Mc 2 CY2001

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
PO. Box 29578 - Raleigh, N.C. 27626-0578-Pho e [phone]
2 41,tsl
WELL CONSTRUCTION RECORD DRILLING CONTRACTOR: �1 'L^ btu ``��
DRILLER REGISTRATION #: I tit -
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE (CheckAppucable Box): Residential Municipal 0 Industrial 0 Agricultural ❑ Monitoring 0
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below) , ) I/
Nearest Town: '`‘ .\/' - --" County.
(Road, Community, thr Subdivision and Lot No.) �/
DEPTH DRILLING LOG
3. OWNER » 0� L. L L cl .i ist; It (� From To Fo ma on Desc ption
ADDRESS ;7-3
�` , . .� JL I) Fc-t/ '��:."hr/i-ILL
(Street or Route No.) / ry/_ I� t_-t C Y =
:xn
City or Town State Zip Code
4. DATE DRILLED IC/ till /
5. TOTAL DEPTH r.'
6. CUTTINGS COLLECTED YES fI NO ✓(
7. DOES WELL REPLACE EXISTING WELL? YES NOR
8. STATIC WATER LEVEL Below Top of Casing: r ` FT.
(Use's' if Above Tap of Casing)
9. TOP OF CASING IS I FT. Above Land Surface "
• Casing Terminated at/or below land surface is illegal unless a variance is issued
in accordance with 15ANCAC 2C .0118 14, I _ _rm _
10. YIELD (gpm): Y1 METHOD OF TEST cn
. 11. WATER ZONES (depth)' f2 '1)'°" Cr "` j` 1,
12. CHLORINATION: Type (I :i - r " Amount y I/ / ` ( If additional space is needed use backgf�forren
o
rrt
n
13. CASING: cm -'
LOCATION SKETCH N E
Wall Thickness
Depth Diameter or Weight/Ft. Material (Show direction and distance from at least two State
From To Ft. Roads, or other map reference points)
From (- To .! ° Ft k 1�7 kC t) 1- C 2 ,� L. al C: j
From To Ft. �� I\ - l
14. GROUT:
Depth Material Method T
From To Ft i� it r, t) I" °' t/
From 8 i To 2_ Ft. P 7 r i• i.4 rail 14.
15. SCREEN:
S lr4 '-
Depth Diameter Slot Size Material
From To Ft in in
From To Ft in in
From , t -Te I _� n - - lin.
16. SAND/GRAVE\PACK, I , ll I'A
1 {*tom Size I ; I (Material
From _i___I To Ft
From _t.C'.To Ft
17. REMARKS; t
I DO HEREBY CERTIFY THAT THIS WELL WAS COJISTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION b I ANUARDS, AND THAT A COPY OFTHIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
„ Y\_ 'A
SIGNATURE OF CONTRACTOR OR AGENT
Submit original to Division of Water Quality and copy to well owner.
GW-1 REV. 1/98
FOR OFFICE USE ONLY
Quad No
Serial No:
DATE

North Carolina - Depeanent of Environment and Nasal Resources - Division of Water Quality - Groundwater Section
P.O. Box 29578 - Raleigh, N.C. 27626-0678-Pho e [phone]
WELL CONSTRUCTION RECORD DRILLING CONTRACTOR:
DRILLER REGISTRATION *•
STATE WELL CONSTRUCT!
i J ' I .J J
ar c. Lue 0" Dr,lh
PERMIT*:
1. WELL USE (ChedcAppluabls 8o34: Reeidendel ty' Munidpal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ if Other, List Use:
2. WELL LOCATION:
Nearest own:
aketph of the location below)
•rl. County %� — t(SC
(Road. Cannily, or Su bdMSo n and
3. OWNER ("Li
ADDRESS
DEPTH
From To
bC r j/ (Street or Nora 2,?l j 2
City or Town SIB Zip Code
4. DATE DRILLED ('3-I Z -'�
5. TOTAL DEPTH QO5
6. CUTTINGS COLLECTED YES ❑ NO©/
7. DOES WELL REPLACE EXISTING WELL? YES NOD,-
8. STATIC WATER LEVEL Below Tap of Caging ( oa FT.
(Use •e WAboas Tap of Casing)
9. TOP OF CASING 1S I FT. Above Land Surface
• Casing Terminated aver below land surface is algal win a Manse is issued
in scmdaaawar 15A NCAC 2C .0118
10. YIELD (gpm):_Q__METHOD OFTEST 4/11-
. 11. WATER ZONES (depth): t. 5 P n. e 3 fB
12. CHLORINATION: Type r- +t �' Amount n r
13. CASING:
Depth Craw
From u To Ft. (-yy
From g ° To-2— Ft. U VQ
From iRC To ISl Ft. (0'Yy
14. GROUT:
Depth Materiel
From To Ft.
From __EL_ To Z. Ft * I
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 —,--,---
sae— , Material
From To Pt
From
17. REMARK•:
Wall Thanes'
or INeIghtlFt tdarorlae-
e6ti pus
yni$S5 (,IK
Method
/16122/12-1/
DRILLING LOG
Formation nasppaon
(Z) - I '3 t-2 D ; 2 �
/So- -10-i
0
0
i
If additional apace is needed use bacilli foS
LOCATION SKETCH
(Slaw direction and distance from at bast two Stele
Ronda, or other map reference points)
rQ
FYTHAT THIS WELL M(AS TRUCTED P1 ACCORDANCE WITH 16A NCAC 2C, WELL
STANDARDS, AND THAT A RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
S&GNA711RE OR AGENT
Subunit original b Minton of Vraler Oually and copy to well armor.
GW-1 REV. 1190
DATE

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
P.O. Box 29578 - Raleigh, N.C. 27626-0578-Pho e [phone] WELL CONSTRUCTION RECORD DRILLING CONTRACTOR: -:5-C )S 4 t c E (AR(D ri1/,1
DRILLER REGISTRATION #: t 1;0
STATE WELL CONSTRUCTION PERMIT#:
243430
1. WELL USE (Check Applicable Box): Residential Municipal 0 Industrial ❑ Agricultural ❑ Monitoring 0
Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below) ((��
Nearest Town- Oil Arlbvu County, ilA6 <?(�"'.e. CC--
.So \ ot. Ste to 40 L Le:(.
(Road. Canmunity. or Subdivision and Lot No.) DEPTH
3. OWNER XU)U tti ri- 14 C L. Wks From To
ADDRESS
(Street or Route No.)
fl
Stele.t j}r i°du }te C_ '1.5-2-
I City or Town Zip Code
4. DATE DRILLED /tCyzZr /
5. TOTAL DEPTH i (6-
6. CUTTINGS COLLECTED YES Ej NOSE
7. DOES WELL REPLACE EXISTING WELL? YES El NO© e
lc; - / t- c—
8. STATIC WATER LEVEL Below Top of Casing: etc FT.
(Use'+• if Above Top Massing)
9. TOP OF CASING IS f FT. Above Land Surface
Casing Terminated atlor below land surface is illegal unless a variance is issued
M accordance with 15A NCAC 2C .0118
10. YIELD (gpm)• (Z METHOD OF TEST 4 11-
. 11. WATER ZONES (depthp C' j Q c
12. CHLORINATION: Type 44 rAmount t/Ij f 41
13. CASING:
Depth
From CTo .Z
From To (C
From To
14. GROUT:
Wal Tnidmesa
Diameter orW haFt Material
Ft. (e i of , liar {
Ft. (0 Zit k't'C—
t r��
F
Depth
From 0 To _ Ft
DRILLING LOG
Formation Description
Jeri -
u
0
rn ern
f-,
M
rn ter,
If additional space is needed use backcj forah o
Material Method
Pr7./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/GRA .-
r, tize
From
From
17. REMARKS:
Ft.
�T• Ft.
v
I DO HEREBY CITIFY MATT/IS WELL WO
w
LOCATION SKETCH cn
(Show direction and distance from at leashevo Stags
Roads, or other map reference points) Z
101hA?>� Lccui
70
N ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS,TAND THAT A • ' ( THIS RECOyv HAS BEEN PROVIDED TO THE WELL OWNER
FOR OFFICE USE ONLY
Quad No:
Serial No.
SIGNATURE OF - . - ORAGENT
Submit original to Dhialon of Water Ouelty and copy to well owner.
GW-1 REV. 1/98
DATE

24 3431
North Carolina - Department of Environment and Natural Resources - Division of Water quality - Groundwater Section
P.O. Box 29578 - Raleigh, N.C. 27626-0578-Pho e [phone]
WELL CONSTRUCTION RECORD
DRILLING CONTRACTOR:
DRILLER REGISTRATION it
STATE WELL CONSTRUCTION
Wpfi
RMIT#:
1.
WELL USE (Check Applicable Box): Residential Ltd' Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
WELL LOCATION: (Show sketch of the location below)
Nearest Town: iflQ' 'rv^ County.
(Road. Commmunity r Subdivision and Lot too.)
3. OWNER W 14, 1 Li ✓ t _ 2
ADDRESS
/14
(Street Of
/ ut No.)
City& Town Slate
4. DATE DRILLED /0 ! rl U I
5. TOTAL DEPTH 3 0T �1
6. CUTTINGS COLLECTED YES ❑ NO ,� 7Qc= Q r ✓e-I
7. DOES WELL REPLACE EXISTING WELL? YES IOW ivO�
8. STATIC WATER LEVEL Below Top of Casing: 30 FT.
(Use'+" if Above Top of Casing)
9. TOP OF CASING IS FT. Above Land Surface•
Casing Terminated avor below land surface is illegal unless a variance is issued
in accordance with 15A NCAC 2C .0118
10. YIELD (gpm): I/ METHOD OF TEST 4 12
. 11. WATER ZONES (depth) t"e__ V �t
12. CHLORINATION: Type (i^`4 Amount )'y ' r?
13. CASING:
DEPTH
From To
DRILLING LOG
Formation Description
Depth
From l To Ft
From �' To 7.f Ft.
From To Ft
14. GROUT:
Depth
From To Ft.
From 0 To 29 Ft.
15. SCREEN:
Zip Code
Wall Thickness
Diameter or Weight/FL Material
67ter
Material Method
Depth Diameter Slot Size
From To Ft in in
From To Ft in in
From To FL in. in
16. SAND/GRAVEL PACK
r QaPth --Sine
From rt }lop -Ft.
From _�'__-f5 F'}-
17. REMARKS:: i
I
'�" t DO HEREBCERTIFY THAT THIS WELL W
CONSTRUCTION SIT NQARDSJND_ThAT A-
i
FOR OFFICE USE_ONLX-
quad No.
Serial No'
aterial
7j— ;c5 6.4
0
Orri
c�
�m
0i , °
If additional space is needed use back oEjon m
rn
LOCATION SKETCH W z
(Show direction and distance from at leash) State
Roads, or other map reference points) z
6,44"
e,3.-
6 (frri4
CTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
F THIS RECORD H : EEN PROVIDED TO THE WELL OWNER.
1
CTOR ORAGENT DATE
on of Water quality and copy to well owner.
GW-1 REV. 1/98

�'Qr;1
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section O.�
P.O. Box 29578 - Raleigh, N.C. 27626-0578-Pho e (919) 7333221 ,, ,, �% 0 �' n
WELL CONSTRUCTION RECORD DRILLING CONTRACTOR: i�a% t`^l Nnl�(wy
DRILLER REGISTRATION #: 551 572
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE (Check Applicable Box): Residential Municipal C3 Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below) ' 1,,
Nearest Town: 7/7/fr4 /� County . U`, el(
�7 C4N NQU ed
(Road:Tommunity, or Subdivision and Lot No.)
3. OWNER g 2 S foiv e
ADDRESS c) en V 579
(Street or Route No.)
City or Town tate
4. DATE DRILLED /& 7 —t
Zip Code
DEPTH
From To
34 9D5
5. TOTAL DEPTH 7 n'p
6. CUTTINGS COLLECTED YES D NO
7. DOES WELL REPLACE EXISTING WELL? YES NO
8. STATIC WATER LEVEL Below Top of Casing: — FT.
(Use "4-* ifAbove 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
In accordance with 15A NCAC 2C .0118
10. YIELD (gpm): METHOD OF TEST
. 11. WATER ZONES (depth)• CT1 p_
DRILLING LOG
Formation Description
r^
CD
t'1
12. CHLORINATION: _ype n. /e _ Amount (Al
Aadditional If 2 • nm
13. CASING:
Depth
From To Ft.
From 6To 3g Ft.-6- ..f=
From To Ft
14. GROUT:
From
From c
15. SCREEN:
Depth
To Ft
To 2) Ft.
Wan Thickness
Diameter or Weight/FL
at -i
LOCATION SKETCH N
Material (Show direction and distance from at least two State
Roads, or other map reference points)
(1. C
Materiai Method
ztf
Depth Diameter Slot Size Material
From To Ft in in
From To Ft. in. in
From To Ft in in
16. SAND/GRAVEL PACK:
Depth Size Material
From To Ft
From To Ft
17. REMARKS:
1 DO HEREBY C�ft`
CONSTRUCTIONf S
\I11 L[
THAT THIS WELL WAS C
DARDS, AND THAT A CO
FOR OFFICE US
Quad No -
Serial No:
dY
U TED IN ACCORDANCE WITH 15A NCAC 2C, WELL
IS RECORD HAS B N PROVIDED TO THE WELL OWNER.
SIGNATURE OF CO
! ^.I Su
▪ Q HI:
d original to Divisi
OR OR AGENT DATE
Water Quality and copy to well owner.
GW-1 REV. 1/98

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section 7 1 3 11P.O. Box 29578 - Raleigh, N.C. 27626-0578-Pho a (919) 7333221
WELL CONSTRUCTION RECORD DRILLING CONTRACTOR: /je D
DRILLER REGISTRATION #: V 1245C
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE (CheckApplicable Box): Residential Er --Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below) �n
Nearest Town: fil deli o 44-1 County-, cj x
(Road, Commu ity, or Subdivision and Lot No.)
3. OWNER /&53r C. /7644ieLI
ADDRESS g Vat N. C a A:7 A
(Street or Route No.)
DEPTH
From To
/J% oriel Ai N C £ ?%CS'2
City or Town State
DRILLING LOG
Formation Description
2S./6/
4. DATE DRILLED 0/ /0' ZZC Gin:
5. TOTAL DEPTH f0
6. CUTTINGS COLLECTED YES 0 NOEr-
7. DOES WELL REPLACE EXISTING WELL? YES NO fl
8. STATIC WATER LEVEL Below Top of Casing: 6 FT.
(Use `+• ifAbove Top of Casing) o
9. TOP OF CASING IS FT. Above Land Surface' Pnm
• Casing Terminated at/or below land surface is illegal unless a variance is issued
in accordance with 15A NCAC 2C .0118
10. YIELD (gpm)• 5 METHOD OF TEST 1/2
. 11. WATER ZONES (depth). ,/,',44
[go
Zip Code
12. CHLORINATION: Type C&te-tr Amount _
13. CASING:
Wall Thickness
Depth Diameter or Weight/FL Material
From To Ft.f,
From 0 To Ft. `r'' �'� 4/0 U {
From To Ft.
14. GROUT:
From
From 6
15. SCREEN:
From
From
F
16. S
Frc
Frc
17. REA,
Depth Material Method
To Ft.
To 20 Ft. -2`7 AEA),"
Depth Diameter Slot Size Material
To Ft in in
To p Ft// in. in
pc -.F% n1-•R(� K11 V S rF in
Depth E Material
To Ft. U
To 7;Ft —J
AR S.
UC
rn
"n
o
ins
If additional space is needed use back Jfomg
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other map reference points)
226
e, C
GROUNDWATER SECTION
1 DO HERESY \ CERTFYII1H r THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CO VS i KUL FION STANDARDS, AND THAT A COPY THIS RE 1a RD PROVIDED TO THE WELL OWNER.
tiP►
SIGNATURE O/. ONTRACTOR OR AGENT DATE
Submit original . Division of Water Quality and copy to well owner.
GW-1 REV. 1/98
FOR OFFICE USE ONLY
Quad No.
Serial No:

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
P.O. Box 29578 - Raleigh, N.C. 27626-0578-Pho e [phone]
WELL CONSTRUCTION RECORD DRILLING CONTRACTOR: t^) f LA-(
DRILLER REGISTRATION #: ( '� 1
STATE WELL CONSTRUCTION PERMIT#:
3 1
7
4.. ; 5 ,
1. WELL USE (check Applicable Box): Residential © Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring
Recovery ❑ Heat Pump Water Injection ❑ Other El If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below)
✓ �"�L-- Coun ►-\. �n —
NearestTown: tY'_
(Road, Community, or Subdivision and Lot No.) DEPTH
3. OWNER fie.A4'ur_Z-Lfli .5GL10lei c1 From To
ADDRESS ! 70I i=Cliry PuTI-
(Street or Route No.)
111A 6L."rime4—+ )1/4-3 C.
City or Town 4.
State
4. DATE DRILLED /1 "27/01
e.5. TOTAL DEPTH 3-7'.75`
6. CUTTINGS COLLECTED YES D NO[
7. DOES WELL REPLACE EXISTING WELL? YES ❑ NO[--
8. STATIC WATER LEVEL Below Top of Casing: FT.
(Use "+• if Above Top of Casing)
9. TOP OF CASING IS / FT. Above Land Surface'
• Casing Terminated at/or below land surface is illegal unless a variance is issued
In accordance with 15A NCAC 2C .0118
10. YIELD (gpm): /0 METHOD OF TEST ni !l'
. 11. WATER ZONES (depth): /0VNtt 1( C
IC) rf Z £) - •? S
�} ?.;2 C
Zip Code
DRILLING LOG
Formation Description
n ,` az.
c
o
0
rn
n �n
Q1 rn
-10 --r
3
w g4
Cf1
12. CHLORINATION: Type f1 0 21-t-9'- Amount /y 4'"4 If additional space is needed use back of font
13. CASING:
Wall Thickness LOCATION SKETCH
Depth Diameter or Weight/FL Material (Show direction and distance from at least two State
From To Ft. Roads, or other map reference points)
From le)ToFt 6 �z' t ( 'IeLid
From To Ft.
14. GROUT:
Depth Material
From To Ft
From em To : -3-C Ft 1
15. SCREEN:
Method
Depth Diameter Slot Size Material
From To Ft in in
From To Ft in in
From To Ft in in
16. SANp1GF€AVEL,15ACK ---
I i Depth SiTe Material
Frorr; To Ft i 1 ..1
Fro_ To FL,
17. REM KSt
zi"
I DO HERE �, FKPEY.THATTFnSIWELL W
CON TRUOTIONSTANDARDS,AND 11F1
FOR OFFICE USE ONLY
Quad No
Serial No:
CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
COPY.019THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
Cti`I au
SIGNATU 6F'CONTRACTOR OR AGENT
Submit original to Division of Water Quality and copy to well owner.
GW-1 REV. 1/98
DATE

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
P.O. Box 29578 - Raleigh, N.C. 27626-0578-Pho e [phone]
WELL CONSTRUCTION RECORD DRILLING CONTRACTOR: USpt,ir Dr.tttM
DRILLER REGISTRATION #:
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:
WELL LOCATION (Show sketch of the location below) q C% !
County. 'VA ----h C `1" te
i G Cr; jR. C#1I sL4 D
(Road, Commun1y (Subdivision and Lotio.) n DEPTH DRILLING LOG
3. OWNER 0:.-.44 L7114_0 1,0-:) . From To Formation Description
ADDRESS g . 0 60 )C %i r
(Street or Route No.) Cr-- i 1\% lLi (f fG6.L
Ne 'O ivy e Y.7r„i ✓
City or Town _ State Zip Code ��l�� 1�
4. DATE DRILLED 1 "L S O
5. TOTAL DEPTH ,--.1
6. CUTTINGS COLLECTED YES n NO©r-
7. DOES WELL REPLACE EXISTING WELL? YES I NOI-------
8. STATIC WATER LEVEL Below Top of Casing: F'r p FT.
(Use "+" if Above Top of Casing)
9. TOP OF CASING IS f FT. Above Land Surface'
Casing Terminated at/or below land surface is illegal unless a variance is issued
in accordance with 15A NCAC 2C .0118rel-/ 2
10. YIELD (gpm): S 5, METHOD OF TES
. 11. WATER ZONES (depth): S % {'/''t
o 9
t h�i
t .i_
r.
r
3 —o
t) cn -22
cn
n
12. CHLORINATION: Type (h Amount -__' If additional space is needed use back Norm =
13. CASING:
Depth
Wail Thickness
Diameter or Weight/Ft. Material
From (0 To (COFt & /y
From To Ft
14. GROUT:
Depth Material Method
From To Ft /
From 0 To C' Ft 2 t (Wl
15. SCREEN:
Depth Diameter Slot Size Material
From To Ft in in
From To Ft in in
From To Ft in in
16. SAND/GRAVFI PACK;— 771--,�
[ -dDe�th , Sitel'IIII Material
From j I I r To I-t I I
From l} To Ft : j I i l i
17. REMA
I I
I DO H�REB1f..CERAFY THAT -THIS WELL WA
CONS RUCTION SSTA(NDARDS;AND THAT A
FOR OFFICE USE ONLY
Quad No'
Serial No:
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other map reference points)
e 0
1-Pr IG
TED IN ACCORDANCE WITH 15A NCAC 2C, WELL
S RECORD HAS_RFFN PR JYIDED TO THE WELL OWNER.
SIGNATUREPF CO RA 'OR OR AGENT
Submit original to vision of Water Quality and copy to well owner.
GW-1 REV. 1/98
DATE

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
P.O. Box 29578 - Raleigh, N.C. 27626-0578-Pho e [phone] i2... 3 4 3 8
(dell Dftlllri
DRILLER REGISTRATION #:
WELL CONSTRUCTION RECORD DRILLING CONTRACTOR:
STATE WELL CONSTRUCTION PERMIT#.:
1. WELL USE (Check Applicable Box): Residential Municipal E Industrial ❑ Agricultural E Monitoring E
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATION:, (Show sketch of the location below) /14
Barest To
w/n: // ete-e,n..� •County
(Road, Communibdivision and Lot No.) DEPTH
/
� From To
3. OW
NER ii(? cl / cC den
ADDRESS ZSr 410.6-c 2d
(Street or Route No.)
/0.0,2� ,(/O
City or Town State
5. DATE DRILLED t_ 5. TOTAL DEPTH �S
6. CUTTINGS COLLECTED YES NO
7. DOES WELL REPLACE EXISTING WELL? YES NOR
8. STATIC WATER LEVEL Below Top of Casing: ,;1(J FT.
(Use "+" 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 varianfe is issued
in accordance with 15A NCAC 2C .0118
10. YIELD (gpm):3 METHOD OF TEST irtila
. 11. WATER ZONES (depth): -7,7/0 l& g pt'
12. CHLORINATION: TypeC./C'u/
13. CASING:
Depth
From To Ft
From C To Ft. Lee
e
From To Ft
oy7sz
Zip Code
14. GROUT:
Depth
From To Ft
From'n` To r)'O Ft
15. SCREEN:
Material
Depth Diameter Slot Size
From To Ft in in
From To Fm-.= -'+ in
From Et.____r ifri \ 1 , ` in
16. SAND/ I L' _ ---- , I I
1 i n , epth Size
From ) t A \l To Ft
From ' i To Ft
17. REMA
5%'. to3
DRILLING LOG
Formation Description
atP
I�i2t
/L.9s-/,-y4a
0
n n
ern-1 -
1-1
Ql
-o -*
= r-t
rz
r.�
Amount � If additional space is needed use back gfjfprm 2
^� a
Wall Thickness
Diameter or Weight/Ft. Material
Method
Material
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other map reference points)
1 DO HER Y HAT -THIS WELL WAS CON
CONSTRUCTION STANDARDS, AND THAT A COPY
FOR OFFICE USE ONLY
Quad No
Serial No:
RUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
THIS R _ORD - _ EEN "OVIDED TO THE WELL OWNER.
7
r81..i • TURE Fri NTRACTOR OR AGENT
Submit origin.) t.%ivision of Water Quality and copy to well owner.
GW-1 REV. 1/98
DATE

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
P.O. Box 29578 - Raleigh, N.C. 27626-0578-Pho e [phone]
WELL CONSTRUCTION RECORD
DRILLING CONTRACTOR:
DRILLER REGISTRATION #
STATE WELL CONSTRUCTION PERMIT#:
243424
g tore, tutu brml
0 (MAD
1. WELL USE (Check Applicable Box): Residential lak Municipal ❑ Industrial C Agricultural 0 Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: Mart-<-EW County
yyC 4
(Road, Community, or Subdivisjpon and Lot No.)
3. OWNER /41 l 0_1 Q
ADDRESS aSQ &erase C`,` RS
(Street or Route No.)
City or Town S(a'`te)c
4. DATE DRILLED
5. TOTAL DEPTH
6. CUTTINGS COLLECTED YES n NOH..r
7. DOES WELL REPLACE EXISTING WELL? YES
8. STATIC WATER LEVEL Below Top of Casing:
Zip Code
NO
FT.
(Use "+" 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
in accordance with 15A NCAC 2C .0118
10. YIELD (gpm):r-�it) METHOD OF TEST 414-
11. WATER ZONES (depth): IXVisa
cS ��tY
12. CHLORINATION: Type e Amount
13. CASING: 6C
Depth
From To
From To
From To
14. GROUT:
From
From
Ft
o7Ft.
Ft
Depth
To Ft
To [I Ft
15. SCREEN:
Depth
From To Ft
From To Ft
From To Ft
Diameter
Wall Thickness
or Weight/Ft. Material
Material
Method
Diameter Slot Size Material
in in
16. SAND/GRAVEL PACK:
From
From ,.» o Ft
17. REMARKS: II II J
LJ
in in
in in
Sr-- Material
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTR
CONSTRUCTION SRAN.ARCS,-AND THAT-AEOPY F�
i
FOR OFFICE s bNL`-
Quad No.
Serial No:
DEPTH
From // To
Q,- r WC
in0 --/ko
DRILLING LOG
Formation Description
0
O
rn
m
c�
r+t
Ol "c
rn
yc
rn
Ca nz
rnz
If additional space is needed use back plonn-
c
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other map reference points)
/Via
,17
Ca
CTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
115 RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
SIZ,ICATURE 0 C
Submit original to D
RACTOR OR AGENT
sion of Water Quality and copy to well owner.
GW-1 REV. 1/98
DATE

