Well Construction Records Burke CY2000

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section is 413
1636 Mail Service Center - Raleigh, N.C. 27699-1636-Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR:
WELL CONTRACTOR CE TIFICATION #: l�
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE (Check Applicable sox): Residential EF 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: Gk7il County: (
(Road Name anp Numbers, Co"unity, or Subdivision and Lot No.) DRILLING LOG
3. OWNER jH.3-1 %'" � 3�q From To
�f
Address jq3 7�
(Street or Route -No.),
s All C, 8 L 1
City or own i /A tate Zip Code :2 .Z
4. DATE DRILLED 2 % S A)a
5. TOTAL DEPTH
6. CUTTINGS COLLECTED YES ❑ NO��N!07
7. DOES WELL REPLACE EXISTING WELL?
B. STATIC WATER LEVEL Below Top of Casing: /, r? FT.
(Use '+' if Above Top of Casing)
9. TOP OF CASING IS -7 FT. Above Land Surface -
*Top of casing terminated at/or below land surface requires a variance in accor-
dance with 16A NCAC 2C .0118 10. YIELD (gpm): %1 METHOD OF TEST A"- 1c�S�o✓
11. WATER ZONES (depth):
12. CHLORINATION: Type
13. CASING:
DEPTH
Fo ation Descnpu�oj
�I a / «tL
)r
CD
o r:�
01
�rn
-�
M
m
ram,
..
C-3
n -
cn
�
z
Amount If additional space is needed use back of form
Wall Thickness
Depth Diameter :Weig t. Ma
7terial
From To Ft. rIC
From To Ft.
From To Ft.
14. GROUT:
Depth atonal_ Method ;
From To 00 Ft. '�� .a rat. ✓�
From To Ft.
15. SCREEN:
Depth
From To Ft
From To Ft.
From To Ft.
16. SAND/GRAVEL PACK:
Diameter Slot Size Material
in. in.
In. in.
In. in.
Depth Size
From To —Ft.
From To Ft.
17. REMARKS:
I DO HEREBY CE
CONSTRUCTION
FOR OF
Quad No:
Material
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other map reference points)
WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
THAT�AGOPY OF THIS RECORD HAS BEE OVIDED TO THE WELL OWNER.
R3 I .1Q
'( Sutirnit
BON CONSTOXTING THE WELL
Quality, Groundwater Section within 30
Serial No.
�'�fsrrtF,i� r
GW-1 RE`!. IV"

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section} F j /t
1636 Mail Service Center - Raleigh, N.C. 27699-1636-Phone [phone] `S t U
WELL CONSTRUCTION RECORD WELL CONTRACTOR: 'e--!J ler—
WELL CONTRACTOR CE TIFICATION #: �--
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE (Check Applicable Box): Residential [D"'� 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: '-1 ���Ci/I �i^ County: _14L 1
Road Name and Nu/r�1 m er , Comu*, or Subdivision and Lot No.,
3. OWNER ! I4 e! i / )L.ln v
Address / S S✓r� n SI��7`
Street o out o.
ity or Town State Zip Code
4. DATE DRILLED 2 /YDGi
5. TOTAL DEPTH / k o
6. CUTTINGS COLLECTED YES ❑ NO
7. DOES WELL REPLACE EXISTING WELL? YES NO❑
S. STATIC WATER LEVEL Below Top of Casing: C 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 .0118
10. YIELD (gpm): _/_� METHOD OF TEST ��
11. WATER ZONES (depth):
12. CHLORINATION: Type
Amount
13. CASING:
Wall Thickness
/' Depth
From —S�To __
Diarneter or Weighr t. Material
Ft.
From To
Ft.
From To
Ft.
14. GROUT:
Depth
atedal Method
From To G
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:
DRILLING LOG DEPTH
From To ation scription
0 Is- Fo cD c
1 _(- 19 L4 0 0 ' {
L-I / S,D ao ( /c
If additional space Is needed use back of form
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other map reference points)
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
Quad No:
Submit
Section within 30 days
Serial No.

l,,, C (u I
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mail Service Center - Raleigh, N.C. 27699-1636-Phone (919) 7W-3221 ,�-� ( /t
WELL CONSTRUCTION RECORD WELL CONTRACTOR: /14' .cct
WELL CONTRACTOR CEIRTIFICATION #: ai/ �> .�c --try,-
STATE WELL CONSTRUCTION PERMIT#:
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 sketc of the location below)
j
Nearest Town: Ql9GviAW A County: 13y.
/ e'
(Road Name an er , Commune or " Msion and Lot No.)
�✓/'/1��r%+G.. �/,
DRILLING LOG DEPTH
Formation
YOWNER /V, G%l
Frog To Oescriptio
;OC A-
Address
L 35 1
-ri
f tree or outs o.
3s ✓
City or Town i State Zip Code
4. DATE DRILLED VPJ (79
5. TOTAL DEPTH v 5"
6. CUTTINGS COLLECTED YES ❑ NOD__�
7. DOES WELL REPLACE EXISTING WELL? YES ;NOr_�
8. STATIC WATER LEVEL Below Top of Casing:
I (Use '+' If Above Top of Casing)
9. TOP OF CASING IS .Z 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 TEST r r'
11. WATER ZONES (depth):
12. CHLORINATION: Type Amount
If additional space is needed use back of form
13. CASING:
LOCATIOfd SKETCH
Wall Thickness
Depth Diameter or WglqhyFt, Material
(Show direction and distance from at least two State
From To Ft. 4' __(z �" ,,Ivc
Roads, or other map reference points)
From To— Ft. —
From To Ft.
o
14. GROUT:
o
n
Depth Material _ _.. Method
From To dC) Ft.�C)c�
L
From To Ft.
15. SCREEN:o
Depth Diameter Slot Size Materials
From To Ft in. in.
From . To Ft. in. In.
C-)
From --- To Ft. in. in.
o
16. SAND/GRAVEL PACK:
Depth Size Material
From __._ To Ft.
From _ To— Ft.
17. REMARKS:_ -
I DO HE
CONSTI
FOR OFFIC5� SE O
Quad No: ll� 'a� '
Serial No.
CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
DPY OF 7 RECORD HEEN PROVIDED TO THE WELL OWNER.
�4AT41Z50 PERSON COt$eRUCTING THE WELL BATE
to DivW6n of Water Quality, Groundwater Section within 30 days
GW-1 REV. 12r9

North Carolina - Department of Environment and Natural Resources - Division of Water Quality . Groundwater Section 2 ,� 4.13
1636 Mail Service Center - Raleigh, N.C. 27699-1636-Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR: IL Lell / goo 2L
WELL CONTRACTOR CERkIFICATION #: 3 L -
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: (Sho�w/ sketch of the location below) f
Nearest Town: County:
(Road Nam Numbers, Community, o S iviljpn an Lot No. DRILLING LOG DEPTH
3. OWNER 1 �e^ %3 / •e From To Form ion Description
Address
(Strees or HOUtO NO. �0 S j Gk
ity or Town State Zip Code
4. DATE DRILLED
5. TOTAL DEPTH
6. CUTTINGS COLLECTED YES ❑ NO[D--/
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 IS0 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;.2 METHOD OF TEST'4" �
11. WATER ZONES (depth):
12. CHLORINATION: Type Amount If additional space is needed use back of form
13. CASING:
Wall Thickness LOCATION SKETCH
Depth Diameter or We' t/Ft. Material (Show direction and distance from at least two State
From To Ft. _L % lD Roads, or other map reference points)
Q v
From To Ft.
M
From To Ft.
14. GROUT:
Dep Paterial� Method /- rn n
From To Ft. M�
rri
From To Ft. _M
15. SCREEN: N Mom'
Depth Diameter Slot Size Material
U1 0
From To _ Ft in. in. x
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:: E TIF�(atTH�T`T((IS`+yVE�L WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
. CONSTRUG� IO�I ANDARDS g9AND THAT A DOPY OF THI RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
FOR OFFICE1, �g . ONLY
Quad No: q� ,� fii��'� i I 1 SI N ERSON C RUCTING THE WELL DATE
" Submit ongi to iyi to Water Ouali , Groundwater Section within 30 days
Serial No. _ ( GWA REV. 12/99
io
ft,

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section 11- 2 4.10 J
1636 Mail Service Center - Raleigh, N.C, 27699-1636-Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR: e-5
WELL CONTRACTOR CERTIFICATION #: 13
STATE WELL CONSTRUCTION PERMIT#:
WELL USE (Check Applicable Box): Residential W Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATIOtx: ,(,Show sketc of the location below) z �j
Nearest Town: �/�1) ya t n >2 County _1� !" � �t P
Cross C.1<�a, •
(Road Name and umbers, Co u ity, or Subdivision and Lot No.) DRILLING LOG DEPTH
3. OWNER i G� Lt%Yl YVIF �T. VI C.. From To Formation Description
Address 'C � 0 C/o di
D CLK Yl ree or y(a o. GjD �t�� �'D (50 c
City or\11own State Zip Code
4. DATE DRILLED -00
5. TOTAL DEPTH �4Q! '
6. CUTTINGS COLLECTED YES 0 NOM
7. DOES WELL REPLACE EXISTING WELL? YES NOZ
8. STATIC WATER LEVEL Below Top of Casing: FT. --
(Use '+' It Above Top of Casing) C... Fri
9. TOP OF CASING ISFT. Above Land Surface" CrT,
'Top of casing terminated at/or below land surface requires a variance In occor- �,,I
dance with 15A NCAC 2C .0118
10. YIELD (gpm): - METHOD OF TEST L�f ✓
11. WATER ZONES (depth): Dt
IU m
12. CHLORINATION: Type a Amount . _ If additional space is needed use back of form
13.-CASING: Z
Wall Thickness LOCATION SKETCH
Depth Diameter or Welght/Ft. �a�enal (Show direction and distance from at least two State
From To q D Ft. %% 522 2 1 V t✓ Roads, or other map reference points)
From To Ft.
From To Ft.
14. GROUT:
Depth Material M, athoo CIO �C,
From '` — To AD Ft, Pat t' N A n = — — - -- - From To Ft. Mo r`( vt f V>K
15. SCREEN: �J v
Depth Diameter Slot Size Material?
From To Ft In. In. ;� .�st
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 0 THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER,
FOR OFFICE USE ONLY d4
Quad No: wpp=` w, • SICj ATURE OF PERSON CONSTRUC IN T WELL DATE
SUbm�l original l%�Divisfon of Water Quality, Groundwater se Ion Within 30 days
Serial No, i!11 1 - GW-1 REV. 12/99

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section 7 iS
1636 Mail Service Center - Raleigh, N.C. 27699-1636-Phone [phone] `f J
WELL CONSTRUCTION RECORD WELL CONTRACTOR:
WELL CONTRACTOR CE14TIFICATION #: /3 L _�
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE (Check Applicable Box): Residential Lf Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATION: (Sho,7 sketch f the location below)
Nearest Town. ���'y-7�' / County:
l..•br/lct�L� � ��+� r� 1-Y
(Road Name and Numbers, Community, or Subdivision and Lot No.) DRILLING LOG DEPTH
3. OWNER �b �� '� _ Frogs To Forma' r Description
Address - 3 �� 11�•2 i") i v �~"�•r y. PU CJ / /U i' /
A (street or /�
City o Town late rC/Zip Code
25
4. DATE DRILLED D ( 1
5. TOTAL DEPTH r 26
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 FT. Above Land Surface*
'Top of casing terminated at/or below land surface requires a variance In accor-
dance with 15A NCAC 2C .0118 �r
10. YIELD (gpm): / 2 METHOD OF TEST ,&, r-
11. WATER ZONES (depth):
12. CHLORINATION: Type Amount If additional space is needed use back of form
13. CASING:
Wall Thickne LOCATION SKETCH
Depth Dtarrteter or W ig Mate (Show direction and distance from at least two State
From To ..i/ f Ft. �� Roads, or other map reference points)
From To Ft.
From To Ft.
14. GROUT:
Depth MaterialMethod O
From To � � Ft. %/�7—, c'
c�
From To Ft. a• oM
15. SCREEN: terry
Depth Diameter Slot Size Material`;
From To - Ft in. in. -�
From To Ft. in. in. �rn
From To Ft. in. —In. N "�
16. SAND/GRAVEL PACK: ='
Qri
Depth Size Material z
From To - Ft.
From To --Ft.
17. REMARKS:
I DO HEREBY Of.R:. IF�(� A,yT T TfS1N -LL Vt/AS� CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTIO A(�QAI}DS r'AN.D�-&W b COPY -OF THIS 7RECRD HAS BEEN P 0DED TO THE WELL OWNER1,1LO 00
FOR OFFICE U L `, ,`
Quad No: t f , SIGNATU PEji N CONS RUCTIN HE WELL ATE
r 4
Submit original to Divi o f W Quality, Groundwat Section within 30 days
Serial No. / GW-1 REV. 12t99

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section f) r) 3 6 G 8
1639 Mail SidNVido COMW , RA1610h, N.C. 27699�11GWPhdhe (09) 713;3221 22
WELL CONSTRUCTION RECORD WELL CONTRACTOR: I-lir koru WP1 1 Dr; 1 ling Co.
WELL CONTRACTOR CERTIFICATION #: 2343
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE (Check Applicable Box): Residential © Municipal ❑ Industrial ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: Morganton County: Burke
5902 Dysartsville Rd.
(Road Name and Numbers, Community, or Subdivision and Lot No.)
3. OWNER Nel 1 y [licks
Address 5902 Dysartsville Rd.
(Street or Route
Morganton t 28655
City or Town State Zip Code
4. DATE DRILLED 12-07-00
5. TOTAL DEPTH 129
6. CUTTINGS COLLECTED YES ❑ NO0
7. DOES WELL REPLACE EXISTING WELL? YES ® NO❑
8. STATIC WATER LEVEL Below Top of Casing: Fr.
(Use '+' if Above Top of Casing)
9. TOP OF CASING ISM_ 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): 9 METHOD OF TEST By Air Test
11. WATER ZONES (depth):
12. CHLORINATION: Type hth Tabs Amount 60
13. CASING:
_o
►— CV
w • • Depth
Fr 0 108 FtCa
Frer)I' n To Ft.
Frotw_ 994 To Ft,
14. GAIT: f
u,Depth
o .rt
Fro f� 0-)_ To 20 Ft,
From Q To Ft
15. SCI`k�EN:
Agricultural ❑ Monitoring .❑
DRILLING LOG DEPTH
From To Formation Description
a
o
Q�c
rr o
Z1C -m t�
tv �'
If additional space is needed use back of form
Wall Thickness LOCATION SKETCH
g� veter or ry�V�eit/Ft. ifferfaIj (Show direction and distance from at least two State
6 4 1'V� PlaSt].c Roads, or other map reference points)
Material
Grot_it
Method
Poured
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
From To Ft.
From To Ft.
17. REMARKS:
Material
7—
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 BEE VIDED TO THE WELL OWNER.
GIZ rr :. R 12-08-00
FOR OFFICE US_
Quad No: � u " ISIGNATURE OF PERSON CONSTRUC E WELL DATE
rc �� Submit of alto Division of Water Quality, Groundwater Section within 30 days
1 ••- C- I if f9 GW-i REV. 12/99
Serial No. /It� e .� -- I I,l

r
North Carolina • Department of Environment and Natural Resources - Division of Water Quellty - groundwater Serllon 2 or 3 6 J 1
1630 Mall Service Center - nelelgh, N.C. 27099.1030-►'bone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR: HkAory Well Drilling. Co.
WELL CONTRACTOR CERTIFICATION It,: 2343
STATE WELL CONSTRUCTION PERMITM:
1. WELL USE (Check Applicable Box): Resldertllal a Municipal ❑ induslilai L Agricultural 0 Monllorblg U
Recovery ❑ Ideal Pump Water Injeollon ❑ Other C] If Other, 1.191 Use:
2. WELL LOCATION: (Show akelch of the location below)
Nearest Town: Morganton County: Burke
077 Pnf"Paf- T)rivP
(Flood Name and Numbers, Cornrnunlly, or Subdlvlslon and Lot No.) DRILLING LOG DEPTH
3. OWNER Don Greene From To Fonnatlon Description
Address Rt79 ir�l "oupea28601
Hickory
City or Town Slate Zip Code
4. DATE DRILLED 12-20-00 {
—
5. TOTAL DEPTH 2n5 _ -- --- -- ---- - ----- ----- - --
6. CUTTINGS COLLECTED YES [_� Now _ _-.___...-..____..___—__.__--___-_.—._.-_
7. DOES WELL REPLACE EXISTING WELL? YES a NO _—� -------E-r—m—
B. STATIC WATER LEVEL Below Top of Cnsing: S__ FT. m orn
(Use '+' If Above Top of Crrsirrg) -- --
9. TOP OF CASINO IS 2 FT. Above Land 81rrfaae' co
'Top of casing terminated atfor below lend surface requires a variance In sccor- p
dance with 15A NCAC 2C .0110 —
10. YIELD (gpm): 5 METHOD OF TEST By Air Tes t
11. WATER ZONES (depth): -Tnr
F:� -- 1
12. CHLORINATION: Type hth Tabs Amount 33 If additional space Is needed use back of 101111
13. CASING:
LOCATION SKETCH
Wait Thickness
Depth Dlif(rftor or Weltilrvri. MAledat (Show direcllbn and distanco Irorn at least two State
From 0 To 105 F1 6 4 Galy. Steel Ronde, or olher rnnp reference polnis)
From To FI.
From To—-----
14. GROUT:-y®
Dopll, Melodnl Mothod
Front _ 0 To 20 rt. Grout Poured
Front To FI.
15. SCREEN:
Depth Dlamelor Slot Slz6 Melerlol
From To FI In, In.
From To Ft. In. In.
From To FI. In. In. 1
16. SAND/GRAVEL PACK / c Cc;�L L
Depth Size Mnlorlal
Front To FI.
Fro in To Ft.
17. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCOnOANCE WITI I ISA NCAC 20, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF Tills RECORD HAS PROVIDED TO TTIE WELL OWNER,
FOR OFFICE US - ,11 '" 12-27
Quad No: } ; ��'" � F Of1AT nE or PERSON CONST Nt3 TIIE WELL DAZE
1' `` Subic d 1 Ito Division of Water Quality, l3 undweler Section Wlillln 30 days
Sedal No. r a ��) oW•I r1EV. 12/99
p 11 It 1,

/) North Carolina - Department of Environment end Natural Resources - Division of Water Quality - oroundwaler Section j 2 3 6 8 O
1le39 Mail Service Center - Relelgh, N.C. 27e99-1e38•F Iwne [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR: Hickory Well Drilling Co.
WELL CONTRACTOR CERTIFICATION #: 2343
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE (Check Appllceble eox): nesidenllal I23 Munlcipnl 0 Industilal ❑ Agricultural 0 Monlloring
Recovery ❑ I feat Purrip Water Injecllon ❑ Other [J If Olher, 1-191 Use:
2. WELL LOCATION: (Show sketch of tho locallon below)
Nearest Town: MorgA Ln __ Counly: - K, lrka _--
1105 Larry Abernathy Ave.
(noed Name and Number, Corrvrurntly, or Subdivision and Lot No.) DRILLING LOG
DEPT11
3. OWNER Larry Abernathy Frorn To
Forrnatton Description
Address 1105 Larry Abernathy
(S' !e9 or Uoul9 NO.1
A
Morganton NC 28655
�,M
City or Town Slate Zip Code
o M
�
4. DATE DRILLED 12-27-00
�r
5. TOTAL DEPTH -- -- - ----------
6. CUTTINGS COLLECTED YES (_.) NO�X---•----_-------- ----
-- ------ �'�
------ - -----CO --3>M
7. DOES WELL TiEPLACE EXISTING WEI-1.7 YES (X-A 1101—j
B. STATIC WATER LEVEL Below Top of Cnsing: F T. _---
-- m
_`_
• (Use *.'If Above Top of Cnsing) ----
�`-
..
9. TOP OF CASINO 18_2 PT. Above Lend Burfeae• ---
C-)—,
n
*Top of ceshrg terminated at/or below land surface requires a vsrlance In scoot- ---
--i
dance•wllh 15A NCAC 2 Oils
10. YIELD (gprn):b METHOD OF TEST yAir `Pest
—'-
11. WATER ZONES (deplh):
12, CHLORINATION: Type hth Tabs Amount 30 If addllionai apace Is needed use back of Torn
13. CASING: --
Well 1111ckness �1
From 0 Depth
ill f t Ql� motor orplv�e�11vr1. Plastic
Front To F1,
Froin. To— FL------ - ------ -----
14. Gnom,:
Doptir Malorlal Molhod
From 0 T•o 20 Fl.GosLL__--- _P4Ur_e_4i _
From _ To FI.
15. SCREEN:
Depth
From
To Ft
From
To Ft.
From
To Ft.
16. SAND/GnAVEL PACK:
Depth
Front
To
Frorn
To
17. REMARKS:
I)lomelor Slot Slz6 Meloilnl
bi,
In,
In,
In.
SIZO
MOIOIIaI
FI.
Ft.
LOCATION SKETCH
(Show dlrecllbn and dislance from at least two Slate
noads, or other reap reference points)
z14,iry
M4
I,G'lS.f r. .
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITI 115A NCAC 2C, WELL
CONSTRUCTION STANDAnDS, AND TIIAT A COPY OF T1115 nECOnD IIAS BEEN (' P� ED TO TI IE WELL OWNEn.
FOR OFFICE USE ONLY
Quad No: '
Sedal No. I , 1 _ .--
ri
IIATUnE Or. r0isof1 CON9MUCT
Division of Witter Quellly, Oroundwel
1G—GO—UV
Tile WELL DATE
rc1lonnowilhln 30 days
OW-1 nEV. 12/99

223250
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: ' Id IA4 /1Y
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 ❑ If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: M 4 A `S l a h a County: it
q8 95" H46r f77-- AY&5- /,fir
(Road Name and Numbers. Community, or Subdivision and Lot No.) DRILLING LOG DEPTH
3. OWNER ��/rfC/�^ 4 A `$ From To Formation Description
Address ggs' ����C _4 L,,CS rf,
�4^1! -o treeto qG o �YG sS—
City or Town State Zip Code
4. DATE DRILLED A
5. TOTAL DEPTH
6. CUTTINGS COLLECTED YES ❑ NOQ
7. DOES WELL REPLACE EXISTING WELL? YES [ NOFS61
8. STATIC WATER LEVEL Below Top of Casing: FT.
(Use '+' if Above Top ofEasing)
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): 8 T METHOD OF TEST E�
11. WATER ZONES (depth):
12. CHLORINATION: Type Amount If additional space is needed use back of form
13. CASING:
Depth Diarneter
From To L� Ft.
From To Ft.
From To Ft.
14. GROUT:
Depth
From To Ft.
From To Ft
15. SCREEN:
Wall Thickness LOCATION SKETCH
or Weight/Ft. 14atenal (Show direction and distance from at least two State
�Wsn G Roads, or other map reference points)
Material Method
Depth Diameter Slot Size Material
From To Ft in. in.
From To Ft. in. in.
From To Ft. in. in.
16. SAND/GRAVEL PACK:
5-7
0
p
O rr
c�
<
rn
y�
�..t\
� 1
rn3
--1
0
z
Depth Size Material
From To Ft.
From To Ft.
17. REMARKS:
1 DO HEREBY CERTIFY �TH�IS ��NNE��}}��¢¢ W S ­O �STRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTIONS ANDARDS VD�"THY>tT �1 C P��F THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
FOR OFFICE USEI,ONLY c, � ` ' 1.2_/
Quad No: ( j t'' j{ ,SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
'� '' Submit od final tdtDivision of Water Quality. Groundwater Section Within 30 days
Serial No. > GW.1 REV. 12199
attl7?'� a i1,''f )p
a lS9 1f tat j +, '

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section ` 2 4 1 8 4
1636 Mail Service Center - Raleigh, N.C. 27699-1636-Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR:
WELL CONTRACTOR CE IFICATION #:
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 ketch of the location below)
Nearest Town: lire-,K County:
(Road Name and Numbers, Community, or Subdivision and Lot No.) DRILLING LOG DEPTH
3. OWNER From l To� Forma tign\Description
Address
�n(Street or HOUtO NO „ C
City or Ton State Zip Code
4. DATE DRILLED dgko_
5. TOTAL DEPTH _ �)S
6. CUTTINGS COLLECTED . YES Q NO
7. DOES WELL REPLACE EXISTING WELL? YES NO
8. STATIC WATER LEVEL Below Top of Casing: Ps- FT.
(Use '+' if Above Top of Casing)
9. TOP OF CASING IS 1 FT. Above Land Surface -
'Top of casing terminated atfor below land surface requires a variance In accor-
dance with 15A NCAC 2C .9q118
10. YIELD (gpm): /cMETHOD OF TEST -!'
11. WATER ZONES (depth):�
12. CHLORINATION: Type Amount It additional space is needed use back of form
13. CASING:
Wall Thickness
)Depth Diameter or Weig t. Material
FromTo Ft. --1
From To Ft.
From To Ft.
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other map reference points)
14. GROUT:
o
c7
ZE
Depth Material
Method
C_
From To I
Q Ft. Kl z
From To
Ft.
0
15. SCREEN:
rn
ter:CD
Depth
Diameter Slot Size
Material
-M1
From To
Ft in.
in.
:R;
From To
Ft. in.
in.
ry
F'i 56 n-t �
From To
Ft. In.
in.
.9-
H
16. SAND/GRAVEL PACK:
z
Depth
Size
Material
From To
Ft.
From _ To
Ft.
17. REMARKS:
I DO HEREBY CERTIrY T�;jAT�THIS W.�Lil,,W �S 4UNS7 HUG I
CONSTRUCTION STANDARDS 'ANO f A COPY OF THIS
FOR OFFICE S �YN ,Vi(�
Quad No:SIGN61URE
Submit original t ivisI
Serial No.
4
IN ACCORDANCE WITH 15A NCAC 2C, WELL
i ORD HAS EB EEN PROVIDED TO THE WOWN
NG THE WELL DATE
it Section withiru 0 days
GW-1 REV. 12199 "

I r 2 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 CE 1FICATION #: 77F3
STATE WELL CONSTRUCTION PERMIT#:
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) n
Nearest Town: f7tir' i \ County:
(Road Name d Numbers Community, or Subdivision and Lot No.) DRILLING LOG DEPTH
3. OWNER �' ��LGitii/� From To Form ion Description
Address ��' ou =v `�_� c� 5+�[� l.�Q �`^ i
q treet orli�out 1)o. `L �n �%/
l `� l�V'l�l it i3.6 n C n i /-
City or To1in State Zip Code
4. DATE DRILLED I D
5. TOTAL DEPTH
6. CUTTINGS COLLECTED YES ❑ NO�
7. DOES WELL REPLACE EXISTING WELL? YES ;NO�F__J8. STATIC WATER LEVEL Below Top of Casing:.
(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 .0,111A 8
10. YIELD (gpm):METHOD OF TEST,&
11. WATER ZONES (depth):
12. CHLORINATION: Type Amount If additional space is needed use back of form
13. CASING:
Wall Thickness
r� Depth Diameter or W i h 1. Material
FromTo Ft.—��
From To Ft.
From To Ft.
14. GROUT:
Depth
Yatenal
Method
From � 6) To 40 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:
I DO HER
CONSTRI
FOR OFFICE U " ONLY
Quad No: !�
Serial No. .__.._
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other map reference points)
CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
JPY OF THIS CORD H EEN PROVIDED TO TH9 WE O
SON ObNSTRUCTING THE
Quality, Groundwater Sectioi
0
c�
m am
M
rn �<
2i o
-a rrn
7, M
N u' M
.. r11;V
:J
cl1 C)
DATE
days
GW-1 REV. 12/99

424181
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 CE'�tTIFICATION #: a 91.3
STATE WELL CONSTRUCTION PERMIT#: /
1. WELL USE (Check Applicable Box): Residential L Municipal ❑ Industrial ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATION: (�Sh w s etch of the location below)y
Nearest Town: �`�`County: Air�.L
(Road Name and NL-e
s, Comrpunity, or Subdivision and Lot No.) DRILLING LOG
3. OWNER f TFrm To
�
Address G L)
(street 4r Route o.
Cit r own tate Zip Code
4. DATE DRILLED % ll
5. TOTAL DEPTH �-
6. CUTTINGS COLLECTED YES ❑ NOED—'
7. DOES WELL REPLACE EXISTING WELL? YE NO[_]
8, STATIC WATER LEVEL Below Top of Casing: i 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 r
10. YIELD (gpm): �_ METHOD OF TEST,
11. WATER ZONES (depth):
Agricultural ❑ Monitoring ❑
DEPTH
Fo ation Description
7
12. CHLORINATION: Type Amount _ If additional space is needed use back of form
13. CASING:
Depth Di ter
From To Ft.
From To Ft.
From To Ft.
14. GROUT:
Wall Thickness LOCATION SKETCH
or Weigh)/Ft, Material (Show direction and distance from at least two State
GG Roads, or other map reference points)
Depth ateri�L_ Method
From _� To c2� Ft. /" r � Xr -
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: --.
0
o
_ Q
c�
a dm
cM
t7► m
4
—p M
rn�
� rn
rn�
rn
.r=- —C-)i
V1 0
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STAND pS,rPND, AT A COPY OF THIS ORD HAS B I�PROVIDED TO THE WELL O NE
'1tug
FOR OFFICE USE O Y l ' t
Quad No: i j,I IS E O 17SON CONSTRUCTING THE WELL DATE
S�utxnit origin �o ston ater Quality, Groundwater Section within 30 days
Serial No. l; GWA REV. 12199

North Carolina -Department of Environment and Natural Resources Division of Water Quality -Groundwater Section 'i , t
1636 Mail Service Center - Raleigh, N.C. 27699-1636-Phone [phone] J1"
WELL CONSTRUCTION RECORD WELL CONTRACTOR:
WELL CONTRACTOR CERTACATION #: 7 -7/ 7-
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE (Check Applicable sox): Residential Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATION' how sket�jh of the location below)
Nearest Town: — - ,a �'! County: Z�rl'
(Road Name and Numbers. Community, or Subdivision and I pt o.)
3. OWNER ' - �. O 9
Address oQ qavo
L et or 7, o.
City or Town State Zip Code
4. DATE DRILLED
5. TOTAL DEPTH
6. CUTTINGS COLLECTED YES ❑ NOZNO❑
�
7. DOES WELL REPLACE EXISTING WELL?
8. STATIC WATER LEVEL Below Top of Casing: J, 0 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): }lam METHOD OF TEST
11. WATER ZONES (depth):
12. CHLORINATION: Type _ Amount
13. CASING:
Wall Thickness
Depth Diameter or Welp
YFt. Material
From —I L_To Ft. '
From To Ft.
From To Ft.
14. GROUT:
DRILLING LOG
DEPTH
From To
Formation De .ption
-7 ( v S-
�Ct.. Af,
go
M ,-
77
C%
^_
=-t
rn
Fi
tV
��
If additional space is needed use back of form C�J't
o
LOCATION SKETCH
(Show direction and distance from at feast two State
Roads, or other map reference points)
Depth
atedal _
— Method
From
_ To e, _ Ft.
Zrrr-- ek,_�/
/'11' `G
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:
L
I DO HEREBYCERTI5
AND THAT 11-,9OPY OF THIS
FOR OFFICE
Quad No:
SutxniI original to
IN ACCORDANCE WITH 15A NCAC 2C, WELL
0 RD HAS ROVIDED TO THE WE
SON CONSPUCTING THE WELL / 0
Quality, Groundwater Section within 30 days
DATE
GW-1 REV. 12199
ail!
Serial No.

3- J0U- WCAP---
North Carolina . Department of Environment and Natural Resources . Division of Water Quality - Groundwater Section Z 4 J
1636 Mail Service Center - Raleigh, N.C. 27699-1636-Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR: d( ao /7C
WELL CONTRACTOR CER IFICATION #: 071
STATE WELL CONSTRUCTION PERMIT#: �-
1. WELL USE (Check Applicable sox): Residential LUG Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATION: (Show sk of th¢ location below)
Ca.�Cf
(-
U lk�.
Nearest Town: County:
DRILLING LOG DEPTH
(Road Name and Ny �_ers, Community, or Subdivision and Lot No.)
3. OWNER CJ( \0.y, to S h.0 W
Fr m To Formation Description
Address 02_ © r c� JP . S IE
�0 `.---
(street or Route o.
C.k C 'cl W
_
(1
City or Town State Zip Code
4. DATE DRILLED
5. TOTAL DEPTH
/j;'-NO
6. CUTTINGS COLLECTED YES ❑ NO9YES
7. DOES WELL REPLACE EXISTING WELL? F_�
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 or -
!ll
dance with 15A NCAC 2C .0 8 r
T�
10. YIELD (gpm): ! METHOD OF TEST
11. WATER ZONES (depth):
12. CHLORINATION: Type Amount
If additional space is needed use back of form
13. CASING: '
LOCATION SKETCH
Wall Thickness
DepthG Diameter or W i t. Mate I
From To Ft. --�
(Show direction and distance from at least two State
Roads, or other map reference points)
From To Ft.
From To Ft.
14. GROUT:
Depth Material Method
��o�
c'
-_
From To Ft.
am
From To Ft.
c�
15. SCREEN:
Depth Diameter Slot Size Material
M
From To Ft in, in.
M
From To Ft. in. in.
mo
cl
From To Ft. in. in.
rn
16. SAND/GRAVEL PACK:
tv
�:o
Depth Size Material
X_
:j
From To Ft.
From To Ft.
17. REMARKS:
iiTRU
D NSTRUC ION 1'AND R O HEREBY CE,�TIF,.Y THA mi VWON
D �TFiL A'z QF° a bF THiCTED IN ACCORDANCE S RI RD HAS BEENIAt D TO THE WELL OWf ER/
FOR OFFICE US N tY j —
tP `=' i : "' DATE
Quad No: �;y. SI, LDivl/sloof
,ATURE PE ON C STRUCTING ELL
Sutxrut originalWa rDu ,Groundwater on within 30d ys
-GW1 REV. 12/99
Serial No. t �`t'c�
_,-cn Asheville tSi l'ii

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] t
I
WELL CONSTRUCTION RECORD WELL CONTRACTOR: r /J .,,g 7 jr_ .
_
WELL CONTRACTOR CER IFICATION #:-�l� - •.��
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: (Sho sketc of the location below)
(fC //
�9
Nearest Town: ��✓`� � County: c
(Road Name and tjumpers, Community, or ubdivision and L)No.) DRILLING LOG DEPTH
3. OWNER F�?r o %Eorrn on De cription
(�d L
11
Address ` J �r , o r irk a e _
treet Or OUte 0. > �%� S (/ i c-
City or own State Zip Code
4. DATE DRILLED �j MOO
5. TOTAL DEPTH
6. CUTTINGS COLLECTED YES ❑ NO
7. DOES WELL REPLACE EXISTING WELL? YES ❑ NOED---
8. STATIC WATER LEVEL Below Top of Casing: > d-G 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 .0118 r �'
10. YIELD (gpm): _L_ METHOD OF TEST A
11. WATER ZONES (depth):
12. CHLORINATION: Type Amount If additional space is needed use back of form
13. CASING:
LOCATION SKETCH
Wall Thickness
Depth s Di eI or wig t. M to I (Show direction and distance from at least two State
From To Ft. Roads, or other map reference points)
CD
From To Ft. -
From To Ft.
14. GROUT:
CD
Dept �+1 atedal Method
vim' Ft.
From To
From To Ft.
M
fir''
15. SCREEN:
N
Depth Diameter Slot Size Material
M
From - To _.._ Ft in. in. Q1
0
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 CERl IFY TbhIA7�THIS WLt�9 C N fiRUCTED IN ACCORDAN E WITH 15A NCAC 2C, WELL
WE OWNER.
CONSTRUCTION S„TA�JD/RC�S, AN4 y,_ A a/i(3 .F
THIS R ORD HA N PROVIDED TO TH
FOR OFFICE USE, �( rrr
DATE
Quad No: I. j ( �'
vii 2(t,IGA
fa RSON STRUCTING THE WEKL
Submit ongieal to Divis ater Qual .Groundwater Section within 30 days
Il :"
GW-1 REV. 12/99
-Sedai No.
i4liti�d:1'6� ttF t it"C

North Carolina • Department of Environment and Natural nesources • Division of Water Quality • Groundwater Section 3 6 () 5
1696 Mali Bervlee 8®nler, Neigh, N;Cfr 27899t1lP§-Ph9ne (9191743•1221
WELL CONSTRUCTION RECORD WELL CONTRACTOR: Hickory Well Drilling Co.
WELL CONTRACTOR CERTIFICATION p: 2343
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE (Check Applicable sox): Residential M Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery [] Heat Pump Water Injection ❑ Other 0 If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: Morgan ton _____ County:. RI rkP
592(1 ni rl Hi ll Rdl
(Road Name and Numbers, Community, or Subdivision and Lot No.) DRILLING LOG
3. OWNER Jim Carswell From To
Address 992oni(imil)—
Mr) r anton (biree or o 0• 28655 —
DEPTH
Formation Description
g
City or Town Stale Zip Code
o
O
4. DATE DRILLED 11-08-00
��-
5. TOTAL DEPTH 409
6. CUTTINGS COLLECTED YES[_] NOY]
7. DOES WELL REPLACE EXISTING WELL? YESTn NO[_]
8. STATIC WATER LEVEL Below Top of Casing: 63 FT.
(Use '+' If Above Top of Casing)
9. TOP OF CASING IS 2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a variance In accor-
ril
dance with 15A NCAC 2C .0118
�•
10. YIELD (gpm): _8 METHOD OF TEST By Ai r Tes t
11. WATER ZONES (depth):
-
12. CHLORINATION: Type hth TAhs Amount 77 It additional space Is needed use back of form
13. CASING:
Depth Diameter
From --To 106 Ft. 1�-1"
Frorn To Ft.
—
From To FL
14. GROUT:
Wall Thickness LOCATION SKETCH
or WelghUFt. Material (Show direclibn and distance from at least two State
PCELaauc Roade, or other map reference points)
/
Depth Material
From 0 To 20 Fl• Grout
From To FI.
15. SCREEN:
Depth
From
To
From
To
From
To
16. SAND/GRAVEL PACK:
Depth
From
To —
From
To_
17. REMARKS:
Method
Poured
Diameter Slot Size Material
Ft in. In.
Ft. In. in.
Ft. In. In.
Ft.
Ft.
Size Material
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 20, WELL
CONSTRUCTION STANDARDS, AND T14AT A COPY OF THIS RECORD HAS BEE OVIDED TO THE WELL OWNER.
FOR OFFICE USE'QN 1( —
Quad No: r �� C ( S Q TUBE F PERSON ONSTFIU I IIE WELL DATE 1121-00
6bmlt'o44I to Division of Water Oualpy, Oroun afar Section within 30 days
Serial No. a OW-1 REV. 12/99
pp

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Oroundwater Section
1636 Mail Service Center - Raleigh, N.C. 27699.1636-Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR: _ Hickory Well Drilling Co.
WELL CONTRACTOR CERTIFICATION 0: 2343
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE (Check Applicable Box): ResidentlalMunicipal [_] Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Ideal Pump Water Injection ❑ Other [] if Other, List Use:
2, WELL LOCATION: (Show sketch of the location below)
Nearest Town: Connelly Springs County: Burke
4457 Mt Gillard Ch. Rd
(Road Name and Numbers, Comrnu lily, or Subdivision and Lot No.) DRILLING LOG DEPTH
3. OWNER Wayne Buff From To Formallon Descrlptlon
Address 4457 Mt Gillard Ch. Rd.
Istreol or Route o.
Connelly S= ri nn_ NC �RF,1
City or Town Slate Zip Code o
4. DATE DRILLED 11-13-00 0
5. TOTAL DEPTH 485
6. CUTTINGS COLLECTED YES E] NO;ffj
7. DOES WELL REPLACE EXISTING WELL? YES NO❑ :�—ern
8. STATIC WATER LEVEL Below Top of Casing: 40= r. t
(Use '+' II Above Top of Casing) co
9. TOP OF CASING IS 2 FT. Above Land Surface'
*Top or casing terminated aVor below land surface requires a variance In ■ccor-
dance with 15A NCAC 2C .0118
10. YIELD (gpm): 30 METHOD OF TEST _hy a 1 r t P.R k M M
11. WATER ZONES (depth): N —'
0
1
12. CHLORINATION: Type h th Tabs Amount 18 If additional space Is needed use back of form
13. CASING:
• LOCATION SKETCH
Wall Thickness
Depth Diameter or WelghVFl. Material (Show directlbn and distance from at least two Slate
From 0 To 37 Ft. h 4 PVC P1 a Gt i r Roads, or other map reference points)
Frorn To F1. , Al
From To— Ft.
14. GROUT:
Depth Material Molhod
From To 20 r:t, Grout Poured
From To Fl. f(0
15. SCREEN: (�(��
Depth Diameter Stol Slz© Materinl .o
From To Ft In. in. U/'GL
From To Ft. In. In.
From To Ft. In. In. b
16. SAND/GRAVEL PACK: S
Depth Size Material
From To FL
From To Ft.
17. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORD WITH 15A NCAC 20, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY O�CORD F PROVIDED TO THE WELL OWNER.
FOR OFFICE USE ONLY 11-21-00
OuadNo:
( SIGNATURE OF PERSON CON CTING THE WELL DATE
t iF %'� �I, ii� jr
_.Subr�nll oil nel to DIvlslon of Water Duality, Groundwater Section within 30 days
Serial No. GW1 REV, 12/99
� p f 3ra i3413' �tii a i r iw931 p
t d l V ie ! Ir ?it

