Bk CY2001

250804
WELL CONSTRUCTION RECORD'
Nest Carolina -Department of Environment ant Natural Resources -Division of Waeer Quality - Groundwater Station
WELL CONTRACTOR (E'NIVIDUAL)NAMR (p',) Ta a 7343
wWMCONTRACIOR COMPANY NAME HICKORY WELL DRILLING CO. ,fun a (828i 324-0335
STATs WELL CONaTROCRONPERMITS ASSOCtAnD WQ PERMIT,
(Ifappliable) Ofaeelicable)
1. WEIL USE (Cheek Applicable Bootle Residential 1K Mmticipul/Publc U Industrial O Agricultural O
Monitoring ❑ Recovery 0 Heat Pump Water Injection U Other U If Other, List Use
2. WELL LOCATION: Hid(E
Nearest Town; HUJI N County
3955 MAR IN FISH F(N) BD.
(ButeN naNumbs.Catoid.8ebenia.ipNa.LpCode)
3. OWNER:_ XER IE HRNE
Address Z 1Th1 T TS PUNS FO Fig 412
POEM, NC (StteraraaateNe� 28603-3698
Gay or TOWN Slit 8ecutr
(828i- "a7-QAQR
AMataPSmeamber
4. DATE DRILLED 12-11-01
5. TOTAL DEPTH:_ 2()5
6. DOES WELL REPLACE E70StING WELL? YESANO O
7. STATIC WATER LEVEL Below Top ofCubic FT.
ma ritmeeaTepdOSd
8. TOP OF CASING IS 2 FT. Above Land Sm$ce'
nap deaths tendsew Mew lad a Commats
v.3) with uAMETHOD
9. YIELDIELD (gpmk OF TEST EY AIR I±Sl
10. WATER ZONES (depot):
11. DISINFECTION: Typo HFH TARS Amount 3)
12. CASING: WeI1 ilildoless
Dicers etWeightiFt Mtaedil
From O Two _ Ft, 612' FVC j3 ASPIC
Front,_ To Ft
From_ ToFe
13. GROUT: Depth Material d
From 0 To 23 pt. (RlJT
From To FL.
14. SCREEN: Depth Dinar Sint Sam menial
From Trt_ Ft, ..—„Ja. in.
From To Ft —in. in.
15. SAND/GRAVELPACT.:
Depth Sias Material
From To
Finat To
16 REMARK
Rik
i l! 2 € r2
A
Topographic/Land setting
[Midge ( o ank effentitte W Mkt
Laliladdlanittade of well location
(dam)
LadnideAmuckrade btu)
map(
REIM pRJL TNG LOG
From To Fonmsion Description
U
es
n
-n
LOCATION SKETCK Nrw
Show direction and distance in ndtaim
two State Rands or County Roads, lmclode We mad
numbers sad common road earn
T THIS WELL WAS CONSUL!
ANDTH TACOPYOF
ACCORDANCE WITH 15ANCAC2G WELL
RD HAS BEEN PROVIDED TO 7112 WELL OWNER
O1--02
SIGNATURE OF PERSON CMG THE WELL DATE
Malan of Water Quality, Groundwater Section, r636 Mail Smite Center -Raleigh, NC
EI C12 j': � p�(919) 224 within 30 days. OW-1 REV. 07/2001
ASH f: `'-

Ft.
FL
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
P.O. Box 29578 - Raleigh, N.C. 27626-0578-Pho e [phone]
WELL CONSTRUCTION RECORD DRILLING CONTRACTOR: 2
DRILLER REGISTRATION #. /// jZ /
5-0
STATE WELL CONSTRUCTION PERMIT#:
247755
1. WELL USE (Check Applicable Box): Residential I_:l" Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town• r r ` 0-1.44 0^' ICounty-
hl t7nAn. J L,. '' ts't�Qn..Jt 1
(Road, Com unity, or Subdivision and Lot No.) DEPTH
t
3. OWNER K From To
ADDRESS f q4' PArr s ou/,t,SXJOnd
(Street or Route No.) 6 — / ) o
City own Zip Code
4. DATE DRILLED I2 "2g'"01
5. TOTAL DEPTH 9 S'
6. CUTTINGS COLLECTED YES NOpr
7. DOES WELL REPLACE EXISTING WELL? YES ❑ NOr�
8. STATIC WATER LEVEL Below Top of Casing: (00 FT.
(Use'+• if Above Top ofCasing)
9. TOP OF CASING IS % FT. Above Land Surface'
Casing Terminated aVor below land surface is Illegal unless a variance is issued
in accordance with 15A NCAC 2C .0118
10. YIELD (gpm): 5 METHOD OF TEST fl I It
. 11. WATER ZONES (depth): f cj fl>Z1 & •JO
t-
DRILLING LOG
Formation Description
v
c.,`:
12. CHLORINATION: Type q.2*-4241- Z Amount ! 3 % E' cG If additional space is needed use bads$$ -for ri;
13. CASING:
Wall Thickness
Depth Diameter or Weight/FL Material
From /0 To /« Y Ft. to /Y. 410 l� �
From /c j To -70 S- FL G / 3 5 (wee
From To Ft
14. GROUT:
Depth Material Method
From To Ft / /} /j
From O To () Ft -4 9 / / �s'r-r'
15. SCREEN: -
Depth Diameter Slot Size Material
From To Ft in in
From To Ft. in in
From To Ft in in
16. SAND/GRAVEL PACK
Depth
From To
From To
17. REMARKS:
I DO HEREBY C
CONSTRUCTIO
Size Material
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other map reference points)
'SWELL WAS CO'FT51*UCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CORD HAS BEEN PROVIDED TO THE WELL OWNER.
THAT COPY OF
SECTION
.,C1 ,,.-EIGE
j I
( Ur `�vlri
TORE OF C OR AGENT DATE
original to Division of Water Quality and copy to well owner.
GW-t REV. 1U98

WELL CONSTRUCTION RECORD 2 4 5 4 4 5
North Carolina - Deporemeot of Tarriroomoatad Nord fille l • Dillies of'WSw Quality - Otamdwnler So
pppivuom-. NAME trod CLRnnaeTaaN R_____
WCONTRACI'Cil rxors a 1 35
waELLC«4 PAC OaCWQANYttwat many Tarn 1RTITTC CO
STATE WILL e= " 'HOC ED _
1. WELL USE (Omsk Applicable Boa): peddeadalC Matielpalifablifl MSS o a
Idesiitorlegp Recovery O Hat Pump Water *dies 0 Othn1 If Other, h the Usk
2. WELL LOCATION:
Nearest Tam& mato I
5321. PEA RIDE RD.
Cow BURK
Mast taew.tMbea.Oew+ert, mashies. LanaCr*
3.OWNERZ , !FAN 8,WfITTAM ATFORT. Histsa°aisda0rs11 mop
5171 WA RI1Y2' RIl Iaasaku)
Cow.Ra eN
KI ANifN IC 755 MIRTo Pa,metiatDowI eim
(a- 584-0995 abr
O.aa
Are win- Puna
12-07-01
4.D ups
S. TOTAL DEnt. x15 UI►�I i YEB NO O
6. DOES WEILREPLACE EXISTING
7. STATIC WATER LEVEL Below Top or Was `n fl
parr from Top etOeiod
8. TOP OF CASINO IS _2 Ft. Above Lod Swam
TopoinplielLind main
PRidge Mope Malley Mkt
iadieddloshack dwell babas
.Tap of des toes& seer bia. boa she .agar
,Ihai - rahMETHOD
O eire
OP TEST BY AIR 1IS1
9. YIELD i(gm)::
It WATER ZONES (dep&)
II. DISINFECTION: ypt» TARO Amami 54
12. CASING: WHIMidas
Feem_D 10 PD.yeraa gYV_IW_ l
lf
p 70 Ptt._ - -
Fla:—..-- Ta m —
13. GROUT: Depth Wald F
Praat_D 'to 2n n. CRCU
14. SCREEN: Depth Dimmer Sot She Medal
From To_._ Pt m. i6
Preen. --To— le. --is— is.
IS. SAND/GRAVEL
Size Simla
Prom To fl
Fro^ —To Ft
16. REMARKS:
Show tweaks ardl discs ist soaks born at iit
two Sea Eta orOoatyRoads. Winds the nod
■ aimsaadcommasmadaamea.
I DO HEREBY CERTIFY THAT THIS WEIL�yyWAS
CONSIRUCIlONSTANDARDS, ATIDTHA OF
as
SIONATURE�z OFPERSON COl18Tlt}iGiE�OTHS WEIL
of Water Qsaliq.GiaodwSMrSeeda ,1435Mail Sotto Paw - itakipb, NC
I.Wilda 30days OW-1 REV. 07/2001
m^r
1�Pt .
MAR 2002
WITH ISANCAC2G C
HAS R(MNTROND)BD TOMB W®L mina
12-18-01
DATE
TOTAL P.01
GROUNDWATER SECTION
ASHEVILLE REGIONAL OFFICE

WELL CONSTRUCTION RECORD
North Carolina -DapstSofEnviroaracet sod Noted Ra O or-DfvSotofWattQslit'-GroadwaterSection
WELL CONTRACTOR ENDWIDUAL) NAME trim)
WELLCONTRACTOS COMPANY NAME HICKW =Mt 0., mt.
ETATZ WELLQ PERMITS
icoNsuwaioN f 1aUPERMITStpplASSOCIATED wt►te
I. WELL USE (Check Applicable Box): Iteddeitialo Mtmidp>l/Publlc D IEdYgrW CI Agiculosal O
Monitoring O Recovery CI Hat Plop Water Ldectlan 0 Other O if OMx, List Use.
Topographic/Lad mein
Midge
CERrWttATION 0.
more s 8281 324-0035
245447
2. WELLLOCATIGN:__ ggyCE
N• % County
(aseMPret. -Ne. plyae divniattr.aprTW
3. OWNER. TRIPLE CREEK FARIVERIAN FE316I R
Addta+s WOO Nnitt T ai 1 PT)
(aastarPaSNSJ 2
SLay Tim Sas
Y 511211�5 a►a2861 1800
m amdrlrat
4. DATE DRJUZ -28-0 -
5. TOTAL monk WZadT YEWNO
6. DO&S WELL REPLACE870STINO
T. STATIC WATER LEVEL Below Top of C- "t
8. TOP OF CASINO IS 2 PT. Above Land Safhcea
*Ted slag onsbaW ster Wow hailads empire
YIELDWL
St USN. r.:410: aNb �ME�THOD OF TEST 1W AIR ITSI'
10. WATER ZONES (doplb
11. DWMFEC IOMTypal-RH TARS Anoat WI
12. CASING: + Wall Maas
iaiPt
eft! *add
P�,�45 W V.
Front_ To._ re
Frorn_ To.— FL
13.OROUT: Depth Material
Prom n T4-2i.--Rai fr
Prat__ To F`Oink, Slot She Maeda14. SCREEN: Depth
Prom --To Ft _ _in. m
Prow To— Ft---in-
IS. SAND/GRAVEL Na
Front_ To I
Fro^ --To Ft
Bet III
Front . To
Method
WiRFT)
tvrRla
.(ie&eprrprbrba0
• iadior dlaRgimde alma bran
Mena
Meagatag
Ponsationtesaiption
Seer d'RrtodaR and down la nella tarn at least
two Sta Roads re Can*/ Ewa Wide) the lad
_Den and est rood ante.
N
NOSY T�
y4o
e3A ROv
1� d N Diend-42
�T�av
•
16. REMARKS.
I DO HEREBY CERTIFY THAT MS WAIL WAS OONST
CONSTRUCTION STANDARDS, AND D COPY OF
J 7-cvrc)1
SIGNATURE OF PERSON cotaniugnie'n'M WELL DATE
of Water Quaky, Groundwater Saetan,1434 MW Sonia NC
I,within 30 days
MAR 2 7 2002
GROUNDWATER SECTION
ASHEVi.I_E REGIONAL OFFICE__
ACCORDANCE WITH ISANCAC 2C. WEL
NM BEEN PROVIDED TO THE WELL OWNER.
0
•
cn
z
TOTAL P.01

WELL CONSTRUCTION RECORD 245448
North Candles - Dynast of sStotault end Natal Ia-M•DivisionofWSlorQerp-Ocaoadw
ater Swaim
wnLCONDaACr01t ,�.� y��'�q�
Was. cor anwcrat .atavtwa urcww SEM DRILL1N CO.. K . none a asaGaa.r+r�o.+�
STA7f WILL CONSTIUCOON MOWN AWOCLITID WOE
MaplWble) it 1
1. WELL USE pie* Applicable H0x): RaidmtW if blisdelpalltello13 Ind -Anal Cl Edlivalvg a
Maaitot*a Reeovar Cl Heat Pomp Water tojeetlen0 Mit0 IfOther, UstM
2. WELLLOCATIrkaasam 1
*War twin
Soonoo aH.Moe. ora.b, "shako, uHoMP0 4
3. oomER:__WEEKT LEIW
M [1IIN WassQ NC 28655
-44.55
Au.ad.eatinsibw 11-29-01
4. DATE
S. TOTAL Data, 4�� +
6. DOES WELL REPIJICSB70S1'A'1CIWEL12 YEla
TV 0.
►. STATIC WATER LEVEL Below Top ofCasiai
Warr If Wawa Utol d
��
lens swan Ind
• 1• d bolos
padydardaani) soy
Na afi LVEllat
Pm To Pa
*Cob
& TOP OF CASINO IS 2 Ft. Above Led Sods*
nu, utd.a lanaleadaaMebabe Wad rase aMbna
.IN.aar.aaaeuaINS 154
9 YIELD OE* METHOD OF TEST BY ATR 7FSF
--.1—
la WATERZONEs (depth)
t1 D gLT1o1N:Typr Hill Iteb Ass by
it CASING: D: ar 'waradaas MANSFssat.. 0Depth 74 ! se WOK
PLASTIC
Fro ._ To F.
13. GROUP' Depth P A l<C1�
Prow d _r° p
F1'all--_Ts
14. SCREEN: Depth Sat at She Mmodal
From To Pt—.Ja. S.
Poem To-____ FL.__.da. is.
1S. SANDKiRAVELPACK: Si:e modalPmm Mob Pt
Prom _. —To— Ft
Paw Maed ard� Rom at least
two Ststa.Resis cc Cossay Rol a. bs:hia the ad
mambas and oases mad ]amen.
N
16. REMARKS;
DO HEREBY CERTIFY THAT THIS SILL WAS CONS1R ACCORDANCE MTH mANCAC 2C. WELL
0
to
C-
0
W
cCONSTRl1Cl70NSTANDARDS, AND THAT ACOPY OF •::y HAS BEEN 'PROVIDED lo naWM.OWNER
SI
MAR 2 7 2002
M NST 12-05 Ol
OF PARSON W '1'� WBLL DA7z
ofWaerQsaUt7,Ginamiwata Sad" 106Mall Semite Coster -RRASA NC 1
I. within 30dsya.
TOTAL P.01
GROUNDWATER SECTION
ASHEVILLE REGIONAL OFFICE

WELL CONSTRUCTION RECORD IA5451
NoeSOahu - dRavi:masa,yd MSSRams . Divide* atWan Quality -
Pili
win. coin,*craR dwW HI� %11L IItII1.It. m. a ttrm x�
WRLCONI tscroaconsmIY NAJI&
STATE WELL CtMY"f (WrIale) �
I. WELL USE (Check Applicable Box): Redden Meson °dtatial CI Ag StS D
Monieotisg 0 Recovery O Hat Pump Water *atlas Other 0 ItO ttr.T.Iat IToo
2. WILL LOCATION:
3.0
Address t. .
es°pdortfraam[Q�'N•� 22601
ace
•` 7,2732, ar.
moat me sae --
4. DATE DRIIL _
S. TOTAL T ant.
Llin
6vials t Y&4$d NO O
. DOES WE(I. REPLACEOUSTING FT.
T. STATIC WATER LEVEL Below Top ;Indio
(tarricseTupstadia
S. TOP OF CASING IS —PT. Above Lad StrNoes
.Tap .1rd.etrae••tdtar Mgr. SA .a, repine •
CRT*_Wing
OM
otv Ilea:Mio•
I��aany
n" LOG
DIM
From . To FotratloaDatdptiaa
spaP-a11: L t
9. YIELD (EMETHOD OP TEST BYAIR 1PSI
1E. WATER 21O14ES (daplk
U. DISINFECTIORrips MTH TARS Mat Eat
12. CASING: WaHTYdtrr
Dwelt Diameter erWdgl tt. Mataid
Ptu n To 117 -13L— ZOE-
Pr. To Pt
FL------Mood13.OROUt Depth Matarl
n,m ie_ a-. Ir
14. SCREEN: Thoth Diane Skit SS MSdd
Ftot ----Ta Ft,--- Ia• is
Proca Tn_ Ft. -it► is
IS. SAND/GRAVEL
PamR_ To E
From_ To Ft.
16. /I MARS;
e DO IOTRENT CERTIFY THAT TieS WELL WAS CONSTRUCTED ,.,.
n a.
s,eiet""- 11-2R-D1
SIGNATURE OF PERSON CONS WEIL DATE
Sabath Mt wtstar
30 Quail .Girard+eaMrBettlay14nnWSmIseCedar- NC
days.
CONSTRUCTION STANDARDS, AND THAT ACOPY OF
West d'rotdoeaid ablate intik, tom at least
twoSmta.Raaie ar Coady Roads. Mkt the toad
aterbtet sal eoe=toad amen
�s qo
bilW LV
-o
MA
U
7 7002 L.)
GROOUNDWATER SECT
ASHEVILLE REGIONAL OFP,CE
W11B 1SANCAC2G WELL
HAS WEN 1 OWDED TOTER WE1J.owNER
TOTAL P.01

245410
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and NKr
(terurces--piivision of Water Quality - Groundwater Section
7
WELL CONTRACTOR (D'1DIVIDUAL) NAME halm//S!//9 !' e ie- Lncia1CATION/ oG
WELL CONTRACTOR COMPANY NAME fine re -ex c-//,9r'i/h - PHONE I f )
STATE WELL CONSTRUCTION PERMIT/ ASSOCIATED WQ PERMIT)/
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential EI MunicipaUPublic ❑ Industrial 0 Agricultural ❑
Monitoring ❑ Recovery d Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELLLOCAT!O);[
Nearest Town: / tr, ot4 Tan.
County A/'! r ,e
(Street Name.Numbers. Community, Subdivision, Lot No., Zip Code)
3. OWNER:..,/ e4v smut.(
Address SS°T ;(f r 1' in R.l
ArcOlviif Z ) ""A vas'
City or Town Sale Zip Code
ANS 0040- Phato amber
4. DATE DRILLED l" �!
5. TOTAL DEPTH:
6. DOES WELL REPLACE EXISTING WELL? YES NO 0
7. STATIC WATER LEVEL Below Top of Casing.
(Use'*" if Above Top of Casing)
8. TOP OF CASING IS _ ___ __ FT. Above Land Surface•
'Top of casing tertnlaated PYor below land surface requires e
variance In actotdeneezj{615A NCAC 2C .0118. /
9. YIELD (gpm): ' / METHOD ff ��F TES /9j /P / i'1'f"
10. WATER ZONES (depth). / XS
11. DISINFECTION: Type %/%W Amount -Seo.z
12. CASING: r7� D�. Wall Thickness
FromTDo / Fk 4J'8 VOW )'l/2
th
From_ To Ft.
From_ To Fk
13. GRFrom 0 Depth Material
From_ n To r2 / Ft. C &Owl'f -
From To Ft
14. SCREEN: Depth Diameter Slot Size Material
Frown To in.
From To Fkan. in
15. SAND/GRAVEL PACK
Depth Size Material
Prom To Ft.
From TO Ft
Method
dur
Topographic/Land setting
❑Ridge ❑Slope ❑Valley o rat
(check appropriate hem
Latitude/longitude of well location
(dcarw./mimaca/sewnds)
Latitude/longitude source:❑GPS❑Topogimpbic soap
(week box)
DEPTH DRILLING LOG
From ToC.P° lion De elipt{on
--zoo Ch nitFv
0
tV
r
C,
n
Un
•
r
J.004TIONSKETCH . n=
Show direction and distance in miles from atCCast n
two State Roads or County Roads. Include
numbers and common road names.
/M:
Ay Glite./%I
� r igei #J11 'Lt,l-
o 5/t dr Ad
16. REMARKS:
1 DO HERESY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 1 SA NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND T A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
Submit the o
27699-1636 Ph
,rre r eTY�Ji.—�
:1r1. 1;ire• 11. NCO ...
o the Ph'lslon. of Water
(919)(733-3221i *11,030
•
UCTINO THE WELL
DATE
Groundwater Section, 1636 Mali Service Center -Raleigh, NC
GW-1 REV. 07/2001
erou�DV;r' a SEMiciv!
r rrEr�
SSd Wd0E:9!i ZellbelitLfWer _ cC E9bbBL : 'ON XUd dWfld '8 1-131 Z13bOW : WOJd

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mail Service Center - Raleigh, N.C. 27699-1636-Phone [phone]
WELL CONSTRUCTION RECORD
WELL CONTRACTOR -
WELL CONTRACTOR CERTIFICATION S: e2 %W7'
STATE WELL CONSTRUCTION PERMITS:
246056
SweetWater Well Drilling & Pump Service, Inc.
1. WELL USE (tack Appiobls than: Residential ® Municipal ❑ Industrial 0 Agricultural ❑ Monitoring ❑
Recovery 0 Heat Pump Water Injection 0 Other If Other, List Use:
2. WELL LOCATIONsketch
Nearest T
w)
county,
(Road Name MS . Cwmaey, or eutavision and to Na.) DRILLING LOG
DEPTH
3. OWNER . C . L. htifl ei c9� From To FomaWonDemotion
Addresshi
jv 1 _el?
No.l
70auwrares Krr.
4. DATE DRILLED
5. TOTAL DEPTH T
6. CUTTINGS COLLECTED YES ❑ No El
7. DOES WELL REPLACE EXISTING W914 YES ❑ NOR
8. STATIC WATER LEVEL Below Top of Cuing: /n FT.
(Use •+• a Move Top S Cuing)
9. TOP OF CASING IS Lc- FT Above Land Surface'
•Topof away W46ueae War below Sod sarfaoa respires a stenos in scoot -
dents with 15A NCAC 2C MU10- YIELD (gpm): t/010— METHOD OF TEST o
11. WATER ZONES (depth). ro�.t Alp )
a gars
219 Code
12. CHLORINATION: Type Amount Aa,
13. CASING:
m
ti additional apace Is needed use b&Ok of loan
ATION SKETCH
Diameterte
Well Ttidvrea (Show direction distance from et at two State
From D DTo epthCPO Ft 4! y ry ud Roads, or map Serra paws)
From To Ft. 0
From To Ft
14. GROUT:
From
Ahthod
Togo Ft. a Ijit4rdL1
From To Ft
15. SCREEN:
Depth Diameter Slot Size
From To in
From To/In.
From To ` Ft.
16. SAND/GRAVEL PACK
Depth
From To FL
From / To / FL
17. R
IDO
a_JJ •L
GROUNDWAT R SECTI
ASHEVILLE RECIONAL OFFICE
fr Act
ficrJSt 1
SIGNATURE OF PERSON •• t "'WELL DATE
to Division of Water ouaay, Gra hater Section within 30 days
nw-r REV. 12.10S

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]
243898
WELL CONSTRUCTION RECORD WELL CONTRACTOR. Pr;Cr Wl)ri ll ins Inc
WELL CONTRACTOR CERTIFICATION #: 3 c o
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE (Check Applicable Sox): Residential ® Municipal ❑ Industrial ❑ Agricultural 0 Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other 0 If Other, List Use:
2. WELL LOCATION: (Show sketch of the locon below) �/�1{ J�
Nearest Town: ('0 vs, Ise 1�1/�f (SJ.vrr County' r✓ uric-.
i Il ..
33yk G,1-, _ a
(Road Name and Numbers. Community. or Subdivision and Lot No.)
3. OWNER 7/mY.1c VA/) Hegel
Address
33if G,LtNLi, ,cYOI
(Street or Route o.)
CcnnC L.t-11, SPa5_ f1.0
City or Town Stall
4. DATE DRILLED i-f7-o!
5:--TOTAL DEPTH 5 S
6. CUTTINGS COLLECTED YES NO®
7. DOES WELL REPLACE EXISTING WELL? YES IT NOD
8. STATIC WATER LEVEL Below Top of Casing: FT.
( (Use': if Above Top of Casing)
9. TOP OF CASING IS I �fos FT. Above Land Surface'
'Top of casing terminated at/or below land surface requires a variance In actor -
dance with 15A NCAC 2C .0115 /f._ ,7
10. YIELD (gpm): METHOD OF TEST
11. WATER ZONES (
Zip Code
DRILLING LOG
From To
0 95
95 MOcv
)00 3oa
:?co 35ser
12. CHLORINATION: Type
13. CASING:
flora, Amount 49.42-/—
Wall Thickness
kMaterial
From To
Depth 9 5-Ft Di/MOW_ 6 «A ! y P vc
From To Ft
From To Ft
14. GROUT:
Depth Material Method aFrom 0 To �Ft _C 0ALr'}e Pvve d ci
From To Ft
15. SCREEN:
Depth Diameter Slot Size Material
From To Ft in in
From To Ft in
From To Ft in
16. SAND/GRAVEL PACK:
Depth Size
From To Ft.
From
17. REMARKS:
To Ft
in
In
Material
DEPTH
?r pnV Description
r
O
t� c)
rrl
cr'
,'
N cni
rn
rn
If additional space is needed use back of fon n
LOCATION SKETCH
(Show direction and distance from at least two State
Roads o other map reference points)
6ocr3e cdectalth5c O,
O
wet
I DO HEREBY
CONSTRUCT'
FOR OFFICE U
Quad No:
Serial No.
DARDS, AND THAT A CO4CIE
2032 0
UCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
IS 91C0 HAS BEEN PROVIDED TO THE WELL OWNER.
/1-00-0
RE OF PERSON CONSTRUCTING THE WELL DATE
on of Water Quality. Groundwater Section within 30 days
GW1 REV. 12/99

North Carolina • Department of Environment and Natural Resources • Division of Water Quality • Groundwater Section
1636 Mail Service Center • Raleigh, N.C. 27699-1636-Phone [phone]
243899
WELL CONSTRUCTION RECORD WELL CONTRACTOR. / /Ce, 11-4 // f�r t tI /S Ln e
WELL CONTRACTOR CERTIFICATION #: 30� J
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE (Check Applicable sex): Residential laMunicipal IDIndustrial IDAgr cultural ID Monitoring ❑
Recovery ID Heat Pump Water Injection 0 Other ❑ If Other, List Use:
(Ike
3. OWN
AddresslC 9
( onne Iv c-pil/I IU, C,` D-236I'
City or To State Zip Code
4. DATE DRILLED k _o
5. TOTAL DEPTH 0 4- F1-
6. CUTTINGS COLLECTED YES El NO©
7. DOES WELL REPLACE EXISTING WELL? YES Q NOD
8. STATIC WATER LEVEL Below Top of Casing: T o FT.
(Use N. if Above Top of Casing)
9. TOP OF CASING IS � fc. FT. Above Land Surface'
'Top of casing terminated at/or below land surface requires a variance In eccor-
danee with ISA NCAC 2C.0 1a ,1 n /
10. YIELD (gpm): r1 METHOD OF TEST Arr13/Cuff
11. WATER ZONES (depth)*
2. WELL LOCATION: (Show sketch of the location below) /�S1
Nearest Town: Co n ne I)/ �f C itt9c County ✓Z1� K
home " Roo
d Name dA Nunte , Community, or Subdivision and Lot No.)
ER ►)9 v ICY CO rl (!nail
DRILLING LOG DEPTH
From To Formation Description
CD too e;r 1- OC%�
/00 ;JOo gran'
;7.Qn .30o ClLi hi 4-Y'
c l ney Rd
Street or outs No.)
12. CHLORINATION: Type f 11 Or-0X
13. CASING:
Amount o9gtcI
Was Thickness
Depth Diameter orweghVFt. t dal
From ( To f0U Ft._6 Vti �VC
From To Ft
From To Ft
14. GROUT:
Depth Material. ethod
From (1 To a0 Ft Cancte4C- /-
From To Ft
15. SCREEN:
Depth
From To _ Ft in
From To Ft in
From To Ft In
16. SAND/GRAVEL PACK:
Depth Size
From
From
17. REMARK
I DO HER
CONSTRU
Diameter Slot Size Material
in
in
In
To Ft.
To Ft
Material
f®"II II
$ERTWrTHAT?IIIS-WEL WxS
It! STANDARDS, AND THAT A a
2L 7 CIE
(Show direction and distance from at least two State
oath, or other map reference points)
#9 ra vi 1lic 0
c
v 5m
rn
C7 cr'
ni
o<
Do
cn
tV
mi
C,
If additional space is needed use back of form
LOCATION SKETCH
CI-b r (�
STRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
OF THIS HAS BEEN PROVIDED TO THE WELL OWNER.
a
NATURE OF PERSON CONSTRUCTING THE WELL
i Division of Water Duality. Gmundwater Salon within 30 days
GW-1 REV. 12f99
H -06--01
DATE
krS•

North Carolina - Department of Environment and Natural Resources - Division of Water Quality • Groundwater Section
1636 Mail Service Center - Raleigh, N.C. 27699-1636-Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR* �r([C �e(I nrr(I n9 .Zinc
WELL CONTRACTOR CERTIFICATION is :90.a
243900
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE (Check Applicable Box): Residential DO Municipal ❑ Industrial ❑ Agricultural El Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATION: ()Shpw sketch of the location below)
Nearest Town: V A 1 tie 5c- County vrkC-
City or Town Stale
4. DATE DRILLED /1- a/ O
5. TOTAL DEPTH S/brzi
6. CUTTINGS COLLECTED YES ❑ NO®
7. DOES WELL REPLACE EXISTING WELL? YES j}7j NOE
8. STATIC WATER LEVEL Below Top of Casing: j¶ FT.
t (Use': a Above Top of Casing)
9. TOP OF CASING IS I J FT Above Land Surface'
Top of casing terminated at/or below land surface requires a variance In accor-
dance with 15A NCAC 2C .a
10. YIELD (gpm): / 0 METHOD OF TEST t
11. WATER ZONES (depth)*
DRILLING LOG
From To
Q ,1A
3a a4OO
aocc r'©o
-24.0 ye0
(Road Name and Numbers, mmunity, oru Lo sign and No.)
3. OWNER W fi)et%L %rS-a,qk-/A-1
Address
(
„4 (street or Route No.) 7g6,70
ass All
Zip Code
12. CHLORINATION: Type
13. CASING:
Depth
From C To 3 a -
Amount
Wag Thickness
Diameter or W ' h
Ft __
From To Ft
From To Ft a0
14. GROUT: `'
Depth Material M�r1ethod �k 'Y
From aTo a� Ft 00 iicre(C VC UIe4 1'
From To Ft
15. SCREEN:
DEPTH
Formation Description
•
tV —�
Dc
• M�
ram
rnz
mz
N
If additional apace is needed use back of form w z
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other map reference points)
Depth Diameter Slot Size
From To _ Ft in in
From To Ft in In
From To Ft. in in
16. SAND/GRAVEL PACK:
Depth Size Material
To Ft
To Ft
From —
From
17. REMARKS:
I DO HEREBY C I Ai TYNS WELL WAS CQMiTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION `4EIDARDS, AND THAT A CQPY (*PITHIS RECORD M AS BEEN PROVIDED TO THE WELL OWNER.
I I
!]II i _ �l
FOR OFFICE USi3 goof !,a<..
Quad No: SfC3NATURE OF PERSON CONSTRUCTING THE WELL DATE
L Submt origi�i al to Division of Water Quality, Groundwater Section within 30 days
GW-1 REV. 129E
Soda' No. if J D. ' r(:;IC"1
ASH J�i_LC GI vAL CFTIC,
it-
ar

C]
2J'
IT1 0r
a � ..i
N --tr.,
➢L
am
0
UI 0
., I.
0
If additional space is needed use back of form
LOCATION SKETCH
Depth ' Diameter or vWaiOVR. Material (Show direction and distance from at least two State
From J To J Ft jF (•, Rods, or other map reference points)
From To Ft
From To Ft
14. GROUT:
Depth Material Method / l
From 0 To - 0 Ft C,n(rd? Pau red /N'
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 Size Material
From To _ ,_ Ft
From To Ft
17. REMARKS:
II:I—
I DO HEREBY. R FYTH% __L- 1„,
WELL WAS
CONSTRUCTIO ANDARDS, AND THAT A C
North Carolina • Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section 243901
1636 Mail Service Center - Raleigh, N.C. 27699-1636-Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR. / / / to LJp1i! 6` I i n
WELL CONTRACTOR CERTIFICATION #: 13(1-9,0
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE (Chock Applicable Box): Residential Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other If Other, List Use:
2. WELL LOCATION/ (Spoinr sketch of the location below) County
�U /C�
Nearest Town: /n �� Tr
(Road Name/and Numoe . Communniityor Subdivision and Lot No.) DRILLING LOG DEPTH
3. OWNER CYO % , ✓7of I I. r>— From
Address • r)
(Street or out No.)
aLfleSS Rc��
City or Town Stale
4. DATE DRILLED // b 2- - o /
5. TOTAL DEPTH
6. CUTTINGS COLLECTED YES Q NO�
7. DOES WELL REPLACE EXISTING WELL? YES Ej NOE
8. STATIC WATER LEVEL Below Top of Casing: FT.
(use •: If Above Top of Casing)
9. TOP OF CASING IS� a FT Above Land Surface'
'Top of casing terminated =Vor below land surface requires a variance In accor-
dance with 15A NCAC 115 �I (
10. YIELD (gpm): METHOD OF TEST Ai ( O,., in.
11. WATER ZONES (depth)•
Tom" Formation Description
.) (?,4�4 ( r-0,0
c9(1;'c)-O
Zip Code
12. CHLORINATION: Type Cine nz Amount Q 1
13. CASING: C)
Wail Thickness
UCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
THIS O HAS BEEN PROVIDED TO THE WELL OWNER.
FOR OFFICE USE QIVLY P° 7002, / Y(`
a�iI
DATE
Quad No:
SIGNA E OF PERSON CONSTRUCTING THE WELL
L Submit original to Division of Water Quality, Groundwater within 30 days
GW-1 REV. 12/99

90
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]
Jr Tv
G
WELL CONSTRUCTION RECORD WELL CONTRACTOR ��� 'elll�112 � 32
WELL CONTRACTOR TIFICATION #: / 5
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE (Check Applicable Box): Residential Municipal ❑ Industrial ❑ Agricultural El Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other If Other. List Use:
2. WELL LOCATION: Show sketch of the location below)
Nearest Town:Pr/ County:
69
(Road Name and Numbers. Community. or Subdivision and Lot No.)
3. OWNER y
Address
(Street or Route p.)
/7^ )
City or Town Stale Zip Code
4. DATE DRILLED 9/f570'
5. TOTAL DEPTH �f r 55—
w, 5�
6. CUTTINGS COLLECTED YES ❑ NO —
7. DOES WELL REPLACE EXISTING WELL? YES ❑ NO[ 9-
8. STATIC WATER LEVEL Below Top of Casing: 3) FT.
(Use . it Above Top of Casing)
9. TOP OF CASING IS ` FT. Above Land Surface'
'Top of casing terminated at/or below land surface requires a variance In accor-
dance with 15A NCAC 2C .0118
I D. YIELD (gpm): _el_ METHOD OF TEST /IC
ti
11. WATER ZONES (depth)- /e6,177e c
12. CHLORINATION: Type e -aye Amount es additional space is needed use back of form
DRILLING LOG DEPTH
From To Formation Description
,s-
n
c') c9
czN
oc.
orn
CJ (1'
C.n
IV o
13. CASING:
t
Wall Thickness LOCATION SKETCH
Depth Diameter or Weight/Ft. Material (Show direction and distance from at least two State
From To Ft Roads, or other map reterence points)
From O To 0 3 Ft. / U
From To Ft
14. GROUT:
Depth Material Method
From T. Ft /
From () To Ft r �� ��
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 r^-., to II , ,FII
17. REMARK i' 1 11
I DO HER
CONSTRI
ERTIFY THAT THIS WELL WAS NSTRU TED CCORDANCE WITH 15A NCAC 2C, WELL
N STANDARDS, AND THAT 0,11CO Y OF $IS B6RD HAS BEFP{ PROVI9ED TO THE WELL OWNER.
FOR OFFICE USE ONLY
Quad No:
Serial No
IGNAE OF PERSbN UCTING THE WELL GATE
Submit origin to Division of Water Oualit mundwater 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.
010693 WELL CONTRACTOR CERTIFICATION #•
STATE WELL CONSTRUCTION PERMIT#• biers Peat_
WELL USE (Check Applicable Box): Residential 0 Municipal 0 Industrial 0 Agricultural 0
Recovery 0 Heat Pump Water Injection I I Other I If Other, List Use•
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: PINEOLA County- BURKE
JOE PORE RD. OFF 'HVI',( 181
(fload Name and Numbers, Community, or Subdivision and Lot No.)
3. OWNER HAROLD FRA;NKLIN
4.
5.
6.
7.
8.
Address P.O. BOX 56 ,
JONAS RIbLnF°r Route No.) NC 286.11
City or Town State
DATE DRILLED 10/31/2001
TOTAL DEPTH 205
CUTTINGS COLLECTED YES 0 NO 0 187 205
DOES WELL REPLACE EXISTING WELL? YES I I NO El
STATIC WATER LEVEL Below Top of Casing: 60 FT
(Use "+" if Above Top of Casing)
Zip Code
Monitoring
DRILLING LOG DEPTH
From To Formation Description
0 105 DIRT
105 170 GRANITE
170 171 QUARTZ
171 186 GRANITE
18e 187 QUARTZ
GRANITE
c
O
9. TOP OF CASING IS 1 FT Above Land Surface*
Top of casing terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2C.0118
10. YIELD (gpm)• 2 METHOD OF TEST Air
11. WATER ZONES (depth)•'1 ppm 170-171 1 porn 186-187
0 clprn 0 ppm
O pnt
zm
CD cm
=rrt
12. CHLORINATION: Type HTH Amount 30
13. CASING:
Depth Diameter
From 0 To 11f'Ft 61/d
From To Ft
From To Ft
14. GROUT:
Wall Thickness
or Weight/Ft.
350
Depth Material
From 0 To 20 Ft '1emant
From To Ft
15. SCREEN:
Depth
From To Ft in in
16. SAND/GRACK:
epthr Size
To Ft
to
17. REMARKS AS -_—
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit original to Division of Water Quality, Groundwater Section within 30 days
GW-1 REV. 12/99
From
From
Diameter Slot Size
26d1
If additional space is needed use Etk ofrow1
cJ7 —4
CO
LOCATION SKETCH z
Material (Show direction and distance from at least two State
PV'C Roads, or other map reference points)
Method
`low,
Material
FOR OFFICE USE ONLY
Quad No.
Serial No

FROM : MORETZ WELL & PUMP
FAX NO. : 7044621322 Dec. 03 2001 07:56AM P13
13. GROUT:
Depth �.[� serial ti ode_Ft
From To Ft.
14. SCREEN:
Depth Diameter Slot Size Material
From To Ft in.
From To Ft. in.
From To Ft. in.
in
in
in
North Carolina Department of Environment & Natural Resources
Division of Water Quality - Groundwater Section
1636 Mail Service Center
Raleigh, NC 27699-1636 Phone: (919) 7IS-0295
WELL CONSTRUCTION RECORD DRILLING CONTRACTOR: MOte t- &el/
STATE %/ELK
STATE WEL
242706
FOR OFFICE USE ONLY
QUAD. NO. SERIAL NO.
Wt Long. RO.
Mhwr Basin
Basin Code
Header Ent. GW-I Ent.
CONSTRUCTION /�/�
DRILLER CERTIFICATION NUMBER:02 ��y/� b to PERMIT NUMBER: ,!/I//
I. WELL LOCATIO`y
` Show sketch of the location bclo
Nearest Town:.. C tf,,/ County: rCJGI /`it
DEPTH
(Road,&om unity, or Subdjyision and Lot No.) From To
2. OWNER (C �/ ¢r ( S 4A- D /' �} / /
ADDRESS / J Street or Route No.) / C F1 /d vof — t. / r C/0 �� .SiA /3 fOh c_
City or Town State z-p Code
3. DATE DRILLEW'& J' D USE OF WELL
4. TOTAL DEPTH 3
S. CUTTINGS COLLECTED YES 0 NO IL37-//
6- DOES WELL REPLACE EXISTING WELL? YES 13'NO C
7. STATIC WATER LEVEL Below Top of Casing: 51-5— FT.
(Use +- if Above Top of Casing)
8. TOP OF CASING IS / FT- Above Land Surface*
'Casino Terminated at1or below land surface is illegal unless a variance is issued
in accordance with ISteNCAC 2C .0118 QQ
9. YIELD (gym): /,� METH^77ODrI1OF TEST ..-'9 f'
10. WATER ZONES (depth): rnt�eo •
DRILLING LOQ
Formation Description
62-- Tbc' - 6tt/6TL
fTi p^
f'Y c
I �-
ca r-
a
tn.i
7 0-
0
11. CHLORINATION: Type%/ 7, Amount 7 n 7 If additional space is needed use back of form
t .CASING:
Wall Thickness
•Fromf To
r7 ?pyseter OFF bt/Ft. N er)al
�� is 1 Ft. YY ?//r+�l / �'fi!'�
From To Ft. LOCATION SKETCH
From To Ft (Show direction and distance from at least two State
Rands, or other map reference points'
is. SAND/GRAVEL PACK:
Depth Size Mater 1i".,'i
From To Ft.
From To Ft.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORI)AN - 5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
e' ' y' 2b 1-cy
GW-1 REV. 11/99
C/PaZ "el
/O-027-
o/
SIGNATURE OF CONTRACTOR R AGENT DATE
Submit original to Division of Water Quality and a copy to well owner.

243918-
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- Price Wrf/ 0f't'n1l&QTTN
WELL CONTRACTOR CERTIFICATION #: 3 GOO
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE (Check Applicable aox): Residential Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heal Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATIOM: (Show,s%etch of the location below) [] K
u r /c
Nearest Town: tlrnryK WE" County U
(Road Name and Numbers, Community, or Subdivision and Lot No.) DRILLING LOG
3. OWNER RAGhF _ LcWn'tEAJ
Address ? 70 5 ro..t-ni)'V L a ,U £ tRCI
(street or Route o.)
nit,ckapq tJc ao o.3
City or Town State Zip Code
4. DATE DRILLED /0-00-0 f
5. TOTAL DEPTH ROC
6. CUTTINGS COLLECTED YES NO®
7. DOES WELL REPLACE EXISTING WELL? YES f NOE
8. STATIC WATER LEVEL Below Top of Casing: I FT.
l
9. TOP OF CASING IS 1 /✓ (Casing)
FT Above LandSurface'
'Top of casing terminated at/or below land surface requires a variance In accor-
dance with 15A NCAC 2C .0118 - 1/OW n
10. YIELD (gpm): ii 0 METHOD OF TEST , /
11. WATER ZONES (depth):
From To
0 a
c .100
416300 evti 5
DEPTH
Formation DescdptioR
c -t2(n t
ECEI ED 11
s r.
r-
MAR 0 8 2002'
NCDEpT nc rn
A AND NATURACu o(IpuNT1:5 „ rn
t, RF^vkYrAL D";'TLL- N
aV —
12. CHLORINATION: Type i - .-e I --Amount agga--4
13. CASING:
Wall Tnidwu
Depth Diameter or Weight/Ft. paM,
From n To 01, Ft --L-- `Pi
From To Ft
From To Ft
14. GROUT:
Depth MataLit �,,_p�,lethcd
From 0 To a0 Ft r-� �` a ��1
From To Ft
15. SCREEN:
Depth Diameter Slot Size
From To Ft _ in
From To Ft in
From To _ FL— in
16. SAND/GRAVEL PACK:
Depth Size Material
To Ft
To Ft
From
From
17. REMARKS:
I DO HEF
CONSTR
FOR OFFI
Quad No:
Sedal No.
Material
in
in
_ In
If additional space is needed use back of formZ
LOCATION SKETCH
(Show direction and distance from at least two State
E ONLY
MAR 12 axe
)NSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
PY OF THIS RECORQ HAS BJEN PROVIDED TO THE WELL OWNER.
'-moo-01_
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
nal to Division of Water Quality. Groundwaleisection withlri 30 days
GW-1 REV. 12/99
GROUNDWATER SECTION
ASHEVILLE REGIONAL OFFICE

North Carolina • Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mail Service Center • Raleigh, N.C. 27699-1636-Phone [phone] WELL CONSTRUCTION RECORD WELL CONTRACTOR. ` p rircW/e// Orr' I //n9 . nc
WELL CONTRACTOR CERTIFICATION a: .i0ot0
STATE WELL CONSTRUCTION PERMITa:
243911
1. WELL USE (Check Applicable Box): Residential ® Municipal ❑ Industrial El Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATION: n /�u (Show skgtch of the location below) l..
Nearest Tow--/Y�' ((�% County. L-C
(Road Name pod Numbers, Community. or Subdivision and Lot No.)
3. OWNER J )Cf to C5les
Address
c ^ ^ (Street or Route o.)
City or Town State
4. 4. DATE DRILLED O i
5. TOTAL DEPTH /
6. CUTTINGS COLLECTED YES ❑ NOZJ
7. DOES WELL REPLACE EXISTING WELL? YES NOE
8. STATIC WATER LEVEL Below Top of Casing: FT.
(Use -« a Above Top of Casing)
9. TOP OF CASING IS ( 1/3" FT. Above Land Surface'
'Top of casing terminated at/or below land surface requires a variance In /I� r accor-
dance with 16A NCAC 2C .0116
10. YIELD (gpm): J0 0 METHOD OF TEST / 7 . )Q l/0�
11. WATER ZONES (depth).
DRILLING LOG
From To
b -70
/ So Or -a n r'4C-
Zip Code
12. CHLORINATION. Type We m/(1 Amount
13. CASING:
ayra Wall Thickness f.}a }yl
Depth Direr
(v r «E�(r/ 1Vl!`
From To �� Ft.
From To Ft.
From To Ft
14. GROUT:
Depth Material/ (N'1�t% Q�
From 0 To 'f O Ft 00 rre_reC T uhod a
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
17. REMARKS:
1 DO HEREB
CONSTRUC
FOR OFFICE
Quad No:
•
•
Slot Size
\11 is,
NR
IFY THAT THIS W,SWW
TAN QS.-AbjO YONr A
SE • NLY
GROUN
i
WFTER SECTI0
- RFCbON$bbiirlthi
Material
in
in
In
Material
�l tl
ii It
SIG
DEPTH
Formation De Jripticmi.
pt 4 ciRcc -
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)
-o
Cu
N
N
TRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
F THItRECO; O H: EEN PROVIDED TO THE WELL OWNER.
-a
TURE OF PERSON CONSTRUCTING THE WELL DATE
on of Water Quality. Groundwater Section within 30 days GW1 REV. 12/99
Serial No

243912
North Carolina • Department al Environment and Natural Resources - Division of Water Duality • Groundwater Section
1636 Mail Service Center • Raleigh, N.C. 27699-1636-Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR• ice 1detl O h ){ 1
WELL CONTRACTOR CERTIFICATION S: 30a 40
STATE WELL CONSTRUCTION PERMITS:
1. WELL USE (Check Applicable Box): ResIdentialrY Municipal ❑ Industrial ❑
Recovery ❑ Heat Pump Water Injectio❑ Other ❑ If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: % c7 p1 t5 E'c w tat County
,St 1()Pr S-(ra-
Q ur-xr
Agricultural ❑ Monitoring ❑
(Road Name and Number, Community, or Subdivision and Lot No.) DRILLING LOG DEPTH
3. OWNER „ cul-h'r-n 5kotar+ct'C f.}O111E-5 From To Fomu'onDDeesuiPUo
Address n 70 �r rt'� Ort
n70 �6a Ertznt c
/! �(Street or Rout No.)
L /001C^y'/oWr1 /t/. C•
4. DATE DRILLED
5. TOTAL DEPTH
6. CUTTINGS COLLECTED YES ❑ NO,
7. DOES WELL REPLACE EXISTING WELL? YES NOIZ
8. STATIC WATER LEVEL Below Top of Casing: FT.
/ (Use N. If Above Top of Casing)
9. TOP OF CASING IS / A FT Above Land Surface'
lop of casing terminated allor below land surface requires a variance In actor -
dance with 15A NCAC 2C .,0115
10. YIELD (gpm): 7 METHOD OF TEST / r i�/8wr'1
11. WATER ZONES (depth)'
Zip Code
act 6ranr
Soo `�'`3O GP7elt}
City or Town State
36 6 I
12. CHLORINATION: Type Cca!
13. CASING:
Amount `61g A I
Wall Thickness
Depth Diameter or Weight/A. 1,,
Z0— From 0 To - Ft �— i
From To Ft.
From To Ft
14. GROUT:
Depth Material
From O To • 0 Ft C©rter r-4r
From To Ft
15. SCREEN:
Depth
From To
Diameter
Ft _ In
From To Ft. in
From __To_Ft. _ In
16. SAND/GRAVEL PACK:
From
From
17. REMARKS:
I DO HEREB
CONSTRUC
Depth
To Ft
To Ft
.JIB .WF• ER
d*I 1 E RlLCIONAL OFFICE
(-Method
Slot Size Material
in
in
In
vi
Material
If additional space la needed use back of form
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other map ref e nce points)
41✓t (1
S
5r
co
ry
UCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
THIS RECORD ; AS BEEN PROVIDED TO THE WELL OWNER.
0-026_
TORE OF PERSON CONSTRUCTING THE WELL GATE
n of Water Quality, Groundwater Section within 30 days
GW-I REV. 12/99

