Md CY2003

267845
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
CERTIFICATION # 2602
PRONE a [phone]
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Larry Wells / Mike Lusk
WELL CONTRACTOR COMPANY NAME Appalachian Well -Dulling
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WO 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: Bernardsville County Madison
Draganet,#1, Lot #129, Bernardsville, 28709
(Street Naine, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: AMERICA'S HOME PLACE
Address Lot$129, Thistle Tree Lane
(Street or Route No.)
Bernardsville, N.C. 28709
City or Town State Zip Code
( )-
Area code- Phone number
4. DATE DRILLED 2-9-03
5. TOTAL DEPTH: 265'
6. DOES WELL REPLACE EXISTLNG WELL? YES O NO El
7. STATIC WATER LEVEL Below Top of Casing: 30 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): 100 METHOD OF TEST Gallon Container
10. WATER ZONES (depth): 205, 260
I I. DISINFECTION: Type TABLET Amount 2
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 155 Ft.
From To Ft.
From To Ft.
13. GROUT: Depth Material
From To Ft. CONCRETE
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Et. in. in.
15. SAND/GRAVEL PACK:
Depth
From To Ft.
From To Ft.
Topographic/Land setting
❑Ridge OSlope OValley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:OGPSOTopographic map
(check box)
DEPTII 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.
14-Z3
POUR Method �H' & 1 CW'* G rLo �t
Oa'I i ti 5 Di. lei t`C_
Size Material
16. REMARKS:
{ Y lc • C�J
YV�'t' `cio o�J � rn
y i s+-(c rCi ce�-
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELI.
CONSTRUCTION STAND, tDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
st 2- I Z-cl 3
r SIGNATURE. RSON CONSTRUCTING THE WELL DATE
rr
Submit the original to the Division of.W'.d(er ality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699 1636 Phone No. [phone], within 40 ys. OW-1 REV. 07/2001
I
c
011-0
0
0

267849
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Reso
WELL CONTRACTOR (INDIVIDUAL) NAME (print)
WELL CONTRACTOR COMPANY NAME
STATE WELL CONSTRUCTION PERMIT#
(if applicable)
1. WELL USE (Check Applicable Box): Residential E Municipal/Public 0 Industrial ❑ Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other ❑ If Other, List Use
Topogran�hie/Land setting
d e Q61ope ❑Valley ❑
2. WELL LOCATION:
Nearest Town: uSdyV
Street Name. Numbers. Community, Subdivision, Lot
3. OWNER:
Address
City or Town
(__)-
Arta code- Phone number I _ (^ r 2
4. DATE DRILLED ^--� J
5. TOTAL DEPTH: 22
6. DOES WELL REPLACE EXISTING WELL? YES NO 0'
7. STATIC WATER LEVEL Below Top of Casing:
(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): ZO MET OD OF S
10. WATER ZONES (depth):
11. DISINFECTION: Type Amount �t.___-
12. CASING: Wall Thickness
//�� Depth Diameter or Weight/Ft. Material
FromyL—To (Q Ft.
From To Ft. ---
From To Ft'
13. GROUT: Depth Material
From To Ft.
�
From To Ft.
14. SCREEN: Depth Diameter Slot Size in.Material
From To Ft. in.
From To
FL in. in.
15. SAND/GRAVEL PACK: Size Materiel
Depth
To Ft. — To Ft. --
- Groundwater Secjp�3)
CERTIFICATION st�.Ls�Qpa�r y
PHONE # l2atiale.4f..7
L.
ASSOCIATED WQ PERMIT
(if applicable)
WV.. Rig Flat
fCounty r r Y1t1Y,(S0I�
u (check appropriate box)
JZip • Ol Latitude/longitude of well location
Zip Code) Z��Q9
(degrees/minutes/seconds)
Latitude/longitude source:OGPS❑Topographic map
(check box)
DRILLING LOG
Formation Description
From.
From
State Zip Code
Method
\
DEPTH
From To
t OCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
Z3 o
•-11*%i \N -(C - \v e 1 •
-fio\Q'r c, Coo C_
- v\ea C-0400 54-
16. REMARKS:
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
rnNSTRI)CTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
. submit the arigii
27699-1636 Phone
mdt
9
SIGNATUR • OF PERSON CONSTRUCTING THE WELL DATE
he Division of Water Quality, Groundwater Section, 1636 Mali Service CGWrI REV4C001
9) 733-3221, within 30 days.
hnC � ;TIOii
hSHEVILLe OWFICE

North Carolina - Department of Environment and Natural Reso ces - Division o
WELL CONTRACTOR (INDIVIDUAL) NAME (print)
WELL CONTRACTOR COMPANY NAME
STATE WELL CONSTRUCTION PERMIT#
(if applicable)
1. W ELL USE (Check Applicable Box): Residential i" Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
WELL CONSTRUCTION RECORD 2 6 7 S 5 0
Groundwater Sec�3
CERTIFIC�A�T�IO�N�#�.�.a�{aQa.w�1
Appall ttC PHONE # 141.T—�t E.
ASSOCIATED WQ PERMIT
(if applicable)
2.
WELL LOCATION:
Nearest Town:
try 3_ me Jbe tub 1
(Street Name. Numbers. Community, Subdivision, Lot No., Zip Cade) Z,$'SO�
3. Wei. IC Y � I
1Q County f Ste`
Ks YK SVf «�
OWNER: i .0
Address (JX •3: -
pt
in6oritouteNoJ I0
cis ��e. rltVls 1
Zip Code
City or Town State
Water Qua
Topog_r_aphic/Land setting
❑Ridge QSlope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minute/seconds)
Latitude/longitude source:OGPSOTopographic map
(check box)
DEPTH DRILL_.ING LOG
From To Formation Description
Area code- Phone number —�-
4. DATE DRILLED
3 ------
5. TOTAL DEPTH: Z.
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO Ce.
7. STATIC WATER LEVEL Below Top of Casing: [ ea 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. f s �• 1��*
9. YIELD (gpm): 7 S METHOD OFTEST.+ 10. WATER ZONES (depth):
11. DISINFECTION: Type Amount __.7...—_
12. CASING: Wall Thickness
/�
Depth Diameter or Weight/Ft. Material
From_C__To rev Ft.
From To Ft.
From To Ft.
l3. GROUT: Depth Material
From To 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
Depth Size
From To Ft.
From To _ Ft.
I OCATION 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
O n
�q z3
Method �A-1 kldsv/ i
�°'��_ -t}-o) cio w.b-F. Cps
c� � 6 k AWfi:
rV c
1AkCdo1\ C.
s ICJ i c-Cs
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTIO AN BARD AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
—6
Submit the origirl(t
27699-1636 Phone
o.(9
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
he Division of Water Quality, Groundwater Section, 1636 Mail Service Ceenter' �vNC
g0,7/2001
9) 733-3221, within 30 days.

269004
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and u+tunl Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) 6 ft.t-t c`+ t e%S'�� CERTIFICATION aJI 1 I
WELL CONTRACTOR COMPANY NAME_REUSEN CALDWELL DRILLING, INC. Q?(8 )254-3581
PHONE
STATE WELL CONSTRUCTION PERMIT/ ASSOCIATED WQ PERMIT/
(if applicable) / (if applicable)
ffJ
1. WELL USE (Check Applicable Box): Residential Municipal/Public 0 Industrial 0 Agricultural ❑
Monitoring ❑ Recovery 0 Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
NearestTown: N\ AILS NA 1-k- county (11\--1401 S'ef
'
a u,tc->{ SY rnA a s -1 L
(Street Name, Numbest Community, Subdivision, tot No., Zip Code)
3. OWNER: IE-No! GatGn�Asl
Address Bo/ at o 1 Nw a6/1O
:V\ AP -SHALL. � ortA Route
City or Town Susie Zip Code
(8a8) 4-q - a0 t
Area coda Rhona number
4. DATE DRILLED 2 1 1/0 3
5. TOTAL DEPTH: 4-1 0
6. DOES WELL REPLACE EXISTING WELL? YES L NO ❑
7. STATIC WATER LEVEL Below Top of Casing: lo D FT.
A cute 't i( Above Top of Cuing)
8. TOP OF CASING IS FT. Above Land Surface•
Top of violet termlaated aUor below Iced surface requires a
varlaoce la accordance rids ISA NCAC 2C.01 U.
9. YIELD (gpm): 10 METHOD QF TEST 21 G - A
10. WATER ZONES (depth): 3 o v L' G Pry\
1 I. DISINFECTION: Type N i
12. CASING:
A Depth
From L To b a
From To
From__To
13. GROUT: Depth
From 3- To 30
7I CC0 o Amount c✓PS
Diameter
FL Cc "
Ft.
Ft.
Material
Ft. CHP1$l.) j
Wall Thickness
or Weight/Ft.
SD t
M 4al
f 0M20(�
From To Ft.
14. SCREEN: Depth Diameter Slot Sire Material
From To Ft. in in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Malcrial
From To Ft.
From To Ft.
16. REMARKS:
Topo�gr phic/Land setting
❑Ridge les lope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(dcpeeahninute hsmdQ
Latitude/longitude source:❑GPS❑Topographic map
(check box)
MIMI DRILLING LOQ
Frpm i 5 FrtDescription
o Jay 2-(So 20E3\
5111 7- `3o 0 ' G /LA 63 t 7-t , n)
300 - 6 GPM
1 o d- 4-1 0' (" A rr I Te-
JOCATION SKETCH `''
Show direction and distance in miles from Seas o
two State Roads or County Roads. Include g5 road="
a
numbers and common road names.
HERRDYICERTIFYMAT I
!C ION STAFTDA2�D$�
WELL WAS CONSTRUCTED IN ACCORDANCE WIT)1 15A NCAC 2C, WELL
13 THAT A1CQry OF THIS RECORD HAS BEEN PROVIDED TO THPa WELL OWNER
-f` TURE OF PERSON CONSTRUCTING THE WELL LATE
Submit the original to the DI -Liston of Water Quality, Groundwater Section, 1636 Mall Service Center -Raleigh, NC
27699-I636 Phone No. (919)731E3221, within 30 days. GW-1 REV. 07/2001
63

269426
WELL CONSTRUCTION RECORD
Secti
North Carolina - Department of Environment and l tural Resources -
WELL CONTRACTOR (INDIVIDUAL) NAME (print)YT
WELL CONTRACTOR COMPANY NAME
STATE WELL CONSTRUCITON PERMIT#
Division of Water Quality - GroundwaterSection r7�7
74__ /J- CERTIFICATION
IIb, fpU 77
Cr PRONE it(%2ti�M O4
07 ASSOCIA�PERMIT# y/%7
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential IZ 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 T9wn;
County
(Street Name, Numbers, tibrununity, Subdivision, Lot No., Zip Code)
3. OW a.Qcna�rO?Les
Address //G
( torn e No.)
711G2.tt�y/� A/ G ft7SZ
City or Town State Zip Code
Topographic/Land setting
❑Ridge ❑Slope Walley ❑Flat
(check 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
Area code- Phone numbs / /
4. DATE DRILLED �/� /0
3
5. TOTAL DEPTH: ..2.Z.1-
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 0
7. STATIC WATER LEVEL Below Top of Casing: 4 5 FT.
(Use.+" if Above Top of Casing)
8. TOP OF CASING IS 1. T FT. Above Land Surface'
`Top of casing terminated at/or below land surface requlra a
variance in accordance with 15A NCAC 2C .0118. .
9. YIELD (gpm): __ METHOD OF TESTVC4, s
10. WATER ZONES (depth): /7'C / —
11. DISINFECTION: Type fliebese Amount 9 oZ
12. CASING: Wall Thiclmess
Diameter or Weight/Ft. Material
From0 To o t2 /) Ft. G t #.2 / Pa r
From To Ft.
From To Ft.
13. GROUT: Depth Material �MoIethod
From.12_ To_b Ft &lneS it 2.�r Itty
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
Fro --To Ft in. in.
Fro To Ft. in. in.
15. SAND GRAVEL PACK:
Depth Size Material
From To Ft.
From /To Ft.
r'a 1 �; REMARIf.3:
IDOHEREBY C T
CONSTRUCTION S T
L' / r
LOCATION SKETCH
Show direction and distance in miles from at
two State Roads or County Roads. Include thexo
numbers and common road names.CO
o
0
V
n
THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
DARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
-e, 6CZ./J
SIGNATURE OF PERSON CONSTRUCTING THE WELL
.7js/D 2
DATE
rSubmrt the arigihal 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 /N1. tural Resources - Division of Water Quality - Groundwater Section �7
WELL CONTRACTOR (INDIVIDUAL) NAME (print) 1 ! , ,�(( 4,, e. �/�� pp�p CERTIFICATION 41(7/
WELL CONTRACTOR COMPANY NAME AA ZI.I)er(2a4.4 I / J4' i0•ttA � PHONE # tfs?�'ifi y9 a «a
STATE WELL CONSTRUCTION PERM
TT# 4/in ASSOCIATED WQ PERMIT# Nip
(if applicable)
(if applicable)
269394
1. WELL USE (Check Applicable Box): Residential Cii Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION: Nearest own: i�14_���.�.1" County) .t4 t , c,
g'7s3
(Street Name umbers, Community, Subdivision, Lot No., Zip Code)
Address // am. i . »74.ee
3. OWNER-
qd
(S or Route .)
Q.lf 1 tp. No.25,75.3
City or Town State Zip Code
(--4F
Area code- Phone numberD
4. DATE DRILLED 471/ 7/
5. TOTAL DEPTH: /.1,5 '
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO CEI
7. STATIC WATER LEVEL Below Top of Casing: ' 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): $ d METJOD OF TEST 7 44-LP
10. WATER ZONES (depth): 712
Topographic/Land setting
❑Ridge ❑Slope Walley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degreWminutes/secands)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
LOCATION S CH
11. DISINFECTION: Type y� sr.. Amount S °_' Show direction and distanc m miles from at least
12. CASING: V Wall Thickness two State Roads or Coun Roads. Includ the road
Depth Diameter or Weight/Ft. Material numbers and common ad names. la & ctP
Ara/ Pvr
From /D To J n Ft.ID
From To Ft.
From To
13. GROUT: Depth
From P2 To ' 2 D
L
Ft
Ft `L25i11d 1 u
From To Ft
ethod
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:
t1Q'IZTANji 1 S,
r
S WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
T A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
doie-ste; 68(2,1 .Z/7/0 3
ATURE OF PERSON CONSTRUCTING THE WFT T DATE
Submit the original to-theDivision of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 #hoar! No. (9191 33-32 tl, within 30 days. GW-I REV. 07/2001

270924
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WEICONTRACTOR (INDIVIDUAL) NAME (print) LARRY WELLS/ MIKE LUSK CERTIFICATION #2603.
MELT
WELL CONTRACTOR COMPANY NAME APPALACHIAN WELL -DRILLING PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT/4 ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ® Municipal/Public ❑ Industrial ❑ Agricultural 0
Monitoring 0 Recovery 0 1 teat Pump Water Injection 0 Other 0 if Other, List Use
2. WELL LOCATION:
Nearest Town: BARNARDSVILLE County MADISON
LOT # 52, BARNARDSVILLE, 28709
(Street Nmne, Numbers, Community, Subdivision, Lot No., hip Code)
Topographic/Land setting
❑Ridge MSlope [Walley ❑Flat
(check appropriate box)
Latitude/longitude of well location
3. OWNER: AMERICA'S HOME PLACE (degrees/ninutes/seeonds)
Address LOT t52 Latitude/longitude source:DGPSOTopographic map
(Street or Route No.) (check box)
BARNARDSV ILLE N.C. 27709 DEPTH DRILLING LOG
City or Town State Zip Code From To Formation Description
( )-
Area code- Phone number
4. DATE DRILLED 2-11-03
5. TOTAL DEPTH: 265
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO EN
7. STATIC WATER LEVEL Below Top of Casing: 80 FT
(Ilse "+" if Above Top of easing)
8. TOP OF CASING IS 1 FT. Above Land Surface*
"'l'op of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): 60 METI IOD OF TEST gallon container
10. WATER ZONES (depth): 225,240
LOCATION SKIPCI-I
I I. DISINFECTION: Type TABLET Amount 2 Show direction and distance in miles from at least
12. CASING: Wall Thickness Iwo State Roads or County Roads. Include the road
Diameter or Weight/Ft. Material numbers and common road names.
Depth
From 0 To 170 Ft.
From To Ft.
From To Et.
13. GROUT: Depth Material Method
From To Fl. CONCRETE POUR
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.
1`i-z3
B xv yri6V
H)eo be Cie
efnstY Cow-f_
ski;4-Iet1?CL�
From To Et.
16. REMARKS:
I DO IIEREBY CERTIFY TIIAT TIIIS WELT. WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARD AND TIIAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO TIIE WELL OWNER
SIGN URE OF PERSON CONSTRUCTING THE WELL
2.- 15
-
DATE
Spbmit the original to thel ivision of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
- 27699-1636 Phone No.-(1/ 9'? 3-3221, )within 30 days. GW-I REV. 07/2001
r��

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section •
WELL CONTRACTOR (INDIVIDUAL) NAME (print) LARRY WELLS/MIKE LUSK
270923
CERTIFICATION # 2603
WELL CONTRACTOR COMPANY NAME APPALACHIAN WELL -DRILLING PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT#
(if applicable)
ASSOCIATED WQ PERMIT#
(if applicable)
I. WELL USE (Check Applicable Box): Residential ® Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring ❑ Recovery O Beat Pump Water Injection ❑ Other 0 if Other, List Use
7
WELL LOCATION:
Nearest Town: BARNARDSVILLE
LOT #70, BARNARDSVILLE, 28709
County MADISON
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Cale)
3. OWNER: AMERICA'S HOME PLACE
Address LOT # 70
(Street or Route No )
BARNARDSVILLE N.C. 27709
City or Town State Zip Code
( )-
Area code- Phone number
4. DATE DRILLED 2-12-03
5. TOTAL DEPTH: 565
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: 80
(Use "v- if Above Top of Casing)
8. TOP OF CASINO IS 1 FT. Above Land Surfacer
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C' .0118.
9. YIELD (grim): 10 METI IOD OF TEST gallon container
10. WATER ZONES (depth): 440-540
I I. DISINFECTION: Type TABLET
12. CASING:
Depth Diameter
From 0 To 170 Ft.
From To FI.
From To FI.
13. GROUT: Depth
From 1'o
From To FI
14. SCREEN. Depth Diameter Slot Size
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size
From To Ft.
Amount 2
Wall Thickness
or Weight/Ft. Material
Topographic/Land setting
DRidge ®Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source: DGPSOTopogaphic map
(check box)
DEPTII 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.
19•
Material Method RbCILM (H e
Ft, CONCRETE POUR #0Imbe cloo :v
leK5 "Dr C'C
—rkis1/41_Le
C)
in.
in.
Material
Material
From To Ft.
16. REMARKS:
I DO IJEREMY CERTIFY T
CONSTRUCT' )N STAN
Submit the ori- inaF
27699-1636 Phone No.
ARDS,
ITS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I SA NCAC 2C, WELL
ND T IAT A COPY OF THIS RECORD HAS BEEN PROVIDED 1'O THE WELL OWN R
SS- 3
SIGNATURE OF PERSON CONSTRUCTING TILE WRIT_ DATE
Division of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
t33-3221, within 30 days. GW-I REV. 07/2001

270917
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Reso ces - Division of Water Qua
y1�i�1JW
WELL CONTRACTOR (INDIVIDUAL)NAME
�pty - Groundwater Sectiono3
��(�print)IMD�Y/7/<�I{ with Ia `• U
WELL CONTRACTOR COMPANY NAME " 1 V.`
STATE W ELL CONSTRUCTION PERMIT',
( i f appl icable)
I . WELL USE (Check Applicable Box): Residential [{Y Municipal/Public 0 Industrial 0 Agricultural 0
• CERTIFICATION',1
PHONE', trairigleeln3
ASSOCIATED WQ PERMIT " '2LsSL
(if applicable)
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION: • I'
Nearest Town in �County a0
1.1:44/i ' 6 ,&� n bin'bin'v%\ t z.S�
'10T
(Street Name. Numbers, Community. Subdivision, Lot No., Zip Code)
Vitist .. l , Itt J \
3. OWNER
Address
tdm gag41N`
City or Town State Zip Code
( )-
Area code- Phone number
4. DATE DRILLED ?3`O 3
5. TOTAL DEPTH:) 5'
6. DOES WELL REPLACE EXISTING WELL? YE 0 NO GP'
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 -
h
.1
Topographic/Land setting
DRidge UP 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'4
9. YIELD (gpm). l METHOD OF TES 1
variance in accordance with ISA NCAC 2C .0118. t
.
O. WATER ZONES (depth): 3 2.10
1l. DISINFECTION: Type 11b1Cc Amount Z
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From To 122. Ft.
To Ft.
To
From
From Ft.
13. GROUT: Depth //i� Material
From To Ft.j jeartt f4&
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
Method
From To
From To
16 REM.A.RKS:
Ft,
Ft.
_1 DO HEREBY CERTIF
CONSTRU sN 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.
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
Z`03
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Canter' REVgh, NC
27699-1636 Phone No. (919)' 33-3221, within 30 days.

272371
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAM (print) o /) A/XI / e 2 4.1. L (n� —/ CERTIFICATION W %77
WELL CONTRACTOR COMPANY NAMEAto -e I v 1, as "I2 Jail IIY K&BONE # MS2D1 4 4/ f d ¥&t
STATE WELL CONSTRUCTION PERMIT# Nave ASSOCIATED WQ PERMIT# Ail,
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential 18/ MunicipaiPublic ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION: Q '' /J
N est own: J%%/.l�lOifae-Gf County 21%/14t/ rt e
a, -4ed -2R7s-5
(Street Nam
umbers, Community, Subdivision, Ict No., Zip Code)
3. OWNER:e -t 4'
Address 244.2.2 L hCe DPci
(Street Route N�3
City or Town
A e "Oil 7/ 0 3
4. DATE DRILLED
r
5. TOTAL DEPTH: 30S
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO IS
7. STATIC WATER LEVEL Below Top of Casing: So FT.
(Use "t" if Above Top of Casing)
8. TOP OF CASING IS . S FT. Above Land Surface*
`Top of using terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118. •
9. YIELD (gpm): / S METHOD OF TEST%.rrcr
10. WATER ZONES (depth): 73' .2/ 5'
State
Zip Code
11. DISINFECTION: Type petaille Amount /.2 °_-
12. CASING: Wall Thickness
From___ To S1D Ft � #.2 /fi or t
th
From To
Ft
From To Ft.
13. GROUT: Depths Material Iv�etbod
From_ To tY 0 Ft resru� ..(i14L��tas/
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.
Material
Psi(
Topographic/Land setting
❑Ridge EISlope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(clack box)
DEPTH DRILLING LOG
From To Formation Description
16. REMARKS:
fitait t3Y-COMFY
snuOiciti
Submit the original .o the
" 27699-I636thonet (919)
ICF
Show directi
two State R
numbers an
C
TIO
and distance in miles from
ds or County Roads. Inc
common road names.
L -
least
the road
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 WEI I OWNER
On -nu: a al/
SIGNATURE OF PERSON CONSTRUCTING THE WELL
Division of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
733-3221, within 30 days. GW-I REV. 07/2001

272360
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section /�
CERTIFICATION #rr 97
WELL CONTRACTOR (INDIVIDUAL) NAM (print) to t
WELL CONTRACTOR COMPANY NAME
STATE WELL CONSTRUCTION PERMIT#
(if applicable)
PHONE # U t'31' /9- e.2,1
SS AOCIATED WQ PERMEDN/.�
(if applicable)
I. WELL USE (Check Applicable Box): Residential fa MunicipalPublic 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town:
County M/ /-Lo-C
eaY 1'-teen, d1 s7 7S3
(Street Name, Number, Community, Subdivision, Lot No., Zip Code)
3. OWNER:reehoj �[�,�
Address 3 e1 5r'GN 13u.Lf Gifu Rd
Q (Sorbet or Route No.)
»7 IV • a O 7SIS
City or own State Zip Code
(fit 84-9
Area code- Phone number
4. DATE DRILLED St ?/ 0 -.
5. TOTAL DEPTH: .Z .2 S
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO ja
7. STATIC WATER LEVEL Below Top of Casing: « r.FT.
/ (Use'4" if Above Top of Casing)
8. TOP OF CASING IS l• . FT. Above Land Surface*
`Top of casing terminated at/or below land surface requires ■
variance to accordance with 15A NCAC 2C .0118. '
9. YIELD (gpm): —S METHOD OF TESTrraaa'
10. WATER ZONES (depth)://ns'
11. DISINFECTION: Type /Yfsc i Amount Si
12. CASING: l Wall Thickness
DepthDiameter J�� #.2'g6t/Ft Iv]pietiat
%% From To Ft �v� a
From To Ft.
From To Ft.
13. GROUT: Depth
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropboot)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
From To Formation Description
•
From 0 To o%fJ Ft. L L_
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.
�1636F6eh
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.
T 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
SIGNATURE 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-1 REV. 07/2001

