Well Construction Records Buncombe 5 CY2000

Ncr,r Carolina - Deoartment of Environment and Natural Resources - Division of Water Quality • Groundwater Sectior
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 El Industrial ❑ Agricultural El Monitor .rc
Recovery ❑ Heat Pump Water Injection Other ❑ If Other, List Use:
2. WELL LOCATI N: Show sketch of the Location below)
Nearest Town: Q JL�Q Q A County
(Road Name a. Numoers, Communi or Subdivision and Lot No.)
3. OWNER
Address 1 n t� 1-i n
0
City or Town State Zip Code
a. DATE DRILLED4�C�
5. TOTAL DEPTH S
6. CUTTINGS COLLECTED YES ❑ NO❑
7. DOES WELL REPLACE EXISTING WELL? YES ❑ NO[Z
8 STATIC WATER LEVEL Below Top of Casing: 5-1 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 2_Q.0118
10. YIELD (gpm):. _ METHOD OF TEST _ Cl_,( I.--
1 1. WATER ZONES (depth):
12. CHLORINATION: Type 11-1 )� Amount
13, CASING:
Depth '^ � Di�rr�ete
From � To �%� Ft. _
From To Ft.
From To Ft.
14. GROUT:
From
From
15. SCREEN:
DRILLING LOG
From To
�oZD 6�7�
DEPTH
Fo ,atio Descnp:io.-
r97
N
0
G
�
C
ro
b
-t
It additional space is needed use back of Ism
_nf
z
Wall Thickness LOCATION SKETCH
or Weight/Ft. Aiaterial (Show direction and distance from at least two State
Roads, or other map reference points)
0
Depth Material
To � Ft.
To Ft.
Depth
From
To Ft
From
To Ft.
From
To - Ft.
16. SAND/GRAVEL
PACK:
Depth
From
To
From
To
17. REMARKS:
Diameter Slot Size
in. in.
in. in,
in. in.
Ft.
Ft.
Method
nil
fi�k?
Material I ,.
JUN 3 01�!r� ,
Size Material
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 OFFIr.F IISF nNl V .1�—r')0—
Quad No:
Serial No
SIGNATURE OF PERSON CONSTRUCTING T_H'E4ELL DATE
Submit original to Division of Water Ouality, Groundwater Section within 30 days
GWl REV. 12/9S
r

rJorm Carolina • Debarment of Environment and Natural Resources • Division of Water Ouahry - Groundwater Section
1636 Mail Service Center • Raleigh, N.C. 27699.1636-Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR
WELL CONTRACTOR CERTIFICATION
STATE WELL CONSTRUCTION PERMIT#:
1 . WELL USE (Cr,eck Applicable Box): Residential Municipal ❑ Industrial ❑
Recovery ❑ Heat Pump Water Injectio Other ❑ If Other, List Use:
2. WELL LOCATION, (Show �sketch of the location below) r-
Nearest Town: (o� Ali -C�'� , 1L. Count; t � p 1�1 Q
_rr 0A_tj P-0 (a nj
Agricultural ❑ Monitor:r.y ❑
(Road Narner Num rs, Commu . , or Subdiyision and Lot No.)
DRILLING LOG
DEPTH
3.
OWNER
From
Forjr.al,ion Descrip:io-
Address t
7 trees or u o. ! S
`
G��
City or Town State Zip Code
N
4.
DATE DRILLED 5 `- ICI _00
��� ��
5.
TOTAL DEPTH 3 25
6.
CUTTINGS COLLECTED YES ❑ NO❑
0
7.
DOES WELL REPLACE EXISTING WELL? YES ❑ NO
C:)
8.
STATIC WATER LEVEL Below Top of Casing: 3, FT.77��
(Use '+' if Above Top of Casing)
9.
TOP OF CASING ISFT. Above Land Surface'
•Top
of casing terminated allor below land surface requires a variance In accor-
dance
with 15A NCAC
C
10.
YIELD (gpm): METHOD OF TEST A AL
11.
WATER ZONES (depth):
fV
v'"`
12.
CHLORINATION: TypeAmountAmount
If additional space is needed
use back of%rm
x
13. CASING
i Depth t' � iar)e}e
From To l �t Ft.(
From To Ft.
From To Ft.
14. GROUT:
{r� Depths ^�
From To Ft
From To Ft
15. SCREEN:
Depth
From
To
From
To
From
To
16. SAND/GRAVEL
PACK:
Depth
From
To —
From
To_
17. REMARKS:
Wall Thickness LOCATION SKETCH
o. ateriaI (Show direction and distance from at least two State
Roads, or other map reference points)
Material Method
Diameter Slot Size Material
Ft in, in,
Ft. in. in.
Ft. in. in.
Size
Ft.
Ft.
Material
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY THIS RECORD H S BEEN PROVIDED TO THE WELL OWNER
FOR OFFICE USE ONLY ��"�""
Quad No: SIGNATURE OF PERSON CONSTRUCTING ELL A
Submit original to Division of Water Quality, Groundwater Section ithin 30 days
SeralNo. py GW•1 REV. 12'9S
0 1` J
C1 !2)

i
Nonn Carolina - Derartment of Environment and Natural Resources - Division of Water Quality - Groundwater Section
t 636 Mad Service Center - Raleigh N C 27699.1636-Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR i t c 4 l %P �� Y't� ► �� ��? _
WELL CONTRACTOR CERTIFICATION #:
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE (Check Applicable Box): Residential Municipal ❑ Industrial ElAgricultural ❑ Moniter.nc ❑
Recovery ❑ Heat Pump Water Injection Other ❑ If Other, List Use:
2. WELL LOCATI - (Show sketch of the location below)
Nearest Town: IO A C1 / fA, County' '` JLL/9-C C L-4, h I
(Road Name .� : Numbers
3. OWNER
Address , )
or Town
or Subdivision and 4ovNo.)
Code
4. DATE DRILLED
5. TOTAL DEPTH
6. CUTTINGS COLLECTED YES ❑ NOO
7. DOES WELL REPLACE EXISTING WELL? YES F-1 NO)t
8. STATIC WATER LEVEL Below Top of Casing:_ FT.
(Use '*' it Above Top of Casing)
9. TOP OF CASING IS FT. Above Land Surface'
'Top of casing terminated at./or below land surface requires a variance In accor-
dance with 15A NCAC 2C .0118
10. YIELD (gpm): _5 METHOD OF TEST Q ��
1 1. WATER ZONES (depth): —
12. CHLORINATION
13. CASING:
Type HII -d Amount
De Diameter
From— T- L FI.tL �I
From To Ft.
From To Ft.
14. GROUT:
From V
From
15. SCREEN:
DRILLING LOG
From To
rya r,
r� 0 ""I
ct (_o (� l�
I ao 1 0
DEPTH
Formation Descnpa7-
Q
LID u
tq ZEE
GZ
If additional space is needed use back of
LOCATION SKETCH W -_I
Wall Thickness M CD
orJW igVFt.� ateri (Show direction and distance from at least two State
Roads, or other map reference points)
Depth Material Method
To QQ Ft. �� P
To Ft.
Depth
From —To—
From
To
From
To
16. SAND/GRAVEL
PACK:
Depth
From
To _
From
To_
17. REMARKS:
Diameter Slot Size
Ft in.
Ft. in.
Ft. in.
Size
Ft.
Ft.
�# �y-�,v
Material
in. t 6 6
in.
Matenal
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND ThkA COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
FOR OFFICE USE ONLY � Z
Quad No: SIGNATURE OF PERSON CONSTRUCTI
Submit original to Division of Water Quality, Groundwater
Serial No.
5
WELL DATE
i within 30 days
GW 1 REV. 12J95

Norm Carolina • Debarment of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mad Service Center - Raleigh, N.C. 27699.1636•Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR: t� �L�' - pa11:�
WELL CONTRACTOR CERTIFICATION is:
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE (Check Applicable Box): Residential Municipal ElIndustrial
ElAgricultural ❑ Monitor.r_
❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑
If Other, List Use:
2. WELL LOCATI ketch o tle locatioyl below)
n
L �'_)
Nearest Town: ) County:
Ll '1� C' (� .l'0_
L.C��1-
(Road Name ano umbers. Community, or Subci isl an No.)
DRILLING LOG DEPTH
3. OWNER 0 DA rl­l1`nC1A1.10 , \JCI'/aL(AlL__
From To ion Descnp:io-
Address �'. C- �`5 ��� - 3
(F�Q',n
o `—' n y
c
0�`'� (Street r outs o.
City or Town _ State Zip Code
DATE DRILLED
5. TOTAL DEPTr, �0
o
6. CUTTINGS COLLECTED YES ❑ N07
o
7. DOES WELL REPLACE EXISTING WELL? YES NO
8. STATIC WATER LEVEL Below Top of Casing: 3 j FT.
e-
a�
(Use '+' if Above Top of Casing)
_�-
9. TOP OF CASING IS FT. Above Land Surface'
N
oC
'Top of casing terminated at/or below land surface requires a variance In accor-
>p
dance with 15A NCAC 2 118
10. YIELD (gpm): METHOD OF TEST''
11. WATER ZONES (depth):
N
n
12. CHLORINATION: Type Amount
If additional space is needed use back of loan
o
Z
13. CASING:
LOCATION SKETCH
Wall Thickness
+ a Depth iarPdte o�rUFt. M teriaall
(Show direction and distance from at least two State
From To J_ Ft. I
Roads, or other map reference points)
From To Fl.
From To Ft.
14. GROUT:
' I/
Dep, //�� Material Method
From 0 To Ft. l-k—n-J 'C-
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.
Ft
Ft
Size Material
,li h i
VOil
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAZ.A,COPY OFRECORD HAS BEEN PROVIDED TO THE WELL O�vNER.
FOR OFFICE USE ONLY jam_
Quad No: SIGNATURE OF PERSON CONSTRUCTING c WELL DATE
Submit original to Division of Water Quality, Groundwater Section within 30 days
Senal No. GW•1 REV. 12i)S

North Carolina - Department of Environment, Health, and Natural Resources FOFi �f`F1C USE ON��f+ '
Division of Environmental Management - Groundwater Section 1
P.O. Box 29535 Raleigh, N.C. 27626-0535 QUAD NO �`ERIAL NO, z f w .+- +
Phone [phone] lat
Minor Basin -fig'^
l
WELL CONSTRUCTION RECORD
Basin Code
!=pHeader LADRILLING CONTRACTOR: .
STATE WELL CONSTRUCTION 0 v r,
DRILLER REGISTRATION NUMBER: � PERMIT NUMBER:
1. WELL LOCATION: Show sketch of the location below)
Nearest Town- County:
(Road, Communitv, or Subdivision and Lot o.). DEPTH DRILLING LOG
2. OWNER + From To Formation Description
ADDRESS r ` . & C
(Sttrre�et or Route No.) �f /f' / U
1
Ci or Town 7 fate' Zip Code U
/ ,� •--�7���— t ,
3. DATE DRILLED3 d USE OF WELL
4. TOTAL DEPTH
5. CUTTINGS COLLECTED YES ❑ NOM
6. DOES WELL REPLACE EXISTING WELL? YES NOT
7. STATIC WATER LEVEL Below Top of Casing: FT. o n
(Use "+" if Above Top of Casing) i✓
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): .h METHOD OF TESTt
fr:
10: WATER ZONES (depth): "'?
•. -r'i J
i`i
11. CHLORINATION: Type Taq Amount If additional space is needed use baWof 6Tyn
12. CASING:
Wall Thickness LOCATION SKETCH
Depth Diameter or Wei h Ft. Material (Show direction and distance from at least two State
From To � Ft. �0T /27 Roads, or other map reference points)
From To Ft. 4I
From To Ft. ((� p
13. GROUT:
Depth Material Method
From To Ft.
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
h'...-
�, d°'0 HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUC ANtA)fDS AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
I �i°�� ,
SIGNATURE CONTRACTOR OR AGENT ATE.
r.W.1 RFv 9/91 Cithmil nrininal In nivicinn of Environmental Management and coov 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]
FOR dl`FlCt U§E dNL " r-
QUAD. NO,. ; a §ERIAL
1
Lo
Minor Basin `, =t`,,=•.�:-�'�..
WELL CONSTRUCTION RECORD Basin Code
. nn� Header En4.
DRILLING CONTRACTOR: Lt C� LLLLIA- v- M.Lru_�
O STATE WELL CONSTRUCTION
DRILLER REGISTRATION NUMBER: 3^1 U PERMIT NUMBER:
1. WELL LOCATIt1 `';'t'h "rh of the location below)
Nearest Town: _ County _ _ ----- —
A o t C� ~
(Roa , Co ity, or Subdivisi n( I Lpt No.) DEPTH DRILLING LOG
2. OWNER 's From To Formation Description
ADDRESS ® 4 V
(St ree or to No.) (� l0�
(V 24A O
e -
City or own State Zip Code —��� /3�
3. DATE DRILLED -Q L t,_U USE OF WELL
4. TOTAL DEPTH a (n S
5. CUTTINGS COLLECTED YES ❑ NO[)o
6. DOES WELL REPLACE EXISTING WELL? YES D NO®
7. STATIC WATER LEVEL Below Top of Casing: rFT.
(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 5A NCAC 2C .0118
9. YIELD (gpm):2404 OF TEST
10. WATER ZONES (depth):
11. CHLORINATION: Type Amount
12. CASING:
Wall Thickness
Depths ,, 2) Djartef �oy1(Vht/Ft• aterial
Fromm To 103 Ft.
From To Ft.
From To Ft.
13. GROUT:
Depth Material Method
From C) To � Ft.
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
From To Ft
From To Ft
oCR A A OVC...:.:_...'. ..
rr -- 1`D`O"JN REBY CE
CONSTaIJ•1� ffN
MAY I
LUU U�
Size Material
a
o ti
S'
[.J
E5
If additional space is needed use�ack o—Porm
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other map reference points)
/Doq
THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
)ARDS, AND. THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
SIGNATURE 4 CONTRACTOR OR AGENT
3(

North Carolina - Department of Environment, Health, and Natural Resources
FOR ;.
d�FICIL USE ONLY
Division of Environmental Management - Groundwater Section QUAD. NO, SERIAL NO.-,. 7.1 r' t•
P.O. Box 29535 - Raleigh, N.C. 27626.0535
Phone [phone] lat (°^ —•-- p ��' ''
Minor Basin
WELL_ 1CSTRUCTION RECORD ~
Basin Code
DRILLING CONTRACTOR: I �(t l � Q (S, V.- t- ik3 -, Header t`nt. ` GW- "�n`t :r• :s •�.;
STA)rE WELL CONSTRUCTION
DRILLER REGISTRATION NUMBER: �j PERMIT NUMBER:
1. WELL LOCATIO ( how sketch of the location below) �'-�>
,
Nearest Town- -3 � t (, C. "� ELL County: ` �LL� r'—�� 0rFn
Q -
�.
(Roa unity, or Subd'vis'on and Lot ) DEPTH DRILLING LOG
2. OWNER I iQ From To Formation Description
ADDRESS r) ,-�C C 14 ki
No.)
Ci y or Town / St tee ( Zip Code
3. DAT DRILLED `d' OLD USE OF WELC�G_Y_"
4. TOTAL DEPTH c-20S
5. CUTTINGS COLLECTED YES ❑ NOM
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NOM
7. STATIC WATER LEVEL Below Top of Casing: .315 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS ON 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): LO METHOD OF TEST t f1
10. WATER ZONES (depth):
11. CHLORINATION: Type LITIJ Amount
12. CASING:
Depths-�j �Di�an(�,e�
From4_a,—To t— Ft. '�—
From To Ft.
From To Ft.
13. GROUT:
"4.4 . "�
If additional space is needed use back of form
Wall Thickness LOCATION SKETCH
orlVllg� igtZt/Ft. Material
� (Show direction and distance from at least two State
t'jN} `�"""-�_ Roads, or other map reference points)
Depth Material
From P To ;:).D Ft. e.P 1l �_ A1.IL
From To Ft.
14. SCREEN:
Depth Diameter Slot Size
From To Ft in. in.
From To Ft. in. _ in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
From fit:
From 'o Ft.
16. REMARKSJI
i
I DO HEREBY CE A TIFAy,T�;�� TJTF''
CONSTRUCTION STANDARDS /
Method
Material
Material
O
p
3
1
0�
C*
a
�d
m
.r
m
..
c")
CO
ca
•� sae
?YELL WA� CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
;,THAT A, COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
GW1 REV.9AJ1
_ j_M2__
SIGNATURE OF CONtPACTOR OR AGENT l pA E
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 2 40.7 4 9 4
1636 Mail Service Center - Raleigh, N.C. 27699-1636-Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR: (2iyEi! Edv99' L IEU- ,M P 00 .
WELL CONTRACTOR CERTIFICATION #: 520:— 202-4-
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE (Check Applicable Box): Residential 121 Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCA N how ketch of the location below)
Barest Town: =Q-- County: V-\
(Road Nam ed umtlers, Comm Ityf Subdivision and Lot No.) DRILLING LOG DEPTH
3. OWNER \ From To Formationpescriptlon
Address ly�A
(btre(ZtZ ?u a o. a 2 - 7Ci
City or Town Slate Zip Code
4. DATE DRILLED 'G2o2-
5. TOTAL DEPTH
6. CUTTINGS COLLECTED YES [__j NO�
7. DOES WELL REPLACE EXISTING WELL? YES Er 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 atlor below lend surface requires a variance In accor-
dance with 15A NCAC 2C .AJ;11�88 p
10. YIELD (gpm): iU METHOD OF TEST--
11. WATER ZONES (depth):
12. CHLORINATION: Type 44 %H Amount %a CV---
13. CASING:
Wall Thickness
�Depih� is er �c,&ig(�yF(� 6 M
From To 0 Ft. c Y ��
From To Ft.
From To Ft.
14 GROUT•
DepthMat rla lliod
From To Ft.
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
Ft.
Ft.
C)
It additional space Is needed use back of form-p
LOCATION SKETCH
c�
(Show direction and dunce from at least two StaWCD
—t
Roads_(�T otherAlp reference points) -c
Material -,I
i
I DO HEREBY CERTIFY THAT THIS WELL WAS CQNSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A jQ9* OFT IS ECOR ftAS BEEN PROVIDED TO THE WELL OWNER.
FOR OFFICE USE ONLY I f P-- 'L- (a r
u k-r rSi?,NATURE OF PERSON CONSTRUCTING THE WELL
bra R 1 Quad No: 4"j.S&nI,(1oJi& to Divlslon of Water Quality, Groundwater Section within 30 days
Serial No. =1i f) , I
° 3 rElttil[F ,r L Lila d �
s
4
DATE
GW•I rIEV. 12199
It additional space Is needed use back of form-p
LOCATION SKETCH
c�
(Show direction and dunce from at least two StaWCD
—t
Roads_(�T otherAlp reference points) -c
Material -,I
i
I DO HEREBY CERTIFY THAT THIS WELL WAS CQNSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A jQ9* OFT IS ECOR ftAS BEEN PROVIDED TO THE WELL OWNER.
FOR OFFICE USE ONLY I f P-- 'L- (a r
u k-r rSi?,NATURE OF PERSON CONSTRUCTING THE WELL
bra R 1 Quad No: 4"j.S&nI,(1oJi& to Divlslon of Water Quality, Groundwater Section within 30 days
Serial No. =1i f) , I
° 3 rElttil[F ,r L Lila d �
s
4
DATE
GW•I rIEV. 12199

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mail Service Center - Raleigh, N.C. 27699.1636•Phons [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR: 6P5£N "t/ F- K U)E^' I- Cel
WELL CONTRACTOR CERTIFICATION a: 6`76-- 2-02--4
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 LOCO, N: (Show sketch of the location below) \
Nearest To n: „� �� County:
(Road NamleLaLd Nurrqers, Co u 'ty, or §ubdivision and Lot No.) DRILLING LOG
3. OWNER From To
Address Irl —
e tzar outs 1404
DEPTH
Formation Description .
City or Town / ate Zip Code
4. DATE DRILLED I
5. TOTAL DEPTH
6. CUTTINGS COLLECTED YES ❑ NO[ fr
7. DOES WELL REPLACE EXISTING WELL? YES ❑ NOd -"
8. STATIC WATER LEVEL Below Top of Casing: FT. ^- -
(Use '+' If Above Top of Yasing) t
9. TOP OF CASING IS FT. Above Land Surface'
'Top of casing terminated at/or below land surface requires a variance In accor- a
dance with 15A NCAC 2C .011
10. YIELD (gpm): METHOD OF TEST A)
1 rl.J
11. WATER ZONES (depth):
12. CHLORINATION: Type {-NTH Amount b It additional space is needed use back of form
13. CASING`
• Wall Thickness
`Depth iarnet�r Cq``y�Zs��t/,�t� serial
From' ( To Ft.
From To Ft.
From To Ft.
14. GROUT:
Depth ' Mae ethod
From To Ss�.,ll .@ Ft. G
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:_
Material
in.
In.
In.
Material
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or ott - -
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A C Y F T EC D HAS BEEN PROVIDED TO THE WELL OWNEP
FOR OFFICE USE ONLY
Quad No:
Serial No. -
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit original to Division of Water Quality, Groundwater Section within 30 days c rr•t PEv• 12M

North Carolina • beparfrsle+3i-ot-�nvuonment and•Matural Resources - 6ivision oTlNater Quality •Groundwater Section - 2150 ;) r�
C t R I i h N C 27699-1636-Phone [phone]
1636 Mail Service en er - a e g
N vE 4 C '
WELL CONSTRUCTION RECORD WELL CONTRACTOR:
LL CONTRACTOR CERTIFICATION #: —"
STATE WELL CONSTRUCTION PERMITk:
1. WELL USE (Check Applicable Box): Residential Municipal ❑ Industrial ❑ Agricultural ❑ 'Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCAT,t ?N.CSh -,# sketch of the location below)
Nearest Town: County: Q-0
DEPTH
(Road Name d Numbers o unity, or Subdivision and Lot No,) DRILLING LOG T6rtration'DescnpGon
3. OWNER From To
Address
II trees or r7 7 1 I
City or Town State Zip Code
4. DATE DRILLED " 8
5. TOTAL DEPTH
6. CUTTINGS COLLECTED YES ❑ NO[�
7. DOES WELL REPLACE EXISTING WELL? YES [] NO[.�
8. STATIC WATER LEVEL Below Top of Casing: ao-- FT.
' (Use '+' if Above Top of Casing)
9. TOP OF CASING IS FT. Above Land Surfitce' C=
-'Top of casing terminated attor below land surface requires a variance In eccor-
-------------
dance with 15A NCAC 2C VA -VI /�
10. YIELD (gpm): �� METHOD OF TESTA)
iz
11. WATER ZONES (depth): =crn
12. CHLORINATION: Type T Amount =' if additional space is needed use back of�3rm
c�
13. CASING:
LOCATION SKETCH
Wall Thickness
- -Depth pia or ig t. le�na (Show direction and distance from at lease two fate
1%7 Cl,� ` " �•�-1 Vim— Roads, or other map reference points)
Fromm' To Ft.2/,,-- R
From To / Ft.-- '
From To Ft. /j
14. GROUT: /
Dept ate 'al Metho
From O To FL
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:
100 HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A Cqy.O THIS RECORD AS BEEN PROVIDED TO THE WELL O NEP��
FOR OFFICE USE ONLY
Quad No:
Serial No.
SIGNATURE OF PERSON CONSTRUCTING THE WELL
Submil original to Divlslon of Water Quality, Groundwater Section within 30 days
PATE
Gw•1 AEV. i2M

UST SECTION Fax:[phone] Jul 2 '99
9:50 P. 01/01
North Carolina - Department o1 EnvJronrnen4. end Naturalesauces • Division of Water'Qtrality - 6rounrater geCtion
P,O. Box 29578 - Raleigh, N.C. 27626.0571�14Pha1e j919) 73M221
WELL CONSTRUCTION RECORD
1, WELL USb&k sid
AppllCabl• sox): ReentialRecoveryHeat Pump Water Injection ❑
DRILLING CONTRAETOR:
FiRii.LM AE'01STRA110N 0; —3-
STATE WELL•CONSTROCTION PERMIT#:
Municipal O Industrial Agricultural d Monitoring 0
Other ❑ If Other; jJst Use: _
2. WELL LOCA N- (Show sketch of the location below)
Nearest Town: �� _�� Co Unity: �J
�OcJ�� l��o� L2eei< <�.� •
(Road, co un; or aivasbn anC dot N) DEPTH DRILLING L0G
3. OWNER C'`� From Tq Formatlon Description
ADORES 3 t
(sue4l a t,toNo., �a��
car or Town ; - at* ZIP, Code
L
4. DATE DRIL
5. TOTAL DEPT --
6, CUTTINGS C LLECT ED YES ❑ f10Q'
7, DOES WELL REPLACE EXISTING WELL? YES ❑ NO[D-
8. STATIC WATER LEVEL Below Top of Casing:. FT. r ''
(Use "«" V 4bove Top of CasinW O
9. TOP OF CASING IS FT, Abow.e Land Surface'
• C Wnp Tarminvi#d avor below land surtaw is Illeykt.anWs a vsrl'ance Is Issued!
In accordance with 15A NGLAC 20 .0118 - _-, •rr;
10. YIELD (gpm): -,3-0 METHOD OF TEST
11. WATER ZONES (depth):
-o
12, CHLORINATION: Type Amount
space le.needed use ba6R'Dt form'
13. CASING: K T _N
Wall 7hicknar4
Depth , lar�otefy yt h F �C� (Stww.bliection and distanco from at lea two Sc�
From To - Ft. Roads, or other map rofertnce i>66 i)
From To Ft.
From To Ft. —
a
14. GROUT:
Depth M e •, ethod
From -a— To Ft. ;
From —To Ft. ----- �
15. SCREEN:
Depth Diameter Stof.Slte Material
To Ft in In
From .---
From To Ft. in77
From —To Ft.---..
16. SANDIGRAVEL PACK: l 17VA 6 `
Depth Size `Magittl iJs
From To Ft. �;.ri
From -
To,
'
1T, REMARKS:
100 HEREBY CERTIFY THAT THIS WELL. WAS CONSTRu VI
ED 1N ACCORDANCE WITH DEC)TOTHE WELL
CAN3TFaUCTICiN STANDARDS; AND THAT A COP HI ECO AS PROTO TWELL OWtvER%
0 Q siGRATURE OF CONTRACTOR OR A05NT OATS
V V H 5uomk crtpinar to biviwan of Water Quaky and copy to w911 owner. W-t REV, SAe

UST SECTION Fax[phone] Jul 2 '99 9:50 P.01/01
North Carolina - Department of Environment, and Natural Asi=ces • Division of Water' t?uaGty - Croun&ater geotion
RO. Box 29578 - Ralelgh,N.C. 27626.0578-Phone {919) 73M221
WELL CONSTRUMON RE.00RD
1, WELL USE R Applleeble 1WXy Radential�
Recovery Heat Heat Purlip Water Injection ❑
2, WELL LOCAT
g:
Nearest Town:
DRILLING CONTRACTOR: -"
Ep8H:1 >=A fiEGf3TEIATION 0t
S v —
STATE WELL'CONSTRUCTION PERMITi:
Municipal ❑ Industrial ❑ Agricultural El Monitoring ❑
Other ❑ I{ Others Oil: Use:
of the location below) (� � � � c� � n
1 County: 1� —
and Lot No.)
3. OWNER e==_
AD[ RES
N h . t ► r' (Sweet or
:DEPTH
From TO
' Cay ot To `Stnce LP Code
4, DATE DRILLS ^� o
5. TOTAL DEPT
6, CUTTINGS C ,LLECTED YES ❑ t10� _ l
7. DOES WELL REPLACE EXISTING WELL? YES ❑ NO�.
8. STATIC WATER LEVEL Below Top of C�sing:. FT.
() ° it M' Top Of Casing /r,)
DRILLING LOGmm
Foallon Deacriplion
( a e 4
9. TOP OF CASING IS / _ FT Abot!elind Surfacal � '=
Casing Terminatad Ivor Mow lend surfam Is II1egk1.anNaa a V24ce Is Isawd . _
In aeoordance with tyA WC -AC 20 .4118
10. YIELD (gpm): 4s_a METHOD OF TEST
11. WATEPI ZONES (depth): a;T,
, Arnount Wadditlorml space le.(ate'.
12. CI-{LORINATICiN: Type needed use bhtk of •
13. CASING:
TION SKETCH z.:
Wall Thlokner4
Depth �lamote� 0 L MaI Al (Show direction and distanco from at least two $tate
FrCrn 0 To _ Ft, """'" Roads, or other map reference polnti)
From -- To Ft. —
From ----To Ft.
14. GROUT:6�AtiQe
Depth. IM ed I Method
From © To
From To ----Ft,
15. SCREEN: '
Depth Diameter Srot.Site !Material
From To Ft in. In.
From ....-- To Ft _.— In. ---
From _ To Ft, In.,--
16. SANDIGRAVEL PACK: v,/AY I
Depth Size N1aetitd
From ._.--- To Ft.
From Tn.. _ Ft.
17. REMARKS: I
Asheville D.2,ir�pa! 9.i
I DO HEREBY gERTIFY THAT THIS WELL WAS CONSTRUCTED I CCORD I
TANDARD.S; AND THAT A HIS REC HAS
CONSTRUCTIONS
i
V
CE WITH 1,cCAC 2C, WELL
E PROVIDED TO THE WELL:OWNER
2
PATE
slG4A1%jR9 OF HIM'8837SUoMk OdWIAW o o�ToATw0OQv*ky onnd copy tO w•u oww.
OGw-i REv, SrA