2. WELL LOCATION: (Show sketch of the location below)
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• T HCr Via i/ L9r`, Jf,t? ]r'1c
WELL CONTRACTOR CERTIFICATION It: "MOO n
STATE WELL CONSTRUCTION PERMITS:
1. WELL USE (Check Applicable eo■): Residential Municipal ElIndustrial ElAgricultural ElMonitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ElIf Other, List Use:
Nearest Town: (14 rAO'i County at/VIVI"
(Road Name and Nunben, nnwnity, or Subdivision and Lot No.) DRILLING LOG DEPTH
3. OWNER Oar? (t Y 95> From To Fo tion Description
Address
(Street or R u a No.)
r1Qr/61/ c
city or own State
of
J
From To
From To
14. GROUT:
4. DATE DRILLED
5. TOTAL DEPTH
6. CUTTINGS COLLECTED YES ❑ NOE
7. DOES WELL REPLACE EXISTING WELL? YES ❑ NO2
8. STATIC WATER LEVEL Below Top of Casing: FT.
(/ (Use '+' if Above Top of Casing)
9. TOP OF CASING IS I l a FT. Above Land Surface'
'Top o1 casing terminated at/or below lend surface requires a variance in accor-
dance with 15A NCAC 2C Q1111 i1 1 �
10. YIELD (gpm): -11" METHOD OF TEST /77 ar{� V I
11. WATER ZONES (depth)'
12. CHLORINATION: Type 0e Amount i — If additional space is needed use back of form
13. CASING:
zip code 01OO rYS�
o?bCJ (-ter n Tj
243914
Depth Diameter
From —To 7--4 Ft !E'j
Ft.
Ft
DepthFrom 0 To
Material,
Ft CONIC tetC
From To Ft
15. SCREEN:
Depth
From To _ Ft _
From To _ Ft.
From To Ft.
16. SAND/GRAVEL PACK:
Depth
From To — Ft.
From
17. REMARKS:
I DO HEREB
CONSTRUC
To Ft.
ethod fI
Uvrrc
Diameter Slot Size Material
in _ in
in In
In In
ILLY THAT THIS' WELL WAS
TAADAIII S, AND THAT A C
2002
Sawaod
E'ER SECTION
VILLE FILGIONAL OFFICE
UCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
THIS RE •RD j • BEEN PROVIDED TO THE WELL OWNER.
Material
�• i
Alp • I
if
TUR OF PERSON CONSTRUCTING THE WELL DATE
n of Water Duality, Groundwater Section Within 30 days GW1 REV. 12199
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other map reference points)
C
0
N
C
1V
sV
—O

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mal Semite Center - Raleigh. N.C. 27699-1636-Phone [phone]
WELL CONSTRUCTION RECORD
244236
WELL CONTRACTOR Sweet Water Well Drilling & Pump Service, Inc.
WELL. CONTRACTOR CERTIFICATION C: .2 7 &'y
STATE WELL CONSTRUCTION PERMfT#:
1. WELL USE (Check Applicable loot): Reeldentlal Municipal ❑ Industrial ❑ Agricultural ❑ Mon torutg 0
Recovery ❑ Heat Purnp Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCA
Nearest Town:
Show sketch of . Son below) //�� 2
Syr !.C'Lr.(/1�ilt
(Road Nnis
3. OWNER
and to No.)
4. DATE DRILLED J0/J i I
5. TOTAL DEPTH //o.T'
6. CUTTINGS COLLECTED YES ❑ NO2
7. DOES WELL REPLACE EXISTING WELL? YES ❑ NOj
8. STATIC WATER LEVEL Below Top of Casing: /9 FT.
(Usee'.'s Aeon Top of Caging)
9. TOP OF CASING IS 1. -5 FT. Above Land Surface*
'Top of wing Wiradmeed afar Show bed swisss nnpgins a vaianos In scoa-
dinee with 15A ICAO 2C,m 1a
10. YIELD (gpm): /&— METH9D OF TEST T
11. WATER ZONES (depth): 76.r
12. CHLORINATION: Type a___Amount _
13. CASING:
DRILLING LOG
From To
Address .J % Of i /o�f4
� t ai S rSeelnTiw]eC JJ o?bpC Code
ay a Town 21p Code
Depth
From 17 To /67 Ft.
From To
Frei" To
14. GROUT:
Ft.
FL
Wel Thickness
Material
From O Tom(90 Ft. & 4-4Y _____ _
From
15. SCREEN:
To Ft
Depth Dlamefer Slot Sae Material
From To Ft In. / In
/
From To Ft. t,. / in
/ !
From f To / Ft.
16. SAND/GRAVEL PACK:
Depth
To
From
From
17. REM
Size Material
I DO HEREBY CERTIFY THAT THIS WELL VIM CONSTRUCTED
. - - STANDARDS. % THAT A/COPY OF --
USE ONLY
DEPTH
Fanner De¢ription
n or.
n�-
r.
n
nv -5
w �
U addleorel space is needed use back on9m o
ft,
LOCATION SKETCH
(Show direction and distance from at Nast two Stars
Roae, or other nap Sanwa points)
1 I Sfl'
4"
ACCORDANCE W1TH 1SA NCAC 2C, WELL
DED TO THE WELL OWNER
/%,2-/e'/
SIGNATURE OF PERSON •• • THE WELL DATE
**V* oars b Division of Wet Quality, Oiou dwabr Section within 30 days
nw.t REV_ 12Ae
J

1&�
Ae gist,
h. �DTr#12
Size Material
$R3NATt1RE OF PERSON
o.1tal to Division of Wane Quality. Section within 90 days
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mail Service Center - Raleigh, N.C. 276991636-Phone (DID) 733-3221
WELL CONSTRUCTION RECORD
244229
WELL CONTRACTOR -Sweet Water Well Drilling & Pump Service, Inc.
WELL CONTRACTOR CERTIFICATION e: -` oh 89 % o
STATE WELL CONSTRUCTION PERMITS:
1. WELL USE (check Applicable so:): Residential VI Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other p If Other, List Use:
2. WELL LOCATION: (Show sketch of the
mlocation below)
tvsarostTown: / n n siz/ Z
(Road Kra and Nuer� «s. rnn.ay, ar (S aid to No.) DRILLING LOG DEPTH
oo
3. OWNER L, C.T NC72ta a9) /� From W To FormonDeso4som
Address y9• • o Ill
� 1�y rptir. r� A/, C , 1 Fl .
/, y orF�'^ swa ap Code
4. DATEDRILLED/OLSlid/
5. TOTAL DEPTH �j/S
6. CUTTINGS COLLECTED YES ❑ No®
7. DOES WELL REPLACE EXISTING WELL? YES ❑ NO[
8. STATIC WATER LEVEL Below Top of Casing: / 7 FT.
(Use "+' I Above Top of CaaLo)
9. TOP OF CASING IS /_ 1` FT. Above Land Surface
flop of casing t oral eaed War below lend surfers remakes ■ vedaras In accor-
dance elan 13A !CAC 2C ails
10. YIELD (gpm): _ 0 METHOD OF TEST ��Gftir.#
11. WATER ZONES (depth)' 7n )
12. CHLORINATION Type 7/-.�- Amount 419. CASING: V
oL
c
O o
O
c 7 r;_
LOCATION SKETCH
!!�� Depth // ,,.,, Diameter « (Show d -•. and dieters:* from at least two Stale
From 0 To _6—Q— Ft (a 1- X !%� Roads, other map Serene* points)
From To FL
0
nN
From To
14. GROUT:
FL
�epth�l Material) 1L`�1`� ' y
From ...Q— To �l D FL �-�' %f
From To Ft.
15. SCREEN:
Depth Dlarneter Slot Size Material
From Tp
From
From _ To / Ft.
16. SAND/GRAVEL PACK:
Depth
From .-To
From 7 To
17. REMARKr$:--
IDO
FOR OFFidt ONLY
Quad No:
0E
ACCORDNdCE WItH 15A NCAC 2C, WELL
DEO TO THE WELL OWNER
// /D
THE WELL. TE
rn
nin ..
n
nw.t REV_ 12A11

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] ^ ! 1 "y Ci n
�� r_`1i I C.
WELL CONSTRUCTION RECORD WELL CONTRACTOR:
WELL CONTRACTOR CERTIFICATION N: rI /5
STATE WELL CONSTRUCTION PERMITS*:
1. 'WELL USE (Check Applicable bop: ResidentialMunicipal 0 Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below) (R o r // t
Nearest Town' , a a - lc i� County: ,I�.)J [ham
(Road Marne arum Commmiy, or a on and tnt No.) DEPTH DRILLING LOG
3. OWNERmi .Al) /(/_ALtJ''�r>arZiF- Fern To Formation
Address So ,�Sirr�r. i. 6 03 5 5
�{! h `I ��i
City or Town Zip Code
4. DATE DRILLED !0 �✓. l o
5. TOTAL DEPTH—
6. CUTTINGS COLLECTED YES[] NO1127 g a
7. DOES WELL REPLACE EXISTING WELL? YES NOE3 o—amn
o<
8. STATIC WATER LEVEL Below Top of Casing: FT.
I
(Use'+ d Move Top of Casing) CO no
9. TOP OF CASING IS I FT. Above Land Surface' -,+ -i0
'Top o1 using terminated at/or below lend surface requires a variance In actor- Z mm
dance with 'SA NCAC ZC .0y1e /.j _ / 1. l W yx
10. YIELD (gpm) “( METHOD OF TEST (,/ `ice r2,/ y z
11. WATER ZONES (depth)' cri cp
i
z
12. CHLORINATION: Type Amount on'f
13. CASING: qO
Was Thickness
Depth Diameter or Weight/R.
From To Ft
Fri.*. To FL
From To Ft.
14. GROUT:
It additional space is needed use back of form
LOCATION SKETCH
Material (Show direction and distance Irons at least two State
Roads, or other map reference points)
Depth Material Method
From To Ft.
From To Ft.
15. SCREEN:
Depth Diameter Slot Size Material
From To Ft in in
From To Ft. in in
From To Ft. in _ in
16. SAND/GRAVEL PACK: '
Depth Size Material
From To Ft.
From To Ft
17. REMARKS:
I DOH CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CO • I•Ir!�TION ',)1N t)ROS, AL al e PY OF HIS RECOR HAS SEEN PROVIDED TO THE WELL OWNER.
FOR O
Quad Nu
SE ONLY
sea.
2002 su
SECIIH
,CivPd_ OFFICE
ATURE OF PERSON �• ' ' NG THE WELL DATE
oda to Divisional Water Ouaity, Groundwater Section within 30 days
_ OW-1 REY. 03/2000

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: Rodney Robbins
WELL CONTRACTOR CERTIFICATION #: 2785
STATE WELL CONSTRUCTION PERMIT #:
240435
1. WELL USE (Check Applicable Box): ® Residential ❑ Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring
❑ Recovery ❑ Heat Pump Water Injection ❑ Other If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: CONNELY SPRINGS County: Burks
MT. GILEAD CHURCH RD. DRILLING LOG DEPTH
(Road Name and Numbers, Community, or Subdivision and Lot No.) From To Formation Description
3. OWNER ROMEY HUDSON
Address 4669 MT. GILEAD CHRUCH RD.
(Street or Route No.)
CONNELY SPRINGS NC 28612
City or Town State Zip Code
4. DATE DRILLED 10/12/01
5. TOTAL DEPTH 145
6. CUTTING COLLECTED ❑ YES ® NO
7. DOES WELL REPLACE EXISTING WELL? ❑ YES ® NO
8. STATIC WATER LEVEL Below Top of Casing: 20 FT.
(Use "+" if Above Top of Casing)
9. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
'Top of casing terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2C.0118
10. YIELD (gpm): 15 METHOD OF TEST: ARD
11. WATER ZONES (depth):
If additional space is needed use back of form
12. CHLORINATION: Type: CHLORYTE Amount: 3
13. CASING: LOCATION SKETCH
Wall Thickness (Show direction and distance from at least two State
Depth Diameter or Weight/Ft. Material Roads, or other reference points)
From 0 To 40 Ft. 6-1/4 SDR27.6 PVC HWY. #10 FROM POLKVILLE. GO THRU CASAR & LEFT ON
From To Ft. WARDS GAP RD. GREY HOUSE APPROX. 6 MILES ON LEFT.
From To Ft. (4669 ON PORCH POST) c
14. GROUT: O c'
Depth Material Method z o_
From 0 To 20 Ft. QUIKRETE POURED C 8-1
c
From To Ft. 1 0-.
15. SCREEN: cn jc
Depth Diameter Slot Size Material -Ici ,'„,
From To Ft in. in. 3 N F,
From To Ft. in. in. '� r''t %o
From To Ft. in. in. .r 2
Co 3
16. SAND?GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
17. REMARKS:
I DO CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THISRECORD HAS BEEN PROVIDED TO THE WELL OWNER.
FOR OFFICE USE ONLY
Quad No:
Serial No.
��GNA OF PERSON C STRUCTING THE WELL DATE
Submit o nal to Division of Water Quality, Groundwater Section within 30 days
GW-1 REV. 12/99
CroundWa Sec' ac

North Carolina Department of Environment S Natural Resources
Division of Water Quality - Groundwater Section
1636 Mail Service Center
Raleigh, NC 27699-1636 Phone: [phone]
WELL CONSTRUCTION RECORD
DRILLING CONTRACTOR: ,'"o,""• litg Py`i/ev
STAT YELL
CONSTRUCTION •
DRILLER CERTIFICATION NUMBER:
,-gd
PERMIT NUMBER:
OLIAD. NO,
Lat.
.Minor Basin
lain Code
Header Ent
FOR OFFICE use ONLY
SERIAL NO.
Long RO.
GW.I Ent
/WA
1. WELL LOCATION: sSnow iketc.n or tne location below) Nearest Town: Get ✓ County: 470triC
(Road. Coommunity. or Subdivision and Lot No.)
2. OWNER �71C (4OM
.ti
ADDRESS QQ r
(StreetL,Route No.)-
L
City or Town /Scale Zip Code
3. DATE DRILLED/�A-
/D ,2" °JSE OF WELL
7
4.TOTALDEPTH 90
5. CUTTINGS COLLECTED YES Q NO tri
6. DOES WELL REPLACE EXISTING WELL YES VNO ❑
7. STATIC WATER LEVEL Below Top of Casing: .'.- FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
•Casing Terminated at/or below land surface Is illegal unless a variance is issued
in accordance with 1jc.{(�NCAC 2C .0118
t.
9. YIELD (gym): / /ps METHOD OF TEST /7fr/`7<
10. WATER ZONES (depth): /GO
1I. CHLORINATION: Type/b`1,7( Amount„ /0 p Z.-
IL CASING:
Depth?
From oQ To Ft.
From To Ft.
From To Ft.
Wall Thickness
D,ylter Or Y '% t4Ft. hlp tcriai
13. GROUT:
p Depth -7 ,Material etho
From ldl To ec/ Ft. G/Fiej'tf OP✓'
From To Ft.
14. SCREEN:
Depth
Diameter Slot Size Material
From To FL in. in
From To Ft. In. in
From To Ft. in. in
15. SAND/GRAVEL PACK:
Depth
From To
From To
Ft.
Ft.
Size Material
DEPTH
From To
DRILLING LOG
Formation Description
�0 77 G/7 ,,544--
yyo
• 4/r a...A; jY
c
0 O
n
-�1
t0
2
If additional space is needed use back of Ica
Dam
an
zm
CI
,y o
PI '-
Doc)
m
)LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other map reference points)
:1
E
/,t-) 1 e I ��
Illt� QSr�dg� ,4
Gemv-it /r OaLtesx hI
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C. WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECQ HAS BEEN PROVIDED TO THE WELL OWNER.
i {r tatP- k-- /0oG--O7
fEc270
GW-1 REV. 11/99
SIGNATURE OF CONTRACTOR OR AGENT DATE
Submit original to Division of Water Quality And a copy to well owner.
Bd Wd60:al T00z 6T '430 EFETZ917170L : 'ON Xt)d
dWfld '8 113M ZlEdOW : WOdd

North Carolina Department Of Environment & Natural Resources
Division of Water Quality - Groundwater Section
1536 Mail Service Center
Raleigh, NC 27699-1636 Phone: [phone]
WELL CONSTRUCTION RECORD ���jjj
DRILLING CONTRACTOR: # 0 re./� 4e///2rtr//
TATE WELL
CONSTRUCTION Sg�
DRILLER CERTIFICATION NUMBER PERMIT NUMBER; /v29
FOR OFFICE USE ONLY
QUAD. NO. SERIAL NO.
Lac Long RO.
Minor Basin
Basin Cock
Pleader Ent. GW-I Ent.
239438
1. WELL LOCATION: (Show skete of the location below)n
dine Town: ,e JrarC✓I ID& County: fOcIf Ae
(Road, CommufptjY or Sub��iitvision and Lot No.)
2. OWNER 6_,/ .r J%us,-5 CeA ina (�
ADDRESS
(Street or Route No.)
Cicy or Town ! State Zip
Code
RI 3. DATE DLLEDM t..OT SE OF WELL Zi
S. TOTAL DEPTH 12s
5. CUTTINGS COLLECTED YES 0 NO ®-
6. DOES WELL REPLACE EXISTING WELL". YES 0 Nov
7. STATIC WATER LEVEL Below Top of Casino: CC FT.
(Use "+- if Above Tap of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
'Casing Terminated at/or below land surface is illegal unless a variance is issued
in accordance with ISASNCAC 2C.0118 ) 9. YIELD (gpm): METHOD OF TEST Oil r//
10. WATER ZONES (depth): /VO '-le O
CO
11. CHLORINATION: Typee Amount 7 0 L If additional space is needed use back of form
12. CASING:
DEPTH
From To
DRILLING LOC
Formation Description
— /04'
/o c 32s ` .�a•� tr
n jx
—
3r.t
b fm
Wail Thickness
_ De t Diagiter 0 i Fsf h 2,1,- al
From To p/6 6 Ft. ro rP / /f/i�-
From To Ft.
From To Ft.
13. GROUT:
Depth
Fromi-b, To t Ft.
From To Ft.
14. SCREEN:
Material,� Method
Depth Diameter Slot Size Material
From To Ft. in. in
From , To Ft in. in
From To FL in. in.
I5. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
2
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other map reference points)
7043t4 vU
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THJ�S RECO HAS BFFN PROVIDED TO THE WELL OWNER
_ /z —/—©/
27 )(fib SIGNATURE OF CONTRA' CTOR oR AGENT DATE
GW1 REV. 11199 n� -� 1 Submit original to Division of Water Quality and a copy to well owner.
6d Wd60:2T TOW 6T '100
EEETE917b02. : 'ON XHd
dN 1d g 113f1 Zl3NOW ' WONJ

North Carolina Department of Environment S Natural Resources
Division of Water Quality - Groundwater Section
1636 Mail Service Center
Raleigh, NC 27699-1636 Phone: [phone]
WELL CONSTRUCTION RECORD
// ( DRILLING CONTRACTOR: (y tt /�
STATER ELL
CONSTRUCTION pp// 4
DRILLER CERTtFICATlON NUMBER SQIo PERMIT NUMBER:
FOR OFFICE L'SE ONLY
QUAD. NO. SERIAL NO.
Lac Loris, RO.
Minor Basin
Basin Code
Header Ent. GWI Ent
2'9501
1- WELL LOCATION: (Show sketch of the location belowFl! //
Nearest Town: AO /3ai( rt..County: /06 r tie
(Road, Co mum or Su (Division and Lot No.)
2. OWNER an oAe-
ADDRESS /c% may/
.(Street or Route No.
Gonne.l fr$OffAj C 2gl.,/2.
Ciry or Town $tam Zip
3. DATE DRILLED/0-g-1,/SE OF WELL /��y
.L TOTAL DEPTH iCC /
5. CUTTINGS COLLECTED YES ❑ NO Ef`
6. DOES WELL REPLACE EXISTING WELL? YES' NO ❑
7. STATIC WATER LEVEL Below Top of Casino: So FT.
(Use"+" if Above Top of Casing)
8. TOP OF CASING IS l FT. Above Land Surface'
•Casing Terminated at/or below land surface is illegal -unless a variance is issued
in accordance with ISA NCAC 2C .0118
9. YIELD (gpm): //60 METHOD OF TEST 4TT `//
IL WATER ZONES (depth): // 9d '
/f II. CHLORINATION: Type /' / Amount .3 rl 7
IL CASING:
Dept q
From To / Ft.
From To Ft.
From To Ft
Wall Thickness
DIaP}eter 0(• tiulFt. h]:1 �i
13. GROUT:
Depth aterinl� ethod
From 7p To apt / Ft. �/y'es•
From To Ft.
14. SCREEN:
Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in
From To Ft. in. in. —
15. SAND/GRAVEL PACK:
Depth Size Material
From To FL
From To Ft.
DEPTH
From To
DRILLING LOQ
Formation Description
Ar— 79 c' 54/
9 ' — /ls- ' C/Ia,t
t--
O
y
>O.
= m�
N rnz
1
If additional space is needed use back of forma
z
LOCATION $kt rCH
(Show direction and distance from at least two State
Roads, or other map reference points)
tea ImmoA, A-cb
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS CORD HAS BEEN PROVIDED TO THE WELL OWNER.
N , 2 7 'n
Gw-I REV. I1/99
8
MEM
SIGNATURE '-ram ONTRACTOR OR NT DATE
Submit original to Division of Water Quality and a copy to well owner.
9d WdE10:ZT T00E ET '1-00
ZZETZ917170Z : 'ON Xtid
dwf)d '8 113M zlRaow • WOdd

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mail Service Center - Raleigh, N.C. 27699-1636-Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR-
WELL CONTRACTOR CERTIFICATION #: 7 % /
STATE WELL CONSTRUCTION PERMIT#:
1. - WELL USE (Check Applicable Box): Residential (a- Municipal ❑ Industrial ❑
Recovery ❑ Heat Pump Water Injection ❑ Other El If Other, List Use:
2. WELL LOCATIO (Show kph of pe location below)
Nearest Town: t< r) ti County.
V Ll,- KT`
(Road Name and,Nurrjers, Communiry�Subdivision and Lot No.)
3. OWNER cry r / cc, G
Address RQ /: - ,: / a /q
(S reet or oule No.
City or Town J State Zip Code
4. DATE DRILLED—C -L01
5. TOTAL DEPTH Z J
6. CUTTINGS COLLECTED YES In NO
Q/
Agricultural ❑ Monitoring ❑
DEPTH DRILLING LOG
From To ofmation Description
U70
JD 7 tic/
7.T 7
7, DOES WELL REPLACE EXISTING WELL? YES NO©K
B. STATIC WATER LEVEL Below Top of Casing: (� FT.
(Use it Above Top of Casing)
9. TOP OF CASING IS % FT Above Land Surface'
'Top of casing terminated at/or below land surface requires a variance In accor-
dance with 1 SA NCAC 2C .0118
10. YIELD (gpm): to METHOD OF TEST [/ W It/
11. WATER ZONES (depth).
12. CHLORINATION; Type' "o eci4
13. CASING: W VC__ CcU
J
Amount /6
Wall Thickness
Depth Diameter or weight/Ft. Material
From To Ft
From - To Ft.
From To Ft
14. GROUT:
Depth Material Method
From To Ft
From To Ft.
15. SCREEN:
Depth Diameter Slot Size
From To Ft in
From To Ft in
From To Ft. in
16. SAND/GRAVEL PACK:
Depth Size
17. REMMARKS: EE Ft'
Material
in
in
in
Material
O f
u
0
•
CO
c•+1
crn
gXe
If additional space is needed use back orm :m
LOCATION SKETCH N o~
(Show direction and distance from at least two Stater
Roads, or other map reference points)
\U
E� 115
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONST aF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
FOR OFF CE_, 1 -flan v II/�L tz.,2 — 6 -0/
Quad No ,'.� - A SIGNATURE OF P NSTRUCTING THE WELL DATE
I ,� ,� qSubmt W ral to Division of Water Quality, Groundwater Section within 30 days
Serial No. I •�
•
GW-1 REV. 03/2000

rd
v" rbrnbty . f-,m, tnrlwnt or Section 2 v 9'7 1. 6
North Carolina - Department of Environment rind rtntr,rnl H,•-,,,,,,n r - ni:i
1636 Mail Service Center • Raleigh. N.C. 2 itYcl- IG'ir,_I'Itn,n, p.i r.,I rut tt. I
WELL CONSTRUCIION'Iu_COlit) WIII curlIHAGlow f.)1i'A'L!X I/ A-)e . 1///.rUC)
WELL. CON MAC! Oil CERTIFICATION ft:
STATE WEI I. CONSTRUCTION PFRMITII:
1. WELL USE (Check Applicable Box): Residontial EJ Municipal PI Industrial ❑
Recovery ❑ Heat Pump Water Injection n Other n If Other, List Use:
2. WELL LOCATION: pow sketch of the location below)
Nearest Town: /Dive fig County
• /Y3, eL' V004 dv Ale
(Road Name
3. OWNER
Address
mee- rs, Cornmu/nn/iity. or Subdivision and Lot Nn )
K
Agricultural ❑ Monitoring ❑
r / , cot or •outn ToI
-hi e— •
i ty or Town Stain 4:.,, (lade
4. DATE DRILLED 7 / 7_Q
5. TOTAL DEPTH 300
6. CUTTINGS COLLECTED YES [ I NOE
7. DOES WELL REPLACE EXISTING WELL? YES [ I NOi
8. STATIC WATER LEVEL Below Top of Casing: FT.
r (Use -d it Above Top of Casino)
9. TOP OF CASING IS .1 FT Above Land Surface•
*Top of casing terminated aUor below land surface requires a variance In accor-
dance with 1SA NCAC 2C .0118
10. YIELD (gpm): & METHOD OF TEST
11. WATER ZONES (depth) 3S .72jo /
3 5`)a /
12. CHLORINATION: Type l fiT�i Amount 90
13. CASING:
16 yJ
Depth
From -/ To '3 9 Ft
From To Ft
From To Ft.
14. GROUT:
Depth
From 6 To 076 Ft
From To Ft
15. SCREEN:
Diamelnr
Wall Thickness
or Weight/Ft, Material
e , /PP 6
Material/
C rA.)
Method
Depth Diameter Slot Size Material
From To Ft in in
From • ' To Ft _ in. _- in.
From =To Ft - in.in
16. SAND/GRAVEL PACK:
Depth Size Mat,aini
From To Ft
From To Ft
17. REMARKS:
DRILLING LOG DEPTH
From To
o— 3a'
32 — 8s
25— 87
6)— 026a
0/43.--
a 6 ,i_ jQ&
� Formation Description
J)t 4•Nert,"/jrre-f7�
Trani
/eJJ
L
oie
ye r 7.4 Alt
—t. ice`
a—
N
rn+
m70
m
It additional space is needed use back of form
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other map reference points)
44 C
Jr
my
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF 1 HIS R -COR HAS DEER PROVIDED TO THE WELL OWNER.
FOR OFFICE USE ONLY
Quad No:
Serial No.
SIGNATURE 0 ERSON CONSTRUCTING THE WELL DATE
Submit original to nivintnn of Water (Duality. Groundwater Section within 30 days
GW-1 REV. 12/99

North Carolina • Department of Environment end Natural Resources • Division of Water Onefity . firnunrlwater Section
1636 Mail Service Center - Raleigh. N.C. 27699-1636-Phone [phone]
2376
!_ v ! f 27
WELL CONSTRUCTION RECORD
WELL CONTRACTOR: Hickory Well Drilling_Go.
WELL CONTRACTOR CERT1FICATIQN 0: 2343
STATE WELL CONSTRUCTION PERMIT*:
1 . WELL USE (Cheek Appecebfe Box): Residential ® Municipal ❑ Industrial [Ti Agricultural U Monilminu EI
Recovery Ej Heat Pump Water Injection E Other (—] If Other. List Use
2 WELL LOCATION: (Show sketch of the location below)
Nearest Town. MO1'MRtWD County . Burke
4!>ygh Hi l l a Ave .
(Road Name and umbers, Community, or Subdivision and tl Nn ) DEPI H VI TILLING LOG
3 OWNER Jim Daniels Frnrrh It,
Address 4630 High Hills Ave.
(Street or Route NW)
_Morganton NC 28655
City or Town State Zip Code
4. DATE DRILLED 09-19-01
5. TOTAL DEPTH 425
6. CUTTINGS COLLECTED YES O NOfl
7. DOES WELL REPLACE EXISTING WELL? YES _ NOr_ 1
8.
FOR OFFICE USE ONLY
Ouad No
Serial No.
STATIC WATER LEVEL Below Top of CaRing• 60 f' I .
(Rea'.' 1t Above Inp no Caaingi
9 TOP OF CASING IS 2 FT. Above Land Surface'
'Top of easing terminated at/or below lend mullion requires a variance In accor-
dance watt 15A NCAC 2C .0110
10. YIELD (gpm) 7 z METHOD OF TEST By. AJx_ Tea.L_
Ii. WATER ZONES (depth).
r'nm Ulinn Uetc,il)tion
C
O =
----n
as
C", o rn
m
CO ��
'D. mom_...
3 o
IV cn
r-2o
n
ti
rV o
12. CHLORINATION: Type hth Tabs . Amount _ JZ .. Ir addibnnal spnCe r needed use track of form
13. CASING: ..
Wet TNckrwa LOCATION SKETCH
Depth Di��tttqn�Nar or)y{e�pla/FI. ararippl. (Show dl,n t;o, and rfslnnce limn nl least Iwo Slat'
From To 72 Ft b y iV1, P - C1C Roads, or other map ialwr enCP points I
From To Ft
From To - Ft..
14, GROUT:
Depth Material Method
From 0 To 20 Ft Grout Poured
From To Ft
15. SCREEN•
Depth Diameter Slot Size Material
From _ To Ft _ in __ in
From —_ To Ft in in
From _ To Ft _ in. in.
16. SAND/GRAVEL PACK:
Depth Size Material
From To Ft
From To Ft.
17. REMARKS:
pivie
u/f6� _ cm. ems,
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDA��?. - WITH 15A NSA : 7C. WFt I.
CONSTRUCTION STANDARDS. AND THAT A COPY or ECORD II PfOVII/Ff? 10 TIIE WEI. I OWNER
09-20-01
I'A I r
SIGNA1UFF OF PrRSnN must IKON': If rg wSiI
Submit unpin& In Divipoo W Want' OuaIit , Gro,n rlwatn, I:oram,, within ao dayr.
Gw' nEV nvaom

North Carolina • Department of Environment end Natural Resources - Division of Water Quality - Urnundwater Section 2 3 7 2 r7 5
1636 Mall Service Ceram r,. Raleigh, N.C. 276fl-1636-Phona [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR: Hickory Well Drilling Co.
WELL CONTRACTOR CERTIFICATIQN e: 2343
STATE WELL CONSTRUCTION PERMn-u:
1. WELL USE (chenn Apptlnble Box): Residential G; Municipal ❑ Industrial ❑ Agricultural C] Monitoring ❑
Recovery O Heat Pump Water Injection ❑ Other El If Other, List Use •
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: Morgn ton County .. Burke
st hip,- ('rppk Church Rd.
(Road Name end NuMbers. Community. or Subdivision and,kol No) DEPTH DRILLING LOG
3. OWNER Stanley Rogers From io Formation nestriptron
Address
5217 Foreman St.
(Sireel or RoulaTib.)
Mnrypnton NC 28655
City 61 Town State Zip Cana
4. DATE DRILLED 09-12-01
5. TOTAL DEPTH 285
6. CUTTINGS COLLECTED YES Q NOM
7. DOES WELL REPLACE EXISTING WELL? YES C] NdJ]
8. STATIC WATER LEVEL Below Top of Casing- 80 Fr.
9. TOP OF CASING IS 2 FT. Above Casing)e Top Of Land
'Top of casino terminated et/or below lend auafeee requires a vrlenoe In actor•
dents with 1SA NCAC 2C .0110
10. YIELD (gpm): A METHOD OF TEST By._Aix Test,
11. WATER ZONES (depth):
12. CHLORINATION: Type
13. CASING:
hth Tabs Amount 43 __
mx
-10
rr---
44 ti
it additional space is needed use back of form i
Wall T1Jckrless LOCATION SKETCH
Depth Di i (er W , hVFI. Mat riel (Show direction and distance from 1t least two State
From 0 To 107 Ft �� a1�. Steel_ Roads, 0r other map IPlarence points)
From To Ft
From To Ft
14, GROUT:
Depth Material Method
From _a_ To 20 FI Grout Poured
From To Ft
15. SCREEN:
Depth Diameter Slot Size Malarial
From . To . Fl _ 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:
tel
C.
6`' a' /i 66'Ft L.
i
I DO HERESY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCF WITH I5A NOAG 2c. WFt t.
CONSTRUCTION STANDARDS. AND THAT A COPY OF THIS RECORD HAS Q?!3 PROVIDED TO THE WELL. OWNEF
FOR OFFICE USE ONLY
Quad No
Serial No.
abfiss
SIGNATURE OF PERSON CONS TI]IiE•PiNG 1HE WELL
Submit ortglnal to Division of Water Quality, Groundwater Section within 30 days
Si•
09-13-01
DATE
OW -I nEv. 03/2000

North Carolina • Department of Environment and Natural Resources • Division of Wator Duality - (inn it Section
1636 Mail Service Center - Raleigh, N.C. 27699-1636-Phone (91g) 7333221
WELL CONSTRUCTION RECORD WELL CONTRACTOR: Hickory Well Drilling Co.
WELL CONTRACTOR CF.RT1FICATIQN ": 2343
STATE WELL CONSTRUCTION PERMIT":
237247
I WELL USE (Check Appucebts Box): Residenlialta Municipal ❑ Induslrial E] Agricultural Li Monilonnp El
Recovery ❑ Heat Pump Water Injection ❑ Other n II Other. List IJ ae
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town Hildebran County. Burke
9340 Costner Rd.
(Road Name end Numbers, Coomuniry. or Subdivision and Lot Na I DEP1 I I UT TILLING LOG
3. OWNER Fred Woody From it.
Address 9340 Costner Rd.
[Street or Route NO )
Hickory NC 28602
City or Town State Zip Code
4. DATE DRILLED 09-24-01
5. TOTAL DEPTH 2RS
6. CUTTINGS COLLECTED YES E, NO
7. DOES WELL REPLACE EXISTING WELL? YES El NO[_
6. STATIC WATER LEVEL Below T up nl Casing 73
(use •.• II Above lop nt (arming,
P TOP OF CASING IS 2__-. FT. Above Land Surface'
Top of casino terminated et/or below hind sudsiest require• a violence Ii. accor-
dance with 15A NCAC 7 115 10. YIELD (gpm): METHOD OF TEST By Air Test
11. WATER ZONES (depth) .. . -
12. CHLORINATION: Type _hth Tabs _ Amount _ 45
13. CASING:
Depth Diamoter
From 0 To 87 Ft 6f
From To Ft
From To _ Ft.
14. GROUT:
t'nnrwirnl rretb+alian
.O sc rn. -
>0-.
CA z
rO c
O --I
II additional Timor' rrneeded uze back nl torn. Z
Well Thickness
or Weight/rt. Malarial
PVC Plastic
Depth Material Method
From C_ To 2Cl Ft Crnnt Poured __.
From To Ft __ ___ .—. _________
15. SCREEN:
Depth Diameter Slot Size Material
From To Ft in in
From To Ft in in
From To Ft in in.
16. SAND/GRAVEL PACK:
Depth Size Material
From To Ft
From To Ft.
17.REMARKS:
LOCATION SKE it)i
(SltOw diranbon and distance from al kraal two Slates
Roads. or oltlm map rolnrpnce points)
(?)
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCT ED IN ACCORDANCE N,'ITN t;). Fly id; 21:. WFI I.
CONSTRUCTION STANDARDS AND THAT A COPY or Tin RECORD IIAS urrN PI 3 .'II 1FP 1("1 TIE WEI I OWNF'.P
FOR OFFICE USE ONLY
Quad No
Serial No.
09-27-01
SIGNAL UF1F OP OF PSON ('.^.HHS InI, '11f`7(i nfr. V;FII IIAlr
Submit origami In Division a' Wale' 9caary, Grog:. .nwatio nit nri will ;II 30 dayo
()w ' Mar' (1101)00

North Carolina - Department of Environment and Natural Resnurr r- - Ilici-.in
1636 Mail Service Center - Raleigh. N.C. 271)99-1 n3n-f'hnnn (9151 r"'l :+. I
WELL CONSTRUCTION RECORD WLt.t. cot,' I IIACTOR. [.$)?/1`4. li /Qe-1/
WELL CONTRACTOR CLRTIFICATION A: o-2' 3 � L)
STATE WELL CONSTRUCTION PERMIT74:
nl w,amr Duality - Groundwater Section 243811
1. WELL USE (Check Applicable Box): Residential (.�1' hlunicipat n Industrial n
Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection n Other ( If Other, List Use:
2. WELL LOCATION (Show sketch of the location below) ^�
Nearest Town: Oo)Z�A7r ,orU {{ County: __L�h'2Re—
( 19 a C, es JJJtcati'3'� ;�OOCSs (.// >9QcStines Can )
(Road N and»umbers. Community. or Subdivision and Lot Na) DRILLING LOGDEPTH
Cot /db'
3. OWNER wry I'le2 _ y From To Formation Descdption
s'f
Address (o �''�2Z� �j-7, .(i , A , O LLie,l G �..�'root or.t oN8, cr.7 `;C 5.s 'JO— / gQ
City or To St,l,,
4. DATE DRILLED
5. TOTAL DEPTH 'JG.O t
6. CUTTINGS COLLECTED Y S Li NOR'--
7. DOES WELL REPLACE EXISTING WELL? YES Cl NOLt<
6. STATIC WATER LEVEL Below Top of Casing: Se.)
(Use'+' it Above Top of Casing)
9. TOP OF CASING IS et FT. Above Land Surface -
'Top of casing terminated eUor below land surface requires a varinnee In accor-
dance with 15A NCAC 2C .O11e
10. YIELD (gpm)• .2 •METHOD OF TEST Al R
11. WATER ZONES (depth): IACD
12. CHLORINATION: Type G h /OR; lie. Amount
13. CASING:
Wall Thickness
Depth , Diame or or Weight/FL frtaleriat
From O To /a7 Ft e 7'1 .s01e 7t vc
From �7 To '•'5 Ft
From To Ft
14. GROUT:
Depth Material Method
From 0
To 2O Ft ceme,V+ f"7_"_ st
From To _ Ft.
15. SCREEN:
.)uses a)1,4
Depth Diameter Slot Size Material
From To Ft in. in.
From " ' To Ft in in
From To Ft in. in
16. SAND/GRAVEL PACK:
From
From
17. REMARKS:
I DO HE
CONSTR
Depth
To
To
Ft
Ft
Size
Material
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)
C
O
m
O^
c� cm
O c rn
>n
-4O
DC —Ca
m
w cn.z
cm a
—4
cn a
Submij one
ATER SECTION
ASHEVIL_E REGIONAL OFFICE
)NSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
Y OF 1 HIRECORD UAS.U_EEN PROVIDED TO THE WELL OWNER.
IGNATURE OF PERSON CONSTRUCTING THE WELL DATE
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
1638 Mall Service Center - Raleigh. N.C. 27699.163E-Phone [phone] ,.i; . , . 7 4
•
WELL CONSTRUCTION RECORD WELL CONTRACTOR. 30 6hc' uS. P01R-
WELL CONTRACTOR CERTIFICATION 0: a ca g
STATE WELL CONSTRUCTION PERMIT,:
1. WELL USE (check Applicable Sox): ResldentlailJa ' Municipal El Industrial El Agricultural ❑ Monitoring ❑
Recovery jJ Heal Pump Water Injection ❑ Oilier II Other, List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: County'
Pj,r Ice..
(need Name and Numbers. Cornmeal , o Subdivision end Lot No.) DRILLING LOG DEPTH
3. OWNER ;\n r 1 P i,a From Ta Formation Description
Address y.5 1
" ISlreot or t7oul o� fln
Coy or Town
l J! nLMQ e l— np Code
4. DATE DRILLED O
5. TOTAL DEPTH S
6. CUTTINGS COLLECTED YES(l NOI71
7. DOES WELL REPLACE EXISTING WELL? YES n NOM
8. STATIC WATER LEVEL Below Top of Casing: 30 FT.
(Use O• If Above Top of Casing)
9. TOP OF CASING IS I FT. Above Land Surface'
-Top of casing terminated uVor below Imd surface require, a variance In ,ccor•
dance wllh 15A NCAC 2C.$$,,18 j� O n=
11. WATER ZONES (depth)
10. YIELD (gpm): d L. METHOD OF TEST Tlr ) rn Sr-,—ti
r
oC
CD =r-I
➢a
CHLORINATION: Typo Amount rep: (Is If additional space is needed use back of torn 3 =o
z
Wall Thickness LOCATION SKETCH pV -
Depth lameto yr e g tt Material ,., (Show direction end distance from al least Iwo Stale Le C_
From�TO 7-7 Ft (9•1•b d� .�'�' L.YS,�J�LK floods, or other map relarence points)
b -y7
41 -4O5
C-
13. CASING:
From To Ft.
From To Ft
14. GROUT:
Depth Materiel Mot_ h_od r
Frog, d To 3 D FL oaQ Ef g bet Kf'd
From To FI
15. SCREEN:
Depth Diameter Slot Size Material
From To Ft In In
From To FI In In
From To Ft in In
16. SAND/GRAVEL PACK:
Depth
To FI
To FI
From
From
17. REMARKS:
I DO HEREBY CERT
CONSTRUCTION E-
OR OFFICE USE
Oared No:
Serial No.
Size
Material
`]TViAT THIS WELL WAS CON
ARDS, AND TI T PY
LOAD //IAl L/&J
/oN A pi 17LY6
TEO IN ACCORDANCE WITH 15A NCAC 2C. WELL
T h o RECORD HAS BEEN P9QVIDEO TO TUE WELL OWNER.
•
sionmuf1E QPI'ERSON CONSTRUCTING TIIE WELL
"J .4dbr8Lidbi6Mllto Division of Water Ouallty. Groundwater Section within 30 days
REGIONAL OFFICE
DATE
GW.I nEV. 12/99

243940
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] Wet(
/ n
WELL CONSTRUCTION RECORD WELL CONTRACTOR. Price {/yet`
WELL CONTRACTOR CERTIFICATION #: 3 al 0
STATE WELL CONSTRUCTION PERMITS:
1. WELL USE (Check Applicable Boa): Residential Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: M Or"? fife 41 County'
� U rke
(Road Name and Numbers Communiy,[or Subdivision and kot Noo. DRILLING LOG
/$k WNER HU/l1 6K5 Cl v eyf.Yf fi"t(� From To
Address p 0
(sir, or-Rouie NoT )
MOrn\r rttr. sat. �iG Zip Code
City or Town
4. DATE DRILLED O (7 r0 %O
5. TOTAL DEPTH
6. CUTTINGS COLL CTED YES ❑ NO®
7. DOES WELL REPLACE EXISTING WELL? YES Et NO53
8. STATIC WATER LEVEL Below Top of Casing: FT.
(Use W if Above Top of Casing)
9. TOP OF CASING IS / /72 FT. Above Land Surface'
'Top of casing terminated at/or below land surface requires a variance in j accor-
dance with 15A NCAC 2C . 177a -�] N
10. YIELD (gpm): If 1 METHOD OF TEST ! -nr t7 b (� (.vim v r
11. WATER ZONES (depth): m
/00
0o 6 o0
/co E5o
DEPTH
ormation De riptiorl-.
/ r`- vt ))
_erqkre,
C
r—r
rrt
12. CHLORINATION: Type Amount-
13. CASING:
Depth / yD
From G To 7
From To
From To Ft
14. GROUT:
Wae T icknesa
Diameter or Welpht/FLJ1ca
Ft JO— C (y
Ft.
Depth Mated ,Methods
From C To a,0 Ft C-onc ree More...0k
From To Ft
15. SCREEN:
Depth Diameter Slot Size Material
From To Ft in in
From To Ft In in
From To Ft in In
16. SAND/GRAVEL PACK:
From
From
17. REMA
I DO H
CONS
FOR OF
Quad No:
Sadal No
SE OQIY
Depth Size
To _ .— Ft.
To Ft.
G_- r � WE
N STANDARDS, AND TH
2002
Material
r1
i
If additional space Is needed use back of for r7ni
0
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other map reference points) 1
p
wc`t
jreeQ0*4
i-11,y t+
soI'
ONSTRUCTED IN ACCORDANCEHSWITH 15A NCAC 2C, WELL
OF THIS RECr1 `RD v BEEN PROVIDED TO THE WELL OWNER.
arl. /'/—° I
SIGNATU OF PERSON CONSTRUCTING THE WELL DATE
to Division of Water Quality, Groundwater section within 30 days GW-1 REV. 17199

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• P7cC 1/rI1 D CI HI l n9 JTn
WELL CONTRACTOR CERTIFICATION 0: 5 0 eg 0
STATE WELL CONSTRUCTION PERMIT#:
243941
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 sk tch of the location below) '/
Nearest Town: Jo MCI 'n CU Yl County or/" c
(Road Name lop Numbers, Community, or Subdivision and Lot No.)
3. OWNER k`); 1 I' IO ✓/'1Sf
Address /�l� i t
five ve Or- NC 9` r na
(Sheet or Ro't}No. q
CiCityr Town State
a O lCl o Zip Code
4. DATE DRILLED 2`0 1
5. TOTAL DEPTH � O O
6. CUTTINGS COLLECTED YES ❑ NO®
7. DOES WELL REPLACE EXISTING WELL? YES ❑ NO ]
8. STATIC WATER LEVEL Below Top of Casing: FT.
/ (Use'Above Top of Casing)
- : a
9. TOP OF CASING IS f f FT. Above Land Surface'
'Top of easing terminated at/or below land surface requires a variance In accor-
dance with 15A NCAC 2C .011e Q i
10. YIELD(gpm): / (I METHOD OF TEST °(/i'kt1' N
11. WATER ZONES (depth):
DRILLING LOG
From To
0 i`ar
12. CHLORINATION: Type `r-j _Amount :9 q
13. CASING:
From
From
Depth c� p Diameter
To 1 `t Ft —fJ—
From
14. GROUT:
To Ft
To Ft
Depth
From I) To _ 0 Ft.
From To Ft
15. SCREEN:
Depth
From To Ft
From __ To _ Ft.
From , To _ Ft.
16. SAND/GRAVEL PACK:
From
From
17. REMA
Depth
To — .— Ft.
To Ft
Wail Thickneu
or.W
Material rMethod
QDG :MR 0+rreel
Diameter Slot Size Material
in in
In — In
in _ In
IDOH=
CONST
FOR OF
Quad No:
Size
Material
DEPTH
Formation Description
�i /1 fr6t'
Qmnrl-c_
If additional space is needed use back of form
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other map reference points)
t
ti
- _ J -U _
N STANDARDS, AND TH
2002
GROUNOW/'
R SECTION
IONAL OFFICE
s,
ONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
P OF THIS R CORDy. BE PROVIDED TO THE WELL OWNER.
0
eM
I
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
nal to Division of Water Quality, Groundwater Section within 30 days
GW-1 REV. 12/99
Sedai 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- iC G 1i1477 ilr`/` `75 inc.
WELL CONTRACTOR CERTIFICATION #: 7o- O
STATE WELL CONSTRUCTION PERMRM:
243937
1. WELL USE (Check Applicable Box): Residential Municipal El Industrial ❑ Agricultural Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATION: (Show sket h of the location below)
Nearest Town: J"klater bin County 66,r '
(Road Name and Numbers.
3. OWNER yac<tN
Ad�dress/}1/, /tJ
/1/i"60 (sir /v
ty, or Subdivision and).ot No.)
/L12b w tDO Ck
9r7 /
City or Town Stale Tip Code
�- � -
e
Flo.)6z_ lid
5. DATE DRILLED _, a G° I
5. TOTAL DEPTH .�-
6. CUTTINGS COLLECTED YES ❑ NOff.--
7. DOES WELL REPLACE EXISTING WELL? YES NO
8. STATIC WATER LEVEL Below Top of Casing: 4 FT.
/7 (Use '+' a Above Top o,,o4'Casing)
9. TOP OF CASING IS/FT. Above Land Surface'
Top of casing terminated error below lend surface requires variance In aeeor-
dance with 15A NCAC 20�J� a
10. YIELD (gpm)• f METHOD OF TEST (r- Pitikt" .-
11. WATER ZONES ( epth):
DRILLING LOG
From To
12. CHLORINATION: Type Amount
13. CASING:
DEPTH
Formation Description
}�/ / . /
rr,v �C
ha�gft.; f-ns
C, -c
rn a
m
-n
3 xm
yr If additional space is needed use back of foci rm
LOCATION SKETCH
Wall Thickness
De th • 'n{ D r or w hva. Material (Show direction and distance from at least two St to
From To /�/ Ft f� !/e Roads, or other map reference points)
From To Ft. ,,e""t ©`1
From To Ft
14. GROUT:
Depth A Material- Method
From To •�� Ft ( ey16 ±l l ci,t(re
From To Ft
15. SCREEN:
N
Depth Diameter Slot Size
From To Ft in
From —. To Ft In
From To Ft. In
16. SAND/GRAVEL PACK:
From
From
17. REMARKS:
I DO HEREE r
CONSTRUC
Depth Size
To _ Ft.
To Ft.
Material
in
In
In
Material
0
FOR OFFICE
Quad No:
Serial No.
- i 2002
submit
3TRUCTED ACCORDANCE WITH 15A NCAC 2C, WELL
OF TH ORD BEEN PROVIDED TO THE WELL OWNER.
/2,4
if IiNATIYRE"OF P RSON CONSTRUCTING THE WELL DATE
nal to Division of Water Quality, Groundwater Section within 30 days
GW-1 REV. 12/99
'mow J V1.AIERSECTION
ASHEVILLE REGIONAL OFFICE

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mail Service Center - Raleigh, N.C. 27699-1636-Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR• r r'lee 4tli 5r\Uin.
WELL CONTRACTOR CERTIFICATION #: i tM2- i
243938
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE (Check Applicable Box): Residential IZ 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: la 01951-7, um in County 3 U rtl e
3. OWNER Drer re'C'% 51/) is scnpuor//
Address 5�8 West c-lem ic� Dr' 0 `6 a 9l a-t<oc IS
(Street or Route No 4az `,.-20J r✓
Q-3r: 1,�n n)C 9(eSS
ity or To State Zip Code
4. DATE DRILLED a
5. TOTAL DEPTH '
6. CUTTINGS COLLECTED YES ❑ NO2
7. DOES WELL REPLACE EXISTING WELL? YES ❑ NO®
8. STATIC WATER LEVEL Below Top of Casing: -,?- FT.
1 (Use': a Above TbpoT Casing)
9. TOP OF CASING IS I ' a FT. Above Land Surface'
'Top of casing terminated et/or below land surface requires a variance In accor-
dance with ISA NCAC 2Cj011a
10. YIELD (gpm): 4cL. METHOD OF TEST I t o711
C uto
11. WATER ZONES (depth)
and Lot No.) \ DRILLING LOG DEPTH
1e��1r.n �l�wr�SU From To Fo 'on 0
r',
L.)
Fri
T`-
m
IV
T ,�
3[ "m
C.J, cn
rn
INS
My
12. CHLORINATION: Type Amount If additional space is needed use back of form z
13. CASING:
Wall ThicknessLOCATION SKETCH
,,cc,� Depth Diameter or W ' nt7t. I (Show direction and distance from at least two State
From t/ To b Ft G tifil Pav/dal Roads, or other map reference points) —
From To Ft. 1)"et
From To Ft (OT"
14. GROUT: fp��©e Cr
Depth Material etlethod`, �) ��` e rtt<j<I
From _0 To AO Ft (10 net r e tic u r ekl `C°s! t i �rXy lL�
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
To Ft
From
From
17. REMA
I DO HE
CONST
FOR OF
Quad No:
Serial No.
To s '\ r ii, I`H II t 1Vj
ERTIFY THAT THIS WELL
N ST,NQARDg, A HA.
E USE ONLY
to
ONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
oYOFTHIS R COPROVIDED TOTHE WELL OWNER
.
GROUNDWA- ER SECTIDfV__.Iodgi
1{SUEvr!zz REalL,NAL 0
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
al to Division of Water Quality, Groundwater Boman within 30 days
GW-1 REV. 12/99

FROM : MORETZ WELL & PUMP
FRX NO. : 7044621322 Sep. 21 2001 07:59RM P2
13. GROUT:
DepthMaterial Method
From/Df To Li Ft G�� ° burn -
Material
From To FL
14. SCREEN:
Depth Diameter Slot Size Material
From To Ft. in. in
From To Ft. in. in
From To Ft. in. in.
1$. SAND/GRAVEL PACK:
Depth Size Material
From To
From To
16. REMARKS:
Ft.
Ft.
North Carolina Department of Environment & Natural Resources
Division of Water Quality - Groundwater Section
1636 Mail Service Center
Raleigh, NC 27699-1636 Phone: [phone]
WELL CONSTRUCTTyI�oN RECORD ,,
DRILLING CONTRACTOR: //�ivft by ./ ‘21-1///r
STATE WE
CONSTRUCTION 2 sg6
DRILLER CERTIFICATION NUMBER: PERMIT NUMBER:
FOR OFFICE USE ONLY
QUAD. NO. SERIAL NO.
Lac Lens. RO.
Miner Basin
Basin Code
Header Est. ow. l Ent
V79
2 t 364.
1_ WELL LOCATION: Shot sketch�of the location bclo
Nearest Town: / l f`r County: nov At -
(Road. Community, or Subdivision and Lot No.)
2. OWNER arni yo, �vI fi
ADDRESS SSYS 7.r/,, ,�erierrS
/ (Street ar oute No.)
1.c..nalet.le_ »
City or Town p"talc Zip Code
3. DATE DRILLEDea7-LTSE OF WELL hit
4. TOTAL DEPTH Es
S. CUTTINGS COLLECTED YES 0 NO
6. DOES WELL REPLACE EXISTING WELL? YE42f NO
7. STATIC WATER LEVEL Below Top of Casing: FT.
(Use + - if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface'
'Casing Terminated aUor below land surface is illegal unless a variance is issued
in accordance with 15A NCAC 2C .0118
9. YIELD (gpm): /IS METHODO n EST /'Y rr/ It
10. WATER ZONES (depth): of
DF,PT
DRILLING LOG
From To Formation Description
7--0/6 - V6' l j sane 6ipte
gs'
11. CHLORINATION: Type
p ,GJTA Amount �S 0 Z If additional space is needed use back of form
12. CASING:
Wall Thickness
_ From To J Depti). '�ceter Or W" ieht/Ft.
•h ml
Ft.D�
From To Ft. LOCATION SKETCH
From To Ft. (Show direction and distance from at least two State
Rands, or other map reference points)
I DO HEREBY CE
CONSTRUCTION STA,
GW-I REV. 11199
THAt TWS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
ARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
c
fIGNATURE OF CONTRACTOR OR AGENT DATE
Submit original to Division canter Quality and a copy to well owner.

