Ma CY2004

WELL CONSTRUCTION RECORD
at,l 1
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section WELL CONTRACTOR (INDIVIDUAL) NAME �(prlot)clLnP11S 'MtI/ � CERTIFICATION Sa/7c"
�
WELL CONTRACTOR COMPANY NAME1.4t)i c irk (IQra !APO rr_11'u �J.3-2/��K PPHONE .3-2 Li —3 a-b 0
STATE WELL CONSTRUCTION PERMITS ASSOCIATED WQ/((iimmrrS
(ifapplicable) (if applicable)
300A92
1. WELL USE (Check Applicable Box): Residentialinunicipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 17 If Other, List Use
2. WELL LOCATION: //
Nearest Town: r'i`/7' County /! I
7 --I {-Ct'rr-i.",- P t, i6 3
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
r
3.OWNER: tI Lila �csfl],15
Address 41'- 0 r t k f. 647
{%
(Street or Route No.)
Cl*n i C „LSr7&
City or Town State Zip Code
Area code- Phone number ..
4. DATE DRILLED t /C - C'
5. TOTAL DEPTH: ez.7 '
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO mr
7. STATIC WATER LEVEL Below Top of Casing: g FT.
(Uu "+" if Above Top of Cuing)
8. TOP OF CASING IS / FT. Above Land Surface'
*Top of cuing terminated at/or below land surface requires a
variance In accordance with ISA NCAC 2C .0118.
9. YIELD (gpm):. 3 O METHOD OF TEST_1�� U
10. WATER ZONES (depth): /o2S ) o% 75'
I I. DISINFECTION: Type
12. CASING:
Depth
From 0 To / I c/
13
14
15
f� Amount 7-A-A S
From To Ft.
From To Ft.
GROUT: Depth
From_ To ri7 Ft.
From To Ft.
SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
SAND/GRAVEL PACK:
Depth Size
From To Ft.
Topographic/Land setting
❑Ridge ❑Slope ❑Valley at
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(cheek box)
DEPTH DRILLING LOG
From To 4-1Fm
Formation Description
V
u' 93
43'
LOCATION SKETCH
Show direction and distance in miles from at (east
Wall Thickness two State Roads or County Roads. Include the road
Di%n ter or Weiiht4Ft. Matepal numbers and common road names. p 0
Ft. _I it. is - .51j CC" r all, r„
G
0C
-7o
-0 010
W g
45
Material Method
3c4i 4 7 pawv
Slot Size
in.
_ in.
Material
Material
From To Ft.
I6. REMARKS:
I +Li
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL I _ ` I
CONSTRUCTION STANDARDS, AND THAT A COPY OF/n� S RECORD BEEN PROVIDED TO THE WELL OWNER ,
Ori l-tD-ocf
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to 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.;

4251
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Russell S. Taylor
WELL CONTRACTOR COMPANY NAME Hedden Brothers Well Drilling, Inc PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
CERTIFICATION it 2187
1. WELL USE (Check Applicable Box): Residential 0 Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LO
Nearest Town: QHH11)�
[cCX fi- _Sa
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: Address 9
�.�p6Q.�-,An Iwn
Lg�e[G76�} Route No.)
(3 ig* oo7 Toe ggicgic t//te'AVIi/i
Area code- Phone number j.
4. DATE DRILLED IO g"O
5. TOTAL DEPTH: IOr
6. DOES WELL REPLACE EXISTING WELL? YESpQ ivo
7. STATIC WATER LEVEL Below Top of Casing: 7V0 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): a, METUQDD pF TEST BLOW
10. WATER ZONES (depth):
County l l 110)(t
tod
A37341
Zip Code
11. DISINFECTION: Type H T H
12. CASING:
From C/ T To
From p=' To
From To
13. GROUT: Depth
From 0 To 20
Depth iameter
Ft.
Ft. (o'
Ft.
Amount 16oz
Wall Thickness
or Weight/Ft, Material
t
Material Method
Ft. benonite & cement pumped
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size Material
Slot Size Material
in.
in.
From To Ft.
From To Ft.
16. REMARKS:
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
Fro w Z,o , Formation Description
DEPTH
clay & sand
granite
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONST UCSTANDARDS, AND T AT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
//,3j0 174
SI ATURE 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-I REV. 07/200L-

WELL CONSTRUCTION RECORD
Nonh Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME �(print) cD.Pn }1 i S 1'1 r' jit'2 rL . CERTIFICATION # .117 ee
WELL CONTRACTOR COMPANY NAME; T f)n} 4 Ikk J)o,44 tiiei 1 Y J I 714 8 J e PL PHONE
T- � •sja4-3cV.60
STATE WELL CONSTRUCTION PERMITH ASSOCIATED WI/PERMIT,/
(if applicable)
{if applicable)
WELL USE (Check Applicable Box): Residential' unicipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other C1 If Other, List Use
2. WELL LOCATION:
Nearest Town: /0 to County An,Cin
Cft t S TesSen-te.e_ L A -let VIG1n.i,es Sfeloc-1
1
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code) 4876 5
3. OWNER: ..5"-Cott-Cott- 171 f ,S1 o (R (L f $11x.,
Address `f%O• f3 b 1( a- 9 5
U S 4c Coo• ��gy-O
(Street or R ute No.)
Ci-ty o5r Town36- State Zip Code
►3)42r5'�.
Area code- Phone number
4. DATE DRILLED // — 4' —0 51
5. TOTAL DEPTH: Epp'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO Qlt
7. STATIC WATER LEVEL Below Top of Casing: 3!) FT.
(Use '4" if Above Top of Cuing)
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 IC .0118.
9. YIELD (gpm): / MET D OF TEST
10. WATER ZONES (depth): 'O
Tphic/Land setting
ORi3ge OSlope OValley ❑Flat
(check appropriate box) a
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
Formation Description
DEPTH
From To
0 e
Cr CC P
tPi • Qloo"
Ve /rn�etx_tere-.
R L k e C vim-, + •e.
LOCATION SKETCH
11. DISINFECTION:,Type iff-tJ% Amount a %A -A 5 Show direction and distance in miles from at least:'
12. CASING: Wall Thickness two State Roads or County Roads. Includerrhe roa
Depth �/
To / " S Ft Diameter or Weight/Ft. Material numbers and common road names.
From i� .?) fi S i. Q
From To Ft.
From To Ft. t
`O
13. GROUT: Depth Material Method
From To Ft.,_,.epy� G.r,� GJQ�,(�
From To Ft. r . C
14. SCREEN: Depth Diameter Slot Size Material C
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK: _ _
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRULI bD IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF TH S RECORD HAS BEEN PROVIDED TO THE WELL OWNER
/--4e.
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to 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
Crjrn
KA cnon
f�
0CA
cP 0
rt

net r
\V LL CONS L'RUCTIIUN RECUR
North cm ovum - Ucpalllacnl of Eovinniment aid Unlu n� oil -Division of Wolci Quality - Uunmdwnncr Section
C'r,lt I IFICAI IUN N
rset.I,cO NIJIACRn(pllnIVIDUAL)mAnit; ulllnl)_ Gr CF,Ite • 1P111 y)7'Z997
wrl.I.ctut IIIAt:IullconlrAnrNAalr.____ <-/ie/a"------------ --_
ASSIICIAI P.11 rvI) I'e.It II IN
SIAIF.trf.LLFIlNS11tUCIIUIV FERMI lN __ _ _-- (ifnlrldicnLlr
if n • 'Ill ,ble
I. \l'I:I.1, ',SR (Check Applicnlrle Ilex): Ilr^.idrulinl la--Mb'u' ripnl/Public U lndonninl Ll Aglicullulnl LI
Monitoring U Recovcly U Ileat I'uogr \Vinci Injection LI Ohm U If Other, Lint Use
Topugrnphidl and netting
Ultidgc IJSlopc LIVMiry 1-11In1
(I,rrk •,gmgnl I. l,n•)
Lnlitudefloogdullc of well Jticnlie)11 e 1
N3C(21 a6 3'Wee93 nY_Vg
,/ �/ plrieerd,olnnlrr -reepi,)
\- U\\'rir t Qav�d G�fQif
y2 Lnliludc/longitude sotllce:(-J JI'S17li,I, , lnpllic imp/\ddl cc5 _�ZD I'-� �1k�G...-r-G✓S_ ..---. (dirt« la,•)
($nrel nl Ronne 11n) Z �� �, UGL' lll UItILi,ll n; I �JI;
NL -__ .. l oonaliml Ilcsclipliun
�(Sly et i u "hn S Ple flnlll TO
itiie
o �5r-- _7 _ —
2. R'1'1.1.11 CAIIIII1: aeon
Fr4y412 Cunnn•
47k:pdc"' __fwllr
ISUrr111emr, Nmnl•nr, t,nomu„Ip, SI1 L,imlu0, 1,1 IL,., 74r Il.lr)
1 _t_ —
Air, rr+lr- 1'lo.nr emultr O y /� O
.1. IIA1141)11ILt1:,1) — -
5. I O rAI I11•P rl l 242
G. IRMS\ti•.LI.RRPI.ACEP!XISIIIIUwl..11.t Y11113.1 �Ulla'
7. SIAlIC\\'AIlilt I,I;VIiI. IlclotE.
`me�r aln Above' lip olrn,{np)
B. 1I01' 1)1' CAS114(11 l _ .- - LT. Abuvr l nud';ulli cc'
• 1 el• of r.,b,r Irrn l,•Ird mitre lido,/ I•nil pm bore ngulrn •
..II.nrt In •rrnrd•nte nllb 15A NUM' IC 1111n.
V. YIEI l 1 (HMI): _/),_ _ bli IIt)I) VI' 1 ES1.1 <r -- ---
10. \5'A 1 lilt ZUPJIiS (droll): -- — LQCAI IVIii_St.1 1 CI
/r%%. d Crhow ditccliun and dislancc in miles Iiou1 el Icaxi
,c_---_ Amount Y� Iwo Stale (loads of County Roods.Include Illc fond
II. IIISIIJII;C III)IJ: I}) Pr nll lbirkncss
12. CASING: mothers and common fond names.
Urplh Ilimncl�r of \I'righVfl. hlntctial
r1l,tlr_ Q_
I-„ .5= rt.G.2.5_ 112.ZL_ "V° o
pt, _ft. — o
t. nir��ii11d Iclboll 1`x
13. IiRUUI'; UrDepth.,// yFCf'°' �,�, ,
non_ --- ..-
en 1; 1 Ulnnlcicr ';InL';irc Mntrlinl i
Id. SCREE 1: I rp11r in. 1-1 nirt fa_ I L__in. -- w �_
_— in. — Q cn:—.
15. SAIIUIUItAVPe I'ACF :
Sirc taldrlinl
ItrpUr
toto To IT
front —
TII_ —_ El.__—_ --------
--
Ofiao
z040fl
16. REMARKS:
1 DO III'RPIt1' Cli.lt 1II'Y 1IIA1.I IIIS Milt \VAS CI INS 11111; IED Itl ACCURUANCII, WITH ISA IJCAC 2C, WE.LI.
CUtJS I RUC IUN SEAWARDS, AND '(IIATA CUI'12 OF •1III S RECORD IIAS BEEN PItUVIDED 1U 11ILI WELL OWI f Elt
lG—!3'ay
SllitiAluitR;1'I9C;UIJCUIJS1133/C111J(1THUWELL UA11,
Submit the a1Iglnnl to (he Uhitlotl of Witter 1)unll(p, Ctnttndrrnlet Section,1636 Mill Service C(,WrI ItEVK1)7tic

03153
pleb!
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Russell S. Taylor
WELL CONTRACTOR COMPANY NAME Redden Brothers Well Ddlling, Inc
ASSOCIATED WQ PERMIT/
(if applicable)
STATE WELL CONSTRUCTION PERMIT*
(if applicable) /
1. WELL USE (Check Applicable Box): Residential , ' Municipal/Public 0 Industrial 0 Agricultural 0
CERTIFICATION a 2197
PHONE e f 828) 369-9591
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELLLOCATII•: /)/)A��
st Town: ounty 1, /
l L1.L
(Street Name, Numbers, Community,Subdivision, Lot No., Zip Code
gure_A`Rpit-tarn
3. OWNER:
Address l8I ( � 1'11CJ
(Street or Route No.)
ndrl Q at, Pr
Ciry orT� Zip Code
Area code- Phone number
4. DATE DRILLED—
5. TOTAL DEPTH:
6. DOES WELL REPLACE EXISTING WELL? YES NO ❑
7. STATIC WATER LEVEL Below Top of Casing: 0 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 1n accordan a Ith 15A NCAC 2C .0118. BLOW
9. YIELD (gpm):ZON�� `fib ODI wo ES _
10. WATER ZONES (depth): 'j� y )
11. DISINFECTION: Type H T H
12. CASING:
/, Depth ,/n Diameter
From C J To Le Ft. (o 41
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From.A____ To 20 Ft. benonite & cement pumped
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ftin. in.
From - To Ft. in. _ in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOCI
Fx. o 1 Formation Description
clay S. sand
granite
LOCATION SKETCH
Amount 16oz Show direction and distance in miles from at least
Wall Thickness two State Roads or County Roads. Include the road
or Weight/Ft. Material numbers and common road names.
O.� 5 ad (/
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTT� CTION STANDARDS, AND THATAJA COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
/I /AAAJ.i/./ T) n.bbbbl .ern 74 -.2/ -0
SIGN f 'URE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the DivisionofWater Quality, Groundwater Section, 1636 Mail Service Ceenter, REV. Raleigh,
NC
27699-1636 Phone No. [phone], within 30 days.

303'752
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Russell S. Taylor CERTIFICATION # 2187
WELL CONTRACTOR COMPANY NAME Hedden Brothers Well Drilling, Inc PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential KI Municipal/Public 0 Industrial 0 Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION: mAGt►�
Neprpst Town: itAte .l f.� County
c,tt4tJ05 QG
(Street dame, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: SmPscv—d
Address 1188 1414f+uh os to
(Street or Route No.)
�►K.0 t. F2, r4 ,6187341
�� pCity oTown_ State Zip Code
(8 2 )- 0
4 y
Area code- Phone number
4. DATE DRILLED 9 1114.17
5 TOTAL DEPTH: 00r
Topographic/Land setting
❑Ridge 0Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
Fr m To Formation Description
clay & sand
a y granite
6 DOES WELL REPLACE EXISTING WELL? YES 0 NO Al
7. STATIC WATER LEVEL Below Top of Casing: 700 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 accordanceith 15A NCAC 2C .0118.
9. YIELD (gpm):.ci METHOD Or TEST BLOW
10. WATER ZONES (depth):
11. DISINFECTION: Type H T H
12. CASING:
From
Frot
From To Ft.
13. GROUT: Depth Material
From 0 To 20 Ft. benonite & cement
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.
Direr
Ft. !0
Ft.r ,/$8
Amount 16oz
Wall Thickness
or Weight/Ft. Material
G
Method
pumped
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 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
fea _•.-+J( /0 -2 / - 0 4
SIGN TURF 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
cnp

303751
3. OWNER:
Address
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Russell S. Taylor CERTIFICATION If 2187
WELL CONTRACTOR COMPANY NAME Hedden Brothers Well Drilling, Inc PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential , Municipal/Public Industrial 0 Agricultural ❑
Monitoring 0 Recovery ❑ Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCAT
st Town:
_county I / I FI GO n)
— Ott .1—* 1
(Street Name, Numbers, Community, Subdivision, Lot No., rZiip�Code)
auXerbi
le4/1f2
(Street or Route No.) so cosi)
tait
City or Town o%eon Zip Code
- ( 7 9b
Area code- Phone number /
4. DATE DRILLED � OtQ'O'/
5. TOTAL DEPTH: / [�
6. DOES WELL REPLACE EXISTING WELL? YES NO 0,
7. STATIC WATER LEVEL Below Top of Casing: FT.
(Use "+" if Above Top o 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 ith ISA NCAC 2C .0118.
9. YIELD (gpm): METHOD OF TEST BLOW
10. WATER ZONES (d pth):
Topographic/Land setting
ORidge ❑Slope OValley OFlat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:OGPSOTopographic map
(check box)
DRILLING LOG
Fr r o Formation Description
clay & sand
allneATO granite
DEPTH
11. DISINFECTION: Type H T H Amount 16oz
12. CASING: Wall Thickness
Depth Di eter or Weight/Ft. Materia
From To BOFt. " •OR5 ��dd
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From 0 To 20 Ft. benonite & cement pumped
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:
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
Alit)/D /d-,2/-a`f
SIG TUBE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Ceentert REV Raleigh,hNC
27699-1636 Phone No. [phone], within 30 days.

0315°
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Russell S. Taylor CERTIFICATION k
WELL CONTRACTOR COMPANY NAME
Hedden Brothers Well Ddlling, Inc PHONE k 1828) 369-9591
WQ PERMIT#
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED(if applicable)
(if applicable)
trial
I. WELL USE (Check
Monitoring 0 RecoveryApplicable 0
H at Pump Water Injection 0 Municipal/Public
❑�ther,sList Use
Agricultural 0
2.
2. WELL LOCATI T
st Town: 1 �ounty
t�31 L1 L*
(Street Name, Numbers,, Community, Subdivision, Lot No., Zip Code)
3. OWNER 7WI q au.$t Q-ftI l-1 lYi)
Address I IC1141J
(Street or Route No.)
t
lb
-
Area code- Phone number
4. DATE DRILLED
5. TOTAL DEPTH:
6. DOES WELL REPLACE EXISTING WELL? YES
7. STATIC WATER LEVEL Below Top of Casing: /W FT.
(Use "+" If Above Top of Casing)
8. TOP OF CASING IS 2 FT. Above Land Surface*
*Top of using terminated at/or below land surface requires a
variance In aecordapchwlth ISAMNECAC 2C BTEST BLOW
9. YIELD (gpm): �{l Q OF
10. WATER ZONES (depth):
Zip Code
11. DISINFECTION: Type H T H
12. CASING:
Depth
From Q To
From To
From To Ft.
13. GROUT: Depth Material Method
From_O To 20 Ft. benonite & cement pumped
Front— 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.
Tdpographic/Land setting
❑Ridge 0Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
Formation Description
clay & sand
granite
LOCATION SKETCH
Amount le
Show direction and distance in miles from at least
Wall Thickness two State Roads or County Roads. Include the road
Di meter or Weight/Ft. ateria numbers and common road names.
Ft. (611 .0 5 � d 0 v.
Ft. p la
Cn '3;�
— O.'
N prs ---
a
nnrn
-0 cs,
oa
N�
J
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
,etaea7aace? lQ-2/-4if
SIGNATUItt OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center
I REV gh, C
27699-1636 Phone No. [phone], within 30 days.

303749
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
2187
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Russell S. Taylor CERTIFICATION #
WELL CONTRACTOR COMPANY NAME Hedden Brothers Well Drilling, Inc
WQ PERMIT#
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED(if applicable)
(if applicable)
1. WELL USE (Check Applicable Box): Residential 0 Municipal/Public 0 Industrial 0 Agricultural ❑
2. WELL LOCAT
\
Nrcest Town.
(Street Name, Numbers, Corn
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other ❑ If Other, List Use
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
3. OWNER:
Add s
r�+T
(S eoute-ift
rye;— 51117
Area code- Phone number m i / /
4 DATE DRILLED l ,Y7 </
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO K
7. STATIC WATER LEVEL Below Top of Casing: FT.
(Use "+" if Above Top of asing)
8. TOP OF CASING IS 2 FT. Above Land Surface"
*Top of casing terminated aUor below land surface requires a
variance in accordan th 1SA NCAC 2C .0118.
9. YIELD (gpm): METHOD OF TEST BLOW
10. WATER ZONES ( epth):
nity, Su
(uea+
, Zip Code)
PHONE # f 626) 369-9591
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
Fro T. f Formation Description
S clay & sand
IS/e',flgl granite
5. TOTAL DEPTH: 00
ag73/
Zip Code
H Amount 16oz
Wall Thickness
Di ever or Weight/Ft.
11. DISINFECTION: Type H T
12. CASING:
Depth y"
From r To Ft.
From . r To Ft. /ems rir.p
MfoFrom To Ft.
13. GROUT: Depth Material Method
From a To 20 Ft. benonite & cement pumped
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.
'al
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
CONSTRU ION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
70/27, d
SIGNAT OF PERSON CONSTRUCTING THE WELL DA
Submit the original to the Division of ater Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

303748
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section187
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Russell S. Taylor CERTIFICATION #
WELL CONTRACTOR COMPANY NAME Hedden Brothers Well Drilling, Inc
STATE WELL CONSTRUCTION PEIiM17# ASSOCIATED WQ PERMIT#(if applicable)
(if applicable)
PHONE # f 828) 369-9591
1. WELL USE (Check Applicable Box): Residential El Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATIO
N 5;;;I
3. OWNER.
Addres
/City
Area code- Phone number 4. DATE DRILLED Q 0
5. TOTAL DEPTH:
6. DOES WELL REPLACE EXISTING WELL? YE
7. STATIC WATER LEVEL Below Top of Casing:
(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 accordanc with 15A NCAC 2C OF8. BLOW
9. YIELD (gpm): MF,T$O p
10. WATER ZONES (depth): %f
Topographic/Land setting
' ❑Ridge ❑Slope ❑Valley ❑Flat
`#02 (check appropriate box)
Latitude/longitude of well location
11. DISINFECTION: Type H T H Amount 18oz
Wall Thickness
Dialer or Weight/Ft. !Veda!
12. CASING:
Depth
From To
From 1 To
From To
13. GROUT: Depth
From 0 To 20
From To
14. SCREEN: Depth
From To
From To Ft.
15. SAND/GRAVEL PACK:
Depth
From To
From To
Ft.
Ft.
Ft.
Material
pt, benonite & cement
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From Tp, , Formation Description
clay & sand
granite
Method
pumped
Ft.
Diameter Slot Size Material
Ft. in. in.
in. in.
Size Material
Ft.
Ft:
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names. "-
O Crn
3 CII Tn
nt o 0
O
sr
ii ri55
-5
co
-F 5
t- r` -,
_3 cn
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTR I� AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED THEWELL OWNER
/Iz °� DATE
SIG TURE 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

30374'7
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Sect2ion
87
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Russell S. Taylor CERTIFICATION #
WELL CONTRACTOR COMPANY NAME Redden Brothers Well Drilling, Inc
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
PHONE # [phone]
1. WELL USE (Check Applicable Box): Residential El Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATI
Nearest T imNu
(Street Ne,
3. OWNER:
Addre
•
(31A)-
Area code- Phone number 1
4. DATE DRILLED 7'3a '67
5. TOTAL DEPTH: 450
6. DOES WELL REPLACE EXISTING WELL? YES9 NO
7. STATIC WATER LEVEL Below Top of Casing: . 1) 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 accordsre with 15A NCAC 2C .0118.
9. YIELD (gpm): METH einer TEST BLOW
10. WATER ZONES (depth): //
i�
Community, Subdivision, Lot No., Zip Code)
County I r lai-/
dx4/.�aw+I;tavt
h f! a)ii6a2/
�p1141 `RNC' 4,9n79/
Tmvn li 7 Sate Zip Code
11. DISINFECTION: Type H T H
12. CASING:
0
Depth DittSter
From To III Ft.
From 0 To_ILL { Ft.
From To Ft.
13. GROUT:
From 0
From
14. SCREEN:
From
Amount 16oz
Wall Thickness
oraWnekghilFt. steal
ite
pvc,
Depth/ / Material
To I, I Ft. benonite & cement
To Ft.
Depth Diameter
To Ft.
in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size
From To Ft.
From To Ft.
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To _ . 1 Formation Description
clay 8 sand
granite
Method
pumped
Slot Size Material
in.
in.
Material
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTR I�ARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
0p7/0'r`
SIG URE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - REV Raleigh,
NC
27699-1636 Phone No. [phone], within 30 days.

303660
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment end Natural Resources - Dmsionof Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) c ennI S Mt IIn.AN11- r CEl(TXP1CAT,1OON d 174'
Cb' WELL CONTRACTOR COMPANY NAM. ')(C 14110 ha 11jP.( I1).aII i( < �/�,5tt IS PN e 1 ONE M f —Sa. t'3 �' 6 0
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ'YERMITe
(if applicable) - (if applicable)
I. WELL USE (Check Applicable Box): Residential' unicipaVPublic 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other C1 If Other, List Use
2. WELL LOCATION: / grapbic/Land setting
'Nearest Town: fii?.9'AIeLi/Y County /4a_teM-' 'dgepo❑Slope °Valley ()flat
4415 P Qe 4i 7j t?' Q: Arils e a - LO 11; 115 (check appropriate boa) a
(Street Name, Numbers, Community, Subdiviilon, Lot No., Zip Code) L or Waif if Latitude/longitude of well location
3. OWNER: %Y):(Ce Vo,,4trtCoAAe
Address (DDIc) -q3 as Ste CR.
(Street or Route No.)
Yaaetn+tn., r'1. 3 .Zd �-
City or Town Slate Zip Code
(q4')- sg-.Q1 .2.to •
Area code- Phone number
4. DATE DRILLED lb - L i -o 9
5. TOTAL DEPTH: Sac'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: .3 0 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
'Top of casing terminated at/or below landsurface requires a
variance in accordance with 15A NCAC 2C .0114.
9. YIELD (gpm): � METHOD OFTEST_Ahditif. t-,
10. WATER ZONES (depth): //b
11. DISINFECTION:, Type if41f
12. CASING:
Depth
From O To 64
From
Amount .-1r1i S
Wall Thickness
Dianwter or WeiishVFt. Mate I
Ft. h' .s1�R��, R1%�,
To Ft.
From To Ft.
13. GROUT: Depth
^,�
From /) To r- ?) Ft.
From To Ft.
14. SCREEN: Depth
From
From
Material
Co-rr dY
Diameter
To Ft. in.
To Ft. in.
Method ,
n
Slot Size - • Material
in.
in.
15. SAND/GRAVEL PACK: -_
Depth Size Material
From To Ft
From To Ft.
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
. - (check box)
DEPTH DRILLING LOG
From To Formation Description
itte21 8l01.4
`fa' too• Vtarn' :c0-Irrt
Jnts' SAD • 3Lue Cyan, i t-C-
LOCATION SKETCF(
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
RECEIVED I DENR I D4dQ
AQUIFER PROTECTION SECTION
OCT 2 6 'L
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 TH{{SR�E�C�ORD S 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. OW -I REV. 07/2001

34
59
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section •
WELL CONTRACTOR (INDIVIDUAL) NAME (print) c�e n PI I S '!,'A /T1 (L,A .4,• - • + CERTIFICATION S i7 `/
o
WELL CONTRACTOR COMPANY NAMIETt°bili S friA'lthrri I/1a.1I J vr, I! ^ud�(�77rt P J PHON'lk y-3 V-b d
STATE WELL CONSTRUCTION PERMITS ASSOCIATED WOERMIT8
(if applicable) - - ifapplicable) ' .
I. WELL USE (Check Applicable Box): Residential' unicipal/Public 0 Industrial ❑ Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 17 If Other, List Use
2. WELL LOCATION:
Nearest Town: riP�.LJGL;� County /Y)GLGdn+
[2zAln-Ics C-heptl n 'ea l.'k.>12-e�
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code) 01 873
3. OWNER: / rn PRA-Aik i /7)
Address 1' 1 1 fitW P/ O.r+ e, L. a me_,
Prea,k/,;� nrwe.o, (03y
Topographic/Land setting
❑Ridge ❑Slope ❑Valley Parr
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/mends)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
PRILLING LOG
City or Town State Zip Code Formation Description
c7;O- 4 al-oy73 4 /2/
Area code- Phone number
4. DATE DRILLED I0 - V 0 4 /
5. TOTAL DEPTH: a2i4'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO Q✓"
7. STATIC WATER LEVEL Below Top of Casing: -4 e FT.
(Use "+" if Above Top of Cuing)
8. TOP OF CASING ]S / FT. Above Land Surface*
*Top of casing terminated at/or below land. surface requires a
variance In accordance with ISA NCAC 2C .0118.
9. YIELD (gpm)• e2 S METHOD OF TEST.4511Wrift
10. WATER ZONES (depth): //a' J / 90 (/ LOCATION SKETCH
11. DISINFECTION: Type il-t// Amount 4 %-A-P 5 Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads. Include the road
Depth Diameter or Weight/Ft. Mate I numbers and common road names.
From To Ft. Thar?Pre--
From
From To Ft.
13. GROUT: Depth ^^ Material
From n To e Z Ft e04,,
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
From To Ft.
From To Ft.
DEPTH
From To ,
v
9.6, tar
To Ft.
Method
U ramp RECENED i DENR I DWG
AQUIFER PROTECTION SECTION
OCT 2 6 2004
Material
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 THfS RECORD���BEEN PI;OVIDED TO THE WELL OWNER
ora 1 ,, -.9-46 -6 V
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

303651
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) c.he n h 1 S /4r) ! lo,.t d, CEl(TIPI�CA,,T,�I/ON� Y� A71,
WELL CONTRACTOR COMPANY NAMSh. jC i�i!InII}P.111l ifr II :�r��(j� 'n C� PNON$Ya�1U .-,zy-'3 �-6
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQfERMITY
Ofapplicable) - (if applicable)
I. WELL USE (Check Applicable Box): Residential'>—Municipal/Public 0 Industrial ❑ Agricultural 10
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other U If Other, List Use
2. WELL LOCATION:
Nearest Town: fs f J,Lt/rt f A/ County AnO-falJ
CPce. NI ck4T4cit }aA 'e2r93t4
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: KO. 11..3 (n 0-1
Address / PA -TT aYI w-11 2rk
(Street or Route No.)
h'ka,jkc;Al A/C 28113L71
City or Town State Zip Code
easq- SatF_37S5F
Area code- Phone number
4. DATE DRILLED fi �! 9 —d it-
5.
TOTAL DEPTH: 3t '
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO ❑�'�
7. STATIC WATER LEVEL Below Top of Casing: /0 FT.
(Use "t" if Above Top of Cuing)
8. TOP OF CASING IS / FT. Above Land Surfaces
*Top of cuing terminated at/or below land surface requires a
9. YIELD (gpm): Vt) METHOD OF TEST_6variance In accordance wltb ISA NCAC 2C .011Y.
l/JI/%i7ft
10. WATER ZONES (depth): ea r�' (jj
11. DISINFECTION:,Type
12. CASING:
„- Depth
From V To C0'7L
From To
From To
13. GROUT: Depth
Material
From_ To rD Ft. CP. i dx
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft in.
15. SAND/GRAVEL PACK:
Depth
From To Ft
From To Ft.
Topographic/Land setting
❑Ridge ❑Slope ❑Valley Dpiit
(check appropriate box)
Latitude/longitude of well location
(degreesiminute heconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
QEPTH DRILLING LOG
From To Formation Description
9 y•
s�
� , o Co • a".a fats—)
, cc Rea ltut /i/L/jatitre—
LOCATION SKETCH
NW-, Amount es TA- Q 5 Show direction and distance in miles from at least
Wall Thickness two State Roads or County Roads. Include the road
Diapeter or Weight/Ft. Matedil numbers and common road names.
Ft.3.16_,SJ ,pY
Ft.
Ft. RECEIVED/DENR/DWQ
AQUIFER PROTECTION SECTION
OCT 2 6 2u1i4
Method
PC.
Slot Size - Material
in.
in.
Size Material
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 TH S RECORD S 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 Mall Service Center -Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. OW-1 REV. 07/2001
0

r
303656
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section / -
WELL CONTRACTOR (INDIVIDUAL) NAME Wanc-hi n N t S ' j I (Ln ra ` - r CERTIFICATION 11)7 4"
WELL CONTRACTOR COMPANY NAMEb9-1)IlrC tJJO ytrl I1)EIIY 14 nc .�(�,j-"n e PHONE (# S0.4-3 2-6 0
STATE WELL CONSTRUCTION PERMITS ASSOCIATED WI(PERMITS
(if applicable) . (if applicable)
t. WELL USE (Check Applicable Box): ResidentialDYMunicipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 17 If Other, List Use
2. WELL LOCATION:
Nearest Town: OtiDD NC- County inaCvn>
441 s weal&l i co (3- p nr+ 0147 43
(Street Name, Numbers, Community, Subdivision, t No., Zip Code)
3. OWNER: c i W1 'etwei I eft.
Address 1 5655 ice s tD I a bes t LT --
(Street or Route No.)
@l earwaA-lt - ttl 33 7iO4I
e/2 City brCa 6 - Joni 3 7 .Zip Code
Area code- Phone number
4. DATE DRILLED Lb -IS -D Si
5. TOTAL DEPTH: /0 no •
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 0----.---
7. STATIC WATER LEVEL Below Top of Casing: 90 FT.
(Use "+" if Above Top of Cuing)
8. TOP OF CASING IS / FT. Above Land Surface*
Top of casing terminated at/or below landsurface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): 1 .5 METHOD OF TEST ,6kI/ipti-,
10. WATER ZONES (depth). o2QO' Q
LOCATION SKETCH
11. DISINFECTION: Type Jtt// Amount 2 7 A -A 5 Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads. Include the road
Depth Diameter or Weiht/Ft, p� numbers and common road names.
From 0 To c3O Ft. r74 pl_esAj Y
From To Ft.
From To Ft.
13. GROUT: Depth "M�aterial� Method
From To r Ft.f /
From To 'Ft.
14. SCREEN: Depth Diameter Slot Size , Material
From To Ft. in. in.
From To Ft in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
T�ographic/Land setting
Mt -he 0Slope OValley ❑Flat
(check appropriate box) 4
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
n 3 a'
,3n' (ono' Q L L) 6-Yt4,rr r p'-e,
Mte'l
RECEIVED/ DEW IDWQ
AQUIFER PROTECTION SECTION
OCT 2 6 2004
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 TH S RECORD BEEN PROVIDED TO THE WELL OWNER
/ r l lla a, / b -i s-o9
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mall Service Center -Raleigh, NC.
27699-1636 Phone No. [phone], within 30 days. OW-1 REV. 07/2001

303685
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
CERTIFICATION * 2045
WELL CONTRACTOR (INDIVIDUAL) NAME (print) James B. Brown
WELL CONTRACTOR COMPANY NAME Hedden Brothers Well Drilling, Inc
STATE WELL CONSTRUCTION PERMIT* ASSOCIATED WQ PERMIT*
(if applicable) (if applicable)
PHONE * f 826) 369-9591
1. WELL USE (Check Applicable Box): Residential 0 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: /y] _
Nea st Town: /d County i icitaf )
€tOat= .A'AJO t &
(Street Name, N bers, Community,, Subdivision, Lot No., Zip Code)
3. OWNER: l - } . G� �i
Address ff �V /IAriA)Qf/I
ttv at. —I
City or TomState Zip Code
3 - b5 g
Area code- Phone number
4. DATE DRILLED /O op
5. TOTAL DEPTH:
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 0
7. STATIC WATER LEVEL Below Top of Casing: kb 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 accordant with 15A NCAC 2C .0118.
9. YIELD (gpm): COO METJII D OFT BLOW
10. WATER ZONES (depth): 0&7
(StreUoSRoute I ), h2.206
11. DISINFECTION: Type H T H Amount 1602
Wall Thickness
Depth `,ten Diameter or Weight/Ft. Martial
Fro To Ft
From To_J I. Ft. //gif
From To Ft.
13. GROUT: Depth
From 0 To 20 Ft. benonite & cement pumped
From To Ft. .
12. CASING:
Material
Method
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size - Material
From To Ft.
From To Ft.
16. REMARKS:
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
r " Formation Description
9fQ
O clay & sand
'� granite
DEPTH
From To
LOCATION SlcFTraj
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION ST.+'ARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
/0 aP -e 5!
SIGNA URE 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
A

WELL CONSTRUCTION RECORD 3 0 3 9 0 4
North Carolina - Department of Environment and Natural Reso rces - Division Water Quality - Groundwater Section �s ....--
WELL
CONTRACTOR (INDIVIDUAL) NAME (print)�r+�iLhJ(.• �1(� p(6� / /� CERTIFICATION-�# G
WELL CONTRACTOR COMPANY NAME Cam.. bout "5 t C Gi/ !D/41 /t � PHONE # (v(?) �2' 37 O 2
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(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 ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town:wn; / �� ( 1pru/!• County !hC
2 8 s fl a trtio-, rr2U i)
(Street Name, Numbers, Community,Subdivision, Lot No., Zip Code)
3.OWNER: 8ez1/4)iYT%/, OAN+J
Address 13/ turtied Pd N'
(Sleet )or Rome Nb?e 3 / 45 o
J rI1 Ma
P�.. ll'i &a-.
City or To Stale Zip Code
CE/M- Vc3 0 3 1
Area code- Phone number
4. DATE DRILLED /0 - t/ 0 V
5. TOTAL DEPTH: j 07
Topographic/Land setting
DRIdge ❑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 Fo ation Descriptiop
6- r --d-S,d*
s— /a)
I2- 3C
1 -dr17
6. DOES WELL REPLACE EXISTING WELL? YES 11NO Er
7. STATIC WATER LEVEL Below Top of Casing: y FT.
1 9 (Use "+" if Above Top of Casing)
8. TOP OF CASING IS U FT. Above Land Surface*
*Top of using terminated at/er below land surface requires a
variance hi accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): / S METHOD OF TEST VI-rte
10. WATER ZONES (depth): __sr"
11. DISINFECTION: Type (-14/4- Amount )/y (Ate
12. CASING: Wall Thiichkfiess V
Depth. Ft. t . deterC or 5/9 1 Material
From 0 To
From To Ft.
From To Ft.
13. GROUT: Depth.,atep}1
From 4 To 01-D Ft. /1-11
From To Ft.
14. SCREEN:
From
From
Depth Diameter
To Ft. in.
To Ft. in.
15. SAND/GRAVEL PACK:
Depth
From To
From To
Ft.
Ft.
Slot Size
in.
in.
Size Material
Material
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
ed
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AID 33IAT A COPY OF S RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIG
ERSON 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

WELL CONSTRUCTION RECORD
303903
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAMEC; (print)
WELL CONTRACTOR COMPANY NAME
'� -re/
al�G
.VI5 I,JG1/ P l) -vs PHONE#7U1) /y fr2-3'f/''
CERTIFICATION # 3 d Scr
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMITS'
(if applicable) (if applicable)
WELL USE (Check Applicable Box): Residential E Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATIO : ]
Nearest own: r�N K /'*/ County
aw� (2 «M. — M4esfic'VieLJkidr
(Street Name, Numbers, Community, Subdivision, No., Zip Code)
3. OWNER: ,�,- G/
..M+✓�/�Va i'4>�ld✓�
Address p1 JJCCAtt- a.-v. CyaRcdA.
(Street or Rdute No.) c )-e7(0
City or Town State Zip Code
( )-
Area code- Phone number ((a
4. DATE DRILLED % _ ? 3 -0 C�
5. TOTAL DEPTH: ) ..
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 0
7. STATIC WATER LEVEL Below Top of Casing: ! 0 FT.
) (Use"+" if Above Top of Casing)
8. TOP OF CASING IS P V FT. Above Land Surface*
'Top of easing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118. /l
9. YIELD (gpm): 3 METHOD OF TEST f'f"'ffi
10. WATER ZONES (depth): i 3-11'
11. DISINFECTION: Type (-4-j4r-
12. CASING:
Amount Pie —
Wall Thickness
Depth. Diameter or Weight/Ft. _Material
From To VO Ft. C./Ze ti S FC-e i
From To Ft.
From To Ft.
13. GROUT:el Depth ^ ()Material C
From To Ft. `.")
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
Method
Topographic/Land setting
❑Ridge ❑Slope llley ❑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 Fymtation Description �
L_k#w /
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
35 ' 327'
Ante ,'"'<
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
CD MI
cr,
numbers and common road names.
5aµf11
i%y
C
q4I
0
aje .z
SeSn cl //'I
ii,se Dkr L-2.T�
Ale,"fti
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDAJ;DS,/1ND TJiAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
TURE OF PERSON CONSTRUCTING THE WELL
--a 3 .
DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD 3 0 3 9 0 2
4orth Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
VELLCONTRACTOR (INDIVIDUAL) NAME (print) 11), fi pit S /411aA rii J CErIYICATION/7 /g Y'
YELL CONTRACTOR COMPANY NAMIch:11n1 S 1101164 a WIN I ��((�rn e J PHONY(N ..� a Y-3 V- 6 0
TATE WELL CONSTRUCTION TERMITE ASSOCIATED WIRERMITY
(if applicable) (if applicable) '
WELL USE (Check Applicable Box): Residential' unicipal/Public 0 Industrial 0 Agricultural Q
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other Ef If Other, List Use
. WELL LOCATIOA / Ipgogr phie/Land setting
'Nearest Town:'//44/L4Ct l /y County AlQ 01)L> td�l(' ge 0Slope OValley °Flat
st r1'/Y £bide-e- .TL/Lrsn/ icL o2 IT3y (check appropriate WO y
(Suet Name, Numbers, Community, Subdivision, Lot No., Zip Code) Latitude/longitude of well location
. OWNER: /7Je/2/,11.5
Address . 3. ©4.F fiche-/
(Street or Route No.)
Prim fl,t) ,t/c. .219 3 51
City or Town State Zip Code.
(i11j- 3S49- 0777
Area code- Phone number
DATE DRILLED I b - a 9-0.
. TOTAL DEPTH: 447S'
. DOES WELL REPLACE EXISTING WELL? YES 0 NO ?J—
. STATIC WATER LEVEL Below Top of Casing: , 300 FT.
(Use "" if Above Top of Cuing)
TOP OF CASING IS / + FT. Above Land Surface*
*Top of casing terminated at/or below landsurface requires a
variance in accordance with 1SA NCAC IC.0113. / /
YIELD(gpm): e�20 METHOD OFTEST_h//JIDi7L�.
. WATER ZONES (depth): 4e36' (�
t- Sut / eirl
LOCATION SKETCH
DISINFECTION:,Type if -t'P Amount a TA- 4 C Show direction and distance in miles from at least
CASING: Wall Thickness two State Roads or County Roads, Include the road
Depth Diameter or Weii ht/Ft. Matefill numbers'and common road names.
From To 70 Ft. hk S-Zaj,,/, Pre -
From To Ft.
From To Ft.
GROUT: Depth
From To_a`!2 Ft.
From To Ft.
SCREEN: Depth Diameter
From To Ft.
Material-
0
in.
From To Ft, in.
SAND/GRAVEL PACK:
Depth Size
From To Ft.
From To Ft.
Method
nG /d0
Slot Size - • Material
in.
in.
- Material
•
(degrees/minutes/seconds)
Latitude/longitude source:OGPSOTopographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
0 Yts'
44 4'
.74 '
7-r
REMARKS:
HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
NSTRUCTION STANDARDS, AND THAT
A COPY OF THES RECORD BEEN PROVIDED TO THE WELL OWNER
,
I 64 /i6 - a 7 0 y
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
emit the original to the Division of Water Quality, Groundwater Section, 1636 Mall Service Center -Raleigh, NC
f9-I636 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 - Groundwater Section
WELL CONTRACTOR(INDIV,IDUAL) NAME � (print) c�e n Yli S I`IT' j1 Qn\ A - e CZ1TWICCAA,T11OONYlotn17 le
WELL CONTRACTOR COMPANY NAM!{}'t.C.n')(i jJt 1)Qaewt lilei I l) tri ''r'K t* i PHONY r p 24_. -J '--3
STATE WELL CONSTRUCTION PERMIT" ASSOCIATED WQ4&RMITS
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential' YMunicipal/Public 0 Industrial 0 Agricultural
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other Cf 1f Other, List Use
2. WELL LOCATION:
Nearest Town: f,Pff4/fc/ rt) County ,4 '
(oct(4) STDne5 ig.eefe:: ac?39
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: Ale 0.4 i
Address is/ 7 ,Qa tj eft s L{7
(Street or Route No.)
Pock vdle:TN 37/53
City or Town State Zip Code
415)- ?R5- ss-aR'
Arca code- Phone number
4. DATE DRILLED C6 - Q6 -6
5. TOTAL DEPTH: �` 00
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: 15 FT.
(Use "+" if Above Top of Cuing)
8. TOP OF CASING IS / FT. Above Land Surface*
*Top of cuing terminated at/or below landsurface requires a
variance In accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): S D METHOD OF TEST_d� U
10. WATER ZONES (depth): / /.S'
303901
Topographic/Land setting
❑Ridge ❑Slope ❑Valley �Ft�
(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
02 �l' 3ta- BLu G-12st,ni t�
11. DISINFECTION: Type
12. CASING:
Depth rl
From 0 . To a
From To
LOCATION SKETCH
%j'#"f/ Amount ,.0. -mg-5 Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
Material numbers and common road names.
Ft. K In _ stet/
Ft.
Wall Thickness
Diapeter or Weight/Ft.
('7
From To Ft.
13. GROUT: Depth Material Method
_ Froml To Ft.__CQyn Qrt p())A�
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.
I6. REMARKS:
I D0 HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF TH S RECORD BEEN PROVIDED TO THE WELL OWNER
ae
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mall Service Center- Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. OW-1 REV. 07/2001

WELL CONSTRUCTION RECORD 303900
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Sectiont/ "
WELL CONTRACTOR (INDIVIDUAL) NAME
E (print) chif)P1l S /41)J!rL,4 - r CZ1T17iCCA�A,,,T�°I�OONS/ d171e
WELL CONTRACTOR COMPANY NAMIrh'flnri I4Aiti«ri Wei111,6IIi' �4(,_"�-ne PHONE S/��itl_. 5a.4-3
STATE WELL. CONSTRUCTION PERMITS/ ASSOC[ATED WQTERMITY
(if applicable) - (if applicable)
WELL USE (Check Applicable Box): Residential' unicipal/Public 0 industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other U If Other, List Use
2. WELL LOCATIO •
Nearest Town: .1.4 /C/ i A/ County Ina_ 1. nt-x
(oqW Tones &eek 24• c2 739
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: W: (l i Q.v.+ /V o 2le_ T
Address 113 9 0—o n •s .P R• Ed
(Sweet or Role/No.) •
lcream', fnJ eO173
City or Town StateZip Code
(Paul- 3 6 9_ 3 at. ci-
Area code- Phone number
4. DATE DRILLED /6 'a S
5. TOTAL DEPTH: eV 75f
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO lD/-e-
7. STATIC WATER LEVEL Below Top of Casing: -2-5 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING 1S / FT. Above Land Surface*
*Top of casing terminated at/or below landsurface requires a
variance in accordance with ISA NCAC 2C .0113. /
9. YIELD (gprn): -.S METHOD OFTEST� 51020i
10. WATER ZONES (depth): CCi1 /so
l 1. DISINFECTION:,Type Amount oZ %A- S
Wall Thickness
Depth` ^ Diameter S o�rWe�UFt. Matepgl
To Try Ft. ` Pr (�
To Ft.
Topographic/Land setting
❑Ridge °Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
. (degrees/minutes/seconds)
Latitude/longitude source:❑OPS❑Topographic map
(check box)
DRILLING LOG
Formation Description
tJa
t- bet et laini
DEPTH
From To
0 3/4a'
ifD' .O7S'
12. CASING:
From
From
0
From To Ft.
Depth Material Method 1
To ri7 Ft. ep y)i Oy,t pav A
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.
13. GROUT:
From n
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 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF S RECORD S BEEN PROVIDED TO THE WELL OWNER
iiYl 16 a5'-'O4
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the 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

WELL CONSTRUCTION RECORD 3 0 3 H 9 9
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section // __
WELL CONTRACTOR (INDIVIDUAL) NAME (print) the n P) i S MIA ' l n�rt fii r CZ1 TIPICATION S/ JV `f'
WELL CONTRACTOR COMPANY NAM6IYIV C 110116sir-I liM0 v4 U cu . apt e , PHONE #' ..3 1 14 —3 2 4 0
STATE WELL CONSTRUCTION PERMITS/ ASSOCIATED wQYERMITY
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential' unicipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other d If Other, List Use
2. WELL LOCATION: Al
Nearest Town: PR.4'A/CL1 County Q Cult—'
1-Ft-1-1 S - .ALS-fan" am Vi e& tea
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code) a /J ,� L f
3. OWNER: m a of /1�1a14kpetiS
Address C Fetal Loh @
(Street or Route No.)
hn Naven z I 3 a.4t-t-4
City or Town State Zip Code
(2 0)- e 2 / - a to
Area code- Phone number
4. DATE DRILLED f6 3 / —0 9-
5. TOTAL DEPTH: 2 Do "
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO ❑----f
7. STATIC WATER LEVEL Below Top of Casing: e2S 0 FT.
(Use Kt" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
*Top of using terminated at/or below land surface requires a
variance In accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): "-ID METHOD OF TEST AD11Ie it
I0.WATERZONES(depth): _CPS' O 74' (�
1 I. DISINFECTION:,Type 14-1-1F Amount a TA -A S
12. CASING: Wall Thickness
Depth Diapvter or Weii t/Ft. Mate i 1
From 0 To MO' Ft. h".12R.V1 ,Qv Li --
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From n To a Ft. CQ.f' dy� poi(
From To Ft.
14. SCREEN: Depth Diameter . Material
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK: -_
Depth Size Material
Topographic/Land setting
❑Ridge ❑Slope OValley ❑Flat
(check appropriate boa)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(chock box)
DRILLING LOG
Formation Description
Clay
SA-,Vdts fertJ.-
pEPTH
From To
0 fat'
(Dta' /Od'
Slot Size
in.
in.
From To Ft.
From To Ft.
) ()CATION 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 1N ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THfS RECORD S BEEN PROVIDED TO THE WELL OWNER
Oralt)L lb -a:/ u
SIGNATURE OF PERSON CONSTRUCTING THE WELL . DATE.
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mall Service Center -Raleigh, NC.
27699-1636 Phone No. [phone], within 30 days. OW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
1 ry
of Environment and Natural Resources - Division of Water Quality - Groundwater Section / -
WELL CONTRACTOR (INDIVIDUAL)NAME (print) cD.e n17I 5 /In !(2n% At../ CERTIFICATIONY
WELL CONTRACTOR COMPANY NAM WT.)
STATE WELL CONSTRUCTION PERMIT('
°bitt�
� �P.II�Itf II Tut-•�-ri. PHON f� J Z Nil-t<_S24-3 2-6 0
ASSOCIATED W ERMITN
0„1a DJ
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential' unicipal/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: tiAi/Rh id County mtt 4'V /
(azkv - Java", .d+ e,2 F'73`f
(Street Name, Numbers, Oosi'nunity, Subdivision, Lot No., Zip ode)
3. OWNER: Ca -it 1 Oaken
Address /0 SES i e/LS t' -P-0 'lit LS—
(Street or Route No.)
ft24.nlcl?Ai Arc.. 4-173 g- DEPTH
From To
or
i-Sc'r
City or Town State Zip Code
022))- 5-2 V-- %/ ? 3
Area code- Phone number
4. DATE DRILLED /D —.2
5. TOTAL DEPTH: 8So'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO QJJ�
7. STATIC WATER LEVEL Below Top of Casing: /So FT.
(Use "I." if Above Top of Cuing)
8. TOP OF CASING IS / FT. Above Land Surface*
*Top of casing terminated at/or below landsurface requires a
variance In accordance with ISA NCAC 1C .0118.
9. YIELD (gpm): /6 METHOD OF TEST .0f0I/ pf-g-
10. WATER ZONES (depth): //0 J .2 Ce D (�
11. DISINFECTION: Type
12. CASING:
Depth ��
From 0 To
From To Ft.
From To Ft.
Ft. l 5-bean P
LOCATION SKETCH
Amount ,- 11:13S Show direction and distance in miles from at least
Wall Thickness two State Roads or County Roads. Include the road
Dia ter or WeIght/Ft. Material numbers and common road names.
n" S YC2
13. GROUT: Depth
From n To Ft.
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size
From To Ft,
From To Ft.
16. REMARKS:
Material
09471
Method
Slot Size Material
in.
in.
Material
North Carolina - Department
303898
To ographic/Land setting
CRidgF ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
Formation Description
Sandi(
0
0
t
N
N
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF TH}SRECORD H S 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

303400
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section / WELL CONTRACTOR (INDIVIDUAL) NAME � �(print) :henna $ % n / I n,r. ti CERTIFICATIONS/ 91 /7 40
WELL CONTRACTOR COMPANY NAMIf'l a° ) S 110 IQYtri W ell> in 1.1n4.4'J•n e J PHONE gt.%ti_Sa 4--3 V-6 6
STATE WELL CONSTRUCTION PERMITS/ ASSOCIATED W ERMITP
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential. unicipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2."WELL LOCATION: Alarest Town: %kA#EL/// 4/ County Ok
t!-t+l N- (' at- C 1P. reek - PAan Ir/n..J /=Cou-
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code) 4 g
3. OWNER: e- re Ada- I ►b
dis
Address iDIFe'C FRQat, ird tm 7.4
(Street or Route No.)
ER o ,ve, d t73 4
City or Towt State Zip Code
eat- 3cf9- ato3P
Ares code- Phone number
4. DATE DRILLED / b ce -U y
5. TOTAL DEPTH: 3.Sd'
ographic/L.and setting
FlidcteP ❑Slope ❑Valley ❑Flat
(check appropriate box)
73 rj Latitude/longitude of well location
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO W-
7. STATIC WATER. LEVEL Below Top of Casing: /...5-0 FT.
(Use "i^ if Above Top of Cuing)
8. TOP OF CASING IS / FT. Above Land Surface*
'Top of casing terminated at/or below landsurface requires a
variance In accordance with ISA NCAC 2C .01111.
9. YIELD (gpm): /0 METHOD OF TEST
10. WATER ZONES (depth): in S' , 3 a s'
11. DISINFECTION: Type Amount ,3 TA- AS
12. CASING: Wall Thickness
Depth p Diameter or We»ht/Ft. Matefill
l
From 0 To ./ Ft. / " $.22a21 fir
From To Ft.
From To Ft.
13. GROUT: Depth_ _ Material Method
pe U'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.
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH PRILLING LOG
From To Formation Description
96 e_io
.96, • sg • 5'a r. es
erit
S9' .3 Sp • el ue- _ /P/1n/, 7 0.
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
•
O crrn
-.tc'
n • rwVG
.-a -arn
o�
—4o
3 `<C
crn
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 THJS RECORD H S BEEN PROVIDED TO THE WELL OWNERae
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. 07/2Q01

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME � �h)j(print) :hen (5 fir)) Il la -A rL - CEIltTUtCCATION Y/ot/% 4
WELL CONTRACTOR COMPANY NAMS') 1'.j S /l2,�a Weil)) t�i I I ..1��/(( in e Mtn( 3 .i 4 �3
STATE WELL CONSTRUCTION PERMIT./ ASSOCIATED WQYERMITN
(if applicable) - (if applicable)
I. WELL USE (Check Applicable Box): Residential' unicipa1/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other a if Other, List Use
2. WELL LOCATION: /
Nearest Town:F/j,UfL,U 4-.County liV2iin�
a2?d W;nA4 intro- DeJ Sohn rkil.ent Pd
(Street Name, Numben, omm iy, Subdivision, Lot No., Zip Code) of g 93 S/
3. OWNER: COha. 2✓t FZr C e-
Address _,../.5-2/ ,T e3h s, T0. 114,n t led
(Street or Route No.)
FPkl01D Al C.40I Y73 V
City er Town State Zip Code
(&4,20- S - 9- 7 V
Area code- Phone number
4. DATE DRILLED /0 -/3 -6 4'
5. TOTAL DEPTH: 02 7S'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: ff• 4- FT.
(Use "+" if Above Top of Cuing)
8. TOP OF CASING IS / FT. Above Land Surface*
*Top of casing terminated at/or below landsurface requires ■
variance In accordance with ISA NCAC 2C .0111.
9. YIELD (gprn): . % METHOD OF TEST/l/1J/%f7G(/--,
10. WATER ZONES (depth): F55IID) 4c..s' Q
aphic/Land setting
dge ❑Slope ❑Valley ❑Flat
(check appropriate box). '
Latitude/longitude of well location
•
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
Formation Description
DEPTH
From To
0 44 •
c- (o • '• 7 / '
LOCATION SKETCH
1 I . DISINFECTION: Type i/ -t"k Amount .a TA -I; S Show direction and distance In miles from at least
12. CASING: Wall Thickness two State Roads or County Roads. Include the road
numbers and common road names.
Depth Dia ter or We»ht/Ft. Mate 1
From 0 To 7 / Ft.' S.b R,$ l , Q �it
From To Ft.
From Tp Ft.
13. GROUT: Depth�Material Method,
From n To e-,0 Ft. earn ikTU
From To Ft.
14. SCREEN: Depth Diameter Slot Size . Material
From To Ft. in. in.
From To Ft in. in.
15. SAND/GRAVEL PACK: - ,_
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF TH S RECORD HAS BEEN PROVIDED TO THE WELL OWNER
Or
/b-/3-v9-
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
303399
gb0
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center- Raleigh, NC - o
27699-1636 Phone No. [phone], within 30 days. GW-I REV. 07/2001 ' -+>

303398
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality- Groundwater Section
WELL CONTRACTOR UNDIYIDUAL) NAME(inlet) ;hellHhi F11S Min A CFI\TIFICATION fl 4/7(P
WELL CONTRACTOR COMPANY NAMK E 4111i 140JJn).nri tiJeiIhlf 1 I ni.4 eJ FHONF Y'M', Sao-3 t •6 0
STATE WELL CONSTRUCTION PERMITM ASSOCIATED FRMITW
(if applicable)
Of applicable)
I. WELL USE (Check Applicable Box): Residential' unicipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other ET If Other, List Use
2. -WELL LOCATI• -
Nearest Town: /ai /?L / / County a- %
17L/ . /eaij 2/e, rf`ga7
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: ' k2r C`I&dm cl
Address as b
(Street or id No.)
fl in n ES3 3 77 er
City Or LOW State Zip Code
(n- Wh- o,969
Area code- Phone number
4. DATE DRILLED k--/0 — U
5. TOTAL DEPTH: Ti)
S '
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO ° J�
7. STATIC WATER LEVEL Below Top of Casing: i SD FT.
(Use "i" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface'
*Top of cuing terminated at/or below landaorfaee requires *
variance In accordance with ISA NCAC 2C .0118. /
9. YIELD (gpm): - METHOD OF TEST /02D1 (,L.
10. WATER ZONES (depth): 7D o • (/
11. DISINFECTION: Type
12. CASING:
Depth
0 To //7
From
From To
Amount r-217L4 S
Wall Thickness
Diayle'tter or Weht/Ft.
Ft. Imo' Sj28 3
Ft.
From Tp Ft.
13. GROUT: Depth
From_ To rt Ft.
From To Ft.
Material
eirt or"
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size
From To Ft.
From To Ft.
MeIsDAI
n Method
h
1
Slot Size Material
in.
in.
Material
�epographie/Land setting
}Midge OSlope °Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:OGPS°Topographic map
(check box)
DRILLING LOG
Formation Description
DEPTH
From To
n /e (op•
fnfn • 4 747r
/I • gas'
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 15A NCAC 2C, WELL C
CONSTRUCTION STANDARDS, AND THAT A COPY OF THfS RECORD H S BEEN PROVIDED TO THE WELL OWNER
c ��a /6 is -D
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE^'-,
0
.a
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Rale Pf9,NC
27699-1636 Phone No. [phone], within 30 days. GW-I REV�'04/2tgr
t
I
•
I,

30339'7
WELL CONSTRUCTION RECORD
'A yl;
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section �
WELL CONTRACTOR(INDIVIDUAL) NAME (print)c2 enhis /'i-e)jhOn ft CE1TIFICATIONI ail /Y
WELL CONTRACTOR COMPANY NAM6t.t)fIC PdtiJO.Ar4 WP.l1> Y'i jIT1ti. 7ne i PHONE gsSaLi/ --3 46 0
STATE WELL CONSTRUCTION PERMIT0 ASSOCIATED W&ERMITM
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential' unicipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other U if Other, List Use
2. WELL LOCATION:
Nearest Town: l/A'JliCL!County 4' -
- t_(0 Li W %� C i+cmi e. .fib r73
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code
3.OWNER: Sh2j2tLr Ec�IO2;I+F(?
Address //(e OM Ha fj frrt Rd
(Street or Route No.)
i=22h11In3 ,,Uc..
`City br own State
(Ras )- &GG % - O B- g
4.
5.
6.
7.
i&73
Zip Code
Area code- Phone number
DATE DRILLED /7) -J/-- D y
TOTAL DEPTH: a OS'
Topographic/Land setting
❑Ridge ❑Slope ❑Valley &]flag
(check appropriate box)
Latitude/longitude of well location
(degrees/miaow/seconds)
Latitude/longitude source:OGPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
5�4
DOES WELL REPLACE EXISTING WELL? YES 0 NO l71✓�
STATIC WATER LEVEL Below Top of Casing: t30 FT.
(Use "+" it Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface•
•Top of casing terminated Wor below landsurface requires a
variance In accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): a O METHOD OF TEST_ /020r7LC/-�
10. WATER ZONES (depth): Aeo ' / 90 '• Q
LOCATION SKETCH
11. DISINFECTION: Type lit -ifs Amount ra TA-1 S Show direction and distance in miles from at least
12. two State Roads or County Roads, Include the road
numbers and common road names.
CASING: Wall Thickness
Depth Diapetter or Weiht/Ft. Mate ' 1
0 To f9 Ft. ' S.bR,$i PP�
From
From To Ft.
From To Ft.
13. GROUT: Depth
From n To Ft.
From To Ft.
Material
Co4r
L'Met
hod
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.
Crn
Tr
m
MG
-Orn
1/40 Cr
"-
Mt"
t
O rn p
c's
n
16. REMARKS: ' r_ _
-
co , ',
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUC1tD IN ACCORDANCE WITH 15A NCAC 2C, WEL�, __
CONSTRUCTION STANDARDS, AND THAT A COPY OF TH S RECORD HS BEEN PROVIDED TO THE WELL dWNER 1 ,; i'
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center -RaIcI j NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. /2(dO1

rt..rnyens rcl
303396
WELL CONSTRUCTION RECORD
i+,
North Carolina - Department of Environment and Natural Resources - DivisionofWater Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) c�-Pn h l S Mt) MLA N CERTIFICATION � I O1I'7
WELL CONTRACTOR COMPANY NAME' 4P
q - Pt In ri a11K1ll T �, . 5a 4-3 g6 0
h1
ijf ./s
r C1C.1_ K PHONE
STATE WELL CONSTRUCTION PERMITS/ASSOCIATED W&ERMITM •
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential'Pnunicipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other U If Other, List Use
2. WELL LOCATIO • Topographi d setting
Nearest_Town: X9 i/ieLr
�' f2 Coun4ty 'L ❑Ridge pe ❑tebo) ❑Flat
((, LEI- CG/AL 41a i Cf2, � / >Gd2 er d (check approprine box)
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code) . 2 93 V Latitude/longitude of well location
3. OWNER: �fl IL �Q fltfl , (degrees/minutes/seconds)
Address P4- a d�J/1./. L Ct !C e tit Fi ! Cgo C.-C.c_. Latitude/longitude source:❑GPS❑Topographic map
(check box)
PRILLING LOG
Formation Description
e
(Street or Route No.)
3 33
City br Town State 7 ci Zip Code
Area code- Phone number
4. DATE DRILLED Eb ,p
5. TOTAL DEPTH: . R DOS
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO ❑y
7. STATIC WATER LEVEL Below Top of Casing: .,%f) FT.
(Use "t" if Above Top of Cuing)
8. TOP OF CASING IS / FT. Above Land Surface'
*Top of casing terminated at/or below landaurface requires a
variance In accordance with ISA NCAC 2C Al1S. /
9. YIELD (gpm): /D METHOD OF TEST !OW/1>f %•
10. WATER ZONES (depth): 96' /9o' (�
11. DISINFECTION: Type H±P__ Amount
12. CASING: Wall Thickness
Depth Diameter or Weiiht/Ft. Matepgl
From 0To �G Ft. (7� e f j'f __> Gei_
From To Ft.
From To Ft.
13. GROUT: Depth
From fl To riff, Ft
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Material
Method
pcjp l/
PEPTH
From To
SQ n i'20"
fl.. on. 13tuearta,Rt-e-
LOCATION SKETCH
.-i r14 S Show direction and distance in miles from at (east
two State Roads or County Roads. Include the road,
numbers and common road names. O oa
u- =ram
1-71
�4
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 TH S RECORD H S BEEN PROVIDED TO THE WELL OWNER
ire I - —1)Y
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Servic ' eli�lr ialNgh CL'.--t
27699-1636 Phone No. [phone], within 30 days. -GW-1 REV. 07/200-1
NOV - 2 2004

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) the f) V) I S /t l I ti n Ad -A CERTIFICATION 8 of/7 to
WELL CONTRACTOR COMPANY NAMICt)flC 14JJ0,'4 IDei Iai>f)i pc ts, Tit ei PHONE 4Sf21i_Ja 4-3 '63
STATE WELL CONSTRUCTION PERMIT,/ASSOCIATED W ERMIT/ (if applicable) - - (if applicable) .
1. WELL USE (Check Applicable Box): Residential'id�Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other Cr 1f Other, List Use
2. WELL LOCATION:
Nare tT w : f Alfa County A('on_'
fN fEport- 2 a - Plain V:.a t4s.t.>
(Street Name, Numbers, Community, �Suubbldivision, Lot No., Zip Code) at k'/3 t f
3.OWNER: Ka. intte. mQ,ff'hGaJ9
Address QS P IQi n Y: vul Lean e�
(Street or Route No.)
FkeantolP-k) ge.-J a• fiat/
City or Town State Zip Code
ear- 3G4— 1aLF9
Area code- Phone number p
4. DATE DRILLED ! . 2 7 -•D
5. TOTAL DEPTH: /
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: //2 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surfaces
'Top of casing terminated Wor below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD(gpm): SO METHOD OF TEST loz /i
10. WATER ZONES (depth): ,“1 - f /7h' (I
13. GROUT: Depth Material
From 1') To_ `2V Ft. e..Q4 rf
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 OValley
(check appropriate box)
Latitude/longitude of well location
(dcgroes/minuteslseconds)
Latitude/longitude source:OGPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
.5 6, • e/ae,,
' 84, • s2nXr�
ca. /tb• f3LUL' QkANir
LOCATION SKETCH v r
11. DISINFECTION: Type Hill Amount , . TA- A 5 Show direction and distance in miles at lecaOs
12. CASING: Wall Thickness two State Roads or County Roads. In a the tag
Depth Di ter or Weight/ft. Mat numbers and common road names. n �G
To _ Ft. sz R 1 P t prrnj
fl
From
From To Ft. GO cit.;
From To Ft. rn
0 00
N AC)
C'Met
hod
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
ae
CONSTRUCTION STANDARDS, AND THAT A COPY OF THJS RECORD H S BEEN PROVIDED TO THE WELL OWNER
finter— a 9 _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-1 REV. 07/2001
n

STATE WELL CONSTRUCTION PERMITY ASSOCIATED Wtry•ERMITY (if applicable) •
(if applicable) ,
I. WELL USE (Check Applicable Box): Residentialt letunicipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other Ef If Other, List Use
2. WELL LOCATIsO�N�r:A, "i
Nearest Town: / /CJ/YkkL I A County�.,�c�
piSN al Pions EZZ Lot*12) Stt a,. Crccic
(Street Name, Numbers, Community, SSuubdivision, Lot No., Zip Code c: P73 y
3. OWNER: /0if7d C{9g.IiS{L
Address J i- 3 C- tree a bile i 4n. L. �. de source:o (degrees/minutes/seconds)
n t Latitude/longitude source:❑GPS❑Topographic map
Oaf �- (Street or Route No.) (check box)
•a . TNr p
City or Town State Zip Cod 30 Fromm To ARILLIN s LOG
(�e5)- 4A 3- S L A AFormation Description
Area code- Phone number h .3.3' t 12
4. DATE DRILLED 9 -age- 0 9 3.3 G 4• V -r n ire!: it' t� t r t
5. TOTAL DEPTH: 30S- faLt. 305' i31ueatzAwr?t
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO ❑-
7. STATIC WATER LEVEL Below Top of Casing: / SO FT.
8. TOP OF CASING IS / (Use.+•• if Above Top of Casing)
FT. Above Land Surface*
'Top of casing terminated at/or below landsurface requires a
variance In accordance with ISA NCAC 3C .0118. /
9. YIELD (gpm): 3 O METHOD OF TEST hlOj/Ji7Ll�--
10. WATER ZONES (depth): a p' J .3, ES . (�
Topograp.hic/Land setting
❑Ridge (8Slope ❑Valley QFlat
(check appropriate box)
Latitude/ongitude of well location
I I . DISINFECTION: Type Amount e-2 IAA 5 Show direction and distance in miles from at IeEst r
12 CASING:
Wall Thickness two State Roads or County Roads. Include th
WELL CONSTRUCTION RECORD
.. i 3• F
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) c 'he n niS f llr., d, -
CERTIFICATIONY
WELL CONTRACTOR COMPANY NAM$I X, jS'�11Q,4A IlleilT t
d't(Tit P J PHONE Yia( .Sa 4-3 g 6 6
From 0 . To (o SF Ft. .a .
From To Ft
From To Ft.
13. GROUT: Depth Material
From 6 To_.- b Ft. .ap
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
To
To
0303 1
LOCATION SKETCH_
Qcrn
:tom
e`jc, ' AL
ehVFt. Mat' numbers and common road names. -or"
o
cc, cr•+�
v
s-
it 1%3 t re'.
Method
Depth Die ter or W
From Ft
From Ft.
16. REMARKS:
Material
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF TH S RECORD S 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 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 Resources - Division of Water Quality - Groundwater Section WELL CONTRACTOR (INDIVIDUAL) NAME (print) tl)-tnPliS Ai )(L, rU - CERTIFICATIONS c11740
WELL CONTRACTOR COMPANY NAM6bep11(i' 0jiQ,.14 Wei It) Yet II:-x 74P PHONE Se24--3160
STATE WELL CONSTRUCTION PERMITS ASSOCIATED WQYERMITY•
(if applicable) (if applicable)
303030
1. WELL USE (Check Applicable Box): Residential' unicipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCATION: 'n Topogra ic/Land setting
Nearest To)vn: L County /Y' Q tor -- ❑Ridge ®Slope ❑Valley QFIat
O /}/ LJ{G mm, pit Rios C'r--' � (check appropriate box) a
(Street Name, Numbers, Community. Subdivision, Lot N ., Zip Code) effr9 3 ( Latitude/longitude of well location
3. OWNER: 11? le h1 am n JJ it . e u 'F i c et/R'l-. (degreeslminuteslsecondr)
4.
Address r) 3 f} fete l osso,r—a Latitude/longitude source:❑GPS❑Topographic map
R QEPTFI
From To
c
�eti,71�1`5fro o< c °', a SF 73 v
City or Town State Zip Code
((Ego- 34-9- 10 3.
DATE DRILLED
9
Area code- Phone number r7
5. TOTAL DEPTH:
ai—U 9'
3b5'
�(p
(check box)
DRILLING LOG
Formation Description
/Gt t,
3c ' -B)
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO m�
7. STATIC WATER LEVEL Below Top of Casing: ,fl FT.
(Use "+" if Above Top of Cuing)
8. TOP OF CASING IS / FT Above Land Surface*
'Top of casing terminated atior below land surface requires a
variance In accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): /0 METHOD OF TEST llogint
10. WATER ZONES (depth): q / / 3Q '
11. DISINFECTION: Type
12. CASING:
0Depth
gr0
FromTo
From To Ft.
From To Ft.
13. GROUT: Depth
From n To r` D Ft.
Amount
Wall Thickness
Diameter or Weiiht/Ft.
i S.bR,3q
Material
_4,-
89421 ar
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:
%-A. S Show direction and distance in miles from at leant n
two State Roads or County Roads. Include the road
numbers and common road names. co
Method
Slot Size
in.
in.
Material
Material
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THjS RECORD H S BEEN PROVIDED TO THE WELL OWNER
ap
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
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LOCATION SKETCH -ThCsrt�
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WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) cb-e f) P11 S IMy)1)�A 1./ CERTIFICATIONo1)7le
WELL CONTRACTOR COMPANY NAMIth9,13nr s 14011644r+ WPIJ.. Y»i i i p44. T-K eJ PHONE #ciat3,2 4-3 V- 6 0
STATE WELL CONSTRUCTION PERMIT./ ASSOCIATED WIRERMITS
(if applicable) . (if applicable)
303029
I. WELL USE (Check Applicable Box): ResidentialTYMunicipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other U If Other, List Use
2. WELL LOCATION: -
Nearest Town: J.fJA/ML i /Y County i%iQ lens
es'? ID; flay Ga ka - e2k'r3 yL
(Street Name, Numbers, munity, bdivision, Lot Ho., Zip Code)
3. OWNER: /QJec ,do/: G/L
Address S/op ©le Ch44 ; fi
(Street or Route No.)
(- Rain lei A.) NC' 02f73Li
ci2tCi- 4e3ty br Town Su339 Zip Code
9- �
Ares code- Phone number
4. DATE DRILLED
5. TOTAL DEPTH.
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: '7 0 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
'Top of cuing terminated atlor below land surface requires ■
valiance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): f 5 METHOD OF TEST , /07//pflh
10. WATER ZONES (depth): oZ `t0' (ff
LOCATION SKETCH
11. DISINFECTION: Type Hill Amount TA -pi 5 Show direction and distance in miles from at leaf,
12. CASING: Wall Thickness two State Roads or County Roads. Include the ro0
Depth Di ter or Weight/Ft. Mart numbers and common road names.
1" `�
-oy
)o r-ographic/Land setting
tdge ❑Slope ❑Valley 4FIat
(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
s1Y• e.Iay)
d (oa• San cr�
(Da • ,Ras • R L u e, 0- # v; -e-
From 0
To (o ,2 Ft.S.a %1,;3 1 P
From To Ft.
From To Ft.
13. GROUT: Depth Material
From n To .-*() Ft. Car 4
From To Ft.
Method
nlJ if°
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF TH S RECORD S 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
•