Fax: [phone].,
P. 0 1 /0 1
UST SECTION
• Division of WatOr &Iiiy - 6rounjwater tecilon
North Carolina 0epadirrient of Environment and Natural Resources
P,O. Box 29578 - RaJe�h,N.0 . -27F,25-057$:Ph0n8 J919) 733-3221 V F
I
RUCTION REC ORD DRILL,Iwa CONTRACTOR: WELL CONS R DR-&LER REGISTRAT-19N
R.UCTION PERMIT*:
STATE WELL CO
WELL USE
Recovery (
2. WELL LOCAT
(Roa(:1, 01,
3. OWNER.
A r) r) Q PCZ
ustrlaj rl Agricultursl ❑ MonitoringLJ
k Applicab'Is sox)t Reis'idential Municil5al rl Ind
Heat PumpWaterInjection El Other other'�I�t Use: ----------------
J- ho Mich of the location below)
n T V1U i�Unty-
county:
DEPTH DRLLING _L0(3
0 or'suo m ion and NO-) ro ion Description
r SO FrOM To
---------------
(Street or Routo
2ip, Code
ity oe Town
4( —CO
4. DATE DRILLS
5. TOTAL DEPT
6, CUTTINGS COLLECTED YESEJ
ELLq YES ❑ NO
7. DOES WELL REPLACE EX!STING W
STATIC; WATER LEVEL Below Top of C6$lng'. FT.
B. ------------ ----------
(U30 Above Top of Casing)r
------------
9, TOP OF CASING IS__L_ FT. Aboyelind Surface* -------------------
w land surfam Is Illegkt.un . loo s varl ance Is 135v�!
• Casing Terminallod At/Of D810
in accordance with 15 f 1) 'n olie
METHOD 05TEST
10. YIELD WPM):
11, WATER ZONES (depth):
It additional apace le.negded use back back bf 10.
-Amount
12, CHLO�INATICJN: Type
13. CASING: IC CpTION.PKETCH.
WWI Thickn94 (Show.*jdliedlon and distancO from at least ty4'Q
F .1
Depth Tit- ROad*s,orother n18Pr01er6106
To 12L
From
From --- � To
from. least IY40 06 points)
From _—To Ft,_
14. GROUT: Ms eethod
Dep
From To 2_0 Ft.
From To _---_,_Ft,
15 SCREEN: AAM.AA1
Depth Diameter Srot SiLe
in
From �TO_F'_
In .
From --TO Ft. � 1,
From --TO Ft. � In.
16. SANDIGRAVEL PACK: 12.7
Depth
From 70 - ).77
7Fromn.
REMARKS:
pp HEHL:0 Y CERTIFY FY THAT THIS WELL WAS CI
STANDAROLS; AND THAT A
DIIN COMAt4CIEWITH ISA NCAC2C ' WFELULIL
WOW/_�NER..
I ECAHAS B�EN PROVIDED TO THE -9- - 0_0__�,,-
()AT5
OR A09NT
SIC'"'ross 0F rONTRACTOA py tr) well ovow.
-.4; GW_I AEV, 1/98
suomft origirltu to olvwon Of water OU01ilyarld"
2 0 9 09

UST SECTION Fax:[phone] Jul 2 '99 9:50 P.01/01
North Carolina - D:parlment of Environment and Natural Resources - Division of Water•Quality- groundwater section
P,O. Box 29576 - Raleigh,N.C. 27626-0576;Phone {919) 733-3221
Q•6 61.E 2t v� 2 �-1-- t �u ni, I
WELL CONSTRUCTION RECORD DRILLING CONTRACTOR: ;
DRILLER RE01;STRA119N M.STATE WELL CONSTRUCTION PERMIT*'
1, WELL USE (Crock Applicable Box): Residential [ . Municipal ❑ Indu' trial ❑ Agricultural t� Monitoring
Recovery [] Heat Pump Water Injection ❑ Other ❑ It Other; list Use.
2. WELL LOCA L'hw sketch of the location below)62
Nearest Towne� County:
DEPTH DRILLING LOG
(Roa(:ICoTm' nD. - or Sub ' 1 and .ot No.)Prom TQ Formation Deacripilon
3. OWNER Q
ADDRESS
1 � (SlreA Or ataNS______-^ �� n
e L ce CF�J Zip �f,
Gay or "town '• � ��
4. DATE DRILLE � 52
5. TOTAL DEPTF NO
6, CUTTINGS COLLECT ED YES ❑ ,_ ds _ o .
7. DOES WELL R�PI_ACE EXISTING WELL? YES � NOP- CD _
B. STATIC WATER LEVEL Below Top o.' CaFT.sing: - c
(Uae "+•" If Above Top of Casing)
9. TOP OF CASING FT. Abovel.and Surface*
• Casing Terminaud avor oelow land surface is Iiiogel.unieas a variance Is Isaued J
in accordance with 15A N AC 20 .0118 n
10. YIELD tUV... P L_ METHOD OF TEST AJ� r
11, WATEP ZONES (depth): r-J
12. CHLORINATION: Type -•Amount Cz- ICadditlorlal space Is.needed uae btd>s!� of form ;
13. CASING: LQQATION SKETCH
Wall ThiokneLS
Depth,,. , / Diameter et huFL material (Show.:dltoctlon and distance from at least two State
From O ToC Ft �' Roads, or other map rofcr6nce pofnte)
From = To Fl.-
From To --.Ft,
14. GROUT:
Depth Mat lal- rVethod
From D — To F1,
From To Ft.
1S. SCREEN: !
D4ptn Dlameter Srot.Siie •Material
From To Ft
From To Ft. In, in.
Ft, .
From To int
SANDIGR.AVEL PACK: 1
Mate DepthSizeL-L
LL
From .._--- To Ft'
From To.. _ Ft.0}31T, REMARKS:.
I DO HERE5y CERTIFY THAT THISWELLHAT A GO CONSTRUCTED
0� HI REIN ACCC RD HAS REEK PROVIDED TO THE WErLEL 0�''�►�ER.`
CONSTRUCTION STANDARi�S,/�
DATE
SIGNnTuRE OF CONTRACTOR OR AGEP4T tr) well owrKv.
2 0 8 9 4 Suomn °riytnal to OHtslon of Water C?uaGty and copy Gw AEV, IM

03/20,12006 13:41 82136227241 CLEARWATER WELL PAGE 02
• r�SifK. C4ltf�t4 ��r 1t�.Pf1� ■11lr I��tnrM TMiOWRM ' f• � I��. ' V�OY��■w 9R�Y!'
IM Md IXwvle4 i5MW - R■1O^ N.C. 3701P1* &f tww (011) 7 t- 01
WELL CONSTRUCTION RECORD WELL eatl►mArmmiWELL CONTI OTM C11101PICATIM Or 2. �� 3
WFATE WaLI. 600OfR1101" I'NINOM
1. WELL UMI ch„k AW1i *W ": fl■W■eOM Munb"1 Q
IndiftW © 4da+ft g 13 AAo*wl +p El
A+eamy 0 "wd ftnw w"w IftJ■own p 0#w t3It Crw u■1 u":
2, tfrtq L LCaGATiOIM: twww w"Icm 010014410118 Ir414nO
N1t+r�4}4! Ti>rwt: CoM�hi;
ft" HWm r,d or !Ii a k1.t and W NO
�IA
..Fmn
TO
Addfa■4
r wnCmft"4
;. ikA� IJRILLEQ�.
i/ =70.ti CgAPJii+Jr' ----
'j. TOTAL QEPT"
6, C UMNQ3 CXCIuscTEI'l yes�] lM4
1. jicE$1lMITU FM KAC E A
tXIVIIVLi WC$.Rt i�
- -
••- — — _---
d. STATIC WATER LEVEL 004W TOO al00W4:
FT.fUvQ-
9. TOP OF MOMtS _ _„� � FT. •,• r IIYvr�I Tt�p et trwtrttll
FT. AiMM+■ LsNwt lturfac8'
— --- --
•Tap ar e"I" 1+ltnttmh fWAr bom m"O rarr+t+ rMrla++ v+tl+ttef In aasar.
dwWWw tUAHCAC4C
to''y1 .awm): �c161rYNt�tQ�Ol�il�Bt'I `
� ,--
K WATER 20HES "410Y,
it CKAMNATI - TFR! An"WO
66111 t d won Ir■++d uff bm* of 1011V
1l CAt3M:
mWakW
DM*vkW or
ice' dUae - rd dbUn* *M of IMI two btmW
Frtsn— ,-- - To �Z.r- Ft. —� -�
rrai t ar q0w mw f+how" f►a*4ttaj
To.,...,-....-. F!. — — _ __� � �..._
Frrtnt Tq,..,...r-- PC----
14. oiQt iT
I,) I u �
t
f)at % mwt■" M*Vwd
,"o- E pf
R'ram _ Tv _ Ft. ...
✓
Frain To —Ft.
is.�:
I�pyY Ehff11■t■r t�il■t Iltsi MIA*rg11
bran► —To_ Ft In. In.
�
Frain _^ To .,..,...,. Ft. —....,- k+. in. �...
�
Frain To KL hL b"
I& $AN MQRAVEt_ PACK;
b"Ih $It* M■I■d■I
From To
All
Ra
17.
i 00l Any c! vM" THAT I.M9 WKLL WAD CC71S7PA &LID IN ACCOMMMM WITH 14A NVAO 90, WFLL
cMWMtIp J0N aTANDARM, ANO T"AT A CO" Of7TN18 RECtSP WO 81194 PAWOP To THE Y FLIt Q►+1atE:a.
poll OflrlCE u lm RNLI►
00dwoc
efft w �r.
■iaw►"ut1+E art pumm xx+urwmmm TN■ wat wYr
au&M a *wd a t7 40Wor"dwOt R". Or+utdw w 4.+rrr wlrxn 30 doy9
anr.r FAV IV"
ed"' a) I
A4,41tr, yes Sam-lvdbd
RECEIVED
MAR 2 0 2005
Asheville Regional Office

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
229639
1636 Mail Service Center - Raleigh, N.C. 27699.1636-Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR:
D. Bowman Well Drilling, Inc.
WELL CONTRACTOR CERTIFICATION #:
STATE WELL CONSTRUCTION PERMIT#:
WELL USE (Check Applicable Box): Residential© Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
1.
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: Weaverville County: Buncombe
Old Homestead Trail
Name Numbers. Community, or Subdivision and Lot No.) DRILLING LUG DEPTH
(Road and
From To Forrnation Description
3. OWNER Margaret Jean--
Address 131 Murphy Hill Road
—(Street or Routs o.
WPaV rvi ] 1 A NC---2sr.-97�p
City or Town State
.e
DATE DRILLED 12/28 00 ._.
2'
4.
5. TOTALDEPTH 300 r Via'
6. CUTTINGS COLLECTED YES ❑ NO®
DOES WELL REPLACE EXISTING WELL? YES ❑ NO® .
c
7.
B. STATIC WATER LEVEL Below Top of Casing: �� FT•
a `�
(Use '+' II Above Top of Casing)
9. TOP OF CASING IS 1 .4 FT. Above Land Surface'
'Top of casing terminated at/or below land surface requires a variance In actor-
cn=
dance with 15A NCAC 2C.0118�
10. YIELD (gpm): 10 METHOD OF TEST ram} _ <-<•
n
11. WATER ZONES (depth): 2 ti D r
`"
12. CHLORINATION: Type tabl Pt Amount —41 -- If additional space is needed use back of form
13. CASING:
LOCATION SKETCH
Wall Thickness
Depth Diameter or Weight/Ft. Material (Show direction and distance from at least two State
r
0 13 0 Ft, 6 1 ,�Ch 8— Roads, or other map reference points)
From To
From To Ft. '—'---
From To Ft. ----
14. GROUT:
Depth Material Method
From -9---- To 20 —Ft• rnnr•ro+ o r< low
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
HAS BEEN PROVIDED TO THE WELL OWN t
CONSTRUCTION STANDARDS, AND THAT A QO ,OF THIS RECORD
ONLY DATE
FOR OFFICE SIGNATUR PERSON CONSTRUCTING THE WELL
:USE
Quad No:
i submit ginal to Division of Water Quality, Groundwater Section within 10 days GW 1 REV. 12/"
Serial No.

North Carolina • Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
229640
1636 Mail Service Center - Raleigh, N.C. 27699.1636-Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR: n Rnwman WR11 nri 1 1;_nrrr Tnc.
WELL CONTRACTOR CERTIFICATION rr: 2809
STATE WELL CONSTRUCTION PERMIT#:
WELL USE (Check Applicable BOX): Residential ff) Municipal ❑
Industrial ❑ Agricultural ❑ Monitoring ❑
1.
Recovery ❑ Heat Pump Water Injection ❑ Other ❑
If Other, List Use:
2.
WELL LOCATION: (Show sketch of the location below)
Nearest Town: Candler County: BULICnmha
Curtis Creek Road
(Road Name and Numbers, Community, or Subdivision and Lot No.)
DRILLING LOG DEPTH
3.
OWNER James F . Leonard
From To Formation Description
Address ur is cove Road
Candler tree outs o. 28715
City or Town State Zip Code
4.
DATE DRILLED 12126 100
5.
6.
TOTAL DEPTH J d 9 '
CUTTINGS COLLECTED YES ❑ NO
7.
DOES WELL REPLACE EXISTING WELL? Y& ❑ NOD
8.
STATIC WATER LEVEL Below Top of Casing: 2 0 FT.
(Use'+' a Above Top of Casing)
9.
TOP OF CASING IS j A - FT. Above Land Surface'
'Top of casing terminated at/or below land surface requires a variance In accor-
dance with 15A NCAC 2C .011E
OF TEST rotaryair
�
10.
YIELD (gpm): 75 METHOD
11.
WATER ZONES (depth):
rn
12.
CHLORINATION: Type t a b1 et Amount 6
If additional space is needed use back of form
13.
CASING:
LOCATION SKETCH fiV_
Wall Thickness
Depth Diameter or Weight/Ft. Material
(Show direction and distance from at least two State at
55 Ft. 6 1 8 Sch 80 )`jam_
Roads, or other map reference points)
From-2—To
From To Ft.
From To Ft.
14.
GROUT:
d
Depth Material Metho
From 0 To 20 Ft. cronr-rPt-P gra�: flow
From To Ft.
15. SCREEN:
Depth Diameter Slot Size Material
From To Ft in. in.
From To Ft. In. In.
From To Ft. In. In.
16. SAND/GRAVEL PACK:
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 THA'�,A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNE
I
{ _ r
FOR OFFICE USE ONLY, SIGNATURE F PERSON CONSTRUCTING THE WELL DATE
Quad No:
__ps., a Submit on anal to Division of Water Quality, Groundwater Section within 30 days GW t REV. 12/99
Serial No.� `')'- —

North Carolina - Department of Environment and Natural Resources - Division of Water Quality • Groundwater Section 2 2 9 R 4 1
1636 Mail Service Center - Raleigh, N.C. 27699-1636-Phone [phone]
WELL CONSTRUCTION RECORD WELLCONTRACTOR: D. Bowman well Drilling, Inc.
WELL CONTRACTOR CERTIFICATION #:
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE (Check Applicable Box): Residential [3 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: _f'l- County: Buncombe
14 Old Curtis Cove Road
(Road Name and Numbers. Community, or Subdivision and Lot No.) DRILLING LOG DEPTH
3. OWNER James E LeOnart9 From To Formation Description
Address 14 Old Curtis Cove Road
(Street or oute o.
Candler NC 28715
City or Town State Zip Code
Q
4.
DATE DRILLED 1 2/ 1 8/ 0 0
5.
TOTAL DEPTH 225' -.
�
c�
6.
CUTTINGS COLLECTED YES ❑ NO[}�
_ rn
<.
7.
DOES WELL REPLACE. EXISTING WELL? YES [� NO®
r`'
8.
STATIC WATER LEVEL Below Top of Casing: 20 FT.
_
(Use'+' u Above Top of Casing)
_ .
mm
9.
TOP OF CASING IS 1 A FT. Above Land Surface'
-Top of casing terminated at/or below land surface requires a variance In actor-
N
�
dance with 15A NCAC 2C.0118 rotary air
10. YIELD (gpm):1 2 -- ME H TEST
O
11.
ODrOF
WATER ZONES (depth):
12.
CHLORINATION: Type t a h l e -Amount _6
If additional space is needed use back of form
13.
CASING:
LOCATION SKETCH
Wall Thickness
Depth Diameter or Weight/R. Material
(Show direction and distance from at least two State
From 0 To 85 Ft. 6 1 .;Ch_$ 0 Pyr
Roads, or other map reference points)
From To Ft.
From To Ft
14. GROUT:
Depth Material Method
From 0 To 20 Ft. r•nnr•rpta rrraxi-t-yFlow
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 F THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
FOR OFFICE USE ONLY SIGNATURE PERSON CONSTRUCTING THE WELL DATE
Quad No:
Submit o ginal to Division of Water Ouality. Groundwater Section Within 30 days GW1 REV. 12/99
C' G �L
Senal No. I ( r

North Carolina - Department of Environment and Natural Resources - Division of Water Quality -Groundwater Section 229647.
1636 Mail Service Center - Raleigh, N.C. 27699-1636-Phone [phone]
WELL CONSTRUCTION RECORD WELLCONTRACTOR: D. Bowman Well Drilling, Inc.
WELL CONTRACTOR CERTIFICATION #: 2809
STATE WELL CONSTRUCTION PERMIT#:
_-
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: ASh.�r11 - County:Buncombe
Lynne Cove :Road
(Road Name and Numbers. Community, or Subdivision and Lot No.) DRILLING LOG
3. OWNER Charles Smith From To
Address 405 Windswept Drive #604
treet or Route o.
Ashyi 1 1 P NT(' �Qn4
City of Town State
ZipSZbode
4. DATE DRILLED 1 1/ 3 0/ 0 0
5. TOTAL DEPTH 22 0 0 '
6. CUTTINGS COLLECTED YES ❑ NO❑X
7. DOES WELL REPLACE EXISTING WELL? YES [] NO®
8. STATIC WATER LEVEL Below Top of Casing: _3.0_- FT.
(Use '+' U Above Top of Casing)
9. TOP OF CASING IS 1 4 FT. Above Land Surface*
'Top of casing terminated at/or below land surface requires a variance In accor-
dance with 16A NCAC 2C .01 8
10. YIELD(gpm): 6 METHOD 8OFTEST rotary air
11. WATER ZONES (depth):
12. CHLORINATION
13. CASING:
Type - a let Amount 6
0 Depth 4 3 0 8
From To Ft.
From To Ft.
From To Ft.
14. GROUT:
If additional space is needeu ubv ua,-n
DEPTH _
Formation Description
LOCATION SKETCH
Wall Thickness
SC11gh8 Material (Show direction and distance from at least two State
5 11 Roads, or other map reference points)
Depth Material Method
From 0 To 20 Ft. Concrete gravity flow
From To Ft. -
15. SCREEN:
Depth Diameter Slot Size Material
From To Ft In. In.
From To Ft. In. In.
From To Ft. In. In.
16. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft. -
17. REMARKS:
r� �
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY /OFF THIS RECORD
/HAS BEEN PROVIDED TO T='o
OWNER.
A.s i JA "Y "AT"1A'Yl.0iV- _ /10
FOR OFFICE USE Of
Quad No:
Senal No.
1 �
Submit ongihal
IATURE OF PERSON CONSTRUCTING THE WELL
Divislon of Water Quality. Groundwater Section within 30 days
DATE
GW1 REV. 12199

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section 2 2 9 ! 48
1636 Mail Service Center - Raleigh, N.C. 27699-1636-Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR: D. Bowman well Drilling, Inc.
WELL CONTRACTOR CERTIFICATION #: 2 R n A
STATE WELL CONSTRUCTION PERMIT#:
1.
WELL USE (check Applicable sox): Residential o Municipal ❑
Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑
If Other, List Use:
2.
WELL LOCATION: (Show sketch of the location below) Buncombe
Nearest Town: WAavAr•v;11i@ County:
536'-2 Blackberry Inn Road
(Road Name and Numbers, Community, or Subdivision and Lot No.)
DRILLING LOG DEPTH
3.
OWNER Bruce Lax
From To Formation Description
Address P.O. Box 594
(Street or Houle o.
City or Town State p Code
4.
DATE DRILLED 11 129LOO
5.
TOTAL DEPTH
A
6.
CUTTINGS COLLECTED YES ❑ NO®
7.
DOES WELL REPLACE EXISTING WELL? YES ❑ NO®
a' - 3
8.
STATIC WATER LEVEL Below Top of Casing: _4_�! FT.
�o C`—',
(Use'+' U Above Top of Casing)
lU c5<
9.
TOP OF CASING IS J_,4— FT. Above Land Surface'
___
?op of casing terminated at/or below land surface requires a variance In accor-
_
MIND- M.
dance
with 15A NCAC2C.0118
�T�r
10.
YIELD (gpm): 2 METHOD OF TEST .rata r a i r
11.
WATER ZONES (depth): 2 6 0 ' — 3 .0 '
IN --�-
N
.
a
12.
CHLORINATION: Type tab]e t . Amount --e---
A.
If additional space is needed use back of form
13.
CASING:
LOCATION SKETCH
Wall Thickness
Depth Diameter or Weight/Ft. Material
(Show direction and distance from at least two State
From n To — — Ft. —b--!- @ — eh n.Y—PVG
Roads, or other map reference points)
From To Ft.
From To Ft.
14. GROUT:
Depth
Material
Method
From _)_ To _2.g— Ft.
t --G
--f 1 ow
e 9 n e ra e e
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 HAS BEEN PROVIDED TO THE WELL OWNE
FOR OFFICE USE ONLY - - S,GNAT OF PERSON CONSTRUCTING THE WELL DATE
Quad No:
Subm onQ1hal,lo Division of Water Quality. Groundwater Section Within 30 days GWt REV. 12/99
Serial No. Al 2

WELL CONSTRUCTION RECORD WELL CONTRACTOR:
WELL CONTRACTOR CERTIFICATION #: 2809
STATE WELL CONSTRUCTION PERMIT#:
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]
D. Bowman Well Drilling, Inc.
229649
WELL USE (Check Applicable Box): Residential Municipal ❑
Industrial ❑ Agricultural ❑ Monitoring ❑
1.
Recovery ❑ Heat Pump Water Injection ❑ Other ❑
If Other, List Use:
2.
WELL LOCATION ($how sketch of the location below)
Fairview Buncombe
Nearest Town: County:
(Road Name and umbers, Community, or Subdivision and Lot No.)
DRILLING LOG DEPTH
3.
OWNER Joe Myers
From To Formation Description
Address 19 Hi k r F
Fairview (Street or&e o. 28730
City or Town State Zip Code
4.
DATE DRILLED 1 1/ 1 7/ 0 0
5.
TOTAL DEPTH 3434— 0'
6.
CUTTINGS COLLECTED YES ❑ NO❑X
7.
DOES WELL REPLACE. EXISTING WELL? YES [] NO©
-
8.
STATIC WATER LEVEL Below Top of Casing: _ R � FT.
(Use'+' p Above Top of Casing)
9.
TOP OF CASING IS 1 . 4 FT. Above Land surface'^
'Top of casing terminated at/or below land surface requires a variance to accor-
N
x�m
dance with 15A NCAC 2C .0118
W
10.
YIELD (gpm): 12 METHOD OF TEST - -rA rV a i r
11.
WATER ZONES (depth):
12.
CHLORINATION: Type tablet Amount
If additional space is needed use back of form
crni�
13.
CASING:
TCH
x
LOCATION SKE
Wall Thickness
Depth Diameter or Weight/Ft. Material (Show direction and distance from at least two State
m
From 0 To 20 Ft. 6 1 8 Sch 80 PVC Roads, or other map reference points)
From To Ft.
From To Ft.
14. GROUT:
Depth Material Method
From 0 To 20 Ft. conccrPtP care-,ri t-u f 1 ow
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 HAS BEEN PROVIDED TO THE WELL OWNER
i3
FOR OFFICE USE ONLY $IGNA OF PERSON CONSTRUCTING THE WELL 1°
Quad No: j
S6"1 original to Division of Water Quality. Groundwater Section within 30 days
Senal No.
TE
GW-1 REV. 12/99

North Carolina • Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section 229 6- 50
1636 Mail Service Center - Raleigh, N.C. 27699.1636-Phone [phone] [1
WELL CONSTRUCTION RECORD WELL CONTRACTOR: D. Bowman Well Drilling, Inc.
WELL CONTRACTOR CERTIFICATION #: 2809
STATE WELL CONSTRUCTION PERMIT#:
2
3
WELL USE (check Applicable Box): Residential ® Municipal ❑ Industrial ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
WELL LOCATION: (Show sketch of the location below)
Leicester
Nearest Town: County:
69 Old Newfound Road
(Road Name and Numbers. Community, or Subdivision and Lot No.)
OWNER Mark & Lynne T)nrGey
Address
treetQr_ tie o.
Leicester 1V 28748
City or Town State Zip Code
4. DATE DRILLED 11 /15 00
5. TOTAL DEPTH fi 0 r
6. CUTTINGS COLLECTED YES ❑ NO®
7. DOES WELL REPLACE EXISTING WELL? YES [3 NO®
8. STATIC WATER LEVEL Below Top of Casing: C0 FT.
(Use'+' 0 Above Top of Casing)
9. TOP OF CASING 1S 1 •4 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): 16 METHOD OF TEST rni-arrair
11. WATER ZONES (depth): 240'
Agricultural ❑ Monitoring ❑
Buncombe '
DRILLING LOG
From To
DEPTH
Formation Description
---c'r-
�rn
GJ oT
D t3
N
12. CriLORINATION: Type tablet Amount 6 If additional space is needed use back of form
13. CASING:
LOCATION SKETCH
Wall Thickness
Depth Diamet r or WeignUFt. Material
— (Show direction and distance from at least two State
From- To _ 96-- Ft. 6 178 Sch 80 PVC Roads, or other map reference points)
From To Ft.
From To Ft.
14. GROUT:
Depth
Material
Method
From 0
To 20
Ft.
concrete
gravity flow
From
To
Ft.
15. SCREEN:
Depth
Diameter Slot Size
Material
From
To
Ft
in.
In.
From
To
Ft.
In.
In..--�
From
To
Ft.
in.
In.
16. SAND/GRAVEL PACK:
Depth
Size
Material
From
To
Ft.
From
To
Ft.
-
17. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL O
WNE
FOR OFFICE USE ONLYff
Quad No:
- NATURE OF ERSON CONSTRUCTING THE WELL DATE
Submit original to Division of Water Quality, Groundwater Section Within 30 du
Serial No. ),'' +{
Mi
••1 REV. 12l99
itA

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: D Bowman well Drilling, .Iric.
WELL CONTRACTOR CERTIFICATION #: 2809
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: T r,i r•o&:Lor County:..BtlneeffiL-e --
Bear Creek Road
(Road Name and Numbers. Community, or Subdivision and Lot No.) DRILLING LOG DEPTH
3. OWNER Tony Henderson From To Formation Description
Address Bear Creek Road
(Street or Houle o.
Leicester NC 28748•
City or Town i 1 % 1 4 %SO 0 Zip C�
4. DATE DRILLED
5. TOTAL DEPTH = U
6. CUTTINGS COLLECTED YES ❑ NOD
7. DOES WELL REPLACE EXISTING WELL? YES ❑ NO®
8. STATIC WATER LEVEL Below Top of Casing: 4 0 FT.
(Use '+' if Above Top of Casing)
9. TOP OF CASING IS 1 • 4 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): —i 2 . METHOD OFTEST rotary air
1 1. WATER ZONES (depth): 210
Ile-
N o
12. CHLORINATION: Type tablet Amount 6 If additional space is needed use back of form
13. GASING:
LOCATION SKETCH
Wall Thickness
0 Depth 94 6 D r r %pi t. Mate zl (Show direction and distance from at least two State
From To Ft.
Seen gtS U Y V Roads, or other map reference points)
From To Ft.
From To Ft.
14. GROUT:
Depth Material Method
From ___0 To _.2 0 Ft.congr-a W l ty flow
From To Ft.
15. SCREEN:
Depth Diameter Slot Size matenai
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 RECXD HAS BEEN PROVIDED TO THE WELL OWNE
'OF PERSON CONSTRUCTING THE WELL
of Water Quality. Groundwater Section within 30 days
DATE
I1)
GW-1 REV. IV"
r