FROM : MORETZ WELL 8 PUMP
FAX NO. : 7044621322 Sep. 21 2001 08:00AM P3
North Carolina Department of Environment S Natural Resources
Division of Water Quality - Groundwater Section
1636 Mail Service Center
Raleigh, NC 27699-1636 Phone: [phone]
WELL CONSTRUCTION RECORD
DRILLING CONTRACTOR:
r L L✓ .-// rtr//2
STATE WELL
CONSTRUCTION
DRILLER CERTIFICATION NUMBER: o% 5"&C PERMIT NUMBER:
FOR OFFICE USE ONLY
QUAD. NO. SERIAL NO.
Las. Loos. RO.
Minor Basin
Basin Code
Hader Ent. OW. I Ent.
L WELL LOCATION: (Show skrrtch of the location below)
Nearest To /lqA IA- County: �6tlR-�
(Road. Community. or Subdivision and Lot No.)
7.. OWNER oce— einAlei
ADDRESS 447 r/ 00/ e tLc% %1y
(Street or Route No.)
lmyalaA VG 213 b-c
tin Code
3. DATE DRILLED15 47[1SE OF WELL Ale
4. TOTAL DEPTH R,
5. CUTTINGS COLLECTED YES ❑ NO 1271
6. DOES WELL REPLACE EXISTING WELL? YES4 NO 0
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 at/or below land surface is illegal unless a variance/(
oCris issued
in accordance with 13A NCAC 2C .0118 rfrlrrY'
9. YIELD (gpm): 1/ METrHOD OF TEST /'i
10. WATER ZONES (depth): fo O
I1. CHLORINATION: Tvpezd Amount
11. CASING:
City or Town
O Srate
Wall Thickness
_ Depth, Er ter Or We'nht/ t.)
From Dr To / l , Ft. From To To Ft
From To Ft.
13 GROUT:
Fromfqq Dept �iaterial
OP To -O Ft. .0 't
From / To Ft
I4. SCREEN:
Depth Diameter
M thud
erial
Slot Size Material
From To Ft. In. in.
From To Ft. in. in
From To Ft. in. in
IF. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
PEPTI-t
From To
DRILLING LOG
Formation Description
60— /S/r :4s41c/
/ s - 32 ` - 6Ann tic
c3
CD
II -additional space is needed use back of form
tifi Co
ro
Cr7
o'
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other map reference points)
/14v:Jo/s 9/t
nfr�
I DO HEREflCZ T 1/ THAT yllYELL WAS CONSTRUCTED IN ACCORDANCE WITH 1.5A NCAC 2C. WELL
CONSTRUCTION STANDARDS, AN T"A COPY OF THIS RECORD 13AS BEEN PROVIDED TO THE WELL OWNER_
SIGNAT OF�TRACTOR OR AGENT DATE
GW-1 REV. 11/99 Submit original to Division of Water Quality and a copy to well owner.

FROM : MORETZ WELL a PUMP
FAX NO. : 7044621322 Sep. 21 2001 08:01AM P5
North Carolina Department of Environment & Natural Resources
Division of Water Quality - Groundwater Section
1636 Mail Service Center
Raleigh, NC 27699-1636 Phone: [phone]
W ELLCONSTRUCTIII�ON RECORD�
DRILLING CONTRACTOR: ///0%e'/t+ !fie"//
CONSTRUCTION �tj�
DRILLER CERTIFICATION NUMBER: lIJJ
STATE WELL
PERMIT NUMBER:
QUAD. NO.
Lat.
Minor Basin
Oasin Code
Header Ent.
FOR OFFICE USE ONLY
SERIAL NO,
Long. RO.
GW-I Ent.
1.7C)fl9r)",
I..L; t.. !..
1. WELL LOCATION: (Show sketch of the location below) L
Nearest Town: Ati^4 Act Ara- County: rt e
(Road. Community. or Sub4iyisioryanyl j,ot No.)
2. OWNER 1erp�y- /'retie-l(
ADDRESS sn$n rleisfa t- Ras'
LOvtse%5� (S�s or t� o.) C/R
City or Town State Zip Code
3. DATE DRILLEDS-y USE OF WELL ,c-S
4. TOTAL DEPTH ‘e9
5. CUTTINGS COLLECTED YES ❑ NO i0-<
6. DOES WELL REPLACE EXISTING WELLT YES NO ❑
7. STATIC WATER LEVEL Below Top of Casing: -5-0 FT.
(Use"+- if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface'
'Casing Terminated atlor below land surface is illegal unless a variance is issued
in accordance with ISA NCAC 2C -0118 9. YIELD (gpm): 2METHOD OF TEST //�7rr/14 T`/T1
10. WATER ZONES (depth): /CO '
I1. CHLORINATION: Type f-> T Amount .$ 0 Z
12. CASING:
_ _y Depth7Pi Ft.
From? pro -
From To Ft.
From • To Ft.
13. GROUT:
Depth
From To PO FL
From To Ft.
14. SCREEN:
Wall Thickness
Dpr ter Or\ey,ilUFt. Ertl
sate 1 ;I /
Depth Diameter Slot Size Material
From To Ft in. in
From To Ft in. in
From To Ft in. in.
16. SA-ND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16, REMAR
I DO RE. l!.[ 1 l$1a!a
CONSTRUCT i �yc ANDARDS, ppAND THA
GW-I REV. I
DEPTR
From To
72' (D'
DRILLING LOG
Formation Description
Li
O
u
CO en
-to�
N �m
Z
n. ft;-4.,
.0 rr/+
m�
CJ1 0
If additional space is needed use back of form
J.00ATION.SK TCH
(Show direction and distance from at least two State
Roads. or other map reference points)
AS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C. WELL
PY OF THIS RECORD HAS EEN PROVIDED TO THE WELL OWNER
d T • 0 -37 o
Atha.
SIGNA OF CONTRACTOR OR. AGENT • DATE
Submit original to Division of Water Quality and 2 copy to well owner.

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone]
239425
WELL CONSTRUCTION RECORD
010303
WELL CONTRACTOR Dewey Wright Well Pump Co., Inc.
2087
WELL CONTRACTOR CERTIFICATION it. Steve eece
STATE WELL CONSTRUCTION PERMIT#'
1. WELL USE (Check Applicable Box): Residential I ?` Municipal Industrial D Agricultural fl Monitoring 0
Recovery n Heat Pump Water Injection fl Other I i If Other, List Use•
I I
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: MORGANTON County: BURKE
IRISH CREEK RD OFF FISH HATCHERY RD OFF HWY 18
DRILLING LOG
3. OWNER
Address
From
229 MTN CIRCLE , 0
LENOIF2.street °'Route Nod NC 28645 120 160 GRANITE
City or Town State Zip Code 160 163 SHALE
4. DATE DRILLED 8/15/2001 163 200 GRANITE
5. TOTAL DEPTH 240 200 203 SHALE
6. CUTTINGS COLLECTED YES I I NO FIX 203 240 GRANITE o
7. DOES WELL REPLACE EXISTING WELL? YES 0 NO I N A
8. STATIC WATER LEVEL Below Top of Casing: 60 FT N E'er
(Use"+" if Above Top of Casing) � c-n
PO
DEPTH
Formation Description
120 DIRT
(Road Name and Numbers, Community, or Subdivision and Lot No.l
TIMOTHY L ?ANDREWS
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 Air
10. YIELD (gpm): 15 METHOD OF TEST
11. WATER ZONES (depth): 5 ClOm 120-160 10 ppm 163-200
0 ppm 0 ppm
12. CHLORINATION: Type FiTH Amount
38
13. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 12Pt 61/8 .350 PVC
From To Ft
From To Ft
14. GROUT: 6
Depth Material Method �^
From 0 To 20 Ft Cement Gravity Flow�' �;0. Ll�.e✓ 7Sc1'
From To Ft CEMENT GRAM I Y FLOW y awr
15. SCREEN: .1e 7
Depth Diameter Slot Size Material Ci 1\
From To Ft in in. _4r
From To Ft in in
From To Ft in in
To
0'
- anti
A In�
rn
t -0
If additional space is needed use bajf fa
LOCATION SKETCH
(Show direction and distance from at least two State
C7 L Roads, or other mapdrSerence points)
16. SAND/GRAVEL PACK:
Depth
From To Ft
From To Ft.
Size Material
V
VY
oWn
8,eec, ROI
N.OYG pL,wTC1 Ii\
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'
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit original to Division of Water Quality, Groundwater Section within 30 days
GW-1 REV. 12/99
�1z
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: Robin McNeely
WELL CONTRACTOR CERTIFICATION #: 2567
STATE WELL CONSTRUCTION PERMIT #:
238425
I. WELL USE (Check Applicable Box): ® Residential ❑ Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring
❑ Recovery ❑ Heat Pump Water Injection ❑ Other If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: CONLEY SPRING County: Burks
VAN HORN RD. .DRILLING LOG DEPTH
(Road Name and Numbers, Community, or Subdivision and Lot No.) From To Formation Description
3. OWNER RAY RONEY
Address 5345 VAN HORN RD.
(Street or Route No.)
CONLEY SPRING NC 28612
City or Town State Zip Code
4. DATE DRILLED 8/28/01
5. TOTAL DEPTH 68
6. CUTTING COLLECTED ❑ YES ® NO
7. DOES WELL REPLACE EXISTING WELL? ❑ YES ® NO
8. STATIC WATER LEVEL Below Top of Casing: 50 FT.
(Use "-4-'" if Above Top of Casing)
9. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
'Top of casing terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2C.0118
10. YIELD (gpm): 18 METHOD OF TEST: STEELTAPE
11. WATER ZONES (depth):
12. CHLORINATION: Type: CHLORYTE Amount: 8.28
13. CASING:
Wall Thickness
Depth Diameter or Weight/Ft Material
From 0 To 68 Ft. 24" CEMENT
From To Ft.
From To Ft.
14. GROUT:
Depth Material Method
From 0 To 20 Ft CEMENT POURED
From To Ft
15. SCREEN:
Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
From To Ft in. in.
16. SAND?GRAVEL PACK:
Depth Size Material
From 50 To 68 Ft. 6M STONE
From To Ft.
17. REMARKS:
If additional space is needed use back of form
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other reference points)
HWY. #10 FROM POLKVILLE. LEFT ON HWY. #I8. RT. ON
MILLER BRIDGE RD. RT. ON VAN HORN RD. 2ND DRIVE ON
RT. (5345 ON BOX)
I DO CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAATeA COPY
OF THISRECORD HAS BEEN PROVIDED TO THE WELL OWNER.
///7Mf 1A-i4, ad( 04d— r r4 0 X/
SIG ATURE F PEGCONSTRUCTING THE L DATE
Submit original to Division of Wate Quality, Groundwater Section within 30 days
GW-1 REV. 12/99
FOR OFFICE USE ONLY
Quad No:
Serial No.

North Carolina • Department of Environment and Natural Resources - Division of Water Duality • Groundwater Seetion
1838 Mail Service Center- Raleigh, N.C. 27699-1638-Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR: Hickory Well Drilling Co.
WELL CONTRACTOR CERTIFICATIaN 0: 2343
237267
STATE WELL CONSTRUCTION PERMIT*:
1. WELL USE ICfr.ck Applicable Box): Residential P21 Municipal 0 Industrial El Agricultural (] Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other D If Other. List Una
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: Morgan ton County' Burke
-- —
John's River Rd. i
(Road Name and Numbers, Community. or Subdivision and t.nl No )
3. OWNER Toe Dupuis
Address 600 Lenoir St.
I- free or Roue .) 28655
Morganton lVG
City or Town State Zip Code
4. DATE DRILLED 08-22-01
5, TOTAL DEPTH 'ILLS
6. CUTTINGS COLLECTED YES n NO®
7. DOES WELL REPLACE EXISTING WELL? YES 1-3 NOE]
8. STATIC WATER LEVEL Below Top of Casing: 3 FT.
(Use x Above Top of Casing)
9. TOP OF CASING IS 2 FT: Above Land Surface'
'Top of using terminated et/or below land surfeit/ requires . veiling. In eeeor-
dance with 1SA NCAC 2C AlAle
10. YIELD (gpm): LU METHOD OF TEST By Air Test
11. WATER ZONES (depth):
12. CHLORINATION: Type hth Tabs Amount b6_
13. CASING:
DEPTH
Fom n
CHILLING LOG
Ft,' allon Description
C
Cs
Cs `T1
f --CT
n�
--63— b
If additional space is needed use back of form
Well Thickness LOCATION SKETCH
Depth Diameter or Weight/Ft. Material (Show direction end distance from Al least two Slate
From D To 55 Ft 6T' EVE Plastic Roads, or other map reference points)
From To Ft
From To Ft
14. GROUT:
Deptrh, Material Method
From 0 To 2O aGrout Poured
From To Ft
15. SCREEN:
Depth Diameter Slot Size Material
From To Fl In _ in. ..-_
From To Ft in in
From To Ft In in
16. SAND/GRAVEL PACK:
Depth Size
From To Ft
From To Ft.
17. REMARKS:
Material
W
S
6
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDS CF. WITH I5A NCAC 2C. WELL
CONSTRUCTION STANDARDS. AND THAT A COPY OF T
"HIIISRECORD H •j N PROVIDED TO THE WELL OWNER
041,001.
BC /
LFOR OFFICE USE ONLY
Quad No
Serial No.
08-29-01
SIGNATURE OF PERSON CO. = U TING THE WELL DATE
Submit original to Division of Water Ouelky, Groundwater Section within 30 days
GW-f REV. 03/2000

North Carolina • Department of Environment and Natural Resources - Division of Water Quality • Groundwater Section
1636 Mail Service Censer- Raleigh. N.C. 27899-1838-Phone [phone]
237266
WELL CONSTRUCTION RECORD WELL CONTRACTOR: Hickory Well Drilling Co.
WELL CONTRACTOR CERTIFICATION M: 2343
STATE WELL CONSTRUCTION PERMrre:
1. WELL USE (Check Applicable box): Residential Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other 0 If Other, List Uae
2. WELL LOCATION: (Show sketch of the location below)
Morganton county Burke
Nearest Town. y' — --- Burke --
High Peak Mtn. Rd.
(Road Name and Numbers. Community, or Subdivision and No) DEPTH DRILLING LOG
3. OWNER Pete Hanley From To rot rvlunn Description
Address
112 Woody Drive
(Street or Route No.)
Valdese NC 28690
City or Town Stab Zip Code
4. DATE DRILLED gA.-71-01
6. TOTAL DEPTH
6. CUTTINGS COLLECTED YES n NO[a]
7. DOES WELL REPLACE EXISTING WELL? YES j—) NOE]
8. STATIC WATER LEVEL Below Top of Casing: Unk. FI.
(Use •.• li Above Top or casino)
9. TOP OF CASING IS 2 FT: -Above Land Surface'
'Top of casing terminated svor below lend surface requires • variance in accor-
dance with MIA NCAC 2C arts
10. YIELD (gpm): —0— METHOD OF TEST By Air Test
11. WATER ZONES (depth):
O
12. CHLORINATION: Type hth Tabs Amount
13. CASING:
_ 0
CO o
If additional space is needed use back of form
Weil Thickness
SKETCH
Depth Diameter or Weight/Ft. Material (Show direction and distance from Al least two Stale
From 0 To 40 Ft 6 PVC _ Plas tic Roads, or other map reference points)
From To Ft
From To Ft
14, GROUT:
Depth Material Method
From 0 To 20 Ft Grout Poured
From To Ft
15. SCREEN
Depth Diameter Slot Size Material
From To Ft _ In _ in
From To _ Ft In _ In. _
From To Ft In In
16. SAND/GRAVEL PACK:
Depth Size Material
From To Ft
From To FL
17. REMARKS:
J o
1 N a-qt
tfieti
S
E
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE`WITH I 5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS U EN�%'ROVIDED TO THE WELL OWNER.
FOR OFFICE USE ONLY
Quad No:
Serial No.
Agra-
SIGNATURE OF PERSON GONSTr'ING THE WELL DATE
Submit original to Division of Water Quality. Groundwater Section within 30 days
cW t fi€V p3rz000
08-29-01

North Carolina • Department of Environment and Natural Resources • Division of Water Quality - (9rnundwater Section
1636 Mail Service Center • Raleigh, N.C. 27699.1636-Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR: Hirkory WQ7I Drilling Co.
WELL CONTRACTOR CSRTIFICATIQN *: 2343
STATE WELL CONSTRUCTION PERMIT*:
1 . WELL USE (Check Applicable Sox): Residential Cl.Municipal 0 Industrial [Ti Agricultural 0 Monitoring []
Recovery ❑ Heal Pump Water Injection ❑ Other ❑ II Other, List Use-
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town. Morgpnton County. Burke
7357 Wrr aior Fork Trail
(Road Name and Numbers, Community, or Subdivision .nd1p1 Na) DEPTH DRILLING LOG
3. OWNER Alvin Smith from, In rrnnallon Description
Address 2357 Warrior FTrail
(reel or Route N6Qor
Morganton NC 28655
City or Town State Zip Cods
4. DATE DRILLED Q8-3n-r11-
5. TOTAL DEPTH 505
6. CUTTINGS COLLECTED YES 0 NOM
7. DOES WELL REPLACE EXISTING WELL? YES gX] NOD
8. STATIC WATER LEVEL Below Top of Cuing y3 F I I.
(the TO if Above Trip er Casino(
9. TOP OF CASING IS 2 FT. Above Land Surface'
Sop or easing terminaled et/or below lend sultana requloe a variance In atoor•
dance with ifA NCAC 2C 911e B Air Test
10. YIELD (ppm): 7+ METHOD OF TEST Y
11. WATER ZONES (depth)' ---
r.
'c
_ c
o 0T
W •gym
Cn
0
CO o
- z -
12. CHLORINATION: Type hth Tam Amount 95-._ _-. If additional space is needed use back CI form
13. CASING: --
Well Thickness
Depth Diameter or WeighUFt. Materiel
From 0 To 101 F1 6 PVC Plastic
From To Ft
From To Ft
14. GROUT:
Depth Material M I d
From 0 To 20 F1 Grout PoutQec
From To Ft
15. SCREEN:
237272
LOCATION SKETCH
(Show dbection and distance from al least two State
Roads. of other map reference points)
N of rr ccrfcc-
4///4/ Z
Depth Diameter Slot Size Material it)
From . To Fl _ in _ in
From To — Ft . in in
From To .___ Ft _ in in.
16. SAND/GRAVEL PACK:
Depth Size Materiel
From To F1
From To Ft
17. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCT ED IN ACCORDANCE WITH 15A NCAC 2C, WE L.
CONSTRUCTION STANDARDS. AND THAT A COPY OF THIS RECORD HAS BEET VIDEO TO THE WELL OWNER.
09-10-nt
SIGNATURE OF PERSON CONSTRUCT . E WELL DAlF
SulNnil original In Division of Wale, Quality. Groun0watpr Srolinn within 30 days
OW.I REV. 03/7000
FOR OFFICE USE ONLY
Quad No
Serial No.

North Carolina • Department of Environment and Natural Resources • Division of Water Gustav . Groundwater Section
1636 Mail Service Center • Raleigh. N.C. 27099-1638-Phone [phone]
237271
WELL CONSTRUCTION RECORD
WELL CONTRACTOR: Hickory Well Drilling Co.
WELL CONTRACTOR CERT1FICATIdN *: 2343
STATE WELL CONSTRUCTION PERMIT*:
1 . WELL USE (Check Applloable Box): Residential V1 Municipal ❑ Industrial CD Agricultural E D Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other [l II Other, List Use
e
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town Morganton County. Burke
6091 Know]in.gs Chapel Rd.
(Road Name and Numbers, Community. or Subdivision cod Lrn No I DEPT I t UfIILLING LOG
3. OWNER Meg Lane
Address 2545 Holly Hills Ave
(Street or Role NO.)
Nbrganton NC 28655
City or Town State Zip Code
4. DATE DRILLED 0 4-01
6. TOTAL DEPTH 2
6. CUTTINGS COLLECTED YES n NO _ _0 �m m 7. DOES WELL REPLACE EXISTING WELL? YES r] NOE 1 _ —I c__
6. STATIC WATER LEVEL Below Top of Casing. 1F I . I o_
(Use'd II nerve Top nr Cain) .. co _.. .__..
9. TOP OF CASING IS 2 FT: Above Land Surface' :-13mom" -"
•Top of cueing terminated at/Of below land surface require' a variance !oaten,- - =C -'
rn
dance with 15A NCAC 2C .0116 _ _._ . _ __ _._�._ •� _
10. YIELD Wpm): 12 METHOD OF TEST By Air Test 0�
11. WATER ZONES (depth)
x
12. CHLORINATION: Type hth Tabs Amount _ ZZ. .. - a additional space is needed use hack of form
13. CASING:
WNI ThicknessLOCATION SKETCH
Depth Diamotar or Weiight/rl, Malarial (Sh9w dheetinn and distance tr,nn al lonst two Stain
From 0 To 60 Ft 6V' PYL_.. Plas Lic Roads, or other hap retnrance points)
From To Ft
From To Ft.
14. GROUT:
Depth Material Method
From 0 To 20 pi Grout Poured
From To Ft
15. SCREEN:
Depth Diameter Slot Size Mammal LC/
From To Ft In in
s
From To Ft in in ,
From To Ft in In tor !
16. SAND/GRAVEL PACK: ,�{{,,
Depth Size Material �`/VOt /nvc€S. cA/4W
From To Ft
From To Ft
17. REMARKS:
7 Vn
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I 5A NCAC 2C. WELL
CONSTRUCTION STANDARDS. AND THAT A COPY OF THIS RECORD HAS BEE#f'tfROVIDED TO THE WELL OWNER
FOR OFFICE USE ONLY
Quad No
Serial No.
Art-
SIQNAIURE OF PERSON COUSIn THE WEIi
Submit original to Division of Water Quality. Grou water Secl'mn within 30 days
e
09-06-01
DAtF
GW FFV 00/9000

North Carolina • Department of Environment and Natural Resources • Division of Water Ouolity - Groundwater Section
1836 Mall Service Center -Raleigh. N.C.2760-1636-Phone (gig) 733-3221
23'7270
WELL CONSTRUCTION RECORD
WELL CONTRACTOR: Hickory Well Co.
WELL CONTRACTOR CERTIFICATI8N0: 2343
STATE WELL CONSTRUCTION PERMIT.:
1 . WELL USE (Check Applicable Sox): Residential Municipal ❑ Industrial 0 Agricultural 0 Monitoring ElRecovery ❑ Heat Pump Water Injection Other r] II Other, List Una
2. WELL LOCATION; jf$hpw sketch of the location below) Burke
Town: Hlldebran County . -. — -- --.-
212 3rd ST. SE
(goad Name and Numbers, Community. or Subdivision and Let No ) DEPTH UI 11lLING LOG
3. OWNER Thomas Webber From in rnorwlnn Description
Address S _ -
lif
Hildebran �i ar Aa (Io.) 28637
City or Town State Zip Code
4. DATE DRILLED 08-30-01
5. TOTAL DEPTH 345
6. CUTTINGS COLLECTED YES n NOX]
7. DOES WELL REPLACE EXISTING WELL? YES ED Nor]
8. STATIC WATER LEVEL Below Top of Casing. _5a
(UM •.• If Above Top of Casing)
9. TOP OF CASING IS 2 FT:' Above Land Surface'
'Top of casino terminated et/or below land surface requires a variance In accor-
dance with 1SA NCAC 7QA11$
10. YIELD wpm): METHOD OF TEST By Air Test
11. WATER ZONES (depth):
12. CHLORINATION: Type hth Tabs Amount __U.___. __
13. CASING:
O
a—
O �?
¢r
c
co 9-c
3 m rr
tV
If additional space is needed use back of to
Wall Thickness
SKETCH
Depth Di 5ter or Weight/Ft. Material (Show direction and distance from nt least Iwo Slate
0 48 6 PVC Plastic
From To Fl ------------- Roads, or other map reference points)
From To Ft
From To Ft
14. GROUT:
Depth Material Method
From To 70 Ft Grout Poured
From To Ft
15. SCREEN:
Depth Diameter Slot Size Material
From To Ft _ � In in
From To Pt In __ in.
From To Ft in In.
16. SAND/GRAVEL PACK:
Depth Size Material
From To Ft
From To Ft
17. REMARKS:
3 (die
sr
f�
U
NA'&Rl
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH t 5A NCAC 2C. WELL
CONSTRUCTION STANDARDS. AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED Tg'r1t4E WELL OWNER.
09-04-01
FOR OFFICE USE ONLY
Quad No
7NSIAl
Serial No.
SIGNATURE OF PER, rbN CCFSTRUCTING 1HE WE 1p1 DATE
Submit original to Division 01 Wale' Ousllty, Groundwater Section w
30 days
GW.t REV. 01/2000

North Carolina - Departmapt of Environment and Natural Resources - Division of Water Quality • Groundwater Section
1838 Mail Service Cenlekr alaiph, N.C. 27690-1838-Phone (01e) 733-3221 O r�
r,.N.: 37260
WELL CONSTRUCTION RECORD WELL CONTRACTOR: Hirknry Wel 1 Dr1.Llslg Co.
zkw , WELL CONTRACTOR CERTIFICATION I: 2343
STATE WELL CONSTRUCTION PERMIT*:
1. WELL USE (Check Applicable Box): Residentafin Municipal [] Industrial ❑ Agricultural © Monitoring ❑
Recovery ❑ • Heat Pump Water Injection ❑ Other f j If Other, List Use:
2. WELL LOCATION: (Show sketah of the location below)
Nearest Town Nebo County diULke
Hwy 126 East
(Road Name end Numbers. Community. or Subdivision end Irol No) DEPTH DRILLING LOG
3. OWNER John & tharlotte McMillan From To rrnmallnn Dcscriptton
Address for a 3t �� t
Nahn NC 28761
City of Town State Zip Code
4. DATE DRILLED 08-03-01
6. TOTAL DEPTH 605
8. CUTTINGS COLLECTED YES Q NOj
7. DOES WELL REPLACE EXISTING WELL? YES F) NOP)
8. STATIC WATER LEVEL Below Top of Casing 50 Fl .
(Use'.' II Above Top or Casino)
0. TOP OF CASING IS 2 FT. Above Land Surface`
Top or casing terminated Win below lend eur6eoe require a v.rl.nca in actor -
dance with 15A NCAC 2C .0116
10. YIELD (gem): 1 METHOD OF TEST By A.]_ Test
11. WATER ZONES (depth):
12. CHLORINATION: Type hth Tabs Amount 117
13. CASING:
Wall Thickness
From 0 DTpclh 81 Ft comma; pratghL/Fl. i eeai
From To Ft b�' l� 11V
From To Ft
14. GROUT:
Depth Material Method
From 0 To 20 Ft Grout Poured
From To Ft
15. SCREEN:
Depth Diameter Slot Siza Material
From . To Ft In in
From To Ft Ip In
From To ._— Ft in In
18. SAND/GRAVEL PACK:
Depth Size Material
From To Ft
From • To Ft
17. REMARKS:
C
w
0
c.)
H cz
=
If additional space is needed use back of lorrn
LOCATION SKETCH
(Show direction and distance from al least two State
Roads, or other rnap reference points)
N
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 BE OVIDED TO THE WELL. OWNER.
FOR OFFICE USE ONLY
Quad No.
Serial No.
SIGNA UREOF rg.ON CONSTRU .- . HE WELL DATE
Submit original to Division of Waler Quality, Groundwater Section within 30 days
OW -I REV, 03/2000
08-14-01

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
P.O. Box 29578 - Raleigh, N.C. 27626-0578-Pho e [phone]
WELL CONSTRUCTION RECORD DRILLING CONTRACTOR:
DRILLER REGISTRATION #: a!�
STATE WELL CONSTRUCTION PERMIT#:
2:'9243
1. WELL USE (Check Applicable Box): Residential L7 Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other If Other, List Use:
2. WELL LOCATION: (Show sk9tch of the location below) C �'
Nearest Town: ft o% (!7/f97 yt /�11l�, County' ,�•%'-) rc
(Road, Community, or Subdivision and Lot No.)
3. OWNER r/rodn-g
ADDRESS
(Street or Route No.)
l 0 t1Loff, •J%
City or Town State Zip Code
4. DATE DRILLED tie 9' 01
5. TOTAL DEPTH 410'r
6. CUTTINGS COLLECTED YES 0 NOF
7. DOES WELL REPLACE EXISTING WELL? YES Q NOR(
8. STATIC WATER LEVEL Below Top of Casing: SO FT.
DEPTH
From To
(Use'+• if Above Top of Casing)
9. TOP OF CASING IS I FT. Above Land Surface
• Casing Terminated at/or below land surface is illegal unless a variance is issued
in accordance with 15A NCeiC 2C .0118
10. YIELD (gpm). t METHOD OF TEST /$'/ g
11. WATER ZONES (depth)* !f z9 f3 i GI -1 &o
12. CHLORINATION: Type C2 a rcx Amount V y 1 J
13. CASING: I
From
14. GROUT:
Wall Thickness
Depth Diameter or Weight/Ft Material
From To Ft
From P To Ft.
To Ft
Depth Material
From To Ft.
From C To _02//)_Ft. %VLF
15. SCREEN:
Method
Depth Diameter Slot Size Material
From To Ft in
From To Ft in
From To Ft in
16. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
in
in
in
From To Ft
17. REMARKS:
/St "
DRILLING LOG
Formation Description
Jjf(J
ti died le zoc4
6 Jere
rat o
7s �m
M1l
rn
a '�
If additional space is needed use back ( fomicel
fna
LOCATION SKETCH tV o
Z
(Show direction and distance from at least two State
Roads, or other map reference points)
4 v le
I DO HEREBY C
CONSTRUCTIC I
FOR OFFICE U
Quad No.
Serial No*
f
lL•kT,{IBnk +e •i&JAISA CS
QP t.p�
.—• SIGNATUR
Crourdwate. Section
DUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
THIS RECORD BEEN PROVIDED TO THE WELL OWNER.
�C
r Ito
Submit orig
Di
J�7RACTOR OR AGENT
sion of Water Quality and copy to well owner.
GW-1 REV. 1/98
DATE
Asheville Regional Office

North Carolina • Departm.m of Environment and Natural Resources - Division of Water Quality • Groundwater Section
1636 Mall Service Center ?Raleigh. N.C. 27699-1638•PFane [phone]
AA3rl n112
WELL CONSTRUCTION RECORD WELL CONTRACTOR• Hickory Well Drilling Co.
WELL CONTRACTOR CERTIFICATIbiN S: 2343
STATE WELL CONSTRUCTION PERMITS:
1 . WELL USE (chock Appicaata box): Residential El Municipal ❑ Industrial El Agricultural El Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other El II Other, List Use•
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: More/inton county. _Burke_
1L1.31 Indian Trai1
(Road Name end Nurnberg. Community. or Subdivision and Lot NO) DEPTH URILLING LOG
S. OWNER Rob Harrigan Fmm Tn r'nnnalion Deacdption
Address 1431 Indian Trail
(Street or Route b.)
Morganton NC 28655
City or own Slats Zip Code
4. DATE DRILLED 07-25-01
5. TOTAL OEFiTH 4U5
6. CUTTINGS COLLECTED YES El NO[ X)
7. DOES WELL REPLACE EXISTING WELL? YES NOn
8. STATIC WATER LEVEL Below Top of Casing: 56 FT.
cuss '.' It Above Top of Casing)
9. TOP OF CASING IS 2 FP'Above Land Surface'
'Top or casing terminated et/or below lend surface requires . variance In accor-
dance with 15A NCAC 2C .0118
10. YIELD (pm): 7-- METHOD OF TESTay Air Tu t
11. WATER ZONES (depth):
12. CHLORINATION: Type hth Tabs
13, CASING:
Amount
O
—1_ o<
CO
yo
rr°i
—y.
Cd -6-
II additional space is needed use back of form
Wall Thickness
SKETCH
Depth Giarppa1er ipr�Y�,l�siphVFl. ,¢{eternal . (Show direction and distance from al least Iwo Slate
0 From To 79 Ft ` ' ' r1aS L1C Roads, or other map relerence points)
From To Ft
From To Ft
14. GROUT:
Depth Material Method
From _0 To 20 Ft Grout Poured
From To Ft
15. SCREEN:
Depth Diameter Slot Size Material
From To Ft _ In In
From To Ft In in
From To _ Ft in In.
16. SAND/GRAVEL PACK:
Depth Size Material
From To Ft
From To Ft
17. REMARKS:
U,
Ivy /8/
5-
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCOR ITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS. AND THAT A COPY OF TI D HAS OVIDED TO THE WELL OWNER.
FOR OFFICE USE ONLY
Quad No
Serial No.
0 21-01
SIGNATURE OF PERSON CONSTRUCTING IRE WELL DATE
Submit original to Divialon Of Water Duality, Groundwater section within 30 days
GW-I REV. 03/2000

North Carolina - Department of Environment and Natural Reeources - Division of Water Duality • Groundwater Section
1636 Mall Service Center,. Raleigh, N.C. 2760¢1638-Phone [phone]
WELL CONSTRUCTION RECORD
237261
WELL CONTRACTOR: Hickory Well Drilling- Co.
WELL CONTRACTOR CERTIFICAT16N N: 2343
STATE WELL CONSTRUCTION PERMIT#:
1 . WELL USE (Check Applicable Boa): Residential fled. Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring El
Recovery ❑ Heal Pump Water Injection ❑ Other ❑ If Other, List Uan
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: Morganton County- Burke
384311vder Ct.
(Road Name and Numbers, Community. or Subdivision and lot No )
3. OWNER Russell Linn
Address 232 Falls St. ATt. E
et (streor Route o,)
Morganton NC 28655
City or Town Slate Zip Code
4. DATE DRILLED 07-05-01
5. TOTAL DEPTH Lin
6. CUTTINGS COLLECTED YES E] NO®
7. DOES WELL REPLACE EXISTING WELL? YES (l NO®
8. STATIC WATER LEVEL Below Top of Casing. _ 94 Ft.
(Use'.' If Above Top or Casing)
9. TOP OF CASING IS 2 FT: Above Land Surface'
'Top of caslna terminated aVor below lend surface requires a variance In accor-
dance with 1SA NCAC 2C al la
10. YIELD (Qom): 5 A6METHO0 OF TEST
11. WATER ZONES (depth):
DEPTH DRILLING LOG
From in rornalion Description
12. CHLORINATION: Type hth Tabs Amount 78_ — II additional space is needed use back oETrm
13. CASING:
Wall Thickness LOCATION SKETCH
0 99 Depth DjaPygier orlvewhvFt. Mriial (Show direction and distance from al least two State
From To FI y V Gat V. Steel Roads, or other map reference points)
From To Ft
From To Ft
14, GROUT:
Depth
From To 20 Ft Grout Poured_
From To Ft
15. SCREEN:
Material Method
Depth Diameter Slot Size Material
From To Ft _ In in
From To Ft In
From To Ft In
16. SAND/GRAVEL PACK:
Depth Size Material
In
In.
From To Ft
From To Ft.
17. REMARKS:
N
� •rf �� 1-1/
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 8ROVIDEO TO THE WELL OWNER
MACCPurevi
FOR OFFICE USE ONLY
Clued No'
Serial No.
08-16-01
SIGNATURE OF PERSON CONSTRjt.Tf THE WELL DATE
Submit original to Division of Water Ouellly. Groundwater Section within 30 days
GW.I 11EV 03/2000

North Carolina - Department of Environment end Natural Resources - Division of Water Quality • Groundwater Section
1636 Mail Service Center.: Raleigh, N.C. 27609-1636-Phone [phone]
237255
WELL CONSTRUCTION RECORD WELL CONTRACTOR: Hickory Well Drilling Co.
WELL CONTRACTOR CERTIFICATION.: 7 141
STATE WELL CONSTRUCTION PERMIT.:
1. WELL USE (Check Applicable Box): Residential ® Municipal 0 Industrial ❑ Agricultural El Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATION: (Show eketah of the location below)
Nearest Town: Morganton County. Burke
Irish Creek Rd.
(Road Name and Numbers, Community. or Subdivision and yet No ) DEPT H DRILLING LOG
3. OWNER Clarenre Wi seman From 10
Address 18161 Poston Ave.
(Street or Route NQ,L
Port Charlotte pi
33948
City or Town State Zip Code
4. DATE DRILLED 07-23-01
5. TOTAL DEPTH ?LS
6. CUTTINGS COLLECTED YES Q NO®
7. DOES WELL REPLACE EXISTING WELL? YES ® NO fl
8. STATIC WATER LEVEL Below Top of Casing: 13 Ff.
(Use'.' II Above Top of Casing)
B. TOP OR CASINO IS 2 FT. Above Lend Surface'
'Top of casing terminated et/or below lend aur('aea requires a variance In accor-
dance with 15A .CAC 2C rie
10. YIELD (gpm): METHOD OF TEST GPM
11. WATER ZONES (depth):
FnmYlinn Description
-0--
12. CHLORINATION: Type hth Tabs Amount 49 If additional space is needed use back of loin 0 z
13, CASING: — .4—no
LOCATION SKETCH
Wall Thickness
Depth Diameter or Weight/Ft. Malarial (Show direction and distance from at least two State
From n To 58 Ft 6 :rr Galv. Steel Roads, or other map reference points)
From To Ft
From To Ft
14. GROUT:
Depth Material Method
From 0 To 20 Ft Grout Poured
From To Ft
15, SCREEN:
Depth Diameter Slot Size Material
From To Ft _ In in.
From To Ft
From To _ Ft
16. SAND/GRAVEL PACK:
Depth Size Material
From To Ft
From - To Ft.
17. REMARKS:
,in in
In In
N
o
S
e__._ G// Wet
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAG 2C. WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN •ROVIDED TO THE WELL OWNER.
FOR OFFICE USE ONLY
Quad No
Serial No.
07-25-01
SIGNATURE OF SON ON ` • TING THE WELL DATE
Submit original to Division of Water Ouslity. Grou -- - - clion within 30 days
GW.I REV. 03/2000

North Carolina • Deputiket
1638 Mall Service
WELL CONS
gf;EnWenment and Natural Resources • Division of Water Quality - Groundwater Section
N.C. 27809-1636-Phone [phone]
ION"RECORD WELL corrTRAcroR•
WELL CONTRACTOR CERTIFICATION I:
STATE WELL CONSTRUCTION PERMITS:
237258
Hickory Well Drilling Co.
2343
1. WELL USE toast -Applabw box): Resldential _ Munioipal Industrial ElAgricultural0 Monitoring ❑
Recovery ❑ 4.:.Heat Pump Water Injection LJ Other If Other, List Use:
2. WELL LOCATION;:(Sholly eketdh of the location below)
Nearest Town: CCoonnellly Springs County: Burke
5487 Old N.C. 18
(Road Nana end Numbers. Community, or Sub6vision and Ipl No.)
3. OWNER Carl R Dorothy Cook •
Address 5487 Old NC 18
Connelly Springs` rye Nbl(1C 28612
City or Town Slate
4. DATE DRILLED`^d7-26-01
5. TOTAL DEPTH' L1f15
6. CUTTINGS COLLECTED YES E] NO®
7. DOES WELL REPLACE EXISTING WELL? YESf�Ii NOn
8. STATIC WATER LEVEL Below Top of Casing: 5U , FT.
Nee •.• II Above Top a Casino)
9, TOP OF CASING IS 2 FT. Above Land Surface'
•Tap of easing Nrmma$. War (Nlew lend audios require• a vrleneq In aNOr-
denoe with 11A NOAO 20 *OM
10. YIELD (gpm)• 2:5 METHOD OF TEST By Air Tes t
11. WATER ZONES (depth).
rip Code
12. CHLORINATION: Type hth Tabs
13. CASING:
Amount 72
DEPTH
From To
DRILLING LOG
Formation Description
C
C
O -_�
cc,
f Ica
ct FE E
-D
3 �U
M s.
tV m�
-4
If additional space is needed use back of jowl ~
0
Wall ThicknessLOCATION SKETCH
0 Dept er i9h/Ft. Pawt (Show direction and distance from at least two State
From . TO j2 Ft ��� s 1C Roads, or other map reference points)
From To Ft
From To Ft
14. GROUT:
Depth Material
From 0 To'20 Fl Grout
From
15. SCREEN:
Method
Poured
Depth,K,;,; Diameter Slot Size Material u/ ¶
From To '' Ft In in From To ' _ " Ft In In d? tL
From To " Ft do In
16. SAND/GRAVEL PACK:
Depth' ; Size Malarial
From To Ft
From To"'. Ft
17. REMARKS: ' M'"
Al
E
I DO HEREBY CERT.IPY'THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE
CONSTRUCTION STANQARDS. AND THAT A COPY OF THIS RECORD HAS BE
FOR OFFICE USE ()icy
,
Quad No
'v
Serial No.
SIGNATUAir
RE OP PERSON CONSTRUCT'
15A NCAC 2C. WELL
IDED TO 'THE WELL OWNER.
08-07-01
G THE WELL
Submit original to Division of Water Quality, Groundwater Section within 30 days
DATE
GW-1 REV. 032000

WELL CONSTRUCTION RECORD
236029
North Carolina -Department of Environment and Natural Resouoert - Division d Watr Quality - Groundwater Section
183E Mail Serotoe Center- Raleigh, N.C. 27689-1636 - Phone [phone]
WELL CONTRACTOR: di, i // �y
WELL CONTRACTOR CE FIC�• ATION t , 'Sots
STATE WELL CONSTRUCTION PERMIT*
1. WELL USE (Check Applicable Sac): Residendd ® Municipal 0 IndushW ❑ Agricultural 0
Recovery 0 Heat Pump Water Injection 0 Other ❑ 6 Other, List Use:
2. WELL LOCATION: (Show sketch of the location below) �%ff
Nand Term: � /er :Spt.n9c Caner. !) irkQ
*IL env, M1 99 2.ewe Nw4e, ar all taiNs) DRILLING LOG DEPTH
Monitoring 0
3. OWNER camp.y,4
Address 99ha�nI Ake
eem/r kJs ,^�
Vj
4. DATE DRILLED % / / err
5. TOTAL DEPTH — • Ft.
6. CUTTINGS COLLECTED YES 0 NO la
7. DOES WELL REPLACE EXISTING WELL? YES 0 NO,[a
8. STATIC WATER LEVEL Below top of Casing so FT.
Noire rMon TTofOri9)
9. TOP OF CASTING IS / FT. Above Land Strfeca'
In Weft reei.dN Soreel.rbrad .err refried a .it... In ear.
. dseM 1MNGIC 2C Aire �
10. YIELD (prep): A"METHOD OF TEST !4 v"
11 WATER ZONES (depth):
12. CHLORINATION: Type 7 1/eh Amount 29
13. CASING
Wallas
From fi 1 DepthTo ammeter
Ft, ammeter Or WeigIS t. 4 rotprrudSC)r
From To Ft.
From To Ft.
14. GROUT:
MAIM
From D DTo 20 Ft. tew'tg aura
From To Ft.
13. SCREEN:
Depth Ovens Slot S)a Maids
From To Ft. In. In.
From To Ft. in. In.
From To Ft. in. in.
16. SANO RAVEL PACK:
Depth Sn
From To Ft.
From To Ft.
17. REMARKS:
Ram Ts FeenteeDeseplee
6- 7/
7/1-72/5- an
U
Jrn
CO
Reddenispealeneededrebarer ben z
C.)
LOCATION St TCH .
(Mar dlndbe end d ce from a hd Dote
Reeds, et ether map nPrenee pekes)
rye Titles,
Moyer
•2,sr/c
tee a
Mdaw
I DO HERESY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE V8TH 1SA NCAC 2C, WELL CONSTRUCTIONS
STANDARDS, AND THAT A COPY OF THIS RECORD NM BEEN PROVIDED TO TJE WELL
FOR OFFICE tME ONLY
Ord ire:
SEW Na
aeid4C 45/a/
rarteTett OF P!labON -• - • TIl1MRL
Sea rgkrrMaim ofI Vibe Opessibarasellen ankh 30imp
at NW in

�� I. vdiwum • vepanmenl al Levi T .V
1636 Mail Service Cenler- Raleigh. NC JGna.lru-Anne (�I•.11;:
WELL CONSTRUCTION RECORD WtL1.CON IItACTOR: likSK �<`t-caai� JOel! r1/r'V3
VJI:I.I. CON T ItAGI011 CERTIFICATION Al:. rx 13 �` -
STATE WELL CONSTRUCTION PERMITS,:
1.
WELL USE (Check Applicable Box): Residential IPI Municipal I I Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other L7 If Other, List Use:
2. WELL LOCATION:,�(Show sketch of the location below) (�
Nearest Town: IA • 0 en \T'A -) County �jv.ZLC�—
(Road Name and Numbers.��Community. or Subdivision and Lot No.)
3. OWNER :10cei-�T_' •0.n6c kr
R.A.y1 � )as.1,
�hr� lStreet Or^o__LLlir
City or Tow Stair <.�e lThd' 7 � y � �Qn� ort�.
4. DATE DRILLED Co" �s-G I / +T•�' `�G.
5. TOTAL DEPTH
6. CUTTINGS COLLECTED YES Li NO[r
7. DOES WELL REPLACE EXISTING WELL? YES NOR
8. STATIC WATER LEVEL Below Top of Casing: n Fr.
(Use'+• it Above Top of Casing)
9. TOP OF CASING IS J FT. Above Land Surface'
*Top of cuing terminated aUor below land surface requires n vnrinoce In accor-
dance with 15A NCAC 2C .5.0
10. YIELD (gpm)• 1 METHOD OF TEST A R.
11. WATER ZONES (depth) clD (SA.) / S6 : CV)
Address
From
15. SCREEN:
DRILLING LOG DEPTH
From To Formation Description,'•,
J4I3L1
�) — So
go - 2ao
12. CHLORINATION: Type C-her.1P-- Amount 6� •
13. CASING:
Depth _ Diarr for
From To �5 Ft.
From cfs To Ft `-
From To Ft
14. GROUT:
Wall Thickness
or Weight/rl. ktalenat
�h.csb
. i38 c-Slrat,
%$ .4e- reek
If additional space is needed use back of form
Depth Material Method _1
From C TogC) Ft S ' per __TcA)Aec�--
To Ft J
Depth
From To
From To
From To
16. SAND/GRAVEL PACK:
Depth
To
To
From
From
17. REMARKS:
Ft
Ft
Ft
Diameter Slot Size Material
in in.
in in
in _ in. ..
Size
Ft
Ft.
Material
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other map reference points) o
0
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACC
CONSTRUCTION STANDARDS, AND THAT A COPY OF HIS RECOR
FOR OFFICE USE ONLY
Clued No:
Sedal No.
15- NCAC 2C, WELL
0 TO THE WELL OWNER.
C
C-a6 c/
or: Or PEnsON CONSTRUC ING THE WELL DATE
of Walrr Otialily, Groundwater Section within 30 days
GW-1 REV. 12/99

