Well Construction Records Mitchell CY2000

North Careflna - .)npnrtmmiif of Environrnnnt, Ifenlih, aid Nafuml Rosoutco9 — Fort OffICE U5E 13NLV
Divi,inn 4Environrnnnlal 1' 111nonlnnnl • O'nufl(I'N1tnr Section ry r.
n.0. nox 29535 ;nlnlgil, N.C. 27626 053$ OI)AU. f1U. _,__-_ 6ERIALNO.2—t-Z'
phone Pig) 733.3221 tat. - Lorq. - RO
Minor pn-:In
"'ELL CONSTRUCTION RECORD N'll—
DnILLING ` J)11 nACTOFi r � Ilnndnr Fist - DW-1 Frill.
S1ATE WELL CONSTI1l1CNON
bRll' nu,.mTRA11011NIIMBL"n: / PERMITNUM1,1F1F11:
------------- ----
VELL LOCATION: (Show 5kelrh of Ih ocallon below) J//
NearestTovrn:-- _-- County: --Mll
In id Conn n. nily- or Sul-11v1^.Inn id LoI Nn.)
2. ZZN _.
ADDRESS OXLq� _
e',Jmnt or rlou�e Nn
City or Iovm stale Zip Code
3. DATE USE Or WELL --LoM .
I. TOTAL DEPIII._
5. CUTTINGSCOLLECIED YESO NO(vol,
3. DOES WELL TIEPLACF EXISTING WELL? YES O NOLO
7. STATIC WATER LEVEL Below Top of Casing: / Fr.
(U,s'd it Above Top of Ca,ing)
3. TOr OF CASITIG I S _--_-' __ FT. Above Land SmIrice'
Casing Terminelod st/nt Wow Iald surface Is Illegal unless a variance Is Issued
In accordance wllh 15A HCAC 713 .0110
1. YIELD(gpnl):._-A__-__METIIODOFTEST
le 'NATER ZONES (depth):
-P-11I_I 1 —DRILLING LOCI_
Fmnl I-, Formnaon bneaiptlon
0
/ o
11. CNLORINAI ION: Typo— 9: /T Amount M II nrfdilionoi elmcn in n9ndnd ud9 back offtm y
12. CASING:
z
Kill nu,ena„ LOCA71O�1_SKE_TCT1
Dnpllt, D Ranier or Wo� Ma1� (show ditor.unn and di5l.lnc9 from at 1991t two Stale -
FromTo /D <f FI. Floadn, nr nllmr nap rolnrenc9 polnle) Pram—
ta. GnoUT:
1?eplh �J�M���ler,fh.,l nlhod
From —O _ to cif FI.S..0l7ritt�.[i—_1Ji�da�1%
From
14. SCREETI:
Dnplh Dinmeler Slot SI70 Malellnl
From _— I o ----- VI
from --_-In_---
From-----To
15. SAND/GIIAVGI_ PACK:
Deplh Size Pvlalednl
�7
From --- To ---- f 1. — ---- —
Flom --_--- To_ F1. — r
16. REMARKS:
1 DO IIEnr- r1 II- I (I-tiUVVl AS cot FI�SJI nLICTEItl .IPE'vil111 J,3A IIAC 2C. %VF1.L
f1-rt'PL3v1UF� WELL OWrIEFl.
COMM 40' W1b10�F
e9
i' su:r lA 1JunF or cr If1AC1 On Or1 ,F.tlr OAIE
OW-1 nEv. 9NI ?k , Cround%ate-,SecfOn Suhnih or 19iml to bivhlon of Frrvlmmm011lnl f.l ill 9,11in fit and cnry to wen a.vrler.

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section rf f'
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone] , 1 / 5 `! V
WELL CONSTRUCTION RECORD WELL CONTRACTOR: Dewey Wright Well Pump Co., Inc.
WELL CONTRACTOR CERTIFICATION #: 2686
COMO STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE (Check Applicable Box): Residential E] Municipal D Industrial 0
Recovery 0 Heat Pump Water Injection E] Other 0 If Other, List Use:
2.
3.
4.
5.
6.
7.
8.
WELL LOCATION: (Show sketch of the location below)
Nearest Town: BAKERSVILLE County:MITCHELL
HUGHES RD. OFF HUGHES GAP RD.
reload Name and Numbers, Community. or Subdivision and Lot Nod
OWNER I. DAVE INGRAM
Address % BILL INGRAM , P.O. BOX 148
BAKERSVM LS' Roote (No) NC 28T05
city or Town State Zip Code
DATE DRILLED 8/30/2000
TOTAL DEPTH 345
CUTTINGS COLLECTED YES 0 NO
DOES WELL REPLACE EXISTING WELL? YESE] NO 0
STATIC WATER LEVEL Below Top of Casing: 80 FT.
(Use "+" if Above Top of Casing)
9. TOP OF CASING IS 1 FT. Above Land Surface*
'Top of casing terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2C.01 a
10. YIELD (gpm): i.5 ��IMIETHOD OF TEST Air
11. WATER ZONES (depth T 4 gpm92-93 opm 3 - 1
0 gpnl 0 gpm
Agricultural0 Monitoring E]
DRILLING LOG
From To
0 53
DEPTH
Formation Descri tion
f iL1DlS.ApJD?GP_A.V�UBLI
53
92
GRANITE
92
93
QUARTZ
93
310
GRANITE
310
311
QUAPP o r
312
345
GRANITE m -
r.,..-
CO
12. CHLORINATION: Type HTH Amount QD If additional space is needed use back of form
13. CASING: LOCATION SKETCH
Wall Thickness to
Depth Diameter or Weight/Ft. Material (Shaw direction and distance from at least two Stale
From 0 To 63 Ft. 6 1/4 .188 GALV. Roads, or other map reference points).NQ�0
From To Ft.
From To Ft. t
14. GROUT
Depth Material Method
From 0 To 20 Ft. Cement Gravity Flow a
From To Ft.
15. SCREEN:
3 e
Depth Diameter Slot Size Material Off(
From To Ft. in. in.
From To Ft. in. in.
From To Ft. in. in.
� l
`
16. SAND/GRAVEL PACK: 1ov 5,
Depth Size Material 143 Q
From To Ft.
From n
�
To Ft. nL�� N�k
17. REMARKS: V`-/
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 PEON P I $ 9r,00
SIGNATURE OF PZ60N CONSTRUCTING THE WELL DATE
Quad No:
Submit 04ginal to Division of Water Quality, Groundwater Section within 30 days
GW-7 REV. 12/99
Serial No. ! gf_

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section " 1 U 1 3 1
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR: Dewey Wright Well Pump Co., Inc.
WELL CONTRACTOR CERTIFICATION #:
000350 STATE WELL CONSTRUCTION PERMITM es (e eece
1. WELL USE (Check Applicable Box): Residential E71 Municipal 0 Industrial 0
Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below)
Agricultural Monitoring 0
Nearest Town: BAKERSVILLE County: MITCHELL
BEANS CRK RD OFF HWY 226
(Road Name and Numbers. Community, or subdivision and Lot No.l
DRILLING LOG DEPTH
3.
OWNER CHARLES D. BYRD
From To Formation Description
Address 130 SHORT LANE,
0 53 DIRT
JONESBCAVorRoute Nod 37659
53 172 GRANITE
City or sown state Ziv Code
172 173 QUARTZ
4.
DATE DRILLED 7/17/2000
173 224 GRANITE
5.
TOTAL DEPTH 245
224 225 SHALE
6.
CUTTINGS COLLECTED YES 0 NO ®
225 245 GRANITE
7.
DOES WELL REPLACE EXISTING WELL? YES 0 NO
8.
STATIC WATER LEVEL Below Top of Casing: B0 FT.
® 'o
(Use "+" if Above Top of Casing)
9.
TOP OF CASING IS 1 FT. Above Land Surface*
CAL)
'Top of casing terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2C.0118
4
10.
YIELD (gpm): METHOD OF TEST Aar
11.
WATER ZONES (depth)! ppm 172-173 3 ppm 224-225
v m�
0 ppm 0 ppm
12.
CHLORINATION: Type HTH Amount 39
If additional space is needed use bat f fo �=:
fl �
13.
CASING:
LOCATION SKETCH
Wall Thickness
Depth Diameter or Weight/Ft. Material
(Show direction and distance from at least two State
From 11 To 57 Ft. 6 114 .188 GALV.
Roads, or other map reference points) "
From To Ft.
q
From To Ft.
�'r4•
14. GROUT:
Depth
From D To -
From To _
15. SCREEN:
Depth
From To_
From To_
From To_
16. SAND/GRAVEL PACK:
Material Method
Ft. Cement Gravity Flow
Ft.
Diameter Slot Size Material
Ft. in. in.
Ft. in. in.
Ft. in. in.
z -
t 0 a i7t!ii'
c

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section i 6130
n13O
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR: Dewey Wright Well Pump Co., Inc.
WELL CONTRACTOR CERTIFICATION #: 2688
00042e STATE WELL CONSTRUCTION PERMIT#: Leslie Reece
1. WELL USE (Check Applicable Box): Residential ® Municipal 0 Industrial
Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: RAK RGVI County: MITCHELL
DUCK BRANCH RD OFF MINE CREEK RD OFF HWY 226
(Road Name and Numbers, Community, or Subdivision and Lot No.)
3. OWNER HOM R I HARDING
Address 715 DI ICK BRANCH RD
RAKFR''1%iPrelar�nr aocte No.l NC 2B705
clty or Town State Zip ode
4. DATE DRILLED 7/17/2000
5. TOTAL DEPTH 125
6. CUTTINGS COLLECTED YES D NO ER
7. DOES WELL REPLACE EXISTING WELL? YES 0 NO
8. STATIC WATER LEVEL Below Top of Casing: 20 FT.
(Use '+" if Above Top of Casing)
9. TOP OF CASING IS 1 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2C.0118
10, YIELD (gpm): 20 METHOD OF TEST Air
11. WATER ZONES (depth)20 oom 81-62 0 Apm
0 oom 0 Apm
12. CHLORINATION: Type HTH Amount 22
13. CASING:
Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 TO A Ft. 8 118 zrin _ PVC
From To Ft.
From To Ft.
14. GROUT:
Depth
Material Method
From n TO
Ft. r'.PmPnf
GravityFirm
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.
Agricultural0 Monitoring
DRILLING LOG DEPTH
From To Formation Description
0 43 DIRT
43 61 GRANITE
81 62 QUARTZ
82 125 GRANITE
If additional space is needed use
fl o
LOCATION SKETCH `
(Show direction and distance from at least two State
Roads, or other map reference points)
v,
17. REMARKS: t
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECO D HAS BEEN PROVIDED TO THE WELL OWNER..
FOR OFFICE USE ON L K 'IS V 0
SIGNATURE OF I ON CONSTRUCTING THE WELL DATE
Quad No: Submit original to Division of Water Quality, Groundwater Section within 30 days
GW-1 REV. 12/99
Serial No.
1\w

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section 1 v 1 C 1 -L 0O O
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR: Dewey W ght Well Pump Co., Inc.
2086
000438 WELL CONTRACTOR CERTIFICATION #: Leslie Reese
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE (Check Applicable Box): Residential Q� Municipal 0 Industrial 0
Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use:
Agricultural Monitoring 0
2.
3.
WELL LOCATION: (Sh f. cation below)
Nearest TJiJ�INf Y County: MITCHELL
(Road Name a nd Numbers, Community, or Subdivision and Lot NeJ DRILLING LOG
OWNER APRIL BYRD From To
Address °NC DO I 0 24
DEPTH
�o� o p� cription
MUurPMA%'_T
tree! c, Route No.l
City or Town Stare Zip Code 2U6 t
4.
DATE DRILLED 7/13/2000
c�
5.
TOTAL DEPTH
0 NO OxIl��
6.
CUTTINGS COLLECTED YES
[ J
7.
DOES WELL REPLACE EXISTING WELL? YES , NO
8.
Iluu
STATIC WATER LEVEL Below Top of Casing: FT.
ry
(Use "+" if Above Top of Casing)
9.
TOP OF CASING IS 1 FT. Above Land Surface*
'Top of casing terminated at/or below land surface requires a variance in actor-
rn
dance with 15A NCAC 2C.01181 Air
n N
10.
t�I
YIELD (gpm): 1JHOPm0�0T3F�374-pplPf dal
11.
WATER ZONES (depth):
—
12. CHLORINATION:
13. CASING:
Depth
From 0 To -
From To _
From To _
14. GROUT
Amount
Wall Thickness
Diameter or Wei ht/Ft. Mat rial
27t. 61/4 .1N C,ALV
_ Ft.
_ Ft.
Depth
Material Method
0
20
Cement Gravity Flow
From
To
Ft.
From
To
Ft.
15. SCREEN:
Depth
Diameter
Slot Size Material
From
To
Ft.
in. in.
From
To
Ft.
in. in.
From
To
Ft.
in. in.
16. SAND/GRAVEL PACK:
Depth
Size Material
From
To
Ft.
From
To
Ft.
If additional space is needed use back of form
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other map reference points)
� N
t0 4cl 01.
� s.
J aae
(I,b .GMT .
e"IwrnlA
17. REMARKS:
DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL SP`
IQ .CW
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN
PROVIDED TO THE WELL OWNER.
FOR OFFICE USE ONLY n w::� Aga g WE , "_'_'" S i}- 06
..
1 3 21jo j SIGNATURE OF PEKJON CONSTRUCTING THE WELL DATE
Quad No: Submit original to Division of Water Quality, Groundwater Section within 30 days
GW-1 REV. 12/99
C.. Serial No....- �'

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section '7 1 71636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR: Dewey Wright Well Pump Co., Inc.
WELL CONTRACTOR CERTIFICATION #: 84
09649 STATE WELL CONSTRUCTION PERMIT#: Dewey Wright, jo
1. WELL USE (Check Applicable Box): Residential OX Municipal 0 Industrial 0
Recovery El Heat Pump Water Injection E�] Other 0 If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: BAKERSVILLE County: MITCHELL
PRIVATE DR OFF HIWY 80 OFF MINE CREEK RID, OFF H
ROdtl Name and Numbers. Community. or Subdivision and Lm No i
3. OWNER KENNETHL CARROLL
Address m1nNCRn
R K RSUI e r Route No.l NC 9R705
City or Town State Zip Code
4. DATE DRILLED 7/14/2000
5. TOTAL DEPTH 425
6. CUTTINGS COLLECTED YES El NO EZ
7. DOES WELL REPLACE EXISTING WELL? YES E:1 NOEXI
8. STATIC WATER LEVEL Below Top of Casing: 1_ FT.
(Use "+" if Above Top of Casing)
9. TOP OF CASING IS 1 FT. Above Land Surface*
'Top of casing terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2C.0118
10. YIELD (gpm): 1/2 METHOD OF TEST Air
11. WATER ZONES (depth)1/2 Apm 131-132 0 ppm
0 Apm 0 Apm
12. CHLORINATION: Type HTH Amount 87
Agricultural Monitoring 0
DRILLING LOG DEPTH
From To Formation Description
0 15 DIRT
15 131 GRANITE
131 132 QUARTZ
132 425 GRANITE
If additional space is needed use
CD
o A-
13. CASING: Wall Thickness LOCATION SKETCH 6c�
Depth Diameter or Weight/Ft. Material (Show direction and distance from at least two State
From n To 21 Ft. 6 114 .168 GAL.V. /1 Roads, or other map re erence points)
From To Ft. L/ll�/,/ �
From To - Ft.
14. GROUT: Ca' d
O
Depth Material Method �
From n To 90._Ft. C:pment rave Flow
From To Ft. �� 1 gp
15. SCREEN:
Depth Diameter Slot Size Material _ C
From To Ft. in. in. N�
From To Ft. in. in. N
From To Ft. in. in.
16. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
17. REMARKS: ` .,V' t,-,e
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A C Y OF THIS RE ORD H S BEEN ROVIDED TO THE WELL OWNER.
FOR OFFICE USE` NLY� � "*-
8- I S- 60
Q SIG URE OF PERS ONSTRUCTING THE WELL DATE
Quad No: Submit origin to 'vision of Water uality, Groundwater Section within 30 days
GW-1 REV. 12/99
Serial No.

North Carolina - Department or Environmentand Natural Resources - Oiviednn of Water Oualiry -Groundwater Section r� i 11. 794
1636 Mail Service Center- Raleigh. N.C. 27699-1636-Phone [phone]
WELL CONSTRUCTION RECORD Weu_CON rnAcron:
WELL CON IIACI Oil CCHTIFICATION
STATE WF_LL CONSTnUCTION PERMITN:
1. WELL USE (Check Applicable Box): Residential L-J Municipal ❑ Industrial ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATION: (Show sketch of I e location below))
Nearest Town: 5/l.)j.' County:
(Road Name and Numbers, Community, or Subdivision and Lot No.)
3. OWNER ,f; r S" /v
Address'
treat or oute o.
.S/r "4r r- q,'I,r A a 7 Y 7
City rTovm r State Zip Code
4. DATE DRILLED ,23 4 C,
S. TOTAL DEPTH 2 an
6. CUTTINGS COLLECTED YES ❑ NO�
7. DOES WELL REPLACE EXISTING WELL? YES 0 NO�
8. STATIC WATER LEVEL Below Top of Casing: gC, FT.
(Use •+' If Above Top of Casing)
9. 70P 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.0�18
10. YIELD (gpm): METHOD OF TEST /4%/t
11. WATER ZONES (depth); 75 f° ?8111,1
12. CHLORINATION: Type h'T /,L Amount 3 0<' _
13. CASING:
Wall Thickness
Depth Diam�etor or Weight/Ft. Material
�
From �� To -7-2 Ft.—:
From To Ft.
From To Ft.
14. GROUT:
Depth Material Method
From To LL Ft. 1fc�
From To FE
15. SCREEN:
Depth Diameter Slot Size Material
From —To—Ft— in. —in.—
From —To _ FE in. in.
From —To _ Ft. In. in.
16. SAND/GRAVEL PACK:
Depth Size Material
From To FE
From To Ft.
17. REMARKS:
DRILLING LOG
Fore To
Agricultural ❑ Monitoring ❑
/a-
2 7
2 2-
3.5
_7 f.
3 F
3R_
Sze
DEPTH
Formation Description
e�2 cc
e nwi T
rnrt i le
rrl
II additional space is needed use back of loin =
co
.. t
LOCATION SKETCH
(Show direction and distance from at leazt two State
Roads, or other map reference points)
DO HEREBY CERTIFY THAT THIS WELL WAS CONST U EDDMR�RDHASIINACCORDANCE WITH 15 NCAC2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COY TEEN PROV� O THE WELL OWNER.
FOR OFFICE USE ONLY
Ouad No: _❑, SIGNATURE OF PERSON CONSTRUCTING(.THE WELL DATE
P (� 1 j Sutgmit original to Dtvislon of water Quality. Groundwater Section within 30 days
Serial No. + - '
GW1 REV. 12/99
SEP 2 5 ')nil

� i8041
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1 1636 Mail Service Center- Raleigh, N.C. 27699-10G-Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR:
WELL CONTRACTOR CERTIFICATION #: •'�C
STATE WELL CONSTRUCTION PERMIT#:
1.
WELL USE (Cheek Applica ble Box): Residential Pa Municipal ❑
Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2.
WELL LOCATION: (Show sketch of the location below)
.;
Nearest To wn• Co/ County:
(Road Name d Numbers, Communit , or Subdivision and Lot No.)
DRILLING LOG DEPTH " is Yr dr
.3. .OWNER
�'1A4a �E'�
From To Formatiopon Descnpllon v
-2
Address
'
City or Town ilb,am t Zip Code
4,
`.5...
DATE DRILLED
TOTAL DEPTH
6.
CUTTINGS COLLECTED YES NOES
7.
DOES WELL REPLACE EXISTING WELL? YES NOEf-
S.
STATIC WATER LEVEL Below Top of Casing: FT.
(Use'+' II Above Top of Casing)
9.
TOP OF CASING ISFT. Above Land Surface'
'Top of casing terminated atlor below land surface requires a variance In accor-
dance with 15A NCAC 2Cy.11e,
�
C��
"
10.
YIELD (glom): METHO OF TEST
11.
WATER ZONES (depth): ,, GT
_
-': 12.
CHLORINATION: Type C e Amount 3-]'Y
If additional space Is needed use back of form
13.
CASING:..
LOCATION SKETCH
Wall Thickness
Depth Dia t r or Weifl'hV.
V EM
(F Show direction and distance from at least two State
_Ma_teSal'
From To Ft. /6 c—Yu-
Roads, or other map reference points)
From To Ft
—
From ' To Ft.
cn
14
GROUT F.
Depth Maleri Method A
c5
From �ML'Tci 20 Ft. ! Ow e'DID v
From :' To
Ft.
`15. SCREEN:.,.',•
r=
Depth
Diameter Slot Size Material
` From To —Ft—
in. in.
From To
Ft. in. _ in.
" r,
•:'From "` 'To _
FL_ In. —in.
16. SAND/GRAVEL PACK:
Size Material
From To
FL
From To
Ft.
_
17., REMARKS:
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, -AND THAT A COP F THIS AEC E - !PROVIDED TO THE WELL OWNER.
GNATunE
FOR OFFICE USE 01+1LY
Ouatl No 4'rt
OF PERSON CONSTRUCTING THE WELL
DATE
•
",wbiptl oeginaNq Division of Water Quality, Groundwater Section within 30 days
,T ��.
Serial NO. =y :,
•�.�,I
GW 1 REV 12199
I'••
i.
• Y Y
'•, :!. '
C J f(, :a Y AJ•JY rI
As ra. Reri :a., •.ce._...... -
Trti 4 211* q
r ,
..'
✓ „�'�'•'F