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section .' 2 8 7 9
1636 Mail Service Center - Raleigh, N.C. 27699.1636-Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR: D. Bowman well Drilling, Inc.
WELL CONTRACTOR CERTIFICATION #: 2809
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: Asheville County: Buncombe —_
122 Foster Estate Drive
(Road Name and Numbers. Community, or Subdivision and Lot No.) DRILLING LOG DEPTH
3. OWNER Ken Hi acri ns From To Formation Description
Address
Asheville "" or out*N . 28806
City or Town State Zip Code
4. DATE DRILLED 1 0/ 2 7 0 0
_
5. TOTAL DEPTH 8 0 r
6. CUTTINGS COLLECTED YES ❑ NO®
o
I--
c'
7. DOES WELL REPLACE EXISTING WELL? YES ❑ NO® Q
8. STATIC WATER LEVEL Below Top of Casing: Fr.
(Use '+• 0 Above Top of Casing) c 7
c rn
9. TOP OF CASING IS,1_ . 4 FT. Above Land Surface'
am
'Top of casing terminated at/or below land surface requires a variance In actor-
yo
dance with 15A NCAC 2C .0110
�p
10. YIELD (gpm): 2 METHOD OF TEST rot a r-.. _ ; r•
11. WATER ZONES (depth): 75 '
'
e.A
GZ=
c-)
-4
12. CHLORINATION: Type tablet Amount 6 If additional space is needed use back of form J
z
13. CASING:
Depth Diameter
From 0 To 30 Ft. 6 1
From To Ft.
From To Ft.
14. GROUT:
15
16
17
LOCATION SKETCH
wall Thickness
or WeighVFI. Material (Show direction and distance from at least two State
Sc:h 80 PVC Roads, or other map reference points)
Depth
Material
Method
From 0
To 2_Ft.
, r'nnr•rinte
gr � p..�,-i;Tzlow
From
To
Ft.
SCREEN:
Depth
Diameter Slot Size
Material
From
To
Ft
in.
in.
From
To
Ft.
In.
In. �—
From
To
Ft.
in.
In.
SAND/GRAVEL PACK:
Depth
Size
Material
From
To
Ft.
From
To
Ft.
REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C. WELL
CONSTRUCTION STANDAFIQS AND THA�fTl A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL C
FOR OFFICE USE,
Ouao No: P fSIGN.ATU E OF PERSON CONSTRUCTING THE WELL
t 9i`ip) Submit orig fa�4� Division of Water Quality. Groundwater Section Within 30 days
nal No. {� e
Su
,/'L,-�IdD
TE
GW1 REV. lZM

Nonh Carolina - Department of Environment and Natural Resources - Division of Water Quality • Groundwater Section
1636 Mail Service Center - Raleigh, N.C. 27699-1636-Phone [phone]
D. Bowman Well Drilling, Inc.
WELL CONSTRUCTION RECORD WELL CONTRACTOR:
WELL CONTRACTOR CERTIFICATION #: 2809
STATE WELL CONSTRUCTION PERMIT#:
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: AchcYl 1 1 P County; Riinr nmhe
00 Sarr-li G Teri vP
(Road Name and Numbers, Community, or Subdivision and Lot No.)
3. OWNER Margaret H. Frizzell
Address 200 Sardis Dr'
trees or HOUIO o.
Asheville NC 28806
City or Town State Zip Code
4. DATE DRILLED 1 O
/26/00
Agricultural ❑ Monitoring ❑
DRILLING LOG DEPTH
From To Fomnation Description
5. TOTAL DEPTH
6. CUTTINGS COLLECTED YES ❑ NO®
7. DOES WELL REPLACE EXISTING WELL? YES ❑ NO❑X o �'
8. STATIC WATER LEVEL Below Top of Casing: 6 0 FT.
(Use '+• II Above Top of Casing) i
9. TOP OF CASING IS 1 • 4 FT. Above Land Surface* N o�
'Top of casing terminated at/or below land surface requires a variance In accor-
dance with 15A NCAC 2C .011E
10. YIELD (gpm): 12 METHOD OF TEST rotary air 3_o
11. WATER ZONES (depth): 180'
12. CHLORINATION: Type—+-a)al®t Amount g If additional space is needed use back of form
13. CASING:
Wall Thickness LOCATION SKETCH
Depth Diameter or Weight/Ft. Material (Show direction and distance from at least two State
From 0 To _$-5 Ft. 6 1 / R �S (-.h R t1 PNI_C__ Roads, or other map reference points)
From To FI.
From To Ft.
14, GROUT:
Depth Material Method
From 0 To 20_Ft.-nnr+rcai-o g"3,z�--low
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 HAS BEEN PROVIDED TO THE WELL OWNER
R OFFICE USE ONLY
FOR
No: �+ 4 .. � `„ i j i Y SIGNATURE F PERSON CONSTRUCTING THE WELL DATE
QuadSubmit On in`al to Division of Water Quality. Groundwater Section within 30 days
-- U '�) No. GW-
Se1 REV. 12/99
mi L li '4
rI tl 1 9?v

North Carolina - Department of Environment and Natural Resources - Division of Water Quality • Groundwater Section 41-
1636 Mail Service Center - Raleigh, N.C. 27699-1636-Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR: D _ Rnw_man_ WP1 Dri 1 1 i ngr Tnc,
WELL CONTRACTOR CERTIFICATION #: 2 8 0 9
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE (check Applicable Box): Residential ® Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring
❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ It Other, List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: Leicester County; B1111COMbe
Old Newfound Road
(Road Name and NN mbers, Community, or Subdivision and Lot No.) DRILLING LOG DEPTH
3. OWNER Bobby & Tami Nelon From To Formation Description
Address P.O. Box 1357
beet or Houle o.
Cii-y or`T&n- tale Zip code
4. DATE DRILLED 1 0/ 2 4/ 0 0
5. TOTAL DEPTH 160
o
6. CUTTINGS COLLECTED YES ❑ NO®
'
p
7. DOES WELL REPLACE EXISTING WELL? YES El NNO[Z]o
r
30
8. STATIC WATER LEVEL Below Top of Casing: 3 0 FT.
OC_-
(Use '+' if Above Top of Casing)
"
m
9. TOP OF CASING IS 1 .4 FT. Above Land Surface*
Q
'Top of casing terminated at/or below land surface requires a variance In sccor-
�fl
dance with 15A NCAC 2C.0110
a
1;0F,
10. YIELD (gpm): 1 00+ METHOD OF TEST rnta—ry a
11. WATER ZONES (depth): 5 0 r
m z
12 CHLORINATION: Type tablet Amount h It additional space is needed use back of form
Z
13. CASING:
Depth Diameter
From 0 To 70 Ft. 6 1 8
From To Ft.
From To Ft.
14. GROUT:
Wall Thickness LOCATION SKETCH
or WeighVFI. Material (Show direction and distance from at least two State
Sch 80 PVC Roads, or other map reference points)
op
0 Dep O Concrete gravity floc
From To Ft.
From To Ft.
15. SCREEN:
16
17
Depth Diameter Slot Size Material
From To Ft in. in.
From To Ft. In. In.
From To Ft. In. In.
SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
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 CC
FOR OFFICE USE
Quad No:
Serial No.
S77
'b-F PERSON CONSTRUCTING THE WELL DATE
of Water Quality, Groundwater Section within 30 days
GW1 REV. 12t"

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section ) 7
1636 Mail Service Center - Raleigh, N.C. 27699-1636-Phone [phone] r �'�
WELL CONSTRUCTION RECORD WELLCONTRACTOR: D. Bowman Well Drilling, Inc.
WELL CONTRACTOR CERTIFICATION #: 73,011
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE (Check Applicable Box): Residential0 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: Fairview county: Buncombe
4 Crystal June Lane
(Road Name and Numbers. Community, or Subdivision and Lot No.) DRILLING LOG DEPTH
3. OWNER John Rice From To FomnationDescription
Address 4 Crystal June Lane
'Street or Houle o.
City or Town State Coda
4. DATE DRILLED 1 0/ 1 9/ 0 0
_
5. TOTAL DEPTH - R 0 '
6. CUTTINGS COLLECTED YES ❑ NOE]
-- _
7. DOES WELL REPLACE EXISTING WELL? YES ❑ NO®
'=
8. STATIC WATER LEVEL Below Top of Casing: 80 FT.
_ r,
(Use'+' 0 Above Top of Casing)
N
rT1 0 �
9. TOP OF CASING IS 1 4 FT. Above Land Surface*
'Top of casing terminated at/or below land surface requires a variance In actor-
r
Co 'm
dance with 15A NCAC 2C .0118
10. YIELD m : 1 METHOD�OFTEST rotary air
Q
11. WATER ZONES (depth). 380
12. CHLORINATION: Type tahl et Amount --
13. CASING:
Wall Thickness
Depth Diameter or Weight/Ft.
From 0 To 45 Ft. -6 1 a %"h R n
From To Ft.
From To Ft.
14. GROUT:
rn;v
If additional space is needed use back of form
LOCATION SKETCH
Material (Show direction and distance from at least two State
PVC' Roads, or other map reference points)
Depth Material Method
From 0 To 20 Ft. r-nnc rete nr=�— low
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 HAS BEEN PROVIDED TO THE WELL OWNER.
FOR OFFICE Uf N1 ' fl flit
Quad No: wt' t� ....°I i ` SIGNATU OF PERSON CONSTRUCTING THE WELL ATE
+Submi rigi4nal to Division of Water Quality. Groundwater Section Within 30 days
GW1 REV. 12/99
�:rr�tlyd�;rait � S�c�:s;

Nonh Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section < <✓
1636 Mail Service Center • Raleigh, N.C. 27699.1636-Phone (919) 733.=1
WELL CONSTRUCTION RECORD WELL CONTRACTOR: D. Bowman well Drilling, Inc.
WELL CONTRACTOR CERTIFICATION f/: 2809
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE (Check Applicable sox): Residential® Municipal ❑ Industrial ❑ Agricultural El Monitoring
❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: Fairview County: Buncombe
Cedar Mountain Road
(Road Name and Numbers, Community, or Subdivision and Lot No.) DRILLING LOG DEPTH
3. OWNER r,rPg P i 1 i pig- 1 i _ From To Formation Description
Address 423 Bob Barnwell Road
treet or Houle o.
Asheville NC 28803
City or Town State Zip Code
4. DATE DRILLED -1 0/ 1 1/ 0 0
5. TOTAL DEPTH 5 Ap '
0
6. CUTTINGS COLLECTED YES ❑ NO[Z]
o
7. DOES WELL REPLACE EXISTING WELL? YES ❑ NOF7
8. STATIC WATER LEVEL Below Top of Casing: 60 FT.
o
(Use '+' g Above Top of Casing) N
ice:
9. TOP OF CASING IS I , A FT. Above Land Surface* co
�o
'Top of casing terminated at/or below land surface requires a variance In actor- y,,
r,-r�
dance with 15A NCAC 2C.0118 -Em
-
10. YIELD (gpm): 1�1 METHOD PF TEST reta�-y air---
0
11. WATER ZONES (depth):
C'
_J
o
12. CHLORINATION: Type tablet Amount F It additional space is needed use back of form
13. CASING:
LOCATION SKETCH
Wall Thickness
Depth Diametgr or Weight/Ft. Material (Show direction and distance from at least two State
From 0 To 66 Ft 6 1 / 8 Sch 80 PVC Roads, or other map reference points)
From To Ft.
From To Ft.
14. GROUT: y�
Depth Material Method o
From 0 To 20 Ft, concrete gravity flow
From To Ft. In
15. SCREEN: .J
Depth Diameter Slot Size Material -F
From To Ft in. in.
From To Ft. In. In. �—
From To Ft. In. In. i
16. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
17. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNERWDAE1
FOR OFFICE USE N"LY , (� ' lOuad
OF PERSON CONSTRUCTING THE WELL
No:, LS`_SIG"T-U
Sutxr *Wri' i 4ll io;0ivislon of Water Ouality, Groundwater Section within 30 days
Ji
Senal No. i � r GWt REV. 12t"

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.`" �-
D. Bpwman Well Drilling, Inc.
WELL CONSTRUCTION RECORD WELL CONTRACTOR: 2809
WELL CONTRACTOR CERTIFICATION #:
STATE WELL CONSTRUCTION PERMIT#:
t . WELL USE (check Applicable Box): Residendat [3 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: Black Mountain County:
Lot #11 Rock Creek
Buncombe
(Road Name and Numbers. Community, or Subdivision and Lot No.)
3. OWNER Vann Harrell
Address
Franklinton t rai �rNC 27525
City or Town State Zip Code
4. DATE DRILLED 9/27/00 ­
5. TOTAL DEPTH 5��'
6. CUTTINGS COLLECTED YES ❑ NO®
7. DOES WELL REPLACE EXISTING WELL? YES ❑ NOF]
8. STATIC WATER LEVEL Below Top of Casing: or, FT.
(use '+' if Above Top of Casino)
9. TOP OF CASING IS 1 ' 4 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): 6-- METHOD OF TEST rp:i;ar-y—a}r-
11. WATER ZONES (depth): -460'
An'
1). CHLORINATION: Type Pahl et- Amount ti
13, CASING:
Wall Thickness
Depth
Diameter or Weight/Ft.Material
0
47
Ft.
6 1 8 Sch 80 PVC
From
To
From
To
Ft.
-
From
To
Ft
14. GROUT:
Depth
Material Method
From
To 20
Ft.
concrete Gravity flow
From
To
Ft.
-
15. SCREEN:
Depth
Diameter Slot Size Material
From
To Ft
In. in.
From
To Ft.
In. In. ^----__
From
To Ft.
in. in.
16. SAND/GRAVEL PACK:
Depth
Size Material
From
— To
Ft.
From
— To
Ft.
17. REMARKS:
DRILLING LOG DEPTH
From To Formation Description
-,
Ction
If additional space is need1;cTD e-bal k of form
LOCATION SKETCH
(Show direction and distance from at least two State
Roads
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 1 SA 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:
Senal No. -
SIGNATURE F PERSON CONSTRUCTING THE WELL
Submit riginal to Division of Water Quality, Groundwater Section Within 30 days
DATE
GWI REV. 12/99

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section ' 9209
1636 Mail Service Center - Raleigh, N.C. 27699-1636-Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR: D. Bowman Well Drilling, Inc.
WELL CONTRACTOR CERTIFICATION #: 2809
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: Mark Mn„ni i n County: Buncombe
Rear Trteg
(Road Name and Numbers, Community, or Subdivision and Lot No.)
3. OWNER Shane & Melissa Colbath
Address 43 A Ouinn Dri
(Street or Houle o.
Leicester NC _ 2R742
City or Town State Zip Code
4. DATE DRILLED 9/26/00
5. TOTAL DEPTH 320—
6. CUTTINGS COLLECTED YES ❑ NO❑X
7. DOES WELL REPLACE EXISTING WELL? YES F__] NOQ
8. STATIC WATER LEVEL Below Top of Casing: _ go FT.
9. TOP OF CASING IS 1 •4
(Use '+' it Above Top of Casing)
FT. Above Land Surface
'Top of casing terminated atlor below land surface requires a variance In accor-
dance with 15A NCAC 25 .0118
10. YIELD (gpm): METHOD OF TEST rotary air
11. WATER ZONES (depth): 220
310
12. CHLORINATION: Type tablet Amoun�
13. CASING:
Depth is e
From 0 To 46 Ft.
From T^ Pt
From —
14. GROUT:
From 0
From
15. SCREEN:
From
From
From
17
SAND/G RA
From
From
REMARKS:
Wall Thickness
or Weight/Ft. Material
Sri- 20. —�V�-
Agricultural ❑ Monitoring ❑
DRILLING LOG DEPTH
From To Formation Description
J
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. r
FOR OFFICE USE ONLY
Quad No:
SIGNATURE PERSON CONSTRUCTING THE WELL DATE
Submit original to Division of Water Quality, Groundwater Section within 30 days
GWi REV. 12/99
Serial No.

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mail Service Center - Raleigh, N.C. 27699-1636-Phone [phone] .�.
WELL CONSTRUCTION RECORD WELL CONTRACTOR: D. Bowman Well Drilling, Inc.
WELL CONTRACTOR CERTIFICATION #: 2809
STATE WELL CONSTRUCTION PERMIT#:
WELL USE (Check Applicable Box): Residential ED Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: Alexander County:
668 Old NC 20
(Road Name arid Numbe lC unity, or Subdivision and Lot No.)
3. OWNER Bean Jt
Address
treat or oute o,
AlaxandL=r Nc a$701
City or Town State Zip Code
4. DATE DRILLED 9/25/00
5. TOTAL DEPTH 100'
6. CUTTINGS COLLECTED YES ❑ NO❑X
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 1 A 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): 35 METHOD OF TEST rnt� air
11. WATER ZONES (depth): 80'
12. CHLORINATION
13. CASING:
DRILLING LOG DEPTH
From To Formation Description
C_—)
Type tablet Amount 6 If additional space is needed use back of form
Wall Thickness
Depth
Diameter or Weight/Ft. Material
0
65
Ft. 6 1 Sch 80 PVC
From
To
From
To
Ft.
From
To
Ft.
14. GROUT:
Dept
�0
Mate al �etho
Vlow,
From 0
To
Ft. concrete gravity
From
To
Ft.
15. SCREEN:
Depth
Diameter Slot Size Material
From
To
Ft in. in.
From
To
Ft. in. in.
Fo m
To
Ft in. in.
r
16. SAND/GRAVEL PACK:
Depth Size
From To Ft.
From To Ft.
17. REMARKS:
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 THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
9 .
FOR OFFICE USE ONLY
Quad No: SIGNAT�PERSONSTRUCTING THE WELL DATE
Submit original to Division of Water Quality, Groundwater Section within 30 days
GW1 REV. 12/99
Serial No.

ural Resources - Division of Water Quality - Groundwater Section
Nonh Carolina -Department of Environment and Nat
1636 Mail Service Center - Raleigh, N.C. 27699-1636-Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR:
D. Bowman Well Drilling, Inc.
WELL CONTRACTOR CERTIFICATION #: 2809
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE (Check Applicable eox): 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: Cap-g �r County: Buncombe
�,a
Warren Creek Road
(Road Name and Numbers, Community, or Subdivision and Lot No.)
3. OWNER Larry Warren
Address Warren Creek Road
(Street or Route No.
C'andI Par iyc' 2871a�
City or Town State Zrp Code
4. DATE DRILLED 9/21 /00
5. TOTAL DEPTH 100
6. CUTTINGS COLLECTED YES ❑ NO❑X
7. DOES WELL REPLACE EXISTING WELL? YES [] NO©
8. STATIC WATER LEVEL Below Top of Casing: 1Q_ FT.
(Use '+' if Above Top of Casing)
9. TOP OF CASING IS 1 •4 FT. Above Land Surface
'Top of casing terminated atlor below land surface requires a variance In accor-
dance with 15A NCAC 2C .0118
10. YIELD (gpm): 75 METHOD OF TEST rotary air
11. WATER ZONES (depth): 70
r
100
12. CHLORINATION: Type
tablet Amount 6
13. CASING:
Wall Thickness
0
Depth 37
Sor cvhe1t0 t Material
VC
From
To
Ft.6�i�rr,eter
From
To
Ft.
From
To
Ft.
14. GROUT:
Depth
Material Method
From 0
To 20
Ft concrete arayity flow
From
To
Ft.
15. SCREEN:
Depth
Diameter Slot Size Material
From
To
Ft in. in.
From
To
Ft. in. in.
From
To
Ft. in. in.
16. SAND/GRAVEL PACK:
Depth
Size Material
From
To
Ft.
From
To
Ft.
17. REMARKS:
DRILLING LOG
From To
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)
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 OW'NE
FOR OFFICE USE ONLY
Quad No:
Serial No.
SIGNATURE OPPERSON CONSTRUCTING THE WELL
Submit original to Division of Water Quality, Groundwater Section within 30 days
DATE
GW.1 REV. 12/99
4 nMl=r

,jonh Carolina • Department of Environment and Natural Resources • Division of Water Ouatity • Groundwater Section 9 l_ 919
636 Mail Service Center • Raleigh, N.C. 27699.1e3e Phone [phone]
WELL CONSTRUCTION RECORD WELLCONTRACTOR: D. Bowman well Drillina,znc.
WELL CONTRACTOR CERTIFICATION 0:pg
STATE WELL CONSTRUCTION PERMIT1t:
WELL USE (Check Applicable BOX): Residential M 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:
33 Ox rpak Rnar3
(Road Name and Numbers. Community. or Subdivision and lot No.) DRILLING LOG
From To
3. OWNER
Address 33 Ox Creek Road
Istr"t cw Routs No.)
Weaverville NC 28787 _-
City w Town State lap Code
a. DATE DRILLED R /T3 / Q 0
5. TOTAL DEPTH
3. CUTTINGS COLLECTED YES ❑ NO
7. DOES WELL REPLACE EXISTING WELL? S ❑ NOM
s. STATIC WATER LEVEL Below Top of Casing: _9 FT.
(Uw'♦' if Above Top of Casing) f
9. TOP OF CASING IS 1 ,.4 FT. Above Land Surface'
-Top of casing terminated at/or below land surface requires a varisnoe In actor'
dancewithISANCiAC2Ci.01II rotary air
10. YIELD (gpm): 4 __ METHOD OF TEST
11. WATER ZONES (depth): '
DEPTH
Formation Description
1-0
1.. CHLORINATION: Type t ^ h i o: Amount { — If additional space is needed ;e7b&ck of form
13. CASING:
Depth Diameter
From 0._---To ---G A Ft, 6 3 12•"
LOCATION SKETCH__
Wall ThiCkneu
or Wsighl/Ft. Material (Show direction and distance from at least two State
94@4---r-dG Roads, or other map reference points)
From -
To
Ft.----
From
• To-----
FL--
--'--
14. GROUT:
Material
Method
0
To 220
at concrete- gLav; k_ f low
From --
From ..__---
To __Ft.
15. SCREEN:
Depth
Diameter Slot Size
Material
From __To.__-_-
Ft . In. ---
in.
From
— To .._—
FL ._._._- In:
In. r------
From
To —
FL. 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 ISA NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPYOFTHIS RECORD HAS BEEN PROVIDED TO THE WELL OW �R-
FOR OFFICE USE ONLY
Quad No: Submit
Serial No.
GNATURE PERSON CONSTRUCTING THE WELL
10 Division of Water Quality. Groundwater Section within 30 days
DATE
OW-1 REV. 12M

vorlh Carolina - Department of Environment and Natural Resources - Division of Water Quality • Groundwater Section ; 2 9 7 0 0
1636 Mail Service Center • Raleigh, N.C. 27699-1636-Phone [phone] D . Bowman Well Drilling, Inc.
WELL CONSTRUCTION RECORD LL CONTRACTOR:
WELL CONTRACTOR CERTIFICATION #: 2809
STATE WELL CONSTRUCTION PERMIT#:
Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
WELL USE (Check Applicable Box): Realdential
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ It Other, List Use:
?. WELL LOCATION:ndlerketch of the location below�n�uncombe
Nearest Town:
1 n n n,- DRILLING LOG DEPTH
me
(Road Naand Numbers. ty, or vlaian and Lot No.) Fortnatlon Description
,3. OWNER Lee Greenleaf From To
Address 4-11
Candler 2871 5
City or Town Slate Code
Cc -
4. DATE DRILLED $ 2 2 0 0
5. TOTAL DEPTH 2 = 02_
5. CUTTINGS COLLECTED YES ❑ NO a
7. DOES WELL REPLACE EXISTING WELL? YES ❑ NOD
® CD
s. STATIC WATER LEVEL Below Top of Casing: FT.
(Uee'.' M Above Top of Casing)
9. TOP OF CASING IS 1 .4 FT. Above Land Surface'
-Top of casing terminated at/ r below land surface requires a variance In aces• , •`' + ,,,..,.. _ s
i
dance with 1$A NCAC 2C511a �—,' r i
10. YIELD (ppm): 2METHOD OF TEST o arY �' r 11. WATER ZONES (depth): 1 5 0'c�
tablet
12. CHLORINATION: Type Amount 6 If additional space is needed use back of form son
_
13. CASING:
Dept tar
From � ----To - 5 Ft6------
From- To------ Ft.
From ___.__.:To---- FL
14 GROUT'
LOCATION SKI
Wall Thickness
PVCai (Show direction and distance from at least two rate
S°`criw°�t,
Roads, or other map reference points)
Depth Material Method
From p____ To ,,,,2g_._Ft. concrete gravity flow
From ._._ To — Ft.
15. SCREEN:
Depth Diameter Slot Size Material
From To Ft __ in. in.
From — To . _.__ Ft. In. In. --- —'
From To Ft..__ In. In. -
16. SAND/GRAVEL PACK: Material
Depth Size
F
OQ7
1 Le
c o�—
j,,+A
From to —
From — To Ft.
17, REMARKS:
I DO HEREBYSTANDARDS. HIS
THAT COPY O THIS RECORD HAS BEEWELL WAS CONSTRUCTED IN N PROVIDED CONSTRUCTION
TO THE WELL OWNER.
S7AUCCTION
LSanal
OFFICE USE ONLY
No:
No. -
Submit
&NATURE OF IfERSON CONSTRUCTING THE WELL
DATE
to Divisiort Of Water Quality, Groundwater Seclion within 30 days GW1 REV. 12"

Jonh Carolina • Department of Environment and Natural Resources • Division of Water Quality - Groundwater Section 9201
1636 Mail Service Center • Raleigh, N.C. 27690.1636-Phone (919) 733-='
WELL CONSTRUCTION RECORD WELL CONTRACTOR: D. Bowman Well Drilling.._ Inc.2809
WELL CONTRACTOR CERTIFICATION N:
STATE WELL CONSTRUCTION PERli
t . WELL USE (Check Applicable Box): Realdential 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: Swannanoa ..County:
203 Harrion Hill Road DEPTH
Subdivision and lot No.) DRILLING LOG
(Road Name and Nurtrbars. CorrYrauvry. From To FonnaGon Description
3. OWNER Terrell 7c)nes --
Address 203 Harrison Hill Road
Swannanoa NC 28778
LP Cod.
City a Town Scab --
4. DATE DRILLED 8---T�
5. TOTAL DEPTH 240 —
5. CUTTINGS COLLECTED YES ❑ NO® --i r
7. DOES WELL REPLACE EXISTING WELL? YES ❑ NO[D
S. STATIC WATER LEVEL Below Top of Casing: g _ FT.
(U" •+' M Above Top,of Casing) �'
9. TOP OF CASING IS 1 . 4 FT. Above Lend Surface'
'Top of casing terminated atlor below IwW Surface requlna a variance In aeoa-
dance with 16A NCAC 2C1.01is
10. YIELD (gpm): 1 -5 METHOD OF TEST .i:^tar" a' r ti %A c?i
1 1. WATER ZONES (depth): 1 0 0 '
180'
12 CHLORINATION: Typ�ablet_ Amount If additional space is needed use back of loan
13. CASING: LOCATION SKETCH
Wall Thickness
or WeighuFt. Malar
Depth piameter ial (Show direction and distance from at least two State
From 0 To 66 Ft. 61 8 Sch 80 _PVC _- Roads, or other map tolerance points)
From - To FL ------
From 'To— Ft.—
14. GROUT:
Depth Material Method
From 0 To .20— Ft. .l' ^,,. r=tom �;"- —� 1 ow
From ._.._— To „_„__ Ft. - — A15. 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: Material
Depth Size
From To — Ft.
From To Ft.
17. REMARKS:
100 HEREBY CERTIFY�ARDS,HIS WELLANG THATNAS CONSTRUCTED IN A COPY OF THIS RECORD HAS BEEN EPROVIDED TO THE WELL OWNER.
CONSTRUCTIONS Q b D
FOR OFFICE USE ONLYSIGNA1ATE
RE OF PE N CONSTRUCTING THE WELL
Quad No: Submit original to Division Of Water Quality Groundwater Section within 30 days
OW-1 REV. 12f99
Serial NO. -

Vonh Carolina - Department of Environment and Natural Resources - Division of Water Oualiry - Groundwater Section `-; n
1636 Mail Service Center - Raleigh, N.C. 27699.1636-Phone (919) 7W-3221 l ,
D. Bowman Well Drillin Inc.
WELL CONSTRUCTION RECORD WELLCONTRACTOR: 809
WELL CONTRACTOR CERTIFICATION 0:
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE (Check Applicable tsox): Residential Municipal ❑If Other, i Industrial
nerusri l F Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ O ❑
2. WELL LOCATION: (Show sketch of the location below) Buncombe— -
NearestTown: T' L.iJrr9pn - County'
159 Ball Gap Road DEPTH
or Subdivision and Lot No.) DRILLING LOG
(Road Name and Numbit Comrrrx,ity, Formation Description
3. OWNER Joe Malaskv From To
Address 59 Ball Gap Road
(Streetor a o. -
A
- ,
City or Town Stab zip Code
s. DATE DRILLED 8/1.r 5 / 0 0
5. TOTAL DEPTH 3 0 0 `' r
3. CUTTINGS COLLECTED YES ❑ NO® —
7. DOES WELL REPLACE EXISTING WELL? YES L] NO[
3. STATIC WATER LEVEL Below Top of Casing: 4-0- FT• - 1
(Use'.' ff Above Top of Casing)
9. TOP OF CASING IS—L. _4 FT. Above Land Surface' ,- -, _
'Top of casing terminated eVor below I" Surface requtreS a vartence Ir Sew- _
dance with 16A NCAC 2C .0115
10. YIELD (gpm): 25 METHOD OF TEST -a
As ndwa ,
11. WATER ZONES (depth): 2 4 0 - 19naF n R
12. CHLORINATION: Type tablet Amount -i If additional space is nee •back of form
13. CASING:
Wall Thickness
Depth Diameter or WeghVFt.
o 66 Ft.61 /8 _Sch 80
From T o
LOCATION SK H
AAatetial (Show direction and distance from at least two State
PY_C._-- Roads, or other map reference points)
From -
— To--
Ft.,
From --_._-_To
-------
FL-----
----
----_'
14. GROUT:
Depth
Material
Method
From
0 To .�20—Ft.
concrete gray-il_- flow
From _
_._ To ___._
Ft.
--
15. SCREEN:
Depth Diameter Slot Size
Material
From __.__
To ._ __— Ft
_----
in. ----
in. __--
From
— To —._ Ft.
___._
. In.
In..------
From _
_ To ---- FL
----
In.
in. -
16. SAND/GRAVEL PACK:
Depth
Size
Material
From
To —Ft.
To
Ft.
From
17. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELLCONSTRUCTION STANDARDS. AND TTHATVA COPY AS NOF THIS RECORD HAS BEEN STRUCTED IN EPROVIDED TO THE WELL OWNER.
CONSTSTR_1� d/$/ov _
FOR OFFICE USE ONLY SIGNATURE Op ERSON CONSTRUCTING THE WELL DATE
ouad No: Submit original to Division of Wait' Ouaiity. Groundwater Section within 30 days
GWt REV. 12!99
Sena) No.