North Carolina - Department of Environment and Natural Resources - Division of Water Gunllty - Groundwater Section
1636 Mail Service Center - Ratcioh, N.C. 276ng.1636.Phnne (n t n) 7a1. n,':' I
nD,f. _ / I/
WELL CONSTRUC'IION,RECO.._ WLt-LCONIRACTOrb b c/Act--a/l IceJ/-"^f/!r45
WELL CONTRACTOR CLRTIFICATION d: r2 13 3 ,
STATE WELL CONSTRUCTION PERMITS*:
2.43794
1. WELL USE (Check Applicable eon): Residential Fr Municipal n Industrial ❑
Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection j-j Other j I If Other, List Use:
2. WELL LOCATION
: (Show skel o.f the location below)
Nearest Town: 1s. County 3,0ke..
3LP2%cemen-it" TA,
(Road Name and Numbers. Community. or Subdivision and Lot No
3. OWNER
Address
W itycl Of Ro1ao No.
City or Town Stale Zip Code
4. DATE DRILLED 0-a2-ei
5. TOTAL DEPTH Pie) tt•
6. CUTTINGS COLLECTED YES Li NO
7. DOES WELL REPLACE EXISTING WELL.? YES NO '
L_I
8. STATIC WATER LEVEL Below Top of Casing: FT.
(Use'-' it Abovo Top of Casino)
9. TOP OF CASING IS t FT. Above Land Surface'
*Top of casing terminated arlor below land surlaco requires a ~inner In accor-
dance with 15A NCAC 2CA 11-a
10. YIELD (gpm)• ao METHOD OF TEST 1�
11. WATER ZONES (depth) CIO ,, S�-
DRILLING LOG
From To
53a
fear
90- /se,
12. CHLORINATION: Type .{ .k2in_Amount
oZ
13, CASING:
Wall Thickness
Depth Diameter or WeighVFt.
From ® �"To t2 Ft. 'O°
S�
From 2 To ITFt 1% - 1 �'
From To Ft
14. GROUT:
Depths 'Mated+
From is To Ft rr
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.
Method
16. SAND/GRAVEL PACK:
Depth
To
From
From
17. REMARKS:
I DO HEREBY CERTIFY THAT THIS WEL s L •
CONSTR rr. -ra t)AN6;TI-'AT u•Y
rig` j
FOR OFFI t 5Li • - e —,;' ��
Quad No:
Serial No.
a(V)$ubmi
UV.
ON
ntt' 1 10 CLHCE
a
To
Size
Ft
Ft.
Material
DEPTH
Formation Description
II 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)
NST UCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
THIS RECO ROVIDED TO THE WELL OWNER.
GNATURE OF PERSON CONSTRUCTING THE WELL DATE
to Division of Water Duality. Groundwater Section within 30 days
GW-1 REV. 12/99

North Carolina - Department of Environment and Nn Wr.1 Ponce two-. - five-.ir.n nt WmorInlay Ontity - Groundwater Section 2 4 38 3 0
1636 Mail Service Center - Raleigh, NC. 27Gna. 1 GSG.r hnno Olt)) 7:1'3 3 t
WELL CONSTRUCT ION f-tmCOitu
Wt-LL CON lit ACT OW F.s ic-/1c-F-13e// /7Oel/ ryt �lr��'1
WELL CONTRACT OR CLFITIFICATION N: cad I 3 �� v
STATE WELL CONSTRUCTION PERMITIf:
1. WELL USE (Check Applicable Box): Residential L7 Municipal n Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection [1 Other n If Olhor, List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: /Vkje hl County U
Cig ke,ntip r2c
(Road Name and Numbers. Community. or Subdivision and Lot No) DRILLING LOG
3. OWNER �ibEJ<2 % CAA -Sid Ic
Address '
(Slrpel or Houle Nq.{_ .3e) �- I g©
City or Town -, —rj 5iatn�J�J' ZTC%^rl'
4. DATE DRILLED C `2 �- 0
6. TOTALH
6. CUTTINGS
COLLECTED `YES f ) NOC1'''.---
7. DOES WELL REPLACE EXISTING WELL? YES ( J ri0
8. STATIC WATER LEVEL Below Top of Casing: FT.
(Use'+' If Abovo Top of Casino)
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 .opa
10. YIELD (gpm)• METHOD OF TEST /a-s
11. WATER ZONES (depth): I5 /60
12. CHLORINATION: Type CJIJ0R1A�e- Amount Scar.
13. CASING:
Depth
From To 30 Ft
From 30 To-3- Ft
From To Ft
14. GROUT:
Wail Thickness
Diameter or Weight/FL Maler'al
at /1c Ai2
Depth
From le, To �0 Ft
From To Ft
15. SCREEN:
From To
—30
DEPTH
Formation Deseeplion
It additional space is needed use back of form
Material Method
itL
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 HE
CONSTR
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other map reference points)
Submi
GROUND V.. A,TEP SECTIG
,ac l E__ •
NS ' UCTED IN ACCORDANCE WITH 'ISA NCAC 2C, WELL
F THIS RECOROVIDED TO THE WELL OWNER.
GNATURE OF PERSON CONSTRUCTING THE WELL DATE
to Division of Water Oualily, 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- Iglg
WELL CONTRACTOR CERTIFICATION #: a &s'S
STATE WELL CONSTRUCTION PERMIT#:
241103
1. WELL USE (Check Applicable Boa): Residential Er Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: m/a��
°r' County: guR/l2
///Luc P61€ /ere P.1
(Road Name and � Numbers, Community, or Subdivision and Lot No.) DRILLING LOG DEPTH
3. OWNER /YAReM £R R/T From To
Address Formation Description
c�6Oa ,G/�/s a
r d / s/ — 3'O gig if
/,1i�dAy
(Street or RNc.) Pa 0 / City or Town State Zip Code
4. DATE DRILLED lv -/7-0(
5. TOTAL DEPTH /
6. CUTTINGS COLLECTED YESO NOQ--
7. DOES WELL REPLACE EXISTING WELL? YES ❑ NOR
8. STATIC WATER LEVEL Below Top of Casing: ,5 F' FT.
(Uses." if Above Top of Casing)
9. TOP OF CASING IS / FT Above Land Surface'
'Top of casing terminated aUor below land surface requires a variance In accor-
dance with 15A NCAC 2C .0118
10. YIELD (gpm)•_ METHOD OF TEST
11. WATER ZONES (depth)• / 2r
12. CHLORINATION: Type ? /7r- 6
13. CASING:
Amount
sa
u
VC
�
rot
730
O
F =i
0
If additional space is needed use back of form
Wail Thickness LOCATION SKETCH
Depth Diameter or WeighVFl. M terial (S • w direction and distance from at least two State
From */ To /OD Ft C+ 3' /�!e•/"i PVC • 's, or other map reference points)
From To Ft
From To Ft
14. GROUT:
Depth ��J,,,ttfatenda1 Method
From 0 To �° Ft ,-02��"�d /1'xn"
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
17. REMARKS:
I DO HEREBY CER
CONSTRUCTION S
Material
AT THIS WELL WAS CONStRUEEN PROVIDED TO THE WELL OW ER.
$ ED IN ACCORDANCE WITH 15A NCAC 2C, WELL
DS,AMbO THAT kg PY OP_T}y RECO HAS B
■ tJ� .. -/ 7 d /
ROUND\
EVILLEE•n
TUR OF PERSON CONSTRUCTING THE WELL DATE
JAI"' loss".lsion f 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]
r_.,1.09
WELL CONSTRUCTION RECORD WELL CONTRACTOR- /$97g1
WELL CONTRACTOR CERTIFICATION #:
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE (Check Applicable Box): ResidentialEr Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other If Other, List Use:
2. WELL LOCATION: (Show sketch 3
/eetc���hof the location below) tel``
Nearest Town: integPr/'r 4 County ^' U,eh�
PA0Nv y I'd — GJ;t /'(u4� iJ &'
(Road Nan%�anndd Numbers. Community. or Subdivision and Lot No.) DRILLING LOG DEPTH
3. OWNER \/PuS
✓P( U�,Gd From To Formation Description
Address (,a yr kw ev Pc/ D — /G a �ao._J.- sJJc
street or Route o.)
(o Ph' e/%-Sp5 PC ---
City or Town State Zip Code
4. DATE DRILLED G ar-al
5. TOTAL DEPTH "6 C
6. CUTTINGS COLLECTED YES Q NOD-
7. DOES WELL REPLACE EXISTING WELL? YES D NOD
8. STATIC WATER LEVEL Below Top of Casing: ..so FT.
(Use*I- If Above Top of Casing)
9. TOP OF CASING IS - / FT Above Land Surface'
Top of casing terminated et/or below land surface requires a variance In accor-
dance with 15A NCAC 2C .0118
10. YIELD (gpm)• r METHOD OF TEST /fir �O"'r
11. WATER ZONES (depth): / 4//
12. CHLORINATION: Type Vi-r-6/97S
13. CASING:
v
O
O 70,D
Jrn
sn
r rrt
S nov
VIZ
01
Amount a 9 If additional space Is needed use back of form
Wall Thickness
Depth Diameter or Weight/Ft. Material
From"' To Ft 1�G� ""'? PUG
From To Ft.
From To Ft
14. GROUT:
Depth AMated Method
From 0 To cQ0'f Ft 4� 2 16/eel n7lie e4
From To Ft
15. SCREEN:
Depth Diameter Slot Size Material
From To Ft in in
From To Ft in In
From To Ft in In
16. SAND/GRAVEL PACK:
From
From
17. REMARN
I DO HER
CONSTRI
Si
L1
e th'�,3
Th
To Ft
FEB 1 i 2002
Material
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other map reference points)
R=
BY C RTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CTIO f''FY,f TJA COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
FOR OFF
Quad No:
Serial No.
VfUU�JI
ON l'
CI"'^:AL CFFCE
/a Ll/cx.�
SIGNATU PERSON CONSTRUCTING THE WELL DATE
Submit original to Division of Water Duality. Groundwater Section within 30 days
GW-1 REV. 12/99

North Carolina • Department of Environment and Natural Re:ni;rce - Dlveunn nl W,a1nr Ounliry - Groundwater Section 0 2 q 3 0
1636 Mail Service Censor - Raleigh, NC. 27ndd, i n:r,.r`hnnn (n 1 91 -ell :U:1 ' 7
WELL CONSTRUCTION.RECORD WLL.I.CON IHACTOIU LiSIRACI-Oei/ l-Qei/ �rC,��r+UG
WELL. CONTRACTOR CERTIFICATION N: cat' 3 �,
STATE WELL CONSTRUCTION PERMITN:
1. WELL USE (Check Applicable Box): Residential [P h1unicipal n Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection [i Other n If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below)
Near County�jOQkQ�
Nearest
Town: o ti
ra1---rzlremoa. M-4-10,
(Road Name and Numbers. Community, or Subdivision and Lot Na.) DRILLING LOG DEPTH
3. OWNER ;ak- -A- '��oot6Ot.2*JC From To Formation Description
Address iZcc vitoicA c e' - �6 ��
��'� i eat or Y7o-o Net) J4tsf, u� 2o'gi✓ s s4..., t..4-4--k, )-,
City or Tow Stain _1Zrp Coda tajr4Ljl ��4
4. DATE DRILLED 1' 2Jr•"( � .- 9 .O ut R•442J
5. TOTAL DEPTH% •
6. CUTTINGS COLLECTED Y S Li NOEI].-----
7. DOES WELL REPLACE EXISTING WELL? YES a NOFiir
6. STATIC WATER LEVEL Below Top of Casing: FT.
(use •+- it Above Top of Casing)
9. TOP OF CASING IS J FT. Above Land Surface'
'Top of casing terminated at/or below land surface requires a variance In accor-
dance with 15A NCAC 2C .0 8
10. YIELD (gpm)- METHOD OF TEST y Al2
11. WATER ZONES (depth): efD Ly 3642 #] Ca
I
12. CHLORINATION: Type S N.ie- Amount C5 . If additional space is needed use back Srm
13. CASING:
C, .J
n% 2rn
c Srn
y0
ttc:r
Wall Thickness LOCATION SKETCH
Depth . Diameter or Weight/R. Material (Show direction and distance from at least two State
From 0 To " 5. Ft `,or Y'oi Roads, or other map reference points)
From ce'� To a Ft 'c'`a
From To Ft
14. GROUT:
Depth Material Method
From 0 To a) Ft S el4eA-11- _ Gc `- -
From To Ft
15. SCREEN:
. /88 _J,4
Depth Diameter Slot Size Material
From To Ft _ in. in
From To Ft in in
. From. To Ft in .- in.
16. SAND/GRAVEL PACK:
Depth Size Material
From To Ft
From To Ft
17. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACC•"- - 15 • NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF HIS RECOR• . AS BEEN PROV r) D TO THE WELL OWNER.
FOR OFFICE USE ONLY
Quad No:
Serial No
SIGNATURE OF PERSON CONSTRUC ING THE WELL DATE
Submit original to Division of Water Quality. Groundwater Section within 30 days
GW-1 REV. 12/99
LS O L'I LS
,71

North Carolina- Department of Environment and Nature/ Resources - Ofvlalon of Water Quality • Groundwater Section
1638 Mail Sevioe Center' Raleigh. N.C. 2780a-1838-Phone [phone] . 3 I r.f O
1 A p
WELL CONSTRUCTION RECORD WELL CONTRACTOR- EHrkory Well Drilling Co.
WEI.L CONTRACTOR CERTIFICATION r: 2343
STATE WELL CONSTRUCTION PERMrr :
1. WELL USE (Check Applicable roe): ResidentlalC( Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ElIf Other, List Use:
2. WELL LOCATION: (Show akelah of the location below)
Nearest Town: Morganton County: Burke
7787 Riorlmnnt Rd
(Road Name and Numbers. Community. or Subdivision and l)ol No.) DEPTH DRILLING LOG
3. OWNER David Withrow From To Formation Description
Address 2782 Piedmont Rd.
(Street or Raul* NO,)
Morganton NC 28655
City or Town State Zip Cods
4. DATE DRILLED 06-29-01
5. TOTAL DEPTH 505
6. CUTTINGS COLLECTED • YES [] NOM
7. DOES WELL REPLACE EXISTING WELL? YES ® NOCI
8. STATIC WATER LEVEL Below Top of Casing: 70 FT.
(Usa 4• II Above Top or Casing)
9. TOP OF CASING IS 2 FT. Above Land 8urfacs•
'Top or casing *intimated atlor below land Burton requires a variance In floor -
dance with 1SA NCAC 2C .0110
10. YIELD (gpmY _] . _ METHOD OF TEST By Air Test
11. WATER ZONES (depth):
12. CHLORINATION: Type hth Tabs Amount 91
13. CASING:
Depth prtr)teter
From 0 To 62 Ft. bti
From To Ft
From To Ft.
14. GROUT:
C
co
r—v
CO
y �o
IV cn
r+l a
C
If additional space is needed use back of form
Wall TNtloass
IA/tight/Ft. rustic
LOCATION SKETCH
(Show direction and distance from al least two Slate
Roads, or other map tolerance points)
®
Depth Material Method 4
From .0 To 20 Ft Grout Poured tee ��a �F�O(�
From _ To Ft Welk 6,, tiT ,(7) y'
15. SCREEN:
Depth Diameter Slot Size Material w Wit E
From To Ft in In.
From To _ Ft. ,in in /
From To Ft in in /j /Yi0/L6wttW
16. SAND/GRAVEL PACK:
Depth Size Material
From To Ft S
From To Ft
17. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH tEA NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN P ji DEO TO THE WELL OWNER.
FOR OFFICE USE ONLY
Quad No
Sadal No.
07-05-01
SIONATUF PERSON CONSiRUCTIN ELL DATE
Submit original to DivlslOn of Water Quality, Groundwater Section within 30 days
Gw t REV. 03/2000

North Carolina • Department of Environment and Natural Resources • Division of Wator DiInlily - (;rnurnlwatgr Sococn
1636 Mail Service Center - Raleigh, N.C. 27889-1636-Phone (g10) 733 3221
WELL CONSTRUCTION RECORD WELL CONTRACTOR: Hickory Well Drilling Co.
WELL CONTRACTOR CERTIFICATION M: 2343
STATE WELL CONSTRUCTION PERMITM:
2372 )0
1 WELL USE (Check Applicable Box): Residential Wi Municipal LJ Industrial [Ti Agricultural Li Mnnitorinu [Ti
Recovery ❑ Heat Pump Water Injection ❑ Other pi II Other, List Llsn
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town' VAl r1Pse County- . Burke
Powell St.
(Road None and Numbers, Community, or Subdivision and Lot Nn l
OWNER Vue Yang / LLeader Homes FIIIIII ll'
Address 9EV PowelltorIto e )
Valdese 28690
City or Town State Zip Code
4. DATE DRILLED 06-25-01
5. TOTAL DEPTH 205 - -- - - — o
6. CUTTINGS COLLECTED YES ElNOM -- ____ ,
7. DOES WELL REPLACE EXISTING WELL? YES pi i NO _ ---.-._--_.. n o`.----
8. STATIC WATER LEVEL Below lop of Carting 6Q I- I .
(Else'.' It Move tnp nl Caning)
9. TOP OF CASING IS 2 FT, Above Land Surface'
'Top of casing terminated WO, below land surfer* ragolrer a variance II. accor-
dance with 1SA NCAC 2C .0110
11). YIELD (gpm)' 8 METHOD OF TEST By Air TeSY-
11. WATER ZONES (depth)'
DEPT It
UItILLING LOU
1 mn�?lio nett -notion
C
m o rr
>c-
� —ice
N -
rt
--I
12. CHLORINATION: Type __.b.th_Tabs . Amount -_3Q. .. If ailtihnnal splice is needed trio back of loon 2
13. CASING:
LOCATION SKETCH
Well I hickness - - - -- -- - -
Depth bi'malor or Weighl/FI_ Material (Show dnee1k'n and distance (Mn At Inast Iw; StatP
Frorn__.Q__To 56 Ft, 6 PUG Plastic Roads, or other map Inlwlanrr points)
From To Ft - - -- - -
From To Ft.
14. GROUT: .
Material Method �//Vy
From 0 Topl p 0 Grout Poured lJ
From To Ft
15. SCREEN:
Depth Diameter Slot 5i7e Material
From To Ft In in
From To Ft — ;in. - _ .. in. .
From To Ft in in
16. SAND/GRAVEL PACK:
Depth Size Material
From To Ft
From To Ft
17. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCI FD IN ACCORDANCF WITH I5A NCA!: P!;, WFI I
CONSTRUCTION STANDARDS. AND THAT A COPY OF THIS RECORD UAS BFFrj/1 (i `JII)FI) TO TI IE WEI.I OWNFF'
Aerie
FOR OFFICE USE ONLY
Quad No
Serial No.
07-12-01
SIGNAT unE OF PFRSON(1^IJS I nLI!:yh� T11E WFI I nA IF
Submit wiping! In oiviisioo of Wale, Quelily, Groundwatol 9rren,l will 30 days
OW I nFv Ill/7rtyi

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: Robin McNeely
WELL CONTRACTOR CERTIFICATION #: 2567
STATE WELL CONSTRUCTION PERMIT #:
234622
I. WELL USE (Check Applicable Box): 0 Residential ❑ Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring
❑ Recovery 0 Heat Pump Water Injection ❑ Other If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: CONLEY SPRINGS County: Burks
WADE LOWMAN RD. DRILLING LOG DEPTH
(Road Name and Numbers, Community, or Subdivision and Lot No.) From To Formation Description
3. OWNER WAYNE BOWMAN
Address 6325 WADE LOWMAN RD.
(Street or Route No.)
CONLEY SPRINGS NC 28612
City or Town State Zip Code
4. DATE DRILLED 06-29-01
5. TOTAL DEPTH 60
6. CUTTING COLLECTED 0 YES ® NO
7. DOES WELL REPLACE EXISTING WELL? ❑ YES ® NO
8. STATIC WATER LEVEL Below Top of Casing:40 FT.
(Use "+" if Above Top of Casing)
9. TOP OF CASING IS 1-1/2 FT. Above Land Surface*
'Top of casing terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2C.0118
10. YIELD (gpm): 20 METHOD OF TEST: STEELTAPE
11. WATER ZONES (depth):
12. CHLORINATION: Type: CI-ILORYTE Amount:9.2
13. CASING:
Depth Diameter
From 0 To 60 Ft. 24"
From To Ft.
From To Ft.
14. GROUT:
Depth Material Method
From 0 To 20 Ft. CEMENT POURED
From To Ft.
15. SCREEN:
Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
From To Ft. in. in.
16. SAND?GRAVEL PACK:
Depth Size Material
From 40 To 60 Ft. 6M STONE
From To Ft.
17. REMARKS:
Wall Thickness
or Weight/Ft. Material
CEMENT
If additional space is needed use back of form
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other reference points)
HWY. #I8 N. FROM FALLSTON INTO BURKE CTY. RT. ON
MILLER BRIDGE RD. ON NOBBY LAIL RD.LEFT ON WADE
LOWMAN RD. 1ST. HOUSE ON RT.
I DO CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THISRECORD HAS BEEN PROVIDED TO THE WELL OWNER.
O
C-
c
r
n
—o
CO
N
CO
FOR OFFICE USE ONLY
Quad No:
Serial No.
e oZ lr `� , ` Orre..- ( -.7 99-0ff
OF P CO STRUCTING THE WELL DATE
Submit original to Division of W r Quality, Groundwater Section within 30 days
GW-1 REV. 12/99
Groundwater Section
Asheville Regional Office

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section 2 3 4 ! 9 9
1636 Mail Service Center • Raleigh, N.C. 27699.1636-Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR- Prr'rro Lei P,'i(t'IS
WELL CONTRACTOR CERTIFICATION N:
STATE WELL CONSTRUCTION PERMITA:
1. WELL USE (Check Applicable Boa): Residential ❑ Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: County: rC (L
(Road Name and Numbers, Community. or Subdivision and Lot No.) DRILLING LOG
3. OWNER From To
Address
a '5o
30 36 5
(Street or Route No.)
City or Town State Zip Code
4. DATE DRILLED 6-30_o
5. TOTAL DEPTH
6. CUTTINGS COLLECTED YES NO❑
7. DOES WELL REPLACE EXISTING WELL? YES ❑ NOZ'
8. STATIC WATER LEVEL Below Top of Casing: $O FT.
(use'♦' if Above Top of Casing)
9. TOP OF CASING IS ( Ili FT. Above Land Surfaces
'Top of casing terminated at/or below land surface requires a variance In accor-
dance with ISA NCAC 2C .0118
10. YIELD(gpm): Li&' METHOD OF TEST et re- birwh
11. WATER ZONES (depth) S a CI r".
12. CHLORINATION. Type
13. CASING:
From
From To Ft.
From To Ft.
14. GROUT:
DEPTH
Formation Description
rfi
(u P ,6n.n, -r
-
C,
c.n
-c%
w
cn1 ,
Amount If additional space is needed use back of form z
LOCATION SKETCH
Wail Thickness
Depth ) Dlaz Iar or Weight/FL Material (Show direction and distance from at least two State
,3»
G To Ft 'r Roads, or other map reference points)
Dept Material Material Method
From To (J�( Ft. Cow reap
From To Ft
15. SCREEN:
Depth Diameter Slot Size Material
From To Ft in in
From To Ft in in
From _ To Ft. in in
16. SAND/GRAVEL PACK:
Depth Size Material
From To Ft
From To Ft.
17. REMARKS:
I O HEREBY CERTIFY THAT This WELL A COPY OF THIS RECORD HAS BEEN PROVIDED TO THEW OWNER.
UCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STi„'^",,..�.^..5.-4"!^—
r, ��
FOR OFFICE USE ft$v " ;:- . -� DATE
iy
dd t NATURE OF PERSON CONSTRUCTING THE WELL
Qued No: odgi j,'Diviswn of Water Quality. Groundwater Seaton within 30 days
Serial No.pp p 18.1
rs.,,
GW-1 REV. 12r99

North Carolina - DeparImq ..of:ErtWorwrwrd and Natural Reaouross - Division of Water Duality - Groundwater Section
1638 Mali Service Ce S RWyra N.C. 27610-1636-Phone (91g) 733-3221
233854
WELL CONSTRUCTION RECORD WELLCONTRACTOR- Hickory Well Drilling Co.
1u,
WELL CONTRACTOR CERTIFICATION it 2343
STATE WELL CONSTRUCTION PERMIT*:
1. WELL USE mesas Appkaata box); Residential ® Municipal In Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ 11 Other, LIst Use:
2. WELL LOCATION: (Show sketclh of the location below)
Noaraat Town. Valdese county. Burke
977 Powell Ave.
(Road Nam. and Number, Community, or 8ubdvisbn and Itpl No.) DEPTH DRILLING LOG
3. OWNER Vang Thao From To Formation Deeerlplion
Address 977 Powell Ave.
(Street or Route NO.) `-'
Valdese NC 28690 0 ��
City or Town State rip Code
4. DATE DRILLED 06-21-01 —r— i;(i
5. TOTAL DEPTH205 - r F.
b ❑ NO� t c
8. CUTT1Nl39C ELECTED `. YES rs1
7. DOES WELL REPLACE EXISTING WELL? YES Imo] NOD
8. STATIC WATER LEVEL Below Top of Casing: 41 Fr. 3
(Us. •.• a Asava Top of Casino) '
9. TOP OF CASING IS 2 FT. Above Land Surface' o
Top of easing tsrmMated ado/ below land aur%.a newton . vW.na. In saeor-
deno. with 1SA NCAC SC OM
10, YIELD (gpm)• 8 METHOD OF TEST By Air Test
11. WATER ZONES (depth).
1-1
12. CHLORINATION: Type hth Tabs Amount 34
13. CASING:
0 Depth 75 pjaquhr or.WaelaMJFI. ieriaf (Show direction and distance from at least two State
From To Flo bb� ll�' l� Roads, or other map reference points)
From To Ft
From To Ft. /V
14. GROUT:
Depth Material Method /./ 71) 7?.tiri teje
From 0 To 20 Fi Grout Poured
W .N
co A
If additional space la needed use back of form
From To Ft
15. SCREEN:
Wall Thames
SKETCH
Depth Diameter Slot Size Material
From To P1 In in
From To Ft 1n In
From To Ft. In in
18. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
til
?pvJt4 pHE.
T S
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 BE ROVIDED TO THE WELL OWNER.
FOR OFFICE USE
Quad No:
Serial No.
i_ 810INATURE OP PERSON CONSTR
Suomi) odpir)al lbtlivision of Water Duality, Guru
rALG 2 4 2001 I j I
;�-
THE WELL
star section within 30 days
6-27-01
DATE
OW1 REV. 03/2000

North Carolina • Department of Environment and Natural Resource. - Division of Water Quality • Groundwater Section
1838 Mall Service Centete•RWiph, N.C. 27609-1036-Phone [phone]
233853
City or Town State
DATE DRILLED 06-1 R-Q]
TOTAL DEPT¢( 265
WELL CONSTRUCTION RECORD
WELL CONTRACTOR- Hickory Well Drilling Co.
WELL CONTRACTOR CERTIFICATION e: 9 143
STATE WELL CONSTRUCTION PERMITe:
1. WELL USE (check Applicable boa): Residential Municipal ❑ Industrial 0 Agricultural Cl Monitoring Cl
Recovery ❑ Heat Pump Water Injection ❑ Other 0 If Other, List Use:
2. WELL LOCATION: (Show aketoh of the location below)
Nearest Town: Morganton County -
(Road
4126 _Baptist Camp Rd.
(Road Name end Numbers, Community, or Subdivision and rat No DEPTH DRILLING LOG
3. OWNER Flrtwr Wrig1t From To Formation Description
Address 4126 Baptist Camp Rd.
(akeel or Roufi Ne.J
Connelly Springs NC 28612
4.
5.
6. CUTTINGS CbLLECTEP + YES ❑ NO 7
7. DOES WELL REPLACE EXISTING WELL? YES ® NOD
8. STATIC WATER LEVEL Below Top of Casing' Sf1 FT.
(Use r.' a Above rep of Cuing)
9. TOP OF CASING IS 2 FT. Above Land Surface'
'Top of casing terminaled allot below land surface requitals variance In seeor-
dance with 1SA NCAC 2C .011e
10. YIELD (gpm): _ 1 rl METHOD OF TEST By 4ir Test
11. WATER ZONES (depth): N)
W
Zip Code
0
CO
n
ram- Cc'
01 rr
f,.
C.)
12. CHLORINATION: Type hth Tahs Amount 45 If additional space is needed use back of form
13. CASING:
Will Tbtkkltau LOCATION SKETCH
Depth Diameter or Weight/Ft. Material (Show direction end distance from al least Iwo State
From 0 To 104 Ft 61/4nr PVC Plas tic Roads, or other map reference points)
From To Ft
From To Ft
14. GROUT:
Depth Material Method
From _In To _20_ Ft Crni tt Poured_
From To Ft
15. SCREEN:
Depth Diameter Slot Size Material
From To Ft In in
From — To Ft. _ In In
From To Ft In In
16. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft
17. REMARKS:
4
E
i8
L�6''wet,
s
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS SEEN PRO) D TO THE WELL OWNER.
FOR OFFICE USE ONLY
Quad No:
Serial No.
` - i� 4ICNATURE OF PERSON CONSTRUCTING DATE
Submit original te Division of Water Duality, Groundwater Section within 30 days
UG 2 4 ?fifli OW.I REV. 03/2000
06-22-01

North Carolina - Department of Environment and Natural Resources - Division of Water Duality - Groundwater Section
1638 Mall Service Center; Raleigh. N.C.2?sn-1e38-Phone [phone]
233851
28602
Zip Code
WELL CONSTRUCTION RECORD WELL CONTRACTOR- Hickory Well Drilling Co.
WELL CONTRACTOR CERTIFICATION *: 2343
STATE WELL CONSTRUCTION PERMIT*:
4
1. WELL USE (check Applicable box); Residenealtn Municipal 0 Industrial[] Agricultural C] Monitoring ❑
Recovery C] Heat Pump Water Injection ❑ Other II Other, List Use:
2. WELL LOCATION: (Show aketo4l of the location below)
Nearest Town- Hi ldebran County. Burke
1730 Wilkies Grove Ch. Rd.
(Road Name and Numbers. Community. or Subdivision and 1pt No.)
3. OWNER Zel la Hudson
Address 1730 Wilkies Grove Ch. Rd.
Hickory . i (aireet p(Fioule Ne.)
City or Town - ' State
4. DATE DRILLED 06-12-01
5. TOTAL DEPTH 20S
6. CUTTINGS CbLLECTED YES Q NO[
7. DOES WELL REPLACE EXISTING WELL? YES rn NOQ
8. STATIC WATER LEVEL Below Top of Casing: 60 FT•
(use •e• a Above Top a Calling)6. TOP OF CASING IS 2 FT Above Land Surface'
'Top or casing terminated et/or below land surlaoe squires a vrianca In accor-
dance with 111A NCAC 2C .011e
10. YIELD (gpm): 2r METHOD OF TEST Ry Air Test
11. WATER ZONES (depth)'
DEPTH DRILLING LOG
From To Formation Description
12. CHLORINATION: Type hth Tabs Amount 30
13. CASING:
o
r
ra c- <.-.
U1
>0
r*i __
rn
IN)
cox
c)
co o
r
If additional space is needed use back of form
Wall Thickness
LOCATION SKETCH
Depth Diamner or Weight/Ft. Material (Show direction and distance from ai least two State
From 0 To 64 Ft 63" PVC Plastic Roads, or other map relerence points)
From To Ft
From To Ft.
14. GROUT:
Depth Material Meths
From 0 To 20 Ft Grout Poured
From To Ft
15, SCREEN:
Depth
From To Ft
From _ To Ft.
From — To Ft
16. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft
17. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEE VIDED TO THE WELL OWNER.
Diameter Slot Size Material =m
In in
In In
in in
i
1"tL1 LL
N
ca. wood
sat fa'
E
FOR OFFICE USE ONL
Quad No:
Elan& No.
(, ,11 (tl1nar' 06-19-01
i5 (� I'SI •IA1 lE OF PERSON CONSTRUE E WELL DATE
Submd mitirnallo p nslph of Water Duality, Groundwater section within 30 days
AUG 2 4 7f[l
GW-1 REV. 03/2000

234683
FOR OFFICE USE 0
Quad No:
Serial No.
3.
O
Address
OWNER
/�J
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• (rCC 1 W/I /�{'/Gn
WELL CONTRACTOR C RTIFICATION S: Pi)
STATE WELL CONSTRUCTION PERMITS:
1. WELL USE (chock Applicable Box): Residential Municipal ❑ Industrial ❑ Agricultural CI Monitoring El
Recovery ❑ Heat Pump Water Injection El Other ❑ If Other, List Use:
2. WELL LOCATION: (Show s etch of the Ipcation below)
Nearest Town: &/c4n-. .1P nC County:
(Road Name an Numbers• Community. or Subdivision and Lot No.)
1 2 Lampe,
(Street or Route No.)
City or Town State Zip Code
4. DATE DRILLED
5. TOTAL DEPTH
6. CUTTINGS COLLECTED YES ❑ NOLj
7. DOES WELL REPLACE EXISTING WELL? YES or,NOD
8. STATIC WATER LEVEL Below Top of Casing: HO FT.
(Use WV Above Top of Casing)
9. TOP OF CASING IS or FT. Above Land Surface'
-Top of casing terminated et/or below land surface requires a variance In accor-
dance with 15A NCAC 2C .011 j 7i7A/
10. YIELD (gpm): 1L_ METHOD OF TEST
11. WATER ZONES (depth).
DRILLING LOG DEPTH
From To Fo lion D�plion
V y r J
Zy
4%' 766- nor C
_y
12. CHLORINATION: Type
13. CASING:
Depth q/
From O To Ft
From To Ft.
From To Ft
14. GROUT:
Darr
Amount
Wall Thickness
or Weioht(R. Material
Depth Material /
From /9 To Ft C ✓4-0.4
From To Ft
15. SCREEN:
Depth Diameter Slot Size
From To Ft
From To Ft
From To FL
16. SAND/GRAVEL PACK:
Depth
From To _ — Ft.
From —r To Ft
17. REMARKS:
in
in
In
Size
Method
Material
in
In
In
Material
C2_
c
-0 r.
r 1 N
If additional apace is needed use back of tom
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other map reference points)
I DO HEREBY CERTI .�-#Ik�'M> ? Y OFUCTED IN ACCORDANCE THISRECORD HAS SEEN PRO IDED TO THEW OWNER.
CONSTRUCTION ST ) g6 /4aC /
Cs--
s _ _ ��''yy�yy//�..���� -//-Zip
sEp I S 2nu SI��.I�t':- ERSON TRUCTINGTHE WELL DATE
Submit original •' -o Water Quality. Groundwater Section within 30 days GW-t REV. 17/99
Groundwater Section
Athevdle Re Tonal Office

North Carolina • Department of Environment and Natural Resources - Division of Water Quality • Groundwater Section
1836 Mail Service Center - Raleigh. N.C. 27699-1638-Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR• Ni rknry Wel I Dri I 1 i r g rn
WELL CONTRACTOR CERTIFICATION e: 2343
STATE WELL CONSTRUCTION PERMIT*:
1. WELL USE (Check Applicable Boa): Residential »I Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, Liel Use:
2. WELL LOCATION: (Show skelah of the location below)
Nearest Town; Morganton County- Burke
Laurel Haven Ave.
(Road Name and Numbers. Community. or Subdivision and riot No I DEPTH DRILLING LOG
3. OWNER Mary L. Carswell From To
Formation Description
Address 240 Valley Trail
(Street or RouSTie.)
Morganton NC 28655
City ofTown Slats Zip Cats
4. DATE DRILLED 05-30-01
6. TOTAL DEPTH -3b5
6. CUTTINGS CbLLECTED • YES ❑ NOEL
7. DOES WELL REPLACE EXISTING WELL? YES n NOj-R1
8. STATIC WATER LEVEL Below Top of Casing' 6T FT.
(Use'.' a Above Tarp or Casting)
9. TOP OE CASING IS 2 FT Above Land Surface'
'Top of c.aing tsrminaled War below land aortae. requires a variance In accor-
dance with 1SA NCAC 2C .0116
10. YIELD (gpm)• 2 _ METHOD OF TEST By Air _Test
11. WATER ZONES (depth).
s.--•ti• mr
fV m23
0
12. CHLORINATION: Type hth Tabs Amount 63 if additional space is needed use back of form
13. CASING:
Well Thickness
SKETCH
Depth Itropter eighVFr. Materiel (Show direction and distance from al least two Stale
From 0 To 82 Ft Plastic Roads, or other map reference points)
From To Ft
From To Ft
14. GROUT:
Depth Material Method
From . 0 To Ft Grout Poured
From To Ft
16. SCREEN:
Depth Diameter Slot Size Material
From To F1 In in
From To —Ft Jn in
From To Ft in _._ In
16. SAND/GRAVEL PACK:
Depth Size Material
From To Ft
From To Ft
til
N
A eel,
1.1
ci I,r s
17. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE . TH 15A NCAC 2C. WELL
CONSTRUCTION STANDARDS. AND THAT A COPY OF THISRECORD HAS : E 0.
parr -
FOR
OFFICE USE ONLY
Quad No
Serial No.
VIDEO TO THE WELL OWNER.
07-10-01
SIGNATURE OF PERSON OONSTRU 'G HE WELL DATE
Submit original to Division or Water Quality, Groundwater Section within 30 days
GW.1 REV. 03/2000

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 CONTRACTOR• /1ri. ha/ •ail `
WELL CONTRACTOR C TIFICATION #: �-7/3
STATE WELL CONSTRUCTION PERMIT#:
WELL CONSTRUCTION RECORD
234771
J,Vc
1. WELL USE (Chock Applicable Box): Residential to Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATION: (Shows tph of the location below)
Nearest Town: ;Of bait- County J/
(Road Name and Numbers, Community, or Su vissero�r� and Lot No.)
3. OWNER < iSnan* �ellllS'vv e G✓/vSh�n% /AY I
Address IE� Z J V [ rj`er an k ad
l�.;CaCa'`1
(Street or Haute No.) /
City or Town
1\t- rai i5(D6?—
r SnN Zp Code
4. DATE DRILLED 7 q-0 /
5. TOTAL DEPTH TO
6. CUTTINGS COLLECTED YES E NO
7. DOES WELL REPLACE EXISTING WELL? YES PT NOD
8. STATIC WATER LEVEL Below Top of Casing: 5' FT.
(Use'i a Above Top of Casing)
9. TOP OF CASING IS „itFT. Above Land Surface'
-Top of easing terminated ator below land surface requires a variance In actor -
dance with 15A NCAC 2C AM,f.rC
10. YIELD (gpm): 4 METHOD OF TEST /'' � 14_�
11. WATER ZONES (depth):
DRILLING LOG
From To
D C)
12. CHLORINATION: Type
13. CASING:
Depth G
From To
From To
From To
14. GROUT:
Amount
DEPTH
Foo tioniteecription
In .1
:
9
If additional space is needed use back of forr& c,
LOCATION SKETCH
Wall TNdMss
Diameter or
Ft —le--
Ft
Ft.
Depth
From 0 To X Ft
MateriaL—
("/h C/)
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 Material
From To — Ft.
Material (Show direction and distance from at least two State
Roads, or other map reference points)
Method /
CYea
Slot Size Material
in
in
In
Ft
From. To
17. REMARKS:
IDOHEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCT!! THAT A COPY OF TNJ RECORDi BEEN PROVIDED TO THE WELL OWNER.
S=y�ol
pE iriS LONSTRUCTING THE WELL DATE
of Water Quality, Groundwater Section within 30 days
�.,�E ...., •�
8 2001ubrttS
Groundwate, Seatl::r,-
ssh ville'troono. C` i
GWt REV. 12/99

234784
North Carolina • Department of Environment and Natural Resources - Division of Water Quail - Groundwater Section
1636 Mail Service Center - Raleigh, N.C. 27699-1636-Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR. tee Dell J%('���R
WELL CONTRACTOR C RTIFICATION #:
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE (Check Applicable Box): Residential EV Municipal ❑ Industrial ❑ Agricultural El Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other El If Other, Ust Use:
2. WELL LOCATION: (Shiny sketch of the location below)
Nearest Town: _ /1") ca)‘h County'
(Road Name and Numbers Community. or Subdivision and Lot No.)
DRILLING LOG
From DEPTH
g Format' Description
3. OWNER � g✓ CRAC)le- Tr�
Address Slat /dz /
Rou allo.
n l 57, --Litt.
.. d2PCoda t o goo Asek
City or Toys( State
4. DATE DRILLED C-/ 5'0/
5. TOTAL DEPTH urn
6. CUTTINGS COLLECTED YES ❑ NOal-----
7. DOES WELL REPLACE EXISTING WELL? YES QUO❑
8. STATIC WATER LEVEL Below Top of Casing: ,S
(Use'i if Above Top of Casing)
9. TOP OF CASING IS a- FT. Above Land Surtac
'Top of casing terminated at/or below land surface requires a variance In accor-
dance with 16A NCAC 2C .0113
10. YIELD (gpm)• .. METHOD OF TEST Art- /ccfri'
11. WATER ZONES (depth)'
12. CHLORINATION: Type
13. CASING:
Amount
If additional space Is needed use back of form
r nrrAT1ON SKETCH
Well Thickness
co Diameter or woe Material (Show direction and distance from at least two State
t'p Ft.— - .{I Pt Roads, or other map reference points)
From C � To
From To Ft
From To Ft
14. GROUT:
Depth Material Method //
From a To ri/) Ft /eaiili Ater
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:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDAROS,,AND THAT A COPY OF THIS REJORD HAS BE ROVIDED TO THE WELL OWNER.
FOR OFFICE USE ONLY SE?Goad No: -; 11 1
Serial No.
8 20th
Submit 0
i:rt ndwatef Section
Ashe the Re gnat 1cg,_ .,_..
UC 1NG THE WELL DATE
stir Duality, omundwater Section within 30 days GW-1 R.

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• � --- Aid/ Of i/9. nil
WELL CONTRACTOR C TIFICATION #: 21/3
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE (Check Applicable Bos): Residential —vtunicipaf ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATION: (Show
3. O
Address oo^��11 'j Jf /g
Sties r Houte o.) v
City or To6m l' Scats
4. DATE DRILLED D/
5. TOTAL DEPTH OC
6. CUTTINGS COLLECTED YES ❑ NOQ�
7. DOES WELL REPLACE EXISTING WELL? YES NOD
8. STATIC WATER LEVEL Below Top of Casing: /o C FT.
(Use 1f Abcws Top W Casing)
9. TOP OF CASING IS FT. Above Land Surface'
'Top of casing terminated Woe below land surface requires a variance In Joeor-
dance with 15A NCAC 2C 0 1a
10. YIELD (gpm): METHOD OF TEST v//r. /�3/c
11. WATER ZONE (depth).
- sketch of the location below) /�U//�
Nearest Town: r �+ '�t1 County /> 6{
(Road Name and Nu rs C/ommuunity, or Subdivision and Lot No.) DRILLING LOG
WNER Cf d From To
Zip Code
12. CHLORINATION. Type
13. CASING:
Amount
Wall Thickness
Depth / Dialrleter Of n Material
Ft
From To 1.._
From To Ft
From To Ft
14. GROUT:
From
From
15. SCREEN:
Depth f1 Materit— Method
To Ft
To Ft
Depth
From To
From _ To
From To _
16. SAND/GRAVEL PACK:
Depth
From To — Ft.
From To Ft.
Diameter Slot Size Material
Ft _ in — in
Ft — in. _ in
Ft. in _ in
Size Material
234785
DEPTH
Formatigq Descdpbon
�! ' /7SC
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)
17. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STAMRARDSrANQTHAT A COPY OF THIS RECD HAS BEEN OVIDEO TO THE WELL OWNER.
FOR OFFICE USE
fluid No:
Mo.
f S ONATU
8 tV80 o4&
C oundwatT Section
psheviiie onal re .__..
c
n
N CONS NO THE WELL DATE
er Duality, 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. l S� Pei/ 41v19 2r/C
WELL CONTRACTOR CERTIFICATION N: i/_.?
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE (Check Applicable Boa): Residential Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATION: (Sh sketry�' of the location below) �! p
Nearest Town:—7z-Ccrel County' f(,
(Road Name ai Npmoers,/Co�nrnunity. or Subdivision and Lot No.)
f 3. OWNER G�- E- �/-m»A...
Gdl/�Ji (Strrf1_,1 .)o.li
Address
City or Town State
4. DATE DRILLED S /9`OI
5. TOTAL DEPTH aid
6. CUTTINGS COLLECTED YES ❑ NO
7. DOES WELL REPLACE EXISTING WELL? YES NOD
8. STATIC WATER LEVEL Below Top of Casing: FT.
(Use •: If Above Top of Casing)
9. TOP OF CASING IS Q_ FT Above Land Surface'
'Top of casing terminated Woe below land surface requires a variance in accor-
dance with 1SA NCAC 2C .01111
10. YIELD (gpm)' Jn METHOD OF TEST
11. WATER ZONES (depth)' Kee'
Jr
Zip Code
freiverd
DRILLING LOG
C1 m To
r �% Acrfr
234689
4s2r g 36
12. CHLORINATION: Type
13. CASING:
Amount
Wall Ttuckneu
Depth Diameter or Weighf/R. Material
From /9 To Ft —4---
From To Ft
From To Ft.
14. GROUT:
Depth
From & To /-1-X 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
Material___ Method
Utz«/
From
From
To _— .— Ft.
To Ft.
DEPTH
Formation Description
a
G)
C
U rn
rn
If additional space b needed use back of forth
�,
Ca
C
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other map reference points)
&e6--12 kj I
17. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION 'ft DS,y 4 TtfA 9OPY OF THIS RE ORD HAS BEjEN PROVIDED TO THE WELL OWNER.
l5 ll7 IS ©© ,��� ����� SIG R OF N CONSF C11NG THE WELL GATE
f
V &U6WII'original to n or clef Quality. GrouMwatef Sedon within 30 days OW1 REV. 12/99
4
Croundwatcs Section
Aufjeville Regional Office

North Carolina • Department of Environment and Natural Resources • Division of Water Quality - Groundwater Section
1636 Mail Service Center - Raleigh, N.C. 27699-1636-Phone [phone] n
WELL CONSTRUCTION RECORD WELL CONTRACTOR* //r� e-- 1✓p/I Di/ i
WELL CONTRACTOR C TIFICATION #: 92/3
STATE WELL CONSTRUCTION PERMIT#:
234697
1. WELL USE (Check Applicable Box): Residential ❑Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATION: (Sho (etch o the location below) �
Nearest Town' County' /10//LC
(Road Name and Numbers, �°nnunity. or )Subdivision end Lot No.) DRILLING LOG DEPTH
3. OWNER / t C/1 1Oa/ten aft
From To Formation Description
Address «LJ ( t� % &Ate aft C ld 0 � i
efii(atrapat r Roule No 1 J. /QO %O7 O r >C
c «T��t� .1.-Pt J1� state � °Z �° I� y6 f 3�1, /1 n/%C
Zip Code
4. DATE DRILLED 4�%L
5. TOTAL DEPTH r
6. CUTTINGS COLLECTED YES ❑ NOQ-1
7. DOES WELL REPLACE EXISTING WELL? YES NOE
8. STATIC WATER LEVEL Below Top of Casing: 70 FT.
en (use -,- if Above Top of Cuing)
9. TOP OF CASING IS FT. Above Land Surface'
'Top of casing terminated atior below land surface requires as vvariance In actor -
dance with 16A NCAC 2C .0.,_118
METHOD OF TEST Ti/(/• 7{ al
10. YIELD (gpm)
11. WATER ZONES (depth)*
12. CHLORINATION: Type
13. CASING:
Amount
Wall Thidwu
/� Depth Diameter/or Weigh Material
(/ From To /87 Ft 4. - 1 i
From To Ft
From To Ft.
14. GROUT:
Depth
From /9 To 2_ Ft
From To Ft
15. SCREEN:
Material
Amen/
ten LA2/7
Method /
Depth Diameter Slot Size Material
From To _ Ft _ in _ in
From _ To — Ft _ in. _ in
From _ To _ Ft. in. _ In
16. SAND/GRAVEL PACK:
Depth Size Material
From To — — Ft.
If additional apace ts needed use back of form
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other map reference points)
c
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 H BEEN PROED TO THE WELL OWNER.
FOR OFFICE USEO
Quad Na
From
Serial No.
NLY"
SIGNATURE OF PE STRUCfl WELL
tlsu odoinai toDivision of W H . Groundwater Section within 30 days DATE
GW-1 REV. 12/99
i;roundw etc.; Section
Asheville Regional