273793
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - aDi/vision of Water Quality Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) \// / 1744-`l 42 CERTIFICATION # a-11 I
WELL CONTRACTOR COMPANY NAME frt)he.s. e:f�O.QP\\ be%\\w j 1 nc •
STATE WELL CONSTRUCTION PERMIT#
(if applicable) (if applicable)
WELL USE (Check Applicable Box): Residential t MunicipaUPublic 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCATION:
az st wm6$unty��
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: k'a ik' �4
Address NoT fta ,e i
(Street or Route No.)
ek4.7,�. A/C_ 2rz 17
City or Town State Zip Code
—sLr— e;i4.
10 WATER ZONES (depth) 3u PM
Arcacodc- Phone number e
4. DATE DRILLED ,S/
5. TOTAL DEPTH:
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO E-
7. STATIC WATER LEVEL Below Top of Casing: ' I In 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 accordancsysith ISA NCAC 2C .0118.
9. YIELD (gpm): i S M THODOF TEST KCCs-
60o— 1a Germ
11. DISINFECTION: Type
12. CASING:
PHONE # (S2,S):254-3 ,S)
ASSOCIATED WQ PERMIT/4
Depth
From( To le Ft.
From To Ft.
From To Ft.
13. GROUT: Depth aterial
74
From 0 To n) Ft. '
Amount
0.76 Wall Thickness
Dmslcr oreight/Ft. Material
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:
lint 710)9'STTf6o
JUL - 3 zoo
Slot Size
in.
in.
/ropographic/Land setting
Ridge ❑Slope ❑Valley OFlat
(check appropriate box)
Latitude/longitude of well location
P3 3Sal-c1 b4' W &SR`4a,769
(degrecs/minut<o czonds)
Latitude/longitude source:fd-GPSOTopographic map
(check box)
DRILLING LOG
Formation Description
O v b/i... ..,pie jA
SIALt /CL (i
2Cen/
A.1'rC-"
z G P>n
L�y N 1 T1.5'
DEPTI I
From / To or
55
551- 4 01
43
4-_ 400
too
o L�
G Ot, — �70
0
to
—•C fir„
LOCATION SKETCH Iv o'1/40
Show direction and distance in miles from at least >.°
two State Roads or County Roads. Include thaltpad
numbers and common road names. N
ALcivt
A!
sT
THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
AND THAT A COPY OF THIS RECQRD HAS BEEN PROVIDED TO THE WELL 0 iR
SIGNATURE OF PERSOI4CONSTKIJ
Submit the original to he Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
n.21699.1636 Phonii:. e (* 9) 733-3221, within 30 days., GW-1 REV. 07/2001
rr,CE

3. OWNER: oNta c t5
Address s(SI dwy aSI
Route
(Street or Roe No.)
AA SNALt_ Nc_ 94153
City or Town State Zip Code
(gdS')- (24-R- Ro31
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Uantnl Resources-
WELLCONTRACrOR(INDIVIDUAL)NAME (print) V, (1.-1-\e
WELL CONTRACTOR COMPANY NAME RF.UBEN CALDWELL
2'74223
Division of Water Quality - Groundwater Section
1 V A S CERTIFICATION a al 7'
DRILLING, INC. PHONEE%8 .?54-3581
STATE WELL CONSTRUCTION PERMIT% ASSOCIATED WQ PERMIT%
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential I/ MunicipaVPublic 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION: p Topographic/Land setting
Nearest Town: N1-ARS4A.-L— County Jt1-I(OLSe C-7•n � ❑Ridge ❑Slope ❑Valley lariatlariatALOfi (L.oe, Tt9TofJ 7`� Nn`A (LSi4 A i-l_- (check appropriate box)
(Street Name, Numbers, Community, Subdivision, Iiot No., Zip Code) Latitud-Jlon nude o e as well 1 t
/Gl o8a°� to
t.>
3S� I
N /f ( a
le.
4. DATE DRILLED
c��A rib
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO Q/
7. STATIC WATER LEVEL Below Top of Casing: b 0 FT.
(Use "+' if Above Top of Casing)
8. TOP OF CASING IS -- FT. Above Land Surfaces
'Top of cuing terminated at/or blow laud surface requires a
variance In accordance with ISA NCAC 3C.0111. n�
9. YIELD (gpm): (O METHOD OF TEST 16 (7 " A I IV
10. WATER ZONES (depth): QO — 6 CDP��
GVa/o3 (,L4Jr{a fw+li 12�c t�
Am code- Phone number
5. TOTAL DEPTH: 4 0 (. C� FM
11. DISINFECTION: Type 11TI a , <- Amount % -
12. CASING: Wall Thickness
Depth Da VC -
ter or Weight/Ft. M tfrial
From To q Ft b'IS 502- I
From To Ft.
From To Ft.
13. GROUT; Depth Material Mc od
From To �U Ft. CEYYknll VDU
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 Material
From To Ft.
From To - Ft.
Material
(devoeshniou/tglseconds)
Latitude/longitude source:I GPS❑Topographic map
(check box)
DEPTH DRILLING LOLL
From ' To , Forrrrppaation Description
— 8S oJre-Qv2D6t3
(qD
Ao
\qc'— 4-30'
LOCATION SKETCH 1
Show direction and distance in miles frordP leas'
two State Roads or County Roads. Include -the rog--
numbers and common road naes. 3
m
w
C.)
16. REMARKS: v 3 I`1 ^a3
i40 Fd$R4 Y (r`EI t
IS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
AND THAT A PY OF THIS REO�BEEN PROVIDED TO � WE�oOWNER
5IGNATURE OF PERSON CONSTRUCTING THE WELL d/A/
rr
to
m�
G
r#glpgF-Euihb Dlvi don of Water Quality, Groundwater Section, 1636 Mall Service Center- Raleigh, NC
2 Q97-16",3'QihoneNT;( 31,)_733-322I,within 30days. GW-1 REV.07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAM J (print)�_/11 J c p)9 L 0 CERTIFICATION P-2 O B
77
ulea itRisditty1L more pp ffs3fri •«9-D/%8!
.CSOCIATED WQ PERMIT" /1/4'
WELL. CONTRACTOR COMPANY NAME
STATE WELL CONSTRUCTION PERMIT"
(if applicable)
(if applicable)
1. WELL USE (Check Applicable Box): Residential Pi Municipal/Public 0 Industrial ❑ Agricultural 0
Monitoring ❑ Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION: / ,,,
Neap TJ/.�.- Co ty
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER;
Address
t or Route No.)
d4d
City or Town State
Areay
DA code-EPhone number, O /%i 7
4 DATE DRILLED Y t,
5. TOTAL DEPTH: ea i
6. DOES WELL REPLACE EXISTING WELL? YES NO
7. STATIC WATER LEVEL Below Top of Casing: 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 1n accordaocre�rit6 ISA NCAC 2C .0118. •
DOF /sTT��u
10. WATER ZONES (depth): �D'
Zip Code
MEiS
9. YIELD (gpm): T TT�
Cf
11. DISINFECTION: Type irto' �f-
12. CASING: ((//
ameter
From To �.6 0 Ft
From To Ft.
From_ To Ft.
13. GROUT: Depth Material
From D To ?0 Ft 60W/04
From To Ft
Slot Size Material
in.
in.
M
274142
Topographic/Land setting
❑Ridge ❑Slope (Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
OegreesimizateSseconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
Formation Description
DEPTH
From To
Roads or County
and co si on ro
Amount 7..'1S OZSbowdirecti
Wall Thickness two State R
or numbers
CD o
T
11
rr.
r-
14. SCREEN: Depth Diameter
From_____. —To Ft. in.
From / To Ft in.
15. SAND/GRAVEL PACK
Depth Size Material
From /To Ft.
Fro To Ft.
16. REMARKS:
IS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15ANCAC 2C, WELL
k�O ODj�BT' , AND THAT A COPY
'OOF_ THIS RECORD HAS BEEN PROVIDED TO THE W/F)1 OWNER
� I III I.,i 111 CCC
44-
v.-
LOCATION SKETCH CAI
on and distance in miles frommDl
Roads. Tnclud�
ad names.
41fy
D
„1.8' D3
SIGNATURE OF PERSON CONSTRUCTING THE WEI I DA
Submit the original _to,_}the Division of Water Quality, Groundwater Section, 1636 Mall Service Center - Raleigh, NC
r4%(,9y,i f'pboa b9) 734-3221, within 30 days. GW-I REV. 07/2001

274140
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAM
($[ (print) � $ 1 CERTIFICATION #DG f 77
WELL CONTRACTOR COMPANY NAMEJ/Ltt�.e -? - / it lei, Sas PHONE P ([( , «9 o9g
STATE WELL CONSTRUCTION PERM7r# 1 ASSOCIATED WQ PERMIT# Af/fi
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential MunicipaiPublic 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery ❑ Heat Pump Water injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Neare ./ •aP my .04114:07.4--
%u-V
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: -�
Address O )3'la f tJ .1
or Route No.)
70 i _,e C. J sYS3
City or Town State Zip Code
en_/.9.3 -S.z49
Area code- Phone number
4. DATE DRILLED y/J 20 3
5. TOTAL DEPTH: / . 5'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO JZ
7. STATIC WATER LEVEL Below Top of Casing: /p Ff.
(Use •+" if Above Top of Casing)
8. TOP OF CASING 1S /. Ff. Above Land Surface'
'Top of casing terminated at/or below land surface rego4a a
variance In accordance with 1SA NCAC 2C .0118. •
9. YIELD (gpm): a OD OF TEST —not-,
10. WATER ZONES (depth): 0 / JDD I
11. DISINFECTION: T
12. CASING:Depth /
From 0 To f D Ft.
From To Ft.
From To Ft.
13. GROUT: Depth.)l Material
From_ To�,u[� Ft LFIP2e.$
From To Ft
Slot Size Material
_ in.
in.
ype
Amount
Wall Thickness
Diameter or
W ght/FtMaterial
14. SCREEN: Depth Diameter
From To Ft. in.
Fromz To Ft. in.
15. SAND GRAVEL PACK:
Depth Size Material
From 7.,..-- To Ft.
From To Ft.
16. REMARKS:
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)
DEPTH DRILLING LOG
From To Formation Description
c
p
ra
r
LOCATION SICETCH
Show direction and distance in miles
two State Roads or County Roads
numbers and common road
tot le " 573
cludglhe reed
co o
CIt . 1' THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WET I.DN ARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
y/4�Io3
S
vSIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the on'�inal .o the Division of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
GROUND 0,276149WIThoneNo. [phone],within 30days. GW-1 REV. 07/2001
ASHEVILLE REGionAL OFFICE
t
t

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and
WELL CONTRACTOR (II4m1vIDUAL) NAMP, (print;
WELL CONTRACTOR COMPANY N .rJA
STATE WELL CONSTRUCTION PERMIT*
(if applicable)
274132
Resources - Division of Water Quality - Groundwater Section
L n CERTIFICATION tht0 p
7.
II CPBON} g (f52W `p vY Vr%
ofr
asSOCIATED WQ PERMITii
(if applicable)
1. WELL USE (Check Applicable Box): Residential ($ Mumicipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCK:
4 ,L1�^2' f " C
Neaeest'('atvn: /J% :e�G� County.
JB-7,s3
(Street Nam; Numbers, unity, Subdivision. Lot No, rip Code)
3. OWNE
Address /0 fj/ -p. em-e At an.?
Roue Ndll
7Wall—(S arc. .21 7s3
City or Town State Zip Code
Mn code Phone munber,
4. DATE DRILLED y/e2
5. TOTAL DEPTH: /WS
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 12
7. STATIC WATER LEVEL Below Top of Casing: 9 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / S FT. Above Land Surface'
'Top of easing terminated at/or below land surface requires ■
variance In accordance stab ISA NCAC 2C .011&
9. YIELD (gpm): 410 METHOD OF TES1r nt,
10. WATER ZONES (depth): 'la 90 '
11. DISINFECTION: Typerckeeta
12. CASING:
Depth , Diameter
From 0 Too w2D Ft. Z. fr
From To Ft.
From To Ft.
13. GROUT: Depth
From te) To a0 Ft.
From To Ft.
Material
Amount
Wall Thickness
a<Wdght/Ft Material
ee
/o
14. SCREEN: Depth Diameter
Froth_..-- To Ft in.
From / To Ft in.
15. SAND/GRAVEL PACK:
Depth Size
From / To Ft.
From / To Ft.
16. REMARKS:
CONS ttUc.HTUNbIAN1
Method -
l.tic�iGl�
Slot Size Material
in.
in.
Material
Topographic/Land setting
❑Ridge ❑Slope Walley ❑Flat
(cbedt appropriate boa)
Latitude/longitude of well location
(dephmimfts/axends)
Latitude/longitude source:❑GPS❑Topographic trap
(cheek box)
DEPTH DRILLING LOG
From To Formation Description
J ()CATION SKETCH tea cn
Show direction and distance in miles titan ate
two State Roads or County Roads. Inchje the -''road
numbers and •. mmon road names. alai
$ydsSc
aK,W
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
SIGNATURE OF PERSON CONSTRUCTING THE WELL
p;igR the Division of Water Quality, Groundwater Sectlon,1636 Mail Service Center - Raleigh, NC
A 0276994636 PlkipE_l [phone], within 30 day}. GW-1 REV. 07/2001

274131
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Grotmdwater Section
WELL CONTRACTOR (INDIVIDUAL) NAM (print)
J� y CZRTUTcnnox a 4
WELL CONTRACTOR COMPANY NAI,st Lap 4, PaoNE s WTI 619-42 gett)
STATE WELL CONSTRUCTION PERMIT* Al./ifi _AshOCIATED WQ PERMIT AV/I,
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential A Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WFT f LOCATION: ���%% �
Newt Town: County Maio Ll.I.r.T_
S[o.6i 7S3
(Street Name, Numben, Cammmity, Subdivision, Lot No., Zip Code)
3. OWNE1t4€d-tr
Address PAS
A. (Stang or Route No.)
7yJ�Z,Ge�ka l� 714 C. , 8753.
City of Town State Zip Code
Area axle- Phone number
4. DATE DRILLED y//jD 3
5. TOTAL DEPTH: 3 aS
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO Id
7. STATIC WATER. LEVEL Below Top of Casing.. 1' FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / S FT. Above Land Surface*
'Top of awing terminated atlor below land surface requires a
variance to aemrdanta with 1SA NCAC 2C .01111. •
9. YIELD (gpm): a- METHOD OF TEST-r-enu
10. WATER ZONES (depth): "t S
11. DISINFECTION: Type , '� r
12. CASING:
Depth Diameter
From 0To y% a k
From To Ft.
From To Ft.
13, GROUT: Deptho�ntrna1 1�el�tod .
From_ To 07 a Ft. /�.fsa� .fad�Y�3L
From To Ft.
14. SCREEN: Depth Diameter Slot Sine Material
Fro To Ft in. in.
From To Ft in. in.
15. SAND/GRAVEL PACK
Depth Size Material
From To Ft.
Fro Ft.
Amount is OZ
Wall Thickness
or Weight/Ft Material
fe.2/ Fvc
Topographic/Land setting
❑Ridge ®Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/mixings/seconds)
Latitude/longitude source:❑GPS❑Topograpbic map
(cheer box)
DEPTH DRILLING LOG
From To Formation Description
`{ [S I M RO:
I DO HEREBY CER..
I ' CONSTRUCTION ST
SIGNATURE OF PERS
LOCATION SICETCH ca
Show direction and distance in miles kw at Bast
two State Roads or County Roads. InclU®e th oad
numbers and common road names.
Ott
0
T THIS WELL WAS CONSTRUC:Ii;U IN ACCORDANCE WITH 15A NCAC 2C, WELL
S, AND T1QTPY OF Jy��•- RD HAS BEEN PROVIDED TO THE WELL OWNER
7/i/03
DATE
" liabn:at- l b.rl n i e-the'Division of Water Quality, Groundwater Section, 1636 Mall 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 Natural Reso ces - Division p(w'atgr Qua - Groundwater Sec( �� f
CERTIF[C'[A.TI�U.N(M�y'�f�}�
f PHONE R )Y.Ls �" �—�
•` tt 'ZLaz.
WELT. CONTRACTOR (INDIVIDUAL) NAME (print)
\\ Eli, CON F RAC TOR COMPANY NAME
STATE milt CONSTRUCTION PERMITM
1il applicable)
oar /
I WELL USE (Check Applicable Box): Residential O Municipal/Public 1.7 Industrial 0 Agricultural
Monitoring ❑ Recovery ❑ Heat Pump Water Injection 0 Other 0 if Other, List Use
2 WELL LOCATION: Topographic/Land setting
�yYci Y(((C County I Lk.❑Ridge OSlope ❑ Valley Vat
Nearest Town.' y Y (,)J//C z$��q (check appropriate box)
�1Q e(,C@ •1 y r Latitude/longitude of well location
()Oleo N:un°, Numbers, Community. SuWis�•siun, tnt No.7_ip Code)
(dcgrees/m i n n ies.'seconds)
Latitude longitude source:DO PSOTopographic map
(check box)
DR't__ ING LOG
Formation Description
274803
3. OWNER:�C
.Address
(Sc•tot Rout• of `/i Oc/
�vcSVl tie NC z 1 `.
City or Town State—
At
code- Phone number �� O�
4. DATE DRILLED ..r--
5. TOTAL DEPTH _ Q %---
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO G'
7. STATIC WATER LEVEL Below Top' Casing:b I�FT.
(Use if"Tr" Above Top of Casing)
8. TOP OF CASING IS ___L.— FT. Above Land Surface*
• Top of caring terminated at/or below land surface requires a
variant° in accordance with ISA NCAC 2C.at 18. „- _ ( ^ _—
9. YIELD (gpm): CC O METH D OF "fES �•�yYr._
10. WATEit ZONES (depth): Z LOCATION SKETCH
Amount 7- Show direction and distance in miles from at IeasS_
1 2. DISINFECTION: Type - two State Roads or County Roads. Include& ro3t
Wall Thickness n
12. CASING: numbers and common road names.
Depth Diameter or WcighUFt. Material -:1':-)//�� t. ---- .w �:
From_5.1.__ To F19 3 .-
To FL — x-r ' I e I ---From_ - 7c,rA-&yd3VI ; :.
Mate Method
_a-J4-uY-_. 1 V I-9 PI0 kr 4 N• i
7.0
!}. GROUT: Depth r,;
From To Ft. /7 v (7 ,.
From--- To—_-- Ft. --- �,/ Y.��K, L.0 l.. 0^.
h Diameter Slot Sizc Material i %•C-C.! e—
1A. SCREEN' Depth in — ▪ o
From To Ft _ in. __ z
Ft om_—
To.___. Ft. _,in. in.
15. SAND/GRAVEL PACK'.
Depth Size Material
From To Ft.__
From _--To. Ft.
.ASSOCIATED WQ PERMIT
(if applicable)
pEPTH
From To
16. REMARKS:—___ ---- WELL
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,
CONSTRUCTION STANDARDS. AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
_ Z3—
S�� -
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
ivislon of Water Quality, Groundwater Section, 1636 Mail Service Center RRaaleigh /N OUI
3-3221, within 30 days.
F—S-Ubitiix the origin S It e
11 27699 16\6 Phone No. (( I )
GROUF:D.t•' TEH SEOTIOtV
ASHFt111LE .EGFC)irlAL OFFICE

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NA.iIE (print) tst tr; CI<t4. a.w V=r'\ CERTIFICATION # ay3Fc
WELL CONTRACTOR COMPANY 14A'TE CI* Sa1,.)rc Q '.�.n WC1131'M7 ♦nc. PHONE # (fr2.9 a 5S- 7_10Sit
STATE WELL CONSTRUCTION PERMITt 0V ASSOCIATED WQ PERMIT#
(if applicable) tl (ifapp]icable
I. WELL USE (Check Applicable Bc:;): Residential Sd Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring ❑ Recovery ❑ Flea: Pump Water Injection 0 Other 0 If Other, List/Use
2. WELL LOCATION:
Nearest Town: ;top_
th. y kS A577J
(Street Name. 4 umbers. Community. Subd..isi on. Lot No_ Zip Code)
County Matti r c4
3. OWNER: 1o,i `ifl9 be.'-
Address PG ('Ja� 1t1
(Street or Route No.)
%fit �S
City or Town State Zip Code
(tn)- ,� So 7a2s
Area code- Phone number
4. DATE DRILLED 4" as- c3
5. TOTAL DEPTH: ties
6. DOES WELL REPLACEEXISTING WELL? YES 0 NO LI
7. STATIC WATER LEVEL Below "'op of Casing: e4D FT.
(ti ; "+" if Above Top of Casing)
8. TOP OF CASING IS i FT. 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): L' METHOD OF TEST rRi'�9
10. WATER ZONES (depth): G
02rd 143
11. DISINFECTION: Type `�:1l5
12. CASING:
ci
Depth Diameter
From `:1 To Ft. iari
From To Ft.
From To Ft.
13. GROUT: Depth
From O To �'b
From To
I4. SCREEN: Depth Diamc(:r
From To Ft. _ in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Si: c
From To Ft.
From To Ft.
16. REMARKS:
Amount r
Wall Thickness
or Weight/Ft. Material
4* 21 11 e.ai eC
F I aerial
Ft. �.-L*'le.nt
Ft.
Slot Size Material
in.
in.
Method
TUC
Material
274620
Tdpooraphic/Land setting
DRidge aSlope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
BIM
(degreeshninutes/seconds)
Latitude/longitude source:❑GPS❑Topographic crap
(check Lox)
DEPTH DRILLING LOG
From To Formation Descript on
}\ i (ci % croc c e e a c ri
tor' 4G5 (+-fa.nl+Q
c
C
4.7
e- c __
LOCATION SKETCH c`_-117
Show ci;-ection and distance in miles from ht lead;:,::
two State Roads or County Roads. Includeiale rr-
numbers and common road names.
Te --
01
it)
I DO HFRFRY CERTIFY THAT THIS WILL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C. WELL
CONSTRUCTION STANDAND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
i...Jr—
I.
Submit the original to thdT Dog ion of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
,L7490-1626 Phone No (919y733-3�21, within 30 days. GW-1 REV. 07/200]
G 1;6UE.' ,.TER SEGIION
ASHEa, I G ...L OEFiCE
GNA-URE OF PERSON CONSTRUCTING THE WELL
DATE

r WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAN"E (print) ilt c r: e1,414. 'S Gun Qr-s CERTIFICATION# a%1»»O
xvELL CONTRACTOR COMPANY NAME (=^'& SCIad a( A st Seer. N C I i, I.. ,I'll 7w a. PHONE #(YLce a 'SS' �(ili
STATE WELL CONSTRUCTION PERMITt .eT ASSOCIATED WQ PERMIT#
(if applicable) (if applicable) NisFl
274614
I. WELL USE (Check Applicable Bon): Residential 6(J Municipal./Public 0 Industrial 0 Agricultural ❑
Monitoring 0 Recovery 0 Hea: Pump Water Injection 0 Other 0 If Other, List/Use
2. WELL LOCATION:
Nearest Town: Mar51r"•t\ County MMC-At5on
29 i Pc s c D-s, /4ac sh', tt (1C 28?b14
(Street Name, Numbers. Community. Subdi'. sion, Lot No.. Zip Code)
3. OWNER: '"iom ja.w o
Address QSt Warr.
(Street or Route No.)
Zip Code
City or Town State
(&a8)- (089- 481/
Area code- Phone number
4. DATE DRILLED
5. 'TOTAL DEPTH: Se
6. DOES WELL REPLACE..EXISTIN:3 WELL? YES 0 NO E1
7. STATIC WATER LEVEL Below T.>p of Casing: mG FT.
(Us/ "+" if Above Top of Casing)
S. TOP OF CASING 1S i FF. Above Land Surface'
*Top of casing terminated at/or below lar 1 surface requires a
variance in accordance with 15A NCAC i : .0118. 9. YIELD (gpm): to METHC D OF TEST itsq 8
10. WATER ZONES (depth):
Tdpographic/Land setting
['Ridge ❑Slope N'Vailey ❑Flat
(check appropriate biz)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPSOTopographic n ap
(check tox)
DEPTH DRILLING LOG
From To Formation Descriptic
4- 1. aT. Qwti j3 QC AC V\
11. DISINFECTION: Type ?:11S
Amount g
12. CASING: Wall Thickness
Depth Diarr:ter or Weight/Ft. Material
From -VI To at Ft. (ICI E if .2i r1c.�i2i
From To Ft.
From To
13. GROUT: Depth M terial Method
From Q To a0 Ft. a"-MQ.TZ _1?0%st 454_
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
From To Ft.
From To Ft.
Size Material
16. REMARKS:
4001t6ElB t:i/GEi"
Cr ro.nr+te_
L
17
c7:
LOCATION SKETCH
�v—
Show di;-ection and distance in miles from leas',
two State Roads or County Roads. Include roN r t
numbers and common road names. ni _�
U1
U.clk
zer12•.
o 4 ',
lc? tf.23
TI'; Y-. AT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
■ • N��' DS, AND TEAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
y '1-v3
��a1I1ID12..tIttE117idinal �0 the
G ?» 97 T64 (-*Hnnc?V'� 919)
Ac, , r. REL
SIGNAT(72E OIM'EJr�
RSON CONSTRUCTING THE WELL DATE
Division of `Vter Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
33-322I, wit iin 30 days. OW-1 REV. 07/2001

