Well Construction Records Avery CY2000

A a North Carolina Department of Environment and Natural Resources-Division of Water Quality•Groundwater Section
t 636 trMaFI SeNIce Center-Raleigh,N.C.27699-1636-Phone[phone] r!
r °` ySWELL CONSTRUCTION RECORD
WELL CONTRACTOR:
WELL CONTRACTOR CERTIFICATION f/:
,r STATE WELL CONSTRUCTION PERMIT
It:
1 ' i ELL USE(Check Applicable sox): Residential['=f Municipal ❑ Industrial❑ Agricultural❑ Monitoring❑ T r
Recovery❑ Heat Pump Water Injection
u ; eyC [] Other If Other, List Use:
WELL LOGATIONi(Showsketch of)he location below)
arestTown f �
KCLACounty: a
yy,q, i / Au e-R
k r Yt P..'ii sf1M
} r 4^k�„ ,(Road Name and umbers,Community or Subdivision and Lot No.) DRILLING LOG DEPTH L"`'x S3r
OWNER fi:
T=
` Address From To7 Formation
y DescrlpGon
tr
ait or
State Zip Cocje A'
4 DATE DRILLED` r.. t°�-t
5 ;iTOTALDEPTH fY5
6 WCUTTINGS COLLECTED YES[] NO[-4-'
-7 `;DOES WELL REPLACE EXISTING WELL? YES Q NOE �E
8,` STATIC WATER LEVEL Below Top of Casing: FT, t,4
s
TO OF GASING IS (Use•+•if Above lop or Casing)
FT.Above Land Surface*
'Top of casing terminated atlor below land surface requires a variance in eccor-
dance with 15A NCAC 2C.0118
10. YIELD(gpm): METHOD OF TEST_ �rxL%,c�
' 11 WATER ZONES(depth):_ At
?12 CHLORINATION: Type e h10 /wc= Amount
t r 13 CASING ,J If additional space is needed use back of form
Wall Thickness LOCATION SKETCH
Depth Diam t r
From p or A r t. Material (Show direction and distance from at least two Stale �
O To Ft. r - Roads,or other map reference points)TOM s
'From To Ft.
To Ft.-
GROUT.,
Depth Material Method M �- -;
From To 20 Ft. G':�I �t czt r
From To Ft.
�•a:
15. SCREEN: - v
Depth Diameter Slot Size Material rn
From To Ft in. in. tv. cn T
rJ
From To Ft. in. in. =r
From To Ft. in. in.
16. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
t From To FL
17 REMARKS: r
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
1 CONSTRUCTION STANDARDS,AND THAT A COPY OF T S RECORD HAS O IDED TO THE WELL OWNER i'
FOR OFFICE USE ONLY
Quad No s a
i SIGNAT�PE'SONONSTRUCTING THE WELL DATE '
F.S�lbmil',onpi�al to Division of water Quality,Groundwater Section Within 30 days Serial No. r _. ' :!• '
GW1 REV 12199

North Carolina-Department of Environment and Nafural Resources - Div;;ion of Wiler Ounlily-Groundwater Section 226511
1636 Mail Service Center-Raleigh,N.C.27699.1636-Phone(919)733-'J;21
WELL CONSTRUCTION RECORD wl.Lt. GONTRACTOIt:
WELL CONTRACTOR CERTIFICATION #:
STATE WELL CONSTRUCTION PERMIT#:
1• WELL USE(Check Applicable Box): Residential
Recovery Municipal Industrial❑ Agricultural❑ Monitoring ❑
ry❑ Heat Pump Water Injection � OIhCr ] If Other, list Use:
2. WELL LOCATION: (Show sketch of thrl location below)
Nearest Town: 1K ' ,�4,g LL
(Road Name and Numbers,Community,or Suhdivision and Lot Nn.) nRILLING LOG
3. OWNER �r'r_I� _- 'Pro DEPTH
Address ---"---- -- — �rnrn To Formation Descriptions o
Rom. ;P1
City or Town
Cndr --
4. DATE DRILLED J�7-C Zi��
5. TOTAL DEPTH U.
6. CUTTINGS COLLECTED YES N y
7. DOES WELL REPLACE EXISTING WELL? [VJ
8. STATIC WATER LEVEL Below Top of Casing: Fr.L�
9' FT.
9. TOP OF CASING IS / (Uso-+•it Above Top of Casing)
r FT.Above Land Surface'
*Top of casing terminated atlor below land surface requires a variance In accor-
dance with 15A NCAC 2�C.�.0r�118 `
10. YIELD(gpm): scx.__-•METHOD OF TEST
11- WATER ZONES (depth):_ � 7S CI`�
12. CHLORINATION: Type led-" Amount s - --- -
13. CASING: If additional space is needed use back of form
Depth Wall Thickness LOCATION SKETCH
p Diamelor or Weight/Fl. t'taterial (Show direction and distance from at least two State
From�To 3 y Fl. c'745� ,/R9 qq,
From To Ft. cam— Ronds,or other map reference points)
_
From —To Ft. _ o
14, GROUT: q
Depth Material Method
From From To _9 Ft.
To Ft. ---- - _
15. SCREEN:
Depth Diameter Slot Size Material rri
From To Ft in.
in. fV C/1
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:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STANDARDS,AND THAT A�COPYTHISORRO ED TO THE WELL OWNER.
EFOROFFICE USE ONLY
No:
i ial �E� P �)�� ri SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
u­47 t'd 1� +�)bmorip r alio Divistnn of Waler Quality,Groundwater Section Within 30 days
No. r i� `1
�i ' GW-1 REV. 12/99

i North Carolina•Department of Environment and Nahual Resrnurn, • Divi:inn of Wnmr O,i;flity-Groundwater Section 226509
1636 Mail Service Center-Raleigh, N.C.27699-1 636-Phone(919) 731-;i;:'21
j WELL CONSTRUCTION RECORD VNELL_ CONrRACTOR:
WELL CONTRACTOR CERTIFICATION
j STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE(Check Applicable Box): Residential Municipal ❑ Industrial❑ Agricultural❑ Monitoring ❑
Recovery❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATION:(Show s h of the location below)
Nearest Town:__ ZI R4-)A-Q. County:_ -u 51 ,�'`4
(Road Name and Numbers,Community,or Subdivision and Lot No.) DRILLING LOG DEPTH
3. OWNER 4, Lam, Grz,'��
Address
From To Formation Description
�
or houie No.)C a���Z �� -
City or Town Stag Zip Code "--
4. DATE DRILLED --
5. TOTAL DEPTH _.___ ._..
6. CUTTINGS COLLECTED YES❑ NO[ � �_-
7. DOES WELL REPLACE EXISTING WELL? YES [] NO
S. STATIC WATER LEVEL Below Top of Casing: FT.
(Use'+'it Above Top of Casino)
9. TOP OF CASING IS FT.Above Land Surfaco'
'Top of casing terminated at/or below land surface requires a variance In accor-
dance with 15A NCAC 2C.01:101
10. YIELD(gpm): 'METHOD OF TEST
11. WATER ZONES(depth):��g�1 R 6-
12. CHLORINATION: Type -c-1Z L/?i r Xt Amount If additional space is needed use back of form
13. CASING:
Wall Thickness LOCATION SKETCH
ODepth Diameter or Weight/A. e.nai (Show direction and distance from at least two State
From To _141 Ft. y 5ch, �- Roads,or other map reference points) Q
From To Ft.—
From To Ft.
14. GROUT: c
Depth Material Method � -
From © To 20 Ft.
From To Ft. 1cJ
-:
15. SCREEN:
Depth Diameter Slot Size Material r'`~
CJ7
From To Ft in. — in.—
From To Ft. in. — in. --
From To Ft. in,
16. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
17. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDAN WITH 15A NCAC 2C,WELL
CONSTRUCTION STANDARDS,AND THAT A COPY OF TH RECORD H<BEEN P O DED TO THE WELL OWNER.
FOR OFFICE USE ONLY �� %%'ICE 'o0
Quad No: SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
S%,mit original to Division of Water Duality,Groundwater Section within 30 days
Serial No.
- GW-1 REV. 12/99

North Carolina•Department of Environment and Natural Resources-Division of Wnter(duality-Groundwater Section 2 2 6 ) O
1636 Mail Service Center-Raleigh, N.C.27699-1636-Phono(919)733-32 21 _ / l
WELL CONSTRUCTION RECORD WELL CONTRACTOR: �') �-, ��/ l���� r /�rDV
-3
WELL CONTRACTOR CERTIFICATION #: nc5c7 U
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE(Check Applicable Box): Residential Municipal ❑ Industrial❑ Agricultural❑ Monitoring ❑
Recovery❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATION:(Show sketch of the location below)
'., Nearest Town: W /1•fd, E1 k Counry:
(Road Nameeaa 1 Numbers,Commuunnit or Subei 1i n and L I No.) DRILLING LOG DEPTH
3. OWNER �„41�`{llel� ►C,c�R► t�i. From To Formation Description
Address
Q , treot o o a o.
City or Town Stale Zip Code � �-
4. DATE DRILLEDy`
5. TOTAL DEPTH
6. CUTTINGS COLLECTED YES❑ NOEa'
7. DOES WELL REPLACE EXISTING WELL? YES ❑ NOE5,
8. STATIC WATER LEVEL Below Top of Casing: FT.
i (Use'+'if 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 15A NCAC 2C.0118
10. YIELD(gpm): C3 METHOD OF TEST
11. WATER ZONES(depth): 15 6 42
12. CHLORINATION: Type Amount It additional space is needed use back of form
13. CASING:
Wall Thickness LOCATION SKETCH
Depth Diamolor or Weight/Fl, Material (Show direction and distance from at least two State
`
From To-122 Ft.(2 X Roads,or other map reference points)
From �To Ft.J�-
�`�
From To Ft.
14. GROUT: C�
Depth Material Method
From To a� Ft. �Re —r1 n
From To Ft. c
15. SCREEN:
Depth Diameter Slot Size Material
From To Ft in, in. v
From To Ft. in. in.
From To Ft. in, in. ut
16. SAND/GRAVEL PACK: `D
Depth Size Material ~
From To Ft.
From To Ft.
17. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
4 CONSTRUCTION STANDARDS,AND THAT A COPY OF THIS RECPRD+KS-I3&W PROVIDED TO THE WELL OWNER.
FOR OFFICE USE ONLY
Ouad No: SIGNATURE OF PERSON COFSTAUCTING THE WELL DATE
�` E P �i p� �� � ubkrnt Original to Division of Water Quality,Groundwater Section within 30 days
Serial No. 0J 1+ p '-, i l GW1 REV.12/99
, I
y

North Carolina-Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section `3 Q p`
1636 Mail Service Center-Raleigh,N.C.27699-1636-Phone[phone] `'�J Q 5
WELL CONSTRUCTION RECORD WELL CONTRACTOR: vw
Z n
eey vvritiiii'vr•eu rut-rip- Lam., Nto.
WELL CONTRACTOR CERTIFICATION#: `
000621 STATE WELL CONSTRUCTION PERMIT#: eshe Neece
1. WELL USE (Check Applicable Box): Residential Municipal 0 Industrial 0 Agricultural F� Monitoring El
Recovery 0 Heat Pump Water Injection Other 0 If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: 6,=,NNER ELK County: i=VERY
ROCKY PARK VAY OFF ROCKY KNOB RD. OFF SHAOk N
(Road Name and Numbers,Community,or Subdivision and Lot No.) DRILLING LOG DEPTH
3. OWNER ROBERT INGALLS From To Formation Description
Address P.O. SOX 1959 , 0 14 DIRT
BANNER'�Lt�or Route No.) NC 28604 14 600 GRANI T E
City or Town State Zip Code
4. DATE DRILLED -11/20/2000
5. TOTAL DEPTH 000 _ o
6. CUTTINGS COLLECTED YES ED NO 0 C_;Do
7. DOES WELL REPLACE EXISTING WELL? YES 0 NO ^ C;-"
8. STATIC WATER LEVEL Below Top of Casing: 120 FT. —
(Use"+"if Above Top of Casing) .� 90
9. TOP OF CASING IS 1 FT.Above Land Surface* ::2 r''c
*Top of casing terminated at/or below land surface requires a variance in accor- r•�
dance with 15A NCAC 2C.0118 r r"-
10. YIELD (gpm): 1 METHOD OF TEST Air rr'�'
a Npm UNKNOWJI 0 Aprli —'
11. WATER ZONES (depth): � r.ID
0 Apm 0 ppm
12. CHLORINATION: Type ,-FFH Amount 96 If additional space is needed use back of form
13. CASING: wall Thickness LOCATION SKETCH
Depth Diameter or Weight/Ft. Material (Show direction and distance from at least two State
From 0 To 21 Ft. 6 1/4 .186 GALV. � Roads,or other map reference points)From To Ft. �
From To Ft.
14. GROUT:
Depth Material Method
From 0 To 20 Ft. Cement Gravity Flow
From To Ft. o � j
15. SCREEN: IDO
Depth Diameter Slot Size Material
From To Ft. in. in. Y
From To Ft. in. in. Y ,� ��' pCd ���•m
From To Ft in. in.
16. SAND/GRAN L'` .�C
s Dth +- �_ S1e) ; ( Material
From �` �� To Ft. t }
L IV
From
17. 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.
FOR OFFICE USE ONLY
SIGNATURE OF PE ON CONSTRUCTING THE WELL DATE
Quad No: Submit original to Division of Water Quality,Groundwater Section within 30 days
GW-1 REV.12/99
Serial No.

North Carolina-Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section 4. 2 2 5 5 3 .
1636 Mail Service Center-Raleigh,N.C.27699-1636-Phone[phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR: Dewey Wright Well Pump Co., Inc.
WELL CONTRACTOR CERTIFICATION 4.
000696 STATE WELL CONSTRUCTION PERMIT4. es le eece
1. WELL USE (Check Applicable Box): Residential F Municipal 0 Industrial EJ Agricultural 0 Monitoring F
Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: BANNER ELK County: AVERY
GARY GWYN RD.OFF ELK RIVER RDM305
(Road Name and Numbers,Community,or Subdivision and Lot No.) DRILLING LOG DEPTH
3. OWNER _-RICHARD ROSENLUND From To Formation Description
Address %BURTON CONSTR. . P.O. BOX 24 0 20 DIRT
LI NVI LLE�street or Route No.) NC 28646 20 103 GRANITE
City or Town State Zip Code 103 104 SHALE
4. DATE DRILLED 11/14/2000 104 261 GRANITE
5. TOTAL DEPTH 285 261 262 SHALE
6. CUTTINGS COLLECTED YES 0 NO © 262 285 GRANITE
7. DOES WELL REPLACE EXISTING WELL? YES NO E
8. STATIC WATER LEVEL Below Top of Casing: 100 FT.
(Use"+"if Above Top of Casing)
9. TOP OF CASING IS 1 FT.Above Land Surface* rn ern
*Top of casing terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2C.0118 2
10. YIELD(gpm): 30 METHOD OF TEST Air V===
11. WATER ZONES (depth):1/2 ;;pm 103-104 29.5 ppm 2 11-262
0 s7pm 0 qpm �'aw
12. CHLORINATION: Type HTH Amount 39 If additional space is needed use big of fag
13. CASING: LOCATION SKETCH
Wall Thickness
Depth Diameter or Weight/Ft. Material (Show direction and distance from at least two State
From 0 To 23 Ft. 6 1/8 .350 PVC Roads,or other map reference points)
From To Ft.
From To Ft. t
14. GROUT: X+"
Depth Material Method \�
From 0 To 20 Ft. Cement Gravity Flow
From To Ft. It
15. SCREEN:
Depth Diameter Slot Size Material �t
From To Ft. in. in.
From To Ft. in. in. Q
From To Ft. in. in.
16. SAND/GRAVEL PACK:
Depth Size Material
From To Ft. 110
�
From To Ft.
2
:_,. off' ,OS�
17. REMARKS: `� )05
1 DO HEREBY C �- J _.1 /E V1� SGCONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION NDARDS, ND T AT"A G 2Y OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
00
FOR OFFICE US Y �)
SIGNATURE OF PERSO CONSTRUCTING THE WELL DATE
Quad No: Subm'0gi1,f, original to Division of Water Quality,Groundwater Section within 30 days
' ` 4 GW-1 REV.12/99
--. ne�liiS t arnt t i tliPi�ri
Serial No.

North Carolina•Department of Environment and Natuml RCSOUrCnS -Divisinn of Warer Oi.inlity-Groundwater Section 226507
1636 Mail Service Center-Raleigh,N.C.27699-1636-Phono(919)733.13 121
WELL CONSTRUCTION RECORD WELL CONTRACTOR: i�/� �c� `�—)�' r l/�J
WELL CONTRACTOR CERTIFICATION
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE(Check Applicable Box): Residential©_� Municipal ❑ Industrial❑ Agricultural❑ Monitoring ❑
Recovery❑ Heat Pump Water Injection ❑ Other (] If Other, List Use:
2. WELL LOCATION' (Show sketch of the location below)Nearest Town:—_LV�t�%�+Uc( County:�/`"/1C�,C
—�-
(Road Name and 17umbes.Community or Subdivision and Lot No.) _nRILLING LOG DEPTH
3. OWNER �h�c'� 1-���,'�;�(� '-h(;c�- A, tom _
ire From To Formation Description
Address GCZ ��/et or out C — (o < -- `- _ _C� ;
�f�� t—
S _ c.
City ir Town -- -
4. DATE DRILLED ��-it - -----
5. TOTAL DEPTH PCHO - _........._.___......._..__.._.__
6. CUTTINGS COLLECTED YES[-] NO[- _ _ _
7. DOES WELL REPLACE EXISTING WELI.? YES
8. STATIC WATER LEVEL Below Top g:of Casing: FT.
(Use'+'it Above'rop of Casing)
9. TOP OF CASING ISM_ FT. Above Land Surfaco' -
'Top of casing terminated at/or below land surface requires a varlance In accor-
dance with 15A NCAC 2C.0118
10. YIELD(gpm): 10 METHOD OF TEST.7_-)16W/t�
11. WATER ZONES(depth): ' 5 95 -tom.
12. CHLORINATION: Type C-h jai A2(2-- Amount It additional space is needed use back of form
13. CASING:
Wall Thickness LOCATION SKETCH
Depth Din me or or Wei hVFt. Material (Show direction and distance from at least two State c,
From To �3 Ft. 6m r 15% !_ Roads,or other map reference points) O c_)
From To Ft.—
From To Ft.
14. GROUT: -
i__7 y
Depth Materiq I Melhod w r .
From To .­2C)_Ft. ���
rD:
From To Ft. tv
15. SCREEN: Wit.
Depth Diameter Slot Size Matorial =t
� o
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:
DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STANDARDS,AND THAT A COPY F THIS REC\QQ 8_HAS-f3EEN�y J VIDED TO THE WELL OWNER.
FOR OFFICE USE ONLY /( -
Quad No: SIGNATURE OF PERSON CONSTFtCTING THE WELL DATE
L, kiv ubrnil d}tgilt l to�lDivis on of Water Ouaiily,Groundwater Section within 30 days
Serial No. GW-1 REV. 12/99
is

226522
North Carolina-Department of Environment and Natural Resources-Division of Water Duality-Groundwater Section � 11
1636 Mail Service Center-Raleigh,N.C.27699-1636-Phono(919)733-3221 W
WELL CONSTRUCTION RECORD WELL CONTRACTOR:
WELL CONTRACTOR CERTIFICATION#: 1Wv2Gla�
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE(Check Applicable Box): Residential[R�' Municipal ❑ Industrial❑ Agricultural❑ Monitoring ❑
Recovery❑ Heat Pump Water Injection ❑ Other ❑ If Othor, List Use: �}va
2. WELL LOCATION': Pow sketch of the location below)
Nearest Town: /251c`&'V_y- County:
(Road Name and Numbers,Community,or Subdivision and Lot No.) DRILLING LOG DEPTH
3. OWNER Goa We- From To Formation Description
Address
treetor out o.` C ' 7 r7P-- //0 rl�,y'e,
Cit //45 //�-
or Town State Zip Code �—}
4. DATE DRILLED `b /f�`on e0a
5. TOTAL DEPTH 8 D0
CD
6. CUTTINGS COLLECTED YES❑ NOEZ]-
7. DOES WELL REPLACE EXISTING WELL? YES ❑ NO�7_1
8. STATIC WATER LEVEL Below Top of Casing: �_FT.
(Use-+'If 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 15A NCAC 2C.0118 -
10. YIELD(gpm): 1pfwf METHOD OF TEST
11. WATER ZONES(depth): I>D
_ c5
12. CHLORINATION: Type Amount 6� It additional space Is needed use back of form a
13, CASING: A3F
Wall Thickness LOCATION SKETCH
Depth Diameter or Weight/FI. M terial (Show direction and distance from at least two Slate
From _ To _Zpz Ft.-s P � � 71P S Roads,or other map reference points) re
From To Ft.—
From To Ft. j
14. GROUT:
Depth Material Method_ / �o
oZ
n d '- uJ G
From ..�_ To Ft. ecl-e—� �crrr�C t✓�'�rr.F
From To Ft.
15. SCREEN: aN/
Depth Diameter Slot Size Material
From To Ft in, in.
From To Ft. in. in. s
From To Ft. in. in. ��
16. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
17. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STANDARDS,AND THAT A COPY OF T IS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
FOR OFFICE USE ONLY G -> /b-/`? 60
Quad No: SIGNATURE CfVPERSON CONSTRUCTING THE WELL DATE
Submit original to Division of Water Quality,Groundwater Section Within 30 days
Serial No. '`` i ��' GW.1 REV.12/99
�i

North Carolina-Department of Environment and Natural Resources -Divirdnn of Water Ouality-Groundwater Section
22653'7 1636 Mail Service Center-Raleigh,N.C.27669-1636-Phone(91 n)73:1-3;21
;j WELL CONSTRUCTION RECORD WELL CONTRACTOR: I `ue l 'l f l�i�
WELL CONTRACTOR CERTIFICATION
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE(check Applicable Box): Residential C7 Municipal ❑ Industrial❑ Agricultural❑ Monitoring ❑
Recovery❑ Heat Pump Water Injection ❑ Olher F� If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below) n
Nearest Town: j' �+ �� � County:ems/
(Road Name and Numbers,.Community,or Subdivision and Lot No.) DRILLING LOG DEPTH
3. OWNER _-�r k M 4J-j-JA— From. To Formation Description
Address -4 1"p
— �foe
--� AA
t— uto at or A o.
�c City
or Town State Zip Code
4. DATE DRILLED Jc� ---
5. TOTAL DEPTH C���'� _..__..._......._..........
___._.___— —
6. CUTTINGS COLLECTED S NO(�"—
7. DOES WELL REPLACE EXISTING WELL? YES CJ NOC_�--
8. STATIC WATER LEVEL Below Top of Casing: FT.
i
i (Use'+'it Abovo Top of Casing)
9. TOP OF CASING IS ( FT.Above Land Surface* CD
'Top of casing terminated at/or below land surface requires a variance In actor- r�
dance with 15A NCAC 2C.0118
U
10. YIELD(gpm): 630 METHOD OF TEST ldw�
r7-1
1 11. WATER ZONES(depth): 7 f 3 7 c C e c=rr
12. CHLORINATION: Type -[ Amount It additional space is needed use back of loW
13. CASING:
Wall Thickness
LOCATION SKETCH
n
Depth Diame or Weight/Ft. Male'al (Show direction and distance from at least two�ate From To 2 ( Ft. �S qa T L Roads,or other map reference points) o -
From To Ft.
From To Ft.
14. GROUT:
Depth Material Method
From C' To � Ft.
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:
DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STANDARDS,AND THAT A COPY OF THIS RECOR EN P OVIDED TO THE WELL OWNER.
FOR OFFICE USE ONLY �' --co
Quad No: � I��,PT .RE OF PERSON CONSTRUCTING THE WELL DATE
jtjSut3 it ot�ngull Id�piwinn�f Wader Quality,Groundwater Section Within 30 days
Serial No. i i it pt GW-1 REV.12/99
APB .
Clt?r3!i,2;
4

North Carolina-Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section 1�' O � 1
1636 Mail Service Center-Raleigh, N.C.27699-1636-Phone[phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR: Devvey Wright well Pump Co., Inc.
000653 WELL CONTRACTOR CERTIFICATION#: Ste-ye e
ray
STATE WELL CONSTRUCTION PERMIT#.
1. WELL USE (Check Applicable Box): Residential EN Municipal 0 Industrial 0 Agricultural F-1 Monitoring E
Recovery D Heat Pump Water Injection El Other 0 If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: 90ONE County: AVERY
FLAT SPRINGS RD. OFF HWY 321
(Road Name and Numbers,Community,or Subdivision and Lot No.) DRILLING LOG DEPTH
3. OWNER DAVID WILLIS From To Formation Description
Address 218 RED MAPLE DR. , 0 45 DIRT
STANLEYStreet or Route No.) NC 28164 45 125 GRANITE
City or Town State Zip Code 125 126 SHALE
4. DATE DRILLED 10/9/2000 125 145 GRANITE
5. TOTAL DEPTH 145
6. CUTTINGS COLLECTED YES E] NO 09
7. DOES WELL REPLACE EXISTING WELL? YES E-1 NO E
8. STATIC WATER LEVEL Below Top of Casing: 10 FT. " -
(Use"+"if Above Top of Casing)
9. TOP OF CASING IS 1 FT. Above Land Surface* r�
*Top of casing terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2C.0118
10. YIELD (gpm): 6 METHOD OF TEST Air r '
11. WATER ZONES (depth):P Apm 125-126 0 ppm
0 ppm 0 Apm
12. CHLORINATION: Type HTH Amount 29 If additional space is needed use bac!a fort/
13. CASING: Wall Thickness LOCATION SKETCH
Depth Diameter or Weight/Ft. Material (Show direction and distance from at least two State
From 0 To 50 Ft. 6 1/8 .350 PVC Roads,or other map reference points)From To Ft. �
From To Ft. \e
14. GROUT:
Depth Material Method
From 0 To 20 Ft.-Cement Gravity Flout
From To Ft. x
15, SCREEN: �— 3:0
Depth Diameter Slot Size Material �'�� �PY�o�S
From To Ft. in. in. m
From To Ft. in. in.
From To Ft. in. in.
16. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
5
17. REMARKS: \�
CON T l�, TII IFTFAAe�p D AA D , A COPY OF TH SEREIC RDCHOAS BEEN RIOVID D TO HE W WELL
ELL OWNER.
FOR OFF SEt IVLY! �� 2��Q
l)tt lU SIGNATURE OF PER CONSTRUCTING THE WELL DATE
Quad No: Sub it original to Division of Water Quality,Groundwater Section within 30 days
GW-1 REV.12/99
Serial No. Groundwater nV01811111

North Carolina-Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section F� O g
1636 Mail Service Center-Raleigh,N.C.27699-1636-Phone[phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR: Dewey Wright Well Pump Co., Inc.
WELL CONTRACTOR CERTIFICATION#:
000594 STATE WELL CONSTRUCTION PERMIT#: Leslie Reece
1. WELL USE (Check Applicable Box): Residential X Municipal❑ Industrial ❑ Agricultural❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: 9 OVVING ROCK County: AVERY
PI LOT RIDGE RD. OFF HWY221
(Road Name and Numbers,Community,or Subdivision and Lot No.) DRILLING LOG DEPTH
3. OWNER DANNY L. GRAGG From To Formation Description
Address_ 560 PILOT RI.tDc}rG,,�yE P.D. . 0 55 DIRT
BLOWINd'Rb ..KuteNo.) NC 28605 55 91 GRANITE
City or Town State Zip Code
91 92 QUARTZ
4. DATE DRILLED 10/2512000 92 218 GRANITE
5. TOTAL DEPTH 260 218 219 QUARTZ
6. CUTTINGS COLLECTED YES ❑ NO © 219 260 GRANITE
7. DOES WELL REPLACE EXISTING WELL? YES ❑ NoEx
8. STATIC WATER LEVEL Below Top of Casing: 40 FT.
(Use"+"if Above Top of Casing) c=�
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): 2 METHOD OF TEST Air-
11. WATER ZONES (depth):112 Apm 91-92 1.5 Rpm 218-219
0 APm 0 APD1 -
12. CHLORINATION: Type HTH Amount 45 If additional space is needed use bag—k�f form"*."
c� -
13. CASING: Wall Thickness LOCATION SKETCH
--
Depth Diameter or Weight/Ft. Material (Show direction and distance from at least two gtate
From 0 To 5 Ft. 6 118 _Q_ PVC Roads,or other map reference points)From To Ft. U
From To Ft.
14. GROUT: (J
Depth Material Method
From 0 To 20 Ft. Cement Gravity Flava
From To Ft.
15. SCREEN:
Depth Diameter Slot Size Material fy
From _To Ft. in. in. N
From To Ft. in. in.
From To Ft. in. in.
16. SAND/GRAVEL PACK:
Depth Size Materials
From To Ft. �
From To Ft.
V 17. REMARKS: t�
I DO E „C RT YH T�IS L WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CO TrR lal. :A DS;A AT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
FOR O U � N�Yt�
I. SIGNATURE OF PE ON CONSTRUCTING THE WELL DATE
Quad N�o: S bmit original to Division of Water Quality,Groundwater Section within 30 days
^ r0111i(i�" "` n GW-1 REV.12/99
Serial No. Rchn�iiliy�}r, P.P.1011d1 tC8

North Carolina-Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section �- 2 0 9
1636 Mail Service Center-Raleigh, N.C.27699-1636-Phone[phone] 13
WELL CONSTRUCTION RECORD WELL CONTRACTOR: Denney Wright Well Pump Co., Inc,
OOOQB3 WELL CONTRACTOR CERTIFICATION#: zodu
Leslie Reece
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE (Check Applicable Box): Residential ® Municipal 0 Industrial 0 Agricultural 0 Monitoring 0
Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: NEWLAM County: -AVERY
PRIVATE DR. OFF HWY 19E
(Road Name and Numbers,Community,or Subdivision and Lot No.) DRILLING LOG DEPTH
3. OWNER JAMES J. CIOCIOLA From To Formation Description
Address 740 CHURCH HOLLOW RD. , 0 38 DIRT
BOONE (street or Route No.) NC 28607 38 104 GRANITE
City or Town State Zip Code -
104 105 SHALE
4. DATE DRILLED 10/2/2000 105 213 GRANITE
5. TOTAL DEPTH 245 213 214 SHALE
6. CUTTINGS COLLECTED YES 0 NO D 214 245 GRANITE
7. DOES WELL REPLACE EXISTING WELL? YES 0 NOEXI
8. STATIC WATER LEVEL Below Top of Casing: 80 FT.
(Use"+"if Above Top of Casing) p
9. TOP OF CASING IS 1 FT.Above Land Surface* t '-
*Top of casing terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2C.0118
10. YIELD(gpm): 5 METHOD OF TEST Air
11. WATER ZONES (depth):1 gam 104-105 4 ppm 213-214 CD
0 apm 0 ppm r,
12. CHLORINATION: Type 'HTH Amount 35 If additional space is needed use back of forfri
r.:
13. CASING: LOCATION SKETCH o
Wall Thickness cal o
Depth Diameter or Weight/Ft. Material (Show direction and distance from at least two State
From 0 To 41 Ft. 6 1/8. .350 PVC Roads,or other map reference points)
From To Ft. �tn.�y\0 Z
From To Ft. 1'
14. GROUT:
Depth Material Method X
From 0 To 20 Ft. Cement Gravity Flonr
From To Ft.
15. SCREEN: 7
Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in. 1 't
1
From To Ft. in. in. 71'
16. SAND/GRAVEL PACK:
Depth Size Material O)�
From To Ft. �E
From To Ft. )aM
17. REMARKS M nn Hi
I DO HERE .HI_ :='•hll�� CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRU STANDARDS,AND TRAY COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
�,n(;� � `
FOR OFFICE ONL
_ SIGNATURE OF PERSON CON UCTING THE WELL DATE
Quad No: 17 y_' Submit rig inal to Division of Water QuaIit roundwater Section within 30 days
p 1.shun waat;r St:ctl;3n s v, v
Aslfeville IZeli011sLL9:,iCL GW-1 REV.12/99
Serial No.