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater S9gio3 4 7 8 / �,`/
1636 Mail Service Center - Raleigh, N.C. 27699-1636-Phone [phone] LL +�
WELL CONSTRUCTION RECORD WELL CONTRACTOR. F !-✓-c// 2,y/'"y L,vc
WELL CONTRACTOR CERTIFICATION #: ) 7/ 3
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE (Check Applicable Box): Residential EMunicipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below) /{ ��
Nearest Town: /"✓`ir./C1:.n-iren County. f
(Road Name and Nu era roty, or Subdivision and Lot No.)
3. OWNER .'/,/ yi/t
Address
( beet or Roli If10.) /
Ci
ty or own State
4. DATE DRILLED f—/'6 /
5. TOTAL DEPTH ISe
6. CUTTINGS COLLECTED YES El� NO11
7. DOES WELL REPLACE EXISTING WELL? YES Q NO❑
8. STATIC WATER LEVEL Below Top of Casing: -24 FT.
t (Use': If Above Top of Cuing)
9. TOP OF CASING IS t ft FT Above Land Surface'
'Top of casing terminated atfor below land surface requires a variance In accor-
dance with 15A NCAC 2C .011a
10. YIELD (gpm)' 7i) METHOD OF TEST i> 'S{C
11. WATER ZONES (depth)*
Lp Code
-76
DRILLING LOG
From To
0 76
/ 7G �
7-63
•
12. CHLORINATION: Type Amount
13. CASING:
Wall Thickness
Depth Diameter orw,e�loS7�ulF_L Material
From Q To Ft —� " r �v
From To Ft
From To Ft
14. GROUT:
From
From
15. SCREEN:
Depth Material Method
0 To Ftle.-,i .Yrc"
To Ft
Depth Diameter Slot Size
From To _— Ft . in.
From To ____ Ft.— In.
From To __. Ft.— in.
16. SAND/GRAVEL PACK:
Depth
From To — — Ft.
From
17. REMARKS:
To Ft.
Material
in
In.
in.
Size Material
DEPTH
Fo , JDescription
ryi
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)
0
c
I HEREBY CERTIFY THAT T}ospiD)IE f1CONSTRUCTED IS RECORD
ACCORDANCE
AS BEEN P WITH
VIDEO TO THEW OWNER.
CONSTRUCTION STA? 1)7 f \70 , CV-6
SEP WC.
C+nrndwater n Sectiia
4 1 O t real `ff"
THE WELL DATE
Grouoawsum Section within 30 days OW-t REV. 12f99

234782
WELL CONSTRUCTION RECORD
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 CONTRACTOR• ^j c �tC`/ /2' •�
WELL CONTRACTOR C RTIFICATION #: ,77I3
STATE WELL CONSTRUCTION PERMIT#:
,LNr
1. WELL USE (Check Applicable Box): Residential Lt Municipal ElIndustrial ❑ Agricultural ElMonitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other If Other, List Use:
2. WELL LOCATION: (Show sketch/of the location below) Nearest Town: /✓�O 'JO/f County ovike
(Road Name antl umbers, C0`'n or Subd lion and Lot No.)
{OWNER OWNER riikky /'C LRm
Address .75g `t1e--� LOAF 1QOArf.
ves1or ut Noll g / S<
City at Town State 21p Code
4. DATE DRILLED St/ '0/
5. TOTAL DEPTH TOO6. CUTTINGS COLLECTED YES ❑ NO_
7. DOES WELL REPLACE EXISTING WELL? YES NOD
8. STATIC WATER LEVEL Below Top of Casing: 2-6 FT.
(Use •+• a Above Top of Casing)
9. TOP OF CASING IS 3 FT. Above Land Surface'
'Top of casing terminated sVor below land surface requires a variance In aeeer-
dance with 15A NCAC 2C�.001�13..
10. YIELD (gpm)• _L2_ METHOD OF TEST, , 1tA
11. WATER ZONES (depth)*
DRILLING LOG
From To
O !0
12. CHLORINATION- Type
13. CASING:
Amount
Wail Thickness
Depth C/ Diameter or VFI.
From C To w Ft
From To Ft
From To Ft.
14. GROUT:
Depth rl.�
From 0 To _2—Ft
From To Ft
„Material
`.gin•.-,.-r�
MethoV
.77,4 `
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 CERTI ..CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STM, 4 D pig AipOl' OF THIS R CORD HAS BEEN PROVIDED TO THE WELL OWNER.
Uu 14�i-tarir r- /- 0 /
SON CONSTRUCTING THE WELL DATE
air Quality. Groundwater Section within 30 days
DEPTH
FoDtion Description
fie
c r t
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)
FOR OFFICE USE 0
Quad No:
Serial No.
SEP Igiu
Cronndwater Section
Asheville Regional Office
GW-t REV. 12/99
V/

North Carolina • Department W Environment and Nature! Resources • Division of Wear Quality • Groundwater Section
1636 Mel BOMoe Censer - Raleigh, N.C. 27600-1638-Phone (el 0) 733•3221
233846
WELL CONSTRUCTION RECORD WELL CONTRACTOR: Hickory Well Drilling Co.
WELL CONTRACTOR CERTIFICATION e: 2343
STATE WELL CONSTRUCTION PERMfTg:
1. WELL USE (Cheek App0a b e Yox): Residential ® Munlolpal ❑ Industrial ❑ Agricultural El Monitoring ❑
Recovery ❑ Heat Pump Water Injection [] Other E] II Other, List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town; Morganton County, Burke
1. `-2781-Adizentist Circle
(Road Name and Humbert Community. ar Subdivision and Lot No.I DEPTH DRILLING LOG
3. OWNER `Jim Morgan - From Tn For.rulbn Description
Address 175 Bermuda Run Dr.
(street or Rout na.)
Advance NC
27006
City or Town State rip Code
4. DATE DRILLED 05-14-01
6, TOTAL DEPTH ' S115
6. CUTTINGS COLLECTED YES ❑ NO®
7. DOES WELL REPLACE EXISTING WELL? YES r�xj NOn
8. STATIC WATER LEVEL Below Top of Casing: 33 F 1.
(Use 'e• it Above Top el Ca inol
0, TOP OF CASING IB 2 FT Above Land Surface
Top of eating to mini ed Won' below land surface requires . variance In *coon
donee with 11A NCAC sC ,011s
10. YIELD (gpm): 7 _ METHOD OF TEST By Air lest
11. WATER ZONES (depth):
12. CHLORINATION: Type hth Tabs Amount 101
13. CASING:
c
L
UToC`
Fr-cm
vcrr
—c
If additional space Is needed use back of form
Wall TNtlmeas LOCATION SKETCH
Depth or Weight/Ft. M tedal
4 "' Dal,Steel (Show direction and distance from AI least two State
From 0 To 84 Ft 6
Roads, or other map reference points)
From To Ft ezo 5
14. GROUT:
�e
From To Ft zl4 N / 1/Itf FP,
Depth Material Method A�
From __0__.To 20 Ft Grout Poured tiEIv1
From To FI
15, SCREEN: L(5� ?-9,
From To F1 In In &
Depth Diameter Slot Size Material W I �l
per
From To Ft. In In �a ,` Q�\/
From _ To FL In In C'''
16. SAND/GRAVEL PACK:
Depth Size Malarial
From To Ft
From To Ft
17. REMARKS:
S
100 HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDAN
CONSTRUCTION STANDARDS. AND THAT A COPY OF MIS RECORD HAS
FOR OFFICE USE ONLY
Quad No:
Serial No.
WITH 15A NCAC 2C. WELL
ROVIDED TO THE WELL OWNER.
05-31-01
SIGNATURE OP PERSON CONST TI G THE WELL DATE
Sulxnil original la Division of Water Quality, Groundwater Section within 30 days
x
(
OW.I REV.032000

• • au1'
North Carolina • Department of Environment and Natural Resources • DMslon of Water Quality - Groundwater Section
1639 Mall Service Center • Raleigh, N.O.27699-1e39-Phone [phone]
233844
WELL CONSTRUCTION RECORD
WELL CONTRACTOR' Hickory Well Drilling Co.
WELL CONTRACTOR CERTIFICATION 2343
STATE WELL CONSTRUCTION PERMIT.:
1. WELL USE (Check Applicable Bomb ReeldentlaF1 Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery 0 Heat Pump Water Injection 0 Other L) If Other, Llst Use:
2. WELL LOCATION: (Show sketch of the location below)
N ITown• Connelly Springs County: Burke
Mtn View Wiwi -
(Road Name and Numbers. Community. or Subdivision and Lol No.)
3. OWNER Charles York
Address
Valdese
100 Piliailrghtts
28690
Cly or Town 05-29- I Zip Code
4. DATE DRII,LED U
5. TOTAL DEPTH— 405 _
6. CUTTINGS COLLECTED YES 0 NO M n
7. DOES WELL REPLACE EXISTING WELL? YES n NOS
6. STATIC WATER LEVEL Below Top of Casing: ion FT.
(Use • a Above Top of Casing)9. TOP OF CASING IS 2 1 FT Above Lend Surface'
-Top of casing terminated sUor below lend surface requires a sedans* In actor.
dance with 13A NCAC 2C 411111
10. YIELD (gpm): 2 METHOD OF TEST BY Air Test ___
Ii. WATER ZONES (depth): y m
`'
DRILLING LOG DEPTH
From To Formation Description
0
12. CHLORINATION: Type hth Tabs Amount 64
13. CASING:
If additional space Is needed use back of ten o
Wet Thickness • LOCATION SKETCH
Depth psiyeler QpffQhtUFl. ,�(41eledal . (Show dlrecllbn and distance from at least two Stele
From 0 To 100 Ft b "" Flag t1C Roads, or other map reference points)
From To Ft
From To Ft
14. GROUT:
DeppMaterial Method
From 0 To "Lb Fl Grout Pours
From To Ft
15. SCREEN:
Depth Diameter Slot Size Materiel
From To Ft In In
From To Ft In in
From To FI 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 ACCORDANC ITH ISA NCAC 2C. WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OFl RECORD HA9.BFOVIDED TO THE WELL OWNER.
FOR OFFICE USE ONLY
Quad No:
Serial No
05-30-01
SIGNATURE OF PERSON CONSTRvCY(NG THE WELL DATE
Submit original to Division of Water Quality. Groundwater Section within 30 days
GW.I REV. 12/99
Cm inthves- Sectirn
Asheville Rwriai 05!ce

North Carolina • Depanment of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1 G36 Mail SeMce Center - Raleigh, N.C. 27eag-1636-Phone [phone]
233843
WELL CONSTRUCTION RECORD WELL CONTRACTOR. H1rknry Well Drilling Co.
WELL CONTRACTOR CERTIFICATION I: 2343
STATE WELL CONSTRUCTION PERMIT*:
1. WELL USE (check Applicable box): Residential •••: Municipal 0 Industrial ❑ Agricultural ID Monitoring ❑
Recovery ❑ Haat Pump Water Injection ❑ Other ❑ If Other, List Uae:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: Glen Alpine Cony. Burke
5500 Powerhouse Rd.
(Road Name and Numbers. Community. or Subdvision and Lot No.) DEPTH DRILLING LOG
3. OWNER Robin Home From To Formation Description
Address PO Box 722
(Street or Route Nb.)
Glen^Alpine NC 28628
City or Town State
4. DATE DRILLED 05-25-01
6. TOTAL DEPTH • 265
6. CUTTINGS COLLECTED YES ❑ NO ] rX�i
7. DOES WELL REPLACE EXISTING WELL? YES C-y NO in
8, STATIC WATER LEVEL Below Top of Casing: S FT.
(U.. •.• n Above Top of Casing)
9. TOP OF CASING IS 2 FT. Above Land Surface'
*Top of casing terminated et/or below land surface requires a variance In scoot-
denca with 15A NCAC 2C ,Op
10. YIELD (gpm): 1e
METHOD OF TEST By Air Test
11. WATER ZONES (depth):
Zip Code
12. CHLORINATION: Type hth Tabs Amount 49
13. CASING:
- u
r-a
I - r-c,
tr.
o-c
30
0 r '
rn
If additional space is needed use back of Its
Wall ThicknessLOCATION SKETCH
Depth Diameter or w lghtFi. Material (Show direction and distance from Al least two State
From_To RR Ft !'4c llr PVC. Pl as i c Roads, or other map reference points)
From To Ft
From To Ft N
14. GROUT:
Depth Material Method 6 ` Ga"
From 0 To 20 Ft Grout Poured
From To Ft -ea
16. SCREEN: E
Depth Diameter Slot Size Material
From To Fl In In &flea/ A/-Yiaa
From _ To — Ft. in In I r i ` ` ' ` k+l+ //wy o
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, • TN 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS. AND THAT ACOPY OFTHI$fiECORDHAS =E• OVIDED TO THE WELL OWNER
FOR OFFICE USE ONLY
Quad No'
Serial No.
05-30-01
SIGNATURE OF PERSON CONSTR G THE WELL DATE
-810Milteittspi to [Yvl}Ion of Water Duality, Groundwater Section within 30 days
AUG ? G ?I!(
GW.1 REV. 03/2000
Lroundwafer Section
A5he/41e Re¢ional Olfla

North Carolina - Department of ErMronmerd and Naturist Recourses - Division of Water Quality - Groundwater Section 233p A n
1636 Mail Service Center - Raleigh, N.C. 27608-1636-Phone (MU) 733-3221
O 'i (..
WELL CONSTRUCTION RECORD WCLLCONTRACTOR: Hickory Well Drilling CD.
WELL CONTRACTOR CERTIFICATION.: 2343
STATE WELL CONSTRUCTION PERMIT.:
1 . WELL USE (Check Applicable Box): Residential te: Municipal ❑ Industrial ❑ Agricultural LI Monilurinp [ T]
Recovery 0 Heet Pump Water Injection Other [-i If Other, List Use.
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: Morganton Coumy._�iurko
6294 Horsewhispering Trail
(Road Name and Numbers, Community. or Subdivision and Lot No I DEFT I'I
3. OWNER Jim & Debbie Carr Fromm I„
Address 1508 Spring View Drive
(Street or Rrise NO
Catawba
28609
City or Town State Zip Code
4. DATE DRILLED 05-23-01
5. TOTAL DEPTH ' 385
8. CUTTINGS COLLECTED YES El NO
7. DOES WELL REPLACE EXISTING WELL? YES r] NO a
8. STATIC WATER LEVEL Below Top of Casing: -38 F I
(Use'+' II Above TOO Of Casing)
P. TOP OF CASING IS 2 FT. Above Lend Surface'
'Top or °nine terminated ever below land surface requlo• a violence I,, eecor-
denee with 1SA NCAC 2C A11a
10. YIELD (gpm): 10 METHOD OF TEST By Air Test
11. WATER ZONES (depth):
12. CHLORINATION: Type hth Tabs Amount 73___
13. CASING:
UIIILLING LOG
ro,nw llnn Detrriplinn
._C_
C
f"'"
Grti
Cam'
Cn
�rn
tic
O H
II additional space is needed use back oliGm m i
C-1
Wit Trickiest JosLOCATION SKETCH
From 0 DepthTo48 Ft Dirtily orlWi t. Plarial . (Show direction and digia nCe horn Al least two Stele
a Roads, or other map In?Arpnre points)
From To Ft
From To Ft
14. GROUT:
Depth Material Method
From 0 To 20 Ft Grout Poured
From To Ft
16. SCREEN:
Depth Diameter Slot Size Material
From To Pt _ In in
From To Ft In In
From To Ft In In
16. SAND/GRAVEL PACK:
Depth Size Malarial
From To Ft
From To Ft
17. REMARKS:
ma' im
kriv
JU
( j)
G" writ
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 P9Q II)ED TO THE WELL. OWNER
FOR OFFICE USE ONLY
Quad No
Serial No.
C
05-30-01
SIGNATURE OF PERSON CONSTRUCIIN . TI WELL DAIF
mn Sbbntlfovai fit DlyHion of Wet,, Gualhy, Grounnwal0 cam within 30 days
U/ L3: E f Ow .l nev 0v2000

North Carolina • Department of Environment and Natural Resources - Division of Water Duality • Groundwater Section
1636 Mall Service Center • Raleigh. N.C. 27640./e36-Phone [phone]
233841
WELL CONSTRUCTION RECORD WELL CONTRACTOR: Hickory w 1 Drill ng Ca-. Inc.
WELL CONTRACTOR CERTIFICATION ": 2343
STATE WELL CONSTRUCTION PERMIT":
1. WELL USE (teak Applicable Box): Residential lid Municipal ❑ Industrial ❑ Agricultural © Monitoring ❑
Recovery ❑ Heat Pump Water Injection 0 Other 0 It Other, List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: MOr416ntou County: Burke
i_n 7907 Knlet Rd.
(Road Name and Nantes. Community. or Subdivision and Lot No) DEFT li DRILLING LOG
3. OWNER Jody & Amy Dobert F,om ip rn.Mllon oerc,lption
Address 7907 Kit�1-t _U.1
I roe r •.
C:nnnelly Springs NC 28612
City or Town Stale Zip Code
4. DATE DRILLED 05-23-01
5. TOTAL DEPTH 305
8. CUTTINGS COLLECTED YES [] NOS
7. DOES WELL REPLACE EXISTING WELL? YES j-] NO
a. STATIC WATER LEVEL Below Top of Casino: (np F t.
--'
2 (U.e •.• If Above toga Casing) c_
9. TOP OF CASING IS FT Above Land Surface• - C u^t
*Top of casing termmeied eVor below lend madman requires • vrbnee In steer. C— r-r.
dance with 1SA NCAC 34 11e I `—
10. YIELD (gpmp 43 METHOD OF TEST By Air Test rat =;-,
11. WATER ZONES (depth): -p RN
o
-C
1:1.7
12. CHLORINATION: Type hth Tabs Amount 51 II additional space is needed use back &soy rm
13. CASING:
LOCATION SKETCH It
(Show direction and distance from Al leas) two Slate
Roads, or other map reference points)
From 0
Wall Thickness
Depth Diameter or Weigla/Fl. Material
To 126 Ft 64:" Galy. Steel
From To Ft
From To Ft
14. GROUT:
Depth Material Melho
From 0 To 20 Ft Grout Pour
From To Ft
15. SCREEN:
Depth Diameter Slot Size Materiel
From To F1 In
From — To Ft. In
From To Ft in
16. SAND/GRAVEL PACK:
Depth Size
From To Ft
From To Ft
17. REMARKS:
In
In
In
Material
N Loaf°
S
tott
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'
Sea& No.
05-25-01
SIG 7URPERSON N TINS THE WELL UATF
Submit original to Division of Waist Qualify, Guru -r clion within 30 days
GW.t REV.03/2000
AUG ? 4 200,
Croundwate- Section
__1st ^regional Dh!:ro

North Carolina - DepanmeM of Envlronntent and Natural Resources - Division of Water Duality - Groundwater Section
1838 Mall Service Center - Raleigh, N.C. 27699-1636-Phone (919) 733•3221
233840
WELL CONSTRUCTION RECORD
WELL CONTRACTOR: Hickory Well Drilling Co.
WELL CONTRACTOR CERTIFICATION 0: 2343
STATE WELL CONSTRUCTION PERMIT,:
1 WELL USE (Ch.ck Applicable boa): Residential ® Municipal ❑ Industrial ❑ Agricultural U Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Ot11er, List Una
2. WELL LOCATION: (Show akeloh of the location below)
Nearest Town: Morganton County .. Burke
100 Allman St
(Road Name end Numbers. Community. or Subdivision and Ln1 No) DEP111 UIIILLING LOG
3. OWNER Gladys Allman F,em In rmmallnn Deac,inlion
Address 100 Allman St.
Morganton r
e
al °`I sis no.)
28655
City or Town Slab Zip Code
4. DATE DRILLED 05-17-01
5. TOTAL DEPTH 405
6. CUTTINGS COLLECTED YES 1-1 NO(i
7. DOES WELL REPLACE EXISTING WELL? YES)ER-] Non
8. STATIC WATER LEVEL Below Top o1 Casing: 100 F I .
(Use'✓ a MD p nl Casing)
9. TOP OF CASING IS 2 Fr. Above Land Surface'
'Top of Dium/np lermin.Nd sVo, below land aurlana renulra• a variance In aeeer-
wah 11IA NCAC 10,101111
10. YIELD (gpm): 2 METHOD OF TEST By Air Test
11. WATER ZONES (depth).
r— c
to
rn ,
---I
12. CHLORINATION: Type hth Tabs Amount 66__.._ _ II atldilionel space Is needed use back of lOnn z
13. CASING:
Wall Thickness p1 n LOCATION SKETCH
O Depth 92 Dian ,xk(eigiwn. PMas Ls1C (Show direction and distance from nl least Iwo Slate
From To Ft b CC VVIL. Roads, or other map falerance Iwinls)
From To FI
From To Ft
14. GROUT:
Depth Material Method
From 0 To 20 Ft Grout Poured
From To Ft
15. SCREEN:
Depth Diameter Slot Size Material
From To FI _ In in
From To Ft In In
From To Ft In In
16. SAND/GRAVEL PACK:
Depth Size Material
From To F1
From To F1
17.REMARKS:
611 wit*
Q 5 f.
LOSj cop ri
s
yti
I D0 HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS. AND THAT A COPY OF THIS RECORD HAS BEE t P61OVIDED TO THE WELL OWNER.
FOR OFFICE USE ONLY
Quad No
Serial No.
05-18-01
SIONRSURE (TF PERSON CONSIRV . II FIE WFLL DATE
Sub, original 10 Division of Wolof Duality, Gmun ater Section within 30 day F.:
AUG 2 4 20!,)'
Ow.i nF.V. 030000
droundwater Section
Ashevii' '2es•Icmal0i11re

North Carolina • Department of Environment and Natural Resources - Division of Water Duality. Groundwater Section
1630 Mall Service Center - Raleigh, N.C. 27699-1636-Phone [phone]
233835
i
City or Town Stale Zip Code
4. DATE DRILLED 05-03-01
5. TOTAL DEPTH •- 405
6. CUTTINGS COLLECTED YES [] NO
7. DOES WELL REPLACE EXISTING WELL? YES IVri NOn
B. STATIC WATER LEVEL Below Top of Casing: 2uu FT.
(Use'✓ If Above Top of Casing)
9. TOP OF CASING IS 2 FT Above Land Surface•
'Top of casing terminated .11or below land surface requires a variance In eccor•
dance with ISA NCAC 2C.0111
ID. YIELD (gpm): 5 METHOD OF TEST By Air Test
11. WATER ZONES (depth)•
WELL CONSTRUCTION RECORD WELL CONTRACTOR. Hinknry Wall Drilling Co.
WELL CONTRACTOR CERTIFICATION 0: 2343
STATE WELL CONSTRUCTION PERMITS:
1. WELL USE (Check Applicable Boat Residential LJ Municipal ❑ Indusltlel 0 Agricultural 0 Monitoring ❑
Recovery 0 Heal Pump Water injection ❑ Oilier 0 If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: Morganton County- Burke
Barnhill Orchard Rd.
(Road Name and Hunters, Corunlly, or Subdivision and Lot No.) DRILLING LOG DEPTH mr
3. OWNER Ken Watkins From To Formation Description
Address PO Box 4155
(Ansel or Houle No.)
Surf City, NC 28445 0
b 6
12. CHLORINATION: Type
13. CASING:
hth Tabs Amount 43
Cr1
tD o
If additional space Is needed use back of form
Wall Thickness • LOCATION SKETCH
Depth DI rq�ler or WeI� hVFt. Material (Show dlrecilbn and distance from at least Iwo State
From 0 To 72 FL 6.t• PVC Plastic Roads, or other map reference points)
From To Ft A'
From To Ft /'�
14. GROUT: D�
Depth Material Method Mp�(R
From 0 To 20 pi Grout Poured / •t/fU
From To Ft
15. SCREEN:
Depth Diameter Slot Size Material
From _._ To _ Ft In in
From To FI in in
From To FI In In
ID. SAND/GRAVEL PACK:
Depth Size Malarial
From To Ft
From To Ft
17. REMARKS:
spa
F
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS ) PROVIDED TO THE WELL OWNEn.
FOR OFFICE USE ONLY
Submit original to Division el Water Quality, Groundwater Secilon within 30 days
Clued No: SIGNATURE OF PERSON CON37jjNC'I'fI G TIIE WELL DATE
Serial No. lid IL - OW-t REV. 12/99
L AUG 2 4 ?fill.
Craundwater Section
Asheville Re tonal Gr(ix
05-17-01

North Carolina. Department of Environment and Natural Resource . Division of Water Quality • Groundwater Section
1039 Mali Service Center -Raleigh, N.C. 27099-1030-Phone [phone]
233833
WELL CONSTRUCTION RECORD WELL CONTRACTOR. Hickory Well Fin fling Co.
WELL CONTRACTOR CERTIFICATION I: 2343
STATE WELL CONSTRUCTION PERMIT.:
1. WELL USE Check Applicable Box): Residential yu Municipal ❑ Industrial ElAgricultural El Monitoring ElRecovery all Heat Pump Water Injection ❑ Other 0 If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town• Morganton County Burke
5107 Sugarloaf Rd.
Name
and Numbict Community, or Subdivision and Lot No.)
3. OWNERGreg Buchanan
Address 5107 Sugarloaf Rd.
(Sires or Route No.)
Connelly Springs NC 28612
City or Town Stale Zip Code
4. DATE DRILLED 05-04-01
5. TOTAL DEPTH . 265
O. CUTTINGS COLLECTED YES n NO
7. DOES WELL REPLACE EXISTING WELL? YEStill NOn
8. STATIC WATER LEVEL Below Top of Casing: 97 FT.
(Use'+' a Above Top of Casing)
9. TOP OF CASING IS 2 FT Above Land Surface'
'Top or casing terminated atlor below land surface requires a variance In accor-
dance with MA NCAC 2C.01 5
10. YIELD (gpm): 0 METHOD OF TEST By Air Test
11. WATER ZONES (depth):
DRILLING LOG DEPTH
From To Formation Description
0
CD
n ..-
C a
U1 -=r-
yam.
3
Tz
n
12. CHLORINATION: Type hth Tabs Amount 35 II additional space is needed use back of IorhP z
13. CASING:
Was Thickness • LOCATION SKETCH
Depth DI rr�ter ar Wa Material (Show directibn end distance from at least Iwo Slate
From 0 To 104 n6t PVChvFt. Plastic Roads, or other map reference points)
From To Ft
From To Ft N 4,4\0
14. GROUT: k 0,60A
Depth Material Molliod
From 0 To 20 FI Grout Poured \ Nwy. /8
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:
CA/ v 6 we"'
0 4Y"
Nc S
"to -
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 BFjtN)ROVIDED TO THE WELL OWNER.
05-14-01
FOR OFFICE USE ONLY
Quad No:
Serial Na
:\UG 2 4 Mr
Groundwater Section
j e he itie Re Tonal Office.
SIGNATURE OF PERSON CONSTTHE WELL DATE
Submit original to Division al Water Quality. OrouIa terSectionwithin 30 days
OW -I REV. 12/99

233832
North Carolina • Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mall Service Center - Raleigh, N.C. 27999-1636-Plans [phone]
WELL CONSTRUCTION RECORD
WELLCONTRACTOR• Hickory Well Drilling Co.
WELL CONTRACTOR CERTIFICATION 0: 2343
STATE WELL CONSTRUCTION PERMIT,:
1. WELL USE (Check Applicable Earth Residential In Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heal Pump Water Injection ❑ Other ❑ II Other, List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town. Morganton county: Burke
6971 Goldmine Rd
(Road Name and Numbers, Community, or Subdivision and Lot No.) DRILLING LOG DEPTH
3. OWNER Chris Franklin From To Formation Description
Address 3485 Lisburne Ln.
(Sleet or Houle No.)
Hayes Virginia 23072
Gly or Town Stale
4. DATE DRILLED 05-03-01
5. TOTAL DEPTH 305
6. CUTTINGS COLLECTED YES Q NOW
7. DOES WELL REPLACE EXISTING WELL? YES i�t NOn
6. STATIC WATER LEVEL Below Top of Casing: e 1 FT.
(Use •: N Above Top of Casing)
9. TOP OF CASING IS 2 FT Above Land Surface'
•Top of cuing terminated aUor below land surface requires a variance In scoot -
dance with 13A NCAC 2C .011e
10. YIELD (gpm)• RMETHOD OF TEST By Air Test
11. WATER ZONES (depth):
Zlp Code
12. CHLORINATION: Type hth 'Thing Amount Si
13. CASING:
C
O
C
;-;
CA
v
w �z
If additional space is needed use back of ion»IL
c2
Was ThicknessLOCATION SKETCH
Depth Diameter or Weight/Ft. Material (Show dlreclibn and distance from at least Iwo Stale
From n To 1 1 R Ft 6y�4ml PVC Pl a ¢tic Roads, or other map reference points)
From To Ft.
From To Ft N a
14. GROUT: ra(0
Depth Material Method I\ I�1
From 0 To 20 Ft Grout Poured
From To Ft 15. SCREEN: W W/A
�k \fiwydf E
Depth Diameter Slot Size Material ,/ MIrJ
From To Ft In In Y .
From To _ Ft _ In In
From To Ft In In
16. SAND/GRAVEL PACK:
Depth Size Material
From To Ft
From To Ft
17. REMARKS:
s
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEE VIDED TO THE WELL OWNER.
FOR OFFICE USE ONLY
Quad Not
y Spial9
AUG 2 4 200'
Groundwater Section
sAsheville Repine cal O v -..-
044400401.
SIGNATURE OF PERSON CONSTRUC IE WELL DATE
Submit original to Division of Water Quality. Oroun. er Section within 30 days
0W-I REV. 12/99
ni-lL-nl

'Top of casing terminated at/or below land surface requires a variance In actor-
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. Air nri1lino Co.
WELL CONTRACTOR CERTIFICATION #: 78nq
STATE WELL CONSTRUCTION PERMIT#:
232172
1. WELL USE (Check Applicable Box): Residential ® Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery El Heat Pump Water Injection ❑ Other El If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town- Valdese County: Burke
(Road Name and Numbers, Community, or Subdivision and Lot No.)
3. OWNER Terry Scronce
Address 2208 Hwy. #10, W.
Newto(n, NCStreer r28658) 0 100' Dirt
225
,
City or Town State Zip Code Rnr•k
DRILLING LOG DEPTH
From To Formation Description
4. DATE DRILLED 5-18-01
5. TOTAL DEPTH 225' n
6. CUTTINGS COLLECTED YES 0 NO r
7. DOES WELL REPLACE EXISTING WELL? YES ❑ NO0 C o i
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'
m m�
dance with 15A NCAC 2C .0118
10. YIELD (gpm): 6 METHOD OF TEST Air c_t T�
11. WATER ZONES (depth): 223'
CO -r
12. CHLORINATION: Type PPR Amount If additional space is needed use back of form
13. CASING:
Wail Thickness LOCATION SKETCH
Depth Diameter or WeighVFt. Material (Show direction and distance from at least two State
FromTo 100 Ft. 6, galy. Roads, or other map reference points)
From To Ft.
From To Ft /• _ -o
14. GROUT: �O"�"
Depth Material Method
From 0 To 20 Ft Grout Poured
From To Ft
15. SCREEN:
Depth Diameter Slot Size Material
From To Ft in in
From To Ft. in In
From To FL In in
16. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
17. REMARKS:
P11-4
valise
I DO HEREBY CER
CONSTRUCTION
11 1 THIswELLUASC
FOR OFFICE USE
Quad No:
Serial No.
ARDS, AND THAT A COF1i
UN
As
"RUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
• THIS RECORD HfS BEEN PROVIDED TO THE WELL OWNER.
&AC—
SIGN\TURE OF PERSON CONSTRUCTING THE WELL DATE
f00ndwateritiol111Cflkihrigi alto LMslon of Water Quality, Groundwater Section within 30 days
She ReiiTDThte
GW-1 REV. 12199
J

FROM : MORETZ WELL E. PUMP
FAX NO. : 7044521322 May. 23 2001 05:17RM P2
North Carolina Department of Environment S Natural Resources
Division of Water Quality - Groundwater Section
FOR OFFICE USE ONLY
1636 Mail Service Center QUAD. NO. SERIAL No.
Raleigh, NC 27699-1636 Phone: (919) 71_-0'_95 Lit. Long. RO
Minor Basin
Basin Code
WELL CONSTRUCTION RECORD /� Hader Ent GW-I Ent.
DRILLING CONTRACTOR: Anf e / t//
STATE WELL
CONSTRUCTION --gyp jj�
DRILLER CERTIFICATION NUMBER: .3 �6 PERMIT NUMBER: /"
9rl
1. WELL LOCATION: (Show sketch of the location bel w) `
Nearest Tqwn: intikaRiDYt County: 7�Gt�/`,,
�
/A
's Rtday 54 c/(4.---
(Road. 'Community, or Sot/division and Lot No.)
2. OWNER Chi ke Shrt
ADDRESS
&JS&/ 4A.
Cily or Town late
S VppCQtIQ
3. DATE DRILLEDV LTSE OF WELL 1 /"-O
4. TOTAL DEPTH aLj
S. CUTTINGS COLLECTED YES 0 NO 121/
6. DOES WELL REPLACE EXISTING WELL! YES 0 NO 12
7. STATIC WATER LEVEL Below Top of Casino: Vt FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface'
'Casing Terminated at/or below Land surface is illegal unless a variance is issued
in accordance with 1=A NCAC 2C .0I18 f,y
9. YIELD(gpm): 90 METHOD OF TEST Af r/trr/
10. WATER ZONES (depth): 2 DO
11. CHLORINATION: Type ,%ii Amount Z.
C. CASING:
(Street or Route No.)
Ax—
Wall Thickness
Depth p' ter Or t"�g,�'ght/ t M t ial
Fran: To C.% Ft. 3c e9At 7s�
From To Ft
From To Ft.
13. GROUT:
Depth Ft )_ta hfet/
N/t
From To ..0 C�'i (/0 rl
From To Ft.
14. SCREEN:
Depth
Diameter Slot Size Material
From To Ft in in
From To Ft. In. In
From To Ft. in in
IS. SAND/GRAVEL PACK:
Depth
From To Ft
From To Ft.
16- RENLARKS:
I DO HEREBY
CONSTRUCTION
CW-1 REV. 11/99
Size
I' t C
e •
ARDS, AND THAT A C
- 6 200I
Material
S
DEPTH DRILLING Log
From To
Formation Description
4/0 -S-7 Cry S4eas�
S7' /S' s At, ff.„-,
'-
-r. o r-
-
C,3 vrl
- `n
m
wz
—3
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)
/AV ,V Y,
4'4 s
virg; ti Ave—
A/wftepu 3frti=
ONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
F THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
/v 0/
NATURE 09'CONTRACTOR 0 GENT DATE
Submit original to Division of Water Quality and a copy to well owner.
ndwater Sidon
Re¢ionil Mks

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
P.O. Box 29578 - Raleigh, N.C. 27626-0578-Pho e [phone]
WELL CONSTRUCTION RECORD DRILLING CONTRACTOR: L K t ji)('.» D(ling
DRILLER REGISTRATION #: 6205 4.
STATE WELL CONSTRUCTION PERMIT#:
232574
1. WELL USE (Check Applicable Box): Residential ❑ Municipal ( Industrial ❑ Agricultural ❑ Monitoring El
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: M6� rµ,r•. O:.1/4- County' t.-^ kP
JP WL t «
(Road, Commnily, orS divisiond Lot No..) 1 DEPTH DRILLING LOG
3. OWNER Ok-nA'. 1"KU:INrein. sLLfp From To Formation Description
ADDRESS LISV On r w«.1 2 1_r-
(Street or Route No.)
(VlOrc(trolit .VC_
City orn State
4. DATE DRILLED 1-'I 'OI
5. TOTAL DEPTH I /+
6. CUTTINGS COLLECTED YES I I NO(X(
7. DOES WELL REPLACE EXISTING WELL? YES NO
8. STATIC WATER LEVEL Below Top of Casing: (,() FT.
(Use "+" if Above Top of Casing)
9. TOP OF CASING IS I FT. Above Land Surface.
Casing Terminated at/or below land surface is illegal unless a variance is issued
in accordance with 15A NCAC 2C .0118
10. YIELD (gpm): METHOD OF TES,T a I r — r"
11. WATER ZONES (depth): I CO
12. CHLORINATION: Type Amount �I
Lig - (i,S
r,
P1
Zip Code
a-- 1_,
If additional space is needed use back ottorm ^-;
r.1
13. CASING: C.fl o
LOCATION SKETCH
Wall Thickness
Depth Dialor Weight/Ft. Material (Show direction and distance from at least two State
From D To 72— Ft ULl --t �- Roads, or other map reference points)
From To Ft
From To Ft
14. GROUT:
Depth Material Method
From _l To Zn Ft "2^ / p3u't✓ri-
From To Ft
15. SCREEN:
Depth Diameter Slot Size Material
From To Ft in in
From To Ft in in
From To Ft in in
16. SAND/GRAVEL PACK:
Depth
From To Ft
From To Ft
17. REMARKS:
Size
Material
I DO HEREBY CERTIFY T
CONSTRUCTION STANDA
a
FOR OFFICE USE ONLY
Quad No.
Serial No:
F
Nwr
11
17 •
IS WELL WAS CONST
D Ipl:ALOP,Y OF
groundwater Sect I • TURE
Ilk Re onal
D IN ACCORDANCE WITH 15A NCAC 2C, WELL
ECORD HAS BEEN PROVIDED TO THE WELL OWNER.
F CONTRACTOR OR AGENT DATE
to Division of Water Quality and copy to well owner.
GW-1 REV. 1/98

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. lief L✓sl/ /% ��
WELL CONTRACTOR C TIFICATION 0: ?7/ 7
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE (Check Applicable Box): Residential E Municipal CIIndustrial ElAgricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection 0 Other if Other, List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: /740 . - M County. /loch r
(Road Name and NurnbfCommunity, S}'bdivision and Lot No.) DRILLING LOG
3. OWNER 1�e16/�*Ft-t From To
D3/ 2 &4z ri o, 71;9r.e get 10 • ?� n r
3C v -�- go4- c
Address
(Street or Route No.) -7�� SS
7notn/nn NG .
City or ovm State Zip Code
(27-0
4. DATE DRILLED
5. TOTAL DEPTH fir C
6. CUTTINGS COLLECTED YES ❑ NO[�
7. DOES WELL REPLACE EXISTING WELL? YES ErICIOE
8. STATIC WATER LEVEL Below Top of Casing: 70 FT.
(Use •.• I1 Above Top of Casing)
9. TOP OF CASING IS c FT Above Land Surface'
'Top of casing terminated slier below land surface requires a variance in accor-
dance with 15A NCAC 2C .0118 �, ^
10. YIELD (gpm): i METHOD OF TEST
11. WATER ZONES (depth):
234772
•
12. CHLORINATION' Type
13. CASING:
From
From
From
14. GROUT:
Amount
Wall Thickness
Depth Diameter or Weigh Vt Material
To . Ft _��
From
From _
15. SCREEN:
To Ft
To Ft
Depth, Material Method
To . Ft 4.- -< i /VI �Y
To Ft
Depth Diameter Slot Size Material
From To Ft in
From To Ft. in
From _ To _. Ft. in.
16. SAND/GRAVEL PACK:
Depth Size Material
From To — — Ft.
From To Ft.
in
In
In
DEPTH
Formation Description
//o C./C
4J
a
o� tr-'.j
Ut
-70
C
If additional apace is needed use back of loon±
U,
m ;i
w o
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other map reference points)
17. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, ANC) THAT A COPY OF THIS RE RD HAS EEN PROVIDED TO THE WELL OWNER.
IFOR OFFICE USE OIYTY1 1-
Quad No: tf <,k
Serial No.
SEPI*CIJU!nm
ti
,_SON CONS RUCTiNO THE WELL DATE
star Quality. Groundwater Section within 30 days
GW-1 REV. 120/9
Csoundwate Section
pshevdtg Regional 0_t'.-

234786
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- /!etc /✓e`/ / 1 /yT _Ave
WELL CONTRACTOR C RTIFICATION e: 7/3
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE (Check Applicable Box): Residential Lam' 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: 411a,:f<-, f>n County'
/JOA&-e
(Road Name and Numb Communi , or Subdivision and Lot No.) DRILLING LOG DEPTH
3. OWNER .442A' i-,1-- /1 From To Fomuntion Description
Address / / %%,,,%Le ,4,.:./ `i,.. Q / inC' R/1�
(Street or Route No.) V/3 D / rah
`
,✓. e. le>..e// S D%gf / 3 S" .2 5"D Ao c lc
CityTown State 'Y
4. DATE DRILLED e
5. TOTAL DEPTH
6. CUTTINGS COLLECTED YES ❑ NOQ".....--
7. DOES WELL REPLACE EXISTING WELL? YES NOD
8. STATIC WATER LEVEL Below Top of Casing:(,) FT.
(Usa •.• a Above Top of Casing)
9. TOP OF CASING IS / a- FT Above Land Surface*
'Top of casing terminated atlor below land surface requires a variance In accor-
daneswith 15A NCAC 2C 1)s �
10. YIELD (gpm) O METHOD OF TEST T',' I �Siri%
11. WATER ZONES (depth)'
12. CHLORINATION- Type
13. CASING:
Amount
If additional space Is needed use back of form
LOCATION SKETCH
Wag Thickness
Depth Diameter or WgghvFf. Material (Show direction and distance from at least two State
From O To / 3S Ft —4--- [ %per /mot Roads, or other map reference points)
From To Ft.
From To Ft
14. GROUT:
Depth Material Method
From ____(4— To 2G) Ft Ghat A(.t--' cir
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.
cn
17. REMARKS:
I DO HEREBY CERTIFY THAT LhIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCT1ONST RARpS,IiAMC THAT ACOPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
V--0 4—OI
�i
I `j(�(��� +NA RSON CON UCTING THE WELL DATE
8 `tQ ,Ltor nall� ' n, star Quality. Groundwater section Within30days GW-tREV. t2199
Groundwater Sec.is ,
Ashe illeRe¢i4^a!

North Carolina • Department of Environment and Natural Resources • Division of Water Quality • Groundwater Section
1636 Mail Service Center - Raleigh. N.C. 27699-1636-Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR* r (6 /Pe / ad.
WELL CONTRACTOR C TIFICATION #: aJ %/ "3 '
STATE WELL CONSTRUCTION PERMIT#:
234787
,1"1;-/C
1. WELL USE (Check Applicable Sox): Residential Er —Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATION: (Sh w sketch of the location below)
Nearest Town: rr XF / County
(Road Name end Numbers, /Community�. �or Subdivision�yand Lot No.) DRILLING LOG DEPTH
3. OWNER f,% i�J1'3 '5,eh' From To F
ormationDescription
Address . , L' �,� y/127— ahr IC
--(Street or ROOOI N4
City or Town 7 State Zip Cods
4. DATE DRILLED y--r2b `0!
5. TOTAL DEPTH 7 30c
6. CUTTINGS COLLECTED YES ❑ NOQ�
7. DOES WELL REPLACE EXISTING WELL? YES Q NOO
8. STATIC WATER LEVEL Below Top of Casing: -'74) FT.
(Use '4.* if Above Top of Casing)
9. TOP OF CASING IS FT. Above Land Surface*
?op of casing terminated odor below land surface requires a variance In accor-
dance with 15A NCAC 2C .0113
10. YIELD(gpm)• P7 METHOD OF TEST d'r l_14--/
11. WATER ZONES (depth)*
35' ys v?t it.
.4e 330 17?
12. CHLORINATION: Type Amount If additional space Is needed use back of form
13. CASING:
Wail Thickness
Depth of ;Air
From To �.� Ft
From To Ft.
From To Ft
14. GROUT:
LOCATION SKETCH
Material (Show direction and distance from at least two State
in" C Roads, or other map reference points)
Depth Material Method
From 1 To Se Ft 6,-,.�—• t 4-1 Lk - c
From To Ft
15. SCREEN:
Depth Diameter Slot Size Material
From To Ft _ in _ in
From To Ft in in
From To Ft. In In
16. SAND/GRAVEL PACK:
Depth Size Material
From To _ .— Ft.
From To Ft.
17. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS. ANC* THAT,A COPY OF THIS • CORD HAS BEEN PROVIDED TO THE WELL OWNER.
z 9!
-__17 I
CD
r
CC)
FOR OFFICE U LY
Quad No: ,. SE
14
Ssdai No.
Cro indwater Section
the Repional One
SON CONS NO
THE WELL DATE
attar Quality, Groundwater Section withiri 30 days
GW1 REV. 12(99

234783
North Carolina - Department of Environment and Natural Resources • Division of Water Quality - Groundwater Section
1636 Mail Service Center • Raleigh, N.C. 27699.1636-Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR' J/J,C(. p n 4/E
WELL CONTRACTOR CERTIFICATION #: 2-7/ 3
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE (Check Applicable Box): Residential LS Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATION: (Show �//sketch f the location below) 6. /IGe
Nearest Town* n �rr/9Le 6^ County.
,/lc hr.,/ �(Road Name and Numbers. Community. or Subdivision and Lot No.) DRILLING LOG clG7QbDEPTH
3. OWNER n Ar- r- From To FomutionDescdpuon
Address ttr ^ r6 / 0 % fr if
(S H
.3 .
(Street or Houle Na.)No.) �/r /oJ /rCZ-
, C lrn� »' , 300
- -
zip
G� Stab
4. DATE DRILLED (/.-,3Q -01
5. TOTAL DEPTH 300
6. CUTTINGS COLLECTED YES ❑ NOQ
7. DOES WELL REPLACE EXISTING WELL? YES NOD
8. STATIC WATER LEVEL Below Top of Casing: FT.
i/ (use •: a Above Top a Casing)
9. TOP OF CASING IS / I)- FT. Above Land Surface-
'Top of casing terminated aVor below land surface requires a variance
1 eaTh.ctor-
dance with 15A NCAC 2C .0
10. YIELD (gpm)' /4 METHOD OF TEST Air /i5
11. WATER ZONES (depth)'
12. CHLORINATION' Type
13. CASING:
Amount
v
If additional space ie needed use back of form
LOCATION SKETCH
Wail Thickness
/� Depth 1��3 Di ter or w IQ Material (Show direction and distance from at least two State
From !f/ To A — Ft /V L Roads, or other map reference points)
From To Ft
From To Ft o
14. GROUT: —
Depth yateriall Method /
From 0 To -90 Ft L feen6-/ / " 1'rrr/
From To Ft
15. SCREEN:
Depth Diameter Slot Size Material
From To _ Ft _ in _ in
From To Ft. in In
From To Ft. In In
16. SAND/GRAVEL PACK:
Depth Size Material
From To Ft
From To Ft.
17. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION ST '�"''�' • - 't •)• �,�7 Py OF THIS REC RD HAS BEEN PROVIDED TO THE WELL OWNER.
w a. "'1'Ir
%3p-6 /
` N CDiNTR(1CTING THE WELL GATE
r Quality. Groundwater section within 30 days OW1 REV. 12199
C
}
-3

I
North Carolina - Department W Environment and Natural Resources - DMeicn of Water Quality • Groundwater Section
1638 Mail Service Center • Raleigh, N.C. 27899.1638-Phone [phone]
WELL CONSTRUCTION RECORD
233829
WELL CONTRACTOR. Hickory Well Drilling Co.
WELL CONTRACTOR CERTIFICATION 0: 2343
STATE WELL CONSTRUCTION PERMITO:
1. WELL USE cheek Applicable Box): Residential® Municipal El Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery Heat Pump Water Injection ❑ Other [] II Other, List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: Morganton County: Burke
Sherwood Forest
(Road Name and Numbers, Conrnunlly, or Subdivision end tel No.) DRILLING LOG
3. OWNER Harvey Foust
Address % Carl Kirksey 323 Sanford Drive
(Street or Route Np,i,
Morganton NM
City or Town Stale
4. DATE DRILLED 04-26-01
5. TOTAL DEPTH 6n5
6. CUTTINGS COLLECTED YES Q NOJ
7. DOES WELL REPLACE EXISTING WELL? YES p NO pei
8. STATIC WATER LEVEL Below Top of Casing: 106 FT.
(Use's' II Above Top of Cuing)
9. TOP OF CASING IS 2 FT Above Land Surface*
'Top of cuing torminsled el/or below lend surface requires a variance In motor-
drome with ISA NCAC 2C.Q1f0 By Air Test
10. YIELD (gpm): 3�4 METHOD OF TEST
11. WATER ZONES (depth):
28655
Zip Code
From To
DEPTH
Formation Description
CD
0
n
C o
r—
r-_
12. CHLORINATION: Type
13. CASING:
hth Tabs Amount 105
0 Depth 52 gpleler
From To Ft
From To Ft
From To Ft
14. GROUT:
Wall Thickness
I:Might/FL.
CA Z
c)
II additional space Is needed use back of form
O
Ylas tic
Depth Material Method
From To 20 Ft Grout Poured
From To Ft
15. SCREEN:
From
From
From
Depth Diameter Slot Size Material
To Ft In in
To Ft In In
To Ft In In
16. SAND/GRAVEL PACK:
Depth
From To
From To
17. REMARKS:
FI
Ft
Size
Material
• LOCATION SKETCH
(Show directibn end distance from et least two Slate
Roads, or other map reference points)
5 /j CO left Cr
Mni To
S
Moor
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORD
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD H
FOR OFFICE USE ONLY
Goad No:
Sgdu:..l
h
rroundwates Section
Asheville Regional Office_,.
E WITH ISA NCAC 2C, WELL
N PROVIDED TO THE WELL OWNER.
05-07-01
SIGNATURE OF PERSON CO UCTINO TIIE WELL DATE
Submit original to Division of Water Gustily, Groundwater Section within 30 days
OW -I REV. 12/99

North Carolina • Department of Environment and Natural Resources - Division of Water Quality • Groundwater Section
1838 Mall Service Center. Raleigh, N.C. 27699-1638-Phone [phone]
WELL CONSTRUCTION RECORD
2,33827
WELLCONTRACTOR• Hickory Well Drilling Co.
WELL CONTRACTOR CERTIFICATION 8: 2343
STATE WELL CONSTRUCTION PERMIT,:
1. WELL USE (Check Applicable Box): Residential IAA Municipal El industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heal Pump Water Injection ❑ Other ❑ 11 Other, list Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: Morg4nton county: Burke
h919 rnrnhi 11 Rrl
(Road Name and Numbers. Community. or Subdivision end Lot No.) DRILLING LOG DEPTH
3. OWNER QTou Vane From To Formation Description
Address 6919 Cornhill Rd.
Connelly Springs`"OUIe"°') NC 28612
City or Town Stale Zip Code
4. DATE DRILLED 04-12-01
5. TOTAL DEPTH 345
6. CUTTINGS COLLECTED YES Q NO Ed
7. DOES WELL REPLACE EXISTING WELL? YESt) NOf
6. STATIC WATER LEVEL Below Top of Casing: g0 FT.
(We •i a Above Top of Casing)
9. TOP OF CASING 1S 2 FT Above Land Surface'
'Top or cuing terminated et/or below lend surface requires a variance in accor-
dance with 15A NCAC 2C .0118
10. YIELD (gpm): 5 METHOD OF TEST By Aix Test
11. WATER ZONES (depth):
12. CHLORINATION: Type hth Tabs Amount 64
13. CASING:
a
O
CT
r= o
rn
C11 ter
JG
rn0
CA
r7
O o
It additional space Is needed use back of loan z
Watt Thickness LOCATION SKETCH
0 Depth 95 D61ar11Rler or WET M lertai (Show direcllbn and distance from al least two State
From To Ft '�4w YVL: Roads, or other map reference points)
From To Ft
From To F1
14. GROUT:
Depi1 t Motorist Moller
From 0 To `U Fl Grout Poured
From To F1
15. SCREEN:
Depth Diameter Slot Size Materiel
From To F1 _ Iri In
From To Ft _ In In
From To _ Ft in In
16. SAND/GRAVEL PACK:
Depth Size Material
From To F1
From To Ft
17. REMARKS:
11/o4
4 *4c t S
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C. WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PBeVJ)ED TO THE WELL OWNER.
FOR OFFICE USE ONLY
Ouad No:
AUG 2 4 20fu
Croundw2ter C.'Ct1`.'ii
Ashevthe Quin,gyl_.-_t,
04-20-01
SIGNATURE OF PERSON CONSTRUCTIN ELL DATE
Submit original to Division of Water Ouellly. Oroundwal Section within 30 days
OW.1 REV. 12/99