274611
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAC1E (print) l7e er' CK 14. ic.w y2rt
WELL CONTRACTOR COMPANN'NAME ! bjJe SO.\.l0 �ecs,t �cn NC ll ddo ril? jAC. PHONE M (Qz9 a$5--14ST
STATE WELL CONSTRUCTION PERMITI ASSOCIATEDIWQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential 6G Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Hea . Pump Water Injection ❑ Other ❑ If Other, List:Use
2. WELL LOCATION:
Neared Town: )(o}-S County neaat Jon
rliuc. Ca) Da9�<N'Ntn Q2ar\.r olto,•t &8743
(Street N. te. Numbers. C"6mmunity. Subdit ision, Lot No., Zip Code)
3. OWNER: LOSS l.aun,a agvc
Address _i to itoCK&1. KnoNG Lomt
(Street or'ttoute No.)
Q3at d.1\t yfl
City or Town State Zip Code
(43'+)- (85 al„
Area code- Phone number
4. DATE DRILLED 5-\°r03
5. TOTAL DEPTH: 405
6. DOES WELL REPLACE.EXISTING WELL? YES ❑ NO RJ
7. STATIC WATER LEVEL Below Top of Casing: qt.) FT.
(Us- "+" if Above Top of Casing)
8. TOP OF CASING IS i I`T. Above Land Surface*
*Top of casing terminated at/or below lat d surface requires a
variance in accordance with I5A NCAC s-C .0118.
9. YIELD (gpm): 'l METHCD OF TEST RSA
10. WATER ZONES (depth):
11. DISINFECTION: Type j it S
12. CASING:
Depth Diameter
From 14 To 10°I Ft.____
From To Ft.
From To Ft.
13. GROUT: Depth
From 0 To U Et.
M aerial
Amount 9
Wall Thickness
or Weight/Ft- Material
+3 �I Ple 3}:�
From To Ft.
14. SCREEN: Depth Diamet:r
Frorn To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Sizt
From To Ft.
Frorn To Ft.
16. REMARKS:
Method
Slot Size Material
in.
in.
Material
CERTIFICATION k o243Lo
Topographic/Land setting
F4dge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutesiseconds)
Latitude/longitude source:❑GPS❑Topographic Trap
(check box)
DEPTH DRILLING LOG
From To Formation Description
loq p're< t, etac+\
1ocf 4sg (rf&rate_
O
W
r
c
0
C ".
LOCATION SKETCH
.
Show direction and distance in miles frontfaneastrt;
two State Roads or County Roads. Includoytjle rop_
numbers and common road names. — -
d.
tns
▪ m
01
Cr,
C
ill DO CfiRTIRX HIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, \VELL
C-ANSTfRHETlON-S+AN11 AND TTEATrA COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
Submit the original to -.the Di'
27699-1636 Phone No.(919) 733
SIGNATURE 0
S'19-o3
ERSON CONSTRUCTING THE WELL DATE
sion of `Hater Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
221, within 30 days. GW-I REV. 07/2001

From
From
16. REMARKS:
WELL CONSTRUCTION RECORD
North Carolina - Department of Envir runent and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NA PIE (print) l7ecr:CK l{. CERTIFICATION# ay3LO
WELL CONTRACTOR COMPANYNAPME e R <t S- we11 »M� rnC• PHONE u (sz9 a55-ZfcSS
yys
STATE WELL CONSTRUCTION PERMIT; ASSOCIATED WQ PERMIT#
(if applicable) Y•. (if applicable) w#
274607
I. WELL USE (Check Applicable Bc;c): Residential 6(f Municipal/Public ❑ Industrial ❑ Agricultural 0
Monitoring ❑ Recovery ❑ Hea: Pump Water Injection ❑ Other ❑ If Other, List/Use
2. WELL LOCATION:
Nearest Town: l+)aC.1l+l \i County !'210:San
ISLA W .iAwoca i%C:ve Marahs\l s18 7 5i1
(Street Nome, Numbers, Community, Subd \ision. Lot No_ Zip Code)
3. OWNER: R:c\.vrd (Secs-4;'c
Address Isq ta. tAbaci, 0a 'gr,ye.
(Street or Route No.)
City or Town State Zip Code
( $�8)- (o8S (o tc\
Area code- Phone number q
4. DATE DRILLED 5-T5 --u-S
5.-TOTAL DEPTH: S5
6. DOES WELL REPLACLEX(STING WELL? YES ❑ NO LI
7. STATIC WATER LEVEL Below `Top of Casing: 10 FT.
(U-.,; "+" if Above Top of Casing)
€. TOP OF CASING IS i FT. Above Land Surface*
*Top of casing terminated at/or below lard surface requires a
variance in accordance with ISA NCAC : C .0118.
9. YIELD (gpm): 'YV METHCD OF TEST Rc 5
10. WATER ZONES (depth):
Tdpogaphic/Land setting
DRidge rope 54Valley DFlat
(check appropriate box)
Latitude/longitude of well location
(degrees/ininutesiseconds)
Latitude/longitude source:DGPSDTopographic nap
(check box)
DEPTH DRILLING LOC
From To Formation Descript on
lo, o'FR< t,team
41 To fir, C
Cr resale.
O
r
c
G
11 DISINFECTION: Type ` ntS Amount (o
12. CASING: Wall Thickness
Depth Dial reter or Weight/Ft. Material
From -t1 To a Ft._10±L— it ti illo,ai:e.
From To Ft.
From To Ft.
13. GROUT: Depth M.tterial Method
From 0 To a'O Ft. C.':ment cu.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
To Ft.
To Ft.
Sia Material
LOCATION SKETCH rV
Show direction and distance in miles from giJea: _-,.
two State Roads or County Roads. IncludcWe reap:
numbers and common road names.Ca
�'
=
'
� rtj• A.f:tk* c. - w;19 iof".+ G
�.° a '.,4,,e;e, R
1 MI HEREBY CERT,IFY7TH
n
J C - S'tRUUTIO9l' STAN"
--s i
IS WELL WAS CONSTRUCTED IN ACCORDANCE WI lH 15A NCACZC, wnt,i.
ND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
M , 5-- (� 3
GNAT.IRE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to th Divi•'on of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh,
NC
27:00-1636fahbrie Neide))733-3 21, wi thin 30 days. GW-I REV. 07/2001
OFGICE

WELL CONSTRUCTION RECORD
273071
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME/(print) Ca A)t inb)p,%b CERTIFICATION # .25//8
WELL CONTRACTOR COMPANY NAME C-SYP one Gras. t/Vt• 1) ^I- PO imp) lRc PHONE # (O-�)S L, 1_ 3/ 1V
VD -1 ASSOCIATED WO PER6IIT#
(if applicable)
STATE WELL CONSTRUCTION PERMIT#
(if applicable)
1. WELL USE (Check Applicable Box): Residential Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water pjection 0 Other 0 If Other, List Use
2. WELL LOCATIO./.
Nearest Tovsm: �(/PC) I/P.Y�/ i //ems County /YALII Se /
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Codc)
3. OWNER: • 12Dn UJ 0/2.4n4
Address to D Be% V / /o lu 0
I (Street or Routt tl / LP
City or
Toowwn State ( Zip Code
Area codc- Phone number
4. DATE DRILLED 4 — a .7 "U 3
5. TOTAL DEPTH: :305
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO 1
7. STATIC WATER LEVEL Below Top of Casing: / Dt) 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): Lc METHOD OF TEST c2 h r S
-10. WATERZONES(depth): en-C — / -spna
I I. DISINFECTION: Type F/-TN Amount it
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From D To 41 4/ Ft. L. 'r P yr
From To Ft.
From To Ft.
13. GROUT: Depth Material
From D To t/) Ft. l �nt � � 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
From To
From To
16. REMARKS:
I DO HEREBY CERTIFY THAT
CONSTRUCTION STANDARD
Ft.
Ft.
Size
Material
NI$
THAT A COPY OF THIS RE
Topographic/Land setting
❑Ridge ❑Slope ❑Valley
(cheek appropriate box)
Latitude/longitude of well location
a
(degrees. ntinutes/seconds)
Latitude longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
Formation Description
la
From To
2
Y
Yl3/)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.
,ORDANCE WITH I5A NCAC 2C, WELL
1.AS BEEN PROVIDED TO TILE WELL OWNER
y2U s — s e 3
IGNATURE OF PERSON CONST U 'G THE WELL DATE
b
Submit the original to the Di sion gt:1Ya$Rr QtraI ty Ground -water ection, 163ti Mail Sere ice Center - Raleigh, NC
27699-1636 Phone No. (919) 733 - vhlltfi70"days. GW-I REV. 07/2001
CTI

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Jeremy H. Bowman' CERTIFICATION82809
WELL CONTRACTOR COMPANY NAME A Rnwman Wel 1 ilri 11 ing, Tnr• PHONE y 87A 952-7779
STATE WELL, CONSTRUCTION PERMITM ASSOCIATED WQ PERMIT#
(ifapplicable) (if applicable)
276001
WELL USE (Check Applicable Box): Residential ix 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: Marcha 11 County Mani son
Big Pin Roan
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
'Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
3. OWNER: Randy Balliew (degrees/minutes/seconds)
Address 3910 Berry' s Mill Road Latitude/longitude source:OGPSOTopographic map
(Street or Route No.) (check box)
Greer SC 29651 DEPTH DRILLING LOG
City or Town State Zip Code From To Formation Description
( )-
Area code- Phone number
4. DATE DRILLED 5/13/03
5. TOTAL DEPTH• o0
6. DOES WELL REPLACE EXISTING WELL? YES O NO 12(
7. STATIC WATER LEVEL Below Top of Casing: 1 00 FT.
(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 OF TEST:. rotary air
10. WATER ZONES (depth): 260' 380'
11. DISINFECTION: Type tablet Amount 6
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From n To 27 Ft.51/8 Sc.h 8-0 PVC
From To Ft.
From To Et.
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.
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
S, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
S//3/o,
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
-.Submit the original to'fe Division of Water Quality, Groundwater Section, 1636 Mall Service Center • Raleigh, NC
27699-1636 Phone No�[phone], within 30 days. GW-I REV. 07/2001
GROUND/ ' ,1
ASHEVILLE R L. i CL
N

275975
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) `e I i-1—., e 03 A S PI CERTIFICATIONS ail i
WELL CONTRACTOR COMPANY NAME_ CALDWELL DRILLING, INC. PHONE
ER8 )254 -3581
STATE WELL CONSTRUCTION PERMITS ASSOCIATED WQ PERMIT.
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential IS/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 jraCest Town A (t S H 1 1- I_
u: s �' /am' Pc -I
LMem
u:i S
County M-Adl,So
None Numbers,
(Strxt ty, ubdivi,ion, Lot No., Zip Code)
3. OWNER: WIJJ•.�tofJ�� (y�eruG
Address /449 t5�N-
(Soeet orRo Route
city or Town Stet
(BM-(0g7- °1g/y
Area code- Plane number
4. DATE DRILLED `F'/ 3 ° 03
5. TOTAL DEPTH: 6 30 /
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 17
7. STATIC WATER LEVEL Below Top of Casing: 6 0 FT.
(Use `+' if Above Top of Cuing)
8. TOP OF CASING IS -i FT. Above Land Surface*
*Top of cuing terminated at/or below land surface requires •
variance In sccord•nc9with ISA NCAC IC.011a. n q
9. YIELD (gpm): `Jya\ GimMETHOD OF TEST Li 6 -
10. WATER ZONES (depth): f� r? ' - 3• G
( 00' — i/a &pfr",
11. DISINFECTION: Type 14 I { ct 0 `., Amount I \ 2
12. CASING: Wall Thickness
Depth Diameter or Wcight/Ft. Material
From - To 35 kr'/� Sb2 4 PV(G
From To
From To
13. GROUT: Depth
From 1- To 0o
From To
14. SCREEN: Depth
From To
From To
15. SAND/GRAVEL PACK:
Depth
From To Ft.
Ft.
Ft.
Ft.
Zip Code
Material Method
Ft. Leri t3N-C pro J Ret
Ft.
Diameter Slot Sire Material
Ft. in. in.
Ft. in. in.
From To Ft
("e'1t6.�I2EFiA1�CSf P,7
CI: HEREu FY7
AND
L; -
Size Material
Topographic/Land setting
❑Ridge LISlope ❑Valley ❑FIat
(check appropriate box)
Latitude/longitude of well location
/V35a0193S' 8,0
(delpees/miauws/seconds)
Latitude/longitude source:❑GPS❑Topographic map
DEPTH
Frpm - To
i
3o'- 6O"
(90' --- boo'
6OD -
bo O'- 6 50
(chock box)
DRILLING LOG
Forrnation Description
0Jet-e:,CR0e0
C>QA&ttel (-0NtT r {C-_
3 Gerr"
hp) i L"
ol-Na GPon
GPn)
LOCATION SKETCH c— T ^,
Show direction and distance in miles from aeastE
two State Roads or County Roads. include the road- 2
numbers and common road names. r5 --7: 1 m
/.5 w (am.-
fr.
C)
S i C(- cii `5
CI7
S WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL G
ND THAT A -COPY OF THIS RECORD HAS BEEN PROVIDED TO HE WELL OWNER
IJ
SIGNATURE OF PERSON CONSTRUCTING THE WELL
03
ATE
GROUNDWATER SECTION
SWHI'ttlffe n of Water Quality, Groundwater Section, 1636 Mall Service Center - Ralelgh, NC
27699-1636 Phone No. [phone], within 30 days. GW-I REV. 07/2001

278351
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment andwal Resources - Division of Water Quality - Groundwater Section �7
WELL CONTRACTOR (INDIVIDUAL) NAM, (print)p07 (Nif/1�G13 � � 4L L p CERTIFICATION 4(�f7/ y
WELL CONTRACTOR COMPANY NAME/lU%di,./r..r /,'7/4i/Itid ,�A ages PHONE Jt(., Zy7-Nita
STATE WELL CONSTRUCTION PERMIlit 11/Y' ASSOCIATED W ERMTTN /Y/S
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential Municipal/Public 0 Industrial ❑ Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION. County____ /,
aLarc-
Nearest Town:
City or Town
Area code- Phone number
4. DATE DRILLED 4/.2 I/O 3
5. TOTAL DEPTH: .1. /7 r
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO,I�I
7. STATIC WATER. LEVEL Below Top of Casing: /g FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface'
'Top of casing terminated 'Der below land surface require
wristlet In accordance with ISA NCAC 2C .0118.
Zip Code
9. YIELD (gpm): /pp * METHOD OF TESTTi to
10. WATER. ZONES (depth): 7/% I t.% d'JP
11. DISINFECTION: Type /yprayit --Amount
12. CASING: IV% Wall Thin
ameter or Wei
From, 0 TDo�y/0 Ft 4 2/
From To Ft.
From To Ft.
imess
ght/Ft.
MateriG
13. GROUT: Depth( Material od .
From_To Ft. (.Eixa.. (rt) hf
From To Ft
14. SCREEN: Depth Diameter Slot Size Material
Fro To Ft in. in.
From To Ft in. in.
15. SAND RAVEL PACK
Depth Size Material
From -To Ft.
From To Ft.
16. REMARKS:
Topographic/Land setting
❑Ridge Qi$lope ❑Valley ❑Flat
(check appropnue box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
Formation Description
DEPTH
From To
-0
m
LOCATION SKETCH
Show direction and distance in miles fro t leaf
two State Roads or County Roads. Inc1u. the niiad
numbers and common road names.
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, ANDT.A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON
Submit the original to the Division of Water Quality,
27699-1636 Phone No. [phone], within 30 days.
c�.27/03
DATE
Center - Raleigh, NC
GW-1 REV. 07/2001

277983
2 WELL LOCATION:
Nearest Town:
17 6_C\
(Street Norm:, N umbers. Communi 1-1 I /�
3. OW'NER L iRwaV&lt4y {&e s
Address 13l ),J.�-Scu c rf oa'r7KI ..
: Strew: or Itogty(o.)
City or Toren Sate Zip Code
Arco code- Phone number
4, DATE DRILLED --
5, TOTAL DEPTH: 414
6, DOES WELL REPLACE EXISTING WELL? YES
7. STATIC WATER LEVEL Below Top of Casing:
(Use "+" if Above Top of Casing)
8, TOP OF CASING IS ` FT. Above Land Surface'
-T r easingre tunneled atror below Iaad surface require
variance in accordance with ISA NCAC SC'0118. OF TES 1 a
10. WATER ZONES (depth): I� y=3 Cti
II. DISINFECTION. Type �blt4 . Amount Z
12, CASING: Wall Thickness
Depth Diameter or WeightiFt. Material
From 0 To'E-CS Ft.
From _ To Ft.
Recovery O Heat Pump Water Injection ❑ Other ❑ If Other, List Use
Topoggr hiCiLand setting
°Ridge 2Slope ❑Valley °Flat
11
Count b
From To FL
13. GROUT: Depth �1� M��ate�rial�p ;;��Method
From To Ft. `-Q\se
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 FL
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and
s Natural Rcso ces -(Division astir(�Qua t
WELL CONY RACTUK(INDI' IDUAL) NAME (DrinoiN t�{ eli`a.-,_ •
w'ELI. COVER A C'rOlr (IOMPANY NAME i!l.C, ulttiVL ilitn. 1�
ASSOCIATED w'Q PERMIT#"
5'FYrE w'ELt CONSTRUCTION PERMIT*
of applicable) (if applicable)
- Groundwater Seci��
1<A a � CERTIFICATION .i'n
PHONE a ra S6�
I, W ELL USE (Check Applicable Box): Residential ' Municipal/Pubile O Industrial ❑ Agricultural ❑
Monitoring O
(cheek appropriate box)
ion, Lot No.,_ip Code) Z,S�1`� q Latitude/longitude of well location
i 4v1
NOCY
FT.
tdegrecs/mino:csrseconds)
Latitude/longitude source:OGPSOTopographic map
(cheek box)
DEPTH DRILLING LOG
From To Formation Description
opu
9. YIELD (gpm): �� Z- ME HOD T C4rh.1ZU ►
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:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STAN' ` RDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE W ELL G ER
y'DATE
SIGNATURE OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mall Ser
27699-I636 Phone No. [phone], within 30 days.
ddcc ("enter -,Raleigh, NC
I )0W-112EV.07i7001:
1.1
GROUNDWATER SECTION
ASHEViLLE REGIONAL OFFICE

WELL CONSTRU TION RECORD
North C arolnw - Department of Environment and Natural Rcso
\YELL CON'1'R M.1 Ok PAVIA.IDUAL) NAME (prim)
N E. I, CON IN 1C'r WI/ COMPANY NAM
S'ra'rE N L. 1.1. CONSTRICTION PERMIT.,
III amp lsacte)
ce9 • Division
277982
Wa r Qua t - Groundwater Seem:
�. CERTIFICATION ay uS/►� .
PHONE 0 1y+i-1•a-y
ASSOCIATED MO PERMIT
11f appl 'cable)
Cal
c 0
ustrial 0
!vton for ngi0 heck
Reco e/ryt 0 teHeat )Pump W aterl Inject on 0 patOtherr0 If Other, List Use__
Ab.cal 0
W ELL LOCATION
Nearest Town die
^�t1 it Coumv_ S
1Sirvtihome.Number. Com moray, Subdivialon. Lot No Z+D Coetel
3 OWNER_!^'C
edit is
g 1S 11M 'We
ti rl ray
Aga n VI St Nv ` From To
1- fly or Tw,n State Zip Code
)- e�
t DATE. DRILLED-_D �• CI 3
5. FOTAI DEPTH:_
opogrepllic/Land setting
edge °Slope °Valley °Flat
i check appropriate box?
Latitude/longitude of well location
toapec oniartea seconoa i
Latitudcitongitude source.OGPSOTopograph!c man
(meta bow)
DRILL IN ' L.�
Formation Description
I , _ IQN SKETCH
AmShow dtreulol and distance in miles from at least
1 4. DISINFECTION Type -ef�T ount
17CASING:W'al Ttwo State Roads or County Roads. Include the read
. 1 I tick
DOES WELL REPLACE EXISTING WELL? YES 0 NO tG'
7 STATIC WATER LEVEL Below Top of Casing: (2,0_FT.
(Lift '*" If Above Top of Casing)
TOP OF CASING 1S � FT. Above Land Surface•
Top of ming terminated ardor below Ind surface r,gs&tl a _ —
varias<e In accordance with ISA NICAC 2C.0116. ---_
M ET. OD OF TEST , O La.l —.-
9. Y IELD lgpm)�, J �.---. -
(` WATER ZONES (depth)-. .._L.t"�.P I O A
mess
Diameter or Wcighv Ft. Material numbers and common road names.
//--yy Depths �},
Frem._a_ ToDe
Ft _.
From �._.—_ To—_ Ft _._- From__ __ To---- Ft.
Method 13 GROUT'. Depth /� Material
From.__ To Ft ,5 ,
From __- To Ft. _ ---
a
Diameter Slot St cc Material
FroSCREEN: Depth
From_ _ To . It In In _
From;o Ft. _in. in.
.__-
I5. SAND/GRAVEL PACK. Depth Site Marenal
From —.To Ft.. _ _—
From�_._To It. __ _ --
16 R L tit rA P K S __.—__---- ---- -- ---
tLai Z13
r r•- rnbY )(- t _;
131A1\ Cyst lt1
E
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
COPY ' 'THIS RECORD HAS BEEN PRGV IDED TO THE WELL
OWNER
CONS'rRUcl ION STA 2AC
3S: A' D THAT A OI OF
:RE. OF PERSON CONSTRUCTING E WELL
DATE
_ ( f
Submit the original to the Division of Water Quatit}, Gruundw Ater Section. 1636 Mall Service Center • Rakish. h. NC
27a9'1-I[)ti Prune Nn. iV 191733.3221, within 3 ays. OW-1 R
GROUNDWATER SECTION
ACUE1,111 r PFrinrdul OFFICE

277980
WELL CONSTRUCTION RECORD
Norte, C .trolin.t . Department of Environment ands Natural Rcs° ces• Division
WELL CON'f RACI OM ilsDR'DUAL) NAME (ponrt s `� eila• ^,P�
sts
.ASSOCIATED v'Q PERMIT
MEL1. CMN I n'. M'fOk COMP Cot NAME
S (ATE MI; I t. C r1NSTRLC:TION PERMIT*
ticabtel
W atpr Qua
(if a, 3icable)
- Groundwater Sec(.**
CCAI•SF[CA.YtICrl1 t
s
�_ratr� •!�
PHONE t �a_sz,��ar�'•�
nt
V� PI+ I2SE i Check Applicable Box)'. Residential it MunicipallPublic 0 industrial 0 Ayncuttural L7
.'vlonnnrtng Cl Recovery 0 Heat Pump Water Injection ❑ Other 0 I[Other, List Use____-.----------
2 • '�,� • ppagrapiric Laid setting
WELL LOCATION: ,t -_�,-hat.Y��
t dge OSlope ❑Vasey CFIeI
Nearest Town:,_ i �•iil _, unt •ut" risk bLsi
�I 1, � ` lchCS apPrclo
I-"-v n 'iibc�jt•.►-am.F�e=- 7.411.1 L7 Latitude.'longieude of well location
ISvcce pain: Nau+bcn. Community. Subdivision La No hip :'�)
_—_ itittresiminaKa/aecnntti
3 OWNER'._.-�__ La!I!udcilonlltude source. GP5OTevoyrz;:hlc man
A �tl '� -_ rl C7'chat:. Post
-�� .� 1 rktici INCDc Los;
JY l Formation Description
No.l
—r to
la__.__.I--
h. tit Tin n Sung
Zip Code
From To
A Ns coot. Phone
t DATE DRILLED0-�--��„�7� j�•3Q a -
5 "O'TAL DEPTH•
___.�csac.-st._ NG GNU (Z'
6. DOES WELL REPLACE EXISTING WELL? Y'S ^ __---
7. STA TIC WATER LEVEL Below Top of Casing: Z•-SL FT.
iUce "•" If Above Top o' i'nsinst
-tOP Ori CASING IS FT Above Lard Surface'
Tolle
nriescc in sreordanee Mt ISA NCAC 3C .at 13-
ram MrTiloD of TEST�L�.,�.�w`'���--
t casingtermiasted 'dor beta.. toad surface retlsiro •
U Y I,_LD (pin) Z __ _-_ - _---__—
10. WATER ZONES (depth) _�.. 5 _ ____ •-----
_ moun, Show direction and distance in nnles from i t least
I ':. DISIN=E:CTION Type
I2. CASING. Wall ihICKQCS5
two State Roads or Counr. Roads, include the read
Diaeter or WcighliF1. Material numbers and common load names
Depth m
Frnrn_yrL,- To 1 Et •.
L
To Ft
From---_-.-- To_—F't----
13 GROUT. Depth
Rom To Ft
Ntaitnal
$1A11 Nct sat ttt#
Method
C�
lo_-____- Fi'--- __.__.___-. -
From. _-�
SCR E.E14 Depth Diameter 510+ SuMateria: e rS
in _ c t
Frtn-_-____- To-_r._._ Ft _�'n in r ------
To_.-__ Ft' in. -- -- ='
Ft:.ny__ --
Depth
15. SAND/GRAVEL POCK. $1Le MatMattitat o
r r;im To Ft. -. -__ _ F r: m-_ _To,, Ft - "'"- -
I6 RCM RKS.
V ACCORDANCE WITH I SA NC AC 2C'. WELL.
!IX)HEI?c3)' CERTIFY THAT THIS WELL
t_ ONS'rRtSTION STA
l � Lab
WAS CONSTRUCTED IC
;DAKDS AND THAT ACOPY OF THIS RECORD HAS BEEN PROVIDED 10 THE WELLOWNER.
SIGN A OF PERSON CONSTRUCTING THE WELL
DATE
c;
ateignC
Seta nit the nr;glnal to rite Division of Water Quality, Groundwater Section. laid Mail Service Center • RaPeiQn' NC' ` n
i76';w-I Gar+Yhmr:n+I. r9t9)733-32T 1, within SA da, s. GW_; R_'1r
t, I;o iI
���L.
-.-
L ;wniFL! C LC I itON
REGiUH'r'''_ OFFICE

