Ry05• Lk/L o1 f /r}rty,(YIU' PHONE # (Ogd>O41/2— 2)'iU
STATE WELL CONSTRUCTION PERMIT# NO R ASSOCIATED WQ PERi\IIT#
(if applicable) (if applicable)
WELL USE (Check Applicable Box): Residential Municipal/Public O Industrial O Agricultural O
Monitoring 0 Recovery 0 Heat Pump Water njection ❑ Other O If Other, List Use
2. `WELL LOCATI
Nearest own: .(/ t,51/e/lP County_
A ve /1�
(Street Name, Numb s, Community, Subdivision, Lot No., Zip Codc)
kit .0I'S t'i:t/P./PG
t// (Street or Route No.))
/[Y nPSUi/�z/ A[ 1.-
Ci r Town State Zip Codc
Area code- Phone number
4: DATE DRILLED 4' -
• 5, TOTAL DEPTH: / R 5 /
6: DOES WELL REPLACE EXISTING WELL? YES O NO
7. STATIC WATER LEVEL Below Top of Casing: .2ED T.
j (Use "+" if Above Top of Casing)
8.TOP OF CASING IS / FT. Above Land Surface*
.*Top or casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): / 3 METHOD OF TEST r5
10. WATER ZONES (depth)' / 5 ' / m
11: DISINFECTION: Type If
12. CASING:
Depth Diameter
From 40 To 31 Ft. c , /!
From To Ft.
From To Ft.
13.; GROUT: Depth
From t To AO Ft.
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
. From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From ' To Ft.
From To Ft.
Amount , '9
Wall Thickness
or Weight/Ft. Material
nv(
/1Material Method
Topographic/Land setting
❑Ridge ❑Slope ❑Valley Iat
(check appropriate box)
Latitude/longitude of well location
(ditroes/minutes/seconds)
Latitude/longitude source:OGPSOTopographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
/
,31" /SS' hn 4-1l/o
n
r—
C7
LOCATION SKETCH
Show direction and distance in miles from at least) r
two State Roads or County Roads. Include tl-Froad
numbers and common road names.
0
0
16. ,REMARKS:
1 PO 1iEREUY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
"CONSTRUCTION STANDAEDS, AND THAT A COPY OF THIS RECORD H.AS� N PROVIDED TO THE WELL OWNER
it It/4 11
SIGNATURE OF PERSON COtjSTR
Submit the original to the Division of Water Quality, Grohd4. terSection, t63h-M1a4 r>ice Canter- Raleigh, NC
27699-1636 Phone No. [phone], within 30 days.
'TING-THEWETL.-.-. _._...-.._ DtATE
lyivvri REV.07/200REV.07/2001
U i

WELL CONSTRUCTION RECORD
North Carolina -Department of Environment and N
WELL CONTRACTOR (INDIVIDUAL) NAM (print) '1
WELL CONTRACTOR COMPANY NAME f7rG2411....i
STATE WELL CONSTRUCTION PERMIT# /1/4).2
' - (if applicable)
al Resources
277516
Divipion of Water Quality - Groundwater Section,/ 7 CERTIFICATION #c'7//
`r2
C PHONE # 1�70 G k' -3 7�
P)
ASSOCIATED WQ PERMIT#
(if applicable)
1.-WELL USE (Check Applicable Box): Residential t Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection ❑ Other 0 I[Othcr, List Use
2. WELL LOCATIOt .
It Town' / County
(Street Name, IMG)hbera, Cgnmunity Subdivision, bpi No., Zip Sode)
OWNER:
Address S Si o.) ) 1)4) .
J(Street or [y No.) A/ ^ .2 A, 7/ /
a
City or own State Zip Code
( )-
Area code- Phone number
4., DATE DRILLED 4' 2'7 03
='5. TOTAL DEPTH:
6.' DOES WELL REPLACE EXISTING WELL? YES ❑ NO,
7, STATIC WATER LEVEL Below Top of Casing: `/o FT.
) (Use'-+" if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surface*
- *Top of casing terminated at/or below land surface requires a
variance In accordance with 15A NCAC 2C .0118. 9. YIELD (gpm): ..3t METHOD OF TEST -2 14 r5
0: WATER ZONES (depth): /n S I - 3Z) cyp m
U� LOCATION SKETCH
Show direction and distance in miles from atlrrfst
two State Roads or County Roads. Include thEZoad z_
numbers and common road names.
Topographic/Land setting
❑Ridge ❑Slope ❑Valley lat
(cheek appropriate box)
Latitude/longitude of well location
(degreesm mutes/seconds)
Latitude; longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
Formatio9 Description
DEPTH
From To ,
/0/
6 / ! sS'
0
1I. DISINFECTION: Type { /%/-) Amount .25
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
d From' D To 4/ Ft. /o r/ PVtL
From To Ft.
From To Ft.
13.'GROUT: Depth Material Method
From 6To 02� Ft. � ,441.2-k."i tT
From To Ft.
14.''SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
5, SAND/GRAVEL PACK:
Depth Size Material
From - To Ft.
From To Ft.
o c.
16:REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDAR S, AND THAT A COPY OF THIS RECORD H%• EN PROVIDED TO THE WELL OWNER
�."� 7_5/.63
SIGNATURE OF PERSON COLT
:`.Submit the original to the Division of Water Quality, Gro
27699-1636 Phone No. [phone], within 30 days.
ING TIIE W-EL-hr _RATE
er Seetionri6366:414ocs,ilc? tp Her - Raleigh, NC
l
Litij
W-I REV. 07/2001

277515
WELL CONSTRUCTION RECORD
North Carolina = Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME�{'(prinq /-! (r4'�-�ltteis CERTIFICATION # 3 a 4 1 /
'WELL CONTRACTOR COMPANY NAME ,CJ�p_P.,I.t.L '/64 bil-a 4Raft H &ONEa (Ds), in 41 .3J9D
STATE WELL CONSTRUCTION PERMIT# /'Y D %z ASSOCIATED WQ PERMIT/
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential Municipal/Public 0 Industrial l7 Agricultural 0
Monitoring 0 Recovery ❑ Heat Pump Water ejection 0 Other 0 IFOther, List Use
, 2. WELL LOCATIO
Nearest Town: ^ County
Ln# /1 Cam" e,vs e' '=✓n re
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: '� L+ t -1 n-r
Address r?4 Pa .k'Mr rR cL CDT .
C, �r(Set or Route,No.) 02g�z /1
r //C
City or To n State Zip Code
Area codc- Phone number ' /
4.;DATE DRILLED �'.2 4` '4 3
`5.TOTAL DEPTH: / RS'
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NOlfel,
7. STATIC WATER LEVEL Below Top of Casing: ab FT.
(Use "+" if Above Top of Casing)
S.?TOP OF CASING IS ' FT. Above Land Surface*
*Top of casing terminated aUor below land surface requires a
variance in accordance with 15A NCAC 2C .0118. 1
9. YIELD (gpm): i .6.-METHOD OF TEST t- h r5
10; WATER ZONES (depth): 6 S' - 53 p n
Topographic/L nd setting
❑Ridge ❑Slope (ley ❑Flat
(check appropriate box)
Latitude/longitude of well location
•
(degrees. minutes/seconds)
Latitude/longitude source:OGPSOTopographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
« 2 ' 611,
y
4' ' /8:5' LIha_t,
11. DISINFECTION: Type H 7-il/ Amount -2 S'
12. CASING: Wall Thickness.
Depth, /
/�/ Diameter or Weight/Ft. serial
To `t Ft. /e ' )
:From ' To Ft.
From To Ft.
3.;' GROUT: Depth aterial
From O To 920 Ft.
From To Ft.
14.:`SCREEN: Depth Diameter .Slot Size Material
-'From To Ft. in. in.
-k'From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From ' To Ft.
From ' To Ft.
From 6
Method
VIT
C7
LOCATION SKETCH
Show direction and distance in miles from atleast`'',:�
two State Roads or County Roads. Include th 9oadL -�
numbers and common road names. o
O
16.; REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STAND S, AND THAT A COPY OF THIS RECORD EEN PROVIDED TO THE WELL OWNER
WA) An -kJ 7- 3/-63
SIGNATURE OF PERSON CONS
Submit the original to the Division of Water Quality, Croon
17699-1636 Phone No. [phone], within 30 days.
TING THE WFL—
ke_ch r t6`+r, riI,1sr
DATE
r - Raleigh, NC
I REV. 07/2001

277514
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division((is�of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) 0-4 / � C7h / CERTIFICATION a -56V /
WELL CONTRACTOR COMPANY NAME 4041 Q.Nr(Ss. it)y -PI q��('l.C�'= PHONE # (fi) 6 "'327D
STATE WELL CONSTRUCTION PERMIT# /TSe) -2- ASSOCIATED WQ PERMIT#
`-' (if applicable) (if applicable)
1, .WELL USE (Check Applicable Box): Residential)9 Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring ❑ Recovery. 0 Heat Pump Wate Injection 0 Other 0 IFOther, List Use
2. WELL LOCATI JJ
NearestTown: ' 1 7 Counnty Ce�lYr� _
—(e is n Tv anrL r
(Street Name, Numbers, ommunity, Subdivision,�Lot No., Zip Code)
C�.J-Cv/l 3, OWNER: ^Cff-t4%
Address . w gr../-
028 7 2 C,
�S �
(Street or Rout Nod
i� Pam:, 2/4 /02_
Crown State / Zip Code
(—)-
Area code- Phone number
4.'DATE DRILLED 2 -5-63
'5, I: TOTAL DEPTH: / .2 S
6. `.DOES WELL REPLACE EXISTING WELL? YES ❑'/NO
7. STATIC WATER LEVEL Below Top of Casing: ? O FT.
(Use "+" if Above Top of Casing)
S.. TOP OF CASING IS 1 FT. Above Land Surface*
tTop of casing terminated at/or below land surface requires a
variance In accordance Ith ISA NCAC 2C .0118.
9. YIELD (gpm): D METHOD OF TEST oh l hr5
10. WATER ZONES (depth): ?E / — o Jr.v,
11.;:DISINFECTION: Type H T1-/ Amount
12. CASING: Wall Thickness
or Weight/Ft. M. terial
From !n J l
From
From
/
13, GROUT: hilatenal
From 0 To ,V) Ft. (O.htjtt
Depth Diameter
To ?n Ft. �P l
To Ft.
To Ft.
Depth
From To Ft.
lCD
Method
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
``From To Ft. in. in.
15.: SAND/GRAVEL PACK:
Depth
From " To
From To
16. REMARKS:
I ➢O HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION "TANDARDSDOPY OF THIS RECORD HAS PROVIDED TO THE WELL OWNER
Size Material
Ft.
Ft.
Topographic/Land setting C rt�
❑Ridge ❑Slope ❑Valley ❑Flat 6e4)--)---
tcheck appropriate box)
Latitude/longitude of well location
(degrees. ininutcs/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
14 £ 4t..,-t.
LOCATION SKETCH -` --
Show direction and distance in miles from at -foist
two State Roads or County Roads. Include tlreetoad'_
numbers and common road names.
CD
0
% r7-3/ - 03
SIGNATURE OF PERSON CONSTjiOf,T-fNG-T+IE-WEE6- ----- DATE
Submit the original to the Division of Water Quality, Groan xf at 8eetierr,-+b36-PM1ai Ser
27699-1636 Phone No. [phone], within 30 days.
K>rtn do - Raleigh, NC
0 HI REV. 07/2001
1,
,Ja
0

12.- CASING:
,i. From /D
From
From To Ft.
13. GROUT: Depth n Material Method
From /fi To ,-V /7 Ft.$) 1 a_4C t 1
From t. . To F
14.'SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
5. SAND/GRAVEL PACK:
Depth Size Material
From ' To Ft.
From To Ft.
WELL CONSTRUCTION RECORD
North Carolina -Department of Environment and Natural Resources / Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME
� (print) at- I\Ct.t1-, GYP P A CERTIFICATION /';79S
WELL CONTRACTOR COMPANY NAME G.-re-echo //t3 05. r-✓'LAX J' aZv OUa'z. -PHONE # jh,(6) 4 7 6 -`;/7°
STATE WELL CONSTRUCTION PERMIT# I Ve.Z ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
277513
1. WELL USE (Check Applicable Box): Residential* Municipal/Public 0 Industrial 0 Agricultural 0
5?iMonitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATIO
- " N own:
0
L. County k/2r./&6 201
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER:
`Address
I.Or Pets t) le NC,
City or wn State ) Zip Code
(-)
CArea code- Phone number
4. DATE DRILLED /A - c-t
5;" TOTAL DEPTH: 9A/.5
6,`;DOES WELL REPLACE EXISTING WELL? YES ❑ NO VI
STATIC WATER LEVEL Below Top of Casing: /, D FT.
(Use "+" if Above Top of Casing)
8,.TOP OF CASING IS 1 FT. Above Land Surface*
`r *Top of casing terminated atior below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9, YIELD (gpm): /, T) METHOD OF TEST ?.4 rS -
O. WATER ZONES (depth): 9`7/S — - Oy , \
11,:'DISINFECTION: Type ,t-1 Th/ Amount /6 2
Wall Thickness
)
Opri Ic Vi. tV (?_0). -
$trcetor Rou N
Depth
To Ft.
To Ft.
Diameter or Weight/Ft. Material
p1
Topographic/Land setting
❑Ridge ❑Slope ❑Valley setting
(cheek appropriate box)
Latitude/longitude of well location
(degrees. minutes/seconds)
Latitude/longitude source: DGPSOTopographic map
(check box)
DEPTH DRILLING LOG
From To , Formation Description
c_
LOCATION SKETCH
Show direction and distance in miles from atilsast
two State Roads or County Roads. Include teroad--
numbers and common road names. C.J
0
0
16, REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSSTRJCTION ST N ARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
(
G/) s X l/1,P11Aug-
7- 3/— D 3
SIGNATURE __ PERSON _......_...JCTING THE WELL DATE
Submit the Original to the Division of Water Quality, Ground
27699-1636 Phone No. (919) 7333221, within 30 days.
C9
bkee'ISection 1636 hli8il leniceCyitita 1 Raleigh, NC
<, 'Glkv- REV. 07/2001
fI
U.
CRO'c'.' ;'C'IA-TR SECTION