243425
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
P.O. Box 29578 - Raleigh, N.C. 27826-0578-Pho e [phone]
WELL CONSTRUCTION RECORD DRILLING CONTRACTOR C% D I�l�
DRILLER REGISTRATION #• / (50
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE (ChedkApparable Box): Residential Er —Municipal 0 Industrial ❑ Agricultural 0 Monitoring 0
Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below) v+ A r+n n
Nearest Town: � (%LL47V" County�
- 6lP.i"2
(Road, Commt ity, or Subdivision and Lot No.) DEPTH DRILLING LOG
3. OWNER C$bt * r From To Formation Description
ADDRESS - 1 f iy Ili •t YZ L
(Street or Route No.)
WI t®tIGw
City or Town
4. DATE DRILLED 4
5. TOTAL DEPTH ,
6. CUTTINGS COLLECTED YES ❑ NO
7. DOES WELL REPLACE IXISTING WELL? YES ❑ NO©r
8. STATIC WATER LEVEL Below Top of Casing: FY) FT.
(Use •+- if Above Top of Casing)
9. TOP OF CASING IS I FT. Above Land Surface
• Casing Temiiialed at/or below land surface is negS unless a variance is issued
In accordance with 15A NCAC 2C .0118
10. YIELD (gpm): METHOD OF TEST 41 A-
ll. WATER ZONES (depth)* 6,9.0 ""' .' So
o- `To a%/[i
70 - 36C
State
2Y7.S 2
Zip Code
c
O O
a
n cam,
Ac
DC �-
rnz
ca 7e.
rn
PO p
,7
12. CHLORINATION: Type deo-Lc(p� Amount 7i7 �-I" If additional space is needed use back of form
13. CASING:
Depth
From To
From © To 79
From To
14. GROUT:
From
From r
15. SCREEN:
Wal Thickness
Diameter or Weight/FL Material
Ft. �—
Ft--�l17 `f v a—
n.
Depth Material Method
To Ft. /
To 2O Ft -2Gt
Powe
Depth Diameter Slot Size Material
From To Ft in In
From To Ft in in
From To Ft in in
16. SAND/GRAVEL PACK:
From
From
17. REMARKSt'.
IDOH
CONSTRi
FOR OFFICE UJSE29IMLY
Quad No•
Serial No:
Ft
Material
SIGMA
Submit original to
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other map reference points)
e
tog)
N t
Iotm LC
IN ACCORDANCE WITH 15A NCAC 2C, WELL
IS RECORD HAS PROVIDED TO THE WELL OWNER.
CTOR OR AGENT DATE
of Water Quality and copy to well oener.
GW-1 REV. 1/98

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
P.O. Box 29578 - Raleigh, N.C. 27626-0578-Pho e [phone]
WELL CONSTRUCTION RECORD
DRILLING CONTRACTOR:
243426
DRILLER REGISTRATION #: (1 2156
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE (Check Applicable Box): Residential G' 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: 3M T6 — County.,
Rtnc D',&uk-. cs4wkit r b
(Road, Community, or Subdivision and Lot No.)
3. OWNER k.w wIt (wLA-
ADDRESS le 6T D i w14- (ihw`^
(Street or Route No.)
VU IA14 s (N
City or Town State
4. DATE DRILLED r 1f 6�
5. TOTAL DEPTH b5
6. CUTTINGS COLLECTED YES NOQ-
7. DOES WELL REPLACE EXISTING WELL? YES ❑ NOLL�/
8. STATIC WATER LEVEL Below Top of Casing: Coo FT.
DEPTH
From To
2, Y7 :1-2--
Zip Code
Vb' Los —
(Use "r" if Above Top of Casing)
9. TOP OF CASING IS 1 FT. Above Land Surface •
• Casing Terminated at/or below land surface is illegal unless a variances issued
In accordance with 15A NCAC 2C .0118
10. YIELD (gpm): IR> METHOD OF TEST A J 12-
. 11. WATER ZONES (depth): 66C, ,a C> /
12. CHLORINATION: Type 0-64--tenc Amount (/1,! t
13. CASING: /
From
From
From
14. GROUT:
Depth
To Ft
To— Ft.-:�
To Ft.
From
From 0
15. SCREEN:
Depth Diameter Slot Size
From
From
From To Ft in.
16. SAND/GRAVEL PACK:
Wall Thickness
Diameter or Weight/FL
Material
Material
Method
Depth
To Ft.
To 20 Ft.
To Ft
To Ft
From
From
17. REMAR
IDOHE
CONSTR
Depth
To
To
in
in
Size
Ft
Ft.
I�Ov
Material
in
in
in
Material
ERTIFYTRAT rHIS WELL
STANDARDS, AND THA
‘? li
j
FOR OFFI
Quad No -
Serial No:
-U§. ONLY
DRILLING LOG
Formation Description
(tvuv u ✓�
C
o
v
n c=�
CD
>o
If additional space is needed use back of9irm ,s
n
LOCATION SKETCH N o
(Show direction and distance from at least two State
Roads, or other map reference points)
ONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
Y OF THIS RECORD BEEN PAR /IDED TO THE WELL OWNER.
SIGNATURE OP'CO
Submit original to Davis!
CTOR OR AGENT DATE
of Water Quality and copy to well owner.
GW-1 REV. 1/98

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section 0 4 3 0 tJ
1636 Mail Service Center - Raleigh, N.C. 27699.1636-Phone [phone] - / twill WELL CONSTRUCTION RECORD WELL CONTRACTOR_ JT UST(L6 twill Urttli j
WELL CONTRACTOR CERTIFICATION #: .P /5-0
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE (Check Applicable Box): Residential Municipal ❑ Industrial 0 Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other In If Other. List Use:
2. WELL LOCATION: Show sketch of the location below)
Nearest Town-'"`- County:
V'° ILA' DEPTH
(Road Name Numbers, Community, or and Lot No.) DRILLING LOG
3. OWNER f,-A'Dk 0 . JL'GYCf'1t7"' / From To Formation Description
Address 5 7 2. /y t t eteri9r_c!�''1i. 4 (id r
(Street or Route No.I V 0 l V ��e'�
Wt. Ay-10W N i - 4 -?sz e�'��
City or Town State 57)--'p node r>f G oft,--------
.-C�-
4. DATE DRILLED _ I)`
5. TOTAL DEPTH
6. CUTTINGS COLLECTED YES ❑ NO[��
7. DOES WELL REPLACE EXISTING WELL? YES n NO©----
8. STATIC WATER LEVEL Below Top of Casing: 4-0 FT.
(Use'+ If Above Top of Casing)
9. TOP OF CASING I5 i FT. Above Land Surface'
'Top of easing terminated error below Land surface requires a variance In accor-
dance with 1SA NCAC 2C.8118
10. YIELD (gpm): l METHOD OF TEST II/ it-
1 l . WATER ZONES (depthp 4,4930 Ca 60 yo rit
12. CHLORINATION: Type Amount
13. CASING:
Depth
From 0 To 2 Ft
From P1 To 57 Ft.
From To Ft
14. GROUT:
Wal Thickness
emir�nua " `w
itd �oYG
Depth Material Method
From To Ft From ( To QD Ft 2;4 / c� irl`"i
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:
1 DO(HE CERTIFY THAT THIS
CON$TRUC RON STANDARD
l('\ •
FOR toi `-eE USE ONLY
Quad .a.+.r� �UCTINGTREWELL DATE
iI ,
--II'' 1 Su
.. _._..__._� tum odpkw a Division of w � a+aliry. Groundwater Section within 30 days
Sedatrva.
a--J
c
O
s -Crn
>0
.yam
1f additional space is needed use back of Rim -D
r;? rn
LOCATION SKETCH al y
(Straw direction and distance from at (east twdState Z
Roads, or other map reterence points)
ACCORDANCE WITH 15A NCAC 2C, WELL
r HAS BETO THE WELL OWNER.
Ow-1 REV. 12/99

North Carolina - Department of Environment and Natural Resources - Division of Water quality - Groundwater Section
P.O. Box 29578 - Raleigh, N.C. 27626-0578-Pho e [phone]
WELL CONSTRUCTION RECORD
DRILLING CONTRACTOR:
DRILLER REGISTRATION#: tI /5�
STATE WELL CONSTRUCTION PERMIT#:
243428
1�1e11 Ord bi^,
1. WELL USE (Check Applicable Box): Residential ii Municipal 0 Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other 0 If Other, List Use:
WELL LOCATION: (Show sketch of the location below)
Nearest Town: /v1 grib,) County
CSt-t0�-F24
IYt C-06az-€
(Road, Community, or S ivision and Lot No.) DEPTH
3. OWNER 11Q ')k j 9,LS-0 From To
ADDRESS U
04 /,1>-
City or Town
(Street or Route No.)
NZ
State
4. DATE DRILLED 20/ D/
5. TOTAL DEPTH /25`
6. CUTTINGS COLLECTED YES ❑ NO
7. DOES WELL REPLACE EXISTING WELL? YES ❑ NOFX
8. STATIC WATER LEVEL Below Top of Casing: )1 FT.
(Use'+• 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
In accordance with 15A NCAC 2C .0118
10. YIELD (gpm):50 METHOD OF TEST /19/�
11. WATER ZONES (depth): 305j+ e /ao r (�
12. CHLORINATION: Type elet u"`1' Amount (y9 erd
13. CASING:
2 )f ?fZ
Zip Code
6- 70
/2�
From
From
Depth
To Ft
To 3O Ft. 64/
Wall Thickness
Diameter or Welght/FL Material
From To Ft.
14. GROUT:
4/O
Depth Material Method
From To Ft.
From 0 To °FL 21/ lawel
15. SCREEN:
Depth Diameter Slot Size Material
From To Ft in. in
From To FL in in
From To Ft. in in
16. SAND/GRAVEL PACK:
Depth
From To
From To
17. REMARKS:
Size
Ft.
Ft
Material
DRILLING LOG
Formation Description
/Lf
O
'r
n
o
rn
1,1
to
If additional space is needed use badcaftfomf
z
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other map reference points)
1 DO HEREBY a RT1FV TRAT THIS WELL WAS
CONSTRUCTIO ?STANDARDS, AND THAT A
Ali I
NI Su
rICF
UCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
TORE OF
original !E
NTRACTOR ORAGENT DATE
Division of Water Quality and copy to well owner.
GW-1 REV. 1/98

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
P.O. Box 29578 - Raleigh, N.C. 27626-0578-Pho e [phone]
WELL CONSTRUCTION RECORD DRILLING CONTRACTOR: `t 4 9
7*- -7Z 50 DRILLER REGISTRATION #: ,� I 5-0
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE (Check Applicable Box): Residential (J Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection D Other 0 If Other, List Use:
WELL LOCATI914: (Show sketch of the location below)
Nearest Town: County.
nc2.2I- 2UP
(Road, Com^m/pity, or Subdivision and Lot No.)
3. OWNER CAA 4/.20 /.41-)'&/f
ADDRESS 130x to R!
�^1��� (Street Of Route No.)
City-orTwm tate
4. DATE DRILLED 9/.17/ OI
5. TOTAL DEPTH "/fQS
6. CUTTINGS COLLECTED YES n NOLJ
7. DOES WELL REPLACE EXISTING WELL? YES n NO©—'
8. STATIC WATER LEVEL Below Top of Casing: wo FT.
(use •+• 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
in accordance with 15A NCAC 2C .0118
10. YIELD (gpm): /5 , METHOD OF TEST Alt
. 11. WATER ZONES (depth). /ti, G 390'
12. CHLORINATION: Type
13. CASING:
ij4 bow-c._ ...t
DEPTH
From To
(Q Fist
Tip Code
Depth
From To Ft
From 0 To 7 Ft.
From To Ft
14. GROUT:
From
From
15. SCREEN:
Amount
Wall Thickness
Diameter or Weight/Ft. Material
Depth Material Method
To Ft
To c6tj Ft. r r
Depth
From To
From To
From To
Diameter Slot Size
Ft in in
Ft in In
Ftin. in
16. SAND/G _,
eith , _ Size i Material
From I;1�ilo �Ft.
From �i To Ft. �i
17. REMARK$a,.j Li' i- I
I DO H CEkTIflTHATTHISAVELSWAS C
CONSTRON STANDARDS, ANb THAT A COI
FOR OFFICE USE ONLY
Quad No.
Serial No:
DRILLING LOG
Formation Description
o
o E.2.n
I
n
o`"r
r— c,
0
no
s -
If additional space is needed use bacic4 Than
LOCATION SKETCHN
(Show direction and distance from at least two State
Roads, or other map reference points)
NSTRUCTED IN ACCORDANCE
PWITH 15A NCAC 2C, WELL
f OF IS REC�Fi6 J ROVIDED TO THE WELL OWNER.
SIGNATURE
Submit origin
CONTRACTOR OR AGENT
to Division of Water Quality and copy to well owner.
GW-1 REV. 1/98
DATE

(Street or Route No.)
Ne'
p State
4. —1i— 0/
5. TOTAL DEPTH goy'
6. CUTTINGS COLLE TED YES El NO�
7. DOES WELL REPLACE EXISTING WELL? YES ❑ NO11,-
8. STATIC WATER LEVEL Below Tap of Casing: jam, c>> FT.
(Use'+' IfAhove Top of Casing)
9. TOP OF CASING IS FT. Above Land Surface •
Casing Temuhlated atlor below land surface is illegal unless a variance is issued
In accordance with 15A NCAC 2C .0118
10. YIELD (gpm):1i_ METHOD OF TEST 7/
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
P.O. Box 29578 - Raleigh, N.C. 27626-0578-Pho a [phone] 2 ,2 3 3 5 2
WELL CONSTRUCTION RECORD DRILLING CONTRACTOR: / (Ate Dt11Ji)9
DRILLER REGISTRATION #: 1 „9 1 ' n
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE (Check Applicable Box): Residential (2 Municipal I Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town• JyJ(ZIAC•-P= County__ IN —2 %1 etC.{
(Road. Comm
3. OWNER
ADDRESS
Suttdr'sMion ;3_nd Lot No.)
DEPTH
From To
�
Clty or Tam
DATE DRILLED
From U
Fro Lo
Frori ' Xl,�2 )
14. GROUT: O
From
From C)
15. SCREEN:
oP 7S2 °—.7GU
Zip Code
9�._ -2,4
. 11. WATER ZONES (depth) I SC/c*t )280
12. CHLORINATION: Type
13. CASING:
DTo�/ to
To :932G
To .;23�r
40S
Depth
To Ft.
To _ Ft.
Diameter
Ft O(�'
Ft.
Ft & Ye/
Amount 7 yre,-%)
Wad Thickness
or Welgtd/Ft. Material
0 pu-e
eel P
FCC
Material Method
LIB.
Depth Diameter Slot Size
From To Ft in
From To Ft. in
From To Ft. in.
16. SAND/GRAVEL PACK
From 1_1 ffo [ ; [FL
L`,
From Iai • Ft.
17. REMARK
J
1 DO H =: CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
ON STANDARDS, AND TWT A COPY q1F THIS RECORD HAS BJFN PROVIDED TO THE WELL OWNER.
c';,ri' II' II,NAT.-P Qn7TION,
FOR OFFICE USE ONLY h P r :.'_ 0!- 0
Quad No• SIGNATURE3W CTOR OR AGENT DATE
Serial No: Submit original to Division of Water Quality and copy to well owner.
GW1 REV. 1/98
Material
in
in
in
Material
DRILLING LOG
Formation Description
gale -
O s_
v
n
4;"
�_ m
Ql
If additional space is needed use back forrr►; a
GJ N �
LOCATION SKETCHext y
(Show direction and distance from at leastRwo Stage
Roads, or other map reference points)
4

North Carolina - Department of Environment and Natural Resources - Di Aston of Water Quality - Groundwater Section 2 4 3 3 5 3
P.O. Box 29578 - Raleigh, N.C. 27626-0578-Pho e [phone]
WELL CONSTRUCTION RECORD DRILLING CONTRACTOR: 2e Tht
he II 'IAlt ittj
DRILLER REGISTRATION #: /� rr� r7
STATE WELL CONSTRUCTION PERMIT#: <2 15z)
1. WELL USE (Check Applicable Box): Residential Er -Municipal El Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: inLQ Lt t9> County / // C L d-
(Road, Community. or SubdMsion and Lot»o.) DEPTH
3. OWNER F t. t (-all From To
ADDRESS / / &nf/��•.� m y9P-r? 02ny„ t;ry,,
(Street or Route No.) 0 - (G 4 , /Z-t
12 a4A_ r 1'J! „Vjz!sz
City or Town State Zip Code -
4. DATE DRILLED 9. - 0/ /0") - Z9O
5. TOTAL DEPTH 30 ar
6. CUTTINGS COLLECTED YES ❑ NO[ 2f - 3 0S /'yt el /era
7. DOES WELL REPLACE EXISTING WELL? YES ❑ NOR--
13. STATIC WATER LEVEL Below Top of Casing: E, p FT. c
0
DRILLING LOG
Formation Description
(Uee'+• ifAbove 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
in accordance with 15A NCAC 2C .0118
10. YIELD (gpm): METHOD OF TEST
. 11. WATER ZONES (depth)• C O ,g, n G?
rZ
12. CHLORINATION: Type
13. CASING:
Depth Dieter
From 0To f`I Ft ��
From--(('ti To MD Ft. C ry
From IPA To (9 4 Ft. (e)* ' F (1.416
qv-at
Wap Thickness
or Weight/Ft tertal
4/0
i U ct
14. GROUT:
S7f-~-'iZ.J&
v c? -
I c^
I o_
vc
-b
-1-,
1'71c
If additional space is needed use backef fon€3
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other map reference points)
Depth Material Method
From To Ft /
From U To .7 Ft. .0 GI Pfw
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 !>` v,
From To Ft
From To Ft.
17. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS
CONSTRUCTION STANDARDS. AND THAT A COPY
FOR OFFICE USE ONLY
Quad No.
Serial No:
`Si NATURE
Submit original to
0
i
22/ -ZTh
IN ACCORDANCE WITH 15A NCAC 2C, WELL
Ct7�8 FM� BEN PROVIDED TO THE WELL OWNER.
Th
CTOR ORAGENT DATE
Won of Water Quality and copy to well owner.
GW-1 REV. 1/98

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section '4 O A r� aj 4 2 3
P.O. Box 29578 - Raleigh, N.C. 27626-0578-Pho a [phone] /-
DRILLER REGISTRATION # .cx / 6-0
WELL CONSTRUCTION RECORD DRILLING CONTRACTOR:
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE (check Applicable Box): Residential 13. Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATION: (Show -sketch of the location below)
Nearest Town: ©et2-6Y--- County'
(Roa , Community, or Subdivision and Lot Nod 1�,, DEPTH
3. OWNER B.LLyIR birztf$w c WIt4+2Czt4+r%�S.)Uttisbi From To
ADDRESS r7$ `8o f7egone 4d doe14%1,
(Street or Route No.) n� ���
tit t4r;ou N G c
City or Town State Zip Code
4. DATE DRILLED Sr.-
81 DI
5. TOTAL DEPTH
6. CUTTINGS COLLECTED YES 7 N0[ (
7. DOES WELL REPLACE EXISTING WELL? VES n NOr,
8. STATIC WATER LEVEL Below Top of Casing: (4)0 FT.
(Use "+" 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
in accordance with 15A NCAC 2C .0118
10. YIELD (gpm): 4_0 METHOD OF TEST /t%2
. 11. WATER ZONES (depth): 2Of Perm P 2 (P 0
cL,fe_OS
/y0-6284-
DRILLING LOG
Formation Description
tat rr
r^
ar-
o r
o -71
U1
-121 r'rt
P+
0 co
r1f c'
rV o
12. CHLORINATION: Type Amount///fa If additional space is needed use back of form
13. CASING:
G yu_ 1.8
o z (0(4 Wall Thickness
Depth Diameter or Weight/Ft. Material
From a To yZ Ft Ct�tt PUL
From �y4 To /(0s Ft ��� �d �U�°
From To Ft
14. GROUT:
Depth Material Method
From To Ft
From 0 To `%O Ft 41
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 } Te --Ft
17. REMAR
I DO HE
CONSTR
r—
ERTIFY THAT THIS WELL
T N STANDARDS, ANUXTHAT
FOR OFFI4E USAF ONLY
Quad No:
Serial No:
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, orother Map reference points)
t
Cs<
Ciry�%
r
,47
�uf/eee/esG'&
/lt
ONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
PY OF LiE RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
SIG r TURE OF ONTTOR OR AGENT
Submit original to Divis . of Water Quality and copy to well owner.
GW-1 REV. 1/98
DATE

�,?3/?22
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
P.O. Box 29578 - Raleigh, N.C. 27626-0578-Pho e [phone]
WELL CONSTRUCTION RECORD DRILLING CONTRACTOR:
DRILLER REGISTRATION #:
z Bell brti t1
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE (Check Applicable Box): Residential Ell , Municipal [] Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other If Other, List Use:
WELL LOCATION: (Show sketch of the location below)
Nearest Town: /��%Ii'r�'1C County
/7'7 rh'c;2J - 71.(k/z,
(Road, Community or Subdivision and Lot No.) DEPTH DRILLING LOG
3. OWNER 1- I L I� v 0 From To Formation Description
ADDRESS / 7 'i v / -' ( ,)1 E (' ,'Iz 1 (,
(Street or Route No.)
$ City or Town State Zip Code
4. DATE DRILLED S — / '- Cr' /
5. TOTAL DEPTH / ? , C
6. CUTTINGS COLLECTED YES❑ NOD
7. DOES WELL REPLACE EXISTING WELL? YES D NO Pi
8. STATIC WATER LEVEL Below Top of Casing: (lin': FT.
(Use'+' if Above Top of Casing)
9. TOP OF CASING IS / FT. Above Land Surface'
' Casing Terminated at/or bebw land surface is illegal unless a valiance is issued
In accordance with 15A NCAC 2C .0118
10. YIELD (gpm): .el METHOD OF TEST t'
. 11. WATER ZONES (depth)• . -`:1,)," 'sr C
12. CHLORINATION: Type (7e ee /
13. CASING:
Amount ,'?c z-7
/
5(5
/err, �--t
m �^
�, CC.
Ql E ri
s
If additional space is needed use back of form
Wad Thickness LOCATION SKETCH
Depth Diameter or Weight/Ft Material (Show direction and distance from at least two State
From To FL Roads, or other map reference points)
From �' To '2(; Ft. ('L, ems., f.(i rr ,F. : 5i: klµkl,:;`1
From To Ft
14. GROUT: n
Depth Material Method
From To Ft.
From ( To "c Ft. (�iiI f�(,(7(.tid7
i
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
From
17. REMARKS
1DOHE
CONSTRU
To Ft.
To Ft.
4-11
FY THAT THIS WELL W/
ANDARDS, ANDTHATA
FOR OFFICE
Quad No:
Serial No:
USE ONLY
ONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
jY OF IS RECO 13-- N PROVIDED TO THE WELL OWNER.
SIGNATUI{E OF C NTRACTOR OR AGENT DATE
Subm
it original to division of Water Quality and copy to well owner.
GW-1 REV.1198

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
P.O. Box 29578 - Raleigh, N.C. 27626-0578-Pho e [phone]
WELL CONSTRUCTION RECORD DRILLING CONTRACTOR:
DRILLER REGISTRATION #: () 091'
STATE WELL CONSTRUCTION PERMIT#:
243'y //"fl ti
1. WELL USE (Check Applicable Box): Residential WV —Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATIO (Show sketch of the location below) ��G�
% Nearest Town: County' /1
rt t eawne,,r. ,-
(Road, Commu Ty, or Subdiliof No.)
3. OWNER Neal 417.4 /- ��/
ADDRESS y49 d),Nc. C4MJrv8L!
J �
(Street or RouteNo.) 387S
G
State Zip Code
€10,
City or Mown
4. DATE DRILLED
5. TOTAL DEPTH - ,4
6. CUTTINGS COLLECTED YES n NO
7. DOES WELL REPLACE EXISTING WELL? YES NO
8. STATIC WATER LEVEL Below Top of Casing: FT.
(Use "+" 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
in accordance with 15A N C 2C .0118
10. YIELD (gpm): ) METHODq�OF TEST i
. 11. WATERZONES(depth): Ae)9Z9M e 2C,d
DEPTH DRILLING LOG
From To Formation Description
12. CHLORINATION: Type 61 ' f3 Amount
13. CASING:
Wall Thickness
Depth /Diameter or Weight/Ft.
From To
From 1) To Ft. C77r Zip
From To Ft
14. GROUT:
c
to CA
UT
If additional space is needed use back ofS ?m o
LOCATION SKETCH
Material (Show direction and distance from at least two State
l Roads, or other map reference points)
Depth Material Method
From To Ft
From 0 To Ft n7*
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. REMARIfq--1 I'-:
I DO HEREBY.CERTIFYTRATlHTS WELL
CONSTRIIIETIQN STANDARDS, AND THAT
i
J
,_ESTICaNI
Q
43 ONST UCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
14 Y CjFJFfIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
SIGNATURE OF
Submit original to
TRACTOR OR AGENT
vision of Water Quality and copy to well owner.
GW-1 REV. 1/98
DATE

