Ha 2 CY2001

r 228683
-I•North Ceroljna•Department of Environment and Natural Resources-Divisional Water Quality-Groundwater Section
106 Mail Service Center•Raleigh,N.C.27699-1636-Phone[phone]
1, Oros. WP I) 9/ P2A-n,p
�(yELL•CONSTRUCT(ON RECORD WELL CONTRACTOR: �ree»L
., -, '` '" WELL CONTRACTOR CERTIFICATION it: .30 41/
STATE WELL CONSTRUCTION PERMITS: - r-
1• WELL USE check Applicable Box): Residential LYJ Municipal ❑ Industrial CI Agricultural❑ Monitoring 0
Recovery DUI Heat Pump Water Injection ❑ Other ❑ If Other,Ust Use:
lf?;:,WELL:LOCATION:rShow sketch of the location below)
Nearest Town: fnriyr4nn County AL A/,Joo')
t,, .tie A s L r m,r_.
Iti '; y.`•'(Read Name and Numbers.Community.o,r1Subdivitan and Lot No.) DRILLING LOG DEPTH
3, ,OWNER -fa P 4 k IN aail1 i m From To Formation Des.-iption
r 6>3$ �I ?'?' 0 5 a c/�
I eat out. o carp �� � 1 2 �3 6 1rra h r.P
�ayncsvr /le , A/C ase7gL
city«Town • Sure zp Code
3IRol v
` 4., DATE.DRILLED -
a S £TOTAL DEPTH : ' S' pt
1;CUTTINGS COLLECTED :YES❑ NO[�
$,7.'?.DOES WELL REPLACE EXISTING WELL? YES 9 NO� t
6, STATIC WATER LEVEL Below Top of Casing: p FT. "t
s
(Ub•✓a Mon a Top of Cuing) > -J
x6• TOP OF CASING IS I FT.Above Land Surface'
,+;,-.flop of Casing terminated seor below lend surface requires a variance In scow- "cO ''-
' .pewee with ISA NCAC 2C.0%10 - _
' 1ox YIELD(gpm): `f METHOD OF TEST a h r c — o
" .11 WATER ZONES(depth): ,ago' - /trm
` 510' - c}.P,.,,
12. CHLORINATION: Type HI-I-/ Amount Q. If additional spas is needed use back d lore,
, '3. CASING:
•, visa 7nrkr.e s LOCATION SKETCH
Depth Diana or Wa9hart Maoerial (Show direction and distance ir-m at least two State
From__ O To .ri 2 Ft.--&-L— P V r Roads,or other map reterecce points)
From To Ft.
'1 `. ,From; To Ft.
F r 141 Q$9UT:
tq' ck } Depth Material Method
From , 0 To 2 _Ft. r1 rnOA-i- +o p
t' '; f From
To Ft.
t. ,,t16t SCREEN: r
r Depth Diameter Slot Size Material
From To—Ft_ in. _ in.
` , From To__—FL__ in. __ in.
a From To__Ft— in. __ in.
„16 $ANWGRAVELPACK:
,' - Depth Size Material
From To Ft
" To Ft.
From ; e
' 17. REMARKS:
'I pc)HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WRH MA NCAC 2C,WELL
CONSTRUCTION STANDARDS,AND THAT A COPY OF THIS FECORD HAS BEEN PROVIDED TO THE WELL OWNER.
FOR OFFICE U�E�1N�'Y�' \ _ f a
OWd No: t I r,., SIGNATURE CIF PERSON CONSTRUCTIING TTE W E11 DATE
Submit Solna to!Nation of Water Quality,Grourdrater Seam wfithln 3?days
GK•1 REV.mil
sodas No. �-

North Carolina• Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section 2 2 8 6 8 2
1636 Mail Service Center-Raleigh,N.C.27699-1636-Phone[phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR: are Bros. We-,) ! 4 To-nt )
WELL CONTRACTOR CERTIFICATION#: JD I
STATE WELL CONSTRUCTION PERMIT#: 14 0 da-
1. WELL USE(Check Applicable sox): Residential ad/Municipal El Industrial C Agricultural❑ Monitoring ❑
Recovery❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATION: (S w sketc• of the location below) f�1
Nearest Town: �1 / i' County: a t.(/O7ONX
C12L`f. 1¢y Nip), / GC . I DEPTH
(Road Name art Numbers.n Community,or Subdivision and Lot No.) DRILLING LOG
3. OWNER i-'t 1 ('Y i c i eJ I n From To Fo rn D h Description
Address a 2 (�1✓p t }.p_ t O Ai-. Pct , 01 `3 is
\ (btre@1 or Houte(vo.f a y-/ 0j / 31 D a L5 AW4
IA}oa4nP.SV 1 1 (f A/ O . / O(D
City or-own 1 State Zip Code
4. DATE DRILLED 3-i 3.- 3
5. TOTAL DEPTH 3aS' o
6. CUTTINGS COLLECTED YES❑ NO[2]."
7. DOES WELL REPLACE EXISTING WELL? YES O NOd o.__
8. STATIC WATER LEVEL Below Top of Casing: 40 FT.
(Use•i it Above Top of Casing) 1
9. TOP OF CASING IS I FT.Above Land Surface' C�
'Top of casing terminated at/or below land surface requires a variance In accor- - _
dance with 15A NCAC 2C.a118 -'
10. YIELD(gpm): (O METHOD OF TEST k_t-'-5 rn7.)
11. WATER ZONES(depth): ?Or 6' .Lei=Lei f r \
bf) ' rica gym. CO `
12. CHLORINATION: Type I"+T N Amount a 1) ll additional space needed use bark of(urn
13. CASING:
LOCATION SKETCH
Wall Thickness
^ Depth Diameter or WeighVFt. tehal (Show direction and distance from ai least two Sate
From !l To 31 o Ft. LP a 'vG Roads,or other map reference points)
From To Ft.
From To Ft.
14. GROUT:
Depth nMaterial Method
From 0 To a D Ft. I tn1 -+pp
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 CE MTIP„TNAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA MCAC 2C,WELL
CONSTRUCT f I STANDARDS,AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WE S L OWNER. G >O /
FOR OFFICE 4S QNLY /I), 61 t-iti- �
Quad Na: AAd SIGNATURE OF PERSON CONSTRUCTING TiC WELL DATE
Submit original to Division or Water Duality,Groundwater Sect.cn Within 30 days Grr41 REV. 1295
Serial No.

North Carolina-Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section 2 2 8 6 81
1636 Mail Service Center-Raleigh,N.C.27699-1636-Phone[phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR: CT1 rt.e- -- cerice, • LAX)) a 'pga.e-p
WELL CONTRACTOR CERTIFICATION #: .a 4) g
/STATE WELL CONSTRUCTION PERMIT#: --f- t�-
1. WELL USE(Check Applicable Box): Residential LE Municipal ❑ Industrial D Agricultural❑ Monitoring ❑
Recovery❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below) I ,
Nearest Town: Y )c i i e- ,in I I P L u County: 1— r4.Mil L 000tr
fl11 DC (s Pkr
(Road Name and Hunters.Community,or)Subdvision and Lot No.) DRILLING LOG DEPTH
3. OWNER 3 F GU1-L `rr t c.2 From To Formation Description
Address I 0 w N P S -Rd r 0 .a-66
(Si eet or oute o.
'-
�. AVi arwn c% a935La �?ri 785 r7r i
City or Town ' St �ate Zip Code -
4. DATE DRILLED 3-14-D I
5. TOTAL DEPTH 7515 '
6. CUTTINGS COLLECTED YES❑ NOd - P
7. DOES WELL REPLACE EXISTING WELL? YES ❑ NO[✓' S ``'
8. STATIC WATER LEVEL Below Top of Casing: Q FT. _" ET)t..-
(Use'+'if Move Top of Casing)
9. TOP OF CASING IS I FT.Above Land Surface* f
'Top of casing terminated aVor below land surface requires a variance In accor- L' _'
dance with 15A NCAC 2C.0118
10. YIELD(gpm): lb METHODOFTEST 2 hrc
11. WATERZONES(depth): 174P-5 1 - a 0 crPr+t
12. CHLORINATION: Type 14 7- H Amount I A a If additional spaces needed use back of fcr 1 0
13. CASING:
LOCATION SKETCH
Wall Thickness
Depth Diameter or WeighVR. Material (Show direction and dunce from at least two Sate
From d To b Ft. P V IL Roads,or other map reference points)
From To Ft.
From To Ft.
14. GROUT:
Depth Material Method
y1
From D To a0 Ft. l Pvv1P --I-op
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 INCAC 2C,WELL
CONSTRUCTIOWEIT*NQARDS;'ANRTHAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WEB OWNER.
FOR OFFICE OSE ONLY Id,Y. Csreea._ Y- .- „A -3D- 0I
Quad No: SIGNATURE OF PERSON CONSTRUCTING TIE WELL DC
9 I ' Submit original to Division of Water Quality.Gioundvnter Secten Nvithin:Q days
r.I' Ga4 REV.1295
Serial No. "

North Carolina-Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section n 7 C` n•
1636 Mall Service Center-Raleigh,N.C.27699-1636-Phone[phone] f r O,
WELL CONSTRUCTION RECORD WELL CONTRACTOR: C7r-P12-2t12- Srns, L , PD 4 Pig
WELL CONTRACTOR CERTIFICATION 0: .3D hi I
STATE WELL CONSTRUCTION PERMITS: %Alb a -
Er
1. WELL USE(Check Applicable Box): Residential Municipal❑ Industrial❑ Agricultural El Monitoring El
Recovery❑ Heat Pump Water Injection ❑ Other ❑ If Other,List Use:
2. WELL LOCATION:(Sh w sk�gptch of the location below)
Nearest Town: 1u P County: 40 Ai utnnrip
IBrODk Jalo I 1 bu r d
(Road Name and Hunters.Community,or Subdivision and Lot No.) DRILLING LOG DEPTH
3. OWNER 0 h J rn P:��TTh From To Formation Description
Address 1 `- o.-ca.lti Cr k,, a / S 3 �
(SInt
r e or Houi°o.o. �gr b ri ?i L3 S ( YY 1'�1
arTown vi I e e L
City or own I Stale Zip Code . O
G_
4. DATE DRILLED -19 -p I r-. --
5. TOTAL DEPTH A.2 S r -
6. CUTTINGS COLLECTED YESf NOj - -O -
_
7. DOES WELL REPLACE EXISTING WELL? YES 0NOI
8. STATIC WATER LEVEL Below Top of Casing: .4 ,r) FT.
(Use-✓II Above Top of Casing) a ri__`
9. TOP OF CASING IS 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): _a—METHOD OF TEST n, h rs - .a Li
11. WATER ZONES(depth):9 L r - to g P ry
ag pl — a tc)pv-N `
12. CHLORINATION: Type )4 T Ft Amount Lo n If additional space Ls needed use back of form
13. CASING:
LOCATION SKETCH
Wall Thickness
Depth Weight/Ft.Diameter or Wei ade (Show direction and distance from at least two Slate
From D To cc22 Ft- /o " 0 l�/ . Roads,or other map reference points)
From To Ft. -
From To Ft.
14. GROUT:
Depth MaA teday Method
_
From D To Ft. .-6..01'Lt-A--c 4-e-p
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 FL
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� J
OF THIS RECORD HAS BEEN PROVIDED` Dw TO^ THE WELL OWNER.
FOR OFFICE USE ONLY &, 7 �`K' 7 3 J3D - I)
l
Quad No: W - -' ' =NATURE OF PERSON CONSTRUCTING THE WELL DATE
^° Submit odginal lb Division of Water Quality,Groundwater Section within 30 days
GW-1 REV. 12/99
Serial No. `, ;;'.:.: -.
1

North Carolina•Department of Environment and Natural Resources•Division of Water Quality•Groundwater Section 228679
1636 Mail Service Center-Raleigh,N.C.27699-1636-Phone[phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR: Gr tall e %I:51'o5 . W�11 `t p1.1--n 3
WELL CONTRACTOR CERTIFICATION#: 3 D 4/
— STATE WELL CONSTRUCTION PERMIT#: •/)4 0 ...
Er/Municipal
1. WELL USE(Check Applicable Box): Residential Municipal El Industrial❑ Agricultural❑ Monitoring ❑
Recovery❑ Heat Pump Water Injection ❑ Other 0 If Other, List Use:
2. WELL LOCATION: Show sketch of the location below) j `
Nearest Town:: T fa�y1� t E kiasL-1 hut County:: f4Q..I,i Wso pGl-
,?uAI/a. Vilbeit — Vt 1 ✓ JM)P,re. MCA,
(Road Name an9.tlumbers,Community,or Subdivision and Lot No.) DRILLING LOG DEPTH
3. OWNER kr %7'SD rA P_5 From To , Forma5on Description
Address /5C1 1/ `c 6 J1a W vFr CDr. D (pS ak t/
i.du.I�pS (street orFt�o.) 435h/9 /eS' /CDS ' 0,-ra..1t.)+ems
City or Town State Zip Code .
4. DATE DRILLED 3'19 -c 1 o L. ,
5. TOTAL DEPTH I LDS' r
6. CUTTINGS COLLECTED YES❑ NOE -"
7. DOES WELL REPLACE EXISTING WELL? YES pi NO r
8. STATIC WATER LEVEL Below Top of Casing: 440 FT. rn
11 (Use Y'If Above Top of Casing) =
9. TOP OF CASING IS JI FT.Above Land Surface' -
'Top of casing terminated at/or below land surface requires a variance In sccor• cn-.--
dance with 15A NCAC 2C.011a fr;"
10. YIELD(gpm): ram METHOD OF TEST Mrs —
11. WATER ZONES(depth): /KD' At c p nn `D CD
12. CHLORINATION: Type l- YEI Amount _z u If additional space a needed use back of form
13. CASING:
Wall Thickness LOCATION SKETCH
Depth Diameter or WeighUft. Material (Show direction and distance from al least two State
From--:0—TO G S Ft._-4�u - fie- Roads,or other map reference points)
From To Ft.
From To Ft.
-14. GROUT:
Depth Material Method
From _la_ To ____Ft C-p+m P.n-'l' -top
From To FL
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 F1.
From To Ft.
17. REMARKS:
1 DO HEREBY CERTIFY THEMILWELLWAS CONSTRUCTED IN ACCORDANCE WITH 1SA AMCAC 2C,WELL
CONSTRUC DARR!.AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED 70 THE WELL Ow ER•
r n ,
FOR OFFICE*ONLY _/J)' 7- 1I o � J n3D vD/
Quad No: i;F SIGNATURE OF PERSON CONSTRUCTING THE WELL OCE
Submit original to Division of Water Quality.Groundwater sow within 30 days
Serial No. Gw-1 REV.1211

North Carolina•Department of Environment and Natural Resources-Division of Water Duality•Groundwater Section 228678
1636 Mail Service Center•Raleigh,N.C.27699-1636-Phone[phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR: Greene Brv5• I-0P)) d- Pttrrp
WELL CONTRACTOR CERTIFICATION #: An r-I. 1
STATE WELL CONSTRUCTION PERMIT#: r 'r 19-V--
1. WELL USE(Check Applicable Box): Residential E Municipal❑ Industrial❑ Agricultural 0 Monitoring ❑
Recovery❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATION: Show s etch of the location below) /�
Nearest Town: ( aD .- `h's (1-rk, County: )a_iq ,I)Drct. C DI/_bi
()AAvk_r RI,SSPI1 � • (j
(Road Name and Numbers,Consnuni ,or Subdivision and Lot No.) DRILLING LOG DEPTH
3, OWNER rn t k e- 0-LAne_, �' h-n From To � / Format Descipton
Address RUSSET kel . `n ` 4/
P LiA /u� S PX ag7al a� a85 .1-1ra r4, '4-e-,
City or Town ( state Zip Code . •
4. DATE DRILLED 3'Ala —0 l
5. TOTAL DEPTH a85 '
6. CUTTINGS COLLECTED YES❑ NOEV o ;_,
7. DOES WELL REPLACE EXISTING WELL? YES D NOd _ c-
8. STATIC WATER LEVEL Below Top of Casing: Ap FT. --0 .--.
(Use'+'if Above Top of Casing) c H
9. TOP OF CASING IS FT.Above Land Surface' cn �'�
'fop or casing terminated at/or below land surface requires a variance In accor-
dance with 1SA NCAC 2C4)18 ,-:-,
10. YIELD(gpm): hr METHOD OF TEST Ar.S -- �';;
tn.:,
11. WATER ZONES(depth): gel 021 pi,.
_ nz.
4.d
12. CHLORINATION: Type 14 1- +1 k
Amount If additional space is needed use bacot form o
13. CASING:
Wail Thickness LOCATION SKETCH
Depth Diameter or Weight/Ft. Material (Show direction and distance from at least two State
From � To --/ q" Ft.S.A— P ti p- Roads,or other map reference points)
From To Ft.
From To Ft.
14. GROUT:
Depth Material Method
From D To a I) Ft. rP rnr in 4- 4-D P
From To Ft.
„
15. SCREEN:
Depth Diameter Slot Size Material
From To Ft in. in.
From To Ft. In. — in.
From To Ft. In. — In.
16. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
17. REMARKS:
(DO HEREBY CERTIFY-THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A MCAC 2C,WELL
CONSTRUCTIDK$T, ID 1DS,, O THAT A COPY OF THIS RECORD HAS BEEN PROVIDED 70 THE WELL OWNER,
FOR OFFICE L E`ONLY �,T, ` thifiA`'Q'
Quad No; l I /, , i ,SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
1� Submltcdginal to Division of Water Duality,Groundwater Section within 30 days
Serial No. Gvr•I REV.1299
f L. 1

North Carolina-Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section 228 677
1636 Mail Service Center•Raleigh,N.C.27699-1636-Phone[phone] /�
WELL CONSTRUCTION RECORD WELL CONTRACTOR: Gret✓le, .5rDS. Well d f--"P
WELL CONTRACTOR CERTIFICATION #: Sb Lk/
_( STATE WELL CONSTRUCTION PERMIT#: , irr
1. WELL USE(Check Applicable Box): Residential LI Municipal ❑ Industrial❑ Agricultural❑ Monitoring ❑
Recovery❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATIO y: (Show sketch of the location below) ) 1
Nearest Town: -0L..K4t n County: I"f o/ 1,0 r)f1(X
l,-�+He Fat* 1-ork lRot . 1
(Road Name and.Numbers,Community,or Subdivision' and Lot No.) DRILLING LOG DEPTH
3. OWNER L{/` 1 ) ) \RYV 1I W1e 11 l S From To Foma•:Co Description.
Address aD q Sellers S+ , /J al 1 nSr11.Vc 1
�((StreetpprHouteNo.) a$ y Z) /4S (nrrAn, fL
EALk to ink /V ri _-_
City or Town Mate Zip Code . O
4. DATE DRILLED 3'2 a —oI . T
5. TOTAL DEPTH /46 '
.-tT
6. CUTTINGS COLLECTED YES In NO
7. DOES WELL REPLACE EXISTING WELL? YES
/j NOE crt
B. STATIC WATER LEVEL Below Top of Casing: FT. —
TM
(Use':if Above Top of Casing) L.:
9. TOP OF CASING IS I FT.Above Land Surface' -:7 rn
m.- •
'Top of casing terminated at/or below land surface requires a variance In accor- _ c i
dance with 15A NCAC 2C.0118
10. YIELD(gpm): 01 b METHOD OF TEST k rS • W o
11. WATER ZONES(depth): ) D f — 3 D c vr
12. CHLORINATION: Type 14-TM Amount aS If additional spacesneeded use back ofform
13. CASING:
Wall Thickness LOCATION SKETCH
Depth Diameter or Weight/Ft. Material (Show direction and distance from a2 least two Vale
l
From � To a Ft.—/-P S'Fe r-1 Roads,or other map reference points)
From To Ft.
From To Ft.
14. GROUT:
Depth Material 1� Method
From D To A FL etroevl+ -l-oP
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 CERT.JeCHAT-THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A AMCAC 2C,WELL
CONSTRUC11b14 STANOAROS,'AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED 70 THE Vial OWNER.
FOR OFFICE USE ONLY W. T. Gre-e-r - Vie, 3 - 31'D1
Quad No: SIGNATURE OF PERSON CONSTRUCTING TIC WELL OAY£
r
Submit original to Division of Water Quality,Groundwater Seon within30 days
Serial No. ScG11•1 REV.1295
4 ,.

234463
North Carolina•Department al 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: JJ JAa 6 1�>J/ °` 4-24,0,
WELL CONTRACTOR CERTIFICATION #: c7ii ig
�( STATE WELL CONSTRUCTION PERMIT#: /,L15�:
1. WELL USE(Check Applicable Box): Residential L- Municipal ❑ Industrial❑ Agricultural❑ Monitoring ❑
Recovery❑ Heat Pump Water Injection ❑ Other ❑ If Other,Ust Use:
2. WELL LOCATION: Jhow sketch ofAbp.I/q/F wn below) }y�/�
NearestTownn: Q �`�-r��,`//"-` -GI/ Cou^p'' "/,!"�//.t)(�(Roaar46 Nffir,A7/....t:
unity.or`„ubdivys+pnOSad Lot N� D/RILLING LOG DEPTH
3. OWNER nt, l From To F ii Description
Address P Q / 4 /: ,
y_ /7 e a ( t 3 l r bute is,
8 7S/ /a it" •�v 6 }IA cG.[a.J
City or wf' lar'i ' (� Zip Code •
4. DATE DRILLED 3 -PhD/
5. TOTAL DEPTH ?DS 1
6. CUTTINGS COLLECTED YES❑ N
7. DOES WELL REPLACE EXISTING WELL. YES ❑ NOS
8. STATIC WATER LEVEL Below Top of Casing: )b D FT.
(Use'.'u Above Top of Casing)
9. TOP OF CASING IS I FT.Above Land Surface'
'Top of casing terminated at/or below land surface requires a variance In accor-
dance with 16A NCAC 2C.0116
10. YIELD(gpm): .1D METHOD OF TEST ir-_ h r5
11. WATER ZONES (depth): -2RS ' - 3G 43/Pm
12. CHLORINATION: Type 1-4 r it Amount 'S ZD If additional space is needed use back cf form
13. CASING:
LOCATION SKETCH
Wall Tniduxss
Depth Diameter a WaighVR Mari (Show direction and distance fr-m at'east two State
From ' To ' ' 1. FL 6 to- Roads,or other map referelce points)
From To Ft.
From To Ft.
c
14. GROUT: o
Depth n Material '.1 ih d — I
From 0To -VD Ft. L�vnt c
!- cc
From To FL _ r.,
15. SCREEN:
co 0<
Depth Diameter Slot Size Material �`'
From _To Ft in. in. 3 m
From To—Ft_ in. in. r>? m`r7
From _To_Ft.— in. in. ctt
1‘., o
16. SAND/GRAVEL PACK: - '-
Depth Size Material
From To Ft.
From To .Ft.
17. REMARKS:yr
I DO HE'; r • WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2.T,WELL
CONS'
ION STANDARDS,AND -A COPY OF THIS RE'C/ORD HFS l BEEN PROVJO�TO THE WELL OWNER. /D D/
FOR OF°Tef US LY OAT%
Quad No:{ gitGNAiLRE OF PERSON CONSTRUCTINGThE well.
-- --..- ''— S•dong'ublNi Duro'to DNawn dr water Duddy.Grananutir Seam witthln 9+day'S Gam.-t REv.UN
Serial No.'

North Carolina•Department of Environment and Natural Resources-Division of Water(Duality•Groundwater Section 236201
1636 Mail Service Center-Raleigh.N.C.27699-1636-Phone[phone] q.�
WELL CONSTRUCTION RECORD WELL CONTRACTOR: .i \hDPAf- Etc, • oak_ 4 2""P) -
WELL CONTRACTOR CERTIFICATION #: 34.> II/
STATE WELL CONSTRUCTION PERMIT#: 71 079.2-
1. WELL USE(Check Applicable Box): Residential Ll Municipal ❑ Industrial❑ Agricultural❑ Monitoring❑
Recovery❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATION: (ShowAketchJ� of a location below)
NearestTow • C (k/('r n-7" County. aier )e",/)(4
#1,/�-t.^. GY •
(Road Name and CommuruN DRILLING LOG DEPTH
3. OWNER k JAI',``,','"/"1'-�,` From To Fomatitn,Di
eesoriptio r.
Address c 5 5 /3hAe) �ut�L £i,ti. 4 /' r t f L
�/n>^ // (street or outs o.) i i(7 ..)n r /g.5 r .C1
. LP�1, y//!; �i
City or Town / State Zip Code •
4. DATE DRILLED 3 "A8 -t1'
5. TOTAL DEPTH /96'
6. CUTTINGS COLLECTED YES❑ NOd
7. DOES WELL REPLACE EXISTING WELL? YES ❑ NOE1/
8. STATIC WATER LEVEL Below Top of Casing: a FT.
(Use'.'if Above Top of Casing)
9. TOP OF CASING IS 1 FT.Above Land Surface'
Top of casing terminated aVor below land surface requires a variance In accor-
dance with 1SA NCAC 2C.01 a
10. YIELD(gpm): METHOD OF TEST .0 }-1 rS
11. WATER ZONES (depth): / 6 D / - 4/) 4b pno
N 12. CHLORINATION: Type -TN Amount 3 3 If additional spry is needed use backcf forn
13. CASING:
LOCATION SKETCH
wall Trickness
Depth Diameter et WeiptiVR. Material (Show direction and distance frrtn at'east two Stale
From (9 To ,2 d Ft. 6 „ 7'V( Roads,or other mac reference points)
From To Ft.
From To Ft.
14. GROUT:
Depth Material Method
From n To �Ft. C p---0-0M _
From To FL o r-'
15. SCREEN: a
Depth Diameter Slot Size Materialcat i-,
From _TO—Ft — in. in. - on _
From ___To_Ft in. — in. a
From To Ft.— in. — in. rn
Cs
rn
16. SAND/GRAVEL PACK: CD WI mw
Depth Size Material IV va _cl
From To Ft. o
z
From To Ft.
17. REMARKS:
I DO HEREBY CERTIFY THAT TWS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISt NCAC 2Z,WELL
CONSTRUCTION STANDARDS,MD THAT A COP'f OF THIS RECORD HAS BEEN PROVI TO THE NELL OWNER.
yL.) , 'Av- 8-/ - 0 /
FOR OFFICE USE ONLY Quad No: yR1GNATURE OF PERSON CONSTRUCTINGCONSTRUCTINGOATg
Submit mglnar to DNafan of Water Duality'.Gro,4waten Seocn witthln 9?days GK•I REV.1214
Serial No.

WELL CONSTRUCTION RECORD 24 0 307
North Carolina-Department of Environment and Natur
I Resources- Division of Water Quality-Groundwater Section ,/
WELL CONTRACTOR(INDIVIDUAL)NASI/F�'(print) �JYGI D /L[.-/8. ^ CERTIFICATION#3/)Y"
/
WELL CONTRACTOR COMPANY NAME (.1TPo.h-! .5 .. / 4 kn,.. VN! PHONE # (22n//(( -3/74e,
STATE WELL CONSTRUCTION PERMIT# J 4//) #2 ASSOCIATED WO PERMIT#
(if applicable) (if applicable)
1. WELL USE(Check Applicable Box): Residential C9—Municipal:Public ❑ Industrial ❑ Agricultural 0
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other 0 IiOther, List Use
2. WELL LOCATION:A Jl Topographic/Land setting
Nearest Town::1 ) ( .am 2�-int. County A /z_I'/"/ ❑Ridge ®'Slope ❑Valley ❑Flat
2-/ // /E /TCt S/ /-- / tdmek appropriate box)
(Street Name,Numbers,Community,Subdivision,Lot No..Zip Code) Latitudes lon�_itude of well location
3. OWNER: C,(l fvl .!A-2/G_� ge C,9�r. (degrees.minutes.seconds)
Address F' [> (S ry. gob 0 Latitudeilon_itude source:❑GPS❑Topographic map
(Street or Route No.) (check box)
/�Q,�1, eft III, Al C. 0? 9 R I '/ DEPTH DRILLING LOG
City or Town State Zip Code From To Fomiatio9t�,Description
(—)- /% qIn (C!
Area code-Phone number 11 (''(n e)7,-6
4. DATE DRILLED C `c2 7 —[) I /
5. TOTAL DEPTH: .17l6 S/
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO V
7. STATIC WATER LEVEL Below Top of Casing: .gyp FT.
(Use"+"if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
"Top of casing terminated aUor below land surface requires a
variance in accordance with ISA NCAC 2C.0118.
9. YIELD(gpm): ,4D METHOD OF TEST a i-, ,--...5
10. WATER ZONES(depth): /o t r - ,_:7 Cl p tin - —
(.9115 t — /h ID M LOCATION SKETCH
I I. DISINFECTION:Type ✓--I-7-{4 . Amount 7 Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads. Include the road
Depth Diameter or Weight/Ft. Material numbers and common road names.
From C) To qi 1. Ft. to" N C
From To Ft.
From - To Ft.
13. GROUT: Depth Material Method
From D To Cr Ft. Cn-,-. o-.—\ 1 irn 0 c
From To Ft. — o
14. SCREEN: Depth Diameter Slot Size Material OZ a„a�
From To Ft. in. in. C cm
From To Ft, in. in. I o`c
crt
IS. SAND/GRAVEL PACK: no
Depth Size Material mo
From To Ft. r N=
From To Ft. •• rn=
O -y
16. REMARKS: - o
z
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I 5A NCAC 2C,WELL
CONSTRUCTION STANDARDS,AND THAT A COPY OFT CORD HAS BEEN PROVIDED TO THE WELL OWNER
/} >/iii l i 4 .. '1 & /D -36 - O /
IIR @ R o NI R IGNATURE OF PERSON CONSTRUCTING THE WELL DATE
ibmit the on inal to th tion of Water Quality,Groundwater Section, 16Jn Mail Sen ice Center- Raleigh.NC
6996 6 e o4e y1' ,if 19: -221,within 30 days. GW-I REV. 07/200 l
Groundwater Section
Asheville Regional Office

North Carolina-Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section I�
1636 Mail Service Center-Raleigh,N.C.27699-1636-Phone[phone]jy, t .8 O/�
U
WELL CONSTRUCTION RECORD WELL CONTRACTOR:
WELL CONTRACTOR CERTIFICATION #: �yl r
STATE WELL CONSTRUCTION PERMIT#: ' —`c
1. WELL USE(Check Applicable Box): Residential D Municipal 0 Industrial D Agricultural❑ Monitoring Ea
Recovery❑ Heat Pump Water Injection ❑ Other ❑ If Other,List Use:
2. WELL LOCATION: (phow sketch of the 1 cation below) �(, - /
Nearest Town: (,i/ County- /7�
(Road Name and Numbers,Co pity,or Subdivision and t NNoo.) DRILLING LOG DEPTH
3. OWNER Q--Q�� ✓ite/ v A' From To Forma Description
Address / 0 3/ / /7 p 7y
/N�/(SIrM t o NQ1
4 Ne- /'Q 7c
City or Town / State �/ Zip Code
4. DATE DRILLED a—-0L_ ac4
5. TOTAL DEPTH
6. CUTTINGS COLLECTED YES❑ NOD
7. DOES WELL REPLACE EXISTING WELL? YES ❑ NOD
8. STATIC WATER LEVEL Below Top of Casing: FT.
(Use N.if Above Top of Casing)
9. TOP OF CASING IS FT.Above Land Surface'
'Top of casing terminated at/or below land surface requires a variance In accor-
dance with 15A NCAC 2C.0118
10. YIELD(gpm): METHOD OF TEST
11. WATER ZONES(depth):
12. CHLORINATION: Type Amount It additional space is needed use back of loam
13. CASING:
LOCATION SKETCH
Wall Thickness
Depth Diameter or Weight/Ft. Material (Show direction and distance from al least two Slate
From To Ft. Roads,or other map reference points)
From To Ft.
From To Ft.
14. GROUT:
Depth Material Method
From To Ft.
From To Ft. c
15. SCREEN: o
Depth Diameter Slot Size Material - s n;7
From To_Ft in. —in. o 7.:i
From To_Ft. in. In. cIrl T
From To___Ft. In. — in.
16. SAND/GRAVEL PACK: 0 r„
ran--
Depth Size Material it-RE.,
From To Ft. r i
From To FL a' o
17. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A AJCAC 2C,WELL
CONSTRUCTION STANDARDS-ANOTHAT.A-COPY,, /5HIS RECORD H BEEN PROVIDED TO THE WELL OWKER.
FOR OFFICE USE;,ONLY `" �,V A0 " O l � ` .9?.??) 7
Quad No: l r' IC VW:
ELL OF PERSON CONSTRUCTING TIC GATE
pik - 4 ?omit .. sl to Oiv4bn of Water Quality,GmurWyratsr Sacscn Within 30 days
Serial No. ow-i REV. i299
C o.mdwate. 5 cnrn
,.Ash w., ie Re.? . _—•..

226601
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: S' `O ✓t o
WELL CONTRACTOR CERTIFICATION #: 07 y1 7
STATE WELL CONSTRUCTION PERMIT#: -yr-A ,
1. WELL USE(Check Applicable Box): Residential Ia Municipal ❑ Industrial❑ Agricultural❑ Monitoring El
Recovery❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATION:(ShowOt 4 _2./' I Q location below) ,� /Jo 6 /
Nearest Town: (-J- -- Q County: 1 O'�-
(Road Name an/dlNu//lnpers,Comm/u,nity�y,o�rrSubdivision and Lot No.) DRILLING LOG DEPTH
3. OWNER l�Ot�t.✓i jilt X IAJj aa. s / From To FomwSon Description
Address 6 /D/o rPn
(Street or Route No.) /.d 7 - 31/5— 9ra - tc
City or Town State Zip Code
4. DATE DRILLED ci M 'O / '
5. TOTAL DEPTH .31705-
6. CUTTINGS COLLECTED YES❑ NOr_a-
7. DOES WELL REPLACE EXISTING WELL? YES 0 NOD---
8. STATIC WATER LEVEL Below Top of Casing: if p FT.
(Use'+'II Above Top of Casing)
9. TOP OF CASING IS / FT.Above Land Surface'
'Top of casing terminated at/or below land surface requires a variance In accor-
dance with 15A NCAC 2C.0131
10. YIELD(gpm): I_METHOD OF TEST K9 A ✓
11. WATER ZONES(depth): 3 D S rSnn"
3Vr 79P)3^--
12. CHLORINATION: Type r 7 / Amount 63�ig,CiS II additional space is needed use bark of form
13. CASING:
LOCATION SKETCH
Wall Thickness
Depth /! D' ter or Weight/Ft. Ma erial I (Show direction and distance from a1 least two Slate
From b To 3 7rFf.._ IC 'S Roads,or other map reference points)
From To Ft.
From To Ft.
c
14. GROUT: o
Depth Material Method CD 3
From To Ft. �J o"
From To Ft. c c'
15. SCREEN:
Depth Diameter Slot Size Material tit
From To_Ft in. _— in. ^r_r
From To—Ft. In. In.
N m
From To_Ft. in. In. '.c- -'
Cn o
16. SAND/GRAVEL PACK: a
Depth Size Material
From To Ft.
From To Ft.
17. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A OJCAC 2C,WELL
CONSTRUCTION STANDARDS,AND THAT A.COPY THIS RECORD H
BEEN PROVIDED TO THE WELL OWNER.
FOR OFFICE 00(. 'ZLY' 'Quad No: SIGNATURE OF PERSON CONSTRUCTING THE WELL DAME
Submit Original to Division of Water Quality,Groundwater Social within 30 days Grr•I REV.1299
Serial No. _! ;F APP

North Carolina-Department of Environment and Natural Resources-Division of Water Quality•Groundwater Section 22 6 802
1636 Mail Service Center-Raleigh,N.C.27699-1636-Phone[phone] WELL CONSTRUCTION RECORD WELL CONTRACTOR: Al_12 � i
-'' - TO-aJ latithe4wyc.3
WELL CONTRACTOR CERTIFICATION #: 029I Y
STATE WELL CONSTRUCTION PERMIT#: /?At
EJ/
1. WELL USE(Check Applicable Box): ResidentialMunicipal El Industrial❑ Agricultural❑ Monitoring 0
Recovery❑ Heat Pump Water Injection ❑ Other ❑ If Other,List Use:
2. WELL LOCATION: ((Show sketch of the location below)
Nearest Town: /If O/l,•cam, i.a &1 Q County: ��[�l-/1 (I
CYC
17S-i- /A 444 nal�td i . D r'
(Road Name and tubers,Community,or Subdivision and Lot No.) DRILLING LOG DEPTH
3. OWNER Y est Oy riI.r.�__. From To Foormabcn-De'scription
Address lay (,,ft�n h, „ 7`.-,. r . 6' - yn 1 �" /
CAJf (street or ouie ND'. ( r1��r� Ye/ - / i Gr21.....*c.
O-own eA I,. �Z
City or Town State Zip Code
4. DATE DRILLEDa'r3J-'O/
5. TOTAL DEPTH /..15-
6. CUTTINGS COLLECTED YES❑ NO[
7. DOES WELL REPLACE EXISTING WELL? YES ❑ NO[-
8. STATIC WATER LEVEL Below Top of Casing: y p FT.
(Use'r'it Move Top of Casing)
9. TOP OF CASING IS 1 FT.Above Land Surface'
?op of casing terminated aVor below land surface requires a variance In accor •
-
dance with 15A NCAC 2C.0118
10. YIELD(gpm): 10 METHOD OF TEST erg A
11. WATER ZONES(depth): /nS
12. CHLORINATION: Type 741 rv! Amount ci2a P� if addnionai space is needed use backof form
13. CASING:
Wall Thickness LOCATION SKETCH
Depth Diameter or Weight/FL. Material (Show direction and distance from at least two State
From (] To Y r/ Ft. t. Sire/ Roads,or other map reference points)
From To Ft.
From To Ft.
14. GROUT:
Depth Material Method
From To Ft. ro
From To Ft. — o
rn_
15. SCREEN: OTC
Depth Diameter Slot Size Material - -cm.
:
From To_ Ft In. _in. cn
From _To_Ft. In. _ In.
D
From To Ft. In. _ In. —rT,
16. SAND/GRAVEL PACK: ty N-
Depth Size Material C
4l o
From To Ft. r
From To Ft.
17. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A AXCAC 2C,WELL
CONSTRUCTION a a`: . Ds THAT A COP F THIS REC D HAS BEEN PROVIDED TO THE WELL OWNER.
_1 j ; i' !I a P'�,�
FOR OFFICE USE`ONLY-- ' „ I' " .4 'i�'r o
Quad No: SIGNATURE OF PERSON CONSTRUCTING THE WELL OCt
Submit original to Division of Water Quality.Groundwater Seacn%within 30 days
Serial No. GW.1 REV.1291

North Carolina-Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section 2 2 6 8 0 3
1636 Mail Service Center•Raleigh,N.C.27699-1636-Phone[phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR: A-a&aut. 4 " Vi-d' A-Ap
WELL CONTRACTOR CERTIFICATION #: ,soy/
STATE WELL CONSTRUCTION PERMIT#: /'/L
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:/(S_how sketch of the location below) /
Nearest Town: waJ � County: a7• A l0
(Road Name an umbers.umbers.Co nity,or Subdivision and Lot No.) DRILLING LOG DEPTH
3. OWNER I i r0.0 ✓I C (24 From To Q DescriptionSon
Address / u",n--�/^w�,--�' a[. // 6 - a/
•
City or Town State //�� Zip Code
4. DATE DRILLED 01,/1- 0/ ,
5. TOTAL DEPTH 4/A C
6. CUTTINGS COLLECTED YES❑ NOQ---
7. DOES WELL REPLACE EXISTING WELL? YES Dii NOQ".
8. STATIC WATER LEVEL Below Top of Casing: a / FT.
(Use':11 Above Top of Casing)
9. TOP OF CASING IS / FT.Above Land Surface'
'Top of casing terminated at/or below land surface requires a variance In accor-
dance with 15A NCAC 2C 0118
10. YIELD(gpm): 1(67 METHOD OF TEST cQ IA r
11. WATER ZONES(depth): -..q SS
12. CHLORINATION: Type rX Amount s`tWket-5 If additional space is needed use back of form
13. CASING:
LOCATION SKETCH
Wall Thickness
Depth Diameter or Weight/Ft. M tonal (Show direction end distance if=at least two State
From 0 To 04/ Ft.--La_ ✓L Roads,or other map reference points)
From To Ft.
From To Ft.
14. GROUT: CD
Depth Material Method o CD ,
From To Ft. 3 `'
From To Ft. `.:1-7
c—c?
15. SCREEN: -
ciT
Depth Diameter Slot Size Material
From To_Ft in. in. -o r„,
From To_Ft. In. In. tv °-
From To_Ft. In. — In. -C- y
16. SAND/GRAVEL PACK: Q' O
Depth Size Material z
From To Ft.
From To Ft.
17. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CON TRUCTED IN ACC RDANCE WITH ISA fNCAC 2C,WELL
CONSTRUCTION STANDARDS.AND TH -ACOP OF THIS RECORD BEEN PROVIDED TO THE WELL
� - t /
OwAER• /
FOR OFFICE USI�'SILY� /ZI / ' ( •A i 1 ir--� r%
Quad No: SIGNATURE OF PERSON CONSTRUCTING TIC WELL DA'£
r lc — Submitonginal to Division of Water Duality.Groundwater section within 3.0 days
Gw•1 REV. 1291
Serial No.

North Carolina-Department of Environment and Natural Resources-Division of Water Duality- roundwater Section
226804
1636 Mail Service Center-Raleigh,N.C.27699.1636-Phone[phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR: A dare "' eir �i � J -
WELL CONTRACTOR CERTIFICATION #: 3 640
STATE WELL CONSTRUCTION PERMIT#: it ,;; _.
1. WELL USE(Check Applicable Box): Residential I EJ Municipal El Industrial❑ Agricultural❑ Monitoring ❑
Recovery❑ Heat Pump Water Injection El Other ❑ If Other, List Use:
2. WELL LOCATION: ( how sketch of the location below) �/
Nearest Town: µM' Ai,- Lk County: ` ( 4 (• )Q G
(Road Name and Numbers,Community.or Subdivision,apd Lot No.) DRILLING LOG DEPTH
f/1
3. OWNER (- '� &d42 PQ ,./ From o From To Forma Description
Address q �„ C�t/p .0 d 6 _7 O c 0�
�� (Sneetor u o So — y�1 rO _ lei
City or Town Stater Zip Code
4. DATE DRILLED4A)/O/
5. TOTAL DEPTH 4,f4'7
6. CUTTINGS COLLECTED YES❑ NO2 -
7. DOES WELL REPLACE EXISTING WELL? YES D NOS---
8. STATIC WATER LEVEL Below Top of Casing: siA FT.
(Use'.'II Above Top of Casing)
9. TOP OF CASING IS / FT.Above Land Surface'
'Top of casing terminated atlor below land surface requires a variance In accor-
dance with 15A NCAC 2C.0118 / r
10. YIELD(gpm): � METHOD OF TEST A
11. WATER ZONES(depth): mall / 9 '�-
12. CHLORINATION: Type TiY Amounts If additional space is needed use back of loan
13. CASING:
LOCATION SKETCH
Wall Thickness
Depth a D)'ameter or WeighVFt. Material (Show direction and distance from at least two State
From To Ft.
U b U EO 7r -15-Arti Roads,or other map reference points)
From To Ft.
From To Ft. o c
14. GROUT: ti
Depth Material Method n
- r
From To Ft.
t
From To Ft. r `=-=;--1
15. SCREEN: o D .n=
Depth Diameter Slot Size Material -0 .
From To Ft In. ._in ry iC2-, 3
c)
From To_Ft. in. — In. .r -,
From To_Ft. In. _ in. as o
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 INCAC 2C,WELL
CONSTRUCTICKSTANDAEWILtataTtIAT A COP THIS RECORD /$BEEN PROVIDED TO THE WEttl ONTER.
���� �,�� ! RR 44. /( //.nr , ,- 2-fl/
FOR OFFICi'11�E0N� P �li�lr r , E'
tc
•Quad No: SIGNATURE OF PERSON CONSTRUCTING DE WIELL OAYE
•
a •k:i, �. `1 . iSs�it original to Division of Water Quality,Grwrsdvrater Saacrs Within 30 nays GYM REV. 1299
Serial No.

North Carolina•Department of Environment and Natural Resources•Division of Water Quality•Groundwater Section( w.
1636 Mail Service Center-Raleigh,N.C.27699-1636-Phone[phone] 2 2 6 8 O 5
WELL CONSTRUCTION RECORD WELL CONTRACTOR: A rPcnc; I. rn`1 helm
WELL CONTRACTOR CERTIFICATION #: 31�1
STATE WELL CONSTRUCTION PERMIT#: Y(dd
1. WELL USE(Check Applicable Box): Residential Municipal ❑ Industrial❑ Agricultural❑ Monitoring ❑
Recovery❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATI : (Show sketch of the location below) �/ I �/ f
Ne rest Town: n�)��� County. I t111g1fo A I
0 Ke4 , e-rne , P1i J
(Road Namg and Numbers, "Unity/;or Subdivision and Lot No.) DRILLING LOG DEPTH
3. OWNER Joni-) l 'nnrj From To F nmDez—ipton.
Address j d, -Er Iv D dil l
Onnl-(rn meaty olp o �R 1 l /n (On — �J�J1 ( 71n ('1 � ,
City or Town Stain Zip Code •
4. DATE DRILLED r t—LD
5. TOTAL DEPTH 57
6. CUTTINGS COLLECTED YES❑ NOD'
7. DOES WELL REPLACE EXISTING WELL? YES NO[.
8. STATIC WATER LEVEL Below Top of Casing: (T( FT.
(Use'+•il 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 1SA NCAC 2C,101 1a
10. YIELD(gpm): () METHOD OF TEST 6 hnt Lr
11. WATER ZONES(depth): I 15I 1 A m _VF
Adi I r' gpt,)
12. CHLORINATION: Type N T l* Amount I W It additicnal space is needed use back cf fora
13. CASING:
Will MadmenLOCATION SKETCH
Depth 9 am r cr weight/a al (Show erection and distance frm at least two State
From To au Ft.1.L�L1_ 1 "1', Roads,or other mac refererce points)
From To Ft.
From To Ft.
14. GROUT: o
Depth Material Method E o'
From To Ft. — c-r�
y ter,
From To Ft. c_
15. SCREEN: cri Li
Depth Diameter Slot Size Material =
-o
From ,To_ Ft _ in. _ in. zc o
From _To_Fr._ in. in. rV ^-'
m;v
From 'To_Ft._ in. _ in. .r 0
16. SAND/GRAVEL PACK: rn o
Depth Size Material
From To FL
From To Ft.
17. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISl NCAC 2Z,WELL
CONSTRUCTION STANOAROS,AND THAT A COPS/OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
FOR OFFICE USE ONLY 1 1 1.((4-1 l('N, t 1114\\( \ ) a- 8-ei
Quad No: , .y9IGNATURE9 PERSON CONSTRUCTING TIC WELL OAT1
Submit rnginat to Dnalon d Water Quality.Grostwa®r Seam wftthln 3?days
Selo No. Gs/4 REv.1271

nh Carolina•Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section
1636 Mad Service Center-Raleigh,N.C.27699.1636-Phone[phone] (1 ti 6807
WELL CONSTRUCTION RECORD WELL CONTRACTOR: ( ust0, 4(�)h �1 in
WELL CONTRACTOR CERTIFICATION #: I- I
STATE WELL CONSTRUCTION PERMIT#: 4 JA,
1. WELL USE(Check Applicable Box): Residential I_ /Municipal❑ Industrial❑ Agricultural❑ Monitoring ❑
Recovery❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATION: Show sketch o�f,1h location below)
Nearest Town: I l ) � n0 s )U County: Wny'I o t
hQ (LDL PI(m ,
(Road Nagle dtturbots,Comrnlaty,orSubdiiviS•'w�gf and LotNo.) A DRILLING LOG DEPTH
3. OWNER ( V V I Ct ( �O. PA 0 n en ( t' P From To Fq bm Description
Address a05 J nn cj Rf Q 0, 0 - ltO U(t
11/114ntn1 ee er ., R`I D loci- 5H� nn �-4t)
City Town State Zip od '
4. DATE DRILLED
5. TOTAL DEPTH c
6. CUTTINGS COLLECTED YES❑ NO(" '
7. DOES WELL REPLACE EXISTING WELL? YES ( NO2
8. STATIC WATER LEVEL Below Top of Casing: I � FT.
(Use Y•0 Above Top of Casing)
9. TOP OF CASING IS I FT.Above Land Surface•
lop of casing terminated at/or below land surface requires a variance in accor-
dance with ISA NCAC 2C.0118
10. YIELD(gpm): • S METHOD OF TTEST
11. WATERZONES(depth): fSfS 11 a t o
12. CHLORINATION: Type NTH{ Amount—9.1_ If addrdonal sp
ate is needed use back of loan
13. CASING:
Wall ThicknessLOCATION SKETCH
n Depth I ,,� Diameter or WeighwL Material (Show direction and distance from a1 least two State
From.�L.t—To V Ft. �a _ pVQ, Roads,or other map reference points)
From To FL
From To Ft.
14. GROUT: o
Dept nn�M,�a,t,erial Method — F
l�'111 • C—
From Ton FL Q M� 7
From To Ft. t �-=,
15. SCREEN: t _
U7 r_,
Depth Diameter Slot Size Material - -a
From To Ft In. _in. nc
From To Ft. In. In. 7 ;'
From ,To FL In. In. r
15. SAND/GRAVEL PACK: o+ z
Depth Size Material
From To Ft.
From To FL
17. REMARKS: •
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A MCAC 2C,WELL
CONSTRUOTION$TA O'AF(0 ,AbD!HAT A COPY OE THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
FOR OFFICE USE ONLY - , A l ;. *l I 4 ' Lll ) Ot—P—01
Quad No: . s' SIGNATURE -PPERSON CONSTRUCTING THE%YELL DATE
SubndVcdginal to Division outer Quality,Groundwater Seetcn within 30 days
Sala!No. - arm REV.1291

#.rt C? '.
1'•Notch Carolina•Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section 228688
1636 Mail Service Center•Raleigh,N.C.27699-1636-Phone[phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR: a-fi.e nt 3rv4 . Wall 4 Pump
WELL CONTRACTOR CERTIFICATION is .i 4I g
STATE WELL CONSTRUCTION PERMIT#: / 4A 2
1. WELL USE(Check Applicable Soo): Residential"Municipal 0 Industrial❑ Agricultural❑ Monitoring 0
Recovery❑ Heat Pump Water Injection ❑ Other ❑ If Other, Ust Use:
,2. WELL LOCATION:(Show sketch of the location below)
Nearest Town: C 6 Al county r` o..-f pc�D eel
4. Crt./.<h
(Road Name andv NNum9ers. or Subdivision and Lot No.) DRILLING LOG DEPTH
3. OWNER ( r i t +CA is rre SS From To Formation Cost-lotion
Addrrees_s 5g 1otr laim RuuAirma FP rg11c 04 'Lt ' Gra.va
City or Town A State Zp Code
4. DATE DRILLED a-27 -PI
5. ; TOTAL DEPTH /45 '
5. + CUTTINGS COLLECTED YES❑ NOc 2
' ` 7. : DOES WELL REPLACE EXISTING WELL? YES ❑ NO97
8. STATIC WATER LEVEL Below Top of Casing: Gig FT. -a '
(Use'✓if Above Top of Casing) _
9. TOP OF CASING IS FT.Above Land Surface* cn __.
lop of casing terminated at/or below land surface requires a variance In scoot- -_
dance Nth15A NCAC 2C.Oita
10. YIELD(gpm): lab METHOD OF TEST .2 1-1 es • — „.
11. WATER ZONES(depth): /,/51 - Lop t p m _ rn"'
-y
ro -
12. CHLORINATION: Type H 7 N Amount -1 Pi If additional spate is needed use backcf fors s
13. CASING:
wait ckness LOCATION SKETCH
Depth Diameaer or We ght/R Ma dal (Show deectton and distance from at least two State
From V To 76 Ft. G rr &Led Roads,or other map relate-4e points)
From To Ft.
From To Ft.
14, GROUT:
Depth a Material Method
From _D To aD Ft. 1-.:8wlGn4- 4-op
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.
18. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
17. REMARKS: e
I DO HEREBY CERTIFY THAT TIC WELL WAS CONSTRUCTED IN ACCORDANCE WITH 154 NCAC 23,WELL
CONSTRUCTION STANDARDS,AND THAT ACOP'!OF THIS meow HAS BEEN PROVIDED TO THE WELL Owr•ER.
FOR OFFICE U$E ONLY W. -/ -JAz_cs"`' `tt-L 4 - A - b /
Clued No: j,..i,. SIGNATURE OF PERSON CONSTRUCTING TI-E WELl. DATA
Submt engin*to Cession at Water Quaity,OrouMvater Sedan within 3?days
Serial No. Gu•t REV.an

228689
i i':
d :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: Or nen, Rro5 . We.i) d Ps..rn P
WELL CONTRACTOR CERTIFICATION #: 3/i $/
STATE WELL CONSTRUCTION PERMIT#: 49- —
1. WELL USE(Check Applicable sox): Residential 13 Municipal ❑ Industrial❑ Agricultural 0 Monitoring
El
Recovery❑ Heat Pump Water Injection ❑ Other ❑ If Other,Ust Use:
.2. :WELL LOCATION:(Show sketch of the location below)
Nearest Town: W A.rine s v)•/1 L County. 1-141 sa o t et.
i '3r q T r a x i
-t. Rd
(Road Nami and Numbers.Community.or Subdivision ar4 Lot No.) DRILLING LOG DEPTH
3. OWNER .LA 1•t ND //t mart From To Formation Des."-iption
9 6r
Address 1D 7uniwAoui�ePoSr Cnu.rt 95 �f,5' Griar+�i e
C44..1%1( A/C a175// - 596/
City or Tom1 ) State Zp Code
4, DATE DRILLED A "1L "01 _
5. >TOTAL DEPTH 4 a 5 ' r,
6. CUTTINGS COLLECTED YES❑ NO[ '
7.-_DOES WELL REPLACE EXISTING WELL? YES ❑ NO3 _
ES. STATIC WATER LEVEL Below Top of Casing: a D FT. -a
(Use•..u Above Top of Casing) -_ _.
f). TOP OF CASING IS FT.Above Land Surface' cn
vrop of casing terminated aVor below land surface requires a variance In actor- _ _
_
dance with 15A NCAC 2C.011a t -'
10. YIELD(gpm): ,S METHOD OF TES a /I it-55 . .
11. WATER ZONES(depth). a ep B ' " 1 P rn _ '1 -)
�i00 ' - l 'IP'''
m
fJ
12. CHLORINATION: Type r, -r/-I Amount If additional spice is needed use bad`d forte'
13. CASING:
LOCATION SKETCH
Wall Trabdine
Depth anew or W ttioNVRxi Malarial (Show direction and distance km at least two State
From 1 To ' ' Ft. " .3te e/ Roads,or other map rererhxe points)
From To Ft.
From To Ft.
14, GROUT:
Depth Material Method
From D To Ft. n mut-+ 4°P
From To Ft.
15. SCREEN: r
Depth Diameter Slot Size Materal -
From _To_Ft, in. _ in.
From _To—Ft._ in. — in.
From _To_Ft_ in. — in.
18. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
17, REMARKS: a
I DO HEREBY CERTIFY THAT TIC WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2.WELL
CONSTRUCTION STANDARDS,AND THAT A COPY OF THIS yRECORD HAS BEEN PROVIDED TO THE WELL OMER.
FOR OFFICE USE ONLY
w J. rU.4.ela-2_ 4/-a a /
quad No:
SIGNATURE OF PERSON GONSIIWCTJtttIG Tt&WELL OATS
$uwM rnglriS to Noon of Witter0uatln/,Orandwatwr Ssarn wtOhln 3?days 6K•1 REV.12!“Serial No.

228690
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] /�11
WELL CONSTRUCTION RECORD WELL CONTRACTOR: are-e.np.Wrn5 W r_11 4 Pump
WELL CONTRACTOR CERTIFICATION I: 30 4-
STATE WELL CONSTRUCTION PERMIT#: 7"1/2 ---
1. WELL USE(Check Applicable Box): Residential EEKMunicipal❑ Industrial 0 Agricultural❑ Monitoring El
Aecovery❑ Heat Pump Water Injection ❑ Other 0 If Other, List Use:
2. WELL LOCATION:( how sketch of the ocation below)
Nearest Town: I.1Ja � YIF.5 lit 1/e County: kin at I J)OOA '
£mokrI Ir14-t'1 . £Q-1.44..Laf - DEPTH
(Road Name and umbers.Community,or Subdivision and Lot ) DRILLING LOG
3. OWNER .. I r tnA, LAY) t'1 i /1. nn
From To Foaton Description
Address 1- n B oi�{l,C(y � r (J JO I D. I &r4 U Li
(Street or Route No.) QC d /�b / b a 4.26 r G•r-n Ylt e'J
Ha z-e, wD0 iv
City or Town ' State Zip Code
4. DATE DRILLED -9. '-D 1 c_'
5. TOTAL DEPTH y a.s I cm u
6. CUTTINGS COLLECTED YES❑ NOZ
7. DOES WELL REPLACE EXISTING WELL? YES 0 N0IX 8. STATIC WATER LEVEL Below Top of Casing: tha FT. o_ __'_
(Use•+'II Above Top of Casing) I _
_
9. TOP OF CASING IS FT.Above Land Surface* lit
'Top of casing terminated at/or below land surface requires a variance In scow-
dance with lSANCAC2C. 11e _
t,or_
101 METHOD OF TEST 11 l.S
10. YIELD(gpm): ••
11. WATER ZONES(depth): 3 ta I - /' C f) in
y oh' - (r of ID rr-1 0'
12. CHLORINATION: Type Pi / H Amount 'I e II additional space"s needed use back of loam
13. CASING:
LOCATION SKETCH
Wall ess
Depths, , rn� Diameter or Weight/Ft. Material 11 (Show direction and distance from as least two State
From D To 1!�-Ft. 6 " >S,r tf'` Roads,or other map reference points)
From To Ft.
From To Ft.
14. GROUT:
Depth n Material 1 Method
From tO To . -2O Ft Cern pia- -{'O p
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 IWCAC 2C,WELL
CONSTRUCTION STANDARDS,AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OwkER.FOR OFFICE USE ONLY n /
Quad
Li), T, � . y t, 3 - 3e
Q No: SIGNATURE OF PERSON CONSTRUCTING THE WELL ()An
Submit original to Division of Water Quality.Groundwater Social within 30 days GYM
REV.1299
Serial No.