North 9941n0 • Pe p.Arirnert( QI E0ronmen4 ®rtd Natural Fiesources - Division of Water Quality - Groundwater Section
106 Mill Uvlde 0mildf = Rftialdh, N.C. 0660-1W-Phefib (§19) iM;5221 1. 3 f?
WELL CONSTRUCTION RECORD WELL CONTRACTOR: Hickory Well Drilling, Co, .
WELL CONTRACTOR CERTIFICATION #: 2343
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE (Check Applicable Box): Residential ❑ Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ I-leat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: TCard County: Burke
7000 Hildebran Mtn Ave
(Road Name and Numbers, Community, or Subdivision and Lot No.) DRILLING LOG DEPTH
3. OWNER Vang Yang Frorn To Formallon Descrlption
Address / Tria Yang 7000 Hildebran Mtn. Ave.
tstreet or Routs o.
Connelly Springs _ NC 28612
City or Town Stale Zip Code o
4. DATE DRILLED 11-07-00 0
5. TOTAL DEPTH— o
6. CUTTINGS COLLECTED YES ❑ NOM
7. DOES WELL REPLACE EXISTING WELL? YES ❑ NO®
8. STATIC WATER LEVEL Below Top of Casing: 59_ FT. r
(Use '+' If Above Top of Casing) co
9. TOP OF CASING IS 2 FT. Above Land Surface'
'Top of casing terminated at/or below lend surface requires a variance In accor-
dance with 15A NCAC 2C .0110
10. YIELD (gpm): 25 METHOD OF TEST BY Air Test _F7 rn�
11. WATER ZONES (depth): N
12. CHLORINATION:
13. CASING:
Type hth Tabs Amount 35 If additional space Is needed use back of form
Wall Thickness
Depth
Olivier
or Wei hm. MasticFrom
0
To 70
Ft. 6 4
11
From
To
Ft.
-
From
To
Ft.
14. GROUT:
Dept lt
20
Matodol Aelhod
Grout I oured
From
To
Ft.
From
To
Ft.
15. SCREEN:
Depth
Diameter Slot S1z6 Material
From
To
FI
In.
in,
From
To
Ft.
In.
In.
From
To
Fl.
In.
In,
16. SAND/GRAVEL PACK:
Depth
Size
Material
From
To
FL
From
To
Ft.
17. REMARKS:
LOCATION SKETCH
(Stow dlrectibn and distance from at least two State
Roads, or other map reference points)
N 0
U/
a
to � W Est'
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDA ITII 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND 7I1AT A COPY :F�,,ow HA ROVIDED TO THE WELL OWNER.
€ E� y 11-21-00
FOR:No.
QI€ iP sY L� �u= �1� ��. Ouad r r�.. ' SIGNATURE OF PERSON CONST TING THE WELL DATE
Su�'nl(440inal to Division of Water Ouallly, Groundwater Section Within 30 days
SeriaOW-1 REV. 12/99
7 r_11:�1 a

North Carolina • Department of Environment and Natural Resources • Division of Water Quality - Groundwater Section 40(.3667
1636 Mail Service Center - rielefgh, N.C. 27699.1636•Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR: Hirkory WP1 1 Drilling Co.
WELL CONTRACTOR CERTIFICATION #: 2343
STATE WELL CONSTRUCTION PERMITM:
1. WELL USE (Check Applicable Box): Residential 0 Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ I feat Purnp Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: Morganton County: Burke
5835 Old NC 18
3
(Road Name and Numbers Co�.p�cnunity, or Subdivision and Lot No.)
OWNER Hazel Hull
Address 5835 Old NC 18
Connelly Springs or au a N. 28612
City or Town Stale Zip Code
4. DATE DRILLED 11-14-00
5. TOTAL DEPTH —
6. CUTTINGS COLLECTED YES ❑ NO®
7. DOES WELL REPLACE EXISTING WELL? YES [9] NOD
6. STATIC WATER LEVEL Below Top of Casing: _ o Fr.
(Use '+' If Above Top of Casing)
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): z METHOD OF TEST By Air `Pest
11. WATER ZONES (depth):
12. CHLORINATION: Type hth Tabs Ainount 96
13. CASING:
Depth Dlir tar
From 0 To 78 Ft. 4
From To Ft.
From To Ft.
14. GROUT:
DRILLING LOG DEPTH
From To Formation Description
ra
�—off
�►
,- c-)
CID
=Cf7
g
M
�
rn�
N
---t
co
2
If additional space Is needed use back of form
Wall Thickness LOCATION SKETCH
o I hurt. retedal (Show directibn and distance from at least two Slate
w,i P1as tic Roads, or other map reference points)
De 1lt
Material
Molhod
Poured
0
ToVO
Grout:
Frorn
—
Ft. -- _--- -
From
To
Ft.
15. SCREEN:
Depth
Diarnelor Slot Siz6
Material
Front
To
Ft In. In.
From
To
Ft. In, In.
From
To
Fl. In. In.
16. SAND/GRAVEL PACK:
Depth Size Material
Frorn _ To Ft.
From To Ft.
17. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACI
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD
y'N�u
SIGNATURE OF PERSON CON
Submit original to Division or Water Quality, d
a�
S
E WITI1 15A NCAC 2C, WELL
t PROVIDED TO THE WELL OWNER.
11-22-
3 THE WELL DATE
Section within 30 days
OW-1 REV. 12199

223675 t
North Carolina - Department of environment and Natural Resources - Division of Water Qusllty - Groundwater Section
1038 Mall Service Center • Relelghr N.C. 27888.1e38•Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR: Hickory Well Drilling Co.
WELL CONTRACTOR CERTIFICATION N: 93113
STATE WELL CONSTRUCTION PERMITN:
1. WELL USE (Check Applicable Box): Residential ID 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: Connelly Springs county: Burke
7935 Will Hudson Rd:
(Road Name and Numbers. Convrwnlly, or Subdivision and Lot No,) DRILLING LOG DEPTH
3. OWNER Allen Hudson From To Formation Description
Address 7935 Will Hudson Rd.
(Street or Route o.
Connelly Springs NC 28612
CI1y or Town State Zip Code o
4. DATE DRILLED 11-30-00 y o
5. TOTAL DEPTH —
6. CUTTINGS COLLECTED YES 0 NO[n
7. DOES WELL REPLACE EXISTING WELL? YES ❑ NOM
8. STATIC WATER LEVEL Below Top of Casing: ()— FT.
(Use'*' It Above Top of Casing)
9. TOP OF CASING IS 2 FT. Above Land Surface* "DII
*Top of casing tarminaled aVo► below lend surface requires a variance In accor- izi
dance with 15A NCAC 2C .011a
10. YIELD (gpm), 25 METHOD OF TEST By Air Test ry M53
11. WATER ZONES (depth):
12. CHLORINATION: Type hth Tabs —Amount Amount 98 If additional apace Is needed use back of form
13. GA51NCa:
LOCATION SKETCH
Depth
Wail Ttdckness
Diameter or Welght/Fl. Matelot
(Show dlreclibn and distance from at least two State
From 0
To 62
Ft.. 6kPVC , Plastic
Road,, or other map reference points)
From
To
Ft.
,1 /
Frorn
To
FI.
,�l
14. GROUi:
\ /
Depth Material Molhod
From 0 To 20 FI. gout Poured
Front To FI.
15. SCREEN:
Depth
From
To Ft
From
To Ft.
From
To Ft.
16. SAND/GRAVEL PACK:
Depth
From
To
From
To
17. REMARKS:
Dlameler Slot Size Material
In.
In.
In,
In.
In.
In.
Size
Material
Ft.
Ft.
1 DO.HEREBY CERTIFY 71-IAT THIS WELL WAS CONSTRUCTED IN AC1
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD
FOR OFFICE USE
Quad No:
Serial No.
t �
5" I
OF PEnSON CON
of Water Ousilly, O
E
6'/u�� L
E WITH 15A NCAC 2C, WELL
I PROVIDED TO THE WELL OWNER.
3 TIIE WELL DATE
Section within 30 days
OW-1 nEV. 12/99

�03676
North Carolina • Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
ion Mail Saryin Gtlnlgr- fielfIlgh, NAG, g7999•1d3 -phone (gig) 733.3221
WELL CONSTRUCTION RECORD WELL CONTRACTOR: Hickory Well Drilling CO.
WELL CONTRACTOR CERTIFICATION #: 2343
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE (Check Applicable Box): nesidentlal[A Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ II Other, List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: Morganton - County: Burke
_ 4718 Tallent Ri
(Road Name and Numbers. r:rrrvrwnliv. or Subdivision and Lot No.)
3. OWNER Mary Ann Harrison/Harold Rudisill
Address 4738 Tallent Rd.
Morgatnon 16frool or Hou O. 28677
City or Town Slate Zip Code
4. DATE DRILLED 11-21-00
5. TOTAL DEPTH V)5
6. CUTTINGS COLLECTED YES [] NOffj
7. DOES WELL REPLACE EXISTING WELL? YES 0 NOW
8. STATIC WATER LEVEL Below Top of Casing: FT.
(Use '+' 11 Above Top of Casing)
9. TOP OF CASING IS__9_____ FT. Above Land Surface'
'Top of casing terminated ■Uor below land surface requires a varlanco In accor-
dance with 15A NCAC 2C .0115
10. YIELD (gpm): 90 METHOD OF TEST Ni_Al r TeS t
11. WATER ZONES (depth):
12. CHLORINATION:
13. CASING:
Type h th Tah. Amount 4? —
Frorn To — Ft.
14. GROUT':
DRILLING LOG DEPTH
From To Formation Description
v
_ 1
ar r
rn
m
.. M ;:7
0
If additional space Is needed use back of form
LOCATION SKETCH
Wall Tidckness
or hVF1, idol is (Sly"a1N� "? wrecllbn a nd M (trap r!! ete pe F1011 r�l distance fm at least two Stale
Depth Malollol Molhod
From n — To _20 FL Cro t pQ rer=1
Frorn To Ft.
15. SCREEN:
Depth Diameter Slot Slze Material
From To Ft Ill. In.
From To Ft. In. In.
From To Ft. In. In.
16. SAND/GRAVEL PACK:
Depth Size
Flom To Fl.
From To Ft.
17. REMARKS
I DO HEREBY
Material
FOR OFFICE U3 d' LY P',Zdj! �' r�Quad No: 1 t')@1f1ubinllo
Serial No. l s
o,
AA
/N'9
u/
Uj
TRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
F TFIIS RECORD HAS S ROVIDED TO THE WELL OWNER.
12—OS-00
IATU OF PERSON CONSTn TIIE WELL DATE
Division of Water Quality, Orodwater Section within 30 days
OW-1 REV. 12/99

North Carolina . Dapertment of Envlronrnent and Natural nesources . Division of Water Quality • Groundwater section 237-15
1666 Mall Gerylee Genler : Ralelph; N,R; 27699=1666-Phon® (919) 749221
WELL CONSTRUCTION RECORD WELL CONTRACTOR: Hickory Well Drilling Co.
WELL CONTRACTOR CERTIFICATION p: 2343
STATE WELL CONSTRUCTION PERMITIII:
1. WELL USE (Check Applicable Box): Resldentlal [K] Municipal L7 Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: Icard County: Burke
5474 Miller Mill Rd.
(Road Name and Numbers. Community, or Subdivision and Lot No.)
3. OWNER Bill Willis
Address
Hickory fe° or 28602
Clly or Town Stale Zip Code
4. DATE DRILLED 11-06-00
5. TOTAL DEPTH 109
6. CUTTINGS COLLECTED YES ❑ NOF
7. DOES WELL REPLACE EXISTING WELL? YES R NO❑
8. STATIC WATER LEVEL Below Top of Casing: 92 FT.
((Use '+' If Above Top of Casing)
9. TOP OF CASING Is 2 frT. Abov Land surfoce•
'Top of casing terminated atlor below land surface requires a variance In accor-
dance with 15A NCAC 2 119
10. YIELD (gpm): L) METHOD OF TEST Y Air Test
11. WATER ZONES (depth):
DRILLING LOG DEPTH
From To Formation Description
12. CHLORINATION: Type hth Tabs Arnounl 4_ It additional space Is needed use back of form
13. CASING:
Depth Dilrrpler
From 0 To 74 Ft. 6 4
Frorn To Ft.
From To Ft.
14. GROUT:
Wall Thickness LOCATION SKETCH
or WelplrVFI. Material (Show direclibn and distance from at least two State
FPlas tic Roads, or other map reference points)
Depth Material
From 0 To 20 Ft Grout
Front To Ft.
15. SCREEN:
Depth
From
To
From
To
From
To
16. SAND/GRAVEL PACK:
Depth
Front
To
From
To_
17. REMARKS:
Method
Poured
Diameter Slot Sizo Material
Ft In.
In.
Ft. In.
In.
Ft. In.
In.
Size
Malerlai
Ft.
Ft.
1 A-qo
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 20, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD FIAp"JEN PROVIDED TO THE WELL OWNER.
FOR OFFICE USE ONLY
1. Quad No: f s I SIGN TUBE OF PE
I' Ir Sub+nll orlpl��al to Division of Wnler
Serial No. _
Iv"
B � r-
1 '
1 � �,'r'E)t39ii,16,°3�if' �ci`'tY39d
lit)
irll3t? act°sir ttl at6,ss t.
TING THE WELL
ller Section within 30 days
—vy
DATE
OW-1 REV. 12/99

North Carolina - Depariment of Environment and Natural Resources - Division of Water Quality - Groundwater Section {-
1838 Mall Service Center • Raleigh, N.C. 27699.1638•Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR: Hickory Well Drilling Co.
WELL CONTRACTOR CERTIFICATION p: 2343
STATE WELL CONSTRUCTION 1 ERMIT#:
1. WELL USE (Check Applicable Box): Resldentlal ® Municipal 0 Industrial ❑ Agricultural ❑ Moniloring ❑
Recovery ❑ Meal Pump Water Injection ❑ Other n If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: Ili 1 debran County: Burke
3879 Dowell St.
(Road Name nd Numbers Cp rwnily, or Subfilsion and Lot No.) DRILLING LOG DEPTH
3. OWNER CJ-ay MIrp I"On [lO �.y From To FarmetlonDescrlpllon
Address PO 13ox 61
(Street or Houle o.
Hildebran NC 28637
City or Town Stale Zip Code p
4. DATE DRILLED 11-15-00
5. TOTAL DEPTH 265 _ ca
6. CUTTINGS COLLECTED YES ❑ NOM �'-
7. DOES WELL REPLACE EXISTING WELL? YES RM NOD � �M
8. STATIC WATER LEVEL Below Top of Casing: -1 3 FT.
(Use '4' If Above Top of Casing)
9. TOP OF CASING Is 2 FIT. Above Lend 8uffaoe• �
'Top of casing terminated aVor below lend surface requires a variance In accor-
dance wlth 15A NCAC2C .0118
10. YIELD (gpm): 'I METHOD OF TEST By Air Test n
11. WATER ZONES (depth): N —'
o
12. CHLORINATION: Type hth Tabs Amount 26 if additional space Is needed use back of form
13. CASING:
Wall Thickness LOCATION SKETCH
Depth Dl?rAetor or weiawn. rlatedal (Slow dlreclibn and distance from at least two State
From 0 To 30 Ft. 6 4 P c Plas tic Roads, or other map reference points)
From To FL
Frorn To Fl. A
14. GROUT:
Dept1t Material Molh 1
d o
From 0 To l0 FI Grout Poure� v
Front To FI. , n
15. SCREEN: O
Depth Diameter Slot Slz6 Malollal L
From To FI In. In. o
From To Ft. In. In. �' Dpt1J ST
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 ISA NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD 1­1 EN PROVIDED TO THE WELL OWNER.
FOR OFFICE USE.ONLY 11-24-
QO
Ouad No: SIOf TURF OF PERSON COf TING THE WELL DATE
`-----Submit original to Division of Water Ouallty, roundwater Section within 30 days
Serial No. I 1 OW-1 REV. 12/99
'MAR -
5 2001
.;c011
�.n

r r .
North Caroline - Department of Environment and Natural Resources - Division of Water Ouallty - Groundwater Section r r [�(�
1636 Mall Service Center - Relelgh, N.C. 27699.1630•Plrone [phone] 9 . 4t3 6 1.) iJ
WELL CONSTRUCTION RECORD WELL CONTRACTOR: Hickory W 1 1 D i 11 in2 Co.
WELL CONTRACTOR CERTIFICATION #: 2343
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE (Check Applicable Box): ResldenllaO Municipal ❑ Induslrlal ❑
Recovery ❑ I feat Purnp Water Injection ❑ Other C] It Other, Llst Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: Morpanton County:
Burke
(Flood Name and Numbers, Community, or Subdivision and Lot No.) DRILLING LOG
3. OWNER Jack Lackey Const./John & Betty Lantorct From To
Address 3872 Stoupe
191reel or Houle—No.
Mnr2antnn NC, 28655
Agricultural ❑ Monitoring ❑
DEPTH
Forrnallon Description
City Yr Town Slate Zip Code
4. DATE DRILLED 11-10-00
5. TOTAL DEPTH 269
�
6. CUTTINGS COLLECTED YES [^� NOEd
7. DOES WELL REPLACE EXISTING WELL? YES (� NO�]
T
��
8. STATIC WATER LEVEL. Below Top of Casing: 20 FT.
1
=F_Ln
e
,
(Use '+' II Above Top of (5asing)
Ca
gErr';
9. TOP OF CASING IS FT. Above Land Surface*
'Top of casing terminated at/or below lend surface requires a variance In accor-
r-D
dance with 15A NCAC 2C .0118
rn
10. YIELD (gpm): L_ METI IOD OF TEST By Air Test
.
r x
11. WATER ZONES (deplh):
N
—+
12. CHLORINATION: Type filth Tabs Amount 5-
13. CASING:
Wall Thickness
Depth Diameter or WelghUFI. Material
From To 20 Ft. k" GalV• Steel
Frorn To Ff.
From To _ Fl.
14. GROUr:
Depth Material Molhod
Frorn T'o 20 FL Grout Poured _
Frorn To -____ Ff.
15. SCREEN:
Depth
From
To
- From
To
From —To
16. SAND/GRAVEL PACK:
Depth
From
To
From
To_
17. REMARKS:
Dlarnoler Slot S1z6 Material
Ft In. In.
Ft. In. In.
Ft. In. In.
rt.
Ft.
Size Material
0
z
If additional space Is needed use back of form
LOCATION SKETCH
(Show directibn and distance from at least two Slate
Roads, or other map reference points)
0 �,90;°�
1
lD r ou
za
/LIG�GAd1�TG�
�D
S
DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORD WITH ISA NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF ITS RECORD Ft PROVIDED TO THE WELL OWNER.
FOR OFFICE USE mI(,, 11-24—
Quad Not ( _ ' 4 'SIOpNAIURE OF PERSON CONS CTINO TIIE WELL DATE
SUb�rlll od�ta} to Dlvlslon of Wale( Ouallly, Oroundwaler Section wllltin 30 days
Serial No.
MAR - 5 2001
OW-1 REV. 12/99

North Carolina - Department of Environment and Natural Resources - Division of Water Ouslity - Groundwater Section ;2 2 3 6 7 O
1636 Mail Service Center - Raleigh, N.C. 27699.1636-Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR: Hickory Well Drilling Co. „
WELL CONTRACTOR CERTIFICATION N: 2343
STATE WELL CONSTRUCTION PERMITN:
1. WELL USE (Check Applicable Box): Residential ❑ Municipal ❑ Industrial ❑ Agricullural ❑ Monitoring ❑
Recovery ❑ I•feat Purnp Water Injection ❑ Other[] It Other, List Use:
2. WELL LOCATION: ( � C a r CI Sh w sketQIt of the location below
Burke
Nearest Town: County:
Mt. Hebron Church Rd.
(Road Name and Numbers, Community, or Subdivision and Lot No.) DRILLING LOG DEPTH
3. OWNER Phillip Cobb Young ConStrLICti0 CO From To FormellonDescdpllon
Address PO Box 1.92
Icard reeNTz1To e o. 28666
City or Town State Zip Code
11-20-00
_
p
4. DATE DRILLED �.
5. TOTAL DEPTH _—
-�
6. CUTTINGS COLLECTED YES ❑ NO®
rn
i
7. DOES WELL REPLACE EXISTING WELL? YES E] NO® co
c
8. STATIC WATER LEVEL Below Top of Casing: 40 FT.
Aa
(Use '+' If Above Top of Casing)
2
rTi M
-M
9. TOP OF CASING IS FT. Above Land Surface*
'Top of,casing terminated atfor below land surface requires a variance In accor-
rT1:7
dance with 15A NCAC 2C 0118
2 By Air Test
n
10. YIELD (gpm): METHOD OF TEST
11. WATER ZONES (depth):
z
12. CHLORINATION: Type hth Tabs Amount 77 If additional space Is needed use back of form
13. CASING:
Depth 4le(neter
From 0 To SO Ft.6 4
Front To Ft.
From To Ft.
14. GROUT:
Depth
From O To 20
Front To —
15. SCREEN:
Depth
From
To
From
To
From
To
16. SAND/GRAVEL
PACK:
Depth
Front
To
From
To
Wall Thickness LOCATION SKETCH
or Welght/Ft. Material (Show directibn and distance from at least two State
PVC Plastic Roads, or other map reference points)
Material Molh d
_Ft. Crout POured
_F1.
Diameter Slot Slz© Malerlal
Ft In. In.
FL In. In.
Ft. In. In,
Ft.
Ft.
Size Material
N
qd
17. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITI 115A NCAC 20, WELL
CONSTRUCTION STANDARDS, AND TI IAT A COPY OF THIS RECORD HA,%0110N PROVIDED TO THE WELL OWNER.
FOR OFFICE USE ONLY
Ouad No: SIONn unE OF PEnsON C(
Subrnll odglnal to Dlvision of Wele(Ouality.
SedalNo. ,' Lr (7
4 MAR - 5 2001
11-30-00
0 THE WELL DATE
Section within 30 days
OWI nEv. 12/99

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section 14 V
1636 Mail Service Center - Raleigh, N.C. 27699-1636-Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR:
WELL CONTRACTOR CERTIFICATION #: ,Sr
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: M o h ;i h' % o' County: 41
A/y G
(Road Name and Numbers, Communi or Subdivision and Lot No.) DRILLING LOG DEPTH
3. OWNER �1/7/4 �/&C S S From To Formation Description
Address �� ��l (I !rC 2J
— (Street or HOU18 o.
City or Town State Zip Code
4. DATE DRILLED
5. TOTAL DEPTH �•3-�
6. CUTTINGS COLLECTED YES ❑ NOQ
7. DOES WELL REPLACE EXISTING WELL? YES ❑ NOD
8. STATIC WATER LEVEL Below Top of Casing: ;!�') Fr.
(Use '+' if Above Top of Casing)
9. TOP OF CASING ISM 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 Amount If additional space is needed use back of form
13. CASING:
Depth C Diameter
From To _-Lw — Ft. �—
From To Ft.
From To Ft.
14. GROUT:
Depth
From To _
From To _
15. SCREEN:
Depth
From
To
From
To
From
To
16. SAND/GRAVEL PACK:
Depth
From
To —.
From
To_
17. REMARKS:
Wall Thickness LOCATION SKETCH
or Weight/Ft. Material_ (Show direction and distance from at least two State
`�14 /)S / (' Roads, or other map reference points)
Material Method
_ Ft.
— Ft.
Diameter Slot Size Material
Ft in. in.
Ft. in. in.
Ft. in. in.
Size
Ft.
Ft.
Material
wi
cn
VE
c�
C
o �.
M
r-n
--t
rCD
0
i
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCT y R �,S,QTIirTHT CC�YIS RECORD HAS BEEN PROVIDED TO THE WELL jN/ v n
FOR OFFICE 1)SI��ONLY �yJ i
Quad No. 11 '1 SIGN !IRE RE OF PERSON CONSTRUCTING THE WELL DATE
L_ Su ton i s at
to Di
vislon of Water Quality, Groundwater Section Within 30 days
Serial No. r ` 1 GW-1 REV. 12/99

NC DEHNR
DEM - GW SECTION
P.O. PDX 29535
RALEIGH, NC E76E6-0535
[phone]
WELL CONSTRUCTION RECORD
QUAD NO. SER. NO.
LAT LONG_
BASIN CODE
HEADER ENT. GW-1
ENT.
r.
1807
DRILLING CONTRACTOR: PITTMAN WELL BORING, LLC STATE WELL CONSTRUCTION
PERMIT NUMBER:
DRILLER REGISTRATION NO: 2567
1.
WELL LOCATION: (SHOW SKETCH OF THE LOCATION
BELOW)
NEAREST TOWN MORGANTON COUNTY:
BURK
RICH RD.
(ROAD, COMM., OR SUBDV. & LOT NO.)
DEPTH DRILLING
LOG
E.
OWNER TODD STILLWELL
FROM TO FORM.
DESC.
ADDRESS_597A RICH RD.
_
_MORGAONTON NC 28655
CITY OR TOWN STATE ZIP CODE
3.
DATE DRILLED: 11-14-00 USE OF WELL: HOUSE
4.
TOTAL DEPTH: 67'
$_
5.
CUTTINGS COLLECTED: YES NO XX__
6.
DOES WELL REPLACE EXISTING WELL? YES NO XX
_rq_
c�
7.
STAT. WAT. LEVL. BEL. TOP OF CASING 47_FT.
( USE + IF ABOVE TOP)
8.
TOP OF CASING IS 18" ABOVE LAND SURF.*
-+�-
9.
YIELD (GPM): E0' METHOD OF TEST -STEEL TAPE
rn
10.
WATER ZONES (DEPTH) :
'-
M-n
11.
CHLORINATION: TYPE CLOROX AMOUNT 1/2 GAL
o
12.
CASING:
W. THICK.
DEPTH DIA OR WT/FT. MTL
--------------------------
FROM __0-TO_67_FT. _24"� _CONC-
LOCATION SKETCH
FROM TO FT.
13.
GROUT:
HWY. 64 E. FROM RUTH.
GO 5
DEPTH MATERIAL METHOD
MILES PAST HWY. 226
TO
FROM CEMENT` POURED
BRENDLETOWN FD. LEFT
ON
-0-T0_E0-FT.
FROM TO FT.
�.
RICH R. 2ND DRIVE ON
LEFT.
14.
SCREEN:
DEPTH DIA SLOT SIZE MTL
FROM TO FT. IN. IN.
FROM TO FT. IN. IN.
FROM TO FT. IN. IN.
15.
SAND/GRAVEL PACK:
DEPTH SIZE MATERIAL
FROM_47' _TO_67' _FT. --NO. 6M,_ STONE
16.
REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
15A NCAC 2C, WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD
--AA�.---laEE'.N--, ''R:OV IDED /TO -THE WELL OWNER.
.lil I
SIGNAT OF CO TR� R�OR GENT DATE
i

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section r) � (� 1 �•`
1636 Mail Service Center - Raleigh, N.C. 27699-1636-Phone [phone] '� 8 `J O
WELL CONSTRUCTION RECORD WELL CONTRACTOR: Yadkin well Company Inc.
WELL CONTRACTOR CERTIFICATION #: aL5721
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE (Check Applicable Box): Residential Municipal Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water InjectionEl[ Other ❑ If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: County: �—•�'
(Road Name and Numbers, Community, or Subdivision and Lot No.) DRILLING LOG DEPTH
3. OWNER IV i24=d2lw a 92 X-4 310 kICCIFrom To , Formation Description
Address 1i 62 1 r
Street or oue o.
City or Town State Zip Code
4. DATE DRILLED l "p- Uo
5. TOTAL DEPTH / 00.2�ra G� rc r %+.f /lVa / 00 os?
6. CUTTINGS COLLECTED YES ❑ NO®
7. DOES WELL REPLACE EXISTING WELL? YES ❑ NO®
8. STATIC WATER LEVEL Below Top of Casing: 20' FT.
(Use'+' if Above Top of Casing)
9. TOP OF CASING IS FT. Above Land Surface- bo
'Top of casing terminated at/or below land surface requires a variance In accor-
dance with 15A NCAC 2�0118
10. YIELD (gpm): .,L METHOD OF TEST 4� 5
11. WATER ZONES (depth): ?
• a� � z
12. CHLORINATION: Type HTH Amount If additional space is needed use back of form
13. CASING: (�
Wail Thickness
Depth Diameter or Wei ht/Ft. . Material
Fro To/20 Ft. • 7•r 1s2► —P VC. -
From To Ft.
From To Ft.
14. GROUT:
Depth M terial Method
From _� To �Ft. SI a
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
From To Ft.
Material
LOCATION SKETCH t
(Show direction and distance fro at tsa.V two State
Roads, or other map refemn ofints),
si
laW04
Y.
GJ ire r �+ w
From To Ft.
17. REMARKS: ��yy
I DO HEREBY CERTI T ATTH LI:LUn UCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STAI DS, AND THAT A COPY t,"
IS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
JAN 2 6 2001
FOR OFFICE USE ON
Quad No: _ 66NAT,
W6F PERS6f4 CONSTRUCTING THE WELL DATE
t:r�ijrV.1wSbbmttrftTnal to Di on of Water Quality, Groundwater Section Within 30 days
Serial No. I }»I1FNUlP, �' nit rt�l n� 4�'c _ .b GW.1 REV. IV"
;e.-. T,,., �,

13 North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section C. �. 8
1636 Mail Service Center - Raleigh, N.G. 27699-1636-Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR: _�e 1, 1
WELL CONTRACTOR CERT (CATION #: a3 Zc r'�� /CvyvF
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE (Check applicable eox): Residential a Municipal ❑ Industrial ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATION: Show sketc o the location below)
(Show
Nearest Town: . %"Cl'l County: J `
Agricultural ❑ Monitoring ❑
(Road Name and Numbers, Community, or Subdivisio and Lot -Ala).
DRILLING LOG
DEPTH
3. OWNER, � C
From To
Formation Description
Ci ��^
/0/'
Address G A,, 4 AW
�S _
treet or out
L �i� e/l CI•� j�5 � L c iG—iG_ 2
�G r
UG
City or Town State Zip Code
If '
=�
4. DATE DRILLED
5. TOTAL DEPTH, 6324EL
6. CUTTINGS COLLECTED YES ❑ NO
!
7. DOES WELL REPLACE EXISTING WELL? YES NO❑
M
S. STATIC WATER LEVEL Below Top of Casing: FT.
(Use •+' if Above Top of Casing)
9. TOP OF CASING IS(9� FT. Above Land Surface -
p,
`Top of casing terminated at/or below land surface requires a varlance)nAccor-
rn
dance with 15A NCAC 2C .0 18 /j r� l�S /
METHOD OF TEST
�—�rn
10. YIELD (gpm):
11. WATER ZONES (depth):
c)
12. CHLORINATION: Type Amount
If additional space is needed use back of form N
o
13. CASING:
Wall Thickness
Depth
From To
Ft.
Dieter or W igh� t. Maw
y C
From To
Ft.
From To
Ft.
14. GROUT:
Depth
2e
Vatena,1- 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.
16. SAND/GRAVEL PACK:
Depth
Size Material
From — To
Ft.
From To
Ft.
17. REMARKS:
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other map reference points)
I DO HEREBY C �T'I , t Hsi° T i}3 �/EC WA ' TRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTIONySTDARDS ANO THAT A jF THIS REC D HAS BEEN PROVIDED TO THE WELL OWNER.
FOR OFFICE USE*Y
Quad No: E 6; SIGNATUR 0 PER N C STRUCTING WELL DATE
Wat Ou ,Groundwater Section within 30 days
•--r tC itidtdtlifi3 i9i 9t>ftt original to vision
Serial No. F� _ 011 ilia c" IOn °�1iik, ., GW-1 REV. 12/99

North Carolina - Department of Environment and Natural Resources - Divi ,inn of Water nunlity - Groundwater Section 226510
1636 Mail Service Center -Raleigh, N.C. 27699.1636-Phone (9I M 733-3 2 1
WELL CONSTRUCTION RECORD 1MELI_ CONTRACTOR: )►`%�4 cY��`l.)�.�� ZQ ,' JcJ
WELL CONTRACTOR CERTIFICATION d:�r ��cJQ 3
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE (Check Applicable Box): Residential L_J Municipal ❑
Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑
If Other, List Use:
2. WELL LOCATION: JShow sketch of the location below)
1
Nearest Town: � Z46En)� rr�!» County: _ � R ke-.
C;C)
(Road Name and Numbers, Co,=9 , r ubdivision and Lot No.)
3. OWNER S
DRILLING LOG DEPTH
Address
From To Formatio Description
treel or oTi�uto rToT
City orT n Stare--
4. DATE DRILLED 1G'' / &- GcD ------
5. TOTAL DEPTH 4J d
_
6. CUTTINGS COLLECTED ES ❑ NO�i
_"-•-_.""__.__,_._____.
7. DOES WELL REPLACE EXISTING WELL? YES
8. STATIC WATER LEVEL Below Top of Casing: FT.
(Use '+' if Above Top of Casing)
9. TOP OF CASING 15 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): 610 METHOD OF TEST
11. WATER ZONES (depth):.. / y G5 _ WE3 Slit �Dr
12. CHLORINATION: Type c hk e­ue%� Amount '77rbC
If additional space is needed use back of form
13. CASING:
Wall Thickness
Depth Diameter
LOCATION SKETCH
r� or Weight/Ft. Material
Fromy To 7� Ft. -?VC-
(Show direction and distance from at least two Stale
From To qq Ft.0 / s 4V__
Roads, or other map reference points) o
C]
From To Ft.
no
14. GROUT:
cv _ i C.;
Depth Material Method
From To cEO Ft. s
r +;
--
FT-
From To Ft.
rC
n
15. SCREEN:
�;
Depth Diameter Slot Size Malorial
From To Ft in. in.
�p o
From To Ft. in. in.From
To Ft. in, in.
16. SAND/GRAVEL PACK:
Depth Size Matefial
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 0�41­1IS RE IAS BEE pROVIDED TO THE WELL OWNER.
FOR OFFICE USE ONLY
Quad No: SIGNATURE OF PERSON CONSTRUCTING THE WELL
Submit original to Division of Water Ouality, Groundwater Section within 30 days
Serial No.
JU-/9-
DATE
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: ✓� r'// �i✓C.
WELL CONTRACTOR CphTIFICATION #:sJ7��
-- i.� STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE (check Applicable Box): Residential E Municipal ❑ Industrial ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATION: (Sho__al} etch Qf the location below)
Nearest Town: C ���/ County: ud-C
Agricultural ❑ Monitoring ❑
(Road Name and Numbers, Community, //or Subdivision and Lot No.) DRILLING LOG DEPTH
3. OWNER / F� � Fo tion Descnob. n
Address �►/I�'l/ �cc 0� riC �71e c c
trees or outs No.) b�(�` �( P
City or Town State Zip Code
4. DATE DRILLED - a `� U0
5. TOTAL DEPTH S
6. CUTTINGS COLLECTED YES ❑ NOE-:3-<
7. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
8. STATIC WATER LEVEL Below Top of Casing: L 5r FT.
(Use '+' it Above Top of Casing)
9. TOP OF CASING IS FT. Above Land Surface'
'Top of casing terminated ottor below land surface requires a variance In accor-
dance with 15A NCAC 2C .011 a-
10. YIELD (gpm): 3 METHOD OF TEST i t rr
11. WATER ZONES (depth):
12. CHLORINATION: Type Amount If additional space is needed use back of form
13. CASING:
Wall Thickness LOCATION SKETCH
Depth Di eter or We yh t. Matedfi (Show direction and distance from at least two State
From To ` 2 Ft. — '> Z Roads, or other map reference points)
From To Ft.
Ci A
From To �Ft.' ' �rn
14. GROUT: c�_-m
Depth ��aterial Method --
From To�� Ft. C Y".`��_ /1� iXf'G/ rn
From To Ft. Mrn
o
15. SCREEN: cn r
Depth Diameter Slot Size Material
From To Ft in. in. r.1t o
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 CERTI�-Y It 1T"i F 11 t L - S CONSTRUCTED IN ACCORDANCE�IOVIDED TO THE WELL OWN H.
CONSTRUCTION ST41)4D�, A(; 3 i i Ak OF THIS R ORD HAS FEW
II ��
FOR OFFICE USF ONLY 9 ii
Quad No: t_ �� $IGNATUR F P SON CONSTFi NG THE WELL DST
Submit original to gfvi n 41,Water Quality, Groundwater Section within 30 dad
Serial No. i ..... t GW-1 REV. 12/99

North Carolina - Department of Environment and Natural Resources - Division of Water Quality -Groundwater Section
3705
1636 Mali Service Center - Raleigh, N.O.27999-1e39-Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR: Hickory Well Drilling; Co.
WELL CONTRACTOR CERTIFICATION #: 2343
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE (Check Applicable Box): Residential U Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heal Pump Water lnjeolion ❑ Other [] if Other, List Use:
2. WELL LOCATION: (Show sketch of the location below) Burke
Nearest Town: Morgan ton County:
Theodore Trail
(Road Name and Numbers, Community, or Subdivision and Lot No.)
3. OWNER Dorothy Townsend % Ernest Townsend
Address - - — -
rea or "GUID o.
City or TomyX6 Slate Zip Code
4. DATE DRILLED 10-11-00
5. TOTAL DEPTH 505
6. CUTTINGS COLLECTED YES ❑ NO®
7. DOES WELL REPLACE EXISTING WELL? YES ( NO[�
8. STATIC WATER LEVEL Below Top of Casing: ; ,fZ_ Fr.
(Use'+' It Above Top of Casing)
9. TOP OF CASING 18 2 FT. Above Land Surface,
'Top of cuing terminated aVor below land surface requires a variance In accor-
dance with 15A NCAC.2C.011a By Air Test
10. YIELD (gpm): METHOD OF TEST
11. WATER ZONES (depth):
12. CHLORINATION: Type
13. CASING:
DRILLING LOG
From To
_ DEPTH
Formation DescrfpUonc?
O "^
O
c7
_
�
iM
t
�rn
� E
CO
vEM
—o
—r z_
_
�
N
—t
_T
t a s Amount It additional space Is needed use back of form
Depth Diameter
From 0 ---To -115-- Ft. 1�
From To FI.
From To Ft.
14. GROUT:
Depth Molorial Mothod
From __ Q___ To 4LJ_ Ft. C'rnl t t- Pnl trpd
From To Ft.
15. SCREEN:
Depth Diameter Slot Slzo Material
From To FI In. In.
From To Ft. In. In.
From To Ft. In. in.
16. SAND/GRAVEL PACK:
Depth Size
From To FI.
From To Ft.
17. REMARKS:_
Wag Thickness LOCATION SKETCH
or Welght/Fl. Material (Show directibn and distance from at least two Slate
PVr _ aaS..ti-C Roads, or other map reference points)
Material
i DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN
CONSTRUCTION STANDARDS, AND THAT A COPY 0k%1q RECC
FOR OFFICE USE
Quad No:
Serial No.
P .
Gam• ,yicn
W V,
k
.c.
S
WITH ISA NCAC 2C. WELL
PROVIDED TO THE WELL OWNER.
`11 YI , f Fm ,UnE OF PEnsoN CON90UCTINO THE WELL
Submit origIna bfslon al Water Ouallly, Groundwater Section within 30 days
Nei,\R
10-17-00
DATE
(3W.1 REV. 12/99