1g04T_
North Carolina - Department of Environment and Natural Resources - Division of Water Quahry - Groundwater Section
'.1636 Mail Service Canter. Raleigh, N.C. 27699-163G-Phone [phone] -' 1 ';•� , h
"S• yt''ax" - 1 J�%�4'L I I � � I � 1 � � s r�.
WELLCONTRACTOR:
WELL* CONSTRUCTION RECORD
,rr WELL CONTRACTOR CERTIFICATION #: a I _3 __3
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE (Check Applicable Box): Residential L7 Municipal ❑ Industrial ❑ Agricultural ❑
Recovery ❑ - Heat Pump Water Injection ❑ Other ❑ It Other, List Use:
2. WELL LOCATIQN; (Show sketch el the location below)
Nearest Town: r?ar P'�k t - County: JLI r l Na
Monitoring ❑
(Road Name and Numbe , Co ity, orSubdivision andLotNo.) DRILLING LOG DEPTH
3.
.OWNER G W� From To Descdpbon`
('t
tFormaf��on
Address`.':
M
et o 1 r elite q. q nA,r
r�
City or Town SAO Zip Coda
4.
DATE DRILLED
5.
6.
.TOTAL DEPTH - )
CUTTINGS COLLECTED NES 0 NOr—
7.
DOES WELL REPLACE EXISTING WELL? YES F-1 NOQ_
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 attor below land surface requires a variance In accor-
dance with 15A NCAC 2C.011# rr
10.
.
YIELD (gpm): -,:I�c7 METHOD OF TEST�_"''/J
11.
WATER ZONES (depth):r. ,
r �,.r• _ _
,.,,_t
- 12.
CHLORINATION:. Type Amount It additional space is needed use back of loan ,",g, w*x'>:.•:�; a
13.
CASING::"-
LOCATION SKETCH
Wall Thickness
Depth Da I r or Wq� V I. Li e (Show direction and distance from at least two State
y l
FromTo —(— Ft. r. Roads, or other map reference points)
c=7
-
From To FL
CJ
From To Ft.
14.
GROUT ,%.:
rU
+tr,-gr-.Depth--ryry��,, MaterialMethod
`°'
From �To � Ft. GE'11
From .�..;, .....- To FLU
,..._'
:`.15.
SCREEN:-
+-. Depth Diameter Slot Size Material
4 .`
From To Ft in. —in.
4 -
From '' ?o_Ft. in. _ in.
From To _ FI.in. in.
,16.
SAND/GRAVEL PACK:
r jf*'Depth Size Material
1
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. REEC BE N PROVIDED TO THE WELL OWNER.
'
�COgP��f'O�FTHIS
FOR OFFICE USE •.....Y C7 lr `l/F--�`�h—r :`--��
Quad
No:.,_,,-,; ', ' U ' f` '— SIGNATUnE OF PERSON CONSTAVCTINO THE WELL DATE' + ,
Sunmll original lb Division of Water Quality, Groundwater Soction within 30 daysWWFr,`�.,.y:.
t '
Serial No I' l �� y GW 1 REV.
12199 i"
nj
'M1 yT°
pf17,

18043
: North Carolina-- Department of Environment and Natural Resources -Division of Water Quality -Groundwater Section
1.1636 Mail Sorvice Center - Raleigh, N.C. 27G99-1 G3G-Phono [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR: F�RhS-�
WELL CONTRACTOR CERTIFICATION #: a 3 3
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) MM
- ..
NearestTowni� -�/Jlk� county: _L'_,f4ck
1r J'
(Road no aqd Numbers. Communit , bt Subdivision and Lot No.)
DRILLING LOG DEPTH '
3.
.OWNER /�-�L YIo (liU ATT'1
n
From To FormatioDescrlpbon y�r %e '
it
7�
--Address :`:::Fro:a 1L+cr%rr^�`
��o`D
�c
Cityor Town State Zip Code
4.
DATEDRILLED
5.
TOTAL DEPTH
-6.
CUTTINGS COLLECTED YES ❑ NO[
7.
DOES WELL REPLACE EXISTING WELL? YES ❑ NOn_
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 allor below land suAace requires a variance In accor.
dance
with 15A NCAC 2C.01,1
10.
YIELD (gpm): _� METHOD OF TEST Jr^iulLi
11.
WATER ZONES (depth):
-' 12.
CHLORINATION:-. Type Amount
If additional space is needed use back of form = 't-,�n�T Ti �
13.
CASING:
Wall Thickness
LOCATION SKETCH
Depth D'fa ae or or Weip OF _htaatepal
Ito
( Show direction and distance from at least two Slate
From To Ft. �=i]-53— -
�J
Roads, or other map reference points)
From - To Ft.
ram_ <.
From .. - To Ft.
rn
14.
GROUT
Depth Mated I Method
'r,-�
aa
From To _ Ft. C6I/LC
Co
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 e" To Ft.
17.. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN
CONSTRUCTION STANDARDS, AND THAT A CQP,]' THIS RE�E
r,
FOR OFFICE US tV ) - t5--�1
WITH 15A NCAC 2C, WELL
oROVIDED TO THE WELL OWNER.
Quad No t { • ONATUHE OF PERSON CONSTRUCTING THE WELL
§ufgn`t odgl tQ Mslon of Water Quality, Gmundwator Section within 30 days
Serial Na
DATE
GWI REV. 1299 �3 rrtis
•i.: �xb5.Wit1"
p}yj,
r 4 -q

1
21SO44
S North Carolina • Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
,!,1636 Mail Service Center- Raleigh, N.C. 27699-1636-Phono [phone]
, � —
I i C- I
WELL CONSTRUCTION RECORD WELL CONTRACTOR: u ��
WELL CONTRACTOR CERTIFICATION #: a 3
3
- STATE WELL CONSTRUCTION PERMIT#:
,--,
'.� 1. WELL USE (Check Applicable Box): Residential E Municipal ❑ Industrial ❑ Agricultural ❑
Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATI ( how sket h of the location below) rye
Nearest Town: r County: /'IIVC/i=-��
(Road Name and liflumbers,Commu or S bdivision and Lot No.) DRILLING LOG DEPTH
3. :OWNER <L � t f�lE1 YlJ From To Fonnatien
Descnpu n
l
Address : ,( G,C �.�....�
�� �,• �,.
Zs
(Street or Route o. h'-j ;- a
-' Cityor Town State Zip Code
-7
4. DATE DRILLED
5. _TOTAL DEPTH ©
6. CUTTINGS COLLECTED I YES 0 NO©-
7. DOES WELL REPLACE EXISTING WELL? YES NO©-
6. STATIC WATER LEVEL Below Top of Casing: FT.
" (Use'+' if Above Top of Casing)
9. TOP OF CASING ISFT. Above Land Surface'
'Top of casing terminated atlor below land surface requires a variance In accor.
dance with 1SA NCAC 2C. 11a
- 10..YIELD (gpm): METHOD OF TEST
11. WATER ZONES (depth): ) a5. fSS,- )c(c( `-
-'` 12. CHLORINATION: Type A= —Amount If additional space is needed use back of form
13. CASING:
LOCATION SKETCH.
Wall Thickness
Depth r , �.,. Dl�x _V or weighuFl] Mated (Show direction and distance from at least two State
(0--3' / qT,,
From To FL Roads, or other map reference points)
From To Ft.
From To Ft.
14. GROUT:.
Depth Mated aJ_r Method
C7
G
�/1tEN/�
:From 'ToFt. e
�1
1 ' From To - Ft.
.15. SCREEN:: .•
rw
Depth, Diameter Slot Size Material
c3 y
From To Ft in. in.
' r`
From To Ft. _ in. In.
From t` `' To _ FL in. —in.
r
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
r :�
'.: CONSTRUCTIONS ARDS A COPY THIS R EN PROVIDED TO THE WELL OWNN�ER. '.
(A�ND(�THpAT
FOR OFFICE USE O
Quad No `
(
�'13
UnE OF PERSON CONSTnUCTINO THE WELL
DATE ss
Submit odgin
Sion of Water Quality, Groundwater Section within 30 days
`t js `
'
Serial No
JCT 6 �f"�
GW 1 REV 12/99 s
i 1s i < ° Ci1Ba
• r; fl'F1��°V 1-j,

c,r
s �
ti3�
`>v18045
,
North Carolina • Department of Environment and Natural Resources - Division of Water Oualiry - Groundwater Section
1636 Mal Service Center- Raleigh, N.C. 27699-1636-Phone [phone]
WELL CONSTRUCTION RECORD WELLCONTRACTOR:�c
WELL CONTRACTOR CERTIFICATION #: ,2 3
STATE WELL CONSTRUCTION PERMIT#:
1. ` WELL USE (Check. Applicable Box): Residential 'LT Municipal ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ `:"
Recovery Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
` 2. WELL LOCATI (Show sketch of the location below)
p� r-
.: Nearest Town: � NCounty: 1_` l '4e lI
41`\I
I
AI t,
1��..
(RoNaNal \Nate and Numbers. Community, or Subdivision and Lot No.) DRILLING LOG DEPTH-
OWNER From To F rmati nDescnpbonEt
s3
j Address •.
�'- �'. r' :," ° `.'-�
r
a
veal Gr oute o.
.v�. 4..• 71 =. 6,�
" City or Town State Zip Code
'
4. DATE DRILLED " 5'
5. TOTAL DEPTH --
6. CUTTINGS COLLECTED YES Q NOE3-�
7.. DOES WELL REPLACE EXISTING WELL? YES NO
8.. STATIC WATER LEVEL Below Top of Casing: FT.
-
�' (Use'+' If Above Top of Casing)
1
9. TOP OF CASING IS FT. Above Land Surface'
-
'Top of casing terminated eVor below land surface requires a variance In accor-
dance with 1SA NCAC 2C.0118
10. YIELD (gpm):.<:� METHOD OF TEST
11. WATER ZONES (depth):
-''12. CHLORINATION: .Type Amount
It additional space Is needed use back of form
.13. CASING'';;..
Wall Thickness
LOCATION SKETCH ,
,per Depth Diaamettt or Weight/t. Matedai, (Show direction and distance from at least two State
.�
From To"FL
Roads, or other map reference points)
From To Fl. Jll
From "To FL
14 GROUT
G7
h Maten I Method
:•
a°\, From To FL
a -., From:.. To - Ft.
15: SCREEN:,
Depth Diameter Slot Size Material
Mi
From To— Ft in. in.
4 _\5
s s v
From To Ft. _ in. _ In.
ref kTt err t
1..'i:_
From r. To _ Ft.— in. —In.
x16.`SAND/GRAVEL PACK:
s� z
r • %w Depth " Size MaterialN,`
4.
y
From To Ft.
From ,.;•,,.: To FL
17. REMARKS.
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
.
_ CONSTRUCTION STA
IS REC BE ROVIDED TO THE WELL OWNER •�; r.
U
FOR OFFICE USE ON
Quad No+ L 0 ',f--,
Si
E OF PERSON CONSTRUCTING THE WELL DATE
�,
\ S \ +
Sorial No ''
Su18nIf:6 Thal I
OCT VV LL
I I
n of Water Quality, Groundwater Section Within 30 days
GW 1 REV. 12 91(r.}��s`t
Asheville Re ional Office
f ?

JIM
North Carolina Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
' 1636 Mail Service Center- Raleigh, N.C. 27699-1 G36-Phone [phone]
WELL CONSTRUCTION RECORD WELLCONTRACTOR:£
WELL CONTRACTOR CERTIFICATION #: a
STATE WELL CONSTRUCTION PERMIT#: 1c G5
1.
WELL USE (Check Applicable Box): Resldential E9� Municipal ❑
Industrial ❑ Agricultural ❑
Recovery ❑ - -:-. Heat Pump Water Injection ❑ Other ❑
If Other, List Use:
2.
WELL LOCATION: (Show sketch f the location below)
..
Nearest Town: - 3y^ ^;ce �I County:
A %Ea$ le f�
,46,eo AQ 2M'Ie c,u � t .3r.1tifc L• & .
(Road Name and Numbers, Communit or Subdivision and Lot No.)
DRILLING LOG
_.
3.
.OWNER -L //lil5-�[>"i
From To
Fort
Address
e7
,, J rector outoL o. q-1,�'7�
oc� - .' 90
4.
City or Town to / Zip Code
DATE DRILLED /G� ALC'C,
- 90 7
3 — D
z
n
5.
TOTAL DEPTH V o �'
I
6.
CUTTINGS COLLECTED YES Q NOQ
7.
DOES WELL REPLACE EXISTING WELL? YES ❑ NOEJ
M II)!
S.
STATIC WATER LEVEL Below Top of Casing: FT.
- (Use'+' II Above Top of Casing)
'r
9.
TOP OF CASING ISFT. Above Land Surface'
'Top of casing terminated attor below land surface requires a variance In eccor-
danco
wlth 1SA NCAC 2C,Tl
10.
YIELD (gpm): j— METHOD OF TEST �} %�
11.
WATER ZONES (depth): v ,S le,4-7e 7
eville Regional
4.3 `/Y)- 5'73
12. CHLORINATION: Type i-i- %lt- Amount 3 t) L If additional space is needed use back of form
13. CASING:
Wall Thickness
Depth
Diamc or or Weight/Ft. Material
From To._!L'n
Ft. e' / V` 6c/�'•
From To
Ft.
From To
Ft.
14.
GROUT
Depth:
Material Method
.,From
(/' :'To ..'�2v
Ft.
From To
Ft.
-15.
SCREEN
Diameter Slot Size Material
From - ' `To Ft
in. in.
From To Ft.
in. _ In.
From "Tci Ft.
In. in.
16.
SAND/GRAVEL PACK:
Depth
Size Material
From To
Ft.
From To
Ft.
17.,
REMARKS:..'�'.lc? fo -�, 97
_f-A2"d lo,^ e fier !
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other map reference points)
y
L'C S4N<' iN CC7r7
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL r
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RREECr(/ORD HAS BEEN PROVIDED TO THE WELL OWNER.
FOR OFFICE USE ONLY�z
Quad No S:GNATURE-16F PERSON CONSTnucrING THE WELL DATE • x"1 v 1
Submit original to Dlvislon of Water Quality, Groundwalor Section within 30 days i jd y
Serial No GW 1 REV t2J99�t,
hid i

North Carolina- Department of Environment and Natural Resources - Division of Water Quality
1636 Mail Service Center- Raleigh, N.C. 27699-1G36-Phono [phone]
f
19IR03
Groundwater Section
WELL CONSTRUCTION RECORD WELL CONTRACTOR: _ � 11c, c c 'tee
WELL CONTRACTOR CERTIFICATION #: a
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE (Check Applicable Box): Residential � Municipal ❑ Industrial ❑ Agricultural ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑
If Other, List Use:
2.
WELL LOCATION: (Sh.rcow sk to of the location below)
.
(
Nearest Town: .S�i °� ti` County: / c�r
DRILLING LOG
(Road Name and Numb�ers. Community, or Subdivision and Lot No.)
3.
OWNER /` N c FUr. /
From To
Address . t3
. '(wreebq oulo o.)
Pktit:
4.
City of Town Slate Zip Code
DATE DRILLED
�IC
5.
TOTAL DEPTH ��y�'
ij� / %G —2
6.
CUTTINGS COLLECTED YES Q NOD—
7.
DOES WELL REPLACE EXISTING WELL? YES ❑ NO©
8.
STATIC WATER LEVEL Below Top of Casing: FT.
(Use': it Above Top of Casing)
9.
TOP OF CASING IS FT. Above Land Surface'
'Top of casing terminated eVor below land surface requires a variance In accor-
dance
with 15A NCAC 2C,�118
10.
YIELD (gpm): .�� METHOD OF TEST)
11.
WATER ZONES (depth):
Croyctirf
s '°Ille RP ion 0
12.
CHLORINATION:. Type f% 7-Amount �aS
If additional space Is needed
13.
CASING:
Wall Thickness
Depth
Diam tar or WelghUFt. Material
From To y�
Ft.
GR /9`',
From To
Ft.
From To
Ft.
14.
GROUT
Depth
Material Method
From L' 'To 5Zc'
FL
CC,h el7L
From,.. To
Ft.
.15.
SCREEN
_ Depth -,
Diameter Slot Size Material
From LTo '_
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:
`' ,
Monitoring ❑
DEPTH
Formation Descriptit
,
Of form
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other map reference points)
1)
r
r '
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL '
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HA
,,S "N PROVIDED TO THE WELL OWNER.
FOR OFFICE USE ONLY
Quad No
Sedal No
�d
SIGNATURE Of p SOH CONSTRUCTING TFIE WELL
Submit odginal to Division of Water Quality. Groundwater Section within 30 days
DATE
`Ky
GW 1 REV 12199t ,, ,( r
nyr`�„u1�ra i.