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Rcso ces - Division o[ Water Qua 't - Groundwater Sec(��3
y�� (( �� �y�ya� /`+P�a► • CERTIFICATION NJ din,
WELL CONTRACTOR (INDIVIDUAL) NAME (prinryJrVl�u ����' a /� -
WEt.l. CONTRACTOR COMPANY NAME LT
STATE \\Ft.t. CONSTRUCTION PERMITS _ASSOCIATED WQ PERMIT
tit applicable)
(if applicable)
WELL USE (Check Applicable Box): Residential IV/ Municipal/Public 0 industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other ❑ If Other, List Use
Topogr phiciLandsetting
❑Ridge aISlope ❑Valley ❑Flat
(check appropriate bat)
Latitude/longitude of well location
277996
tit Mitt • a\ iy& a T PHONES tali sir43
�1 t.
2. WELL LOCATION: tt i
Nearest Town:T3(%Le.YOslltte-County JF`W.
jar 51, �-t ) Gle.u.3 ?s K 3-
(Strom Name, Numbers, Community. Subdivision, Lot No.. Zip Code)
,(C'dj OwA �1 �.e_e�-(Pvb) (degrecs/mimuevsecandal
3. OW'NER Y`� Latiutderlongitude source:❑GPS❑Topographic map
Addrea �l1Sit e -- -- (check bux)
Snag a R�yto No.) DEPTH DRILLING LOG
'6 ki5'n 3� 4 A � From To Formation Description
Cmy ur io,an Stale
te Zip Code
Area code- Phone number ���— O�
4. DATE DRILLED el' )
5. TOTAL DEPTH: 305
6. DOES WELL REPLACE EXISTING WELL? YES 0 O C' _ 7 STATIC WATER LEVEL Below Top of Casing:
(Use-+" if Above Tcp of Casing)
S. TOP OF CASING IS _ 11 _ FT. Above Land Surface'
Top of casing terminated atfur below tend surface requires a•
variance In accordance with 15A NCAC 2C .0118. �- 1
9 Y10_ IELDlgpm).-3METRO OFTES'i lal0_ �j —
10. WATER ZONES (depth). Z—�
II. DISINFECTION: Type —rib 1A.4 Amount._
12. CASING: Wall Thickness
,r__.t_Depth Ayy_� Diameter or WcightFt. Material
y From_To I`T'--� Ft.
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From _ To_ Ft.CtI "' 4s ?Otee
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.
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road nacreslq if
0
cv
16 REMARKS.
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTR ST . RDS. AND THAT 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 Water Quality, Groundwater Section. 1636 Mail
27699-1636 Phone No. [phone], ss'ith in 30 days.
rr,
Ci
GROUNDWATER SECTION
ASHEVILLE REGIONAL OFFICE

7. STATIC WATER LEVEL Below Top of Casing: (aO—FT-
(Use "+•' if Above Top of Casing)
R. TOP OF CASING IS _ FT. Above Land Surface'
at/or below laud surface requires
variance in accordance with 15A NC AC 2C.0118. II s ��`,
of METHOD OF TES QI
O. WATER ZONES (depth): tile
II. DISINFECTION: Type�blll..`� Amount Z.
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From
From To l �� Ft.
From To Ft.
From To Ft.
l3. GROUT: Depth �1� Matenal��Method
From To Ft. `'Q\L%f
From To _. Ft.
14. SCREEN: Depth Diameter Slot Sze Material
From To _ Ft. in. in.
From To Ft. in. . _ in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft. -- --
From To Ft.
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Rcso ces - Division o Water Qua 't - Groundwater Secj l a
CERTIFICATION
WELL CONTRACTOR (INDIVIDUAL) NAME (print)
\VELI. CONTR AC'rOIt COMPANY NAME
STATE\\ EI.I. CONSTRUCTION PERMIT%
I if applicable)
ASSOCIATED WQ PERMIT
(if applicable)
r73 4
L
�I %
PHONE % y
L
I. WELL USE jChcck Applicable Box): Residential hd Municipal/Public 0 Industrial ❑ Agricultural 0
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other ❑ If Other, List Use —
2. WELL LOCAT ON: - , `, ,(�a�
Nearest Town�,4•- County V11�Q�1
l-crFit skin !ek-� .6h k‘cMUt IV
t Street Name. Numbers. Community. Subdivision, Lut No., Zip Code)
•
3. OWNER. �•..�y,,�Il. a fe^J41/
ndch ess rV l[f VNA1 Qom/-j Y• —
3 .1161X1 irec 1i` Cu,No )if
City or Town State n Zip Code 4rea code- Phone lumber \ _ 0
4. DATE DRILLED I `
5 TOTAL DEPTH: 305'
6 DOES WELL REPLACE EXISTING WELL? YES 0 NO
Topogr hic/Land setting
°Ridge HSlope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/mu:derseconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
Trip c easing tt ac terminated � -;
9 YIELD (gpm). 100 M TIV.
r OC ATI` ON SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
19` 2.3
M vd &y' 1 t 2 cmat
0 0
*1 6 \2
v)kR.t*s a o W-76s
0
tV
Ib. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CON' TNDDS: AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL
OWNER
DATE
SIGNATURE OF PERSON CONSTRUCTING THE WELL
Sub it the original to the Division of Water Quality, Groundwater Section, 1636 Mail
27699.1636 Phone No. [phone], within 30 days.
CO 11
GROUNDWATER SECTION
ASHEVILLE REGIONAL OFFICE

277935
WELL. CONSTRUCTION RECORD
North C aralina • Department of Environment and N�aIRcsou(�;� Division
\Y ELL CONTR&Cl OK ON Dl V(DtJAL1tiAMC tpriae) �4hh1lbw_ -
%Ft.t. CON TKtCtOR COMPANY NAME ��
11.
T • , AssOCikTEO wQ PERMIT
s r &'[F tt 4.1 I. CC/Win-flit"►ERMITN 1 if applicable)
I P apphcablel
I WELL. LSE IChcck Applicable Box): Residential CV Municipal/Public 0 Industrial ial 0 Agncultural 0
Monitoring 0 Recovery 0 Heat Pump Witter Injection 0 Other 0 If Other,
WELL LOG. n'rl �.6,.`' Co my
Nraresl Town' l` Z ��
���k�li��%, zde)
I in:c� F.me. Rumben. Cnnimuaity. Subdivision, La Na 2+p "oriel
LiI06( (O•greeifminutesnecondat
OWNER . � f7T�7 Latoudcilon nude source.OGPSOTopographlc map
Adkldi iv�, __ ,l '0. ,-La check box,
t� so or Route;.yl (DEPTH 2RI1L1! J&Q
Ltiy l 1 I � �' zC��
From To FormationDescription
C uy ur Town State Zip Code `------_� .__
Wa r Qua t
Groundwater Sec{ se
CERTIFICCATIIOONto
PHONE a 7LL7�}
Area code • Phone
i DATE DRILLED a __ r J
5, TOTAL DEPTH:__
6. DOES WELL REPLACE EXISTING WELL? VES 0NO GI'
7 STATIC WATER LEVEL Below Top of Casing.
(Um ' of Casing)
S TOP OF CASING IS — FT. Above Land Surface'
•Top arc asing terminated Wor below lead surface ragetr � a
warts nee In accardenee t INCAC IC.011S.
v. Fist stet
IELD (gpm): `C� ; s�METNp OF TES
CS
10WATER ZONES (dephty 1 `�j--
Topographic- Land setting
ORidge Mope °Valley CFIa(
tchstk apprupnne bce)
Latitude/longitude of well location
f iSCATI . akfTCH
..y i . 1 AmoShow direction and distance in miles from at !cast
I !. DISINFECTION. Type,Jf.iJ-j�-- unt L—Wall Thickness two State Roads or Count Roads. Include the read
12. CASING:
Deprh
From 0 _. To 2C)
From To
From__. To._._
13 GROUT': Depth
From____..__. From To
4 SCREEN'. Depth
From____-- To,__._
From__ To
15. SAND/GRAVEL PACK.
Depth
rtort To
From._TO
Diameter or Weight/Ft. Material
Ft
Ft
Material ;PO
Ft Q�nars O %LY
Diameter Slot Site Matcrlal
Ft in n
Ft. _in. in.
Ft,
Ft.
Site Matcrtat
numbers and common road names.
z5 -`To
>icE Cyet
(1-2_ > \4
16 KLM ARKS.
I DO HEREEre CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRU - t N STANDAR S N? THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
--- — —
`y\ SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water
, Quality, Groundwater Section. 1636 Mail Service CeCjatWer, Rakish, NC
001
EC-EC
OCT 2 7 2003
GROUNDWATER SECTION
ASHr--VILLE REGIONAL OFFICE

277385
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and H•nsral Resources-Diivvision of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) CERTIFICATIONS
WELL. CONTRACTOR COMPANY NAME RF.UI3EN CALDWELL DRILLING, INC. PHONE4i8 ?54-3581
STATE WELL CONSTRUCTION PERM ITT ASSOCIATED WQ PERMITS
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residenlial-C MunicipaVPublic 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nea, stTown�A+/S //i/ County 44-D/co.f.)
l�cs/ Cr-CP- /
(Street Name, Numbcn, Community, Subdivision, la No., Zip Codc)
3. OWNER:
Address a3 r SXt Atar.A 17,4 . P.2 r
, (Street or Roue No.)
l.J0 WO<Rutlle 11Y;— .2 ga 7P
r� City or Town State Zip Code
L &i — (o(.50
Arca coda- Phone number
4. DATE DRILLED 7/p eh 3
5. TOTAL DEPTH: . .Ta
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO-1Hr'
7. STATIC WATER LEVEL Below Top o(Casing: rfiZ FT.
`s if Above Top of Cuing)
8. TOP OF CASING 1S / e y2- (UI.FT. Above Land Surface*
'Top of cuing terminated at/or below land serfue requires a
variance In accerdaacs with ISA NCAC IC .011S.
9. YIELD (gpm): /o METHOD OF TEST /1 ! Gr-
I O. WATER ZONES (depth): Z
11. DISINFECTION: Type /14-4.
12. CASING:
v( 0
From+ / 4, To 15 Ft. / (
Depth
From To Ft.
From______To FL
13. GROUT: Depth Materia)...{.
Front_ To 7-O Ft. /2)//d.e4e-/
Amount S 67
Wall Thickness
or Weight/Ft. MAtcrial
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.
/ Mtypl
ry�c.ct
Slot Size . Material
in.
in.
Material
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Lalituddlon rude of well Location
11,35 510 .,573 o Wo&, 33./c6
(deaea/mimnn/Iecoods)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
�prtnatio�ion
sai.,14-4.-e Aar O
PEPTU
From To
- a7
? 2 0
LOCATION SKETCH
Show direction and distance in miles from at least:
two Slate Roads or County Roads. Include
numbers and common road names.
— -r'N''J-L'"
( c Lfrt-Le eejc
N.
e road
C
16. REMARKS:
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED M ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD I IAS BEEN PROVIDED TO TILE WELL O'
SIGNATURE OF PE
Submit the original to the Division of Water Qualls
27699-1636 Phone No. [phone], within 30 days.
2/
STRUCT1NG THE WELL
jindwater Section, 1636 All
DATE
l- 03
rvlce Gisler - Raleigh, NC
GW-I REV. 07/2001
;

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Na
WELL CONTRACTOR (INDIVIDUAL) NAM - rent)
WELL CONTRACTOR COMPANY NAME
STATE WELL CONSTRUCTION PERMITS
279505
Resources - Division of Water Quality - Groundwater Section
CERTIFICATION r 5777
/
HONEy/# (a(61VY Din)
(if applicable)
N/q
ASSOCIATED WQ PERMIT#
(if applicable)
1. WELL USE (Check Applicable Box): Residential MunicipabPublic 0 Industrial ❑ Agricultural Ltl
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Neare Town:
County
(Street Name, Numbers,
Comm
3. OWNER:
Address /J
Subdivision, Lot No., Zip Code)
City or Town State
023176e 7,"
Zip Code
Arca code- Phone number
4. DATE DRILLED S?l.2 2/ .0 3
5. TOTAL DEPTH: ./G.S'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO j:M.
7. STATIC WATER LEVEL Below Top of Casing: .3c r FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 7. .9 FT. Above Land Surface'
"Top of casing terminated at/or below land surface requires ■
variance In accordann with 15A NCAC 2C .0118.
9. YIELD (gpm): YA METHOD OF TEST- e-st+i
10. WATER ZONES (depth): /DS'
11. DISINFECTION: Type Q/. J` Amount to •�
12. CASING: vv Wall Thickness
Depth ameter or Weight/Ft.
To3a
'
From_—
From To
From To
13. GROUT: Depth
From0 To 07 n
From To
14. SCREEN: Depth
From To
From
15. SAND/1 RAVEL PACK:
Depth
To
From / To
To
16. REMARKS:
Ft o?/
Ft.
Ft.
� Method,
Ft enaZa - ti,4l -47
Ft T
Material
®da
Diameter Slot Size Material
Ft. in. in.
Ft. in. in.
Size Material
Ft.
Ft.
Topo hic/Iand setting
❑Ridge Slope ❑Valley '❑Flat
(check appropriate box)
Latitude/longitude of well location.
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box) LI
DEPTH
From To Formatio Descriptikd ) j
NI
LOCATION SKETCH --0
Show direction and distance in miles from aneast^ m
two State Roads or County Roads. Include li roaa`4
numbers and common road names.
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND T1iP,T A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
TU12E ' ea/IC
SIGNA OF PERSON CONSTRUCTING THE WELL
s/b7/a ?
DATE
ow]
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

279495
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and marurall.Besourey - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (prim)�`-')I"L-) ••o-)AS'N F.CERTIF1ICATIONa al 1I
WELL CONTRACTOR COMPANY MAME_RUBEN CALDWELL DRILLING, INC. PHONEYr?f8 54-3581
STATE WELL CONSTRUCTION PERMRa ASSOCIATED WQ rERMfla
(if applicable) (if applicable)
1. 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: /AA (LS N A 1-' _ county Ma bI So
out, Name,�tumben, Community, Su eion, Lo No., Zip Code)
3. OWNER: C. .. McEti\/E, $
Address 1 Do W . OAn1I A (,t3Ret4 651v/b
(Siren or e4Route
NF
bANiis QAC-1 LA _ 3S o 4
City or Town State Zip Code
(i61- - �i as — bq -1
Area coda- Phone number
4. DATE DRILLED u / 7 0 3
5. TOTAL DEPTH: R O '
6. DOES WELL REPLACE EXISTING WELL? YES 10 0
7. STATIC WATER LEVEL BelowTop of Casing: 1 4-a FT.
1 (Use -.- if Above Top of Casing)
8. TOP OF CASING IS FT. Above Land Surface•
Top of cuing terming/II at/or below had surface requires •
variance 1n •ccordaaca with SA NCAC IC .0110.
9. YIELD (gpm): METHOD OF TEST %( 6 A at'
10. WATER ZONES (depth): 3 So' '� G Pyv.‘
io50 " ' GPn"
11. DISINFECTION: Type I-! /h 9 v `(n Amount a I) -
12. CASING: Wall Thickness
Depth / to or rW,qei�ght/Ft. Material
From 1 To ? O FL b' SS Sr/�-P t 9✓O
Frost_ To Ft.
From To FL
13. GROUT' Depth Material /� Method
From .' To a-O Ft. C LT �b�n) i /✓n tt (Lep
From To Ft. U
14. SCREEN: Depth Diameter Slot Silt . Material
From To Ft. in. in.
From To Ft. in. T_ in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
Topogtaphit/Lai ettiDg
❑Ridge ❑Slope alley °Flat
(check appropriate box)
Latitude/longitude of well location
At55° a sreeSGuto$aazhd?
(deDeuheimne✓racmds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEMI DRILLING LOG
Frgm / To i Fo lion Description
i — '15 0 bKRI)8N
—1$'—' .�-30' ���;j
7,307.- 65o'
65u'
('50'- S0 &a_
rf
eery,
ATile
co =
Co,
Ere cm
)OCATIONSKETCH -a ZT.
Show direction and distance in miles hong, leaCal
two State Roads or County Roads. Include -the roe
numbers and common road names. lr o{
t;
'ktimoK 1' 6
O ma
/WU
3,eDrn
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED M ACCORDANCE WITH ISA NCAC 2C, WELL
CONSTRUCTION STANDARDS, AT A COPY OF Till RECORD HAS BEEN PROVIDED T`yO�/T/p`{/-{p� 1v�L`L OWNER
R
SIGNATURE OF PERSON CONSTRUCDNG THE WELL
r)
Urx
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mall Service Center- Raleigh, rid'
27699-1636 Phone No. [phone], 'within 30 days. GW-I REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality
WELL CONTRACTOR (INDIVIDUAL) NAME (print) DQee CCK 1AC41-ti S0.w,ye AM
join Nea
WELL CONTRACTOR COMPANY NAME CA 'arriP AA
STATE WELL CONSTRUCTION PERMIT# _ -- ' ASSOCIATED W Q PERMIT#
(if applicable) (ifa licablc)
1. WELL USE (Check Applicable Box). Residential ® Municipal/Public 0 Industrial ❑ Agricultural ❑
Monitoring 0 Recovery 0 Heat I ump Water Injection 0 Other 0 If Other, List Use
279291
- Groundwater Section
CERTIFICATION # 243fo
PHONE # ( S %(aS-jtc
111.1111Ssn
2. WELL LOCATION:
Nearest Town: lib Sr vtqnrt5 County /43-C i 6 o "
o-L4% R2ev2oK41
(Street Name. Numbers. Community, Subdivis an, Lot No.. Zip Code)
3. OWNER:
Address
PC cAnc4 h &eeve
24 reeves n0ad
(Street or Route No.)
7�C1• Spiin9:� ga
City or Town tate
,A$7243
Zip Code
( )-
Area code- Phone number
4. DATE DRILLED 'S- 3 '`' a
5. TOTAL DEPTH: (.oO 5
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO WO
7. STATIC WATER LEVEL -Below To,, of Casing: S,20 FT.
(Use' r" 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 .10.18.
9. YIELD (gpm): �' METHOL OFTEST 2;eka
10. WATER ZONES (depth):
11. DISINFECTION: Type
12. CASING:
Depth
From 1-1.To 55 Ft.
From To Ft.
From To Ft.
13. GROUT: Depth Mat .vial Method
From 0 To Zo Ft. Ce' flan* PO al
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. -1. in.
15. SAND/GRAVELPACK:
Depth Size MaterialCP
From To Ft. _ -a-
From To Ft. Ca
Topographic/Land setting
❑Ridge 1651ope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutesisecon is)
Latitude/longitude source:❑GPS❑Topographic map
(check boo
DEPTH DRILLING LOG
From To Fomiation Description
ir 1
is 3f
Oyes 9,e D n
3£j Tin 004 Ccw:re.
t1\� Amount
Wall Thickness
Diamenr or Weight/Ft. Material
(Otz. 1121 P\CIS F:L
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers End common road names.
O
w
C/2
rn
—D
1/40
3
0
0
c )�
On
On
�m
0<
>0
mo
16. REMARKS.
I DO HEREBY CERTIFY THAT THIS WELI WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THA T A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
23-0
SIGNATUF.E OF PERS COL STRUCTING THE WELL DATE
Submit the original to the Division o(111,ater Quality, Groundwater Section, 1636 Mail Service Center
rip
REV. 27699-1636 Phone No. [phone], with 30 days.
mar

WELL CONSTRUCTION RECORD96
North Carolina - Department of Environment and N : Resources - Division of Water Quality - Groundwater Section
WELLWELL CONTRACTOR (INDIVIDUAL) NAM 1(print I/ / i C t 'Lo CERTIFICATION i,Lop77 }�
WELL CONTRACTOR COMPANY NAME 4 .aA ' l A.w�r iL PHONE N Y�i.oT�d S_7-DYOC/
STATE WELL CONSTRUCTION PERMTD$ 4//4" ASSOCIATED WQ P gig
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential( Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest To %%%O/ County J
/.J9a4 - ,-, 8
(Suet Name, Number, Community, Subdivision, Lot No., Zip Code)
(�$/�p5j or��Route No.)
City or Town State Zip Code
�}
Area code- Phone number
4. DATE DRILLED 8// g/,, 3
5. TOTAL DEPTH. .2. 11.S
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO Xl
7. STATIC WATER LEVEL Below Top of Casing: _` FT.
(Use •4" if Above Top of Casing)
8. TOP OF CASING IS %S FT. Above Land Surface*
'Tap of casing terminated at/or below land surface requires ■
variance in accordance with 1SA NCAC 2C .0118.
9. YIELD (gpm): t) METHOD OF TESTT ri
10. WATER ZONES (depth): `6 /> ' p la f
11. DISINFECTION: Type (la Amount i/ ""
12. CASING: Wall Thickness
Depth or Wei t/Ft
3. OWNER:
Address
14. SCREEN: Depth Diameter
Fro
Fro
From om
O To Cot Ft at/ and
From-_ To Ft.
From To Ft.
13. GROUT: Depth
From 0 To a /l Ft
From To Ft.
Slot Size Material
FL in. in.
o Ft in. in.
Topographic/Land setting
❑Ridge ❑Slope I,Valley ❑Flat
( appropriate tax)
Latitude/longitude of well location
(depeea/mimues/sewnds)
Latitude/longitude source:❑GPS❑Topographit'mxyr____� _I
(check box) --
DEPTH DRII.LIN(ilrai-- _ -=
From To Formation Description
0
PJ
LOCATION SKETCH =
Show direction and distance in miles t 1e
two State Roads or County Roads. Intl (the Mad
numbers and common mad names. co 0
i 1. LZt %4J1/
15. SAND/GRAVEL PACK
Depth Size Material
From to Ft.
From To Ft.
16. REMARKS:
1 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
rte: �v P1/�
SIGNATURE OF PERSON CONSTRUCTING THE WELL
(//8/03
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-1 REV. 07/2001
ttl
rue /4 S°
At
0

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality
WELL CONTRACTOR (INDIVIDUAL) NAME
"�'�(priintt) U }) -lam :PASN
WELL CONTRACTOR COMPANY NAME J]L1/_Y-
280412
- Groundwater Section
CERTIFICATION # a-r'rI
PHONE # (S, D: f.k •F- a B %
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 ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
41 Sin)
Town: IIA-A�4Al-.L. County
4-15 (]L1/4)13131A-4 to r.)E
(Street Namc, Numbers, Community, Subdivision, Lot No., Zip Codc)
3. OWNER:
L A f-ry 1-y-rc 2
Address 415 3iUC, Q\12D .At3C
(Street or Route No.)
A(LsHA1-)— n)c a-8'153
Zip Code
(gas )- b#rt - O 6 6 I
City or Town State
Arca code- Phone number /
4. DATE DRILLED G/ al/ O 3
5. TOTAL DEPTH: aka /
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: AFT.
(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 2
variance in accordance with 15A NCAC 2C .0118. 99�
9. YIELD (gpm): 3 0 METHOD OF TEST 1`t G -i° 1 a-
10.WATERZONES(depth): }/O/J" 3o 6QM
I1. DISINFECTION: Type �T� q0 (o Amount 1 1
12. CASING: Wall Thickness
Depth 1�Qigrpeter or Weight/Ft. Material
From To 7,0 Ft. v/� soLal P'fG
From To Ft.
From To Ft.
13. GROUT' Depth Material //n� Method
From To pm Ft. C-e t✓`e r( Y"ooa-ce
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 ❑Flat
(chcck appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(chcck box)
DEPTH DRILLING LOG
Fr9mZTowy Fomyation Description
—
AAO s1 FY 11.-6 St-Pt43
36 "— Ile GO-A&tra w r6 mete
tip / -D Q r
I` -to - ado' wily/ G ILA trtr.-
LOCATION SKETCH
Show direction and distance in miles from at
two State Roads or County Roads. Includ�;
numbers and common road names.
0
V)
g5
nw(5
i-4
O
lease
e road
c s.
ti
(-1 c.c.) /
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONtTRU(,TO • ,•:.'.e _, • • a A A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
r'
OF PERSON CONSTRUCTING THE WELL
ll (+
SubiTut the original to the DLuf4on Qi lv3/4 er Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
276919-1636 Phone No. [phone], ,ivithi130 days. GW-1 REV. 07/2001
J
(1)

WELL CONSTRUCTION RECORD
North Carolina - Department orEnvirc nment and Natural Resources - Division )f Water Quality - Groundwater Section
WELLCONTRACI'OR(INDIVIDUAL) NA 4E (print) Devi`tCM I:tar-9� ��aQCJ
w'ELL CONTRACTOR COMPANY NAME Q--N''sa 5`3._.atve.0tat - Qe
STATE WELL CONSTRUCTION PERMIT:: ASSOCIATED WQ PERMIT#
(ifa I cable)
(if applicable) - -
I. WELL USE (Check Applicable Bo r)- Residential Municipal/Public 0 Industrial 0 Agrict((Diuraffl
281104
CERTIFICATION 9_1r Lie"
PHONE 4 < (p(c S-:_CL;_
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other ❑ If Other, List Use -
2. WELL LOCATION:
Nearest Town: !Acts I \ \
l'J•+l\ Cre.e-
(Street Name, Numbers, Community. Subdi ision, Lot No.. Zip Code)
3. OWNER: And' An&ecsc-r`
Address PO J% :139,
(Street or Route No.)
I\e"wflr v:Ue t\C
City or Town State
(eW)- (c5ce C'Ac(o
Arca code- Phone number
4. DATE DRILLED ' ° —
5. -TOTAL DEPTH: \-SOS
6. DOES WELL REPLACE EXISTIt'
7. STATIC WATER LEVEL Below]
(us.
8. TOP OF CASING IS 1
*Top of casing terminated at/or below la,
variance in accordance with t5A NCAC
9. YIELD (Rpm): a METH('
10. WATER ZONES (depth):
County ,e.�aso�
3>ade��
fl l rob?
Zip Code
G WELL? YES ❑ NO E3
op of Casing: Sib FT.
..+' if Above Top of Casing)
T. Above Land Surface*
d surface requires a
C .0118.
D OF TEST RA
Topographic/Lan >el ing
[]Ridge Eglope. ❑ d%' 0Flat
(check appropriat 81'4
Latitude/longitude of "i4cation
(degrees/minutes/5
Latitudelongitude sous;:❑GP
(thee
DE'TH
From To
}1 t-ti
RILLIN
Forr Cation Descriptic
C YCc 2-osat-z 4t
1 I. DISINFECTION: Type )' :‘s5
12. CASING:
Depth Diar eter
From T` To `ct FL A
From To Ft.
From To Ft.
13. GROUT: Depth
From
0 To ,2c
From To Ft. _.
14. SCREEN: Depth Diame er
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth
From To Ft.
From To Ft.
Amount /0
Wall Thickness
or Weight/Ft. Material
M aerial
Ft. _C,Olsrognt
Method
Slot Size Material
in.
in.
Siz Material
LOCATION SKET;H
Show di ection and distance in roles from at least
two Stat, Roads or Courty Roads. Include the toa I
numbers ar.d common read name;. ='c
CO
o "=
m
0
r
cA
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WE -L WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, VELL
CONSTRUCTION STANDARDS, AND Tf AT A COPY OF THIS RECORD HAS BEET I PROVIDED TO THE WELL OWNER
-i/ IX \ }J Y \\-(o-C3
SIGNAT .IRE ' F PERSON CONSTRUCTING THE V ELL DATE
Submit the original to the Division of Nater Quality, Groundwater Section, 1636 Mail Service Ceenterf RFVgh, NC i
27699-1636 Phone No. [phone], wit hin 30 days.