2"237-0G
North Carolina • Department of Environment and Natural Resources • DMalon of Water Quallty, - Groundwater Section
193E Mail Service Center • Raleigh, N.C. 27699.1636-Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR: Hickory Well Drilling Co.
WELL CONTRACTOR CERTIFICATION #: 2343
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE (Check Applicable Box). ResidentiallM Municipal [] Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ other[] if Other, List Use:
2. WELL LOCATION: (Show sketch of the location below) Rt irke
Nearest Town: _ Hi 1 dehran County:
9324 Costner Road
(Road Name and Numbers. Community, or Subdivision and Lot No.) ORILLINQ _LOG
3. OWNER Louise Cooke From To
Address 9324 Costner Rd. —
Hlckory (Street or FIT fqo.j28602 0
City or Town Stale Zip Code O
4. DATE DRILLED 10-12-00 ;u
S. TOTAL DEPTH _-2-2-5 r'
6. CUTTINGS COLLECTED YES 0 NOJ—m]
7. DOES WELL REPLACE EXISTING WELL? `VtS ® NOD t ��
S. STATIC WATER LEVEL Below Top of Casing: 60 FT.
(Use .+- It Above Top of Casing) m
9. TOP OF CASING IS _2__— FT. Above Land Surface* Uri
-Top of casing terminated at/or below land surface requires a variance In accor- .. M W
dance with 15A #CAC 2C .C115
10. YIELD (gpm): .A -METHOD OF TEST By Air r TAs t• z
11. WATER ZONES (depth):
12. CHLORINATION: Type t a S Amount If additional space Is needed use back of form
13. CASING:
LOCATION SKETCH
Walt Thickness
0 Depth 126 pyiReter or SWealo V • Me 181 (Show dlrectlbn and distance from at least two State
From —.0 To Ft. b li 1 Roads, or other map reference points)
From To FI.
From To Fl.
14. GROUT:
Depth Material Mothod
From --a— To 20 Ft. Grolt Pnttred
From To Ft.
15. SCREEN:
Depth Diameter Slot Size Material
From To Ft Ill. In,
From To Ft. In. In.
From To Ft. In. In.
16. SAND/GRAVEL PACK:
Depth Size
From To Ft.
From To Ft.
17. REMARKS:-
Material
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN
CONSTRUCTION STANDARDS. AND THAT A COPY OF THIS RECC
FOR Of
Quad No:
Serial No.
A/
Ul)
�2
S
f0 ��u/EW
JATURE OF PERSON C(
Division or Water Quailly;
DEPTH
Formation Description
WITH ISA NCAC 2C. WELL
PROVIDED TO THE WELL OWNER.
10-17-00
iCTING THE WELL DATE
Hater Section within 30 days
OW-1 REV. 12/99

North Caroline • Department of Environme 7 an Natural
Resources (9 9) 733i322jn of Water Quality • Groundwater Section tj
1636 Mail Service Center Raleigh, N.C. 2
WELL CONSTRUCTION RECORD WELL CONTRACTOR: H j "kory Well Drilling CO.
WELL CONTRACTOR CERTIFICATION #: 2343
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE (Check Applicable Box): Residential
❑ Municipal ❑ Industrial
U�❑e: Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Ina ❑ ❑ It Other, List
2. WELL LOCATION�(Slhoese etch of the location below) Burke
Nearest Town: a cCtl County:
3314 High Peak Valley Rd. DEPTH
(Road Name and Numbers, Comrmnlly, or Subdivision and Lot No.) DRILLING_ LOG
From To Formation description
3. OWNER 11Pnn-
Address 3314 Hi Drh Peak Valley Rd.
as or ou aNCo. 28690 »
Valdese City or Town 10-09-0� late m Zip Code
T� M
�
4. DATE DRILLED
5. TOTAL DEPTH jb�)-
6. CUTTINGS COLLECTED YES 0 NOO
7. DOES WELL REPLACE EXISTING WELL? YES [M NOFJ rn
8. STATIC WATER LEVEL Below Top of Casing:.GO-- FT. N�
(Use *' If Above Top of Casing) r -
9. TOP OF CASING IS
FT. Above Land Surface' n
'Top of casing terminated ■Uor below land surface requires a vorlance In accor-
dance with 15A NCAC 2C .01111
10. YIELD (gpm): S METHOD OF TEST By Air Test
11. WATER ZONES (depth):
12. CHLORINATION: Type hth Tabs Amount 64 If additional space Is needed use back of form
13. CASING: LOCATION SKETCH
wan Thickness
Depth meter q�r y5yy IghUFI I�aledal (Show directibn and distance from at least two State
61 6'4 YVL Plastic weds, or other map reference points)
From 0 —To Ft. �
From TO Fl. A/
From To Fl.
14. GROUT: 1
Depll Mr v1 of lhod,
Grout E'o
From 0 To �0 Fl.
Fiorn To Ft.
15. SCREEN:
Depth Diameter Slot Sizo Material yAGN Pam./ f
V.q(�c
From To Ft In. In. -- R V�i .
From To Fl. In- In. —
From To Ft. In. In.
kA
16. SAND/GRAVEL PACK:
Depth Size Melollal
From To Ft.
From To Fl.
17. REMARKS:
100 HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C. WELL
CONSTRUCTION 3TANDARD3, ANO THAT A COPY OF THIS RECORD HAS PROVIDED TO THE WELL OWNER.
q�� � •F 10-18-0
FOR OFFICE USE ONa ONAT ;RE OF PERSON CON O THE WELL GATE
Ouad No:
( ; Subrnp,od Inel 16INvislon of Water Ouelily. O ndwater Section within 30 days
MAR
nnffy} OW-1 REV. 12/99
Serial No. � i�AR � � �������

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
�23'708
1 m Mall service Center - Raleigh, N.C. 27699.1636-Phone [phone]
WELL CONSTRUCTION RECORD WELLCONTRACTOR: Hickory Well trilling CO.
WELL CONTRACTOR CERTIFICATION #: 2343
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE (Check Applicable Box): ResidenllelffI Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other 0 It Other, List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: _N awl ;ran County: lurk -
.....
(Road Name and Numbers, Community, or Subdivision and Lot No.)
3. OWNER RLIW Keller —
Address
Hickory
(Street or ou e o. C 28602
-
City or Town State Zip Code
4. DATE DRILLED
5. TOTAL DEPTH
6. CUTTINGS COLLECTED YES ❑ NO{El
7. DOES WELL REPLACE EXISTING WELL? S ® NO❑
8. STATIC WATER LEVEL Below Top of Casing: �1-_32 FT.
(Use *+* it Above Top of Casing)
9. TOP OF CASING ISM— FT. Above Land Surface'
*Top of casing terminated sVor below land surface requires a variance In accor-
dance with 15A NCAC 2C .011e Rv Air Tact -_
10. YIELD (gpm): ._19- METHOD OF TEST
11. WATER ZONES (depth):
12. CHLORINATION: Type
hth Tabs
ount 99
13. CASING:
Wall Thickness
Depth
D�a�eier
Ga�lv71 Steel
138 Fl.
From
—To
From
To —
From
To
Fl
14. GROUT;
0
tU "IU
Grout MaroNat
p
Poured d
From
To
Fl
From
To
Fl.
15. SCREEN:
Depth
Diameter Slot Slzo Matellal
From
To
Ft In.
In.
From
To
Ft. In.
In.
From
To
Ft. In.
in. --
16. SAND/GRAVEL PACK:
Depth
Size
Material
From To Fl
From To Ft.
17. REMARKS:
DRILLING —LOG DEPTH
From To Formation Descapilon
p
ra
=�
D•
p m
CO
arI
n
� r•ry
�
m� -
n�
.n..r
N
o
It additional space Is needed use back of form
LOCATION SKETCH
(Show dlrectibn and distance from at least two State
Roads, or other map reference points)
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCOR1
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS
60
FOR OFFICE USE ON' z�t �1,
Quad No: C t 5N T E OF PERSON CC
{ Submll orlpinaf o�14sion of Water Quality,
Serial No. r
X Wi� �2001 l�r`
J6
S
WITH 15A NCAC 2C. WELL
PROVIDED TO THE WELL OWNER.
3 TIIE WELL DATE
Section within 30 days
OW1 REV. 12/99

North Caroline - Department of Environment and Natural Resources - Division of Water ouelity - Groundwntnr Serllon 2 3 71
1636 Mall Service Center - Fteleiph, N.C. 27699.1636-r irons [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR: llickorY Well Drilling Co.
WELL CONTRACTOR CERTIFICATION M: 2343
STATE WELL CONSTRUCTION PERMITM:
1. WELL USE (CheckAppllc■ble Box): Resldentlal Municippl Industrial ElAgrlculturnl U Monitoring El
Recovery ❑ Heal Pump Writer Injection%] Other 1-1 If Other, List Use:
2. WELL LOCATION:,�S Ijjo��(vV akelch of 111e locatlorl below)
Nearest Town: Ellldebrall —__-- Counly: l3uL kc
8724 County Line Rd.
(nond Nnme and Numbers. Cornrnunlly, or Subdlvl+Ion and [.of No.)
3. OWNER Les Ingle ---------.._.._._
Address 724 -
Hickory ree o o � 0. -- 28601--
Cily or Town State zip code ---
_ DRILLING LUG
from To
DEPIII
•rmrnnllnn neerrrpllnn
4. DATE DRILLED 10-20-00----------...__...-- -- -
-----------�
--
5. TOTAL DEPTH 1 h S
_.. _p....._.�:
---•
6. CUTTINGS COLLECTED YES [ _1 NoUl -
- L
7. DOES WELL REPLACE EX19IING WELI_7 YF3 FY) I'lo
8. STATIC WATER LEVEL Below Top of Cnsing:F 1. _ .... _ ..
_... _. _.__.ra
._
--�(Z--
(Use -r•' It Above Top or Cneing)
....r.«c
. .
9. TOP OF CASING IS i FT. Above Lnnd Surrnre'
="M
'Top of cesinp lerminsled sVor below lend surface require■ s vnrrnnce In ncnnr•
___
__.._..__.__
l
—
dence,wllh 1SA NCAC Z0110
Air Ies L
10. YIELD (gprn); METHOD OF TEST _ -- -- - _- _
r
11. WATER ZONES (depth): ----- ------ — — — —------- — ----
— -- - — ---"
12. CHLORINATION: Type hth Tabs—Arnounl—24
13. CASING:
LOCATION SKETCH
Wall Thickness --'—
gr}y�plrVrl, Mnlerinl , (Show dlrecllbn end distnnce Ironl Ill lengl IWo S1nle
f'Vl, _ ['l-aS L_I.0 Bondn, or olhnr tnnp minrence points)
0 Depth 67 DlipyVnr
Frorn To Ff. b
Frorn To Ff.
From To— Ff,
14. GROUT:
Depth Malorinl Moihnd
From 0 — To 20 Ft. C;rcrt 1tFrom To Fl.—_--
15. SCREEN:
Depth
Diameter
From -- To
Ft _ In
From To
Fl. In
From To
Ff. III
16. SAND/GRAVEL PACK:
Depth
Sire
From To
rI. ---
Frorn To
Ft.
17. REMARKS:
Slot SI7h MnImInt
Mnlerl:►I
If eddllionni span space Is neded use bnck of forIn Z
DO TIEREBY CERTIFY THAT TI IIS WELL WAS Coris i num ED IN ACCOr1UAN
CONSTRUCTION STANOAnDS, AND T1IAT A COPY OF T111S RECORD I IAS
FOR OFFISWO1gLYN� glollATUnE or rEIISON CONST
Suf IIll:oilolrlai to Division of Wnler Ounllty, drat
Serial No.
WI I11 15A NCAC 20. WELL
InOVIDEO TO 111E WELL OWNcn.
3 TIIF.. WELL DATF.
Secllal Willthl 30 days
OW-1 fiEv. 17199
5-00

371
North Carolina • Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mall Service Center • Raleigh, N.C. 27e99-163e.Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR: Hickory Well Drilling -.Co.
WELL CONTRACTOR CERTIFICATION N: 2343
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.
3.
WELL LOCATION: (Show sketch of the location below)
Nearest Town: Connel ly Springs County: Burke
5722 Mi11Pr B idge Rd.
(noad Name and Numbers, Comrnunlly, or Subdivision and Lot No.) DRILLING LOG
OWNER Irene Lail ^—_ Frorn To
Address 57 2 11 R —
2 rae or ou e t o f llri .--_
City or To Slate No 21p Code
4. DATE DRILLED 10-24-00
5. TOTAL DEPTH _1109
6. CUTTINGS COLLECTED YES [_—] N
7. DOES WELL REPLACE EXISTING WELL? WS Fj NOE]
6. STATIC WATER LEVEL Below Top of Casing: g— FT.
(Use 's' If Above Top of Casing)
9. TOP OF CASING is 2 FT. Above Land Surface'
'Top of casing terminated aUor below lend surface raqulrss a variance In accor-
dance with 15A NCAC 2C .011E
10, YIELD (gpm): —1— METHOD OF TEST By Air TES t-
11. WATER ZONES (depth):
12. CHLORINATION: Type hth Tabs Amount 6h
13. CASING:
Well Thickness
Depth Diameter or WelglrVFl. Material
From To 19 5 Ft. 6:14" Cq 1 X7-- qtp)--
From To Fl.
From To FI. ---- — ---
14. GROUT:
Depth Matodal Molhod
From 0 To 20 FL Poured —
From
To ---FI.
15. SCREEN:
Depth
From
To Ft
From
To FI
From
To Ft
16. SAND/GRAVEL PACK:
Depth
From
To
From
To
17. REMARKS:
Diameter Slot Sizu Malollal
In.
In.
In.
In.
In.
In.
Size
Malerlal
FI.
Ft..
DEPTH
Formallon Descrlptlon
w
p
7� o
"U
rr, r`,
� i-ri
c�
If additional space Is needed use back of form)
--t
o
LOCATION SKETCH
(Show direction and distance from at least two
State
Roads, or other map reference points)
N
S�
_S
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCOR
CONSTRUCTION STANDARDS, AND TI IAT A COPY OF T1its RECORD F1A
FOR OFFICE USE ONLY
Ouad No: SIONATUnE OF PEnSON C(
jl Su�x.1i 6doln 110 Division of Waler Ounllly,
Serial No.
WITH 15A NCAC 2C, WELL
PROVIDED TO THE WELL OWNER.
10-31
0 TIIE WELL DATE
Secilon within 30 days
OWI nEV. 12/99

221201
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]
r` � .
WELL CO S RWCTION RECORD WELL CONTRACTOR:
l q , % WELL CONTRACTOR CER�IFICATIOIN #:,� ' ? ?
'i STATE WELL CONSTRUCTION PERMIT#:
1 WELL USE (Check Applicable Box): Residential L 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: I ? I� County:
(Road Name and Numbers, COmmu 'ty, or Subdivision and Lot No.)
f r G2�
DRILLING LOG DEPTH
Formation Descrip on
F _---
3. OWNER _ y
�7— `is
Address ���
�� T ,1.:%
lC
_3.41
treat or o e o.
City or Town State Zip Code
%U •-�
DATE DRILLED U
.
4.
DEPTH
5. TOTAL
6. CUTTINGS COLLECTED YES ❑ NOD
EXISTING WELL? YES ❑ NO�
c?
�-
o
�r
m^
7. DOES WELL REPLACE
8. STATIC WATER LEVEL Below Top of Casing: FT.
o
(Use •+• if Above Top of Casing)
r FT. Above Land Surface'
o'er`
9. TOP OF CASING IS __
*Top of casing terminated at/or below land surface requires a variance In accor-
3
;0 rn
dance with 16A NCAC 2C .0118
10. YIELD (gpm): 6/0 METHOD OF TEST s
w
mM
11. WATER ZONES (depth):
W
"'
Amount
If additional space is needed use back of form
Z
12. CHLORINATION: Type
_
13. CASING:
LOCATION SKETCH
Wall Thickness
Depth Di eter or W9igtVFt. Material
(Show direction and distance from a t two cafe
map referen a o' ts)
G, Ft.
Roads, or other
To
From®mac,
From To '--
From To
14. GROUT:
:,5 �'a- le
Depth Material �_ Method
7 .
From To CJ 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:
Materials
Depth Size
From To Ft. —
!
From _ To Ft.
17. REMARKS:
I DO HEREBY CERTIF�`,f' THATT)41 W L WA CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTI r8TAiyDkOD ; AID ij A�aA y OF THIS RECO D HAS BF,EN PROVIDED 70 THE WELOWNER.
y UG
FOR OFFICE U FuQ �Y I` I DATE
�il " IGNATURE O PE CONSTR NG THE W ELL
Guad No:„�� v•.I"
SubmitLci al to Divislon Wate�asitY• Groundwater Section within 30 days GW.1 REV. 17J99
Serial No.

North Carolina - Department of Environment and NaRlrrltl Re&WCeti • VMelon of Water Quality - Groundwater Section
1636 Mail Service Center - Raleigh, N.C. 27699-16311l+PfW W (919) •r*3221
WEST LINCOLN Wild, DR11A,1N3
WELL CONSTRUCTION RECORD WMLL CWRACTOR CERTIFICATION #: 2092
STATI: W9LL CONSTRUCTION PERMIT#:
Industrial ❑ Agricultural ❑ Monitoring ❑
1. WELL USE (Check ApplloafbN Box): Resident(�I[: 06P Q (f Other, List Use:
Recovery ❑ Heat Pump Water Injection
2. WELL LOCATION: (Sh lW sketch of the locatl0ll00IOW) r k�
Nearest Town:— ,,.,.,.�... Galnty,
�o►'�.. )RILLING LOG DEPTH
(Road Name and Numbers, Co unity: ubdivll$lGA VW I.* No.)
Formation Description
n ' / ; c K.� L.0.i I 'I" `i • Ain , mrl• � it��... From To
3. OWNER 6 r -- laq� r---
Address �) a i� r - 2i r rrtiii • �
N or outs o.)_ I G9
City or Town Slate
4. DATE DRILLED ) JQ `0O
5. DOTAL DEPTH
6. CUTTINGS COLLECTED YES ❑ NO
7. DOES WELL REPLACE EXISTING WELL? —
8. STATIC WATER LEVEL Below Top of CaIN.
(use '+' it AOM Tep OIMMW) _
9. TOP OF CASING IS j FT. Above L*W SWI(ic��
'Top of casing terminated atior below land surface rogw$4 • Vrt im" Ip Aqw'
dance with 15A NCAC 2C .0114
10. YIELD (gpm): 3— METHOD OF TE.JT .,.i. —
Pry) I I IYl 5
1 1. WATER ZONES (depth): 1 f
ran (ra r S' It additional space is needed use back of form
12. CHLORINATION: Type { AMOUrA ;
ZE
— c�
13. CASING: 4. LOCATION SKETCH
Was T1110A944 Vidal (� ow direction and distance from at least two State
Depth Diameter or W
From ► , fo— F1• �EUa' Roads, or other map reference points)
From—_
To
Ft. -- --
From
To
FI.— --�* —
14. GROUT:
Depth
` Material
To
FI.
From
_QQ_—
From —.--To
Ft. --
15. SCREEN:
Depth Diameter Slot Silo dolls"
From --
To Ft
in. —
From _
To Ft.
in. ---. 111..•„* —^.�--
Fron1
To Ft.
In. ------------
16. SAND/GRAVEL,:YA(.K::
From 1. ta44 to
From 4 �iTo�.�.--• tFit
17. REMA Ali s
i
1 DO I1REBY Cl;♦Tftf3tlEaTi1A"TGiliFi
CONS7RU97I,I04%
FOR OFFICE USE ONLY
Quad Nu:
Serial No.
Mrfl(efl�
1 rr1
0
• i 1
IV\
`� I 'L
S WELL",WAS QMMMWTF.O IN CCOFiDANCE WITH 15A NCAC 2C, WELL
NO --,HAT A COPY Of TWO RECO 10 HAS BEEN PROVIDED TO THE WELL OWNER.
v_
PTUNFAmpgf.50N CONSTRUCTING THE WELL DATE
Subn* or" 19 pWW" of W+1or Quality, Gruundwater Section within 30 days Gm REV 12/99

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
P.O. Box 29578 - Raleigh,N.C. 27626-0578-Phone [phone]
WELL CONSTRUCTION RECORD DRILLING CONTRACTOR: � ��� � �=�� t '2J,_&,Z.,
DRILLER REGISTRATION #:
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE (Check Applicable sox): Residential Q---lMunicipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATION: (Show sket •h of the location below)
Nearest Town: r"G; ;' County: ✓�% ��
(Road, Commur ity, or Subdivesio and Lot No.) DEPTH DRILLING LOG
3. OWNER ` From To Formation Description
ADD
7 pp (Street or Route No.)
City or Tom�tate Zip Code f�
4. DATE DRILLED
5. TOTAL DEPTH
6. CUTTINGS COLLECTED YES ❑ NO0
7. DOES WELL REPLACE EXISTING WELL? YES ❑ NO�-
8. STATIC WATER LEVEL Below Top of Casing: FT. c.
(Use'+" if Above Top of Casing)
9. TOP OF CASING ISFT. Above Land Surface* _
' Casing Terminated aVor below land surface is illegal unless a variance is issued
in accordance with 15A NCAC 2C .0118
10. YIELD (gpm): a % !METHOD OF TEST r 3 -
11. WATER ZONES (depth): -"
12. CHLORINATION: Type E —,/, Amount 144 If additional space is needed use back of foFO
13. CASING:
LOCATION SKETCH
Depth
Wall Thickness
Diame�er or Weight/Ft. aterial
(Show direction and distance from at least two State
From —L— To 6 7�
Ft.
Roads, or other map reference points)
From
To
Ft. --
From
To
Ft.
14. GROUT:
Depth
To )
Mat rial thod
Ft.
From
From
To
Ft.
/y
15. SCREEN:
y /
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/
2�' '(7
From
To
Ft.
From
To
Ft.
S
17. REMARKS:
I DO HEREB T I€itiNd� ONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUC t�CJt S N R 6 N�j%TF-iST _ PWF THIS RECORD HA�)EEN PROVIDED TO THE WELL OWNER.
Q00 SIGNATURE OF CONTRACTOR OR AGENT ATE
Submit original to Division of Water Quality and copy to well owner.
GW-1 REV. 1/98

c l
NorRt Carolina - Department of EnvimnmerK and Natural Rasourcwt - Division of Water ()ua&ty - Groundwater Section 4. 4 0 (J 5 6
1636 MAU Service Canter - Raleigh, N.C. 27699-16336-Phone (919) 793-=1
WELL CONSTRUCTION RECORD WELL CONTRACTOR: .lames W. Camp, Jr.
WELL CONTRACTOR CERTIFICATION #.- 2138
STATE WELL CONSTRUCTION PERMIT*:
1. WELL USE (Crteok Appucabte Box): ResidentiaJ G� Municipal ❑ Industrial ❑ Agricultural 0 Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, Ust Use:
2. WELL LOCATION: (SPOW 1Skgtch of the location below)
NoarestTown: County:4;2r,d Y K
(Road W1d_04Mbq45. Co ily, or AU401vision and Lot No.) DRILLING LOG DEPTH
3. OWNER J Ftorn .To For pescripw
Address 1/ A( e t r% 0 �.2 pt
rea o a a� 5 t n G
a 1c�es� L_ Gqo
city or Town State Zip Code
4. DATE DRILLED
5. TOTAL DEPTH
6. CUTTINGS COLLECTED YES [D NO
7. DOES WELL REPLACE EXISTING WELL? YES Ef NOE]
8. STATIC WATER LEVEL Below Top of Casing: FT. Ca
(Usa •+• It Above Top of Casing) _
9. TOP OF CASING 1S 1 FT. Above Land Surface'
'Top of casing terminated Wor below lend surface raqutrea a varleftae In accix- 1
dance with 15A NCAC 2C .011ti
10. YIELD (gpm): 50_ METHOD OF TEST Air -
11. WATER ZONES (depth): -o -
T2_ CHLORINATION: Type GrrO111110C Amounl If additional space is needed use back of form
13.-CASING: —'
0
Wall TNcknesa LOCATION SKETCH
Depth Diameter or WelIahVFL Material (Show direction and distance from at Isast two State
From 0 To � Ft. 6 tea SDR21 PVC Roads, or other map reference points)
From To Ft.
From To Ft.
14. GROUT:
Depth Material Method
From 0 To 20 Ft, Neat cement Hand
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 �� Cif
Depth Size Material
From To Ft. 1
From To FL
17. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A, NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY O ' HIS RECORD HAS BEEN P OVIDED TO TH WELL OWNER.
FOR OFFICE USE ON .� '�
Quay No: SlG NijAIE OF PERSON CONSTRUCTING TKEAWELDATE
6 Submit original to tH of Water Quality, Groundwater saction within 30 days
Serial No. �i )l� .
Gw-t Iv.1ti�

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] l 4.40686
(� [� p C
WELL CONSTRUCTION RECORD WELL CONTRACTOR:V tl C7 `)
WELL CONTRACTOR CE FICATION #:
STATE WELL CONSTRUC ION PERMIT#:
1. WELL USE (Check Applicable Box): Residential ❑ Municipal rll- Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATION: (Show 4etch of the location below) '�
Nearest Town: l
County: 1 "u (Z'i
C. rct J41 o e
(Road Name and Number , Commnity, or Subdivision and Lot No.) DRILLING LOG DEPTH
3. OWNER ' From To Formation Description
Address LIU
treet or hOU10 o. "" 57)
£rI y �a
City or T wn State Zip Code
4. DATE DRILLED
5. TOTAL DEPTH
6. CUTTINGS COLLECTED YES ❑ NOQ
7. DOES WELL REPLACE EXISTING WELL? YES NO©�
B. STATIC WATER LEVEL Below Top of Casing: r6® FT.
(Use '+' if Above Top of Casing)
9. TOP OF CASING IS FT. Above Land Surface'
'Top of casing terminated atlor below land surface requires a variance In accor-
dance with 15A NCAC 2C .011
10. YIELD (gpm): METHOD OF T T %¢- i
11. WATER ZONES (depth):
12. CHLORINATION: Type Amount If additional space is needed use back of form
13. CASING:
Wall Thickness LOCATION SKETCH
Depth Diameter or Weights. Material (Show direction and distance from at least two State
From To Ft. —,_ Roads, or other map reference points)
From — To—;5_3-- Ft.
From To Ft.
14. GROUT:
Depth Material Method Q
From To Ft.
From _402_ To 7_. Ft. _CZ
(� L
15. SCREEN: Y ;_
Depth Diameter Slot Size Material J�
D
From To Ft in. __,__ in.
From To Ft. in. in. «
From To Ft. in. in.
16. SAND/GRAVEL PACK: rV o
Depth Size Material From To Ft.
From To Ft.
17. REMARKS: `
I DO HEREBY CERTIFY THAT THIS WELL WAS CO ST CTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STAWQ.AHDS AND THAT A COPIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
FOR OFFICE USE ' r, JRJEJ _%4 1 - -
Quad No; RE F RSON CONSTRUCTING THE WELL DATE
�1'/ Submit origi vision at ater Quality. Groundwater Section within 30 days
Serial No. vy 2 1 200p GW-1 REV. 12/99

North Caroline Department of Bnvlronment and Natural nesouroea • Olvlslon of Waist Quality • Groundwater Bsollon �
1@qq Moll gerviGA G4nifi , Fiolifigh, N,B, g7o®q-1 pirone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR: Hickory Well Drilling Co.
WELL CONTRACTOR CERTIFICATION M: 2343
STATE WELL CONSTRUCTION PERMITN:
WELL USE (Check Applicable Box): Residential E3 Municipal ❑ Industrial ❑ Agricultural ❑ Monlloring ❑
Rocovery ❑ I -feat Pump Water Injeollon ❑ Other ❑ If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: Morganton County: Burke
' 11(; John r c River RCl
(noad Name and Numbers, Community, or Subdivision and Lot No.) DRILLING LOG
3. OWNER Jerry Gragg From To
Address I31 h 1p hn OR River Rd. `-
—"—(Sires or rioule No.)NC 28655 _
Morganton
City or Town Slate Zlp Code
4. DATE DRILLED 10-02-00
5. TOTAL DEPTH
6. CUTTINGS COLLECTED YES ❑ NOCJ
7. DOES WELL FIEPLACE EXISTING WELL? YES [—I NOM
6. STATIC WATER LEVEL Below Top of Casing: _C_ FT.
(Use '+' if Above Top of Casing)
9. TOP OF CASING IS 2 FT. Above Land Surface*
'Top of casing terminated sUor below land surface requires a variance In accor-
dance with 15A NCAC 20.0118
10. YIELD (gpm): -6 METHOD OF TEST By Air Test
11. WATER ZONES (depth):
12. CHLORINATION:. Type hth Tabs Amount 39
13. CASING:
Depth Dlirpptor
From 0 To 85 Ft. 6 4
Frorn To Ft.
From To Ft.
14. GROUT:
DEPTH
Formallon Description
r
—i
11 additional space Is needed use back of form
Wall Thickness LOCATION SKETCH
pVC
rryve►gl,UFt. ytaledal (Show directibn and distance from at least two Slate
Plastic Roads, or other map reference points)
Det�11
L�
Material Molh d
Grout Poured
From
To
Fl.
From
To
Ft. _
15. SCREEN:
Depth
Diameter Slot Slzo Materlal
From
To
Ft In. In.
From
To
Ft. In. In.
From
To
Ft. In. In.
16. SAND/GRAVEL PACK:
Depth
Size Material
From
To
Ft.
From
To
Ft.
17. REMARKS:
1 DO HERESY
CERTIFY THAT THIS WELL WAS CONSTRUCTED IN AC,
CONSTRUCTION STANDARDS, AND THAT A COPY OjaHIs nECOnD
FOR OFFICE USE ONLY
Quad No:
Serial No.
SIONATUnE OF PERSON C(
Subrnll original to Division of Water Ousllty,
C
S
WITH ISA NCAC 2C, WELL
PROVIDED TO THE WELL OWNEn.
1V—V0—VV
31116 WELL DATE
Section within 30 days
OW-1 nEV. 12/99

223' O42
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: Hickory Well Drilling Co.
WELL CONTRACTOR CERTIFICATION #: 2343
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE (Check Applicable sox): Residential El Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection 0 Other E ] II Other, List Use:
2. WELL LOCATION: (Show sketch of the location below)
Town: Hildebran County: Burke
Nearest
61 h Rd
(Road Name and Numbers. Community. or Subdivision and Lot No.) DRILLING LOG
_ DEPTH
3. OWNER Alton & Cathy Crowe From To
r
Formation Description
Address
r
tclreel or nuunx o.
City or own Stale Zip Code
4. DATE DRILLED 09-0026-
cr,r
5. TOTAL DEPTH
6. CUTTINGS COLLECTED YES O NOffd
WELL? YESP NOim8.
7. DOES WELL REPLACE EXISTING
STATIC WATER LEVEL Below Top of Casing: FT.
(Use '+' II Above Top of Casing) —
^-
rn
9. TOP OF CASING IS 2 _. FT. Above Land Surface'
*Top of coming terminated atior below land surface requires a vedence In accor-
dance with 15A NCAC 20.0116
10. YIELD (gpm): _12_ — METHOD OF TEST By Ai-,- TP a t-
z
11. WATER ZONES (depth):
12. CHLORINATION: Typ
13. CASING:
©
h th Tabs Aniounl 32 If additional space Is needed use back of form
Wall Thickness
Depth
60
Mmeter or Welght/Ft. Material
Ft64 PVC Plastic
From-0
To
From
To
Ft.
From
To
Fl
14. GROUT:
0
Dep
l0
Material Method
Grout Poured
From
To
Ft• _
From
To
Fl. --
_ —
15. SCREEN:
Depth
Diameter Slot Sizo Material
From
To
Ft In. In.
From
To
FL In. In.
From
To
Fl. In. In.
16. SAND/GRAVEL PACK:
Depth
Size Material
From
To
Ft.
From
To
Ft.
17. REMARKS:__
LOCATION SKETCH
(Show direclibn and distance from at least two State
Roods. or other map reference points)
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 B N PROVIDED TO THE WELL OWNER.
10-12-00
FOR OFFICE USE ON "Y ,. DATE
Quad No: N U I', IONA RE OF PER RUCTING TtiE WELL
SwMnil o�Ig to Division of Wale(Quellly. O or Section within 30 days QW t REV 12199
Ser1a1 Na.
T ➢ 19 MI\p - 5 ?_001

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section L
1636 Mail Service Center - Raleigh, N.C. 27699-1636-Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR:
WELL CONTRACTOR C RTIFICATION #: �'V l lc9t�t' �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 etch of the location below) /� J
64"0 07t l) County: i 01, Ie c
Nearest Town: � ty�
(Road Name and Numbers, Community, or Su ' 's n and Lo No.) DRILLING LOG DEPTH
3. OWNER "'� � '�' �lLJ�7 From To Fo ation,DescnptiQn
Address G �! ,r P_ r / C _ <' a `� C L
treet or outs o. 1i 0 • 0 0,3 _ k.
—City, or Town State Zip Code
4. DATE DRILLED
5. TOTAL DEPTH
6. CUTTINGS COLLECTED YES ❑ NO2r", 'T
7. DOES WELL REPLACE EXISTING WELL? YES ❑ NO[� CD
8. STATIC WATER LEVEL Below Top of Casing: FT.
(Use'+• If Above Top of Casing) r^o
9. TOP OF CASING IS r FT. Above Land Surface' cnz
*Top of casing terminated ottor below land surface requires a variance In accor- ••
dance with 15A NCAC 2C .0/118
10. YIELD (gpm): --t-- METHOD OF TESTS
11. WATER ZONES (depth):
12. CHLORINATION: Type Amount If additional space is needed use back of form
13. CASING:
LOCATION SKETCH
Wall Thickness
Depth �( �� Diameter or Weig t/Ft. Material (Show direction and distance from at least two State
From ) To �' Ft. %` �' 0 Roads, or other map reference points)
From To Ft.
From To Ft.
14. GROUT:
Depth, atonal Method f
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.
16. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
17. REMARKS:
I DO HER
FOR OFFIq 1E
Quad No:j ti,(Il G
CONSTRUCTED IN ACCORDANCE
0PY OF THIS R5PORD HAS BEEW
SIGNATUR OF PEF iON CONSTRU
;Inal to g'ivisl n of Y((aj r Quality, GroUno
l
H 15A NCAC 2C, WELL
VIDED TO THE WELL OWNER.
'; �- -vf
3 THE WELL DATE
Section within 30 days
GWA REV. 12/99
Serial No.

North Caroline • Department of EnNronrnent and Natural Resources . Division of Water Quality . Groundwater Section r r
1638 MAN 81rAds ©f111Ief * �1#If►I0h, N.C. IY809163A-Phone [phone]." 1. 9 1 �
i
WELL CONSTRUCTION RECORD WELL CONTRACTOR: Hickory Well Drilling Co.
WELL CONTRACTOR CERTIFICATION #: 2343
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE (Check Applicable Boa): Reeldentlal E3 Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ ' Heal Pump Water Injection ❑ Other [] It Other, List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: Icard County: Burke
Shady Grove Church Rd.
(Road Name and Numbers. Community. or Subdivision and Lot No.) DRILLING LOG DEPTH
3. OWNER Elbert Tipton Fran To Formation Descripllon
Address PO Box 541
Connelly Springs ° °' NC 28612
City or Town SIGN Zip Code
A. DATE DRILLED._LQ-25 OO
6, TOTAL DEPTH
8. CUTTINGS COLLECTED YES C) NO(J
7. DOES WELL REPLACE EXISTING WELL? YES (yj NO[^]
8. STATIC WATER LEVEL Below Top of Casing:. . IT.
(Use'4' M Above Top c Coming)
9. TOP OF CASING IS 2 FT. Above Land Surface'
*Top of casing terminated eVor below land surface requires a variance In accor-
dance with 15A NCAC 2C .011e
10. YIELD (gpm): . 40 METHOD OF TEST By Air. Tes t
11. WATER ZONES (deplh): —
12. CHLORINATION: Type hth Tabs Amount 54 It additional space Is needed use beck of form
13. CASING:
Wall lhIckness
O
156
61 r° ler
y. I. Steel
From
-Toth
FI,
_Gat
From
To
Ft.
From
To
Ft.
14. GROUT:
Deptl
�0
matorlal
Grout-Method
Mt
To
Fl.
From
From
To
Ff.
15. SCREEN:
Depth Diameter Slot Size Matellal
From
To Ft
In.
In.
From
To FL
In.
In.
From
To Ft.
In.
In.
16. SAND/GRAVEL PACK:
Depth
Size
Malerlal
LOCATION SKETCH
(Show dlrectlbn and distance from at least two Slate
Roads, or other map tolerance points)
V
tiwy
From To Ff. S
From To Ft.
17. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITI1 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OP THIS RECORD HASJWgN PROVIDED TO THE WELL OWNEn.
FOR OFFICE USE ONLY — d ell'
Ouad Na SIGNATURE of PEnsoN a
SubWI original to Division of Water Quality,
Sedel No,
10-10-00
3 THE WELL DATE
Section within 30 days
OW-1 nEV. IV99

North Carolina - Deparlmenl of Environment and Natural Resources • Division of Water Quality, - Groundwater Section r i 9 11 •
1600 Mall Service Center - Ritilelyh, N.C, 27e98-1836-Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR: Hickory Well Drilling Co.
WELL CONTRACTOR CERTIFICATION #: 9343
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE (Check Applicable Box): ResidentlaM 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: Hi 1 debran County: Burke
86-16 Cojint)z Line Rd.
(Road Name and Nu e(a. Cormmnlly, or Subdivision and Lot No.)
3. OWNER Yee VanQ
Address 8636 County Line Rd.
Hickory (Street or ou e Fft 28601
City or Town Slate Zip Code
4. DATE DRILLED , 09-13-00
5. TOTAL DEPTH Any
6. CUTTINGS COLLECTED YES 0 NOffJ
7. DOES WELL REPLACE EXISTING WELL? YES M NO❑
8. STATIC WATER LEVEL Below Top of Casing: FT.
(Use '+' If Above Top of Casing)
9. TOP OF CASING IS 2 FT. Above Land Surface'
'Top of casing terminated aVor below land surface requires a variance In accor-
dance with 15A NCAC 20.0118
10. YIELD (gpm): .6 METHOD OF TEST RV A i r Ti-,; t
11. WATER ZONES (depth):
DRILLING LOG DEPTH
From To Formation Description
12. CHLORINATION: Type h h TnhS Amount _7 5 If additional space Is needed use back of form
13. CASING:
Depth Diameter
From -_—To — 38 Ft.
From To FL
From To Ft.
Wall Thickness LOCATION SKETCH _
cr Welght/Fl. Material (Show directibn and distance from at least two Stale
PVC Past c Roads, or other map reference points)
14. GROUT:
Depth
Material
Molhod
From __ SZ_ _ To . 0 Ff, Grout
Poured
From To
Ft. _
15. SCREEN:
Depth
Diameter Slot SIz6
Malerial
From To
Ft Irt.
In.
From To
Ft. in.
In.
From To
Ft. In.
in.
16. SAND/GRAVEL PACK:
Depth
Size
Material
From To
Ff.
From To
Ft.
17. RE
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACr
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD
Go�Nr F�
u
S
WITH 15A NCAC 2C. WELL
'ROVIDED TO THE WELL OWNER.
FOR OFFICE USE ONLY
Ouad No: SIGNATURE OF PERSON CONST2111110010 THE WELL
SutxWl original to Division of Wale( Duality. Oro ndwater Section within 30 days
Serial No.
DATE
GW1 REV. 12/29