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section ?_ ]. 22 38
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone]
WELL Pf,NSTRUCTION RECORD WELL CONTRACTOR: Dewey Wright Well Pump Co., Ino.
2081
000310 WELL CONTRACTOR CERTIFICATION M
STATE WELL CONSTRUCTION PERMIT#:
1. WE' ' ii 'Check Applicable Box): Residential ® Municipal Industrial 0 Agricultural El Monitoring 0
Rec,. r_i, -I Heat Pump Water Injection 0 Other EJ If Other, List Use:
2. WELL LGCATION: (Show sketch of the location below)
NearestTcwn: BAKERSVILLE County: MITCHELL
DFFR PARK I AKF Fin (OFF HWY ?96
-- IRca Name and Numbers, Community,or Subdivisionand Lot No.) DRILLING LOG DEPTH
3. OWNER BILLY R. HUGHES, JR. From 0 To25 DIR�rmation Description
Address
( Route No,)
uty or town Jooe uy wuc
4. DATE DRILLED 5/30/2000
5. TOTAL DEPTH f$o­
6. CUTTINGS COLLECTED YES 0 NO
7. DOES WELL REPLACE EXISTING WELL? YES 0 NOEN
8. STATIC WATER LEVEL Below Top of Casing: 30 FT.
(Use " ', if Above Top of Casing)
9. TOP OF CASING IS 1 FT. Above Land Surface*`
'Top of casing terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2C.01 Is Air
10. YIELD (gpm): MET90� ZJ _
11. WATER ZONES (depth)1 PP
O
12. CHLORINATION: Tvoe Amount If additional space is needed use be
13.
CASING:
LOCATION SKETCH
Depth
Wall Thickness
Diameter or wei hVFt. Material
PVC
(Show direction and distance from at least two
State
From
0 To
31 Ft.
61/8 .35tl�
Roads, or other map reference points)
From
To
Ft.
•J� \'
From
To
Ft.
H ti�Y 2zry
14.
GROUT:
Depth
Material Method
a
From
0 To
20 Ft
Cement Gravity Flow
From
To
Ft.
15,
SCREEN:
y,
U
Depth
Diameter Slot Size Material
Cj
From
To
Ft.
in. in.
L
From
To
Ft.
Ft.
in. in.
in. in.
^QS
�
From
To
,0
16.
SAND/GRAVEL PACK:
l'JC
Depth
Size Material
From
To
Ft.
From
To
Ft.
17. REMARKS: � 0 . M7a \\\b
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL V
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
FOR OFFICE USE ONLY
Quad No:
Serial No.
A —
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit original 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 2 2 2 3 9
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone] J
WELL CONSTRUCTION RECORD WELL CONTRACTOR: Dewey Wright Well Pump Co., Inc.
000312 WELL CONTRACTOR CERTIFICATION #: Steve Reece
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE (Check Applicable Box): Residential I •'I Municipal E] Industrial
Recovery D Heat Pump Water Injection 0 Other EJ If Other, List Use:
2.
WELL LOCATION: (Show sketch of the location below)
Nearest Town: SPRUCE PINE County: MITCHELL
DOVEHILL LN OFF BENT RD. OFF HWY 19 E
IFI-1 N.,.,o a�a NnmFc,a Co.., o. nr s., mri siren and I nt No I
3. OWNER DEWAYNE WOODY
Address 215 DOVE HILL LANE,
SPRUCE MErOO1eNO NC 28777
iN o, Town State rip code
4. DATE DRILLED 5/31/2000
5. TOTAL DEPTH 405
6. CUTTINGS COLLECTED YES 0 NO
7. DOES WELL REPLACE EXISTING WELL? YES 0 NO
8. STATIC WATER LEVEL Below Top of Casing: 50 FT.
(Use '+" if Above Top of Casing)
9. TOP OF CASING IS 1 FT. Above Land Surface*
'Top of casing terminated at/or below land surface requires a variance in actor
dance with 15A NCAC 2C.011
10. YIELD (gpm): METHOD OF TEST Air
11. WATER ZONES (depth):5 gpm130-134 0 gpm
0 gpm 0 gpm
12. CHLORINATION: Type
Amount
Agricultural D Monitoring E]
DRILLING LOG
From 0 To
130 1 4
134 405
DEPTH
DI F rmation Description
UKANR
� tip
i
N mom,
If addrtronal space is needed use back of form
13. CASING:
LOCATION SKETCH
Depth
Wall Thickness
Diameter or Weig hUFt. Material
(Show direction and distance from at least two State
From
0 To
80 Ft.
6 118 .350
PVC
Roads, or other map reference points)
From _
To
Ft.
C�
From
To
Ft.
14. GROUT:
Depth
Material
Method
From
0 To
20 Ft.
Cement
Gravity Flow
From
To
Ft.
v
15. SCREEN:
G
Depth
Diameter
Slot Size
Material
f
TIP
From
To
Ft.
in. in.
\I
i
From
To
Ft.
in. in.
V.I
From
To
Ft.
in. in.
a-- -�
16. SAND/GRAVEL PACK
Depth Size Material I
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
Submit original to Division of Water Quality, Groundwater Section within 30 days
DATE
GW-1 REV. 12/99

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section ! 12240
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR: Dewey Wright Well Pump Co., Inc.
99725 WELL CONTRACTOR CERTIFICATION #:
STATE WELL CONSTRUCTION PERMIT#: —SFe—ve Heece
1. WELL USE (Check Applicable Box): Residential © Municipal 0 Industrial El
Recovery D Heat Pump Water Injection 0 Other E] If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below)
Agricultural ❑ Monitoring 0
3.
Nearest Town: BAKERSVILLE County: MITCHELL
" 261
(ROdtl Nam and Numbers. Community, or Subdivision and LONo.) DRILLING LOG DEPTH
OWNER LOUIS SHAW From To Formation Description
Address 5611110 CHISOLM RD. 0 49 DIRT
JOHNS I `A'NdouteN0.i SC 29455762
V Ll
49 70 GRANITE
city or Town state Lip code
70 73 SHALE
4.
DATE DRILLED 5/29/2000
73 345 GRANITE O
5.
TOTAL DEPTH 345
6,
CUTTINGS COLLECTED YES El NO
7.
DOES WELL REPLACE EXISTING WELL? YES D NO ©
=nT
8.
STATIC WATER LEVEL Below Top of Casing: 20 FT.
(Use "+" if Above Top of Casing)
1
�^'
9.
TOP OF CASING IS FT, Above Land Surface*
'Top of casing terminated at/or below land surface requires a variance in accor-
IV
f*1 a
dance with 15A NCAC 21C.011�
Air
O
- i
10.
YIELD (glom): METHOD OF TEST
11.
WATER ZONES (depth)? 9Pm70-73 0 gpm
_
0 gpm 0 gpm
12.
CHLORINATION: Type HTH Amount 67
If alidttj ��i. Reeded use back of form
13. CASING
Depth Diameter
From 0 To 54Ft. 61/4
From To Ft.
From To Ft.
LOCATION SKETCH
Wall Thickness
or Weight/Ft. Material (Show direction and distance from at least two State
.188 GALV. Roads, or other map reference points)
14. GROUT:
Depth Material Method
From 0 To 20 Ft. Cement Gravity Flow
From To Ft.
15. SCREEN:
Depth Diameter Slot Size Material
From _—To Ft. in. in.
From To Ft. in. in.
From To Ft. in. in.
16. SAND/GRAVEL PACK:
Depth Size
From To Ft.
From To Ft.
17. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS
CONSTRUCTION STANDARDS, AND THAT A I
FOR OFFICE USE ONLY
Quad No:
Serial No.
Material
J ill:J
STRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
SIGNATURE OF PERSON CONSTRUCTING THE WELL
Submit original to Division of Water Quality, Groundwater Section within 30 days
-1),-Ott
DATE
GWT REV. 12/99

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section 21.2237
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR: Dewey Wright Well Pump Co., Inc.
WELL CONTRACTOR CERTIFICATION #: 2687
000200 STATE WELL CONSTRUCTION PERMIT#: Steve Reece
1. WELL USE (Check Applicable Box): Residential © Municipal D Industrial EJ
Recovery 0 Heat Pump Water Injection D Other D If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: BAKERSVILLE County: MITCHELL
HWY 80 OFF MINE CREEK RD. OFF HWY 226
(Road Name and Numbers Community or Subdivision and Lot No )
9
4.
5.
6.
7.
8.
Agricultural El Monitoring 0
DRILLING LOG DEPTH
OWNER BONNIE MULLIS From To Formation Description
Address 115 BROOK VALLEY RD. 0 5 DIRT
COLUME Rost or aouto
No) SC 29223 5 220 GRANITE
City or Town State Zip Code 220 223 QUARTZ
DATE DRILLED 5/27/2000 223 305 GRANITE
TOTAL DEPTH 305
CUTTINGS COLLECTED YES El NO
DOES WELL REPLACE EXISTING WELL? YES EI NOEA © o
STATIC WATER LEVEL Below Top of Casing: 80 FT.
„_.
(Use "+" if Above Top of Casing)
9. TOP OF CASING IS 1 FT. Above Land Surface*
•Top of casing terminated at/or below land surface requires a variance in accor.
dance with 15A NCAC 2C.0118
10. YIELD (gpm): 3 METHOD OF TEST Air
11. WATER ZONES (depth)3 gpm220-223 0 glom
0 glom 0 gpm
12. CHLORINATION: Type HTH Amount 46
13. CASING:
Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 22Ft. 61/8 .350 PVC
From To Ft.
From To Ft.
14. GROUT:
Depth Material Method
From 0 To 20 Ft. Cement Gravity Flow
From To Ft.
15. SCREEN:
Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in. r
From To Ft. in. in.
16. SAND/GRAVEL PACK: _
Depth Size Material
From To Ft.
From To Ft.
If additional space is needed
LOCATION SKETCH —
(Show direction and distance from at least two State
Roads, or other map reference points)
n.
17. REMARKS: �LY'
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COP FF TFTjIS RECORD HAS B EN PROVIDED TO THE WELL OWNER.
FOR OFFICE USE ONLY ' � 'ZIC-I — �- C
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Quad No: Submit original to Division of Water Quality, Groundwater Section within 30 days
GWA REV. 12/99
Serial No.

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
WELL CONSTRUCTION RECORD WELL CONTRACTOR: Dewey Wright Well Pump Co., Inc.
WELL CONTRACTOR CERTIFICATION #: 2686
000031 STATE WELL CONSTRUCTION PERMIT#: Leslie Reece
1. WELL USE (Check Applicable Box): Residential ® Municipal E] Industrial 0 Agricultural El Monitoring ❑
Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use:
2.
WELL LOCATION: (Show sketch of the location below)
Nearest Town: RAKFRRVII I F County:-MITC.HFI I
r:l IR C'RFFK RD r1FF HWV ?26
IRoatl Name and Numbers, ommum[y, or ubtlims!on and Lot No.)
3. OWNER BROWN R. BYRD
Address 4 80
BAKER fLlr °°te N°) NC 28705
City or Town State Zip Code
4. DATE DRILLED 7/10/2000
5. TOTAL DEPTH 245
6. CUTTINGS COLLECTED YES NOD
7. DOES WELL REPLACE EXISTING WELL? YES 0 NO ER
8. STATIC WATER LEVEL Below Top of Casing: 60 FT.
(Use "+" if Above Top of Casing)
9. TOP OF CASING IS 1 FT. Above Land Surface*
'Top of casing terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2C.0118
10. YIELD (gpm): 30 METHOD OF TEST Air
11. WATER ZONES (depth)2 gpm64-65 28 qpm 22'
12. CHLORINATION: Type HTH Amount 39
13. CASING:
Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To _ 5 Ft. 61/8 350 PVC
From To Ft.
From To Ft.
14. GROUT:
Depth Material Method
From 0 To -20 Ft. Cement Gravity Flow
From To Ft.
15. SCREEN:
Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
From To Ft. in. in.
16. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
DRILLING LOG DEPTH
From To Formation Description
0 46 DIRT
46 64 GRANITE
64 65 QUARTZ
65 221 GRANITE
221 222 SHALE
222 245 GRANITE c
o a
0
C L-[rn
-----------------
Y
m
rn
_;r- -=rn
22 [ zn
m
N rn?
m �1
If additional space is needed use back of(fnrm
z
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other map reference points) M-w
:oo-
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
-9D-(
Quad No: SIGNATURE OF PER
N CONSTRUCTING THE WELL DATE
Submit original to Division of Wat r Quality, Groundwater Section within 30 days
GW-1 REV. 12/99
Serial No. _...
& t)

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section 213147
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone]
Dewey Wright Well Pump Co., Inc.
WELL CONSTRUCTION RECORD WELL CONTRACTOR: 2887
000307 WELL CONTRACTOR CERTIFICATION tt: Stpvp Rpecp
STATE WELL CONSTRUCTION PERMIT*
1. WELL USE (Check Applicable Box): Residential E� Municipal E] Industrial 0
Recovery 0 Heat Pump Water Injection D Other El If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below)
Agricultural El Monitoring El
Nearest Town: RIIRNSVII I F County: MITCHELI
OFF MCMAHAN OFF BRUSHY CRK RD OFF OLD 19 E
(Road Name and Numbers, Community, or Subdivision and Lot No.l DRILLING LOG DEPTH
3. OWNER MAUDE LEWIS From To Formation Description
Address RT. 2 BOX 202, 0 28 DIRT
SPRUC2"NEbouts No) NC 28777 28 50 GRANITE
City o, mwn sate na code 50 54 SAND/STONE
4. DATE DRILLED 5/26/2000 54 160 GRANITE
5. TOTAL DEPTH 200 160 163 SHALE
6. CUTTINGS COLLECTED YES E] NO ® 163 200 GRANITE
7. DOES WELL REPLACE EXISTING WELL? YES 0 NOPq
8. STATIC WATER LEVEL Below Top of Casing: 20 FT.
(Use "." if Above Top of Casing)
4
9. TOP OF CASING IS 1 FT. Above Land Surface*
Top of casing terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2C.011
10. YIELD (gpm): - METHOD ST Air o;.1
11. WATER ZONES (depth)3 gpmesj� 2 g 661 zrn
:r m
12. CHLORINATION: Type Amount If additional space is needed use back of for 7�
z rn
13. CASING: LOCATION SKETCH O rn:;Q
Wall Thickness n
Depth Diameter or WeighuFt. Material (Show direction and distance from at leasC�A%vo B$bte
From 0 To 35Ft. 6 1/8 .350 PVC Roads, or other map reference poiwi _
From To Ft.
From To Ft.
T% P
14. GROUT: � ��
Depth Material Method r; 016
From 0 To 20 Ft. Cement 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.
Slot Size Material
in.
in.
in.
li
Material
17. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CON;
CONSTRUCTION STANDARDS, AND THAT A COPY
FOR OFFICE USE ONLY
Quad No:
Serial No.
DIN ACCORDANCE WITH 15A NCAC 2C, WELL
RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit original 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 r] ^ (�
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone] J Y 0
WELL CONSTRUCTION RECORD WELL CONTRACTOR: Dewey Wright Well Pump Co Inc
WELL CONTRACTOR CERTIFICATION #: 2687
000263 STATE WELL CONSTRUCTION PERMIT#: Steve Reece
1. WELL USE (Check Applicable Box): Residential � Municipal ❑ Industrial 0
Recovery EJ Heat Pump Water Injection Other E] If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below)
Agricultural0 Monitoring EJ
Nearest Town: County: �MITTTTCCHELL
l o tl nd b o nit r b n and Lot No.l
DRILLING LOG DEPTH
3. OWNER TIMOTHY 1AruORTEN From To Formation Description
Address a� to.l 1) C 48 DIRT
r ou
Q4ttcoSVILL€ NC 2n7(1`d 48 go CRANIW
City or Totfifi� State Yp�Cotle
4. DATE DRILLED 5r2@gznnn
5. TOTAL DEPTH 245
6. CUTTINGS COLLECTED YES EJ NOD 7. DOES WELL REPLACE EXISTING WELL? YES 0 NO E2
8. STATIC WATER LEVEL Below Top of Casing: in FT.
(Use "+" if Above Top of Casing)
Y�Y
9. TOP OF CASING IS 1 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2C.0118
10. YIELD (gpm): 4 METHOD OF TEST Air
11. WATER ZONES (depth)3 gpm90-93 1 gpm 299-225
0 aDm 0 aom _
12. CHLORINATION: Type HTH Amount 48 If additional space is needed use baclt'Cf for
13. CASING:
Wall Thickness
Depth Diameter or Weight/Ft. Material
From n To ____54Ft. amain 350_ PVC:
From To Ft.
From To Ft.
14. GROUT:
Depth Material Method
From n To 20 Ft. Cement Gp2vitbf Flew
From To Ft.
15. SCREEN:
Depth
From To_
From To_
From To_
16. SAND/GRAVEL PACK:
Depth
From To —
From To
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other map reference points)
CO
rT0 I I ;tf I '�
W
17. REMARKS: j
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A VN2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
FOR OFFICE USE ONLY " iO — '� 0 — 60
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Quad No: Submit original to Division of Water Quality, Groundwater Section within 30 days
5W-1 REV. 12/99
Serial No.
Diameter Slot Size Material
Ft. In. In
Ft. In. In.
Ft. In, In. tea_,
Size RE7 Material
_ Ft.
_ Ft.

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section (� (� M
1636 Mail Service Center - Raleigh, N.C. 27699-1636-Phone [phone] L 1. V .5 9 3
WELL CONSTRUCTION RECORD WELLCONTRACTOR: � S u7LII ool c7Gt �l_
WELL CONTRACTOR CERTIFICATION N: :;Z ) Z
STATE WELL CONSTRUCTION PERMITN:
1. WELL USE (Check Applicable sox): Residential [Municipal ❑ Industrial ❑ Agricultural ❑ tAc.
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below) M
Nearest Town: `�1=t�sy, ��P — CounNJL/tt_.
99i2�2 7�)e_
(Road a and Numbers, Community, or Subdivi1sion and Lot No.) DRILLING LOG
3. OWNER �i2�W\�G G" y From To Formation C,
AddressPre- a�
er Houto Q_ . �), f 17
City or Town +---� Stale Zip Code
4. DATE DRILLED /')
5. TOTAL DEPTH 156 — —
6. CUTTINGS COLLECTED YES FJ NO[`�'
7. DOES WELL REPLACE EXISTING WELL? YES ❑ NO[fr-
B. STATIC WATER LEVEL Below Top of Casing: FT.
(Use '+' It Above Top of Casing)
9. TOP OF CASING ISFT. Above Land Surface'
'Top of casing terminated at/or below land surface requires a variance In accor-
dance with 1SA NCAC 2C.0118
10. YIELD (gpm): 51125' METHODOFTESTrBJOWN
11. WATER ZONES (depth):--
i
0
CD
C
- c1
.Ti
LfJ
CJ
(.)
12. CHLORINATION: Type r - 1 o— Amount If additional space is needed use back of t.,�...
13. CASING:
Depth DtaTc r
FromTo ar% Fl. �'/�
From To Ft.
From To Ft.-
14. GROUT
Wall Thickness
or Weight/Ft. Material
w ly� A 14_
Depth Material. Method t
From _(!C> To DC' Ft. e C� ne Vd 7o V 2p�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:
Depth Size Material
From To Ft.
From To Ft.
17
LOCATION SKETCH
(Show direction and distance from at least two C'
Roads, or other map reference paints)
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY F THIS RE N PROVIDED TO THE WELL OWTIF Ft.
FOR OFFICE USE ONLY -- '7 / -
Quad No: SIGNATURE OF PERSON CONSTRUCTING THE WELL%
Submit original to Division of Water Quality, Groundwater Section Within 30 days
Serial No. Gw-,

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section (. J 4 Cl 9!1
1636 Mail Service Center - Raleigh, N.C. 27699-1636-Phone [phone] `)
WELL CONSTRUCTION RECORD WELL CONTRACTOR:
WELL CONTRACTOR CERTIFICATION #: c _.
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE (Check Applicable Box): Residential L) Municipal ❑ Industrial ❑ Agricultural ❑ ...
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use: --
2. WELL LOCATION: (Show sketch of the location below) I
Nearest Town: )4' J!*4Ar- County: rn•a�llel
® 0- )'Y-,IvA tZc�
(Road Name and Numbers. Community, or Subdivision and Lot No.) DRILLING LOG _ DFP
3. OWNER clya(G �2h-91L From To Fomtatio.n D_.
Address �yo,3� c - yy(�
—�(Slreet OrHoulo o. r"ly— �E('� ?)L-e—
fic �A r� 0 3en�h -I A- _5 30F_O
Cit r Town Slate Zip Code
--'—
4.
DATE DRILLED `7-fa"
------ CD
5.
TOTAL DEPTH_ 60
--------
6.
CUTTINGS COLLECTED YES F_� NOE3—
C_—
7.
DOES WELL REPLACE EXISTING WELL? YES 0 NOQ
�-,
8.
STATIC WATER LEVEL Below Top of Casing: FT.
(Use'+' If Above Top of Casing)
_.
r^
9.
TOP OF CASING IS�_ FT. Above Land Surface'
'Top
of casing terminated atlor below land surface requires a variance In actor-
r r1 ,3
dance
with 15A NCAC 2C.0118
12 OF TEST )bwL)
-- W
C,
10.
YIELD (gpm): METHOD
11.
WATER ZONES (depth): SS y i=25r 14 1S .&__
12. CHLORINATION: Type r 6Kiti1L-
Amount
If additional space Is needed use back ^_t ,.
13. CASING:
LOCATION SKETCH
Wall Thickness
Depth Diameter
L
or WeightlFt. Material
(Show direction and distance from at least t :,2 ;
From
To C1 Ft.-
Roads, or other map reference points)
From
To Ft.
From
To FL
14. GROUT
Depth Material /Method
From O To _Q Ft. C e~622_
From To Ft.
15. SCREEN:
Depth
Diameter
From
To _
Ft in.
From
To
Ft. in.
From __
To _
Ft. In.
16. SAND/GRAVEL
PACK:
Depth
Size
From
'To
Ft.
From
To
Ft.
17. REMARKS:
Slot Size Material
_ in.
in.
in.
Material
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWvz_.
FOR OFFICE USE ONLY
Quad No:
Serial No.
SIGNATURE OF PERSON CONSTRUCTING THE WELL D`
Submil original to Division of Water Quality, Groundwater Section within 30 days
- OCS