North Carolina•Department of Environment and Natural Resources-Division of Water Duality-Groundwater Section
230624
1636 Mail Service Center•Raleigh,N.C.27699-1636-Phone[phone] ) n
WELL CONSTRUCTION RECORD WELL CONTRACTOR: Greene L- 3. Ge%,1/ -4 1"4f, r-c
WELL CONTRACTOR CERTIFICATION #: .3 D 4
STATE WELL CONSTRUCTION PERMITS: / '/2 Si.'''
1. WELL USE(Check Applicable Box):Residential[B/ Municipal ❑ Industrial D Agricultural❑ Monitoring ❑
Recovery❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: I r Th.ti n rA v r lb County. 4al VD 6 nil-
cSl verS Love✓
(Road Name and Numbers.Conrnunity.or Subdivisbn and Lot No.) DRILLING LOG DEPTH
3. OWNER 1'l14-n . I) i ea.t) al 1derc From To Formation Description
Address 3 _ c1 1 ��)1 �oOr> 4 . 6 SD/' co,,,,,
(Street or IOW*No.) dA or d { 8G Qo ' aD.J ' C7 rA.!^�.
w npcv, 1 )e
City or Town ( Slate Zp Code
4. DATE DRILLED j-9 -p /
5: TOTAL DEPTH r f 4 r
' 6. CUTTINGS COLLECTED YES❑ NOd
7. ' DOES WELL REPLACE EXISTING WELL? YES O NO[3.-
8. STATIC WATER LEVEL Below Top of Casing: p FT.
(Use':If Above Too of Casing)
9. TOP OF CASING IS I FT.Above Land Surface'
'Top of casing terminated st/or below land surface requires a variance In accor-
dance with 1SA NCAC 2C.0111
10. YIELD(gpm): 46 METHOD OF TEST ,g, k r•s ,
11. WATER ZONES (depth): f ID E - 4"Q 43 pm
12. CHLORINATION: Type /4T H Amount .3 io If additional sere is needed use back cfaprat
13. CASING:
Wall Tradu ess LOCATION SKETCH
Depth Dearest or W.yhuR. 1.4aeda1 (Show erection and distance fro at least two State
From 0 To _ Ft. PVC Roads,or other map relerrrce points)
From To Ft.
From To Ft.
14. GROUT:
Depth Material Method
From 0 To a C' Ft. rt,ernv rtk 'ft y1 0 0
From To Ft. o
15. SCREEN: a �a
Depth Diameter Slot Size Material it on
From __To_Ft _ in. _ in. r
From _To—Ft._ in. in. _,,c
From _To__.FL_ in. _ in. zo
16. SAND/GRAVEL PACK: h
Depth Size Material IV
From To Ft. _
From To Ft.
17. REMARKS: e •
I DO HEREBY CERTIFY-THAZZHIS..WE)LL WAS CONSTRUCTED IN ACCORDANCE WITH 1Sl NCAC 27...WELL
CONSTRUCTION,` • 0it.a 4'aANb THAT A COPY)
OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
FOR OFFICE U�'- r �l/ ✓. ,�7itati-t- (129 .S-a -01
Quad No: " 71ir i $IGNATRE CW PERSON CONSTRUCTING ThE WELL DAT'S
I 'Suble pglnar to Dsdon of Was Duality.Gro. dwater Seaan wiithln 33 dayGe.s I REv.ma
Sala No. _
oundwater Section
Ashevik 'te^ionaLJffice

F } x "i• VS.i{ Y'.. t44{iv4 ,`r .
g1iCe.hlepartmII t of Environment'and Natural Resources•Dlvlsion of Water Quality•Groundwater Section C• 0 1 Q 5
.i it„ ryl Garltpf•Raloph,SI.C.27689 1636•Phone[phone]
''a1 Lt� cd TR!�CTIONRECORD WELL CONTRACTOR: Pi eene, (,err)•
.: WELL CONTRACTOR CERTIFICATION S: 30v
STATE WELL CONSTRUCTION PERMITS:
r• yit�L{r USE(cnckAppllabis ao:):ResidentlalO' Municipal ❑ Industrial❑ Agricultural❑ Monitoring❑
• :H ° ,coyary[l Heat Pump Water injection ❑ Other [] If Other,List Use:
a _+
.:4
' ytLQGATIP ' Show sketch of the location below) 1,-,�f J111nO(19
1t 0 e County: J
} �t tr• . v 1 1 ,Id �lit Subdivision and Lot No.) DRILLING LOG q/1mDyEPTH
_+r I) SQ-n'af.'J 'eft t From To Feu i C Desuipuon
WUFp i-7'p /� T� p _ Q'/
"'hiss , .'�39'”EI ., 4 -� • - „ #q o - 30� gran ilt
.� 1I a. Coda
atLAI , Uy Torn aA) - zip
',tit''').
FAAT�•( RILLED
TA;DEPTH
{7 v-rriNe$COLLECTED = YES Q NOD'
:DOES WELL REPLACE EXISTING WELL? YES C] NOD✓
1 ,. o WATER LEVEL below ToP of Casing: n FT.
w Fa ` °,rye» ,,t:° r' (um','II Above Top of Casing)
•r.-' Q,(a QF GASINe IS >FT.Above Land Surlace':
r •
of cuing{wapnstsd sUor below land surface re9Plrea a variance In ice
or-
r I 1 wUh 1JA NQAQ 2G 110
',WPM) r•, _.METHOaD
F TEST h Y5 .
.. 1 TFp Z N`�ES(depth):
•
F+ F -it q',{ ATL x 1-4+1 ' Amount 55 If additional space a needed use bactcat loan
t ,Gsi4oRINATION, i Type
3GASlNG I LOCATION SKETCH
' - t„r ';.. ' i 'Da th D for or Waphhtin MMat Iiiai (Show direction and d"w.tanca from as least two Slate
? t „Ta r N 7 FE It ' -•Y-+� Roads,or other map ralerence points) p
o a
a�� Ft. - •,i .7-
29 wnrSs'Pr4F1Pi'n j '• a 1 Li C`
, � 6 i l ,
vwv7l p�
Method
" , ▪ PaPth� ('PniPnf' T"
u ;y ' ,fr ,,,To,.. Ft. = rt,
IAN3 n
N�
1 p FL �_ --
; • Diameter Slot Size Material r o
3N ` 'ri i .-w DsPIh � In.:
. z
T4 FI...,�,..-.• n, r, --in.
e', � w ' PTO FL•.r--* — In.� r.,._ In.
•; t gjyAELPACK:' Size Material
NS'-'I 777 To Ft,.,,....,...— —
•
"ti'aq*.1.,'J WHEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A INCAC 2C,WELL
x ,k,, C TRVCnQI ;PUP O •
•qNp TA COPY OF THIS RECORD HAS BEEN PROVIDED 30 THE WE L OWnER. `O
.FQRQf(C.g USEQNUY oArE
„ t -.� SI NATO F PERSON CONSTRUCTING Tit WELL
„,t e t�(" a submit original to OtvlsWn a water Duality.Cyoundwrater Seocn Within
30 says Gw•I Rev.lei

North Carolina•Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section 22 6 813
1636 Mail Service Center-Raleigh,N.C.27699-1636-Phone[phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR: >l /e - fet/Chtt-D
WELL CONTRACTOR CERTIFICATION #: crii2
Er--
WELL CONSTRUCTION PERMIT#: .>?",r-
1. WELL USE(Check Applicable Box): Residential LJ Municipal ❑ Industrial❑ Agricultural❑ Monitoring ❑
Recovery❑ Heat Pump Water Injection ❑ Other ❑ If Other, Ust Use:
2. WELL LOCATION h w sketch of location below) Ike / n�v
Nearest Town: I A)f_tri l 1 !/( L U County "tt)"tonal,
(Road Name Numbers.Corryrnyhity,°A SSubgi4sn and Lot No.) DRILLING LOG DEPTH
3. OWNEf 27 (A�( , y (��""V (�f /t ) From To F�Qi 'na 0es—p on
Address(VV�777 , a, ,(n)c 1 L/.�� /i� /y 'e l yO Jay)
(A )0linLA ((hQtLQoutaN . 0) c5 / (-1'1 /00 ' lFS ClG'2-hl-fc,
City on own Stab zip Code
4. DATE DRILLED
5. TOTAL DEPTH 5
6. CUTTINGS COLLECTED YES❑ NO[-
7. DOES WELL REPLACE EXISTING WELL? YES ❑ NOD
8. STATIC WATER LEVEL Below Top of Casing: /OO FT.
(Use•+•I 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 SSA NCAC 2C.0118
10. YIELD(gpm): it) METHOD OF TEST 2 hr'
11. WATER ZONES(depth): l UO - /n 9pfri
12. CHLORINATION: Type l 4 Ill Amount II additional spry is needed use back cf form
13. CASING:
wa Tn tlmess LOCATION SKETCH
Depth r cr WeighVR. 2.4.arial (Show diection and distance trm at least two State
From - To /6)11 Ft. 02 rr P 1 C• Roads,or olhe:map referecce points)
From To Ft.
From To Ft.
14. GROUT: c
Depth Material Method o
0
From To Ft. c,70
From To Ft. a '5-11
15. SCREEN: cr'
t j.
Depth Diameter Slot Size Material - u't
From _To Ft _ in. _ in. -o �G
From _To Ft. in. — in. a r„
cn--
From 'To_Ft. in. _ in. ry r*j:n
c
16. SAND/GRAVEL PACK: —1
CIS 0
Depth Size Material
From To Ft.
From To Ft.
17. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 153. NCAC 27.,WELL
CONSTRUCTION STANDAR9S.AtiD IId6TAGOP tf OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
FOR OFFICE US d y
Ouad No: ' Si1GNATUR PERSON CONSTRUCTING Ire WELL DATE
i'. r ry = . Sulxnp mgjrw to Dwblo water Duality.Gm.rowatsn Seam witthln 37 days
Sedai No. - - Gs-I Rau.12ri

North Carolina-Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section
254615
1636 Mail Service Center-Raleigh,N.C.27699.1636-Phone[phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR:0 1 P I
µ^""" (1)Q-1 orb(IIILnb �1`IC,
WELL CONTRACTOR CERTIFICATION N:
STATE WELL CONSTRUCTION PERMITM: 14-I )
1. WELL USE(Check Applicable Box): Residential Municipal ElIndustrial ElAgricultural 0 Monitoring El
Recovery❑ Heat Pump Water Injection ] Other 0 If Other, List Use:
2. WELL LOCATION (Show sketch of the location below) r �oo�
Nearest Town: Ij0-ki t(. Utna ) County:
(Road Name and Numbers,Community,or SubdivisionDRILLING LOG DEPTH
and Lot No.) For ation Description
3. OWNER 1. - • From To
% o - ( CD dfi
Address an_n1 Ub .-. y4S tali:an )
a St
.1 i , a i• 1 1 lio
_ ..
City or own State Zip Code Co
4. DATE DRILLED� -
5. TOTAL DEPTH C
6. CUTTINGS COLLECTED YES❑ NO
7. DOES WELL REPLACE EXISTING WELL? YE ❑ NO
8. STATIC WATER LEVEL Below Top of Casing: AC) FT.
(Use'+'II Above Top of Casing)
9. TOP OF CASING IS FT.Above Land Surface'
'Top of casing terminated et/or below lend surface requires a variance In accor-
dance with 15A NCAC 2C.1118
10. YIELD(gpm): o� /k METHOD OF TEST CU A'
11. WATER ZONES(depth):
12. CHLORINATION: Type U
AYll IIaV Amount 2b r= • It additional space is needed use back of form
13. CASING: LOCATION SKETCH
Wall Thickness
.�.
Depth (qi er or Weight/Ft. Material (Show direction and distance from at least two State
FromiliTo Ft. SM Al n�r c , Roads,or other map reference points)
From To Ft.
From To Ft.
14. GROUT:
Depth Mated I Mettiko o
From fl To .-C Ft. ( tll L1 (fin{A}Pad no
(U)
From Ft.To c c
15. SCREEN: —
Depth Diameter Slot Size Material -.t
r
From To. Ft _ in. in. v r-,
From To—Ft.— In. _ In. a ,
N�
_—
From _To_Ft._ In. In. C r" ''�"
N -�
16. SAND/GRAVEL PACK: ao 0
Depth Size Material 2
From To Ft.
From To Ft.
17. REMARKS:
(� pp
rR&
gIUFY�HT LL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C_ a e , I'a •1-a , , „ AT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE W
i� �r FFI�WST QNt�02 IGNAn1RE OF PERSON CONSTRUCTING THE WELL DATE
a.
wbmit original to Division of Water Quality,Groundwater Section within 30 days &A FtEKWISiiii SECTION
1 N ASHEVILLE REGIONAL OFFICE
ASHEVILLE REGIONAL OFFICE

North Carolina- Doperimont of Environment and Nnturni Resources-Division of Water Quality.Groundwater Section a
1636 Mall Service Center-Raleigh,N.C.27699-1636-Phone(919)733•3221 26833 6
WELL CONSTRUCTION RECORD WELL CONTRACTOR: BP LiIVA ( S. PO i-k
WELL CONTRACTOR CERTIFICATION ": .:-. Qa g
STATE WELL CONSTRUCTION PERMIT": keeczvciStel
1. WELL USE(check Applicable Boa): Residentlal63 Municipal ❑ Industrial Ell Agricultural n Monitoring ❑
Recovery n Heal Pump Water Infection ❑ Other Ej If Other, List Use:
2. WELL LOCATION: (Spew sketch of the location below)
Nearest Town: IA1� /,t1ti T241_ -e ! County: N6S.lit.r /A/0 Q CA
jai. e
(need Name enSJ1umbors,Con-money,or Sybdivlslon and Lot No.) DRILLING LOG DEPTH
3. OWNER (t-) ,LJ-FYI.(.( Q Rom To Fomiatlon Desrdpuon
Address
£Tr ' SlaIe
� ne n �' 4F17sce 9 - � 8
Zip Code d — l S tl
4. DATE DRILLED O-is-O - - '�+f
S. TOTAL DEPTH
6. CUTTINGS COLLECTED YESI 4 NOIV{
7. DOES WELL REPLACE EXISTING WELL? YES [1 NO[Vf
8. STATIC WATER LEVEL Below Top of Casing: ,, FT.
(Use'.'II Above Top of Casing)
9. TOP OF CASING IS l FT.Above Land Surface' - '
•Top of casing terminated ever below land surface requires a variance in accor-
dance with 15A NCAC 2C.5111E s
10. YIELD(gpm): /-/O METHOD OF TEST Rt q
11. WATER ZONES (depth):
'HLORINATION: Typo —.AmouniA R p t II S If additional space Is needed use hack of form
13. CASING:
Wall Thickness LOCATION SKETCI1
Depth ., O m lasete r eIe tv[J. Material (Show direction and distance horn at least Iwo State
From To Ft. rj Rends,or other map reference points)
From To Ft. n�� 4
From To FLVcjS///
14. GROUT: Q�v
Depth Malarial Method
From a To AO_Ft. Cpp 2Pf E �ara6 — --4—e e
From To Fl. C(C�/t��/ l/
15. SCREEN: 0 0
Depth Diameter Slot Size Material • -n ol_
From To Ft In. In. rTt
From To Ft. In. In. cJ '
From To Ft. In. In. rio _- -
16. SAND/GRAVEL PACK: ? r.�
Depth Size Material c„ -::
From , To Fl. .. n"a
From To Ft. {_IT o
17. REMARKS:
I DO TIER lipFl((�H TI,IS 1�Vf 1.1.* i STRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRU I A A t�D. e ± e e Iliad or THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
ROFFIC ONLY Y� _ aid... . . /_� b` 5-a I
n V GNATUG OF PERSON CONSTRUCTING THE WELL DATE
rNro t —
Subnit rdelnal to Division of Water Duality.Groundwater Section Within 30 days
Serial rle. DATE
nEV. 12/99
,� irE

WELL CONSTRUCTION RECORD 251150
North Carolina-Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAME (print) Jeremy H. Bowman CERTIFICATION 028O9
WELL CONTRACTOR COMPANY NAME t1 Rowman W®11 Drilling, Inc. PHONE / in a ac2 7779
STATE WELL CONSTRUCTION PERMITIO ASSOCIATED WQ PERMIT/
(if applicable) (if applicable) ' '
I. WELL USE(Check Applicable Box): Residential E Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other,List Use
2. WELL LOCATION: Topographic/Land setting
Nearest Town: Waynesville County Haywood El Ridge ❑Slope ❑Valley ❑Flat
12 Helen Drive Waynesville 2R7R6 (check appropriate box)
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) Latitude/longitude of well location
3. OWNER: Mark & Affie Hightower (degrees/minutes/seconds)
Address 12 Helen Drive Latitude/longitude source:❑GPS❑Topographic map
Waynesville (Street or Route No.) 28786 DEPTH (check box)
DRILLING LOG
City or Town State Zip Code From To Formation Description
U-
4.
AreaDATE code-DRILLED Phone number 12 2 2 01
5. TOTAL DEPTH: 240 ' .
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO L2
7. STATIC WATER LEVEL Below Top of Casing: 60 Fr.
(Use"+"if Above Top of Casing)
8. TOP OF CASING IS 1 • 4 FT.Above Land Surface'
*Top of casing terminated at/or below land surface requires■
variance In accordant with ISA NCAC 2C.0118.
9. YIELD(gpm): 04 METHOD OF TEST rotary ai r
10. WATER ZONES(depth): 1 80 '
220 ' LOCATION SKETCH •
11. DISINFECTION:Type to h1 pi- Amount 6 Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads.Include the road
Depth Diameter or Weight/Ft. Material numbers and common road names.
From 0 . To 57 Ft. 6 1 /8 sch 80 PVC
From To Ft.
From To Ft.
13. GROUT: Depth - Material Method
From 0 To 20 Ft. concrete gravity flow c
o
From To Ft. ' - _ N C
14. SCREEN: Depth Diameter Slot Size Material o'`t
From To Ft. in. in. 70 cc-'
m
From To Ft. in. in. N oc
15. SAND/GRAVEL PACK: •
NI >o
Depth Size Material . ' S �o
From To FL _ m
From To Ft. o �^'C --t
16. REMARKS: o
I9O D HT THRCTED COANH AC ELL
D ( N�T iEli iN r"DARDST A ,AND
WELL THAT
WAS A COPYCONST OF THISU RECORDIN A HASCRD BEENCE PROVIDEDWITISA TONC THE 2C,W WELL OWNER
• rJ % Z/Z-Z/6 J
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
� AI t G
Submit the
Poriginal to the Division of Water Quality,Groundwater Section,1636 Mail Service Center-Raleigh,NC
GROUNDW S ttim.No.[phone],within 30 days. GW-I REV.07/2001 .
ASHEVILLE REGIONAL OFFICE

Nosh Carolina-Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section 2 4 6 2 0;6
1636 Mad Service Center-Raleigh.N.C.2769E-1636-Plane(910)733-3221
SweetWater Well)billing&Pump Service,Inc.
WELL CONSTRUCTION RECORD YWLLCONTRACTOR:RCERYIFICATION0: e2 3 77
STATE WELL CONSTRUCTION PERMIT,:
1. WELL USE(Cheek Applicable So*Realdfat® Municipal 0 Industrial 0 Agricultural 0 Monitoring 0
Recovery 0 Heat Pump Water In)setlon ❑ Other 0 If Other,List Use:
2. WELL LOCATION;4Show e1 I1 of the location below) �/
Newest Town: i. t,,oy�a-c. Cony:
h'&y -#a74 Alegi'NC •
(Rood Name Wring.tbrrwarly,or and to No.) DRILLING LOG DEPTH
3. OWNER e.:14Lrt.) V b�yrLt la 1 From To Familial Description
Address
Hcrl y
car«Town
OP ton
4. DATE DRILLED
5. TOTAL DEPTH w f1.T c
6. CUTTINGS COU.ECTED YES❑ NO®
7. DOES WELL REPLACE EXISTING WELL? YES 0 NO[ (..._
8. STATIC WATER LEVEL Below Top of Casing: .7 FT. x". <'-;
(ues•i II Mow Top el Cairo) n, -
9. TOP OF CASING IS /.5se FT.Above Land Surface' Co -,
•Top ol mac irmiWed W«below lead requires a mimeo inaeoor- . .__.
dame ofarl6A NCAC LC Atli -'t
10. YIELD(gpm): DLO METHOD OF TEST72u-0 = m:
11. WATER ZONES(depth): �`2,.1 Cr
ro a,
12. CHLORINATION: Type Amount It additions'specs Ises needed u of loan
13. CASING: V U3�
LOCH SKETCH D
gars oWaa TNdowwrom.n fAaeS (Show direction and ham el Nat two Stale
From 0 Depth
Ft.,/o�; S7icL gesds,"anerm.p Pd^u)
figi
From To FL �`
a From To Ft.
14. GROUT:
Mf(8ad
From 0 TToo c D FL (k¢+� /a 1.7i` t V
From To Ft. ! e ,
15. SCREEN: �—/
Depth Diameter Slot Size Materiel
From .To /Ft.
Ft In. in.
From /To / In. /In. /
From / To FL In. In.
18. SAND/GRAVEL PACK: (� I] ' r= O
DepthL�Sass Lr,, a Mai S 1
From / To /
From / To
17. REMARKS:
100 HEREBY CERTIFY THAT IN ACCORDANCEfWWIITTHHItSA NCAC 2C,WELL /
CONSTRUCTION STANDARDS A' ��I&��// THE WEiI CED TO THE W��DA I�
FOR OFFICE USE ONLY SGNATURE OF PERSON C13145 UCtrq TE
I Quid Na Sundt MOO to DMNon of view ouS y,Groundsman section wthln 30 days
r»v-r REV.MotO�iJ IL I...

;ins-Department of Environment and Natural Resources•Division of Water Duality•Groundwater Section "S O J
larvica Censer-Raleigh N.C.27699-1636-Phone[phone]
CONSTRUCTION RECORD WELL CONTRACTOR: SweetWater Well Drilling&Pump Service,Inc.
WELL CONTRACTOR CERTIFICATION 1:grt.2 7 tY
STATE WELL CONSTRUCTION PERMITS:
_USE(check Apple wa sox):Reeldents l 1 Municipal 0 Industrial 0 Agricultural 0 Monitoring El
miry 0 Heat Pump Water Injection Other❑ u Outer,Ust Use:
.LOCATION:( tow sus rJ1 of Ms location below) ,/ /�
uTw . 6 Courtly: P1areL.aen
d Name ,r}iedwrbn and Lot No.) DRILUNG LOG DEPTH
ER From To For am Der+ipfa+
is C'
or e 4
1
ty DRL E SS Code D/a/G/O/
L DEPTH /L s' c
INGS COLLECTED YES 0 NO t j ai WELL REPLACE EXISTING WELL? ❑ NO®, L n
IC WATER LEVEL Below Top of Casing: a FT. Jr•
(Use+'a Move Top dl Casing) = `__
JF CASING IS '� be FT.Above La Surface' r -
*IQ leninikid War below lead sewn aquas a urines In Boor- —
15ANCAC2C Vie Tr
t(gpm): 6M OF TEST . 4 o "c.
A ZONES(depth): / y
�, [L q� a Stto l specs Is needed use beck of in i
+RINATION: Type �1�6 Lc[ —ar�rrr2-�-x-6�—
+fG: VV
LOCATION SKETCH
Wall Thickness
Depth p-T1ark��I1_ar lTht sal (Show dksctbn and discs hom at lean ? O
Q To_iS L�Ft. /o u •Z/ j'I/L'� Roads,r other map points),
To Ft. // , 010
a To Ft. thr
�y
Jr: d o
Depth v F
0 To 4nF LLn LiLG ' \ (1ccK
To Ft. DAL.
E'EN: hfII111,
Depth Diameter Slot 5z® Malaria( J
To Ft in. I�n
i ! OP'd9`=
/To To v Oft L4n.
D/GRAVEL PACK I J
--f-Depot i�!L Sire Materiel
Ix/. To f `_= i Imo. fits) //n
gApy(„S GROLIWV,Aife Srra�Inni
ASP['JIL_E REGLIIA' Cf-:'ICE
HERESY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 19A NCAC 2C,WELL
'STRUCTION STANDARDS,AND THAT A COPY OF D PROVIDED TO THE WELL OWNER./
1FFICE USE ONLY aC / ,4/4/
°: S O$ATURE OF PERSON THE WELL DATEt'>tiAkra wlpYrl le Man of water .Onouudrnalr Seoeon within 90 nw.1 REV.1219E

Department3
orth Carolina- of ErMronmsnt and Natural Resources•Division of Water Quality•Groundwater Section O
1636 Marl Sena Censer-Raleigh,N.C.27699-1636-Phone[phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR: SweetWater Well Drilling&Nunp Service,Inc.
WELL CONTRACTOR CERTIFICATION 6:,#!".2 7!1d y
STATE WELL CONSTRUCTION PERMITS,:
1. WELL USE(amdt Applicable Sox):Residential MuNdpaf 0 Industrial 0 Agricultural 0 monitoring 0
Recovery 0 Heat Pump Water In4ec$on ❑ Other p If Other,List Use:
2. WELL LOCATION: Show ek tch of the location below) (� n
Nearest Town: County / •� .� na'1'
elets 4,it Aa. ej
(Road Nome and Iswajus, and to No.) DRILLING LOG DEPTH
3. OWNER m,/� O ' ./ irr--4--. From To Foemsaa 0eeulption
,/�,
Address ..,c UI d
as
City or Town Zip Code
4. DATE DRILLED X2//17 o
5. TOTAL DEPTH .3ex
6. CUTTINGS COLLECTED YES 0 NO374 2
7. DOES WELL REPLACE EXISTING W91? YES� NOIJ
8. STATIC WATER LEVEL Below Top of Cuing: ,/— FT. r, 1
fuse.•s Above Tap el Caine)
9. TOP OF CASING IS 2..5 FT.Above Land Surface co _
'Top of omens seraiusa elver sloe sad ceases requires■whine In woe.
.
dance ea6116A MAC 11S.�tta b i--
10. YIELD(gpm): .�=i MEJZ IOOO OF WET��Licr o _ Rl
11. WATER ZONES(depth): 7-5 r J oC• 7' "'
12. CHLORINATION: Type Amount 1�� If additional space le needed as back of loanCo It
y
i 3. CASING:
Wall Thickness
SKETCH
Depth,,i — Dymssr aarr�lNelLtsa tiles(Slow direction and distance horn at Wet State
From0 To /a Ft. A :•7 % f t/C Roads,or other map +ca tom)
From To Ft.
a From To Ft. D
14. GROUT: , �r Sy. //p_ Fide o' 0614d
Depth 4 Material From _/ To a Cann —pr�l
From To Ft.
15. SCREEN: '
Depth Diameter Slot Size Material
From /To Ft /h. /h
From To Ft.FL h. h. /
From To FL In. h. `
16. SAND/GRAVEL P r� ( �`° 'J I
Depth y ay tiAalpl� V
From / To ` Ft.
From To I! Pt. 7i? J 1; ). J i . s
17. REMARKS: •
I
I DO HEREBY CERTIFY THAT&$g Nang rt. t� Ira IN ACCORDANCE WRH 15A NCAC 2C,WELL.
CONSTRUCTION STMIDARD tMQhhATAfCOPYa.- „ j- •-•-DHAS : a- PROVIDED TO THE WELL OWNER
/'! / /
FOR OFFICE USE ONLY �dla' � / �� I7 D
auaa No SIGNATURE OF - =--r- C ONSTRUCIR IG THE WEIL GATE
S Arra alpbrl b OlSon of Ws ovary,Grasdwar 8ectsn within 30 days
C.JJ\L nW.1 NEV.1291111

North Carolina-DepvN,eM of Environment and Natural Resources-Division of Water Quality-Groundwater Section
246202
1636 Mail Sonia Censer-Raleigh.N.C.27599-1636-Phone[phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR: SweetWater Well Drilling&Pump Senrice,
WELL CONTRACTOR CERTIFICATION 1: t2 g 77
STATE WELL CONSTRUCTION PERMITS:
1. WELL USE Mack Applicable Sea):Redderillal2 Municipal❑ Industrial 0 Agricultural❑ Monitoring 0
Recovery 0 Heat Pump Water Injection ❑ other❑ If Other,Ust Use:
2. WELL LOCATION: Show sketch of •loc n below) d/
Nearest Tel Candy to J
C(Road Name Iiii'' La No.) ORILUNG LOG DEPTH
3. OWNER _ _ -`/71''!w/�—., From To FamalemDsarpion
Address _I / sa I, •
2 es
-"
CMyaTown ... Code �
4. DATE DRILLED /� L.D/ c-. c-`"
5. TOTAL DEPTH C)i.
8. CUTTINGS COLLECTED YES❑ No® N Cif'1
7. DOES WELL REPLACE EXISTING WELL? YES ❑ NO[ ) co
8. STATIC WATER LEVEL below Top of Casing: _e?o FT.
(lea•+•I Above Top el Calm) 1 i"
9. TOP OF CASING IS A..5- FT.Above Land Surface* 7.- c
'Top el malty Lrarlaeeed eller bases Medsudse requires•mimeo In aeoor-
donee wMr15ANCAO'lCS115 CO `,
10. YIELD(gpm): . .,..- METHOD OF TEST T-u„ca
11. WATER ZONES(depth): 75 r /sue r
12. CHLORINATION: Type cf Amount A/ I It addlonsi epees is needed as back of lone
13. CASING:
LOCH • ' SKETCH
pe ieer alp J4lR.ill IMAM (Show direction and • - . from at last too State
From 0 Depth Se2 Ft, 4. - Pat- Roads,or ohm .. rsNrenae poise)
From To Ft.
From To Ft.
14. GROUT:
To°m a ��rr Material Method
From I) To H. /t.ns Gtle5`'iI
From To Ft.
15. SCREEN:
Depth Diameter Slot Size Malarial G l� y
From To / K71
Ft In. h.
SAND h. I
18. " S L S "�1�Man ; ` �rlG�d n
From o Ft. /-1 +. I ` /
/
From o Ft_, * I. 1 .
17. R r:_. . '
I DO CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
assail;
.. it
ACOPKST D HAS BEEN,WITH
5• TCAC2C, 110WlfEiL
imR OFFICE USE ONLY i >Orm No: TUNE OF PERSON •• .: - . < THE WELL DATE
Supra odanel es OMslon of Weer Quality, c . . Smart within 30 days rrw.,wEv.krns
0 4-I

North Carolina-Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section .'2 4 5 8 2 6
1636 Mall Service Center-Raleigh,N.C.27699-1838-Phone[phone] � L�
se-WELL CONSTRUCTION RECORD WELL coNTRACTOR �
: ��`J
WELL CONTRACTOR CERT) ATION if: 4.5/30
STATE WELL CONSTRUCTION PERMITS:
1. WELL USE(Check Applicable Box):Residential Municipal 0 Industrial 0 Agricultural 0 Monitoring El
Recovery 0 Heat Pump Water Injection Other [] If Other, List Use:
2. WELL LOCATIO (Show sketch o(the location below) i (�y 0 a
Neares(t�Town- �dy n)P'S �) . \ - County: f7
• F I p\,C. W fsjA- DEPTH
(Road N and Numbers,Coovnunity,or Subdivision and Lot No.) DRILLING LOG
3. OWNER Pa. roc.-e..0 From To Formation Oescdpdon /
Address f / Hg DY, 2 et,200/l.
(Street or Route No.) `,,
GryorTown Slate Zip Cade lig )05 /n( kn.Li-e-
4. DATE DRILLED .0'1\"O\
5. TOTAL DEPTH \OS
6. CUTTINGS COLLECTED YES CRT NO(l
7. DOES WELL REPLACE EXISTING WELL? YES ri NONT
B. STATIC WATER LEVEL Below Top of Casing: `).5 FT.
(Use•t If Above Top of Casing)
9. TOP OF CASING IS I FT.Above Land Surface' -*Top of of casing terminated actor below land surface requires a variance In actor-: .._. . .,,,.- - - - -
dance with ISA NCAC 2C.0119
10. YIELD(gpm): _1.0_METHOD OF TEST ILI
11. WATER ZONES(depth):
12. CHLORINATION: Type C i L.5 Amount- 7 If additional space Is needed use back of form
13. CASING:
LOCATION SKETCH
Wall Thickness
Depth Diameter or Weightfa Male�ria[ (Show direction and distance from at least two State
'�" i To IN Ft. f0 it 024 Ili"' , G Roads,or other map reference points)
From _
From To Ft.
From - To .. Ft.-- ----- ---. __ -
0
14. GROUT: tv
l�
Depth 7�11 Material , Method r_ - -:
_ p
From d To �v Ft. (Lenient- ( OtLfel� .
From To Ft. ry =-
v
15. SCREEN: �'
Depth -Diameter Slot Size ` -Material - -. n r.
z
From -__To Ft in. In. (I';7
From To Ft. In. In. r
From To Ft. In. In. CO -
J o
16. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To FL
17. REMARKS:
I DO HERE: a a s. '- ' - STRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRU r hill S 1 ARtt$,A�1D�r A+-- 'itOF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
5 `e —c, /.2—//—v/
FOR OFF)C= �r aNLY DATE
Quad No: j i - _ �,I V 4.NATURE OF PERSON CON RUCTING THE WELL
JI i 1 f. O bmit-I) • Division of Water Quality.Groundwater Section within 30 days
Serial No. f GW-1 REV. 12/99
GROUNDWATER SECTION
t ASHEWLLE REGIONAL OFFICE -

0ti 0n
4- =
North Carolina-Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section '-
1
1636 Marl Service Center-Releigh.N.C.27699-1636-Phone[phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR: SweetWater Well Drilling&Pump Service,Inc.
WELL CONTRACTOR CERTIFICATION I: 1.2',g3
STATE WELL CONSTRUCTION PERMITS:
1. WELL USE(area Applicable soak Residential f Municipal❑ Industrial❑ Agricultural❑ Monitoring❑
Recovery 0 Heat Pump Water Injeetfon ❑ Other D If Other,List Use:
2. WELL LOCATIO ::(Show b d1 of the location below)
Ne.ro i- �rl county: �a�'�' 1�
(Road Near . • Capillarity,or . . . and Let No.) DRILLING LOG DEPTH
3. OWNER a _ .I. _«�- /�,�/ From To Fom+tlm mgW Den
Address -a - —ed.,._.a..< A
City or Town Zip Coy
es-
4. DATE DRILLED F
5. TOTAL DEPTH tol _ -
6. CUTTINGS COLLECTED YES 0 NO® a
7. DOES WELL REPLACE EXISTING W91?YES ❑ NO[5 a:7
S. STATIC WATER LEVEL Below Top of Casing: 7r' FT. c-,
i (uas'i'a Above TopofCasing) — o
9. TOP OF CASING IS ,i FT.Above Land Surface• r
'Top of casing tarailnalled actor blow bad eorhee r•9rdn a snare N scow- •
dance ash lSA NCAC 4C.011a —0
10. YIELD(pm): /J METHOD OF TEST T�rr1 ,F- rn-_
11. WATER ZONES(depth): 7.751 /91. f
1V 3
:2. CHLORINATION: Type T R Amount Z . tt additional apace M needed use back of loan
!3. CASING:
Wag Marisa
Depth Dana, or weiflfl.. Maeda' (Show direction and .:..... .. from at least two State
From.—Q--To/o20 R. 4 'L SDQay Pee' Roads,or other .• rennce poirrs)
From To Ft.
From To FL
i 4. GROUT: %PyV
Depth A `material Method
From __LL_ To t.ln Ft 6..dy.W r \• 0
From To Ft.
15. SCREEN: . 4,
Depth Diameter Slot Sae Material 4
Forme To t fn 1r • ' •
r
From To Ft In. . Z '4
From To FL inIn. QI
6. SAND/GRAVEL PACK: . .
Depth Size Material
From To Ft. /
From / To ` Ft.
7. REMARKS:
rr ry`_
I DO Him � 1t n-
rY THAT THIS WELL" IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTAUCt M S fAt�ARDS;7aIDTRAT llA�O f BEEN TO THE WELL OWNER
�FOROFF(C ;afs�EONL,Y -� 9y ,
Chart!no: I LI J 'i, ✓sbareARmE OF PERSON THE WELL Da
I Suns edpert to Division of Water ,Oteu dwwr Section within 90 days
- - rnv.r rev.rus

North Carolina-Department of Environment and Natural Resources•Division of Water Quality-Groundwater Section 2 3 e7 5 5 2
1636 Mail Service Canter•Raleigh,N.C.27699-1636-Phone[phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR: SweetWater Well Drilling&Pump Service,Inc.
WELL CONTRACTOR CERTIFICATION I: e777 tF ..27 s'
STATE WELL CONSTRUCTION PERMIT.:
1. WELL USE(a ws Applicablea k�►oa):Residential ta,l Municipal❑ Industrial 0 Agricultural 0 Monitoring 0
Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other,Ust Use:
2. WELL LOCATION:4Show sketch of the location below) ,/
Nearest Town: .y �
County: lY ayef A1(
3 ,Uc .
(Road Nonecued or and Lot No.) DRIWNG LOG DEPTH
3. OWNER lA/51..4 From To FontWmOeaapson
Address , _ / ` g
.r Pam -
avee zNp Cad. -
4. DATE DRILLED ._
5. TOTAL DEPTH O.T
6. CUTTNVGS COLLECTED YES 0 NO 7,-
4-.,
•
7. DOES WELL REPLACE EXISTING WELL? YES D NOwi IT,
8.8. STATIC WATER LEVEL Below Top of Casing: /S• FT. _
1Use WI s Above Top d Casing) -!
9. TOP OF CASING IS /O.— FT.Above Land Surface xi c
m
*Top dcasing terminated Mew Slew land surface nqure.•vrWeatiaeap-
mro
dens cent 15A NCAC 2C.o11a � -,
10. YIELD{g)lrn): /t METHOD OF TEST _
11. WATER ZONES(depth): 70 r ?
12. CHLORINATION: Type 729..5 Amount / It additional space Is needed use back of form
13. CASING:
Wall TNrioea. LOCATION SKETCH
Depthi � p��fI�^r�L orWeight/Ft. (Show d and distance from at lean two State
From D To-ems=Ft.-lei- id=�/ iJ'r _. fioads. - Other mop reference points)
From To Ft. / W.
From To Ft.
14. GROUT: Depth Material Method ,
From 0 TO a ( >41 0146e,yC//
From To Ft. 0
15. SCREEN: t t
Depth r Slot Size Malarial f i �b
From To ` In. / in.
From To FL/ h. h. ! v
_. Q
From To FL In. In. C.
16. SAN From/
PQ
SW Material
jr From FL From
3
From FL /17. RE
I DO HEREBY t.Eni WFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STANDARDS,AND THAT A COr DD}HAS DED TO THE WELL OWNER.
FOR OFFICE USE ONLY [ s/..Z9�o/
Gird it SIGNATURE OF PERSON C� THE wu. !/ DATE
PrIV - G Submit airs a Dhabi of was W.gy,ieoudwr Swoon within 30 days
c_J.,.... nw.I REV_ 12A.

North Carolina-Department of Environment and Natural Resources-Division of Water Duality-Groundwater Section " " "
1636 Mail Service Center-Raleigh,N.C.27899.1636-Phone[phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR: SweetWater Well Drilling&Pump Service,Inc.
WELL CONTRACTOR CERTIFICATION If: 2 3 y
STATE WELL.CONSTRUCTION PERMITS:
1. WELL USE(at.dk Apollo/We sox):Residential la Municipal 0 Industrial❑ Agricultural❑ Monitoring❑
Recovery 0 Heat Pump Water injection ❑ Other 0 If Other,List Use:
2. WELL LOCATION:(Show sketch of the location below) /f
�a•��Town /Elute County: 8/2./id1nw-
(fl�.re v
(Road Nn id MateewL�?(�,or Stledwldon �Le�t No.) DRILLING LOG DEPTH
3. OWNER JQ. � From To FosnaeortDs..4eon
Address Ito/ vrei ideate Q r&
U/.�.as.° ov.C_. .287/6
City or Town Mat Zip Code
4. DATE DRILLED%5 5. TOTAL DEPTH
6. CUTTINGS COLLECTED YES Q NO Iro
7. DOES WELL REPLACE EXISTING WELL? NONE
8. STATIC WATER LEVEL Below Top of Casing: FT.
(tee:a Abovs Top of CWig)
9. TOP OF CASING IS /.S FT.Above Land Surface'
top ct offing tenwburd tor below had mesa requires a Vsdence In actor-
dance with 1SA NCAC 2C41+1111
10. YIELD(gpm): /S" OF TEST T..Grste
11. WATER ZONES(depth): 25-.5 t
12. CHLORINATION: Type Tr,R Amount a. _ it et:Monal space 4 needed use back of form
13. CASING:
Wall'Nelms • .A •. . •, -Nit B iK
Depth ,, or wei wR. T• (Show direction and distance from lust two Stale ,
From 0 To 3 1> Ft. # 42/ t-!'�• Roads,or other map •: points) (!(�Y
From To Ft. V l ' Lora/2
From To Ft. (1I
14. GROUT:
Depth Material Method . T
From _b To a p FL fia4ne (.r IN"thy
From To Ft. _ r tf�"
15. SCREEN: ly rt.Al O o
Depth Diameter Slot Size Material
From To Ft in. ///in. /‘ c -::
From S To Ft / in. / h. / V
N _r,
From To Ft / In. / in.
16. SAND/GRAVEL ACtt U ;
is m,--
Depth Size Material
From To F1 m
From To / N
o
17. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 1SA NCAC 2C,WELL
CONSTRUCT )N STANDARDS,AND THAT A COPY OF D HAS BEEN DED TO THE WELL OWNER.
FOR OFFICE1 : ONLY�� _aerie GCONgn / 'f� •
Cued Na I ).1 rRr l : . SIGNATURE OF PERSON :ltxs3 TttE was DATE
i SuMtt sepia to(*View,of warn Duality.Orou1Oe section within 30 days
nu-1 REV. 17199
heat

2 7 � r
35595
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: SweetWater Well Drilling&Pump Service,Inc.
WELL CONTRACTOR CERTIFICATION 0: .2 7 7 y
STATE WELL CONSTRUCTION PERMITS:
1. WELL USE(creak Appltnte.sox):Re&dential l Municipal❑ Industrial 0 Agricultural❑ Motlttoring❑
Recovery❑ Heat Pump Water Injection ❑ Other ❑ If Other,List Use:
2. WELL LOCATI • (Show sketch of the location below) n
NearestT.�L ...dirt, Crpunry:
(Ror//lf. „y
Mood Nero and Numbers. r Lot Na.)Ma.) o DRIWNG LOG DEPTH
3. OWNER it From To Formalize Description
Address
t stun
4614-D at P , .2
Cyar Town SUM ap Cods
4. DATE DRILLED s
5. TOTAL DEPTH n.r
6. CUTTINGS COLLECTED YES 0 NOJ]
7. DOES WELL REPLACE EXISTING WELL? YES (� NOVI
8. STATIC WATER LEVEL Below Top of Casing: T' FT.
(fees':s boove Tap of Casing)
9. TOP OF CASING IS I.
S FT.Above Land Surface'
-Top of casing Mradnaesd We.below Tend surfer*requites a variance In seoor-
dance will 15A NCAC 2C Dirt,
10. YIELD(gpm): yZ METHOD OF TEST 7 n-v0
11. WATER ZONES(depth): /A'0 ' ,
12. CHLORINATION: Type Amount / If additional apace la needed use bath of form n
13. CASING
w.eTlklvwo LOCATIONSK I c_ n *( fr
Depth D wo a file
(Show direction end distance from at
From 7 To',WO Ft. r° 4/ �_ / vC• Roads,or other map rdwsnro .-. , )
From To Ft.
I`
From To a r.v) it,
14. GROUT: i= AO TO
Depth A Material NNtlpd r ..t,. ea-cr�0
From d To OD Ft. /.trr'Lt..t� (A /'ter-r L o Ah MipsFrom To Ft
15. SCREEN: Y
Sc
Depth Diameter Slot Size Material
! //1:O / E / aja.
}b A
16. SAND/GRAVEL PACK: k
Depth Size Motorist v
Fr
From '-- To Ft /
ofn / To / Ft / /
17. RE
I DO HEREBY CERTIFY THAT TIC WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15fi 'CAC 2C,WELL
CONSTRUCTION STANDARDS,AND THAT A COPY /0HAS DED TO THE WELL OWNER
FOR OFFICE USE(71 1( .:! .__ �.>�Sf / S/�5 0/
and At I „' SIGNATURE OF PERSON WELL DA
Suer,*edging to Division of wafer Quality, Section whin 30 days
,
I a Taws REV.fzas
a
) 1
60 l';31.

Nonh Carolina-Department of Environment and Natural Resources•Division 01 Water Quality-Groundwater Section 2 3 3 5 3
1636 Mail Service Center-Raleigh.N.C.27699-1636-Phone[phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR: SweetWater Well Drilling&Pump Service,Inc.
WELL CONTRACTOR CERTIFICATION r: OL 7 r 3
STATE WELL CONSTRUCTION PERMITS:
1. WELL USE(Chick Applicable Boa)Re ldenealEl Municipal 0 Industrial❑ Agricultural❑ Monitoring❑
Recovery 0 Heat Pump Water Injection 0 Other 0 If Other,List Use:
2. WELL LOCATI phew sketch of the location below) U �
Nearest Town: 61r" County- J ezr,)-A-rrif/
e-tcyfrit
(Road Name Nursers.Carmody,«1AaAalsbn and La No.) DRILLING LOG DEPTH
3. OWNER C��/(/137ttJ 4 'f d- .nn From To FarrWmDesr+4tion
Address a2 7r •
tsy own ���sbe. Lp Code
4. DATE DRILLED J el /
5. TOTAL DEPTH :s'
6. CUTTINGS COLLECTED YES 0 NO "-
7. DOES WELL REPLACE EXISTING WELL? YES C Ngel c ci'
8. STATIC WATER LEVEL.Below Top of Casing: . =
psi••••I Move Top ofCasing) ' rr
9. TOP OF CASING IS / ,j FT.Above Land Surface* --1
7'. PI .
*Top of wing termrraaad etbr below bad awfaoe requires a wWree In soon- rn
dance with/SA NCAC Ie I! -
10. YIELD(gpm): Pt DJOF TEST T-4tc/ r
11. WATER ZONES(depth): b <
12. CHLORINATION: Type 7jrvl
R Amount / If additional ogre Is needed use back of loan
13. CASING:
Wall TNdowse e.- ,ai :,-alp
Depth ar MMpeabbkr�WW (Stow dikactiort distance at toast lw0 Stab 1
From To 3 D Ft. o %� . Y./2 . Roads,ar other crop •- point)
From To Ft. O
From To Ft. D w•
14. GROUT: Depth ^� qq
Material
rlitor� e
From To Ft.
15. SCREEN:
Depth Diameter Slot Size Material -
From To in. , , a, 44
e
From /T F / In. I. v OR
From !/ T FL In. In. / h
16. SAND/GRAVEL PACK: N
SW MalarialE
o / Ft / `
From To Ft /
17. R
A � K
I DO HEREBY Lott trY THAT THIS WELL WAS CONSTRUCTED IN ACC0RDANCE Whin/1 NCAC 2C,WELL
COWSiAUCTt •ACOPY OF D DED TO THE WELL OWNER.
FOR OFFICE "
cad No: t SIGNATURE OF PERSON THE WELL DATE
7r° b Melton or WakeOva Ovary.OrandW w1 Section within 30 days
e_.�..... I . .• num REV_12/99
Groundwater Section
__Asheville Regional Qffice

North Carolina-Department of Environment and Natural Resources•Division of Water Quality-Groundwater Section O 7 6 0
1636 Mail Service Center•Raleigh,N.C.27699-1636-Phone[phone] ` '•
WELL CONSTRUCTION RECORD WELL CONTRACTOR: • &/ /aa /Jfi 1/772' he
WELL CONTRACTOR CERTIFICATION#: c•- J/V O
STATE WELL CONSTRUCTION PERMIT#: •er4' '-9—
1. WELL USE(check Applicable Box): Residential El Municipal ❑ Industrial 0 Agricultural❑ Monitoring ❑
Recovery❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATIO : (Show sketch of he location below) L/�il/im�4�//GIG�
i fT
Nea st Town: // County:
� ,..a ea 203(0
(Roa epwp Numkers,Cornyrairy,or Subdivision yid Lot No.) DRILLING LOG DEPTH
3. OWNER `c-'j A_ u 5.ji ci- 1 7 I/ From To/ Formation Description
Address / OL2_ ed.P-49-0_, sr. D - ,7
/,//> 0,• _ (Streelor/R/o,}t�to No.) �— LLQ
(gym•-"'"^'�u:.. �t C� a 7 ea,0 i ,cam /ty or Town Slate Zip Coda 6 b -Cr! i
4. DATE DRILLED ) D` `>r (rJ�
5. TOTAL DEPTH Lei' 70 �o�r
6. CUTTINGS COLLECTED YES f NOn eo-- '7c.5- 4-"412a L
7. DOES WELL REPLACE EXISTING WELL? YES n NO[ I R-c CB 5
8. STATIC WATER LEVEL Below Top of Casing: FT. c,
(Use'+'It Above Top of Casing) 0 n A
9. TOP OF CASING IS / FT.Above Land Surface' Q Zr;
'Top of casing terminated actor below land surface requires a variance in accor- — Cc'.dance with 15A NCAC 2C.ell Q
10. YIELD(gpm): METHOD TEST .7 -p -'.,
11. WATER ZONES( epth):.,`'~e•% -75p, 3 xrn
o
N w<
12. CHLORINATION: Type 7Q Amount _ If additional space Is needed use back of formal "-'
13. CASING:
Wall Thickness LOCATION SKETCH
/ Depth Diameter or Weight/Ft. M anal (Show direction and distance from at least two Stale
From f( To s`� Ft.—1�— —Y Roads,or other map reference points)
From To Ft. �0�•�o;t�
L f1 From To FAfr
14. GROUT:
Depth Material thud
From To FL��flM '
From To Ft.
15. SCREEN: t
Depth Diameter Slot Size Material Po t a
From To Ft In. In. N t l\:
From To Ft. In. In. Ipyr,
From To Ft. In. In.
16. SAND/GRAVEL PACK: '/
Depth Size Material 1(1 U}.b NI
From To Ft.
From To Ft. /K14
17. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STANDARDS,AND THAT A COPYPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER. /
FOR OFFICE USE ONLY 'l 22"� / �P/ �/
Quad No: NOV I 5 2001 SIGNATURE OF PERSON CONSTRUCTING THE WELL ATE
Submit original to Division of Water Quality,Groundwater Section within 30 days
Sedal No. GM REV.12/99

•
onh Carona-Department of Environment and Natural Reeoun.s-Division of Water Quay-Groundwater Section
O.Box 29578-Raleigh.N.C.27828-0578-Pho e(919)733-3221 2 13 0 O
VELL CONSTRUCTION RECORD DRILLING CONTFMCTOR• - ('. _ • Y / - ))11 v
DRILLER REGISTPA770N#: • - 0l
� STATE WELL CONSTRUCTION PERMIT#:
WELL USE(check Appease ewe: Residential L_l/ Municipal 0 Industrial❑ Agrlcuhtnal 0 Marttoring 0
Recovery 0 Heat Pump Water Injection 0 Other 0 ff Other,List Use:
WELL LOCATION:(Show sketch of the location below)
NeamstTown: (le(L'i f )UL} county;• itY/4/ C)0 0
)
(
(Road.Commonly,or Subdivision and Ld No.) DEPTH DRILLING LOG
OWNER � ) , Y(./I Vlr-rf f-�A_Q-'i.. From To Formation Desaipeon
ADDRESS (0(0 i1< -r(3? It . Rr L-_5-}- -4Z�
0 X Kx-1 Icy (Sseet�o, ' ) �t°T f
City or Town State Zip Code
DATE DRILLED. c
TOTAL DEPTH Z Z'( '
p n
CUTTINGS COLLECTED YES❑ NO L r1 _,
DOES WELL REPLACE EXISTING WELL? YESNO� 0 r
Di
STATIC WATER LEVEL Below Top of Casing: ', (I FT. — S,
(Use'v IfAbove Top ofCasing) y o
TOP OF CASING IS / Ff.Above Land Surface' = rn -
sing reminded soar below land surface is Segal Wass a variance Is issued +'1
tad With 15A NCAC 2C .O118 /� I /'� ( cn cis ,
YIELD(gpm): le) METHOD OF TEST!' ' !-1 ac-1 I V- 1 Ni --,
WATER ZONES(depth): (max r7 o 0
CHLORINATION: Type P>LE:T Amount�L_ If additional apace is needed We tack of form
CASING:
yyM LOCATION SKETCH
r' Depot _/ ante! or WelghuFL Malachi (Show Amnon and distance tun at least two State
From T J To 1'�') Ft. Roads.orothermepdnferencepoints)
From To Ft ✓ Lee
From To • Ft
J__
GROUT:
r__;t.2fe
Material "th r " ' .l) ,/
From - - �?kgFL D. t f_ftC �0 1�(�
SCREEN: •
Depth Diameter Slot Size Material
From To Ft In in. )A 4t Y' L LA \K.
From To Ft in. In.
From To Ft. In. In.
SAND/GRAVEL PACK
Depth Size Material
From ' To Ft. •
From • To FL
REMARKS:
I DO HEREB Nil ACCORDANCE WITH 16A NCAC 2C,MU.
CO NBTRU A F THIS HECORD HAS a f1 •�.TO THE OWNER
)ROFFICE NLY �' , ClJ� l L j ( - i 6 1
dal MAR - 7 2002 ... -' Of DRAWN! DATE
C original te ONsbn(MarQuaadagytowesowner.
„i M/ iM0
GROUNDWATER SECTION
ASHEVILLE REGIONAL OFFICE

orth Caroline-Department of Environment and Natural Resources-Division of Water Quality-Grounds Section 2 4 3.3 8 8
O.Box 29578-Raleigh,N.C.27628-0578-Piro e(919)733-3221
VELL CONSTRUCTION RECORD DRILLING CONTRACTOR: An�k 't'—c5 —' tic �\—D1 )(I'
DRILLER REGISTRATION 0: S 2.. 4
STATE WELL CONSTRUCTION PERMITS:
. WELL USE(Cheek Applicable So* Residential El Municipal 0 Industrial 0 Agricultural❑ Monitoring❑
Recovery❑ Heat Pump Water Inject on ❑ Other❑ If Other,List Use:
. WELL LOCATION:(Showy sketch of the location below) f l.�l�lX)�(
Nearest Town: C ri"1`C !� . County,
•(Road ,f Su No,) DEPTH DRILLING LOG
. OWNER J,fC-1.1( / ci OW-it-, From To Formation Desaiptian
ADDRESS / Z-i iiiY29 -,40 ),�i.J CQ
C�x� w c u
or Route No.) Z ,7 .) ( r.
City or Town ) ( rip Code
. DATE DRILLED /(YP-Mie
• TOTAL DEPTH ?A} 'I I o n
. CUTTINGS COLLECTED YES❑ NO 0--' — °_
DOES WELL REPLACE EXISTING WELL? YES El NO� t�
4. STATIC WATER LEVEL Below Top of Casing: FT. `,",
(Use+•If Above Top of Casing) PJ q m
I. TOP OF CASING IS I FT.Above Land Surface' >o
Casing Terminated al/or below land surface Is Nepal Mess a variance Is Issued � "'r
In accordance with 15ANCACJc A116 N,z
0. YIELD(gpm):(ri' ) METHOD OF TEST(f1 TiCChrd1 V-L�
1. WATER ZONES(depth): fie'') NI Hc• 'v
7o d o i
[2. CHLORINATION: Type -ro L C Y Amount Z-' If additional space is needed use bads of form
3. CASING:
LOCATION SKETCH
Wall Thickness •
7.From %�) Depth`To ,r FL Diameter or Welg thin Material (Show direction and distance from at least two State
Roads,or othermep reference points)
From To FL _--
From To • FL —L-
C)
14. GROUT: 1 ��.1�(
Depth Material Method (. ILj C J- I
From To FL Oa)'1 e 3 f �t U -.0 1_1 •
From To FL HGJ / ) ) c)
15. SCREEN: •Depth Diameter Slot Size Material r (�Y )
From To Ft In. In. 4 i J�{ )
From To Ft In. In. y' /�! I r(j / `�
From To Ft In. In. ..�� • (,.Fi •� / tli (C LD
10. SAND/GRAVEL PACK: ��
Depth Size Material
From To • Ft.
From • To Ft
17. REMARK :—, -__.._ --- —
1 DO HEREBY L,grcr trYTHATTHISWEQWPS tf ACCORDANCE WITH 15A NCAC 2C,WELL
CONBTRU9TION STANDARDS,AND THAT A OOP*OF RECORD HAS BEEN PR,VIDED TO THE WELL OWNER.
FOR OFFICE USE ONLY $ R G
Quad Na OF CON1RACTOR ENT DATE
I Seder No: .. ..- 1 r orkdral to DWisbn of Wean ally and copy to well owner.
.....,.,. .�•

Environment and Natural Resources-Division of Water Quality-Groundwater Section n A n O 0 9
•
North ox 2957 Department of l l 'J •
P.O.Box 29578-Raleigh,N.C.27628-0678-Pho a(919)733.3221 ,
WELL CONSTRUCTION RECORD DRILLING CONTRACTOR: }gri-YT I < C_ & 4-e Q! \-- )< < .,
DRILLER REGISTRATION#:
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE (Check Applicable Box): Residential El Municipal 0 Industrial❑ Agricultural 0 Monitoring❑
Recovery❑ Heat Pump Water Injection 0 Other ❑ If Other,List Use:
2. WELL LOCATION: (Show sketch of the location below) i I - i`` k�I
NearestTawn: c� VC 1-(2- \( County:' r) (
DEPTH DRILLING LOG
(Road,Co ty,or �'and L t .) Formation Description
ll' V-- \ C�I,E,` b�. From To
3. OWNER N \l
ADDRESS (c(,) 4:12,,- i(,i`',,A •i ir I0t, i .)C_
�y� ( I (Skeen,Route No.) 77
City or Town / Stale Zip Code
4. DATE DRILLED• I" C t' G'
5. TOTAL DEPTH 3( ''i I
6. CUTTINGS COLLECTED YES❑ NO©
7. DOES WELL REPLACE EXISTING WELL? YES ❑ N®'
8. STATIC WATER LEVEL Below Top of Casing: FT.
(Use'WI If Above Top of Casing)
9. TOP OF CASING IS FT.Above Land Surface•
•Casing Terminated at/or below land surface Is Illegal unless a variance Is Issued r
In accordance with 15A Q2C .0118 __ '1 ';C�'ll 16' l 1.
10. YIELD(gpm): ` `c;Cr METHOD((OF TESP{ o
11. WATER ZONES(depth): , fj 1 O o
12. CHLORINATION: Type 41 I)) _t Amount
If additional space is needed use back of(part x
zr^
13. CASING: LOCATION SKETCH o<
�o
Wag Thickness --1
, Depth Diameter or Weight/FL Material (Show direction and distance from at least two State m0
( - Roads, or other map reference points) ma,
From ' To J Ft. / __
From To Ft. ci �� C _ I-<<� �7 6'\_
From To ; Ft.
14. GROUT: 1 I t r�K-=
i
Depth Material Method - I C, CL ` t-
From To Ft. (' / I(1 4 Sr i f, lf- l% ` �, uL ` 1\ _�•
From To FL `—�
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 FL •
From • To Ft.
17. REMARKS:
I O HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED•NORD D HAS B NPROVIDED TO THE WELL OWNER.
CONSTRUCTION ST
�j /���` i � / o— ( -0
FOR OFFICE USE ON ' I .�t OF CONTRACTOR OR AGENT DATE
Quad No: ! , .. .:Ito Division of Water Quality end copy to wed owner.
Serial No: - �,•,• ••••• •��
Groundwater Section
Asheville Regional Office

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(919)733-3221 , ,
c v',ll \.
WELL CONSTRUCTION RECORD DRILLING CONTRACTOR: - x —
DRILLER REGISTRATION#: 'T" '
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE(Check Applicable Box): Residential 0 Municipal 0 Industrial 0 Agricultural 0 Monitoring 0
Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other,List Use:
2. WELL LOCATION: (Show sk$tch of the location below) - /
Nearest Town:
<1r/L - !Q l'- County:' ITa.LI 6 L:1;0
DEPTH DRILLING LOG
(Road,Communityor``Subdivision and Lot No. Formation Description3. OWNER
a-e bra Jr9 1 {l, From To
ADDRESS ) G. '>i)I 11\ 1 f(9—')*'
(Sheet or Ro .)
(14V--1'<T4. jV07 l5 ) IU
City or Town
4. DATE DRILLED• �_ ) -ai l
5. TOTAL DEPTH 2 o' / /
6. CUTTINGS COLLECTED YES❑ NOCl/7 �--�/
7. DOES WELL REPLACE EXISTING WELL? YES O NOD
8. STATIC WATER LEVEL Below Top of Casing: ;,
T.
(Use"+•If Above Top of Casing)
9. TOP OF CASING IS ) FT.Above Land Surface'
•Casing Terminated atfor below land surface Is Illegal unless a variance is Issued ,
In accordance with 15A N AC 2C .0118 ��/,�r�,ten , °--( A.,\
10. YIELD(gpm): (f'' METHOD OF TEST
11, WATER ZONES(depth): f 1 O o
I Y??{ E 1 Amount /-- If additional space is needed use back of f�r e
12. CHLORINATION: Type a 1
z-'
13. CASING: LOCATION SKETCH a'r'.-,,
Wall Thickness •
l� Depth (/ Diameter or Weigh/Ft. Material (Show direction and distance from at least two my
To '1 ) c Ft. Roads, or other-map reference points) 74 ',FA
From El m�
From To FL f !-C ( /
a
From To • Ft.
14. GROUT: 7�C,tin�� �,/E $a'C.
Depth Material Method
From To Ft. < ('3>('ti( c• 'tX L'.,ti— i 1 �.
From To Ft. J ‘��1
15. SCREEN: \ 1 C )._._ Li OF
Depth Diameter Slot Size Material �'/) i . ,
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'ir i
. is,nrct t WAR C UCTED IN A CE WITH 15A NCAC 2C,WELL
CONSTRUCTION D1�g8,ID ry lO F IS RE HAS B PROVIDED TO THE WELL OWNER• Z Q
FOR OFFICE USE l5 'U' � (�- � �%��--� � DATEiURE 0 CONTRACTOR ORAGENT
Quad No: it original to Division of Water Duality and copy to well owner. .^^, .M•
Serial No: ( `
Groundwater Section
Ashev,iie Re tonal Office

North Carolina-Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section A. 1 -i V 8
P.O.Box 29578-Raleigh, N.C. 27626-0578-Pho e(919)733-3221
WELL CONSTRUCTION RECORD DRILLING CONTRACTOR: R (8(5-'.11�� &Z 'e j ( - ' > .1
DRILLER REGISTRATION#: ( 'O v) 03
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE (Check Applicable Box): Residential EY Municipal ❑ Industrial El Agricultural❑ Monitoring ❑
Recovery❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below) � / / r
Nearest Town: (°4Yl�a`'V' County:• /-7 y �dO�-
(Road,Community or Subdivision aqd Lot No.. t DEPTH DRILLING LOG
3. OWNER (.-H I ' 1 Y1 From To Formation Description
ADDRESS—P° r�� �5 1 I
jot, vvciii; (Street or Route No.
City or own -= -l —Slate/ Zip Code
h o
4. DATE DRILLED �- c o
5. TOTAL DEPTH
6. CUTTINGS COLLECTED YES NOj •t g cq
7. DOES WELL REPLACE EXISTING WELL? YES NO ser^
8. STATIC WATER LEVEL Below Top of Casing: / 2() FT. r r_rr.,
(Use"+•i(Above Top of Casing) Do
9. TOP OF CASING IS I FT.Above Land Surface' S Ao
•Casing Terminated at/or below laud surface Is Illegal unless a variance is Issued N . �zz
In accordance with 15A NCAG,,2C .0118 �p�
10. YIELD(gpm):. (2 METHOD OF TEST! I (R21-a i tcsou m o
11. WATER ZONES (depth): Z Z _ -- z
4-5
12. CHLORINATION: Type _ /, h ( Amount -C- If additional space is needed use back of form
13. CASING:
Wall Thickness LOCATION SKETCH
Fe) Depth Diameter or WeighUFt. Material (Show direction and distance from at least two State
From l� To - -)— Ft. Roads, or othermap reference points)
From To Ft.
From To Ft.
14. GROUT: CS YI F-(% Yj / r t
Depth Material ) _ Method
From To Ft. �'U�C'� -�� i( �'//h/L._ E_ I � ,
From To Ft.
15. SCREEN: • ( 1 0
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: rr, l I H y�1 L` "-�
u _
I DO HEREB( kIFY THAT THIS pW,E�LLp WAS VSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUC' TAt4 DS /aNINtr A OF THIS REC OHAS BEEN PROVIDED TO THE WELL OWNER.
FOR OFFICE USE ONLY U � b�� {s ) '(I' 11
Quad No: - _ rS1 NATURE F CONTRACTOR OR AGENT DATE
Serial No: UKULIN DWAIER SECTION �uSmit original to Division of Water Quality and copy to well owner.
• ASP#r 'rLLE REGIONAL OFF GW-1 REV. 1/98

•
North Carolina-Department of Environment and Natural Resources-Division of Water Quality-Groundwater q 7
p Section 2 3 9 i
P.O. Box 29578-Raleigh, N.C.27626-0578-Pho e(919)733-3221
WELL CONSTRUCTION RECORD DRILLING CONTRACTOR: f n I 'I.>) //I r
DRILLER REGISTRATION#: '0 3 -'
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE (Check Applicable Box): Residential©' Municipal El Industrial❑ Agricultural El Monitoring ❑
Recovery❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATIO : (Show sketch of the location below) f
Nearest Town: 5 n461f County: . 4q. 1 ci
(Road,Cornmnity,or Subdivisioni and Lot No.) DEPTH DRILLING LOG
ni
3. OWNER y _4 S)Uc(Y� V11 1 From To Formation Description
ADDRESS ZC)t 5+O )e I -Pate-- 0 c.
—
(Street or Ro to No.) 0
Cic: n�GYI N C Zsoiu =
City or Town Stale Zip Code --C_ r"'
4. DATE DRILLED 3-0 1 coo
-'
5. TOTAL DEPTH S 2.7 ` -v me
6. CUTTINGS COLLECTED YES n NO71 Jr ,--nc
7. DOES WELL REPLACE EXISTING WELL? YES NOV-- rel "''
8. STATIC WATER LEVEL Below Top of Casing: 'Q FT. ra --r
(Use"+^if Above Top of Casing) N o
9. TOP OF CASING IS 1 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 /L, /7
10. YIELD(gpm): I METHOD OF TESTAb-�' l 6YIU-6t At`
11. WATER ZONES (depth): 3(-3/-D
66O
12. CHLORINATION: Type -i'kb‘C.A- Amount Z If additional space is needed use back of form
13. CASING:
Wall Thickness LOCATION SKETCH
QDepth _co Diameter or Weight/Ft. Material (Show direction and distance from at least two State
From To 5 Ft. Roads, or other map reference points),
From To Ft. / ' O . I a Lr e'.il� ' `�—
From To Ft. l
14. GROUT: •ICI:014. 3 COc).e..- td
Depth Material ethod
/1
From To Ft. ( n n OTC ? LuA q IiLQCYI 1-;t^' i t IC..-
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 ACCOR NCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STANDARDS,AND THAT A COPY OF THIS RECORD HAS SEEN PROVIDED TO THE WELL OWNER. y
FOR OFFICE USE ONLY M ":1 r '6(1' �j�J� "`' `^ �� S� l
Quad No: '= SIGNATURE, CONTRACTOR OR AGENT DATE
Serial No: i Submit on l 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 Gusty-Groundwater Section 2 3 3 0 85
1636 Mall Service Center-Raleigh,N.C.27699-1636-Phone[phone] D. Bowman Well Drilling, Inc.
WELL CONSTRUCTION RECORD WELL CONTRACTOR:
ELL CONTRACTOR CERTIFICATION I: ?809
STATE WELL CONSTRUCTION PERMIT.:
1. WELL USE(Check Applicable Box): Residential Municipal CI Industrial El Agricultural CI Monitoring 0
Recovery El Heat Pump Water injectionLi Other El If Other,List Use:
• 2. WELL LOCATION:(Show sketch of the location below) Haywood
Nearest Town: r'lyde
760 Osborne Road DRILLING LOG DEPTH
(Road N n Number,Community.or Subdivision and Lot No.)
3. OWNER
" e�oney B. Moore From To Formation Description
Address P.O. Box 326
Clyde (Street orHou .) 28721
City or Town Stale Zip Code
4. DATE DRILLED 2/01 /01
5. TOTAL DEPTH c pp pp r
6. CUTTINGS COLLE'jCTED YES f NO[J
7. DOES WELL REPLACE EXISTING WELL? YES I0 N
8. STATIC WATER LEVEL Below Top of Casing:
FT.
' 1 ,4 (Use':11 Above Top of Casing)9. TOP OF CASING IS FT.Above Land Surface'
'Top of caring terminated alter below land surface requires a variance In accor-
dance with lSA NCAC
2C•01113 30 METHOD OFTEST rotary air
10. YIELD(gpm):
11. WATER ZONES(depth): 440 '
4 4 0 '
12. CHLORINATION: Type
tablets Amount 6 If additional space Is needed use back()Harm
13. CASING: LOCATION SKETCH
Wet Thickness
Depth Diameter or WelghuFt. lamed& (Show direction and distance from at least two Stale
From 0 To-.AL-Ft. 61 /8 Srh 80 PVC Roads,or other map reference points)
From To Ft.
From To Ft.
14. GROUT:
Depth Materiel, Method o
From .�— To 20 ri. rnnrrptp gamily flow O p
From To Ft. C °'
15. SCREEN: �^
Depth Diameter Slot Size Materiel z--
o
From To Ft in. _._-In. rIv o c
From —To_—.Ft.— in. .—_ In. m r,
From To Ft. In. . In. 3 "'r^
16. SAND/GRAVEL PACK: O n`a
Depth Size Material -' 0
Qn a
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.
Y Gltntin-_o 1/61/d
Wad No:FOR OFFICE USE ONLY NATURE PERSON CONSTRUCTING THE WELL DATE
Vbr1 o o Division of Water Weary.Groundwater Section within 30 days GWI REV. 17/99
Serial No.• �f
v unaware. Cf U, -

Nat CarolinaDepartment of s..60.111aa.R aid Natant_E -Division of Wafer Cua�N:-GrowidwatarS.dbn :.2 4 4 2 25 .: -
1636 maw Sarvk+Cer>Fer-Raleigh,N.C.27r>s9-7B36-Pt+tiss(918)733322f-' - _
WELL CONSTRUCTION RECORD ' WELL coNTRACToe: % `')6'`-2
WELL CONTRACTORC ATION fk 02'y36
STATE WELL CONSTRUCTION PERMITS:
1. WELL USE(Check Appiable soak Residential Municipal[I Industrial 0 Agricultural CI Monitoring El
ROCatrery 0 Heat Pump Water Injection (_( Other[] If Other,List Use:
2. WELL LOCATION: (Show sketch of the location below) , / c`c��
Nearest Tows k c v.,7 c 5e /�4 Co ndy: /�L
(Road Nana aid n arx ma Canni���lyy/or subdvistan and tot No.) DRILLING LOG DEPTH
3. OWNER nn d.c Hi1)?k From To FotrnKon Cesaipilon
Address • t / 90 D//x2 .CJegalo/t,
(Street or Rabe No.)
City acTown r) Sate Zip Code qn /b$ +d itC
4. DATE DRILLED II 9JOj
5. TOTAL DEPTH OS
6. CUTTINGS COLLECTED YES f NOD
7. DOES WELL REPLACE EXISTING WELL? YES [l NOt
8. STATIC WATER LEVEL Below Top.of Casing: ,5 FT. -
(Use't 8 Above Top d Casing) . .
9. TOP OF CASING IS I FT.Above Land Surface' •
-Tap of wing terminated atfor below land surface requires a sedans*In stem _ ,.,. .. .. ..
dance with ISA NCAC 2C.0118 n
10. YIELD(9pm): c,O METHOD OF TEST '\t'-
11. WATER ZONES(depth):
12. CHLORINATION- Type C c (i s Amount 1 If additional specs s needed use bad(of ban
13. CASING:
LOCATION SKEFG=1
WWI Thicknen
Material ( dime-Jeridime-Jeriand distance from at[eat two State
From 4- Depth p q(par�r��{/t.er w WWeight/R., To /d FL it 02- EC-' Scads,or other map reference points.)
From. To Ft. c
From - Ta A. .. -. . . O v
14. GROUT:
Depth_ Material +Lod
From To .- T) Ft. r.Onl I 1Of e `_-'t.n .
From To Fl. -1 r
ytt,-
15. SCREEN: -o
Depth Diameter- Slot Size `Material - a(,,,
From To Ft ` In. In. f V m
o
From —.--To Ft. In. In. N3 -,
From
To FL In. In rA z
16. SAND/GRAVEL PACK:
Depth Size Material
From To FL
From To FL
17. REMARKS:
I DO S CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C.WELL
CON S�Y�N ciR OPY OF THIS RECORD BEEN PROVIDED TO THE WELL OWNER
I \__, I
FOR O SE ONLY
\ '�,�, SIGNATURE OF STRUCtlNG WE'-L. GATE
:J
pud Na - _ 2002 a to G;�al Wafer may.Gwdwater Section within 30 days
�4: Gw-t REV.
Serial No. '[ J
1

24422?
North Caroline-Department of EntvrcrK and Natural-Resources-Division of Water Cully• -Gtoundweter t -
tt136 Mug Service Carder-Raleigh,N.C.27ss3-1�e-Pttat+a(sty T.ssaat - -6-40,-> -_ -
it
WELL CONSTRUCTION RECORD W cCOORO CERTIFICATION E: S2
,,aa,�// STATE WELL CONSTRUCTION PERJURE:
•Residential to Municipal❑ Industrial❑ Agricultural❑ Monitoring❑
1. Recovery
USE it7fad Appltuble Bonk C3 Other it Other,list Use:
R�pygryr 0 Heat Pump Water Injection ❑ .
2. WELL LOCATION:(Show sketch of the location below) / 4/��fJ
Nearest Towrc /i1iiA-r'lr��, ',O. Coua ty: !' '
(Road Name and Numbers.Community,or SUSIIVI tar and tat No.)
•
-- DRILLING LOG DEPTH
I<w a l )a`6 S e r From To Fa netioa Desaipaan
3. OWNER "le Al^ 7' / 38" 4Y42 ,e5-ead.on.'
Address
(Street or Route No.)
City or Town Slate ap Code �� /y5 �C/��-11�t�
4. DATE DRILLED J4"c3u u
5. TOTAL DEPTH I S
6. CUTTINGS COLLECTED YES Er NO(—I
7. DOES WELL REPLACE DUSTING WELL? YES [] NOf(
8. STATIC WATER LEVEL Below Top of Casing: j( FT. -
(Use'-C If Above Top d Casing) •
.
9. TOP OF CASING IS_1__ FT.Above Land Surface' •
.. .
'Top of casing terminated aver below land surface requires a verLnca In actor ._ -
10:• YIELD
h l iC.a/.2 METHOD OF TEST 6 Y�
10: YIELD(gpm): � O
• 11. WATER ZONES(depth): -
i II s Amount i If additional space Is needed use bacc of 'con
1 CHLORINATION: Type _� '—'
13.. CASING: LOCA TCN S CE CH
Wai �rilicime
Depth niameter a WrI-ao ri. Matsu' Show direction and distance front at Least two Slate
_ Roads,or otht map r:'fefer'".�'points)
From. ----To FL— --:— — g'I�-C'r
From—"�--I To 3 U F1.
From - To- Ft.
14. GROUT: Method S c3
Oepih Material �.J
0 Tc . 0 Ft. �2.ment i OILre I=
m
Fr. - n c_ •i
From To Ft. — _c_,
off
15. SCREEN: - 'n
Depth Diameter Slot Size `-Material ' y
zu
tc mom'
From To Fi - In. In. S w c
From To F1. In.' _—In. N "'
m-c
From _._To Fi. In. in. N
16. SAND/GRAVEL.PACK CO o
Depth
Size Material =
From To FL
From To FL
17. REMARKS:
1 DO HEREB�,,i.4 TlF TRAT1THISI IN ACCORDANCE WITH 15A NCAC 2C.WELL
CONSTRUCTIGIN STANOARDIS ANO THAT'A I F THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
-�LI� J I- =.; i I - - o
FOR OFFICE IIISEDNLY , OF SrRucnNG
Cued NisLi1 - b f Division d Water Quality.Groundwater Section within 30 days
li DATE
GW-1 REV.
t