North Carolina - Oepartrneni of Environment and Natural Roaowcas . Division of Water aueNty - Groundwater Section �a
16 Mail Service Center - Rs9dpt% N.C. 2TOW1e36-Phone [phone] !.. 9112
63
WELL CONSTRUCTION RECORD WELL CONTRACTOR: Hickory Well Dulling Co.
WELL CONTRACTOR CERTIFICATION If: 2343
SPATE WELL CONSTRUCTION PERMITA:
1. WELL USE (Check Applicable Box): Residential [2 Municipal ❑ Industrial ❑
Recovery ❑ Heat Pump Water Injection ❑ Other I] It Other, List Use:
2. WELL LOCATION: ($how sketch of the location below) Burke
Nearest Town: Morgan ton County:
Persitmton Rd
(noed Name and Numbers, Community, or Subdivision and Lot No.)
3. OWNER Danny Huf fman
Address
Hickory (street or NO C 28602
City or Town Stale Zip Code
4. DATE DRILLED—.09-06-0
4
ti. TOTAL DEPTH
6. CUTTINGS COLLECTED YES L_j NO(U �'t��
7. DOES WELL REPLACE EXISTING WELL? YE8 (J N
S. STATIC WATER LEVEL Below Top of Css1no:4Q ____ FT.
(Use '+' N Above Top of Casing)
S. TOP OF CASING IS 2 FT. Above Lend Surface'
'Top of e:slns torminated Wet below land surfsea requfraa s varrsnea In saecr•
dance with 1!A HCAO 20.01If B Air Test
10. YIELD (gpm): 1_ METHOD OF TEST
11. WATER ZONES (depth):
Agricultural ❑ Monitoring ❑
DRILLING LOG DEPTH
From To Forms"on Description
c3
CD c
o {` -
12. CHLORINATION: Type hth Tabs Amount __22� It additional space is needed use beck of form
13. CASING:
Depth Dt�rt�ter
From 0 To 62 Ft. 6-- --
Frorn To Ft.
Wall Thickness LOCATION SKETCH
or WelpIff.l. Material (Shaw dlrecllbn and distance from at least two Slate
PVC; Plas tic Roads, or other map reference points)
From
To
Fl.
14. GROUT:
Dept i
0 �O
Malodal
Grout
Molitod
Poured
Ftorn
To
rI.
^
From
To
FI.
15. SCREEN:
Depth
Diameter Slot Slzo
Malellal
Fran:
To
Ft
In.
In.
From
To
Fl.
In.
In.
From
To
FI.
In.
in.
16. SAND/GRAVEL PACK:
Depth
Size
Material
From
To
Ft.
H
From To FI.
17. REMARKS:
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 20. WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF TEAS RECORD HAS" PROVIDED TO THE WELL OWNER.
09-07-00
FOR OFFICE USE ONLY DATE
Quad No GNAT E OF I EnSON CONS THE WELL
Submit odginel Io Nvislon of Water GusMty, O afar Section Wlihln 30 days OW-1
nEV. 12/99
Serial No. - -

North Carolina - Department of Environment and Natural Resources . Division of Water Quality - Groundwater Section r) .L 8 O 8
1636 Mail Service Center - Raleigh, N.C. 27699-1636-Phone (919.) 733.3221
WELL CONSTRUCTION RECORD WELL CONTRACTOR: � ,ICE 6(11 ,�-161A I it
WELL CONTRACTOR CERIiIFICATION #:
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE (Check Applicable sox): Residential E Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATION: (S�hovr sket h of the location below)
Nearest Town: County:
(Road Name and Numbers,,Gommunity, or Subdivision and Lot No.)
DRILLING LOG DEPTH
3. OWNER el, 1rPel"
From To Formation De cription
Address ya PeGLaL T) Dr
f9 '0
(street or RoUte o.
O C.je
City or Town �}�� Mate— lip Code
4. DATE DRILLED Co
-
5. TOTAL DEPTH 5 7=-
6. CUTTINGS COLLECTED YES ❑ NO�
f ;
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 .011
A/,
10. YIELD (gpm): METHOD OF TEST
11. WATER ZONES (depth):.
12. CHLORINATION: Type 0 11% kC fI'4-_Amount
if additional space is needed use back of form
13. CASING:
Wall Thickness
LOCATION SKETCH
Depth . Diameter or Wei VFt. Material
FromTo �� Ft. �� __ OIL.'t=�
(Show direction and distance from at least two State
Roads, or other map reference points)
From To Ft.
From To Ft.
14. GROUT:
Depth Material _ Method
From t1 To 2'e Ft. �r"`�° `
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:
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� BEEN PROVIDED TO THE WELL OWNER.
r; 1 en — , ,-A0
FOR OFFICE USE ONLY
Quad No:
Serial No.
SIGNATURE
Submit original to Division`
INSTRUCTING THE WELL
Groundwater Section within 30 days
DATE
GWA 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]
4.17967
WELL CONSTRUCTION RECORD WELL CONTRACTOR: Air Dril ling Co.
WELL CONTRACTOR CERTIFICATION #: 2343
STATE WELL CONSTRUCTION PERMIT#:
1. VELL USE (check. . 'Applicable Box): Residential El Municipal D Industrial ❑ Agricultural El Monitoring
❑
Recovery
. . 'E1 4..,".'!-,Heat Pump Water Injection ❑ Other It Othbr, List Use:
2. WELL LOCATION: (Show :7sketch `iof the location below)
Nearest Town :':--`ya I dgjj�,
—County:Anrka
-
(Road Name and Numbers, Community, or Subdivision and Lot No.)
DRILLING LOG DEPTH
3. OWNER PAv6irHq Rie-1,=Q From To Fo'rmatfon Description
Address
tweet or Houle No.)
TA-noir,NQ 28645 0 ---- 162—1
167' 305'
City or Town State Zip Code
4. DATE DRILLED Epp_
5. TOTAL DEPTH SUS'
6. CUTTINGS COLLECTED YES El NO®
7. DOES WELL REPLACE EXISTING WELL? YES [:] NOD
S. STATIC WATER LEVEL Below Top of Casing: FT,
9. TOP OF CASING IS 1 1 (Use '+'It Above Top of Casing)
a FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires avarianca In actor-
dance with 15A NCAC 2C.0118
10. YIELD (gpm):12 METHOD OF TEST Air
11. WATER ZONES (depth): 302'
12. CHLORINATION: Type - RrPT4 ----Amount
13. CASING:
DeWall Thickness
pth Diameter or Weight/Ft. Material
Fromm -To 167 Ft. PVC
From To Ft._
From To - Ft._
14. GROUT:
Depth Material Method
From 0 To _ 20 Ft. Grout Poured
From To —Ft.
15. SCREEN:
Depth Diameter Slot Sizi Material
From To Ft In.
in.
From. To F. in. In.
T
M
From T�i�, 0"FL
16. SD/GRAVEL'1;Z—k--­
-Depth Size
Material
From Ft._
From.—, To Ft._
17. REMARKS:
Dirt
-----'7-
3—
cn
F�3
It additional space is needed use back of form
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other map reference points)
I DO HEREBY CERTIFY THAT Ti41
',S WELL'WELL
WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WE
CONSTRUCTION STANDARDS, TANDARDS, AND TkATA COPY OF THIS RECORD HAS,
PROVIDED TO THE WELL OWNER.
FOR OFFICE
Quad No:
SGOIATURE OF PERSON CONST�XTING THE WELL DATE
Submit originalto Division of Water Quality, Groundwater Section within 30 days
Serial No.
GW-I REV. 12/99

3.
North Carolina • Deparlmenl of Bnvkorunent and Natural Resources - Division of Water Quality - Groundwater Section • , i. 9 11
IWe Mail Service Center • RaNIgh, N.Q. 27e00.1e36-Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR: Hickory Well Drilling CO.
WELL CONTRACTOR CERTIFICATION 0: 2343
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE (Check Applicable Box): ReeldentlaI M Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ It Other, ListUse:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: Lard _ County: Rtl k -
3903 Ownes Mtn. Ave.
(need Nam• nd • Qonenunlly, or Subdivision and Lot No.) DRILLING LOG
3 OWNER a 9'piva Fran To
Address 3902 Owens Mtn. Ave.
ae or a o. _
Connelly Sari ngs NC 28612 -,
City or Town Slate Zip Cod*
4. DATE DRILLED
6. TOTAL DEPTH 225
6. CUTTINGS COLLECTED YES 0 1`400
7. DOES WELL REPLACE EXISTING WELL? YES (_j No
S. STATIC WATER LEVEL Below Top of Casing: �_ FT.
(tee 'a' N Above Top of CAei(g)
s, TOP OF CASING ISM_ FT. Above Land Surface' _
'Top of easing 1•rrnlnet•d "or below land ourfoo• r•qufre• Is variance In oacor•
done• with 16A NOAC 20.011e dr e
10. YIELD (gpm): .� 14 METHOD OF TESTVrllp a _• Section
�t"'•zl QNit
11. WATER ZONES (depth):
DEPTH
Formation Description
12. CHLORINATION: Type htth Tabs Amount __ 5 __— If additional space Is needed use back of form
13. CASING:
• LOCATION SKETCH
Depth
Wall Thickness
Dlamgser or We Irilfl. Material
(Show direcllbn and distance from at least two Stele
0
80
FI. 6 4 PVCPlastic
Roads, or oilier map reference points)
From
From
To
To
•
FL —
From
To
Ft.
14. GROUT:
0
Dept ►
Material Molhod
Orou t Poured
From
To
Fi, —
From
To
Ft• -- --
15. SCREEN:
Depth Diameter Slot Slzo Malerlal
Front To Ft In. In.
From To FI. In. bl.
From To Ft. In. In.
16. SAND/GRAVEL PACK:
Depth Size Material
Front To Fl. -- From To Ft.
17. REMARKS:-
1 DO HEREBY CERTIFY THAT THIS WELL WAS COFIsTRUCTED IN ACI
CONSTRUCTION STANOARDS, AND TIIAT A COPY 01 p Its RECORD
GcvEw• s � S
/►9iN.
FOR OFFICE USE ONLY�� Aa
quad No: SIONATunE OF mnsoN c<
Subrnll original to Dlvlslon of Waist Guaft
Serial No.
WITH 15A NCAC 2C, WELL
PROVIDED TO TILE WELL OWNER.
0 TIIE WELL DATE
section within 30 days
OW 1 REV. 12/99

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section :1 (n�
1636 Mall Service Center - Ralelgh, N.C. 27699-1636-Phone [phone] 6
WELL CONSTRUCTION RECORD WELL CONTRACTOR: Hickory Well Drilling Co.
WELL CONTRACTOR CERTIFICATION #: 2343
STATE WELL CONSTRUCTION PERMIT#:
WELL USE (Check Applicable eox): nesldentlaLO Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ I-leal Pump Water Injection ❑ Other [] If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: Val dpsP County: Ri irkP
4658 Old Clark Place
(Road Name and Numbers. Comrnunity, or Subdivision and Lot No.) DRILLING LOG DEPTH
3. OWNER Grant & Jean Deal From To FormationDescrlptlon
Address Ah58 0 d Clark P
1stlace
—---reTree or Hoou`le NO.
CannP1 1)4 Snri nos NC 986112
City or�Town . - — Stale Zip Code
4. DATE DRILLED 08-25-00
5. TOTAL DEPTH 405
6. CUTTINGS COLLECTED YES C1 NOW
7. DOES WELL REPLACE EXISTING WELL? YES 9 NOU]
8. STATIC WATER LEVEL Below Top of Casing: _ FT.
(Urge •.• It Above Top of C0191111)
9. TOP OP CABINO 1s -_ MT. Above land Surface
'Top of casing terminated atfor below land surface requires a varlance in accor-
dance with 15A #CAC 2r..0136
10. YIELD (gpm): D METHOD OF TEST By Air Tes t
11. WATER ZONES (depth):
12. CHLORINATION: Type Mh Tabs Amounl 75 If additional space Is needed use back of form
13. CASING:
Depth
68
From
To
From
To
From
To
14. GROUT:
Depth
From
To
T
-
From
From _
To
15. SCREEN:
Depth
Front
To
FI
From
To
Ft.
From
To
Ft.
16. SAND/GRAVEL PACK:
Dept,
From
To
From
To_
17. REMARKS:
r,
qD
O -o
c-�
Wall Ibickness LOCATION SKETCH
Npelor ork�lelnirttri. -Mated 1. (Show direcllbn and distance from at least two State
Ft. 4 YVG Roads, or other map reference points)
FI. „,r
`to y�CAa
Mal olhod
Ft. —Grout Poured --- — — MTIj, Iw
Ulanletor Slot SIz6 Malorinl
In. In. (Od ��Ap�
In. In, lhN���� Imo"
In. In. _
a
Size Materlal `
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACGORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF T1 its RECORD H"EN PROVIDED TO THE WELL OWNER.
FOR OFFICE USE ONLY
Quad No:
Serial No.
SIGNATURE OF PERSON t
Submit original to Division of Water Ouallt
/: • 11
3 71IE WELL DATE
Section within 30 days
Ow•1 REV. 12/99

I I
North Carolina • Department of 6nvkorxnenl and Natural Reeorxcee • Dlvlebn of Wolof Quality •Groundwater Seollon 1- 1 9 1 0 9 I
1We Malt S*rAce Center • pdetgh. N.O.21'eoo•1636•P1wn. (910) 733 32Zt
WELL CONSTRUCTION RECORD WELLCONTRACTOR: [hrh lk W'EM' Co'
WELL CONTRACTOR CERTIFICATION it: 2343
SPATE WELL CONSTRUCTION PERMIT#:
1. WELL USE (Check Applicable Sox). Residential [n Municipal ❑ industrial ❑ Agricultural ❑ Monitoring ❑
Recovery C) Heat Pump Water Injection ❑ other ❑ If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below) Burke
Nearest Town: Morganton County:
225R Warrinr Fnrk Trail
Inoed Name and Humbere. Conerwntty, or Subdivision and Lot No.)
3. OWNER . Steve Matson
Address 2258 Warrior Fork Trail-11m—
ree Of ou a 0.
Nc 28655 —'
Mor anton city or Town slate zip code --
4. DATE DRILLED 08-28-00
6. TOTAL DEPTH NOX _
e. CUTTINGS COLLECTED YES ❑)
7. DOES WELL REPLACE EXISTING WELL? YES NO(.__)
e. STATIC WATER LEVEL Below Top of Casing: 6 F r•
(Use'*' M Above Top oe Casing)
9. TOP OF CASING 182 FT. Above Land Surface' —
*Top of eielnIII terrrrineted ever below land surface requires a verlanee In eeeer• —
dance with 15A NCAC ZC. is By Air Test
10. YIELD (gpm): 1� METHOD OF TEST —
11. WATER ZONES (depth): —
12. CHLORINATION: Type hth Tabs Amount 30
13. CASING: LOCATION WFICH -
Material (Show direcllbn and distance from al least two State
Plastic Roads, or other map reference points)
Molhod �l[
DRILLING LOG DEPTH
Fran To Forma"on cesertptlon
Depth D4apelsr
From 0 79 FI. 6--To 4
From To Fl.
From To Ft.
14. GROUT:
Depth Matellol
From -LL -- To f rnr r t _
From To--
15. SCREEN:
Depth Diameter Slot Slzo Matellai
From To FI In. In.
From To Ft. In. In. ---
From To FI. In. --- In. _— -
16. SAND/GRAVEL PACK:
Depth Size
From To Fl•
From -- To Ft.
17, REMARKS:
+1
C+7
Well TNckness
PV�rohvFt.
Material
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN
CONSTRUCTION STANOARDS, AND THAT A COPY OF THIS nECC
=No:
NLY
II additional space Is needed use back of
SIONA1unE OF PEnSON CC
Submit original to Division of Water Ouellty.
S PA l RD u(L o�/�
-i
f=
73
0
��Wy lei &AA!f6A)
S
WITH 15A NCAC 2C, WELL
PROVIDEO TO THE WELL OWNEn.
09-06-0(
INO THE WELL DATE
er Section Within 30 days
OW•t nEV. 1?/99

North Carolina • DepaAmenl o18mMorxnenl and Natural Resources • DM91on of Water Quality • Oroundwaler Section 9111
•
1636 Map Service Cenler • RMttighr N.Q. gT$9o•1e3A-Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR: Hickory Well Drilling CO.
WELL CONTRACTOR CERTIFICATION #: 2343
SPATE WELL CONSTRUCTION PERMIT#:
1. WELL USE (Check Applicsbls Boa): Residentlal E3 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: Morgan ton County: -
.Pea Ridge Rd. DEPTH
(Flood Name and Nurnipts, Cow"nlly, or Subdlvlslon and Lot No.) DRILLING LOG Formation Description
3. OWNER Rev. AiVin S. . Jones Fran To
Address 2371 Plateau Rd.
Vale 14e or Fi e 0. NC 28168
City or Town Slate Zip Code
4. DATE DRILLED, 08-31-00
6. TOTAL DEPTH �n_05 —
e. CUTTINGS COLLECTED YES C) NO 7. DOES WELL REPLACE EXISTING WELL? WS NO[__]
S. STATIC WATER LEVEL Below Top of Cooing: 9_ Fr.
(Use •+• M Above Top of Casing)
0. TOP OF CASING FT. Above Land Surface'
,Top al irraln/ lerminslei aYsr, frslow lend eurfese requires a verlanee In asser•
dance with 111A NCAC: cjl4 is by air test
10. YIELD (gpm): METHOD OF TEST
I I WATER ZONES (death):
12. CHLORINATION:
13, CASING:
Type t ! S Artlount It additional space Is needed use beck of form a
Wen TNckness
Depth
Dlameler or welghVFl. Material
0 Ft. ter— L'�
-- .Plastic
From—.
To --821-
From
To --
- F1.
From
To
Fl.
14. GROUT:
0
Dept)
�0
Malofiol
Grout
Molltocf
Poured
From
To
rt.
Flom
To
Ft.
---
--
15. SCREEN:
Depth
Diameter Slot Slzo
Mateflal
From
To
Ft _
I"-
I" • -----_
From
To
Ft.
in.
In.
From
To
Fl.
In.
in.
16. SAND/GRAVEL PACK:
Depth
Size
Maloflal
Front
To
Ft.
--
-
From
— To
Ft.
17. REMARKS:
1 t)o HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACI
CONSTRUCTION STANDARDS, AND THAT. A COPY O HI9 RECORD
FOR OFFICE USE ONLY
Quad No: SIONATUnE OF PEnsoN Col CTING TIIE WELL
SubnAl original to Dfvislon of Water Ousllly, Orvundwal" Section Wllhln 30 days
Seda1 No.
LOCATION SKETCH
(Show direcllbn and distance from at least two State
Roods, or other map War once points)
AY
WITH 15A NCAC 2C, WELL
PROVIDED TO THE WELL OWNER.
09-06-00
DATE
ow.I REV. 12/99

North Carolina - ()apartment of Snvironmenl and Natural Resources - Division of Water Quality - Groundwater Section ! 19 10 1
1036 Mall aervlce Center - Raleigh, N.O. 27e90.1630-Pimne [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR: Hickory Well Drilling Co.
WELL CONTRACTOR CERTIFICATION #: 2343
STATE WELL CONSTRUCTION PERMIT#:
WELL USE (Check Applicable Box): ResidenllalM Municipal ❑ Industrial ❑ Agricultural ❑ Monlioring ❑
Recovery ❑ Heat Puinp Water Inf ectlon ❑ Other ❑ If Other, List Use:
2, WELL LOCATION: (Show sketch of the location below)
Nearest Town: Morganton County: Burke
(Road Name and Nu e(a. Comrnunlly, or Subdivision and Lot No.)
3. OWNER Ferguson Cabinets/James Ferguson
Address 4188NC Hm 181
Teo 0 ou . 6
city bf Town State Zip Code
4. DATE DRILLED 08-08-00
5. TOTAL DEPTH SO5^—
6. CUTTINGS COLLECTED YES(_.( NO ;_
7. DOES WELL REPLACE EXISTING WELL? WS Fj NO(= J
8. STATIC WATER LEVEL Below Top of Casing: g?_ F T.
(Use '+' If Above Top of Casing)
9. TOP OF CASING ISM_ FT. Above Land Surface'
'Top of casing (e(rnhisled at/or below lend surface requires a variance In accor-
dance with 15A NCAC 2C5.011e By Air Test
10. YIELD (gpm): MET[ (OD OF TEST
11. WATER ZONES (depth): _ -- -
12. CHLORINATION: Type t a s Amount $�-
13. CASING:
Depth Diameter
From To -1-39- Ft. :"rb"' --
Frorn To F1.
From To Ft.
14. GROUT:
DRILLING LOG DEPTH
From To Formallon Description
If additional
�W;ta'_
..
Watl'Ihickness - - -
or WeIghU171. Material (Show directibn and distance from at least two Stale
PV(' _P I q -,t1C Roads, or other map reference points)
Depth Material
From _-!) ___ To __ 20 Ft. ._G1:..QU1:--- ..-- -- - --.
From ___----- ---_
15. SCREEN:
Depth
From
To FI
From
To Ft.
From
To Fl.
16. SAND/GRAVEL PACK:
Depth
Front
To
Front
To
17: REMARKS:
Method
-__J?uur_ d._
Diameter Slot Siz© Material
In. In.
In. In.
In. _ In.
Size Mateflal
F-i.
Ft.
YEA rP-
J
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORD E WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY 09 1111S RECORD PROVIDED TO THE WELL OWNER.
FOR OFFICE USE ONLY 08-15-00
Quad No: SIGNATURE OF PERSON CON CT NO TI IE WELL DATE
Subfnll original to Division of Water Duality. Groundwater Section within 30 days
GWA REV. 12/99
Serial No.

North Caroline • Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section !.; 9 1 0 O
1636 Mall Service Center - Raleigh, N.C. 27699.1636-Phone [phone] r 1
WELL CONSTRUCTION RECORD WELL CONTRACTOR: Hi ekory Well Dri l i nZ Co. _
WELL CONTRACTOR CERTIFICATION #: 2343
STATE WELL CONSTRUCTION PERMIT#:
I. WELL USE (Check Applicable Boa): Residential u Munlcipal ❑ Industrial ❑ Agricultural ❑ Moniloring ❑
Recovery ❑ Heat Pump Water InJeolion [:1 Other [] If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: _ Hi l dPhrarT County: Burke _
5550 B&J Hosiery•Mill St.
(noad Name and Numbers, Cornrnunity, or Subdivision and Lot No.) DRILLING LOG
3. OWNER 1-.',84K Kennels/Karen Parker _ _—_ From To
Address 5550 B&J Hosiery Mill St. —
i(5 rrae or N oule IVY•
_
Hickory 28602
City or Town Slate Zip Code
4, DATE DRILLED029-01-00
5. TOTAL DEPTH - i05
6. CUTTINGS COLLECTED YES [� ] N , "�`�''" m
7. DOES WELL REPLACE EXISTING WELL?
6. NO( _] r 1 ��_ V—C
6. . STATIC WATER LEVEL Below Top of Cosing: _ 5n F r.
(tree '+' If Above Top of Casino) _ _
9. TOP OF CASINO Is—!-- FT. Above Land Surfaga• tl 0�_
*Top of cuing terminated at/or below land surface requires a variance In accor- r
dance with ISA NCAC 2C .011E "-
10. YIELD (gpm): 7 METI IOD OF TEST By Air --- -" un
11. WATER ZONES (depth): ----r----Aslleville I?egrl O/fer
12. CHLORINATION:
13. CASING:
DEPTH
Formation Description
Type hh Tabs Amount 54 - - _ - If additional space Is needed use back of form° o
t
Depth
UI �m� for
From 0
To 86
Ft. 6
From
To
FI.
From —
To-
Fi.--
14. GROUT:
LOCATION SKETCH
Wall 'I hickne ss
or Wel hurl. Material (Show direction and distance from at least two Slate
PVG� Plastic Roods, or other reap reference polnls)
Depth Malollnl Mothod
From �_ To 20 _ Ft.._.. Croy t - Poured
From_ To �___ F 1. --------_--- -...--------
15. SCREEN:
Depth Dlamelor Slot Sizo Malollnl
From To Ft
From To I'll.From _ _— To Ft._------
16. SAND/GRAVEL PACK:
Depth Size Molorial
From To . rt. — _ --
From To Ft.,__----
17. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACC
CONSTRUCTION STANDARDS, AND It ]AT A COPY OF THIS RECORD
FOR OFFICE USE ONLY ' tL- - yea-e
Quad No: SIGNATURE OF PERSON C(
Sut„nll ortolnel to Division of Witter Ousllly,
Serial No.
WITH ISA NCAC 2C, WELL
PROVIDED TO THE WELL OWNER.
a 71IE WELL DATE
Section within 30 days
GWA REV. 12/99

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section O O 3
1636 Mail Service Center - Raleigh, N.C. 27699-1636-Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR: - II ,'� -'n c, �—i✓�,
WELL CONTRACTOR CE TIPt FICATION #: L0-' L `>��,� e `071-?
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: (Shows elch of the location below) %� J
Nearest Town: _�� �dt'�<C2. County:
(Road Name and N/�mbers, Co unity, o Sjbdivi ion and Lot yo.) n DRILLING LOG
3. OWNER v1-14 `%a. c� M�/#t!�' dfrr^�c�r �f��/�,o r'JPu.� Fr m To
Address G'. 13OK 36, 32, - / � ��
4r 4tree or outs /o. ` / C' C_/ C /}
City or Town � State Zip Code
4. DATE DRILLED �% " C)O
5. TOTAL DEPTH
6. CUTTINGS COLLECTED YES ❑ NOD___"
7. DOES WELL REPLACE EXISTING WELL? YESP NO[a�
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 acc�r-
dance with 15A NCAC 2C .CJAt18
10. YIELD (gpm): LL METHOD OF TEST Al Its
11. WATER ZONES (depth):
DEPTH
Fo ation Description
r1,7— o-- g c
C rc 7r /G C
12. CHLORINATION: Type C v. �_Amount - C `� / if additional space is needed use back of form
13. CASING:
Wall Thickness
n Depth Diameter or Wei h t. Material
From _ (� To CL Ft. / % <' -»L
From To Ft.
From To Ft.
14. GROUT:
Depth aterial — Method /
From 69 To 2 U Ft. (_ 6-en ' /-" � X�u
From To Ft.
15. SCREEN:
Depth Diameter Slot Size Material
From To Ft in. in.
From To Ft. in. in.
From To Ft.
16. SAND/GRAVEL PACK:
Depth
From To _
From To_
17. REMARKS:
Ft.
Ft.
In. in.
Size Material
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other map reference points)
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF IS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
FOR OFFICE USE ONLY �
Quad No: SIGNATURE OF PEFirSON C STRUG� NG THE WELL DATE
Submit o ginal to Divisl n of W t , Oual G ndwater 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
WELL.CONSTRUCTION RECORD WELL CONTRACTOR: --REA
WELL CONTRACTOR CERTIFICATION #: 33
STATE WELL CONSTRUCTION PERMIT#:
I.:.; WELL USE (Check Applicable Box): Resident! al ET —Municipal F-1 Industrial Agricultural
Mon on'
it in, g
'Recovery Heat Pump Water Injection Other M If Other, List Use:
2. -WELL LOCATION: (Show sketc4 of the location below)
�-p
Nearest Town, County:
(Road Nam6 and Numbers, Community, or Subdivision and Lot No.) DRILLING LOG DEPTH
weet or Route No.
City6rTowrV State Zip Code
5. ..TOTAL DEPTH
:6. CUTTINGS COLLECTED 'YES NO�
7. . DOES WELL REPLACE EXISTING WELL? YES [__1 NOD--
S. STATIC WATER LEVEL Below Top of Casing: FT.
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 15ANCAC2C. 11
11. WATER ZONES (depth):
12. CHLORINATIOt %mount It additional space Is needed use back of form
13. CASING:
Wall Thickness LOCATION SKETCH
)ept or Weight/Ft Material (Show direction and distance from at least two State
From —To L2 Ft. -AL ��L .11V0Zt Roads, or other map reference points)
To—
R.--------From
-------
��___—
—TO
Ft.-
Depth
Materiah
Method
Fro
From
Diameter Slot SIz6
Material
16..SAND/GRAVEL PACK:
W Depth
Size
Material
Fr6 To
Ft.
'=' To------''^-------
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN
ACCORDANCE WITH 15A
CONSTRUCTION STANDARDS, AND THAT A COP�Y THIS RECN=44�EqN PROVIDE[
FOR OFFICE USE,.,qN4�yi tVj
NCAC2C.WELL ^ .`
TO THE WELL OWNER.
Quad No: J K|IU§IPwxroncorPERSON CONSTRUCTING THE WELL
uuwn Division mWater Quality, Groundwater Section within 3Odays
_ �
v ^"""

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section 2 17 n 4 2-
P.O. Box 29578 - Raleigh,N.C. 27626-0578-Phone [phone].�-
WELL CONSTRUCTION RECORD DRILLING CONTRACTOR: JC421&ggy sej'ongac
DRILLER REGISTRATION #: 2!2*y
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)
NearesUown: 1'44— _ County:
Kd'*X0,0 116'// AA4
(Road, m unity,. , Subdivisio and Lot No.) DEPTH
3. OWNER i &q A From To
ADDRESS.F^
r (Street r Route No
� i
City or Town State // (" Zip Code
4. DATE DRILLED 0
5. TOTAL DEPTH
6. CUTTINGS COLLECTED YES NO[.]"`'
7. DOES WELL REPLACE EXISTING WELL? YES a NO�-
8. STATIC WATER LEVEL Below Top of Casing: �0 FT.
(Use "+" if Above Top of Casing)
9. TOP OF CASING ISFT. Above Land Surface -
Casing Terminated atior below land surface is illegal unless a variance is issued
in accordance with 15A NCAC 2C .0118
10. YIELD (gpm): _■, METHOD OF TEST
11. WATER ZONES (depth): ABM_
DRILLING LOG
Formation Description
CIO
.. C_J
w o
12. CHLORINATION: Type Amount If additional space is needed use back of form
13. CASING:
Depth Diam t r
From To M Ft. 4
From To Ft.
From To Ft.
14. GROUT:
Wall Thickness LOCATION SKETCH
or Weight/Ft. INAterial (Show direction and distance from at least two State
Roads, or other map reference points)
Depth Material Wthod
From 4 To -;2,0 Ft. _Ad*�Ak
From To Ft.
15. SCREEN:
Depth
From
To
From
To
From
To
16. SAND/GRAVEL
PACK:
Depth
From
To —
From
To
17. REMARKS:
I DO HER
CONSTRI
Diameter Slot Size Material
Ft in. in.
Ft. in. in.
Ft. in. in.
Size Material
— Ft.
Ft.
H �`i�
3TIF THATTS WEL;L`;
STANDARDS, AND TH'A'
s
n a a S
CONSTRUCTED IN ACCORDA CE WITH 15A NCAC 2C, WELL
DPX-tOF THIS RECORD HAS EEN PROVIDED TO THE WELL OWNER.
SIGNATU�E OF CONTRACTOR OR AGENT ! DATE
Submit original to Division of Water Quality and copy to well owner.
GW-1 REV. 1/98

North Carolina - Department of Envlronmonl and Natural Fiesources - Division of Water Quality - Groundwater Section `"+ (1 (1 (1
1636 Mall Service Center - RalIIIghr H,C. 27899.1638•Phons [phone] 7 11 J
r t
WELL CONSTRUCTION RECORD WELL coNTaAcroR:..�. Wpj T Dri 11 i no, (',n
WELL CONTRACTOR CERTIFICATION N: 306
STATE WELL CONSTRUCTION PERMITN:
1, WELL USE (Check Applicable Box): Resldentlaff ] Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ i-feat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATIO%(S,ft4ese etch of the locatlon below) Burke
Nearest Town: V ld County:
3195 Fay Lowman Rd.
(Flood Name and Numbers, Community, or Subdivision and Lot No.)
3. OWNER James Key
Address 3195 Fay Lowman Rd.
(915011yr Tou a o.
Rutberf d College.. NC 28671
City or Town gists Zip Code
4. DATE DRILLED 07-10-00
5. TOTAL DEPTH 205
6. CUTTINGS COLLECTED YES CI NOffj
7. DOES WELL REPLACE EXISTING WELL? YES ] NO(]
8. STATIC WATER LEVEL Below Top of Casing: �0 FT.
(Use '+' Il Above Top of CAe1119)
9. TOP OF CASING- IS__9___._ FT. Above Land Surface'
*Top of casing terminated at/or below land surface requires a variance In accor-
dance with 15A NCAC 2C .011E
10. YIELD (gpm): 90 METHOD OF TEST By Air Test
11. WATER ZONES (depth):
DRILLING LOG DEPTH
From To Formellon Description
12. CHLORINATION: Type h 1-h Tang Amount 11 additional space Is needed use back of lorm
13. CASING: KETCH
Depth Diameter
From m —To 92-- Ft• Elk" —
Frorn — To___ F1.
Froth _---'To-- F1.----------
14. GIiOU T:
LOCATION S
Wall Tldckneas
or Welgliffl. Matelot (Show directlbn and distance from at least two State
P`7C -�St1C noods, or other map reference points)
Mollrocl
Depth .
Material
From 0
1.0 20 rt. 4iliv_---•--
Frorn
To .
Ft. _ --•
--
15. SCREEN:
Depth
Diameter Slol SIz6
Meterinl
rrom
To
FI 111. .—__ Ill.
__---•_--
From
To
Ft. In. In.
—
F om
To
Ft. Ill. .--- In.
—
r
16. SAND/GRAVEL PACK:
Depth Size
Frorn To FI. —•
Front To Ft. —
17. REMARKS: —
Material
I DO I IEREBY CERTIFY TIIAT 71118 WELL WAS CONSTRUCTED IN ACCOnDANCE WITH 15A NCAC 2C. WELL
CONSTnUCTION STANDARDS, AND TI (AT A COPY OF TI118 nECOnD HAS BEEN PROVIDED TO THE WELL OWNEn.
Way V� L DRILLING CO, RIB. 07-1,
FOR OFFICE USE ONLY DATE
Louad No:
l No.
SIGNATURE OF n�i� WELL
Subrnll original to Division of Witter ¢I14. 6"c r�section within 30 days
WWDRY, 2
OW-1 nEV. 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] U O O 2
WELL CONSTRUCTION RECORD WELLCONTRACTOR: Yadkin Well Company Inc.
WELL CONTRACTOR CERTIFICATION #: Z '5-13/
STATE WELL CONSTRUCTION PERMIT#:
1 WELL USE (Check Applicable Box): Residential 12 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: &P)t el County: �w ke' `-O ,
Ccckc C4 ( 4-t-4�3 : V-11drS�
- �, e,) 11 9 8� 8,�3d 30$3
(Road Name 9nd Numbers, Community, or Subdivision and Lot No.) DRILLING LOG DEPTH
3. OWNER CAa.,,, 5 S /I a, IV wi LCL r 14' mMr From To Formation Description
Address }DD '.Qo.4/ 3 9 � 2 3 9-5 La/�eG�ar/CS� ', O
treet or ouzo o.
C'
Q �u� d/-. 286/9
City or Town State d k"
Zip Code
4. DATE DRILLED -Zo - W !o"�' li01
5. TOTAL DEPTH 3v
6. CUTTINGS COLLECTED YES [] NO��
7. DOES WELL REPLACE EXISTING WELL? YES X 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' c;
•Top of casing terminated at/or below land surface requires a variance In accor- ^,
dance with 15A NCAC 2C .0119
10. YIELD (gpm): yMETHOD OF TEST �i� ov..,.o c� c, ..'•;
11. WATER ZONES (depth):
12. CHLORINATION: Type HTH Amount u "— r-1
it additional space is needed use back of form = ;;o r-I
13. CASING:
Wall Thickness J LOCATION SKETCH W ---+
From DToth r y�{gtght/ fit. Material (Show direction and distance from at least two State
From To Ft.
From To Ft.
14. GROUT:
Depth
From a' To _ Zy Ft.
From To Ft.
15. SCREEN:
Roads, or other map reference points)
a{ka
MatMatedt Lc. Me)hod
Depth Diameter
From To Ft in
From To Ft. in
From To Ft. in
16. SAND/GRAVEL PACK:
Depth Size
Slot Size Material
in.
in.
in.
Material
From To Ft.
From To Ft.
17. REMARKS:__
I DO HE7iE�Y CERTIFY THATsTHi WELL WAS CONST
CONSTRUCTION STANDARDS, AND THAT A COPY OF
FOR OFFICE USE ONLY
ouad No: SIGN��A
Submit original to 19i
Serial No.
AT6
Jd7
UrZxc.� �'X.i
IN ACCORDANCE WITH 15A NCAC 2C, WELL
:,ORD HAS B NrOVIDED TO THE WELL OWNER.
OF PERSON CONSTRUCTING THE WELL DATE
of Water Quality, Groundwater Section within 30 days
GW-1 REV. Q/99

North Carolina - Department of Environment and Natural Resources - Division of Water quality - Groundwater Section !, 1 6 6 0 1
1636 Mail Service Center - Raleigh, N.C. 27699-1636-Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTHAC1011:
WLLI_ CON I IIAC1011 CL'IITi (CATION N:
STATC W[l-l_ CONSTRUCTION PERMITII:
1. WELL USE (check Applicable sox): 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: �`%+ywS P County:
{ W i ci�3
(Road Namd and Numbers, Comm nity, or Subdivision and Lot No.)
3. OWNER C- 1;� 37�
Address
treel r Route 0.
City or Town State Zip Code
4. DATE DRILLED 5
5. TOTAL DEPTH
6. CUTTINGS COLLECTED tYES ❑ NOE�
7. DOES WELL REPLACE EXISTING WELL? YES ❑ NOE:`
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 .4118
10. YIELD (gpm): La_ METHOD OF TEST
11. WATER ZONES (depth): �D -55-
12. CHLORINATION: Type oRr'A­"(aAmount 3�
13. CASING:
Wall Thickness
Depth Diameter or Weight/A aterial
From � To Cq Ft. 6 '/9 �
From To Ft.
From To Ft.
14. GROUT:
Depth Material Method
From To Ft. r' e*Lkt--Z�l `-'
From To Ft.
15. SCREEN:
Depth
From To Ft
From To Ft.
From To Ft.
16. SAND/GRAVEL PACK:
Diameter Slot Size Material
in. in.
in. in.
In. in.
Depth Size
From To Ft.
From To Ft. _
17. REMARKS:
Material
DRILLING LOG DEPTH
From To Formation Description
L —
h
n .
f.t
T,-�J
C7
If additional space is needed use back of form
h
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other map reference points)
DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS REC BE,fEN PROVIDED TO THE WELL OWNER.
FOR OFFICE USE ONLY
Quad No:
Serial No,
K,e3
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit original to Division of Water Quality, Groundwater Section within 30 days
GW-1 REV. 12199

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section 0'_ 1 U 606
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)
Nearest Town: ew �0,0d County:
,&^I
(Road Name and umbers, Community, or Subdivision and Lot No.)
DRILLING LOG
DEPTH
3.
OWNER
From To
Formation Description '
Address
(Street or Route o.
-ee� /i� L j'(t ' %
7 S' - % bo
lC�O /03
�� clPrcc.�
City dr Town State Zip Code
- 3` oa
/D�
4.
DATE DRILLED
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.
(Use '+' II Above Top of Casing) @
9. TOP OF CASING is FT. Above Land Surface's
'Top of casing terminated at/or below land surface requires a variance In accor-
dance with 15A NCAC 2C 0118
10. YIELD (gpm): :EL METHOD OF TESTSrI
11. WATER ZONES (depth): 6
If additional spaceIsneeded use back of for -'
r,
12. CHLORINATION: Type ZAP- Amount
13. CASING:
Wall Thickness
Depth Diameter or Weight/Ft. Material .
From ��To %� Ft.--�4— a P`/G
From—Z­r To Y-r- Ft. GA /90—
From To Ft.
14. GROUT:
Depth
From To Ft.
From To Ft,
15. SCREEN:
Material Method
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: �F D
LOCATION SKETCH
(Show
R<
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 EEN PROVIDED TO THE WELL OWNER.
FOR OFFICE USE ONLY
Quad No: SIGNATURE OF PERSON C RUCTING THE WELL DATE
Submit original to Division of Water Quality, Groundwater Section within 30 days
Serial No. GW-1 REV. 12/99

North CarcB-.i - Dr
partment of Environment and Natural Resources -Division of Water Duality -Groundwater Section �
1636 Ma;!.. � vico Center - Raleigh, N.C. 27699-1636-Phone [phone] "j
WELL .'OT.1S1'RUCTION RECORD WELL CONTRACTOR:
WELL CONTRACTOR CERTIFICATION 0: 1g9
STATE WELL CONSTRUCTION PERMITH:
1. WE''.t_ (check Applicable Box): Residential Er Municipal ❑ Industrial ❑ Agricultural F ! :ring ❑
Ro:�;, ­ ,ry ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WEI-1. I-OCATION: (Show sketch of the location below)
Neare: t Town- County:
arrd Num'b�e,r/s, Community, or Subdivision and Lot No.)
,r `Zy �%ai'/r/rG1'1
DRILLING LOG
3.
OWI /�"'
From To
Fn.- .. ;:lion
% yes© -J A�
D— '76,
%� f-
Street or ouzo o.
(y
30 /p0
r;:—, �,.� Zip Code
/q
4.
oState
DAT- '- '(I En
5.
TOT I-)
/2 f 7 5
6.
Cl!Tr'­�1.(_ECTED YES ❑ NO�
l i S a gszr%
7.
DO '.I r1'LACE EXISTING WELL? YES NO❑
a9 s- .997
Of le-
8.
ST.' "Ef; LEVEL Below Top of Casing: FT.
9.
(Use '+' If Above Top of Casing)
TO' ^ "!IN!G Is FT. Above Land Surface•
--
op a or ow an surface requires a variance in accor- r: q
dance w I C 2C 0118
10. YIE1 >,): -3 METHOD OF TEST
11. WAT 'C idES (depth): fDo2 i01 c< _
12. CH! r ' 1A'rI0N: Type A' >f _Z Amount
13. CA 7'
Wall Thickness
From
Depth� ��--
~_f To A_
Diameter or WoighdFL
Ft. 5wegf
Material
Fror-..._-_;-,L_
To 3d
Ft.-
Frrr
__._.__-____To
Ft.
14. G F !;
... :
Depth
Material.` Method
Fro!-
__A2 _. To P&-'_
Ft, de,-0 c-.,r,. aa
0'i''.
Fr, ­
To
Ft.
15. SG -
Fro•,
Fro--
Fr
16. SA':
From
Fri
17. R'1
To
To
PACK:
Depth
To—
To —
Diameter Slot Size
Ft in.
Ft. in.
Ft. in.
Ft.
Ft.
Size
Material
in.
in.
In.
Material
if additiorial space is needed us
LOCATION SKE'`
(Show direction and distance from W ' -
Roads, or other map reference r^
1 D'-' ' r FOTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, v11-1. I.
CO:: _'.;;'I`i^(; STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WE!.'
FOI; -:ONLY
�Quar' � SIG ATURE OF PERSON CONSTRUCTING THE WELL _._.._
—•- Submit original to Division of Water Ouality, Groundwater Section Within 30 day
12199
Iy 10