North Carolina Department of Environment and Natural Resources • Division of Water Quality • Groundwater Section `_ C) /� Q
1636 Mail Service Center • Raleigh, N.C. 27699-1636-Phone [phone] J �S `.
D. Bowman Well Drilling, Inc.
WELL CONSTRUCTION RECORD WELL CONTRACTOR CERTIFICATION ft:
STATE WELL CONSTRUCTION PERMITO:
1. WELL USE (Check Applicable sox): Residenbal® 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: Asheville County: Buncombe
Old Leicester Hwy. DEPTH
(Road Name and Numbers. Convnunity, or Subdivision and Lot No.) DRILLING LOG
From To Formation Description
3. OWNER Louise Reel
Address 1168 Old Leicester Road
Ashe it °e °ute o. C 28806
City or Town State Zap Code
4. DATE DRILLED 20 00
5. TOTAL DEPTH ti 0
6. CUTTINGS COLLECTED YES ❑ NOD
7. DOES WELL REPLACE EXISTING WELL? YES [] NOo c_
8. STATIC WATER LEVEL Below Top of Casing: 90 ' FT•
(Use '+' 9 Above Top of Casing) -
FT. Ab7.
ove Land Surface' I `-
9. TOP OF CASING IS 1 _ 4
'Top of casing terminated aVor below land surface requires a variance In actor-
dance with 15A NCAC 2C.011E r
10. YIELD (gpm): 30_.__ METHOD OF TEST Eatarry atr-
35n' :i
11. WATER ZONES (depth):
CO
12, CHLORINATION: Type tablet- Amount — If additional space is needed use back of form
o
13. CASING: LOCATION SKETCH
Wall Thickness
Depth Diameter or Weight/Ft. Material (Show direction and distance from at least two State
From O —To -4-;.5- Ft. -6--1 f a g-cft-$$ PVC--- Roads, or other map reference points)
From To Ft. —
From To Ft. -'
14. GROUT:
Depth
Material Method
From 0 Top 20—Ft• concrete gX.&yj-v flow bI�Q A.P)�C%�8r
From To _____--Ft.
15. SCREEN: `4
Material (.�
Depth Diameter Slot Size
c
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 7 /�
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RETHE WELL OWNER HA BEEN PROVIDED TO 7.
-------------
FOR OFFICE USE TURE PERSON CONSTRUCTING THE WELL DATE
Ouad No:
gi ivltl°n of Water Quality, Groundwater Section Within 30 days GW t REV. 12/99
Sena] No. p

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section of y A�!
1636 Mail Service Center - Raleigh, N.C. 27699-1636-Phone [phone] i-, .1. 5.
WELL CONSTRUCTION RECORD WELL CONTRACTOR: n Bowman Well nr_ i 1 1 i ng Tnc .
WELL CONTRACTOR CERTIFICATION #: 2809
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE (check Applicable Box): Residential D Municipal ❑ Industrial ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: Candler County: Buncombe
Milksick Cove
(Road Name and Numbers, Community, or Subdivision and Lot No.)
3. OWNER Clay Plemmons
Address
Cand ertor Wd Dula ane
28715
City or Town State Zip Code
4. DATE DRILLED 6/ 2 6/ 0 0
5. TOTAL DEPTH 1 4 0 '
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 1 . 4 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): 70 METHOD OF TESTrotary air
11. WATER ZONES (depth): 10 0 '
12. CHLORINATION: Type tablet Amount 6
13. CASING:
Wall Thickness
Depth Diam ter or Wei hVFt. Material
From 0 To 64 Ft 61 78 Sch 80 PVC
From To Ft.
From To Ft.
14. GROUT:
Agricultural ❑ Monitoring ❑
DRILLING LOG DEPTH
From To Formation Description
.C.,
C—D EJ
�yy J
Y- , V r
m
tV U)
rta 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)
Depth Material Method
From 0 To 20 Ft. concrete gravity flow
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
Ft.
Ft.
Material
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.
FOR OFFICP=USE NLY ;.'
Ouad No. IGNATURE OF RSON CONSTRUCTING THE WELL DATE
s ry ) d �a��� Submit on nal to Division of Water Ouality, Groundwater Section Within 30 days
Serial No f + ' h: R GW-1 REV. 12/99
In

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 }
�..t5485
WELL CONSTRUCTION RECORD WELL CONTRACTOR:
WELL CONTRACTOR CERTIFICATION #:
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE (check Applicable Box): Residential0 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: Fairview County: Buncombe
49 Garren Lane
(Road Name and Numbers, Community, or Subdivision and Lot No.)
3. OWNER Brad Phares
Address 49 Garren Lane
Fair iew r outs 28703
City or Town State Zip Code
4. DATE DRILLED 6 / 21 / 0 0
5. TOTAL DEPTH 5 0 0 '
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 1 . 4 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 0 METHOD OF TEST rot a r)Z air
11. WATER ZONES (depth): 490
'
DRILLING LOG DEPTH
From To Formation Description
r-�
N
N
--t
12. CHLORINATION: Type tablet Amount 6 If additional space is needed use back of form
13. CASING:
Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 62 Ft. 61 /8 Sch 80 PVC
From To Ft. -
From -To- Ft.
14. GROUT:
LOCATION SKETCH
(Show direction and distance from at least two State
Roads,,or other map reference points)
Depth Material Method
From 0 To 20 Ft. concrete gravity flow
From To Ft.
15. SCREEN:
Depth Diameter Slot Size Material
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:
in.
in.
in.
Material
%b
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: I , IGNATUI
' r Su¢mfl o nPinal to Drvlsl,
Serial No..i
OGERSON CONSTRUCTING THE WELL DATE
of Water Quality, Groundwater Section within 30 days
GW-1 REV. 12/99

North Carolina - Department of Environment and Natural Resources - Division of Water Quality • Groundwater Section f , -j /� (� �J
1636 Mail Service Center- Raleigh, N.C. 27699-1636-Phone [phone]- .1- .. � `t 8 1
WELL CONSTRUCTION RECORD WELLCONTRACTOR: D. Bowman well Drilling, Inc.
WELL CONTRACTOR CERTIFICATION #: 2809
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: Black Mountain County:
Rock Creek Hill Lot #19
Buncombe
(Road Name and Numbers, Community, or Subdivision and Lot No.)
3. OWNER Don Juhlin
Address 41 treet or outs o.
Arden Nr ?R704
City or Town State Zip Code
4. DATE DRILLED 6/ 1 6/ 0 0
5. TOTAL DEPTH 380 '
6. CUTTINGS COLLECTED YES ❑ NO❑X
7. DOES WELL REPLACE EXISTING WELL? YES M NOQ
8. STATIC WATER LEVEL Below Top of Casing: FT.
(Use '+' if Above Top of Casing)
9. TOP OF CASING IS 14 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 2 METHOD OF TEST rnt- a rg Air
11. WATER ZONES (depth): 280'
12. CHLORINATION: Type tablet Amount 6
13. CASING:
Wall Thickness
Depth Dia eter or Weight/Ft. Material
From 0 To 57 Ft. 61 %8 Sch 80 Pvc
From --To- Ft.
From To Ft.
14. GROUT:
DRILLING LOG DEPTH
From To Formation Description
c
o
m�
:a FiMj
�
If additional space is needed use back of form
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or Qther map reference points)
Depth Material Method
From 0 To 20 Ft. concrete gravity flow
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
0`
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
FOR OFFICE USE ONLY"';, Mi ;711^j4"^ 2'-J L
Quad No: g {',. [;i t t.,.. `---5`�GNATURE OF ERSON CONSTRUCTING THE WELL DATE
Submit original to -Division of Water Ouality, Groundwater Section within 30 days
Serial No. GW1 REV. 12/99

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section A Q
1636 Mail Service Center - Raleigh, N.C. 27699-1636-Phone [phone] !
WELL CONSTRUCTION RECORD WELLCONTRACTOR: D. Bowman well Drilling, Inc.
WELL CONTRACTOR CERTIFICATION #:
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE (Check Applicable eox): 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: Alexander County: Buncombe
40 Panther Branch Road
(Road Name and Numbers, Community, or Subdivision and Lot No.)
3. OWNER Alan Teasda
Address 40 Panther Branch Road
Alexander ute No.NC 28701
City or Town State Zip Code
4. DATE DRILLED 6/ 1 5/ 0 0
5. TOTAL DEPTH 3 0 0 '
6. CUTTINGS COLLECTED YES ❑ NO❑X
7. DOES WELL REPLACE EXISTING WELL? YES ❑ NO®
8. STATIC WATER LEVEL Below Top of Casing: 1 5 1 FT.
(Use '+' it Above Top of Casing)
9. TOP OF CASING IS 1 - 4 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 rnt-a r4z Air
11. WATER ZONES (depth): 2 2 n '
12. CHLORINATION: Type tablet Amount 6
13. CASING:
Wall Thickness
Depth Diameter or Wei hVFt. Material
From 0 To 40 Ft 61 /8 Sch 80 PVC
From To Ft. —
From -To- Ft.
14. GROUT:
DRILLING LOG DEPTH
From To Fonnation Description
� v
C7
r,
N cn
rat
N —s
0
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)
Depth Material Method
From 0 To 20 Ft. concrete gravity flow
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.
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.
ro
FOR OFFICE USE dN,LY i.. `' -.4
Quad No: SI NATURE OF PERSON CONSTRUCTING THE WELL DATE
, Sy m onginal to Division of Water Quality, Groundwater Section within 30 days
Serial No. '1GW-1 REV. 12199
i

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section 1.) .q 4 8 9
1636 Mail Service Center - Raleigh, N.C. 27699-1636-Phone [phone] 'C- 1 "•
WELL CONSTRUCTION RECORD WELLCONTRACTOR: D. Bowman well Drilling, Inc.
WELL CONTRACTOR CERTIFICATION #: 2809
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: Fletcher County: Buncombe
275 Joe Bailey Road
(Road Name and Numbers, Community, or Subdivision and Lot No.)
3. OWNER ,Tames Donaldson
Address
Flethcertor ou 28732
City or Town State Zip Code
4. DATE DRILLED 6/ 1 2/ 0 0
5. TOTAL DEPTH 6 9 5 '
6. CUTTINGS COLLECTED YES ❑ NO®
7. DOES WELL REPLACE EXISTING WELL? YES ❑ NO®
8. STATIC WATER LEVEL Below Top of Casing: 6 n� FT.
(Use '+' if Above Top of Casing)
9. TOP OF CASING IS 1 - 4 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): 20 METHOD OF TEST rota rr air
11. WATER ZONES (depth): 6 9 '; '
Agricultural ❑ Monitoring ❑
DRILLING LOG DEPTH
From To Formation Description
is
i7tr
N
r*1=v
y
12. CHLORINATION: Type tablet Amount 6 If additional space is needed use back of form
13. CASING:
Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 55 Ft 61 /8 Sch 80 PVC
From To Ft.
From To Ft.
14. GROUT:
15
0 DepthMa
20 concrI8
From To Ft.
From To Ft.
SCREEN:
grav�i y df low
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:
I DO HEREBY CERTIFY THAT THIS
CONSTRUCTION STANDARD,$; Af,V
FOR OFFICE
Quad No:
Serial No.
Material
LOCATION SKETCH
(Show direction and distance from at least two
Roads, or other map reference points)
N- C
"/10Per clt.
�Ml: .
V'
VAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
A'COPY //OF THIS RECORD
�HAS
, BEEN PROVIDED TO THE WELL OWNER.
Ate, . � /� �ol?,c/ht- �._ �• /,
. 1Submit
IGNATURE 0 PERSON CONSTRUCTING THE WELL DATE
al to Division of Water Quality, Groundwater Section Within 30 days
GW-1 REV. 12/99
{

212993
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]
D. Bowman Well Drilling, Inc.
WELL CONSTRUCTION RECORD WELL CONTRACTOR:
WELL CONTRACTOR CERTIFICATION #: 2809
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: Fairview county: Buncombe
Hickory Forest Lot #19
(Road Name and Numbers, Community, or Subdivision and Lot No.)
3. OWNER Stet hPn R Pi char
Address 56 Foxfire Drive
(Street or Houle o.
Asheville NC 28803
City or Town State Zip Code
4, DATE DRILLED S 1 2 4/ 0 0
5. TOTAL DEPTH 7 0 0 ' _
6. CUTTINGS COLLECTED YES ❑ NOE]
7. DOES WELL REPLACE EXISTING WELL? YES E]0 NO[�
8. STATIC WATER LEVEL Below Top of Casing: FT.
(Use '+' if Above Top of Casing)
9. TOP OF CASING IS 1�4 FT. Above Land Surface -
•Top of casing terminated at/or below land surface requires a variance In accor-
dance with 15A NCAC2C T118 rotary air
10. YIELD (gpm): METHOD OF TEST
11. WATER ZONES (depth): 600'
12. CHLORINATION: Type
tablets
Amount 6
13. CASING:
Wall Thickness
Q
DTOth 60
p
I iter
S CriiWetSt' prial
From
t.
From
To
Ft.
From
To
Ft.
14. GROUT:
Depth
From o To 20
Ft,
From To Ft.
15. SCREEN:
Material
concrete
DRILLING LOG DEPTH
From To Formation Description
If additional space is needed use back of form
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other map reference points)
Method
gravity flow
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:
W r ,''f ), i--s --
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: ASIGNATUR F PERSON CONSTRUCTING THE WELL DATE
Submit original to Division of Water Quality, Groundwater Section within 30 days
GW1 REV. 12/99
Serial No.

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section 212,994
1636 Mail Service Center - Raleigh, N.C. 27699-1636-Phone [phone]
WELL CONSTRUCTION RECORD WELLCONTRACTOR: D. Bowman well Drilling, Inc.
WELL CONTRACTOR CERTIFICATION #: 2809
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: Fairview County: Buncombe
Snowshoe Drive Lot #9
(Road Name and Numbers, Community, or Subdivision and Lot No.)
3. OWNER Dale Beardsley
Address 8 Bethel Drive
(Street or Route o.
Ashevi 1 1 e NC. -28� �
City or Town Stale Zip Code
4. DATEDRILLED 5/19/00
5. TOTAL DEPTH 500
6. CUTTINGS COLLECTED YES ❑ NO X❑
7. DOES WELL REPLACE EXISTING WELL? YES [� NOFX]
8. STATIC WATER LEVEL Below Top of Casing: 90_ FT.
(Use '+' if Above Top of Casing)
9. TOP OF CASING IS 1-4 FT. Above Land Surface'
*Top of casing terminated at/or below land surface requires a variance In accor-
dance with 15A NCAC 2C .0118
10. YIELD (gpm): 3 METHOD OF TEST rotary air
11. WATER ZONES (depth): 420'
12. CHLORINATION
13. CASING:
Type tablet
Agricultural ❑ Monitoring ❑
DRILLING LOG DEPTH
From To Formation Description
Amount 6 If additional space is needed use back of form
Wall Thickness
0
DTot�5
6ia 1e78 Schr or ig80 PVC Material
From
Ft.
From
To
Ft.
From
To
Ft.
14. GROUT:
Depth
Material Method
From 0
To 20
Ft,
concrete PVC-
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)
0
0 ZE
0
C nn
it VI Cn
y� N :r m
)�M
r
o
Ell r-n
{i
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
FOR OFFICE USE ONLY —
Quad No:
Submit
Serial No.
SIGNATUROF PERSON CONSTRUCTING THE WELL DATE
at to Division of Water Quality, Groundwater Section within 30 days
GW-1 REV. 12199

212995
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: D. Bowman well Drilling, Inc.
WELL CONTRACTOR CERTIFICATION #: 2809
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: Asheville County:
Buncombe
55 Tampa Avenue
(Road Name and Numbers, Community, or Subdivision and Lot No.)
DRILLING LOG DEPTH
3. OWNER Nicole Cryderman
From To Formation Description
Address 42 Greenwood Road
Asheville (Street or 9Vto o. 28803
City or Town State 7Jp Code
4. DATE DRILLED 5/ 1 2/ 0 0
5. TOTAL DEPTH 1 8�_
6. CUTTINGS COLLECTED YES ❑ NO®
7. DOES WELL REPLACE EXISTING WELL? YES ❑ NO®
8. STATIC WATER LEVEL Below Top of Casing: ? n , _ FT.
(Use '+` 0 Above Top of Casing)
9. TOP OF CASING IS 1.4 FT. Above Land Surface'
'Top of easing terminated at/or below land surface requires a variance In accor-
dance with 15A NCAC 2C .0118
10. YIELD (gpm): -3 0 METHOD OF TEST rnhary ai
11. WATER ZONES (depth): 1 4 5 '
12. CHLORINATION: Type t a h 1 P t Amount h
If additional space is needed use back of form
13. CASING:
Wall Thickness
0
Depth 60
Di.,uretar a- We'.3t'1FtpV&terW
From
To
Ft. 6 1 / 8 S---$-Q-
From
To
Ft.
From
To
Ft.
14. GROUT:
Depth
Material Method
From . 0 To 20 Ft. c^nrrate gr,-­7; t� f 1.0
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)
CD
O
w C_
C
1�
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.
FOR OFFICE USE ONLY l° L!� 7�`5�// ? J�
Quad No: SIGNATURE F PERSON CONSTRUCTING THE WELL DATE
Submit original to Division of Water Quality, Groundwater Section within 30 days
Serial No. GW1 REV. 12199

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section ( 1299 7
1636 Mail Service Center - Raleigh, N.C. 27699-1636-Phone [phone] `
WELL CONSTRUCTION RECORD WELLCONTRACTOR:D. Bowman well Drilling, Inc.
WELL CONTRACTOR CERTIFICATION #.
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 sketch of the location below)
Nearest Town: Asheville County: B11nQQmhe
Fernwood Avenue Lot #1
(Road Name and Numbers, Community, or Subdivision and Lot No.) DRILLING LOG DEPTH
3. OWNER nAN7i ri Rpr-k From To Formation Description
Address P.O. Box 68
(Street or Houle o.
Leicester NC 28748
City or Town State Zip Code
4. DATE DRILLED 5 /0 9 / 0 0
5. TOTAL DEPTH 3001
6. CUTTINGS COLLECTED YES ❑ NO[D
7. DOES WELL REPLACE EXISTING WELL? YES ❑ NO[�]
8. STATIC WATER LEVEL Below Top of Casing: 6 0 ' FT.
(Use 'i' if Above Top of Casing)
9. TOP OF CASING IS 1 - 4 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 .Air ram—
11. WATER ZONES (depth): 9 A 0.'
12. CHLORINATION: Type ab l P t Amount 6 If additional space is needed use back of form
13. CASING:
Depth Diameter
From 0 To .16 0 Ft.6 1 8
From To Ft.
From To Ft.
14. GROUT:
Wall Thickness LOCATION SKETCH
or Weighl/Ft. Material (Stow direction and distance from at least two State
S ch 80 PVC Roads, or other map reference points)
Depth Material Method
From 0 To 20 Ft..r nncrptP gravi tylow
From To Ft.
15. SCREEN:
Mr
17
Depth Diameter Slot Size Material
From To Ft In. in.
From To Ft. In. In.
From To Ft. In. in.
SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To --Ft.
REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
FOR OFFICE USE ONLY
]
Quad No:
Serial No.
SIGNATURE & PERSON CONSTRUCTING THE WELL
Submit original to Division of Water Quality, Groundwater Section Within 30 days
p
CD
Q P s,
�
I i c
/( 6U
DATE
GW-1 REV. 12199

P12898
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: D. Bowman Well Drilling. Inc
WELL CONTRACTOR CERTIFICATION #: 2809
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE (Check Applicable Box): Residential M 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: Candler County: Bunrnmha
South MorganBranch Road
(Road Name and Numbers, Commnity, or Subdivision and Lot No.) DRILLING LOG DEPTH
3. OWNER M i k A P. A n n i,r�r'c-7. ]_j, u s From TO Formation Description
Address P.O. Box 993
ree or Routs o.
Candler NC 28715
City or Town State 71p Code
4. DATE DRILLED 5 R / 0 0
5. TOTAL DEPTH 2 a 0 '
6. CUTTINGS COLLECTED YES ❑ NO[:
7. DOES WELL REPLACE EXISTING WELL? YES ❑ NOO
8. STATIC WATER LEVEL Below Top of Casing: 7 0 ' FT.
(Use'+' fl Above Top of Casing)
9. TOP OF CASING IS 3 4 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): _4�p__ METHODO F TEST air rotary
11. WATER ZONES (depth):
12. CHLORINATION: Type tablet Amoui•it 6 If additional space is needed use back of form
13. CASING:
Wall Thickness
Depth Diameter or Weight/Ft.
From To _-3 6 Ft. -6 —1 / 8 Scmi-�
From To Ft.
From To Ft.
14. GROUT:
LOCATION SKETCH
Material (Stow direction and distance from at least two State
P;ZG Roads, or other map reference points)
Depth Material Method
From _.0— To 20 Ft. eoige,.e#e �r
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.
Material
OZE
o
CC:
n
flow
M
) �.
n p
✓Itzr�r�,�:;o
z
ell
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.
FOR OFFICE USE ONLY
Quad No:
Serial No.
/SIGNATURE dF PERSON CONSTRUCTING THE WELL
Submit original to Division of Water Quality, Groundwater Section within 30 days
' ct 7
DATE
GW-1 REV. 12199

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section ? 1 `� n n O
1636 Mail Service Center - Raleigh, N.C. 27699-1636-Phone [phone]
WELL CONSTRUCTION RECORD WELLCONTRACTOR: )], Bo;.xm@_n WQ11 ar-illing-, In.c.
WELL CONTRACTOR CERTIFICATION #: 2809
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: Leicester County: Buncombe
Came Sharp Road
(Road Name and Numbers, Community, or Subdivision and Lot No.)
3. OWNER Dnng ShAr=
Address P.O. Box 1332
'Street or oute o.
Leicester__ NC 28748
City or Town State Zip Code
4. DATE DRILLED 5102100
5. TOTAL DEPTH A n o 1
6. CUTTINGS COLLECTED YES ❑ NOU
7. DOES WELL REPLACE EXISTING WELL? YES ❑ NO[�
8. STATIC WATER LEVEL Below Top of Casing: 6 0 ' FT.
(Use'+' if Above Top of Casing)
9. TOP OF CASING IS 1, 4 FT. Above Land Surface -
'Top of casing terminated at/or below land surface requires a variance In accor-
dance with 15A NCAC 2C.0118 air rotary
10. YIELD (gpm): 40 METHOD OF TEST _._ Y
11. WATER ZONES (depth): 3601
12. CHLORINATION: Type tablet Amount 6
13. CASING:
Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 1 50 Ft. h1-18 -Siah—$-0 P11C
From To Ft.
From To Ft.
14. GROUT:
DRILLING LOG DEPTH
From To Formation Description
If additional space is needed use back of form
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other map. reference -points)
7 r"
Depth
Material
Method
O a
From _0— To 2n Ft.
crinrxe#.e
gr=�flow
o
From To
Ft.
�,�
y c
15. SCREEN:
Jr\) ism
w
Depth
Diameter Slot Size
Material
-� o
From To
Ft
in.
in.-'m
From To
Ft.
in.
in.
From To
Ft.
In.
In.
16. SAND/GRAVEL PACK:
Depth
Size
Material
From To
Ft.
From To
Ft.
17. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
FOR OFFICE USE ONLY
Quad No:
Serial No.
S GNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit original to Division of Water Quality, Groundwater Section Within 30 days
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] `
WELL CONSTRUCTION RECORD WELLCONTRACTOR: D. Bowman Well Drilling, . Inc.
WELL CONTRACTOR CERTIFICATION #: 2809
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: Leicester County: - Buncombe
Came Sharp Road
(Road Name and Numbers, Community, or Subdivision and Lot No.) DRILLING LOG
3. OWNER nr)iig Sharp From To
Address P. O. Box 1332
(Street or Route o.
City or Town State p Code
4. DATE DRILLED 5 / 01 / 0 0
5. TOTAL DEPTH 1 2 0 '
6. CUTTINGS COLLECTED YES ❑ NO®
7. DOES WELL REPLACE EXISTING WELL? YES ❑ NO®
8. STATIC WATER LEVEL Below Top of Casing: 2 C) i_ FT.
(Use '+' If Above Top of Casing)
9. TOP OF CASING IS 1 . 4 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): 40 METHOD OF TEST a r rot a ry
11. WATER ZONES (depth): 10 0 '
Agricultural ❑ Monitoring ❑
DEPTH
Formation Description
12. CHLORINATION: Type tablet Amount 6 If additional space is needed use back of form
13. CASING:
Wall Thickness
Depth
Diameter or Weighl/Ft. Material
From 0
To 20
Ft. 6 1 8 Sch 80 PVC
From
To
Ft.
From
To
Ft.
14. GROUT:
Depth
Material Method
From 0
To 20 Ft. c"nnc rr-eta gra zi t-
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
LOCATION SKETCH
(Stow direction and distance from at least two State
Roads, or other °rap-1 ference:points)
i� o
i� _.._ C7 c'
t= C
J rn
N' c�
flow
M
T
Gw�teStIrd. `o
From To Ft.
From To Ft. /
17. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
FOR OFFICE USE ONLY
Quad No:
Serial No.
SIGNATURE OF PERSON CONSTRUCTING THE WELL
SubrnU original to Division of Water Quality, Groundwater Section Within 30 days
,/ 13
DATE
GW-1 REV. 12/99