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
P.O. Box 29578 - Raleigh, N.C. 27626-0578-Pho a [phone]
WELL CONSTRUCTION RECORD DRILLING CONTRACTOR (
DRILLER REGISTRATION #• 2 l S©
STATE WELL CONSTRUCTION PERMIT#:
229238
641 DY.II.1
1. WELL USE (Check Applicable Box): Residential ❑ Municipal Dv.
Industrial ❑ Agricultural ❑ Monitoring 0
Recovery 0 Heat Pump Water Injection 0 Other ❑ If Other, List use:
WELL LOCATION: (Show sketch of the location below)
Nearest Town: County
Ikea Phk 4d
(Road. Community, or Subdivision and Lot No.) DEPTH DRILLING LOG
3. OWNER /4-/cti-L4-okiA-t+ 17.14-14-5 From To Formation Description
ADDRESS 42 b .90X4-0, l44 otra,a ( Route No.) 9Gp
7/ (0- go fp i /
City or Town 8 State Zip Coder D � -< c/S &r.4 r2 Le
U
4. DATE DRILLED (4
5. TOTAL DEPTH 3 4 }r
6. CUTTINGS COLLECTED YES NOE
7. DOES WELL REPLACE EXISTING WELL? YES ❑ NOQ/
8. STATIC WATER LEVEL Below Top of Casing: to FT. c o
(Use •+• IfAbove Top of Casing) -- c-a
9. TOP OF CASING IS / FT. Above Land Surface •
*Casing Terminated at/or below land surface Is Illegal unless a variance is issued -
(V
In accordancewith 15A NCAC 2C .0118
10. YIELD (gpm)• — METHOD OF TEST 4t'
11. WATER ZONES (depth)' €i c (QAl Cc' 32 o = r^-�o
12. CHLORINATION: TypeC '/27
13. CASING:
—O .N2
Amount (r7 ca If additional space is needed use bads of fonE2
_
vvM Thidobss LOCATION SKETCH
Depth Diameter or Weight/FL Material (Show direction and distance from at least two State
From To (J FFt t. " 'V t Roads, or other map reference pants)
From To �' `�
From To Ft
14. GROUT:
Depth Material Method
From To Ft. r
From 0 To 2 C Ft. CI IV
15. SCREEN:
Depth Diameter Slot Size Material
From To Ft in in.
From To Ft. in in
From To Ft. in. (n
16. SAND/GRAVEL PACK
Depth Size Material
From To Ft
From
17. REMARKS:
To
Ft.
0
Dtkit
I DO HEREBY CERTIFY S WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION ST - r -, A. THIS RECORD HAS BEEN PROVIDE) TO THE WELL OWNER.
t t ''D ,off') _ —
oRAGENT DATE
f !Omit origins! to D1vWon of Water Quality end copy to wed owner.
GW-1 REV. tree
Groundwater Section
Asheville Re'out Office

Material Method
Diameter Slot Sim Material
Ft 4n In
Ft. In. in
Ft In.
lorth Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1.0. Box 29578 - Raleigh, N.C. 27626-0578-Pho e (919) 7333221
NELL CONSTRUCTION RECORD DRILLING CONTRACTOR:
239239
Qfate WukRI
DRILLER REGISTRATION #: OBI/6-6
STATE WELL CONSTRUCTION PERMIT#:
Z.
WELL USE (Check Applicable Box): Residential El Municipal 0 Industrial ❑ Agricultural ❑
Recovery ❑ Heat Pump Water Injection ❑ other ❑ If Other, List Use:
WELL LOCATION: (Show sketch of the location below)
Nearest Town: 0 C b fC County:
M-c-OcoieL.L
✓oe(C• el l:_rci4'_ rc
(Road. Community,or Subdivision and tot No.)
3. OWNER L y4-% e �y(� k�"
ADDRESS &t ort 2-ofe Ccr ¢- c
(�Q4 - (StreetarRoute No.)
City or T nI1State np Code
4. DATE DRILLED ' 322 01
5. TOTAL DEPTH ,,2o5'
6. CUTTINGS COLLECTED YES ❑ NOEV
7. DOES WELL REPLACE EXISTING WELL? YES ❑ NO©--
8. STATIC WATER LEVEL Below Top of Casing: 6r, FT.
(Use %" ifAbova Top of Casing)
9. TOP OF CASING 1S r FT. Above Land Surface
• Casing Terminated aVor below land aafate is illegal unless a valiance Is issued
In accordance wdh 15A NCAC 2C .0118
10. YIELD (gpm): 2Z0 METHOD OF TEST Art Kt'
11. WATER ZONES (depth)• 705. p/vt I S °
12. CHLORINATION: Type Q-L" -"'<< Amount 7 q
13. CASING:
DEPTH
From To
Wad Tlddoress
Depth Diameter or Wdgtni a Material
From To Ft
From O Tor Ft.--J�-Vg
lit)
From To Ft.
14. GROUT:
Depth
From To Ft
From f) ,ToL°Ft L%
15. SCREEN:
Depth
From To
From To
From To
16. SAND/GRAVEL PACK
Depth
To
To
From
From
17. REMARKS:
IDO HEREBY
CONSTRUCTIO
Size
Ft.
Ft.
in
Material
Monitoring ❑
DRILLING LOG
Formation Description
(r fzAvu 'ace
0
y
-
o
0a
c
c
N a<
If additional space is needed use back etforme,
LOCATION SKETCH
(Show direction and distance from at least two State
Roads. or other map reference points)
e
11
a
g41 c goe ,ej
IN ACCORDANCE WITH 15A NCAC 2C, WELL
F THIS RECORD HAS = '-a PROVIDED TO THE WELL OWNER
_...y sIGNATURE of
Oub it original to
`iar.
CTOR ORAGENT DATE
of Water Quality and copy to wed owner.
GW-1 REV. 1/98

North Carolina - Department of Environment and Natural Resources • Division of Water Quality - Groundwater Section
P.O. Box 29578 - Raleigh, N.C. 27626-0578-Pho e [phone]
WELL CONSTRUCTION RECORD DRILLING CONTRACTOR WADr-t�,k�
DRILLER REGISTRATION #: / 5-6
STATE WELL CONSTRUCTION PERMIT#:
n?92".i0
1. WELL USE (CheckApplicable Box): Residentia112r Municipal Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
WELL LOCATION: (Show sketch of the location below)
Nearest Town: A WY
-�fb
C IYGI—e.
County.,
M Del
3. OWNER ;((Road, Community, or Subdivision and Lot No.) DEPTH DRILLING LOG
UAL et s. 'i From To Fonnation Description
ADDRESS MA vcicri C? cc (...--
(Street or Route No.)
fM Ar a.r tit C 7f'75 2-
City or Town O State Zip Code
4. DATE DRILLED 0 -12t-o I
5. TOTAL DEPTH /v oS
6. CUTTINGS COLLECTED YES E NOES
7. DOES WELL REPLACE EXISTING WELL? YES ❑ NO[j
8. STATIC WATER LEVEL Below Top of Casing: 36 o FT.
(Use "+" IfAbove 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
in accordance with 15A NCAC 2C .0118 /n
10. YIELD (gpm)• I �r
METHOD OF TEST / cz
. 11. WATER ZONES (depth). tTAI {Pr .t' 6— CO
O - ye eiff-/4iD
12. CHLORINATION: Type Ij%orc k AmountkkJ5'
13. CASING: /
-D cm
IV 6-77.
Sm
Dc
So.
a m�
n rnz
, ..N
c-�
ro -o
If additional space is needed use back of form
Wall Thickness LOCATION SKETCH
Depth Diameter or Weight/Ft. Material (Show direction and distance from at least two State
From To C� Ft.� �JJ —fir Roads, or other map reference points)
From To 7 7 Ft. / `/ `YO T -
From To Ft
14. GROUT:
Depth
From To Ft
From_ To 2a Ft
15. SCREEN:
Material Method
Depth Diameter Slot Size Material
From To Ft in in
From To Ft. in in
From To Ft in in
16. SAND/GRAVEL PACK
Depth Size Material
From To Ft.
From To
17. REMARKS:
Ft.
c•
I DO HEREBY CERTIFY THAT THIS WELL WAS CONS
CONSTRUCTION ST
FOR OFFICE USE 0
Quad No*
Serial No.
Croundwater Section
Asheville Re:'onal Office
UCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
THIS RECORDBEEN PROVIDED TO THE WELL OWNER.
{SIGNATURE OCTOR OR AGENT DATE
$db(nit origina✓to Divl of Water Quality and copy to well owner.
GW-1 REV. 1/98

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
P.O. Box 29578 - Raleigh, N.C. 27626-0578-Pho e [phone]
�39-249
WELL CONSTRUCTION RECORD DRILLING CONTRACTOR:
DRILLER REGISTRATION #
STATE WELL CONSTRUCTION PEkMIT#: : /`3 U
1. WELL USE (check Applicable Box): Residential Municipal ElIndustrial E Agricultural ElMonitoring ElRecovery ❑ Heat Pump Water Injection Other ❑ If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: County
r //
47 /J � / ,f( /—/
(Road, Commuhity,yr$IlbdlV4ion ana Eot `No.) r�\ DEPTH
3. OWNER 4 T `1 ' From To
ADDRESS / yYy
� 2' (Streg( df houte'No.) /`'`--
- fWi Ftown�"' 'y ' SIt'. - . p�Cotle
4. DATE DRILLED O r
5. TOTAL DEPTH 6'
DRILLING LOG
Formation Description
A
,, .!>
6. CUTTINGS COLLEGYT YES n NO
7. DOES WELL REPLACE EXISTING WELL? YE5-ri NO =
8. STATIC WATER LEVEL Below Top of Casing: FT.
(Use "+° if Above TopPa�asing)
9. TOP OF CASING IS / FT. Above Land Surface * N o C
Casing Terminated at/or below land surface is illegal unless a variance is issued o
in accordance with 15A NCAC 2C .0118 A
10. YIELD (gpm)' { METHOD OF TEST r, , 2 = No
11. WATER ZONES (depth): At' /- �G cr'ia
—+
12. CHLORINATION: Type Likt-e)e, Amount /
13. CASING:
o
If additional space is needed use back of form z
Wall Thickness LOCATION SKETCH
Depth Diameter or Weight/Ft. Material (Show direction and distance from at least two State
From To Ft Roads, or other map reference points)
From 0 To S— Ft r y yo J/i `G"
From To Ft / ce /
14. GROUT: t % % -
Depth Material Method III. f
From
From To Ft ,+
15. SCREEN: To �/) Ft J /�G / I
Depth Diameter Slot Size Material e / i \`r -- I \
From To Ft in in t
From To Ft in in
From To Ft in in }
16. SAND/GRAVEL PACK: .r
Depth Size Material
From To Ft
From To Ft
17. REMARKS:
I DO HEREBY C
CONSTRUCTIOF
FOR OFFICE US
Quad No
Serial No:
Q�
_toy��3
anrit �21
tT�S �jVrUit h r'
� A � ni r r
Cwkndwate Section
Ashev Be r:-r'^^al Office
ISTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
OF THISfRECORD HAS BEEN PROVIDED TO THE WELL OWNER.
1GN 145 OF CON OR OR AGENT
iubmit original to Di on of Water Duality and copy to well owner.
GW-1 REV. 1/98
DATE

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) 7333221
WELL CONSTRUCTION RECORD DRILLING CONTRACTOR `J
DRILLER REGISTRATION #:
STATE WELL CONSTRUCTION PERMIT#:
245113
1. WELL USE (Chedcnpplicable Bo$: Residential Municipal Q Industrial ❑ Agricultural 0 Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other CI If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below) „^�/ A n n
p 0' e,.t1 C)bd ' ///
3. OWNER %Qnn.Y
ADDRESS
Nearest Town: f 4 Q e"-,- County
(Road, Community, or Su and Lot No.)
h40,44-Cs-- (Street or R No.) .) js2
City or Town _ State Zip Code
4. DATE DRILLED 2 —J -U
5. TOTAL DEPTH 965
6. CUTTINGS COLLECTED YES NO Er
7. DOES WELL REPLACE EXISTING WELL? YES 0 NOE21"-
8. STATIC WATER LEVEL Below Top of Casing: 9f) FT. o 0
(Use '4? if Above Top of Casing)
9. TOP OF CASING IS / FT. Above Land Surface'
' Casing TenNnated atlor below land surface is legal unless a variance is issued
hi accordancewith 15At�C�C 2C .0118
10. YIELD (gpm): METHOD OF TEST SA/iE_'
. 11. WATER ZONES (depth)' vg % tJ ist„ M /x/ coo - f;,
12. CHLORINATION: Type �(fnZva Amount ire if additional space is needed use bads oth m y
13. CASING:
DEPTH DRILLING LOG
From To Fomration Desolptlm
/3i - 90,r
r
Saw
n_
Ir;
J :c
in Depth
From To AC q Ft.
From el. 9 Toin—Ft.
From lig To PH Ft.
14. GROUT:
Depth
From To Ft.
From 0 To O Ft
15. SCREEN:
From
From
From
Material
E/
Method
Depth Diameter Slot Size Material
To Ft in. In
To Ft
To Ft.
In. in.
in. in
16. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To
17. REMARKS:
IDO HEREBY
CONSTRUCT'bi
FOR OFFICE Q/'6/E[6NLYu,
Quad No:
Serial No:
Ft.
ANDARDS,
200?
0
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other map reference points)
kost
tioac
0 Pik+
TRUCTED IN %4CCtJkD., • WITH 1 NCAC 2C, WELL
F THIS REGORD HAS BEEN PROVIDED TO THE WELL OWNER.
SIGNM1 R OF CONTRACTOR ORAGENT DATE
Submit original to Dls4alon of Wabr Quality and copy to well owner.
GW-1 REV.1/98
SECTION
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 a [phone]
WELL CONSTRUCTION RECORD DRILLING CONTRACTOR:
DRILLER REGISTRATION #•
229236
I/
STATE WELL CONSTRUCTION PERMIT#
I/ 1. WELL USE (Check Applicable Box): Residential ❑ Municipal ElIndustrial E Agricultural ❑ Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATION;1646wsltetcbtof the location below) /o-., ; % / I ,..-, /' #'
Nearest Town: ^� I .://-,.i ,y. /�i' ; CP ty/. ... �
_ _/� �' ryt yr
(Road. Comfiunity', o4Srubf ivjsOgrand,lotNo:};•�%��
3. OWNER •" �,f ;i.
ADDRESS -. /
(Street.or'Rpu% No.)
City or Town „2 aJ State
4. DATE DRILLED 2
5. TOTAL DEPTH
6. CUTTINGS COLLECTED YES NO
7. DOES WELL REPLACE EXISTING WELL? YES. NO1
8. STATIC WATER LEVEVBelow Top of Casing: FT.
(Use "+" if Above Top of Casing)
9. TOP OF CASING IS FT. Above Land Surface"
Casing Terminated atfor to9low land surface is illegal unless a,yaria ee is issued
N in accordance with 15A AC 2C .01r18 /7 `� / '-
10. YIELD (gpm): METFIOQD6 TEST,'
. 11. WATER ZONES (depth)
12. CHLORINATION: Type
13. CASING:
Zip Code
KOI7} MR DEPTH
From To
(1—
% J 4
`�- Amout2'
�lT7sNl thickness
/:^^ De th pjdr We meter 'oigbt/Ft/ Material
From
From
From
14. GROUT:
From
From
15. SCREEN:
From
From
To \Ft
To
/
DRILLING LOG
Formation Description
r)
o
co z
c, N2
If additional space is needed use back effonmy
tV o
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other map reference points)
Depth Material Method /'
ToL Ft
/ Y
To Ft
Depth
To
To
From To Ft
16. SAND/GRAVEL PACK:
Depth
To
To
From
From
17. REMARKS:
Diameter Slot Size Material
Ft in in
Ft in in
in in
Ft
Ft
Size Material
I DO HEREBY CERTIFY THAT THIS WELL WAS 'C, QNSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STAND,ARDS,AND THAT A COPY OF THIS�2ECO S- £EN PROVIDED TO THE WELL OWNER.
L \, t L
FOR OFFICE USE 0
Quad No•
Serial No:
LY`eth
' _t..i. SIGNATURE OFCONTRACTOR OR AGENT
kbflit original to Division of Water Quality and copy to well owner.
GW-1 REV. 1/98
Croundwate' Section
Ashe!iik 2ec+ I rtf pre
DATE

f'o9241
North Carolina - Department of Environment and Natural Resources Division of Water Quality - Groundwater Section
P.O. Box 29578 - Raleigh, N.C. 27626-0578-Pho e [phone]
WELL CONSTRUCTION RECORD DRILLING CONTRACTOR:
{/C_ »A
1-7
DRILLER REGISTRATION #. G ' l AC
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE (Check Applicable Box): Residential L( Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
'^•/) (Suet or (tou4p No.)
City or Town / State
4. DATE DRILLED // ( ( 0
5. TOTAL DEPTH / /61>
6. CUTTINGS COLLECTED YES ❑ NOL
7. DOES WELL REPLACE EXISTING WELL? YES n NOLj -
8. STATIC WATER LEVEL Below Top of Casing: ei, c.) FT.
(Use "+• if Above Top of Casing)
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
10. YIELD (gpm): METHOD OF TEST i4 1 rt-
. 11. WATER ZONES (depth) )/2'1 /� l et-5-
RAO
DEPTH
From To
DRILLING LOG
Formation Description
PJ 70 p/t1
70' hoS Cta
WELL LOCATION: (Show sketch of the location below)
Nearest Townkrk CUtt n"" County-
rr
(Road, Community, or Subdivision and Lot No.)
3. OWNER ! Y'1C1--P- L.. 1 Lk:4dv-
ADDRESS qt. ( i _')s 1(7
c9r1->2---
Zip Code
12. CHLORINATION: Type \'(19! n.-->/ Amount "it/e7
13. CASING:
From
From
From
14. GROUT:
From
From
15. SCREEN:
From
From
From
Wall Thickness
Depth Diameter or Weight/FL Material
To II Ft
J To Ft.
To Ft
Depth Material
To Ft
0 To t700 Ft =r
Depth Diameter Slot Size
To Ft in
To Ft in
To Ft in
16. SAND/GRAVEL PACK:
Depth Size
From To Ft
To Ft
From
17. REMARKS:
in
in
in
Method
0
O 0
0
A
'D
(V
c1
1.�
cn
c
0<
vc
33.
If additional space is needed use back of Ern ""=
to7,t4J,/
Material
Material
I DO HEREBY CERTIFY THAT THIS WELL WAS CON
CONSTRUCT!
FOR OFFICE
Quad No.
Serial No:
7 N
Section
LOCATION SKETCH N o
(Show direction and distance from at least two State
Roads, or other map reference points)
RUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
FFTTHIS RE` D HA 1LIDED TO THE WELL OWNER.
'' SIGNATU E OF ONTRACTOR ORAGENT
Ep ...���JJJ1 t Submit o ' inal to Division of Water Quality and copy to well owner.
GW-1 REV. 1/98
DATE

4. DATE DRILLED
5. TOTAL DEPTH in
6. CUTTINGS COLLECTED YES NO
7. DOES WELL REPLACE EXISTING WELL? YES (l NO v
8. STATIC WATER LEVEL Below Top of Casing: pi= FT.
(Use "+" 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
in accordance with 15A NCAC 2C .0118 �J
10. YIELD (gpm): 30 METHOD OF TEST 4/%0
. 11. WATER ZONES (depth) 7gati
12. CHLORINATION: Type Amount ___Cr
13. CASING:
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
P.O. Box 29578 - Raleigh, N.C. 27626-0578-Pho e [phone]
WELL CONSTRUCTION RECORD DRILLING CONTRACTOR:
DRILLER REGISTRATION #:
STATE WELL CONSTRUCTION PERMIT#:
2392,18
1. WELL USE (Check Applicable Box): Residential IJ' Municipal ❑ Industrial E Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other If Other, List Use:
WELL LOCATION: (Show sketch of the location below)
Nearest, Town: »'I 044' "
County
(Ra d'Community, ,,orff$�ubd.��ivviIision andt No.)
3. OWNER �j/AG�e_`1e ADDRESS S y q(,p QJi y 0 _�
(Street or Route No.)
a.,_,... tu C_ as)? Vie -
City or Town tale Zip Code
�r-ter
Depth
From To Ft
From a To 7 3 Ft
From To Ft
14. GROUT:
From
From 6
15. SCREEN:
From
From
From
Wall Thickness
Diameter or Weight/Ft. Material
6, ' go c
DEPTH DRILLING LOG
From To Formation Description
0- 7o .ts
c
O �
—13
N
mr
r-
n ca
If additional space is needed use back of -form ti
Depth Material Method
To Ft
To Ft .VC7 d l2Ll�
Depth Diameter Slot Size Material
To Ft in in
To Ft in in
To Ft in in
16. SAND/GRAVEL PACK
Depth
From To
From To
17. REMARKS:
Size Material
Ft
Ft
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other map reference points)
I DO HEREBY CERTIFY THAT THIS WELL WAS CON
CONSTRUCTION STANDARDS, AND THAT A COPY
FOR OFFICE USE ONLY
Quad No
Serial No.
T tICTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
15 RECOR0.HAS BEEN PROVIDED TO THE WELL OWNER.
SIGNATURE OF ONTRACTOR OR AGENT
Submit original to Division of Water Quality and copy to well owner.
GW-1 REV. 1/98
DATE

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section 2 3 4 4 9 5
P.O. Box 29578 - Raleigh, N.C. 27626-0578-Pho e [phone] r.
WELL CONSTRUCTION RECORD DRILLING CONTRACTOR:
DRILLER REGISTRATION #: a 1 5®
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE (Check Applicable Box): Residential ❑ Municipal U Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
WELL LOCATIONi,Shoycskgtch of the location below) Jul/ cr,v,, p J
Nearest Town: County /1 �"
(Road, Comm tt t ubdi2wsign »otNo.)
3. OWNER //33 JJ ��tt ii From To
ADDRESS /
DEPTH
(Street o p to No.)
City or Town / pate Zip Code
4. DATE DRILLED . ../5'
5. TOTAL DEPTH
6. CUTTINGS COLLECTED YES n NO iii-
7. DOES WELL REPLACE EXISTING WELL? YESrfl NO
8. STATIC WATER LEVEL Below Top of Casing: rip-' FT.
9. TOP OF CASING IS
• Casing Terminated at/or below land surface is illegal unless a varianceAis issued
in accordance with 15A N9 2C .0118 77 ( 2
10. YIELD (gpm): METH OF PEST( f
. 11. WATER ZONES (depth): ss
(Use "+^ if Above Top of Casing)
FT. Above Land Surface
DRILLING LOG
Formation Description
i l
hi
C
Y' 15 67Ar r ere/
Y
-
q rn
5
CetWolc (qC'O
12. CHLORINATION: Type Amount If additional space is needed use back of form
13. CASING:
From
From
Wall Thickness LOCATION SKETCH
Depth Diameter or Weight/Ft Material (Show direction and distance from at least two State
To Ft 6,4 62V. - v Roads, or other map reference points)
To Ft. YY //
From To Ft
14. GROUT:
Depth Material Method
From C To Te_ Ft. jp/
From To Ft
15. SCREEN:
Ao IC de
Depth Diameter Slot Size Material
From To Ft in in
From To Ft in in
From To Ft in in
16. SAND/GRAVEL PACK:
Depth Size Material
To Ft
From
From To Ft.
17. REMARKS:
/if
I DO HEREBY C
CONSTRUCTIO
tri
O UCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
Iry THIS RECORD HAS EEN PROVIDED TO THE WELL OWNER.
L, %SIGNATURE OF -CONTRACTOR OR AGENT
Submit original to Division of Water Quality and copy to well owner.
GW-1 REV. 1/98
DATE

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section 234494
P.O. Box 29578 - Raleigh, N.C. 27626-0578-Pho e [phone]
WELL CONSTRUCTION RECORD DRILLING CONTRACTOR: C k�1 f A\i11
DRILLER REGISTRATION #: dl tom,) 5
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:
WELL LOCATION: (Show -sketch of the location below)
Nearest Town: V 1t \ l-W' County_
(Road, Community, or Subdivision and Lot No.) DEPTH DRILLING LOG
3. OWNER (7 . 0CW'y From To Formation Description
ADDRESS o .:Z c-( re 40 oel 12k
IA � (Street Ca—WrRoute No.) h1Q7 _2- c,— 7) )! 17 ; —
City or Town State Zip Code
4. DATE DRILLED (P"5'&(
9o- S'"°, (or rarw
5. TOTAL DEPTH 9'F1'St
6. CUTTINGS COLLECTED YES NOEy
7. DOES WELL REPLACE EXISTING WELL? YES NO©V
8. STATIC WATER LEVEL Below Top of Casing: o FT. O =<
(Use "+• 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
In accordance with 15A NctiC 2C .0118
10. YIELD (gpm): _� METHOD OF TEST A., A 1( C-
. 11. WATER ZONES (depth): / t t M DQ`
12. CHLORINATION: Type 6 m4- Amount 1/41/ i��
13. CASING:
Wall Thickness
Depth Diameter or Weight/Ft Material
From �J To Ft. U�
From To iV Ft. (o r-I (16
From To Ft.
14. GROUT:
Depth Material
From To Ft. (
From c� To 2-b Ft. ,%4-%t
15. SCREEN:
Method
Depth Diameter Slot Size Material
From To Ft in in
From To Ft._ in in
From To Ftin. in
16. SAND/GRAVEL PACK:
Depth
From To Ft
From To Ft,
17. REMARKS:
Size Material
i;Err;
3 ^'
If additional space is needed use back oClbmi
V
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other map reference points)
a
t�;2x
J�itut _
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION --+ • F THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
FOR OFFICE USE 4i }}
ONRACEN Quad No• G I $¢GNATIR CTTOR OR AGENT DATE
`0' 1 el S.tbmit original to Division of Water Quality and coov to well owner.
Serial No:
GW-1 REV. 1/98

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section 7 3 4 4 9 3
P.O. Box 29578 - Raleigh, N.C. 27626-0578-Pho e [phone] WELL CONSTRUCTION RECORD DRILLING CONTRACTOR: 9abo,
DRILLER REGISTRATION #. 47 2 / cv
STATE WELL CONSTRUCTION PERMIT#:
1 WELL USE (Check Applicable Box): Residential ❑ Municipal Efr Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
WELL LOCATIONI(Shewsketch of the location below) Q o' _ _ „ /J�
Nearest Town: A [D*f,6'Lcounty :° �f/'�/Gt"
(Road, Commu ' kor ubdivision and Lot No.) DEPTH DRILLING LOG
3. OWNER o-o—CA_
From To Formation Description
��
(Street or Rut No.) `Z �+j1 /�,
„7752-
City orTownILLE ^"/A 6IState Zip Code ,.ra �+� [rRfrite/
4. DATE DRILLED b [�Dif i
5. TOTAL DEPTH fof
6. CUTTINGS COLLECTED YES ❑ NO12"--
7. DOES WELL REPLACE EXISTING WELL? YES n NOI t'i
8. STATIC WATER LEVEL Below Top of Casing: FT.
(Use "+" 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
in accordance with 15A NCAC 2C .0118
10. YIELD (gpm): / METHOD OF TEST A '
. 11. WATER ZONES (depth): F ,2862
see o
.fV4 12. CHLORINATION: Type ."x Amount -j If additional space is needed use back of form
13. CASING:
ADDRESS
— o
o..
CO
Wall Thickness
SKETCH
Depth Diameter or Weight/FL Material (Show direction and distance from at least two State
From To Ft �Q �rc Roads, or other map reference points)
From 0 To Ft.
From To Ft
14. GROUT:
From
From
P
Depth Material Method
To Ft
To rFt. o�E/
15. SCREEN:
Depth Diameter Slot Size Material
From To Ft in in
From To Ft in in
From To Ftin in
16. SAND/GRAVEL PACK:
Depth Size Material
From To Ft
From To Ft.
17. REMARKS:
I DO HEREBY CERT4FY4HAT.TH1SWELL3NAW CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION` AVS,R,Nb T{ T C w /( OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
FOR OFFICE US
Quad No.
Serial No
Groundwat_
Ashevni' :oi
S GNARE dF CONTRACTOR OR AGENT
Submit original to Division of Water Quality and copy to well owner.
GW-1 REV. 1/98
DATE