North Carolina • Department of Environment and Natural Resources - Division of Water Duality - Groundwater Section
1636 Mall Service Center - Raleigh, N.C. 27699-1036-Phone [phone]
233824
I
WELL CONSTRUCTION RECORD WELL CONTRACTOR' Hickory Well Drilling Co.
WELL CONTRACTOR CERTIFICATION 0: 2343
STATE WELL CONSTRUCTION PERMITS*:
1. WELL USE (Check Applicable Sea): Residential ® Municipal El Industrial ❑ Agricullural El Monitoring 0
Recovery ❑ Heal Pump Waler Injection ❑ Other El If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: Mnrgsn ton county: Burke
Charleston Drive 4th on left
(Road Name and Numbers, Community, or Subdivision end Lol No.) DRILLING LOG DEPTH
3. OWNER Hoyle Enterprises/Bill Hoyle From To Formation Description
Address 5300 Denton Chapel Rd. ='
(Siegel or Roulelllo.) 28655 c�
Morgatnon LLVVGG
GlyorTown Slats ZIP Coda C'
4. DATE DRILLED 04-12-01 1 0 ,
5. TOTAL DEPTH 305 UT
6. CUTTINGS COLLECTED YES® NO(f � �
7. DOES WELL REPLACE EXISTING WELL? YES n NO® S.
o
8. STATIC WATER LEVEL Below Top of Casing: 60 FT. rn-"-
(Uae '.' a Above Top or Casing) w n
9. TOP OF CASING IS 2 FT Above Land Surface' CO --
'Top of casing terminated seer below lend surface requires a variance In 'moor- CM o
dance with ISA NCAC 2C .0110 x
10. YIELD (gpm)' 20 METHOD OF TEST By Air Test
11. WATER ZONES (depth)•
12. CHLORINATION: Type hth Tabs Amount 51 II additional space is needed use back ol lorm
13. CASING:
Wet ThicknessLOCATION SKETCH
Depth Diameter or WelghuFl. Material (Show directibn end distance from at least two State
From 0 To 1 3 Ft 6311 PVC Plas tic Roads, or other map relererice points)
From To Ft 2
From To Ft
14. GROUT: geS<
Depth Material Method
From 0 To 20 Ft Grout Poured 0'
From To FI
15. SCREEN: W
Depth Diameter Slot Size Material
From To _ Ft In In
From To _ FI In in
From To Ft In In
16. SAND/GRAVEL PACK:
Depth Size Material
From To FI
From To Ft
17. REMARKS:
N
s
f
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDA
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD H
FOR OFFICE USE ONLY
Ouad No:
Ogre I
j AUG 2 4 ?OCR'
Eroundwz;e- Section
Ashev'iie auc!on ] Q" I
WITH ISA NCAC 2C, WELL
PROVIDED TO THE WELL OWNER.
04-18-01
SIGNATURE OF PERSON CONS • , `O THE WELL DATE
Submit original to Division ol Water Oualily, Groundwater Section within 30 days
OW -I REV. 12/99

North Caroline • Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1 E130 Mail Service Center • Raleigh, N.C. 27099-1630-Phone [phone]
233823
I
FOR OFFICE USE ONLY
Quad No:
AUG ? 4 700'
WELL CONSTRUCTION RECORD WELL CONTRACTOR. Hirknryr WPl1 Drilling en
WELL CONTRACTOR CERTIFICATION O: 2343
STATE WELL CONSTRUCTION PERMITO:
1. WELL USE (Check Applicable Box): Residentlat1 Municipal El Industrial El Agricultural El Monitoring ❑
Recovery Q Heal Pump Water In)eollon ❑ Other O II Other, List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: Morganton county Burke
9Rn2 Tanrel HPi &its Drive
(Roed Name and Nunbers, Community, or Subdivision and Lod No.) DRILLING LOG DEPTH
3. OWNER Larry Fleming From To Formation Description
Address 3RH2 T r l P y rs Drive
Morganton 're�orii�ePiQo'.} 28677 r�
n�
city or Town Slats
4. DATE DRILLED 04-04-01
5. TOTAL DEPTH 3f5
8. CUTTINGS COLLECTED YES Q NO01
7. DOES WELL REPLACE EXISTING WELL? YES IXJ NOn
8. STATIC WATER LEVEL Below Top of Casing: 3G FT.
(Ues II Above Top of Casing)
9. TOP OF CASING IS 7 FT Above Lend Surface'
'Top of casing terminated sVor below land surface requires a variance In accor-
dance with 1SA NCAC 20.01111
10. YIELD (gpm)• . 9f1 METHOD OF TEST Ry Air T st
11. WATER ZONES (depth)•
•
Zlp Code
12. CHLORINATION: Type hth Tabs Amount 58
13. CASING:
Deplh
From 0 To 68 Ft
From To Ft
From To Ft
14. GROUT:
r—
cn
3 �T
W nz
C)
If additional space is needed use back of form
Wail Thickness
Diameter or Weight/Ft. Material
61rm PVC piactic
Depth Material Molhod
From _0__— To 20 FI Orni it Pni mod
From To Ft
15. SCREEN:
Depth Diameter Slot Ski Material
From To _ Ft _ In In
From To _ Ft In ' In
From To Ft. In In
is. SAND/GRAVEL PACK:
Depth Size Material
From To FI
From To Ft
17. REMARKS:
• LOCATION SKETCH
(Show direction and distance from at least Iwo State
Roads, or other map reference points)
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORD
CONSTRUCTION STANDARDS. AND THAT A COPY ORECORD H
Ars
E WITH 15A NCAC 2C, WELL
N PROVIDED TO THE WELL OWNER.
04-11-01
SIGNATURE OF PERSON COti?NIOLeTIND TIIE WELL DATE
Submit original to Division of Water Quality, Groundwater Section within 30 days
ow.1 net 12/ga

I
North Carolina • Department of Environment and Natural Resources - Division of Water Quality -Groundwater Section
1039 Mall 5mlgg Ginter • Raltigh1 N,G1117044.10@4Phons (914) Tal-agt I
WELL CONSTRUCTION RECORD
233822
WELL CONTRACTOR. Hickory Well Drilling Co.
WELL CONTRACTOR CERTIFICATION 0: 2343
STATE WELL CONSTRUCTION PERMIT?:
1. WELL USE (Check Appllceble Boa): Residential ® Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heal Pump Water Injection ❑ Other [l If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: Morganton county: Burke
4504 .Silver Creek (:h. Rd.
(Rood Nam* end Hunters. Community. or subdivision and Lot No.) DRILLING LOG DEPTH
C3
3. OWNER Dean Wilson From To Formation Deeesttion_ i.
Address 4504 Silver Creek Ch. Rd. —
L
Morganton IS feel or NoleNo.)
28655
City or Town Slate Zip Code
4. DATE DRILLED 04-10-01
5. TOTAL DEPTH 2R5 �f
6. CUTTINGS COLLECTED YES IDNOM
7. DOES WELL REPLACE EXISTING WELL? YES NOn
8. STATIC WATER LEVEL Below Top of Casing: 90 FT.
(Use Y' It Above Top of Casing)
9. TOP OF CASINO IS 2 FT Above Land Surface'
'Top of casing tsiminslad at/or below land malice requires a variance In accor-
dance with ISA NCAC 2C .title By Air Test
10. YIELD (gpm): METHOD OF TEST
11. WATER ZONES (depth).
12. CHLORINATION: Type hth Tabs Amount 49
13. CASING:
r a±s:
U
Ir
rn
CD
rn
—
If additional space Ls needed use back of form
Wee ,y yT1a. -
Thickness LOCATION SKETCH
0 Den ,gtenter CV hWi. Yletea riel . (Show direction and distance train at least Iwo Slate
From To Ft Roads, or other map reference poInts)
From To Ft
From To Ft.
14. GROUT:
Depth Malarial Method
From 0 To 20 FI front Poured
From To Ft
15. SCREEN:
Depth Diameter Slot Slza Material
From To Ft In In
From To Ft In In
From To Ft In In
10. SAND/GRAVEL PACK:
Depth Size Material
From To Ft
From To Ft
17. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 20, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEy9OVIDEO TO THE WELL OWNER.
FOR oFFIGE-USE-ONLY
j lima tto. M fi `Li 1
iiiir1al No.
L_i AUG 2 4 200i
04-11-01
SIGNATURE OF PERSON CONSTRUC HE WELL DATE
Subn>M original to Division of Waler cushy. Oro stet Section Within 30 days
OW -I REV. 12/99
Croundwater Section
Asheville Ronal Office

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section O v
2 n n lJ n p
1636 Mail Service Center - Raleigh, N.C. 27699-1636-Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR- PIif lid /
—LP(
WELL CONTRACTOR C RTIFICATION #:
STATE WELL CONSTRUCTION PERMIT&:
1. WELL USE (Check Applicable Box): Residential ��Mun)c)pal ❑ Industrial El Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection El Other If Other, List Use:
2. WELL LOCATION: plowsketch of the location below)
z
Nearest Town: ( lit County
ay/e
(Road Name endirbegt ity, or Subdivision and Lot No.) DRILLING LOG
3. OWNER , 1GG4c 2- _ /, Fr To
Address ,;?.:2 / i (Ja)rrtOr clot( K-d0 (J
GS
tree or Rou a No. i. 3 4-7
C1orro n na n n %go p C 7 / CO
City or To Sots Lp Cods
4. DATE DRILLED (/- r-I'C /
5. TOTAL DEPTH (-1 S-- i
6. CUTTINGS COLLECTED YES ❑ NOQ/
7. DOES WELL REPLACE EXISTING WELL? YES 0 NO
d
8. STATIC WATER LEVEL Below Top of Casing: 7 FT.
(Use': it Above Top of Casing)
9. TOP OF CASING IS ) FT. Above Land Surface'
Top of casing terminated aVor below lend surface requires a variance
. 11accor-
dance with 15A NCAC 2C a
10. YIELD (gpm): S METHOD OF TEST Alir / r of-)
11. WATER ZONES (depth)'
12. CHLORINATION: Type Amount
13. CASING:
0
Y
— o`<
—o
s Tr
La cn
ci
If additional space is needed use back of loT? o
z
IACATION SKETCH
Wall Thickness
From (J
Depth / '7 Diameter or w Material (Show direction and distance from at least two State
To �=- Ft .�—— Roads, or other map reference points)
From To Ft.
From To Ft
14. GROUT:
Depth�y Material Method
From 6 To re31—Ft (ra•m''nt ith2
From To Ft
15. SCREEN:
Depth Diameter Slot Size Material
From To __. Ft in in
From To Ft in In
From To Ft. In In
16. SAND/GRAVEL PACK:
Depth Size Material
From To — Ft.
From To Ft
17. REMARKS:
I DO HEREBY CERTIFY THAT.THtS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY O%FLThUCNGThEWE
RECORD HAS BEEN PROVIDED TO THE WELL OWNER. /
�
' ��
4
SIGOPEHSD LL Y DATE
Submit original n of water slily, Groundwater Section within 30 days GW-1 REV. 12/99
FOR OFFICE USE ONLY
Quad No:
Serial No.

Zip Cods
North Carolina • Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mail Service Center • Raleigh, N.C. 27699-1636-Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR: j/flI'Cr, /J�ll �rt'��� Liv(
WELL CONTRACTOR C TIFICATION S: 9 7/ 7
STATE WELL CONSTRUCTION PERMITS:
230978
1. WELL USE (Check Applicable Box): Residential❑Municipal ❑ Industrial El Agricultural ElMonitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: /fir r/�f fir'^ County. I�t// LE
(Road Name and Numbers. Community, or Subdivision and Lot No.)
3. OWNER silt/ c fuc�
Address
(Street or Houle No.)
City or Town Stare
4. DATE DRILLED q- ¥ OI
5. TOTAL DEPTH $.- Q i
6. CUTTINGS COLLECTED YES c NO[]
7. DOES WELL REPLACE EXISTING WELL? YES [:1NOJ - cn
8. STATIC WATER LEVEL Below Top of Casing: O FT. _.
(Use': If Above Top Casing) saw ri^
FT. Above Land Surface' c
9. TOP OF CASING IS
DRILLING LOG
From To
/7 %/2
// 2_ / / 7
DEPTH
Formation Description
naC./r.
.77ocIc
'Top of casing terminated at/or below land surface requires a variance In accor-
dance with 15A NCAC 2C.0113 A
10. YIELD (gpm): / METHOD OF TEST /It r /-eS 77-5
11. WATER ZONES (depth)•
12. CHLORINATION: Type Amount
13. CASING:
O ;-T
YO
Tr ti..
C3 "--
If additional apace is needed use back of kit
Wall Thickness LOCATION SKETCH
Depth / Diameter or well; Material (Show direction and distance from at least two State
From v To Ft — - 0/ G Roads, or other map reference points)
From To Ft
From To Ft
14. GROUT:
Depth Material Method
From n To 72C' Ft (,'n.r.wf m(Y�G/
From To Ft
15. SCREEN:
Depth Diameter Slot Size Material
From To Ft in in
From To Ft. in In
From To Ft. in In
16. SAND/GRAVEL PACK:
Depth Size Material
From To Ft
From To Ft
17. REMARKS:
I DO HEREBY CERTIFV'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 USEONLY
Quad No:
Serial No.
i
SIGNATUF NCONSI tING THE WELL DATE
Subnit original to or Quality, Gmundwater Section within 30 days
GW1 REV. 12/99

North Carolina • Department of Environment and Natural Resources - Division of Water Quality • Groundwater Section 2 3 lJ 9 6 5
1636 Mail Service Center - Raleigh, N.C. 27699-1636-Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR- %Anr /le1�^��" L�7��
WELL CONTRACTOR CERTIFICATION e:
STATE WELL CONSTRUCTION PERMITS*:
1. WELL USE (Check Applicable Boa): Residential Er Municipal ❑ Industrial ❑ Agricultural El Monitoring 0
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: �F°"?` `" County. l7
(Road Name and Numbers, Cover wnity, or Subdivision and Lot No.) _ DRILLING LOG DEPTH
3. OWNER /sattrr.- Mj'� �X/� n � From ToFo uon Description
Address•—10 I FS-41. C � 130-- d 5711-
it
\\\ 4 (5 NI or Houle N0. l it-,', .S ti .lei
City or Tovm r SS3 N rp Code
4. DATE DRILLED
5. TOTAL DEPTH / ill -.-
6. CUTTINGS COLLECTED YES ❑ NO =
:o-
7. DOES WELL REPLACE EXISTING WELL? YES NO� --4
8. STATIC WATER LEVEL Below Top of Casing: �/) FT. P
(use': If Above ToP CCasing) YTj
9. TOP OF CASING IS i FT. Above Land Surface* -+-)
v
?op of casing terminated atlor below land surface requires a variance In actor- 3 C '
dance with 15A NCAC 2C .0118 4- . �_ C.,) � a
10. YIELD (gpm): -.2 di METHOD OF TEST JCS/eel ca i
11. WATER ZONES (depth)'
12. CHLORINATION: Type
13. CASING:
Amount
Wall Thickness
Depthf / Diameter or W
From (' To 1---(- Ft �—
From To Ft.
From To Ft•
14. GROUT:
Material
nj� Depth Ml ateriaMethod
From V To Pti Ft (r.•+.-'t ^^Ji'st
From To Ft
15. SCREEN:
Depth Diameter Slot Size Material
From To — Ft In in
From To Ft. in In
From To Ft. in in
16. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
17. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECQRD HASJBEEN PROVIDED TO THE WELL OWNER.
// Ay--/`_r (/
L SIGNATURE pE N CON SI NG THE WELL DATE
Subnna original to Divlsl of Quality, roundwater Sadion within 30 days GYM REV. 17N9
0
If additional space Is needed use back of form
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other map reference points)
FOR OFFICE USE ONLY
Quad via:
Serial No.

230964
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. �nYv t e c( O,/% itit
WELL CONTRACTOR CERITIFICATION f:
STATE WELL CONSTRUCTION PERMITS:
1. WELL USE (Check Applicable Box): Residential L7 Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATION: (Show sketchpf the location below)
Nearest Town: c)ci✓Ci l County:
(Road Name and Nu en, Community, or Subdivision and Lot No.)
3. OWNER MA-1,(?ph."! f
Address )32 16j old ({furl.)) a
cPSU�I1Z I
1/l t trfet or Ju; No. I C (
City or Town Stan
4. DATE DRILLED y `‘ U
5. TOTAL DEPTH 70 )
6. CUTTINGS COLLECTED YES ❑ NO, -,
7. DOES WELL REPLACE EXISTING WELL? YES D NOE(
8. STATIC WATER LEVEL Below Top of Casing: yr FT.
(Use': if Above Top of Casing)
9. TOP OF CASING IS FT. Above Land Surface'
'Top of casing terminated at/or below land surface requires a variance In accor-
dance with 16A NCAC 2C .011118
10. YIELD (gpm): 4' . METHOD OF TEST /* Sate
d
11. WATER ZONES (depth)*
DRILLING LOG DEPTH
From To Formation Description
a
-25' _::>Gc /7fC,/c
•
Zip Code
12. CHLORINATION: Type Amount
13. CASING:
Wail Tbidkness
Depth S Diartvfter or Mateirial
.,
From To Ft
From To Ft
From To Ft
14. GROUT:
Depth Material Method J
From 0 To .2L/ Ft (e,'+., . r �Ve-e
From To Ft
15. SCREEN:
Depth Diameter Slot Size Material
From To Ft in in
From To Ft in In
From — To Ft In in
16. SAND/GRAVEL PACK:
Depth Size Material
From To — Ft.
From To Ft
17. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN
CONSTRUCTION STANDAMDS. AND THAT A COPY OF THIS REC5
FOR OFFICE USE ONLY
Quad No:
0
0
c
32
9 VI 2
C+) o
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)
ftCORDANCE WITH 15A NCAC 2C, WELL
D HAS BEEN PROVIDED TO THE WELL OWNER.
jl. st e
SIGNATURE F P, N CONS NG THE WELL DATE
Submit original to ofor Gusiity, G ar Section within 30 days
/ // GIN-1 REV. 12/99
Serial No.

North Carolina Dep. rtnten: of Environment & Natural Resources
Division of Water Quality - Groundwater Section
1636 Mail Service Center
Raleigh, NC 27699-1636 Phone: [phone]
WELL CONSTRUCTION RECORD
DRILLING CONTRACTOR: /Y y(f ,f2//Ait) L)eil" / C "D.,// STATE\ ELL
229623
n
FJF OFFICE USE ONLY
OLSO NO SERIALNO.
iv. Lang. 8O.
Mars Pain
nab, Caic
Hod:: Ent.
OW -I Ent
CONSTRUCTION Q�r Q'
DRILLER CERTIFICATION NUMBER: � IO O PERMIT Ni:A1DER:
i. 'YELL LOCATION: ISIlow sketch of [hp location Solo ,/
Nearest Town: l7 l�de beq 4jaunty: pCJj/sG
(hoed. ':ommurtit}• or, Su division and of No.)
OWNER %�i
ADDRESS h - Z; e hOEL4oe
(Street or RonteNo.:
/ /J Qom/
C 't na e//y �LT�/—!J
City or Tone Stow Zip Cat
i jam` a TE DRII LEn r:VatitSi._DLWELL_.ga me. _..
4. TOTAL DEPTH y
5. CUTTINGS COLLECTED YES 0 NO 5.-X
6. DOES WELL REPLACE EXISTING WELL? YES 12(NO
7. STATIC WATER LEVEL Below Top of Casing: . C FT.
�� (Use "+- i^ Above Top of Casing:
8. TO? OF CAUSING IS _ FT. Above Land Sot:'
'Casino Terminated aCor below lend surface I: the^a1 unies, vor is act Es 'sound
in accordant: with 7?A NCAC 2C .7 t 1 c
S. YIELD (gpm): C METHOD OF TEST,9//eterecr
1. NI ATER ZONES (depth): t).(a — y3 / v
11. CHLORINATION: Type race Ateounr /__/£ C ups
12. CASING:
Wall Thickness
Depth DLIT/eel Or Weight'Ft. }taterial
Frar..___To Ft YY
From ______To _._ Ft. __
From Ti Ft.
13. GROUT:
Depth, Materir! AJ}thud�J
From To 4U Ft C%6Yf %dr'Pd
From To Ft
it SCREEN:
Depth Diameter Slot Saxe Mnterin,
From To Ft. in. In -
From To Ft. in. in
From To __„_ Ft. in, in _—__
Y. S.ANDPGRAVEL PACK:
Depth
From aO To '0 Ft
From To Ft.
Size/9
:6. REMARKS: title f?zalri if :tv T.' nT 94.PUe 41-9,// . 11.ah .(.els,p; for fhe peJtel
I DO HERER OT 7t1i$}}T TB,JS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A. NCAC 2C, WELL !"
CONSTRUCTInSIARDS. AND THAT A COPY OF IS RECORD HAS BEEN PR9VIDED TO THE WELL OWNER.
Maier' I
DEPTH
From
DRII LING tOt't
Formation Description
-
_ . 0Q
N rna
J3! H
Ca
O
If additional space is needed ute back of form
LOCATION SKETCH
(Snow direction and distance Fran, a: least two State
Roads, or other map reference points)
GW-I REV. 11:99
SIGNATURE OF NTRACTOR.6R AGENT DATE
Submit original to Division of Water Qua Bey and a copy to well owner.

233819
i
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1630 Mail Service Center- Raleigh, N.C. 27699-1630-Pion. (919) 7333221
WELL CONSTRUCTION RECORD WELL CONTRACTOR- Hirknry We11 Dri 11 i ng Co.
WELL CONTRACTOR CERTIFICATION 0: 2343
STATE WELL CONSTRUCTION PERMIT.:
1. WELL USE (cheek Applicable Box): ResldenUal El Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other [] if Other, List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: Morganton County: Burke
7043 Nuggett Drive
(Road Hama and
Ny. Dillingham
Subdivision and tot No.)
3. OWNER Jack
DRILLING
DRILLING LOG DEPTH
From To
Formation Description
Address 7043 Nuggett Drive
(Street or Houle No.)
Morganton NC 28655 a
City or Town State zip Code d Q
4. DATE DRILLED 03-30-01 _
6. TOTAL DEPTH 245
6. CUTTINGS COLLECTED YES Il NO Kr C a `
7. DOES WELL REPLACE EXISTING WELL? YES 1312 NOn r c_
S. STATIC WATER LEVEL Below Top of Casing: 40 F!. (SI c
(Uwe'e' I Abev. Top el desire) —4..._
P. TOP OF CASINO 18 9 FT. Above Land auda.a• C r
'Top of casing terminated at/or below land eurleee requires a v.rlano. In new i rr
dance with ISA NCAC 2G.011e W mN
10. YIELD (gpm): �_ METHOD OF TEST Ry Air rec t
11. WATER ZONES (depth): 0 0
tt
12. CHLORINATION: Type hth labs Amount 43
13. CASING:
II additional space Is needed use back of lorm
•
wall Thickness LOCATION SKETCH
Depth Diameter or W htTt. Material (Show directibn and distance from at least two State
From 0 To 123 Ft. 6ir r PVC Plastic Roads, or other map reference points)
From To Ft
From To Ft
14. GROUT:
Depth Material Method
From 0 To 20 Ft Grout Poured
From To FI
15. SCREEN:
Depth Diameter Slot Size Material
From To _ Ft In In
From To __ Ft In in
From To Ft. In In
16. SAND/GRAVEL PACK:
Depth Size Material
From To Ft
From To Ft
17. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C. WELL
CONSTRUCTION STANDARDS. AND THAT A COPY OF THIS RECORD HAS BEEN P ED TO THE WELL OWNER.
i 04-02-01
SIONATUR P SON CONSTRUCTINGJHE-WELL DATE
Submit original to Division of Water Meaty. Groundwater Secnon within 30 days
OW-1 REV. 12/09
FOR OFFICE USE ONLY
Ouad No:
Dwp� i
l AUG 2 4 2O{i'
Groundwater Section
Ashevaie Reciona, Office

2325R9
Size
North1636 Carolina er Department - of Environment and N636 P oneRes1- 3ision of Water QualityGroundwater Section
1636 Mail Service Center - Raleigh, N.C. 27699-1636-Phone [phone] % ter
WELL CONSTRUCTION RECORD WELL CONTRACTOR tV►J- `
k TA Al
WELL CONTRACTOR C IFICATION #:
STATE WELL CONSTRU TION PERMIT#:
1. WELL USE (Check Applicable Box): Residential Lf' Municipal ❑ Industrial ❑ Agricultural El Monitoring D
Recovery ❑ Heat Pump Water Injection ❑ Other El If Other. List Use:
2. WELL LOCATION] (S)bo iicelchfo� ve location below)
Nearest Town: //!!99 //t�'"'�� County
goia
(F o 17ame and 1Tumbelis. C& Nty. or Subdivision and Lot No.) DRILLING LOG DEPTH
3. OWNER /1 eirP Cen
/C From To Foation Description
Address5/•�2 4t/4t or Ha ,t t ` " .Lt Cc
414 MC- `V Yap Cie c Q S tJu
4. DATE DRILLE
5. TOTAL DEPT
6. CUTTINGS COLLE YES ❑ NO
7. DOES WELL REPLACE EXISTING WELL? ES n NOEr CD p
8. STATIC WATER LEVEL Below Top of Casing: FT.
(Use': if Abov op of Casing)
c>-
9. TOP OF CASING IS FT Above Land Surface' Lt..�`',
'Top of casing terminated at/or below land surface requires a variance In accor- — O-- c^
dance with 15A NCAC 2C .0118 r
10. YIELD (gpm): jj METHOD OF TESTA (a • ›-
11. WATERZ0NES(depth):= , as • �m
SP4s r, rn2
�,al / I1 additional space is needed use back of forrr '
12.3CHLORINATION: Type�lr Amour fricc e P
13. CASING:
z
LOCATION SKETCH
Wan Thickness
Depth Diameter or WeighVFL Material (Show direction and distance from at least two State
From To Ft. Roads, or other map reference points)
From T,- Ft6/7, ✓u `j/ C_
Fro rt> Tb - Ft14. GROUT: . 6, LA ill; IU P 1
Material Method /`�
a
Depth
From To Ft
Fro T�G F��4 /314
15.SC N: G
Depth Diameter Slot Size Material
From To Ft in in
From To Ft in in
From To Ft in in
16. SAND/GRAVEL PACK:
Depth
From To Ft
To Ft
From
17. REMARKS:
I DO HERE
CONSTRUC
Material
ONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
F THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
a
/ - ,tom
k4' • 1.4`eN CONSTRUCTING THE WELL DATE
Io Division r ater Cluality, Groundwater Section within 30 days
GW-1 REV. 12r99

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]
230993
WELL CONSTRUCTION RECORD WELL CONTRACTOR* �s��,7 /-'rf( L2;M -1 /vC
WELL CONTRACTOR CS TIFICATION #:
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE (Check Applicable Box): Residential a Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below) Our At.
Nearest Town: /'err it/1County.)/J
(Road Name and Nu re, Community, or S bdivision and Lot No.) DRILLING LOG DEPTH
�
3. OWNER I�, From To Fo on Description
-� �A_ © •'OQ•f
Address �►�1 , f ) r//ra31 % /� / D q i3
City tit r own • J% Zip Code
4. DATE DRILLED e
5. TOTAL DEPTH
6. CUTTINGS COLLECTED YES ❑ NOIE7
7. DOES WELL REPLACE EXISTING WELL? YES NOE
8. STATIC WATER LEVEL Below Top of Casing: CS' FT.
(Use'i If Above Top of Casing)
9. TOP OF CASING IS f FT. Above Land Surfaces
'Top of casing terminated at/or below land surface requires a variance In accor-
dance with /5A NCAC 2C.0a
10. YIELD (gpm)• /lrr METHOD OF TEST I4
11. WATER ZONES (depth)'
12. CHLORINATION: Type Amount
13. CASING:
s
r-
ern
0 =^
��
W ma
If additional space is needed use back of form
Wall Thickness LOCATION SKETCH
/� Depth q D r or WrIgNIFt. (Show direction and distance from at least two State
From (� To /�J Ft -�b7,�¢" Roads, or other map reference points)
From To Ft
From To Ft
14. GROUT:
Depth Mateda1__ Method
From 0 To Ft C'erwcnI en ;Yea
From To Ft
15. SCREEN:
Depth Diameter Slot Size Material
From To Ft in in
From To Ft in In
From To Ft. in In
16. SAND/GRAVEL PACK:
Depth Size Material
From To Ft
From To Ft.
17. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDAA9StANO THAT A COPY OF THIS RE RD HAS BJEN PROVIDED TO THE WELL OWNER. 1
. i �/� 3
Q
SIGNATU OF� SON CON UCTING THE WELL DATE
SubrNl original to n 9t ater Quality, Groundwater Section within 30 days GW-1 REV. 12199
FOR OFFICE USE ONLY
Quad No:
Serve No.

Zip Code
'Top of casing terminated atior below land surface requires a variance In accor-
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'
gw°
WELL CONTRACTOR CERTIFICATION #:
STATE WELL CONSTRUCTION PERMIT#:
2 ' I
1. 'WELL USE (Check Applicable aced: Residential ❑ Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATION:: (Show sketch of the location below)
Nearest Town: /"! C). i 3? ja'77L0 %7)/ /1/0_ County:
,5U(rh r_
(Road Name RA N)rmblers, Cornnunii , or Su/bdivisio%r antldj4 No.)
3. OWNER U'(-1- (f(cGg�� /1 6car s/ ( /1yyr7 r j�F
Address 7° 30 �1en 6-56Y? 1 l f K!,)
�Fil . �+o �� '11
(Street or outs
City or Town ate
4. DATE DRILLED 7/2 /1 2C> t' /
5. TOTAL DEPTH 4'Ga
6. CUTTINGS COLLECTED YES ❑ NO
7. DOES WELL REPLACE EXISTING WELL? YES Q' NOE
8. STATIC WATER LEVEL Below Top of Casing: p FT. o
(Use'+' if Above Top of Casing) _ D
9. TOP OF CASING IS FT. Above Land Surface'
a a7:i
DEPTH
DRILLING LOG
Formation Opsaipbon
/'rI—
oa<
dance with 15ANCAC 2C.0118 bK`l J / '� cn++
10. YIELD (gpm): .{ METHOD OF TEST %"'cvG-tr c-h CO o<
11. WATER ZONES (depth): �o
3 A�
12. CHLORINATION: Type )3Jz`r k Amount 14 4/tee ( If additional space is needed use back e4ormmg
13. CASING:
Wall Thickness LOCATION SKETCH N z
Depth Diameter or Weight/Ft. Material (Show direction and distance from al least two State
From To Ft Roads, or other map reference paints)
From To Ft
From To Ft /
14. GROUT:
Depth Material Method
From 0 To 20 Ft
From To Ft
15. SCREEN: VL
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:
—7 0
_ /60
0
-1f'7ci.-
4-%U
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF TMIS RECORDD�HAS BEEN PROVIDED TO THE WELL OWNER.
'`4� " f� 7/7 Sl2vU
FOR OFFICE USE ONLY
Quad No.
Serial No.
SIG TUBE OF PERSON CONSTRUCTING THE WELL DATE
Submit original Division of Water Quality, Groundwater Section within 30 days
GW-1 REV. 03/2000

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- Yadkin WW1 Cry Inc.
WELL CONTRACTOR CERTIFICATION S: 'Z V3 /
STATE WELL CONSTRUCTION PERMITS:
1. WELL USE (Check Applicable Box): Residential Municipal ❑ Industrial ❑ Agricultural ❑
Recovery ❑ Heat Pump Water Injection 0 Other If Other, List Use:
2. WELL LOCATION: (Show sketch/of the location below)
Nearest Town: LM0 h9 4 re-s �"J County
(- "/. /1 '`�// a -
(Road Name and Numbers, rrcnunity, or Subdivision and Lot No.) DRILLING LOG
3. OWNER 'al, I._ I._ AY /c in- 32 % - fl oo' From To
Address
Monitoring ❑
(Street or Route No.)
hit zf-`-+`QS=-2l8r — %G
90 �7
City or Town State Zip Code
4. DATE DRILLED 24?e11
5. TOTAL DEPTH
6:. CUTTINGS COLL CTED YES ❑ NO
7. •. DOES WELL REPLACE EXISTING WELL? ES C NO�]
8. •. STATIC WATER LEVEL Below Top of Casing: v FT.
(Use 'Y If Above Top of Casing)
9. `;TOP OF CASING IS / FT. Above Land Surface'
'Top of casing terminated at/or below land surface requires a variance In actor- . -
`dance with ISA NCAC 20.0118
10: YIELD (gpmp It' METHOD OF TEST d -er4 ye
11.'WATER ZONES (depth). /Cc 4-1. 337 V tie
12. CHLORINATION: Type .1�_ Amount
/et- _LGz
z�— 7°
13. CASING:
Wan TNdaess
Depth?'? 4jag1setar or8lelohtl , h�j�r�iet
From
(� To / / Ft la"� JUUTr�z Pere
From To Ft
From To Ft.
14. GROUT:
15.
Depth Material Meth
From 0 To ZI Ft r f
From To Ft 6e(coo ..-4- rah
Depth Diameter Slot Size Material
SCREEN: /
From To
From To
From To
16. SAND/GRAVE
DEPTH
Formation Description
r(2- .' 1
it ltt ((
6,7
It
ii t ( c (
cl
a
t-
rr
o
cn't
C)
ti
If additional space is needed use back of form
Ft in In
Ft in In
Ft in in
en. �-
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other map reference points)
"leV
Pot
I e HEF(Eat CERi,FY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITHH 15A NCAC 2C, WELL
CO
1
2
29531 3.1v
64 rd
t ) t o vrt tl c
I %Psti
SI.BUCTION STANbARDS, AND THAT A COPY OF, S RRECOR/ f / PROVIDED TO THE WEI .OWNER.
FOR OFFICE USE ONLY
Quad No
Cnri71 Nn
iNATURE OF PERSON CONSTRUCTING THE WELL
Submit o nal to Division of Water Ousay, G.o.Mwate( Section within 30 days
DATE
GW-I REV. I2/99

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section 2 3 U 9 4 7
1636 Mail Service Center • Raleigh, N.C. 27699-1636-Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR. I '. �r �.f!l��if1 he
WELL CONTRACTOR CERTIFICATION #: e)71.t
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE (Check Applicable Box): Residential ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ if Other, List Use:
2. WELL LOCATION: (SA:ketch of the location below)
Nearest Town: / - ^�%An County:
(Lv/r e
(Road Name and Numbs . Comnunity�, r Subdivision and Lot No.) DRILLING LOG DEPTH
3. OWNER —/l./ pre l I1 +4n Ili
� From To Fom aucn�cdp6�
Address l£ / (i3 f :chi Ili) ° o
St
City or Tovel State Zip Code
`�-
4. DATE DRILLED 3-it -47
5. TOTAL DEPTH ,,9t)
6. CUTTINGS COLLECTED YES E NO
7. DOES WELL REPLACE EXISTING WELL? YES [' NO❑
8. STATIC WATER LEVEL Below Top of Casing: FT.
fuse N.' II Above Top or Casing)
9. TOP OF CASING IS FT. Above Land Surface*
-Top of casing terminated at/or below land surface requires a variance In accor-
dance with 15A NCAC 2 ef. s
10. YIELD (gpm): 1x METHOD OF TEST "4/ 1 .4"-Weel
11. WATER ZONES (depth)
3 r3-o
•
12. CHLORINATION: Type Amount
13. CASING:
Wall Thickness
Depth Diajneter or W M7te, �+J
From To g Ft b �/v �.
From To Ft.
From To Ft.
14. GROUT:
Dep Material Method
From Toei
Ft ���� en,tYee/
From To Ft
15. SCREEN:
m
o rH
IV vl j
O
It additional space is needed use back of form
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other map reference points)
Depth 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:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS R5CORD HAS B5EN PROVIDED TO THE WELL OWNER.
/� 3-,9-0
OF SON CONS TINO THE WELL DATE
of ater Quality. oroundwater section within 30 days
FOR OFFICE dl$E ONLY
Quad No: F
SIGNA
Submit original to D'v
GW1 REV. 17199
Serial No.

North Carolina • Department of Environment and Natural Resources - Division of Water (Duality - Groundwater Section
1636 Mail Service Center - Raleigh, N.C. 27699-1636-Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR. riv / -ii Q /Li �^ c
WELL CONTRACTOR CERtIFICATION I: 027, )i
STATE WELL CONSTRUCTION PERMIT#:
230961
1. WELL USE (Check Applicable Boa): Residential 11K Municipal ❑ Industrial El Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATION: (Show sketchppf the location below)
Nearest Town: /17444-nre— County' 73,n" kc
(Road Name and Numbers. Commune or sion and Lot No.) DRILLING LOG DEPTH
Community.
3. OWNER f r le. �' From To Formation Description
Address 5 o 7 ,e-//i 5 or, ca 50 �r, r
streqeet or Route No.) -2 / " if / fc: c'/c
l ldi f �r /l�� a2 s�'�0 SS S /fo olz
City or Town State / np Coda
4. DATE DRILLED 3`7 -0/
5. TOTAL DEPTH -S 1 S
6. CUTTINGS COLLECTED YES ❑ NO_
7. DOES WELL REPLACE EXISTING WELL? YES r NOD
8. STATIC WATER LEVEL Below Top of Casing: a- FT.
(use •• If Above Top of Casing)
9. TOP OF CASING IS .-) FT. Above Land Surface'
'Top of casing terminated at/or below land surface rsquiru a valence In accor-
dance with 15A NCAC 2C .018
10. YIELD (gpm)• ; METHOD OF TEST
11. WATER ZONES (depth)*
12. CHLORINATION: Type Amount
13. CASING:
If additional space is needed use back of form
LOCATION SKETCH
Wail Thickness
„, Depth _ Diameter or Weep Material (Show direction and distance from at least two State
From ! / To S Ft PC- Roads, or other map reference points)
From To Ft
0
From To Ft. O
0
14. GROUT: Deptp., „Material Method Zr n a
--
From 0 To if Ft = n -C
—
_!']
om
From To Ft O >o
15. SCREEN: 3rii
r,
fV v>_c
., r+t�
O —�i
0
z
Depth Diameter Slot Size Material
From To _ Ft _ in _ in
From To Ft. In in
From To Ft. In In
16. SAND/GRAVEL PACK:
Depth Size Material
From To _ .— Ft.
From To Ft.
17. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS REC RD HAS .... PROVIDED TO THE WELL OWNER.
SIGNATUR PERSON CONSTRI THE WELL DATE
Submit original to n of Water Quality, Groundwater Section within 30 days GW1 REV. 12/99
FOR OFFICE USE ONLY
Quad No:
Serve 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.
230985
l l Qt . [ /.: C"IC
WELL CONTRACTOR CERTI#ICATION #: a 1 / 3
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE (Chack Applicable Box): Residential OV—Municipal ❑ Industrial El Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other If Other, List Use:
2. WELL LOCATION: (Showisketch of the location below)
Nearest Town: ...-1/erjroninn County.
(Road Name and Numbers Aommoncty, or Subdivision and Lot No.)
3. OWNER , etv'61 gr
Address 1't: �y 6,4
(Street or Houle No.)
City or Town State
4. DATE DRILLED 3 " 8 -° /
5. TOTAL DEPTH ?n
6. CUTTINGS COLLECTED YES 0 NO
��
7. DOES WELL REPLACE EXISTING WELL? YES NOS
8. STATIC WATER LEVEL Below Top of Casing: '7 FT.
fuse •+' If Above Top of Casing)
9. TOP OF CASING IS ( FT. Above Land Surface'
-Top of casing terminated at/or below land surface requires a variance In accor-
dance with 15A NCAC 2C.0JJa
10. YIELD (gpm): �_ METHOD OF TEST Ar r /�S/ `�
11. WATER ZONES (depth): '3 5 0 C ( 4
ni
DRILLING LOG
From To
�7r �30
/3C 3GS`
Zip Code
DEPTH
Formation Description
'( t
G A
n
A p''
c
o m�
-, ;
W %ia
ca _
12. CHLORINATION- Type Amount If additional space Is needed use back of form
13. CASING:
LOCATION SKETCH
Wall Thickness
Depth Diameter or W t/R. Material (Show direction and distance from at least two State
From /1 To Ft �— b/ '? /iv( Roads, or other map reference points)
From To Ft
From To Ft
14. GROUT:
Depth Material Method
From (1 To 90 Ft. ( n ct / _04 i' h-cr
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 HEREQ.Y..CERTIFY-THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BE PROVIDED TO THE WELL OWNER.
9./-Ol
FOR OFFICE USE ONLY
Quad No: it
SIGNATUR%OF
Submit original to
N CONSTNG THEW WELL
it Quality, Groundwater Section within 30 days
DATE
GW1 REV. 12/99
Serial No.

North Carolina - Department of Environment and Natural Recourses - Division of Water Quality - Groundwater Section
1836 Mail Service Center • Raleigh. N.C. 27899-1838-Phone [phone]
228577
WELL CONSTRUCTION RECORD
WELLCONTRACTOR• Hickory Well Drilling Co.
WELL CONTRACTOR CERTIFICATION M: 2343
STATE WELL CONSTRUCTION PERMIT.:
1. WELL USE (Check Applicable Box): Residential 41 Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery El Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: Morganton County. Burke
108 Tnpa? Ave.
(Road Name and Numbers. Community. or Subdivision and Lot No ) DEPTH DRILLING LOG
3. OWNER Vernon Webb From To Formation Description
Address 108 Topaz Ave.
(Street or Rals No.)
Morganton NC 28655
City or Town State Zip Cod.
4. DATE DRILLED 03-7R-01
5. TOTAL DEPTH 3F5
8. CUTTINGS COLLECTED YES n NO0]
7. DOES WELL REPLACE EXISTING WELL? YES in NOD
8. STATIC WATER LEVEL Below Top of Casing: so FT.
(Use •.• II Above Top of Casino)
9. TOP OF CASING IS 2 FT. Above Land Surface'
?op al casing terminated et/or below land surface requires a varlenae In
dance with 15A NCAC 2C .0110
10. YIELD (gem)* 2 METHOD OF TEST By Air Test
11. WATER ZONES (depth)'
12. CHLORINATION: Type hth Tabs Amount 60
13. CASING:
O 2
v
II additional space is needed use back of tom C)
Wall Thickness LOCATION SKETCH
Depth Diameter or Weight/Ft Material (Show direction and distance frorn al least two State
From 0 To 89 Ft 64:" PVC Plastic Roads, or other map relerence points)
From To Ft
From To Ft
14. GROUT:
Depth Material Method
From 0 To 20 Ft Grout Poured
From To Ft
15. SCREEN:
Depth Diameter Slot Size Material 1(/
From To Ft In. in
From To _ Pt In In
From To Ft in In
16. SAND/GRAVEL PACK:
Depth Size Material
From To Ft
From To Ft
17. REMARKS:
N
L
I D0 HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS. AND THAT A COPY OF THIS RECORD HAS BJ PROVIDED TO THE WELL OWNER.
FOR OFFICE USE ONLY
Quad No
Serial No.
03-29-01
SIt1NATU4E OF PERSON CONSTG THE WELL DATE
Submil original Io Division of Water Quality, Gym nowater Section within 30 days
GW.1 REV. 03/2000

•
North Carolina - Depanment of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mall Service Center - Raleigh. N.C. 27899-1838-Phone [phone]
228576
WELL CONSTRUCTION RECORD
WELL CONTRACTOR- Hickory Well Drilling Co.
WELL CONTRACTOR CERTIFICATION a: 2343
STATE WELL CONSTRUCTION PERMf W:
1 . WELL USE (Check Applicable Box); Residential Municipal ❑ industrial ❑ Agricultural © Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other J II Other, List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: Morganton County, Burke
4320 St. Paul Church Rd.
(Road Name and Numbers. Community. or Subdivision and Lot No
3. OWNER Tr ant Sheets
Address 4320 St. Paul Church Rd.
Morganton
City or Town
(Street or Route No.)
NC
28655
State Zip Code
4. DATE DRILLED 03-2B-01
5. TOTAL DEPTH q?
8. CUTTINGS COLLECTED YES n NO]
7. DOES WELL REPLACE EXISTING WELL? YES ® NOE]
8. STATIC WATER LEVEL Below Top of Casing: i(c) FT.
(Use'+' II Above Top or Casing)
9. TOP OF CASING IS 9 FT. Above Land Surface'
'Top of casing terminated efyar below land surface (squires a variance in scoot -
dance with 1SA HCAC 2C .0118
10. YIELD (gpm): 4 METHOD OF TEST By Air Test
11. WATER ZONES (depth)•
DEPTH DRILLING LOG
From To
12. CHLORINATION: Type hth Tabs
13. CASING:
Formation Description
(.)
iv
Amount 51 _ II additional space is needed use back of form
Wall Thickness LOCATION SKETCH
Depth pQiiym1aior or yJ�fohVFi. MNuial (Show direction and distance from al least two Slate
From 0 To 158 Ft b>4 Y•G Plastic - Reeds, or other map reference points)
From To Ft
From To Ft N
14, GROUT:
Depth Material Method
From _9___ To 20 Ft Croat Poured
From To Ft
15. SCREEN:
Depth Diameter Slot Size Material
From To Ft In in
From To Pt In in
From To Ft in
16. SAND/GRAVEL PACK:
Depth Size
From To Ft
From To Ft.
17. REMARKS:
In
Material
L✓ ,Q35 ��r E
12
9 G
by � �l
Pf"
I D0 HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS. AND THAT A COPY OF THIS RECORD HAS BE ROVIDED TO THE WELL OWNER.
FOR OFFICE USE ONLY
Ouad No
Serial No.
SIGNATURE OF PERSON CONSTRU
Submit anginal to Division of Water Oually,.>;iroui1 vstar Section within 30 days
03-29-01
THE WELL DATE
GW-I REV. 03/2000

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]
oc8 7a
WELL CONSTRUCTION RECORD
WELL CONTRACTOR. Hickory Well Drilling Co.
WELL CONTRACTOR CERTIFICATION 0: 2343
STATE WELL CONSTRUCTION PERMITM:
1 . WELL USE (Check Applicable Sort): Residential ® Municipal ❑ Industrial [] Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: Morganton County. Burke
2726 Piedmont Rd.'
(Road Name end Numbers, Community. or Subdivision and Lot No.)
3. OWNER Ted Lane
Address 2726 Piedmont Rd.
Morganton
(Street or Rout` jio.)
28655
City or Town Slate Zip Code
4. DATE DRILLED 03-26-01
5. TOTAL DEPTH 305
6. CUTTINGS COLLECTED YES n NC#®
7. DOES WELL REPLACE EXISTING WELL? YES (1 NO(-1
8. STATIC WATER LEVEL Below Top of Casing: 80 Fr.
2 (Use'•' II Above Top et Casing)
9. TOP OF CASING IS Fr. Above Land Surface'
Top of oaring terminated allor below land mrtacs requires • variance In floor -
dance with 15A NCAC 2C Alla
10. YIELD (gpm): 3 METHOD OF TEST By Air Tits t
11. WATER ZONES (depth)•
12. CHLORINATION: Type hth Tabs Amount 47
13, CASING:
DEPTH DRILLING LOG
From To Formation Dettriplion
(n
C)
01 0
If additional space is needed use back of form
Wall Thickness
SKETCH
0 Depth 40 Dpytlpter or W19 /FI. Material
tic (Show direction and distance from al least two Stale
From To Ft b�� YVG Roads, or other map reference points)
From To Ft
From To Ft
14. GROUT:
Depth Material Method
From 0 To 20 F) Grout Poured
From To Ft
15. SCREEN:
Depth Diameter Slot Size Material
From To Ft _ In in
From To Ft in In
From To Ft in In
16. SAND/GRAVEL PACK:
Depth Size Material
From To Ft
From To Ft.
17. REMARKS:
N
6
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 6E$ 7ROVIDED TO THE WELL OWNER.
FOR OFFICE USE ONLY
Quad No
Serial No.
Ater" -
SIGNATURE OF PERSON CONSTRTHE WELL
Submit original to Division of Water Quality, Groufdwater Section within 30 days
03-27-01
DATE
SW.1 REV. 03/2000