281824
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Na I- Resources - Division of Water Quality - Groundwater Sectionr
WELL CONTRACTOR (INDIVIDUAL) NAME (print)�/ �tO N/Y/ C. B.57 L. CERTIFICATION # , 7/�7
WELL CONTRACTOR COMPANY NAME_atz �i eld.Lb/ LI.leLF -1 £ts4 f ji .L PRONE # Oaf 4 y% Di$2G)
STATE WELL CONSTRUCTION PERMIT# 'VIC ASSOCIATED WQ PERMIT# AV,/
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential (9 Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest -Town:
County
d e2 2? 2S'l
(Street Name, Numbers, Canmunity, Subdivision, Lot No., Tap Code)
3. OWNER:0-re •/tAJJyy2-
Address .Z/b
n (Spinat or Route No.)
7770A0 .r N.C, 2 8753
City or Town State Zip Code
Arca code- Phone number
4. DATE DRILLED 9Y9/ D 3
5. TOTAL DEPTH: a b S
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO J$
7. STATIC WATER LEVEL Below Top of Casing: % FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1 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): ' METHOD OF TEST /-Gt?-Ll
10. WATER ZONES (depth): i% �i t /..2 S r
11. DISINFECTION: Typef-
12. CASING:
From p �7n Ft Diameter
From To Ft
From To Ft
13. GROUT: Depth Ma
From 0 To SS -Ft
Amount /d O
Wall Thiclmess
or Weight/Ft. Material
S- ..e.2( ©dG
From To Ft
14. SCREEN: Depth Diameter Slot Size Material
From Ft. in. in.
From To Ft. in. in.
15. S /GRAVEL PACK:
th Size Material
From / To Ft.
Method
FromL To Ft.
16. REMARKS:
Topographic/Land setting:_
($Ridge ❑Slope ❑Valley Qh9a
(check appropriate box) f
Latitude/longitude of well loCati4fi
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑To
(check box)
DEPTH
From To Formation Description
LOCATION SKETCH
Show . tion and distance in miles from at (east
two State R. . ds or County Roads. Include the fold
numbers and c,mmon road names. o t✓•�1
co
N)
7.10
0
1 DO HEREBY CERTIFY THAT THIS WFI 1 WAS CONSTRUCTED TN ACCORDANCE WITH ISA NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
63
9/03
SI A PERSON CONSTRUCTING THE WELL DATE
/ions c
$Ire
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

WITLL CONSTRUCTION RECORD
North Carolina - Department of Envire nment and Natural Resources - Division if Water Quality - Grour dwater Section
WELL CONTRACTOR (INDIVIDUAL) NA 4E (print) DesP:e-x IcA„r
WELL CONTRACTOR COMPANY NAME C1>a1e& S�-`dYQCD tl ZGet LSV ' pIA"e PHONE # c C S- 2GZ'
STATE WELL CONSTRUCTION PERMIT;- ASSOCIATED WQ PERMIT#
(if applicable) i_ (if applcable
283155
CERTIFICATION #_at ±_31.c
a- t.
I. WELL USE (Check Applicable Bo <): Residential frI Municipal/Public ❑ Industrial ❑ Agricul ural ❑
Monitoring 0 Recovery 0 Heel Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: Mots CA\ County 1--1ca
9.5S So‘iinAias 'ate��{t
(Street Name, Numbers,mmunity, Subdi ision, Lot No., Zip Code)
3. OWNER: ((J 'QuhC'n1S eA
Address ass 3c,y.S luny
(Street & Route No.) C7
evlq.r5NNONN +NC 25in S .3
City or Town State Zip Code
(121)- C00%?,c,89
Area code- Phone mmnber
4. DATE DRILLED \0-$-O3
5. -TOTAL DEPTH: Sob
6. DOES WELL REPLACE EXISTID G WELL? YES ❑ NO ■
7. STATIC WATER LEVEL Below 7 op of Casing: (cO FT.
(tie : "+" if Above Top of Casing)
8. TOP OF CASING IS 1 T. Above Land Surface*
*Top of casing terminated at/or below la .d surface requires a
variance in accordance with ISA NCAC :C .0118.
9. YIELD (gpm): 1 METH('D OF TEST R.�q
10. WATER ZONES (depth): d
11. DISINFECTION: Type a,t1.1 Amount it
12. CASING: 1 Wall Thickness
Depth` Diar ,eter or Weight/Ft. Material
From -1t1 To &a Ft.JQ-3+2\ Vk;st:c
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From n To at Ft. l.2vvt-in t Ocuved
From To Ft. 1
14. SCREEN: Depth Diame or Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Siz i Material
From To Ft.
From To Ft.
16. REMARKS:
Topographic/Land setting
[]Ridge al Slope ❑Va ley ❑Flat
(check appropriate t tx)
Latitude/longitude of wt 11 location
(degrees/minutes/sect ads)
Latitudelongitude source:❑GPS:Topographic n ap
(check l ox)
DE'TH L RILLING LCG
From To Forr ration Descrip tic
41 g(v QY.IC iJ cd ,-,
R(a Esne=
LOCATION SKETCH �O it
Show di -ection and distance in re- les from at least at'
two Stat Roads or County Road . Include th a : cCD
numbere and common read name a o
I DO HEREBY CERTIFY THAT THIS WE .,L WAS CONSTRUCTED IN ACCORDAN :E WITH ISA NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND Tf AT A COPY OF THIS RECORD HAS BED' PROVIDED TO THE WELL OWNER
Baru te}< 11k t�� � ,�°� ai)'' D3
SIGNAT IRE OF SON CONSTRUCTING THE V'ELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center • Raleigh, NC
27699-1636 Phone No. [phone], wi' hin 30 days. GW-1 REV. 07/2001

283154
WELL CONSTRUCTION RE CORD
North Carolina - Department of Envin nment and Natural Resources - Division rf Water Quality - Grour dwater Section
WELL CONTRACTOR (INDIVIDUAL) NA'4E (print) De-C:r-x • \AAA .1)o,, v
WELL CONTRACTOR COMPANY NAME QV -Ate- Sv`N‘rVc' a SOAL3 •t P+"se PHONE Y (E't% (04S• CL_'
STATE WELL CONSTRUCTION PERMIT,- ASSOCIATED sVQ PERMIT#
(if applicable) ®fir (ifappl cable)
la— I. WELL USE (Check Applicable Bo c): Residential &J Municipal/Public ❑ Industrial ❑ Agricul ural ❑
Monitoring ❑ Recovery ❑ Her t Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: (\44-sba.\\ County 'MAa:4sr
�bl Raerfse `�jj -SA r:n fica( as3')53
(Street Name, Numbers. Comairy, Subdi ision, Lot No., Zip Code)
3. OWNER: )taro aan 't'ne\Sorn
Address \(o\ RoomttN .Sne\snot (inoA
(Street or Route�a)
fr 1:1e9\r4\l ter
City or Town State
(bt)-
Arca code- Phone number
4. DATE DRILLED %0• S -03
5.-TOTALDEPTH: e2,25
6. DOES WELL REPLACE EXISTIP
7. STATIC WATER LEVEL Below 1
(Uc
8. TOP OF CASING IS t
*Top of casing terminated at/or below la
variance in accordance with ISA NCAC
9. YIELD (gpm): t0 METH(
10. WATER ZONES (depth):
Zip Code
G WELL? YES ❑ NO al
op of Casing: 30 FT.
"+" if Above Top of Casing)
'T. Above Land Surface*
d surface requires a
C .0118.
D OF TEST R•ej
CERT171CATION #_ ' i_W-c
Topographic/Land setting[]Ridge Deslope ❑Va ley ❑Flat
(check appropriate b tx)
Latitude/longitude of wt 11 location
(degrees/minutes/sect nds)
Latitudelongitude source:❑GPS7Topographie nap
(check I ax)
DE'TH ERILLINGLOG
From To Forr'anon Descriptic
49t Ov .v f lurdcs
q9 2'2 S S� � a'A e
I I. DISINFECTION: Type rows
12. CASING: 7
Depth Diar ,eter
From ar \ To g\ Ft. Coy_
From To Ft.
From To Ft.
13. GROUT: Depth K rterial
From 0 To a0 Ft. Cement
From To Ft.
Amount 8
Wall Thickness
or Weight/Ft. Material
33d\ ra6 \:C
14. SCREEN: Depth Diame er
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Siz
From To FI.
From To Ft.
16. REMARKS:
Method
you a ci
Slot Size Material
in.
in.
Material
d
to
CD
C=7
Cri
0
0 r
rn.
Show di 'ection and distance in rr'ties from a east^',-:,
two Stat: Roads or County Road, Include (hi
number; and common read name;. p 2
0 E5
LOCATION SKETCH
I DO HEREBY CERTIFY THAT THIS WE WAS CONSTRUCTED IN ACCORDAN :E WITH ISA NCAC 2C,
CONSTRUCTION STANDARDS, AND TE AT A COPY OF THIS RECORD HAS BEET 1 PROVIDED TO THE WILL OWNER
r
tt
E N CONSTRUCTING THE V 'ELL
SIGNAT O
10-CS'a3
DATE
Submit the original to the Division of Nater Quality, Groundwater Section, 1636 Mail Service Center-. Raleigh, NC
27699-1636 Phone No. [phone], wn hin 30 days. GW-1 REV. 07/2001

3. OWNER:
282872
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WILL CONTRACTOR (INDIVIDUAL) NAME (prtat) Si t 1 t- 6 K CERTIFICATION 0 ----i / \
WELL CONTRACTOR COMPANYNAME_RF.UHEN CALDWELL DRILLING, INC. PHONE
Q8 .2.54-3581
STATE WELL CONSTRUCTION PERMIT, ASSOCIATED WQ PERMITS
(if applicable) / (if applicable)
1. WELL USE (Check Applicable Bos): Residential 13 MunicipaVPublic 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: Rich Slag/46S County fl/LA tJ) cS °tJ
8' C N 1-1L0 1_ . C_01 kr (i--2 A
(Street Nurse, Numben, Community, Subdivision, Lot No., Zip Code)
C 21 c- /O L,a)
Address 8c Ca212-c)_t-- Co 'r,Sb
(Street or Route No.)
AlLi1/49-5N4y,L 13 c_. dr 53
City or Town Stare Zip Code
01B)- (5G - gaOk
Arn code. Phone number
4. DATE DRILLED O c1t 6 3
5. TOTAL DEPTH: 1/n
6. DOES WELL REPLACE EXISTING WELL/ YES 0 NO 19
7. STATIC WATER LEVEL Below Top of Casing: 4-0 FT.
(Use `+- if Above Top of Cuing)
8. TOP OF CASING 1S - - FT. Above Land Surface•
•Top of cuing Iermloated Mier below land surface requires a
variance In accardaocs with ISA NCAC 2C .011s.
9. YIELD (gpm): 3 o METHOD OF T T rU G ' Al
10. WATER ZONES (depth): I 9 — 40 G P„n
I1. DISINFECTION: Type
12. CASING:
Depth
From To t 0°
From To
From To
13. GROUT: Depth
From 1 To ao Ft.
N i U'U Amount /.9-
Wall Thickness
Diameter or Weight/Ft. Material
FL 7 i4
Ft.
Ft.
Material Method
(.864$1Qi QO J(Z$D
From To. Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From__To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Slot Size , Materiel
in.
in.
16. REMARKS:
Topographic/Land setting
❑Ridge ❑Slope ❑Valley F1at
(check sppeoprime box)
Latitude/longitude of well location
N3, 2,44,S I, IDS'3,°u/.LAC,
(degreex/m imnes/seemds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLENG LOCI
Fr3m _ T,g
ye_
100- t5v
130'
130 %-- 110'
Foi-matti n Descri lion
p���)�oer,J
hi4Pza 1Ltgt 5 J-C
(i,2A4%) t r6 rz
So CDP/n'
iiTe %�t� -
1—_
Show direction and distincLi IILLfrom at least
two State Roads or County Roads. Include the road
numbers and common road names. c tTt S 4A LI,
f S;
a (OWN
L'l t t-jvr`-
t3,c
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH SA NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COP OF THIS RE ORD HAS BEEN PROVIDED TO THE WEL! OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE/
Submlt the original to the Division of Water Quality, Groundwater Section, 1636 Mall Service Ccntcr- Raleigh, NC
27699-1636 Phone No. (919) 733-322I, within 30 days. GW-I REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and N
WELL CONTRACTOR (INDIVIDUAL) N
WELL CONTRACTOR COMPANY NAME
STATE WELL CONSTRUCTION PERMIT#
(if applicable)
283390
Resources - Division of Water Quality - Groundwater Section
,,,..
L CERTIFICATION��- i�a /7y�
�/ (Aid/ .4_p�Ray PHONE it ��/to otew
ry/Iy ASSOCIATED WQUPERMIT/I N
(if applicable)
I. WELL USE (Check Applicable Box): Residential iv MunicipaUPubiic O Industrial O Agricultural O
Monitoring O Recovery ❑ Heat Pump Water Injection O Other O If Other, List Use
2. WELL LOCATION: NearAagiedoz-c
t "Town: County
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER:
Address s� .y
�Li��i� /f ($trLet NoJ n p�� D / t-�..7
City or Town
State
d4
Zip Code
gba
Area code- Phone number
4. DATE DRILLED /�/' / o
5. TOTAL DEPTH: ,qOs
6. DOES WELL REPLACE EXISTING WELL? YES O NO,If
7. STATIC WATER LEVEL Below Top of Casing: 40 FT.
(Use '4" if Above Top of Casing)
S. TOP OF CASING IS led"- FT. Above Land Surfaces
'Top of casing terminated at/or below land surface requires a
variance In accordanf a with ISA NCAC 2C .0118.
9. YIELD (gpm): (p METHOD OF TEST) C#n.,
10. WATER ZONES (depth): /90 I D
11. DISINFECTION: Type i,
12. CASING: v
Depth/ Diameter
_a_!P From . To Ft. G
From Tc Ft.
Amount 1y «-
Wall Thickness
or Weigbt/Ft. Material
From To Ft.
13. GROUT: Depth Material
From /7 To,ZD Ft.f'sift+�1
From To Ft.
14. SCREEN: Depth Diameter
From / To Ft. in.
From / To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size
From fo Ft.
From To Ft.
Method •
Slot Size
in.
in.
Material
Material
16. REMARKS:
Topographic/Land setting
btRidge OSlope OValley OFlat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:OGPSOTopographic map
(check box)
DEPTH DRILLING LOG
From To Forma
Show direction and distance in mil
two State Roads or County Roads.
numbers and common road names
0
N7
N9p
ItC
i DO HEREBY CERTIFY TREAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS,'/ THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
al,////. t 0 3
SIGNATURE PERSONCONSTRUCTING 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

283377
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources -
Division of Water Quality - Groundwater Section
d�In
WELL CONTRACTOR (INDIVIDUAL) NAM (priot)4R/7 .VAN C �13 11�L (-- CERTIFICATION co /��7
WELL CONTRACTOR COMPANY NAMEF414-- iGje. btleerisL/yus+.yy f.G PHONE # }I j-rr7ll O
ASSOCIATED WO PERMIT#
STATE WELL CONSTRUCTION PERMIT#
(if applicable)
4/'7
/11
(if applicable)
1. WELL USE (Check Applicable Box): Residential W Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:_
Nearest Town:
(StrtlkrName, Num
City or Town
Atn code- Phase number
4. DATE DRILLED /D//%l 2.3
5. TOTAL DEPTH: / $Sr
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO O
7. STATIC WATER LEVEL Below Top of Casing: Y FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / .J 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): 3 7 METHOD OF TEST / J
10. WATER ZONES (depth): //d I
1.1. DISINFE.CTION: Type Amount
12. CASING: Wall Thickness
or Weight/Ft. Material
O #.2/ OVC
adeZ_ County Watetti-
a.4-0
, Community, Subdivision, lot No., Zip Code)
State
Zip Code
From
From
From
13. GROUT: Depth Method .
From 0 � __ ( —yl+�
From
14. SCREEN: Slot Size Material
in.
in.
Depth
To D
To
To
To 0
To
Depth
From To
From /To Ft
Diameter
Ft.
Ft
Material
FL Cp tllaet��
q
Ft.
Diameter
Ft. in.
in.
15. SAND/GRAVEL PACK:
Depth Size Material
From_ o Ft.
From To Ft.
16. REMARKS:
Topographic/Land setting
❑Ridge ❑Slope Walley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH
From To
i7
Fotttraho{l,Descn tpu__�_-/
PRILlLNG i3OCF—)
LOCATION SKETCH
Show direction and distance in miles fr
two State Roads or County Roads. Ind . d
numbers and common road names.
crt
e J
7r/V
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRULIED IN ACCORDANCE WITH ISA NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
on0-24, rt /%710
SIGNATURE OF PERSON CONSTR CITNG aim 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

r - County i5 /S 0._,
in L24, a Ce,'C
lie c_, N.isis, lv'uarocrs. Coa'mwniry, Suboiv uion. LSI NW. Zip Cooc)
:3 0,A:NER. (/Aar)es /%,M1y 0%r
..1ar:Sa ,V '5 S-u obt.. `K-t-rV r.
\Sweet se Rourc Noy
__Le'c es+C .78•74R
Cay Jr Tarn Slim Zip Cudc
gay- roi33-3s-a3
'a:auc- Pbon: awnocr
D.;TE DRILLED /D -Jo-07
S. TOTAL DEPTH: 3 f-
o. DOES WELL REPLACE EXISTING WELL? YES 0 NO e
7. STATIC' WATER LEVEL Below Top of Casing: 5-0 FT
IU;c'.''l r Above Top or Cm,na) S. TOP OF CASING IS ____ FT. Above Land Sun'ace
wrap Of 1vialmanca AL ur bclu\v iana surryee r c uiros rarianec laace oraairac,vir4 19.t NC.0 3C.011E. -�—
y YIELD (spin):METHOD OF TEST B
lu. WATER ZONES tdcpth): / CO' bwla� • p--.----
i I. DISINFECTION: Type ID p "�,w lZ !r
I22. C AS
- Arnounr
Wall Thiehncs;
Depth Diameter or Weigh[/Ft. Marcrial
To /05 Frd /Z!— c/c
ro Ft.
To Fr.
Dcplh Mai -coal Method
Frae
From .Toe D.•r;n
FL
-i SCREEN. Dcpul
From •p.
Fmin TO
15. SANDIGP.,;VEL PACK
Dcprh
1'o
TJ
Topographic/Land setting
Di Ridge ❑Slope ❑Valley ❑Flan
(cheek appropriate box)
/v3r'dq Jci Won°well
4t.a727
(degreesminwc�spcionai)
udesource: LTG PSOTopographle map
(chccj box./
DRILLINGLOCI
Finmation Description
From
From
Fmm
13. 1/4.31:0UT:
298721
WELL CONSTRUCTION RECORD
Norm Carolina - Dcpartmenrof Enviromncnc and Istz
ral Resources - Division of Water Qualify - Groundwater Section
\\ELL CO:vl'RvCC31: On U11'IDU.aL) NAME (prow) ��nj lii'/✓ " /,Jr fV'
i?• ;lc. (G S CERRTWFJC.{'noN 3/46
\YULE CO,t PR.CTOil COMPANY NnY1L•',•s..a ✓tiS�NS
�Jt.J ��/i Dpi ll) %YGf Ca . PHONE aag an Y7 L� s1'.+1'L' WELL CJi\i1-RUCTION PERMIT*J
ASSOCIATED WQ PE1Z\•l1Tn
inapplicable)
I. WELL LISE \Checl; Applicable Box): Resi4eprii1 ere. fviunicipiliPublic ❑ tndusnial ❑ Agricultural 0
Plmtuor m= ❑ Recovery ❑ Hcat Pump WaLcr lnjcelion ❑ O[hcr 0 1r Other. List List
2. Y(ELL LOCATIL N
iV
I c4restf own: .0.. 4501
From
From
I o. ):END;RIIS
Diameter
Ft. in.
Fr. In.
Ft.
Fr.
Slor Sizc
In.
in.
Ste Material
D0 HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED EN ACCORDANCE WITH 1.SA NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
sIONATUP.S OF PERSON CO /U CONSTRUCTING THE WELL DATE
:?u99-163o ?bony No.. (919) 733.324 within 30 days.
Submit inc uri;final [o the Division of Wafer Quality, Groundwater Section, 1636 Mail Service Center- Raleigh, NC"
GW-1 REV.09r2007:
La❑n d"cilbngi
DEPTH
From To
A) - /JS
:yr
5d .PertV
LOCATION SKETCH
Show direction and distance in miles from EL lcasr
two State Roads or County Roads. Include the road
numbers and common road names.
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WELL CONSTRUCTION RECORD
STAID WELL CONSTRUCTION PER111Tn
298717
Norm 0;mwu - Dcpirunent or Environment and ra! Resources - Division of Water Qualiry - Oroundwarer Soecion /!��
HELL COVIFACro[ (INDIVIDUAL) NANIE (pri Lic) � , L] NGS CERTIFICATION 3/ 41),
w ELL CON-II:_,,C OIT COiNIP,+NV Nn,MIR ferjt Sows IJ JJ 2)d,../I,%y� . PHON2 r;RS asfl-Y (�,
.ASSOCIAT2D WQ FERMI/Ty
Dr spplirsblc-I
'At ELL LISE (ChcaC Apphcablc Hox), Re idenrial 0 Mur,icipaJPublic ❑ Induarrial ❑ Agricultural 1
\IJnttortag 0 Rcaor cry 0 Hear Pump Winer lnjociion 0 Other 0 It Other. List Use
2. In Ell_ LOCATION:
Di;oresr To,vn./%<-3IJ/ County /7 fon
Iiac,i. N.mx. iPum Rs, Catnm umry, Suboiru ion. Lot No., Zip CoUc)
0W)NER. . tic( f"9;/'C>s
5- 7a-
7s3
Zip Cuuc
bi- Iwo- 3/0 y
.;eta Ccao-Ph0rlc Ilumncc
4, D=:'TEDRILLED /J-Z/-DT
yyrr,,� 1]Scc,.i! IZouro No.1
ine, fa. her /I NC
C�qo,-Tm.n Swlc
5. TOTAL DEPTH: /
o. DOES WELL REPLACE EXISTING WELL) YES 0 NO I
7. STATIC WATER LEVEL Below Top of Casing: 7j FT.
+ (Bit "r'-ii nboec Top urCisln3)
S. TOP OF CASING IS , FT. Above Lund Surface*
Pop or r.)1u; trminsma -cur bcluw Iona surrso° rcquires a
rivicc w .:core ancc wlr4 13a NCAC 2C .011S.
9. YIELD (sprit): 60 METHOD OF TEST BbGl4qq -,rr
0. W.ATER ZONES (depth): //d ' /t•� J .7
Topographic/L.ann J--se ning
❑Ridge ❑Slope Malley OFIac
(check appropriate box)
Lurir9idc/longim)ie of well location
�5.7t4'worn°zs,flQ'
(degreesrminuIcvsrconds)
Latitude/longitude source: L?GPS❑Topographic map
(chuck Dux)
DRILLING LOCI
Fortpation Description
7-2 -f
<'e// ,
DEPTH
From To
U- zr�
Z')-
- 3d
Y - Ric
II. DISINFECTION: Type(''MMR„ve,
l3, CASING:
Ucp[h
From 4 To.3Q
FCJ it TJ
FNnI To
Amount f AO:
Well Thiel:ncs
FL 2- /el-Iarneter u Wc;ghrFl. Ma¢rial
.oiiz/ AIPC
Er.
Fr
13. GROUT: Depth Materiel
To O Ft. cciYCQ. e
From To Ft.
14. SCREEN. Dcprh Diameter
Front To Ft. in.
From To Fr. in.
13. SAND;ORAVEL PACK:
Depth Size LIa¢nal
From To Fr.
From To Fr.
IYlcrhod
Slot Sizc vIorcrial
in.
in.
G
0
O
r- 0
c =�
LOCATION SKETCH Ei
Show direction and distance in miles from titleas*rn
two Stine Roads or County Roads. include4 coati,,
numbers and common road names. aC
th rw�y Izd- ��
Ina2s14(I,WC-
0
Ia. REMARKS
I DO HEREBY CERTIFY TWIT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH UA NCAC 2C, WELL
CON"1'
�TRLCTIDN STANDARDS, .AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
X -2/ /J E/ - of
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Suomir me ori;inel ro me Division of 1Varer Quality, Groundwater Section, 1536 MailService Center - Raleigh, NC
3?699-1o3o Phone lye. )919) 733.3221, wirnin 30 days. G W-1 REV. 07/2001