North CnrNona - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mal -,,,ce Center - Raleigh, N.C. 27699-1636-Phone [phone]
WELL CONSTRUCTION RECORD WELLCONTRACTOR:
WELL CONTRACTOR CERTIFICATION #:
STATE WELL CONSTRUCTION PERMIT#:
1. WE'1. ! ISE (Check Applicable Box): Residential E! Municipal ❑ Industrial ❑ Agricultural ❑ .-gyring ❑
Rerc• ry ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use: Ior,'U44e _.
2. WELL LOCATION: (Show sketch of the location below) )
Nea,^ !Tovn: 402ucC l2idle County: pryy�/ y
(R-" bme and NN berss,, Coo-m-munity,, or Subtlivision and Lol No.) DRILLING LOG
3. OWt!'--1 )(r�dGO /iG /JJ/'✓/U From To Fn -:icn
Addztrees or oUNDlTo.T ,-,'7r� .� •r 3 B - yi
�ow4� v.
r ? "vm tale Zip Code —7""�" Ale
4.
DAT`'-,-ItLLED
9/ - .sly/i^c�/CV
5.
TOT4
nrPTH 8G
/r/7"0.1-
6.
7.
CUT""^SCOLLECTED
DO'-:- ''
YESQ NOOK'
-LL REPLACE EXISTING WELL? YES NO®
/tf r — a/7 / C
8.
STA'I
=
'WATER LEVEL Below Top of Casing: FT.
_4
A o SIG a
,2C7 a y/°y y3.
(Use'+' If Above Top of Casing)
g/q— ,2 p ry, 7 Q p -
9.
TOP ^
- ^ nSING IS FT. Above Land Surface-
'Top of
holed aHor below land surface requires a variance In actor.
c>.
--- � C -.• �;:;
dancowl•'
2C. 116
LKMETHODOFTEST A'r
10.YIEI_,-!'rm):
11.WATFi'Z0NES(depth):
Y/�-�IG,S=R-
/9>-rsf
12.
CH: r'Y'
4TION: Type %e//e Amount 3 0 L _
It additional space is needed us,,'
�•`�
Wall Thickness
LOCATION SKEW _"
_
Depth Diameter or WeiphUFl. Material
�__—_To �O 4 PVC
(Show direction and distance from at -
From.
Frog.,..-
Fl /"/sues
ye-- Toy1 FLU IF 8 GQ/U
Roads, or other map reference n
D
Fro- _._
To Ft.—r
so �e
14. GR-
:
Depth
Material Methoda
Fro-,
6 To RC'
Ft.
C-sneni-- _fogr&
Frr"
..__ To
Ft.
15. SC`
Depth
Diameter Slot Size Material
From
___To_Ft_
in. in.
�Oc ow
XP
!\
r're
From ___
To _ Ft.
_ in. _ In.
V
Frr'-...
_ __ To _ Ft.
In. In.
�8
16. SA!
-AVEL PACK:
Depth
Size Material
,p OR
o y
r
e
ty4�
Fro —To
Ft.
_—
r
6 ',d
pNdc
Fr, --
_ To
Ft.
17. RC
I D- CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, N/7:'
COr '7,70N STANDARDS, AND THAT
((�AC777OPP7F T IS RECORD HAS BEEN P IDED TO THE WEU/�
FOH ONLY ` �zO ✓ f -/(g
aFarD'c� --
Qua,' - — - SIGNATURE OF PERSON CONSTRUCTING THE WELL
Suhmil original to Division of Water Oualily, Groundwater Section Within 30 day9
Sera, ` I J99

North Carolina • Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section 16607
1636 Mail Service Center • Raleigh, N.C. 27699-1636-Phone [phone] h, n
WELL CONSTRUCTION RECORD WELL CONTRACTOR: + L ` -t Z` L_'Ltv
WELL CONTRACTOR CERTIFICATION M: ,78F
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE (Check Applicable Box): Residential ❑ Municipal ❑ Industrial ❑ Agricultural ❑ Monleting ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below) /
Nearest Town: Fn,�d, F:, C_ County:
rd4nlc/AWt40 o5-Vn Ie{-f
(Road Name and Numbers, Community, or )Subdivision and Lot No.) DRILLING LOG DEPTH
/ 3. OWNER , _ lJ4n c 5e) e2 From To Formation Description
Address fj- &C, egfk .". /
treet or RouteNOT—/De— $00
City or Town State Zip Code
4. DATE DRILLED 6D
5. TOTAL DEPTH o v
6. CUTTINGS COLLECTED YES ❑ NOEEr -
7. DOES WELL REPLACE EXISTING WELL? YES ❑ NOQ
8. STATIC WATER LEVEL Below Top of Casing: 3 oa FT.
(Use'+' If Above Top of Casing)
9. TOP OF CASING IS FT. Above Land Surface.
'Top of casing terminated atlor below land surface requires a variance In accor-
dance with 15A NCAC 2 0116
10. YIELD (gpm): 4'44' METHOD OF TEST - %✓
11. WATER ZONES depth):
12. CHLORINATION: Type
13. CASING:
Amount
Wall Thickness
Depth Diametor or WeighVFl. Material
FromTo 1'9c) FL 4 9yA;l /01/C
From /6 r To 16 6 Ft. 6' F Age 60/41
From To Ft.
14. GROUT:
Depth
From To Ft.
From To Ft.
15. SCREEN:
Material Method
Depth Diameter Slot Size Material
From —To—Ft— in. _ in.
From To — Ft. _ in. _ In.
From —To —FL _ in. —In.
16. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
7
f n_ .• w „_
rt
__
to
n
It additional space is needed use back of form
LOCATION SKETCH
(Show direction and distance from at least two Slate
Roads, or other map reference points)
III
From To Ft.
17. REMARKS: IF0531JIe- rLa-len
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.
FOR OFFICE USE ONLY 11Q��- -t/ -, _'(� � b -" (_ C O
Quad No:
Serial No.
SIGNAvWRE OF PERSON CONSTRUCTING THE WELL DATE
Submit original to vision of Water Ouality, Groundwater Section Within 30 days
OW-1 REV. IZ199

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR:
Dewey Wright Well Pump Co., Inc.
WELL CONTRACTOR CERTIFICATION #:ERMenny or an
00182 STATE WELL CONSTRUCTION PIE
1. WELL USE (Check Applicable Box): Residential [X Municipal 0
Industrial E:1
Agricultural El Monitoring 0
Recovery [:1 Heat Pump Water Injection El Other D
If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: BAKERSVILLE County: MITCEHLL
BEAN CREEK RD#1325-4.2 MILE OFF HV1IY 2211
(Road Nemeand Numbare, ommunity, or Subdivision and lot No.l
DRILLING LOG
DEPTH
3. OWNER NATHAN BYRD
From
0
To
80
Formation Description
SHALE GRANITE
Address RT 1 BOX 357 A
BAKERS CLE OO1e "°) NC 28704
80
118
GRANITE
uw or I own sate zip ode
118
120
FLINT SHALE,VVH.QRTz
4. DATE DRILLED 4/11/2O0O
120
134
134
135
GRANITE
FLINT SHALE
5. TOTAL DEPTH 140
CTED YES 0 NO ©
135
140
GRANITE
6. CUTTINGSCULL
7. DOES WELL REPLACE EXISTING WELL? YES 0 NO 0
6. STATIC WATER LEVEL Below Top of Casing: 50 FT...
(Use "+" if Above Top of Casing)
9. TOP OF CASING IS 1 FT. Above Land Surface* .tt
•Top of casing terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2C.01'60 Air
10. YIELD (gpm): METHOD OF TEST
11. WATER ZONES (depth) 9pm118-12O 4 9 �1
9pm 9pm
12. CHLORINATION: Type Amount If additional space is needed use be f I
.i
13. CASING:
Depth Diameter
From 0 To _ OFt.61/4
Wall Thickness
or Weight/Ft. Material
.188 GALV
From
To
Ft.
From
To
Ft.
14. GROUT:
From
Depth
0 To 20
Material
Ft. Cement
Method
Gravity Flow
From
To
Ft.
15. SCREEN
Depth Diameter Slot Size
From To Ft. — in. in.
From To Ft. in. in.
From To Ft. in. in.
16. SAND/GRAVEL PACK:
Depth
From To —
From To
17. REMARKS:
I DO HEREBY CERTII
CONSTRUCTION ST
FOR OFFICE USE ONL
Quad No:
Ft.
Material
g
Size Material
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other map reference points)
143
A
�r C" f�
LI/^(CON CTED IN ACCOORDANCE WITH 15A NCAC 2C, WELL
HYTTJS COP IS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
-ada
later
to Tonal Offic RE RSON CONSTRUCTING THE WELL DATE
Submit original to Division of Water Quality, Groundwater Section within 30 days GW 1 REV. 1299
A �
Serial No.
4 A 0 � `�

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR: Dewey Wright Well Pump Co., Inc.
00122 WELL CONTRACTOR CERTIFICATION #: tJU9 Jordan
STATE WELL CONSTRUCTION PERMIT#: Kenny
1. WELL USE (Check Applicable Box): Residential [Z Municipal 0 Industrial E] Agricultural 0 Monitoring E]
Recovery E] Heat Pump Water Injection El Other D If Other, List Use:
2.
WELL LOCATION: (Show sketch of the location below)
Nearest Town: BAKERSVILLE County: MITCHELL
SR#1306 OFF PINE ROOT BRANCH RD.
(Road Name and Numbers Community or Subdivision and Lot No 1
DRILLING LOG
DEPTH
3.
OWNER DONALD STREET
From
To
Formation Description
Address PO BOX 1332 ,
0
10
BROWN DIRT,BOULDEI
BAKERS�ifLE Route "° l NC 28705
10
28
RED CLAY
City or Town state Zip Code
28
33
GRAVEL
4.
DATE DRILLED 4/10/2000
33
58
RED CLAY
5.
TOTAL DEPTH 240
58
98
SHALE ROCK
6.
CUTTINGS COLLECTED YES ❑ NO ©
98
100
FLINT,WHITE QUARTZ
7.
DOES WELL REPLACE EXISTING WELL? YES 0 NO 0
100
138
GRANITE
8.
STATIC WATER LEVEL Below Top of Casing: 10 FT.
138
141
FLINT,WH.QRTZ,GRNT
(Use "+" if Above Top of Casing)
141
189
GRANITE C3
1
9.
TOP OF CASING IS FT. Above Land Surface
189
191
1: INT;WH. RNT
'Top of casing terminated at/or below land surface requires a variance in actor-
191
240
GRANITE
dance with 15A NCAC 2C.011
'0 Air
10.
YIELD (gpm): METHOD OF TEST
tit C.)11.
WATER ZONES (depi gpm98-100 �� gpm 138-1 1
o-
3 gpm gpm
12. CHLORINATION:
Amount
13. CASING: wall Thickness
Depth Diameter or WeighUFt. Material
From 0 To 63Ft. 61/4 .188 GALV
Frnm Tn Ct
If additional space is needed use
LOCATION SKETCH
(Show direction and distance from at leasitwo
Roads, or other map reference points)

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR: Dewey Wright Well Pump Co., Inc.
zuua
00177 WELL CONTRACTOR CERTIFICATION #:
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE (Check Applicable Box): Residential EN Municipal 0 Industrial 0
Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: BAKERSVILLE County: MITCEHLL
71/0 MILE GREASY CREEK OFF HUGHES GAP
(Road Name and Numbers, C.mmunity, or ubdivision and Lot No.)
7
4.
5.
6.
7.
8.
Agricultural0 Monitoring 0
DRILLING LOG
DEPTH
OWNER JESS SHEETS
From
To
Formation Description
Address 724 GREASY CREEK ROAD,
0
10
SHALE ROCK
BAKERSVIEtE Round No' NC 28705
10
141
GRANITE
ity or Town State zip ode
141
142
FUNT,WHITE QUARTZ
DATE DRILLED 4/10/2000
142
180
GRANITE
TOTAL DEPTH 180
CUTTINGS COLLECTED YES 0 NO
DOES WELL REPLACE EXISTING WELL? YES 0 NOFX
STATIC WATER LEVEL Below Top of Casing: 40 FT.
(Use "+" if Above Top of Casing)
9. TOP OF CASING IS 1 FT. Above Land Surface*
'Top of casing terminated at/or below land surface requires a variance in accor.
dance with 15A NCAC 2C.01
10. YIELD (gpm): 10 METHOD O F. TEEggT Air
11. WATER ZONES (depth)3O 9pm141-142 gpm
gpm gpm
12. CHLORINATION: Type ""' Amount
13. CASING:
Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 23 Ft. 6 1/8 .350 PVC
From To Ft.
From To Ft.
14. GROUT:
Depth Material Method
From 0 To 20 Ft. Cement Gravity Flow
From To Ft.
15. SCREEN:
If additional space is needed use
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other map reference points)
Depth Diameter Slot Size Material `J
From To Ft. in. in. N bfG/�/�Inr,
From To Ft. in. in. Z i
From To Ft. in. in.
vw�
16. SAND/GRAVEL PACK: � �, ��✓
Depth Size Material JQCd2Z P ���
From To Ft.
From To Ft.
17. REMARI t` M
I DO HEUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRDS, AND THAT A CO THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
FOR OFFI�1hI 1 - 7�1��1IGN TURE OE PER ON CONSTRUCTING THE WELL DATE
Quad No:t �rlglnaI to ivision of Water Quality, Groundwater Section within 30 days
roundwate.
As leville Recional Office GW-1 REV. 12/99
Serial No. �_U.

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR: Dewey Wright Well Pump Co., Inc.
WELL CONTRACTOR CERTIFICATION #:
2669
99762 STATE WELL CONSTRUCTION PERMIT#:
Kenny Jordan
1. WELL USE (Check Applicable Box): Residential ® Municipal 0 Industrial 0 AgriculturalEl Monitoring 0
Recovery 0 Heat Pump Water Injection 0 Other ❑ If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: BAKERSVILLE County: MITCEHLL
STAGGFR .RF K RD OFF CAN R K RD
(Road Name and Numbers, Community, or ubdivision and Lot NO.) DRILLING LOG
DEPTH
3. OWNER FRANK GAI F From To
Formation Description
Address n 197
RFD MtIn,GRAVFI
et or oute No.l
RFAlIFO SC 299Q2 197 134
GRANITE
tty or town rate zip ode 134 136
SHALE ROCK
4. DATE DRILLED 4/6/2000 136 189
GRANITE
5. TOTAL DEPTH 240 189 192
SHALE, FLINT,WH.QRT-z
6. CUTTINGS COLLECTED YES 0 NO © 192 210
GRANITE
7. DOES WELL REPLACE EXISTING WELL? YES 0 NO 0 210 212
FLINT WHITE QUARTZ
8. STATIC WATER LEVEL Below Top of Casing: 40 FT, 212 240
GRANITE
(Use "+" if Above Top of Casing)
9. TOP OF CASING IS 1 FT. Above Land Surface*
'Top of casing terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2C.0118
10. YIELD (glom): 60 METHOD OF TEST Air
11. WATER ZONES (depth)1.5 gpm134-136 35 gpm 189-1
23.5aam210-212 am
12. CHLORINATION: Type HTH Amount 42
13. CASING:
Walt Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 127 Ft. 8114 -1 RR GAI V
From To Ft.
From To Ft.
14. GROUT:
Depth Material Method
From 0 To 90 Ft. Cement Gravity Flow
From To Ft.
15. SCREEN:
Depth Diameter Slot Size Material
From To Ft. in. in.
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 CERTI
CONSTRUCTION STVrDS, AND THAT A l
JUN 1 9 2WO
OR OFFICE USE ONI Y—
Quad No: Grollrldw
n A hevill
2101ju
Serial No.
Material
If additional space is needed use
LOCATION SKETCH `4
(Show direction and distance from at least two
Roads, or other map reference points)
C�VC
Vl"
VP v Q J
rED IN ACCORDANCE WITH 15A NCAC 2C, WELL
S RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
J� —,/ _ ,;�eC9 b
NAIURE OF -PERSON CONSTRUCTING THE WELL DATE
to vision of Water Quality, Groundwater Section within 30 days
J
GW-1 REV. 12/99

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR: Dewey Wright Well Pump Co., Inc.
WELL CONTRACTOR CERTIFICATION #: 26159
99761 STATE WELL CONSTRUCTION PERMIT#: Kenny Jordan
1. WELL USE (Check Applicable Box): Residential EX Municipal EJ Industrial EJ
Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below)
Agricultural EJ Monitoring 0
Nearest Town: BAKERSVILLE County: MIICEHLL
GTA n R W D RD OFF ANE CREEK RD.
(Road Name and Numbers, Commonity,or bdlvlsion and Lot No.)
DRILLING LOG
DEPTH
3. OWNER CANE CREEK COMMUNITY BUILDING
From
To
Formation Description
Address . COOKE 1398 STAGGER WEED ROAD
0
15
GRAVEL
BAKERS j`C1`R0o1B NO.) NC 28705
15
37
RED MUD
City or Town state Lip Code
37
40
GRAVEL
4. DATE DRILLED 4/4/2000
40
62
GRANITE
5. TOTAL DEPTH 80
62
67
SHALE ROCK
6. CUTTINGS COLLECTED YES E-1 NO ©
67
80
GRANITEo o
7. DOES WELL REPLACE EXISTING WELL? YES[—] NO 0
o
O
8. STATIC WATER LEVEL Below Top of Casing: * FT.
(Use'," if Above Top of Casing)
9. TOP OF CASING IS 1 FT. Above Land Surface*
Top of casing terminated at/or below land surface requires a variance in accor.
dance with 15A NCAC 2C.011
10. YIELD (gpm): T5 METHOD OF TEST Air
11. WATER ZONES (depth)25 gpm62-67 gpm
gpm gpm
12. CHLORINATION: Type HTH Amount 17
If additional space is needed use
13. CASING: Wall Thickness LOCATION SKETCH
Depth Diameter or Weight/Ft. Material (Show direction and distance from at least two State
From 0 To 40 Ft. 61/4 .188 GALV Roads, or other map reference points)
From To Ft.
From To Ft.

North Carolina - Department of Environment, Health, and Natural Resources -' FOR 6'rRct_ u5E ONLY'" -'-
Division of Environmental Management - Groundwater Section .. �n
P.O. Box 29535 - Raleigh, N.C. 27626-0535 QUAD. NO.: SERIAL NO
Phone [phone] La1 RO -
-
Minor Basin
WELL CONSTRUCTION RECORD Basin Code
DRILLING CONTRACTOR: Header Ent GW-��hl
STATE WELL CONSTRUCTION
DRILLER REGISTRATION N MBER: /O 6 el PERMIT NUMBER:
1.
WELL LOCATION: (Show sketch f the location below) I / 0 `
�N� !Hf
Nearest Town: ,S��ii%r-�-eCounty: 1"""
JA-Lt "
(Road, Community, or Subdivision and Lot No.)) DEPTH
DRILLING LOG
2.
OWNER �_�.ai�,.,A/A/ LOd4.R/I LecLS'r�l<4)\ From To
t (
Formation Description
ADDRESS L.fiLt Sw1Yz r
(Street or Route No.)
R Nt 1 (Z
�
ity or Town Stale Zip Code
3.
DATE DRILLED S-29-Oc USE OF WELL A&EdKV
4.
TOTAL DEPTH 905- ,LOdy E
5.
CUTTINGS COLLECTED YES ❑ NOEE�
6.
DOES WELL REPLACE EXISTING WELL? YES Q NO®--
7.
STATIC WATER LEVEL Below Top of Casing: :So FT.
o
8.
(Use',' it Above Top of Casing)
TOP OF CASING IS FT. Above Land Surface-
r, 0 %
n
• Casing Terminated atlor below land surface Is Illegal unless a variance Is Issued
y=, om
In
9.
accordance with 15A NCAC 2C .0118
YIELD (gpm):1�— METHOD OF TEST ��
o
10.
WATER ZONES (depth): %�
bo
Ir
rnG
11.
CHLORINATION: Type Amount If additional space is needed use ba� of i1"
12.
CASING:
e,
�-
Depth Diameter
From !� To Ft.-679-1
From To - / Ft
'
From —
13. GROUT:
15.
j-14d HI REBti
t1 j 5 `'eONSTRUCT
APR 2 8 2
Cshzaipe �p^;.d'.i
Ft.
Wall Thickness
or Weiceiggh^ht/Ft. Material
LOCATION SKETCR z
(Show direction and distance from at least two State
Roads, or other map reference points)
ED IN ACCORDANCE WITH 15A NCAC 2C, WELL
RECORD HAS BEEN PROVIDED TO THE WELL OWNER.