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section 2 4 4 9 2
1636 Mail Service Center - Raleigh. N.C. 27699-1636-Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTORaik Dc` ),,o)
WELL CONTRACTOR CE FICATION S: 50
STATE WELL CONSTRU ION PERMITS: -& 1
1. WELL USE (Check Applicable Box): Residential gr Municipal © Industrial ❑ Agricultural 0 Monitoring ❑
Recovery ❑ Heat Pump Water Injection D Other n If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below) ) y\ . 1 _ I}�1
Nearest Town: ��11 M($r.l.lertii County: l .Ucf�JY�((
1MT PS-ftk
3. OWNER Sr; o
(Road Name and Numbers, mmunity.pr Subdivision and Lot No.) DRILLING LOG DEPTH
t
Address l ?gypt tel
fi�/(� (Street or R$ e"(�o.
n 1 G'ltirri
ref ttl
From To Formation Description
City or Town / . State p 0 v / j © <4..t�r/.(
4. DATE DRILLED `IcL�`
5. TOTAL DEPTH , ;� Yt,
6. CUTTINGS COLLECTED YES In NO�
7. DOES WELL REPLACE EXISTING WELL? YES [l NO[Tfr i
120- 73 5 0`^`-
8. STATIC WATER LEVEL Below Top of Casing: L 0 FT. (Use'+ � (` it Above Top of Casing) / 7S-- rLC li
9. TOP OF CASING IS 6e FT. Above Land Surface' 0
n
'Top of casing terminated atlor tow land surface requires a variance In actor -
dance with 15ANCAC 2C.a}la — r ''
10. YIELD (gpm)• J.'7 METHOD
�1OMFTEST IA
11. WATER ZONES (depth): /5^9ptk "� 4b
12. CHLORINATION: Type ).d.$_Amount
13. CASING:
WaB Thickness
Depth Diameter or WeightFt.
From To Ft AtO
From 0 To- Ft. -1
From To Ft
14. GROUT:
Depth Material
From To Ft
From ® To S�_Ft.
15. SCREEN: ✓✓
Material
Method
Depth Diameter Slot Size Material
From To Ft in in
From To Ft in in
From To Ft in in
16. SAND/GRAVEL PACK:
Depth Size Material
From To Ft
From To
17. REMARKS:
Ft
If additional space is needed use back of form 3
LOCATION SKETCH ca
(Show direction and distance from at least two State!
Roads, or other map reference points)
I DO HEREBY CERTIFY THAT THIS WELL WAS CON ` ' UCTED IN ACCORDANCE WITH 15A NCAC 2C. WELL
CONSTRUCTION STANDARDS. AND THAT A COPY THIS RECORD BEEN J ROVIDED TO THE WELL OWNER.
FOR OFFICE k1SEOYt:c \fi
`��... ...-J i' % SIGHTURE CONS UCTINGTHE WELL DATE
SubmItierleinai to Division of aler a uality. Groundwater Section within 30 days
Quad No:
Serial No
GW-1 REV. 12199
N"
Groundwater Section
<nevilie Regions, u

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section 7 3 4 4 91
1636 Mail Service Center - Raleigh, N.C. 27699-1636-Phone [phone] ' 1'
WELL CONSTRUCTION RECORD WELL CONTRACTOR- it+Cl �l�c� — IV��°`v��'I'I
WELL CONTRACTOR C TIFICATION #: IS_ O
STATE WELL CONSTR CTION PERMIT#:
1. WELL USE (Check Applicable Sox): Residential Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATI9 (Show sketch of the location below)
NearestiTow�n: 01;1b/��� , .-bl\. County
(Road Name and Numbers. Community, mor Subdivision and Lot No.) DRILLING LOG DEPTH
3. OWNER 'Si:.Aft. • e V%-t.. C`O From To Formation Description
Address 6c=in-i p�� `2 �.
�(Street or to No.) Q .— / (0G b i 2'} S A W „�^ �A�
City or Town State Zp Code
4. DATE DRILLED "-5 0
5. TOTAL DEPTH
6. CUTTINGS COLLECTED YES of NOEQ
7. DOES WELL REPLACE EXISTING WELL? YES in NOtyr L
8. STATIC WATER LEVEL Below Top of Casing: 1 J O FT. C
1).
(Use if Above Top of Casing)
9. TOP OF CASING 1S J FT. Above Land Surface'
'Top of casing terminated at/or below land surlace requires a variance In accor-
dance with 15A NCAC 2C .0118
10. YIELD (gpm): iq fl METLry�p OF TEST
11V. WATER ZONES (depth). fl R p c '/b
c�
v
H
3 mV
CO co
m --,
/� w
12. CHLORINATION: Type [ .eirl .0-* Amount If additional space is needed use back of form
13. CASING:
Waa Thickness LOCATION SKETCH
Depth Diameter or Weight/Ft. Material (Show direction and distance from at least two State
From To Ft
From To /04 Ft
From To Ft.
14. GROUT:
Depth Material Method
From � To Ft �o/� _7,e — /')
From To Ft. � G�I��
15. SCREEN:
Depth Diameter Slot Size Material
From To Ft in. in
From To Ftin in
From To FI in in
16. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft
17. REMARKS:
Roads, or other map reference points)
nTa
D
IDS
I DO HEREBY CERTIFY THAT THIS WELL WAS CONS; l UCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY •) THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
FOR OFFICE 1 �'
Quad No: tt LS U9 Y O `� SIGNATURE • PE - ' • • ' S - UC71NG THE WELL DATE
Su br a original to Division al at ality. Groundwater Section within 30 days
GW-1 REV. 12/99
z:oundwate
-heoiIle Rein:

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section 2 3 4 4 8 9
P.O. Box 29578 - Raleigh, N.C. 27626-0578-Pho e [phone]
WELL CONSTRUCTION RECORD DRILLING CONTRACTOR: SX �-tJr et Ut `` i
DRILLER REGISTRATION #: Ix 1 Sv
STATE WELL CONSTRUCTION PERMIT#: 1-24' If"
1. WELL USE (Check Applicable Box): Residential Er Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
WELL LOCATION: (Show sketch of the location below)
Nearest Town: ' - - County
i)
(Road, Community, or Subdivision and Lot No.) DEPTH DRILLING LOG
3. OWNER From To Formation Description
ADDRESS
(Street or Route No.)
% —
City or Town State
4. DATE DRILLED / 5. TOTAL DEPTH G7 Gam) 7 i
6. CUTTINGS COLLECTED YES NO in (-ir rj y cc k
7. DOES WELL REPLACE EXISTING WELL? YES L] NO! /( 76.
7`c_.)
Zip Code
8. STATIC WATER LEVEL Below Top of Casing: L) FT.
(Use "+° if Above Top of Casing) - y 3tit. i c:
9. TOP OF CASING IS I FT. Above Land Surface' O
• Casing Terminated at/or below land surface is illegal unless a variance is issued
in accordance with 15A NCAC 2C .0118 ' t `> - i (y. �' `- r `- C n
10. YIELD (gpm)* -_'C METHOD OF TEST / ' r" c
. 11. WATER ZONES (depth): ' ` _-
12. CHLORINATION: Type
13. CASING:
Amount
If additional space is needed use back of3fdrn r
-1,
•• m�
Wall Thickness LOCATION SKETCH cc)
Depth Diameter or Weight/Ft. Material (Show direction and distance from at least twO�,tStatQ
r,
From () To Ft "/1 , J,, % t' ( Roads, or other map reference points)
From To Ft.
From To Ft
14. GROUT:
Depth Material Method,
From To Ft i f
From To Ft
15. SCREEN:
Depth Diameter Slot Size Material
From To Ft in. in
From To Ft in in
From To Ft in in
16. SAND/GRAVEL PACK:
Depth Size Material
To
From
From
17. REMARKS:
To
Ft.
Ft
•
I DO HEREBY
CONSTRUCT!
'Aj3D�DE A�
2roundw t..-
•//eV
A
CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
pY F THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
i >
SIGN4tUR OF CONTRACTOR OR AGENT
Submit original to Division of Water Quality and copy to well owner.
GW-1 REV.1/98
DATE

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
P.O. Box 29578 - Raleigh, N.C. 27626-0578-Pho e [phone]
2292r15
WELL CONSTRUCTION RECORD DRILLING CONTRACTOR: 419L
DRILLER REGISTRATION #: &0 2(
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE (Check Applicable Box): Residential Eriaicipal ❑ Industrial ❑ Agricultural 0 Monitoring 0
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
WELL LOCATION: ($tjgw skkstch of the location below)
Nearest Towrr
gwf._
(Road, Community, or Subdivision a t Nq.) DEPTH DRILLING LOG
3. OWNER /ut*4i�P From To Formation Description
ADDRESS
Coun
(Street or Route No.)
f7/OArt N� deiit2
City or Town State Zip Code
4. DATE DRILLED /
5. TOTAL DEPTH /G
6. CUTTINGS COLLECTED YES f NO Fq"---
7. DOES WELL REPLACE EXISTING WELL? YES NO©•'"—
8. STATIC WATER LEVEL Below Top of Casing: yp FT.
(Use "+" 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
in accordance with 15A NCAC 2C .0118 ,1
10. YIELD (gpm): 470 METHOD OF TEST /`T 1.4
. 11. WATER ZONES (depth)' raog,M+ 0
)15/it
1 -tlQC
Lyo
12. CHLORINATION: Type it1Fn2C� 1� Amount
13. CASING:
0
O 0
to C->
C)
rn
N 0<
-..1>0
0
If additional space is needed use back oftorm -i
0
Wall Thickness LOCATION SKETCH
Depth Diameter or Weight/Ft Material (Show direction and distance from at least two State
From To ��p Ft Roads, or other map reference points)
From 0 Tom Ft. ` ( If6 = Q
From To Ft
14. GROUT:
Depth �n Material Method C
From (0 To Ft CI* / /
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:
ia
O
ete
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRf12TED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY O IS RECORD HBEE P-OVIDED TO THE WELL OWNER.
FOR OFFICE USE ONLY
Quad No.
Serial No:
SIG OF C . TOR OR AGENT DATE
Stibmit original to -sion f Water quality and copy to well owner.
' GW-1 REV.1/98

From
14. GROUT:
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
P.O. Box 29578 - Raleigh, N.C. 27626-0578-Pho e [phone]
WELL CONSTRUCTION RECORD
DRILLING CONTRACTOR:
DRILLER REGISTRATION #:
STATE WELL CONSTRUCTION P
232576
WSJ 1741,1
�. sc
RMIT#: 4'�'�"�`�
1. WELL USE (Check Applicable Box): Residential ❑ Municipal ❑ Industrial ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATION:.(Show sketch of the location below)
Nearest Town: / 6+444"- County'
(Road, Commyr�i ,t or Subdivisio - nd Lot No.)
3. OWNER /J,C/c: %i /fG�.1i/
ADDRESS
2/
(Street or Route No.)
City or Town �p.at
4. DATE DRILLED ' >> C -
5. TOTAL DEPTH -ter'/ 5
6. CUTTINGS COLLECTED YES n NOf
7. DOES WELL REPLACE EXISTING WELL? YES l NOI c}i'
8. STATIC WATER LEVEL Below Top of Casing: GAO FT.
(Use "+ 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
in accordance with 15A NC2C .0118
10. YIELD (gpm)• 4 METHgD OF TES
. 11. WATER ZONES (depth): / i
DEPTH
From To
Agricultural ❑ Monitoring 0
,87.2(, /
Zip Code
jir �,„)
12. CHLORINATION: Type eAtet, Amount 1";:/14(9
//
13. CASING:
Wall Thickness
Depth Diameter or Weight/Ft. Material
From To Ft
From 1 To jFt. r
To Ft
Depth
From To Ft
From 1 To r✓r') Ft
15. SCREEN:
Depth
From To Ft
From To Ft
From To Ft
16. SAND/GRAVEL PACK:
Depth
From To
From To
V(1
Material Method
! 1 "/ /
Diameter Slot Size
in
in
in
17. REMARKS:
I DO HEREBY CERTIFYT
CONSTRUCTION STAND
FOR OFFICE USE ONLY
Quad No
Serial No:
Material
in
in
in
fEf1
S WELL WAS CON
SIGNA
Submit
DRILLING LOG
Formation Description
a1->
0
o
— c>
c
ID10
0 m
If additional space is needed use back of -farm =
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other map reference points)
D IN ACCORDANCE WITH 15A NCAC 2C, WELL
ECORDHAS BEFQ PROVIDED TO THE WELL OWNER.
I
E OF PONI'RACTOR OR AGENT DATE
riginal t Division of Water Quality and copy to well owner.
GW-1 REV. 1/98

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mail Service Center - Raleigh. N.C. 27699-1636-Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR -
WELL CONTRACTOR CERTIFICATION #:,
STATE WELL CONSTRUCTION PERMIT#:
232577
1, WELL USE (check Applicable Box): Residential LL ' Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other El If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below) {t
Nearest Town: tl.P„� County: 1.41 P
(Road Name Numbers. Community, or Subdivision and Lot No -I
3. OWNER 1/7d7 jc7 ail
Address I
1,3eJro
City or Town
From
17. REMARKS:
From To Ft
14. GROUT:
(Street or Rol
yet
Stale Zip Code
4. DATE DRILLED 5= 3- 01
5. TOTAL DEPTH 0990
6. CUTTINGS COLLECTED YES ❑ NOQ�
7. DOES WELL REPLACE EXISTING WELL? YES f
8. STATIC WATER LEVEL Below Top of Casing: FT.
DRILLING LOG DEPTH
From To
Formation Description
6 — %: g (/G f
(on �qo
0
V 0
•
/ (Use': it Above Top of Casing) r•>--.,
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 .0116 — c
10. YIELD (gpm): 7t" METHOD OF TEST, /�
11. WATER ZONES (depth): •75 o r e o ,a mom,
12. CHLORINATION: Type Amount
13. CASING:
Wall Thicimess
Depth Diameter or WeighVFL Material
From To Ft.
From To Ft,_ C4t7 PU -c
Depth Material Method
From To Ft r From 0'0 To 7t7 Ft .2E'/ I-0,...t
15. SCREEN:
Depth Diameter Slot Size Material
From To Ft in in
From To Ft in in
From To Ft- in. in
16. SAND/GRAVEL PACK:
Depth
From To Ft.
To Ft
Size Material
r!i
11 additional space is needed use back of fatal
rn
LOCATION SKETCH
(Show direction and distance from at least We State
Roads, or other map reterence points)
0
2Z6 -5
fret
0 •,
I DO HEREBY CERTIFY THAT THIS,
CONSTRUCTION `t "i•Sri;tA DWP;AQjD•1`j WISRECO'4HAS BE. PROVIDED TO THE WELL OWNER.
FOR OFFICE USE
Quad No:
Serial No.
TED IN ACCORDANCE WITH 1SA NCAC 2C, WELL
P SON CONSTRUCTING THE WELL DATE
Water Quality. Groundwater Section within 30 days
GW-1 REV. 12/99

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
P.O. Box 29578 - Raleigh, N.C. 27626-0578-Pho e [phone]
WELL CONSTRUCTION RECORD
232575
DRILLING CONTRACTOR: )u4Y;Cc lid; —OC; ling
DRILLER REGISTRATION #• SQ.
STATE WELL CONSTRUCTION PERMIT#: 7�
1. WELL USE (CheckApplicable Box): Residential ❑ Municipal l4 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: MOPton County. i� = l7owcl
VervcC %rooK
(Road, Community, or Subdivision and Lot No.)
. 11. WATER ZONES (depth)
1 DEPTH DRILLING LOG
3. OWNER G.r) DrCCrS From To FormationDescription
ADDRESS Ce"rrerbrt oY- U — 1,2
l7�rT
(Street or Route No.)
City or Town Slate
4. DATE DRILLED -1L1-
5. TOTAL DEPTH
6. CUTTINGS COLLECTED YES I NO J�
7. DOES WELL REPLACE EXISTING WELL? YES 0 NON.]
8. STATIC WATER LEVEL Below Top of Casing: 4 FT.
(Use "+' if Above Top of Casing)
9. TOP OF CASING IS 1 FT. Above Land Surface•
Casing Terminated at/or below and surface is illegal unless a variance is issued
in accordance with 15A NCAC 2C .0118
10. YIELD (gpm): METHOD OF TEST Al r
gi 53.0A e sso
(92 — LI05 —e
Zip Code
0
O o
N
CJ m
�r`
12. CHLORINATION: Type UoroX Amount If additional space is needed use back oform z
13. CASING:
Wall Thickness LOCATION SKETCH
Depth Diarrteter or Weight/Ft. Material (Show direction and distance from at least two State
From o To (;6 Ft (, `j ijn p 0 (... Roads, or other map reference points)
From To Ft.
From To Ft
14. GROUT:
Depth Material Method
From 0 To a()Ft t e�re L
From To Ft I
15. SCREEN:
Depth Diameter Slot Size Material
From To Ft in. in
From To Ft in in
From To Ft in in
16. SAND/GRAVEL PACK:
Depth
To Ft.
To Ft
From
From
17. REMARKS:
I DO HEREBY CERTIFY
CONSTRUCTION STAND
Size
Material
FOR OFFICE USE ONLY
Quad No
Serial No:
IS WELL WAS CONST
AND TjIF T fk cppy OF
r
D IN ACCORDANCE WITH 15A NCAC 2C, WELL
IECORpJIAS BEEN PROVIDED TO THE WELL OWNER.
R ONTRACTOR OR AGENT DATE
mit ificip to Division of Water Quality and copy to well owner.
GW-1 REV. 1/98

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
P.O. Box 29578 - Raleigh, N.C. 27626-0578-Pho e [phone]
WELL CONSTRUCTION RECORD
DRILLING CONTRACTOR:
DRILLER REGISTRATION #:
STATE WELL CONSTRUCTION PERMIT#:
234438
1. WELL USE (Check Applicable Box): Residential ❑ Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATION: (Show -sketch of the location below)
3
Nearest Town: County'"
(Road, Gommudity, or Subdivision and Lot No.)
ADDRESS
DEPTH DRILLING LOG
From To Formation Description
(Stre?t or Route No.)
City or Town .r• - State,
4. DATE DRILLED
5. TOTAL DEPTH ' ;AD
6. CUTTINGS COLLECTED YES ( I NO T
7. DOES WELL REPLACE EXISTING WELL? YES 1 I NO
8. STATIC WATER LEVEL Below Top of Casing:: t\ : f FT.
Zip Code
2 (Use "+" 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
in accordance with 15A NQAC 2C .0118 7
10. YIELD (gpm): METI49D OF TEST",
. 11. WATER ZONES (depth) ' Y ..', (-
12. CHLORINATION: Type .; `' Amount
13. CASING:
Wall Thickness
Depth Diameter or Weight/Ft. Material (Show direction and distance from at least two State
CC
If additional space is needed use back of four
CJ
n
LOCATION SKETCH
r—
From To - Ft
From To ' Ft.
From To Ft
14. GROUT: _
Depth Material Method
From To - Ft
From To - Ft 1, ..•`,.
15. SCREEN:
Depth Diameter Slot Size Material
From To Ft in in
From To Ft in in
From To Ft in in.
16. SAND/GRAVEL PACK:
Depth Size Material
From To Ft
From To Ft
17. REMARKS:
Roads, or other map reference points)
I DO HEREB'4,Qg&F ,THATTHI$WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCT .ttt( STANOAReS,j}1NQI;THAT A COPY OF THIS REQORD HAS PEEN PROVIDED TO THE WELL OWNER.
1L55 tt�� / \g`
FOR OFFICE
Quad No
Serial No:
ONLY
IIItfR'
T
ty
SIGNATURE OF CONTRACTOR OR AGENT
Submit original to Division of Water Quality and copy to well owner.
GW-1 REV. 1/98
DATE
Croundwate' Sect:r:
A*,hevillP. Repi!;P3i a. L

North Carolina - Department of Environment and Natural Resources Division of Water Quality - Groundwater Section o v ,q 'i ,q o ry
P.O. Box 29578 - Raleigh, N.C. 27626-0578-Pho e [phone] ) `3
WELL CONSTRUCTION RECORD DRILLING CONTRACTOR: -N US7.'r P Aitki � t tin
DRILLER REGISTRATION #: c2-10
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE (check Applicable Box): Residential IA Municipal ❑ Industrial ❑ Agricultural E Monitoring E
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATION,: (Show sketch of the location below)
Nearest Town: f r IG r , CW1 County'
71 1 l I Yt S t GJ"ir L4 scl
(Road, Community, or Sub ivision and Lot No.)
3. OWNER M.Ore or,Jevi4/\
ADDRESS_3I 9I S41iln r-i. y d .
VYlcr nr1
City or Town
5. DATE DRILLED
5. TOTAL DEPTH
6. CUTTINGS COLLECTED YES ( I NO
7. DOES WELL REPLACE EXISTING WELL? YES NO
8. STATIC WATER LEVEL Below Top of Casing: Q FT.
(Use "+" if Above Top of Casing)
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 NC4C 2C .0118 r
10. YIELD (gpm): y METHOD',/IOF TEST A r r
'7 . 11. WATER ZONES (depth): G Pm Q 2C\n
(Street or Route No.)
Iv' C ,
State
Zip Code
(
cpoum
DEPTH
From To
O —
12. CHLORINATION: Type C-Iinfo Y Amount
13. CASING:
DRILLING LOG
Formation Description
o
Q N ]
If additional space is needed use back of f00n
Wall Thickness LOCATION SKETCH
Depth Diajneter or Weight/Ft. tedal (Show direction and distance from at least two State
From d To ��7 Ft �ir �� Roads, or other map reference points)
From To Ft
From To Ft
14. GROUT:
Depth Material �(J Metho
From 0To 2f) Ft a I T �%
From To Ft
15. SCREEN:
Depth Diameter Slot Size Material
From To Ft in in
From To Ft in in
From To Ft in in
16. SAND/GRAVEL PACK:
Depth Size Material
To
From
From
17. REMARKS:
To
Ft
Ft
tJ
2)
I DO HEREBY - • - - -- ' &CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTOF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
SIGTURL' OF CONTRACTOR OR AGENT
Submit original to Division of Water Quality and copy to well owner.
GW-1 REV. 1/98
DATE

City or Town
5. DATEDRILLED -
5. TOTAL
L DEPTH
6. CUTTINGS COLLECTED YES NO
7. DOES WELL REPLACE EXISTING WELL? YES
8. STATIC WATER LEVEL Below Top of Casing:
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
P.O. Box 29578 - Raleigh, N.C. 27626-0578-Pho e [phone]
WELL CONSTRUCTION RECORD
234436
DRILLING CONTRACTOR:
DRILLER REGISTRATION #:
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE (Check Applicable Box): Residential & 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: Mck r ION County
(Road. Community, QQr Subdivision pnd Lot No.)
3. OWNER E-a 1 Ret
ADDRESS 3'i'67 A s),fasor+h, P d
(Street or Route No.)
111q r •1c7
State Zip Code
2if7 S2
NO
FT.
(Use "+' if Above Top of Casing)
9. TOP OF CASING IS _I_ FT. Above Land Surface *
Casing Terminated at/or below land surface is illegal unless a variance is issued
in accordance with 15A NCAC 2C .0118
10. YIELD (gpm): /n METHOD O TEST )
. 11. WATER ZONES (depth): ) 0 6 /'m . / 90
DEPTH
From To
nD
cdo - 90
50-aa5
12. CHLORINATION: Type Ci11r0%(
13. CASING:
DRILLING LOG
Foormatiop Description
n, r t
Seq. /zock
rcn.1 c_
C-
O
n
L c-
rr-- r- 2=
-rL
r-
Amount f/h If additional space is needed use back of Torn
J
Wall Thickness
Depth Diameter orW ii9hVFt. aterial
From To )03 Ft 4) VI`flJ ��
From To Ft
From To Ft
14. GROUT:
Depth Material ethod
From 0 To CO Ft a f % OLib 34
From To Ft
15. SCREEN:
Depth
From To
From To
From To
16. SAND/GRAVEL PACK:
Depth
To
To
From
From
17. REMARKS:
Ft
Ft
Ft
Diameter Slot Size Material
in
in
Ft
Ft
in
in
in in
Size Material
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other map reference points)
I- go
•
I DO HEREBY
CONSTRUCTI
C6gFiFir-TNAFTId.......WASGONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
FOR OFFICE US
Quad No:
Serial No:
ADiD4AIilD!AIA prie OFT HIS RECORD HASTEN PROVIDED TO THE WELL OWNER.
SIGNATU
Submit on
v
TRACTOR OR AGENT
al to Division of Water Quality and copy to well owner.
GW-1 REV. 1/98
DATE