�lnlL Ir a1
ELL COINS UUCTION PERMIT
,Ir...rl _:blc1
WELL CONSTRUCTION RECORD
Non 11 Cacti - Dcparmloni.of Environment and NJ( iral Resources - Division of Warcr Quality - Groundwarer Sterion
\\ EIL
LL COAT.Cj1 C. (1NUl1'1DUAL) N,ANLE (prior) .tJ
1:LL CU�N"rltkcron couue.+NI' N.+,11 L' T e%�l �„f L( feN / ✓/p`�//,N G
J .SSOCL+'FED WQ p1l'Rk11T]{
(if ,Pplic_,blc'1
I. WELL USE \Chccic Appl;eablc Box); Residential gj lviunici >UPublic
Maniwr lrh ❑ I: P 0 Ihel.etriul 0 Aynculmral ❑
t<�\,cD� ❑ Hear Pump Water lnjce[ion 0 Other 0 If Other, Lis[ Use
WELL LOCATION.
Ncsresr Town. /2-s4.
7C) t F -,' ,Pe%,
,9ra n.,,n c, Vuarcc e, Ca,nawmry, Subdi ruion, Lot No.. Zip Coac)
298715
CERTIFICATION x.3/46
• PHONE
Iga/4 a 5 E YYY4.
Co Ull
3. OWNER.
-ouress
Ya
tillrct G( 12,]uCC No.)
4shev,-//e d. C .2-e$a6
1-_01, 1'0 SuZip Cud:
(5? - &figr.- 964,
IaJc- PIIdllc Ile 111 Dcr
DATE DRILLED /0 —
3. TOTAL DEPTH: WC C
o. DOES WELL REPLACE EXIST[NG WELL? YES ❑ NO Er
7. STATIC WATER LEVEL Below Top of Casing; /0° FT.
/ (Uic"r'"if +nave Top or Camng)
3. TOP OF CASING IS FT. Above Land Surface'
"rap of,rapa mr,nimarcd avur bclutr lanil :urlpet requires u
-.elan.: ,n a.eoraan::N
c with ISA CAC 2C.011d.
9 YIELD (_pnil: 3 METHOD OF 'T B�,ril,'rJ •�ri
--------'
lu. WATER ZONES (doplh): / JD JEr/v. J
Topo�gr�a hie/Land sccting
❑Ridge 1.7SIope ❑Valley ❑Flay
(check nppmpriara box)
Latitude/Ion44'timde of well location
iV ?i ' .$2.. 34// stC14. rqj r
(degrees/minuresncconds)
Latirudeilongirude source: GPSLOTopogrophic map
(check bog)
DEPTH DRILLING LOG
From To mationDescriprion
0 — / � For.?
II. D1SLNFEC
I_'. CASINO.
Frum a
From
From_
!3. GROUT:
TION: Type_' Otl ice_a_ Amount /2
Nall Thickness
D,prn DlsmerE or Weight/Fr. Maf riul
To2L Fr 4../2t- Sl».r7/ %v✓G
co F.
Fr.
Depth lvlarcnal Mcrnon
LOCATION SKETCH
Show direction and distance in miles From or least
nvo State Roads or County Roads. Include the road
numbers and common road names.
�A Fork �d .
To
Frolu._ 0 TO_ Jaya_ Fr_C_a
From To Fr.
.'. SCREEN. Dcpch Diarncmr
F10111 To Fr
m,
From
.1.o Fr. in.
.5. SAND/GRAVEL PACK:
Qcplll She
From Tc
From
a. REMARKS:
Fr.
To Fr.
Slot Sizc b.lalcrial
m.
in,
Material
30 HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN .A000 _INSTRUCTION STANDARDS, .AND THAT A COPY OF THIS RECORD HAS
arbor/L
SIGNATURE OF PERSON CONSTRUCTINGT
AN . Lr j✓� S
/2/14r5Aft-fr, ACE,
TLDANCE WITH 15A NCAC 2C WELL
BEEN PROVIDED TO THE WELL OWNER
HE WELL DATE
-outi( tnc original co the Division or Wurer Quality, Groundwater Secr[on, 1636 Mail Service Center- Raleigh, INC
GW-I REV.07/2001
d99-1o3o ?hulk ,Ya. (919) 733.32:1, tvirniu 30 days.
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WELL CONSTRUCTION RECORD
Noun Caro lino - Dcp rtmcnoor Environmcnc and NQIaIrurut ResouLrces
V.ELL CONTRACTOR (INDIVIDUAL) N.:0H Z ((-prior) UrfCA Jt•
w O ELL C\TRk.CTOR COmP.AN\ NAME fe-eyu cat q1 4.CJ)
STALL WELL CONSTRUCTION PERh11Tif
i:r ,nc ll: _brat
298703
- Division of Water Quali y - Groundwarer Section
/(LS CERTIFICATION 42i443
Pe//t- PHONE yrhe'Je'Fr i4
ASSOCIATED WQ PYlirrllT»
(if .replica bltl
I, WELL USE 1Chectr Appbaable Box): Rceide ial L'1 Ir1unicipaUPublic 0 Industrial 0
Moatiorurg 0 Reeoy ery 0 Hear Pump \Vatcr Injection 0 Other 0 1COrher. Lisc Use
2. WELL LOCATION:
U a'ccr Name, Nan -Were Conmwniry, Subdivision, Lor No., Zip Cudc)
County /yeeCJoa
OWNER:
=.lards
nla(sh4ti
Cit) Town Sam
1.2k )- to b9- Q rl
A eo toot- Phanc pumocr
T. DATE DRILLED 5 Vt QJ
TOTkLDEI'TH: /kr
o. DOES WELL REPLACE EXISTING WELL? YES 0 NO riv
(indr or Rourc No.)
C
a.T4r/s 21
Zip Code
7. STATIC WATER LEVEL Below Top of Casing: 4/0 FT.
Above Top o(Casing)
3. TOP OF CASING IS FT. Above Land Sul -lace*
^'lbp oRevn; rcrminxrta 4Uur below land surto e requires
rarixoac m accaraaacc cairn I5A NCAC 2C .0116. y
9. YIELD Loin): 20 liETH9D OF TEST fa /D""'+J—�'j
10. WATER ZONES (depth): 43/O. 0� /70
Agricultural ❑
Topographic/Land seating
❑Ridge CAS lope ❑Valley ❑Flat
(check npprnpriare box)
Lurityde/Ionginld of well loco[ 1
1J 37 S� m1.? WO t4 ° 341)7 r
(degree/minuet' econds)
Larirudeilongitude source: GP ❑Topographic map
lchee& box)
DEPTH DRILLING LOG
From To F0.pala[n Description
r- 20 cr.
Lo - Jer • G-<.,,-A.
II. DISINFECT[ON:Type C4e,1C Amount I. 4411
L2. CAS NG: Wall Thickness
Depth j1iamcrer or Weight/Fr. [trial
From 0 To 2P Ft. brit Q.22) L From To Fc.
From To Fr.
13. GROUT: Dcprh Nlarenal
Frorrl-__o___ To JO Fr. ConaG%C,
From To Fr.
Id. SCREEN, Depth Diameter Slur Size Material
From To Fc in.
m.
From To Ft in. ill.
15. SAND/C./RAVEL PACK:
Dcprh Size Material
From To Fc.
From
DD Mcrhod
o REM. PJC5:
To Fr.
c
r
A
0
cn�
cc"
rV gm
JO
LOCATION SKETCH 3 aC3
Show direction and distance in miles from at IJAsr m�
two SraLe Roads or County Roads. Include LheJpad�
numbers and common road names. O% c
goo (rat r,-rr-il .3e-, tact.
p1arsha!/,✓✓f.
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
CONSTRION STANDARDS AND THAT p c0PY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATUREOF DATE
CONSTRUCTING THE WELL DA D�
E
Submit the original co the Division of Warer Quality, Groundwarer Section, 1636 Mail Service Cancer- Raleigh, NO
27699-153o Phone No, (919) 733-324 within 30 days.
GW-I REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resourcesu- Division of Water Qualiry - Groundwater Saeriou
\YELL CONTRACTOR (INDIVIDUAL) NAME (print) 4 - ., tcC-CS CERTIFICATION N,?/4".`7
\Y ELL CONTRACTOR COMPANYN.a,ME z,"//..rj•
STATE WELL CONSTRUCTION PERMITa ASSOCIATED WQ PERMIT/
(if applicable)
Gr . opliablel
1. WELL USE (Check Applicable Box): Residential ®K Municipal/Publie ❑ Industrial ❑ Agriculrural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection ❑ Oilier ❑ If Other, List Use
2. WELL LOC.ATI�` 'N:
Nearest Town:/"J«S/i< / County / 2cci o'I
%l.1 her
rSacn Nemc, Nurnocrs, Cmnmuniry, Subdivision, Lot No., Zip Code)
3. OWNER:
Address `7/C/ ,[?MI- r d5r e .
(Saver ur Route No.)
i%'grshcr
Ciry or Town State
. 8753
Zip Code
(r )- &Sk-3/43
Area code- Phone number
4. DATE DRILLED ( 10 -03 /
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO I°J
7. STATIC WATER LEVEL Below Top of Casing: 6/L FT.
(Use "-r"'if Above Top of Casing)
S. TOP OF CASING IS / FT. Above Land Surface
`Top or easing terminated arfor below land surface requires a
variance in Accordance wlm ISA NCAC aC .011e.
9. YIELD (gpm): Z METHOD OF TEST ,(J�o.✓-� 455
r
293700
PHONE {kSr) e)srl--S'15C
Topographic/Land seeing
Ridge ❑Slope ❑Valley ❑Ftar
(check appropriate box)
Latirude/Ion rirude of well location
pJ 3; '& -- s�Jd WO rL°- .3//
(degrees/minutest'y econds)
Larirudeilongirude source: PLOPS❑Topographic map
(check Dux)
DRILLING LOG
Formation Description
O—
DEPTH
From To
0 - S�
s F- x2r
5. TOTAL DEPTH: 125
10. WATER ZONES (depth): 77 ,26/61 ? ' - 5Tvr^t
I I. DISINFECTION: Type /4/,r,"et Amount giy:6s
12. CASING: Wall Thickness
Depth_ Diameter or Weight/Ft. Material
From D To S t Ft. (, % At
From To FL
From To Fr.
13. GROUT: Depth Material Merhod
From 0 To .20 Fr, Canc-v1C /7o4-,:-,f
From To Ft.
14, SCREEN: Depth Diameter Slot Size Material
From To Fr. in. in.
From To Fr, in. in.
15. SAND/GRAVELPACK
Depth Size Material
From To Fr.
From To Fr.
lo. REMARKS:
r)
,rn
0<
LOCATION SKETCH ao
Show direction and distance in miles 47,,n ao�tagr
two Stale Roads or Counry Roads. Inc de dth glad
numbers and common road names. �a
/-Irt ✓T Cr
Mart ha 0, IV- C
CJ7
Ol
0
I DO' HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THr4T-A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
'x V G - zo -03
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Qualiry, Groundwater Section, 1636 Mail Service Center- Raleigh, NC
27699-163o Phone No. [phone], within 30 days. GW-I REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality -
\4ELL CONTRACTOR (INDIVIDUAL) NAME (print),�/'�'1
WELL CONTRACTOR COMPANY NANIE
MAcs
298697
Groundwarer Seerion
CERTIFICATION N ?/vo
PHONE or-sdn1»- f'e/re
STATE WELL CONSTRUCTION PERD11TW ASSOCIATED WQ PERh11Tp
(if:tpplieable)
i ifapplicable)
1. WELL USE (Check Applicable Box): Residential LI MunicipaliPublic ❑ Industrial 0
Moniroring❑ Recovery 0 Heal Pump Warer lnjecrion 0 Other 0 If Other, Lisr Use
'2. WELL. LOCATION:
NeK es[ Town: /7c'u/2"-./ / Counry /24-.-cs..,
I ut/ /Ind Dom• /Agar..) N,/i
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER. rwe ar C 1 r✓DR
ieu ;Ja
.ASdress e-2 t 7-u o R.
(Street or Route No.) pp
74Che ��e NG. ,e74 ee)
City or 'Pawn Scats Zip'Code
�SaX. (R i-41.3a
Aieu CO3c- Phone number
4. DATE DRILLED (o - /G ' 03
5. TOTAL DEPTH: .26S-
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: b-J FT.
(Use "-Will Above Top of Casing)
S. TOP OF CASING IS 1 FT. Above Land Surface*
`Top or casing terminated actor below land surface requires a
variance in a ceo rdance with Ii.A NCAC 2C .0118.
9. YIELD (gpm): METHOD OF TEST,41•-•.-7
10. WATER ZONES (depth): / C/S / /Cs'
I I. DISINFECTION: Type('/'-,'ne
12. CASING:
Depth
From 0 To 41
From To
From To
Amount / Ads -
Wall Thickness
Diameter or WeighUFr. Material
Fr. 6 :Ai Ac-it
Fr.
Ft.
13 GROUT: Depth Material
From 0 To et /� Fr. S ,nc-c/2
From To Ft.
14. SCREEN: Depth Diameter
From To Fr. in,
From To Fr. in.
15.SAND/GRAVEL PACK
:
Depth Size Material
Frain To Fr.
From To Fr.
Merhod
ro4-•el,
Slot Size Material
in.
in.
Ib. REMARKS:
Agriculrural 0
Topographic/Land setting
PRidge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
U7, 1rig tic)-zo 3.;. 1/2-2-'
(degrees/minuleyy'--+'coands)
Larirudeilongirude source: L9'OPSOT opographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
IO2 - 1‘3 G
O
coat
LOCATION SKETCH
Show direction and distance in miles froirt at t
two State Roads or County Roads. Inc IN Qe thB
numbers and common road names,
T.'r« Send -DR
/774.2s H•7( ivC
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
0-7
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center- Raleigh, NC
27699-163o Phone No. [phone], within 30 days, GW- I REV. 07/2001

299696
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
\YELL CONTRACTOR (INDI\1DUAL) NAMF (prior) £i•c, £ )(L/ Aes.
WELL CONTRACTOR COMPANY N&NIE
STATE WELL CONSTRUCTION PER\11Tie ASSOCIATED WQ PERMIT$0
Air--_Ppll able) (if applicnblel
CERTIFICATION rir/yJ
PHONE gk'r-) art- ?c/a
WELL USE (Check Applicable Box): Residential Q Ivlunicipal/Public ❑ Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Hear Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: /'2 Sd,// County ne(s .i
//r- , v r/ /jc 4fcc r S Aa / t
tSncci Name, Numbers, Community, SubOivision, Lai No., Zip Code)
3. OWNER: 8i.a.t, jkr)
lddre>; 7/ 2 1 G.Jh ;eh in
(Sneer or Roue No.)
4 24 e inPe /Y c
afr8o�
City or Town Store Zip Code
(CK). 2a5- /a3, a -
Area :uc- Phone number
-. DATE DRILLED 6 - //e 03
5. TOTAL DEPTH: 4b C.-
6. DOES WELL REPLACE EXISTING WELL') YE ❑ NO l'f
7. STATIC WATER LEVEL Below Top of Casing: &V FT.
(Use "r"'i f Above Top of Casing)
S. TOP OF CASING IS / FT. Above Land Surface,'
`Cop or cuing terminated aror below land surface requires a
va riauce in nceorda ace with I5A NCAC 2C .0115.
9. YIELD (gpm): 3'p METHOD OF TESTA---1 /
JO. WATER ZONES. (depth): VS/ 4rS—�
DISINFECTION: Type cw.-rht
12. CASING:
Depth Diameter
From Ci To fr'W FL 6 /9
From To Fr.
Amounci A-( .
Wall Thickness
or WeighdFr. laterial
"✓G
From To Fr.
13. GROUT: Depth Material
From 0 To 2° Fc. C✓nook
From To Fr.
1-. SCREEN: Depth Diameter
From To Ft. in.
From To FL in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Fr.
From To Fr.
Method
f0.• ^x.toif
Slot Size Material
in.
in.
16. REMARKS:
topographic/Land seeing
ge ❑Slope ❑Valley . ❑Flat
(check appropriate box)
,Ladmde/longirude of well location
fir/ /t f3 `/!, .S�-/s- ��-o rz ".31.,.?7 7
rely rijrlarge, 6 (degreesiminute conds)
r ' "J/ atitudeilongitude source: igilliGPSEITopographie map
(check box)
DEPTH DRILLING LOG
From To Formation Description
0
0
LOCATION SKETCH =g 2oa
Show direction and distance in miles froir lei
two State Roads or County Roads. Inclurje...11e r�
numbers and common road names. tV r-n
pp rz- o
t//er Ford Pd. rngrbhn i10.=��.1�to
.wn
Ncn o
n�
if H
Q1 G
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH l5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
- /z -
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27099-163o Phone No, [phone], Within 30 days. GW-1 REV. 07/200I

/ FT. Above Land Surface*
"Top or casing terminated at/or beluw land surface requires a
variance in accordance with ISA :NCAC 2C .0118. ,r
9. YIELD (gpm): Z r METHOD OF TESTO/O.JY - Its
10. WATER ZONES (depth): YO' 2/0 Zr't'
.Area code- Phone Pumber
4. DATE DRILLED (o - la O J
5. TOTAL DEPTH: 26 C
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO I"
7. STATIC WATER LEVEL Below Top of Casing: lvo FT.
(Use "*"'if .Above Top of Casing)
S. TOP OF CASING IS
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources -``D�ivision of Water Quality -
\\ ELL CONTRACTOR (INDIVIDUAL) NAME (print) lei (itr. , 5
MULL CONTRACTOR COMPANY NAME / Crf..W-IS 4.'c 1/ ,D-• //..'t
298695
Groundwater Section
CERTIFICATION # - VC)
PHONE onr 6,ri -S'fl''
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
{if applicable) (irapplicablel
1. WELL USE (Check Applicable Box): Residential (2 MunicipaVPublic ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection 0
2. WELL LOCATION:
Nearest Town /'/C/s %-1 if
Gs5 e /S Cie.le 16(
County 1917CcA/50.•1
(Snca Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: -- (rre
tk
Address i/ 1 f &4hi? 1e d ire
(Sneer or Route No.)
Mars 1471 /V C 89SW
Cin or Town State Zip Code
(Sin:- (' s 9- abo f
Industrial 0 Agricultural 0
Other 0 If Other, List Use
I I. DISINFECTION: Type (`/o..n[ Amount 7 /,'6s
12. CASING:
Depth
From 0 To 7./ Fr
From To Fr
From To Fr
13. GROUT:
From 0
Depth
To 20
From To
14. SCREEN: Depth Diameter
From To Fr. in.
From To Ft. in,
15. SAND/GRAVEL PACK:
Depth Size
From To Fr.
From To Fr.
16. REMARKS:
Wall Thickness
Diameter or Weight/Ft. Material
('' f /1✓G.
Material Method
FL
Slot Size Nla[erial
in.
in.
Material
Topographic/L_aiO se sting
❑Ridge ❑Slope aiVatley ❑Flat
(check appropriate box)
Latiru�dg/lon 'inlde of well location
N,rOyr. 4I 2.' 1✓0Free h/7
(degreesiminutee'y' seconds)
Latitude/longitude source: at OPS❑Topographic map
(check box)
DRILLING LOG
Formatioo Description
DEPTH
0F,om To
-7°/- 265
rn• Az
O
A
LOCATION SKETCH
ra >ri
Show direction and distance in miles from at
two State Roads or Counry Roads. Include thud
numbers and common road names,
(pII Oahrt'efsC2e-ec/ONG
mars 11 ,%/ /✓ c - rn
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
CONSTRUCTION STANDARDS, 4ND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
-1 t) 6-lv-o3
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center- Raleigh, NC
27699-1630 Phone No. [phone], within 30 days. GW-I REV. 07/2001
tnz
reia
0
1
i

298688
WELL CONSTRUCTION RECORD
Nairn Carolina - Dcparimenr.oiEnvironmcnr and Natural Resources - Division of Water Quality - Groundwater Section
I5 ELL CONTR.ccTOR (INDIVIDUAL) N.ANIE ((print) % ' gel les I�'yef CERTIFICA.TION p a/�
w ELL CONT RECTO P.COMPANY NAME. F,i.. lm / Ae't ,a -char, PnONG
5l'ALC \YELL COi'STauCTION FERAIzT5, ASSOCIATED WQ PWIUvI ITD
(if inplicublc)
I. WELL USE LCheel: ..ppli,:>ble Box): Residential L-J Municipal/Public ❑ Indusrria[ ❑ Agricultural ❑
hwnitoring ❑ Recovery 0 Hear Pump Water injection 0 Other ❑ It Other, List Use
2. WELL LOCATION: /,
N._r sr Town:/7 ) / // County "1106 07
,'—l- St.( .s N.//
ISa'c:: N.nnc, Nun -loco, Camnwniry, Subdisuion, Ur No
3 OWNER: lson/ Derr..(
=..]arch pD 80ie C /
(Sneer or Root N-)
were✓-e(u)ire Y1C ae7e
yap ar Town Suit Zip Code'
$c l-__.r3b— 3So 7
.aea .0Jc- Phon: numbc
-I. DATE DRILLED /.G3
5. TOTAL DEPTH: 2O 8d
�opographie/Land sexing
Ridge ❑Slope ❑Valley ❑Flat
(check nppropriara box)
Lutitu de/I n >inide of well location
Pi $J3 wen°33.489)
(degrees; m inutcsiseconds)
Latitude/longitude source: IJ'FiPS❑Topographic map
DEPTH (chcalc bu.e)
DRILLING LOG
From To Formation Description
p; Q,�f
St,efidsv{
9'7. 3pr
o. DOES WELL REPLACE EXISTING WELL') YES ❑ NO rr
7. STATIC WATER LEVEL Below Top of Casing: w FT.
/ (Use "r ii above Top of Caainy)
S. TOP OF CASING [S FT. Above Land Surface.
"'rap or cawitcrmtnatcd nVor below Lind surface rcquirto a
yariauccm acca raaucc with IjA ?CAC 7C .011s. //77
9. YIELD Ginn): 2 0 ivtETH9D OFa� 77''$ST/��o...a/ —.f
10. WATER ZONES ldepth): // /% 27�/ 2.10
I. DISINFECTION: Typeae.' c
[2. CASING:
From 0
13. GROUTDeprh
From 0 To 2.°
Zip Code)
Amount
Wall Thickness
Depth Diameter or Weight/Ft. nLterial
To V7 Fr4.ht Met/ rat
from To Fc.
From To Fr,
hlaccrial
Ft. 64^ ("Cr
From To Fr.
Ia. SCREEN. Depth Diameter
From To Ft. in.
From To Fr. in.
G. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Fr,
n
r
•L
Cm('
LOCATION SKETCH N CDc.
Show direction and distance in miles from at east no
Iwo State Roads or County Roads. Include t
numbers and common road names.
er%alyd
�r.
MAn N;l(
fvlcthod
-."1
Slot Si2c Nlareriol
in.
Io. REMARKS
-ftrhsof q
lN.C.
c>,
roarr°
m
0
G
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH t5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, .AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
• -t 9-1-03
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Sunnlir the ori;inal to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center- Raleigh, NC
27699-163o Plinnc No. 1919) 733-3.121, within 30 days.
GW- I REV. 07/2001