. ta... DISH ..ei vies.'.enter - naicign, N.L,. 2 /07?- I oib-I'hnnn ([, t •.l I /. CI-.l.'.' I
WELLCONSTRUCTION RECORD WLI.LCON rItACTOIL L)tA5we)) Wen I7r t(I,Ne
WELL CO NTF1ACTOR CERTIFICATION N: •,Z c/ 22893
..1'ATI' WLI I GnriGTIIIICTInN rrnmint:
•
1. WELL USE (Check ApplIcable Box): Residonlial FP"' Municip;d rl Industrial El
Recovery❑ Heat Pump Water Injection n Other n If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: 61c.si41P,Ne Cn,lnty 1'K �.
Or:PIO ON Li sti. (le /2,.+e.•
(Road Name and Numbers, Community. or Subdivision and Lot Nn)
3. OWNER
Address ••
Agricultural 0 Monitoring ❑
DRILLING LOG
) ..5 K o K�irri From To
(s
JzS “P-i
1Y Zen
tree or • cute ao.
n-c 603
City orTolNn Stale
4. DATE DRILLED 3' 1 S - O i
5. TOTAL DEPTH 'o 0
6. CUTTINGS COLLECTED YES in NO
7. DOES WELL REPLACE EXISTING WELL? YES J J NOLV(
B. STATIC WATER, LEVEL Below Top of Casing: 15 FT.
(Use'+- It Above Top of Casino)
9. TOP OF CASING IS I FT. Abovo Land Surface -
'Top of casing terminated aVor below land surface requires a variance In etcnr-
dance with 15A NCAC 2C .011 a
10. YIELD (gpm): In METHOD OF TEST 13 IO w r/
11. WATER ZONES (depth): r% S
I S2
ZI rCn
DEPTH
FonnatIon DesclpUon // � (�
leer 6rAlee/ rY Re r1kJe, s
5n F+' ant. r'/ N S/' 7r
t-r.osri 13k,f get
12. CHLORINATION: Type HT )i__ __ _- Amount .2. TABif!s It additional space is needed use back of form
13. CASING:
From
l J
From
From
14. GROUT:
Wall 1 bicker sr.
Depth Dian -mint or Wniehl/PI. r�l.lrri:d
To 5 Ft C1 IA/ LSF - A(v
To Ft --- - -- -
To Ft
Depth
From _ 0 To z r7
From To
15. SCREEN:
Depth
From To
From To
From To
16. SAND/GRAVEL PACK:
Depth
From To
From To
17. REMARKS:
Ft
Ft
Ft.
Material Method
Ft ' cw'L €.,r-,4 PC• r erg
Ft
Diameter Slot Si:.o Material
in in
in in
in. _ in.
Size
Ft
Ft.
Material
LOCATION SKETCH
(„how direction and distanco from at least two Stale
Floods, or other map rorarence points)
--D
o
O
W
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COP `L OF THIS RECORD HAS PEEN PROVIDED TO THE WELL OWNER.
accv
FOR OFFICE USE ONLY
Quad No:
Serial No.
SIGNATURE OF: PG ON CONSTRUCTING THE WELL DATE
Submit rnic.nat to Dvi;lnn nl IVa ter Geality, Groundwater Section within 30 days
OW-1 REV. 12/99
ii

I
North Carolina - Department of Environment end Natural Resources - Division of Water Quality • Groundwater Section
1639 Mail Service Center- Raleigh, N.C. 27e90.163e-Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR. Hickory Well Drilling Co.
WELL CONTRACTOR CERTIFICATION N: 2343
STATE WELL CONSTRUCTION PERMIT,:
22356�
1. WELL USE (check Applicable Boa): Residential® Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring El
Recovery El Heat Pump Water Injection ❑ Other 0 If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: Trani County: Burke
Barkwnnd Ave -
(Road Name and Numbers. Community. or Subdivision end Lot No.) DRILLING LOG DEPTH
3. OWNER Joyce Sebastian porn To Formation Description _
Address 5009 p m 1 L.
Jacksonville" 32210 r.
City or Town Stale Zip Code A c-c
4. DATE DRILLED 03-01-01 I
5. TOTAL DEPTH 2115
6. CUTTINGS COLLECTED YES n NOl
7. DOES WELL REPLACE EXISTING WELL? YES pcxi NOE] --0 rfrr:-'
8. STATIC WATER LEVEL Below Top of Casing: 60 FT.
(Use's• ii Above Top of Casing) ' r
9. TOP OF CASING IS 2 FT Above Lend Burrwoe• rt.) -t
'Top eI easing term/paled cVor below lend wr/aee rag,nrea a verlanae In J O
dance with tSA NCAC 20 t le
10. YIELD (gpm)• 20 METHOD OF TESTBY Air Test
11. WATER ZONES (depth)•
12. CHLORINATION: Type hth Tabs Amount 30 II additional space Is needed use back of form
13. CASING:
LOCATION SKETCH
wan Thickness
From 0 Depth 65 To FI Diiaar tier orWeeiightFL Plastic (Show dlrecllbn and distance from at least Iwo Stele
Roads, or other map relerence points)
From To Ft.q."•_6 t/ cem,V
From To Ft. Ai
14. GROUT: a &AraJon0
Depth Maiodal Mothod i AJE.
From 0 To 20 FI Grout Poured
From To Ft / ..�
15. SCREEN: W se.
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
Frorn To Ft
From To FI
17. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WIT II 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS B PROVIDED TO THE WELL OWNER.
03-05-01
DATE
s
FOR OFFICE USE ONLY
Quad No:
Serial No.
S NATU E OF PERSON CONSTFJDtWWO TIIE WELL
Submit original to Division of Water Quality, Oro ndwater Section within 30 days
OW-1 11EV. 12/99

arancor• haie'Qn. era,. d/WO-1 h.t,.l'hen() (`, ..,
WELL CONSTRUCTION RECORD
WILT I. CON FRAC! 011. !✓r,,5 e) l•vc// %7r/(/ Hn998
WELL CONTRACTOR CERTIFICATION S,:_ .Z 3FS 9 2
�J ci
STATE Wri 1 CONCTRNCTION PERMITS,:
1.WELL USE (Cheek Applicable Box): Residential I Vr Municipal jl Industrial ❑ Agricultural D
Recovery Heat Pump Water Injection Ei Other ❑ II Other, List Use:
2. WELL LOCATION: (Show sketch of the location below) ((��
Nearest Town: }N10r5J}1 7-fl Al County 1)0 rLs tr;
ow&P OLD )iC /as" Rd
(Road Name and Numbers. Community. or Subdivision and Lot Na DRILLING LOG
3. OWNER '77'9V+`S C rao0ICS
rift GLC,ra. (Seat or Houle Na.) ,I '-I
City or Town) Stale Zip Cnd• / �`) 2 t.T C)
4. DATE DRILLED 3 -) 1.- 4 i
5. TOTAL DEPTH 1. 4 0
6: .CUTTINGS COLLECTED YES NO
7. DOES WELL REPLACE EXISTING WELL? YES C] NOI__L
8. STATIC WATER LEVEL Below Top of Casing: 3 b
(Use •.• II Above Top of Ceero)
9. TOP OF CASING IS / FT. Above Land Sudan" -
"Top of casing terminated Wor below land surface require, a verinnre in error•
dance with 15A NCAC 2C .011e ?
10. YIELD (gpm)• L.METHOD OF TEST _js�%o_it74,1li_ ...
11. WATER ZONES (depth): ) S �� = 4•16Rr1
.ZIS= I
Frnm
C) i4t3
Monitoring ❑
DEPTH
Formation Descdpt(on
Snit LtrueSipau
NNrr) L f'1.ne .S)tes
/-/slyd Crc y ,Shole
12. CHLORINATION: Type C)-o..cSr__ Arnnunl ;2:7413iets If arlrtillnnal space is needed use back of form
13. CASING:
Depth
From a To ) Li CI Ft
From To Ft.
From To Ft
14. GROUT:
Depth
From 0 To _3 0 Ft (re v'n e w4" i°0 ^ cc!
From To Ft.
15. SCREEN:
Depth Diametor Slot Size Malarial
From To Ft in in.
From To Ft in in
From To Ft in
16. SAND/GRAVEL PACK:
Depth Size tdoinlinl
Diamnier
!, 1/ {
Wall I lecknr5,
nr Wninhl PI_ LM.rlrriai
_LC 15 3A1v
From To — Ft
From To Ft
17. REMARKS:
Material Method
LOCATION SKETCH
(;hew direction and distance from at least Iwo Slate
Rands, or other map rolorence points)
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COP}SOF THIS RECORD HAS BEENFROVIDED TO THE WELL OWNER.
iFOR OFFICE USE ONLY
Ouad No:
Sedal No -z---
ADf'
3--13- 0
SIGNATURE OF PERSON 6KIJSTRUCTING THE WELL DATE
Suhrnl nripinal to Db-Jnn of Warr( Quality. Groundwater Section within 30 days
GW-I REV. 12/99

North Carolina Department of Environment S Natural Resources
Division of Water Quality - Groundwater Section
1636 Mail Service Center
Raleigh, NC 27699-1636 Phone: [phone]
WELL CONSTRUCTION RECORD
DRILLING CONTRACTOR: /$sre
�zal Dr,llw9 +-14 0
STATE WELL
FOR OFFICE USE ONLY
QUAD. NO. SERIAL NO.
Lat. Lon^. RO.
Minor Basin
Basin Code
Header Ent. Gw-I Ent.
3 11
CONSTRUCTION
DRILLER CERTIFICATION NUMBER: c6S3 PERMIT NUMBER:
O
1. WELL LOCATION: (Show sketch of the location below))
Nearest Town: MdPSA,44.4/ County: LS tJf,�/ip
',ea SS .(au)r»,RN Rd - 6,•-cdcq, e N%/c er AGO Sc-4 DEPTH DRILLING LOG
(Road, Community, or Subdivision anti Lot No.) From To Formation Description
2. OWNER -.7os.4 Uri /tcJA/4 b2
ADDRESS _ . a.e.... ez
s'S3-R Rana 4aSeSSpj auftS9•)
City or Town State Zip/\ Code
3. DATE DRILLED��/—i
3 USE OF WELL C
4. TOTAL DEPTH a ya
5. CUTTINGS COLLECTED YES ❑ NO ID-
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NOQ.-
7. STATIC WATER LEVEL Below Top of Casino: oZ FT.
(Use"+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
'Casing Terminated at/or below land surface is illegal unless a variance is issued
in accordance with 15A NCAC 2C .0118
9. YIELD (gpm): 0 METHOD OF TEST
10. WATER ZONES (depth): q. i 3'
o
-1�+ o•
zt_i
i o...
CO Yo
t7 cnt
:
II. CHLORINATION: Type ;-,s-Cf/e,e Amount 3 If additional space is needed use back of form
12. CASING:
Wall Thickness
0
_ Depth D7'agteter Or W'eighdFt. nterial
From -0- / To tJ- Ft. G ././ VVL
From To Ft. LOCATION SKETCH
From To Ft. (Show direction and distance from at least two State
Roads, or other map reference points)
13. GROUT:
1
From To Ft in in
From To Ft in. in
From To Ft in. in.
6 Teoth —9�Ft %2r/Ar J /rl;PCB.' ya DN°� .f';•
l Method
From'V
From To Ft.
14. SCREEN:
Depth Diameter Slot Size Material
15. SAND/GRAVEL PACK:
Depth
From To Ft.
From To Ft.
16. RENL4RKS:
Size
Material
�N
Boss � tW R�
e,iatn" Sc.e R�
I DO IIEREBY-Cf IF • TI(3ATHIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION ,4,q :..THAT A COPY OF THIS RE2&JD HAS BEE PRROVEDED TO THE WELL OWNER
cr—
SIGNATURE OF CONT R OR AGENT DATE
Submit original o tvision of Water Quality and a copy to well owner.

North Carolina - Department of Environment and Nalurel Resources - Division of Willer Duality - Groundwater Secilon
1636 Mall Service Center - Raleigh, N.C. 27899.1836-Phone [phone]
2 8368
WELL CONSTRUCTION RECORD WELLCONTnneron• Hickory Well Drilling Co.
WELL CONTRACTOR CERTIFICATION ": 2343
STATE WELL CONSTRUCTION PERMIT":
1. WELL USE (check Applicable Boa): Residential G. Municipal ❑ Industrial Agdcullurnl LI Monllnrlog El
Recovery [] I -feat Pump Water Injection ❑ Other ElII Oilier, list Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: Valdese County: _Btirke
3298 Mnntanya Vipw Dr
(flood Name and Numbers. Correnmdly, or Subdivision and Lot fro.) DRILLING LOG DEP I I I
3. OWNER Mark Ros tan From 7o formation Description
Address PO Box 758
Valdese (SlreelordlppleNo.) 28690
City or Town State 71n Code
4. DATE DRILLED 02-01-01 '-U
5. TOTAL DEPTH 945
6. CUTTINGS COLLECTED YES Ill NOk_I _. _.. .-, I
7. DOES WELL REPLACE EXIS IING WELL? YES IX 1 1101 I -, -
8. STATIC WATER LEVEL Below Top of Casing: 13 , 6 F I . —+-�
(Use 'a'll Above Top olCroing) -_-... t—;-i
9. TOP OF CASING IS 2 FT. Above Land Surface'
•Top of casing terminated al/or below land surface Numbs• a valence In actor- '----- --- - -- ---
dance with lSA NCAC 2C.0110 —.1—�
10. YIELD (goat). 30 METHOD OF TEST By Air TPSt - �
11. WATER ZONES (depth):
12. CHLORINATION: Type hth Tab¢ Amount A9 -- If additional space Is needed use back of (urn,
13. CASING: .•_---- -- - — -------------
Walt Thickness _LOCATION SKE I CH
Depth Diameter or Weigl e11. Materiel (Show direction and distance horn ni least Iwo State
From 0 To SO Fl.6ktn _PVC__ Pl ac t i c Rands, or other map reference points)
Front To Ft. _ Y'
From To Ft T a /V
14. Gnour: ------------ \Jt f-90
Depth Materiel Molhod
Frorn 0 To 20 Ft Grout Poured
From To Ft
15. SCREEN:
Depth Diameter Slot Size Maleulal
From To FI In. In
From To Fl In In
From To Ft. In In
10. SAND/GRAVEL PACK:
Depth Size Material
Front To FT
From To Ft
17. REMARKS:
-3
W Z�
dA s, E
J:
?����i
S s,
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCT ED IN ACCORDANCE Win l 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS J PROVIDED TO THE WELL OWNER.
Ladiftage
FOR OFFICE USE ONLY
Ouad No:
Serial No.
02-13-01
SIGNATURE OF PERSON COh1NO DIE WELL DATE
Submit original to Division of Wider Ouallly. Oroundwelar Section within 30 days
ow-i NEV. 12/99

i
North Carolina • Department of Environment and Natural Resources • Division of Water Quality • Groundwater Section
1036 Mall service Center - Raleigh, N.O. 27699.1a36-Plane [phone]
WELL CONSTRUCTION RECORD
223594
WELLCONTRACTOR. Hickory Well Drilling Co.
WELL CONTRACTOR CERTIFICATION I: 2343
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE (Check Applicable Dort Residential El Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ 'leaf Pump Water Injection ❑ Oilier II Other, Llst Use:
2. WELL LOCATION- (Show sketch of the location below)
Nearest Town: Morganton CountyBurke
3362 Fish Hatchery Raod
(Road Name and Numbers, Community, or Subdivision end Lot No.) DRILLING LOG DEPTH
3. OWNER Ross Hutchins From To
Address 3362 Fish Hatchery Raod
(Street or Route No.)
Morganton NC 28655
City or Town Stale ZIP Code
4-, DATE DRILLED 02-08-01
5. TOTAL DEPTH 24.5
6. CUTTINGS COLLECTED YES Li NOprRj
7. DOES WELL REPLACE EXISTING WELL? YES INO[_]
8. STATIC WATER LEVEL Below Top oI Casing: 80 rr.
(Use •.' 11 Above Top of Casing)
9. TOP OF OASINO iS 7 PT Above Land Surface•
'Top of casing lermineled Wor below land surface require• a voidance In accor-
dance with ISA NCAC 2C .0116
10. YIELD (gpm): 10 METHOD OF TEST By Air Test
11. WATER ZONES (depth)• - ... .-
12. CHLORINATION: Type hth Tabs Amount 35
13. CASING:
Form/Mon Description
n
-Ti
:a
-o C
17.
r-: a
N
II additional space is needed use back of form
Wall Thickness LOCATION SKETCH
Depth Dh+Snplor o , / QhVFl. Material (Show directlbn and distance from et least Iwo Slate
From 0 To 89 AbZ rVl. Plastic Roads, or other map relerence points)
From To Fl
From To Ft
14. GROUT:
Depll Malonint Molhod
From To 20 Ft Grout Poured
From To Ft
15. SCREEN:
Depth Diameter Slot Size Materiel
From To Ft In In
From To Ft In In
From To FI In In
16. SAND/GRAVEL PACK:
Depth Size Material
From To Ft
From To Ft
17. REMARKS:
N
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITI I ISA NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD ItAS BEEOVIDEO TO THE WELL OWNER.
FOR OFFICE USE ONLY
Ouad No:
Serial No
era' 02-21-01
SIONAIURE OF PERSON CONSTRU I IE WELL DAZE
Submit original to Division of Wale: Duality, Oroun Ater Section within 30 days
.. , . OW.1 REV. 12/99

i
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1838 Mall Service Center - Raleigh, N.C. 27899-1838-Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR- Hickory Well Drilling Co.
WELL CONTRACTOR CERTIFICATION S: 2343
STATE WELL CONSTRUCTION PERMITS:
228593
1. WELL USE (Check Applicable floe): Residential * Municipal ❑ Industrial CI Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other 0 II Other, List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: Morgnton County HI irke
Rosecreek Rd.
(Road Name and Numbers. Community. or Subdivision and Lot No.) DRILLING LOG
3. OWNER Eric Settlemyre From io
Address 409 East Concord St.
Morganton (street or Hotlle}lo.)
28655
Clly or Town Slate 2lp Code
4. DATE DRILLED 02-15-01
5. TOTAL DEPTH 665
6. CUTTINGS COLLECTED YES El NOEK-)
7. DOES WELL REPLACE EXISTING WELL? YES (—I NOV]
8. STATIC WATER LEVEL Below Top of Casing: 100 Fr.
S. tom oh OArrNO w vie a Abeve Ton ar Caen. )
IK Ab eq Ia q• Iaraneea
'Top of easing terminated at/or below land aortae* requlm .valence In accor-
dance with ISA NCAC 2C 11e
tO.YIELD (gpm)• METHOD OFTESTBy Air Test
11. WATER ZONES (depth)•
DEPIII
formation Description
O
�J
N -+
J o
12. CHLORINATION: Type hth Tabs Amount 77 II additional space Is needed use back of form
13. CASING:
1� WaifaThicknessluMaterielLOCATION SKETCH
0 Depth75 gil rr for Wen Plas (Show direciibn end distance from al least two Slate
From To Ft bb V Ronde, or other map reference points)
From To Ft. •
N „ �bti
From To FI MU°G
GROUT:
14.
Depth Material Method \mil
From 0 To 20 FI Circuit Po rred /
From To FI ijw/- l�
15. SCREEN: I
Depth Diameter Slot Size Material lid ‘‘)4 1C��,Q/-(
From To Ft In In c_! IAA ,
From To Ft In In
From To Ft In In E J (
16. SAND/GRAVEL PACK: s
Depth Size Malarial t
From To Ft �11�E�(,
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 BE,�Ii,PROVIDED TO THE WELL OWNER.
FOR OFFICE USE ONLY
Quad No:
Serial No
02-21-01
O TIIE WELL DATE
Submit original to Dlvlslon of Water ouelityn lr2 writer Section within 30 days
1.t N !� !1 OW-1I1EV. 12/99
SICNATUf1E OF PERSON C

i
North Carolina - Department of Environment end Natural Resources • Division of Water Duality - Oroundwater Section
1636 Mall Service Center. Raleigh, N.C. 27699.1836-Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR- Hickory Well Drilling Co.
WELL CONTRACTOR CERTIFICATION II: 2343
228563
STATE WELL CONSTRUCTION PERMIT":
1. WELL USE (Check Applicable Box): Residential ® Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring El
Recovery ❑ Heat Pump Water Injection ❑ Other 0 If Other, list Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town• Morgan f-nn County: Rl irk
6352 Dysartsville Rd.
(Road Name iknd Nurpbert Community. or Subdivision and Lot No.)
3. OWNER uennis Heaver
Address 6352 Dysartsville Rd.
(street or Route No.)
Morganton NC 28655
City or Town Slats
4. DATE DRILLED 02-26-01
5. TOTAL DEPTH 20S
6. CUTTINGS COLLECTED YES 0 NO
7. DOES WELL REPLACE EXISTING WELL? YES 11.E NOfJ
8. STATIC WATER LEVEL Below Top�giof Casing:A60 FT.
I. TOM OP Salida la Mf a/�b:va Letnriiurrl:si0)
'Top of cuing terminated Wor below lend surface requires a variance In accor-
dance with 15A NCAC 2C .011E
10.YIELD (gpm)• 5 METHOD OF TEST By Air Test
11. WATER ZONES (depth):
DRILLING LOG DEPtH
From To Formation Description
12. CHLORINATION: Type
13. CASING:
Zip Code
hth Tabs
Amount 30
C)
II additional space Is needed use back of form
LOCATION SKETCH
Wall Thickness
Depth Diameter or WeigheFI. Material (Show dlrecllbn and distance from at least Iwo Slate
From 0 To 60 Ft 63/411 PVC Plas tic Roads, or other map reference points)
From To FI
From To Ft.
14. GROUT:
Depth Materiel Method
From 0 To 20 FI Grout Poured
From To Ft ' ,/
15. SCREEN: W
Depth Diameter Slot She Material
From To Ft In In
From To FI In In GG /)
From To FI In In �r'/ /=7A'✓e a.
16. SAND/GRAVEL PACK: +�
Depth Size Material
From To Ft (pu OH/
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,pt(9 IDED TO THE WELL OWNER.
N
1/0 MGfCAN7o/
FOR OFFICE USE ONLY
Ouad No:
Serial No.
SIGNATUREkt
PERSON CONSTRUCTlyinrir WELL
Submit original to Division or Water Ouslily, Groundwater Section within 30 days
03-05-01
DAZE
ow•i nEv. 12/99

Nor.h Carolina - Department of Environment. Health. and Natural Resources
Division of Environmental Management • Groundwater Section
P.O. Box 29535 • Raleigh, N.C. 27626-0535
Phone [phone]
WELL CONSTRUCTION RECORD
DRILLING CONTRACTOR: Zr) k kkil Drf/6n9
STALE WELL CONSTRUCTION
DRILLER REGISTRATION NUMBER: 27/ `J PERMIT NUMBER:
FOR OFFICE USE ONLY
QUAD. NO. SERIAL NO.
Lat Long. RO
Minor Basin
Basin Code
Header Ent GW-1 Ent
226118
1. WELL LOCATION:y(Show sketc of the location below)
Nearest Town: %! orb} CrTon CountyjlJ r / 'C
� i/ irk 8'
(Road, ommuniry, r Subdivision and Lot o.) DEPTH DRILLING LOG
2. OWNER n rrl1L(] ood Horn PS From To Formation Description
ADDRESS
(Street or Ror to No.)
rr7vr>Eo�� Ili te i8'4, 55
City own State Zip Coyle
3. DATE DRILLED 2-/6-.00o( USE OF WELL 3 (via/ c
4. TOTAL DEPTH h U`7
5. CUTTINGS COLLECTED YES 7 NOIZK
6. DOES WELL REPLACE EXISTING WELL? YES E NO'
7. STATIC WATER LEVEL Below Top of Casing: yU FT.
(Use'.' if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
' Casing Terminated aVor below land surface is Illegal unless a varlaynt Is Issued
In accordance with 15ay NCAC 2C .0118 (}l4 Tett
9. YIELD (gpm): METHOD OF TEST R&GE w lL
10. WATER ZONES (depth)•
0
0
C
0
/ 1 o
11. CHLORINATION: Type flit Amount / Cy If additional space is needed use back of form
12. CASING: JKLf P VG
Wall Thickness LOCATION SKETCH
Depth Diameter or Weight/Ft. Material (Show direction and distance from at least two State
From To Ft. Roads, or other map reference points)
From To Ft.
From To Ft.
13. GROUT:
Depth Material Method ,.f it
From To Ft _ W '
From To Ft
14. SCREEN: Ei7A/�t
Depth Diameter Slot Size Material
From To Ft in in
From To Ft in in
From To Ft. in in
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft
From To Ft
16. REMARKS:
0
v
0
c,
I DO HER TIffylrEIAT TMMIS INELL•WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTR WARDS:AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
APR 2 6
GW-1 REV. 9r91 '.
J)y77SI&'412
TURE OF CONTRACTOR OR AGENT L
Submit original to Division of Environmental Management and copy to well owner.

FROM : MORETZ WELL 8. PUMP
FAX NO. : 7044621322 Mar. 12 2001 07:13RM P3
13. GROUT:
Depth Material Method
From 114) To FL- to - 77.61Aethr J
From To Ft.
14. SCREEN:
Depth Diameter Slot Size Material
From To FL in. in
From To Ft. in. in
From To Ft. in. in
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
DRILLING CONTRACTOR:
CONSTRUCTION /
DRILLER CERTIFICATION NUMBER: 2 S26 PERMIT NUMBER:
•
North Carolina Department of Environment & Natural Resources
Division of Water Quality - Groundwater Section
1636 Mail Service Center
Raleigh, NC 27699-1636 Phone: (919) 7 L•0295
WELL CONSTRUCTION RECORD
/190 re-? t G!/e-//
STATE WELL
FOR OFFICE US"e ONLY
QUAD. NO. ScRIAL NO
Lat. Long. RO
Minor Bum
Basin Cot
Heade: Ea:. u'.I EnL
Z2°7352
I. WELL LOCATION: f$how skitch of the location bolow,
Nearest Town: �YT GRiO Counts.: C-t r
DEPTH DRILLING LOQ
(Road, Community, or Subdivision and Lot No.) From To Formation Description
2. OWNER �/1(. /Y]LLQ.Nite-�/
DRESS Co/ QLsc 1 ALtr�7
/ (Street or Route No.) -/op, ! Q /a - Shy /Q.
70 — / q 3--5 rots"Ht.-
Cir.y or Tarn Stain z,,,
code
3. DATE DRILLED-2,3 QSE OF WELL
1. TOTAL DEPTH / 9S __ //
S. CUTTINGS COLLECTED YES ❑ NO W
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO Er
7. STATIC WATER LEVEL Below Top of -Casing: FT.
(Use "+ ^ if Above Top of Casing)
8. TOP OF CASING IS a FT. Above Land Surface+
• Casing Terminated at/or below land surface is illegal unless a variance is issued
in accordance with 15A NCAC 2C .0118
9. YIELD (gpm): 20 METHOD OF TEST Airist-A -
10. WATER ZONES (depth): Cie 1
1I. CHLORINATION: Type /17W Amount V Z
12. CASING:
Wall Thickness
r::
If additional space is needed use back of form
Q Dept Diameter Ory�,;gjgltf(Ft. Material
From tOr To �0 Ft. .__.(a. ��K ems(/
From To Ft LOCATION SKETCH
From To Ft. (Show direction and distance from at least two State
Roads, or other map reference points)
Q&A Aj
faz
�0�,/i50ti Nl At
16. REMARKS:
I DO HERB GE TVY' Alt TRIS'WVELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
CONSTRUCTI 9ia'll;CRJSS;-AA 5 THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER,
2 -23- 0/
SIGNATURE 6P CONTRACTOR OR AGENT DATE
GW-1 REV.11/99 Submit original to Division of Water Quality and a copy to well owner.
[� / CO✓�%�l h
n

227811
'diviion u1 water yuatity - t,roundwater section
1636 Mail Service Center
Raleigh, NC 27699-1636 Phone: [phone]
WELL CONSTRUCTION RECORQ
DRILLING CONTRACTOR: West Lincoln Well Drilling
STATE WELL
CONSTRUCTION
DRILLER CERTIFICATION NUMBER: 2092 PERMIT NUMBER:
QUAD NO.
Las.
Minor Basin
Basin Code
Header Ent.
FOR OFFICE USE ONLY
SERIAL NO.
no.
OW -I Ent
I. WELL LOCATION: (Show sketch of the location below)
Nearest Town: M n r1 c t&4e y County: 91,t_14C 2.
L' 153 gC'AyKp ett DEPTH DRILLING LOG
(Road, Come• unity, or Subditision and Lot No.) From To Formation Description
2. OWNER \VI a(}-{-r \,'J r hl-
ADDRESS `-IIS3 (BGtn t ('rapQ i'd. / q
(Street or Route No.) — I / ' 1 A L(
eon ne(l Sr ,ikJ tk)C as /n l2_. q%r— 23/' C[YL i�e
City or To State Zip Cone
3. DATE DRILLED"- zo o i USE OF WELLborv`esiic,. __
d. TOTAL DEPTH Z3I `I. t ,
5. CUTTINGS COLLECTED YES ❑ NO Err'
6. DOES WELL REPLACE EXISTING WELL? YES NO
7. STATIC WATER LEVEL Below Top of Casing: 30 FT.
(Use"+" if Above Top of Casing)
8. TOP OF CASING IS I FT. Above Land Surface"
*Casing Terminated atier below land surface is illegal unless a variance is issued
in accordance with ISA NCAC 2C .0118
9. YIELD (gpm): 20 METHOD OFTEST Atrj 6)O bt%
10. WATER ZONES (depth): Yz )0 (0 ' %z CnelitZ 202-
1176Dm6)1601 GPM(.) Z31
11. CHLORINATION: Type 6f-Asty. tar Amount 3glb5.
12. CASING:
u
r3
N =
O
l Cr
N 5
If additional space is needed use back of form
Wall Thickness
_ DepthDiameter Or\ve ht/Ft. htnterial
From I To 9 s Ft H- PV c.
From To Ft LOCATION SKETCH
From To Ft. (Show direction and distance from at least two State
Roads, or other map reference points)
12. GROUT:
Depth �7 Material Method
From 0To 70 Fe.toI4(0n, etar,ei,4 116 v
From To Ft.
I4. SCREEN:
Depth Diameter Slot Size Material
From To Ft in. in
From To Ft in. in
From To Ft in. in
IS. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
CONSTRUCTIONSTA\'DAR SS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
GW-I REV. 11/99
2/zo/o/
SIGNA
DATE
Submit orieina[ to Division of Water Ouality and a COPY to well owner.
.Yvt D�1
OF CONTRACTOR OR AGENT

2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: /IIl3K<it Pal County -
(Road Name and Numbers, Community, or Subdivision and Lot No.)
3. OWNER C',,, .r,/_ --( •f'.( ,./H , , ,
/ 1 Address / ., `
i44,42 , ,,./ -
(&tree) Route No.)
r/i._.,,. t i. t 2--'.,-r 1JG/.:-
City or Town /- S 9 Zip Code
4. DATE DRILLED ' -/C-C /
5. TOTAL DEPTH J fir
6. CUTTINGS COLLECTED YES ❑ NO
7. DOES WELL REPLACE EXISTING WELL? YES 2 NOD
8. STATIC WATER LEVEL Below Top of Casing: 91C FT.
/ (Use': 11 Above Top of Casing)
9. TOP OF CASING IS / / Z FT. Above Land Surface*
'Top of casing terminated et/or below land surface requires a variance In accor-
dance with 1SA NCAC 2C Q116.
10. YIELD (gpm): c1 S METHOD OF TEST /1:''r /CSk
i
11. WATER ZONES (depth)*
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mail Service Center - Raleigh, N.C. 27699-1636-Phone [phone] 1
WELL CONSTRUCTION RECORD WELL CONTRACTOR: ,Ce /1k// rOr,//s'y .L,i(
WELL CONTRACTOR CE TIFICATION #: ,27/3
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE (Check Applicable Boa): Residential Er --Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
Ernest L Br[ttain
p Sugar -Loaf Rd
rfrc
DRILLING LOG
From
o
12. CHLORINATION: Type
13. CASING:
pr.Depth C z
From { -1 To (7 2 Ft
From To Ft.
From To Ft.
14. GROUT:
881 N
c0 w1lye spa C22812-B121
DEPTH
Fo ion Description
df O(��
/'0cfc
ci
u 0
0cn
c.1 —I
Amount If additional space is needed use back of form
Wall Thickness
Di ter or Weight/Ft. Material
g VC -
Depth Material Method
From �) To 9-0 Ft let,' /PCf
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
To
From
From
17. REMARKS:
To
Size
Ft
Ft
Material
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other map reference points)
I DO HEREBY CERTIFY
CONSTRUCTION stop
FOR OFFICE USE ONLY, ,,
Quad No:
Serial No.
LL{��VAS.CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
AT'A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
� — � ��� /dr 04
PERSON CONpCTING THE WELL DATE
Water Quality, Groundwater Section within 30 days
GW4 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• j9t'O' zJc i J/J//,✓ 'TN"
WELL CONTRACTOR CER IFICATION #: ,) .7I
227085
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE (Check Applicable Box): Residential Municipal El Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: ,/r/P, 7r\ County:
n,k-c_
(Road Name and umbers, Commuu//pppi�(y/4q/.r Subdivision and Lot No.)
OWNER y
Address 71Q7'RIA ;Ike ji0/30
,( treat or Route No.
City or town State Zip Code
4. DATE DRILLED 3-8--c
5. TOTAL DEPTH 600
6. CUTTINGS COLLECTED YES NOQ/
7. DOES WELL REPLACE EXISTING WELL? YES jam, NO2
8. STATIC WATER LEVEL Below Top of Casing: ticci FT.
DRILLING LOG DEPTH
From To Formation Description
7.3 .?a r /c -'C
S (to r (/C r:47
r� (Use': it Above Top of Casing)
9. TOP OF CASING IS �l FT. Above Land Surface'
'Top of easing terminated at/or below land surface requires a variance In accor-
dance with 15A NCAC 2C .011E e
10. YIELD (gpm): fin/ METHOD OF TEST Jt'Sc
11. WATER ZONES (depth)•
12. CHLORINATION: Type Amount
13. CASING:
From
From
From
14. GROUT:
Wall Thickness
Depth Diameter or Weight/Ft. Material
(2 To �� Ft f ✓C;
To Ft
To Ft
Depth//Materi L Method ,
From ( ) To YU Ft (.TMP/1J
From To Ft
15. SCREEN:
Depth Diameter Slot Size Material
From To Ft
From To Ft
From To Ft _
16. SAND/GRAVEL PACK:
Depth Size Material
From To Ft
From To Ft
17. REMARKS:
I DO HEREBY CERT
CONSTRUCTION $'tJ
in _ in
in in
in in
o -
rn
w
rn
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)
E�S`
FOR OFFICE USE ONLY
Quad No:
Serial No.
,WtS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
R D_ F("T_AICOPY OF THIS R RD HAS BEEN PROVIDED TO THE WELL OWNER.
/G1, � ��� � � - � � � /
SIGNATURE F PE ON ONSTR TING THE WELL DATE
Submit original to Divisio of W er Quality, G ndwater Section within 30 days
GW-1 REV. 12199

227086
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mail Service Center • Raleigh, N.C. 27699-1636-Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR -
WELL CONTRACTOR CETIFICATION #: r) % /3
STATE WELL CONSTRUCTION PERMIT#:
,r'c eve it l)rl /b •?] Tiv<
1. WELL USE (Cheek Applicable Sox): Residential Ere -
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: /I4injc;i irr•1 County'
(Road Name Numbers, Community. or Subdivision and Lot No.) DRILLING LOG DEPTH
OWNER i/ ,2 %^r Ogel, f From To Foo ation Description
Address yreyG,'% /✓?/`/,i_ey deem L);`T— (iUc k
(Street or uta o.) 3 S"3 af`7 ,?d c is
(en&�/0M'2 s 'iL/c. -- $7 /2- P7 )YG no lc
City of Town State Zip Code
4. DATE DRILLED Z i- t I O o
5. TOTAL DEPTH -27n 1,-T
6. CUTTINGS COLLECTED YES ❑ NOQ"-
7. DOES WELL REPLACE EXISTING WELL? YES Q�O0
I
8. STATIC WATER LEVEL Below Top of Casing: --lit FT. t
(Use'+' II Above Top of Casing) - =-
9. TOP OF CASING IS c)- FT. Above Land Surface' r'
'Top of casing terminated atior below land surface requires a variance In aecor- O cn-i
dance with 1SA NCAC 2C .0118
10. YIELD (gpm): METHOD OF TEST A r^ itWee/ co `-'
11. WATER ZONES (depth): 01
•
12. CHLORINATION: Type
13. CASING:
Amount
•
c�
If additional space is needed use back of form
Wall Thickness LOCATION SKETCH
/ Depth C
Diameter or Weigh I. Material (Show direction and distance from at least two State
From C To Ft —rr— L f �a� Roads, or other map reference points)
From To Ft.
From To Ft
14. GROUT:
r Depth Material._ Method
From U To ---)1 Ft s 4+^''t y in 1 Xt'"4�
From To Ft
15. SCREEN:
Depth Diameter Slot Size Material
From To _ Ft in in
From To Ft in in
From To _ Ft _ in In
16. SAND/GRAVEL PACK:
Depth 'Size Material
From To Ft
From To Ft
17. REMARKS:
I DO HEREBY CERTIFYTHAYTHIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD H; BEEN PRO ADED TO THE WELL OWNER.
FOR OFFICE USE ONLY
Quad No:
Serial No
SIGNATURE OF PE
Submit original to Division,Of W
c)-- Cl
STRUCTING WELL DATE
Groundwater Section within 30 days
GWI REV. 12/99

r
13. CASING:
North Caroline • Depanmenl of environment end Nalural Resources • Division of Water Quality - Groundwater Section
1816 Mall Service Center - Re1e19h, N.C. 27899-1636-Plane [phone]
WELL CONSTRUCTION RECORD
228R15.
WELL CONTRACTOR: Hickory Well Drilling Co.
WELL CONTRACTOR CERTIFICATION ,: 2343
STATE WELL CONSTRUCTION PERMIT,: —"
1. WELL USE (Check Applicable Boa): Residential
Recovery ❑ Heal Pump Waler Injection® Municipal CIIer, L stal ❑ Agricultural ❑ Monlloring ❑ Oilier (� If Other, ll Use: CI
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town:_ cnnnelly Spring¢
7425 fetter Shell Ave.
_county:_B�rkP
(Road Name end Numbers. Community, or Subdivision end Lol No)
3. OWNER Dick Fraley/farm-Tom Hosiery DRILLING LOG DE PTI-�
Address 7425 fetter Shell Ave. From To Formallon Description
Connelly Sprin�sr of C. 28612
Cily or Town Slats
4. DATE DRILLED01 —12—D1 Zip Code
5. TOTAL DEPTH _9/5
6. CUTTINGS COLLECTED YES NO(*5
•
7. DOES WELL REPLACE EXISTING WELL? YES 1.0 EI
8. STATIC WATER LEVEL Below Top of Casing: Ste. F�
(Use •.• a Above Top o(Casino) 9. TOP OF CASING IS 2
Top of cuing terminated slier below land surface lrAbove Land $
equea a viriao ee• In scoot.
dence with 15A ,CAC 2C .0118
10. YIELD (gpm): 2.Q___ METHOD OF TEST Ry Air Tes t
11. WATER ZONES (depth):
•
12. CHLORINATION: Type hth Taha A
mount 41 It additional space Is needed use back of form
Depth Wall Thlckneas LOCATION SKETCH
From 0 p 108 Fl 6 iameler o�VC hvfl Malarial (Show direclibn and distance from at least two Stale
TO Plastic
From To F1 Donde, or niher map reference points)
From To FI
14. GROUT:
Depth Malarial Mollrod
From Q_ To 20 Ft. _Grail__
Pnurarl
From `
To Ft
15. SCREEN:
Depth Diameter Slol Slza Malarial
From To El —__ In. In.
From To Ft. _— In. —_ In.
From To —_ FI. In. In.
16. SAND/GRAVEL PACK:
Depth Size Material
From To Ft
From To Ft
17. REMARKS:
Al
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN OVIDED TO THE WELL OWNER.
FOR OFFICE USE ONLY
Quad No:
Serial No.
F
01-16-01
SiCift1SON INO TIIE WELL
SUIMdl original to Envision alWaler Costly, Omun cllon within 30 days DATE
OW -I REV. 1V99

North Caroline . Department el Environment and
1iU Moll Strvlgo Conger • Holelph, KG, R1UVV-1e30 Pllgne (He) ?PM;
of
Wan Dually ry - Groundwater aeelion
WELL CONSTRUCTION RECORD
STATE WELL CONSTRUCTION PERMITIh 7349
i• WELL USE (Check Applicable Box): Resld II I�
Agricultural ❑ Monitoring ❑
WELL CONTRACTOR;
WELL CONTRACTOR CERTIFICATION
Recovery - Heel PumpWater en a Municipal 0 Ier, LI gal [] Irlleollon Outer (: If Oilier, Usl Use:
Horn
From
17. REMARKS:
2• WELL LOCATION: (Show sketch of the locello below)
3419 Fish Hatcher Ave.
Nearest Town: organtOn ll
County:
Burke
(Road Name end NumbestCommunity, or Subdivision and Lol No.)
3. OWNER Gene Wilson
Address 3419 Fish Hatcher Av
e.
rae or ou a o.
City or Fton NG RF55
4• DATE DRILLED 01-19-01own a1s Zip Cods
5. TOTAL DEPTH
NGS COLLECTED YES
7. DOES IWELL REPLACE EXISTING WELL? YE p NO®•
e. STATIC WATER LEVEL Below Top of Casing: @ Fr.
e. TOP OF CASINO IS (Use .•. If Above Top of Cosine)
'Top of casing laminated aVor belowland surface l faceFT. aequu a varive Lendance In accor-
dance with 15A NCAC 2C .9J le
10. YIELD (gpm): 13 METHOD OF TESTS Air Test
11. WATER ZONES (depth):
12. CHLORINATION: Type hth Tabs
13. CASING:
From
From_
From
14. Gnou r:
From
From
15. SCREEN:
0
Depth 84
To
To
To
Dom h
To L0
To
Depth
From To
From To
From To
16. SAND/GRAVEL PACK:
Depth
To
To
weler
Ft.
Ft.
rt.
Amount 37
Wall Thickness
cVslyeteht?I. Materiel
YPlastic
Malorial
rl, Grout
FL _
Diameter
Ft
Fl.
Ft.
F1.
Ft.
In.
In.
In.
Size
Molllod
Poured
Slot Size Malarial
In.
In.
In.
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCO
CONSTRUCTION STANDARDS, AND THAT A COPY pE THIS
Material
DRILLING BOG_ DEPTH
From To Formation Description
Q
If add:Ilona, apace Is needed use back o f lorr&
LOCATION SKETCH
(Show (lreollbn and distance from al least Iwo Stale
Roads, or other map reference points)
N
CE WITH 15A NCAC 2C. WELL
EN PROVIDED TO THE WELL OWNER.
SIGNATURE OF PERSON CO • TRUCTINO TIIE WELL
Pi1g net to Division of Wale, Dually. Groundwater Section within 30 days
E
01-23-01
DATE
ow-1 REV. I2/99

•
1
North Carolina • Deportment of Environment and Nelural Ruourcee - Division of Water Duality • Groundwater Section
1030 Melt Service Center • Raleigh, N.D. 27699.1036-Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR• Hickory Well Drilling Co.
WELL CONTRACTOR CERTIFICATION if: 2343
228585
STATE WELL CONSTRUCTION PERMITII:
1. WELL USE (Check Appticebls Boa): Residentlat Municipal El industrial El Agrlcullural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Indention ❑ Oilier 0 If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: Connelly Springs County- Burke
8168 Ward's Gap Rd.
(Road Name and Numbers, Community, or Subdivision end Lot No.) DRILLING LOG DEPTH
3. OWNER Deanna Norville
Address 8168 rR f rEd.
Connelly Spi ings` °° ° NC 28612
City or Town Slate
4. DATE DRILLED 01-26-01
5. TOTAL DEPTH 145 r 6. CUTTINGS COLLECTED YES C NOb_ I
7. DOES WELL REPLACE EXISTING WELL? YES L NO
8. STATIC WATER LEVEL Below Top of Casing: So _ FT.
piss *en Above Top of Casing)
9. TOP OF CASINO IS 2 FT Above Land Bmlace•
•Top of casing Ruminated aVor below land eurrsce requires a variance In accor-
dance with 15A NCAC 2C .011e
10. YIELD (gpm): 20 METHOD OF TEST Ry Air Tag
11. WATER ZONES (depth)•
Zip Code
From To Formation Description
12. CHLORINATION: Type hth Tabs
13. CASING:
_,
o
—a C-
,
c.
-1 o
Amount 62 if additional space Is needed use back of form
Wall Thickness LOCATION SKETCH
Depth Diameter or wsighvri. Material (Show direction end distance from at least Iwo State
From 0 . To 60 pi 61 r PVC Plastic Ronda, or other map relerence points)
From To Fl. N
From To Ft
14. GROUT:
Depth Malodor Mothod
From 0 To 20 Ft Crniit' Pnurad
From To Fl
15. SCREEN:
Depth Diameter Slot Size Malarial
From To Ft In In
From To Ft In In
From To Fl In In
10. SAND/GRAVEL PACK:
Depth Size Malarial
From To El
From To Ft
17. REMARKS:
0IP //W/ /29
i'i9zy
gtogiA
tai0
6
F
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WAX 5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS ri IIAS BEE • Mr DED TO THE WELL OWNER.
FOR OFFICE USE ONLY
Quad No:
Serial No
02-09-01
SIGNATURE OF PERSON CONSTRUCTING 711E WELL DATE
Subnil original to Division al Water Guailly, Groundwater Section within 30 days
OW-1 REV. 12/99

North Carolina • Department of Environment and Natural Resources • Division of Water Quality • Groundwater Section
1836 Mall Service Center - Raleigh, N.C. 27699-1838-Plane [phone]
228583
i
WELL CONSTRUCTION RECORD WELLCONTRACTOR• Hickory Wall Drilling Co.
WELL CONTRACTOR CERTIFICATION 0: 2343
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE (Check Applicable Sox): ResidentialEl Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Neal Pump Water Infection ❑ Other 0 If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: Gonnelly Springs County' Burke
7134 Knobs Landing
(Road Name and Numbers. Comnunlly, or Subdivision and Lot No.) DRILLING LOG DEPTH
3. OWNER Margie Deal From To Formation Description
Address
Spriinnggs o of
ig
Connelly
28612
Clly or Town Stale
4. DATE DRILLED 01-28-01
Zip Code
5. TOTAL DEPTH 305
6. CUTTINGS COLLECTED YES[_1 NOJ
7. DOES WELL REPLACE EXISTING WELL? YES NO[ —I 7s
8. STATIC WATER LEVEL Below Top of Casing: 5 FT.
(Use •+ II Above Top of Casing) I _
9. TOP OF CASING IS 2 FT Above Land Surface'
•Top of casing terminated allor below lend surface requires a variance In accor-
dance with 15A NCAC 2C .olt6
10. YIELD (gpm)• 3 METHOD OF TEST By Air Tes t
r^.>a
11. WATER ZONES (depth)*
12. CHLORINATION: Type hth Tabs
13. CASING:
Amount 54
IN..)—r
II additional space Is needed use back of form
wen thickness LOCATION SKETCH
Depth Diameter or Weight/TT Material (Show dlrectibn and distance from at least Iwo Slate
From Q To 86 FI 6 %t t Galy Steel, Roads, or other map reference points)
From To FI
From 14. GROUT: To FL ij t J Al L 6
Depth Matodol Molhod �( lYl
Frorn _0 To 20 FI Grout Poured ggc,l1S LehND/ate
From To FI
15. SCREEN: 64)
Depth Diameter Slot Size
From To FI In In
From To FI In In
From To FI In In
16. SAND/GRAVEL PACK:
Depth Size Material
From To Ft
From To FI
17. REMARKS:
Malotiol (.i
f/tux 20
5
oo " uJEGL
I DO IIEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITII 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND TItAT A COPY OF TIIIS RECORD HAS BEEN )y1691 DED TO THE WELL OWNER.
FOR OFFICE USE ONLY
Ouad No:
Sedal No
e
ata
SIGNATURE
OF PERSON CONSTRUCTINWELL DATE
Submit original to Division al Walar Quality, Omnndwalllf Secilon within 30 days
01-31-01
GW-1 NEV. 12/99

I
North Carolina • Department of Environment and Natural Resources - Division of Water Quality • Groundwater Section 2 2 8 (1 O
1e36 Mall Service Center -Raleigh, N.C. 27000-1636-Phone [phone] •
J
WELL CONSTRUCTION RECORD WELL CONTRACTOR. Hickory Well Drilling Co.
WELL CONTRACTOR CERTIFICATION N: 2343
STATE WELL CONSTRUCTION PERMIT'S:
1. WELL USE (Check Applicable Boa): Residential Aq Municipal ❑ Industrial CI Agricultural ❑ Monitoring 0
Recovery ❑ Heat Pump Water Injection El Other 0 II Other, LIsI Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: Morn ton County. Burke
7207 F R Cnffey PcI
(Road Name and Numbers. Community, or Subdivision end Lot No.) DRILLING LOG DEPTH
3. OWNER Hazel Abernathy From To Formation Description
Address 2207 F.R. Coffey Rd.
Morganton
(Shot or Roulpyo.)
City or Town Stale
4. DATE DRILLED 01-11 —01
5. TOTAL DEPTH 305
6. CUTTINGS COLLECTED YES CI NOW
7. DOES WELL REPLACE EXISTING WELL? YES NOfJ
8. STATIC WATER LEVEL Below Top of Casing: 28 Fr.
(Use -•- If Above Top ol Cuing)
0. TOP OP CASINO IS 7 MT Above Land Surface•
'Top of casing terminated at/or below land surface require. a variance In accor-
dance with ISA NCAC 2C.011f1
10.YIELD (gpm)•--a_METHODOFTEST By Air Test
11. WATER ZONES (depth)•
28655
21p Code
12. CHLORINATION: Type hth Tabs
13. CASING:
Amount 53
O a;
1—
r
c,
II additional space is needed use back of form
wen ThicknessLOCATION SKETCH
Depth D er or WeighVFL Materiel (Show direction and distance from at least Iwo Slate
From 0 To 117 Ft, Gaiv. Steel Roads, or other map reference points)
From To Ft.
From To Ft.
14. GROUT:
Depth !Astoria! Method
From 0 To 70 PI Grniit Poured
From To F1
15. SCREEN:
Depth Diameter Slot Size Materiel
From To Ft In In
From To _ Fl In In
From To Ft In In
16. SAND/GRAVEL PACK:
Depth Size Material
From To Ft
From To Ft
17. REMARKS:
F_
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECO(1Q HAS BEEN P TO THE WELL OWNER.
FOR OFFICE USE ONLY
Quad No:
Serial No
07-13-01
SIGNATURE OF PERSON CONSTRUCTING TI1!'WELL DATE
Submit original to Division ol Water Quality, Groundwater Section within 30 days
OW -I REV. 11/99