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] i� J.
WELL CONSTRUCTION RECORD WELL CONTRACTOR: 4ifll
WELL CONTRACTOR C TIFICATION #: i ✓t v`t-71-7
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:
. r
2. WELL LOCATION: (Show sketch of. the location below) /
Nearest Town: , �� !�` 1 County: —
(Road Name and Numbers. Community, or SJub�ivision and Lot No.) DRILLING LOG
3. OWNER Vrte s From To
Address �h"'K 1 �G � %.�u �s�l fr�ek�c
tree or outs 1Vo j--T — , ? _2
y l
City or Thwn State Zip Code
4. DATE DRILLED f OD
5. TOTAL DEPTH ;71 -L)
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 r�)' FT. Above Land Surface'
`Top of casing terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2C .O}
10. YIELD (gpm): METHOD OF TEST • IL / rc
11. WATER ZONES (depth):
DEPTH
Forma lio Description
71,LiC
r- u-
CD
-i
0
12. CHLORINATION: Type
Amount
If additional space is needed use back of form
13. CASING:
Wall Thickness
LOCATION SKETCH
From C
Depth Di eter
To Ft.
or Weigh t. Material
—,�
(Show direction and distance from at feast two State
Roads, or other map reference points)
From
To Ft.
From
To Ft.
14. GROUT:
Depth Materia_l_,..— Method /
From To 20 Ft.
From --To Ft. _
15. SCREEN:
Depth
Diameter
From To
Ft in.
From To
Ft. in.
From To
Ft. in.
16. SAND/GRAVEL PACK:
Depth
Size
From To Ft.
From To Ft.
17. REMARKS:
Slot Size Material
in.
in.
In.
Material
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION S - Nl4A gRqDS, ANq THAT,A COPY OF THIS CORD HAS-BEEN PROVIDED TO THE WELL OWNER.
FOR
Quad No:
Serial No. _
�. 11�✓zb?nit
SCTING THE WELL DATE
Quality, Groundwater Section within 30 days
GWA REV. 12/99

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section "j ►*� +'
1636 Mail Ste Center -Raleigh N C 9-1 636-Phone l9141 734-a29t �4 i
WELL CONSTRUCTION RECORD WELL CONTRACTOR:
r
WELL CONTRACTOR CE TIFICATION #: /­2
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: Pr4 I
WELL LOCATION: (Show sketch of the location below)
Nearest Town: �County: A/
(Road Name and Numbers, Counity, or Subdivision and Lot No.) DRILLING LOG
3. OWNER Ii / �4 ��li�l i r From To
Address 6) 66
(Street or Route o. CK) f 6
City or Town Stale .� Zip Code
- .s-a
4. DATE DRILLED L ~UO
5. TOTAL DEPTH )
6. CUTTINGS COLLECTED YES ❑ NO�
NO
DEPTH
Formation Description
7. DOES WELL REPLACE EXISTING WELL. YES ❑ 177
8. STATIC WATER LEVEL Below Top of Casing: FT. r n =
(Use '+' If Above Top of Casing) C:D
9. TOP OF CASING IS FT. Above Land Surface's r
'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):
12. CHLORINATION: Type Amount
13. CASING:
Wall Thickness
Depth Diameter or We t. Ma;I
—f-- From ' To Ft.y
From
To Ft.
From
To Ft.
14. GROUT:
Dept . 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.
16. SAND/GRAVEL PACK:
Depth
From To -
From
17. REMARKS:_
To
Ft.
Ft.
Size Material
If additional space is needed use back of form
CA o
LOCATION SKETCH --
(Show direction and distance from at least two State
Roads, or other map reference points)
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORPANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS;, AND THAT,A COPY OF THI ECORD H BEEN PROVIDED TO THE WELL OWNER.
FOR OFFICE USE�`�
Quad No:
2
3 THE WELL
Section within 30 days
DATE
GW-1 REV. 12/99
Serial No.
s

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section 3
1636 Mail Service Center - Raleigh, N.C. 27699-1636-Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR: �'� %�e
WELL CONTRACTOR CERT (CATION #: 4rw I 71J,
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: ��/Y/�n�=l
2. WELL LOCATION: ( Show sketch 9f the location below
Nearest Town: 11pl�Ct'2iG/� County: 13otk?
(Road Name and Numbers, Community,
/Q�r Subdivision and Lot No.) DRILLING LOG
3. OWNER V- 0 0. v. J V Y' 0 C �60 r �J From To ffy
Address I I I u(o 4 �� b L'
beet or oute o.)
City or Toi State Zip Code
4. DATE DRILLED %'c-Z -190
D TH �/1
DEPTH
Formation Descri Lion
a c.,lc
TOTAL P <L
5. -,
6. CUTTINGES COLLECTED YES ❑ NO[�/
7. DOES WELL REPLACE EXISTING WELL? YES ❑ NO© r'
8. STATIC WATER LEVEL Below Top of Casing: l FT.
t, .
(Use •+• if Above Top of Casing) C7 ���
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.011a
10. YIELD (gpm): METHOD OF TESTS
11. WATER ZONES (depth): r t
Ga
12. CHLORINATION: Type Amount If additional space Is needed use back of formCO o
13. CASING:
13. CASING:
Wall Thickness
Depth
Q j '� U
Diameter or W I I. serial
G
From
To
Ft.
- jr
From
To
Ft.
From
To
Ft.
14. GROUT:
Depths
Mated Method/
From
To - ,6
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:
I DO HEREBY CERTiF
FOR OFFICE USF, ONLY
Quad No: 11.11 . f
Serial No.
HIS WELL WAS CONST
'AND THAT A COPY OF
20�11nn ,
)U ' ^ ....9N�9
Submit o ' inal to D
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other map reference points)
ED IN ACCORDANCE WITH 15A NCAC 2C, WELL
RECORD BEEN PROVIDED TO THE WELL OWNER.
fPIPERSON1d�§TRUCTING THE WELL DATE
Water Quality, Groundwater Section within 30 days
GW-1 REV. 12/99
hs
(iC'1,`

r 4 r
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section tz .�_ 7 3 8
1636 Mail Service Center - Raleigh, N.C. 27699-1636-Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR: 1
WELL CONTRACTOR CE TIFICATION
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE (check Applicable Box): ResidenUai ❑ Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use: s ;ot, I
2. WELL LOCATION: (Show AlKetch of .the location below)
Nearest Town:/ County: t, u E.
(Road Name and Numbers, Community, or Subdivision and Lot No.)
DRILLING LOG
3. OWNER 7
t )
�[✓
n From To
Address
,
f i !
(Street
or Route N
c
o S--
City or Town
Stale
p de
4. DATE DRILLED 4 G)
5 TOTAL DEPTH
DEPTH
Formation Description
O' E .9- lac I�
6. CUTTINGS COLLECTED YES ❑ NOE:K
7. DOES WELL REPLACE EXISTING WELL? YES NO2 o
8. STATIC WATER LEVEL Below Top of Casing: FT. --
(Use '+' If Above Top of Casing) r4'r
9. TOP OF CASING IS FT. Above Land Surface'
'Top of casing terminated at/or below land surface requires a variance In accor- ^—i a r_-:
dance with 15A NCAC 2C .01 10
10. YIELD (gpm):
METHOD OF TEST
11. WATER ZONES (depth):
rr �J
-^i
12. CHLORINATION: Type Amount If additional space is needed use back of forrem
13. CASING:
Wail Thickness
Depth, .D Diameter or Wf i t. Mate9al
From _ _- — TO —Ft.
Ft.
From--- To Ft.
From To Ft.
14. GROUT:
Depth Material Method
Fromy To Depth- Mated
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:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONST
CONSTRUCTION S1�AN6ARDS AND THAT A COPY OF
� I
FOR OFFICE ONL�'Y'rr ftfl
Quad No: AJD 200 (' " SI NA
Sutirt!jif odoin to
Serial No.
.riiG, �lN 1nta
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other map reference points)
ED IN ACCORDANCE WITH 15A NCAC 2C, WELL
ECORD HAS BEEN PROVIDED TO THE WELL OWNER.
OF PE N CONST UCTING HE WELL DATE
of Wat oualiry, Grip ndvat�Seclion within 30 days
A GW-1 REV. 12/99

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section e; .i ,
1636 Mail Service Center - Raleigh, N.C. 27699-1636-Phone [phone], 1 a) 7 4 U
WELL CONSTRUCTION RECORD WELL CONTRACTOR: lit �JC_
WELL CONTRACTOR CE TIFICATION #: -O 71-3
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE (check Applicable Box): Residential 13 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 Subdivif/� ion and Lot No.)
DRILLING LOG DEPTH
Fo7)��q,'
3. OWNER Gt�(e,4L f LI)a C l _
Fromm' To n _Description /
/
Address 3y ir,
treed No.}�
,/J�
s D
� �i % �/C
or Duce
lm� nic_.� 55
o i 30
City or Town State Zip Code
4. DATE DRILLED
5. TOTAL DEPTH -
6. CUTTINGS COLLECTED YES ❑ NOE3-'
7. DOES WELL REPLACE EXISTING WELL? YESO
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 attor below land surface requires a variance In accor-
dance with 15A NCAC 2C.0118
10. YIELD (gpm): METHOD OF TESTA
11. WATER ZONES (depth):
12. CHLORINATION: Type Amount
If additional space is needed use back of form
13. CASING:
LOCATION SKETCH
Wall Thickness
Depth rr Diameter or Wei htlFt. Material
�f
(Show direction and distance from at least two State
From To () Ft. 1? b -ri/l/(_
Roads, or other map reference points)
From To Ft.
From To Ft.
14. GROUT:
/ } Depth Material_ Method
From To
_ —Ft.—.
r
From To Ft.
C:)
15. SCREEN:
P
Depth Diameter Slot Size Material
C=- = "
From To Ft in. in.
c_
From To Ft. in. In.
'1 T �_-
From To Ft. in. in.
m
16. SAND/GRAVEL PACK:
= v�
Depth Size Material
•• r`''�
r�
From To Ft.
o
-J o
From To Ft.
17. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED
CONSTRUCTION STANDARDS AND THAT A COPY OF THIS R'y
FOR OFFICE USE NLY
Quad No: �"�� ) SIGN/ATUR OF
p L S��(l)originl (ssDivis n of Y
Serial No.
N ACCORDANCE WITH 15A NCAC 2C, WELL
,ORD HAS BEED!-PROVIDED TO THE WELL OWNER.
C_ r _2 _) 4
rNSTIJO NG THE WELL DATE
Groundwater Section within 30 days
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] ?• r r>< r
1_51 I, $.��
WELL CONSTRUCTION RECORD WELL CONTRACTOR:
WELL CONTRACTOR CEF(TIFICATION #:-1"!• 4 "40 —
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: Sh w sketch of the location below)
)
Nearest Town: P%IDI/" County: —
(Road Name and Zurnbers, Community, or Subdivision and Lot No.) DRILLING LOG DEPTH
3. OWNER From To Formation Description `
Address l,il /��Q ��r Ct C ,f c c r;L_ /7 �s^ U cj 9— GG k
/I tree or outs No. � �{k !J C
s/1rr.1L y r` /i/C. , Z "[L�� I_ —
City or Town �„.��_ �St'ate Zip Code ?
4. DATE DRILLED
5. TOTAL DEPTH :)_0 C__
6. CUTTINGS COLLECTED YES ❑ NOE
7. DOES WELL REPLACE EXISTING WELL? YES NO❑
8. STATIC WATER LEVEL Below Top of Casing: 'a 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 .91 W `—"-'
10. YIELD (gpm): METHOD QF TEST
11. WATER ZONES (depth): /Y_8
12. CHLORINATION: Type Amount If additional space is needed use back of form
13. CASING:
Wall Thickness
�` Depth r �/ Diameter or wei h t. M�
From l.J —To. Ft. —
From To Ft.
From To Ft.
14. GROUT:
Dept Svlatenal— Method
From _ To Ft. _.. �'' y —a24
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:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED
CONSTRUCTION,STA IDARDS,F,ND THAT ACOPY QF THIS R5
FOR OFFICE USE�,Q t
Quad No: ^ ! (,i "• 1 �#dl! ATUR OF
1 %� tAl origlr)ai td bivi n of V
Serial No.
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other map reference points)
ACCORDANCE WITH 15A NCAC 2C, WELL
RD HAS BEEN PROVIDED TO THE WELL OWNER.
^
ST�CTIN DATE :dwatlection within 30 days
GWt REV. 12/99

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section 2 _!. 3 4 V 4
1636 Melt Service Center - Ralelgh, N.C. 27699.1636-Prone [phone]
WELL CONSTRUCTION RECORD WELLCONTRACTon.. Hickory Well Drilling Co.
WELL CONTRACTOR CERTIFICATION N: 2306
STATE WELL CONSTRUCTION PERMITN:
1. WELL USE (Check Applicable eox): Residenllai R2 Munlclpal I] Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Purnp Water Injection [] Other 0 If Other, List Use:
2. WELL LOCATION: (Show sketch of the locatlon below)
Nearest Town: Connelly Springs County: Burke
3701 Baptist Camp Rd.
(Road Name and Numbe(s. Community, or Subdivision and Lot No.) DRILLING LOG
3. OWNER Roger Francis From To
Address 3761 Baptist Camp Rd. _
(Sl!eelor ou a o.
Connelly Springs NC 28612 _
DEPTH
Formallon Description
City or Town Slate Zip Code
4. DATE DRILLED.M-n7-0a__
i r
5. TOTAL DEPTH
6. CUTTINGS COLLECTED YES El NO
7. DOES WELL REPLACE EXISTING WELL? YES (_J NO(
6. STATIC WATER LEVEL Below Top of Casing: 100 rr. -- ------�--
__ I o r
(Use '**If Above Top of Cashrg)
9. TOP OF CASING Is 2 FT. Above Land Surface' - - --- --` ----
r}
—�\
---
*Top of casing terminated ■Vor below land surface requires a variance In actor-'-------
`- ��
url
dance with iSA NCAC 2C.0116
10. YIELD (gprn): a METHOD OF TEST By Air TPst-
—vim '^:;=
11. WATER ZONES (depth): —
i3
X
12. CHLORINATION: Type �Hrft( Labs, Amount -3`� It additional space Is needed use back of form
13. CASING:
Depth Dlarnelor
From —To 95 Ft. �r
From To Ft.
From __To__ Ft.
----
14. Gf10Un
Wall thickness LOCATION SKETCH
or Welghl/Ft. Material (Show direclfbn and distance from at least two Slate
PVC Plas tic Ronde, or other map reference points)
Depth
Malorinl Mothod
From - 0
- To
20 -Ft. .
Grout --.-- .-_-- _ Poured __--
Flom —
-- To ---
— — F t
----- --- -- - - ---- --
15. SCREEN:
Depth
Diameter
Slot Siz6 Malollal
From
To
FI
In. In. _ —
Front
To
Ft.
In. In.
From
To
Ft.
In. .___ In.
16. SAND/GRAVEL PACK:
Depth
From To Ft.
From To rl.
17. REMARKS:
Size Material
6� `
n
6
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE Willi ISA NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF This RECORD I IA3 0 E P VIDED TO THE WELL OWNER.
Wm vrN 01.1 1.1 f r )• 06-15-00
FOR OFFICE USE ONLY
Quad No: SIONA t f �"'Fb' TRUCTING TIIE WELL DATE
Submit odginel to Divlslorl o1 V�,1/ 11, dwaler Section within 30 days
Serial No. Wz11, L a� OW1 REV. 12/99
l,sk

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] U 3 �1
WELL CONSTRUCTION RECORD WELL CONTRACTOR:
WELL CONTRACTOR CERTIFICATION #:
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE (Check Applicable Box): Residential ❑ Municipal ❑
Industrial ❑ Ag ' ultural Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
(
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: r/1 %/%s 1��1 County:
Al < c
(Road Name and Numbers, Comm lty, or Subdiv'sior� and Lot No,)
.
DRILLING LOG
DEPTH
3. OWNER �� �`� —� _
From To
Form ' n Description
�• ..,s��
Address f f�/`Y l /J��l,2ra��. �f",rL �
, r ,r
treat or HOU10 o.
t_ SAq
.�
VC
et
City or Town State Zip Code
;
c '.
�� \�
4. DATE DRILLED _ _
5. TOTAL DEPTH
6. CUTTINGS COLLECTED YES ❑ NO�
7. DOES WELL REPLACE EXISTING WELL? YES ❑ NOED--'
8. STATIC WATER LEVEL Below Top of Casing: 0 FT.
(Use '+' if Above Top of Casing)
9. TOP OF CASING ISFT. 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. l�n /Qlf
11. WATER ZONES ("d th):
12. CHLORINATION: Type
Amount
13. CASING:
Wall Thickness
Depth .�� y
Diameter or Weight/Et. Material
From
To '
Ft.
r- �• �-
From
To
Ft.
From
To
Ft.
14. GROUT:
Depth,
Material— Method
From !--
To �_�'
Ft.
1.,: ,ti. 1-71 KYy
From
To
Ft.
15. SCREEN:
Depth
From
To
From
To
From
To
16. SAND/GRAVEL
PACK:
Depth
From
To —
From
To_
17. REMARKS:
Diameter Slot Size Material
Ft in. in.
Ft. in. in.
Ft. In. in.
Size Material
_ Ft.
_ Ft.
It additional space Is needed use back of form
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other map reference points)
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL J:
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN,BROVIDED TO THE WELL OWNER.
A/
FOR OFFICE USE ONLY
Quad No:
Serial No.
SIGNATURE 9F� /�PE'RSdtl CONSTRUCTING T+f�LL DATE
Submit original to Oivisio of,
Quality, Groundwater Seaton within 30 days
GW1 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: r ��
WELL CONTRACTOR CE TIFICATION #:?
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE (check Applicable Box): Residential rf Municipal ❑ Industrial ❑ Agrif�ultural El Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use: plluiyil
2. WELL LOCATION: (Show s�ke�tch of the location below)
Nearest Town: _ + l J1 "' n County: + �% `� t, /, n
(Road Name and Numbers, Community, or Subdivision and Lot No.)
3. OWNER &-ve'e_ WGL4 SZ 1_%
Address 41jP� Ga-koe5 S+
treet or HOute o.
City or Town State Zip Code
4. DATE DRILLED 22
5. TOTAL DEPTH e) �—
6. CUTTINGS COLLECTED YES ❑ NO
7. DOES WELL REPLACE EXISTING WELL? Zo NO©Y
8. STATIC WATER LEVEL Below Top of Casing: J.) FT.
(Use '+' If Above Top of Casing)
9. TOP OF CASING IS t� FT. Above Land Surface'
'Top of casing terminated at/or below land surface requires a variance In accor-
dance with 15A NCAC 2C .0
10. YIELD (gpm): METHOD OF TEST J) "
11. WATER ZONES (depth):
DRILLING LOG
From To
DEPTH
12. CHLORINATION: Type Amount If additional space is needed use back of form
13. CASING:
Wail Thickness
Depth
j
Diameter or Weight/Ft. Material
From
To
Ft.
From
To
Ft.
From
To
Ft.
14. GROUT:
Depth
Material __ Method J
From
To��'
Ft.
(^ Z I ^ M II
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other map reference points)
From To
Ft.
15. SCREEN:
ca
Depth
Diameter Slot Size
Material
n
From To
Ft in.
in.
r-
From To
Ft. In.
In.
From To
Ft. in.
in.
16. SAND/GRAVEL PACK:
Depth
Size
Material
ko
From To
Ft.
y "
From To
Ft.
G
17. REMARKS:
z
I DO HEREBY CERTIFY THAT THIS WELL WAS CONST
CONSTRUCTION STANDARDS, AND THAT A COPY OF
FOR OFFICE USE ONLY--�
Quad No: SIGNA
S t original to 9i
Serial No. I %
'ED IN ACCORDANCE WITH 15A NCAC 2C, WELL
RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
e/)Gr
OF PEON CdNSTRUc-n/NG I-�E WELL DATE
Of Was r Quaiity; Groundwater Section within 30 days
� / GW1 REV. 12/99

North Carolina • Daparlment of Environment and Natural Resources • Division o1 Water Quality • Groundwater Section 213410
1036 Mall Service Center • Flalelph, N.C. 21699.1636-Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR: Hickory Well Drilling Co.
WELL CONTRACTOR CERTIFICATION #: 2306
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE (Check Applicable Sox): Residential Municipal ❑ Industrial ❑ Agrlcullural ❑ Monitoring ❑
Recovery ❑ Beat Pump Water InJOollon ❑ Other ❑ II Other, List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: Morgall ton County: Burke
1961 Spainhour Rd.
(Road Name and Numbe(s, Cornxnunity, or Subdivision and Lot No.) DRILLING LOG DEPTH
3. OWNER Dave Corder From To Formatlon Descrlpllon
Address 1961 Spainhour Rd.
Morganton 1,
(Streetor Au e o. 28655
_
City or Town Slate Zip Code - --
4. DATE DRILLED 06-26-00 --
5. TOTAL DEPTH _6U5_ ---- - - ------------ - --
6. CUTTINGS COLLECTED YES [] NOM -•--- �-'
7. DOES WELL REPLACE EMS PING WELL? YES U NO[,]
8. STATIC WATER LEVEL Below Top of Casing: �_ F r.�-
(Use '+' II Above Top of Casing)
9. TOP OF CASING IS 2 FT. Above Land Surface* frM'r
*Top of casing totmlrtsted st/or below land surface requires a variance In accor• "" ----�- m
dance with 15A NCAC 2C .011tt
10. YIELD (: 187 • METHOD OF TEST Measuring Line w ;
11. WATER ZONE epth). �'rn
12. CHLORINATION: Type EII1 Tabs Amount 106 If addlltonal space Is needed use back of Imm o
13. CASING:
Wall Thickness LOCATION SKETCH
Depth Diameter or Welphm. Material (Show dlreclibn and distance from at least two State
1 rr
From �-- To 101 Ft. -6-- fUyz-Steel Roads, or other map reference points)
From To Ft. —
From —To•- Ft.---- ------ - ------
14. GROUT:
Depth Malodal Molhod nAl��oU�j
From- 0 To 20 -Ft. Grout -- _ - Pot.ir-ed _ 5
.17
Frorn _ To .-_-.Ft. _�-----____-• _
15. SCREEN:
Depth Diameter Slot Siz6 Melorlal
From To Ft In. In. Q 'yam
From To Ft. In. In.
From To Ft.
16. SAND/GRAVEL PACK:
Depth Size Malerlal S
From To Ft. _----- - --- --- — —
From To Ft.--
17. REMARKS:
I DO HEREBY CERTIFY TIIAT 71119 WELL WAS CONSTRUCTED IN ACCORDANCE WITII 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND TIIAT A COPY OF 7111S RECORD IIA B PROVIDED TO THE WELL OWNER.
DRIL awm wai L00. - 06-28-00
FOR OFFICE USE ONLY
Quad No: COIlSTFIUCTINO TIIE WELL DATE
SuMZ"r&lv%
nj�,/ It�11�V,�Oroundwsler Secllon within 30 days
Serial No. `� `I I'i IWAY, 4 2 OW-1 F1EV. 1v99
t ,r
,i
I;

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:!o
WELL CONTRACTOR C RTIFICATION #:
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE (Check Applicable sox): Residential ❑ Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATION: (Show sket h of the location below)
Nearest Town: ' ' /�r:� �'+ n County: i IA L
(Road Name and Numbers Cornmuni or SuVivision and Lot No.) DRILLING LOG
3. OWNER G114' From To
Address
street or HOUte o.
i�ty or T wn / StaFe !
Zip Code -
4. DATE DRILLED �"+ ` -C)
5. TOTAL DEPTH r�o = y
6. CUTTINGS COLLECTED YES ❑ NO� —
7. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
8. STATIC WATER LEVEL Below Top of Casing: 7W Fr.
(Use '+' if Above Top of Casing)
9. TOP OF CASING IS FT. Above Land Surface'
'Top of casing terminated ayor below land surface requires a variance In accor-
dance with 15A NCAC 2C10t & !j`�• ���.�
10. YIELD (gpm): METHOD OF TEST
WATER ZONES de th)'
DEPTH
Formation Description
r •—
IlAz
11. ( p --
12. CHLORINATION: Type Amount If additional space is needed use back of form -_
13. CASING:
LOCATION SKETCH
Wall Thickpess
De th q t�'s8 AtOr or Wei i/Ft. M teri I (Show direction and distance from at least two State
From To
p FtI� � - Roads, or other map reference points)
�� . ��,;�
From To Ft.
From To Ft.
14. GROUT:
•� MethQd
Depthr���
Material
From To Ft.
0
From To Ft.
C.
15. SCREEN:
o_
t� n
Depth Diameter Slot Size Material
ro
r '
From To Ft
in. in.
From To Ft. __
in. in.
�.
o
From To Ft.
in. In.
16. SAND/GRAVEL PACK:
T
rrt �V
Depth
Size Material
CA3
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 REC D HAS BEEN PROVIDED TO THE WELL OWNER.
FOR OFFICE USE ONLY
Quad No: SIGNATUP,E OF//PE CONSTRUCTING HE WELL. DATE
Submit original to Divisl�tofWate uality, Groundwater Section Within 30 days
Serial No. L/ GW-1 REV. 12/99

North Carolina • Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section f t 2 2� Q
1636 Mail Service Center - Raleigh, N.C. 27699-1636-Phone [phone] !.
WELL CONSTRUCTION RECORD WELL CONTRACTOR: A, Let,( .tee
WELL CONTRACTOR CER IFICATION #:�r19 213
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE (check Applicable Box): Residential ❑ Municipal ❑ Industrial ❑ Agricultur I El Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other If Other, List Use: .S�,n
2. WELL LOCATION: (Show sqketch of the location below)
Nearest Town: �i(7 rc /% / t County: - t J r ✓I c e
(Road Name and Numbers, Commu ty, or Subdivision and Lot No.)
DRILLING LOG
3. OWNER C l�� �� �^ I���Pt( S�l
From To
Address
treet or ute
7
City or Tohn State Zip Code
DATE DRILLED `1 a - 065
r
4.
5. TOTAL DEPTH 1 :3
6. CUTTINGS COLLECTED YES ❑ NO
7. DOES WELL REPLACE EXISTING WELL? YES [] N0ED"�
8. STATIC WATER LEVEL Below Top of Casing: - 0 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 t �--
10. YIELD (gpm): _6ETHOD OF TEST �� •^ �,--yf�%
11. WATER ZONES (depth):
12. CHLORINATION: TypAmount .-
13. CASING:
DEPTH
Fonn ion Description
Q
� O
If additional space is needed use back of form
Wall Thickness LOCATION SKETCH
Depth Diameter or WelgWt. Material (Show direction and distance from at least two State
From 2 To 2L Ft. 4— --1 -12iL Roads, or other map reference points)
From To Ft.
From To Ft.
14. GROUT:
Depth atenal,- I Method �f
From
To 262 Ft. �� arc r'eGV
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:
I 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.
`c C)
FOR OFFICE USE ONLY
Quad No: SIG 11 RE SON CONSTRUCTING THE WELL DATE
Submit odgIn4(60;;b-vision 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 212259
1636 Mail Service Center - Raleigh, N.C. 27699-1636-Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR: /��-��� �✓��'� t��.'s/,-�4.G.
WELL CONTRACTOR C ICATION #:
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE (check Applicable eox): Residential [3 Municipal ❑ Industrial Agricultural 4 Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use: 'Al�.rS� �l
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: —_� M ''� County: f ��
(Road Name and Numbers, Community or Subdivision and Lot No.)
�)
DRILLING LOG
To
3.
OWNER �11 ) of ;
FF m
_�
Address ( j
treet or Route o.�
Vo S-O
rC, r) n N C
1 C) _11-0� S�
City or Tohn State Zip Code
4.
DATE DRILLED
5.
TOTAL DEPTH
6.
CUTTINGS COLLECTED YES ❑ NO
7.
DOES WELL REPLACE EXISTING WELL? YES ❑LNO[✓�-
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 requires a variance In accor-
dance with 15A NCAC 2C 01,18
10.
YIELD (gpm): (a METHOD OF TEST. r-
11.
WATER ZONES (depth): ,0 ���' 170 '
DEPTH
Formation Description
__
6-
o
�
O
c�
a�
0
cn --
—o
12. CHLORINATION: Type r if;
Amount
If additional space is needed use back of form
13. CASING:
LOCATION SKETCH
Depth Diameter
Wall Thickness
or Weiy t.
t� I
/
(Show direction and distance from at least two State
To � Ft. k
�i
Roads, or other map reference points)
From
From To Ft. —
From -To- Ft.
14. GROUT:
Depth.,, � aterial._ MetFtod
From .
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.
L=?,J J<c
From To Ft.
17. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THI ECORD HAS/BN-PROVIDED TO THE WELL OWNER.
FOR OFFICE USE ONLY DATE
Quad No: SIGN O�FP� SON CONSTR TING THE WELL
Submit original �d sion 6f ater Quality, Groundwater Section within 30 days
Serial No. GW1 REV. 12J99

n 1
12260
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 CER IFICATION #: ��� l y p 2013
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE (Check Applicable Box): Residential Municipal ❑ Industrial ❑ Agf'cultural� Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ if Other, List Use:
2. WELL LOCATION: (Show ketch of the location below)
Nearest Town: � ' rt rr;tV` 6In County: �ir r
(Road Name and Numbers, Communf , or Su ivisioq and lot No.) DRILLING LOG
3. OWNER .ram From To
Address outs Off( t
tree or o.
City or Town J State Zip Code
4. DATE DRILLED
5. TOTAL DEPTH
6. CUTTINGS COLLECTED YES ❑ NO[13'/
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 118
10. YIELD (gpm): METHOD OF TEST
11. WATER ZONES (depth):
12. CHLORINATION:
13. CASING:
DEPTH
Formation Description
C rn
.�—C
h�
m
rn�o
x
Type C kItW , I Amount _/ ILLI If additional space is needed use back of form
Wail Thickness
From L� DToth 1 Oiarr�eter oryv i � L M � GI
Ft. —� r
From To Ft.
From To Ft.
14. GROUT:
Depth /Material Method
From _.. To _�,)_J Ft.
From To Ft.
15. SCREEN:
From
From
Depth Diameter Slot Size Material
—To—Ft— in. in.
To - Ft. In
From To Ft. In. _
16. SAND/GRAVEL PACK:
Depth Size
From To Ft.
From To Ft.
17
In.
In.
Material
i DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS R
FOR OFFICE USE ONLY
Quad No: S►GNA E OF
Submit original to Qt sion of4
Serial No.
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other map reference points)
ACCORDANCE WITH 15A NCAC 2C, WELL
,RD HAS BE_gN-PROVIDED TO THE WELL OWNER.
6ON CONSTRUCTING THE WELL
Quality, Groundwater Section within 30 days
iA" �Ch�
DATE
GW-1 REV. 12/99

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section .12257
1636 Mail Service Center - Raleigh, N.C. 27699-1636-Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR: J '
WELL CONTRACTOR C RTIFICATION #:
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE (Check Applicable sox): Residential OrMunicipal ❑ Industrial ❑ Agricultura ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATION: (Show sk� h of the location below)
Nearest Town: �/C /GLi�7�-4 County:
(Road Name and Numbers tt Co unity, or Subdivision and Lot No.) DRILLING LOG
3. OWNER A-\ KD ` 6Lr-Ze,, �S h t Q — From To
Address o , &) � 4C) 2 4X
street or oute �% A -7 C
AD � � � _ -
City or To State Zip Code
4. DATE DRILLED
5. TOTAL DEPTH t
DEPTH
Ftion Description
7r1
6. CUTTINGS COLLECTED YES ❑ NOL.�d-
7. DOES WELL REPLACE EXISTING WELL? YES + NO�
O
p
�
_
8. STATIC WATER LEVEL Below Top of Casing: FT.
(Use '+' it Above Top f Casing)
9. TOP OF CASING ISFT. Above Land Surface*
ch
'Top of casing terminated at/or below land surface requires a variance In accor-
dance with 15A NCAC 2941 1
10. YIELD (gpm): METHOD OF TEST%�'
11. WATER ZONES (depth):
m
rs--
12. CHLORINATION: Type -r' Amount
If additional space is needed use back of f0n
i
13. CASING:
_
LOCATION SKETCH
Wall Thickness
Depth, Diameter or W igh t. Material
(Show direction and distance from at least two State
From To i Ft. 7 '+
Roads, or other map reference points)
From To Ft.
From To Ft.
14. GROUT:
From _
C Tepthao
Ft. I�
Method y,
From
To
Ft.
15. SCREEN:
Depth
Diameter Slot Size
Material
From
To Ft
in.
in.
From
To Ft.
in.
in.
From
To Ft.
in.
in.
16. SAND/GRAVEL PACK:
Depth
Size
Material
From
To
Ft.
From To Ft.
17. REMARKS:
I 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 BE PROVIDED TO THE WELL OWNER.
FOR OFFICE USE ONLY '{ t
Quad No: SIC' 1 O ISON CONSI`fi�1CTING THE WELL DATE
Submit original to pyisslon &I ater 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
213023
[phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR:ei�
WELL CONTRACTOR CERTIFICATION
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE (Check Applicable Box): Residential ❑ Municipal ❑ Industrial ❑ Agr' pitural Monitoring ❑ Recovery ❑ Heat Pump Water Injection
[] Other ❑ If Other, List Use:j�Jyypr _1 n
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: County:
�- t
Ummr)�y,or
(Roand Numbersivision and Lot No.�.1 ) DRILLING LOGDEPTH
3. OWNER l-n�,,,
Address From To Formation Description
0 �tj�
-- (5tr et or ou a o.
/% C.
City org own Stale Zip Code
4. DATE DRILLED 2 2 �OdO
5. TOTAL DEPTH
6. CUTTINGS COLLECTED YES [] NO[]
7. DOES WELL REPLACE EXISTING WELL? YES D NO ET
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 atfor below land surface requires a variance In accor-
dance with 15A NCAC 2C
.0118
10. YIELD (9Pm): METHOD OF TEST
;o
11. WATER ZONES (depth):
"f
o
12. CHLORINATION: Type Amount
Uw
mti
It additional space is needed use back of fdT;
13. CASING:
— t
f-,
Wall Thickness LOCATION SKETCH
Depth Diameter or igl va aterial (Show direction and distance from at least two State
From To Ft. Roads or other map reference points)
From To Ft. W. ; ; t
i'
Ofl
From I ` ..._ °r, -. D A U'�►�t;�0R�t t7>�l
To _.
Ft.
14. GROUT:
r la i Ji
Depth /n1 Mat na Me od �1 ., '. t i ;' } s•
�— 2V
j �� .
y b`I tL
to
RV,
From To Ft.a �
From To Ft. a
15. SCREEN:
vepin 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
From To 2 () Ft. #- /3
From To Ft.
17. REMARKS:
i4,1 ohv��c;rnpAYlzi
i� t1t ti�5
#40 ��`� �moP,bR>)40,0
100 HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
i p�
FOR OFFICE USE ONLY Ci,4, S v ©6
Quad No: SIGNATURE OF PERSON CONSTRUCTING THE WELL DA E
Serial No. Submit original to Division of Water Quality, Groundwater Section within 30 days
GW1 REV. 12/99

NoNh C0rollna - Department of Environment and Natural Resources • division of Water Quality - Groundwater Section 213387
1636 Mail Service Center - Raleigh, N.C, 27699.1638•Plrone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR: Hickory Well Drilling Co.
WELL CONTRACTOR CERTIFICATION #: _ 2306
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE (Check Applicable sox): ResldenllalM Municipal ❑ Industrial ❑ Agrlcultural ❑ Monitoring
❑
Recovery ❑ I-leat Purnp Water Infection ❑ Other ❑ If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below) .
Nearest Town: Morganton County: _ Burke
_6069 Walker's Chapel Rd.
(flood Name and Numbers, Comrnunlly, or Subdivision and Lot No.) DRILLING LOG
_DEPTH
3. OWNER LOLI1-e Hudson Frorn To Fonnalion Descrlprlon
Address 6069 Walker's---_
-(Sir-e-eT—ortioule
NC 28655
_Morganton
City or Town Slate Zip Code
C.�
05-09-00
4. DATE DRILLED
5. TOTAL DEPTH --•-•---- r
n
��
_
6. CUTTINGS COLLECTED YES [__) NOKXJ
7. DOES WELL REPLACE EXISTING WELL? YES
8. STATIC WATER LEVEL Below Top of Casing: -io_ F r.
l
_ _ -
(Use 'f' Ir Above Top of Caeing)
2 ---
r�
u
9. TOP OF CASING IS FT. Above Land Surface'
'Top of casing lermineted nVor below lend surface requires a varlanco In actor-
Cl)
dance with 15A NCAC 2C .0118
10. YIELD (gpm): 15 METf10D OF TEST By Air Tes t
z
11. WATER ZONES (depth):
12. CHLORINATION: Type HTE-( Tabs An1our11 33 If addlllonat space Is needed use back of form
13. CASING:
Depth
0
80
From.
To
Front
To --
Front
to--
14. GROUF:
Depth
Fiord _0____ To 20
Front __ To —_
15. SCREEN:
Dopth
Front
To Ft
From
To Ft.
From
-- To --Ft.
16. SAND/GRAVEL PACK:
Depth
Front
To
From
To
17. REMARKS:
Wall Thickness LOCATION SKETCH
or get/n. Irdal , (Show dlrecllbn and dlstnnce from at least two Slate
YVGFiastic noadn, or other map reference points)
Malorinl Molhod
FL Grout Poured
Diameter Slot Slz6 Malerlal
In. In.
In. In. _
In. _ Ili.- — -- -
r- i.
F1.
Size Mntollal
N
y�y
W
S
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WIT1115A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND Tf IAr A COPY OF T11I9 nECOnD IIA9 BEEN PnoviDED TO T1IE WELL OWNER.
FOR OFFICE USE ONLY riWMLMING(A`TW' 05-10-00
Quad No; SIGN ❑ ''�nI;PVE" D6�6v 4�ee1�� TING THE WELL
SUNpit original to 01091onRl QM46"142d rrndwaler Section wllllln 30 days
Serial No. am,
I
DATE
GW I nEV. 12/99