'4onh Carolina . Department of Environment and Natural Resouroea • Division of Water Quality • Groundwater Section 9
1636 Mail Service Center . Raleigh, N.C. 27699.1636-Phone (919) 733'3221 Inc.
D. Bowman Well Drilling,
WELL CONSTRUCTION RECORD WELL CONTRACTOR:
WELL CONTRACTOR CERTIFICATION #: 78()9
STATE WELL CONSTRUCTION PERMIT#:
1 . WELL USE (Check Applicable Box): Re Injection
❑ Municipal ❑
Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ It Other, List Use:
?, WELL LOCATION: (Show sketch of the location below) u„r,r•nmhP
Nearest Tow rArden County: --B
Hare Road DEPTH
Subdivtsior+ and Lot No.) DRILLING LOG
(Road Name and Numbers. Comrrxx>Ity. From To Formation Description
3. OWNER
Address Hare Road
Arden NC 28704
City or Town s. Lp Code
4. DATE DRILLED R/ 1 4/ 0 0_
5. TOTAL DEPTH 2 a n '
o. CUTTINGS COLLECTED YES ❑ NO® c�
c�
7. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
,9. STATIC WATER LEVEL Below Top of Casing: i
(Uas •.' ff Mow Top of Caeinp) _
9. TOP OF CASING IS 1 • 4 — FT. Above Land Surface*-
-Top of casing tarminated at/or below land surface requires is variance 1n ecoor• cz�
dance with 16A NCAC 2C .01U METHOD OF TEST a , r r—Q l a rY r;
10. YIELD (9pm): , =
11, WATER ZONES (depth): 1 0 0 - • • r`
180'
12. CHLORINATION: Type tablet Amount _6 If additional space is needed use back of form w F5
13. CASING: LOCA��H
Wall Thickness Show direction and distance from at least two State
O Depth �ur ScahWe' hVFI. Material
6 / 8 tS 0 PVC C _ Roads, or other map reference points)
From To — ; 7 Ft. -'
From—- To — Ft.
From
14. GROUT: Method
Depth Material
Ft. cn —crr xj-t4 f i ow
From 0 -- To 2-- �co--
From — To ___.--Ft. f , I'1(
15. SCREEN:
Depth Diameter Slot Size Material sher�dwa�e� jry �
In. RE% �d r \ . �
From _..- To ..._— Ft In. one/©�Ao (I` • v
From — To — Ft. — In. In. ,I
To FL..._..- In. In. / 1
From __.._. �
16. SAND/GRAVEL PACK: Material 0:5
Depth Size
From — To __—Ft.
From — To Ft.
17. REMARKS:
I DO HEREBY CERTIFY THAT THIS D � WA COPY OF THIS RECORD HAS BEEN CONSTRUCTED IN EPROVIDED TO THE WE OWNER.
CONSTRUCTION STANDARDS. Q llt�
FOR =USE DATENATUgEOp RS
ONCONSTRUCTING THE WELIQuad t prigina► Division of water quality. Groundwater Section within 30 daysGw•1 REV. 12r99Serial

2
North Carolina - Department of Environment and Natural Resources - Division of Water Oualrty •Groundwater Section 9 nta
1636 Mail Service Center - Raleigh, N.C. 27699-1636-Ptwne [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR:
D. Bowman Well Drilling, Inc.
WELL CONTRACTOR CERTIFICATION #: 9 A n Q
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: Asheville County: RiinrnmbQ
7 Creek View Drive DRILLING LOG DEPTH
(Road Name and N tubers Cormxutity, or Subdivision and Lot No.) Formation Description
3. OWNER RiMra & Donna Bowman From To
Address P.O. Box 547
(Street or
Leicester NC 28748
City or Town Staff Code
a. DATE DRILLED
5. TOTAL DEPTH -tO.L>.-'---
5. CUTTINGS COLLECTED YES ❑ NO® '
7. DOES WELL REPLACE EXISTING WELL? YES ❑ NO©, f=;
s. STATIC WATER LEVEL Below Top of Casing: 2 5 '_ Fr.
(Use'.' M Above Top of Casing) (, .
9. TOP OF CASING IS 4_ FT. Above Land Surface' N�
'Top of casing terminated at/or below land eurfece squires a variance In "cor•
dance with 16ANCAC2C.011J air rotary
10. YIELD (gpm): 2_ METHOD OF TEST �__..._.
11. WATER ZONES (depth): 90 G j
12 CHLORINATION: Type tablet Amount 6
13. CASING:
Wall Thickness
Depth owm.ter or WeghVFI. Material
61/8 Sch 80 PVC
Fromm—To-,-E.q-- Ft. -- --
From — To Ft. --
From ----=To------ FL —
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)
14. GROUT:
Depth Material Method
From �..�. _r -E
0 To 2_ 0 Ft. nonrretYA•z .ow
From To ____._Ft. -- — - `
15. SCREEN:
Depth Diameter 5lot 5►Ze ma►eneu
From To_ Ft ._._ In. in.
From To Ft. In. In. —.
From To Fl. in. In.
16. SAND/GRAVEL PACK:
Depot Size Material
From .._...- To — Ft.
From — To Ft.
17. REMARKS:
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.
/2 .rn, --. 0l6 i /
FOR OFFIGE USE ONLY
Quad N0:
Serial No.
Sl TURE OF P RSON CONSTRUCTING THE WELL
Sub�l o�inal Division of Water Ouality. Groundwater Section Within 30 days
DATE
GW1 REV. 12t"

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: n Rowman we-11 r-iiiing, inc,
WELL CONTRACTOR CERTIFICATION #: 2809
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE (check Applicable Box): Residential ® 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: Leicester County: BunCOMbe _
Walnut Lane
(Road Name and Numbers. Community, or Subdivision and Lot No.)
3. OWNER Pall 1 CAI d5.re I 1
Address 353 New Leicester Hwy. B1d_. E
—�jstreet or outs o.
ply or own tale Zip Code
4. DATE DRILLED 4127100
5. TOTAL DEPTH _-660'
6. CUTTINGS COLLECTED YES ❑ NO[O
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 1 _ 4 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): 4 METHOD OF TEST a ; r ramt; ry
11. WATER ZONES (depth): 4 8 0 '
12. CHLORINATION: Type tablet Amount 6
13 CASING:
Wall Thickness
Depth Diameter or WeighVFI. Material
From 0 To 80 Ft. 6 1 8 Sch 80 PVC
From To Ft.
From To Ft.
14. GROUT:
Depth Material Method
From 0 To 20 Ft. concrete gra-,7i tT
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
17
From To Ft.
From To Ft.
REMARKS:
I DO HEREBY QEJM
CONSTRUCT I N'VT
FOR OFFICES NLY
Quad No: 61 W A G
Serial No.
DRILLING LOG
From To
DEPTH
Formation Description
C z!E
C.1�
C,
a.
- —>rn
r�
t
�rn
� y d
�i
It additional space is needed use back of form
Q n ;.o
LOCATION SKETCH
s �
0
2
(Show direction and distance from at least two State
Roads, or other map reference points)
lao�li, T� �+1 N � •
f low ✓�(J
m
4
T
SAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
AICOPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
I�j SIGNATURE 04ERSON CONSTRUCTING THE WELL DATE
I 9 20�fubmitlldg�hf to Division of Water Quality, 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]
WELL CONSTRUCTION RECORD WELL CONTRACTOR: n Bowman well 1 Dri1 1 ; na Tnc_
WELL CONTRACTOR CERTIFICATION #: 2809
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: Leicester County: Buncombe
18 Plantation Drive
(Road Name and Numbers, Community, or Subdivision and Lot No.)
3. OWNER Brad Snelson
Address 295 Alexander Road
trees or oute o.
Leicester N 28748'
City or Town State Zip Code
4. DATE DRILLED 4/ 2 6/ 0 0
5. TOTAL DEPTH 3 0 0
6. CUTTINGS COLLECTED YES ❑ NOQ
7. DOES WELL REPLACE EXISTING WELL? YES ❑ N00
8. STATIC WATER LEVEL Below Top of Casing: III— FT.
(Use '+' if Above Top of Casing)
9. TOP OF CASING IS 1 . 4 FT. Above Land Surface -
'Top of casing terminated aUor below land surface requires a variance In accor-
dance with 15A NCAC 2C .0118
10. YIELD (gpm): 8 METHOD OF TEST air rota
11. WATER ZONES (depth): 2 6 0 '
DRILLING LOG
From To
Agricultural ❑ Monitoring ❑
DEPTH
Formation Description
12. CHLORINATION: Type tablet Amount 6 It additional space is needed use back of form
13. CASING:
Wall Thickness LOCATION SKETCH
Depth Diameter or Weight/Ft. Material (Show direction and distance from at least two State
From 0 To 45 Ft 6 1 /8 Sch 80 PVC Roads, or other map reference points)
From To Ft.
From To Ft.
14. GROUT:
Depth Material Method
From . 0 To 20 Ft. c'Qn -rPtP c1ravi t flow
From To Ft.
15. SCREEN:
16
17
Depth Diameter Slot Size
From To Ft in.
From To Ft. in.
From To Ft, in.
SAND/GRAVEL PACK:
Depth Size
From To Ft. —
From To Ft. —
REMARKS:
Material
in.
in.
in.
Material
0
t2
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTIOh=TAnPA NP"`iM?Mrr.A*Cp-,, O" OF THIS RECORD HAS BEEN PROVIDED TO THE WELL 0
FOR OFFICE U tO ' "� -`
Quad No: NATURE OF ERSON CONSTRUCTING THE WELL DATE
7 1 9 2Ri1 0 ' i Division of Water Quality, Groundwater Section within 30 days
Serial No. GW1 REV. 12/99

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mail Service Center - Raleigh, N.C. 27699-1636-Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR: D. Bowman Well Drilling, Inc.
WELL CONTRACTOR CERTIFICATION #: 2809
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 sketch of the location below)
Nearest Town: ;*.igiay;ir=11 I e County: $1_3n.cnmhim
1360 New Stock Road
(Road Name and Numbers, Community, or Subdivision and Lot No.)
3. OWNER Evelyn C. Rich
Address
Weayeryille1eetor outs o. 28787
City or Town State Zip Code
4. DATE DRILLED 4 / 21 / 00
5. TOTAL DEPTH 1 8 5 '
6. CUTTINGS COLLECTED YES ❑ NO TI
7. DOES WELL REPLACE EXISTING WELL? YES F_� NOFXJ
8. STATIC WATER LEVEL Below Top of Casing: ._3.5— FT.
(Use '+' if Above Top of Casing)
9. TOP OF CASING IS 1 _ 4 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): 14 METHODOFTEST air rot-ary
11. WATER ZONES (depth): 1 40'
DRILLING LOG DEPTH
From To Formation Description
12. CHLORINATION: Type tablet Amount 6 It additional space is needed use back of form
13. CASING:
Depth Diameter
From 0 To 30 Ft. 6 1/ 8
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
Sch 80 PVC Roads, or other map reference points)
/tit v SEo�, k
Depth Material Method
From 0 To 20 Ft. concrete cfravity flow
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:
I DO HEREBY�TJ
CONSTRUCTI T
FOR <
OFFICE�jhh N Y
Quad No: ��JJ 11 ��
Serial No.
Slot Size Material
in.
in.
in.
Material
_WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
F A 0__(Q ! OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
1 20„ 1 IGNATURE OF ffERSON CONSTRUCTING THE WELL DATE
bmi n to Division of Water Quality, Groundwater Section within 30 days
Gw-I 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: O Rawman Wel 1 Drilling, inc.
WELL CONTRACTOR CERTIFICATION #: 2809
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE (check Applicable Box): Residendal(X] Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: AleXander County: Runrrnmhe
382 JPnki nG Va 1 _.._.
(Road Name and Numbers. Community, or Subdivision and Lot No.)
3. OWNER 200pQ r'nvt
Address 416 Upper Glady Fork Rd.
(Street or HoUle o.
Candler NC 28715
City or Town State Zip Code
4. DATE DRILLED d /
5. TOTAL DEPTH 200
0
6. CUTTINGS COLLECTED YES ❑ NO
7. DOES WELL REPLACE EXISTING WELL? ES ❑ NOO
B. STATIC WATER LEVEL Below Top of Casing: 40 Fr.
(Use '+' it Above Top of Casing)
9. TOP OF CASING ISM , 4 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): 30 METHOD OF TEST air rotary
11. WATER ZONES (depth): 1 60 t
12. CHLORINATION: Type tablet Amount 6
13. CASING:
Q� Wall Thickness
tena
From 0 To Otf1 3 Ft [Zam�tgr$ orb( hVF6.o IaVCi
From To L Ft. b // II1l ttSS
From To Ft.
14. GROUT:
DRILLING LOG DEPTH
From To Formation Description
b
0 0
C�
r n
o�
w .ma..yy _r
D
tiz
0 n
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)
Depth Material Method
From 0 To 20 Ft concrete gravity flow
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
r4—
,A
C
I DO HEREBY .Efi71F TtkiAT_THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTI TA�DA@DS AtD ��IA A OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
FOR OFFICE U LY IIJJ LL55 (UJ UU 1 e
Quad No: I )fin 1 IGNATURE PERSON CONSTRUCTING THE WELL DATE
LUBUbmit to Division of Water Quality, Groundwater Section within 30 days
GW1 REV. 12/99
Serial No.

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mail Service Center - Raleigh, N.C. 27699-1636-Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR: D. Bowman 2eelll Drilling, Inc.
WELL CONTRACTOR CERTIFICATION #:
STATE WELL CONSTRUCTION PERMIT#:
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) Buncombe
Nearest Town: Candler County:
135 Medford Branch Road
(Road Name and Numbers, Community, or Subdivision and Lot No.)
3. OWNER Mi g—ke —Campbell
Address 135 Medford Branch Road
(street or Houle 1430
Candler NC 28715
City or Town Stale Zip Code
4. DATE DRILLED 4/ 1 8/ 0 0
5. TOTAL DEPTH 4 5 0 '
6. CUTTINGS COLLECTED YES ❑ NO®
7. DOES WELL REPLACE EXISTING WELL? YES ❑ NO®
8. STATIC WATER LEVEL Below Top of Casing: 4 0 v FT.
(Use '+' if Above Top of Casing)
9. TOP OF CASING IS 1 4 FT. Above Land Surface -
•Top of casing terminated at/or below land surface requires a variance In accor-
dance with 15A NCAC 29.81d8 rotary air.
10. YIELD (gpm): I METH Q4 OF TEST
Agricultural ❑ Monitoring ❑
DRILLING LOG DEPTH
From To Formation Description
11. WATER ZONES (depth): 4
o
12. CHLORINATION: Type tahl Pt Amount Fi It additional space is needed use back of form
1.1 CASING:
Wall Thickness
Depth
Diameter or Wei hVFt. Material
PVC
0
To
30 Ft. 6 1 8 S cK 8 0
From
From
To
Ft.
From
To
Ft.
14. GROUT:
Depth
Material Method
From --Q— To 20 Ft. concrete -aravity
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)
f low
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTIO PY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
P°'% r2 ia 2 11 m r2 m 1� -/ /4 /
• ..
Serial No
NATURE PERSON CONSTRUCTING THE WELL
9 2WIto Ili&
Division o Water Quality, Groundwater Section within 30 days
DATE
GW1 REV. IM9
n

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mail Service Center - Raleigh, N.C. 27699-1636-Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR: D. Bowman well-Drillincf, Inc.
WELL CONTRACTOR CERTIFICATION #: 2809
STATE WELL CONSTRUCTION PERMIT#:
2
3
WELL USE (Check Applicable Box): Residential® Municipal ❑ Industrial ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
WELL LOCATION: (Show sketch of the location below)
Nearest Town: Green Mountain County:_
Brush Creek Road
(Road Name and Numbers, Community, or Subdivision and Lot No.)
OWNER Bob Baldwin
Address Rt.2, Box 192
Green Mounttan outs NC 28740
Agricultural ❑ Monitoring ❑
DRILLING LOG DEPTH
From To Formation Description
City or Town State Zip Code
4. DATE DRILLED
5. TOTAL DEPTH 44n,
c+
C7
0
6. CUTTINGS COLLECTED YES ❑ NO�]
7. DOES WELL REPLACE EXISTING WELL? YES NO�
B. STATIC WATER LEVEL Below Top of Casing: 5' FT.
r„a
m
(Use '+' if Above Top of Casing)
"�
g
9. TOP OF CASING IS 1 4 FT. Above Land Surface'
3%110
4-
*Top of casing terminated at/or below land surface requires a variance In accor-
dance with 15A NCAC 2C .0118
10. YIELD (gpm): 3-_L_ METHOD OFTEST air rotary
-
11. WATER ZONES (depth):.3 Q 0
490,
}
12. CHLORINATION: Type tablets —Amount 6
It additional space is needed use back of form
13. CASING:
LOCATION SKETCH
Wall Thickness
Depth Diameter or WeighVFt. Material
(Show direction and distance from at least two State
From 0 To --4 Ft. 6--,— 8 Grh R 0 UyC
Roads, or other map reference points)
From To Ft.
From To Ft.
14, GROUT:
Depth Material Method
From _n To 20 Ft. c-n _xet&=gEavi?y
flow
From To Ft.
15. SCREEN:
Depth Diameter Slot Size Material
From To Ft in. in.
-4-
\`
C
From To Ft. in. in.
L MI
From To Ft. In. in.
ram` 4'
t`
16. SAND/GRAVEL PACK:
��
Depth Size Material
s�
From To Ft.
From To Ft.
17. REMARKS:
i DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS. AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
OFIERSON CONSTRUCTING THE WELL
of Water Quality, Groundwater Section within 30 days

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: D. Bowman well Dr; 11 inq, Tnc,
WELL CONTRACTOR CERTIFICATION #: 2809
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE (Check Applicable sox): Residential ® Municipal ❑ Industrial ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: Barnardsville County: Buncombe
111 Stoney Fork Road
(Road Name and Numbers, Community, or Subdivision and Lot No.)
3. OWNER John Isgrig
Address 28 Forest Knoll
Weavervil eeetor de o. 28787
City or Town State Zip Code
4. DATE DRILLED 4/ 1 0/ 0 0
5. TOTAL DEPTH 2 0 0
6. CUTTINGS COLLECTED YES ❑ NO®
7. DOES WELL REPLACE EXISTING WELL? YES ❑ NO ]
8. STATIC WATER LEVEL Below Top of Casing:_ FT.
(Use '+' it Above Top of Casing)
9. TOP OF CASING IS 1 • 4 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): 20 METHOD OF TEST rotary air
11. WATER ZONES (depth): 1 45'
12. CHLORINATION: Type tablet
13. CASING:
Amount 6
Wall Thickness
DepthMaterial
From 0 To37 Ft6oi�m�ter orScK 9�0 PVC
From To Ft.-tt55 S
From To Ft.
14. GROUT:
Agricultural ❑ Monitoring ❑
DRILLING LOG DEPTH
From To Formation Description
0
O
o
v
3
pi
o0
`
CJ
S
_
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)
Depth
Material
Method
From 0
To 20
Ft.
concrete
gravity flow
From
To
Ft.
15. SCREEN:
Depth
Diameter Slot Size
Material
From
To Ft
in.
in.
From
To Ft.
in.
In.
From
To Ft.
in.
in.
16. SAND/GRAVEL PACK:
Depth
Size
Material
From
To
Ft.
From
To
Ft.
17. REMARKS:
,
,�� r'►� �Ht,�, fey
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION �C�H THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
FOR 0 FICF)U,SE
Quad No: I A ATURE PERSON CONSTRUCTING THE WELL DATE
Iv 1 9 Q11 orip ivislon of Water Quality, Groundwater Section within 30 days
GW1 REV. 12/99
Serial No.

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mail Service Center - Raleigh, N.C. 27699.1636-Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR: n Bowman Wel] Drill ing, Inc -
WELL CONTRACTOR CERTIFICATION #: 2809
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE (check Applicable Box): Resident)al ® 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: Weaverville County: BUnCOMbe
468 Upper Flat Creek Road
(Road Name and Numbers, Community, or Subdivision and Lot No.) DRILLING LOG
3. OWNER Aaron Zaretsky From To
Address 4bd peer Flat Ureell<oa
(Street or Route o.
Weaverville NC 28787
City or Town State Zip Code
4. DATE DRILLED 4/03/00
5. TOTAL DEPTH 540'
6. CUTTINGS COLLECTED YES ❑ NO®
7. DOES WELL REPLACE EXISTING WELL? YES ❑ NO®
8. STATIC WATER LEVEL Below Top of Casing: __t5j0__ FT.
(Use'+' If Above Top of Casing)
9. TOP OF CASING IS 1 .4 FT. Above Land Surface -
•Top of casing terminated at/or below land surface requires a variance In sccor-
dance with 15A NCAC 2C .0118
10. YIELD (gpm): 1 METHOD OF TEST Rota Ai r
11. WATER ZONES (depth): 510 '
DEPTH
Formation Description
12. CHLORINATION: Type tablet Amount 6 If additional space is needed use back of form
13. CASING:
Depth Diameter
From 0 To 30 Ft. 6 1 8
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
SCh 80 PVC Roads, or other map reference points)
IN
0
Concrete
Method iy flow
From
Top1h20
Ft
From
To
Ft.
15. SCREEN:
- tAl
L14--
Depth
Diameter Slot Size
Material
From
To
Ft in.
in.
From
To
Ft. in.
In.
From
To
Ft. in.
In.
16. SAND/GRAVEL PACK:
fi aq k� H"N
Depth
Size
Material
From To Ft.
From To Ft.
17. REMARKS:
I DO HEREB aHA69-W1=L-L—WA •CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUC f S1gN%R , B1V H ,T Y OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER. CU
FOR OFFICE NLY I)/
Quad No: O I 9 200 ►SIGNATU OF PERSON CONSTRUCTING THE WELL DATE
u rF ial to Division of Water Quality, Groundwater Section Within 30 days
GWt REV. 12/99
Serial No.

P.O. BOX 27e97 - RALEKIF(IM 27e11, PHONE [phone]
WELL CONSTRUCTION RECORD
Quad. No. — Serial 2.0 1 1
7 F
Lat. Long. Pc
Minor Basin
Basin Code
Header Ent. OW-1 Ent.
DRILLING CONTRACTOR "i��
DRILLER REGISTRATION NUMBER =-- /y�3 STATE WELL CONSTRUCTION
PERMIT NUMBER: 7
I. WELL LOCATION: (Show sketch of the location below)
Nearest Town: County:.
•
(Road, Commtmlt , or Subdivision and of No,) Depth DRILLING LOG
2. OWNER From To Formation Description
ADDRESS
v lA�i treat or route No.
City or Town V.. State Zip Code
3. DATE DRILLED -.�-T
USE OF WELL LC�y
4. TOTAL DEPTH CUTTINGS COLLECTED ❑ Yes [0 C/)
5. DOES WELL REPLACE EXISTING WELL? ❑ Yes
6. STATIC WATER LEVEL: aD • FT. 0 above TOP OF CASING,
TOP OF CASING IS FT. O below
ABOVE LAND SURFACE,
7. YIELD (gpm): METHOD OF TEST
8. WATER ZONES (depth):
9. CHLORINATION: Type % Amounts-
10. CASING:
Wall Thickness
Depth Diameter or Weight/Ft. Material
6-
From �_ 1
To Ft.
From To Ft.
From To Ft.
11.OROUT: --_ --
Depth J Material Method
From _ t� To=0 Ft.
From ___ To__ Ft.
12. SCREEN:
Depth Diameter Slot Size Material
From To_,__ Ft, k> In _
From Tom_ Ft, in in
From To___ Ft, k> h
13. GRAVEL PACK:
Depth Size Material
From To— Ft.
^•' 77
tiD
N
~y f
n
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)
ID
SEP 7
From To Ff.
14. REMARKS:
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15 NCAC 2C, WELL CONSTRUCTION
STAJ�QARDS,,.:.AND THAT A COPY OF THIS RECORD HAS BEEN.PROVIDED TO THE WELL OWNER.
t , SIGNATURE OF CONTRACTOR OR AGENT
+ { DATE
igRevay .4 1999 t ¢` Submit original to Division of Environmental Management and copy to well owner.
r�l
y

P.O. BOX 27e07-AMXJQKKQ 27011,,P"ONE (e1e)733-3221
Quad No. sods, (�flo�• • ��
Lat. Long. Po
WELL CONSTRUCTION RECORD eBminor Codde1
Header Ent. QW-1 Eft._
DRILLING CONTRACTOR f
DRILLER. REGISTRATION NUMBER /*,al VSTATE WELL CONSTRUCTION
PERMIT NUMBER: /4�D
1. WELL LOCATION: (Sh sketch ol'the location below)
Nearest Town: .. • County:
(Road, Community, or Subdivision Lot No,)
2. OWNER
ADDRESS
or
City or Town �,, State / ZIP Code
4 �
3. DATE DRILLED /;f USE OF WELL A—
4. TOTAL DEPTH CUTTINGS COLLECTED ❑ Yes Sw
5. DOES WELL REPLACE EXISTING WELL? ❑ Yea QNo
6. STATIC WATER LEVEL: PT, O above TOP OF CASING,
ow
TOP OF CASING IS � I _ FT. ABOVE LAND SURFACE.
I. YIELD (gpmr METHOD OF TEST A �-
8. WATER ZONES (depth):
9. CHLORINATION: Type 442-111 Amount
10. CASING:
Depth Diameter Wall Thickness
$ Material
From _.4 To �� Ft.�" y"0
' From -----_ To FI.
From To _._._F1.__
11. GROUT:
Depth aterlal Method
From To nd Ft.
From To.__ Ft.
12. SCREEN: --^
Depth . Diameter Slot Size Material
From Tc� Ft.In, In,
From __ To—, Ft. U:. in,
From. To.__ FL km. In,
13. GRAVEL PACK:
Depth Size Material
From _„_TO _,__ Ft.
From. To. Ft.
s
14, REMARKS:
Depth DRILLING LOG
From To Formation Description
r
0
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)
4
v-
CP .
Cw
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE• WITH 15 NCAC 2C, WELL CONSTRUCTION
STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN.PROWDED TO THE WELL OWNER.
GW-1 Revised 6/8a
LJ `J 34j..y:;v /,0- /_ 52,i7
SIGNATURE OF CONTRACTOR OR AGENT DATE
Submit original to Division of Environmental Management and copy to well owner.
ate'>�v.' •r,__ ,
;:am�r

P.O. BOX 27687-RALU3H KQ 9761111s.ffiONE [phone] Quad. No. Serial NoQ_L2_
Lat. Long. — Ise
Minor Basin
WELL CONSTRUCTION RECORD Basin Code
Header Ent. OW-1 Ent —
DRILLING CONTRACTOR.,% STATE WELL CONSTRUCTION
DRILLER. REGISTRATION NUMBER PERMIT NUMBER: ON
1. WELL LOCATION: ?(Sh7w sketch ol"the location below)
Neareq Town: County: lxea9z�.
(Road, Commr tubdl Isfon Ad Lot No,) Depth DRILLING LOG
2. OWNER. n7r� From TO j. Formation Description
ADDRESS zo
(Street or Route N I o.j •
S915�
City or Town State ZIP Code
3. DATE DRILLED USE OF WELL lIVe7,=
4. TOTAL DEPTH CUTTINGS -COLLECTED Dyea f31%
5. DOES WELL REPLACE EXISTING WELL? 0 Yes -&No
6. STATIC WATER LEVEL: PT. 0 above TOP OF CASING,
1 E3
TOP OF CASING IS FT. ABbelow
OVE LAND SURFACE.
7. YIELD (gpmk METHOD OF TEST _Cl /L-
8. WATER ZONES (depth):
9. CHLORINATION: Type _Ar� -hl Amount
10. CASING:
Depth Diameter
Wall Thickness
or Weight/Ft. Material
From 43
To ­12 Ft. 6
From —
To —Ff.—
From -.To
—Ff.—
;1.. anon.
Depth Material Method
From
To 6 Ft.
From
To.__ Ft.
12. SCREEN:
Depth Diameter
Slot Size Material.
From
To.,_,_._ Ff.
im _ in.
From
To Ff.
im_ in.
From—
To— FL
In kL
13. GRAVEL PACK:
If additional space Is needed use back of form.
(Show direction and distance from at least two State Roads,
or other map reference points)
7S,)
D601h Size Material
From Toym
—. F I. J-3
From. To-- Fl.
14. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE'WITH 15 N . CAC 2C, WELL CONSTRUCTION
STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL NER
WELL
SIGNATURE OF CONTRACTOR OR AGENT DATE
GW-1 Revised 6/88 Submit original to Division of Environmental Management and copy to well owner.