North Carolina'.Department of Environment and Natural Resources-•Division of Water Quality-Groundwater Section
1636 Mail Service Center Raleigh,N.C.27699-1636-Phono(919)733.3221tii? " �Fs, .
.. ;I''avb'S?'�y';�f�A:nl a�y�'lv.: _.:, _ LCC.`jL✓r�-t'L.• �ii.�.�'t.� �\ �c��.E� I'r��>�,rct�i� ihtifV.l
WELL CONSTRUCTION RECORD WELL CONTRACTOR: '
WELL CONTRACTOR CERTIFICATION ##:
r. STATE WELL CONSTRUCTION PER
MIT#:
❑
1. WELL USE(Chack: Applicable Box): Residential(�' Municipal ❑ Industrial❑ Agricultural❑ Monitonng
Recovery❑ Heat Pump Water Injection ❑ Other ❑ It Other, List Use:
2. WELL LOCATION: (Show sketch of the location below)
d
Nearest Town �,//� ��r r'�� County: )��117 ,e 5 Y
(Road Nar e-.w•,d N mbers,Commu ity,or Subdivision and Lot No.) DRILLING LOG DEPTH
'Y_"'J
3..;OWNER /� t::` / i j From To FormationDescriptionr
Address' ;
(Sirm o cute No.) /'7—
City or Town State Zip Code //fa le I/ P C'k Aa& �`
b-6 U A9 �/^ L.,S, f//41 /oc !C r1•910V- +
4. DATE DRILLED T_ h
5. TOTAL DEPTH otec > s ,/s 7 hl/, rN le,7i
3. CUTTINGS COLLECTED YES❑ NO EI� s 7 — `'c' �{r'`'
7. DOES WELL REPLACE EXISTING WELL? YES ❑ NO©
3. STATIC WATER LEVEL Below Top of Casing: , O FT. !�
(Use'+'It Above Top of Casing)
3. TOP OF CASING IS FT.Above Land Surface* + t
'Top of casing terminated at/or below land surface requires a variance In accor-
.tanco with 15A NCAC 2C. 118 J P
10. YIELD(gpm):. i 5 METHOD OF TEST
11. WATER ZONES(depth): If2' IS"?
Asheville Reionai ifficr4y
12. CHLORINATION:, Type pe 7'-/`J Amount If additional space is needed use back of form
P
13. CASING:,`",
2
Wall Thickness LOCATION SKETCH rt ;
Depth Diameter or Weig VFL Material (Show direction and distance from at least two St',
From To f Ft. /�h - '� Roads,or other map reference points)
from To Ft.
L�
From 'To Ft.
14 GROUT
t Depth.' Material Method T ,
From '�To. Ft: <+n �� �crrn ,cf
From :To Ft. � +
15. SCREEN:
Depth Diameter Slot Size Material
From, t <, To' Ft in. in.
From "To Ft. in. In.
From,t x 7o Ft.- In. in.
16 SAND/GRAVEL PACK:
, L *�Depth Size Material
aMtiSM
From To Ft.
From To Ft. ;�^
17..REMARKS
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL tf
CONSTRUCTION STANDARDS,AND THAT A COPY OF THIS CORD HAS BEEN PR VIDED TO THE WELL OWNER t `
'F
of
FOR OFFICE USE ONLY
Quad NO (`'{ t .+ SIGNATURE OF P SON CONSTRUCTING THE WELL DATE �}
Submit original to Division of Water Quality,Groundwater Section within 30 days Yrry,{� °
Serial No GW1 REV 12/1l9r9�8',
,ti'r

r w.
s
North Carolina•Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section
1636 Mail Service Center•Raleigh,N.C.27699.1636-Phono(919)733.3221
WELL CONSTRUCTION RECORD WELL CONTRACTOR:
WELL CONTRACTOR CERTIFICATION #: cs(� l
STATE WELL CONSTRUCTION PERMIT#: 7.
s
1, 'WELL USE(Check Applicable Box): Residential_rEr Municipal ❑ Industrial❑ Agricultural❑ Monitoriing ❑
Recovery❑,:;; Heat Pump Water Injection ❑ Other ❑ if Other, List Use:
2. WELL LOCATION Show skett h of the location below) i
Nearest Town r -r ' /i'",`�u County: ,r'
R h
(Road Name and Numbers,Community,or Subdivision and Lot No.) DRILLING LOG DEPTH
z 5<< S
3 :OWNER }r���� /fly- /�i uivec; From To Formation Descrtpdon ,`
K
Addre S {•: 'L /7 /c7c�c j,t� r'irg trlvo
treet or Houle o. _ 3 a pr
,. �`i.t .••c.>_ t.�-.-ice `71 ' L-,. ,� � �,'�c
C'y or Town qq fate Zip Code �r� 4,. &c
4. DATE DRILLED 1f-'— 7- �)� .9R-, /cc
5. TOTAL DEPTH J f' 1A9ci
6. CUTTINGS COLLECTED .YES❑ NO
J ;
7. DOES WELL REPLACE EXISTING WELL? YES ❑ NO ]
8. STATIC WATER LEVEL Below Top of Casing: _26 FT. �
(Use'+'if Above Top of Casing)
9. TOP OF CASING IS -/ FT.Above Land Surface'
'Top of casing terminated attor below land surface requires a variance In accor- -�
dance with 15A NCAC 2C f 118 �s' y 14
10. YIELD(gpm) METHOD OF TEST Ul
11. WATER ZONES(depth): 2-2_3
7/-,a S _ Groundwater etc0in
4x
12. CHLORINATION Type /YT fi` Amount If-Btirlitional"space is needed use back of form
13. CASING:
Wall Thickness LOCATION SKETCH 1
r
Depth Dim for or Weight/FL M�teriaI (Show direction and distance from at least two State
From ` To "t U Ft. ��r7 "��L11 Roads,or other map reference points)
-From To Ft.-
From To Ft.
14 GROUT t° t9 2 5 ay•:frlr fj `
Depth Material Method
: nF J s
F.rem To'7. _ Ft: G�•,�,t2'+ UP ec
From :' '� To Ft. �
15. SCREEN-
,.Depth.. Diameter .Slot Size Material 3
.From.. TO Ft In. In. vut, In
r rC v,N
From To Ft. in. in. I
N . , ,w
From ' :Tti Ft: in. In. ir• 'rwFfhw�F ,r�, 3 '
16 SAND/GRAVEL PACK:
,LL-Depth Size Material sy'( v r.
From To Ft. �
From To Ft.
2�cr yhy +K 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 y
FOR OFFICE USE ONLY � �„ x���� Ae
Quad No t. ,a , ;' SIGNATURE OF PERSO ONSTnUCTING THE WELL DATE;,
Submit original to Division of Water Quality,Groundwalor Section Within 30 days
Sod No GW-1 REV /2f99
t� �;,1,.4 .. r I�.r lyr'14,j't{}11L�'1 �*'1rx a�t�i ,3'•i

5 1
North Carolina-Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section
1636 Mail Service Center Raleigh,N.C.27699 1G3G-Phone[phone] /[ ///-�/
'�i—F "�t.-dC✓ Z--,.
WELL CONSTRUCTION RECORD WELL CONTRACTOR:
ti,t WELL CONTRACTOR CERTIFICATION #: a "
Jos{ , STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE(Check Appllcabie eox): Residential L`J Municipal ❑ Industrial❑ Agricultural Monitoring ;.
Recovery❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use: i %« >:
' 2. WELL LOCATION (Show sketch of)he location below)
/ ,•
Nearest Town Ifle' ' rU,� /—County:
r,f/ "-`._i\.yt..t..e__. �•c•`t- JC,� '1"l.E'.r �--� -C^' ���L,.. w.Y � -;. ,
(Road Name and Numbers,Community,or Subdivisi nand Lot No.) i DRILLING LOG DEPTH
.:' > �7G' ^ To FormationDescripGon
3 :OWNER �'llC;cl'C='. C'� i From
•3..2
' %^ 777
beet Of OUiO O. S rlel eC/� ant �`� ':t ., ry�u I' '/r'+•.(�
.116 (C�i�._ Gj`1 �G'/l r7T Ll UC
Cityor Town State Zip Code I
4, DATE DRILLED.:�C`�'l t C, - G/` %, c`• it.; 1i �c7�9't+r� s I
5. .TOTAL DEPTH 7.26
6. CUTTINGS COLLECTED .YES❑ NO�
7. DOES WELL REPLACE EXISTING WELL? YES ❑ NO� �
13. STATIC WATER LEVEL Below Top of Casing: .76 c) FT. ,
(Use*+'If Above Top of Casing)
9. TOP OF CASING IS -� FT.Above Land Surface* tom "
'Top of casing terminated at/or below land surface requires a variance In actor- _
dance with 15A NCAC 2C.0118 Ct10It
10. YIELD m • METHOD OF TEST /9'r to• �j 0 ice
(gp ) '// —Fssheydle Re m
11. WATER ZONES (depth):
'12. CHLORINATION:"' Type /fT� Amount 3 d� It additional space is needed use back of form
13. CASING
LOCATION SKETCH -
Wall Thickness
Depth Diam ter or Wei hl/Ft. M terial (Show direction and distance from at least two State —
From �}' ' To y Ft. 5 ' � J����" Roads,or other map reference points) /
from— To Ft. J
w
From To Ft.
14 .GROUT
Depth> Material Method
' From Cry To y Ft: <c=.i/c�� 7 Ore �*
From .::,:':':To . FL
15. SCREEN y`
Depth Diameter Slot Size Material
j v
,(tF y sr
From To Ft in. in. le
From To Ft. in. in,
From To Ft: in. In.
16 SAND/GRAVEL PACK:
,�y�z,i1�C evcJ
F Depth Size Material 1 � >
;To Ft.
"From '> �� '.:To Ft.
17.,..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 REC D HAS EJEENVIDED TO THE WELL OWNER. '
FOR OFFICE USE ONLY
Quad No t'{ q ! SIGNATURE OF F[rl ON CONSMUCTING THE WELL DATE
` Submit original to Division of Water Quality,Groundwater Soction Within 30 days
Serial No. '• GW t REV.
t j '• 'tt s y� , �f�i��'�`1���"bi`:�=�i�ffl� ti ,�1:

l
North Carolina-Department of Environment and Natural Rosourcnr.-Divi:ion of Writer Quality-Groundwater Section 226540.7
1636 Mail Service Center•Raleigh,N.C.27699.1636-Phono(919)733.3221
WELL CONSTRUCTION RECORD WELL CONTRACTOR:
WELL CONTRACTOR CERTIFICATION#:
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE(Check Applicable Box): Residential❑ Municipal ❑ Industrial❑ Agricultural❑ Monitoring ❑.
Recovery❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: ' County:
(Road Name and Numbers,Community,or Subdivision d Lot No.) / DRILLING LOG DEPTH
3. OWNER �9� w 'f-% ` [`�' From To Formation Description'
Address '' 6 — a o
/ (Street or Route o. ?,(7 — G U
City or Tlbwn State Zip Code °J�`T•
4. DATEDRILLEOl/'" CJO —714 � � 9la/e'lecK svz'lywvfP<•
S. TOTAL DEPTH ° `� �D ✓�t^a��,�P c!�'7'c�ca„y5
6. CUTTINGS COLLECTED YES❑ NO[D
7. DOES WELL REPLACE EXISTING WELL? YES ❑ NO❑v
8, STATIC WATER LEVEL Below Top of Casing: 3 6 FT.
(Use-+-If Above Top of Casing) O
9. TOP OF CASING IS• _2- 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): 3 METHOD OF TEST
11. WATER ZONES(depth): 72- Z E ._ 3�,(
12. CHLORINATION: Type 1 f r Amount _ If additional space is needed use back of fc
13. CASING: 0 -�
LOCATION SKETCH
Walt Thickness -'
Depth Diarnor or Weight/Ft. Material (Show direction and distance from at least two State
From—�—To Ft. ( /I �'s'��� - Roads,or other map reference points)
From To Ft.—
From To Ft. -
14. GROUT:
Depth Material . Method
From To 20 Ft. e cnI et 4 'Sr 2c
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.
f
17. REMARKS: %,`N('[�'c !'% }no do�'� �o, <,�•�f�r Gc'rr��^ Ccr� s�o f s �'f %{ /1UC-s�itn -
100 HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STANDARDS,AND THAT A COPY OFT IS REC D HAS BEEN PROVIDED TO THE WELL OWNER.
FOR OFFICE USE ONLY
Quad No: 4SIGNATU P[RSON CONSTRUCTING THE WELL DATE
I Su m fv'bngj ial t 91, Di j lon�of VhtrrQuality,Groundwater Section within 30 days
Serial No. ' - GW1 REV. 12199
�t(tL< <, r3, ,
1,

North Carolina-Department of Environment and Natural Resources Division of Water Quality-Groundwater Section 226501
1636 Mail Service Center-Raleigh,N.C.27699-1636-Phone[phone] '
WELL CONSTRUCTION RECORD WELL CONTRACTOR: )
WELL CONTRACTOR CERTIFICATION#:
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE(Check Applicable Box): Residential❑ Municipal❑ Industrial❑ Agricultural❑ Monitoring ❑
Recovery❑ Heat Pump Water Injection ❑ Other If Other, List Use:
2. WELL LOCATION:(Show sketch of the location below) A
Nearest Town: t'C r C h i2 L County: r�(l e 'I c
(Road Name and Numbers,Community,or Subdivision and Lot No.) DRILLING LOG DEPTH
3. OWNER C ma A- From To Formation Description
Address
Or Route o.1
City or Town State Zip Code 7, '-'rla"I-.n c-
le
4. DATE DRILLED- /-� `� c��� � l� �'
5. TOTALDEPTH �f� �{ //Y
6. CUTTINGS COLLECTED YES❑ NO[3' / 4 r '�z 7�
r .
7. DOES WELL REPLACE EXISTING WELL? YES ❑ NOffJ t: 70
8. STATIC WATER LEVEL Below Top of Casing: FT. 2 7 r �?7n y r
(Use'+'it Above Top of Casing)
37L•
9. TOP OF CASING Is l 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): 7"' METHOD OF TEST 4 :',-
11. WATER ZONES(depth): 7;"yd -7%
12. CHLORINATION: Type /�TP Amount 7 v� If additional space Is needeb use back of form
13. CASING:
Wall Thickness LOCATION SKETCH
Depth Diem ter or Weight/Ft. Material (Show direction and distance from at least two State
s From "/ To .1— Ft. i y "f/1- Roads,or other map reference points)
From To Ft.—
From To Ft. p CD
14. GROUT: C-n_--;
-71
Depth Material Method cm C-
From To —Ft. �.`
From To Ft.
15. SCREEN:
Depth Diameter Slot Size Material
From To Ft in. in.
From To Ft. in. in. D
�9
From To Ft. In. In.
16. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
17. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STANDARDS AND T"-TA`COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
I''f
FOR OFFICE USE ONLY.,
Quad No: SIGNATUREDF PERSON CONSTRUCTING THE WELL DATE
Submit original to Dniislon of Water Quality,Groundwater Section within 30 days
Serial No. GW-1 REV.12/99

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] 223986
WELL CONSTRUCTION RECORD WELL CONTRACTOR: r,..__._
L'Yrtt)fIL tl'dCit ruinll
i�'CVVC`•1
WELL CONTRACTOR CERTIFICATION#: 2�
000434 STATE WELL CONSTRUCTION PERMIT#: "" eecc
1. WELL USE(Check Applicable Box): Residential E9 Municipal 0 Industrial 0 Agricultural 0 Monitoring 0
Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use:
2. WELL LOCATION:(Show sketch of the location below)
Nearest Town: FANNER ELK% County: AVER`r
LOT#5.'2 OFF ROCKY F,k=:j-;YV,li:t' OF= _*H.A04NEE RD. OF
(Road Name and Numbers,Community,or Subdivision and Lot No.) DRILLING LOG DEPTH
3. OWNER ROBERT INGA?LS From To Formation Description
Address F.O. BOX 1059 . C 32 JI RT
E'A.NNER LstLeM or Route No.) NC 28804 32 130 GRANITE
I E
City or Town State Zip Code .I CU AI C
4. DATE DRILLED -131 E+pu CRANI I E
5. TOTAL DEPTH 0'OD o
6. CUTTINGS COLLECTED YES 0 NO 0 C7
7. DOES WELL REPLACE EXISTING WELL? YES 0 NO 0 e—
C:T
8. STATIC WATER LEVEL Below Top of Casing: FT.
(Use"+"if Above Top of Casing) c� r
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 ;_ rn
10. YIELD (gpm): l� METHOD OF TEST )
11. WATER ZONES (depth):` "prnCR' H'D`E 0
0 01311r1 0 qiirri
If additional space is needed use back o formes
12. CHLORINATION: Type NTH Amount
13. CASING: wall Thickness LOCATION SKETCH �e
Depth Diameter or Weight/Ft. Material (Show direction and distance from at least two State
From C. To 36 Ft. 6 118. 361� PVC Roads,or other map reference points)
From To Ft.
From To Ft. �1
14. GROUT: N.,
Depth Material Method
From 0 To 20 Ft. t_arnent lGravicv Flow � 9 � ? �q`f
From To Ft. `-E'AE:`JT GRAVITY FLCJ`d\f
15. SCREEN:
Depth Diameter Slot Size Material -r-
From To Ft. in. in.
From To Ft. in. in. x-
From To Ft. in. in.
16. SAND/GRAVEL PACK ,...-
q (i e�',thjj iq Size Material
Fro r- 0
Fr
To Ft.J,17. RE tAR .
I DQ HEREBY CERTIF`(`T)HAT;THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCT IOJ STpARDS,AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
FOR OFFICE USE ONLY
SIGNATURE OF PE N CONSTRUCTING THE WELL DATE
Quad No: Submit original to Division of Water Quality,Groundwater Section within 30 days
GW-1 REV.12/99
Serial No.

North Carolina-Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section r- 1 .1 890
1636 Mail Service Center-Raleigh,N.C.27699-1636-Phone[phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR: c ult- l=
WELL CONTRACTOR CERTIFICATION
STATE WELL CONSTRUCTION PERMIT#-^�
1. WELL USE(Check Applicable Box):Residential Municipal❑ Industrial❑ Agricultural❑ Monitoring ❑
Recovery❑ Heat Pump Water Injection ❑ Other❑ If Other, List Use:
2. WELL LOCATI : (Show sketch pf the location below)
Nearest Town: LiZ" County:
(Road Name and Numbers, nity, Subdivision and Lot No.) DRILLING LOG DEPTH
3. OWNER Address From To Formation Description
�51[551 or Houle o.
ity or Town state Zip Code
4. DATE DRILLEDCD
5. TOTAL DEPTH
6. CUTTINGS COLLECTED YES M NOM_
7. DOES WELL REPLACE EXISTING WELL? YES ❑ N?2p
8. STATIC WATER LEVEL Below Top of Casing: _FT. _
(Use'+'If Above Top of Casing)
9. TOP OF CASING IS FT.Above Land Surface*
'Top of casing terminated at/or below tend surface requires a variance In accor-
dance with 15A NCAC 2C.0118 i
10. YIELD(gpm): �METHO OF TEST
11. WATER ZONES(depth):—_�``�
12. CHLORINATION: Type _7_,'Vd Amount .� if additional space is needed use back of form
13. CASING: Wall Thickness LOCATION SKETCH 'S y) t L -
Depth Oi meter or Weight/Fl, I�Jaenn�al (Show direction and dis nee from at least two State
From To Ft. S 2 Roads,or other p reference points)
From To Ft.
From To Ft.
14. GROUT:
Depth Material Method
From !GGw_ To �Ft. A
From To Ft.
15. SCREEN:
Depth Diameter Slot Size Material
From To Ft_ in. in.
From o n.
From To Ft. in. in.
16. SAND/GRAVEL PACK: /
Depth Size Material
From To Ft. \
From To
17. REMA KS:
I DO HEREB AT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUC S QR�S,�N[ 'f"" Y COR=ROVIDED TO THE WELL OWNER.
FOR OFFICE NLY u L/
Quad No: SIGNATURE OF PERS4k6NSTRUCTING THE WELL ATE
Su to Division of Water duality,Groundwater Section Within 30 days
Serial No. GW-1 REV.12M
(droundwater Section
heville Re ienal Off1ce�...

North Carolina-Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section �' 0 8 6 4
1636 Mail Service Center-Raleigh,N.C.27699-1636-Phone[phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR: Dewey'v'Vdght vdell Purrip Co., Inc.
WELL CONTRACTOR CERTIFICATION#: 2686
000557 STATE WELL CONSTRUCTION PERMIT#: Leslie Reece
1. WELL USE(Check Applicable Box): Residential 0 Municipal Industrial E7 Agricultural 0 Monitoring F
Recovery 0 Heat Pump Water Injection E-1 Other 0 If Other, List Use:
2. WELL LOCATION:(Show sketch of the location below)
Nearest Town: _- LINVILLE County: AVERY
PILOT RIDGE RD. OFF HVVY 221
(Road Name and Numbers,Community,or Subdon and Lot No.) DRILLING LOG DEPTH
3. OWNER —DARREN ASH From To Formation Description
Address_ % BAXTER NORRIS CONSTP.. . P.O. BOX 159 SHOP 0 37 DIRT
ZI ONVILL(treet or Route No.) NC 28698 37 398 GRANITE
City or Town State Zip Code
378 399 SHALE
4. DATE DRILLED 0/30/2000 399 505 GRANITE
5. TOTAL DEPTH 505
6. CUTTINGS COLLECTED YES ED NO
7. DOES WELL REPLACE EXISTING WELL? YES ED NO ® r-'.
8. STATIC WATER LEVEL Below Top of Casing: 200 FT.
(Use"+"if 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 actor- N
dance with 15A NCAC 2C.0118
10. YIELD (gpm): 3.5 METHOD OF TEST Air
11. WATER ZONES (depth):3.5 ppm 0 0pm
0 slpm 0 ppm
12. CHLORINATION: Type HTH Amount 64 If additional space is needed use bac• f fort
tV c7
13. CASING: Wall Thickness LOCATION SKETCH
Depth Diameter or Weight/Ft. Material (Show direction and distance from at least two State
From D To d Ft. R 'I/P mill PUC �` �'1
e��Roads,or other map reference points) QV
From To Ft.
From To Ft. `
14. GROUT:
Depth Material Method
From 0 To _:0 Ft. Cement Gra%rity Flown C7
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.
\� o
17. REM/ aKS:
I DO I-'.:REB R Y ,T IS�yVE, AS
I CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONS1'RUC AN1bHA ��OPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
r
FOR OFFICE N �' tiginal
" " "� /
U ?n(��' RE OF P ON CONSTRUCTING THE WELL DATE
Quad No: Su ision of ater Quality,Groundwater Section within 30 days
GW-1 REV.12/99
t;iroundwat s Section
Serial No. Re Tonal Office

North Carolina-Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section � 1 916-
1636 Mail Service Center-Raleigh, N.C.27699-1636-Phone[phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR: DeWey Wright VVell PUMP CO., Inc.
WELL CONTRACTOR CERTIFICATION#. 2686
000433 STATE WELL CONSTRUCTION PERMIT#: Leslie Reece
1. WELL USE(Check Applicable Box): Residential 0 Municipal F-1 Industrial 0 Agricultural 0 Monitoring
Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use:
2. WELL LOCATION:(Show sketch of the location below)
Nearest Town: EA INFR ELK County:A'?VERY
I OT454 OFF R(-)f-.,r P4�VbrY' "rFF R QKY KNOB OFF SH
(Road Name and Numbers,Community,or Subdivision and Lot No.) DRILLING LOG DEPTH
3. OWNER PD ,FP.T HIJOA.l I F: From To Formation Description
Address P n RnX IQF,11i 0 6 DIRT
tr t or Route No.)
RA�.IPIFR iNC28604 6 81 GRjkNITE
City or Town State Zip Code 81 83 SHALE
4. DATE DRILLED 01717000 8.'_'. 277 GPI 4PdITE
5. TOTAL DEPTH 6nn 277 272 SH.A.LE
6. CUTTINGS COLLECTED YES 0 NO 0 278 600 GRANITE
7. DOES WELL REPLACE EXISTING WELL? YES 0 NO 0
8. STATIC WATER LEVEL Below Top of Casing: 20 FT.
(Use"+"if Above Top of Casing)
9. TOP OF CASING IS 1 FT.Above Land Surface* o
*Top of casing terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2C.0118
10. YIELD(gpm): 4 METHOD OF TEST Air -°
11. WATER ZONES (depthk - clpm R1-83 2 Apm 277-278
0 Ai=m 0 APM
12. CHLORINATION: Type HTH Amount 117 If additional space is needed use baciaf fore
m
13. CASING: LOCATION SKETCH
Wall Thickness
Depth Diameter or Weight/Ft. Material (Show direction and distance from at learn wo ate
From n To 21 Ft._6 1/2 2F1pin PVC Roads,or other map reference points)
From To Ft.
From To Ft. LA
14. GROUT:
Depth Material Method 1
From 0 To 2 in Ft.Cement Gravity Flow r
From To Ft.
v
15. SCREEN: 5.
Depth Diameter Slot Size Material 9 /1
From To Ft. in. in. (�
From To Ft. in. in.
From To Ft. in. in.
O
16. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From___ To Ft.
00
17. REMARKS:
I DO HEREBY CERTIFY,THATEHI WL4 WAS,GONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRU T16'W AND(ARD8,AND THATA COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
FOR OFFICE USE ONLY - � !:-
(�94 j SIGNATURE OF SON CONSTRUCTING THE WELL DATE
Quad No: fi, Submit origifal to Division of.Water Quality,Groundwater Section within 30 days
GW-1 REV.12/99
Serial No.

y h
LJ V/l.I�� 'ir `t?a'tf'.1 ..P 1,'�? •`� �il,fkt
r`636 Ma(1 ServloNorth Carolina,;,DCpnterent of Raleigh,E N.C.27099.1 fi36-Phono ronment and Natural Resources 33 3221n of Water Quality-Groundwater Section a "
Ott/�'.P4ir���fly.fir=rt��Ri^'!SGvxC'•lpr, ( )
• WELL'CONSTRUCTION RECORD WELL CONTRACTOR: �J `
WELL CONTRACTOR CERTIFICATION#: 2 13 3
STATE WELL CONSTRUCTION PERMIT#:
r� t
1 WELL USE(Check Applicable Box): Residential t Municipal ❑ Industrial❑ Agricultural❑ Monitoring.0w 4
Recovery❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use: }' ; s
2 WELL LOCATION (Show stitch of the location below)
Q/+I�
Nearest Town County:
' l +i4arS dti I. k.
1.,.
(Road Name�nd NunIbers,Community,or Subdivision and Lot No.) DRILLING LOG DEPTH J.•- t� G,, ,.f ,i5w�
3 OWNER f ti JtJ From To Formation Descriptiontx try i�
cr F Address�,1"n; ,r.. �Cp C,Cec, l_:. ,.F t• �ti C� /� l c,rJtli::rt�Q�`� a� is.,`G �iis
>E y,i.t 1-• a."Yd fr , tre t of Houle o.
tl+ +. etJ j a ) •�... t.`/"ln /� t .r2,+' s i
/) 'L• ' e:.�O(�''a" 1 � yetis �'A"'�a
Star ,
. ... ;..City or Town State Zip Code � , =-,aK ,a a
"�„-,Y a , r
4 DATE DRILLEO'
5 ;TOTAL DEPTH
6 CUTTINGS COLLECTED .YES❑. NO©'
7. DOES WELL REPLACE EXISTING WELL? YES ❑ NO f-'
8 STATIC WATER LEVEL Below Top of Casing: (2 0 FT.
7
• Ya . '::a4' r;'' (Use'+'if 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 15A NCAC 2C.011,4..
10..YIELD(gpm) ;;t' _METHOD OF TEST ...... T1
11 WATER ZONES(depth):
t ,j 3� �ty�Af,`Y3`�i5f%t"'�+ er_ I a✓t,��N'�WY�kdtT'���`,,�1�;��jis
12 CHLORINATION Type h r/'-� Amount � � If additional space is needed use back of form ,,
13.
yr.
Walt Thickness LOCATION SKETCH -
,,K . + t
Depth Diametor or Welght/Fl. Material (Show direction and distance from at least two State r tr * _
Fro m "To Ft: Roads,or other map reference points)
from To Ft.-
From, To Ft.
14 GROUT
C•Depth Material Methodyr �,
From Ft: r�
Ft.
15 SCREEN
1 p Diameter Slot Size Material F
9
Ft in. in.
From.,-,-, vTo t Ft. in. in.
,4 From�I`, s, Ft: in. in. ,r�'rrrf m a, yuJ
16 SAND/GRAVEL PACK +rY V
N
Depth, Size Material "
h:} RYK ,I cC s ft kl n
d From ° a To Ft. t Q
tV C
r .From rl t .,of of"�� To Ft. i i.t'a4a r4'°a4+kta a }, 7
17 REMARKS ra+ t �•�y+ �r? � �x`; ,�w'
DO HEREBY•CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL s � ¢ �4's,
CONSTRUCTION STANDARDS,AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
FOR OFFICE USE ONLY lip i i! !:'' // � `�l�' •�' ` ' t�r,i„+,)1 �'' ,*t��
Quad Noi s�fr I�r�l SIGNATUR OF PERSON CONSTRUCTING THE WELL DATEi4t
Submit original to Division of Water Quality,Groundwater Soction Within 30 days
Serial No'Ma t 4 �,k• • b, .,
— 62000 GW 1 REV
qVJeyyN k1p ti�J'i 'r i OCT
+( I 1 8�j>),�i 3Y JV ` I I •rJ�; .y + v7
�r�.a 1°+`3'')k} r;�'ayll �d3t + �,•:. .. .>.,»-..:;1 M+� 't1 ' � +114�j,, 5ri�}
W..Y�d+(.
4(Dt.litrla Ott.,. + '•
f
�iMi.-villa

North Carolina-Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section !:, l 91. 93
1636 Mail Service Center-Raleigh, N.C.27699-1636-Phone[phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR: Dewey Wright Well Pump Co., Inc.
WELL CONTRACTOR CERTIFICATION#:
000442 STATE WELL CONSTRUCTION PERMIT#: es to Nsince
1. WELL USE(Check Applicable Box): Residential 0 Municipal F-1 Industrial 0 Agricultural 0 Monitoring 0
Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: SPRUCE PINE County: AVERY
RED DIRT RD. OFF HENSON CREEK RD. OFF OLD 19E
(Road Name and Numbers,Community,or Subdivision and Lot No.) DRILLING LOG DEPTH
3. OWNER HAROLD PRINCE From To Formation Description
Address P.O. BOX 371 . 0 19 DIRT
ELLENBd4t5t or Route No.) NC 28040 19 600 GRANITE
City or Town state Zip Code
4. DATE DRILLED 8/18/2000 -
5. TOTAL DEPTH 600
6. CUTTINGS COLLECTED YES 0 NO ©
7. DOES WELL REPLACE EXISTING WELL? YES 0 NO ®
8. STATIC WATER LEVEL Below Top of Casing: FT. R• ,v �` (� i�i 1 s"",:,9 —
(Use"+"if Above Top of Casing) � ' n •)
9. TOP OF CASING IS 1 FT. Above Land Surface* 10111 ni r �.
*Top of casing terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2C.0118 11
10. YIELD(gpm): 0 METHOD OF TEST Air
11. WATER ZONES (depth)0 gpm DRY HOLE 0 ppm Cn Y+
0 Am 0 ppm a �ngl flffn
12. CHLORINATION: Type HTH Amount If additional space is needed use ck of form
13. CASING: Wall Thickness LOCATION SKETCH
Depth Diameter or Weight/Ft. Material (Show direction and distance from at least two State
From D To —2$Ft. 8 1/8 -350 PVC Roads,or other map reference points)
From To Ft. recddtrtfa,
From To Ft.
14. GROUT: N, end offweme,af �Q
Depth Material Method
From n To 20 Ft. Cement Gravity Flow r 6 �Q)
From To Ft. /`2 rnIle5
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:
0�
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL �1
CONSTRUCTION STANDARDS,AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
FOR OFFICE USE ONLY f " "
SIGNATURE OF P SON CONSTRUCTING THE WELL DATE
Quad No: Submit original to Division of Water Quality,Groundwater Section within 30 days
GW-1 REV.12/99
Serial No.