2 A 0
North Carolina Department of Envin nnfc and NaOaatReaotrceS-Dtvm of Water Quality.-Groundwater Section _
1636 Ma Service Carder-Raleigh,N.C.27699'16i84Thiere(919)7333221 " -�
WELL CONSTRUCTION RECORD wet
CONTRACTOR: 7%X"��j��/�/ Azar' St
��`>
WELL CONTRAC1DR CERTIRtATION t: 4'VS3
STATE WELL.CONSTRUCTION PERMITL
1_ WELL USE(Cmdr Applicable Bosh Residential(`��, Q al ElOthr UUse:nctustrtas CI A �❑ Monitoring El
Recovery ElHeat Pump Water Infection ❑
If 2 WELL Taw t da,'oi`SCow ch of 1,./A: location below) tY /4 `yt<K�c
Nearest Tmwc
(Road Name and Hunters.Community.or Subdivision and Lot No.) DRILLING LOG DEPTH
3. OWNER ChAC ley Teat QIAF Flan To Forme/on Desaipaon
Address O • 1- / 97 ne/C /5f2etd/l�
(Skeet a Route No.)
City or Town Slate Ztp Cade 97 3gS .C/nf eL.R it.
4. DATE DRILLED )1-a9 -01
5. TOTAL DEPTH _I i'1
6. CUTTINGS COLLECTED YES CZ NO❑
7. DOES WELL REPLACE IXISTING WELL? YES [� NC
8. STATIC WATER LEVEL Below Top of Casing V- 'FT. -
(Use'+'8 Above Tap d Casing)
g. TOP OF CASING IS I FT.Above Land Surface' • -
•
- -Top of easing terminated attar below land surface requires a venoms In actor.::. .... . . .. ..
dance with 15A NCAC 2C.8118
10: YIELD(gpm): /.J METHOD OF TEST /11'�— •
11. WATER ZONES(depth): a
12. CHLORINATION: Type 1 i Lls Amount 6 _ If additional space is needed use back of form
• 13. CASING: LOCATION SKETCH
War TMcasess
Depth 7) Diameter or NeigMrf. Mateth$ (Show direction and distance from at least two Slate
• From 7' 1 7. To / FFL- (D--T-- 1 c / �f CFI - Roads,or other map reference points) .
From To FI.
From - To A. .. -. . . _
14. GROUT: cp o_
Material ,Dep;hh T Ft. (l.a yn t3AL /,Method LL�e tn -r.'.'._'
•
From0 To d71 n �_.• ;
From To FL
c
15. SCREEN: '4 ;Sc.-Depth -Diameter Slot Size `,Material - -o i
From To Ft - In. _ In. S r
From To FL In.. In. cr
iV a
From To Ft. In. In. f.. -)
16. SAND/GRAVEL PACK: co oz
Depth Size Material
From To Ft.
From To Ft.
17. REMARKS:
I DO �EBY F,RTIFY THAT THIS NSTR)CTEO IN ACCORDANCE WTTH 15A NCAC 2C.WELL
HHEE I AND_THAT A OF THIS RECORD HA$BEEN PROVIDED TO THE WELL OWNER
CONSTT{W FT�T'cil�iDAdOS.
FOR OFF14>•=}!SE ONLY ,, , .) DATE
ft SIGNATURE OF PERSON CONSTRUCTING THE-WELL
Ottad l i 4. Sn6c-nR o of to Okialan Waler avail.Gmdwa tater section Within 30 days
. GW-1 REV.
serial No. -._
1

. -
:' - t]wtafon of Wider Ow�g-t3rourdwatet-3taelbru O .- C ._ -.: .. .
1North836 t'.d Swlktaam
- of Raleigh,Erw N.C.27 and i6364:1 t - - :_...,. -
1ti36 Matt Servks Cart- N.C. -76 -Pl+rltw(919)T�i 21' • ..
WELL CONSTRUCTION RECORD WELLcovmAclon:
-fah tar WELL Tt CONTRAC OtH t .ATTON i►: c 'Y3
. STATE WELL CONSTRUCTION PERMIT*
1. WELL ry�( mom m Residential t Municipal El Industrial O A9*�Itural❑ Monitodng El
Heat Pump Water Injection u Other Ei It Other,List Use:
Recove
2. WELL LOCATN](Show ��91yeocationbelow , I
NearestTaaet Q�/ ll,l f7 D
G-'r e t i- DRILLING LOG DEPTH
(Road Naas and Nrmibers.Ccennva ity.or Subd vlekn and tot No.) DRILLING
To Formation DesviQBan
3. OWNER Oq\d, I�OcKC<� Fra�- / Ito 4 t5€ pef2a'0it.
Address 0
(Street a Rode Na)
Sly or Town Sale Zip Coda j\0 a 05 - kn.Li-a
4. DATE DRILLED /C-RR
O.`i c
5. TOTAL DEPTH O
6. CUTTINGS COLLECTED YES ar NO(—{ -c
7. DOES WELL REPLACE EXISTING WELL? YES [] NO�' c,
c3 o�
8. STATIC WATER LEVEL Below Top sofCasing (00 .FT- - c c„C
(Use'+it Above Top d Casing) -_
9. TOP OF CASING IS� FT.Above Land Sudan' . - . t I am
• 'Top of easing tennetated allot below land surface requires a varWroe In sceor-:.. -_ .. .. .' at0
dance with 15A NCAC 2D.0118 _ -7� >e
pm
10. YIELD(9Pm)- I • METHOD OF TEST Q+, •
C� ni
• 11. WATER ZONES(depth): CA
12. CHLORINATION: Type i i Lt 5 Amount. -1 If ea:Nonni space b needed tee bath of fora a
13. CASING: LOCATION SKETCH
Wad elgiwThickness Shaw direction and distance from at feast two Slate
/ Depth C aammypper a Welgtte a. old ed�aj(
From 4- To VI O Ft. �p"' #a-l i/u''-" C G Roads.or other map reference points)
•
Flom To Ft.
From - To Ft. -. . .
14. GROUT: Method
From
�n Depth" A Material l /J
(J To "CV Ft. P-r EAT. ✓e
-
From To Ft.
15. SCREEN:
Depth Diameter Slot Size t.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 F?.
From To FL
17. REMARKS:
r�--- IS fl O IN ACCORDANCE WITH I5A NCAC 2C.WELL
I DO MESSY F:fTIIF/THATT A11n :I.WAC**Y CF THIS
_
CONS Er)) IEeTAwne1 arJn Tud CIQPY OF THIS RtxO� OVIDEO TO THE WELL OWNER. -a..a2 -U
--
FOR OFFl ��Y`yy E O��.I-!L D ZO DATE
Goad No: L L,I ' C.D G v LUO[ - SIGNATURE OF PERSON CONSTR within'Nile 30 days Sublet oriel alto Division d Water Quality.Gmudaater Sectfoa y GW-1 REV.
Serial No.
CRGII CWAAT R 6EC IO i
Ac E.V LE REGIONAL OFFICE
�_— p
t

•
Seatian n ��9
North Carona Departmental Environment and Nairn ..
sorces-Markin of Wader DuallyYV Grourdweter _
1838 Mali Sarviee Carter-Raleigh,N.C.27W94ti3B-PttaTle(B19)7S1'322f - �O
WELL CONSTRUCTION RECORD s-
wacoN acrt n:
WE I.CONTRACTORG ATLON it: 4 4'360
STATE WELL CONSTRUCTION PERMITS:
1. WELL
Appaobte ttmr):Residential tr�> j Municipal 0 Industrial 0 Agnlcun tral 0 Monitoring 0
RE
Heat Pump Water infection 1_ Other❑ 1t Otteir�,List Use:
2. WELL LOCATION((Shovi(s e of the location below) /1� D DU
Nearest�/ Towrc o t0 Courtly 7
/'/ui( eC. �T DRILLING LOG D H
(Road t and N urters,community,.or Subdivision and Lot No.)
3. OWNER 'ifvat Sieh5 From To Formation Desoipeon
Address
t / 90 D/42 8ea�on-i
(Skeet a Route No.)
CaraTowrn Sum 21pcade QC 3;5 ...eft Li-a
4. DATE DRILLED /o-/9-a l
5. TOTAL DEPTH 5a5
6. CUTTINGS COLLECTED YES ar Nor}
•
7. DOES WELL REPLACE EXISTING WELL/ YES [] NO
8. STATIC WATER LEVEL Below Top of Casing: /op FT. - c
(Use . It Above Top of Casing) • . n -
9. TOP OF CASING IS Fr.Above Land Surface' ' - o ,
rewires a vadano In green - - . .. .. c c
'Top owith IS NCAC ed actor below land surface feq - 0 c m
ni
dance with 15A NCAC 2C.a118
10. YIELD(gpm): 5' METHOD OF TEST Pia .iicm o<
11. WATER ZONES(depth): >0
'9 -
12. CHLORINATION: Type fl i tL S Amount__i. if additional space is needed use back of tonne,= n m
13. CASING: LOCATION SKETCH Cri -"-I
WW1 Thickness
Depth ab-
c)am er a WeighUH. Mat (Show direction and distance from at Ica;two St2 _
From '� I To O Ft f P Ira-, f/aA t i G Roads.or ether map ref aroma points)
From To Fl.•
From - To Ft. .. . .
14. GROUT:
Depth
h � Material _Method
From O t e
To Ft. me—AI POLL✓ea_
From To Fl.
15. SCREEN: Depth Diameter Slat Size -Material ,
From To Ft ' In. In
From ____-To FL In. In
FromTo Ft. In. In.
16. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To FL
17. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C.WELL
CONSTRUCTION$JAND4Rr1q,MO_THAT A COPY OF THIS R�BEEN TO THE WELL OWNER
FOR OFFICE USE ONLY_ -- II DATE
Tl1RE OF PFASON CONSTR THE W61
O'er f� of Water Gtotar twaler Seeaon within 30 days
Sulam!edgwl �' GW-1 REV.
Seri No. ) ���(. .
u,L oFFir,E

•
O417n" 6 - - -_:-
Noth carom.-Department of Environment and Natural-Reaotrw-Dtvlsfen_of Water Cu Sly-GrotadwatrS Son
1638 Mall Service Caret•Raleigh,N.C.27W9-1t33B-PNo11a(B19)7333?2t'-'
WELL CONSTRUCTION RECORD WELL CONTRACTOR: -0( )t dam` )
WELL CONTRACTORC ATION fk tS2 4436
STATE WELL CONSTRUCTION PERMITN:
1. WELL USE(aria Apptlabts Boat Residential Municipal 0 Industrial 0 Agriculduaf 0 Monitoring❑
Recovery 0 Heat Pump Water InfectionU Other Ell It Other,tint Use:
2. WELL LOCATION:(Show sketch o3 the location below)
NeareatTawm Lnoy rt.)e_4n tp11 if P County. 4 t4y lid 1)n�
Ti. G r e e K- ex_ DEPTH
iH
(Read Name and Numbers,Community.or Subdivision and tat No.) DRILIJNG LOGFerrPt
3. OWNER gLotC.SIro. (;CO�Jr' From To
Desolption
Address ' 71- / to6 Q!/,Ck Sea hit.
(Street or Rouen No.)
City or Town State Zip Cad' Ln-5 "0.5 21.9 -fl it e
4. DATE DRILLED to-a3•o1. c
5. TOTAL DEPTH 7(35 L—
.) o
6. CUTTINGS COLLECTED YES f NOD c'
7. DOES WELL REPLACE EXISTING WELL? YES 1-1z NOP' u o
8. STATIC WATER LEVEL Below Tap of Casinc )So 'FT. - • {
(Use'+'OMews Toed CasYq) • 1 t-'"
9. TOP OF CASING IS FT.Above Land Surface' - . to vr r
ni
'Toy of easing terminated al/or below land statue requires a variance In Kea - ... .. .. - _ m
. dancewlth 1SANCAC 2C.0118 2Nz
10. YIELD(gpm): '/a METHOD OF TEST R:c L3 r-na
11. WATER ZONES(depth): '' 2
CT
12. CHLORINATION: Type P i U.s Amount. C0 It additional space is needed use back of loan
13. CASING:
LOCATION SKETCH
Wait Thickness
Depth C.' er m WeighVR. Mated (Stow direction and distance learn at least two Slate
• From 1`/ To (t S FL 1 t' '46024 'pI{`'tx1 G Roads,or other map reference points) -
From --- To Ft. r
From - To . Ft. .. .. _ .
•
14. GROUT:
Depth Material ,Method i
From d To Ft. (I'ernEAt I OLL✓eU-
From To Ft. •
15. SCREEN:
Depth Diameter Slot Size Material
From To Ft ' In. In.
From To Ft. In. In.
From _.__To R. in. In.
16. SAND/GRAVEL PACK:
Depth Size Material
From To FL
•
From To FL
17. REMARKS:
100 HEREBY CB 1JCTED IN ACCORDANCE WITH iSA NCAC 2C.WELL
CONSTRUCTNipOST}AIJPATTOS,L/1ND,'THAT A CO THIS RECORD HAS BEEN PROVI U ... TO THE WELLEOWNER. 3 �(
FOR OFFICE 7LY
Cued Na
TARE t P N CONSTRUCTINGWELLDATE
'i , .' S;)Wit on atW Water av a y,Grad tslten
warer S vdtlnln 30 days
Sedal Na. i I QW-t .
i L_
N!DYli � SFCTIGN -
1_ _F : ,t,L oFHCE

` North Carolina•Department of Environment and Natural-Resources-Division of Water Queity.GroundwaterSectlon ' a_ O ) - --
1838 Mail Service Carder-Raleigh,N.C.276'99-1636-Phcrte(919)733322T- - "�� .
WELL CONSTRUCTION RECORD WELL coNTRAcroR: x 6�'`,
WELL CONTRACTOR=CERT1 ATION I: 4 4/SO
STATE WELL CONSTRUCTION PERMITh:
1. WELL USE(Cnedc Applicable Balch Residential Municipal 0 Industrial D Agricultural ElMonitoring EltiA
Recovery❑ Heat Pump Water Injection Other❑ if Other,List Use:
2. WELL LOCATION:(Show sketch sf the location below) q
Nearest Tow�mn�
� c-V tn)c� v . (1,,," Count /`7G/ 63D r_) ( .
1N`Name
and n\\ -_ / D e - DEPT7i
(Road Name Numbers,C.covreedty,or Subdivision and Lot No.) DRILLING LOG
3. OWNER C`A0.t\.t tu€T t From To FormationDeac(pUan
Address P t / io3 Dd:R teidon,
(Street or Route No.)
City or Town Slate Zip Code -tea Lie-
r�
4. DATE DRILLED 'L- r�O'b\ (93 3a5
5. TOTAL DEPTH rest
6. CUTTINGS COLLECTED YES( ' NCO
7. DOES WELL REPLACE EXISTING WELL/ YESp NOM
8. STATIC WATER LEVEL Below Top of Casing: 0 'FT. -
(Use't If Above Top d Casing)
9. TOP OF CASING IS FT.Above Land Surface' ' -
'Top of casing terminated et/or below land surface requires a variance In actor _ ,. . . .. ..
' dance with 15A NCAC 2C.0118
10. YIELD(gpm): _METHOD OF TEST ksc
11. WATER ZONES(depth): -
12. CHLORINATION: Type C i lets Amount t If additional space Is needed use back of loon
13. CASING:
LOCATION SKETCH
Depth 1 Clam ter Wor WWeian ight/ . Mated-1 (Show direction and distance from at least two Slate
From 'r / To b✓ Ft. I P 4 �a2-I �Q�Cr"' ' G Roads,or other map reference points)
From To Ft. Y
From -- To ' Ft. _ _.
14. GROUT:
Depth, T Material y tjlhcd ,1 c
From d To oW Ft. (1'emeh/ /J -t&eJ- a o
From To Ft. C 2=
n o�
15. SCREEN: —Icm
Depth Diameter Slot Size `'-Material - Ca 0<
From -._-T_TO Ft " In. In. — yo
From To Ft. tn. ln. MC xi o
From To Ft. In. In. p1 man
16_ SAND/GRAVEL PACK cv
)V
Depth Size Material N o
From To Ft. 2
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 EEN PROVIDED TO THE WELL OWNER
FOR OFFICE US€.bNLY (r - _ /0 -.7 -e/
Quad No: -_—=-1 -2 S *1 NATURE OF PERSON CO UCTING THE WELL DATE
t i,,.
r.
'
Submit gfaai to Division al Water Qualify,Groundwater section within 30 days
q99 GW-1 REV.12/99
Serial Ne. i J
� .. ../
l Groundwater Section
11) Asheville Regional Office

` ( ,_ 1
North Carolina-Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section r2 3 O 9 a 3
1638 Mali Service Center-Raleigh,N.C.27699-1638-Phone(919)733=3221 - ""y p
WELL CONSTRUCTION RECORD WELL coNTRACT �(7f�OR: its� )
WELL CONTRACTOR CERTON I: 4 yS(70
STATE WELL CONSTRUCTION PERMITS:
1. WELL USE(Check Applicable Box):Residential Municipal 0 Industrial 0 Agricultural 0 Monitoring❑
Recovery 0 Heat Pump Water Injection Other Ei If Other,Ust Use:
2- WELL LOCATION: (Show sketch of N1¢¢/location below) )`
Neares Town: L JCII to e s J 1 1 I e County. lily y IAJ co
•
(Road Name a'n'd'�N^umbeprrs.Community,or Subdiivisl and Lot No.) DRILLING LOG DEPTH
3. OWNER V n cS_/ Sri i'lL From To _) Formation Description
Address // f/ 'O S ,a ,tie /"2IO/.,
(Street or Route No.)
City or Town State Zip Code S- Y r J L tJ C LA L e.{-
4. DATE DRILLED ' V-D/ J .u/l)
5- TOTAL DEPTH n 2 CRT
6. CUTTINGS COLLECTED YES Id! NO1-1
7. DOES WELL REPLACE EXISTING WELL? YES n NO9'
8. STATIC WATER LEVEL Below Top of Casing: yn FT.
(Use'.'It Above Top of Casing)
9. TOP OF CASING IS I FT.Above Land Surface' •
'Top of casing terminated at/or below land surface requires a variance in acccr - ,
dance with ISA NCAC 2S A118
10. YIELD(gpm): /0 METHOD OF TEST i
11. WATER ZONES(depth):
12. CHLORINATION: Type ( i its Amount /5 if additional space Is needed use back of form
13. CASING:
LOCATION SKETCH
Wall Thickness
Depth /'(/ arneter or Weight/FL Material (Show direction and distance from at least two State
From -f i To s- Ft. ?0 it 02-1 /p/a-c G Roads,or other map reference points)
From To Ft. p -
From To Ft._ --._._. o
14. GROUT: 0
Depth., a Material Method c-)
From d Too .!/ FL (t'QYhCAt j PLLr`t' , r- a%n
From To FL ='
15. SCREEN: c ti
4- -c
Depth Diameter Slot Size -Material -- A -`>0
From To Ft In. In- _ co
From To FI. In. In. O m r 1�
From To Ft, in. In. 0
16. SAND/GRAVEL PACK: CO i
Depth Size Material
From To Ft.
From To Ft.
17. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C.WELL
CONSTRUCTION STANDARDS,AND THAT A p OF THIS R CO D HAS BEEN PROVIDED TO THE WELL OWNER.
FOR OFFICE USED �. Jy d
Quad No: ATURE OF PERSON CO RVCTING THE WELL DATE
1 fort al Water Q mtfty.Groundwater Section withIn 30 days
Serial No. GW-1 REV.12/99
1 .
t,pt Iloundwsr Section
Asheville Regional Office

North Carolina-Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section 2_0 t 5_7 r3
1636 Mail Service Center-Raleigh,N.C.276 9 9-1 6 3 6-Phone[phone] ' - '-I
WELL CONSTRUCTION RECORD WELL CONTRACTOR: Jar it- 4-6`J
WELL CONTRACTOR-CERTFFI ATION 1: 14 5/36
STATE WELL CONSTRUCTION PERMIT.:
1. WELL USE(Check Applicable Box): Residential Municipal❑ Industrial❑ Agricultural❑ Monitoring❑
Recovery❑ Heat Pump Water Injection Other 0 if Other, List Use:
2. WELL LOCATION: (Show sketch of the location below) q.��� w O O�
Nearest Town- r,ACi7 a5 i 1.p 11 County: 1rf
(-1-\\P‘rjs Ge
(Road Name and Numbers,Community,or Subdivision and Lot No.) DRILLING LOG DEPTH
3. OWNER 'Tv in 1'\D\on.^b l'yC Formation Fran To Foation Description
Address I t- / To CLI? DI/ei ,fSeidon.
(Street or Route No.)
Gry or Town Stale Zip code r? r .2 r l LA if e-
4. DATE DRILLED 2D -f) (
5. TOTAL DEPTH 1-12S
6. CUTTINGS COLLECTED YES CET NOn
7. DOES WELL REPLACE EXISTING WELL? YES n NO 1
8. STATIC WATER LEVEL Below Top of Casing: FT.
(Use•+'if Above Top of Casing)
9. TOP OF CASING IS I FT.Above Land Surface•
*Top of casing terminated tutor below land surface requires a variance In actor- - ..
dance with ISA NCAC 2C.0110 nn
10. YIELD(gpm): c METHOD OF TEST ,5
11. WATER ZONES(depth):
12. CHLORINATION: Type 1 i(A.5 Amount- I D II additional space is needed use back of form
13. CASING:
LOCATION SKETCH
Wall Thickness .--
i Depth f.7/ameler or WeighVR. Maled,,at[ (Show direction and distance from at least two State __
From 4- I To Ft. p 0 a-/ f/u"` ,G Roads,or other map reference points) Cr ,
From To Ft. c—
From To Ft.---- —'- N
14. GROUT: UN r-
�1 Depth Material , Method --
From D To oW Ft. (1'QYh E/lC �J t1 f e �'
From To Ft. v
n
15. SCREEN: N
Depth -Diameter Slot Size Material - cn 0
z
From __.To Ft in. In. -
From --_To Ft. In. In.
From .To Ft. In. In.
16. SAND/GRAVEL PACK:
Depth Size Material
From To F!.
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 S RECORD BEEN PROVIDED TO THE WELL OWNER.
, FOR OFFICE USt.ONLY "— I ._ � ��/
Quad No: '' SIGNATURE OF PERSON ONSTR�I TING4NE WELL DATE
Submit original to Division or Water Quality.Groundwater Section Within 30 days
Sedgi No. GW-I REV. 12/99
t 1
a

I
North Carolina-Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section ��_� 0
1636 Mall Service Center-Raleigh,N.C.27699-1636-Phone[phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR: C/yde sicza/t=C cfr sot)
WELL CONTRACTOR CERTIFICATION if: .25/L1Z,
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE(Check Applicable Box): Residential9--Municfpal ❑ Industrial❑ Agricultural El Monitoring❑
Recovery❑ Heat Pump Water Injection ❑ Other El' If Other, List Use:
2. WELL LOCATION:Qiyes'q 0 ilec.location below)
County. /��y &4 00�
Nearest Town: �
,4 -de Ln4 u
(RoadName and
�Nuu imrs.Community,or Subdivision and Lot No.) DRILLING LOG DEPTH
3. OWNER /"/Gt N PO era 'o rI eS From To Formation Description
Address
(Streak or Route No.) -71--/ 7t L)velm. Ut`f tva
City or Town State Zip Code
4. DATE DRILLED O '0 74-15- Tv 32 �i-/'4`r''D c
5. TOTAL DEPTH 32�5� .—
6. CUTTINGS COLLECTED YES El NOQ� `'r
7. DOES WELL REPLACE EXISTING WELL? YES ni NO Et"--- cam;
8. STATIC WATER LEVEL Below Tap of Casing: 3D FT. 'e=
(Use'+'II Above Top of Casing) - . I
9. TOP OF CASING IS / . FT.Above Land Surface' r:
*Top of casing terminated atlor below land surface requires a variance In actor- m c
dance with lSA NCAC 2C.031.8 O cam:
10. YIELD(gpm): 7 METHOD OF TEST {-r a
11. WATER ZONES(depth): TOi
CO ..
12. CHLORINATION: Type Pt(IS Amount cP If additional space Is needed use back of form
13. CASING:
LOCATION SKETCH
Wall Thickness
Depth Dla ngter or WelittUFt. iptedak (Show direction and distance from at least two Slate
From '�'"/ To 5 Ft. 67 #1 / Roads,or other map reference points)
From To Ft.
From To Ft.
14. GROUT:
Depth Material L Method
From n To .26 Ft. „„Material
e0"'r•rS---
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 Fl.
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
� �RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
FOR OFFICE USE ONLY DATE
Quad No: SIGNATURE OF PERSON CONSTRUCTING THE WELL
i Submit original to Division of Water Quality,Groundwater Section within 30 days
Serial Na. OW-I REV. 12/99
y)
3 4
d
.....1 MAI-, , `i_ _..
I
Crotundwats«S-S
Asheville ep`!:

•
r
North Carolina•Department of Environment and Natural Resources•Division of Water Quality-Groundwater Section 2 4 3 t) 0 5
1636 Mall Service Center-Raleigh,N.C.27699-1636-Phone[phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR: 30 bhr A al. P044
WELL CONTRACTOR CERTIFICATION N: I Qa 2
r-
-,ESTATE WELL CONSTRUCTION PERMITN:
1. WELL USE(Check Applicable Box): Residential[3 Municipal ❑ Industrial❑ Agricultural❑ Monitoring ❑
Recovery❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: Wniine5 v11le County. I-1auL.IQeD
(Road Name and Numbers.
CCommunlly,or Subdivision and Lot No.) DRILLING LOG DEPTH
3. OWNER Sieve J VA4Okj From To Formation Description
Address 31 I G eot e'5 `P r.�,d .
r (Sheol or 1MpCo.) n$�$C D 90 r 1 /�
�Cn rT�vi1le IIIISttk\\tailte' Zip Code) 90 - a105 Rfd-egt is .
4. DATE DRILLED S- 4-O I -
S. TOTAL DEPTH 5Z foe C a
6. CUTTINGS COLLECTED YES Ell NOM o �s
7. DOES WELL REPLACE EXISTING WELL? YES n NO T. cs c0'
8. STATIC WATER LEVEL Below Top of Casing: g d FT. — o-
(Use'.'it Above Top of Casing) asn,
9. TOP OF CASING IS 1 FT.Above Land Surface* a ri--
'Top or casing terminated aVor below land surface requires a variance In actor- "r �c
dance with ISA NCAC 2C.9118 7,. cn�
10. YIELD(gpm): SO METHOD OF TEST C, cs
11. WATER ZONES(depth): as o
12. CHLORINATION: Type Amount A/S+1 Il s If additional space Is needed use back of form
3ASING:
Wail ThicknessLOCATION SKETCH
Depth Plameto r eiglict Materrial. (Show direction and distance from at least Iwo Stale
From O To 90 Ft. w '''• I b LYS.: Roads,or other map reference points)
From To Ft.
From To Ft.
14. GROUT: G r
Depth Material Mot U lQ d f �rLlQ 5 �Y•
From �_ To a 0 Ft. Ct a2N E ttl. �.1
From To Ft. WQi{n Vl 1 IC/ uti�C.
15. SCREEN: ��ll
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 cEnThrtmALT STRUCTED IN ACCORDANCE WITH ISA NCAC 2C,WELL
CONSTR STANDARDS,AND.tIt4TA OF THIS RECORD HA72ViDO THE WELL OWNER.
Ir - 1I it
-OR OFFI ONLY _.t 1 1 ,
dad No: in jl l NATUR F PERSON CONSTRUCTING TIE WELL DATE
:u-Submit ir4laral o Division of Water Duality,Groundwater Section within 30 days
Serial No. I GW-1 REV. 12/99
I .
:�. ..

III IT T ':, - ..I... _ - " 7 ry •. llr.e @11ACIA $ y .:.$i' 1 ,
! 1 1 .
•
1 .. I r. 1/. fhai I si "►,. : Ibe�wr"MMr? ,ty., , „ •
, ., . . , .,
I I , ' 1 i'• i -,.E %• ,.; . j 1i,l"i}�t gait . r
i F, � , ` 1 - 243 1
I ; ,' ,, 1 , , na '
:gob Cnrrc,n . I h.:to •n'n1 11106ti„ant rind nnitltni nnnhorcee•1/lvklen ci Mtn Oriehly•OuoNntwnl1 1 Snc11""
1636 f.1n11!'^rite „Cnn,r, IlnirluI,,I It.21699 163ed'honn 1?191131.3221t ' • ' • t;. (/Nr
- ! alin
WELL GUI IS1 III 1U11011 iUECOUIU 1 ' wia.t.comnAC1on:
1NELL cofilnncton ermine/1llc 1 .: •, -r. �o71?
i SIAlEWE(L cons,nUC1ION1'Elltdlle: _--- __ ____ _.--
_-_.._.. .1
1, VlEU 11C1' trh•cl.n1.flb IN.tin.): ilasldnnllnIt ; MnnleirmlU Inducldnl U Agdcullnrnl t_J Moellering L_I_.
Outer II Other,list Use: —
Ilecnvrry I _1 I kitPolypWnlot Injection , ' U ,
Z. WELI I (I('A11Ol1: .4 hmv sNr Ich a?the hocelloll below)
NnnIP°I In n WSJ n C A,s Flo lcuunry: ----.
I ' t ,
_ I Ut11LLINO LUt3._l. _ - - UErll .....--
tnp.•R,a n �.I^lm�,i_, �L�u,.n.�,n�n.ndly,or Sulxevblon and�bl No) f1011) To f om,enon UcSc,rPnnn
ag ' --- --
Addrf�a r - ca — ...
p,t,,•/1�l� Ir,,rl9 Y1C 8Z4 a--; Fern_
I "Ira,. Celle ,. r , 1 pseuds , S
Ciry m ,n , I
ad9d / I1 1 1 `' ,,
5. ioG. tAl. l!rI1111I C 1E )--^U I Nog '
7, UOES wrl.L I111•1 ACE Ilelew o WELLS YES (J HOLD z
8. SIAlIC WA!Ell Lt;VELflclowitwee sing:`_3co .fl' '.
tuns'"'Mpybvs tor olcoot"... i -----i---':Th; ,,,;-,
g, lop r r CASIr1(1 Is___( _- Fi.Above Lend Seance-I ; '
z`=
donee
nee well it
tricnctn,l nl'rt helovllend tOdeeeitluVS aVldenGs Ifs.e0001, Q �.
d,nee w 01 tort O. _-,n e I "!II ' 9 --- -4�
10, YlE1utoIn,) _- ME`IIIOUOFI EST.
11. WA1E117.0i1E5(d^pllt):_Lf - ' I : , _.._-
1 J_ m
L ` II eddlllonnl mince is needed rise hock el hem mx
Anrouul..�--�� O o
i1Z. CIIL(mI11A11OtJ: lyre- _i.1J-�-r' I j
• 1,! l ;i I ii{ t ,. \
13. CASIIIG: ,, ' LOCA11011 51(E1CF1_
". Wag lhklnMs
LINO //tC le`�e,,� btt vintteigni, meeann`lyer�� (Shaw direction runt dlstenr:n bete nt lend two We
�� rl.Yi2'✓ .. .v'F""-- i G•,hoed, or oilier nay rere,ei,ce pvinu)
Flom_ - -in - 1 ,•
Ff P�
I
from . . _. _I,•... FL 1• 1 I � t
14. GllOrn: �7 _plated L, '
1'rplh M-nhad�al-�I � Meth , : tonrct
trout U. -- lt, � n. ^
„
,' I from __.._ to _.__ 1 ` 'J.
15. SC111:1711. I 1 I I Mnlminl
Itrl,ll, IUlrnnole( I Slot Site I $ I l
! - 1 ..._-:-. hl ; -" 1 .
1 1 .
F -t''—'� P �j- - - .' h, ' r ?
r - o r , 1 . al ( , � t �11,tt 1 ..
18. S ,IIAVFI.PACK:1C. , ��i 1. , f t i`i1"g N -•.
1 1 Mnlellnll , i1 I• -
. AlF1Ih tP. f
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, 1
,. pt1A98EENrrt te� Ep1Ct T11EWGLt.DWIirn.
� IbUlirllr nr C.Fllnfv Tt let 11119 WELL WAS
CUNS,rIIUtl(EU III AC'IU110nJJCE WIIII ISA 11(:M.24„WEII. �VD��-
COt I S I wiry,1Ur l S I ANnA11U3,AND 1111AF A COPY OF 111'9 ItF•� ---_r•
91n11AIlUnE OF FF1 S011 C011919U ItIM ins W[,1.
On1E
Ian iil 1 ICE USI°.oi1LY 1I1 I Nut!Won Wllhln 3O drays
Obed IIo _.- .. Y41 9uM,tl1 bdpind to blvblon ut WUN Ouldny,Oralk,tM 0y(.1 nu.
V199

. I
North Carolina•Department of Environment and Natural Resources•Division of Water Quality-Groundwater Section 243513
1636 Mall Service Center•Raleigh,N.C.27699-1636-Phone[phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR: BO b kt, al". Yo4-1-s
WELL CONTRACTOR CERTIFICATION I: t Oa g
,/STATE WELL CONSTRUCTION PERMIT'S:
1. WELL USE(Check Applicable Box): Residential l.ta Municipal El Industrial❑ Agricultural❑ Monitoring El
Recovery❑ Heat Pump Water Injection ❑ Other El if Other, List Use:
2. WELL LOCATION: how;ketch of the location below) I
Nearest Town: ('a v+'.i1 61^") county: W(3 Oa -
(Road Name and)(umbers.CorymunitQ y�jbdivision and Lot No.) DRILLING LOG DEPTH
3. OWNER 'J .3. L From To Formation Description
Address 4 ii:e)el oriprCo °IL
° k D - 5 s r 2+cia , ov N^^C 3, 'l lLa S q - 90 S' fd.c/3de,
City or Town Stale Zlp Code
4. DATE DRILLED ,, -1-D I -
5. TOTAL DEPTH 4D A ' ,f
6. CUTTINGS COLLECTED YES f] NOI v f
7. DOES WELL REPLACE EXISTING WELL? YES n NO( of
8. STATIC WATER LEVEL Below Top of Casing: .C/ FT.
(Use':II Above Top of Casing)
9. TOP OF CASING IS I 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): 1 1-'3 METHOD OF TEST
11. WATER ZONES (depth):
s
12. CHLORINATION: Type Amount 7D
N If additional space is needed use back of form
13. CASING:
LOCATION SKETCH
Wall Thickness
(� Depth 4 O, Plamele r� eig IV 1. Maateddaall (Show direction and distance from at least two State C
From To J 7 Ft. —�__ r am" Roads,or other map reference points) 0 o
From To Ft. ^ i t-, c'-
From To Ft. {�/�L I , r, „ n o^
/ r I -c^�-'� cmi
14. GROUT: CD.—
Depth Material Method r.,
yc
From To a0 FL CbnaEfE - 1IC, , j�.6G1 = ,m
From _ To Ft. '� "J O cnz
15. SCREEN: rt'
Depth Diameter Slot Size Material U7 n
to o
From To Ft in. In. x
From To Ft. In. In.
From To Ft. In. In.
16. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
17. REMARKS:
I DO HEREE
__ TRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRU 0&AND`fl�A1tAc FTHISRECORDHASBEEN ROVIDEDTOTHEWELLOWNER.
FOROFFICIII � /�� ' � y -tOuad No: ,iMM'' I ATURE OF ERSON CONSTRUCTING THE WELL DATE -�-
1guimll o f 0 Division 0i Water Duality.Groundwater Section within 30 daysSerial No. GW.1 REV. 12/99
I
S'r '
1 ,LI.E10"

•Division of Water Quality•Groundwater Section (� ('1
North Carolina•Department of Environment and Natural Resources2 4 U 9 1 0
1636 Mail Service Center-Raleigh,N.C.27699-1636-Phone[phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR: I ',epem.w,t(a/al Er7 1 ilocjinc
WELL CONTRACTOR CERTIFICATION #: 0,b R-6
STATE WELL CONSTRUCTION PERMIT#: L-C,;T
1. WELL USE(Check Applicable Box): ResidentialL6J Municipal ❑ Industrial❑ Agricultural❑ Monitoring ❑
Recovery❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATION how s k tQ ch of the location below) //� �� ,/
�fY�� Court :`C a
Nearest Town: ty
(Road Name Numbers,Com�uni y,oror Subdivision and Lot No.) DRILLING LOG DEPTH
3. OWNER �� p ./ /I�J rL From To Formation Description
Addres� [� r��/J�y 17 - 7'! �l 1-
l)/J(!iloll (b eetorAa+�-r1o,,) p ,� ��a r - ,{'�" a1R
City or Town State (' Zip Code •
4. DATE DRILLED 7
5. TOTAL DEPTH S
6. CUTTINGS COLLECTED YES❑ NOta
7. DOES WELL REPLACE EXISTING WELL? YES ❑ NOM- c
o t.:,
8. STATIC WATER LEVEL Below Top of Casing: FT.
(Use':if Above Top or Casing) 'TT 17
9. TOP OF CASING IS I FT. Above Land Surface' v `'
*Top of casing terminated at/or below land surface moults,a variance In actor- I ::,
dance with 15A NCAC 2C\111a : ;'�
10. YIELD(gpm): METHOD OF TEST r/t i ---
11. WATER ZONES(depth):
�I c Nc tQA Amount /3 - ' If additional space is needed use back of form co 2 L
12. CHLORINATION: Type _
13. CASING: 0
LOCATION SKETCH
Wall Thickness
Depth r� Diameter or Weight/Ft. Mate
'al
� (Show direction and distance from at least two State
From + To I A FL (r (7I Cne ''7 F s•c' Roads,or other map reference points)
From To Ft. ���
From To Ft. ' - LJv .L.\'\ `- C_;\:Li
14. GROUT: ics " -c_ r'�� . :'. 6.
Depth Material Metho _
From i� To �0 Ft. �Q )1°0/A Qlcer 1� a s,Q �\ C c' y\d/ �j
From To Ft. U _\ i�) r'
15. SCREEN: -
Depth Diameter Slot Size Material �-L,�� \ �w
From To Ft In. In. 1
From _To Ft. in. In. —Th r I a C C F-/
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 .i CONSTRUCTED IN ACCORDANCE WITH ' C(EC 2pW WLR \\i; '�I
CONSTRU .re . lra 1';'',;A$ le OF THIS R ORD BEENPR2VIDED THEME OWNER : i,
FOR O: • 1 • ' feel, (7 DATE l
Quad No: h; lY !I aii GNATson OF PERSON CONSTRUCTING c* tLh
':Su�cri{)inal to Division of Water Oualily,Groundwater Se km thin 30 days
[, a 1 GW•1 REV. 12199 1 Serial No. i� - —
l
Cro+lndtva r Section
Asheville regional0 t e____ j

Natural Resources-Division of Water Quality-Groundwater Section 2 4 6 9
North Carolina Department of Environment and 1
1636 Mail Service Center-Raleigh,N.C.27699-1636-Phone[phone] /�//�� totoWELL CONSTRUCTION RECORD WELL CONTRACTOR: O. /,ik 0//l 2ZU/ 1Ajli_/b/itk510
WELL CONTRACTOR CERTIFICATION#: 0,b R-
STATE WELL CONSTRUCTION PERMIT#: -far'-'
1. WELL USE(Check Applicable Box): Residential ra Municipal ❑ Industrial❑ Agriculture!CI Monitoring ❑
Recovery El Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATION/�SFf skelc t�IQcation below) ���t -,/
Nearest Town: f /uyy ffa County: %�(/Jr C�--
(Road Name and. Numbers,Community,or bdivision and Lot(lo.) DRILLING LOG DEPTH
3. OWNER C_ .(�K-e+' J From To Formation Description
Address SQ S? Rd- & J �0 ` (nf
City or Them State Zip Code
4. DATE DRILLED /I l 9.Q/ O
5. TOTAL DEPTH ri�r7•S- C
6. CUTTINGS COLLECTED YES(l NO1± -rn
rn
7. DOES WELL REPLACE EXISTING WELL? YES NOt rn
8. STATIC WATER LEVEL Below Top of Casing: FT. ' c
(Use'+'II Above Top of Casing)
9. TOP OF CASING IS / FT.Above Land Surface' --- ;
-Top of casing terminated at/or below land surface requires a variants In actor- ——
dance with 1SA NCAC 2C.011a U1 c.-7
10. YIELD(gpm): (2') METHOD OF TEST a A ; w
11. WATER ZONES(depth): Gil "
12. CHLORINATION: Type iat uUu1-Amount I/a C- • It additional space is needed use back of form
13. CASING: (f
LOCATION SKETCH
Wall Thickness
Depth //1 Diameter or Weighhtt/Ft. terialt (Show direction and distance from at least two State
From—. / To— Ft. ta I '/ S `,1 /•"M f / C, Roads,or other map reference points)
From To Ft. 00/ l //0
From To Ft.
14. GROUT: VO / /�� �L ( 7/(0)
/) To :- 1 ['(]iaterial i 27 0 _Method. _ 6 Sad l( (ji C CJ c��From (J To ��/O Ft. L�_� Z- .}lG(�" U /"
From To Ft. a/a_[ L�i��%1 -��
15. SCREEN: - / V) -
Depth Diameter Slot Size Material Q�I,Q ./(_)�
From To Ft in. in. /n CQnLJ
From • To Ft. in. _ In. Y'a' j J
From To Ft._ In. __ In.
16. SAND/GRAVEL PACK: L�Ln
Depth Size Material �Gl�'"` g
From To Ft. •
fr e�Q--
From To Ft.
17. REMARKS:
I DO HEREBY CERTIFY THAT THIS NSTRUCTED IN ACCORDANCE WITH 15 W rNNR.1C' ��
CONSTRUC 4 i V ,fin YtOF THIS RE O�RD BEEN PR VIDEQ I _ r
1u1 UU I155 /, 1� e�IlJ1 /. 4/1)
FOR OFFICE U NL DATE
Quad No: is 1 IONA E OF PERSON CONSTRUCTING THE L,
. Subra ddgin to Division of Water Quality,Groundwater Senior it h 30 days
GW4 REV. 12/99I
Serial No. - IL_._.____.._ ---.J
F
C oundwater Section i0LA
Asheville Recoral Office

North Carolina•Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section 2 5 4 6 1 3
1636 Mail Service Center-Raleigh,N.C.27699-1636-Phone[phone] /�/nn"A",,,� '/� �,/�p
WELL CONSTRUCTION RECORD WELL CONTRACTOR: O/W41L n /L I, I"`//fly J
WELL CONTRACTOR CERTIFICATION#: =��(( cI 1 I
STATE WELL CONSTRUCTION PERMITS!:
1. WELL USE(Check Applicable Box): ResldentialI Municipal 0 Industrial 0 Agricultural,0 Monitoring ❑
Recovery 0 Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATION:(Shov(sketch of the location below) t 'boa_2 ,
Nearest Town: -N`— County: j�..,
DRILLING LOG DEPTH
(Road Name and u rs,Community,o S bdivl an d Lot No.)//1���� Formation Description
3. OWNER /�h CCXC4U From To U�/
Address
/ 9/2f /7 :� ' /0)3 O l /r/,Z///J1 L
ini
( /Y //)XX.P. (Street or e •.) . n p79 y5
City or Town State f�Ozip Code
4. DATE DRILLED //- //a-/)
5. TOTAL DEPTH /c/ S
6. CUTTINGS COLLECTED YES❑ NOdff •
7. DOES WELL REPLACE EXISTING WELL? YES al NO.j
8. STATIC WATER LEVEL Below Top of Casing:, 30 FT.
/ (Use':II Above Top of Casing)
9. TOP OF CASING IS_1—_ FT.Above Land Surface*
'Top of casing terminated at/or below land surface requires a variance In accor-
dance with 16ANCAC2C 518
10. YIELD(gpm): :JY METHOD OF TEST 12/s
11. WATER ZONES(depth):
1 CHLORINATION: Type "'
1
_ __
1rit f I( Amount ( It additional space is needed use back of form
3.
13. CASING: asimarassimaasi
LOCATION SKETCH
Wall Thickness
Depth .ThDiartw,ter or Weight/Ft. Mat 9'Oat n (Show direction and distance from at least two State
From 11 To Ft. 02q 7 Roads,or other map referenceef points)
From To— Ft. I O CCnn.�� 1 0 \�- 1-`�O"`.��U Qjj
From To Ft. ID J n \.@9—t Om. al�.o r t SO`0
14. GROUT: ��^`�'
Depth Material .� MethoL —CO
O eo`1 n_" _ -71
From To cqQ Ft. U/"U/"' �,RIOR Octal,— - C: OcX. ltsl
From To Ft.
15. SCREEN: 'Ben.... / —Depth Diameter Slot Size Material c
From To Ft_ in. _____ in. c
POFrom To_Ft._ _ in. —in. a `;
From To__—FL_ In. — In.
16. SAND/GRAVEL PACK: _1 ,GT
Depth Size Material -
-9 r, -.
From To Ft. s
From To Ft. $' " -
17. REMARKS: r i i1 1,' \i '\��
I DO HERE R T S L
STRUCTED IN ACCORDANCE WITH 15A NCA P I
I
Pa. r I
, ! ,
CONSTRUC C "OF THIS RECORD HAS BEEN PROVIDED TO T _L OWNER.
FOR OFFICE ONLY 1 DATE
Quad No: _ JUN 1 2002 IGNATURE OF PERSON CONSTRUCTING THE WELL —_j
Submi odgina to Division of Water Quality,Groundwater Section within 30 d s_._ .. y[@p,/—__ o.-'.
Serial No. ASE EvLLLE REGiC!iyI OFP-E
GItOUNU ATER SECTION
ASHEVILLE REGIONAL OFFICE

North Carolina-Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section 24680
1636 Mail Service Center-Raleigh,N.C.27699-1636-Phone[phone] et-11/1-00/2-0,ACLUOIC&L-
WELL WELL CONSTRUCTION RECORD CONTRACTOR CERTI:
STATE WELL CONSTRUCTION PERMITN: p4,"l
1. WELL USE(Check Applicable Box): Residential± Municipal❑ Industrial El Agricultural El Monitoring❑
Recovery 0 Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATION:I(S- w sketch of the location below) �o��)nnd
Nearest Town: U iU 0 e p !o ' County:
DEPTH
(Road Name and mbar!,Community,or ,�i't0"and Lot No.) F�DRILLING LOG To Fonnatlon/DesfdpGon�
3. OWNER L •l/.l� 1/iA ' _ /c�a 0
Address 80 O 5-
it
JO' twill Zip Code
City or Tovh
4. DATE DRILLED I0%8/o a'
5. TOTAL DEPTH QOS
6. CUTTINGS COLLECTED YES❑ NOL 4 :_
7. DOES WELL REPLACE EXISTING WELL? YES ❑ NO ] �,
se
8. STATIC WATER LEVEL Below Top of Casing: FT. m ,;
(u •:a Above Top of Casing)
9. TOP OF CASING IS 1 FT.Above Land Surface' 1
'Top of casing terminated.Vor below land surface requires a variance In scow- _
dance with 16A NCAC 2C.0,1,U C.
10. YIELD(gpm): 7 METHOD OF TEST n 1 A -D T
) ":-
C.
11. WATER ZONES(depth): •• ' '"
q _�
/lam%�/Y1Jrf[fl L Amount l/z If additional space is needed use back of form o_
12. CHLORINATION: Type �{�
131 CASING: (f J.LOCATION SK TCH
Wall Thickness Depth Diameter orWeight/Ft. Material (Show direction and distance from at least two State
"""
!"/ To /04 Ft. [,1I/ SD2 01 y laati- - Roads,or other map reference points)
From li /�] ^ (_�Gt 4
From To Ft. ( e
From To Ft. (, ortI 4'k- (9 /2d.
14. GROUT: Q-
/� Depths n q Material,_ ,,Metth�o�dy;� /� �Q �.,p ,n ,,,�L
From n To toa_Ft. Pnb3d 9?-1m°d`v' d X - . /,, li /,, "`^'
From To Ft. lJ . L(/�G.Q �J lie. a9c N
eill-
15. SCREEN: ` i4, o-vi a/EV) a_
Depth Diameter Slot Size Material r-6(�l 't,�,-,�,,o1�3�{"From . To_.__Ft_._. In. _ In. ( . IG��'G '
From —To__Ft.— In. _In.
From To___.Ft.-- In. ._— In.
16. SAND/GRAVEL PACK: Material
Depth Size
From To Ft.
From TD Ft.
17. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSSTTR C ED IN
ORDC ORDANC g ENEP ITHIDED TONC C 2 WELL OWNER.
2C,WELL
CONSTRUCTION STANDARDS,AND THAT Ar
FOR No: 7S • - -. .. - . NGa EWELL DATE
D �IL� d g' : Iriny •
Quad No: q � , �.� � �R ,n of Wider Quality.Gtoundwa S+p on within 30 days
SuWi,,sing' GYM REV.12/99
�' LJ
Serial No. _ ..
1.- '
i GROUNDWATER 5� rll N
c ;
F'`; __�1 11 EMCEE REGIONAL 01HCE

Division Quality Carolina-Department of Environment and Natural Resources D sion of Water •Groundwater Section 246872
1636 Mail Service Center-Raleigh,N.C.27699-1636-Phone[phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR: l -fOn„m-40c.-r" fLA..d .C``-t1- 'Q7-C-
WELL CONTRACTOR CERTIFICATION#: ON ir R-4
STATE WELL CONSTRUCTION PERMIT#: `u. -r__
1. WELL USE(Check Applicable Box): Residential Elf Municipal ❑ Industrial❑ Agricultural❑ Monitoring ❑
Recovery❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATION:(Show sketch of the location below)
Nearest Towne . 'CI z. 4(\QA k-129 County:Y.\CLLjl DC-C6_-
(Road Name and Numbers,Community,or Subdivision and Lot No.) `DRILLING LOG DEPTH
3. OWNER Ejt cCG tttw-O)Li From To Forma�tionD�elscdplion
Address / / O - 70
an / ep t tme t. • 70 - 3LIS Sianrf:r�
/LPna .r ah-2- y14r aQ 3.7aa
City or Town State Zip Code •
4. DATE DRILLED 69/3qt° I
5. TOTAL DEPTH -11-4 S
6. CUTTINGS COLLECTED YES 0 NO l -
=.
7. DOES WELL REPLACE EXISTING WELL? ES ❑ NO[ o
6. STATIC WATER LEVEL Below Top of Casing: /0 5 FT. ,T
(Use'4.'0 Above Top of Casing)
9. TOP OF CASING IS / FT.Above Land Surface' ' `l'
'Top of casing terminated at/or below land surface requires a variance In actor- I r'
dance with 15A NCAC 2C.0118 1 0
10. YIELD(gpm): g METHOD OF TEST au--'
-
11. WATER ZONES(depth):
(31 ;.-(2?7,
o
12. CHLORINATION: Type Q10/hJAO'- Amount /Z�C • If additional space is needed use back of form r
13. CASING: u
LOCATION SKETCH
Wall Thickness
Depth Dir°ter or Weight'Ft. Material (Show direction and distance from at least two State
From—Li- -To 70 Ftc•D 11-1 SIV?�7 tc. Roads,or other map reference points)From To Ft. ()Lie 1-1() , aO • InnG jco-,
From To Ft.
14. GROUT: 6 Or ('so, adp
Depth Material �M�ethodd I_
From 0 To r�.9 Ft. (D K U y1"'_ (Jab uj `o �e'
From To Ft. p '-._ate an W O-L
15. SCREEN: - 1 1
U
Depth Diameter Slot Size Material 6/-bn 6 f I j . W Lift
From To Ft To Ft._ In.in. _ in.In. 6�/• - (1 a00 (�� •e ce
From _ — _ v
From To Ft. In. In. P 1-
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
CONSTRUCTEO%. • •ARBS T • "••• • '� •v • • TOTHE WELLOWNER.
arrivl P- i 7- i 62ti �
FOR OFFICE U` 1 r
Quad No: L I OF PERSON CONSTRUCTIN< - ELL. DATE
I T'1 y 41. of Water Quality.GrounM�ater (thn 30 days
Serial No. All
r•I GW I REV. 12/99
Groundwater Section �6ROUNDWAi ,ECTION
Asheville Re;onal0ffice I ,F; EVILLE REF _L OFFICE

246870
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 n `tS' hi £ `�
WELL CONTRACTOR CERTIFICATION #: 0-,he k4-
CO STATE WELL CONSTRUCTION PERMIT#: mil"
1. WELL USE(Check Applicable Box): Residential Municipal ❑ Industrial D Agricultural❑ Monitoring ❑
Recovery❑ Heat Pump Water Injection 0 Other ❑ If Other, List Use:
2. WELL LOCATION: (Sho��/�w sketch of the location below) �(�
Nearest Town: 4 tadazze-- County: c//i'� �o-ee
(Road Name and Numb,rpornmunlly,or Subdivision and Lot No.) DRILLING LOG DEPTH
3. OWNER &2L.t /2? Quart ) From �To Formation Dedcription
Address /a SOgirs Gr�QC_ Tics- r'rA - QS 6Qt�a/C/JC7A i
City or To State Zip Code
4. DATE DRILLED 0 9/�GA;
5. TOTAL DEPTH .40 S
6. CUTTINGS COLLECTED YES❑ NOEf !"'
7. DOES WELL REPLACE EXISTING WELL? YES E NO,� o -:
8. STATIC WATER LEVEL Below Top of Casing: -3 0 FT. N
(Use'+'If Above Top of Casing) rTt
9. TOP OF CASING IS / FT.Above Land Surface' cc) E
r
*Top of casing terminated at/or below land surface requires a variance In accor- r
dance with 15A NCAC 2C.0118
10. YIELD(gpm): 7 METHOD OF TEST a - �_C
11. WATER ZONES(depth): cl1 w==
12. CHLORINATION: Type 1 t"-"Amount 1/2.e . If additional space is needed use back of formc.c.) `
13. CASING:
LOCATION SKETCH
Wall Thickness
Depth 9iapleter or Weight/Ft. Material (Show direction and distance from at least two State
From t " �! .f P2�1 Roads,or otherrefer
ence points
—To�Ft..—Y-- J
From To Ft.
From To Ft. (�y/ po -4 . i yl
14. GROUT: (d0`µ"" �/�
Depth Material Method O �p J�OGt-
From 19 To - 0 Ft. �i221- ^°" . . C/� ^/A npp &t 2tL
From To Ft. (� � U /"""� r
15. SCREEN: - frh 0 /a SO 077 Nadi' lK)
Depth Diameter Slot Size Material © JL n/
From To Ft In. in. ;, 1p� � ri C 2 p
From To Ft. In. _—_ In. _�u U
From To.__Ft. In. — In. � Q (r L`e 4
16. SAND/GRAVEL PACK: � .
Depth Size Material D )
From To Ft.
From To Ft.
17. REMARKS:
I DO HEREBYEaTIEZaithaT THIS WEI L WASQ )NSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTICFSTOIDMIDE Ill
OF THIS R 0 D BEEN PR VIDEO TO THEW ELL OWNER.
FOR OFFICE Ur i NLY G NE WELL DATE
1
Quad No: i! l�Submit on of Water Duality Gmundwa rt on within 30 days
c �Ft�, � -. ,CD- GW-1 REV. 12N9
Serial No. -
Cro indwa e-S2ction
I
L.___....A:sjr-tM.7..Hini J`"^.E
GROUNDWATER SECTION
ASHEVILLE REGIOI?AL OFFICE

North Carolina-Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section 246836
1636 Mail Service Center-Raleigh,N.C.27699-1636-Phone[phone] _' •.,,,-�I I {(��� (�,
WELL CONSTRUCTION RECORD WELL CONTRACTOR: Oba, j±a) p"A
WELL CONTRACTOR CERTIFICATION #: ,1 ! I
�,
STATE WELL CONSTRUCTION PERMIT#: f —
1. WELL USE(Check Applicable Box): Residential L Municipal El Industrial❑ Agricultural El Monitoring ❑
Recovery❑ Heat Pump Water Injection 0 Other ❑ If Other, List Use:
2. WELL LOCATI N: (, how sketch f t e ation below) (�7/�� ,_�1,
Nearest Town: County: `.,9n V
(Road Name 81 Numbers,Community, r Subdi 'an and Lot No.) UDRILLING LOG DEPTH
3. OWNER \ }Q Fro o FomwtioSDescription
Address (J l7 ( ,1 r �((1Jfiii . L
Gly or'f (��� � _Lte Zip Code I/lt
4. DATE DRILLED���9fU \
5. TOTAL DEPTH , ,.yyy;,���y
6. CUTTINGS COLLECTED YES❑ NO[�
7. DOES WELL REPLACE EXISTING WELL? YES [-J NO0
8. STATIC WATER LEVEL Below Top of Casing: WO FT.
(Use•✓11 Above Top of Casing) c
O o
9. TOP OF CASING IS FT.Above Land Surface'
-Top of casing terminated et/or below land curiaos requires a variance In actor- —rt rn C)z
donee with 16A NCAC 2C.0118 "
10. YIELD(gpm): —5....... METHOD OF TEST 0 J cc
—
11. WATER ZONES(depth):
12. CHLORINATION: Type sib-uJ4A- Amount 1/3 C-• If additional space is needed use back of form C
13. CASING:
LOCATION SKETCH Cam) 2
Wall Thickness o
y / Depth ��(,�i QD Dieter cor,We'yh/Ft. tedal (Show direction and distance from at least two StaleW r
From�To Ft. [Q /1( ` -( �- Roads,or other map reference points)
From To Ft. fin_ / &ab ® oic /
From To Ft. /� (;Q�(�K v��n (.(�
14. GROUT: / I�. Va vi. 1. J On(, —). e ( C..�-
Depth //)�, Material
etho c�
From To aQ Ft. ( Ulm e N tip Jwi O in �Q QJ)c
From To Ft.15. SCREEN: - 00
0 U + -- d,
Depth Diameter Slot Size Material
From To Ft in. in.
From To Ft. in. _ In.
From _To_Ft. In. In.
16. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
17. REMARKS: a ittin
l
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC )
CONSTRUCTION STANDARDS,AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TOT • • LL OWNER. ilI
'j I t
.. -. . ._-_ .r_n—.,.- ��/ JL i�l I� i�.._.J
FOR OFFICE�1SF Ogoe,� ; `i i DATE
Quad No: 7I (i : -IGNATURE OF PERSON CONSTRUCTING THE WELL
I _11 Stbti anginal to Division of Water Quality.Groundwater Section within 30 days --
Serial No. 1
�I 6WIR
Croundwater 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] 24 C 8 37
WELL CONSTRUCTION RECORD WELL CONTRACTOR:C QanA-1-00-ttlt-ti-giigi "-"i4(- 1C y
WELL CONTRACTOR CERTIFICATION#: Cy? I
STATE WELL CONSTRUCTION PERMIT#: 4 * 7
1. WELL USE(Check Applicable Box): Residential 53. Municipal❑ Industrial❑ Agricultural El Monitoring ❑
Recovery❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATIrOr\.�: (Show�sk_etch of/*pie, location below)
Nearest Town: ` xi n D"t't�� Lit u o County: dLn
(Road Name an (lumbers.Corn uniityt or Subdivision and Lot No.) DRILLING LOG DEPTH
3. OWNER lack. t�J:.4.�-� From To Formation Description
Address a lac CIS .
n de treetOr oue aQ-13a y s - ass
City or Town ���� Stale Zip Code
4. DATE DRILLED
�1p(L,LI�_
5. TOTAL DEPTH JJ�5 rr++vv
6. CUTTINGS COLLECTED YES El NO o --:
7. DOES WELL REPLACE EXISTING WELL? Y S ❑ NOa] rn
8. STATIC WATER LEVEL Below Top of Casing: (nO FT. cc
(Use'+'II Above Top of Casing)
9. TOP OF CASING IS I FT.Above Land Surface'
'Top of casing terminated at/or below land surface requires s variance In aeeor- -0 -t
dance with ISA NCAC 2C.Oite • —u:
10. YIELD(gpm): 1 METHOD OF TEST C-t-t-A h-
1 t. WATER ZONES(depth): CO
nN'In Ca a
M
12. CHLORINATION: Type V Amount NC.. If additional space Ls needed use back of form
13. CASING: ()
LOCATION SKETCH
Wall Thickness
Depth Diameter of WWei�hVFt. Material (Show direction and distance from at least two State
From -i- I To 4 c Ft. (.I '�M ' Roads,or other map reference points)
From To Ft. -`"�.
From To Ft. ' - 4-k, cm alit_
• 14. GROUT: `J e-yt r(� Q� O
Depth Material Metbiy �J
From 0 To �YU Ft. �fK9/a- �IfTQf t'x. P,t� P.11/K. nc.a,��
From To Ft. U ` ,,
15. SCREEN: - &A - K /t 91.1.- -
Depth Diameter Slot Size Material
From _To Ft in. in.
From _To Ft. in. In.
From To Ft. In. _ In.
16. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
17. REMARKS:
•� tIC I Ij 9I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NC t� 'WELL '
CONSTRUCTION STANDARDS,AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO IC ELL OWNER. ,1 I{nIII
-s e At I Lr
FOR OFFICE IA E gNI�Y I u U L. DATE
Quad No: I Ll l ------. •IGNATURE OF PERSON CONSTRUCTING THE WELL
1 Sutra! o'ghat to Division o1 Water Quality,Groundwater Section within 30 ldays
Serial No. GYM � ^<
6rowtdwater Section
Asheville Regional NiceJ

North Carolina•Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section 2 4 6 8 3 8
1636 Mail Service Center-Raleigh,N.C.27699-1636-Phone[phone]
WELL CONSTRUCTION RECORD WELL CONTRACTORf 6tt za if RU-61
WELL CONTRACTOR CERTIFICATION#: !
STATE WELL CONSTRUCTION PERMIT#:
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:,(�h�w sketch of the location below) / j
Nearest Town: l/,����/iv County:
(Road Name and Nu .Community,or ivi>d nand lot No.) DRILLING LOG DEPTH
3. OWNER Ap�'�', From To Formation Description
p
Addres 3 O - tit
f
JAL
treater WO O. a��/G 3`�- a2s /0/iiit..
ny or Town Sate Zip Code
4. DATE DRILLED I /O
5. TOTAL DEPTH �0 " c;
6. CUTTINGS COLLECTED YES❑ NO -N:'t c->_
7. DOES WELL REPLACE EXISTING WELL? YES ❑ NOt r-T
8. STATIC WATER LEVEL Below Top of Casing: .4(0 FT. W `_
(Use'+'0 Above Top of Casing) r __'
17
9. TOP OF CASING IS, / FT.Above Land Surface' >%
'Top of casing terminated atlor below land surface requires a variance In accent- 3 _
dance with 1SA NCAC 2C.0118 ='
10. YIELD(gpm): hq METHOD OF TEST ./24-2) LP U
11. WATER ZONES(depth): c.t n
GJ o
/y�
12. CHLORINATION: Type r��7��--: Amount Yea G If additional space is needed use back of form
13. CASING:
LOCATION SKETCH
Wall Thickness
_L Depth „ Oi�preter or WeiQhVFt. Mate al (Show direction and distance from at least two State
From 7 To Ft. Y Roads,or other map reference points)oi
From To Ft. l a r// .t.(7- _
From To Ft. !�O A'/ / /_ 1
14. GROUT: Jab-
L, r
a ael i:I
Depth Material Method G� y /f /1
From 6 To 46 Ft. (O/i7J Rl a /•t . �k C- 600
From To Ft. o //' . ((/// S_ /J,/
•
15. SCREEN: - ( �/u /y� J • QG�
Depth Diameter Slot Size Material
From To Ft_ in. _in. O/K_ ALICL
From To_Ft. in. _ In.
From _To Ft._ In. _ In.
16. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
17. REMARKS: L] (r P: VI (:,
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCA7 I —1
CONSTRUCTION STANDARDS AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO TN LL OWNER.
FOR OFFIC ilf I. L -L LI V H 7490^JL �-1 '
Quad No:
IGNATURE OF PERSON CONSTRUCTING THE WELL i 1 DATE I
Subrry IA) al to Division of Water Quality,Groundwater Section Within 30 d ys
S ___ I
Serial No, ' sP GW4 REV.12l9h.
Croundwater Section
Asheville Regional Office 1 •

North Carolina•Department of Environment and Natural Resources•Division of Water Quality-Groundwater Section 4 4
1636 Mail Service Center•Raleigh,N.C.27699-1636-Phone[phone] n,,,,,,, n `1 2 6 8 1
WELL CONSTRUCTION RECORD WELL CONTRACTOR: � Yl <<�SQ� W'lr�� Q�"
WELL CONTRACTOR CERTIFICATION #: .. YYY9 I
STATE WELL CONSTRUCTION PERMIT#: 4Wit-
1. WELL USE(Check Applicable Box): Residential It Municipal ❑ Industrial❑ Agricultural❑ Monitoring ❑
Recovery El Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATION:001 s etph of the location below) aii ��O A
Nearest Town: Ifni County: �j C�
(Road Name N�ufmmb¢ers,Co pity,/or Subdivision and Lot No.) DRILLING LOG DEPTH
3. OWNER w � l t From 1 To Formation Description
Address (((/// (J d co o L p tO- /I0-- 7/ It tn,, '
�r eetor ut0 a0 " i NJ — Q./ac /�
City or T State Zip Code ((//
4. DATE DRILLED /0/ _r,
5. TOTAL DEPTH to
6. CUTTINGS COLLECTED YES❑ NO ro
(�'f '9 _, .,
7. DOES WELL REPLACE EXISTING WELL? YES ❑ N0
8. STATIC WATER LEVEL Below Top of Casing: FT. co `7q
(Use' if Above Top of Casing) I ci_=
9. TOP OF CASING IS ' +FT.Above Land Surface' ='
'Top of casing terminated at/or below land surface requires a variance In moor- S r"-
dance with 15A NCAC 2C.0118 .,,..i
10. YIELD(gpm): 01 METHOD OF TEST c Cn r"
11. WATER ZONES(depth): cca -'
/,( , o
12. CHLORINATION: Type "] Z.Y/ CIA ) Amount ligC • If additional space is needed use back of form
13. CASING: (�
LOCATION SKETCH
Wall Thickness
Depth Di ter or Weight/Ft. ��'///��lM/a/teriall (Show direction and distance from at least two State
From f / To // ' Ft. ( '1 Can e2 I )'cn'aZC Roads,or other map reference points) �y
From To Ft. / ����`��� ,Z A"' --\A.t.\41-a
From To Ft. °A \ \ `��` . O CD
CN-
14. GROUT: c 1--
Depth Material Meth°ci ;nC\1\t..( O.."COV" \ %� (�`\ (e10.L.,1
From a To SW—Ft. ixmx� �SAIi!TLL- \"�� l
From To Ft. u -SU C'SC- - .a t''J 'b tn.u,Q. o 1%- Le.
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 NCAJ ,Wit C t ,'� E
7
CONSTRU. TaQM 5.74 {QARDS,AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO T N ¶LL OWNER.
i
FOR OFFI I
Quad No: j; O IGNATURE OF PERSON CONSTRUCTING THE WELL L.
i t f L . I S groat to Division of Water Quality,Groundwater Section with�t DATE 30 gays
Serial No. i fLI U l L .R 1-SEv_12/99_.l i. N
i ClNO # ICE
• .._..I _
1)iiice