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section. 3 7 3 J
1636 Mail Service Center - Raleigh, N.C. 27699.1636-Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR:
WELL CONTRACTOR CERTIFICATION #:
STATE WELL CONSTRUCTION PERP111T#:
1. WELL USE (check Applicable Box): Residential Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATION:-LShow sketch of the location below)
Nearest Town:- l /f�/L£/-J'Aff County: �l1!Ylr/✓YK.f1
(Road Name and Numberj�, Community, or Subdivision and Lot No.) DRILLING LOG DEPTH
3. OWNER 7
%)1 From To Formation Description
Address
(reel or Houle o. / 1�45' 4,
i
City or Town State Zip Code
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'+'Il Above Top of .
9. TOP OF CASING IS i FCasing) T. 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): ; 0.0 METHOD OF TEST
11. WATER ZONES (depth):10 1-2-117
12. CHLORINATION: Type j"/S� Amount
13. CASING:
Wall Thickness
Depth Diameter or Weight/Ft. Material
From i% To /. l Ft. 6 "
From To Ft.
From To Ft.
14. GROUT:
Depth tlaterial Method
From - 6 To .� r: Ft. / • SJ a 4_
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 `Stz�e
From ' iTo
From To Ft.
17. REMARKS' ii I aAils T 6 2W
100 HERE qY C
CONSTRUC10
FOR OFFICE USE ONLY
Quad No:
Serial No.
In.
Material
.If additional space is needed us-e back of form
LOCATION SKETCH
(Show direction and dEs;tance from al least two State
Roads, or other map reference points)
ISTRUCTED IN ACCORDANCE WITH 15A 114CAC 2C, W'ELL
OF THIS RECORD H4 BEEN PROVIDED 70 THE WELL OWNER.
-u1:9
SIGNATURE OF PERSON CONSTRUCTING THE WrELL DATE
Submit original to Divisbn of Water O"ity, Groundwater Sectcn within a0 dvys
Gym REY. 1299

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section 2 13 7 3 "
1636 Mail Service Center - Ralei h N C 27699 1636 P
9 , . . - "one [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR:
WELL CONTRACTOR CERTIFICATION #:
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE (Check Applicable Box): Residential [X Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: �-1 /= b-'L x, County:
/
�CtJN[lrnl (mac.
DRILLING LOG DEPTH
(Road Name and N mbers, Community, or Subdivision and Lot No.)
3. OWNER C / .I'
From To Forma: cn Description
Address
(street or ute o.)
r. rJL
City or Town State Zip Code
4. DATE DRILLED ell 6
5. TOTAL DEPTH
6. CUTTINGS COLLECTED YES ❑ NO®
7. DOES WELL REPLACE EXISTING WELL? YES [5 NO❑
S. STATIC WATER LEVEL Below Top of Casing: �_ FT.
(Use'+' it Above Top of Casing)
9. TOP OF CASING IS�_ FT, Above Land Surface'
'Top of casing terminated at/or below land surface requires a variance In accor-
dance with 15A NCAC 2C .0118
10. YIELD (gpm): _16 METHOD OF TEST
11. WATER ZONES (depth):-_-'prx_
12. CHLORINATION: Type �f%/l� Amount _7'Z1_
It addr8onal space its needed use bads of corm
13. CASING:
Wall Thickness
Depth Diameter or Weight/Ft. Material
From L) To // � Ft.
From To Ft.
From To Ft.
14. GROUT:
Depth =aterial Method
From ._.1L_ To /A 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:
From
41'f
From ` "o Ft.
17.. REMARKS:'! € a � AUG a 6
z Material
el t
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other map reference points)
I DO HEREBY CEpTIFY AT THWELLIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A 04CAC 2C, WELL
CONSTRUCTION ST 1NDq, jCS;, AND THAT A COPY OF THIS RECORD HAS BE N PROVIDED TO THE WELLOAhER.
<, _..
FOR OFFICE USE ONLY/r 6<
Quad No: SIGNATURE OF PERSON CONSTRUCTING Tile WtELL OA7E
Submit original to Division of Water O"ity, Groundwater Sectcn within V days
Serial No. Grr•1 REv. 1299

001193 J
P.O. BOX 27087 - RALEKIKKC. 27011, SHONE (a1e)733-3221
I
uad No. Sarin NO.
at. Long. Po!
WELL CONSTRUCTION RECORD
[IMAIrm
ainCodeeader
Ent. QW-1 Ent._
DRILLING CONTRACTOR f
DRILLER REGISTRATION NUMBER -' �'��'
STATE WELL CONSTRUCTION
PERMIT ✓�D
NUMBER: -
1. WELL LOCATION: (Show sketch of'the location
below)
Nearest Town:
County:.
(Road, Ct-INII.Y. or5 bdlvlsion a d Lot No,)
Depth DRILLING LOG
2. OWNER
Fr ToF Irmat(oo Description
ADDRES
treat or u o.
U
f
City or Town �,. Slate Zip Code
� 3. DATE DRILLED ✓ate 1 USE OF WELL-IA4-t: I —
4. TOTAL DEPTH -�,2-�7' CUTTINGS COLLECTED ❑ Yes 0-Ab
5. DOES WELL REPLACE EXISTING WELL? ❑ Yes -0-No
6. STATIC WATER LEVEL: ''7� FT. O above
_.. TOP OF CASING,
TOP OF CASING IS _..—L_ FT. ABOVE LAND SURFACE.
7. YIELD (gpm} __ METHOD OF TEST
8. WATER ZONES (depth): J66+
9. CHLORINATION:. Type _% Amount
10. CASING:
--
Wall Thickness
Depth Diameter or Weight/Ft. Material
If additional space Is needed use back of form.
From _,_•U -- To Ft. 4/, �/C
-LOCATION SKETCH
�^
' From
(Show direction and distance from at least two State Roads,
- To __Ft.
or other map reference points)
From —.To _..__Ft.—
11. GROUT:
Depth Material Method
.From �_. To.:zd —Ft.
ILn
-'=`
From _ To. Ft.
n ---,
CZ)r
12. SCREEN:
ry -
Depth Diameter Slot Size Material
-,
From_,__ To_-,___ Ft.______ h._ In.
From --- To h
Ft. h.,
From------ To_._ FL __ h. h.
c�
,' cs. c.
13. GRAVEL PACK:
Depth Size Material
From--.TO-.Ft.
From. TO-- Ff.
14. REMARKS:
1 DO HEREBY CERTIFY THAT :THIS WELL WAS CONSTRUCTED IN ACCORDANCE•WITH 15 NCAC 2C, WELL CONSTRUCTION
STANDARDS, AND THAT -A --COPY OF -THIS RECORD HAS BEEN.PROVIDED TO WELL
WNER.
9
9 I�
SIGNATURE OF CONTRACTOR
OR AGENT DAB-
GW-1 Revised 6/88 Y Submit original to Division of Environmental Management and copy to well owner.

P.O. BOX 27087 - PALEIOH,N.O. 27411, PHONE (e ie)733-3221 Quad. No. Seria�j f�.
Lat. Lore. Po
minor Basin
WELL CONSTRUCTION RECORD Basin Code
Header Ent. OW-1 EnL_..__
DRILLING CONTRACTOR I�r,_ uaoa ,�- Q AMP
ORSTATE WELL CONSTRUCTION DRILLER REGISTRATION NUMBER PERMIT NUMBER:
I. WELL LOCATION: (Show sketch ol•the location below)
Nearest Town: ,; a„v a County:'. -kin 0 i(py-n VV
_ 51n�rr h r1 � n�, •
Depth DRILLING LOCv
(Road, Community, or Subdivision and Lot Nos �� .From To Fomlatlor o scriptlon
Z. OWNER ..,_.� �n 'RCS
�O
ADDRESS �� �' A 0 (05 1
treet or ROUIS N01
City or Town Slate Zip Code;,
3. DATE DRILLED 5 "t2" G�► USE OF WELL --V-�Q1 LQA
4. TOTAL DEPTH • LA O'-) CUTTINGS COLLECTED ❑ Yes 0-r4oag
5. DOES WELL REPLACE EXISTING WELL? Q Yea Q"No
6. STATIC WATER LEVEL: �,,.__..1�T. ❑ above TOP OF CASINO,
TOP OF CASING IS below
FT. ABOVE LAND SURFACE.
7. YIELD (gpmk. METHOD OF TEST 21
8. WATER.ZONES (depth):_,
8. CHLORINATION: Type! :.... Amount ,
10. CASING:
Depth�,� Dlameter Wall Thickness Material
From Q To _t,.)6 Ft.
From —To —Ff.—
From To —Ft.....-....._..
11.OROUTi:.. .
Depth Malarial Method
From .� To 2-D �Ft. �.4LQ6.
Front To,._�, Ft.
JZ SCREEN
Depth Diameter Slot Size Material
From ._,._._._
To.,,,,-- _„ FL,_
I%______ In.
From ._.,_,,.__
To_.-�,Ft.
�_ in in.
From ._.._.—._,
To._,,..._,. FL
In. In.._.,.
13. GRAVEL PACK:
j
Depth .
Iej �M1�eri�� [�
From...;._.__
From
To_..-..-.., F
Tom Ft.
0 �_..
• I N 1 2, 2nnn
14. REMARKS:
I -CERTIFY THAT-THISW. U
T. A COPY OF THIS
Gw•1 ealAN — 5 2000 �J ,l,
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)
c
D IN AbCORDANCE'WITH 15 NCAC 2C, WELL CONSTRUCTION
'ROVIDED TO THE WELL OWNER.
SIGNATURE OF CONTRACTOR OR AGENT DATE
Submit original to Division of Environmental Management and copy to well owner.

North Carolina - Department of 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: 211-t go,
WELL CONTRACTOR CERTIFICATION #:
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE (Check Applicable Box): Residential ® Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
1iecovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATION:Show sketch of the location below)
Nearest Town: - �(r� /k/y__Ae;Y County:
(Road Name umbers, Community, or Subdivision and Lot No.) DRILLING LOG DEPTH
3. OWNER c From To Fonna:icn Description
Address (ram = J ,�; 7 �Z_-tl�
treet or mute o.)
` City or Town State Zip Code
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: /,0 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 J/ l
10. YIELD (gpm): METHOD OF TEST _ a� Lizrr )
11. WATER ZONES (depth): d17,
� 65,P i
12. CHLORINATION: Type Ff�� Amount �7y If additional snares is needed usa bade of fncm
13. CASING:
Wall Thickness
Depth Diameter or Weight/Ft, Material
From 6_ To y� Ft._
IdL
LOCATION SKETCH
(Show direction and dis3ance from at least two State
Roads, or other map reference points)
From
To
Ft.
From
To
Ft.
14. GROUT:
Depth
Material
Method
From ; %
To �Q 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.
Inw
16. SAND/GRAVEL PACK:��
Depth
Size
1) p,MdteHai"
�
From
To
Ft.
tll!;
From
To
Ft.
Li I
17. REMARKS:
DO HEREBY CERTIFY THAT THIS WELL WAFS,CONgtA' :TEb-1N'ACCdRDANCE WITH 15A AQCAC 2C, YtELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN IFROVIDED 1170 THE WELL O"NER,
FOR OFFICE USE ONLY
Quad No:
Serial No.
c�
o
CD
C_ c X
C c M
C-3
-- r'n
M�
r*rn
N —C-)�r
O o
z
SIGNATURE OF PERSON CONSTRUCTING TKe WfELL DA E
Submit original to Division of Water Duality, Groundwater Sectcn within n dTys
GW-I REV. 112911

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section �_ , 0 9 9
1636 Mail Service Center - Raleigh, N.C. 27699-1636•Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR: NkAb o Y, n & cr) L �,3o A a et urat n
WELL CONTRACTOR CERTIFICATION #: Z.y
STATE WELL CONSTRUCTION PERMIT#: 1 �inZ
1. WELL USE (Check Applicable Box): Residential LY Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below) a
Nearest Town:_s i VYA01In County. �+-�-L-�D1 & C11YL�1Q
- +�1 .J .--4l 0 0 1 'a C_Ag4
(Road Name and Numbers, Community. or(;ATdivisicn and Lot No.) DRILLING LOG DEPTH
3. OWNER From To Fonnatim Des=iption
Address LlMA
(street or Floute o.
C ti lam\ C. &(D)y11 `1 n
City or Town State Zip Code
4. DATE DRILLED l i- O
5. TOTAL DEPTH
6. CUTTINGS COLLECTED YES ❑ NO[D-' rn mac`'
7. DOES WELL REPLACE EXISTING WELL? YES ❑ NOf�:J nl
8. STATIC WATER LEVEL Below Top of Casing: Mtn FT. N ��
(Use '+' it Above Top of Casing) -p
9. TOP OF CASING IS FT. Above Land Surface' rn
'Top of casing terminated attor below land surface requires a variance In aacor- rn;:5
dance with 15A NCAC 2C .011 e ,cli
10. YIELD (gpm): � Do } METHOD OF TEST
11. WATER ZONES (depth):
lick '� C]�tYl z
12. CHLORINATION: Type Amount
13. CASING:
wall Triickrwss
Depth Diarneder cr We'ght/FL kta
From To LA c,-) Ft. t
From To Ft.
From To Ft.
14. GROUT:
Depth Material Method
From L— To .L') Ft. 0 n t T
From To Ft.
15. SCREEN:
From
From
Depth Diameter Slot Size . Material
_ To F3 in. - in.
To Ft
From 'To Ft.
16. SAND/GRAVEL PACK:
Depth
From To
Ft.
From To Ft.
17. REMARKS:
in. in
in. in. _
Size Material
If additicnal spare is needed use backcf fort
LOCATION SKETCH
(Stow drection and distatnce frm at least two State
Roads, or other map• referem. a points)
I DO HEREBY GERTIF-lf THAT T.KS..WEIL.L,WAS CGNSTRUCTED IN ACCORDANCE WITH I!A NCAC 2r, WELLCONSTRUM1T PtRTADgia, &ND[THATA`COP i(OF THIS RECORD HAS BEEN PFtOVIDEEO TO THE: r/ELL OM ER.
FOR OFFI L
E ONLY k ' w i AJ`
Quad No: 2211(�1 Ji SIGNATURE OF PEFSON CONSTRUCTitNt3 T WE: L OATS
.)bm� ' inaC to Dwisfon of Water Quality. C3w-4%vator Sea= witthin 8r day,s
Serial No. GW-1 REV, t2'!T

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section �' '' 10
1636 Mail Service Center - Raleigh, N.C. 27699-1636-Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR: Cyr,, fVD
WELL CONTRACTOR CERTIFICATION M 30�_1 I
STATE WELL CONSTRUCTION PERMIT#; 1 �-AO 2
1. WELL USE (Check Applicable sox): Residential Er 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: rZ b1 ('+ S + l County. 2 k Y\ 0 C,
(Road Name atW Numbers. Community. or Subdivision and lot No.)
DRILLING LOG DEPTH
3. OWNER l
From To Formation Des=iption
AddressrN-��V to I o F /
r rRoute 0.
-
City or Town State Zip Code
4. DATE DRILLED 00
5. TOTAL DEPTH
6. CUTTINGS COLLECTED YES ❑ N0[Ej-'
7. DOES WELL REPLACE EXISTING WELL? YES M NO�
o
B. STATIC WATER LEVEL Below Top of Casing: FT.
r-, o
(Use •+• If Above Top of Casing)
0�
9. TOP OF CASING IS S FT. Above Land Surface
E,
`Top of casing terminated at/or helow land surface requires a variance In accor-
dance with 15A NCAC 2C.0118
10. YIELD (gpm): ? ') METHOD QF TEST 1 V3
Dv
11. WATER ZONES (depth): nDM
12. CHLORINATION: Type Amount
rrr
rr
If additicmi space is needed use back c( form
13. CASING:
_
Wall Trickness
z
LOCATION SKETCH
Depth Diameser cr Weight/A. Malarial
From 0 122 -,* (�
(Show directron and distance trcm at feast two State
To Ft. -d
Roads, or other map reference points)
From To Ft.
From To Ft.
14. GROUT:
Depth MlaterW Method
From �_ To . 2- Ft. En I. \ 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 Material
From To Ft.
From To Ft.
17. REMARKS:
I DO HEREBY CERTJFYTH4,T; _K,S;,.W..ELL_WAS:CGNSTRUCTED IN ACCORDANCE W!ITH 15� NCAC 2;,, WELL
CONSTRUCTIOj I°3] AN0A6D%r Np TJ'AT;* C, ? OF THIS F[Ecorl) HAS BEEN PROVIDED TO THE r/EL OWNER.
FOR OFFICE U7 "4°NLY `t 3 1 1 - t �--
Quad f4o: A01 9�krNATUAE OF PEFWN CONSTRUCTING T►E w DATA
Submit Ina�;to Dwislon of waterOuality. Groj-4wator Sect= wMhin 31 day ,$
Serial No. I GW-I Rev. 12?1

North Carolina •Department of Environment and Natural Resources -Division of Water Quality •Groundwater Section 103
1636 Mail Service Center - Raleigh, N.C. 27699-1636•Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR: �`��� c " cu Q�x� 1' ' �' ��+ Pt tsr'-p
WELL CONTRACTOR CERTIFICATION #: �'�QL�'I
STATE WELL CONSTRUCTION PERMIT#: x-() Z
1. WELL USE (Check Applicable Box): Residential❑ "Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATIQN: (Show sketch of the location below)
Nearest Town:. County.
(Road Name d Numbers, Comm�{ury, or Subdivision and Lot No.)
DRILLING LOG DEPTH
3. OWNER ��'1Y11 0 A n_ZQCI_C)k G
From To FormationDes=iptior.
Address ` 1 A 'a 6?r1
In
Ct C1 11 I(� C� (SN eet or �1C o
City or Town State Zip Code
4. DATE DRILLED t 0 - 0 .�
5. TOTAL DEPTH t tl
Q
6. CUTTINGS COLLECTED YES ❑ NO[a'
o
7. DOES WELL REPLACE EXISTING WELL? YES ❑ NO[D'
rr e�rt'
8. STATIC WATER LEVEL Below Top of Casing: s��� FT.
n Cm
(Use'.*' If Above Top of Casing)
N
9. TOP OF CASING IS�_ FT. Above Land Surface*
�o
'Top of casing terminated aUor below land surfaos requires a variance In actor.
_
dance with 15A NCAC 2C .011 e
10. YIELD (gpm): I,o C� METHOD OF TEST _-Sul
-' m�
11. WATER ZONES (depth): Z to CU
CD -�-+
0
'
12. CHLORINATION: Type d Amounts
z
If additicnal space is needed use back ct for=
13. CASING:
LOCATION SKETCH
Wail rricknm
Depth Diameaer cr WeighVFL rial
I l A k Q " '— ` e---
(Show drection and distance trim at Seast two State
From To Ft.
Roads, or other map reference points)
From To Ft.
From To Ft.
14. GROUT:
Depth Material Method
From To Ft. F_
From To Ft.
15. SCREEN:
Depth Diameter Slot Size . Matecal
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 W_�i1.L,,,,�l�I�S:CGfNSTRUCTE'O IN ACCORDANCE WITH 15A NCAC 2r, WELL
CONSTRUCTIOt 5'�JCN A t' AN6VII'h:tl9'T 11 C� Ire THIS FtECOi;A HAS BEEN PFtOVIDL. A TO THE r/El.:�' OwfER.
FOR OFFICE Y SEIQNLY ' v ` `
Ouad No: 'Y IGNATURE OF PEF ON CONSTRUCTItNG TIC We 1. DATA
2056)b4 In to Dhaion o/ W&WOualitq, Grov:+dwataer Sedan wftthln 37 days
a 'I GK' t Ri<v, t2l9
Serial No.
{ p�rsttrl

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section 2 0.4 41
1636 Mail Service Center - Raleigh, N.C. 27699.1636-Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR: Q-1f_Pelno'Ivm
WELL CONTRACTOR CERTIFICATION N: _ 2 y 18
STATE WELL CONSTRUCTION PERMIT#: ►4r)2.
1. WELL USE (Check Applicable Box): Residential & Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑ Aecovery ❑ Heat
Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: IP nA - Cl r 14--� County: ►'�1 t Y\(' ChrY�h
IA"vd-P
r�
(Road Name and Numbers, Corrnrurnity, or Subdivision and Lot No.) DRILLING LOG DEPTH
3. OWNER C .p I-,VN rv-1 n r r
_
From To Fomuxn DescriptionAddress ,�� AV+P �S ��P �
Q 1\2
�
�/ ree or _ 1 12 50 5
[' C12iPr� 28`
0q
City or Town State zip
4, DATE DRILLED 1 Del
5. TOTAL DEPTH 'So�
6. CUTTINGS COLLECTED YES ❑ NO[a-
7. DOES WELL REPLACE EXISTING WELL? YES ❑ No
S. STATIC WATER LEVEL Below Top of Casing: (� n _ Fr,
(Use'+' II 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): 2E2._ METHOD OF TEST ZhrS
11. WATER ZONES (depth):- ?roll - ,.5as
12. CHLORINATION: Type't1'i Amount
._ It additional s
13. CASING: Pace is needed use back of form
Wall Thickness LOCATION SKETCH
Depth Diameter or Welght/Ft. Material (Show direction and distance from al least two State
From - To _I_l_2� Ft. _U I_
- ___.S� ,t,_ Roads, or other rrap reference points)
From______— To Ft._
From .-.-__To .._._ Ft.
14. GROUT:
Depth Material Method c�
From To 2Cl Ft. IW1 a n-4 fJ c�71
From ._ To —Ft. Ca
15. SCREEN: t .
Depth Diameter Slot Size Material r'
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 114CAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WE'U. ON'KER,
FOR OFFICE USE ONLY h` 11.
Quad No: SIGNATUR RSON CONSTRUCTING THE WrELL DATE
Serial No. submit original to.Divislon r Quality, Groundwater Sector, within V days
Grr.t RI=v.12"
ttllRea •

North Carolina -Department of Environment and Natural Resources • Division of Water Quality •Groundwater Section
U40
1636 Mail Service Center • Raleigh, N.C. 27699-1636•Phons [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR: �,rp_-__ erg _'�,✓r�5 (Kie L t 'i PuMjo
WELL CONTRACTOR CERTIFICATION #: N 1?
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE (Check Applicable Box): Residential 12" Municipal ❑ Industrial ❑
Aecovery ❑ Heat Pump Water Injection ❑ Other ❑ if Other, List Use:
Agricultural ❑ Monitoring ❑
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: --- '�yri-r- r1 County: h
(Road Name and Numbers. Community, or Subdivision and Lot No.) DRILLING LOG DEPTH
3. OWNER —7 P S_Y1_[_1► na r� From To Fomutim Description
Address V ` \ 2 �CA
City or Town State Zip Code
4. DATE DRILLED At-214,00
5. TOTAL DEPTH s n %AE-,
6. CUTTINGS COLLECTED YES ❑ NO
7. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
EEr-
8. STATIC WATER LEVEL Below Top of Casing: FT.
9. TOP OF CASING IS 1 (Use's• U Above Top of Casing)
FT. Above Land Surface*
'Top of casing terminated at/or below land surface requires a variance In accor.
danoe with 15A NCAC2C.0118
10. YIELD (gpm): AT METHOD OF TEST h►3
11. WATER ZONES (depth):
12. CHLORINATION: Type Amount If addioonal s
13. CASING: pace is needed use back at focm
Wall Thickness LOCATION SKETCH
Depth Diameter or Weight/Ft. Material (Show direction and d'atanee from at least two ftie
From —.%LTo _ L 12 Ft, To Ft. -Roads, or other map reference points)
From._._
From To._._ Ft._..___
14. GROUT:
Depth Material Method
cj
From ...Qr To .10_ Ft. 01 JC) , o C
From To —Ft. - t�
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.w._- Ft.
17.. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I SA 114CAC 2C, W'ELL
CONSTRUCTEO i°f rT- OF THIS RECORD HAS BEEN PROVIDED 'TO THE WELL OWxER.
ft
FOR OFFICE U LY U
Quad No: NATURE OF PERSON CONSTR T1e yWELL OATS
i i9�4rN1 Serial No. Divlslon of Water Ouality. Groundwater Sect;cn within 30 days
Gw•1 NEV. 12"
Groundwater Section
Asflevilla Raeinnrl

'.)0O((��
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section �- �- 6.. V 9 5
1636 Mail Service Center - Raleigh, N.C. 27699-1636-Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR: (')c��PnPc�� lt�`x� t _L �
WELL CONTRACTOR CERTIFICATION #: 30 LA t
STATE WELL CONSTRUCTION PERMIT#: I LA02-
1. WELL USE (Check Applicable Box): ResidentialQ"' 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: - '11-Dw-v t County. - ► tt lc Cl'Mh('.
(Road Name andNiknbers, Community, or bdivWon and Lot No.) DRILLING LOG DEPTH
3. OWNER From To Formation Desc:iptior.
Address 1 QCA C� Lj
(.Street or Route o. `j{ )
�A E mol- '2_8W-�
City or Town Stets Zip Code
4. DATE DRILLED `1-
5. TOTAL DEPTH
6. CUTTINGS COLLECTED YES ❑ NOQ-
7. DOES WELL REPLACE EXISTING WELL? YES ❑ NOEr
B. STATIC WATER LEVEL Below Top of Casing: kC1C) FT.
(Use '+' Il Above Top of Cuing)
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 .011tt
10. YIELD (gpm): �_ METHOD OF TEST
11. WATER ZONES (depth): 2�
12. CHLORINATION: Type "2U� Amount
13. CASING:
watt sickness
Depth Dian*ner sY wesight/R, Ataderial
From C—To LA - Ft. r � V -0
From To Ft.
From To Ft.
14. GROUT:
Depth MaterW Method
From 0 To _L Q___ Ft. 0 SL tS (L_ T
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:
lm%a o
It additicrel space is needed use back c fo=
LOCATION SKETCH
(Show direction and dista=e fr-m at least two State
Roads, or other map reference points)
I DO HEREBY CERTIFY THAT THIS WELL WAS CCtNSTRUCTED IN ACCORDANCE WITH 15A NCAC 2r, WELL
CONSTRU�CI„ QN S ANOAFt S MO THAT A COPY OF THIS RECORD HAS BEEN PF. OVIDc.O TO THE r/EL::. OWNER.
FOR OFFIO" +D D
Quad No: k ! SIGNATURE OF PERSON CONSTRUCT1iN hE We L DATA
nigInai to Dw4lon or water Qualitty. GM r4wat*r SeaGn wftthln 53 days
Serial No. GV(-I Re_Y, iZ"

North Carolina - Department o1 Environment and Natural Resources - Division of Water Duality . Groundwater Section : A- 4, 1 0 0
1636 Mail Service Center - Raleigh, N.C. 27699-1636-Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR: 0_n e � E
WELL CONTRACTOR CERTIFICATION #: y Ili
STATE WELL CONSTRUCTION PERMIT#: 40'L _
1. WELL USE (Check Applicable sox): Residential al'- Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, Ust Use:
2. WELL LOCAT N: (Show sketch of the location below)
Nearest Town: �) L CK RY1(I i2 fl County ,P ► 1 L(1 �Yl� b
(Road Name anANumbers,_QommuNty. or Subdivision and Lot No.) DRILLING LOG
3. OWNER From To
Address
j treet �or Hou�tse o. y�Q , l r �� \lL� b 1 l ��. �� C�7
City or Town State Zip Code
4. DATE DRILLED L
5. TOTAL DEPTH \ B2r5
6. CUTTINGS COLLECTED YES ❑ N00--
7. DOES WELL REPLACE EXISTING WELL? YES ❑ NOEf:r
8. STATIC WATER LEVEL Below Top of Casing:. FT.
(Use '+' it Above Top of Casing)
9. TOP OF CASING IS_1_ FT. Above Land Surface*
'Top of casing terminated at/or below land surface requires a variance In accor-
dance with 15A NCAC 2C .011 a
10. YIELD (gpm): IA� METHOD O ; TEST _hL,
11. WATER ZONES (depth):
Yy-)
DEPTH
Formation Des=iptior.
a
v
O v
n Cm
12. CHLORINATION: Type 1� ZAmount I It additicrial space is needed use back forte
13. CASING:
Wall Tnickrim
Depth Diame+ler cr Weght/R nal
From To Ft.
From To Ft. -
From -To- Ft.
14. GROUT:
Depth Material Method
From l; To C) Ft. f VYA V 0 f +'a4Q
From To Ft.
15. SCREEN:
Depth Diameter Slot Size . Mateeal
From To Ft in. in.
From To Ftin. in.
From 'To -Ft-- in. _
16. SAND/GRAVEL PACK:
Depth Size
From To Ft.
From To Ft.
17. REMARKS:
in.
Material
LOCATION SKETCH
(Show drect;on and distance trrn at least two State
Roads, crr other map referr=e points)
I DO HEREBY CERTIFY THAJ THIS WELL WAS CCINSTRUCTED IN ACCOIRDANCE WITH 1S; NCAC 2;,, WELL
CONSTRUOTTC2,fJ $,TAIlQAJRI0% AN, T)r1AT, COP'( OF THIS RECORD HAS BEEN PROVIDER TO THE YIEL'! OWNER.
FOR OFFICq U� ONLY t l t
Quad f1o: lI �,p 11 SIGNATURE G wSa PEFN CONSTRU G W:1. OATS
'JAN � � Fl�(�,�u (hat to Dnalon or water0ualuq, Grar+dwatrer Sear rt witthln 51 days
Sertai No.
GW•1 RAY. 12?t
�.,tntrti��t'4ttG5 a]R4t`ii(�tt
Ash , iile R..'Viollal Office,m-H..