277512
WELL CONSTRUCTION RECORD
•North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
..ELL CONTRACTOR (INDIVIDUAL) NAM (print) Al- /Lnr I p Dr0CERTIFICATION # 36Zi/
WELL CONTRACTOR COMPANY NAME( r&QYIIP Bros, L(/.o K-t Qtbl-Tp CPHONEq(X9g 4,4/8'3/la
STATE WELL. CONSTRUCTION PERMIT# / y D .2 ASSOCIATED WO PERM IT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential Municipal/Public ❑ Industrial ❑ Agricultural 0
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION
Nearest Town:
�1ra
(Street Na e, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: �rP� R. ej
Address
Ll�ni_-IInes‘jtlib) MC aSt7gj
City co -frown State Zip Code
Area code- Phone number
4 DATE DRILLED % - 5 - O z
5;',TOTAL DEPTH: <i s S '
6..DOES WELL REPLACE EXISTING WELL? YES 0 NO'
7.. STATIC WATER LEVEL Below Top of Casing: J't FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surface*
'Top of casing terminated at/or below land surface requires a
variance In accordance with ISA NCAC 2C .0118.
9: YIELD (gpm): (p � METHOD OF TEST .? krc -
1Q.WATER ZONES (depth): .2 /05' — / €p >1
It rne6sLAr_ Qr� -
(Strget or Route No.)
400' -5 gper'
11.1 DISINFECTION: Type H7-14 Amount '7.2
12. CASING: Wall Thickness
DepthDiameter or Weight/Ft. Material
From�pn " To�S_Ft. o ' ' Pve_
From To Ft.
From To - Ft.
13, GROUT: Depth Material i Method
From Q To ,2n Ft. fQ
From - To Ft.
14. SCREEN: Depth Diameter Slot Size Material
.. From To Ft. in. in.
-' From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
I DO HBREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STAD DS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
o% ICI /J_2_P. Li (%i 4° . % - 3/ _ 6 3
SIGNATURE OF PERSON CONSTT3tUCT#NG-TH-E WELL-- DATE
I
Submit the original to the Division of Water Quality, Grou44naplQrSeeHefr,-Ibae-Matt Service] Ceti r - Raleigh. NC
27699-1636 Phone No. [phone], within 30 days. I r` I d - I REV. 07/2001
County y tD d
Gi'P.S �
Topographic/Land setting
❑Ridge lope ❑Valley ❑Flat
check appropriate box)
Latitude/longitude of well location
(degrees: minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
Ichcck box)
DEPTH DRILLING LOG
From To Formatiok Description
_c 4 a.5 rtlt r t
n
C.a
LOCATION SKETCH
Show direction and distance in miles from aT Te st E
two State Roads or County Roads. Include the road:uS
numbers and common road names. -3 -
GD
0

277432
WELL CONSTRUCTION RECORI)
,Nut Ih Cat Mina - Department of Lnvironnleot ;md Natural Resources - Division of Water Quality - Groundwater SectiiOn
r / �taA/A,e-. CEIt(IFICATIONN
VAI11 ('UCllt.AC'I OIt (IN'lllAInL AI,)N.AAIr vua) CpF 1 LLL����t /� /��z_5
�7.Ce. tv/ 7—�1��_'r/ _- __Atom: 6c22)
vv) I 1 c(t�ru.vt-ror. Coy)rvNv N.vytI< ----
I .\ In: \ P:I.I. (OC41 IA:('a IO\ I'L:R?11'1 # ASSOC1\ 1 E1) \V() I'EI(MIm
IiLu)'cable) fife) ,'cable)
I. A I:LI. USI (Chock -Applicable lion). kesidcn ttl IIX-lunicipal/Public ❑ !mho -Aria' 0 Agricultural ❑
Mullin,' nut, 0 12:coveny 0 Heat Pump Wu cr Injection ❑ Other ❑ I[Other, List Esc
2. WELL LOCATION:
Nearest TowiLlil
rwR77 A Xt, e"/
1�'ael N.uua. N'umhe is. nwnits, Subdnision, Lot No.. Zip Code)
:\,dress ✓,g_c? n/
/// / Illthnnr ,nlc Nul
C /j4r/e//e A/ , l
.' Io.,n tim.nc
Via. e,Jc- I'h.ne numbs
C0❑ t,
opogriphic/Land setting
WOp idLte ❑Slope ❑Valley ❑Plat
(check appropri.uc bolt
I atitude/longitude of well location
Idepees iinisesiscconds)
Eat itudc/longitude sourccDGP SOTopogrophic map
',meek ties)
l)l PTII DRILLING LOG
Pnnn To l'rtiol) )cscriplion
�p
I. U.AII- DI:III.ED 7 4/-05 457� /Li-.
(1 I)OFS VA'I[LL RI PI_ACI! I2XIS"LING WELL? YES 0 NO
STATIC AVATER LEVEI. 13clow Top oFCasing: /CCJ FT.
(use 11 Abuse top ol'Cnninp)
S. TOP DI' CASING IS —..._ _ _ET.. hove Lund Seduce*
- inn ul casing mn nnialed al/to below Land surface re:Hires a
cnriaun• in uccu rdnure with I>:\ NCAC 2C .1111S.
YIHI.D (epm): „5" NIETI-IOD OF TIES r. 14,�
I n U',A I LR /.ONE'S (depth):
DISINFECTION. Type �r` Anneuut
12. CASING: AVal) htckncss
Uchllt Diusncter or V. IJnl a. .N ttcrwl
Flom -*a To66__ H. 6 //6/ /4,S51,C
1- o n_ - To R.
tram Ta_ PL -- ---
I3 (ROUT licptl, Matcii.J //Meth,,,
Ilom.. c__._ Tp_ OTC! -._I I.0 e,1__
I..runt Ty —_. Pt.
Li _ SCI:PP.N: Depth I) ai Ictcr Slo; `:i,c ALiterinl
'Torn_.______ To la.in. in.
la om To 1-t..__ -_.in. .__ - in.
15
Depth Sim Tate;i;d
I loin llm_ IL_
I- win ___ ----I"
Io ItI'.AI,AVK.S:
Alf -02,5—
LOCATII)N SIKEICI I
Show direction and (listance in miles from at Ies%st
10) State Roads or County Roads. Inch thccru)ad
c--
numbers and common rout names. v
C
0
/6/i4)a76
0
I I)r) I IERL'I3Y CERTIFY HI AT T I IIS WELL. WAS CONSTRUCTED IN ACCORDANCE AVITI I I5A NCAC 2C, WELL
1YINI I H('CIION SF ANDARDS, AND THAT A Cop OF THIS RECORD IIAS BEEN P ROVII)E_D TO IIIE WELL OWNER
SI(1NAIU IOI E' SONa Hilff'ttk'fi-rtttNtt`Cl"r- I 1 DATE
Submit (Inc original to the Division ()I' Water Quality, ULIo,ln(1walcr Section, 1636 Dlail Ic Center- Raleigh, NC
27699-1636 Pluoic No. [phone], within 30 da) s.
GW-I REV. 07/2001

277431
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and N?tural Resources - Division of Water Quality - Groundwater Section
CERTIFICyA-wTIIONtt�o
79
PHONE # ycvn) 77-gsn
WELL CONTRACTOR (INDIVIDUAL) NAME (print)
r lAie/,
VA'ELI. CON't I2ACcolt COAIPANV' NAME
V M19
STATE \\ ELL COSStRUCt1ON I'ER\IIT# ASSOCIATED \wQ PER\IIT#
(if applicable)
(if applicable)
1. WELL USE (Check Applicable Box): Residential I�1unicipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION///'
Nearest Town: (toe
(Street Nance, Numbers, Community, Subdvision, Lot No., Zip Code)
County/9 yW 00
3. OWNER:
Address
o?/02 OS x/9r.
Street or Route No.)
!4/4/4/6 /Ne . ( oY 7g6
uy or TM" State Zip Code
)-
Area code- Phone number
4. DATE DRILLED Tr>22-03
5. TOTAL DEPTH:_¢ 5 �
6. DOES WELL REPLACE EXISTING WELL? YES l9'NO ❑
7. STATIC WATER LEVEL Below Top of Casing: 60 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): 30 METHOD OF TEST 4zr
10. WATER ZONES (depth): ��//
I I. DISINFECTION: Type %7
12. CASING:
Depth Dia�eter
From't� To 7g Ft. ti,'
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From Q To d0 F416,cz.--'N-s,71—
From To Ft.
14_ SCREEN: Depth Diameter Slot Size Material
Front To Et. in. in.
Front To Ft. in. in.
15.SAND/GRAVEL PACK:
Depth Size Material
Amount
Wall Thickness
or Weight/Ft. Material
7 4./363
Front to Ft.
From To Ft.
16. REMARKS:
0
0
0 7
cn
I DO HEREBY CERTIFY THAT THIS WELL \VAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
t' .k2, DATE
Vcezzi
L
T EOF PERSON C]'1"ii)kITR 1PGT
Submit the original to the Division of Water Quality, €o Ddwater Section, 1636 Mailifliv'e Center - Raleigh, NC
LLLIII 1J JJ GW-1 REV.07/2001
27699-1636 Phone No. O19) 733-3221, within 30 days. � '
L--
Midge
setting
Midge DSlope ❑Valley DFIat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPSOTopographic map
(check box)
DEPTH DRILLING LOG
From To erytation Description
0
0
go
/a5 026.5-
020
/O '
Lie
Ni e
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural///Re/sourc/es - Division of Water Quality - Groundwater Section
ke �h /.. •*-FU'1� e felgi
CERTIFICATION # b
WELL CONTRACTOR (INDIVIDUAL) NAME trim i p ,may
VVEI.I. CONT ItACtOR COMPANY NAME i' (e GIN //91 /v. PHONE # f �) 71
STATE \VEI.I. CONSIRUC"1ION nnizm1"r# ASSOCIATED WQ PEIt\IIT#
(if applicable) (if applicable)
WELL USE (Check Applicable Box): Residential Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: (el N to /1/
t Street Name, Numbers, Community, Subdivision, Lot No.. Zip Code)
3. OWNER: 0, en/rrg-,9^i
Address o G'o//$/a 73
County ktuooc
(Street or Route No.)
//,fie N'/914 N. / F24(5`
z�Topographic/Land setting
lIIltidge ❑Slope ❑Valley :Mat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:0G PSDTopographic map
(check box)
DEPTH DRILLING LOG
From To For ratio 1 Description
A
76/ -.N
7� /cS . -to a , A.,.e
5. TOTAL DEI'T H: 07f/ S /,05
7. STATIC WATER LEVEL Below Top of Casing: />/o( FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS_ FT. Above Land Surface*
*'fop of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): %0 METHOD OF TEST Qi
ID. WATER ZONES (depth): �/
11. DISINFECTION: Type Jf /l/
12. CASING:
From f.2
From To Ft.
From To Ft.
13. GROUT: Depth Material
From e To JD
From To
14. SCREEN:
277430
City or Town State Zip Code
( )0
Area code- Phone number
4. DATE DRILLED 7/23/0
6 DOES WELL REPLACE EXISTING WELL? YES 0 NO
Amount
Wall Thickness
Depth 9to meter or�8kht/Pt. <py�ntcna
To 7a FL Cn /S/ 2 e
Ft. r'^4eNt
Ft.
Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. _ in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Method
LOCATION SKETCH
Show direction and distance in miles from at (east
two State Roads or County Roads. Include the road
numbers and common road names.
0
0
7
rV
0
16. REMARKS:
I DO I IEREI3Y CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
1/(--X2766e C l— `33— 03
SIGNATUR OF PERSON CON 11 141y1G HE fE
Submit the original to the Division of Water Quality, Grou ItiV IF Section, 1636 Mail ScrvI
��
27699-1636 Phone No. (I19) 7_13-3221, within 30 days. � Ill
I
cr - Raleigh, NC
-I REV. 07/2001
r:
G

unle
od
Lot No Zip Code)
277429
CERTIFICATION H°2/
PHONE tt (tY) 6Q7 4 5
��Topographid/Land setting
Ridge ❑Slope ❑Valley ❑Plus
(Check appropriate host
Latitude/longitude of well location
b ao
I I-
(U FA!. DGrru: '/Y� /3T - -YS
0. DOTS WELL REPLACE EXISTING AV111.1.7 YES ❑ NO
TI
Sl'AIC WATER. LEVEL Blow Top ofCasirg: /tip Ff.
(Use ii Abocc Top ol'Cusincl
s- TO1' Or CASING IS PT. Above Land Surface*
"Il 1 of caning terminated :)1/or helms laud surface rcaatr es a
\aliance in accordnucc s th I5.\ N'C:\C 2C .III IS.
SII:LD 1ppnl). _'� .— VIGI I IOD OF TES !� Lei,
111-AA'VTId 7.1)NFS (depth): - _. _
Alc.t O,de- Plimme iminhel //
1. D,VI L URII.I.LD 7-/(p" 0 3
(degrees ountltC49econdi)
L;Ilitucic'loneltudc source:❑GPSalopogruphic n)ap
lehmk box)
DI!1'T.I1 DRILLING LOG
Froln To Vorwalio) Description
ao G� s "40y
r-lN, fC
WELL CONSTRUCTION RECORI)
North ('luolina - I)cparintent of Yuvironincnt and Nat tral Rciour//ccs - /Division of AVater Quality - Groundwater Section
e,
VA ta.l. cox 'IIt.A(IOI ('1011' AN) N.ANI
F I A t r. ACEI.t. ('UN I H.(IIUN 1111t)1114 _ ASSOC( .-A I El) NV() rratalrrf
1'1. Al icable) (iFa llicablc).
1 \\ LI.I. CSI (C IL Lk Applicable Boxy 1Cesiden. al Nl unicip:dl'ublic ❑ Industrial ❑ Agricultural ❑
Al milwinu 0 Recovery ❑ Beat Pump Wm _r Injection ❑ Other ❑ II Uthcr, list Use
VA FI I (ON I It V (" I OR 11AI)IA'I l)C.:AI.) S:AAIT (Primt)
WIII. LOCATION:
__ Nc:lr'sl To).Vn: / f✓U//�e
N Line. N'umhers. C' wnlnunllnc. Suhdnasi
O\\NI:R: WL/%q ?
�J 1
\ddle,s /D 7 . hie ty rP
/^// A y,anx/lI,ot No.l 3029a
4.
Cu; in low) Stale %Ip CuJe
(.()CATION SKIi.1 CI
Show direction and distance in miles Prom at lelist
1 I. C A INNI G('"IIUN. TA pc /�% Villt u i Iwo State Roads or County Roa(Is. Inch thc7oad
I_' 1'A51'NCi: AA'all hlJ.ntss
ttumhcrs and common road names.
�yt kph Di:unelrl' urA ILht FL NI �Ia e[[ria /// 7 L -
1 ions fd-'A lo Sg 1, �� �`/ /723YcC �o �/ �� l._ _
1 Kohl In 1
114n11 To Pt.
1 111<( /l; I . 1)cptlt NI:Ilcrial j Method
1 tool 0 to 9f) F(^'Aea✓
1 tool I n it
I.I NC'ICI _I.N_ Depth I hametei Slo, adc Nlutctinl
I trin 1 0 1 t. in. in.
I Tom fo I1.
Ii. S.A NI) ('IICAVI!I. I'ACI:
Depth Size Laicarial
Dann I II.
IWill To PI.
i'. RI{NIAICKS:
N
O
0
I181II1 KFIt1 (118IIFY IIIAIIIITSVAI:I.I. AVASL( iNS IRUC I FA) IN AC ('OWAN('I1 WI III ISA N('rAC 2C,AVI:LL
( DNS( IWCI ION SI AND:AItDS- AND THAT A COIr OF HIS RIiCORD I IAS BEEN PROVIDED IC) TI IL WELL OWNER
.tiIGN;AS I I UCh!^'[: I I11 AA'PLI DATE
IAi 1
Merle -villain,' I6�6 A�ail .r
Submit the original to the Division of AA'ater Qu:.lily,
276991/41636 Plinth. No. [phone], vchitin 30 (Iays.
ik
• Center - Raleigh, NC
GW-I REV. 07/2001