North Carolina-Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section e) ♦ (1
1636 Mail Service Center-Raleigh, N.C.27699-1636-Phone[phone] 6 1 l�
WELL CONSTRUCTION RECORD WELL CONTRACTOR: Dewey Wright Well Pump Co., Inc.
WELL CONTRACTOR CERTIFICATION#: 2686
99816 STATE WELL CONSTRUCTION PERMIT#: Leslie Reece
1. WELL USE(Check Applicable Box): Residential ® Municipal 0 Industrial 0 Agricultural 0 Monitoring 0
Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: __BANNER ELK County:AVERY
LOT#'10 DEER CRK FALLS OFF BEECH MTN PRK`WY OF
(Road Name and Numbers,Community,or Subdivision and Lot No.) DRILLING LOG DEPTH
3. OWNER JOHN J. BELLIVEAU From To Formation Description
Address 510 ELDERBERRY RIDGE RD. , SOUTHCREST#D3 0 15 DIRT
BANNER L5LrW or Route No.) NC 28604 15 102 GRANITE
City or Town State Zip Code 102 103 SHALE
4. DATE DRILLED 8/9/2000 103 198 GRANITE
5. TOTAL DEPTH 425 198 190 SHALE
6. CUTTINGS COLLECTED YES 0 NO EXI 199 425 GRANITE
7. DOES WELL REPLACE EXISTING WELL? YES 0 NO ® r a
8. STATIC WATER LEVEL Below Top of Casing: 100 FT. O
(Use"+"if 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): 2 METHOD OF TEST Air cn
11. WATER ZONES (depth(/4 ppm 102-103 1.7 ppm 198-19.9
0 Rpm 0 Rpm ZZ G=-�Q
12. CHLORINATION: Type HTH Amount 67 If additional space is needed use back of form r
.J o
13. CASING: W ll Thickness LOCATION SKETCH
Depth Diameter oar Weight/Ft. Material (Show direction and distance from at least two State
From_ 0 To 21 Ft. 6 IM .188 — GALV. ,X Roads,or other map reference nts)
From To Ft.
From To Ft.
t
14. GROUT: �r�C�,L
Depth Material Method
From_0 To 2_Ft.Cement Gravity Flow 1 q
From To Ft. v f
4' nor
15. SCREEN:
Depth Diameter Slot Size Material T
From To Ft. in. in.
From To Ft. in. in. \�
From To Ft. in. in. -�
Jc
16. SAND/GRAVEL PACK: '
Depth Size Material
From To Ft.
From To Ft.
17. REMARKS: 4vv-y 105
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION;STAN RDS,AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
FOR OFFICE USE ILL 4€) g �V
Quad No: )s ° ; I � 2r1f1f1 ,rt l 7;U 6fGNATURE OF SON CONSTRUCTING THE WELL DATE
ortsinal',to Division of Water Quality,Groundwater Section within 30 days
41 GW-1 REV.12/99
Serial No.
311 trgifn�. rt11f{ ;;1 ii

North Carolina-Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section � 77911
1636 Mail Service Center-Raleigh,N.C.27699-1636-Phone[phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR:
WELL CONTRACTOR CERTIFICATION#:_
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE(check Applicable Box): Residential E!r Municipal ❑ Industrial❑ Agricultural❑ Monitoring ❑.
Recovery❑ Heat Pump Water Injection ❑ Other ❑ if Other, List Use:
2. WELL LOCATION: (Show skplch of th location below)
Nearest Town: ,` " `� //L' ���� ����», County:- �7
(Road N�'4m�' a and(lumbers.Comm nity,or Subdivision and Lot No.) DRILLING LOG DEPTH
3. OWNEIi;�zti�� 4���i°.snry From To Formation Description
Address7C:� � L -- I > �,,�-���,,, 4
�-(street or u e o.)
dYrctc<< 'C
Y City or Town State Zip Code /3 /33 f f A
4. DATE DRILLED
5. TOTAL DEPTH
6. CUTTINGS COLLECTED YES❑ NO {r -
7. DOES WELL REPLACE EXISTING WELL? YES ❑ NOS .3i0 32-29V
8. STATIC WATER LEVEL Below Top of Casing: FT. 313
(Use'+'If Above Top of Casing) _
9. TOP OF CASING IS FT.Above Land Surface- u -
'Top of casing terminated attor below land surface requires a variance In accor-
dance with 15A NCAC 2C.0118 b
10. YIELD(gpm): 6 METHOD OF TEST I4j�
11. WATER ZONES(depth): y-Z e r/3 s'
m-
12. CHLORINATION: Type L L Amount 3G�. _ If additional space is needed use back of fo�
13. CASING:
Wall Thickness LOCATION SKETCH
Depth Diiaam�tor or Weight/Ft1 Material (Show direction and distance from at least two State From To 72 Ft. — f��''�/ ��� Roads,or other map reference points)
From To Ft.
From To Ft.
14. GROUT: «<Me
Depth Material Method «:��,/w
From f To o.C' Ft. Cc.,<,�,✓� Cat" G.J �ra/rip c
From - To Ft. F c
15. SCREEN: eS.
Depth Diameter Slot Size Material =f pl';.
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:
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.
FOR OFFICE USE ONLY PJ
Quad No: k "j' ` iq S;GNgTURE OF PERSON CONSTRUCTING THE WELL DATE
t'd SUb¢iit original(o Division of Water Quality,Groundwater Section within 30 days
Serial No.
r ' ; GW1 REV. 12/99
SEP 2 52000 '_.

North Carolina-Department of Environmont and Natural Rosourcr±s-Division of Water Quality-Groundwater Section Nj 1636 Mail Service Center-Raleigh,N.C.27699-1636-Phone[phone] �� i / 9 9 5
WELL CONSTRUCTION RECORD WF-LLCONTFIACTOFI: CC
WLLL CON IIIACTOII CLFITIFICATION 0: C .J 5?V
STATE WELL CONSTRUCTION PERMITd:
1. WELL USE(Check Applicable Box): Residential IT Municipal ❑ Industrial❑ Agricultural❑ Monitoring ❑.
Recovery❑ Heat Pump Water Injection M Other n If Other, List Use:
2. WELL LOCATION:: (Show sketch of the location below)
Nearest Town:_ Nell,,/1 OU.l 1
County:
(Road Name and Numbers,Community,or Subdivision and Lot No.) DRILLING LOG DEPTH
3. OWNER _' �1(. L"�a /�� �D d�N✓��Svc �39 7�3 5(� From To Formation Description'
Address )0•0, �Q X d� �C !�'G� 0 `
— joireet or HOU10 o.
- /N _
City or Town State Zip Codo
4. DATE DRILLED o2S � � G j — /a
5. TOTAL DEPTH Lt /i2y /•7/ k 1p
6. CUTTINGS COLLECTED YES[] NOE11- /�/ ` /GG 5rl r�'K• c'
7. DOES WELL REPLACE EXISTING WELL? YES ❑ NOrr-]-
8. STATIC WATER LEVEL Below Top of Casing: 9 FT, r
(Use-+-it Above Top of Casing) G ;
9. TOP OF CASING IS J- FT.Above Land Surface* �
`Top of casing terminated at/or below land surface requires a variance In actor-
dance with 15A NCAC 2C.0118 c-
10. YIELD(gpm): c2 D METHOD OF TEST
11. WATER ZONES(depth):_ 6 P'C`/ /Os£'/ r—
12. CHLORINATION: Type T H Amount_ If additional space is needed use backfaf forfii� 3
13. CASING:
Wall Thickness LOCATION SKETCH 't _
Depth Diametor or Weight/Ft. Material (Show direction and distance from at least two State
L
From To 2.3 Ft. 196 - U .. Roads,or other map reference points)
From- 2-1 Tom— Ft.� f 2 PP6
From To Ft.
14. GROUT:
Depth Material Method
From To �2C Ft. Z-Vf
From To Ft.
15. SCREEN:
Depth Diameter Slot Size Material Do 4te —_4
From To Ft in, in. %cr2/paclv
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:
DO HEREBY CERTIFY THAT THIS WELL WAS CONST UCTED IN ACCORDANCE WITH 1SA NCAC 2C,WELL
CONSTRUCTION STANDARDS,AND THAT A//CQPY YIHRE RDHA EENPRO D TO THE WELL OWNER.
FOR OFFICE USE ONLY l J�/ ��
Quad No: SIGNATURE OF P-R SON CONSTRUCTIN HE WELL DATE
Serial No. Submit original to Division of Water Oualily.Groundwater Section Within 30 days
GW-1 REV. 12/99
t - �r
vJ
SEP 2 5 20H

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] cJ 17 6 4 3
WELL CONSTRUCTION RECORD WALL CONTRACTOR:
WELL CONTRACTOR CERTIFICATION#:
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE(Check Applicable sox): Residential EB" Municipal ❑ Industrial❑ Agricultural❑ Monitoring [�
Recovery❑ Heat Pump Water Injection ❑ Other ❑ It Other, List Use:
2. WELL LOCATION:(Sh° sk Jtch of the location below) {
Nearest Town: �r �LG14 County: y/ e "
ay
(Road Name as d Numbers,Community,or Subdivision and Lot No.) DRILLING LOG DEPTH
3. OWNER LJ�� u• J ���/�,ti Address From To Formation Description
" Xo cl�L'/,rra M1,d
beet or outo rc
o. i, — ja7 A"'o-t, S 4'Q le-, -';J&
C+tyorTown state Zip Code
���/ _ / S�afera�k .r.Le
4. DATE DRILLED B {S-cZi7aJ /37 3 Ufa�r�or/< !(o�.w��c,r•.
5.. TOTAL DEPTH a 60 /3`1` /4 ,�^oo✓r`><c.
6. CUTTINGS COLLECTED YES❑ NO❑ 1`! 196 G/tits 7n/,4- hoc
7. DOES WELL REPLACE EXISTING WELL? YES ❑ NO❑ l y /o q I-m; �
8. STATIC WATER LEVEL Below Top of Casing: 0 o FT.
(Use'+'if Above Top of Casing)
9. TOP OF CASING 1S FT.Above Land Surface-
'Top of casing terminated at/or below land surface requires a variance In accor-
dance with 15A NCAC 2C. 118
10. YIELD(gpm): METHOD OF TEST
11. WATER ZONES (depth):
SG f a!a p�5%1
12. CHLORINATION: Type _ A/T 14 Amount 'o-Z _ If additional space is needed use back of form
13. CASING:
Wall Thickness LOCATION SKETCH
Depth Diameter or Weight/A. Material (Show direction and distance from at least two Stale
From - To /3 Ft. G /Y 9 Roads,or other map reference points)
From To Ft.
--
From To Ft.
14. GROUT:
Depth Material Method r"'
t�
From _ To 26 Ft.
r ,S'u
From To Ft.
15. SCREEN:
Depth Diameter Slot Size Material
From 7o Ft in. in. Ile
From To Ft. in. In. co
c�
From To Ft. in. in.
16. SAND/GRAVEL PACK: 2
Depth Size Material
From To Ft.
From To Ft. Sri J
�G S0/
17. REMARKS:__{yG /VCCc� /iti�/C/ '.` ¢ �v /HOCZ�j ��0r✓ A4,/e� eto�rri� G�e'a. �c�7
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STANDARDS,AND THAT A COPY OF THIS REWRD HAS BEEN PROVIDED TO THE WELL OWNER.
FOR OFFICE USE ONLY � 45 _1 co
Quad No: SIGNATURE OF PEAS-dN.CONSTRUCTING THE WELL DATE
Suhmit original to Divlslon of Miter buality;Groundwater:Section within 30 days
Serial No.
GW-1 REV. 12199
111 SEP - 5 2001

i "15f3
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: Dewey Wright Well Pump Co., Inc.
WELL CONTRACTOR CERTIFICATION#:
000484 STATE WELL CONSTRUCTION PERMIT#: Leslie Reece-
1- WELL USE(Check Applicable Box): Residential 0 Municipal El Industrial 0 Agricultural 0 Monitoring [�
Recovery 0 Heat Pump Water Injection 0 Other D If Other, List Use:
2. WELL LOCATION:(Show sketch of the location below)
Nearest Town: SPRUCE PINE County:AVERY
OLD 19E OFF HWY 19E
(Road Name and Numbers,Community,or Subdivision and Lot No.)
DRILLING LOG DEPTH
3. OWNER JAY GRINDSTAFF From To Formation Description
Address % MAE WI SEMAN , 2767 THREE MILE HWY 0 12 DI RT
NEWLAN1yreet or Route No.) NC 28657 12 41 MUD/SAND/GRAVEL
City or Town State Zip Code 41 383 GWAI TE
4. DATE DRILLED 8/25/2000 383 364 QUARTZ
5. TOTAL DEPTH 426 384 426 GRANITE
6. CUTTINGS COLLECTED YES 0 NO 0 G9
7. DOES WELL REPLACE EXISTING WELL? YES 0 NO ® m < "
8. STATIC WATER LEVEL Below Top of Casing: 30 FT.
(Use"+"if Above Top of Casing) — rT1
9. TOP OF CASING IS 1 FT.Above Land Surface* -m
*Top of casing terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2C.0118
10. YIELD(gpm): 1 METHOD OF TEST Air
11. WATER ZONES (depthJI: qpm 383-384 0 ppm
0 Apm 0 ppm
12. CHLORINATION: Type HTH Amount 84 If additional space is needed use back of form
13. CASING: LOCATION SKETCH
Wall Thickness —
Depth Diameter or Weight/Ft. Material (Show direction and distance from at least two State
From 0 To 45 Ft. 6 1/4 .188 GALV. Roads,or other map reference points) -
From To Ft.
From To Ft.
14. GROUT: i
Depth Material Method
From 0 To 20 Ft.Cement Gravity Flow
From To Ft.
15. SCREEN:
Depth Diameter Slot Size Material Ill
From To Ft. in. in. S'
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: ' u�
I DO HEREBYETIF"%fiFj' T TIIjjW�LLiiWAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTIO STANDARD ,AND THAT t4 COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
�Iw s
FOR OFFICE US .3?CSNLY � (� 8 2000 SIGNATURE OF PE ON CONSTRUCTING THE WELL DATE
.t i
Quad No: a Subm!lt original to Division of Water Quality,Groundwater Section within 30 days
GW-1 REV.12/99
Y
Serial No.

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]
1 '7564
WELL CONSTRUCTION RECORD WELL CONTRACTOR: Devvey 4^dright Well Pump Co., Inc.
WELL CONTRACTOR CERTIFICATION#: 2
000457 STATE WELL CONSTRUCTION PERMIT#: Leslie eece
1. WELL USE(Check Applicable Box): Residential 0 Municipal ❑ Industrial ❑ Agricultural❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATION:(Show sketch of the location below)
Nearest Town: BANNER ELK County:AVERY
DARK RIDGE RD. OFF BEECH IvlTN RD. OFF HWY 194
(Road Name and Numbers,Community,or Subdivision and Lot No.)
DRILLING LOG DEPTH
3. OWNER DALE C. MCGUIRE From To Formation Description
Address 327 WEST COMMERCE RD. 0 15 DIRT/BOULDERS
MI LFORD(street or Route No.) MI 48381 15 33 GRANITE
City or Town State Zip Code 33 37 MUD
4. DATE DRILLED 8/12/2000 37 54 GRANITE
5. TOTAL DEPTH 305 54 55 SHALE
6. CUTTINGS COLLECTED YES ❑ NO 0 55 96 GRANITE
7. DOES WELL REPLACE EXISTING WELL? YES ❑ NO ® 96 97 SHALE
8. STATIC WATER LEVEL Below Top of Casing: 30 FT. 97 227 GRANITE --
(Use"+"if Above Top of Casing) 227 228 SHALE ,. R:^f'•.
9. TOP OF CASING IS 1 FT.Above Land Surface* 228 241 GRANITE
*Top of casing terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2C.0118
10. YIELD(gpm): 14 METHOD OF TEST Air 242 305 GRANITE
r-,
11. WATER ZONES (depth: qpm 54-55 4 Bpm 96-97 �+
3 opm 227-228 3 Iipm 241-242 —�
12. CHLORINATION: Type HTH Amount 56 If additional space is needed use back of form
13. CASING: Wall Thickness LOCATION SKETCH
Depth Diameter or Weight/Ft. Material (Show direction and distance from at least two State
From 0 To — 42 Ft. 6 1/4 .188 Gil.V Roads,or other map reference points)
From To Ft.
From To Ft. J Qo_ 1(2r P i
14. GROUT:
Depth Material Method ,DC
From 0 To 20 Ft.Cement Gravity, Flow
From To Ft. � S
15. SCREEN: {
Depth Diameter Slot Size Material ��`�
From To Ft. in. in. 0
From To r
Ft. in. in. 3
From To Ft. in. in.
16. SAND/GRAVEL PACK:
Depth Size Material
From To Ft. 00
From To Ft.
17. REMARKS: k5
I DO HEREBY CERTIFY THAT THIS NE�L WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C WELL
CONSTRUCTIONSTAN'IARIS, 1N4 T�'AT`A COP,•Y OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
FOR OFFICE USE ONLY
hhL �r
Quad No: ` -h i SEY 1 8 2000
Submit Q 3_ SIGNATURE OF PER CONSTRUCTING THE WELL DATE
nnginat,l to Division of Water Quality,Groundwater Section within 30 days
GW-1 REV.12/99
Serial No.

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] � 17 5 6 J
WELL CONSTRUCTION RECORD WELL CONTRACTOR: Dewey Wright Well Pump Co., Inc.
WELL CONTRACTOR CERTIFICATION#: 2686
000449 STATE WELL CONSTRUCTION PERMIT#, Leslie Reece
1. WELL USE(Check Applicable Box): Residential ® Municipal 0 Industrial 0 Agricultural 0 Monitoring 0
Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use:
2. WELL LOCATION:(Show sketch of the location below)
Nearest Town: BANNER. ELK County:AVERY
BEECH IVITN RD.OFF SAM ELLER RD. OFF HWY 194
(Road Name and Numbers,Community,or Subdivision and Lot No.)
DRILLING LOG DEPTH
3. OWNER BOYD MCCLOUD From To Formation Description
Address % CHARLES ULERY , 3480 BEECH MTN RD. 0 21 DIRT
ELK PARgtreet or Route No.) NC 28622 21 42 GRANITE
City or Town Y� state Zip Code 42 43 SHALE
4. DATE DRILLED 8/15/2000 43 87 GRANITE
5. TOTAL DEPTH 325 87 88 SHALE
6. CUTTINGS COLLECTED YES 0 NO 0 88 291 GRANITE n
7. DOES WELL REPLACE EXISTING WELL? YES 0 NO 0 291 293 SHALE r , c
8. STATIC WATER LEVEL Below Top of Casing: 20 FT. 293 325 GRANITE crs `'':;
(Use"+"if 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 i
10. YIELD (gpm): 5 METHOD OF TEST Air
11. WATER ZONES (depth/2 ppm42-43 112 ppm
4 ppm 291-293 0 pprn r
12. CHLORINATION: Type HTH_ Amount 64 If additional space is needed use ba f form
13. CASING: LOCATION SKETCH
Wall Thickness _
Depth Diameter or Weight/Ft. Material (Show direction and distance from at least two State
From 0 To 25 Ft. 6 '1/8 .350 PVC Roads,or other map reference points)From To Ft. r(r 44w, 11)yl
From To Ft.
14. GROUT:
Depth Material Method
From 0 To �0 Ft.Cement Gravity Flow ' k�
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. L
16. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
17. 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 RECO D HAS BEEN PROVIDED TO THE WELL OWNER.
FOR OFFICE USE ONLY
SE!!J p SIGNATURE OF PE N CONSTRUCTING THE WELL DATE
Quad No:
t f ��0��
Submit ori'inal to Division of Water Quality,Groundwater Section within 30 days
GW-1 REV.12/99
Serial No. J r° ,t;-a
1

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] `) a r �'
. ,) 4S
WELL CONSTRUCTION RECORD WELL CONTRACTOR: Dewey Wright Well Pump Co., Ino.
000271 WELL CONTRACTOR CERTIFICATION#:
STATE WELL CONSTRUCTION PERMIT#. eve e y
1. WELL USE(Check Applicable Box): Residential 0 Municipal ® Industrial 0 Agricultural 0 Monitoring []
Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: NEWLAND County:AVERY
CRANBERRY WATER SYSTEM OFF OLD HVVY 19E
(Road Name and Numbers,Community,or Subdivision and Lot No.)
DRILLING LOG DEPTH
3. OWNER CRANBERRY WATER ASSOC. From To Formation Description
Address P.O. BOX 537 . 0 70 DIRT
ELK PARW,reet or Route No.) NC 28622 70 100 GRANITE
City or Town State Zip Code 100 105 SHALE
4. DATE DRILLED 8/23/2000 105 130 GRANITE
5. TOTAL DEPTH 405 130 132 QUARTZ
6. CUTTINGS COLLECTED YES 0 NO 0 132 370 GRANITE/QUARTZ
7. DOES WELL REPLACE EXISTING WELL? YES 0 NO 0 370 372 QUARTZ
8. STATIC WATER LEVEL Below Top of Casing: 30 FT. 372 405 GRANITE/QUART
(Use"+"if Above Top of Casing) p =4
r7
9. TOP OF CASING IS 1 FT.Above Land Surface* -,
"Top of casing terminated at/or below land surface requires a variance in accor- rn �,�,
dance with 15A NCAC 2C.01 V f?
10. YIELD (gpm): METHOD OF TEST Air —
11. WATER ZONES (depth ppm 100-105 5 ppm 130-132 r. t;
5 Rpm 370-372 0 Apm
ins M
12. CHLORINATION: Type HTH Amount 75 If additional space is needed use back=of form r
rn
13. CASING: LOCATION SKETCH '-n
Wall Thickness 'A o
Depth Diameter or Weight/Ft. Material (Show direction and distance from at least two State
From 0 To 84 Ft. 5 1/4 .188 GALV. Roads,or other map reference points)
From To Ft.
From To Ft.
14. GROUT:
Depth Material Method
From 0 To 84 Ft.Cement Gravity Flow
From To Ft. G)
15. SCREEN: `
Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
From To Ft. in. in. G r
16. SAND/GRAVEL PACK: Q
Depth Size Material
From To Ft.
From To Ft.
17. REMARKS:
I DO HEREBY CERTI Y THATT S E WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCT S /�Nj'AR+IS��4f� T�FAY C
PPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
FOR OFFICE U N r�
Quad No: c{ 8 ?000 SIGNATURE OF PER N CONSTRUCTING THE WELL DATE
Submit original to Division of Water Quality,Groundwater Section within 30 days
GW-1 REV.12/99
Serial No, i

i
1 :
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] A- -� 75 37
WELL CONSTRUCTION RECORD WELL CONTRACTOR: Dewey Wright Well Pump CO., Inc.
2686
000505 WELL CONTRACTOR CERTIFICATION#: Rv
-
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE (Check Applicable Box): Residential ® Municipal 0 Industrial 0 Agricultural 0 Monitoring ❑
Recovery ❑ Heat Pump Water Injection 0 Other El If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: LINNVILLE County.AVERY
CARROLL GRAGG RD. OFF HWY 221
(Road Name and Numbers,Community,or Subdivision and Lot No.) DRILLING LOG DEPTH
3. OWNER DANNY W. GIPSON From To Formation Description
Address P.O. BOX 1353 , 0 23 DIRT
LI NNVI LLLEStreet or Route No.) NC 28646 23 b8 b b FUNE
City or Town State Zip Code 58
ya
4. DATE DRILLED 8/31./2000
5. TOTAL DEPTH ____.._�185 84 163 �-'
6. CUTTINGS COLLECTED YES 0 NO 0 16 b 11 -'
7. DOES WELL REPLACE EXISTING WELL? YES ❑ NO 164 1 `' — M
8. STATIC WATER _i:',' L Below Top of Casing: 40 FT. - r,
(Use"+"if Above Top of Casing) t-?
9. TOP OF CASING IS-_- 1 FT. Above Land Surface*
*Top of casing terminated tit!or below land surface requires a variance in accor-
dance with 15A NCAC 2C.01 -
10. YIELD (gpm): �$ METHOD OF TEST
r
th , pom 83-84 Apm - 6 11. WATER ZONE� (depr n "<
AP111 0 plorn ko c>
12. CHLORINATION: 'Type Amount If additional space is needed use back of form
13. CASING: Wall Thickness LOCATION SKETCH
Depth Diameter or Weight/Ft. Material (Show direction and distance from at least two State
From 0 To __ 62 Ft 6 1/8 .350 PVC Roads.or other map reference points)
From To Ft.
From To Ft.
14. GROUT:
Depth Material Method
From 0 To 20_Ft.Cement Gra.Ay Flow
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: T
Depth Size Material 3
From To __ Ft.
From To _ Ft.
17. REMARKS
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL 1l�
CONSTRUCTIbN SThN AR �, N THATiA COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
FOR OFFICE US�IL
1), Ip 2000 ' SIGNATURE OF SON CONSTRUCTING THE WELL DATE
Quad No: �� Subtriit-ooriginal to Division of Water Quality,Groundwater Section within 30 days
_ GW-1 REV.12/99
t
Serial No.
twiw��4�F

North Carolina-Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section i C.[. O
1636 Mail Service Center-Raleigh,N.C.27699-1636-Phone [phone] 16 U
WELL CONSTRUCTION RECORD WELLCONTRACTOR:
WELL CONTRACTOR CERTIFICATION 0:
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE(Check Applicable Box): Residential Municipal ❑ Industrial❑ Agricultural❑ Monitoring
Recovery❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use: J'A jU'-,4?
2. WELL LOCATION:(Show sketcc f the location below)
Nearest Town: y/'" County: w ell' r'1
(Road Name of Numbers,Community,or Subdivision and Lot No.) DRILLING LOG DEPTH
3. OWNER _ �h�r G a1-4 f_3 From To Formation Description'
J
Address ` J - !•S c��`Af.4„�r=..._r�,f
Street or H.Lit. o.
City or Town S ate Zip Code 4,1er'bGk
4. DATE DRILLED c�o0?j s_ r fo nror��fe
5. TOTAL DEPTH If 6
6. CUTTINGS COLLECTED YES❑ NO Q /S2- ra'o t `r-
7. DOES WELL REPLACE EXISTING WELL? YES ❑ NOQ
8. STATIC WATER LEVEL Below Top of Casing: FT.
(Use'+-If Above Top of Casing)
9. TOP OF CASING IS FT.Above Land Surface-
'Top of casing terminated atlor below land surface requlres a variance In accor-
dance with 15A NCAC 2C.0118 ` r-
10. YIELD(gpm): v2 6 METHOD OF TEST I�L%r
11. WATER ZONES(depth): '70 " �2-4*t 1:s'6•-1J.�
12. CHLORINATION: Type ff7-174' Amount 111Z__ It additional space is needed use back of log 10 r
13. CASING:
Wall Thickness LOCATION SKETCH �Wj
Depth Diamo r or Wei hVFt. Material (Show direction and distance from at least two Srate o
From �f To vZ U Ft.—t2-- ���.- Roads,or other map reference points)
From To Ft.-
From- To Ft.
14. GROUT:
Depth Material Method
From a To "0 Ft. evz our
From To Ft.
15. SCREEN:
Depth Diameter Slot Size MaterialX
N
From To . Ft in. in. fa
From - To Ft. in. in. ( �
From To Ft. in. in.
16. SAND/GRAVEL PACK:
Depth Size Material
From To Ft. )t7
From To Ft.
17. REMARKS:
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.
FOR OFFICE USE ONLY �v-"
Ouad No: SIGNATURE� RSON CONSTRUCTING THE WELL DATE
Submit original to Division of Water Ouality,Groundwater Section within 30 days
Serial No.
GW1 REV.12/99

North Carolina-Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section O
1636 Mail Service Center•Raleigh,N.C.27699-1636-Phone[phone] �. j
WELL CONSTRUCTION RECORD WELL CONTRACTOR:
WELL CONTRACTOR CERTIFICATION
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE(check Applicable sox): Residential EK Municipal ❑ Industrial❑ Agricultural❑ Monitoring ❑.
Recovery❑ Heat Pump Water Injection ❑ Other (l If Other, List Use: 1, i d,7-I42
2. WELL LOCATION: (Show sketch of the location below)
Neares�tTn"n: Alew- io County:—Ade'of;j
(Road Name(. d Numbers,Community,or sub Won and Lot No.) DRILLING LOG DEPTH
3. OWNER _ G4/zfI From To Formation Description
Address 6 /7
� (Street or Roulo o. r
City or town State Zip Code
4. DATE DRILLEDW.
- —�`iO�
5. TOTAL DEPTH
6. CUTTINGS COLLECTED YES❑ NO �-
7. DOES WELL REPLACE EXISTING WELL? YES NOE] 44 o r
8. STATIC WATER LEVEL Below Top of Casing: FT. ;,a • ,
(Use'+'if Above Top of Casino) c�
9. TOP OF CASING IS-�_ FT.Above Land Surface-
*Top'Top of casing terminated at/or below land surface requires a variance In accor- —
dance with 15A NCAC 2C. 118 }.:
10. YIELD(gpm): . METHOD OF TEST ni
11. WATER ZONES(depth):-- `� { lw4 '=
r
.. C;-
12. CHLORINATION: Type d r6e Amount If additional space is needed use back of forrttV o
13. CASING:
Wall Thickness LOCATION SKETCH
Depth Diameter or Weight/Ft. Matik�lynal (Show direction and distance from at least two State
From To Ft. 9D G .. Roads,or other map reference points)
From To Ft.
From To Ft. T
14. GROUT:
Depth Malorial Method paw a
From d To as Ft. r�.ty rr _ C'
From To Ft. e ,
15. SCREEN: a
Depth Diameter Slot Size Material a
From To Ft in. in. 'G Aip
From To Ft. in. in.
From To Ft. In. in. ej 47
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 OFT IS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
FOR OFFICE USE ONLY
Quad No: SIGNATURE.O SON CONSTRUCTING THE WELL. DATE
Submit original to Division titer Ounlity.Groundwater Section within 30 days
Serial No,
GW1 REV.12/99

North Carolina-Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section i �'1636 Mail Sorvice Center-Raleigh,N.C,27699-1636•Phone[phone] C- 1 l 6 4 6
WELL CONSTRUCTION RECORD WELL CONTRACTOR: �' z'' 121,
WELL CONTRACTOR CERTIFICATION#:
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE(Check Applicable Box): Residential 117J� Municipal ❑ Industrial❑ Agricultural❑ Monitoring ❑
Recovery❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATION: (Show sketch of the ldcation below)
Nearer Town: z4u _ _/, .� ��•�F l`
County: �-
(Road Name and Numbers,Community,or Subdivisio and Lot No.) DRILLING LOG DEPTH
3. OWNER % �miirn v.� From To Formation Description
Address j treot or out o. -
City or Town state e
Zip Code
4. DATE DRILLED ^/7 �r't' goo
5. TOTAL DEPTH 0 D
6. CUTTINGS COLLECTED YES❑ NO�
7. DOES WELL REPLACE EXISTING WELL? YES ❑ NO©
8. STATIC WATER LEVEL Below Top of Casing: FT,
(Use'+-It 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 15A NCAC 2C.0118
10. YIELD(gpm): `�L METHOD OF TEST
11. WATER ZONES(depth):- 96 6 f1
12. CHLORINATION: Type _ f/`7 —Amount_ ?ter) _ If additional space is needed use back of form
13. CASING:
Wall Thickness LOCATION SKETCH
Depth t Dim ter or Weighl/Ft. Material (Show direction and distance from at least two State
From To—__ Ft. a X Roads,or other map reference points)
From To Ft.
From To Ft.
14. GROUT:
Depth Material Method
From - /9 _ To
From To Ft. J ='
o
15. SCREEN: q
Depth Diameter Slot Size Material
From To Ft
From Ft. in.
To ry(n. D
From To Ft. in. In.
16. SAND/GRAVEL PACK: —�
Depth Size Material 9? r
From To Ft. ry
From To Ft c�
17. 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.
FOR OFFICE USE ONLY
Quad No: r SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE71
original to l)iwslori of Water Quality,Groundwater Section Within 30 days
Serial No,
jr� GW-1 REV. 12/99
r ajL i 3 21 J�I�Q1) f ,'
J

North Carolina-Department of Environment and Natural Resources-Division of Water Ctuality-Groundwater Section
1636 Mail Service Center-Raleigh,N.C.27699-1636-Phono(919)733-3221 rj ti (r
WELL CONSTRUCTION RECORD WELL CONTRACTOR: u� -� e c —
WELL CONTRACTOR CERTIFICATION#:__
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE(Check Applicable Box): Residential❑ Municipal ❑ Industrial❑ Agricultural❑ Monitoring[].Recovery❑ Heat Pump Water Injection ❑ Other❑ If Other, List Use:
2. WELL LOCATION; (,dhow sketch of the location below)
Nearest Town:
County:— y
(Road N e and Nu ers,Co"yT'unity,o�Subdivis�ffon ��
DRILLING LOG DEPTH
3. OWNE , .�i+c C, �
Address From To Foormaationn Description
2 _/Cn dl/'r 1.5Iole-e
treet or oute o.
City r Town. State f 7 D Jr
4. DATE DRILLED
�D�) Zip Code 1��r. /Gc
S. TOTAL DEPTH O�� _ 710 9/? s'Zo
6. CUTTINGS COLLECTED YES C] NO '7 /3 -le
7. DOES WELL REPLACE EXISTING WELL? YES NOE]
8. STATIC WATER LEVEL Below Top of Casing: FT.
(Use'+'It 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 15A NCAC 2C.0118
10. YIELD(gpm): METHOD OF TEST
11. WATER ZONES(depth):
42 _
12. CHLORINATION: Type f 14 Amount 13. CASING; It additional space is needed use back of form
Wall Thickness LOCATION SKETCH
Depth Diameter or Wei ht/Ft. Material (Show direction and distance from at least two State
From—To_T_1___ Ft. =c?+-- C�4ll.-' Roads,or other map reference points)
From To Ft.
From To Ft.
14. GROUT:
Depth. Material Method
From . 6 To eil­(? Ft. _ G�i,•,� t� c�.
CD
From CD
To Ft.
15. SCREEN: -moo
Depth Diameter Slot Size Material —From To Ft in, in.
From To Ft. in. in.
From To Ft. in. In• �r
16. SAND/GRAVEL PACK:
Depth Size Material
rJ
From To Ft.From To Ft.
17. REMARKS:
DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C,WELL
CONSTRUCTION STANDARDS,AND THAT A COPY OF THIS f1ECORD HAS BEEN PROVIDED TO THE WELL OWNER.
FOR OFFICE USE ONLY
Ouad No: _ SIGNATURL01"PERSON CONSTRUCTING THE WELL DATE
Serial No. D` sro of w�tri O¢�hty{GroFuntlwater,§eciion within 30 days
Iu { ` fit € ��f �< GW-1 REV. 12/99
{
I �(ry1 l II
r _
a ?
I