WELL CONSTRUCTION RECORD
Norm Carolina - Dcparunent of Environment and Natural Resources
\ ELL CONTRACTOR (INDIVIDUAL) NAME (pane) BrAs% XC
Fvs�"Da toe/I
WELL CONTRACTOR COMPANY NAME
STATE WELL CONSTRUCTION PETNI1T4
nr snc G._61..-1
298686
-IDivision of Water Qualio' - Groundwarer Section
WNt f CERTIFICATION a) ivd
/JC eh( PHONE )orz%, ea r- emu,
ASSOCIATED WQ PERMITit
I iPaoPllc,bicl
I. WELL USE tChack Applicable Box): Rcsidenrial vfunieipal/Publie 0 Industrial 0 Agricultural ❑
Monitoring ❑ Recovery 0 Hear Pump W'aier Injection 0 Other C If Ocher. List Use
2. WELL LOC.ATION:
Neurest Town: Mti! !f••/1 County/ .,o'.
G a/ /Ir c.-J 62rvu/(/leis /Ju/
iSocn Nuns, Numacrs, Coinmumry, Subdivision, Lor No., Zip Code)
3 OWNER: 2/ch4•a44 a10r lu'y
=.da re SS d9 /YGtwl lt(O& v1
[Sneer ar Raurc No.)
/1'l4 N/' /Y r a47X9.
Cip. arTown Sure Zip Code
gas;- ?S a — 2a /..
.v ca iodc-Phone number
4. DATE DRILLED 7-/ 2- o 3
5. TOTAL DEPTH: 2 2P
a. DOES WELL REPLACE EXISTING WELL? YES ❑ NO 0
7. STATIC WATER LEVEL Below Top of Casing: 20 FT.
(Use "*"Lif .Above Tap or Casing)
S. TOP OF CASING IS / FT. Above Laud Surfaces
^tip or urminnta a0ar below land eu rrece requires a -
var1411:c1111ciL/ISI me wire ISA :VCAC:C.Ui I S.
9. 1'IELD (prn): gi0 METHOD OF TEST/" ".1.1i' �J
10. WATER ZONES (depth): to, is-0, LOY
LOCATION SKETCH
Show direction and distance in miles from aksasr i rn
two State Roads or County Roads. Include iircroa
numbers and common road names.
11. DISINFECTION: Type)oe•ht
Amount 9- Tcf!
12. CASINO: Wall Thickness
Depth Diameter or Weighr/Fr. Material
Front 0 To 35 Fr. S.nr SD22r A✓_
From To Fr.
From To Fr.
13. GROUT' Depth Material Method
From O To ?O FL CO•trrc..4 P..•tif
From To Fr.
14. SCREEN: Depth Diameter Slor Size Material
From To Ft. in. in.
Frain To Ft in. in
L5. SAND/GRAVEL PACK.
Depth Size Marerial
To Fr.
To Fr.
From
Front
Topographic/Land serving
ERidge ❑Slope ❑Valley !Flat
(check appropriar box)
Latitude/Iongirude of well location ,
fl °'f:. kai von' 2 -J'o3
(dagreesiminuksiscconds)
Latirudeilongiwde source: 15GPS❑Topographic map
(check box)
DRILLING LOG
Formation Description
per- r
DEPTH
From To
D-34
3Y-3S S.-1ds/.,c
3c- ur
al/yewCroundN
dots N /% /✓ C ON
lo. REMARKS:
1 DO HEREBY CERTIFY TH,ATTHIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
CONST TION STANDARDS, .AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
v b--/z-o3
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original w the Division of Water Quality, Groundwater Section, 1636 tvlail Service Center -Raleigh, NC
27699-163o Phone No. [phone], within 30 days. GW-t REV. 07/2001

298616
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Divisionvi�J//of Water Quality - Groundwater Section
,
WELL CONTRACTOR (INDIVIDUAL) NAME (print) ,6911C /47C P1 CERTIFICATION #3apr,G
WELL CONTRACTOR COMPANY NAME Fi rg ,..5,, ., W(
et/ �r, 1'1,Iyt.C'i Co, PHONE fYB%➢M1 67?—YtP
STATE WELL CONSTRUCTION PERMIT# 1 ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential 12— 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: et."(/7';Q// County �a/�J� S an
.5na i 4k. /C/nti'S e(: '! /
(Street Name, Nry, Numbers, CoommuninS�uJbdivision, Lot No., Zip Code)
Nu
3. OWNER: kid Rd prl5
Address /3/',' tit), ilea Sire e-t
�i (Street or Route No.)
C,if//cc S-C.
Ciiy or Town Slate
fl )- & w - 9 v59
0?40• 33
Zip Code
Area code- Phone number
4. DATE DRILLED E -- n 3
5. TOTAL DEPTH: / La. C
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO ]-
7. STATIC WATER LEVEL Below Top of Casing: /.S 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 l5A NCAC 2C .0118.
9. YIELD (gpm): a C METHOD OF TEST RI
10. WATER ZONES (depth): 2 Y /
l 1. DISINFECTION: Type ACE) f/ Amount / 3 oe
12. CASING:
Wall Thickness
Depth Diar)teter or Weight/Ft. Material
From 0 To 3 0 Ft. .,CDR a 1 PVC
From To Ft.
From To Ft.
13. GROUT: Depth
From 0 To a O Ft.
,Material
Goner -air
Metho
ore -
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
:Midge ❑Slope Q'calley ❑Flat
(check appropriate box)
Latitude/longitude of well location
3.57 S'6/'jS'N - oe7/3
(degrees/minutes/seco ds)3/a
Latitude/longitude source: IMPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
0 "0 Vit7
// 720 , J r --,.;e—S h f9-Je
a To
Gon.t, /r
O
o
� o a �
LOCAT[OhiSKETCH 0
Show direction and distance in miles from at least rn
two State Roads or County Roads. Include the rid r ramel
numbers and common road names. tV r`^r, A
cn
U1
G
Sni Ph, Cret 4 gel .
/J1grs yf.t/, NC-
l6. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUC lED IN ACCORDANCE WITH 15A 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 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.-07/200i.-->

298675
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources -/Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME ( /print) ',40 /T £ llpy) CERTIFICATION #TT.& t
WELL CONTRACTOR COMPANY NAME /rc-20, „n L .1,t/( D r I t �C Co PHONE &t.2r � f - 9r/f%
STATE WELL CONSTRUCTION PERMIT/ / ASSOCIATED WQ PERMIT/
(if applicable) (if applicable)
WELL USE (Check Applicable Box): Residential yr Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
7
WELL LOCATION:
Nearest Town: /7-261t-j1m7/ County Mrs O'snn r _
(Street Name, Numbers, Communir Subdivision, Lot No., Zip Code)
3. OWNER: R7ge.k /5714Aec
Address /(Q 3-8 TV/et !K,r. jam/
(Street or Route No.)I
nit'Sha. w Nc aS7s'3
City or Town State Zip Code
(xax)- (og2-7SJ3
Area code- Phone number
4. DATE DRILLED / — a2e - a j
5. TOTAL DEPTH: 4.26,
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO E-
7. STATIC WATER LEVEL Below Top of Casing: oi5- FT.
/ (Use "+" i fAbove Top of Casing)
S. TOP OF CASING 1S / 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): 30 METHOD OF TEST /x
O. WATER ZONES (depth): /3 0
11. DISINFECTION: Type
12. CASING:
From 0
From
From
13. GROUT:
From U
From
14. SCREEN:
From
From
//0,%
Depth
To 00 Ft.
To Ft.
To Ft.
Depth
To .20
To
Depth
To
To
15. SAND/GRAVEL PACK
Depth Size
From To Ft.
From To Ft.
16. REMARKS:
Diameter
it
Amount ,: kp o Z,
Wall Thickness
or Weight/Ft. aterial
sew.? I ?vc
Material
Ft. thncrele
Method
Bored
Ft.
Diameter Slot Size Material
Ft. in. in.
Ft. in. in.
Material
Topographic/Land setting
❑Ridge ❑`Slope OValley ❑Flat
(check appropriate box)
Latitude/longitude of well location
37-nf.R/. /a Vc✓
(degrees/minutes/seconds}
Latitude/longitude source: &YGPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
O 3 c) ?ed C/,¢y
3/ Sin Sha /e
p o
J O G
LOCATION SKETCH
Sbow direction and distance in miles from at leas(
two State Roads or County Roads. Include the roams
numbers and common road names. _1
/6 3-3 111017 (? f. .
44xLieShcc/ir /Yc
1 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
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-I REV: 07/2001

298674
WELL CONSTRUCTION RECORD
North Carolina - Departmenc of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) 991/24 , /hn CERTIFICATION#3GirFC
WELL CONTRACTOR COMPANY NAME PHONE$ )
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable)
(if applicable)
1. WELL USE (Check Applicable Box): Residential IS—Municipal/Public 0 Industrial ❑ Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION,�::,�/) LL //
Nearest Town: / 742r5//c9 l/ County f'/ 9Q/SOY/
/:14.ri Je Vdrl.L F.Ch r✓ artp.�C'h
(Streeet Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER:
Address
(Street or Route No.)
ij%rsha. ,i1/r
Ciry or Town State Zip Code
15,22- 7G s - tl/33
Area code- Phone number
4. DATE DRILLED —,7 it 03
5. TOTAL DEPTH: 0 S— •
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 3---
7. STATIC WATER LEVEL Below Top of Casing: 445' FT.
(Use `+" i f Above Top of Casing)
3. TOP OF CASING IS / FT. Above Land Surface'
"Top of casing terminated at/or below land surface requires a
variance in actor'-^"ywith l5A NCAC 2C .0118.
9. YIELD (gpm): _ __ T • METHOD OF TFyST 7?.�
10. WATER ZONES (depth): ,,il)t'
11. DISINFECTION: Type ,4"D/{
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To CIU Ft. 4+'V SA.&a/ ?pc
From
From
To Ft.
To Ft.
13. GROUT: Depth
From C To D
From To
14. SCREEN: Depth
From To
From To Ft.
15. SAND/GRAVEL PACK:
Depth Size
From To Ft.
From To Ft.
Material
Ft. Co 41Qrr
Ft.
Diameter
Ftin.
in.
Amount ;mot,
&Method,
Slot Size Material
in.
in.
Material
Topographic/Land setting
❑Ridge G}8t6pe ❑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 'Po ! Formation Descrjption
0 30 San D s4e_
W 90
0
Y o73
3 - ,-'
.� cc'
y:
N :rn
to �o
—o rip
`N rn
LOCATION SKETCH
Show direction and distance in miles from at least#
two State Roads or County Roads. Include the roa4f
numbers and common road names.
f3
r
&rf' 6r.:f,
16. REMARKS:
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STAND AND THAT 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 Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh;NC
GW-I REV. 07/2001
27699-1636 Phone No. [phone], within 30 days.
cfi'Z.
rn
0r

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and
WELL CONTRACTOR (INDIVIDUAL) NAME (print)p
WELL CONTRACTOR COMPANY NAME /Cry
STATE WELL CONSTRUCTION PERMIT#
(if applicable)
298671
Natural Resources - Division of Water Quality - Groundwater Section /
CERTIFICATION #g .�/n
PHONE ORM ((Yr-/¢f:9
/%AAK /4//er?
,Ca ia// 7)r.%)�,n< (ro,
ASSOCIATED WQ PERh11T#
(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 LOCATION:
Nearest Town: 4/ r County rho s.-fl
ay22,24/9aw gel a q' 44w, t 3
(Street Name, Numbers, Community, o[ No. Zip
tY Code)
3. OWNER:71")RrlNair.ile
Address 2e9, a 43
te
(Street or Route No.)
I2 ea7LCr /yr
City or Town State
(3R6)- Ai99- 09?S
Area code- Phone numbe
ta
4. DATE DRILLED— %— O j
5. TOTAL DEPTH: 02GC
Zip Code
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO &
7. STATIC WATER LEVEL Below Top of Casing: 3S 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 accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): d METHOD OF TEST X.5
10. WATER ZONES (depth): /,f0 / /9s�r
11. DISINFECTION: Type
12. CASING:
Depth
From 0 To to
From To
From To
13. GROUT: Depth
From a To aU
From To
14. SCREEN: Depth
From To
From To
15. SAND/GRAVEL PACK:
Depth
From To
From
Diynerer
Ft. G—Y
Fr.
Ft.
Material
Ft. COQCralc
Amount e,2 3 oZ_
Wall Thickness
or Weight/Ft. Material
-5PR.2 / f vct
Ft.
Diameter
Ft. in.
Ft. in.
Meth�/ od,
re_ r
Slot Size Material
in.
in.
Size Material
Ft.
To Ft.
?E
_Topographic/Land setting
at ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well locatio
357/Ya/5" t✓ — ob/fe-9 57
(degrees/minutes/seconds)
Latitude/longitude source: ❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
534zso rr
7' 8d /9/ram 6,4,444;4
en 0
r G0
PT,
rn
�o
1 Z
LOCATION SKETCH
m0
Show direction and distance in miles from at leas
two State Roads or County Roads. Include the road
numbers and common road names.
-4 co rLila !/a,_/Zqt
OFF ,y63
)'(C
16. REtv1ARKS:
[ 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 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
O

2996'70
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) (//%R .c 4/4n CERTIFICATION #,�a�f�
WELL CONTRACTOR COMPANY NAME Ce C5 La SOn I.COACI Ur,�,n4 L. PHONE S ‘S'i -9c/7p
STATE WELL CONSTRUCTION PERMIT!,ASSOCIATED WQ PE RMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential O— 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: /eta -5-Prs,r 5 County AZ, 0 2nn
ower 5),/i47 PO {i eel cc, sr r!
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: 74-11 / /1 S �f-}VI S "
Address ila vs£'e,.. # la NC
(Street or Rebte No.)
Sri Jen.,rI4,Aket.s,4*. s3oca
City or Town State Zip Code
Area code- Phone number
4. DATE DRILLED /.2 / os
5. TOTAL DEPTH: O
6. DOES WELL REPLACE EXISTING WELL.> YES 0 NO @-
7. STATIC WATER LEVEL Below Top of Casing: 46' FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
*Top of casing terminated actor below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): / S METHOD OF TEST /2
10. WATER ZONES (depth):
11 DISINFECTION: Type 1711)ii
12. CASING:
Depth a Diameter
From To 4' J Ft.621(
From To Ft.
From To Ft.
Amount
Wall Thickness
or Weight/Ft. Material
SDza, }DVC
13. GROUT0 Depth Material
From To .0 Ft. (cr'/crtic
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Metho
or'R
Slot Size Material
in.
in.
Topographic/Land setting
U,Ridge 0Slope OValley ❑Flat
(check appropriate box)
Latitude/longitude of well locati9n
3f�srT/02 /J- c972/S9f �✓
(dlggrees/m inuteslseconds)
Latitude/longitude source: ❑GPS❑Topographic map
(check box)
DRILLING LOG
Formation Description
O ."-ater SSA nd//fun/Q
04,r ..S/!4 /-9
DEPTH
From To
tc c"
A G rrn
T, or'
tV
0
LOCATION SKETCH -O rrrto
Show direction and distance in miles from at least3
N�
two State Roads or County Roads. Include the roatd3 n"
numbers and common road names. !r
co,,Qr Sh•t >Z
a#1
(2e h cr" 13 r4,y J
H-u t—C p r•,'(5S �v C -
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
2 O
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-I REV. 07/2001

298665
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
". /t. . YaLS CERTIFICATION Iti��J
WELL CONTRACTOR COMPANY NAME ry.54J""4 WGn 'Ord/ PHONE lir) Gel- 4
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMITS
(if applicable) (if applicable)
WELL CONTRACTOR (INDIVIDUAL.) NAME (print) it/-rc-..1
1. WELL USE (Check Applicable Box): Residential i7 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 To ^f Co-et/d
/ti/mil/t/ /[eA
County prof/2
(Street Name, Nmn''bers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: Ch4.rl;c
Address (e i w Y19.//a r
(Speer or Route No.)
1-Set/ ;vy J✓c at?
Ciry or Town State Zip Code
(PE)- 4-2-s— 3,47
Area code- Phone number
4. DATE DRILLED ( S" 03
5. TOTAL DEPTH: ,2 4 5
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO JET"
7. STATIC WATER LEVEL Below Top of Casing: 'S/5' FT.
(Use "t"'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 aceordanie with l5A NCAC 2C .0118.
9. YIELD (gpm): Cr METHOD OF TEST..%•••, -,�'p
10. WATER ZONES (depth): / %f , 2-/e/
I I. DISINFECTION. TypeCoe/.vt,
12. CASING:
Depth // Diameter
YL From 0 To Fr l %r
From To Ft,
From To Ft.
13. GROUT: Depth Material
From 0 To it (-7 FL C.nc•rlk
Amount 6 oZ
Wall Thickness
or Weight/Ft. Material
j3vC
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Fr in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To - Ft.
Method
Slot Size Material
in.
in.
,, opographic/Land setting
Qjttdge ❑Slope ❑Valley ,❑Flat
(check appropriate box)
ci[uQe/l20 t/uf2° IS'OS2WD/•8W
(degrees/minutes/seconds)
Latitude/longitude source: ❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
412-205-- 6"., ve
O
L cn
o
(3 -
numbers and common road names. lv
LOCATION SKETCH N
Show direction and distance in miles from at le
two State Roads or County Roads. Include the r98d
gd 033 it Ulam,gel-
1401-St1-1W5s /✓C
16. REMARKS:
1 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 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

298662
WELL CONSTRUCTION RECORD
North Carolina • Department of Environment and Natural Resources
.-/Division of Water Qualiry - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) r"a/•(i 1t• INI$1Lf CERTIFICATION NS7V0
WELL CONTRACTOR COMPANY NAME F( fn S ew j evefi P. // PHONE oink- ft - svv4
STATE WELL CONSTRUCTION PERMIT -
(if applicable)
ASSOCIATED WQ PERM1T4
(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 If Other, List Use
2. WELL LOCATION:
N7est Town: A
ri Cat/ / .fr
(Suter Name, Numbers, Community, Subdivision, Lot No., Zip Code)
y,
3. OWNER: 15(Aiwa)l arnc.r
Address -9/.5' Thc4 tl� 5r' %t e I2t1
SSuear or Route NJ.)
County /14: . bnt
/17Ars 4/,// /v c a87,5' 9
Ciry or Town State Zip Code
(i- q. aoa7
Area code- Phone number
4. DATE DRILLED numbers
5. TOTAL DEPTH: r3PS
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO 1
7. STATIC WATER LEVEL Below Top of Casing' 2 FT.
(Use "+" if Above Top of Casing)
S. 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): If METHOD OF TESTMo'°rs '/'y
10. WATER ZONES (depth): tir' IC0
1 1. DISINFECTION: Type C/e ".'N2
12. CASING:
Depth
From 0 To aY
From To
From To
13. GROUT: Depth
From (D To ao FL
From To Ft.
Ft.
Ft.
Diameter
6 h/
Amount 3 a .
Wall Thickness
or Weight/FL. Material
,o✓C
Material
Con e "efv
14. SCREEN: Depth Diameter
From To Fr in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth
From To Ft.
From To Fr.
Method
poareaL
Slot Size Material
in.
in
Size Material
�T opographic/Land setting
LD tldge 0Slope ❑Valley❑Flat
(check uppropriare box)
Latitude/longitude of well location
N3a°SN.?or .joYz 34.07)'
(degrees/minutep seconds)
Latitude/longitude source: 2"GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
O_ CD
2 Rh
a ca
LOCATION SKETCH o m
Show direction and distance in miles from at Id*Jt yo
two State Roads or County Roads. Include the ;aid rrn.=
numbers and common road names. cn
Z• 14 AAA, ear red .
/y{tt9•Ws /1•%! iv('•
3 �^
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH l5A NCAC2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
- L/ 2s of
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. (9l9) 733-3221, within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD 223
650
North Carolina - Depanmenr of Environmcnr and Natural Resources - Division of Water Qualiry- Groundwater S ction
.A
WELL CONTRACTOR (INDIVIDUAL) NAME
(prinr)tr�eMn eG. £C/ 4r CERTIFICATION # V
cro
WELL CONTRACTOR COMPANY NAME Aie. &le,/ '-'t ni PHONE pYj/'j 2./ "-#4•rr
STATE WELL CONSTRUCTION PERMITS ASSOCIATED WQ PERMITN
iir uorIucablct
(it applicable)
1. WELL USE (Check Applicable Box): Residential Cf Iv funicipaUPublic 0 Industrial 0 Agriculeural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 It' Other, List Use
2. WELL LOCATION:
Nearest Town: no-ifil County f%44fH
Hwy` f11areshH-11
tSatc NonC, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: e-0R-R C.eG WQ,uia
Addres 433.4 14wr) aI�
(Street or
.376 3
Routs No
(
f kv-Sha11 1V(C.
Cry or Town Sute Zip Code
(t )- 9.9- 3te43
.Area rode- Phone number
4. DATE DRILLED Q - OI
5. TOT.AL DEPTH: 32r
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO Eri
7. STATIC WATER LEVEL Below Top of Casing: 2.0 FT.
(Use "+"'itAbove Top of Casing)
S. TOP OF CASING IS / FT. Above Land Surface"'
'Top or casing terminated ac'or below land surface requires a
variance in accordapet with IiA NCAC 2C .O118.
9. YIELD (gpm): Y ME IHOD OF TESTA v..y.4
10. WATER ZONES (depth): s'o
l I. DISINFECTION: Type ii/rigse Amount /2'eh
12. CASING: Wall Thickness
Depth Diamerer or Weight/Ft. & arerial
From 0 Toft Ft.4.Jer� S-401
From
From
To Fr.
Ft.
To
13. GROUT: Depth Marerial
From b To 2D ,ce Fr. Cp.t4
From To Fr.
I4. SCREEN'. Depth Diameter Slot Size
From To Fr. in.
From To
15. SAND,QRAVEL PACK
Depth Size
From To Fr.
From To Fr.
16. REN1.ARKS:
[v(erhod
Marcrial
in.
Fr. in. in.
(Ida teria1
Topographic/Land sexing
❑Ridge ❑Slope fey CFlac
(cheek appropriate box)
Latitude/longitude of well location
Aja-o SAS. 4 tF'Ir ee s J ? Uy
(degreesiminute�v onds)
Larirudeilongirude source: ❑CPS❑Topographic map
(cluck box)
DEPTH DRILLING LOG
Eromf To Formation Description
CT 3zr 4
O v
r c
Tn
n
rt
LOCATION SKETCH o m
Show direction and disrance in miles from at 1ea6P 7p
two State Roads or County Roads. Include the road r"o
numbers and common road names. ~`�
4394 }}wy13
1 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
SIGNATURE OF PERSON CONSTRUCTINGTHE WELL DATE
Submit the original ro the Division of Wafer Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-163o Phone No. [phone], within 30 days.
GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Boparunenr of Environment and Natural Resources ��-""�Division of Water Qualiry - Groundwater Section
\\ELL CONTRACTOR (INDIVIDUAL) NAME ( rinr) LUI'IP.ge1 K, , CERTIFICATION # Pr°
w ELL CONTRACTOR COMPANY NAME pt.7.'1.1 tea 42 th".7, PHONE elrt-PVi(e
STATE WELL CONSTRUCTION PERMIT#
EH sepli:ablc)
ASSOCIATED WQ PERMIT#
(if applicable)
I. WELL USE (Check Applicable Box): Residential 121"<unicipaUPublic 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Towll: tJ /�(OM,�-�—Counryrte4"
/4a�7
. es Cooclaf mod•
tSseet Nunn, Nuinbcrs, Com,nuniry, Subdivision, Lot No., Zip Code)
3. OWNER: CA-3111412-d- iry nn,
Address 1--{ SabPJJMR TDt.
(Sire[ or Route No.)
pR4:1 , rf c. • a,8764
Loy or Town Sure Zip Coda
( )-& ')- b%26L
.Area code- Phane number
4. DATE DRILLED r /r-03
5. TOTAL DEPTH: ye. r /
O. DOES WELL REPLACE EXISTING WELL? YES- l NO L3
7_ ST.ATIC WATER LEVEL Below Top of Casing: O FT.
(Use 'Ns-itAbove Top afCasing)
S. TOP OF CASING IS FT. Above Land Surface•
wrop or casing terminated abor beluw land surface requires a
variance in Accordance with 15A NCAC 2C.ai Id.
9. YIELD (gptn): Z METT�»OD OF TEST ,tiw.,K rat)
10. WATER ZONES (depth): /
DISINFECTION: Type C4nae Amount / / Tcss
12. CASINO': Walt Thickness
Dcprh Diameter or Weight/Fr. Material
Frain 0 To InFc.G. /L f JPX Z/ mit
To Fr.
To Fr.
13. GROUT' Depth
From 0 To l0
From
From
FL.
Material
CI'KiU/L
From To Fr.
14. SCREEN: Depth Diameter
From To Fr. in
From To Fr. I11.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Fr.
From To Rt.
Method
Slot Size Material
in.
in.
Id. REMARKS:
298647
opographic/Land setting
Ridge OSlope ❑Valley OFlat
(check appropriate box)
Latirude/lon girude of well location ,
/ (O57,»'moreJa 4/J
(degrees/minutes/seconds)
onds)
Larirudeilonginide source: [TOPS❑Topographic rnap
(check box)
DEPTH DRILLING LOG
From To Formation Description
0 • W. Jr, /-
r ScC /� C /�
•f47 Gam.
ra �—
in A
lJ (.24
LA a
LOCATION SKETCH 01
Show direction and distance in miles from at least
two State Roads or Counry Roads. Include the road
numbers and common road names.
Amos Cases:,
f'Y1,4l5/IA-/I, NC.
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,'WELL
CONST ICTION STANNDARDS, .A/��
ND,THAAT�A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
S
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Qualiry, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-163o Phone No. [phone], within 30 days.
GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources Division of Water�Qluality
WELL CONTRACTOR (INDIVIDUAL) NAME (print) !3o to by (.{/ t /9d%(5
WELL CONTRACTOR COMPANY NAME F- yose#vr /Wel( hr/1/I/q� CO
STATE WELL CONSTRUCTION PERMIT# �/ ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
298641
- Groundwater Section CERTIFICATION # IX^^ ci a Lap
r PHONE «a)6g3-`/i'Y9
1. WELL USE (Check Applicable Box): Residential 07/ Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring 0 Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: No" SPMa1in S County ael,Sdw!
Chak gal 4,-PP op'pr'- sA0$:.0
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: LCIU/vq le4//ictin/e
Address Po/'Ytes iMC2.YA % g Coon rA
(Sneer or Route No.)
r -Sp,2g fs lVC f17�f3
City or own State Zip Code
(g44)- 1' as. — 7/97
Area code- Phone number
4. DATE DRILLED 9/274J
5. TOTAL DEPTH: 2 S' — /
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO l9'
7. STATIC WATER LEVEL Below Top of Casing: 2 0 FT.
(Use "+" if Above Top of Casing)
S. TOP OF CASING IS / FT. Above Land Surface*
"fop of casing terminated at/or beluw land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): /11,4 METHOD OFTEST43fn&an,/J
10. WATER ZONES (depth): 2t0
11. DISINFECTION: Type 1-a,4/tlt
12. CASING:
Depth
From_ To '17j, Ft
From To Ft
From To Ft
13. GROUT: Depth
From_ Tot_ Ft
From To Ft.
14. SCREEN:
From
Amount 9O2
Wall Thickness
Diameter or Weight/Ft. Material
./44 Oce/
Depth Diameter
To Ft. in.
From To Ft. in.
I5. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Method
Pct ode"
Slot Size Material
in.
in.
numbers and common road names.
CroohRd. 0 ?fShuf Ind
F{-SPfl 1 5 nC
o-gb8
an —A7
z78 - 2 TS
Topographic/Landjetting
❑Ridge ❑Slope Walley ❑Flat
(check appropriate box)
Latitude/longitude ofe�wy ll location
A/ 3S-°SeIe af7 uMgA° sa. 277°
(degrees/minutes/�s conds)
Latitudeilongitude source: aGPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
i»7
6~4. 7'C
O V
"7a
� Cn
T m
rV
LOCATION SKETCH tV )
Show direction and distance in miles from at left en
two State Roads or County Roads. Include thelrad z�
m
• Ct
Cn G
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
SIGNAT{1RE OF PERSON CONSTRUCTING THE WELL DA?E Oi
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 Natural Resources - Division of Water Quality - Groundwater Section /�
WELL CONTRACTOR (INDIVIDUAL) NAME
-(print) Soh by 1/0V t Potts CERTIFICATION L D. p
T
WELL CONTRACTOR COMPANY NAME Go VSOA/S Weil Dr///Iry CO. PHONES )$ ,gj —9rr
STATE WELL CONSTRUCTION PERMIT'S ASSOCIATED WQ/PERMIT'S
(if applicable) (if applicable)
298595
1. WELL USE (Check Applicable Box): Residential !Y Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town:f'1ar$ Hill Coun /n /Soh/
(t5 ear bra/1;th Ito act /L3ear- Cove
(Street Name, Numbers, Community, Subdivision, LGGt No., Zip Code)
3. OWNER: �t s h T( AP{in
5
Address ac gb / it R-' 33
(Street or Route No.)
M.4-es 14.7/ /vc nn7fl'
4
5
6
City or Town State Zip Code
(Y;X)- L 95- 3ctvo
Area code- Phone number
DATE DRILLED 3 //3 /0 3
TOTAL DEPTH: 7o S F-F /
DOES WELL REPLACE EXISTING WELL? YES ❑ NO 12/
7. STATIC WATER LEVEL Below Top of Casing: . U FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surface*
*Top of easing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118. / 'p
9. YIELD (gpm): ( METHOD OF TEST atowt y (R/
10. WATER ZONES (depth): IRi I )MO
11. DISINFECTION: Type ire/el
12. CASING:
Depth Diameter
From O To t'/ Ft. 4•96"
From To Fr.
From To Ft.
13. GROUT: Depth Material
From m To .o Ft. Car,Cfe/Y
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 /5035
Wall Thickness
or Weight/Ft. Material
a�L.r3s MSD.a./
16. REMARKS:
Method
?Oft red_
Slot Size Material
in.
in.
Material
Topographic/Land setting,
tdge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of ell location
3S°s5.L3 4/ osx'32. SAW
(degrees/minut ss conds)
Latitude/longitude source: 2GPS❑Topographic map
(check box)
DRILLING LOG
Formation Description
Din 7-'
G-.Vrni Ye
DEPTH
From To
— Ref
$V — 70 S
7
m
-----
Show direction and distance in miles from at IbdYra
t O
two State Roads or County Roads. Include the nod r*to
numbers and common road names.
_ �rn
rP
r^
LOCATION SKETCH
$lq4- / - /?(l/ .
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY 0 THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
ATURE OF PERSON
ONSTRUCTMG 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