S I I\\T: I (.1)N ST It(.1 ION ('hat\IIT'3
277428
WELL CONSTRUCTION RECORD
North C arolimt - Department of Environment and N: tural Resoles - Division of Water Quality - Groundwater Section
\\IIL('ONII.U'iOl((INnn' Int'Ail NAME (print) j�eJ h A -u/i0Q CERTIFICATION tt 02Y61
l'te 1 //0 fury rlIO\E # erc2f0 6,77-r 53'3
ASSOCIATED \cQ 1'E R?lrrn
1 it upplirublel (if apI licablc)
WELL ESL: (Check Applicable Hos): Rcsi(Icn ?al (�lunieipa Vl'ublie 0 Industrial ❑ Agricultural ❑
VIonitofing ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 IfOther, List Use
VVliI.l. 1.00AII0N:
NetJest }own:(1/0/De
h/oer /'2)1-N.,
tStmd N.nuc. min iuis. Coliuilu ity. Suhdicision. Luc No hip Code)
OAVNIIC_ /- /�i� 4.keieL <"
AAdesA [CJ0 elpL.<. 4C11 /kW11
I>nm of ,i r No.l
L 3s Lo33
logo slab iq,(,�de
County 0000
1)1.I II I
Etoin To
1 )- 0 o2'0
Aye., e,de- rl,��ne nnnh" �1J /0C
-1. l)A II: URII— a3 /04— /c73
�. TOTAL 1)I'.1'1 II: ,0,C
/ems �S
6. DOHS 11'LLI. REPLACE EXISTING WELL'? YES ❑ NO (n
S IATIC\\'A"1YIC I. I(VIT. Below TopofCasiiig: o7O FT.
(I4c"'i"itAboee lhp of('nsingl
H TOP ()I' CASING IS FT. Above Land Surface.*
hip ul racing terminatvd at/ur below land surface reouires a
varim¢e iu anon(:mre with 15 \ NCA(' 2('.1111X.
'1_ 111:LI) (gpni): NI IC[I IOD OF I I'S f gir
lu. AV',Cfl[R ZONES (depth):
I I. DISINFECTION. Type r74zjg Aineunt
C,ASIN(i: AVal(- hickness
Ilcplh or UpcichllFL :Al: teriul
From To �o3 rt. (n�5/ ,JJ�i 5J J
From To Ft.
Iirom To Pt.
( ilt011 F. Depth i\Ftterial
I n( 0 Tod20 Et 0.-,e,b77
From _ To
SURE I':N: Ucpth Di;uneter Slot Size
hroln I PI. in. in.
From To II. in in.
N let hot(
Drplh Size Alaterial
Ii 0 III Io I'I.
Material
Topographic/L�aan�dd setting
1? ❑Ridge ❑Slope Valley ❑Flat
(check uppnq,i ;tle bust
Latitude/longitude of well location
(degrees not tc;/sccnds)
iludelloneiludc sourc0Gl'SfTopovr: phic map
amok boll
DRILLING LOG
Iran% align Description
/H
0
,-.0„6: oS77cNr
LOCATION SRIiTCI I
Show direction and distance in miles from at leas[;
two State Roads or County Roads. Include road!
numbers and common road names. ;v "_
;AND
O
Iloln to PI.
o. REMARKS:
DO UO 1IhRI':131' CERTIFY II IAT II IIS VVIiI.L WAS CONSTRUCTED IN ACCORDANCE AvITI 115A NCAC 2C, WELL
('UNSII:VII ION STANDARDS. AND ill I AI' A COP'.' OF THIS RECORD I IAS BEEN PROVIDED TO TIII'. WELL OWNER
.Submit the original to the Division of \Paler Qu:li(s'
27699-I(36 ('hone No. (919} 733-3221, within 30 (la} s.
*IX21, —1— I S— 03
SIGNP( II!I/L o1 Pli.SON i SAL LITN(jFf1nlli \\ a11(J -.-Ni DATE
Iwaler Section, 1636 A 1ai Li
en e Center - Raleigh, NC
iJ
GW-I REV. 07/2001
0

WELL CONSTRUCTION RECORD
Noah ('arolinu - Dcp;ulmcnt of Environment ;Ind Nat iral Resources - Division of Water Quality - Groundwater Section
VA1111.('OS'I R:A(1olt (IND)IVIDUAL/NAME (priut)JC I*�4 4LYJV.2,0� CCERTIFICATION911(0p
N‘ LIT. ('O\ I R.\cr0R ('O\I t':\\V NAME CC We// liced9vr1,2 rno.\E a j$<.t�)6.�%-5:55/
I.\ II: \\ I I.I. ('o\5I Itt('rl(\ I'E ltMIMIS
\SSOCIA'I'I 1) \\'Q Pr:R\I Ft'll
I ❑ nlicahlc) (if ;u )licable)
277427
._ AA l,Ll. USL (Check Applic:lble nos): Residen'l;al ix—NlunicipiIl'ublic ❑ Industrial ❑ Agricultural 0
Monitoring 0 Recovery ❑ I Icat Pump AV;ncr Injection ❑ Other ❑ If Other, List Use
2. \VE:I.I. LOCATION:
Nearest Toven.
lSh
1Srarl N.iuw Numba..
•.vi/y COMO\ /' J/L✓OOc
Subdivision. 1 of No_. /qt Code)
fopographic'La id setting
dge ❑Slope ❑Valley ❑flat
(cheek appropriate has 1
Latitude/longitude of well location
_. O AV N I'. R :E_7 �.a--,y // Idegrecsudnulea/seunulsl
Vddres, L✓ / ,�- p.y�/-S /r� Latitude lun�uitude vourcc:OGPSOTopogrlphic mop
ISinvi of Rook No.) Idmck bus)
rdoe ��, © 7 2 / DIII'TII DRILLING LOG
(a., �„ a:�,rn iodic hip C„d. from To Pyy'I)lullon Description
11- ...______—
Vicy. oidu Phone nunib:r
I. DATE DRILLED 7-7- 03
_,. TOTAL DNPTII: ,_5"05-
0_ DOES WELL REPLACE EXISTING WELL? YES 0 NO 6"--
S1 :V1 IC VVA!1R I.ICVI!I. 13clovv Top of Casio 28 FT.
"� (UseilAhosc lop of Casing)
5. Top or CASING IS of FT. Above Land Surface'
"nip ur casing turminaled al/or below I:uul nurfuce moth -es a
vuriaucc hi aeuordanrc with 15A ,N(':\C 2C .II118. \
o. YIELD (ppm): - NIL'TIIOD OF TES f �'%—
lo. WATER /ONES (depth):
LOCATION SKEI Cli
1 I. DISINFECTION. Type Amrunt Show direction and distance in miles from al least
'. CASING: AVallThickness two State Roads or County Roads. Include the road
Ucplh D%utKlcr or V. ciehCP( i
\I; icraC
T7l numbers and common road names.
I'nan1� To �/6_ Ft. & /9 _ y_.(1 C_ 3
0 _0,2U
02o yt
- t we
0
hall,rt, Ft.
F n)n1 T(1 PI.
I3 I.GUU T. Depth Material hlclhId
loin 0 t o 2C) I I �P..6 4- QVi
ta
I loin To It.
LI tiC RI I : Dcpth Ununcio blot Nzc \imcrial
I'loin I 11.in. in
I I0111 hOLlt. in. _
I? SANI)(iRAA"I[I_PACK
:
Depth Siic '.lutcri:d
I70111 I n
0
(i3
0
N
O
Plunl___.
1�. RI!.VAI21i.S.
I DO I IliR1il3Y (I:RTTI'Y I I I:AT 11115 VV1.1.1. WAS CONS! RUC I El) IN ACCORD:WCE AVI I 1115A NCAC 2C, AVELL
1 t.(NS IPI ('IION S'fAND.ARUS. AND TIIAT A COI' OP T I-IIS ILEC012D I IAS 131'HN I'ROVIDHD TO TIIE WELL OWNER.
.„±a, Cc.(
SIGN,\'I U421t OP Pli Sl
.Submit the original to the Division of Water Qu:.Iih
17699-I636 Phone No. [phone], within 31) day s.
N'h6RlVK I I'G(1, I��II 1AI ILA r----
hiulwater Section, 1636 i iJti 5�
L
...G'(lo tl ' : fioN
'1=l-'03
DATE:
<n C
ce Center - Raleigh, NC
GAV-I REV. 07/2001

Submit the original to the Division of Water Quality
27,099-IQ6 Phone No. [phone], within 30 days.
WELL CONSTRUCTION RECORD
orth Carolina - Department of Environment and Natural Resources: 'vision of Water Quality - Groundwater Section
ELt.CONTRACTOR(INDIVIDUAL)NAMS(print) p /�/N L41/e-1)G CERTIFICATION #..71/i
WEt.f•CONTRACTOR COMPANY NANIE ``f!'C.r NC ADro S . Lh.II c'% / lt}vy, PHONE - 3�
STATE WELL CONSTRUCTION PERMIT# / 17 r +� ASSOCIATED WQ PERMIT# -
(if applioable) (if applicable)
277084
'WELC USE (Check Applicable Box): Residential l9"Municipal/Public ❑ Industrial 0 Agricultural ❑
onitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
., WELL LOCATIO
Nearest(Town:
141
County Fiat tee) bet
(Street Name, N rs, Community, Subdivision, Lot No., Zip Code)
Topographic/Land setting
❑Ridge ❑Slope ❑Valley I;lPtat
(check appropriate box)
Latitude/longitude of well location
'3. OWNER: b 4 Ad -, . /W i l / (decrees minutes/seconds)
Address - 3 'lee .SE. Soez70I'0'r
(Street or Route No.)
3'/e} % 7
City or Town St& Zip Code
Area code- Phone number
4i'sDATE DRILLED 3-- 30 — D 3
C _J re h Latitude/longitude source:❑GPS❑Topographic map
(check box)
,x. 1 DEPTH DRILLING LOG
From To Formation Description
n 33
38' 8os' C1n., .fix
`5:'TOTAL DEPTH: g05 '
gPOES WELL REPLACE EXISTING WELL? YES ❑ NO (9'
'7.' STATIC WATER LEVEL Below Top of Casing: 100 FT.
(Use "+" if Above Top of Casing)
$.':TOP OF;CASING IS I - FT. Above Land Surface*
*Top of easing terminated at/or below land surface requires a
' variance In accordance with 15A NCAC 2C .0118. 9 YIELD (gpm): n METHOD OF TEST c^ in r5
19. WATER ZONES (depth): Lo &.5 ' - 1 -Ap rt.
DISINFECTION: Type 1-i T hl Amount j 09
CASING: Wall Thickness
Depth - Diameter or Weight/Ft. Material
From . D To 3 8 FL is it P V C.
From To Ft.
From To Ft.
QROUT: Depth Material Method
From h To a b Ft. (14 A.via ,a. —roam
From To Ft.
:'SCREEN: Depth Diameter Slot Size Material
,From To Ft. in. in.
{From'- To Ft. in. in.
'''$AND/GRAVEL PACK:
Size Material
From To Ft.
From To Ft.
LOCATION SKETCH
Show direction and distance in miles from at (east
two State Roads or County Roads. Include the road
numbers and common road names.
P. MARKS:
1 DOHBREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
}CONSTRUCTION STAND , AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
e. 6 -30 -6 3
SIGNATURE OF PERSON CONSTRUCTING it WELL DATE
&atif Se+itioh, Io3b Mail�:rs a Center - Raleigh, NC
GW-I REV. 07/2001
OCT 2 9
"nil! inirn
TCD err -rim]
0
0