From �;_ 7o
17. REMARKS:
North Carolina - Department of Environment and Natural Resources - Division of Water Quality
P.O. Box 29578 - Raleigh, N.C. 27626-0578-Pho e [phone]
WELL CONSTRUCTION RECORD
- Groundwater Section
3x1�
243415
DRILLING CONTRACTOR: j ti c� / WI Ord 1i v1�
DRILLER REGISTRATION #:
IS
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE (Cheek Applicable Box): Residential Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATION; (Show sketch of the location below) n I
Nearest Tcwn: yJy,�A�4� !1'A ha— County- % 1�"(
t � o 0,6A. 1
(Road, Community, or SubdivisionandLot No.), DEPTH DRILLING LOG
3. OWNER 0 2- 6 j�% r JU -.j- I A%g From To Formation Description
ADDRESS
h I _ / (Street AoorRoute No.) ��r`i
City or Town State"p c de
4. DATE DRILLED-r17-0I
5. TOTAL DEPTH 705
6. CUTTINGS COLLECTED YES In NO _
7. DOES WELL REPLACE EXISTING WELL? YES In NO
8. STATIC WATER LEVEL Below Top of Casing: I co FT.
/ (Use "+" if Above Top of Casing)
9. TOP OF CASING ISFT. Above Land Surface *
Casing Terminated at/or below land surface is illegal unless a variance is Issued
in accordance with 15A Npietc 2C .0118
10. YIELD (gpm) %9- MUHOD OF TEST /MC
. 11. WATER ZONES (depth). 'ice Fri 6E? off -'
tS 7o<
12. CHLORINATION: Type 6—L0I0-Ye
13. CASING:
Depth Diameter
From To Ft I/
From tf To 9`/ Ft. it'1(7 5eo P4/T'
From To Ft
14. GROUT:
Amount �Ur c i'`
Wall Thickness
or Weight/Ft. Material
Depth Material Method
From r. To Ft
From To 70 Ft. 21/ 7-fti
15. SCREEN:
Depth
From To Ft in
From To Ft in
From To Ft in
r �,
16. SAND/GRAVjEC1ry /�FK • � 11 k
SiLe
From I �10 Ft
Ft'
Diameter Slot Size Material
in
in
aterial
Xi,rd
1� as
(7 UP
c_
T _4$
V y
gC
If additional space is needed use back fonr`iz
rn n
Co
LOCATION SKETCH
(Show direction and distance from at leas tw oState
Roads, or other map reference pothfs) Gi
Lew.- c.1 v:.r
u
1 DO HEREBY CERTIFY THATTHIS WELL VITAS CO
CONSTRUCtION-STANDARDSAND T14A A
FOR OFFICE USE ONLY
Quad No.
Sedal No:
RUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
F THIS RECORD HAS BE ROVIDED TO THE WELL OWNER.
SIGNATURE •F
Submit original to
NTRACTOR OR AGENT
Mslon of Water Quality and copy to well owner.
GW-1 REV. 1/98
DATE

North Carolina - Department of Environment, Health, and NL tural Resources
Division of Environmental Management - Groundwater Section
P.O. Box 29535 - Raleigh, N.C. 27626-0535
Phone [phone]
WELL CONSTRUCTION RECORD
DRILLING CONTRACTOR: C t E V'tU J)(tt(Ih#)
4% ST.{7E WELL CONSTRUCTION
DRILLER REGISTRATION NU BER: Jfa%j/ aMO PERMIT NUMBER:
QUAD NO'SERL
NO
Loa t
Minor Barn r`
Basin Code*,
HeadeitnY. �.
OFFICE USE ONLY"
GW-1 En
1. WELL LOCATION: (Show sketch of the location below)
Nearest Town: /1,'rt bL,v j` County 1, (Pa
(Gioad, Community, or Sut�piJYs;4rtdLot No'P1/"" i
2. OWNER
ADDRESS r�X (Sfr{
eef 6r Ro,.F
4City or Town gale - /4 .0
9
DEPTH
From To
DRILLING LOG
Formation Description
3. DATE DRILLED 4.e/6_,}/ USE OF WELL t" otz. yam, ro5
4 TOTAL DEPTH
5. CUTTINGS COLIelo D YES I J NO
6. DOES WELL REPLACE EXISTING WELL? °fES NO
7. STATIC WATER LEVEL Below Top of Casing: FT.
(Use "+" if Above T[g// sb?Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
• Casing Terminated at/or below land surface Is illegal unless a variance is Issued
In accordance with 15A NCAC 2C .0118
9. YIELD (gpm)- y. METHOD OF TEST -i
10. WATER ZONES 'epth)•
y7ppr
"4/
11. CHLORINATION: Type 40‘ 4 Amountytre
If additional space is needed use bacl for
0
0
o
C. o—' --,
?c
12. CASING:
Wall Thickness
LOCATION SKETCH u7 0
Depth Diameter or Weight/Ft. Material (Show direction and distance from at least two State
From To Ft. Roads, or other map reference points)
From en.To Ft.
From To97— Ft 6// Q`) Ai(
13. GROUT:
Depth Material Method
From To Ft
From �a-- To Ft Alma
�
14. SCREE°N al:-") � I ALI/:Cea'
Depth Diameter Slot Size Material
From To Ft in in
From To Ft in in
From To Ft. in in
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft
From
16. REMARKS:
I DO HEREBY C
CONSTRUCTIO
Y THAT THIS WELL W
Da ANDTHATA
NSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
SIGNATURE?OGNTRX
GW-1 REV. 9/91 s„h,..a...a{,J,,,
FroFf-ACiEt.a
DATC

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Secton
1636 Mail Service Center - Raleigh, N.C. 27699-1636-Phone [phone]
WaZ
WELL CONSTRUCTION RECORD WELL CONTRACTOR' " ri t
WELL CONTRACTOR CE IFICATION St:' Q
STATE WELL CONSTRU ON PERMIT#:
1. WELL USE (Check Applicable Box): Residential ❑ Municipal industrial D Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other If Other, List Use:
2. WELL LOCATION: Sh sketch of the location below tl
//��
Nearest Town: County: f 4
d Y
(Road Nam hl a Comm, ty. or Subdivision and Lot No.)
Address
3. OWNER e.ke 2i
(three or Route Nod
City or Town
a
J� Stale zip code
4. DATE DRILLED y'_:23-0/
5. TOTAL DEPTH 4'n-r
6. CUTTINGS COLLECTED YES ❑ NOQ'-
7. DOES WELL REPLACE EXISTING WELL? YES in NOE;
8. STATIC WATER LEVEL Below Top of Casing: 30 FT.
(Use 11 Above Top o1 Casing)
9. TOP OF CASING IS / FT. Above Land Surfaces
'Top of casing terminated at/or below land surface requires a variance In accor-
dance with 16A NCAC 2C.0118
10. YIELD (gpm): / METHOD OF TEST Al/C-C faci
11. WATER ZONES (depth) /3,•0*, c 34-0
232571
DRILLING LOG DEPTH
From To Formation Description
6 0 - yor l
12. CHLORINATION: Type
13. CASING:
0
G o
C._
fir-•
>.r
m�
'
C]
W
Amount If additional space is needed use back of loan o
Wall Thickness
Depth Diameter or Weight/FL Material
From To Ft
From 0 To 040 Ft. fie(
From To Ft
14. GROUT:
From 6 To __ry Ft (eal )7�:4:1Depth
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'
CONSTRUCT
FOR OFFICE
Quad No:
Serial No.
TIjZdiTII 7HAS A
Submi
origr
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other map reference points)
o rna` w,n µ7 C
NSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
! OF jf i1S RECORQ HAS BEEN PROVIDED TO THE WELL OWNER.
y7"
SIGNATURE OF SON CONSTRUCTING THE WELL DATE
N to Division at Water Quality, Groundwater Section within 30 days
GW-1 REV. 12/99
CrollHlMater Section
Asheville Regional Office

North Carolina - Department of Environment and Natural Resources
P.O. Box 29578 - Raleigh, N.C. 27626-0578-Pho e [phone]
WELL CONSTRUCTION RECORD
Division of Water Quality - Groundwater Section
DRILLING CONTRACTOR:
DRILLER REGISTRATION #:
STATE WELL CONSTRUCTION PERMIT#:
232572
i4 eyk tY ` tI t ti)
1. WELL USE (Check Applicable Box): Residential2 Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATION: (.6_13o1 sketch of the location below)
Nearest Town:
11 e'f�
County
(Road, CQrnn , ye or Subdivision and Lot No.)
3. OWNER U%Y ° t i -tLt
ADDRESS PIA`-CCI ('v' ` @`-
p, (Street or Route No.)
City or+own State
4. DATE DRILLED 'I-6-oI
5. TOTAL DEPTH
6. CUTTINGS COLLECTED YES NO
7. DOES WELL REPLACE EXISTING WELL? YES NOMM"-
8. STATIC WATER LEVEL Below Top of Casing: / FT.
9. TOP OF CASING IS /
DEPTH
From To
DRILLING LOG
Formation Description
20- =r y ,S i," f it)s— KcicAt
Zip Code
(Use "f" if Above Top of Casing)
FT. Above Land Surface
Casing Terminated at/or below land surface is illegal unless a variance is issued
in accordance with 15A NQAC 2C .0118
10. YIELD (gpm): >" MET OD OF TEST '' '
. 11. WATER ZONES (depth)'
2 it"
O
3 �m
ce
w
12. CHLORINATION: Type C'e-61-9—X Amount K -a If additional space is needed use back of form
13. CASING:
Wail Thickness
Depth Diameter or Weight/Ft. Material
From
0To8 To 5 Ft
Ft 6 /hi 4/6From
From To
14. GROUT:
Ft
Depth Material Method
From To Ft L n
From 0 To c D �Y Ft �j
15. SCREEN:
Depth Diameter Slot Size Material
From To Ft in in
From To Ftin in
From To Ft in in
16. SAND/GRAVEL PACK:
Depth Size Material
From To Ft
From To Ft
17. REMARKS:
re co n
T I DO HEREBY CEF1 I TIIi4Ti4HIgWH L C
CONSTRUCTION rill $ARDS, AND THA A li
TiVrai
FOR OFFICE USE
Quad No
Serial No:
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other map reference points)
�YiSr'(
/�• / /&,lLi
FTt
rFTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
fF THIS EFj CORD HA BEEN TO THE WELL OWNER.
•
S tNATURF'OF CONTRACTOR OR AGENT
Suomit original to Division of Water Quality and copy to well owner.
GW-1 REV. 1/98
Gmundwater Section
Aihe1e Rail 0 fte
DATE

North Carolina - Department of Environment and Natural Resources
P.O. Box 29578 - Raleigh, N.C. 27626-0578-Pho e [phone]
WELL CONSTRUCTION RECORD
Division of Water Quality - Groundwater Section
DRILLING CONTRACTOR:
DRILLER REGISTRATION #:
232573
014 NC
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE (Check Applicable Box): Residential ❑ Municipal
Recovery ❑ Heat Pump Water Injection ❑ Other
WELL LOCATIOJ(j(Show sketch of the location below)
Nearest Town: / "Utt2t.- County'
Industrial ❑
If Other, List Use:
j"s\ C bcA.-J-'`
L-Qr U --e
(Road, Community, or Subdivision and Lot No.)
3. OWNER b 5,,,wt---
ADDRESS
(Street or Route No.)
DEPTH
From To
Agcultural ❑
Monitoring ❑
City or Town State
4. DATE DRILLED
5. TOTAL DEPTH 8
6. CUTTINGS COLLECTED YES I NO ✓r
7. DOES WELL REPLACE EXISTING WELL? YES NO
8. STATIC WATER LEVEL Below Top of Casing: I20 FT.
9. TOP OF CASING IS
Zip Code
(Use "+ if Above Top of Casing)
FT. Above Land Surface *
• Casing Terminated at/or below land surface is illegal unless a variance is issued
in accordance with 15A NC2C .0118
10. YIELD (gpm): IS METHOD OF TEST Al (2
. 11. WATER ZONES (depth): i 51 P K^ € 9 Go
/7o— :5
12. CHLORINATION: Type C -se1L Amount y71tj'c..('
13. CASING:
Wall Thickness
Depth Diameter or Weight/Ft. Material
From
From 0To I FL Ls— Iy Lib c U L,
From To Ft
14. GROUT:
Depth Material Method
From To Ft
From O To °it) 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
To Ft
From
17. REMARKS:
I DO HEREBY CERTFY,
CONSTRUCTION ST'NI
u
DRILLING LOG
Formation Description
f1t
r-,
0
r
c 5
U tnz
0
If additional space is needed use back ofdfatn i
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other map reference points)
L uc 04 et N (7+t K4101. 1 get,y[u/
IIIAT THIS WELL WAS CC
r�RDS,oah?D THAT A COP
FOR OFFICE USE 0
Quad No:
Serial No:
LY
UCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
IS RECORD HAS BVIDED TO THE WELL OWNER.
�--l�r[/L t.--
Groundwater Section
(Asheville Regional Office
SIGN TORE OF C#TRACTOR OR AGENT
Sub original to Division of Water Quality and copy to well owner.
GW-1 REV. 1/98
DATE

From —
14. GROUT:
From
From
15. SCREEN:
From
From
From To _-
16. SAND/GRAVEL PACK:
Depth
To
To
From From
17. REMARKS:
North Garolina - Department of Environment
fit and Natural636-Pes (ur e - Division
1 of Water Quality - Groundwater Section
1636 Mail Service Center - Raleigh,N.C.
WELL CONSTRUCTION RECORD WELL CONTRACTOR: '
WELL CONTRACTOR CE FICATION #: —
STATE WELL CONSTRUCTION PERMIT#: i� U
Industrial ❑
Agricultural CI Monitoring ❑
1, WELL USEry(check Applicable Pump
p Residential lnjectio Municipal
0 «Other, List Use:
Recovery D Heat Pump Water Injection ❑
2. WELL LOCATION: (Show sketch of the location below)
ounry: C ��
r — DRILLING LOG
From To
3
Nearest Town:
City or _ Stare
4. DATE DRILLED 7 f
5. TOTAL DEPTH
6. CUTTINGS COLLECTED ES ❑ NO
7. DOES WELL REPLACE EXISTING WELL?'WS 0
8, STATIC WATER LEVEL Below Topof Casing:
FT.
(Use g 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 15ANCAC 2C.0113
10. YIELD (gpm): 3C2— METHOD OF TEST
11. WATER ZONES (depth): `r
url —,
12. CHLORINATION: Type Amount ((
—
13. CASING:
Depth
From To Ft. l v
From To —Ea— Ft. — -
To Ft. r j w c
c.
Mere 1 G C Method
Wan Thickness
edal
Diameter or Weight/R.
Depth
_ To Ft.
0_ ToT IIIFt.
Diameter Slot Size 0 M
DepthTo P4Lnictrifin in. el
To Ft.t S cin.
Ft. in. —mac
Ft.
Ft.
Size
Material
232581
A
DEPTH
Formation Description
ti
-------
II additional space is needed use bat k of 1°r=
LOCATION SKETCH
(S direction and distance from at least two State
oads, or other map reterence points)
0
t1
L CONSTRUCTED IN ACCORDANCE WITH 1SA NCAC 2C, WELL
A WAS i
A7ACOOF THIS RECORD HAS EEN PROVIOED TO THE WELL OWNER.
SON CONSTRUCTING THE WELL DATE
r Duality. Groundwater Section within 30 days GW t REV. 12/99
NATURE
ubnat original to Oiviston of W

232578
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mail Service Center • Raleigh, N.C. 27599-1636-Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR.
WO Dell
WELL CONTRACTOR CER CATION it: 4/50
STATE WELL CONSTRUCTION PERMIT#: tretiag
1. WELL USE (Check Applicable Box): Residential Er Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ 1f Other. List Use:
2. WELL LOCATION: (Show sketch of the location below) / %
Nearest Matte
nTown: M (mU-i_.e"K-. county: /(If
�� -VI R1,QPR.Ltni —
(Road Name an. Numbeerrs Comm/u�nity. or Su on and Lot No.) DRILLING LOG DEPTH
3. OWNER ,rA n Y U ML ' From To Formation Description
Address
'reet0r ..ute'o. y n — 9Q b i rit-
Atici-en. /.(1 Q ;2Y'Ase7 . o_
City or Town $tare Zip Code q
4. DATE DRILLED (d — Q` S cs 4 CD
5. TOTAL DEPTH=� n
C o;-'
6. CUTTINGS COLLECTED YES ❑ NOW--
7. DOES WELL REPLACE EXISTING WELL? YES n NO +� — coco
rn
B. STATIC WATER LEVEL Below Top of Casing: `5O ET. ;-o
(Use •+ 11 Above Top of Casing) rn p
9. TOP OF CASING IS / FT Above Land Surface'MC
—rrt
-
•Top of easing terminated at/or below land surface requires a variance In accor-
dance with 1511 NCAC 2C .0118
10. YIELD (gpm): /-' METHOD OF TEST P. I fZ
11. WATER ZONES (depth)' I SC,f rv. I a`f j
12. CHLORINATION: Type t MA-X Amount Y/e r •' )
13. CASING:
w
clt
If additional space is needed use back of form
Wall Thickness LOCATION SKETCH
Depth Diameter arweighltn. Material (Show direction and distance from at least two State
From To Ft / yy Roads, or other map reference points)
From \( To CI1 Ft 6? l/y L
From To Ft.
14. GROUT:
Depth Material
From To Ft I�
From P To �t) Ft iTq(
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:
' 1
Method
7 PouAti-e 4-7
r-4 #L
1 DO HEREBY CERTIrY Ti IAT TH+SWEkk-WAS.00NS�t�,CTED IN ACCORDANCE WITH 15A NCAC 2C. WELL
CONSTRUCTION ST S,1if H&T � r Or ,1tRuS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
FOR OFFICE USE O
Quad No:
Serial No
Submit °Aetna]
RE OF PERSON CONSTRUCTING THE WELL DATE
la1 of Water Quality. Groundwater Section within 30 days
GW-1 REV. 1Z199
�RlPIOMI

FOROFFICE U
Ouad No:
Serial No
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mail Service Center - Raleigh, N.C. 27699-1636-Phone [phone]
WELL CONSTRUCTION RECORD
WELL CONTRACTOR-
232579
WELL CONTRACTOR CFICATION #: / i 5 t9
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE (Check Applicable Box): Residential LIy Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other D If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearesd,T wn
1�j/ -,1d ip 12ri
(Road N and Numbers, Communi , or Subdivision and Lot No.)
3. OWNER W �n "Ivrea/
Address j?75eA,(��_4
County
tr t C4tvw 73'2.
City or Town Stale p Code
4. DATE DRILLS �-_
5. TOTAL DEPTHQ § 1Gir
yVl - rntl-7QQ
DRILLING LOG
From To
®' �
.'�) — �t0 Sr
6. CUTTINGS COLLECTED YES ❑ NO1 yr
7. DOES WELL REPLACE EXISTING WELL? YES (l NO(v(
8, STATIC WATER LEVEL Below Top of Casing: FT.
(Use': it Above Top of Casing)
9. TOP OF CASING IS / FT. Above Land Surface'
-Top of casing terminated at/or below land surface requires a variance In accor-
dance with 15A NCAC 2C 011 a
10. YIELD (gpm)- 4 METHOD OF TE T Aim
11. WATER ZONES (depth) CT," (' S2r
DEPTH
Formation Description
- rfT7/-
n
r n
C o -'
— *r7i
v
(Nn�
12. CHLORINATION: Type—adVAX Amount yC 957, It additional space is needed use back of try
13. CASING: ��
From
From
From
14. GROUT:
Depth Diameter
To c-y FI. th "'Y'—
To 7 Ft.
To Ft.
WaB Thickness
or Weight/R. Material
Depth Material Method
From To Ft fJ
From © To old Ft r ,cam'
15. SCREEN:
Depth
From To Ft
From To Ft.
From To Ft
16. SAND/GRAVEL PACK:
Depth
From To Ft.
To Ft
Diameter Slot Size Material
in in
in in
in in.
From
17. REMARKS:
Size Material
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other map reterence points)
itat
!a
nz
r-,
0
I DO HEREBY CERTIFY THAT THIS WELL WAS CON
CONSTRUCTION STANDARD$ 8ND.41ATA.CQPY
Q 1u
Groundwater Sectton
Asheville Regional Offi
TED IN ACCORDANCE WITH 15A NCAC 20, WELL
THIS RECOROVIDED TO THE WELL OWNER.
NATURE • PER
N CONSTRUCTING THE WELL DATE
Division • Water Quality. Groundwater Section within 30 days
GW-1 REV. 12/99

FOR OFFICE USE ON
Quad No:
Serial No.
North Carolina - Depanment of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mail Service Center • Raleigh, N.C. 27699-1636-Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR -
WELL CONTRACTOR CEThtFICATION #:
STATE WELL CONSTRUCTION PERMIT#:
232580
�
W /rt"t
xi/ i
,F t1 Q `L
1. WELL USE (Check Applicable Box): Residential C� I Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery E', Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATION: (Sttow sketch of the location below) -
Nearest Town: /"i? mac-ti''-- //// �-'c . <
Gounry
(Road Name and jtumbars, Community. or Subdivision and Lot No.) DRILLING LOG DEPTH
3. OWNER /C&'„- 7i.r
l r' ''
�:"t"` J' From To Formation Description
,
Address /'; / <..- 4 (.t't%_ -� r1-7 ;: Y
(Street or Route No.)
/9O;i. - b✓''. -'�•
City or Town State Zip Code
4. DATE DRILLED iC' )
5. TOTAL DEPTH _3/ 4/ ()
6. CUTTINGS COLLECTED YES ❑ NO©
7. DOES WELL REPLACE EXISTING WELL? YES In NOILI
8. STATIC WATER LEVEL Below Top of Casing: 'p U FT.
(Use •+•' i1 Above Top of Casing) 0 a-
9. TOP OF CASING IS / FT. Above Land Surface'
'Top of casing terminated atlor below Land surface requires a varience in accor-
dance with 15A NCAC 2C .0118
19 10. YIELD (gpm): /O METHOD OF TEST / / /—
— 11. WATER ZONES(depthp !/'^w., rGt"'
" -
1:'
4r' `
•` / /
t_•.' /4-
/210 - _ OS %/2,246c-i
n
0
12. CHLORINATION: Type (fVe/`-t Amount //J4 (�
13. CASING:
It additional space is needed use back of f rat us
rn a
r,J --
Was Thickness LOCATION SKETCH clt o
Depth Diameter orweightrt. Material (Show direction and distance from at least two State
From To Ft. _.-. /„ Roads, or other m reterence its
From (-1-; To l'%..5 Ft. h)7 e.2 5 '- C,, (i� b!C
From To Ft.
14. GROUT:
Depth Material Method
From To Ft
From f , To -.=-10 Ft
'
15. SCREEN:
Depth Diameter Slot Size Material
From To Ft in in
From To Ftin in
From To Ft in in
16. SAND/GRAVEL PACK:
Depth Size Material
From To
From To
17. REMARKS:
Ft
Ft
/ r _
r
1 DO HEREBY CERTIFY THAT THIS WELL WAS CO •UCTED IN ACCORDANCE WITH -ISA NCAC 2C, WELL
CONSTRUCTION STA •� re
LiE ��Viti� YaG'r •1SR£COR HAS BEEN PROVIDED TO THE WELL OWNER.
E 1
rM� -SIC �� T • OF P N CONSTRUCTING THE WELL DATE
JUN LSuOmiftiiiginal to ,,; m of Wa r Quality. Groundwater Section within 30 days
GW-1 REV. 12/99
Groundwater Section
Asheville Regional Office

(Street or Rome CNo
OFFICE US
NILf IV
FOR
Quad No:
Serial No.
North Carolina - Depanment of Environment and Natural Resources - Division of Water Quality - Groundwater Section k/1 23258
2
(At
1636 Mail Service Center - Raleigh, N.C. 27699-1636-Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR- ' D(,%ki
WELL CONTRACTOR CE FICAT10N w: R46. a
STATE WELL CONSTRUCTION PERMITI: j
1, WELL USE (Check Applicable Boa): ResidentialE Municipal Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other 0 If Other. List Use:
2. WELL LOCATION:,I(Show sketch of the location below)
Nearest Town: / 41A .---. County:
(Road Nand Nu itif / r r Subdivision and Lot No.) DRIWNG LOG DEPTH
3. OWNER From To Formation Description
Address
Cvvct ,1
City or Town $tare Zip Code T r• 3�/-
4. DATE DRILLED ��%' or 7 t1 Y
5. TOTAL DEPTH 5 tic
6. CUTTINGS COLLECTED YES NOR'-
7. DOES WELL REPLACE EXISTING WELL? YESp NO ✓9.
8. STATIC WATER LEVEL Below Top of Casing: / FT.
(Use': it Above Top of Casing) 9. TOP OF CASING IS I FT. Above Land Surge'
-Top of casing terminated afar below land surface requires a variance In accor-
dance with 1SA NCAC 2C .0118
10. YIELD (gpm): Jo METHOD OF TEST ,4uZ
11. WATER ZONES (depth)- 3cf,� e a�3J
Pe-
,2�JSL
laelTe
Gia��
c3
CD-
f_ n
G cn-t
Tm
sm
—4.
r•�
r.) "T -•
W
0
12. CHLORINATION: Type et Amount V/tyn./ 11 additional space is needed use back of form
13. CASING:
Wee ThicknessLOCATION SKETCH
Depth Diameter orweight/FL Material (Show direction and distance from at least two State
From To Ft Roads, or other map reference points)
From Tom? Ft 6* 4t0
From To Ft.
14. GROUT:
Depth
From To Ft
From _ To 2_0 Ft.
15. SCREEN:
Material Method
Depth Diameter Slot Size Material
From To Ft in in
From To Ftin in
From To Ftin in
16. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft
576*
Itu,t r
23(
17. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTR
CONSTRUCTION STANDARDS, AND THAT A COPY OF
W 11 d tL r t
r Submit Orgaal
jl
D IN ACCORDANCE WITH 15A NCAC 2C, WELL
RECORD AS BEEN VIDEO TO THE WELL OWNER.
3NATURE OF/PER SSJ CONSTRUCTING THE WELL DATE
o Division of Water Duality, Groundwater Section within 30 days
GW-1 REV. l2/99
Groundwater Section
Asheville Regional Office _

North Carolina - Department of Environment and Natural Resources - Division of Water Quality • Groundwater Section
1636 Mail Service Center - Raleigh, N.C. 27699-1636-Phone [phone]
WELL CONSTRUCTION RECORD
WELL. CONTRACTOR -
WELL CONTRACTOR CE
/ O�I'2232583
IFICATION #: e/�
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE (Check Applicable Box): Residential Lod' Municipal ❑ Industrial ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ 1f Other, List Use:
2. WELL LOCATION: (Show sketch of the location below) c
Nearest Town: J4/t/(/t4-C L, County: hi—C'-" "'--)
te
?2
(Road Name and Numbers. Community, or Subdivision and Lot No.)
3. OWNERt4w Sere
Address 32 / c1�o {6L�i Rd
(Street w Route o-
�,t'�/'i.vti,vv NG
City or Town State
4. DATE DRILLED 3-Z7-o/
5. TOTAL DEPTH
6. CUTTINGS COLLECTED YES ❑ NOR
7. DOES WELL REPLACE EXISTING WELL? YES D NO��
S. STATIC WATER LEVEL Below Top of Casing: tab FT.
(Use to-- it Above Top of Casing)
9. TOP OF CASING IS / FT. Above Land Surface*
`Top of casing terminated atfor below land surface requires a variance In accor-
dance with 15A NCAC 2C .0118
10. YIELD (gpm): if METHOD OF TEST R r 2
Agricultural ❑ Monitoring ❑
DRILLING LOG
From To
T 90
e, • 0 A7
11. WATER ZONES (depth): eicen. e
12. CHLORINATION: Type oat-N-tl Amount rgyeti
13. CASING:
Wae Thickness
Depth Diameter or Weight/FR. Material
From To n� Ft ,—
From 0 To. Ft. . `— )-6
From To Ft
14. GROUT:
Depth Material Method
From To Ft /
From E7 To 2° Ft ,- 1/ &
15. SCREEN.
Material
Depth Diameter Slot Size
From To Ft in in
From To Ft in in
From To Ft in in
16. SAND/GRAVEL PACK:
Depth
From To Ft.
To Ft.
Zip Code
From
17. REMARKS:
Size Material
DEPTH
Formation Description
D,;e/ S E 1
o
C o
3 �c
w
.rr
1f additional space is needed use back of form
LOCATION SKETCH
(Show direction and distance from at least two St-te
Roads, or other map reference - • • is
e
j �Y
0 TRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STAI lipSil 1�u i • 1 • '• F THIS R RD HAS BEEN PROVIDED TO THE WELL OWNER.
FOR OFFIC ONLY
Quad No: - V IGNA OF PERSON CONSTRUCTING THE WELL DATE
al to Division of Water Quality. Groundwater Section within 30 days
Serial No. 1 1 GW-1 REV. 12/99
I DO HEREBY CERTIFY.TNAT411