246887
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] /����p
WELL CONSTRUCTION RECORD WELL CONTRACTOR: (Yf41/i1 'L iii f" 19 A%vim
WELL CONTRACTOR CERTIFICATION#:
Ell
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE(Check Applicable Box): Residential Ell Municipal El Industrial❑ Agricultural❑ Monitoring ❑
Recovery❑ Heat Pump Water Injection ❑ Other El If Other, List Use:
2. WELL LOCATION: ow sk tch of the location below) grid
e*'
Nearest Town: Ci County:
(Road Name and a Co/mmunity, •,Subdivision and Lot No.) DRILLING LOG DEPTH
3. OWNER aOb44 k` a� From To Formation amignon
Address ^ U (�� Vag-) �_ ! c
C/J��27L eetorRo e Ua o SS1 ////7;S-
City or own Stale Zip Code •
4. DATE DRILLED
5. TOTAL DEPTH ,1S
6. CUTTINGS COLLECTED YES El NO[t iv ?y
7. DOES WELL REPLACE EXISTING WELL? YES NO[ iv
B. STATIC WATER LEVEL Below Top of Casing: O FT. , ., R 7:
(Use'*'II Above Top of Casing) W
9. TOP OF CASING IS / FT.Above Land Surface* c-
'Top of cuing terminated at/or below land surface requIres a variance In scow-
dance with 15A NCAC 2C.0118 "'D m;
10. YIELD(gpm): 1QD METHOD OF TEST (2/A . ' =d r,;
11. WATER ZONES(depth): rn u)=
c.a C)
12. CHLORINATION: Type ount ' O . If r
additional space is needed use back or form o_
13. CASING:
LOCATION SKETCH
Wall Thickness
-�—
Depth q Di ter or Weight/Ft. lariat (Show direction and distance from at least two State
Fromil—To 51 Ft.-( -- Roads,or other map reference points)
From To Ft. 6• CO"-
j� ` �
From To Ft. 0196 �� ��
14. GROUT: I 7j_ Lam-- Citi
Depth,t nMaterial ,My/ethod
From /9 To 41 FL r D�'� '�`t/i"" ' r/
From To FL �w ,;t6 ale? / Q Al , L/ )4
15. SCREEN: - �/~cam'
Depth Diameter Slot Size Material v /
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 11 Y h fi l: -`-kd r �"9Brj. T,g1l6T rt} ELL DATE
Quad N0: D r q�' L '- �su mit orinnal v of Water Duality,Groundwater$gctldr4 within 30 days
Serial No. $ I •
: ! � , 1 I GW-1 REV.12/99
!
i: ;, i i
i ii
6roundwaterSecNon
Asheville Recinnalntn e C OJ
ASH' E REG CE

North Carolina-Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section 246854
1636 Mail Service Center-Raleigh,N.C.27699-1636-Phone[phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR: O oa aUhill Alille,n(nc
WELL CONTRACTOR CERTIFICATION p: 91
STATE WELL CONSTRUCTION PERMIT#: )t 171
1. WELL USE(Check Applicable Box): Residential Municipal ❑ Industrial❑ Agricultural 0 Monitoring El
❑ Heat Pump Water Injection Q Other El If Other, List Use:
2. WELL LOCATION:I!' h�p,w sketcgh�o�f the I cation below) I�` A �
Nearest Town: (I A`J k 4 4nu t� County:_(� r
(Road Name umbers.Comm I .or COSubdivision and Lot No.) DRILLING LOG DEPTH
3. OWNER 11✓ J i 1 lU /10 From To„ Formation Description
Address V Q IQ� (�� 1 citree or ou a . adl �� — x
City or own State Zip Code
4. DATE DRILLED U 01
5. TOTAL DEPTH 5
6. CUTTINGS COLLECTED YES❑ NOLX o
7. DOES WELL REPLACE EXISTING WELL? YES O Not C.,_
8. STATIC WATER LEVEL Below Top of Casing: FT. „
(Use'+'II Above Top of Casing) CO _ _•
9. TOP OF CASING IS I FT.Above Land Surface* _
'Top of casing terminated at/or below land surface requires a variance In eccor•
dance with 16A NCAC 2C.011p r"-
__
10. YIELD(gpm): 1I a METHOD OF TEST (2-AJ
11. WATER ZONES(depth): " cn:
v
12. CHLORINATION: Type(ThQ.rnJ RK Amount 1-- . If additional space is needed use back of form w o
13. CASING:
LOCATION SKETCH
Wall Thickness
,� Depth Diameter or Weight/Ft. atiex (Show direction and distance from at least two State
From J--To 9 Ft. "' 'l S�XI {��(.'Oti(' Roads,or other map reference points)
From To Ft. 1 r9/ kt-71
�Q� /'' �//From To Ft. ` �� / �/ L�tG�� I✓''% /rq
14. GROUT: 'W
Mat�enal Method ry1
O Depth ayil kka
From To _ .(2-Ft. p per — 0'� 1/
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 F .
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 ACOI- , II I �t I�f ICED TO THE WELL OWNER.
r V ,
OR OFFI aI Li U Or 1 I I RE OF PERSON CONSTRUCTIN HE WELL DATE
Quad No: ,�I'`f S •' l engind i Ion of Water Quality,Grpundw or ion within 30 days GW IREV.12199
Serial No. IIII� , t i I I _ �
... n ,11 1 Ir.'11
1 J1 I 1
I i eTION
�� n ;� i OFFICE I
a5rzt,

North Carolina•Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section 246855
1636 Mail Service Center•Raleigh,N.C.27699-1636-Phone[phone] � n �
WELL CONSTRUCTION RECORD WELL CONTRACTOR: �}
WELL CONTRACTOR CERTIFICATION a:
STATE WELL CONSTRUCTION PERMIT#: lr I-C-7
1. WELL USE(Check Applicable Box): Residential Municipal ❑ Industrial❑ Agricultural❑ Monitoring El
Recovery❑ Heat Pump Water Injection El Other ❑ If Other, List Use:
2. WELL LOCATION: how scotch of the location below)
Nearest Town: IJI nP a) County:
CNOLtrocri
LOG DEPTH
(Road Name and NCommunityors.Communityr Sury bdi Mon and Lot No.) DRILLING 9
(� 141 r , .r(i��n Fr �1p Formation e;criPGon
3. OWNER _ ISJt_A"� 1.PJZ�Lac Cali
Address WY.fY� vest oroyt a o. rt Pri'11
A - tA 4 S Gr „
City or Town State Cl Zip Code
4. DATE DRILLED O
5. TOTAL DEPTH c
6. CUTTINGS COLLECTED YES❑ NO� c
7. DOES WELL REPLACE EXISTING WELL? YES NO� N"Ti '
8. STATIC WATER LEVEL Below Top of Casing: FT. m ,
r.i
(Use'+'II Move Top of Cuing) I Ca -.:._:
9. TOP OF CASING IS I FT.Above Land Surface* � - =;
>r-;
'Top of casing terminated et/or below land surfacerequires a varianceIn actor- _ 'O _
dance with 15A NCAC 2C-p a .- a
10. YIELD(gpm): I.\ METHOD OF TEST l I it..._) 9.1 ,-,411. WATER ZONES(depth): w �'
_ ���� p W o
12. CHLORINATION: Type n7,11LIc+J0 Amount I �3 C • If additional space is needed use back of form
13. CASING: U
LOCATION SKETCH
Wall Thickness
I Depth pi�e ter or WeighVFt. ,1A^aterra) (Show direction and distance from at least two State
From -1- 1 To Ab Ft. n�..N %)4(a7 Roads,or other map reference points) �l
From To Ft. JT'�.�, a I S �na�� •/�a��'�J
From To Ft. Q,0 �a��O° K fLt U'uf�Ckk�.
14. GROUT: U� ��y�p,���
Depth _ Matari§l Method [� tC(j (��a 1i' /
From D To �Ft. D/KX t�U(]1Y1dY� /a,) Ifs It . r. Q'.`® Q 1t W t
From To Ft. "� y, �IYJV`� r 09 )
15. SCREEN:
ct
Depth Diameter Slot Size Material aC�
From —To Ft In. In. © '
From _To_Ft.— In. _ In. ' '^`-^ -O (a
From . To Ft. In. _ In. Y 1LLO^n
•
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 g
OL 'r aQuad No: E t TFh WELL DATE
� -. -.•t d al not Water Oualay,Groundwater Seat cn within 30 days DWI REV.12199
Serial No. 7 ; fin;
CroundwaterSection GROUNDWATER SECTION
Asheville Re,Tonal thrice I ASHEVILLE REGIONAL G-F'CE

254614
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]
(416
WELL CONSTRUCTION RECORD WELL CONTRACTOIsan-f '�'17 �L�/1
WELL CONTRACTOR CERTIFICATION#: i 1
STATE WELL CONSTRUCTION PERMIT#: __
1. WELL USE(Check Applicable Box): Residential Municipal ❑ Industrial❑ Agricultural El Monitoring 0
Recovery❑ Heat Pump Water Injection ❑ Other ❑ If Other. List Use:
2. WELL LOCATION: �+pw�'ayknelc,b of the IQc tion below) �� 1 �
Nearest Town:_ 1�yr LA. County: T1
(Road Name and •=rs,Community,or hdivision and Lot No.)
DRILLING LOG DEPTH
From To Fomation sc¢ption
3. OWNER /Y7(« _ .5 p
Address /Sst O /��
tree a o. � O — �02� v y��7':.�P-i
ft-?G (/
M./x.4
wn ;tate Zip Code
5. DATEO DRILLED
5. TOTAL DEPTH �
6. CUTTINGS COLLECTED YES❑ NO'
7. DOES WELL REPLACE EXISTING WELL? YES NOj
8. STATIC WATER LEVEL Below Top of Casing: FT.
(Use'ill 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 1SA NCAC 2C.o11a
10. YIELD(gpm): ,2C METHOD OF TEST ,
11. WATER ZONES(depth):
13. CHLORINATION: Type
Amount I C ' If additional space is needed use back of form
13. CASING:
LOCATION SKETCH
Wall Thickness
Depth� i ter �orrr We' hVFFl. tent (Show direction and distance from at least two State
11-/ To Sy Ft.Lft-ti_. — — �c' Roads,or other map reference points)
From � � , - _
From To Ft.
From To Ft VC\s15� C i�g O 3\a X_I \'
. n-
14. GROUT:
Depth JOe Caso,,(� U• r� cm -
�
From 0 To 6 Ft. np/Material rn-�'t Me c
From To Ft. �' c
N
15. SCREEN: c_ -`_=--
Depth Diameter Slot Size Material C r-'
*i
From To c-Ft _ In. .___ in. — o_`
From To_Ft._ In. _ In.
vii,
From To Ft._._ In. __ in. a�
16. SAND/GRAVEL PACK: r'
. m:
Depth Size Material .
0
N "r
From To Ft. CO 0
From To Ft. iMI.
i,- - n
17. REMARKS: (� �OF Ili i '^�'
CO Ira A,�III F• I AS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2r�
I a t y1E e` STANDARDS,AND RI
' COPY OF THIS RECORD HAS BEEN PROVIDED TO THE �1
FOR M'W E unotityi n 02 U ��, %/ �a�'
Quad •IGNATUEiEOF PERSON CONSTRUCTING THE WELL GROI.�JG+.ATER SECTION
r
Su• original to Division of Water Duality,Groundwater Section within 3. daysA A .t�,,.:y *,, NAL OFFICE
Sedal o. ECTION
ASH ILLE HtblU •L OFFICE

246825
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, 11
WELL CONTRACTOR CERTIFICATION #:
,,{{�� STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE(Check Applicable Box): Resldentiall, Municipal ❑ Industrial❑ Agricultural El Monitoring❑
Recovery❑ Heat Pump Water Injection ❑ Other Ej If Other, List Use:
2. WELL LOCATION: ((Stow sketch of the location below) a�WC
Nearest Town: \ C"`� �� County- J
(Road Name enumbers,CommuN or Subdivision and Lot No.) DRILLING LOG DEPTH
3. OWNER * \0_1(- C-1L�"&._ From To Formation Description
Address j (yl1 7� � 5,Q IZd - 0 — p
Cr ;5 reel0r °yo.) C} C ode
t 4 �\ — l9 S '�
M
City or Town State
4. DATE DRILLED cSl2_a 10 I
5. TOTAL DEPTH b O S N r>
6. CUTTINGS COLLECTED YES Q NOft
7. DOES WELL REPLACE EXISTING WELL? YES ❑ NO[ W ,
rH
8. STATIC WATER LEVEL Below Top of Casing: FT. '_
(use N.'if Above Top of Casino) I
9. TOP OF CASING IS I FT.Above Land Surface* _;o
ri
*Top of casing terminated afor below land surface requires a variance In actor- v 3 �,
dance with 1SA NCAC 2C.0118 rn
10. YIELD(gpm): 7 C�.�METHOD OF TEST C''r
r fl �4
11. WATER ZONES(depth): rV o
r,�� fr k,, " usez
12. CHLORINATION: Type V Amount D- C— • If additional space is needed back of form
13. CASING: u
LOCATION SKETCH
Well Thickness
Depth GG�� Diameter or Weigt_iVFt. dater (Show direction and distance from at least two State
From I To—��—Ft. Um ['A SDP--d-(,(, c'e '` Roads,or other map reference points)
From To Ft. ,^ j 1, , „
From To Ft. 1 -\t.'�^ '\� - "`
14. GROUT: Depth i.,iiMA= Method T \, t r A , �� %Lk
From 0 To �—Ft. %CiLLT —
Fromm 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
CONSTRUCTIO F R VIDEO TO THE WELL,OWNER.
t.cs/
FOR OFFICE US Y DATE
Quad No: ky •IA ERSON CONSTRUCTING TH E
i Submit o' I Divlsbi of ter Quality,Groundwater secti i n 30 days
GW-1 REV. 12/99
Serial No. ' L� �I '��O`
rn L _
_ _ L-,'+� r tv/JER SEGI;ON
--""� ,SHEVl EGION L OFFICE

North Carolina-Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section F• + G "2 8
1636 Mail Service Center-Raleigh,N.C.27699-1636-Phone[phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR:n -)w N,Lw`p3LA
WELL CONTRACTOR CERTIFICATION#: irR —
STATE WELL CONSTRUCTION PERMIT#: P CZ9'
1. WELL USE(Check Applicable Box): Resldendalth Municipal ❑ Industrial❑ Agricultural D Monitoring ❑
Recovery El Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATION: how s etch of the location below)
Nearest Town: County: tA`",-x'St.-130
(Road Name and unterss,Community,or Subdivision and Lot No.) DRILLING LOG DEPTH
3. OWNER lA4-G.— e kl- - From To Formation Description
Address 'VD.C, Z >y moo--- 8F7
0 (Street or �No� acc +lo O 1 a lls J<<a'v-�- Q
City or Town Stale Zip `Code V
4. DATE DRILLED 0 2- O c
5. TOTAL DEPTH a C o c3
6. CUTTINGS COLLECTED YES El NO[�
7. DOES WELL REPLACE EXISTING WELL? YES ❑ NOD'
-
6. STATIC WATER LEVEL Below Top of Casing: co Q FT. - i
(Use + II Above Top of Casing) 1 it,:
9. TOP OF CASING IS ‘ FT.Above Land Surface' :1-
'Top of casing terminated et/or below land surface requires a variance in actor- ct r-.,
dance with 15A NCAC 2C, 011e ^
(IO METHOD OF TEST ri ' 1 -) rr'-
10. YIELD(gpm): � --,
11. WATER ZONES(depth): c.
N o
12. CHLORINATION: Type 73.0-".^'"--Q c""-'Amount ' C • If additional space is needed use back of form
13. CASING:
LOCATION SKETCH
Wall Thickness
Depth —7 Diameter or We huFt. credal (Show direction and distance from at least two State
+
From , To % ` Ft (-9 S L
14 c_ Roads,or other map reference points)
From To Ft. p p C .SL Z iQ
14. GROUT:
From To Ft. C- ��c� I \W top
�mC9-���" C'
Dept ( " Material MeLk A.CJu°-
From To . Ft. , Ma a O' 1`"a`��
From To Ft. pt 0.d C�iNA--t-t-Lki w SL 4
15. SCREEN: tL� � nnun
Depth Diameter Slot Size Material V-- l00 IL - °�� v
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
CONSTRUCTIO I� D THAT A •- OF �,, L� e' a t-c" a THE WELL OWNER.
FOR OFFICE US ,
Quad No: ,. JA 14$PERSON CONSTRUCTING T c I DATE
u Submit ad i Did •1 atm polity.9r?unoIwst sect 1. in 30 days GWIREV. 12ros
Serial No. ) 1 J
oundwatc ion CR��11V F F� SECTION
,_.._.._..R ` .__ :...r-....J AS _r CiONP-.L OFFICE

•
North Carolina•Department of Environment and Natural ResourcesDivision of Water Quality-Groundwater Section 2 4 6 7'0 9
1636 Mail Service Center-Raleigh,N.C.27699-1636-Phone[phone] n1 �( , �(//��`I
WELL CONSTRUCTION RECORD WELL CONTRACTOR O'///C//rYL"KLt ALA
WELL CONTRACTOR CERTIFICATION#: ON b k-A
STATE WELL CONSTRUCTION PERMIT#: -i'f--
1. WELL USE(check Applicable Box): Residential' Municipal❑ Industrial❑ Agricultural❑ Monitoring ❑
Recovery❑ Heat Pump Water Injection 0 Other 0 If Other, List Use:
•
2. WELL LOCATION: R7h w sketch of the location below) V '/
Nearest Town: �l itxtly//10 , County: r d_
(Road Name anT ers, mmunity,or Subdi ion and Lot No.) DRILLING LOG DEPTH
3. OWNER From ToSI' Formation Description
Address ? J (�j . Chit
/J 3 hge�or oRu1� .} l Q[tQ 7 Y - s rig/Kai-
�2City C��
/c2c��uol2 Y( C c Cr
City or Town Slate Zip Code o
4. DATE DRILLED IN^/^ao/o 1 N 4__.
5. TOTAL DEPTH AO S rt
6. CUTTINGS COLLECTED YES❑ NO[ rn ,-
W
7. DOES WELL REPLACE EXISTING WELL? YES ❑ NO4 I u_;
8. STATIC WATER LEVEL Below Top of Casing: FT. :C. _
(Use'.'it Above Top of Casing) T -I
9. TOP OF CASING IS / FT.Above Land Surface* 3 ^T^
'Top of casing terminated at/or below land surface requires a variance In actor- Cn U''
dance with 15A NCAC 2C.0118 I.
10. YIELD(gpm): /n METHOD OF TEST l o
T
11. WATER ZONES(depth): ,-,�7
12. CHLORINATION: Type Y 14/li'ti- Amount I�Z a- It additional space is needed use back of form
13. CASING: //
LOCATION SKETCH
Wall Thickness
Depth�y p' 9map)e er or Weight/Ft. le'al (Show direction and distance from at least two State
From 4- ( To—L°F . // Snit-a? ci- Roads,or other map reference� points))
From To Ft. p�(,JG d O. 1 Ti c`o` 0� MC`-i\
From To Ft. Nr,C , , r nen: reCAZ. ® g \OOP
14. GROUT:A �Depth Material Method \o\/ 00 O 1� `1\OU\\..Q.,G \.v 1JL.1 ''�'�L
From To Ft. 00 CND ite %�.Lvp Itea..C, 1\-.
Fm To FL CA" &:c g L� QC ��
15. SCCREEN: h ��\u_ �~'S
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 NC ViLu rA iU L., '�
CONSTRUC M (� OF THIS R ORD BEEN PR VIDEO T,OIt"M
V IS , - / - .fre2f I mil
FOR OFFICE l '
Quad No: SIGNA E OF PERSON CONSTRUCTING THE WELL r DATE __..
- V Subnl to Division of Water Quality,Groundwater Section within 30 days
GW-I REV. 12/99
Groundwater Section
Asheville Regional Office

North Carolina-Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section 2 4 6 7 6 1
1636 Mail Service Center-Raleigh,N.C.27699-1636-Phone[phone] �/�
WELL CONSTRUCTION RECORD WELL CONTRACTOR:I/�-07 p �' rAth �L�_//u& 114<-c
WELL CONTRACTOR CERTIFICATION#: a k fJ
STATE WELL CONSTRUCTION PERMIT#: / '/ ?7'
T ❑
1. WELL USE(Check Applicable Box): Residential ICJ Municipal ❑ Industrial❑ Agricultural D Monitoring
Recovery❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below) _ J /
Nearest Town: County: eede/ lLJnr)ol
(Road Name am:IA.1.111r Community,or Subdivisi n and Lot No.) DRILLING LOG DEPTH
3. OWNER Lit XV° 1/:A/1(L � From,r� To,(1 Formaatiioo�n�Dessccription
Address a/ Ql �7 ) 37 ryj�Q_ �f.._ %y. c 'e
. t a u t t�G(c � 467. 33 3/ r Y Q�la/bU
City or Town State Zip Code U
4. DATE DRILLED 0
5. TOTAL DEPTH c
6. CUTTINGS COLLECTED YES❑ NO' o
7. DOES WELL REPLACE EXISTING WELL? YES N0IX c
Iv
/
B. STATIC WATER LEVEL Below Top of Casing: FT. —n^1
(Use'✓II Above Top of Casing) C r m�
9. TOP OF CASING IS / FT.Above Land Surface' I c=•-
*Top of casing terminated at/or below land surface requires a variance In accor- i=o
dance with 15A NCAC 2C.0118
10. YIELD(gpm): L-Q O METHOD OF TEST a r\
11. WATER ZONES (depth): Gil tr T
rJ
til n•
12. CHLORINATION: Type 321 X c 2., - Amount r/3 C' If additional space is needed use back of form — z
13. CASING:
LOCATION SKETCH
Wall Thickness
Depth ry Diameter or Weight/Ft. terial (Show direction and distance from at least two State
From 4- / To ?6 Ft. 6 VY gin ? Roads,or other map reference points)
From To Ft.
From To Ft. (0 /3 ed-
14. GROUT: oe=�l�
Depth Material Metho CCLlL¢J
From 0 To Ft. �0 - UU
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[ (N E II \\II E .1
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC; 1_AI[E1.J2 U V
CONSTRUfl '4¶AI/J9AI�SfAfip Tr OF THIS RECORD►jA., BEEN PROVIDED TO'H ELL.OWNER.
FOR OFFICE ttTnlill ONLYY LS U L5 jt V.")
. ) 4 / 024 APR 1 9 2002
rij
Quad No: II w SIGNA E OF PERSON CONSTTR�UCLLTING THE WELL DATE
J14 I)g1 L. J , Su jgN nal to Division of Water Quality,Groundwater Section with n 30 r av5
Serial No. GROOMVEL€PiiikeTION
ASHEVILLE REGIONAL OFFICE
Groundwater Section
Asheville Regional Office

North Carolina-Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section
2 4 6 7 7 4
1636 Mail Service Center-Raleigh,N.C.27699-1636-Phone[phone] dC�Q !/
WELL CONSTRUCTION RECORD WELL CONTRACTORELL .CERTIFICATION A
STATE WELL CONSTRUCTION PERMIT#: / 7'7"�
1. WELL USE(Check Applicable Box): Residential it
Municipal 0 Industrial ElAgricultural ElMonitoring ❑
Recovery❑ Heat Pump Water Injection Other ❑ If Other, List Use:
2. WELL LOCATIOntow sketch of t¢ oc n below)
Nearest Town: / (/ Ssy (Yee ee - County: �/� -
O C/ U DEPTH
(Road Name and ors,Community,or Subdivision and Lot No.) DRILFroLING
LING T LOG o Formaatiioon Description
3. OWNER j/J,v-� ,6/1O/!1L- / /J - 4o /J�/1lO
Address/� ee /,j' /�/y�p�� /�/`?/ /yj
Ety i r%,P it-late e aO _ ��S
ZipCode •
4. DATE DRILLED U 5. TOTAL DEPTH tv
6. CUTTINGS COLLECTED YES❑ NO Fri ^�_
7. DOES WELL REPLACE EXISTING WELL? ES ❑ NOCI tb -_ -
8. STATIC WATER LEVEL Below Top of Casing: ,QaO FT. I =.
(Use'+'if Above Top of Casing) r I `-.
>u
9. TOP OF CASING IS / FT.Above Land Surface' fa m
Top or casing terminated at/or below land surface requires a variance In roof- :7C —,
dance with ISA NCAC 2C.0118 -S i
10. YIELD(gpm): �S METHOD OF TEST 0c,�
11. WATER ZONES(depth): — •
z
12. CHLORINATION: Type 1(/n_t°6.---_- Amount / I/3 r It additional space is needed use back of form
13. CASING: LOCATION SKETCH
Wall Thickness
Depth Diar!t¢ter or Weight/Ft. M enal (Show direction and distance from at least two State
From t/ To LaO Ft. It 'Ai 502.E 2 Roads,or other map reference points)
From To Ft. gip, put \�\QW —VU
From To— Ft. -es \ -•-& , �,J\\\b e. up o�
14. GROUT:
Depth
atonal MethodC U C o Q
From 0 To �Ft. �i I ��C LPN_�`-_ e�
•
From To Ft.
15. SCREEN: -
Depth Diameter Slot Size Material
From To Ft in. _ in.
From To Ft._—_ In. — In.
•
From To Ft.— In. in.
16. SAND/GRAVEL PACK:
Depth Size Material
From To Ft. ,
From To Ft.
17. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STANDARDS,AND THAT A S OF THIS R ORDIBE VIDEO TO THE WELL
f i '' ?VIDEO
l2t�u
FOR OFFICE .S �L 1 ELL DATE
Quad No: u 1fI SI• OF PERSON CONSTflUCTIt�O;+ ti
41 Subrr t.�t3 tc yvi , of Water Quality,Groundwater -t within 30 days Gw t REV.17199
A Y.
UU ' J
Serial No. x ,�
.af. 2 -2 2007 `r
z. Croundwater Section G6 t ILIER SECIIO11
Asheville Regional Office ASHL.t, :. I,EGIONAL OEH?II

2 4 G 7 9 0
North Carolina-Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section
1636 Mail Service Center•Raleigh,N.C.27699-1636-Phone[phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR: .�p2i to
7WELL CONTRACTOR CERTIFICATION#: "D—yq�j��Jg
4II
STATE WELL CONSTRUCTION PERMIT#: '7 4.-1 7
--
1. WELL USE(Check Applicable Box): Residential) Municipal El Industrial El Agricultural❑ Monitoring ❑
Recovery❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATION:/(n$how sketch oft IocaT n below) �f/ ��
Nearest Town: 9'`d��0 County: /�y
or
(Road Name and Nu ars, nvnunl rr Subdivision and Lot No.) DRILLING LOG DEPTH
3. OWNER ��L From To Fomwtion/^%esyption
Address y� f / p�r/ . // ,,oa j "J/:(JG�'(/[C
tty I r state Zip Code D 3/�S 6 Na c
4. DATE DRILLED Na
5. TOTAL DEPTH I-,TO rn -�
6. CUTTINGS COLLECTED YES❑ NOtin
c T c`
7. DOES WELL REPLACE EXISTING WELL? YES NO('� t
B. STATIC WATER LEVEL Below Top of Casing: y 0 FT. 2-
(Use'.'II Above Top of Casing) _ ; �;
9. TOP OF CASING IS 1 FT.Above Land Surface'
'Top of casing terminated at/or below land surface requires a variance In accor• Ul ,r"•.._`
dance with 16A NCAC 2C.0J1a c,p
10. YIELD(gpm): �_ METHOD OF TEST /,IA.� p o
11. WATER ZONES (depth): /���� Z
12. CHLORINATION: Type "`( '�'vuda,- Amount N3 C- If additional space is needed use back of form
13. CASING: (/
LOCATION SKETCH
Wall Thickness
./- Depth Di er or Weight/Ft. lee I (Show direction and distance from at least two State
From -1
�3/ Ft.—r - cQfL a/ / Roads,or other map reference points)/J ,wl/���(�x/"`•`''�``
From To Ft. GO Ofif �GC � U
From To Ft. n _
14. GROUT: (�-��`�-
Depth Material Metho 62.0
_ /d , ,QQIL �g
From To 40 Ft• C`�,-h-L4 � L�jyl l A ���y n
From To Ft. t� 4�/��/)f `� 17-2 -
15. SCREEN: - pL ._ U - p //) __ , 'Depth Diameter Slot Size Material -to curU O7YJC 5/Cl// �O'
From To_Ft in. in. C
From To_Ft. in. — In. M' 64 ak-&,�
From To__Ft. In. — In. Gd�-�� � �/ 7�/
16. SAND/GRAVEL PACK: .X//t-C- . v -t7 •G`-'l'` cc t 7 64
Depth Size Material ticl/� � ' U/t-itt 1 O( � .,
From To Ft. ��L -w A"n , yg.�Qy,� CLtl/ure
From To Ft. r� ; .ram C�,�z 0-e--
17. REMARKS:_ U
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C LL O1 f�Ed I�
CONSTRUCTION STANDARDS,AND THAT A COPY OF THIS RECORD HAS BEEN PR I��D t) ` 5 e �:_ I 1'
FOR OFFICE), 4IL
0 d II
Quad No:OFFICE),
IGNATURE OF PERSON CONSTRUCTI Wig WELL DATE
is Su aJ ha to Division of Water Quality.Groundwater Section within 30 days GW I REV.12/99
Serial Na. 3- 2002. 1
Croundwater Section
Asheville Regional Office 1 -

Noah Carolina-Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section 2 4 G rf 8 61636 Mail Service Center-Raleigh,N.C.27699-1636-Phone[phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR:0//4iVii)i!-i'-> OR I f4J JG
WELL CONTRACTOR CERTIFICATION#: / I
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE(Check Applicable Box): Residential Municipal El Industrial❑ Agricultural El Monitoring El
Recovery❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
•
2. WELL LOCATION: (Show sketch of the'I atioon below)
Nearest Town:LOCATION:
ea County: A yQfirl"
(Road Name andfdpripers, mmunity,or uvision and Lot No.) DRILLING LOG DEPTH
3. OWNER /A/�/7 J drditi /.//Iil/n/,,,/�J From To_ Fomwtio Description
Address
, Mr t or gu e --11- �� (Ll� i/S
City or wn State Zip Code .
4. DATE DRILLED 03
5. TOTAL DEPTH
6. CUTTINGS COLLECTED YES❑ NO p c
7. DOES WELL REPLACE EXISTING WELL? S n NOcStj NI CS
8. STATIC WATER LEVEL Below Top of Casing: �7j. FT. '1 -c-=-
(Use'+'if Above Top of Casing) -I i
9. TOP OF CASING IS ) FT.Above Land Surfaces
'Top of casing terminated sUer below land surface requires a variance In senor- -i
dance with 15A NCAC 2C.01 a v -—c
10. YIELD(gpm): -Q(1 METHOD OF TEST i2 M)
-'l
11. WATER ZONES(depth): W (":;
12. CHLORINATION: Type /ry vr//CLCl it--' Amount 123C • If additional space is needed use back of form -- z
13. CASING: •
LOCATION SKETCH
Wall Thickness
Depth Diameter or Weight/Ft. teal (Show direction and distance from at least two State
From t I To I/S Ft. (d(('-J 53/C 2/ Roads,or other map reference points)
From To Ft. Lal��a4 d
From To Ft. )�j �
14. GROUT: 5 _ 010-) , 0 hxdr
aall Depth A Material nn11MethoQd ✓�
From v To �Ft. t,yJt k pit h& �� r/� 6n6 dJti./IIiC/��
From _ To Ft. Ea_ ®.�k Po_ U
15. SCREEN: - rJ (f
Depth Diameter Slot Size Material 1/49 JA /�(�//�{(//Q t / J From _To Ft in. in. e e ` g-/i L
From _To Ft.— In. In. � � D �//
From _To_Ft. In. In. Gz �JJto J
16. � �J
SAND/GRAVEL PACK:
Depth Size Material Q
From To Ft. CF(f1 P.
From To Ft.
17. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 1> It2tWFy rP riCONSTRU cTION SS;TA(N�DARRDS AND THHAT A COPPY OF THHISS RECOO}RD HAS BEEN PROVIDE iTt Vd` I`n
FOR OFFICE 9 ILI& 6 On �) 46119 �0 I/f
br,I� -IGNATURE OF PERSON CONSTRUCTING TF) .Mill I . Date v
Quad No:
Su veinal to Division of Water Quality,Groundwater Sect on wit in 30 days
Serial No. t •JAN 2-1_ 2002 as GW-t RFV 19teg
GROUNDWATER SECTION
ASHEVILLE REGIONAL OFFICE
Groundwater Section
Asheville Regional Office

7 North Carolina-Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section 2 4 6 7 2
1636 Mail Service Center-Raleigh,N.C.27699-1636-Phone[phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR:
WELL CONTRACTOR CERTIFICATION#: 1/ 9 I
STATE WELL CONSTRUCTION PERMIT#: "
1. WELL USE(Check Applicable Box): Residential Municipal 0 Industrial❑ Agricultural❑ Monitoring ❑
Recovery❑ Heat Pump Water Injection ❑ Other ❑ If Other,List Use:
2. WELL LOCATION: (Show sketchthe ocation below) � l 'J
Nearest Town: L/f%l QrIO,OP County' dp(y
(Road Name and ��-�niters,Community.or bdivision and Lot No.) DRILLING LOG
DEPTH
3. OWNER p From To Formation Description
/ //L/�v.e -4 D _ lci//,,�
Address �/l b6 Lr L��t<, 7o y - 4;j /'
L/�i
( treeor oua o. 'e . 4i 7I
1�Iti_
City or T State Zip Coda
•
4. DATE DRILLED
5. TOTAL DEPTH r�-(,�t c:
6. CUTTINGS COLLECTED YES❑ NO2
7. DOES WELL REPLACE EXISTING WELL? ES ❑ NO[ coo
8. STATIC WATER LEVEL Below Top of Casing: FT. -1 ` "
(Use•+'II Above Top of Casing) fli s r,
9. TOP OF CASING IS I FT.Above Land Surface' --
•Top of casing terminated at/or below land surface requires a variant.In actor- -c 7'
J-*L
dance with 1SA NCAC 2C.o1)6 'T7
10. YIELD(gpm): /(/ METHOD OF TEST (2.0-1 --::a
11. WATER ZONES(depth): ..r. n
12. CHLORINATION: Type �I/I/11,L( /4A- Amount �e . If additional space is needed use back of formcnts3 5
14
13. CASING: U LOCATION SKETCH
Wall Thickness
Depth q Diameter or Weight/Ft. .ten.1 _ (Show direction and distance from at least two State
From + I To (0 f Ft. (0 t(�" \MD? //- 7 Roads,or other map reference points)
From6614-
To Ft. l�"~ n ,� a js (� 5,�
From To Ft. �'oJ/ /�,�, r/n
14. GROUT: i/n y�Jo. ed.. �L r T
Depth Material Metho�� Y F 04, fin" 1 �J`c
From To Ft. !1(!l L ,/ O /// ,
From To Ft. (J�,�(()
15. SCREEN: ' Ca
Depth Diameter Slot Size Material ^ 0 6 ��,p
From —To_—._Ft_ in. in. /J�) /pC G cJ q— o D
From __To.—_Ft. in. In. frial.
FromTo Ft._ In. _..— in. U�
UJ
16. SANAND/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 SA BED NCAC
TOC THE ,WELL
OWNER.
CONSTRUCTION :.t a:?.a a s" ' e� ii it -1�
M R • �/� r L
FOR OFFIe T3�171v7t] V .I5 1 `F�/i/ _fir__te.f
��� ��� -• .-`7 TORE OF PERSON CONSTRU 1 NI HE WELL DATE
Quad No:
u Su. L' ��Ivlslonof Wateratiity,Gmund �- ion within 30 days DW-I REV. 12/99
Serial No. .1 2 2002 1
GroundwaterSeelcton I GRC I LsCATER SECTION
pshevilleRe, ASHEVILLE REGIONAL OFFICE

246731
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] &ea%
idle/ �����WELL CONSTRUCTION RECORD WELL CONTRACTOR:
WELL CONTRACTOR CERTIFICATION#:
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE(Check Applicable Box): Residential Municipal ❑ Industrial D Agricultural D Monitoring 0
Recovery❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATION: h w ske h of the location below)
;/�/��j�
Nearest Town: 1 � County: �2�°'
(Road Name and mbbcez,Comm • or bdivision and Lot Na) DRILLING LOG DEPTH
3. OWNER �! From To Formation Description
Addr s t(/ tqVOC •
Beee r e r'7/�
ity or Town ��vv11 State Zip Code
4. DATE DRILLED voS l A
5. TOTAL DEPTH 4/o5
6. CUTTINGS COLLECTED YES❑ NO[f
7. DOES WELL REPLACE EXISTING WELL? VES ❑ NO / o
8. STATIC WATER LEVEL Below Top of Casing: FT. IN)0 ",
(Use'+'it Above Top of Casing) Tr C'-
9. TOP OF CASING IS / FT.Above Land Surface' m �'-_'
'Top of casing terminated auor below land surface requires a variance In accor- 1 0
dance with 15A NCAC 2CAA011 ��� ' ' I ri
10. YIELD(gpm): �r%-( METHOD OF TEST -
y\
11. WATER ZONES(depth): Cr,ri
C Nm
/� / nnt
12. CHLORINATION: Type OM./nUV- Amount ` f/a-C . It additional space is needed use back of form Ca)
tu
13. CASING: (J o
LOCATION SKETCH
Wall Thickness
Depth Diameter or Wei ht/Ft. ted I . (Show direction and distance from at least two State
From #. / To 7' Ft. I>Y/ G Roads,or other map reference points)
From To Ft. /�� J�
From To Ft. C� SG/Ala
14. GROUT: giz /IS ��
Depth r Material Method; 6a/V
From Ft. �g Ft^ ' ex /o(// /
FromC To Ft. SO (i-�eal tJa-a- ','
15. SCREEN: - !A" //WWJ7""__ �
Depth Diameter Slot Size Material - Li a�L,� 'yy`-/
From To Ft in. in. yn7y� o/Y'r
From _To Ft.— In. In. � / 0,0774-1
From To Ft._ In. In. /J
16. SAND/GRAVEL PACK: -7 „ , a lJ� JJ� Co
Depth Size Material f/UN� M� q �6 4
From To Ft. Jc'
From To FL MC �, J
17. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC WELLTHE WELL OWNER.
CONSTRUCTION STANDARDS,AND THAT A COPY OF L.• t U r
FOR OFFICE N Quad No: A'1 GNA-U OF PERSON CONSTRUCTING E NULL DATE
t �� '
to Submit t DINblo of Water Duality,Groundwater Se or thin 30 days
_-1 GW-1 REV.12/9S
Serial No. i :!A" i
J
Groundwater Section ASH VILE R� 'E
.� AshevilleSionalOftice , -- .---

•
North Carolina-Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section 2 4 A 7 1 5
1636 Mail Service Center-Raleigh,N.C.27699.1636-Phone[phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR. •EI 9 '• e-
WELL CONTRACTOR CERTIFICATION#:
STATE WELL CONSTRUCTION PERMIT#: / '7
1. WELL USE(Check Applicable Box): Residential Municipal❑ Industrial❑ Agricultural❑ Monitoring 0
Recovery❑ Heat Pump Water Inject) n ❑ Other ❑ If Other, List Use:
2. WELL LOCATIOIw;ketch of the location below) . 1� _,,//��
Nearest Town: to County: � t'lit
(Road Name and N IroJ('Cominuniry�Su division and Lot No.) DRILLING LOG DEPTH
3. OWNER % ay Fromn r o Formation Description
Addres / / ^D / A. FU VI/
/,/ ^�n�� _
fee of a O. /�r/ 4 a - 77 5 ry,eL
U
or T /,Sinn Zip Code
4. DATE DRILLED D//•297;
5. TOTAL DEPTH WV.5
6. CUTTINGS COLLECTED YES❑ NO±
7. DOES WELL REPLACE EXISTING WELL? YES ❑ NO[ ]
8. STATIC WATER LEVEL Below Top of Casing: FT. .
(use':if Above Top of Cuing) ^_,
9. TOP OF CASING IS / FT.Above Land Surface' m r
'Top of casing terminated et/or below land surface requires a variance In moor- W C r:-
dance with 15A NCAC 2C,.9118 r 7-'T
10. YIELD(gpm): 72 METHOD OF TEST /-e�--,
v �-c-,
11. WATER ZONES(depth): 1 =c
f�(O/X.4',4“-Amount 3 If additional space Is needed use back of form •4. �
12. CHLORINATION: Type r., _�
13. CASING: 01 O
LOCATION SKETCH 2
Wall Thickness
..� Depth c'� Diameter or Weight/Ft. rial -(Show direction and distance from at least two State
From- ' To-5`2 Ft. Sail '.7i)-V-Ov�lr_ Roads,or other map reference points) ��j
From To Ft. �/ 4nt
.,From To Ft. OG� "�Y�� U�r%
14. GROUT: _t� ice /[N. Sg� p c
Depth /� Material / MethodG / ' "/ `�iC l/�fi
From o To �Q Ft. `�� iaT i�[�u;, f5aákat y® n . ��p
From To Ft. �iQe ail -X av�`
15. SCREEN: - LCy! O tom-
Depth Diameter Slot Size Material 6(Y4 Cf�s '.Z3/6
A.
G�
From To Ft_ in. _In. C� _ /ila( d-e_f
From _To—Ft._ In. — In. /� ��
From . To Ft. In. _ In. a i Kj/ ^'^l "y� (�/�t x�
16. SAND/GRAVEL PACK: �f/O"
Depth Size Material 19,/‘0�1/�,�,, �� n/ ' "e
From To Ft. Lie _/ „"'" L[/c
From To Ft. Oa
17. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION$TANDARDS:AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
i! i er-
lHFOR OFFICE U NL7f"` r� e nn Tcr 7u,G1iHE WELL DATE
Quad No:
„ (1 0 or,-Submit . •� on or Water Duality,Groundwa n •on within 30 days
_ U f-;11 __; -
_ Gw.t aEv. 17199
Serial No. _ r� 4E•, - J
PAS* ' GROUNDWATER SECTION
ASHEVILLE REGIONAL OFFICE

246714
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 CONTRACTO : /#47/.1 ��i 1'G1 c"4`°
WELL CONTRACTOR CERTIFICATION#: Lx "/ I
STATE WELL CONSTRUCTION PERMIT#: //77
1. WELL USE(check Applicable Box): Residential•' Municipal 0 Industrial❑ Agricultural 0 Monitoring 0
Recovery 0 Heat Pump Water Injection 0 Other ❑ If Other, List Use:
2. WELL LOCATION}.(/$how ak tch of the location below) G` � /�/J///1,
Nearest Town: a ifh/ Counry. 7XxL
(Road Name Numb .Community.or S b ivlai rf d I No.) • DRILLING LOG DEPTH
3. OWNER y� From Toff Formation Description
Addr O — 96/y /��n
City or Town State Zip Code !/ -
4. DATE DRILLED // 0
5. TOTAL DEPTH n S
6. CUTTINGS COLLECTED YES❑ NO,
7. DOES WELL REPLACE EXISTING WELL? YES
NO�
B. STATIC WATER LEVEL Below Top of Casing: FT. e ci
it
ruse'+' Above Top of Casing) N
9. TOP OF CASING IS
FT.Above Land Surface' r-ry _
Top of casing terminated st/or below land surface requires a variance In accor- c0 =.
dance with 15A NCAC 2C.Ott,6 `5
10. YIELD(gpm): Ls, METHOD OF TEST r i
11. WATER ZONES(depth): n� s C;
12. CHLORINATION: Typerakk, Amount �/3c • If additional space is needed use back of form "E. ,Y, a
13. CASING: o
LOCATION SKETCH z
Wall Thickness
Depth giagter or Weight/Ft. ` M'alen ,, (Show direction and distance from at least two State
From �/ To 70 Ft. co" scat D./ 6�.' Roads or other map reference points)/in
From To Ft. L L/ d /ed. ��I�
From To Ft. i %t"" `-�J
14. GROUT: /�� /fa� ��J a X-O �/� �✓��Q ,
Depth /�j1Matt 1�r / n� //I� ����"`- _ —
From � To 4� Ft. l" 0 Qi�{_0 �f�
From To Ft. Ate
15. SCREEN: - 4 V O/ rael ak.
/J 1� ���
Depth Diameter Slot Size Material p� trri,e;
TG�
From To___Ft _ In. In. A ^ 6(J
From _To FL._ In. _ In. U"i�C� ` .,
From To_Ft._ In. _ In. J /j/X
16. SAND/GRAVEL PACK: LC/._1 "
Depth Size Material
From To Ft.
From To Ft.
17. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS C DAIJC 5A NCAC 2C,WELL
CONSTRUCTION STANDARDS,AND THAT A CO It•. u' 1�4S*EtP ED TO THE WELL OWNER.
Ldo
FORdNo: 1:Lt OFFIC cIMLSR RE OF PERSON CONSTRUC ' E WELL DATE
UOrdon�(iter�,lualiryBatGnaw 'on within 30 days
GW-1 REV.12/99
Serial No.
.IJ"ti 'L 0 "'0 GROUNDWATER SECTION
7PSFIEVi' LE REGIONAL OFFICE
eei Ie Reglo' nM Office 1

246'749
North Carolina-Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section
1636 Mail Service Center-Raleigh,N.C.27699-1636-Phone[phone] (/' I �� �,� �y��
WELL CONSTRUCTION RECORD WELL CONTRACTOR: Cae �u- i I (/(' prduinb,c_.WELL CONTRACTOR CERTIFICATION#: 4 7
,,��•.•.,/( STATE WELL CONSTRUCTION PERMIT#:
LYJ
1. WELL USE(Check Applicable Box): Residential Municipal❑ Industrial❑ Agricultural❑ Monitoring El
Recovery❑ Heat Pump Water Injection ❑ Other El If Other, List Use:
2. WELL LOCATION (Show ketch of the location below) Al Nearest Town: Q County: 0 (lAA I r)0(Yi
(Road Name and mbers.Community,or ubdivision and Lot No.) DRILLING LOG DEPTH
3. OWNER '
1 irgnl e i`� `X Fromom _ To FormationDesciption
Address NG Q I11Vt (1�4In '` J athAA / � A Z
(Street o}Rou�nte No.h �R�l r ro 7a- a oc
City or Town Stale t l (J Zip Code ci
4. DATE DRILLED
5. TOTAL DEPTH OS •-1-1 1:'._,
6. CUTTINGS COLLECTED YES n NO p ;
7. DOES WELL REPLACE EXISTING WELL? ES NOM
8. STATIC WATER LEVEL Below Top of Casing: SQ FT.
(Use•r•If Above Top of Casing) -•
9. TOP OF CASING IS I FT.Above Land Surface' ;=
Top of casing terminated et/or below lend surface requires a variance In accor-
dance with 15A NCAC 2C.011e CO �-
10. YIELD(gpm): -7 METHOD OF TEST atN rn 2
11. WATER ZONES(depth): :c
12. CHLORINATION: Type V OAtLd (AA--Amount 1/2'C - If additional space is needed use back of form
13. CASING:
LOCATION SKETCH
Wall Thickness
y Depth Diameter or WeighVFt. t al (Show direction and distance from at least two State
From—l--To Ft. C. cn-La7 dt I Roads,or other map reference points)
From To Ft. \ow c+�..c\S C.CO Y3sot-vCa.r�
From To Ft. C\C•C M Y7 ^_co \ \ eC\
14. GROUT: ) Y� ;•2•v V�
Depth Material 0 eth�d - 1 �_ \\ `C � 'l2 c' ) l,v)�,\\be_
From 0 To Ft. 0CilL)A 1 IIJPU LJIi-�
From To Ft. Stsv\• \ct3L./1.12._, 03\/•-& . 4" \4 1-0 Cism -t•1 .a...l
15. SCREEN: - `
o... g`cts ., y..S'�C O1.51\
•
Depth Diameter Slot Size Material OTC •�..1) � 1
From To Ft In. in. �\ C`c� VC -_-�
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 • - •RD HAS BEEN PROVIDED TO THE WELL OWNER.
1111
FOR OFFICE US .'Ds L5 U V t5 `' fl, I for , _ _ •^ DATE
Quad No: Cr 1. ATl IR • PERSON C• r
p� I
,
Submit o 1, t DivlllonSWaler Quality,Groundwater Secti•n(di hin 30 days
ai114 tt�� - ( _! 11; GW-1 REV. 12199
Serial No. it 1.2 B .I (- , ,
- t..
�Repieee!°Mein v f, e I

WELL CONSTRUCTION RECORD 255080
North Carolina-Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAME/1(print) 1�rtL 1. ru 'L1/�_ n CERTIFICATION# -3L�Y/
WELL CONTRACTOR COMPANY NAME (-re.t- `J5ro� - Lt.)!'-I ( `f I�E'4Mp,lrncPHONE # ( $ t2__ - 3/ '7n
STATE WELL CONSTRUCTION PERMIT# 14b- ASSOCIATED WQ PERMIT#
(if applicable) - (if applicable)
I, WELL USE(Check Applicable Box): Residential,Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection❑ Other❑ If Other, List Use
2. WELL LOCATION: Topographic/Land setting
Nearest T wn: ' ,0._ elC1ounty OQrt ❑Ridge 'Slope ❑Valley ❑Flat
i 7 , (� �Q� /)O (check appropriate box)
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) Lal itude/longitude of well location
q
3. OWNER: I oxa.- & v 1/n. -5-
- Ken e-e -cov`L+2 J 1 (degrees minutes/seconds)
Address 18 C5 Na ea'1-,t' r r rA .;r, . Latitude/longitude source:❑GPS❑Topographic map
(Streeter Route No.) J (check box)
1..-00 " nt S\I i i 1 p C. $'1 $ t.o DEPTH DRILLING LOG
CiCityo Zip Code` From To Formation Description
own State
(—)- 0 S.i e
Area code-Phone number 40 ' (o OS' et
1-t.w.�.Le.
4. DATE DRILLED I D - 1 C -i 1
5. TOTAL DEPTH: b 0 S ' , -
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO IF1
7. STATIC WATER LEVEL Below Top of Casing: c f Y) FT.
(Use"+"if Above Top of Casing)
8. TOP OF CASING IS I FT.Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance,with l5A NCAC 2C.0118.
9. YIELD(gpm): zW METHOD OF TEST c 2 in rth
10. WATER ZONES(depth): 3 0.5 1 - to Os '
LOCATION SKETCH
11. DISINFECTION:Type I—I. -1-1--1 Amount I D '7 Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads. Include the road
Depth Diameter or Weight/Ft. Material numbers and common road names. c
From D To 49 Ft. Lc " P V6'', o 0
IV
From To Ft. L --.
From To Ft. C cr
13. GROUT: Depth Material Method = -'
o-
From D To .0.0 Ft. CQ,'w . * I c p co 0n
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material 3 „m—,'
From To Ft. in. in. a r"n-c.:
From To Ft. in. in. C.,)
15. SAND/GRAVEL PACK: CO E
Depth Size Material
r--� From - -To -' Ft.
x From i 'To�n Ft.
1• i 16. REMARKS:
L.f)1 ::
1 • I DO HEREBY CERTIFY:THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I 5A NCAC 2C,WELL
CONSTRUCTION STA#4DARQS,AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality,Groundwater Section, 1636 Mail Service Center-Raleigh,NC
' 27699-1636 Phone No.(919)7333221,within 30 days. GW-I REV. 07/2001

•
•
257314
WELL CONSTRUCTION RECORD
North Carolina-Department of Environment and Natural Resources-Divi ion/ Or
Water Quality-Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAME (print) )L(n /C LA CERTIFICATION a?7///g
WELL CONTRACTOR COMPANY NAME G'ree41L,Sys �lI .2‘ Pi�i � • PHONE a £fl 4 V2 �3/`76
STATE WELL CONSTRUCTION PERMIT# /��.2 ASSOCIATED WQ PERMIT#
•
(if applicable) (if applicable)
1. WELL USE(Check Applicable Box): Residential*. Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION Topographic/Land setting
ear tt Town: County_1 �� ❑Ridge ❑Slope ❑Valley at
C' 2l 1•(�LI ( - .q-tw.( (check appropriate hox)
(Street Name, rs,Community,Subdivisio of N .,Zip Code) Latitude/longitude of well location
3. OWNER: (degrees.minutes/seconds)
Address ��.5 �. Latitude/longitude source:OGPSOTopographic map
(Street•ofp IIjjoute No.) (check box)
424//t, Vie OC61/y '7Y DEPTH DRILLING LOG
City Town State • Zip Code From To H z Form ' Description
(—)-
Area code-Phone number 71 z a -/
4. DATE DRILLED /D - .20 '?/
5. TOTAL DEPTH: a?S i
L
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO AL
7. STATIC WATER LEVEL Below Top of Casing: //-D FT.
(Use••+"if Abovc Top of Casing)
• 8. TOP OF CASING IS I FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with)SA NCAC 2C.0118.
9. YIELD (gpm): /4O METHOD OF TEST a 'Tura _ -
10. WATER ZONES(depth): a/)6-1 — /.212 fin '
6" LOCATION SKETCH
I I. DISINFECTION: Type f-/T/-/ Amount ,jvj Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads. Include the road
Depth Diameter or Weight/Ft. Material numbers and common road names.
• From O To /77 Ft. 4 zi Nyt
From To Ft.
From To Ft.
13. GROUT: Depth Material ./. Method
From /9 To ,W Ft. Co A1•t e,n.! /D p c>-
From To Ft. -• �;
14. SCREEN: Depth Diameter Slot Size Material I
From To Ft. in. in. -
=i
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material cnc
From To Ft. crt f
From To Ft. •••-.f
c
~16. REMARKS:
r '1 ( l DO'HEREBY C 2 'VHAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTIORRhSI`A .,,/ 'S,AND THAT A COPY OF THI RD HAS BEEN PROVIDED TO THE
WELL OWNER
U Li i SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
LSubmit the original to tt a Division of Water Quality, Groundwater Section, 1636 Mail Sen ice Center-Raleigh,NC
• ""i1376994636PholdeNo.[phone],within 30 days. GW-1 REV. 07/2001
I,: LICE

_. z _
• 240299
WELL CONSTRUCTION RECORD
North Carolina-Department of Environment and Natural Resources- Division/I of Water Quality-Groundwater Sectionq �/
WELL CONTRACTOR(INDIVIDUAL)NAME (print) h0 13, it ![2/p b 1,� CERTIFICATION#.2 41/ D-
WELLCONTRACTORCOMPANYNAMEIcrePYnP .Kitt Li�C_1� `s) YJIrni) Zit.. PHONE # (&7S)CS _- 90
STATE WELL CONSTRUCTION PERMIT# /fib.2 ASSOCIATED WQ PERMIT#
(if applicable) -/ (if applicable)
GY 1. WELL USE(Check Applicable Box): Residential Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION"). // L/ Topographic/Land setting i
NearestT wnf C�t L!_ ounty /`y'zz-y/r)ro�,P ORidge OSlope OValley 8FIat
Nearest
_N-I,t-L it . (check appropriate box)
(Street Name, bers,Community,Subdivisi n,Lot No.,Zip
ACode) / Latitude/longitude of well location
3, OWNER: - ➢t iA )&''e-L/jld-11 1 (degrcesminutesseconds)
Address //-733 .-4 LA (,tev Id. Latitude/longitude source:❑GPS❑Topographic map
(Street or Route No.) (check box)
0-0-2-at l `�t 8 9 . 1 DEPTH DRILLING LOG
City or Town State Zip Code From To Forman n Description
(—)- Q /n c c///,}}tq/ z
Area code-Phone number / S 'le)5 Cd -ItiSL,i.L2.
4. DATE DRILLED /D - D- D I '
5. TOTAL DEPTH: It 5' /
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO E
7. STATIC WATER LEVEL Below Top of Casing: /56 FT.
(Use"+"if Above Top of Casing)
8. TOP OF CASING IS J FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with I5A NCAC 2C.0118.
9. YIELD(gpm): 4 METHOD OF TEST 4 h r5
•
10. WATER ZONES(depth): /.;j5' SL q p m
J LOCATION SKETCH
I1. DISINFECTION:Type /-{ TF-I Amount /„2 '7 Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads. Include the road
Depth Diameter or Weight/Ft. Material numbers and common road names.
From To lo.5"-- Ft. Z '/ /Yr-
From To Ft. c
From To Ft. p za-
c
13. GROUT: Depth Material Method — n
From 4 To d' Ft. it.(rak-n t •477 O om
From To Ft. C =n
14. SCREEN: Depth Diameter Slot Size Material t oCJ1m
From To Ft. in. in. nba
From To Ft. in. in. 3 mo
15. SAND/GRAVEL PACK: rni
Depth Size Material f- rnzi
o
From To Ft. 0 "'t
—! o
From To Ft. z
16. REMARKS:
a.Rb4 E 41f A H S WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
A.. ,ID THAT A COPY OF ECORD HAS BEEN PROVIDED TO THE WELL OWNER
_. " �IGNATURE OF PERSON CONSTRUCTING TI IE WELL DATE
•
Sub 'sj+);.:+li '.�,. ;.�'�trte Divisbn of Water Quality,Groundwater Section, 163o Mail Sem ice Center- Raleigh,NC
2/n - ' o -u '•''t r»-a 21,within 30 days. GW-1 REV.07/200I

.ram_
WELL CONSTRUCTION RECORD 2 4 0 3 1. 9
North Carolina-Department of Environment and Naturaltu�l1 Resources-Division of Water Quality-Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAME 1(print) /�n ri CLrtA `LIYLI/I CERTIFICATIONtl J/L�4//
WELL CONTRACTOR COMPANY NAME IYrer•,G Bra-> //P-J I a" r[tz,r[? AP/te,PHONE 0 (f G YR --3/76
STATE WELL CONSTRUCTION PERMITS/ /4/ ASSOCIATED WQ PERMITS/
(if applicable) / (if applicable)
1. WELL USE(Check Applicable Box): Residential Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 II Other, List Use
2. WELL LOCATION / / Topographic/Land setting
Nearer Town: r2Ur7'x- County A-yew-gel ORidge 6d51ope ❑Valley ❑Flat
1L r /
"(r�re�LC L, i`L./';J._- (check appropriate box)
(Street ame,Numbers,Community,Subdivision,Lot No.,Zip Codc) Latitude/longitude of well location
3. OWNER: (X/Y21-af 7 �.{�'in.- ill/!'./ (decrees in inures/seconds)
Address ..S//s t% .? LI?, . In, n.r,+.e4- X','/ Latitude/longitude source:❑GPS❑Topographicmap
/2 LS eet or Route No) y (check box)
C. A2�,Z,(rin% 0d 7/�' DEPTH DRILLING LOG
City or Town Stare Zip Code From To Formation Description
(—)- I 22 z
Area code-Phone number „71 70 S '
4. DATE DRILLED /0 -IG -l') /
5. TOTAL DEPTH: '7D 5- '
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 2"
7. STATIC WATER LEVEL Below Top of Casing: %DO FT.
(Use"+"if Above Top of Casing)
8. TOP OF CASING IS ' FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a -
variance in accordance with 15A NCAC 2C.0118.
9. YIELD(gpm): A METHOD OF TEST 2 A rS
10. WATER ZONES(depth): /n Z>C) ' - ? p re-)
LOCATION SKETCH
I1. DISINFECTION:Type /-t rig Amount /2. 7 Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads. Include the road
Depth Diameter or Weight/Ft. Material numbers and common road names.
From ') To -2 2 Ft. (c 'I Pi/(?
From To Ft. c
From To Ft. p
13. GROUT: Depth Material Method — cc)
From ( To 02 Ft. ic.,Q„ 1- 10/) 0 S'
1
From To Ft. c an
14. SCREEN: Depth Diameter Slot Size Material I o<
Crl —rn
From To Ft. in. in. �o
�
From To Ft. in. in. = A�
rm
IS. SAND/GRAVEL PACK: eni
Depth Size Material •• nz
From To Ft. G
From To Ft. -..1z
16. REMARKS:
e, R r S WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C,WELL
R TILL.
�T j/D, 2' AJD THATACOPY OFT 1ORD HAS BEEN PROVIDED TO THE WELL OWNER
__
,..A ii 2p 23321 GNATURE OF PERSON CONSTRUCTING THE WELL DATE
SUhait-thP oni ingl In the ,ivisi m of Water Quality,Groundwater Section, 163o Mail Service Center-Raleigh,NC
• 276997M: railel 733-32 I,within 30 days. GW-I REV. 07/2001

WELL CONSTRUCTION RECORD 2 `�
North Carolina-Department of Environment and Natural/a Resouurces✓Division of Water Quality-Groundwater Section '/
WELL CONTRACTOR(INDIVIDUAL)NAME (print) /Jrtt lu:-1 £ru LA...( CERTIFICATION# 341 'f
WELL CONTRACTOR COMPANY NAME lYrPPJv &us LUCI I q Pr.0 f l lti- PHONE # (8g L`l$ - 3,7C
STATE WELL CONSTRUCTION PERMIT# / Y°' 2 ASSOCIATED WQ PERMIT#
(if applicable) f if applicable)
I. WELL USE(Check Applicable Box): Residential I'Municipal/Public ❑ Industrial El Agricultural ❑
Monitoring ❑ Recovery 0 Heat Pump Water Injection El Other 0 If Other, List Use
2. WELL LOCATION / Topogra hic/Land setting
Nearest Town:
/,LJ/LyttSV/ilt County i—ktfli/OIA ❑Ridge WSlope OValley ❑Flat
V Lir- Arri vl —€'q —w I (check appropriate box)
(Street Name,Numbers,Comrhunity,Subdivision,J Lot No.,Zip Code) Latitude/longitude of well location
3. OWNER: n n`"1 r e —Par k t n S (degrccs5ninutes/scconds)
Address . 3 g'3 V/Lv- A r(l ntl-tnt / Latitude/longitude source:❑GPS❑Topographic map
^'/ (Street or Route No.) (check box)
l X ZIP Ai 0 c78 7 2/ DEPTH DRILLING LOG
City orftown / State Zip Code From To Formation Description
( )- /) /05 ,�)(7. aq -�
Area code-Phone number // 6" 22S Y1 r-et nvGCJ
4. DATE DRILLED l0 - lc -/4 /
5. TOTAL DEPTH: 32 S '
6, DOES WELL REPLACE EXISTING WELL? YES ❑ NO 13"
7. STATIC WATER LEVEL Below Top of Casing: .90 FT.
(Use"t"if Above Top of Casing)
8. TOP OF CASING IS I FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordan�c/eG with ISA NCAC 2C,01l s.
9. YIELD(gpm): METHOD OF TEST .2 Jir.s •
10. WATER ZONES(depth): tQ15 ' - 45-11-,:v`
LOCATION SKETCH
I 1. DISINFECTION:Type N T. H Amount /li) Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads. Include the road
Depth Diameter or Weight/Ft. Material numbers and common road names.
From t To //I Li Ft. Z tr g tie_
From To Ft.
From To Ft. a
13. GROUT: Depth Material Method 0 0
From C) To 3i/ Ft. 06 w .f Ft^ra pp-
From To Ft. 0 c)ri
ac
14. SCREEN: Depth Diameter Slot Size Material t 'E'='
o<
From To Ft. in. in. tJI no
From To Ft. in. in. —0 m--.
15. SAND/GRAVEL PACK: MC zm
Depth Size Material ma
From To Ft. n
0 --t
From To Ft. . v 2
z
16. REMARKS:
I DO HBFTav CFRTIFV THAT Tjl1S WELL WAS CONSTRUCTED IN ACCORDANCE WITH I 5A NCAC 2C,WELL
CONSTR IT�E�RI(�,iJ Hki.A COPY 0 THIS RECORD HAS BEEN PROVIDED TO TILE WELL OWNER
p1 NAT- OF PERSON-CONSTRUCTING THE WELL DATE
,v
Submit e o ginal to the Division of Wat r Quality,Groundwater Section, I63t Mail Service Center- Raleigh,NC
27699-16 6 Phone GiouiRAM101141164,trRthin 0 days. GW-I REV. 07/200I
Asheville Regional Office

WELL CONSTRUCTION RECORD 2 4 0 3 2 1
North Carolina-Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section '/ �j
WELL CONTRACTOR(INDIVIDUAL)NAMEn(print) ) ) z . CERTIFICATION N �c2 Y'/6
WELL CONTRACTOR COMPANY NAME ``✓ee 1L/ 7fo5 . I(ai 1 CC lnf'"N Y1LC PHONE N (gigIII 8 - 3/ 2C
STATE WELL CONSTRUCTION PERMIT# /'if' 1 ASSOCIATED W'Q PERMIT#
(if applicable) (if applicable)
1. WELL USE(Check Applicable Box): Residential l3(Municipal/Public 0 Industrial ❑ Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 I(Other, List Use
2. WELL LOCATION3i) JJ / Topographic/Land setting
Nearest Town: ( (?4-i +st County )/ocL ORidge m8fpe OValley ❑Flat
997„t et zar<i /a). (check appropriate box)
(Street Name,Numbed.,Community,Subdivision,Lot No.,Zip Code) Latitude/longitude of well location
r
3. OWNER: /5 7,L/- / ;"C�+'t��'�' / (degrees/minutes/seconds)
Address /cy O >7 ,, sA,Ly ,€. . Latitude/longitude source:❑GPS❑Topographic map
(eltreet or Route No.) 0 r,� (check box)
. 2- L mi , tit .7d 7/& DEPTH ' DRILLING LOG
City or Town Stare Zip code From To Formatio Description
(—)- / c579
Area code-Phone number f{r? , G,S r'
4. DATE DRILLED in - 9 - C I (
5. TOTAL DEPTH: . 4/) S /
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 27-
7. STATIC WATER LEVEL Below Top of Casing: /✓�1 FT.
(Use"+"if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C.0118.
9. YIELD(gpm): 7 METHOD OF TEST 0Q A r3
10. WATER ZONES(depth): /8-' -
LOCATION SKETCH
11. DISINFECTION:Type /I 77-/ Amount '$t/2 Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads. Include the road
Depth Diameter or Weight/Ft. M en I numbers and common road names.
From Z1 To gJ Ft. /I ii Fre o
From To Ft. O o
From To Ft. OZ a�
13. GROUT: Depth Material Method ,C a
From.„ ) To -VI Ft. fL 4nI4 I o=
From To Ft. cn Da
14. SCREEN: Depth Diameter Slot Size Material ---t\
From To Ft. in. in. = xten
ry
From To Ft. in. in. F' r`U,
15. SAND/GRAVEL PACK: O 2
Depth Size Material vCD
From To Ft.
.........From ■■ryry UT., `Ft.
IA�RIU ® LS
till V
Aqit.ERY ICERTIFY " THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
NSTEBIftlCTION STANLIIC DS, AND THAT A COPY OF THIS ORD HAS BEEN PROVIDED TO THE WELL OWNER
//i 1 it
f,.ti(xrlwIt�r Sectiit411.it(1 YZc,� /ll - 32' /
Asheviiie Regiona 0. Ice SIGNATURE OF PERSON CONSTRUCTING TIIE WELL DATE
Submit the original to the Division of Water Quality,Groundwater Section, 163n Mail Service Center-Raleigh,NC
' 27699-1636 Phone No.[phone],within 30 days. GW-I REV.07/200I

244427
WELL CONSTRUCTION RECORD
North Carolina-Department of Environment and Natural Resources- Division of Water Quality- Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAME (print) xTY-y/t-1ci) '. t UI1(' I CERTIFICATION it .q/t`/L
WELL CONTRACTOR COMPANY NAME Pyre Vito /'BY ' /t.2 ) b- Pap, I)' -•PHONE # (gn L, 91 --3/ ��
STATE WELL CONSTRUCTION PERMIT# / ' ASSOCIATED WQ PER:MIT#
(if applicable) (if applicable)
I. WELL USE(Check Applicable Box): Residential ❑/Municipal/Public 0 Industrial 0 Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION: Topographic/Land setting
Nearest Tp,wn:_1 ��g2 County /t`/& 'iJ9e2 ❑Ridge OSlope ❑Valley ❑Flat
��� A ![_-fi l?/ IC ![_12 (check(check appropriate box)
(Street Name,Numbers,Community,Subdivi}�on,Lot No.,Zip Code) Latitude/longitude of well location
3. OWNER: lj P (degrees minutes/seconds)
Address o2 L> rf • Ili ;/7"1 Latitudeiloneitude source:❑GPS❑Topographic map
ffStreet or'bay No.) �/ (check box)
(7/2mot .i n ! 7L-C �J 7/a DEPTH DRILLING LOG
City or Town State Zip Code From To Form i n Description
(—)- _O _ZJ r C Pet
Area code-Phone number ,�/.3 DS / / ,
4. DATE DRILLED /L9 — 4- -a / (J
5. TOTAL DEPTH: /p,7 r
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO tV
7. STATIC WATER LEVEL Below Top of Casing: .._+/-L) FT.
(Use"+"i f Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordant with ISA NCAC 2C.0118. •
9. YIELD(gpm): -30 METHOD OF TEST e 2 /i rz •
10. WATER ZONES(depth): 5 7,5- r - �17 C7 pM
U LOCATION SKETCH
11. DISINFECTION: Type N TN Amount / p el Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads. Include the road
Depth Diameter or Weight/Ft. Material numbers and common road names.
From D To 3 Ft. It; " P1/0
From To Ft.
From To Ft.
13. GROUT: Depth /Material 1 Method C
From in To a Ft. (.L-c f C o
From To Ft. O 9-
14. SCREEN: Depth Diameter Slot Size Material rti 0�
From To Ft. in. in.
_ �m
From To Ft ,,, tV ,
15. SAND/GRAWE4�P K -p ti�
1 b�pt� S,ze ` n b a nal MC jj
rn
From 1iTo FL Ii l Pi
From I1 ';TOI FL - „v,- i N Pi
CO
0
16. REMARKS: I I I Z
i;:
I DO HEREBY CIEIRTIFY THAT THIS WELL(WAS-CONSTa UCTED IN ACCORDANCE WITH I 5A NCAC 2C,WELL
CONSTRUCTION` AND THAT A COPY OF TH CORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSO TRUCTING TIIE WELL DATE
Submit the original to the Division of Water Quality,Groundwater Section, 1636 Mail Service Center-Raleigh,NC
27699-1636 Phone No.(9I9)733-3221,within 30 days. GW-I REV. 07/2001