NORTH CAROLINA DEPARTMENT OF NATURAL RESOURCES AND COMMUNITY DEVELOPMENT
DIVISION OF ENVIRONMENTAL MANAGEMENT - GROUNDWATER SECTION
P.O. BOX 27687 - RALEIGH,N.C. 27611, PHONE [phone]
WELL CONSTRUCTION RECORD
DRILLING CONTRACTOR
DRILLER REGISTRATION NUMBER
a 5//8
FOR OFFICE USE ONLY
Quad No. Serial No.
Lat Long. Pc
Minor Basin
Basin Code
Header Ent GW-1 Ent
27753
STATE WELL CONSTRUCTION ^
PERMIT NUMBER:/ /Z-J
1. WELL LOCATION: (Show sketch of the location below)
Nearest T
2. OWNER
ADDRESS
& SO4t
(Road, Communist . or Subddision and Lot o
a AA -/°i ntiu(-r-rJ
3() 7 1.4 kJ_ Lea etAtt_
C�(Street or%oyte,No.d 7g'7/ /
City or Town C State` Zip Cole.
Ci
3. DATE DRILLED /� //" 3 �0) 3 USE OF WELL ^%�'�-^'Z
i`
4. TOTAL DEPTH 10-5- y CUTTINGS COLLECTED Ill
}% Yes -blo
5. DOES WELL REPLACE EXISTING WELL? ❑ YesNo
6. STATIC WATER LEVEL'
TOP OF CASING IS
7. YIELD (gPm):
/00 FT. al El belowabove TOP OF CASING.
FT ABOVE LAND SURFACE.
/s
8. WATER ZONES (depth).
9. CHLORINATION'. Type
10. CASING:
METHOD OF TEST aC1 A ?es
ow S '
2 S ' 9' �.
firs Amount (1 f 3
Depth
From /v To .?
From To Ft
From
11. GROUT:
From
From
12. SCREEN:
Wall Thickness
Diameter or Weight/Ft. Material
6 I Ft
PVC
To Ft
Depth oo1� Material i � Method
To d) Ft. ( PA.M P.1.L[�
To Ft.
Depth Diameter Slot Size Material
From To Ft. in. In.
From To Ft. in. in.
From To Ft in. in.
13. GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
14. REMARKS.
CERTIFYI DO THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15 NCAC 2C, WELL CONSTRUCTION
County:
Depth DRILLING LOG
From
3/
` To ) ho ation Description
{ , 1/
CO
-73
CO
If additional space is needed use bac�f foal.
LOCATION SKETCH u
(Show direction and distance from at least two State Roads.
or other map reference points)
GW-1 Revised 6/88
TA HEREBY AND
STANDARDS, THAT A COPY OF THIS RECORD HA, S BEN PROVID �O THE �WE�OWNER. �/ � 3
SIGNATUREAREOF CON RACTTOR OR AGENT DATE
Submit original to Division of Environmental Management and copy to well owner.

NORTH CAROLINA DEPARTMENT OF NATURAL RESOURCES AND COMMUNITY DEVELOPMENT
DIVISION OF ENVIRONMENTAL MANAGEMENT - GROUNDWATER SECTION
P.O. BOX 27687 - RALEIGH,N.C. 27811, PHONE [phone]
WELL CONSTRUCTION RECORD
DRILLING CONTRACTOR &4 /6-41- }LLLUU_
DRILLER REGISTRATION NUMBER 4.,7•q YS
FOR OFFICE USE ONLY
Quad. No. Serial No.
Lat Long. Pc
Minor Basin
Basin Code
Header Ent e" _
STATE WELL CONSTRUCTION //
PERMIT NUMBER: /'Y'Q
1. WELL LOCATION: (Show sketch of, the locationbelow)
NearesTt-own: A.,n�
County: 4'tLL/ /.tje7Ord
Depth DRILLING LOG
(Road, Communit%x, or/subdivision/ and Lot No.) P / ' �/
2. OWNER ...jn1 ,C-34(aL+rfl?.... //b'/-�-J� ,JJ�I. e J �6e U ,I
ADDRESS `l )� I (,(,Ji2�4-4.J ei-Lc1.. /c/X /Dl pio iLiif�u7 to
Str e or Route o.)
V)2a. 14trmor ,c7c _2 f 751
CUy(Pr Town Sl tate Zip Code} i
/^-
3. DATE DRILLED 1'a 2 -%) -i USE OF WELL ,%LP 1d PY 14 A-J'
4. TOTAL DEPTH .546' CUTTINGS COLLECTED El Yes 'lo
5. DOES WELL REPLACE EXISTING WELL? ❑ Yes
6. STATIC WATER LEVEL: / FT. belowabove TOP OF CASING,
TOP OF CASING IS / FT ABOVE LAND SURFACE.
7. YIELD (gpm): 4 METHOD OF TEST 02 AP 5
8. WATER ZONES (depth).
a 26' 3 m
4 (AC ' %
9. CHLORINATION: Type / /7 Amount 9� 'fLy/A
10. CASING:
Wall Thickness
Depth Diameter or Weight/Ft. Material LOCATION SKETCH
/� i 1
From 0 To /(/ /� Ft !o V (Show direction and distance from at least two State Roads,
From To Ft or other map reference points)
From To Ft
11. GROUT: thode
Depth P_ //77 Material M
From � To�Ft. (�iYVLO b1
From To Ft.
12. SCREEN:
Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
From To Ft in in.
13. GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
14. REMARKS'
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15 NCAC 2C, WELL CONSTRUCTION
STANDARDS, AND THAT A COPY OF THIS RECORD )HAS/BEEN PRO �,{CI.DD TO THE WELL OWNER. g
From To /
drittiion Description
W
•
If additional space is needed use back of for.
t
r ��
GW-1 Revised 6/88
SIGNATURE OF CONTRACTOR OR AGENT DATE
Submit original to Division of Environmental Management and copy to well owner.

WELL CONSTRUCTION RECORD
277534
North Carolina- Department of Environment and ral /Resources -
Division
/pf Water Quality - Groundwater Section
�/
WELL CONTRACTOR (INDIVIDUAL) NAND (print) P h I ,v '((-[,t/0J 4 _ /s CERTIFICATION�JI�# a/?�(7/ia
WELL CONTRACTOR COMPANY NAME( rr/OPfl , £rv6• £t)QYJ 9 {Y)(/ /7�%)Ol[il- PHONE # (rJ,�(f'(O¥6 ..3/?�'
/462 /
STATE WELL CONSTRUCTION PERMIT#
(if applicable)
ASSOCIATED WQ PERMIT#
(if applicable)
1, WELL USE (Check Applicable Box): Residential Municipal/Public ❑ Industrial ❑ Agricultural CI
r Monitoring ❑ Recovery 0 Heat Pump Water YIN.
0 Other 0 If Other, List Use
WELL LOCATIO
st Town: / County
(Street Name, bus, Community, Subditislon, Lot No.. Zip Code)
.3. OWNER:
Address P n am( /? / 3
(Stre t of Ro tc .)
lryiQ, tyrov4r1NG -$7J/
( City rpwn State Zip Code
. 1/r
(�)
Area code- Phone number
41';DATE DRILLED 7- / ' - D.
5. TOTAL DEPTH: / dig
6, DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7,, STATIC WATER LEVEL Below Top of Casing: 80 T.
(Use "+" if Above Tap or Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
valance In accordanci with ISA NCAC 2C .0118.
9. WIELD (gpm): /S METHOD OF TEST 07 / ,PS
W. WATER ZONES (depth):
1.. DISINFECTION: Type /-f 7 7-/
12F'CASING:
/,25' - I< pm
Depth ir,Diameter
From 0 To •56 Ft. 6 r' PV C
;::.From To Ft.
From To Ft.
l3.'GROUTh, Depth A Material Me hod
From F/ To C Ft. (P .Vvt.('iir
From To Ft.
-14. SCREEN: Depth Diameter Slot Size Material
,'»From. To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
Amount / a
Wall Thickness
or Weight/Ft. Material
From To Ft.
From To Ft.
Topographic/Land setting
❑Ridge ❑Slope ❑ValleyFlat
(cheek appropriate box)
Latitude/longitude of well location
(degrecs,m inures/seconds)
Latitude/longitude source:OGPSOTopographic map
(check box)
DEPTH DRILLING LOG
From To f Formation
nDDescription
5R' %dS' �..�
tTh
CO cr.
n_
0
LOCATION SKETCH
Show direction and distance in miles from at let
two State Roads or County Roads. Include the, ad -,:
numbers and common road -names. '•
CD
16;' REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STAND D , AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSO
Submit the original to the Division of Water Quality,
`27699-1636 Phone No. [phone], within 30 days.
7-3/-�3
FII DATE
t
��L t r1
LIlh.1ndidAtt FF r) itle Center - Raleigh, NC
GW-I REV. 07/2001
JJ
GRDUN!
f

277532
WELL CONSTRUCTION RECORD
orth Carolina - Department of Environment and Natural Resources - �Div4Jsion/of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NA�MJ�''�(print) /"�Q �7 /.f LG/C� h A CERTIFICATION # .i III/S
WELL CONTRACTOR COMPANY NAME`s} t, PD ► AA AI . U)/.1f. 4- ra-itri BONE q (yo /O S/ D' - 3 / 7n
: TATE WELL CONSTRUCTION PERMIT# / yaz ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
WELL USE (Check Applicable Box): Residential Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATIO
Nearest Town: County
/n*F n dht-/ e/Xr P, r �,
(Street Name, Numbers, Community, Subdivision, Lotd7oo,.?Zip Code)
3 `OWNER: tthli /61/{7. (lint 4 ,C, ,L
•
'Address 130 Ha t6 t/r";4
z (Street or Route No.)
/.LAte.)
JG &d p /
//nP S If //J 7 A ' &'(
City or own State Zip Code
( )-
Area code- Phone number
4 'DATE DRILLED %' /.Q
.5.+TOTAL DEPTH: 75/5 /
6,;DOES WELL REPLACE EXISTING WELL? YES 0 NO Gra
7. STATIC WATER LEVEL Below Top of Casing: /Do FT.
I(Use "+" if Above Top of Casing)
8. TOP OF CASING IS FT. Above Land Surface*
tTop of casing terminated at/or below land surface requires a
-.`- variance in accordance with ISA NCAC 2C .0118.
-4„YIELD (gpm): .2 METHOD OF TEST c2 AR-S •
10. WATER ZONES (depth): - q pm
II. DISINFECTION: Type f-i-754-
12. CASING:
Depth Diameter
From D To .67 Ft. /' "
From To Ft.
From To Ft.
131, GROUT: Depth
From 1) To .29 Ft.
Frbm To Ft.
Amount / I 1 a
Wall Thickness
or Weight/Ft. Material
PI/e.
()Material _t
(t AzIL.4r�l�-
ethod
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
5., SAND/GRAVEL PACK:
Depth Size Material
From ` To
From To
Ft.
Ft.
Topographic/Land setting
❑Ridge Ifd'Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees: minutes/seconds)
Latitude/longitude source:OGPSOTopographic map
(check box)
DEPTH DRILLING LOG
From To Formationpescription
D .S/��
l / ' 75/S' „/,.0 1 �
0
LOCATION SKETCH - Show direction and distance in miles from at iitst _- two State Roads or County Roads. Include tt e 'oaden
numbers and common road names.
16.REMARKS:
I DO HFREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STAN S, AND THAT A COPY OF THIS RECORD HAS
BEEN PROVIDED TO TIIE WELL OWNER
`tom %lJe-t c� l' •..ii
SIGNATURE OF PERSON CON RtrffiCffrn -WEtt- -t?ATE
I 1 1 .I
Submit the original to the Division of Water Quality, Groud4W.lkt ctimr, 1636 6ntlterdce e * r - Raleigh, NC
27699.1636 Phone No. [phone], within 30 days.
f1`I 11 i Clyt-1 REV.07/2001
J I� ;' J'
t. ,

14. `SCREEN:
From
From To
15. SAND/GRAVEL PACK:
Depth Size
From ' To Ft.
From To Ft.
277531
WELL CONSTRUCTION RECORD
.North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section J
WELL CONTRACTOR (INDIVIDUAL) NAM (print) CERTIFICATION # 364
WELL CONTRACTOR COMPANY NAME it 0 aw.,.L/ /Qhi4 • /t%t,L.l, 1< .«h ' ONE # l�-7k �' in? -3/ 4TATI WELL CONSTRUCTION PERMIT*, / S/D 2. ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential ♦Municipal/Public 0 Industrial ❑ Agricultural 0
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2.' WELL LOCATIO l
-. e est Town: Q�U 4me S z / � N0- County ! e .< L an fr I "nq In. - V,'l/a-jrc ePln (itpp L.
(Street Name, Nuel-nbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: �CLhSOJ� er
Address % a 4-7rr A
(Street o Route No.)
tb_Al es of /% I A/ !� rfl 7 g to
CI or Town Stare Zip Code
Area code- Phone number
4 :DATE DRILLED '7 It' - O3
5. TOTAL DEPTH: 1,06-
6: DOES WELL REPLACE EXISTING WELL? YES 0 NO lW
,7. STATIC WATER LEVEL Below Top of Casing: 4 /, FT.
(Use "+" if Above Top of Casing)
`8. TOP OF CASING IS FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance In accordance with ISA NCAC 2C .0118. q
r 9. YIELD,(gpm): a METHOD OF TEST c�[ 17 yes •
10. WATER ZONES (depth): 90 / - i r�1
11.DISINFECTION: Type / /
12. CASING:
Depth Diameter
From e To a / Ft. 6 "
From To Ft.
From To - Ft.
Amount /.2 7
Wall Thickness
or Weight/Ft. Material
13. GROUT: Depth Mauer ial y Method
`-, Frpm d Too 0 Ft. r!'y�yy�e.N-C
From To Ft.
Depth Diameter Slot Size Material
To Ft. in. in.
Ft. in. in.
Material
Topo raphic/Land setting
❑Ridge Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees. minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To _ , Formation Description
v a / �p
v2 / ' ,54/t1' it/
�.
LOCATION SKETCH —
ShorO direction and distance in miles from aUgast two State State Roads or County Roads. Include t roadi
numbers and common road names.
16.:REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
'7-3/ —n 3
SIGNATURE OF PERSON CON
Submit the original to the Division of Water Quality, Grou
27699-1636 Phone No. (919) 733-322t, within 30 days.
CTING THE iSLLL ,DPTE
illtkilir-Seet-iettzi-fr3trAtait
r - Raleigh, NC
I REV.07/2001