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section P.O. Box 29578 - Raleigh, N.C. 27626-0578-Pho e [phone] 2 3
9 2 .J 0
WELL CONSTRUCTION RECORD DRILLING CONTRACTOR: ZI
DRILLER REGISTRATION #:
STATE WELL CONSTRUCTION PERMIT#:
l/
1. WELL USE (Check Applicable Box): Residential 0 Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use: WELL LOCATIONASJ3gwoFketch of the location below) /1 l .b
. oA.v—e_IP
Nearest Toyer';> 't County-
; './ 1 A '... • �f �?2J-�-' 1"teI .r... f.N i ._c'
(Road,Conynuhjty„griubdWiyprpgd-Lo .) A9Li CR•ISP DEPTH DRILLING LOG
3. OWNER / 3 . (e ^ J L G H !' 4. si L '2 i From To Formation Description
ADDRnS,S,re.ov- (9 / . �„ b . (, -<
/i tdi(Street or _gt#'No.) 4) b 75 2 .
City or Town 7 (.51re Zip Code -, r i 61?)-+ t-t-"
4. DATE DRILLED 4/45-
5. TOTAL DEPTH
6. CUTTINGS COLLECTED YES NO El L
7. DOES WELL REPLACE EXISTING WELL? YES i NOE
8. STATIC WATER LEVEL Below Top of Casing: FT. o
C
o
(Use "+" if Above Top of Casing)
9. TOP OF CASING IS FT. Above Land Surface'
N `;a
'Casing Terminated at/or below land surface is illegal unless a vaiince is'ssued4AC 2C o
n
in accordance with 15AN .0118 /! �'�- J i1 P' -1 z^'
10. YIELD (gpm). METHOD OF TEST IV
. 11. WATER ZONES (depth)' ! "-Le /4 -11'11' 5 2 O
e 1/4-V
>o
_s .tea
12. CHLORINATION: Type Amount/ If additional space is needed use back t?orm m
13. CASING:
Wall Thickness
Depth Diame eror Weight/Ft Material
O From To •i/,!, /
Ft /7 90 >/JC
From To Ft.
From To Ft
14. GROUT:
Depth Material Method
From ' To '7() Ft ? / c�t/i.t/I
From To Ft
15. SCREEN:
Depth Diameter Slot Size Material
From To Ft in in
From To Ftin in
From To Ft in in
16. SAND/GRAVEL PACK:
Depth Size Material
From To Ft
From To Ft.
17. REMARKS:
LOCATION SKETCH N z
(Show direction and distance from at least two State
Roads, or other map reference points)
I DO HEREBY CERTIFY THAT THIS WELL WAS CONr4TRUCTED IN ACCORDA CE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COp F 'HIS REC., PROVIDED TO THE WELL OWNER.
FOR OFFICE USE ONLY;
Quad No:
Serial No:
SIGNATURE OF/E ONTRACTOR OR AGENT
Submit original to Division of Water Quality and copy to well owner.
GW-1 REV. 1/98
DATE

North Carolina Department of Environment and Natural Resources - Division o! Water Quality - Groundwater Section 228966
}I2, O �I7, tU U {i1�y
1636 Mail Service Center - Raleigh. N.C. 27699.1636-Phone [phone] �51 IUD W ✓' I
WELL CONSTRUCTION RECORD WELL CONTRACTOR
WELL CONTRACTOR CERTIFICATION #:
STATE WELL CONSTRUCTION PERMIT#: 4 -
1. WELL USE (Check Applicable Box): ResidentialEB- Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring D
Recovery ❑ Heat Pump Water Injection ❑ Other El It Other, List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: ,r 1`-'---- County:
(Road Name and Nun cs, Consrwrpy. or Subdivision and Lot No.) DRILLING LOG DEPTH
3. OWNER L-' eJ t'-y ly✓ vy✓ - From To Formation Description
Address / cR ': r! 7
(Street or RoutsH6) 7
City or Town _ State Imp Code
4. DATE DRILLED L-7/'5' fir iyr a_:1Jr- 0
5. TOTAL DEPTH 2/'r i o
6. CUTTINGS COLLECTED YES 0 NOm-� " _•
L•L�
7. DOES WELL REPLACE EXISTING WELL? YES n NOQ - ro ,.
8. STATIC WATER LEVEL Below Top of Casing: FT. ccz ,
(Use': it Above Tap of Casing) r'-'
9. TOP OF CASING IS / FT. Above Land Surface' n
-Top of casing terminated at/or below land surface requires a valiance In actor- _c. y
dance with 15A NCAC 2C.011e
10. YIELD (gpm): -0 METHOD OF TEST M r < cot. v
c1
11. WATER ZONES (depth)' .4 "7J /' tV o
12. CHLORINATION: Type // A^ • 4--y Amount js - If additional space is needed use back of form
13. CASING:
Wail Thickness LOCATION SKETCH
Depth Diameter or Weighin. Material (Show direction and distance from at least two State
From To Ft Roads, or other map reference points)
From To R Ft. 6 % Z/"t 'Z' (--
From To Ft
14. GROUT: •
Depth Material Method .
From To Ft ,/—" a
From To 7a
15. SCREEN:
Depth Diameter Slot Size Material
From To Ft in in
From To Ftin. in
From To Ftin in
16. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft
17. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS C
CONSTRUCTION STANDARDS, AND THAT A CO
FOR OFFICE USE ONLY
Quad No:
Serial No
ISTRUCTED IN ACCORDANCE WITH 15A NOAC 2C, WELL
OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
stet '1`'flgof RSON CONSTRUCTING THE WEU. DATE
Submit o iginal to Div'stot4 of Water Quality Groundwater Section within 30 days
e
re" ;c
Gw-t REV. 12/99

228965
North Carolina - Department of Environment and Natural Resources - Division of Water Quality • Groundwater Section
1636 Malt Service Center - Raleigh, N.C. 27699-1636-Phone [phone] I
WELL CONSTRUCTION RECORD WELL CONTRACTOR: v6,;re, 4' d5cl LE If'`
t'I Drt tA",
WELL CONTRACTOR CERTIFICATION #: t
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE (Check Applicable Box): ResidentialO Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other n If Other, List Use:
2. WELL LOCATION: (Show_sK.etch of the location below)
Nearest Town: F;","": ,'' - County' i
2
(Road Name and Numbers. Corrmunjty. or Subdivision and Lot No.)
3. OWNER `.ZF•,, , ( r:
Address ( t gl..
1 (Street or Route I•(o. f _
City or Town State Zip Code
4. DATE DRILLED- )'<"
5. TOTAL DEPTH -' >•
6. CUTTINGS COLLECTED YES ❑ NOQ'
7. DOES WELL REPLACE EXIS11NG WELL? YES in NOf
8. STATIC WATER LEVEL Below Top of Casing.? 0 FT.
/ (Use •+ if Above Top of Casing)
9. TOP OF CASING IS ( FT. Above Land Surface'
'Top of casing terminated atfor below land surface requires a variance in accor-
dance with 1SA NCAC 2C.0118
10. YIELD (gpm): / 2• METHOD OF TEST, 1 )Z
11. WATER ZONES (depth). / Z 5`w 121- / ,�
DRILLING LOG DEPTH
From To Fomation Description
0 L/r=
/�,.. /( A"
r
12. CHLORINATION: Type (J' -r" Amount/Y % �•'
13. CASING:
0
•O '
a.
'O o^
� r
r.i
v
ri
n
cn;_
rn
c-:
If additional space is needed use back of form
F,
Wal Thickness LOCATION SKETCH
Depth Diameter or WeighuR. Material (Show direction and distance from at least two State
From To Ft Roads, or other map reference points)
�S From (2To
4 Ft.r
From To Ft
14. GROUT:
Depth Material Method
From To Ft
From 0 Toft) Ft ..1e/
15. SCREEN:
Depth Diameter Slot Size Material
From To Ft in in
From To Ft in in
From To Ftin in
16. SAND/GRAVEL PACK:
Depth Size Material
From To Ft
From To Ft
17. REMARKS:
it
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTR
CONSTRUCTION STANDARDB\ AND'sl-fmA COPY F_
FOR OFFICE USEQNLY
Quad No:
.TED IN ACCORDANCE WITH 15A NCAC 2C, WELL
S RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
SIGNATURE OF RSOSTRUCTING THE WELL DATE
Submit original to Division of W er Outiic, Groundwater Section within 30 days
GWI REV. 12/99
Serial No.

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
P.O. Box 29578 - Raleigh, N.C. 27626-0578-Pho e [phone]
WELL CONSTRUCTION RECORD DRILLING CONTRACTOR
DRILLER REGISTRATION #:
239234
IA Da)
STATE WELL CONSTRUCTION PERMIT#: /s c
1. WELL USE (Check Applicable Box): Residential 01. Municipal 0 Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery 0 Heat Pump Water Injection ❑ Other If Other, List Use.
WELL LOCATION: (Show sketch of the location below) c p�
Nearest Town: /"1G'2tcU- County__ / Gic e
Wv� A )0
(Road, Comm or Subdivision and lot No.) DEPTH DRILLING LOG
3. OWNER /c-OSS tb1/'1 From To Formation Description
ADDRESS
(Street or Route No.)
0 (2o
City or Town State Zip Code
4. DATE DRILLED .2--05-(0( i24:->_ 0:0
5. TOTAL DEPTH 4/0s
6. CUTTINGS COLLECTED YES ❑ NO ©i
7. DOES WELL REPLACE EXISTING WELL? YES 0 NO[Ek
8. STATIC WATER LEVEL Below Top of Casing: 6b FT.
/ (use '+• 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 valance is issued
In accordanm with 15A N 2C .0118
10. YIELD (gpm)• METHOD OFST 4( 2
. 11. WATER ZONES (depth). 7)j7,€ co
12. CHLORINATION: Type -% Amount
13. CASING:
�',cf.
0
0
4,1 V 1
rU T,
c c�
0<
a
3 A0
•• m�
If additional space is needed use back of foul
Wall Thickness LOCATION SKETCH
Depth Diameter or Weight/Ft Material (Show direction and distance from at least two State
From To Ft Roads, or other map reference points)
From /) To --Ili— Ft. 6 gle -i fo it''.*
From To Ft
14. GROUT:
Depth Material
From To 'jFt /
From (20 D To _ Nee Ft 2 ct rNeed
15. SCREEN:
Depth Diameter Slot Size
From To Ft in in
From To Ft. in in
From To Ft. in in
16. SAND/GRAVEL PACK
Depth Size Material
Method
Material
From To Ft.
From To Ft
17. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION ST# NDARgS, AND THAT A COPY OF I t RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
FOR OFFICE USE Of441'<
Quad No:
Serial No'
SIGNATURE OF CTOR OR AGENT DATE
Submit original to Division of Water Quality and copy to well owner.
GW-1 REV. 1/98
Cronnriwate-Sp
Ash 10

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
P.O. Box 29578 - Raleigh, N.C. 27626-0578-Pho e [phone]•
9 2 0 9 t 9
WELL CONSTRUCTION RECORD
DRILLING CONTRACTOR:''
DRILLER REGISTRATION #: a 150
STATE WELL CONSTRUCTION PERMIT#:
WELL USE (Check Applicable Box): Residential LLY Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other If Other, List Use:
WELL LOCATION: A(Shoow sketch of the location below)
!'
Nearest Town: ( 47 tcR4 / County
(Road, Community, oprr Subdivision and Lot No.)
3. OWNER %t 6Jt-..
ADDRESS 9 N. en- Kea
(Street
(o�rr(�Route No.)
Ci or Town State
4. DATE DRILLED o2%- 0
5. TOTAL DEPTH �(o$�
6. CUTTINGS COLLECTED YES n NO
7. DOES WELL REPLACE EXISTING WELL? YES j] NOr-
8. STATIC WATER LEVEL Below Top of Casing: gel FT.
(Use "+^ 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
in accordance with 15A NCAC 2C .0118
10. YIELD (gprn). METHOD OF TEST AOC
. 11. WATER ZONES epthr _ (!� �` 34d /�,�
12. CHLORINATION: Type —Amount_ Vpr
13. CASING: 7
Wall Thickness
Depth Diameter or Weight/FL Material
From To Ft
From 0 To - - Ft.
From To Ft
14. GROUT:
c, lye
Depth
From To Ft.
From To r Ft. v`lkii //_
15. SCREEN:
Material Method
Depth Diameter Slot Size Material
From To Ft in in
From To Ft in in
From To Ft in in
16. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft
17. REMARKS:
DEPTH DRILLING LOG
From To Formation Description
rr�� ?f2 m- /29
'Erp de
4 rg sCaoti
(2o - 4405- sauf �z
0
0
oa za
u cc.
rn
N *r`*t
3 re 1.4
If additional space is needed use back of forrrR
4
PO 0
LOCATION SKETCH z
(Show direction and distance from at least two State
Roads, or other map reference points)
.SU
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTR
CONSTRUCTION STANDARDS, AND THAT A CQFY
FOR OFFICE USE ONLY
Quad No.
Sedai No:
CTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
S RECORD HAS BEEJJ PROVIDED TO THE WELL OWNER.
IGNATURf/OF CONTRACTOR OR AGENT DATE
Submit origtlfal to Division of Water Quality and copy to well owner.
GW-1 REV. 1/98

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
P.O. Box 29578 - Raleigh, N.C. 27626-0578-Pho e [phone]
WELL CONSTRUCTION RECORD DRILLING CONTRACTOR: t
DRILLER REGISTRATION #: (/ 5trc
239 51
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE (Check Applicable Box): Residential LP" Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection D Other ❑ If Other, List Use:
WELL LOCATION: Showsketch of the location below)
Nearest Town: 4.44.' County
:2g 2d
(Road, Community, or S ' ion a Lot N �.) p
3. OWNER L® /� aryl
trt�L
ADDRESS 07115 /l „thr g
tutus,( et or Route No.) 'S�/
City or own to ( C. ' Code
1)4-`Dowe
DEPTH DRILLING LOG
From To Formation Description
CO
4. DATE DRILLED
5. TOTAL DEPTH 65 r+ 3
6. CUTTINGS COLL YES � NO®�
7. DOES WELL REPLACE EXISTING WELL? YES NO
brycl
8. STATIC WATER LEVEL Below Top of Casing: <<v FT.
(Use "+^ 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
in accordance with 15A NC C2C .0118
10. YIELD (gpm): efd METHOD OF TEST !4j
. 11. WATERZONES(depth) ._!' 7/M ® 31D1
12. CHLORINATION: Type
13. CASING:
Depth
From To
From D To 70
From To Ft
14. GROUT:
Depth Material
From To Ft. ,I
From to To aFt. r24:4
15. SCREEN:
Amount
Wall Thickness
Diameter or Weight/Ft Material
F
Method
Depth Diameter Slot Size Material
From To Ft in in
From To Ft in in
From To Ft in in
16. SAND/GRAVEL PACK:
Depth Size Material
From To Ft
From To Ft.
17. REMARKS:
V
O
Stri
N ='
a �\
-
If additional space is needed use back-rf form-r
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other map reference points)
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTFED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF S SE.CORD(I A(tS BEEN PROVIDED TO THE WELL OWNER.
FOR OFFICE USE ONLY
Quad No.
Serial No:
SIGNATURE OF COCTOR OR AGENT DATE
Submit original to Division of Water Quality and copy to well owner.
GW-1 REV. 1/98

228963
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section WELL CONSTRUCTION RECORD WELL CONTRACTOR., `� +
1636 Mail Service Center - Raleigh, N.C. 27699.1636-Phone [phone] �, yr I I �/t (lt
�7 ( ((/
WELL CONTRACTOR C2iio#:IFICATN tX , .
STATE WELL CONSTRUCTION PERMIT#: r �-
1. WELL USE (Check Applicable sox): Residential ❑ Municipal Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other If Other, List Use:
2. WELL LOCATION,: (Show §ketch of the location below)
Nearest Town
7 County
P(
(Road Name and Numbers, Co ity. or/Subdivision and Lot No.) DRILLING LOG DEPTH
3. OWNER 64M Yr cg_ 1 From To Formation Description
Address
(Street or Route No.)
0 --
City or Town State
f
4. DATE DRILLED
5 TOTAL DEPTH r .,
Zip code f)c/—r,/f ,
6. CUTTINGS COd CtED YES ❑ NO 7f
7. DOES WELL REPLACE EXISTING WELL? YES [] NOn
8. STATIC WATER LEVEL Below Top of Casing: @ FT.
/ (Use . it Above Top of Casing)
9. TOP OF CASING IS / FT. Above Land Surface'
'Top of casing terminated at/or below land surface requires a variance In accor-
dance with 15A NCAC 2C.8j18
10. YIELD (gpm): /14) METHOD OF TEST t / ` �-
11.WATERZONES (depth): /L'2/7/'?(t7 /1'-J
12. CHLORINATION: Type
Jr Amount ete
13. CASING:
Wall TNUmess
Depth Diameter or Weight/FL Material
From To _ � Ft --r--
From To /f-/- Ft. `'77
From To Ft.
14. GROUT:
From
From (i
15. SCREEN:
From
From
From
Depth
To
To
To
cr;;
Depth Material
To Ft
To a<, Ft. C->i
Diameter Slot Size Material
Ft in in
Ft in. in
Ft in. in
16. SAND/GRAVEL PACK:
Depth
From To
From To
17. REMARKS:
Method
4
Et
Ft
Size Material
/iL5. /e,
0
O
It additional space is needed use back of fors_ y
LOCATION SKETCH
(Show direction and distance from at least twO State
Roads, or other map reference points)
DO HEREBY CERTIFY TH81THS/
IS WELL WAS CONRUCTED IN ACCORDANCE WITH 1SA NCAC 2C, WELL
I
L5 "I'
CONSTRUCTIO S L
N S THAT A C 14 OF THIS RECpADTfnS'BEEN PROVIDED TO THE WELL OWNER.
FOR OFFICE -USE ONLY
Quad No:
SIGNATURE QF PERSON CONSTRUCTING THE WELL DATE
Submit original to Division of Water Duality. Groundwater Section within 30 days GW 1 REV. 12l99
Serial No.

228961
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'""'"'"' �� D/r C�-
57)
WELL CONTRACTOR CEf4TIFICATION #:
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE (Check Applicable Box): Residential L]d Municipal ❑ Industrial 0 Agricultural 0 Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATION:�1�1(Show sketch of the location below)
Nearest Town' 416. r' C1V County'
PA r/Cer s CA4,,eL
(Road Name and Numbers, Community. or Subdivision and Lo No.)
/r
3. OWNER if - 7 -34-tVeiv S or}
DRILLING LOG
From To
Address 0g ( rker'C%L�pGd' Dr-
( treet or Route") -• / O O
MgtjOFe 7ti Z 1'3712:
City or Town State Zip Code
4. DATE DRILLED / / -- 02
5. TOTAL DEPTH 3 I
6. CUTTINGS COLLECTED YES ❑ NOLg**-
7. DOES WELL REPLACE EXISTING WELL? YES ❑ NOri
8. STATIC WATER LEVEL Bebw Top of Casing: C/,.) FT.
(Use •+ if Above Top of Casing)
9. TOP OF CASING 15 / FT. Above Land Surface'
'Top of casing terminated at/or below land surface requires s variance In accor-
dance with 1SA NCAC 2C .0118 /•�,
10. YIELD (gpm): _L_ METHOD OF TEST
11. WATER ZONES (depth): / .o+ C Amount T7 9
a?S
12. CHLORINATION: Type � -
4-41 CSC
13. CASING:
An -.3VS-
Wall Thickness
Depth Diameter or Weight/FL Material
From To Ft
From n To / 09 Ft. L+ A/ 1/0 / k&
From To Ft
14. GROUT:
DEPTH
Formation Description
O o
:a r.
If additional space is needed use back of I@Nf
Depth Material Method
From To Ft
From 0 To 70Ft 51/ 7Jarci-/
15. SCREEN:
Depth Diameter Slot Size Material
From To Ft in. in
From To Ft in in
From To Ft in in
16. SAND/GRAVEL PACK:
Depth Size Material
From To Ft
From To Ft
17. REMARKS:
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other map reference points)
I DO HEREBY CERTIFY THAT THIS WELL WAS CO STRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS. AND THAT A COl OF THIS Rp60R0 HAS BEEN PROVIDED TO THE WELL OWNER.
FOR OFFICE USE ONLY
Quad No;
SI(NATyRE�PERSON CONSTR TING THE WELL
Submit original to by
of Water Duality, Groundwater Section within 30 days
DATE
GW-1 REV. 12199
Serial No.

North Carolina - Department of Environment, Health, and Natural Resources
Division of Environmental Management - Groundwater Section
P.O. Box 29535 - Raleigh, N.C. 27626-0535
Phone [phone]
WELL CONSTRUCTION RECORD
DRILLING CONTRACTOR:
DRILLER REGISTRATION NU ER: 7['
ATE WELL CONSTRUCTION
PERMIT NUMBER:
4. in
aJ„ of -( gel
( , Com pity, or S ivision and Lot No.)
2. OWNER 5 %i��.
ADDRESS Ni ftftor (Pla . I
%9/ �1 (Street or Route No) p 7
•t 2-Y� DIP �- a ` i .�ti
City or Town Sta a ip Code
3. DATE DRILLED A 3-e/_ USE OF WELL
4. TOTAL DEPTH �7 Qom_
5. CUTTINGS COLLECTED YES NO -( Z
6. DOES WELL REPLACE EXISTING WELL? YES NO t,
7. STATIC WATER LEVEL Below -Top of Casing: FT.
(Use "+" if Above Top of Casing)
FT. Above Land Surface*
1. WELL LOCATIO,,,//F�,y(: (Show sketch of the location below)
Neare t Town: /p% County. JI4 � �"
Fd
8. TOP OF CASING IS I
• Casing Terminated at/or below land surface is Illegal unless a variance is issued
In accordance with 15A CAC 2C .0118
9. YIELD (gpm) METHOD OF TEST NI tee,tee,10. WATER ZONES (depth): 7$'/at 61jL °
11. CHLORINATION: Type Amount
12. CASING:
#4,
DEPTH DRILLING LOG
From To Formation Description
6-it a
r
O
n --,
P = M_c
o r>)
co
If additional space is needed use back gif formo
wall Thickness LOCATION SKETCH
Depth Diameter or Weight/Ft. Material (Show direction and distance from at least two State
From To Ft. Roads, or other map reference points)
From D To-n Ft. Gl!/ Wei / is
From To Ft
13. GROUT:
Depth
From To ? Ft
From To " Ft 0,
14. SCREEN:
Material
Method
Depth Diameter Slot Size Material
From To Ft in in
From To Ft in in
From To Ft in in
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft
From To Ft
16. REMARKS:
PalPsi
I DO HEREBY CERTIFY THAT THIS WELL WAS CON TRUCTEi ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY F THIS R CORD HAS BEEN PROVIDED TO THE WELL OWNER.
StSJQATURE OF CONTRAZ R OR AGENT DATE
Submit original to Division Environmental Management and copy to well owner.
GW-1 REV. 9/91

North Carolina - Department of Environment and Natural Resource - Division of Water Duality - Groundwater Section
1636 Mad Service C.nwr - Raleigh, N.C. 27099-1636-Phone (11a) 733.3221
WELL CONSTRUCTION RECORD WELL CONTRACTOR.
WELL CONTRACTOR CERTIFICATION I: L,Z $ 77
STATE WELL CONSTRUCTION PERMITS:
246208
SweetWater Well Drilling & Pump Service, Inc.
1. WELL USE (Check App abb. Soz): RoaidaMFWMunicipal ❑ Industrial 0 Agricultural 0 Monitoring 0
Recovery 0 Heat Pump Water Injection Other p If Other, List Use:
2. WELL LOCATION: ( location below)
Nearest T ��ph17 couir M61
a St tMbn, �� la�Na) -7 DRILLING LOG DEPTH
3. OWNERRr�1�C� i?j44.C�*a .�p1 J� From To Fonrnsm Onu4tla.
Address
dy atTovn z4 Coda
4. DATE AS3/1,317.
5. TOTAL DEPTH ys
6. CUTTINGS COLLECTED YES 0 No®
7. DOES WELL REPLACE EXISTING WELL? YES ❑ NO®
8. STATIC WATER LEVEL Below Top of Casing: / C FT.
(Use 'e I Above Top al Casv)
9. TOP OF CASING IS ZS FT. Above Land Surface
*Top of casing earaditiled Woe below Sad awlaoa requites a vrYroa In eeoor-
danea wM IEA NCAC aC AMA
10. YIELD (ppm)• M OF TESTT-�'to
11. WATER ZONES (depth). ,S' '-'D
12. CHLORINATION. Type yfi> Amoun2.2 7
13. CASING:
LOCATION
Yves Thickness Depth
k�5sr/eefrIW (Show direction and distaeu from least two Stales
From 0 To le D Ft etV G Raids, or Ater map pints) LaaAt
I O
From To
To Ft
Ft. 1,-)] 0 ,
r-e From /
14. GROUT:
L)
N
672
r ",
o
S additional apace Y,needed use back of *arm
From �_ Tom o7D FL gn/
From To Ft
15. SCREEN:
Depth
Diameter Slot Sizb Material
EE4A/%
/ !/
16. SAND/GRAVEL PACK
Material
From
From
17. RtMnnrv': i t
I DO HEREBY CERTIFY THAT THIS WELL AS
CONSTRUCTION STANDARDS. AND THAT CORN
GROUNDWATER SECTION
FOR OFFICE USECNttE R Gr!NAL OFFICE err
Cued Na SIGNATURE OP PERSON
Sufi adds to DMdon of WOW -.
ISA NCAC 2C, WELL
DED TO THE WELL 0Wt1ER.
/92uh/A 1
THE WELL TE
Gand+enar Sedan whin 30 days
MN-t REV. 12i111