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR: Dewey Wright Well Pump Co., Inc.
000211 WELL CONTRACTOR CERTIFICATION #:
STATE WELL CONSTRUCTION PERMIT#: Steve Reece
1. WELL USE (Check Applicable Box): Residential ® Municipal 0 Industrial 0 Agricultural0 Monitoring 0
Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use:
C
3.
4.
5.
6.
7.
8.
WELL LOCATION: (Show sketch of the location below)
Nearest Town: BAKERSVILLE County:
MITCHELL
CONNELLY RIDGE RO#1164
(Road Name and Numbers, Community, or Subdivision and Lot No.l
DRILLING
LOG
DEPTH
OWNER LARRY S. FORTNER
From
To
Formation Description
Address 2908 SNOW CREEK ROAD,
0
48
DIRT,SAND
BAKERS"EtERoaoeNo. 1 NC 28705
48
120
GRANITE,FLINT
City or Town state Zip Code
120
124
QUARTZ o
DATE DRILLED 4/20/2000
124
305
GRANITE,F T B
TOTAL DEPTH 305
CUTTINGS COLLECTED YES 0 NO
DOES WELL REPLACE EXISTING WELL? YES 0 NO
STATIC WATER LEVEL Below Top of Casing: 80 FT.
(Use'+" if Above Top of Casing)
9. TOP OF CASING IS 1 FT. Above Land Surface*
'Top of casing terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2C.011
10. YIELD (gpm): METHOD OF TEST Air
11. WATER ZONES (depth)2 gpm120-124 9pm ,
9Pm 9pm
12. CHLORINATION: Type H I H Amount 40 If additional space is needed use back of form
13. CASING:
Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 54Ft. 61/8 .350 PVC
From To Ft.
From To Ft.
14. GROUT:
Depth Material Method
From 0 To 20 Ft. Cement Gravity Flow
From To Ft.
15. SCREEN:
Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
From To Ft. in. in.
16. SAND/GRAVEL
From T
From T
17. REMARKS:
I DO HEREBY CEI
CONSTRUCTION
FOR OFFICE USE ONLY
Quad No:%/ /
Serial No. Oil,
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other map reference points)
D IN ACCORDANCE WITH 15A NCAC 2C, WELL
RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit original 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: Dewey Wright Well Pump Co., Inc.
2687
000204 WELL CONTRACTOR CERTIFICATION #: Steve Reece
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE (Check Applicable Box): Residential ® Municipal 0 Industrial 0
Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: BAKERSVILLE County: MITCHELL
SR# 1253 OFF HWY 226
(Road Name and Numbers, Community, or Subdivision and Lot No.l
Agricultural0 Monitoring 0
DRILLING LOG
DEPTH
3. OWNER DANNY MCLAIN
From
To
Formation Description
Address 767 SAYLOR LAKE ROAD
0
15
DIRT
BAKERS ME oueNo.) NC 28705
15
30
GRANITE
or Town state zip code
30
33
SANDSTONE
4. DATE DRILLED 4/19/2000
33
240
GRANITE
5. TOTAL DEPTH 405
240
244
QUARTZ
6. CUTTINGS COLLECTED YES 0 NO ®
244
405
GRANITE o
7. DOES WELL REPLACE EXISTING WELL? YES 0 NO ®
o 0
8. STATIC WATER LEVEL Below Top of Casing: 20 FT
(Use "+" if Above Top of Casing)
9. TOP OF CASING IS 1 FT. Above Land Surface*
•Top of casing terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2C.01 �,f€E.
111. WATER ZONES (depth):M gpm DSJTHODEST Air gpm
WTI i gpm
12. CHLORINATION: Type
m i n
Amount ro
If additional space is needed use baci,& fort'
2
13. CASING:
LOCATION SKETCH
Depth
Diameter
Wall Thickness
or Weight/Ft. Material
(Show direction and distance from at least two State
From 0 To
21 Ft 6 1/4
.188 OALV
Roads, or other map reference points)
From To
Ft.
From To
Ft.
��Q�i4Jl1\\Z
14. GROUT
0 vi>"y°�low
DToth 20 Cemencerial Gra
From
Ft.
From
To Ft.
�
��tll�oi�
15. SCREEN:
Depth Diameter Slot Size Material
N
3
T
From
To Ft. in. in.
From
To Ft. in. in.
-I
From
To Ft. in. in.
16. SAND/GRAVEL PACK:
fZ
Dept Material
I
From
From
(�
To t.l (�A
To
�p
^ —A
17. REMARKS:
I DO HEREBY CERTII
CONSTRUCTION ST
FOR OFFICE USE
Quad No:
1)
1
<Ne)
T THIS WELL WAS COAISTR CTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
ln.S.ONIr1 THAT G rr1P OF HIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
Eroundwate, Section /—
heville Reginr:rV Off p �F�tA 7 —'2 3 _ �j'2 3 _ 0 0
• SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Serial No.
Submit original to Division of Water Quality, Groundwater Section within 30 days
GW-1 REV. 12/99

"North Carolina .
�':.. Departmental Environment and Natural Resources Division o! Water Oualiy -Groundwater Section
163a Mali SeNICe Canter • Ralelph, N.G. 27699-1636�Phonn (919) 79:1 322t
r"u"
'4'" WELL CONSTRUCTION RECORD WELL CONTRACTOR:
ci WELL CONTRACTOR CERTIFICATION 0:-
1' STATE WELL CONSTRUCTION PERMITM:--^.,.t
(„� WELL.USE (Check Applicable Box): Residential L'7 Municipal ❑ Industrial ❑ Agricultural ❑
MOOhO
v
# w,x.r Recovery ❑ Heat Pump Water Injection ❑ Other If Other, List Use:
,
ra 7
p 2.' . WELL LOCATION: (Show sketch of the location below)
°r �
Nearest Town: 1�v j.A-%Peru County:
. (Road Name and Numbers, Community, or Subdivision and Lot No.) DRILLING LOG DEPTH
3. OWNER _�eQe.I a)\,J.4o/J From To Formation Oes irpt!
Address 15-
or ou o yl L� - _ !Sr ."ice ems_
.:1y,•.ti
City or Town Slate Zip Coda
!
4. DATE DRILLED.�2'
5.. TOTAL DEPTH
6. CUTTINGS COLLECTED YES F-1 NOEB—
7. DOES WELL REPLACE EXISTING WELL? YES NOPJ—
I z 8. STATIC WATER LEVEL Below Top of Casing: FT.
(Use 'i it Move Top of Casing)
9. TOP OF CASING IS_J__ FT. Above Land Surface-
-Top of easing terminated atfor below land surface requires a variance In actor-
a
dance with 15A NCAC 2C 19118
/�
10. YIELD (gpm): METHOD 017 TEST
:;11. WATER ZONES (depth): Si
12. CHLORINATION: Type L�� Amount
13. CASING:
Depth Oiam�t r
From To
From To Ft.
From To Ft.
14. GROUT:
Depth
From To ­720 Ft.
From To Ft.
15. SCREEN:
Depth
From
To
From
To _
From
—To _
16. SAND/GRAVEL PACK:
Depth
From
To
F
T
It additional space is needed use back of
Wall Thickness LOCATION SKETCH
or Woi nUFI. Malena (Show direction and distance from at least two
•' C �. Roads, or other map reference points)
Material
Mothod
Diameter Slot Size Material
Ft in. in.
Ft._ in. —in.
Ft. In. In.
Size Material
rom o
17. REMARKS:
T
DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C. WELL
.CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER, 'i
FOR OFFICE USE ONLY
Quad No. inM., -R . n TURE OF PERSON CONSTRUCTING THE WELL DATE
Serial No.
of Water Ouakty, Groundwater Section Within 30 days
GW1 REV.
JUUMAY 3 120UM
I�n�llne JINd 2 8 2f0
Croundwata- e,..-;-n
Ashevd(e •,,.,

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:
-e
WELL CONTRACTOR CERTIFICATION #: I .�
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE (check Applicable Box): Residential Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heal Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATION: Show sketch of the location below) y1 //
Nearest Town: R.<y1��'�— County: - 7 " t r C- e-
/17v Cove,
(Road Name and Nu rs, Community, or Subdivision and Lot No.) DRILLING LOG DEPTH
3. OWNER From To Fomtation Description
Address o - cl
(feet or Houle o. y — ,5a0 r-vt ic-A-
City or Town State Zip Code
4. DATE DRILLED L(
5. TOTAL DEPTH a0
6. CUTTINGS COLLECTED Y SD NOQ—'
7. DOES WELL REPLACE EXISTING WELL? YES NOM_
8. STATIC WATER LEVEL Below Top of Casing: FT.
(Use'i it Above Top of Casing)
9. TOP OF CASING IS FT. Above Land Surface -
'Top of casing terminated atfor below land surface requires a variance In accor-
dance with 15A NCAC 2C .0118
10. YIELD (gpm): 1",Ix METHOD OF TEST 1 A�
11. WATER ZONES (depth): f
12. CHLORINATION: Type Amount It additional space is needed use back of form
13. CASING:
Wall Thickness
Depth Diamgt�r or Weights
'
serial
From
To —ER—Ft. 120 •��-
From
To Ft.
From
To Ft.
14. GROUT:
O Depth Material Method
From
To 20 Ft.
From
To Ft.
15. SCREEN:
Depth Diameter
From To_Ft in.
From To —Ft. In.
From —To _ Ft. in.
16. SAND/GRAVEL PACK:
Depth
From To Ft.
From To Ft.
17. REMARKS:
Slot Size Material
in.
In.
In.
Size Material
LOCATION SKETCH
(Show direction and distance from at least two Slate
Roads, or other map reference points)
v
O £
O �
Corn
c
m
I zv.<
u1 £rn
0
v n
zm
IV m;U
c
C.JI
00 0
z
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTIO THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER. L�
FOR OFFICE U _ oZ 7 —00
Quad No: N ELL DATE
Q Submit Jo f D s I Water Ouallty, Groundwate JJnWv ithin 30 days
Serial No. 2 ?, GW4 REV. 12/99
1 .JUN 2 8 2000
51 Cmnr.d W2:Y'
#$hey„ f...

North Carolina - Department of Environment and Natural Resources - Division of Water Ouality - Groundwater Section
1636 Mail Service Center - Raleigh, N.C. 27699-1636-Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR: �Ai 4. e_II 4jell 7z"
WELL CONTRACTOR CERTIFICATION #:
STATE WELL CONSTRUCTION PERMIT#:
l L
1. WELL USE (Check Applicable Box): Residential 2/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: "<yAc- County: - %)'L ' �1e. �!
C,4xK CA _
(Road Name and Numbers, Community, or Subdivision and Lot No.) DRILLING LOG DEPTH
3. OWNER i40ni,-_R AVPRS From To Formation Description
Address C-)
�pLll oast or o o
City or Tom State Zip Code
4. DATEDRILLED 'l-lq-�
5. TOTAL DEPTH IT
6. CUTTINGS COLLECTED YES F-1 NO©--
7. DOES WELL REPLACE EXISTING WELL? YES NO[2-
8. STATIC WATER LEVEL Below Top of Casing: FT.
(Use'i if Above Top of Casing)
9. TOP OF CASING IS Fr. Above Land Surface'
'Top of casing terminated attor below land surface requires a variance In accor-
dance with 15A NCAC 2C .9118
10. YIELD (gpm): METHOD OF TEST
11. WATER ZONES (depth): I .
12. CHLORINATION: Type t- �ok- Amount J_ It additional space is needed use back of form
13. CASING:
Wall Thickness LOCATION SKETCH
Depth Diametgr or Weight/R. Material (Show direction and distance from at least two State
1'14 ' irg
C3 '
From To Ft. _ V r g ✓ Roads, or other map reference points)
U
C)
o
From To FL
From To Ft.
Z
6rn
14. GROUT:
1
0<
Depth Material Method
From
`�
yo
To Ft. e a+•-e-�—
s
Mm
From To Ft.
ry
cnz
15. SCREEN:
Mp
Depth Diameter Slot Size Material
�
C3
From To Ft in. in.
z
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
CONSTRUCTIONF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
FOR OFFICE USE
`I — �©
Ouad No: AT F R N M T T G HE, yyy�vvvELL DATE
M �(? 9 t on vi 1�h�within 30 days
Serial No. S 1 I GW-1 REV. 12M
AIN 2 8 2000
AsherakReaon.l

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mail Service Center - Raleigh, N.C. 27699-1636-Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR: 5 '-.�� �e/� _3 ''Afv4
WELL CONTRACTOR CERTIFICATION
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE (Check Applicable Box): Residential Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below) 1
NearesTown: �Pa✓� � County: _f 4�c--
C
�."_4nM .S .' -?-ao
(Road Name and Numbers, Cc unity, or Subdivision and Lot No.) DRILLING LOG DEPTH
3. OWNER %��'� ,A-iRpSi- /P-'�tj'LC',S From To Formation Description
Address '!�!) — /Z �%d_Z'W'�L
r treat oute o. 7K- ayo
et -/ 7-). C'
City or Town State Zip Code
4. DATE DRILLED /,)'0
5. TOTAL DEPTH 0
6. CUTTINGS COLLECTED YES Q NOE '
7. DOES WELL REPLACE EXISTING WELL? YES ❑ NO[ ✓�
8. STATIC WATER LEVEL Below Top of Casing: FT.
(Use'+' II Above Top of Casing)
9. TOP OF CASING IS�_ FT. Above Land Surface'
'Top of casing terminated stfor below land surface requires a variance In accor-
dance with 16A NCAC 2C .011
10. YIELD (gpm): _ZL3 METHOD OF TEST Joe✓A-)
11. WATER ZONES (depth):
12. CHLORINATION: Type ' Amount It additional needed use back of form
13. CASING:
Wall Thickness
LOCATION SKETCH
Depth
Diameter
or weight/Fl. Materia
(Show direction and distance from at least two Slate
From(::2 To
Ft.
-Lee-
Roads, or other map reference points)
From To
FL
From To
Ft.
14.
GROUT:
Depth
Material Method
From 62 To �
Ft.^
�'
C
o
From To
Ft.
`
�a
15.
SCREEN:
cm
Depth
Diameter Slot Size Material
I
o<.
From To Ft
in.
in
rn
ao
From To Ft.
in.
— in.
3
;:am
From _ To _ Ft.
in.
_ in.
m�
16.
SAND/GRAVEL PACK:cn
N
y
Depth
Size
Material
s0
2
From To
Ft.
From To
Ft.
17.
REMARKS:
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUC ND THAT A COPY OF THISRECORD HAS BEEN N PROVIDED TO THE WELL OWNER.
FOR OFFICE /' a C�
Quad No: S U E C S U THE WELL DATE
Su i Ion of Water Quality, noun ction within 30 days
Serial No. 9 20o1J GW-1 REV. 12199
;UN 9 8 2000
%� �� a 6rgundwaeer soft@___--

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: If �e�l 1711%7%r`�
WELL CONTRACTOR CERTIFICATION #: a /
,, /STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE (Check Applicable sox): Residential [E Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATI (Show sketch of the location below) _/I
Nearest Town: k=an—or- % (e County: A. a e
GR ..
(Road Name and Numbers, Community, or S�u1bdivision and Lot No.) DRILLING LOG DEPTH
3. OWNER HA ��n.rC�S"�(-- From To Formation Description
Address
r ktreelo out 0. /O — 160 11n 11Cr4 �I e,zs�r )ve ai 705
City or Town State Zip Code
4. DATEDRILLED 12020P
5. TOTAL DEPTH /_ 00
6. CUTTINGS COLLECTED YES Q NOQ--'
7. DOES WELL REPLACE EXISTING WELL? YES NO�
8. STATIC WATER LEVEL Below Top of Casing: FT.
(Use'+' ll Above Top of Casing)
9. TOP OF CASING ISM_ FT. Above Land Surface'
?op of easing terminated atfor below land surface requires a variance In accor-
dance with 15A NCAC 2C.0118
10. YIELD (gpm): � METHOD OF TEST jcz 1A
11. WATER ZONES (depth):- 50 y 6,5-
12. CHLORINATION: Type �i Amount If additional space is needed use back of form
13. CASING:
Wall Thickness
LOCATION SKETCH
Depth
Diameter or Weight/R
Material
(Show direction and distance from at least two Slate
//��
From_L.G_To =
P664"
Roads, or other map reference points)
From
To
Ft.
From
To
Ft.
14. GROUT:
CD
Depth
Material Method
From d
To
Ft. t-
From
To
Ft.
1
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 CE
CONSTRUCTION
FOR OFFICE USE
Quad No:
Serial No.
Slot Size Material
in.
in.
_ in.
Submit i
Material
-o
s
N
Co
IN ACCORDANCE WITH 15A NCAC 2C, WELL
DORD.kA6-BEEN PRQVIDED TO THE WELL OWNER.
30 days
DATE
G
� Z
GW-1 REV. 12199
JUN 2 8 2000

forth Carolina- Department of Environment. Health, and Natural Rnsonrcns
4-;�4 Division of Environmental Management -Groundwater Section
P.O.'Box 29535 - Raleigh, N.C. 27626-0535
,c Phone [phone]
WELL CONSTRUCTION RECORD
DRILLING CONTRACTOR:STA WELL
_�4�r�e,1�
DRILLER REGISTRATION NUMBER: 60 PERM NUM ERNSTRUCTION 207196
Fy r
1- WELL LOCATION: (Show sketch of the location below) 1 J li
Nearest Town: tsA kf V / ' /12 _ County: -6dch e I I
/i1:Ne, C r-. 20
(Road, Community, or Subdivision and Lot No DEPTH DRILLING LOG
2. OWNER From To Formation Description
ADDRESS
(Street or Route No. _4.tC f )) . c_ - 8—
City of Town State Zip 1Code_r
3. DATE DRILLED /-/y-09 USE OF WELLS den'7� �-
4. TOTAL DEPTH /
5.' CUTTINGS COLLECTED YES E] NOL!c - -
6. DOES WELL REPLACE EXISTING WELL? YES L]
7. STATIC WATER LEVEL Below Top of Casing: FT.
(Use '+" it Above Top of Ca::ing) ---_ _----- _ -_
8. TOP OF CASING IS t FT. Above Land Surface' --
Casing Terminated at/or below land surface Is Illegal unless a variance Is issued ;'a
In accordance with 15A NCAC 2C .0118 =..
9. YIELD (gpm):_(0 METHOD OF TEST 310WA)
10. WATER ZONES (depth): 7Z!�r 55� 1Y2 v
11. CHLORINATION: Type 3 -twit If additional space is needed use back of fornrFr
12. CASING:
Wall Thickness LOCATION SKETCH
Depth Diameter or Weight/Ft. �� Material (Show direction and distance from at least two State
Z( ia
s
From TO Ft. _-� t')'(_t" Roads, or other map reference points)
From To Ft.
From To Ft.
13. GROUT:
Depth Material Method
From Q To 212 Ft.
From To Ft.
14. SCREEN
Depth
From
To
From
To
From
To
15. SAND/GRAVEL PACK:
Depth
From
To —
From
To_
16. REMARKS:
FER ? r T011,
Diameter Slot Size
Ft in.
Ft. in.
Ft. in.
Ft.
Ft.
Size
Material
in.
In.
in.
Material
WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
) THAT A COPY OF THIS RFCORD HAS BEEN PROVIDED TO THE WELL OWNER.
SIGNATURE Of= CUM I RAC rOR OR AGENT DATE
Submit original to nivisinn of Environmental Management and copy to well owner.