' North Carolina-Department of Environment and Natural Resourcos-Division of Water Quality-Groundwater Section ; • � ►•j(;
1636 Mail Service Center-Raleigh,N.C.27699-1636-Phone[phone] �- �- ;� ►} ` c+
WELL CONSTRUCTION RECORD WL'Ll_ CONTRACTOR:
WELL CONTRACTOR CERTIFICATION#: oc
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE(Check Applicable Box): Residential❑ Municipal � Industrial❑ Agricultural❑ Monitoring❑.
Recovery❑ Heat Pump Water Injection ❑ Other ❑ It Other, List Use:
2. WELL LOCATION:(Show ketch f the location below)
Nearest Town: R cu"A 6 �� County:
C,f CD. �2 4el e
(Road Name d Numbers;Community,or Subdivision and Lot No.) DRILLING LOG DEPTH
3. OWNER { �v -�' u � ��From To Formation Description'
Address O� �� r r m� :^f lr 61,,
treet or Ro to o.
� LxU',cL� 7 —
City or Town State Zip Code '
4. DATE DRILLED 14) ':2000 103 5147 .�
5. TOTAL DEPTH
6. CUTTINGS COLLECTED YES❑ NO E�fj' S� f 6'b —
7. DOES WELL REPLACE EXISTING WELL? YES ❑ NO Q-
8. STATIC WATER LEVEL Below Top of Casing: _FT. r
(Use'+'If Above Top of Casing) O
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 15A NCAC 2C,.0118
10. YIELD(gpm): ____S METHOD OF TEST `3 °
11. WATER ZONES (depth): y "103
5 ,A
12. CHLORINATION: Type ,f�`I/`f Amount 3a _ It additional'space is needed use back of for(b cnL:1
13. CASING: w c7~
LOCATION SKETCH W
Wall Thickness
l Depth Diam for or Weight/Ft. Material (Show direction and distance from at least two State
From—To � Ft. �' /R F Gr,w Roads,or other map reference points)
From To Ft. -
From To FI. -
14. GROUT:
Depth Material Method
From b To SJ Ft. Gerar•y f o r[' Gc c,��
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:
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.
FOR OFFICE USE ONLY ;P
Ouad No: SIGNATURE O --RSON CONSTRUCTING THE WELL DATE
Suhmit original to Division of Water Ounlity.Groundwater Section Within 30 days
Serial No. GW-1 REV. 12/99

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 W1=LL CONTRACTOR: L ��� - G,j
WELL CONTRACTOR CERTIFICATION H:
STATE WELL CONSTRUCTION PERMITH:
1. WELL USE(Check Applicable sox): Residential❑ Municipal L!n Industrial❑ Agricultural❑ Monitoring (�.
Recovery❑ Heat Pump Water Injection ❑ Other E�J-If Other, List Use: 4aklIc 07ZG%_--e-Q,
2. WELL LOCATION: (Show sketch f the location below)
Nearest Town: , �w�u'lU County: 1lrU��
(Road Name and Numbers,Community,or Subdivision and Lot No.) / DRILLING LOG DEPTH
3. OWNER _ C'r Gy & From To Formation Description
Address ri 3112- Pe4dlI14-
treet or Route o. 31P �{L>
�-Ck� ,c�
Ct y or Town State Zip Codo fa Sv23 �' ,r /vttr�li ua
4. DATE DRILLED !
5. TOTAL DEPTH 7' S vt Sr— /�A?
6. CUTTINGS COLLECTED YES❑ NO©—
7. DOES WELL REPLACE EXISTING WELL? YES ❑ NO�' l(9
8. STATIC WATER LEVEL Below Top of Casing: FT. o
(Use'+'If 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 15A NCAC 2C.0118 J '
10. YIELD(gpm): METHOD OF TES1• '-
11. WATER ZONES(depth): S " r
_. ;r-,
J'
12. CHLORINATION: Type —Amount If additional space is needed use back of form•• r-n;3
13. CASING: �
Wall Thickness
LOCATION SKETCH
`
Depth Diameter or Weight/Ft. Material (Show direction and distance from at least two State
From _ To J-2 Ft. _ems /�Q .. Roads,or other map reference points)
From To Ft.—
From To Ft.
14. GROUT: n
Depth Material Method
From To �_Ft. 44We-f '-e
C._
From To Ft.
15. SCREEN:
Depth Diameter Slot Size Material
From To Ft in, in.
From - To Ft. in. in. 05 {
From To Ft. in, in.
16. SAND/GRAVEL PACK:
r rF !
Depth Size Material
From To Ft.
From To Ft.
17. REMARKS:
DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STANDARDS,AND THAT A COPY OF TWS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
FOR OFFICE USE ONLY
Quad No: SIGNATURE O SON CONSTRUCTING THE WELL. DATE
Suhmil original to Divislon of Water Quality,Groundwater Section within 30 days
Serial No. GW1 nEV. 12t99

North Carolina-Department of Environment and Natural Resources-Division of Water quality-Groundwater Section 226524
1636 Mail Service Center-Raleigh,N.C.27699-1636-Phone[phone]WELL CONSTRUCTION RECORD WELL CONTRACTOR:
WELL CONTRACTOR CERTIFICATION#:
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE(Check Applicable Box): Residential a Municipal ❑ Industrial❑ Agricultural❑ Monitoring ❑.
Recovery❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town; ' C �� o'--JCounty:_ L
(Road Name and Numbers,Community,or Subdivision and Lot No.) DRILLING LOG DEPTH
f '
3. OWNER I"crr�. e'i� ���i'r l-s' From To Formation Description
Address \ '' /2 p�,1��"� s�v/c'
(Street or Houte 970 o27o c.,.�, `' -`•7!��—tc-<�.•7rcfp-cecr�s
City or Town State Zip Code 3
°2
4. DATE DRILLED 121 tsn
7-
5. TOTAL DEPTH
6. CUTTINGS COLLECTED YES❑ NO[a
7. DOES WELL REPLACE EXISTING WELL? YES ❑ NO�� ►� n-`
8. STATIC WATER LEVEL Below Top of Casing: (E FT.
(Use-+'If Above Top of Casing)
9. TOP OF CASING IS FT.Above Land Surface'
'Top of casing terminated at/or below land surface requires a variance in actor-
dance with 15A NCAC 2C.0118
10. YIELD(gpm): METHOD OF TEST
11. WATER ZONES(depth):- 9v a �-•i �f1�/ O_
12. CHLORINATION: Type Amount If additional space is needed use back of form
13. CASING:
Wail Thickness LOCATION SKETCH
Depth Diameter or Weighl/Fl. Material (Show direction and distance from at least two State
From J� To '2� Ft. 4 1 P'T Roads,or other map reference points)
From To Ft.
From To Ft.
14. GROUT:
Depth Material Method ---
From To Ft.
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. s ,c rj
16. SAND/GRAVEL PACK: ` .
Depth Size Material
hz
From To Ft. _
- �
From To Ft.
17. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STANDARDS,AND THAT A COPY OF THI RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
FOR OFFICE USE ONLY /o?
Quad No: SIGNATIIF OF RSON CONSTRUCTING THE WELL DATE
Submit.original to Division of Water Quality,Groundwater Section within 30 days
Serial No. GW-1 REV. 12199
i
-
t
��r35o• t+ �nnapa � ,, �';

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] 4 513
WELL CONSTRUCTION RECORD WELL CONTRACTOR: Dewey Wright Well Pump Co., Inc.
WELL CONTRACTOR CERTIFICATION#: 2686
000421 STATE WELL CONSTRUCTION PERMIT#: Leslie Reece
1. WELL USE(Check Applicable Box): Residential 0 Municipal ❑ Industrial ❑ Agricultural❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATION:(Show sketch of the location below)
Nearest Town: NEWLAND County: AVERY
HORNEY RD. OFF TRIM BRANCH RD OFF SPA NI SH OA
(Road Name and Numbers,Community,or Subdivision and Lot No.) DRILLING LOG DEPTH
3, OWNER VINCENT C. STAMEY From To Formation Description
Address' 1773 HORNEY RD. . 0 58 DIRT
Nt3treet or Route No.) NC 28657 58 94 GRANITE
City or Town State Zip Code 94 95 SHALE
4. DATE DRILLED 7/18/2000 95 151 GRANITE
5. TOTAL DEPTH 185 151 152 SHALE
6. CUTTINGS COLLECTED YES ❑ NO 0 152 185 GRANITE
7. DOES WELL REPLACE EXISTING WELL? YES ❑ NO FX
8. STATIC WATER LEVEL Below Top of Casing: 30 FT.
(Use"+"if 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 CJ 1 =m
10. YIELD(gpm): 3 METHOD OF TEST Air ac
11. WATER ZONES (depth)! ppm 94-95 2 Rpm 151-152
0 ppm 0 ppm N
m-
12. CHLORINATION: Type HTH Amount 34 If additional space is needed use bacdgffog
o_
13. CASING: Wall Thickness LOCATION SKETCH
Depth Diameter or Weight/Ft. Material (Show direction and distance from at least two State
From 0 To 63 Ft. 6 1/8 .350 PVC QJ Roads,or other map reference points),From To Ft. 4+w 221
From To Ft. �gl
14. GROUT:
Depth Material Method
From 0 To _20 Ft. Cement Gravity Flow
From To Ft. 011 r"�
15. SCREEN:
v
Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
From To Ft. in. in.
16. SAND/GRAVEL PACK:
la t, REP
�I7.g4)
({

North Carolina-Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section 1 n
1636 Mail Service Center-Raleigh, N.C.27699-1636-Phone[phone] J
WELL CONSTRUCTION RECORD WELL CONTRACTOR: Dewey Wright Well Pump Co., Inc.
0003915 WELL CONTRACTOR CERTIFICATION#: es le eece
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE (Check Applicable Box): Residential M Municipal 0 Industrial 0 Agricultural 0 Monitoring 0
Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: NEVVLAND County: AVERY
OLD 19E OFF HWY 19E
(Road Name and Numbers,Community,or Subdivision and Lot No.) DRILLING LOG DEPTH
3. OWNER CLARK STONE From To Formation Description
Address_10801 HM 421 . 0 57 DIRT
ZI ONVI LLfftreet or Route No.) NC 28698 57 805 GRANITE
City or Town State Zip Code
4. DATE DRILLED 7/20/2000 t—_;
5. TOTAL DEPTH 805 c� 9
6. CUTTINGS COLLECTED YES 0 NO E ='-�
7. DOES WELL REPLACE EXISTING WELL? YES 0 NO EX �`
8. STATIC WATER LEVEL Below Top of Casing: FT. tv �-�u"'
(Use"+"if Above Top of Casing)
9. TOP OF CASING IS 1 FT.Above Land Surface* r*1
*Top of casing terminated at/or below land surface requires a variance in accor- r7
dance with 15A NCAC 2C.0118 F'►c� -'':
10. YIELD(gpm): 0 METHOD OF TEST Air qa
11. WATER ZONES (depthP €tpm DRY HOLE 0 ppm c,
0 ppm 0 ppm
12. CHLORINATION: Type HTH Amount If additional space is needed use back of form
13. CASING: Wall Thickness LOCATION SKETCH
Depth Diameter or Weight/Ft. Material (Show direction and distance from at least two State
From_0 To 63 Ft. 6 1/4 .188 GALV. Roads,or other map eference tints)
From To Ft.
From To Ft. Ft
14. GROUT:
Depth Material Method
From 0 To 20 Ft. Cement Gravity Flow s
From To Ft.
15. SCREEN:
Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in. r ul
From To Ft. in. in.
16. SAND/GRAVEL PACK:
Depth Size Material
From To Ft. \a�
From To Ft. p,
17. REMARKS:
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION=STAgp NDARDSi AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
i dt3 i� J
L,Y
FOR OFFICE USE bNLY
SIGNATURE OF PER N CONSTRUCTING THE WELL DATE
Quad No: ) 3 ���j6ubmit original to Division of Wat r Quality,Groundwater Section within 30 days
GW-1 REV.12/99
Serial No.

North Carolina-Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section 216115
1636 Mail Service Center-Raleigh,N.C.27699-1636-Phone[phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR: Dewey Wright Well Pump Co., Inc.
WELL CONTRACTOR CERTIFICATION#: 2797
000439 STATE WELL CONSTRUCTION PERMIT#: Jerry Wilson
1. WELL USE (Check Applicable Box): Residential ® Municipal F7 Industrial 0 Agricultural 0 Monitoring F7
Recovery D Heat Pump Water Injection E Other EJ If Other, List Use:
2. WELL LOCATION:(Show sketch of the location below)
Nearest Town: LINVILLE County: AVERY
SUGAR VISTA OFF SUGAR MTN#2 OFF HWY 181 OFF
(Road Name and Numbers,Community,or Subdivision and Lot No.) DRILLING LOG DEPTH
3. OWNER KEN MYSI AKOWRKI From To Formation Description
Address 1R9 GIIGAR VISTA RO 0 12 DIRT/SANDiSHA.LE
WI NIE AN�treet or Route No.) NC' ?R857 1? 19 SHAI E
City or Town State Zip Code
19 30 GRANITE
4. DATE DRILLED 71251?C11710 RO 31 SHALFIQUARTZ
5. TOTAL DEPTH ;mi 91 55 GRANITE
6. CUTTINGS COLLECTED YES E NO ® 55 80 SHALE r,
7. DOES WELL REPLACE EXISTING WELL? YES 0 NO ® 60 285 GRANITE © Q
8. STATIC WATER LEVEL Below Top of Casing: _150 FT. 285 286 QUARTZ {'>
(Use"+"if Above Top of Casing) 2$6 305 GRANITE - o t'�
Un
9. TOP OF CASING IS 1 FT.Above Land Surface* iaa c
*Top of casing terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2C.0118
10. YIELD(gpm): 7.5 METHOD OF TEST Air —+ ;=
11. WATER ZONES (depthp.5 gpm 55-60 5 apm 285-286 —� �76
0 apm 0 ppm
12. CHLORINATION: Type HTH Amount 49 If additional space is needed use back citform• 1
13. CASING: Wall Thickness �v LOCATION SKETCH
Depth Diameter or Weight/Ft. Material J� (Show direction and distance from at least two State
From 0 To 23 Ft. 6 118 350 PV(` Roads,or other map reference points)
From To Ft. V
From To Ft.
14. GROUT:
Depth Material Method
From n To —20 —Ft. C''aminnt 2rmdtsL.FInw
From To Ft. N
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:
I DO HEREBY CERTIFY§THAT THI'S)WE�LL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STAN,DARDSL,AND)I'HAT A COPY OF THIS RECORD HAS BE N PROVIDED TO THE WELL OWNER.
FOR OFFICE", ONE r�
��t1 ATURE OF PERSON CONSTRUCTING THE WELL DATE
Quad No: Submit original to Division of Water Quality,Groundwater Section within 30 days
GW-1 REV.12/99
Serial No.

North Carolina-Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section 2 176 4 4
1636 Mail Service Center-Raleigh,N.C.27699-1636-Phone[phone] -
WELL CONSTRUCTION RECORD WELL CONTRACTOR:
WELL CONTRACTOR CERTIFICATION#:
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE(Check Applicable Box): Residential❑ Municipal ❑ Industrial❑ Agricultural❑ !`--nitoring ❑.
Recovery❑ Heat Pump Water Injection ❑ Other �f Other, List Use: &,r//Zt4
2. WELL LOCATIOQ�.: G#1ow skgtch of the location below)
Nearest Town:—�:K"-7w'-6 CCee�- County:_�iLt ff���
11
(Road Name and Numbers,Community,or Subdivision and Lot No.) DRILLING LOG DEPTH
3. OWNER _ G /� l p, From To Formation 0^scription'
Address �La ��rrti1
trees or ou a o.
Cilyl or Town Stale Zip Code
4. DATE DRILLED o?/�Of coo
5. TOTAL DEPTH
6. CUTTINGS COLLECTED YES NO[w'
7. DOES WELL REPLACE EXISTING WELL? YES NO❑
8. STATIC WATER LEVEL Below Top of Casing: FT.
2 (Use'+"If 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 15A NCAC 2C.0118
10. YIELD(gpm): METHOD OF TEST r
11. WATER ZONES (depth):
12. CHLORINATION: Type Amount _ If additional space is needed use back _!n
13. CASING: ,
Wall Thickness LOCATION SKETCH
Depth Diameter or Weight/Ft. Material (Show direction and distance from at least t­--Late
From—To— Ft.— Roads,or other map reference points) —
From To Ft.
From To Ft.
14. GROUT:
r"7
Depth Material Method q
From To Ft. _
From To FL r r1
15. SCREEN: -v
Depth Diameter Slot Size Material IV
From To Ft in. rn
From To Ft. in. In.
-
r_0_..l
From To Ft. In, in. t? 1­1_1
16. SAND/GRAVEL PACK: ry
Depth Size Material
From To Ft.
From To Ft.
17. REMARKS:
DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STANDARDS AND THAT A COPY OF THIS RE ORD HAS BEEN PROVIDED TOO THE WELL OWm1.-,.
FOR OFFICE USE ONLY
Quad No: SIGNATURE OF PE__ ON CONSTRUCTING THE WELL P"?
Submit original to O" slon'of Water'OU I''1y.,Groundwater Section within 30 days
Serial No. , n
5 �UUO fir GW.t nEv. 12/99

0
North Carolina-Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section 6605
1636 Mail Service Center-Raleigh,N.C.27699-1636-Phone[phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR:
'ZrcZe 4 �
WELL CONTRACTOR CERTIFICATION N: a21"_
STATE WELL CONSTRUCTION PERMITN:
1. WELL USE(check Applicable Box): Residential El Municipal ❑ Industrial❑ Agricultural❑ "oring ❑.
Recovery❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below)Nearest Town:- E7f Pan County: '0 1✓'F/
(Road Name and Numb rs:Community,or Subdivision and Lot No.) DRILLING LOG
3. OWNER ? 0 - -
iG/GI From To Forma" • ;ption
Address
t _�ttreetor outsNo.). �6,2
���✓
City or Town State Zip Code
S3'
4. DATE CjR!LLED �-�-
5. TOTAL DEPTH O G�
6. CUTTINGS COLLECTED YES❑ NO❑ 7_12 ` —
7. DOES WELL REPLACE EXISTING WELL? YES ❑ NO❑ I al—/ate
8. STATIC WATER LEVEL Below Top of Casing: FT. I'a _l'/v p
(Use'+'It Above Top of Casing) :ti� )
9. TOP OF CASING IS FT.Above Land Surface' s
`Top of casinn terminated at/or below land surface requires a variance In accor-
dance with 1SA NCAC 2C. 18 r �?
10. YIELD(9pm): a METHOD OF TEST �"� �z '` ai��� " --
11. WATER ZONES(depth): S}�© /q
(75 ,
38� q, g
12. CHLORINATION: Type ��� Amount _ If additional space is tideded usrt h,
13. CASING: _
W LOCATION SKETCH
Wall Thickness �_ ' r
;:,D"21
Depth Diameter or Weight/Ft. Material (Show direction and distance from at
From To i 21 Ft._- _ "'87 64Z— Roads,or other map reference poin, ` w r)
From To Ft. o
From To Ft. `
14. GROUT:
Depth Material Method A/ '/r
From To 44 Ft. C,Aetv!i e� r
From To Ft.
15. SCIZF.iCt!;
Depth Diameter Slot Size Material a64­�e
PAit
From To Ft in. in.
From -To Ft. in. in.
From ___To Ft. In. _ In.
16. SAN !GRAVEL PACK:Depth Size Material
From To Ft.From To _ Ft.
17. REM^RKS:
DO H-.-r7f3Y CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTF;UCTION STANDARDS,AND THAT A COP THIS RECO D HAS BEEEEEN�ROVIDED TO THE WELL O"•'
FOR ('3C USE ONLY c'_, �.�'�c�CY�
Quad N,,: SIGNATURE OF PERSON CONSTRUCTING THE WELL.
Submit original to Division of Water Ouality,Groundwater Section Within 30 days
Serial fin. _ G"' 12J99

North Carolina•Department of Environment and Natural Resource,-Division of Water Ouality-Groundwater Section 0 [? ((��
1636 Mail Service Center•Raleigh,N.C.27699-1636-Phono(919)733-3221 1 V 6 V 3
WELL CONSTRUCTION RECORD WELL CONTRACTOR: C' rL' c,
WELL CONTRACTOR CERTIFICATION N: o'Z li 6 q
STATE WELL CONSTRUCTION PERMITH:
1. WELL USE(Check Applicable Box): Residential 21 Municipal ❑ Industrial❑ Agricultural❑ Monitoring E.
Recovery❑ Heat Pump Water Injection ❑ Other ❑ It Othor, List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: County:— U
rv0 iv veyov JC D
(Road Name d Numbers,Community,or Subdivision and Lot No.) DRILLING LOG DEPTH
3. OWNER b rh. ' `Ct kwE r From To Formation Description
Address _ 3�� L-'41e- 'PjulAlec CyeeL d 7S 1't��'
(Street or Houto o.
City or Town State Zip Code
4. DATE DRILLED �• 0 8-a
5. TOTAL DEPTH ! l .File%r•^cx-A/
..
6. CUTTINGS COLLECTED YES❑ NOQ' /`f �✓w�' {e -
7, DOES WELL REPLACE EXISTING WELL? YES ❑ NO[°� /J5r- /J8 silclp�'c�x
8. STATIC WATER LEVEL Below Top of Casing: FT.
(Use'+'II Above Top of Casing) xd,i­r
9. TOP OF CASING IS FT.Above Land Surface• , q \;.
'Top of casing terminated at/or below land surface requires a variance In actor- �� 3�8t 4
dance with 15A NCAC 2C. 118 '�E
10. YIELD(gpm): METHOD OF TEST %^ � '`t. o
.11. WATER ZONES(depth)./-&l02 b= -� `
�o
12. CHLORINATION: Type Amount 3 62 _ li' dditional,s� ce �ieeded'use back of form
13. CASING: k ,;
4�LOCATION SKETCH _J
Wall ThicknessT
Depth Dia otor or Weight/FL Material (Show direction and distance from at least two State
/ � f��a Pr�� o
From TO Ft. Roads,or other map reference points) n'
From- To 93 Ft. G--5 /s'8 9ld i
From To Ft.
14. GROUT:
Depth Material Method p
From To az' Ft. <c�o�-•->< co �N ,�
From To FL
j/olrbv a
I
15. SCREEN: �ow
Depth Diameter Slot Size Material r�v���
From To Ft in. in.
From To Ft. in. In.
B �
From To Ft. In. in. f
16. SAND/GRAVEL PACK:
Depth Size Material C
From To Ft. t'=�
M .
From To Ft.
17. REMARKS:�[q a /v &c) e/veil le o//4 e/LY►
DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STANDARDS,AND THAT A COPY OF THIS RE ORD HAS BEEN PROVIDED TO THE WELL OWNER.
FOR OFFICE USE ONLY !
Cluad No: SIGNWFURE OF SON CONSTRUCTING THE WELL DATE
Submit original to Divislon of Water Ounlity,Groundwater Section within 30 days
Serial No. GW-1 REV. 12/99

North Carolina-Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section 4 6 6 '7 3
1636 Mail„orvice Center-Raleigh,N.C.27699-1636-Phone[phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR:
WELL CONTRACTOR CERTIFICATION N:
STATE WELL CONSTRUCTION PERMIT#-*
1. WELL USE(Check Applicable Box): Residential Municipal ❑ Industrial❑ Agricultural❑ tcr,ng ❑.
Recovery❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use: 42P I`K77llf _._.
2. WELL LOCATION: (Show sketch ot;the location below) L
Nearest Town: - e �� , ( County:. y
(Road Name and Numbers,Community,or Subdivision and Lot No.) DRILLING LOG D
3. OWNER 12a42-w�y y"a a/114 From To Form" !;on
Address ?3'� .%�r; a�SP��r��
/--, trees or Routeo.)N !�7 �p0. 5�1.ze
? - � �o rya
,y or Town Stale Zip Code !
4. DATE DRILLED
5. TOTAL.nFPTH ©d Spa - o o
6. CUT'" ,S COLLECTED YES❑ NO ![�
7. DOL '1.LL REPLACE EXISTING WELL? YES ❑ NO[!
8. STATIC' ':'!ATER LEVEL Below Top of Casing: _76 FT.
(Use'+'If Above Top of Casing)
9. TOP O-'CASING Is FT.Above Land Surface-
'Top of r�rmfnatad at/or below land surface requires a variance In accor-
dance wf�. + 7!_AC 2C. 18 CD
10. YIEI D (-rpm): METHOD OF TEST /Y'12
11. WATFR ZONES (depth): 90-S9 —«Vc -
12. CHLORINATION: Type lILI Amount 3O'Z If additional space is needed use t,l ; M
13. CASIrdG: _-
LOCATION SKETC'I r Nrr
Wall Thickness
Depth Diametor or Weight/Ft. Material (Show direction and distance from at Ie m 7a
From— To Ft. /o S Roads,or other map reference po; W o
From_ S7 To_6 L Ft._
From r To Ft. Arlz
14. GRO'_'i:
Depth Material Method
From To �a Ft. C eo,"v, f 'Vey". �—
Frorn -. To Ft. b
15. SC '' Gov
Depth Diameter Slot Size Material
From To Ft in. in.
From _To Ft. in. in. Q17 r1
Fror^ To Ft. In. in.
M�
16. SAt IC';' a ;AVEL PACK:
Depth Size Material
From _ To Ft.
From To Ft.
17. REP.,. .f, :S:
D')I-'7!'_!3Y CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WE1.1
s
CON_,: Ti;UCTION STANDARDS,AND THAT A COS RECORD HAS BE PROVIDED TO THE WELL
FOR : USE ONLY ZYZ? _ L .04
Quad, •: SIGNATURE OF PERSON CONSTRUCTING THE WELL ^
Submit original to Division of Water Quality,Groundwater Section within 30 da},s
Serial F'-,.
r f 2199

North Carolina-Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section %; �e � c
1636 Mail Service Center-Raleigh,N.C.27699.1636-Phone[phone] 8 0
WELL CONSTRUCTION RECORD WELL CONTRACTOR: � �' tjt_e_ -' �y
WELL CONTRACTOR CERTIFICATION P: 093X _
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE(Check Applicable sox): Residential Municipal ❑ Industrial❑ Agricultural❑ -.-'goring ❑.
Recovery❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATIOjShow sketch of the location below)
Nearest Town:-- rr� County: 0r/
r9`- /—, 13 � )
(Road Name and N mbers,Community,or Su division and Lot No.) DRILLING LOG DF' "•'. _
3. OWNER i �� ���%� 6 From To Forma` ription
Address �s� me
��5treet or outs o. ' �!f' — �a /, r
City or Town (/ State Zip Code
4. DATE DRILLED 7 -,,TGbo
5. TOTAL DEPTH
6. CUTTINGS COLLECTED YES❑ NO[jEj-
7. DOES WELL REPLACE EXISTING WELL? YES ❑ NO®'
8. STATIC WATER LEVEL Below Top of Casing: �;4) FT. s t c7
(Use'+'it Above Top of Casing) ,,, ; i� �W� 4' Y` -C:5
_..
9. TOP OF CASING IS FT.Above Land Surface*
'Top of casing terminated aUor below land surface requires a variance In actor-
dance with 15A NCAC 2C.0fi18
10. YIELD m / r�► W- .
(gp ,)' METHOD OF TEST _ _ c-�<-
11. WATER ZONES(depth): Y 'qS ����
-rn
r<_
12. CHLORINATION: Type � Amount 4'40 It additional space is needed use ba<' :i,p
13. CASING: -��
LOCATION SKETCH o
Wail Thickness -
Depth Diameter or Wetght/Fl. Materiel (Show direction and distance from at lea^'
From —� To X3 Ft. 1�' ' �D�/y Roads,or other map reference poin-c'
From To Ft. -
From To Ft.
14. GROUT:
t 9
Depth Material Method
From To 191)_Ft. 4:/J `42f_ Jaa4,-erol3/►1f "�
From To Ft.
15. SCREEN: 1 _
Depth Diameter Slot Size Material
From To Ft in. in.
From To Ft. in. In.
From To Ft. in. In.
16. SAND/GRAVEL PACK: Ga4cL
Depth Size Materialye
M(
From To Ft.
From To Ft.
17. REMARKS:
DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STANDARDS,AND THAT A COP OF THIS RECORD HAS BEEN PROVIDED TO THE WELL O"„
FOR OFFICE USE ONLY (Zs- E o 0 - L( ^60
Quad No: SIGNATURE OF PERSON CONSTRUCTING THE WELL µ
Submit original to Division of Water Ouality,Groundwater Section Within 30 days
Serial No.
12199

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] �� ?
1
WELL CONSTRUCTION RECORD WELL CONTRACTOR: —
WELL CONTRACTOR CERTIFICATION #:
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE(Check Applicable Box): Residential 2" Municipal ❑ Industrial❑ Agricultural❑ t'-•,iroring ❑.
Recovery❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATION- (Show sketch of the location below)
Nearest Town: -`� <<�' County:
(Road Numbers,Community,or Subdivis'on and Lot No.) DRILLING LOG DEPTH
3. OWNER 'J �� /�Q f�L[Jl✓ From To Formati-,n -iption
Address d" �-� /I � .J l'rw
✓�� (St r at or ou a o.
�4�
City or Town TS—ta a Zip Code
4. DATE DRILLED 7 /7 90100 0170 - f _
5. TOTAL DEPTH D 0 ;Z 90 d P r
6. CUTTINGS COLLECTED YES❑ NO %z 9 5~ Y�'ct -✓ �`�
7. DOES WELL REPLACE EXISTING WELL? YES ❑ NO U91
8. STATIC WATER LEVEL Below Top of Casing: FT.
(Use'+'If Above Top of Casing)
9. TOP OF CASING IS . FT.Above Land Surface• ),{; 83
'Top of casing terminated at/or below land surface requires a variance In actor- W
dance with 15A NCAC 2C.0118
10. YIELD(gpm): _! METHOD OF TEST
11. WATER ZONES (depth): �-
12. CHLORINATION: Type Amount If additional space is needed use bar:' -
1:4
13. CASING: 63 v
Wall Thickness LOCATION SKETCH
Depth DialnVer or Weight/Ft. Mat at . (Show direction and distance from at least+ t9
From —�— Ft.---2— 70 Roads,or other map reference points)
From -- To Ft.
From— To Ft. r-%
14. GROUT:
Depth Material Method G�/e
From To " Ft. r---1 —
From To Ft. '
15. SCREEN:
Depth Diameter Slot Size Material
From To—Ft in. in. lip
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: - --
i DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STANDARDS,AND THAT A COPY OF THIS FIECORD HAS BEEN PROVIDED TO THE WELL OW'!''.,.
FOR OFFICE USE ONLY
Quad No: SIGNATUR PERSON CONSTRUCTING THE WELL -
Submit original to Division of Water Quality,Groundwater Section within 30 days
Serial No.
G�nr,i