WELL CONSTRUCTION RECORD
pith Carolina - Department of Environment and Natural Resources - Division of Water Quality
r l f 1 7
WELL CONTRACTOR (INDIVIDUAL) NAME (print)
WELL CONTRACT R - .
OR COMPANY NAME iYL'en YDS •�Z_ J) `I Yu »sALP
STATF_WELL CONSTRUCTION PERMIT# /'SRO-t ASSOCIATED w'Q PERMIT#
(if applicable) (if applicable)
PHONE #
277530
- Groundwater Section (
CERTIFICATION # a4// a'
gig. - 3I 7D
I: WELL USE (Check Applicable Box): Residential Municipal/Public 0 Industrial 0 Agricultural 0
.Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATIO, !� //
Nearest To n: Jr.) County A6 yI hi9F.L
',(Strcet Name, Numbers, Community, Subdivision, Lot No., Zip Code)
�+ {{Street ooute No.)
City or Town State s Zip Code
( )
Area code- Phone number
4., DATE DRILLED 7 — 9 - 3
5. TOTAL DEPTH: 4 af5
6, DOES WELL REPLACE EXISTING WELL? YES ❑ NO ti
7.'; STATIC WATER LEVEL Below Top of Casing: inn FT. w
' p (Use "+" if Above Top of Casing)
8:' TOP OF CASING IS / FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
, -variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): % :L METHOD OF TEST a I rS .
-o
Topographic/Land setting
❑Ridge ❑Slope ❑Valley `1-It
(check appropriate box)
Latitude/longitude of well location
Idegrees:minutes/seconds)
Latitude/longitude source:DGPSOTopographic map
(check box)
DEPTH DRILLING LOG
From To Forma Description
.4
4Ij5- Azic.,L,.
': 10. WATER ZONES (depth): 3 25 ' - I es{) on
11. DISINFECTION: Type /-47-24 Amount j r 6 3
12.: CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From o To 3Q Ft. 6 t, pv/'
From To Ft.
-'.From To Ft.
i 13.!GROUT: Depth Material Method
From 0 To 2L) Ft. 0tA wA,id
: From To Ft.
M. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
' 15. SAND/GRAVEL PACK:
Depth Size
From• To Ft.
From To Ft.
Material
LOCATION SKETCH c�1 <a.-
Show direction and distance in miles from atVast r-,
two State Roads or County Roads. Include thSoad
numbers and common road names.
16. RE1v1ARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STAND ' D AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
7 _.3 /: D 3
SIGNATURE OF PERSON CONST �l-}c1.
tI
$ubWit the original to the Division of Water Quality, Ground w rFetion, 1636 Mail Service 41t Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. I ify� �I REV. 07/2001
n
NG_THE'WNE[j '..
•

WELL CONSTRUCTION RECORD 277529
North Carolina - Department of Environment and Natural, in L
Resources - Division of Water Quality - Groundwater Section p
.W
WELL. ) FONTRACTOR (INDIVIDUAL) NAME (print) h t A')P ��h CERTIFICATION # 2Vi
WELL CONTRACTOR COMPANY NAME G rttay 81-0 i — L-Ujj 4- Pc ..oce PHONE k iaa L - 3 1 ' t
-STATE WELL CONSTRUCTION PERMIT# I Y'b a ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
WELL "USE (Check Applicable Box): Residential
Monitoring 0 Recovery 0 Heat Pump Water
WELL LOCATIO
NeTowp:
,Municipal/Public 0 Industrial ❑ Aericultural O
njection 0 Other 0 IFOther, List Use
County aY/1/t ce)._
f)ao QS .
(Street Name, N ers, Communnii'Subdivision, Lot No., Zip Code)
1 OWNER: bit, (/ .0 . NU
Address
1284/- flirt ,, C gal: ret)•
cct or Route No.]C City or Town State/ Zip Code
( )
Area code- Phone number
4. DATE DRILLED `� - '1 - 0 •3
C aAt�f' �o1$7!LO
(Use "+" if Above Top of Casing)
Submit the original to the Division of Water Quality, Groun
27699-1636 Phone No. [phone], within 30 days.
'5.: TOTAL DEPTH: 4 a5
6.''DOLS WELL REPLACE EXISTING WELL? YES 0 NO 114.
7.``'STATIC WATER LEVEL Below Top of Casing: / cu FT.
$. TOP OF CASING IS I FT. Above Land Surface*
'Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9.. YIELD (gpm): 4 D METHOD OF TEST a ti rs
;10. WATER ZONES (depth): cos S ' - 4 0 q p m
Topo raphic/Land setting
❑Ridge lope :Walley ❑Flat
check appropriate box)
Latitude/lonaitude of well location
(degrces. minutes/seconds)
Latitude/longitude source:OGPSOTopographic map
(check box)
DRILLING LOG
Forma Description
l' r.
DEPTH
From To
D /a2
ia2 1 41aC'
I L' DISINFECTION: Type Hi T N
12, CASING:
Depth
From 0 To /.i.,_ Ft.
From To Ft.
From To Ft.
Diameter
G
Amount 4 9
Wall Thickness
or Weight/Ft. Material
PVl.
13,,GROUT: Depth Material Method
From L To .2D Ft. C D nn..e.M± 4r.----13
From To Ft.
14.' SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From ` To Ft.
From To Ft.
[t to . ie
0jui
C
C)
LOCATION SKETCH
Show direction and distance in miles from at:Waist ,=-
two State Roads or County Roads. Include thloroad•:%-.
numbers and common road names. c-'
0
16. REMARKS:
� ` 1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STAN DS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
C
SIGNATURE OF PERSON CONS TING THE WFI I D
ftllrtlr ifi�4n hl ail-1 r a etitk
t-1
3
- Raleigh, NC
I REV. 07/2001

WELL CONSTRUCTION RECORD
277528
'North Carolina - Department of Environment and Nat al Resources - Division of Water Quality - Groundwater Section ,/
WELD CONTRACTOR (INDIVIDUAL) NAM print) /�1�7 �,I A-+IJ�t� ��,,ii J,//t�_�—, �, CERTIFICATION # `N/
WELL CONTRACTOR COMPANY NAME IO_4.Np, /r,/aide, Y /!Y zlYR!'-PHONE #
ASSOCIATED WQ PERMIT#
STATE WELL CONSTRUCTION PERMIT#
(if applicable) (if applicable)
1.- WELL USE (Check Applicable Box):Residential iMunicipal/Public❑ Industrial Agricultural
Monitoring ❑ Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use
2.' WELL LOCAT ON Top aphic/Land setting
Neartes Town: /L County y. \,�C/�f �O ❑Ridge lope ❑Valley ❑Flat
.: 1 / / f a.� tCL - .iP Pi -LCLC �LLf'1.11-(-!ry t`„-FJ-i- Ln (Iw -: ppropriatc box)
(Street Nam , Numbers, mmunity, Subdivision, Lai No., Zip Code) Latitude/longitude of well location
3: OWNER: Cd Lan - CICX-z-ett 1" (degrees minutes/seconds)
-Address '7 enJ. ' i. ' Cyl � •. RA_ Latin) e gitude source:C7GPS❑Topographic map
treet or Route No.) )check box)
J( dI � % %Z. I DRILLING LOG
CityorT wn State Zip Code Form io Description
/S1Ua
Submit the original to the Division of Water Quality, Groundw
27699-1636 Phone No. [phone], within 30 days.
Area code- Phone number
4:DATE DRILLED %- 3 - b 3
5. TOTAL DEPTH: L305 '
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO '14-
7,. STATIC WATER LEVEL Below Top of Casing: 07/0 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surface*
*Tap of casing terminated at/or below land surface requires a
variance In accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): /o METHOD OF TEST � Ii e5 -
10. WATER ZONES (depth): l 41 t - 45pm
11. DISINFECTION: Type N T1-1 Amount 5/
12. CASING: Wall Thickness
^ Depth,. Diameter or Weight/Ft. at'nal
From---6/�- I�To L/23 Ft. //7 /l 't
- From To Ft.
i r From To - Ft.
13. GROUT: Depth aterial hod
From 6 To �� Ft. l OnYN /Att r�
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
-From To Ft. in. in.
:From To Ft, in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From - To Ft.
From To Ft.
DEPTH
From
4,3'
0
CO
G
LOCATION SKETCH
Show direction and distance in miles from atabut c.:.
two State Roads or County Roads. Include the-rroad
numbers and common road names.
16, REMARKS:
t DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARD$, AND THAT A COPY OF THIS RECORD FI$-BLEN PROVIDED TO THE WELL OWNER
7-3/-03
SIGNATURE OF PERSON CONSTRUCTING THE WELL nfATEE
1 ^ t
kaleigh, NC
lEV.07/2001
J
7 Lh
LL"

WELL CONSTRUCTION RECORD 277527
North Carolina Department of Environment and NaJ.y(ral Resources - Division of Water Quality - Groundwater Section ' /
WELL CONTRACTOR (INDIVIDUAL) NAME print) /tiJ/C/ etAtt LL , A CERTIFICA ION #.3/0Y'/
WELL CONTRACTOR COMPANY NAME lt4lL.ta /L' /S�r �i1 //) ) CG i(i. U -45I4ONE # �o VS -
STATE WELL CONSTRUCTION PERMIT# / z ASSOCIATED wQ PERMIT#
- - (ifapplicable) (if applicable)
l WELL USE (Check Applicable Box): Residential [ Municipal/Public 0 Industrial 0 Agricultural ❑
L Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other 0 I (Other, List Use
2.'WELL LOCATIONA
Nearest Tpym: l �xt u /7rtr.
�C� ///9
(Street Name, Num s, Community, Subd
OWNER: W�
Address .5r 6Y-Yin
(Street or Route No.)
LY)C
City or Town / State
(—)-
'Area code- Phone number
4.'(DATE DRILLED /n - 3D-03
S. TOTAL DEPTH: St /)S
6.4-DOES WELL REPLACE EXISTING WELL? YES Q NO
7. STATIC WATER LEVEL Below Top of Casing: 40 FT.
(Use "+" if Above Top of Casing)
8, TOP OF CASING IS 1 FT. Above Land Surface*
*Top of casing terminated al/or below land surface requires a
variance In accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 7 METHOD OF TEST 02 Lrs
10. WATER ZONES (depth): !o - a q p n--)
County____ f
ion. Lot No.. Zip Code)
Zip Code
Depth Diameter
From /i To /a3 Ft. G " /2 L/a
'`From To Ft.
From To Ft.
13.' GROUT: Depth /,4�`A'�aterial
_Frgm 1 To_�_ Ft. Li).Vf -P4( r
n
:.: From To Ft.
14. SCREEN:, Depth Diameter Slot Size Material
From To Ft. in. in.
. From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
11. DISINFECTION: Type N 771 Amount /x'3
12. CASING: Wall Thickness
or Weight/Ft. Material
Method
Topog aphic/Land setting
❑Ridge Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/loneitude of well location
(degrees: minutes/seconds)
Latitude/loneitude source:❑GPS❑Topographic map
Ichcck box)
DRILLING LOG
To Format'on Description
/03 ' 1
DEPTH
From
/t3
riet
U
LOCATION SKETCH r
Show direction and distance in miles from atlaast
two State Roads or County Roads. Include the„eoad -4
numbers and common road names. c;
O
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
'Yj }J
SIGNATURE OF PERSON CONSTRUTh D4Q1i1TUE. W€LL__
7 J/ G3
DATE
Submit the original to the Division of Water Quality, Groundwatdrj SeUio;i.-463t. M�ai1Scr ice_Ckutetq f la eigh, NC
27699-1636 Phone No. [phone], within 30 days.
i �. GW-111 fl.EN. 07/2001

I DO HB.REBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
t';. CONSTRUCTION ST ARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO TIIE WELL OWNER
,Z ,h�e,I
WELL CONSTRUCTION RECORD
27752.6
North Carolina - Department of Environment and Nan�{(al Resources - Division of Water Quality - Groundwater Section , /
WELL CONTRACTOR (INDIVIDUAL) NAME (print) /�,L,�7j�Lt.I /].t t t /�llr/.C-�f'� CERTIFICATION(4...36 Y'/
( fyso-, L.�u _ 17t *-FHONE # (god.i to 4ig - .3 / 7 °
WELL CONTRACTOR COMPANY NAME err e e... /
STATE WELL CONSTRUCTION PERMIT# /'`'M .2 ASSOCIATED WQ PERMIT#
(if applicable)
(if applicable)
1. WELL USE (Check Applicable Box): Residential* Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery ❑ Heat Pump Water Injection ❑ Other 0 If Other, List Use
WELL LOCATIO
Nearest)Town�lt /% County
( t7 n(1 )�r�{
(Street Name, Numbers, Community, SubdivikIon, Lot No., Zip Code)
OWNER: l'}c�Ci �A C7" }t -
Address / 2 9 ' Dfl� �x r. t
(Street or Route No.)
City or Tfwn State
( )-
Area code- Phone number
4 'DATE DRILLED to - � 03
5.: TOTAL DEPTH: 705' �,/
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO i1
7. STATIC WATER LEVEL Below Top of Casing: 2 d FT.
(Use "V' if Above Top of Casing)
8.-TOP OF CASING IS ( FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
`variance In accordance with ISA NCAC 2C .0118.
9.. YIELD (gpm): '3 METHOD OF TEST 2 A rS
10, WATER ZONES (depth): G 55 ' - `3 rM
02s'7z
Zip Code
To aphic/Land setting
❑Ridge lope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(dcerucs minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH - DRILLING LOG
From To
o gs1'
g i ' '765'
I. DISINFECTION: Type /1 r /
12. CASING:
Depth Diameter
From D To g 7 Ft. t' "
From To Ft.
From To Ft.
Amount
Wall Thickness
or WeighdFt. Material
D4�
_ 13. GROUT: Depth Material _t_.
From D To �C Ft. 0eMt a�tt .0
From To Ft.
14.' SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15,'SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Fom at n Description
21A,
G7
LOCATION SKETCH
Show direction and distance in miles from atiatst
two State Roads or County Roads. Include thfoad^`-
numbers and common road names.
—
16. REMARKS:
N ct 7-3/-63
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE-(
Submit the original to the Division of Water Quality, Groundwf ter Section, 1636 Nlail Sin lee Center'- JFaleigh, NC
27699-1636 Phone No. [phone], within 30 days. GVU 1 REV. 07/2001
ULFICE