North Carolina - Department of Environment and Natural Resources - Division of Water Gustily - Groundwater Section
1636 Mall Service Center - Raleigh, N.C. 27699-1630-Phone [phone]
228589
WELL CONSTRUCTION RECORD WELLCONTRAcrOR• Hickory Well Drilling Co.
WELL CONTRACTOR CERTIFICATION S: 2343
STATE WELL CONSTRUCTION PERMITS:
1. WELL USE (Cheek Applicable Boa): Residential :�.' Municipal ❑ Industrial ❑ Agricultural D Monitoring ❑
Recovery El Heat Pump Water Injection ❑ Oilier Ej II Other, List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: Mnrpfantnn county. Rt irk
2207 F.R. Coffey Rd.
(Road Name end Numbers. Community. or Subdivision sod Lol No.)
3. OWNER Hazel Abernathy
Address 2207 F.R. Coffey Rd.
(Street or Houle No.)
Morganton NC 28655
City or Town
Stale Zip Code
DRILLING LOG DEPTH
From To Formation Description
4. DATE DRILLED 31-01
5. TOTAL DEPTH 5
6. CUTTINGS COLLECTED YESCI NO(-XJ
7. DOES WELL REPLACE EXISTING WELL? YES Dcl NO[1
6. STATIC WATER LEVEL Below T`TaAd op of Casing: 4001 Fr.
9. TOP OP CASINO le 2 Pbor blenBmte4l
'Top of casing terminated et/or below lend aurfaes requlrss a valance In aecor•
dance with 15A NCAC 2C .0118
10. YIELD (gpm): 0 METHOD OF TEST By Air Test
11. WATER ZONES (depth)*
12. CHLORINATION: Typo hth Tabs
13. CASING:
Depth Diameter
From 0 To 106 Ft 6e
From To Ft
From To FI
14. GROUT:
Depth Malarial
From 0 To 20 Fi Grout
Amount 27
II addlllonal space Is needed use back of form
Wag Thickness LOCATION SKETCH
or Weight/rt. Material (Show direction and distance from at least Iwo State
Galv. Steel Roads, or other map reference points)
From To Ft
15. SCREEN:
Method
Poured
Depth Diameter Slot Size Material
From To Ft In In
From To Ft In In
From To Ft In In
16. SAND/GRAVEL PACK:
Depth Size Material
From To Ft
From To Ft
17. REMARKS:
1.0
Al
6"wgt17
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS B€E
FOR OFFICE USE ONLY
Quad No:
Serial No
II I5A NCAC 2C, WELL
VIDEO TO THE WELL OWNER.
02-13-01
SIGNATURE OF PERSON CO1ISTRUCy(l6 TIIE WELL DATE
Submit original to Division of Water Ouelily, Groundwater Section within 30 days
oW-1 NEV. 12)99

North Caroline - Deparimant of Environment and Natural Resources - Division of Water Quality • Groundwater Section
1030 Mall $ervlce Center - Ralg1Qhl N.C, 27Q99-1836-Phone (ele) 733.3221
WELL CONSTRUCTION RECORD
22)R1.2
WELL CONTRACTOR; Hickory Well Drilling co.
WELL CONTRACTOR CERTIFICATION if: 2343
STATE WELL CONSTRUCTION PERMITN:
1. WELL USE (chick Applicable Box): Residential T Municipal ❑ Industrial ❑ Agricultural ❑ Monlloring ❑ Recovery [] Heal Pump Waler Injection tUJJ Oilier II Other, List Use:
2. WELL LOCATION: (Show sketch of Me location below)
Nearest Town: 1. ca r(1 County'
Taylor Ave.
((load Name and Number, Comnunlly, or Subdivision and Lot No )
3. OWNER Bill. Cotisino
Burke
Address 4381 rl Rri
ee r Routeo
Connally Springs, NC 2R617
City or Town Stale Zip Code
4. DATE DRILLED 01-03-01
5. TOTAL DEPTH 465
6. CUTTINGS COLLECTED YES Li No(
7. DOES WELL REPLACE EXIS ZING WELL? YES I J NO[—J
8. STATIC WATER LEVEL Below Top of Casing: 4N FL.
(Use's' if Above Top of Casing)
9. TOP OF CASING IS 2 FT Above Lend Surtece•
-Top of casing Ionnlnslad actor below land sudaca raqulrss a variance In accor-
dance with ISA HICAC 2C.011a
10. YIELD (gpm): 7 METHOD OF TEST By Air Test-
11. WATER ZONES (depth):
DRILLING LOG DEPTH
From To Formation Description
12. CHLORINATION: Type hth Tabs Amount R7
13. CASING:
7
t
IN) -a
II additional space Is needed use back of form
Wen Thickness LOCATION SKETCH
Depth Dlanieler or Weight11. Material (Show direclibn and distance from al least Iwo Slate
Front 0 To _�26 rt. 6�.r, PVC P1 as f i r Roads, or olher map reference points)
From To Fl.
Front N -„7i es1 I
to FI M '
14. Gf101/1:
DOE) lII Mato, Inl MOnlorl
Front __0___ 7o __ 70 _ Ft. 1;LuuL_ Euurari
Front To FI.
15. SCREEN:
1lopill 111aniolor Slot Size Material
From - To II hi In
Front To FI In In
From To II In. - In
16. SAND/GRAVEL PACK:
Depth Size Material
Front To _ F1
From _ To Ft.
17. REMARKS:
V 'iji
I DO HEREBY CERTIFY THAT TIIIS WELL WAS CONSTRUCTED IN ACCORDANCE WIT
CONSTRUCTION STANDARDS, AND TI IAT A COPY OF THIS RECORD HAS BEEN P
FOR OFFICE USE ONLY
Clued No:
Serial No.
5A NCAC 2C. WELL
ED TO THE WELL OWNER.
01-12-01
SIGNATURE OF OF PERSON ELL DATE
Subinll original to Division of Water Gustily. Groundwater Secllon within 30 days
OW.I nEv, 12/99
i

North Caroline • Department of Environment end Natural Aesourau - Divisional Water Duality • Groundwater Section 2 2 S H' 1V3V Mill 6ervlgo crier - Hal,Ighl NiP, a TBV9.1a3e-Phgna (91 e) 733.322I 11
WELL CONSTRUCTION RECORD WELL CONTRACTOR: Hickory Well Drilling Co.
WELL CONTRACTOR CERTIFICATION II: 2343
STATE WELL CONSTRUCTION PERMITS:
1. WELL USE (check Applicable fox): Residential El Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery p Heel Pump Water Injection ❑ Oilier LI II Other, List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: Mnrgintnn County Ritrkp
Sweetbriar Lane
(Hoed Name end Numbers. Community. or Subdivision and Lot No.)
3. OWNER Billy West % Ted Deal
Address PO Box 240
Glen Alpine ISlreel or TIKer No.)
LVC 28628
Clly or Town Stale Zip Code
4. DATE DRILLED 017,02 —01
60
5. TOTAL DEPTH
6. CUTTINGS COLLECTED YES 0 NC) •
7. DOES WELL REPLACE EXISTING WELL? YES (l NOrI _>
8. STATIC WATER LEVEL Below Top of Casing: �[ FT.
2 (um'i it Above Top oYCasino)
9. TOP OF CASINO IS FT. Above Land Surface•
'Top or casing terminated Wor below land surface requlns a valance In actor -
dance wilt, ISA NCAC 2CElla _J
10. YIELD (gpm): . 2 METHOD OF TEST By Air Test
o-
11. WATER ZONES (depth):
DRILLING LOG DEPTH
From To Formation Descdpllon
4
Ci
12. CHLORINATION: Type hth Tabs p
YP Amount 1<� II additional space Is needed use beck of form
`
13. CASING:
From
From To FI.
Wall Thickness LOCATION SKETCH
0 Depth48 I�lneler or Welphl?t. Materiel (Show direction and distance from at least Iwo Slate
To Ft 6 PVC Plastic Roads, or other map reference points)
From To FI. N
la: ssttrnH re
Depth Malorlol Method
From 0 To 2n n Grniit Pnrirprl
Frorn To Fl
15, SCREEN:
Depth Diameter Slot Size Material
Frorn To Fl In. In
From _ To Fl In. In
From To Ft In. In
10. SAND/GRAVEL PACK:
Depth Size Material
From To FI
From To Ft
17. REMARKS:
5
S
la,/x t
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDA
CONSTRUCTION STANDARDS, AND TI MT A COPY OF THIS RECORD HAS
FOR OFFICE USE ONLY
Ouad No:
Serial No.
WITH ISA NCAC 2C, WELL
PROVIDED TO THE WELL OWNER.
01-12-01
SIGNATURE OF PERSON COtISTp%C1Ri(7 THE WELL DATE
Subnitrutinetb Dlv)>fon td Water aurally. Groundwater Secllon within 30 days
r.t
Ow-1 REV. 12/99
1

r
North Carolina • Department of Environment and Natural Resources - Division of Water Qually • Groundwater Secllon
1036 Mall Service Center - Raleigh, N.C. 27899-1636-Phone [phone]
Address 3308 G.W. Abee St.
[ShConnelly SpringsuleNa.l NC 28612
City or Town Slats Zip Code
4. DATE DRILLED 01-04-01
5. TOTAL DEPTH bUS
6. CUTTINGS COLLECTED YES CI NO ,J
7. DOES WELL REPLACE EXIS TING WELL? YES al NOn
8. STATIC WATER LEVEL Bolow Top ol Casing: 4a FT.
9. TOP OF CASING IS 2 (Use's' a Above lop of Casing)
FT Above Lend 8urfaos•
'Top of casing lerminaled aior below land surface requbea a valance In accor-
dance with ISA "CAC 2C .0110
10. YIELD (gpm): 1 METHOD OF TEST By Air Tes t
11. WATER ZONES (depth):
228610
WELL CONSTRUCTION RECORD WELL CONTRACTOR: Hirknry Uo11 Nr111 ng Cn
2343
WELL CONTRACTOR CERTIFICATION ":
STATE WELL CONSTRUCTION PERMIT":
1. WELL USE (check Applicable Box): ResldentlaC® Municipal ❑ Industrial ❑ Agrlcullural ❑ Monlioring ❑
Recovery[] Heal Pump Water Injection ❑ Oilier (J II Oilier, List Use:
2. WELL LOCATION' (Show sketch of Ilie location below)
Nearest Town: °altlese Burke
County:
3308 G.W. Abee St.
(Road Name and Number. Community. or Subdivision and Lol No.) DRILLING LOG
3. OWNER Leo Byers DEPTH
From To Formation Description
12. CHLORINATION: Type hth Tabs Amount 110
13. CASING:
C
_7
II additional space Is needed use back of lorry_ 0
-I
Walt Thickness LOCATION SKETCH
Depth Their or Weight/11 Malteds!(Show direclibn and distance from at leash Iwo Stale
From 0 To 86 Ft. Z PVC Plastic
From floods, or other map reference points)
To Ft
From To Ft.
14. GROUT:
Depth Malarial Method
From 0 To 20 FI Grout Poured
From To FI
15. SCREEN:
Depth Diameter Slol Size Materiel
From To __ Ft In In
From To Ft In
In
From To Fi In In
10. SAND/GRAVEL PACK:
Depth Size Malarial
From To FI
From To Ft.
17. REMARKS:
iFOR OFFICE USE ONLY
Quad No:
Serial No.
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HASJMN PROVIDED TO THE WELL OWNER.
—01
SIGNATURE OF PERSON CON RUC TING TI IE WELL 01 —1 1 Submit orginallo Division ol Water Dually ndwaler Section within 30 days DATE
OW -I nEV. 12/99
I

North Caroline • Department of Environment and Natural Resources • Division of Weiler Duality - Groundwater Section
1636 Mall Service Center - Raleigh, N.C. 27899-1638-Phone [phone]
WELL CONSTRUCTION RECORD
228609
WELL CONTRACTOR: Hi r'knry Wp 1 1 Ilri 1 1 i ng Co
WELL CONTRACTOR CERTIFICATION 0: 2343
STATE WELL CONSTRUCTION PERMIT.:
1. WELL USE (Check Appucabl• Doak Residenliall0 Municipal El Industrial ❑ Agricullurol ❑ Monitoring ❑
Recovery ❑ fleet Pump Water Injection ❑ Oilier p If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: Morganton county: Burke
9777 Hnllybrook Lane
(Road Name and Numbers. Community, or Subdivision end Lot No.) DRILLING LOG
3. OWNER Bobbie Ralph/William Solis DEPTH
Address 2085 Playmore Beach Rd.
Lenoir (Sheol orTiro.) 28645
Clly or Town Stalle
4. DATE DRILLED 01-03_ni
5. TOTAL DEPTH T0S
6. CUTTINGS COLLECTED YES [I NOI X I
7. DOES WELL REPLACE EXISTING WELL? YES [ J NO PI
6. STATIC WATER LEVEL Below Top of Casing: FT.
(Use'•- if Above Top or Casing)
9. TOP OF CASING IS 2 FT. Above Lend Surface•
-Top of casing lermbuied si/or below land swim raqulro a variants in actor•
dance with ISA NCAC 2C .0116
10. YIELD (gpm): 4 METHOD OF TEST By Air Test
11. WATER ZONES (depth)•
•
From To Formailon Description
12. CHLORINATION: Type hth Tabs Amount 49 II eddlitonal space Is needed use back of Iola 5
•
�1 LOCATION SKETCH
0 SR pill Dlapipw (Siow direcllbn and distance horn al least two Stale
From 'To FL b- Roeds, or oilier map reference points)
Frorn To Ft
From To FI N �'/�
14. cnour:
Depth Malarial Method ��tjU Cx�
From 0 To 20 F-t Grout Poured
Frorn To VI
15. SCREEN:
O
Q
N
13. CASING:
Zip Code
Well Thickness
or hill. Meted&
�° Plastic
Depth Dlerneler Slot Size Malerlal
From To Ft In In
From ___ To __ Ft In In
From To FI In In
IS. SAND/GRAVEL PACK:
Depth Size Mnlollal
Horn To Ft
From To Fl
17. REMARKS:
%1
o%cdELL
so 1E
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C. WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD IlAS N PROVIDED TO THE WELL OWNER.
FOR OFFICE USE ONLY
Quad No:
Serial No.
01-11-01
SIGNATURE OF PERSON CONS !NO TIIE WELL DATE
Submit original to Division of Weler Quality, p undwaIter Secilon within 30 days
OW.1 REV. 12/99
i

North Carolina - Department of Environment and Natural Resources • Division of Water Quality - Groundwater Section 2 2 7 t t 9 9
1636 Mail Service Center - Raleigh, N.C. 27699-1636-Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR- r,/,'Ce A/C -If
WELL CONTRACTOR CERTIFICATION #: ,-171 3
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE (Check Applicable Box): Residential El Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring El
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below)
%rr.c.;�0'^ County
Nearest Town:
(Road Name and Nuq,ers. Community, or Subdy'vision and Lot No.)
3. OWNER j7.64^ (ucct/e 1/
State Zip Code
4. DATE DRILLED /-30 _C
5. TOTAL DEPTH 3CS"
6. CUTTINGS COLLECTED YES D NO®
7. DOES WELL REPLACE EXISTING WELL? YES Q NOE
8. STATIC WATER LEVEL Below Top of Casing: 4 <� FT.
(Use it Above Top of Casing)
9. TOP OF CASING IS .1 FT Above Land Surface'
'Top of casing terminated attor below land surface requires a variance In aeeor-
dance with 15A NCAC 2C .0118
10. YIELD (gpm): METHOD OF TEST) / l / C c/
11. WATER ZONES (depth):
DRILLING LOG DEPTH
From To
c..S!
r S' S <5
?its
Address S� � ? � I ��
V ( treat Ordouse
n PACirgQ y � c9 SS
City or Town
12. CHLORINATION: Type
13. CASING:
Fomiatio escriplion
?1cCk
0
O co
Amount If additional space is needed use back of form
Wall ThicknessLOCATION SKETCH
I� Depth <-� - Diameter or Weip t. Material (Show direction and distance from at least two State
From L To ✓ Ft _ b C ,4,d__ Roads, or other map reference points)
From To Ft
From To Ft
14. GROUT:
Depth Material Method
From /) To L Ft `--^/ --I,'k'c'Cl
From To Ft
15. SCREEN:
Depth Diameter Slot Size Material
From To Ft in in
From — To Ft in in
From - To Ft In in
16. SAND/GRAVEL PACK:
Depth Size Material
From To Ft
From To Ft
17. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RHCORD HAS BEEN PROVIDED TO THE WELL OWNER.
/ 2 _
SIGNATU E OF •Pye+SON CONSTR THE WELL DATE
FOR OFFICE USE ONLY
Quad No:
Serial No.
Submit oda( l�otINion o sf ter Quality. Groundwater Section within 30 days
GW-1 REV. 12/99

North Carolina • Department of Environment and Natural Resources - Division of Water Duality - Groundwater Section
1636 Mail Service Center - Raleigh, N.C. 27699-1636-Phone [phone]
WELL CONSTRUCTION RECORD
WELL CONTRACTOR• ('G C
WELL CONTRACTOR CERTIFICATION #:
Pei/ A,t/-
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE (Check Applicable Box): Residential El Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: County
(Road Name and NNu^umbers, Corrvnury, or Su iwsion and Lot No.) DRILLING LOG
3. OWNER r),,m_ I C._ --11. a, 1- From To
t .
(9Addressrxuri p ip_,IJ,�- ‘,1 -‘1,,,� Knr IZ�Q I Q
Con/� C ( treat or Route No. () e7
ry\1\
e )Q ri hG S \(
City or Town i I 'State
4. DATE DRILLED J— S- 6 f
5. TOTAL DEPTH 'a CO
6. CUTTINGS COLLECTED YES NO❑
7. DOES WELL REPLACE EXISTING WELL? YES NOD
8. STATIC WATER LEVEL Below Top of Casing: 5 FT.
/
9. TOP OF CASING IS (/ (Use
,7 FT. Above Land Surface'
'Top of casing terminated at/or below land surface requires a variance In accor-
dance with 1SA NCAC 2C -0118
10. YIELD (gpm)• ) S- METHOD OF TEST CC e h A n
11. WATER ZONES (depth). (rR ci - I S - A^"
T ?c-'
I?U
Zip Code
12. CHLORINATION: Type / 7/4 ^( Amount
13. CASING:
Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To Ft I lC- /7 ve
From To Ft.
From To Ft-
14. GROUT:
Depth-)
th Material / Method
From (.i ToFt L.a/iG/eaT From To Ft
15. SCREEN:
Depth Diameter Slot Size Material
From To Ft in _ in 'er l ] A c /co/ -
From To Ft in in
From To Ft In In
16. SAND/GRAVEL PACK:
Depth Size Material
From To Ft
From To Ft
17. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY O IS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
r,
DEPTH
Formation Description
cli r+
0
v
a
fri
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)
tP
FOR OFFICE USE ONLY
Quad No:
SIGNATURE OF PERSON L`ONSTRUCTING THE WELL
Submit original to Division of Water Quality, Groundwater Section within 30 days
DATE
GW-I 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. 'CC Nei/
WELL CONTRACTOR CERTIFICATION #: 7/
STATE WELL CONSTRUCTION PERMIT#:
227094
1. WELL USE (Check Applicable Box): Residential Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring El
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATION: (Show ketch of the location below)
Nearest Town: /�4-,ti7rk County'
(Road Name and Numbers, Community, 9r Subdivision and Lot No.) DRILLING LOG DEPTH
3. OWNER tiv%-/f<.S From To Formation Description
Address (street Onroe / �v, 4), f% fU �il
«eet or oute o.) % .s(i X /J!>C:k
+yy6 ne/�
City o n S to ` ' Zip Code �'� J
4. DATE DRILLED "2 -of
5. TOTAL DEPTH
6. CUTTINGS COLLECTED YES 0 NOL
7. DOES WELL REPLACE EXISTING WELL? YES ❑ NOQ'
8. STATIC WATER LEVEL Below Top of Casing: FT.
(Use 14.1 if Above Top of Casing)
9. TOP OF CASING IS FT. Above Land Surface'
?op of casing terminated at/or below land surface requires a variance In¢cor-
dance with 15A NCAC 2C .0118 /
10. YIELD (gpm): /UD METHOD OF TEST/ter /,/�
11. WATER ZONES (depth):
12. CHLORINATION: Type
13. CASING:
Amount
If additional space is needed use back of form
•
Wall Thickness LOCATION SKETCH
/�
Depth Diameter or w i t. Material (Show direction and distance from at least two State"
From 4'
p cm
To ,J J Ft _Ed_ Roads, or other map reference points)
From To Ft co -t
)
5From To Ft
14. GROUT:
Depth ateriall Method J
From el To — Ft men ^Mr'>�J
From To Ft
15. SCREEN:
Depth Diameter Slot Size Material
From To Ft in in
From — To — Ft in in
From _ To Ft In In
16. SAND/GRAVEL PACK:
Depth Size Material
From To Ft
From To Ft
17. REMARKS:
I DO HEREBY CERTIFY. THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
FOR OFFICE US$ ONLY ADZ 5
Quad No:
PERSD STRUCTING THE WELL DATE
of Water Quality, Groundwater Section within 30 days
GW1 REV. 12/99

227096
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. /7tt 4' II lit'//%1f jam(
WELL CONTRACTOR C TIFICATION #: ,a9) Y
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE (Check Applicable Sox): Residential Lid" Municipal ❑ Industrial ❑ Agricultural El Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATION: (ShoAsketch of the location below)
Nearest Town: / Ji-i yf I County.
Qurkc
(Road Name and N mbers, Community, or Subdivision and Lot No.) DRILLING LOG DEPTH
3. OWNER L't/Cl Sc /%r✓ C From To Formation Description
Address �aS( tJe ems noj 0ri2,sc L.1 C0 2.3 r?9 c-k
(Surka ineet o out L .( ?3 /0cnOlzvane le
City or own State Zip Code
4. DATE DRILLED 1')-`)"0/
5. TOTAL DEPTH //70
6. CUTTINGS COLLECTED YES NOQ/�-''I 6S
7. DOES WELL REPLACE EXISTING WELL? YES NO I-'"----
8. STATIC WATER LEVEL Below Top of Casing: FT.
(Use -.' it Above Top of Casing)
9. TOP OF CASING IS a FT. Above Land Surface'
Top of casing terminated actor below land surface requires a variance In accor-
dance with 15A NCAC 2C 2 j1a /f _ /
10. YIELD (gpm)' ` I METHOD OF TEST �f/ t ._._lCC3'
11. WATER ZONES (depth)'
12. CHLORINATION: Type
13. CASING:
Depth ,-
From 0 To ail Ft
From To Ft
From To Ft
14. GROUT:
Diane
Amount
If additional space is needed use back of form
LOCATION SKETCH
Wall Thid ass
or Wgigy/Ft. Material (Show direction and distance from at least two State
Roads, or other map reference points)
r,c
Depth M,pterial Method
From 0 To ')n Ft (`G)..ea-' `I^1a'e
Ofr
From To Ft
15. SCREEN:
Depth Diameter Slot Size Material
From To _ Ft _ in in
From To — Ft — in _ in
From _ To _ Ft. _ In In
16. SAND/GRAVEL PACK:
Depth Size Material
From To Ft
From To Ft
17. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS -ECORD HAS BEEN PROVIDED TO THE WELL OWNER.
FOR OFFICE USE ONLY_
Quad No: �F1i
Serial No.
t
PERSON ONS TING THE WELL DATE
of Water Quality, undwater Section within 30 days
GW-1 REV. 12799

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• - - wct( n,; !(• y C c
WELL CONTRACTOR CE TIFICATION #: 9-7 H' 9- 7)3
STATE WELL CONSTRUCTION PERMIT#:
227100
1. WELL USE (Check Applicable Box): Residential L'J' Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: tille7 County.
& r f`�-
(Road Name and Numbers, Convnun7iry, or Subdivision and Lot No.)
3. OWNER f (' 4tcc- From To
76
Address VI ifins- n pi r I
(Street or outs No. �Q 3 5 (�(
/..) .21.117✓1 M G . 2dyi
City or Town State
4. DATE DRILLED / _ J 7-el
5. TOTAL DEPTH r20 O
6. CUTTINGS COLLECTED YES NO[�'
7. DOES WELL REPLACE EXISTING WELL? YES Q OE
8. STATIC WATER LEVEL Below Top of Casing: FT.
(Use'+' it Above Top of Cuing)
9. TOP OF CASING IS % FT. Above Land Surface'
'Top of casing terminated at/or below land surface requires a variance In accor-
dance with 15A NCAC 2C .011 q
irfra
10. YIELD (gpm) METHOD OF TEST /14 r • c
11. WATER ZONES (depth):
DRILLING LOG DEPTH
Formation Description
v C
i-' .70e dClc
Zip Code
12. CHLORINATION: Type
13. CASING:
Depth Diameter
From To as Ft G
From To Ft
From To Ft
14. GROUT:
Amount
Depth
th Maten Method
/�
From 6� To Ft [ e .-"3'-0
From To Ft
15. SCREEN:
Depth Diameter Slot Size Material
From To Ft _ in _ in
From _ To _ Ft in in
From To Ft in In
16. SAND/GRAVEL PACK:
Depth Size Material
From To Ft
From To Ft
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)
17. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS - ECORD HAS BF,F;N PROVIDED TO THE WELL OWNER.
FOR OFFICE USE ONLY
Quad No:
Serial No.
-� 7 '/1
5 • SIGNS, RE •F P RSON CO rCTING THE WELL DATE
Submit odgitiit l nawstar Section within 30 days
GW-1 REV. 12/99

1
From t' To
North Carolina - Department of Environment and Natural Resources - Division at Writer Duality - Groundwater Section
1636 Mail Service Center • Raleigh, N.C. 27699-1636-Phone [phone],,21
WELL CONSTRUCTION RECORD WELL CONTRACTOR- tS72 {S-C-- // /0e1/
WELL CONTRACTOR CERTIFICATION #: nx l 3' f
STATE WELL CONSTRUCTION PERMIT#:
22FF53p
1. WELL USE (Check Applicable Box): Residential rtm- Municipal n Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ri Other ❑ If Other, List Use:
2. WELL LOCATION (Show ,ketch oho location below)
Nearest Town:
414-4.4"6"l County' fir
(Road Name and Numbers, Community. n•'.:hdivision and lot Ni
3. OWNER - c'e J71.4— ; /7a• 4 'f -,c
Addres�`s//ten/
City or Town :I,lo
4. DATE DRILLED C/
5. TOTAL DEPTH -7 re)
6. CUTTINGS COLLECTED YES El NO!
7. DOES WELL REPLACE EXISTING WELL.? YES [ j
8. STATIC WATER LEVEL Below Top of Casing: 3 FT.
(Use '+- it Above Top or Casino)
9. TOP OF CASING IS 1 FT. Above Land Surface'
'Top of casing terminated etor below land surface requires a variance In accor-
dance with 15A NCAC 2C .0118
10. YIELD (gpm): - METHOD OF TEST A.,-
11. WATER ZONES (depth): /.7c --/3s /,5', /
_9/ d V
nmLl_WG LOG
From To
DEPTH
Formation Description
d -- /!t f(C,'„ f j e' rk
/C i /30 /n,, r-:fen- 6./ /'''n;-'*'
/70 • /-9i 1/S4.7'cc I J'rrra%rv,-
O
m
L
12. CHLORINATION: Type 4" % /-f Amount .• Ye T- It additional space is needed use back of form
13. CASING:
Wall Thickness
Depth Diamolnr or Wcight,'PL Malarial
From -/ To /e l Ft _1 f Y 4/r
From To Ft.
From To — Ft.
14. GROUT:
Depth
r
Material Method
Ft «.:. ,2 rif/"ezZ _
From To Ft
15. SCREEN:
Depth
From To
From To Ft
From To Ft
16. SAND/GRAVEL PACK:
Depth
To Ft
To Ft
From
From
17. REMARKS:
Diameter Slot Size
Ft in
in
it
Size Material
cite•
LOCATION SKETCH
(Show direction and distance from at least two
Ponds, or other map reference points)
0.,)
lice
n�
N _=
C)-
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.
--2 i"ace/
SIGNATURE or PER., N CONSTRUCTING
THE WELL DATE
5ohmii original In Dwisinn of Water Quality. Groundwater Section within 30 days
GWI REV. 12/99

North Carolina • Department of Environment and Natural Resnurcns - Dlv..� n of Worm Quality - Groundwater Section
1636 Mail Service Center - Raleigh. N.C. 27699-1 E36-Phone [phone]
226529
WELL CONSTRUCTION RECORD
WELL CONTRACTOR !R<r2I/ IO1eI/
WELL CONTRACTOR CERTIFICATION #:
STATE WELL CONSTRUCTION PERMIT#:
WELL USE (Check Applicable Box): Residential rF Municipal ❑ Industrial ❑
Recovery ❑ Heat Pump Water Injection rl Other n If Other, List Use:
2. WELL LOCATION: Show sk tch f tt o location below)
Nearest Town: /� 'C--- County Gi42'An
Agricultural ❑
Monitoring ❑
(Road Name and umbers, Commit
3. OWNER ..�.�
Address
Iy. . - uhdivision and Lol No )
r..l
Citvor Town -tale Z'n Coma
4. DATE DRILLED / 7/-'-' /
5. TOTAL DEPTH /Zlc?
6. CUTTINGS COLLECTED YES r]
7. DOES WELL REPLACE EXISTING WELL? YES I NOLi9
8. STATIC WATER LEVEL Below Top of Casing:
(5 ate H,uloTto.)— 6.7— 9/'
° `al'C aBLyI 96
(Use it Above Top of Casing)
9. TOP OF CASING IS 2 FT. Above Land Surface'
'Top of casing terminated aVor below land surface requires a variance In accor-
dance with 15A NCAC 2C .0118
10. YIELD (gpm): CO METHOD OF TEST 4r'f
11. WATER ZONES (depth): 7 o j9 .'jy /
ia7 /7/ y7 r/
12. CHLORINATION: Type h/tN Amount - 02
13. CASING:
From
From
-7
Wall Thickness
Depth Diameter or Weight/It. Material
To Ft l:j /21
To Ft — --.
From To Ft
14. GROUT:
Depth Material Mnlhod
From fir' To am Ft _Cl ‘,-= -/- �'eav_cd _.
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:
93—/;27
DRILLING LOG DEPTH
From To Formation Description
Vi J/%i/YTGc A", eti,pr
4i e t.. /sr /['
rfa/ei is
7; 2 -if,
/3/- / Yo
c
O tr-
It additional space is needed I. back or
0
(Show direction and distance from at least two State
Rnnds, or other map reference points)
O
LOCATION SKETCH
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND TF{AT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
FOR OFFICE USE ONLY
Quad No:
Serial No.
SIGNATURE of PER S( WCONSTRUCTING THE WELL
Submitunp rat lgDivis en 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
1636 Mall Service Center - Raleigh. N.C. 27699-1636-Phone [phone]
WELL CONSTRUCTION RECORD WELLCONTRYkTOR 5 Camp )Y•
WELL CONTRACTOR CERTIFICATION #: � J 3 g
STATE WELL CONSTRUCTION PERMIT#:
2 4104
1. WELL USE (Check Applicable Box): Residential 0 Municipal
Recovery ❑ Heat Pump Water Injection ❑ Other
2. WELL LOCATION:.v�(Show sketch of the location below)
Nearest Town: Lo,utc)I\/ S?rlrlra5 County:
S . Mourtfalyf Park ' "lie
(Road Nano and Numbers, Community, or Subdivision and Lot No.)
3. OWNER 60k't1L ML . Sta}e- P0.rk
Address 3oo S M•t Park f111e-
( treat Of %We� pp..)
"s ryi_
C mnr.)I( JAYI nl{ i$(, (a.
City or To n State Zip Code
4, DATE DRILLED
5. TOTAL DEPTH j 4 4
6. CUTTINGS COLLECTED YES n NO
7. DOES WELL REPLACE EXISTING WELL? YES [] NO[
8. STATIC WATER LEVEL Below Top of Casing: FT.
(Use 'r' II Above Top of Casing)
9. TOP OF CASING IS I FT Above Land Surface'
'Top of casing terminated atlor below land surface requires ■ variance In actor -
Industrial 0 1�Agricultural 0 Monitoring ❑
If Other, Ust Use: Paisiir
B tA. r ke-
dance with 1454 NCAC 2C 0119
10. YIELD (gpm)• 50 METHOD OF TEST Ai
11. WATER ZONES (depth).
DRILLING LOG
From To
fro
go pH"
12. CHLORINATION: Type (7rGlkt.M la Amount I cup
13. CASING:
Depth
From V To 0
From To
From To
14. GROUT:
Wall Thickness
Di np or or WelghvFI.
Ft (pt# SDR-ZI
Ft.
Ft
PVc
Depth M trial M thodl
From 0 To 2n Ft Weerl•Ptrteni 110-nz1
From
15. SCREEN:
To Ft
Depth Diameter Slot Size Material
From To Ft In In
From To Ft. In In
From To Ft in in
16. SAND/GRAVEL PACK:
Depth Size Material
From To Ft
From To Ft
17. REMARKS:
DEPTH
Formation Description
C-o )&So lida-ted rock
U
w "2
`9
r
F' o
If additional space is needed use back of form
LOCATION SKETCH
(Show direction and distance from - least two State
Roads, or other map reference •olnIrj
I DO HERESY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
•
CONSTRUCTION STANDARDS, AND THAT A COP �ATUR� DFPFRs�N� BEEN
STRUCTIt�d THE WELLY WELL OWNER.
/D 'O
N
DATE
Submit odglnafto Division of Water Quality, Groundwater Section within 30 days C
GW-1 REV. 12/99
FOR OFFICE USE ONLY
Quad No:
Serial No.

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mall Service Center - Raleigh, N.C, 27699.1636-Phone [phone]
224118
i
WELL CONSTRUCTION RECORD
WELL CONTRACTQR• J W es 14). ea mTr
d9
WELL CONTRACTOR CERTIFICATION #: 3 S
STATE WELL CONSTRUCTION PERMIT.:
1. WELL USE (Chock Applicable Pox): Residential 52Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Infection ❑ Other El If Other, List Use:
2. WELL LOCATION: (how sketch of the location below)
Nearest Town: 1Y4O v'pd Kt° K County:
1 -rj. itRm`Col r I ni
RUrke
(Roadand/roars,� ry, r Subdivision and Lot No.)
3. OWNER (,10.(
Address .i 6A k Pp0. K TyYa c eVolidE !reel grout No.) g� 70
City or Town V Stale Zip Code
4. DATE DRILLED
5. TOTAL DEPTH •R' 6"
6. CUTTINGS COLLECTED YES 0 NOn
7. DOES WELL REPLACE EXISTING WELL? YES [T/ NO7
8. STATIC WATER LEVEL Below Top of Casing: 1 ) 0 FT.
(Use'+' 11 Move Top of Casing)
9. TOP OF CASING IS I FT Above Land Surface'
'Top of wising terminated at/or below land surface requires a variance In accor-
dance with 15A NCAC 2C .0118
10. YIELD (gpm)- 90 METHOD OF TEST
11. WATER ZONES (depth)•
DRILLING LOG
From To
0 20
AI✓
12. CHLORINATION: Type tj✓at.riK1al' Amount
13.-CASING:
Wall Thickness
Depth Di star or Weight/FL
,A From 0 To 0 Ft t 4 SDR)J
From To Ft.
From To Ft
14. GROUT:
cup
Malarial
P)' c.
Depth k I Material -I- Methof
From D To 2-D Ft Ni'at cemevll ha n rJ
From To Ft
15. SCREEN:
Depth Diameter Slot Size Material
From To Ft In In
From To Ft In In
From To Ft- in in
16. SAND/GRAVEL PACK:
Depth Size Material
From To Ft
From To Ft.
17. REMARKS:
DEPTH
Formation Description
d hit
aJel
CcvlSoldaell Yock
O
C_
rn
-0
rrl
CD
'
V
ES
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)
Mtp
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 PROVID D TO THE WELL OWNER.
44 4. [3. rlJhAt C . /-10-64
i l SIO4TURE OF PERSON CONSTRUCTING E WELL DATE
Splunit d4ginallil0ivislon of Water Quality, Groundwater Section within 30 days
FOR OFFICE USE ONLY
Quad No:
Serial No
GW-1 REV. 12/99

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mail Service Center - Raleigh, N.C. 27699-1636-Phone [phone]
WELL CONSTRUCTION RECORD
224146
WELLCONTRACTOR• i/.n
'. CC test/ rir,%/. • A_'✓G
WELL CONTRACTOR CERTIFICATION #: 97i 1
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE (Check Applicable Box): Residential E Municipal [] Industrial El Agricultural ❑ Monitoring ❑
Recovery El Heat Pump Water Injection ❑ Other El If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: .. f , fCn County:
(Road Name one' —hors, Community, or Subdivision and tot No.) f DRILLING LOG DEPTH
3. OWNER JtKc'l /n From To Formation Description
Address , �,rC%. / :�c.:,l 3 .. /
treat or Route flo.) C ;) S (. .'? " %L
C _ rcy
City or Town State Zip Code J 'r ` 17 r l k-
4. DATE DRILLED —/'
5. TOTAL DEPTH
6. CUTTINGS COLLECTED YES 0 NO©-71
7. DOES WELL REPLACE EXISTING WELL? YES [�/10ILI
8. STATIC WATER LEVEL Below Top of Casing: 70 FT.
(Use': if Above Top of Casing)
9. TOP OF CASING IS FT Above Land Surface'
'Top of casing terminated at/or below land surface requires a variance In accor-
dance with 15A NCAC 2C Tye
10. YIELD (gpm)- METHOD OF TEST 4, - AFIC,
11. WATER ZONES (depth).
12. CHLORINATION: Type
13. CASING:
Amount If additional space is needed use back of form-0
Wall Thickness
o Depth m Diaeter or Weig VFt. Material
From To ,S Ft .1' 1 /7'" i Os'
From To Ft.
From To Ft
14. GROUT:
Depth Material Method i
From 4'9 To 9 C Ft It^-i
From To Ft
15. SCREEN:
Depth Diameter Slot Size Material
From To Ft in in
From To Ftin in
From To _ Ft in In
16. SAND/GRAVEL PACK:
Depth Size Material
To Ft
From
From To
17. REMARKS:
Ft
To
LOCATION SKETCH
(Show direction and distance from at least two Stag
Roads, or other map reference points)
I DO HEREBY CtEfT1 Y-TAT-T44IS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCT, TANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
I�r ",6-- /—/-CO
FOR OFFICE INS
Quad No:
Serial No.
SIGNA OF P ON CONDUCTING THE WELL
DATE
'$Ubrrdt original to on of Water Quality, Groundwater Section within 30 days
GW1 REV. 12/99

t l 1 Groundwater Section
Ho..n c+.e•..+ - o.p.nm.m oart-nranmant and Natural ResourCeS - Division or beaker Ouaky
•
1636 Mail Service Center - Raleign, N.C. 2ve99-1636-Pnone t919) 733-3221
TION RECORD WELL CONTRACTOR: /in7'e /1e// ,)"/Zf £fit
WELL CONTRACTOR C£R IFICATION 0: S"171 3 _/ --
STATE WELL CONSTRUCTION PERMITS:
(Check Applicable Rem): Residential LJ
Recovery Q Heat Pump Water Injection ❑
2. WELL LOCATION
Nearest Town:
Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Other If Other, List Use:
(Show sketch of the location below)
County
(Road Name and�r ur ben. Community, or Subdivision and Lot No.)
3. OWNER J Urn S /Gu'Sc"1
Address 5'137 M,W«
,onfr
(Street Or FORA No.) _
1nV' ,1/JCS ;,., r 'I• as6O.1 37 357)
Cly or Tann State zip Code
4. DATE DRILLED / N "6 /
5. TOTAL DEPTH ?XL)
6. CUTTINGS COLLECTED YES ED NO li/
7. DOES WELL REPLACE EXISTING WELL? YES
8. STATIC WATER LEVEL Below Top of Casing: L () FT.
(use•+• If Above Top oI Casing)
9. TOP OF CASING IS 1 , FT. Above Land Surface'
Top of using terminated at/or below land surface requires a rarlence In @coon
dance with /5A NCAC 2C.0111
10. YIELD (gpm): L/ METHOD OF TEST drii'
11. WATER ZONES (depth):
DRILLING LOG
12. CHLORINATION: Type
13. CASING:
From To
11 c
Amount
Depth ., Damps.
From To J.f Ft L
From To Ft
From To Ft
14. GROUT:
Depth
From t2 To . 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 Material
Wax Thickness
or 6elgnJ'FL '1}
f.Matertaall
From
From _
17. REMARKS:
I DO HERE
CONSTRU
Method
r'YeW
To Ft.
To Ft.
Slot Size Material
In
in
in.
227079
DEPTH
Formation Description
C r Ile m
a
m
cn=-
It additional space is needed use back of form
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other map reference points)
r1'te itli lie'L6p 1f CONSTRUCTED IN ACCORDANCE WITH 15A NOAG 2C, WELL
TANDAROS, AND THAT ACOPY OF THIS RECORD HAS EEN PROVIDED TO THE WELL OWNER.
FOR OFFICE
clad No:
Shed No.
SIGN-.'
Submit origkyNe
RSON STRUCTING THE WELL DA
Stet Quality. Groundwater Section within 30 days
OW-1 REV. 12/99

245408
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and N ?sources - Divisionsiof Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (pry(,at) � O I�i°i/Z. CERTIFICATION s oC
WELL CONTRACTOR COMPANY NAME 2% ev/� .Ori//i oer. PRONE r J71( Y6°d3 Z?
STATE WELL CONSTRUCTION PERMIT#
(if applicable)
—ASSOCIATED WQ PERMIT#
applicable)
1. WELL USE (Check Applicable Box): Residential til Mtmicipal/Public 0 Industrial Cl Agricultural ❑
Monitoring L7 Recovery Cl Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCATION•
,• �r
Nearest Town: MprsevoLeA. County coke
(Suter Name, Numbers, Commtmity. Subdivision, Lot No., Zip Code)
3. OWNER: 65051- 71WPf- 17ptt"iA4
Address / .G. ,�"/t.:a�/ [/`-
y.t (Street or Route No.) O
/� aafQaA.af% it 4 2 S&S
City or own State Zip Code
Area node- Phone number
4. DATE DRILLED / `" ^ 0
5. TOTAL DEPTH: 3'
Topogr4hfc/Land setting
❑Ridge ope ❑Valley ❑Flat
(cheek apptopriae box)
Latitude/longitude of well location
(degroain3mtkalseeoods)
Latitude/longitude saurce:0OPSOTopograpbic map
(cbedc boa)
D PTH DRILLING LQG
F m �o Forgtation Description
/ 6' — 4C?'
6. DOES WELL REPLACE EXISTING WELL? YES NO fd y2 � S."
7. STATIC WATER LEVEL Below Top of Casing: s
(Use wn ifAbove Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface'
'Top of cadre terminated at/or below land anent requires
valiance L aettvrdme tth ISA NCAC 2C.aila I [�
9. YIELD (gpm): IX METHOD OFTESTAV.1 ft
10. WATER ZONES (depth):
11. DISFECTION: Type Amount
12. CASING:INwall Thickness
DPW or Wei t/FL lviataisl
Pro To � Ft � S.4li,�/ P
From To Ft.
From To Ft,
13. GROUT; Depth Material Method �O Fran . To4O Ft. Cemtaf tarred
From To Ft 7
14, SCREEN: Depth Diameter Slot Size Material
From______ To Ft. in. in.
____-
From._ To Ft,__ in. in
IS, SAND/GRAVEL PACK;
Depth Size Material
From To Ft
Prom __To Et
UG
16. REMARKS'
gigs t its
LOCATION SKETCH
n
ae m•
zr
Show direction and distance in miles from at leas t N
two State Roads or County Roads. Include thud
numbers and common road names. o
_Caters Al
At- /tab
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
CONSTRUCTION STAND ND
' a S, AND
�THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNERtinran: le.:
Sob
27699-
glnal to the Divi,4RR of
ne 119; 73341 wit
PERSON CONSTRUCTING THE WELL DATE
uality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
ays. OW-1 REV. 07/2001
Gd W
GROUND RETu ONFL OFFICE
EE2IE9PPOL : 'ON XHd dWi1d '3 1 13M Z13aOW : WOW

245407
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and N Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (paint)j /£.1/ // r DInP t CERTIFICATION a 259h
/rt
WELL CONTRACTOR COMPANY NAME t if.71z Over✓/ 7/fl ibse PHONIC e
120SS.2 I. R
STATE WELL CONSTRUCTION PERMIT* ASSOCIATED WQ PERMITM
(if applicable)
(if applicable)
1. WELL USE (Cheek Applicable Box): Residential 0/Municipal/Public C7 Industrial O Agricultural ❑
Monitoring O Recovery ❑ Heat Pump Water injection ❑ Other Q If Other, List Use
2. WELL LOCATIONLL
Nearest Town: met yetiolL county 44(J4a.
3. OWNER:
(Street Names Numbers, Community,/ Subdivision, Lot No.. ZipCode)
CeNly-l< se / 6cuit�4
Address J a .E A-Aanrp< /ir
City or Town state Zip Code
Area
4. DATE DRILLED J y o
5. TOTAL DEPTH: -'i0O /
6. DOES WELL REPLACE EXISTING WELL? YES O 0'
7. STATIC WATER LEVEL Below Top of Casing: S FT.
(Use'w' if Above Top attests)
8. TOP OF CASING IS / FT. Above Land Surface`
*Top of ensue termleated atfor below had sedate requires a
rartance in scard`"� a� ISA NCAC IC .OI IR �� //��,
9. YIELD (gpm): DOFTBSWj�I!'A'flf"
10. WATER ZONES (depth): /gO 1
11. DISINFECTION: Type /i d Amount S O Z.
12. CASINO:
Depth
afQ To F 5 t. FroTo
Talter
From To Ft.
From To Ft
13. GROUT: Devil,Material Method
From To D Ft. Ce•Jneter 19otired
From,,._ To Ft
I4. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Fr. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
Wall Thickness
or Weight/Ft. Material
5R-2/ /VG
6cator ltowe No.)
Prom To Ft
From To Ft.
Topoc/Land setting
ORidge 12Slope QValley ❑Flat
(ebeea appreptiate box)
Latitude/longitude of well location
(deg aes/minmer/sxonds)
Latitude/longitude somce:OGPSOTopographie map
(check box)
DRILLING LOQ
Pomaauuon Description
C/120 fha/2/ (0.-Acskir
DEMI
--
93' -- 3bo' GnrA,fe
ry
n.'
.n
O
n
>0
m.
01 z
•LOCATION SKETCH cn
Show direction and distance in miles from at )post o
two State Roads or County Roads. Include the road
numbers and common road names.
846(ti %at eteL.
/VG /a6
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WFT.T WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC2C,WELL
CONSTRUCTION STANDARD AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
S
Submit the original to the Division
27699-1636 Phone No. [phone], within 30
'ATURE OF :Imiti N iaePil�`tRy NOCsr
of Water a,:i { Groundwater s oti 1
DATE
Service Canter _ Raleigh, NC
OW -I REV. 07/2001
Sd Wd6Z:90 ZOOS 0T 'Lief
GROUNDWATER SECTION
REGIONAL CFHOE
Z£SZ9PP0L T '0N XUA
dWfld 8 113M Z13?JOW : Wald

245408
WELL CONSTRUCTION RECORD
NOnh Carolina - Department ofmnvironment and Na Rtesouroeeaa- Divisionsiof Water Quality- Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (Pp/idt.,a) /• •O re-,Z- atuDISCAT[ONa oC-STO
WELL Cows RAMOS COMPANY NAME 1%n' / Zli-Vhor PHONE a c7m- r a%3
STATE WELL CONSTRUCTION PERM IT# ASSOCIATED WQ PERMIT#
(if applicably) (if applicable)
I. WELL USE (Check Applicable Box): Residential VMunicipalfPubiic 0 Industrial Cl Agricultural 0
Monitoring Cl Recovery ❑ Beat Pump Water Injection 0 Other 0 If Other, List Use
2. WETI LOCATION,”1
Nearest Town: ///Digel/ITad\ County
(street Name, Nomben, Commmhy. SdM)!W� imy Lot No., Zip Codc)
\3. OWNER: C-o /1eAtttiPt- /7DLCS14y
(Seed or Route No) a1
Address - / Mr
/mi aA4 t SsNG 2 s�`
City or State Zip Code
Ares axle. Phone amber
4. DATE DRILLED I- - C)/
5. TOTAL DE •/
6. DOES WELL REPLACE EXISTING WELL? YES JJ NO 13 I/� — 365,
7, STATIC WATER LEVEL Below Top of Cuing:
(Use w^ if above Top of Casing)
8. TOP OP CASING IS � FT. Above Land Surfacer
nap or mine terminated atlor below Imes mince requires a
vadaam lo acmrdao[}plth ISA NCAC 2C .011s. �s / [�
9. YIELD (gpm): 0( METHOD OF TEST$'/'/r� 7 r
10. WATER ZONES (depth): 1 p7!')'
Topogcapkic/Land setting
ORidge Mope OVallcy OFlat
(chukappropriate box)
Latitude/longinde of well location
Ottreeshninutedsecoma)
Latitude/longitude source:OGPSOTopogmphic map
(chcgkWm)
P.FZES MILLNIN.15N
F m 41y Fnation Description
11. DISINFECTION• Type Amount
12. CASING: Wall Thickness
Fro DTotP h5 d Ft. a w �"`t.
m
From To Ft.
FrOt11,,. To Ft.
13. GROUT: Depth Material
From 74XO To 9O m Ft. C2e.af
Front_ ./ To Ft.
14. SCREEN: Depth Diameter Slot Size
From To Ft. in. in
Frorr_,_,To Ft___in. , in
15. SAND/GRAVEL PACK;
Depth Size Material
From To Ft
Prom To Ft
6I- '
slit /e. tf Stan.I *c-
LOCATION SKETCH „^
Show direction and distance in miles from at least rn
two State Roads or County Roads. Include th 1. ad
numbers and Common road names. --
mi-
-S)/ters /id
Az. 4%
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WEI I WAS CONSTRUCTED IN ACCORDANCE WITH I5ANCAC 2C,WRIT
CONSTRUCTION STAND ' a S, AND THAT A COPY OF THIS RECORD HAS BEENPROVIDED TO THE WELL OWNER
WD
PERSON CONSTRUCTING THE WELL DATE
Sabng3 gland to the Div1pInn of rr!!ra a ualigy, Groundwater Section, 1636Men Service Center-Ralelgl,NC
27699-i .i neNjog919iTi3-3H1( wit Si ,aye• GW-I REV.'07/2001
GR\O/UND p GIONAL _OM
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