North Carolina-Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section 1636 Mall Service Center-Raleigh,N.C.27699-1636-Phone[phone] r: !r 5 9 3
WELL CONSTRUCTION RECORD WELL CONTRACTOR: �l� UtG��'
WELL CONTRACTOR CERTIFICATION
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE(Check Applicable Box): Residential E?T-- Municipal ❑ Industrial❑ Agricultural❑ Monitoring ❑.
Recovery❑ Heat Pump Water Injection ❑ Other ❑ It Other, List Use:
2. WELL LOCATION: (Show sketch of the location below) `
Nearest Town: X ,ywe f �/K County:.__
(Road Name and Numbers,Community,or Subdivision and Lot No.) DRILLING LOG DEPTH
3. OWNER _ /`"�per^ /( ��'�.ti jya From To Formation Description
Address � d-- /`/E rrJc��r•��y�
City or Town State Zip Code /Y9~- /91 .'01,le "C'k
4. DATE DRILLED
"as."On Zip
360
5. TOTAL DEPTH 3Gb
6. CUTTINGS COLLECTED YES❑ NO[:!�—
7. DOES WELL REPLACE EXISTING WELL? YES ❑ NO[ff" -�
8. STATIC WATER LEVEL Below Top of Casing: FT.
(Use-+-if 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 actor- 5� —T
dance with 15A NCAC 2C.01113
10. YIELD(gpm): 2-6 METHOD OF TEST 1_1 � a — n,
11. WATER ZONES(depth): /aQ 9-l9( �d g21
12. CHLORINATION: Type _ /y7� Amount ��'� _ If additional space is needed use back of form
13. CASING: /If )-rr
w o
Wall Thickness LOCATION SKETCH =-
Depth f p Diameter or Weight/Fl, Material (Show direction and distance from at least two State
From—�To Ft. 8� ��' 6Wcl.- Roads,or other map reference points)
From To Ft.
From To Ft.
14. GROUT:
�t
Depth Material Method � r,y✓tis� tG�4.r.�.-„�/,�/
From spy To b�0 Ft. co , v* -,�
From To 'b Ft. Cc w e.ry f-- v oT '?ea
15. SCREEN: �'� •� D
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 f o
From To Ft.
From To Ft.
17. REMARKS: Joe, Al f Xe�`oewM suer- 1907 2' 0-*4r�/1
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORD C ITH 1 SA N C 2C,W
CONSTRUCTION STANDARDS,AND THAT A COPY OF THIS REC AS PR ID THEW WNER, rr``
FOR OFFICE USE ONLY `'Vti
Quad No: SIGNATURE OF PERSON CONSTRUC IN6 THE WELL DATE
Submit original to Divislon of Water Ouality,Groundwater Section within 30 days
Serial No. GW1 REV. 12199 I
l

North Carolina-Department of Environment end Natural Resource!;-r)ivi•c6.n of Water nuaiiiy-Groundwntor Section A 1636 Mail Service Center-Raleigh,N.C.27699-1636-Phone[phone]:12 t I 1 •-6r� C� v Q
4
WELL CONSTRUCTION RECORD W1 Lt.CON'rHAC'IOil:
WELL CONTIIACTOR CERTIFICATION 11:
STATE WELL CONSTROCTION PERMITft:
1. WELL USE(Check Applicable Box): Residential V" Municipal ❑ Industrial❑ Agricultural❑ Monitoring ❑.
Recovery❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: �Q'v�'�''" County:
(Road Name-end lumbers,Commu ity,or ubdivision and Lot No.) DRILLING LOG DEPTH
3. OWNER L From To Formation Description
Address
trees
City or Town Slate Zip Code
4. DATE DRILLED 7-ad
5. TOTAL DEPTH dc;t0 1ye` `73 felt�CrP
6. CUTTINGS COLLECTED YES❑ NO[Z4 — /72- - Je
7. DOES WELL REPLACE EXISTING WELL? YES ❑ NO© y1 t`%,Nl�\\`
8. STATIC WATER LEVEL Below Top of Casing: 5,'n FT.
(Use'+'if 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 actor i <�lyf C_­�
dance with 15A NCAC 2C�,A118 r
10. YIELD(gpm): 53 METHOD OF TEST t
11. WATER ZONES(depth): //O^19-
pnr
,,:... sue— := �,
12. CHLORINATION: Type ff 7`/f Amount ✓' r✓Z _ I(addition f apace Is needed use back of form �L
13. CASING: '
LOCATION SKETCH t�
Wall Thickness r i
Depth Diame or or Weight/Ft. Material (Show direction and distance from at least two Str t%
From To y Ft. l° /�� l"j Roads,or other map reference points) o
From To Ft.
From To Ft.
14. GROUT: -•
Depth Material Method
From _0 To 219 Ft. C P�-it�'f o r m•�:v��
From To Ft. ;,
15. SCREEN:
Depth Diameter Slot Size Material
From To Ft in. in.
From To Ft. in. In.
From To Ft. In. in.
16. SAND/GRAVEL PACK:
�NsS� ls7f lise rti�f
Depth Size Material >c
From To Ft. � 7
From To Ft. f0A r
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 R CORD HAS BEEN PROVIDED TO THE WELL OWNER.
FOR OFFICE USE ONLY
Quad No: SIGNATURE OF PE N CONSTRUCTING THE WELL DATE
Submit original to Division of Water Quality,Groundwater Section Within 30 days
Serial No. GW-1 REV. 12/99

North Carolina•Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section L. i 6 J 9 J
1636 Mail Service Center•Raleigh,N.C.27699-1636-Phone[phone] r\
WELL CONSTRUCTION RECORD WELL CONTRACTOR:
WELL CONTRACTOR CERTIFICATION
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE(Check Applicable Box): Residential� Municipal ❑ Industrial❑ Agricultural❑ Monitoring ❑.
Recovery❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use: X1,,'aole
2. WELL LOCATION: (Show sketch of thp location below)
Nearest Town: County:__Alriei•u
(Road Name an umb rs,C unity or Subdivision and Lot No.) - DRILLING LOG DEPTH
3. OWNER + �z�L iu� �y�
From To Formation Description•
Address 0 3y A Q & '-1/1 6/
�— treat of oulo ,o.ems,
City Or Town state Zip Codo
4. DATE DRILLED o "
S. TOTAL DEPTH . �, S`>— _ G�Z ,ST oC.,t gi-4,U,'-le
6. CUTTINGS COLLECTED YES❑ NOQ�
7. DOES WELL REPLACE EXISTING WELL? YES ❑ NOE]'_ Yo`
8. STATIC WATER LEVEL Below Top of Casing: FT.
(Use'+'It Above Top of Casing) of�— a li/ JX /a i'cc l' .71.
9. TOP OF CASING IS FT.Above Land Surface' 1 �_ sarJ z
'Top of casing terminated atfor below land surface requires a variance In actor- ��1"cD " p
dance with 15A NCAC 2C.QJ 18
10. YIELD(gpm): 5 METHOD OF TEST77
11. WATER ZONES(depth): �o Syr r 5'Jc/ a -act
12. CHLORINATION: Type // y Amount 3 625
_ If additional space is needed use back of lord '
13. CASING:
Wall Thickness
LOCATION SKETCH
Depth OiamoI r or Weight/Ft. Material (Show direction and distance from at least two We --i
From To� _ 67 Ft. lee dllell.. Roads,or other map reference points) ca
i
From To Ft.
From To Ft.
14. GROUT: /
Depth Material Method
From To Ft. _ C ern e,,
From To Ft. F e IN/,
15. SCREEN:
Depth Diameter Slot Size Material
From To Ft in. in. j t
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:
DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 1SA NCAC 2C,WELL
CONSTRUCTION STANDARDS,AND THAT A COPY OF THIS CORD HAS BEEN PROVIDED TO THE WELL OWNER.
FOR OFFICE USE ONLY ";'"v7' .-z�r0
Quad No: SIGNATURE OF P ,ON CONSTRUCTING THE WELL DATE
Submit original to Division of Water Quality,Groundwater Section Within 30 days
Serial No.
GW1 REV. 12/99

North Carolina-Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section as
1636 Mail Service Center-Raleigh,N.C.27699-1636-Phone[phone] `
WELL CONSTRUCTION RECORD WELL CONTRACTOR: Dewey Wri-ht Well Pump Co., Inc
WELL CONTRACTOR CERTIFICATION#: —2686
000391 STATE WELL CONSTRUCTION PERMIT#: __Leslie Reece
1. WELL USE(Check Applicable Box): Residential Municipal M Industrial 0 Agricultural D Monitoring El
Recovery 0 Heat Pump Water Injection Other El If Other, List Use:
2. WELL LOCATION:(Show sketch of the location below)
Nearest Town: n�C1aR County: _,A VERY
PILOT R1Dr=EN�D OFF HWY o�1.C1FF H� 321
(F�oaame and FumTiers,Community,or Sum vision and lot DRILLING LOG DEPTH
3. OWNER PHILLIP T HEDRICK From To Formation Description
Address n 24 IItRT
HIGH Ro t tigt or oute o. Nr �7�R5 7d 78 ('RANITF
City or Town 1 State Zip odZ` e 72 75 jSHAI F
4. DATE DRILLED 7�n/9nnn 75 151 C;RANITF
5. TOTAL DEPTH 185 151 1512 0I IART7
6. CUTTINGS COLLECTED YES D NO 152 185 GRANIM
7. DOES WELL REPLACE EXISTING WELL? YES 0 NO
8. STATIC WATER LEVEL Below Top of Casing: 30 FT.
(Use"+"if Above Top of Casing) O
9. TOP OF CASING IS 1 FT.Above Land Surface* o p
*Top of casing terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2C.0118
10. YIELD (gpm): _20 METHOD OF TEST Air 1 Yi r' c rtl
11. WATER ZONES (depth)2 gpm73-75 18 gpm 151-152 c� f nrrr I it ty
7.�--1'-r--
0_ gom 0 apm o
12. CHLORINATION: Type HTH Amount 32 ;j If additional space is ne4ded use back p ormHCD
13. CASING: i! '4 LOCATION SKETCH M�J -
Wall Thickness O --{
Depth Diameter or weight/Ft. Material (Show direction and distance from at leastqZo Stedte From O To 2 Ft. A 1/9 .360 PVC Roads,or other map reference points) "~
From To Ft. D
From To Ft.
J
14. GROUT: '
Depth Material Method 00
From 0 To 20 Ft. Cement Gravity Flow (6
From To Ft.
,a
15. SCREEN:
Depth Diameter Slot Size Material
From To Ft. in. in. nJ
From To Ft. in. in.
From To Ft. in. in. Z '
16. SAND/GRAVEL PACK:
Depth Size Material
From To Ft. \�4� �.yt �c`5ines5
From To Ft. t
17. REMARKS: flcp
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 - 20-00
FOR OFFICE USE ONLY
Quad No: SIGNATURE OF PE ON CONSTRUCTING THE WELL DATE
Submit original to Division of Water Quality,Groundwater Section within 30 days
j
GW-1 REV.12/99
Serial No.
�. 3�`

North Carolina-Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section 216 t1 f C O 2
1636 Mail Service Center-Raleigh,N.C.27699-1636-Phone[phone] 0
WELL CONSTRUCTION RECORD WELL CONTRACTOR: {lCc�'L( �• t,Ci/.���� >,ccCQ
WELL CONTRACTOR CERTIFICATION#;
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE(Check Applicable Box): Residential E Municipal ❑ Industrial❑ Agricultural❑ Monitoring ❑.
Recovery❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: '�'-''o $'s A'e ,, County:
(Road Name and Numbfrs,Community
or
Subdivision anb Lot No.) DRILLING LOG DEPTH
3. OWNER _' 'Q`'Nc`�� C /*�� ���—J From To Formation Description
Address, J o �r 0 ��-�� _
et or Route o.
-71
City or Town State ZipL —
4. DATE DRILLED (-©G Do
5. TOTAL DEPTH ^ y
6. CUTTINGS COLLECTED YES❑ NO[�
7. DOES WELL REPLACE EXISTING WELL? YES ❑ NOET / o ACV 0V
8. STATIC WATER LEVEL Below Top of Casing: /r• FT.
(Use-+'II Above Top of Casing) 10
9. TOP OF CASING IS FT.Above Land Surface*
`Top of casing terminated at/or below land surface requires a variance In actor- ��15R a I J
dance with 15A NCAC 2C.D 18 ^
10. YIELD(gpm): METHOD OF TEST 44-r el j
11. WATER ZONES(depth): Yin 9 q- �;</ C= -
107—(So
12. CHLORINATION: Type r unt 3 az If additional space is needed use back of form __ �'-Amo
13. CASING: i r__ati
Wall Thickness LOCATION SKETCH
Depth l�,� Diameter or Wei hVFI. M tenal , (Show direction and distance from at least two Stath'
From —� To yd Ft. �C Roads,or other map reference points)
From 9 0 To c Ft.6 p — ` -
From To Ft.
14. GROUT: Grcfsi�� r�
Depth Material Method L✓ 9`rs
From To - Ft.
From To Ft.
15. SCREEN:
Depth Diameter Slot Size Material
From To Ft in. in.
0
From To Ft. in. in. � /3 !c
From To Ft, in. in.
16. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
17. 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 BEEOVIDED TO THE WELL OWNER.
FOR OFFICE USE ONLY L- ���� G O
Quad No: SIGNATURE OF PERSON CONST40CTING THE WELL DATE
Submit original to Division of Water Quality,Groundwater Section Within 30 days
Serial No. GW-1 REV.12/99

North Carolina-Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section �- 5-1636 Mail Service Center-Raleigh,N.C.27699-1636-Phone[phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR: �� �l.e.t'
WELL CONTRACTOR CERTIFICATION #:
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE(Check Applicable Box): Residential[B" Municipal ❑ Industrial❑ Agricultural❑ Monitoring ❑.
Recovery❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: Lc C`" "� J County:--/Y��/�G az4
(Road Name an Num7b rs,Co unity,or Subdivision and Lot No.) DRILLING LOG DEPTH -
3. OWNER )QL6 .Lti �' lt� l.L`�c From To Formation Description
Address /J 6 A61
treelor Route o.. 'Age
City Or own Stale Zip Code
` ma lr,> - a 7S �i.�g"��P
4. DATE DRILLED 30" 627J"
5. TOTAL DEPTH D o
6. CUTTINGS COLLECTED YES❑ NOQ� )G �Od Ao•,.,'fP
7. DOES WELL REPLACE EXISTING WELL? YES ❑ NO[Ej�
8. STATIC WATER LEVEL Below Top of Casing: FT.
(Use'+-if 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 15A NCAC 2C,,0118
10. YIELD(gpm): 21-Q METHOD OF TEST 14% .
11. WATER ZONES(depth):
12. CHLORINATION: Type rf 72CE Amount�: If additional space is needed use back of fornP
YP p
13. CASING:
Wall Thickness LOCATION SKETCH )
Depth Diameter or Weight/Ft. Mate.al , (Show direction and distance from at least two Sty r
From —I To.- 4 Ft. Roads,or other map reference points)
From 7o Ft.-
From To Ft.
14. GROUT:
Depth Material Method f
From To It a Ft. Grp,e-. 7t o°i'
From To Ft.
15. SCREEN:
Depth Diameter Slot Size Material
From To Ft in. in.
From To Ft. in. in. s1/i
From To Ft. In. in.
16. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
17. 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.
FOR OFFICE USE ONLY
Quad No: SIGNAT OF PERSON CONSTRUCTING THE WELL DATE
Submit original to Division of Water Ouality,Groundwater Section within 30 days
Serial No. GW-1 REV.12/99

North Carolina-Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section 4 `J J 9 7
1636 Mail Service Center-Raleigh,N.C.27699-1636-Phone[phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR:
WELL CONTRACTOR CERTIFICATION H. A f�7
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE(check Applicable Box): Residential[B" Municipal ❑ Industrial❑ Agricultural❑ Monitoring ❑.
Recovery❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: 1t'1v1R"-1 County:
(Road Name arlo Numbers,Community,or Subdivision and Lot No.) DRILLING LOG DEPTH
3. OWNER .-4^ass From To Formation Description
Address /"ifs d""C" a,4 9,/
treat or Ute No.) Z��S-7 �9 lv h✓� n r o K• f['
City or Town Stale Zip Code G S / b' �/Fc k�^o� .►c�
4.. DATE DRILLED r' `ab'—Avc Xd'"' 34S'
5. TOTAL DEPTH y 9 5 J97 k+rc
6. CUTTINGS COLLECTED YES❑ NO©' 397 y as Q•v'
7. DOES WELL REPLACE EXISTING WELL? YES NO❑
8. STATIC WATER LEVEL Below Top of Casing: FT. n
(Use'+'It Above Top of Casing)
9. TOP OF CASING is FT.Above Land Surface-
`Top of casing terminated attor below land surface requires a variance In accor-
dance with 15A NCAC 2C.0118
10. YIELD(gpm): . a. 5 METHOD OF TEST
11. WATER ZONES(depth): 3 9.5 2"
12. CHLORINATION: Type ffT/7`
yp Amount �� If additional space is needed use back of formal �
13, CASING: CD
Wall Thickness LOCATION SKETCH `
Depth Diameter or Weight/Ft. Material (Show direction and distance from at least two State
From / To `5 Ft. 6-4 Roads,or other map reference points)
From To Ft. — !v
From To Ft.
14. GROUT:
Depth Material Method J
From _0 To Ft. 7— 0ee ��-�
From To Ft. s
15. SCREEN: A) 4d�
Depth Diameter Slot Size Material
From To Ft in. in. �Al
From To Ft. in. in.
From To Ft. in. in.
16. SAND/GRAVEL PACK:
Depth Size Material
From To - Ft. 'ep
From To Ft.
17. REMARKS:
DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STANDARDS,AND THAT A COPY OF THIS ECORD HAS BEEN PROVIDED TO THE WELL OWNER.
FOR OFFICE USE ONLY
Quad No: SIGNATU E OF PERSON COA!`TRUCTING THE WELL DATE
Submit original to Division of Water Quality, roundwater Section Within 30 days
Serial No, GW-1 REV.12/99
51.

North Carolina-Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section i /i/ 9 n
1636 Mail Service Center-Raleigh,N.C.27699-1636-Phono(919)733-3221 A
WELL CONSTRUCTION RECORD WELL CONTRACTOR:
WELL CONTRACTOR CERTIFICATION #: cs i :3 3
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE(Check Applicable Box): Residential L Municipal ❑ Industrial❑ Agricultural❑ Monitoring El
Recovery❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: - County:. 4V eR
(Road Name nd N bers,Community,or Subdivision and Lot No.) DRILLING LOG DEPTH
3. OWNER J C sk_) t:j e rn 04o'ki From Fortnatio Description
Addres
rt / 'Street or Route Nod
City 6r Town State Zip Code
4. DATE DRILLED fl.-1
5. TOTAL DEPTH car-1'`� ---•— ----- --
6. CUTTINGS COLLECTED YES❑ NOE:!� --- —
7. DOES WELL REPLACE EXISTING WELL? YES ❑ NO[5—'
8. STATIC WATER LEVEL Below Top of Casing: FT. _
(Use'+'if 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 15A NCAC 2C.011 18
10. YIELD(gpm): METHOD OF TEST� �'J _
11. WATER ZONES (depth): �=d©7
12. CHLORINATION: Type G l'6_2 -Amount 3 S It additional space is needed use back of form
13. CASING:
Wall Thickness LOCATION SKETCH
Depth Di t Wei na ,Otr or W ht/ t. _Mate r�i'J (Show direction and distance from at least two State
From o To -
Ft.—! °I� Roads,or other map reference points)
From To Ft. �`JJ
From To Ft.
14. GROUT:
Depth Material Method
From To Ft. r-•e� o
From To Ft. O o
15. SCREEN: c—
:M�
Depth Diameter Slot Size Material r-- CD
From To Ft in. in. o
From To Ft.___ in. in. _ yM
From To Ft. in. in. — �
co
16. SAND/GRAVEL PACK: C ) 2 cn
Depth Size Material W ��
From To Ft. — o
From To Ft.
17. REMARKS:
DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STANDARDS,AND THAT A COPY OF THIS RECORD AS BEEN PROVIDED TO THE WELL OWNER.
FOR OFFICE USEFu
r� � r�� L7 LI � � ° � i� � � r� .
Quad No: , TURE OF PERSON CONSTA,I) �ING THE WELL' `s"D" TE
nI rr4 t
Submit oriel I ivislon of Water Quality Grcun f vplerlSection within 30 days f
Serial No. '������ 1 REV.12/99
3 2t?G0 I�� AUGG 6 2000
i
Li
Groundwater Section
Asheville Re Tonal Office ,..�...j "'

North Carolina-Department of Environment and Natural Resources•Division of Water Quality-Groundwater Section 2,13295
1636 Mail Service Center•Raleigh,N.C.27699-1636-Phone[phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR:
WELL CONTRACTOR CERTIFICATION#: 023 '9�
STATE WELL CONSTRUCTION PERMIT#: _
1. WELL USE(Check Applicable Box): Residential❑ Municipal ❑ Industrial❑ Agricultural❑ Monitoring ❑.
Recovery❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATION: (Show sketch of the locattgn' _below /
Nearest Town: ounty:
(Road Name and N mbers,Communy,or Subdivision and Lot No.) DRILLING LOG DEPTH
3. OWNERS-' ��}L� )Z( From To Formation Description
Address ,� G`�.Li� E-. -�-� 0 — l Z /I e,CiOd r, r(_ _
trees or oute o. 9 7 2-
_9 p d•r. G'
City or Town Stale Zip Code 7a 86 A v r G�
4. DATE DRILLED �� add �30 -- P d 7 rayF �
5. TOTAL DEPTH 30ov/o
6. CUTTINGS COLLECTED YES❑ NO[� ary Sod c,ra.,.. & _
7. DOES WELL REPLACE EXISTING WELL? YES ED NO2
8. STATIC WATER LEVEL Below Top of Casing: 34,6 FT.
(Use'+'If 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 15A NCAC 2C.011
10. YIELD(gpm): L . METHOD OF TEST
11. WATER ZONES(depth): 70 vo go IS _.
;L©� -.2/a 40
12. CHLORINATION: Type �L'L_Amount -- If additional space is needed use back of form
13. CASING: 4/,,-
Wall Thickness LOCATION SKETCH
Depth /� Diameter or Weight/Ft. M��aterial (Show direction and distance from at least two State -
From `_1 To Ft.�_ -��- �� 11— Roads,or other map reference points)
From To Ft.
From To Ft.
14. GROUT:
Depth Material Method o
From To Ft. C
From To Ft.
15. SCREEN:
Depth Diameter Slot Size Material ' yo
From To Ft in. in. o
From To Ft. In. in. fV cn:z
From To Ft. In. in. j w C
16. SAND/GRAVEL PACK: U� ��.1�i I C
Depth Size Material
From To Ft. Groundwater Section
From To Ft. heville Re ' nal ce
17. 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.
FOR OFFICE USE Y';�
Quad No: SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
SO rnil original to Division of Water Quality,Groundwater Section Within 30 days
Serial No. ;` GW-1 REV. 12199

North Carolina-Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section 213293
1636 Mail Service Center-Raleigh,N.C.27699-1636-Phone[phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR:WELL CONTRACTOR CERTIFICATION#: A .9 F R
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE(Check Applicable Box): Residential❑ Municipal ❑ Industrial❑ Agricultural❑ Monitoring ❑.
Recovery❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATION:(Show sketch of)t�e,location,below)
-r-r�X. c rr a /
Nearest Town: �-�� County:
(Road Name and Numbers,Community,or Subdivision and Lot No.) DRILLING LOG DEPTH
3. OWNER Gf/a 0 ti Y' G /ate From To Formation Description
Address 6 — of- edw''' -/'
(street or Houle C. ,�f-- 1147
City or Town State Zip Code
4. DATE DRILLED 5 16" —�/� ' '��� rr�1.0 f 1LC
5. TOTAL DEPTH
r �s
6. CUTTINGS COLLECTED YES❑ NOD' Ala` ;�o -V
7. DOES WELL REPLACE EXISTING WELL? YES NO❑
8. STATIC WATER LEVEL Below Top of Casing: Q FT.
(Use-+-If 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 15A NCAC 2C.Qa18
10. YIELD(gpm): $ METHOD OF TEST
11. WATER ZONES(depth): �/� 4'49 l
A/or
12. CHLORINATION: Type Amount `3 ° If additional space is needed use back of form
13. CASING: r
Wall Thickness LOCATION SKETCH
Depth Dia ter or Weight/Ft. Material (Show direction and distance from at least two State
From To Ft. — Roads,or other map reference points) p
From To Ft. G) Q
From To Ft. _
14. GROUT: r Crrl
rC)
Depth Material Method t o:�
From To Ft. w ter'
From To Ft. 3 ro
rn
15. SCREEN:
Depth Diameter Slot Size Material
From To Ft n a via
c7D o
From To Ft. in. i
From To Ft. in. in.
16. SAND/GRAVEL PACK: � p� � z
Depth Size M erial
r
From To Ft. '! ,
From To Ft. Gtnundwlite tf*
17. REMARKS: e � `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..
FOR OFFICE USE ONLY £ � -Q 9_ 6 Jo r A.
Quad No: SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit original to Division of Water Quality,Groundwater Section within 30 days
Serial No, GW-1 REV. 12/99

4'. North Carolina-Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section 213294
1636 Mail Service Center-Raleigh,N.C.27699-1636-Phone[phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR: IJ
WELL CONTRACTOR CERTIFICATION N: .2 3 P T
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE(check Applicable Box): Residential❑ Municipal ❑ Industrial❑ Agricultural❑ Monitoring .
Recovery❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use: _
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town, G �o�5,ll�A� County: c%C�
(Road Name and Nu ers,Community,or Subdivision and Lot No.) DRILLING LOG DEPTH
3. OWNER e-/ 0 Pam/'' From To Formation Description
Address Lv Fyn 1 i�� �l d -'r ag4l, It
(Street or RoU10 NO.1 �/"= ����/b Arg v/A.- a
City or Town State Zip Code 6/0 +�--G� 9 TLn-e4,e ir
4. DATE DRILLED 4"�3'"a� �v// ! •
S. TOTAL DEPTH /'Pd e '76 f-- 9 o R� C�'G�to
6. CUTTINGS COLLECTED YES❑ NO®' 0 9967 if en
7. DOES WELL REPLACE EXISTING WELL? YES ❑ NO� F0 7 -- �'0 ?f G•^e�e-
8. STATIC WATER LEVEL Below Top of Casing: FT. ge N— /cc) awJ�e
(Use-+-If Above Top of Casing)
9. TOP OF CASING IS a FT.Above Land Surface'
'Top of casing terminated atlor below land surface requires a variance In accor-
dance with 15A NCAC 2C.0118 r
10. YIELD(gpm): METHOD OF TESTS ri
11. WATER ZONES(depth): 6%6 h o 7 Qa 8O y
12. CHLORINATION: Type Amount It additional space is needed use back of form
13. CASING: i�q(v 10Wet[
Wall Thickness LOCATION SKETCH
Depth Diamelor or Weight/Ft. Material (Show direction and distance from at least two State
From To Ft. 1 mil° Roads,or other map reference points)
From To Ft. -
From To Ft.
14. GROUT: a �'
Depth Material Method c— CD m
From To Ft. ice' rr)
From To Ft. t
CJ rn
15. SCREEN:
Depth Diameter Slot Size Material �o
From To Ft in. in, m
From To Ft. w C-)
From To Ft. ilk - - o
16. SANDIGRAVEL PACK:
Depth CUutr
From To Ft. : ?
From To Ft. I 1�3' TOO
17. REMARKS: Groundwater Section {
DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A'N6AG'20,::WELL
CONSTRUCTION STANDARDS,AND THAT A C P OFJHIS CORD HAS BEEN PROVIDED TO THE WELL OWNER.
FOR OFFICE USE ONLY [(, 6 00
Quad No: SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit original to Division of Water Quality,Groundwater Section within 30 days
Serial No. GW-1 REV.12199

213290
North Carolina-Department of Environment and Natural Resources-Division of Water Quality-Groundw eCr Section
1636 Mall Service Center Raleigh,N.C.27699-1636-Phone[phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR: WC,INI ►l`T'1
WELL CONTRACTOR CERTIFICATION#: 0?38?
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE(Check Applicable Box): Residential El"" Municipal ❑ Industrial❑ Agricultural❑ Monitoring ❑.
Recovery❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: County:
'g/t vfAv G f{
(Road Name and umbers,Community,or Subdivision and Lot No.) DRILLING LOG DEPTH
3. OWNER , +�1D 4BH fiyli 7<�1 e- _ From To Formation Description"
Address �� ov),u` G12 46
Greet orRoutetTO. ¢ /�a .r/Bsv;fc
City or Town State Zip Code
4: DATE DRILLED 6_��'aoo0 /5`S Soo _ a wove lie tL�%�a.P';" �v
S. TOTAL DEPTH SQ CS
6. CUTTINGS COLLECTED YES❑ NO[-
7. DOES WELL REPLACE EXISTING WELL? YES NO©•
8. STATIC WATER LEVEL Below Top of Casing: FT.
(Use'+'If Above Top of Casing)
9. TOP OF CASING IS f FT.Above Land Surface-
'Top of casing terminated atlor below land surface requires a variance in accor-
dance with 15A NCAC 2C.418
10. YIELD(gpm): d" METHOD PF TEST
11. WATER ZONES(depth): APO f`f
12. CHLORINATION: Type /rf 1`/`� Amount 02 _ If additional space Is needed use back of form
13. CASING:
Wall Thickness LOCATION SKETCH
Depth DI a for or Weight/Ft. Material (Show direction and distance from at least two State From To 6*1 -Ft. — -A/- Roads,or other map reference points)
From To Ft. l �a,,�
v
From To Ft.
O
14. GROUT: in
Depth Material Method S C om
From To Ft. G'.rn e, f o ^ ��P IUD
r-' m
From To Ft. rod` '
oe
15. SCREEN: .
rn
Depth Diameter Slot Size Material P ,� mm
From To Ft in. in. MW
From To Ft. i8, ---tiro - '" w CD
•..--- U ' y CO o
From To -- z
16. SANDIGRAVEL PAC
Depth Size Ma
From To t. 200�
From To
17. REMARKS: r Section
jt�ltevi8e Re ono
I DO HEREBY CERTIFY WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STANDARDS,AND THAT A COPY F HI RECOR HAS BEEN P O DED TO THE WELL OWNER.
FOR OFFICE USE ONLY ""
Quad No: SIGNATURE OF PERSON CON STRUCT;I`NGITJHErWELL i DATE
Submit original to Division of Water Quality,Groundwater Section Wlth1tl 30"ddys "
Serial No. 6W1 REV. 12/99

North Carolina-Department of Environment and Natural Resources-Division of Water Quality-Ground w ter Section 213291
1636 Mail Service Center•Raleigh,N.C.27699-1636-Phone[phone] D
WELL CONSTRUCTION RECORD WELL CONTRACTOR:
pJ1
WELL CONTRACTOR CERTIFICATION ff: 023 88
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE(Check Applicable Box): Residential Municipal ❑ Industrial❑ Agricultural❑ Monitoring ❑.
Recovery❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATION: Show sketch of the location below)
Nearest Town: �lrilaroaf' County: Alre5f
(Road Name and Numbers,Community,or Subdivision and Lot No.) DRILLING LOG DEPTH
3. OWNER ,�pp O A e#4 Sst ;��/ .u From To Formation Description
Address (lJt�cr�;u 6 G R 6" ?7(Street or or ou a o.) S 7 ` �I o5' �rrc�iF
u
City or Town Slate Zip Code ��� —T-
4. DATE DRILLED —�`1;Z406
S. TOTAL DEPTH S a
6. CUTTINGS COLLECTED YES❑ NOQ"
7. DOES WELL REPLACE EXISTING WELL? YES ❑ NO[�+
8. STATIC WATER LEVEL Below Top of Casing: Up FT.
(Use'+•it 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 15A NCAC 20.0118
10. YIELD(gpm): `' _METHOD OF TEST A,;
11. WATER ZONES(depth): A, y
12. CHLORINATION: Type ---Amount 0-2 = If additional space is needed use back of form
13. CASING:
LOCATION SKETCH
Wall Thickness o
Depth Dia for or Wetght/Ft. Material (Show direction and distance from at least two Statp O
,,�.
From � Ft. — � Roads,or other maw r Terence points)
From To Ft. � cC" m
From To Ft. rn
14. GROUT: SGalft, �v �'
Depth Material Method �Q
From To 9-0 Ft. Ce-0 e u ^ xp
From To Ft. c'
15. SCREEN: Go z
Depth Diameter Slot Size Material
From To Ft in. _...,,-ira.-
From To ifi r, 4�in
e2�'— ! i
lvJ k
From To � ,vl�
16. SAND/GRAVEL PA CIi'
Depth i� 3 � I I��nG
From To M.
SRO
From To ion
17. REMARKS: hp Me tie ionei Office ^i/�wl a f .a f.,.,.
100 HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STANDARDS,AND THAT A COPY F T IS R ORD HA EEN PROVID , THE WELL OWNER.
FOR OFFICE USE ONLY "-as °
Quad No: SIGNATURE OF PERSON c6NSTRUCT1_NG'lT19 WELL DATE
Submit original to Divislon of Water Quality,Groundwater Section within 30 days
Serial No. GW-1 REV.12/99

North Carolina-Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section 213155
1636 Mail Service Center-Raleigh,N.C.27699-1636-Phone[phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR: Dewey Wright Well Pump Co., Inc.
WELL CONTRACTOR CERTIFICATION#: 2687
000280 STATE WELL CONSTRUCTION PERMIT#: Steve Reece
1. WELL USE (Check Applicable Box): Residential © Municipal 0 Industrial 0 Agricultural 0 Monitoring
Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use:
2. WELL LOCATION:(Show sketch of the location below)
Nearest Town: BANNER ELK County: AVERY
COW CAMP RD OFF SPANISH OAK RD qEE AVERY HI
(Road Name and Numbers,Community,or Subdivision and Lot No.l
DRILLING LOG DEPTH
3. OWNER _ALBERT J SCOTT From To Formation Description
Address_ 1836 COW CAMP RD. , 0 35 DIRT
eet or Route No.l
NEWLM N 8657 35 70 GRANITE
City or Town State Zip Code 70 73 _SHALE
4. DATE DRILLED 6/2/2000 73 125 GRANITE
5. TOTAL DEPTH 125
6. CUTTINGS COLLECTED YES 0 NO
7. DOES WELL REPLACE EXISTING WELL? YES 0 NO 0 n
8. STATIC WATER LEVEL Below Top of Casing: 20 FT. en r
(Use"+"if Above Top of Casing) C7
9. TOP OF CASING IS 1 FT.Above Land Surface* am
*Top of casing terminated at/or below land surface requires a variance in actor- `t
dance with 15A NCAC 2C.011
10. YIELD(gpm): METHOD OF TEST Air m
11. WATER ZONES (depth)6 gpm70-73 0 gpm .:,-
0 gpm 0 gpm
12. CHLORINATION: Type HTH Amount 22 If additional space is needed use back@for "'
CO —t
13. CASING: Wall Thickness LOCATION SKETCH z
Depth Diameter or Weight/Ft. Material (Show direction and distance from at least two Itaite
From 0 To 42 Ft. 6 1/4 .186 GALV. Roads,or other map reference points)
From To Ft.
From To Ft.
14. GROUT: V 1 3
Depth Material Method
From 0 To 20 Ft. Cement Gravity Flow
From To Ft.
W N
r3
15. SCREEN:
Depth Diameter Slot Size Material IQ
From To Ft. in. in.
From To Ft. in. in. aj
From To Ft. in. in.
16. SAND/GRAVEL PACK ggti.
Depth I; �1e _ is l - I° � Material
From jlo�Il Ft.
From ;70 11 �t�17. REMARKS:
I DO HEREBY CERTIFY THAT,THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STANDARD,AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
0
FOR OFFICE USE ONLY -- 1'`� /1 �,P.r,P ��!ZI , CSC')
Quad No: SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit original to Division of Water Quality,Groundwater Section within 30 days
GW-1 REV.12/99
Serial No.