\v`1 303028
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - DivisionofWater Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) c?-en VI1 5 J!Jl)11art 1 L ' CERTIFICATION # 02.17 [to
WELL CONTRACTOR COMPANY NAME lyal 0101)Oirici IDei 1al v'r 1I-R_.(, :j--n e . PHONE # edi_,SQ 4--3 -b 0
STATE WELL CONSTRUCTION PERMIT,/ ASSOCIATED W4ERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential'LrMunicipal/Public ❑ Industrial 0 Agricultural 0
Monitoring 0 Recovery ❑ Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION: M ToDographic/Land setting
Nearest Town: rigif/na-ill/ County //IQGgyL, DRaggo ❑Slope ❑Valley 4FIat
C M- aks C Govt.- ES fa t e5 o2-idly (check appropriate box)
(Street Name, Numbers, Co munity, Subdivision, Lot No., Zip Code)
3. OWNER: L Q 2 R3 I2,,1 e y; Z
Address S0a4 AL w. / I q tk, ratae e
(Street or Route No.)
Co raj— Spr;•.oSir/• 33026
City or Town State it Zip Code
(95-f4- a;'7 - a 77 /
Area code- Phone number
4. DATE DRILLED 4 — 3 a -6 `74
5. TOTAL DEPTH: (0 n S
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: 1 tD FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING 1S / FT. Above Land Surface*
*Top of casing terminated at/or below landsurface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm)• 0> METHOD OF TEST I1020.07f/1--,
10. WATER ZONES (depth): ff0 (�
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
-50 02 (o • e f.
5Q'
5P•
i0 os•
sa,,a&fir,.
RIut C-v4nr7•e—
r� LOCATION SKETCH
I I. DISINFECTION: Type Ha-P Amount r�s�L TA S 5 Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads. Include the sBad
Depth f+,, Dia ter or Wen ht/Ft. Mate:Dial numbers and common road names. a
From V To DerFt. , S.�j a,$ Q �V �
From To Ft. - n 730 `
From To Ft. "'"t -or"
13. GROUT: Depth Material Method - +1 p�
From n To_a_ Ft. Cant 4.7 p ALl/ 70 �C
rn rnrl
From To Ft. A
14. SCREEN: Depth Diameter Slot Size Material O o0
From To Ft. in in. tv
o
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From - To Ft.
From
16. REMARKS:
To Ft.
J fil
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF TH SS RECORD HqS BEEN PROVIDED
�TO THE WELL OWNER
i
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
• .t

14. GROUT:
Depth%Material Method
From () To ° Ft C-�/•1�..�
From To Ft
15. SCREEN:
Depth Diameter Slot Size Material
From To _ Ft _ in _ in
From To _ Ft _ in _ in
From To _ Ft in _ In
16. SAND/GRAVEL PACK:
Depth Size Material
From To Ft
From To Ft.
17. REMARKS:
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section 0 4 3 3 8
1636 Mail Service Center - Raleigh, N.C. 27699-1636-Phone [phone]
WELL CONSTRUCTION RECORD WELLCONTRACTOR• �/ln!L C✓A-1Jc
CRANE BROTHERS WELL DRIWNG,WELL CONTRACTOR CERTIFICATION #:7 J
INC STATE WELL CONSTRUCTION PERMIT#:
pan ruawc rtor,
1. WELL USE (Cheek Applicable Box): Residential [21. Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATIW.(Show sk2t7h of the location below) /�
Nearest Town: r,4Iul6r N / • County r A -CA&
Sl t�S1, ieol-
(Road Name1 and Nunteh, Corwnunfty, or Subdivision and Lot No.) DRILLING LOG DEPTH
—
3. OWNER Pion!: etA APP4. From To
Address ---��,� \Iq.,.
(� Street orRoutd o.)
ifej
City or Town State Zip Code
4. DATE DRILLED �'d
5. TOTAL DEPTH
6. CUTTINGS COLLECTED YES ❑ NOE
7. DOES WELL REPLACE EXISTING WELL? YES n NOE
B. STATIC WATER LEVEL Below Top of Casing: .U'D FT.
(Use'+• 11 Above Top of Casing)
9. TOP OF CASING IS 1 FT Above Land Surface*
Top of casing terminated at/or below land surface requires a variance In accor-
dance with 15A NCAC 2C .0118
10. YIELD (gpm)• 110 METHOD OF TEST 147Ir
11. WATER ZONES (depth).
O- /
12. CHLORINATION: Type
13. CASING:
Formation Description
P
Amount If additional space is needed use back of form p
0
Wall Thickness ci
LOCATION SKETCH © r,�-,e,
Depth -LA-7—
Di or Weight/Ft. Material (Show direction and distance from at least two State-_ -urn
From b To Ft. 0 zy pOL Roads, or other map reference points) —
From To Ft. -Cr mn
From To Ft c,'
cJ ca
-„o
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A CQRY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
FOR OFFICE USE ONLY
Quad No:
Serial No
ILLe-d (r/�i4n.� ///f>4/'
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit original to Division of Water Quality, Groundwater Section within 30 days
GW-1 REV. 12/99

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Russell S. Taylor. CERTIFICATION # 2187
WELL CONTRACTOR COMPANY NAME Hedden Brothers Well Drilling, Inc PHONE # f 828) 369-9591
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable)
(if applicable)
I. WELL USE (Check Applicable Box): Residential 9 Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATIO
Npgrpst Town:
(Street Name, Numbers, Community, Subdivision, Lot Ndjzip Code)
3. OWNER: ,(1(Pe l./911/14%
Address CO r
-7�pJs9�sr�71'gyn Sey,Sor o�e Np.), 73'
(BzRity ^In/ g l e3 �/`� Zip Code
Area code- Phone number J�
4. DATE DRILLED /(: 'a9' 69
5. TOTAL DEPTH: O(on
6. DOES WELL REPLACE EXISTING WELL? YES 0 0fd
7. STATIC WATER LEVEL Below Top of Casing: FT.
(Use "+" if Above Top of asing)
8. TOP OF CASING IS 2 FT. Above Land Surface'
*Top of casing terminated at/or below land surface requires a
variance in accordan' w 15A NCAC 2C .0118.
9. YIELD (gpm): METHOD (IF TPST5.13LOW
10. WATER ZONES (depth): 170 > 1 1
11. DISINFECTION: Type H T H
12. CASING:
0 Depth
From To
From M,pt To
From To
13. GROUT: Depth
Amount 16oz
Wall Thickness
Diameter or Weight/Ft. atenal
Ft. Q r
Ft. ID r, , D
Ft.
Material Method
From 0 To 20 Ft. benonite & cement pumped
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
ORidge ❑Slope OValley OFIat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:OGPSOTopographic map
(check box)
DRILLING LOG
Fir ggt To f Formation Description
clay 8 sand
granite
DEPTH
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONS UCT�DARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO WELL OWNER
, 4
SI ATTIRE 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

WELL CONSTRUCTION RECORD
304414
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) James B. Brown CERTIFICATION # 2045
PHONE # f 828) 369-9591
WELL CONTRACTOR COMPANY NAME Hedden Brothers Well Drilling, Inc
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable)
(if applicable)
1. WELL USE (Check Applicable Box): Residential 0 Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATI
Near Town.
tn.
(Street Name, Nu
3. OWNER:
Addre
Area code- Phone number
4. DATE DRILLED
5. TOTAL DEPTH: k
vision, Lot No., Zip Code)
PI
Zip Code
6. DOES WELL REPLACE EXISTING WELL? YES NO 0
7. STATIC WATER LEVEL Below Top of Casing: cfi) FT.
(Use "+' if Above Top of Casing)
8. TOP OF CASING IS 2 FT. Above Land Surface*
*Top of cuing terminated at/or below land surface requires a
variance In accordanyywlth ISA NCAC 2C .0118.
9. YIELD (gpm): 2S METHOD OFT T BLOW
10. WATER ZONES (depth):
I I. DISINFECTION: Type H T H
12. CASING:
Wall Thickness
Depth 1 ,. Diameter or Weight/Ft.
From To �!J)so
From _ To Ft. /n" iieii
From To Ft
13. GROUT: Depth
From 0 To 20
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. - in. in.
15. SAND/GRAVEL PACK:
Depth Size - Material
From To Ft.
From To Ft.
Material
Ft. benonite 8 cement
Method
pumped
Topographic/Land setting
❑Ridge ❑Slope Malley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
DEPTH (check box)
DRILLING LOG
Frog of * Formation Description
clay & sand
granite
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the
numbers and common road names.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STANPyDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATUREOF PERSON CONSTRUCTING THE WELL DATE
Submit the origi 1 to 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

(Street Name,
3. OWNER:
Address
WELL CONTRACTOR COMPANY NAME Redden Brothers Well Drilling, Inc
STATE WELL CONSTRUCTION PERMITS ASSOCIATED WQ PERMIT*/
(if applicable)
(if applicable)
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) James B. Brown
CERTIFICATION It 2045
PHONE I [phone]
1. WELL USE (Check Applicable Box): Residential 0 Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATIO
Ne t o
j
1r/ JIFIfIT ripe
'Ili
City o Town
•
Area code- Phone number
4. DATE DRILLED
5. TOTAL DEPTH:
County / //4.65%..,
, Subdivision, Lot No., Zip Code)
P1i47,u/tJ('
6
Zip 8Cod72
6. DOES WELL REPLACE EXISTING WELL? YES NO
7. STATIC WATER LEVEL Below Top of Casing: ��
(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 accordanc��w��ep¢ ISA NCAC 2C .0118.
9. YIELD (gpm): v i4J METHOD OP,TEST
10. WATER ZONES (depth): (J"J
BLOW
11. DISINFECTION: Type H T H Amount 16oz
12. CASING: Wall Thickness
Depth //////////// DiaMaterial
or Weight/Ft.
From—� To Ft. j
From WO' To Ft. /o ,l8$ iir
From To Ft.
13. GROUT: Depth Material Method
From 0 To 20 Ft. benonite 8 cement pumped
From To Ft. .
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. __ in.
From To Ft. in. in,
15. SAND/GRAVEL PACK:
Depth Size - Material
From To Ft.
From To Ft.
16. REMARKS:
Topographic/Land setting
ORidge OSlope OValley OFlat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:OGPSOTopographic map
DEPTH(check box)
DRILLING LOG
From Tn_, Formation Description
clay 8 sand
granite
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
O
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STRDS, AND THAT A 'PY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNAT
PERSON CONSTRUCTING THE WELL
DATE
l
304412
0)It
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

3. OWNER:
Address
'„city o
Area code- Phone number P ��
4. DATE DRILLED
5. TOTAL DEPTH:
6. DOES WELL REPLACE EXISTING WELL? YES ❑.13pA.
7. STATIC WATER LEVEL Below Top of Casing: /t 1 JJ FT.
8. TOP OF CASING IS 2 (Use "+" it Above Top of Casing)
FT Above Land Surface*
*Top of casing terminated actor below land surface requires a
variance In accordance 1 b ISA NCAC 2C .0118.
9. YIELD (gpm): 1h METHOr> QF TEST BLOW
10. WATER ZONES (depth):
l 1. DISINFECTION: Type H T H e Amount l6oz
STATE WELL CONSTRUCTION PERMIT#
(if applicable) (if applicable)
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (prior) Russell S. Taylor
CERTIFICATION # 2187
WELL CONTRACTOR COMPANY NAME Haddon Brothers Well Ddlling, Inc
PHONE # f 628) 369-9591
ASSOCIATED WQ PERMIT#
I. WELL USE (Check Applicable Box): Residential ® Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATIO
Neare0 o
J. /�..,ItI�I ,J.e ounty N /u� MU
e . ��I.II airramL"
rs, Community,
(Street N N
Name, u 1
al
Sr /C
• :a
u N.
ubdivision, Lot No., Zip Code)
Zip Code
12. CASING:
T
Wall Thickness
Depth Diameter or Weight/Ft. M eriai
Fro To Ft. (G
Fro t To Ft. (0' r MS
fj'
From To Ft.
13. GROUT: Depth Material
From 0 To 20 Ft.
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.
Method
benonite & cement pumped
16. REMARKS:
Material
304677
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
Fr. T • Formation Description
clay & sand
granite
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONDUCTION STAINPARDS, AND THPvi7A COPY OF THIS RECORD HAS BEEN PROVIDED TO T E WE OWNER
SIG)QA(TURE OF PERSON CONSTRUCTING THE WELL TE
J
Submit the original to 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 ResourcesWater of Quali'y
WELL CONTRACTOR (INDIVIDUAL) NAM E (print)`/"—W1e� �—
WELL CONTR:\CTORCo>IPA\SSANIEW ert2�t—
SFATE RILL CONSTRUCTION PER>IITS ASSOCIATED \yQ PERMIT=
(if applicable) - (ifaoplicable)
- Ground«ater Sectio�n/{/r.�q4(J
CERTIFICATION 10
PHONE R R.' T -'S 15Z7
1. WELL USE (Check Applicable Box): Residentialy(I Municipal/Public 0 Industrial 0 Agricultural 0
Nlonitoring 0 Recovery 0 Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCATIQ;N
%%��' County i%���%'
Nearest Town:�t
Cia
ert
. (S:rcaa:r.e. Numbers. opununity. Subdi'isior.. Lot Na.. Zip Code)
3. OWNER.
Address
(Seruct or RSd:: No.
City or gut: Zip Cod:
leg /7
Area ;:de- Phone number {�
4. DATE DRILLED
5. TOTAL DEPTH: 30
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO X1
7. STATIC WATER LEVEL Below Top of Casin_: G 0 FT.
(Use "T' if Abuxe Top of Casin_ l
S. TO? OF CASING IS I FT. Above Land Surface-
-Top of casing terminated aCur betuw land surface requires a
%a:lance in accordance with 1:A \CAC 2C .0I1S. /�
9. YIELD (gpn): ' 3 D METHOD OF TEST Ai r
10. WATER ZONES (depth): 4o O
II. DISINFECTION: Type
12. CASING:
Depth
From 0 To
From To
From To
13. GRO'.:T: Dcpth
From 0 To of
From 3 To AO
14. SCREEN: Depth
From To Ft.
From To Ft.
15. SAND -GRAVEL PACK:
Depth Size NIateria;
Amount PR 9s
Wa!i Thickness
Diameter
or \ceieh: Ft. Mate i I
Ft. 1.,V4 `dl s'tA a
Ft.
Ft.
Ft. grit)
Ft.
Diameter Slot Size Nlaxr,3
in.
in.
Method
From To Ft.
•From To Ft.
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
In.
in. •
Topographic/Land setting
❑Ridge ;i1Slope ❑\'alley ❑Flat
(check appropriate box)
Latitude longitude of well location
(de3reei Blinn:ei stCOrds)
Latitude'longitudc source:❑GPSOTopographic map
(:he;: box)
DEPTH DRILLING LOG
From To Formation Description
j 4,c
'1/ - /Ioo ��
.47 7-Vox
LOCATION SKETCH
Show direction and'distance in piles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
14:,V 1i-
va
v`,sW
SIGNATURE OF PERSON CON3TRLCTING THE \V ELL DATE
Submit the original to the Division of NVater Quality, Groundwater Section, 1636 Mail Scnice Center I
entrl RaNigh, NC
27699-1636 Phone No. (`)19) 733-322I, within 30 da.)s.

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - WELL CONTRACTOR (INDIVIDUAL) NAME (print)_c��t7vitCD;vrsionofWaterQuality-GrotmdwaterSecti
WELL CONTRACTOR COMPANY NAM
STATE WELL. CONSTRUCTION PERMIT/ PHONE #
(if a.. licable) ASSOCIATED ERMIT/
(if a icable)
1. WELL USE (Check Applicable Box): Residential Jtcipal/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 Tow
(Street Name. Numbers,
� Community, Subdivision, Lot No., Zip Code)
3. OWNER: 1L D6cr j
Address
City or Town S to
Zip Code
R
Area code- P- hone numb- er
4. DATE DRILLED /--- —0
5. TOTAL DEPTH:
6. DOES WELL REPLACE EXISTING WELL? YES ° NO
7. STATIC WATER LEVEL Below Top of Casing:
8. TOP / (Use "+" if Above Top of Cuing)
OF CASING IS____-f--__ FT Above Land Surface*
•Top of easing terminated at/or below land surface requires •
variance In accordance with 15A NC4c 2C .0118.
9. YIELD (gpm): METHOD OF TEST
10. WATER ZONES (depth): -
11. DISINFECTION: Type „ r r
12. CASING: — -- Amount
Wall Thickness
From__ To �/ BSFt q12.€424PA.
From To
From To Ft.
13. GROUT: Depth
From_,a_ To Material
From— Ft.�rpA.,, a.,,`T
To Ft. '—^ �+w —
14. SCREEN: Depth
From To
From To
15. SAND/GRAVEL PACK:
Depth
From To Ft.
From To Ft.
16. REMARKS:
Ft
Dia} ! or We
Diameter
Ft. in.
Ft. in.
ight/Ft. Mate 'a
Method
Slot Size Material
in.
in.
Size Material
3O4.8 1
CERTIFICATION/ o1/] le
graphic/Land setting
edge DSlope ❑Valley °Flat
(check appropriate box)
Latitude/longitude of well location
Latitude/longitude s urce:DGPSDTopographic map
DEPTH (check box)
From DRILLiNG
To Formation Description
LOCATI`CH Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
cr cFa
—is;
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COP OF{
T HS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
e e�Jn' lri rrjlll
lL . Dn
SIGNATURE OF PERSON CONSTRUC
TING THE WELL DATE�—
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center-
27699-1636 Phone No. [phone], within 30 days.
Raleigh, NC
GW-1 REV. 07/2001

2• WELL LOCH
Nearest Town:
•
(Street Name, Numbers, C
3. OWNER: SU L
Address
304 84
North Carolina - Department of Environment
Y;g
and Natural Resources - Division of Water Quali
WELL CONTRACTOR (INDIVIDUAL) NAME (print) c��f Pl l ) I lY- Groundwater Section
WELL CONTRACTOR COMPANY NAM CERTIFICATION if of /% (I
STATE WELL CONSTRUCTION PERMITS PHON;B �y_3 g6
(if a.. licable) ASSOCIATED W ERMIT
Of a..licable
1. WELL USE (Check Applicable Box): Residential' cipal/Public 0 industrial ❑ Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other aIf Other, List Use
TI0
(Street or RoutcNo.)
7Qh4Ssee l�l 1 Inca
Lao)
Town State r
Lao)-- S7� - n1 SS c .Zip code
Area
County
munity, Subdivision, Lot No., Zip
flea .
co
de. Phone number
4. DATE DRILLED
5. TOTAL DEPTH:
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: _aFT.
8. TOP OF CASING IS (Use "t' if Above Top of Casing)
•Top of casing terminated at/or below land Aare requirese La d Surface*
variance In accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): �_ METHOD OF TEST
10. WATER ZONES (depth): :5' /S,
ge Slope OValley ❑Flat
(check
From
To r -/-. .
From To Ft
From To Ft.
13. GROUT: Depth
Material
WELL CONSTRUCTION RECORD
L.0 t /i / 9 appropriate box) i
a tiny Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source;❑GPS❑Topographic map
(check box)
DRILLIN LOG
Formation Description
DEEM
Froxn To
Rr o Trees
1 1. DISINFECTION: Type_ �—
12. CASING: Amount Show direction and distance in miles from at least
Depth Dia Ker. orWall WeiihtFt. Matert I numbers and common Toad ess two State Roads or County names.Include the road
S YC�
From__Q_ To_a' i� Ft. Method
cth°d
From To__Ft --- ictL�k6L
14. SCREEN: Depth Diameter Slot Size
From To Material
From Ft'in• in.
To Ft. in.
15. SAND/GRAVEL PACK: in.
Depth Size Material
To
From
From
16, REMARKS:
Ft.
To Ft.
graphic/Land setting
ld ❑
LO ATION K Tru
14
0Cs
cnq
I'
Cl
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF TH S RECORD H S BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL //y /DAT_V
Submit the original to the Division of Water Quality, Groundwater Section,1636 Mall Service Center 27699-1636 Phone No. [phone], within 30 days. Raleigh; NC.
OW -I REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment WELL
WELL CONTRACTOR COMPANY NAM _
STATE WELL CONSTRUCTION PERMITN
(if a..licable)
a it
304885
vtronrnent and Natural Resources - D' CONTRACTOR (INDIVIDUAL) NAME 'jI Division of Winter Quality - Groundwater Section
(print)
CERTIFICATION# oL/7le
ASSOCIATED Wd4ERMIT
(if a..licable
I. WELL USE (Check Applicable Box): Residential' cipal/Public 0 Industrial O A
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other Cf If Other, List Use
Agricultural
2. "WELL LOCATION:
Nearest Town:.. C4 i /
County
(Street Name Numb rs, Community, Subdivision, Lot No., Zip Code)
3. OWNER: .LL} o�2 C a..
Address
,��-.ar_,6�,� rate
Area Cod- �(i k' Zip
Phone number—�-e
City or Town g
Code
Two ographic/Land setting
Y�ki4 ()Slope ❑Valley ❑Flat
(check appropriate box).
Latitude/longitude of well location
(dcgrees)minutes/seco nds)
Latitude/longitude source:OGPSOTopographic map
(check box)
From To
DRI. IN OG
4. DATED �/�j������7� _
KILLED '�Z� c
5. TOTAL DEPTH: ,
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO '
7. STATIC WATER LEVEL Below Top of Casing:
(Use "+' if—�.2FT. —_
8. TOP OF CASING IS �_ oveveanp d Surface —_
*Top of casing terminated at/or below land fs Above requiresi Surface*
variance In accordance with ISA NCAC 2C .0118.
9. YIELD (gpm); METHOD OF TEST
10. WATER ZONES (depth): ell. e
I I. DISINFECTION: Type
12. CASING:
Depth
m Ft.
From
From To Ft.
From To
13. GROUT: Depth -
From Material
From To�_ F[.
14. SCREEN: Depth
Ft.
To Ft
From T
From T
15. SAND/GRAVEL
De
From T
From
16. REMARKS:
Diameter
o Ft. in.
• FL in.
PACK:
pth
• Ft.
• Ft.
f Amount
Wall Thickness
Dia eter S orRWeh�UFL Matefill
4
Method
Slot Size Material
in.
in.
Size Material
Formation Description
LOCATION K T
Show direction and distance in miles from at least
two State Roads or County Roads, Include the road
numbers and common road names.
14
I DO BY CERTIFY
HAT THIS WELL WAS CONSTRUCTED IN
CONSTRUCTION STANDARDS, ANDHAT A COPY OF TH S RECORACCORDANCE
flBEEN PROVIDED TO THE �n n + WITH 15ANCAC 2C,.WELL
WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service C nerDATE
27699-1636 Phone No. [phone], within 30 days.
-Raleigh, NC
GW-I REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water
(print) <��ri Vll Quality •Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME
5 Illn rl. y —..
WELL CONTRACTOR COMPANY NAM_CEETIFICATION
STATE WELL CONSTRUCTION PERMITS/ g PHONE Mill{ `;j a4-3 g6
Of licable) ASSOCIATED ERMITM
(ifa licable
1. WELL USE (Check Applicable Box): Residential',
Monitoring 0 Recovery 0 Heat Pump Water injection pclpaOther tC( If Other,strLit Use Agricultural
2. "W WELL LOCATIO :
Nearest Town: L ' County°pographic/Land setting
Midge ❑Slope OValley :pat
6u
304311
(Street Name, Numbers, Community,
I`
3. OWNER:TUYYI D ��• w
Address �� 2
Sr. Au(Street or Route No.) �1
estrw / ! c3aa$SF
City or T vn Stale
(9- S0 zip code
Area code. Phone number
4. DATE DRILLED 11 — / / — U e L
5. TOTAL DEPTH:
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL' BelowTop of Casing: _�
` 8. TOP OF CASING IS Use "+" if Above Top of Casing)
_4_ FT. Above Land Surface" -----_
•Top of casing terminated at/or below landsurface requires ■
variance In accordance with 1SA NCAC 2C .0118.
9. YIELD (gpm): / 2 METHOD OF TEST
I0. WATER ZONES (depth):
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:OGPSOTopographic map
MEM
From To Formation Description
DRILL_ ING LOB,
f I. DISINFECTION: Type, L OCATI_ OCt•
12. CASING: Amount Show direction and distance in miles from at least
Wall Thickness two State Roads or County Roads. Include the road
From 0 To Depth/ O If Ft Dta Kor S or Weight/ft. �Ma_ D repel numbers and common road names.
From To Ft Y
From Tp Ft
13. GROUT: Depth ___......Material
From n To '('� Ft. 2 ar- Method
From To Ft. r ""
14. SCREEN: Depth Diameter Size - , Material
From To Ft. in. in.
From To Ft. in.
15. SAND/GRAVEL PACK: in
Depth Size Material
From To Ft.
From To Ft.
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 TH S RE
CORD H S 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.
OW-1 REV. 07/2001

304343
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print)‘DU ‘Doe,, Co•ctu( qd
'! C CERTIFICATION
�.#�.J 7I
WELL CONTRACTOR COMPANY NAME S C,7JV$ LDXL��/ N ���i�J,lJ/C, PHONE # [�G/V.Ly %rp
STATE WELL CONSTRUCTION. PERMIT#------- - ASSOCIATE6WQ PERMIT#
(if applicable) (if applicable)
WELL USE (Check Applicable Box): Residential* Municipal/Public 0 Industrial 0
Monitoring 0 Recovery 0 Heat Pump Water lnjection 0 Other 0 If Other, List Use
2. WELL LOCATJQN:
Nearest Town: N County l,dh(.+
Mul rrr
(Street Name, Numbers, ommunity, Subdivision, Lot No., Zip Code)
3. OWNER
Address
laprchet-
(Street or Route No.)
/ 1 c
City or Town State
viay
Zip Code
( )-
Area code- Phone number
4. DATE DRILLED /Olt" 0 fl
5. TOTAL DEPTH: 7 dr
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 0
7. STATIC WATER LEVEL Below Top of Casing: d_CIP 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): / METHOD OF TEST i}.e
10. WATER ZONES (depth):
Agricultural 0
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
11. DISINFECTION: Type Amount
12. CASING: Wall Thickness
Depth G Diameter or Weight/Ft. Material
From DTo I2/ Ft. 1.054" /VC -
From To Ft.
From To Ft.
13. GROUT: Depth Material
From Q To U Ft. el L4/-E-
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
in.
in.
Method,
Material
16. REMARKS:
✓.4a,i�c...
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names. -
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION /S�T NDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
j(Uo7WCe trni�
SIGNATURE OF PERSON CONSTRUCTING THE WELL ATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mail Service Center - Raleigh, N.C. 27699-1636-Phone [phone]�
WELL CONSTRUCTION RECORD WELL CONTRACTOR- L / kv 4 �L entl-Nt
CRANE BROTHERS WELL DRIWNG. INC.
'JygA. 4i7IS RJ
(Roadame rind Numbers Nty, or Subdivision and Lot No) DRILLING LOG DEPTH
3. OWNER Gil.) I✓ From To Formation Description
Address Trek!
A fed
417
u r2e,zRouteNg,L ` S. % 3pe
WELL CONTRACTOR CERTIFICATION #: eJ 7/
304341
STATE WELL CONSTRUCTION PERMIT#:
--AA ro1ME CIRCLC
FRANKLIN, NC 28734
1. WELL USE (Check Applicable Box): Residential Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring El -
Recovery ❑ Heat Pump Water Injection Other ❑ If Other, List Use:
2. WELL LOCATION• (Showw sketch of the location below)
Near ststt(JTown: fh )J it -A-) County 1 ' VT�ia
N
City or Town State Zip Code
4. DATE DRILLED c21-6
5. TOTAL DEPTH DS fl- , 345- rQ/t.%_U
6. CUTTINGS COLLECTED YES 0 NOE
7. DOES WELL REPLACE EXISTING WELL.? YES 0 NO0
8. STATIC WATER LEVEL Below Top of Casing: /a D FT.
(Use'+' i1 Above Top of Casing)
9. TOP OF CASING IS / FT Above Land Surface*
'Top of casing terminated at/or below land surface requires a variance In accor-
dance with 1SA NCAC 2C .0118
10. YIELD (gpm)• 3 64- METHOD OF TEST 4!Y
11. WATER ZONES (depth).
•
12. CHLORINATION: Type Amount
13. CASING:
Wall Thickness
Depth DIaTe)gr/ or Weight/Ft. Material (Show direction and distance from at least two State
Fromel) To iZS( Ft /o %/ Roads, or other map reference points)
a- X? eifY
If additional space is needed use back of form
From To Ft
From To Ft
14. GROUT:
Depth Material Method
From b To t _ Ft �,%11 ✓T 2b w e/Ey
From To Ft Y
15. SCREEN:
Depth Diameter Slot Size Material
From To _ Ft _ in _ in
From To Ft.— in _ in
From To _ Ft in _ in
16. SAND/GRAVEL PACK:
Depth Size Material
From To Ft
From To Ft
17. REMARKS:
LOCATION SKETCH
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A CO OF mis RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
/
f F -yid
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit original to Division of Water Quality, Groundwater Section within 30 days
GW-1 REV. 12/99
FOR OFFICE USE ONLY
Quad No:
Serial No.

WE I-lailaTialillakitedeD
248 CRANE CIRCLE
FRANKLIN, NC 28734
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mail Service Center - Raleigh, N.C. 27699-1636-Phone [phone] ,^, ,w, /I
WELL CONTRACTOR- �ed C/ ,'f7VG
WELL CONTRACTOR CERTIFICATION #: L' b 7 51
STATE WELL CONSTRUCTION PERMIT#:
304340
1. WELL USE (Check Applicable Box): Residential ® Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATIO • (Show sketch of the location below) y
Nearest Town. AAW,'A1 County r f neau
0DUJee,
(Road Name and Numbers, Community. or S
3. OWNER Q7cIfne.5 air
Address fp, O Ax/2
D , t� (StreetgrFt No.)
City or Town / State
pivision and Lot No.)
C✓
Zip Code
DRILLING LOG
From To
O- ?V
4. DATE DRILLED - �- V
5. TOTAL DEPTH 5
6. CUTTINGS COLLECTED YES ❑ NO❑
7. DOES WELL REPLACE EXISTING WELL? YES NOE
8. STATIC WATER LEVEL Below Top of Casing: v 66 FT.
(Use'+' If Above Top of Casing)
9. TOP OF CASING 15 / FT Above Land Surface'
'Top of casing terminated aVor below land surface requires a variance In accor-
dance with 15A NCAC 2C .0118
10. YIELD (gpm)' e ro METHOD OF TEST AI V.
11. WATER ZONES (depth).
•
DEPTH
Formation Description
12. CHLORINATION: Type Amount If additional space Is needed use back of form
13. CASING:
•
Wall Thidmess LOCATION SKETCH
Deptty, 7 Ft ' To `7 / Oi t r or Weight/Ft. Material (Show direction and distance from at least two State
From /0 V (..— Roads, or other map reference points)
From To Ft
From To Ft
14. GROUT:
Depth Materi Method
From b To a� A Ft. fie b y
From To Ft
15. SCREEN:
Depth Diameter Slot Size Material
From To _ Ft _ in _ in
From To _ Ft in _ in
From To _ Ft. in _ in
16. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft
17. 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.
//'frdr
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit original to Division of Water Quality, Groundwater Section within 30 days
GW-1 REV. 12/99
FOR OFFICE USE ONLY
Quad No:
Sedal No

WELL CONSTRUCTION RECORD
T 4
North Carolina - Department of Environment and Natural Resources - Division of ater Quality - Groundwater Section
WELL CONTRACTOR (INDIV,IDUAL) NAME (print);Nell rlt S f'!r' j)lift ri1 '1CERTIFICATION 1 12`c
WELL CONTRACTOR COMPANYNAMICh°,I)nr t 1""'jIQQnri liJe0 Yet1124 Trno J PHONE M Z4--3 <fl 0
STATE WELL CONSTRUCTION PERMITS ASSOCIATED W&ERMITS •
(if applicable) •(if applicable) '
I. WELL USE (Check Applicable Box): Resident aI' unicipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other CT If Other, List Use
2. WELL LOCATION:
Nearest Town: Fi GM -s Al County/14 9-CBri�
itI&*s CiapelR.L— ICJleher V'a S1t S fe!2d.
(Street Name, Numbed Community, Subdivision, Lot No., Zip Code)
3. OWNER:
Address
Oun R pleas
0.JRDice Scj./
(street or Route
FRA•NkL:a/ A/No.) C, c 7'+'-f
Zip Code
ant- 4a/_ a. •
Area cede• Phone number
4. DATE DRILLED l a -. —D
5. TOTAL DEPTH: if OD
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO .Ql�
City or Town State
7. STATIC WATER LEVEL Below Top of Casing: 90 FT.
(Use "f" if Above Top of Cuing)
8. TOP OF CASING 1S / FT. Above Land Surfaces
-cop of cuing terminated etlor below !end.wrfaos requires a
variance in accordance with ISA NCAC 2C .011a.
9. YIELD (gpm): / 5- METHOD OF TEST_ �lll/irVI
10.WATERZONES(depth): Hair 3pn' (�
• LOCATION SKETCH
%T ip Amount ,_2 71}1, 5 Show direction and distance in miles from at least
Wall Thickness two State Roads or County Roads. Include the road
Diameter S-oorrWellj Ft. Matep I numbers and common road names.
r
Ft. 67 Y
Ft..
Topogtapjtic/Land setting
24Rtaie ❑Slope ❑Valley ❑Flat
(check appropriate box) 41
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
PRILL!NG LOG
Formation Description
lfG Crrl(y'2r
Ite' LEDO• 3LUe- c- atopiYt"
DEPTH
From To
0 do e/'
(04' (f•�e
II. DISINFECTION: ,Type
12. CASING:
Depth
CI To //S
To
From
From
From To Ft.
13. GROUT: Depth
From () To r Ft.
From To Ft.
SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
5. SAND/GRAVEL PACK:
Depth
From To Ft.
From To Ft.
Material Method
(��r 47� T CAeA.,
.
Slot Size • Material
in.
in.
Size Material
6. REMARKS:
DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
ONSTRUCTION STANDARDS, AND THAT A COPY OF TH S RECORD H S BEEN PROVIDED TO THE WELL OWNER
ap
SIGNATURE OF PERSON CONSTRUCTING THE WELL , DATE
0
C
ubmit the original to the Division of Water Quality, Groundwater Section, 1636 Mall Service Center -Raleigh, NC
1699-1636 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:- Groundwater Section W ELL CONTRACTOR (INDIVIDUAL) NAME (print) ch-n Yl15 Firs I ' CERTIFICATION F of /74 -
WELL CONTRACTOR COMPANY NAMS'l .l?i1n(C Ilk I I00404 [iJPII11 I-14 yn to J PHONL Y iD,-.5'a1-3
STATE WELL CONSTRUCTION PERMIT/ ASSOCIATED W BRMITY
(if applicable) • .(if applicable) •
I. WELL USE (Check Applicable Box): Residential• unicipaVPublic 0 industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other EI If other, List Use
2. WELL LOCATION:
Nearest Town: FAkMeL: sd County /yJhCa--
etayics(fhape-1 £ - FU?Chen- V stA Sea,..
(Street Name, NumSers, Community,
, Subdivision, lot No., Zip Code) (T 3. OWNER: uely YQam
Address D f9-t5X
r(Street or Route No.) rlenv; z, A/C. d?734,
City br Town State Zip Code
Elie- '7 S1-3 - 1 !c9
Area code- Phone number
4. DATE DRILLED 13 —/ O 54
5.
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO •
7. STATIC WATER LEVEL Below Top of Casing: 4S0 FT:
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface* -
'Top of cuing terminated actor below landsurface requires ■ -
variance In accordance with ISA NCAC 2C ,0111.
9. YIELD (gpm): METHOD OF TEST_/O29t7L(�.
10. WATER ZONES (depth): 6S0' (��
• JOCATION SKETCH
}f'/-/. Amount .- TA-Q S
Wall Thickness
Dia ter or Weight/Ft. Mate • l
-1
FL h" s.12R,3l Pr.
Ft,
ppdgeographic/Land setting
❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
, (degrealminutes/scconds)
Latitude/longitude source:OOPS❑Topographic map
(check box)
DRILLING LOG
Formation Description
t eetni e.�l 1 Pc
I trt GY tin I
DEPTH
From To
(p/' /66'
/06' //¢'
TOTAL DEPTH: Ft15
11. DISINFECTION: Type
12. CASING:
Depth
From To J/�'
From To
From To Ft.
13. GROUT: Depth Material Method
From To ,-,7) Ft. CQ.yndp,' pcii�
From To Ft.
4. SCREEN: Depth Diameter , Slot Size . , Material
From To Ft. in _ in.
From To Ft in _ in.
5. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
6. REMARKS:
DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THjS RECORD H BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL . DATE
ubmit the original to the Division of Water Quality, Groundwater Section, 1636 Mall Service Center -Raleigh, NC
7699-1636 Phone No. [phone], within 30 days. OW-1 REV, 07/2001

t I. DISINFECTION:, Type
12. CASING: •
Depth
From V . To % 5
From To
From To
13. GROUT: Depth
From___Q_ To e Z
From To
4. SCREEN: Depth
From To
From To
5. SAND/GRAVEL PACK:
Depth
From To
From To
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality- Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) cb-, n VD s /14A Han% r� '+ CERTIFICATIONS oT /7 (P
\YELL CONTRACTOR COMPANY NAM$)>t)nr C 40110 Wei I \ y arttitirry e J PHONE 4 Teat Sao-3
STATE WELL CONSTRUCTION PERMITS ASSOCIATED WIPPERMITO •
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box):Residential lae'a nicipal/Public ❑ Industrial Q Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other Ef If Other, List Use
2. --WELL LOCATION:
Nearest Town: T.PA'Jfi![- I ,a/ County /no Coy
4N(...ftWasdGrrntnt. Liea-o,vt,Pet-by
(Street Name, Numben, Community, Subdivision, Lot No., Zip Code) gei "
3. OWNER:.1: effe
Address o24- 83 L Lt Le sk_e_.
(Street or Route No.)
Pad.,, och.8-aa4s,. , El. 3 3 Wo
City Or Town State Zip Code
65ie0- 8'E-?- o s q5
Area code- Phone number
4. DATE DRILLED I I — 36 —O cfL
5. TOTAL DEPTH: Race
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO IIlI�
7. STATIC WATER LEVEL Below Top of Casing: e�.0 FT:
Topographic/Land setting
❑Ridge ❑Slope ❑Valley aFtai
(check appropriate box) ' y
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
Formation Description
DEPTH
From To
(Use "t" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
*Top of cuing terminated at/or below laudsurface requires ■
variance In accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): fp >7 MATTHOD OF TEST
10. WATER ZONES (depth): "fS') of (S' f
•
LOCATION SKETCH
%fill. Amount t� TA-5 Show direction and distance in miles from at least
Wall Thickness two State Roads or County Roads. Include the road
Diapeter S or Weight/Ft. MMatepal numbers and common road names.
FL At jj 1
Ft.
Ft.
Material Method
Ft f)��
Diameter . Slot Size • Material
Ft. in. in.
Ft. in. in.
Size Material
Ft.
Ft.
6. REMARKS:
DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
ONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD BEEN PROVIDED TO THE WELL OWNER
0 �i.+o �11-3n-04
SIGNATURE OF PERSON CONSTRUCTING THE WELL , DATE
ubmit the original to the Division of Water Quality, Groundwater Section, 1636 Mall Service Center - Raleigh, NC
t699-1636 Phone No. [phone], within 30 days, GW-I REV. 07/2001
vtC.

305368
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) c-hen wl 5 AI am rl-* CERTIFICATION oZ/7le
WELL CONTRACTOR COMPANY NAMIEben) C Pei Wort lilel I'iv`rjim .j.KP i PHONE #iltEtsca 4-3.26 b
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WIPPERMITN
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential b---Municipal/Public ❑ Industrial 0 Agricultural ❑
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: Fit Ali k L r /1/ County � cunt,
0 IPvtks (v" I P- - Q vwvne+ a P.-a'a may
(Street Name, Numbers, Ohmmunity, Subdivision, Lot No., Zip Code)
Tpagraphic/Land setting
W1t'dge ❑Slope [Walley ❑Flat
(check appropriate box)
Latitude/longitude of well location
3. OWNER: k'o4", t (-6 tin W 0.,t, (degrees/minutesheconds)
Address I Yrti tn-t s 12,:t Latitude/longitude source:❑GPS❑Topographic map
F120.nk_I (Street or Route No.)
a&73 J
w City or Ton State Zip Code
crab- 5a4- - 9 g- 3g'
Area code- Phone number
4. DATE DRILLED II -1 9 -D X
5. TOTAL DEPTH:r 3nari '
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO m------
7. STATIC WATER LEVEL Below Top of Casing: /Sb 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 accordso(e with ISA NCAC 2C .01l8. /
9. YIELD (gpm): o! 0 METHOD OF TEST h /UI/Jr7f4.
10. WATER ZONES (depth): / So' (/
LOCATION SKETCH
11. DISINFECTION: Type HIP Amount .-3 %/I-/} 5 Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads. Include the road
Depth Dia eter or Weight/FL Mate ial numbers and common road names.
From To iFt. ' 5.(R4I PY�
From To Ft.
From To Ft.
13. GROUT: Depth Material Meth
/) From To ` - Ft. C07ny7,t 60bt
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
DEPTH
From To ,
0 -1
2 ` 3,2 S'
(check box)
DRILLING LOG
Formation Description
G 16!„t
RL, Ctaio'tt
9S :8 WV 8- 330 fi0
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 S R�E//CORD 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

WELL CONSTRUCTION RECORD
306445
North Carolina - Department of Environment and Natural /Resoolurces - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME/1(print) t �IC.IyY/1zc-. �71� CERTIFICATTIONN�r����jy
WELL CONTRACTORCOMPANY :NAMMEI Y�f a V lid(ae ///1y J)1-k- PHONE # J3i(b.)Vu4�YJ
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
WELL USE (Check Applicable Box): ResidentialeT Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
WELL LOCATION:
Nearest Town: fl4t44/ County mp-r-e,'J
(Street Name, Numbers, Community,
Subdivision, Lot No., Zip Code)
VJ
3. OWNER:4- 043-VAv-en/
Address
Fricln (Street or Route No.)
N en tYis
City or Town State Zip Code
( )-
Area code- Phone number
4. DATE DRILLED /&-Q- )y
5. TOTAL DEPTH: ' 1 S
6. DOES WELL REPLACE EXISTING WELL? YES ❑ O ❑
7. STATIC WATER LEVEL Below Top of Casing: /yO FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): Lb METHOD OF TEST f)-, ✓
10. WATER ZONES (depth):
11. DISINFECTION: Type
12. CASING:
Depth Dyya�mfter
From a To //3 Ft. %
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From (J To r2 U Ft. t�a.e ..i/ �QQ y.
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Amount
Wall Thickness
or Weight/Ft. Material
PVC-
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
r,
rtz,
Len
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING .LOG --
From To Formation Description
3
dos
16. REMARKS:
O
1
is
LOCATION SKETCH
Show direction and distance in miles frbdl at lei
two State Roads or County Roads. Includ4 the r4ad�
numbers and common road names.
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRU TION STANDARDS, � AT 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

WELL CONSTRUCTION RECORD
306444
North Carolina - Department of Environment and Natural Resources � - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME �(print)�pi. P L37/wt/t— CERTIFICATION #362 /
WELL CONTRACTOR COMPANY NAME c rieSt JYU7 Lied( 1 045 sf-iUL. - PHONE # 25�%ZlY23^
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ♦3"- Municipal/Public ❑ Industrial ❑ Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATIO? -
Nearest Town:_______________________
County trinta
r 104-lcc Cie) mitt 1
(Street Name, Numbers, CoMmunity, Subdivision, Lot No., Zip Code)
3. OWNER:
Address
Tali
._ o e,J S t).r
(Street or Rout No.)
- AA/A ,✓ .r% ayi3y
City or Town State Zip Code
( )-
Area code- Phone number
4. DATE DRILLED Jc2-av - V�
5. TOTAL DEPTH: vos
6. DOES WELL REPLACE EXISTING WELL? YES Cr NO 0
7. STATIC WATER LEVEL Below Top of Casing: /! o FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): 3r0 METHOD OF TEST reb V
10. WATER ZONES (depth):
11. DISINFECTION: Type
12. CASING:
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box) Latitudeilongitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box) _
DEPTH DRILLING LOG
From To Formation Description
9 r Cff,2,
/! (;- 14°5
Depth/ Diam ter
'7 From U To f Ft.
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From v To p7 D Ft. en/ p (.46 4,
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
Amount
Wall Thickness
or Weight/Ft. Material
pu
15. SAND/GRAVEL PACK:
Depth
From To
From To
Ft.
Ft.
Size Material
0
tV
LOCATION SKETCH -z c"=
Show direction and distance in miles from at le�st�
two State Roads or County Roads. IncSL the foal_
numbers and common road names.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTF34JCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
d.
/—,t—G 5—
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

WELL CONSTRUCTION RECORD
306443
North Carolina - Department of Environment and
WELL CONTRACTOR (INDIVIDUAL) NAME (print)
WELL CONTRACTOR COMPANY NAME �- 1
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
al Resources - Division�sof Water Quality - Groundwater Section
0.491eie CERTIFICATIONd[6 /7/Jp
PHONE # 07 J5.Z/-7/.26.
1. WELL USE (Check Applicable Box): Residential.0— Municipal/Public 0 Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATI
Nearest Town: it .4 �
11 w-74 s /C.Y.
County /}1IQ-tan
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: .Silty f -Vi Address )#) Ty riph 4 �1 Lid
4t-/n-,�4-w (GPI- '3-n3�/i
City or Town State Zip Code
( )-
Area code- Phone number
4. DATE DRILLED
5. TOTAL DEPTH:
6. DOES WELL REPLACE EXISTING WELL? YES El NO El7. STATIC WATER LEVEL Below Top of Casing: aa- J FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): / METHOD OF TEST a, 1/
10. WATER ZONES (depth):
11
12
(Street or Rout No.)
DISINFECTION: Type Amount
CASING: Wall Thickness
Depth Diamry�eter or Weight/Ft. Material
From 0 To Ito % Ft. b Vy pit
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From 0 Toa2 0 Ft. e!L)ll�if
From To Ft. / G
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in, in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source: ❑GPS ❑Topographic map
(check box)
DRILLING LOG
Formation Description
DEPTH
From To
0
yr
r'
LOCATION SKETCH —'L' T,
Show direction and distance in miles HOti at lease
two State Roads or County Roads. Includ the road
numbers and common road names,
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
CONS UCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
_e /may IDS
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 3 0 6 4 4 2
North Carolina - Department of Environment and '(Natural Resources/- Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) ,V,.�jr.JYl uQ,n/G (�`/}y1LT
WELL CONTRACTOR COMPANY NAME l .Y /iL t[a/Vlj, I4 , Lvt_
CERTIFICATION
PHONE # Y/.COA�dydi %�
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if apnlicahlet (if applicable)
1. WELL USE (Check Applicable Box): Residential -- Municipal/Public ❑ Industrial 0 Agricultural ❑
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: r Countyilci
I 14 atael.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: PA/ActLtekTrPA/ActAddress L
(Street or Route No.)
City or Town State Zip Code
( )-
Area code- Phone number
4. DATE DRILLED )/
5. TOTAL DEPTH:
-off
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 0
7. STATIC WATER LEVEL Below Top of Casing: 02.5"-'6 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): 1/7 METHOD OF TEST Ate`r
10. WATER ZONES (depth):
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
1‘)
c)t
(degrees/minutes/seconds) •
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
Formation Description
DEPTH
From To
11. DISINFECTION: Type Amount
12. CASING: Wall Thickness
Depth Di me//t��r or Weight/Ft. Material
From 0To 37 Ft. %y PJV
From To Ft.
From To Ft.
13. GROUT: Depth Material / Method
From D To �u Ft. �e44//L?` plain,
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.
CD
01
iV
r5
o
LOCATION SKETCH
Show direction and distance in miles frogaat IeaSL `
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 STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
one (-zK--as-
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

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Q l�ygyq/L
WELL CONTRACTOR COMPANY NAME (..—t,fffrio U,Q v5 "id/&Vi(/i s> , t& -
ASSOCIATED WQ PERMMIT#
(if applicable)
STATE WELL CONSTRUCTION PERMIT#
(if applicable)
CERTIFICATIONl7J/ # J
PHONE # 155i 7k
I, WELL USE (Check Applicable Box): Residential-12— Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearer Town:
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: -t r11 9�-
Address POr/m r
Street or Route No,)
County 41gt6v
City or Town State
( )-
Area code- Phone number 1�,,�
4. DATE DRILLED //i/'0 S/
5. TOTAL DEPTH: It
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO ❑
7. STATIC WATER LEVEL Below Top of Casing: /Ct 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): V METHOD OF TEST 4, V
10. WATER ZONES (depth):
Zip Code
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitudeilongitude of well location,
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box) DEPTH DRILLING LOG
From To Formation Description
iv
(Tv
- free-
11. DISINFECTION: Type Amount
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 1) To to 7 Ft. (e & /(A/L
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From () To a o Ft. (e/Yre pht[ri)1y
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 Ft.
From To Ft.
Size Material
n
s
r-
LOCATION SKETCH z,i=
Show direction and distance in miles fror„ttat leas` 3
two State Roads or County Roads. Includeythe rod`'
numbers and common road names `"
0
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
Li/ et4 e
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

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) ,,rpp-"�j�'ec )EI'r,4/(/L CERTIFICATION�/�IO# YS77
WELL CONTRACTOR COMPANY NAME C te/US £4LJ �yt'/l,/Uf, _TOG. PHONE # tL;Cp J s- 7;71
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(ifapolicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential -Et- Municipal/Public 0 Industrial ❑ Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Near st Town: Fratitt ;t1
Ckn1er are,£.
(Street Name, Numbers, Community. Subdivision, Lot No., Zip Code)
3. OWNER``t.,�},);a %/i-V
Address Dog f v AV,
(Street or Route No.)
Sim Ina%n
d C4 4't/(/d?
City or Town 1State Zip Code
( )-
County MA
Area code- Phone number
4. DATE DRILLED /6-,27— efe
5. TOTAL DEPTH: S7i
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 0
7. STATIC WATER LEVEL Below Top of Casing: ire FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): So METHOD OF TEST Ai y-
10. WATER ZONES (depth):
Topographic/Land setting
❑Ridge ❑Slope OValley ❑Flat
(check appropriate box)
Latitude/longitude of well location
t0s
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map -
(check box)
DEPTH DRILLING LOG -
From To Formation Description
D- /ed
/ab - s`ns 7 ;49
11. DISINFECTION: Type Amount
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To AO Ft. to %y
From To Ft.
From To Ft.
13. GROUT: Depth Material / Method
From Q To Ft. CPjlryeh7 /X'tt.k 14
From To Ft. %—"��"7`-
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
O
[N.)
c
Show direction and distance in miles froth at leasC''�,
two State Roads or County Roads. Inclucf he road-
numbers and common road names.__ a -
LOCATION SKETCH -n
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
N
Ai ed-47 --
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
S
ri
Uri

WELL CONSTRUCTION RECORD
30 4"
North Carolina - Department of Environment and Natural Resourcessv- Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME
Y (print) Vim" /CV"nne r CERTIFICATION #,_3029 WELL CONTRACTOR COM PANY NAME (y4N< Kt'YD$ t44/UL ' - - T., Zit. PHONE # f0�. 7�ti `` 7f�
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(ifapplicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential-B— Municipal/Public ❑ Industrial ❑ Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Neatest Town
J1Lpz c d
(Street Name, N mbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: ae `qq m,'ll o
Address 3 5- , L.o�t,#/
(Street or Route No.)
f 'rmk/.ij n4/
CountyM &i tN
LjA/
t)sli'7 )y
City or Town State Zip Code
( )-
Area code- Phone number
4. DATE DRILLED II—S- &/
5. TOTAL DEPTH: WSS
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO 0
7. STATIC WATER LEVEL Below Top of Casing: a VO FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): e? 0 METHOD OF TEST AK
10. WATER ZONES (depth):
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names----
/7c— fri
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location, -
(degrees/minutes/seconds) Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
CJ — C/'5,
11. DISINFECTION: Type Amount
12. CASING: Wall Thickness
Depth Diamet r or Weight/Ft. Material
From (7 To /7 9 Ft
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From c To .. 0 Ft. CP/no�/ tog v. Ai,
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.
vat C
OrTt
:ra _
n
C .aY
Oa
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
CONST CTION STANDARDS, AAND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
i`,it J`'/— d 6--
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 Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) d /ra✓(Artt Cyp-n/C CERTIFICATION #3 VS) /
WELL CONTRACTOR COMPANY NAME Ci yie C �(J� jr��y�C PHONE # 0452Y,7%/,,,
STATE WELL CONSTRUCTION PERMIT# .ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): ResidentialJEKMunicipal/Public 0 Industrial 0 Agricultural ❑
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION;
Nearest Town: 717/92/
1f1 o/kj, q , g9ri
(Street Name, umbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: Yee W4s5;//0
County i1 4C2/t'
/
Address `'33ne, Lski LiInc 7/,d%qy
(Street or Route No.)
cVL� ZnVf c.
FiAfr
City or Town State Zip Code
( )-
Area code- Phone number
4. DATE DRILLED 1/ r 3/
5. TOTAL DEPTH: S�--
6. DOES WELL REPLACE EXISTING WELL? YESpi NO 0
7. STATIC WATER LEVEL Below Top of Casing: ir FT.
(Use "+" if Above Top of Casing)
S. TOP OF CASING IS / FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with I5A NCAC 2C .0118.
9. YIELD (gpm): S'D f METHOD OF TEST 4,jr
10. WATER ZONES (depth):
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box) .... ...__
DEPTH DRILLING LOG
From To Formation Description
e - 0' r7
497 '7SS-
11. DISINFECTION: Type Amount
12. CASING: Wall Thickness
Depth Di�f'tete or Weight/Ft.
From ti To 497 Ft.
From To Ft.
From To Ft.
Material
13. GROUT: Depth Material Method
From t To 02 0 Ft. COmz'z/ parr;>77
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 ; 4t''
From To Ft. '{`'- "
From To Ft. ^
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRU5TION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
MM4 C,� _ / - v s
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
EATT
rel

306410
North Carolina - Department of Environment and Natural Resources Quality - Groundwater Section
Division of Water /� ""
WELL CONTRACTOR(INDIVIDUAL) NAME (print) e/Y1e Ij h15 I�-A' 0.,� {' CERTIFICATION */ o1I% 40
WELL CONTRACTOR COMPANY NAME: 111)1 Jt1AIlQ enri II)P.II�Yi1ltu r4-f PHONE Ya¢.]4�.524-'3 v'6
�
(if applicable)
STATE WELL CONSTRUCTION PERMIT*/
(if applicable)
ASSOCIATED wERMIT*/
I. WELL USE (Check Applicable Box): Residential' unicipaVPublic 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other E7 If Other, List Use
2. WELL LOCATION:
Ne st Town:tP 4'J1k2-
L le hi -ea hc4 - f
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: £'4. .41, ' licrel-t
Address 3 9r) fl e PO 4/
(,) 3?)- rl 9,3 -
A/ /t (StreetorRou3teNo.) Ti
ii o
Cr Town
�/,
Sute Zip Code From
D
Area code- Phone number
4. DATE DRILLED -"3' 0 y
5. TOTAL DEPTH: 93-0
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO ❑ram
7. STATIC WATER LEVEL Below Top of Casing: Co D FT.
/ (Use "t" if Above Top of Casing)
/
8. TOP OF CASING 1S FT. Above Land Surface'
*Top of cuing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C ,01111.
9. YIELD (gpm): 7 METHOD OF TEST_O Wept
10. WATER ZONES (depth): / -SS' 34S •
1-0'
85•
Latitude/longitude of well location _ -
Y 1.
, (degrees/minutes/seconds) ? "-`
Latitude/longitude source:❑GPS❑Topographic mail
(check box) 4
DRILLING LO ` `V-3 --
DEPTH
To Formation Description
ci4• (e./
y eje a LA- l t te-,
2 L t/ e_ c a tm ; t e-
�s•
LOCATION SKETCH
I I . DISINFECTION: Type {'fr?» Amount c2 YI 6 S Show direction and distance in miles from at least
12. CASING:
Depth c
From i� . To Q5
WELL CONSTRUCTION RECORD
l Topographi nd setting
/ n
County /'I -JLIY-{C' ❑Ridge o�81'pe OValley ❑Flat
trX l f't7 1(L f . 1% 3 y (check appropriate box) y
Wall Thickness two State Roads or County Roads. Include the road
Diaputer or Wei•gitUFL Magill numbers and common road names.
Ft. h " ni R ,n, A Ye,.' •
From To FL
From To Ft.
13. GROUT: Depth Material Method
From1_ To Ft. CQyyi polyp
From To Ft.
4. SCREEN: Depth Diameter . Slot Size - , Material
From To Ft. in. in.
From To Ft. in, in.
5. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
6. REMARKS:
DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
ONSTRUCTION STANDARDS, AND THAT A COPY OF THjS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
l-• 5 —o ff
SIGNATUREOF PERSON CONSTRUCTING THE WELL . DATE
ubmit the original to the Division of Water Quality, Groundwater Section, 1636 Mall Service Center -Raleigh, NC
7699-1636 Phone No. [phone], within 30 days. GW-I REV. 07/2001
ri
Ffiri

• . WELL CONSTRUCTION RECORD .
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR(INDIV,IDUAL)'NAME(print) c1r H N 1 S
I IIirkA L.
•T ' CE1RTIFI�C,A,TIIOON s of/7(e .
WELL CONTRACTOR COMPANY NAMSh))')fC Of kiwi 'JJ lI�1'1YS)1 pc.. I•Kte J. PHONE Yam: 32Y-3,-bO
STATE WELL CONSTRUCTION PERMIT. ASSOCIATED WQpERMITI - • _
(if applicable) • {if licable)
1. WELL USE (Check Applicable Box): Residentiar unicipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other C! If Other, List Use
2. WELL LOCATION:
Nearest Town: f1eANk24 4/ County4l,Cert.
G' v-r- c-J/: JAy RA_ ff'73
(Street Name, Numben, Community, Subdivision, Lot No., Zip Code)
3. OWNER: Rohr✓/FJa,/z 2-
A�
Address 4WD S /L • .54 nu (W'
(Street or Routs No.) / `b
J �/-�fi3��. '
City. . Town Stain - Zip Code
0 3)
Arca code- Phone number
4. DATE DRILLED / — -O-S
5. TOTAL DEPTH: :3M 1
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO Ql-
7. STATIC WATER LEVEL Below Top of Casing: AD FT.
(U.c"t` if Above Top of tieing)
8. TOP OF CASING IS / FT. Above Land Surface*
*Top of casing terminated at/or btlow)sodsurface requires a -
variance la accordance wltb ISA NCAC 3C.0111. / /
9. YIELD(gpm): .2l METHOD OF TEST DIOI//i71(�—�
10. WATER ZONES (depth): eV.g (1
Topographic/Land setting
❑Ridge ❑Slope ❑Valley 4l1
(check appropriate box)
Latitude/longitude of well location
•
, (dcgn&minutes/secondr) 4- "3,
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG ill_
From To Formation Description -`,
%'
dam• rino• LU GYO.rt.-Y-e..
LOCATION SKETCH
I I . DISINFECTION:,Type 1 414 Amount e./. TA- 1; 5 Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads. Include the road
Depth Dia ter or Weight/Ft. Meter;AI 'numbers and common road names.
From 0. To a Z Ft. C` t a I ®rj®y 5�e/ •
From To Ft.
From To Ft.
13. GROUT: Depth Material
From_ To i•Q7i Ft. &yr
From______ To Ft.
4. SCREEN: Depth Diameter . Slot Size : , Material
From To Ft. in. in.
From To Ft in. in. -
5. SAND/GRAVEL PACK:
Depth Size
From To Ft.
From To Ft.
ethod
pM
Material
6. REMARKS:
DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
ONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OP PERSON CONSTRUCTING THE WELL . DATE
ubmit the original to the Division of Water Quality, Groundwater Section, 1636 Mall Service Center -Raleigh, NC
7699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001
tHl/
i
73 -CT
n-:

13
14. SCREEN: Depth
From To
From To
15. SAND/GRAVEL PACK:
Depth
From To
From To
WELL CONSTRUCTION RECORD 3 0 4 3 3 2
North Carolina - Department of Environment and Natural Resources - DivisionofWater Quality- Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) c7V I7 Vl t S l /OM rl� 1
/`! r� I �� CERTIFICATION 8 0<-n l✓
WELL CONTRACTOR COMPANY NAMICbkni S 14101I(LnA If1el l l)yi 1 l -7'-4 c' J PHONE li% SQ. Y-3 .6 6
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WORERMIT0 (if applicable)
(if applicable)
1. WELL USE (Check Applicable Box): Residential'C t icipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other CI If Other, List Use
2. WELL LOCATION: M
Nearest Town: County / / / /Zi Se,&.-
`/ ! S Pape_ Pro .;2.F76,3
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER:
Address
or �--Dv,Za leZ
D. Ue EDn /fa/
D HD (Street olRoute No.) PILLS
a
City or Town State Zip Code
o .o/.2- 436 Y
Area code- Phone number n
4. DATE DRILLED //— 6
5. TOTAL DEPTH: &7 )'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO J-
7. STATIC WATER LEVEL Below Top of Casing: 17c 6 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
*Top or casing terminated actor below landsurface requires a
variance In accordance with ISA NCAC 2C.0118. // //
9. YIELD (gpm): _ 7 METHOD OFTEST �hfUI,/1
10. WATER ZONES (depth): 'far' (��
11. DISINFECTION: Type /ii'f1-f
12. CASING:
Depth Diamp�eeter
From 0 To ?t' t. /n"
From To Ft.
From To Ft.
GROUT: Depth
From O To rcfp FL
From To Ft.
16. REMARKS:
Topographic/Land setting
❑Ridge ❑Slope ❑ValleyOPfat
(check appropriate box) a x
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPSOTopographic map
(check box).
DRILLING LOG
Formation Description
/.9.44
a Litt lead., fie-
DEPTH
From To
0 as
J Q ' (e oat
LOCATION SKETCii
Amount 4. 7-A-A 5 Show direction and distance in miles from at least
Wall Thickness two State Roads or County Roads. Include the road
or Weight/Ft. material numbers and common road names.
7SP. -4je-
Material
CP��
Method
Pam
Diameter Slot Size Material
Ft. in. in
Ft. in. in.
Size
Ft.
Ft,
Material
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL - ;
CONSTRUCTION STANDARDS, AND THAT COPY ��CORD HAS BEEN PROVIDED TO THE HEM WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL ! DATE
Submit the original to the 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

•
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources1- Division of Water Quality- Groundwater Section /
WELL CONTRACTOR (INDIVIDUAL)-NAME� �(print) cD�n}lis MI)/la-. CElcT1FI�CA,,r,i,/on# �.of-��Y'
WELL CONTRACTOR COMPANY NAMK I r..bt C'kllOgw4 (J)ei I ri I ( 4��It' 176 e i PHONE M O�d1:J a 4-3 v_-6 0
STATE WELL CONSTRUCTION PERMITS ASSOCIATED WfjhERM1Til •
(if applicable) (if applicable)
304334
I. WELL USE (Check Applicable Box)::Residential' unicipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other U If Other, List Use
2. WELL LOCATION: T graphic/Land setting
Nearest Town: fR4/1/2L / /V/ County f} Cat D.Ridge 0Slope ❑Valley ❑Flat
�f 415 d� - „nffrvu � Q f ds a �i — j(N : ow s cF-eof Pa. (check appropriate box)
(Street Name, Numbers, tyommunity, Subdivi on, Lot No., Zip Codc) 01 i<C073 Latitude/longitude of well location
3. OWNER:10,-V; a SO In S
Address 134-3 ADD/MC-ton R(Liciere pa.
FIQ A"NW L`; (Street or Route No.) ^ f r13 4
City' or Town Al State Zip
Zip Code
(Said- Sa.4- (c)7O gi
Area code- Phone number
4. DATE DRILLED / / — / O —O Li
5. TOTAL DEPTH. 4‘00
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: SO FT.
/ (Use "t" if Above Top of Cuing)
8. TOP OF CASING IS / FT. Above Land Surface*
''Top of casing terminated at/or below landsurface requires a
variance In accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): J' METHOD OF TEST_ h /07/ihL(,{—�
10. WATER ZONES (depth): /.�S 2 3SS e (�
11. DISINFECTION: Type It-/"// Amount a ! /t/J S
12. CASING: Wall Thickness
Depth Die eter or Weight/ft. Mate },I
From 0 To /tt• Ft. SW ,, 7 AYv
From To Ft.
From To Ft.
13. GROUT: Depth as al . i Methodv
From n Toorifi Ft. y)� D
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.
(degrees/minutes/seconds)
Latitude/longitude source:OGPSOTopographic map
(check box)
PHPTH DRILLING LOG
From To Formation Description
•
6, • /bts•
[00 t-Oo• -e [t rG
J.00ATION SKETCH
Show direction and distance in miles from at (east
two State Roads or County Roads. Include the road
numbers and common road names.
JAIL • 4 Si
16. REMARKS: r•;'r.
r
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUC I ED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF TH S RECORD HAS BEEN PROVIDED TO THE WELL OWNER
Or
ID—o4-
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the 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

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of
&ter Quality • Qroundwater Section
305600
WELL CONTRACTOR(INDIVIDUAL)?NAME� (print) c'h4 PP)i sI !�'A11/) Otis, CL CCERTIFICATIONo_ /7Y'
WELL CONTRACTOR COMPANY NAME;j'i �'.l)j')(S hiat) PHONE a
STATE\VELL CONSTRUCTION PERMITS( ASSOCIATED Wl'i'ERMITII
(if applicable) . .(if applicable) •
I. WELL USE (Check Applicable Boxy. Residential' unicipa1/Public 0 Industrial O Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other C7 If Other, List Use
2. WELL LOCATION: Ors—)
Nearest Town: F.?A�1/!Ct!.:! /✓ County M Q
(vL}I,)- Clsnm wa. Rj A.P73 of
(Street Name, Numbers, Community,ySubdivision, tut No., Zip Code)
3. OWNER: ea.fl J LtIQ i Yt e�
Address .20q CMm-vv; tcJ rN
(Street or Route No.)
14:ItShnrDasaslo /(/C. Ai 27'
City or Town ($fate Zip Code
619)- 117/. 4 71'7
Area code- Phone number
4. DATE DRILLED /1-3 —o
5. TOTAL DEPTH: Seto '
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO •QJ�
7. STATIC WATER LEVEL Below Top of Casing: oi' n FT:
(Use "t" if Above Top of Casing) - - -
8. TOP OF CASING 1S / FT. Above Land Surface*
•Top or casing terminated at/or below landsurface requires a
OF TEST O/Lint-,
variance In accordance with ISA NCAC 2C .0118. /.
9. YIELD (gpm)' J• METHOD
10. WATER ZONES (depth): / 91) •
Topographic/Land setting
❑Ridge ❑Slope ❑Valley at
(check appropriate box)
Latitude/longitude of well location
, (degrees)minutes/seconds)
Latitude/longitude source:OOPS❑Topographic map
(check box)
DRILLING LOG
Formation Description
n[a�
F L U C:- r t2 n rYG...
DEPTH
From To
O n'
.30' Ao•
I I. DISINFECTION: Type
12. CASING:
Depth 30
From To
From
From
r LOCATION SKETCH
%i--i'/4. Amount .� 75943 5 Show direction and distance in miles from at leas
Wag Thickness ncu two State Roads or County Roads. Include the r
Dia ter or Weight/ft. MateAl 'numbers and common road names. 0
Ft. 1" S.iZ R ,37 Pr PA' rri
To Ft.
To Ft.
13. GROUT: Depth
From () To 1-91, Ft.
From To Ft.
Material
Cerra
Method
FQU.c../
4. SCREEN: Depth Diameter Slot Size • Material
From To Ft. in in.
From To Ft. in. _ in.
5. SAND/GRAVEL PACK: _
Depth Size Material
From To Ft.
From To Ft.
0
6. REMARKS:
DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
ONSTRUCTION STANDARDS, AND THAT A COPY OF TH S RECORD H BEEN PROVIDED TO THE WELL OWNER
/ 1- 3 -U"/
SIGNATURE -OF PERSON CONSTRUCTING THE WELL , DATE
0
0
m
0
00
ubmit the original to the Division of Water Quality, Groundwater Section, 1636 Mall Service Center • Raleigh, NC
T699-1636 Phone No. [phone], within 30 days. GW-I REV. 07/2001

tt)
305599
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of ater Quality - Groundwater Section
WELL CONTRACTOR (INDIV,tDUAL) NAME (print) Chen vi I S IM Pori, d. • CZJ TIFICCAATION Y/4a
WELL CONTRACTOR COMPANY NAME I4 1411044r4 �) IPII d'!yea! %l tL TFlf J PHONE 214-'3 26 0
STATE WELL CONSTRUCTION PERMITH ASSOCIATED W&ERMIT#
(if applicable) .(if applicable)
I. WELL USE (Check Applicable Box): Residentiial' unicipal/Public ❑ Industrial O Agricultural 0
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other Cf If Other, List Use
2, WELL LOCATION:
Nearest Town: 1+1 CJ+Lf.t.DS County All/1-epn
Lott- E • 1 Lt l2 t-i a PoYa a . R.a a S'lei
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER:'fete— C-1 ea.ntR_
Address BOX ID /
(Street or Route No.)
J41CHL.aA.ac NC— agit/ l
Citybr Town State Zip Code
g t- aJa
!2(0- 49ra
Arca code- Phone number
4. DATE DRILLED 12 —b —O' f-
5. TOTAL DEPTH: 00. S'
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO.ml—r
7. STATIC WATER LEVEL Below Top of Casing: JO -FT
(Use "t" if Above Top of Cuing)
8. TOP OF CASING IS / FT. Above Land Surface`
*Top of casing terminated actor below landsurface requires a
variance In accordance with ISA NCAC 2C .0113.
9. YIELD (gpm): �Q_ METHOD OF TEST_ /l�U1^
10. WATER ZONES (depth): /OS'J a`120 .370' t/ LOCATION SKETCH
II. DISINFECTION: Type 11414. Amount TA -A 5 Show direction and distance in miles from at least
12. CASING: • Wall Thickness two State Roads or County Roads, Include the road
Depth Diapeter or We-IighUFt. Mat`eP I numbers and common road names.
From 0 To -/ Ft. h" .5-bR1 l Pr
From To Ft
From Tq Ft.
13. GROUT: Depth Material Method
From n r To Ft. e0471 p()UA
From To Ft.
4. SCREEN: Depth Diameter Slot Sire • Material
From To Ft. in in.
From To Ft. in. in.
5. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
To phic/Land setting
L9Rt�ge ❑Slope OValley ❑Flat
(check appropriate box) a
Latitude/longitude of well location
From To Ft.
, (degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To For lion Description
v-Perm e_LAI r-4._
RLuE GRIt,Nfte.
(PbS-
O
rn
F
p
6. REMARKS:
DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 1544 NCAC 2C, WELL
ONSTRUCTION STANDARDS, AND TVHHA,T�/A� COPY OFTTf�HIIS�RECORD H(�AS BEEN PROVIDsED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL DE
rn
0
IV
oo
ubmit the original to the Division of Water Quality, Groundwater Section, 1636 Mall Service Center -Raleigh, NC
1699-1636 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) WILLIAM BRADLEY LEWIS CERTIFICATION It 3388
WELL CONTRACTOR COMPANY NAME CHEROKEE WELL DRILLING AND PUMP COMPANY, INC. PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
306074
I . WELL USE (Check Applicable Box): Residential X3 Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other O If Other, List Use
2. WELL LOCATION:
Nearest Town: TOPTON County MACON
NANTAHALA - CAMP BRANCH
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: BRANDON WILSON
Address 323 RAYMOND WILSON RD
(Street or Route No.)
TOPTON NC 28781
City or Town State Zip Code
( 828 )- 321-0595
Area code- Phone number
4. DATE DRILLED 12-17-2004
5. TOTAL DEPTH: 245'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 0
7. STATIC WATER LEVEL Below Top of Casing: 100 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surface*
`Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .811R
9. YIELD (gpm): 60 METHOD OF TEST AIR
10. WATER ZONES (depth): 220'
11. DISINFECTION: Type CHLORINE
Amount 100 PPM
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 40 Ft. 81/8` SDR21 PVC
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From 0 To 20 Ft. CEMENT GRAVITY
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. is in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth
From To
From To
16. REMARKS:
Ft.
Ft.
Size Material
Topographic/Land setting
(Ridge ['Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
3516.500N/8338.834W (degrees/minutes/seconds)
Latitude/longitude source)OGPSOTopographic map
(check box)
DRILLING LOG
Formation Description
BROWN SLATE
20' TO 40' BLUE GRANITE
GRANITE
DEPTH
From To
0' TO 20'
40' TO 245'
0
LOCATION SICETCH
Show direction and distance in miles from at (east v)
two State Roads or County Roads. Include the road -,0
numbers and common road names.
ai 41-1 p,U
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND AT (,,COPY OF THIS tECO13D HAS BEEN PROVIDED TO THE WELL OWNER
2 -17 /
DATE
Coast,
SIGNATURE OF PERSON CONSTRUCT
to-{2
THLrWELL
Submit the original to the Division of Water Quality, Attn: Information Management, 1617 Mail Service Center -
Raleigh, NC 27699-1617, Phone No. [phone], within 30 days.
GW-1 REV. 09/2004

. WELL CONSTRUCTION RECORD # 3 0 6 0 7 2
i ortn Caroiina - Deparuirent of Environment and Natural /R�esources - Division of Water Quaihy: Groundwater Section
CERTIFICATION: /
(print) au 3L Q T/r11.�
WELL CONTRACTOR (INDIVIDUAL) NAME �L�r
1 ;,,it PHONE t r im=�-3VZ1
CELL CON'FR:\CTOR CO?IPANS NA?1E%f�1 4Yf��Y1�� ` � Drit"
STATE WELL CONSTRUCTION PERMIT: ASSOCIATED %'Q PERMIT
(ifapolicable) - (ifaaolicable)
WELL USE (Check Applicable Box): Residtentialk, MunicipatIPublic ❑ Industrial 0 Agricultural ❑
Monitoring❑ Recovery 0 Heat Pump Water Injection Other❑ If Other, List Use
WELL LOCATION:
Nearest Town: e
Countv
Vc:e. Numbs. Ccrtmcait....a`.dicision. Lot Na.. Zip o�
3. OWNER: trliCe
AddrosS SY W or'S U'r C'*' �1y C% /
or Rout: No. 3a S�, nP:L1 I .�"iS/
Topographiu'Land setting
❑Ridge ❑Slop: ❑\'alley 'Flat
(:he;k appropriatt box)
Latitude'longitude of well location
(d:.raeiiainottaie:ords)
Latitudc'longimde soure:❑GPS❑Topogr_?his nap
(cbtak box)
DEPTH DRILLING LOG •
From To Formation Description
O --A '1
g- -Z/'J
y 1--i5t)
7. STATIC WATER LEVEL Belo:,.. Top o`Casin_g: o.!) FT.
(L'se'=" VASo.: Top orCasinst
S. TO? OF CASING 13 1 FT. Above Land Surface-
-1 rq ur cuiin;p tcr-..riru red at'or bclurt land surface requires a
.ia-iance in ac:urd n:e 1,1:h 15.\ NCAC 2C .011S. j'x, e
9. YIELD (_pn):'-50 METHOD OF TEST /'ri ir'
10. WATER ZONES (depth): 31 .
Show direction.and'dis' from a: leas:
11. DISINFECTION:IGTvp- 1 r� i A ou''. L Roads. Include the road
r. 1':_ i Thickness -
two State Rdads o-: Cc'.:n::
L'. CASING: '1 Ti M nice ers and common road names.
De D' — c-
Fro:n 0 To ,.3 9 Ft.
Ron: To Ft.
Fro:ii To Ft
From 0 To 3 Et"' 8_-+•ar `fc/_
From ..N Toes () Ftb0.,.'tn rite. t�1,.ti-� dal1a. SCREEN: Dr_ . D.an:e:er Scut Size N !a'e":
From To Ft. in. in.
Fror: To Ft. in. in. '
15. SAND GRAVEL PACK:
Depth Size Meteria'
Ct:i oc 1 OW!! S'a:: Zip CO.!
(so- 493—aool
Arc::, dc- ?non:: ruittber.
4. DATE DRILLED lU—;27—Lov
S. TOTAL DEPTH: %5
6 DOES WELL REPLACE EXISTING WELL? YES ❑ NOl'E]
Zyv 18 ,14)41 6
Fror: To Ft.
•Fror.: To Ft.
LOCATION SKETCH
0
` GC
-acz
nCt
N f�
c�
16. REMARKS:
I DO HEREBY CEP.TI-F THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C. V.TLL
CONSTRICT T?„\DARD-. .ND THAT A COPY OF THIS P=CORD HAS BEEN PROVIDED TO THE WELL OWNER
/c 15-- i
SIGNATURE OF PERSON COT ¶R_C T ING THE WELL DATE
Submit ti:e original to the Division of Water Quality, Ground toter Section. 1536 1laa Swica Cec::r - Ra'eigh, NC
27699-1636 Phn-: No. (919) 733-322I. within 30 days.