9366
North Carolina - Department of Environment, Health, and Natural Resources _-
Division of Environmental Management - Groundwater Section FOR OFFICE USE CNLY
P.O. Box 29535 - Raleigh, N.C. 27626-0535 QUAD. NO. - - SERIAL No.
Phone [phone] Lat. - Lorg: -" RQ'--'•� -
Minor Basin -
WELL CONSTRUCTION RECORD Basin Coda
DRILLING CONTRACTOR: (t Header Ent { GW-f �ht
STATE WELL CONSTRUCTION
DRILLER REGISTRATION NUMBER: 106 y PERMIT NUMBER:
1. WELL LOCATION: (Show sketg oflhe location below) �j/
Nearest /Town: �A� /�/�G. County: /Xzz . �
(Road, Community. or S ivisi apdjf otGNo7.) DEPTH DRILLING LOG
2. OWNER .� GiM+� From To Formation Description
ADDRESS—
(Street or Route No.)
'C4�./-w /V C �P777
jitily or Town State Zip Code
3. DATE DRILLED (/
— ,1 #2USE OF WELL _1 (_G.r�iC
4. TOTAL DEPTH -4o` :L
5. CUTTINGS COLLECTED YES 0 NO[Q-
6. DOES WELL REPLACE EXISTING WELL? YES NO[�J-
7. STATIC WATER LEVEL Below Top of Casing: _7_ FT.
(Use'.' if Above Top of Casing)
8. TOP OF CASING IS FT. Above Land Surface'
Casing Terminated atlor below land surface Is Illegal unless a variance Is Issued
In accordance with 15A NCAC 2C .0118
9. YIELD (gpm):_I METHOD OF TEST 4/ 2
10. WATER ZONES (depth): 1 q ?F0
_ N r.
11. CHLORINATION: Type Amount If additional space is needed use bac A_ f form
12. CASING:
Wall Thickness LOCATION SKETCH
Depth Diameter or WeighuFt. Material (Show direction and distance from at least two State
From To Ft. Roads, or other map reference points)
From—. 6 To Ft.
From To Ft. ,
13. GROUT: `_y1
Depth
From To —
From © To20
14. SCREEN:
Depth
From To Ft
From To FL
From To Ft.
15. SAND/GRAVEL PACK:
A
Material Method
Ft. '
Ft.%
Diameter Slot Size Material
in. in.
in. _ in.
in. in.
Size Material
P��o�SE21
Iwjyj'Z
vFp
'L,,, V
BY CERTIFY TH T T IS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
DS, ND_ THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
WU

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] V , 2 o
WELL CONSTRUCTION RECORD WELL CONTRACTOR: I �Tr �f?l�f �r -`\\4
WELL CONTRACTOR CERTIFICATION 19: Zi5B1
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE (check Applicable 90:): Residential ❑ Municipal Ey / Industrial ❑ Agricultural ❑ Monitoring El
Recovery ❑ Heat Pump Water Injection ❑ Other If Other, List Use:
2.
WELL LOCATION_ Show sketchof the location below r
; '
Nearest Town: County:
(Road Name and Numbers. Community, or $otldivision and Lot No.) DRILLING LOG
3.
OWNER From
To
Address; —�
yi veer or ore )
C•�. - �� ,-;
J ,ems, _
'
City or Town State Zip Code.-
4.
DATE DRILLED
5.
6.
TOTAL DEPTH < • '% -
CUTTINGS COLLECTED YES Q NOQ/
7.
DOES WELL REPLACE EXISTING WELL? YES Q N0177—
8.
STATIC WATER LEVEL Below Top of Casing: FT.
(Use': it Above Top of Casing)
%
9.
TOP OF CASING IS Ff. Above Land Surface'
-Top of casing terminated at/or below land surface requires a variance In accor-
dance with 15A NCAC 2C .0118
10.
YIELD (gpm): METHOD OF TE$T
11.
WATER ZONES (depth):
DEPTH
Formation Description
12. CHLORINATION: Type t r/�'—"`� Amount If additional space is needed use back of form
13. CASING:
Wall Thickness
Depth
Diameter
or WeighVR. Material
From
�To
To Ft.
��
From
Ft.
41
From
To
Ft.
14. GROUT:
Depth
Material
Method
From
To
Ft.
—­ �'
From
To
Ft.
-" � /
; c 1,.:':
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
I DO HEREBY CERT L WAS CO, 5TRUCTED
CONSTRUCTION SJAVS(ikNRT*Tt6 IS RE,
FOR OFFICE
Quad No: �V �r77rryy11rr11 REC
I�u6W[INrigin t 's(on of
Serial No.
LOCATION SKETCH
(Show direction and distance from at least two Stale
Roads, or other map reference points)
a
S�l%i Cf
v ,r C
CCORDANCE WITH 15A NCAC 2C, WELL
ID EEN PROVIDED TO THE WELL OWNER
SON CONSTRUCTING THE WELL DATE
Quality. Groundwater Section within 30 days
GWC REV. 12189

. . C,P
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section r 1 J .J .
1636 Mail Service Center - Raleigh, N.C. 27699-1636-Phone [phone]
WELL CONSTRUCTION RECORD WELLCONTRACTOR: J�r���/Y. -o f Z4_
WELL CONTRACTOR CERTIFICATION 0:
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE (check Applicable Box): Residentia(Q_ Municipat ❑ Industrial ❑
Recovery ❑ Heat Pump Water Injection Other ❑ If Other, List Use:
2. WELL
3. OWNER
Address
the location below
. County:ounty: �2llfil (iD
4. DATE DRILLED O
S. TOTAL DEPTH
6. CUTTINGS COLLECTED YES ❑ NO
7. DOES WELL REPLACE EXISTING WELL? ES M NOM
6. STATIC WATER LEVEL Below Top of Casing: 5_ FT.
L (Use '+' a Above Top of Cuing)
9. TOP OF CASING IS 1L FT. Above Land Surface,
'Top of using terminated at/or below land surface requlrea a vulenea In scow.
dance with 15A NCAC 2C *J01 a
10. YIELD (gpm): sL METHOD OFTEST TGss ri
11. WATER ZONES (depth):
12. CHLORINATION: Type
13. CASING:
Wag Thickness
Depth DI ter or welghVFI L aria!From To 2222 Ft.—
From To Ft.
From To Ft.
14. GR0UT:
Depth Metbod .
From To a�2_ Ft.
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.
From To Ft.
17. REMARKS:
IDO HEREBY
CONSTRUCT
FOR OFFICE L
Quad No:
Sedal No.
DRILLING LOG
From To
Agricultural ❑ Monitoring ❑
DEPTH
Formation Description
eded use back of form
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other map reference points)
IN ACCORDANCE WITH ISA NCAC 2C, WELL
CORO HA"MN PROVIDED TO THE WELL 0
iATURE OF PERSON WNSTRuenNG THE WELL
Division of Water Quality, Gmundwalor Section within 30 days
GW-1 REV. 12f"

North Carolina - Department of Environment and Natural Resources - Division of Water OuaMy - Groundwater Section '-• 1 9 8
1636 Mail Service Center - RaW9h. N.C. 27W94636-Rene [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR: Vqjeg26W=J_ � V-1 Zee
WELL CONTRACTOR CERTIFICATION #: 4 %
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE (ararAppucabis eox): Residential® Municipal ❑ Industrial ❑
Recovery ❑ Heat Pump Water Injection ❑ Other If Other, List Use:
2. WELL LOCATIOjV: (Show
Nearest Town:
3. OWNER
Address
ury Of rOwn stare zip coos
4. DATE DRILLED
5. TOTAL DEPTH
6. CUTTINGS COLLECTED YES Q NO®
7. DOES WELL REPLACE EXISTING WB17 YES 0 NO[Z
a. STATIC WATER LEVEL Below Top of Casing: FT.
Mon'. I Above Top of CMM)
9. TOP OF CASING ISLZ_ FT. Above Land Surfsoe
-Top of eaaI terodnated suer blow WW surface requires a variance In accor-
mrre.etdrl6ANe,►c2c 1s
10. YIELD (gpm): _ 4 METHOD OF TEST T� r
11. WATER ZONES (depth): /D A '
12. CHLORINATION: Type Arrmnt -7._
13. CASING:
DRILLING LOG
From TO
Agricultural ❑ Monitoring ❑
DEPTH
Formation Daudpeon
If additional space is needed use back of larm
wal Thickness LOCATION SKETCH
Depth or wowNR. (Slaw direction and distance from at learnt two State
FromTo Ft. _ 1L'•fGS.- Roads, or other map reference points)
From To FL
From To Ft.
14. GROUT:
Depth moo
-_-1_
From To FL
From To Ft.
iE�-3eL-T��:E
Depth Diameter Slot Size Material
From To Ft In. m.
From To FL In. In.
From To Ft. in. In
1a. SANDIGRAVELPACK*
Depth Size MaterW
From To Ft.
From � To FL
17. REMAR
I DO HEREBY CE
CONSTRUCTION
Oust! No:
F PER60N 0ONSMt1Ct9#t3 THE WELL
water Ouaty. Groundwater Section within 30 days
Nrvsc
BMW No- - -
QW1 REV. 12f99

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] .� (' .� f j 0
WELL CONSTRUCTION RECORD WELL CONTRACTOR: Dewey Wright Well Purnp Co., Inc.
WELL CONTRACTOR CERTIFICATION #:
0008521 STATE WELL CONSTRUCTION PERMIT#, evvey yvingrit
1. WELL USE (Check Applicable Box): Residential ® Municipal 0 Industrial 0
Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use:
2.
9
4.
5.
6.
7.
8.
WELL LOCATION: (Show sketch of the location below)
Agricultural Monitoring 0
Nearest Town: SPRUCE PINE County: MITCHELL
WHITE ROCK RD. OFF HUMPBACK MTN P.D. OFF ALTOP
(Road Name and Numbers, Community, or Subdivision and Lot No
DRILLING LOG
DEPTH
OWNER KEVIN W. MELTON
From
To
Formation Description
Address 100 BIGGERSTAFF RD. ,
0
25
DIRT
SPRUCE PITIE°r lour, No l NC 28777
25
125
GRANITE
City or Town state zip coda
125
138
QUARTZ
DATE DRILLED 10/9/2000
136
505
GRANITE
TOTAL DEPTH 505
CUTTINGS COLLECTED YES 0 NO
DOES WELL REPLACE EXISTING WELL? YES 0 NO
STATIC WATER LEVEL Below Top of Casing: FT.
(Use "+" if Above Top of Casing)
9. TOP OF CASING IS 1 FT. Above Land Surface*
•Top of casing terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2C.0118
10. YIELD (gpm): 0 METHOD OF TEST Aar
11. WATER ZONES (depth):0 ppm DP.Y HOLE 0 ppm
'T7
0 ppm 0 ppm
12. CHLORINATION: Type HTH Amount If additional space is needed use bath forrtl+
13. CASING:
Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 30Ft. B 118. .350 PVC
From To Ft.
From To Ft.
14. GROUT:
Depth Material Method
From 0 To 20 Ft, Cement Gravity Flova
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:
IDO HEREB
CONSTRUC
FOR OFFICE
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other map reference points)
1' lie
3TRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
SIGNAT JA OF PERSON C�STRUCTING THE WELL DATE
Su iginal to C1tVislon of Water Quality, Groundwater Section within 30 days
GW-1 REV. 12/99
Quad No: —
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] i. i. O �} 3
WELL CONSTRUCTION RECORD WELL CONTRACTOR: Dewey Wright Well Pump Co., Inc.
WELL CONTRACTOR CERTIFICATION #:
OOO637 STATE WELL CONSTRUCTION PERMIT#: Leslie Neece
1. WELL USE (Check Applicable Box): Residential ® Municipal D Industrial
Recovery E� Heat Pump Water Injection E] Other D If Other, List Use:
2.
3. OWNER CLYDE R. RIDDLE
Address 1831 HUMPBACK MTN. P.D. ,
91PRUCEVI`112"`o teNo.l NC 28777
Cry or Town State Zip Code
4. DATE DRILLED 10/5/2000
5. TOTAL DEPTH 405
6. CUTTINGS COLLECTED YES F� NO
7. DOES WELL REPLACE EXISTING WELL? YES D NO
8. STATIC WATER LEVEL Below Top of Casing: 50 FT.
(Use "4" if Above Top of Casing)
9. TOP OF CASING IS 1 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2C.0118
10. YIELD (gpm): 30 METHOD OF TEST Air
11. WATER ZONES (depth):30 gpm36&388 0 qpm
0 qpm 0 qpm
12. CHLORINATION: Tvpe HTH Amount 75
13. CASING
Depth Diameter
From 0 To 31 Ft, 8 1/8
From To Ft.
From To Ft.
14. GROUT:
WELL LOCATION: (Show sketch of the location below)
Nearest Town: SPRUCE PINE County: MITCHELL
WHT ROCK RD. OFF HUMPBACK MTN RD. OFF ALTAPA
(Road Name and Numbers, Community, or Subdivision and Lot No.)
DEPTH
Formation Description
DIRT
Agricultural Monitoring 0
DRILLING LOG
From
To
0
27
27
388
388
369
389
405
GRANITE
QUARTZ
GRANITE
v
If additional space is needed use baq f fo_"
Wall Thickness LOCATION SKETCH
or Weight/Ft. Material (Show direction and distance from at least two State
.350 PVC Roads, or other map reference points)
C�V
i
Depth
Material
Method
From
0 To
20 Ft. Cement
Grareity Floyu
From
To
Ft.
15. SCREEN:
/�
' �/a p�
Depth
Diameter Slot Size
Material
From
To
Ft. in. in.
From
To
Ft. in. in.
Q
From
To
Ft. in. in.
jry W.ty 1DiXfJuh7hj I
16. SAND/GRAVEL PACK: s TF
Depth Size Material R
From To Ft.j
From To Ft. T
i
17. REMARKS:
I DO HEREE
CONSTRUC
Quad No:
SO _ 1>
;TRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
I U -
SIGNATURE 0. ERSON CONSTRUCTING THE WELL DATE
Su mrt iginal to Division o Water Quality, Groundwater Section within 30 days
GW-1 REV. 12/99
Serial No.

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mail Service Center- Raleigh, N.C. 27699-1636 - Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR: Dewey Wright Well Pump Co., Inc.
0006241 WELL CONTRACTOR CERTIFICATION M
Leslie Reece
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE (Check Applicable Box): Residential EN Municipal 0 Industrial 0
Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use:
FJ
WELL LOCATION: (Show sketch of the location below)
Nearest Town: SPRUCE PINE County: MITCHELL
FOX RUN LANE OFF HWY 19E
Road Name and Numbers. Community. or Subdivision and Lot No.)
3. OWNER ROBERT M.LETTERMAN
Address 40 FOX RUN RD.
SPRUCE 111JEr Roble No.l INC 28775
City or Town State Zip Code
4. DATE DRILLED 11/1/2000
5. TOTAL DEPTH 420
6. CUTTINGS COLLECTED YES 0 NO
7. DOES WELL REPLACE EXISTING WELL? YES 0 NO
8. STATIC WATER LEVEL Below Top of Casing: FT.
(Use "+" if Above Top of Casing)
9. TOP OF CASING IS 1 FT. Above Land Surface*
"Top of casing terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2C.0118
10. YIELD (gpm): 0 METHOD OF TEST fur
11. WATER ZONES (depth):0 qpm DRY HOLE 0 qpm
0 Apm 0 qpm
12. CHLORINATION:
Amount
Agricultural Monitoring 0
DRILLING LOG DEPTH
From To Formation Description
0 16 DIRT
16 420 GRANITE
c: i
c,
a
B
If additional space is needed use baokDf fo(rio
13.
CASING:
LOCATION SKETCH
Depth
Diameter
Wall Thickness
or Weight/R. Material
(Show direction and distance from at least two State
From
0 To
21 Ft. 6 1/4
.186 GALV.
Roads, or other map reference points)
From
To
Ft.
From
To
Ft.
14.
GROUT:
Depth
Material
Method
From
0 To
20 Ft. Cement
Gravity Flovv
From
To
Ft.
15.
SCREEN:
Depth
Diameter Slot Size Material
From
To
Ft. in.
in.
From
To
Ft. in.
in.
y
From
To
Ft. in.
in.
16.
SAND/GRAVEL
PACK:
Depth
Size
Material
V
From
From
To
To
Ft.
Ft.
S fµL6 �y
k
17.
REMARK
I DO HER
E I
T L
S CONSTRUCTED IN ACCORDANCE
WITH 15A NCAC 2C, WELL
CONSTR
I
COPY OF THISRECORDHAS BEEN PROVIDED TO THE WELL OWNER.
ONLY
^'''�
"")Do
SIGNATURE OF P
ON CONSTRUCTING THE WELL DATE
No:
FOr'ROFFIC
ubm
original to Division of ter Quality, Groundwater Section within 30 days
�!n'I".'
"CiiOflGW-1
REV. 12/99
l No.
,D aiOffce

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section O Q i
1636 Mail Service Center - Raleigh, N.C. 27699-1636- Phone [phone] it. A.
WELL CONSTRUCTION RECORD WELL CONTRACTOR: Deeirey VvrigiltWell Pump Co., Iric.
WELL CONTRACTOR CERTIFICATION #:
999132 STATE WELL CONSTRUCTION PERMIT#: e� le eece
1. WELL USE (Check Applicable Box): Residential 0 Municipal E] Industrial 0
Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use:
2.
1
4.
5.
6.
7.
8.
WELL LOCATION: (Show sketch of the location below)
Agricultural 0 Monitoring EJ
Nearest Town: SPRUCE PINE County
MITCHELL
MCKINNEY MINE RD. OFF CHESTNUT GROVE
CH. RD. 0
(Road Name and Numbers, Community, or Subdivision and Lot No,)
DRILLING
LOG
DEPTH
OWNER WARREN DANIELS
From
To
Formation Description
Address 12DOMEADOWLARK LANE,
0
22
DIRT
WAXFjAWtnmorRodedNo.) NC 28173
22
163
GRANITE
City or Town state zip coda
163
164
QUARTZ
DATE DRILLED 10/31/2000
164
348
GRANITE
TOTAL DEPTH 420
348
349
QUARTZ
CUTTINGS COLLECTED YES D NO ©
349
420
GRANITE
DOES WELL REPLACE EXISTING WELL? YES 0 NOFXI
STATIC WATER LEVEL Below Top of Casing: 60 FT.
(Use ",'if Above Top of Casing)
9. TOP OF CASING IS 1 FT. Above Land Surface*
'Top of casing terminated at/or below land surface requires a variance in actor
dance with 15A NCAC 2C.01
10. YIELD (gpm): 14 METHOD OF TEST 'fir
11. WATER ZONES (depth):1/8 ppm 163-184
7
0 APm Ld APm
12, CHLORINATION: Type HTH Amount 72 If additional space is needed use backof form-,
13. CASING: Wall Thickness LOCATION SKETCH r�
Depth Diameter or WeighVFt. Material (Show direction and distance from at lea�14wo State
From 0 To 26 Ft. 6 118 .350 PVC Roads, or other map reference points)
From To Ft. f.1
From To Ft. �tt11
14. GROUT: V
Depth Material Method
From 0 To 20 Ft, Cernent Gravity Flow
From To Ft. CEMENT GRAVITY FLOW
15. SCREEN:
Depth Diameter Slot Size Material '',,
From To Ft. in. in. V
From To Ft. in. in. X
From To Ft. in. in. tDTV
16. SAND/GRAVEL PACK: City
Depth Size Material �--
c
From To Ft.
v
From To Ft. x
17. REMARKf0 Q;�e
I DO HER E I T S CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTR DI N COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
FOR OFF( 01�LIV I jn�(j
SIGNATURE OF P SON CONSTRUCTING THE WELL DATE
Quad No: lubm original to Division of Water Quality, Groundwater Section within 30 days
GW-1 REV. 12/99
vpyihp1'8ater ection
Serial No. .pin al flffirn

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR: Dewey Vlright Well Pump Co., Inc.
WELL CONTRACTOR CERTIFICATION #:
999133 STATE WELL CONSTRUCTION PERMIT#: es le eece
1. WELL USE (Check Applicable Box): Residential 0 Municipal 0 Industrial 0
Recovery 0 Heat Pump Water Injection D Other 0 If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: SPRIICEPINE County: MITCHELL
MrI KINNFY MINF RD OFF CHESTNUT GROVE CH. RD.
ROdtl Name and Numbers, Community, or Subdlvislon and Lot No.l
3. OWNER WARREN DANIELS
Address 1�OOf"�ADO'vNrLARK LANE
1NAXHAVVeetorRouteNa.l NC 28173
Cry or Town state Zip Code
4. DATE DRILLED 10/31/2000
5. TOTAL DEPTH 160
6. CUTTINGS COLLECTED YES EJ NO EA
7. DOES WELL REPLACE EXISTING WELL? YES O NO 0
8. STATIC WATER LEVEL Below Top of Casing: 50 FT.
(Use "+" if Above Top of Casing)
9. TOP OF CASING IS 1 FT. Above Land Surface*
•Top of casing terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2C.0118
10. YIELD (gpm): 30 METHOD OF TEST Air
11. WATER ZONES (depth):30 qpm 134-136 0 ppm
0 nom 0 ppm
12. CHLORINATION: Type HTH Amount 23
13. CASING:
Wall Thickness
Depth Diameter or Weight/Ft. Material
From D To _ 4 Ft. 6 118 .350 PVC_
From To Ft.
From To Ft.
14. GROUT:
Depth Material Method
From 0 To 20 Ft. Cement Gravity Flora
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:
IDO HEREE
CONSTRUC
FOR OFFICE
Quad No:
Slot Size Material
in.
in.
in.
Material
DRILLING LOG
From To
Agricultural Monitoring
DEPTH
Formation Description
38 134 GRANITE
134 136 SHALE
136 160 GRANITE
i
If additional space is needed use bacR( f form_
rV r
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other map reference points)
NSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
'Y OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
Y- - — _ .. -
SIGNATURE OF PE N CONSTRUCTING THE WELL DATE
— 2co!1 Sub ' final to Division of Water Quality, Groundwater Section within 30 days
im
Serial No.
GW-1 REV. 12/99