North Carolina-Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section 213151,
1636 Mail Service Center-Raleigh, N.C.27699-1636-Phone[phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR: Dewey Wright Well Pump Co., Inc.
000311 WELL CONTRACTOR CERTIFICATION#: eve eece
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE (Check Applicable Box): Residential ® Municipal 0 Industrial 0 Agricultural 0 Monitoring
Recovery 0 Heat Pump Water Injection 0 Other F-1 If Other, List Use:
2. WELL LOCATION:(Show sketch of the location below)
Nearest Town: BANNER ELK County: AVERY
HICKORY NUT GAP RD. OFF HWY 184
(Road Name and Numbers,Community,or Subdivision and Lot No.) DRILLING LOG DEPTH
3. OWNER DAVID W. LANGHORNE From To Formation Description
Address P.O. BOX 1302 , 0 70 DIRT
BIG PINOMY Route No.) FL 33043 70 100 GRANITE
City or Town State Zip Code 100 103 SHALE
4. DATE DRILLED 6/1/2000 103 270 GRANITE
5. TOTAL DEPTH 325 270 274 SHALE
6. CUTTINGS COLLECTED YES 0 NO EX 274 325 GRANITE
7. DOES WELL REPLACE EXISTING WELL? YES E] NO © a
8. STATIC WATER LEVEL Below Top of Casing: 80 FT. o
(Use"+"if Above Top of Casing)
9. TOP OF CASING IS 1 FT.Above Land Surface* G
'Top of casing terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2C.011
10. YIELD (gpm): METHOD OF TEST Air
11. WATER ZONES (depth) gpm100-103 7 gpm 270-274 �r?�
0 gpm 0 gpm z ��
12. CHLORINATION: Type HTH Amount 55 If additional space is needed use back of Twin m�
CD --�
13. CASING: Wall Thickness LOCATION SKETCH �'
Z _
Depth Diameter or Weight/Ft. Material (Show direction and distance from at least two State
From 0 To 77Ft. 6 1/8 .350 PVC Roads,or other map reference points)
From To Ft. <
From To Ft. t4 W`� I O S /
/e
14. GROUT:
Depth Material Method
From 0 To 20 Ft. Cement Gravity Flow
From To Ft.
15. SCREEN:.
Depth Diameter Slot Size Material ^4/'�From To Ft. in. in. � 14, \
From To Ft. in. in. C,
From To Ft. in. in.
16. SAND/GRAVEL PACK:
Depth Size Material K
From To Ft:'
From l:0 Tt Le -i
17. REMARKS: ,;,����, :i
I DO HEREBY CERTIFY THAT'THIS W LL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NC 2C,WE l
CONSTRUCTION STANDARDS,AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WEL WNE
-� Q�
FOR OFFICE USE ONLY
Quad No: SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit original to Division of Water Quality,Groundwater Section within 30 days
GW-1 REV.12/99
Serial No.

North Carolina-Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section R O J
1636 Mail Service Center-Raleigh,N.C.27699-1636-Phone[phone] 13
WELL CONSTRUCTION RECORD WELLCONTRACTOR: e�'e II �'�e/j
WELL CONTRACTOR CERTIFICATION It: Z J
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE(Check Applicable Box): Residential Municipal ❑ Industrial❑ Agricultural❑ Monitoring ❑
Recovery❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATION:(Show sketch of�Ia location below)
Nearest Town: — ►��+� C P, County: A_LJLP,'J
(Road Name and Numbers,Co unity,or Subdivision and Lot No.) DRILLING LOG DEPTH
3. OWNER t ,�S �t RAlK m e ' From To Formation Description
Address 3
treet or Route o. ?7 i �Q GEC
0-('..6 -7l , C_- Age o -
City or Town State Zip Cede
4. DATE DRILLED -)3 �D(5
5. TOTAL DEPTH 1 2© �
6. CUTTINGS COLLECTED YES❑ NOQ�
7. DOES WELL REPLACE EXISTING WELL? YES ❑ NOEf— _
8. STATIC WATER LEVEL Below Top of Casing: FT.
(Use'+'it 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 15A NCAC 2C.0118
10. YIELD(gpm): 44''� METy09 OF TEST J L_
11. WATER ZONES(depth):—,.
12. CHLORINATION: Type `�� Amount It additional space is needed use back of form
13. CASING:
Wall Thickness LOCATION SKETCH
Depth Diameter or Weight/Fl. Materi ' (Show direction and distance from at least two State G
From 52 To © Ft. Roads,or other map reference points) O ci
From To Ft. O _
From To Ft. G i'`i
14. GROUT: �_ �`
i
Depth Material Method iV m
From To Ft. '0" —o rno
From To Ft. 70 M
15. SCREEN: W rn
Depth Diameter Slot Size Material cA
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:
DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STANDARDS,AND THAT A COPY OF THIS,!�EGD AS BE7 PROVIDED TO THE WELL OWNER.
FOR OFFICE USE t Y a t/
Quad No: I TURE OF PERSON CON,I �1�yCyTI% t E 4 L r' DATE
Submit odgi I vision of Water Quality,Grt dv4 ter Secl en WI hlil 3D day
Serial No. 3 2MOv. W REV.12/99
AUG 1 6 2000 r °1 r,
.lo'111 orate-Section w
;;•>tla,nu+, Regional

North Carolina-Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section �-,. 1 3 81 t
1636 Mail Service Center-Raleigh,N.C.27699-1636-Phone[phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR: Dewey Wright Well Pump Co., Inc.
WELL CONTRACTOR CERTIFICATION#:
000314 STATE WELL CONSTRUCTION PERMIT#: eve Reece
1. WELL USE(Check Applicable Box): Residential © Municipal❑ Industrial ❑ Agricultural❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATION:(Show sketch of the location below)
Nearest Town: LINVILLE County: AVERY -
HILLSIDE DR. OFF GOLF COURSE RD OFF CLUBHOU
(Road Name and Numbers,Community,or Subdivision and<ot No.) DRILLING LOG DEPTH
3. OWNER _JOE C. SOUTHER From To Formation Description
Address 58 HICKORY HOLLOW , 0 58 DIRT
WINDERIstreetorRouteNo.) GA 30680 58 70 GRANITE
City or Town state Zip Code 70 73 SHALE
4. DATE DRILLED 6/22/2000 73 360 GRANITE
5. TOTAL DEPTH 405 360 365 QUARTZ
6. CUTTINGS COLLECTED YES ❑ NO EX 365 405 GRANITE
7. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
8. STATIC WATER LEVEL Below Top of Casing: 40 FT. c�
(Use"+"if Above Top of Casing) 46.
O
9. TOP OF CASING IS 1 FT.Above Land Surface* C 'ar
*Top of casing terminated at/or below land surface requires a variance in accor- Cr,�
dance with 15A NCAC 2C.011$
10. YIELD(gpm): 90 METHOD OF TEST Air c+J �
11. WATER ZONES (depth)3 gpm70-73 7 gpm 360-365
0 gpm 0 gpm 3 Iry
12. CHLORINATION: Type HTH Amount 73 If additional space is needed use baotaDf foci=
CD .y
13. CASING: LOCATION SKETCH fl d
Wall Thickness
Depth Diameter or Weight/Ft. Material (Show direction and distance from at least two State
From 0 To 63Ft. 6 1/8 .350 PVC Roads,or other map reference points)
From To Ft.
From To Ft.
14. GROUT:
Depth Material Method fi
From 0 To 20_Ft. Cement Gravity Flow
From To Ft.
15. SCREEN: _
Depth Diameter Slot Size Material p �hholt_,e
From To Ft. in. in. p�Chin
From To Ft. in. in. `L— •-7---� ►7
From To Ft. in. in. � LJ
16. SAND/GRAVEL PACK: d� //x
Depth Size Material
From To Ft.
From To Ft.
17. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION $T ANDIgRDq, N%,rHnT PY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
FOR OFFICE USE ONLY
Quad No: iI; AlJG 2 1 2000 !SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
;. Sub mt ongi al to Division of Water Quality,Groundwater Section within 30 days
GW-1 REV.12/99
Serial No.
4 pinn

North Carolina-Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section r
1636 Mail Service Center-Raleigh,N.C.27699-1636-Phone[phone] 1 ��
WELL CONSTRUCTION RECORD WELL CONTRACTOR: Dewey Wright Well Pump Co., Inc.
000366 WELL CONTRACTOR CERTIFICATION#: zoo 1
STATE WELL CONSTRUCTION PERMIT#: Steve Reece
1. WELL USE(Check Applicable Box): Residential ® Municipal 0 Industrial 0 Agricultural 0 Monitoring 0
Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: NEWLAND County: AVERY
TURBYFILL RD. OFF HWY 194
(Road Name and Numbers,Community,or Subdivision and Lot No.) DRILLING LOG DEPTH
3. OWNER LARRY M. MCKEE From To F rmation Description
Address 484 TURBYFILL RD. , 0 56 DIRT°
NEWLMMeet or Route No.) NC 28657 56 249-- GRANITE
City or Town State Zip Code 24
4. DATE DRILLED 6/26/2000 251 300 GRANITE
5. TOTAL DEPTH 300
6. CUTTINGS COLLECTED YES 0 NO E
7. DOES WELL REPLACE EXISTING WELL? YES 0 NO EN o
8. STATIC WATER LEVEL Below Top of Casing: 40 FT.
(Use"+"if 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.011
10. YIELD (gpm): 1 5 METHOD OF TEST Air
11. WATER ZONES (depth) •5 gpm248-251 0 gpm A l j ; � Ifln 1 1ter,,
0 gpm 0 gpm r � c...,r r .. rn
12. CHLORINATION: Type Amount ""lf addit)opal space.is_rleeded use back�8forrw t
13. CASING: Wall Thickness LOCATION SKETCH
Depth Diameter or Weight/Ft. Material (Show direction and distance from at least two State
From 0 To 61 Ft. 6 1/8 .350 PVC Roads,or other map reference points)
From To Ft. oo
1
From To _Ft.
14. GROUT:
Depth Material Method 194 y W
From 0 To 20 Ft. Cement Gravity Flow a t0
From To Ft.
15. SCREEN:
Depth Diameter Slot Size Material _0
From To Ft. in. in.
From To Ft. in. in.From To Ft. in. in. 4-
16. SAND/GRAVEL PACK:
Depth Size. Material
—
From To Ft.
From To Ft. .__.-
17. REMARKS:
I DO HEREBY CERTIFY THAT TH!,�V ELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STANDARDS,A'A)THAT A COPY F THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
FOR OFFICE USE ONLY
Quad No: SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit original to Division of Water Quality,Groundwater Section within 30 days
GW-1 REV.12/99
Serial No.

North Carolina-Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section n i
1636 Mail Service Center-Raleigh,N.C.27699-1636-Phone[phone] 2 1 `7
WELL CONSTRUCTION RECORD WELL CONTRACTOR: ' ��-�� •^�
WELL CONTRACTOR CERTIFICATION#:
STATE WELL CONSTRUCTION PERMIT#:
1. "WELL USE(Check Applicable Box): Residential Municipal ❑ Industrial❑ Agricultural❑ Monitoring ❑
Recovery❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: County: Y1/�
M; I lle'g'S G
(Road Name and Numbers,Co munity,co-rr Su" '"ivi'sion and Lot No.) DRILLING LOG DEPTH
3. OWNER C, K,CC. iV,4UK-'A- From To Forrnption Description
Address C 'r `� LtC�c v' ZZ
12t C • `jam y—
trees or o 19 o.C� S '13 - /gQ /�Y'YC
City or Town _ State Zip Code --- — +
4. DATE DRILLED 5 r -Vb C C� --
5. TOTAL DEPTH 0 4k—L.
6. CUTTINGS COLLECTED ❑ NO�
7. DOES WELL REPLACE EXISTING WELL? YES ❑ NOE�J—
8. STATIC WATER LEVEL Below Top of Casing: FT.
(' (Use'+'it Above Top of Casing)
9. TOP OF CASING IS l 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): 12' METHOD OF TEST�fm '�
11. WATER ZONES (depth): I _
12. CHLORINATION: Type Amount . It additional space is needed use back of form
13. CASING:
Wall Thickness LOCATION SKETCH
Depth Diapper or Weight/Ft. Ma'teria"l (Show direction and distance from at least two State
From To � Ft.- — Roads,or other map reference points)
From To Ft.
From To Ft.
14. GROUT:
Depth Material Method
From To 215 Ft. r 9J2a'<AL
From To Ft. o
15. SCREEN: C7 a
Depth Diameter Slot Size Material
From To Ft in. in. ram— orn
From To Ft. in. in. :.--L
From To Ft. in. in. N n
16. SAND/GRAVEL PACK:
Depth Size Material
w Co MI
From To Ft. — =�
w
From To Ft. o
17. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELLW -QON•TRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION D�H,41jf-A( T`O THIS RECORD HAS BEEN P OVIDED TO THE WELL OWNER
lIl ll�s emu•. :t ;r t _tic
FOR OFFICE USE G
Quad No:
}j �� , TUBE OF PERSON CONSTRUII T i WILL
UL 3SG�init origi ivislon of Water Quality,Gmundv}aler'S�ction within 30 days �" 8
Serial No. AUG 1 6 2000 GW r,REV. 12/99
Groundwater Section
Asheville Re tonal Office

North Carolina•Department of Environment and Natural Resources-Division of Water Ouality-Groundwater Section n O R
1636 Mail Service Center-Raleigh,N.C.27699-1636-Phone[phone] �� t) F'
WELL CONSTRUCTION RECORD WELLCONTRACTOR: IS94s4''e'lf �r ' I/$
WELL CONTRACTOR CERTIFICATION #: ca�
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE(Check Applicable Box): Residential[Er Municipal ❑ Industrial❑ Agricultural❑ Monitoring ❑
Recovery❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATION:(Show sketc of the location below)
Nearest Town: n/��44+-� �l-�t,Vr`��� County:
(Road Name and Numbers,Community,or Subdivision and Lot No.) DRILLING LOG DEPTH
3. OWNER ' Qe<}�- � h�Cap/V From To Formation Description
Address (Street or Houls
City or Town State Zip Ccde —•— `
4. DATE DRILLED 3" '
5. TOTAL DEPTH
6. CUTTINGS COLLECTED YES❑ NO[H-
7. DOES WELL REPLACE EXISTING WELL? YES ❑ NO[`
8. STATIC WATER LEVEL Below Top of Casing: FT.
(Use'+'II Above Top of Casing)
9. TOP OF CASING IS— FT.Above Land Surface'
'Top of casing terminated attor below land surface requires a variance In accor-
dance with 15A NCAC 2C.0118
10. YIELD(gpm): J-4'j= METHOD OF TEST 'Aife 1-40
11. WATER ZONES(depth):. 130 .
12. CHLORINATION: Type t• Amount If additional space is needed use back of form
13. CASING:
Wall Thickness LOCATION SKETCH
Depth Diameter or Weight/Ft. feria: (Show direction'and distance from at least two State -
From © To a Ft. BSc lu g� V L- Roads,or other map reference points) -
From To Ft.
From To Ft.
14. GROUT:
Depth Matedal�A Method
From 0�9 To �.� Ft.
From To Ft.
15. SCREEN:
Depth Diameter Slot Size Material
From To Ft in. in. �C�
From To Ft. in. in.
C., n
From To Ft. in, in. may, iC o
16. SAND/GRAVEL PACK: N Fir,F a IJ L51
c�
Depth Size Mat '."�` �'. N r
From To Ft. ZZ
21
From 70 Ft. _� AUG I 6 2000
17. REMARKS: f� r.... rn�
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE 'WITH 15A NCAC 2C,WELL
CONSTRUCTION R I le 11. PTHIS REC EN P OVIDED TO THE WELL OWNER.
FOR OFFICE USE
Quad No: ATURE OF PERSON CONSTRUCTING THE WELL DATE
3 S�t odo Nvislon of Water Quality,Groundwater Section within 30 days
Serial No. J U
gD GW-1 REV.12/99
�'rc:mdwate�CECtiOn
._ _ .SI1E;YlI!P,t IOn-{I IT T

North Carolina-Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section 212233
1636 Mail Service Center-Raleigh,N.C.27699-1636-Phone[phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR: Dewey Wright Well Pump Co., Inc.
WELL CONTRACTOR CERTIFICATION#: 268
000252 STATE WELL CONSTRUCTION PERMIT#: Steve Reece
1. WELL USE (Check Applicable Box): Residential © Municipal ❑ Industrial ❑ Agricultural❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: ELK PARK County: AVERY
JERRY R FK Rn(CFI= ROARING CRK RD OFF OLD 1
(Road Name and Numbers,Community,or Subdivision and Lot No.l DRILLING LOG DEPTH
3. OWNER - EDNA RUTH HUGHES From To Formation Description
Address-RL 1 BOX 374 . 0 80 DIRT
NEWL_Aleator outeNo.) N 8657 80 100 GRANITE
Gty or Town state zip Code 100 103 SHALE
4. DATE DRILLED 9122190nn 103 125 GRANITECD
5. TOTAL DEPTH 125 O
ra
6. CUTTINGS COLLECTED YES ❑ NO
7. DOES WELL REPLACE EXISTING WELL? YES ❑ NOENr cm
8. STATIC WATER LEVEL Below Top of Casing: 60 FT.
(Use"+"if Above Top of Casing) .s
9. TOP OF CASING IS 1 FT.Above Land Surface* ) )' , r,rt(tI ;10�
*Top of casing terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2C.0118
10. YIELD(gpm): 30 METHOD OF TEST Air j r,
11. WATER ZONES (depth)30 9PM100-103 0 gpm
0 gpm 0 gpm
12. CHLORINATION: Type HTH Amount 13 If additional space is needed use back of form
13. CASING: Wall Thickness LOCATION SKETCH
Depth Diameter or Weight/Ft. Material (Show direction and distance from at least two State
From 0 To — 8 Ft. 6 1/8 —.350 VC Roads,or other map reference points)From To Ft.
From To Ft. ` F) E
14. GROUT:
Depth Material Method
From_ 0 To 20 Ft. Cement Gravity Flow
From To Ft. \C�
15. SCREEN: t�
Depth Diameter Slot Size Material
From To Ft. in. in. C`��K 2�
From To Ft. in, in. 2�trrr� '
From To Ft. in. in.
16. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft. , c)
17. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STANDARDS,AND THAT A COPY OF T�IECORD HAS BEEN PROVIDED TO THE WELL OWNER.
FOR OFFICE USE ONLY
Quad No: SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit original to Division of Water Quality,Groundwater Section within 30 days
GW-1 REV.12/99
Serial No.

North Carolina-Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section 2 12 2 3 J
1636 Mail Service Center-Raleigh,N.C.27699-1636-Phone[phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR: Dewey Wright Well Pump Co., Inc.
WELL CONTRACTOR CERTIFICATION M 2687
000298 STATE WELL CONSTRUCTION PERMITM Steve Reece
1. WELL USE(Check Applicable Box): Residential ® Municipal 0 Industrial Agricultural El Monitoring 0
Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: RANNERELK County: AVERY
QFF TAMARACK ANF(OFF HWY 184
(Road Name and Numbers,CI
ommunity,or Subdivision and Lot No.) DRILLING LOG DEPTH
3. OWNER _ WAI TER VnI I FNWFIDER From To Formation Description
Address P 0 BOX�691 n I,Q nIRT/ROCK
RANNERS Iekr`RouteNo.) N 171 F,fld 1g in GRANITE
City or Town State Zip ode
30 32 SHALE
4. DATE DRILLED 5/23/2000 32 140 G4RANITF
5. TOTAL DEPTH 165 140 149 1RHAI F
6. CUTTINGS COLLECTED YES 0 NO ER ' <; 1*4NITE '©
7. DOES WELL REPLACE EXISTING WELL? YES 0 NO ER ?,z ,s o
8. STATIC WATER LEVEL Below Top of Casing: 10 FT. 3 t�',4,+. C_
(Use"+"if Above Top of Casing) (} �� ,Zt���� `t cc')
9. TOP OF CASING IS 1 FT.Above Land Surface* °
*Top of casing terminated at/or below land surface requires a variance in accor- "d r i
dance with 15A NCAC 2C.0118
10. YIELD(gpm): 20 METHOD OF TEST Air
11. WATER ZONES (depth)2 gpm30-32 18 qpm 140-142
m.r> .• f�l�
0 qpm 0 qpm
12. CHLORINATION: Type HTH Amount 32 If additional space is needed use ba f forth
r-,
13. CASING: Wall Thickness LOCATION SKETCH
Depth Diameter or Weight/Ft. Material (Show direction and distance from at least two State
From 0 To 9 Ft. 8114 188 GAL Roads,or other map reference points)
From To Ft.
From To Ft.
14. GROUT:
Depth Material Method
From 0 To _90 Ft. Cement Gravity Flow '�)
From To Ft.
15. SCREEN: 11--
Uc
Depth Diameter Slot Size Material 'r-) q)
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:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STANDARDS,AND THAT A COPY OF THI RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
FOR OFFICE USE ONLY eZZ4r/`L U
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Quad No: Submit original to Division of Water Quality,Groundwater Section within 30 days
GW-1 REV.12/99
Serial No.

North Carolina- Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section 212236
n
1636 Mail Service Center-Raleigh, N.C.27699-1636-Phone[phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR: Dewey Wright Well Pump Co., Inc.
WELL CONTRACTOR CERTIFICATION#: 2661
000270 STATE WELL CONSTRUCTION PERMIT#: eve eece
1. WELL USE (Check Applicable Box): Residential © Municipal ❑ Industrial ❑ Agricultural❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATION:(Show sketch of the location below)
Nearest Town: BANNER ELK County: AVERY
ROCK BROOK CT LOT242 IN ELK RIVER OFF HWY 184
(Road Name and Numbers,Community,or Subdivision and Lot No.) DRILLING LOG DEPTH
3. OWNER STEVE RAVILLE From To Formation Description
Address 242 ROCK BROOK CT. , 0 60 DIRT
BANNER( t!€<rRouteNo.) NC 28604 60 90 LIMESTONE
City or Town state Zip Code 90 93 LIMESTONE
4. DATE DRILLED 5/22/2000 93 110 LIMESTONE
5. TOTAL DEPTH 205 110 113 LIMESTONE
6. CUTTINGS COLLECTED YES ❑ NO 113 170 LIMESTONE
7. DOES WELL REPLACE EXISTING WELL? YES ❑ NO ® 170 173 LIMESTONE
TONE
8. STATIC WATER LEVEL Below Top of Casing: 60 FT. 173 205 " t
(Use"+"if Above Top of Casing)
rym
9. TOP OF CASING IS 1 FT.Above Land Surface* err'
*Top of casing terminated at/or below land surface requires a variance in actor- lfl QC
dance with 15A NCAC 2C.0118 Air
DO
10. YIELD (gpm): 50 METHOD OF TEST
11. WATER ZONES (depth).-10 011190-93 10 gpm 110-113
30 gpm170-173 0 gpm w cn.-
12. CHLORINATION: Type HTH Amount 30 If acldjtiqnark5 c ti l`?ieeded use balk off r
o
a
13. CASING: Wall Thickness LOCATION SKETCH
Depth Diameter or Weight/Ft. Material (Show direction and distance from at least two State
From Q To —GZFt. 6 1/R R5n PVC: Roads,or other map reference points)From To Ft.
From To Ft.
14. GROUT:
Depth Material Method
From n_ To _ 9n Ft. CPmPnt G'I mvity Flow
From To Ft.
15. SCREEN:
Al
Depth Diameter Slot Size Material 6
From To Ft. in. in.
From To Ft. in. in. a 1
From To Ft. in. in.
16. SAND/GRAVEL PACK:
Depth Size Material
From To Ft. 'y
From To Ft. >
17. 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�R,,--ECORD HAS BEEN PROVIDED TO THE WELL OWNER.
FOR OFFICE USE ONLY •�'z;_ ����� .4 /� _
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Quad No: Submit original to Division of Water Quality,Groundwater Section within 30 days
GW-1 REV.12l99
Serial No.

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: Imo ` u'�`" �'` �`�
WELL CONTRACTOR CERTIFICATION#: +
STATE WELL CONSTRUCTION PERMIT#: r 3YX
1. WELL USE(check Applicable Box): Residential Municipal ❑ Industrial❑ Agricultural❑ Monitoring❑.
Recovery❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATION- (Show sketch of the location below)
Nearest Town:— K&­-'Iodec' County:. e,%Ej
,fl7 m ,6i OWA) AIV
(Road Name and Numbers,Community,or Subdivision and Lot No.) DRILLING LOG DEPTH
3. OWNER ,J.J V/ C 4/��h�� From To Formation Description
Address ���' � _ L ,� _
treet or outo-1 j4 D y — 44
RC-�57
Cil or Town State zip Coda
4. DATE DRILLED Jf a7' 9 CC.)a l e,6
5. TOTAL DEPTH / PD _/Z�_ _
6. CUTTINGS COLLECTED YES❑ NO E�j' --/!S /C 8
7. DOES WELL REPLACE EXISTING WELL? YES ❑ N0Za' /G 9 `/ 76
8. STATIC WATER LEVEL Below Top of Casing: �2S—FT. /70 - ! 0 iv,`
(Use'+-If Above Top of Casing)
9. TOP OF CASING ISM FT.Above Land Surface-
-Top of casing terminated atfor below land surface requires a variance In accor-
dance with 15A NCAC 2C.0118
10. YIELD(gpm): /IQ METHOD OF TEST /9;P
11. WATER ZONES(depth):
12. CHLORINATION: Type 117-lf Amount 3 _ 11 additional space is needed use back of form
13. CASING:
Wall Thickness LOCATION SKETCH
Depth Diametor or Weight/Fl. Material (Show direction and distance from at least two Slate
From To 99 Ft. '-/ L tW_LP11Zf Road or other map reference points) �
From To Ft. ----
C5 C-5
From To Ft. --- © C)-
14. GROUT: G C1c;
Depth Material Method M-
From _0 To a° Ft. Crm t�Z� �ovi t1i aar''t
From To Ft. -a MC,
15. SCREEN: - :3C z r"
Depth Diameter Slot Size Material C')�
From To Ft in. in. Ln -i
From To Ft. in. in. x
From To Ft. In. in.
16. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
17. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTR T IN ACCORDANCE WITH 15A NCAC 2C WELL
CONSTRUCTI AND THAT A O HI ECO AS r:r0AO`VIDED TO TH OWNER.
FOR OFFICE U
Quad No: AT RET+bF(tR �N ONST -OCTING THE WELL DATE
Submit I i tor��dL1Jn1c�f5tutti _Giounlcjwata Sb'ction within 30 days
Serial No. 22000 (I i 9 GW-I REV.12199
e�,qw Gmndwater UUN 2 8 2000
ville Re 'on
Groundwater Section
Asheville 12egi4nal,n�?f(icl o�

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: ncrvl'o��✓aSluG//
WELL CONTRACTOR CERTIFICATION #:
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE(Check Applicable Box): Residential 0 Municipal ❑ Industrial❑ Agricultural❑ Monitoring 0.
Recovery❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATION:(Show sketch of the location below) ,�/
Nearest Town: r"v e,,541"Id County: /f 1 ':74
(Road Name and Numbers,Community,or Subdivision and Lot No.) DRILLING LOG _ DEPTH
3. OWNER From To Formation Description
Address 0— 3S
or _Route Co. ?S' �P g N i f e
c e.^cr
City or Town G State ZipCodo
4. DATE DRILLED_` 2 /—.0Q
5. TOTAL DEPTH 5nn
6. CUTTINGS COLLECTED YES❑ NO� 1 LAB— D0
7. DOES WELL REPLACE EXISTING WELL? YES ❑ NO�
8. STATIC WATER LEVEL Below Top of Casing: �_FT. fl
(Use'+'If Above Top of Casing) n
9. TOP OF CASING IS FT. Above Land Surface- ,
`Top of casing terminated at/or below lanc(,surtace requires a variance in accor-
dance with 15A NCAC 2C.0ir18cill
t .
10. YIELD(gpm): I .. ..METHOD OF JEST
11. WATER ZONES(depth): I 3 rd l Z rr'a
NZ
rn
12. CHLORINATION: Type Amount kf_ It additional space is needed use back of form C-)
13. CASING: �
Wail Thickness LOCATION SKETCH
Depth Di am ter or Weight/Ft. Material (Show direction and distance from at least two State
From To �10 Ft. --D a PyC Roads,or other map reference points)
From To Ft. ,/8 8
From To Ft. —
14. GROUT:
Depth Material Method
From _0 To .24 Ft, 6zeu,'9 / u/e
From To Ft.
15. SCREEN:
Depth Diameter Slot Size Material
From To Ft in. in.
From To Ft. in. in. E� , c��eJaQpPy5vtk,
From To Ft. in. in. ns�
16. SAND/GRAVEL PACK: ^'�e^1�;rlcf
Depth Size Material
From To Ft.
From To Ft.
17. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STANDARDS,AND THAT A C PY OF THIS RECOR HAS BEEN PROVIDED TO THE WELL OWNER.
FOR OFFICE t, S
Quad No: IG FIE OF PERSON CONSTRUCTING THE WELL DATE
Submi r i I I ry lonNI VJ(�er raial' (Wu wa ri lion within 30 days
Serial No. I ,.,�. V GW1 REV. 12/89
sec Im JUN 2 2000
AdIville Regional tce
Grnundtleatt:r Sectic=11