Mina - Department of Enveonmatt and Natural Resources - Division of Water Quality - Groundwater Section
Sena Center • RaNteh, N.C. 27699-1636-Phone [phone]
CONSTRUCTION RECORD WELL CONTRACTOR'
WELL CONTRACTOR CERTIFICATION r 4 & ' 77
STATE WELL CONSTRUCTION PERMITS:
246207
SweetWater Well Drilling & Pump Service, Inc.
L USE (Chock Applicable Soap Residential ® Municipal 0 industrial 0 Agricukural 0 Monitoring 0
wary 0 Heat Pump Water Injection 0 Other p If Other, List Use:
LOCATION: Show Sketch of the location below) �r f /J/J
si To y//yy__�titZi� CaedY J 42 ,21
4 None and Nuhgyra. Canannty, c 4 dNeim poi tat No.)
ER
%'s/, ) Anode/ ed
ay oXTann
DRILLED
.L DEPTH
1NGS COLLECTED YES ❑ NO®
3 WELL REPLACE DDSTING WELL? YES O NO®
1C WATER LEVEL Below Top of Casing: /r FT.
(Uw +' t Above Top el Casing)
JF CASING IS / S FT Above Land Surface*
rep tonMawd sear below bad «rice. requites ■ manse In a000r-
13A NCAC 2C J1111
} (gpm): M OF TEST
ER ZONES (divot*6
: INATION: Type 2dAmount —L
VG:
awls
O
ap Code
DEPTH
FamesatDesulpbn
c
rV
c
w o
N Stone spew Is needed we back of form
ww Ricer a LOCATION SKETCH
'�a�twLta a Wine tIR. (Stow direction and distance from at Mast . Swts
Two 9G R. °�i �— _ i� / v! . Roads, or other map refraoe points)
To FL
To FL
UT:
_D_ TD:palth bFL ea=t
To Ft.
!EN:
Depth Diameter Slot Size
To Ft (n. b.
To / Ft. / / in
To / FL in. in.
RAVEL PAGIQ
HEREBY THIS WELL WAS
Maier;
GF'F; iE REGIONAL OFFICE r�
•FFICE USE O
Y # 70 e
ACCORDANCE CE WITH 15A MCC 2C, was.
TO THE WaLawi R
SONATtMEOFPERSON •• .. THE WELL SATE
Subset NOW to DWkon or Were Owlet c 3.aon within 90 days
TAM REV. 12191

24t201
1North 636 Nailhne - Genre •n ofRalEnvigh, nip C nt and Na8a6Plans (Yr 7333221n of Water Quaky • Oroundwmer Section
Ser
WELL CONSTRUCTION RECORD WELLWCOON RA�RCERTIFICATION 0: 178 V
STATE WELL CONSTRUCTION PERMIT*:
SweetWater Well Drilling & Pump Service, Inc.
1. WELL USE (aa.ar appinwe soh: Reekilltaliad Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Irr)action ❑ Other 0 If Other, Llat Use:
2. WELL LOCATION:Atm skndr of the location below) e a�GL. I�G'l
Nsa.stTown: ai?it Count
e n 4 £drck
or yAd,Yon and No.) DRILLING LOG O
(ft//��i�f rameren o..edvsan
3. OWNER From To
N('
City or Town I^_ /Stele 2111 Code
4. DATE DRILLED 5. TOTAL DEPTH
8. CUTTINGS COLLECTED YES Q NO[
7. DOES WELL REPLACE EXISTING WELL? YES p NO®
8. STATIC WATER LEVEL Below Top of Casing: .J • . FT.
(Us. •: a aeon. Top of Cueing)
9. TOP OF CASING IS 2 S FT. Above Land Surface'
lop of away temirrsed S below lord suttee requires • valWwe In weer -
donee with ISA NCAC IC .919
10. YIELD (gpm): f 5 METHOD OF TEST —Nee to
11. WATER ZONES (depth): 70 ' ESQ '
12. CHLORINATION: Type Amannnt /� 7'
13. CASING:
Depth
From To> �0 Ft.
From— To FL
From To FL
14. GROUT:
Thicansaa
ckrMSIsrW (Show direction and . • from at ad Sao
p�G Roods,«aharmap - poet
N
r
CO
f addltionr apace Is needed use back of term
From _22—. To c2h FL P
From To R
15. SCREEN:
Depth Diameter Slot Size Matelot
From To Ft kn. in.
From in.
To / R. / In. 7 In
From To FL In. Si.
16. SAND/GRAVEL PACK:
Depth Size Material
From ILffT
o Aso �t A'vI0 r .1
From .
17.R �-
CERTIFY �WRH15A NCAC2C.WELL
' ' DED TO THE WELL OWNER.
100
(X)NgTpt1C f F+11 STANDARDS, AND THA * r �aZ�.� f�/D
IFOROFFICE FvFL Y,,ATEE E F1EJ 1 T WELL
GATE
�IdNx SHED �l E REGI ±; ICE SIGNATURE OF PERSON •• ..
SrbmTt oilgi al to Division W Wear May, Oround+etw Section within 30 days arrr.r WV. rbas
5
EXIT 94
OLLL
LOT D
QJJ \4

North Caroline - Department of Environment and Natural Reaourca - Division of Water Duality - Groundwater Section
1636 Mail Service Censer - Raleigh. N.C. 27699-1636-Phone [phone]
WELL CONSTRUCTION RECORD
WELL CONTRACTOR.
WELL CONTRACTOR CERTIFICATION It: 4 S 7'%
STATE WELL CONSTRUCTION PERMITS:
246051
SweetWater Well Drilling & Pump Service, Inc.
1. WELL USE (Check Applicable Sox): Residential Municipal 0 Industrial 0 Agricultural El Monitoring El
Recovery El Heat Pump Water Injection Other ❑ If Other, List Use:
2. WELL. LocATtoN„(�^fhow nhe Ioc.tbn below)ee` .) /�.4 �e
Nimrod Tarn: f"r� ((/
c1C fla
(Road Nerve and mercers. Canna*'� tot No.) DRILLING LOG DEPTH
3. OWNER G� A—(E G ^ '(�jt!/'� From To Fcnt i eo .ta.
7nyrT.-� //
DATE DRILLED L 0/ City or Teen art cod.
4.
5. TOTAL DEPTH / R 8 e c_)
6. CUTTINGS COUECTED YES ❑ NO10 N
7. DOES WELL REPLACE EXISTING WELL? El NOR r_
8. STATIC WATER LEVEL Below Top of Casing: /C FT. - E
(Ua UAboes Top al Casing) ry o
9. TOP OF CASING IS / 4 FT. Above Land Surface'
'Top of acing terminated Wier below lend wale* mMine a stenos In moot -
donee .IS 15A NCAC 2C pis
10. YIELD (gpm): 4 � OF TEST T i
11. WATER ZONES (dSpth)' n J i
12. CHLORINATION: Type tt Amount i
13. CASING: 1/
m
ca
N
U1 0
I additional apace S needed two back of tom
ATION SKETCH
Wed (Show direction distance hum at Mast two Stale
From 0 Depth
et J Ft. #. Iv( Roads, or a9 it map reference poMda)
Fmm To FL
From To FL
14. GROUT:
Depth
P.LL tiV
From _� To cYn FL (D„ti?i "a'`"'t
From To Ft
15. SCREEN:
Depth Diameter Slot Size Material
From To //Ft in. M.
From /To /FL / In. /in /
From To FL In. in
16. SAND/GRAVEL PACK:
Depth Size MsterW
From To FL
/
From % To 7 Pt.
17. REMARKS:
IDO
CONSTRUCT
FOR OFF!
Quad Na
STANDARDS, AND 'MAT
7 2002
9GNATUFE OF PERSON
tROIJ iv TER SECTION original
ASHEVILLE REGIONAL OFFICE
to Division of Water
h5c..t IP
p. t C K
Tuo E txirw r
WITHt5A NCAC2C.WELL
PROVIDED TO THE WELL OWNER.
THE WELL %gib
Groundwater Section within 30 clays
nW.1 AFV- 12/41

North Carolina - Department of En*onment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mai Service Canter - Raleigh. N.C. 27699-1636-Ptione [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR.
WELL CONTRACTOR CERTIFICATION 11: 1,2 % 8 9
STATE WELL CONSTRUCTION PERMR#:
246052
SweetWater Well Drilling & Pump Service, Inc.
1. WELL USE (Cheat Applicable Dad: Reeiden$ai ® Munk:loai ❑ Industrial 0 Agricultural 0 Monitoring 0
Recovery 0 Heat Pump Water Injection ❑ Other El If Other, List Use:
2. WELLLLOCA`TION_ _�how�sketch k�- w) / J �� Ns�r�rAt cAwL .clr/.G/ en/IA/
(Road raertrGr�f �� a No.) DRILLING LOG
3. OWNER �] From To
Address ryy �
Xr,,,
7Y14T-au//sr.. gal7SL
City or Town , / / Sgee aP Cods
4. DATE DRILLED
5. TOTAL DEPTH
6. CUTTINGS COLLECTED YES ❑ No2)
7. DOES WELL REPLACE EXISTING WELL? YES ❑ NOM
8. STATIC WATER LEVEL Below Top of Casing: /o C FT.
(Use 'es a Abuse Tope. Owing)
9. TOP OF CASING IS /. 5' FT. Above Land Surface*
'Top et easing to aitawd War below Sod aarraoa 'equate a swine In mew -
dents attain NCAC 2C Aite
10- YIELD (ppm) ./12_ MEDHOD oFTEST72fl'a
11. WATER ZONES (depth)' /J'D t " t2/ 0
12. CHLORINATION: Type 1Amount ^.J- 11 additional apace is needed as back of tonne
13. CASING:
DEPTH
Fannason Owr+ipi
o C
r)
N -
? r
Depth From 0 ./ Ft
From To Ft.
From To FL
14. GROUT:
A Mated
From To D FL Lot
From To Ft
15. SCREEN:
Depth Diameter Slot Size
From To Ft In. %rr in.
From 1 To ! Ft. In. ! In
To FL in. In.
Well T :knew
16. SAND/GRAVEL PACK
Depth
From To
From / To
17. REMARKS:
IDO
Material
Stzs Material
G OUNDAIER SECTION
A*-'E i'LLE (EEETCl FL OFFICE
LOCATION SKETCH.
(Show direction and distant* hem at least two State
Floods, or other map Sanwa ponds)
0Wu,
fires y t 70
TORE OF PERSON •• .. '.r' WELL
Guidon of Wear Quality, Groundwater Section within 30 days
CA
nw.l RFV_ 12/99

North Carolina - Department of Erwironment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mail Service Center - Raleigh. N.C. 27599-1636-Phone (91D) 733-3221
246030
WELL CONSTRUCTION RECORD WELL CONTRACTOR. SweetWater Well Drilling & Pump Service, Inc.
WELL CONTRACTOR CERTIFICATION Ili wZ 7 S'S'
STATE WELL CONSTRUCTION PERMITI:
1. WELL USE (Check Appaabis box): Residential ® Municipal 0 Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other 0 If Other, List Use:
2. WELL LOCATION: (Showaetch of the location below) nL
Nearest To re County: a S
(hoed Name rsertean0CI a SubliMsko and Lot No.)
Lv
3. OWNER {f/f/'/
Address - y
;aa1 r11alea 1ea.1 Acfd
City or Tarn .. - 2 Code
4. DATE DRILLED
5. TOTAL DEPTH
5. CUTTINGS COLLECTED YES Q NO®
7. DOES WELL REPLACE EXISTING WELL? YES NO®
8. STATIC WATER LEVEL Below Top of Casing: FT.
(use t• a Avow op of Casing)
9. TOP OF CASING IS 5 FT. Above Land Surface*
'Toy of acing Isminaled SAx bellow tad mews regale's a vrWroe In aeor-
dawe With 1SA CAC 2C Jp14
10. YIELD (gprn): 0 METHOD OF TEST 'Z flC#
11. WATER ZONES (depth) -/co' 3e2o
DRILLING LOG
From To
DEPTH
Frain Oecdplian
o _<
r
7-0 rh
12. CHLORINATION: Type Amount 11 'dialogist apace is needed use beds of Pan
13. CASING:
cod TMerwo
Depth DWr»tr orWeight/R eW (Show direction and
From O Tora° Ft. jo-19 AE��U� Roads, or other
Frown To FL
From To Ft.
14. GROUT:
From d To n9a FL G=r—
From To Ft
15. SCREEN:
Depth Diameter Slot Sae
From To /// Ft // in. /JJJ In
From / To / Ft. / In. � In
From To / FL / In. in
Warfel
18. SAND/GRAVEL PACK:
Depth Size Material
From To
From / To
17. REMARKS w w_
IDO
FORD
Quad Ho:
ROUND 'TER SECTION
ASHEVILLE REGIONAL OFFICE
AccoRD/WCE WITH 15A NCAC 2C, WELL
HAS / • f• TO THE WEILOWNER.
TUBE OF PERSON .•... tTHE WELL DATE
b Otvrbn swarm away, Gwmd•rsrr sector' within 30 days
nw.1 iikV. 12I 9
01 IV
ifroit
Hayst

North Carona - Department of Environment and Natural Resources - Division of Water Duality - Groundwater Section
1636 Marl Senna Canal - Raleigh, N.C. 27599-1636-Phons (9/9) 733-3221
WELL CONSTRUCTION RECORD WELL CONTRACTOR-SweetWater Well Drilling & Pump Service, Inc.
WELL CONTRACTOR CERTIFICATION a: 7 g 9
STATE WELL CONSTRUCTION PERMITI:
2460E10
1. WELL USE (Caeca Ant.bls son): Residential RI Municipal ❑ Industrial 0 Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ 1f Other, List Use:
2. WELL LOCATION: n Show *etch the location below) iy%e
Nearest TowJ'�'�' county
(toad NameConnotes
OWNER / `J
3.
Address /_� t «
aaNW
a.) DRILLING LOG DEPTH
dta
o
tW No
M�LGcvc- NC. f 752-
ay«Town r ,ewe zpCode
4. DATE DRILLED
5. TOTAL DEPTH
From To Formation Description
6. CUTfNGS COLLECTED YES Q NOE r ,
7. DOES WELL REPLACE T70STING WELL? YES NO2 r o
8. STATIC WATER LEVEL Below Top of Caabg: FT. zw,
(tMs elMon Tap aCaging)
9. TOP OF CASING IS / _S FT. Above Land Surface* - :
'Top of anima lerararead attar Wow led swlaoa requiem a widow* if a000r-
dwe. WIN 1SA !CAC 2C .tiny -rl E
10. YIELD (ppnl). S MEJHOD OF TEST 7.Lst�i
11. WATER ZONES (depth)- /sr
r
tV rn
-4
��r���Dp--��c//
12. CHLORINATION: Type . ,L«L�L Amount GT a additional spate i medal w back of ben r.
13. CASING: VV
Depth /
From 0 To CP 0 Ft
From To FL
From To R
14. GROUT:
From 0 To&O FL (a _MSdC-
Depth
From To Ft
15. SCREEN:
Yysti nears
al"
Depth Diameter Slot S¢e Material
From �To t / In. / in. 77
From To / R h. h.
From To F1 It h.
16. SAND/GRAVEL PACK
Depth SW Material
From To FL From / /
� To � FL17. REMARKS:
100
FOR OFFICE
Quad No:
v
STANDARDS, AND THAT A
044R 2 7 2002
LOCATION SKETCH
(Show dkacrbn and oMat
nt two State
« Roads, other mop per)
fetil
ort)fili°}31/
�yo /,G,t;rect 9n
IN ACCORDANCE WITH 15A NCAC 2C, WELL
RECORD HAS SEEN DED TO THE WELL OWNER
SONATUR! OF PERSON THE WELL DATE
>bti ortgra a Dlefalon of Wow ovary, Ovoundnusr Smcson within 30 days
GROUNDWATER SECTION nvr-1 REV.1W
ASHEVILLE REGIONAL OFFICE

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mad Service Center - Raleigh, N.C. 27699-1636•Phon. (919) Tfl-3 11
WELL CONSTRUCTION RECORD WELL CONTRACTOR.
246033
SweetWater Well Drilling & Pump Service, Inc.
WELL CONTRACTOR CERTIFICATION s:
STATE WELL CONSTRUCTION PERMITS:
1. WELL USE (Check Applicable 6a.): Residenea1121 Municipal 0 Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other p If Other, uat Use:
2. WELL LOCATION: y location below) Newest Town: j� t U /f l4U-ccf
j �� 'Coaalty. //�
__iws / DRILLING LOG
3. OWNER and
Gd'f J From To
Address
txy-orTown
4. DATE DRILLED 1//t o 4/
5. TOTAL DEPTH . T
6. CUTTINGS COLLECTED YES 0 NO®
7. DOES WELL REPLACE EXISTING WELL? YES NO[ ,.
8. STATIC WATER LEVEL Below Top of Casing: FT.
(Use •+'a Maw Top el Paired
9. TOP OF CASING IS /-a FT. Above Land Surface*
*Top or inns t ra dirled Serf Wow Sad marten aquae. a wine in wow -
donee adds 15A NCAC 3C .�01�15+
10. YIELD (gpm): 1y-Z METHOD OF TEST re12r/
11. WATER ZONES (depth)• /7.S.
tfl7 z
Zp Cad
DEPTH
Fomiellen Dercdp on
N
L
a c- <_
N m
12. CHLORINATION: Type Amount ' t wit awl spec* Y needed era back o� a 113
13. CASING:
w From 1-*" To Le.
From
From To FL
From To FL
14. GROUT:
From 0
From To P1.
15. SCREEN:
wall Trims..
«w,i 'a Par,
ar ` (Show dksctbn and disdisgracepra
% / Floods, of other nap
it
TTDepth
�o Ft /'actor
Depth Diameter Slot Sae Material
EE40
in./EY
//In.
Ft In.
16. SAND/GRAVEL PACK:
Depth SW Material
From To Ft
From /` To Pi.
17. R
1I,.titiroitthf 2U
GROUNDWATER SE TION
ASHEVILLE REGIONAL OFFICE
0413 a_
4
AS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
A COPYD HAS TO THE WELL OWNER.
SIGNATURE OF PERSON CCN8IRIIC 1NG THE WELL DATE
Weird/ b Division of We. Malay, Geoundraeur Swam within 30 days
nw-1 REV. 12/911

d
Stan and Lot Na) DRILLING LOG
From To
Q2B'74 a—
re Code
North Carolina • Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mail Service Center - Rdsigh• N.C. 27699-1636-Pfore (919) 711:+221
WELL CONSTRUCTION RECORD WELL CONTRACTOR• SweetWater Well Drilling & Pump Service, Inc.
WELL CONTRACTOR CERTIFICATION 1: l 4?
STATE WELL CONSTRUCTION PERMIT/f:
244245
1. WELL USE (Check Applicable Bot): Residential ® Municipal 0 Industrial El Agricultural El Monitoring ElRecovery ❑ Heat Pump Water Injection [J Other p If Other, List Use:
2. WELL LOCATI
Nit
3. OWNER
ON: LBhoA.etch ol the location below) _744n
Nearest TOWS:
Numbers.
t*y or Tmn/ Slay
4. DATE DR)LLED O
5. TOTAL DEPTH '
6. CUTnnoS COLLECTED YES No Da
7. DOES WELL REPLACE EXISTING WELL? YES ED NOM
8. STATIC WATER LEVEL Below Top of Casing: /q FT.
(useAeon Top l Casing)
9. TOP OF CASING IS / S FT. Above Land Surface'
-Top of using tsar etad allor blow tad static* rear a manse In aewr-
denee with 13A NCAC 2C�otta .
10. YIELD (gpm)• .3 D MET OF TEST L.e c o
11. WATER ZONES (depth).26z2 '
12. CHLORINATION: Type Amount _L7r
13. CASING:
Depth
Fran—.12—To %/I, Ft.
Frorn To Ft.
From To FL
14. GROUT:
wea Thickness
A
FFromD NJ?) FL j I
From To Ft
15. SCREEN:
Depth Diameter Slot Size Material
From To in
From / To / Ft / in. /h
From / To Ft / h. h
16. SAND/GRAVEL PACK:
Depth Size Matsdei
From To
From To /
17. REMARKS:
/ /
DEPTH
Formation Desdption
I additional awe I needed use beck of loan
LOCATION SKETCH
(Show clinic/Jon and distance ham at Weep two State
Roses, or other neap refersncv pokes)
=yD
I DO HERESY !COMFY -THAT MS WELLWII
CONSTRt firig ARDS, AND THATTA
FOR OFFICE USE ONLY
awl t
a
Fir '
IN ACCORDANCE WITH 15A NCAC 2C, WELL
OF r D HAS DED TO THE WELL OWNER
TUNE OF PERSON CLt S1ry I & C THE WELL TE
to Division of War Mat a/de stator within 30 days
nw_1 REV. I2AQ

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mail Service CenW - Balogh, N.C. 27699-1636-Phone (911i) 733-3221
WELL CONSTRUCTION RECORD WELL CONTRACTOR- SweetWater Well Drilling& Pump Service, Inc.
WELL CONTRACTOR CERTIFICATION I: .1 A ~/ 7
244238
STATE WELL CONSTRUCTION PERMIT/:
1. WELL USE (Check Applicable Boa): Ftelliderlital0 Municipal ❑ Industrial ❑ Agricultural ❑ Mordtoring ❑
Recovery ❑ Heat Purnp Water Injection ❑ Other p If Other, Litt Use:
2. WELL LOCATION: jShow sketch of the location below)
Nearest Town: //j al--ei n-X County. M e
(Flood Narita,y . Community or IAAdNMion - to No.)
3. OWNER /' •vsL. i.�
Address
or
DRILLING LOG
From To
City or Town tip Code
4. DATE DRILLED / t' 1
5. TOTAL DEPTH
6. CUTTINGS COU-ECTED YES ❑ Nola
7. DOES WELL REPLACE EXISTING WELL? YES ®, NOn
8. STATIC WATER LEVEL Below Top o1 Casing: ,n FT.
_ (Urns•+• I Above Top of Caging)
9. TOP OF CASING IS 1..5 , FT. Mow Land Surface'
'Top of casino terminated SW rneq below led whore require. a variance In wow -
data wit 15A NCAC 2C fi I
10. YIELD (gpm): ¥ METHOD OF TEST -rLs-rn r,
11. WATER ZONES (depth)' /'7" OOS''
12. CHLORINATION: TypeG Amount
13. CASING:
Fn'm_L
Frain. To
ROM To
14. GROUT:
Depth /�_
To -Lab- Ft.
FL
Ft.
WaI TNtkrwaznusweat
DEPTH
Formation Desalpeon
0
o 171-.-
ri
is
rV
TN.)
N
n
co
tt mideio S apace is needed use back of form
Depth
7o S
From
P�= L .j� XSL FL
From To Ft
15. SCREEN:
Depth Diameter Slot Size
From To Ft
Fresno / Ft.
From To !/ FL
16. SAND/GRAVEL PACK:
Depth SW
From +To / FL
From - To_f FL f
17. REMARKS/
r _ -
I DO ERTWV THAT TWELL WAS Qq
IES
CLMsnftt STANDARDS, ANQJHAT A w
FOR OFFIC' USELONLY 1 J
Quad Nu: ff
Material
Material
18TRUCTED IN
OFF
SIGNATURE OF PERSON,
SOrdi, edprwl
b DFAsion a Wyse
WITH 15A NCAC 2C, WELL
PROVIDED TO THE WELL OWNER
THE WELL DATE
caoudw.rr Section within 30 days
r1w.1 REv. rate

North Carolina - Dsparfinent of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mail Service Center - Raleigh, N.C. 27699-1636-Phone [phone]
244235
WELL CONSTRUCTION RECORD WELL CONTRACTOR. SweetWater Well Drilling & Pump Service, Inc.
WELL CONTRACTOR CERTIFICATION.: 025 77 o� 3,
STATE WELL CONSTRUCTION PERMIT.:
1. WELL USE (Check Applicable Box): Reeldenlfal j2 Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring 0
Recovery [] Fleet Pump Water injection ❑ Other p II Other, Litt use:
2. WELL LOCATION: Show *etch of the location below) „n 1 / „
Nearest Town:i-n-t_
(Road Mane and
3. OWNER %f ti
Add7esS 3 /
75-7--
City or Tor, , , slple np Code
4. DATE DRILLED
5. TOTAL DEPTH
6. CUTTINGS COLLECTED YES 0 NOt
7. DOES WELL REPLACE EXISTING WELL? YES ®. NOD
B. STATIC WATER LEVEL Below Top of Casing: qq— FT.
tun•+ a Above Tip el Casing)
9. TOP OF CASING IS %. 5 FT. Above Land Surface'
•Top at casing Waieasd sax below lead aorta requires a weWes i1 accor-
dance Wei 1SA NCAC 2C inn
10. YIELD (gPm) METHOD OF TEST Tau,
11. WATER ZONES (depth)- 7/0'
,al and lot No.)
r /P
12. CHLORINATION: Type ,ace.! Amount 7��°
13. CASING:
Depth
From 0 To .�Q- Ft
To Ft.
Finn To Ft.
14. GROUT:
Wall Thickness
Depth ,,q Material
From O To �l0 Ft er-flat/ "
From To Ft
15. SCREEN:
Depth Diameter Slot Size
From fro Ft inkn.
From / To Ft / In.
From To Ft in. ti
18. SAND/GRAVEL PACK:
Depth Sias Material
From To /' Ft
From 7" To / Ft /
17. REMARifS:—__.
ADO
THAT-THISWE t ,
STANDARDS. AND THAT'/.)
DRIWPIG LOG DEPTH
From To For mach Descdpaon
0
'Tr
�•0
sw'm
N Cr' IC
0
It additional epees Y needed use back of tonm
(Show direction and
Roeder a other
ACCORDANCE WITH 15A NCAC 2C. WELL
HAS BEEN�iti 780ED TO THE WELL OWNER.
/%22/a/
TUNE OF PERSON THE WaL DATE
to °Melon of Waer Chalky, Grouibwsit Swoon within 30 days
new-1 REV. 17H4