WELL CONSTRUCTION RECORD '� 18
North Carolina-Department of Environment and Natural Resources- Division of Water Quality-Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAME
�(print) -/'�C 5 FS1 n b)e_.6 ((�� CERTIFICATION# d viic
WELL CONTRACTOR COMPANY NAME 61'ret1 arts., LC.) LI ai 7-atmp 4s.t-.PHONE # (F,?,)I a *3/2<'
STATE WELL CONSTRUCTION PERMIT# I 1��.. ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential D.- Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 I[Other, List Use
2. WELL LOCATION:/ _ Topographic/Land setting
Nearest Town: ///Ct.t, no.t�i y,�4 County � pe ❑Ridge ❑Slope ❑Valley f3Flat
'Q (check appropriate box)
(Street Name,Numbers
ommuniiy,Subdivision,Lot No..Zip Code) Latitude'longitude of well location
3. OWNER: ( I �(^n� C L�,S L� (degrees minutesiseconds)
Address `� �/ [) /3 ✓✓/(os(p 3 Latitude/longitude source:❑GPS❑Topographic map
Midi
r/ Icheckbox)
( K-7�idi / 1- - .2X o2 / DEPTH DRILLING LOG
City or Tolvn State Zip Code From To Formation Description
( ) O 8S" '
Area code-Phone number g, 3 IR c- '
4. DATE DRILLED /D —3 1 -U / Cl "fib
5. TOTAL DEPTH: S s'_S I
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: z(c) FT.
(Use"+"if Above Top of Casing)
8. TOP OF CASING IS 1 FT.Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with I5A NCAC 2C.0118. A
9. YIELD(gpm): /0 METHOD OF TEST —2 rs
10. WATER ZONES (depth): 36 5" ' - /t 9?Pr)
LOCATION SKETCH
11. DISINFECTION: Type /4 7-1-1 Amount '7/ Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads. Include the road
Depth Diameter or Weight/Ft. Material numbers and common road names.
From 0 To 8$ Ft. (o " PI1c'.
From To Ft. _
From To Ft. _C
13. GROUT: Depth Material O c
Method 0 n—
From C To ,QC) Ft. Cya-vv-4_,Lli -I-t�m o
From To Ft. n .'
=r,
14. SCREEN: Depth Diameter Slot Size Material N �a
From To Ft to In no
15. From ll
SAND/GRAY IP C>S' Pt In 'I fit' �m
I
N ms
R14 : Size Ma cri[I
From to 1 �'
From I L i ^It'- - 7°°2 � 0
`J
Z
16. REMARKS:
CROUND..!" ER CCCRGN
ASHEVICLE REGIONAL OFFICE
I DO HEREBY CER'I7rt—ttnct IHLSWELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
CONSTRUCTION STANDARDS,AND THAT A COPY HIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
Yt.-? J.
SIGNATURE OF PERSON CONSTRUCTING TIIE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Sersice Center-Raleigh,NC
27699-1636 Phone No.[phone],within 30 days. GW-I REV. 07/2001

244429
WELL CONSTRUCTION RECORD
North Carolina-Department of Environment and Natural Resources- Division of Water Quality-Groundwater Section /
WELL CONTRACTOR(INDIVIDUAL)NAME
��(print) A,7i/ e /rez e—t. CERTIFICATION#yqt 4`/
WELL CONTRACTOR COMPANY NAME (Ile e c-t ,��, ���,,,pr1; (Jt�.L { Pt1.6t�,' • PHONE # (Q,7d)l. CLS�-3/7�'
STATE WELL CONSTRUCTION PERMIT# /S" ASSOCIATED WO PEROIIT#
(if applicable) /\ (if applicable)
I. WELL USE(Check Applicable Box): Residential la Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection O. Other 0 I(Other, List Use
2. WELL LOCATION: Topographic/Land setting
Nearest
Town: /ymn.)n,tE/ / Q o . County P'�u/i 2O,1 J ❑Ridge Ca<llope ❑Valley ❑Flat
/ L.) (cheek appropriate box)
(Street Name,Numbers,Community,Subdivision,Lot No..Zip Code) Latitude/longitude of well location
3. OWNER: froiL,,'"'4/ P /j ,y[. ‘74742� (degrees minutes/seconds)
Address /6-15" Ili/}-, . ` 21-/-z, , ,Qd. Latitude/longitude source:OGPSDTopographic map
(Street or Route No.)
(check box)
Z//t kfri tef-U/// / x7 ;281714- DEPTH DRILLING LOG
City or yown State Zip Code From To Formation Description
(_)- O 076 1 _ -C/a-r
Area code-Phone number 076 '1D5 I
•
4. DATE DRILLED /t' - 3/ - ° /
5. TOTAL DEPTH: 7GS/ —/
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO EI
7. STATIC WATER LEVEL Below Top of Casing: ern FT.
(Use"+"if Above Top of Casing)
8. TOP OF CASING IS / FT.Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C.0118.
9. YIELD(gpm): L3 METHOD OF TEST .' A e-S
10. WATER ZONES (depth): •SzD6' — ,.?1p,Yn
LOCATION SKETCH
1 I. DISINFECTION: Type NTH Amount / .2 'J Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads. Include the road
Depth Diameter or Weight/Ft. kjiiterial numbers and common road names.
From 6 To &L) Ft. /o '/ r Ye
From To Ft.
From To Ft. _
13. GROUT: Depth Material Method
From () To a D Ft. CD., .w- -h
From To Ft. / 0 zE
14. SCREEN: Depth Diameter Slot Size Material D
From To Ft. in. in. 0 air
Fr .To !F[ in. in. n s q
15. SA FGRAVEL P4CKI ( it --^\ N Pc-
I I IL ` Depth ' ll '',/ SSae 1" Material j r�
0
Frgrp.-,t To Ft.—1 r
jcp
Frdrt i L To Ft. II men
IN) CnZ
16. REMARKS:
—u
z
I DO HEREBY,CERTIFY THAT Ttfl$1WELL W CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C,WELL
CONSTRUCTION$TANDAIR:DS,: kT 'OPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality,Groundwater Section, 1636 Mail Service Center-Raleigh,NC
27699-1636 Phone No.[phone],within 30 days. GW-I REV. 07/2001

244423
WELL CONSTRUCTION RECORD
North Carolina-Department of Environment and Natural Resources- Division of Water Quality-Groundwater Section l_x '/
WELL CONTRACTOR(INDIVIDUAL)NAM/X(print) �L�rfaQ r,t�fL CERTIFICATION# girl/
WELL CONTRACTOR COMPANY NAME '!£'f ALL. 2 P. 3. U -ti i Y 1/'k-t++r t Z"-t -PHONE # (F,a� b 2I R -5l'7 L)
STATE WELL CONSTRUCTION PERMIT# / ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE(Check Applicable Box): Residential Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other 0 I(Other, List Use
2. WELL LOCATIO :J p Topographic/Land hic/Land setting
Nearest Try: it /�e- County �utJnnd ❑Ridge MS-lope ❑Volley ❑Flat
^JJ(( JJ``, Aai+ h . (check appropriate box)
(Street Nam e,Nu((��er))s,Community,Subdivision,Lot No.,Zip Code) Latitude/longitude of well location
3. OWNER: &1. KP/tp,JAIL (degree.minuets/seconds)
Address 999 `7 ii/.31.q-t. 9.1 ,n 0 Latitude/lon_itude source:❑GPS❑Topographic map
(Street or Route No.) (check box)
d FL 33r293 -/54// DEPTH DRILLING LOG
City or n Stale Zip Cale From To Formaattiioonn Description
—( ) D 3/ ' )ft �H
Area code-Phone number 3 .J/o S h.A au.
4. DATE DRILLED I O - a 3 -to )
5. TOTAL DEPTH: .5(05 '
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO 12/
7. STATIC WATER LEVEL Below Top of Casing: (n D FT.
(Use"+"if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C.0118.
9. YIELD(gpm): /5 METHOD OF TEST o2 ))r5 -
10. WATER ZONES(depth): 541, r — /S tf p net
LOCATION SKETCH
11. DISINFECTION: Type HTF-1 Amount /0,3 Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads. Include the road
Depth Diameter or Weight/Ft. Material numbers and common road names.
From D _ To .3/ Ft. Lr " PVC. Q
From To Ft. _ CD -
0
From To Ft. O na
13, GROUT: Depth Material Method F'ri :a„h
From D To A[0 Ft. CI.en+zk ) .- P C7 c c,
From To Ft. r. o�
14. SCREEN: Depth Diameter Slot Size Material Ac
~\
From To Ft, in. in. 20
Fro To Ft in.. in. N tii
15. SAN / LS b/i n�'
Y )S'z�r' r Material 03 -
From i To Ft. 'I z
Fro Tp Ft,,,,,„
16. REN(ARKI:
on vlA.f-, i
I DO HEREBY Cf,; 4 ?'1 t,4, ,eWAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTR �— — — 4 5 " Y OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
(Z/J -L @ / -4 - 0 i
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality,Groundwater Section, 1636 Mail tiers ice Center-Raleigh,NC
• 27699-1636 Phone No.[phone],within 30 days. GW-1 REV. 07/2001

244424
WELL CONSTRUCTION RECORD
North Carolina-Department of Environment and Natural Resources- Division of Water Quality-Groundwater Section ,,//
WELL CONTRACTOR(INDIVIDUAL)NAME
(print) 1:]Y1.tZu�C > /tJ PPD CERTIFICATION 14 ,jC 7 /
WELL CONTRACTOR COMPANY NAME I,-1✓P-44-iti it—zp I) V A.,_.,ri,Jic(' PHONE # tot? ' 4- VK-3/7l'
STATE WELL CONSTRUCTION PERMIT# /�����/nnnZ., . ASSOCIATED w'Q PERMIT#
(if applicable) A (if applicable)
I. WELL USE(Check Applicable Box): Residential G1 Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other❑ If Other, List Use
2. WELL LOCATION Topographic/Land setting
Nearest Town: / C-ci--u,'�/z'�) County 7� eJez'� ❑Ridge O3fope OValley ❑Flat
b__Kyj/d.!4,4- FJLii/S r (check appropriate box)
(Street Name,Numbers,Community,Subdivision,Lot No..Zip Code) Latitude/longitude of well location
3. OWNER: J z / ke f7 (ih n (deerce,minutes/seconds)
Address 41 S'I Yi/w nh�� /ed. Latitude/loneitude source:❑GPS❑Topographic map
/� l (Street or Route No.) J G )check box)
( .!-2/14 •/o,v X-C-; 02 S'7 / (b DEPTH DRILLING LOG
City or Town ' State Zip Code From To Formation Description
( )- 0 73 ' tt& y
Area code-Phone number I 7-4 J SS' Gyn k.a,a-i"i-
4. DATE DRILLED IID -..(e -0 0
5. TOTAL DEPTH: / SS '
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO 2'
7. STATIC WATER LEVEL Below Top of Casing: rQ(? FT.
(Use 'f"if Above Top of Casing)
8. TOP OF CASING IS / FT.Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance In accordance with ISA NCAC 2C.0118.
9. YIELD(gpm): a O METHOD OF TEST ' {A rs
10. WATER ZONES(depth): //Pi' ' - Q O J fl on
LOCATION SKETCH
I I. DISINFECTION:Type /-/.7-14 Amount ,a 17 Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads. Include the road
Depth Diameter or Weicht/Ft. Material numbers and common road names.
From () To 73 Ft. G tr PVC
From To Ft. -
From To Ft. 2 a
13. GROUT: Depth Material Method cI—
From D To �G FL et ars, 1 -- f ) r- I f Cro
From To Ft. _ m
14. SCREEN: Depth Diameter Slot Size Material N.)
From To Ft. in. in. HC
From _'o Ft` it in. 3 .6
15. SAKI, WEL A ,, :L•I 1'i�l IL
I ' t N mz
L De(rb S,zv I I 11 Material n
Fro I To Ft. v o
Fror4iI . I To Ftjm- ��
i L! L.
16. REIv4ARKS: J
( F�t )i�
[DO HERBY Cp FrR")'IFY rWI4,AT'THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I 5A NCAC 2C,WELL
CONSTRL TIONSTANLT AN THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
` el. J. ��hz--l-.f,-t_- /a - c -C' /
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality,Groundwater Section, 1636 Mail Service Center-Raleigh,NC
' 27699-1636 Phone No.[phone],within 30 days. G W-I REV. 07/2001

244420
WELL CONSTRUCTION RECORD
North Carolina-Department of Environment and Natural Resources- Division of Water Quality- Groundwater Section
11 WELL CONTRACTOR(INDIVIDUAL)NAME (print) 0 Ai rp� ) bit LA CERTIFICATION# 's �
m.WELL CONTRACTOR CONIPANY NA\IE ere'r a ,S✓GS LVtu 1 -1 PH-n+Pt 1"-e- ' PHONE P ( g -Y /+ V e - -3 1 -76
STATE WELL CONSTRUCTION PERMIT# I ,)-• ASSOCIATED WQ PERMIT#
(if applicable) — / (if applicable)
1. WELL USE(Check Applicable Box): Residential Ld' Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 I[Other, List Use
2. WELL LOCATION: ' / Topographic/Land setting
Neareswn: /.�CLu oPe; ,i, I4 County /'%/2./O)Dn� ❑Ridge ❑Slope ❑Valley I It
✓"(A' 1�12-La��-, c tZ_- .n.. /c<X . (cheek appropriate box)
(Street Name,N�ummbers,Community,Subdivision,Lot, No../ Zip Code) La)itude.!longitude of well location
3. OWNER: )7) . //.-<-P_ 3 4-PILh-CJ , iiketees m mutes.sceonds)
Address ,?34/ QQ 1 ,<)0 ) f Latitudvlongitude source:❑GPS❑Topographic map
p (Street 9r Route No.) 1 (cheek box)
(( jU -4,/)r //4/ '-1je'` Yg7Vs DEPTH DRILLING LOG
Cityge Town State Zip Code From To Formation Description
( )- D .3'7 �el1�2 .
Area code-Phone number 3 7 9,25 ' K-Sha-+-.t-t.o.
4. DATE DRILLED /D -/ '7 -p /
5. TOTAL DEPTH:. 9 a 5 '
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO B '
7. STATIC WATER LEVEL Below Top of Casing: Li-D FT.
(Use"+"if Above Top of Casino)
8. TOP OF CASING IS / FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance In accordance with 15A NCAC 2C.0118.
• 9. YIELD (gpm): METHOD OF TEST ,2 im CS
10. WATER ZONES(depth): 91)5 ' - / 2 ,pn.-,
LOCATION SKETCH
1 I. DISINFECTION:Type H rH Amount / (y.,r Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads. Include the road
Depth Diameter or Weight;Ft. Material numbers and common road names.
From /) To 3 7 Ft. Ca " f i/C.
From To Ft.
c
From To Ft. O o
13. GROUT: Depth Material t. Method
From n To �2L FL (1e.,r'P1 -}-Err 0 n�
rt
From To FL n cr'
m
14. SCREEN: Depth Diameter Slot Size Material - "— c<
From To Ft. in. in. N Da
From To Ft. in. • in. _ ^mo
15. SAND/GRAVEL PACK: • ter^
f r r Depth §iz Material N ( �
ma
F' m,1 To L Vt. `-- I ' - _�i
Figrie!I To Ft. I . 2
Wit; 'I '
16. RE 1A KS:;m,,,, Di? i1 •
I DO F!EREBtCFRTIEY_THAT THIS WF L WPS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C,WELL
CONSTRUCTION:STANDARetSIANLnHAT A :OPY OF THIS RECORD -IAS BEEN PROVIDED TO THE WELL OWNER
1 —1
YYf ti7_. -� ..._ i.z - '7 -b /
SIGNATURE OF PERSON CONSTRUCTING TIIE WELL DATE
Submit the original to the Division of Water Quality,Groundwater Section, 1636 Mail Service Center-Raleigh,NC
' 27699-1636 Phone No.[phone],within 30 days. G W-I REV.07/2001

2444�1
WELL CONSTRUCTION RECORD
North Carolina-Department of Environment and Natural Resources- Division of Water Quality-Groundwater Section
WELL CONTRACTOR(INDIVIDUAL) T NAME (print) RC) 2)t r-i /DP A/)�) CERTIFICATION#021/8
WELL CONTRACTOR COMPANY NAME O-r0 P.nc lSRZS. /€bit 4 !'et I'Y;l� rat PHONE # (Op L4e ---3/76
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential 0"---clunicipal/Public 0 Industrial 0 Agricultural 0
Monitoring❑ Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:n ` Topographic/Land setting
Nearest Ten: / •(�y,,:i County Air1 /�iJ, ct �r
��— ❑Ridge ❑Slope ❑Valley LH�lat
_Li C 4-wi , (check appropriate box)
(Street Name,Numbers,Community,Subdivision,Lot No..Zip Code) Latitude/longitude of well location
3. OWNER: , YZA2-l�f� � I deurecs in inumsscconds)
Address p!/// lr /(, Latitude/longitude source:❑GPSOTopographic map
t Street or Ro to o.) (check boil
(7,
� / g 7^2 DEPTH DRILLING LOG
City or own State Zip Code From To Formation Description
—)- •
Area code-Phone number q yt �S5 r a
4. DATE DRILLED /O -9 -G / '
5. TOTAL DEPTH: .42 YS `
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO 1/
7. STATIC WATER LEVEL Below Top of Casing: t FT.
(Use"+' if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C.0118.
9. YIELD(gpm): (p D METHOD OF TEST c2 Are,
10. WATER ZONES (depth): 0 Le 5 ' - Lr,0 9 rd,r
LOCATION SKETCH
11. DISINFECTION:Type L-I T/-1 Amount ,5-1 Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads. Include the road
Depth Diameter or Weight/Ft. Material numbers and common road names.
From t To %k' Ft. L // P/i(l
From To Ft._
From To Ft.
13. GROUT: Depth Material Method e
From C To ..n) Ft. f Q-yrt4a:;� v 2 o
From To Ft. m z^
14. SCREEN: Depth Diameter Slot Size Material CD r-c
From To Ft. in. in. irk
c
From To Ft. in. in. N --r-
15. SAND/GRAVEL PACK: -o ��
Depth Sup Material 3 �o
Fro Tie L n Ft i L .1 N rni
Fro FL i _, n
—1
Co16. RE . _ , Inn- l J =
12 :VI r:-
I DO HE BY ERTIFY THAT THIS WEL WAS FONSTRUCTED IN ACCORDANCE WITH I5,A NCAC 2C, WELL
CONSTR CTI A CCPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
( t
A^ .. L� RE' 1 4 . i ,�E — 0 /
�— �`.1ti�J /.z - 7
SIGNATURE OF PERSON CONST a I ING THE WELL DATE
Submit the original to the Division of Water Quality,Groundwater Section, 163li Mail Son ice Center-Raleigh,NC
27699-1636 Phone No.[phone],within 30 days. GW-I REV. 07/2001

245472
WELL CONSTRUCTION RECORD
North Carolina-Department of Environment and Natural Resources- Division of Water Quality-Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAME (print) ��/ [ - /£J ru-e i CERTIFICATION# Sell/
%r ilt WELL CONTRACTOR COMPANY NAME P-e. - tic . /fie-I/ 1I Aar,a cJ.'t CM# ( G 5/d '3/ 7E'
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PER)IIT#
(if applicable) / (if applicable)
1. WELL USE(Check Applicable Box): Residential R Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery ❑ Heat Pump Water Injection ❑ Other❑ If Other, List Use
2. WELL LOCATIO) ) j ) Topographic/Land setting
Nearest Town: ( /d -*t tt-tit County . O/t DRidge Qd hope OValley ❑Flat
421 /9- 2 3 / (check appropriate box)
(Street Name,Numbers,Community,Subdivision,Lot No..Zip Code) Latitude/longitude of well location
3. OWNER: C,J�v-I.- / / .) (degrees minutes/seconds)
Address (/ it)/)5- 44i4tlf /0 -.,23 Latitude/Ion_zitudesource:DGPSOTopographic map
(Sycc or Route No.) i (check box)
(2-4-4t./-Lefti , 45,S17/`5 DEPTH DRILLING LOG
City or Town Stafe Zip Code From To Formati n Description
(—) n /Area code-Phone number 74 gp-ci '
4. DATE DRILLED //) -a -0 1
5. TOTAL DEPTH: c GS
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO V
7. STATIC WATER LEVEL Below Top of Casing: art.' FT.
(Use"+"if Above Top of Casing)
8. TOP OF CASING IS / FT.Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with)5A NCAC 2C.0118.
9. YIELD(gpm): c2 METHOD OF TEST ca 1,rs
10. WATER ZONES(depth): 4.57: / - -.>7 4 r•',-
.J LOCATION SKETCH
11. DISINFECTION:Type //.7 /-I Amount /63 Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads. Include the road
Depth ,` Diameter or Weight/Ft. Material numbers and common road names.
From 0 To r/'Y Ft. L I/ P110-
From To Ft.
From To Ft.
13. GROUT: Depth Material , Method c
From Toh Ft. (ig,--e.-p ,.,_( N o
From To Ft. L 9"3
14. SCREEN: Depth Diameter Slot Size Material a Sr)
c r �
From To Ft. in. in. — -
From To Ft. in. in.
15. SAND/GRAVEL PACK: -o
�a D,ep E ,s oize Material �m
' I Elam.0 )I'o� Ft.� N cnz
CI From To Pt. ` r- m�
I
n 5
w
iJ 6 ; N}Alail(S: 1 200? "�)
I DOLHERF YS:ERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I 5A NCAC 2C,WELL
CONSTRUCTION/!A AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PER FTCONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality,Groundwater Section, 163o Mail Service Center-Raleigh,NC
' 27699-1636 Phone No.(919)733-322I,within 30 days. G W-I REV. 07/2001

210305
WELL CONSTRUCTION RECORD
North Carolina-Department of Environment and Natural Resources- Division of Water Quality-Groundwater Section
R WELL CONTACTOR(INDIVIDUAL)NAMI/ am-a-EE art
HA A/ ,i /tie..1, L CERTIFICATION# <,4"8
Ly
WELL CONTRACTOR COMPANY NAME re e eD1 - Id LII Si PLL.%W, aµt.PHONE # fgzil 6 yg -3/ 70
STATE WELL CONSTRUCTION PERMIT# /'yn- ASSOCIATED WQ PERMIT#
(if applicable) / (if applicable)
1. WELL USE (Check Applicable Box): Residential f :Municipal-Public ❑ Industrial 0 Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 IfOther, List Use
2. WELL LOCATION: Topographic/Land setting
Nearestd'own: j-e t� County No//y/}per) ❑Ridge ❑Slope OValley @Flat
mgr e�. )LLr/.A. 04 (cheek appropriate bowl
(Street Name,Numbers,Community,Subdivision,sio Lot No.,Zip Code) Latitude,longitude of well location
FI
3. OWNER: CA L h, e_ ICE.., (decrees.minutes,seconds)
Address P n Rity. 9 R. Latitude/longitude source:❑GPS❑Topographic map
Lie,
_rctrcet of Route9 No.) ' (check box)
/.!-Ke, ,I Lind or
A/e �g 7Y/s- DEPTH DRILLING LOG
City or Town State Zip Code From To Formatio Description
(—)- 7J AFC) _t •
Arca code-Phone number SiLi 3( S
4. DATE DRILLED 9-/ 7 -6 /
5. TOTAL DEPTH: J S '
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: Lo r FT.
(Use••✓'if Above Top of Casing)
8. TOP OF CASING IS I
FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C.0118.
9. YIELD(gpm): /eil METHOD OF TEST ..--) Ars •
10. WATER ZONES (depth):
LOCATION SKETCH
I1. DISINFECTION: Type /f Tf-I1 'Amount C. 7 Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads. Include the road
Depth Diameter or WeightFt. Material numbers and common road names.
P From To &Ca Ft. 6, if Pile
From To Ft.
From To Ft.
13. GROUT: Depth Material Method 0 g
From CO To SQP /�
Ft. L G.vNd.A7 o
From To Ft. 02 a„t
14. SCREEN: Depth Diameter Slot Size Material 'C Cm
From To Ft. in. in. t oc._..
cn
From To Ft. in. in. nc
15. SAND/GRAVEL PACK: -0 ��
Depth Size Material r^
From To Ft. t mg
From To Ft.
v o
x
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I 5A NCAC 2C,WELL
CONSTRUCTION STAND` 3,AND THAT A COPY OF TH J31ThCQRD HAS BEEN PROVIDED TO THE WELL OWNER
7/ I ..i //e.tt \N�i+� /a -36 - 4' /
-(Irl II M (2 r SIGNATURE OF PERSON CONSTRUCTING TI IE WELL DATE
ii
•
Submit the oII Urigiinal15to .(vision of Water Quality,Groundwater Section, 163n.Mail Sen ice Center-Raleigh,NC
27k9y ,+�'u.(913 7p3-3,')-1436 i 221,within 30 days. GW-I REV. 07/21)U
7 ..J
Groundwater Section
Asheville Retinal Office

WELL CONSTRUCTION RECORD
? ". 03O4
North Carolina- Department of Environment and Natural LLResources- Division of Water Quality-Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAME (print) k F/)K bJe- b b CERTIFICATION# #74//8
WELL CONTRACTOR COMPANY NAMEGreene ftc-, . (C/`a-)1 9/LC rat0.Lr,l PHONE # Ft231 t 9g - 3i 90
STATE WELL CONSTRUCTION PERMIT# /1/4)-2 ASSOCIATED WQ PER\IIT#
(if applicable) (if applicable)
(t3"/
I. WELL USE(Check Applicable Box): Residential Municipal/Public ❑ Industrial 0 Agricultural ❑
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 IfOther, List Use
2. WELL LOCATION: s Topour hic/Land setting
Nearest Town: 1141� / County 4.1,rniter/ ❑ ge 0 RidSIope ❑Valley ❑Flat
Ll_!KL .Le Pi4 't , (check appropriate box)
(Street Name,Numbers,Communiry,Subdivision,n Lot No.,Zip Cade) Latitude/longitude of well location
3. OWNER: / LT-1^-t1 ( -[( (r.) Ide roes minmes seconds)
Address 4/,a9T AM vtr pla. Latitude;lon_itude suurce:OGPSOTopographic map
// (Street or Route No.) (check box)
[_,L.c/nC5 yr //e A/C: DEPTH DRILLING LOG
City r Town Stag Zip Code From To Formation Description
(—) /9 i e/ eirli .
Arca code-Phone number ?y /`.3 q f JL
4. DATE DRILLED O -a 1 - 0 I
5. TOTAL DEPTH: //0 5 '
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO E
7. STATIC WATER LEVEL Below Top of Casing: 6/) FT.
(Use"+"if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C.0118.
9. YIELD (gpm): /2 METHOD OF TEST A r5 .
10. WATER ZONES(depth): /I/5 ' - /.2 j pm
LOCATION SKETCH
IL DISINFECTION: Type /-/ TH - Amount „1' CJ Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads. Include the road
Depth /,// Diameter or Weight/Ft. Material numbers and common road names.
From C To C Y- FL / r/ PVC,
From To Ft. _
From To Ft.
13. GROUT: Depth Material Method o
From 1 To ,2/1 Ft. eL +'11 lir
O o
From To Ft. 2 c"' :„
ryl
14. SCREEN: Depth Diameter Slot Size Material C co
From To Ft. in. in. I =rn
0
From To Ft. in. in. N na
15. SAND/GRAVEL PACK: -0 r"-'„-..._
Depth Size :Material Z � n
From To Ft. flu
From To Ft. O a
-I
o
z
16. REMARKS:
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 BEEN PROVIDED TO THE WELL OWNER
i) j //IA 2 .L /5 - 3/' ' .."' /
w
E C E I - E ATURE OF PERSON CONSTRUCTING TIIE WELL DATE
i4 it the original to the I 11
u of Water Quality,Groundwater Section, Wit Mail Sert ice Center-Raleigh,NC
1I.-1153A1PGyn1 KOle)7 -I ,within 30 days. GW-I REV. 07.2001
Groundwater Section
Asheviiie Re:irnal Office

r ...
WELL CONSTRUCTION RECORD ? 1 n '
•
North Carolina-Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAME
� (priory •Zr-y /i� eft,C1Y- CERTIFICATION# ��ti
WELL CONTRACTOR COMPANY NAME�Trtp.sve-, 13rrv5 hp J) 4 P=-hil —4/.t- PHONE # (8-aG+j/g `3i 7`
STATE WELL CONSTRUCTION PERMIT# /44—Z ASSOCIATED wQ PERMIT#
(if applicable) _ (if applicable)
/
1. WELL USE (Check Applicable Box): Residential t7 Municipal.Public ❑ Industrial 0 .Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCAT,,IO� 1N: - � I TopoeraphiciLand setting
Nearest Town: Wri, OPSJI � ie County ALit/P)6A ❑Ride L9SIope ❑Valley ❑Flat
L,C KSY-p't l RA , (check appropriate box)
(Street Name,Numbers,Community,Subdivision.Lot ..Zip Code) Latitude/longitude of well location
3. OWNER: V71,144. l2 ` Ide,;ree ntinuresseconds)
Address 77_3 natL 1y4., 7 ,lJh. Latitude,longitude source:❑GPS❑Topographic map
(Street or Route No) 'check box)
Y.//)l -i/it, 97/ ' rf72 DEPTH DRILLING LOG
Ci or Town S/ate Zip Code From To Formation Description
(—)- l' 2 R
Area code-Phone number 7 E 2 4)5 /)2(4, ._
4. DATE DRILLED / -d I -1'
5. TOTAL DEPTH: „74/5 '
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO CY
7. STATIC WATER LEVEL Below Top of Casing: 10 n FT.
(Use"✓'if Above Top of Casing)
8. TOP OF CASING IS I FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with I5A NCAC 2C.01Iri.
9. YIELD (gpm): 1D METHOD OF TEST . 1,r5
10. WATER ZONES(depth): ion ' - 1 O clip r-s-).
LOCATION SKETCH
11. DISINFECTION: Type 1-\T I-1 Amount 1// Show direction and distance in miles from at least
12. CASING: Walt Thickness two State Roads or County Roads. Include the road
Depth Diameter or Weight/Ft. Majer ai numbers and common road names.
From GO To '7 Ft. Zr ill
From To Ft.
O to
From To Ft. _ to
13. GROUT: Depth Material Method 2 .2x
From D To Qn Ft. C1t.vr i e c cn
zrn
From To Ft. I rp<
of
14. SCREEN: Depth Diameter Slot Size Material ➢Crl o
From To Ft. in. in. mo
_ pact
From To Ft. in. in. rn
15. SAND/GRAVEL PACK: r �a
Depth Size Material 0 --t
v o
From To Ft. Z
From To Ft.
16. REMARKS:
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I 5A NCAC 2C, WELL
CONSTRUCTION STA DARDS,AND THAT A COPY OF iLS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
X:� /, ( L 4,._/- `e/ // -3 el) - c /
TURE OF PERSON CONSTRUCTING THE WELL DATE
p'M E C E I V E -
S t • t t • a I Water Quality,Groundwater Section. 163o Mail Sen ice Center-Raleigh, NC
2 i l.36 Phone No (919)733- ; .I ithin 30 days. GW-I REV. 07/2001
Groundwater Section
Asheville Regional Office -__1

1111 ---Ic •A-- yes. _
255075
'. WELL CONSTRUCTION RECORD
North Carolina-Department of Environment and Natural ResourcescerB rite.)
- Division of Water Quality-Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAME
11(print) /J Y c,I1 �l CERTIFICATION# S 41/
WELL CONTRACTOR COMPANY NAME ( rr 2P"At- YDs We II 4 Pk.,p,.LPHONE # fa.I9 L7 . — 3/ ry0
//
STATE WELL CONSTRUCTION PERMIT# PIP 2. ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE(Check Applicable Box): Residential, Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other❑ If Other, List Use
•
2. WELL LOCATION:: 1 I 1 1 Topographic/Land setting
Nearest Town: l _r -F-Irw County /4 n}i w�ooCA ❑Ridge % ,Slope ❑Valley ❑Flat
LC 4- I D1 h'tA 144-,'c reeve — N e-t.J-h-Gtuel (check appropriate box)
(Street Name,Nurnberg,Community,Subdivision,^ � Lot No..Zip Code) Latitude/longitude of well location
"-Du))3. OWNER: )I ry �1J D Y\0. �A r-,.. (degreesminute>4econds)
Address P 0 J e-t. '96S Latitude/longitude source:❑GPS❑Topographic map
C-.p1/41 (Street or Route No.) (check box)
cx I f,/G .9 ce 1-I ) La DEPTH DRILLING LOG
City or Town State Zip Code From To Fo tion Description
(—)- 0 9 g ' ti.A we it
Area code-Phone number - 9 Q ' cg e,LS ' ,4,Lv.n.,-lL.
4. DATE DRILLED q - a L -c I
5. TOTAL DEPTH: Q 1-)5 '
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NOI
7. STATIC WATER LEVEL Below Top of Casing: S FT.
(Use"+"if Above Top of Casing)
8. TOP OF CASING IS / FT.Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with)5A NCAC 2C.0118. h I
h
9. YIELD(gpm): /- METHOD OF TEST r5 -
l0. WATER ZONES(depth): .n DO ' - 1 S Vrv-v
LOCATION SKETCH
11. DISINFECTION:Type 1-1 7-H Amount 4/2 Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads. Include the road
Depth Diameter or Weight/Ft. Material numbers and common road names. Y
From C To Depth",
6 Ft. to " _ S+c-t( N `o
From To Ft. c>_
From To Ft. c `'r',
13. GROUT: Depth Material Method Z cm
From 0To !D Ft. Csanr o w� 1 e p wN o
From To Ft. -C
14. SCREEN: Depth Diameter Slot Size Material = -c
From To Ft. in. in. O cn2
From To Ft. in. in. CO y
.i) 15. SANDtGRAW JL IFA w
�fheptlVP I Size Material
-)'—rom To t.
1i I; 1, From To t.
Ii—)
l H16. REMARKS:
1136 'E$$BY dk I T T IS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CbHSTR ICTr�1W , , ND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
`Y,( /Y. �1.�,1.�r /�t-r,,r- to - a 6 -0 x
SIGNATURE OF PERSON CONSTR TING THE WELL DATE
Submit the original to the Division of Water Quality,Groundwater Section, 1636 Mail Sins ice Center-Raleigh,NC
27699-1636 Phone No.[phone],within 30 days. GW-I REV.07/2001

North Carolina•Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section 2 4 0 f 8 5 5
1636 Mail Service Center•Raleigh,N.C.27699-1636-Phone[phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR: ) 1 aa.p £»„, Ld&Lt ' {).c , '1
WELL CONTRACTOR CERTIFICATION #: a lb R
STATE WELL CONSTRUCTION PERMIT#: try'0 Z.
1. WELL USE(Check Applicable Box): Residential[ / Municipal ❑ Industrial❑ Agricultural❑ Monitoring ❑
Recovery❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATION:(Stow sketch of the-location below) /
Nearest Town: V--L/n 4e IL Linty. f n/{, 06ZOfe.i
(Road Name�and v7 m//tiers, y unity.or Subdivision and,Lot No _DRILLING LOG DEPTH
3. OWNER 7 ) 'I-r . 7 } .. A F+ .^ From To FemuGm Description
Address 3 1 AJ..2XYar.�X1 ri end C 1 oo r
�Q..o-5�e�t/`outeNo.j, , cam 71'6 /OO i 8s rg24 tI
City or wn I Sttate Zip Code
4. DATE DRILLED q"aU -D 1
5. TOTAL DEPTH / $S '
6. CUTTINGS COLLECTED YES❑ NO Ea'
7. DOES WELL REPLACE EXISTING WELL? YES 0 NOnv
8. STATIC WATER LEVEL Below Top of Casing: 61 O FT.
II (Use'.'if Above Top of Casing)
9. TOP OF CASING IS I FT.Above Land Surface'
'Top of casing terminated at/or below land surface requires a variance in accor-
dance with 16A NCAC 2C.0118 II
10. YIELD(gpm): 3 O METHOD OF TEST cQ n r5 .
11. WATER ZONES(depth): 1 a 5i - I Co 6 ' 3P CS p on
v o
etA
12. CHLORINATION: Type )4 T H Amount 3 3 If additional space is needed use backcf for=n nrn
13. CASING:
Wall Tridu ess LOCATION SKETCH �'n
ofo
Depth Diameter Cr Weight/R IAaedall (Show direction arb distance ircrn at least two State D+�
re
From To J ®P Ft. L' " YW( ', Roads,or other map reference points) Y - =m
From To Ft.- C rn,%
From To Ft. 13
14. GROUT: O Z
Depth Material i Method
From D To _O ) Ft. Ctl
From To Ft.
15. SCREEN:
Depth Diameter Slot Size Materal
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 HERE ` " '�4 JE L tV��. CONSTRUCTED IN ACCORDANCE WITH ISA NC-AC\C 2..,WELL
CONSTRU rug nn� a,aAu I Y'W A C OP'.((OF THIS PIECOW H#-S BEEN PPOVIDr�V�E1 HE WELL OWTER.
FOR OFFIC ONLY i 7`J/7l fiat,
�n — ,
SIGNATURE OF PERSON GON6TfWCTIMIG Tl& OATS
e;-,n na mgnat to Dwion of Water Gualiow.Giro rrtwauer Seam witthln 9?day's
Serial No. rr tindw ter Section • GR•1 REV. 12)3
rwe-
RtgionalOffice

North Carolina-Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section 2 4 11 83 6
1636 Mail Service Center•Raleigh,N.C.27699.1636-Phone[phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR: �APten £hc03 Lcl-0-0.1 Net P. ,
WELL CONTRACTOR CERTIFICATION #: c2:/
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE(Check Applicable Box): Residential Er Municipal ❑ Industrial❑ Agricultural❑ Monitoring ❑
Recovery❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATION: (Sh sket of the location below) / J
Nears own: County. Y Y/.1/.-//deo 31
(Road Name and Npmoers.Community.o Subdivison as: of No.) U DRILLING LOG - DEPTH
3. OWNER Pb Gl.t-I t )F IA i Y From To Fomiadm Description
Address / O 3 4 I /p
/}/1 veer or outs a. j a -' >aClYh a .<t}
City or T n / State Zip Code •
4, DATE DRILED 9 -/8 -vi
5. TOTAL DEPTH d€2ri '
6. CUTTINGS COLLECTED YES 0 NO2/
7. DOES WELL REPLACE EXISTING WELL? YES E NO19/
8. STATIC WATER LEVEL Below Top of Casing: is, D FT.
(Use':I1 Above Top of Casing)
9. TOP OF CASING IS I FT.Above Land Surfacer
'Top of casing terminated aVor below land surface requires a variance In accor-
dance with 15A NCAC 2C.0118 a�
10. YIELD(gpm): I D METHOD OF TEST ram[ h rS -
11. WATER ZONES (depth): -2 DS r _ I 0 t j>rn
0
12. CHLORINATION: Type 4--} T H
YP Amount co o
It additicFtal spare is needad use bade cf for:71^ 0
13. CASING:
Wall TrdtivKss LOCATION SKETCH �_ Z'T
Depth Diameter cc Weight/R. Material (Show d ection and distance frrn at least two State fir^
From 0 To -.� Ft. 4a rr PVC Roads,or other mar referexe points) �a
From To Ft. 3 vzp
From To Ft. O ma
14. GROUT: IV -'
ck
Depth Material Metch�o-y�d- z
nFrom 1) To n Ft. C bnrno i 4- i
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 CRTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH IM NCAC 2',WELL
CONSTRUCTIOh"SSAt�ARWSfilNpl TAIp4T[Zi C�OF THIS pFtOVItY�-Tp THE r/EL'_OWNER. � - /
LS lJ 15 11 U IS ` °
FOR OFFICE USf LY
Quad No: ^fn r 'a JACNATURE CIF PERSON CONSTRUCTING Tt-E WELL DATE
- tJbmlt o cola" o Dnaion of WaterOuaaly,Oro. water Searn within 3?day's
Serial No. Gst-1 REV.1271
Groundwater Section

North Carolina•Department of Environment and Natural Resources-Division of Water Quality•Groundwater Section " " 5
1636 Mail Service Center-Raleigh,N.C.27699-1636-Phone[phone] y�� (D n
WELL CONSTRUCTION RECORD WELL CONTRACTOR: n L_ /gado . 1�tA
WELL CONTRACTOR CERTIFICATION #: a y / 9
Ere
WELL CONSTRUCTION PERMIT#: Div•2._-
1. WELL USE(Check Applicable Box): ResidentiaI[El Municipal ❑ Industrial❑ Agricultural 0 Monitoring El
Recovery❑ Heat Pump Water Injection ❑ Other O If Other, List Use:
2. WELL LOCATION.:ISt/ow sketch of the location below) y
, Nearest T�o.w.7n:1 .!/Li D A.-4 .t 4) County. Q /.r).14/,t
y� '� /�•n�7�-� it.,1..�
(Road me nd Numbers,; unity, r�n and Lot No.) DRILLING LOG DEPTH
3. OWNER r •p A ��..tf1/ From To FcrmationDesciption
Address ,S 3 £ 'iP - , 3jo ' Q� �{
a/�� Sreet or Home No.) �"�'� aI, ,SbS ' a
City or Town i State Zip Code
4. DATE DRILLED 9'/'f D /
5. TOTAL DEPTH SOS '
6. CUTTINGS COLLECTED YES NOE(
7. DOES WELL REPLACE EXISTING WELL? YES (A NO[-7-
8. STATIC WATER LEVEL Below Top of Casing: 1../ FT.
(Use':it Above Top of Casing)
9. TOP OF CASING IS FT.Above Land Surface' r.
'Top of casing terminated aVor below land surface requires a variance in accor•
dance with 15A NCAC 2C.0118 10. YIELD (gpm): ‘3 METHOD OF TEST r /1� h r5 • eE
11. WATER ZONES(depth): R6 I - .3 o n, - fl
12. CHLORINATION: Type /4 rH Amount y a It additicnal space is needed use backcf tonci•f Cm
z
13. CASING: '�
war LOCATION SKETCH a rn
rn�
Depth Diameter or WeighVR Medal (Show exertion and distance ftam atseast two sag �m
From0To 3 6 Ft. /o Ir PVC' �z
Roads,or other referee points) O m�
From To Ft. CO --4
From To Ft. C z
14. GROUT:
Depthf1(� Material , Method
From /) QD To Ft. D,snu4a-
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: .__—_may
100 HEREBY CPI -r 1W M 0 JL STRUCTED IN ACCORDANCE WITH 1SA NCAC 2V,WELL
CONSTRUCTION DARDS,AND THAT A X p r OF THIS FEC - HAS BEEN P . 0 THE r/ELL OWNER.
FOR OFFICE US SLY
". I L1vuz o. �J /fi.,LL-u.t - F� • �D -.1 �D
Quad Ho: S GNAILRE OF PERSON CONSTRUCTING TN&VIE.L DATE
routbiwater Setsrnk trglna to DNaion or Water Dusting,Gm ndaatmr Searn witthIn 97 day's
Sochi No. As mil) ReFionl Office Gtt•t REV.1214

North Carolina-Department of Environment and Natural Resources-Division of Water Duality-Groundwater Section 2 3 fl 9 4
1636 Mail Service Center•Raleigh,N.C.27699-1636-Phone[phone]
•7 l l
WELL CONSTRUCTION RECORD WELL CONTRACTOR: �h.r4.r.- AO'S. h1-Q-E.�- `K P'/� V
24a.O, 4'
WELL CONTRACTOR CERTIFICATION #: lit!'
STATE WELL CONSTRUCTION PERMIT#: '7r f
1. WELL USE(Check Applicable Box):ResidentialLt Municipal ❑ Industrial❑ Agricultural❑ Monitoring El
Aecovery❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATION: Sho sketc of the location below) y J / -
Nearrj�a�l�Town: ( �rxJ County: J�YO..' 4 )00,rd
Y ..L agand Np 1 m y of J (l
(Road N and Npri errs,Community or Subdhsion and Lot No.) DRILLING LOG DEPTH
3. OWNER .L-lst a�JQ� ) Cl .LA&, 1 From To FfAaatL
Des.—iption
Address / a U '(h f�,, 4 oa? 'n treetorRo o.) U 4 �! .215' e.� 1 )
CCity or Town J State Zip Code
4. DATE DRILLED Z ) -0 I
5. TOTAL DEPTH 1 25 '
6. CUTTINGS COLLECTED YES❑ NOd
7. DOES WELL REPLACE EXISTING WELL? YES ❑ NO[f
8. STATIC WATER LEVEL Below Top of Casing: top 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 1SA NCAC 2C.0115
10. YIELD(gpm): c S METHOD OF TEST -Q .1-v-s
11. WATER ZONES(depth): .SLP5 - 095. 0p1 n
12. CHLORINATION: Type }4'1- 44 Amount 5 / II additional space is needed use back cl form
13. CASING:
Wall TitanessLOCATION SKETCH
Depth Diameaer cv We gh&R Material (Show diection and distance from at'east two State
From n To b .) Ft. 6a .5'fe�1 Roads,or other map reference points)
From To Ft.
From To Ft.
14. GROUT:
0
Depth Material i Method O a
From B To n17 Ft. C e+ u co N
From To Ft. in"V c0
15. SCREEN: -'n'
Depth Diameter Slot Size Material ---1 no
From To_Ft in. in. 3 r'ro
From _To_Fs. in. — in. o m r
From To Ft_ in. _ in. e7
16. SAND/GRAVEL PACK: a- -to
-7-1
Depth Size Material =
From To Ft.
From To Ft.
17. REMARKS:__ - •
I DO HEREBY CER 'Fr'%RO- Jill t T AACar'O TIS I(RECACCORDANCE WITHH 1St NCAC 2Z,WELL
TO THE WELL OWTER.
CONSTRUCTION�( qR c� � I D /e�j/
FOR OFFICE USE C.i=
V . 1 lire- - n/ -/6 6 /
Quad No: PIGNai LURE OF PERSON CONSTRUCTING TIE WELL DATE
f mundwa'e°�S'krtitA'g"'u 10 Don a walerOuamy.Gro ndwauer Sedcn wiithln 37 days
Serial No. At ^„flip^ ,•. Qffr,• GK•I REV.1214

North Carolina-Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section 2 3 9 0 4 :J
1636 Mail Service Center-Raleigh,N.C.27699-1636-Phone[phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR: artaha- Yo5. hie-li 91- Pwn,,o, ..trc
WELL CONTRACTOR CERTIFICATION #: ,-//g
STATE WELL CONSTRUCTION PERMIT#: /41D2.
1. WELL USE(Check Applicable Box):Residential2/ Municipal 0 Industrial❑ Agricultural❑ Monitoring ❑
Recovery❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATION: Sh w sketch of the location below)
Nearest own: d-+)r i/A County. V��l�to
W L
(Road and NupibeSs.Con-Triunity.oAubdivision and Lot No.) DRILLING LOG DEPTH
3. OWNER i %J2/.12/ -4-€) From To FmnaGm Desciptior.
Address ��y j Zi D S.2 r ��
/7,tr9 rNo4 G`e 32 r 2b s-' ,u.
City Of wnState zip Cade
4. DATE DRILLED V -/ -o /
5. TOTAL DEPTH 02 G.V '
6. CUTTINGS COLLECTED YES❑ NO111'
7. DOES WELL REPLACE EXISTING WELL? YES ❑ NO211
8. STATIC WATER LEVEL Below Top of Casing: _ID FT.
(Use•:if Above Top of Casino)
9. TOP OF CASING IS / FT.Above Land Surface
-Top of casing terminated aVor below land surface requires a variance In accor-
dance with 1SA NCAC 2C.0118
10. YIELD(gpm): r METHOD OF TEST .i A+r1 .
11. WATER ZONES(depth): /4/.C' - 53/ )cal
12. CHLORINATION: Type H7H Amount 1.__ If additiccal sere is needai use backer to=T
13. CASING:
watt rr ness LOCATION SKETCH
Depth Diameter or waighVa Marial (Show erection and distance frrn at feast two State
From /) To S a Ft. 4 vv P 1<()_ Roads,or other map referexe points)
From To Ft.
From To Ft.
14. GROUT: o
O
/n
Depth aterial Mgthod �
From __ 2_ To .-V� Ft. / > tyTl a
From _ To FL _c,`r,
15. SCREEN: o{
Depth Diameter Slot Size Material --A
Da
From To Ft in. in. s am
From _To_Ft. in. — in. Q. rr"„W
From To_Ft— in. _ in. 2
16. SAND/GRAVEL PACK: '- TS
Z
Depth Size Material
From To Ft.
From To Ft.
17. REMARKS:
I DO HEREB ;111,• t •C, E . 1J-E 'Ir STRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCT i AWARDS.AND THAT �'• R OF THIS HAS BEEN PROM C THE WELL OWNER.
FOR OFFICE 1 1 LY
,t..u,«.� 9-/o -Cr/
Quad No: GNATURE OF PERSON CONSTRUCTING DC WELL OATS
meter Seetreafrne piglet •to Onion or Water Quality,Gro ndwater Seam wiithln 37 days
Serial No. Regional Office Gx'•1 now. 1271

North Carolina-Department of Environment and Natural Resources-Division of Water Quality•Groundwater Section 0 1./ 9 l/5 0
1636 Mail Service Center-Raleigh,N.C.27699-1636-Phone[phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR: X-+ADa4 , 4, k& `` A-'`'",, 14,
WELL CONTRACTOR CERTIFICATION#: JO Sit
STATE WELL CONSTRUCTION PERMIT#: 7-90. .
1. WELL USE(Check Applicable Box): Residential Er Municipal 0 Industrial❑ Agricultural❑ Monitoring❑
Recovery❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATION: (Shgiv sketc of the location below) / It-Nearest Town: e • �-s'`� County: c�' -
' ' r h,"y'-4P DEPTH
(Road Name and u ers,Community.oro/ Subdivision�a d Lot No.) DRILLING LOG
3. OWNER ! — � .*,it. • / t j _-141 From To Formation Description
Address ,O 3 9 '
& tufeute k _7 et?
/s 39 1/.16 ' h.
City or Town &fate Zip Code
4. DATE DRILLED g -3 "D 1
5. TOTAL DEPTH `fZ 5'
6. CUTTINGS COLLECTED YES❑ NO[ '
7. DOES WELL REPLACE EXISTING WELL? YES ❑ NO[✓I
8. STATIC WATER LEVEL Below Top of Casing: /5' FT.
(Use•.'u Above Top of Casing)
9. TOP OF CASING IS I FT.Above Land Surface'
'Top of casing terminated at/or below land surface requires a variance In accor-
dance with 15A NCAC 2C-0118 11
10. YIELD(gpm): METHOD OF TEST .-. n rs .
11. WATER ZONES (depth): hip ' - / 9p m
3 20' - 42,S' 1/9.74
12. CHLORINATION: Type 1-IT 1-1 Amount 7 P It additional space is needed use back c loam
13. CASING:
LOCATION SKETCH
Wall'Thickness
Depth Diameter sr W eight JR Mee, gr_ (Show erection and distance irm at least two State
From © To 2 el Ft. 4 4-.--, i-v Roads,or other map Telerate points)
0
From To Ft. p
._., -6-
From To Ft. cra n
14. GROUT: sr-n
Depth Material Method _ ^'
From .�._ To An Ft. co 't nQ
From To Ft. a ~.--
m
15. SCREEN: Mr err,
Depth
rnZ
Depth Diameter Slot Size Material CZ/ nZ
From _To—Ft — in. — in. —'
o
From __.To_Ft— in. in. z
From To_Ft— in. in
16. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
17. REMARKS:
Ilt r `.
I DO HEREBY C1rp' h.T4SthWEILL.-4 WITH CONSTRUCTED IN ACCORDANCE 15s, NCAC 27,WELL
C0NSTRUGTI0I(1 OAR*JS,AND THAT A QP!OF THIS FI£�OnO HAS BEEN PFiOV(f THE r/EL OWNER. /O -Q /
FOR OFFICE U. L " I- rij i �EAce/ OATS
Quad rio: '„� �GNANATURE OF PERSON CONSTRUCTINGTFE well
rrpg water seder:main to Damon o/W aim()uality.owtwatrer Seam witthln 3?days
Sedal No.
Ashevill Regional Office Gvc-I Rev.int

North Carolina•Department of Environment and Natural Resources_Division of Water Quality•Groundwater Section 0 2 C) i ' fr.: el
1636 Mail Service Center-Raleigh,N.C.27699.1636-Phone[phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR: t^-'t'"- S-424'• 41411 91 P"""p, "-
WELL CONTRACTOR CERTIFICATION#: a 4/ J
STATE WELL CONSTRUCTION PERMIT#: /'AO P-
1. WELL USE(check Applicable Box): Residential[E/ Municipal ❑ Industrial D Agricultural❑ Monitoring ❑
Recovery❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATION: (Sho etch f the location below) �/
Nearest Town;, County: . /a //...),00d
, •
(Road Name and Numbers,CuwerGnity,or Subdl/v.'( n and Lot No.) DRILLING LOG DEPTH
3. OWNER /v/4-Qe-i-0✓ From To Formation Description
Address O 66% 3.2 9 A .2 i e'
iiiii (st Worn No.) ,,2 ��z 7 .2 4 ' /OS' &r
City or Town / State by Code '
4. DATE DRILLED 7-I-0 /
5. TOTAL DEPTH /OS r
6. CUTTINGS COLLECTED YES 0 NO0
7. DOES WELL REPLACE EXISTING WELL? YES 9 NO17.--
8. STATIC WATER LEVEL Below Top of Casing: A FT.
(Use':if Above Top of Casing)
9. TOP OF CASING IS I FT.Above Land Surface'
'Top of casing terminated at/or below land surface requkes a variance In accor-
dance with 1SA NCAC 2C.011S
10. YIELD(gpm): SD METHOD OF TEST 2 I rs .
11. WATER ZONES (depth): /A 1 - .3O`.1 q pm
12. CHLORINATION: Type H 7 AI Amount a 2- It additional space is needed use back c(1or:a
13. CASING:
LOCATION SKETCH
Walt Tnidtness
Depth Diameter cv Weight/R. Maarial (Show direction and distance try at least two State
From 29 To Ft. a Ve Roads.or other mat refererte points)
From To Ft.
From To Ft. C
14. GROUT: D
Depth n/Material Method N cn
From 0 �To a0 Ft. ` NU MP, -a cc
From To Ft. — o•
m
--c
15. SCREEN: ---I tr;
nc
Depth Diameter Slot Size Materal p' m
p MC ii.c
From To Ft _ in. in.
rm
o to
From _To_Ft:. in. — in. _ cs
From To_Ft.— in. in. F o
16. SAND/GRAVEL PACK: z
Depth Size Material
From To Ft.
From To Ft.
17. REMARKS:
� 1
I DO HEREBY Cil TA' . t STRUCTED IN ACCORDANCE WITH 1St NCAC 2: WELL
CONSTRUCT ANDAR*J$,AND THAI C f OFgTHIS RECORD HAS BEEN PFOVID DJ91HE r/EL OwtERp
FOR OFFICE IN ' r,
d27.P1 - C7�t/\ / _/6 .. 0/
L'N
Quad No: t IGNATURE OF PERSON CONSiRUCTi1N0 TI-E W E:.L OATS
-S bntd mginat to Di.6bn of Water Duality.Oroniwater Seacn within 37 days
'round?ate:Secton GK I REV.1271
Serial No.

239052
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: ltinat 14-11 9/ legsner
WELL CONTRACTOR CERTIFICATION #: a 'V/f
STATE WELL CONSTRUCTION PERMIT#: 7-549
1. WELL USE(Check Applicable Box): Residential E 'Municipal ❑ Industrial❑ Agricultural❑ Monitoring❑
Recovery❑ Heat Pump Water Injection ❑ Other D If Other, List Use:
2. WELL LOCATION: (Sho sketch of the location below) x J
Near stTown: / 1 County: -Y��U),0 6
�a Name and Numbers,Coavnunity, r Subdivision�9:A Lot No.) DRILLING LOG • DEPTH
rr. Cy ID rrn, From To Fonnatim s.-Deiption
3. OWNER Vi
Address ' Vlialcib 4 .9 G 9 ' `�
Qjuzzi( treat or Houya jigb14 L? i .Jd.S '
City or Town / State Ep Code •
4. DATE DRILLED A- 7 _0/
5. TOTAL DEPTH S06 '
6. CUTTINGS COLLECTED YES❑ NO[
7. DOES WELL REPLACE EXIS11NG WELL? YES D NOE(
8. STATIC WATER LEVEL Below Top of Casing: /Cao FT.
(Use':11 Abode 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.01111
10. YIELD(gpm): ___,.g METHOD OF TEST ni A rs
11. WATER ZONES(depth): 5/a5-' - .35Pr✓I
12. CHLORINATION: Type 0 T N Amount IQ If additional space is medal use backcf form
13. CASING:
LOCATION SKETCH
Wall Trigkness
Depth Diameter. tY We ighVR M/>ar nail (Show C action and distance Irm at least two State
From /0 To /9 T Ft. /.rr. / 'JI'- Roads,or other map refererre points)
From To Ft. -
From To Ft.
14. GROUT: t:D
Depth Material MethodsoFrom To -W Ft. �o to N-.70
From To Ft. m o r"
-1, cm
15. SCREEN: v<
Depth Diameter Slot Size Material "1 an
From To_Ft _ in. in. a m
From _____To—Ft.— in. in.
From To—Ft._ in. — in. Q m�
_ cn
16. SAND/GRAVEL PACK: z
Depth Size Material
From To Ft.
From To Ft.
17. REMARKS: m
�I Yi
I DO HEREB R GNSTRUCTED IN ACCORDANCE WITH 1Sl NCAC 2',WELL
CONSTRUG THA _ 'I OF L THIS FE - HAS BEEN PPOVIDE E WELL.ONTER.
FOR OFFICE ONLY
Quad No:
h�2,AtL 91../� -Q /
` 'IGNATURE OF PERSON CONSIRUCTRNG The WELL DATt
t;uba ma to talon of water Quality.Groaiwale Sedcn wiithln Si days
Sedal No. s h ,edlo¢ 1 on-i Rev.Uri

North Carolina•Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section 2 3 9 053
1636 Mail Service Center-Raleigh,N.C.27699.1636-Phone [phone] /'�/
h
WELL CONSTRUCTION RECORD WELL CONTRACTOR: Y� uAte- Sn ii20--0-1- 9` �4,"'f' •
WELL CONTRACTOR CERTIFICATION ft: Jt'41/
�{ STATE WELL CONSTRUCTION PERMITS: /far
1. WELL USE(Check Applicable Box): Residential lid Municipal 0 Industrial El Agricultural El Monitoring El
Recovery❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATION: (Showsketch of the location below) /
Nearest Town: `L! Tie V r //e. / County. i J/�)d D d
Vr //a eS o 1 Phil. ! 1 -4
(Road Name d Numbers.44 unity.or Subdivision and Lot No.) DRILLING LOG DEPTH
3. OWNER / i en P 55u4 / From To Forma •esciption
Address /o �u.J �f/��_ i/d I) 99 al n��
99 (snee�q� o o. e 7i6 91 /45' ine
tyorT nvcvr/ AVC o?
ity or Ten 'Stare Zp Code
4. DATE DRILLED 9-/3-D/
5. TOTAL DEPTH /OS'"
6. CUTTINGS COLLECTED YES❑ NO®
7. DOES WELL REPLACE EXISTING WELL? YES Ei NO®
8. STATIC WATER LEVEL Below Top of Casing: /D FT.
(Use':if Above Top of Casing)
9. TOP OF CASING IS FT.Above Land Surface'
'Top of casing terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2C.0118
10. YIELD(gpm): ,kko-/- METHOD OF TEST o7 /1rs
11. WATER ZONES(depth): //1,0 r - 44 q pm
12. CHLORINATION: Type /-47-i-/ Amount -2 9 If additional space is needed use back of form
13. CASING:
LOCATION SKETCH
wall Tniduress
Depth Diameder sr weight/FL Material (Show erection and distance fr at least two State
From 0 To Ft. 6 ,t_i., m S ire e_/ Roads,or other map reference points)
From To Ft. _
From To Ft.
14. GROUT:
0
Depth Material Method O
From D To ad FL �a /De N ors
n
From To Ft. rrt am
15. SCREEN: "9 m=rn
_
Depth Diameter Slot Size Material r nrn
od
From _To_Ft in. in. a r-1
From _To_Ft.__ in. in. 3 o
rn
From _To_Ft.— in. _ in. o ^'r,,
16. SAND/GRAVEL PACK: ,C c
Depth Size Material z
From To Ft.
From To Ft.
17. REMARKS:
I DO HEREBY C TO'S CS S STRUCTED IN ACCORDANCE WITH 1S% NCAC 2C,WELL
CONSTRUCTIO OF THIS RE - HAS BEEN PROVIDED E r/EU Ow'nER.
t9t�, —/O O /
FOR OFFICE US 1 Y,t'y % ( DAM
No: I NATURE Of PERSON CONSTRUCTING1TE WELL
• nat Dragon or Water Quality.Grar+owatea Berson whlhln 37 days
Serial No. re ndwater Section ow-1 REV. 1216
oh, Ile Reponal Office

North Carolina•Department of Environment and Natural Resources•Division of Water Quality•Groundwater Section
239054
1636 Mail Service Center•Raleigh,N.C.27699-1636-Phone[phone] QQ
WELL CONSTRUCTION RECORD WELL CONTRACTOR: PA-Ate a IC4)) e A"',,``'"-
WELL CONTRACTOR CERTIFICATION #: .30it(
STATE WELL CONSTRUCTION PERMIT#: 740Yr "
1. WELL USE(Check Applicable Box): ResidentialW Municipal ❑ Industrial D Agricultural❑ Monitoring ❑
Aecovery❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATION: (Show sketch'of the I9capo below)
Nearest Town: �
c. /�-� .C.e, Uh ;Ay County. �ny iaJ�D
- ll
reorii
(Road Name and Nu— irn ('mbe�rs.Corrvnuni or Subdivision a4 Lot No.) DRILLING LOG DEPTH
3. OWNER / ftA.L �A-> From To Forrnaticn Destiption
r I ( S
Address 54 Y) ' T 5C1 . 4 9 S
3t a or Sputa No. � -� 9'i U�a.S A
ria �r{^,I 1 e I�ai. cc{ AIC Jr?
City or w� State r Zip Code
4. DATE DRILLED R- yS-o /
5. TOTAL DEPTH 4%4 S '
6. CUTTINGS COLLECTED YES❑ NO '
7. DOES WELL REPLACE EXISTING WELL? YES El NO0
8. STATIC WATER LEVEL Below Top of Casing: 42 5 FT.
jj (Use it Above Top of Casing)
9. TOP OF CASING IS FT.Above Land Surface'
'Top of casing terminated atior below land surface requires a variance In accor-
dance with 15A NCAC 2C.e 16
10. YIELD (gpm): fn METHOD OF TEST cQ Arc .
11. WATER ZONES (depth): cr `f-O r - /oL/ rrt
12. CHLORINATION: Type /-T// Amount 2.6 II additicral space is needal use back ci form
13. CASING:
LOCATION SKETCH
we-Thickness
Depth Diameter cr WeignVR Material (Show direction and distance flan at feast two Stale
From To 96 Ft. Orr PVC Roads,or other map refererce points)
From To Ft.
From To Ft. -
14. GROUT: a
Depth n Mate Method cm0
From _e.._ To a6 Ft. S A fop N a m
From To Ft. -o c n
15. SCREEN: — o<
Depth Diameter Slot Size Material J -cm
From _To Ft in. in. _me 73o
rn
From __ To Ft. in. in, o ma
From To_____Ft._ in. — in. w"k
-1
16. SAND/GRAVEL PACK: F o
z
Depth Size Material
From To Ft.
From To Ft.
17. REMARKS: 'M1, I`�{ E
I DO HEREBY C `r Li TIL I '"'" TRUCTED IN ACCORDANCE WITH 1St NCAC 2,:,WELL
CONSTRUCTI ?II DARDS,AND THAT AFF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
FOR OFFICE US RI Y sei
Quad No: k St BE OF PERSON CONS1RUCTIING TrE Weis OATS
andwater wiping Noon of WaterQualit9'.Gran:Mauer Seacn witthln S7 days
CrSerial Ho. k heIilie Regional Office G1c-1 ROW.1294

239057
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: M/i+us. SAS L)i-a X Pu'"P `-g
WELL CONTRACTOR CERTIFICATION#: .241/9
STATE WELL CONSTRUCTION PERMIT#: yy�jl�—
1. WELL USE(Check Applicable Boa): Residential% Municipal ❑ Industrial❑ Agricultural❑ Monitoring ❑
Aecovery❑ Heat Pump Water Injection ❑ Other If Other,List Use:
2. WELL LOCATION: ow ske`t�/h—ol the location below) ,()(
Nearest Town: / 7'�' County. 511727,P)04 A
(Road Name and N e//rs.Comnuni or Subdivison and Lot No.) DRILLING LOG DEPTH
3. OWNER r n 4 t ✓/S 1/4JTa-na- -L From To Forman",Description
Address I) 6/ y )133 O ° /n� g
o o7S7 /6
oast or Ho o r 7
City or Town �/ Stare Zip Code
4. DATE DRILLED D'r?0 --D
5. TOTAL DEPTH nos' •
6. CUTTINGS COLLECTED YES❑ NO11-
7. DOES WELL REPLACE EXISTING WELL? YESig NON'
8. STATIC WATER LEVEL Below Top of Casing: FT-
(Use':u Above Tap of Casing)
9. TOP OF CASING IS FT.Above Land Surface'
?op of casing terminated at/or below land surface requires a variance In accor-
dance with 15A NCAC 2C.9118
L
10. YIELD(gpm): D METHOD OF TEST a /t rs .
11. WATER ZONES(depth): /4" ' - i A q p✓„
12. CHLORINATION: Type /-/ TN Amount €2el If additional space is needed use backcl lorui
13. CASING:
Wall ThicknessLOCATION SKETCH
Depth Diameter, cr Weight/R ec Mafia (Show udon and distance Irm at feast two State
From I) To l V Ft. 6 a PW. Roads,or other map ref ererce points)
From To Ft.
From To Ft.
0
14. GROUT: O --
Depth n Material Method N 9-,
From D To o70 Ft. l D
From To Ft. on
o`ti
15. SCREEN:
v >0
Depth Diameter Slot Size Material = -i
pp CD
From To_Ft in. _ in. rn
C "'z
From To Ft _ in. _ in. rr,
-1
From To Ft— in. _ in. or a
16. SAND/GRAVEL PACK: 2
Depth Size Material
From To Ft.
From To Ft.
17. REMARKS: r�[;� C
I DO HEREBY i �a "-��L+ ••w ^'- LiSTRUCTEDIN ACCORDANCE WITH 1SA NCAC 2',WELL
CONSTRUGTIO ��i 1 DARTJS,AND T IAT A �Li J •F THIS l •"• H6S BEEN PROVI• • O THE a/EL'L OWhER.R.- /
Iii
FOR OFFICE US• 'All V �L r 7 /D 0
Quad HO: §ia TUBE OF PERSON CONSTRUCTING WELL DATt
undwater bi hrlglnar • DNaton or Water Quaint aww natmr Seccn witlhln 3?days
Serial No. : file Re- ona1l un1 Glut REV.12 $