North Carolina • Department of Environment and Natural Flesources - Division or Water Quality - Oroundwater Section � 13 ) 9 ��
1830 Mall Service Center - Ralelghr N.C. 27890-1ll38-Plrons [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR: _ Hi _korV WP11 1)ri 11 ing' C',r-t.
WELL CONTRACTOR CERTIFICATION #: 2306
STATE WELL CONSTRUCTION PERMIT#:
WELL USE (CJteck Applicable eox): Residential [A Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ I feat Pump Water Injectlon ❑ Other CI II Other, 1-191 Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: Hi Idphran County: - Riirka
6902 Hiiffmnn Hill Rd.
(Road Name and Numbers, Cornrnunlly, or Subdivision and Lot No.)
3. OWNER Robert & Kathy Huffman
Address 6902 H�, � e, "l
Rd.
ret OrRouleN
Connelly Springs NC 28612
City or Town Slate Zip Code
4. DATE DRILLED 05-09-00
5. TOTAL DEPTH 245
6. CUTTINGS COLLECTED YES 0 NOW
7. DOES WELL REPLACE EXISTING WELL? YES I NOU
6. STATIC WATER LEVEL Below Top of Casing: 4 � F F.
(Use '+' It Above Top of Casing)
9. TOP OF CASING IS 2 FT. Above Land Surface*
'Top of casing terminated st/or below land surface requires a varlance In accor-
dance with 15A NCAC 2C .0118
10. YIELD (gpm): 12 METHOD OF TEST —By Air Test
11. WATER ZONES (depth):
DRILLING LOG
Frorn To
DEPTH
Formation Description
cs
C7
Q
-----ram„
tJ I M
M
rn_
x
12. CHLORINATION: Type HT( -I Tabs Amount 43 II additional space Is needed use back of form
13. CASING:
Depth Dfamri ff
From 0— To 98 Ft. 6 4
Frorn To Ft.
From l'o— Ft.
14. GROUT:
Depth
Frorn __ 0 __ To 20
From _.__—__ To
15. SCnEEN:
Wall Thickness LOCATION SKETCH
or wet hvr i. Maledal (Show dlreclibn and distance from at least two Slate
FM Plas tic Floods, or other map reference points)
Malodal
rt,
Depth Diameter
Diameter
From
To Ft In.
From
To Ft. In.
From
To Ft. in.
16. SAND/GnAVEL PACK:
Depth Size
From
To Ft.
From
To Ft.
17. REMARKS:
Molhod
Poured
Malorinl _
Mnterlal
a
1 DO HEREBY CEnTIFY THAT THIS WELL WAS CONSTnUCI ED IN ACCORDANCE WITI 115A NCAC 2C, WELL
CONSTRUCI ION STANDARDS, AND THAT A COP nT � O l �l 1 F' VIDED TO THE WELL OWNER.
FOR OFFICE USE ONLY
Quad No:
Serial No.
ROAD
SIONAIUfII�OUEq"J 18TRUCTINOTHEWELL DATE
Submll odglnal to Div[ 1p g' yylAlpr C.Kpilly, star Section within 30 days
;` 'at�� r' GW.1 f1EV. 12199

North Carolina • Deparlmont of Environment and Natural Resources • Division of Water quality • Oroundwater Section 2 4 O
1639 Mali Service Center • Raittigh, N.C.. 2271j99.1fil -Plmne (919) 733•a221
WELL CONSTRUCTION RECORD WELL CONTRACTOR: Hickory Well Drilling Co
WELL CONTRACTOR CERTIFICATION #: 2306
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE (Check Applicable Box): Residentlal= Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ It Other, List Use:
2. WELL LOCATION: (Show sketch of life location below)
Nearest Town: Morgan ton — County: Burke
5393 River Road
(Woad Name and Numbers, Communlly, or Subdivision and Lot Ile.) _DRILLING LOG _ UEPTFI
3. OWNER Janet Ben ton/Lower Creek Homes Ffom To Forrnalion Description
Address5-39.3 ��q��a�d�
reo or off u1eN0..j -- ---- — — — --- —
MnrQantnn NC 2i3Ct�5 �
City or Town Slate Zip Code
4. DATE DRILLED 05-05-00
5. TOTAL DEPTH 20.L5 ___—__— —_ —ram T
6. CUTTINGS COLLECTED YES [ _1 NOU
7. DOES WELL REPLACE EXISTING WEl_L7 YES[— _) NOJ r=t
6. STATIC WATER LEVEL Below Top of Casing: �— Fr.
— r i
(tJss '+' II Above Top of Casing)
9. TOP OF CASING IS 2 FT. Above Land Suffnco• -- -- ,-- — �m
'Top or casing terminated at/or below lend surface requires a valence In accor• N
dance with 15A NCAC 2C .0118 l0 rn�
10, YIELD (gpm); 10 _ METHOD OF TEST By Air Test L
11. WATER ZONES (depth):
12, CHLORINATION: Type
13. CASING:
HTH Tabs
Depth Dlamelcljrr,
From 0
To 42 Ft. 6 '4
Front
To FI.
From _
To— Ft.— --
14. GROU 1':
Amount _ 41
If addillonal space Is needed use back of form
Wall Ihlcknoss LOCATION SKETCH
or irUFl. M lariat (Show dlreclibn and distance from at least Iwo Stale
P � _u P as t is roads, or other map reference points)
Depth Malodal
Front To 20 .- FL ...CrnLIL—..---------
Front To
15. SCREEN:
Depth
Diameter
Front .__
To
FI _ In.
From
To
Ft. —_ In.
From ---
To _--
Ft. ----- In.
16. SAND/GRAVEL PACK:
Depth
Size
From -•- -- --...
_ i o .._.._:.___
_ I'I.. _ _ ..-
Front _.._—�_
to—-•
F1.....__-.-
17. REMARKS:
Molhod
Slot Slzo Meleflal
Matorial
W
C
100 IIEREBY CERTIFY TIIAT TIIIS WELL WAS CONSTRUCTED IN ACCORDANCE WI111 15A NCAC 2C, WEt.L
CONSTRUCTION STANDARDS, AND-IIIATAi YO` '� tJ/1 J�EFJ�('nOVIDEDTOlifE WELI.OWNER,
FOR OFFICE USE ONLY }�Y ih A"ESjjS ROA(jD�lYp���'
Quad No: SIONU(� Rt�� ONSTf1UCTINO TIIE WELL
Subrnll odglnel to DI'vl3lon'oIWlr1ter QDx Oroundwalor Secllon Whitln 30 days
Serial No. 2°.'
05-30
DAIS
OW-1 FIEV. 12/99

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section 2 1 3 %2 9 1
1636 Mall Service Center - nalelgh, N.C. 27699.1636-Phone [phone]
WELL CONSTRUCTION RECORD WELLCONTRACTOR: _ Hickory Well Drilling Co.
WELL CONTRACTOR CERTIFICATION N: 2306
STATE WELL CONSTRUCTION PERMITN:
1. WELL USE (Check Applicable Box): Residential Municipal C] Industrial ❑ Agricullural ❑ Monitoring ❑
Recovery ❑ I leaf Pump Water Injection ❑ Other ❑ It Other, Llst Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: 11 i l d e b r a n County:
Burke
—$R(ln 4,`rrIn,MPa ws Dr Lot #2
(noad Name and Numbers. Conununlly, or Subdivision and Lot No.) DRILLING LOG
3. OWNER Brian & Patricia Finch From To
Address 8800 Spring Meadows Dr. Lot #2
Hickory fea or
ou 28601
City or Town Slate 21p Code
4, ' DATE DRILLED 05 -11- 00
5. TOTAL DEPTH 2 8 5
6. CUTTINGS COLLECTED YES L_j NOW
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 2_ FT, Above Land Surface'
'Top of casing terminated at/or below land surface requires a variance In accor-
dance with ISA NCAC 2C g116
10. YIELD (gpm): / METIIOD OF TEST By Air Test
11. WATER ZONES (depth):
12. CHLORINATION: Type
13. CASING:
Depth
0
7 2
From
To
From
To
From
To
14. GROUT:
HTH Tabs Amount
LUalnpf er
Ft. bb 4
FI.
Ft.
DEPTH
Formallon Description
CA
C_
n :�
r"-
c `•n
o.c
rn
Y
mW
Cn
—I
Z
if additional space Is needed use back of form
Wall IhIckness LOCATION SKETCH
or )Nealglr VL Malift e 1 (Show direclibn and distance from of least two Stale
the 11 J Roads, or other map reference points)
Depth Material
Front 0— To 2_ FI. _f r oiL�
From To FI. _
15. SCREEN:
Depth
From
To
From
To
From
To
16. SAND/GRAVEL PACK:
Depth
From
To —
From
To_
17. REMARKS:
Molhod
-Poured-
Diameter Slot SIz6 Matellnl
FI In. In.
Ft. In. In.
Ft. In. In.
FI.
Ft.
Size Materlat
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITII 15A NCAC 20, WELL
CONSTRUCTION STANDARDS, AND TFIApIiIJ13 QCrQu8l9,Pr N PROVIDED TO THE WELL OWNER.
FOR OFFICE USE ONLY 340 1-46 AI^,l^ES8 ROAD 05-17-00
Quad No: Slt#!l/1UUr �N CONSTnUCTING THE WELL DATE
Subrnll 0dgt(1 q '1 1 n or alef� alltX, Groundwater Section within 30 days
Serial No. ' r r F� �s ��',1�jj OW 1 REV. 12/99
i
?' r

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section 1) 1
163el Mall Service Center - Raleigh, N.C. 27699-163f1-Phone [phone]
WELL CONSTRUCTION RECORD WELLCONTRACTOn: Hickory Well Drilling Co.
WELL CONTRACTOR CERTIFICATION 0: 2306
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE (Check Applicable sox): Residential EN 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: Icard County: Burke
5190 Miller Mill Rd.
(noad Name and Numbers, Community, or Subdivision and Lot No.) DRILLING LOG DEPTH
3. OWNER Keith Downing From To Formation Description
Address 5190 Miller Mill Rd.
(Street or ou a o.
Hir,knry NC 2f 602
City or Town ' Stale Zip Code
4. DATE DRILLED 05-10-00
5. TOTAL DEPTH 1991
�-- --
6. CUTTINGS COLLECTED YES E] NO10
7. DOES WELL REPLACE EXISTING WELL? YES r� NOU
8. STATIC WATER LEVEL Below Top of Casing: $�jj Fr.
(Use'+' If Above Top of Cnsing)
9. TOP OF CASING IS 2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a variance In sosoa
dance with 15A NCAC 2C , to
10. YIELD (gpm): 1 METHOD OF TEST B y Air Test
11. WATER ZONES (depth):
12. CHLORINATION: Type HTH Tabs Amount 51
13. CASING:
Depth D grq�pr
From To 135 Ft.
From To Ft.
-
From To Ft.
14. GROUT:
If additional space Is needed use back of form
Wall lhlckness LOCATION SKETCH
a6Waelg ri. Meleriaei e 1 (Slow direcllbri and distance from at least two Slate
.LL JJ Ct Roads, or other map reffeerrence points)
!X
\ -1--w
Depth Malorlol Molhod
From ___0 To 20 r-I. Grout Poured
From To Fl.
15. SCREEN:
Depth Diameter Slot Siz© Malorlal
Front To Ft In. In. _
From To FL In. In.
From To Ft. In. In.
16. SAND/GRAVEL PACK:
Depth Size Material
a �o
V,
Pat
0 5
From To Ft.
From To Ft.
17. REMARKS:
F
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THI9 RECORD H 9 B KPROVIDED TO THE WELL OWNER.
M(ORYQ1, LDRILLtaVG O..Ff 05-17-00
FOR OFFICE USE ONLY OAnT (;(`CQ(Z pnnr) -
Quad No: SIONI�TUDE�r
Submit original to p vis n
Serial No. lIf 3{�t0 ii T
P!J,CONSTnUCTING THE WELL DATE
IdttM,f�oroundwater Section wlthin 30 days
i t 1 0 OW-1 nEV. 12/99

212215
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 #:',D
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE (check Applicable Box): Residential [L]" 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:'676 1,c!/7/1/TGstil County: ./4 0h(1
(Road Name and lN�mbers, Community, or Subdivision and Lot No.) DRILLING LOG DEPTH �= 3. OWNER �7 C < M17 11-I'd 6 /4' �` /%'m /Z S From To Formation Description
Address 0 0
N�� (Street or I/,oUleNO.)� '� >S_.2
City or Town State Zip Code
I
' & v J
a
4. DATE DRILLED
�—
5. TOTAL DEPTH S S
6. CUTTINGS COLLECTED YES ❑ NOa
�--
Q —
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 ri
METHOD OF TESTS
10. YIELD (gpm):
11. WATER ZONES (depth):
12. CHLORINATION: Type
13. CASING:
Amount if additional space is needed use back of form
Wall Thickness
Depth Diameter Diameter or Weight/Ft. atenal
From To V Ft.- /I 6—
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.
16. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
17. REMARKS:
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other map reference points)
I DO HEREBY•CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 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:
Serial No.
SIGNATURE OF PERSON CONSTRUCTING THE WELL
Submit original to Division of Water Quality, Groundwater Section within 30 days
DATE
GW-f REV. 12/99

n
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section 12193
1636 Mail Service Center - Raleigh, N.C. 27699-1636-Phone [phone]
WELL CONSTRUCTION RECORD WELLCONTRACTOR:
WELL CONTRACTOR CERTIFICATION #: o�I2i
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE (check Applicable sox): Residential ❑ Municipal E—er Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATION:^(h w sketch of the location below)
k
Nearest Town: l V�� p County: %t
r e
t
,l r>_a f R r,'Jae _
(Road Name and Numbers, or Subdivision and Lot No.)
DRILLING LOG
—Community,
3. OWNER %G_k &_ Ttbtrt e s 5 "--k ! a�_ Pa / K
From
To
Address P O _' y 3 4 D
D
L _ —
�� treat or Houle o
1�0:�—
City or Town Stale Zip Code
—
4. DATE DRILLED 5_3;_12Z)
—
5. TOTAL DEPTH 52) 5
—
6. CUTTINGS COLLECTED YES ❑ NO®
y.
7. DOES WELL REPLACE EXISTING WELL? YENO®
8. STATIC WATER LEVEL Below Top of Casing: 9' FT.
b`
(Use '+' If Above Top of Casing)
9. TOP OF CASING IS— FT. Above Land Surface*
,.
t)
� f� ��T-
OWL
-Top of casing terminated at/or below land surface requires a variance In accor-
y 1 } :,
;-� i —'
dance with 15A NCAC 2C .0118
10. YIELD (gpm): METHOD OF TEST
11. WATER ZONES (depth):
12. CHLORINATION: Type e Amount
13. CASING:
Wall Thickness
Depth Diameter or Weight/Ft, ate al
From ® To � Ft. D �L
From To Ft.
From To Ft.
14. GROUT:
Depth Mdel Method
From �— To �� Ft. a eei k4f.Q
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:
DEPTH
If additional space is needed use back of form
(Show direction and dista
Roads, or other map
least two State
t �-D
Wla
OA_ l.aC 8rlI e
C-GC55 �
�T�i
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS CORD HAS BEENPjROVID D TO THE WELL OWNER.
FOR OFFICE USE ONLY—'00
Quad No:
Serial No.
SIGNATUREPF PERSON CONSTRUCTING THE WEd DATE
Submit original to Division of Water Quality, Groundwater Section within 30 days
GW-1 REV. 12199

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mall Service Center - Raleigh, N.C. 27699-1 G36-Phono [phone]
r�'t� Swell (eJc►1t`ilM�q`.;'
WELL CONSTRUCTION RECORD WELL CONTRACTOR: — .�,� , •.
WELL CONT11ACTO11 CERTIFICATION M:_?%
STATE WELL CONSTRUCTION PE-RMITI/:
1. WELL USE (Check Applicable sox): Residential ❑� Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑.,,
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ It Othor, List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: A�' �O� County:
(RoacYNAme and Numbers, Community, or Subdivision and Lot No.) DRILLING LOG DEPTH
3. OWNER '•y `LJ C-on scR4 From To Fonnatlo Description'
Address — CD -- 71
/ v tree, or ou o.� ' 7 j 1-16>2 —E%Le E�22c AL
City or Tg State Zip Code
4. DATE DRILLED
5.. TOTAL DEPTH
6. CU77INGSCOLLECTED YES❑ NO❑' — �'' �`•
7. DOES WELL REPLACE EXISTING WELL? YES ❑ NOEI-
8. STATIC WATER LEVEL Below Top of Casing: FT.
(Use '+' If Above Top of Casino)
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 .Q1 8
10. YIELD (gpm): METHOD OF TEST
11. WATER ZONES (depth): L —'" 'y
12. CHLORINATION: Type h k3� Amount If additional space Is needed use back of farm
13. CASING:
Depth Diam9tor
i
From To 26 Ft. C2
From To - Ft.
From To Ft. —
14. GROUT:
Wall Thickness LOCATION SKETCH
or WoiohVFI. Material (Show direction and distance from at least two Stale
x), - _�C-- lloads, or other map reference points)
Dept Matorta
From 0 To d Ft. C�11t e-
From To Ft.
15. SCREEN:
Depth Diameter Slot Size
From To Ft in. _
From To Ft. in. _
From To Ft. in. _
16. SAND/GRAVEL PACK:
Depth Size
From To Ft.
From To Ft.
17. REMARKS:
Method /)
Material
in.
In.
In.
Material
CD
C1
C
1
N
Ln
_J
100 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.
OF PERSON CONSTRUCTING THE WELL DATE
749 1111 roundwater-Seelion-Wit in 30 days
�TnHW� x_
FJUN2 8 2000
GW1 REV. 12/99

!17I'L
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: Hickory Well Drilling
WELL CONTRACTOR CERTIFICATION #: 2306
STATE WELL CONSTRUCTION PERMIT#:
218317
Co.
1. WELL USE (Check Applicable Box): Residential O Municipal ❑ Industrial ❑ Agricultural ❑
Monitoring ❑
Recovery ❑ Heat Pump Water In)ectlon ❑ Other ❑ If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: Icard County: Burke
4810 Mt. Hebron Ave.
(Road Name and Numbers, Community, or Subdivision and Lot No.) DRILLING LOG DEPTH
3. OWNER —Fthpl Rohprfs From To Formation
Description
Address 4810 Mt. Hebron Ave. _
(Street or ou a o.
Connelly Springs NC 28612
City or Town State Zip Code
c-
4. DATE DRILLED 04-17-00
—
5. TOTAL DEPTH 31715'
6. CUTTINGS COLLECTED YES ❑ NOFa] _
in
7. DOES WELL REPLACE EXISTING WELL? YES �] NO®
1-' n
B. STATIC WATER LEVEL Below Top of Casing: -70 FT.
--
(Use's' If Above Top of Casing)
2
G, TOP OF CASING IS FT. Above Land Surface*
a
'Top of cuing terminated at/or below lend surface rsqulres a vsrlsnc• In scoor-
dance with 13A NCAC 20.0111111
10. YIELD (gpm): 2 METHOD OF TEST Bw Air Test_
r„
11. WATER ZONES (depth):
sn —„�- l—
r j1 0
12. CHLORINATION: Type HTH Tabs Amount 49 If additional space Is needed use back of
form
13. CASING:
Depth DIaTFIer
From 0 To 58 Ft. 6 a
From To Ft.
From To Ft.
14. GROUT:
Wall Thickness LOCATION SKETCH
or WeiAhVFt. Material (Show direction and distance from at least two State
PVC; Plastic Roads, or other map reference points)
Depth
Material
Method
From 0
To 20
Ft. Grout
Poured
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
From To Ft.
From To Ft.
17. REMARKS:
Size Material
�p N
E
1 )���jtClJ IG'
S
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.
Fg-CKORY Vil!l DRILLNG CO,, nL
,NSTRUCTING THE WELL
Qrovndwater Section wllhlfl 30 day;

i5f-
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section 2 18 3 1 3
1636 Mail Service Center - Raleigh, N.C. 27699-1636-Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR: Hickory WPI I 6ri l l ; g Co.
WELL CONTRACTOR CERTIFICATION #: 2306
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: - Morganton • County: Burke
(;110 Rir.h Mtn. Rd.
(Road Name and Numbers, Community, or Subdivision and Lot No.)
3. OWNER James Suttles
Address 6110 Rich Mtn. Rd.
(Street or Route o.
Morganton NC 28655
City or Town Stale Zip Code
4. DATE DRILLED 04-10-00
5. TOTAL DEPTH 245'
6. CUTTINGS COLLECTED YES ❑ NO®
7. DOES WELL REPLACE EXISTING WELL? YES [Z3 NO❑
8. STATIC WATER LEVEL Below Top of Casing: 9_ FT.
(Use 't' 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): 1. METHOD OF TEST By Air Test
11. WATER ZONES (depth):
DRILLING LOG DEPTH
From To Formation Description
12. CHLORINATION: Type HTH Tabs Amount 4_ If additional space is needed use back of form
13. CASING:
Depth Diaeter
III"
From 0 To 54 Ft.
From To Ft.
From To Ft.
14. GROUT:
Wall Thickness LOCATION SKETCH
or WeiAhVFt. Material (Show direction and distance from at least two State
PVC; Plastic Roads, or other map reference points)
A
Depth Material
From 0 To 20 Ft. Grout
From To Ft.
15. SCREEN:
Depth
From
?o Ft
From
To Ft.
From
To Ft.
16. SAND/GRAVEL PACK:
Depth
From
To
From
To
17. REMARKS:
Method
Poured
Diameter Slot Siz6 Material
in.
In.
In.
In.
In,
In.
Size
Material
Ft.
Ft.
L
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.
{p�?IX I II L DRILL CG., IBC. 04-12-00
FOR OFFICE US L 1nrn' c
Quad No: " T�j ON CONSTRUCTING THE WELL DATE
Subfnll o -
Illy, Uroundwolar 54allon Wlihin 30 days
W al No.. r 12 2000

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section a1 1636 Mail' Service Center - Raleigh, N.C. 27699-1636-Phone [phone]
7505
/
WELL CONSTRUCTION RECORD WELL CONTRACTOR: Joe M. Fercfuson
WELL CONTRACTOR CERTIFICATION #: 2026
STATE WELL CONSTRUCTION PERMIT#: ' I
1 WELL USE (check Applicable sox): Residential ❑ Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ® If Other, List Use: Retreat- i on Area
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: Morganton County: R11 rkP
(Road Name and Numbers, Community, or Subdivision and Lot No.)
DRILLING LOG DEPTH
3. OWNER National Forests in N.C.
From To Formation Description
Address 160—A Zillicoa Street
0-30 Soft White Sand Rock
— 'ZStreetor HOUIG o.
30-80 Sand Rock
Asheville NC 28802
80-84 Bedrock
City or Town State Zip Code
84-202 Grey Granite
4. DATE DRILLED 4-05-00
225
202-203 Crevice —Water
5. TOTAL DEPTH
6. CUTTINGS COLLECTED YES® NJO❑
203-225 Grey Granite
7. DOES WELL REPLACE EXISTING WELL? YES ❑ NOE]
8. STATIC WATER LEVEL Below Top of Casing: ._6 0_— FT.
(Use '+' If Above Top of Casing)
9. TOP OF CASING IS 2 FT. Above Land Surface*
4
*Top of casing terminated atfor below land surface requires a variance In accor-
dance with 15A NCAC 2C .0118
10. YIELD (gpm): 20 METHOD OFTEST Big
<-°P�
11. WATER ZONES (depth):_,
ca
12. CHLORINATION: Type HTH Amount 38
If additional space is needed use back of forfi7
^'
13. CASING:
'
LOCATION SKETCH r �o
Wall Thickness
Depth Diameter or Weight/A. Material
(Show direction and distance from at least two St e - P
0
From 0 To 84 Ft. 6-2-5 .188 Gaily- Stee lRoads, orother map reference points) _-
From To Ft.
From To Ft.
14. GROUT:
Brown Mtn. Recreation Area
Depth Material Method
Burke County
From 0 To - 84 Ft. Cement nrPGGurp
of.f. State Highway 1 405
From To Ft.
15 miles NW of Morganton, NC
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 THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OFT RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
FOR OFFICE USE;QNLY
Quad No: ISIG6AURE OF PERSON CONSTRUCTING frTE WELL DATE
g Submit o0&al to Division of Water Quality, Groundwater Section within 30 days
Serial No. .Y't .I.IUiJ GW-1 REV. 12/99
;j i

North Carolina • Department of Environment and Natural Resources • Division of Water Quality • Groundwater Section 213398
1636 Mall Service Center • RpIRI9h,N.C. 27t1q8 1�� Phone (step 7� 2zz1
WELL CONSTRUCTION RECORD WELL CONTRACTOR: _Hickory Well Drilling Co.
WELL CONTRACTOR CERTIFICATION P: 2306 .
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE (Check Applicable Box): nesldentlalf] Municipal El Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2, WELL LOCATION: (Show sketch of the location below)
Nearest Town: �`'in_rDAntrnl county: Burke
4879 Pea Ridge Rd.
(Road Name and Numbers. Corrvnunily, or Subdivision and Lot No.)
DRILLING LOG DEP 1`11
3. OWNER Billy Forbes
_
From To Formation Description
n
Address 4879 Pea. Ride Rd.
o
�—(5 reo or ou C j—
Morganton NC 28655
— �
------- - ---
m
_ _
City or Town Zip Code
�52h�State
4. DATE DRILLED-.��JS�-
5. TOTAL DEPTH
— —
6. CUTTINGS COLLECTED YES L_-( NU&X_J
tea
7. DOES WELL REPLACE EXIS TING WELL? YES (_ _) fJU
.i_ -
�M
8. STATIC WATER LEVEL Below Top of Casing: —— Fr.
- ��,rri
(Use '+' If Above Top of Casing)
_
Cn
,4
9. TOP OF CASING ISM_ FT. Above Land Surface'
"--
0
'Top of casing terminated at/or below lend surface requires a variance In accor-
dance with 15A NCAC 2C .gq118
_
10. YIELD (gpm): 1 METHOD OF TEST By Air Test
11. WATER ZONES (depth): _
12. CHLORINATION: Type HTEI Tabs Amount 68
It additional space Is needed use back of form
13. CASING:
Wall Thickness
LOCATION SKETCH
Depth 0(alyelor q� IghVFI. Material
0� 97 4 tJPlastic
(Show dlrecllbn and distance from at least two Stale
From To Ft. _
Roads, or olhor rnap reference points)
From To Ft. —
From To Ft._
14. GROUT':
\
Depth Malorlol Mothod
From _Q _-- To 2(.L__
From _ .—. _ To--
15. SCREEN:
D©pth
From
To
From
To
From
--- To
16. SAND/GRAVEL PACK:
Depth
Frorn
To
From _...__�
To-
17. REMARKS:
Diameter Slot SIz6 Matolini
Ft _ — In. In. _
Ft. In. In. _
Fl. In. _..--- In. - --- --
Size Mateflal
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.
# M MLL DRfP_LNNG CO.., 04M, OS-12
FOR OFFICE USE ONLY ++Rn�SY. ■Haar-.... .�n_._r, _
Quad No:
Serial No.
n, Yi ill)1E'&.Yy'�EQ��§1oil)df3HsTnUCTING THE WELL
Submit ortolnarl tory�/Vll�Rgi pr•.WIr 4211�Rlily, Groundwater Section within 30 days
q + ?._.
DATE
GWA nEV. 12/99

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section 13 r3 7
1636 Mail Service Center - Raleigh, N.C. 27699-1636-Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR: Hickory wet I ,Dr-i 11 in2 Co
WELL CONTRACTOR CERTIFICATION #: 2306
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE (Check Applicable Box): Residenllal E3 Municipal ❑ Industrial ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: Morganton County: Burke
6110 Rich Mtn Rd
(Road Name and Numbers, Community, or Subdivision and Lai No.)
3. OWNER James Suttles
Address 6110 Rich Mtn. Rd.
Jbireet or tioule o.
Morganton NC 28655
City or Town State Zip Code
4. DATE DRILLED 04-10-00
5. TOTAL DEPTH 24.5'-
6. CUTTINGS COLLECTED YES ❑ NO®
7. DOES WELL REPLACE EXISTING WELL? YES (0 NO❑
8. STATIC WATER LEVEL Below Top of Casing: 9 _ FT.
(Use '+' If Above Top of Casing)
9. TOP OF CASING ISM_ 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): 1 METHOD OF TEST 4 Air Test
11. WATER ZONES (depth):
Agricultural ❑ Monitoring ❑
DRILLING LOG DEPTH
From To Formation Description
O
U
-r`=
a ci
rn
cn
fT2�
CA
=�
0
z
12. CHLORINATION: Type 111H TahS Amount 41 If additional space Is needed use back of form
13. CASING: '
Depth Diameter
From 0 To 54 Ft. 6 4
From To Ft.
From To Ft.
14. GROUT:
Wall Thickness LOCATION SKETCH
or Weight/Ft. Material (Show direction and distance from at least two State
PVC Plastic Roads, or other map reference points)
Depth Material Method .
From 0 To 20 Ft. Grout Poured
From - To Ft.
15. SCREEN:
Depth Diameter Slot Size Material
16
17
From
To
Ft In.
In.
From
To
Ft. in.
In.
From
To
Ft. In,
in.
SAND/GRAVEL PACK:
Depth.,
Size
Material
From
From
REMARKS
�1
N
E
I DO HEREBY CERTIFYTFI`AT'jiW'Wi=LCWAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
MC`(ORY W:N L DRILLNG CO., IBC. 04-12-00
FOR OFFICE USE ONLY _
Quad No: 0��T�j N CONSTRUCTING THE WELL DATE
9ulaftll off 11 j � qJIly, Oroundwatar Sealion Within 30 day9
8erlal Na. 0W' 1 ngv: 12/99

North Carolina - Department of Environment and Natural Resources - Division of Water Quality • Groundwater Section 213381
1636 Mail Service Center - Raleigh, N.C. 27699-1636-Phone [phone]
WELL CONSTRUCTION RECORD WELLCONTRACTOR: Hickory Well Drilling Co.
WELL CONTRACTOR CERTIFICATION #: 2306
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE (Check Applicable eox): ResidentialE3 Municipal M Industrial 0
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: M0r2ant0n County:
Burke
2332 Crestview St
(Road Name and Numbers, Community or Subdivision and Lot No.)
3. OWNER Thomas Suttles
Address 2332 Crestview S t .
(Street or Route o.
Mori?anton NC 28655
City or Town State Zip Code
4. DATE DRILLED 04-18-00
5. TOTAL DEPTH ?05 r
6. CUTTINGS COLLECTED YES M NO y-
7. DOES WELL REPLACE EXISTING WELL? WS (^I NOE]
e. ATATIQ WATEN LIIVUL below Tap of oatalnpt � - ".
(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 .0110
10. YIELD (gpm): 4 _ METHOD OF TEST .11W Air Test
11. WATER ZONES (depth):
Agricultural ❑ Monitoring ❑
DRILLING LOG DEPTH
From To Formation Description
Q
C hn—
crn
c�
rst +: M
-= M
rn;oo
x -
12. CHLORINATION: Type HTH Tabs Amount 30 If additional space Is needed use back of form
13. CASING:
Wall Thickness
Depth Diameter or WelghVFI. Material
From (1 To 108 Ft. 1 r�1 —PVC Plas is
From To Ft.
From To Ft.
14. GROUT:
Depth
Material
Method
From 0 To _20 Ft.Cro11
'
PnurPrl
From To
Ft.
15. SCREEN:
Depth
Diameter Slot Slze
Material
From To
Ft
In.
in.
From To
Ft.
In.
In.
From To
Ft.
in.
in.
16. SAND/GRAVEL PACK:
Depth
Size
Material
From To
Ft.
From To
Ft.
17. REMARKS:
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other map reference points)
yv
w �1�
PIC S
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.
Way wa DRUI G Co., INC.
- - -- - -
INSTRUCTING THE WELL DATE
Ofoundweler boeilon within 30 dayQ
aw.l nEV. ts/ot+

28 North Carolina - Department of Environment and Natural Resources - Division of Water Oualiy - Groundwater Section � 1
1636 Mail Service Center - Raleigh, N.C. 27699-1636-Phone [phone]
WELL CONSTRUCTION RECORD WELLCONTRACTOR: Hi ko , Drilling Co
WELL CONTRACTOR CERTIFICATION #: 2306
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE (Check Applicable Box): ResidentlalMunicipal ❑ Industrial ❑
Agricultural ❑ MoNtoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATION: gghow ketchh of th i cation below) Burke
College
Nearest Town: Ruthi- County:
l-lnrhnr PJ r10P Rr)
(Road Name and Numbers, Community. or Subdivision and Lot No.) DRILLING LOG
DEPTH
3. OWNER lamas Wilkie kj e From To
Formation Description
Address PO Box 222
(Street or Ro No.)28136
Polkville
c,
City or Town State Zip Code
4, DATE DRILLED _ 04—?7-00
5. TOTAL DEPTH 499�
C Qm
6. CUTTINGS COLLECTED YES ❑ NOE
F=
7. DOES WELL REPLACE EXISTING WELL? YES [---] NOFX]
•, GTATIC WATUM LiVKL. oolow Top of Cominpt GO FT.
(Use '+' If Above Top of Casing)
`
9. TOP OF CASING IS 9 FT. Above Land Surface*
M
'Top of casing terminated aVor below land surface requires a variance In accor-
:a Fria —
dance with 15A NCAC 2C .o11e $y Air Tes t
10. YIELD 4 METHOD OF TEST,
n
(gpm):
^
11. WATER ZONES (depth):
12. CHLORINATION: Type HTH Tabs Amount 77 If additional apace is needed use back of form
13. CASING:
LOCATION SKETCH
Wall Thickness
Depth Diameter or Welght/Fl. Material (Show direction and distance from at least two State
From 0—To 84 - Ft. id, _PVC 21,stiC Roads, or other map reference points)
From To Ft. �/� �p ��/t/EG1,
From To Ft.
14. GROUT:
Depth Material Method lvmf S/D
From 0 To 20 Ft. Grout Poured
From To Ft.
15. SCREEN: �iu/� �� �FtJ�
Depth Diameter ,Slot Size Material w � O.i1��`�G� f
From To Ft In. —in.—
From To Ft. In. in. jr� 1/0
From To Ft. In. in.
16. SAND/GRAVEL PACK: s
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 I ECORD HAS' BEEN PROVIDED TO THE WELL OWNER.
05-01-00
FOR OFFICE USE ONLY p� DATE
Quad No: Slap f P N CONSTRUCTING THE WELL
aauGfnll orlpirJpn�� ®reundwlllf+r;941lgn Within 30 days
GWt PIFV.tzi�v
5
13i ,3t1 y,s 9 f

�13280
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 WELLCONTRACTOR: Hickory Well Drilling Co:
WELL CONTRACTOR CERTIFICATION #. 2306
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE (Check Applicable Box): Residential ® Municipal ❑ Industrial ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: Connelly Springs County: Burke
5877 Buzz Lowman Rd.
(Road Name and Numbers, Community, or Subdivision and Lot No.) DRILLING LOG
3. OWNER Gary Huffman From To
Address / Rex Huffman 5877 Buzz Lowman Rd.
(streConnelly Springor s NC 28612
City or Town State Zip Code
4. DATE DRILLED 04-18-00
5. TOTAL DEPTH 3_
6. CUTTINGS COLLECTED YES ❑ NOrl
7. DOES WELL REPLACE EXISTING WELL? YESM NO❑
8. STATIC WATER LEVEL Below Top of Casing: FT.
(Use '+' If Above Top of Casing)
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): 2 METHOD OF TEST By Air Tes t
11. WATER ZONES (depth):
12. CHLORINATION: Type HTH Tabs Amount 51
13. CASING:
Wail Thickness
Depth Diameter or Welght/Ft. Material
From . 0 To 119 Ft. "' I -PVC -Plass i c
From To Ft.
From To Ft.
14. GROUT:
Depth Material Method
From _-0 To 20 Ft. Gre11 Pntir _C
From To Ft.
15. SCREEN:
Depth Diameter Slot Size Material
From To Ft in. in.
Agricultural ❑ Monitoring ❑
DEPTH
Formation Description
If additional space Is needed use back of form
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other map reference points}
W
From To Ft. in. in.
From To Ft = i in.
16. SAND/GRAVEL PACK: i; C
Depth I Size ; i, Material J
From
To y 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.
HWRY WaL DRILLING CO., lu�l`t�.. 0 4 - 21- 0 0
FOR OFFICE USE ONLY 940 1ACJ
rlkSIGNATURErQF E TRUCTING THE WELL DATE
Quad No: I rr Y
rnhn l e t,; . tn, r�i hlnn I u rl.,! Br Sortion Wit }��I q0 a','?
5utSrhi OrigMei to Ury r i � eW9iJi sscim.t vvniiil� Ju aY5 OW,t nBV, I1109
A*r1al Ne,

North Carolina - Department of Environment and Natural Resources - Division of Water Duality - Groundwater Section 2 1 3 2 71
1636 Mail Service Center - Raleigh, N.C. 27699.1636-Phone [phone]
WELL CONSTRUCTION RECORD WELLCONTRACTOR: Hickory Well Drilling Co.
WELL CONTRACTOR CERTIFICATION #: 2306
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE (Check Applicable Box): Resldentlal ® Municipal ❑ Industrial ❑ Agricultural 0 Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: Hi1debran County: Burke
8634 County Line Rd.
(Road Name and Numbers. Community, or Subdivision and Lot No.)
3. OWNER YPr Vang
Address 8634 County Line Rd.
tree or Route o.
Hickory NC 28601
City or Town Stale Zlp Code
4. DATE DRILLED 04-18-00
5 TOTALDEPTH 409 '
6. CUTTINGS COLLECTED YES E] 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 2 FT. Above Land Surface -
*Top of casing terminated at/or below land surface requires a variance In accor-
dance with 15A NCAC 2C .0 18
10. YIELD (gpm): 2 METHOD OF TEST B y Air Te St
11. WATER ZONES (depth):
DRILLING LOG
From To
DEPTH
Formation Description
o
�
c.71
r n
._ o
m
fn �U
Ln
-�-1
tA
z
12. CHLORINATION: Type 14TI4 Tabs Amount 74 If additional space Is needed use back of form
13. CASING:
Wall Thickness LOCATION SKETCH
Depth Diameter or WefghWt. Material (Show direction and distance from at least two State
From 0 To 45 Ft. 6 4" PVC Plastic Roads, or other map reference points)
From To Ft.
From To Ft.
14. GROUT:
Depth Material Method
From 0 To 20 Ft. Grnttt- PntirPd
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: `lf
Depth Size'' a �`Ma�teri'als
Pi
From To Ft'.
From To Fti aEiht i+ i s Ii
17. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELLWAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THP�%Q,CQ Y� iIVG 1iV., iBEEN PROVIDED TO THE WELL OWNER.
FOR OFFICE USE ONLY
Quad No:
9erlai No:
OR
MRFaj N CONSTRUCTING THE WELL
Submit orin M1L a�Y' Groundwater Section within 30 days
4 - 1
DATE
ON M. 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] %2 7 8
WELL CONSTRUCTION RECORD WELL CONTRACTOR: Hickory Well Drilling Co.
WELL CONTRACTOR CERTIFICATION It: 2306
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE (Check Applicable Box): Residential El Municipal ❑ Industrial ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ II Other, List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: 1Card County: Burke
4810 Mt. Hebron Ave.
(Road Name and Numbers, Community, or Subdivision and Lot No.)
3. OWNER Fthal RnhPrts
Address 4810 Mt. Hebron Ave.
ree or ou a o.
Connelly Springs NC 28612
City or Town State Zip Code
4. DATE DRILLED 04717-00
5. TOTAL DEPTH 31715'
6. CUTTINGS COLLECTED YES ❑ NOS
7. DOES WELL REPLACE EXISTING WELL? YES ❑ NO®
8. STATIC WATER LEVEL Below Top of Casing: 70 FT.
(Use'+' If Above Top of Casing)
G. TOP OF CASING IS 2 FT. Above Land Gurfooe•
'Top of casing terminated at/or below land surface requires a variance to accor-
dance with 18A NCAC 20.0116
10. YIELD (gpm): _ 2 METHOD OF TEST By Arr Tact
11. WATER ZONES (depth):
12. CHLORINATION:
13. CASING:
Type HTH Tabs Amount 49
Depth Dian"er
From 0 To S8 Ft. 6 4
From To Ft.
From To Ft.
14. GROUT:
Agricultural ❑ Monitoring ❑
DRILLING LOG DEPTH
From To Formation Description
r^�
CD
7'
ZTC-)
T�
lii
N Ti--
:s
�
cJ7
0
If additional space Is needed use back of loan
LOCATION SKETCH
Wall Thickness
or WelghVFt. Material (Show direction and distance from at least two State
PVC; Plastic Roads, or other map reference points)
Depth
Material
Method
From 0
To 20
Ft. Grout
Poured
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
From To Ft.
From To Ft.
17. REMARKS:_
Material
p N
�'P
E
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 20, WELL
CONSTRUCTION STANDARDS, AND THATKA COOPRYYOvP, � THIS
DRf LNRECORD
CHAS O � BEEN PROVIDED TO THE WELL OWNER.
o4A 14A Ar 04-19-
FOR OFFICE USE ONLY v-r I -r- I,---.-- DATE
Quad No: SI A N CONSTRUCTING THE WELL
Submit vrlpllJ�l);
0rotlndw8ter Section Wilhin 30 days
t `` GW1 1`1EV. 12199
Serial No.
i