306155
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Ablator Quality - Groundwater Sectionn
WELL CONTRACTOR (INDIV•IDUAL) NAME (print) c.h� fl PI i S / 11()�A rt..,.t, CERTIFICATION./ TIFICATION./ 2: /7 cf'
WELL CONTRACTOR COMPANY NAME:'t)nr C oe IIo..,.-I ID)P.i I: v't l h 774 e J PHONE Y dam _p Z L/ 3 2 6 0
STATE WELL CONSTRUCTION PERMITS/ ASSOCIATED WORERMITS
(if applicable)
(if applicable) •
1. WELL USE (Check Applicable Box): Residential' unicipal/Public 0 Industrial CIAgricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other C( If Other, List Use
2. WELL LOCATION:
Nearest Town: 0 td County M 4-00Y1
44-1 C C'n(ueer& Lath R.d a81b7)
(Street Name, Numbers,^Community, Subdivision, Lot No., Zip Code)
3. OWNER: .) Q vs I., il10RGQ�
Address it I Cotueat- u La I(R RA
(Street or Route No.)
1n1-11i NG O2?7b3
City or Town State Zip Code
r8a�!• 3 Co 9- (0 3 79
Area code- Phone number
4. DATE DRILLED I el " 36 -0 `-/-
5. TOTAL DEPTH: %Sn "
T ograp{tic/Land setting
dge ❑Slope ❑Valley ❑Flat
(check appropriate box) x
Latitude/longitude of well location
(degreeilminute✓aeconds)
Latitude/longitude source:❑GPS❑Topographic map,
(check box)
DEPTH DRILLING LOG
From To Formation Description
D 39' CI
3 R 6 ' sa ck
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 02----""
7. STATIC WATER LEVEL Below Top of Casing: L l) FT:
(Use "t" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
'Top of easing terminated at/or below land.surfaee requires a
variance In accordance with ISA NCAC 2C .01111. //
9. YIELD (gpm): 2. , METHOD OF TEST hiOiJJ f�J
10. WATER ZONES (depth): f 5o e (/
m
fTa '
if,,
LOCATION SKETCH
11. DISINFECTION: Type %%-tP. Amount e2 %113S Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads. Include the road
Depth Diameter or Wet t/Ft. Mat`eP I numbers and common road names.
From 0 Ito FL bm 5.bR. 1 ParAt0
From To Ft. r�
From To Ft. w `-
13. GROUT: Depth Material Method - al r'---'
From f7 To Ft. ap, paw° . U7
From To Ft. -u r"'"•
4. SCREEN: Depth Diameter Slot Size • • Material }
n
From To Ft. in. in. C
From To Ft. in. _ in. - • . - N
5. SAND/GRAVEL PACK: - a' <CI
-
Depth Size Material
From To Ft
From To Ft.
6. REMARKS:
DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
ONSTRUCTION STANDARDS, AND THAT A COPY OF TH S RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL
I a, 3o .y
DATE
ubmit the original to the Division of Water Quality, Groundwater Section, 1636 Mall Service Center -Raleigh, NC
7699-1636 Phone No. [phone], within 30 days. OW -I REV. 07/2001

306154
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIY,1DUAL) NAME (print) ¶D� p %I S '!I'A I1!LA (Li` . t CERTIFICATION #ocn)7Y
WELL CONTRACTOR COMPANY NAME;'IIt Ii OAjtoyy4 1JThI�lvijlsu.�((T-tt ,Y PHONE a /2Le--3 a6 6
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQfERMIT# .
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential' unicipaVPublic 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other E( If Other, List Use
2. WELL LOCATION:
Nearest Town: %'RA/Vet i iV' County AAA (svt-'
r o Sf i✓- -a-oCC h , 22 - llnn en, tau r2/W; K� hntw �d
Topographic/Land setting
❑Ridge ❑Slope ❑Valley , at
(check appropriate box)
(Street Name, Numbers, Community, subdi i ion, Lot No., Zip Code) Latitude/longitude of well location
3. OWNER: _ tt. Ay SG 4 fi.) J , (degree&minute✓seconds)
Address (o(o � S '- L- p4 > bit l? n t r 3 tJ.X U pal , Latitudellongitude source:❑OPS❑Topographic map
(So; Rd o) . • (cheek box)
Ly C- 3 DEPTH DRIG
City' or Town Stain Zip Code From To .Formation Description
A
riibA-Nk o o _o a R
N v LING LOG
(a)- .94f9_ 13.0
Area code- Phone number
4. DATE DRILLED 1 `r� - a 9 -U
5. TOTAL DEPTH: o2.5-- •
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO ❑ jr
7. STATIC WATER LEVEL Below Top of Casing: /fl FT.
(Use "t" if Above Top of Casing)
8. TOP OF CASING 1S / FT. Above Land Surface'
*Top or cuing terminated at/or below landsurfaee requires a
variance In accordance with ISA NCAC 2C .011S.
9. YIELD (gprn): /S METHOD OF TEST /UI/ii)f��-.
10. WATER ZONES (depth): /.20'/ /6/5 ' (�
LOCATION SKETCH
I I. DISINFECTION: Type H-tP. Amount c2 714-A c Show direction and distance in miles from at lea& COI
12. CASING: Wall Thickness two State Roads or County Roads. Include the rail -.lit.
Depth Dia ter or We-ijht/Ft. Material • -numbers and common road names.`
From 0 . To g 0 Ft. . , ,1 g !'j' s -ate
From To Ft clt 0-
From To Ft. Cart
i3. GROUT: Depth Material Method., - �_
From To Ft. �.ynGy�. eCUA/ -3� . c� r i
From To Ft. tilt tv "'-
6I
4. SCREEN: Depth Diameter Slot Size , Material
From To Ft. in in.
From To Ft. in. in.
5. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
n 39'
fig• 40'
90 • *'
e_Lo
sa-nri-eArt,- 4-
RL//` (Chair,: t-e-
6. REMARKS:
DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED 1N ACCORDANCE WITH 15A NCAC 2C, WELL
ONSTRUCTION STANDARDS, AND THAT
ynA COPY OF TH}SRECORD H BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL . DATE
ubmit the original to the Division of Water Quality, Groundwater Section, 1636 Mall Service Center -Raleigh, NC
t699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

aeo
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) c1)-tf) PI15 M-r'rU �' CZI\TIPI�ra/ CAT�ION
E1.014
WELL CONTRACTOR COMPANY NAM[S Al�2,ytri 1.01 1V4.1171s Y ' PHONE ric_,,5-24-3 246
STATE WELL CONSTRUCTION PERMITS ASSOCIATED WORMIT# •
(ifapplicable)
(if applicable) ' .
1. WELL USE (Check Applicable Box): Residential' unicipal/Public 0 Industrial 0 Agricultural Cl
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other Cf If Other, List Use
2. WELL LOCATION:
Nearest Town: ��, unty MCt.00+"•-
Li-9-1 3 _ dr-4r eft idt.. 12a_ �er7aV
(Strut Name, Numbers, Community, bdivision, Lot No., Zip Code)
3. OWNER Q.RQ41 ate LriQ.r._-
Address /1L q 62?
To graphic/Land setting
ge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(Street or Route No.) (L (check box)
F12Q.nt1,l nai ^/ C ar813 7 PEPTH DRILLING LOG
From To Formation Description
0 •
�• [�9
(07• 5fon•
City Or Town State Zip Code
Area code- Phone number
4. DATE DRILLED f a-- 2-1 —O.q
5. TOTAL DEPTH: 446C, •
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 123/-c
7. STATIC WATER LEVEL Below Top of Casing: 1-79 FT.
(Use "+" if Above Top of Cuing)
8. TOP OF CASING IS / FT. Above Land Surface*
'Top of cuing terminated at/or below land surface requires ■
variance In accordance with ISA NCAC 2C .0111.
9. YIELD (gprrl): / S METHOD OF TEST_5 /U7/}/"'
10. WATER ZONES (depth): 3pn' (l
11. DISINFECTION: Type /f
12. CASING:
Depth / �7
From V ToFt.
From To Ft.
From To Ft.
13. GROUT: Depth
From_ To .4 Ft
From To Ft.
LOCATION SKETCH
a'/•/ Amount of TA C Show direction and distance in miles from at least
Wall Th ckness two State Roads or County Roads. Include the road
Dia ter or Wieiight/Ft. Mete ' 1 'numbers and common road names.
1i" 5. R,f1 PK
/�
Material
C- YYLb
4. SCREEN: Depth Diameter .
From To FL in.
From To Ft. in.
5. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
Method
pC/1110
Slot Size Material
in.
in.
From To Ft.
6. REMARKS:
DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
ONSTRUCTION STANDARDS, AND THAT A COPY OF TH S RECORD H S BEEN PROVIDED TO THE WELL OWNER
84
SIGNATURE OF PERSON CONSTRUCTING THE WELL . DATE
t4
ubmit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
1699-1636 Phone No. [phone], within 30 days. . GW 1 REV. 07/2001
77-7
Sri
cY
c.
LL

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of
WELL CONTRACTOR (INDIVIDUAL) NAME (print) 1) I
titer Quality - Groundwater Section
:hen h S CZITIFICATION,/ of /7 (p
$ Apls 0101100,4 I!)P(1�tai�t J PHONEY SC.5.2 h 4.
Clio
30589'6
\v ELL CONTRACTOR COMPANY NAMA
STATE \YELL CONSTRUCTION PERMIT,/ ASSOCIATED WQ-PERMIT# - ' (if applicable) .(if applicable) ' .
1. WELL USE (Check Applicable Box): Residential' unicipal/Public ❑ industrial 0 Agricultural Q
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other t7 If Other, List Use
2. WELL LOCATION:
Nearest Town: d County /V)A-Cfl h
Ll CL l 5 re en-i--tr r �a � ► cLi 1 se Nat)
(Street Name, Numben, Community, Subdivision, Lot No., Zip Code) a 87 f. 3
3. OWNER: P. 1 m.a— e s l+unfiep-
Address o2l'f flea
CcL Q L U 1= It gal.
S(Street or Route No.)
,/Iva„ra- Gaa
City Or Town State Zip Code
Area code- Phone number
4. DATE DRILLED /— l 7 — a
5. TOTAL DEPTH: a •
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
30 4.Flo7
Igpograpttic/Land setting
IE ZIge ❑Slope OValley Opal
(check appropriate box)
Latitude/longitude of well location
, (degrees/minutes/seconds)
Latitude/longitude source:❑GPSOTopographic map'.
(check box)
DRILLING LOG
Formation Description
C-4 Glen
PEPTH
Front To
5F3 •
it?' '17' ,sari' fr
Vt 1 7 • /'i/• tnsrCc.ir -
7. STATIC WATER LEVEL Below Top of Casing: '7O FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
'Top of casing terminated at/or below landsurface requires a
variance In accordance with ISA NCAC 2C ,0118.
9. YIELD (gpm)• So METHOD OF TEST �!rent�(,!^
10. WATER ZONES (depth): 3Ot7 • (l
LOCATION SKETCH
1 I. DISINFECTION: Type Hill Amount .. I" A- 5 Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads. Include the road
Depth Diapzter or Weight/Ft. Material numbers and common road names.
To_3 t Ft. In " 5./2$p3 7,, Pr
To Ft.
To Ft.
13. Depth
To r,r) Ft
To Ft.
Depth
From 0
From
From
GROUT:
From 1
From
Material
/s
4. SCREEN: Diameter
From To Ft. in
From To Ft. in.
5. SAND/GRAVEL PACK: _
Depth Size Material
From To Ft.
Method
Slot Size , Material
in.
in.
From To Ft.
D
fri
W
6. REMARKS:
DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED 1N ACCORDANCE WITH 15A NCAC 2C, WELL
ONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD H BEEN PROVIDED TO THE WELL OWNER
ste
SIGNATURE OF PERSON CONSTRUCTING THE WELL . DATE
ubmit the original to the Division of Water Quality, Groundwater Section, 1636 Mall Service Center -Raleigh, NC
1699-1636 Phone No. [phone], within 30 days. . OW -I REV. 07/2001
--
0

aied
g 16 "7
WELL CONSTRUCTION RECORD
di,tti.'.
North Carolina - Department of Environment and Natural Resources - Division of Water Quality- Groundwater Section� "
WELL CONTRACTOR (INDIV,IDUAL) NAME (print) ;hen 171 S / I (l.r\ rim � CEicTIFICATION # of 17 ye
WELL CONTRACTOR COMPANY NAMt J)nrC !kiwi I1le4 yti (p44 77wr I PHONEY 3"3 2
STATE WELL CONSTRUCTION PERMIT# .ASSOCIATED WOkERMITY $
(if applicable) .(if applicable) -- -
1. WELL USE (Check Applicable Box): Residential7YMunicipal/Public 0 Industrial 0 Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other LI If Other, List Use
2. WELL LOCATION: q� Topograp d setting
Nearest Town: n county A 1 Q L(h•C-' ❑Ridge ope ❑Valley ❑Flat
G/ ¶ —IDi nric/ Qia99e. QA-. dJI x LLi.Y1W (check appropriate box) \
(Street Name, Numben(Communk, Subdivision, Lot No., Zip Code) d, 9-7 43 Latitude/longitude of well location
3. OWNER: / 0 U ri l ZZ /
Address ,2 3.3 C 6 V e. t a h e
(Street or Route No.)
Egg nIeja.) .✓G a81Y3
City or Town Sum - Zip Code
- v _ o .a 4 9
Arca code- Phone number
4. DATE DRILLED IcPq�,� 4 -u sf
5. TOTAL DEPTH: 4400'
, (degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
Formation Description
DEPTH
From To
p `E4.•
4' -14•
yno•
D /1 c_
2_n i f--e"
LOCATION SKETCH
I I. DISINFECTION:,Type R'-t/%. Amount a TJI -I;'5 Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads. Include the grd
Depth Diameter or Weight/It. Mate' I numbers and common road names. O
From 0 To SG Ft. ha' 5..?2 (j,3 7 p `,-•• 7
From To Ft N
From To Ft.
13. GROUT: Depth Material Method - -o
From n To r Ft Coon dr7< po
From To Ft. cf?
Depth Diameter Slot Size , Material
To Ft. in. in. r-`O
From To Ft. in. in.
5. SAND/GRAVEL PACK:
Depth Size Material
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO Qlre
7. STATIC WATER LEVEL Below Top of Casing: l 6 FT.
/ (Use "t" if Above Top of Cuing)
8. TOP OF CASING IS / FT. Above Land Surface'
'Top of cuing terminated at/or below landsurface requires a
variance In accordance with ISA NCAC 3C.011L / /
9. YIELD (gpm)• a A METHOD OF TEST hl1 ei7f (f .
O. WATER ZONES (depth): SSA; 37A• (j
4. SCREEN:
From
From To Ft
From To Ft.
6. REMARKS:
DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
ONSTRUCTION STANDARDS, AND THAT A COPY OF TH S RECORD H S BEEN PROVIDED TO THE WELL OWNER
SIGNATURE -OF PERSON CONSTRUCTING THE WELL
is -it; - �
DATE
ubmit the original to the Division of Water Quality, Groundwater Section, 1636 Mall Service Center -Raleigh, NC
1699-1636 Phone No. [phone], within 30 days. OW -I REV. 07/2001

• 6
•
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
weLLCONTRACTOR(INDIVIDUAL)NAME (print) c l)enill S I4f)11QnA rU ` '•t CUTIPICATION# 01-
WELL CONTRACTOR COMPANY NAMir )4n(S bi Ilpyud Illel l )[jjj p .,r��- �n-e J PHONrc Ytat,Sa. Y-3 g
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED W ERMITY
(if applicable) (if applicable)
•
I. WELL USE (Check Applicable Box): Residential' unici•
pal/Public 0 Industrial 0 Agricultural p
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other C( 1f Other, List Use
0
2. WELL LOCATION:
LL/C./// County�nt Cn /j) graphic/Land setting
Nearest Town:
�T �I7 &Ridge ❑Slope ❑Valley ❑Fiat
I- 1
a EF L And ;Its Sri Ina. L bt.t}• - 5 (check appropriate box)
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code) a $141 Latitude/longitude of well location
3. OWNER: Lyr, O)Pnei Ro_iaQ.e'! - , (degraes/minuteslaeconds)
Address 90 a o R j-►+ S % De. 0 R • Latitude/longitude source:❑GPS❑Topographic map
(Street or Route No.) • (check box)
�eRR.y Ca. Sin4:09 DEPTH' DRILLING LOG
Chy or Town State Zip Code From To Formation Description
(tz£A- T/44..T2n 0 34• • i�_.
Area code- Phone number 3 ea • 12 _ Si,
4. DATE DRILLED /a-9—O'f "- ;,11-• t t Jt02__.
5. TOTAL DEPTH: 3 OS.
DOES WELL REPLACE EXISTING WELL? YES 0 NO 0---"
7. STATIC WATER LEVEL Below Top of Casing: Co p FL
(Use "t" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface'
*Top of casing terminated atior below laodaurface requires a
variance in accordance with ISA NCAC SC .O1I8.
9. YIELD (gpm): a 0 METHOD OF TEST
10. WATER ZONES (depth): /SO o??D'
LOCATION SKETCH
11. DISINFECTION: Type 1-P/1. Amount c-i 759-A S Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads, Include the rc9J
Depth Diapj �eter or We'i•ght/Ft. MatePy l numbers and common road names.
From 0 . To 71 Ft. h' S.bR./2 i, PY c n
From To Ft. C->
From To Ft. N
13. GROUT: Depth Material Method`
From n To rZ Ft. Cyyy1 4j. / pay A---)
From To FL
4. SCREEN: Depth Diameter Slot Size . , Material
From To Ft. in in.
From To Ft. in. in.
5. SAND/GRAVEL PACK:
Depth Size Material
From To Ft
From To Ft.
6. REMARKS:
DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
ONSTRUCTION STANDARDS, AND TH,(�AT� �A COPY OFTT/�H�I,SS RECORDyfDH BEEN PROVIDEDQTO THE. WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL . DATE
ubmit the original to the Division of Water Quality, Groundwater Section, 1636 Mall Service Center -Raleigh, NC
1699-1636 Phone No. [phone], within 30 days. . GW-I REV. 07/2001
o'er
rrt

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality
WELL CONTRACTOR (INDIVIDUAL) NAME (print) James B. Brown
WELL CONTRACTOR COMPANY NAME Hedden Brothers Well Drilling, Inc
305707
- Groundwater Section
CERTIFICATION # 2045
PHONE # j828) 369-9591
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential 0 Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATIO
Neares Town: i�/i, 1'.�i. County
(Street Name, Nu
3. OWNER:
Ad
t Q��tovJN . 33V70
c y V. 41
Area code- Phone number / / 0
4. DATE DRILLED vs
5. TOTAL DEPTH: (O60
hip Code
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:OGPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From " Formation Description
clay & sand
granite
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: `
(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 h ISA NCAC 2C .0118.
9. YIELD (gpm)• r':p METHO5QFIES BLOW
10. WATER ZONES (depth): ��(( LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
11. DISINFECTION: Type H T H Amount 16oz
12. CASING: Wall Thickness
" Depth Diyneter or Weight/Ft. Material
From C.)To ���Ft. (0 rn .40 ep
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From 0 To 20 Ft. be tonite 8 cement pumped
From To Ft. .
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size - Material
From To Ft.
From To Ft.
16. REMARKS:
I DO HEREBY CERTIFY TH THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STAN . a •., AND THAT A CO py OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
/o?-/-o <
SIGNATUKE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original 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
aea
305706
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) James 8. Brown CERTIFICATION # 2045
WELL CONTRACTOR COMPANY NAME Hedden Brothers Well Drilling, Inc PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable)
(if applicable)
1. WELL USE (Check Applicable Box): Residential El Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATIO �( —1
Na es �Tyyx1: /. I. II , // County r/
(Street Name, Nutgber§(fiommunity, Subdivision, Lot No., Zip Code)
3. OWNER: `r2 CiJO�X2, Address
City or Tow
Kd9)-%7b-- r/d
Area code- Phone number
4. DATE DRILLED s/ ,c . 01/
5. TOTAL DEPTH: 9 of �(
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO W,
7. STATIC WATER LEVEL Below Top of Casing: cDO FT,
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 2 FT. Above Land Surface*
Zip Code
*Top of easing terminated at/or below land surface requires •
variance In accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): PO* METH ,D OF TEST BLOW
10. WATER ZONES (depth): 910
11. DISINFECTION: Type H T H
12. CASING:
Amount 16oz
Wall Thickness
Dept Dieter or Weight/Ft. a erial
From To Ft.
From 3� To Ft
From To Ft.
13. GROUT: Depth
From 0 To 20
From To Ft. .
Material
Ft. benonite & cement
Method
pumped
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size - Material
To Ft.
To Ft.
From
From
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map -
(check box)
DEPTH DRILLING LOQ
From( To , • Formation Description
clay & sand
granite
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 15A NCAC 2C, WELL
CONSTRUCTION STARS, AND THAT A COPY F THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
//—/o —0 CG
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mali Service Center -Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-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) James B. Brown CERTIFICATION */ 2045
WELL CONTRACTOR COMPANY NAME Hedden Brothers Well Drilling, Inc
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable)
(if applicable)
PRONE # 028) 369-9591
1. WELL USE (Check Applicable Box): Residential D Municipal/Public 0 Industrial 0 Agricultural ❑
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATIO
Neafgst Town
County !//,4.1/47U
(Street Na(fjE, Numbers, Community, Subdivision, Lot NA., Zip Code)
3. OWNER:
Address %6
ski/fia--t/
lAtiAk(cif et or Roufe No.)
City or Town State
(8z8)- SAY- li0
Area code- Phone number ^, /
4. DATE DRILLED / / iz(9>•/i
5. TOTAL DEPTH: ege,00'
6. DOES WELL REPLACE EXISTING WELL? YES QQNO g
7. STATIC WATER LEVEL Below Top of Casing:
(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 aecordau5 Ith ISA NCAC 2C .ells.
9. YIELD (gpm): (Q MET Qp OF TEST BLOW
10. WATER ZONES (depth): Misr
'.
ha/
Zip Code
I I. DISINFECTION: Type H T H
12. CASING:
Depth / / !!II ,, Di meter
From To 01- Ft. f"
From tj' ' To / Ft. /,'
From To Ft.
13. GROUT: Depth Material Method
From 0 To 20 Ft. benonite 8.cement pumped
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft._in. in.
From To Ft._in. in.
15. SAND/GRAVEL PACK:
Depth Size - Material
From To Ft.
From To Ft.
Amount 16oz
Wall Thickness
or Weight/Ft. MalFrial
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds) ..
atitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG.
Formation Description
clay & sand -_
0 granite
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
16. REMARKS:
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STA . S, AND THAT A COP F THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
er nt_ -) // a2 9-40 >>
SIGNATU CIF 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
e_.
707

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) dames B. Brown
WELL CONTRACTOR COMPANY NAME Hedden Brothers Well [Kling, Inc
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMITS
(if applicable)
(if applicable)
CERTIFICATION # 2045
PRONE # f 828) 389-9591
1. WELL USE (Check Applicable Box): Residential El Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATI
Neare�t� o yn: /)( jn(} County/Mita j
(Street Name, Numbers, Community, Subdiv' ion, Lot No., Zip Code)
n n 4
3. OWNER:
Addres
City or To
V ' V
(Street o. Ron)
Area code- Phone number
4. DATE DRILLED
5. TOTAL DEPTH:
V
Zip Code
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 2 FT. Above Land Surface*
*Top of cuing terminated at/or below land surface requires a
variance In accordanfe tb 15A NCAC SC .0118.
9. YIELD (gpm): /�J ME,Tiiii,09 QF/T T BLOW
10. WATER ZONES (depth): `'`/f
11. DISINFECTION: Type H T H Amount leoz
12. CASING: Wall Thickness
From0Depth 2 Diameter or Weight/Ft. Material
To �3�Ft. [� ,r G1ye
From To Ft. —/—""
From To Ft.
13. GROUT: Depth Material Method
From 0 To 20 Ft, benonite & cement pumped
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 OFlat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:°GPS OTopographic tap
(check box) -
DEPTH DRILLING LOG
Front To 6 + Formation Description
J3, /
clay&sand -
granite
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 ISA NCAC 2C, WELL
CONSTRUCTION STAiW 4RDS, AND THATACOPY 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
305704
•

WELL CONS RUCTION_ RECORD
�V1 1ek co F�
North Carolina - Department of Environment an Na ral Res urces -Division of Water Qualiiy - Groundwater Section _
WELL CONTRACTOR (INDIVIDUAL) NAME net) 'Tj)K>eT''7CERTIFICATION # (7 5
PHONE # (64) 71;2- )78
WELL CONTRACTOR COMPANY NAME
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED W(fERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential Er 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: r4, " /l r 4.4 S County / I (n teed
Lakra$kQ hi Semi Nit, o2S77s
(Street Name, Numbers, Community, Subdivision, Lot No., ip Code)
3. OWNER: j9'.P^/T�S Cie',
Address r d ic'» 75
(Street or Route No )
se,,,ay Mr r-Lr 2t7?5'
City or Towel State Zip Code
Area code- Phone number / �/
4. DATE DRILLED / - / / - U 7
5. TOTAL DEPTH: 1 7 '
6. DOES WELL REPLACE XISTING WELL? YES 0 NO 0
7. STATIC WATER LEVEL Below Top of Casing: (j d ` FT.
ti (Use `+" if Above Top of Casing)
8. TOP OF CASING IS it Isf FT. Above Land Surface*
'Top of casing terminated at/or below land surface requires a
variance in accordance ith ISA NCAC 2C .0118. %
9. YIELD (gpm): METHOD OF TEST /
10. WATER ZONES (depth): 1a0
11. DISINFECTION: Type j4-4.-1 Amount tics.
12. CASING: Wall Thiclmess
Depth.)�Diameter or Weight/Ft. NI erial
From To
c/re,b Ft. , S,(1/td/ U
From To Ft.
From To Ft.
13. GROUT: Depth
From 4 To r) 0
From To
14. SCREEN: Depth
From To
From To
15. SAND/GRAVEL PACK:
From
From
Depth
To
To
16. REMARKS:
Ft.
Ft.
Method
Diameter Slot Size Material
Ft. in. in.
Ft. in. in.
Ft.
Ft.
Size Material
Topographic/Land setting
l l+tdge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
0
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
Formation Description
DEPTH
From To
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Includ
numbers and common road names.
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AN TIJAT, • COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
/ 2-i/- 0V
DATE
SIGNOF 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. 0712001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Russell S. Taylor CERTIFICATION # 2187
WELL CONTRACTOR COMPANY NAME Hedden Brothers Well Drilling, Inc
306862
PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable)
(if applicable)
1, WELL USE (Check Applicable Box): Residential ® Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATIO
Nearest Town:
County //14.r,R)1/4—.)
(Street Name, Numbers, Comm ity, Subdivision, Lot No. Zip Code)
3. OWNER:
Address
rtreat or Route No.)
dWJ , NC 07873g
City or TowState,Zip Code
(&)- 3 -lao5
Area code- Phone number
4. DATE DRILLED / / ' /0'
5. TOTAL DEPTH: 3oa 5 /
6. DOES WELL REPLACE EXISTING WELL? YES 0 0
7. STATIC WATER LEVEL Below Top of Casing: FT.
(Use "+" if Above Top of sing)
8. TOP OF CASING IS 2 FT. Above Land Surface
*Top of casing terminated at/or below land surface requires a
variance in accord cewith 1SA NCAC 2C .0118.
9. YIELD (gpm): r- METHOD OF TEST BLOW
10. WATER ZONES (dept :
11. DISINFECTION: Type H T H
12. CASING:
^ Depth
From tJ To
FrotruZAL. To
From To Ft.
13. GROUT: Depth
From 0 To 20
From To
14. SCREEN: Depth
From To
From To
15. SAND/GRAVEL PACK:
Amount leez
Wall Thickness
Di eter or Weight/Ft. Material
at eri l
Ft, w
(8t 5tee0
Material Method
Ft. benonite & cement pumped
Ft.
Diameter Slot Size Material
Ft. in. in.
Ft. in. in.
Depth Size Material
From To Ft.
From To Ft.
Topographic/Land setting
❑Ridge ❑Slope 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 / Formation Description
clay & sand
33' 3' granite
LOCATION SKETCH
Show direction and distance in miles from atst
two State Roads or County Roads. Include the/Mad
numbers and common road names. c.-
ra
-TY
CJ
GI
0
16. REMARKS:
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION S, AND HAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
GNATURE OF PERSON CONSTRUCTING THE WELL
DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001.

150 306864
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) James B. Brown
WELL CONTRACTOR COMPANY NAME Hedden Brothers Well Drilling, Inc
CERTIFICATION # 2045
PHONE # f 828) 369-9591
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable)
(if applicable)
1. WELL USE (Check Applicable Box): Residential in Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATIO ,�J//
Neare$ Town: County/%��ttc
(Street Name, Nu,•e ommunity, Subdivision, Lot No., Zip Code)
3. OWNER:
Address fe
a(^craft or Route No.)
�.�/. IJL
City or Town S1
Area code- Phone number
4. DATE DRILLED fI % ' 0
5. TOTAL DEPTH: QOD'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO k
7. STATIC WATER LEVEL Below Top of Casing: 500 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 accordapcIth ISA NCAC 2C .0118.
9. YIELD (gpm): 1'.5 METAL) OF TEST BLOW
10. WATER ZONES (depth): `(
ed
'873y
Zip Code
11. DISINFECTION: Type H T H
12. CASING:
Amount 16oz
Wall Thickness
Dept�j� Djam,ter or Weight/Ft. enal
From To LOD Ft. (.P
From8 To3.(_ Ft._ oL . !hi'
From To Ft.
13. GROUT: Depth Material
From 0 To 20 Ft. benonite & cement
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
pumped
From To Ft.
From To Ft.
Topographic/Land setting
ORidge ❑Slope OValley °Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:OGPSOTopographic map
(check box)
DEPTH DRILLING LOG
From Tp„ , Formation Description
clay & sand
granite
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 15A NCAC 2C, WELL
CONSTRUCTION STAN t:.t.s S, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE F PERSb CONSTRUCTING ONS1 TR TING THE WELL DATE
4.2-,2--0 V
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. 07/200I:

�� /1
WELL CONSTRUCTION RECORD (J 3 0 7 2 21
11. DISINFECTION: Type CHLORINE Amount 100 PPM
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 120 Ft. 6 1/8" SDR 21 PVC
From To Ft.
From To Ft.
13. GROUT: Depth Method
From 0 To 20 GRAVITY
From To Ft.
14. SCREEN: Depth
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
From Ft.
From
Depth
To
To Ft.
16. REMARKS:
Size
North Carolina Department of Environment and Natural Resources - Division of Water Quality
WELL CONTRACTOR (INDIVIDUAL) NAME (print) WILLIAM BRADLEY LEWIS CERTIFICATION # 3368
PHONE # f 904) 837-8008
WELL CONTRACTOR COMPANY NAME CHEROKEE WELL DRILLING AND PUMP COMPANY,INC.
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): ResidentialXi Municipal/Public ❑ Industrial O Agricultural °
Monitoring 0 Recovery ° Heat Pump Water Injection ❑ Other O If Other, List Use
2. WELL LOCATION: _
Nearest Town:Sea /° ' 'county MACON
E. SILVERMINE RD. TO WILKES RD.
(Street Name, Number, Community, Subdivision, Lot No., Zip Code)
3. OWNER: LON OGDEN
Address 405 PERIWINKLE PLACE
(Street or Route No.)
JACKSONVILLE, FL 32259
City or Town State Zip Code
(904 )- 254-8386
Area code- Phone number
4. DATE DRILLED 12-28-2004
5. TOTAL DEPTH: 445'
6. DOES WELL REPLACE EXISTING WELL? YES ° NO O
7. STATIC WATER LEVEL Below Top of Casing: 100 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING 1S 1 FT. Above Land Surface"
•Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .01Ifl
9. YIELD (gpm): 6 METHOD OF TEST AIR
10. WATER ZONES (depth):
Material
Ft. CEMENT
Diameter Slot Size
in.
in.
Material
Material
Topographic/Land setting
CRidge El Slope °Valley °Flat
(check appropriate box)
Latitude/longitude of well location
3518.393N/8336.131W
(degrees/minutes/seconds)
Latitude/longitude sourcelOGPSOTopographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
0' TO 20' RED DIRT/GRAVEL
20' TO 40' BOULDERS/ROCKS
BROWN DIRT
40' TO 100'
100' TO 120'
120' TO 405'
GRANITE
GRANITE
LOCATION SKETCH
Show direction and distance in miles from at (east
two State Roads or County Roads. Include the road
numbers and common road names.
us I
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT COPY OF TH REC a R a HAS BEE i' OVIDED TO THE WELL OWNER
N
r9
SIGNATURE OF PERSON •NSTRUC f G T E WELL
DATE
Submit the original to the Division of Water Quality, Attn: Information Management, 1617 Mail Service Center -
Raleigh, NC 27699-1617, Phone No. [phone], within 30 days.
GW-1 REV. 09/2004
CO
0
0
c.

2. WELL LOCAT
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print)G,r/7 /7 Ss''n irWle j'
WELL CONTRACTOR COMPANY NAME fl='/'/Y vP// Y /` L/4n /r/> PHONE # (fi➢' `J » t t•
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PEILMIT#
(if applicable) (if applicable)
CERTIFICATION # 7'7e1/1
1. WELL USE (Check Applicable Box): Residential 0 Municipal/Public ❑ Industrial ❑ Az. 'cultural O
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 OtherIf Other, List Use Gam'[® g"*3
0
Topographic/Land setting r�
❑Ridge ❑Slope ❑Valley ❑R
Nearest Town: County Mtra-9z
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: 0() SPA colour)) pN,J t
Address �t/:5 (?si4 -
(Street or Route No.)
City or Town State Zip Code
( )-
Area code- Phone number
4. DATE DRILLED 7 - lJ ,0
5. TOTAL DEPTH:.7e71.
6. DOES WELL REPLACE EXISTING WELL? YES_ 0 NO ❑
7. STATIC WATER LEVEL Below Top of Casing:'3 U 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.Ot IS.
9. YIELD (gpm): C METHOD OF TEST 0.-Ot-
10. WATER ZONES (depth): I/1 v 71 /i C7
11. DISINFECTION: Type
12. CASING:
Depth Diameter
From 0 To/i .7- Ft. 6:
From To Ft.
From To Ft.
Amount
Wall Thickness
or Weight/Ft. Material
13. GROUT: Depth Mate ial
From 0 To 9-7-
Ft/ ,
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size
From To Ft.
From To Ft.
16. REMARKS:
(check appropriate box)
Latitude/longitude of well iocatiotj
r
(degrees/minutes/seconds) tO
Latitude/longitude source:❑GPS❑Topographic maps
(check box)
DEPTH DRILLING LOG
From To Ff rmation Description
iQ •//JCJ
/r%' '1t' lffrrza.!'_
n'4/ 7e-4 d/ cer."-rtt"
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.
Method '4t .G
Slot Size Material
in.
in.
Material
yet, /e'
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTIONSTANDARDS, D THAT OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
7 -/c`opt-
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

292'701
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resourcesur+- Division of Water Quality - Groundwater Section
p�p
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Q'Et-U"S a Q eau -et CERTIFICATION # 4'rr?`� 1
WELL CONTRACTOR COMPANY NAME lTssrl \U. ""UU tP G) PHONE # IM)3�--tISS
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable) --- --'-'
1. WELL USE (Check Applicable Box): Residential (hT Municipal/Public ❑ Industrial ❑ AgictJllura1 E3—
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATI N_
Nearest To
(Street Name, Numbe
_nty
m,nity, Sy`bd'vision, Lot No., Zip Code)
Intl(
4dgopographic/Land setting
e ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
3. OWNER: (degrees/minutes/seconds)
Address D Latitude/longitude source:❑GPS❑Topographic map
(cheek box)
DEFT DRIL�O
From To i
' Fo
o'
I Coto' ill'
5. TOTAL DEPTH: ail
6. DOES WELL REPLACE EXISTING WELL? YES ❑ IiO
7. STATIC WATER LEVEL Below Top of Casing: 15 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 accord nce with 1SA NCAC 2C .0118.
9. YIELD (gpm): METHOD OF TEST
10. WATER ZONES (depth): W'
11 1tft%
1(o sie No.)
aQ(City r Town State
Area code- Phone number 1
4 DATE DRILLED
11. DISINFECTION: Type A
12. CASING: Wall Thickness
Depth , Iji�uneter o igght/Ft. at 'al
From h To 1. La Ft ldt•r442.9
From To Ft.
From To Ft.
13. GROUT: Depth cu Ma eiia
From n To (oco Ft.
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size
From To Ft.
From To Ft.
16. REMARKS:
Amount
Slot Size
in.
in.
Material
rn Z
t? m=
LOCATION SKETCH tV
Show direction and distance in miles from atkast oZ
two : tate Roads or County Roads. Include the roan
nu s and common road names.
kCk
T
Tt u�G
ff
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUL I ED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE LL R
SIGNATURE OF PERSON CONSTRUCTING THE WELL D
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

JUN-14-2006 01:18 FROM:HRYESUILLE WELL DRIL 8283899155
TO:16282997043 P.3
WELL CONSTRUCTION RECORD
Not* Carolina - Depathnem of Environment and NMI! Reeomces - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (ItD11'NAMEDAL) NAME (pelt) ,"'tLLL RYA .-T'E€Yt'L% c6RlvrcxTort*OPP
wtyCpr}TRACFOR COMPANY NAME }i'1R"fEetltll %at-U:1LL,I MC) PHONE •ORSaRet$i5Sr
STATE WILL CONSTRUCTIONPERMRe ASSOCIATED WQ PERMITS
(ihpplicabk) (if appgaable)
1. WELL USE (Cheek Applicable Box): Residential 13 Municipal/Public D Industrial D Agricultural O
Monitoring D Recovery D Heat Pump Water Injection D Other ❑ If Other, List Use
muse
3. OWNER r `C(derscalmiaareaame)
Address s i tatltuddlongitudoo eouroo:QGPSDFopoWaphic map
face kail
DEEM DRflLING14DG
E D Coy From To F Rion Description
,1 d �
Midge DSlloop ElVafeyOFlat
(clack appmp alebox)
Latitude/longitude dwell location
Area cods- Dam ember
4 DATBDRE1.BD
5. TOTAL DEPTH.
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO L9/
7. STATIC WATER LEVEL Below Top of Casing: (27 FT,
(Om-40 Venom Top attain)
8. TOP OF CASING IS l FT. Above Land Suites
flop Wadeslawtntmd sear below Ind mine mantra
vWaea b awed whit ISA NCAC IC .e11a.
9. YIELD (Spun): METHOD OF TEST MIA"
10. WATERZONES(depth): \
11. DISINFECTION: Type Amountotom,
12.CASING: Wall >�+ t
prom
m V Ft . s1
Front Tt?_ Fr
room _ To Ft
13. GROUT•. Uapth M wristFimn__/,? Tu (o t_
Front To Ft
14. SCREEN: Depth
Diameter Slot Sim M
et
e
rs-
gw,m To Ft.__.jn. _ in.
From To Ft fin. _ in
15. SAND/GRAVEL PACK:
Deptk Sine Material
From To Ft
From To Ft
16. REMARKS:
l f7t' r1s4
i"l5' °Jo5t
CATION gr(rrrr li
Show direction and distance ill miles from at
two State Roads or County Road:
numbers and eaunnon mad names.
0'5'
Wtf CA .
road
inn,e&p oz.
I DO HEREBY CERTIFYTHAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITS 15ANCAC 2G wEl.
CONSTRUCTION ST AND THAT ACOPY OF THIS RECORD HAS BEET PROVIDED TO tFt43 OWNER
Lize4n4 4. it- A
SIGNATURE OF PERSON CONSTRUCTING THE WELL 11 DATE
Submit the erdgloil to the Division of Water Quality, Groundwater Section, 1636 Mall Service Center- RR NEV. C
01
27699.1636 Panne Ne. [phone], within 30 day:
JUN 14 2006

29973Q
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) i l /L no 5 I �r) j it QM rl. CERTIFICATION # a.l7 If
WELL CONTRACTOR COMPANY NAMECTXI }sq (ciP Tiara lliPavvli"1r .roe i PHONE 70 ..Sa.4-3 �6
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ-PERMITH
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residentiafid�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: Id -•' 7I'IC L r Al county 0 to)t_,
(r4C,L Il:,J4y Grillo,. rn-0--1-)
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code) c,2c % 3 t f
Area code- Phone number [,�
4. DATE DRILLED 0 —/ 7 —0 /
5. TOTAL DEPTH: e+VSt''
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing:f) FT.
(Use "+" if Above Top of Cuing)
8. TOP OF CASING IS / FT. Above Land Surface•
•Top of casing terminated atior below land surface requires a - - - -
variance In accordance with I5A NCAC 2C .0118.
9. YIELD (gpm): a METHOD OF TEST it»!),7L/,f—.
10. WATER ZONES (depth): .Q•O.5 J �/1 " (�
Topographic/Land setting
e DSlope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
3. OWNER: 7--e r e Sr FCC (} It -e 4 -e— (degrees/minutes/seconds)
Address �/-I -7—RI—/-N— 1- ', II Latitude/longitude source:❑GPS❑Topographicmap
(Street or Route No.) (check box)
frc :R4r(L LJ A/ 4.(C -- ,JQ C 13 `i PRILLING LOG
City or Town State Zip Code Formation Description
(i=ail- 4/- I - 7 OW r I 6,
S!t n5
DEPTH
From To
0 3 7 •
.31' WI'
(C!s'
LOCATION SKETCH
I I. DISINFECTION: Type H-/'f% Amount o1.T4. S Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads. Include the road
Depth Diapcter or Weight/Ft. Mate, l numbers and common road names.
From 0 To lc I) Ft. /o" S.jzg,�j Pr To Ft.
From To Ft.
13. GROUT: Depth Material Method
From i) To ri'(i Ft. CPm )A pQA)
From To Ft.
14. SCREEN: Depth
From To
From
Diameter Slot Size Material
Ft. in. in.
To Ft. in. in.
3a
15. SAND/GRAVEL PACK: - _ Q
Depth Size Material - _
From To Ft. iD
From To Ft.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF TH S RECORD HAS BEEN PROVIDED TO THE WELL OWNER
Ordi I ervfru
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, I636 Mall Service Center- Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

29Cw
9
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) ib-enoi 5/InnQnh A CERTIFICATIONS Din le
WELL CONTRACTOR COMPANY NAMICbeh)jf S 1de1)0 girl 111P., I1)1fer TN4,:fr u PHONES way-3 �6
STATE WELL CONSTRUCTION PERMITS ASSOCIATED W ERMITS
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential % unicipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: C' 77% 4/ C- County inn (fop
44-I .S: e'Nr Crrnm.
(S«eei Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: IL Ck IIt�S
Address 5 / 0 0 (Zu, R eI
(Street or Route No.)
1- h 0_11V.. Iv A/�
73g-
City or Town State Zip Code
Area code- Phone number
4. DATE DRILLED •) -' 11 —y' ct
5. TOTAL DEPTH: -3 7,5
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO IZ1-
7. STATIC WATER LEVEL Below Top of Casing: .2 rm FT.
(Use "+" if Above Top of Cuing)
8. TOP OF CASING IS / FT. Above Land Surface*
•Top of cuing terminated at/or below land mrface requires ■
9. YIELD (gpm): / 5 METHOD OF TEST_ .Stifvariance In accordance with 15A NCAC 2C .0118.
10. WATER ZONES (depth): 2•a3 (�
Topo aph d setting
o ❑Ridge rOS1 pe ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude sources❑GPS❑Topographic map
(check box)
DRILLING LOG
Formation Description
0 /0 1
R L Lei. C /e /41', ,
DEPTH
From To
s� 375
LOCATION SKETCH
11. DISINFECTION: Type %! i"» Amount ,4 T A 1; 5 Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads. Include the road
Depth / Diap�eter or Weight/Ft. Mate 1 numbers and common road names.
From 0 To �Sll Ft. /0 S.jbg,3I 0 r_
From To Ft.
From To Ft.
13. GROUT: Depth
From n To r t Ft.
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
Material
CQma
Method
prnA
Slot Size - Material
_ in.
in.
15. SAND/GRAVEL PACK: - _
Depth Size Material
From To Ft.
From To Ft.
zaai
0
eJD
16.REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF TH S RECOBEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mall Service Center -Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. OW -I REV. 07/2001

2987'28
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources1- Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIYIDUAL) NAME (print) cl)-e 11 Y)IS '+" (Jam CERTIFICATION M oZ/7 Y'
WELL CONTRACTOR COMPANY NAMIS gn1S 0101)Q.04 I/)elItltfr 1171445.r'I'K(r) PHONE M i0 .Sea4"3 l66
STATE WELL CONSTRUCTION PERMITM ASSOCIATED W liVERMITI/
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residentia[Q 1 unicipal/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: Tr- rQAA, Lt/L/ County&tifCN�1
((.. l- S'f 6-4.c.hirC 0_h. fZc 73 if
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER:�,I) i C.k . 'c a)e ° I
Address 33// p2film ZLA
(Street or Route No.)
F,e,*�.u/ I4/ 4/ e- �"13 �
City or Town State Zip Code
(R2 V 3/" — $5; �1- --
Area code- Phone number
4. DATE DRILLED •3 -/ E`'69
5. TOTAL DEPTH: _ jC- S
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 173-----f
7. STATIC WATER LEVEL Below Top of Casing: CI FT.
(Use "+" if Above Top of Cuing)
8. TOP OF CASING IS / FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance In accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): / :1 METHOD OF TEST Jiro
10. WATER ZONES (depth): t
ographic/Land setting
edge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH pRILLINGLOG
From To Formation Description
(r• 3 ' C I n,.11
✓2YL_)lf. C(_i rt
? L L C (,.- 2 4 4,-, r -t-
1�3'
i ia• AoS
1I. DISINFECTION: Type /It
12
CASING:
Depth
From el To II 2_ Ft
From To Ft
From To Ft
13. GROUT: Depth
From n To ,- {7 Ft
From To Ft
14. SCREEN: Depth
From To Ft
From To Ft
15. SAND/GRAVEL PACK:
LOCATION SKETCH
Amount 4 %fi k S Show direction and distance in miles from at least
Wall Thickness two State Roads or County Roads. Include the road
Diapieter or Weight/Ft. Mateiit numbers and common road names.
Material Method
Diameter Slot Size Material
in. in.
in. in.
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
a
0
t0
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 H j5 BEEN PROVIDED TO THE WELL OWNER
ap
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the 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

298120
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality • Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Mitchell D. Cook CERTIFICATION k 2043
WELL CONTRACTOR COMPANY NAME Hadialacelacs ' r[llirgt PHONE k 132S) 369-9591
SATE ATE WELL CONSTRUCTION PERM ITH ASSOCIATED WQ PERMIT#(if applicable)
(if applicable)
I.
2.
WELL USE (Check Applicable Box): Residential ® Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
Topographic/Land setting,'
❑Ridge ❑Slope ❑Valley ❑Flat
- (check appropriate box)
Latitude/longitude of well location
WELL LOCATION:
Nearest Town: Franklin County Macon
South Skeenah
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: Pete & Lori Ray
Address 232 Marion Thomas RA
(Street er Route No )
Franklin, NC 28734
- City or Town State Zip Code
(32-8.)- 524-9785
Area code- Phone number
4. DATE DRILLED 3-1-04
5.TOTAL DEPTH'. 175'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO f
7. STATIC WATER LEVEL Below Top of asin:50 FT.
(Use" Top ofg)
8. TOP OF CASING 1S 2 FT. Above Land Surface'
'Top of casing terminated at/or below land surface requires a
variance In accordance with 15A NCAC 2C .0118. blow9. YIELD (gpm): 40 NIETHOD OF TEST
10, WATER ZONES (depth): 160'
11. DISINFECTION: Type H T H
12. CASING:
Depth Diameter
From_0—_ To 83 Ft" 6"
From $i' To $7 Ft. 6"
From To Ft.
13. GROUT: i Depth Nlaterial Method
From 0 To 20 Ftba'mite & cblt+LL tame
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. i in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Amount 1 6oz
Wall Thickness
or Weight/Ft. Nlaterial
pvc
.188 teem
16. REMARKS:
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
0 85' clay & srd
85' 175' granite
LOCATION SKETCH'
Show direction and distance in miles from at least
two State Roads or County Roads. Include the roan
numbers and common road names. o
.C-•
2m
?rn
r?•<
>m
ara
3 70a
l0
a
A
1
CO
N
cn2
n21
O
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
-�-oaf
DATE
SIGNATURE 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-I REV. 07/2001

298111
WELL CONSTRUCTION RECORD
North Carolina • Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Mitchell D. Cook CERTIFICATION k 2043
WELL CONTRACTOR COMPANY NAME HaCEEn; mECS Veil -11 1 r lit PHONE k [phone]
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
I. WELL. USE (Check Applicable Box): Residential 25 Nlunicipal/Public ❑ industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: Otto County Macon
John Teague Rd to Taylor RA
(Street Name, Number, Community, Subdivision, Lot No. Zip Code)
3. OWNER: Vicki Mason
Address PO Box 725
(Street or Route No.)
Otto NC 78763
City or Town State Zip Code
(828)- 349-0367
Area code- Phone number
4. DATE DRILLED 2-25-04
5. TOTAL DEPTH: 500'
6. DOES WELL REPLACE EXISTING WELL? YESU NO ❑
7. STATIC WATER LEVEL Below Top of Casing: 300 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. blow
9. YIELD (gpm): 6 METHOD OF TEST
10. WATER ZONES (depth): 440'
I1. DISINFECTION: Type H T H
12. CASING:
Depth Diameter
From_Q_ To 66 Ft. 6" L"'C
From 66' To 70 Ft. 6" _jag teel
From To Ft.
13. GROUT: Depth Material Method
From 0 To 20 Ftl:enhite &beret ruired
From To Et.
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:
Amount 16oz
Wall Thickness
or Weight/Ft. Material
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:DGPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
0 68' day& sani
68' 900' granite
LOCATION SKETCH
Show direction and distance in milesfromat least
two State Roads or County Roads. Include the road
numbers and common road names. p o
3
CO
3
LO
rV
r
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
?1-,/trYte2& .2 -- S - o 174
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
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298334
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources
WELL CONTRACTOR (INDIVIDUAL) NAME (print) LARRY F. JONES
WELL CONTRACTOR COMPANY NAME CHEROKEE WELL DRILLING AND PUMP COMPANY, INC
Division of Water Quality - Groundwater Section
CERTIFICATION it 3295
PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential El Municipal/Public 0 Industrial O Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: TOPTON County MACON
78 MOM FALLS RD, TOPTON, NC 28781
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: FAYE ABLER
Address W 141 N 6633 FLORENCE AVE
(Sheet nr Route No.)
MENOMONEE FALI WI 53051
City or Town State Zip Code
( 262 )- 252-3378
Area code- Phone number
4. DATE DRILLED 03-19-2004
5. TOTAL DEPTH: 425'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: 90 FT
(Use "1-" if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surfaces
"Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 10 METHOD OF TEST AIR
10. WATER ZONES (depth): 380.
1 I. DISINFECTION: Type CHLORINE
12. CASING:
Depth
From 0 To 132
From To
From
13. GROUT:
From 0
To
Depth
To 20
From To
14. SCREEN: Depth
From
From To
15. SAND/GRAVEL PACK:
Depth
From To Ft.
From To Ft.
Ft.
Ft.
Ft.
Material
Ft. CEMENT
Diameter
6 1/8"
Amount 100 PPM
Wall Thickness
or Weight/Ft. Material
SDR 21 PVC
Ft.
Diameter Slot Size
To Ft. in.
Ft. in.
16. REMARKS:
in.
in.
Size Material
r
O
r
Topographic/Land setting
El Ridge 0Slope ❑Valley ❑Flat
(check appmpriale box)
Latitude/longitude of well location
3515.465N/8339.172W
(d<pees/mi nutes/seconds)
Latitude/longitude source:®GPSOTopographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
0' TO 20' BLACK DIRT
20' TO 60' SAND As GRAVEL
60' TO 100' GREY GRANITE BOULDEF
100' TO 132' GRANITE
132' TO 425' GRANITE
in
a
LOCATION SKETCH cri
7.
Show direction and distance in miles from aleast� rn
two State Roads or County Roads. Include the roa-,(7;
numbers and common road names. m o
n
NZ
r-x
o --t
C G
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF T IIS REC D HAS BEEN PROVIDED TO THE WELL OWNER
S[S NATURg FPERSOIYCON>3fitUC INGTIIF. WELL
3 -17-at
DATE
Submit the original to the 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

298340
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIYIDUAL) NAME (pent) 1)-e 11 via finI 1 ay, rh CERTIFICATIONS/ oZ/74
WELL CONTRACTOR COMPANY NAME / hnl i jl2rrt Ik d n e 1' PHONE # �_.Sa 4 —3 a b 6
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WIPPERMITIl
(if applicable)
(if applicable)
I. WELL USE (Check Applicable Box): Residentiaf2YMunicipal/Public 0 Industrial ❑ Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: FJ94.tt k LC 4/ County A4 (>E GOYv
CIOt -tks Cha el-CtcIeher7 2,1 _ Cu 1 lelz
(Street Name, Number's, Community, Subdivision, Lot No., Zip Code) '(/ j ./ C✓
.-a173y
3. OWNER: L et) in DO YL 2
Address (C I CI free_-h.pyri (sod
C U 12 (Street or Route No.)
11-eI;C Ott.
Do
S.3
City or Town State Zip Code
(90C)- 'I 17 W - _3k9
Area code- Phone number
4. DATE DRILLED 3 — I % —0 r/
5. TOTAL DEPTH: 1 155
jitatraphic/Land setting
ORidge ❑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
h C1-• V P t rit
c(-t?t It55 %�I ue_ Jr RApt'11--c-
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO Q3-
7. STATIC WATER LEVEL Below Top of Casing: ('Co FT.
(Use "+" if Above Top of Cuing)
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 .0I13.
9. YIELD (gpm): _ 3 METHOD OF TEST Ij/Ul?tlft }-.
10. WATER ZONES (depth): "D(rC " (1
LOCATION SKETCH
,4
I I. DISINFECTION: Type fly Amount .-2T,4I 5 Show direction and distance in miles framat Icasg
12. CASING: Wall Thickness two State Roads or County Roads. Inch ye the i U
Diameter or Weight/Ft. Mate I numbers and common road names. �.=`,
n` YCi yc
m
GI=
rn:a
c�
G
From
From
From
Depth
0 To CI- 3 Ft. - E,,T% O
To Ft
To Ft.
13. GROUT: Depth Material
From n To r- D Ft. �yr WI --
From To Ft.
14. SCREEN: Depth Diameter Slot Size • Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK: _
Depth Size Material
To Ft.
To Ft.
From
From
LO
0
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
0
Method
pay
3—/ 1- Ci V
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the 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

298229
1-Qrk I nJ ,L c
City or Town State Zip Code
(Eli). �3 e: `7 — <13
Area code- Phone number
DATE DRILLED _3 -4 — Q f1
TOTAL DEPTH: • -.5c'
'734
japegraphic/Land setting
QJ edge ❑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
rr '7' 0 / a1
7' .5 7, •5 and G'fntcv
5"7' • 25e- /3/-L'g G- RAI t re_
DOES WELL REPLACE EXISTING WELL? YES 0 NO 3�
STATIC WATER LEVEL Below Top of Casing: / C FT.
(Use "+" if Above Top of Cuing)
8. TOP OF CASING IS / FT. Above Land Surface*
Top of casing terminated at/or below land surface requires a
variance In accordance with 1SA NCAC 2C Al1a.
9. YIELD (gpm): .-2 O METHOD OF TEST I hUIUy7L(}�
10. WATER ZONES (depth): // 5' (�
1 1. DISINFECTION: Type
12. CASING:
From
From
From
13. GROUT:
From (3
LOCATION SKETCH
i141-/ Amount r. TA- $ Show direction and distance in miles fralirat lean
Wall Thickness two State Roads or County Roads. Ind
Depth Dia eter or Weight/Ft. Mate ' I numbers and common road names.
V To .57 Ft. k` saR,ff Dr
To Ft.
To Ft.
Depth
To r9V Ft.
To Ft.
Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size
From To Ft.
From To Ft.
From
14.SCREEN:
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Sectionn
WELL CONTRACTOR (INDIYIDUAL) NAMEj��(print) %be nIII 5 fin / I2,A rli CERTIFICATION IS c- /74'
WELL CONTRACTOR COMPANY NAMIEbP,I C J�OfI(Z,ra II)PIl44lYet ll-ue( 7s'le lz PHONE# 7%1 S24-3 �-6
STATE WELL CONSTRUCTION PERMITS/ ASSOCIATED W ERMITS/
(if applicable)
(if applicable)
1. WELL USE (Check Applicable Box): Residentia(Ld—'Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATIO '
Nearest Town: PX'4 4/,�Li Al County MaL[-'72_7
i
.>QN L'•t�t.rTQcx-(!i;itm.) Pa-�_ 1I
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code) ,J
3. OWNER: ItP1 r n !:�,0 cr
Address / 3�S / erla_j/l,z_'IZx+.
(Street or Route Nd)
4
5
6
7
Material
C0?T e7+7
Slot Siz
Method ,
e
in.
in.
Material
Material
.v
3
W
0
r
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF TH S RECORD H S BEEN PROVIDED TO THE WELL OWNER
Or a 0 3-ate-
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
G
Submit the original to 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 Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR(1NDIYIDUAL) NAME (print)c7)i n Y1 i5ti-n!1'QM rti CERTIFICAT,I/ON*/ 0Z174a
WELL CONTRACTOR COMPANY NAME: h)jj i J�lln,r4 Wei I j y' j 1 :l<d_ Tn.P � PHONE */ IU yj ate-3 g b
STATE WELL CONSTRUCTION PERMITH ASSOCIATED W1143PERMIT$
(if applicable) (if applicable) ..,._
WELL USE (Check Applicable Box): ResidentiaFO-%iT icipal/Public 0 Industrial 0 Agricultural 0
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town:( E d,2let's 19/ County A'IaCBIv
Cr4-LLI LL'aL oLK. 2<? r?k 93
(Street Name, Numbers, Codunonity, Subdivision, Lot No., Zip Code)
3. OWNER: Cre 2 2 (L)a e
Address %0-'�/i -6Ce_,n rtc. %Yrr ,' - 6'1✓1
(Street or Route No,)
L 11 }kCor?L_ i=r Y-02a-t/-
CAy or Town State Zip Code
(951)- { 7S- 1 7.37
Area code- Phone number
4. DATE DRILLED e-) s --b
5
6
7
TOTAL DEPTH: // ('h'
DOES WELL REPLACE EXISTING WELL? YES 0 NO Q1—
STATIC WATER LEVEL Below Top of Casing: .O r 1 i FT.
(Use "a" if Above Top of Cuing)
8. TOP OF CASING 1S / 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): / D METHOD OF TEST h/019/- —,
10. WATER ZONES (depth): ,� 5
LOCATION SKETCH
1 I. DISINFECTION: Type Hill Amount c>1 %A-1; 5 Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads. Include the road
Depth e.-.,cy Diameter or Weight/Ft. i 1 Mate numbers and common road names.
From 0 To /a Ft. fr' 5.aE,,/ Pr
From To Ft
From To Ft.
U. GROUT: Depth Material Method
From (5 To 40 Ft.__Carn „71 p(T),1
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
298376
Topograp and setting
DRidge ope ❑Valley DFlat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
.5.5'
4-r
q). LtCiO'
F
15. SAND/GRAVEL PACK:
Depth
From To
From To
Ft.
Ft.
Size Material
O
CO
01
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF TH 'S RECORD H jS BEEN PROVIDED TO THE WELL OWNER
1;y }I Q C(natiu�OLr 3-5- o
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mall Service Center -Raleigh, NC
27699-1636 Phone No, [phone], within 30 days. OW -I REV. 07/2001
TL
0

Depth -
From 0 To / S
From To
From To
13. GROUT: Depth
From n To
From To
14. SCREEN: Depth
From To
From To
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIYIDUAL) NAME (print) xbenhls I /12n rt CERTIFICATION of /7 sp
WELL CONTRACTOR COMPANY NAMK 1}flri'd II,,.a I)JPI I1jipsiX.rte J PHONE 8 C.3 Y-3 ab
STATE WELL CONSTRUCTION PERMIT,/ ASSOCIATED WQYERMITB
(if applicable) (if applicable)
298375
1. WELL USE (Check Applicable Box): Residentiala-" icipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION: ,I
Nearest Town: 0/17) /t" C- County Q tpy__, Lc-r
4UI S O/ly- rntrlketztz- Q;rtc�.p# q
(Street Name. Numbers, Community, Subdivision, Lot No., tp Code) c, e,..)6
g ' 3
3.OWNER: Lilit leloeOrerz.
Address Iha Rai Sk(ctiv TRc1 A/
(Street or Route No.)
iU 'Pa lir act,) CI
City or Town State
(14)- gi@
Area code- Phone number
4. DATE DRILLED 3 — 1 -C t/
5. TOTAL DEPTH: ((C C
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: '90 FT.
(Use "+" if Above Top of Cuing)
8. TOP OF CASING IS / FT. Above Land Surface*
•Top of casing terminated at/or below land surface requires a
variance In accordance with ISA NCAC 2C .0118. /
9. YIELD (gpm): . METHOD OF TEST h/02U17L/�j-,
10. WATER ZONES (depth): / i(5 (/
Zip Code
Topographic/Land setting
(Midge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To FormationDescription
(rs"r I Ll'l1 is-P4A/ /i�-
LOCATION SKETCH
1 I. DISINFECTION: Type H -il-/ Amount ,. TA A5 Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads. Include the road
or Weight/Ft. Material numbers and common road names.
Dia eter
Ft Ft
Ft
/1m
Material --/ Method
FL lJoh 4 pcnA'O
Ft.
Diameter Slot Size Material
Ft. in. in.
Ft. in. in,
15. SAND/GRAVEL PACK: _
Depth Size Material
From To Ft.
From To Ft.
O
Sze
rn
0
CO
Cn
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 THES RECORD Hf S BEEN PROVIDED TO THE WELL OWNER
{I rZC(nq�y ,3 -9 _ i,
DWI col_ 1
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
G
Su bmit the original to the Division of Water Quality, Groundwater Section, 1636 Mali Service Center -Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-I REV. 07/2001

WELL CONSTRUCTION RECORD
295495
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
SN ELL CO\TRACTOR (INDIVIDUAL) NAME (print) James B. Brown CERTIFICATION # 2045
WELL CONTRACTOR COMPANY r.AMEHedden Brothers Well Drilling, Inc PHONE e$28) 369-9591
STATE \FELL CONSTRUCTION PER;\IIT? ASSOCIATED W'Q PERMIT: -
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential ( Municipal'Public 0 industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 if Other, List Use
2. WELL LOCATION:
Nearest Town: Franklin County Macon
21 Del Rio Lane
(Street Name. N.unbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: DeWayne Conley
Address 21 Del Rio Lane
(Street or Route No.)
Franklin, NC 28734
City cr Town State
( 828- 524-6639
Area ;ode- Phone number
4. DATE DRILLED 3-12-04
Zip Ccde
5. TOTAL DEPTH: 795'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO VC
7. STATIC WATER LEVEL Below Top of Casing: 200 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 l5A NCAC 2C .0118.
9. YIELD (gpm): 100+ METHOD OF TEST blow
10. WATER ZONES (depth): 7931
11. DISINFECTION: Type H T H
12. CASING:
Depth
From 0 To 29 Ft.
From 29' To 32' Ft. 6
From To Ft.
13. GROUT: Depth
From 0 To 20
From To
Diameter
Amount 16 oz
Wail Thickness
or Weight Ft. Material
' pvc
.188 steel
Material Method
Ft. be -Mite & csralt pumped
Ft.
14. SCREEN: Depth Diameter
From To Ft.
From To Ft. in.
15. 5AND/GRAVEL PACK:
Depth Size
From To Ft.
From To Ft.
Slot Size Material
in.
in.
Material
Topographic/Land setting!'
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude.'longitude of well location
(degrees1ni nute5 seconds)
Latitudc'Iongitude source:❑GPS❑Topographic map
(Meek box
DRILLING LOG
Formation Description
clay & sand
DEPTH
From To
0 30'
30' 795'
granite
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. e
^
I
c r,;
o<
s_m
yC
m�
=o
r*t
uss
r*s 2
r7
G
Z
O
b
vD
16. RELIARKS:
I DO HEREBY C I I Y THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCT aN ST. NDARDS, AND THAT A OPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
-%
SIGNA
!RE OF PERSON CONSTRUCTING THE WELL
DATE
Submit the C riginal to the Division of Water Quality, Groundwater Section, 1636 6lail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-I REV. 072001

298144
WELL CONSTRUCTION RECORD .
North Carolina - Department of Environment and Natural Resources - Division of Water Quality • Groundwater Section
WELL CONTRACTOR (INDIV,IDUAL) NAME � �(print) t�1n h 15 fin jiQn\ A./CERTIFICATION Yrsr-/7 (e
WELL CONTRACTOR COMPANY NAM s; t.l:'.pyj(i kit larJ Wei l a)16 I l 71t 7 P% t! PHONE */ 3a 4-3 g 6 6
STATE WELL CONSTRUCTION PERMIT*/ ASSOCIATED WdiPERMITE
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential' unicipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other CS If Other, List Use
2. WELL LOCATION: Nearest Town:/�rP-R';l /2 L i 4/ County /^'4 a Grit-'
6'r/E.YG.-lhrYL_FeCtlia'C t.S Lnt#3
(Street Name, Numbers, Community, Subdivision, Lot No., hip Code) a&13 v-
3. OWNER: NT C V C k.
Address .3537.k ' LIQi7{O.2ci L a�tc
(Street or Route No.)
5I; Aejr L-a, rlv`f(rO
City or Town State Zip Code
(4P5)- o4-7— 177cc9 •
Area code- Phone number
4. DATE DRILLED 3 — —O
5. TOTAL DEPTH: .?Sn
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO ❑�
7. STATIC WATER LEVEL Below Top of Casing: o1r) 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 .011S. /
9. YIELD (gpm): cp METHOD OF TEST h OW.f7f
f 10. WATER ZONES (depth): r' (�
Topographic/Land setting
ge ❑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
3X'' (CIO,
�� (cc' ,t(Pfm1Pr,.lrie-
Cr y' -36 Da Eli, e ( Q >+-e-
LOCATION SKETCH
11. DISINFECTION: Type 1 -hi/ Amount ..-271-1-/3 S Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads. Include the road
Depth Dia eter��or Wei hiFt. Mate 1 numbers- and common road names.
From 0 To (ll� ' Ft. /_S-k J 7 P r
From To Ft.
From To Ft.
13. GROUT: Depth�s� Material _ J Method
From (3 To r9V Ft. eon, 1 n
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft, in. in.
From To Ft in. in.
15. SAND/GRAVEL PACK: -
Depth Size Material
From To Ft.
From To Ft.
w
N
c
O
Cs�
o"
rrn
o<
rc
ncn
m-
e7
G
2
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF TH S RECORD H S BEEN PROVIDED TO THE WELL OWNER
ap
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mali Service Center -Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-I REV. 07/2001

298117
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Mitchell D. Cook CERTIFICATION k 2043
WELL CONTRACTOR COMPANY NAME Fisifen Brothers ?»11 fa-illirgr PHONE p (23) 369-9591
STATE WELL CONSTRUCTION PERMIT* ASSOCIATED WQ PERMITO
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential 6 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: Franklin
564 Stanley Mtn Rd
(Street Nntne, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: Leonard & Marcella Lattin
Address 564 STamey Mtn RD
(Street or Route No.)
Franklin, NC 28734
County Macon
• City or Town State Zip Code
(828)- 369-2081
Area code- Phone number
4. DATE DRILLED 2-17-04
5. TOTAL DEPTH: 450'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: 200 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 2 FT. Above Land Surface*
•Top of casing terminated atior below land surface requires a
variance In accordance with 15A NCAC 2C .011 S.
9. YIELD (gpm): 20 METHOD OF TEST blow
10. WATER ZONES (depth): 440'
I H. DISINFECTION: Type H T H
12. CASING:
Depth
From 0 To 51
From 51' To 55'
From To
13. GROUT: Depth Material
From 0 To 20 Ftba rite & call
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
Diameter
6"
6"
Amount 1 6oz
Wall Thickness
or Weight/Ft. Material
PVC
.188 steel
Method
Ft.
Ft
Ft.
Ft.
From To Ft.
16. REMARKS:
Topographic/Land setting'
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
0 53' clay & sard
53' 450' granite
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
I DO HEREBY CERTIFY THAT THIS WELL \VAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
Z/'-2-J7-a4'
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 Plionc No. [phone], within 30 days. GW-1 REV. 07/2001
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orn
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3. OWNER:
WELL CONSTRUCTION RECORD
29811r
North Carolina • Department of Environment and Natural Resources - Division of Water Quality • Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Mitchell D. Cook CERTIFICATION # 2043
WELL CONTRACTOR COMPANY NAME Hall" Breel2rS Ill �tu%lr 1tt PHONE i! 623) 369-9591
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(ifapulicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential 3 Municipal/Public 0 Industrial ❑ Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: Scaly
High Holly
County Macon
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
William "Bill" Morris
Address 3978 Valle Del Sol
(Street or Route No.)
Bonsall, CA 92003
City or Town State Zip Code
760 )-724-4150
Area code- Phone number
4. DATE DRILLED 2-13-04
5.TOTAL DEPTH: 800'
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: 550FT.
(Use "+" if Above Top cf Casing)
3. 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): 5 METHOD OF TEST blow
10, WATER ZONES (depth): 85' & 630'
11. DISINFECTION: Type H T H
12. CASING:
Depth Diameter
From 0 To 74 Ft. 6"
From 74' To 78' Ft. 6"
From To Ft.
13. GROUT: Depth
From 0 To 20
From To
14. SCREEN: Depth
From To
Amount 1 6oz
Wall Thickness
or Weight'Ft. Nlaterial
pvc
18A Steel
Nlaterial Method
Ftbartnite & ualaiL pawed
Ft.
Diameter Slot Size Material
Ft. in. in..
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
To Ft.
To Ft.
From
From
Topographic/Land setting
❑Ridge ❑Slope ❑Valley :Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:DGPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From Tg Formation Description
0 76 clay &sand
76' 800' granite
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 \VAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
_/1� 2 -/3-d
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], sN ithin 30 days. GW-1 REV. 07/2001

298112
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) James B. Brown CERTIFICATION # 2045
WELL CONTRACTOR COMPANY NAME Hedden Brothers Well Drilling, Inc PHONEu828) 369-9591
STATE WELL CONSTRUCTION PERMIT; ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
WELL USE (Check Applicable Box): Residential IN MunicipalPublic ❑ Industrial 0 Agricultural 0
Ntonitoring 0 Recovery 0 Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: Franklin
Buck Creek Rd
County Macon
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: Harold Ammons
Addr:ss Rt 1 Box 4870
(Stye:: or Route No.)
Highlands, NC 28741:
City or Town State
( 84 526-3632
Area code- Phone number
4. DATE DRILLED 2-24-04
Zip Code
5.TOTAL DEPTH: 420'
6. DOES WELL REPLACE EXISTING WELL? YESx6 NO ❑
7. STATIC WATER LEVEL Below Top of Casing: 300 FT.
(Use "*" if Above Top of Casing)
S. TOP OF CASING IS 2 FT, Above Land Surface*
*Top of casing terminated al/or below land surface requires a
variance in accordance with ISA NCAC 2C .0I18.
9. YIELD (gpm): 3 METHOD OF TEST blow
I0. WATER ZONES (depth): 85' & 135'
11. DISINFECTION: Type H T H .Amount 16 oz
12. CASING: Wall Thickness
Depth Diameter or Weight'Ft. Nlaterial
From 0 To 44 Ft. 6" 188 gtpel
From To
From To
GROUT: Depth
From 0 To 20
From To
SCREEN: Depth
From To
From To
SAND/GRAVEL PACK:
Depth
To Ft.
To Ft.
From
From
Ft.
Ft.
Nlaterial Method
Ft. b3atite & wtrilL pumped
Ft.
Diameter Slot Size
Ft. in. in.
Ft. in. in.
Material
Size
Material
Topographic.'Land setting
❑Ridge OSlope ❑Valley ❑Flat
(check appropriate box)
Latitudellongitude of well location
(degreeslmi nu tes.'seconds)
Latitudellongitude source:❑GPS❑Topographic map
(check hoz)
DEPTH DRILLING LOG
From To Formation Description
0 42' clay & sane
42420' granite
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
o
eT
( .it)
Co o:7—.:
>m
a o
tip reljb—
co
�
16. REMARKS: N
2
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
G+�rn�-ate
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality. Groundwater Section, (636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW- I REV. 07/2001