210306
WELL CONSTRUCTION RECORD
North Carolina-Department of Environment and Natural Resources- Division of Water Quality-Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAM/E1(print) •Ri/zv-v-t '1t�r-Lt_tA r� CERTIFICATION# 3b�/
WELL CONTRACTORCOMPANYNAME L,9'^e.E.ct. ,&i vS . IDe li -I- R1`^ i 1 Ji-t-•PHONE # (878) 4 4/g -3/ 70
STATE WELL CONSTRUCTION PERMIT# /'s P ASSOCIATED WQ PER\IIT#
(if applicable) (if applicable)
I. WELL USE(Check Applicable Box): Residential ( 'Municipal,Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery 0 Heat Pump Water Injection ❑ Other 0 I['Other, List Use
2. WELL LOCATION: • Topographic/Land setting
Town: U1iiy/ 7r5/// /�c County /- 7h)Doeci ❑Ridge Q.glope ❑Valley ❑Flat/ 9J nzi. e.I- I I (check appropriate box)
(Street Name,Numbers{Community,Subdiivisio)n,Lot No..Zip Code) Latitude/longitude of well location
3. OWNER: e l r A (1 f/ )T1-I» er (decrees minutes:seconds)
Address P /) R / .21,3 Latitude,longitude source:❑GPS❑Topogaphic map
' (Street or Route No.) (check box)
Li/[2 -/i7C5 (/r lie if/C. "cilia DEPTH DRILLING LOG
Ctty6r Town State' Zip Code From To Formation Description
Area code-Phone number 4r _ 5' _____IA..,;...
4. DATE DRILLED ' - '7 -G 1
5. TOTAL DEPTH: .3C55 1
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO Q'
7. STATIC WATER LEVEL Below Top of Casing: SIO FT.
(Use"t•'if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C.0118.
9. YIELD(gpm): % METHOD OF TEST 7 J-iYS .
10. WATER ZONES (depth): oi QO' - i e' p rn
-3 LOCATION SKETCH
11. DISINFECTION:Type MI TN Amount .6% Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads. Include the road
Depth Diameter or Weight/Ft. Material numbers and common road names.
From 4 To 4 9 Ft. C " Min c
From To Ft. 0
c>
From To Ft. x ct
13. GROUT: Depth Material Method 0 c�
From To / f Ft. � �n� 1 zo
From To Ft. CM o''>o
14. SCREEN: Depth Diameter Slot Size Material y
m�
From To Ft, in. in. 2 am
From To Ft, in. in. .r rci
15. SAND/GRAVEL PACK: 0 y�
Depth Size Material rJ g
From To Ft. 2
From To Ft.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STANDARDS,AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
C 1., SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
iE
t `
ubmit the original U i ivision of Water Quality,Groundwater Section, I636 Mail Service Center-Raleigh, NC
i.,1
27699-16364thone No,( ,:3-3221,within 30 days. GAV-I REV. 07/2001
i
l indWa!er Section
;..z', --.1Office

North Carolina•Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section a, 4 11 c) kJ 3
1636 Mail Service Center-Raleigh,N.C.27699-1636-Phone[phone] /1
WELL CONSTRUCTION RECORD WELL CONTRACTOR: (4 -e4..e .151r-125. Wen 'J 1 €4-iser, .tne- .
WELL CONTRACTOR CERTIFICATION #: 07 /f
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE(Check Applicable Box): Residential 0/Municipal ❑ Industrial❑ Agricultural El Monitoring El
Recovery❑ Heat Pump Water Injection ❑ Other 0 If Other, Ust Use:
2. WELL LOCATION: (S ow sketch of the location below) J I
Nearest own: Svc /1 P. County: Sicd G7/I el ell
/ I , h� £
(Road Name�and Numbers�oanunity bdi ' and t.ol Na.) DRILLING LOG DEPTH
3. OWNER V i d� // (.C�� From To FonnaGm Description
Address i �" n 1 I a ct
/J �D �s /tor oK224 f1 / '� Kdf �D
( 4, yG -2g2z/ O/) h/�.S ' ha + tom
City or T n State Zip Code
4. DATE DRILLED S-3a -c./
5. TOTAL DEPTH S 45 r
6. CUTTINGS COLLECTED YES E3 NOE( ,
7. DOES WELL REPLACE EXISTING WELL? YES El NO71
8. STATIC WATER LEVEL Below Top of Casing: 34)0 FT.
(Use'+'if Above Top of Casing)
9. TOP OF CASING IS� FT.Above Land Surface
'Top of casing terminated at/or below land surface requires a variance In actor- C
dance with 15ANCAC 2C.0116 rn i
10. YIELD(gpm): METHOD OF TEST 3 h rs 0 e
11. WATER ZONES (depth): .3,1re r - l r/2 �c77 p vv., n o rrl
/MS•- I r/z- ,C`` Prn �_ zm
12. CHLORINATION: Type E1-7-1-1 Amount' q 4 If additicclai space is needed use bacicef lord im
Da
13. CASING:
Wall ThicknessLOCATION SKETCH c=p N i
Depth Diameter cr We'ght/R. Maria) (Show diectfon and distance tr.rn at feast NOSI !- - tm'sm
From LO To Ft. le" PVC' Roads,or other ma,-, referoxe mints) ^7- --,
From To Ft. 2
From To Ft.
14. GROUT:
Depth ,Material Method
From I) To .n 1�Ft. ( Gva.. i /.
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 HEREB>✓f TEY'JJA II W t;CJNSTRUCTED IIINN�REgAACCORDANCAS E WITH
H11155AA/\NOAC 2y,WELL
CONSTRUCT {�THIS r'��EENPFcO� I TO THE t/ELLOWNER.
FOR OFFICE )NLY
O - R - D
Quad No: t;li 9 20l02 SSIGNATURE OF PERSON CONSTRUCTING TPE WELL DATE
$ubrrlt melee' to Dusion N Water Ousting.Groarlwater Sedan witthIn 3?days
Serial No. Ground 96I) ater Section OW-I REV. 127T
OV11)g p ionli office

North Carolina•Department of Environment and Natural Resources•Division of Water Quality-Groundwater Section 1 0 O
1636 Mail Service Center•Raleigh,N.C.27699-1636-Phone[phone] A�
WELL CONSTRUCTION RECORD WELL CONTRACTOR: AretenV RvnS Ide.11 d Pu-np,�4.-c •
WELL CONTRACTOR CERTIFICATION #: 30 41 /
STATE WELL CONSTRUCTION PERMIT#: -/'/-2
1. WELL USE(Check Applicable Box): Residential I.2/ Municipal ❑ Industrial❑ Agricultural❑ Monitoring ❑
Recovery❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATION: Show sketch of the(location below) L `
. Nearest Town: 7n (7q ua D Deaf County. 7�a.i,11s)n0 of
a e,'..- T,L Pa . a
(Road Name and Numbers.Community.or Sub ivispn and Lot No.) DRILLING LOG DEPTH
3. OWNER ` .Z.) 1_fi17t J(nit_ From To FonnationOast-iption
Addres S8
• (Street or otne O. SR /o.S' nn
ity or Town Slats 21p Code
4. DATE DRILLED g- 30 -a /
5. TOTAL DEPTH Lob 'r'
6. CUTTINGS COLLECTED YES❑ NOE(
7. DOES WELL REPLACE EXISTING WELL? YES ❑ NOE(
8. STATIC WATER LEVEL Below Top of Casing: er ) FT.
(Use'+'II Above Top of Casing)
9. TOP OF CASING IS I FT.Above Land Surface'
'Top of casing terminated at/or below land aurface requites a variance In accor-
dance with 15A NCAC 2C.0118 10. YIELD (gpm): 7 h. METHOD OF TEST ram/ in r6 - .
11. WATER ZONES(depth): .4 st5' - ,2 a p m o
0
12. CHLORINATION: Type 147-/-1 Arnunl 1 Cie II additional space's needed use back d fo0 =d
o t
13. CASING: _ -
Wall Tnickrtea LOCATION SKETCH o<
CT r1
Depth _ Diameter cr weighVR Manal (Show d•ection and distance horn at'east two Seale Z;;;4°
From p• rli
To FL L' " P V l°< Roads,cc other map refererre points) _ 7,o
From To Ft. - O mTo
From To Ft. Co
N -i
14. GROUT: 0 Z
Depth n Material Method
From © To t b Ft. ( DA,A A - `I-b-p
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:
F
I DO HEREB k' ' L:% W4 Tdd IE.11 t,...• STRUCTED IN ACCOIRDANCE WITH ISA NCAC 27.,WELL
CONSTRUC •' •TANDARDS,AND TD T AY • ( ir'•f OF THIS RECORD HAS BEEN PFtOVIDt 0 THE WEL1L OWNER.
i
FOR OFFICE I. ONLY
c? Q .„11.
2 N., j8tc.,a4a, /a -2 - o /
Quad No: SIIGNATURE OF PERSON CONSTRUCTING WE1 DATA
— ati mg at to Dvaion of Water 0uality.arondwaber Seacn within 37 days
®rumidw ter Section GK-t Rev.1271
Serial No. _ e Ra•i?naf 0T a -•,••.I

North Carolina•Department of Environment and Natural Resources-Division of Water Quality•Groundwater Section 2 'l OS `) J
1636 Mail Service Center-Raleigh,N.C.27699-1636-Phone[phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR: Vr,oPap t ro5 . &...AI q Pu44>0, -
WELL CONTRACTOR CERTIFICATION #: cR /;
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE(Check Applicable Box): Residential V 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: I)),LrOsyu os-1-�-tQ--Z.E. county. klaa t,Don
Ait ihA t. ,--)/A 'd 0
(Road Name and Numb rs,Community.or Subdyiis.on a^d Lot No.) DRILLING LOG DEPTH
3. OWNER / l _iD, a_ .J From To Formation Description
•
Address / D9/o J6h-4g2. //-t a-ou e"�JN z g ri F
��,-tor Flo No.) azs3 .2 '7 ,g65'
illfri
City or Town / State ZZp Code
4. DATE DRILLED Sl - 3D -D /
5. TOTAL DEPTH a/>.5''
6. CUTTINGS COLLECTED YES(l NO IX
7. DOES WELL REPLACE EXISTING WELL? YES ❑ NOFf
8. STATIC WATER LEVEL Below Top of Casing: /DO FT.
(Use':if Above Top of Cuing)
9. TOP OF CASING IS I FT.Above Land Surface'
'Top of casing terminated at/or below land surface requires a variance In accor-
dance with 1SA NCAC 2C.0118
10. YIELD(gpm): /5 METHOD OF TEST i
krs •
11. WATER ZONES(depth): ./ A/5 ' - /5 ,p rn - s
O o
12. CHLORINATION: Type 14 .7." Amount 6''7 If additional space is needed use back et loci; Ern,,
13. CASING: -
LOCATION SKETCH ON gm
Wall Thickness
Depth pp yy Diomede/ r cr Weight/Fsrial (Show direction and distance tram at feast two SIS —ai-.
From�To 1 / Ft. LP " ' ' C Roads,or other mac refererce points) _ 73p
From To Ft. O mA
From To Ft. N
tO
14. GROUT: i
Depth Material Method
From (') To __calP_Ft. CO 4'rt e `4-v-p,
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. REMARK : u
t
I DO HER `D .Mr/4' CONSTRUCTED IN ACCORDANCE W'ITH 1SA NCAC Y,WELL
CONSTR STANDARDS,AND TI•iA r A COPY OF THIS RECORD HAS BEEN P . TO THE NNEU OwnN_R.
t3 ' ` �s) W ( 7 /0 '.2 - 0 /
FOR OFFI ONLY - /4 � �
Quad No: SSIGNAi11RE OF PERSON CONSTRUCTI FE Was DATE
at\r Section 5otirrill cecina,to D'.on of Water Oualny.Gro..niwaser Seaan wiithln 3?days
Serial No. Asheville Res ional Office Ga-1 REV,127E

240866
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: ( -re-P.vW pros . "II 'I t� I
WELL CONTRACTOR CERTIFICATION 4: r2 41n
STATE WELL CONSTRUCTION PERMIT*: ' c 4 -y j L
1. WELL USE(Check Applicable Box): Residential E/ Municipal ❑ Industrial 0 Agricultural❑ Monitoring ❑
Recovery❑ Heat Pump Water Injection 0 Other ❑ If Other, List Use:
2. WELL LOCATION: (Show sketc"h of the location below) ti
n
Nearest Town: Jr— County: ! Yn) 2i MOGI
r 1
d i
(Road Name and N 4 ors, unit',or Subdivis,o9 and Lot No.) DRILLING LOG DEPTH
3. OWNER c-4..t4 4 ,ppC From To Fomrae es.—iptior.
Address D b / � .
doe Ceb6 / 5 ti
( treat or gouts No. in./ .345 t
City or Town ' Stale Tip Code .
4. DATE DRILLED -.0-0 (
5. TOTAL DEPTH CR 45 r
6. CUTTINGS COLLECTED YES 0 NO[2.--
7. DOES WELL REPLACE EXISTING WELL? YES NO Fr
8. STATIC WATER LEVEL Below Top of Casing: D FT.
11 (Use-C if Above Top of Casing)
9. TOP OF CASING IS.�J FT.Above Land Surface'
Top of casing terminated at/or below land surface requires a variance In accor-
dance with 15A NCAC 2C.0118 �t 7 r-•
10. YIELD (gpm): .:5 METHOD OF TEST of h r S' • • O g
11. WATER ZONES (depth): -2 R 5 r 6- CY�ywvv O c>.,,
UU CA 8 rn
12. CHLORINATION: Type f-!TM Amount to 3 -� Err
YP If additional space is necdM use back of form- o<
13. CASING: no
wan Tnidwess LOCATION SKETCH = a�
Depth Diameter or wei ht/R Materialrn
P r t q (Show diection and distance frm at least two Soot y z
t� m7J
From To Ft. �a T��� Roads,or oche:map referees points) N y
From To Ft. - O a
From To Ft. Z
14. GROUT:
Depth n Material Method
From ® To .CA) FL U Q
From To Ft.
15. SCREEN:
Depth Diameter Slot Size Material
From To_Ft in. in.
From _To Ft in. in.
From _To Ft. in. in.
16. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To - Ft.
17. REMARKS'
} _N ! L_ n .
I DO HERE.r „ �. CONSTRUCTED IN ACCORDANCE WITH tSA NCAC 27.,WELL
CONSTRUC' e i STANDARDS,ANO TF-IA.f tiQ[D��IS�HASPF.tOVIDc E y/EL'L OWNER.
1 FOR OFFICE t ONLY _
J ID - a -CO/
Quad No: SIGNATURE OF PERSON GONSTRUCTIING ThE WF-:1. DATt
_ GrniSw&er Section,,txrvt nldnat to OWsion of Water Duality.Grosowater Seam,witthln 3'days
Serial No. _ Asheville Regional Office GIs-I REV.1211

240868
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and NaturalJ ResourcesJ) - Division of Waterj /Quality- Groundwater Section /
WELL CONTRACTOR(INDIVIDUAL)NAME./m (print) ( A//1).Y(-5 ,e. (-/�eAS--/Y _ CERTIFICATION# ''2`/` /2
WELL CONTRACTOR COMPANY NAME(G(e�¢au /�tnL 11�t// V P11Lnf'.1 'r.VC PHONE # (gf AY"A -3) 7D
STATE WELL CONSTRUCTION PERMIT# :ASSOCIATED WQ PER.AIIT#
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential E<Municipal Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other❑ I/Other. List Use
2. WELL LOCATION J // Topographic/Land setting�� �
NearestTown: (fl.12.�t' County Play M .elee ❑Ridge ❑Slope ['Valley ❑tFlatt
MDSO. McL(.('l pLi) Idteek appropriate box)
(Street Name.Numbers,Community,Subdivision.Lot No..Zip Code) Latitude longitude of well location
3. OWNER: Oen y(u r y T e A C'-✓1 S (degrees minutes seconds)
Address .3b 4 Smo kJ,/ CD ve. 1R.J • Latitude longitude source:❑GPS❑Topographic map
Street or Route No. Check box)
(2f.Tt )r& L4/e" „?5)9/6 DEPTH DRILLING LOG
City or Town State Zip Code From To Formation Description
IA- 273- ‘0,9z o e D (�
Area code-Phone number �Zi S/n.5 n �At.,t-t
4. DATE DRILLED Si- a . - C� / V!
5. TOTAL DEPTH: 5A 5 '
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: Si' FT.
(disc") it..-Abotc Top oltasim_I
8. TOP OF CASING IS I FT. Above Land Surface*
'Top of easing terminated at/or below land surface requires a — O
variance in accordance w'th ISA NCAC 2C.0118.
9. YIELD (gpm): CIA METHOD OF TEST h CS • O o
10. WATER ZONES (depth): 5D5 ' 4c pM CI
,J LOCATION SKETCH C9 0rn
I I. DISINFECTION:Type /-I 77) Amount /D 3 Show direction and distance in miles froms leasttsrLI
12. CASING: Wall Thickness tax State Roads or County Roads. Includthe rolrn
Depth Diameter or Weight Ft. Material numbers and common road names. a m),
From l To csiD Ft. h u Pyze Z voo
From To Ft. co) mo
From To Ft. N en
13. GROUT: Depth Material Method O . Z
From /� To JD Ft. e
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
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:
(" _5 aU TIC Ir1.* -i THAT THIS WELL AA'AS CONSTRUCTEDI N ACCORDANCE WITH I S.A NCAC 2C,WELL
€! O UJ I1t:'Sr r4ARDS,AND THAT A COPY OF TI RECORD HAS BEEN PROVIDED TO TIIE\VEIL OWNER
•
.ai2 jh�ZNa /D - 3 - � l
9� SIGNATURE OF PERSON C�6NSTRUCTING TIIE WELL DATE
Subn,rt�(gIn�cy;� :�:.fal to he Division of Water Quality,Groundwater Section, 163e Mail Senire Center Raleigh,NC
=,� , t,05 =1p.1r�{sp@e No.( 9)733-3221,within 30 days. GVV I REV 07/2001

2 4 0 8 G 9
WELL CONSTRUCTION RECORD •
North Carolina- Department of Environment and Natural Resources- Division of Water Quality- Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAME (print) CkLr ICS R . U Jr(h.. CERTIFICATION# a in
WELL CONTRACTOR COMPANY NAME Gree.4.L ars5 , L)e.lt `- P&Ampt Twr. PHONE # ($L&24 i —3/7°
STATE WELL CONSTRUCTION PERMIT# / 'p b— . ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE(Cheek Applicable Box): Residential Cl/ Municipal.Public 0 Industrial 0 Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 I[Other. List Use
2. WELL LOCATIO (1 )) Topographic/Land setting
Nearest Town: A,f17e5t/o f I �
t County, ❑Ridge ❑Slope ❑Valley IBtlat
3 P n Sp Yin fie, 1 ret- c_ iciheckappropriate box)
(Street N. Number.,Comm miry,Sub vision.Lot o._Zip Code) Latitude longitude of well location
3. OWNER: Nl.}_Lt—C.t� !!.-L�L (degrees minutes seconds)
Address 73 2r.kzzAi)nd Latitude,longitude source:❑GPS❑Topographic map
Street or Rout'No) (cheek ho
.eO� /U4 A t)
.3DD3 0 DEPTH DRILLING LOG
City or Town State Zip Code From To Formation Description
(yn0- 3'78 - 4'793 0 6 '7 !'fie•
Area code-Phone number 1-
4. DATE DRILLED g—j' 7 —D / �'� °j�5 � `'�`��
5. TOTAL DEPTH: .305 '
6. DOES WELL REPLACE EXISTING WELL? YES pi NO Cie
7. STATIC WATER LEVEL Below Top of Casing: <fro FT.
(Use...if Abote Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surface` --
*Top of casing terminated at/or below land surface mawices a
variance in accordance with I5A NCAC 2C.0118. . p
9. YIELD(gpm): / 'l, METHOD OF TEST G.r s . O
/ ! c.r
10. WATER ZONES(depth): A 5.- — a a. n^- ti
.3 PE ' — 9 'la 9s M LOCATION SKETCH B ae_rn
11. DISINFECTION: Type WI- Amount `��°'�-(o Show direction and distance in miles from 7thleasgm
12. CASING: Wall Thickness two State Roads or County Roads. Ineludgie rort�
Depth Diameter or WeiehtFt. Material numbers and common road names. y0
From 0 To /0 9 Ft 6 " P✓et Z. v3o
From To Ft. cea
.-
From To Ft. n�
N -t
13. GROUT: Depth Material Method O o
From 0 To �D Ft 0e.r4e-.J- rb p _
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From _To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
..R Ff MIAJ1R KLRSS,.,....,.
..,.. is L DU L LTl Z'
_, ,X i II R Y Es 21 'THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A N'CAC'_C,WELL
i CONSTRUCTION TAP DARDS,AND THAT A COPY OF ECORD I IAS BEEN PROVIDED TO THE WELL OWNER
1 J Yoi 2 At c,2` ,,, LA
eJ /4) ..3 - a/
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Cronnlwate-Section
fi__,pfitSfre {ta,¢boat tuithe Division of Water Quality,Groundwater Section, 16.36 NIail Service Center-Raleigh,NC
27699-1636 Phone No.[phone],within 30 days. GW-I REV. 07'2001

210871
WELL CONSTRUCTION RECORD
North Carolina- Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAME (print Y fl.. - rf�t'�D CERTIFICATION# 3b 4 I
WELL CONTRACTOR COMPANY NAME crP tt.h.P(�� nrO3 . lI P-1 I 'r/ / u-srperi/K-PEIONr. # (Vie . e/g) —31 74
STATE WELL CONSTRUCTION PER.\1IT# / " —2- ASSOCIATED\vQ PERMIT#
(if applicable) if applicable)
I. WELL USE (Cheek Applicable Box): Residential LNZMunicipal Public 0 Industrial ❑ Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other 0 IlOther. List Usc
2. WELL LOCATION: Topographic/Land setting
Nearest Tgwn: _ //i-n- County /4 14-V€4 ❑Ridge ❑Slope ❑Valley Llhltrt
in I/e— L6. I check appropriate box)
(Street Name.Numbers.Community.Suubl�dicisioyyn.Lot No..Zip Code) Latitude longitude of well location
d
3. OWNER: - P /1(7 f r(ZC'YN idcurccs minum_s seconds)
Address II-27 ID Vi. 2Asn 2r4 . Latitude longitude source:❑GPS❑Topographic map
/� /(Street or Route No.) (check box)
44t_Y-T-+-/ A.../c. ..2 ']/Lo DE_PTI I DRILLING LOG
City or Toon Stare Zip Code From To Formation Description
(M)- 2aC- 95126 A .3,4 Pi01
Area code-Phone number 3 e /e) g ,0 44
4. DATE DRILLED 8 -2/ -A/
5. TOTAL DEPTH: /PS '
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO Re
7. STATIC WATER LEVEL Below Top of Casing: did FT.
(Usc"*"i f Abocc Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface* c
*Top of casing terminated at/or below land surface requires a o G
variance in accordance with 15A NCAC 2C.0118.
9. YIELD (gpm): <30 METHOD OF TEST ,_ it t;5 - C. co
T,n
10. WATER ZONES(depth): 5-.2 - /05 ' CI cn
LOCATION SKETCH �'
o<
II. DISINFECTION: Type N Tf-/ Amount /8 Show direction and distance in miles from:R7lhast o
12. CASING: Wail Thickness two State Roads or County Roads. Include t4iroac
Depth Diameter or Weiaht.EL Material numbers and common road names. = 7um
From /5 To 3 8 Ft In i" fir O n�
From To Ft. N "A
From To Ft. 0 z
13. GROUT: Depth Material 1 Method
/
From 0 To <)D Ft t c-w. )✓=d)
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
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:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C,WELL
R• i .. .• •i .,.9 ARDS,AND THAT A COPY OF TIllS RECORD HAS BEEN PROVIDED TO TIIE WELL OWNER
.i11dL ri/w �xD 4 - 3 -
ilduSIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
LSubti ,the origin I t t e Division of Water Quality, Groundwater Section. 1636 Mail Sect ice Center- Raleigh,NC
27699-1636 Phone N .(91')733-3221,within 30 days. GW-I REV. U7/20(I I
roundwater Section
evdfe ae�ional Oifce t

• 240873
WELL CONSTRUCTION RECORD
North Carolina-Department of Environment and Natural^tResources-Division of Water Quality-Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAME (print) CA-4d. FrttA-tc-t . rei.eI CERTIFICATION# •32"�1
• WELL CONTRACTOR COMPANY NAME 6eiree-41.i. /J{05 r/2 J. / )f 51 T cum.P, 'Jae .PHONE k f SW q jo f/g -3/9 v
/ T
STATE WELL CONSTRUCTION PERMIT# C 1—_ ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE(Check Applicable Box): Residential 13'/Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION: /� ) Topographic/Land setting
Nearest Town: fait)fl_5I/i e County Ally lt)DO/X- ❑Ridge QSlope ❑Valley ❑Flat
#`41.& �l (check appropriate box)
(Street Name,N�umb�ers,Community,Subdivision,Lot No.,/I Zip Code) Latitude/longitude of well location
3. OWNER: Y ber� Si-re- TC/itr (deerecs,minutes/scconds)
Address 7 /J C*Y /3 4 /,t Latitude/longitude source:❑GPSOTopographic map
/; _J,Stre�et or Route No.) (check box)
iii/!C JO 4 C 24 knt /✓C .,187 I/5 DEPTH ' DRILLING LOG
City or Townr State Zip Code From To Formation Description
(8m- to t '7 - DG 29 � pitit
Area code-Phone number 74 .Sg
4. DATE DRILLED �Q -/4-1> / 5
5. TOTAL DEPTH: _585 '
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO ar--
7. STATIC WATER LEVEL Below Top of Casing: FT.
(Use"+"if Above Top of Casing) 0 L
8. TOP OF CASING IS I FT. Above Land Surface* o
*Top of casing terminated at/or below land surface requires a n T'
variance in accordance with ISA NCAC 2C.0118. n O cmi
9. YIELD(gpm): cZ METHOD OF TEST o7 ti r5 _ ^r^
10. WATER ZONES (depth): S n'
5/5 ' - .. pa 1T *m
LOCATION SKETCH ss m�
11. DISINFECTION: Type {-I.774 Amount /D'J Show direction and distance in miles from argast =m
12. CASING: Wall Thickness two State Roads or County Roads. Include taoa %
Depth Diameter or Weight/Ft. Material numbers and common road names. PS _ —1-1
From I) To 7 Ft. in " Pre ca 3
From To Ft. _
From To Ft.
13. GROUT: Depth Material Method
From 1 To 'QC Ft. (/�h Ax.o.t,--E 496
From To Ft.
I4. SCREEN: Depth Diameter Slot Size Material
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:
12 Fr,a : E( arty CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C,WELL
0 IS - IOItFSTANDARDS/A D THAT A COPY OF THIS RECORD EEN PROVIDED TO THE WELL OWNER
t i rf -1,' 1.":- t SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
r . ' : ttbkobl inal tot e Division of Water Quality,Groundwater Section, 1636 Mail Service Center-Raleigh,NC
' ASIT i9SD teNe,[phone],within 30 days. G W-I REV. 07/2001

240874
WELL CONSTRUCTION RECORD
North Carolina-Department of Environment and'N ral Rnesouyc(,es- Division of
Water Quality-Groundwater Section /
WELL CONTRACTOR(INDIVIDUAL)NAME (print) /-'t4 X /.iA (, Ott n/..J r u CERTIFICATION#-3Py
WELL CONTRACTOR COMPANY NAME ils-1^ r2,W-- /JrCS j/)2 -Q `i /'.t o, PHONE # 1102l 4, '/i - 3 / 7e
STATE WELL CONSTRUCTION PERMIT# ��'J`/ �e•�� ASSOCIATED WQ PER.IIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential Municipal/Public 0 Industrial ❑ Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:)) JJ J // Topographic/Land setting
Nearest T wni A/- E i✓r /lt Co nt �/2 //.d on�L-
�/xy� ORidge CdSlope OValley ❑Flat
CLL/'/) _ (/)fl bL left - (check appropriate box)
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) Latitude/longitude of well location
3. OWNER: G /.4-4y1 ant, red (degrees:inutes/seconds)
Address /a 6 <Jit-lockci Vie u d d-Dr- . Latitude/longitude source:OGPSOTopographic map
treat or Route No.) (check box)
• !%�Ji C'��. y A/e � �g�� DEPTH DRILLING LOG
City or Town State Zip Code From To Formation Description
(7.2.i- 4 4/r - V) .2 7) 98 ' .
Area code-Phone number 6 g -2/ 3-/
•
4. DATE DRILLED ,'-/.2 -et) 1
5. TOTAL DEPTH: .)Z, 6 '
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO V
7. STATIC WATER LEVEL Below Top of Casing: a G FT.
(Use"+"if Above Top of Casing)
8. TOP OF CASING IS � FT. Above Land Surface* . _
*Top of casing terminated at/or below land surface requires a
variance in accordance with)SA NCAC 2C.0118. O
9. YIELD(gpm): /ZID + METHOD OF TEST c2 ))rs � O 0
0
10. WATER ZONES(depth): ,.? 4/5 / - 11W' 1- q pm — o
J LOCATION SKETCH n o'^
11. DISINFECTION:Type 1-{T)-) Amount -Ire l Show direction and distance in miles from leassqt-
12. CASING: Wall Thickness two State Roads or County Roads. Includhe roaQn ef�
Depth Diameter or Weight/Ft. Material numbers and common road names. ��
From cr' To qry FL lr " PVC = zm
From To Ft. O r na
nz
From To Ft. N y
13. GROUT: Depth ea
Method 0 o
From /) To '0/) Ft. La a-n.e�.J /up _
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
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:
j, J4 f,1,..v THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I 5 A NCAC 2C,WELL
[i:) IUlleos_ T U7(� IO�S A AARRDS,AND THAT A COPY OF $ECORD HAS BEEN PROVIDED TO THE WELL OWNER
2 ,j ; SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Subniit,the original to the Division of Water Quality,Groundwater Section, 1636 Mail Service Center-Raleigh,NC
''2T699=763tPiii%e No.(9E9)733-322I,within 30 days. GW-I REV. 07/2001

WELL CONSTRUCTION RECORD 2 4 0 87 5
North Carolina-Department of Environment and N•turalResources-Division of Water Quality-Groundwater Section
E,
WELL CONTRACTOR(INDIVIDUAL)NAM (print) 4-1.4A-n s r;.il.ui Y-L,c1.— CERTIFICATION# 3I'411
�
WELL CONTRACTOR COMPANY NAME �'r//.It1. /✓.4./S' . h>,,,/ >4 % ,LiAaHoNE # (gig) Gdik'31 .74)
STATE WELL CONSTRUCTION PERMIT# //D.2- ASSOCIATED WQ PERMIT#
(if applicable) (if applicable) -
1. WELL USE(Check Applicable Box): Residential 1' Municipal/Public 0 Industrial ❑ Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 I[Other, List Use
2. WELL LOCATION / Topographic/Land setting
Nearest'[ownf L 1 ee ' -)Zi-Counnttyp/Z.i/tr�0 ❑Ridge ftSlope OValley ❑Flat
f'l/2 n/ t nt ,EA , / (cheek appropriate box)
(Street Name,Numbers,Comryuuity,Subdivision,Lot No.,Zip Code) Latitude/longitude of well location
3. OWNER: / D O� Tlje/' (degrees/minutes/seconds)
Address any I-4o-+aaALnq &At 'Ti-). Latitude/longitude source:❑GPS❑Topographicmap
/' ) (Street or Route No.) J (check box)
�J�fnr<y, // A/C .28'9go> DEPTH ' DRILLING LOG
City r Town JStat' Zip Code From To Formati n Description
( $91f)- V5(o Ser.O IL; / 41
Area code-Phone number . I) pe,e- /
4. DATE DRILLED S- /.2 -D I•
/
. . - 5. TOTAL DEPTH: q/OS" '
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 1:17
7. STATIC WATER LEVEL Below Top of Casing: eaf)CO FT.
(Use"+"if Above Top of Casing)
8. TOP OF CASING IS 1 FT.Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C.0118. O
9. YIELD(gpm): 02 METHOD OF TEST .2 h r 5 . - v -*
10. WATER ZONES(depth): 3/;S t - ,, c r r - CD -
LOCATION SKETCH 0 . am
I I. DISINFECTION:Type (-I T/•f Amount ./6,iC Show direction and distance in miles frost leap
12. CASING: Wall Thickness two State Roads or County Roads. Include-the rEet�
Depth Diameter or Weight/Ft. Material numbers and common road names. al ' .c
From Al To 2e-)Ft. I, " Pi' a m.,
From To Ft. _ �t�+t
From To Ft. C m%
13. GROUT: Depth ,Material L Method fN, --I-I
From /) To CV) Ft. (sting-1+-! /o j 0 a
z
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
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:
I no.HFRFRYPFRTIFY TROT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I 5A NCAC 2C,WELL
DCQ@JStilit �N B(fA DFf2Sf,AND THAT A COPY OF THIS R D HAS BEEN PROVIDED TO THE WELL OWNER
llSS IIJJ V '
1 ?A ''-cam /o '3
.y SIGNATURE OF PERSON CON Rt7CTING THE WELL DATE
ti
submit the original to t to Di tision of Water Quality,Groundwater Section, 1636 Mail Service Center-Raleigh,NC
' 2769y.IL6dfuehogerNee(919)733-3221,within 30 days. GW-I REV. 07/2001
t As`- ,.;:Doan Office 3

•
WELL CONSTRUCTION RECORD 2 4 0 8 7 7
North Carolina-Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section /
WELL CONTRACTOR(INDIVIDUAL)NAME (print) Tr. ,$) . 1�r' \C\,+ tJ r c l CERTIFICATION# 3o 4/
WELL CONTRACTOR COMPANY NAME ( res.n..4.-, 3ro3 . Luej () 4 Pb ,,,n) .14,p PHONE # (P.8 &'/9—3)rip7
STATE WELL CONSTRUCTION PERMIT# / n .Z ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
I. WELL USE(Check Applicable Box): Residential Eat Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION: //// L / Topographic/Land setting
Nearest Town, q� t K.//Pt/County / ✓eu/(�,boe4 ❑Ridge 01Slope OValley ❑Flat
,e//„ ," "A,v rr"t( (check appropriate box)
(Street Name,Numbers,Community,Subdivviisiojd Lot No.,Zip Code) Latitude/longitude of well location
3. OWNER: Y, LpJ y,
t ,t `RC? t, J (degrees:minutes/seconds)
Address 5143 F/.c1,te e, Latitude/longitude source:❑GPS❑Topographic map
// / // Street or Route joo..) a (�
C //� fF'r�/t✓f-x- r ✓�J �'� (cheek box)
DEPTH•
DRILLING LOG
City or Town State 1 Zip Code From To Formation Description
(_fib 3?s Soy / p 11,,_i
Area code-Phone number —2Lp , z,
4. DATE DRILLED A- 4- - 0 / rci
5. TOTAL DEPTH: „2 zi. z
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO d
7. STATIC WATER LEVEL Below Top of Casing: n FT.
I (Use"+"if Above Top of Casing)
8. TOP OF CASING IS I FT.Above Land Surface*
*Top of casing terminated at/or below land surface requires a - O
variance in accordance with)5A NCAC 2C.0118. 0 f
a
9. YIELD (gpm): .,2t METHOD OF TEST e0 brs . �-„
10. WATER ZONES(depth): /RS t - .21) c p n-. CO7 • or"
`� LOCATION SKETCH - ?^t
11. DISINFECTION: Typeter'yp / jT/ Amount 3 Show Direction and distance in miles frost lea8-pc
12. CASING: Wall Thickness two State Roads or County Roads. Includg,(he rna,
Depth Diameter or Weight/Ft. Material numbers and common road names. DC =m
From t To iL Ft. of it PVC. O rncfaz
From To Ft. PO• y
From To Ft. O a
13. GROUT: Depth Material Method Z
From t To n Ft. ('o4,1ie.„
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
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:
UNo • - AT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I 5A NCAC 2C,WELL
R T RDS,AND THAT A COPY OF THIS RE HAS BEEN PROVIDED TO THE WELL OWNER
[/ / eJ t- e 1ttlE /n 3 7
SIGNATURE OF PERSON CONST TING THE WELL DATE
• in tot to Division of Water Quality,Groundwater Section, 1636 Mail Service Center-Raleigh,NC
a No.(91 I)733-3221,within 30 days. GW-I REV. 07/2001

WELL CONSTRUCTION RECORD 2 4 4 4 1. 9
North Carolina-Department of Environment and Natural Resources- Division of Water Quality-Groundwater Section ,,//WELL CONTRACTOR(INDIVIDUAL)NAME (print) ✓ur a rLLLC CERTIFICATION# 3/)T/
tr d
WELL CONTRACTOR COMPANY NAME (...;r ep rhos [[)Z/J el Ativitt.. PHONE # ( �t G _g__ 3/1 G
STATE WELL CONSTRUCTION PERMIT# / ASSOCIATED WQ PER:\IIT#
(if applicable) (if applicable)
I. WELL USE(Check Applicable Box): Residential ( "Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION: / Topographic/Land setting
Nearest Town:11 U,)I)1Aiio44i, ile. County P/a.,J/r4)z�z� ❑Ridge l lope OValley ❑Flat
Jt_t V90 6.&AJa.)___777 (cheek appropriate box)
(Street Name(Numbers,Community,Subdivision.Lot No.,Zip Code) Latitude/longitude of well location
6.3. OWNER: si�hA-w-7-42..1..t.„- (decree.,minutes/seconds)
Address rQ 9 y . o n, W.-2.-Ion . Latitude/longitude source:❑GPS❑Topographic map
(StreoroF Route No.) (check box)
�2-Cci, -e a? V7aLJ DEPTH DRILLING LOG
City o Town State . Zip Code Front To Formation Description
(—)- f J /
Area code-Phone number 941 r /n,s_ L71-
z -
4. DATE DRILLED g -That --/) /
5. TOTAL DEPTH: iO/)S
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO .Ii1/1
7. STATIC WATER LEVEL Below Top of Casing: RDL) FT.
(Use"+"if Above Top of Casin_)
8. TOP OF CASING IS / FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C.0118.
9. YIELD(gpm): 3/Li METHOD OF TEST eQ In r5
10. WATER ZONES(depth): 3//p / - 3/0 en p
1LOCATION SKETCH
11. DISINFECTION: Type /--'.T I--I Amount /13 Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads. Include the road
Depth ,,/i Diameter or Weight/Ft. Material numbers and common road names.
From /) To 9 if Ft. /a )/ 0 KC
From To Ft. O
From To Ft, Co o
13. GROUT: Depth Material + Method 0 n
From C To ,:- /9 Ft. CoAn l T r•l 0•
From To Ft. _n cc c"
m
14. SCREEN: Depth Diameter Slot Size Material �'=
m
From To Ft. in. in. pc:
"O m---
From To Ft. in. in. _ 3 rD
15. SftNDLQRAVEL PACK: N r'=
IQeptlt rS1z Material
C)
F{901 ToH ( T L CO CO 3
F1ot. l To—FtnI . _
l ' ll
I
16. SHARKS: ' /
I DO HEREB'Y£ERTIFYZHALTHIS WFLL W S CONSTRUCTED IN ACCORDANCE WITH l5A NCAC 2C, WELL
CON$TR AN
UCCT1ON STD ;Ai' THAT COPY OF THIS REQ�,RD)HAS BEEN PROVIDED TO THE WELL OWNER
�. - liP l Lj4.t.1_�„L /a1 - /r7 -0 /
�/ SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality,Groundwater Section, 1636 Mail Service Center-Raleigh,NC
27699-1636 Phone No.[phone],within 30 days. GW-I REV. 07/2001

245469
WELL CONSTRUCTION RECORD
North Carolina-Department of Environment and Naturalur Resourcese -Divisionivvi of Water Quality-Groundwater Section ,/
WELL CONTRACTOR(INDIVIDUAL)NAM (print) £rtj& a_J % ha-IL&-t n CERTIFICATION# 3CYi/
WELL CONTRACTOR COMPANY NAME /7ire.�.t�+-,(�i�,--vs 14)e) ) -/ `_zr-�+, aY4-i- PHONE # f 621E VS -3/7''
STATE WELL CONSTRUCTION PERMIT# 7` 44 .. ASSOCIATED WQ PERMIT('
(if applicable) - (if applicable)
1. WELL USE(Check Applicable Box): Residential E M/ unicipal/Public ❑ Industrial 0 Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection❑ Other❑ If Other, List Use
2. WELL LOCATION: �� )) Topographic/Land setting
Neare�`p���l�own: II 1 . ' County )fir/[+ )L1!)� ❑Ridge ❑&lope OValley ❑Flat
J 2 Vi / YAK.. u t . (check appropriate box)
(Street Name,Numbers,Community,Subdivision,Lot No..Zip Code) Latitude/longitude of well location
3. OWNER: L 1 f .5 1 curO (decrees.minutesheconds)
Address / 1i? p_k_., P-[? Latitude/longitude source:❑GPS❑Topographic map
(Street or Roue o.) (check box)
0)/1f.t ne.0 v,j/.t NC , 2c' 7 t IP DEPTH DRILLING LOG
City or Town State / Zip Code From To , Formation Description
f___)- C) .2 S
Area code-Phone number a% it y S-
4. DATE DRILLED S --S-C /
5. TOTAL DEPTH: 9145-
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 1W"
7. STATIC WATER LEVEL Below Top of Casing: St FT.
(Use"+"if Above Top of Casing)
8. TOP OF CASING IS I FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C.0118.
9. YIELD(gpm): /pD+ METHOD OF TEST c..V h rs •
10. WATER ZONES(depth): 4L%o ' - LpP+ term
LOCATION SKETCH
11. DISINFECTION: Type /-1—/-( Amount ?-j Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads. Include the road
Depth Diameter or Weight/Ft. Material numbers and common road names.
From U To ? R Ft. Lc I PVC, c
From To Ft. o --:
0
From To Ft. noc7
13. GROUT: Depth Material i Method Z c"
From h To -QO Ft. eh-vs-tat -4-e a -_
From To Ft. — c-I
r,
14. SCREEN: Depth Diameter Slot Size Material :yam
From To Ft. in. in. 3 -',
From To Ft. in. in. N `A'RC'
15. SAND/GRAVEL PACK: y�
Depth Size Material W c
From To Ft. =
t- —
REMARKS: ! IL i
i
HEI IL(Y CERTIFY THAT IVY ELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C,WELL
1- 1
CO1STRUCTION STANDARDS AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
( Yu ) 7 0
P.%.-' _ S1CINATURE OF PERSON STRUCTING THE WELL DATE
Submit the original to the Division of Water Quality,Groundwater Section, 1636 Mail Service Center-Raleigh,NC
• 27699-1636 Phone No.[phone],within 30 days. G W-I REV.07/2001

North Carolina•Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section 2 3 6 2 10
1636 Mail Service Center-Raleigh,N.C.27699.1636-Phone[phone] /�� I �
WELL CONSTRUCTION RECORD WELL CONTRACTOR:
(reP.em, Aron. �//t)/ I Ytirq i .ZNC.-
WELL CONTRACTOR CERTIFICATION e: 3D//
STATE WELL CONSTRUCTION PERMrTN: 7'ftie-a
1. WELL USE(Check Applicable Box): Residential® Municipal ❑ Industrial❑ Agricultural❑ Monitoring ❑
Recovery❑ Heat Pump Water Injection ❑ Other ❑ If Other, Ust Use:
2. WELL LOCATION:(Shhow sketch of the location below) f pp
Nearest Town: ( /n m 4br7•-- County. /in e i/d e)O aL
'7 r /o / Aom Sl'n £ • DEPTH
(Road Name and ry.or Subdi and Lot No. DRILLING LOG
Fontaticn Des:triode.
3. OWNER � e � L�r.a From T5' /
Address 3 t �)oq,r�. �I 4y
treetor out. o.) -5-17/r 725 Y-'D 4'J}l_i
e 4 y71C ., e7 / to
City or Town / State Zp Code
•
4. DATE DRILLED 7-IR -DI
5. TOTAL DEPTH '715' •
6. CUTTINGS COLLECTED YES❑ NOG
7. DOES WELL REPLACE EXISTING WELL? YES E NOEI,
8. STATIC WATER LEVEL Below Top of Casing: ye FT.
(Use•.'ifAbove Top of Casing)
9. TOP OF CASING IS I FT.Above Land Surface'
Top of casing terminated at/or below land surface requires a variance in actor.
dance with 1SA NCAC 2C.011e
10. YIELD(gpm): _J—. METHOD OF TEST r- in r5 -
11. WATER ZONES(depth): .13D ` - 1/2- I p nt
/n'JD' - i a b p r�
12. CHLORINATION: Type H'T N m Aoun /3 ) If additional space is needed use backs(fors
13. CASING:
LOCATION SKETCH
Wall Thickness
Depth Diameter or We1ghva bad& (Show d-rection and distance tram at least two State
From 0 To •c4' Ft. L P✓r Roads,or other mac reference points)
From To Ft.
From To Ft. -
14. GROUT:
Depth Material i Method O
o n
From I� To .a D Ft. r Lm"-� 1 �, �
From To Ft. c -C>
15. SCREEN:
4-_ _
l r-:
Depth Diameter Slot Size Material -
From To_Ft— in. — in.
From _To_Ft._ in. — in. �„• Q• m
From To__Ft-__ in. — in. IV16. SAND/GRAVEL PACK: W o
Depth Size Material 2
From To Ft.
From To .Ft.
17. REMARKS:
I DO HEREBY CERTIFY THATTt9S WELL WAS CONSTRUCTED IN ACCORDANCE WITH 1SA NOAC 2',WELL
CONSTRUCTION STp�DJ4RJS,AND THAT A COPY OF THIS FtECCORcO BEEN PEG D TO THE rlElL Ov nER.
FOR OFFICE USEQNUY oAT�
Quad No: ` SIGNATURE OF PERSON CONSTRUCTING Tf&wE:l
, Sgbri t mglnat to Dr lion of Water Malloy.Grardwate Seats wiithin 37 days Get'•1 REV.121/
Serial No. -

North Carolina•Department of Environment and Natural Resources•Division of Water Quality-Groundwater Section 2 3 6 2 1 1
1636 Mail Service Center•Raleigh,N.C.27699-1636-Phone[phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR: MAca•i,t 4%S4 • j4L d P4`" 0, 44M
WELL CONTRACTOR CERTIFICATION #: ..2412
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE(Check Applicable Box): Residential Municipal ❑ Industrial❑ Agricultural❑ Monitoring❑
Recovery❑ Heat Pump Water injection ❑ Other ❑ If Other, Ust Use:
2. WELL LOCATION:(Shox sketch of the location below)
-Naate/s/tTown: 4M 4tr� County. /91ry71 do 0 rL
! 0--t /A e f D Ve- —Rd.
(Road Name and Nurf�rs.Communig:,or Su. bdiv and Lot No.) DRILLING LOG DEPTH
3. OWNER /tp-Y� fifra -ti± From To ''// Formation Description
Address Let A e v i /Jr /J /5`� ' ('1 n.'
/ Kett o $7 a / o /'LD ' 5/O5-I /h i-)
M YT"�-7 la /
City or Town ' State Zip Code
4. DATE DRILLED 7 -/9 -6 /
5. TOTAL DEPTH Ales '
6. CUTTINGS COLLECTED YES❑ NOS
7. DOES WELL REPLACE EXISTING WELL? YES ❑ NO0
8. STATIC WATER LEVEL Below Top of Casing: /Q/) FT.
II (Use'+'it Above Top of Casing)
9. TOP OF CASING IS�1_ _ FT.Above Land Surface'
'Top of casing terminated at/or below land surface requires a variance In accor-
dance with 1SA NCAC 2C.01 8
10. YIELD(gpm): to METHOD OF TEST e- ln rS
11. WATER ZONES (depth): t'5 ' — 41 J pm
1/5LS' - a 'Pnew
12. CHLORINATION: Type N T.1'"1 Amount g 5 If additicnal space is needed use back ct form
13. CASING:
LOCATION SKETCH
Wall Thickness
Depth / Diameter cc we;9ht/R Martel (Show direction and distance from at least two Slate
From 7) To 1,4 Ft. 4 " Pyr Roads,or other map refererce points)
From To Ft.
From To Ft.
14. GROUT:
;_
Depth Material Method �
From n To an Ft. ` Orr) +Vf c
EH
From To Ft. ca c=
15. SCREEN: I
=�'
Depth Diameter Slot Size Material o
-'a
From _To_Ft _ in. _ in. za. r.,`-
From __To_FL— in. in. a? "'
rn -
From _To_Ft.— in. — in. ,t a
16. SAND/GRAVEL PACK: 1/40 5
L
Depth Size Material
From To Ft.
From To Ft.
17. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELLWAS CONSTRUCTED IN ACCORDANCE WITH 1SA NCAC 2.7,WELL
CONSTRUCTION STANDARDS,II a j)IT A CAP'))!OF THIS RECORD HAS BEEN PROV O THE WELL OWMER.
FOR OFFICE USE ONLY1.
l`� �� Q P'1 10' 91-111)
/ ' O /
Quad No: SIGNATURE OF PERSON CONSTRUCTING WELL OATW
Submit mane'to Noon of Water Guilty.Grovndwat®r Seats wiithln 37 days
CVOREV.1211
SeAal No.

•
North Carolina-Department or Environment and Natural Resources•Division of Water Quality-Groundwater Section h '- 6 214
1636 Mail Service Center-Raleigh,N.C.27699-1636-Phone[phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR: iC/h Ate. £r4-2, /)ram Pt
WELL CONTRACTOR CERTIFICATION #: i k'/ g
STATE WELL CONSTRUCTION PERMIT#: 1-44u
1. WELL USE(Check Applicable Box): Residential Municipal ❑ Industrial❑ Agricultural❑ Monitoring❑
Recovery❑ Heat Pump Water Injection 0 Other If Other,Ust Use:
2. WELL LOCATION: Show sketch of the o ation below)
Nearest ow : / County: NI/it )et)a
(Road Name mbers.Community,or Subdivision and Lot No.) DRILLING LOG DEPTH
3. OWNER L e. V t. From To Formation Desolater.
Address 01 r Ur Rd • n 2 22 ' (Val
uetor outs O. C � 7 � g .? ? ' gDSI � u'
City or Town St • Zp Code •
4. DATE DRILLED 7-25 -.0/
5. TOTAL DEPTH SDS"' .
6. CUTTINGS COLLECTED YES C] NOg 0 NO®
7. DOES WELL REPLACE EXISTING WELL? ES •
8. STATIC WATER LEVEL Below Top of Casing: 3 DD FT.
(Use':if Above Top of Cuing)
9. TOP OF CASING IS FT.Above Land Surface'
'Top of casing terminated odor below land surface requires a variance In actor.
dance with 15A NCAC 2C. 115
10. YIELD(gpm): 3 41 METHOD OF TEST r2 h r 5 •
11. WATER ZONES(depth): 4IA ' " 3/4/ o_irn
12. CHLORINATION: Type N T N Amount /4'Y If additional spree is needed use backs(lor:al
13. CASING:
LOCATION SKETCH
Wall Trickness
Depth Diameter or Weight/FL Material (Show erection and distance from at least ten State
From AO To nti/ Ft. E' " PVC Roads,or other map Telerate points)
From To Ft.
From To Ft. o
14. GROUT: o G
Depth Malarial Method C -5
From To �' /) Ft. Cd Yv o x -
From To Ft. cm 9 .:
15. SCREEN: m N
Depth Diameter Slot Size Materialr=-
From _To_Ft in. __ in. 9 m=
From _To—Ft— in. in. N cs
From _._To_Ft— in. _ in. 1.0 O
z
16. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
17. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH iSA NCAC Z.WELL
CONSTRUCTION STANDARDS,AND THAT A COP'!OF THIS RECORD HAS BEEN PF.iOVI TO THE WELL OWNER.
V/li -/ - G /
FOR OFFICE USE ONLY
Quad No: SIGNATURE OF PERSON CONSTRUCTING ThE WELL DATA
I Submit Mine to Owen of Water quality.Gro-ndwate r Seam wiithln 97 days
WI REV.12l1
Seidel No. .... '..

North Carolina•Department of Environment and Natural Resources•Division of Water(Duality-Groundwater Section 2 3 6 2 0.5
1636 Mail Service Center•Raleigh,N.C.27699.1636•Phone[phone]
WELL CONSTRUCTION RECORD WWELL
CONTRACTOR:CERTIFICATION� L #: / / ��
Er/
WELL CONSTRUCTION PERMIT#: /Ste x
1. WELL USE(Check Applicable Box): Residential L✓J Municipal ❑ Industrial❑ Agricultural Cl Monitoring Cl
Recovery❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATION:(S/h/ow sketch of the location below) -
Nearest ter: ` `it^" "- ��County. " ..�'�1/vknl/r)
_Let-u-2.5-Ad A'"." x,��t— / DEPTH
(Road Name an ers,�"nnity.or Subdivisionnd a t a) DRILLING LOG
3. OWNER d J A/11 YY) p-lit -�(, From To Foanatwi Des.—iption
Address 3/ Q n LO D r (vA Ai
��'-,-c/- �7.'f D ' 605 ' ,bn&An),7`!l
PSteetorRout Ro.) 020716
City or Town ' State Zp Code •
4. DATE DRILLED 1-/. -. I
5. TOTAL DEPTH !o DS ' •
6. CUTTINGS COLLECTED YES❑ NO ✓❑(
7. DOES WELL REPLACE EXISTING WELL? YES [] NO[
8. STATIC WATER LEVEL Below Top of Casing: /) FT.
(Use':it Atove Toy 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 1SA NCAC 2C.01111
10. YIELD(gpm): /D METHOD OF TEST .'O by S
11. WATER ZONES(depth): -SAD ' - ID a P^''
12. CHLORINATION: Type H r I-I Amount 109 If additional spry is needed use back cf form
13. CASING:
LOCATION SKETCH
wall Tri,duiess
Depth Diameter sY Weight/R Material (Show daectron and distance fnm at least two State
From D To /o n Ft. " P dC Roads,or other map relerate points)
From To Ft.
From To Ft.
14. GROUT:
Depth Material! Method o 0
From To aU /1 Ft. l &YinA-84i °e b c�
From To Ft. c `- .
15. SCREEN: t -
m —
Depth Diameter Slot Size Material
From _To_Ft in. _ in. ='r
From _To_Ft.— in. in. 9 m=
From _To_Ft._ in. in. N
ci
_
16. SAND/GRAVEL PACK: in o
z
Depth Size Material
From To Ft.
From To .Ft.
17. REMARKS:
I DO HEREBY CERTIFY THAT THIS WEiLI.WAS CONSTRUCTED IN ACCORDANCE WITH 16A NOAC 2',WELL
CONSTRUCTION STANDARDS,AND THAT A COPY OF THIS PECORD HAS BEEN PROD TO THE WELL OWNER.
Id...) ,6Ihr.*. 8-i -o /
FOR OFFICE USE ONLY DATA
Cluad No: SIGNATURE OF PERSON CONSTRUCTING TFff WELL
Submit mginas to Dnafon of wateroutlay.Gro. Owatmr Seacn witthln 37 days GK I RSV.Ind
Serial No.

North Carolina•Department of Environment and Natural Resources•Division of Water Duality•Groundwater Section 2 3 6 2 0 6
1636 Mail Service Center•Raleigh,N.C.27699-1636-Phone[phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR: a I SMAIO- • /, 20 P 4 6D .`-i"L
WELL CONTRACTOR CERTIFICATION #: 2 t /1
STATE WELL CONSTRUCTION PERMIT#: /' D Z
1. WELL USE(Check Applicable Box): Residential Eli Municipal❑ Industrial❑ Agricultural❑ Monitoring❑
Recovery❑ Heat Pump Water Injection ❑ Other D If Other, List Use:
2. WELL LOCATION: (ShQw sketch of the location below)
Neatest Town: lo.kaine 6U' //_ County: /4.-y1d4/5,-,1 -
/LJin7Ge///; hn l Bvee
(Road Name and Ndrppers.Community.or Su ivisan ar Lot No.) DRILLING LOG DEPTH
3. OWNER - / DA/L�/_// 4)fjt-p -0gg�t)A From To FomuUaDeescriyptior.
Address / / 0 Of ONO
J h ham) ( V e. 4 '7� (� 0
Y120-�t,/I n/�J/ //4- 0Ne o. -C. a 02 g 7 8/ 291 PIS ' .�/t�Naiit-)
City or town Slate zit Code •
4. DATE DRILLED 7 -a -D l
5. TOTAL DEPTH /41-5
6. CUTTINGS COLLECTED YES❑ NOd
7. DOES WELL REPLACE EXISTING WELL? YES D NOd
8. STATIC WATER LEVEL Below Top of Casing: a p FT. _
(Use'.'if Above Top of Casing)
9. TOP OF CASING IS FT.Above Land Surface'
'Top of casing terminated at/or below land surface requires a variance In accor-
dance with 1SA NCAC 2C.0115
10. YIELD(gpm): 30 METHOD OF TEST .� krs •
11. WATER ZONES (depth): /a 5 t 30 iv",
12. CHLORINATION: Type H T N Amount a_J If addlticeal spice is needed use bead for=
13. CASING:
LOCATION SKETCH
" Wall Trniamess
m
Depth Diameter WaighVR Made (Show erection and distance irm 4 least two State
From To 7 7 Ft. to PVf Roads,or other map referer+ce points)
From To Ft.
From To Ft.
14. GROUT:
Depth Material Method o
From 1) To - n FL Co.m-a w 'b {� o
From To Ft. q, rn
15. SCREEN:
Depth Diameter Slot Size MaterialG7 c S
Material
From —To_Ft in. — in• cn ;I
From To_Ft. in. in. r=�.
From _To_Ft. in. — in. "'
16. SAND/GRAVEL PACK: •• rn
Depth Size Material Ns
in o
From To Ft.
From To Ft. _
17. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2.,WELL
RID
CONSTRUCTION STANDAS,AND THAT A COP`(OF THIS RECORD HAS BEEN PPOVtt B10 THE WELL OWNER.
FOR OFFICE USE ONLY
WI
) - 8-/ _o /
Quad No: SIGNATURE OF PERSON CONSTIWCI'I1N0 Th&WE:l DAM
Submit Mgina'to D.Son of Water Quad*D%ndwaber Seacn within 97 days Os.' REV.tat?
Serial No.

236202
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] Li
WELL CONSTRUCTION RECORD WELL CONTRACTOR: �/Aa-F4i, /"� �� �""`1'' -1
N '1—
WELL CONTRACTOR CERTIFICATION #: a 4// 7
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE(Check Applicable Box): Residential Er Municipal ❑ Industrial❑ Agricultural D Monitoring❑
Recovery❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATION: (Show ketch of the location below) / p
Neares wn: �{ '7. n r• 5 ✓r /�e- County. Gi-t 1626 U d
,.�. let .
(Road amalifind ers.Commu5y.or Subdivision and Lot No.) DRILLING LOG DEPTH
3. OWNER 0 ' Th/ From To Formation Description
Address () p-7l" /D 3 f) ^nt f�
veet or ONO 0. ��'�� h/'/
�� ,t ,L�
City orTown State / Zip Code •
4. DATE DRILLED '7-/-0 /
5. TOTAL DEPTH RS '
6. CUTTINGS COLLECTED YES Q NOEr/
7. DOES WELL REPLACE EXISTING WELL? YES E NO[
8. STATIC WATER LEVEL Below Top of Casing: 1,0 FT.
(Use• •if Above Top of Casing)
9. TOP OF CASING IS 1 +FT.Above Land Surface
'Top of casing terminated aUor below land surface requkea a variance In accor-
dance with'SA NCAC 2C.0118
10. YIELD(gpm): .3D METHOD OF TEST h r'S
11. WATER ZONES (depth): 5' - 30 `yp"'
12. CHLORINATION: Type It 7"/-1 Amount /La It additional space is needed use back GI form
13. CASING:
LOCATION SKETCH
Wall Thickness
Depth Diameter cc Weight/Ft. te Material (Show direction and distance Crum at feast two State
From /9 To 4/7 Ft. /< " pvc Roads,or other map releraxe points)
From To Ft.
From To Ft.
14. GROUT: c-
Depth Material Method o
To cW Ft. Ct ) Li p 0
From e �y —
From To Ft. C %,
r,
15. SCREEN:
cJn c�
Depth Diameter Slot Size Material -r--
From _To_Ft in. in. - 1T a
rl
From ___To_Ft._ in. in. —"'
co
From To_FL_ in. — in. .. rn7•
N —ni
16. SAND/GRAVEL PACK: a
Depth Size Material z
From To Ft.
From To Ft.
17. REMARKS:
I DO HEREBY CERTIFY THATTHIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NOAC 27,WELL
CONSTRUCTION STANDARDS,MO THAT A COP(OF THIS RECORD HAS BEEN PROVIDct 0 THE PIEUL OWNER. / d /
FOR OFFICE USE ONLY �v J. /Jif t2� e_ CP�',�)
Quad No: giGNATURE OF PERSON CONSTRUCTING TIC WELL DATE
Subna Mginat to Denton of Was°ualitty.Grarowate r Seam wiithln 3?days Gts l REv. 12l9
Serial No.

236203
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] J�. 1.
WELL CONSTRUCTION RECORD WELL CONTRACTOR: 1IA PIA,' Z A.ed Z/ V ' "'^�
WELL CONTRACTOR CERTIFICATION *I: Jo e/
STATE WELL CONSTRUCTION PERMITP: -r
1. WELL USE(Check Applicable Box): Residential 2( Municipal 0 Industrial❑ Agricultural❑ Monitoring❑
Aecovery❑ Heat Pump Water Injection ❑ Other El If Other, Ust Use:
2. WELL LOCATION: (Staow sketch of th_e location below) y y ���A r n
Neareesstt/Town: /(Jail ✓)P S lv r /it_ County-. �/ OL
'A-in �otranQ"`Y DRILLING LOG DEPTH
(RN ERama and Numh 7 ' .I't�,or Subdivision tot No.)
3. OWNER c a , / / )(-t /i-aJ) From To Formation Description
Address ,Spy �y,/��r41,..LA6oci -R/4,
f ( neat or RouteG 9 7 a...,C ty or Town t/ �e� State) Zp Code
•
4. DATE DRILLED 7-J a_a /
5. TOTAL DEPTH -3YYS '
6. CUTTINGS COLLECTED YES❑ NOE( •
7. DOES WELL REPLACE DUSTING WELL? YES ❑ NO[
8. STATIC WATER LEVEL Below Top of Casing: 40 FT.
(Use':if Above Top of Casing)
9. TOP OF CASING IS FT.Above Land Surface'
'Top of casing terminated atfor below land surface requires a variance In accor-
dance with 1SA NCAC 2C.0116
10. YIELD(gpm): 2D METHOD OF TEST c21 in r 5
11. WATER ZONES(depth): 5�ar{ek a 3/.'
3.5 ' - /e. a pm
12. CHLORINATION: Type NTH Amount CP 3 If additional space is needed use back Of form
13. CASING:
LOCATION SKETCH
Wall crtess
Depth Diameter cr WeighVR. Material (Show erection and distance Iran at least two State
From To Ft. Roads,or other map relereace points) }},.�v�-�
From To Ft. l`�' D,v-- A
From To Ft.14. GROUT: / _(� t^
Depth Material Method L t 1,
From 0 To a n Ft. Co a -It> 1, — d� f a-e "
From To . Ft.
GDi a o.—
15. SCREEN: c`'
Depth Diameter Slot Size Materal 1 c
m er
From ___To—Ft — in. — in. `
From —To—Fs._ in. — in.
ZC
From To—Ft..— in. — in. co n w
16. SAND/GRAVEL PACK: ry mo
Depth Size Material =
From To Ft.
From , To .Ft.
17. REMARKS:
I DO HEREBY CEFRT *JF71-4 t WAS CONSTRUCTED IN ACCORDANCE CE MINIM NCAC 2Z,WELL
CONSTRUCTION S'd 9AROS,AND THAT A COP'(i OF THiS FIE COW HAS BEEN P P . O THE WELLOWIER. /
FOR OFFICE USE OaY
`G/1 .2 ti 2.e w g - o
Quad No:
SIGNATURE OF PERSON CONSTRUCTIINO ThE vies
DATE
c-- - *Isom�erigmar to°fusion d watt cumin/.Grarawatrer Sect=wtehln 37 day's Gat'•I DATE
trill
No.