: ?`:' ..
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:
WELL CONTRACTOR CERTIFICATION#:
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE(Check Applicable Box): Residential 23' Municipal ❑ Industrial❑ Agricultural❑ Monitoring O..
Recovery❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: �n.v�ns.�� �� County:_ er k
(Road Name and Numbers,Community,or Subdivision and Lot No.) DRILLING LOG DEPTH
3. OWNER .S'G `! N/ e bee From To Formation Description'
Address
(Street or Houzo o. �q 3dN�
City or Town State v Zip Code
4. DATE DRILLED S- 'cVC 7l✓ ��>dHi G s�rul r oc ,
5. TOTAL DEPTH �P 0 --2,/ �' �e I n'oak
6. CUTTINGS COLLECTED YES❑ NO[e-
7. DOES WELL REPLACE EXISTING WELL? YES ❑ NOOK Z s o?�^ C"etear 4MIA411 a,
8. STATIC WATER LEVEL Below Top of Casing: too Fr. ��s I R-00 -rmrv%�C
(Use'+'It 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 actor- �
dance with 15A NCAC 2C.0118 ,
a= > 10. YIELD(gpM): METHOD OF TEST
11. WATER ZONES(depth): c2gL Al 7 ldD�o�_
12. CHLORINATION: Type /�T/y Amount _ If additional space Is needed use back of low
13, CASING: '1g-r-A ::Fc �d
rn
LOCATION SKETCH =
Wall Thickness N rn:
Depth Diameter or W ' htt/FFt. Material (Show direction and distance from at least two Sly n
From To Ft. — —PSG - Roads,or other map reference points) o
From To 7 Fl. 3 B B
From To Ft. ----
14. GROUT: x�
Depth Material Mothod lie
From To Ft. ��
From To Ft, /_7
15. SCREEN:
Depth Diameter Slot Size Material
From To Ft in. in.
From To Ft. in. in.
From To Ft. In. in. "'1C
16. SAND/GRAVEL PACK: A ar d�QPry s
Depth Size Materialo
From To Ft.
From To Ft.
17. REMARKS: /71&a /i,yc sr�C// -Ioej
DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 1 NCAC 2C,WELL
CONSTRUCTION STANDARDS,AND THAT A OP H�ECORD BEEN PROV TO THE WELL OWNER.
FOR OFFICE USE ONLY � �
Ouad No: rM
.,,,r.. NATURE OF PERSON CONSTRUCT G THE WELL DATE
h, nri i i cvrn�,wlt>� vs�t1 ion within 30 days
W
Serial No. 1�i5,5 G1 REV.12189
�— 1 W 2 �000
�ro.gndwate? Sectie-fn
Asheville ie v
_J

North Carolina-Department Of Environment and Natural Resources-Division of Water Duality-Groundwater Section
r .}; 1636 Mall Service Center-Raleigh,N.C.27699-1636-Phone[phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR:
`J4. WELL CONTRACTOR CERTIFICATION
J,r.
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE(Check Applicable Box): Residential Municipal ❑ Industrial❑ Agricultural❑ Monitoring .
Recovery❑ Heat Pump Water Injection ❑ Other It Other, List Use:
2. WELL LOCATION:(Show sketch of the location below)
Nearest Town: inn a c e, D i y County:
(Road Name and Numbers,Commun'ty,or Subdivisio o.)and Lot N DRILLING LOG DEPTH
3. OWNER �d— From To Formation Description
Address 49 l-3 reeIAa f Ace v co,-rr e,,
(Spet or outs o. (3- 1-3`1 f C
City Or own State Zip Code y C G 6 Ar,
4. DATE DRILLED 'off S` OL'G & Ac wlti�a ua.�fs,
5. TOTAL DEPTH
6. CUTTINGS COLLECTED YES❑ NO�
7. DOES WELL REPLACE EXISTING WELL? YES ❑ NO� '
8. STATIC WATER LEVEL Below Top of Casing: �_FT. _o 0
(Use'+'It Above Top of Casing) -A 7
9. TOP OF CASING IS� FT.Above Land Surface-
*Top
At 'Top of casing terminated at/or below land surface requires a variance In actor-
dance with 15A NCAC 2C 118cn
r
10 YIELD(gpm): .�METHOD OF TEST if
R ~ ?'
11.WATER ZONES(depth): 13` ZZO aQ 617
12. CHLORINATION: Type r/7' Amount— _ If additional space is needed use back of form C
13. CASING: 637)4 &ft,, — z
Wall Thickness LOCATION SKETCH
Depth Diameter or WoignuFl. Material (Show direction and distance from at least two State
From To Ft. — - c Roads,or other map reference points)
From To Ft.
From To Ft. -
14. GROUT:
Depth Material Method
From _Q_ To 6_Ft. c car e,l•f Decill
From To Ft. 1 'vc_*�
/Un
15. SCREEN:
Depth Diameter Slot Size Material /q
From To Ft in. in.From To Ft, in. in.
From To Ft, in. in.
TA/'/fell wex�
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 ACCORDA E WITH 1 SA NCAC 2C,WELL
CONSTRUCTION STANDARDS,AND THAT A C PY THIS R RD H EN PROVIDE HE WELL OWNER.
FOR OFFICE USE ONLY `��a� ���
Quad No: P le IA}AfURE SF PE ON CONSTRUCTIN HE WELL DATE
-111on vis+omo�vwrFITTI
n within 30 days
Soda)No. GW-1 REV.12199
�� 7MAY IN JUN 2 8 2000
Gmundw11 w SectW
Asheville Off" (a 4

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: /✓RCS ft 'II J_-)Q;A,,,
WELL CONTRACTOR CERTIFICATION#: l33
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE(Check Applicable Box): Residential E Municipal ❑ Industrial❑ Agricultural❑ Monitoring❑
Recovery❑ Heat Pump Water Injection ❑ Other If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nc uJlaNa� County:
y��•y
Nearest Town: ty:
(Road Name and Numbers,Community,or Subdivision and Lot No.) DRILLING LOG DEPTH y
3. OWNER lrya�1 e '6C.y�i r_:for From To Formation Description
Address `f,5.3 ,Qr,, 10,0 n 3 0 /'e-06 k o tL�,ti
- t treet or KOUte o. _3 �%02 e s /,,f
/✓C.i-k 4+Nc-Y /UC 2 d
City or Town State Zip Code' Va 5 3 T G�-Y r ,s'`ia�� -
s'/o n2oc�
4. DATE GRILLED 5 3 7 '
5. TOTAL DEPTH / 0 7 a 7.S C-r e d c s
6. CUTTINGS COLLECTED YES Q NOQ'
7. DOES WELL REPLACE EXISTING WELL? YES ❑ NOQ ri-ag,45. 9'0'mw+ '�c
8. STATIC WATER LEVEL Below Top of Casing: /zo FT. ?S- /�a ?NIl e .
(Use'+-It 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 15A NCAC 2C.0118
10. YIELD(gpm): 19 METHOD OF TEST A)r
11. WATER ZONES(depth): 7 2 - 9 5 •- 8!�a i
J
12. CHLORINATION: Type Amount If additional space is needed use back of form
13. CASING:
Wall Thickness LOCATION SKETCH -
Depth Diameter or Wetght/Ft. Material (Show direction and distance from at least two State From 1t To -Ft. (0 513 R Al Ai t Roads,or other map reference points)
From rya To Ft.6-
o .
From To Ft. O
n
14. GROUT: c,
Depth Material Method � C)ri
From To Ft. xr`'
0
From To Ft.
15. SCREEN: -1a rn�
Depth Diameter Slot Size Material M
From To Ft in. in. rn-u
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:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 20,WELL
CONSTRUCTION STANDARDS AND THAT A COPY OF THIS RECORD HAS BEEN OVIDED TO THE WELL OWNER.
IMA
FOR OFFICE US
Quad No: ATURE �� ER NgO T C'WIG HE ,�. DATE
onivislon 119 t r ua 1 y round te�'SRff, 4 in 30 days
Serial No. 1AY �1U GW-1 REV.1W9
� SUN 2 8 2000
u�
•
IN Grcundwate,Section
Asheville lit„,c!w,!

North Carolina-Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section
1636 Mail Service Center-Raleigh,N.C.27699-1 636-Phono(919)733-3221
WELL CONSTRUCTION RECORD WELL CONTRACTOR: &L--JGec-+ (`) c" i"`
WELL CONTRACTOR CERTIFICATION#: I
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE(Check Applicable sox): Residential ED Municipal ❑ Industrial❑ Agricultural❑ Monitoring❑.
Recovery❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATION:(Show sketch of the location below) �
Nearest Town: - -G f o 5 S.5 i'C 'l County:_- lTyet�+
��Z/• .�in /� �t � D iv�i���C? J�lc c.K�7�%��e `1 o�-/�Z
(Road Name and Numbers,Community,or Subdivision and Lot No.) DRILLING LOG DEPTH
3. OWNER Pc7 u f ever /-a 15�v From To Formation Description
Address h;Ille a,A- 0g /����Qi. 74
-- Street or Route o. ,�� - G•3 /j c o7w s'c a .�'
City or Town 8tate Zip Code
4.. DATE DRILLED -S -�� a oo� !3� /O� ol�d•�;/G s�ule'roc ,
5. TOTAL DEPTH
6. CUTTINGS COLLECTED YES❑ NO[�J- ;2/V %2/7
7. DOES WELL REPLACE EXISTING WELL? YES ❑ NOE]- 217 ,2/s -/��,7re oTi2 yl�ucan{S
8. STATIC WATER LEVEL Below Top of Casing: /6b FT. 2 f 9—3Fp aw >
(Use-+-if Above Top of Casing)
9. TOP OF CASING IS FT. Above Land Surface-
'Top of casing terminated atfor below land surface requires a variance In accor-
dance with 15A NCAC 2C.0118
10. YIELD(gpm): METHOD OF TEST �J r
11. WATER ZONES (depth): /494 "/D•, o_S
12. CHLORINATION: Type -ii(?'/� Amount If additional space is needed use back of form
13. CASING: 141
Wall Thickness LOCATION SKETCH
Depth � Diameter or Weight/Ft. Material (Show direction and distance from at least two Slate
o
From .. To l _Ft. 12 �`j�� Roads,or other map reference points)
From To Ft.
0
From To Ft. C:) c,
14. GROUT:
Depth Material Method
From __L1__ To .-6 Ft. -m,-n 64(11 Cn r*�
From To Ft.
15. SCREEN: �rnN cn=
Depth Diameter Slot Size Material
From To Ft in. in. "-I
J o
From To Ft. in. in. x
From To Ft, in. In.
16. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
17. REMARKS:
DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A AC 2C,WELL
CONSTRUCTION STANDARDS,AND THAT A C Y T l R�GeRD HAS EEN `
PROVIDE WELL OWNER. (�
FOR OFFICE USE ON ��. �
Quad No: 1441 O' ` rfiS t _`7H WELI i DATE
I of 1}` O ry lit yroidvteecn vf�r't ih 30 days
Serial No, jj GW-I REV.12199
2000 JOU N 2 2000
Groundwate,Section
Ashevil�e,.�t•: .ionll_0€ficcy�,,,�,,,

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] Al"LL CONSTRUCTION RECORD WELLCONTRACTOR: 3 �IZS�GI' (�e�� � �!
WELL CONTRACTOR CERTIFICATION#: _,'�'
STATE WELL CONSTRUCTION PERMIT#: _ 0
1. WELL USE(check Applicable Box): Residential CB' Municipal ❑ Industrial❑ Agricultural❑ Monitoring ❑.
Recovery❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATION:(Show sketch of the location below)
Nearest Town: Ale tv A a Nd County: v eP�f
C�, ,1 e, K-e AO 0 fry
(Road Name and Numbers,Community,or Subdivision and Lot No.) DRILLING LOG DEPTH
3. OWNER R 03 &/` e-C/- From To Formation Description
Address 733 641te Aocr.,l O lJS pee I d"w
'Street or HOUTO o. a :5'd
Ale is/zQ/,,,i Al C 2 8 S23 G-b c c, <
City or Town State Zip Code
4. DATE DRILLED ra /b_3 -i� ObcS 6o �f�r��a f����d �
5. TOTAL DEPTH "(iR•f tvh;fe d�rc�Fsr�,f�
6. CUTTINGS COLLECTED YES❑ NOQ-
7. DOES WELL REPLACE EXISTING WELL? YES ❑ NO[D'
8. STATIC WATER LEVEL Below Top of Casing: IS FT.
(Use'+-if Above Top of Casing)
9. TOP OF CASING IS J 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): J0 METHOD OF TEST_6 r
11. WATER ZONES(depth): -� 2 _6 0 62/
12. CHLORINATION: Type Amount If additional space Is needed use back of form
13. CASING: C�alv
Wall Thickness LOCATION SKETCH
Depth 1� v Diameter or Weight/Ft. Material (Show direction and distance from at least two State
From d To Ft. 4 /'�2 6'?/G Roads,or other map reference points)
From To Ft.
From To Ft.
14. GROUT: ca
Depth Material Method �j CD Z
From �_ To a C Ft. 6&m a,v f X n
From To Ft. corn
,
15. SCREEN: i
oM
Depth Diameter Slot Size Material r
From To Ft in. in.
From To Ft. in. in. m�
From To Ft. in. in. C5
16. SAND/GRAVEL PACK: � o
Depth Size Material
From To Ft.
From To Ft.
17. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STANDARDS,AND THAT A COP THI REC D HAS BEEN PPAVIDED TO THE WELL OWNER.
FOR OFFICE USE Flyl
Quad No: Y URE EFIR060111il }t `�`ff DATE
Submit odgi Ision W t r Quality,Groundwater Secti 1N t in 30 days
Serial No.
AY 2 9 2000 GW-1 REV.12199
� JUN 2 � 2000
Grotindwater Sectietl
n Asheville C
12�Flanttl , c fl �;,_,. „.� 1

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: � 5�✓c1I 1-Jc l/ ���f/'
WELL CONTRACTOR CERTIFICATION N: 2 13
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE(Check Applicable Box): Residential❑ Municipal Industrial❑ Agricultural❑ Monitoring❑ .
Recovery ElHeat Pump Water Injection ❑ Other If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town:6d.V1y'L%r i'-W! County:— d u e=" H
(Road Name d Numbers,Comm nity,orllSubdivision nd Lo1 No.) DRILLING LOG DEPTH
3. OWNER v � 16`cQ From To Formation Description
Address shale ,c,c,
tr et or Houte o.) gve5��je rcrc1 5/a7ie
City or Town State Zip,Code
5-(r 2 0 L���s,v i f e-
7b 23
4. DATE DRILLED
5. TOTAL DEPTH / W 3 //D - �'r`f e
6. CUTTINGS COLLECTED YES❑ NOD" f/0-- 113
7. DOES WELL REPLACE EXISTING WELL? YES ❑ NOE�J- 113 /a3
8. STATIC WATER LEVEL Below Top of Casing: ge-, FT. i 2 3
(Use'+'If Above Top of Casing) /a kyo tr r a 4v
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 15A NCAC 2C.0118
10. YIELD(gpm): 36 METHOD OF TEST 1r
11. WATER ZONES(depth): �-r a f 70 -7.� Qg o/ //0-113
12. CHLORINATION: Type Amount If additional space is needed use back of form
13. CASING: 6dil
Wall Thickness LOCATION SKETCH
Depth Diameter or Weight/Ft. Material (Show direction and distance from at least two State
From _ To 3 Ft. y $ ��li' Roads,or other map reference points)
From To Ft.
From To Ft.
14. GROUT: o
Depth Material (vlethod CD ¢
From d To Ft. Ce,v
From To Ft. 2
15. SCREEN:
Cil AM
t �<
Depth Diameter Slot Size Material
From To Ft in. in. �v
From To Ft. in. in. C/)=
N m1-0
From To Ft. in. in. :
16. SAND/GRAVEL PACK: x
Depth Size Material
From To Ft.
From To Ft.
17. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CO STRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STANDARDS THIS COR HAS BEEN PROVIDED TO THE WELL OWNER.
FOR OFFICE U N _.O r
Quad No: NATUR ©., S2 SIN _THE.,.ELt. DATE
2 it o Divislo f er Quality,Groundwater Sect o 4 ithin 30 days
Serial No. C�vV p'e„ �anrl GW-1 REV. 12199
low
Groundwater S f
ecGfan
�, AshMAla Re ions{Office„�

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: Dewey Wright Well Pump Co., Inc.
WELL CONTRACTOR CERTIFICATION#: 2067
000214 STATE WELL CONSTRUCTION PERMIT#: eve eece
1. WELL USE(Check Applicable Box): Residential © Municipal 0 Industrial 0 Agricultural 0 Monitoring 0
Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use:
2. WELL LOCATION:(Show sketch of the location below)
Nearest Town: BANNER ELK County: AVERY
(OFF DOBBINS RD. OFF HWY 184
(Road Name and Numbers,Community,or Subdivision and Lot No.) DRILLING LOG DEPTH
3. OWNER MARY M. ELDER From To Formation Description
Address 375 GREEN COVE RD. , 0 20 DIRT/GRVL
BANNERI�kr Route No.) NC 28604 20 60 DIRT/SHALE
City or Town State Zip Code 60 80 GRANITE
4. DATE DRILLED 5/3/2000 80 83 SHALE
5. TOTAL DEPTH 125 83 110 GRANITE
6. CUTTINGS COLLECTED YES 0 NO C 110 112 QUARTZ
7. DOES WELL REPLACE EXISTING WELL? YES 0 NO ® 112 125 GRANITE
8. STATIC WATER LEVEL Below Top of Casing: 20 FT. -�
(Use"+"if Above Top of Casing) O
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): 25 METHOD OF TEST Airco
o.0
11. WATER ZONES (depth)10 gpm80-83 15 gpm 110-112 y�
0 gpm 0 gpm s M.
12. CHLORINATION: Type HTH Amount 22 If additional space is needed use ba&f fob
� • ti
13. CASING: Wall Thickness LOCATION SKETCH v
Depth Diameter or Weight/Ft. Material (Show direction and distance from at least two State
From 0 To 6 Ft, 6 114 _.188 GALV, Roads,or other map reference points)
From To Ft. 10-9
From To Ft.
14. GROUT: <6—
Depth Material Method L
From_ 0 To _20 Ft. Cement Gravity Flow
From To Ft.
15. SCREEN: QL
Depth Diameter Slot Size Material In �
From To Ft. in. in.
From To Ft. in. in.
From To Ft. in. in.
16. SAND/GRAVEL PAC
DKS , �"Y"�°�"
TA ®S�eT. -� g4aterial
From
From T' I i _
i��� r�U
17. REMARKS:
I DO HEREBY CER1rIFY, A �� l=LyetW1S CONS: RUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTIONS ANDA,ti aIAN(3 sTH;k�YfA(COPY F THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
FOR OFFICE USE ONLY3�-
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Quad No: Submit original to Division of Water Quality,Groundwater Section within 30 days
Serial No.
1 _-_-� GW-1 REV.12/99

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: Dewey Wright Well Pump Co., Inc.
000235 WELL CONTRACTOR CERTIFICATION#:
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE(Check Applicable Box): Residential Municipal❑ Industrial ❑ Agricultural❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection Other ❑ If Other, List Use:
2. WELL LOCATION:(Show sketch of the location below)
Nearest Town: RANNFR PI K County: AVERY
fn 1 mqe an 'R_Rn
�(F�oa ame an R'umbers, ommunrty,or Subdivision and Lot No.)
DRILLING LOG DEPTH
3. OWNER —MICHAEL n SRARKS From To Formation Description
Address 0 30— DIRT
Rne N treet o Route No.)
city or Town M N State TN 3 6 no SrinIRT
�P od — 50 53 ALE
4. DATE DRILLED 5/1/2000 - 53 85 GRANITE
5. TOTAL DEPTH R5
6. CUTTINGS COLLECTED YES ❑ NO E3
7. DOES WELL REPLACE EXISTING WELL? YES ❑ NO ® V5
8. STATIC WATER LEVEL Below Top of Casing: 90 FT. C A
(Use"+"if Above Top of Casing) L �
9. TOP OF CASING IS 1 FT.Above Land Surface* zrrt
*Top of casing terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2C.0118
10. YIELD(gpm): 40 METHOD OF TEST Air qo
11. WATER ZONES (depth).40 gpm50-53 0 gpm ...t. rrio
0 gpm 0 qpm cni
12. CHLORINATION: Type HTH Amount 13 If additional space is needed use back blforn4­
o_
13. CASING: LOCATION SKETCH
Wall Thickness -
Depth Diameter or Weight/Ft. Material (Show direction and distance from at least two State
From 0 To 4 Ft. 8 118 ss.0_ Pyr Roads,or other map reference points)
From To Ft. t (C's
From To Ft. t✓
14. GROUT:
Depth Material Method
From 0 To —90 Ft. Cement Gravity Flow
From To Ft.
15. SCREEN:
Depth Diameter Slot Size Material
From To Ft. in. in. 6 C X
From To Ft. in. in.
From To Ft. in. in.
16. SAND/GRAVEL PACl< ( p PI4
Depth 31 '�"� ial �hr1
From To FFt. yy� Cam.rimer
From To ' FJP N a i3
17. REMARKS: �Ak.
I DO HEREBY CERTIFY THAT T,1$jWRL9 i',�/AS,fIJQNSTR CTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STA tYARI S',ANLTTH'AT A OOP1 F HIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
FOR OFFICE USE ONLY
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Quad No: Submit original to Division of Water Quality,Groundwater Section within 30 days
f GW-1 REV.12/99
Serial No.

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: Dewey Wright Well Pump Co., Inc.
WELL CONTRACTOR CERTIFICATION#: 2687
99892 STATE WELL CONSTRUCTION PERMIT#: Steve Reece
1. WELL USE(Check Applicable Box): Residential ® Municipal F-1 Industrial Agricultural 0 Monitoring 0
Recovery F7 Heat Pump Water Injection D Other El If Other, List Use:
2. WELL LOCATION:(Show sketch of the location below)
Nearest Town: BANDER ELK County: AVERY
I (1TS�RR�q IN THE GI FNIQFF dVW 10S
(Road am an'd f�umbers,Community,or bubdrvision and Lot o.l
DRILLING LOG DEPTH
3. OWNER THE GI FIT OF GRANDFATHER From To Formation Description
Address 3.73 THE G' N�IS RI VD 0 55 DIRT
RAnI�IF I ree °r oufa No.)E RANITF LK NC 2 6 t - 5fi inn -G
City or Town State ip ode
130 133 -gI4AII=
4. DATE DRILLED 5/5/2000 133 75n GRANITF
5. TOTAL DEPTH 7R.5 950 953 QUARTZ
6. CUTTINGS COLLECTED YES F NO 5 8 GRANITE
7. DOES WELL REPLACE EXISTING WELL? YES D NO
8. STATIC WATER LEVEL Below Top of Casing: 90 FT.
(Use"+"if Above Top of Casing) c73
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): 12 METHOD OF TEST Air C orn
11. WATER ZONES (depth)A gpm130-133 8 g mg_250-253 :rM
0 gam 0 gpm co rn
12. CHLORINATION: Type HTH Amount 55 If additional space is needed use back Q"or rn�.
3
13. CASING: LOCATION SKETCH tV M;
Wall Thickness C)
Depth Diameter or Weight/Ft. Material (Show direction and distance from at least evo Stab
From 0 To -A Ft. 8114 1AA (; tsAI V Roads,or other map reference poin Z
From To Ft. S�A
From To Ft.
14. GROUT:
Depth Material Method
From-Q To 90_Ft. C cement Gravity Flow 'V'VvF'sli2q,vp1�-4TIf�
From To Ft.
15. SCREEN: Q '�
Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
From To Ft. in. in. r
y cr
16. SAND/GRAVEL PA' I$,• I� ,1�7 .d,,r Axj.
Dep h �G Material
From To Ft.
From To !ju, I
17. REMARKS:
1 DO HEREBY CER FY THIh+ h1CONS RUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION 8 N'M 5T HAT-A'COP C F THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
FOR OFFICE USE ONLY bc)
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Quad No: Submit original to Division of Water Quality,Groundwater Section within 30 days
/�/t-z GW-1 REV.12/99
Serial No. .-�,/�

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:
WELL CONTRACTOR CERTIFICATION#:
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE(Check Applicable Box): Residential Municipal ❑ Industrial❑ Agricultural❑ Monitoring ❑
Recovery❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATION: (Show sketc of the location below)
Nearest Town:-- /�� County:
✓J7�. �����ly
(Road Name and Numbers,Community,or Subdivision and Lot No.) DRILLING LOG DEPTH
3. OWNER _ C--` (2i5►&ag, 7 From To Formation Description
Address
y (Street or Route N
City or Town State Zip Code
4. DATE DRILLED
5. TOTAL DEPTH 60
6. CUTTINGS COLLECTED YES❑ NOQ/
7. DOES WELL REPLACE EXISTING WELL? YES ❑ NO©�
8. STATIC WATER LEVEL Below Top of Casing: FT.
(Use'+'if 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 15A NCAC 2C.0118
10. YIELD(gpm): METHOD OF TEST
11. WATER ZONES(depth):- /
12. CHLORINATION: Type lu Amount If additional space is needed use back of form
13. CASING:
Wall Thickness LOCATION SKETCH
Depth Diameter or Weight/Ft Materi I (Show direction and distance from at least two Sto
From To td Ft._4
-2=� � Roads,or other map reference points) *�
From To Ft. C m
From To Ft. t 3,�
14. GROUT: r-n Grn
Depth Material Method -o r�*tC:)
From d To Ft. Ge 'ti A rn
=
cn
From To Ft. N �-
15. SCREEN:
p
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:
I DO HEREBY CERTIFY THAT THI ONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUC N Y OF IS RECORD HA POVIDEP TO THE WELL OWNER.
FOR OFFICE
Quad No: �n�(�((�► IGN' OF'PERSO °CONS•R CT ih iE WELL DATE
Y 9 2C%bmi to 'i f rot Water Quality,Groundwat lion within 30 days
Serial No. JUN 2 8 2000 GW1 REV.12/99
ff4sGhrev4111ewater$ac1 Re onal
GrOUtidlVatL'!'SeCtian
Asheville Mr?

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: Bx.SWL li
WELL CONTRACTOR CERTIFICATION#:_a j 3 3
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE(check Applicable Box): Residential E3 Municipal ❑ Industrial❑ Agricultural❑ Monitoring 0
Recovery❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below)
Neares/t TTown:+ County:
(Road Nanid and Numbers,Community,or bdivision and Lot No.) DRILLING LOG DEPTH
3. OWNER _ 1+,_-wK v -i�v��lr4ryrkr� From To Formation Description
Address C::s __>o d l.*
(Street or outs o. �0— 95 -S fee ���
C'y or Town State Zip Code
4. DATE DRILLED L - -On
5. TOTAL DEPTH 0f1f
6. CUTTINGS COLLECTED YES❑ NOD'
7. DOES WELL REPLACE EXISTING WELL? YES ❑ NO©'
8. STATIC WATER LEVEL Below Top of Casing: FT.
(Use-+'If Above Top of Casing)
9. TOP OF CASING IS_ i _ FT.Above Land Surface*
'Top of casing terminated at/or below land surface requires a variance In accor-
dance with 15A NCAC 2C rS�118
10. YIELD(gpm): METHOD OF TEST 3jo w N
11. WATER ZONES(depth): 30 3 •
12. CHLORINATION: Type c�foz +��- Amount-J 40hS It additional space is needed use back of form
13. CASING:
Wall Thickness LOCATION SKETCH
Depth Diametor or Weight/A. mat dal (Show direction and distance from at least two State
From © To Ft. G t`�F� a'�?y': Roads,or other map reference points) 0
a
From To Ft. C --
From To Ft. G M
14. GROUT:
1
Depth Material Method cnrn
From To — Ft. '� M1_.
From To —Ft. Q
15. SCREEN: rV mW
Depth Diameter Slot Size Material Ln -_+
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:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION A COPY OF THIS RECORD EEN PROVIDED TO THE WELL OWNER.
FOR OFFICE USE
Quad No: U S- .=G S:-U IN �'t LL DATE
V n 2 9�' dgi Isio o. ter Quality,Groundwater SeI'tho ithin 30 daysSerial No. HI �UUU pl N � 8 2000GW-1 REV.12/99
eville Re i n I i � CroundwateF ilecitY�n `'"�

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: Dewey Wright Well Pump Co., Inc.
WELL CONTRACTOR CERTIFICATION#: 2687
000128 STATE WELL CONSTRUCTION PERMIT#: Steve Reece
1. WELL USE(Check Applicable Box): Residential ® Municipal E] Industrial 0 Agricultural F7 Monitoring 0
Recovery F-1 Heat Pump Water Injection 0 Other F1 If Other, List Use:
2. WELL LOCATION:(Show sketch of the location below)
Nearest Town: BANNER El K County: AVFRY
C1FF RC)SFRC�RrI Rr1fE1F;i�
load #mean. um ers, ommunity,orSubdivisionandLotNo.l DRILLING LOG DEPTH
3. OWNER WATTS HAMRIf K From To Formation Description
Address SO 0 3.5— CURT
RANN, geWr outs o.l KI 7RRr1d 35 70 I IMFST0 NF
City or Town LftCC state odZ e 7n 73 BROWN I IMFSTONF
4. DATE DRILLED 4/1812000 73 1190 1 IMFSTC)NF GRANITE
5. TOTAL DEPTH 705 ISO 163 SHAI F 8�-
6. CUTTINGS COLLECTED YES 0 NO 1B3 q05 GRANITE
7. DOES WELL REPLACE EXISTING WELL? YES EI NO ERC
8. STATIC WATER LEVEL Below Top of Casing: 70 FT. ,�rn _
(Use"+"if Above Top of Casing)
9. TOP OF CASING IS 1 FT.Above Land Surface* AQ
*Top of casing terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2C.0118
10. YIELD (gpm): 30 METHOD OF TEST Air W
11. WATER ZONES (depth)20 gOM70-73 10 apm 160-163 ni C"i
t
apm apm o
12. CHLORINATION: Type HTH Amount 39 If additional space is needed use back of form
13. CASING: Wall Thickness LOCATION SKETCH
Depth Diameter or Weight/Ft. Material (Show direction and distance from at least two State
From 0 To A Ft. 6 1/4 1FIR C'AI V Roads,or othe�map reference points)
From To Ft. ���
From To Ft. v
14. GROUT:
Depth Material Method
From 0 To 9_Ft. GPment Grayi4 Flow
From -i o Ft. Q-0
15. SCREEN: S
Dept 1 Diameter Slot Size Material q1
From To Ft. in. in. b
From To.. Ft. in. in. 1Lq"y PLwi
From To Ft. in. in.
m v
16. SAND/GRAVEL PACK:, p�`J
Depth
From TO tl�..•... _ "t
From To
r �
17. REMARKS: ;, .W iJUN 2000 z.«
I DO HEREBY CERTIFY THAT .HIS WELL WAS CONS RUGS ED IN ACCORDANCE WITH 15A NCAC 2 ,WELL
CONSTRUCTION STANDARDS (�Ir/� Y OF THS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
Asheville
. ..,r i°ei Rn aI Tclo
FOR OFFICE USE ONLY - � � S d o O
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Quad No: Submit original to Division of Water Quality,Groundwater Section within 30 days
j, O t/ GW-1 REV.12/99
Serial No. "�--.�//-- p�

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: Dewey Wright Well Pump Co., Inc.
00128-2 WELL CONTRACTOR CERTIFICATION#: 2687
Steve Reece
STATE WELL CONSTRUCTION PERMITM
1. WELL USE(Check Applicable Box): Residential ® Municipal 0 Industrial 0 Agricultural 0 Monitoring 0
Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use:
2. WELL LOCATION:(Show sketch of the location below)
Nearest Town: BANNER ELK County: AVERY
ROSEBORO RD#1511 OFF HWY 221
.(Road Name and Numbers,Community,or Subdivision and Lot No.) DRILLING LOG DEPTH
3. OWNER WATTS HAMRICK From To Formation Description
Address % PARADISM HOME BUILDERS , 9218 HWY 105 SO 0 15 DIRT
BANNER(Lu@.e°f Route No.) NC 28604 15 60 LIMESTONE
City or Town State Zip Code 60 63 SPACE
4. DATE DRILLED 4/6/2000
5. TOTAL DEPTH 705
6. CUTTINGS COLLECTED YES 0 NO ® 383 705 LIMESTONE
7. DOES WELL REPLACE EXISTING WELL? YES 0 NO EN C3
8. STATIC WATER LEVEL Below Top of Casing: 200 FT.
(Use"+"if Above Top of Casing) :e!=
is m-
9. TOP OF CASING IS 1 FT.Above Land Surface* Cl)
'Top of casing terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2C.01 t� Air tT1'
10. YIELD (gpm): ETHOD f TF�T 3fv
11. WATER ZONES (depth) gpm 0-3ti;i gpm M: - :I.. _
gpm gpm ..
12. CHLORINATION: Type Amount If additional space is needed use ba f f
13. CASING: Wall Thickness LOCATION SKETCH
Depth Diameter or Weight/Ft. Material (Show direction and distance from at least two State
From 0 To 42 Ft. 6 114 .188 GALV Roads,or other map reference points)From To Ft. ►`/PiJ�`"'`� `�kl
From To Ft.
14. GROUT:
Depth Material Method 9
From 0 To 20 Ft. Cement Gravity Flow
From To Ft.
flue 2;dcge nA,4-h
15. SCREEN:
Depth Diameter Slot Size Material
From To Ft. in. in. d rl1
From To Ft. in. in.
From To Ft. in. in.
16. SAND/GR VEaL GK��
lid
eh USi Material
From o Ft.
From o
17. REMARKS: 4
I DO HEREB CE TT, iL LTaf:!H89C`h0 LL WAS ONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUC IONj NOAFM OPY OF THIS RECORD HAS BEEN PROVIDED TO/THE WELL OWNER.
FOR OFFICE USE ONLY .r� .� `mil r 1S U
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Quad No: Submit original to Division of Water Quality,Groundwater Section within 30 days
'-1 -1n GW-1 REV.12/99
Serial No. f 1 f-