29S11^
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division, of Water Quality
WELL CONTRACTOR (INDIVIDUAL)NAME (print) James B. Brown
WELL CONTRACTOR COMPANY NAME Hedden Brothers Well Drilling, Inc
STATE WELL CONSTRUCTION PERMIT: ASSOCIATED WQ PERMITh
(if atoneable) (if avolicable'):
- Groundwater Section
CERTIFICATION k 2045
PHONE ee ) 369-9591
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: Franklin County Macon
Clark's Chapel Lot #2
(Street Name, Numbers, Community, Subdl)ision, Lot No., Zip Code)
3, OWNER: Desota Trail Realty
Address 282 East Main Street
(Street or Route No )
Franklin, NC 28734
City or Town State Zip Code
(828). 524-8488
Area code- Phone number
4. DATE DRILLED
S.TOTAL DEPTH: 500'
6. DOES WELL REPLACE EXISTING WELL? YES ONO en
7. STATIC WATER LEVEL Below Top of Casing.: FT.
(use "*" if Above Top of Casing)
S. TOP OF CASING IS 2 FT. Above Land Surface'
*Top of casing terminated atror below land surface requires a
variance in accordance tvIth ISA NCAC 2C .0119.
9. YIELD (g.om): 6 METHOD OF TEST blow
10. WATER ZONES (depth): 103' , 160!, & 225'
2-25-04
11. DISINFECTION` Type H T H
12. CASING:
Depth Diameter
From 0 To 63 Ft. 6"
From . To Ft.
From To Ft.
13. GROUT: Depth
From 0 To 20 Ft.
From To Ft,
14. SCREEN: Depth Diaa',eter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth
From To Ft.
From To Ft.
Topographic/Land setting ''
❑Ridge ❑Slope OValley ❑Fiat
(c:re:'k appropriate box)
Latitude/longitude of well location
(degrees. lninuteshecands)
Latitudctlongitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
0 61' clay & sana
61' 500' granite
LOCATION SKETCH
Amount 16 oz Show direction and distance in miles from at least
Wall Thickness two State Roads or County Roads. Include the road
or Weicht'Ft. Nlateriai numbers and common road names,
.188 steel
Material Method
'termite & taralt pumped
Slot Size Material
in.
in.
Size Material
O
CO
'-O
16. REMARKS` -
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
CONSTRUCTIOU STANDARDS, AND THAT
TAACOPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
`y25'_o S�
SIGNATUU RE OF PERSON CO\STRUCTING THE WELLDATE
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

298106
WELL CONSTRUCTION RECORD.
North. Carolina - Department of Environment and Natural Resources - Division of Water Quality
WELL CONTRACTOR (IiNDIVIDUAL)NAME (print) James B. Brown
WELL CONTRACTOR COMPANY NAME Hedden Brothers Well Drilling, Inc
STATE W. ELL CONSTRUCTION PERMIT:
(if applicable) (ifapplicable)-
- Groundwater Section
CERTIFICATION 2045
PHONE a 8281 369-9591
ASSOCIATED \\'Q PERMIT;
I. WELL USE (Check Applicable Box): Residential Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: Franklin
Fulcher Vista Dr
County Macon
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3, OWNER: Anthony Pecoraro & Elyane Samarkos
Addr ss 5416 Sunray Drive
(Street or Rowe No.)
Holiday, FL 34690
City or Town State Zip Code
(727)- 937-7597
Area cede. Phone number 2-17-04
4. DATE DRILLED
5. TOTAL DEPTH: 800'
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO L�9
7. STATIC WATER LEVEL Below Top of Casing: 400 FT.
(Use "+" it Above Top of Casing)
S. TOP OF CASING IS 2 FT. Above Land Surface'
-Top of casing terminated at/or below land surface requires a
variance In accordance with ISA NCAC 2C .0119.
9. YIELD (gpm): •5 METHOD OF TEST blow
10. WATER ZONES (depth): 240'
Topographic/Land setting'
❑Ridge 0Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degres':ninutes:seconds)
Latitude'lanitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
0 62' clay & sand
62' 800' granite
LOCATION SKETCH
11. DISINFECTION: Type H T H Amount 16 oz Show direction and distance in miles from a: least
12. CASING: Wall Thickness two State Roads or County Roads. Include the road
Depth Diameter or 1` eiehVFt. Materia: numbers and common road names
From 0 To 61 Ft. 6" pvc
From 61 ' To 64 Ft 6" .188 steel
From To Ft.
13. GROUT: Depth Material Nlethod
From 0 To 20 Ft. bar rite & t,atbIL pumped
From To Ft.
14. SCREEN: Depth Diameter Slot Size i Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND'GR.AVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS`.
l0
N
V7
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTR:;CTION SJ.\'.'DARDS, AND THAT A CO 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 Resources • Division of Water Quality - Groundwater Sec
WELL CONTRACTOR (INDIVIDUAL) NAME (print) James B. Brown CERTIFICATION;
WELL CONTRACTOR CONIPANYNAN1EHedden Brothers Well Drilling, Inc PHONE ;$281 369-9591
STATE WELL CONSTRUCTION PER.,\I1T;
(if applicable)
298105
Oil
2045
ASSOCIATED WQ PERMIT;
(if applicable)
WELL USE (Check Applicable Box): Residential MunicipatPublic ❑ Industrial ❑ Agricultural ❑
:Monitoring 0 Recover: 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2, WELL LOCATION:
Nearest Town: Franklin County Macon
6911 Murphy Rd
(Suet Nana, Nu:nbcrs, Community, Subdivision, Lot No.. Zip Code)
3. OWNER: Garland King
Address 6911 Murphy Rd
(Street Cr Route No.)
Franklin, NC 28734
City or To'.vn Sex Zip Code
(828)- 369-7589
Area code- Phone number
4. DATE DRILLED 2-23-04
i.TOTAL DEPTH: 260'
6. DOES WELL REPLACE EXISTING WELL? YES NO ❑
7. STATIC WATER LEVEL Below Top of Casing.: 100 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 .0115.
9. YIELD (eon): 40 NIETHOD OF TEST blow
10. WATER ZONES (depth): 11 5' , 125' , & 235'
l I. DISINFECTION: Type H T H
12. CASING:
Depth Diameter
From 0 To 100 Ft. 61'
From 100' To 103 FL 6"
From To Ft.
13. GROUT: Depth
From 0 To 20 Ft.
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From Ft. in.
Amount 16 oz
Wall Thickness
or WeichtFt. Material
pvc
188 sl-pel
Material Nlethod
tstrtite & txtic. pumped
To
15. SAND/GRAVEL PACK:
Depth Size Material
Slot Size Material
ir.
in.
From To Ft.
From To Ft.
Topographic/Land setting:`'
❑Ridge ❑Slope ❑Valley ❑F;at
(check appropriate box)
Latitude/longitude of well location
(degrees minutes:seconds)
Latitude/on itude source:❑GPS❑Tepographia map
(check box)
DEPTH DRILLING LOG
0 From
To 101 FormationlDescription
and t.on
101 ' 260' granite
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and corrunon road names. p o
Zt as
c
zm
a<°
ern
>o
rn�
n
03
16. REMARKS: -
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRLiCTIOy 5s ANDARDS, AND THAT A CQPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGN.ATURE 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

298104
From To
14. SCREEN: Depth
From To
To
15. SAND/GRAVEL PACK:
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section.
WELL CONTRACTOR (IiNDIVIDL'.AL)^i.A IE (print) James B. Brown CERTIFIC.ATION'# 2045
WELL CONTRACTOR CON'PANY N.ANIEHedden Brothers Well Drilling, Inc PHONE e 28.) 369-9591
STATE WELL CONSTRUCTION PERM ITpASSOCIATED S.Q PERSIITa
(if aoolicable) (if aoolicable)
WELL USE (Check :Applicable Box): Residential ei Municipal/Public ❑ Industrial ❑ Agricultural E
!Monitoring 0 Recovery 0 Heat Pump Water Injection. 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: Highlands
Wildwood
County Macon
(Street name, Nmnbcrs, Cemmwllty, Su:division, Lot No., Zip Code)
3. OWNER: Patrick & Cynthia McCarty
Address 4716 Amberwood Lane
(Street or Roue No.)
Anniston, AL 36201
Gm or Town 5:::e Zip Code
(256). 236-5347
Area code- Phone number --
4. DATE DRILLED 2-19-04
5. TOTAL DEPTH: 400
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Belotv Top of Casing: 200 FT.
(L'ss "✓' if .Above Top of Casing)
8 TOP OF CASING IS 2 FT. Above Land Surface'
*Top of casing terminated atror below land surface requires a
variance In accordance with 15A NCAC 2C .0118.
9. YIELD (pm): 12 METHOD OF TEST blow
10. WATER ZONES (depth): 155' & 277'
11. DISINFECTION: Type H T H Arnount 16 oz
12. CASING: 1Va11 Thickness
Depth Diameter or Weight'FI. Material
From 0 To 37 Ft. 6" pvc
From 37 To 40 Ft. Err .188 steel -
From To Ft.
13.GROUT: Depth Material Method
From 0 To 20 Ft. tsulite & CtsTe t pumped
Ft.
Diameter Siot Size Material
Ft. in. in.
From Ft. in.
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCT! o rflANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
Topographidtand setting
❑Ridge ❑Slope ❑Valley ❑Flat
(cheek appropriate box)
Latitude.'longitude of well location
(deg rees'einutes(s:conds)
Latituda'longitude source:❑GPS❑ T opoeraphic map
(cheek box)
DEPTH DRILLING LOG
From To Formation DescrL tion
0 38' clay & sana
38' 400' crranite
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
•
a
COOtt
Ca'l
SIGNAL L'RE 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. 0772001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (IN'DIVIDUAL)NAME (print) James B. Brown CERTIFICATION tt 2045
WELL CO\TRACTOR CO>1PANY NA>IEHedden Brothers Well Drilling, Inc PHONE * $28'1 369-� 95 1
STATE WELL CONSTRUCTION PERMITn ASSOCIATED WQ PERMIT*
(ifaonlicable) (if applicable)-
298103
I. WELL USE (Check Aoplicaole Box): Residential E Municipal/Public 0 Industrial ❑ Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: Franklin County Macon
Sunset Mtn Sub —Division
(Street Na!ne, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: Shane Stikeleather
Address 75 Wallalieu Rd
(Street: cr Route No.)
Otto, NC 28763
C::;y Cr To.en State Zip Code
( 828. 524-5604
Area cede• Phone number
4, DATE DRILLED 2-27-04
5, TOTAL DEPTH: 440'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casino: 100 FT.
(Use "+" if Above Top of Casing)
S. TO? OF CASING IS 2 FT. Above Land Surface"
•Top of casing terminated atror below land surface requires a
variance In accordance with 15A NCAC 2C .0115.
9. YIELD (gpm): 50+ METHOD OF TEST blow
10. WATER ZONES (depth): 75', 115', 400', & 415'
I I. DISINFECTION: Type H T H Amount 16 Oz
12. CASING: Wail Thickness
DeFromTo 63 Ft. 6"thmere. or R'3i86'Ft. Material
0 188 steel
From To Ft.
From To Ft.
13. GROUT: Depth Material Me:hod
From 0 To 20 Ft. termite & wile' pumped
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in
From To Ft. in.
15
Slot Size Material
in.
ir..
SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Topographic/Land setting
ERidge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees 'minutes seconds)
Latitude; longitude source,❑GPS❑Topographic map
(c'nesk box)
DEPTH DRILLING LOG
From T Formation Descrotion
0 61 ' clay & sand
61' 440' granite
LOCATION SKETCH
Show direction, and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
0
S
co
16. REMARKS:
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION NDARDS, AND THAT A CO OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATUi 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 Rhone 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) Mitchell D. Cook
WELL CONTRACTOR COMPANY NAME lb1931 alto S u f2-Illirnr 71]C
299245
- Groundwater Section
CERTIFICATION tt 2043
PHONE # (R7S R69-9591
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) - (if applicable)
1. WELL USE (Check Applicable Box): Residential Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: Franklin Count)Macorl
Cold Springs
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: John Schiffli Jr.
Address PO Box 725
(Street or Route No.)
Highlands, NC 28741
City or Town State Zip Code
(828)- 526-2880
Area code- Phone number
4. DATE DRILLED 7-1-04
5. TOTAL DEPTH: 575'
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO I2c
7. STATIC WATER LEVEL Below Top of Casing: 200 FT.
(Use "r' if Above Top of Casing)
8. TOP OF CASING IS 2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance In accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 30 METHOD OF TEST hi d w
10. WATER ZONES (depth): 550'
11. DISINFECTION: Type
12. CASING:
Depth
From 0 To 40
From 40' To 44
From To
13. GROUT: Depth
From 0 To 20
From To
14. SCREEN: Depth
From To
From To
15. SAND/GRAVEL PACK:
H T H Amount 16 rn
Wall Thickness
Diameter or Weight/Ft. Material
Ft. 6" pvc
Ft. 6" .188 steal
Ft.
Material
Ftf nii-a & n-rirlt
Ft.
Diameter Slat Size Material
Ft. in. in.
Ft. in. in.
Method
P ITrPel
Depth Size Material
From To Ft
Topographic/Land setting.
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPSOTopographic map --.
(check box) l
DEPTH DRILLINGLLOG
From To Formation Description
0 42' clay & sand
arani to
42' 575'
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Includeroad-
numbers and common road names. . - .
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
ai.,c_iegia /D . ce2c0
SIGNATURE OF PERSON CONSTRUCTING THE WELL
7- /_ 011
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

From 117'
WELL CONSTRUCTION RECORD
299244
North Carolina - Department of Environment and Natural Resources - Division of Water Quality Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Mitchell D. Cook CERTIFICATION # 2043
WELL CONTRACTOR COMPANY NAME Felda1 &otters l Drilling, Inc PHONE # 182P31 169-9591
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential Municipal/Public ❑ Industrial ❑ Agricultural ❑ '..
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
NearestTown:Franklin County Macon
Cowetta Lab Rd
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: Keith Jenkins
Address 14942 US 64W
(Street or Route No.)
Murphy, NC 28906
City or Town State
( 828- 249-4574
Area code- Phone number
4. DATE DRILLED 6-29-04
Zip Code
5. TOTAL DEPTH: 500'
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO fl
7. STATIC WATER LEVEL Below Top of Casing: 300 FT.
(Use "i' 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): 10 METHOD OF TEST hi r w
10. WATER ZONES (depth): 420'
I I. DISINFECTION: Type H T H
12. CASING:
Depth
From 0 To 117 Ft. 6
To 121
From To
13. GROUT: Depth
From 0 To 90
From To.
14. SCREEN: Depth
From To
From To
15. SAND/GRAVEL PACK:
Amount 16 oz
Wall Thickness
Diameter or Weight/Ft. Material
pvc
Et. 6'r— .188 steel
Ft.
Material
Ft tmrni to RE r
Ft._
Diameter Slot Size Material
Ft. in. in.
Ft. in. in.
Method
Pad
Depth Size Material
From To Ft.
From To Ft.
Topographic/Land setting.
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographid map
(check box)
DEPTH DRILLIN`'LOG--
From To Formation D4scription
clay & srtct---`
granite
0 119'
119' 500'
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the re
numbers and common road names.
L
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
y ee;th- o.Of 20. an
SIGNATURE OF PERSON CONSTRUCTING THE WELL
l0--29- oq
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 2 9 9 243
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Mitchell D. Cook
CERTIFICATION 2043
WELL CONTRACTOR COMPANY NAME F 1 Bathers W311 Drilling, IIY' PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT#
(if applicable)
ASSOCIATED WQ PERMIT#
(if applicable)
WELL USE (Check Applicable Box): Residentia143 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 Franklin County Macon
rerlar Springs Subdivision
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: Neal Keenum
Address 5401 Balboa Circle
(Street or Route No.)
Pinson, AL 35126
City or Town State Zip Code
( 205)- 853-9752
Area code- Phone number
4. DATE DRILLED 6-28-04
5. TOTAL DEPTH: 300'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NOS
7. STATIC WATER LEVEL Below Top of Casing: 50 FT,
(Use "-r" 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 I5A NCAC 2C .0118.
9. YIELD (gpm): 60+ METHOD OF TEST h1 pw
10. WATER ZONES (depth): 180' & 280'
11 DISINFECTION: Type H T H
12. CASING:
Depth Diameter
From 0 To 138 Ft. 6"
From 138' To 142 Ft. 6"
From To Ft.
13. GROUT: Depth
From 0 To 20
From To
14. SCREEN: Depth
From To
From To
15. SAND/GRAVEL PACK:
Depth Size
From To Ft.
From To Ft.
Amount 16 07
Wall Thickness
or Weight/Ft. Material
pvc
,188 steel
Material
FLjrrtnitin R n-m-mot
Ft.
Diameter Slot Size Material
Ft. in. in.
Ft. in. in.
Method
pirripa
Material
Topographic/Land setting
❑Ridge 0Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map---
(check box)
DEPTH DRILLING Op_
From To Formation Description
0 140' clay & sand
140' 300' orandte
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
w
N
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
%-<2.8-oy
DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
27699-1636 Phone No. (919) 733-322I, 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) Mitchell D. Cook CERTIFICATION # 2043
WELL CONTRACTOR COMPANY NAME Hadim Brothers S€.1 Drilling, Irr; PHONE # {R28) R1;9-9591
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
299242
I. 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: Otto
Tiffany Lane
County Macon
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: Clara Dills
Address PO Box 325
Otto, NC(str2e0763.) n e No
City or Town State Zip Code
(828)- 349-0940
Area code- Phone number
4. DATE DRILLED 7-6-04
5. TOTAL DEPTH: 400'
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO EX
7. STATIC WATER LEVEL Below Top of Casing: 200 FT.
(Use "+" if Above Top of Casing)
S. TOP OF CASING IS 2 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): 10 METHOD OF TEST blow
10. WATER ZONES (depth): 130'
11 DISINFECTION: Type H T H
12. CASING:
Depth Diameter
From 0 To 114 Ft. Err
From 114'To 118 Ft.
From To Ft.
13. GROUT: Depth
From 0 To
From To
14. SCREEN: Depth
From To
From To
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Amount 16 nz
Wall Thickness
or Weight/Ft. Material
pvc
6.188 steel
Material
20 FLJ-rrnit'a & rynt=rtt
Method
P'rive
Ft.
Diameter Slot Size Material
Ft. in in.
Ft. in. in.
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Fiat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds) -
Latitude/longitude source:❑GPSOTopdgraphte map
(check box) t'
DEPTH DRILLINCyLt1C.------
From To Formation Description
0 116s clay & sand
_granite
116400
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
0
rcn
—
N\)
16. 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
7- 6-ov
DATE
Submit the original to the Division of NVater 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) Mitchell D. Cook
WELL CONTRACTOR COMPANY NAME FBI BEOI±Es VrY'Ll j ii. irrrr 771C
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
299241
CERTIFICATION # 2043
PHONE # (FOR) It 9-9591
1. WELL USE (Check Applicable Box): Residential$ Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: ScalY Mtn County Macon
Fastside Duck Mtn
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3, OWNER: Christine "Chris" Brooks
Address PO Box 5
(Street or Route No.)
Scaly Mtn, NC 28775
City or Town State Zip Code
(828)- 526-0221
Area code- Phone number
4. DATE DRILLED 7-8-04
5. TOTAL DEPTH: 400'
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO>10111
7. STATIC WATER LEVEL Below Top of Casing: 200 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): 10 METHOD OF TEST hl nw
10. WATER ZONES (depth): 350'
II. DISINFECTION: Type H T H Amount 16 07
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 57 Ft. 6" pvc
From 57' To 61' Ft. 6" .188 steel
From To Ft.
13. GROUT: Depth Material Method
From 0 To 20 Ft4crinitP R rintriTt Trperi
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 Material
in.
in.
Topographic/Land setting.
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds) '
Latitude/longitude source:❑GPS❑Topo4raphk-map -_.
(check box)
DEPTH DRILL1140. -OG,_._..
From To , Formation Description
0 59 clay & sand
59' 400' granite
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.
rJ
N
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
in„taelto 20.
SIGNATURE OF PERSON CONSTRUCTING THE WELL
%- g- o47'
DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Nlail Service Center -Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-I REV. 07/2001
0

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) L. Bruce Morgan CERTIFICATION # 2047
WELL CONTRACTOR COMPANY NAME H3d-h2 Brothers W.11 Drilling, Inc PHONE # (82R) 369-9591
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
299240
1. WELL USE (Check Applicable Box): Residential S Municipal/Public 0 Industrial 0 Agricultural ❑
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: Franklin
Whisper Mountain Estates
County Macon
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER:Trish Rowland
Address 629 West Drive
(Street or Route No.)
Delray Beach, FL 33445
City or Town State Zip Code
( 561)- 276-6763
Area code- Phone number
4. DATE DRILLED 6-24-04
5. TOTAL DEPTH: 450'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO CI
7. STATIC WATER LEVEL Below Top of Casing: 200 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING 1S 2 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): 20 METHOD OF TEST hl tut
10. WATER ZONES (depth): 425' & 430'
I . DISINFECTION: Type H T H
12. CASING:
Depth
From 0 To 9 Ft.
From 9' To 30 Ft.
From To Ft.
13. GROUT: Depth
From 0 To 20
From To
14. SCREEN: Depth
From To
From To
15. SAND/GRAVEL PACK:
Depth
From To Ft.
From To FL
Diameter
6"
6"
Amount 16 07
Wall Thickness
or Weight/Ft. Material
pvc
188 steel
Material
Ft.j-Krrni1-p & n-m-.tt
Ft.
Diameter Slot Size Material
Ft. in. in.
Ft. in. in.
Method
i n fnl
Size
Material
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat;
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topogi-aphIc-map--;:_-
(check box) '
DEPTH DRILLING LOG ---
From To Formation Description
0 28clay & sand
28' 450' granite
LOCATION SKETCH
Show direction and distance in miles from at (east
two State Roads or County Roads. Include the road
numbers and common road names.
0
C
s
ro
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
SIGNATURE OF PERS!•' CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center -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 Natural Resources - Division of Water Quality - Groundwater Section
CERTIFICATION # 2047
WELL CONTRACTORCOMPANY NAME HandlE3tersFk11.fk'illimr Inc PHONE N fR2R)
WELL CONTRACTOR (INDIVIDUAL) NAME (print) L. Bruce Morgan
STATE WELL CONSTRUCTION PERMIT#
(if applicable)
299239
ASSOCIATED WQ PERMITN
(if applicable)
1. WELL USE (Check Applicable Box): Residential Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: Franklin County Macon
Oak Grove
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: Eddie Poindexter
Address PO Box 464
(Street or Route No.)
Franklin, NC 28744
City or Town State
(828)_ 524-7906
Area code- Phone number
4. DATE DRILLED 6-22-04
Zip Code
5. TOTAL DEPTH: 450'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: 250 FT,
(Use "x" 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 ISA NCAC 2C .0118.
9. YIELD (gpm): 10 METHOD OF TEST hl nra
10. WATER ZONES (depth): 275' & 375'
I L DISINFECTION: Type H T H Amount 16 m
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 88 Ft. 6" pvc
From 88' To 91 Ft. 6" .188 steel
From To Ft.
13. GROUT: Depth Material Method
From 0 To 20 Ftrirt nita & cwirrIt. rupla
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
From
To Ft.
To Ft.
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
0 89' clay & sand
89' 450' _granite
LOCATION SKETCH
Show direction and distance in miles frotn at least
two State Roads or County Roads. Include the roadR
numbers and common road names. r—
c •
t=
o
r— ni
16. REMARKS:
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCT!! TANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
ZZ
SIGNATURE OF PERSON
WELL DAT
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 CONTRACTOR (INDIVIDUAL) NAME (print) L. Bruce Morgan
WELL CONTRACTOR COMPANY NAME H31531 artheY5 11t11 Drilling. Inc
WELL CONSTRUCTION RECORD
299278
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
CERTIFICATION p 7
PHONE # f828) 169-9591
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable) -- '
I. 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: Franklin County Macon
Cowee Community to Tippett Creek
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: Neil & Maria Humphery
Address 301 NW 3rd Street
(Street or Route No.)
Florida City, FL 33034
City or Town State Zip Code
(305)_ 248-5880
Area code- Phone number
4. DATE DRILLED 6-23-04
5. TOTAL DEPTH: 400'
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO 9
7. STATIC WATER LEVEL Below Top of Casing: 200 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): 6 METHOD OF TEST hl ow
10. WATER ZONES (depth): 57' & 230'
11. DISINFECTION: Type H T H Amount 16 07.
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 47 Ft. 6 ' pvc
From 47' To 50 Ft. 6" .188 steel
From To Ft.
13. GROUT: Depth Material Method
From 0 To 20 Fttn nice R: t -trait PErni
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 ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic.map
(check box)
DEPTH DRILLIN LOG
--i----
From To Formation Description
0 48' clay & sand
granite
48' 400'
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
r=
n
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
°e V /lien
SIGNATUR$OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of ater Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

299369
WELL CONSTRUCTION RECORD
,,J:
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section WELL CONTRACTOR(INDIVIDUAL) NAMES �(print) c�?nhi 5 fiinI (LA rim CERTIFICATION# oZ/7 le
WELL CONTRACTOR COMPANY NAMICh°, fll C lc-0 f104,A lllei I kl vii) I e J PHONE YV esi_3. CI --3 E
STATE WELL CONSTRUCTION PERMIT,/ASSOCIATED W ERMITN
(if applicable) (if applicable)
1 WELL USE (Check Applicable Box)• Residential' unicipal/Public 0 Industrial 0 Agricultural 12,
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other Elk klf Other, List Use El Li
2. WELL LOCATION: C -
'Nearest Town: f� n: i C-H L.A!LI�S County .�1Q(�m.
LP 4 LT IA IM-; 1 _ YVict Icee en eP
c,(
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code) l gqq /
3. OWNER:C1-Fr i C-IC. I 0 <rLLty
Address 10-0 fl'k't /r'e e/7 e rL t--
(Street or Route No.)
14 ; Cj (7 ) O„eks Ale-'
(2-
or Town State
999—n700
Area code- Phone number
4. DATE DRILLED 7— S —l) //-
5. TOTAL DEPTH: /CS'
Zip Code
Topo ra ic1Land setting
❑Ridge lope ❑Valley QF1at
(check appropriate box) a'
Latitude/longitude of well loca€ion;
• (degrees/minutes/seconds)
Latitude/longitude source:❑OPS❑Topo1;taphic may
(check box) _--�
PEPTH - PRILILING LOG ." --
Formatiott Description
0/
[3/ut rat ;7 -2--
From
e5 /'
' `F05
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO Ulm
7. STATIC WATER LEVEL Below Top of Casing: 76 FT.
(Use "+" i( Above Top of Cuing)
8. TOP OF CASING IS / FT. Above Land Surface*
*Top of casing terminated et/or below landsurface requires a
variance In accordance with ISA NCAC 2C .01 II.
9. YIELD (gpm): /0; METHODr�OF TEST / lwz'7lL(,{—.
10. WATER ZONES (depth)• /irii / (�
LOCATION SKETCH
1. DISINFECTION: Type H-/'f-% Amount ,_2 %/A-, 5 Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads. Include the road
Dia eter or Weight/Ft. Mate l numbers and common road names.
Ft. " S.bR,,7' 91"
Ft.
Ft.
Depth
From 0 To
From To
From To
13. GROUT: Depth
From o To Ft.
From To Ft.
14. SCREEN: Depth
Material
C �r�
Diameter
From To Ft. in.
From To Ft in.
5. SAND/GRAVEL PACK:
Depth Size Material
Method (�
From To Ft.
From To Ft.
Slot Siz: ' Material
in,
in.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPYY OF THJS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
%-15—O c/L
SIGNATURE -OF PERSON CONSTRUCTING THE WELL . DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mall Service Center • Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. OW -I REV. 07/2001

2 9t9.:ti8
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources • Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print):hen Ylis PT) JJizAtvi .'. CERTIFICATION# ot/7et-
WELL CONTRACTOR COMPANY NAME'1.1ehrg k llOgc II)a,(14N r JJ 4 !'vie PHONE g�o-�.•.J3L/-3 o7b
STATE WELL CONSTRUCTION PERMIT/ ASSOCIATED WIRERMITS
(if applicable) (if applicable)
WELL USE (Check Applicable Box): Residential - unicipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use
1
2. WELL LOCATION: - nq
'Nearest Town:fii /M*L; /1 /` County `QLoxJ
</Y/N-MQc/c ER,R4— t5 Rose»,oajR•
(Street Name, Numbers, Community,Subdivision, Lot No., Zip Code) 9. S Od
3. OWNER: �thre S4, Ra
Address 15 JbSer»cr,T 7E,
(Street or Route No.)
Pi2aLnwirg 0 3 V
City or Town State Zip Code
( iC)- •-a it Tgb7
Area code- Phone number
4. DATE DRILLED 7—/S —O
5. TOTAL DEPTH: .,2Eb'
Topographic/Land setting
❑Ridge ❑Slope ❑Valley(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:OGPSOTopographic map
(check box)
DRILLING LOG
Formation Description
et
Ta nre c ran-n -
r3LVL QQ.4-,Y; tc.
DEPTH
From To
S.5' 7'7'
�' 2v'
6. DOES WELL REPLACE EXISTING WELL/ YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: 4 0 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface'
•Top of casing terminated at/or below landsurfacerequires a
variance In accordance with ISA NCAC 2C .eita. /
9. YIELD (gpm)' .b METHOD OF TEST A/07.0,7L{�--,
10. WATER ZONES (depth): C 6 ` l ' (l
LOCATION SKETCH
1 I. DISINFECTION: Type H-1—/-/ Amount o2 7,1}' 135 Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads. Include the road
Dia^ e4ter or Weight/Ft. Mate . 1 -numbers and common road names. o ;:az
From 0
From
From
11. GROUT: Depth Material Method,
From n To rif7 FL CQ'yr47'i pO74AJ
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.
Ft.
Ft.
Ft.
16. REMARKS:
DepthTo
To
Tp
L
r--
r
0
0
0
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL,
CONSTRUCTION STANDARDS, AND THAT A COPY OF TH S RECORD H S BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE i
Submit the original to the Division of Water Quallty, Groundwater Section, 1636 Mall 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 Resources - . ` Division of Water Quality -Groundwater Section
NELL CONTRACTOR (INDIVIDUAL) NAME (print) <7).P h N r t VELL CONTRACTOR COMPANY NAM
�!,I n CERTIFICATTONY or-�%CP
TATE WELL CONSTRUCTION PERMITB PHONE Mit, 511/—rj 2 ti--3 g�,
(ifa icable) ASSOCIATED W ERMITtt -
(if a licable
. WELL USE (Check Applicable Box): Residential'cipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other C7 If Other, List Use
WELL LOCATION:
'Nearest Town:� �. ,, y L
(Stree t Name, Nilmben, Community, s on
OWNER:
Address
City or Town State Zip Code
Area code- Phone number
DATE DRILLED
TOTAL DEPTH:
DOES WELL REPLACE EXISTING YES 0 NO QL >TATIC WATER LEVEL Below Top of Casing: 9 D -j-
-OP OF CASING IS Use "Y' ifAbove Top SurfCasing)
'Top of casing terminated at/or below land Above egfind ires Surface*
variance In accordance with 15A NCAC 2C .0118.
'IELD (gpm): . T2 METHOD OF TEST
'ATER ZONES (depth): (gyp'
1SINFECTION: Type
ASING: Wall Thickness
�t Depth Diameter or We dFt. Mate - om� To al
Ft. e $ R,37'
Ft.
Ft.
pographic/Land setting
idge ❑Slope ❑Valley I]FIat
No., Zip Code)—�- (check appropriate box)
a Eli f[ Latitude/longitude of well location
c , c Ch. Pa_
(Street or Rou No.)
-3 tiC ) c73
om To
om To
LOUT: Depth
Im f To_
To
REEN: Depth
To
m To
ND/GRAVEL PACK:
Depth
To
To
BARKS:
Material
Ft _apenyj,�
Ft.
Diameter
Ft. in.
Ft. in.
Ft
Ft
Size
Method
.F2Ca `L
Slot Size Material
in.
in.
Material
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILL ING LOG
From To Formation Description
10
LOCATION SKET('H
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
tEBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C,
UCTION STANDARDS, AND THAT A COPY OF JS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL 7` - U
DATE
le original to the Division of Water Quality, Groundwater Section, 1636 Mall Service Center -Raleigh, NC
6 Phone No. [phone], within 30 days.
GW-1 REV. 07/2001
299367

299 ,66
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) c7)�n 015/ 1l QM A. CERTIFICATION II of/7(0
WELL CONTRACTOR COMPANY NAME NIT i H'Oa,ytr4 WeiI1)� J I'll d_. )-/l f' l PHONE H 7%C..S, Y-3
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED Wc5 ERMIT#
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential'id----Municipal/Public ❑ Industrial 0 Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: t,Qi/V/CLi 4/ County & tem a
Golf L Cl/ Ja.v pe3 - Ec en Vat LoY-17='a5
(Street Name, Nurnberg,, Community, Subdivision, Lot No., Code) g 73 T
3. OWNER: /COrK'_c;n)
Address
D- P o x Q 7
(Street or Route No.)
�{ QM </ ! A � e/
City or Town State Zip Code
XJ- 5' '- - 1 9 D 9
Area code- Phone number /-y— /
4. DATE DRILLED / —La
5. TOTAL DEPTH: R gyp'
,7y
opographic/Land setting
J
gee ❑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
7.-1 Q�
�7(� S✓/or,. l,te
3 Et ' RI u�- (>—r n', r-e—x
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO Cam`
7. STATIC WATER LEVEL Below Top of Casing: (on FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface'
'Top of casing terminated at/or below land surface requires a
variance In accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): 54n METHOD OF TEST 10?J)y7LC/
10. WATER ZONES (depth): <�tl>' (�
11 DISINFECTION: Type hifji
12. CASING:
Depth Diapeter
From 0 ToFt. h
From To Ft.
From To Ft.
13. GROUT: Depth
From 1') To r`%fi Ft.
From To
14. SCREEN: Depth
From To
From To
15. SAND/GRAVEL PACK:
Depth
From To Ft.
From To Ft.
Amount o� TA A S
Wall Thickness
or Weight/Ft. Mate 1
Material_ �
Ft.
Diameter
Ft. in.
Ft. in.
Size
Method
CTA
Slot Size Material
in.
in.
Material
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL:..
CONSTRUCTION STANDARDS, AND THATp,A COPY OF TH1SREECORD HpS BEEN PROVIDED TO THE WELL OWNER
.Or 04— e cam' / -i a -U L%
SIGNATURE OF PERSON CONSTRUCTING THE WELL
DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center-R'ateigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV;-07/2001
0

299 .65
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section / -
WELLCONTRACTOR(INDIVIDUAL)NAME (print) c� h Y1115 /In Han. Ad - -CERTIFICCMATIONS 1/7Y'
WELL CONTRACTOR COMPANY NAME
1)jjiC MID I1/�ri�d�Yrr li il(.t .�.n('J PHONE S�J-°6i .5a4-3 �-6 0
STATE WELL CONSTRUCTION PERMITS ASSOCIATED WOE/ ERMIT/I
(if applicable) (if applicable) - -
I. WELL USE (Check Applicable Box): Residential LYMunicipal/Public ❑ Industrial 0 Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATIO: Topographic/Land setting
Nearest Town: / L 1?/U f /1' County Al a_ ant- ❑Ridge ❑Slope ❑Valley giFkttr
6 4 E - ra / ion R,\ - is a -,0 cm n c, P A 5 h 0.dy, &vo t (check appropriate box)
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code) O t_gn,t. Latitude/longitude of well location
asg3X
/—
3. OWNER: G o1ci r e O f1)�}/) S (degrees/minutes/seconds)
Address / 4-_3 5 h a c) 9f)Y'oo k L R,,_e_. Latitude/longitude source:❑GPS❑Topographic-map ..
(Street or Route No7 (check box)
rRO17111 //7J VC,' ,C2 ig 3 41 DEPTH DRILLING LOG _
City' or Town State Zip Code From To Formation Description
($,x)- i.2�-<3orQD b 3S' C/ /
Area code- Phone number, ,j, j' • r� S - L U�- I`Qi1-t i r"—�-
4. DATE DRILLED 7 - / /f — V 51
5. TOTAL DEPTH: •511S
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 0--------
7. STATIC WATER LEVEL Below Top of Casing: &' 0 FT.
(Use "+'• if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surfaces
'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_ kei7Llf
10. WATER ZONES (depth): / 0 • (%
LOCATION SKETCH
11. DISINFECTION: Type PiP Amount .-2 %4 5 Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads. Include the road
Depth Dia eter��or WeishiFt. Mate' 1 numbers and common road names.
From To 35 Ft. /�' 5-I2R,T1 OF
From To Ft.
From To Ft.
13. GROUT: Depth f)
Material Method l
From (3 To r-}t7 Ft. CQ.yyt �AA.)
From To Ft. 1
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.
r
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 F TH JS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
Or
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

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and N tural Resourcesw- Division�of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME
t (print) `/ t * C eelif CERTIFICATION
A 30 ��
WELL CONTRACTOR COMPANY NAME C-/'.t11 OYI.O- /4*// Orif_0'/G- PHONE N �7iC017�tr Ji��?6
STATE WELL CONSTRUCTION PERMIT,/ _ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Resident1aLla 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: /!/flL,�/✓
Nearest Town: �j'fHl/7 County
.Rvrelr"t 14Mk)
(Street Name, Nuinbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: l./190 0 PIMe.v4S
Address /Q—b b VVtirrt
(Street or Route No.)
(lei: k•4- A-/ 3LS0I
y or Town State Zip Code
Area code- Phone number
4. DATE DRILLED to'a-6Y
5. TOTAL DEPTH: 3 SS
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 0
7. STATIC WATER LEVEL Below Top of Casing: /v 0 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surface*
'Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0I18.
9. YIELD (gpm): e% V METHOD OF TEST fii r
10. WATER ZONES (depth):
Topographic/Land setting
❑Ridge 0Slope ❑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
11. DISINFECTION: Type Amount
12. CASING: �f*� Wall Thickness
From () DepToth �v % Ft. /p �/% or Weight/Ft Material
r L
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From I To ° - Ft. Cate.-po
/- l -25
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
Frort To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
To
To
From
From
Ft.
Ft.
to 7 ?3-'S
299504
c/o-
c—
J
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 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE ��i R
DATE �'`/
SIGNATURE OF PERSON CONSTRUCTING THE WELL
-: Cr_-__':
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
erTui

WELL CONSTRUCTION RECORD
299502
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME �(priint)1 �i-11/eirACi1Jt- CERTIFICAATTIIOONrSat.
119
WELL CONTRACTOR COMPANY NAME My9r"ttS- LK I.ULr.c//rN, T-/UCy PHONE # td7(_1.7w ‘
STATE WELL CONSTRUCTION PERMITS ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential 2Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATI`�
Nearest To ! / 11/n✓'1S County /l()EitaA)
-3-Fed- 6 " tio+-1- At -kJ
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER:
Address
et� //fr RouteNt G a 67y'/
City of Town State Zip Code
Area code- Phone number l /
4. DATE DRILLED 7—/yo
5. TOTAL DEPTH: y %S
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 0
7. STATIC WATER LEVEL Below Top of Casing: /VC) FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
*Top of casing terminated at/or below /and surface requires a
valiance In accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): I.S METHOD OF TEST Al Y
10. WATER ZONES (depth):
11. DISINFECTION: Type
12. CASING:
Depth,
From To 0 ! O 7 Ft.
From To Ft.
From To FL
13. GROUT: Depth
From 0 To -2 a Ft.
From To Ft.
Amount
tjer, Wall Thickness
la or Weight/Ft. Material
pUL
Material
CM/VA't
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth
From To Ft.
From To Ft.
16. REMARKS:
Method
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/secoads)
Latitude/longitude source:❑GPS❑Topographic trap
(check box) '.
DEPTH DRILLING LOG — -
From To Formation Description
^ /toy
Slot Size Material
in.
in.
Size Material
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the
numbers and common road names.
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
i — ' `t
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

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
IJ�
WELL CONTRACTOR (INDIVIDUAL) NAME (print) , G.0 e r,-A✓e CERTIncAATIot(iQ,,,`i/C .
PHONE M ( 97,6
WELL CONTRACTOR COMPANY NAME e lik
i- s- !Ala Drij_jdc..
29 el
STATE WELL CONSTRUCTION PERMIT# _ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential-B" Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATIO,
Nearest Town:
ioos.)Aril) County Nj4a#)
Ae/VOw
(Street Name. here, Community, Subdivision, Lot No., Zip Code)
3. OWNER: D t+ . ?gel
Address dd 6611 / (o b''C
Fr kb-Aitreet % Route
c316 37
City or Town State Zip Code
Area code- Phone number
4. DATE DRILLED GD '3 —0
5. TOTAL DEPTH: t f r
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO ❑
7. STATIC WATER LEVEL Below Top of Casing: 9 L7 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface"
`Top of casing terminated at/or below land surface requires a
variance In accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): y0 -I- METHOD OF TEST it! ✓
10. WATER ZONES (depth):
Topographic/Land setting
❑Ridge 0Slope ❑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
a- e� intA -,�
11. DISINFECTION: Type
12. CASING:
Depth Diameter
From_ To (sr% Ft. tr—G T�JL—
From To Ft.
Front To Ft.
13. GROUT: Depth Material Method
From[_ To 9.0 Ft. (te /YIe.A/ ('- ,potty'. Al
From To Ft. T /
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.
Amount
Wall Thiclmess
or Weight/Ft. Material numbers and common road names.
Slot Size
in.
in.
Material
16. REMARKS:
G1 j
r
r.) c-.._.
j,OCATION SKETCH
Show direction and distance in [Hiles from at lea]t
two State Roads or County Roads. Include the cad
Ut
c r.
r—
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED 1N ACCORDANCE WITH 15A NCAC 2C, WELL
CON UCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
Aide. /�j--ad —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-1 REV. 07/2001

299 i00
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print >/'1 Ale �/a'4e _ CER 1F1CATIONJ- ?1
WELL CONTRACTOR COMPANY NAME e-
GA > N.(yeil l'5il/Gr PHONE M r 7%C 1�1(�-�i_
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential -Er- Municipal/Public 0 Industrial ❑ Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION•
Harp J�✓1s County Thi4CJA)
Nearest Town:
(Street e, Numbers, Community, Subdivision, lot No., Zip Code)
3. OWNER: J)yy1 1/A'ttsiN
Address `j.19v 4-t4 e 7 c
Ala ft Route No.)fl
City or Town State Zip Code
Ares code- Phone number
4. DATE DRILLED (. -a aroV
5. TOTAL DEPTH: )
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 0
7. STATIC WATER LEVEL Below Top of Casing: gb FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS J FT. Above Land Surface*
'Top of wing terminated at/or below land surface requires ■
variance in accordanc9 with I5A NCAC 2C .0118.
9. YIELD (gpm): / METHOD OF TEST "Pr
10. WATER ZONES (depth):
Topographic/Land setting
❑Ridge 0Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
o
- /
11. DISINFECTION: Type Amount
12. CASING: Wall Thickness
Depth Dia)neger or Weight/Ft. Material
From 0 To .b Ft. 0 �I// fade --
From To Ft.
From To Ft.
13. GROUT: Depth Material Method „_
From_ �_ Tory � Ft. �'(./{'llAt�` —�
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.
h
- (n
1�
LOCATION SKETCH
Show direction and distance in miles from at least s
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 15A NCAC 2C, WELL
CONS UCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
/ 7
OA/12e/ £ tj1L...
o
0
a
L q,--
7-ao-of,
SIGNATURE OF PERSON CONSTRUL 1INC 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 of Water Quality - Groundwater Section �"
WELL CONTRACTOR (INDIVIDUAL) NAME (print) ThenY1 i 5 fit IittAr<� - CERTIFICATION d-l%,y
WELL CONTRACTOR COMPANY NAM6)h11ls 0101104rta 111e1IiL-,c.( -fin c' J PHONE N.,sa k-3 g6 a
289 j.3
STATE WELL CONSTRUCTION PERMITN ASSOCIATED WERMITN
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential' unicipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 5 If Other, List Use
2. WELL LOCATION:
Nearest Town: 14o h I a• S County //)6t. (.U)v
I UCc II d0.n(1-_ b74I
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: , II / 1-1 CUt*; Vt
Address /O(a 1- 5/) is r S
(Street or I(oute No.)U
1-k qh Ir2,Ns /)/G b 71
c14, or Town State Zip Code
Area code- Phone number
4. DATE DRILLED 7— i - 0 q
5. TOTAL DEPTH: ,
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO QJt
7. STATIC WATER LEVEL Below Top of Casing: —7(0 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
•Top of casing terminated at/or below land surface requires a
variance In accordance with 15A NCAC 2C.0118. '
9. YIELD (gpm): , S- METHOD OF TEST_ h10.11/4--,
10. WATER ZONES (depth): ,?(t+ S' Sf0(5 ' (�
pographic/Land setting
idge ❑Slope ❑Valley ['Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
pEPTH PRILLING LOG
From To Formation Description
0 LIGoj
/.
LOCATION SKETCH
1 I. DISINFECTION: Type , -t'P Amount cr, Y,4 S Show direction and distance in miles from at least 1-3
12. CASING: Wall Thickness two State Roads or County Roads. include the road
From 0
Depth Dia eter or Weight/Ft. Mateii I numbers and common road names.
To ,.2 / Ft. 5-b R ,$ j P Y
From To Ft.
From To Ft.
13. GROUT: Depth
From 0 To_. _
From To
14. SCREEN: Depth
From To Ft. in.
From To Ft, in.
15. SAND/GRAVEL PACK:
Depth
From To Ft.
From To Ft.
16. REMARKS:
Size
Mn i Method Qi
Ft.
Diameter Slot Size Material
in.
in.
Material
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUL 1 ED IN ACCORDANCE WITH 15A NCAC 2C, WELL N
CONSTRUCTION STANDARDS, AND THAT A COPY OFTTH15 RECORD H S BEEN PROVIDED TO THE WELL OWN
tAk /. r tLGC %— —U SL
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to 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

299658
WELL CONSTRUCTION RECORD
North Carolina • Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) cb-e f) P) I S I i'I} f' CERTIFICATION 4 oL, /7 4'
WELL CONTRACTOR COMPANY NAMI;N..11n1S f�"1jlnylc'l Wei lal Yet II cA VP eJ PHONEw -l—Sa 4•-3 6
STATE WELL CONSTRUCTION PERMIT/ ASSOCIATED WERMITY
(if applicable) (if applicable) '
I. WELL USE (Check Applicable Box): Residential'rd.--Municipal/Public ❑ Industrial 0 Agricultural ❑-
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other a if Other, List Use
2. WELL LOCATION: -
Nearest Town: f+1(;.HLAil-IbS County /i)t2 Gen
l�fa - li? 4�On��r05 4 0287y!
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3.OWNER: C�-PD1Y1-(1 n -`)
Address /A C, lit (f(S
14(Street or Route o.) c B 7 V �Ahln,�s
fciij or Town State Zip Code
Area code Phone number
4. DATE DRILLED / --/
5. TOTAL DEPTH: (r55'
Taphic/Land setting
tdge ❑Slope 0Valley • QFlat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑TopoOraphic map,
(check box) 1_.——=-
pEPTH - DRILLING LOG
From To Formation Description
n r.2. / ` . S'r: r,: a S f tn,—c,
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO Q1I�
7. STATIC WATER LEVEL Below Top of Casing: i 50 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
*Top of casing terminated allor below landsurface requires a
variance In accordance with ISA NCAC 2C.0111.
9. YIELD (gpm): / 0 METHOD OF TEST /l1!/Ji7f�(—,
10. WATER ZONES (depth). a SO' (�
LOCATION SKETCH
11. DISINFECTION: Type Jt-i -! Amount 759- 5 Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads. Include the road
Depth Diapnetter or We hUal Ft. Mate numbers'and common road names.
From 0 Tot h" S-bR,T7 Pr
From
From
GROUT:
From n
From
To Ft.
To Ft.
DepthMaterial nMMetthod
^
To rf(^i Ft. eo4 J t
To Ft.
SCREEN: Depth Diameter Slot Size Material
From To Ft. in. _ in.
From To Ft in. in.
SAND/GRAVEL PACK:
Depth Size Material
From To Ft. •
From To Ft.
o -
16. REMARKS:
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 154 NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF TH S RECORD H S BEEN PROVIDED TO THE WELL OWNER
bra i. c)--/;-6
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mali Service Center - Raleigh, NC
27699.1616 Phone No. [phone], within 30 days. OW -I REY. 07/2001

299657
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources1- Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) c-h-en M 1 5 II `" / t rU CERTIFICATION fa ot-/7 `P
WELL CONTRACTOR COMPANYNAMwhhnrS IJiJ4ra �I�P,I��I yeI I%u!{l.�i9-f' J PHONE M-3S<.Sa.4-3 g6
STATE WELL CONSTRUCTION PERMIT,/ ASSOCIATED W ERMITM
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential'(d'Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other CI If Other, List Use
2. WELL LOCATION: �/1 Topographic/Land setting
Nearest Town: /L / C../-i L/1- till' County "l r et (t.-)DRidge ❑Slope ❑Valley at
(4 4 E C (-) C 41 ; -e R 5 . I. A f� 12 , CLL P C,.(- (!----, (check appropriate box)
(Street Name, Numbers,(( Community, Subdivision, Lot No., Zip Code) ip &'7 L/ % Latitude/longitude of' well location
3. OWNER: <To CI 13 Cup 1( lY f -i-?,--% (degrees/minutes/seconds)
Address /Lf S 7) Mt,, I "7` Y' e,e .0.,,,., 17 IQ_(C. Latitude/longitude source:❑GPS❑Topographic map
/� (Street or Route No.) (check box)
i—t -t II E tt S (7-71 �� P (<DEPTHFRILLING LOG
City or Town State Zip Code From To Formation Description
Area code- Phone number / �^ - 0 —)r / eCS r I L /i [ ��--Y«-ts l t-�
4. DATE DRILLED
5. TOTAL DEPTH: W-C i
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 0--------
7. STATIC WATER LEVEL Below Top of Casing: S 0 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
•Top of casing terminated at/or below land surface requires a
variance In accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): (m, METHOD OF TESTI /III/ihttm
10. WATER ZONES (depth): .S6C-'") 700 ' (�
LOCATION SKETCH
11. DISINFECTION: Type 1-/ -f» Amount t TAP, 5 Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roadsasclude the road
0
Depth Diay�e�t�er or Weight/Ft. Matep' 1'numbers and common road names.
From ToV_ Ft. /�' S.i2 R,$j pY- —
From To Ft.
From To Ft. ro
I . GROUT: Depth Material Method % �
From n To_a Ft. C4-r Oy,. p0-m, / -
From To Ft. —_
14. SCREEN: Depth Diameter Slot Size Material _
From To Ft. in in. Iv —
From To Ft, in. in. CJI cl-.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF TH S RECORD H S BEEN PROVIDED TO THE WELL OWNER—
(r 014 O• 7 6
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

NC
HIM
2. WELLLOCA1A110N
NearestTown:'NW-I CountyrVlaCOrl
ramp frc,vlrIt /Iw.
(Sheet Name, Numbee, Community, Subdivlalon, Lot No. Zip Cale)
3. OW N E R:C5-Qi'N1 ; eghr eta_
Address P. fl. P&i) 5'1
(signior Route No.)
i oPr0 NC P S
City or lows State Zip Cole
( )-
Ain code- phone number
4. DATE DRILLED r1- - rO -I
5. TOTAL DEI'TII: 31r1S'
6. DOES WELL REPLACE EXIS'1'INU WELL? YES O NO RI-
7. STATIC WATER LEVEL Uclow Top of Casing:.2D'
(Uwe "+" If Above lop or Coxing)
8. 101' 01' CASING IS I rr. Above Land Sur faces
'Top of caving ter minded wl/or below Ind con lice req oh et ■
eulrnce In accordance with I5A NCAC IC .011N. \\
9. YIELD (gpm): l e :Art moo Of TEST - \\ p°i\e
10. WATER ZONES (depth):
11. DISINFECTION: Type\R \SeS'S Aluolnit S
12. CASING: Wnll'Ihickness
Depth Diameter or WeighVhl. Material
From I-)To70' FL /0„2$ <DC21 Ct/L
Iron To
Froii To
13. GROU f: Depth Material Medved
From 0 To ab' IL prc4 lat1r4 ? P'Sure
From To II.
14. SCREEN: Depth Diameter Slot Size Material
Front To 11. in. in.
now,, TO Fl. in. in.
15. SAND/GRAVEL PACK:
Depth Size Mnletinl
Eton t To FI.
Irons To It.
16. REMARKS:
rt.
WELL CONSTRUCTION J4ECO!W 2.11)17.
North Carolina - Dcpatuncut of Environment and Nnlwal Resources - Division of Water Quality - Groundwater Section
\YELL CONTRACTOR (INDI VIDUAL) NAME (pint) Jon-vie-4)\rc\' u,) .5 on CERTIFICATION N 290c)
11
WELL CUNTRACIDR COMPANY NAME m;11tc Q t...,\ J C l\ V,e10'
STATE WELL CONS [RUC' ION PERAII IN ASSOCIATED WU I'ERMrfN
(if npplicnblc) Of npplicnble)
WELL USE (Check Applicable Ilex): Residential iWThluuicipal/Public O Industrial Cf Aglicultutal O C)
Monitoring 0 Recovery CI Ileat 1'oup Water Injection O Other O If Other, List Use
w
Topographic/Land setting
1:11Udgc 1136tope ❑Valley OI'lal
(check upptop:Inte box)
Latilugc/lon Rude of well location
enS DRrfau-va-• rvv (-ii"`f7e`r 1..18oi°34 a'...
(deareex/minutetfeenndQ
Latitude/longitude sourcc:OGPSO I upographic neap
(check box)
PRIL1.LQ_LVQ
Fort: lion DFscription
man
Trout To
— ID'
liO - Con'
(Qn ' ?,OS'
0
LOCATION sKI:Tc11
Show direction and distance in miles frgm atleast
two Stale Roads or Courtly Roads. Inclrfde the;toad
numbers and common road names. '
/147/Q11qk?
I DO IIEREDY CEIVFIFY11LAT11IIS WELL WAS CONSIRUCIED IN ACCORDANCE WITII ISA NCAC 2C, WELL
CONS1RUCT ION STANDAIWS, AND TITAT A COI'Y OF 17115 RECORD IIAS BEEN PROVIDED TO TIIE WELL OWNER
SIONATUIIE OF PERSON CONSTRUCTING 111E WELL
''7- /-O Ci
DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mall Service Center - Raleigh, NC
17699-16.16 I'Ituue No. [phone], vhhhn 3U days. UW-I REV. 07/2001

-
NC V OWNER
MIIO
WELL CONSTRUCTION RECORD 2 9 9 7 61
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CON TRACTOR (INDIVIDUAL) NAME (prinl) , )QYVI ES `I (o:\ SInh CER1IFICATION pyr�DY
WELL CONTRACTOR COMPANY NAME VY): tIPr LA5to 1.1 l ili nQ PIIONE N (gzs) r--2Q47
STATE WELL CONSIRUCI ION FERMI IN ASSOCIATED WO PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Icon): Residential Municipal/Public LI Industrial D Agticultutal
Monitoring ❑ Recovery D Ilea( l'uulp Water Injection D Other 0 If Other, List Use
2. WELL LOCATION:'1
Nearest Town: hAvttuhfile, County VVIClCt2Y1
(surd ame,Umnbel%Community, Subdi virlon, Lol No., Zip Code)
3. OWNEIt:p//G'L%FPh
Address p 0..&$ /Q S
(Sheet or Route o.)
ArO9(1w',) C, 3 1?oI
City or Town State Zip Cale
At re rode- phone number
4. DATE DRILLED 7-.?-Oy
5. TOTAL DEPTH: 24/5'
6. DOES WELL REPLACE EXIS'FINU WELL? YES D NO F.7-
7. STATIC WATER LEVEL Below Top of Casing: ,-,WO ' _Ff.
((Inc "+" If Above lop of Dollop)
8. TOP OF CASINO 1S / IT. Above Land Sulfacc•
•Tap of redo/ Irrtnlndell aUnr below lend out fare requites a
rulrnre In accordance with ISA NCAC IC .0118.
9. YIELD (gp111): 6i METIIOD OF'FEST//,✓1
10. WATER ZONES (depth): 11. DISINFECTION: Typelr'//
Ji fp/t'eir
12. CASING:
Depth Diameter
Front 0 To (col Pt. /hu
Pions To 1'I.
From To Pt.
13. GROUT: Depth Malaria `
Pwun 0 To ,2o ' Pt. G
1'r0111 To Pt.
14. SCREEN: Depth Diameter Slot Size
Dion t To Pl. in. in.
I'wnt'I'o 1'I. in. in.
15. SAND/GRAVEL. PACK:
Depth Size Mn(crial
Front To I'l.
l'rotit To It
Amount
Wall 'thickness
or Weight/Et. Mateiial
SG/1/ 'MC
Topographic/Land setting
❑Judge EU&lope DVallcy OPIat
(check eppnoprinle box)
Latitude/longitude of well location
n-
0
w
0
CD
(degrees/minnlesrreconth) ----
Latitude/longiludc sowcc:DGI'SD lop reptile imp
(check boa)
DEPTH 12IULI4LL LQQ
Formation Description
e /aiy
% r - .47) ' Sg a i.r r
SA ' ays' Aran: r
Front To
G ire
i_
N - —
J
LOCATION SUITCIIE
Show direction and distance in miles froOOI at -least
two Stale Roads or County Roads. d ludi We road
numbers and conunon road names.
pr
Mewaa / Corn/
ife,arzte I I o . �t�i 44
Matetial
'we ii
16. REMARKS:
a
41/4., 1 (Y
JAY,/.f
I DO HEREBY CERNI'Y MAT11115 WELL WAS CONS' 7tUCIED IN ACCORDANCE WITH ISA NCAC 2C, WELL
CONS. RUCTION STANDAIWS, AND MAT A COPY OF TIIIS RECORD IIAS BEEN PROVIDED TO TI lE WELL OWNER
SIUNAIUItE OF PERSON CONS 'IRUCTINO TIIE WELL DA1 E
Submit the orlglnnl to the Division of Water Quality, Groundwater Section, 1636 Mall Service Center- Raleigh, NC
27699-1636 Ilium Nu. (919) 733-J221, n l(Itin 3U days. GW-I REV. 07/2U0

3.00112
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) c7)-enMll 5 / jitti n, CERTIFICATIONS or-%74,
WELL CONTRACTOR COMPANY NAMIC ltn1C lit !'a, Iile0y, I'm&TneJ PHONES t" ,' ay-s ab o
WELLSTATE CONSTRUCTION PERMI7tY ASSOCIATED W EAMITY
(if applicable) (ifapplicable)
1. WELL USE (Check Applicable Box): Residentialti--- unicipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other C1 If Other, List Use
2. WELL LOCATI��
earest Town: / K 9 1 k L j /11 County /�/1 a (fr>ti
4C. Obey, fir �11'1t (2� o2fi73
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: fkiCLkn 1v La-11 LZnn n
Address (e-2,S /-EI C-/4L/-F4-1lf /ZT
(Street or Route No.)
I ! amid inn) NC-, a C73 t}
City or Town State Zip Code
(S21-')- S-2'f— r3 L1/
Area code- Phone number
4. DATE DRILLED — — 0 df
5. TOTAL DEPTH: (( ()Si
Topo ap and setting
❑Ridge ope ❑Valley QFIat r
(check appropriate box) : C t �-
Latitude/longitude of well location a
(degrees/minutes/seconds) �l _
Latitude/longitude source:❑GPS❑Topographic map
(check box) �o
DEPTH DRILLING LOG
From To Formation Dpscription
P I (A.,
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO ❑lam
7. STATIC WATER LEVEL Below Top of Casing: 90 / FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
•Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD(gpm): / METHOD OFTESTI/029h
10. WATER ZONES (depth): q G '
11. DISINFECTION: Type H -�"i' Amount
12. CASING: Wall Thickness
J OCATION SKETCH
7-)j-4 5 Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
Depth Dia ter or Weight/ft. Matey- 1 numbers and common road names.
FromQ To Ft. 5 R R. p y
From To Ft.
FromTo Ft.
13. GROUT: Depth Material Method
From n To r}(7 Ft. ias j2�it--)
From To Ft. I
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 Material
in.
in.
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 TH S 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 Mall Service Center -Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-I REV. 07/2001
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WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Mitchell D. Ccok CERTIFICATION # 2043
WELL CONTRACTOR COMPANY NAME Han PECthatl rr trtQ, Ti'r PHONE # WO) 169-9Ccil
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable)
(if applicable)
�Ulb'30
1. WELL USE (Check Applicable Box): Residential$ Municipal/Public 0 Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATIO
Near eSt Town:
County gG(/.C:O/v
(Street Name, Nunb- s, Community, Subdivision, Lot No., Zip Code)
3. OWNER:
Address
treet or - . to
City or T n at Zip Code
(15)-
Area code- Phone number
4. DATE DRILLED 9' 1y 70' /
5. TOTAL DEPTH: /38 t D04- ,{�
6. DOES WELL REPLACE EXISTING WELL? YES a�0 Olt
7. STATIC WATER LEVEL Below Top of Casing: FT.
(Use "+" if Above Top of Casing)
S. TOP OF CASING is 2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance In accordance 15A NCAC 2C .0118.
9. YIELD (gpm): MET QIPQF TEST hl nur
10. WATER ZONES (depth): 1 II ((JJ
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
0 clay & sand
granite
11. DISINFECTION: Type H T H Amount 1 E 07
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From_Q_ To Ft
From To Ft.
From To Ft.
13. GROUT: Depth Material
From__ To 20 Fttx tent= & menc it
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
Method
Fri
Slot Size Material
in.
in.
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.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
»Z, 2 h42 11%. C /- 0 4/
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

301675
WELL CONSTRUCTION RECORD
+id{ a, .
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section / -
WELL CONTRACTOR (INDIVIDUAL) NAME (pit) ;MCI VI 5 [1) J llZA1 A.,_' _ CERTIFICATIONle
0 01�1
WELL CONTRACTOR COMPANY NAMSh'.1)11I S AOl I4,Ir► Ines f l v4 I (�St.(- -cm e J PHONE T a ira a Y "3 a- b 6
STATE WELL CONSTRUCTION PERMITS ASSOCIATED W ERMI'ri
(if applicable) (if Viable)
I. WELL USE (Check Applicable Box): Residential' unicipal/Public 0 Industrial ❑ Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other CI If Other, List Use
2. WELL LOCATION:
Nearest Town: PR4i21kL1 A County ma Len" -
& q e- /(/Qa./nor CAtt t- fg 3 c f
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: FPe6 r: C L' Keene X_
Address 7a7.2. Ili jrilands lea
(Street or Pau 0)
�t?Q,)7vinth ,VC- 402173 y
City or Town State Zip Code
(Brag' 3699- 93ia.
Area code- Phone number
4. DATE DRILLED 9— / ' D y-
5. TOTAL DEPTH: / SS`
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO EY--
7. STATIC WATER LEVEL Below Top of Casing: of D FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface'
'Top of casing terminated atior below landsurface requires a
variance In accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): METHOD OF TEST b loWnti(-.
10. WATER ZONES (depth): (D 2- l D be
(�
Topographic/Land setting
❑Ridge ❑Slope apitifiey QFlat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To ,. Formation Description
0 t{y j7' c$' arvc`S )`-e"-e-.
Atrr' / 53"' /3 to e C--R.ekrt.e...
11. DISINFECTION: Type
12. CASING:
From 0
LOCATION SKETCH
ht-t// Amount .-.1 -S S Show direction and distance in miles from at least
Wall Thickness two State Roads or County Roads. Include the road
Depth Dirtter or Weight/Ft. Mate 1 - numbers and common road namesAp,,, te..,�O
To Ft._12'_ 3z2 e . n, Pr tope /Q
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From i) To rZ Ft. e9.171d,r p
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:
tit eiv,p,
Sep `alio/A.4o
4 9 ?Oaf TjpN
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF TH S RECORD BEEN PROVIDED TO THE WELL OWNER
trot,i� 9 i og
SIGNATURE OF PERSON CONSTRUCTING THE WELL D
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mali Service Center -Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. _ GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section / -
WELLCONTRACTOR(INDIVIDUAL) NAME(print);hen vl+S ko i CLA[i ' CERTIFICATIONS r2-/'`f'
WELL CONTRACTOR COMPANY NAMB'tR TS h401111e4/1 IW ell) ijIIT1c.L 174 e I PHONE uilliCtjaY-3 '-6
STATE WELL CONSTRUCTION PERMITS ASSOCIATED W ERMITS
(if applicable) (if applicable)
301671_
1. WELL USE (Check Applicable Box): Residential' unicipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other 5 If Other, List Use
2. WELL LOCATION:
Nearest Town: r&AtHLcL; /t' County / r sa-Ldy,—>
4415• (,�a-tes 13R. •.1-fr'73y-
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: /7 R. r) 01J
Address 33/ St' NNy La, Are —
(Street
�-, (Street or Route No.)
FR4.vnLiAl ,✓C— 02orin11
City or Town State Zip Code
(DSO- 3b9- 230
Area code- Phone number
4. DATE DRILLED 7-a --r,3.4
5. TOTAL DEPTH: .3QS'
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: 30 FT.
(Use "t" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): Si METHOD OF TEST 1UI/i, tt
10. WATER ZONES (depth): 02 SF-O' (�
11. DISINFECTION: Type if -kW Amount e,2 Mk 5 Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads.Jncl jle the road
h Dia ter or Weight/Ft Mate _ _numbers and common road name4Ur
Tgpographic/Land setting
C idge ❑Slope ❑Valley QFIat
(check appropriate box) +
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
Formation Description
riq,-)
3Lt/Cl 6 ra»,,t -•
DEPTH
From To
t) a5'
r05 • .3 os •
From 0
From
From
13. GROUT:
From (3
Dept p
To_01,1 Ft. k " S-z2Q,S 1
To Ft.
To Ft.
Depth Material Method,ll
To V Ft. Ca r M+f re,,,
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
sep PAI
4 oiko
200 CTipy
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OFTH#S RECORD HBEEN PROVIDED TO THE WELL 0'
0
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
_ 1 11 I
'0 { i
r-c
V
jai j
V2.>€R soa. l G''
q' -a--0 z yn:i'
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mall Service Center- Raleigt,
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001
��1

301672
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) c1)e)1 Vl l S l j Idas,t�
CERTIFICATION # ' Y'
%, dt)jIOMaI�)Pjl�it�L1a. - nee PHONE ifilt M.4-3�-6
\YELL CONTRACTOR COMPANY NAMRjyjjl '
STATE WELL CONSTRUCTION PERMITl ASSOCIATED WQtERM1TI
(if applicable) (if applicable) .
1. WELL USE (Check Applicable Box): Residential' unicipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other Ci If Other, List Use
2. WELL LOCATION: At
Nearest Town: fLflivli // County t co'rt.)
1 r/l>/ Covet Comm_ /11e'edrsanrts 26
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code) 'a..S73 /
3. OWNER: Sr. Pool e.
Address l 3 .$IVY J—fl /e St'
(Street or itolne No.)
J2Cf g nit /n3 gCi o2 R /73 y DEPTH
City b , Cst9_St( 43 zip Code Fr6 T
Area code. Phone number n (y y y' 7.r'
4. DATE DRILLED a" ,:et --- 0/ %S' //3'
5. TOTAL DEPTH: 75' J /3 ' 3 7S'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: /00 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING I5 / FT. Above Land Surface*
'Top of cuing terminated at/or below landsurface requires a
variance In accordance with 15A NCAC 2C.o118.
9. YIELD (gpm): 2' METHOD OF TEST l fliiiTf�(f-�
l0. WATER ZONES (depth): /ail /4,0' (�
JH-/F Amount C
t I. DISINFECTION: Type
12. CASING:
Depth
From 0 To 1/ 3
From To
From To
13. GROUT: Depth
From () To r9f) Ft.
Wall Thickness
Diapeter S or Wes�,ghUFt. Mate I
K YCL.
Ft. .bR J
Ft.
Ft.
Material
CP'Yr
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size Material
Method
#20-214—
Slot Size Material
in.
in.
From To Ft.
From To Ft.
16. REMARKS:
Topographic/Land setting
ge ❑Slope ❑Valley QFlat
(check appropriate box) 4'
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
Formation Description
e6n1
y e rerrl r��crr,,,,4,a.t�t s��r�-
B�u st .9te Te�
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names. 4 R
R`eo
Sep ate,6y/�iyP
0 1p0 SFCT/H
S'
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF TH S RECORD S BEEN PROVIDED TO THE WELL OWNER
if. \r - a 7 -c
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to 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

301673
WELL CONSTRUCTION RECORD
. F
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME E (print) c1).e i) h 1 5 [,}n ! l a,A d, CERTIFICATION # ot-/7 (P
E:'I .
WELL CONTRACTOR COMPANY NAMeelYjji Mt Ito yui Weil yetiJ PHONEY 5,2 4 —3 ?6 6
STATE WELL CONSTRUCTION PERMIT*/ ASSOCIATED WQf14ERMIT$ •
(if applicable) . (if applicable) .
I. WELL USE (Check Applicable Box): Residential' unicipal/Public ❑ Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other cf If Other, List Use
2. WELL LOCATIO ^n
Nearest Town: -R L:,V County /f'QGT'L-
01?AINwet a men. 3 u bDS 72Q.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code) 02 gem y
3. OWNER: a-V, a 14% +e
Address 1 R' 4LA9 C , f /Lt 1 ory 57
(Street or Route No.)
Linz Ga•
DEPTH
City o own State Zip code From To
(13)- or-Town
l girl) 6 (03'
Area code- Phone numbs
4. DATE DRILLED I —36 — o V
5. TOTAL DEPTH: 3 -SS '
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO IZ✓-s-
7. STATIC WATER LEVEL Below Top of Casing: 90 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
*Top of easing terminated at/or below landsurface requires ■
variance in accordance with ISA NCAC 2C .0118. /
9. YIELD (gpm): ;co METHOD OF TEST_. IO2O N (J-.
10. WATER ZONES (depth): 33o ' Q
33 599
11. DISINFECTION: Type It-t//
12. CASING: Wall Thickness
D th Dia ter�or Weit/Ft. Mete }�1
From 0 To /03 Ft. /�' S-(2R. 3 O)P
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From n To aip Ft. P47147,1 p0n4
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:
(03' /05'
ins- ' 35S
19pographic/Land setting
DR age ❑Slope ❑Valley DFlat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
Formation Description
Pl/2
s
fan
8Luc twit; i rc
LOCATION SKETCH
Amount r- TA -A Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common mad names.
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL,
CONSTRUCTION STANDARDS, AND THAT A COPY OF TH S RECORD S 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 Mall Service Center -
RaleihiVC,T_
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 317/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section / -
WELL CONTRACTOR (INDIVIDUAL) NAME (pint) J).tn VII S /!}7l I/OzA �i CERTIFICATION/ nZ/7 of
WELL CONTRACTOR COMPANY NAME91)71S IJtIlori Wei l Yft 1179. Tit P _J PHONE it ki_.Sa 1.4--3 g6 0
STATE WELL CONSTRUCTION PERMITS, ASSOCIATED WIPPERMITII •(if applicable) . (if applicable)
1. WELL USE (Check Applicable Box): Residential' unicipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other Cr If Other, List Use
2. WELL LOCATION:
Nearest Town: Ofin County noon,
49-I S saw.-. 5 e& ; e. Pck ail76
(Street Name, Numbers. Community, Sub/division, Lot No., Zip Code)
3. OWNER: !`7 he e ¥Ck
Address /O/ Sam Sea,/t /2e1
O (Street or RC- No.) O2 E nb 3
City br Town State Zip Code
(U2)- S.2 SA_ 'V 3 9
Area code- Phone number
4. DATE DRILLED an. _ 7 —O y
5. TOTAL DEPTH: 3OS'
301'T 31
Topographic/Land setting
❑Ridge I ❑Valley QFlat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/ongitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
0 44'
qQ' 90 S'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO �f
7. STATIC WATER LEVEL Below Top of Casing: G 0 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING 1S / FT. Above Land Surfaces
*Top of casing terminated at/or below landsurface requires a
variance In accordance with ISA NCAC 2C .01Is.
9. YIELD (gpm): 96 METHOD OF TEST /01.ili Ld{—.
10. WATER ZONES (depth): ea! PO' (�
LOCATION SKETCH
11. DISINFECTION: Type /HP Amount .-i 7-4 S 5 Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads. Include the road
Depth Diaeter��or Weiiht/Ft. Matey. 1 numbers and common road names.
From 0 . To Ft. /o' S.bR,” DYL 4G/PFi
From To Ft.
From T9 Ft.
Depthq Material
To r f) Ft £yyt
To Ft.
13. GROUT:
From n
From
(D Met
f-
14. SCREEN: Depth Diameter Slot Size - , Material
From To Ft. in. in.
From To Ft. in. in,
15. SAND/GRAVEL PACK: _
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF TH S RECORD H S BEEN PROVIDED TO THE WELL OWNER
Or 9-7 --6
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to 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 Resources1- Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME �(print) c'enhI5 A/" I) CERTIFICATION II
WELL CONTRACTOR COMPANY NAME:)1°hjjtC (4 !!o1J lL3el 1)Yri IJn4 _T-n P_.) PHONE #craraja 1-1-3 V-6 0
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED W ERMIT#
(it applicable)
(if applicable)
1. WELL USE (Check Applicable Box): Residential' unicipal/Public 0 Industrial 0 Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 0. If Other, List Use
2. WELL LOCATIO -
Nearest Town: I?• L / NCounty a co.-
C9A/ 'p_se egeefe..,mm• 022,73 y
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: it) 11 hQ-ss ea
Address D 1?os G 7 Y,c e/ z a
(Street or Route No.)
g/73
City or Town State Zip Code
(fr2&( . 4 - 7tG607
Area code- Phone number
4. DATE DRILLED -/ - 3 re
5. TOTAL DEPTH:
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
To ographic/Land setting
ge ❑Slope ❑Valley 4FIat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
To Formation Description
�r
.ins •
From
0
•
9 a'
7. STATIC WATER LEVEL Below Top of Casing: .SO FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS ! FT. Above Land Surface*
'Top of easing terminated at/or below landsurface requirts a
variance In accordance with ISA NCAC IC .0118.
9. YIELD (gpm): i 5 METHOD OF TEST_ /07/�27it
10. WATER ZONES (depth): 1.43A.) ICED ' (�I
�2,y,/J LOCATION SKETCH
11. DISINFECTION: Type J7 - Amount c.L` TA- S Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads. Include the road
Depth Dia ter or Weight/ft. Mateppl numbers and common road names.
To Ft. SZ2RIf Pr v.--
Ft.
Ft
From 0
From To
From To
13. GROUT: Depth
s�;�
From n To c*f)
Material i Method
F Ft. L-Dyyt y� apA_.,
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.
142G,�F,
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 TH S RECORD S 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 Mall Service Center -Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-I REV. 07/2001