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. 5 4 6 4
WELL CONSTRUCTION RECORD WELL CONTRACTOR: cc oil
WELL CONTRACTOR CERTIFICATION if:
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE (Check Applicable Box): Residential p Municipal El Industrial ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATION: Show sketch of the location below)
Nearest Town: N i9IFU1 13 County: _ kLw fY1 Cr�Yx l>p
Agricultural ❑ Monitoring ❑
(Road Na4and Numbers, Community, or Subdivision and Lot No.) DRILLING LOG DEPTH
3. OWNER o From To Forma:im Description
Address �( k6a 0
treet or Ro o.) O �o O
ggl
City or Town Stale Zip Code
4. DATE DRILLED
5. TOTAL DEPTH lo6i_
6. CUTTINGS COLLECTED YES ❑ NO
7. DOES WELL REPLACE EXISTING WELL? YES 0 N0g]
B. STATIC WATER LEVEL Below Top of Casing: FT.
(Use '+' it Above Top of Casing)
9. TOP OF CASING IS FT. Above Land Surface -
'Top of casing terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2C .0118
10. YIELD (gpm): 04 METHOD OF TEST -2�.A��
11. WATER ZONES (depth):
12. CHLORINATION: Type Amount If add'rdonal space is needed use back of corm
13. CASING:
Wall Thickness LOCATION SKETCH
Depth Diameter or Weight/Ft. Material (Show direction and dLidance from al least two State
From a To 46 Ft. ____4 "1 �' Roads, or other map reference points)
From To Ft.
From To Ft.
14. GROUT:
Depth Material Method
From G To 1_ 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
0
0
�=•
c;
x�
rn
Cc
0
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A 64CAC 2C, W'ELL
CONSTRUCTION; S' IAf'OARDS; AND THAT�A COPV<OF THIS RECORD HAS BEEN PROVIDED -TO THE WELL OWNER.
t (t --..'
FOR OFFICE USEiONLY r�11,
''
Quad No: � W v I � a i( ++ ! 7j iI l Ir P I SIGNATURE OF PERSON CONSTRUr:TING THE WSLL DA7'7 £
sl :.,� t �` t f
96b,mlt p r alto Division of Water Ouality, Groundwater Sect4n within V dvys
Serial No. a'_.
ti to,Grr•1 REV. 1297

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section 15 4 6 3
1636 Mail Service Center - Raleigh, N.C. 27699-1636-Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR:.
WELL CONTRACTOR CERTIFICATION
STATE WELL CONSTRUCTION PERMIT#:
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:- �1Jn- County: ---la,r�Qr�d>��1¢
(Road Name and bers, Community, or Subdivision and Lot No.)
DRILLING LOG DEPTH
3. OWNER ,uA _
From To Forma: on Description
Address N Q &
6
(Streetor oute o.
_ j1,ig, AC I Ale.70•? 7
City or Town V Stale Zip Code
4. DATE DRILLED
5. TOTAL DEPTH ,,56
6. CUTTINGS COLLECTED YES [1 NOE]
7. DOES WELL REPLACE EXISTING WELL? YES[] NOg]
8. STATIC WATER LEVEL Below Top of Casing: 1,g 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 .0118 /
10. YIELD (gpm): _-2 METHOD OF TEST
11. WATER ZONES (depth): ---?4
12. CHLORINATION: Type Amount_
If additional space is needed use back of foem
13. CASING:
Wall Thickness
LOCATION SKETCH
Diameter or Weight/Ft. Material
Depth lye,
From To Ft. 6 "' �_
(Show direction and distance from a3 least two State
Roads, or other map reference
From To Ft.
points)
From To Ft.
14. GROUT:
Depth
Material
Method
From o
To 40 Ft. C-cW"ajd _ _
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
CD
c-D
c;
r= ,'T,
& w
M
�1-D
M
^'r=,-,
kn
rn
From To Ft. o
From To Ft.
17.. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A 69CAC 2C, W'ELL
CONSTRUCTION STANDARDS,_AND.THAT.A COPY OF THIS RECORD HAS BEEN PROVIDED 70 THE WELL O'AhER.
FOR OFFICE USEON Y _l� - �J .ICI
Quad No:
Serial No.
A
.9-
SIGNATURE OF PERSON CONSTRUCTING THE WrELL DA E
�l ''S6 nil oiiguial to Division of Water Quality, Groundwater Section within n days
Grr-I Rev. 121"

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section J. 5 `•} 5 9
1636 Mail Service Center - Raleigh, N.C. 27699-1636.Phone [phone]
WELL CONSTRUCTION RECORD WELLCONTRACTOR: , X.�9.__ ,(�9 (A
WELL CONTRACTOR CERTIFICATION
STATE WELL CONSTRUCTION PERMITC
1. WELL USE (Check Applicable Box): Residential �] Municipal ❑
Industrial ❑ Agricultural El Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other
If Other, List Use:
2. WELL LOCATION: how sketch of the location below)
Nearest Town, County:
(Road Name Numbers, Community, or Subdivision and Lot No.)
DRILLING LOG DEPTH
3. OWNER
Address
From To Fonna:onDescription
n 'A I �lr� J
treet or out. o.
el,�'JC a� 2/
—
City or Town State Zip Code
4. DATE DRILLED _ 7 //- I a
5. TOTAL DEPTH
6. CUTTINGS COLLECTED YES ❑ NOZ
7. DOES WELL REPLACE EXISTING WELL? YES ❑ NOM
8. STATIC WATER LEVEL Below Top of Casing: FT.
(Use '+' If Above Top of Casing)
9. TOP OF CASING
IS�_ FT. Above Land Surface -
*Top of casing terminated at/or below land surface requires a variance In accor-
dance with 15A NCAC 2C .0118
10. YIELD (gpm): �' METHOD OF TEST
11. WATER ZONES (depth): /s,�ID�.
12. CHLORINATION: Type AL% A oun'
If additional space is needed use back of form
13. CASING:
Wall Thickness
Depth Diameter
LOCATION SKETCH
or Weight/Ft. Material
From To _ _dg(__ Ft. & /�
(Show direction and dissance from as least two Mate
1.1_
From To Ft.
Roads, or other map reference points)
From To Ft.
14. GROUT.:
t_.,
Depth Material Method
D �errli•�r>IT-�
o
c:>
From To 146 Ft.
From To FL
rTl
15. SCREEN:
Depth Diameter Slot Size Material
-�y
From To Ft In. in.
From To Ft. In. in,
From To Ft. In. in.
16. SAND/GRAVEL PACK:
—J
o
Depth Size Material
From To Ft.
From To Ft.
17.. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A AdCAC 2C, V4'ELL
CONSTRUCTION`STANOARDS, AND THAT A COPY OF THIS RECORD HAS EEN PROVIDED 70 THE WE' I.OIA hER.
FOR OFFICE USE ONLY
Quad No: t , a t �t�r� SIGNATURE OF PERSON CONSTRUCTING Tf•C WrELL DAT• £
Sutxnll original to Division of Water Ouality, Groundwater Sectcn within a0 d.TyS
Serial No. a'
Gyr•I Rev. 1299

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: . &j
WELL CONTRACTOR CERTIFICATION #: �o�X
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE (check Applicable Box): Residential IR Municipal ❑ Industrial ❑
Recovery ❑ Heat Pump Water injection Other E] If Other, List Use:
2. WELL LOCATIO : (Show sketch of the location below)
Nearest Town: )D 111i l <2- County:
Agricultural ❑ Monitoring ❑
(Road Name and umbers, Community, or Subdivision and Lot No.) DRILLING LOG DEPTH
3. OWNER 4 C From To Formation Description
Address t
tree o oute o. __"
r
City or Town State Zip Code
4. DATE DRILLED - L) U
5. TOTAL DEPTH ,?d S
6. CUTTINGS COLLECTED YES ❑ NOE]
7. DOES WELL REPLACE EXISTING WELL? YES NOZ
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 attor below land surface requires a variance In accor-
dance with 15A NCAC 2C .0118 /
10. YIELD (gpm): -246 METHOD OF TEST /1
11. WATER ZONES (depth):
12. CHLORINATION: Type Amount_ If additional space its needed use back of form
13. CASING:
Wall Thickness
Depth Diame err or Weight/Ft. Material
From 0 To :� Ft. L
From To Ft.
From To Ft.
14. GROUT:
Depth tenal Method
From d To -. 20 _ Ft. msrdc _
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 Matetial a
From To Ft. j { �'
From To Ft.
17.. REMARKS: HIM tall.
I DO HEREBY CERTIFIM16I THIS WELL WAS
CONSTRUCTION STA lR--cm- . 10
FOR OFFICE USE 0
Quad No:
JUN -
Sedal No.
gq-- im
LOCATION SKETCH
(Show direction and disunce from al least two State
Roads, or other map reference points)
Co
a
L.
C
co
X0
3
n`
v
15 ' 04CAC 2C, W -ELL
DE0 SO THE WEU. 0%%ER.
'X� u'f . ( YJ ro _
OF PERSON CONSTRUCTING Tic WELL DAT. E
of Water Quality, GrourKiwater Sectcn within 80 d.TyS
t�
0
c7 �
o�
c
tnrn
t
�C7
mC3
=o
rn
cnz
m�
Cl)
0
x
Grr.t REv. 12"

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 #: a ��
STATE WELL CONSTRUCTION PERMIT# A 9 02 _
1. WELL USE (Check Applicable eox): Residential E Municipal ❑ industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ if Other, List Use:
2. WELL LOCATIO (Show sketch of the location below)
Nearest Town: - I r- County: 2l x_nr (Y11nP
(Road Name and Numbers, Community, or Subdivision and Lot No.) DRILLING LOG DEPTH
3. OWNER P (' ht�m1->�t� 0-10 ^ t �'1Pr^l�1- -C From To Formarm Description
Address 1?>��t4 QL-1 v-1Q0 :i ��tut,t O e �a
I -
trees or oute o. �ti
'�4 t Q 1 e n > Ki C. 28 `l -,�c
City or Town State Zip Code
4. DATE DRILLED
5. TOTAL DEPTH
6. CUTTINGS COLLECTED YES ❑ NO CD
_,
CD
7. DOES WELL REPLACE EXISTING WELL? YES ❑ NOEr
e=
8. STATIC WATER LEVEL Below Top of Casing: P_ 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 .nt 18
10. YIELD (gpm): _'��QCL METHOD OF TEST Zy)r-,
11. WATER ZONES (depth):
'? a 51 )_,gt
o
12. CHLORINATION: Type i-1T1-1 Amount If addmonal space is needed use back of form
13. CASING:
LOCATION SKETCH
Wall Thickness
Depth Diameter or Weight/Ft. Material (Show direction and diissance from al least tHo Iolale
C -1 U , PVC
From To Ft. —S () - Roads, or other map reference points)
From To Ft.
From To Ft.
14. GROUT:
Depth Material Method
From To 1-0 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-•C•• RTIFY THAT THIS WELL.WAS CONSTRUCTED IN ACCORDANCE WI 5A 69CAC 2C, V0ELL
CONSTRUCTE9 T�146XRk AND THAT A COPY O o B N R THE Y/E OwhER.
1171111FD70
FOR OFFICE U ON
���� OATE
Quad No I I .SIGN OFr vwLLL
oripin'al �il n days
Submit to of . t within
f Serial No. Grr•1 Rev. 121"
'
i
j, Groundwaier Section

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: - (- y Q D it.0 f�or�
WELL CONTRACTOR CERTIFICATION #: Z� 1
STATE WELL CONSTRUCTION PERMIT# � Z
1. WELL USE (Check Applicable Box): Residential Municipal ❑ Industrial ❑ Agricultural Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATI,(�N: (Show sketch of the location below)
Nearest Town: l` � n d � t t>~ County: L l no iont ke
(Road Name and Numbers. Community, or Subdivision and Lot No.) DRILLING LOG
3. OWNER _SoNAn CnQ i--Pf'. From To
Address P. ()a,,.,N F�
(Street or oute o. r
City or Town State Zip Code
4. DATE DRILLED ,S`1 L-00
5. TOTAL DEPTH 21 o f
6 CUTTINGS COLLECTED YES ❑ hitl
DEPTH
Forma•.im Description
0 ('t I I
7. DOES WELL REPLACE EXISTING WELL? YES ❑ NOrl
S. STATIC WATER LEVEL Below Top of Casing: 1C�-) FT.
(Use '+' if Above Top of Casing)
9. TOP OF CASING IS�_ FT. Above Land Surface-_
'Top of casing terminated atlor below land surface raqulres a variance In accor-
dance with 15A NCAC 2C .0118
10. YIELD (gpm): METHOD OF TEST
11. WATER ZONES (depth):
12. CHLORINATION: Type Amount 'nrt) It additional space is needed use back of forte -�
13. CASING:
Wall Thickness
Depth Diameter or Weight/Ft. atenal
FromToFt. �0 " -
From To Ft.
From To Ft.
14. GROUT:
Depth Material Method
From Q_ To?D Ft. 0S m 1A } AC�Q_
From To Ft.
15. SCREEN:
Depth
From To Ft
From To Ft.
From To Ft.
16. SAND/GRAVEL PACK:
Depth
From To _
From To_
17. REMARKS:
Diameter Slot Size Material
in. in.
In. in.
In. In.
Size Material
Ft.
Ft.
t DO HEREBY CERTIFY THAT Jh)a VI LL 1V
CONSTRUCTION'STANOA�j iD; A�DfAjg<
FOR OFFICE USE`ONLY - L55 1`'1' t�
Quad No: rj f� fish
�H t
Serial No.
LOCATION SKETCH
(Show direction and distance from as least two S.1ate
Roads, or other map reference points)
STRUCTED IN ACCORDANCE WITH 15A 04CAC 2C, YirELL
OF THIS RECORD HAS BEEN PROVIDED TO THE NIEU OwhER.
R$P"RSOWOON&TRUCTINT
'WrELL `J OAT• E
of Water Duality, Groundwatern ,within � days
MAY I i 2000 l Grr.1 RrzV. 12'"

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: 21a't"_ Ad6a. LL111
WELL CONTRACTOR CERTIFICATION it:
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE (Check Applicable Box): Residential[A Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATION- (Show sketch of the location below)
Nearest Town: (�2/i 11, r J )1 J County:L.
(Road Name and Numbers, Communi , or Subdivision and Lot No.) DRILLING LOG DEPTH
3. OWNER From To Forma5on Description
Address ,L� � � ,1 n �,n'�a� i
(Street or outs o. �� n „ _LLL�L
City -or Town Stale Zip Code
4. DATE DRILLED- //- 6 a
5. TOTAL DEPTH 3-2.5'
6. CUTTINGS COLLECTED YES ❑ NOR]
7. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
8. STATIC WATER LEVEL Below Top of Casing: k6 FT.
(Use '+' If Above Top of Casing)
9. TOP OF CASING IS FT. Above Land Surface -
'Top of casing terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2C .0118
10. YIELD (gpm):METHOD OF TEST
11. WATER ZONES (depth): -A Q 6
12. CHLORINATION: Type Amount If additional space is needed use back of form
13. CASING:
Wall Thickness
LOCATION SKETCH
Depth Diameter or Weight/Fi. Material
(Show direction and d',ssance from a3 least two Mate
From 46
To 6 5' Ft. 4-a _
Roads, or other map reference points)
From
To Ft.
From
To Ft.
-yam
14. GROUT:
cO
x
Depth ateMethod
o
L
�
C)
From G
�rial
To.n Ft. —S 1Z1�7L[.aL_ �—
Z
CZ rn
From
To Ft.
t
-_ rn
15. SCREEN:
00�rn
Depth Diameter Slot Size Material
rnC3
From
To Ft In. in.
o
z
From
To Ft. in. In.
X_
c')
From To
16. SAND/GRAVEL PACK:
Co
Depth [y Size Mat
From
From
To---ti
To
17.. REMARKS:
I DO HEREBY C s • sFlUff-ED IN ACCORDANCE WITH 15A 64CAC 2C, W'ELL
CONSTRUCTIO N R F THIS RECORD HAS EEN PROVIDED TO THE WELL M-NER.
FOR OFFICE US Y -U
Quad No: J JN --. J 2000 IATURE OF PERSON CONSTRUCTING Tie WELL DATE
Submlt on iPrio, ivWon of Water Quality, Groundwater Section within V days
Serial No. Gvr.t Rev, 1299
—�t18UtldwatOf
/�`' Asheville Rettig

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Ground -water Section
1636 Mail Service Center - Raleigh, N.C. 27699-1636-Phone [phone]
WELL CONSTRUCTION RECORD WELLCONTRACTOR: O'Liy o o Flo tiU0 Q _Dt24rQt.. 1q/
WELL CONTRACTOR CERTIFICATION #: 2-2,Sn
STATE WELL CONSTRUCTION PERMIT#: 1 LA 02-.
1. WELL USE (Check Applicable Box): Residential ED Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATI: (Show sketch of the location below)
Nearest Town: Xa ryl � I N County: Dk k n r nryk 1C1 0i.
:a,, Y1 n
(Road Name and Numbers. Community, or Subdivision and Lot No.)
DRILLING LOG DEPTH
3. OWNER TArn�t F nA (I KmJ
From To Forrna:ion Description
Address t
n ZC _ o. c a_u
trees or, use o.
(1-`(1 h (}
CityorTown State Zip Code
4. DATE DRILLED 2- ZC1 • CO
5. TOTAL DEPTH U y
6. CUTTINGS COLLECTED YES ❑ NO�
CD
_ .
7. DOES WELL REPLACE EXISTING WELL? YES ❑ NO�
8. STATIC WATER LEVEL Below Top of Casing: k 00 FT.
p
(Use '+' if Above Top of Casing)
9. TOP OF CASING ISFT. Above Land Surface -
c_7
'Top of casing terminated at/or below land surface requires a variance In accor-
dance with 15A NCAC 2C .0118
10. YIELD (gpm): ice. METHOD OF TEST
11. WATER ZONES (depth): `-A 2 �
w --,
12. CHLORINATION: Type —Amount
If additional space its needed use back of focm
13. CASING:
LOCATION SKETCH
Wall Thickness
Depth Diameter or Weight/Ft. Material
% %
�— )P
(Show direction and disiance from as least hvo Male
From To Ft. � .0
Roads, or other map reference points)
From To Ft.
From To Ft.
14. GROUT:
Depth Material Method
From _ To 9_0 Ft. 0 � M M }
From To
15. SCREEN:
Depth
From To Ft
From To Ft.
From To Ft.
16. SAND/GRAVEL PACK:
. Ft.
Diameter Slot Size Material
in. in.
in. in.
in. in.
Depth Size
From To Ft.
From To Ft.
17. REMARKS:
Material
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A AQCAC 2C, W'ELL
CONSTRUCTION,STANDARDS, AND THAT A.COPY OF THIS RECORD HAS BEEN PROVIDED TO THE we" O"'hER.
FOR OFFICE USE ONLY „ a n. I
Quad No: j �i `. ' Q SIGNATURE OF P NSTRU CTING I I DATE
20Qt•7ubrr t'o��it�inal to Division of Wa ity, Groundwater .c uv i ddys
Serial No. a a✓ar ; MAY I ( LtnJ�f Grr•I RrzV. 12%
'`''•,:' r%'';^°t groundwater Section
' �rtAshevilie �e�ti�mal.�tfice 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: -0JU `+
WELL CONTRACTOR CERTIFICATION #: 2
STATE WELL CONSTRUCTION PERMIT#: y�fl2
1. WELL USE (Check Applicable Box): Residential12 Municipal ❑ Industrial ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town F� Q- Q H County: ►�1 \ t'\ f' c iu _
Agricultural ❑ Monitoring ❑
(Road Name and Numbers, Community, or Subdivision and Lot No.)
DRILLING LOG DEPTH
3. OWNER ('��1 V:_U" 7.....
From To Forma:icn Description
AddressX
C) k2_E�)
(Street or Soute o.)
cLr'1 NC' _ ?�L)—"I Ir—)L�
City or Town IState Zip Code
4. DATE DRILLED 2X-1)
5. TOTAL DEPTH ��10� _
6. CUTTINGS COLLECTED YES ❑ NO[D—
7. DOES WELL REPLACE EXISTING WELL? YES ❑ N0O-
o
8. STATIC WATER LEVEL Below Top of Casing: 2 _c) FT.'
(Use '+' if Above Top of Casing)
n
9. TOP OF CASING IS �_ FT. Above Land Surface -
'Top of casing terminated at/or below land surface requires a variance In accor-
'
dance with 15A NCAC 2C 0118
10. YIELD (gpm): = METHOD OF TEST Zhu
}��
`-'r=
11. WATER ZONES (depth):
12. CHLORINATION: Type d Amount C
6a i
If additional space is needed use back of form C)
13. CASING:
LOCATION SKETCH
Wall Thickness
Depths Diameter or Weight/Ft. Material
(Show direction and dis3ance from al least two S`.ate
FromTo 1- Ft. k 6—
Roads, or other map reference points)
From To Ft.
From To Ft.
14. GROUT:
Depth Material Method
From _ To 2_0_ Ft. y\ b
From To Ft.
15. SCREEN:
Depth Diameter Slot Size Material
From To Ft in. in.
From To Ft.
From To Ft.
16. SAND/GRAVEL PACK:
Depth
From To
From To
17. REMARKS:
in. in.
in. In.
Size
Ft.
Ft.
DOHEREBY'CERTIfY :TfISE
'
CONSTRUCTION STANOARS-, AN(?T
FOR OFFICE USE ON 4 2Q
Quad No:
_sub
Serial No.
�J •!iir
Material
EO IN ACCORDANCE WITH 15A AQCAC 2C, Vo-ELL
gE)1Q8D, IHAAS, BEEN PROVIDED -TO THE WE_ILL OWhER.
Ol
OF PERSON CONSTRUriTIN ! LL DAT, £
of►1Np�r I a�ity�G!' naw Se .cn wvtthin V days
�Y�11 l,� I L Grr•t REV. 12'49

PA awX 270e7 7 RM.E1Q► AC. 27011.,PHONE to te)733-3221
WELL CONSTRUCTION RECORD
1------•�•—"�•�
{ DAIL.LINO CONTRACTOR 0 (
���`—
2y DRILLER REW.STRATION NUMBER .:.., _�
Quad. No. Sariat�VbJ 1
Let. LO% Po
Mino Basin
BasCode
Header Ent. GW-1 EnL- ,
STATE WELL CONSTRUCTION
PERMIT NUMBER:
I. WELL LOCATION: (Slow sketch 0144 locolion below)
" ' Nwell Town:
County: ►�i,I vi o in
A
(flood, Comm(rtlty, or Subdivision and Lot NoJ
Depth
DRILLING LOG
n '
Z.:OWNER -t'ill..r.... Lk-D ,�Z`P .,..��YZ_Vf i ....,.:�.-.
From To ^
(J t n � 1
Formation Description
ADM$$ 13 Z C•
LQ U l t_7
r, i Q tree I\ cNO.) aul*288 al
City or Town 10. State ZIP Code
0. DATE DRILLED ? USE OF WELL
4. TOTAL DEPTH' 2- CUTTINGS COLLECTED .Q'ires 0-140
a
6. DOES WELL REPLACE EXISTING WELL? Q Yes G-N'o
CD r
8. STATIC WATER LEVEL;-,_.�_..• PT. 0 above TOP OF CASING,
' ow
TOP OF CASING IS.._.._....._ FT. ABOVE LAND SURFACE.
7. YIELD (ppmk S METHOD OF TEST 1111S
L
I. WATER.ZONES (depths 12
S. CHLORINATION:'. -.Type -L� Amount
10: CASING: hh
Depth Diameter o�kWelpht%FI s Material
From To 7 Ft, a�
r From To Ft.__
ri
From To,.....,...�FL..-.._.-....
11. GROUT!,'
Depth Qlameter Slot Size Material
From....._,...,. To...,,..,.FL;_..._,_, h� In.._„__
If additional apse* Is needed use bsok of loan.
LOCATION SKETCH
(Show direction and distance from at least two State Roads,
or other mop reference points)
F►om �...�,., Ta,,.;�;� FL irk In..�
From.- To.....,.... FL In•,....__ In.
I& GRAVEL PACK: .
q�; 6
Oepdt : Size Material
From T „ FI rt� t ""
"�...•.+ o+�••....... • �....
From.- Tom.,_,_ Ft.
14. REMARK$; ;.
R-As-$�j CERTIFYTHAT THIS WELL WAS CONSTRUCTED IN ACCORDANCEWITH 15 NCAC 2C, WELL CONSTRUCTION
Mm-
S, [APq THAT A COPY OF THIS RECORD HAS SM. pRROVIDED TO THE. WELL OWNER. ^
GW-1 6/8 R' Q ?_QU!�
SIGNATURE OF CONTRACTOR OR AGETVTl DATE V -
Submit original to Division of Environmental Management and copy to well owner.