North Carolina•Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section 2 3 9 0 '9
1636 Mail Service Center•Raleigh,N.C.27699-1636-Phone[phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR: i)".... • £L-4E o' i`-nr\44w
WELL CONTRACTOR CERTIFICATION #: g id
Er'
WELL CONSTRUCTION PERMIT#: L
1. WELL USE(Check Applicable Box): Residential[ / Municipal ❑ Industrial 0 Agricultural❑ Monitoring ❑
Aecovery❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATION: Sho sketch/pf the location below) �/J
Nearest Town ( S`�'��� County: /`'�/Lt)!'is
4.
(2 •
Gym^^' 0
(Road Name and Nu ,vornmunity,or Su �`'and Lot No.) DRILLING LOG DEPTH
•
3. OWNER 4 F /t 4 From To FemuUmDes. ption
Address V oz .9i73 /) /oD ' eine,"
et /y n�..J (bveat Route No.) 2 F7/6 D [`O-6- r[Ls,.1_1)
City or Town / Sin Zip Code '
4. DATE DRILLED 7-/ 7 •-•"' /
5. TOTAL DEPTH 5/0S'
6. CUTTINGS COLLECTED YES❑ NO[/
7. DOES WELL REPLACE EXISTING WELL? YES 0 NO[.
6. STATIC WATER LEVEL Below Top of Casing: yip FT.
(use -. If Above Top of Casing)
9. TOP OF CASING IS 1 FT.Above Land Surface
Top of casing terminated stior below land surface requires a variance In accor-
dance with 15A NCAC 2C.0118
10. YIELD(gpm): 1tl_ METHOD OF TEST t9 h rs -
11. WATER ZONES (depth): 3IP6 ' - H5Prn
LIPS' - 6rrm
12. CHLORINATION: Type fitrii Amount If additional spry a needed use back cf foram
13. CASING:
Wall rn duress LOCATION SKETCH
Depth Diameder Cr We'ghVR Masrial (Show criection and distance trim at least two State
From /7 To.1,1) Ft. 6 " P✓C Roads,or other mac reference points)
From To Ft.
From To Ft.
14. GROUT:
/
Depth Material Method
0
�
From To -W Ft. (-12-4 -1 ass. o
O
c
From To Ft. P+7
15. SCREEN: _ =n
m
Depth Diameter Slot Size Materal v D rn
From To Ft in. in. =sa -is,
From _To_Ft:. in. — in. 3 am
From To_Ft in. _ in. G r°
16. SAND/GRAVEL PACK: -
Depth Size Material o
x
From To Ft.
From To Ft.
17. REMARKS:
I DO HEREBY CER•I T L : E i 'y ' STRUCTED IN ACCORDANCE WITH 1St, NCAC t,WELL
CONSTRUCTION •L C+ , )1OETHIS PIECO/ORO HAS BEEN PROVIDED TOTHE WEL'�OWNER.
FOR OFFICE USE t �t1 i - 21,t t i.e /�—/I o /
Quad No:
l 2JMi ilIRE OF PERSON CONSTRUCTIING Tt•E W E-L OATS
$ubm t tvtginal to Brion of Water Quality.Grarv}wauer Seam within 37 days
Serial No. I roundwa` $ l n G$'I REV.1208

North Carolina•Department of Environment and Natural Resources-Division of Water Duality-Groundwater Section 239041
1636 Mail Service Center-Raleigh,N.C.27699-1636-Phone[phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR: rrrrr°nc ,fer05. lilt// St pumPi a
WELL CONTRACTOR CERTIFICATION #: io 71/
��
STATE WELL CONSTRUCTION PERMIT#: 7 VC Z
[E/
1. WELL USE(Cheek Applicable Box): Residential Municipal ❑ Industrial El Agricultural❑ Monitoring ❑
Recovery❑ Heat Pump Water Injection El Other ❑ If Other, List Use:
2. WELL LOCATION: (Show s etch2off e location' below)
. Nearest Tow,{/ (/C d-/ z, County.. 52/IJn�
CeIn
(Road Name and Nu jrnmmunity,or drv•tsion ard Lot No.) DRILLING LOG DEPTH
3. OWNER //,L C �OD� From To Forma-a+Destiptior.
Address
//�� 1 j�aier e o �7 7 r � ��
C��/iJL7'l�.�eet or f[put Ro.)� d O ! '4 47.2 c �Cl S�XA•t1.1-
City or Town Stan Zip Code •
4. DATE DRILLED 7-13-D/
5. TOTAL DEPTH 'ra.5" '
6. CUTTINGS COLLECTED YES NO[f .
7. DOES WELL REPLACE EXISTING WELL? YES El NOM'
8. STATIC WATER LEVEL Below Top of Casing: jai FT.
(Use'. it Atove Top of Casing)
9. TOP OF CASING IS FT.Above Land Surface
Top of casing terminated atlor below land surface requires a variance In accor-
dance with 15A NCAC 2C.0118
10. YIELD(gpm): -_/___ METHOD OF TEST of A rS
11. WATER ZONES (depth): /-ID 1 - /j p rn
12. CHLORINATION: Type En" Amount___9 --- If additional spa-.e is needed use badr d forT
13. CASING:
LOCATION SKETCH
wall Tar:knees
Depth ,/ Diameeer t<Weight/R. Material (Show&cotton and distance frm at kart two State
From d0 To 711 Ft.--10—IL- PVC Roads,or other map reference points)
From To Ft.
From To Ft.
14. GROUT:
Depth Material Method
From � To �_Ft. �� "��'7-y-- a
From To Ft , o o_
15. SCREEN: ato a~
rn ofr.
Depth Diameter Slot Size Material -0 zm
From To Ft in. in. lb<
From _To Ft — in. in. a "Li—,prt
From To_Ft.— in. _ in. = as
16. SAND/GRAVEL PACK: C mTa
Depth Size Material co
From To Ft. 4- oz
From To Ft.
17. REMARKS:
I DO HEREBY CE}j FYUCH�TugS�IEs.4s ' STRUCTED IN ACCORDANCE W'ITH 15A NCAC 2:,WELL
CONSTRUCTION 9_frYwn-uAHzub.EslYTrtEr' 'rD OF THIS PEH4S BEEN PFOV TO THE wail.OWNER.
FOR OFFICE US LY i AAo.¢.rt.L 9-7/-a /
Cued No: i INATURE OF PERSON CONSTRUCTINO TM W El OATS
rSuMt trenar s Dr oon of Water Quality.Gros/Neater Seccn witthln 3?day'S
Segal No. Grouidwater Section Gts•I REV.ian
I£diawle Regional Office
x

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�'rP.ene, .}irrs. Idell4 A nif, Sec- .
WELL CONTRACTOR CERTIFICATION #: •qp 4/ /
/STATE WELL CONSTRUCTION PERMIT#: 9 i/d 2-
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: how sketch of t elo ion below) L/ /
, Nearest T n: County. /`7'AyG,nnd
a � f /
(Road Name and Numbers.//Co/�munity, Subdivision and Lot/No. DRILLING LOG _ DEPTH
3. OWNER _, . ! A �0-4J�/1/ From To Formation Description
Address ' h�0� i J. it 71 'D . /d 3 r 2�
YrJt tre> Koute N j^ J ��� p /,23 a2 5 '
f)sLd.L1i/�i ,cry
City or To Stets As Code
'
4. DATE DRILLED 7-25--D/ .
5. TOTAL DEPTH • 7'S-'
6. CUTTINGS COLLECTED YES❑ NOL( .
7. DOES WELL REPLACE EXISTING WELL? YES ElNOL✓ .
8. STATIC WATER LEVEL Below Top of Casing: .r7Lp FT.
(Use'.'II Above Top of Casing)
9. TOP OF CASING IS 1 FT.Above Land Surface'
'Top of casing terminated ettor below land surface requires a variance In accor-
dance with 15A NCAC 2C.Otte
10. YIELD(gpm): //9 METHOD OF TEST o7 1,rs •
11. WATER ZONES(depth): a 212 ' - 41 ym
.2g(1 I - t p �n ,n
12. CHLORINATION: Type H T Amou3,
1a.LG_ It additional spars is needed use back cf loran
13. CASING:
Wall Tn dv ess LOCATION SKETCH
Depth Diameeer et We ght/R. MM. /xxdai (Show dwect on and distance tram at least two Stale
From To �a� FL G �� - - ' r/� Roads,or other mac referrce points)
From To Ft.
From To Ft. -
14. GROUT: o
Depth n Material 1 Method O f
From /0 To OW FL /
0
From To Ft. -vs cm
15. SCREEN: o¢
Depth Diameter Slot Size Material "i nc
From To Ft in. _ in. a rn
_ 7:3rn
From _To—Ft in. _ in.From _To_Ft— in. — in. -. tN
o
16. SAND/GRAVEL PACK: o
Depth Size Material z
From To Ft.
From To Ft.
17. REMARKS:
I DO HEREBY I t E•,1 TRUCTeDD IN ACCORDANCE WITH 1'A NCAC 2',WELL
CONSTRUCTIO•� •4f,.� _'.'��1 =- i ��a F THIS RECORD HASBEEN PROVIDED T WEL&OWNER. 6 J
FOR OFFICE US: `'�Y :�`;,� `." '"tat- 9 —/ /
Oued No: , it: TORE cc PERSON CONSIRUC1ING 1W WELL OATS
$ubrne en. no • Dneton of Water Outing,Orou+dwauer Seocn witth)n 37 days
ce-t RirV.t291
Serial No. C.., ndtvatc-Section
,s,. -- - afOffice

239043
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] //JJ
WELL CONSTRUCTION RECORD WELL CONTRACTOR: s A," �z� 44E 9- 4-41) ana
WELL CONTRACTOR CERTIFICATION e: S4'I/
_ STATE WELL CONSTRUCTION PERMIT-a: 7 —
1. WELL USE(Check Applicable Sox): Residential Lr1/ Municipal ❑ Industrial❑ Agricultural❑ Monitoring❑
Recovery❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATION: (Show sketch of the local n below) �/ /
Nearest Town:�� 9lrif � un� FY/l�ii J/�A/�
(Road name Nur7bers. oCo wnu"f'� or Subdi s .d Lot No.) DRILLING LOG DEPTH
3. OWNER Lot o !7 l tihJ From To FormaGm Des.-iption
Address ‘ t JeLdl7?J A 541
(Since OrHUNeN (-107.51712,d. -IV ,,jd.3-. �e2
Ciry awn 'State ZZp Code
4. DATE DRILLED 7-&G -1 /
5. TOTAL DEPTH -S/) 5
6. CUTTINGS COLLECTED YES❑ NOd •
7. DOES WELL REPLACE EXISTING WELL? YES D NO[(
8. STATIC WATER LEVEL Below Top of Casing: /n FT.
(Use•.it Atone 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.0116
10. YIELD(gpm): _NA METHOD OF TEST .4 Ar5 _
11. WATER ZONES(depth): / 26 ' - /L
rn
12. CHLORINATION: Type // 7N unt 92- If additional space is neede7 use backcf form
13. CASING:
Wan rriU ass LOCATION SKETCH
Depth _'/ Diameter cr we.gnUR Material (Show erection and distance(rm at least trio State
6 From A To 't` Ft. G pya Roads,or other map referecce points)
From To Ft.
From To Ft.
14. GROUT:
Depth n Material Method C
From D To ._ Ft. ! Oar
n
From To Ft. rrn am
15. SCREEN: -tz_ zarc^c
Depth Diameter Slot Size Materal -a n rn
From To_Ft in. in, y r--+t
From To Ft— in. — in. = N=
From _To Ft_ in. — in. 9 rrl
16. SAND/GRAVEL PACK: - c
Depth Size Material Z
From To Ft. _
From To Ft.
17. REMARKS:
I DO HEREBY •d`W it ,r, ,T L . .1"1 F. r it r STRUCTED IN ACCORDANCE WITH 151. NCAC 2",WELL
CONSTRUCT!.Ii l •e •e-,. ,A.ND THAT . r,' OF THIS RE/ " HAS BEEN PEOVI O THE WELL OWNER.
FOR OFFICE U' i I LY '�' �7 /I' /
Quad No: 1 S NATURE OF PERSON CONSTRUCTIING TI-E Vli<LL OATS
--::Submit mginat#o Dnebn of Water Quality.Gro e:Mawr Seam witthIn 3?days
Sedal No. Grotintw?'`.• GWI Mr.127!

239044
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: AZ.L,4elr•. fla V P«'Yh'
WELL CONTRACTOR CERTIFICATION #: 36 4"/
.
STATE WELL CONSTRUCTION PERMIT#: �i .1--n-5
1. WELL USE(Check Applicable Box):Residential[(( Municipal ❑ Industrial D Agricultural❑ Monitoring ❑
Recovery❑ Heat Pump Water Injection 0 Other ❑ If Other, List Use:
2. WELL LOCATION: Sh w sketch of the to a ion below)
NearestT n:
d AA County. - /1,l�n�
J/��! /
Road Nam umbe Compunity.or Subdivision arc:. ALot .) DRILLING LOG DEPTH
3. OWNER a A. >ze/_4.€ 44 +- From To Formation D -iption
Addressn -z/ r
/ �� de(Street or �`�/477-gi 41 /k,5 ' �J
City or T n 1 State Zip Code .
4. DATE DRILLED 7-24 a/
5. TOTAL DEPTH /R '
6. CUTTINGS COLLECTED YES❑ NO
7. DOES WELL REPLACE EXISTING WELL? YES D NO71
8. STATIC WATER LEVEL Below Top of Casing: go FT.
(Use'I.'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.011S
10. YIELD(gpm): METHOD OF TEST 02 fll5
11. WATER ZONES(depth): 90 / - 6 479 n-'
/D5 ' - yNypm
12. CHLORINATION: Type /-17 N Amount r 3.q If additional space is needed use back ct form
13. CASING:
LOCATION SKETCH
Will Yrickness
Depth Diameter. cr Weight/R. tat (Show erection and distance tram at least two State
From To S� Ft. 41 -to- �� Roads,or other map reference points)
From To Ft.
From To Ft.
14. GROUT:
Depth �Materialy Method
From _II_ /
_ To -OD Ft. l .o.+irt.rcl
From To Ft. o
15. SCREEN: N a�
Depth Diameter Slot Size Material Fri on,
-0 =m
From To Ft in. — in. z_
J o r
From To Ft.— in. _ in. yo
From _To_Ft. in. — in. - 3 �rn
16. SAND/GRAVEL PACK: O �u
Depth Size Material ..1
From To Ft. 'L-- o
a
From To Ft.
17. REMARKS:
1
I DO HEREBY CE-11 - LC, F I E_r . UCTED IN ACCORDANCE WITH TEA NOAC 2Z,WELL
CONSTRUCTION I`(j ARDS,AND ThIAT A CO i THIS REC." HAS BEEN PFaOVID=e a THE wasOWnER.
FOR OFFICE USE i"I ri, ' P ' • -0--m
Ouad Ilo: • T ORE OF PERSON CONSTRUC IIING TIE WELL OATS
r r •n er wateroualitq.Gros4watrer Stacy) days
��R., r, GK-I REV.1291

239045
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: . "h0e �� � , Liaa-
WELL CONTRACTOR CERTIFICATION #: .24'/8
_ /STATE WELL CONSTRUCTION PERMIT#: /S45'2 '
1. WELL USE(Check Applicable Box):Residential21 Municipal ❑ Industrial❑ Agricultural❑ Monitoring ❑
Recovery❑ Heat Pump Water Injection ❑ Other ❑ II Other, List Use:
2. WELL LOCATION: (Sh w sketch of the to ation below) �`
Nearest own: -swill County. H/,l.(./LC)One4
de/
(Road Name and/ry�/pers u cy or Subdi .d Lot No.) DRILLING LOG DEPTH
3. OWNER (t' to 4tAt+L-rrr.2 From To Formation Description
Address 72 � iYvrti,.. yyj�y,. red,
street or F outs o.)
_y 4jJ,n./.4.//2 i o 5'LG o?g 77L
City own ' State Zip Code •
4. DATE DRILLED 7'57-0 i CAI-;t)set UP 5' c e,-
5. TOTAL DEPTH .3 S-t J r,rt VX rs k .•rj suet t, •
6. CUTTINGS COLLECTED YES❑ NO[
7. DOES WELL REPLACE EXISTING WELL? YES ❑ NOM
8. STATIC WATER LEVEL Below Top of Casing: Bo FT.
(Use w II Above Top of Casing)
9. TOP OF CASING IS 1 FT.Above Land Surface'
Top of casing terminated at/or below land surface requires a variance In accor-
dance with 15A NCAC 2C.pin
10. YIELD(gpm): n0 METHOD OF TEST e2 firs
11. WATER ZONES(depth): 37© 1 - L0 2,m
12. CHLORINATION: Type /-/ rid Amount -2 9 If additional space is needed use back ci form
13. CASING:
Wall Tr mess LOCATION SKETCH
Depth binder cv Wer'ght/R Ma ltal (Show direction and distance f.m at least two State
From To Ft. Roads,or other map referecte points)
From To Ft.
From To Ft.
14. GROUT: o
DepthaD n Method o
From _� To Ft. C2 rxt co n—
m rn o
From To Ft. -o a c-'
15. SCREEN: — a-c
Depth Diameter Slot Size Materal `I *rn
A
From To Ft _ in. in.
S zCc
From _To_FL_ in. in o mz
From To_Ft— in. in. _ cs
ti
16. SAND/GRAVEL PACK: 4- o
Depth Size Material z
From To Ft.
From To Ft.
17. REMARKS:
I DO HEREBY CE T 4c tL!WASCgt ' UCTED IN ACCORDANCE WITH 1'A NCAC 2,,WELL
CONSTRUCTION 4Jrb`OR e THIS RE HAS BEEN PRO TO THE WELL OWNER.
�. �� /
FOR OFFICE USE i � 4. 7 /i- C t-
Quad No: Y sI>- TORE OF PERSON CONS1RUCiIING The WELL DATE
gubmt two , 'to r ,..nor Water Quality.Gro.ndwaterr Seocn wiithln 3?day'S
Serial No. a Groundwater Section GW-I REV.12W
list eville Regional Office _,

North Carolina-Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section 2 3 :1 0 4 6
1636 Mail Service Center•Raleigh,N.C.27699-1636-Phone[phone] WELL CONSTRUCTION RECORD WELL CONTRACTOR: Y Q�tiicnro 4110-• 4-4-le V Pial`Pe '
WELL CONTRACTOR CERTIFICATION #: a 41/S
—/STATE WELL CONSTRUCTION PERMIT#: - 2,1. WELL USE(Check Applicable Box): Residential[2 Municipal El Industrial❑ Agricultural❑ Monitoring ❑
Recovery❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
a WELL LOCATION: (Show sketch of the location below)
Nearest Town: V"d / fl-S2./die County. M'y/7)nnri
(Road Name and Numb�s/s�Community.or Su ��and ifn� No.) DRILLING LOG DEPTH
3. OWNER X J�i.l , /� X/rr/�r iii 1 From To Fomiasm Description
Addrreesss� � 7nj� �!Y/a��Z �7p./ ii7 ' of
VP-24C1it„Oav///2/outsN y2C_ t /6GD '�7 / 25 .Gil r�.r✓
City or T n State / , Zp Code •
4. DATE DRILLED -23 -D/
5. TOTAL DEPTH h'-+
6. CUTTINGS COLLECTED YES❑ NOd
7. DOES WELL REPLACE EXISTING WELL? YES ED NO 1-
B. STATIC WATER LEVEL Below Top of Casing: j/) FT.
(Use• if Abode Top of Casing)
9. TOP OF CASING IS / :FT.Above Land Surface'
'Top of casing terminated at/or below land surface requires a variance In accor-
dance with 15A NCAC 2C.0118 /
10. YIELD(gpm): 2 METHOD OF TEST a i1 r5
11. WATER ZONES (depth):/-�' - 4 Vm
12. CHLORINATION: Type H rR Amount //3 If additional spars is needed use back d form
13. CASING:
LOCATION SKETCH
will Tradeass
Depth �y Dial ewer n WaighVR %Val
c (Show Clacton and distance iron at feast MO State
From--IL--To—��L Ft. 4 - - . � Roads,or other mac referee points)
From To Ft.
From To Ft.
14. GROUT: o
Depth „Material Method 0 o
n
From D To Q2D Ft. ��2�' Crrtn a
From To Ft. --0_ an
15. SCREEN: czic
-a rn
Depth Diameter Slot Size Materal nc
From _To_ Ft — in. in. 3 rn
c
From —To_Ft._ in. in. G ;1
From __To_Ft_ in. — in. — C,
16. SAND/GRAVEL PACK: .o' o a
Depth Size Material
From To Ft.
From To Ft.
17. REMARKS:
I DO HEREBY ay . .i, r.. ;lvf ( • "TRUCTED IN ACCORDANCE WITH 1st NCAC 2t WELL
CONSTRUCTIO Cj = - ; '. e F THIS RECORD HAS BEEN PF+OVI THE WELL Ownf_R.
FOR OFFICE US� 'ti 'Y)1r 1 '110 �. itil./ / 9-/i -11 /
Quad No: i TUBE OF PERSON CONSTRUCTING TI-E WELL OATS
Submit w.Inn:I Division of Wafer Guailty,Grossilwaber Secen wiith)n 3?day'S
Serial No. i ndwate'Section GA-1 REV.1291
-
Ashev_ile Regigna,19ffice

244396
WELL CONSTRUCTION RECORD
North Carolina-Department of Environment and Natural Resources- Division of Water Quality-Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAME (print) O ID � ) -624. CERTIFICATION# 7// !'
/ b
WELL CONTRACTOR COMPANY NAME (irk?P I-t.L. r c . lit)/ 4 UI%41. ..14-, - PHONE # en /d Y'b -31 9 t'
STATE WELL CONSTRUCTION PERMIT# / �' ASSOCIATED WQ PERMIT#
(if applicable) \ (if applicable)
I. WELL USE(Check Applicable Box): Residential Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring ❑ Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION: Topographic/Land setting
Nea1Town: y&i //'. County .JocEt DRidge II�Slope OValley ❑Flat
�.- L 4-1- 4-, (check appropriate box)
(Street Name,Numbers,Community,Subdivis4n,Lot No..Zip Code) Latitude/longitude of well location
3. OWNER: / .>7 Ardi�_-,-�// F (decrees minwesiscconds)
Address /7 /7- /3 3 Co Latitude/longitude source:❑GPS❑Topographic map
722.. (Street or Route No.) �7 (check box)
G/,rn1441, j/,i/ ..? up / ��L' DEPTH DRILLING LOG
City✓fawn State Zip Code From To Formt ti n Description
( )- D 45 '
Area code-Phone number ,-/i I /, '5V
4. DATE DRILLED 7• Q4-e9 / c
5. TOTAL DEPTH: /51.6-r _0 o
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO d p 9__
7. STATIC WATER LEVEL Below Top of Casing: 446 FT. r .I ,rn
n ?-C
(Use"V'if Above Top of Casing) „r
8. TOP OF CASING 1S I FT. Above Land Surface* $f'i
*Top of casing terminated at/or below land surface requires a :+C
variance In accordance with ISA NCAC 2C.0118. I '�
9. YIELD (gpm): , /D METHOD OF TEST c 2 /1r5 � s xi
10. WATER ZONES(depth): /.?5 1 - JCS e p r Cl m'
LOCATION SKETCH 2
11. DISINFECTION: Type I-I T-I Amount a5 Show direction and distance in miles from af'1'eastzo
12. CASING: Wall Thickness two State Roads or County Roads. Include the road
Depth Diameter or Weight/Ft. Material numbers and common road names.
From iD To 41.5 Ft. Z) 11 Piie.
From To Ft.
From To Ft.
13. GROUT: Depth A Material L 1Method
From /9 To V D Ft./ m D / L p
From To Ft.
14. SCREEN: Depth .Diameter Slot Size Material
From To Ft. in. in.
From to . r- Ft in. --.\, in.
15. SAND/Qi s[CL'RAM , 1
•
-rt, I Depth Size 7 Material
From _To Ft.
From To_ Ft
rr,
16. REMARKS,
t �r 1i0?J
I DO HER4, BY CERTIFY SIEF I/HfS WELrLTF✓AS CONSTRUCTED IN ACCORDANCE WITH I 5A NCAC 2C,WELL
CONSTRUCTION STANDARDS,AND THAT A COPY OF THIS CORD HAS BEEN PROVIDED TO THE WELL OWNER
Yam- J, ./8ht_d-... /a - 7 - 0 /
SIGNATURE OF PERSON CONSTRUCTING TIIE WELL DATE
Submit the original to the Division of Water Quality,Groundwater Section, 1636 Mail Service Center-Raleigh,NC
27699-1636 Phone No.[phone],within 30 days. GW-I REV. 07/2001

North Carolina•Department of Environment and Natural Resources•Division of Water Quality•Groundwater Section
234 4 G7
1636 Mail Service Center•Raleigh,N.C.27699-1636-Phone[phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR: 6rCr '•11'n5 • lcQ-n 14 AtAiri
WELL CONTRACTOR CERTIFICATION#: 3D`f
STATE WELL CONSTRUCTION PERMIT#: /4/4 9
1. WELL USE(Check Applicable Box): Residential$. Municipal ❑ Industrial❑ Agricultural❑ Monitoring ❑
Recovery❑ Heat Pump Water Injection ❑ Other ❑ If Other, Ust Use:
2. WELL LOCATION: Show sketch of ttle to on below)
Near Town: O lip f k tr �lif County: (1r /JOn
u .QQLoacd rrrti -�- Iidett *1 I
(Road Name and kltmbers.Communnbdlvision and Lot
No.)) DRILLING LOG DEPTH
3. OWNER ....-a/'r.Q l � A....LQi+'"`...c' r" From To /mil r Formation Description.
Address Q
et
ty t or • o R 00.981761 /l e7 ' /.0 O' "Mn/,.t.,
�4r�a1,1
City or T state f ) yD Code
4. DATE DRILLED 6 '2 2 -0 i
5. TOTAL DEPTH f DSO
6. CUTTINGS COLLECTED YES 0 NO%)
7. DOES WELL REPLACE EXISTING WELL? YES ❑ NO54
8. STATIC WATER LEVEL Below Top of Casing: co FT.
(Use'+'0 Above Top of Casing)
9. TOP OF CASING IS FT.Above Land Surface'
'Top of casing terminated at/or below land surface requires a variance In actor•
dance with 15A NCAC 2C.011e I
10. YIELD(gpm): -2 METHOD OF TEST fa Pt rS
11. WATER ZONES(depth): a at) '
12. CHLORINATION: Type H T id Amount / g i II additional spice is needed use back cf form
13. CASING: o
LOCATION SKETCH co _c
Wall Tniduxss
Depth , i n Damraer cv WewighVR Material (Show drection and distance trm at least two State a__,
From D To i i g- Ft. G f"- Roads,or other mac referaxe points) r c r,
From To Ft. w o f
From To Ft.
--co m^
14. GROUT: y ^n
Depth Material Method
=
C.L YV7? i �? N m
From To a D Ft. cn -".
From To Ft. 'v o
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 1Sti NCAC 2:,WELL
CON STRUC a 'Fie OF THIS RECORD HAS BEEN PRO,[IDED TO THE r/ELIL OWNER.
1RWEIGIF 'II W E , 4 /�,�u r C�3�J 7./° �D/
FOR OFFICE 1 : e ' ).l �p
Ouad No: I SIGNATURE OF PERSON CONSIRU TrE WELL DATE
<I ' '`rn 17 Submit teginas to D.vron d water Quoity.ante waver Seam wtithln 97 days GSMREv.1279
Serial No.

2344G-6
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: )8A_ens 0h1DS thin it �4 , Ltes
WELL CONTRACTOR CERTIFICATION #: D 4
STATE WELL CONSTRUCTION PERMIT#: ri -4) 2a
1. WELL USE(Check Applicable Box): Residential Municipal❑ Industrial❑ Agricultural❑ Monitoring ❑
Recovery❑ Heat Pump Water Injection 0 Other ❑ If Other, List Use:
2. WELL LOCATION: (Sh w sketch of the to a ion below)
Neareflown: C 1 L / t. County Na-�d [0O6a •
-�
(Road Name and ers.Communitll or bdivisron and Lot No.) DRILLING LOG DEPTH
3. OWNER /i_Ai mil'O.U-P ht.l7 Fromro To sii 7 FomwGm•es`—iptlor
Address Q t g C p r f
`� Mgt: i8 75/ s* r WSJ r S/) M L
4]4'V C quote Zpp� .
Oily wn
4. DATE DRILLED Lo"/.x - 2/
5. TOTAL DEPTH _i 1?5 '
6. CUTTINGS COLLECTED YES❑ NOM-
7. DOES WELL REPLACE EXISTING WELL? YES O NO1911.
8. STATIC WATER LEVEL Below Top of Casing: . ,af) FT.
(Use':9 Abode Top of Casing)
9. TOP OF CASING IS FT.Above Land Surface'
'Top of casing terminated aVor below land surface requires a variance In accor-
dance with 15A NCAC 2C.011e
10. YIELD(gpm): /pu &METHOD OF TEST rQ lnr5 •
11. WATER ZONES (depth): opt -- jIbtp nn
O
12. CHLORINATION: Type H 1-4-1 Amount '7 j If additicnal space is needed use bead Ionm
13. CASING:
LOCATION SKETCH
Wall Wall Tniduness
n Depth 5`/ Diafna{er cv Wa'ghVR. M.�.e0/1 (Show direction and distance from at feast biro State
From 7! To Ft. (p r„ ' Roads,or other map refererce points)
From To Ft.
From To Ft.
14. GROUT: o o
Depth Materal M L cT
From 0 To a6 Ft. r f) �From
cT
From To Ft. —
15. SCREEN: cc-
coc-
Depth Diameter Slot Size Material to
r~"o
From _To_Ft _ in. _ in. ry �=
From —_To—Ft— in. — in. r.. y
ma
From _To_Fs. in. — in. Ni o
16. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To .Ft.
17. REMARKS:
I DO HEREBY CURTIF'Y.TkikT"[MS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C.WELL
CONSTRUC'@ql STANNiRgS,iN?ri(ltf kAT A COP'R OF THIS FiEC HAS BEEN PROV}OB�TO THE rlEt.!!OW'hER.
I , , ) /, ./) 7_,e, :d /
FOR OFFICE U9EI=ONLY ; "�' A 0 p'"�-i
' . S GNATURE OF PERSON OONSTRUCT1ING TIC WE'1 DATE
Quad No: `J,1r
{� gul>EIna[b Dnaldn N Water Quality.Gro,ndwatar Seam wiithin 33 days GK•I REV.12?9
Serial No. 7
i

North Carolina•Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section
O 9 A 4 r 0
1636 Mail Service Center•Raleigh,N.C.27699.1636-Phone[phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR: lW-J AAA . Latitit A4`^",• '4"'"
WELL CONTRACTOR CERTIFICATION p: JD/it/
STATE WELL CONSTRUCTION PERMITS: -/-544ar
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: Sh sketch of the to a'on below) U /
Nearest Town: a2 �t ) County: /-)A /-[.)c4 DA
(Road Name and Numbers.Con ay//munity.or Subdl • - a Lot No.) DRILLING LOG DEPTH
3. OWNER L-/idi/i4.Jr From To Fcrmalm Des.—ipti .
Address D 61/2/ 6 9/ '
trout or pit 0. ,3
'q 7 7J�7-..�/
cd
City or T / State Zip Code
4. DATE DRILLED 6 -6 -6/
5. TOTAL DEPTH 32)5 ' .
6. CUTTINGS COLLECTED YES❑ NO®
7. DOES WELL REPLACE EXISTING WELL? YES E NOTEI
8. STATIC WATER LEVEL Below Top of Casing: A/D FT. -
(Use'+'U Above Top of Casing)
9. TOP OF CASING IS FT.Above Land Surface*
'Top of casing terminated atior below land surface requires a variance In accor-
dance with 1SA NCAC 2C.9111
10. YIELD(gpm): It METHOD OF TEST
11. WATER ZONES (depth): /Ds ' " 'IAprn tre
...7 BD ' - Ln 00rA p rv-12. CHLORINATION: Type I--I- N Ar&wunt 3_/D If additional space is needed use back el fors
13. CASING:
LOCATION SKETCH
Wall Tniauxss
A Depth Diameter a Weight'R Material (Show deectfon and distance fran at least two State
From F/ To 7 Ft. (D AAU S71-44.) Roads,or other map reference points) cs
From To Ft. o c'
0From To Ft. c _;rn
14. GROUT: r c -'
Depth Material Method a:::
l n,vn.t k ' top w
From To �� Ft. -t7 n�
From To Ft. s c
m
15. SCREEN: N N Cn y
Depth Diameter Slot Size Material tit
From To Ft in. _ in to o
From To R. in. in. -
From To_Ft.— in. in.
16. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
17. REMARKS:
I DO HEREBY C`a EWAS STRUCTED IN ACCORDANCE WITH 154 NCAC 2',WELL
CONSTRUCTIO 11 S • T T11/4C5 d OF THIS FIE HAS BEEN PF.rOV .to - O THE WELL OWNER. d D /
FOR OFFICE US PLY, ` t� DATE
Quad Ho: ';rl' 1 I Tr `` p.StIGNATURE OF PERSON CONST UC11tN0 T JELL
Submit(rfglnar.to Denton of Water 0uality.Grartlwatrer Seam wlithln 3?day'S
Gw-I REV.12]S
tart 1w ttr Sect-9

North Carolina•Department of Environment and Natural Resources•Division of Water Quality-Groundwater Section 2 3 62 09
9
1636 Mail Service Center•Raleigh,N.C.27699-1636-Phone[phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR: ,C_7AWit AL.' 2 V f'"..79,
WELL CONTRACTOR CERTIFICATION#: ..7 it/9
STATE WELL CONSTRUCTION PERMIT#: ifd-SL.
1. WELL USE(Check Applicable Box): ResidentiallZ Municipal Cl Industrial❑ Agricultural❑ Monitoring Cl
Recovery❑ Heat Pump Water Injection ❑ Other E If Other, List Use:
2. WELL LOCATION: (S o sketch of the Ipcation below) /
Nearest�� Town" �.0l��r//.t' County. , J'/L//LJO D ct
.-1 ,07111irr't R I r&1�(p . 7ld
(Road Name and Numbers,Commudiry.or Subdi ' and Lot No.) DRILLING LOG DEPTH
3. OWNER I /70YY1lcO/) N h AJ L From To Foma a Destiption
Address py� /°'��_ �y L. 4 312 r Au�
/D Gl /` tree orA �No.) P r,7
? LS 4- `3 7 ' 2 45 r .�/v4 n-v_Ct--
City or Town ' State 0 Zip Code •
4. DATE DRILLED Lo -iq -D
5. TOTAL DEPTH 445" '
6. CUTTINGS COLLECTED YES❑ NO
7. DOES WELL REPLACE EXISTING WELL? YES ❑ NO®
8. STATIC WATER LEVEL Below Top of Casing: $n FT.
(Use'+' Above Top of Casing)
9. TOP OF CASING IS I a FT.Above Land Surface
'Top of casing terminated atlor below land surface requires a variance In accor-
dance with 15A NCAC 2C.011a
10. YIELD(gpm): gob METHOD OF TEST - hrs -
11. WATER ZONES(depth): a•25 ' - /5 if rn
a45 ' - 5 epm
12. CHLORINATION: Type PM Amount zri 3 If additicstal space is needed use back cl form
13. CASING:
LOCATION SKETCH
Wall-Thickness
Depth Diameaar or Weight/FL material (Show daection and distance fern at least two State
From To 7 Ft. 6 rr PV! Roads,or other mac reference points)
From To Ft.
From To Ft.
-
14. GROUT:
nn Depth Material Method
From G� To fin Ft. Uo.4- 4 +D
From To Ft. CD n
15. SCREEN: b `92n
Depth Diameter Slot Size Materal C =
From _To_Ft _ in. _ in. i E
From To Ft in. in.
From _To_Ft-____. in. — in. rt A El,
^
rn
16. SAND/GRAVEL PACK: ao
Depth Size Material m a
IV
From To Ft. `D o
From To .Ft.
17. REMARKS:
I DO HEREBY CERTIFY.THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH'MA NCAC 2:,WELL
CONSTRUCTION STANDARDS,AND THAT A COPY FINIS P57D HAS BEEN PROVIDE THE NNEL:L OwtER.
FOR OFFICE USE ONLY 4 JJA`e o `
Quad No: SIGNATURE OF PERSON CONSTRUCTING TrE WELL DATt
ff ubrntt wginar to DNabn of water quality.Chostidwaber Seccn within 37 days
- GK-I REV.1271
Serial No.

236212
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: klun13 £ • id-A-Al v tjnc
WELL CONTRACTOR CERTIFICATION it: 3D 41/
STATE WELL CONSTRUCTION PERMIT#: -i//-2_
1. WELL USE(Check Applicable Box): Residential l2- Municipal ❑ Industrial❑ Agricultural❑ Monitoring ❑
Recovery❑ Heat Pump Water Injection ❑ Other ❑ If Other, Ust Use:
2. WELL LOCATION:(Sow sketch of the location below) I
Nearest,Tpwn: /,ize—e ,.o.dal, lit- County: - -ed/.c)0nrA
(Road Name and d Nurrders.Community.or Subdivision and Lot No.) DRILLING LOG DEPTH
3. OWNER z) M �/ ecit
From To Formation Description
Address 5.1sit i vtr /'"v k. ✓r l l Jr . /) an' 1 ��41
(Street or Houle No.) ,9U i '
7/Y//7 ' - �Gf ri
,ii/, 4u1/ec-l-,lie. rt .3.zd> -2-
City or Town) ' State Zp Code •
4. DATE DRILLED (o -.2'/-D /
5. TOTAL DEPTH 440 '
6. CUTTINGS COLLECTED YES❑ NO®
7. DOES WELL REPLACE EXISTING WELL? YES ❑ NO®
8. STATIC WATER LEVEL Below Top of Casing: /p FT.
(Use'+'a Above Top of Casing)
9. TOP OF CASING IS I FT.Above Land Surface'
Top of casing terminated at/or below land surface requires a variance In accor-
dance with 1SA NCAC 2C.0118
10. YIELD(gpm): `/O METHOD OF TEST 2 I.r
11. WATER ZONES (depth): /n 5 r - 917 m e?a5" - 9??fn.
4/a/ a31rm
12. CHLORINATION: Type J4T aAmount W a If additional spare is needed use basic o(lor:ot
13. CASING:
Wall ihidmess LOCATION SKETCH
Depth Dian)eder cv W.ghVR dal (Show diction and distance fro n at feast two State
From /) To ./r? Ft. �� PV( Roads,or other map'tierce points)
From To Ft.
From To Ft.
14. GROUT:
0
Depth Material Method - O
From alb� Ft. !n n v /0 a
From To Ft C 5•T1
c" c• ;
15. SCREEN: 1 -6 7--
Depth Diameter Slot Size Material al =r-,
From _To_Ft in. _ in. s>•
From To—Ft.— in. in. p "
CD (t-ni a
From To_Ft-______ in. — in. 0
16. SAND/GRAVEL PACK: N --,
o
Depth Size Material =
From To Ft.
From To Ft.
17. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 1.M. NCAC 2',WELL
CONSTRUCTION STANDARDS,ANFfiTrIAT ACOP•f OF THIS RECORD HAS BEEN PEIOVIDc THE WELL OWTER.
FOR OFFICE USE ONLY
yvi ,bite ts ) de-/-4 /
Quad No: SIGNATURE OF PERSON CONSTRUCTINGDATi£
• Submit mglnar to Dnakfn at Water Quality.Grosclwaber Seams witthln 97 days
Sedal No. Gts'•1 Rett 12r

North Carolina•Department of Environment and Natural Resources-Division of Water(Duality•Groundwater Section rj ° 6 2 0 7
1636 Mail Service Center-Raleigh,N.C.27699-1636-Phone[phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR: E.loo.n. (0^ `e) ,/' 71,...Q
WELL CONTRACTOR CERTIFICATION #: a /a
STATE WELL CONSTRUCTION PERMIT#: 7�D�
1. WELL USE(Check Applicable Box): Residential la/ Municipal 0 Industrial❑ Agricultural❑ Monitoring ❑
Recovery❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:e
2. WELL LOCATION:(Show sketch of the location below) �/ �nncC
Nearest Town: [/) -1ne<vt//P County.
Lad/ R/ lelDRILLING LOG DEPTH
-
(Road and Nu Cammunty-., it i�c^sa^ Lot No.) FormaUm Description
3. OWNER /1 n,'/7/ From To
Address ega i i Rr i -Pr/ • 4 /oil r
f ( treetp,,Hoot. 0. /�'41 r q ii i �'"G`�'-� �>
li
City or Tq n Stahl Zp Code
•
4. DATE DRILLED 4' -.26 -6 I
5. TOTAL DEPTH 345- '
6. CUTTINGS COLLECTED YES❑ NO[✓(
7. DOES WELL REPLACE EXISTING WELL? YES ❑ NOR'
8. STATIC WATER LEVEL Below Top of Casing: /DD 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 1SA NCAC 2C.0115
10. YIELD(gpm): 12�METHOD OF TEST a )n r5 "
11. WATER ZONES(depth): 3.i5 r - 1.131) pY'"
12. CHLORINATION: Type A 7-14 Amount L0 3 If additional space is needed use back cf tor=
13. CASING:
LOCATION SKETCH
Wall Thickness
Depth ./ Diameter a We ight/A Material (Show erection and distance iran at kart two State
From D To /D it Ft. i= -P VC- Roads,or other map referecce points)
From To Ft.
From To Ft.
14. GROUT:
Depth Material Method _ z
From D To 20 Ft. C_b f AL — �^
From To Ft. -'c g^
15. SCREEN: c) -'
I
Depth Diameter Slot Size Material ._
-
From —To—Ft _ in. in. ='+`
From —To___Ft_ in. — in. R4
N mI
From _To_Ft..— in. — in. n
16. SAND/GRAVEL PACK: IV� —o'
Depth Size Material z
From To Ft.
From To Ft.
17. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2:,WELL
CONSTRUCTION STANDARDS,AND THAT A COPY OF THIS RECORD HIS BEEN PROVI THE WELL OWNER.
�it ens L- g. -,0 /
FOR OFFICE USE ONLY �NATUREOF PERSON CONSTRUCTING TYEWELL - DATA
Quad No:
SubmittnplrWt to Dwalon ofwtdera,ality.GrandwatkBr Seamwiithin Sr aye Cat.,REV.flee
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] 236200
WELL CONSTRUCTION RECORD WELL CONTRACTOR: IL-/Aneti+t £4 ' CLI/ c t -.'y', J->w.
WELL CONTRACTOR CERTIFICATION#: a1//9
/STATE WELL CONSTRUCTION PERMIT#: /;40 --71. WELL USE(Check Applicable Box): Residential L� Municipal ❑ Industrial❑ Agricultural 0 Monitoring❑
Recovery❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATION:(Show sketch of the location below) 7 p
Nearest Town: `�-l/ // //t- County. i`vag/-JtaO
Y(1/4}44,24.. a tu.
(Road Name and Nu .Community.or Subdl ' annLnl o.) DRILLING LOG DEPTH
3. OWNER /Ii i2 wnt .e'-w ✓-1!N'1Lir-) From To FormaticnDDe_s:Moton
Address as0 (, n k-iij-Pl ,l A) 95 r "i,
‘ J ( treat Houldr7 L ,217 O, SS I to OS ' .L�I
/ILO iLvna�i/
City or Tyro State Zp Code '
4. DATE DRILLED 4 -a,2 -D
5. TOTAL DEPTH /n 05'
6. CUTTINGS COLLECTED YES❑ NO2/
7. DOES WELL REPLACE EXISTING WELL? YES ❑ NOD/
B. STATIC WATER LEVEL Below Top of Casing: /A O FT.
(Use':II Above Top of Casing)
9. TOP OF CASING IS I FT.Above Land Surface'
Top of casing terminated at/or below land audios requires a variance In accor-
dance with 15A NCAC 2C.9111
10. YIELD(gpm): / 2- METHOD OF TEST )'1rs •
11. WATER ZONES (depth): 4IDD ` / a cd/ r"'
12. CHLORINATION: Type }'"(r 1-/ Amount i D q It additicnal space is needed use back cf tor:at
13. CASING:
LOCATION SKETCH
Wall Trickness
Depth Diameter er Weight/FL Ma serial (Show erection and distance frm at least two State
From To Ft. &o .l Roads,or other map referrxmxe points)
From To Ft.
From To FL o
14. GROUT: ID
Depth Material Method y. L?=
�+
From /) To -20 Ft. ( Pnn.e.A4Z41771a ter'
0 c
From To Ft. I Q Ert=
1 5r--
15. SCREEN: o
Depth Diameter Slot Size Material = rn
—
From To Ft — in. in. m miry
From _To_Ft._ in. in. N 0
From . To_Ft.— in. — in in o_
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 1!A NCAC 2V,WELL
CONSTRUCTION STANDARDS.ANO THAT A COP(OF THIS RECORD Has BEEN PRO TO THE r/EUL OwnER.
FOR OFFICE USE ONLY /IJ �it,L.l�t- 2 J/- 0 I
Quad No: SIGNATURE OF PERSON CONSTRUCTING TtE WELL OATS
Submit ovine!'to tAsvfon or water°ualay.Gro,rawater Sean,witthln 37 days
Serial No. cs-1 R .V.12.l1

North Carolina•Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section 2 3 f) 1 9 9
1636 Mail Service Center-Raleigh,N.C.27699-1636-Phone[phone] n J
WELL CONSTRUCTION RECORD WELL CONTRACTOR: ,C I A 6o t e . le)-al " I`�
WELL CONTRACTOR CERTIFICATION #: 01.7 ?S
STATE WELL CONSTRUCTION PERMIT#: /'AG.:L
1. WELL USE(Check Applicable Box): Residential /Municipal ❑ Industrial❑ Agricultural❑ Monitoring Cl
Recovery❑ Heat Pump Water Injection ❑ Other D If Other, Ust Use:
2. WELL LOCATION: ( ( +`Sho sketch f the location below) N
Nearest] wn: w County. / 72.-e f LJorr rk
V )C'5�1tth.O. 7 / ti' ,/T/Y .
(Road Nameand Number!, or Subdivision ad Lot No.) DRILLING LOG DEPTH
3. OWNER L/V'7Ji'r . le• ti -/�Vr M RiG,�J`"" p't- From To Fonnati,�+DpStiptior•Address a p S/ Anlf 44 -- U-se,/ . /) /Uqi rI/Y� (ste �, o2P 9G /D9 ' a 2S ' AU/1 -�-
awed �f`City Town i state re Code •
4. DATE DRILLED G -.29 -‘) / -
5. TOTAL DEPTH 325 ' .
6. CUTTINGS COLLECTED YES❑ NO[ "
7. DOES WELL REPLACE EXISTING WELL? YES
/> NOd
8. STATIC WATER LEVEL Below Top of Casing: FT.
(Use• ' Above Top of Casing)
9. TOP OF CASING IS 1 + 0 FT.Above Land Surface'
'Top of casing terminated at/or below land surface requires a variance In accor-
dance with 16A NCAC 2C.011e 1
10. YIELD(gpm): a'D t METHOD OF TEST , hr5 -
11. WATERZONES(depth): 3DD ' - 5t t pm
12. CHLORINATION: Type /4/ N Amount In P It additicnal space is needed use back ci lora
13. CASING:
LOCATION SKETCH
Wall TriOness
Depth Diamaoer CC Weighing. nal (Show direction and distance tra at least two Stale
From 6 To hi 1 Ft. to " x'�Pc Roads,or other map retererce points)
From To Ft. o
From To Ft. z" '?
14. GROUT: S `_,t
Depth Material Method I `_
From D To .9D FL CErytt,,,.- +err
From To FL - r F.
15. SCREEN: co m
Depth Diameter Slot Size Material No -,
From _To_Ft in. — in. NO o
From To_Ft. in. in.
From _To_Ft.— in. — in.
16. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
17. REMARKS:
I DO HEREBY CERTIFY THAI.T'4SWE'LL WAS CONSTRUCTED IN ACCORDANCE WITH'OA NCAC 2',WELL
CONSTRUCTION STANOAROS,lAND THAT A COPY OF THIS FIE 4S BEEN PPtOVI THE?/EL:L OWNER.
FOR OFFICE USE ONLY - //). " ' /`l.Q"VA',P 8 -/_6 /
Quad No: SIGNATURE OF PERSON CONSTRUCTIING TrE W OATS
Submit region to Dwlon of Water Quality.Gross/water Seam within 37 days
Gat•I REV.1211
Serial No.

239038
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] Q��/
aft
WELL CONSTRUCTION RECORD WELL CONTRACTOR: sarrim i64.1-d . 4/pie Oat
WELL CONTRACTOR CERTIFICATION #: ..7 Af/8
STATE WELL CONSTRUCTION PERMIT#: 14-: r
1. WELL USE(Check Applicable Box): Residential[Z.' Municipal ❑ Industrial 0 Agricultural❑ Monitoring ❑
Recovery❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATION: ( ho sketch of the 1 anon below) 1
Hearn:—/GS .4- County: /fie>i7(.11
(Road Name wig Numbefs,Commur 5/uh/divison and Lit No..))� DRILLING LOG DEPTH
3. OWNER !��}n� 4f tI.h4-ken , ` /c/bes...SC From To Fomubm Des..-ipUon
Address P p /j,«x s-2, O 7 15 ,5
(7u�yrRouaNLt d i? SSS� '7&
Yiv iv ; 41.1 7c
City or wn State Zip Code
4. DATE DRILLED to -/V-z' /
5. TOTAL DEPTH /700
6. CUTTINGS COLLECTED YES El NOR(
7. DOES WELL REPLACE EXISTING WELL? YES n NOf
B. STATIC WATER LEVEL Below Top of Casing: ,2,00 FT.
(Use'.'it Above Top of Casing)
9. TOP OF CASING IS 1 FT.Above Land Surface'
Top of casing terminated ator below land surface requires a variance In accor-
dance with 15A NCAC 2C.0113
10. YIELD(gpm): — METHOD OF TEST rtP Arc -
11. WATER ZONES(depth): JCS
3 r - Q f'rn
12. CHLORINATION: Type H TN Amount /n A II additional space is needed use back ci for-at
13. CASING:
Will Tr/No-less
SKETCH
Depth �' r"�per- Diameter Cr Wacht/FL vial (Show erection and distance frvrn at least two State
From /9 To K3 Ft. to r/ ( Roads,or other map reference points) cp
From To Ft. C o
From To Ft. y
14. GROUT: -12rri ccr":
I� Depth /. Material •
Method — o-
From (+ To ID FL 1 no
From To Ft. _ �o
15. SCREEN: a m
rn
ma
Depth Diameter Slot Size Material y
From To Ft in. in. o
From _To_Ft. in. — in
From , To_Ft._ in. _ in.
16. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
17. REMARKS:
F FiC-Ti T'KadLdU Ua
I DO HEREBY •� � I t "- �e++ STRUCTED IN ACCORDANCE WITH tSl NGAC 2',WELL
CONSTRUCTIa - I.NDAROS,AND THAT A NF•r OF77THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
FOR OFFICE U- LY J. te./• /</r1J1'r. C9-//-e/ /
Quad No: 9 S: NATURE OF PERSON CONSTRUCTING ThE Vial. OAT
$Jtirre 1rl+glnat S33,,'_�,Don of Water Duality.Grant«aber Sears within 53 day
Serial No. .. GK-I ROW. 1221

>_.
• - n408T8
WELL CONSTRUCTION RECORD
North Carolina-Department of Environment and Natural Resources-Diviiss,i n of Water Quality-Groundwater Section /
WELL CONTRACTOR(INDIVIDUAL)NAME (print) //l"1 Cat Ca t /':n//t-Cl-C�� Jr."- CERTIFICATION 3_1)`./
WELL CONTRACTOR COMPANY NAME ( )-nop- t /.(7 rJos. /e/1�/ r �it<'t+y't PHONE q (g,2� /III
STATE WELL CONSTRUCTION PERMIT# 1 9 Z ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE(Check Applicable Box): Residential la---Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection❑ Other❑ I['Other, List Use
2. WELL LOCATION; f Topographic/Land setting
Nearest Town: laid/ntS{ t.�� County - Je'+Ol� DRidge &Slope ❑Valley ❑Flat
/-t)_ f A-I{ _h..i 0a] (check appropriate box)
(Street Name,Numbers,Comreunity,Subdivision,Lot No.,Zip Code) Latitude/longitude of well location
3. OWNER: £11) 17L/Y/P LA) intt-t) C V /4.�/�" (degrees/minutes/seconds)
Address .2�R P1 se m L. ,.l)r • 1 Latitude/longitude source:❑GPS❑Topographic map
n (Street or Route No.)`JJ (check box)
C_ ct 4 -c.e"--- ) A/C ,. R`7 1 o DEPTH DRILLING LOG
City or Town State Zip Code From To Formation,Description
(Y ! )- ( 4 - R99O a ac>' C-Qe-4-1
Area codc-Phone number )f. 3 L1-j' vt A I-t -
4. DATE DRILLED to - / I - C) / U
5. TOTAL DEPTH: 3 45 '
•
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO V
7. STATIC WATER LEVEL Below Top of Casing: 4b FT.
(Use"+"if Above Top of Casing) -
8. TOP OF CASING IS � FT. Above Land Surface* 0 c
*Top of casing terminated at/or below land surface requires a t. �
variance In accordance with 15A NCAC 2C.0118. �/tt /I n Gn
9. YIELD (gpm): g METHOD OF TEST eaZ /-I r,s • ?m
10. WATER ZONES(depth): a 5 ' - �-d - -2 p t-n. m—
/06 ' - 8c\ LOCATION SKETCH Ob yo
11. DISINFECTION:Type 1-/Tt-1 Amdant 1„3 Show direction and distance in miles from atittast mo
12. CASING: Wall Thickness two State Roads or County Roads. Include t tEroaCz
Depth Diameter or Weight/Ft. Material numbers and common road names. C - em"1�
From rn To in) FL tr 'I P )VC rO, '-'
From To Ft. O z
From To Ft.
13. GROUT: Depth Material Method
From n To can Ft. Pea,....," /. p
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
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:
1-'291'L"CAY CC'TWFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C,WELL
[11 CT1S:R T N DS,AND THAT A COPY OF T CORD HAS BEEN PROVIDED TO THE WELL OWNER
/A P-0.at i_ v?"� A° "3 --to /
-- SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the orie nal t the Division of Water Quality,Groundwater Section, 1636 Mail Service Center-Raleigh,NC
' 'ro119d59 -104.'4P.hone No. 19)733-3221,within 30 days. GW-I REV. 07/2001

232357
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] /J
WELL CONSTRUCTION RECORD WELL CONTRACTOR: Crreerle ZY/1S. i' ti, (' 14"-rni SI`e- -
WELL CONTRACTOR CERTIFICATION #: 3D SL/
�,1 STATE WELL CONSTRUCTION PERMIT#: N-',1 . -
1. WELL USE(Check Applicable Box): Residential L Municipal ❑ Industrial❑ Agricultural 0 Monitoring ❑
Recovery❑ Heat Pump Water Injection ❑ Other ❑ If Other, Ust Use:
2. WELL LOCATION: (Snrsw sketch of the I cation below) /
Nearest Too Pu P..7 / .i,) "cC County- / 2-yi, ,oes
C,�/'I fil-
_JI ni-riC✓ t.- .
(Road Name and Numbers.Community.or Subdi and Lot No.) DRILLING LOG DEPTH
`' 'tt 5mo l
3. OWNER J/P,n � p ex- From
From To Frnnatlor+0es-ipGon
Address 7" 'su t orAout No. 6 a /) .74/4 G r epAix
City or Town • State Zp Code
4. DATE DRILLED 5'// -a /
5. TOTAL DEPTH 4 G 9 r
6. CUTTINGS COLLECTED YES❑ NO®
7. DOES WELL REPLACE EXISTING WELL? YES [] NO®
8. STATIC WATER LEVEL Below Top of Casing: 4 O FT.
(Use'+'if 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 axor-
dance with 1SA NCAC 2C.0118
10. YIELD(gpm): f,s METHOD OF TEST a 1,r t .
11. WATER ZONES (depth): 42a 5 r - /o r3 f,-,-s
12. CHLORINATION: Type //Tfl Amount g7o If motional space is needed use backer for:at
13. CASING:
WallTryuu ess LOCATION SKETCH
Depth ,,// Diameter a WeighUP. " nal (Show direction and distance Iran at least two State o
From t To 't Ft. �I /�' Roads,or other map refereece points) (0 c
From To Ft. c'—
From To Ft c c'^
14. GROUT: 1 0<
Depth /! Material Method CO ��c
From 7) To Se' Ft LIP 4414 at Jr.
m
From To Ft. N=
a D m�
15. SCREEN: o
NI
Depth Diameter Slot Size Material --I 0
z
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 TI STRUCTED IN ACCORDANCE WITH 1SA NCAC 27.,WELL
CONSTRUCT' !OF THIS F.tE�HO S BEEN PROVIDE?TO THE WELL OwhER.
FOR OFFICE NLYII .pj 5 709! ' /-/Al Alma_ .� , D 7
Ouad No: NATURE OF PERSON CONSTRUCTING Tt& OAT£
Su n 'to Niacin of Water Duality,Grarcwa fer Seacn wiithln 37 day's
Sedal No. Awe Wad Section GW-I REV. 1219

North Carolina•Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section 2 3 2 3 5 6
1636 Mail Service Center.Raleigh,N.C.27699-1636-Phone[phone]
•WELL CONSTRUCTION RECORD WELL CONTRACTOR: .C/.laa- LA.�• `l�°�� RAA-'1' `1"G •
WELL CONTRACTOR CERTIFICATION #: a /g
STATE WELL CONSTRUCTION PERMIT#: -ei-•4/b.2
1. WELL USE(Check Applicable Box): Residential) Municipal❑ Industrial❑ Agricultural❑ Monitoring ❑
Aecovery❑ Heat Pump Water Injection ❑ Other ❑ If Other,List Use:
2. WELL LOCATION: (SI, w sketch doff the location below) /
Nearest Town: `-/�/JT�' i2> County: ///'%1/,,)ez,
/1Je'l-/r , ( . 140, reef
(Road Name and N 91a.Community,or Subdivision and Lot No.) DRILLING LOG DEPTH
3. OWNER ()n ned,t. I' /IJA Y/IP /� From To Formatim/Destiption
Address /iota /v!/O('- C Er . 4 /r� / ce�M
n J ( trees or �ROR .j) g'7/�o //4// /425' � 7,�.�-,afi✓
•
City or Town r State Zip Code
4. DATE DRILLED -S-I6 -II
5. TOTAL DEPTH /45'
6. CUTTINGS COLLECTED YES❑ NOal
7. DOES WELL REPLACE EXISTING WELL? YES NO®
�f 8. STATIC WATER LEVEL Below Top of Casing: p FT.
(Use':if Move Top of Casing)
9. TOP OF CASING IS I FT.Above Land Surface'
'Top of casing terminated at/or below land surface requires a variance In sctor-
•
dance with ISA NCAC 2C.0118
10. YIELD(gpm): ~ METHOD OF TEST S° Ars -
11. WATER ZONES(depth): /c? 6 v - IS I pnn
12. CHLORINATION: Type yTH Amount i B It additional spare is needed use back et fora
13. CASING:
LOCATION SKETCH
Wall Thickness
Depth ,/ Diameter a Weight/Ft Maria] (Show direction and distance tram at feast two State
From ,2 To // 1 Ft. 4 " Peer Roads,or other map refere ce points)
From To Ft.
From To Ft.
14. GROUT: o
Depth Material Method 0 0
From h To o2L6 Ft. eDe'ng-lit Frio)
c'`'
From To Ft. Z c;.;
15. SCREEN: I E"
Depth Diameter Slot Size Material CO yo
From —To—Ft — in. in = z�;
From —To Ft. in. — in• ao m cti
it
From To—Ft— in. — in.
IV -r
16. SAND/GRAVEL PACK: "1 ES
Depth Size Material
From To Ft.
From To Ft.
17. REMARKS:
I DO HEREB -R - iL �{ 7 - 7ONSTRUCT®IN ACCORDANCE WITH 1L•NCAC 27,WELL
, • izrCONSTRUG e `• 7i '"r OF THIS RECORD HAS BEEN PROVIDED
TO THE r/Eta OwnER•
FOR OFFICE iii ONLY , I , `. , //ei4a. ` e -/ n`
Quad No: l In,' • 20fl11 I $]GNA111RE OF PERSON CONSTRUCTING TIC WELL DATA
Su• nat.to Dwiston of Water Quality,Grarcwaber Seam wiithIn 3?days
_ G1t'-I REV.1211
Sadal N°' di' ter Section
lie Regional Office

North Carolina•Department of Environment and Natural Resources-Division of Water Duality•Groundwater Section 232355
1636 Mail Service Center•Raleigh,N.C.27699.1636-Phone[phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR: X✓�anv- 16''-� • /2 / 6?44 'r`-
WELL CONTRACTOR CERTIFICATION#: 30 41/
STATE WELL CONSTRUCTION PERMIT#: / Vs .2
1. WELL USE(Check Applicable Box): Residential Municipal ❑ Industrial❑ Agricultural❑ Monitoring ❑
Recovery❑ Heat Pump Water Injection ❑ Other 0 If Other,List Use:
2. WELL LOCATION: (Sh sketch of the location below)
Nearest Town: (A4'7 County: . k)/-30e)-
L 5 ni-ea, r-€r41-1 2 .
(Road Name and Numbers.cio"rnunity,or Subdixison and Lot No.) DRILLING LOG DEPTH
/3. OWNER /l ( If Ale P,l' Q From To 7 �F zption
Address) ,S-� V ES S 4t nar 4 n ,
/ ( uet lforRoute chi 8 81�
C[ /A6 ' 34s' M
nesvr .
City or Town i stars Lp Cade
4. DATE DRILLED 5-15--t y
5. TOTAL DEPTH 3 4Sr
6. CUTTINGS COLLECTED YES❑ NOjEr
7. DOES WELL REPLACE EXISTING WELL? YES ❑ NO0
8. STATIC WATER LEVEL Below Top of Casing: 410 FT.
(Use•.••if Above Top of Cuing)
9. TOP OF CASING IS I FT.Above Land Surface'
flop of casing terminated at/or below land surface requksa a variance In accor-
dance with 1SA NCAC 2C.0115
10. YIELD (gpm): 11) METHOD OF TEST a Ar4
•
11. WATER ZONES(depth): 3 20 r - 1 O v pr n
12. CHLORINATION: Type iN ri-1 Amount ,5 It additicxtal space is needed use back of lot=
13. CASING:
LOCATION SKETCH
Walt Tniykness
Depth Diameeer cr WeiighVFL Material (Show di an ec0on and distance tr at least two Scale
From To hp IP Ft.�. '— P eG Roads,or other map reference points)
From To Ft.
From To Ft.
14. GROUT:
Depth Material Method
From /2 To 4i Ft. ir' o.4t t terry)
From To Ft. c'
15. SCREEN: 0
Depth Diameter Slot Size Materal c_ '.
From _TO_Ft — in. _ in. C `,
From _To—Ft.— in. in z''
. I o.:c
co
From To_Ft-- in. _ in. n
_v c
16. SAND/GRAVEL PACK: a r"
Depth Size Material co c?
From To Ft. N
From To Ft -...i o
z
17. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2�.,WELL
CONSTRU • .Wj•P•C OF THIS IPECORD HAS BEEN PPtOVID° O THE PrEti OWNER.
11A
FOR OFFIC 7j. - ' "`1 • oAT�
Clued No: 1 rt �tGNATURE OF PERSON CONSTRUCTINGTt&WF.1
JUN I 5 LOOI 3u• f.. , nil:to Dnabn of Water Quality.Grw+Avatter Sea=wiithln 97 days GA-1 REV.12”Serial No.
^.rnundwate•SerSibn
.tie Re _ _

North Carolina•Department of Environment and Natural Resources•Division of Water Quality•Groundwater Section 2 3 2 3 51
1636 Mail Service Center•Raleigh,N.C.27699-1636-Phone[phone] l '
WELL CONSTRUCTION RECORD WELL CONTRACTOR: 4 /AOt t¢C- 4112° ldt 4.-20,
WELL CONTRACTOR CERTIFICATION #: 03 4/
STATE WELL CONSTRUCTION PERMIT#: 72-7-.2 -
1. WELL USE(Check Applicable Box): Residential- Municipal ❑ Industrial❑ Agricultural Cl Monitoring ❑
Aecovery❑ Heat Pump Water Injection ❑ Other Et If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below)Nearest Town' ( /.l�»"Inn County. A//.A/i.)19/2, /
...T/-l_lil.u,lGJ-C) %�J7 Fr EL,
(Road Name and Numb ,Community,or Sward Lol No.) DRILLING LOG DEPTH
3. OWNER l /J From To Fomut:ADescripton
Address �o o Tr . 4 ,0.3 r_,"`�
vi,//tree o�oR Mile l /na 1 4266-r ht �- -
f /�� y Jl ..2 7 3 3D
City or To /Stab Zip Code •
4. DATE DRILLED 5-14 -D 1
5. TOTAL DEPTH alb,-.5 '
6. CUTTINGS COLLECTED YES Q N0,0
7. DOES WELL REPLACE EXISTING WELL? YES ED NORI
8. STATIC WATER LEVEL Below Top of Casing: SL.a FT.
(Use':9 Above Top of Casing)
9. TOP OF CASING IS FT.Above Land Surface'
'Top of casing terminated atior below land surface requires a variance In accor-
dance with 1SA NCAC 2C.0115
10. YIELD(gpm): G'D d- METHOD OF TEST i I-, r 5
11. WATER ZONES(depth): a CP I - LP D + g p nn
12. CHLORINATION: Type 7-14 Amount 41'9 It additional space is needed use bead lost
13. CASING:
Wall Tritlmess LOCATION SKETCH
A Depth / I.-
Diameter cr Weight/R. directionR. Marial (Show direction and distance frrtl at least two State
From /' To CP FL�� I'tr Roads,or other map referecte points)
From To Ft.
From To Ft.
14. GROUT:
Depth Material 1 Method
From / . To ,2D Ft. fc.rr+ i,p
0
From To Ft. CD
15. SCREEN:
c _,
Depth Diameter Slot Size Material c off;
From _To _Ft_ in. _ in. _r"
From ___To_Ft_ in. _ in. co =_
l"
From _To_Ft._ in. _ in. a --
3 z;,i
16. SAND/GRAVEL PACK: cD u :----
Depth Size Material a
From To Ft. -a
v o
From To Ft. z
17. REMARKS:
IDO HEREBY CEPTiwruLTT 1Swc1U WAS rflNThT IN ACCOIRDMCE WIT H is'. NGAC2',WELL
CONSTRUCTION Del ,April Armor THIS RECORD HAS BEEN PROVIDt% THE WELL OW'.ER.
FOR OFFICE USE ) - g a /� Le�1 \ / /'
Quad No: 1 IN I 5 9Q TUBE OF PERSON CONSTRUCTING TI-E W��....LL DATE
JIJ mgi • )won or Water Duality,Orandwatew Seoan Within 33 days
Serial No. Gw-t REV.1255
`
Gro11Rdweter Section
Asjgi ville Reginnal Office __—

232349
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: Ilh * . 13-A--e-k pi1/2 '
WELL CONTRACTOR CERTIFICATION #: .3 D `V/
STATE WELL CONSTRUCTION PERMIT#: - s_
1. WELL USE(Check Applicable Box): Residential Municipal 0 Industrial❑ Agricultural❑ Monitoring❑
Recovery❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATION: (Sh w sketch of the location below) /
Nearest To ca�t-1<t-r✓ County. / uy/+Jnn/X
(Road Name and Nu' rs.Community.or Subdiscn and Lot No.) DRILLING LOG DEPTH
3. OWNER l'iti I174i (//C� ^r-n o41-) From To Formation Desciption
Address 4,2 �fate, Cl, e-el /7 //S �
(/vector Route Nc i/3 v t-/ j`_ ij 'J(24. i�,u mot- ?7is
City or Town ` State Zip Code •
4. DATE DRILLED S-/ -"
5. TOTAL DEPTH dos '
6. CUTTINGS COLLECTED YES❑ NOta
7. DOES WELL REPLACE EXISTING WELL? YES ❑ NO,®
8. STATIC WATER LEVEL Below Top of Casing: ,st/ FT.
(Use•..il Above Top of Casing)
9. TOP OF CASING IS / FT.Above Land Surface' - -
'Top of casing terminated atior below land surface requires a variance In actor •
-
dance with ISA NCAC 2C.01111
10. YIELD(gpm): METHOD OF TEST rl in r.S
11. WATER ZONES(depth): 3 s 5 r - a . S 1 p en
37g ' - 7 •5 even
12. CHLORINATION: Type H TFI Amount `7`' If additiccal spa a is needed use back cf fors
13. CASING: - -
Wall rnkyuness LOCATION SKETCH
Depth _ Diameder cr Wergh/R. Mxeiial (Show direction and distance fraan at least two State
From To //5 Ft. U ✓" r�
- - Roads,or other mac reference points)
From To Ft.
From To Ft.
14. GROUT: o
Depth Material Method — o
(' 0
From Z) To J4 Ft. -e.4-t '�'rP c- =�
= c`,.
From To Ft. 5:
15. SCREEN: co
T,
Depth Diameter Slot Size Material a y0
From _To Ft _ in. _ in. _ z;Fti
From ___To_Ft._ in. _ in. cn `;f5
From _To_Ft.— in. _ in. N
16. SAND/GRAVEL PACK: v i
Depth Size Material
From To El.
From To Ft.
17. REMARKS:
I DO HEREBY CERTtPV T".tT T UCTED IN ACCORDANCE WITH 154 NCAC 27.,WELL
CONSTRUCTION r`0)VS 4 f 4JAIP r THIS RECORD HAS BEEN PROVIDFA.TQTHE WELL OWNER.
FOR OFFICE USE r y4 • ,4 1,t�t- ,, - 6 a /
Quad No: i UN . 5 700I 1URE OF PERSON CONSTRUCTING TFE WELL OATS
3ubmt lit.
of water Quality.Gross/waist Seacn witthln 37 days
Serial No. Git•I REV.1221
ndwater Section
Asheville Reginna'Office_._