301
WELL CONSTRUCTION RECORD
F
North Carolina - Department of Environment and Natural Resources - Divisioniof Water Quality - Groundwater Section —1
WELL CONTRACTOR (INDIVIDUAL) NAME � �(print) c'hemi ,$ /4 lays, CERTIFICATION w ot-/, l
WELL CONTRACTOR COMPANY NAME"I P.hl')I C f 10110. vi Wm I .1i `' I I :'R r(_ T/. P r PHONE Y'"fl _g a 4-3 .6 0
STATE WELL CONSTRUCTION PERMITH ASSOCIATED WIRERMITI1
(if applicable) . - (if applicable) ' .
1. WELL USE (Check Applicable Box): Residential' unicipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other O If Other, List Use
2. WELL LOCATION: -
Nearestar�^^Town:8 n Countys % Q con.
�f Cf�Ss ani et Ie /`A. S-76j3
(Street Name, Numbers, Co unity, Subdivision, Lot No., Zip Code)
3.OWNER: .YOmrriy ,5'€arc (Street wrRoute No.)
5
6
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 casing terminated atlor below land surface requires a
variance In accordance y�'Ith 1SA NCAC 2C .0118.
9. YIELD (gpm)• (p METHOD OF TEST /(»/i/Nl-.
10. WATER ZONES (depth): ORS' Q
Address /O / ,S .ss . Sea 9-
City or Town State hip Code
(8a23- rsa �— 7/ 3 /
Area code- Phone number
4. DATE DRILLED 4
TOTAL DEPTH: 30.5
DOES WELL REPLACE EXISTING WELL? YES O NO
opographic/Land setting
edge ❑Slope ❑Valley C)Flat
(check appropriate box)
Latitude/longitude of well location
. (degrees/minutes/seconds)
Latitude/longitude source:❑GPSOTopographic map
(check box)
RIMING LOCI
Formation Description
DEPTH
From To
Y/Jjn eea-// y-t.
8 L b �. roe, r y-.•a.
LOCATION SKETCH
11. DISINFECTION: Type /HP Amount o2 FA -A S Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads. Include oa
Depth Dia ter or Weight/Ft. Material numbers and common road names. FC
,P� 4 -
From 0 To (sS Ft. S.IZg,;? 7 .6 `e,0
From To Ft. tf' �O.<O
From To Ft. 4 j .cc‘,
13. GROUT: Depth Material Method, S 4From n To r`}f7 Ft. CDyr tit/ pow—) �0 �c� 0
From To Ft. Oy . ty
14. SCREEN: Depth Diameter Slot Size , Material
From To Ft. in. in.
From To Ft. in. in. 15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
ile
CONSTRUCTION STANDARDS, AND THAT A COPY OF TH S RECORD S 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 Mall Service Center - Raleigh; NC
27699-1636 Phone No. [phone], within 30 days. GW-I REV. 07/2001

I2 'CASING
WELL CONSTRUCTION RECORD
North Carolina • Department of Environment and Natural Resources -:Division of Water Quality Groundwater Section
WELL CONTRACTOR (INDIVIDUAL)NA;MME (print) James B. Brown CERTIFICATION 22045
WELL CONTRACTOR CONIPALYNAht6 Redden Brothers Well Drilling, IncFMONE a $291 369-9591
S'fATE WELL CONSTRUCTION. PERMITO AScOC11TED 1YQ PERMt7d
. " (if applicable) Cif applicable).
WELL USE (Check Applicable Ecx) Residential 8 ' Municipal/Public ❑ .Industrial 0 Agricultural ❑
Monitoring 0 Recovery ❑ Heal Pump' Water Injection ❑ Other ❑ If Other List Use
2 WELLLOCATI
Near" 6q�
/_�Ae�tn
1jd./a
/ Per rein
StreetName, Numbers; Community, Subdivtsiot, Lot No., Zip Code)
County
,q (Streeter Route No.) Aid 7,4A
zesCily r T w%i mt •• Zip Ccdc
Area code. Phone number
,4. DATE DRILLED -'
5 TOTAL DEPTH:`
6 DOES WELL REPLA E EXISTING WELL? YES 0� NO jzC
7 STATIC WATER LEVEL Below Top of Casing: Kt� FT
• (Use "+' if Above Top of Casing)
8 TOP OF CASING IS 2 FT. Above Land Surface*
•Top el' casing terminated at/or'below. land surface requires a
Topographic/Land setting
CRidge 0Slope ❑Valley °Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source: 0GPSDTopographic map
(check box)
DEPTH DRILLING LOG
From T Formation Description
D a Cray & sand
ga' oe' cranite
variance In accordance with ISA NCAC 2C 0118,
9 YIELD (gpm) _ METHOD F EST blow
10 WATERZONES (depth) I lip13
11 .DISINFECTION:Type H T H Amount -. 16 oz
Wall Thickness
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads, Include the road
Diameter or WtrhVFl M teri) numbers and common road names.
Ft. ((GG le
Ft`
13. GROUT: ' , Depth r Material Method
From' 0 To '20 Ft.bernite 8 r33ri31t Fwnned
14;'SCREEN ;'Depth Diameter Slot Size
From To Ft. in sn
From ' To Ft. in. _ in.
15..SAND/GRAVEL PACK:
Material
Size
MateriaF:;
d6 REM`ARKS
I DO HEREBY CERTIFY THAT THIS WELL WAS. CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
CONSTRUCTION STAN DS, AND THAT A COP OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
API E 34
SIGNATURE 0 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
301791

WELL CONSTRUCTION RECORD
3 OWNER
Address
(720,-
Arca code• Phone number p
4. DATE DRILLED 6/./ 'Q'�
5 TOTAL DEPTH: 00
6 DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7, STATIC WATER LEVEL Below Top of Casing: /00 T.
(Use "V' if Above Top cf Casing)
8, TOP OF CASING 7S 2 FT. Above Land Surface
'Top of casing terminated atior below land surface requires a
variance In accordance with ISA NCAC 2C.0118. 9, YIELD (gpm) / METHOD OF TEST blow
10 WATER ZONES (depth): /Oil
County Me
North Carolina - Dcpartmert or Em ironment and Natural Resources— Division of Water Quality • Groundwater Section
WELL CONTRACTOR (IiNDIYIDUhL)NAJ1E (print) James E. Erc t CERTIFICATION 42045
WEtL CON RAC1 OR COMPANY nun,E Hedde^.Brothers Well Drilling, Inc PHONE a$28) 369J,591
SLATE WELL CONSTRUCTION PER,MIT9 ASSOCIATED WQ FERMIIT0
(if applicable) - - (if applicable)..
I WELL USE (Check Applicable Box): Residential J Municipal/Public ❑ Industrial 0 Agricultural ❑
Monitoring Recovery.0 '1-eat Pump Water Injection 0 Other ❑ If Other, List Use
WELL LOCATIC
Nearot Town:
(Sweet Nme, Numbers, Co {mmmmunily, Subdivision, Lot No., Zip Code)
t/i�f o oo Fes/
,Street
or Route a‘t,l,)4 sga
Zip Code
11. DISINFECTION: Type H T H
12 CASING:
Depth
From 0 - To it Ft
From .59 t To Ft.
From- To Ft.
15,
Amount 16 cz
Wall Thickness
Di meter or Weight/Ft. Material
ee -
GROUT: Depth Matena
From 0 To ' 20 Ft. be -mite
From Tc : Ft.
SCREEN Depth - Diameter
From - To. Ft. in
From ,. To Ft. in
SAND/GRAVEL PACK:
Depth
From
From
Size
I
c- tts
Method
PumPea
Slot Size Material
in
in.
Material
Topographic/Land setting
ORidge OS lope OValley ❑Flat
(check appropriate box)
Latitude/longitude of well location
301788
(dtgreeshni-nutes/seconds)
Latitude/longitude source. OGPSOTopographic map
(check box)
DEPTH DRILLING LOG
From jQ� Formation Description
clay & sand -
granite
LOCATION SKETCH
Show direction and distancein 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 13A NCAC 2C, \VELL
CONSTRUCTION 75jJ DARDS, AND THAT A COPY OF THIS RECORD HAS SEEN PROVIDED TO THE WELL OWNER
SICNATOR. OF PERSON CONSTRUCTING 7HE 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 crintronment and Natural Resources - Dlviswn of Water Quality - Grcund.vater Section
WELLCONTRACIOR(INDIYIDUAL)-NAME (prltlt) JzmeS B. EreWn CERTIFICATION ;,'_2045
WELL C0NIRACTOR C0MFANYNAME Heetden Brothers Well Drilling; Inc PHONE k 369-9591
S'CATE WELLCONSTRUCTION PERMITM ASSOCIATED WQ PERMIT#
.. (if applicable) :(duplicable)
WELL USE (Check Applicable Box) Residential EMunicipal/Public 0 industrial 0 Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water injection 0 Other 0 If 0tner, List Use
2 WELLLOCATIC
Nearoww'
County %9G
Street Nal NuuilTbfet7; Community, Su!divkion, LotNo., Zip Code)
OWNER: / VI='
Address ��}} Sze Zo7
r t nee tits )Vd& cairn
city Tow ' cJat Zip Code
(99g8 Arei code• Phone number
4 DATE DRILLED 8'9 OJT
5 TOTAL DEPTH ,,..SOD e
6 DOES WELL REPLACE EXISTING WELL? YES :-(]nF
NO
Pt
• 7 ;STATIC WATER LEVEL Below Top of Casing: `�!p
(Use 't"'if Above Top of Casmy)
8 TOP OF CASING IS 2 FT, Above Land Surface*
• 'Top, of caslni( terminated atlor below Ian d:au dace requires a
variance In accordance tyy1lth 15.A-NCAC 2C 011S.
9 YIELD (gpm) Co ME`�i- OD OF TEST blow
10. WATER ZONES (depth) 86Y S2S'
13
DISINFECTION: _ype ee m H Amount - 16 oz
Wall Thickness
From ' 0 To
•From act' Ft: /At
at
riot
Method
From 0 To 20 Ft bite 8 affect pumped
GROUT: , Depth Material
• 14: SCREEN ; Depth ^ Diameter Slot Size -
15
Material
SAND/GRAVEL PACK
Depth Size Material
r.__-.
Topographic/Land setting
0Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
301787
(degrees/m m9les/seconds) -
-Lautuec/long tulle source OOPS:Topographic map
• (check box)
DRILLING LOG
Formation Description
clay & sand
DEPTH
From To
0
oa
e 560' aranite
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the read
numbers and common road names.
16 REMARKS.
I DO HEREBYCERT}F
CONSTRUCTIONIST]
THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 1 SA NCAC 2C, WELL
ARDS, AND THAT A COPY OF THIS RECORD HAS SEEN PROVIDED TO THE WELL OWNER
.n
` N ` SIGNATU ... FPERSON 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. GWV-1-REV 07/2001

WELL CONSTRUCTION RECORD 301786
North Caroline - Department of cnvircnmentind Natural Resources - Divs cr of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL)NAME (print) James A. Frown CERTIFICATION 2045
YELL CONTRACTOR COMPANYNAME1 den Brothers Well Drilling, I.....c PHONE aA23l 369-9591
STATE WELL CONSTRUCTION PERMIT0 ASSOCIATED WQ PERMIT#
(if applicable) • - -. (iffaoclicable)•
I WELL USE (Check Applicable Box) Residential `.'Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring O Recovery 0 heat Pump Water Injection 0 Other 0 If Other, List Usc
2 TI Nearest
/i
Nearerest st o ownn County
(Street Nat Number& Community, bddiiviion, Lot No.. Zip Code)
3. OWNER:
��IJ/.SWJ o l d Address
(Street or Route Ne
Yntv,,h/ cat) 3�(6R.
Zip Code
12, CASING, Wall Thickness
Depth --. D ammeter cr Weight/FI,,.M
From 0 To Ft
From lye To Ft.
From To Ft,
13
GROUT: ' .Depth
City or T w tat
(,�(z)- 4 M-) (06
Area code• Phone number
a DATE DRILLED er--
S. TOTAL DEPTH:-
6 DOES. WELL REPLACE EXISTING WELL'S YES 0 NO J1�
7 STATIC WATER LEVEL Below Top of Casing 0100 FT.
(Use "y"if Above Top cf Casing)
8 TOP OF CASING IS - 2 FT. Above Land Surface"
'Top of casing terminated ardor below, land surface repulses a
• variance In accordancc},with ISA NCAC 2C.0118:
9 YIELD (gpm)'CS METHOD OF TUT blow
10 WATER ZONES (depth): A10' 37Y
II. DISINFECTION. Type H T H
Amount 16 oz
n
rid
Material .:.Method
From. 0 To 20 Ft: t-tite &`terasiL pumped
14SCREEN Depih Diameter Slot Size
,'Materiel
15 SAND/GRAVEL PACK.
- Depth - Size
From `.To, Ft..
From To Ft.
Matertaf
Topographic/Land setting
❑Ridge OSlope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(cegreeshn mutes/seconds)
Lot tilde/longitude source OGPSOTopographic map
(check box)
DEPTH. GRILLING LOG
From r Formation Descrion
0 clay & sand
a granite
LOCATION SKETCI{
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common read names.
.O
c `F��Q
16 REMARKS.
I D0 HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
CONSTRUCTION. STA ,S RCS, AND THAT A. COPY OF THIS RECORD HAS SEEN PROVIDED 70 THE WELL OWNER
SIG CONSTRUCTING THE WELL DATE
•
Submlt the ori;mal to the Division of Water Quality, Groundwater Senior, 1636 Mail ServiceCenter Raleigh, NC
27699.153E Phone No..:[phone], within 30 days. GW-1 REV. 07/ 001
NAT R.. OF

WELL CONSTRUCTION RECORD
North Carolina - Department or Environment and NaturalResoulces • Division of Water Quality • Groundwater Section: d
WELLCO,NTRACIOR(INDIYIDUAL)NAN1E (print) James E. Eram" CERTIFICATION: 2045
WELL cohr'i RAC1 OR CO&IPANY NAME Fadden brothers Well :Drilling, Inc P-oNE e EaLlat91,91
STATE WELL CONSTRUCTION PERMIT st ASSOCIATED WQ PERiMIT;.
'.'(if applicable) ' `..(if applicable).
1 WELL USE (Check Applicable Box) Residential Municipal/Public ❑ Industrial O Agricultural ❑
Monitoring ❑ Recovery 0 Heat Pump Water injection 0 Other ❑ If Other, List Use
2 WELLLOCATIC
Nearesj,T�own:
County 717"^'•0
. (Street .Name, Number , Community, Subdivuhon, Lot No., Z p Code)
3. OWNER:.
Address r®.
9
( ire for Roui» ,a„7,/�/
�j 7a%
sly Or
'c n s m (o Zip Code
)it iQ'S
Area code• Phone number ,A[
4 DATE DRILLED 8�! fo,'(/y/� er
5 TOTAL DEPTH 01'
6. DOES WELL REPLACE EXISTING WELL? YEy 0 NO4
77 STATICWATER:LEVELBelowTopofCasing• Coo
(use '+" if Abcve Top of Casing)
8 TOP OF CASING IS 2 FT. Above Land Surface'
• *Top of casing terminated at/or below land surface requires a
variances-accordtne with 15.A� NCAC 2C 0118:"
10. WATER ZONES (depth). 15
Topographic/Land setting
❑Ridge ❑Slope ;°Valley 0Flat
(check appropriote box) •
Latitude/longitude of well location
(degrees/minuses/seccnda)
Lautudc/longitude ource.DGPSOTopcgraphic map
(check box) - ---
DEPTK DRILLING LOG
From 7
blow
9 YIELD:(gpm) - (Q0 METRO, OFT 7og
S
I I .DISINFECTION: Type H T H Amount -"16 oz
12. CASING: ' Wall Thickness
De th Dca ter or Weight/Ft N -tenal
From 0 To q Ft - (
From=To bl Ft left 1
19 GROUT: ' Depth
From "0 To 20
From Tc
14: SCREEN Depth
IS SAND/GRAVEL PACK
Depth
From < • To ' Ft.
From' To Ft.
6. REMARKS
Material :Method
Ft. to -rite & cs3rent pumped
Diameter : Slot Size 'r Material
Size Material:.:.._
301"85
Formation, Description
clay & sand
granite
LOCATION SKETCli
Show direction and distance: in miles flom at least
two State Roads or County Roads. Include the road
numbers and common roan names:
1,00 HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 1SA NCAC 2C, WELL
CONSTRUCTION ST D RDS AND THAT AA PY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SiChNATL E OF PERSON CONSTRUCTINCTHE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center • Raleigh,' NC
27699-1636'Rhonc- 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 • Groundwater Section
\YELL CONTRACTORO DIYIDUAL)NAY1E (prim James E. Brown CERTIFICATION 4Z045
WELL CONTRACTOR COMPANY NAME Redden Brothers Well Drilling, Inc PHONE k k78') 369-CC9'I
STATE WELL CONSTRUCTION PERMIT: -ASSOCIATED WQ PERNIITa
'. (if applicable) - - (ifapplicable)• •
WELL USE (Check Applicable Box): Residential Municipal/Public 0 Industrial 0 Agricultural ❑
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 if Other, List Usc
2 WELL LOCATIO _
N rester Tow_ J�..�'� County liCl
�ii.11;Qp [I.(i
"(Street Name, Numbers, Community, Subddiii yisloa, Lot No Zip Code)
3 OWNER: 4rl IOIQ/1
Address JC
(Street r Acute Nc.)
rty or Tow r
r oozy0 State Z.p Code
cam• 4-
Area code" Phone number O A/
4. DATE DRILLED' y 611
5. TOTAL DEPTH; YiJCJr ,,{
6. DOES. WELL REPLACE EXISTING WELL? YES 0 NO K
/. STATIC WATER LEVEL Below Top of Casing: 300 FT.
(Usc "+"if Above Top of Casing)
8. -TOP OF CASING IS 2 FT. Above Land Surface"
•Top, of easing terminated at/or below land surface requires a
variance In accords nc with. ISA NCAC 2C .0118, -.
Si.YIELD (gpm) METHOD OF TEST blow
10 WATERZONES(depth): lin' d 3 1
I I. DISINFECTION: Type H T H Amount - 16 o2
12 CASING: Wall Thickness
Depth Diameter or Wei hVFI Ma end
From 0 To F31i Ft. le" :IS6
From . To Ft.
From -To Ft.
13 GROUT: Depth Material
From 0 To 20 Ft. bsrn1te & eta
Method
pumped
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. to
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
301796
Topographic/Land setting
ERidge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/ionuitude of well location
(degrees/minutes/seconds)
Latitude/longitde eource:❑GPS❑Topcgraphic map
(check box)
pEPTH DRILLING LOG
From To. Formation Descrotion
Q__.. __._..
tion
O ` �3Lt clay & sand
aII
RZ' LIC]D' ite
LOCATION SKETCH,
Show direction and distancein miles fruit at least
two State Roads or County Reads, Include the road
numbers and common road names.
16, REMARKS.
I. DO HEREBY CERTIFYTHAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15.4 NCAC 2C, WELL
CONSTRUCTION STANDAA S, AND THAT A COP OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
YJ O
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center- Raleig'n, NC
27699.1636-Phone No. [phone], within 30 days. GWI. REV. 07/2001

North Carolina •Department of Envirerment and Natural Resources - Divtstor of Water Quality'
ELL C0TRAC10R(IINDIYIDUAL)hA(1E (print)
James Be Brown
\YELL CON" RACTOR COMPANY NAME Hed°en Erotuhers Well Drilling, Inc.
STATE WELL CONSTRUCTION PERMIT" AScOCIATED WQ PEANUT
Of applicable) (if applicable)
WELL CONSTRUCTION RECORD 301795
Groundwater Section
CERTIFICATION„ 20a5
PHONE a :2rl 369-9591
WELL USE (Check Applicable Box): Residential Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 - Other ❑ If Other, List Use
2 WELL I; N: rill
��/r�est own. cwn: ;�^e��ajpi� County 111C1.Cax.J
4,0
(Street Name, Numbers, Co mtumty, Subai vuion, Lot Nc Zip Code)
3,OWNER:_
Address
'/'�',y+121D''�(SsP,tr'\n)et or �tyyt�la.) 8�3
City or tun ate Zip Cade
( )-'161- (alb
Area code. Phone number r, 1, „/
4. DATE DRILLED' b7T'O7
5. TOTAL DEPTH: ta00'
6. DOES WELL REPLACE EXISTING WELL? , YES 0 NO jr1,,
7 STATIC WATER LEVEL Below Top of Casing: ,,300 FT.
(Use'+" if Above Top of Casing)..
S. TOP OF CASING IS 2 FT. Above Land Surfaces
'Top of casing terminated avor below land surface requires a
variance In accord6nce Izith ISA NCAC 2C.0118. •
9. YIELD. (¢pm): -/ METHMETHWIRIF TEST blow
10 WATER ZONES (depth): „Ti
11.,DISINFECT1ONIType H T H
12. CASING:
Deptii Dfineter
From,..0 To IiAt Ft
From To ,a� Ft.
From To Ft.
13 GROUT: Depth - Material
Amount 16 02
Wall Thickness
or Weight/Ft. Material
id—
.186
Method
From 0 To 20 Ft. brute & Leid1L pumped
From To Ft,
SCREEN Depth - Diameter .Slot Size Material
in
From To Ft in. it
SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS
1 D0 HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDA�HAT A C PY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER-
7 4,/ o
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Nlail Service Center • Raleigh, NC
27699.1636 Phone No. [phone]-, within 30 days, - GW-1. REV'. 0 i/2001
Topographic/Land setting
'Ridge ❑Slope ❑Valley , Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/ln inu Les/seconds).
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTHDRILLING LOG
From lair
Formation Descr Lion
0
ar1; clay& sand
600' aranite
LOCATION SKETCI4
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names,
ott
fel
O

14. SCREEN:
From
From To Ft in.
15. SAND/GRAVEL PACK:
Depth Size Material
From
From
13. GROUT:
From n
r LLI
WELL CONSTRUCTION RECORD 302150
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR(INDIYIDUAL) NAME (print) xi), BV)I S 17r'!hl'A di ' CERTIFICATIIOONY l/7le
WELL CONTRACTOR COMPANYNAMKTxhills AAA"aza (DellTi+r1I 477KP J PHONE 8 7fi—JlaY-3 'b
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED W ERMITB - T
(if applicable) . (if applicable)
I. WELL USE (Check Applicable Box): Residential' unicipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 17 If Other, List Use
2. WELL LOCATION: Topographic/Land setting
Nearest Town: Se a,/ Min County in Ctrs, ❑Ridge ❑Slope ❑Valley at
y't} i 3 /2-1 4-b _ sea Izy Y> 1 ry a a'77 S (check appropriate box)
(Street Name, Numbers, Community, Subdivision, Lot No., ip Code) Latitude/longitude of well location
'TS
3. OWNER: / rbwOtd•' S
Address 3 3 a- e h lJ ci (tin
(Street or Route Jjo )
Mtn. /V
SrA Iya g775
City of own State Zip Code
(7nIR)- 74-G.3317
Area code- Phone number
4. DATE DRILLED `T a U— d rf
5 TOTAL DEPTH:
(degrees/minutes/smooth)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH PRILLING LOG
From To Formation Description
al5' ff /a�7
.k' Rto' Fil u arta,n; r�-
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO fib
7. STATIC WATER LEVEL Below Top of Casing: / D FT.
(Use "+" if Above Top of Casing)
8. TOP OF' CASING IS / FT. Above Land Surface"
*Top of casing terminated at/or below Iandsuriaee requires ■
variance In accordance with ISA NCAC 1C A118.
TEST /020f �A--.
0(� LOCATION SKETCH
Amount .- TA' 6 5 Show direction and distance in miles from at least
Wall Thickness two State Roads or County Roads. Include the road
Depth Diameter or WeIght/Ft. Matey I -numbers and common road names, q.
From 0 To -05 Ft /�' S22R.B7 pY O G'
::-
cr.
To Ft. - t =Ftin
To Ft Cr) r�C
n v3c
Depth Materiel i Method , -or'^
y nQuill o
To rif7 Ft. apey r ( . no ▪ otv
From To Ft rrr1
Depth Diameter Slot Size , Material i0
To Ft, in, in.in. o oQ
..-
▪ rn
10. WATER ZONES (depth): .12 OD '
11. DISINFECTION: Type 1-/-//
12. CASING:
From To Ft.
From To Ft.
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 TH S RECORD HAS BEEN PROVIDED TO THE WELL OWNER
Or
64
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mall Service Center - Raleigh, NC
17699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

30209'7
WELL CONSTRUCTION RECORD
• F
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section "
WELL CONTRACTOR (INDIVIDUAL) NAME � �(prlot) ['henv)15 MIAa,A ti CERTIFICATION #`o117�
WELL CONTRACTOR COMPANY NAMK'I.1�hnis.'���0 •/W Weil II i 7nt' i PHONE "jj1�.�a b
STATE WELL CONSTRUCTION PERMIT" ASSOCIATED WQ4ERMITI1
(if applicable) . (if applicable) .
1. WELL USE (Check Applicable Box): Residential' unicipa1IPublic ❑ Industrial 0 Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection 0 Other CT if Other, List Use
2. WELL LOCATION: / n /Y 1
Nearest Town: PiJJQ/YK L / /Y County t Q WS—.
to4E. Elt:J� tee - I l , 4 ..- 12a- a(T3
(Street Name, Numbers, mmunity, Subdivisio Lot No., Zip Code)
3. OWNER: /] e41- — 14; -Jrn—,
Address 3TSc/ Chore./ ReL
(Street or Route No.)
Fie alt e In0 a S13 y
Fatecity or Town State Zip Code
)- .R(09- a76/
Area code- Phone number
4. DATE DRILLED 9-1/S-0 y
5. TOTAL DEPTH• eY
6. DOES WELL REPLACE EXISTING WELL/ YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: So FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING 1S 1 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
9. YIELD (gpm): Co METHOD OF TEST JIWvariance In accordance with 1SA NCAC 2C .0118.
(/
10. WATER ZONES (depth): /('0) 2!O' (�
Topographic/Land setting
❑Ridge f4Slepf- ❑Valley QFlat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/secondi)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
PRILI.ING LOG
Formation Description
*44
5aUt-ttel 3GL4.�
SLUG � ,P.a.0 : r 4...
DEPTH
From To
O .53'
5.3' q.2'
9.31
LOCATION SKETCH
I I. DISINFECTION: Type /74-fi% Amount a t4-Q S Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads. Include the road
Depth tiel Diater or Weight/Ft. MatefiAl numbers and common road names.
From_ To zsZ.Ft. (�' 5.baj
Ft.
Ft.
From To
From To
13. GROUT: Depth
From_ To
From To
14. SCREEN: Depth
From To
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth
From To Ft
From To Ft.
Material
Ft. GpM' a;
Method
Diameter Slot Size - Material
Ft. in in.
in,
Size Material
16. REMARKS:
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 154 NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD FIPAS BEEN PROVIDED TO THE WELL OWNER
qr a
9-j s-off
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
0

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - DivisionofWater Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME
__(print) c.he n V) i 5 '`}'O 114.A ti CERTIFICATION M o.17 4a
WELL CONTRACTOR COMPANY NAM6b./41M 011)116.ylr( Wen Y`r)ip_ 4eJ PHONE./i'�. 5a' 3 V-60
STATE WELL CONSTRUCTION PERMIT./ ASSOCIATED W&ERMITM •
(if applicable) - (if applicable)
1. WELL USE (Check Applicable Box): Residential' unicipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other O If Other, List Use
2. WELL LOCATION: - ,/
'Nearest Town: flak/. /Y County aZtrr J
Stc,/ 4 J':m y3tief'`f Rz 021173
(Street Name, Numbers, Community,Subdivilron, Lot No., Zip Code)
3. OWNER: L•. E. Art6-eI
Address S(o 2 J: m 8-e fat. , 2€&
(Street or Route No)
fay-k!.i ,VC- 02113 y
����
City or Town State Zip Code
OW - S i'1 — Li/SS
Area code- Phone number n
4. DATE DRILLED 7 —/9 —U
5. TOTAL DEPTH- e2..T.S'
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
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 landsurface requires a
variance In accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): c.S METHOD OF TEST
10. WATER ZONES (depth): 67J' 701 90, /SD'
Topographic/Landcfsetting
❑Ridgern,p° ❑Valley QFlat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
Formation Description
r et,
Ve fP n t-/e (AA it -e--'
1RLue- t f2OWltt
DEPTH
From To
4f tie
y• w;'
Co 3' d5s-
LOCATION SKETCH
11. DISINFECTION: Type 1-1'-1-P Amount oZ tQ-;; Show direction and distance in miles from at least
12. CASING:
Depth p
From 0 . To (93 Ft. .izg,a
From To Ft.
From To Ft.
13. GROUT: DepthMateriel
From To .-*D Ft. CD YY/ Cy+a
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
To Ft.
From To Ft.
Wall Thickness two State Roads or County Roads. Include the road
Diameter or WeighiFt. MMat i numbers and common road names.
k S Y C.�
Method
C'kt^-�
Material
16. REMARKS:
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED 1N ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THHAATT�A COPY OF TH S RECORD S 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 Mall Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

302004
LOCATION SKETCH
11. DISINFECTION: Type {f ±/' Amount ,-2 T.4- AS Show direction and distance in miles from at !east
12. CASING: Wall Thickness two State Roads or County Roads. Include the road
Depth Dia ter or Weight/Ft. Mate gl numbers- and common road names.
From 0. To� Ft.h S-Ilg f l Pr e-
To Ft. F
To Ft. co
13. GROUT: Depth Material Method - -rp
From To r-i''fi FL L.0-fr dp,t p(UA../ r
From To Ft. tV
14. SCREEN: Depth Diameter Slot Size , Material Z
From To Ft. in. in.
From To Ft. in, in. iV
15. SAND/GRAVEL PACK: _ w
Depth Size Material N
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
nn1
WELL CONTRACTOR(INDIVIDUAL) NAME (print) e�1f Vll 5 J4nl12A t� CERTIFICATION II ei/74e
WELL CONTRACTOR COMPANY NAME%hnr C PO fig IDei I)) tr 11 T-n 0 J PHONE # , 4' 9-3 a-6
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED Wsr•r•ERMIT#
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential' unicipa1/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other El If Other, List Use
2. WELL LOCATION: -
Nearest Town: D ItO County Mi(.cM_-
4'qi S Cow-teta- R: v_e ' Pd .tPi4 3
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
l�Q a4, Ple
15 C071r.'z - 1?; vtrzL2, e_,
3. OWNER:
Address
D H. d(Slreet aNc No.) a P76 3
City or Town State Zip Code
(S t 3449_ 44 7.5 SY
Area code- Phone number (n
4. DATE DRILLED 7—/D—Uf
5. TOTAL DEPTH- an'
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO Ql�
, (degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING 1 00
Formation Description
n e03' C/A.
13' Ss • SL6+%G avan, 1te_
7. STATIC WATER LEVEL Below Top of Casing: /0 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS �_ FT. Above Land Surface'
*Top of casing terminated at/or below land surface requires a
variance In accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): 7 METHOD OF TEST /Wi7L(�.
10. WATER ZONES (depth): do' /60' (j
Topographic/Land setting
❑Ridge ❑Slope ❑Valley WtB-
(check appropriate box)
Latitude/longitude of well location
DEPTH
From To
From
From
From To Ft.
From To Ft.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF TH S RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL
9-/0 -d y
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
Q

WELL CONSTRUCTION RECORD
North Carolina • Department of Environment and Natural Resources - Division of \Vater Quality
WELL CO:yTRACTOR IINDI\IDPAL) NAME (print) James B. Brown
\VE:.L CONTRACTOR COi\IPA,NYNAMEHedden Brothers Well Drilling, Inc
STATE WELL CONSTRLCTION PER.M!Tn ASSOCIATED WQ PER lIT#
f f acnl)cable) (if aonlicable)
300743
• • Groundwater Section
CERT[FICATIO.\ # 2045
PHONE e 625) 369-9591
WELL USE (Check Applicable Box): Residential El Municipal/Public ❑ Industrial ❑ Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2 WELL LOCATION:
Nea st Town
.re:
3. OWNER:
Arn code. e!-c^,e-�rcbe-
;. DATE DRILLED y3-
TOTAL DEPTH: eJSjO'
6.
7. TIC WATER LE\ EL Below Top. of Casing: 160 FT.
(Use `*" if Above Top of Casing,,
L. TO? OF CASING IS 2 FT. Above Land Surface'
'Top of casing terminated atlor below land surface requires a
varlanee in accordance with ISA NCAC 2C A1IS.
S YIELD (gprn): IQ METHOD OFTEST blow
7A
lo. WATER ZONES (depth): of5; a, 17a'
.A
Lot No., Zrp Code)
DOES WELL REPLACE EXISTING WELL? YES ❑ NO X STATIC
11. DISINFECTION: Type H T H Ama"nt 16 oz
I2. CASING: Wa:i Thickness
From 0 To 4tt12Ft. G t/CdYY
From Tc Ft.
From To
13 GROUT' Depth vtater,a: Method,
From 0 To 20 Ft. bernite & tzetee>L pumped
From To Ft
1e. SCREEN_ Dept- Diameter Slot Size Ma;e:ia:
From To in. F:
'• in.
Frc-, To Ftin, in.
15. SAND GRAVEL ?ACK
Depth Size Material
From To Ft.
From To Ft.
16, REMARKS:
TopographiciLand setting
°Ridge ❑Slope °Valley 0Fat
(check apprcpr:ate box)
Latitudefiongihude of well location
(,de; eesiml nmesrseco-as)
Latitudc'longi:ude source:OGPSOTco^eraphi. n
ap
(c'teck b^xt
DEPTH DRILLING LOG
From r 0 Formation Des;r ^lion
�+�Q a clay & sand
yea also granite
LOCATION SKETCH
Show direction and distance in miles ;Tar, at least
two State Roads or County Roads. Ina; -,de the road
numbers and common road names.
t.7
1 DC HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STPy �?,DS, AND THAT A COPYQF THIS RECORD HAS BEEN PROVIDED TO THE WELL. OWNER
CSIGNATURE F PERCONSTRUCTING THE WELL
7 -3-o f
CATE
Submit the original to the Division of \\ ater Quality, Groundwater Section, 1636 Mail Service Center- Raleigh, NC
27699.1636 Phrnc No. [phone], within 30 days,
Gvp-1 REV, 07/2901
O
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\b'ELL CONSTRUCTION RECORD
Nort!. Caro:Ha - Department of Envircnrent and Natural Resources - Division. of Water
WELL CO'TRACTOR (IND!YIDUAL) 6A11E (print) James B. Brown CERTIFICATIOS; 2045
WELL CON'I R•\CTOR COMPANY NAME Redden Brothers Well Drilling, Inc PHONE [phone]
STATE WELL CONSTRUCTION PER:MITI ASSOCIATED WQ PERMIT;
(if applicable)
(ifzpp°cab:e)
WELL USE (Check Applicable Box) Residential Municpal/Public O Industrial 0 Agricultural
Monitoring C Recovery ❑ Heat Pump Water Injection ❑ Other ❑ if Other, List Use
2. WELL LOCATIQiN
Ne;nst Town,
cOlkatAttl
(street Name, N.-nebers, Com
3. OWNER:
Add'css
n!ty, Subdivis-
County!.
1 C t/77L./
Lot No.. Zip Code)
2., Cccie
5. TOTALDEPTH:ale
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO eK
7. STATIC WATER LEVEL Below Top of Casing i5O FT.
(L'se" if Above Tcp of Casing)
5. TOP OF CASING IS 2 FT. Above Land Surface'
'Top or casing terminated aror below land surface requires a
variance In accordance with ISA NCAC 2C .011s.
9 YIELD (gpm): 7 METHOD OF TEST blow
10 AVATER ZONES (depth): t /5 e. Jbae Pr —
Are, co-e. Phc,e number
DATE DRILLED 8-5.011
H. DIS.NFECTIONt Tvpe H T H
12. CASING:
Depth A Dl:met r
From 0 To Job Ft. (O
II
From To Ft.
From. To F:.
13. GROUT: Depth
From. 0 To 20
From To
14 SCREEN: Depth Dla,.._...
From To Ft. i
From To Ft._
15 SAN'D:GRAVEL PACK
Depth Size Material
From To Ft.
Amount 16 oz
Wall Thickness
pr188 .Stet"
Mara tMetnod
Ft. be -mite & L :c L pureed
Slot Size Material
in.
in.
Ground.veE1
Topographic/Land setting
0Ridge OS1ope ❑Valley OF;at
(check zoom:nate box)
Latitude/longitude of we!; location
(degrees lnm.i es'sexads)
_aitudo.1ons...rde source.;_,GPS.Tcpcarachic map
,c'!:e;K box)
DEPTH DRILLING LOG
From To Formation Descr'ot._r.
0 JOG s clay & sand"
)Db' %Sdae granite
LOCATION SKETCH
Show direction and distance in miles f „m _,
hvo State Roads or Co°un;y Roads. Include the road
r rr.bers and comcmon r._-, n_r..es.
From To Ft.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH .SA NCAC 2C, WELL
CONSTRUCTION STANDARD LCTIO.v
S. ANDARD$.,2,ND THAT A. COPY OF THIS RECDRD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE F PERSON CONSTRUCTING THE WELL
DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service tenter Raleigh, NC
2'699.1636 Phunc No. [phone], within 30 days. GW-I REV. 07/2001

301307
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
CERTIFICATION it 2261
WELL CONTRACTOR (INDIVIDUAL) NAME (print) CHRISTOPHER L. DICKEY
WELL CONTRACTOR COMPANY NAME CHEROKEE WELL DRILLING AND PUMP COMPANY, INC. PHONE N f 828) 837-8008
STATE WELL CONSTRUCTION PERMITN ASSOCIATED WQ PERMIT#
(if applicable) (ifapplicable) _
I. WELL USE (Check Applicable Box): Residential ® Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: TOPTON
301 SAM WATERS RD
County MACON
(Sheet Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: CHARLIE WILSON
Address 301 SAM WATERS RD
(Stnxl or Route No.)
TOPTON, NC 28781
City or Town State Zip Code
( 828 )- 3213480
Area code- Phone number
4. DATE DRILLED 08-31-2004
5. TOTAL DEPTH: 625'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO El
7. STATIC WATER LEVEL Below Top of Casing: 80 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surfaces
'Top of lasing terminated at/or below land surface requires a
variance In accordance with 15A NCAC 2C .8118.
9. YIELD (gpm): 25 METHOD OF TEST AIR
10. WATER ZONES (depth): 620'
I I. DISINFECTION: Type CHLORINE
Amount 100 PPM
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 76 Ft. 6 1/8- SOR 21 PVC
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From 0 To 20 Ft. CEMENT GRAVITY
From To Ft.
14. SCREEN:
From
From
Topographic/Land setting
®Ridge ['Slope ❑Valley ❑Fla)
(check appropriate box)
Latitude/longitude of well location
3513.922N/8335.674W
(degrees/minutes/seconds)
Latitude/longitude source:KIGPS❑Topographic map
(check hex) - __ _.
DEPTH DRILLING LOG
From To Formation Desc[iption__
0' TO 20' BROWN DIRT
20' TO 40' SAND
40T0 60' BROWN DIRT/SLATE
60' TO 76' BLUE SLATE/GRANITE
76' TO 625' GRANITE
Depth Diameter Slat Size Material
To Ft. in. in.
To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
LOCATION SKETCH D
Show direction and distance in miles from at least Vt.!.
two State Roads or County Roads. Include the road 5,0 2
numbers and common road names. (I' p6FO1,0
�C- kN*
o tis°
54- 4 t0Atc.e4
t DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND AT COP OF THt�RECORD i�S BEEN PROVID ..D TO THE WELL OWNER
9-Z-of..1C
DATE
ON CONSTROCTINGTHE WELL
Submit the original to the 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

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section // "_
WELL CONTRACTOR (INDIVIDUAL) NAME
,,(print) t1)PnPIiS I4d IIn,.Ari • CERTIFICATION it 01/7Y
WELL CONTRACTOR COMPANY NAMt 4fl1efrC 141In,,4I Wel� II 7:nt i PHONE # , Sao-3 a6a
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED W ERMIT#
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residentias'(d�Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other CI 1f Other, List Use
2. WELL LOCATION:
Nearest Town: fjfpiii :J.) County Qd_Av
g;1pA.re _ Rit/PrrA
(Street Name, Numbed, Community,f1
!/ Subdivision, Lot No., Zip Code) e 93
3. OWNER: TBtt' P-Lt' if
C 7
Address Bt l RI i
(Street or Route,No.)
F,en ''/:/r c d €7 t tj
City or Town State
- sa q.. g5f2
Area code- Phone number r,
4. DATE DRILLED d —/ 9 'U
5. TOTAL DEPTH: S30'
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
Zip Code
Topogra ic/Land setting
❑Ridge Winne ❑Valley QFlat
(check appropriate box)
Latitude/longitude of well location
(degreeiminuleslseconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
Formation Description
mr tDg S a�
7. STATIC WATER LEVEL Below Top of Casing: 3 n FT.
Rix "+" if Above Top of Casing)
8 TOP OF C SING S / FT. Above Land Surface
Top o(casing terminated at/or below land surface requl
variance In accordance with 1SA NCAC 2C .011 a.
9. YIELD (gpm): / sr METHOD OF TEST_
10. WATER ZONES (depth): arj'/. S'
A I
res a
DEPTH
From To
0 sue' C I
.Sfp' 4 4 1/P w r L ra it t-e.
4• lOSc' aan. a5iv--a
8LUe—&y'OAnr-r<..
q LOCATION SKETCI{
11. DISINFECTION: Type if"// Amount ..-. TA Ai S Show direction and distance in miles from at lean
12. CASING: Wall Thickness two State Roads or County Roads. Include the road
Diameter S or We VFt. M tepgl numbers and common road names.
to ` . -Z2 B Y C�i
0 Depth A
From To !b X Ft.
From To Ft.
From To Ft.
13. GROUT: Depth
From /) To Ft.
ePerli
Material 7
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size Material
nMetL,l 5
Slot Size , Material
_ in,
in.
From To Ft.
From To Ft.
16.REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF T S RECORD H8S BEEN PROVIDED TO THE WELL OWNER
-t 9 -o y
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
gin
Submit the original to 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
300902
i

3009n1
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME �(print) t))enhls (LA (Ad . CERTIFICATION ti oz/7�
WELL CONTRACTOR COMPANY NAMSb'bn[S ND 05.rrl (iJP.i 1 Zi yr l (a--N �YI r . PHONE a s?rl .5 e2 y —3 ;4 ...
-__:
STATE WELL CONSTRUCTION PERMITS ASSOCIATED WIRERMITS -
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential' unicipal/Public 0 Industrial 0 Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other d' If Other, List Use
2. WELL LOCATION: t1
Nearest Town:J/) .4tCounty / 2 Zan,
4/L[/ S- Pin..£L m Rei/ Rd r,2943
(Street Name, Numbers, Community, Subdivision,isLot No., Zip Code)
3. OWNER: J h)'tHI. e-t-ziet
Address en /// /1V//f 2 Ste
'Pe mbrn/c.e r/. 33D��
(Street or Route No.)
City or Town State
a -9,s�
4. DATE DRILLED P-t S
5. TOTAL DEPTH: 4'.
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER. LEVEL Below Top of Casing: 9L' FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface'
*Top of cuing terminated at/or below land surface requires a
variance In accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): 5- METHOD OF TEST 1020/2ft
10. WATER ZONES (depth): F S'
Arca code. Phone number
11. DISINFECTION: Type f%-f'k
12. CASING:
Depth, e,
From 0 To i Ft.
From To Ft.
From To Ft.
opographic/Land setting
dge ❑Slope ❑Valley QFlat
(check appropriate box)
Latitude/Iongitude of well location
(degrees✓minutes/seconds)
Latitude/Iongitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
.?7' ._`1 `i (iLr), PC' / 1
/.C.
LCf. G
LOCATION SKETU(
Amount a 14 S Show direction and distance in miles from at leac
Wall Thickness two State Roads or County Roads. Include the roa+
Diapay�eeter or We ghVFt. Mate I numbers and common road names.
toe` .Z2 R .D p Vt
13. GROUT:
From n
Zip Code
Depth Material Method
To _ Ft. e` 4;r palt�
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
From
To Ft.
To Ft.
16.REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND T,HHAATT A COPY OFTTHf S RECORD BEEN PROVIDED TO THE WELL OWNER
en 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 Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (prtot) tlI)'P_nhiS / 11'1(Ls�1� • CERTIFICCATIIOON#a/-7 0
WELL CONTRACTOR COMPANY NAMSi)S 1�!!�Orel Wei I alyri 11 :x Q_ 17n P i PHONE eZ Li-3 a7% 6
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED W ERM1T# •
(if applicable) . (if applicable) - .
1. WELL USE (Check Applicable Box): Residential Ld'lvlunicipal/Public 0 Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery 0 Heat Pump Water Injection ❑ Other U If Other, List Use
2. WELL LOCATION:
Nearest Town: FAjJL/CL/ /Y County M a Um-
69' L%. h' 11 " (2.a _ tee P n Ve 1 L✓
(Street Name, Numbers, Comnfunity, Subdivision, Lot No., Zip Code) -/
3. OWNER: '6}v 5 2Y/C er
Address f.,�// C7,
r (Street or Route No.)
LL
l/'�/lri/kJ/l't /2/4.
.S51G,2_
Cicy or Town State Zip Code
(=. )- te a ^ — c 7 75
Area code- Phone number U 4. DATE DRILLED O _ /91
5. TOTAL DEPTH:
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
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 wltb ISA NCAC 2C .0118. /
9. YIELD (gpm): METHOD OF TEST hlll20,X-fi—,
10. WATER ZONES (depth): 7(, / ' (�
300900
Toopographic/Land setting
�RI ge ❑Slope ❑Valley QFlat
2 ig3y (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
C` 3c' i!G`_)
n3 b• r- /Z9,Z / T£
LOCATION SKETCI{
11. DISINFECTION: Type H-tF Arnount c TA -AS Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads. Include the road
Depth
From 0 To Dia ter or Weight/Ft. Matey' I numbers and common road names.
^ Ft. 5.Z1 &fpI QY
From To Ft.
From To Ft.
13. GROUT: Teeth nMaterialA i Method "
m FroToa Ft. t�� yy� (D��
From To Ft. i
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.
0
0 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 TH S RECORD S 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 Mall Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-I REV. 07/2001

300833
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section "" WELL CONTRACTOR (INDIVIDUAL) NAME (print) t7)/ f1lelI S I'Ir'/ ifleA CERTIFICATION # �/74s
WELL CONTRACTOR COMPANY NAME 1XtlntC ICIA/inst<i WP.iI _er j4—tt J PHONE 4211C_3 4-3 26 0
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED wiPtenmiTa -
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential'Ld'(vtunicipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other If Other, List Use
2. WELL LOCATION: / 'TDnographic/Land setting
Nearest Town: ��A/l/IC/ ! /Y County/14 Q /f7t ,l '
(o4 C 11 a I n. P o dge ❑Slope ❑Valley C]Flat
`k L d ('^ d.it(check appropriate box)
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code) (2 s 73 q Latitude/longitude of well location
3. OWNER:)0S2�h 012P t h tvn, -
Address in0 3 L-ec Card LiC i2.- RA•
(Street or Route No.)
RI all CA) Ai a 73y
City or Town State Zip Code
ea)- <39-9_ ,3 933
Area code- Phone number CC
4. DATE DRILLED O - i3"0
5. TOTAL DEPTH:
, (degrees/minutes/seconds)
Latitude/longitude source:DGPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
0 to Si' e 1 4.
CIS' .3Ss— Y$ L U�G r(r( Ron i t4.
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: /flfl FT.
(Use "+" if Above Top of Cuing)
8. TOP OF CASING IS / FT. Above Land Surface*
*Top of cuing terminated atlor below land surface requires a
variance In accordance with ISA NCAC 2C .0118, /
9. YIELD (gpm): 3 0 METHOD OFTEST h1020, Q .
10. WATER ZONES (depth): / 15" / aS0 (/
l 1. DISINFECTION: Type
12. CASING:
Depth �0
From To
From To
From To
13. GROUT: Depths�;.
From To .4 D Ft.
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.
0
1#-/1--/ Amount i-)-5 Show direction and distance in miles from at least r ^
Wall Thickness two State Roads or County Roads. Include the roacc o e
Di ter or Wei t/Ft. Matep' I numbers and common road names. onz 7-1Ft. S-bR,3I' OY� N
Ft.
Ft.
Material
CP
joMethod
eau
Slot Size Material
in.
in.
LOCATION SKETCH C o
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OFTTHjS RECORD BEEN PROVIDED TO THE WELL OWNERlin
I-W-C�e�r - l3-D �}
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to 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 300144
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Mitchell D. Cook
WELL CONTRACTOR COMPANY NAME %ten ErCith3CS ❑ri ll ircr, ] t PHONE # fROR) i09-9S91
ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
CERTIFICATION # 2043
STATE WELL CONSTRUCTION PERMIT#
L WELL USE (Check Applicable Box): Residential Municipal/Public ❑ industrial ❑ Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATI•
Nya(est Town: i/ /ki911lOS County Ittm tJ
Mean AS IrItX)k.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWN �
Addressss OWNER: T TrJ 12,0
(Street or Route No.)
(v4- 44005 NC a,$-lt I
City Or Town State Zip Code
(i)- .6.7o-a01
Area code- Phone number
4. DATE DRILLED 7- fr-frO I
5. TOTAL DEPTH: SCY) t
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing:
(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 ISA NCAC 2C .0118.
9. YIELD (gpm): • A METHQDef TEST hl rna
10. WATER ZONES (depth): 'I
11 DISINFECTION: Type H T H
12. CASING.
Depth
From__ To Ft
From aor To WI Ft.
From To Ft.
13. GROUT: Depth Material
From__ To 20 Ft.} nit R rioaraerlt.
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.
Amount 16 oz
Wall Thickness
Diameter or Weight/Ft. N_ateal
.188 ((staDO
Method
Slot Size Material
in.
in.
16. REMARKS:
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
O Aa' clay & sand
as r co' granite
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
—a
IV
C..3
kts
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
..* ar.Ze ./D. c 7 -' 9- ov
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

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Mitchell D. ',NBC CERTIFICATION # 2043
WELL CONTRACTOR COMPANY NAME Fiedian &tor 1Abll D it l irnr Tar PHONE # f e Al '3fi1:1-cA01
STATE WELL CONSTRUCTION PERMIT#
(if applicable)
.iuu143
ASSOCIATED WQ PERMIT#
(if applicable)
1. WELL USE (Check Applicable Box): Residential$ Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELLLOCATI0p:
Nearest Town: Me OS _County
414ptOF; go- Ii it-16- Pant I
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Cod )
3. OWNER: TM ( it/iitYI3
es
Add yss J959 iM iron)
1 (Street or Route No.) -
e78
Cipp/'�fi�)- o &-�&1 Zip Code
(oi.n)-
Area code- Phone number
4. DATE DRILLED %-zo-Ofi
5. TOTAL DEPTH: West/5 aOk) &W ' 0 apeMalgt
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 1K,.
7. STATIC WATER LEVEL Below Top of Casing: 500 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): .5 METHOD OF TEST hl nm
10. WATER ZONES (depth): JACO it i o i
11. DISINFECTION: Type
12. CASING:
Depth
From_ To a
From To Ft.
From To Ft.
H T H Amount 16 n7
Wall Thickness
Diameter or Weieht/Ft. Material
1St 5{a1.P
13. GROUT: Depth Material
From_To_2.0Ftbritl itn & alltent
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft, in.
15. SAND/GRAVEL PACK:
Depth
From To
From To
Method
Farra3
Slot Size Material
in.
in.
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
Formation Description
O J.4 ' clay & sand
/9' 800' granite
DEPTH
From Tn
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
Size Material
Ft.
Ft.
16. REMARKS: De -lc l Nf}t Y-Z 5 `0 / gob' I keie m
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
) ,-•/ J2
SIGNATURE OF PERSON CONSTRUCTING THE WELL
7.20-av
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 of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Mitchell D. Cook
WELL CONTRACTOR COMPANY NAME H i rs —11 nri 11irt Trr,
300141
CERTIFICATION # 2043
PHONE # (PDS) V9-9591
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
WELL USE (Check Applicable Box): Residential$ Municipal/Public ❑ Industrial 0 Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: Franklin County Macon
Meadows RD
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3, OWNER: Jess Meadows
Address 313 Green Street
(Street or Route No.)
Franklin, NC 28734
City or Town State Zip Code
( 828. 524-9448
Area code- Phone number
4. DATE DRILLED 6-7-040 '
5. TOTAL DEPTH: 400'
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO $t
7. STATIC WATER LEVEL Below Top of Casing: 275' 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): 3 METHOD OF TEST hi cwr
10. WATER ZONES (depth): 170
l I. DISINFECTION: Type H T H
12. CASING:
Depth Diameter
From 0 To 66 Ft. 6
From 66' To 70 Ft. 6"
From To Ft.
13. GROUT: Depth
From 0 To 90
From To
14. SCREEN: Depth
From_ To
From To
Amount 16 nz
Wall Thickness
or Wight/Ft. Material
6" pvc
.188 steel
Material
Ft.J ntni F. & rralerrt
Ft.
Diameter
Ft. in.
Ft. in.
Method
P VIVA
Slot Size Material
in.
in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
Formation Description
clay & sand
granite
DEPTH
From t
0
68' 400'
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
c
Cs o
C
Or,
cr
0
oC
0
rfl
v r*m rn
3 /rn
tnz
N m?
C % J
G
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. 07/2001T.

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Mitchell D. Cook
300140
CERTIFICATION */ 2043
WELL CONTRACTOR COMPANY NAME Hatilin BECtilers TAp11 IY"I11 i me it PHONE N (FM 189-9591
STATE WELL CONSTRUCTION PERMIT*/ ASSOCIATED WQ PERMIT*/
(if applicable) (if applicable)
I. 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: Highlands
Wilson & Rich Gap
County Macon
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: Zeke Chastain
Address PO Box 844
(Street or Route No.)
Highlands, NC 28741
City or Town State
( 82q.. 526-5471
Area code- Phone number
4. DATE DRILLED 7-15-04
Zip Code
5. TOTAL DEPTH: 575'
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO EX
7. STATIC WATER LEVEL Below Top of Casing: 100 FT.
(Use "+" if Above Top of Casing)
S. TOP OF CASING IS 2 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): 40 METHOD OF TEST hl nw
10. WATER ZONES (depth): 555'
I1. DISINFECTION: Type
12. CASING:
Depth
From_0___ To 82
From 82' To 86
From To
13. GROUT: Depth
From 0 To 20
From To
14. SCREEN: Depth
From To
From To
H T H Amount 16 o7
Wall Thickness
Diameter or Weight/Ft. Material
Ft. 6" pvc
Ft. 6" .188 sTis
Ft.
Material
Ft.j�arini t a & (-Tarrant
Ft.
Diameter Slot Size Material
Ft. in, in.
Ft. in. in.
Method
rnri
15. SAND/GRAVEL PACK:
Depth
From To Ft.
Size Material
From To Ft.
Topographic/Land setting
❑Ridge 0Slope ❑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
0 84' clay & sand
84' 575' granite
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 ISA NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
A.
SIGNATURE OF PERSON CONSTRUCTING THE WELL
7-/5-a41
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 Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR(INDIVIDUAL) NAME (print) Mitchell D. Cook CERTIFICATION# 2043
WELL CONTRACTOR COMPANY NAME F 1 1 IC35 LtL'll M 11 i mr 1r
300139
PHONE # ($RR) 369-9591
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential i Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: Franklin County
245 Morrison Church Rd
Macon
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: Missy Gibson
Address 245 Morrison Church Rd
(Street or Route No.)
Franklin, NC 28734
City or Town State
(a29- 142-8335
Area code- Phone number
4. DATE DRILLED 7-13-04
Zip Code
5. TOTAL DEPTH: 400'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 1:7
7. STATIC WATER LEVEL Below Top of Casing: 150 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 accordan a with 15A NCAC 2C .0118.
9. YIELD (gpm): zo METHOD OF TEST, hl rxu
10. WATER ZONES (depth): 270' & 390
1 I. DISINFECTION: Type H T H
12. CASING:
Depth Diteter
From 0 To 50 Ft. 6
From 50 To-3-4—
o Ft. 6"
Amount 1 F nz
Wall Thickness
or Weight/Ft. Material
pvc
.188 steel
From To Ft.
13. GROUT: Depth Material
From 0 To 20 Ft.h=rtini}a A rr+m-»L
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth
From To Ft.
From To Ft.
Method
pTT r3
Slot Size Material
in.
in.
Size Material
Topographic/Land setting
:Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From TQ, Formation Description
0 5LL clay & sand
52' 400' granite
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
o
p 53sai
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
7-/?-04/
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. 0'7/2001 '' _

301119
WELL CONSTRUCTION RECORD
nt,
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) then VI t S1 / 011 a,A rk. CERTIFICATIONS o1 /%
WELL CONTRACTOR COMPANY NAMIC i° 1 C 1410(IQ,tnr) ("MO vc 114k.�1(-17yL P J PHONEY tata2 Li —3 3-b
STATE WELL CONSTRUCTION PERMIT/ ASSOCIATED WIjPERMITE -
(if applicable) __ (if applicable)
I. WELL USE (Check Applicable Box): Residentia)'rd-'tvlunicipal/Pubiic 0 Industrial ❑ Agricultural ❑
Monitoring 0 Recovery ❑ Heat Pump Water Injection ❑ Other C1 If Other, List Use
2. WELL LOCATION:
Nearest Town: © County 412/1 fire
4Y/ S- reta1e C"-t2. 02f143
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: SCE E d, /SuA.-kM-b&
Address 1 i 4-0 M 1 aek /-G CJzn4,
0 i� (Snot or Route No.) a 1/ 4 3
/V
City or T3 ry ¢ sign, irO Zip Code
c.
Area code- cfodddee- Phone number p
4. DATE DRILLED X 4• —D
5. TOTAL DEPTH: ra s'
6. DOES WELL REPLACE EXISTING WELL/ YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: Sti 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 3C .0118. /
9. YIELD (gpm): /6 METHOD OF TEST,_, /ati7/�{--�
10. WATER ZONES (depth): c24',D (�
ographic/Land setting
dge ❑Slope OValley gnat
(check appropriate box)
Latitude/longitude of well location
(degrees&minutWseconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
Formation Description
r' l Cti.
5 c? ii ( 1-AnC_
FLUE 61 12;I-L t 1
DEPTH(
From To
r
LOCATION SKETCH[
I I. DISINFECTION: Type H tJ/ Amount a %Q-i3 5 Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads. Include the road
Depth Di ter or Weight/Ft. Matey' i
From 0 To �l.-; Fi_h$-bR,s7 %JY
From To Ft.
From To
13. GROUT: Depth
From To
From To
14. SCREEN: Depth
From To
From To
I . SAND/GRAVEL PACK:
Depth
From To
From To
Ft.
Material
Ft. epyyt dr�
Ft.
Diameter
Ft. in.
Ft. in.
Method
Slol Size Material
in.
in,
Size Material
Ft.
Ft.
numbers and common road names. O 0
'arc;
Gn
o
G
? to
a
Q
16. REMARKS:
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NC
CONSTRUCTION STANDARDS, AND THAT A COPY OF TH S RECORD BEEN PROVIDED TO
&
SIGNATURE OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mall Service
27699-1636 Phone No. [phone], within 30 days.
ern
nter- R
�taleigh, NC
GW-I'tiYV.;07/20Or:
1 2004

301118
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) c'ham I S I A!!1ffL s rig CERTIFICATION or-/7le
WELL CONTRACTOR COMPANY NAME) 'JW)IS' IJQN.I LsJei I )1 yr J : W.4 77n P ) PHONE a 62 (% -'3 at:, Q
STATE WELL CONSTRUCTION PERMITS/ ASSOCIATED W ERMITB
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential' unicipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 17 If Other, List Use
2. WELL LOCATION:
Nearest Town: FRAji!!/ : $) County /Q Ldk+
9 U! S .*; rr, e 4 b t 12,4 of 13 1�
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: R cb CLL%Je
Address 12 D v• Ca..(tt EA
(Street or Route No.)
rFan lit J 41(... a 1; 9(sa
Citypr Town State Zip Code
3to9.. 9.3j9
Area code- Phone number
4. DATE DRILLED 2 074 —0 y
5. TOTAL DEPTH- OS'
6. DOES WELL REPLACE EXISTING WELL/ YES 0 NO QJr
ographic/Land setting
WKidge ❑Slope ❑Valley OFlat
(check appropriate box) +
Latitude/longitude of well location
(degrees/minutes/almonds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH PRILLING LOG
From To Formation Description
0 ss - fJa.,1
Ss• 77• y e t n(i r. f a t e-
l?? RI_Ve- ran,t4.
7. STATIC WATER LEVEL Below Top of Casing: So FT.
(Use "+" if Above Top of Cuing)
8. TOP OF CASING IS / FT. Above Land Surface*
*Top of using terminated at/or below land surface requires a
variance In accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): _2_ METHOD OF TEST JDJ//i7f�(J-.
10. WATER ZONES (depth): a,? PO' (�
11
12. CASING:
DISINFECTION: Type
�V 1 Depth,
7
From To
From To
From To
13. GROUT: Depth
From To
From To
14. SCREEN: Depth
From To
From To
15. SAND/GRAVEL PACK:
Depth
From To
From To
fs4
Ft
Ft.
Material Method
n
Ft. lapU"!,V0
Ft.
Diameter Slot Size Material
Ft. in. in.
Ft. in. in.
Amount e2 TA- A 5
Wall Thickness
ght/Ft. Mate ' I
Ft. a Di ter or We S.12 R ,3 3 Pr
Size
Ft.
Material
Ft.
LOCATION SKETCH
Show direction and distance in miles from
two State Roads or County Roads. Include
numbers and common road names.
at (east
the road e
0 G
ciz rn
O a—
~ A
tJ
j
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NC
CONSTRUCTION STANDARDS, AND THAT A COPY OF TH S RECORD BEEN PROVIDED TOT_ T
Uk- - a or
SIGNATURE OF PERSON CONSTRUCTING THE WELL
F-'
Lr F,- 2004 ! J
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mall Service Center 'Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. OW-l' V" U712i),Ur -,!J
Cam.-11 E

Area code- Phone number np
4. DATE DRILLED if -0 -051
5. TOTAL DEPTH: o2 t2S'
WELL CONSTRUCTION RECORD
301117
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) %D� mil l S /4A ' i (JA% CERTIFICATION a or 17 le
WELL CONTRACTOR COMPANY NAME))'.4fliq kit ,4 I1JPI I�tr )i-,< �Kf PHONES edi_5�4-3 V-b0
STATE WELL CONSTRUCTION PERMITS ASSOCIATED W4PERMrfS
(if applicable) . - (if applicable) .
1. WELL USE (Check Applicable Box): Residential 7YMunicipaVPublic 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other Q If Other, List Use
2. WELL LOCATION:
Nearest Town: f'fAft *L L i 4/ County /1/l a (mt.... g �✓ row,.,, con, ^F l3 f1
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code) Nu
3. OWNER: l �i air a. ies ir -} i Its
Address 3 f G y n ., a V:
(Street or Route No.)
f-va,P,u.,J /lit - 173c,! DEPTH
City or Town State Zip Code From To
(Fa -le 3&,4— S 's 3 0 ay•
7 7 '
1-7'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO J-
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 casing terminated at/or below land surface requires a
variance In accordance with ISA NCAC 2C .0111. /
9. YIELD (gpm) 5` 0 METHOD OF TEST //07I1hL(j-.
10. WATER ZONES (depth): 8D ,, / tf D ' (�
�e graphie/Land setting.,',/
�S[teg=❑Slope ❑Valley Igrtat
(check appropriate box) i
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
Formation Description
P/n
c am r f m, s .
faLE/ e- 12&let ire.
LOCATION SKETCH
11. DISINFECTION: Type i4/41--f , Amount a "7" A A Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads. Include the road
Depth Di ter or Weight/Ft. Mate ' I numbers and common road names.
From 0 To S% Ft. a '4$,bR,g7 QvP�
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From n Ft. Cant ail p(i)Ad(..>
Torte
From To
14. SCREEN: Depth
From To
From To
15. SAND/GRAVEL PACK:
Depth
From To
From To
Ft.
Diameter Slot Size , Material
Ft. in. in.
Ft. in. in.
Size Material
Ft.
Ft.
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 TH S RECORD BEEN PROVIDED TO THE WELL OWNER
01- / -aC, =
SIGNATURE OF PERSON CONSTRUCTING THE WELL DV E'
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mall Service Cen er;Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. 0 4 REV. 6E601-

301116
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - DivisionofWater Quality - Groundwater Section
WELL CONTRACTOR(INDIVIDUAL) NAME � �(print) c�.Pf)VII5 f /1 I(LA eL • • CERTIFICATION# ot•n/74
WELL CONTRACTOR COMPANY NAM& )jj�i'.AhIS' t Jk'.na Wliel d al y i l l :� .( TE B in. t• J PHONIC
_6s 4 —3 - 6 a
STATE WELL CONSTRUCTION PERMIT# __ASSOCIATED W(fPERMIT# •
(if applicable) (if applicable) .
I. WELL USE (Check Applicable Box): Residential'iYMunicipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other U If Other, List Use
2. WELL LOCATION:
Nearest Town: Pf NXCLi/j/ County Alia
419/ S . r,_ >`7,wBI2;c at. ad_ S. Skeea.a
(Street Name, Numbers, Comtanity, Subdivision, tot No., Zip Code) �d
a873t/
3. OWNER:�R CL✓t I � eli KS J R•
Address q- at 11 12 e /G Q.4 Latitu
(Street or Route No.)
4
5
6
7
r174. 1e r,) A/07 tg311
City or Town State Zip Code
(9217- .91)9- 46/ (o .
Area code- Phone number
DATE DRILLED Si"—5.-6 Zf
TOTAL DEPTH: -.3 Do '
Topographic/Land setting
❑Ridge ❑Slope ❑Valley errat
(cheek appropriate box)
Latitude/longitude of well location
DEPTH
From
9 3'
10'
(degronfminutes/seconds)
de/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
To Formation Description
S43' Cis..
' Se.,.. -F frrv..t
n0A L U e- G_ 12&nit c
DOES WELL REPLACE EXISTING WELL? YES ❑ NO ❑ j�
STATIC WATER LEVEL Below Top of Casing: . f FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface'
*Top of casing terminated Wor below laud surface requires a
variance In accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): 44 METHOD OF TEST ,61UJU/7f��
10. WATER ZONES (depth): a Set' (/
I I. DISINFECTION: Type
12. CASING:
Depth From 0 To 70
From To
From To
13. GROUT: Depth
�1,�
From_ T To rt/
From To
14. SCREEN: Depth
From To
From To
15. SAND/GRAVEL PACK:
LOCATION SKETCH
%f'-/ 1/ Amount .•2 71)- i%i 5 Show direction and distance in miles from at least
Wall Thickness two State Roads or County Roads. Include the road
Diapeter or Weight/Ft. Mated& numbers and common road names.
Ft.�2 i }! S' S jce/
Ft.
Ft.
Material Method
Ft.
Ft.
Diameter
Ft. in.
Ft, in.
Slot Size Material
in.
in.
Depth Size Material
From To Ft.
gra.,p as,-�j
SIGNATURE OF PERSON CONSTRUCTING THE WELL Qh'FE
(^ pp — 1 2004
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mall Service Cter r9slei NC
27699-1636 Phone No. [phone], within 30 days. 9W-I IEV. 07/2001
From To Ft.
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 THJS RECORD HF ,S BEEN PROVIDED TO THE -(r-9WNEfk --

WELL CONSTRUCTION RECORD
301115
North Carolina - Department of Environment and Natural Resources - DivisionERof Water Quality - Groundwater Section _
WELL CONTRACTOR (INDIVIDUAL) NAME (print) ,b.en PI1 S /4,5 / T„A d, • CERTIFICATION eat /7 s/P
WELL CONTRACTOR COMPANY NAMt;'belTI c Pt114eJ Well 221Yei 1 i 1.T"n A J PHONE ,/ . SQ.L/-3 a6 0
STATE WELL CONSTRUCTION PERMIT,/ ASSOCIATED WERMITS
(if applicable) - (if applicable) .
WELL USE (Check Applicable Box): Residential7YMunicipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other U If Other, List Use
2. WELL LOCATI N: /
Nearest Town: Pimiel / /Y County a
T
9-41 S v4.n%sss (312. Re? -.Merl, 0 4 ar+ 7 �/
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code) eat F 3 7
3. OWNER: 1? am V &emi lL
Address / 3 / 4 7 BACK one RA
(Street or Route No.)
t'v; rcess An„t MD 021 ES
City or Town State Zip Code
(1/40)- (OS/_ to?
Area code- Phone number
4. DATE DRILLED d - 5 -0
5. TOTAL DEPTH: SOS'
Topograp_bidtand setting
DRidge**grope DValley OFIat
(check appropriate box)
Latitude/longitude of well location
(degrees/mimeo/seconds)
Latitude/longitude source;❑GPS❑Topographic map
(check box)
DEPTH pRILLING LOG
From To Formation Description
D 60' (1 Ac�,
(ob' /63• Firrrr% gr. i,T-e...
/D3' .3ASp,LVG Ctt&.,)7.�
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 14-
7. STATIC WATER LEVEL Below Top of Casing: Sb FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
'Top of casing terminated at/or below land surface requires a
variance In accordance with ISA NCAC 2C .0118.
9. YIELD (gpm):.S0 -/- METHOD OFTEST_ Ai/PZ/, Ai/Pp/Xt.
10. WATER ZONES (depth): //S J o290' (�
1 I. DISINFECTION: Type
12. CASING:
Depth
From To /D
From To
From To
13. GROUT: Depth
From n To r
ff�14 Amount .-27A-1;5
Walt Thickness
Ft Di ter S` r2 Wee,s 3UFt. Matep •
Ft. Y
Ft.
Ft.
Material Method
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To in.
From To Ft. in. in.
15. SAND/GRAVEL PACK: -
Depth
From To Ft,
From To Ft.
Ft in.
Size Material
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
16.REMARKS.
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF TH S RECORD BEEN PROVIDED TO T It
'2LJ� `
SIGNATURE OF PERSON CONSTRUCTING THE WELL !pwre
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mall Service Ce
27699-1636 Phone No. [phone], within 30 days. C
" Gip — 1 2004
er1-Ralelg,, C
-1 REV. 07/2001

WELL CONSTRUCTION RECORD
i;,,
•
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
301114
WELL CONTRACTOR (INDIVIDUAL) NAME (print) c*he II VI I S f�'O''1L+A rU CERTIFICATIOON1i ci/71,0
WELL CONTRACTOR COMPANY NAMIE 1°ij i ii/OP .vtrl II)P.11 alY5 1,1 ;-u .( n c PHONE B ia y-3 gb 6
STATE WELL CONSTRUCTION PERMIT% ASSOCIATED W6%'ERMITB (if applicable) (if applicable)
I. WELL USE (Check Applicable Box): ResidentialtrMunicipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other C 1f Other, List Use
2. WELL LOCATION:
Nearest Town: '?A�}t&Ji it/ County �2Q-L
L#41 UJmr
a tC;_..Q� . Ra c2213t�L
(Street Name, Numbers, Community, SubdiViaion, Lot No., Zip Code)
3. OWNER: Ice ✓e n Ret2-
Address 1 3.5 Pox L. A-s 2G R
(Street or Route No.)
rPanti jai A/C
thvOr•/o(O2.vin State
Area code- Phone number(
4. DATE DRILLED er—a 6 —D 91
5. TOTAL DEPTH: eitOS •
a,73�
Zip Code
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: //] 0 FT.
(Use "+" if Above Top of Cuing)
8. TOP OF CASING IS / FT. Above Land Surface*
*Top of cuing terminated st/or below laud surface requires a
variance In accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): ..21) METHOD OF TEST Min
10. WATER ZONES (depth)• ! a s' 3S0 '
I I. DISINFECTION: Type hi.-IP%
12. CASING:
Dia ter
FromTo 9 5 Ft.
Depth
From To Ft.
From To Ft.
13. GROUT: Depth
From_)Z To_ Ft.
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.
Amount e-2 / KPJ S
Wall Thickness
or Weight/Ft. Mate . l
s.22Raq p
Material
CAY)t k
Method
Slot Size Material
in.
in.
From To Ft.
Topograph and setting
❑Ridge C951ope ❑Valley OFlat
(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
tIA2
<}G • s y •Ve,cs*r r c IA_t
5 9 • Q,j• SrkaA fT� A—
Glue- Y2nItt
4s' 4vs'
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.
I6. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF TH S RECORD BEEN PROVIDED TO TH k�EU OWN&R.--
Ora' �- .�
SIGNATURE OF PERSON CONSTRUCTING THE WELL 147.,1 CCCCpp
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Cereal tl aleigg,4VC — 1 2004
27699-1636 Phone No. [phone], within 30 days. GW-1 V. 07/2001
=

284488
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section / -
\YELLCONTRACTOR (INDIVIDUAL)NAME (print) t7)-enVl15AlIIaMLvi CERTIFICATION it cZJ71,
WELL CONTRACTOR COMPANY NAMK gni S'41U Mine-4 � I nel l rrlyr e PHONE #1J-1i_cc a 4 —3 a 6 6
STATE \VELL CONSTRUCTION PERMIT# ASSOCIATED W ERMIT# _� _.."....
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential' lunicipal/Public 0 Industrial 0 Agricultural ❑ -
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other d' If Other, List Use
2. WELL LOCATION: �
NearestTowfp: rX),92'k:L )4, County /Y/Q-z-CD't,.
1141 N O ru d R% T 010 e e 1s tar\ fl 7? t-
Topograp Land setting
❑Ridge NISSiope ❑Valley ❑Flat
(check appropriate box)
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code) Latitude/longitude of well location
3. OWNER: }ICd.t 0-243 iA.m.a
Address . 5 (' f[ J. hYIG ; ri S Y-
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic:map...
(Street or Route o.) (�7 ? L / (check box)
�izeza,w I no6 DEPTH DRILLING LOG
City br Town State Zip Code From To Formation Description
(3
Area code- Phone number S6.' So6. L LrL�tt le A-N ire_
4. DATE DRILLED I —14—L) LL
5. TOTAL DEPTH: -S0.31-'
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO 0-----"-c-
7. STATIC WATER LEVEL Below Top of Casing: ''0 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface'
'Top of casing terminated at/or below land surface requires a
variance In accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): -3 METHOD OF TEST Si
10. WATER ZONES (depth): Cn-S'
{{14'» Amount
11. DISINFECTION: Type
12. CASING:
Depth /
From 0 To .SAC' Ft.
From To Ft.
From To Ft.
13. GROUT: Depth
From (5 To !9U Ft.
To
Depth
To
From
14. SCREEN: Diameter
From Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Wall Thickness
Diameter or Weight/Ft. Material
PY
Material Method
0-1
9471 a7- rJCrkic
Ft.
Slot Size Material
in.
in.
16. REMARKS:
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
0
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED 1N ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF TH S RECORD H S BEEN PROVIDED TO THE WELL OWNER
tidg
P ILL — may
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