P.o. BOX By"?-RALEIQ►IKO.87e11,.Miom(e1e)7W3221
j
Quad
Minor aaeln
WELL CONSTRUCTION RECORD
Basin Code
Header F.M.
OW-1 Erd._..._.
GRILLING CONTRACTOR �'�
. GRILLER REGISTRATION NUMBER -' `r 1
STATE WELL CONSTRUCTION
PERMIT NUMBER: o
I. WELL LOCATION; (Show sketch o1•thi location below)
Neupe,t Town: `- 1 f; Vt� 0 `� _.....::;..�..+._._
County:'. .I (1.YVlLi
Mood, CommWly. or Subdivision and Lot Noi •
Depth
DRILLING LOG
Z.:OWNER 1,,.... �,.n �.�.,5..�1;; L
F m To C, c
Formation Description
ADDRES8�i
j "trSol or Cie No.)ve
1 f; h t._.._
City or Town !,. Slate Zip Code
3. DATE DRILLED -`"Fay;-*fin„ USE OF WELL �n La
CD
4. TOTAL DEPTH' CUTTINGS COLLECTED ❑ Yes
�C =n
G. DOES WE" REPLACE EXISTING WELL? ❑ Yes 0'14
$. STATIC WATER LEVEL: , PT. 0 be ow TOP OF CASING.
' TOP OF CASINO IS FT. ABOVE LAND SURFACE.
r
7. YIELD (ppmk� METHOD OF TEST h n
7,V1
.-
I. WATERZONES (depths - ,2;
o
0. CHLORINATION:'.. Type Amount
10. CASING; II T I k
If additional space 1s needed use back of loan.
Wa c ness
h Depth Diameter or We phi/Ft. Material
TO nt - ..� , p� LOCATION SKETCH
From . Ft.�.S�.__ . (Show direction and distance from at least two State Roads.
' From .— To _....Ft._.-.._, or other map reference points)
..From ....,...,,_.. To.• —.•—FL........... ._.�...
11. GROUT..:'
. poplh Material Method
From _,5.. .,. To?.�.....FL ` s y •.T^
From ...._...... To......,.... Ft.
It SCREW
Depth Diameter Sol Size Material
From _,........ To..,..".. Ft.,,.,..,.,_. �...._.,.,. in• _,�.,
From -------- To.:.,.;,. Ft. ,..,..., h— In.
Ftom, T0...;�.,..,. FL .�._.._- k1.___._.. In.
13. GRAVEL PAf,'.K: .
DoPth +: Size Material
From,... To.-.OWW". F L-------
From.—.. TO .... Ft,
14.
REMARKS;-0 HEREBY PERTIFY THAT .THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15 NCAC 2C, WELL CONSTRUCTION
$TADWk NO-THAT.A COPY OF THIS RECORD HAS BEEN. PROVIDED TO THE- WELL OWNER,
MAR Q 2��� SIGNATURE OF CONTRACTOR OR AGENT DATE
GW1 Rev AI; ( Submit original to Dlvlslon of Environmental Management and copy to well owner.
I f:roundwate° Section .
t.Asheville Re c�.i3lOtfice

P.a box 27ee7 - PAa,J:1Q►V0. 27o11,
Quad No. `• Soria "" M `7 I
• •j'MOWEia1e)>'3S-3Y21
Lat. Lora. ib._...
WELL CONSTRUCTION RECORD
Minor Basin
Basin Cod.
Header Ent. OW-1 EnL_..._.
DRILLING CONTRACTOR .�.,t, x ,� l�o C (,
�"
DRILLER REGISTRATION NUMBER ' . , Zy
STATE WELL CONSTRUCTION
PERMIT NUMBER,
I. WELL LOCATION. (Show sketch of ft' ocallon below)
County:
(Rood, Comr%Wtyi or Subdivision and Lot NoJ
Depth DRILLING LOG
nn
2. OWNER
F om q,,_To Fonnallon Descriplion
ADDRESS 1 `1
'—`•'�"""
Q `I
Irae or Routs N577
tti �n� G Q ti :_..fQ— C— A F�
.
�C
IV Or
Town !.. State Zip Code
3. DATE ORILLEO
USE OF WELL
4. TOTAL DEPTH
CUTTINGS COLLECTED ❑ Yes ❑"Fio
CD
6. DOES WELT. REPLACE EXISTING WELL? ❑ Yes [3- o
6. STATIC WATER LEVEL: PT. 0 below TOP OF CASING,
.
' TOP OF CASINO IS..... �,...._.. FT. ABOVE LAND SURFACE.
�
2
7. YIELO (ppmx METFi00 OF TEST 2-Ing�_>
--
I. WATERZONES ONE8 (depths V/))
{wl.�.i
1
• C7
si. CHLORINATION:'. Type H 'Amount
10. CASING: hh s
If additional space Is needed use back of kmm
Depth Diameter or�WilpAt%Ft Material
�
From. To FL.,.,,,,_....w_
LOCATION SKETCH
_......
(Show direction and distance from at least two Slats Roads,
t From To _F1..._._,__
or other map reference points)
From ....,.._,,. To ,.........Ft. ..:._,.._ .,
.
11. GROUT;.
Pspih .:; Material Method
From .....,..,, To 2-0
From ...._..... To...,....., Ft.
12. SCREEN;
Depth P14meter Sot We Malarial
From....., To...�..,,. Ft,;,;.......... o•,..�.. Im
'100
STAh
I
S WELL WAS CONSTRUCTED IN ACCOROANCE*WITH 15 NCAC 2C, WELL CONSTRUCTION
f THIS RECORD HAS BEEN. PROVIDED TO THE' WEIJ..OWNER.
GWI Rw*W &88 MAR 1 0 ?000
Crol dwate�Sec'ion
Asheviile. Regional'onfl __..
SIGNATURE OF CONTRACTOR OR AGENT �-' + DATt
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 4 J 9
1636 Mail Service Center - Raleigh, N.C. 27699-1636-Phone [phone]
WELL CONSTRUCTION RECORD WELLCONTRACTOR:R.CALDWELL DRILLING, INC.
WELL CONTRACTOR CERTIFICATION #2140
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE (Chock Applicable eox): Residential ❑ Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATION ho}sket f the location below)
Nearest
Town: i/ t� F��rt County:��? CO�� ► r
(Road Name and umber$, mmunity, or Subdivision and Lot No.)
DRILLING LOG
DEPTH
3. OWNER Lam`
From To
F ation Description
7 1 f ��
Address �, f,
—
-1 ' l
treet or Houleo.
C)
! 3 ZS O
c
City or Town State Zip Code
4. DATE DRILLED
5. TOTAL DEPTH
COLLECTED YES ❑ NOOK
6. CUTTINGS
WELL? YES F-1
7. DOES WELL REPLACE EXISTING
8. , STATIC WATER LEVEL Below Top of Casing: y[t U FT.
(Use'+' If Above Top of Casing)
9. TOP OF CASING IS FT. Above Land Surface'
'Top of casing terminated at/or below land eurtace requires a variance In accor-
dance with 15A NCAC 2C / 6
10. YIELD (gpm): MET OD OF TEST t
11. WATER ZONES (depth):N--
0
12. CHLORINATION: Type ffT —Amount
If additional space Is needed use back of form
13. CASING:
Wall Thickness
Depth
-73
Diameter or Wei t1F1. Material
�j
From
' -!—_ To
Ft.
From
To
Ft.
From
—'I o
Ft.
—
14. GROUT:
Depth
1-0 Ft.CO-
Material Method
cye
From
To
From
To
Ft.
15. SCREEN:
Depth Diameter Slot Size Material
From To Ft in. in.
From To Ft. In. In.
Front _-To Ft. In. In.
16. SAND/GRAVEL PACK:
Depth Size Material
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other map reference points) t--)
& 4.1-e-
AJ
From _ To Ft. (' I IC��
7� - - —
From _ To ---Ft.
17. REMARKS:
# 7 ai) t �l in k1 i ri 1
1 DO HEREBY CEl`iTIFY THAT
CONSTRUCTION STANDARD
5;
F
FFICE USE,ONLY
o:
o.
AND THAT A
Subirdt original to
tD IN ACCbO�CE WITH 15A NCAC 2C, WELL
RECORD A BEEN PROVIDED TO THE WELL OWNFR.
PER ON CONSTRUCTING THE WELL / / DATE
of Water Quality, Groundwater Seaton within 30 days
GW-1 REV. 12/99

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section j" r 4 0,98
1636 Mail Service Center - Raleigh, N.C. 27699-1636-Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR:R.CALDWELL DRILLING, INC.
WELL CONTRACTOR CERTIFICATION 1t?140
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE (Check Applicable Box): Residential0 Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATION: holsketch; f he location below) .�
Nearest Town: �' (�� county:
�LZ�"t yY►
(Road Name a umbers, Community, oMilion and Lot No.) DRILLING LOG DEPTH
3. OWNER L)A From 1 To Formation Description
Address©-"�SI Cam-./ l✓� C�4-%
1 / ke"
or t �f } X f / TJ - 705 1 Pc -
City or Town State Zip Code
4. DATE DRILLED
5. TOTAL DEPTH -
6. CUTTINGS COLLECTED YES ❑ NOEZ""
7. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
8. STATIC WATER LEVEL Below Top of Casing: Jlq FT.
, jj f� (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): ' 2— METHOD OF TEST + '
11. WATER ZONES (depth):
12. CHLORINATION: Type 14T ff Amount -
13. CASING:
Wall Thickness
Depthp 7
Dia eter or Wei �1t. MateL
' llq f`
From! 1-- To --
Ft.
From - To
Ft.
From To
Ft.
14. GROUT:
Depth
Material Method
From To _2
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
17. REMARKS:
To Ft.
DO HEREBY CERTIFY THAT THISfflELL WA%CC
CONSTRUCTION STANQARD,S, AN61TOAT A tJP'
FOR OFFICE USE ONLY
Quad No:
Submit origina
n
Serial No.
r-� o
N
r*r:a
C11
--t
0
z
If additional space Is needed use back of form
c�
LOCATION SKETCH
(Show direction and distance from at least t o State
Roads, or other map reference points)
ISTRUCTED IN CCORDANQEYVITH 15A NCAC 2C, WELL
OF THIS RE HAS B EN �R}OVIDED TO THE WELL 0
GNATORE OF PERSON/t;ONMUCTING THE WELL
to Division of Water Oua tty, Groundwater Section within 30 days
GWI REV. 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:R.CALDWELL DRILLING, INC.
WELL CONTRACTOR CERTIFICATION #?140
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: ho sketc location below)
Nearest Town: County:
(Road Name nd Numbers, Community, orsut4ivision and Lot No.) DRILLING LOG DEPTH
3. OWNER From To Formatio
Descd n
Address 14:' q_Z9
(Street or ou a o.
City or Town State Zip Code
4. DATE DRILLED
5. TOTAL DEPTH
�-
6. CUTTINGS COLLECTED YES ❑ NO�
7. DOES WELL REPLACE EXISTING WELL? YES ❑ NO[Er
8. STATIC WATER LEVEL Below Top of Casing: FT.
(Use '+' It Above Top of Casing)
9. TOP OF CASING ISFT. Above Land Surface'
tV 7
'Top of casing terminated at/or below land surface requires a variance In actor-
ci
dance with 15A NCAC 2C .0118 r
M
10. YIELD (gpm): METHOD OF TEST
fV M71)
11. WATER ZONES (depth): -
cn :j
0
12. CHLORINATION: Type Amount It additional space Is needed use back of form
13. CASING:
Wall Thickness
Depth Di meter or Weight/Fl. tenal
From:t I —To 11�2-- Ft. 4—
Front To Ft.
From To Ft.
14. GROUT:
Depth Material thod
From To 71/2_ Ft.
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 HEREBY,
Diameter Slot Size Material
_ Ft in. in.
'Ft. in. In.
-Ft. In. In.
Size Material
Ft.
Ft.
T.-THIS WELCWAS
FOR OFFICE USE ONLY 19
Quad No: N; f�(c,
Subrnit 6
Serial No.
t
92,
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other map reference pointsl
)ANCE WITH 15A NCAC 2C, WELL
BEEN PROVIDED TO THE WEkCZ
GNATURE OF PERSON CONSTRUCTING THE Wee `—
to Divislon of Water Quality, Groundwater Section within 30 days
�_O O
DATE
GW-1 REV. 12/99

North Carolina - Department of Environment and Natural Resources - Division of Water Quality • Groundwater Section ?) e-
1636 Mail Service Center • Raleigh, N.C. 27699-1636-Phone [phone] " 2 4 0 9 f
WELL CONSTRUCTION RECORD WELL CONTRACTOR:R. CALDWELL DRILLING, INC.
WELL CONTRACTOR CERTIFICATION #2140
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: ,how ketclocation below)
Nearest Town: County:
(Road Named N er , �unily or Subdivision and Lot No.)
3. OWNER
Address
tree ou o. Z45_
City or Town State Zip Code
4. DATE DRILLED L2- 1.5-- Z9 O
5. TOTAL DEPTH Q2 5�
6. CUTTINGS COLLECTED YES ❑ NOE9--'�
7. DOES WELL REPLACE EXISTING WELL? YES [�NO❑
8. STATIC WATER LEVEL Below Top of Casing: FT.
(Use '+' If Above Top of Casing)
9. TOP OF CASING IS_�_ FT. Above Land Surface -
'Top of casing terminated at/or below land surface requires a variance In accor-
dance with 15A NCAC 2C .0118
10. YIELD (gpm): © METHOD OF TEST
11. WATER ZONES (depth):
12. CHLORINATION: Type _4 ,�4 Amount,
13. CASING:
Wall Thickness
Depth Diameter or Weight/Ft. Material
From � To 2 S' Ft. � SOR -
From To Ft.
From -To Ft.
14. GROUT:
Depth Materialthod
From �_ To 20 Ft. CPs4P.L��_
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:
DRILLING LOG DEPTH
From To Formatio Description
s�
x -
TJ
_
cn
If additional space is needed use back of form
z
LOCATION SKETCH
(Show direction and distance from at least two Slate
Roads, or other map reference points)
\{O
Depth Size Material
From To Ft. �J
From To Ft.
17. REMARKS:
FOR OFFIC6USE ONLY
Quad No: � �4
Serial No. '
WAS CONSTRUC D IN ACCORDANCE WITH 15 NCAC 2C, WELL
E A COP OF T CORD HAS BEEN PROM D TO THE WELL OWNER.
O
SIGNATURE OF P RSON O TRUCTING T ELL DATE
W! original to Division of Water Quality, Groundwater Section within 30 days
GW1 REV. 12/99

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section 4 099
1636 Mail Service Center - Raleigh, N.C. 27699-1636-Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR:R • CALDWELL DRILLING, INC.
WELL CONTRACTOR CERTIFICATION #?140
Pvs+ 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 LOCATIO (S)how ske;gh of the location below)
Nearest Town: k6f% w (-P— County: - (hL �C,E •7� h P
(Road Name d Numbers, Communit�j,�or Subdivision and Lot No.)
DRILLING LOG
DEPTH
3. OWNER AJA-)s �'t / 1 r P, nS j
Address
From ( To
Formation Description
n i treet or No.
City or Town State Zip Coe —
State��:�
4. DATE DRILLED 2
5. TOTAL DEPTH
6. CUTTINGS COLLECTED YES F-1 NO
fl
7. DOES WELL REPLACE EXISTING WELL? YES
8. STATIC WATER LEVEL Below Top of Casing: FT.
(Use '+' It Above Top of Casing)
`�
t1 <
r,
9. TOP OF CASING IS FT. Above Land Surface'
X-C
'Top of casing terminated attor below land surface requires a variance In accor-
3^•
dance with 15A NCAC 2C . 11
10. YIELD (gpm): METHOD OF -TES
11. WATER ZONES (depth): I 1
Cn
-+
C_
T
12. CHLORINATION: Type Amount
If additional space Is needed use back of form
13. CASING:
Wall Thickness LOCATION SKETCH
��-Depths ,,� D'a' mgt�r, or ght/Ft. eA (Show direction and distance from at least two te
From _-'A'!_To � Ft. (—�'(t �i Roads, or other map reference points)
From --- To — Ft.
From —To Ft.
14. GROUT:
Depth aterial 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
From To Ft.
From To Ft.
17
REMARKS:
Material
�t
1 DO HEREBY!!'CERTIFY AT(THI,S, WEL4WAS CONSTRUCTED IN �ORDANCE T 15A NCAC 2C, WELL
CONSTRUG`�IpNtST D RD , AND jfHAT A'COPY OF THIS REC090HAS BEEN RO IDED TO THE WELL OWNER.
FOR OFFICE'U; E i `` ,� s" ,-.. r
)I <<;_, ;
Quad No: i .:? ) F' SIGNATURE OF PERSON CO TR PING THE WELL DA
Submit original to Division of Water Quality)Groundwater Section within 30 days
Serial No. _�'_ GW-1 REV. 12/99

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section '.� ; 7 C
1636 Mail Service Center - Raleigh, N.C. 27699.1636-Phone [phone] �' " 6 4 J
WELL CONSTRUCTION RECORD WELL CONTRACTOR: R.CALDWELL DRILLING, INC.
2 WELL CONTRACTOR CERTIFICATION #. 140
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE (Check Applicable Box): Residential ❑ Municipal G Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use: A.D 7t 5c-s reM
2. WELL LOCATION: Show sketch of the location below)
Nearest Town: � +'�� County:
A;
al' . t I' lO A `a% i5y1e
Road Name and Numbers, Commurn , or Subdm ion and Lot No� DRILLING LOG DEPTH
3. OWNERU%_ APL From To Formation Desciption
Address
0,
(bireet
or Houle TZ - h
r--- c�.
2.,a D O 5 3- l 16
City or Town State Zip Code
4. DATE DRILLED ?(1'
5. TOTAL DEPTH i 7
6. CUTTINGS COLLECTED YES ❑ NO❑ _ .5
7. DOES WELL REPLACE EXISTING WELL? YES ❑ NO❑ rn�
grin_
8. STATIC WATER LEVEL Below Top of Casing: I o U ` FT. n
n
r/ (Use'+' If Above Top of Casing) 140
�O
9. TOP OF CASING IS FT. Above Land Surface-
3YC7
'Top of casing terminated at/or below land surface requires a variance In accor.
dance with 15A NCAC 2C .0119
� d
10. YIELD (gpm): GO METHOD OF TEST L fV
m v
11. WATER ZONES (depth):
('1
i
12. CHLORINATION: Type o� Amount '� It additional space Is needed use ackof form
13. CASING:.
{, Depth
%(O
Well Thickness
tmeter of Welght/Fl. �Material�
/�— �1�t
From{- To
Ft.
From To
Ft.
From To
Ft.
14. GROUT:
Depth
From 0 To EZ
Ft.
feria Meth
From To
Ft.
15. SCREEN: \% tq5, "e
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 Materlal
From To
Ft.
From n To
17.
ei
LOCATION SKETCH
(Show direction and distance from at leas
Roads, or other map reference nt*
0
WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
) THAT,A_CQPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
FOR OFFICE USE�°ONLY °"` " - «-
Quad No: r �i I _ I9 NATURE OF ER N CONSTRUCTING THE WELL DATE
i 1-' j C�� sppmit g�ggio Division of Water Quality, Groundwater Section within 30 days
Serial No. ;}} I q GW-1 REV. 12/99

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section 233938
1636 Mail Service Center - Raleigh, N.C. 27699-1636-Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR:R•CALDWELL DRILLING, INC.
WELL CONTRACTOR CERTIFICATION #� 140
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 LOCAT (S ow sketc o the location below)
Nearest Town: - � � County: t l'1`-O f., 6'�:,
(Road Name an Numbers, Co Wily, or Subdivision and Lot No.)
DRILLING LOG DEPTH
3. OWNER _Ueit1Uy
From To Formation Description
Address 15 - • 7 ✓
)]
rn rest r oI e
3f 2-5 I ,t
City or Town State Zip Code
4. DATE DRILLED
5. TOTAL DEPTH
6. CUTTINGS COLLECTED YES ❑ NOEE
c'
7. DOES WELL. REPLACE EXISTING WELL? YES ❑ NO t�, rs Gm
8. STATIC WATER LEVEL Below Top of Casing: ; FT.
(Use '+' If Above Top of Casing)
rn c
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): 20 METHOD OF TEST
11. WATER ZONES (depth): j r " - q " 1673
ry C-)
(0 1 ` q 0
N o
12. CHLORINATION: Type Mr/>f Amount
It additional space is needed use back of form
13. CASING:
Wall Thickness
Depth Diamel r or Weight/Fl. lenal
From } To 30 Ft. r, 2%
From To Ft.
From To Ft.
14. GROUT:
Depth ) Material Method
From To �� Ft.
From
To
15. SCREEN:
Depth
From
To Ft
From
To Ft.
From
To Ft.
16. SAND/GRAVEL PACK:
Ft
Diameter Slot Size Material
In. in.
in. In.
In, in.
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)
�l
r�k
1 DO HEREBY CERTIFY�THA7,wT_HIS..WELL,INAS CQNSTRUCTED IN ACCORD E WITH 5A CAC 2C, WELL
CONSTRUCTION 7Ri1VDP�5i0¢� A(�D�'(j1lj A CiOP,Y OF THIS RECORD�HAOENOIDE O THE WEL�:W
r
ILA;_ ll� LL tt}} �U ``
I FOR OFFICE U ,, NLY fQuad No: 20(1l /S6IGNATURE OF PERSON CONSTRU NG THE WELL
AUGt+l gui bmil g dgln to Division of Water Quality, Groun ater Section Within 30 days
Serial No. I I I GW-1 REV. 12/99

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section 2 2 R 0 5
1636 Mail Service Center • Raleigh, N.C. 27699-1636-Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR:R.CALDWELL DRILLING, INC.
1 WELL CONTRACTOR CERTIFICATION #2140
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE (Check Applicable Box): Residential ❑ Municipal ❑ Industrial ❑ Agricultural ❑ Monitorin ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use: (r A VV_ rib TQwl
2. WELL LOCATION: (Showasketch of the location below)
Nearest Town: L-1 I P-2-IS-Z County: -
& rA o 11.6-
ty oad Name and Numbers, Community, or Su division and Lot o.)
DRILLING LOG
DEPTH
3. OWNER _1*ACC ,/�I%- r i4llmg14 1
From To
Formation Descripti n
Address P. D, igs ct+.5- el
�- 2.5—
— (5tre t or ou-Te No.)—
si- 9,�•
Y-r-
City or Town Stale Zip Code
r
�-- D
.,
a
4. DATE DRILLED 1 O 9,_S�
5. TOTAL DEPTH
o
6. CUTTINGS COLLECTED YES ❑ NO❑
7. DOES WELL REPLACE EXISTING WELL? YES[] NO❑
M
n
8. STATIC WATER LEVEL Below Top of Casing: FT.
-- �-�
(Use'+' If Above Top of Casing)
y.o
9. TOP OF CASING IS FT. Above Land Surface'
-v rri -
*Top of casing terminated at/or below land surface requires a variance In actor-
=CD
cnx
dance with 15A NCAC 2C.0118
GA
p
10. YIELD (gpm): 1 f:Ar. METHOD OF TEST
sa
11. WATER ZONES (depth): " •S �' 1
o
12. CHLORINATION: Type A �. 7� gA Amount— If additional space Is needed use back of
13. CASING:
Wall Thickness
Depth Diameter or'WeelahVFt. Material
From —To .LIL— Ft. 6 ,ke 1?,
From To Ft. r
From To Ft. file--. - `n o P--
14. GROUT:
Depth Mated I thod
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
From To Ft.
From To Ft.
17. REMARKS:4i'A4e,W - Ch&;A
FOR OFFICE Us� Y !
Quad No: -.
Material
(Show direction and distance from at
Roads, or other map
-/Sf'Te_ -
9UCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
THIS RECORD HAS BEEN PROVIDED TO THE WELL 0
dXTURILOF PERSbN CONSTRUCTING THE WELL /
Division of Water Quality, Groundwater Section within 30 days
State
0�
. X
Serial No.
tnd <
GW-1 REV. 12/99

North Carolina - Department of Environment and Natural Resources . Division of Water Quality - Groundwater Section Z
1636 Mail Service Center - Raleigh, N.C. 27699-1636-Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR:R. CALDWELL DRILLING, INC.
WELL CONTRACTOR CERTIFICATION #? 140
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE (check Applicable Box): ResldenUal2 Municipal ❑ industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATION:tch of the location below)
Nearest Town �lyem'(Nyi l fly- County:1141'1"-_�I­-, �-
(Road Name Numbers, ommu - or•Subdivision and Lot No.) DRILLING LOG DEPTH
3. OWNER Cnp deS� n," ii ` 0 From t ( Formation Description
Addresy-Z Ltd �X ` J'c- VA)ad ' ;
City or Town State Zip Code
4. DATE DRILLED �! ���-uu
5. TOTAL DEPTH Q.;z_
6. CUTTINGS COLLECTED YES ❑ NO[[,�
7. DOES WELL REPLACE EXISTING WELL? YES ❑ NOP'__
8. STATIC WATER LEVEL Below Top of Casing: C) FT.
(Use '+' It Above Top of Casing)
9. TOP OF CASING IS FT. Above Land Surface -
•Top of casing terminated at/or below land surface requires a variance In accor-
dance with 15A NCAC 2C .01-1,8
10. YIELD (gpm): IJ METHOD OF TEST r4
11. WATER ZONES (depth):
12. CHLORINATION: Type AmlunI L If additional space is needed use back of form
13. CASING:
Wail Thickness LOCATION SKETCH
Deptht - Dia eter or Weight/Ft. ��f a ( Show direction and distance from at least tvGo State
From '' 1� To q— Ft. i �- �� ai Roads, or ther map reference points)' *' )
I
From To Ft. 1 es"�
From To Ft.
14. GROUT:
Depth Material etho
From To 2-0 Ft.
From To Ft.
15. SCREEN:
Depth
From To Ft
From To Ft.
From To Ft.
16. SAND/GRAVEL
From
From
17. REMARKS:
I DO HEREBY CE
CONSTRUCTION
FOR OFFICE USE ONLY
Quad No:
Serial No.
Diameter Slot Size Material
In. in.
In. In.
Ft.
HIS'WELL WAS CONSTRUCTED IN
, AND THAT A COPY OF THIS RECC
SIGNATURE,XF PER
Submli original to Division of Water
b
C
)ANCE WI 15 NCAC 2C, WELL
BEEN P VID D TO THE WELL OWNER.
.rn
RuctmGrTHE WELL I DATE
.Alundwater Section within 30 days
GW1 REV. 12/99

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section r 22007
1636 Mail Service Center - Raleigh, N.C. 27699-1636-Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR: R. CALDWELL DRILLING, INC.
WELL CONTRACTOR CERTIFICATION #?140
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE (Check Applicable Box): Resldentlal lam' Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCAT N (Show0 etch of the location below)
Nearest Town: (ll �✓ County: —244/1 [.0 4_\b It
/
Numbers, Com' "IH, r Subdivision and of No.)
(Road NamAelir'KA4A
DRILLING LOG DEPTH
3. OWNER
ation Description
From . To (- Ft5t_\
`
Address
0 - 0 i}.�/ , C4 >r
treat or eNO.)
0
City or Town Stale Zip
4. DATE DRILLED (� Z �0
5. TOTAL DEPTH
6. CUTTINGS COLLECTED YES ❑ NO��
�r-
c�
7. DOES WELL REPLACE EXISTING WELL? YESr
NO❑
8. STATIC WATER LEVEL Below Top of Casing: FT.
(Use '+' It Above Top of Casing)
o
9. TOP OF CASING IS
FT. Above Land Surface'
*Top of casing terminated at/or below land surface requires a variance In accor-
dance with 15A NCAC 2C .0118
Cr
10. YIELD (gpm): 17— METHOD OF TEST
�,ry
11. WATER ZONES (depth): ��>7 t
_
o
12. CHLORINATION: Type 4T14 `o Amount Q
It additional space Is needed use back of form
13 r.ACINr �7i 1.
Wall Thickness
Depth 2 Dlar�yt r !Sweig ( to 'al
From � To z Ft. �,/ Z ��
From To Ft.
From To Ft.
14. GROUT:
Depth (Yaterial Method
From To 7-0 Ft.
From To _
15. SCREEN:
Depth
From To
From To
From To
16. SAND/GRAVEL PACK:
Depth
From T
From T
17. REMARKS:
l
1 DO HEREBY CERTIFY 1
CONSTRUCTION STANC
FOR OFFICE USE ONLY
Quad No:
Serial No.
Ft.
Diameter Slot Size Material
Ft In. —
Ft. in. _
Ft. In. _
Izpl
Ft. 1I1J t�l
in.
In.
In.
NSTRUCTEDIN
(OF'THIS RECC
SIGNATU,E OF PER
Submit original to Division of Water
LOCATION SKETCH
(Show direction and distance from at least two State e
Roads, or other map reference points)
NCAC 2C, WELL
TO THE WELL O
///Z S/Z.00v
INSTRUCTING THE WELL
Groundwater Section within 30 days
GW-1 REV. 12/99

North Carolina - Department of Environment and Natural Resources - Division of Water QualityGroundwater Section
1636 Mail Service Center - Raleigh, N.C. 27699.1636-Phone [phone] �- �~•
WELL CONSTRUCTION RECORD WELL CONTRACTOR:R•CALDWELL DRILLING, INC.
WELL CONTRACTOR CERTIFICATION #? 140
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE (Check Applicable Box): Residential Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATION: (Show sketc of the loc t' n below)
Neare own:
( d N me and ers, Corv�uni'Su iv ion nd Lot No DRILLING LOG DEPTH
3. OWNER e1 ��Y`�� 1-�� From To Formation Description
Address
tr t or Houle o. L� 7ty
�L� 'Z G
City or Town State Zip Code /�� ��
4. DATE DRILLEDyTF —
5. TOTAL DEPTH `� r
6. CUTTINGS COLLECTED YES ❑ NO❑
7. DOES WELL REPLACE EXISTING WELL? YES ❑ NO❑ o
8. STATIC WATER LEVEL Below Top of Casing: FT. 0
(Use '+' If Above Top of Casing) CD o
9. TOP OF CASING IS �`� FT. Above Land Surface'
'Top of casing terminated at/or below land surface requires a variance In accor-
dance with 15A NCAC 2C .0118
10. YIELD (gpm): LK METHOD OF TEjT id 0
11. WATER ZONES (ddpt :
12. CHLORINATION: Type Amount It additional space is needed use back of Wn iix,
13. CASING:
Wall Thickness
LOCATION SKETCH CD
Depth Diameter WelghVFt. VAatedal
Front To — Ft.
From To Ft.
From To Ft.
14. GROUT:
Depth Material ethod
From 0 To n_ Ft. �'t"� t
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.
Ft.
Ft.
Size Material
(Show direction and distance from at least two State
Roads, or other map reference points)
�)Olf r r�
�1
. \ Lo,
o\��
n \�G
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
1
CONSTRUCTIONS �9D D�jj TAT r PY` ;F THIS RECORD HAS BEEN PROVIDED TO THE WELL O NER. ''
FOR OFFICE USE i
Quad No: 11,111 AT RE OF ERSON CONSTRUCTING THE WELL DATE
"-utxnit origl o .f slon of Water Quality, Groundwater Section within 30 days
Serial No. GW-1 REV. 12/99