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: Dewey Wright Well Pump Co., Inc.
00101 WELL CONTRACTOR CERTIFICATION#:
2687
STATE WELL CONSTRUCTION PERMIT#: eve eece
1. WELL USE(Check Applicable Box): Residential © Municipal 0 Industrial 0 Agricultural 0 Monitoring
Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use:
2. WELL LOCATION:(Show sketch of the location below)
Nearest Town: LINVILLE County: AVERY
PILOT RIDGE RD#1515-1.6 OFF EDGEMONT RD.
(Road Name and Numbers,Community,or Subdivision and Lot No.)
BOBBY CARPENTER DRILLING LOG DEPTH
3. OWNER From To Formation Description
Address- 6288 HWY 182 , 0 10 DIRT
CHERRYW1r ERoute N°') NC 28021 10 40 GRANITE
City or Town State Zip Code 40 44 SHALE
4. DATE DRILLED 4/10/2000 44 60 GRANITE
5. TOTAL DEPTH 405 60 63 SHALE
6. CUTTINGS COLLECTED YES 0 NO © 63 340 GRANITE;e . �z
7. DOES WELL REPLACE EXISTING WELL? YES 0 NO 0 340 343 SHALE
8. STATIC WATER LEVEL Below Top of Casing: 20 FT. 343 405 GRANITE
(Use"+"if Above Top of Casing) rn
3ll:.i
9. TOP OF CASING IS 1 FT.Above Land Surface* "v r"~'
*Top of casing terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2C.01
10. YIELD(gpm): METHOD OF TEST Air a*1�
11. WATER ZONES (depth)? gpm340-343 gpm -�
gpm gpm
12. CHLORINATION: Type HTH Amount 76 If additional space is needed use back of form
13. CASING: wall Thickness LOCATION SKETCH
Depth Diameter or Weight/Ft. Material (Show direction and distance from at least two State
From 0 To 21 Ft. 6 1/8 .350 PVC \�rG Roads,or other map reference points)
From To Ft. h
From To Ft. \X41
14. GROUT:
Depth Material Method
From 0 To 20 Ft. Cement Gravity Flow
From To Ft.
15. SCREEN: 44 ,4 7,ZI
Depth Diameter Slot Size Material 3,5
From To Ft. in. in.
From To Ft. in. in.
From To Ft. in. in. �rJ �-
16. SAND/GRAVEL PACK:
e h I Material
From T P/D
From o Ft. �t
�
17. REMARKS JUN 1 9 2000
1 DO HERE C JEY WA CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRU TION Slle' [1�f4Fd#�6Sda AT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
/asheUilleRe ional Office
FOR OFFICE USE ONLY
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Quad No: Submit original to Division of Water Quality,Groundwater Section within 30 days
� j� � j GW-1 REV.12/99
Serial No. 1

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: Dewey Wright Well Pump Co., Inc.
00128-1 WELL CONTRACTOR CERTIFICATION#: eve Reece
STATE WELL CONSTRUCTION PERMITM
1. WELL USE(Check Applicable Box): Residential EX Municipal 0 Industrial 0 Agricultural 0 Monitoring 0
Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: BANNER ELK County: AVERY
ROSEBORO REM 511 OFF HWY 221
(Road Name and Numbers,Community,or Subdivision and Lot No.) DRILLING LOG DEPTH
3. OWNER WATTS HAMRICK From To Formation Description
Address % PARADISM HOME BUILDERS , 9218 HWY 105 SO 0 15 DIRT
BANNER( LVr Route NO-) NC 28604 15 40 LIMESTONE
City or Town state Zip Code 40 44 SHALE
4. DATE DRILLED 4/4/2000 44 150 LIMESTONE
5. TOTAL DEPTH 705 150 154 QUARTZ
6. CUTTINGS COLLECTED YES 0 NO © 154 705 LIMESTONE
7. DOES WELL REPLACE EXISTING WELL? YES 0 NO 0
8. STATIC WATER LEVEL Below Top of Casing: 100 FT.
(Use"+"if 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.011 "}
10. YIELD(gpm): 1?4 METHOD OF TEST Air
11. WATER ZONES (depth)1/4 9PM150-154 gpm
12. CHLORINATION: Type Amount If additional space is needed use b x_of.f+�m
o
Z
13. CASING: Wall Thickness LOCATION SKETCH
Depth Diameter or Weight/Ft. Material (Show direction and distance from at least two State
From 0 To 23 Ft. 6 1/4 .188 GALV Roads,or other map reference points) ��
From To Ft. �e" ' 4k�(
From To Ft.
14. GROUT:
Depth Material Method i
From 0 To 20 Ft. Cement Gravity Flow J,
From To Ft. �jlue 2��c�e(okwa�
15. SCREEN:
Depth Diameter 'Slot Size Material
From To Ft. in. in. ` V
From To Ft. in. in.
From To Ft. in. in. '
16. SAND/G RAVE
',PAC '; 1
nth � 0 U,l S12e i � Material
From n�`�+✓
From FIt.
17. REMARKS:
I DO HEREBY ;,, AS C NSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTI N"�TA%PWA } �TArC Y OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
FOR OFFICE USE ONLY
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Quad No: Submit original to Division of Water Quality,Groundwater Section within 30 days
1 0 n 's ' 1 GW-1 REV.12/99
A., - (.-a 1- :)
Serial No.

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: Dewey Wright Well Pump Co., Inc.
WELL CONTRACTOR CERTIFICATION#: 2687
99914 STATE WELL CONSTRUCTION PERMIT#: Steve Reece
1. WELL USE(Check Applicable Box): Residential a Municipal 0 Industrial 0 Agricultural 0 Monitoring 0
Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: I INVII I F County: AVERY
rIFF N A/V��1_3 d All F� S C1F I IVFg4HIFI D
(Road Name and Numbers,Community,or Subdivision and Lot No.) DRILLING LOG DEPTH
3, OWNER MELISSA PARLIER From To Formation Description
Address O/o BURTON CGNSTR I .TION CPC) BOX 94 0 75 DIRT
I INVI Street or Route No.) N . 98646 75 110 GRANITE
City or Town State Zip Code 110 112 SHALE
4. DATE DRILLED 4/7I2000 112 130 _GRANITE
5. TOTAL DEPTH 165 130 133 SHALE
6. CUTTINGS COLLECTED YES 0 NO ® 133 165 GRANITE p
7. DOES WELL REPLACE EXISTING WELL? YES 0 NO ® Q
8. STATIC WATER LEVEL Below Top of Casing: 20 FT. a)
F
(Use"+"if Above Top of Casing) `1r'
9. TOP OF CASING IS 1 FT.Above Land Surface* r ^�
*Top of casing terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2C.0118
10. YIELD (gpm): 10 METHOD OF TEST Air
11. WATER ZONES (depth)5 gpm110-112 5 qpm 130-133
qpm qpm ram
12. CHLORINATION: Type HTH Amount 30 If additional space is needed use.bacMffocgi
x
13. CASING: LOCATION SKETCH
Wall Thickness _
Depth Diameter or Weight/Ft. Material (Show direction and distance from at least two State
From _ ro Ft. 6 114 .188 GALV Roads,or other map reference points)
From To Ft.
From To Ft.
14. GROUT: `
Depth Material Method , t
From 0 To 20 Ft. Cement Gravity Flow
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. J�
�k
16. SAND/GRAVE �`rj �',i J I�
Ize Material
From Ft'
From Ft �
17. REMARKS:
I DO HEREBY ERTI.FYAt'"A.11?.Ili�CWAS C NSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STANDARDS,AND T Ate` OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
FOR OFFICE USE ONLY -2, 69e�_ �Z-2T -oLl-)
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Quad No: Submit original to Division of Water Quality,Groundwater Section within 30 days
GW 1 REV.12/99
Serial No. 0

"j; -
North Carolina=Department of Environment, Health,and Natural ReSOUrcns
` M lvislon of Environmental Management-Groundwater Section 4, FOR Q {=)QEAUSE Q
tfi ���"•:P.O.'Box 29535- Raleigh, N.C.27626-0535 QUAD NOk" yI+tSE I t
0.tp C1� h 1`Phone [phone] Lac
r Minor Dasin
WELL CONSTRUCTION RECORD
.`!;:'.• Bashi Co
DRILLING CONTRACTOR• c Header Ent FS �`�' .
�'jJ �.)�.._.l�,�t ��; t�`� G Ent,.
STATE WELL CONSTRUCTION
DRILLER REGISTRATION NUMBER: 16 _ PERMIT NUMBER:
1. WELL LOCATION: (Show sketch of the location below)
Nearest Town: —`i• >✓�'� JNr
_�.�1— County:�:_._
(Road,Community,or Subdivision and Lot No.) DEPTH DRILLING LOG
2. OWNER``fie IZ- i- MO/\> _ _ From To Formation Description
ADDRESS _ � _ 5� .�
- (Street or Route -- 50 t60
City olIr Town State Zip Code
3. .DATE DRILLED_ `29-00 USE OF WELL act`sk A4I
4. TOTAL DEPTH loc�> _
5.1 CUTTINGS COLLECTED YES[1 NOOK _
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 FT. Above Land Surface' ---
'Casing Terminated at/or below land surface Is Illegal unless a variance is issued.:In accordance accordance with 15A NCAC 2C .0118
9. YIELD(gpm):!CZ METHOD OF TEST
10. WATER ZONES (depth): _
11. CHLORINATION: Type f`oQ r.�- Amount
12. CASING: If additional space is needed use back of form
'
Wall Thickness LOCATION SKETCH
Depth Diameter or Weight/Ft. Material (Show direction and distance from at least two State
From © To --5 Ft.-6 � � _...�.}'Ny_� Roads,or other map reference points)
From To Ft.—
From To Ft.
13. GROUT:
Depth Material Method CD
From To p Ft. s�.�►e .�� C_
M
From To Ft. _ Cl0
m
14. SCREEN: ' o�
ctt cros
Depth Diameter Slot Size Material
From To Ft = in. in. rn
From To Ft. in. in, tv Ana
rn
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
ff
CONSKM
A COPY OF TI IIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
w�.
AY 2 9 20010. _ �3
GW-1 REV.9 CNRCT AGENT DATE
NAT F
mitao ivision of E viron ental Management and copy to well owner.
r$ectl0n
Ile
Re • nal Office
Groundwater Selctionce
'` Asheville

North Carolina-Department of Environment,Health,and Natural Resources ; z �x,
Division of Environmental Management-Groundwater Section hrFOR QFFCUSi=ONLV �`
P.O. Box 29535- Raleigh,N.C.27626-0535 Ql)AD'IJO >` t ` 1 ik S `I�IAL NCi
Phone[phone]A�� a
�A mor dasui
WELL CONSTRUCTION RECORD BasinCocl6 `+rQ'F� .« A, ,.-I. I_kv,> '
DRILLING CONTRACTOR: _Dewey Wr i ght We 11 & Pump Co.
STATE WELL CONSTRUCTION
DRILLER REGISTRATION NUMBER: 2681 PERMIT NUMBER:
1. WELL LOCATION: (Show sketch of the location below)
Nearest Town:._ F:T.K_MTT,T.R County: AVERY
OFF `BUCKEYE RD. OFF HWY 321
(Road,Community,or Subdivision and Lot No. DEPTH DRILLING LOG
2. OWNER ELIZABETH STEGALL
3 From To . Formation Description
ADDRESS '
(Street or Route No.)
0 1-5— DIRT
SUGAR GROVE , NC 28679 15 86 GRANITE
City or Town State Zip Code 86 8 7 QUART 7.
3. DATE DRILLED 02/10/00 USE OF WELL PVT 87 395 GRANITE +
4. TOTAL DEPTH 405 ' 395 396 SHALE
5. CUTTINGS COLLECTED YES❑ NO[�]x 396 405 GRANITE r;.
6. DOES WELL REPLACE EXISTING WELL? YES NO®
7. STATIC WATER LEVEL Below Top of Casing: 20 FT.
(Use"+"if Above Top of Casing)
8. TOP OF CASING IS
1 FT. Above Land Surface*
*Casing Terminated atfor below land surface Is Illegal unless a variance Is Issued
In accordance with 15 CAC 2C .0118
9. YIELD (gpm):�METHOD OF TEST AIR c n =;
10. WATER ZONES (depth): _ 39 o
11. CHLORINATION: Type HTH Amount i4 bs If additional space is needed use back of form
12. CASING.
Wall Thickness LOCATION SKETCH
Depth Diameter or Weight/Ft. Material (Show direction and distance from at least two State
From To Ft. Roads,or other map reference points) '���5
From 0 To 21 Ft 6 1/4 0. 18 8 GALV. K Y`r`
From To Ft.
13. GROUT:
Depth Material Method
From —0— To — 2 0 Ft. CEMENT
From To Ft. 13o
14. SCREEN: Act-
Depth Diameter Slot Size Material
From To Ft in. in.
From To Ft. in. in.
From To Ft in. in.
15. SAND/GRAVEL PACK o
From Depth To J tG7 S,ie-I °l �, Material
Ft. _ v
From To It 421
o
I'16. REMARKS:_ ,, "
" W~LECERTIF T AT THISIWEL V/V S CONSTRUCTED IN ACCORDANCE WITH
15A NCAC 2C,WELL
tONSTANDA DS`AND'THATA COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.00 5eve �e��
GW bW'* nod te-Section SIGNATURE O CONTRACTOR OR AGENT DATE
il gional C"•', o Submit original to Division of Environmental Management and copy to well owner.

00
North Carolina-Department of Environment,Health,and Natural Resources
Division of Environmental Management-Groundwater Section FOR OfICE USE 6Ni, x ,
P.O. Box 29535- Raleigh, N.C.27626-0535 QUAb NOk r" SERIAL(VC) '
Phone [phone] �d} , ' °` �w,$`Lof pn'
.xi 1 t ��1t�y,�Ysf�� �yz"}�u�s�� s�� •� ,,y��rc 4.�y r vt
WELL CONSTRUCTION RECORD r t ��xk
�3SInOOe -cM;Ka v�t+a'!r*vd x�tctrwi-a-+ii
DRILLING CONTRACTOR: n_Pewey Wright Wt=1 1 & Pump Co, aderEnd .. .GWi n °
STATE WELL CONSTRUCTION
DRILLER REGISTRATION NUMBER: 9 AR 1 PERMIT NUMBER:
1. WELL LOCATION: (Show sketch of the location below)
Nearest Town: SPRUCE PINE County: AVERY
OFF OLD 19E OFF HWY 19E
(Road,Community,or Subdivision and Lot No.) DEPTH DRILLING LOG
2. OWNER STEPHEN SHELL From To Formation Description
ADDRESS PATRICK TOLLEY
(Street or Route No.) 0 37 IRT
ELK PARK , NC 28622 37 87 GRANITE
City or Town State. Zip Code 8 7 a 8 SHALE
3. DATE DRILLED 02/11/00 USE OF WELL PVT —88 9 10 GRANITE
4. TOTAL DEPTH 385' 210 211 QUARTZ C-) _
5. CUTTINGS COLLECTED YES❑ NO® 211 360 GRANITE cD
6. DOES WELL REPLACE EXISTING WELL? YES F-1 NO® 360 361 SHALE
7. STATIC WATER LEVEL Below Top of Casing: 0 FT. 361 385 GI�ANITE
(Use"+"if Above Top of Casing) 7 r,.
8. TOP OF CASING IS 1 FT.Above Land Surface*
^p v•Casing Terminated allot below land surface Is Illegal unless a variance Is Issued
In accordance with 15A1fV¢AC 2C .0118 AIR
9. YIELD (gpm): - METHOD OF TEST •• o'
10. WATER ZONES (depth):
210-211 � o
11 gpm�6®-361 '
11. CHLORINATION: Type HTH Amount 7 R tabs If additional space is needed use back of form
12. CASING:
Wall Thickness LOCATION SKETCH -
Depth Diameter or Weight/Ft. Material (Show direction and distance from at least two State
From—�—To 42 Ft Roads,or other map reference points)
From To Ft. � 0 — V' a
From To Ft. �V
�� t� 44wY 19 c �
13. GROUT:
Depth Material Metho o
From 0 To 20 Ft, CEMENT
From To Ft.
14. SCREEN: Q
L
Depth Diameter Slot Size Material Q po Cr
From To Ft in. in. q k Q
From To Ft. in. in. n p
From To Ft. in, in. 11
N_
15. SAND/GRAVEL PACK: (-n
D An
iz aiteri4l
From
From T16. REMARKS:
U D }IEF�EBY CERTIFY THAN THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STANDARDS,AND'`I`HA A COPYOr THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
OR
-,5 2000 ��-�1 y
SIGNATURE CONTRACTOR OR AG
DATE
Submit original to Division of Environmental Management and copy to well owner.

North,,CaroIIna:=Department of Environment, Health,and Natural Rosourcns s'a;;rv`f.;;N,rr*+?mA
Dlvlalon of Environmental Management-Groundwater Section 4, FO O �JC. O
P,O.'Box 29535- Raleigh,N.C.27626-0535 QUAD4N0v S I
f" Phone [phone] A
Lat. .� l,'r��.rMLp
,1
WELL CONSTRUCTION RECORD Minor Dueln "%'11�� .
3 `r, Basin Codoy�Wr�rtiA+ad1� Ml�F R�r
DRILLING CONTRACTOR: c Header Ent i 1�`i�l6tci�1 .
STATE WELL CONSTRUCTION
DRILLER REGISTRATION NUMBER: PERMIT NUMBER: 4207201
1. WELL LOCATION: (Show sketch of the location below)
Neare'stTown: EANA%k-4 1=11k County: Ave-kv
i
(Road,CommuAty,or Subdivision and Lot No.) DEPTH DRILLING LOG
2. OWNER z2A- �vC��
ADDRESS "�� ' 4�1� '�/� — From To Formation Description
�y n(Street or Route No.) a,I � ��
City or Town State Zip Code
3. .DATE DRILLED `1:Z`00 USE OF WELL jQ&rA,
4: TOTAL DEPTH —�o� _ CD
5.1 CUTTINGS COLLECTED .ES❑ NOE:?----
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: _ FT.
(Uso"+"if Abovo Top of Ca
8. TOP OF CASING IS—_ FT. Above Land Surface`
Casing Terminated at/or below land surface Is Illegal unless a variance Is issued—
In accordance with 15A NCAC 2C .0118 T
9. YIELD (gpm): I0Q METHOD OF TEST
10. WATER ZONES (depth): - 39__ W_
11. CHLORINATION: Type _G�(aR i ry2 Amount_ „S_ If additional space is needed use back of form
12. CASING:
Wall Thickness LOCATION SKETCH
Depth Diameter or Weight/Ft. Matorial (Show direction and distance from at least two State -
From--�—To —W11 Ft.— % �Vs_ Roads,or other ma reference
_9--- p points) -
From To Ft.
From To Ft.
13. GROUT:
Depth Material Method
From Q To -- Ft. -_ C 00
From To Ft. _
14. SCREEN: •
Depth Diameter Slot Size Material
From To Ft in. in._
From To Ft. in, in.
From - To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material ' 4;
From To Ft.
t
From To Ft._ _ _ MAC �(���
16. REMARKS:
100 HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCOR' 'IV t WITH 11�5A"NCAC 2C,WELL
a.GO(;IS' tUCTI fJ TJDARDS,AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
L
LFEB8 2000 ..J 7-7 -
1 SIGNATURE OF CONTRACTOR OR AGENT DATE
Submit original to Division of Environmental Management and copy to well owner.
Groundwater Section
Asheville Re Tonal Office

North Caroitna-Department of Environment, Health,and Natural Resources
, tDlvision of Environmental Management-Groundwater Section + rF+ { JCE�IJS
`, �� l;a: •.P.O.'Box 29535- Raleigh,N.C.27626-6535 QUAD;NO + N -• S I
Phone [phone] La � Long
Mlnor 0aein 0M
WELL CONSTRUCTION RECORD Header Ent efn'code�rn'ri��''—
DRILLING•CONTRACTOR: _J� , L e j L7� f; ��� 's i'^Vr�A:>'i ' G En
G-= ---.,__ n a
STATI�WELL CONSTRUCTION 2 07 2 0 2
DRILLER REGISTRATION NUMBER: PERMIT NUMBER:
1. WELLLOCATION: (Show sketch of the location below)
Nearest Town: t=IK Y?AoZ_k County:
(Road,Com ,or Subdivision and Lot No.) DEPTH DRILLING LOG
2. OWNER I munia zav v rl C=i j1 From To Formation Description
ADDRESS D Ad //Z
tre t of Route No�
City or Town State Zip Code
3. ,DATE DRILLED 1—/3--00 USE OF WELL _Zes,JeA.; ,AA r�
4. 'TOTAL DEPTH V00
5.i CUTTINGS COLLECTED YES F NO�'''
6. . DOES WELL REPLACE EXISTING WELL? YES ❑ NOE�!J'
7. STATIC WATER LEVEL Below Top of Casing: FT. _ .
(Use"+"if Above Top of Casing)
8. TOP OF CASING IS FT. Above Land Surface*
*Casing Terminated atlor below land surface Is Illegal unless a variance is issued
;in accordance with 15A NCAC 2C .0118
9. YIELD(gpm): Zi2—METHOD OF TEST
10. WATER ZONES (depth): Cl el __ _ o
11. CHLORINATION: Type Amount __ if additional space is needed use back of form
12. CASING:
Wall Thickness LOCATION SKETCH
Depth� Diameter or Wei h Ft. Material (Show direction and distance from at least two State
Fro69
m To —[Z[— Ft.-�- �g 'f - ..gµj►r Loads,or other map reference points)
From To Ft.
From To Ft. —
13. GROUT:
Depth Material Method
From 0 To -qO Ft. Ce^e­-'}
From To Ft.
14. SCREEN: '
Depth Diameter Slot Size Material
From To Ft in. in.
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK: f
Depth Size Material
From To Ft.
From To Ft. 6 WO
16. REMARKS: _
I DO HEREBY CERTIFtTHAT:-THIS- „ LL WAS CONSTRUCTED IN AICi✓°ORDA''4C!E WITH 1'5A NCAC 2C,WELL
CON �t3 L15r-VT�NVAf��Srg�A AT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
15 l! l
FEB 2000
SIGNATURE OF CON I RACTOR OR AGENT DATE
GW-1 REV. 1 Submit original to Division of Environmental Management and copy to well owner.
Croundwate*Section
Asheville Re 'onai Office

qq
North Carolina-Department of Environment, Health, and Natural Resources FOR OFFICE CJSE ONLY 2 C�
Division of Environmental Management-Groundwater Section n '� t atG 5 1i I:
Ql�i4D NO ' ifi S� IALt�O t `a� t#aa ':_
P.O. Box 29535- Raleigh,N.C.27626-0535 F
Phone[phone]
M
�norBasiri
WELL CONSTRUCTION RECORD
GW
DRILLING CONTRACTOR: Dewey W�ightWe 1-1. & pump W
Co '
STATE ELL CONSTRUCTION
DRILLER REGISTRATION NUMBER: 2 e as PERMIT NUMBER:
1. WELL LOCATION: (Show sketch of the location below)
Nearest Town: BANNER EL County: AVEr Y
JUST OFF HWY 194 ON 19E
(Road,Community,or Subdivision and Lot No.) DEPTH DRILLING LOG
2. OWNER JUNIOR HOLTSCLAW From To Formation Description
ADDRESS PO BOX 141
(Street or Route No.) 0j
ELK PARK , NC 28622GRANITE
City or Town State Zip Code —SHALE
3. DATEDRILLED 01/07/00 USEOFWELL PVT 44--55 —GRANITE
4. TOTAL DEPTH 1451 55 56 QUARTZ SHALE
5. CUTTINGS COLLECTED YES F� NO❑X 5 6 130 •.RANITE
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO x❑ 130 131 SHALE
7. STATIC WATER LEVEL Below Top of Casing: 10 FT. 131 145 GRANITE
(Use"+"if Above Top of Casing) c�
8. TOP OF CASING IS 1 FT. Above Land Surface* � T
•Casing Terminated at/or below land surface Is illegal unless a variance Is Issued
-,�
In accordance with 15A.A1CZ4C 2C .0118 AIR 't �
9. YIELD(gpm):-6.METHOD OF TEST c `'r.;,
10. WATER ZONES (depth): _ _ 6 '
i�
=�
rt
11. CHLORINATION: Type HTH Amount__3 g tabs If additional space is needed use back of form ^l
12. CASING: o
LOCATION SKETCH
Wall Thickness -
Depth Diameter or Weight/Ft. Material (Show direction and distance from at least two State
From—To — Ft.-6 1/4 0 . 188 GALV Roads,or other map reference points)
0 21
From To Ft.
From To Ft.
13. GROUT:
Depth Material Method
From 0 To —90-Ft. ___CEMENT PUMPRn 4-1 Q
From To Ft. Ul
14. SCREEN: E 3ob`� 1 '
Depth Diameter Slot Size Material
From To Ft in. in.
From To Ft. in. in.
From To Ft. in. in. (T:
15. SAND/GRAVEL PACK: S
Depth Size Material
3
From To Ft. I
From To Ft.
16. REMARKS:
THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 1 DIkOAt^�t 2C�1NL�t?
ONSTRUCTION STAN $,AND THAT A COPY OF THIS RECORD HAS BEEN PROV TO THE WELL OWNE�
S-Feve
`oil. s �IGf V OF CONTRACTOR OR ENT
a :I „ , DATE
GW_1.AEfiI'5K51 " Submit original to Division of Environmental Management avid copy to well owner.

8
North Carolina-Department of Environment, Health, and Natural Resources
Division of Environmental Management-Groundwater Section ;` , M�OR(�FFiCE llE'O�ILY :�, h
�1 k �
P.O. Box 29535- Raleigh,N.C.27626-0535 .QUAD rye. � 3 , ' k z :F S RlALNOt `• � i
Phone[phone]
MmofBasin > ,a rer �r s�'}ra"�k
WELL CONSTRUCTION RECORD BsinCoae n
DRILLING CONTRACTOR: N66 er ErDewey WLfytlt Well &
ik.
_Pff*EC*ELtd6W§TRUCTION
DRILLER REGISTRATION NUMBER: PERMIT NUMBER:
1. WELL LOCATION: (Show sketch of the location below)
Nearest Town: BANNER ELK County:
CURTIS CREEK OF HWY 194
(Road,Community,or Subdivision and Lot No.) DEPTH DRILLING LOG
2. OWNER--EOEEY GWYN From To Formation Description
ADDRESS 17 g 1 CNRTI S CK-1.ID
(Street or Route No.) 0 58 DIRT
ELK PARK , N 28622 58 91 GRANITE
City or Town State Zip Code
3. DATE DRILLED rn i_ ?aT rnrn USE OF WELL PLAIT 9 2 115 GRAXI
4. TOTAL DEPTH 12 5 o
5. CUTTINGS COLLECTED YES❑ NO® 116 2 5 GRANITE
.-
6. DOES WELL REPLACE EXISTING WELL? YES NOR]
7. STATIC WATER LEVEL Below Top of Casing: 9.@ FT.
(Use"+"if Above Top of Casing) r
8. TOP OF CASING IS FT. Above Land Surface*
*Casing Terminated at/or below land surface Is illegal unless a variance Is Issued - -'
In accordance with ISA N AC 2C .0118 �" =
9. YIELD(gpm): 1 METHOD OF TEST AIR o
10. WATER ZONES (depth): w o
6 gpm 9 - gpm -
11. CHLORINATION: Type Amount 29 t s If additional space is needed use back of form
12. CASING:
Wall Thickness LOCATION SKETCH
Depth Diameter or Weight/Ft. Material (Show direction and distance from at least two S1
From TO Ft. Roads,or other map reference points
From--0 To 6 3 Ft. 6 1 4 0 . 188 GALV t32t C
From To Ft.
13. GROUT:
Depth Material Method
From �_ To 2 0 Ft.
Ems- ..
From To Ft.
14. SCREEN:
Depth Diameter Slot Size Material
From To Ft in. in.
From To Ft. in. in.
From To Ft. in. in. C)
15. SAND/GRAVEL PACK: r 1 Igo
Depth Size Material 4-4,2
From To Ft.
From To Ft.
16. REMARKS:
RO H�;Rgo'Y Eli ll� T A THIS WELL WAS CONSTRUCTED IN ACCORD�NC,E I'ITN115;A NC�Q 20,WE(
CONS rFIUdTI- `NAND .� AND THAT A COPY OF THIS RECORD HAS� N'PROVIDED TO`THE_ LL` WNER.
M S+-e,�e, I Q,
�y {
2V
Groundwater Section - -•= E OF CONTRACTOR OR GENT '° DATE
G ;1 REV.1}t$t ljlle!22?jOn it Ofi lrB Submit original to Division of Environmental Managemon't and copy to well owner.

q
North Carolina-Department of Environment, Health,and Natural Resources s xe!t A c; �
Division of Environmental Management-Groundwater Section �' y r�fj; FO�tFFICEUSO�IL ,�.Oi x �
P.O. Box 29535- Raleigh, N.C.27626-0535 #� z' 'n `�"
QUAD CIOERIAI NO
Phone[phone] Laf ' r at' `Long �Ea'��'y�s�����¢���°�'c:'��Abf��F
'r Sp f? ° 4 a '7S°u a k;}nths �tryFP y^i'h' p'ayti
Minor t3dsin ifs m2rna ,�wi grm �Ix
WELL CONSTRUCTION RECORD Bann CcF
DRILLING CONTRACTOR:
9ewey Wright Well ",N@aderE'ht ��.:n� �i �,ss. r�SAv­GVV i� n� hN`�s�z
S �E�t TRUCTION
DRILLER REGISTRATION NUMBER: 2681 PERMIT NUMBER:
1. WELL LOCATION: (Show sketch of the location below)
Nearest Town: County: AVERY
PRIVATE DRIVE . 2 MILES OFF ANDREW ROAD "
(Road,Community,or Subdivision and Lot No.) DEPTH DRILLING LOG
2. OWNER EDWARD LOPHR From To Formation Description
ADDRESS %T&M CONST. OF NC q t'24 Arld� 4ks P-d
(Street or Route No.) 0 69 DIRT
BANNER ELK , NC 28604 69 380 GRANITE
City or Town State Zip Code SH
AMM-
3. DATE DRILLED 01/17/00 USE OF WELL PVT 381 393 R
ANIIE
4. TOTAL DEPTH 405' 393 394 SHALE
r:-
5. CUTTINGS COLLECTED YES❑ NO© — 394 405 — RAC IT—E O A
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO[R]
7. STATIC WATER LEVEL Below Top of Casing: 30 FT. _r;
(Use"+"if Above Top of Casing)
CID ril
8. TOP OF CASING IS 1 FT.Above Land Surface'
*Casing Terminated at/or below land surface Is illegal unless a variance Is Issued r
In accordance with 15A AC 2C .0118 AIR
9. YIELD(gpm): METHOD OF TEST r*
10. WATER ZONES (depth): a ='
gpffF393-3941, •c�
11. CHLORINATION: Type HTH Amount. 105 abs If additional space is needed use back of form
12. CASING:
Wall Thickness LOCATION SKETCH
Depth Diameter or Weight/Ft. Material (Show direction and distance from at least two State
From To Ft. Roads,or other map reference points)
From 0 To 74 Ft, 6 1/4 0 . 188 GAL V 9 � ��
From To Ft.
13. GROUT:
Depth Material Method �arp
From o _ To 2_Ft. GEM ENT- PUMPED Y�
From To Ft.
14. SCREEN: d�
Depth Diameter Slot Size Material W 1014
From To Ft in. in.
From To Ft. in. in. �
From To Ft. in. in.
15. SAND/GRAVEL PACK: '-
Depth Size Material I
From To Ft. ��• � O
From To Ft. -----
16.
414RALUA, IIS WELL WAS CONSTRUCTED IN ACCO� �9414HIN
5A� N A��'LC h ELL
STRUCTION STANDARDS,?AND THAT A COPY F THIS RECORD Hq`, N PROVIDED TO THE ` w OWNER.
li .0 tl ��,I l
t...�. T' � ': MAR 2 (J! t lit
,a SI T RE OF CONTRACT ;OR GENT3ss .°•. DATE
GW 1 REV.5/91 Submit original to Division of Environmental Management and copy to well owner.