284487
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division 1 of Water Quality - Groundwater Section
/ -
WELL CONTRACTOR (INDIVIDUAL) NAME� (print) s7wnvll 5 'I J1n,A� CERTIFICATION# rsc-/7 Y'
WELL CONTRACTOR COMPANY NAM�1X;hjj1C 1JIlo4 Wei1l)y' YnPJ PHONE #�'2-�_5�.L —3 g6
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED W ERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): ResidentialTYMunicipal/Public 0 Industrial 0 Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other El If Other, List Use
2. WELL LOCATION: Nearest Town: /),!}/NCLi 4/ County /{/!And Lam,
(p(l-C(/, u)old mu12Pt/Pd4 — :1 one's «112c'e z
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code) ,7 g-113 ({
3. OWNER: <S‘t'z2A - 0 4ILail GU;
Address `P 0 • /BOK `tu 30
(Street or Route No.)
FY (cm k 1 i✓ Ai Ci
City or Town State Zip Code
(S'Ya�)- �3 Sr-9 — 0 S �o
Area code- Phone number
4. DATE DRILLED / -/ s - O V
5. TOTAL DEPTH: S ' f '
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 0/---
7. STATIC WATER LEVEL Below Top of Casing: S71 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. %//n/,J
9. YIELD (gpm): (/ METHOD OF TEST h UL!/lh
10. WATER ZONES (depth):
Topographic/Land setting
tdge ❑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
30' C' l(L_
h' .5- ce.) plL' �r.214ldy
11. DISINFECTION: Type 1 t» Amount _fraTh115
12. CASING: Wall Thickness
Depth Dia�'etter or Weight/Ft. Mate 1
From 0 To JL� Ft. /_ ' S- 2 If 1, PV
From To Ft.
From To Ft.
13. GROUT: Depth Material
From n To r9D Ft. ap4'7r Da
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 Ft.
From To Ft.
16. REMARKS:
LOCATION SKETCH
Show direction and distance in miles from atleast
two State Roads or County Roads. Include-thetread _:
numbers and common road names. '., ...
O
L
fV
'O
a
tJ
IV
0
oo
crn
z ^t
of
>c
-4�
mo
ern
emit
0
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF TH S RECORD H S BEEN PROVIDED TO THE WELL OWNER
ae
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

284489
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - DivisionofWater Quality - Groundwater Section --
WELL CONTRACTOR (INDIVIDUAL) NAME
(print):Nen h I s I / ln.,A [vi CERTIFICATION # d-/7 s// f' .
WELL CONTRACTOR COMPANY NAM&'I Xn'jjC id-o1i24J Wei I 1 y' 11'r'1c t .1_4 f' J PHONE #ia%f' ,5 .2Y-3g 6 O
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED W ERMIT# ,
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential' unicipal/Public ❑ Industrial 0 Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other D If Other, List Use
2. WELL LOCATI9N:
Nearest Town: rrto 44rk:L l /�/ County Ao-LCw
( to OatieLL D CrrE .2e n B R 39 3 f
(Street Name, Number?, Community, Subdivision, Lot No., Zip Code)
3. OWNER: c. e1P-9 EN'G1.c�L)
Address 'h Or A Q )' rV S9f
(Street or Route No.)
OnShr Qs AL'
C771
City br Town State Zip Code
(SW- r/Ll.3 — Gc ROSY
Area code- Phone number
4. DATE DRILLED I - I Ja-
5. TOTAL DEPTH: 4-%i,'
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO C�-
7. STATIC WATER LEVEL Below Top of Casing: 3 !h / FT.
(Use'4" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm)' METHOD OF TEST 1ort x-1,�-,
10. WATER ZONES (depth): Y--k (�
ographic/Land setting
edge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topogtaphic map -
(check box) `'-" -'---
DEPTH DRILLING LOG
From To Formation Description
(7 3 r e lGL
,�Si` cfna` 13Lt4 % QAWITC
LOCATION SKETCH
11. DISINFECTION: Type ithiP Amount 4 TA I; S Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads. Include the road
Depth (, Diameter or Weight/Ft. MMatep I numbers and common road names.
From 0 To 3 if Ft. (nit S7,2g,.2 j Y
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From /3 To rt) Ft. 00471 D p0U x)
From To FL 1
14. SCREEN: Depth Diameter Slot Size . Material
From To Ft. in. in.
in. in.
From To Ft.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
_D
S
CO
c
O
ern
rn
CD
on
›-
--tom
mC
rn=
m
r7
H
G
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF� �CH�BEEN PROVIDED Ti THE WELL OWNER ^/ ea. DATE
SIGNATURE 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

284490
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL)NAME j��(print) c7)-enVl15 f41)/)n„\ d / CERTIFICATION or-/%Y'
WELL CONTRACTOR COMPANY NAMahntC hi -to fl 4 WeaverI l;u/Q(,. j. nP PHONE A�'2-%fi.—s2y�3 ,66
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQYERMIT#
(if applicable) (if applicable)
WELL USE (Check Applicable Box): Residential ti----Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: C t/) .47(= County 44 a C67(
4Lq/ S -�'<<:n') Fitt h ft) r c4 ___ ko 73
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: IT 0 � `
� 1'
l i-(.0 tr7
Address 02 .5"7 7" n.4,7'I'
(Street or Route No.)
L/2%49/✓/At(/ A7S-13y
City or Town State Zip Code
()- • `�'•? tf — .§ /
Area code- Phone number , /
4. DATE DRILLED / —G -'U `i-
5. TOTAL DEPTH: 9Ci'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO ¢lf
7. STATIC WATER LEVEL Below Top of Casing: 'tD FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface'
*Top of casing terminated at/or below land surface requires a
variance In accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): 17 METHOD OF TEST //970r72—.
10. WATER ZONES (depth): (,'.-Z (�
Topograph. and setting
DRidge ope DValley ❑Flat.
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic Map
(check box)
DRILLING LOG
Formation Description
/? Lo
DEPTH
From To
fr,
Jv' cs'
C IZAw'/ fC—
LOCATION SKETCH
11 DISINFECTION: Type iff/1 Amount ra %, A S Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads. Include the road
Depth__ Diameter or Weight/Ft. Material numbers and common road names.
From To : 7- Ft. (� S-� J p y�
From To / Ft.
From To Ft.
13. GROUT: Depth �(M,,aterial Method
From n To r (�i Ft. Ly1-)“.9� !!CM�
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:
3
W
fV
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY F TH)S RECORD HAS BEEN PROVIDED TO THE WELL OWNER
Or
DATE
SIGNATURE 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

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR(INDIVIDUAL) NAME (print) 41)-n V)I 5 fin all2n cU ' r CEKTW1CATIONI 0t,74a
WELL CONTRACTOR COMPANY NAMKt f I S 1410110,8r4 IiieI I Zi fr I.17-14 —rs'l e PHONE Y/$121(-6z y —3 � b
STATE WELL CONSTRUCTION PERMITS/ ASSOCIATED WQr'(4ERMITY
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential' unicipal/Public 0 industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other D If Other, List Use
2. WELL LOCATION:
Nearest Town: n(l m 1' / • )�i County 0 g z—p
/n 4-uL) 1- ett .ectg Pn s ' (3— r-C7
(Street Name, Numbers, Community, ubdivision, Lot No., Zip Code)
I
3. OWNER: //1-t1C R-CcSf ei/e
Address 1 l a I-1 <` -P I.: , 112. R.a
(Street or Route No.)
r avt(il,1,l tfc_ ,2&'03y
City or Town State Zip Code
Area code- Phone number .
4. DATE DRILLED 'Z S /) C�
5. TOTAL DEPTH: /
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO m�
7. STATIC WATER LEVEL Below Top of Casing: 7-ZJ FT.
(Use "+" if Above Top of Cuing)
8. TOP OF CASING IS / FT. Above Land Surface'
'Top of casing terminated at/or below landsurface requires a
variance In accordance with 1SA NCAC 2C .0118.
9. YIELD (gpm): --' METHOD OF TEST 1117/J/ s
10. WATER ZONES (depth): '%C / (�
I I. DISINFECTION: Type Ht"%/ Amount a TA-1; S Show direction and distance in miles fr, at i€jst
12. CASING Wall Thickness
293449
Topographic/Land setting
❑Ridge ❑Slope ❑Valley 01-fot--
(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
C i
(r3' s-snr ?LI,JnJC .4AIItL—
C'
t
0x
zm
m
I r"j
LOCATION SKETCH :>b
two State Roads or County Roads. Incl= theca
Depth / Diapeter or WeighUFt. Mate,l -numbers and common road names. 0
From 0 To 61 3 Ft. /n' S-72R,, 7 Y Lii __-
From To Ft.
From To Ft. I,I;
13. GROUT: Depth Material Method
From n Tor Ft. Cant a," p(iUN
From To Ft. 1
14. SCREEN: Depth Diameter Slot Size , Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED 1N ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THJS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
071 11A, `
SIGNATURE OF PERSON CONSTRUCTING THE WELL
5 0 y_
DATE
Submit the original to the 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

293448
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) i. J-e(l Vl l S An I )QlA rlL CERTIFICATION Y 0//' ee
WELL CONTRACTOR COMPANY NAM pjj I
E ° ISl�if III 778P J PHONE 47S1 .SaLi-3 �6
STATE WELL CONSTRUCTION PERMITH ASSOCIATED WG*ERMIT0 •
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential' unicipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 17 If Other, List Use
2. WELL LOCATION:
Nearest Town: r)-or\tc I'; v() County /r'i (on '
441S Pifesa„r id. It R — hi Skeenh
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: JCicIG 'C�CilaLAS,�-o�
esd a 3 yt
Address -iO1 ReX i Sn t t 2.
(Street or Route No.)
7 / tG-Mtvntr,. r�rtoo, p/. 30715
City or Town State (' Zip Code
(31)- (el, 3 — -3 3c�4
Area code- Phone number
4. DATE DRILLED —4 -Oy-
5. TOTAL DEPTH: �(Z^'
6. DOES WELL REPLACE EXISTING WELL?
7. STATIC WATER LEVEL Below Top of Casing: �C(n FT.
(Use "t" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surfaces
'Top of casing terminated at/or below land surface requires a
variance In accordance with ISA NCAC 2C .0118. /
9. YIELD (gpm): if"' METHOD OF TEST kipix(
10. WATER ZONES (depth): .1'7.S' (/
I I. DISINFECTION: Type %t'-rig
12. CASING:
From 0
From
From
13. GROUT:
From n Ft.
From Ft.
Depth e. Diameter
Material Method
14. SCREEN: Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth
From To Ft,
From To Ft.
Amount rig-S 5
Wall Thickness
or Weight/Ft. MMate Al
To /2LFt. " S-ZbR.�J
To Ft.
To Ft.
Depth
To eZ
To
Depth
16. REMARKS:
YES 0 NO
Slot Size Material
in.
in.
Size Material
Latitude/longitude sou
DEPTH
From To
(PS'
/ ��' 1 al'
LDi' _S nn'
r—
ographic/Land setting j'r,
iFRdge ❑Slope ❑Valley ❑ }a[!
(check appropriate box) "
1
Latitude/longitude of well location
(degrees/minutes/seconds)
rce:❑GPS❑Topo
(check box)
DRILLING LOG
Formation Description
Ll a,
e2mrcal; Ft;
05l i r e'- A c on i+ -e—
raphic ma
el
LOCATION SKETCH rV on
Show direction and distance in miles frt at I
eoi
two State Roads or County Roads. 'notate theToM
numbers and common road names. _
O
IV
(n=
ma
G
z
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF TH S RECOBEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL " DATE
Submit the original to the 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

293262
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources • Division of Water Quality - Groundwater Section
WELL CONTRACTOR(INDIVIDUAL) NAMEE (print):he. n V115 P'AjJ(3n\ri • CERTIFICATIIOON II el/7(P
WELL CONTRACTOR COMPANY NAMS,1411(114r1 77Ke i PHONE YTIS) .�J eZ y^'3 .G
STATE WELL CONSTRUCTION PERMITS/ ASSOCIATED W&ERMITit
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential' unicipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 17 If Other, List Use
2. WELL LOCATION: Pict
setting
Nearest Town: 0/}71) fl.t County /tlel)u ("+' idge ❑Slope ❑Valley ❑Flat
44 / S --re SS e r7 f e e., Cc m ,, , 2 g %3 7 (check appropriate box) \
(Street Name, Numbers,umnCommunity, Subdivision, Lot No., Zip Code) Latitude/longitude of well location
3. OWNER: ,7`CA71n l a 0 C Litio
en7e/2. (degreeshninutes/seconds)
Address 4/ R /[C1 ess en fie e- Rd- Latitude/longitude source:❑GPS❑Topographic map
� (Street or Route No.) (check box)
/'ie �7yeL > IVA11- 4873 9' DEPTH PRILLING LOG
City or Town State Zip Code From To FormationDescription
Tar- .S-;t �` 9 /Jj 7 0 Lf4 .
Area code- Phone number Cf r (e. CJ r
4. DATE DRILLED c -/6-6S („q, ,5z-n-
5. TOTAL DEPTH: •.-Q/-7”/
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO Qll
7. STATIC WATER LEVEL Below Top of Casing: .- Sn FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
'Top of casing terminated atlor below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): - $ METHOD OF TEST hn//e7t�(f--.
10. WATER ZONES (depth): %S' / 9e' (�
Q
o `o
—n 9
LOCATION SiCETCI-t W om
I I. DISINFECTION: Type %T--'P Amount TI S S Show direction and distance in miles films at I
12. CASING: Wall Thickness two State Roads or County Roads. lnclS % the o0
Depth . Diaetter or WeighUFt. Matt numbers and common road names. 3
From fl To �r% Ft. /n' S-� R ,� PY Chi -
From To Ft. ens
From To Ft. N —s
13. GROUT: Depth Material Method - ' n
From n To, r9'f7 Ft. Cot' Material
(7()y(.A..)
From To Ft
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF TH S RECORD H S BEEN PROVIDED TO THE WELL OWNER
Or a yap- �i� 6 17`
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to 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 Resources - DivisioniIof Water Quality - Groundwater Sectionn// --
1n
WELL CONTRACTOR (INDIVIDUAL) NAME (print) :Imp M l 5 /4-O 11 Qnh CERTIFICATION #- DiDinxf'
‘YELL CONTRACTOR COMPANY NAMIC r.i (7oj)(14nrl I)JPIIa)'fr I I'; Hit_. rlPJ PHONE N 7S1—S2 14-'3 g66
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED W ERMIT#
(if applicable)
(if applicable)
293261
I. WELL USE (Check Applicable Box): Residential'unicipal/Public ❑ Industrial 0 Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: FSANISL i /1/ County '/ C/rnr
(? 4-/E LLIRd s7a�
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: 73 t I) ('ttasfet n
Address (c'74/ Cs) Lf'hiR/ oor5
(Street or Route No.)
St Lcr'; g AA 0, 3/ aI
City or Town State Zip Code
— 4 t0 V
Area code- Phone number
4. DATE DRILLED 09—/ / — 0
5. TOTAL DEPTH: LT}
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO W-
7. STATIC WATER LEVEL Below Top of Casing: Co0FT.
(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): 5 METHOD OF TEST_ /020/ l�
10. WATER ZONES (depth): �' (�
11. DISINFECTION: Type i»t» Amount TA- k3 S
12. CASING:
Depth
From 0 To Jt
From To
Topograph' and setting
❑Ridge agfOpe ❑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
0
'0)6-' 5-o• 01 7z'hA�
Sn` CIO ' RLL/L ('24A fY2_
t
0
0
-11
CO
Non
C tin
Do
ti
LOCATION SKETCH = rno
Show direction and distance in miles fron—lt
t lea r2
Inclu
Wall Thickness two State Roads or County Roads.
numbers and common road names. noDia eter or Wei�ht/Ft. Mat 1/40 o
Ft. OY
Ft.
From To Ft.
13. GROUT: Depth Material
From n To c9D Ft. can ar
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
Meth
pay
Material
From To Ft.
From To Ft.
16. REMARKS:
det erg
r
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT COPY OF TH)S RECORDBEEN 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 293121
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section /�
WELL CONTRACTOR (INDIVIDUAL) NAME (print) c-n 7)VIIS JJt) 'JnrA rid CERTIFICATION # le tin
WELL CONTRACTOR COMPANY NAM6}�bIX,.hnri 140jlignr4 Wel I.I Y`r l(;lt .! }. rtP J PHONE #po-7S1-Se24-3 �-6
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED W ERMIT#
(if applicable)
(if applicable)
WELL USE (Check Applicable Box): Residential L1---Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: ! 49Ake/ L % /✓ County 1'fl /t (6'Yti
& A' (`'pile c (nin m • .9 '7 3 y
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: f`i n /0<_b:;j
Address 9 {'% n e ./) R
/` 4.7.n/LL;St3 or Route 07g73 7
City or Town State Zip Code
(gaV 3&'Q— _3er,V7Q
Area code- Phone number
4. DATE DRILLED ) — 9 —6 cf
5. TOTAL DEPTH: -_CC,
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
Topographic/Land setting
❑Ridge 0Slope ❑Valley Detar
(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
b 53' C12
' Srt na> 1m -ems
7. STATIC WATER LEVEL Below Top of Casing: / 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 accordance with 15
9. YIELD (gpm): R'
10. WATER ZONES (depth):
A NCAC 2C .0118.
METHOD OF TEST_ / W/},7u.1-,
11. DISINFECTION: Type
12. CASING:
From 0
From
From
13. GROUT:
From (3 To r}(7
Depth
Amount .-2 %A S
Wall Thickness
Diapeter S� Weight/Ft. Mat jt e
K Y
To 5" 2 Ft. & 1
To Ft.
To Ft.
Depth
Ft.
Material
(t9m
From To Ft.
14. SCREEN: Depth Diameter
From To Ft, in. in.
From To Ft. in, in.
15. SAND/GRAVEL PACK:
Depth Size
From To Ft.
From To Ft.
16. REMARKS:
Method
U Ws-J
Slot Size Material
Material
0
r
-'1 a
LOCATION SKETCH m cm
Show direction and distance in miles from -at league
two State Roads or County Roads. Include -Ale rdicU
numbers and common road names. -v m
Nm
cnz
0
co
--t
G
z
0
171
c_
r—
u
v
c
0
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF TH#S RECORD HAS BEEN PROVIDED TO THE WELL 0 NNER
02— -rJV
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
ij

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) c'nMe h h l s I O JTT3 �rA c CERTIFICATION II of /—r
/
WELL CONTRACTOR COMPANY NAMK)'>'hfri 140/A Wei I1)Y`r IBIS /(j-.)..I%(' J PHONE,/ -511/-6e'2k-3-6 STATE WELL CONSTRUCTION PERMIT,/ ASSOCIATED W&ERMIT#
(if applicable) (if applicable)
293122
1. WELL USE (Check Applicable Box): Residential unicipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other O If Other, List Use
2. WELL LOCATIO:
Nearest . Town: f .+4 CL', County Al a Cnrti
rX %4/ /9iRpnr-I-RA_ -ra—fierraa
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)eV g r/ 3 y
3. OWNER: C'/'E'YL LLJ2.IC.�ii /
Address a 4-3- /-1 % 2 POYT PC -
(Street or Route No.)
F�YQ4�ILInJ A/C -
City or Town State Zip Code
cQ 7 :3
Area code- Phone number
4. DATE DRILLED el -
5. TOTAL DEPTH: a r
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO 171----"-
7. STATIC WATER LEVEL Below Top of Casing: 9'o FT.
(Use "+" if Above Top of Casing)
S. TOP OF CASING IS / FT. Above Land Surface`
*Top of easing terminated at/or below land surface requires a
variance In accordance with ISA NCAC 2C.0118. j/0�/
9. YIELD (gpm): METHOD OF TEST h
10. WATER ZONES (depth): / 6FL>'
Topographic/Land se ing
❑Ridge ❑Slope ley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
Formation Description
e, et,
5ar')d-Sfan
IV -e (L [4a i
DEPTH
From To
/ 53'
53' fv -
PP
O —
LOCATION SKETCH � 0
c,,
11. DISINFECTION: Type fi"Hi Amount ,-2 %1}1 S Show direction and distance in miles fror at leaf
Wall Thickness two State Roads or County Roads. Include�ti e act
Depth Dia afar or Weight/Ft. Mate al
numbers and common road names. r >o
s R Pet �,
3 as
9 vz
12. CASING:
From V To Ft. l " .Z2 1
From To Ft.
From To Ft.
13. GROUT: Depth
From O To r9V
Material
Ft. IP4-?tMl
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.
MetL' k�v
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF TH S RECORD H S BEEN PROVIDED TO THE WELL 0
0 —or
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
c-4
H
f
Lij
c_
C

WELL CONSTRUCTION RECORD
North Carolina -Department of Environment and Natural Resources - Division of Water Quality
WELL CONTRACTOR (INDIVIDUAL)NAME (print) James B. Brown
LCONTRACTOR COMPANY NAME Hedden Brothers Well Drilling, Inc
STATE WELL CONSTRUCTION. PERMIT: ASSOCIATED WQ PERM1IIT"
(if applicable) - - - (if applicable)
292634
- Groundwater Section
CERTIFICATION g 2045
PHONE : [phone]
I. WELL USE (Check Applicable Box): Residential Municipal/Public 0 Industrial 0 Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: Franklin County Macon
259 Daves Creek Rd
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: Randy Drinnon
Address 259 Daves Creek Rd
(Street or Route No.)
Franklin, NC 28734
City or Town. Sate Ztp Code
( 828- 524-5530
Area code. Phone number
4. DATE DRILLED 1-19-04
5. TOTAL DEPTH: 480'
6. DOES WELL REPLACE EXISTING WELL? YESX5t NO 0
7. STATIC WATER LEVEL Below Top of Casing: - FT.
(Use "+" if Above Top of Casing)
S: TOP OF CASING IS - 2 FT. Above Land Surface"
'Top of casing terminated at/or below land surface requires a
variance In accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): 0-DRY METHOD OF TEST blow
10. WATER ZONES,(depth):.
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
- (degreeshninutes/seconds)
Latitude/longitude souse:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
F0rom To' Formation
y & sanrd lion
clay
38' 480' .. ranite
11. DISINFECTION: Type H T H Amount 16 oZ
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 37 Ft. 6" pvc
From 37' To 40 Ft. 6" .188 steel
From To Ft.
13. GROUT: Depth Material Method
From 0 To 20 Ft. bennite & ors t pumped
From . To Ft
14. SCREEN: Depth Diameter Slot Size Material
From - To Ft. - in, in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
De, Ih Size Material
From To FL
From To Ft.
7
�JptiL'':.:',F
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road o
numbers and common road names. O o
.F'
-,
n
CO Cm
z_
of
>0
rn
�
m=
CI
1/40 O
16, REiMARKS`.
I DO HEREBY 'CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STANDAS ND THAT A CO THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
ERSON 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-I REV. 07/2001

«'ELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources -Division of Water Quality • Groundwater Section
N'ELLCONTRACI'OR(INDIVIuuAL)N.AiME (print) James B. Brown CERTIFICATIONi< 2045
-WEt,L CONTRACTOR COMPANY NAtN1EHedden Brothers Well Drilling, Inc PHONE #[phone]
STATE WELL CONSTRUCTION PERMIT;
(if applicable)
ASSOCIATED WQ PERMIT:
(if applicable)
I. WELL USE (Check Applicable Box): Residential ( Municipal/Public ❑ .Industrial ❑ Agricultural ❑
Monitoring Q Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: Franklin
146 Daves Creek RD
County MaCOn
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: Bill Drinrion
Address 146 Daves Creek RD
(Street or Route No.)
Franklin, NC 28734
City or Town State. Zip Code
(32B)- 524-6846
Area code- Phone number
4. DATE DRILLED 1-21-04
5. TOTAL DEPTH: -180'
6, DOES WELL REPLACE EXISTING WELL? YES fl NO 0
7, STATIC WATER LEVEL Below Top of Casing: 15 FT
(Use "4" 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 .011S.
9. YIELD (gprn): 30 METHOD OF TEST blow
10. WATER ZONES (depth): 95 & 165'
I I. DISINFECTION. Type
12. CASING:
Depth
From 0 To 27
From 27' To 10
From To
13,GROUT: Depth
From 0 To 20
From To
14. SCREEN: Depth
From To
From • To
15, SAND/GRAVEL PACK
Depth Size
From To Ft.
From To Ft.
H T H Amount 16 oz
Wall Thickness
Diameter cr Weight/Ft. Material
Ft. 6" pvc
Ft.6" 188 steel
Ft.
Material Method
Ft. tarilite & ta,L pumped
Ft.
Diameter Slot Size Material
Ftin. in.
Ft, in. in.
Material
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude dwell location
(degrees'minutes'seconds).
Latitude/longitude source:OGPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
0 28' clay &
28' 180' granite
LOCATION- -
Show direction and distance in miles from at least
two State Roads or County Roads. include the road
numbers and common road names.
60 :II WV h- 833 10
16. REMARKS'.
I DO HEREBY CERTIFY T
CONSTRUCTION STA
T THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
S, AND THAT A Cf}f Y OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
41,
NATIA
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
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WELL CONSTRUCTION RECORD.
• 292632,
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) James B. Brown CERTIFICATION k 2Q45
WELL COMI'RACI'OR COMPANY NAn1EHeddenBrothers Well Drilling, Inc PHONE # fi3') 369-9591
STATE WELL CONSTRUCTION PERNMIT# ASSOCIATED WQ PERMIT#
(if applicable) - (if applicable)
1. \VELL 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: Franklin County Macon
259 Daves Creek RD--Well #2
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code) •
3 OWNER: Randy Drinnon
Address 259 Daves Creek RD
(Street or Route No.)
Franklin, NC 28734
City or Town State Zip Code
( 82$- 524-5530
Arca code- Phone number
4. DATE DRILLED 1-20-04
5. TOTAL DEPTH: 140'
6. DOES WELL REPLACE EXISTING WELL? YES>iiii NO 0
7. STATIC WATER LEVEL Below Top of Casing 75' FT.
(Use "+" if Above Top of Casing)
S. TOP OF CASING IS - 2 FT. Above Land Surface"
'Top of casing terminated at/or below land surface requires a
varlance In accordance with 15A NCAC 2C.0118.
9. YIELD (gpm): 8 METHOD OF TEST blow
I0. WATER ZONES (depth): 105'
I 1. DISINFECTION: Type
12. CASING:
Depth
From 0 To 70 Ft.
From - To Ft.
From To FL
13. GROUT: Depth
From 0 To 20
From To
14, SCREEN. Depth
From To
From To
H T H
Diameter
6n
Amount 16 oz
Wall Thickness
or Weight/Ft. Material
188 steel
Material
Ft. )nir to & caaTt
Ft.
Diameter Slot Size Material
Ft. iti, in.
Et. in. in.
Method
pumped
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees'minu!es'secon ds)
Latitude/longitude source:❑GPSC'Topographic map
(dmckbox)
DEPTH DRILLING LOG
From To Formation Description
0 68' clay & -sana
68' 140'
granite
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers ar.d common road names.
O
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16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STAND.A: i AND THAT A COPY O HIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center- Raleigh, NC
27699-1636 Phine No. [phone], within 30 days. - GW-I REV. 07/2001
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WELL CONSTRUCTION RECORD
North Carolina - Deportment of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR(INDIYIDUAL) NAME (print) Mitchell D. COOK
WELL CONTRACTOR COMPANY NAME 15 hell M11—imr
STATEWELLCONSTRUCTION PERMIT# ASSOCIATED WO PERNIITN
(if applicable) - (if applicable)
292,628
CERTIFICATION # 2043
PHONE k 628l 369-9591.
1. WELL USE (Check Applicable Box); Residential Municipal/Public❑ Industrial 0 Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑. ' Other ❑ If 0ther,'List Use
2. WELL LOCATION.:
Nearest Town. Highlands County Macon
Highlands Hills Sub Div Lot #14
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: Bob Boshell
,Address 2108 Parkview Drive South
(suet, or Route No.)
Montgomery, AL 36117
• City or Town State Zip Code
(334)• 954-2594
Area code- Phone r,ur,ber
4, DATE DRILLED 1-16-04
5. TOTAL DEPTH: 550'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO CY
7. STATIC WATER LEVEL Below Top of Casing: 350 FT,
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 2 FT. Above Land Surface*
'Top of casing terminated aUor below land surface requires a
variance In accordance with 15A NCAC 2C .0I IS.
9. YIELD (gpm): 10 METHOD OF TEST blow
10. WATER ZONES -(depth); 470'
11 DISINFECTION: Type H T H
12. CASING:
Depth
From 0 To 29 Ft.
From 29' To 111 Ft.
From - To Ft.
13. GROUT: Depth.
From 0 To 20 '
To
Diameter
6"
Amount 16oz
Wall Thickness
or Weight/Ft. Material
•
DVC
2RR - steal
Material Method
Fd n".ite & c-eLa tants3
From Ft.
14, SCREEN: Depth Diameter
From To - Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size Material
Slot Size Material
in.
In.
From To Ft.
From To Ft.
Topographic/Land setting •
❑Ridge 0Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degreeshnlneteslseoondS)
Latitudelongitude source:OGPSDTepographic map
(cheek box)
DEPTH DRILLING LOG
From Te Formation Description
0 31' clay & 3
31' 550' granite
LOCATION SKETC14 - . -- -
Show direction and distance in miles from at least
two State Roads or County Roads, Include the road
numbers and cornrnon road names, 'p
-n
m
W
16, REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTIONTI�IOMSTANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
70-,
A
O
tD
/ ,/ % //7 L,C
SIGNATURE OF PERSON CONSTRUCTING THE WELL ' DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 NIail Service Center -Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-I RE.V.'07/2001
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WELL CONSTRUCTION RECORD 9
North Carolina - Dopartment of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Mitchell D. COOk - CERTIFICATION k 2043
WELL COtN'IRACTOR COMPANY NANIE Hea±ri i'StS 'P71 frith grt TYL - PHONE k 125) 369-9591
STATE WELL CONSTRUCTION PERMIT0 ASSOCIATED WQ PERMITS
(if applicable) •
(if applicable)
I. WELL USE (Check Applicable Box): Residential 25 Municipal/Public 0 Industrial ❑ Agricultural 0
. Monitoring 0 Recovery 0 ,Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: Highlands County Macon
Kettle Rock Rd Well.#2
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: Allen & Randy Armstrong
Address 309 Golden Wings Way La
(Street or Route No.)
Greer, SC 29650
• City. or Town State Zip Code
(864- 877-7006
Area code- Phone number
4. DATE DRILLED 1-25-04
5. TOTAL DEPTH: 900'
6. DOES WELL REPLACE EXISTING WELL? YES ❑ N0 da
7. STATIC WATER LEVEL Below Top of Casing: FT.
(Use "+" if Above Top of Casing)
S. TOP OF CASING IS 2 FT. Above Land Surface*
*Top of casing terminated actor below land surface requires a
variance In accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 0—DRY METHOD OF TEST blow
10. WATER ZONES (depth):
1 I. DISINFECTION: Type
12. CASING:
Depth
From 0 To
H T H Amount 16oz
Wall Thickness
Diameter or Weight/Ft. Material
25 Ft. 6" pvc
From 25' To 29 Ft. 6" _ 1 RA steel
From To Ft.
13. GROUT: Depth, Material - Method
From 0 To 20 Ft mite & txitwL arted
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To - Ft. in. in.
IS. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
From To
0 27'
27' 900'
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
. (check appropriate box)
Latitude/longitude of well location
(degreeslmi mttesls econds)
itude/longitude source',❑GPS❑Topographic mop
(check box)
DEPTH DRILLING LOG
Formation Description
clav & s
granite
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 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OFOTHIS 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
I'
J

WELL CONSTRUCTION RECORD
North Carolina • Department of Environment and Natural Resources - Division of Water Quality • Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Mitchell De Co)C CERTIFICATION n 2043
WELL CONTRACTOR COMPANY NAME liErnThri at:t"atV ad-1- Tit T PHONE # [phone]
ASSOCIATED 11'Q PERMIT:
(if applicable)
STATE WELL CONSTRUCTION PERMITH
(if applicable)
1
WELL USE (Check Applicable Box): Residential L29 Municipal/Public 0 Industrial 0 Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2, WELL LOCATION:
Nearest Town: Franklin County MaCOri
428 Park Ridge Drive
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code) -
i
3. 0\VNER:Norman Leedon
Address 428 Park Ridge Drive
(Si reel or Route No.)
Franklip, NC 28734
• City or Town State Zip Code
(828 )- 524-3106
Area code Phone number
4. DATE DRILLED1-28-0409"
5. TOTAL DEPTH: 700'
6. DOES WELL REPLACE EXISTING WELL? YESXS NO ❑
7. STATIC WATER LEVEL Below Top of Casing: 100 FT.
(Use "+" if Above Top or 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 I5A NCAC 2C ,0115. blow
9. YIELD (gpm): 5 METHOD OF TEST
I0. WATER ZONES (depth): 70'
I L. DISINFECTION: Type H T H
12. CASING:
From 0
From 49'
From
13. GROUT:
From 0
Depth Diameter
To 49 Ft. 6"
To 53Ft. 6"
To F
Depth
To 20
Amount 16oz
Wall Thickness
or Weight/Ft, Material
pvc
-188 steel
Material
FtkLite & )3IE
From To Ft.
14. SCREEN: Depth - Diameter
From To Ft. in.
From To Ft.- in.
15, SAND/GRAVEL PACK
From
From
Depth Size
To Ft.
To Ft.
16. REMARKS.
Method
fumed
Slot Size Material
in.
in,
Material
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
latitude/longitude of well location
- .(degrees/mi saes/seconds)
Latitude/longitude source,DGPSOTopagraphic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
0 51' clay & sand
51' 700' granite
0
LOCATION SKETCF ' `
Show direction and distance in miles from at least
two State Roads or County Roads, Include the road
numbers and cornrnon road names.
0
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CO
• 0
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Sr
enz
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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 RELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the originnl 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
�I
II

WELL CONSTRUCTION RECORD
North Carolina -Department of Environment and Natural Resources -Division of Wafer Quality -Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) c'e n N i S J'}A' 1 Q_ A rli CERTIFICATION # y.17
WELL CONTRACTOR COMPANY NAMIri%P,nni S 1101100J Wel I al VI I �'7144 T4 C J PHONE #77%{_52 14-'3 gb 6
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED W(j'PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential unicipal/Public ❑ Industrial ❑ Agricultural ❑ i
Monitoring' ❑ Recovery ❑ Heat Pump Water Injection ❑ Other D. If Other, List Use
2. WELL LOCATION: Nearest
-Town: f, 141/C'L-/ 4/
Countynn
p40,C
�0 /V)e C. T S-C r2t73 5/
(Street Name, Numbers, CommunibuSubdivision, Lot No., Zip Code)
3. OWNER: l�11(LeIPS �s I4eYl cd7'V
Address c 03 'S, C-ecicw Sf'
(Street or Route No.)
LI)alhaii WC, a9lo 4J
Zip Code
(2(o yz(o 2 2' -0-/ 3 a_ e)
Citybr Town State
Area code- Phone number Li 7'
4 DATE DRILLED / — - /)
5. TOTAL DEPTH: 4407 "
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO ❑!
7. STATIC WATER LEVEL Below Top of Casing: 90 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 (gprn): -5-0 METHOD OF TEST_ /OW/
10. WATER ZONES (depth): r.,70' f 3en' Q�
11. DISINFECTION: Type t t» Amount — za_rg_❑❑>
12. CASING: Wall Thickness
Depth /, Diameter or Weiiht/Ft. Matey' 1
From 0 . To l6 Ft. - te, S-jZ(.?% Y
From To Ft.
From To Ft.
13.. GROUT: Depth Material . i
From n To r`-D Ft. e047,y�
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 Ft.
From To Ft.
16. REMARKS:
Tyaphic/Land setting
tLtddge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
Formation Description
DEPTH
From To
yr7
Sete)9:"
� S'
e/
Sc ae,l' fora
ri
) :J
L—.-
LOCATION SkET-CH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
O O
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W cr'
m
1 0<
✓ ern
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rn1' wo
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I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF TH S RECORD H S BEEN PROVIDED TO THE WELL OWNER
Orr OZAk /''at I l —a
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
un

292531
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
James B. Brown CERTIFICATION#
WELL CONTRACTOR (INDIVIDUAL) NAME (print) .
WELL CONTRACTOR COMPANY NAh1E Hedden Brothers Well Drilling, Inc PHONE #828) 9— 369591
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
WELL USE (Check Applicable Box): Residential N Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitdring.❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: Franklin County Macon
42 John Tallent Rd -
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: Steve Tallent
Address 42 John Tallent RD
(Street or Route No.) Franklin, NC 28734
City or Town State Zip Code
(828)- 524-7140
Area code- Phone number
4. DATE DRILLED 11-25-03
5. TOTAL DEPTH: 340'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO M r_ 'H
7. STATIC WATER LEVEL Below Top of Casing: 200 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 ISA NCAC 2C .0118. blow
9. YIELD (gpm): 10 METHOD OF TEST
10. WATER ZONES (depth): 155' & 310'
Topographic/Land setting
❑Ridge ❑Slope DValley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
0°m 55' clayson D& sand cription
55' 340' granite
11. DISINFECTION: Type H T H Amount 16 oz
12. CASING: Wall Thickness
Depth Diameter or WeighttFt. Material
From 0 To 54 Ft. 6" pVG-
From 54' To 57 Ft. 6" .188 steel
From To Ft.
13. GROUT: Depth Material Method
From 0 To 20 Ft. mite & c nrH1t. pumped
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:
f L
2 LUt T
r-H SEMONI
LOCATION SK TC1-hc- ,:-G ti 'I_ FFICE
Show direction and distance in milesTrom at least
two State Roads or County Roads. Include the road
numbers and common road names.
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I DO HEREBY CERTIFY T. • T THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
CONSTRUCTION STA DS, AND THAT A
C OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
/
���L mot! DATE
SIGNATURE OF PERSON CONSTRUCTING THE WELL
Submit the origi /I 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

292532
WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print)
James B. BrOWfl CERTIFICATION #
WELL CONTRACTORCOMP.ANV NAN1EHedden Brothers Well Drilling, Inc PHONE #'28) 369-9591
STATE \\'ELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1.
2,
\\'ELL USE (Check Applicable Box): Residential Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring .❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
WELL LOCATION:
Nearest Town: H] ghl ands
Kettle Rock Rd
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: Allen & Randy Armstrong
Address 0
County Marnn
(Street or Route No.)
Greer, SC 29650`
City or Town State
( 864-877-7006
Zip Code
Area code- Phone number 12-1 8-03
4. DATE DRILLED
5. TOTAL DEPTH: 900'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO fl
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. blow
9. YIELD (gpm): 0--DRY METHOD OF TEST
10. WATER ZONES (depth):
I I. DISINFECTION: Type H T H Amount 16 oz
12. CASING: Wall Thickness
Depth Diameter or \VeightfFt. Material
From 0 To 20 Ft. 6" pVC
From 20' To 23' Ft. 6" .188 steel
From To Ft.
13. GROUT: Depth Material Method
From 0 To 20 Ft. berrnite & tatt3lt pumped
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size - Material
From To Ft.
From To Et.
16. REMARKS:
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes'seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formationclay& sa
nd
Otton
0 21'
21' 900' granite
i
I'1:d 9 "-..
LOCATION SK TCH ION
h t "�, E
Show direction and distance i mlleslii'enmai-}ea�t ._---
two State Roads or County Roads. Include the road
numbers and common road names.
0
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I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
CONSTRUCTION STANQA DS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF
ON 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

292533
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print)
James B. Brown CERTIFICATION #
WELL CONTRACTOR COMPANY NAME Hedden Brothers Well Drilling, Inc PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
WELL USE (Check Applicable Box): Residential Municipal/Public 0 Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
WELL LOCATION:
Nearest Town: Franklin
716 ('arson Rd
County Ma con
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: Shonda MaGaha
Address 716 ('arson rove Rd
(Street or Route No.)
Franklin, NC 28734
City or Town State Zip Code
(_828)- 574-4763
Area code- Phone number
4. DATE DRILLED 1-6-04
5. TOTAL DEPTH: 200'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO l
ix
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
0 20' clay & sand
20' 200' granite
STATIC WATER LEVEL Below Top of Casing: 100 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): 6 METHOD OF TEST blow
10; WATER ZONES (depth): 115'
11. DISINFECTION: Type H T H Amount 16 oz
12. CASING: Wall Thickness
Depth
From 0 To 20 Ft.
From 20' To 21 Ft.
From To Ft.
13. GROUT: Depth Material Method
From 0 To 20 Ft. bite & oanait pumped
Frorn To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
Diameter or Weight/Ft. Material
A"
6"
pvc
.188 steel
From To Ft.
From To Ft.
16. REMARKS:
,11
2 ri
LOCATION KET _ FC! EE
Show direction and distant mt es iii atTeast�
two State Roads or County Roads. Include the road
numbers and common road names.
O
-n
m
co
N
CO
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2d, WELL
CONSTRUCTION STAN . S, AND THAT A COPY 0 THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
,ems/ / / — U (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
27699-1636 Phone No. [phone], within 30 days. - GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
292534
North Carolina - Department of Environment and Natural Resources - Division of Water. Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) James B.,Brown CERTIFICATION 2045
WELL CONTRACTOR COMPANY NAME Hedden Brothers Well Drilling, Inc PHONE 0$28) 369-9591
STATE WELL CONSTRUCTION PERi\IITK ASSOCIATED WQ PERMIT0
(if applicable) - - (if applicable)
WELL USE (Check Applicable Box): Residential N Municipal/Public 0 Industrial 0 Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: Franklin County Macon
Highlands Gate
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: Ken Valdespino
Address 2037 Henley Place
(Street or Route No.)
Wellington, FL 33414
City or Town State Zip Code
( 561)_ 791-9044
Area code- Phone number
4. DATE DRILLED 1-8-04
5. TOTAL DEPTH: 620'
6, DOES WELL REPLACE EXISTING WELL? YES 0 NO -
7. STATIC WATER LEVEL Below Top of Casing: 50' 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 .0115.
9. YIELD (epm): 100 METHOD OF TEST blow
10. WATER ZONES (depth): 619'
1 I. DISINFECTION: Type H T H Amount 16 oz
12 CASING:
Vali Thickness
or Weight/Ft. Material
pvc
Depth
From 0 To 80 Ft.
From 80' To 83 Ft.
From To Ft.
13. GROUT: Depth
From 0 To 20
Diameter
6"
6"
188 steel
Material
Ft. termite & cener t
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size • Material
From To Ft.
From To Ft.
Method
pumped
16. REMARKS.
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOGL
From 81' Formation saner lion
clay
81' 620' granite
it
1
LOCATION SKETCH--------
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
O
-n
rn
Ca
N
'v
fV
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STAND? R'D%, 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
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WELL CONSTRUCTION RECORD
292535
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) James B. Brown CERTIFICATION F 2045
wELL CONTRACTOR COMPANY NAMEHedden Brothers Well Drilling, Inc PHONE4 '28) 369-9591
STATE WELL CONSTRUCTION PERMIT: ASSOCIATED WQ PERLIIT#
(if applicable) - • (if applicable)
1. WELL USE (Check Applicable Box): Residential Municipal/Public ❑ Industrial 0 Agricultural ❑
Monitoring .❑ Recovery 0 Heat Pump Water Injection 0 Other 0 11 Other, List Use
2, WELL LOCATION:
Nearest Town: Franklin County Macon
28N to Double Branch Cove Rd
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: Linda Palmer
Address 993 Jacobs Branch Rd
(Street or Route No,)
Frankliitn, NC 28734
City or Town State
( 828_ 524-6636
Area code- Phone ncmber
4. DATE DRILLED 1-16-04
5. TOTAL DEPTH: 300'
6, DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: 200 Al
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 2 FT, Above Land Surface*
'Top of casing terminated at/or belon land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (2pm): 8 METHOD OF TEST blow
10. WATER ZONES (depth): 153 & 160'
Zip Code
11. DISINFECTION: Type H T H Amount 16 oz
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 109 Ft. 6" pvC
From 109' To 112 Ft. 6" 188 steel
From To Ft.
13.GROUT: Depth Material - Method
From 0 To 20 Ft. bafnite & wi aiL pumped
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
From
From
Depth Size
To Ft.
To Ft.
16. REMARKS:
1
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees9ninutestseconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
0 1
om 10' Fclayation& saDescnrjdption
110' 300' granite
--------------
LOCATION SKE
Show direction and distance in miles from at least
two State Roads or County Roads. Include the roaL
0
O
m
ora
ern
oR1
7:)o
m_
n
--1
0
numbers and common road names. o
co
co
c.3
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STANfJ:hijDS, AND THAT A COPOF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
/G =d S�
DATE
SIGNATURE 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. G\V-I REV. 07/2001

WELL CONSTRUCTION RECORD 2 9,2 5 3 6
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
James B. Brown CERTIFICATION# 2045
WELL CONTRACTOR (INDIVIDUAL) NAME (print)
WELL CONTRACTOR CO,\IPANY NAMEHedden
Brothers Well Drilling, Inc PHONE '13) 369-9591
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMITS
(if applicable) (if applicable) -
1. WELL USE (Check Applicable Box): Residential PI Municipal/Public ❑ Industrial ❑ Agricultural ❑ f
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: Franklin
Battle Branch
County Macon
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: Tim Hughs
Address BD Box 904
(Street or Route No.)
Franklin, NC 28744
City or Town State Zip Code
(824- 369-8662
Arca code- Phone number
4. DATE DRILLED 1-22-04
5.TOTAL DEPTH: 260'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: 165' FT.
(Use "+" if Above Top of Casing)
S. 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): 10 METHOD OF TEST blow
10. WATER ZONES (depth): 135' & 240'
11. DISINFECTION: Type H T H
12. CASING:
Depth Diameter
From 0 To 89 Ft. 6"
From 89' To 97 Ft. 6" .188
From To Ft.
13. GROUT: Depth Material Method
From 0 To 20 Ft. mite & t.trtall pumped
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in.. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
Amount 16 oz
Wall Thickness
or Weight/Ft. Material
pvc
steel
From To Ft.
From To Ft.
16. REMARKS.
Topographic/Land setting
❑Ridge ❑Slope ❑Valley DFlat
(check appropriate box)
Latitude/longitude of well location
(degrees'mi notes/seconds)
Latitude/longitude source:OGPSOTopographic map
(check box)
DEPTH DRILLING LOG
F0rom T90' Fclayion& sDanrjdntion
90' 260' granite
LOCATION S1KETOH....
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
O
c!n
cc7
cm
OG
D0
mo
Xo
cnz
rn�
n
G
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STA ' •ARDS, AND THAT PY OF THIS RECORD HAS BEEN PROVIDED TOTHE 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

•
WELL CONSTRUCTION RECORD
2924°0
NorthCarolina- Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) C..1)-ef) h l 5 [1111l QM rU CERTIFICATION #
WELL CONTRACTOR COMPANY NAMQ1Xhn[i 1411(10,4 WP,I I.1-iVtII :lt �/t( .YIP PHONE
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ4ERMIT#
(if applicable) (if applicable)
Say-s'-b 0
1. WELL USE (Check Applicable Box): Residential' unicipal/Public ❑ Industrial 0 Agricultural 0
Monitoring. ❑ Recovery 0 Heat Pump Water Injection 0 Other Cr If Other, List Use
2. WELL LOCATION: ^
Nearest Town: I7 I %/f L AA)f S County A4 Q ten._
('Ieettau r?A—mo.JLal. 14o).., t?el ,1E19l
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: TAtrill Q5 (J)
Address (n77 /0ctC/!_iD;) SOY'. 2c4
(Street or Route No.) e 7/, /
City br Town State Zip Code
5Q _ 33co 7 •
Area code- Phone number
4. DATE DRILLED / /L, —0 T
5. TOTAL DEPTH: , ibS'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: / 5' FT.
(Use"+" if Above Top of Casing) `
8. TOP OF CASING 'IS / 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_ J/7L(f
10. WATER ZONES (depth): a %b'
TopographitiLand setting
❑Ridge lope ❑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
0 9-4r e /a..
kG/ • Sam c\S Ji
.SOS"
0
O o
LOCATION SKETCH z
II. DISINFECTION: Type H'ti» Amount rr.L 7" Q 5 Show direction and distance in miles frortc at lea
12. CASING: Wall Thickness two State Roads or County Roads. IncludRto roX
-D
S
W
ra
Depth c9
From 0To a
From To
From To
13. GROUT: Depth
From n To r,(7 Ft.
From To
14. SCREEN: Depth
From To
From To
15. SAND/GRAVEL PACK:
Depth
From To
From To
16. REMARKS:
Diap'etter or Weieht/Ft. Mate:''t numbers and common road names.
FL to -- :, / f 81, J tc L
Ft,
Ft.
Material
Ft,
Diameter
Ft. in.
Ft. in.
Ft.
Ft.
Method
Slot Size Material
in.
in.
Size Material
1UUIY 2 5 2'.J04 i
GROUNDWATER SECTION
AeL.E,;! ar-Din, /il UH-F.E
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL '
CONSTRUCTION STANDARDS, AND THAT A COPY OF TH}S RECORD HPAS BEEN PROVIDED TO THE WELL OWNER
rlr auk 1
'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 2 9 31 n 6
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print)\-)4ttW-3 R, IAD,ISOn CERTIFICATION,/c2U/0t
WELL CONTRACTOR COMPANY NAME mLIUC.R IAD&I c r, I', tf)
STATE WELL CONSTRUCTION PERMIT,/ ASSOCIATED WQ PERMIT,/
(if applicable) (if applicable)
PRONE a fbas) 537-1! 2
-
-
I r— -
it
1. WELL USE (Check Applicable Box): Residential trMunicipaUPublic 0 Industrial ❑ Agricultural
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATI`C�
ON;\
pNp�eearest1Town: fl(VC) Countyf`(\UC G
TIO (�
I-,ti IG «rf{f
(Street Name, NumbercCommunity, Subdivision, tat No., Zip Code)
3. OWNER:F //i S4or
Address 1fJ\lo 1.--i. \\Q CYmca.);\ Qr\
) .C\UO``d`l`f�1
C\Q-
City or Town State Zip Code
Area code- Phone number
4. DATE DRILLED I-lel -(>t-I
5. TOTAL DEPTH: �-9S
6 DOES WELL REPLACE EXISTING WELL? YES ❑ NO EV
Topographic/Land setting
❑Ridge ,/Slope ❑Valley ❑Fljit
(check appropriate box) „- I
Latitude/longitude of well locrdtibij
(degrees/minutes/seconds)
Latitude/longitude sourcc:CJGPSDTopographic Iitap--
(e1,Rk box)
DRILLING LOG
Fnrmatiot Description
e9 — c 1
LUPIN-1
Fa u To
i - A%'
7. STATIC WATER LEVEL Below Top of Casing: CO„ ` FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS f FT. Above Land Surfaces
*Top of casing terminated at/or below land surface requires a
variance In accordance with 1SA NCAC 2C .0118. ���
9. YIELD (gpm): I D METHOD OF TES'1 L4; 4
10. WATER ZONES (depth):
11. DISINFECTION:Typeh \ PP\\G- S Atnouut
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From D To S ' Ft. /r i aA- S(i2 ( P V (
From To Ft.
From To Ft.
13. GROUT: Depth r,� Material
From/_ To >F)' Ft. 1'aj('rlckf\pl
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. OI Choc,g
Method
c)Ce Cu Fr
� o
CO am
oc
av a r-1
;>o
LOCATION SKETCR !;,1.�
Show direction and distance in miles furn at
two State Roads or County Roads. Inc(iiste tIR road
numbers and common road names.
16. REMARKS:
1; Hie
Che9^
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-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural lResources - Division of Water Quality - Groundwater Section
y
WELL CONTRACTOR (INDIVIDUAL) NAME (print) 2. C ' /rmne CERTIFICC+A�TIION� ,`,pf�.
WELL CONTRACTOR COMPANY NAME (YAdt. erV215- idea riilI.AI5 G. PHONE . to )JdJ"T772
STATE WELL CONSTRUCTION PERMIT. _ASSOCIATED WQ PERMIT.
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCATIO
NTown:
/N%tee
am um Comm
(Street 19 e, tan, unity,
3. OWNER: Lnn
County1 *CM -
Subdivision, Lot No., Zip Code)
ti/is
Address
(Street or Route No.)
tirnU4;1 V
City or Town State Zip Code
Area code- Phone number
4. DATE DRILLED '— .-11
5. TOTAL DEPTH: P
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 0
7. STATIC WATER LEVEL Below Top of Casing: men FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surfaces
`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 /air
10. WATER ZONES (depth):
11. DISINFECTION: Type Amatmt
12. CASING: Wall Thickness
Depth Diamejer or Weight/Ft. Material
From 0To 714 Ft. %ter/ ��L
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From d le Ft. �!�?ta 'ogee:2 y
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 Material
_ in.
in.
16. REMARKS:
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
(pZ) — s S- �j ✓IS�c
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
I DO 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
Ate 3i/ —'6V
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

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and NaturalResources- Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) t� O 11 .t_ CERTIFICAATIION�M/,✓v7-3 /
WELL CONTRACTOR COMPANY NAME CfIt k 6/a5. (/dj�,J / 2X;t& SAJC PHONE II f (iG F-r/ 7-7
STATE WELL CONSTRUCTION PERMIT# JSSOCIA✓TED WQ PERMIT','
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential IX Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery ❑ Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION'
Nearest Town: f 4/i it'A/
CP: i/4 kb I
County mAUN
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER:"P/}- C4/dati/
Address
(Street or Route No.)
f=Y 1i A, Nt_ CS2 73 V
City or Town State Zip Code
Area code- Phone mnnber
4. DATE DRILLED la -fir a ¥
5. TOTAL DEPTH: 380
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 0
7. STATIC WATER LEVEL Below Top of Casing: strgFT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
'Top of cuing terminated at/or below land surface requires a
variance In accordance with 1SA NCAC 2C .0118.
9. YIELD (gpm):vZSit 3 b METHOD OF TEST A,1^
10. WATER ZONES (depth):
11. DISINFECTION: Type Amount
12. CASING: Wall Thicbtess
Depth Di or Weight/Ft Material
From_ D To Si Ft. to %Y IOU t
From To Ft
From To Ft.
13. GROUT: Depth Material Method
From 0 To_ 2a 0 Ft 61///mzi ti?
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
Front To Ft. in. in.
15. SAND/GRAVEL PACK
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
Topographic/Land setting
❑Ridge 0Slope Malley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPT$ DRILLING LOG
From To Formation Description
cti rim
ie
LOCATIONSKETC$
Show direction and distance in miles from atleast
two State Roads or County Roads. Include the road
numbers and common road names.
0
0
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WFJ r
CON _ ' UCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
3-.Sd
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

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural'11��Resourcesps� - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) s Dp1)/I/I/ -' //&Ant aterifICATION #3a
WELL CONTRACTOR COMPANY NAME franc 1&n Zrh// 2,//;11_ ran- PHONE # (6d 1 V-iin4
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMITS
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential), MunicipallPublic 0 Industrial ❑ Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATIO
Nearest Town: Ail/7 N County / fi 4A(.64)
Moth) cd' Crate
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER:s.-�" 90( inlcie
Address '6' 'J / -try / Ali [
(Street or Rohe No.)
City or Town State Zip Code
(-)-
Area code- Phone number
4. DATE DRILLED
5. TOTAL DEPTH:
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 0
7. STATIC WATER. LEVEL Below Top of Casing: /Ub 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 la accordance with 1SA NCAC 2C .0I18.
9. YIELD (gpm): /.S METHOD OF TEST "Sri'
10. WATER. ZONES (depth):
Topographic/Land setting
❑Ridge 0Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(cited( box)
DEPTH DRILLING LOCI
From To Formation Description
11. DISINFECTION: Type Amount
12. CASING: Wall Thickness
or Weight/Ft. Material
Diameter
From D To Depth v i Ft 107V
From To Ft.
From To Ft
13. GROUT: Depth Material
From Tom_ Ft. /limsd
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.
Method
16. 16. REMARKS:
:17
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.
(n
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL 1CON TRUCCION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
o C ..-c-- —is-di/
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

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural�.�^^"''ResourcesI/�- Division of Water Quality - Groundwater Section
f
WELL CONTRACTOR (INDIVIDUAL) NAME//J� ,((p.rint) T end t: t#t G ..ffz� CERITPICATION k 3.&��0
WELL CONTRACTOR COMPANY NAME v-f44L errs S. te&// Ore7X2,y 124 PHONE # Y 6
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential Eir Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring ❑ Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION: (
N stTown: A/ County/VDU-
fact, j I/L/iluf
(Street Name, n umbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: a , cl 7T [ ALYS
Address /57•v $ t&c . Q.,1:15' -Ian- (_r
(Sheet or Route No.)
rn; f9111,- P/ 31 7s—
City or Town State Zip Code
Area code- Phone number
4. DATE DRILLED / 2a54"9
5. TOTAL DEPTH: c/ SS
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 0
7. STATIC WATER LEVEL Below Top of Casing: /See FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surface'
*Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .011S.
9. YIELD (gpm): / METHOD OF TEST /i.'V
10. WATER ZONES (depth):
11. DISINFECTION: Type Amount
12. CASING: We Thickness
Depth or Weight/Ft. Material
From 0 To 1 D Ft.� et --
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From To c2h Ft. eaten -/- 11"/rldq
From To Ft. J
14. SCREEN: Depth Diameter Slot Size Material
From To FL in. in.
From______ To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
Topographic/Land setting
❑Ridge 0Slope ❑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
,4 �,#,
y641.-4e.
LOCATION SKETCH
Show direction and distance in miles from at (east
two State Roads or County Roads. Include the road;
numbers and common road names.
t
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
SA A.a-ram— 1 /.r iVe
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
1

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME��f (print) �fb/iifr2 ,'£t S*teo — CERTlncAriopt.?b7/
WELL CONTRACTOR COMPANY NAME /417/ kehi s. [4/ LOYiW A.. t.LZUL -
STATE WELL CONSTRUCTION PERMITS ASSOCIATED WQ PERMTIN
(if applicable) (if applicable)
PHONE N
I. WELL USE (Check Applicable Box): Residential 4' Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water I 'action 0 Other 0 If Other, List Use
2. WELL LOCATIO
Nearest Town:
\jiMflt
County / 1464 AJ
(Street Name, Number, Community, Subdivision, Lot No., Zip Code)
3.OWNER:T t i�alt4
Address a/ O rr 3-#, t es' -
(Street or Route No.)
�iC-e-AC/u!/r .t/. 3aa-yy
City or Town State Zip Code
Area code- Phone number
4. DATE DRILLED
5. TOTAL DEPTH: Tsr-
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 0
7. STATIC WATER LEVEL Below Top of Casing: ,7 d-o FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface'
'Top of cuing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .011g.
9. YIELD (gpm): / D METHOD OF TEST_ --At'
10. WATER. ZONES (depth):
11. DISINFECTION: Type
12. CASING:
Depth
From To_? 5 Ft.
From To Ft.
From To Ft.
13. GROUT: Depth
From O To�O Ft.
From To Ft.
Diameter
b/y
Material
Amount
Wall Thickness
or Weight/Ft. Material
a)I/L
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.
Method
Slot Size Material
_ in.
in.
16. REMARKS:
Topographic/Land setting
❑Ridge 0Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/mimutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(cheek box)
DEPT$ DRILLING LOG
From To Formation Description
31- 7ir rZtL
'
LOCATION SKETCH
Show direction and distance in miles from Ut (east
two State Roads or County Roads. Include the road
numbers and common road names. - L.
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRi1CIlON STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WFI.1 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
k.0
0
0
1
E
{
1

WELL CONSTRUCTION RECORD
296001
North Carolina - Department of Environment and Natural Resources - Dlvision of Water Quality - Groundwater Section
Y'ELLCOINTRACTOR(Ilti'DIVIDU•AL)NAME (urird) James_13. Frown CERTIFICATION 2045
\YELL CONT RACTOR COMPANY NAME Redden Brothers Well Drilling, Inc PHONE 0P8') 369-9591
STATE WELL CONSTRUCTION PERMIT# - ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)_.
I. WELL USE (Check Applicable Box): Residential ( Municipal/Public 0 Industrial 0 Agricultural ❑
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: Franklin CountvMaCOn
Featherstone Dev
(Street Name, Nel tubers, Cmnnw nity, Subdivision, Lot Na„ Zip Code)
3. OWNER: Bill Vernon Well #2
Address 4248 BUtninotowfl RD
(Street or Route No.)
Franklin, NC 28734
City or Town State Zip Code
(8282-524-0863
A rea code Phone number
4. DATE DRILLED 5-25-04
5.TOTAL DEPTH: 700'
6. DOES WELL REPLACE EXISTING WELL? YES,0 NO 0
7. STATIC WATER LEVEL Below Top of Casing: 600 FT.
(Use "+" if Above Top of Casing)
8, TOP OF CASING IS 2 FT. Above Land Surface'
'Top of casing terminated atior below land surface requires a
variance In accordance with 15A NCAC 2C .0118.
9, YIELD (gpm)' 6 METHOD OF TEST blow
10. WATER ZONES (depth): 349 & 651'
I I. DISINFECTION: Type H T H
12. CASING:
Depth Diameter
From 0To 80 Ft. 611
From 80 To 83 Ft. 6"
From To Ft.
13. GROUT: Depth
From 0 To 20
Amount 16 oz
Wall Thickness
or Weieht/Ft. Material
pvc
.188 steel
Material Method
Ft. bat -crate & uat 7i purnped
From ' ' To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ftin. in.
From To Ftin. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:OGPSOTopographicmap
(check box)
DEPTH DRILLING LONG
FOrom To Forma
I & 52nq. teen
R1 Y
81' 700' granite
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names, ' o
c
C_
c
>a
O
0
16. REMARKS:
I D0 HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTIO1 D.ARDS, AND THAT 'DRY 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. G W-I. REV. 07/2001
en c•:
r,

From To
3. GROUT: Depth Material
From 0 To 20 Ft. barnits & cewnL
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.
WELL CONSTRUCTION RECORD
North Carolina • Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (IiNDIYIDUAL)NIVE(print) James B. Brown CERTIFICATIONS 2045
WELL COhrrRACTOR COMPANY NAME Hedden Brothers Well Drilling, Inc -PHONE a e.28) 369-9591
STATE WELL CONSTRUCTION PERiMlTA ASSOCIATED WO PERit'lIT#
(if aonlicable) cif applicable)
295999
WELL USE (Check Applicable Box): Residential - Municipal/Public ❑ Industrial ❑ Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 .Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: - Franklin County Macon
Featherstone Dev
(Street Name. Numbers, Community, Subdivision, Lot No., Zip Code)
3, OWNER: Nile & Toni Hartman
Address 3958 St. Georges St
(Street or Route No )
Duliith, GA 30096-1409
City or Town State Zip Code
( 678- 938-0365
Area code. Phone number
4. DATE DRILLED 5-21-04
5. TOTAL DEPTH: 900'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO ICK
7. STATIC WATER LEVEL Below Top of Casing: 700 FT.
(Us: "+" if Above Top of Casing)
S. TOP OF CASING IS 2 FT. Above Land Surface*
'Top of casing terms n ated at/or below land surface requires a
variance In accordance with ISA NCAC 2C .011S.
9 YIELD (gpm): 1 1 /2 METHOD OF TEST blow
10. WATER ZONES (depth): 722' & 762'
11 DISINFECTION: Tvpe H T H
12. CASING:
Depth
From 0 To 115
Diameter
6
Ft.
From To Ft,
Ft,
Amount 16 oz
Wall Thickness
or Weight/Ft. Material
pvc
Method
planned
Slot Size Nlaterial
in.
in.
16. REMARKS'
Topographic/Land setting ,
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source,❑GPS❑Topovraphicn>,ap
(check box)
DEPTH DRILLING LOG
Formation Description
clay & sand
From 1Tf3'
113' 900' granite
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.
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I SA NCAC 2C, WELL
CONSTRUCTION STANDARD THAT A COPY THIS RECORD HAS BEEN PROVIDED TO THE W ELL OWNER
SIGNATURE. F PERSON CONSTRUCTING THE WELL DATE
0
0
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center- Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. - GW-I REV. 07/2001

29: 9n8
WELL CONSTRUCTION RECORD
North Carolina • Department of Environment and Natural Resources • Division of Water Quality - Groundwater Section
)TELLCOINTRACTOR(IINDIVIDU,AL)NAME (print) James B. Brown CERTIFICATION2045
WELL COL'IR,\C1ORCOniPA,NY NAME Redden Brothers Well Drilling, Inc PHONE a$28) 369-95°1
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT*
(if applicable) (if applicable) -- --- -
I. WELL USE (Check Applicable Box). Residential [ Municipal/Public ❑ Industrial ❑ Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 ifOther, List Use
2. WELL LOCATION:
Nearest Town: Franklin County Macon
Featherstone Dev --Lot #8
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3, OWNER: Bill Vernon Well #1
Address 4248 Burningtown Rd
(Street or Route No.)
Franklin,.,NC 28734
City or Town State Zip Code
$28 )-524-0863
Area code. Phone number
4, DATE DRILLED 5-19-04
5. TOTAL DEPTH: 700'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: FT.
(Use "+" if Above Top of Casing)
3, TOP OF CASING IS 2 FT. Above Land Surface'
`Top of casing terminated at/or below land surface requires a
variance In accordance with 1sA NCAC 2C .01Is.
9. YIELD (¢om): 0 DRY METHOD OF TEST blow
10. WATER ZONES (depth):
Topographic/Land setting ,
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Desct otion - -
0 65'clay & sand
65' 700' granite
11. DISINFECTION: Type H T H
12. CASING:
Depth Diameter
From 0 To 64 Ft. 6"
From 64To 67 Ft. 61T-- .188
From To Ft.
13. GROUT: , Depth Material
From 0 To ' 20 Ft. ksrnite & claret
From To Ft.
14. SCREEN: Depth Diameter Siot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Amount 16 oz
Wall Thickness
or Weight/Ft, Material
pvc
steel
Method
pumped
LOCATION SKETCH
Show direction and distance in miles frolr, at least
two State Roads or County Roads. Include the road
numbers and common road names.
O
CD
16. REMARKS'
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
CONSTRUCTION STJSN r RDS, AND THAT A CO ' F THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
9-oj
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 Fiume No. [phone], within 30 days. GW-I REV. 07/2001

297997
WELL CONSTRUCTION RECORD
North Carolina -Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (I!NDIVIDUAL)NAME (print) James A. Hrown CERTIFICATION 2045
WELL CoiNr RnCTOR COMPANY NAME Hedden Brothers Well Drilling, Inc PHONE;: 28.) 369-9591
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMED'.
(if applicable) - (if applicable)
I. WELL USE (Check Applicable Box): Residential Municipal/Public 0 Industrial ❑ Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection G Other 0 if Other, List Use
2. WELL LOCATION:
Nearest Town: Franklin County Macon
Burningtown Rd
(Street Name, Numbers, Community, Subdivison, Lot No., Zip Code)
3. OWNER: Bill Vernon
Address 4248 Burningtown RD
(Street or Route No.)
Franklin, NC 28734
City or To:en State Zip Code.
(.828)- 524-0863
Area code- Phone number
4. DATE DRILLED 5-19-04
5. TOTAL DEPTH: 700'
6, DOES WELL REPLACE EXISTING WELL? YES ❑ NO VC
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.01 t8.
9. YIELD (gpm): 0—DRY METHOD OF TEST blow
10. WATER ZONES (depth):
LOCATION SKETCH
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source.OGPS❑Topo_raphic map
(check box)
DEPTH DRILLING LOG •
From To Formation Description
0 65' clay & sand
65' 700' granite
11. DISINFECTION: Type H T H
12. CASING:
Depth
From 0 To 64 Ft.
From 64To 67' Ft.
From To Ft.
13. GROUT:
From 0
From
Amount 16 oz
Wall Thickness
or Weight/Ft. Material
PVC
188 stee
Depth Material
To 20 Ft. L-arrdte & wi
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.
Method
pumped
Slot Size Material
in.
in.
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names,
a
16.REMARKS`
I. DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STT RDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
nObrn.dc/ S-/9-0V
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the 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
n
0

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources -Division of Water Quality • Groundwater Section
YELL CONTRACTOR (INDIVIDUAL) NAME (print) James B. _Brown CERTIFICATION 4 2045
WELL COirrRACTORCOMPANY NAME Hedden Brothers Well Drilling, Inc PHONE a 8281 369-9591
STATE WELL CONSTRUCTION PERMITM ASSOCIATED WQ PERMIT,
(if applicable) (if applicable)
WELL USE (Check Applicable Box): Residential Municipal/Public ❑ Industrial 0 Agricultural ❑
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: - Franklin
Ray Cove --Well #2
County Macon
(Street Name, Numbers, Community, Subdi vision, Lot No., Zip Code)
3, OWNER: Fred Hobbs
Address Po Box 2033
(Street or Route No.)
Franklin,; NC 28744
- City or Town State Zip Code
(828 )- 369-8255
Area code- Phone number
4. DATE DRILLED 5-18-04
5. TOTAL DEPTH: 500'
6. DOES WELL REPLACE EXISTING WELL? YES3S5 NO ❑
7. STATIC WATER LEVEL Below Top of Casing: 400 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 1C .011S.
9. YIELD (gpm): 2 METHOD OF TEST blow
10. WATER ZONES (depth): 90' & 105'
I1. DISINFECTION: Type H T H Amount 16 oz
12. CASING: Wall Thickness
Depth Diameter orWeighUFt, Material
From 0 To 62 Ft. her pvc
From 62' To 65 Ft6r 13- Steel
From To Ft.
13. GROUT: Depth Material Method
From 0 To 20 Ft. termite & =EC pumped
From To -Ft.
14. SCREEN: '. Depth Diameter
From To • Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth
From To Ft.
From To Ft.
Slot Size Material
in.
in.
Size Material
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:OGPS❑Topographic map
(check box) DEPTH DRILLING LOG
From To Formation, Description
0 63' clay & sana
63' 500' granite
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 15ANCAC 2C, WELL
CONSTRUCTION. STANDS, AND THAT A COPY • THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE •F a SON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
27699.1636 Phone No. [phone], within 30 days. GW-I REV. 07/2001

29 7134
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality -.Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print)[7)-en vliS I111Qn 4, ' • CERTIFICATION 8 a/74'
WELL CONTRACTOR COMPANY NAMIK e.M1I i Pt Iggnri WO V t 11 :k c 1710t e J PHONE Il„Sate-3 fl 0
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED Wd3PEIRMIT8 -
(if applicable) - (if applicable) - .
I. WELL USE (Check Applicable Box): Residential' unicipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other CI If Other, List Use
2. WELL LOCATION;Topographic/Land setting
Nearest Toyn: �A- AA/ L.; 4/ County Ai a/iN( ❑Ridge ❑Slope ❑Valley at
gg-1i. 0/),, ),, 0 n i m , I) ec"I4- > (r y get (check appropriate box)
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code) L 7 3l' Latitude/longitude of well location
3: OWNER: Lf C -.); a c dt
Address /
(Street or out<No)
riita/n0f), t:=2f/3y
City or Town State Zip Code
(3/3)- 59/3- .Q.
Area code- Phonc number
4. DATE DRILLED 5 -,2 6 —6
5. TOTAL DEPTH: 4{n. Se
(degreesiminutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
pEPTH DRILLING LOG
From To Formation Description
c/ra
C't) -4 '4M 0 )
rl.t_ r ran, 71- -Q-
6 7h '
' 9h,
9(1' 'fhs'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: /L) FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface'
*Top of casing terminated at/or below land surface requires a
variance In accordance with ISA NCAC 2C .0118. //
9. YIELD (gpm): /h METHOD OFTEST,�h1OI//r
10. WATER ZONES (depth): /(/h' 1 3 S'
LOCATION SKETCH
I I. DISINFECTION: Type )/-/"/-/ Amount o2 %/)-5 Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads. Include the road
or Weight/Ft. Material
- numbers and common road names.
l" Fr
Depth Diap
From 0 . To �/) Ft. a jeter
From To Ft.
From To Ft.
13. GROUT: Depth
From n To r9D
From
Material _-/ Method
Ft. �yr or F'�'`'u)
IC
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:
1 D0 HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF TH S RECORD H S BEEN PROVIDED TO THE WELL OWNER
64 1
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the 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
tJ

WELL CONSTRUCTION RECORD
•
l t ...•.
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) ;hell V1 IS J�-njlfirA. u ' CERTIFICATION# of nee
WELL CONTRACTOR COMPANY NAMICbta r S Ia'/kiwi IliPi I ° H t I I7344 yn e , PHONE fict2ILsca 4-3 2-6
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED W6\'ERMIT#
(if applicable) (if applicable) .
1. WELL USE (Check Applicable Box): Residential' unicipal/Public 0 Industrial ❑ Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 17 If Other, List Use
2. WELL LOCATION: ^^
'Nearest Town: fj 4A/PLr41/ County Ma cry(
rit-n h->/ 11YYl Y)t -- �- n emi e . P .) (4((�
(Street Name, Numbers, ComEunity, Subdivision, Lot No., Zi Code) (7 3 t.
3: OWNER: 3• I ( c11 eL« )
Address ,335- (11 ; nnn n B. f p
1 (Street or Route o.) C��. 3iS can
City or Town State Zip Code
e ? » 3 — ��' ! /)
Area cdde• Phone number
4. DATE DRILLED c S ; 2S — L) 1/
5. TOTAL DEPTH: 44, SC'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 3-
7. STATIC WATER LEVEL Below Top of Casing: e26) 0 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surfaces
*Top of casing terminated at/or below land surface requires a
variance In accordance with ISA NCAC 2C .0118. /
9. YIELD (gpm): n METHOD OF TEST h/U)/ pt..8--,
10. WATER ZONES (depth): 3t/) r �SC-0 (�
Topographi and setting
ORidge QS1 OValley QFlat
(check appropriate box)
Latitude/longitude of well location
(dcgrees/minutes/seconds)
Latitude/longitude source:OGPSOTopographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
LU2 C on,kj-c
n tn'
Clbr
11. DISINFECTION: Type it-ili Amount ra TA -A S
12. CASING: Wall Thickness
Depth,, Diameter or We;ght/Ft. Matey l
From 0 To (0 Ft. !n " sbarri Pr
From To Ft.
From To Ft.
13. GROUT: Depth �a al _ i Method
From n To rif7 Ft. y� pow°
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 Material
in.
in.
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 D0 HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF TH S RECORD HAS BEEN PROVIDED TO THE WELL OWNER
Or fee
SIGNATURE OF PERSON CONSTRUCTING THE WELL
— 5—�)�
DATE
Submit the original to the 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
-o D:i c