NecOP
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Reso ces - Division to Water Qua
WELL CONTRACTOR (INDIVIDUAL) NAME,//�� (print)
yyyyyy
WELL CONTRACTOR COMPANY NAME April
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT
(if applicable)
(if applicable)
270916
- Groundwater Sec(
CERTIFICATION 83.(jQ7„l
4..1,• (i1 1�1 PHONE # in WWI ti.3
t, . ups
1. WELL USE (Check Applicable Box): Residential qY Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATI•N:
Nearest Town: . _im .. - Cou
(Street Name
3. OWNER:
Address apS LA 0 Dom•
y�1��1Dd
rs, Community, Subdivision, Lot No., Zip Co
GY
City or to
( )-
Area code- Phone number
4. DATE DRILLED 3— S-v./0
5. TOTAL DEPTH: +.LC) tS
6. DOES WELL REPLACE EXISTING WELL? YES L] _NO C-
7. STATIC WATER LEVEL Below Top of Casing: •+gyp FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS FT. Above Land Surface*
Zip Code
(Street or
T owta
'Top of casing terminated attor below land surface requires a
variance In accordance nIth ISA NCAC 2C .0118.
9. YIELD (gpm): METHOD OF —TEST.
10. WATER ZONES (depth): 3q. LJ
11. DISINFECTION: Type -Tit h1k4 Amount Z
12. CASING: Wall Thickness
Depth Diameter or WeighUFt. Material
From 0 To 4 5 Ft.
From To Ft.
From To Ft.
13. GROUT: Depth Materialsos v
From To Ft.�Q» •A>1
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
Ft. in in.
Ft. in. in.
Topogrra�pphic/Land setting
❑Ridge OSlope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
Frotn To Formation Description
!, (' vsltiwth
From To
From To
15. SAND/GRAVEL PACK:
Depth
From To Ft.
From To Ft.
16. REMARKS:
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
-NttA.M4I 22.,4„( ` vS
(:?((eu)‘"d CokYa C9L`<
Size Material
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
CONSTRUCTION S TANDAR , AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
3-1R•0'�
NATURE F PERSON CONSTRUCTING THE WELL DATE
Submit the original to the.Dtvist�n of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. (919) 7334221, within 30 days. GW-1 REV. 07/2001

279512.
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and NResoutces - Division of Water Quality - Groundwater Sectiotp2 f%
WELL CONTRACTOR (INDIVIDUAL) NAM (prlat) /U �/ C J A71-L CERTIFICATION
WELL CONTRACTOR COMPANY NAME
. y-et e4. (1S t C.P t ital iw PHONE 1 f?gf SV9- d f'Ka
STATE WELL CONSTRUCTION PERMIT# �{/ ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential Pit Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other ❑ If Other, List Use
Topographic/Land setting
❑Ridge %Slloope [Walley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(depots/minutes/seconds) I ' -- - i-;
Latitude/longitude source:❑GPS❑Topographic t$p
(check box) ...-
DEPTH DRILLING LOG
From To Formation Description
fn
rn
l•l
0
C)
tV
LOCATION SKETCH `a "= a
R
11. DISINFECTION: Type Amount 5' d Z Show direction and distance in miles fromtlea4 1--
12. CASING: Wall Thickness two State Ito.. or County Roads. IncludeRSe roaal%n
Depth Diameter or Wei t/Ft. Tbers and
From 0 To 4 D Ft.ni P'//Cr Q
From To Ft.
From To Ft.
13. GROUT: Depth ' Material �MethGocd .
From To.�tl_ Ft. fib- t
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/ RAVEL PACK: y
Depth Size Material
From o Ft.
From To Ft.
2. WELL LOCATION:
Neare Town County /tre/�
� v J�
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER:
Address J %/) Z°&at. .e etc - .S. Pry #7 I
Route
t/NC. r-.28 ///
(Street
City or Town State Zip Cate
Area code- Phone number//
4. DATE DRILLED lO ca..5//J .3
5. TOTAL DEPTH: .z I S '
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO .N
7. STATIC WATER LEVEL Below Top of Casing: 3 a FT.
(Use "+- if Above Top of Casing)
8. TOP OF CASING IS /,S FT. Above Land Surface'
'Top of casing terminated atfor below land surface requires a
variance is accordance 15A NCAC 2C .0118. •
9. YIELD (gpm): METHOD OF TEST % t
10. WATER. ZONES (depth): /4/2
16. REMARKS:
mmon road names. tV
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUL 1tt) IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, Ajub'}'fiAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
j!TJi ! _
SIGNATURE OF PERSOIS CONSTRUCTING THE WELL / DATE
cn 5,
m�
c1
0
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
Not ('aiolimi - Department olt'.uvironntent and `aural Resources - Division of Water Quality- Groundwater Section
\\ 41. I. coy! u\("nut comp \N\ \.\\I4: raze 3/L/
s fAIT: \Vl-.LI. ('0\S fKCC"I'IOS I'r:u sin"I N
Iii IppleIhle)
VAI1.1. (()A Il(.A( I Olt (IADIA IllU. L) N.AAll f) will')
e//De
(1:} or lo"n S1.::1: hip ('!dc
l )
:A:ca coe- rn:,nc !Hind,•f','✓�j
t.:A I I. DILII.I.IiD J' Q_•3
5 ItTAI. l)FPTI
o. I)0I S WELL. RI::I'LAL Ii EXISTING WELL? YliS` /D NO127
7. S FAIR: \VA 1rR LEVlil, Below Top ul Casir 7� FT.
tusc"''i(Al'u •'fop ofCasinpl
X. 1 ()II OI' CASING IS « PI'. Above Lind Surface'
`lop nl casing lenniu.n ra al/or beiurt land aurae rc^Hirer a
rariauac in vrcor-dance \cilli I5:\ NCAC 2C .0118.
YIELI)(cpni): 420 MI[TIIODOETEST A(r-
lu_ AA'A IM< ZONES (depth):
11. I)ISINFI!CT ION. Type -l/7-# Am: -ant
:'. QASIN(I: AVall-:hicknc,ss
Depth Di:fn tier or \'. cieh Cl l 1.Ilerial
IoIl a I l �� I . 0'T ((s*(—
hnnn ru----__.- I.1 --- - -- — - -
iY (ikOJ1 Depth blatcriu AIcrhod
Itow._Q.____Tn.._c2D__ 19. C ,m64-i
t 1. SCRI'.IiN: Depth I)iaulelcr Slut '.I zc \I:ntria
I loan fu
I loin IU ._____ I't._ - ._III. -___.- In.
SAND (iltAVIII. PACK:
Urinh Site ' \I:a er iai
279579
/1/ T/`O CJ CERTIFICATIOCERTIFICATION11'"W6!
✓ —
ASS()CIA fF:n \AQ I'lt(\IITli
(il ❑pplicable)
I WTI" LSI. (Check Applicable Uo.N): Rcsidert::al Dr. -TV unlcipalil'ublic 0 Industrial 0 Agricultural 0
\Innitoring 0 Recovery O Beat Pump \'Vo'cr Injection 0 Other 0 Ift)thcr. List Esc
VA'ELL. LOC'iATION: . /
NL,r sI ow": .9Ago ✓... --- - (aunl. 4 WO01G7
IGhir Aan:e. N r.h a. ('oi : �n1)in. SuhJ: �'.i q ll in Nb_. Zip L� dc1
( 1 W NI I:: --rq .y
\dth as. 1rtm (A14.V
\II.Y'I Runic No.)
Inro Io _- _- Tit.
IIt'll l To II.
Its If I'.AI:\RKS:
Topographic/Uric! setting
L99l,,c ❑,lope ❑Valley Dflot
(check ::,,,.-,':':I hex)
Lutitude!lon_Iwdc ut wett locution
Idcgrccs.:ninl:esisccoudtl
Lalinldcaongiuldc sourcc:OGPSOTopograpllic map
tcheck boil
Dlil'TII ORII_I.ING Loa
I rnln To Ij,!r )at un 'description
670
f7
,C Oct'
LOCATION SK FTCII
Show direction and distance in miles limn al least
Iwo Stale Roads or County Roads. Include the road
numbers and common road names
tt' /3
3
O
111) I 'LIMB)" )" C FR Il P1" Il IAF TI I IS WELL WAS CC •NSl RUC TED IN ACCORDANCE WED! I iA NCAC 2C, WELf;r
CONS I RUCTION STANDARDS. AND TILAT A COP'( OF THIS RECORD I IAS BEEN PROVIDED TOI TIIE WELL CIWNEji
SIGNATURE OF I'E7SON CONSTRUCTING THE WELL
DATE
Submit the to In the I)ivisio❑ of water Qua ' -.lily, Groundwater Section, I6}(1 Mail Sec ice Center- Ral(tigh, NC
27699-1636 Thane Nu. [phone]• within 71) dais, CiW-I RE\F•'O712001
'tat r-'---.-

WELL CONSTRUCTION RECORD
\'I,ItPi (.:iiolina I )eparinlenl or Environment and `,Hurd fjesowccs - Division of WaterVA t:ll (UAI 1tV( IOlt (IAD1AIDI AL);A.AMI (Iriur),Itj!/�Ui�� (1
Zyr
\\VI I t()Nnt x(r MU (WII \N\ \,\)Ir: /,(-C Neil?" Un
ti I'.\ IF \\ 1 1.1. (lt\S! RI"CI'IU\ I'I(u\(rips
t ifnppliclhle)
279578
Quality - Groundwater Section
CERTIFICATION a0.774Y
PHONE x ) 7
\SSUCIA I ED wQ PEIt\ ITS
(irap[llialble)
VVI:l I. USE (Check Applicable Box): Resider:ial ❑ INliinicipaPPuhlic ❑ Industrial ❑ Aericullural ❑
monitoring 0 Reeuccry 0 IIcat Pump Wa'cr Injection ❑ (idler 0 I(Othcr, List Use
2. WELT I.I. LOCATION:
Nc'Ircsa TI'vvn okkes v%Ile
---(Amury y14),,,,
ncclN,tin . Naunber, (\nlnuuullr Sul in'Fuji Lnl Ab_Lip Codel
OAVNI:I(.t$oU`I- O..)IE2f�
Add,— uric 7 f—��l/�
trey u : Rollie Nil.l �j
�1\e)QSv 4 L1�1 - 07 DEPTH
Toro I I lie Lam:I setting
❑Riduc slope DValley ❑PI:II
Idnck:ppn, :acb„I
Lalitude'longitude of weir location
1degrces m inules>ecu ids\
La iiitic:Io tit de sourcc:OGPS❑Topouruphic map
(check bm1
DRILLING LOCI
r I,ncn SLae 71p (',tde [Finn Fuin:lr on Description
( )-
ae
r // •
/'Ir'N• T�
rl_ DIES VVLLl_ ItEI'LACL EXISTING VNULL! YNS ❑ NO V
7 S VATIC AA ATIiR LEVEL Below Top or Casin'c: c2aX. FL
tllse -. ' it Aisne Top orCasinel
"ICA' UPC':ASIN(i IS Fr. Above Land Surfiec*
ne ul casiu„ Wrrrlinaird at/or helu., lanll i,rrace re:;vires a
c:lri:nlcc in accur Mute rrilh 15.\ NCAC 2C.011S. _\
11" YIELD(=''PIII): AINTI1OD OF ThSr .69-1,
11_ AV:ATFAZ ZONNS (depth):
I I. UISINI:L'CTION_ Type Ain: tint
12 CASING: AVolt Iiickiiess
I)epthDi net o\'. eieht'Pt.
Frolu ItTo r 7ik IrLL
Proin To__
I tom T,I I-t.
(ilZl ll' IDepth
I low _P "Io
I "fo
I Si I'I 4'- _Depth
Iloin Io
I rota I IL___. ..
I.' SAN!).
Depth
I rolls IU
I lnlll _. _.._.. I IL.
lb REMARKS:
A
rlaleri:d \Iethnd
lIc p.vi f!'
fu'ng
1h;unelel Slot :'...ic ;ACnerial
III.
111. III.
tit/e ' :Lkric I:II
FI
D1T I. DEPTH- /-?5 + yc',s-
LOCATION SKETCH
Show direction and disluncc in miles from al Teas
t vri S1a!e Roads or County Roads. Ineludc ru:-g
numbers trod common road mantes. (..)
I 1 n) I II'RI!lil" CFIZ ll l'1' "fl IAT THIS WELL WAS C(.-N'STRUCTED IN ACCORDANCE WITI 115A NCAC 2C, WELL
( DNS TRUCI ION STANDARDS. AND TI1AT:A COP'' OF THIS RECORD I IAS BEEN PROVIDED TO 'HIE AVELUOWr ER
-v
N o<
\Drat r'
a ,—'-I
3 z
O rfl
n
O
9:3
SICN;A ruRL uF Pr,:x)IN CONSTRUCTING THE WELL DATE
.Stilintil the urigival to the Division of Hater Qu lily, Groundwater Section, 1636 Mail Service ('enter R c;Qi NC
2709-I6to Phone No. [phone], s ithin 31) d.n s. - CiAl 1 Rfh4S O/hUB}-_. __:

279576
WELL CONSTRUCTION RECORD
Nnrlll ('mAuld - Department or Environment and N; coral Resources - Division or Water Quality - Groundwater Section
„1 I ON1U%('!Olt II\DI\'!DU .,I.)\.%N 4: (rrlul) it±{.Q CE121-litc vi #
IIL \(I(11. ( min AN1 \A\IEf.cC L _Q-2VMp.____--- ------ P DOND: # fQ71,f77g-O/0
„b.I.I. CO\S I ICCI ION rF:u i
l;lphlicuhlrl
ASSOCIATE!) ED,r Q Prt(\Irrn
f it applicable/
I \VNI.I. t)SI. (Check :\pplic;lblc IhN): Resider: ial 13 IV lunicip;lil'ublic ❑ Industrial ❑ Aericuhural ❑
Vlonilorine ❑ Recovcry 0 Heat Pump War Injection 0 Other 0 Irathcr, List Usc
'. WELL LOCATION:
Nc;l cs'I I'w,,./L_1�R, j Collnl:. 'Y)/((%'rej
1 ¢imrl Niue. Number..(omn uml tv. Su6divlmuti, I,u1 No_ 7.p Cock/
,. n\VNI1It: ic/ottrn n
n,llhe,. 1y1.7
( i1C nr ),n,n
151rcut .n I(oulc Nn.l
`idle lip Code .Arc, a:Idc- Phone numbs
I. D:\tdi DIM .I.LiU " .1
,- Lc) rAI. urrrl l lam FJ
UOFS \VELI. RLI'LACG LNISFING WELL!
7. S VATIC AVATh:R 1.8VFI. IJriow Top orCasin
Iuse it ,\hove
101' Or CASING IS FT. /Ahove 1
')bp nr casing terminated :n/or helm, I:nul ,urrace rcn
rari:Incc in accord:u,'c with I5.\ :NCAC 2C .II1 IN.
r u.LD (spin): /0 tin'.TIIOD OF TES
u. AVAI'FR ZONE.S (depth):
YES 0 NO Er
Top or Casing)
.and Surklcc'
area a
rA."T
opographic::Land setting
titles ❑Slaps ❑Valley Ono
(check apptoprruc bout
Latiludc'lungitudc orvveil location
Idegrecsdninul tux'eon Jet
Lotivalelluncitudc sourcc:DGPSOTopoerapllic map
t cheek bus)
DItII.I.ING I.OG
Inn Description
yi
rmirriI
17um fu
p rS
7e,
Zt L�—
I I. DISI :1I'ITCIION-Tvpc /cf _ Arm tilt
i_ G\SING: \Val/ iickncss
To
Di:y»cicr ur/G,e tI PL3F-reeII
In,n1 �lb � hL_�/j �/ /7
/
17u1n To
Lunn__ _ lh Pt.
i 1 GROUT: Depth �^ Matorial .lethal
I nru1QTn C Ll.Ce e t
I lol,I Tl1 1:1.c.
LI. SCI+.I'-II.N` Ucpd1 I)i:uncicr Slur b zc ,Alatcrinl
I tom To l9. in.
De1/111
IYa111 I,I
11I II11 I,I
Site
Et.
I.
' Material
J5'g-vD/
A/Q �a rDS (lL
purl tii/e
LOCATION S K ITC/1
Show direction and distance in miles from at lead
t vu St:tic Roads or County 1(oads. Include the road
nunlbe,_s and common road names.
/305
CD
0
c
0-
0 r;'
cr,
0<
-4o
H�
rno
rn
flz
0
c1
0
I I )O I II RI:131 CLICI In 'HINT THIS WELL WAS CT•NSTRLC fED IN ,ACCORDANCE win' I iA NCAC 2C, WELL Ir t. t)1NS 11/l-(LION S I ANDARDS ANDTI-IAl A COP'' OF THIS RECORD IIAS HENN PROVIDED TIIE WELL OWIVE$'
1-15- 03
SIGIN:AILttE OF PERSON CONSrRLCT I:NG 1li1 WELL DATE
Submit the original to the Division of \Vater Qurlity, Groundwater Section, 1636 \i:lil Service Center- Raieiph il'C .•
27699-1636 Phone No. [phone], ,vithin 30lass. CiAV-1 REV. 0 t2f1D

WELL CONSTRUCTION RECORD
.North (:Irolina - DeparInienl of Environment and N)/;4Inra/Il csources -[ Division of Water Quality
\\ 1.1 I. CON Ul. \('1(lI (INDIVIDUAL) (trill)' 7/e�/{�y 1,yTV/i De
\\L:1 I.coy:it.\('loI< (O\II'\\\ NAND: (.Le WQ� 2 F
S I \l r: \\'F EL CONS -IR('CI'10\ I'EIt\IIT# ASSOCIATED \\ Q I'ER\Irr#
I irapltrc:J,le)
(H.:1ppl'cable)
279575
- Groundwater Section Q
cE.Itrl FIC'AIION #CQ51d/
in
I WELL t:SLi (Check Applicable fax): I:csiden.i:l O tAlunicipald'ubhe ❑ Industrial ❑ ,Aerictltural ❑
Monitoring 0 Recovery 0 Heat Pump Wafter Injection 0 Other 0 IIOlher, List Use
VVI:LL. LOC:ATIC N: l
Ne:Iresi Town: Qn1 04✓—Caunl, ,14/1AIL cc
CI J,}ree A91-, _
', Vmu:. ": ubal.. ('•nIn „ ih. Svhdivi „'I. Lsn No.. Zip C.idel
OWNI:I::T:MJ' � ;��,�
ddl,•ss (jig Erg?))/ e /YI`-
11ImeI ar ItoWL No.)
ErN,0Ai AI,C. 02g7/6
Loy 1u„„u Sile Zip Code
\ nine I'hnlm main„: . '1
1. D:viI DRll.l.lit —1 — o ?
s. rot Ai. NTT II: yg3—le-f-
( I)0I'S WELLILLI'L.ACL EXISTING WELL.' VIiS ❑, NO I�
7. S IA"IIC AV'ATLI< LEVEL Below Top of Casing: g.& Fr.
llJ e•+"it Ahow Top o1Casing)
T(,I' ()F C:\SING 1S Fl. Ahovc !.and Surlbce*
"'I tip id' c:rsiug'Irrmin:nett altor helm. land suR:mc re:; •.!ices a
variance ill acuonlau a rvirh I5.\ NC:\C 2C .0113.
ELD Icpni)- CJ ME1l SOD OI''I
n.\ r.ST /� i
IL WATER ZONES (depth):
TopograpIlieThmi>etting
❑ Ititlge ❑Slope (9'V,Illey ❑FEO
{cheek ,trpopi k Ite b„N)
Latitude, long itude of well location
I degrees; m i11 W esixcouds 1
LatitWJe lonciluilc source:❑GPS❑Topoerlphic map
(cheek bos)
DRILLING LOG
Ply;nhyliott,Description
L . my
c?o S't
-o /n
Zos *t S
DILPT11
Rota To
U 0.10
II- DISINFEC1loN. Type //I/ Am•..an'.
12 LASING: AVal) iickncsa
Ucplh Di;yneier or \'.eight 3 1. 91ay_ri it
noturo_ Ti) 7tS itG7 //y
Ron) l n h.
1'ronl To_._
1l (ik( IL f: Dcpd1 alcrial ./ 1 lcthod
I root _Q__ T„„_°AC PI. LNle—t evil"
I loin To 1'1.
1.1. SCI I EN. Depth O„'under Slur `..e Material
I tom. .Io Et.__..__.in
I loin Eo I t in
I3. SAND („RAVE!. PACK:
Depth Size '\laterial
from _- Io I'I.
1 loll' to I'I.
lo. RENI:A IL KS'.
LOCATION SKETCH
Show direction and distance in n)iles from al (east
tvvo Sent Roads or County Roads. Include the road
numbers :Ind C0111111011 road names.
/567
0
CO
m
-13
\D
O
r
r.
1)O I II Chit (EILIII 1 0 LAT THIS WELL WAS C(•NSI ILLC rED IN ACCORDANCE WITI I I\A NCAC 2C, WELL1-
CONSIPL(_I ION STANDARDS. ANDTIIAl A COI'1. OF THIS RECORD IIAS I3EEN PROVIDED TO TiIE WELL (*NO(
9-a3
DATE
-� ��a f/ SIGNAIL'RE OF PERSON CONSTRUCTING it-IE WELI
Submit the original to the Division of Water QL:. lily, Groundwater Section, 1636 ;\Tail Service ('enter- Ral(ugi, NC
227699-1636 Phone No. 1919) 733-3221, within 31) th:i . CiAV-I ILEV 07/2001

WELL CONSTRUCTION RECORD 279574
.North ('atohm:1 - Department of -Environment and'd(u Iral Rc.ources -/Division of"Water Quality - Groundwater Section// NWI.CON] I<.\LI< II<(INDI\IIDUAL) NANII rilil)1/�e•7' /4-.764fie CERTIFICATION
\\ 111 CO NI It.\C FOR (I \II \N1 N.\NIF:P e le/e// (/M------------—-----_rnosi k gat)6g2ra
SI.\'IF: \\ ELL CONSTRUCTION I'EIt\IT# ASSOCI:\l El) \\Q I'ER\IIT#
(:(applicable) (ir apLicublcl
VA 1:1.1. LSE (Check Applicable I3ox): Residen:al EriclunicipaI'I'ublic O Industrial ❑ Aooricuhural O
:Alcnilorine 0 Recovery ❑ Haut Pump Vv'aier Injection 0 Other 0 IlOther, List Use
VALLL LO( :A I ION;
Neves 'rO\\n d1��e_ Cuunl•
tee t2e -
Nam:. N nl ",< coiniminu,. Subdi�i.I u. Loi No. IT C' oriel
OWNER:rr, Gig���
il
tll r reus'miuwesisecoals)
Add'css �i. S_ . L:ui iudeilungitudc souree:OGPSOTopocraphie map
y4o_c R- / DPTl DRIII.NG LOG(Slleel s(cheek bust
TopographiclimsLtielting
❑ILitIUc ❑Slope 'alley ❑Plat
I check aerropi elle boll
Luli ludclongitude or \Veil IOcalian
CuF nr lone Si le lip Cede
Area aide- Thine uuud, •
I. DATI.ORILLIit,-0�0-03
S.
lul'AI. 1)I[I')'11: /4,5 {p-
O_ DOES WELL REPLACE EXISTING WELL? V'IiS 0 NO Ekt—
7. S I:\1lC \VATLR LEVEL1Below Top of Casil'.•':x.
Use ''+" IIAhocc Top or Carmel
tor Or CASING IS F"f. Ahovc Land Surface
'Tqt u1 easing terminated al/or belmv land surface re;: ires a
variance in accord:mei: with ISA NC:\C 2C.(1113.
V1EL12lupin): 57OF TEST /�
(!. WATER ZONES (depth):
Run) To Form' t ioly Description
c2o
y7
1.00'A'IION S KIITC'H
I. DISINI YCTION. Type f47'/74 Amr wilt Show direction and distance in miles loan :it least
C : ASING: Avail 1lickness Iwo Siaue Roads or County Roacls. Include the road
Depth!iJi D;im,,leler or V. 2ieht; I:I i\1 tes iul !twill -lets and common road name:
o-
I:ion Tn I'I_ 4/ 35 CO o
I!um 111 I t C n C)
r*i
(iKOI T: Ucpd1 Material plethoJ -p e"
I- l o n .
i2 —0!Q I'I. rCGKi�AZ� (V
I cunt To Ft2,0
.
I -I. S(P LIEN'. Ucpth l) vneter S'ot Line M:neriul 20. m�
3 O
zr.r
., mz
she
1'1011 I 1__. 1O I Liu iu.
Depth Si/e .I:Ierial
I.z rt
Ilon1 .ro
la. RE AIA12KS
I Ut) HEREBY I21'.IBY CER l I!:Y TI IA"I THIS WELL WAS Cl •NSTRUC ED IN ACCORDANCE \VI11I I SA NCAC 2C, WELLV
ONSI RLCIION SIANDARDS. AND TI-IAT A COPY OF THIS RECORD 1-IAS BEEN PROVIDED 10 TICE WELL CO/NE
Vv SIGN;ATl1RE OF I'EI:SON CONS-H(UCI INGTIiE. WELL DATE
0
Submit the original to the Division of 11'ater Qurlity, Groundwater Section, I616 Mail Scrci<c Ccnlrr- 12:dciy,If, 1 �C
27699-1636 Plume No. [phone], within 31) day,- G\V-I REV;fi. )01
LL.:

WELL CONSTRUCTION RECORD
North (';oolin:t - Deportment of Environment and/Ninural Resources - Division of Water Quality - Ciroundwater Section'//�j
\\ ra I. ('ON'I It.\('T(lR (I\UI\ Illt \I.) NANII print) / /� ( is/1i E. CERTIFICATION k.2 r(�/
\\n IT ('ON'I If. \(' FOR (C ONO' \N 1 N.\NIP:/'f�Cc 1.2.4 /pk- J,a FnONE # t9?S 472-$SYS
r.cI F. \\ 1,.I.1. ('0\S rRCCI-ION I'EIt.\lI I N
I T;litlicuhlel
ASSOCIATED wQ I'ERNI ITN
(ir ❑pplicablc)
I AA'LI.L USI. (Chuck Applicahlc Box): Residcn:i;ll IEK-Nlunicipal%I'uhlic O Industrial 0 Auricullurul 0
.Alonilorinu ❑ Recovery 0 Heat Pump VVa'.ar Injection 0 Other 0 II Otllcr, List Use
_. AVGI.I. LOCATION:
Nen.es1 I t\e11 47/ fount:.,.
(Sliccl iNtlnla. '1nulhmlr.(',NIm unity. 5ubdivisitnl. Lm No 7.
l l\VNlflt:
AN
\ddlc., D' ate'-Ql` /f)- .�2_
(odct
/'r,/k I\li.el sit nip 4-• N�i.)ir-�O
I I. UISI^J I'PCTR)N
(IIAnr ltn` aide lip (tide
,Ale.( coda I.6"lie uurnhs
1. D,All( URILI.IiU� -QV C2.-3
IOTA(. 1)EI'111: / �}
6. DOES AVLL I. REPLACE EXISTING WELL? 1-ES ❑ NO
7. SI':\'I IC WATER LEVEL 13clow"fop orCasin-1: 022 FT.
X. tUse ".." if Abut,' 1 op of Ca+ingl
'I'(11' OE CASING IS Q� .Above i.and SurLlcc'
m up of a:wiu;; ierminatcd al/ur Il lim laud a:rrare retdlires a
variance its uccuriancevtilt 15A NCAC 2C .0118.
Qr 'n. YIN LI) egpnll: >0 NII:'fI IC
I1!. AVATEI3 ZONES (depth):
..hype-�A
C:ASI.N(.i:
......-Topt-Itz,rapiticitancl setting
0ltidge ❑tilOJC ❑V,Illey ❑Plat
(check app-up-iaic htnl
Ldliludc�lun� Itudr of Weil loc,lliun
Idegrceslwinules;seeondsl
Laliludcilongitudc soarcc:OGl'SOTopographic map
dmck bust
ONPTI 1 DRILLING LOCI
I -rule Ta Forryttitin Descripl ion
9
LOCATION. SIC P:TC'll
2795.73
hers and common mac( names. 9
o 26
w
From //5�
Ir nn lL Irl.
I GICOUI: Ue1n11 cu.I NIcihod
hum; T /�/ 6c`> , �•-fie
Depth Di; nielel
wilt Tt, y� �y
I win hp
1-1. SC.RP.I+N: Depth Di:uncicr Slo; :.izc Nlnlcri:d
I'I nm Tu II. iu. in.
I lout f)I__. I1. In. iu.
12'. SAND'(IILVVI.I. ('AUK: _
)cplli Si'c ..I.:lerial
Amc Show direction and distance in miles from al lensi
Wall hickuess two SI:uc Roods or County (toads. Include the road
or \`. _iuhl'Pt. D1 tcri:d ntml
rake /
I.11t111 IU II
I (tall _ I I1 1:1
It, ULAIARKS:
✓tT-
�r1
o<
>0
m
cno
rn r
n�
0
I Do 111RI 131 CERTIFY II Y II I:AT II-IIS WELL WAS CC-NSI RIJCTED IN ACCORDANCE WIT( I I SA NCAC 2C, WELLCONS"ONSTRUCTION STANDARDS. AND TI1Al A COP `' OF (HIS ftECORD I1AS 136IfN PROVIDED l'O TIIL WELL OWNER I
///a GW44,t— Y
SR ;NATURE: OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the (Division of Water Qn::lily, Groundwater Section, 16361\Iail Service Center- Rolcig{i;-NC
27699-1636 Plume NO. [phone], within 3(1 love. (iAV-I REV. 0712011