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section (1 C ry
1636 Mail Service Center- Raleigh, N.C. 27699-1636 - Phone [phone] J i
WELL CONSTRUCTION RECORD WELL CONTRACTOR: Dewey Wright Well Pump Co., Inc.
WELL CONTRACTOR CERTIFICATION #:
0006522 STATE WELL CONSTRUCTION PERMITM Dewey Wright
1.
WELL USE (Check Applicable Box): Residential EZ Municipal 0
Industrial 0 Agricultural Monitoring 0
Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use:
2.
WELL LOCATION: (Show sketch of the location below)
Nearest Town: SPRI IC'F PINT County: MITCHELL
HI IMPRAt:K MTN RO fiFF AI TOR.AR4 RD OFF KWY 19
Road Name and Numbers, ommvnity, or Subtllvision and Lot No.l
DRILLING LOG DEPTH
3.
OWNER KEVIN W. MELTON
From To Formation Description
Address- 100 RIGGER�eS�TA.FF RD
0 38 DIRT
SPRLICEI 11VCrR°uteNO NC 28777
38 122 GRANITE
City or Town st,ti, Zip Code
122 126 QUARTZ
4.
DATE DRILLED 10/10/2000
126 235 GRANITE
5.
TOTAL DEPTH 305
235 235 GRANITE
6.
CUTTINGS COLLECTED YES 0 NO ©
235 275 GRANITE
7.
DOES WELL REPLACE EXISTING WELL? YES 0 NO 0
275 275 GRANITE
8.
STATIC WATER LEVEL Below Top of Casing: 20 FT,
275 305 GRANITE
(Use "4" if Above Top of Casing)
9.
TOP OF CASING IS 1 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a variance in accor.
dance with 15A NCAC 2C.0118
10.
YIELD (gpm): 30 METHOD OF TEST Air
11.
WATER ZONES (depth):10 Apm235 20 Apm 275
D Apm D Apm
-
12.
CHLORINATION: Type HTH Amount 58
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 leas[two.State
From 0 To 4 Ft. 6 1/8 .350 Pvc_
Roads, or other map reference pgir3ts) <-
From To Ft.
From To Ft.
0
14, GROUT:
Depth Material Method
From 0 To 20 Ft, Cement Gravity Flow
From To Ft. __..
15. SCREEN:
Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
From To Ft. in. in.
16. SAND/GRAVEL PACK:
Depth Size
From To Ft.
From To Ft.
17. REN
IDO
CON
FORC
Quad
I
Serial
Material
AS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
A C Y OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
VrURE OF PEFVN CONSTRUCTING THE WELL DATE
Division of Water Quality, Groundwater Section within 30 days
GW-1 REV. 12/99
,?-IPD01

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section ` n 0 O 7 4
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone] �4 'J
WELL CONSTRUCTION RECORD WELL CONTRACTOR: Dewey Wright Vlell Pump Co., Inc.
000712 WELL CONTRACTOR CERTIFICATION #: es le eece
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE (Check Applicable Boxl: Residential Z Municipal E] Industrial E]
Recovery D Heat Pump Water Injection 0 Other 0 If Other, List Use:
E
WELT. LOCATION: (Show sketch of the location below)
N(,;,. tTown: BAKERSVILLE County: MITCHELL
_MINE BRANCH RD. OFF HWY 226
IR ad Name and Numbers Communut or Subdivision and Lot No 1
Agricultural Monitoring 0
n Y.
DRILLING LOG
DEPTH
3.
(,o" RONNIE D. BURLESON
From
To
Formation Description
p, P.O. BOX 314
0
42
MUD/GRAVEL
BAKERS CLt Route No NC 29705
42
87
GRANITE
- Town state Zip Code
87
Be
SHALE
4.
D/ . ILLED 10/27/2000
88
129
GRANITE
5.
TC _ DEPTH 165
129
130
QUARTZ
6.
CL F(INGS COLLECTED YES 0 NO ®
130
165
GRANITE r
7.
DOES `NELL REPLACE EXISTING WELL? YES D NO F71
8.
STATIC WATER LEVEL Below Top of Casing: 10 FT.
_
(Use',' if Above Top of Casing)
-
9.
TOP OF CASING IS 1 FT. Above Land Surface*
>
'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 Air
--
11.
WATER ZONES (depth):2 ppm87-88+ 1 ppm 129-130
0 Qom 0 ppm
12.
CHLORINATION: Type HTH Amount 34
If additional space is needed use bac"form_
13. C,, ING:
Depth Diameter
Wall Thickness LOCATION SKETCH
or Weight/Ft. Material (S rw direction and distance from at least two State

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] F- �-- 0 91 6
WELL CONSTRUCTION RECORD WELL CONTRACTOR: Dewey Wright Well Pump Co., Inc.
WELL CONTRACTOR CERTIFICATION #:
999131 STATE WELL CONSTRUCTION PERMIT#: Leslie Heece
1. WELL USE (Check Applicable Box): Residential E� Municipal D Industrial
Recovery 0 Heat Pump Water Injection 0 Other ❑ If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below)
Agricultural El Monitoring E]
Nearest Town: SPRUCE PINE County: MITCHE:LL
MCKINNEY MINE RD. OFF CHESTNUT GROVE CH. RD. O
(Road Name and Numbers, community, or Subdivision and Lot No.) DRILLING LOG DEPTH
3. OWNER WARREN DANIELS From To Formation Description
Address 1 D FAFADOWLARK LANE 0 25 DI PT
WAXHAV `reef or Route No.l NC 29173 25 705 GRANITE
City or Town State Zip Code
4. DATE DRILLED 8/22/2000
5. TOTAL DEPTH 705
6. CUTTINGS COLLECTED YES D NO
7. DOES WELL REPLACE EXISTING WELL? YES 0 NO F
8. STATIC WATER LEVEL Below Top of Casing: FT.
(Use "+" if Above Top of Casing)
9. TOP OF CASING IS 1 FT. Above Land Surface*
'Top of casing terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2C.0118
10. YIELD (gpm): 0 METHOD OF TEST Air
11. WATER ZONES (depth):0 qpm DRY HOLE 0 qpm
0 qpm 0 qpm
12. CHLORINATION: Type f'{TH Amount
13. CASING:
Wall Thickness
Depth Diameter or Weight/Ft. Material
From n To 'A Ft. B 1/S lift PVC
From To Ft.
From To Ft.
14, GROUT:
Depth Material Method
From _ 0 To 20 Ft. Cement Gravity Flova
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. REMA
IDOH
CONSIT
ION STANDARDS,
JAN-9.
FOR OF
SE ONLY
Quad N
8'til Sec
AsheVi1le Rpzional
-
let
Serial No.
Material
aS CONSTRUCTED IN
A COPY OF THIS RED
D 0 . I .
CJ r'
r-�
If additional space is needed use backrdill
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other map reference points)
�e
�t
Iw
p.1
,too 3.
-i
ONCE WITH 15A-NCAC2C, WEL
BEEN PROVIDED TO THE WELL
SIGNATURE OF PERSON CONSTRUCTING THE WELL
original to Division of Water Quality, Groundwater Section within 30 days
DATE
GW-1 REV. 12/99
I

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section (� f
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone] j J
WELL CONSTRUCTION RECORD WELL CONTRACTOR: Dewey Wright Well Pump Co., Inc.
000820 WELL CONTRACTOR CERTIFICATION #: _1es to eece
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE (Check Applicable Box): Residential EN Municipal 0 Industrial EJ Agricultural 0 Monitoring
Recovery 0 Heat Pump Water Injection 0 Other E] If Other, List Use:
2.
3.
4.
5.
6,
7.
8.
WELL LOCATION: (Show sketch of the location below)
Nearest Town: BAKERSVILLE County:
MITCHELL
PRIVATE DR. OFF HWY 261
(ROdd Name and Numbers,Community, or 5ubdivislon and Lot No
DRILLING LOG
DEPTH
OWNER JOHN C. EIRIGGS
From
To
Formation Description
Address P.O. B01 1144 ,
0
19
DIRT
EIAKERSti'liCEF Route No.) NC 28705
18
274
GRANITE
City or Town State Zip Code
274
275
QUARTZ
DATE DRILLED 10/4/2000
275
345
GRANITE
TOTAL DEPTH 345
CUTTINGS COLLECTED YES El NO
DOES WELL REPLACE EXISTING WELL? YES 0 NO EN
STATIC WATER LEVEL Below Top of Casing: 20 FT.
(Use ",' if Above Top of Casing)
9. TOP OF CASING IS 1 FT. Above Land Surface*
'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
CD
.`J
11. WATER ZONES (depth): ) ppm274-275 0 ppm
0 ppm 0 ppm �7
12. CHLORINATION:
13. CASING
Depth Diameter
From 0 To 21 Ft. 6 114
From _ To Ft.
From To Ft.
_ Amount 67 If additional space is needed use back of form -
Wall Thickness LOCATION SKETCH cn CD
or Weight/Ft. Material (Show direction and distance from at least two State
.188 GALV. Roads, or other map reference points)
Rrx�n 1��
14. GROUT:
Depth Material Method
From 0 To 2`1 Ft. Cement Gravity Flow
From To Ft.
Pr, pr X
15. SCREEN:
Depth Diameter
Slot Size Material
From
To Ft.
in. in. ry�
From
To Ft.
in. in.
From
To Ft.
in. in. ram'
16. SAND/GRAVEL PACK:
Depth
Size Material
From
To Ft.
From
To Ft.
17. RE
sppY�C�tf\&
ID E
Y H IS
L WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CO
I
I HAT AppCOPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
FOR
NL
SIGNATURE OF PER N CONSTRUCTING THE WELL DATE
Quad Jo:
ubmit original to Division of Water Quality, Groundwater Section within 30 days
C nnndw2fe, SPctio
GWT REV. 12/99
Serial y1o.
' "^?

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone] L (1 9
1
WELL CONSTRUCTION RECORD WELL CONTRACTOR: Dewey VySight V<`ell Pump Co., Inc.
WELL CONTRACTOR CERTIFICATION #: 26
000602 STATE WELL CONSTRUCTION PERMIT#: Leslie Reece
1. WELL USE (Check Applicable Box): Residential DI Municipal EJ Industrial El Agricultural E] Monitoring 0
Recovery D Heat Pump Water Injection 0 Other 0 If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: BAHERSVILLE County: M ITCHELL
HAMBURG WAY OFF BEAR CREEK RD.OFF HAMBURG
IRoatl Name and Numbers. Community. or Subdivision and Lot No.l
3. OWNER Mil DRED BUCHANAN
Address % LARRY BUCHANAN . 135 HAMBURG WAY
BAKERSil Route No. NC 28705
Ityor Town state Zip Code
4. DATE DRILLED 10/4/20D0
5. TOTAL DEPTH 245
6. CUTTINGS COLLECTED YES 0 NO
7. DOES WELL REPLACE EXISTING WELL? YES El NO
8. STATIC WATER LEVEL Below Top of Casing: 10 FT.
(Use "+" if Above Top of Casing)
9. TOP OF CASING IS 1 FT. Above Land Surface*
'Top of casing terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2C.0118
10. YIELD (gpm): 2 METHOD OF TEST Air
11. WATER ZONES (depth):2 ppm38-39 0 qpm
0 ppm 0 ppm
12. CHLORINATION: Type HTH Amount 48
DRILLING LOG DEPTH
From To Formation Description
17 38 GRANITE
38 39 SHALE
39 245 GRANITE
If additional space is needed use back of ftmn
13.
CASING:
LOCATION SKETCH
Wall Thickness
Depth Diameter or Weight/Ft. Material (Show direction and distance from at least two State
From
in To 21 Ft. 6 114 1g8 G,ALV tit6�,)�E Roads, or other map reference points)
From
To Ft.
From
To Ft.
14.
GROUT:
_
Depth Material Method
1 t\
ejtuy
From
0 To 20 Ft. Cement Gravity Flo
"
f!Q
From
To Ft.
ti
15.
SCREEN:
/J�1
Depth Diameter Slot Size Materia
From
To Ft. in. in.
4
D
From
To Ft. in. in.
From
To Ft. in. in.
�`+_%/ 7ct4avi Rork 4 uafry
rar Cr4. -QJ
16.
SAND/GRAVEL PACK:
' ;3
Depth Size Material
'ram
From
To Ft.
m
From
To Ft.
V)
17.
REMARK
�Qtµ
Qi L
I DO HERECSTANDARDS,
WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRU
AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
FOR OFFIC
SIGNATURE OF PERS CONSTRUCTING THE WELL DATE
Quad No:te
�_._. :,,_..__
Section Submit ri final to Division of Water Quality, Groundwater Section within 30 days
9 Y� Y
GW-1 REV. 12/99
Serial No.

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section C A (�
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone] ) `f
WELL CONSTRUCTION RECORD WELL CONTRACTOR: Dewey Wright Well Pump Co., Inc.
WELL CONTRACTOR CERTIFICATION #:
000749 STATE WELL CONSTRUCTION PERMIT#: es le eece
1. WELL USE (Check Applicable Box): Residential Dq Municipal 0 Industrial 0
Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use:
2.
3.
4.
5.
6.
7.
8.
WELL LOCATION: (Show sketch of the location below)
Agricultural Monitoring 0
Nearest Town: BAKERSVILLE County: MITCHELL
PRIVATE RD. OFF HWY 80 SOUTH OFF MINE CREEK RD
(Road Name and Numbers, Community, or Subdivision and Lot No
DRILLING LOG
DEPTH
OWNER PHIL DALE
From
To
Formation Description
Address 305 MAIN GATE RD.,
0
100
DIRT
COLUME)lXeet or Rats No.l SC 29223
100
136
GRANITE
City or Town State zip Code
138
139
SHALE
DATE DRILLED 11/6/2000
139
2113
GRANITE
TOTAL DEPTH 240
216
217
SHALE
CUTTINGS COLLECTED YES 0 NO ©
217
240
GRANITE
DOES WELL REPLACE EXISTING WELL? YES 0 NO
STATIC WATER LEVEL Below Top of Casing: 50 FT.
(Use "+' if Above Top of Casing)
9. TOP OF CASING IS 1 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 213.0118
10. YIELD (gpm): 3 METHOD OF TEST Air
11. WATER ZONES (depth):1 ppm 138-139 2 ppm 21&217
0 ppm 0 qpm
12. CHLORINATION: Type HTH Amount 40 If additional space is needed use back of form
13. CASING
Depth Diameter
From 0 To 103Ft. 6118
From To Ft.
From To Ft.
14. GROUT:
LOCATION SKETCH
Wall Thickness
or Weight/Ft. Material (Show direction and distance from at least two State
.350 PVC
Roads, or other map reference points)
O
C�
'2
o
.ai
Depth
Material
Method
From
0 To
20 Ft.
Cement
Gravity Flow
��
Z
r
From
To
Ft.
ti
15. SCREEN:
2
Depth
Diameter
Slot Size
Material
V')
From
To
Ft.
__ in.
in.
O
From
To
Ft.
in.
in.
From
To
Ft.
in.
in.
y
C'S
v
16. SAND/GRAVEL PACK:
0Of
Depth
Size
Material
From
To
Ft.
From
To
Ft.
17. REMARKS
, WELL
CONSTRUCTI�II t6ITA[�DD A 1D19H A PY OF THIS
nREENSTRUCTEDICORDCORDANCE HAS BEEN RIOVID D TOTHE CWELL OWNER.
FOR OFFICE US UU Y ')-— /R_a
Quad No: .! �IGNATURE OF RSON CONSTRUCTING THE WELL DATE
Submi origi al to Division of Water Quality, Groundwater Section within 30 days
t } GW-1 REV. 12/99
U!r '."�2t SCiI'0
Serial No.

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR: Dewey Wright Well Pump Co., Inc.
000750 WELL CONTRACTOR CERTIFICATION #: zuau
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE (Check Applicable Box): Residential ® Municipal 0 Industrial 0
Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: BAKERSVILLE County: MITCHELL
HARRILL HILL RD. OFF HWY 197 NORTH OFF HWY 226
(Road Name and Numbers, Community, or Subdivision and Lot No.)
3. OWNER MAE MILLER
Address % REESE MILLER , 2206 BEAVER BROOK DR.
GREENSOOR(!) Route No.) NC 27406
4. DATE DRILLED 11/8/2000
5. TOTAL DEPTH 290
6. CUTTINGS COLLECTED YES 0 NO
7. DOES WELL REPLACE EXISTING WELL? YES 0 NO
8. STATIC WATER LEVEL Below Top of Casing: 20 FT.
(Use '+` if Above Top of Casing)
9. TOP OF CASING IS 1 FT. Above Land Surface*
'Top of casing terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2C.0119
10. YIELD (gpm): 1 METHOD OF TEST 'tur
11. WATER ZONES (depth):1 ppm33-34 0 ppm
0 ppm 0 ppm
12. CHLORINATION: Type r .. Amount "
13. CASING:
Depth Diameter
From 0 To 21 Ft. 6 114
From To Ft.
From To Ft.
Agricultural0 Monitoring 0
DRILLING LOG
DEPTH
From
To
Formation Description
0
15
DIRT/BOULDERS
15
33
GRANITE
33
34
SHALE
34
290
GRANITE
Ga
C5 ca
If additional space is needed use back
rV
Wall Thickness LOCATION SKETCH O
or Weight/Ft. Material (Show direction and distance from at leastAo
.188 GALV. Roads, or other map reference poinli
O
14. GROUT:
Depth Material
From 0 To 20 Ft. Cement
From To Ft.
15. SCREEN
.0ii
N o
z
Method �y��,
Gravity Flow
Depth Diameter Slot Size Material I From To Ft. in. in.
From To Ft. in. in. lY
From To Ft. in. in. —
16. SAND/GRAVEL PACK:
Depth
From To Ft.
From To Ft.
17. REMARKS:
IDO HEREB
CONSTRUC
Size Material
IJ
!D IN ACCORDANCE WITH 15A NCAC 2C, WELL
RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
FOR OFFICE �QQPNLY
jj L $' SIGNATURE OF RSON CONSTRUCTING THE WELL DATE
Quad No: is Supmit original to Division of Water Quality, Groundwater Section within 30 days
a �• - ? GW-1 REV. 12199
Serial No.

225 North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section 4- 4 8
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR:
Dewey'rrPlghtt'vveii Purrip Co., Inc.
000838 WELL CONTRACTOR CERTIFICATION #:
STATE WELL CONSTRUCTION PEMe ee eRMIT#:
1. WELL USE (Check Applicable Box): Residential ® Municipal ❑ Industrial ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2.
0
4.
5.
6.
7.
8.
Agricultural ❑ Monitoring ❑
WELL LOCATION: (Show sketch of the location below)
Nearest Town: EAKERSVILLE County:
MITCHELL
HWY 226
(Road Name and Numbers, Community. or subdivision and Lot No.)
DRILLING
LOG
DEPTH
OWNER MARGARET H. SHULL
From
To
Formation Description
Address 1103 WEST ELM ST. ,
0
38
DIRT
SHELE3 Istreet or Route No l NC 28150
38
47
GRANITE
City or Town state Do code
47
48
SHALE
DATE DRILLED 11/2/2000
48
95
GRANITE
125
95
96
QUARTZ
TOTAL DEPTH
❑ ®
96
125
GRANITE
CUTTINGS COLLECTED YES NO -39
DOES WELL REPLACE EXISTING WELL? YES ❑ NO
STATIC WATER LEVEL Below Top of Casing: 30 FT.
(Use "+" if Above Top of Casing)
9. TOP OF CASING IS 1 FT. Above Land Surface*
-Top of casing terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2C.011
10. YIELD (gpm): 0 METHOD OF TEST Air
11. WATER ZONES Idepth):2 OPM47-48 8 APm95-$8
0 qpm 0 qpm
12, CHLORINATION: Type HTH Amount
13. CASING:
Depth
From 0 To _
From To _
From To
14. GROUT:
Diameter
42 Ft. 6 1/8
_ Ft.
_ Ft.
co
If additional space is needed use back of $pn a)
LOCATION SKETCH N
Wall Thickness 0
or Weight/Ft. Material (Show direction and distance from at least two
.350 PVC Roads, or other map reference poirt14
Depth Material Method
From 0 To 20 Ft. Cement Gravity Flow
From To Ft.
15. SCREEN:
Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
From To Ft. in. in.
16. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
17. REMARKS: _
I DO HEREBY
CONSTRUCTI
674
STRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
;NATURE OF PE&tON CONSTRUCTING THE WELL DATE
to Division of Water Quality, Groundwater Section within 30 days
GW-i REV. 12/99
e
Quad No:
Serial No. and Vs::

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section 0! Z ? [Il
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR: Dewey WrightViYell Pump Co., Inc.
OD0714 WELL CONTRACTOR CERTIFICATION #: Zvou
STATE WELL CONSTRUCTION PERMIT#: Leslie Reece
1. WELL USE (Check Applicable Box): Residential ® Municipal 0 Industrial 0 Agricultural0 Monitoring 0
Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: BAKERSVILLE County: MITCHELL
LOGGIN RD. OFF DELPHA RD. OFF HWY 261
(Road Name and Numbers, Community, or Subdivision and Lot No.l
3. OWNER LARRY D. MICHAEL
Address P.O. BOX 1285 ,
BAKERSM'CetlE,Houle No.) NC 28705
City or Town late Zip Code
4. DATE DRILLED 11/6/2000
5. TOTAL DEPTH 185
6. CUTTINGS COLLECTED YES 0 NO
7. DOES WELL REPLACE EXISTING WELL? YES 0 NOPq
8. STATIC WATER LEVEL Below Top of Casing: 10 FT.
(Use "+" if Above Top of Casing)
9. TOP OF CASING IS 1 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2C.01
10. YIELD (gpm): .1METHOD OF TEST Aar
11. WATER ZONES (depth):2 ppm37-38 �43-
0 ppm 0 ppm
12. CHLORINATION: Tvoe HTH Amount 37
DRILLING LOG
DEPTH
From
To
Formation Description
0
14
DIRT
14
37
GRANITE
37
38
QUARTZ
38
143
GRANITE
143
144
QUARTZ
144
185
GRANITE
If additional
is needed use back of
8 c
rV
13.
CASING:
LOCATION SKETCH
i
Depth
Diameter
Wall Thickness
or Weight/Ft. Material (Show direction and distance from at least Stg
From
0 To 21
Ft. 6 1/4
.188 GALV. Roads, or other map reference poi n z
From
To
Ft.
From
To
Ft.
14.
GROUT:
Depth
Material Method -�
From
0 To 20
Ft. Cement
Gravity Flow/p�'c a
From
To
Ft.
Z
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.
(��Ce
Q
17.
REMARK
I DO HER
E IF T T
H L
CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTR
COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
FOR OFFIC
ONLY _
SIGNATURE OF RSON CONSTRUCTING THE WELL DATE
Quad No:
S bmit
riginal to Division of Water Quality, Groundwater Section within 30 days
Croundwat
$ectim
GW-1 REV. 12/99
Serial No.
Asheville Re
nA rl'T;ram