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division .00ff{Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME//(print) 84,46 y (ti /I Potts CERTIFICATION #ao?
WELL CONTRACTOR COMPANYNAh1E re .Ace it if �!// Qnl('np Lo PHONE IV
STATE WELL CONSTRUCTION PERMIT# ASSOCIATEDCWQ PERMIT#
(if applicable) (if applicable)
298594
1. WELL USE (Check Applicable Box): Residential C'S Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION: 11t
Nearest Town: pia Hi l/ County /2) ad/ SAN
/o'1 c9-+`d9f' goad (Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER. e/I,�/ieks 17r ri4C�
Address y0 .t? * % / ieaq e n i?r/
(Scree[ or Route No.) J
JZt4,e z k // /v C .V sr71-
City or Town State Zip Code
(W)- •fl oeve'
Area code- Phune number
4. DATE DRILLED 3//Y/o 3
5. TOTAL DEPTH: / 5
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO (�
7. STATIC WATER LEVEL Below Top of Casing: 30 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING I5 j. FT. Above Land Surface*
*Top of casing terminated actor below land surface requires a
variance in accordance with l5A NCAC 2C .0118.
9. YIELD (gpm): /i9 METHOD OF TEST /3/01 i r%l a'9
10. WATER ZONES (depth): /OS Cl" — /Dy pns /
Topographic/Landting
❑Ridge ❑Slope Malley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/mi to conds)
Latitude/longitude source: GPS❑Topographic map
(check box)
DRILLING LOG
Formation Description
Creanettc
DEPTH
From To
_ed
I I. DISINFECTION: Type 'dG/cis Amount 3.z3
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 4 To eta Ft. •S 5 ai&';5 PtCSD,€ (
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From 0 To g d Ft. Cmhc ✓etr p,aTed.
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:
LOCATION SKETCH
tJ Wit^
Show direction and distance in miles from at least
two State Roads or County Roads. Include the roado1-21
numbers and common road names. en55
W
O
!lop, /c. ry5 C )201.
26-14s ,L!:J/, N( .
1 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
Hir/%
SIGNATURE OF PERSON CONSTRUCTING THE WELL
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

298592
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division]���o Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAM(print) 13et46y 14j, )e CERTIFICATION #%i72ff
YI
WELL CONTRACTOR COMPANY NAME fe9tise 5 Wee' elan Iisng Co. PHONE('l8 d24 (a 3-9 yI(Q
ASSOCIATED WQ PERMIT#
(if applicable)
STATE WELL CONSTRUCTION PERMIT#
(if applicable)
1. WELL USE (Check Applicable Box): Residential Vd" Municipal/Pub(ic 0 Industrial ❑ Agricultural 0
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
ft
Nearest Town: %14QaL Covuty
Fox Cove F e /, rn;M. yetis
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: firm��Alec-
Address]
31a FOKC C VQ E8-FC..-fc
t 0 5 I4l `I(Street or NC -re No.) a$1514
City or Town State Zip Code
(VA- 6%9 "IQ al
Area code- Phone number
4. DATE DRILLED /2-D/0}
5. TOTAL DEPTH: , D S
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO a7
7. STATIC WATER LEVEL Below Top of Casing: /0 FT.
(Use "+" if Above Top of Casing)
3. 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): 2, METHOD OF TEST 13(OL'i.2/- y%
�t
10. WATER ZONES (depth): id F7`
Topographic/Lanp(etting
❑Ridge ❑Slope OValley ❑Flat
(check appropriate box)
Latitude/longitude of well location
N in
(degreestseconds)
Latitude/longitude source: OGPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Forma,tion Description
p — 30 n Pient
3p - gas H 6:roe?.7e
v
LOCATION SKETCH -•
11 DISINFECTION: Type +d-EJI €..is Amount 9 A 7. Show direction and distance in miles from at least w
12. CASING: Wall Thickness two State Roads or County Roads. Include the road O
Depth Diameter or Weight/Ft. Material numbers and common road names. O
From O To 30 Ft.Jo. a5 alm.IQ TVCSVRaI
From To Ft.
From To Ft.
13. GROUT:
From 0
Depth Material Method
To a0 Ft. eTho—p €C. T cured
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ftin. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
Fox Cave
Mars Pit I, NC
Es-Fa_te /Sm cis. Greet
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY F THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
GNATURE OF PERSON CONSTRUCTING THE WELL
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

298626
WELL CONSTRUCTION RECORD
North Carolina - Depamnent of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NANIE (print)p//' /ne J et/itvl CERTIFICATION#3 ,,f'4
WELL CONTRACTOR COMPANY NAME/� r C.LA <I II U� r lj D rJU-iln-5 aO PHONE giifp.tl ‘5'.3 y� p
STATE WELL CONSTRUCTION PERMIT'S ASSOCIATED WQ PERMIT'S
(ifapplicablel (if applicable)
I. WELL USE (Check Applicable Box): Residential I!d' MunicipaVPublic 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: / 2ar5 j'-J141 !
&obit s /r— �-
Counry /144I.6-0Y)
(Street Name, Numbers, Communiry, Subdivision, Lot No., Zip Code)
3. OWNER: LPo drr-
Address {IS(J. Les-- Az.'. it W,Lc1. ) 9
(Sneer or Route No.' J
fl14l' mill /Y- C , 97.,53Z
Ciry or Town State Zip Code
(fl$ - 429- 9s�
Area code- Phone number
4. DATE DRILLED Sr'� / 3 - c s
5. TOTAL DEPTH: erg Ys v
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO (i
7. STATIC WATER LEVEL Below Top,of Casing: AS— PT.
(Use "+" if Above Top of Casing)
3. 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): /5— METHOD OF TEST y iAc)
10. WATER ZONES (depth): 1(J(% / .j- / 5.
11. DISINFECTION: Type ,I/D 114 Amount 30z...
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To____F. 'bkr" $fl lj pvc
From To Ft.
From To R.
13. GROUT: Depth Material i Method
From 0 To .r20 Ft. Cc'aelette $o reels
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in
From To Ft. in.
I5. SAND/GRAVEL PACK:
Depth Size
From To Ft.
From To Ft.
Slot Size Material
in.
in.
Material
Topo�gr�ap�h c/Land setting
38 ❑Ridge fope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
35- ti7/'7t,-0id/sypety4/
(degrees/minutes/seconds)
Latitude/longitude source: ❑GPSDTopographic map
(check box)
DRILLING LOG
Formation Description
DEPTH
From To
0 30
�/ s-
a - o? ter
G
O
1 Gi
tJto
tJ 7l.—
s
tom? 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.
6,2brIels Crt tic
ma rs /Fa, /V C
16. REMARKS:
t 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
8'13-U3
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-I REV. 07/2001
ds

298625
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural)Resources
- Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) t "ur4-k t7ilGvt CERTIFICATION tO,..?l
WELL CONTRACTOR CONIPANY NAME .rP rr. rw COO L.a i Pi) t-JLi r`In4 4IO PHONE ll d — g4c)
J J
STATE WELL CONSTRUCTION PERNt1Tit ASSOCIATED WQ PERMITM
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential Fre-Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCATION:
411
Nearest Town: /7arIS l-�I I)
Geb/t.5 /tree.I--
County /040ISO /I
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: -31 C. Lk) oer1
Address 'R O s 0 &c,-. .
(Street or Route No.)
r,>-s dj/le /✓( a e7/v
City or Town State Zip Code
Area code- Phone number
4. DATE DRILLED S — / 3 - U3
5. TOTAL DEPTH: reg1%S v
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO rz
7. STATIC WATER LEVEL Below Top,of Casing: .25 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): /S METHOD OF TEST Waif)
10. WATER ZONES (depth): JOKY <9- /5's'
11. DISINFECTION: Type AID 41 Amount 3ferL
12. CASING: Wall Thickness
Depth // Diameter or Weight/Ft. Material
From 0 To�LFt. k?Lcr biz»a) PVC
From To Ft.
From To Ft.
13. GROUT: Depth Material i Method
From 0 To a2 CZ Ft. CUa.erett $o red
To Ft.
From
14. SCREEN: Depth Diameter
From To Ft in.
From To Ft. in.
Slot Size Material
in.
in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Topo�grap�hic/Land setting
❑Ridge Lk8Tope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
35/7/O7(no/3V/cn
(degrees/minutes/seconds)
Latitude/longitude source: ❑GPS❑Topographic map
(check box)
DRILLING LOG
Formation Description
DEPTH
From To
0 30
3 / gr
l
?- dur
▪ n
C▪ . D3 �
2%
N 4
LOCATION SKETCH 'a�'
rn
Show direction and distance in miles from at lea P"—
two State Roads or County Roads. Include the rocg �
numbers and common road names. OA
Z
V4brirls Creell-
fyjars ff•v/,
/✓ c
l6. 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
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-I REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resourcees/s-�1- Division of Water Quality - Groundwater Section
pp��
WELL CONTRACTOR (INDIVIDUAL) NAME (print)�QC k (42ile t/1 CERTIFICATION g______
WELL CONTRACTOR COMPANY NAME jP.fQ 01 cm el (-4-2 D.II -Mrlt1t Ylr't CCU. PHONE egr %n S'3-1r%9
STATE WELL CONSTRUCTION PERMIT/ J ASSOCIATED WQ PERMIT/0
(if 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 0 If Other, List Use
WELL LOCATION: 77Jl
NearestTown:�7cir5 /7� i)County 77.2011/ P1
cS CkPo/ Air ets a /4're /24 cc ,4! %/
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: 4diSon
Address 5 7 3 B
(Street or Route No
N/anSha// N fe
City or Town State
a8753
Zip Code
(;9Y)- 629 - ,79a,
Area code- Phone number
4. DATE DRILLED V-
5. TOTAL DEPTH: 3 ? {— r
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: 4t 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 accords ce with ISA NCAC 2C .0118. D
9. YIELD (gpm): 5a METHOD OF TEST n •
10. WATER ZONES (depth): /of r -- a(AS
11. DISINFECTION: Type i+/.C9/9
12. CASING:
Depth
From 0 To
From- To 73
From To
13. GROUT: Depth
From U To a O
From To Ft.
Dia eter
Ft. 6Ft. �
Ft.
Amount , ' O2,
Wall Thickness
or Weight/Ft. Material
„SR Fat
/9I 5/e/I
�r
Material Metho�Jl
Ft. CO/IG ✓L � e C+
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.
298624
Topographic/Land setting
❑Ridge ❑Slope ❑Valley L9Ftar
(check appropriate box)
Latitude/longitude of well location
3i/50/..) tJ -0901/3V0 w
(degrees/minutes/seconds)
Latitude/longitude source: LDS❑Topographic map
(check box)
DRILLING LOG
Formation Description
"Resi (7/4/V
DEPTH
From To
C) /0
r Ca 7 jAnlT �S/ztnt
Blue Gran, ,
fr —73
s<- 3Bs�
231,4-c (Gran:1-o
0 O
A o
-im
ci
%rr
N
LOCATION SKETCH -0 m
Show direction and distance in miles from at least rn
two State Roads or County Roads. Include the road N f
numbers and common road names. al
CP s
/it2ase Game.
r5
/. A/,C
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTIONSTANDARDS, AND THAT AA COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
ON
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-I REV. 07/2001

298618
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources -, Division of Water Quality - Groundwater Section
\YELL CONTRACTOR (INDIVIDUAL) NAME (print) leW. net
WELL CONTRACTOR COMPANY NAME rry w 1On /mot// eC /2 ,.
CERTIFICATIO/N t 3/r4)
PHONE 47h r tf CO/C.
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT14
(if applicabla) (if applicable)
I. WELL USE (Check Applicable Box): Residential la/Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION'
Nearest Town: ;AllLew-tl Counry /i7c/Cer1
fineltAvg/ Fm-K /,L
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER. Zia al tephsr*
Address __�. fir✓ d . ,e a
f fa !/,iAou Wt�}2o a No.)
S.G e,49sa
Ciry or Town State Zip Code
( )- o' - 2..45-68
Area code- Phone number
4. DATE DRILLED (ti%- DJ
5. TOTAL DEPTH: re"'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO la"
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 or casing terminated arior below land surface requires a
variance in accordance with l5A NCAC 2C .0118.
9. YIELD (gpm): 2 METI-IOD OF TEST P OP/tI
10. WATER ZONES (depth): [/BO Z s-os 3-61-
11. DISINFECTION: Type a tee- Amount - Ames
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From rU To 6O Ft 61.41 .t/4 2s Pre De.,
From To Ft.
From To Fr.
13. GROUT: Deprh Nlarerial
From O To -o Ft. Co/Prt)1-e
From To Fr.
/Topographic/Land setting
tidge 0Slope ❑Valley []Flat
(check appropriate box)
Latirude/longitucje of well location,
3G.7Ur 1. ofcJ/.2/
(degreesiminuresrseconds)
Latitude/longitude source: L3'GPS❑Topographic map
(check box)
DRILLING LOG
Fo ation Description
DEPTH
From To
0 60
Go 3-f� s-
L
13 atLOCATION SKETCH
Show direction and distance in miles from at leas[
two State Roads or County Roads. Include the road
numbers and common road names.
c s
Guar Late-, MAArS F'riv, N Q.
IA. SCREEN' Deprh Diameter
From To Ft. in.
From To Ft in.
15.SAND/GRAVEL PACK:
Deprh Size Material
From To Ft.
From To Ft.
Method
tritareet
Slot Size Material
in.
in.
O G
t c'c
c0
3 y —
N 9i rn
c
NI?r_
7
tnN G
l6.REMARKS:
'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
ILLd res- 4/- /J = 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
27699-1636 Phone No. (91.9) 733-3221, within 30 days. GW-I REV. 07/2001

298617
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natupral Resources - Division of Water Quality - Groundwater Section //
WELL CONTRACTOR (INDIVIDUAL) NAME (print) itic✓I 2. W'^ea CERTIFICATION # dit-71�
WELL CONTRACTOR CONIPANY NAME '"Sw 3 des L✓t'i Dr•' /I••jf PHONE 6112 ei 03- CIWI
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
Inapplicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential 0/Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION: //
Nest Town: /'7''2 /T 1' County ?ICJ )ro'T
kns%Sk ftmt/i /174/•644-ci ,VC.
(Street Name, Numbers, Community, 7Subdivision,/Lot No., Zip Code)
3. OWNERtLt'efulo2ld non,e., Adee/cb)
Address o. Bay Si?
(Sneer or Route No.)
Zip Code
City or Town State
(%/3 )- 33/- a.o)
Area code- Phone number
4. DATE DRILLED Y - /b o3
5. TOTAL DEPTH: ,305
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 12/
7. STATIC WATER LEVEL Below Top of Casing: 40 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 l5A NCAC 2C .0118.
9. YIELD (gpm)• a METHOD OF TEST -1/0 ✓•15
10. WATER ZONES (depth): 75' -z$'0'
II. DISINFECTION: Type t' /.%
12. CASING:
Depth Diameter
From 0 To S5 FL (a%
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From__C To Ra FL oone re f ts prin.. re--ct
From To F.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth
From To Ft.
From To Fr.
Amount -tabs
Wall Thickness
or Weight/Ft. Material
a,a, /a5 Presozs/
Size Material
!. Topographic/Land setting
Ell ridge 0Slope ❑Valley ;❑Flat
(check appropriate box)
Li�tirude/lon'Irud of well location
Nis
(degrees/minute' seconds)
Latitude/longitude source: PS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Fo ation Description
0- S'5 pit
5 5 - 30.5
G >k
'G
n
O cf a
a
N �rn
G ��
• rnG
— • N'R
LOCATION SKETCH ' 0
Show direction and distance in miles from at least 1/40 x
two State Roads or County Roads. Include the road
numbers and common road names.
('h,rw t((I'0t Rd.
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
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

298614
WELL CONSTRUCTION RECORD
North Carolina - Department o(Environment and Natural Resources - Division of Water Qualify- Groundwater Section
\\ ELL CONTRACTOR. (INDIVIDUAL) NANIE ( rinr) "rt., i 4V,eJ CERTIFICATION N J/Vo
DELL CONTR4CTOn COMPANY NAME AVl ra fin): hotel/ oal", !� PHONE jJZ 2r#-lstq
STATE DELL CONSTRUCTION PERNIITA ✓ ASSOCIATED WQ PERMITS
ilr _oxlir_blcl (iranplicablel
I. WELL USE i3Ohectc Applicable Box): Residential E IvtunicipaLIPublic ❑ Industrial 0 .Agriculalral 0
Monunring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, Lis[ Use
2. WELL LOCATION:
NearestTovirnie2"' /
ca e cosy d
tSa'r, Name, Numoers, Community, Subdivision, Lol No., Zip Code)
3. OWNER: ioir tnC2 Seto Ma We.
Adore» ,P 6 Sol et 3 3
(Sneer or Route No.;
4/4 rshraru nr -387s3
oiry or Town Suite Zip Code
( )- 1nte9-99/y
County 0411c447�
.lea eedc- Phone number
+. DATE DRILLED 7 3`7 - O3
5. TOTAL DEPTH: 3-tic
C. DOES WELL REPLACE EXISTING WELL? YES 0 NO Cr-
7.
STATIC WATER LEVEL Below Top of Casing: no FT.
(Osc +irAbove Top orCasing) n�
�j
S. TOP OF CASING IS FT. Above Laud Surface
DEPTH
From To
O- Zr
eS — 30S
Topographic/Land serring
Ridge ❑Slope ❑Vahey ❑Flat
(check appropriate box)
Latitude/longiude of well location
Ndlr°,ro. /fo'worz.�.e,4 4
(degrees/minuiesr ands)
Ladwde/longitude source: L3GPeS❑Topographic map
(check box)
DRILLING LOG
Formation Description
G .•h
t Clio
"lop ar casing tcrminarca avur below land surface requires a
variance in xccurdiim.qc with l5A NCAC )C.0US. pp -
9. YIELD(gpm) 20 METHOD OF TESTO�r,at.���'ff
10. WATER ZONES (depth) 90 /t'
11. DISINFECTION: Type Chi.. "e, Amount Q Jtls
12. CHASING: Wall Thickness
Depth Diameter
From 0 To LS Fr G •/lr
From To Fr.
From To Ft.
13. GROUT: Depth Nigeria' Method
From 0 To Zsi FL On& egqi. eoei..i.yf
From To Fr.
14. SCREEN: Depth Diameter Slot Size Nlarerial
From To Fr in. in.
From To F. in in
15. SANDiORAVEL PACK:
Depth Size Material
or Weight/Ft. Material
5.Q?e, five
From To Ft.
From To Fr.
0.4
f-
ram^
LOCATION SKETCH J rn-a
Show direction and distance in miles From at least �'.
Iwo State Roads or Counry Roads. Include the road
numbers and common road names.
gate nary /?d.
nietishai
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH l 5 A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
-z -V %—: )
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit [hc original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-163o Phone No. [phone], within 30 days. GW-1 REV. 07/2001