29 i
.'
WELL CONSTRUCTION RECORD
91,4;,. F.
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAM�(print) c�e f) V1 i 5 Pt I nrA r;. ' CERTIFICATION # 0Z/7 (,o
%YELL CONTRACTOR COMPANY NAMIfbrr:l)nli 1410 jiRrrl InPlI4yet II Tk a(_�YI.P PHONE#iite,.1ia 142-6
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WIPPERMIT# -
(if applicable) - (if applicable) .
I . WELL USE (Check Applicable Box): Residential' unicipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other Ef If Other, List Use
2. WELL LOCATION: -
'Nearest Town: FX44/ALL-i d/ County Al ( Pam,
(
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
ETh
3. OWNER: IZ 01I0y1.-1 L e cal rJ
Address ; �'J PAL /y F I? 1) f2
Ip
te
(Street or Route No.)
FRA/1/yi ', A/ /V i_ (J {z i73
city Or Town State Zip Code
( )e- 967
Area code- Phone number
4. DATE DRILLED 5 .02) —6 V
5. TOTAL DEPTH: 5'7) S
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO QJ�`
7. STATIC WATER LEVEL Below Top of Casing: 2 Z FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surfaces
*Top of casing terminated at/or below landsurface requires a
variance In accordance with ISA NCAC IC .Olio.
9. YIELD (gpm): 2 S METHOD OF TEST I /(17/Jr
10. WATER ZONES (depth): 2, k c--,
Topographic/Land setting
❑Ridge ❑Slope OValley CJFIat---
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
O 170' (7I a
71 • 3 h c • l� tr u el c ,r a m, r r ,-e .
11. DISINFECTION: Type rit-,14 Amount 4 %1)- 13 S
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
To 170 Ft. lr7
From 0
From To
From To
13. GROUT: Depth
From () To r
From To
14. SCREEN: Depth
From To
From To
15. SAND/GRAVEL PACK:
Depth
From To
From To
Ft.
Ft.
Material Method
Ft. Cyr f2O 1it—
Ft.
Diameter Slot Size Material
Ft. in. in.
Ftin. in.
16. REMARKS:
Size Material
Ft.
Ft.
LOCATION SKETCH
Show direction and distance in miles from at least C , -
two State Roads or County Roads. Include the road e
numbers and common road names. `
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF TH S RECORD H S BEEN PROVIDED TO THE WELL OWNER
Or a
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to 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
W

295429
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) c71.PnP11 S /J-tjiti, r{. CERTIFICATION If ri/%(e
WELL CONTRACTOR COMPANY NAME: bo,hnr i (J1l(1,yrri IIMI I Z.) yS j 1 -sr .{ # V P__4In e i PHONE ssJ a. 4-3 g6
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED W ERMIT#
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential' unicipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other Er If Other, List Use
2. WELL LOCATION: pographic/Land setting
Nearest Town: m (Al County m 0 C{rn . idge ❑Slope ❑Valley 0Flat
�" i % S - c enie t- rn/
CoCM , / r l ; A) I'e (0 p g `l (check appropriate box)
(Street Name, Numbers,Community, Subdivision,a Lot No., Zip Code) gi N3 Latitude/longitude of well location
I3. OWNER: J 0 n 3)t; f'-P• (degrees/minutes/seconds)
Address 1 5 Hn /f5fnw (Car P.--I Latitude/longitude source:❑GPS❑Topographicmap
(Street or Route No.) c (check box)
PQm le l ) A/C--.:Q r1'73 V DEPTH DRILLING LOG ----
city orTown State Zip Code From To Formation Description
(1,22)- ?I/9- roin4 • 0 '71,' rlo('
Area code- Phone number/ ( 97('.,, /fi" .'Ta nA j ilsa`--a-
4. DATE DRILLED 0l —.�—f //p' 3rS' RLtit- C.-vamI-ram
5. TOTAL DEPTH: -.3 OS'
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: -n FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface•
'Top of casing terminated at/or below land surface requires a
variance In accordance with I5A NCAC 2C .0118. //
9. YIELD (gpm): / S METHOD OFTEST�h/OIIUh .—.
10. WATER ZONES (depth): IQD ' l `EO' /leo' c2,.n' (!
LOCATION SKETCH
11. DISINFECTION: Type it-i'» Amount a %il-g 5 Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads. Include the road
Depth Diameter or Weight/Ft. Material numbers and common road names.
_5f''/
From To Ft. to
From To Ft.
13. GROUT: Depth a Method , <
From n t-q ^)�� nTo r7tl FL Cam. nL•a••wr`�1 +
From To Ft. T t
14. SCREEN: Depth Diameter Slot Size Material .. 1
From To Ft. in. in. -0
From To Ft. in. in. - -''
15. SAND/GRAVEL PACK: - _ c-?
Depth Size Material - r
From To Ft. (J
From To Ft,
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF TH S RECORD H S BEEN PROVIDED TO THE WELL OWNER
Oral
SIGNATURE OF PERSON CONSTRUCTING THE WELL DAT
Submit the original to the 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

295428
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and NaturalTResources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME cU� n YI I$ MY, 1IfirA CERTIFICATION *' or-/7 ee
WELL CONTRACTOR COMPANY NAMS'I X. MI q'tk f O,ytri iliPI1 Y' I I < 4, T '' e PHONE a (� c
STATE WELL CONSTRUCTION PERMIT*' ASSOCIATED W&ERMIT#
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential' unicipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other 5 If Other, List Use
2. WELL LOCATION:
Nearest Town: f2{9 /1 21.. i 4/ County A4 a
4Ld V :ocl {dnny{f hn e rpmrn.
(Street Name, Numbers, Comrrt4unity, Subddsion, Lot No., Zip Code)
3. OWNER: V e-etL tc eel
Address in/ 47 5j7 I ;(I D%Z
(Street or Route No.)
htO'viv1nh NC— g9311
City or Town State Zip Code
2 - . 5-7Y-- 218 e2
Area code- Phone number
4. DATE DRILLED c f' Z2y. q rG
5. TOTAL DEPTH:
Topographic/Land setting
❑Ridge ❑Slope ❑Valley �IF4St
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
Formation Description
DEPTH
From To
6 QJ r
/ ` (CO
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO (Y�
7. STATIC WATER LEVEL Below Top of Casing: e>? 0 FT.
(Use'•+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surfaces
'Top of casing terminated at/or below land surface requires a
variance In accordance with ISA NCAC 2C .o118. 9. YIELD(gpm)• /in METHOD OFTEST_h//
!U)U1
10. WATER ZONES (depth): /c2n" J / g'
13Llie_iC-ra ;7-c
Ci
LOCATION SKETCH
I I. DISINFECTION: Type H-/'/F Amount a 11)-13 S Show direction and distance in miles from at -least
12. CASING: Wall Thickness two State Roads or County Roads. Include thejad n%=
Dia eter or Weight/Ft. Material numbers and common road names.
Depth
From 0 To -2-
/ From To Ft.
From To Ft.
13. GROUT: Depth
From n To r Ft.
From To Ft.
Depth
Material Method
CoM, c/r 0014 A -)
14. SCREEN: Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK: • _
Depth Size Material
From To Ft.
From To Ft.
Slot Size , Material
in.
in.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THJS RECORD H8S 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 Mall Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-I REV. 07/2001

295507
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Na
WELL CONTRACTOR (INDIVIDUAL) NAME
WELL CONTRACTOR COMPANY NAME
Resources - Division of Water Quality - Groundwater 3 Sections
CERTIFICATION 00 Wn 3
PHONE M j¢?garaatiM7L
STATE WELL CONSTRUCTION PERMIT* ASSOCIATED WQ PERMITM
(if applicable)
(if applicable)
1. WELL USE (Check Applicable Box): Residential -Er 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:
N s Town Lib County CMLOAJ
(Street Name, NNuumbben, Community, Subdivision,�"Lot No., Zip Code)
3. OWNER:`'— iII� M. £&4#tiltrLi
Address y� O. YtS7f Z!
O` (Street or RouteC—)Q-rJ k
City or Town State Zip Code
Area coda Phone number
4. DATE DRILLED I �� Y
5. TOTAL DEPTH: 14 n 5
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 0
7. STATIC WATER LEVEL Below Top of Casing: /5 6 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surfaces
*Top of casing terminated at/or below land surface requires a
variance In accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): METHOD OF TEST .#'
10. WATER ZONES (depth):
t 1. DISINFECTION: Type Amount
12. CASING: Wall Thiclmess
Depth yt
Di t or Weight/Ft. Material
From To Ft.I /h../ c.
From To Ft.
From To Ft.
13. GROUT: Depth Iviatcrial Method
From 0 To cZQ FL syJion� �d six
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACIC:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degme /minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRTT.T.ING LOG
From To Formation Description
- �c
L- n
LOCATION SKETCH W c
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common mad names.
0
^�{
c
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONtUCTION 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 Man Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

295505
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and ICI Resources - Division of Water Quality - Groundwater Section J ��
WELL CONTRACTOR (INDIVIDUAL) NAME�rr (print) �/2 �%/ t4/1IZ_ CERTIFICATION t..23
WELL CONTRACTOR COMPANY NAME Cr,41..L &dS. L J,e4 JVi7I ivi, 7Jt/t PHONE N (O 521 j"�4
STATE WELL CONSTRUCTION PERMITS/ ASSOCIATED WQ PERMITS/
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential a Mtmicipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATI N L n
Nearest Town: County
(Street Name, Numbers, Community,unSubdivision, Lot No., Zip Code)
3. OWNER: UiRVN(C ! ks)cJ
Address r, o . *etc) It
(Street or Route No.)
CY.t, -4 N Gam- 3131 Z
City of Town State
Area code- Phone number
4. DATE DRILLED 3 1,24/--DY
5. TOTAL DEPTH: f a -OS
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 0
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
valiance to accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): 40 METHOD OF TEST 4: Y
10. WATER ZONES (depth):
Zip Code
11. DISINFECTION: Type
12. CASING: Diameter
From U To Depth,
Ft. ro %y
From To Ft.
From To Ft.
13. GROUT: Depth
From () To Z- 1 Ft. ae/JYsf' 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.
Amount
Wall Thickness
or Weight/Ft. Material
„talJG
Material Method
Slot Size Material
in.
in.
16. REMARKS:
Topographic/Land setting'
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check hox)
DEPTI{ DRILLING LOG
From To Formation Description
SW/ yetea„
s-tf. /Z a3
L
LOCATION SKETCH
Show direction and distance in miles from af9 ast r
two State Roads or County Roads. Include (I t roag'
numbers and common road names.
I DO HEREBY CERTIFY THAT THIS WFf 1 WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONS`6RUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
ex 71,46avn---
SIGNATURE OF PERSON CONSTRUC t ING THE WELL
l� l—py
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

295504
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources � Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAM^E//(p�rint)L A'#e'G. rC//ry!/C CERTIFICA�TIONN41 CC"
WELL CONTRACTOR COMPANY NAME a i43L YvS Lh✓AnVi IAv3. Z%tti PHONE upcav2",/ 74
STATE WELL CONSTRUCTION PERMIU ASSOCIATED WQ PERMIT%
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential -Er Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCATI9361.: NeTown: f+YnitJ n/ County 414011)
r7• i / /91t/C
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: I / Iaju e. (' m.lt—
Address /..z 73 /D ?val. s f- /i;
-i�'✓�/ (Street ate No.)
City or Town State Zip Code
Area code- Phone number
4. DATE DRILLED _ A-Gy
5. TOTAL DEPTH: e'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 0
7. STATIC WATER LEVEL Below Top of Casing: /ii) FT.
(Use "+" if Above Top of Cuing)
8. TOP OF CASING IS ) FT. Above Land Surface*
*Top of cuing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): 3' METHOD OF TEST Qt C
10. WATER ZONES (depth):
11. DISINFECTION: Type Amount
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 6 To ld5—Ft. 6'4' fot/ c—
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From 0 To ea-4 Ft. (4,07,1+.f / 0 0
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
Topographic/Land setting
[Ridge 0S1ope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degreedminutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOQ
From To Formation Description
it)S- G t/ O %"
.r
r_
Liz
LOCATION SKETCH
Show direction and distance in miles from atiease: -
two State Roads or County Roads. Include t}i8 road
numbers and common road names.
-,r- cn•
ca
0
tJ
0
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
£* ,t f/
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

295503
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Resources��- Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME -(print) .W'C/ ' .- `_{�"at . CERTIFICAATIIOONt#36 7-,
WELL CONTRACTOR COMPANY NAME Criodit.iV)) S L.! (L/ ILJV'. ?Mit 2'v PHONE tt Odd N'�i0 174
STATE WELL CONSTRUCTION PERMITM ASSOCIATED WQ PERMITS
(if applicable) (if applicable) -_..
I. WELL USE (Check Applicable Box): Residential ly Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring ❑ Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATI
NearestTown: t-mJrel..'di County /Yj.gr-oA)
Net avow e -
(Street Name, Nkmbers, Community, Subdivision, Lot No., Zip Code)
3. OWNERSM Li hag S
Address )Ot3 --Willi
(Street or cute No.)
)-}rh Sh41 -I A/C- a-
dy or Town Slue Zip Code
Area code- Phone number
4. DATE DRILLED .3 0.) 3 --011
5. TOTAL DEPTH: 4 0.5
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 0
7. STATIC WATER LEVEL Below Top of Casing: /tQ o FT.
(Use "+" if Above Top of Cuing)
8. TOP OF CASING IS / FT. Above Land Surface'
*Top of cuing terminated at/or below land surface requires a
variance In accordance with ISA NCAC 2C .0I1S.
9. YIELD (gpm): 30 t METHOD OF TEST 4t f-
10. WATER ZONES (depth):
11. DISINFECTION: Type Amount
12. CASING: Wall Thiclmess
Depth Diameter or Weight/Ft. Material
From To / CC Ft. lc Of -. c.
From To Ft.
From To Ft.
13. GROUT: Depth Material 1
From _To e1-0 Ft. tern
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 S
From To Ft.
From To Ft.
16. REMARKS:
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
O - /OS P1in' )D1-- /fd5
Method
frinat
Material
L 9-
t
LOCATION SKETCH
Show direction and distance in miles from adeast ri
two State Roads or County Roads. Include tore roe&
numbers and common road names. .75
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15ANCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
e.fi L/i.A — 6 '7— oy
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the 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

n9
:100
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (peat) () 04 en (,i4W�t CERIFI TCAATION 8�47
WELL CONTRACTOR COMPANY NAME C-!A E' eVADS. PHONE M fo(YSo2y��%4
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT,/
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential.8' Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATI
Nearest Town: /f 61- N County i e-i l.-)
aob
(Streeta e, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: !4erCk t, Tr/
Address aL gY1b
(Street or Route No.)
/YLt'& bL(fh 0'
City or Town State
,30 3 573
Zip Code
Area code- Phone number
4. DATE DRILLED S -16---v%
5. TOTAL DEPTH: ? p O
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 0
7. STATIC WATER LEVEL Below Top of Casing: FT.
(use "+^ if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance In accord nce with ISA NCAC 2C .01I8.
9. YIELD (gpm)JC METHOD OF TEST gilt
10. WATER ZONES (depth):
Topographic/Land setting
❑Ridge ❑Slope ❑Valley OFIat
(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
.J d Ci�►7/hGLU�
4 —
- -79v
11. DISINFECTION: Type Amount
12. CASING:
From
From
From
13. GROUT:
From 0
From
Wall Thickness
Depth Di ter or Weight/Ft. Material
To 31) Ft. ai /04/
G
To Ft.
To Ft.
Depth Material Method
Tom Ft. ee!/t ..t- El)
To Ft.
14. SCREEN: Depth
From To
From To
15. SAND/GRAVEL PACK
Depth
To
To
From
From
16. REMARKS:
Diameter Slot Size Material
Ft. in in.
Ft. in. in.
Size Material
Ft.
Ft.
LOCATION SKETCF[ �.
Show direction and distance in miles from east
two State Roads or County Roads. Include t1'ie mid
numbers and common road names.
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 WEI 1 OWNER
SIGNATURE 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

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
%YELL CONTRACTOR (INDIVIDUAL) NAME (print) c�)Cnv11S ILoiia-Act, . CERTIFICATION# at ill?
%VELL CONTRACTOR COMPANY NAME;IX.in1C j(�tinitir4 Wel Ijiyr J„j PHONE Mt4%. 4-3 i6
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WIRERNHTM
(if applicable)
(if applicable)
I. WELL USE (Check Applicable Box): Residential'id--'Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other U If Other, List Use
2. WELL LOCATION:
Nearest Town: 4/1EL rr /1/ County NI ai tent,
R 1,0 -{z,-t Li lee% m m. 2 7173.L
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
�m_t) She m tee_
I <Rgcve(z_12:kc a Ed_
Or) a(.C. r-
(Sueet Cor�Route No.)3 %c2,,ao
3. OWNER:
Address
C"�i y or Town State Zip Code
7Z6- 97/— (40 3-?
Area code- Phone number
4. DATE DRILLED S —L3 "" D
5. TOTAL DEPTH: r%CS`
pleat�Opographic/Land setting
❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑OPS❑Topographic map
(check box)
DRILLING LOG
Formation Description
DEPTH
From To
CL/'
9 i ' -7Os'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: �Sn FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING 1S l FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance In accordance Ith ISA NCAC 2C .0118.
9. YIELD (gpm): METH OF TEST lD2f i�LGf-
10.WATERZONES(depth): 02(z'Ot(,•.3n' (�
11. DISINFECTION: Type
12. CASING:
From
From
From To
13. GROUT: Depth
From () To9_
From To
14. SCREEN: Depth
From To
From To
15. SAND/GRAVEL PACK:
Depth
From To Ft.
Depth1 Diameter or Weiahr/Ft. Map l
To Ft. C'
Ft.
Material Method
Ft. �.)r 47 r oneu.>
Ft.
Diameter
Ft. in.
Ft, in.
To Ft. k S-22g,,Tj P
Slot Size , Material
in.
in.
Size Material
From To Ft.
16. REMARKS:
5-CZa✓AS
iiLOG 6r2n, te_
c
LOCATION SKETCH a G
Amount TA- 5 Show direction and distance in miles frorypt least:.
Wall Thickness two State Roads or County Roads. Include�he ro$d
numbers and common road names.
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUL 1 ED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF TH S RECORD H S BEEN PROVIDED TO THE WELL OWNER
Or -3 —o V m
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to 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

8{{0� n.Q
i.:J tJ �t5�
WELL CONSTRUCTION RECORD
Water
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) c?) nYli s I�'A jinn\ rL , CERTIFICATION # otn-/74
WELL CONTRACTOR COMPANY NAMK hnIS jcboilrL ri IIJP.IIZif II7l(.t_ TryCJ PHONE # %( .5a4-3 g6 0
STATE WELL CONSTRUCTION PERMIT, ASSOCIATED W443PERMIT0 •
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential' unicipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other C7 If Other, List Use
2. WELL LOCATION:
Nearest Town: (CAA/ kL", /1/ County ! "' G orx
(04 (= Fw I tv `tea _ Fe c t i„e-r S to+_d— S tx-i€ D •
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code) a g-73 L/t
3. OWNER: �,4 ogNre_
Address fa 9. 7 9 C R If- Ci
(Street or Route No.),J
L-I Ve. Oak 1✓J• 3,aO
pp �����City or Town State n1 Zip Code
V3'1_)- 3to a -A 3.5
Area code- Phone number
4. DATE DRILLED cf- a 7 - D
5. TOTAL DEPTH: .FOSS
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO Qli
7. STATIC WATER LEVEL Below Top of Casing: `te10 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface'
'Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118. /
9. YIELD (gpm): g METHOD OF TEST !D)D,7f�(/�
10. WATER ZONES (depth): �f Sir)" (�
I I. DISINFECTION: Type it-i» Amount ,-.2 119-k S
12. CASING:
Depth
From 0 To /el Ft. •b
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From () To r-}(i Ft._4Q6n a,t FOnUL>
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.
ppographic/Land setting
rdge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
Formation Description
P/t2-
j M 1L�
C 6P"9-AAr42-
DEPTH
From
0
To
/ "
5 0
C+
r
J.00ATION SKETCH 5 "C1
Show direction and distance in miles from at.EeaSt � t
Wall Thickness two State Roads or County Roads. Include tsroad-_-'.
Dia eter or Weight/Ft. Mate I -numbers and common road names. 0
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF TH S RECORD H S 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 Mall Service Center -Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Camlina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) DAVID F. MCKINNON CERTIFICATION "
2411
WELL CONTRACTOR COMPANY NAME CHEROKEE WELL DRILLING AND PUMP COMPANY, INC. pIIONE " [phone]
STATE. WELL CONSTRUCTION PERMIT" ASSOCIATED WQ PERMIT"
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential VI Municipal/Public 0 Industrial 0 Agricultural O
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other ❑ If Oilier, List Use
2. WELL LOCATION:
Newest Town: AQUONE County MACON
WAYAH RD TO BOAT RAMP, 1ST DRIVE ON LEFT
(Street Name, Number, Community, Subdivision. Lot No., Tip Cate)
3. OWNER: COE STEPP
Address 74 OLD ROCKY BRANCH RD
(Street or Route No.)
AQUONEE NC 28781
City or Tram State Zip Code
( 828 )_ 321-4378 Area code- Phone number
4. DATE DRILLED 05-04-2004
5. TOTAL DEPTH: 245'
6. DOES WELL REPLACE EXISTING WELL? YES O NO E
7. STATIC WATER LEVEL Below Top of Casing: 75
(Use "+" if Above Top of Ca.inr)
8. TOP OF CASING IS 1 FT. Above Land Suffice*
*Top et casing terminated at/ar below land surface requires a
.ariaay in accordance witb 15A NCAC 2C .011g.
9. YIELD (gpm): 30 METHOD OF TEST AIR
Ill. WATER ZONES (depth)__
11. DISINFECTION: Type CHLORINE
12. CASING:
Depth Diameter
From_ 0
From
From
1.3. (GROUT:
Trout_
From To
Amount 100 PPM
Wall Thickness
or Wcight/FL. Material
To 85 Ft. 8 183 SDR 21 PVC
To Ft.
To Ft.
Depth Material Method
To 20 Ft. CEMENT GRAVITY
Ft.
14. SCREEN: Depth Diameter Slot Size Material
Irons_ To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth
Front To Ft.
From - - To Et.
Topographic/Land setting
C]Ridgc ®Slope OValley ❑Flat
(check appropriate box)
Latitudellongitude of well location
3510.853N/8339.391 W
idegre stminutes/secnnds)
Latitude/longitude source:EGPSOTopogmphic map
(check box)
DliET11 DRILLING LQQ
From To Formation Descriptioh
0' TO 20' SAND ti GRAVEL
20' TO 4tr __ SAND 8 GRAVEL
40' TO 60' BOULDERS/SAND/GRAVE
60' TO 85' BLUE GRANITE
85 TO 245
Size Material
16. REMARKS:
r
t c-i
-4 %' t •
LOCATION SKETCH —c
Show direction and distance in miles from at Int c!n
Iwo Stale Roads or Cntmty Roads. Include the road �ci
numbers and common road names. r- o
�,. rn
to
n'
r
A-1k c-D
I DO HEREBY CERTIFY TIIAT Tins WELL WAS CONSTRUC TEI) IN ACCORDANCE WI'll I I5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND TTIIAT A COPY OF THIS RECORD IIAS BEEN PROVIDED TO 'II IIE J--{ W�E�LL OWNER
_/t�- __ .:stt-0 V
SIGNATUREOF PERSON CONSTRUCTING 7 I IF. WELL OAIF:
Submit the original to the Division of Water Quality, Groundwater Section, 1636 stall SenIce Center l RaeiRaleigh, NC
2O(l I
27699-1636 Phone No. [phone], within 30 days.
cam'
Z

WELL CONSTRUCTION Itli1C014D
Nei th Cal olitia - DamnIntent of Environment and Natural Resources - Division (71 Watei Quality - Groundwater Section
WEN. CONTRACTOR (INDIVIDUAL) NAME (pried) DAVID F MCKINNON CERTIFICATION /I 2411
writ, roNTRAE-pag EompANy NAME CHEROKEE WELL DRILLING AND PUMP COMPANY, INC ',(IONE is 1828) 837-8008
STATE ALI T CONSTRICTION PF.RNIITK ASSOCIATED MOTERA1111
ganneav=Rivithle.) a plicalnel
I. \\ ELL usE (Cheek Applicable 13ox): Residential I Mitilicipall'ublie D Industrial LI Agricultural 0
NIonitiningLI Reuther) D Deal Pump Water Injection 0 Other 0 II Other, List Use
2. WFLL K:ATR)hf:
Nearest Town: ANDREWS
774 CLOODWALKER COVE
isin•ot ;ilrill;T: I .3-inittnity. don I lit Na.. 7iii1:0.1.1
`).
1€43 SE CI if la
County MACON
0,3/4,1 '`' URI le NO
FL
32091
iiro !tit
) •127-974.1
Zip lode
•I. UArF. I )RII LE1)_)-( 05 2004
-; , )1,11 111111-1 l'I's
0 hi 717,S, 1. V171 I ft 10-0 ACE' V‘rEl 12 ITS V) TJ
7 s F.VC it • w A E \ FL_ Below Top of ('asjog: 5 I I
" if Pi luny 1.1 I i
N I I'll' IN I 14 r ,'hove 1_4111(1 Sill
'Top or riiiinp Proilpatid i tor below kind gorface require.; 3
t 111 liccoi darn I' 1,111115A tsc z(
".} If-L I) (01717: 2_1'2 NI 1311(11) (717 'TEST
I All 17. ZONES (li•gthr
--------------
11.I )1 NIN I I CI 1(11‘i. ['Vile CHLORINE Amount 1(10P"'i!,1 .
12 CASI.N, i• Wall I Ineth .• (
I idriii Orptwier OT WeTIII I 1 NI 11,9'111
I ••oin_y____ I 0 1•:0 1 t 6 1/8" SDR 21 Piro
11.0in It _
1 n",T, I 0 Et._
I 1. ( !R)I il'I rpth i‘lidriiiil
I rillTI 11 1 0 ';.r.I I t CEMENT c7F4 'in,
four
iv It.
10 50REI1.0: IF.011 Diamder Ii101S170 ‘I il. ri 0
i miTi I r It 10 11'
I mai 11' 1 1 III ill
15 5:AND 1717,1 \ lit l'"t'_-t.:
ikrni Site athen,
I ion) 1 0 Ft
I rrirti .1 0 Ft
I 0 I" I \ IthS• _
a a
-1.0pogralThic1Land setting:
RIR idgc 0Slope 0Valley D Flat
licti orpiopriate hin)
I it iltificiorPitiitie ni v..:11 location
I :lintel. I•99.9inde source•IJCIPSUrogographie map
ielett hNl
171 YID DRILLIN(7 hpf
I nen Formation Desertipti on
•_7' 10 it; (71WWN DIR I
20' TO nr EIOULDERS& GRAVE.
tu• TO f.ir GRAVEL & SAND
Fa 10 1;0 GRAVEL & SAND
10' 10 'I, GRANITE
IOU ID TI!" GRANITE
""l•
CI
lc re-;
:21.0
Ij it 'Al 11)N SKI' ICH
0 r
: 4 r-
J (J
chop tliStalwe ITt II1IICS 1.1.0111
PIC or 1 nuns Roads. Include t1;7740i4f.,511
2r•
tidiptis.
/a
DLO
I Di I 'Ey" ji Ill.AT wFLL wAs 01) 1st f I: WI I Nt iv. 21,
()Nis 497 \ !WS, AND ivTHATeA COPY OF TI(.97t1 t II S TER( WI/ I WET!, /1NF
R
,cij F 5-3-99
siiNi:inworPFtSONCI s. IN(
DAtr
Submit the original to the DIvillon or Water Quality, Groundwater Section, 16.11. \ Lill Seri ire Cotter - Raleigh, NC
2•1609-16.16 Ittione No (9111) 711-3221, within 311days. GW-1 REV. 07/2001

29rnl n
11. DISINFECTION: Type
12. CASING:
Depth
From 0 To /h
From To
From To
13. GROUT: Depth
From n To r7l/q�
Ft.
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth
From To Ft.
From To Ft.
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) c%)1.enVlI 5 fit) iOn r{L - s CERTIFICATION# e1/7le
WELL CONTRACTOR COMPANY NAMI; I}}X. i% '1I011QMr4 run(e PHONE Ma j_3 Li -3 a-6 t
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED W ERMITM
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential' unicipal/Public 0 industrial 0 Agricultural 0
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other U If Other, List Use
2. WELL LOCATION:
Nearest Town: f---712,44(k2-//2/ County Ma Gw
�1ix/ (-nafee mmr /y)."ea_e ; 1--c7 Rd
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code) ' 73
3. OWNER'Tha ICrri C kcackcc
Address e? I ,PQ. On
(Street or Route No.)
vlex) ,(/(;
City Or Town State
Zip Code
Area code- Phone number
4. DATE DRILLED Jr_—F ,G
5. TOTAL DEPTH: QS2T
graphic/Land setting
idge ❑Slope ❑Valley 0Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
Formation Descriptieo
c1,,
_
'l Lr (i Y2o, e 9-
DEPTH
From
0
To
/_ /_ rs
r0s
6. DOES WELL REPLACE EXISTING WELL/ YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: (F, /7 FT.
(Use "+" if Above Top of Cuing)
8. TOP OF CASING IS / FT. Above Land Surface'
*Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118. /
9. YIELD (gpm): go METHOD OFTEST_h/OZZ/1 tom(/—.
10. WATER ZONES (depth): 700 4'0 (�
LOCATION SKETCFI
Amount a TA-R 5 Show direction and distance in miles from at least
Wall Thickness two State Roads or County Roads. Include the road
Diapieter or Weight/Ft. Mate ' l numbers and common road names.
s.ag v 1 19 r
Ft.
Ft.
Material Method
aP411 art
Slot Size Material
in.
in,
Size Material
72
t
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 TH S RECORD HPAS BEEN PROVIDED TO THE WELL OWNER
Or 014k 0-
SIGNATURE OF PERSON CONSTRUCTING THE WELL
DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mall Service Center- Raleigh, IC,
27699-1636 Phone No. [phone], within 30 days. GW-I REV. 07/2001 j [

296411
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - DivisionofWater Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print):hell 1/1 15 fii)i1 Gen rU - CERTIFICAT,I,ON# °In le
WELL CONTRACTOR COMPANY NAMt hnt i '44 J1/2.44 J Weill) Yi i 1 t Tne _J PHONE # X)/_,5/,a. 4-3 ,-e 0
STATE WELL CONSTRUCTION PERMIT. ASSOCIATED W&ERMIT#
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential'7YMunicipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 5 If Other, List Use
2. WELL LOCATION:
Nearest T9w% /C4v/1 L; /✓ County /i" n lQlirrt
.SN L`frure-e_ enmrn. /Yl. Pc C��[,, /1cf�
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code) N pal 3
3. OWNER: . r1 5 11kpit teYr.)
Address /7 /h . C4. ~ ; P.-(
(Street or Route No.)
FP E74, i' i 03 ,ic c 17 3 I-f
City or Town State Zip Code
( fr t7 02
Area code- Phone number �^
4. DATE DRILLED ✓ — 0
5. TOTAL DEPTH: t7S'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO k-
7. STATIC WATER LEVEL Below Top of Casing: ,--Qn FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance In accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): -D METHOD OF TEST_.hl (/
10. WATER ZONES (depth): /,3h' '
LOCATION SKETCH
I I. DISINFECTION: Type JFtV-I Amount Mk 5 Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads. Include th road
Mpate4 numbers and common road names. p
Topographic/Land setting
❑Ridge OSlope ❑Valley girrar
(check appropriate box)
Latitude/longitude dwell location
From
From
From
13. GROUT:
From 0
From
14. SCREEN: Diameter Slot Size Material
From Ft. in. in.
From Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Diapetter or Weight/Ft.
Ft. het SZ/R,Tq
Ft.
Ft.
Material
0Q-t ar
Method
F'rn
DeptIF.,(J�
To J
To
To
Depth
To Ft.
To Ft.
Depth
To
To
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
010,5' rr /
c/S' 619' ea s 0-nA J
if / ` ?ns' B if C. C Y&.-n I y-L
b
v
0
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 TH S RECORD H S 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 Mall Service Center- Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-I REV, 3772001

296410
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) c?Pnil 1 5 /�-/) i IL.A et CERTIFICATION g ,1/7 e✓
WELL CONTRACTOR COMPANY NAM Is,1,LMIS C IdlIOrest IW)eilZ)Yi ns Tn.e PHONE -isf_5�. L-32-6 LI
STATE WELL CONSTRUCTION PERMITB ASSOCIATED WQPPERMITN
(if applicable) (if applicable)
1
WELL USE (Check Applicable Box): Residential' unicipal/Public 0 Industrial ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other d if Other, List Use
2. WELL LOCATION:
Nearest Town: JR ANAL, A/ County A Grry
174q/ 5 „A/, 51/-e-P',«, - Pi ea1 ,ed
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code) el- g 13 UL
3. OWNER: kJ aim 171 i n
Address -/Ap, 1:2hx .%35 Lati
(Street or Route No.)
/Yaseic-the rsi
City or Town State Zip Code
RV)- r (n7- n
Area code- Phone number [1
4. DATE DRILLED 6—// -D /
5. TOTAL DEPTH: St+-.571s
Agricultural 0
Tgpographic/Land setting
1{ tdge ❑Slope OValley qFlat
(check appropriate box)
Latitude/longitude of well location
DEPTH
From To
n It
� II 9-i5"/) r
(degrees/minutes/seconds)
tude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
Formation Description
0/LL1.44
RLUG�
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO J�
7. STATIC WATER LEVEL Below Top of Casing: can n FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
*Top of casing terminated at/or below landsurface requires a
variance In accordance with 15A NCAC 2C .0118. 9. YIELD (gpm): / D METHOD OFTEST I /OW/
10. WATER ZONES (depth): ///Di ,>1727) 4L.2n
LOCATION SKETCH
11 DISINFECTION: Type Hill Amount en.%-.} A 5 Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads. Include the road
Depth _ I Dieter or Weitt/Ft. Matep l numbers and common road names.
From 0
To Ft.
To Ft.
3ei'753
To Ft.
13. Depth Material `� 2 Method
�` j2 ToFt. CQ YrT I "L,l..l. i�l.
14. SCREEN: Depth Diameter
From To Ft. in
From To Ft. in.
15. SAND/GRAVEL PACK:.
Depth Size
From To Ft.
From To Ft.
S-a/3,$y• P
From
From
GROUT:
From V
From To Ft
l6. REMARKS:
Slot Size Material
in.
in.
Material
O c
r
CO
.. rn
O
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF TH#S RECORD H@S BEEN PROVIDED TO THE WELL OWNER
G
Oran
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mall Service Center -Raleigh, N♦b
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2004

296207
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section / _
WELL CONTRACTOR(INDIVIDUAL) NAME (print) c%)-en VIIS /4-011On rli ' CERTIFICATION) or-�'y'
WELL CONTRACTOR COMPANY NAM&hbflr S 141I44,ta (Bela) Yi U;u 4Y�ri e PHONEY si. SI4-3 g60
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WIPPERMIT# •
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residentialt- unicipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other O. If Other, List Use
2. WELL LOCATION:
Nearest Town: S C &-1 7 YYI to County in O_Nryt
Itip S, S(fvt+-n: , 8-77s
(Street Name, Numbers, Community{Subdivision, Lot No., Zip Code)
3: OWNER: Teft s f h.
Address /CIL li+ (,-Yreeh C-0 i.'R Ct
seal ni7 (Street o )Rohe No.)
City-br Town State Zip Code
SSaL,_.579_
Area code- Phone number
4. DATE DRILLED _0 b - y
5. TOTAL DEPTH: / 5S'
Topographic/Land setting.
❑Ridge ❑Slope OValley eclat
(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
n .j6' Cl�.
/Ss' .A�L(i 6- rain irc
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: ' FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface'
*Top of casing terminated at/or below land surface requires a
variance In accordance with ISA NCAC 2C ,aila. / /
9. YIELD (gpm): .j O METHOD OFTEST_h!0711/2 —,
10.WATER ZONES (depth): i6D' (/
LOCATION SKETCH
I I. DISINFECTION: Type At 11/ Amount a 779-6, S Show direction and distance in miles from at least
12. CASING: Wall Thickness
Depth Diameter or Wci tt/Ft. Matey' I numbers'and common road names.
0 To Ft. h" .S.jj)r3 j Pr
Ft.
From
From
From To Ft.
13. GROUT: Depth Material Method
From n To AFt. dcy7t 47,pelt /C.}
D
From To Ft. I
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:
two State Roads or County Roads. Include the road
f DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF TH►S RECORD HAS BEEN PROVIDED TO THE WELL OWNER071 Y
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the 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
ZZ :C lid '1Z AVW h0

4
5
6
7
296206
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) c�ef)Vlts /4/)jln,,Ar1, ' - CERTIFICATION# oZ/7la
WELL CONTRACTOR COMPANY NAMIE XIMIi (kjln,n,a I11ei II\Yrr]I"V Q ,TKP i PHONE M , Shy-3..6 0
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WIPPERMIT8
(if applicable)
(if applicable)
1. WELL USE (Check Applicable Box): Residential' unicipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other C1 If Other, List Use
2. WELL LOCATION:
Nearest Town: 0 7' l 6 County Al I (i_ tLfw
1 4I S /YlttI0.en) P1_ n1-0 2S7b3
(Street Name, Numbers, Community, Subdivaion, Lot No., Zip Code)
3: OWNER: �Yl 4 (\c) -P D YLLi0.4� (l AC,Bt
Address . fl R 0 X J I Y
R (Street or Route Lid C . 3 9--
City or Town State Zip Code
V:.)S5- _ <5507
Area code- Phone number
DATE DRILLED S — / 9 - 6
TOTAL DEPTH: S A5"'
•
opograpbic/Land setting
idge ❑Slope ❑Valley °Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
O 5f0' n 1 ,9
7,' I C/. t4.' S/3.vt r4�'5 / L
ry-L�.
l uV-' Sac' L t� 2 ra .i j--e_
DOES WELL REPLACE EXISTING WELL? YES 0 NO
STATIC WATER LEVEL Below Top of Casing: /n()' FT.
(Use "s" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
*Top of casing terminated at/or below landsurface requires a
variance In accordance with ISA NCAC 2C .0118. /
9. YIELD (gpm): S METHOD OF TEST /7lD2J},7t { —,
10. WATER ZONES (depth): if ,t(D ' (/
1 I. DISINFECTION: Type
12. CASING:
Depth
From 0 To / Vy-
From To
From To
13. GROUT: Depth
From n To rif7
From To Ft.
%t-"%/ Amount raTA-135
Wall Thickness
Dia eter or Weight/Ft. Mte ' I
FL h' 5-bRiS3 Oa'.
Ft. •
Ft.
open
,
Ft. Cp n, ar7
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.
Method
n
Slot Size Material
in.
in.
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.
N
-D
r_ .)
N
N
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED 1N ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF TH S RECORD H S BEEN PROVIDED TO THE WELL OWNER
ee
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mall Service Center -Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-I REV. 07/200I_.__. __.

296205
LOCATION SKETCH
11. DISINFECTION: Type /f-"// Amount a ng- Ai 5 Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads. Include the road
Depth Diameter or We1ght/Ft. numbers and common road names.
To /0 S Ft. !� " S.j2 @„? 1 ��
To Ft.
To Ft.
13. Depth Material
To_r_Ft.J'O.n dr
To Ft,
14.
STATIC WATER LEVEL Below Top of Casing: go 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 �wl h ISA NCAC 2C .0118.
9. YIELD (gpm): Y METHOD OF TEST i//W77L
10. WATER ZONES (depth): .427> (�
Topographic/Lan djetting
❑Ridge ❑Slope Malley OFlat
(check appropriate box)
Latitude/longitude of well location
(degreeslminutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
Formation Description
DEPTH
From To
n Al-7'
�i (n to -
(p A - !0S'
R L u e C ro-,, , r 12_
From 0
From
From
GROUT:
From ()
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources • Division of 1Vater Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) ch•e f1 h 15 fin jl n„A • CERTIFICATION */ 01/71/
W ELL CONTRACTOR COMPANY NAMtbetin[C 14/10,,€L !DPI 11)161IT1t�1 •t C. PHONE RpJ-ISi 62L/-3 a2 (�
STATE WELL CONSTRUCTION PERMIT*/ ASSOCIATED W ERMIT*/ -
(if applicable) (if applicable)
WELL USE (Check Applicable Box): Residential'lYMunicipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other d' If Other, List Use
2. WELL LOCATION:
Nearest Town: fifq&ly/LL%/✓ County 4.)Q [ori�
CC14-I� LQ.r�UOq/t 4 P,Crirnm, .'.��'71/
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code) //
3. OWNER: J U S it) �Qn
Address /.,? / %/l; n h ee 5 P; rr I e.
(Street or Route No.)
rk^lJs, jUnJ ye_ ,Q kg-5 11
City or Town State Zip Code
( $()- 37/ -/cn,
Area code- Phone number
4. DATE DRILLED S--/ —l�Lt-
5. TOTAL DEPTH: 3/7 S'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7.
From
SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
#pate' I
nMethod )
I "al
Slot Size Material
in.
in.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF TH S RECORD H4S BEEN PROVIDED TO THE WELL OWNER
/& 6v
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE ----
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mall Service Center -Ralelgh,.N.C__._..
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

296204
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division1of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) ciyen P1 15 IP-/) IT1 Q.A rL CERTIFICATION,N or-/7
WELL CONTRACTOR COMPANY NAM E;i9nnr C Aollr y, Wei I11yed 1 ;'ll yn P . PHONE itC„iLe ,24-3
STATE WELL CONSTRUCTION PERMITN ASSOCIATED WOPPERMITN
(if applicable) (if applicable)
t. WELL USE (Check Applicable Box): Residential' unicipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other a If Other, List Use
2. WELL LOCATION:
Nearest Town: FPA-,/i�� L i 4/ County J /J (/fyl
(Street Name, Numbels, Community, Subdivision, Lot No., Zip Code)
3. OWNER: Oe eS I bdti>15t3�
Address //7 /2/(Z popy P
(Street or Route No.)
FV2k4/k1, n/ 4/CI 73 V-
City or Town Star Zip Code
COS0- 53 (1-,- ci5 9 y
Area code- Phone number
4. DATE DRILLED .5 / % -6
5 TOTAL DEPTH ?__Cs'
ilMON
ographic/Land setting
Midge ['Slope ❑Valley L 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
0 zt '' e. / p
'}s'' .5ri' .Sa.-1�sf-n-7r.a
' c 3-5-5-' 13L/!C (Lvwh'.ta_
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: 7(') FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
•Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): / S METHOD OF TEST
10. WATER ZONES (depth): 0260
LOCATION SKETCH
11. DISINFECTION: Type Amount .- 74} $ Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads. Include the road
Depth Dia eter or Wei hVFt. Mate ' 1 numbers and common road names.
From 0 To s% Ft. t'1/4
From
From To Ft.
13. GROUT: Depth
From 1) To rYD Ft.
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
To Ft. .
Material
0-04Yri
Method
CT1AJ(..
•
.,,
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 TH{S 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 Mall Service Center- Raleigh, NC __:.
27699-1636 Phone No. [phone], within 30 days. GW-I REV. 07/2001

296203
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - DivisionofWater Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAMEj��(print) c1).e n vil S l 1 !(-A tL .• CERTIFICATION N al/7 let
WELL CONTRACTOR COMPANY NAM/Chilli e Jdt/l .,,ra I/MOYriji -,t heJ PHONENp,t% Sao-346 c
STATE WELL CONSTRUCTION PERMITN ASSOCIATED W ERMITH
(if applicable)
(if applicable)
1. WELL USE (Check Applicable Box): ResidentialC- icipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other E7 If Other, List Use
2. WELL LOCATIO
Nearest Town: F/</7
4,(kLi N County,
6*e 1X'•ces e1z.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip C e)
3. OWNER: V.Ck. & p-) 07)'Th 5
Address .`<) / fie e k- 5 ('q ap_ _ L�
(Street or Route No.)
Fv o t L_ 5 /0 / Ci
%3 cf
City or Town State Zip Code
(Z)- , 5 a 3.5 6 _
Area code- Phone number
4. DATE DRILLED '- ,/ S` —0 y
5. TOTAL DEPTH: '{h 5t'
Topographic/Land setting
❑Ridge OSlope ❑Valley at
(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
(p0 • sins', 81 tie-16LCA-..v, t-e.
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: f i FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING 1S / FT. Above Land Surface*
'Top of casing terminated at/or below land surface requires a
variance In accordance w th ISA NCAC 2C .0118.
9. YIELD (gpm): M yTHOD OF TEST_
10. WATER ZONES (depth): /
LOCATION SKETCH
11. DISINFECTION: Type %7l'f"F Amount %A-R 5 Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads. Include the -road
Depth. �P'�y Dia eter��or WeighNFt. MateiiI numbers and common road names. 0
From to
0 To__�6L Ft. lam' 522 J j OY ti r
o
From To Ft. ri
From To Ft. -c i
13. GROUT: Depth Material Method N
From () To_ Ft. Con yrt pQ] A)
`
From To Ft, "c) r"o
j
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:
W rit
". TJ
IV o
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF TH S RECORD HAS BEEN PROVIDED TO THE WELL OWNER
s_/y_o
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to 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

?96202
WELL CONSTRUCTION RECORD
• x'
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) c.h.ef)hl 5 An /lath rj CERTIFICATIONS/ el/7 •('
\VELL CONTRACTOR COMPANY NAME fljC fdtjIn,,rd WPM yet II T4 "j_no ONE M 3ati-3 �6
STATE WELL CONSTRUCTION PERMITS/ ASSOCIATED W&PH
ERMITS/•
(if applicable) - __ Muni(if applicable) •
I. WELL USE (Check Applicable Box): Residential'Ld--cipal/Public ❑ industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: .1/ County 4 a (t(vt,
�PCt P eut 93
(Street Name, Numbers, Community, Subdivision, Lot No., Zip C )
3. OWNER: I-1 e 13eclT-i S lYi
Address .33 9 4-> e t Pao) H Latitu
(Street or Route No.) rea,„ /nJ i 0 / 3 Y-
IL �('�
Area code• Phone number
4. DATE DRILLED �) . a L L
5. TOTAL DEPTH: (QrrY
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: .Jri (1 FT.
(Use'4-" if Above Top of Casing)
8. TOP OF CASING 1S / FT. Above Land Surface*
*Top of casing terminated at/or below landsurface requires a
variance In accordance with ISA NCAC 2C .0118. /
9. YIELD (gpm): / METHOD OF TEST /7/O7/%i7f (f .
10. WATER ZONES (depth): t END' (�
DEPTH
City or Town State hip Code From To
(0 5,.2.(4-_ 4- y 7 • 0 1.2
7" ?'
/n' Ct)f,'
11. DISINFECTION: Type
12. CASING:
Depth
From 0 To /03
From To
From To
13. GROUT: Depth
From () To 2D
Topo aphic/Land setting
ge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
de/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
Formation Description
rl4/161
R L V r /: R A /✓, t C-
LOCATION SKETCH.
i7` -/"f/ Amount ,j. r,4s 5 Show direction and distance in miles from at least
Wall Thickness two State Roads or County Roads. Include the road
Diap e't�er or WeishVFt. Mate ' I numbers and common road names.
FL lam' Raq' D>t�-
Ft.
Ft.
Material Method
Ft. P47077- pav &)
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 Ft.
Size Material
From To Ft.
N
N o
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 TH S RECORD H/ S BEEN PROVIDED TO THE WELL OWNER
Or
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mall Service Center -Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. OW-1 REV. 07/2001
Ci

297994
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources • Division of Water Quality - Groundwater Section
WELL.CO,NTRACTOR (IINDIYIDU,AL) NAIVE (print) James A, Brown CERTIFICATION 2045
WELL CONTRACTORCOiLIPANV NAh1EHedden Brothers Well Drilling, Inc PHONE[phone]
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT"
(if applicable) - - (if applicable)-.
I. WELL USE (Check Applicable Box). Residential tl Municipal/Public 0 Industrial ❑ Agricultural 0
Monitoring Recovery .❑ Heat Pump Water injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: Franklin County
Macon
Ray Cove --Well #1
(Street Name, Numbers, Community, Subdivision, Lot No.. Zip Code)
3. OWNER: Fred Hobbs
Address PO Box 2033
(Street or Route No.)
Franklin, NC 28734
City or Town Sate Zip Code
(828)- 369-8255
Area code. Phone number
4, DATE DRILLED 5-17-04
5,TOTAL DEPTH: 500'
6, DOES WELL REPLACE EXISTING WELL? YES O NO
7. STATIC WATER LEVEL. Below Top of Casing FT.
(Use "+" if Above Top of Casing)
S. TO? OF CASING IS 2 FT. Above Land Surface`
*Top of casing terminated at/or below land surface requires a
variance In accordance with ISA NCAC 2C .011S.
9. YIELD (gpm): 0 DRY METHOD OF TEST blow
10. WATER ZONES (depth):
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/intrudes/seconds)
Latitude/longitude source:OGPSOTopographic map
(check box)
DEPTH DRILLING LOG.
From To Formation Description
33' clay &.sand
33' 500' granite
I I. DISINFECTION: Type H T H Amount 16 oz
12, CASING: Wall Thickness
Depth Diameter or Weight/Ft, Material
From 0 To 32 Ft. 6" pvc
From 12' To 15 Ft. 6" 1 RR Steel
From To Ft.
13.GROUT: Depth Material Method
From 0 - To 20 Ft. termite & wcait pumped
From To Ft,
14, SCREEN: Depth Diameter = Slot Size Material
From - To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size
From To
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 earthier, road names,
in
}
0
Ft. Lo
Material
16. REMARKS:
I. DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STAN DS, AND THAT A COP OF THIS RECORD HAS SEEN PROVIDED TO THE WELL OWNER
°d 6 �e 45401.1x.) —/ 7 —Usle
- - SIGNATURE. OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center- Raleigh, NC
27099.1636 Phone No. [phone], within 30 days. GW•I REV. 07(2001
c
0
:fl

WELL CONSTRUCTION RECORD
North Carolina • Department of Environment and Natural Resources • Division of Water Quality - Groundwater Section
WELL CONTRACTOR (IhDIY!DUAL)iNANE (print) James Fs. Brown
WELL COY(R.ACTOR COMPANY NAME Hedden Brothers Well Drilling, Inc
STATE WELL CONSTRUCTION PERMITP - - ASSOCIATED WQ PEANUT:
(ifacelicable). - - - (if applicable) -
295992
CERTIFICATION A_Z045
PHONE a �28) 369-9591
WELL USE (Check Applicable Box): Residential M Municipal/Public ❑ Industrial ❑ Agricultural 0
Monitoring❑ Recovery .O Heat Purnp-Water Injection 0 Other 0 IIOther, List Use
2. WELL LOCATION:
Nearest Town' Franklin County Macon
Rose Creek
(Street Name, Numbers, Community, Subdivi lion, Lot No., Zip Code)
3. OWNER:: Bob Kuppers
Address 176 Forest Hells Drive
(S veei Or Route No.)
Franklin, NC 28734
City or Town State Zip Code
(828). 524-3729
Area code. Phone number
4. DATE DRILLED 5-14-04 -.
5. TOTAL DEPTH: 280'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: 15 FT.
(Use "P' if Above Top of Casing;
8, TOP OF CASING IS 2 FT. Above Land Surface'
'Topof casing terminated at/or below land surface requires a
. - variance In acco rdancesvith ISA NCAC 2C ,0118.
9. YIELD (gpm) 80+ METHOD OF TEST blow
I0,WATER ZONES (depth): 118' & 267'
1 I. DISINFECTION: Type H T H Amount 16 oz
12. CASING: Wall Thickness
Depth Died eter or Weigh'Ft. Material
From 0 To 42 Ft. 6 pvc
From 4 To 45 Ft 6" .188. steel
From To Ft.
13.°GROUT: Depth Material Method
From 0 To ` 20 Ft. temnite & L I L ptunD
From To Ft.
14. SCREEN: '. Depth Diameter Slot Size > Material
' From To Ftin. in.
From To. Ft. -in.' in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From ` To Ft.
Toographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(c'neck appropriate box).
Latitude/longitude of well location
(degre esSr inutas.'secocds)
Latiiudo/longitude source:DGPSDTopoeraphic map
(check box)
DEPTH DRILLING LOG From To Formation Description
0 43' clay & sand
43' 280' Granite
LOCATION SKETCH
Show direction and distance in miles from at•least
two State Roads or County Roads. Include the road
numbers and corn non road names.
v.
0
. ca
16, REMARKS'
I. DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STAND). , AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
S-/Se-ate
SIGNATURE TRUCTINGTHE .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
FF PERS
tn
0

WELL CONSTRUCTION RECORD
North Carolina-- Department. of Environment and Natural Resources - Division of Water Quality
WELkCO,NTRACTOR(IiNDIYIDUAL)IVA!11E (print) Janes B. Prowm
\YELL CoiN'l RACTOR COMPANY NAME Hedden Brothers Well Drilling, Inc
295987
- Groundwater Section
CERTIFICATION r_20a5
PHONE a 93 ) 369-9591
STATE WELL' CONSTRUCTION PER,MIT9 - ASSOCIATED WQ PER&IIT0
(ifaopiicable) - - - - - (if aoplicable)-.
1. WELL USE (Check Applicable Box): Residential El Municipal/Public 0 Industrial ❑ Agricultural 0
•,Monitoring 0- Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Usc
2.WELL LOCATION:
Nearest Town: Franklin
353 W. Old Murphy Rd
County
Macon
• (Street Name, Numbers, Community, Subdivision, Lot No. Zip Code)
3. OWNER: Jerry Baugh •
Address 353 West Old Murphy Rd
(Street or Route No)
Franklin.,- NC 28734
City or Town Stott Ztp Cod: .
(128- 369-7086 •
Area code- Phone number •
4. DATE DRILLED 5-10-04
5. TOTAL DE?TH: 500'
. 6. DOES WELL REPLACE EXISTING WELL? , YES O NO CEtc
7. STATIC WATER LEVEL Below Top of Casing: 300 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): 1 METHOD OF TEST blow
10, WATER ZONES (dep:h): 951
11. DISINFECTION Type H T H Amount- 16 oz
12. CASING: Wall Thickness
Depth ' Diameter or Weight/Ft. Material
From 0• To 18 Ft. 6" '
From —To 21 Ft. 6" .188 stet
From To Ft.
13.'GROUT. ' Depth Material From 0 ' To 20 Ft, beznite & rl
From ' To ' Fr
14. SCREEN: ' Depth. Diameter Slot Size • Material
From To - " Ft in, in.
From ' To Ft.in.- in.
SAND/GRAVEL PACK.
Depth Size Material
From To Ft.
From ' To ' Ft.
Method
purnced
16. REMARKS'
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STA RDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude-/longitudesou« e:OGPS0Topographic map
(check boa) --- DEPTH DRILLING LOG
From T e Formation Description
0 19 clay & sena
19' 500' granite
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,
SIGNATURE •
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. OW I REV, 07/2001
F PERSON CONSTRUCTING THE WELL.
DATE

From 0 To 38 Ft. 6 C
From 38' To41't 6" .188 Et -Dr --
From
To Ft.
13.'GROUT:. Depth, Material
From 0 To 20 Ft. ba'rzlite & tnnrrsil
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.
Method
pumped
WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources - Division of Water Quality • Groundwater Section
}YELL COtNTRACT0R(IN'DIVIDUAL)NAME (print) James A. Brown CERTIFICATIONg 2045
WELL CONTRACTOR COMPANY NAd1ERedden Brothers Well Drilling, Inc PHONE a828) 369 91
STATE WELL CONSTRUCTION PERMIT,/ ASSOCIATED WQ PERDiITl
(if applicable) . (if applicable)
WELL USE (Check Applicable Box): Residential Municipal/Public O industrial ❑ Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other O If Other, List Use
2. WELL LOCATION:
Nearest Town: Franklin
Lower Burningtown
County Nacan
(Streit Name, Ntunbcrs, Community, Subdivision, Lot No,. Zip Code)
3. OWNER: Sharon Karras
Address PO Box 445
(street or Route No.)
Dillsboro, NC 28725
City or Town State
(828). 586-8934
Area code- Phone number
4 DATE DRILLED 5-3-04
Zip Code
5. TOTAL DEPTH: 240' 6. DOES WELL REPLACE EXISTING WELL? YES O NONZ
7. STATIC WATER LEVEL Below Top of Casing: 100 FT
(Use "+" if Above Top of Casing)
8. TOP OF CASING 1S 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 (gam): 20 METHOD OF TEST blow
10. WATER ZONES (depth): 95' , 137' . & 231 '
Topographic/Land setting ;-
❑Ridge 0Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:OGPSOTopographic map
(check box)
DRILLING LOG
Formation Description
clay & sand'
DEPTH
From 39'
39' 240'
granite
LOCATION SKETCH
11. DISINFECTION: Type H T H Amount . 16 oz Show direction and distance in miles From at least c
12. CASING: ' Wall Thickness . two State Roads or County Roads. Include t'a27roado
Depth Diameter or Weight/Ft Material numbers and cornmon road names. '� c�_
C Em
etc
From To Ft. -
16.REMARKS
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STAND.* 51 AND THAT A COPY,QF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE 0
ERSON CONSTRUCTING THE WELL
3'3
DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Nlait Service Center -Raleigh, NC
27699-1636 Phone No. [phone]., within 30 days. GW-I REV, 07/2001
CO 77
rs pre
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s

WELL CONSTRUCTION RECORD
29?7r6
North Carolina - Department of Environment and Natural Resources • Division of Water Quality - Groundwater Section
WELL CONTRACTOR (IINDIVIDUAL)NAME (print) Mitchell D. Cook CERTIFICATION# 2043
WELL .CONTRACTOR COMPANY NAME Hdlla E20eKS5 ,E Ertll irk-,+ Dr PHONE p 28) 369-9591
STATE \YELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMITS
(if applicable) (ifacclicable)
I. WELL USE (Check Applicable Box): Residential 225 Municipal/Public ❑ industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Purnp Water Injection ❑ Other ❑ If Other, List Use
2, WELL LOCATION:
Nearest Town: Franklin
Skennah to Sanders Rd
County Mamn
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER Tim McMahan
Address 1194 Sanders Rd
(Stet or Route No.)
Franklin, NC 28734
City or Towr. State Zip Cod:
(828)- 524-9988
Area code- Phone number
4. DATE DRILLED 3-1-04
5, TOTAL DEPTH: 400'
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: 200 FT.
(Use "+" if Above Top of Casing)
8. TO? OF CASING IS 2 FT. Above Land Surface'
•Top of casing terminated at/or below land surface requires a
variance In accordance with I5A NCAC 2C AI I8.
9. YIELD (gpm): 2 METHOD OF TEST blow
10. WATER ZONES (depth): 110'
11, DISINFECTION: Type H T H
12. CASING:
Depth Diameter
From_ To_7_ Ft.�"
From 77To - Al Ft A" 188
Amount 16oz
Wall Thickness
or Weight/Ft. Material
From To Ft.
Pere
ct-Pel
13. GROUT: Depth - Material Method
From 0 To 20 Fttetnite & area Arrcth
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size Material
Slot Size Material
in.
in..
From To Ft.
From To Ft.
Topographic/Land setting
❑Ridge 0Slope ❑Valley ❑Flat
(cheek appropriate cox)
Latitude/longitude of well location
(dtgreeshninu tea/seconds)
Latitude/longitude source:OGPSOTopographic map
(cheek box)
DEPTH DRILLING LOG
--
From To Formation Description
0 79' Hay & sand
79' 400' granite
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
-a
ram)
16. 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 1V ELL OWNER
�f%o t-c-/e .10. Z -a' 3- / - o'Y
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mall Service Center -Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. OW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina • Department of Environment and Natural Resources • Division of Water Quality • Ground.vat r
WELL CONTRACTOR (INDIYIDUAL)NAME (prfnQ Janes B. Bram CERTIFICATI '.N91
wELL co R,\CTOR comyANY NAMEPedden Brothers Well Drilling, Inc PHONE K $28) 369-9591
STATE WELL CONSTRUCTION PERMITS
(if applicable)
ASSOCIATED WQ PERMIT
(ifapolicablej..
I. WELL USE (Check. Applicable Box): Residential Municipal/Public O - Industrial 0 Agricultural 0
Monitoring O Recovery 0 Heat Pump Water injection 0 Other 0 If Other, List Use
2, WELL LOCATION:
Nearest Town: Fein County Macon
Highlands Rd
(Street Name, Nwnbers, Community, Subdivision, Lot No.. Zip Code)
3. OWNER: Ken Mashburn
Address PO Box 233
(Street or Route No.)
Franklin, NC 28744
Clue or Town Stare Zip Code
( 82H. 524-4007
Area coda Phone number
4. DATE DRILLED 4-27-04
5, TOTAL DEPTH: 500'
6. DOES WELL RE?LACE EXISTING WELL? YES ❑ NO ZIK
7. STATIC WATER LEVEL Below Top of Casing: 400 FT.
(Use "-' if Above Top of Casing)
S. TO? OF CASING 1S ' 2 FT. Above Land Surface*
'Top ofcasing terminated at/or below land surface requires a
variance In a ccordan(e tvlth ISA NCAC 2C ,0115.
9, YIELD (gpm): L METHOD OF TEST blow
10. WATER ZONES (depth): 118' & 453'
I I DISINFECTION: Type ' H T I?
12. CASING:
Depth Diamelet
From 0 To 83 Ft. 6"
From 83' To 86 Ft. 6" 188
From To Ft.
GROUT: Depth, . iMatera! - Method
From 0 To 20 Ft. to rnite & carrat pumped
From •' To ' Ft, ..
SCREEN: Depth. Diameter Slot Size ., Material
From ' 'To - Ft. in.
From " To Ft. in. in
SAND/GRAVEL PACK:
Depth
From To
From ` To
Amount 16 oz
Wall Thickness
or Weight/Ft, Material
pvc
steel
Size
Ft.
Material
Topographic/Land setting
❑Ridge OSlope OValley ❑Flat
(cheek appropriate bon)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:OGPSOTopograpihic map
(check box)
DEPTH • DRILLING LOG
FOrom To Formation Description
84' clay & sena
84' 500' crrar.ite
LOCATION SKETCH .
Show direction and distance in miles from at leao
two State Roads or County Roads. Include the r 4 n„
numbers and common road name's. y.
--4Eft
16. REMARKS
I. DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STA T DS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WILL OWNED.
i
CONSTRUCTING THEWELLDATE
Subnilt the original to the Division of Water Quality, Groundwnter Section, 1636 ttilaU Service Center • Raleigh, NC
27699.1636 Phone No. [phone], within 30 days. GWI REV. 07/2001
1
W
"O
2a
W
c
r
ce.--r

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources -Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) James B. Brown CERTIFICATION 2045
WELL CONTRACTOR COMPANY NAME Redden Brothers Well Drilling, Inc PHONE #$%5) 369-9591
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERNIIT#
(ifaoolicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential el Municipal/Public 0 Industrial 0 Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other ❑. If Other, List Use
2. WELL LOCATION:
Nearest Town: Otto County Macon
Tessentee to Justice Rd
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: Dewayne Isacs
Address PO Box 662
(Street or Rout: No.)
Otto, NC 28763
City or Town State
( 82$_ 369-7191
Zip Code
Area code- Phone number
4. DATE DRILLED 4-12-04
5. TOTAL DEPTH: 500'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO)
7. STATIC WATER LEVEL Below Top of Casing: 300 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): 2.5 METHOD OF TEST blow
10. WATER ZONES (depth): 115'
11. DISINFECTION: Type H T H
12. CASING:
From 0
Depth
To 73 Ft.
From 71' To 76 Ft.
From To Ft.
13. GROUT: Depth Material
From 0 To 20 Ft, barnite & carat
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15.SAND/GRAVEL PACK:
Depth Size Material
Diameter
6"
611
Amount 16 oz
Wall Thickness
or Weight/Ft. Material
pvc
188 steel
Method
pumped.
From To Ft.
From To Ft.
292798
Topographic/Land setting'
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topegraphir map
(check box)
DEPTH DRILLING LOG "'
F0rom To Formation
y & Description
clay
74' 500' granite
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
0
CO
-10
3
is
0
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION DARDS, 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. 07/200I

294630
/1 Depth
From V To
From To
From To
13. GROUT: Depth
From n To r9t7
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) c'e 11 Y)1 5 / n I) an% A. CERTIFICATION Y d 17 le
WELL CONTRACTOR COMPANY NAM&h°hn1 S 140114ifirt I11P.0Yi 714�(_ Tn r 1 PHONEY %t) --.5-a 4-3 6 c
Q I(� _.___...__._...
STATE WELL CONSTRUCTION PERMIT./ASSOCIATED W ERMITY t.---"-..-
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residentiata- unicipal/Public 0 Industrial 0 Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATIO
Nearest Town: k 24,ikA/ County /Mato)
44t5 hr/1,"(41awl p2—.1(73�
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Cods)
3. OWNER: C 0 12 i 11 h E•, 7
Address `hr. Rrx 1 ( 3
p� (Street or Route No.)
( f C •
1-1 ec-
City or Town State Zip Code
(mac• .5. 2 y_ 7 7 )
Area code- Phone number
4. DATE DRILLED 7'
5. TOTAL DEPTH: :-?n•S
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO ❑ f�
3
TopographiclLand setting
akttgge ❑Slope OValley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds),; --.-- __
Latitude/longitude source:❑GPS❑Topographic map
(check box) L._---`—_"---
DEPTH R LLING LOG
From To Formation Description
b .5-6' nl ati11
7. STATIC WATER LEVEL Below Top of Casing: 5411 FT.
(Use "+" if Above Top of Cuing)
8. TOP OF CASING 1S / FT Above Land Surface'
*Top of casing terminated at/or below land surface requires a
variance In accordance with ISA NCAC 2C.01111.
9
10.
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.
WATER ZONES (depth):
YIELD (gpm): .17 METHOD OF TEST h Si7tf.8--.
• • �r '
I I. DISINFECTION: Type J -f-f'1 Amount o2 74 A S
12. CASING: Wall Thickness
Diapeter n` S or Weight/Ft.
From To
14. SCREEN: Depth
From To
From To
15. SAND/GRAVEL PACK:
Depth
From To Ft.
Ft. -b R ,a 1
Ft.
Ft.
Material Method ,
Ce411 Pt' rQN
p`fa
Ft.
Ft.
Diameter Slot Size ' Material
Ft. in. in.
Ft. in. in.
Size Material
From To Ft.
]3+
ra
16. REMARKS:
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF TH S RECORD H S BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL
DATE
Submit the original to the Division of Water Quality, Groundwater Section, I636 Mall Service Center -Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-I REV. 07/2001

From 0 To .-3 / Ft. $ jZ, , p
From To Ft.
From To Ft.
13. GROUT: Depth Maleritl
From n To r9'i7 Ft. Ca.-n, y/,7
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK: _
Depth Size Material
From To Ft.
From To Ft.
Method
n(ilAil)
16. REMARKS:
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources -
WELL CONTRACTOR (INDIVIDUAL) NAME
(print) ;be n v) 15
WELL CONTRACTOR COMPANY NAME;i gntC (tl JJn,nra 111eiI
STATE WELL CONSTRUCTION PERMIT# - ASS
(if applicable)
(if applicable)
�-9 ifjn9
Division of Water Quality - Groundwater Section
l / /LA r{i CERTIFICATION to of /7
v i l l :l(4 p1 e J PHONE 8 75) ,-..Se') L/--3 ;2 i
OCIATED W ERMITH
WELL USE (Check Applicable Box): Residential t---" icipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
•G,P-$,1 !C L / A County All 2 iP�L)Topographic/Land setting
Nearest Townj, L f DRidge QSf�❑Valley ❑Flat
AS', /I/ L'-1:• e. f• ({"-)))In • .7 51 "l:r /i, li -� p 73 C/ (check appropriate box)
(Street Name. Numbers, Community, Subdivision, Lot No., Zip Code) Latitude/longitude of well location
ID
3. OWNER: I I (p I-) y S Ott:
Address / g«,J>. n`) rr cl p,A
(Street or Route No.)
1"i2Llmy.lpp A S 73
City or Towp State Zip Code
( 50- 3LI-q_ k$/S
Area code- Phone number //
4. DATE DRILLED �f-- —0 T''
5. TOTAL DEPTH: •,1 7.5 r
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO E3-
7. STATIC WATER LEVEL Below Top of Casing: .t2 r FT.
(Use "+" if Above Top of Cuing)
8. TOP OF CASING IS / FT. Above Land Surface'
'Top of casing terminated at/or below land surface requires a
variance In accordance wllh 15A NCAC 2C .0118. /
9. YIELD (gpm): 3n METHOD OF TEST h/LL'!),
10. WATER ZONES (depth): . S---S j /.3n -
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
Formation Description
(' -�2 / ' e la; 1
15'l/td t ra1iifc--
DEPTH
From To
a1.5'
LOCATION SKETCH
I I. DISINFECTION: Type ,q- ,i, Amount -',� TAB 5 Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads. Incl t8e theLoad
Depth Dia eter or Weight/Ft. Mate ' I numbers and common road names. .c-
�� )P�
-0
_an;
o
W =rn
a r.i�
y �m
cn
o
W c
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL,, •;:l
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNiIR
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, I636 Mall Service Center Ralelg , NC (-(
27699-1636 Phone No. [phone], within 30 days. GW-I REV. 7/2001

294628
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR(INDIYIDUAL) NAME (print)c hefV)t S I�-Ojiln\r�1 CERTIFICATION it of/Ile
WELL C ELTORCOMPANYNAM6)>hntS f4112.,da Wei Ih�friI'ikd_ 17ttPi PHONE N V�.3aL/--3 �.e O
STATE WELLLCOCONSTRUCTION PERMITS ASSOCIATED W ERMITN
(if applicable)
(if applicable)
I. WELL USE (Check Applicable Box):'Residentiaf l---g icipal/Public 0 Industrial ❑ Agricultural 0
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other 0 !f Other, List Use
2. WELL LOCATION:
Nearest Town: F{? Q,L / L i A' County Al C C','l .y
LFL4 SI :11\teiLk,4. 1.31
(Street Name. Numbers, Community, Subdivision, Lot No., Zip C e)
3. OWNER: -)Cor I e c)
Address f `(-.Q y' I)h1.1_1a1P fn1-n , 2.b
(Street or Route No.)
rig Q vt I i ki
City or Town State
Area code- Phone number t�
4. DATE DRILLED Lf-.�rL••
5. TOTAL DEPTH: 4c l r
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO J-
7. STATIC WATER LEVEL Below Top of Casing: C FT.
(Use "+" if Above Top of Cuing)
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 .011a.
9. YIELD(gpm): /0 METHOD OF TEST tIlll/J1?ft.
10. WATER ZONES (depth): '7C')' -2 tr.
Zip Code
ographic/Land setting
IffiticiDeP ❑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
T' �b4C. /1//te�T,ranit-C__
I I. DISINFECTION: Type H-tA Amount
LOCATION SKETCH
c2 TA -A 5 Show direction and distance in miles from
12. CASING: Wall Thickness two State Roads or County Roads. Include
Depth Ft.Diameter S or Wei ht/Ft. Matefit numbers and common road names.
From To( -a (3 Y C'�
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From n To r D Ft. (�r� (7rn,{)
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:
O
CO
7a
O
C)
at least
the road
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF TH S RECORD H S 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 Mali Service Center -Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-I REV. 07/2001

294n]4
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME
(print) c 111 S �� n I !iOn' cL CERTIFIC
ATION Y�d-t%40
WELL CONTRACTOR COMPANY NAMIO-Y) ))jrs 14110,n 4 Wei 11)Vi 11 Alt T51. J PHONE M �a C Y-3 g 6 6
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED W6ERMIT#
(if applicable) (if applicable)
t. WELL USE (Check Applicable Box): Residential' unicipal/Public 0 Industrial ❑ Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other U If Other, List Use
2. WELL LOCATION:
Nearest Town: rf/�Ad/L�/J� County Ma (m—'
(,/fttl `'a//S 82 .:2d''73 (Street Name, Numbers, Community, Subdivision, Lot No., Zip
ip Code)
3. OWNER: i1 Utbel, + 73t'c/CJ v �lpl7-Sft�
Address ji S 5 r ��h., y 0 h, .P ro
(Street or Route No.)
/—/z a„ e i» 0 A/C— %3 t f
City or Town State Zip Code
( )- 5`21,1-_ r'235l
Area code- Phone number
4. DATE DRILLED
5. TOTAL DEPTH: 35n'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO ljli
7. STATIC WATER LEVEL Below Top of Casing: e2 0 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
•Top of casing terminated at/or below land surface requires a
variance In accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): /0 METHOD OF TEST 102/11 �(�-�
10. WATER ZONES (depth): 9h' (�
II. DISINFECTION: Type /7L-t-P
12. CASING: Wall Thickness
Depth p�eter or WeighVFt. Mate
From 0 Dia
To Ca 3 Ft. b4 3IbR.3 j Pr
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From n To (90 Ft. Cant oil A..)
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
Topographic/Land setting
paid& ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
Formation Description
DEPTH
From To
0 `i-5' e/ac
fir, 43' U(1201c'i, /) > e
6, e 35,' 13/u Jan;t--ems
LOCATION SKETCH
Amount 4 %1:1-. S Show direction and distance in miles from atlisl rit"'
two State Roads or County Roads. Include theisad
numbers and common road names. c)
—'
t
tT `=
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THJS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
4ma�
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the 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