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] 223995
WELL CONSTRUCTION RECORD WELL CONTRACTOR:ulli w"lei; r itiw VJ., ii iC
WELL CONTRACTOR CERTIFICATION #:i['=r_
0006 24 2 STATE WELL CONSTRUCTION PERMIT#: LuBlie 7dmce
1. WELL USE (Check Applicable Box): Residential 0 Municipal 0 Industrial 0 Agricultural 0 Monitoring 0
Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below)
s1,=,.lr=mite.. County:
Nearest Town: , i '�'�`- y: ' —'
FOx RUN LN 0"� H'dV`( 121
(Rood Name and Numbers, Community, or Subdivision and Lot No.l DEPTH
3. OWNER ROEERT M _ETTERN.�Pi
Address 40
grRUCEl�llrRouteNn.l N,_ ~ g77'
City or Town State Zip Code
4. DATEDRILLED 1n,�r'2�_
5. TOTAL DEPTH
6. CUTTINGS COLLECTED YES 0 NO 0
7. DOES WELL REPLACE EXISTING WELL? YES 0 NO 0
8. STATIC WATER LEVEL Below Top of Casing: 5 FT.
(Use'," if Above Top of Casing)
DRILLING
From
LOU
To
4
Formation Description
CAI RT
14
131
,RAi%a' 7l114
. _
.-le._
-" iNJ; 7
7R4
-500
GN4iJiTE
� 'cm
� c c'
9. TOP OF CASING IS 1 FT. Above Land Surface* _ '. n
'Top of casing terminated at/or below land surface requires a variance in actor- _ icD <
dance with 15A NCAC 2C.0118
10. YIELD (gpm): L5 METHOD OF TEST u'r vo
m
11. WATER ZONES (depth):" ` "' r^ t3'- }_ '' Z'
0 oom L Gorr; N m�a
12. CHLORINATION: Type HITH Amount—C'L If additional space is needed use bacl pf forcfi
13. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 111 To 21 Ft. c V.
From To Ft.
From To Ft.
14, GROUT:
Depth Material Method
From 0 To 2i1 Ft.=erren'r Gra;^ty Flor<
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:
S t Dil 1- ,i i� Size
From 7 ""Ft
From To � Ft
'1�Rt
�hwea ,
17. REMAR
I DO HE
CONSTRUCTION STANDARD!
FOR OFFICE USE ONLY
Quad No:
Serial No.
Material
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other map reference points)
WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
1T A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
SIGNATURE (
Submit original to Division
Rf/et
li-l&-
)N CONSTRUCTING THE WELL DATE
Quality, Groundwater Section within 30 days
GW-1 REV. 12/99
I

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section r )-7
1636 Mail Service Center - Raleigh, N.C. 27699-1636-Phone [phone] (� O
WELL CONSTRUCTION RECORD WELL CONTRACTOR:
WELL CONTRACTOR CEitfiFICATION #:
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE (check Applicable Box): Residential ❑ Municipal NK Industrial ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ It Other, List Use:
2. WELL LOCATION: (Show
(Road N
3. OWNER
Address
of the location below)
UL County: UY` a ""
Agricultural ❑ Monitoring ❑
or Subdivision and Lot No.) DRILLING LOG DEPTH
iU,%/t..r From To Formation Description
gy b:(^,
`v ity or Town Stata Zip Code _
o
4.
DATE DRILLED ' vr,
O
S.
TOTAL DEPTH 7_�
6.
—i
CUTTINGS COLLECTED YES Q NO[� A
YES NO—;
or1
7.
DOES WELL REPLACE EXISTING WELL?
8.
STATIC WATER LEVEL Below Top of Casing: FT.
' (Use': bt it Above Top Casing)
�c
9.
TOP OF CASING IS FT. Above Land Surface' -9
r-',.,�
_
-Top of casing terminated actor below land surface mqulres a variance In accor-
dance with 15A NCAC 2C�01ja z7 j ((.._
m�
10.
YIELD (gpm): ' V M TH D OF TEES
11.
WATER ZONES (depth): —mot Cw
=i
z
12.
CHLORINATION: Type Amount y ,: "'� if additional space is needed use back of form
13. CASING
LOCATION SKETCH
Depth
Wall Thickness
Diameter or Weight/R. Material
(Show direction and distance from at least two State
From
To Ft.
(
'T�-
Roads, or other map reference points)
From
Tt� Ft..
L —
L L. �L
From
To Ft.
(i /
`kack) f Arc(
14. GROUT:
Depth
Material Method
/
From
To Ft.
From
To %y 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
e \ �
- �n ;off`,
I DO HEREBY CEF).TIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION$TANCiAR6S.ANIkTHATACOPY FTHISRECORD ROVIDEDTOTHE WELL OWNER.
FOR OFFICE USE ONLY
Quad No: ',,!4{ , SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit original to Division of Water Quality. Groundwater Section Within 30 days
Serial No. GW-I REV. 12199

North Carolina - Department of Environment and Natural Resources - Division of Water Quality . Groundwater Section 4— 4 4 0 1 2
1636 Mai; Service Center - Raleigh, N.C. 27699-1636-Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR: 2=
WELL CONTRACTOR CE IFICATION p:
STATE WELL CONSTRUCTION PERMIT*: ref
1. WELL USE (Check Applicable sox): Residential ❑ Municipal industrial ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
Agricultural ❑ Monitoring ❑
2. WELL LOCATIO i (Show sket. of the location below)
Nearest ToCounty:
r^
(Road Nar5e and Nupmoers, Communi or Subdivision and Lot No.) DRILLING LOG DEPTH
3. OWNER �[%-�%r�.__�/��CL'd-vr+'� From To Formation Description
Address Z2 -7
(Str�� �y/•�(� �� �!,j�(
o.
,
/
Q—jO
eet or outs
2d'77
/_11y or Town State Zip Code
Sil
4.
DATE DRILLED
5.
TOTAL DEPTH
6.
CUTTINGS COLLECTED YES ❑ NO[}--
7.
DOES WELL REPLACE EXISTING WELL? YES ❑ NOQ�
6.
STATIC WATER LEVEL Below Top of Casing: /L) FT. fig",
r tl�rwt Y
(Use'+' if Above Top of Casing)
9.
TOP OF CASING IS FT. Above Land Surface'
--
-Top of casing terminated atior below land surface requires a varlance In accor-
dance with 15A NCAC 2C.0118
_
OF TEST 4/t
co
if�1
10.
YIELD (gpm): _� METHOD
11.
WATER ZONES (depth): "7 A 42 2e
12. CHLORINATION: Type C&COV Amount -�
13. CASING:
Depth Diameter
From To Ft.
From To .-TrY FL_.
From To Ft.
14. GROUT
Wall Thickness
or WeighVFI. Material
Depth Material
From To Ft.
�r
From -,L'2_ To 2.4 F(.
15. SCREEN:
Depth Diameter Slot Size
From To Ft in. _ in.
From To Ft. in. in.
From —To Ft. in. in.
16. SAND/GRAVEL PACK:
Method
Material
Depth Size Material
From To Ft.
T
If additional space is needed use back of fo* :
.. rN
LOCATION SKETCH w
O o
(Show direction and distance from at least two State --
Roads, or other map reference points)
From To Ft.
17. REMARKS: fL'2ee.' r/ fuM
I DO HEREBY CERTIFY THAT THIS WELL WAS CON
CONSTRUCTION STANDARDS, AND THAT A COPY
FOR OFFICE USE ONLY
Quad No: SIGI
c1fiN:% Serial No. Submit original to
U_ u(
,CCORDANCE WITH 15A NCAC 2C, WELL
ID HAS BEEN PROVIDED TO THE WELL OWNER
SON CONSTRUCTING THE WELL DATE
Quality, Groundwater Section Within 30 days
GW-1 REV. 12199
n

III
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] '. Z ^ 0 r
WELL CONSTRUCTION RECORD WELL CONTRACTOR: C%tiTlC j���1� DJ " C` '3
WELL CONTRACTOR CE TIFICATION #:
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: �I�t County: L IfI0-%
:�
lit/• /i e� /�
(Road Name and Numbers, Community, or Subdivision and Lot No.) DRILLING LOG
3. OWNER.'Ji9YLFJui/ �,��(,1r-S From To
Address < /�f�A%�.i<- /�I.1 —
—jMeet or Houle o.
5f�t <,uz /I_%C 2C'7717 t' /S
City or Town State Zip Code
4. DATE DRILLED 'IC `2, "e _
5. TOTAL DEPTH 665 `
6. CUTTINGS COLLECTED YES ❑ NO©-
7. DOES WELL REPLACE EXISTING WELL? YES NO[i _ - i l - -! S /'.o-•� Y-c'
8, STATIC WATER LEVEL Below Top of Casing: vc FT.
(Use': if Above Top of Casing)
9. TOP OF CASING IS FT. Above Land Surface' o
-Top of casing terminated atfor below land surface requires a variance In accor-
dance with 15A NCAC 2C .011a _ a
10. YIELD (gpm): / 7 METHOD OF TEST % !—
z
11.WATER ZONES (depth):�j1r%
12. CHLORINATION: Type (�G.%.tz'-ti Amount 40;
13. CASING:
Wall Thickness
Depth Diameter or Weight/A. Material
From To Ft.
From To Ft. /^ 1/o' Sic'7 (' L
From To Ft.
14. GROUT:
Depth Material Method .
From To Ft.
From To ­7e Ft. 777rr-.=<
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
DEPTH
Formation Description
If additional space is needed use back of form -
LOCATION SKETCH N
(Show direction and distance from at least two Stz
Roads, or other map reference points)
n : —
J_
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF�ry IS RECORD) HAS BEEN PROVIDED TO THE WELL OWNER.
FOR OFFICE USE ONLY Xrli1
Quad No:
Su�m((o
Serial No.
GNATURg OF PEKSON CONSTRUCTING THE WELL DATE
to Division of Water Quality, Groundwater Section within 30 days
GW4 REV. 12199

North Carolina • Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section 226499
1636 Mail Service Center - Raleigh, N.C. 27699-1636-Phone [phone] WELL CONSTRUCT7-?
ION RECORD WELL CON TRACTOR: r i!!W'_ tll AJe(/
WELL CONTRACTOR CERTIFICATION #:
STATE WELL CONSTRUCTION PERMIT#�
1. WELL USE (Check Applicable Box): Residential Ll/Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection Other ❑ If Other, List Use:
2. WELL LOCATIQ(Show sketch of the location below)
Nearest Town:— 044-cis-r'lo County.
OdUn'� utq l � r
(Road Name antl Numbers. Community, or Subdivision and Lol No.) DRILLING LOG DEPTH
_i
3. OWNER ,� o1i.Up� � a.l From 7o Formation Description
Address - `-/ 7 c1 -._k
triept� n. c..� 7a5 - %yo o'AAr
City or Town State Zip Cart„ —
4. DATE DRILLED `i-20
5. TOTAL DEPTH /.------------------- —
6. CUTTINGS COLLECTED YES NOE�]-' _._._._..
7. DOES WELL REPLACE EXISTING WELL? YES F-1 NOE�f"'
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 &Vor below land surface requires a variance In accor.
dance with 15A NCAC 2C .0118
10. YIELD (gpm): Cn METHOD OF TEST
11. WATER ZONES (depth):
12. CHLORINATION: Type C 1710 Rr'/�C' Amount 3 S If additional space is needed use back of form
13. CASING:
Wall Thickness
LOCATION SKETCH
O
Depth
Diamor or WcighVFL maleriat
(Show direction and distance from at least two State
From
To -3
Ft.
f Iy �L.
Roads, or other map reference points)
From
To
Ft.
From
To
Ft.
14. GROUT:
Q_
From `-2
Depth
To
Ft.
Material Method
k— ` e^
-T7
71
_ram
_
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
N
C RI
e.0
0
<J
r:7
100 HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS. AND THAT A COPY OF TC080_UAS BEEN PROVIDED TO THE WELL OWNER.
FOR OFFICE USE ONLY
Quad No: SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
- �✓{j r�nt5,,lhmil prigmal to Divislon of Water Quality. Groundwater Section within 30 days
Serial No. r ❑ �?/ j '.
GW4 REV. 12/99
i i'
f?

North Carolina - Department of Environment and Natural Resources - Division o! Wn:er Onaary Groundwater Section 226498
1636 Mail Service Center - Raleigh. N.C. 27699-1636-nhnnn (919) 7:11 -1,'21
WELL CONSTRUCT ION RECORD WLLLCONrHAC1OH:�«��
WELL CONTRACTOR CERTIFICATION N:
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE (Check Applicable Boa): Residential 2 Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATION: (Show sketch ole location below) �In r _ 1
Nearest Town: SORi)C�_ 'N2 County: r ' ` 7�eA --
�R>ES-6'�f�
(Road Name and Numbers. Community. or Subdivision and Lot No.) DRILLING LOG DEPTH
3. OWNER Gil e" E- C> k-- L)A) From To Formation Description
Address
Irett.or HouleNo.)y �ry
t
City or Town `tare Zip Gnn, —
4. DATE DRILLED el - -�
5. TOTALDEPTH —
6. CUTTINGS COLLECTED v YES 0 NOED--------
7. DOES WELL REPLACE EXISTING WELL? YES NOQ-f
B. STATIC WATER LEVEL Below Top of Casing: FT.
(Uso'+' II Above Top of Casing)
9. TOP OF CASING ISFr. Above Land Surface'
'Top of easing terminated eVor below land surface requires a valance In accor-
dance with 15A NCAC 2C.0118
10. YIELD (gpm): IC-' METHOD OF TEST
11. WATER ZONES (depth):'
12. CHLORINATION: Type cJR m o u n I .S It additional space is needed use back of form
13. CASING:
Depth Diametec
From- FI..�
From To Ft.
From To Ft.
14. GROUT:
Wall Thickness LOCATION SKETCH
or Weight/Ft. MaledTl (Show direction and distance from at least two State
/Iig C B-`l-'V` Roads, or other map reference points)
Depth Material Method
From To-`c 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. ----
Material
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPP OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
FOR OFFICE USE C
Quad No:
Serial No.
„ _ SIGNATURE OF PERSON CONSTRUCTING THE WELL
0r t`al to Division of Water Quality. Groundwater Section Within 30 days
6=S
DATE
GW-1 REV. 12/99

North Carolina - Department of Environment and Natural Resm.mcns - Div­,n of v n:,r n�.inloy - Groundwater Section 226506
1636 Mail Service Center - Raleigh, N C 27C; r-1 r_'r-Phnnn (919) T' 1, :11
WELL CONSTRUCTION RECORD WELLCONFRACFOrI:=/�4� IL-"eJl �iCrM '
WELL CON-FRACTOH CERTIFICATION #: S9O
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE (Check Applicable Boa): Residential ©'� Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other It Other, List Use:
2. WELL LOCATI¢t; (Show sketch of the location below)
Nearest Town: kzRsv, tt e. County:_�'?��c=��
—f"- k m-w' `t?,A - C-co ku,,::ry
(Road Name and Numbers. Community. or Subdivision and Lol Nn.) nRILLING LOG DEPTH
3. OWNER M0A From To Formation Description
Address �a Y'�tir' r _ cv= 5� c� , !- ids:,25 i
Ireot nr outa --
` ra kers y, /!e 70 Ll1 --- -
City orTown -._, Zn Qt rbc.k ^.�
4. DATE DRILLED 20 - 5-<se�
5. TOTAL DEPTH t�h'.-
6. CUTTINGS COLLECTED YES[] N0F7--
7. DOES WELL REPLACE EXISTING WELL? YES Cl NOL✓
8. STATIC WATER LEVEL Below Top of Casing. FT.
(I)sn'.' if Ahovo Top of C" oa)
9. TOP OF CASING IS t FT. Above Land Surface' --
'Top of easing terminated at/or below land surface requires a variance In accor-
dance with 15A NCAC 2C.00,11188
10. YIELD (gpm): METHOD OF TEST ![Z(e'r1-40
11. WATER ZONES (depth): 9(2f uO ,
12. CHLORINATION: Type cAmount .v— v—� If additional space is needed use back of form
13. CASING:
Wall Thickness
From
Depth ��
To
Ft.
Diaame{er or Weigh UFL Malerial
� yfis �t
From
To
Ft.
From
To
Ft.
14. GROUT:
0
Depth
�
Malerial Method f
From
To
Ft.
e__:2erv"t
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 Mntorml
in.
_ in.
Maimm!
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other map reference points) p
"Tl
n
p
N
0.11
lD
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY,OF THIS READ H/)r$ BEEN PROVIDED TO THE WELL OWNER.
FOR OFFICE USE ONLY
Quad No:
Serial No.
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit original to Division o' Water Ouahly, Groundwater Seclion Within 30 days
GW-1 REV. 12r99

North Carolina • Department of Environment and Nntural Resources - r), inn of VJNnr r)�.in!uy - Groundwater Section 226505
1636 Mail Service Center- Raleigh, N.C. 276n9-1636-Phonn (PIa) 77.1.9I'.71
WELL CONSTRUCTION RECORD WLLt.CON rRACTOn: 1-��/��k �� ��r,C'�� '-�Zr%�i✓LC,
WELL_ CONTRACTOR CERTIFICATION #:_ KS�jO V
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE (Check Applicable Box): Residential D Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery 0 Heat Pump Water Injection Olhor ❑ If Other, t_isl Use:
2.
WELL LOCATION: � (Show sketch of the location below) `
Nearest Town: U, )IE- Cneny:
_1PkeRS
L C.kee k
(Road Name and Numbers, Community.r�or ^:rhdivivon and Lot Nc)
DRILLING LOG
3.
OWNER C)IC.J�'%L'-'�{fl r`\lCf��
Firm To
Address p
%
,l l
�Irecl or,Culo o. 1---
_ rj'ry _.
City or Town State Zip Cndn---`---�--
4.
DATE DRILLED rE-ry-c0
----
5.
TOTAL DEPTH U--------,-
6.
CUTTINGS COLLECTED ESD NO(-,.}�
7.
DOES WELL REPLACE EXISTING WELL? YES L NOL>/
S.
STATIC WATER LEVEL Below Top of Casing: qo FT.
_
(Use'.' if Above Top of Casing)
9.
TOP OF CASING IS ( FT. Above Land Surface*
'Top of easing terminated atlor below land surface requires a variance In actor
dance
10.
with 15A NCAC 2C.01]8
YIELD (gpm): a. METyHOD OF TEST S )c-�)
11.
WATER ZONES (depth):
12. CHLORINATION: Type : �cB I NE. _ Amount
13. CASING:
Wall Thickness
Depth Diamt;ler or WCIghUF, b!almri:d
From To L`= Ft. �b�8 4 /g �_K_
From To Ft.
From To Ft.
14. GROUT:
Depth Material I.1nlhnd
From To 120 Ft. C-eineN kii
From To Ft.
15. SCREEN:
Depth
From To_
From To _
From To _
16. SAND/GRAVEL PACK:
17
Depth
From To.
From To
Diameter Slot Size Material
Ft in. in
Ft. in. in.
Fl. in. in.
Ft.
Ft.
Size MalnliAI
DEPTH
Formation Description
6t9i4ii-f . ofe—
II additional space is needed use back of form
O
LOCATION SKETCH
rI
(:,how direction and distance from al least tw"tale
L; `,;
Roads, or other map reference points)
lD
:-r1
�
r=o
CJ7
--r
sD
o
100 HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY 9F THIS RECORD HAS S EFN PROVIDED TO THE WELL OWNER.
FOR OFFICE USE ONLY
Quad No:
Sedal No.
i O - -/- cX
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit original to Division of Water Duality, Groundwater Seclicn within 30 days
GWA REV. 12199