/ 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: il&" Giv� dam:
WELL CONTRACTOR CERTIFICATION #:
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE (Check Applicable Box): Residential 10 Municlpal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other 0 If Other, List Use:
2. WELL LOCATION: (She)y sketch of 1,4e location below)
Nearest Town: C:Z a A� County:
(Road Name and Nj�j'bars. Co nity, or division and Lot No.) DRILLING LOG
3. OWNER Iv From To
Address '
,� (Streetor � C'�/
City or Town % Slate Zip Code
4. DATE DRILLED r 2�9DD
5. TOTAL DEPTH i
6. CUTTINGS COLLECTED YES ❑ NOF__j —
7. DOES WELL REPLACE EXISTING WELL? YES NO10
8. STATIC WATER LEVEL Below Top of Casing: FT.
// (Use '+' it Above Top of Casing)
9. TOP OF CASING ISM[_ 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 Amount
13. CASING:
Depth 444 Diameter
From To Ft.
From To. Ft.
From To Ft.
14. GROUT:
DEPTH
Formation Description
C2
Q
_rn
a:
_gip
.....
ai
If additional space Is needed use back of fornwl
Wall Thickness LOCATION SKETCH
or Weil atarlai I/Ft. (Show direction and distance from at least two Stale
—� Roads, or other map reference points)
PoCf O C"Cft�p
Depth Material. Melho r �-�� 0}_0 _
From To -4o Ft.. %� � �' �
From To Ft.
15. SCREEN:
Doplh Diameter Slot Size - Material
From To Ft in. In.
From To Ft. In. In:
From To Ft. in. in.
16. SAND/GRAVEL PACK:
De
oto 10 m,,
+� a e4l-%,
SpX &
if7d
'0�
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF j [S RHAS B EN PR9VIDEDP THE WELL OWNER.
SON CONSTRUCTING THE WELL '
Ouallty, Groundwater Section within 30 days

4
North Carolina ':Department of Environment, Health, and Natural Resources
Division of Environmefital Management, Groundwater Section
P.O. Box 29535 • Raleigh, N.C. 27626 0535
Phone [phone]
QUAD NO SERIAL NO
Lat Long RO
Minor Basin
Basin Code G U
WELL CONSTRUCTION RECORD Header Ent J GW1 Ent
DRILLING ,CONTRACTOR} Rowan .Well Drtlhng t STATE ;WELL, CONSTRUCTION
-- DRILLER 'REGISTRATION NUMBER 1635 PERMIT NUMBER -
1. WELL LOCA`I ION: (Show sketch of the location below)
Nearest Town: .`,Morganton County: Burke
:Goodman Lake
(Road, Community or Subdivision and Lot No) DEPTH DRILLING LOG
2. OWNER Laura Clark From To Formation Description
ADDRESS 2896 Piedmont Road
(Street or Route No)
Ctt&'r `own State " Zip Code
3. DATE DRILLED 4•-28--00 USE OF WELL homo
4. TOTAL DEPTH 3 0 S
5. CUTTINGS COLLECTED YES NO x
6. DOES WELL REPLACE EXISTING WELL? YES NO x
' 10
7. STATIC WATER LEVEL Below Top of Casing: 20 FT.
'sG7
(Use-.- if Above Top of Casting) -----
n
—------ ------------ — —_
8, TOP OF CASTING IS 1 FT. Above Land Surface*
* ter'
* Casing Terminated at/or below land surface is illega('unless a.variance':is
ib
issued in accordance with 15A NCAC 2C .0118
n��-
9 YIELD (gpm): METHOD OF TEST -� f
2: o
10. WATER ZONES (depth):
80 i t .
11. CHLORINATION. Type: chlorine Amount: 10 oz.
•`_t _
_
12. CASING::
If additional space is needed use back of form
Wall Thickness
'Depth Diameter or Weight/Ft Material
LOCATION SKETCH
From u_To 5f_ Ft. H _ 2Syl�/�Q___ �y� _
(Show direction and distance from a least two State
From T,o,' ' Ft.
Roads, or other map reference points)
From Tti';> Ft.
• 13. GROUT:
Submit original to Division of Environmental Management and copy to well owner

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: �A,-%We.II Wert i �Z� jjrN4
WELL CONTRACTOR CERTIFICATION #: Z 133
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE (Check Applicable sox): Residential E 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:— Jgh�d-�L1 County:
(Road Name and Numbers, Community, or Subibivision and Lot No.) DRILLING LOG DEPTH
C—oItalA&I
3. OWNER From To Formation Description
Address YJ 0 19 <:�-6Ie;1 `�, - '7r7 d
aQUr Route o.
City or TOM State Zip Code
4. DATE DRILLED "0
5. TOTAL DEPTH v
6. CUTTINGS COLLECTED 4ES ❑ NO[3'
7. DOES WELL REPLACE EXISTING WELL? YES ❑ NO(�"
8. STATIC WATER LEVEL Below Top of Casing: FT.
(Use'+' it Above Top of Casing)
I
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 .01 8
10. YIELD (gpm): METHOD OF TEST ! lCl,-�iJ
11. WATER ZONES (depth): 9
12. CHLORINATION: Type T1742 R J'`27— Amount�4N If additional space Is needed use back of form
13. CASING:
Wall Thickness LOCATION SKETCH
Depth Diameter or Weight/R. atnal (Show direction and distance from at least two S e
> / � �o' G
From � y �
A
To —� Ft. _ Roads, or other map reference points) O
�
From To Ft.
o�
From To Ft.
ter^
14. GROUT: ut
n
Depth Material Method
From To v�� GCinaA �?e
m
-;a Pr),
Ft.
From To Ft. tV
��
15. SCREEN: to
::j
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:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION DS, AND THAT A COPY OFT IS RECORD RO IDED TO THE WELL OWNER.
FOR OFFICE USE f L/ r?��
Quad No: TU = S `N ElU _'SIN_ G„T, E WELL DATE
A Submit odgi ivisi ater Quality, Groundwater Sef P
7 ithin 30 days
Serial No. 1� GW1 REV. 12/99
2000 "JUN 2 8 2000��

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
P.O. Box 29578 - Raleigh,N.C. 27626-0578-Phone [phone]
WELL CONSTRUCTION RECORD DRILLING CONTRACTOR:"o�E��ll{��
DRILLER REGISTRATION #: ? ?'
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE (check Applicable Box): Residential FC1 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: �� ✓/-k I-
f�'.�
(Road, Community, or Subdivision and Lot No.) DEPTH DRILLING LOG
3. OWNER _ t,i<a , :'- fi N s�� From To Formation Description
ADDRESS d
(Street or Route No.)
6 dlrl 14,11 11. r � ,-127/
City or Town State Zip Code
4. DATE DRILLED fa 11. a o /7
5. TOTAL DEPTH ',I Va
6. CUTTINGS COLLECTED YES❑ NO® e,,
7. DOES WELL REPLACE EXISTING WELL? YES ❑ NO® v
8. STATIC WATER LEVEL Below Top of Casing: �r n FT.
(Use "+" if Above Top of Casing) . ;n�
9. TOP OF CASING IS
FT. Above Land Surface*
Casing Terminated aVor below land surface is illegal unless a variance is issued a
in accordance with 15A NCAC 2C .0118
10. YIELD (gpm):�O n METHOD OF TEST
11. WATER ZONES (depth): a C7 _ M
C o
12. CHLORINATION: Type h(i/G r Amount (­1 If additional space is needed use back4*.orr6
13. CASING:
LOCATION SKETCH >
Wall Thickness:
Depth Diameter or Weight/Ft. Material (Show direction and distance from at least twt '.$tate
From n To Ft. -42j, —F4, '4:2 C Roads, or other map reference points) „Yw'
From To Ft.
From To Ft. /`-1d �` �'� 0,L",
14. GROUT: k
Depth Material Method
From 0 To 9 ?9 Ft. 11 A✓
From 4,-) To _r�Ft.
15. SCREEN: V/4,
Depth Diameter Slot Size Material o ch
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. 2 /,lI C �,z 01
From To Ft. d
17. REMARKS:
I DO HEREBY CERTI F-! 1.UCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION ST DS, AND THAT A COP ,HIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
FOR OFFICE USE 01 L .1
Quad No:. k:� IGN TURE OF CONTRACTOR OR AGENT DATE
Serial No: s ur€)Hrt�f� a P Section Subrpi original to Division of Water Quality and copy to well owner.
�sht vtlie iR ,imvil 01 ice
GW-1 REV. 1/98

Narth Carolina - Department of Environment Health and N t 1 R
a ura esources :'L . ,
Division of Environmental Management - Groundwater Section FOR OFFICE USE ONLY
P.O. Box 29535 - Raleigh, N.C. 27626.0535 QUAD. NO. SERIAL NO.
Phone [phone] Lat LongRO
WELL CONSTRUCTION RECORD Minor Basin
Basin Code
DRILLING CONTRACTOR: Ht C-� L210 44 / /kh Header Ent GW-1 Ent
l 'TATE WELL CONSTRUCTION _-
DRILLER REGISTRATION NUMBER: PERMIT NUMBER:
1. WELL LOCATION: (Show sketch of the location below)
Nearest Town: County: vUJ4 X
,ty:
G10'�C'_(l /t LI/
(Road, Community, or Subdivi ion and Lot No.) DEPTH
2. OWNER (2. Q 5 From To
ADDRESS LS 1.3s C
(Street or Rout N
AA ro.) U�
n G
City or Town, State Zip Code
3. DATE DRILLED 3 ��% USE OF WELL ��i LrC 260
4. TOTAL DEPTH 77177—
5. CUTTINGS COLLECTED YES ❑ NO� ` 2- 00
6. DOES WELL REPLACE EXISTING WELL? YES (`�NO�
7. STATIC WATER LEVEL Below Top of Casing: FT.
7 (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 with 15A N�QAC 2C .011e
9. YIELD (gpm): c u METHOD OF TEST
10. WATER ZONES (depth):- /C.2 6II S C)
11. CHLORINATION
12. CASING:
DRILLING LOG
For ation Description
r*t=
y
�„ x
Type C'r tVP Q � Amount If additional space is needed use back of form
DepthDiaq+eter
From 0 To {/� Ft.c
From To Ft.
From To Ft.
13. GROUT:
Depth
From To Ft.
From To Ft.
14. SCREEN:
Wall Thickness LOCATION SKETCH
o W i t/Ft. Material (Show direction and distance from at least two State
W, U Lit' _ Roads, or other map reference points)
Material Method
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
From To Ft.
From To Ft.
16. REMARKS:
Material
0 •-
ELL
CTfOfV T%DARDS H��V HA AWAS
COPY OF THIS RECORD HAS B ENEPROVIDED TO THE WELL OWNER.
JUN ! 9 2000 r,
ndwater Section
SIGNATURE OF CONTRACTOR OR AG NT t,
GW-1 R V. 9191 eville Relglonal Office
., •-.••r- Submit original to Division of Environmental Management and copy to well owner.

North Carolina - Department of Environment, Health, and Natural Resources
Division of Environmental Management - Groundwater Section
P.O. Box 29535 - Raleigh, N.C. 27626-0535
Phone [phone]
Fok dl=>: bt UsE ciNL SERIAL NO. `
QUAD. NO..
-� - "'.: • • �::� -
Lat
Is;Lorxj:
01
inor sin
WELL CONSTRUCTION RECORD
Basin Code
DRILLING CONTRACTOR: Header Ent <$` ''
STATE WELL CONSTRUCTION
DRILLER REGISTRATION NUMBER: �Q� PERMIT NUMBER:
1. WELL LOCATION: (Show sketch of the location below)
Nearest Town: d2 6 N aoN County:
(Road, Community, or ubdrvision and Lot No.) DEPTH DRILLING LOG
ADDRESS
2. OWNER ��i j/,I� From To Formation Description
Yz A kt&Aj(Street or Route No.) y
City or Town S ate C Z �
Zip Code
3. DATE DRILLED �-�� USE OF WELL
4. TOTAL DEPTH - 3 aIq-
5. CUTTINGS COLLECTED YES ❑ NO[R-
6. DOES WELL REPLACE EXISTING WELL? YES NO[;-
7. STATIC WATER LEVEL Below Top of Casing: _� FT.
(Use'+' it 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 with 15A NCAC 2C .0118
9. YIELD (gpm):.�_ METHOD OF TEST
10.' WATER ZONES (depth):09
11. CHLORINATION: Type a Amount k
12. CASING:
Depth
Wall Thickness
Diameter or WeighvFt. Material
From
To
Ft. —f
From O
To — 2 0
Ft. �
From
To
Ft.
13. GROUT:
Depth
Material Method
From To
��
From __ To
Ft.
Ft. 2 E
14. SCREEN:
Depth Diameter Slot Size Material
From
To Ft
in. in.
From To —
From To _
15. SANDIGRAVEL PAC
Depth
From To _
From To
Wy I t? 'VEREarct 1`IFl
CONSTRUCTI04 STAP
t
APR 2 8 '
Ft. in. _ in.
Ft. in. in.
ILI
If additional space is need
LOCATION SKETCH �
(Show direction and distance from at least two State
/t2 A
♦ is
Roads, or other map reference points)
Q ,
�t
:uJS�,
Qs�•��
�LLIJ Ngl?tLI!Y.V.a�'zm'QN-.5T CTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.

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: WP1 1 Dri 11 i ng Co.
WELL CONTRACTOR CERTIFICATION #: 2306
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE (Check Applicable Box): Residential ® Municipal ❑ Industrial ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATION: (Show sketch.o(.the location below)
Nearest Town: Morganton County: Burke
1.353 Rock Hill St
(Road Name and Numbers, Community, or Subdivision and Lot No.)
3. OWNER James L.ingerfel t
Address 1353 Rock Hill St.
Nebo (street or to. 28761
City or Town State Zip Code
4. DATE DRILLED 03-24-00
5. TOTAL DEPTH 245
6. CUTTINGS COLLECTED YES ❑ NOEa
7. DOES WELL REPLACE EXISTING WELL? YES 0 NOEI
8. STATIC WATER LIIVEL Below Top of Oaaing: PT.
(Use '+' it Above Top of Casing)
9. TOP OF CASING ISM_ FT. Above Land Surface -
*Top of casing terminated at/or below land surface requires a varlance In accor-
dance with 15A NCAC 2C .0118
10. YIELD (gpm): 1 METHOD OF TEST By Al r Tact
11. WATER ZONES (depth):
12. CHLORINATION: Type M Tabs Amount 47
13. CASING:
Wall Thickness
Depth Diameter or Wei ht/FI. Material
From 0 To 140 Ft. 6V Galy. Steel
From To Ft.
From To Ft.
14. GROUT:
Depth Material Method
From 0 To 20 Ft. Grout Poured
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
From To Ft.
From To Ft.
17. REMARKS:
Material
Agricultural ❑ Monitoring ❑
DRILLING LOG DEPTH
From To Fonnatlon Description
If additional space is needed use back of form
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other map reference points)
N
J
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT F J, IS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
A Q Ik, L DRILU ING CO., Ili;' 04-10
FOR OFFICE USE ONLY �t �,; I� 1f� �f' , Ldtl err -
c�QoAD �-
Quad No: FOR
T F CONSTRUCTING THE WELL GATE
or PAI , ft„©roundwallr Sticlion wlihin 30 day3
i(,i (( ow11 fldV: 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]
WELL CONSTRUCTION RECORD WELL CONTRACTOR: Hickory Well Drilling Co.
WELL CONTRACTOR CERTIFICATION #: 2306
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: Hildebran County: Burke
4575 Rudisill St.
(Road Name and Numbe(s, Community, or Subdivision and Lot No.) DRILLING LOG DEPTH
3. OWNER ._ Mike & Carol Prather From To Formation Description
Address 4575 Rudisill St.
Hickory (Street or RV No.)28602
City or Town State Zip Code
4. DATE DRILLED 03-27-00
5. TOTAL DEPTH 609'
6. CUTTINGS COLLECTED YES ❑ NO®
7. DOES WELL REPLACE EXISTING WELL? YES ® NO❑
8. STATIC WATER LEVEL Below Top of Casing: j ra6 FT.
(Use *+* If Above Top of Casing)
2
9. TOP OF CASING IS Fr. Above Land Surface•
`Top of cuing terminated at/or below land surface requires a variance In actor-
ice-_.
dance with 15A NCAC 2C .011
10. YIELD (gpm): 1 2 METHOD OF TEST By Air Test
11. WATER ZONES (depth): —
12. CHLORINATION: Type _ HTEI Ta e Amount A? If additional space Is needed use back of form
13. CASING:
Depth Diameter
From 0 To 128 Ft. 1 t�2Z o
From To Ft.
From To Ft.
14. GROUT:
Wall Thickness LOCATION SKETCH
or WefghVFI. Material (Show direction and distance from at least two Stale
PVC Plastic Roads, or other map reference points)
Depth
Material
Method
From _0 To 2_ Ft.
Grni i t-
Pni i rpd
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:
N
C
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS.RECO 0 AS EN PROVIDED TO THE WELL OWNER.
_WMM WaL DRILLING C�I.,1 FOR OFFICE USE ONLY'' 04-10-
i ggg..gl��C�:ES� RQAD
Quad No: ;; - $I 4 N CONSTRUCTING THE WELL DATE
Sutxnll Oft I n Q al"p�' groundwater Section within 30 days
Serial No. ' '., �i s F vo,19 I i L +j y GW1 ql V. 12/99
i [ 0 2Ll0
;11 ii� e'•en t

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: Hickory Well Drilling Co.
WELL CONTRACTOR CERTIFICATION #: 2306
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE (Check Applicable Box): Residential ® Municipal ❑ Industrial ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: Tcard County: Burke
7741 Decker Rd.
(Road Name and Numbers, Community, or Subdivision and Lot No.)
3. OWNER Tampa Herbert Broyhill
Address 7741 Decker Rd.
(Street or Fioule 28612
Connelly Springs
City or Town State Zip Code
4. DATE DRILLED 03-21-00
5. TOTAL DEPTH 309 r
6. CUTTINGS COLLECTED YES ❑ NOM
7. DOES WELL REPLACE EXISTING WELL? YES ® NO❑
8. STATIC WATER LEVEL Below Top of Casing: 491 FT.
(Use'•r' 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): _8 , METHOD OF TEST By Air Test
11. WATER ZONES (depth):
12. CHLORINATION: Type HTH Tabs Amount 54
13. CASING:
Agricultural ❑ Monitoring ❑
DRILLING LOG DEPTH
From To Formation Description
C7
Q
n
0
cts .r_
n•r -j�
0
It additional space is needed use back of form
Wall Thickness
Depth Dt ter or Wei hVFt. Material
From 0 To 83 Ft. PVGp Plastic
From To Ft.
From - To Ft.
14. GROUT:
Depth Material Method
From 0 To 20 Ft. Grout Potirpd
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:
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other map reference points)
IQ I"*
OMB IztfJf.E CH• k
alhpNtSS -
Depth Size Material s
From To Ft.
From To Ft.
17. REMARKS:
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
WORY Vt.M DRILLING CO.,1.440 03-29-00
FOR OFFICE USESlYr' �f o�►n 1CIG8 Rnnn
Quad No: (( O A g SON CONSTRUCTING THE WELL DATE
�, Spot 0 iv �-W ¢��(��IIlyr groundwettu Stdign within 30 days
Ad ' ' ( E C ( , 4Jttt i ..i�ir! aW+t R9Y, 17�89
& Na,

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: Hickory Well Drilling
WELL CONTRACTOR CERTIFICATION #: 2306
STATE WELL CONSTRUCTION PERMIT#:
Co.
1. WELL USE (Check Applicable Box): Residential [y� Municipal ❑ Industrial ❑ Agricultural ❑
Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATION: (Show sketch of location below)
-the
Nearest Town: Icard County: Burke
4641 nib Creek Road
(Road Name and Numbers, Community, or Subdivision and Lot No.) DRILLING LOG DEPTH
3. OWNER Clyde S troupe From To Formation Description
Address 4641 Cub Creek Rd.
jbtr!et or Route o.
Connelly S12rings NC 28612 '
City or Town Stale Zip Code
4. DATE DRILLED 01-12-00
5. TOTAL DEPTH 1 r; 5 t
rt
6. CUTTINGS COLLECTED YES ❑ NO[D
z'-
7. DOES WELL REPLACE EXISTING WELL? YES [D NO[:]
P -�
8. STATIC WATER LEVEL Below Top of Casing: FT.
(Use '+' it Above Top of Casing)
9. TOP OF CASING ISM_ 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): 10 METHOD OF TEST R)r Ai r T st
11. WATER ZONES (depth):
cn'r
a c;
12. CHLORINATION: Type HTH Tabs Amount 24 If additional space is needed use back of form
13. CASING:
Wall Thickness
Depth Diameter or Wel ht/Ft. Matedal
From 0 To 81 Ft. 6 4" PVC Plas tic
From To Ft.
From To Ft.
14. GROUT:
Depth Material Method
From 0 To 20 Ft. Grout Poured
From To Ft.
15. SCREEN:
Depth Diameter Slot Size Material
From To Ft In. in.
From To Ft. in. In.
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other map reference points) /
Sm
i0
r
From To Ft. In. in.
16. SAND/GRAVEL PACK: S
Depth Size Material ><
From To Ft.
From To Ft.
17. REMARKS:
I DO HEREBY„CERTIFI N ITT ISI VE4L WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRU 1 STAC�(DADS�AIJDAJMf W6fffflaD AS BEEN PROVIDED TO THE WELL OWNER.
FOR OFFICE $ . O r� 340 1-46 ArcF� Qqp 03-28-2000
Quad No: ' ' � t:J' .U� S 3N UEMRF N CONSTRUCTING THE WELL DATE
lubmit efi len ► wa y, Groundaler BeG110n within 30 days
Serial No. ,iE E i3 GW1 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: ickory Well Drilling Co.
WELL CONTRACTOR CERTIFICATION N: 2306
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE (Check Applicable Box): Realdential0 Municipal ❑ Industrial ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
Agricultural ❑ Monitoring ❑
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: _ Morganton County: Burke
3772 Laurel Heights Dr.
(Road Name and Numbers, Community, or Subdivision and Lot No.) DRILLING LOG
3. OWNER _Ken Stamey From To
Address 3772 Laurel Heights Dr.
Morganton
root or ROM, No.)28655
City or Town State Zip Code
4. DATE DRILLED 03-13-00
5. TOTAL DEPTH 309 1
6. CUTTINGS COLLECTED YES ❑ NO®
7. DOES WELL REPLACE EXISTING WELL? YES® NO❑
8. STATIC WATER LEVEL Below Top of Casing: 512_ FT.
(Use '+' It Above Top of Casing)
9. TOP OF CASING ISM_ FT. Above Land Surface*
'Top or casing terminated at/or below land surface requires a verlence In accor-
dance with 18A NCAC 2C .0118
10. YIELD (gpm): 12_ METHOD OF TEST By Air Test
11 WATER ZONES (depth):
12. CHLORINATION: Type 13TH Tabs Amount 51
13. CASING:
Wall Thickness
Depth Diameter or Weight/Ft. Material
From— 0 To 61 Ft.1 PVC .Plan t c
From To Ft.
From To Ft.
14. GROUT:
Depth Material Method
From _0 To 20 Ft, Grout Poured
From To Ft.
15. SCREEN:
Depth Diameter Slot Size Material
From To Ft in. In.
From To Ft. In. in.
From To Ft. In.
16. SAND/GRAVEL PACK:
Depth Size
From To —Ft. —
From To Ft.
17. REMARKS:
DEPTH
Formation Description
r-:
CM_=
'7
i�
mfi,
Ell
N
a
If additional space Is needed use back of form
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other map reference points)
1A
0al
� Ye
5
i`
-qO
.P
���� 1lGTs• V� -
5•
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTEd'14ORIDANCE WITI4 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THATpV�� Y F T S RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
iist:R&Y? r�,VL DRILUIVG CO,,1KC.. 03-28-00
FOR OFFICE USE ONLY 3Q LAD JICCrSS RG�4
Ouad No: SIG�km( Fit P gj� CONSTRUCTING THE WELL DATE
Subol gr9Qi(1�GtpP g�pte7,�jj Aroundwlltar section within 30 days
Berial No. IFtttt 11 /1j GW.l nE:V, 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: _11ickory Well Drilling Co.
WELL CONTRACTOR CERTIFICATION #: 2306
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: Connelly Sayings County: Burke
Hubert St.
(Road Name and Numbers, Community, or Subdivision and Lot No.) DRILLING LOG DEPTH
3. OWNER -Michael Walker/Leader Horses From To Formation Description
Address Pn Rnx 122.4
treet or HOUle o.
To arra (SIC 28666
City or Town State . Zip Code
4. DATE DRILLED 03-10-00
5. TOTAL DEPTH
6. CUTTINGS COLLECTED YES ❑ NO x;
7. DOES WELL REPLACE EXISTING WELL? YES F_J NO r.;
8. STATIC WATER LEVEL Below Top of Casing: 30 FT.
(Use '+' If Above Top of Casing)
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): 8 METHOD OF TEST By Air Tes t
11. WATER ZONES (depth):
C.3
G }
na
"�
12. CHLORINATION: Type HTH Tabs Amount 48 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 To 68— Ft. 6 ' PVC Plat; Lic Roads, or other map reference points)
From To Ft.
From To Ft.
14. GROUT:
Depth Material Method
From 0 To —20 Ft. Grout Poured
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
S..
Material
From
To
Ft.
From
To
§ t.kt
Ft.
e
17. REMARKS:�-
u A I /scut! / b
4 u/lcc
��i1F:Uli%F lat^rYlfE3f•+t t
I DO HEREBY CERTIFY THAT THIS WELLWAS CON,pST� 66TEEDDpINpACCj�ORDAFNCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT /��,1 D V1i L UKIL(RG tbB IEN PROVIDED TO THE WELL OWNER.
Ify FOR OFFICE USE ONLY 340 1-40 AceFss RoAn 03-28-00
Quad No: SIGNf nLJ9Ef6Xq2JtCONSTRUCTING THE WELL DATE
ygfnil grfQipa f r royndvfller Section within 30 days
Serial No. �� r' ��' GW-1 t1@V. 12A9
f-

...... ,....... ........
,,�
North Carolina - Depattr)tent of: Environment, Health, and Natural Resources
Division of Eriyira(tfnerttal,Menagament - Groundwater Section
P•Or;ERX�9535„ �r.Rale(gh, N.C. 27626-0535
r ';.P..Ijotle, (919) .733.3221
WELL'('CONSTRUCTION RECORD
DRILLING CONTRACTOR: _Hickory Well Drilling Co.
DRILLER REGISTRATION NUMBER: 718 STATE WELL UUNS I RUCTION
PER0 0
MIT NUMBER: U
1. WELL LOCATION: (Show sketch of the location below)
Nearest Town: —Mn r Dan ton County: Burke
_Belvedc3
Rd
(Road, Community, or Subdivision and Lot No.) 2. OWNER Pete Wilson DEPTH
ADDRESS- 3566 Morganton/Lenoir Airport Ave From To
(Street or Route No.)
Morganton NC 28655
City or Town State. Zip Code
3. DATE DRILLED 03-08-00 USE OF WELL Domestic
4. TOTAL DEPTH -325 r
5. CUTTINGS COLLECTED YES C] NO
6. DOES WELL REPLACE EXISTING WELL? YE 0 NO®
7. STATIC WATER LEVEL Below Top of Casing: 2 SFr.-
8. TOP OF CASING IS (use "+ if Above Top of casing)Fr. Above Land Surface-
—
• Casing Terminated at/or below land aoo s Illegal uness a variance Is Issued
In accordanoo with 15A NCAC 2C '.0118
9. YIELD (gpm): 15 . METHOD OF TEST By Air Tes t
10. WATER ZONES (depth):
DRILLING LOG
Formation Description
u
cs
�;
nj
o
11. CHLORINATION: Type HTH Tabs Amount -- L3
12. CASING: If additional space is needed use back of form
From
0 Depth325
Wall Thickness
DJa 9ter or 18VetlFt. -M�teri
L'1�G
To
Ft.
1' as c
ti
From
To
Ft.
From
To
Ft.
13. GROUT:
Depth
0
Material Method
From
To _ 20 Ft.
Grout _ poCrpri
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
From
To
Ft.
From
To
Ft.
16. REMARKS: '
- LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other map reference points)
Al
&4) ���
Nwyr
5
t uv ntrttt3T GEHTIF,Y'THATTHIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
'CONSTF UC�ION ST/ ,I. RQS, AND THATA COP H . $EEN PROVIDED TO THE WELL OWNER.
MCKORI�IA�c::L���l i �,$.r'% �.
i 3401-40 ACCESS ROAD
( ►WAY @ 0 ;���'}� P. 0. BOX 4216
11 1 R V S CTOR OR AGENT 0-13-00
tt,tttitrl� tt° ' E_ Submit original to Division of Environmental Management and copy to well owner, DATE

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 #: 3M
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:, ow sketch f the location below)
Nearest Town: County: �✓
(Road Name an umbers, Community, r Subdivision and Lot No.) DRILLING LOG
DEPTH
3.
OWNER From To
Formation DescripUo(x'
Address 17
p
treat or H te
City or Town State Zip Code
='
4.
DATE DRILLED
5.
TOTAL DEPTH
�
r,
6.
7.
CUTTINGS COLLECTED YES 0 NO❑
DOES WELL REPLACE EXISTING WELL? YES ❑ NO
�=?
cn
8.
STATIC WATER LEVEL Below Top of Casing: .�� FT.
(Use '+' it Above Top of Casing)
fl
ca
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
11. WATER ZONES (depth):
12. CHLORINATION: Type Amount If additional space Is needed use back of form
13. CASING:
Wall Thickness LOCATION SKETCH
Depth Dia ter or Weight/Ft.
From 0 To Material (Show direction and distance from at least two State
� Ft. e Roads, or other map referencepoints) L�
From To Ft.
From To Ft.
14. GROUT:
Depth aterial, Method r
From 0 To = Ft. Gs� � �.��
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:
�1 Depth
From I, Tom
From h0
17. REMARKS:
I DO HEREBY 011
CONSTRUCTIOyN ST/a
i
FOR OFFICE USE ON
Quad No:
C3 oo4 5 -' 41
W0�
r4l199
rl,6#4
A'�9f3 iti1
o�fe�
I
Size Mat ri gyp
c u Ft. A 7
W 1_� . ow W �d
t0 14IIgWFi�3 0ONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
A DARDS, AND THAT COPYT�H'ISSRECORDHAS BE N PROVIDED TQ THE WELL OWNER.
driatE'i SuCtt01t I
OF I 1ltt5aiI
`° SIGNATURE OF PERSON CONSTRUCTING THE WELL
Submit original to Division of Water Quality; Groundwater Section within 30 days
GW-1 REV. 12/99

North Carolina - Department of Environment, Health, and Natural Resources
Division of Environmental; Management - Groundwater Section
P.O.' S6x 29535.-.Raleigh, N.C. 27626-0535
Phone [phone]
WELL CONSTRUCTION RECORD
DRILLING CONTRACTOR: Hickory Well Drilling Co.
STATE WELL CONSTRUCTION n © U
DRILLER REGISTRATION NUMBER: 718 PERMIT NUMBER: f 0
1. WELL LOCATION: (Show sketch of the location below)
Nearest Town: Rutherford College County:
Alnine St.
(Road, Community, or Subdivision and Lot No.)
DRILLING LOG
2. OWNER Tom & Becky Phillips
_DEPTH
From To Formation Description
ox
ADDRESS 860
(Street or Route No.)
Rutherford College NC 28671
City or Town State Zip Code
-
3. DATE DRILLED 03-01-00 USE OF WELL Domestic—
- -- --
4. TOTAL DEPTH 285 r -
- --
5. CUTTINGS COLLECTED YES Q NO --
--------- — --- —
6. DOES WELL REPLACE EXISTING WELL? YES ® NOr-1
7. STATIC WATER LEVEL Below Top of Casing: _10 FT.
— q
(Use "+" If Above Top of Casing)
8. TOP OF CASING IS 2 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
10 BY Air Tes t
--j
9. YIELD (gpm): METHOD OF TEST
10.- WATER ZONES (depth):
ma
11. CHLORINATION: Type H'I'H Tabs Amount 54
If additional space is needed use back o()orm
12. CASING:
z
Depth
From 0 To 62 Ft.
From To Ft.
From To Ft.
13. GROUT:
Depth
From 0 To 20 Ft.
Wall Thickness
giaVneter ft A elght/Ft. )faS GiC
Material Method
Grout Poured
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other map reference points)
From To. Ft.
14. SCREEN:
Depth Diameter Slot Size Material U/
From To Ft In. in.
From To Ft. In. in.
From To Ft. in, in. r /
15. SAND/GRAVEL PACK:
Depth Size Material,
From To Ft.
From To Ft.
16. REMARKS:
yG�
r
I DO HEREBY CERTIFY THAT THISWELLWAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTJON S7ANDARDS,'AND,THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
t�(',KORY ML DRILLING CO., INC.
1, 3441.40 ACCESS ROAD
AY E ?0 0! 1 P. 0. 60X 4216 03--06-00 -
SIC��F R OR AGENT DATE
GW 1 REV. l91 s Submit original to Division of Environmental Management and copy to well owner.

67.O I�JrfF:f✓.c.:l':W.A': nr.....-�+.. .....re. t.11yy.yvl•M•1�1pr1M'-s+iM1Pw-•.a... .mr,n.ly'.... �
North Carolina - Deparfinent of Environment, Health, and Natural Resources
Division of Envirogmental Management - Groundwater Section
P.O: , . x 29535­' Raleigh, N.C. 27626.0535
Phone (PI 9) 733-3221
WELL?CONSTRUCTION RECORD
DRILLING CONTRACTOR: Hickory Well Drilling Co.
STATE WELL CONSTRUCTION
DRILLER REGISTRATION NUMBER: 718 PERMIT NUMBER:
2 0 O" 91
1. WELL LOCATION: (Show sketch of the location below)
Nearest Town: Connelly Springs County. Burke
4296 Baptist Camp Rd.
(Road, Community, or Subdivision and Lot No.) DEPTH
DRILLING LOG
2. OWNER Robert & Candy Mathis From To
Formation Description
ADDRESS 4296 Baptist Camp Rd.
(Street or Route No.)
Connelly Springs NC 28612
City �orTown IState '. Zip Code
3. DATE DRILLED 02-21-00 USE OF WELL domestic
L'
4. TOTAL DEPTH 285' ---- -- - - - --
o "
------ --
5. CUTTINGS COLLECTED YES F__j NO®CD
—'"'
6. DOES WELL REPLACE EXISTING WELL? YES F__] NO —
--`-'
r=
7. STATIC WATER LEVEL Below Top of Casing: 6()! FT.
— CD
(Use "+" if Above Top of Casing)
s ;_`;
8. TOP OF CASING ISM_ FT. Above Land Surface'
• Casing Terminated al/or below land surface is Illegal unless a variance Is Issued
In accordance with 15A CAC 2C '.0118
By Air Test
C'_
9. YIELD (gpm): METHOD OF TEST
10. WATER ZONES (depth):
t-0
11. CHLORINATION: Type HTH Tabs Amount 39 If additional space is needed use back of form
12. CASING:
Depth Diameter
From 0 To — 6 Ft.- —
From To Ft.
From To Ft.
13. GROUT:
From 0
From
14. SCREEN:
Wall Thickness LOCATION SKETCH
or Weight/Ft. Material (Show direction and distance from at least two State
PVC— Plastic Roads, or other map reference points)
Depth Material
To _20_ Ft. Grout
To Ft.
Method
Poured
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
From To Ft.
From To Ft.
16. REMARKS:
Material
Iu
15
I DQ HEREBY ,EA-tIFrYTHATTHIS WELL WAS CONSTRUCTED I C ANCE WITH 15A NCAC 2C, WELL
COSTj�t�CTION TAf�D1.iRDS, AND TH/�i�R L t$EEN PROVIDED TO THE WELL OWNER.
'1 :tU!?(i
MAY �
340 140 ACCESS ROAD
P. 0. BOX 4216
2G 02-23-2000 —
t SIGNATURE OF CONTRACTOR OR AGENT DATE
GW-1 REV 5/9,1s�1:a;tG r �` '.` ' " + '. Submit original to Division of Environmental Management and copy to well owner.

North Carolina - Department of Environment. Health, and Natural Resources
Division of Enyirggmental Management -. Groundwater Section
P.6.'86_ 29W5.-"Raleigh, N.C: 27626.0535
;Phone [phone]
WELL 'CONSTRUCTION RECORD
DRILLING CONTRACTOR: Hickory Well Drilling Co.
STATE WELL CONSTRUCTION
DRILLER REGISTRATION NUMBER: 718 PERMIT NUMBER:
208792
1. WELL LOCATION: (Show sketch of the location below)
Nearest Town: Connelly Springs County: Burke
_
4112 Baptist Camp Rd.
(Road, Community, or Subdivision and Lot No.) . ' DEPTH
DRILLING LOG_
2. .OWNER .Terry - R T.i ncla Wi 1 ki e From To
Formation Description
ADDRESS 4112 Baptist Camp Rd.
(Street or Route No.)
Connelly Springs NC 28612
City or Town State Zip Code
—
3. DATE DRILLED 09-17-00 USE OF WELL Dorn S i
4. TOTAL DEPTH 9A9 —---------_.-- -- ---- _--
— r ? _�
5. CUTTINGS COLLECTED YES F__j NO®
6. DOES WELL REPLACE EXISTING WELL? YES © NOr_j
r
7. STATIC WATER LEVEL Below Top of Casing: 50 FT.
(Use "+" if Above Top of Casing)
—< M
B. TOP OF CASING IS FT. Above Land Surface*
fir'•
• Casing Terminated at/or below land surface Is Illegal unless s variance is Issued
r
In accordance with 15A NCAC 2C .0118
Ci
9. YIELD (gpm): 15 METHOD OF TEST By Air Test
•• �-,
10. WATER ZONES (depth):
w C,
11. CHLORINATION: Type HTHTabs Amount 41 if additional space is needed use back of form
12. CASING:
Depth ' Diameter
From 0 To 48 Ft.6k"
From To Ft.
From To Ft.
13. GROUT:
Depth
From 0 To 20 Ft.
From To Ft.
Wall Thickness LOCATION SKETCH
or Wei hVFt. Material (Show direction and distance from at least two State
Me Plas tic Roads, or other map reference points)
Material Method
Grout Poured
i
14. SCREEN: w �
Depth Diameter Slot Size Material
From To Ft in. in.><�1� fA I!,'
From To Ft. in. in.
From To Ft. in. in. �Tl
15. SAND/GRAVEL PACK:
Depth I.,Size Material
From To Ft.
From To Ft.
16. REMARKS:
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THATVj�%ft?WSMWO%$NMN PROVIDED TO THE WELL OWNER.
340140 ACCESS ROAD
MY 6
?I o Pr V r OX Q
_�.d IC a QQ- -
SIG RE O CONTRACTOR OR AGENT DATE
GW 1 REV. 591 Submit original to Division of Environmental Management and copy to well owner.

North Carolina - Departrpent of Environment, Health, and Natural Resources
Division of Environmental Management - Groundwater Section
P.O.. Box`29535 - Raleigh,. N.C. 27626.0535
;Phone [phone]
k;
WELLCONSTRUCTION RECORD
DRILLING CONTRACTOR: Hickory Well Drilling Co.
STATE WELL CONSTRUCTION
DRILLER REGISTRATION NUMBER: 718 PERMIT NUMBER:
'�S"193
1. WELL LOCATION: (Show sketch of the location below)
Nearest Town: Connelly Springs County: Burke
_6063 Rock.Falls Rd.
(Road, Community, or Subdivision and Lot No.)
DEPTH
LOG_
2. OWNER _Rickey & Barbara McCurry
From To
_DRILLING
Formation Description
ADDRESS 6063 Rock Falls Rd.
(Street or Route No.)
Connelly Springs NC 28612
City or Town State .. Zip Code
3. DATE DRILLED 02-08-00 USE OF WELL Domestic
------- -
T -
4. TOTAL DEPTH 305'
c�
5. CUTTINGS COLLECTED YES [] NO®
Q `J
6. DOES WELL REPLACE EXISTING WELL? YES W NO
-__ _
7. STATIC WATER LEVEL Below To of Casing: FT.
P 0� 96
(Use "+" If Above Top of Casing)
2
=
-
8. TOP OF CASING IS FT. Above Land Surface*
—
• Casing Terminated aVor below land surface is Illegal unless a variance Is Issued
In accordance with 15A CAC 2C '.0118
1
—_ --
9. YIELD (gpm): METHOD OF TEST By Air Tes t
q cr, _ ,
10. WATER ZONES (depth):
--
11. CHLORINATION: Type HTH Tabs Amount 44
If additional space is needed use back of form
12. CASING:
Wall Thickness
LOCATION SKETCH
Depth Diagtpler o7 Wei ht/Ft. Material
0 115 6 PVG� Plastic
(Show direction and distance from at least two Stale
From To Ft
Roads, or other map reference
points)
From To Ft.
From To Ft.
13. GROUT:
N
/
Depth Material Method
(`��`'//
G�04foj
1° C
From —0 To 20 Ft. Grnt,t PniIrpd
From To Ft.
14. SCREEN:
E
Depth Diameter Slot Size Material
br' Ici ll�'
From To Ft in. in.
From To Ft. in. in.
From To Ft. in. in.
( 3
15. SAND/GRAVEL PACK:
.Depth Size Material
.
From To - Ft.
?
From To - Ft.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STAfVDARDS, AND TF ��C I.L Njt.Ltt� lruD 06 BEEN PROVIDED TO THE WELL OWNER.
3401 40 ACCESS ROAD
IS 'y'it H �i11 I). U. BOX?.1.6
tOW„'Ett9it3te'7° '7 tt5 AE 61 C N FIACTOR OR AGENT DATE
GW i REV. 5i5� Submit original r„ h,,�j,ll tub �ti t)to Division of Environmental Management and copy to well owner.