WELL CONSTRUCTION RECORD
North Carolina - Department of Envirottment and Na
WELL CONTRACTOR (INDIVIDUAL) NAME (print
WELL CONTRACTOR COMPANY N
STATE WELL CONSTRUCTION PERMTT#
(if applicable)
279508
Resources - Division of Water Quality - Groundwater
Section
CERTIFICATION 472/9
6iO eltfliONE # irt Eel yel
ASSOCIATED WQ PERMIT#
(if applicable)
1. WELL USE (Check Applicable Box): Residential Pit Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATIO :
Nearest TCounty,
(Street Name, Numbers,
umbers, Conununity, Subdivision, Lot No., Zip Code)
// 3. OWNER: (1un
Address + / ZL S .e ed
t (Street or R«No.)
eice. k MC. ea- r,
City or Town State Zip Code
(-7c
Arca code- Phone numbers
4. DATE DRILLED Cr/ *2.� O ✓�
5. TOTAL DEPTH: .2 i S
6. DOES WELL REPLACE EXISTING WELL? YEA❑ NO PO'7. STATIC WATER LEVEL Below Top of Casing: ..2 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS J S FT. Above Land Surface'
`Top of using terminated at/or below land surface requires a
variance In accordance with 1SA NCAC 2C .0118.
9. YIELD (gpm): / T METHOD OF TEST k-ink?o
10. WATER ZONES (depth): 75' / 5!s'
11. DISINFECTION: Type Amount s O Z
12. CASING: Wall Thickness
Depth ameter or Weight/Ft.Material
From To 1, Ft 2.
From To Ft.
From To Ft.
13. GROUT: Depth„ ,At Mate,rials� aid '
From 0 To t�a Ft. (.���7LYr.D� .t-�-/TttiT,/
From To Ft.
14. SCREEN:
From
Fro
15. S
From
From
Depth Diameter Slot Size Material
O Ft. in. in.
To Ft. in. in.
/GRAVELPACK:
Depth
7/To Ft.
16. REMARKS:
To Ft.
Size Material
Topographic/Land setting
❑Ridge *Slope ❑Valley ❑Flat
(chkh appropriate box)
Latitude/longitude of well location
is
(de&tes/mimaes/seconds) _-- i j il1
Latitude/longitude source:OGPS❑Topographielnapc ,
(check box)
DEPTH DRILLING LOG "-_ —�•
From To Formation Description
c
m
LOCATION SKETCH
Show direction and distance in tniles from a(ast `2,
two State Roads or County Roads. Include thOroacg
numbers and r mmon roaC ,names.
to r
my
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THe)' A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL D TE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

2 \ V 2'i0
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR(INDIVIDUAL) NAME (print) 'biter Z(K efi ' .0.K, v.Cg CERTIFICATION a4'}fc
WELL CONTRACTOR COMPANY NAME C WAR )Qu% t th on faeV\*"reu m'P In PHONE # ( !o(oS-ile,2"-Z
STATE WELL CONSTRUCTION PERMIT# - ' ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box) Residential IN Municipal/Public 0 Industrial ❑ Agricultural 0
Monitoring 0 Recovery 0 Heat I ump Water Injection 0 Other 0 If Cther, List Use
2. WELL LOCATION:
Nearest Town: Cc--nlor County l,�wCa
(do et 5}ac 0..-aae 2aoa awl lio
(Street Name, Nwnbers, Community, SYbdivis an, Lot No.. Zip Code)
3. OWNER: tI ._J
A1ek <H^o-'
CDC' At 'tos (i�ye
(Street or Route No.) f
cca4Gf MC- aSIRD
City or Town State Zip Code
(53Z )- (of*S- 11.71
Area code- Phone number
4. DATE DRILLED 8- aa'03
5. TOTAL DEPTH: 3O b
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO RI
7. STATIC WATER LEVEL -Below Top of Casing: 180 FT.
(Use' t" if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surface*
*Top of casing terminated at/or below land mrface requires a
variance in accordance with 15A NCAC 2C .2118.
9. YIELD (gpm): 5 METHOL' OF TEST R: d
10. WATER ZONES (depth):
Address
Road
SIN
1
Topogrghic/Land setting
❑ltidge °elope ❑Valley ❑Flat
(check appropriate bos)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check hot)
DEPTHDRILLING LOG
From To Formation Description
A- :0 m$ eves C,etdae'
be To 306 CrM:�e
II. DISINFECTION: Type ir\S
12. CASING:
Depth Diamei 7.r
From t A To CPS Ft. (oEk
From To Ft.
From To Ft.
13. GROUT: Depth Mat rial
From 0 To aO Ft. Ce-44nt
Amount
Wall Thickness
or Weight/Ft. Material
#}2.1.
TS F;C
Method
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. 'n. in.
From To Ft. 'a. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
1 DO HEREBY CERTIFY THAT THIS WELL L WAS CONSTRUCTED 1N ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THA T A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
gaoo3i
SIGNATULE OF PER N COt STRUCTING THE WELL DATE
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the mat
numbers and comrnon road names. W
nm
rn
m
-0
O
c.n
Submit the original to the Division of Ater Quality, Groundwater Section, 1636 Mail Service Center -Raleigh; NC
27699-1636 Phone No. [phone], withn 30 days.
GW-I REV. th/2001
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WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section }�
WELL CONTRACTOR (INDIVIDUAL) NAM[ (print) DCec:C Ic }\fQ�1s baw.>t�e cg CERTIFICATION #
bon filet\Q-?uni int PHONE # ( to(05-go2'L
WELL CONTRACTOR COMPANY NAME �\\ '�l�f� P
ASSOCIATED WQ PERMIT#
(if applicable)mancommeacommoccom n
STATE WELL CONSTRUCTION PERMIT# `
.(ifapplicable)
I. WELL USE (Check Applicable Box): Residential ® Municipal/Public O Industrial ❑ Agricultural O
Monitoring O Recovery O Heat I ump Water Injection O Other O If Cther, List Use
Topographic/Land setting
AitRidge ❑Slope OValley OFIat
(check appropriate bo::)
1 atitude/longitude of well location
2. WELL LOCATION:
C. k. t� County Tia>,i,a 0 00
Nearest Town: —
33 S & cc-....a1.4)ct ,(b)na
(Street Name, Numbers. Community, S bdivis an, Lot No., Zip Code)
3. OWNER: re- cc Aka." ^0.4,
Address 3-b. S latc.nabee\ P.caa
(Street or Route No.)
tal rl t to Ci r„� NC Zip Town State Code
(j)_ tnv8 Sicb5
Area code- Phone number
4. DATE DRILLED b' \i,o-el _
5. TOTAL DEPTH: t IS 5 r
6. DOES WELL REPLACE EXISTING WELL? YES El NO
NO N ,;2,o
7. STATIC WATER LEVEL -Below Tol . of Casing: /0 FT.
(Use' t" if Above Top of Casing)
8. TOP OF CASING IS t FT. Above Land Surface*
*Top of casing terminated actor below land surface requires a
varianceIELDin accordance):0ith 15 METHOE NCAC 2C OF TEST R: 9. YIELD (gpm):
10. WATER ZONES (depth):
11. DISINFECTION: Type_ca\_._._—_— Amount %
12. CASING: Wall Thickness
Diamei sr or Weight/Ft. Material numbers and common road names
Depth r
From t-\ To ao FL_JQ i#2t 4\45i:e_
From To Ft. _
From To FL
Depth Mat 'dal Method
13. GROUT: p From O To a0 Ft. C¢, inn+ Po rs
From To Ft _.
Diameter SCREEN: Depth Material
From To Ft. :n.
From To Ft. ia.
15. SAND/GRAVEL PACK: y
Depth Size
From To Ft._ _
From To Ft._
(degrees/minutes/seconds)
Latitude/longitude source:OGPSOTopographic ma p
(check box)
DEP H DRILLING LOG
From To Formation Description
} \ io 2.0 QVQS Pag'dnrs
185 Gs-o.:re.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELI
CONSTRUCTION STANDARDS, AND THA
Slot Size
in.
in.
Material
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
0
WAS CONSTRUCTED IN ACCORDANCE- WITH I5A NCAC 2C, WELL
T A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER'CTI
_ tV
SIGNATUI E PERSON CONSTRUCTING THE WELL d (4t
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center- Raleigh, NG ;r r_s*
27699-1636 Phone No. [phone], with n 30 days.
DATE

\\ I I, ('O\'II( k('l(11((I\DI\ I )t \I.) 1:\\IL:
«I(I I ('O\'I R. \(`I (r CO\IP \N1 \.t\ii
279577
WELL CONSTRUCTION RECORD
North (':colts' - Department ar Environment and Natural Resources - Division of Rater Quality - Groundwater Section
print) / ✓lL /Y�U1} D� L'k; R'rI FIC\"Il0]' tay69
�%.._7 rno\IC s l ii-g$YS
I cI?: \\ h.l.l. ('O.S"I (1.(l ION I'EI \Irru \SSOCI:\ IT D 1\'Q 1'ER\II'r8
(if ap,j lii'ablel
lit applicable)
I AVLI.L USE': “Check Applicable 130.x): Residential Ili IAlunicipatI'ublic 0 Industrial O Agricullural ❑
\ioniloriue 0 Recovery G Heat Pump AV;I:.:r Injection 0 Other 0 If Other, List Use
_. WELL LOCATION: N: res' 1 own'.- NP _INA co.!,a"r&/-$ _� arm
1 Snecl Nana N:nnbcrc (''o/m:nm:n_ SubJkisi„n. Lot No_. 71p Ci,Jel
Cc
O\VNlflt:
\\Wi cs>
1A 'A c: Rul:lc No!(
Iy nrluo:: Sue /:pCode
1 1-
:1ica :�•dc- rh„ao numb:i�/
D:\"Ili URILI .L[1_/"/ 7-03
OTAI. miry if:
`,yk1 *?4tbp"
(:. DOES WELL REPLACE EXISTING WELL? VES O NO
7. S I':\ITC \VATLIL LINEI. Below Top ofCasir 0. .33 PT.
( Ilse `r" &Aha.e Top oiCasinpl
•.. lit OF CASING IS ( PC ;Ahave Land Burrow'
'aLp or casing lermivarcil aUnr brine I:uut ', rLac requires a
Variance in accordance silt 15:\ \CAC :IC .0118.
'1. YIELD (cpnll: /0 NII:TIIOO OE !NSr 6,51,-1--
Id_ AVA!FI< /ONES I depth):
II_ DISINII!CIION_ Type
12. C:ASIN(i:
opographic'Land setting
Lid,_c ❑Slope ❑V:dley ❑Plat
(check appnq,nate 1,0n 1
Latitudeflungilude or well location
I egrees:minwe>/seconds)
latitude/longitude sourcc:OGPSOTopog raphic map
(clmd: has)
DRILLING LOG
uNP111
otn Tn
-Q 670
y-2
P -gi:Rio t Description
is
Depth Di:i ncier
How To 90 Ft. ‘;///
1rl,Ill I I,
1,„,,,,_ fo 1'I.
II (iltf! F. Uc1iili s Iteriul \lothod
CI TI loin o� � aE-.i/1)YMMM�
1 win to
1-1. Sr h.l I:N: Depth Dl:uncler Sln`dir :Nlatcriul
I loin To lit iu. ill.
I oot Tu Pt_ in. ill.
IS
Dept ll
I-cral
!pan
lh RFAIAIt KS:
Size 9 NI:aerial
LOC'A"IION SKI: rcI I
AnP,-:-Inl Show direction and clislance in stiles from to (east
VA'all tickuc,ss two Sine Roads or County Roads. Include the rc9l
or V. sicht:Tt_ Nrtc•ridy numbers ;Ind COM111011 road names.0
7 I'/) /
o
rn
Dc
a m°
0
O m�
limom
r
lc -
I DO I Within' CERTIFY 1 T HA"!' 0-ITS WELL WAS CI. NS IRUCTED IN ACCORDANCE WITI I ISA NCAC 2C, WELL '
CONS I RLC HON STANDARDS. AND THAT A COPY OE I HIS RECORD IIAS BEEN PROVIDED TO TIIF WELL OWNER -
SIGNATURE OF PERSON CONSTRUCTING TIE VVIELI.. DATE
Submit the original to the Division of \\'aler Qu: lit', Groundwater Section, Ih16 ;\Tail Service Center - Raleigh, NC-.
27699-1636 Phone No. [phone], sitTin 31) dins. G\V-I REV. tYT001--...-