294013
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) \D-en VI15 fin j)nn1L - CERTIFICATION # el/74I
WELL CONTRACTOR COMPANY NAME? nnrC JJtjk)ori WPl1I✓ii-144 rt PHONE #ate()_,5a.4-3 g6G
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED W&ERMITH -
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential Q- ii icipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other CS If Other, List Use
2. WELL LOCATION:
Nearest Town: n /i C_ County Al a [inc-,
/19/_S rP,d,)fl, 7<F/
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: `.1� iilY L- 0.�.e
Address
(Street r Route No.)
l'R4tiI/J ; �% 13 9/
City or Town State Zip Code
(- /Oaf
Area code- Phone number
4. DATE DRILLED yi 3 — Uy
5. TOTAL DEPTH: on he., •
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO QJI�
7. STATIC WATER LEVEL Below Top of Casing: 5Th FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface'
•Top of casing terminated atlor below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): / /2 METHOD OF TEST 107/J,7L(f
10. WATER ZONES (depth): 1 Qh ' (�
pographic/Land setting
ICJ -Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To , Formation Description
11 DISINFECTION: Type H'-f"F Amount a %%)-S
12. CASING: Wall Thickness
Depths Diapieter or Weiiht/Ft. Material
From 0 To ! n Ft. . HU K1 eeA
From To Ft.
From To Ft.
Depth Material Method
To r9D Ft. CQ�t4711 f7oW-
13. GROUT:
From ()
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 Material
in.
in.
c
LOCATION SKETCH[ is
Show direction and distance in miles from at*East U,f
two State Roads or County Roads. Include thecpad
numbers and common road names.
s
r
16. REMARKS:
ET.L -
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF TH S RECORD H6S 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 Mall Service Center -Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-I REV, 07/2001

294901.
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) i TI7. f) to 15 /Jl) II nrA rU CERTIFICATION N of 17
WELL CONTRACTOR COMPANY NAME hntS JJ,ojk 4IWJei1�i`ir II;1<,U 7'n P I) PHONE */i6)_L5M Ll-3 o'Z (sic
STATE WELL CONSTRUCTION PERMIT*/
(if applicable)
ASSOCIATED WQ PERMIT#
(if applicable)
1. WELL USE (Check Applicable Box): ResidentiafLd�Municipal/Public ❑ Industrial ❑ Agricultural ❑ -
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: /? AA e L i ,2/ County Ai ct (07L)
i£tfC /i,rye 2d n.1is Il,-tcR y
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: e h t-7 9 InLLQits
Address 9(' 120(te9r— 4vt
(Street or Route No.)
I V.ayvvf,->ci ,(its
City or Town State Zip Code
(J213 3 Li-9- C/ 6,11
Area code- Phone number
4. DATE DRILLED •3 - .3 / c0 `f
5. TOTAL DEPTH: 7CS
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO 0----"----
7. STATIC WATER LEVEL Below Top of Casing: .,CC) FT.
(Use "+" if Above Top of Cuing)
8. TOP OF CASING IS / FT, Above Land Surface'
'Top of casing terminated at/or below land surface requires a
variance In accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): /CAI METHOD OFTEST _h/OIUi7L{�
10. WATER ZONES (depth): 7r_5' ( O
LOCATION SKETCH C ';t.
II. DISINFECTION: Type *ill Amount ,-.7, Q $ Show direction and distance in miles frorgtt (eat
I2. CASING: Wall Thickness two State Roads or County Roads. Include rol4
Diameter or Weight/Ft. Map numbers and common road names. o
YCi
opographic/Land setting
tdge ❑Slope ❑Valley ❑Fiat
(check appropriate box)
Latitude/longitude of well location
(degrecs/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box) ! - --
DEPTH DRILLING LOG
From To Formation Descrtption-
Tr) .,l' P Ir-L9
/' 706' t?I/IC P/<'/-}iv;-t�
From
0
From
From
13. GROUT:
From n
From
Depth
To --2 ( , Ft.
To Ft
To Ft.
Depth
Tor Ft.
To Ft.
14. SCREEN: Depth
From To
From To
15. SAND/GRAVEL PACK:
Depth
From To
From To
nk S-Ui/ P
Material Method
P471 ecru 4--)
Diameter Slot Size ' Material
Ft. in. in.
Ft. in. in.
Size
Ft.
Ft.
Material
c
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF TH S RECORD H S BEEN PROVIDED TO THE WELL OWNER
Ora 1 .3.3' —nv
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
r'c
cn
r�-
0
cj-t

294902
DISINFECTION: Type ' ' ' ' f Amount ,--/. %f AS
Depth //
From 0 To 4L" Ft.
From To Ft.
From To Ft.
13. GROUT: Depth Material _i Method
From n To ri(D Ft. Cem.�i pmA�
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.
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME �(print) t /)� t1 MI 5 /Jt) ITIo,,,,. rI, CERTIFICATION $ (% (p
WELL CONTRACTOR COMPANYNAMIth°,f)nt C 't Ifrlieri (l)PI Ik1 Yes 1'ki(_ nt0 J PHONE N XI ,Sall--3 oi. (q L
STATE WELL CONSTRUCTION PERMITS/ ASSOCIATED WIRERMITN
(if applicable)
(if applicable)
1. WELL USE (Check Applicable Box): ResidentiaFC-1i icipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATI9N: j/j
Nearest Town: �'!4- �L'// Li; 4/ County / i4 (hlq �
•XestAT /7 i1 1"r-Y- Prd -Lti; II(Nit s P071, .
(Street Name. Numbers, Community, Subdivision, Lot No., Zip Code) i.73 y /
3. OWNER: krvt IA /4-r'tc' 0 /S
(Street or Route No.�
Address (.3.5- ft"J(L/-J ,1,>" ie
/ 4-4/ct;Ai /.'C. .�1/73`-
(�� City or TownZee.? — 3 State (e a Zip Code
Area code- Phone numb
4. DATE DRILLED 3 •2 S D LL
5. TOTAL DEPTH: S?lN y
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO Z"
7. STATIC WATER LEVEL Below Top of Casing: ? FT.
Topo_grapiefLand setting
❑Ridge 3151-ape ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
Formation Description
DEPTH
From To ,
rl y'
(Use "+" if Above Top of Cuing)
8. TOP OF CASING 1S / FT. Above Land Surface*
•Top of casing terminated at/or below land surface requires a
variance In accordance with ISA NCAC ZC .0118.
9. YIELD (gpm)• METHOD OF TEST_/1/01/%y7L/,}-.
10. WATER ZONES (depth): .r;1T'' (�
-S ar"
LOCATION SKETCH s
1 I. Show direction and distance in miles from at east
12. CASING: Wall Thickness two State Roads or County Roads. Include theyad
u,,:
DiaDeter or Weight/Ft. Mat�l numbers and common road names. N r.-
n"
T -e
S.R.Sj' A
1
a Z
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED
CONSTRUCTION STANDARDS, AND THAT A COPY OF TH S RECORD H BEEN PROVIDED TO THE WELL OW
NER
ill' OA- 0 — a s —0
OF PERSON CONSTRUCTING THE WELL
SIGNATURE
DATE
Submit the original to the 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

294476
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR(INDIYIDUAL) NAM�(print) c7)?nPll 5 I-J-r)jiQn\ rU CERTIFICATION,/ of/74A
WELL CONTRACTOR COMPANY NAMICbeI)r)1C jJti1n,nri I/JPI 14\YrrJ!'kd_ Trrt j PHONE Yi"gedCSrQY-3
STATE WELL CONSTRUCTION PERMIT,/ ASSOCIATED WOOPERMITH
(i f applicable)
(if applicable)
1. WELL USE (Check Applicable Box): 'Residentiafid�Municipal/Public ❑ Industrial ❑ Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Towne ? „Lk 1--;
4tii :Li a ub; 1,4.
(Street Name. Numbers, Community, Subdivision
3. OWNER: /<CSS /110 7)(\(r.cz%/
Address e •J)(2 / tm—, e t2 Ec, _
(Street or Rowe No.)
/-rant 1n3 At —
City or Town State Zip Codc
Lig). .`3h9 `? 7 8
Area code, Phone number
4. DATE DRILLED 4' - Si- —1'9
5. TOTAL DEPTH:
•
County 44 ((bu.J
, Lot No., Zip Code) X2€ 7 3 t Latitude/longitude of well location
3,lopographic/Land setting
L4RI`dge ❑Slope ❑Valley ❑Flat
V; S fi (check appropriate box)
(degrees/minutes/seconds)
Latitude/longitude source;❑GPS❑Topographic map
(check box)
DRILLING LOG
Formation Description
DEPTH
From To
7 '
sn „e , 17,--11
ST' .352 RLLJC, (r124n%t-e-
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: I -TO FT.
(Use "+" if Above Top of Cuing)
8. TOP OF CASING IS / FT. Above Land Surface*
'Top of casing terminated at/or below land surface requires a
variance In accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): •,2 ( METHOD OF TEST /2/1?/Ji7t�J
10. WATER ZONES (depth): . .20' (�
LOCATION SKETCH
I I . DISINFECTION: Type H-t k Amount rn T4 £ 5 Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads. Include thei9ad
Depth Diamp�eter or Weighr/Ft. Mate ' I numbers and common road names. c c=
From 0 To Ft. /n" sbR. f' Pr $
From To Ft. A ;
- From To Ft. -
13. GROUT: Depth Material Method
From n To r90 Ft. Ca yn� (rnAA)
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK: _
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF TH S RECORD H S BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL D TE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center- Raleigh, NC
27699-1636 Phonc No. (919) 733-322I, within 30 days. GW-I REV. 07r2001 h-
G

WELL CONSTRUCTION RECORD
294475
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section4a
WELL CONTRACTOR (INDIVIDUAL) NAME
(print) x)PDYll5 I 1T11On1 rl� CERTIFICATIONN oa/7
WELL CONTRACTOR COMPANY NAMIC-L.1�hn[i kifrlylrl LI)PO) hy' Il'kw_Tit Id PHONE /10-cdi_Sa 4-3
STATE WELL CONSTRUCTION PERMITH ASSOCIATED W ERMITN
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residentiaff__ �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 Tpwn: - 4 'l - L' / County AI a_ C lr n
-2 -CAT ( /ol.u'f F tt,in)ne CA_ 6The
(Sven Name, Number, Community, Subdivision, Lot No., Zip Code)
3. OWNER: L-e t2 �. ! trit
Address .2,FT CCt, Lc21Cr=Snnr� 717
(Street or Route No.)
el- IErzI 39-
City or Town State Zip Code
(ix- -3`V--'%//%
Area code- Phone number
4. DATE DRILLED -±) -6L/
5. TOTAL DEPTH: S00
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO m-
7. STATIC WATER LEVEL Below Top of Casing: of 0 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT, Above Land Surface•
•Top of casing terminated at/or below land surface requires a
9. YIELD (gpm): 10 METHOD OF TEST_6/070/5ft
10. WATER ZONES (depth): -27S (/
variance In accordance with ISA NCAC 2C .0118.
Topographic/Land setting
❑Ridge ❑Slope ❑Valley at
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH
From To
/) S(o•
,S/o• ep•
9v' .Sao•
DRILLING LOG
Formation Description
A/UG a r4 n r �-c_-
(7/
LOCATION SKETCH
I I. DISINFECTION: Type Amount �' %� � S Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads. Include the road
Q Depth To jib) Ft Diapeter S or Weight/Ft. MMatepgl numbers and common road names.
To Ft.
Ft.
Material 1
Ft. COyyt 6j,
Ft.
Diameter
Ft. in.
Ft. in.
From
From
From
To
13. GROUT: Depth
From n To
From To
14. SCREEN: Depth
From To
From To
15. SAND/GRAVEL PACK:
Method
Slot Size Material
in.
in.
Depth Size Material
From To Ft.
From To FL
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELLI
CONSTRUCTION STANDARDS, AND THAT A COPY OF TH S RECORD H S BEEN PROVIDED TO THE WELL 0)VNEI
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mall Service Center- Ralei [y N
27699-1636 Phone No. [phone], within 30 days. GW-I REV D7/2

WELL CONSTRUCTION RECORD
2 0375.9
North Carolina - Department of Environment and Natural Resources - Division of Water Quality • Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Mitchell Da Cook CERTIFICATION # 2043
WELL CONTRACTOR CONIPAN YNAME Fi3-1FrOt e S Veil a lla , PHONE : 8281 36'9--9591
STATE WELL CONSTRUCTION PER;M1Ttl ASSOCIATED WO PERM(-1)4
(ifapolicable) - (if applicable)
1, WELL USE (Check Applicable Box): Residential 25 Municipa!Public ❑ Industrial ❑ Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use
2- WELL LOCATION:
Nearest Town: 7bpton
20625 Wayah Rd
County Maoon
(Street Name, Numbers, Community, Su)s:ditilsl an, Lot No.. Zip Code)
3. OWNER. Fula Mae Morgan
Address 20625 Wayah Rd
(Street or Rowe No.)
Topton, NC 28781
City or Town 5tate Zip Code
(828. 321-4600
Area code- Phone nun'be:
4. DATE DRILLED 3-1 6-04
5. TOTAL DEPTH: 100'
6. DOES WELL REPLACE EXISTING WELL? YE903 NO 0
7. STATIC WATER LEVEL Below Top of Casing: 20 FT.
(Use "4" if Above Top of Casing)
8. TOP OF CASING IS 2 FT. Above Land Surface`
`Top of casing terminated aGor below land surface requires a
variance in accordance with ISA NCAC 2C ,0119.
9. YIELD (gpm): 30 METHOD OF TEST blow
10. WATER ZONES (depth): 40' & RO'
11. DISINFECTION:Tvpe F T H Amount 16oz
12, CASING: Wa11 Thickness
Depth Diameter or Weight/Ft. Material
From 7Q{ To q Ft. 6" pvc
From `7' To 10 Ft 6" 1.88 deal
From To pt.
13. GROUT: Depth Material Method
From 0 To 20 Ftbertnite & ut LL ranr d
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 ❑Fla:
(check amp raprl ate box)
Latitude/longitude of well location
(degrees/mfm,:esrseconds)
Latitude/longitude source:❑GPSET000grap'hic ague
(cheek box)
DEPTH DRILLING LOG
From To Formation Description
0 28' clay & sand
28' 100' granite •
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 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
3- 16 -05�'
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mall Service Center -Raleigh, NC -= t
27699-1636 Phone No. [phone], within 30 days. . OW -I REV, 07/2001

WELL CONSTRUCTION RECORD 2 94 287
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section •
WELL CONTRACTOR (INDIVIDUAL) NAME (print) JYen It
vi15 l +n Hnn\ Ai r CERTIFICATIONS c217 le
WELL CONTRACTOR COMPANY NAMt hnj C kitl rtr( OO)P.I I 1-i,(1 11 -at a_ qK P J PHON$ Ailyj`e2 Y—a g b C
STATE WELL CONSTRUCTION PERMITS ASSOCIATED WePPERMITS -
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): ResidentialTYMunicipal/Public ❑ Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other O If Other, List Use
2. WELL LOCATION:
Nearest Town: f/1,Q/1ICt i /i County 44 a 100
(c4E /L': CkC ct V2c_ .Q2vSzm° I A-cr 5u4-t
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code) a- S'73 y-
3. OWNER: Wile LIY. ; Mx"
Address (e SOS Santa r I as t Rivd'
(Street or Route No.) ,
Rt 'Pe; t'lr e T / 3 t-i-�t 5
City or Town State Zip Code
(' o- "1-tr5-1ts93
Area code- Phone number 4. DATE DRILLED 1f-9 '—0 Z�
/
5. TOTAL DEPTH: Ors•
�opographic/Land setting
idge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
Formation Description
eta,/
8L11ei nM;-f-2
DEPTH
From To
cal' coos'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO m-
7. STATIC WATER LEVEL Below Top of Casing: inn 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 YIELD (gpm): �accordan e with ISA NCAC 2C MIS.
� METHOD OF
TE
ST EST hl/P/)rt4
I .
0. WATER ZONES (depth): .5.�0' (l
Depth/
From 0 To
From To Ft.
From To Ft.
13. GROUT: Depth
From () To ,
From To
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size
From To Ft.
From To Ft.
Material
Ft. 0,9,yr
4
Q F'
Eiro
' Cr
v
77 rn
27.
tV r CI
'jG
LOCATION SKETCU
�T4a5 .'G
I I. DISINFECTION: Type %ff'� Amount Show direction and distance in miles from mast %� r;
12. CASING: Wall Thickness two State Roads or County Roads. Include th r ad r,
hDiameter or Weikht/Ft. Mat;it 1 numbers and common road names. i
is ,��' P>%�
Ft. .i2 R f
Ft.
Method
nC/ JC
Slot Size Material
in,
in.
Material
16.REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF TH S RECORD H S BEEN PROVIDED TO THE WELL OWNER
The OA �, el —ell' 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
Depth Diay�e'�t�er or We ht Ft.
From To e-a( Ft. /2S.Zj
From To Ft.
From To Ft.
13. GROUT: Depth Material Method From n To Ft. 094^/td,'f pCTV/ 0
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in in.
From To Ft. in. in
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
2.94286
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) c-h-e 7 i SI fin /IA et - � CERTIFICATIONS/ el /7 et
WELL CONTRACTOR COMPANY NAMS'h111 S (41)Oytri WPI1 T1 Y'r i l nt d_ 771.1. 1' J PHONE #irlicC,45. 4-3 g6
STATE WELL CONSTRUCTION PERMITS/ ASSOCIATED WIRERMITS
(if applicable) (if applicable)
WELL USE (Check Applicable Box): Residential' unicipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other a if Other, List Use
2. WELL LOCATION:
Nearest Town: /-i/Ciltit/t])S County 4/1a tan__
C4)9-C 1 1,4r Alt 4/, 2d eD2744/
(Street Name, Numbers, Community, Subdivision,�Lot No., Zip Code)
3. OWNER: Su
10re V'zr-2-
Address (g b X I. f)
(Street or Route No.) ? f
I1 I C I+ L AA-1) f ,, /C
City or Town StateZip Code
17_221- Z If (6 3
4
5
6
7
Area code- Phone number
DATE DRILLED
TOTAL DEPTH: /
DOES WELL REPLACE EXISTING WELL? YES 0 NO ❑—
STATIC WATER LEVEL Below Top of Casing: C?(10 FT.
(Use "t" 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 MIS.
9. YIELD (gpm): .3D METHOD OFTEST_ i02Z1/2 —.
I0. WATER ZONES (depth): Q/.<' .5-'7 (/
�Fographic/Land setting
LARidge ❑Slope OValley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
Formation Description
C/a
DEPTH
From To
0
9 /' gal.ce
LOCATION SKETCH
1 I. DISINFECTION: Type it-(--/ Amount a Fig-. S Show direction and distance in miles from at -/east a
12. CASING: Wall Thickness two State Roads or County Roads. Include (e roach-
numbers and common road names.
p`
16. REMARKS:
i n1
ct? n�
•I
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF TH S RECORD HAS BEEN PROVIDED TO THE WELL OWNER I
—/—LiX
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mali Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV, 07/2001

WELL CONSTRUCTION RECORD
294285
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME
(print) c )LY)YlI S JJ71 Hart\ rk, - CERTIFICATION o1/7
WELL CONTRACTOR COMPANY NAMICh°,1nrS 14/lay, ri Wei I > yi trod ye. Ll PHONE Yif'n-ce_. -24-3 26
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED woPpgRmini
(if applicable) (if applicable) .
WELL USE (Check Applicable Box): Residential' nicipal/Public ❑ Industrial ❑ Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 5 if Other, List Use
2. WELL LOCATION: "�
Nearest Town: l'i? A A ILL , 11 County Al Cc CCU
/', rules C6, ape: R s - e b. e 2 VA a r7 f-
(Street Nmnc, Nu bets, Community, Subdivision, Lot No., Zip Code)
3. OWNER: -Br II /11QIncie
Address 41L2 7 Phan,/ tic ) I [' T
(Street or Rouo.)
I—PO411C/ ; Al 4/L> .73 V-
�City or Town State Zip Code
(&2.FC)- Se)SL-- (n7tcI
Area code- Phone number
4. DATE DRILLED If -.J/ --O 9
5. TOTAL DEPTH: 0LS0'
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO ❑-
7. STATIC WATER LEVEL Below Top of Casing: — 0 — FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
'Top of casing terminated at/or below landsurface requires a
variance In accordance with ISA NCAC 2C .0118.
9. YIELD (gpm):.?o METHOD OF TEST loz/J1'Xi .
10. WATER ZONES (depth): /r'i0 j /Y0J (l
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
PRILLING LOG
Formation Description
Si?,l `l-1 int- e
c3
O o
LOCATION SKETCH , o ,
1 I. DISINFECTION: Type ff- » Amount .- 71)-k 5 Show direction and distance in miles from at I
12. CASING: Wall Thickness two State Roads or County Roads. Include the r j2
numbers and common road names. c cn r
rn
U?
r-, o
tT
From 0
Depth
Diampfeter or Weight/Ft.
ln
To_ " S __ Ft. Zz R i f
From To Ft.
From To Ft.
13. GROUT: Depth
From ID To rtilD Ft.
From To Ft.
Material
MatefiAl
Method
pU> 00
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16.REMARKS:
in.
in.
Topographic/Land setting
❑Ridge ❑Slope ❑Valley at
(check appropriate box) 4.
Latitude/longitude of well location
DEPTH
From To
O .-? '
3/nr _2,2r
' .3 sn
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF TH S RECORD H S BEEN PROVIDED TO THE WELL OW R —
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mali Service Center -Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-I REV. 07/2001
2=:v

297713
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section / -
WELL CONTRACTOR (INDIVIDUAL) NAME (print) c�I•ef) V1 i $ /'}n n(ln% (kJ CERTIFICATION #�01)7 40
WELL CONTRACTOR COMPANY NAM& PhI S Id !Ji'L, r4 Wei I Th V1r I I `K�/j ],. vve _, PHONE # CAh.. sy5 D. h/ _3 2 Q
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED W6 'ERMIT# (if applicable)
(if applicable)
I. WELL USE (Check Applicable Box): Residential unicipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION: ographic/Land setting
Nearest Town: FRAthe L, r County y `
Q LOYL�Ekt 0Slope ❑Valley ❑Flat
� 4-C WO1 YLtct PP{Z.Qc -L- ?a-ht ✓j..RQ -L Cufu - ea/nyQiJ (check appropriate box)
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code) L0 fib 16 Latitude/longitude of well location
f873Sf
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
Formation Description
alai
V P f;' m e�
c�-I 7 t -
/�
R) Ue- Ir_%ZOini--%
3. OWNER: M t Lk (Le -+RDSS
Address s.29.3 iron2.1 r1
Street or Route No.) J
J
DEPTH
City or T wn State Zip Code From TO
%51.4)- '7 a _ �9.
o0S'
8
9. YIELD (gpm): ' METHOD OF TEST_ /tVDJ >1 t'�
10. WATER ZONES (depth): i `� n'
11. DISINFECTION: Type H-tf% Amount .•Z %1i-k S
12. CASING: Wall Thickness
Depth �7 Diameter or Weight/Ft. Material
From 0 To / Ft., /, - S-7)is, p K�
From To Ft.
From To Ft.
13. GROUT: Depth Material_ Method
From fl To ri7 Ft. efi.Vyr dill pal
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
Area code. Phone number G
4. DATE DRILLED (;� -'0 -O
5. TOTAL DEPTH: as'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: MO 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 .011.
From To Ft.
From To Ft.
16. REMARKS:
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT COPY F THH�CORD H S 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 Mai( Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-I REV. 07/2001

City or Town State Zip Code
(k )- �35c9_ 3g4`7 n 4D'
Area code- Phone number/
4. DATE DRILLED 49 -7 _
5. TOTAL DEPTH: c? QS-
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: -5 FT.
(Use "+" if Above Top of Cuing)
8. TOP OF CASING IS / FT. Above Land Surface`
*Top of casing terminated at/or below landsurface requires a
variance In accordance with ISA NCAC 2C .0118. /
9. YIELD (gpm): 5L0 ME,Ti'�OD OF TEST 10211,E C/
10. WATER ZONES (depth): --pc;75' (�
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Sectionn/ _
WELL CONTRACTOR (INDIVIDUAL) NAME (prlut) CI)4 f)VIIS AliI rA r1� ' ' CERTIFI�C�A,,T�I/ON0 /d.174°
WELL CONTRACTOR COMPANY NAME I}l[ i Jti6?!I()ytrl lik,111l yS II ill Tit i PHONE ',bi3p- -`ra Li —3 2-b Q
STATE \VELL CONSTRUCTION PERMIT', ASSOCIATED WIRERMITI1 Of applicable) (if applicable) i--
29'l12,
1. WELL USE (Check Applicable Box): Residential7YMunicipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other C( If Other, List Use
2. WELL LOCATION: nn
Nearest Town: %0 0 County / r' inn,
)g4(eh. 2a _ �rJn', f l+ollfrte) SIB {�J •
(Street Name, Numbers,/l1Community, Subdivision, Lot No., Zip Code) s % 5 y
ern
3. OWNER: f f) r IC 2 k vt E p p
Address (% 7.V Re/lr° Q7m.rJr.)1. Pry
Topographic/Land setting
❑Ridge ❑Slope ❑Valley E Flat
(check appropriate box) a
Latitude/longitude of well location
(degrees/minutes/seconds) -
Latitude/longitude source:❑OPS❑Topogrl)p'hic map
(Street or Route No.) (check box)
PY&i Ill -).) ,1/e ri.R7? q DEPTH DRILLINC-Lee--
From To Formation Description
RLtre..J grin:+
Ain' r ClT'
LOCATION SKETCFj
1 I. DISINFECTION: Type E'-'// Amount rA-a S Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads. Include the road
Diameter or Weight/Ft. Mate ' l numbers and common road names.
Ft. !n S.b$,f 3 P y
Ft.
Ft.
Material Method
Depth
From 0 To .//D
From To
From To
13. GROUT: Depth
From () To rt
From To
Depth
Ft. event Gr [ pow°
Ft.
14. SCREEN: Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK: -
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF TH S RECORD HAS BEEN PROVIDED TO THE WELL OWNER
�
L
Or�
SIGNATURE OF PERSON CONSTRUCTING THE WELL
Submit the original to the 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
DATE

297711
WELL CONSTRUCTION RECORD
w
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Sectionn
WELL CONTRACTOR(INDIVIDUAL) NAME (print) c�enII /9t s I!)'t) /TIIOrArl� CERTIFICATION 8/rsr-/%l
WELL CONTRACTOR COMPANY NAME hillS'S liC IMiI)ys Il-14.t��Pt P i PHONE NiJ-5.
—�7 a L%-3 '%LI
STATE WELL CONSTRUCTION PERMIT*/ ASSOCIATED WIRERM1T0
(if a applicable) -----
PP (if
I. WELL USE (Check Applicable Box): Residential' unicipal/Public 0 Industrial 0 Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 1:1- If Other, List Use
2. WELL LOCATION:
'Nearest Town:
rAl County ' lQ (/tYp(
.77—t-Le—Ch,IZr+. (l;rtrt'it 1•ITIILn) UCtk'+-e�•
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code) , fjrj'3 9.
3. OWNER: 0—P A Y) h 1 P 1
Address c I ({- F�.4'Y'Y B n `f I t+ l.Lt n S 12 d
(Street or Route No.)
City Or Town State
( ,SO rf Si 6,(7)
Area code- Phone number/
4. DATE DRILLED el -7 —U
5. TOTAL DEPTH: ,3C2r'
9.3 SL
Zip Code
Topographic/Land settng
❑Ridge ❑Slope Q»i*lley QFIat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topoyraphicmap
(check box)
DEPTH DRILLHdG.LOG
From To Formation Description
C 1()lM
S'Cfn S*m7-,.
Rive_ /. Rr7n'it4=
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 921----""
7. STATIC WATER LEVEL Below Top of Casing: 0 fl FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface'
*Top of casing terminated atlor below landsurface requires a
variance In accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): / t METHOD OF TEST hreP8,
10. WATER ZONES (depth): /•Sn' (�
I I. DISINFECTION: Type
12. CASING:
Depth,
From 0 - To �O
From To
From To
13. GROUT: Depth
From n To ri(7 Ft.
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth
From To
LOCATION SKETCH
H-1-P Amount c TA-5 Show direction and distance in miles from at least
Wall Thickness two State Roads or County Roads. Include the road
Diam�eter or WeighUFt. Matea 1 'numbers and common road names.
Ft. 62 522 ar, Q Y �
Ft.
Ft.
Material Method
CQyr paw
From To
Slot Size Material
in.
in.
Size Material
Ft.
Ft.
O
c_
P
C—
•
r.z
F
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 TH S RECORD H S 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 Mall Service Center -Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

297 <'10
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR(INDIVIDUAL) NAME (print) c7)•enntsI!�-e')il(kA rk, - CERTIFICATION# 01/7i
WELL CONTRACTOR COMPANY NAMIC ,t S o`IQytri [DPI I a-i y'i .4�((, .�11 e J PHONE fiSe1 Y-3 g b 6
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WIRERMIT#
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential' unicipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 17 If Other, List Use
2. WELL LOCATION: n
Nearest Town: !�/t 4-4,$/1 / i 4/ County,4'1& tem
//>SS Pe& p,4„ I �l //� �L V - ,-f (-73 V
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: T P hOz-ta a-.( Il_
Address I0l'7 PA/m \,/ Etc) fQ
(Street or Route No.)
a ivy h) r I. 3 (-ka ra t
City or Town State Zip Code
&I )- sto5z-n •
Area code- Phone number
4. DATE DRILLED & -? 0 V
5. TOTAL DEPTH: S/). '
Topographic/Land setting
?Singe ❑Slope ❑Valley QFIat
(check appropriate box) 1.
Latitude/longitude of well location
(degrees/minutes/seconds) `--
Latitude/ongitude source:❑GPS❑Topogf'aphic map,
(check box) ii__..__ _--
DEPTH DRILLING LOG
From To Formation Description
n_ '
C,2 ' 4-DC"
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: .C,n FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface'
'Top of casing terminated at/or below landsurface requires a
variance In accordant with ISA NCAC 2C .0118. 9. YIELD (gpm): METHOD OF TEST_ lDei (/
10. WATER ZONES (depth): 7/5 (�
II. DISINFECTION: Type 111/ Amount a TA -A S
12. CASING: Wall Thickness
Depth Dia ter or WehUFt.
From 0 To Sot Ft. S 2 R.,V 7
From To Ft.
From To Ft.
13. GROUT: Depth
From O To "QC') Ft.
From To Ft
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15, SAND/GRAVEL PACK:
Depth Size Material
pi%
Material Method
CPar dxt paw°
From To Ft.
From To Ft.
2
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
0
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 H S BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
7-73
0 ,a
0
Submit the original to 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

20779
79.ir
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section / -
WELL CONTRACTOR (INDIVIDUAL) NAME (print) x7)� n vi 15 J-J-i) 112,r\ rU CERTIFICATION# a 174-
\YELL CONTRACTOR COMPANY NAME I)n, c (Ce lk).ar4 IW)el I)1 Y`r 11 ;mot ej... )_ n e l PHONE #�l2-edi_.ri a 4-3 a.6 O
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQYERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential YAM inicipal/Public D Industrial ❑ Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION: Nearest Town: �/f i}/b/�( �—/ N County /14a %[NU
( E LvalnuZ" GP- —2d- (Z193II
(Street Name. Numbers, Communit
y
, Subdivision, Lot No., Zip Code)
3. OWNER: a-ea-49 4-3 CULZ2 L
Address (0 a Lo q l- f -3 t1 I n,n i4 2 cl
Street or Route o.)
Fr cim f/ C,- 4 S'/13 ti
City or Town State Zip Code
ag)- r3(e)9_
4.
5. TOTAL DEPTH:
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: 5f0FT.
(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): .7 b METHOD OF TEST /U7b/7LC}
10. WATER ZONES (depth): 3�5 ' 0
Topographic/Land setting
❑Ridge ❑Slope ❑Valley
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topograffilc map
DEPTH
From To
0 3 n `
.3n • r3o.s-
Area code- Phone number q
DATE DRILLED ^ l -
1 I. DISINFECTION: Type
12. CASING:
From V
Depth
To 3
From To
From To Ft.
13. GROUT:
From n
(check box)
DRILLINGOC
Formation Description
fat)
6-ra-) t-¢-
LOCATION SKETCH
Amount rig_ 13 S Show direction and distance in miles from at least
Wall Thickness two State Roads or County Roads. Include the road
Dia eter or Weight/Ft. Mateeia1 numbers and common road names.
FL h ' sa R V) P
Ft.
Depth Material
To�f Ft. 6.)yt ay
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth
From To Ft.
From To Ft.
Method l
JUJU-)
Slot Size Material
in.
in.
Size Material
O
c
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF TH S RECORD HAS BEEN PROVIDED TO THE WELL OWNER
ell 0 e — G-9 0y
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
\S e
UT'

29r'GZrO
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division
of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) c71-ehI1'lls -n lln„�r+� CERTIFICATION 11 c_J7 e
WELL CONTRACTOR COMPANY NAME 1X.hjjlS'VIr7�li�,✓iri �i�P,i�kl Yer li: x4 ]CL e J PHONE M L%--3 �'- 6
STATE WELL CONSTRUCTION PERMITS/ ASSOCIATED W ERMITS/
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential' unicipal/Public 0 Industrial 0 Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other C( If Other, List Use
2. WELL LOCATION:
Nearest Town: Fier%4/k L r 41 CountyJ9')/ (, J
•2 $ A/ t --r' wec CC mL cecim 'Fyn et ('zf-YJ /2-a
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code) 4 g 73 y
3. OWNER: •)f -epc!?e U !)Ct/tItZS
Address 5'/LI t`e •nt 'norI / e4E e'-
(Street or Route No.)
k'cswe// 6-4. •-3rr'7&
4
5
6
7
City' or Town State Zip Code
(710)- qQ )-Ci'y;2V
Area code- Phone number
DATE DRILLED S --C-0 7(7/
TOTAL DEPTH. fr Oi''3'
pEPTH
From To
C� 5-3`
P.
to3 r
DOES WELL REPLACE EXISTING WELL? YES 0 NO 0.---"a
STATIC WATER LEVEL Below Top of Casing: c" FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
'Top of casing terminated at/or below landsurface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): / METHOD OF TEST_ /02iU/7f —,
10. WATER ZONES (depth): /. r' (�
I I. DISINFECTION: Type "HP Amount
12. CASING:
From >7
From
From
13. GROUT:
From ()
Wall Thickness
Depth Diapetter or Weight/Ft.
To-? Ft. sza.2 i
To Ft.
To Ft.
Depth Material
To r9D Ft, eQ4-yi
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.
I6. REMARKS:
opograpbic/Land setting
WRidge ❑Slope ❑Valley ❑Flat
(check appropriate box) •
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
Formation Description
e 7n-4
glUC re—
LOCATION SKETCH
T4 P S Show direction and distance in miles from att'eat
two State Roads or County Roads. In lc1 e th ;road
P
numbers and common road names.
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAG.iCLL
CONSTRUCTION STANDARDS, AND THAT A COPY OF TH S RECORD HAS BEEN PROVIDED TO THE L OWNER
Or
r' a �
SIGNATURE OF PERSON CONSTRUCTING THE WELL
s" o
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

From To Ft. in.
15, SAND•GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
WELL CONSTRUCTION RECORD
North Carolina - Doparlment of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL)NAME (print) James B. BrownCERTIFICATION? 2045
WELL CONTRACTOR CO.O/IPAN YNAME Hedden Brothers Well Drilling, Inc PHONE [phone]
STATE TELL CONSTRUCTION PERMIT= ASSOCIATED UQ PERMIT-
(irr aooliaable) (if aoolicable)
297307
1. WELL USE (Check Applicable Box): Residential ? NlunicipalPub;ic ❑ Industrial ❑ A ricultural ❑
Nlonitoring ❑ Reco,,ery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town:nanklin County Macon
Featherstone -Well #3-Lot #22
(Street Name. Number,, Community, Subdivk..on, Lot No., Zip Code)
3. OWNER. Bill Vernon
Address 4248 Burningtown RD
(Street cr Route No.)
Franklin, NC 28734
City or To an Satz Zip Code
(828_ 524-0863
Area ;rode- Phone nwrbe:
4. DATE DRILLED 5-26-04
5, TOTAL DEPTH: 700'
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO K
7. STATIC WATER LE\'EL Below Top of Casing.: 500 FT.
(Use " if Above Top cfCasi.ng)
5. TOP OF CASING IS 2 FT. Above Land Surface"
'Top of casing terminated ar'or below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): 6 METHOD OF TEST blow
10, WATER ZONES (depth): 309' & 450'
I I. DISINFECTION: Tape H T H Amount 16 Oz
12. CASING: Wall Thickness
Depth Diameter or AWeight'Fe Material
From 0 To 70 Ft.- 6" pvc
From 70' To 73 Ft. 6" 188 steel
From To Ft.
13. GROUT: Depth Material N1et'nod
From 0 To 20 Ft. barnite & Caret pumped
From To Ft.
14. SCREEN: Depth Diameter Slot Size ALterial
From To Ft. i, . in.
in.
Topographic/Land setting'.
DRidge ❑Slope ❑valley ❑Flat
(ctmeck appropriate box)
Latitudelloneitude of well location
(de_raes'minntes(seeends)
Latitudo'longitude souse,❑GPS0Topo raphic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
0 71' clay & sane
71' 700' granite
LOCATION SKETCH
Show direction and distance in miles from at leas;
tmo 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 I SA NCAC 2C, WELL
CONSTRUCTION',ST. 'DARDS, AND THAT..) COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
�/ SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
ji
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. GAW-I REV. 0712001

WELL CONSTRUCTION RECORD
297306
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) James B. Brown CERTIFICATION # 2045
WELL CONTRACTOR COMPANY NAME feirial PrtnitiP S Hpj1 rrilliig, Trr PHONE # fFOR) 16q_'591
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential ®c Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: Franklin Macon
County
Clarks Chapel
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: Shane Stikeleather
Address 75 Wallalieu RD
(Street or Route No.)
Otto. NC 28763
City or Town State
(828)- 524-5604
Area code- Phone nutnber
4. DATE DRILLED 6-2-04
5. TOTAL DEPTH: 700'
Zip Code
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NOx
7. STATIC WATER LEVEL Below Top of Casing: 500 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): 10 METHOD OF TEST blow
10. WATER ZONES (depth): 4R5& 563'
1 I. DISINFECTION: Type H T H Amount 16 oz
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 57 Ft. 6" pvc
From 57' To 60 Ft. 66 .188 steel
From To Ft.
13. GROUT: Depth Material Method
From 0 To 20 Ft.barnite & agent prrpai
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From 5 Tp Formation Description
0 ti clay & sand
58' 700' granite
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
0
N
03
0
0)
I DO HEREBY CERTIFY THAT THIS WELL \VAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
r
INrah�J -.,2-Q 7
SIGNATURE OF PERSON CONSTRUCTING THE WELL f v DATE
v
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

?O7305
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) James B. Brown
CERTIFICATION # 2045
W ELL CO.N'FRACTOI2COMPANYNAME 11iYla7 BE I1FPrS W11 rti11irT3 Trr PHONE # (MR) 9591
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable)
(if applicable)
I. WELL USE (Check Applicable Box): Residential Rk Municipal/Public ❑ Industrial ❑ Agricultural 0
Monitoring 0 Recovery ❑ Heat Purnp Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: flaiclin
Tessentee woods --Well #1
County
Mac -on
(Street Name. Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: Steve Koster
Address 82 Old Clarks Chapel Rn
(Street or Route No.)
Franklin, NC 28734
City or Town State
(828)- 349-3489
Area code- Phone number
4. DATE DRILLED 5-31-04
Zip Code
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
0 103' clay & sand
103' 700' granite
5. TOTAL DEPTH: 700'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO iac
7. STATIC WATER LEVEL Below Top of Casing: FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING 15 2 FT. Above Land Surface*
•Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): 0—DRY METHOD OF TEST blow
10. WATER ZONES (depth):
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
11. DISINFECTION: Type H T H Amount 16 nz
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft.
From 0 To 102 Ft. 6"
From 102' To 105 Ft. 6" ,188
From To Ft.
Material
pvc
steel
13. GROUT: Depth Material Method
From 0 To 20 Ft.barnite & gmEnt pnped
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.
Slot Size Material
in.
in.
Material
0
N
CO
rn
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A CQ,PY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
.31.0 Ss v3 /—a «.
SIGNATU!( F 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-t 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) Janies B. Brown
WELL CONTRACTOR COMPANY NAME FAT adtETS [np11 il-i11in-, Try
297304
CERTIFICATION # 2045
PHONE # JRLR) 7 Q-959t
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential liaC Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2 WELL LOCATION:
Nearest Town:Franklin County Macon
Tessentee Woods -Well #2
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: Steve Koster
Address 82 Old Clarks Chapel RD
(Street or Route No.)
Franklin, NC 28734
City or Town State
( 82B- 349-3489
Area code- Phone number
4. DATE DRILLED 5-31-04
Zip Code
5. TOTAL DEPTH: 300'
6. DOES WELL REPLACE EXISTING WELL? YES IE NO ❑
7. STATIC WATER LEVEL Below Top of Casing: 149 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): 17 METHOD OF TEST blow
10. WATER ZONES (depth): 130' & 279'
11. DISINFECTION: Type H T H
12. CASING:
Depth Diameter
From 0 To 122 Ft. 6"
From 122' To 125 Ft. 6"
From To Ft
13. GROUT: Depth
From 0 To 20
From To
14. SCREEN: Depth
From To
From To
15. SAND/GRAVEL PACK:
Amount 16 07
Wall Thickness
or Weight/Ft. Material
pvc
.188 steel
Material Method
Ft tundte & cement pnped
Ft.
Diameter Slot Size Material
Ft. in in.
Ft. in. in.
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
0 123' clay & sand
123' 300' granite
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
I DO 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
/ 9
= E� �... c-3 i-v `i
RE 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
Ca

297303
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) James B. Brown CERTIFICATION # 2045
WELL CONTRACTOR COMPANY NAME Ha-3iatr BrOtbers 10,1=11 rid 11irg, Trr PHONE # MR) 169J1591
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ®c Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: Franklin County Macon
466 Jacobs Br
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: Scott Browning
Address 466 Jacobs Branch
(Street or Route No.)
Franklin, NC 28734
City or Town State Zip Code
(828)- 421-0288
Area code- Phone number
4. DATE DRILLED 6-3-04
5. TOTAL DEPTH: 260'
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO 9
7. STATIC WATER LEVEL Below Top of Casing: 60 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): 10 METHOD OF TEST blow
10. WATER ZONES (depth): 137' R 717'
11. DISINFECTION: Type H T H Amount 16 07
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 84 Ft. 6" pvc
From 84' To 87 Ft. " .188 steel
From To Ft.
13. GROUT: Depth Material Method
From 0 To 20 Ft.barnite & caret p.nped
From To
14. SCREEN: Depth
From To Ft.
From To Ft.
15. SAND/GRAVEL PACK:
Depth
From To Ft.
From To Ft.
Ft.
Diameter Slot Size Material
in. in.
in. in.
Size Material
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
0 85 clay & sand
85' 260' granite
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 15A NCAC 2C, WELL
CONSTRUCTION STAND/A/RDS, AND THAT
A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
V ,«�
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 ,

297417
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (Irmo LARRY F. JONES
WELL CONTRACTOR COMPANY NAME CHEROKEE WELL DRILLING AND PUMP COMPANY, INC
CERTIFICATION # 3293
PHONE I [phone]
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ® Municipal/Public 0 Industrial ❑ Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: ANDREWS County MACON
1081 EAST SILVERMINE RD
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: MARK 8 LORI TODSEN
Address 10119 TARPON DR
(Street or Route No.)
TREASURE IL, FL 33706
City or Town State
( 727 )_ 3604501
Area code- Phone number
4. DATE DRILLED 06-14-2004
Zip Code
5. TOTAL DEPTH: 505'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO RI
7. STATIC WATER LEVEL Below Top of Casing: 10 FT.
(Usc'+" if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surface*
*Top of casing Terminated aUor below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): 2 METHOD OF TEST AIR
10. WATER ZONES (depth):
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road;-'
numbers and common road names.
Topographic/Land setting
❑Ridge ®Slope ['Valley ['Flat
(check appropriate box)
Latitude/longitude of well location
3518.398N/8336.134W
(dcgrc&ininutes/scconds)
Latitude/longitude source:RIGPSOTopographic map...
(check box)
DEPTH DRILLING #OG
__ --
From To Formation Description
0' TO 16' BROWN DIRT 8 GRAVEL
16'TO28' GRANITE
28' TO 505' GRANITE
11. DISINFECTION: Type CHLORINE
12. CASING:
Depth
From 0 To 28 Et.
From To Ft.
From To Ft.
13. GROUT: Depth Material
From 0 To 28 FL CEMENT
Amount 100 PPM
Wall Thickness
Diameter or Weight/Ft. Material
6 1/8" SDR 21 PVC
Method
TREMIE PIPE
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
I . SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
SLATE
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITII ISA NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A 99OPY OF THIS RECORD 1BEEN PROVIDED TO THE WELL OWNER
r
S(GNAT
SON CO STR 9r NG TI IE WELL DATE
Submit the original to 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

297
35
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) C JTTJ� n» t 5 I I i(ieA CERTIFICATIONS/ o2-/7 (e
WELL CONTRACTOR COMPANY NAMIC 11fl cIJ Parr' IIiP,l � l tfcJ l ; e( Tis J PHONE WireLIK, .5a 1-/ g e 6
STATE WELL CONSTRUCTION PERMITS/ ASSOCIATED Wd\'ERMITY
•
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential'ra-- fvt micipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other U If Other, List Use
2. WELL LOCATION:
Nearest Town: t7 4 4//2L; d County AI a [orrice
r 8W Fhnelowet (hale; ne. ,Qkr735z
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: c m
Address C%D3 Xanadt) Plac
-�
�J Lf (Street or Route No.)
. i-e
r
Cny or Town StateZip Code
(701 )- .9 tit _ (e 4.„0 �.
Area code. Phone numberr!
4. DATE DRILLED b — I/ —U4
5. TOTAL DEPTH: '/OS'
a 3 Y7r7
bpographic/Land setting
idge ❑Slope ❑Valley QFIat
(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
b 6( o ' -
(Ole,' I 0 5 '
JDS' v0S'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO Z�
7. STATIC WATER LEVEL Below Top of Casing: /00 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. j/
9. YIELD (gpm): _CO METHOD OF TEST h /07Wj
10. WATER ZONES (depth): e.2 OSj 3 -r
11. DISINFECTION: Type
12. CASING:
Depth
From 0 To /(? 5
From To
From To
13. GROUT: Depth
From (3 To
From To
14. SCREEN: Depth
From To
From To
15. SAND/GRAVEL PACK:
Depth Size
From To Ft.
From To Ft.
c-1
v
•
%7111-1 Amount a TJ}g 5 Show direction and distance in miles frCar at leasi
Wall Thickness two State Roads or County Roads. Incltldie the -road
Dia eter or Weiihr/Ft. Mate' 1 numbers and common road names. O --
Ft. S�R,�j Alt —
Ft.
Ft.
Material Method
Ft.
Ft.
Diameter
Ft. in.
Ft. in.
Slot Size Material
in,
in.
Material
LOCATION SKETCH
16.REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUC IED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
—II —0
cJL-
SIGNATURE OF PERSON CONSTRUCTING THE WELL DAttE
Submit the original to 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

297534
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME �(print) ¶D4n Pl l s M-O Pam r , .. CERTIFICATION Y d-/7 (0WELL CONTRACTOR COMPANY NAMIRbP t1T ft10_110,q,-I Weiliryed1-14 rte J PHONEY
STATE WELL CONSTRUCTION PERMITN ASSOCIATED WQPPERMITH
•
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residentialfl- tvt micipal/Public ❑ Industrial ❑ Agricultural 0
Monitoring 0 Recovery ❑ Heat Pump Water Injection ❑ Other CT If Other, List Use
2. WELL LOCATION: Nearest Town: /1,4/VkLr A/ County/A4'n
l�ccc .
.�.�/✓ GSenne+F Ra - Rost Cn...wR- ccvnrn•
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: k. � iV Q� r� k� O LLI S
Address 1 ttCi y�"0 00C; I Aro Its gA
(Taz- say - 3 n7 a_.
Area code- Phone number / �(
4. DATE DRILLED (o_/'-(- _O /
5. TOTAL DEPTH: Co CIO'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO Q1/�
7. STATIC WATER LEVEL Below Top of Casing: 44O0 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
*Top of casing terminated at/or below landsurface requires a
variance In accordance with 15A NCAC 2C.0118. / /
9. YIELD (gpm): - ? 0 METHOD OF TEST h!0)/%y'tej_. o rn
10. WATER ZONES (depth): (o (7o' (�
(Street or Route No.)
City or Town State
e% 73 y
pographic/Land setting
idge ❑Slope ❑Valley OFlat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
0 53' (7/2�
.53' (onil, 8Lvz /(:-rd.vs t"-te.
Zip Code
11. DISINFECTION: Type } 4-/V--f
12. CASING:
Depth Diap�eter or We t/Ft. Matep' I
From 0 To _S-3 Ft. (n" 5.72p,33 QV
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From n To (Z Ft.
From To Ft.
14. SCREEN: Depth Diameter Slot Size - , Material
From To Ft. in. in.
From To Ft, in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Amount
Wall Thickness
16. REMARKS:
(Par ar — pcne.t)
LOCATION SKETCH C
T,4�} 5 Show direction and distance in miles from at (east N
two State Roads or County Roads. Include the road —
numbers and common road names.
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF TH S RECORD H S BEEN PROVIDED TO THE WELL OWNER
G -/ 4- —a cf
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mali Service Center -Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-I REV. 07/2001

297533
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) c.b-e 1$ i'.. ' rl�
WELL CONTRACTOR COMPANY NAME-)b"--^� � CERTIPICATIONY oZ�%(P
STATE WELL CONSTRUCTION PERMITS/
(if applicable) ASSOCIATED WERMITIt
(if applicable)
PHONE 8it,a. ,2 4-3 4 0
1. WELL USE (Check Applicable Box): Residential'rd—tvtunicipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 17 If Other, List Use
2. WELL LOCATION: - Al
arest Town: 0 t/G County / / l Q CvyL
4(41 S Tecc r)+a., ea —nr) Io (an- wrnrn
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
a8-63
3. OWNER: Wilt" na , tut. I.1 n'1
Address I54- �I11n0Stor.- 6_7)//.4
(Street or Route No.)
c;?g93 Lf
^ity or Town State Zip Code
F)/n5 •
Area code- Phone number
4. DATE DRILLED 6 - (b - U cf
5. TOTAL DEPTH: 2 30
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO ni
7. STATIC WATER LEVEL Below Top of Casing: /00 FT.
8. TOP OF CASING IS / (Use "+" if Above Top of Casing)
FT. Above Land Surface*
'Top of casing terminated at/or below landsurface requires a
variance In accordance with ISA NCAC IC .01I8. 9. YIELD (gpm): / 5-METHOD OF TEST I k2u
10. WATER ZONES (depth): , 3 ,CZ) j 3 qt.) -
T graphic/Land setting
dge ❑Slope ❑Valley C)Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
To Formation Description '
DEPTH
From
—2'
S.D' (n0' .V Ppf t-1
' 30' �/,r (r27/„ r y--e.
I I. DISINFECTION: Type LOCATION SKETCH
YP Hili Amount c. FA-. 5 Show direction and distance in miles from
12. CASING: Wall Thickness two State Roads or County Roads. Include
Depth / Diameter or Weight/Ft. Matep- I - numbers and common road names.
From V To C0C' Ft. ? 5-b R,s j Pr
From To Ft.
From To Ft.
13. GROUT: Depth Material () Method l From To r9Z Ft. CQ47 4,17 p(n c)
From To Ft.
14. SCREEN: Depth Diameter Slot Size . . Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK: _
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
at least°
the road'
L
C
G)
O
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THJS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
/tn/t
DATE
SIGNATURE OF PERSON CONSTRUCTING THE WELL
Submit the original to 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

297532
WELL CONSTRUCTION RECORD
Noah Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME �(print) cbe n n l 5 fin I Ti2A �- CERTIFICATION,/ o1/74o
WELL CONTRACTOR COMPANY NAML' 4111 S (kijIr q,rl I11PI1Z) IN I ; t<4 17n e J PHONE r , .Sa L!-3 fl 0
STATE WELL CONSTRUCTION PERMIT./ ASSOCIATED W ERMIT./
(if applicable)
(if applicable)
1. WELL USE (Check Applicable Box): Residential'a,d—(yunicipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other CJ If Other, List Use
2. WELL LOCATION: -
Nearest Town:County �}r)Q(dn,
2/4/ S - (7m, l�iQ Rova. S7b3
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: !C 0 or farm e
Address r�StnkLvMt)(St*7 /
rY I2A1 ) reel a C—)ute No.)/ f n c2 1-7
ity Or Town State Zip Codc
.5-o41— 85/9/
Area code- Phone number
4. DATE DRILLED b -/ 7 —D S/
5. TOTAL DEPTH: 4¥0,5'
To graphic/Land setting
• e DSlope OValley QFlat
(check appropriate box) i
Latitude/longitude of well location
(degrees/mimes/seconds)
Latitude/longitude source:OGPSOTopographic map
(check box)
DRILLING LOG
Formation Description
From
0
DEPTH
To
(p to
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO Q)/`
7. STATIC WATER LEVEL Below Top of Casing: /SO FT.
8. TOP OF CASING IS / (Use"+" if Above Top of Casing)
FT. Above Land Surface*
*Top of cuing terminated at/or below landsurface requires a
variance In aceordanee with 15A NCAC 2C .0118,
9. YIELD (gpm): r2 D METHOD OF TEST
10. WATER ZONES (depth): 3 Op' 3 Se r
11. DISINFECTION: Type
12. CASING:
Depth
T (
From 0 To
From To
From To
13. GROUT:
From n
14. SCREEN: 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.
Diapneter or Weight/ft. Mate 1
Ft. s.1zRa9 Pr
Ft
Method
ptTlet
Depth
i� Material
To rZ(Z Ft. pr�
From To Ft.
Depth
16. REMARKS:
P I �,
v,A-4/1-7,n P
l LLI Z L I`4.., ; 1-4
LOCATION SKETCH
Hill Amount o277)-.4 5 Show direction and distance in miles from at least
Wall Thickness two State Roads or County Roads. Include the ad
numbers and common road names.
C
IV
v
w
O
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF mi
S RECORD S BEEN PROVIDED TO THE WELL OWNER
a 0-10
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mall Service Center -Raleigh, NC
27699-1636 Phone No. [phone], within 30 days.
OW -I REV. 07/2001
cn z
c,

297080
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section1/-
I•CERTIFICATION# or./7 le
WELL CONTRACTOR COMPANY NAM& C hn S f t) JIO,/,u-I I/Jpi O Yrt I I �r Tn t' PHONE M
STATE WELL CONSTRUCTION PERMITS f '
WELL CONSTRUCTION RECORD
WELL. CONTRACTOR (INDIVIDUAL) NAME (print) 7)4n P1 S l�,) J(0,� A,
(if applicable)
ASSOCIATED W ERMIT#
(if applicable)
I. WELL USE (Check Applicable Box): ResidentialT:3---V nicipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELLLOCATIO,N:
Nearest Town: I-79 ✓ICL; I1/ County Al ac.GVC.
4-4tCco- C. z.aa Q ecm-Pa.,3 S (-I—I5G
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code) a S 4 3l(
3. OWNER: QM CT/ine G l
Address - (FG cb-ep,r,._ la
(Street orRoute No,)
P I2 3 a 7
City or Towfi State Zip Code
&S o)- s £'I - '.) ;- (I- L
Area code. Phone number //
4. DATE DRILLED C-
5. TOTAL DEPTH: e aS'
Qpographic/Land setting
edge ❑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
To Formation Description
99.2 Cons' IU u c (:-ran•,- 2
From
0
4e(o'
6, DOES WELL REPLACE EXISTING WELL? YES 0 NO 123.---"
7. STATIC WATER LEVEL Below Top of Casing: 1 o)0 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface'
*Top of casing terminated at/or below landsurface requires a
variance In accordance with ISA NCAC 2C .0118. //
9. YIELD(gpm): '/ METHOD OF TEST_hl/A///7ft.
10. WATER ZONES (depth): 30
LOCATION SKETCH
0
c_
11. DISINFECTION: Type At-N-1 Amount ,2 T1O-4 5 Show direction and distance in miles from at lean
12. CASING: Wall Thickness two State Roads or County Roads. Include the road,
Depth Dia eter or We'i,(;ht1Ft. Mate '' I numbers- and common road names.
From 0 To __ Ft.� S,j2 fi-,$ 3 k' �,
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From h To r�{7 Ft. 09� Dili na)A�
From To Ft.
14. SCREEN: Depth Diameter Slot Size - , Materiel
From To Ft. in. in,
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THE S RECORD HAS BEEN PROVIDED TO THE WELL OWNER
IRS(`
SIGNATURE OF PERSON CONSTRUCTING THE WELL
DATE
Submit the original to the 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
W rt. Y_
m-
c� -

WELL CONSTRUCTION RECORD
North Carolina - Department of Environmeht and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) c�f) h i S 4nL 1Owt A, t
I'! r r � � CERTIFICATION # oZ1%
WELL CONTRACTOR COMPANY NAMS>1»11 S Pin PO ',Art 11)el I a1Y'jJ I Alta T'Pt is 1 PHONE atilitc 4-3 6
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED W ERMIT$
(ifapplicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential'u--lvtunicipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other Cr If Other, List Use
2. WELL LOCATION: Nearest Town: rY1 tileL; 4/ County, r `(,), 6enro(tleeCom • R, cew. CALLA. to3 y
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: S e kJ ET 128 ty-tq_.,
Address ( fA.ed e
(Street or Route No.)
�VOinleIn3 AJG n`203
City or Town State Zip Code
.53 f - 5 .39_
Area code- Phone number
4. DATE DRILLED 6 -,9. S y 5. TOTAL DEPTH: O2SS'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: 90 FT.
(Use •'+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
*Top of casing terminated at/or below landsurface requires a
variance In accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 3 D METHOD OFTEST_//D)/fi7L({-.
10. WATER ZONES (depth): 2 9-0 (�
11. DISINFECTION: Type {t-i'/-% Amount ca A-A5
12. CASING: Wall Thickness
Depth Dia eter or We�ItUFt.
From 0. To l0)5 Ft. " -bR,37
From To Ft.
From To Ft.
13. GROUT: Depth
From n To , D
From To
14. SCREEN: Depth Material
From To
From To
15. SAND/GRAVEL PACK:
Depth
From To Ft.
From To Ft.
pY
16. REMARKS:
Material
Ft. (ly yyt o,i
Ft.
Diameter Slot Size •
Ft. in. in.
Ft. in. in.
Method
prn4.4—.)
Size Material
T ographic/Land setting
alKidge ❑Slope, ❑Valley LFIat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
Formation Description
DEPTH
From
To
n (n Cr
(On'
IDS'
c.255'
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. e
r
G�
CO
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF TH S RECORD H S 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 Mall Service Center -Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
297078
North Carolina - Department of Environment and Natural Resources - Division1of Water Quality - Groundwater Section /-
WELL CONTRACTOR (INDIVIDUAL) NAME (print) t?P f) P1 t s /tin/iOiA rti • . CERTIFICATION If or-n7/7 Y
WELL CONTRACTOR COMPANYNAM6b',()f IS 1d110teA W19-0 PII -7—YyP J PHONE Nil-V_524-3 gb 0
STATE WELL CONSTRUCTION PERMIT,/ ASSOCIATED W E /RMITY
(if applicable)
(if applicable)
1. WELL USE (Check Applicable Box): Residential' unicipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other U If Other, List Use
2. WELL LOCATION:
Nearest Town: /7; 6f Lf}/1/j 5 County Al Q (_,ry)._-,
Ni hla„as— Webb rntraJ _,Qk74-/
(Streel(aine, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: "-a)-e nY ?-1)o H-S
Address 10 019 14 C K S R c+
(Street or Route No.)
)licjh\Ca,...>S A/C_—
CiryCdr Ton State
05t)- 7 7 —c cf u &
Zip Code
Area code- Phone number
4. DATE DRILLED (1 4) 9 -D L/
5. TOTAL DEPTH: 705'
Topo_grapLand setting
❑Ridge @Slope ❑Valley QF1at
(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
n 23' rrI
op-3/ '%7S' /31U8- 7,-VO/ni7-P—
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 0-
7. STATIC WATER LEVEL Below Top of Casing: /S0 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface'
'Top of casing terminated at/or below landsurface requires a
variance In accordance with ISA NCAC 3C.0118. ` /
9. YIELD(gpm): /5 METHOD OF TEST hfkeit
10. WATER ZONES (depth): 5` fs'
LOCATION SKETCH
11. DISINFECTION: Type hl---/'A Amount r-..2 TA -A 5 Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads. Include the road
Depth 2 Ft Diameter S or We t/Pt. Matep l numbers and common road names. p
0 From To J (Z� ,�2R.3 . PYCam. .�
From To Ft. r_
From To Ft. CT-
t
13. GROUT: Depth Material Method
From n To c 17 Ft. ec- y/, C'
From To Ft. ---0
14. SCREEN: Depth Diameter Slot Size • Material
From To Ft. in. in. W
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
.c-
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF TH S RECORD S 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 Mall Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

STATE WELL CONSTRUCTION PER1rIT4 - ASSOCL\TED WQ PERNI17
' (if applicable) - - (ifaoolleab1e)
WELL USE (Check' Applicable Box): Residential Municipal/Public❑ Industrial ❑ Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 -other 0 It Other, Lis: Use
WELL LOCATION
Nearest Town: Otto - Coun!y Macon
Covered Tree Lane
(Street Nana, Numbers, Community, Subdivision Lot No:, Zip Code)
3. OWNER. Rich-Mest
4
5
6
7
WELL CONSTRUCTION RECORD
2197092
North Carolina • Deportment ofEnvironment and Natural Resources - Division of Water Quality - Groundwater Section
• WELL CONTRACTOR(IN'DIVIDUAL)NA,ME (print) ?atone? D, Cook CERTIFICATION 4 20d3
WELL CONTRACTOR COMPANY NAME HECifE3schtt•es cif. Q'i11ir>,r Tit PHONE #.ai1 369-9591
Address 1507 Ventana Drive
r Route N
Runkin, FLreet 33573 ? )
• City or Town State Zlp Code
(941)• 351-R277
Area coda Phone number
DATE DRILLED 5-17-04
TOTAL DEPTH: 425'
DOES WELL REPLACE EXISTING WELL? YES 0 NO I
STATIC WATER LEVEL Below Top of Casing: 215' FT,
TOP OF CASING IS 2 (UOe '`Above Top of Caging)
FT. Above Land Surface`
•Top.oteasing terminated odor below land surface requires a
variance to accordance with ISA NCAC 2C .0118
9. YIELD (gpm): .6 METHOD OF TEST blow
. 10, WATER ZONES (depth): 180' & 310; '
II. DISINFECTION: Type H T H - Amount 1 6oz
12. CASING: Wall Thickness
From • Do 39 Depth Diameter or Weight/Pi "Material
Ft. 6 y�c..
Frans 34To=Ft. 6 S
From To.. ..Ft.
13 GROUT. Depth Material • Met?,cd
From n ` To 20 nrztite & caret r
From To Ft'
14 SCREEN ' Depth ' Diameter Slot Size Material --
From ,.To Ft, in in
From To. Ft in. in.
15. SAND/GRAVEL PACK
Depth Size Material
From To Ft
.:. From To Ft
16, REMARKS:
DEPTH
From To
0 41'
41' 425'
Topographic/Land setting'
❑Ridge ❑Slope ❑Valley ❑Flat
(cheek appropriate box)
Latitude/longltuds of Well location
(degrees/i, .1 tesheconds) :
_ctitudc longitude source:OGPSOTopograohic mop
(check box)
DRILLING LOG
Formation Description
clam & Ord
granite
LOCATION SKETCH, •
Show direclion:and distance in miles from at least
two State Roads or Coudty Roads. Include the {gad
nurnbers and rnr,,....,.. road .._-_
I DO HERESY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS SEEN PROVIDED T07H: WELL OWNER
2,1�LDo n _L
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE..
Submit the original to the Division. of IYaterQuality, Groundwater Section, 1636 Marl Service Center• Raleigh, NC
27699.1636 Phone No [phone], within 30.days.
GWI REV. ov:po1

WELL CONSTRUCTION RECORD
297091
North Cruolhna Department of Environment and Natural Resources - Division of Water Quality -:Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAME `(prinq Mitchell D. Cook CERTIFICATIONS 2O 3
WELL CON"' FACTOR COMIPANYi'ANIE iefeen E"t(Y^,S Fell Q-iliwc,- Dr PHONE gp25 ) 369-9591
5'rATE WELL COi\STRUCTION PERMIT* : ASSOCIATED WQ PERMITS
(if applicable) - (ifadolieable).:
1 WELL USE (Check Applicable Box), Residential Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 : Heat Pump Water Injection 0 Other ❑.lf Other, Lis: Use
2, WELL LOCATION:
Nearest Town: Highlands CountyMacon
Hickory Nut Gap
(Street Name, Numbers, Ccmm unity, Subdi vsi on, Lot No., ZIP Code) .
3 'OWNER: Timberland Investors
Addross Po Box 7497
(Street or Route No.)
Macon, GA 31209
City or Town ' State Zip Code
(800 )- 763-9083
Area code• Phone rmmber
Topog,rapnic/Land setting'
:Ridge ❑S!oce ,❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degretehrutoeeAeccads)
Latitudes/ion itudesource:OGPS❑Topographic map
(check bon)
DEPTH DRILLING LOG
From To Formation Description
0 40' clan & End
401 1200' granite
LOCATION S KETCF[
Show direction and distance in miles from at len:-
12 CASING Wail Thickness two State Roads or County Roads. Include the road
From 0 ToDeptn 42 Ft Diifimeter or1Weight/Ft.. Materiia1 numbers and common road names. t
6st
From To Ft. 1.
From.. To:. .:.Ft
13, ;GROUT: Depth Material Method
4, DATE DRILLED 5-6-04
5.TOTAL DEPTH. 1200'
6. DOES WELL REPLACE EXISTING WELL? YES ❑.NO 30t,c
7. STATIC WATER LEVEL. Below Top cffCasing: 1075 FT.
(Use "✓'tf Above Top of Casing)
S, TOP OF CASINO IS 2 FT. Above Lana Surface*
*Top of casing terminated at!or below land surface requlres a
variance In accordance with ISA NCAC 2C .0118.
9, YIELD (gpm); 2 METHOD OF TEST blow
10, WATER ZONES (depth); 1040'
II DISINFECTION: Type H T H Amount 1602
From 0 To 20 Fttite & csB;t nrgt
From To Ft:-
14 SCREEN. ' Depth Diameter Slot Size Material
From To '. Ft in,
In
From To - Ft:. in.
15. SAND/GRAVEL PACK
Depth Size Material
From To Ft:
From To. -Ft.
16.. REMARKS:
Gl
w
1 Do HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA .NCAC 2C, WELL
CONSTRUCTION STANDARDS AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDE TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL ern V
DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mall Service Center -Raleigh, NC
27699.1636 Phonc Na,. [phone], within 30 days• •
OW -I REV. 07/20b1_._
LID
n_

297282
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) c2.e f) M I S /)-n / in n d, - - CERTIFICATIONS of /7 (e
WELL CONTRACTOR COMPANY NAMIChinjC 'ttl)d-i IJMI I I Tit a PHONES &i_524-3 6
STATE WELL CONSTRUCTION PERMITS ASSOCIATED W ERMITH (if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential' unicipaVPublic 0 Industrial 0 Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other Cf If Other, List Use
2. WELL LOCATION:``t�//--
Nearest Town: /-iz County 41 42 Gc
(fill S 0t-fp Cninim�, Sht� CGz -Qd
3. OWNER: JA/�'. C / ®/l(Ekci
Address /37 r5; s ,CC4
(Street or Route No.)
n�ea-' C7a- 3o(O en
City or Town State Zip Code
)- .sc2Y_ ` 3o9
Area code- Phone number/
4. DATE DRILLED ( —/ 7 - U
Li
5. TOTAL DEPTH: 1/47 3
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 1-
7. STATIC WATER LEVEL Below Top of Casing: -(7 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance In accordance with ISA NCAC 2C .0118. /
9. YIELD (gpm)' METHOD OF TEST A/07/1/7f�f-,
10. WATER ZONES (depth): (r+.`i Q
LOCATION SKETCH
I I . DISINFECTION: Type ll -1 -1 Amount TA -A 5 Show direction and distance in miles from at lean
l2. CASING: Wall Thickness two State Roads or County Roads. Include the road =_
Depth Diae•t�er or Weight/ft. Matep. I numbers and common road names.
To -5-0 Ft /�" S-b/R,$7 PY
To Ft.
To Ft.
13. Depth Material Method
t
To r Ft. now f)o�./
To Ft.
(Street Name, Numbers, Community, Subdivision, Lot No., Zi Code) f 763
�Topographie/Land setting
idge ❑Slope ❑Valley QFlat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
QEPTH DRILLING LOG
From To Formation Description
r) SV clay
.52, • (is 13
From
0
From
From
GROUT:
From n
From
14. SCREEN: Depth Diameter . Slot Size - Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK: _
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF TH S RECORD S BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
c-
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mall Service Center -Raleigh, NC,
27699-1636 Phone No. [phone], within 30 days. GW-I REV. 07/200t

To /o 3 Ft._
From To Ft.
From To Ft.
13. GROUT: Depth
From () To_, Ft.
From To Ft.
14. SCREEN: Depth
From To
From To
15. SAND/GRAVEL PACK:
0
LOCATION SKETCH
11. DISINFECTION: Type it -/'/F Amount %/ ?-g 5 Show direction and distance in miles from at (east
12. CASING: Wall Thickness two State Roads or County Roads. Include the road
Depth Dia eter or Weint. Material numbers and common road names.
' SP.g" Ste,/
297281,
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section �"" WELL CONTRACTOR (INDIVIDUAL) NAME (print) [7). f) vt I S l II N rA rig . - e CERTIFICATION eZ /7 et
WELL CONTRACTOR COMPANYNAMIV,.Cbt')r4 jtLOf)Q,y, -LJjMj la-lYs I1;14 A�PtP PHONE Mira. 4-3 n 0
STATE WELL CONSTRUCTION PERMITN ASSOCIATED W6r'ERMITM (if applicable) (if applicable) .
1. WELL USE (Check Applicable Box): Residential' unicipal/Public 0 Industrial 0 Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other CT If Other, List Use
2. WELL LOCATION:
Nearest Town: PP,&44 L) 4/ County / " a rim--
e 11 5 Cketo,12Z_Ill aShhiuus-)1 Q,e4_ f�
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code) 7 3 I
3. OWNER: mQ b(utJ
Address I9(4-n Mash If) LIr 2, (2d
(Street or Route No.)
rram()InD /1,/C.. (-Q 17.3 Y
City or Town State Zip Code
-)9- #2/, 9
Area code- Phone number/ ^ U 4. DATE DRILLED (� — . 3
5. TOTAL DEPTH: 3 7,5
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO UJ-
7. STATIC WATER LEVEL Below Top of Casing: 0 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface'
'Top of casing terminated at/or below landsurface requires a
variance In accordance with ISA NCAC 2C .0118. /
9. YIELD (gpm): /0 METHOD OF TEST
10. WATER ZONES (depth): .3w.�`"
Topographic/Land setting
❑Ridge ❑Slope ❑Valley r4F+ar---
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
To Formation Description
(oo C 1 lb
(,,3'
DEPTH
From
n
n'
/L7'I CI'S f1Xt_o--
7 oieIUL VO4n,i-C
From 0
Material Method
ec4nar7 poe4A )
Diameter Slot Size Material
Ft. in. in.
Ft. in. in.
Size Material
From Ft.
From Ft.
Depth
To
To
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF TH S RECORD H S 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 Mal( Service Center Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Doparlment of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR(IND!AIDEAL)NAME (print) James B Brown CERTIFICATION 2045
WELL CONTRACTOR co>tPANv nAnlEHedden Brothers Well Drilling, Inc PHONE = 828'1 369-9591
STATE WELL CONSTRUCTION PER,WIT= ASSOCIATED \\ Q PERMIT=
(if acalicable) (if annlicable)
297308
I. WELL USE (Check Applicable Box): Residential NlunicipatPublic 0 Industrial 0 Agricultural ❑
NIonitoring 0 Recovery ❑ Heat Pump Waver Injection 0 Other 0 1(0ther, List Use
2. WELL LOCATION:
Nearest Town: Franklin County Macon
Featherstone —Well #4—Lot #29
(Street Nacre, Numbers, Community, Subdivision, Lot No., Zip Code)
3- OWNER: Bill Vernon
.-Address 4248 Burningtown Rd
(Sine: er Route No.)
Franklin, NC 28734
City or Town State Zip Code
(828- 524-0863
Area code- Phc::;e number
4. DATE DRILLED 5-27-04
5, TOTALDEPTH: 600'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO SX
7. STATIC WATER LEVEL Below Top of Casing:400 FT.
(Lis:"--" if Above Top of Casing)
S. TOP OF CASING IS 2 FT. Above Land Surface'
'Top of casing terminated atror below Iand surface requires a
variance In accordance with 15A NCAC 2C .011S.
9. YIELD (gprn): 4 NIETHOD OF TEST blow
10. WATER ZONES (depth): 65' 82', & 418'
11. DISINFECTION: Type
12l CASING:
Depth
From 0 To 44
From 44' To 48
From To
13, GROUT: Depth
From 0 To 20
From To
14. SCREEN: Depth
From To
From To
15. SAND/GRAVEL PACK:
Depth Size
H T H Amount 16 oz
Wall Thickness
Diameter or Weight'Ft. Material
Ft. 6" pvc
Ft. 6" .188 steel
Ft.
Material Nlethod
Ft. tarnite & 1,1iL pumped
Ft.
Diameter Slot Size Material
Ft. in. in.
FL in. in.
From To
From To
Ft
Ft.
Material
Topographic/Land setting'
❑Ridee ❑Slope ❑Valley ❑Flat
(c:hz:k appropriate bey)
Latitude.'lonsitude of well location
(degrees. minutes/seconds)
a:it udc.'lon_itade source.❑GPS❑Toco_ra?hic map
(check boar
DEPTH DRILLING LOG
From To Formation, Description
0 46' clay & sand
46' 600' granite
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. tta
fV
c�
MWo
0
W
0)
16. REMARKS:
I D0 HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STAND.R, AND THAT A CO)? OF 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 JlaiI Service Center • Raleigh, NC
27699-1636 Phone No, [phone], within 30 days. GW-I REV. 07.2'301