North Carolina - Departf_ggt of. Environment, Health, and Natural Resources
Division of Erivi!,"iital,;Management -Groundwater Section
P.Of �o,.cs,35 Raleigh; N C 276260535
�� yone(919)733.3221.
t.r� 1
WELL CONSTRUCTIONM RECORD
DRILLING CONTRACTOR:
STATE WELL CONSTRUCTION 208794
DRILLER REGISTRATIQ,N.NUMBER: PERMIT NUMBER:
1. ' WELL LOCATION:'($how sketch of the location below)
Nearest Town: Hi ldebran County: Burke
8615 Old Laurel Rd..
(Road, Community, or Subdivision and Lot No.) DEPTH DRILLING LOG
2. OWNER Brent Fender From To Formation Description
ADDRESS Pc) Rnx 668
(Street or Route No.)
DrpxPl NC, 28619
City or Town State Zip Code
3. DATE DRILLED 02-07-OQJSE OF WELL domestic o;
4. TOTAL DEPTH �,___—
5. CUTTINGS COLLECTED YES C] NOM
6. DOES WELL REPLACE EXISTING WELL? YES [n NOQ :77
7. STATIC WATER LEVEL Below Top of Casing: 59 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 2 FT. Above Land Surface"
' Casing Terminated at/or below land surface Is Illegal unless a variance Is Issued O cn
in accordance with 15A NCAC 2C '.0118
9. YIELD (gpm): 100 :� METHOD OF TEST R)z Air Test
0
10. WATER ZONES (depth):
11. CHLORINATION: Type HTH Tabs Amount 52 If additional space Is needed use back of form
12. CASING:
Wail Thickness LOCATION SKETCH
Depth Diameter or Weight/Ft. Material (Show direction and distance from at least two State
From 0 To 82 Ft. Err PVC Plastic Roads, or other map reference points)
From To Ft.
From To Ft. /V
13. GROUT:
Depth Material Method �o
From 0 To:`--'20 Ft. Grout Poured
From To Ft.
14. SCREEN:
Depth; Diameter Slot Size Material I)�
From To Ft in. in.
From To Ft. in. in.
From To Ft. In. in.
15. SAND/GRAVEL PACK: 1 s
Depth` Size Material
s ` From To Ft.
i From To Ft.
16. REMARKS:
I DO HEREBY;CEPTIFYTHAT. THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONS717100ION1$TANDARDS, AND THAT A COPY OF THIS RECORD HAS EN PROVIDED TO THE WELL OWNER.
' HMRY VaL DRILLING CO., I .
340 1-40 ACCESS ROAD
I' �' P. 0. BOX 4216
„ SIG F OR AGENT DATE
GW-1 REV, 5/91 Submit original to Division of Environmental Management and copy to well owner.

North Carolina - Department of Environment and Natural Resources/Division of Water QualitylGroundwater
Sectior�P.0. Bo 78/ Raleigh, N.C. 27626-0578 - Phone [phone] -
�I DRILLING CONTRACTOR.
WELL CONSTRUCTION RECORD ON
SDRILLIINIIG TATE WELL CONSTRUCTION PERMIT#: ---- -'—
municipal El Industrial ❑ Agricultural ❑ Monitoring ❑
1. WELL USE (Check Applicable Box): Residential p
Recovery [] Heat Pump Water Injection E] Other [] If Other, List Use:
2. WELL LOCATION: (Show sketch Hof" theelcation below) County: ` u �
Nearest Town: 4 n
(Road, Community, or Subdivision and Lot No.)
s
3. OWNER
ADDRESS S & G I/ k v
State Zip Code
City or Towrl
c_�
4. DATE DRILLED � � p�op —
5. TOTAL DEPTH
6. CUTTINGS COLLECTED ❑ Yes No ❑
No
7. DOES WELL REPLACE EXISTING WELL? Yes— ft.
8. STATIC WATER LEVEL Below Top Of Casing: (Use „+ if Above Top of Casing)
9. TOP OF CASING IS --�--- ft. Above Land Surface'
•casing Terminated atlor below land ,urface is illegal unleca a variance r !,.sued in Decordanec
with 15A NCAC 2C .0118
10.YIELD (gpm); METHOD OF TEST
11. WATER ZONES (depth): y a -70
12. CHLORINATION: Type �/A""
1A �'� — Amount G � P—
13. CASING: Depth Wall Thickness
Diameter or Weight/Ft Material
Ft. ?6SD,< pI
From To
From To Ft.
From To Ft.
14. GROUT: Depth Material Method'%
From �— 70 G —1-- Ft' 1 I � e
From �Q To t� Ft. v�
15. SCREEN Depth Diameter Slot Size Material
From
To Ft. in. in.
From To Ft. —in.—In--
From To Ft. in. Inr------
16. SAND/GRAVEL PACK: Depth
Size Material
From To Ft. From To Ft.
17. REMARKS:
I DO HEREBY.
STANDARDS,;
FOR OFFICE USE ONLY
Quad No:
Serial No:
Depth DRILLING LOG
From To Formation Description
o -ao a
_ 31-5 I° 0 Y7
t�
v
rn.
If additional space is needed use b c�i?of for
o -+
LOCATION_ SKETCH Qn 3
Show direction and distance from at least two State Roa6,
or other map referance points
t:J X �7 /7 I
�" Noe �
U ?9� o
►1
T,HAT,-THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15 NCAC 20, WELL CONSTRUCTION
Tti1 CoPY ,,0F`k 'HIS. RECORD HAS BEEN PROVIDED TO THE WELL OWNER
€;
DATE
AR � 0 9,000 � t 1IGNATURE CO RACTOR OR AGENT
fi Submit original to Division of Environmental Management and copy to well owner.

NC DEHNR
DEM - GW SECTION
P.O. BOX 29535
RALEIGH, NC 27626-0535
[phone]
WELL CONSTRUCTION RECORD
207567
QUAD NO. SER. NO.
LAT LONG
BASIN CODE
HEADER ENT. GW-1 ENT.
DRILLING CONTRACTOR: PITTMAN WELL BORING, LLC STATE WELL CONSTRUCTION
PERMIT NUMBER:
DRILLER REGISTRATION NO: 946
----------------------------------------------------------------------------
----------------------------------------------------------------------------
1.
WELL LOCATION: (SHOW SKETCH OF THE
LOCATION
BELOW)
NEAREST TOWN MORGANTON
COUNTY:
BURK
WATERS RD.
(ROAD, COMM., OR SUBDV. & LOT NO.)
DEPTH
DRILLING LOG
2.
OWNER _DAVID_WATERS
FROM TO
FORM. DESC.
ADDRESS 6559_WATERS_RD.
MORGANTON NC
28655
CITY OR TOWN STATE
ZIP CODE
3.
DATE DRILLED: 02-26-00 USE OF WELL:
HOUSE
4.
TOTAL DEPTH: 285F
!'
5.
CUTTINGS COLLECTED: YES NO XX
o �'
6.
DOES WELL REPLACE EXISTING WELL? YES
NO XX
7.
STAT. WAT. LEVL. BEL.TOP OF CASING
_60_FT.
c
(USE + IF ABOVE
TOP)
o
8.
TOP OF CASING IS 18" ABOVE LAND
SURF.*c
9.
YIELD (GPM): 35 METHOD OF TEST-ARD
10.
WATER ZONES (DEPTH):
cn :-
11.
CHLORINATION: TYPE CLOROX AMOUNT
1/2 GAL
c�
12. CASING:
W. THICK.
DEPTH DIA OR WT/FT. MTL
FROM_0_TO_7 0_FT . _6 -1 / 4 " _PVC_
FROM TO FT.
13. GROUT:
DEPTH MATERIAL METHOD
FROM_0_TO_20_FT . CEMENT_ PRESS
FROM TO FT.
14. SCREEN:
DEPTH DIA SLOT SIZE MTL
FROM TO FT. IN. IN.
FROM TO FT. IN. IN.
FROM TO FT. IN. IN.
15.
SAND/GRAVEL PACK:
DEPTH SIZE MATERIAL
FROM TO FT.
16. REMARKS:
I DO HEREBY CERTIFY
__A5A..,NCAC...2C, WELL
iEAC B,�Ep PROVIDED T
z
LOCATION SKETCH
HWY. 226 N. FROM POLKVILLE.
LEFT ON HWY. 64. APPROX. 2
MILES ON RT. (SIGN TO CAT-
FISH LAKE) HOUSE ON RT.
PAST CATFISH LAKE.
THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
STRUCTION STANDARDS AND THAT A COPY OF THIS RECORD
THE WELL OWI)�Rf:-�_4;j
I
TURF OF CONTRACTOR OR AGENT'� I j }

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 WELLCONTRACTOR:
WELL CONTRACTOR CERTIFICATION #: Al 3 9
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE (Check Applicable sox): Residential IP Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other If Other, List Use:
2. WELL LOCATION: (Show sket h of the location below) ,
Nearest Town: Mr, county:
.-91 , n T D i_
(Road Name and Numbers. Community, or Subdivision and Lot No.)
DRILLING LOG DEPTH
3. OWNER d e-
From To Formation Description
Address IAI Dv.
0 A ree or o to o.-
/ �j D �i 3 p yt5p ct
D Ck
City or T6wn State Zip Code
4, DATE DRILLED
5. TOTAL DEPTH 33C,
r' ,
6. CUTTINGS COLLECTED YES ❑ NO
7. DOES WELL REPLACE EXISTING WELL? YES ❑ NOZL
8. STATIC WATER LEVEL Below Top of Casing: �2 r FT.
F-
rTi
(Use '+' If Above Top of Casing)
9. TOP OF CASING IS FT. Above Land Surface*
- -
f
'Top of casing terminated at/or below land surface requires a variance In accor-
dance with 15A NCAC 2C.0118
10. YIELD (gpm): f00 METHOD OF TEST All"
11. WATER ZONES (depth):
12. CHLORINATION: Type C 4 e- Amount
if additional space is needed use back of form
13. CASING:
u
K�
Wall Thickness
LOCATION SKETCH
Depth Di=ter or Weight/Ft. Material
From F% To ? Ft.` L PVr.c
(Show directlo and distance from at least two State
Roads, ther
�-----
or map reference points)
From To Ft.
From To Ft.
14, GROUT:
Depth Mated ethod
From To e v Ft. Lf M e n
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:
S tbv
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:
o 7ubr �t c �fni
Serial N
;.
u v v wr•
OF PERSON CONSTR C G THE WELL
of Water Quality, Groundwater Section within 30 days
DATE
GW-i REV. 12,99
{:�,riiln �'t)rrll2it::i fi�if

North Carolina - Department of Environment, Health, and Natural Resources
Division of Envirqprnental. Management -Groundwater Section
13.0.ft'29535-Raleigh, N.C.27626-0535
-_• P}�one [phone]
WEL' CCONSTRUCTION RECORD
DRILLING CONTRACTOR: Hickory Well Drilling Co.
STATE WELL CONSTRUCTION
20811,7 1
DRILLER REGISTRATIO,N.NUMBER: 718 PERMIT NUMBER:L
1. WELL LOCATION: (Show sketch of the location below)
Nearest Town:. Morganton County: Burke -
1409 Henderson Mill Rd.
(Road, Community, or Subdivision and Lot No.) DEPTH
DRILLING LOG
2. OWNER Richard Carter From To
Formation Description
ADDRESS en erson Mili Rd.
-
(Street or Route No.)
Morganton NC 28655
City or Town State Zip Code
01-15-00 Domestic
E OF
3.• DATE DRILLED USWELL
4. TOTAL DEPTH — - -
_— --
5. CUTTINGS COLLECTED YES 0 NOM ----- -----
--- = ^'
6. DOES WELL REPLACE EXISTING WELL? YES ® NOF-]
7. STATIC WATER LEVEL Below Top of Casing: FT.
.20
(Use •+" If Above Top of Casing)
ca
8. TOP OF CASING IS 2 FT. Above Land Surface*
r�
• Casing Terminated at/or below land surface Is I11e961 unless a variance Is Issued
�; C
In accordance with 15A N AC 2C '.0118'
By Air Test
9. YIELD (gpm): METHOD OF TEST
10. WATER ZONES (depth):
w
11. CHLORINATION: Type [T H Tabs Amount 60 If additional space is needed use back of form
12. CASING:
Depth Diameter
From 0 To 100 Ft. --6k"
From To Ft.
From To Ft.
13. GROUT:
Wall Thickness LOCATION SKETCH
or Weight/Ft. Material (Show direction and distance from at least two State
Cal v fie. Roads, or other map reference points)
Depth Material Method
From 0 To 20 Ft. Grout Poured
From To Ft.
14. SCREEN:
Depth Diameter Slot Size Material
From
To Ft
In.
From
To Ft.
in.
From
To Ft.
in.
15. SAND/GRAVEL PACK:
Depth
Size
From
To Ft.
From
To Ft.
16. REMARKS:
I
In i�
N1 00al
MAY 1 0 ?00()
N
AV('GA�rUN
a
I DO HEREBY CERTIFYTHAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT P F THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
((�Rt WILL DRILLING CO., NC.
3401-40 ACCESS ROAD
P- Or BOX 4216 02-
slGWVNiVWF_d6VjTh on AGENT . DATE
GW-1 REV. 6191 Submit original to Division of Environmental Management and copy to well owner.

North Carolina - Department of Environment, Health, and Natural Resources
Division of Environmental;Management - Groundwater Section
o.
P.O.'Box;99535: Raleigh, N.C. 27626-0535
�s'c k Phone [phone]
WERUCTION RECORD
DRILLING CONTRACTOR: Hickory Well Drilling Co.
. STATE WELL CONSTRUCTION
2081 *3
DRILLER REGISTRATIOf� NUMBER: 718 PERMIT NUMBER:
1. WELL LOCATION: (Show sketch of the location below)
Nearest Town: Connelly, Springs County: Burke
2434 Cannon Ln.
(Road. Community, or Subdivision and Lot No.) DEPTH
DRILLING LOG
2. OWNER -_Bo Sturgill From To
Formation Description
ADDRESS 2434 Cannon Ln.
(Street or Route No.)
ConnellySprings NC 28612
City or Town State Zip Code
Q _
3. DATE DRILLED 01-24-00 USE OF WELL Domestic
-.
4. TOTAL DEPTH �95'
5. CUTTINGS COLLECTED YES F] NOM
6. DOES WELL REPLACE EXISTING WELL? YES ® NO[]
7. STATIC WATER LEVEL Below Top of Casing: 4C) FT.
'-+-
(Use "+" It Above Top of Casing)
- -
8. TOP OF CASING IS" 2 FT. Above Land Surface*
U =
O rT,
• Casing Terminated at/or below land surface is Illegal unless a variance Is Issued
r;
In accordance with 15A NCAC 2C '.0118
9. YIELD (gpm): 25' METHOD OF TEST By Air Tes t
r -'
�'� s
10. WATER ZONES (depth):
11. CHLORINATION: Type HTH Tabs Amount 39 If additional space is needed use back of form
12..CASING:
Wall Thickness
Depth Diameter or Weight/Fl.
From 0 To -82= Ft. 1- A " PVc.
From To Ft
LOCATION SKETCH
Material (Show direction and distance from at least two State
pl,qS ti c Roads, or other map reference points)
From To. Ft. .
13. GROUT:
Depth Material Method
From 0 To ' 20 Ft. Grout Poured
From To ' ' Ft.
14. SCREEN:
bit Al CANIV'04
LRrJr10 �
Depth Diameter Slot Size Material/ / E
From To Ft in. in.
.< From. To Ft. in. Jj-i s `ii ,, !/►c � G�n�
From To Ft. in.
15. SAND/GRAVEL PACK:1•
Y1
Depth Size iate�Y
.From To Ft.I
From To Ft.
16. REMARKS:
I DO HEREBY'CERTIFYTHATTHIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND T It1r7ttf lJttlli.fl'TLi (,v:, SAS BEEN PROVIDED TO THE WELL OWNER.
340 WU ACCESS ROAD
02-0
�'si KAYURE OF CONTRACTOR OR AGENT DATE
GW-1 REV. 6/91 Submit original to Division of Environmental Management and copy to well owner.

North Carolina - Deparilment.of Environment, Health, and Natural Resources
Division of Envir nental;Management - Groundwater Section
P.O F :29W'; Raleigh, N.C. 27626-0535
`;;=t`Phone' 919 733-3221
WELUZONSTRUCTION RECORD
DRILLING CONTRACTOR: Hickory Well Drilling Co.
STATE WELL CONSTRUCTION 208775
DRILLER REGISTRATION,NUMBER: 718 PERMIT NUMBER:
1. WELL LOCATION:.(Show sketch of the location below)
Nearest Town: --Morganton County: Burke
116 Dogwood Ridge Rd.
(Road, Community, or Subdivlsion and Lot No.)
2. OWNER Lora Gantt
ADDRESS 11F, 1)nRwn�p Rol.
(Street or Route No.)
Morganton NC 28655
City or Town State Zip Code
01-28-00 Domestic
3. DATE DRILLED USE OF WELL
4. TOTAL DEPTH
—
5. CUTTINGS COLLECTED YES Q NO®
6. DOES WELL REPLACE EXISTING WELL? YES PUq NOF—]
7. STATIC WATER LEVEL Below Top of Casing: 22FT.
(Use "+".if Above Top of Casing)
8. TOP OF CASING IS 2 FT. Above Land Surface*
• Casing Terminated at/or below land surface Is Illegal unless a variance Is Issued
In accordance with 15f NCAC 2C '.0118
9. YIELD (gpm): METHOD OF TEST By Air Test
10. WATER ZONES (depth):
DEPTH DRILLING LOG
From To Formation Description
C
�'
-a
`'�
n —
fir•.
E5
cn _
0
X
11. CHLORINATION: Type HTH Tabs Amount 85 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 0
To `35
Ft 6 r'_ PVC Plastic Roads, or other map reference points)
From
To
Ft.
From
To
Ft. N
13. GROUT:
D06-i4l
Depth
Material
uMethod
From 0
To * 20
Ft. Grout Poured
From
To`
Ft.
14. SCREEN:
Q
Depth
Diameter Slot Size Material 711 E
From
To
Ft in. in.
From
To
Ft. In. in.
From
To
Ft. in. � I ` 10 l'
15. SAND/GRAVEL PACK:.
f' t9 si H
Depth
Size ` M to I I�
� VAT 1 0 2000
From
To
Ft. !1
From
16. REMARKS:
To
Ft. ry I'
;;
., Ffytiri"
-
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.
WCKORY VVLO L DRILLING CO.,
340 1­40 ACCESS ROAD
K 0, BOX 4210 02-04.2000
r E • TOR OR AGENT DATE
GW-1 REV. 6191
Submit original to Division of Environmental Management and copy to well owner.

North Carolina - Department of Environment, Health, and Natural Resources
Division of Environmental,Management - Groundwater Section
P.O '.Bi;i 29535 =:Raleigh, N.C. 27626-0535
•:`',:;.; Phone; [phone]
WELL" CONSTRUCTION RECORD
DRILLING CONTRACTOR: Hickory Well Drilling Co.
STATE WELL CONSTRUCTION 2 O O ri 6
DRILLER REGISTRATION NUMBER: 718 PERMIT NUMBER:
If
1. WELL LOCATION: (Show sketch of the location below)
Nearest Town:: Valdese County: Burke
Garland Lane
(Road, Community, or Subdivision and Lot No.)
2. OWNER _Pat Zimmerman
ADDRESS 204 East Main St.
(Street or Route No.)
Valdese NC 28690
City or Town State Zip Code
3. DATE DRILLED 01-24-00 USE OF WELL Domestic
4. TOTAL DEPTH 3401
5. CUTTINGS COLLECTED YES F-1 NORfl
6. DOES WELL REPLACE EXISTING WELL? YES [IR NOQ
7. STATIC WATER LEVEL Below Top of Casing: g— FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 2 FT. Above Land Surface"
• Casing Terminated at/or below land surface Is Illegal unless a variance Is Issued
In accordance with 15 NCA_ C 2C -.0118
9. YIELD (gpm): -3 METHOD OF TEST By Air Test
10. WATER ZONES (depth):
11. CHLORINATION: Type HTf-I Tabs Amount 61
12. CASING:
DEPTH DRILLING LOG
From To Formation Description
o
W
o
If additional space is needed use back of form
Wail Thickness LOCATION SKETCH
Depth Diameter or Wei ht/Ft. Material (Show direction and distance from at least two State
From C To 68 Ft. 6 r PM Plastic Roads, 2r other map reference points)
From
To
Ft.
From
To
Ft.
13. GROUT:
Depth
From 0
To 20
Ft.
From -
To
Ft.
14. SCREEN:
From
From
Material Method
Grout Poured
Depth Diameter Slot Size Material
-To Ft in. in.
To Ft. in
From To Ft. in. _
15. SAND/GRAVEL PACK:
Depth Size
From To . Ft.
From To Ft.
16. REMARKS:
0
M Jod A�
.�(' qo
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.
HICKORY WELL DRILLING CO., RIC'.
340 1-40 ACCESS
��t ROAD
R1 ^[ nq
s�
GW-1 REV.5/91
WWAAM& dbi4AMM OR AGENT DATE
Submit original to Division of Environmental Management and copy to well owner.

North Carolina - Department of Environment, Health, and Natural Resources
Division of Envirgn,)rtental Management - Groundwater Section
P.O.:Bgx,29535`- Raleigh, N.C. 27626-0535
!'.hone [phone]
WELL`YCONSTRUCTION RECORD
DRILLING CONTRACTOR: Hickory Well Drilling Co.
STATE WELL
DRILLER REGISTRATION. NUMBER: 718 PERMIT NUMBERCONSTRUCTION
ERMNUMBERNSTRUCTION 2 O 8 rf 1 rj
1. WELL LOCATION: (Show sketch of the location below)
Nearest Town:` Morganton County: Burke
1868 Denton Ave.
(Road, Community, or Subdivision and Lot No.)
2. OWNER Donald Earl
ADDRESS 868 Denton Ave
(Street or Route No.)
Morganton NC-. 28655
City or Town State Zip Code
3. DATE DRILLED 0.1--12-.00_ USE OF WELL Domestic
4. TOTAL DEPTH 505
5. CUTTINGS COLLECTED YES F-1 NO®
6. DOES WELL REPLACE EXISTING WELL? YES F__j NO
7. STATIC WATER LEVEL Below Top of Casing: 22.5 FT.
(Use "+" If Above Top of Casing)
S. TOP OF CASING IS 2 FT. Above Land Surface*
• Casing Terminated at/or below land surface Is Illegal unless a variance is Issued
In accordance with 15A NC C 2C '.0110
9. YIELD (gpm): METHOD OF TEST By Air Tes t
10. WATER ZONES (depth):
11. CHLORINATION: Type HTH Tabs Amount 101
12. CASING:
Depth Diameter
From —0 To 68 Ft. 61�r—
From - To Ft.
From To Ft.
13. GROUT:
Depth
From 0 To 20 Ft.
From To Ft.
14. SCREEN:
DEPTH
From To
DRILLING LOG
Formation Description
r-,
Q
0
_
n
GrJ
o
If additional space is needed use back of form
Wall Thickness LOCATION SKETCH
or Weight/Ft. Material (Show direction and distance from at least two State
PVC Plas tic Roads, or other map reference points)
Material Method
Grout Poured
Depth
Diameter
Slot Size Material
From
To
Ft in.
in.
From
To
Ft. in.
in.
From
To
Ft. in.
s, in. ,
15. SAND/GRAVEL PACK:
Depth
Size
Material
From
To
Ft.
a.;^'+ MAY 1l
From
To
Ft.
1
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A CqUMMMOOfi1OiP "MON PROVIDED TO THE WELL OWNER.
340 1.40 ACCESS 'ROAD
P. 0. BOX 4216
Nt('KOttti/ ":C. 28601' 01-27-00
SIGNATURE OF CONTRACTOR OR AGENT DATE
GW-1 REV. 6/91 Submit original to Division of Environmental Management and copy to well owner.

North Carolina - Department of Environment, Health, and Natural Resources
Division of Environmental (management - Groundwater Section
P.'-;Raleigh;'N.C.27626-0535
Kati i.�8 P,hone (919).733-3221
r
' A
WELL CONSTRUCTION RECORD
DRILLING CONTRACTOR: Hickory Well Drilling Co.
STATE WELL CONSTRUCTION �r
DRILLER REGISTRATION NUMBER:_ 718 PERMIT NUMBER: 9 n Q 01 I'tt
1. WELL LOCATION: (Show sketch of the location below)
Nearest Town: runnel lt,-nri nngc County:
5Fi71 Rhnnpv Rnar1
(Road, Community, or Subdivision and Lot No.)
2. OWNER _ Helen Propst
ADDRESS 5671 Rhoney Rd.
(Street or Route No.)
Connelly Springs NC 28612
City or Town State - Zip Code
3. DATE DRILLED 01-05-00 USE OF WELL Domes tic
4. TOTAL DEPTH 205
5. CUTTINGS COLLECTED YES Q NO©
6. DOES WELL REPLACE EXISTING WELL? YES [::] NOM
7. STATIC WATER LEVEL Below Top of Casing: 7A FT.
a. TOP OF OASINO IS."' 2 ""AS s"raonTS ur aoeO'
• Casing Terminated at/or below land surface Is illegal unless a variance is issued
In accordance with 15A NCAC 2C '.0116
9. YIELD (gpm): 20 `... METHOD OF TEST _.BVAir Tes tTes t
10. WATER ZONES (depth):
11. CHLORINATION: Type HTH Tabs Amount 28
12. CASING:
Wail Thickness
Depth Diameter or Weight/Ft. Material
From 0 To .45 Ft. 6V' PVC Plas tic
From To Ft.
From To Ft.
13. GROUT:
From 0
. From _
14. SCREEN:
Depth
To 20 Ft.
To Ft.
Material Method
Grout Poured
Depth Diameter Slot Size Material
From To Ft In. in.
From To Ft. in. _
From To Ft. in. _
15. SAND/GRAVEL PACK:
Depth Size
From To Ft.
From To Ft.
16. REMARKS:
_ in.
_ In.
DEPTH DRILLING LOG
From To Formation Description
z as
., r• i �.
c-s
G? �
If additional space is needed use back of form
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other map reference points)
w
/Y
.v�
� r
bit
� Env F
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
{CKORY KI.L DRILLING CO., Ik1C'.
340 I-40 ACCESS ROAD
P. 0. BOX 4216 01-20-2000
GW-1 REV. 5/91 Submit original to Division of Environmentat Management and copy to well owner.

North Carolina - Department of Environment. Health, and Natural Resources
Division of Envlro6mental Management -.Groundwater Section
P.O. Bdi!29535`-;Raleigh, N.C. 27626-0535
`�0°'''' Phone [phone]
��.
WELL"?.CONSTRUCTION RECORD
DRILLING CONTRACTOR: Hickory Well Drilling
STATE WELL CONSTRUCTION
DRILLER REGISTRATION NUMBER: 718 PERMIT NUMBER:
1. WELL LOCATION: (Show sketch of the location below)
Nearest Town:< Conne 7 y Springs County: Burke
2086 US 70
(Road, Community, or Subdivision and Lot No.) DEPTH
DRILLING LOG
2. OWNER Ricky Wilkinson From To
Formation Description
ADDRESS 2086 US 70
(Street or Route No.)
28612
Connelly springs NC
City or Town State Zip Code
r
3. DATE DRILLED 01`-11-00 USE OF WELL Domesti -
c=)
4. TOTAL DEPTH SAS
xr
`''77;
5. CUTTINGS COLLECTED YES[] NO]
6. DOES WELL REPLACE EXISTING WELL? YES E] N05a
7. STATIC WATER LEVEL Below Top of Casing: 120 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS'' 2 FT. Above Land Surface*
• Casing Terminated at/or below land surface Is Illegal unless a variance Is Issued
E5
In accordance with 15A NCA,C 2C '.0118
9. YIELD (gpm): ? METHOD OF TESTB3/ Air TPst
C�
o -
10. WATER ZONES (depth):
11. CHLORINATION: Type
HTH Tabs
Amount 85
If additional space is needed use back of form
12. CASING:
LOCATION SKETCH
Depth
Diameter
Wall Thickness
or Welght/Ft. Material
(Show direction and distance from at least two State
From 0 To. 86
Ft. 61"
PVC; Plastic
Roads, or other map reference points)
From To
Ft.
From To
Ft
13. GROUT: �I
DepthY Material Method 0016"
From 0 To .20 Ft. Srout Poured (,J�,l �
From To Ft. Uft �IW� /q
14. SCREEN: 1'
Depth Diameter Slot Size Material 3
From To Ft in. in. 1q
From To Ft. in. in. S�UA0I,Uh�
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth' ` Size Material S
From To, Ft.
From To Ft.
. 16t. REMARKS: pp
IRi��O ER BY C R4Y'
)CONSTRUCTION STANI
,;1 MAY 6 0 O
GW-1 REV.6/91
AT•THIS WELL WAS CONSTRUCTED IN IN ACCORDANCE WITH 15A NCAC 2C, WELL
;DS, AND THATkM qq ffL Ut(ILLII Ag,gE
EN PROVIDED TO THE WELL OWNER.
6 % ; 340 1-40 ACCESS ROAD
P. 0, BOX 4210 01-19-00
DATE
.._,� SI b FtOR AGENT
Submit original to Division of Environmental Management and copy to well owner.

North Carolina - Department of Environment, Health, and Natural Resources
Division of Environmental Management - Groundwater Section
P.O:,Box'2965: Raleigh, N.C. 27626-0535
Phone (91,9) 733-3221
WELL!CONSTRUCTION RECORD
DRILLING CONTRACTOR: Hickory Well Drilling Co.
STATE WELL CONSTRUCTION
DRILLER REGISTRATION NUMBER:_ 718 PERMIT NUMBER:
1. WELL LOCATION: (Show sketch of the location below)
Nearest Town: Morganton County: Burke
4958 Laurel Haven Ave.
(Road, Community, or Subdivision and Lot No.) DEPTH
2. OWNER Jamie Morgan From To
ADDRESS 4958 T.aitrel Haven Ava.
Morganton (saeet or NC Route No.) 28655
City or Town State Zip Code
3. DATE DRILLED 01-12-00 USE OF WELL domestic
4. TOTAL DEPTH fir— ------
5. CUTTINGS COLLECTED YES Q NOU
6. DOES WELL REPLACE EXISTING WELL? YES M NOF-1
7. STATIC WATER LEVEL Below Top of Casing: 6 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 2 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
9. YIELD (gpm): METHOD OF TEST
10. WATER ZONES (depth):
DRILLING LOG
Formation Description
r�
C/' ;..
C7
c_J o
11. CHLORINATION: Type Amount If additional space is needed use back of form
12. CASING:
Wall Thickness LOCATION SKETCH
Depth
Di?meter or We Material (Show direction and distance from at least two State
Plastic
From 0
To 88 Ft.
6t PVC Roads, or other map reference points)
From
To Ft.
From
To Ft.
13. GROUT:
0
Depth
20
Material Metho---------
Grout Poure
From
To Ft.
From
To ' Ft.
PAO0
14. SCREEN:
Depth Diameter
Slot Size Material Uj
From
To Ft
in. in.
From
To Ft.
in. in.
From
To Ft.
in. in. C�� �E-
15. SAND/GRAVEL PACK:
Depth
Size Material
From
To Ft.
From
To Ft.
16. REMARKS:
I DO HBREBY
ERTIRY-T A
WAS CONSTRUCTED IN ACCORDANCE WITH I SA NCAC 2C WELL
CONS TI Nj DglAl jrwELL
D HAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
_
111MORY 6; LL DRILL NG CO., i; 'C.
MAY I ® �U[7
340 1.40 ACCESS ROAD
P. 0, BOX 11216
li
S16Q�('f) #1 OF..COt(DMAMR OR AGENT DATE
GW 1 REV. b g 1
p t 9tit ntati '{ r
Submit original to Division of Environmental Management and copy to well owner.

North Carolina - Department of Environment, Health, and Natural Resources
Division of Environrnental, Management - Groundwater Section
P.O.: Box_29535.-.Raleigh, N.C.27626-0535
i,. Pone [phone]
WELL;CONSTRUCTION RECORD
DRILLING CONTRACTOR: Hickory Well Drilling Co
.
STATE WELL CONSTRUCTION 208 1
DRILLER REGISTRATION NUMBER: 718 PERMIT NUMBER:
1. WELL LOCATION: (Show sketch of the location below)
Hildebran Count Burke
Nearest Town: y.
5242 Paige St
(Road, Community, or Subdivision and Lot No.)
2. OWNER Terry & Tina Rogers
ADDRESS 5242 Paige St.
(Street or Route No.)
Hickory VC,. 28602
City or Town State Zip Code
3. DATE DRILLED 01-06-00 USE OF WELL domes tic
4. TOTAL DEPTH 205'
5. CUTTINGS COLLECTED YES C] NO®
6. DOES WELL REPLACE EXISTING WELL? YES DM NOQ
7. STATIC WATER LEVEL Below Top of Casing: 25 FT.
(Use '+" It Above Top of Casing)
8. TOP OF CASING IS 2 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
9. YIELD (gpm): 7 METHOD OF TEST By Air Test
10. WATER ZONES (depth):
11. CHLORINATION: Type Amount 1R
12. CASING:
Depth Diameter
From D To — A Ft. 1-64
From To Ft.
From To Ft.
13. GROUT:
14
Wall Thickness
or Weight/Ft. Material
Mrr. .Plastic
Depth Material
From 0 To 0 Ft. Grout
From To Ft.
SCREEN:
Method
P
Depth Diameter Slot Size Material
From
To Ft
in. —
From
To Ft.
in. —
From
To Ft.
in. _
15. SAND/GRAVEL
PACK:
Depth'
Size
From
To Ft.
From
To Ft.
16. REMARKS:
._
in.
in.
in.
Material
DEPTH DRILLING LOG
From To Formation Description
ca fz'
=:vc,
rn
C1 co
If additional space is needed use back of form
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other map reference points)
S
(CER't'IFYTHAT � IS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
'ION STANDARDS, AND THAT A CrQ� O Y'(j Tk,?Rn LINffl B _:EhI PROVIDED TO THE WELL OWNER.
MAY I 'DODO �t RU
340 1--4�+0- ACCESS ROAD
P. 0. BOX 4216 Q1-17-C
SIGNA O MA A R AGENT DATE
i,h� villa I+`F?,iaf6 rC ""' Submit original to Division of Environmental Management and copy to well owner.

North Carolina - Department of Environment, Health, and Natural Resources
Division of Environmental Management - Groundwater Section
P.O. Box 29535 - Raleigh, N.C. 27626-0535
Phone [phone]
WELL CONSTRUCTION RECORD
DRILLING CONTRACTOR: Price Well Drilling, Inc.
FOR OFFICE USE C t 4 4
QUAD. NO. _ SERIAL NO.
Lat Long. RO
Minor Basin
Basin Code
Header Ent. GW-1 Ent.
-- STATE WELL CONSTRUCTION -
DRILLER REGISTRATION NUMBER: 1534 PERMIT NUMBER: Burke
1. WELL LOCATION: (Show sketch of the location below)
Nearest Town: I..organton County: Burke
(Road, Community, or Subdivision and Lot No.)
2. OWNER Charles Fisher
ADDRESS 1720 Bost R
(Street or Route No.
Morganton, NC �8655
City or Town State Zip Code
3. DATE DRILLED 1/7/0 0 USE OF WELL private
4. TOTAL DEPTH 230-
5. CUTTINGS COLLECTED YES ❑ NO[2
6. DOES WELL REPLACE EXISTING WELL? YESF7 NO x0
7. STATIC WATER LEVEL Below Top of Casing: 60 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 2 FT. Above Land Surface"
• Casing Terminated at/or below land surface is Illegal unless a variance Is Issued
In accordance with 15A NCAC 2C .0118
9. YIELD (gpm): 30 METI lIq�RFITfST air
10. WATER ZONES (depth):
11. CHLORINATION: Type Clorox Amount 2 gal.
12. CASING:
Wall Thickness
Depth Diameter or Weight/Ft. Material
From n To --I )5 Ft. L 1 Z 8 sch 40 pvc
From To Ft.
From To Ft.
13. GROUT:
Depth
From 0 To 20 Ft.
From To Ft.
14. SCREEN:
Material Method
cement pour
Depth Diameter Slot Size
From To Ft in. in.
From To Ft. in. in.
From To Ft. in. in.
Material
DEPTH DRILLING LOG
From To Formation Descriptic
0 105 hit water 1G
n
C o
c�
v�
N
If additional space is needed use back om"m
LOCATION SKETCH.
(Show direction and distance from at least two State
Roads, or other map reference points)
Q.
k T3•
15. SAND/GRAVEL PACK: �
Depth Size Material �n
From To Ft. �b'�
From To Ft.
16. REMARKS:
II;DO,HEAEBY C_ERTJPY,THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION T NDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
fi '
'Vi C I
, t , g s a11EEf;s; SIGNATURE OF CONTRACTOR OR AdFI4T 1
Submit original to Division of Environmental Management and copy to wail owner.

Norh Carolina - Department of Environment, Health, and Natural Resources
Division of Environmental Management - Groundwater Section
P.O. Box 29535 - Raleigh, N.C. 27626-0535
Phone [phone]
FOR OFFICE USE OWD C 4 0
QUAD. NO. SERIAL KNO.``ii
Lat Long. RO
WELL CONSTRUCTION RECORD Minor Basin
Basin Code
DRILLING CONTRACTOR: ice- 11 j e Cl Header Ent. GW-1 Ent.
r 6TE WELL CONSTRUCTION
DRILLER REGISTRATION NUMBER: IS34 PERMIT NUMBER:
1. WELL LOCATION: LShow sketc f the locati n alp r G Nearest Town:
(Road, Communi or S division a Lot No.)
DEPTH
DRILLING LOG
2. OWNER G Af i
ADDRESS © 'I C
From To
_ Lr
�F son Description
J17I L
(Street or Route No.)
b(C u14
3 a f �,
1� rJ
City or Town state Zip Cod
' Z S
} /!J
U -
0GIC
ha
3. DATE DRILLED USE OF WELL f't
4. TOTAL DEPTH JA0
_
0,
5. CUTTINGS COLLECTED YES ❑ NO
6. DOES WELL REPLACE EXISTING WELL? YES NO[:]
Wes'
7. STATIC WATER LEVEL Below Top of Casing: ,jFT.
(Use '+' it Above Top of Casing)
8. TOP OF CASING IS Z FT. Above land Surface*
;� o
' Casing Terminated at/or below land surface is Ilw col unless a varlanq Is issued
In accordance with t V.1kCAC 2C .Ott •
9. YIELD Al
_.
(gpm): METH OF TEST
-�
10. WATER ZONES (depth): - -K-(
11. CHLORINATION: Type O QO_T Amount Z
If additional space is needed use back of form
12. CASING:
Wall Thickness
Depth-1 i eter o�W 'gWt. �ijenall
From - To c� Ft. /Vrf�
From To Ft.
From To Ft.
13. GROUT:
Depth Material Method
From To Z-L) Ft. _C&r- lOC& T' D G
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:
LOCATION SKETCH
(Show direction and dstance from at least two State
Roads, or other map reference points)
/ t< /YC4/
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
IyDUO HOER#B'0m1Cd' iTIF�Y7HAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 1SA N IC 2C, WELL
C�NSTRt�C7lOIJ ST�NbARDS. AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNEFf..
iE 3 li'
l: _ie IIIf
1 ,