North Carolina-Department of Environment and Natural Resources232348
-Division of Water Quality-Groundwater Section ..
1636 Mail Service Center•Raleigh.N.C.27699.1636-Phone[phone]
•
WELL CONSTRUCTION RECORD WELL CONTRACTOR: Greene 2et5 . we I) 4 Pia'AP, a5"-
•
WELL CONTRACTOR CERTIFICATION #: 24 /3
STATE WELL CONSTRUCTION PERMIT#: /`/O-Z
1. WELL USE(Check Applicable Dos): Residential Municipal 0 Industrial❑ Agricultural❑ Monitoring❑
Recovery❑ Heat Pump Water Injection ❑ Other 0 If Other,List Use:
2. WELL LOCATION: (Shownsketch/C�1 thet location below) / r
Nearest To n: ,7 /`1'7144_*Inn �_/ County: Y/2.1iJD0001
!//0-1- o ( �Ar2tt r�9` (DRILLING LOG DEPTH
(Road Name and t mbe Commiur rY.or Sc ar/q�L/qt )
3. OWNER ( .(mil-r.-L/2ri Ge_e- From To / FormaGo+De�s=iption
Address vZ 3 (o o(�� Lo C,uS Crrp UF� i�-� . fO ,5 ��i' 0
/r�..oglayiff �/ HoDune NohC✓ -?8 7 a5 ' 3 b 5 ' �'i1an' /
City or Town Slate zip code
4. DATE DRILLED 5-3 -o /
5. TOTAL DEPTH .8/n 5 '
6. CUTTINGS COLLECTED YES❑ N0TE1_
7. DOES WELL REPLACE EXISTING WELL? YES r] NO®
8. STATIC WATER LEVEL Below Top of Casing: ?j FT.
(( (Use•:a Above Top of Cuing)
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.0116
10. YIELD(gpm): If METHOD OF TEST .- h r3
11. WATER ZONES(depth): / 75 i - I/ cAlm
o
12. CHLORINATION: Type I-T 71 Amount O 7 If addNcrtal space is needed use backer loam
13. CASING:
LOCATION SKETCH
Wall Tnckness
/1 Depth Diameter sr Wa'ghVR Ma4rial (Show direction and distance tram at least two Slate
From
4 To -1 5- Ft. 4 " Pre Roads.or other map referexe points)
From To Ft.
From To Ft.
14. GROUT: o
Depth Material } Method o c
From P To i_Ft. UP 4/' t_
From To Ft. a
c R
15. SCREEN: I r=.RI
Depth Diameter Slot Size Material GO -`r;
>-•c
From _To_Ft _ in. — in. 'T `T'--DC ter ,
From ___.To_Ft._ in. in. CO rr,,z
From _To_Ft_ in. — in. .
16. SAND/GRAVEL PACK: --.I5
z
Depth Size Material
From To Ft.
From To Ft.
17. REMARKS:
I DO HEREBY CERTI JCTED IN ACCORDANCE WITH 1SA NCAC 2:.WELL
)
CONSTRUCTION ST . D . T C if )Fits RECORD HAS BEEN PROV TO THE WELL OWNER.
FOR OFFICE USE Of OAT'
Quad No: ,JUN i 5 ?OME OF PERSON CONSTRUCTING Tr l&WE
es Submit mynas nor Water Quality.Grar+Mrateu Seam witthln 3?day's
GK-t new.1211
Serial No.
Groundwater Section
Arlie,R!?ianal Office 4"

North Carolina•Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section 2 3 2 3 1 0
1636 Mail Service Center•Raleigh.N.C.27699-1636-Phone[phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR: Greene ues. /i)e)/ t¢ Arlo/ 1/4..aitc.
WELL CONTRACTOR CERTIFICATION #: 36 Li/
STATE WELL CONSTRUCTION PERMIT#: / //' -'--
1. WELL USE(Check Applicable Box):Residential, Municipal ❑ Industrial❑ Agricultural❑ Monitoring ❑
Recovery❑ Heat Pump Water Injection ❑ Other 0 If Other,List Use:
2. WELL LOCATION:(Show sketch of the location below)
Nearest Tow • LI-4i)1 P-S. Vs lie County. ttLdOn`
(Road Name and Nu rs.Community.or SSobdivison and Lot No.) DRILLING LOG DEPTH
3. OWNER / pin in ✓ `SAP G ttn '.) From To Fo��Des-iption
Address 3 ci 6 NA.z-e1 rho o c! Ave- . /9 /D5
(gm;«RouteNo.) /4c' 3406 ' .>L1/ re !
ii 1�L(ntSVr //6_, is/<_ ,/g 1 g7
•
city Of FOYM State Zip Code
4. DATE DRILLED S-/ '7 -t i
5. TOTAL DEPTH 3 L S'
6. CUTTINGS COLLECTED YES❑ NOS
7. DOES WELL REPLACE EXISTING WELL? YES D NO®
8. STATIC WATER LEVEL Below Top of Casing: /p FT.
(Use'+'if Move 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.0115
10. YIELD(gpm): .-_ METHOD OF TEST .1 ) r s
11. WATER ZONES (depth): 34 ' - to. Ipr '
12. CHLORINATION: Type /4 7''1 Amount lP 3 If additional space is needed use back ct form
13. CASING:
LOCATION SKETCH
Vial Trickness 1��
ADepth Diameter «weighPR. N l'Ca (Show dtecdon and distance hem at least two State
From /0 To 5 Ft. "� Y l� Roads.or other map refererce points) P.
From To Ft. o c
From To Ft. n__
o C n.
14. GROUT: z cn
Depth n Material Methodmr S:=
From D v
To a D Ft. ! p n .41-t.
b m-�
From To Ft. 3 r
15. SCREEN: rho m-
Depth Diameter Slot Size Material Iv _�
From _To_Ft _ in. — in• J o
z
From _.To Ft._ in. — in•
From To_Fs._ in. — in•
16. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To .Ft.
17. REMARKS:
I DO HEREBY CE=TIPYI#Y : TF W STRUCTED IN ACCORDANCE WITH 15A NCAC 2.17,WELL
CONSTRUCTIONS OF THIS RECORD HAS BEEN PF.fOVI TO THE WELL OWNER.
•
•
FOR OFFICE USE •11•�1 x N 5 200$ „,7Chad No: PuRE OF PERSON CONS1RUCf11NGTIC WELL DATE
Submit tote/eon or waterQuality.Gro.newater Seacn wiithln 3?days Gx'1 REV.1291
Sedal No. Gr andante'Settee
♦ ,Ill.Regional Office

r
North Carolina•Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section 312
1636 Mail Service Center-Raleigh,N.C.27699-1636-Phone[phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR: "rephf 3r--5. `z4// / f c:.4,°, 1 �
WELL CONTRACTOR CERTIFICATION 4: 3/)54/
STATE WELL CONSTRUCTION PERMIT#: } --
1. WELL USE(Check Applicable Box): Residential% Municipal ❑ Industrial❑ Agricultural❑ Monitoring ❑
Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use:
2. WELL LOCATION:(§§how sketch of the location below)
Nearest Town: C/t...44..`Fffw County. /71 L2)6 OC
l.
6Ja v�a�( ( X) VP-)
(Road Name and Numders.lConinunity.or Subdivision and Lot No.) DRILLING LOG DEPTH
3. OWNER , 1 an X i) naGi , 0 4 ni)'1, eh� From To Fomwtim Des-iption -
Addrreess aJ9 Inon�e& /QwP_ . /0 9/ ' <?I.4,
(�Qi17C'��Y.r.,`sstraetorAcute o.A g /5/ 9/ 5// ' ir .�-fvi
City or Town State Zip Code •
4, DATE DRILLED 5-a/ -D /
5. TOTAL DEPTH 5// '
6. CUTTINGS COLLECTED YES❑ NOTZ o
7. DOES WELL REPLACE EXISTING WELL? YES ❑ NOX o 0
8. STATIC WATER LEVEL Below Top of Casing: /a/) FT. `-'-
(Use se"0 Above Top of Casing) a. r-
9. TOP OF CASING IS I FT.Above Land Surface' 1 0
'Top of casing terminated at/or below land surface requires a variance In senor- t.cr :—rn
dance with 16A NCAC 2C.0118 +-_,a
10. YIELD(gpm): 44 METHOD OF TEST ,Q 11 rs . rn,_
11. WATERZONES(depth): /VC'- 3 ym 7 ,C' "5L!-r w- W my'
A
12. CHLORINATION: Type >!{ n Amount V If additicctal spice is needed use bade cf lot—1 o
13. CASING:
Wall rn d ness LOCATION SKETCH
Depth Diana Cr WaghVFl Medal (Show direction and distance frm at least two State
From ICI To 9/ Ft..---6.-1 - eVC . Roads,or other map retererce points)
From To Ft.
From To Ft.
14. GROUT:
ii Depth Material Method
From e/ To ,"7D Ft. enti 1'1 P-11± 40 p
From To Ft.
15. SCREEN:
Depth Diameter Slot Size Materal
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: L
CONSTRUCTION S'TMND W LI-WA C UCTED IN ACCORDANCE WITH is; NCAC ZT,WELL
C
I HEREBY CEf'1°4uF1u 0.Z3 THIS FIE J f HAS BEEN PROVIDED TO TH " OWNER.
FOR OFFICE USE fit J. t ez4,-/' C�i 4 -/ 0 /
Quad No: JL ' 5 LUUI -�/TORE O F PERSON CONSNRUCT1ING The wEL L OAT'S
3ubcr t 'to Dw on of Water Quality,Grarcwatax Seccn within 3?days
Sedai No. SKS Gts-1 REV.1221
Asheville Rjonal Offig •

North Carolina•Department of Environment and Natural Resources-Division of Water Duality-Groundwater Section 2 3 2 3 0 9
1636 Mail Service Center-Raleigh,N.C.27699-1636-Phone[phone] //'�
WELL CONSTRUCTION RECORD WELL CONTRACTOR: &Teen- *evos . hie 11 / Pam, `ste--
WELL CONTRACTOR CERTIFICATION #: 07/"/9
STATE WELL CONSTRUCTION PERMIT#: /di. .Z'
1. WELL USE(Check Applicable Box): Residential. Municipal ❑ Industrial❑ Agricultural❑ Monitoring ❑
Recovery❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATION: S ow sketch of the location below) yy� �
Nearest Town: ((2M .->v County-. �`f/2-7/4)0/7/l
V.liSio-n -grad D7f;t oTPct/rr4 IPG1j
(Road Name and Numbers, nary,or Subdivision and Lot No.) DRILLING LOG DEPTH
3. OWNER l O m M i il/Yma.> P.YS' From To Formal Description
Address FJ �j ��[, sii ii n 477/ e �
iSireet or Route rlo) 7 r 7c'iS ' .21 �--
.L/�lz c/c a g 7zJ
City or Town / slate Tip Code •
4. DATE DRILLED S-/7 -D I
5. TOTAL DEPTH 6 .2 6 '
6. CUTTINGS COLLECTED YES❑ NOZ
7. DOES WELL REPLACE EXISTING WELL? YES ❑ NO®'
8. STATIC WATER LEVEL Below Top of Casing: cjOD FT.
(Use'+'if Above Top of Casing)
9. TOP OF CASING IS I FT.Above Land Surface'
'Top of casing terminated aVor below land surface requires a variance In actor-
dance with 15A NCAC 2C.d 1a
10. YIELD(gpm): 9- METHOD OF TEST c-', h CS •
11. WATER ZONES(depth): .3CO r " %x�pev
lnn9/15r 31 ,- irm
n
12. CHLORINATION: Type 7N Amount PS It additional space is needei use back cf form
13. CASING:
Wall Thickness LOCATION SKETCH
Depth din Diameter cc WeghVR Material m al (Show erection and distance 1r at least tao State
From 4 To 41 7 Ft. " Al/C Roads,or other map reference points)
From To Ft.
From To - Ft.
14. GROUT:
Depth A Material Method o
From (2 To -2() Ft. ( P ..&t.t "Top-) cm L
From To Ft. c— a
C o -
15. SCREEN: a -, l
Depth Diameter Slot Size Material 1 a -
From To_Ft_ in. _ in. >.�
From _To—Ft.— in. _ in. F.
o
From To_____Ft_____ in. _ in. cO rrnn
16. SAND/GRAVEL PACK: no 2
Depth Size Material `f c
From To Ft.
From To Ft.
17. REMARKS (({{���� JJ®®�f (u�
I DO HERE UCWY HA:TTHISW WELL N ONSTRUCTED IN ACCORDANCE WITH 1Ss, NCAC 2',WELL
CONSTRUC- STANDAR?S,.App,�HA• Pr OF THIS RECORD HAS BEEN PR0VI 0 THE WELL OWNER.
FOR OFFICE ONLll
Y �� J• / AJ- A vtC &O / I, /
Quad No: §IGNATLRE OF PERSON CONSTRUCTING ThE WELL OAT£
C•n tndater bm12 •to Dvslon of WaterQuality,Gro.rematier seam within 9?days
Sera:No. _-- .,din^+1.0 G1a•t REV.1271

234462
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: St- leltO1 • I 'di )4 Pt'r7"' '
WELL CONTRACTOR CERTIFICATION #: 2 5//2
STATE WELL CONSTRUCTION PERMIT#: / '/e.2-
1. WELL USE(Check Applicable Box): Residential. Municipal ❑ Industrial❑ Agricultural❑ Monitoring❑
Recovery❑ Heat Pump Water Injection ❑ Other 0 If Other, List Use:
2. WELL LOCATION: Show sketch of t}1e oc i, n below) Way
f 1. J
Nearest Town: Mal 4Jk'� County. �/C2.///34(YX
Go/ /. (� c1 -e)
(Road Name and Nun rs. nary.or iviscn and 0.) DRILLING LOG DEPTH
3. OWNER / ) rL�'`L'p/ �) ,�� From To F • estiptia, )
Address �C Y� �J J 7- AJ D /bS ' �/)zte_24-L
a, ��s�rf�°�or Roue No..,J,/�,1-, �,�' v7 / /°`> ' .3 sic' a ,vi.vii..ta'>
�.ti Ga(�f'1'OA 71-C.-� U
Cit own jar
Zip Code
4. DATE DRILLED 5"-1 4 -D
5. TOTAL DEPTH Vic' .
6. CUTTINGS COLLECTED YES 0 N04.. (-'�
7. DOES WELL REPLACE EXISTING WELL? YES 0 NOn.
8. STATIC WATER LEVEL Below Top of Casing: WO FT.
(Use-.•If Above Top of Casing)
9. TOP OF CASING IS I FT.Above Land Surface'
-
'Top of casing terminated at/or below land surface requires a variance In accor-
dance with 15A NCAC 2C.0116
10. YIELD(gpm): — METHOD OF TEST ,t hrc •
11. WATER ZONES (depth): l6 S ' - 3 t pm
32S' - a r7 4 torn
12. CHLORINATION: Type H T f"l Amount in . If additional space is needed use back cf for.T
13. CASING:
Wall
all Triclmess
Depth Diameter cr Weight/Ft. dal (Show erection and distance tram at least two State
From t To it 6-- Ft. 6 -i-.- '.� Roads,or other map reference points)
0
From To Ft. o n
From To Ft. - n7_.
14. GROUT: r c c:
Depth �1 Material A Method _ _'--
l D l n.b mil --ity p -
From � To �n Ft. f`7 -.•,
From To FL -o ��
15. SCREEN: rnrrn
Depth Diameter Slot Size Material tV t*t
From To_Ft _ in. in. cn —'
ro o
From To—Ft in. in.
From To_Ft— in. in. -
16. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
17. REMARKS:
I DO HEREBY CER j r T , E t Ti' 3 GINSTRUCTED IN ACCORDANCE WITH 1S1 NCAC 2:,WELL
CONSTRUCTION ) e 7. t P•ee OF THIS FIE OW HAS BEEN PF(OVICF THE WEL&OWNER.
f-/D , U /
FOR OFFICE USE 49 r ''` w NI' '
Quad No: c " 'SIGNATURE OF PERSON CONSTRUCTIING ItE west. DATE
Submit opine'to Dr.isfon of Water Duality.Gro ndwater Sedan!Within 37 days
Serial No. C =r - Gta.l REV.1210

- 234453
North Carolina-Department al Environment and Natural Resources-Division al Water Quality-Groundwater Section
1636 Mail Service Center-Raleigh,N.C.27699-1636-Phone[phone] ll�� �1/{J, , - ' � /11. � ' P��p
�1/ 00kt . &�JA) I- 11 / �./•"7 )
WELL CONSTRUCTION RECORD WELL CONTRACTOR: ,J
WELL CONTRACTOR CERTIFICATION #: a its g
STATE WELL CONSTRUCTION PERMIT#: /hl0-.-
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:t (Sh w sketch of the location below)
Nearest Town; 1 iYtr . l _ _County. 44.47irkeid
`Roa +e B Pizit
DEPTH
(Road Name an4Numbe , unity,or Sups/yn and Lot N/p.) �+I DRILLING LOG
3. OWNER /ki`r &)O' -Cali ' `✓ha k-' From To Fomutim DestipGan
Address4 SiL • o
( ueetoroao.) flcfZ/ fly ' 4 ' S-
citydli or T / State Zip Code
4. DATE DRILLED -S'L/ -O/
5. TOTAL DEPTH 4'4'5'
6. CUTTINGS COLLECTED YES❑ NOE( -
7. DOES WELL REPLACE EXISTING WELL? YES Q NO v
8. STATIC WATER LEVEL Below Top of Casing: 9D FT.
(Use-+'II Above Top of Casing)
9. TOP OF CASING IS I FT.Above Land Surface'
Top of casing terminated at/or below land surface requires a variance In accor-
dance with 1SA NCAC 2C.0115 in 10. YIELD(gpm): _JrZ METHOD 0FTES� Jc-Q YS
1
11. WATER ZONES(depth): SC
12. CHLORINATION: Type N 774 Amount W / If additicrlal sots is needed use backcf form
13. CASING:
LOCATION SKETCH
Wall eight/ess
Depth 0 • rWaighVR. Made] (Show direction and distance from at least two State
From iia To O 3 Ft. R C Roads,or other mac referete points)
From To Ft. o
From To Ft. o `C
14. GROUT:
c %''r-.rt.
Depth Material Method C o
m-r.k�-�-�— / r CFI
FromD To Ft. -17-pp — <
Ft. CO sr-'
From To c
15. SCREEN: s m�
Depth Diameter Slot Size Materal - IV La
From _To_ Ft _ in. — in.
From To Ft. in. in. ND o_
From _To_Ft.— in. _ in.
16. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To .Ft.
17. REMARKS: �" '4/4_
I DO HEREBY C� FY R}i4 T �CQNSTRUCTED IN ACCORDANCE WTrH 1'A !CAC 2",WELL
CONSTRUCTIOf( � Gnn,:.+5,n u inn(A 01 OF THIS JCO W HAS BEEN P TO THE WELL OW NE,ER. C)7
FOR OFFICE US4 tY :p ')ff`' }l j lr �J- ^i/LL1�s z'
Quad No:
yr'tGNAT1JRE OF PERSON CONSTRUCT11N L 0 Tr&WE DATA
I ubri Q root to Dwalon or Water Quality.Gradwate Sec=wiithln 33 days
6w-I REV, Mt,
Serial No. �f 711'2�� � _..
. .Y- a- .

- 234457
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: Slim., . /:1n$4 . 2.kii 4 rt`^'-fik-Le'
WELL CONTRACTOR CERTIFICATION if: <IV /iL/8
STATE WELL CONSTRUCTION PERMIT#: =:
1. WELL USE(Check Applicable Box): Residential E/ Municipal ❑ Industrial El Agricultural❑ Monitoring Cl
Recovery❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATION: (Sl�pw sketcp of the location below) /'
Nearest Town: Lkne County. 4-/7/Jr)/�
WGrrc—iiii
(Road Name andA umbers.Community.or Sfilivison a Lot No.) DRILLING LOG DEPTH
3. OWNER /tu tA,_tit- From To FortnaUm Destipdon
Address /1/4)3 ,3,t .n a-a., ate- 19 /n '7 '_ (14 }
(Su or Route No.) ij v (p T rj r -fig Y /uy1 , y� 078786
City own Slate Zip Code
4. DATE DRILLED 5-/S -o /
5. TOTAL DEPTH !o /5'
6. CUTTINGS COLLECTED YES❑ NO[✓7
7. DOES WELL REPLACE EXISTING WELL? YES ❑ NOR'
8. STATIC WATER LEVEL Below Top of Casing: oto FT.
(Use'+'if Above Top of Casing)
9. TOP OF CASING IS FT.Above Land Surface*
'Top of casing terminated avor below land surface requires a variance in actor-
dance with 15A NCAC 2C 11a
10. YIELD(gpm): 4'4 METHOD OFT ST tQ Firs -
11. WATER ZONES(depth): 5LP 5' //? prYI
to4..5-i - r/'f I prn
12. CHLORINATION: Type NTH Amount /7/A If additicctal space is needed use backcf form
13. CASING: -
wa1Tn dv ess LOCATION SKETCH
Depth r cr WaighVR. Maria (Show di rsn ectfon and distance t at'east two State
// r
From // To C� / Ft. Tr
PVT, Roads,or other mac reference points)
From To Ft. on
From To Ft. - o 0
14. GROUT: c_.
/1 Depth /T Material .L Method rC- oc
From _S) To JD Ft. ` k-5nn -4J 1 a p —
W fir-
From To Ft. nc
15. SCREEN: =
Depth Diameter Slot Size Materal N wr.
nw
From _To_Ft in. in. lit --4
From To Ft. in. in. N o
From To_FL in. _ in.
16. SAND/GRAVEL PACK:
Depth Size Material
From To Ft. _
From To Ft.
17. REMARKS:
I DO HEREBY Yvw Tli'St, i ry LL AS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2:,WELL
CONSTRUCTIP PP(OF THIS RECORD HAS BEEN P . vtr TO THE was O tER.
1.FOR OFFICE 4) ONL r 11 ;ep)r„ _.u�_t— \J / _/C — L (
Quad No: '.... ZIGNATURE OF PERSON CONSTRUCTING Tt-E WELL DAM
__3ubm,d mginat to Don or Water Quaky,Gan:Maw Seam)witthln 37 days
Serial No. Ciaird ate'$ t - Gal REv.12l9

240819
WELL CONSTRUCTION RECORD
North Carolina-Department of Environment and Natural Resources- Division of Water Quality-Groundwater Section/ 6
WELL CONTRACTOR(INDIVIDUAL)NAM/ES�(print)_(?!y(_/F,e . lO.p)J„ ' CERTIFICATION#.
WELL CONTRACTOR COMPANY NAME itre tut.
(((��/��, ��n7J5 41 /.0 . "/ ( PHONE I/ 612 +4��"3/7�
STATE WELL CONSTRUCTION PERMIT/4 / y- ASSOCIATED WQ PERMIT#
(if applicable) \ (if applicable)
1. WELL USE(Check Applicable Box): Residential Er/Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other❑ If Other, List Use
2. WELL LOCATION / / J Topographic/Land setting
Neares ownJ /?�I2YL'n- Countyn y/�//dsrlc�D�'(� ❑Ridge ❑Slope ❑Valley C011at
hlr.! r�21� m�'1, KCC (check appropriate box)
(Street Name,Num Community,Subdivision,Lot No.,Zip Code) Latitude/longitude of well location
•
3. OWNER: -2.4 la JL2i (degrees/minutes/seconds)
Address (/ //a It/L,t.h4 LA.-s,2- Latitude/longitude source:❑GPS❑Topographic map
/J n Street or Route No.) (check box)
Xa C v71-e- .,g 7 )- A DEPTH DRILLING LOG
(i.4
�2 ay orr wp / State /� Zip Code From To Forma o Description
`�g Y /) S/ _ �a
Area code-Phone number —
4. DATE DRILLED -.,-// -tO / S(r 6 _5 `
5. TOTAL DEPTH: (n/0 5' r
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO I/
7. STATIC WATER LEVEL Below Top of Casing: FT. a
-
(Use"+"if Above Top of Casing) C
8. TOP OF CASING IS 1 FT. Above Land Surface* ita
rail C.)
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C.0118.
9. YIELD(gpm): 3 METHOD OF TEST ,j i'.es_ Z^t
Q
10. WATER ZONES(depth): LI S / - 3 5 f5 rvt Qt sm
LOCATION SKETCH Zia —lo
11. DISINFECTION:Type ff TN Amount / an Show direction and distance in miles frorai leaspa
rn
12. CASING: Wall Thickness two State Roads or County Roads. Include r
Depth Diameter or Weight/Ft. Material numbers and common road names. N
From D To 5/+ Ft. /- " n j.',". O E
2
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From /9 To A-d) Ft. r_ ,.t,e,„�r 1 Icy
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
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: -
THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C,WELL
lid
1501 tj III i - • 'DS,AND THAT A COPY OF CORD HAS BEEN PROVIDED TO THE WELL OWNER
,j(1t�.j22 SIGNATURE OF PERS eeNSTRUCTING THE WELL DATE
i al to the Division of Water Quality,Groundwater Section, 1636 Mail Service Center-Raleigh,NC
Ashe a pp �h�a a No.((19)733-3221,within 30 days. GW-I REV.07/2001

230640
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: �{,-+rer'AD. 18nns. Y,r)e-'))
WELL CONTRACTOR CERTIFICATION #: a 4/ ' r
_ STATE WELL CONSTRUCTION PERMIT#: 4-1
1. WELL USE(check Applicable Box): Residential Lt1/Municipal ❑ Industrial❑ Agricultural❑ Monitoring❑
Recovery❑ Heat Pump Water Injection ❑ Other ❑ II Other, List Use:
2. WELL LOCATION: ( how sketch of the location below) 1
Nearest Town: 4/N> f,n County- tE/,TASifJo(r�.
(Road Name anq,bumbers,Community,or SFbdtviun/and Lot No.) DRILLING LOG DEPTH
3. OWNER '. .o //3 c 14/1 .tt)K t »S From To,r / / Fom a on Dest�ption
Address �D Weil �,� r tO !1(� 4
( treat or,NOM NO.) 1/4" /.2 3 f �i r
A S P v at A/C. c 2 b ter,
City or Town Stan/ Zp Code •
4. DATE DRILLED 4-A0-1) I
5. TOTAL DEPTH /25'
6. CUTTINGS COLLECTED YES❑ NOD/
7. DOES WELL REPLACE EXISTING WELL? YES El NO17(
8. STATIC WATER LEVEL Below Top of Casing: 4D FT.
+(use- -If Above Top of Casing)
9. TOP OF CASING IS I FT.Above Land Surface'
'Top of casing terminated atror below land surface requires a variance In accor-
dance with 1SA NCAC 2C.0118
10. YIELD(gpm): 40 METHOD OF TEST 1 r5
11. WATER ZONES (depth): ADS ' - iD lint
12. CHLORINATION: Type _ hi TH Amount c a If additiocal spry is needed use back of fora
13. CASING:
LOCATION SKETCH
Wall manes,
Depths DNameaer weghVR Maeda! (Show&action and distance tram at:least two State
From 0 To "/ sr Cr Ft. 6 " P VG Roads,or other map reterecce points)
From To Ft.
From To Ft.
14. GROUT: Method
From
TTopl°CG FL 1�.117 7- /p
From To Ft. p a
15. SCREEN: t'
Depth Diameter Slot Size Material a ati
From _To_Ft_ in. in. --c o tr,
f --t
From _To—Ft— in. — in. v wi
m
From _To_Ft.— in. _ in. o
16. SAND/GRAVEL PACK: arot
Depth Size Material W y=
From To Ft. VI
From 0 To Ft. 2
17. REMARKS: .
I DO HEREBY CERTIFY THAT TWS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2:.•WELL
CONSTRUCTION -T• t'AP:�jJ4O TFdAT ACOP`!OF THIS RE HAS BEEN PROVI THE WELL OWt'R.
t (' �t� o�r jikw-- V S- a -o /
FOR OFFICE U [-ii LY OATS
Quad No: it
I SIGNATURE OF PERSON CONSTRUCTIING TtE wE1
AA^'n 2 Ithrnit n s to Dwbbn o/WaiteOualky,Grarowatsr Seacn wtithln 37 days
Serial No. W GK-I REV.1211
r ..ate•S� e- ctl-'o 1 C d
..r A:h •'.'!f'$Ice...-,.

North Carolina•Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section
230639
1636 Mail Service Center.Raleigh,N.C.27699-1636-Phone[phone] /� ,/J
WELL CONSTRUCTION RECORD WELL CONTRACTOR: & P re „r. T. .ns. lJeil -t Pw , e- •
WELL CONTRACTOR CERTIFICATION#: a / 2
STATE WELL CONSTRUCTION PERMIT#: A '/ek2
1. WELL USE(Check Applicable Box); Residential 107 Municipal ❑ Industrial❑ Agricultural❑ Monitoring❑
Recovery❑ Heat Pump Water Injection ❑ Other ❑ If Other, Ust Use:
2. WELL LOCATION: (Show sketch of the location below) 1/)
Old,Nearest Town: nM� County. 7GL�li�c�r:XA
t /tnL
(Road Name Su
`'�� n. �ty.or vision ar Lot No.) DRILLING LOG DEPTH
3. OWNER rif--/Z, - From To FomweonDes-iption
j Address ` 2)1 / n Pi, / 1 at
r (Su etallo ( oi'), �G argva /O ' /oas, (4-ra/�t r.
City or Town Slats zip Code •
4. DATE DRILLED ire-"is _ec r
5. TOTAL DEPTH Cis"
6. CUTTINGS COLLECTED YES❑ NO ff
7. DOES WELL REPLACE EXISTING WELL? YES ❑ NO1-11
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'
lop of casing terminated etlor below land surface requires a variance In accor-
dance with 15A NCAC 2C pis
10. YIELD(gpm): __ METHOD OF TEST e ))rS .
11. WATER ZONES(depth):
12. CHLORINATION: Type H rH Amount It additional spre is needed use back ct for=
13. CASING: -
Wall Thickness
LOCATION SKETCH
l,, Depth Diameter or Wtght/Ft Material (Show*action and distance 1rcn at least two State
From To /'/t R. P`O) Roads,or other map relererce points)
From To Ft.
From To Ft.
,, 14. eROUT:
Depth Material Method O c5
From . To D Ft. /e)NI tar sup o
From To Ft. ro
y o hl
15. SCREEN:
r +rn
Depth Diameter Slot Size Material - v L
From _To_Ft _ in. _ in. -
From _To_Ft.— in. in. 3 ao
From _To_Ft.— in. _ in. w "'''m-
ry �35
16. SAND/GRAVEL PACK: r
Depth Size Material i
From To Ft.
From To Ft. _
17. REMARKS:
I DO HEREBY CERTIFY THAT Tilts WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA HOAC 2C vies
CONSTRUCTION STMNDAROSNANDSkIATA COPY-OF
nTHIS FECCORA HAS BEEN PROVIDED TO THE WELL OWNER.
FOR OFFICE USE a T1�`" `- 5-02
Quad No: ' "SIGNA1URE OF PERSON CONSTRUCTING DE WE:L DAM
I MOnat!to Noon of Water Outlay.Gttudwaterr Stoat wfithin 37 days
•
Serial No. ���� _..� Gov-I new.1271
S:a� St Section
A,i -,,1 of ice _•

North Carolina•Department of Environment and Natural Resources•Division of Water Duality•Groundwater Section
•
230636
1636 Mail Service Center•Raleigh,N.C.27699-1636-Phone[phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR: AL-Q1-4"- fit. /44e/// ci P'70 V'tc .
WELL CONTRACTOR CERTIFICATION if: —4D h1
STATE WELL CONSTRUCTION PERMIT#: .c-i-160-014
1. WELL USE(Cheek Applicable Box):Residential Municipal❑ Industrial❑ Agricultural❑ Monitoring 0
Recovery❑ Heat Pump Water Injection ❑ Other Cl If Other, Ust Use:
2. WELL LOCATION', (Show sketch of the location below) �po�
.Nearest Town: 1-� u1 e S v I l P..., County. iThial
,5.:Aor+ r4Att , EA
(Road Name ansibluolbers, or Subdivision arm lot No.) DRILLING LOG DEPTH
3. OWNER alai tS t From To FormationDes-TipUon
Address .- )- f /Rank Rd, D go
' �
5 /9 f Ott
y r
r n—/�(SJuoo)«liou<�e„)NG) 8 7�� L�' !r 45
City or Town I / 6(p1 Stan Zip Coda
4. DATE DRILLED 4 -'.. • "D /
5. TOTAL DEPTH 1,04S
6. CUTTINGS COLLECTED YES❑ NO[+
7. DOES WELL REPLACE EXISTING WELL? YES ❑ NOEf
8. STATIC WATER LEVEL Below Top of Casing: g/) FT.
e•.•a n Ara Top of Casing)
9. TOP OF CASING IS I (Us FT.Above Land Surfaces
'Top of casing terminated aVor below land surface requires a variance In accor-
dance with 15A NCAC 2C.011a
10. YIELD(gpm): a.. METHOD OF TEST .1 Lv r S
11. WATER ZONES(depth): 3 5 ' - /.5.gr p rn
to a-D' - •5 pm
12. CHLORINATION: Type HT hi Amount // 1e 11 additional space is needed use back d loyal
13. CASING:
LOCATION SKETCH
WO Thickness
n Depth ,„, Damodar at WuyhtlR. Mazda] (Show direction and distance trm at least two State
From 1--) To 70 Ft. 11 - Roads,or other mac tolerate points)
From To Ft.
From To Ft.
14. GROUT: •
Depth,. Material M thod o
From 0 Top 0 Ft. `---rn O o
From To Ft. a o
15. SCREEN: t -t =m
Depth Diameter Slot Size Material ....„1o�
rn
From To_Ft _ in. _ in.
n.
From __.To—Ft.— in. in. yy
From _.__To_Ft._____ W in. — in.
16. SAND/GRAVEL PACK: r
Depth Size Material i
From To Ft.
From To .Ft.
17. REMARKS:
I DO HEREBY CERTIFY THAT TM$WELL WAS CONSTRUCTED IN ACCORDANCE WITH t5A NCAC 2',WELL
CONSTRUCTIa -.4$ri •. , _ OiTHATACOP'COFTHISFE HAS BEEN PROVIDEDJTJ WELLONTER.
. i .c , - .., C 5 3--- -a /
FOR OFFICE US -rr
g1GNA11IRE OF PERSON CONSTRUCTING TIE WELL OATS
Clued No: I ! l I • Varna Molnar to Daitlon of Ware Glumly.omuawater Seucn Within 37 days
Senai N0. W GK•I REV.121f '
- -ndv e:.. ''.'tiv'
• evili

North Carolina•Department of Environment and Natural Resources-Division of Water Quality•Groundwater Section 2 3 0 6 31
1636 Mail Service Center•Raleigh.N.C.27699-1636-Phone[phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR: .PPPAR- £rDS &e]/ � �'*-> , •
WELL CONTRACTOR CERTIFICATION #: .340 11,
��/STATE WELL CONSTRUCTION PERMIT#: -'�-
1. WELL USE(Check Applicable Box): Residential(� Municipal ❑ Industrial❑ Agricultural❑ Monitoring❑
Recovery❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATION: (Shot, sketch of the location below) Q
Nearest Town: ! r5ur 11f County. R.i1iJ(YII-z�J
sum, �-t „I�.tt LI. /
(Road Nana and Nu a Coarnun ity.or Su i ' and Lot No.) DRILLING LOG DEPTH
3. OWNER E YA F/ft lititt.4_: From To FomutionDes-iption
Address <3 a Cr et � , n �'D r /�� ,
L^-�n-1�5-/ue:rat .2g 7�/ ep r e��f r �,a ;
City or Town '// �tate 1 Tip Code
4. DATE DRILLED 7-'2 3 -I
5. TOTAL DEPTH 414/'
6. CUTTINGS COLLECTED YES❑ NOd
7. DOES WELL REPLACE EXISTING WELL? YES ❑ NOE(
8. STATIC WATER LEVEL Below Top of Casing: f'D FT.
(Use'.II Above Top of Casing)
9. TOP OF CASING IS I FT.Above Land Surface'
Top of casing terminated et/or below land surface requkes a variance In accor-
dance with 1SA NCAC 2C.0113
10. YIELD(gpm): C. S METHOD OF TEST er h r S
11. WATER ZONES (depth): 1 '70 r - 3 0A p rr
QVD r - .O , yin
12. CHLORINATION: Type /4 7-14 Amount 91) If additional space is needed use bead foc i
13. CASING:
Wall T ss LOCATION SKETCH
Depth Diameter cv WeightR r'r dal (Show direction and distance hart at least two State
From To �0 Ft. " r - Roads,or other mac referaxe points)
From To Ft.
From To Ft.
14. GROUT:
Depth Material Method
n
From d To OW FL / and24,-1-
o
From To Ft. `O a-
15. SCREEN: a n
Depth Diameter Slot Size Material cry
From _To_Ft_ in. _ in. V (Tic,
From _To_R. in. in. t o
From To Fti_ in. _ in. .
16. SAND/GRAVEL PACK: St) iii
Depth Size Material .,n y
From To Ft. • 2
From To Ft.
17. REMARKS:
I DO HEREBY CERTIFY TtM#T 7193 WEILL.WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2',WELL
CONSTRUCTION S CARE/S.AND THAT A CcOOPY OF/JTHIS RECORD HAS BEEN PROVIDED THE
THE M/EL OWNER.
FOR OFFICE U eNLY T/�./ ey`9> '2 6 /
Quad No: I !oink; ' -',;nl; SIGNATURE OF PERSON CONSTRUCTING*GE WELL OATS
` Submb engine:to Diction or water Quairtt/.Grou+dwaar Sacco within 37 days
Serial No. ` CS-I REV.12l1
m'Immr. • . .ter Section
sheaiii�?e,ional Vice

North Carolina•Department of Environment and Natural Resources-Division of Water Quality•Groundwater Section 2 3 0 6 3 0
1636 Mail Service Center•Raleigh,N.C.27699.1636-Phone[phone]
//�J e
WELL CONSTRUCTION RECORD WELL CONTRACTOR: L�r -
-5. / eE 11 �i�Mp,4`e--
WELL CONTRACTOR CERTIFICATION#: 3D S•/
/STATE WELL CONSTRUCTION PERMIT#: ,'t'Cr*-
1. WELL USE(Check Applicable Box): Residential LJ Municipal ❑ Industrial❑ Agricultural❑ Monitoring❑
Recovery❑ Heat Pump Water Injection 0 Other ❑ If Other, List Use:
2. WELL LOCATION:(Sh w sketch of the I cation below)
Nearest Town: /2 �/)P SV i Ile, County: A.ry l<)Odd
//r) / ( A1J.1-
(Road Name and Numbers rtrnuni or Suadivison and Lot No.) DRILLING LOG DEPTH
3. OWNER ALP P a L iL/n n From To Formation oesiniion
Address /09 ! esle 6rt-Oe. 61 D 3$ rr
:retry
Route Nq_ C.
i 8 7 -f ,341 4/n g ' P�'r
City or Town C ,�1Ct S/� /J Zip Code4. DATE DRILLED 4 -/� _Q /
5. TOTAL DEPTH ''4,q'
6. CUTTINGS COLLECTED YES❑ NOazr-
7. DOES WELL REPLACE EXISTING WELL? YES n NO2r
B. STATIC WATER LEVEL Below Top of Casing: FT.
(Use•:If Above Top of Casing)
9. TOP OF CASING IS FT.Above Land Surface'
'Top of casing terminated atior below land surface requires a variance to actor•
dance with 15A NCAC 2C.011a ^
10. YIELD(gpm): METHOD OF TEST c L r c
11. WATER ZONES(depth): a3D. - ao4pm
12. CHLORINATION: Type H TN Amount VP If additional space is needed use back cf loran
13. CASING:
LOCATION SKETCH
Wall Thickness
Depth Diameter et we,gnVF. Ma ecial (Show&ection and distance frm at least two State
From e To� Ft.—ea.:L— la.- Roads,or other map referexe points)
From To Ft.
From To Ft.
14. GROUT:
Depth ci Material M thod
From D To ai D Ft. ( •P-}'»6 ACT
From To Ft.
15. SCREEN: a
o a
Depth Diameter Slot Size Material
From —To_Ft — in. — in. • a�
From —To—Ft.— in. — In 1 rn
From ___To__Ft.— in. — in. v a-
rn
16.16. SAND/GRAVEL PACK: r m
Depth Size Material z
m
From To Ft. Co a
From To .Ft.• -r‘s "17. REMARKS: a
I DO HEREBY CERTIFY THAT TIRS WELL WAS CONSTRUCTED IN ACCOIRDANCE WITH 1SA NOAC 2;,,WELL
CONSTRUCTIONS • • - enNo TEAT kCOPYC OF THIS RECORD HAS BEEN PROVI.4e TO THE WELL OWNER.
FOR OFFICE US v1 �� �"��'",. 5 Al. a
■1� SIGNATURE OF PERSON CONSMUCTII IG DE w U. DATA
Quad Na: �"
$udhYt ntglnS to DeNon d Water quality',OrahWausr Sean within 9?days �1 REv.1219
Slaw No.
r
Crow, watt Section_,
h.a: 2.i(rice

232342
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: 41Aiese Snao . /Q) L i P44--70, .
WELL CONTRACTOR CERTIFICATION#: 07.F7-g
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE(Check Applicable Sox): Residential0/ Municipal ❑ Industrial❑ Agricultural❑ Monitoring ❑
Aecovery❑ Heat Pump Water Injection ❑ Other ❑ If Other, Ust Use:
2. WELL LOCATION: (Show sketch of the location below) i /
Nearest Town: 7/.4 GJnrs v. SIC County. 41-y./2)0e /
!
.cA0aI t, /P
(Road Name and Numbers.Community. Subdivision and Lot No.) DRILLING LOG DEPTH
3. OWNER CTG1tk t'<-r'_,., From To Formation Description
Address ,�/, 3 /`)„ ere `
(Street Or Route o. " �1n�t t
rris6u Air 02fder5
City or Town 1 State Zp Code •
4. DATE DRILLED V- 30 -A /
5. TOTAL DEPTH 4 410 ' & /td J
Drr�
6. CUTTINGS COLLECTED YES ElNOd
7. DOES WELL REPLACE EXISTING WELL? YES V NO[?J
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'
?op of casing terminated atfor below land surface requires a variance In accor-
dance with 1SA NCAC 2C. tie
10. YIELD(gpm): pp METHOD OF TEST a hrs -
11. WATER ZONES (depth): Sat r - Lotiprr,12. CHLORINATION: Type NTH p Amount / g If additional spate is needed use back Of foram
13. CASING: — -
Wall rr autess LOCATION SKETCH
Depth Diamener cr Weight/R. Martial (Show dkecdon and distance from at least two State
From To Ft. Roads,or other map refererte points)
From To Ft.
From To Ft.-
14. GROUT:
Depth Material Method o 0
From 0 To aD Ft. r-e-n'lts-(. '_
L c)T
From To Ft. c an,
15. SCREEN:
Depth Diameter Slot Size Material co -m
From _To_Ft _ in. _ in. — ---+G
From _To_Ft._ in. _ in. _rn
GU N1
From To_Ft. in. _ in. _ n
N .,
16. SAND/GRAVEL PACK: o 0
Depth Size Material
From To Ft. _
From To Ft.
17. REMARKS:
I DO HEREBY - „ TRUCTED IN ACCORDANCE WITH 1S4. NCAC 2:,WELL
CONSTRUCTION IANIE - , c CHO-giC. . aFTHIS FE HAS BEEN PF'OVIDEEDr E WELt!OWNER.
FOR OFFICE USE f�U -Y de1 -l-- \ JZ
JL
Quad No: IL...-.OF PERSON CONSTRUCTING TrE WELL DATA
Submit • • Dt.6ron or water Quality,onuawatsr Seacn wtlthln 33 days
Serial No. Qtt-1 REV.1299
ndwater Section
Asheville Regional Office

North Carolina•Department of Environment and Natural Resources•Division of Water Quality-Groundwater Section 232354
1636 Mail Service Center-Raleigh,N.C.27699-1636-Phone[phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR: aC/ncnao- igiLaa• 4L //9 _
WELL CONTRACTOR CERTIFICATION #: ,-2 4/ g
STATE WELL CONSTRUCTION PERMIT#: - -
1. WELL USE(Check Applicable Box): Residential® Municipal El Industrial❑ Agricultural C Monitoring❑
Recovery❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATION: (Shqw sketch of the location below)
Nearest Town: 72,41t ne c v/die, County. 7 CI_-L!tio etc,"
7i,L21211-e W //F Cti-e2
(Road Name and Nu rs.rGbmmurity,or SaBdiviscn and Lot No.) DRILLING LOG DEPTH
3. OWNER c' !J.-W: /U42,1c� - '/R91, Jod From To Formation Description
Address 3742.� //tJP�yt�a.M) Si, J 4 ;g girt/zit-
City
n n ,, Street or outs No.) �e2/ 3 ' .�C>J�
or Tot' State Zip Code •
4. DATE DRILLED 41-7/-/1
5. TOTAL DEPTH •Sd5
6. CUTTINGS COLLECTED YES❑ NOS
7. DOES WELL REPLACE EXISTING WELL? YES NO®
8. STATIC WATER LEVEL Below Top of Casing: u0 FT.
(Use•.'II Above Top of Casing)
9. TOP OF CASING IS FT.Above Land Surface'
Top of casing terminated at/or below land surface requires a variance In accor.
dance with 15A NCAC 2C.01.18
10. YIELD(gpm): _ METHOD OF TEST hrs
11. WATER ZONES(depth): Q 4/5' - JPr'''
12. CHLORINATION: Type /4 r h Amount 9,2 If additional spice is needed use back cf tors
13. CASING: -
Wall Tnidmess LOCATION SKETCH
Depth � Diameter cr Weight/FL Material (Show d ection and distance frcrn at least Iwo State
From 4 To_t5uL_ Ft. ° r PIVet Roads,or other map reference points)
From To Ft.
From To Ft.
14. GROUT:
Depth Material Method
From A To �d Ft. f-A Ad it",/)
From To Ft. C'
15. SCREEN: o c
Depth Diameter Slot Size Material c- "r
�_.
From To_Ft _ in. _ in. z c c
From _To_Ft— in. — in. f-
From To_Ft_ in. in. >
0
16. SAND/GRAVEL PACK: DC arn
,°
Depth Size Material Co c
From To Ft. rV n
From To FL -4 o
z
17. REMARKS:
t DO HEREBY CERTIFY THAT TM TRUCTED IN ACCO FIDANCE WITH 15A NCAC 2;.,WELL
CONSTRUCTION Aff Ill A THIS PIECORO HAS BEEN PEiOVIDED TO THE WELL OWNER.
FOR OFFICE USE / 1-042-_-A4 Res
Quad No: TORE OF PERSON CONSTRUCTING T}C WELL OATS
UN ( mql n of Water0uality.Grannie atef Sean,witthln 37 days
Serial No. G1s•I REV.1219

North Carolina•Department of Environment and Natural Resources•Division of Water Quality-Groundwater Section ( 3 2353
1636 Mail Service Center-Raleigh.N.C.27699-1636-Phone[phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR: 02+.o! . , F1-01 Pam,
WELL CONTRACTOR CERTIFICATION#: ,2 L//r
STATE WELL CONSTRUCTION PERMIT/4: Y"/" 2
1. WELL USE(Check Applicable Box): Residential- Municipal ❑ Industrial❑ Agricultural❑ Monitoring 0
Recovery❑ Heat Pump Water Injection 0 Other 0 If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below)
Ne7/6/1/4/
are tTown: ie-74-///c1F � County- iY//slor>/1
7/6//!/,24J �" p! .1 e-
(Road Name arld Nu ers,t�dmuni .or Subdivision and Lot No. DRILLING LOG DEPTH
3. OWNER C C % E-wt4 - .- From To FomutionDes.-iption
Address j�j J',�-f„�CsL�,.p� �i ,� '/ cant 40i.i/f' -I-
n) J ( veal orR.outeNo.) d 7,2/ a �]' .p4S r .U/te .c-Le/
( � d// f��
City or T6wn n Zr State Code
i 4. DATE DRILLED i/-1 4/
5. TOTAL DEPTH 02AS' -
6. CUTTINGS COLLECTED YES❑ NOST
7. DOES WELL REPLACE EXISTING WELL? YES 0 NO®
8. STATIC WATER LEVEL Below Top of Casing: /nQ FT.
(Use•.U 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 1SA NCAC 2C.0116
10. YIELD(gpm): I S METHOD OF TEST cz2 A r s
11. WATER ZONES(depth): /a d/5 ' - I6 i p m
r1
12. CHLORINATION: Type 771 Amount If additional space is needed use backer form
13. CASING:
N,�Tr q.ess LOCATION SKETCH
Depth Diameter or We:COUR Material (Show erection and distance Inm at least too State
From P To o2 Ft. G 'air. Roads,or other map reference points)
From To Ft.
From To Ft.
14. GROUT:
Depth Material Method
/
From ) To .20 Ft. �'l'-rvie-nf !cif o
0
From To Ft.
15. SCREEN: C off'
Depth Diameter Slot Size Material ? wry]
From To_Ft _ in. _ in. co c
From _To_Ft. in. in. a y
From To Ft._ in. _ in. m r
16. SAND/GRAVEL PACK: Co
r)iv
Depth Size Material -'
0
From To Ft. z
From To Ft. _
17. REMARKS:
I DO HEREBY CE A TRUCTED IN ACCORDANCE WITH ISA NCAC Z.WELL
CONSTRUCTION F THIS��P�//ECORD HAS BEEN PROVIDED TO THE WELL OwhER.
-FOR OFFICE USE IN 1 ?(�fc
�/iL2P1tie En 4 -/- o /
Quad No: TURF OF PERSON CONSTRUCTING hE WELL DATE
subrM DV 'to nor Water Quality.Groaning Sector.wiithln 3?days
Serial No. ndwater Sr'd11ffi GK•I REV.all
s eyitle Re ionat Offiet

North Carolina•Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section 2 3 2 ' 7
1636 Mail Service Center•Raleigh,N.C.27699.1636-Phone[phone] Q� `• ` it
WELL CONSTRUCTION RECORD WELL CONTRACTOR: >!_/.Lon-a.o &-+-4o • %12t, / �- ,
WELL CONTRACTOR CERTIFICATION #: Jill/
STATE WELL CONSTRUCTION PERMIT#: r9tzr-X"
• 1. WELL USE(Check Applicable Box): Residential Municipal ❑ Industrial❑ Agricultural❑ Monitoring 0
Aecovery❑ Heat Pump Water Injection jJ Other ❑ If Other, List Use:
2. WELL LOCATION: S ow sketch of the o ation below)
7 G
Nearest To n: -// 4../)zztt f�unty. �/ f 0 4)e,CSC
(Road Nana and ers, nu Subdivison and Lot N .) DRILLING LOG DEPTH
3. OWNER r4ti}'./rtc1 eta-r-rn — From To FoenationOes—iption
Address 3 O'�" 4 4 / � /0 3 a ' w0
/1 /, (Strout or Rotn�7.) .3 e2 ' -2 Ls' ,tij�,, ,._rx.
City or wn State ZZp Code
4. DATE DRILLED 41 "6 _h
5. TOTAL DEPTH 016,6 '
6. CUTTINGS COLLECTED YES❑ NOgg
7. DOES WELL REPLACE EXISTING WELL? YES p NO®
8. STATIC WATER LEVEL Below Top of Casing: 4,4 FT.
(Use':if Above Top of Casing)
9. TOP OF CASING IS I FT.Above Land Surface
Top of casing terminated at/or below land surface requkas a variance In accor-
dance with 15A NCAC 2C.0115
10. YIELD(gpm): /n METHOD OF TEST 9. )i r 5
11. WATER ZONES(depth): a 45"/ - IL) J m
12. CHLORINATION: Type k Tb! Amount 4L 7 If additional space is needed use back cf foram
13. CASING:
Wall Trydvass LOCATION SKETCH
/., Depth Diameter cr WeighVR Ma4rial (Show erection and distance frm at least two State
From To q Q Ft. CP " - 71l/e. Roads,or other mac referexe points)
From To Ft.
From To Ft.
14. GROUT: c;
/) Dept Material l Method I c
From r. To c n Ft. (•-0 t �l r'7r� `cl
ccFrom To Ft.
15. SCREEN: f c
Depth Diameter Slot Size Material 2,`
From _To Ft ____ in. _ in. a 7
From ____To Ft.— in. _ in. CO mN
From _To_Fes_ in. in. PO 2
16. SAND/GRAVEL PACK: o
z
Depth Size Material
From To Ft.
From To Ft.
17. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 1.14 NCAC 2:,WELL
CONSTRUCTION STANDARDS AND THAT A COPY OF THIS;RECORD HAS BEEN PFtOVI 0 THE NELL OwTER.
FOR OFFICE USE OM
T ` C £ I V if 0 o /
Quad No: 'I 911 E OF PERSON CONSIRUCTIING Tf LL€WE GATE
d pt I $7bq fi lnat 4t ion of Weer Quality.Grp-rawer yearn wirthln 97 days
Serial No. J LUUI_ ✓ CVO REV.12t!

North Carolina•Department of Environment and Natural Resources•Division of Water Quality•Groundwater Section 2 3 2 rot ,0
1636 Mail Service Center•Raleigh,N.C.27699.1636•Phone[phone] l
WELL CONSTRUCTION RECORD WELL CONTRACTOR: >21-41.-t-44t- 4-#4 k2 -0 / Pr"t'i %se-sc-
WELL CONTRACTOR CERTIFICATION #: 30 lit/
STATE WELL CONSTRUCTION PERMIT#: /41 C 3--�
1. WELL USE(Check Applicable Boa):Residentiai0- Municipal ❑ Industrial❑ Agricultural❑ Monitoring Cl
Recovery❑ Heat Pump Water Injection ❑ Other ❑ If Other, Ust Use:
2. WELL LOCATION: (Sb9w sketch of the location below) Y/ /
Nearest Town. �J (r)M County. /i�iJ,/,ce
(2/4-4,LPl -4� -
(Road Name and tturrber{f nity,or Sub nOne.d Lot No.) DRILLING LOG DEPTH
3. OWNER 212,4 7/cil'YI L'LL - From To FormaGmDDeeess`ription
Address .,'(a� t 0 1(,iJ ) k brow L,a . /4 24 ,
(,C/ , ¢
7 ( rest or tote Flo oni-p a/, ' .57 /L .ru
(2/lricvn / - // P L 33 7G 3
City or Town State Zip Code
4. DATE DRILLED 41-at-0 /
5. TOTAL DEPTH I'S'7 •
6. CUTTINGS COLLECTED YES❑ NOO
7. DOES WELL REPLACE EXISTING WELL? YES ❑ NO'I.
8. STATIC WATER LEVEL Below Top of Casing: LLD FT.
(Use' if Top of Casing)
9. TOP OF CASING IS I : Above FT.Above Land Surface'
Top of casing terminated aUor below land surface requires a variance In accor-
dance with 1SA NCAC 2C.0113
10. YIELD(gpm): METHOD OF TEST it h r5 •
11. WATER ZONES(depth): A2 D / 2 41 r i'''
12. CHLORINATION: Type /I 7-El Amount (O,Z If additional space is needed use backof fOC
13. CASING:
LOCATION SKETCH
Wall TnidWuss
Depth ��i nn Diameter or Ws'ht/R Material (Show direcrion and distance from at least two State
From 7) To .2L— Ft. P " /61 l tt Roads,or other map refere re points)
From To Ft.
From To Ft.
14. GROUT:
Depth n Material y� Method c
From _12_ To .-2P Ft. l pwr��rt.l -0 p o
From To Ft. c G^,
15. SCREEN: z cc
Depth Diameter Slot Size Materal 1 a'z-
oo fir-
From _To_Ft_ in. _ in. no
From ___To_Ft.— in. — in. a rn_3 a;,
From _To_Ft— in. — in. o
Cn rn::.
16. SAND/GRAVEL PACK: IV
Depth Size Material --.1 8
z
From To Ft.
From To Ft.
17. REMARKS:
I DO HEREBY CE 11eAArrlEII tt r NC
STRUCTED IN ACCOIRDAE WITH 1SA NCAC 3',WELL
CONSTRUCTION IWR•411A 1Afin 1► ilflr OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
1.4
FOR OFFICE USE .Y 9 ( /� A e P� ,
Quad No: -�(�� " O�J1 WAIVRE OF PERSON CONSTRUC IIING TF€WELL OATE
3u 'to Division or WaterQualnq.Gra:twat**Seacn wiithin 3?day's
Serial No. Gat per12»
Cr undwater Section
�� eiional Office

North Carolina-Department of Environment and Natural Resources-Division of Water Quality•Groundwater Section 2 3 2 3 4 5
1636 Mail Service Center-Raleigh,N.C.27699-1636-Phone[phone] WELL CONSTRUCTION RECORD WELL CONTRACTOR: �� n Bras . U// // / Art,1
/+ h-c- •
WELL CONTRACTOR CERTIFICATION#: 301/21/
STATE WELL CONSTRUCTION PERMIT#: I Iin
1. WELL USE(Check Applicable Box): Residential EZ Municipal ❑ Industrial❑ Agricultural❑ Monitoring D
Recovery❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATION: (Show sketch of a IAcation below)
Nearest Town: Y1�as0 , Y, p/�24/ County: elU/eD
G/11 Co(/�) izu 4
(Road Name and Nu rs, ty.or ran.)o.) DRILLING LOG DEPTH
3. OWNER /9A'/� I-44 O .
From To Foana aDes Tipton
Address o�F1 AJ 4 �o? r
��pp 7(St or ou s No. R �4 ' 3.t'S /4 OM
.2e2r4 sa83a
City or Town ' Slaw Zp Code
4. DATE DRILLEDlit/5-AO/
5. TOTAL DEPTH 3.2 C.r
6. CUTTINGS COLLECTED YES NO2v
7. DOES WELL REPLACE EXISTING WELL? YES ❑ NOEL-
B. STATIC WATER LEVEL Below Top of Casing: in FT.
(Use':U Above Top of Casing)
9. TOP OF CASING IS I FT.Above Land Surface'
Top of casing terminated at/or below land surface requires a variance In accor-
dance with 15A NCAC 2C.011a
10. YIELD(gpm): 1_ METHOD OF TEST cO in rS
11. WATER ZONES (depth): Siff'/gpnn €Q&0 ' - 6-dprn
30 _ r/ pm
12. CHLORINATION: Type Hi///lH-(((( Aunt If additional space is needed use backd for..n
13. CASING:
Wall LOCATION SKETCH
Depth Diameter cc weaght'Ft Mnare al (Show tfsectfon and distance trm at least two State
From de) To Ft.--1.,—,r r � Roads,or other mac referee points)
From To Ft.
From To Ft.
14. GROUT:
Depth a Material Method
o
From _L To c10 FL r p
0
From To Ft. c)
15. SCREEN: a o--;
Depth Diameter Slot Size Material z cfpl
1 0
From _To_Ft — in. _ in. co r fi c
r+;
From _To—Ft._ in. — in. y -'
From To_Ft._ in. _ in. = zG
16. SAND/GRAVEL PACK: N
C)
Depth Size Material N
07 3
From To Ft.
From To Ft.
17. REMARKS:
I DO HEREBY CERTIFY THAT THIS WEILLWAS-CGINSTFUCTED IN ACCORDANCE WITH 154 NNC4AIC2C,WELL
CONSTRUCTIONS RTI T CRP• •F IS(RECORD HAS BEEN PROVIDED SAZ HE WELLOWNER.
FOR OFFICE USE
Quad Ho: '� pu�N F 7(� '�� 'E OF PERSON CONSTRUCTING ThE VV OATS
UVN I Su�rritc gl •. -..n or Water Duality.Gro,r+dwater Seacn wiithIn 3?day's
Sedal No. GIs-1 REV.I2l1
Groundwater Section
aaF-•'-t-::nuu"nnal Office

2'-' Li i
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: MAnanao . 4n.od • it2J d Pu-,.y,, o..-e,
WELL CONTRACTOR CERTIFICATION #: 3G 4/
STATE WELL CONSTRUCTION PERMIT#: r1 40-3-
1. WELL USE(Check Applicable Box): Residential LI/ Municipal ❑ Industrial D Agricultural❑ Monitoring❑
Recovery❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATION: (S or sketc of the location below) /t
nr7 /
Nearer r o n: County: Air a y Ii/ ^
a�J
(Road Name an�tjNumbers. ' .or bdivisbn and Lot No.) DRILLING LOG DEPTH
3. OWNER /30-1, D.v e• �}n�-n,np�1Q J From To FormaGmDescription
Address () /f 5- / e.t.a-et 6 3 r i,�CL/
Vi) Mt Cot our �g,7g/ 11 3 r / / ' 7
,�yLQdU� [ V (/
City Town �[[ State Zip Code
4. DATE DRILLED `/ -6 -DI
5. TOTAL DEPTH /71/
6. CUTTINGS COLLECTED YES D NOT:21*---
7. DOES WELL REPLACE EXISTING WELL? YES ❑ NO0'
8. STATIC WATER LEVEL Below Top of Casing: ID FT.
(Use':if Above Top of Casing)
9. TOP OF CASING IS �__ FT.Above Land Surface'
?op of casing terminated atror below land surface requkea a variance In accor-
dance with 1SA NCAC 2C.0118
10. YIELD(gpm): 6D METHOD OF TEST --- kr-
11. WATER ZONES(depth): to 90 r - l48 tern
12. CHLORINATION: Type fit H Amount / C If additional spire is needed use backcf loran
13. CASING:
LOCATION SKETCH
Wall TricWuss
^A Depth/� Diameter n Weight/FL l (Show direction and distance tram at:feast two State
From y'J To.1�3-• Ft. /P!r"-' Pie C Roads,or other map reference points)
From To Ft.
From To Ft. o
14. GROUT: o --'
Depth Material Method r_ Et,::
!1 C El�'
From b To �0 Ft. ` 9L r c_
From To Ft. - '-
c�
W -rn
15. SCREEN:
Depth Diameter Slot Size Material v r''c
1
From _To_____FL — in. in. r"=
From _To_Ft in. in. 01
From To_ Ft._ in. — in. 1v a
16. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
17. REMARKS:
I DO HEREBY C rF IFYjiH4J TO E L VM?'S CONSTRUCTED IN ACCORDANCE WITH 15; NOAC 2",WELL
CONSTRUCTION t1#FA.CW'$'OF THIS RECORD HAS BEEN PROVIIW TO THE was OWNER. C r C `
FOR OFFICE USJ SLY d ' 1t " &" 7
Quad No:
SIGNATURE OF PERSON OONSIRUCTIINC DATE
_ guwNt eTtglnulo Division J Water Duality,GrondwauBr Searn within days
Serial No. Cry! rwaLL S 2n-• a GK'•I REV.1219

' :North Carotins•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: Gretna 73rec. We)) 4 Pm me
WELL CONTRACTOR CERTIFICATION ft: 345 4/
_ /STATE WELL CONSTRUCTION PERMIT#: "/4t A
1.-WELL USE(Check Applicable Box):Residential L7 Municipal❑ Industrial 0 Agricultural❑ Monitoring 0
Recovery❑ Heat Pump Water Injection ❑ Other 0 If Other, List Use:
. .2. WELL LOCATION:(Show sketch of the location below) �1 )' pp
H
Newest Town: 1 .v v1 nt-1-o County. klei-tj r il Dnel
'Re ) )1 rut "'f l I I 'Rd. ,
(Road Name and ellar7 mmbers,Community.or Subdivision and Lot No.) DRILLING LOG DEPTH
3. OWNER , t•1 1 L..A U L From To Focma�ttiio'n"'''Descipdon
Address % r- p i )t sts }4 r I I )Rd , % E ' S fr '' c<Y ran, 1r
n, ( t C-Aoutallo. ,RI ) 6
( /LYL
• City or Town y Stay zip Code •
4, DATE DRILLED q'5-0I
1:; 5. TOTAL DEPTH a 9E '
6. CUTTINGS COLLECTED YES NOEr _-
7. DOES WELL REPLACE EXISTING WELL? YES ED NOd' 0
B. STATIC WATER LEVEL Below Top of Casing: p FT. y _.
(Use':if Above Top of Casing) _a - ..
9. TOP OF CASING IS FT.Above Land Surface' -_
'Top of u ct sing terminated at/or below lend surface remains a variance In aor- c 1
1 _
dance with 15A NCAC 2C.O11e ' --
10. YIELD(gpm): __k_METH00 OF T.E1ST AY.S • -
11. WATER ZONES(depth): it ' - 2 m
ALDI " I/ Vnn -. rcli:-
12. CHLORINATION: Type /I 7 •/-I Amount -I If additional space is needed use back cf foram o
13. CASING:
wag Tnidvkss LOCATION SKETCH
Depth Diarneeer er Weight/Ft Material (Show&ecdon and distance than at least two State
From—S---.To-Al-Ft. __ PVC_ Roads.or other map referate points)
From To Ft.
From To Ft.
,; 14 GROUT:
Depth Material Method
From _0 To 0/0 Ft e rn, nth dap
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: e
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH'SA NCAC 2I7.WELL
CONSTRUCTION STANDARDS,AND THAT A COPY OF THIS Fi£CORD HAS BEEN PROVIDED TO THE NELL OWN'/ER.
FOR OFFICE USE ONLY �, ,--/ IL• SA144- r - a--d /
Qued No: SIGNATURE OF PERSON CONSTRUC'TONO T)*WELL OATS
Submit angina to Noon of Water Quality.Oinueimater Seam within 3?clays
Sinai No. Gw'•I REv. 12l1 •

228687
North Carolina-Department of Environment and Natural Resources-Division of Water Quality•Grou'ndwater Section
1636 Mail Service Center-Raleigh,N.C.27699-1636-Phone[phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR: &rleY1P, arws. GJPJ 1 4 PIAmP
WELL CONTRACTOR CERTIFICATION #: ?il)4 I
STATE WELL CONSTRUCTION PERMIT'S: /4-,t' --
1. WELL USE(Check Applicable Box): Residential2/Municipal ❑ Industrial❑ Agricultural D Monitoring ❑
Recovery❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATION': ^-ow sketch of the location below)
Nearest Town: r-(.11'Al r"1 P_Sii I lie, County: 147 Ad r a)Ona
Jmr,D 1�if, Sprint, MA , /
(Road Naha and Nummbefs,Comm ty.or Subdivision and Lot No.) DRILLING LOG DEPTH
3. OWNER ( , i r 1-5 ..c) }vat) From To For axn Description
Address ---P 0 _j3oX )5� /b D ,V/) 0494.1
( trees r oute No. ,-Q L) 1 '7 rJ G-r,z�7, •{'Pr_
r\rnag!�DGAy %t �I�1 Pet A/C- c2B /S I _;
City orS3 df�m Sty Zip Code $
4. DATE DRILLED .3-1 -0 1 -5. TOTAL DEPTH el"1'7 -n _
6. CUTTINGS COLLECTED YES❑ NO[7(
7. DOES WELL REPLACE EXISTING WELL? YES Di NOD'
Ai
8. STATIC WATER LEVEL Below Top of Casing: 0 FT. -
(Use'.'it Above Top of Casing)
9. TOP OF CASING IS I FT.Above Land Surface* —
'Top of casing terminated at/or below land surface requires a variance In actor- — C
dance with 1SA NCAC 2C.0118 lL o
10. YIELD (gpm): �_ METHOD OF TEST ea h es =
11. WATER ZONES(depth): Si 5' ' iii- CA P r'n
7/0Di - IoS5V4opm
12. CHLORINATION: Type 1-4 T H Amount /4 I It additional space is needed use back Of loan
13. CASING:
Wait Thickness LOCATION SKETCH
Depth Diameter or Weight/Ft. Material (Show direction and distance from ai least tiro State
From D To - C2./�L Ft. LP" P V r Roads,or other map reference points)
From To Ft.
From To Ft.
14. GROUT:
Depth Material Method
From n To "QD Ft env,e an 4- +-D p
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 I SA AdCAC 2C,WELL
CONSTRUCTION STANDARDS,AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED 70 THE WELL OWNER.
FOR OFFICE USE ONLY Ldi / , Q1). k0 a - 30 -e) 1
Quad No: SIGNATURE OF PERSON CONSTRUCTING DC WrELL DA E
Submit original to Division of Water Quality,Groundwater Sectcn'within 30 days
Serial No. Grr.1 REV. 129$