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mail Service Cent - Pialelch. N.C. 27699-1636-Phone [phone]
WELL CONSTRUCTION RECORD WELLCONTRACTOR- SweetWaterWell Drilling &RmipService, Inc.
WELL CONTRACTOR CERTIFICATION 0: e2 % S3 +�
STATE WELL CONSTRUCTION PERMIT.:
244230
1. WELL USE (csck Applicable Soap Raeldential J Municipal ❑ Industrial ❑ Agricultural 0 Mon toning ❑
Recovery ❑ Heat Pump Water In)ectlon ❑ Other ❑ If Other, Llat Use:
2. WELL LOCATION: (Show sketch o1 the location below)
Nearest Town: /.2L1i17iA.. County
(Road Name and Numbers, or Subdvisbn and i o No.)
3. OWNER 71t1
Address 3ft.2.? Jamie gcl
Day or Town
ILLS /`Y / i
4. DATE DRRILLED ,30 D
5. TOTAL DEPTH .
6. CUTTINGS COLLECTED YES ❑ NO®
7. DOES WELL REPLACE EXISTING WELL? YES NOM
8. STATIC WATER LEVEL Below Top of Casing: FT.
(Use'.' a Above Top of Ceiba)
9. TOP OF CASING IS J S FT Above Land Surface'
'Top of casing terwiwesd slot blow lead surface requires ■ varWrae In accor-
dance nth ISA NCAC SC .611a
10. YIELD (gpm): _L._ METHOD OF TEST T-,
11. WATER ZONES (depth). LI Q I
DRILLING LOG DEPTH
From To Pomace Oescrip6on
zip oda
12. CHLORINATION' Type ,y-ar Amount /6 oZ
13. CASING:
Wel Thickness
Depth ar (Show direction and
From To! -7/ Ft 1 P fir Roams, or other nap
From To FL
From To FL
14. GROUT:
r,
O r
C)
-a
If additional apace Y needed use back of Ionr1 `
Depth
�� �� 1aM�
From O To_DCL.FL
From To Ft
15. SCREEN:
Depth Diameter Slot Size Material
From To M /
From f To / Ft / Fn. hh l//
From To ‘ Ft In.
16. SAND/GRAVEL PACK:
Depth SW Material
To
To
From
From
17. REMARKS: ---
DO FIERE$V,
} r NA T SW l
C0NSTRu0T7Qti STANDARDS, AND THAT
! I i
FOR OFLR
Chad Nix
TORE OP PERSON THE WELL r TE
to t tvision of Waar Cutely, Section within 90 days
nIN.1 REV_ 12/99

North Carolina - Dapanment of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mail Service Center - Raleigh, N.C. 27699-1636-Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR• �/
WELL CONTRACTOR CERTIFICATION S: bc. % 59 — a S n
STATE WELL CONSTRUCTION PERMITS:
SweetWater Well Drilling& Pump Service, Inc.
1. WELL USE (Crack Applicable Box): Reeidentiste Municipal 0 Industrial 0 Agricultural ❑ Monitoring 0
Recovery 0 Heat Pump Water Injection ❑ Other p If Other, Let Use:
2. WELL LOCATION:
Town:
(Road
3. OWNER
Address
location below)
County: MC 8,.c.Zeffi
Cavnunky. or .•• ... and Lot Na)
//
O ,
`%1I: rrr ^ter . •
'I �afirdiel
City orE
4. DATE DRILLED
5. TOTAL DEPTH '
6. CUTTINGS COLLECTED YES ❑ NOM
7. DOES WELL REPLACE EXISTING WELL? YES ❑ NO®
8. STATIC WATER LEVEL Below Top of Casing: / 4 FT.
run Y' II Above Top el Casing)
9. TOP OF CASING IS /..1 FT. Above Land Surface'
Top of mew tartafasbid War below had surface requires a warm In accor-
dance nth 1SA IiCAC 2C 11
10. YIELD (gpm): V d M OF TEST T.!¢c-C!
11. WATER PONES (depth) • 3 0
DRILLING LOG
From To
12. CHLORINATION: Type 4& JAmount 6 ty
13. CASING:
Depth
From 0 To160 Ft.
From To FL
From
14. GROUT:
til
From _0 T'o .SSG FL � rcciIra
From To Ft
15. SCREEN:
wal Thera
To FL
Depth Diameter Slot Sae Materiel
From ,To Ft in / k1.
From / To I Ft / In. . in
ROM /// To E - Ft C tr1. 111 „
16. SAND/GRAVEL PACK:
Depth Size Material
Ft.
To
Froth Ft.
17. REMF.RK.. : To i
I DO HEREBY
CONSTR
FOR OFFICE
Grad atix
.P#Teriffionsib,
DEPTH
For OseorlpUon
0
C
to
"D
r
01
LOCATION SKETCH
(Show direction and disband from at least two Stela
, or other map r.tsreras prints)
r
THE WELL
of wah(Mualay, Graadwaw Becton within 30 days
nw-I My - 12/99

237555
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mail Service Cent - Raleigh, N.C. 27699-1636-Phone (919) 7' -3fl1
WELL CONSTRUCTION RECORD WELL CONTRACTOR.
SweetWater Well Drilling & Pump Service, Inc.
WELL CONTRACTOR CERTIFICATION I:
STATE WELL CONSTRUCTION PERMITS:
e278y� e2$77
1. WELL USE (Check Ap sscatra Boa): Realdenbal tZ Municipal ❑ Industrial ❑ Agricultural 0 Monitoriny ❑
Recovery ❑ Heat Pump Water Injection ❑ Other Ej If Other, Ust Use:
2. WELLTOCATION: (�Shq�jlraylocation below e ✓I /County:c
Road!/C�Comm�ky.ar _ .. Lot No.) DRILLING LOG
3. OWNER j�/� I • From To
Address
4-1—
city w Tovn
4. DATE DRILLED i5 ib/
5. TOTAL DEPTH /9
6. CUTTINGS COLLECTED YES ❑ NO®
7. DOES WELL REPLACE EXISTING WELL? YES
8. STATIC WATER LEVEL Below Top of Casing:
%)r riL 7/l
D/
Zip Code
NOj
Fr. Zm
DEPTH
Fom+Won D«cr49w+
O
n
(Use •+• II Mom top of Casing)
9. TOP OF CASING IS / ,j FT. Above Land Surface'
'Top of easing isnailaYd Afar know Sand news requiem a a inn' In new -
dance Ma115A NCAC SC A1N
10. YIELD (gpm), a2,2_ METHOD OF TEST 7 ,t-c.
11. WATER ZONES (depth)' /400 I
12. CHLORINATION: Type 7 »B Amounr
13. CASING:
Depth
From D To l/ O Ft
From To FL
Frc n To FL
14. GROUT:
Depth
From __12__ To tit FL
From To Ft
15. SCREEN:
Depth
From To
From To R
Frram /To FL
18. SAND/GRAVEL PACK:
Depth
From To /
From /' To
17. REMARKS:
We T19do ns
WeliWEL
rep,
C? on
:m
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C. WELL
CONSTRUCTION STANDARDS, AND THAT A COPY Q -fl $ RD HAS DED TO THE WELL OWNER.
FOR OFFICE USE ONLY
Quad Ho: j4`t
"-an
ref
s 2�
rn —
z
s/5z3/ o /
SIGNATURE OF PERSON CONST!tOCTMIO THE WELL DATE
Sutra SOW b DkSon of Wear OuaNy, Woudwatar Simeon within 90 days
nw.t REV. 11r9k

North Carolina • Department of Environment and Natural Resource - 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: e2 78' 44 a D 77
STATE WELL CONSTRUCTION PERMITS:
237554
1. WELL USE (amok Appkabls so:): Residential l Municipal ❑ Industrial 0 Agricultural ❑ Monitoring ❑
Fiaoweny 0 Heat Pump Water Inject4on ❑ Other p If Other, List Use:
2. WELL LOCATION: • Sh sketch of the location
Nearest Town: &1zc. - oCcounty: I'll e _LArz.c.-el,
?VC �- G d
(Road Name and Co m ae r and tot No.) DRIWNG LOG DEPTH
3. OWNER jJ From To FonrWon Description
Address a_ yg vizaiffni Ay
CyorTa r 8 i 2Ip Code
4. DATE DRILLED
5. TOTAL DEPTH
6. CUTTINGS COLLECTED YES ID NO®
7. DOES WELL REPLACE EXISTING WELL? YES D NO®
8. STATIC WATER LEVEL Below Top of Casing: 3 p FT.
(Use %e a Above To of Cadre)
9. TOP OF CASING IS . .S FT. Above Land Surface'
'Top al casing tersbuSW eeror before lead arafeoe requites a variance In s000r-
demv vette 1SA NCAC 2C Atla
10. YIELD (gpm). /0 METHOD OF TEST 7 s-r-tfi
11. WATER ZONES (depth)' /ie)/ I
12. CHLORINATION: Type 'TWA
13. CASING:
Amount
Wall Thickness
Depth a taWrial (Show dkedian and distance at least two Stag
From To Ft. —t�=�— > + •�•'-/ nit Roads, or other map _a)
n
.00
n om
m
rr
m
rn
all
rn
z
ti adAlional apace Y neared use back or form
From To Ft
From To R
14. GROUT:
From 0 To R
From To P1
15. SCREEN:
Depth Diameter Slot Size Material
From To Ft In. in.
From
To / in. 7,LGt
From w1t FL / in / br
16. SAND/ RAVEL PACE(:
Depth Size Material
From To R
From �To Ft
17. REMARKS:
-
I DO HEREBY CERTIFY THAT TIC WELL WAS CONSTRUCTED W ACCORDANCE WITH 15A NCAC 2C, WELL
COt4STRUCTION STANDARDS, AND THAT A COPY OF
FOR OFFICE USE ONLY
Cad No:
F r,
SIGNATURE OF PERSON
HAS BEEN - -1 = a TO THE WELL CWNER.
THE 1Nft1
edge* to Division or Weser Duality, Groundwater Section within 90 days
0.4-I .L.
rnv.r REV. 12/99

North Carolina - Department of ErMronment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mail Service Center - Raleigh. N.C. 27699-1636-Phone (919) 71.1-no91
WELL CONSTRUCTION RECORD WELL CONTRACTOR.
237553
Sweet Water Well Drilling & Pump Service, Inc.
WELL CONTRACTOR CERTIFICATION #:.237 7 4- a 7 $'y
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE (Check Applicable Sox): Residential I2 Municipal ❑ Industrial ❑
Recovery ❑ Heat Pump Water Injection El Other If Otter, Ust Use:
2. WELL LOCATION• (ShG�the location below)
Newest Town:
(e, county /{/ C 41
d
OWNER
a ���)
3. K�
er
w
malt���
(Road Name and
or Town 20 Code
4. DATE DRILLED Mai- eil
5. TOTAL DEPTH / SP C
6. CUTTINGS COLLECTED YES Q NO®
7. DOES WELL REPLACE EXISTING WE.L? YES Ej NO(
8. STATIC WATER LEVEL Below Top of Casing: 1,22_ FT.
9. TOP OF CASING IS . ` (Use W a Above Top of Casing)
FT. Above Land Surface'
'Top al wing aerwratea srbr below lead earsaoe requires ■ variance In accor-
dance r.t h 13A NCAC 2C *us
10. YIELD (gpm): 7 2. M OF TEST' --- •
11. WATER ZONES (dpth)•
Agricultural ❑ Monitoring ❑
DRIWNG LOG
From To
12. CHLORINATION: Type 7—At8 Amount 1-
19. CASING:
WalThllawse
Depth
From Too6 / Ft.-LL-it—
F To FL
From To FL
14. GROUT:
From To �QFt (1 t
From To Ft
15. SCREEN:
Depth
From /// To In.
From / To
From / To Ft / in. h
16. SAND/GRAVEL PACK:
Depth
From CTo
From / To (/
17. REMARKS:
Diameter Slot Sae
Size
Material
Material
DEPTH
Formation Demotion
If additional span is traded use back ofSim
F A chi ait
(Show direction and distance • at Tent Iwo State
Roads, or other map - points)
SJ91R ,Llt6L Rd
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY D HAS O THE WELL OWNER
FOR OFFlCE USE ONLY LE.,
Chad tax F'-t
SIGNATURE CC PERSON cotismuent.3 weDATE
Submit WOW b DSW .1 WsM* Duality, tirandww Soon within 30 days
tvJ
a »•
nW_t REV_ 12/99

North Carolina - Department of Ernlronment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mail Service Center - RNeiph, N.C. 27699.1636-Wane [phone]
WELL CONSTRUCTION RECORD
WELL CONTRACTOR.
WELL CONTRACTOR CERTIFICATION 0: ,.27R'9 — e2` —2.7
STATE WELL CONSTRUCTION PERMITS:
237548
SweetWater Well Drilling & Pump Service, Inc.
1. WELL USE (Chat Applicable Boa): Residential0, Municipal ❑ Industrial ❑ Agricultural ❑ Mon toning ❑
Recovery [] Heat Pump Water Injection ❑ Other If Other, List Use:
2. WELL LOCATION: Show *catch of the location below) /�
Nearest Towne %itl�r� 4/, C C. county `1'/C'Q,n—..L-4-6
,lam.,f .) qd
(Road Mary Nu W ,or f� and to No.) DRIWNG LOG
3. OWNER From To
Address
Zip Code
4. DATE DRILLED g/V/D I
5. TOTAL DEPTH �44,4 ar
6. CUTTINGS COi1FCTED YES 0 NO�
7. DOES WELL REPLACE EXISTING WELL? YES NOM
8. STATIC WATER LEVEL Below Top of Casing: FT.
(Um': I Afore Top a Daring)
9. TOP OF CASING IS �_ C FT. Above Land Surface*
?op of casing terminated anion below Mad mrfese requites a variance Si saoor-
dan s site 15A NCAC 2C .0116
10. YIELD Wpm)* ,iQ METHOD OKTEST %Gs`e/
11. WATER ZONES (depth).
&r/
a
City r Town
aff
12. CHLORINATION: Type 7�, Ar curd .
13. CASING:
From 0 Depth
Ft.
From To Ft.
From To R
14. GROUT:
Wall TM
awa�/R. /vim
th Material
From To O[ i) FL Je' ed •(
From To Ft
15. SCREEN:
Depth Diameter Slot Size Material
From To Ft In. in.
From / To ! R / In / In /
From To Ft In ( in
16. SAND/GRAVEL PACK:
Depth
From To
From To
RE
17.
Grad No
ALE
Size Material
R l
DEPTH
FomWion Descdpeon
0
0
n edition specs i needed use tacked form
LOCATION SKETCH
(Show direction and cane from at Tent two State
Roads, or other reference points)
r
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED W ACCORDANCE WITH t5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF D HAS BEEE g --,, �. TO THE WELL OWNER.
/
FOR OFFICE USE ONLY C� / / C/ , A/
SIGNATURE OF PERSON CONSTRUCTING Was DATE
odpeW to OMebn or Water Warty, Gmwdwater Season within 30 trays
RW_1 REV_ 12199
NMI

North Carolina - Department of Environment and Natural Resources - Division of Water Quality • Groundwater Section
1636 Mail Service Center - Raleigh. N.C. 27899-1636-Phone (919) 7-41-sool
WELL CONSTRUCTION RECORD
237564
WELL CONTRACTOR Sweet Water Well Drilling & Pump Service, Inc.
WELL CONTRACTOR CERTIFICATION,: J 7 R SI- 76
STATE WELL CONSTRUCTION PERMIT,:
1. WELL USE (Check Appll aba sod): Residential (2 Municipal 0 Industrial 0 Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Infection ❑ Other ❑ If Other, Ust Use:
2. WELL LOCATI • • • sketch of the location below) r�(/ //�
Nearest Town: / i.ag► 7» C 0lY IPA I.uaAM
(Rod Name and •. �: .. ►c) DRIWNG LOG DEPTH
3. OWNER /N� _ .e' <j -4 •
From To Formation
Address if . ,y ra�/J. Oaaulpeon
City or Town
4. DATE DRILLED
5. TOTAL DEPTH
f
6. CUTTINGS COLLECTED YES 0 NOM
7. DOES WELL REPLACE EXISTING Was? YES NOM
8. STATIC WATER LEVEL Below Top of Casing: FT.
(Use •+• a Above Top el Casing)
9. TOP OF CASING IS / q FT Above Land Surface
'Top of casing tsrmkrWd odor below land wane 'squints a variance In scoa-
danea alai 13A NCAC 2C A1111
10. YIELD (gpm)• / 5 METHOD OF TEST -.Gar co
11. WATER ZONES (depth):. fl4°# i - /no r
/&t n4 .2./o'
12. CHLORINATION: Type 7-4a Amount 2
13. CASING:
Depth
From _0 To �Q Ft.
From To FL
From To FL
14. GROUT:
Ws rradoen
Cr Welnik AM �S (Show direction and
1�' al— "'-� Boccie, oc u1Nar
Depth Material Method
From 0 To v%O FL f! r i 1-S
From To P1
15. SCREEN: ,
Depth Diameter Slot Size Material
From To / Ft // aya
/! /(((/
16. SAN RAVEL PACK:
Depth Srze Material
From
From_7„,...,.To To t. ,- 7„........./
17. REMARKS:
0
rn
0
n addtiond apace le mild use back of form
. •..A ♦•a
reference Points)
I DO HEREBY LEH u 1r•Y THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARD$, AND THAT A COPY OF-1illl RD HAS o / a za TO THE WELL OWNER. i
Nov
FOR OFFICE USE ONLY i
G
Quad Na SIGNATURE OF PERSON . THE WELL
9 )(Ara o.ighid b dv'skn or Wear Otatity, Otoutlwater swoon within 30 days
sr/7/o/
DATE
nW-1 REV. 12/99

North Carolina • Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mail Service Center - Raleigh, N.C. 27699-1636-Phone [phone]
WELL CONSTRUCTION RECORD
23'7563
WELL CONTRACTOR SweetWater Well Drilling & Pump Service, Inc.
WELL CONTRACTOR CERTIFICATION I: .2 %6J7 t3
STATE WELL CONSTRUCTION PERMITI:
1. WELL USE (puck Applicable eou): Residential VI Municipal ❑ Industrial 0 Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Purnp Water Injection ❑ Other If Other, List Use:
2. WELL LOCATION:�Z�(Show sketch of the location below) A
Nearest Town: 7tc O(Sr.t 4/ r C. County:�i C t47iLG��
Cad
(Road ftedid and Lot Na) DRIL NG LOG DEPTH
3. OWNER n�-r14Jy,nj from m
To FoaYm Oeeulpson
Address /7. C� es
� K ASS. 012,,5�
d or Tam zip Code
4. DATE DRILLED p/S�/D
5. TOTAL DEPTH /RS r
6. CUTTINGS COLLECTED YES Q NO[_
7. DOES WELL REPLACE EXISTING WELL? YES ❑ NO®
e. STATIC WATER LEVEL Below Top of Casing: /p FT.
9. TOP OF CASING IS �• (Use -4.- l Aboe Top of Casing)
j FT. Above Land Surface
-Top or using tnnYWad Max below lead surface requites a nSnca In moor -
dance with 1SA NCAC 2C .011a
10. YIELD (gpm). METH90 OF TEST %Gsc .s
11. WATER ZONES (depth) 0 2 t
12. CHLORINATION: Type rive Amount 2-
13. CASING:
0
� c
— sn
m
rn
It additional apiece M needed use back of Iorm
Wd Things LOCATION SKETCH
Depth r� Dlrnew or w. to . Mwdal Show direction and distance from at twat two SteM
Fromm _0 To / 0 Ft. 6 te it a/ Pu? Roach, or outer map rNwn c. pokes)
Fran To Ft.
Frcn To FL
14. GROUT:
th
Material
Fran _ L.. To 26 FL & .014-1 M.
From To Ft
15. SCREEN: %
Depth Diameter Siot Size Material
From To / Ft
From / To / FL / M in /
From !/ To f Ft. ( In. in
16. SAND/GRAVEL PACK:
Depth Size Material
Fr:7 To
17.From
To / ( ze/
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF�D HAS BEEN P )WJ€D TO THE WELL OWNER.
FOR OFFICE USE ONLY e-cc
mrad Mix SIGNATURE OF PERSON
THE Vitt
Nov _a 4pdowi M is tabu a Wes May, OkoudeSr Section within 30 days
ray.t REV. 12n12

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mail Service Center - Raleigh. N.C. 27699-1636•Plone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR- SweetWater Well Drilling & Pump Service, Inc.
WELL CONTRACTOR CERTIFICATION 0: '7 If 3
STATE WELL CONSTRUCTION PERMIT::
238315
1. WELL USE (Clack Applicable Box Residential (I Municipal [ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Purrnp Water Injection ❑ Other If Other, List Use:
2. WELL LOCATION: . / the location below)
T
,..d&d
(Road Nana or and lot )
3. OWNER/e�J
Address or Q ate' al
4. DATE DRILLED City or Town //G/Di
5. TOTAL DEPTH S1/2 S
6. CUTTINGS COUFCIED TESL] NO[[
7. DOES WELL REPLACE EXISTING WELL? YES 0 NOp1
8. STATIC WATER LEVEL Below Top of Casing: & it FT.
(Usti 1 Atom Top et Gip)
`1 9. TOP OF CASING 15 / C FT. Above Land Surface*
'Top of casing taetMated suer below bed salvo* sequin,* is verWroe In seoor-
danes eta 15A NCAC 2C.01 1 `
10. YIELD (gpm): / METHOD OF TEST T.Lst ci
11. WATER ZONES (depth). r26 4-1 ?So'
DRIWNG LOG
From To
County:
12. CHLORINATION: Type 774.9 Amount Z--
13. CASING:
DEPTH
Foreman an Description
H
If additions! apace 1. needed w back of lam
Wet Thaws'LOCATION SKETCH
Depth Dianeter or /'vc (Show direction and distance from at least two
Fro
nt 0 To 40 Ft L 1! i� _� s Roads, or other map reference pokes)
From To Ft
From To Ft.
14. GROUT:
Depth Mate,ia�l a
From 0 To ,3-6-FL �L
From To Ft
15. SCREEN:
Depth Diameter Slot Sue Malarial
From
From To
/ To / f/FL In. In
From To Ftt in. in
18. SAND/GRAVEL PACK:
Depth
From
From To
17. REMARKS:
Size Material
CHu2CH
1 DO HEREBY t.En t at-Y THAT THIS WELL VMS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A= RECORD I l/, DED TO THE WELL OWNER.
FOR OFFICE USE ONLY �f/jf/
Quad No:
S GNATWIE OF PERSON THE WE►L TE
Submit wane to Division of Waata Mary, Oiaedwwr Seaton within 30 days
sew., REV 12fa9

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section 2 3 8 3 1 4
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 t'2 7E9
STATE WELL CONSTRUCTION PERMIT,:
1. WELL USE (check Apptcabs cos): Realdentlal jZl Municipal 0 Industrial 0 Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other 0 If Other, List Use:
Nearest Town:-2naLGavc. county: Me ILfrj zi
2. WELL LOCATION: (Show sketch of the location below) /n//)
e��
Cficc/rs /Qc S of #t c9
(Road Nn I an, Gmw*y Ste:Noon and Lot No.)
3. OWNER G .lilts f✓f�CL cta ...Lef r'
Address
/Vee0 "� .flfl/
CyrrTown stair Code
4. DATE DRILLED
5. TOTAL DEPTH .'J S
6. CUTTINGS COLLECTED YES 0 NO®
7. DOES WELL REPLACE EXISTING WE3l4 YES NO®
8. STATIC WATER LEVEL Below Top of Casing: FT.
(uss •i a Above Top or Casing)
9. TOP OF CASING IS / .l FT. Above Land Surface*
*Top or wog t raifld sslar below Mad awls requites a vrWtee to accor-
dance with 1SA NCAC 2C Via
10. YIELD (gpm). /4. METHOD OF TEST /.Csu fi
11. WATER ZONES (depth)' J- o D /
DRILLING LOG DEPTH
From To Fromatiat Deecdpaon
12. CHLORINATION: Type -7-4d3
13. CASING:
Depth
From 40 To s.S.. Ft
From To Ft.
From To FL
14. GROUT:
Amount
Wall Thickness
r WeighliFt. MY edS (Stow direction • distance from at Mast two State
tat_ 'VC- Roads, or - r map reMnros points)
If additional specs is made d use
From 0 To �� Ft.
Depth feral L MattttX! r
��+'+t-� From To Ft
15. SCREEN:
Depth Diameter Slot Size Material
EE40/E/E/E
/
16. SAND/GRAVEL PACK:
Depth
From To Ft
From /.... To Ft /
17. REMARKS:
Site
Matsdal
Ins
s
--1
0
Pot
LoArle
© pw
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED W ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COW C0RRID HAS TO THE WELL OWNER �j /
FOR OFRCE USE ONLY. 7 ' f 7 7,%`
Quad No: SIGNATURE OF PERSON CONSTRUCTING THE WET. DATE
Subma Mahal M Dirigat of Water Quality, Groundwater Section within 30 days
nw.1 REV. 1199

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mail Service Carper - Raleigh, N.C. 27699-1636-Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR- SweetWater Well Drilling& Pump Service, Inc.
WELL CONTRACTOR CERTIFICATION 0: a 7 g y
STATE WELL CONSTRUCTION PERMITS:
238313
1. WELL USE (Chick Applicable Boa): Reeidenlial(2f Municipal 0 Industrial 0 Agricultural ❑ Monttoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other El 1f Other, List Use:
2. WELL LOCATION: (S w a tc)h of the location below)%�D�
Nearest,; own: county /� r e ►i�/
4-1314/c 70
Nara r • sib:ober,. ; .aand and Lot No.)
/lam
3. OWNER
Address
t, 70
/YcR o
City or Tower r , Stale
r427G/
Zip Code
DRIWNG LOG
From To
4. DATE DRILLED
5. TOTAL DEPTH f
6. CUTTINGS (OUFCT D YES ❑ NO®,
7. DOES WELL REPLACE EXISTING WELL? YES= NO
8. STATIC WATER LEVEL Below Top of Casing: ) t- t
(use V II Above Top Of Casing) 9. TOP OF CASING IS J - FT. Above Land Surface'
Tap of amino to MSd War below lead .arises requires a variance In aocor-
danaa with 15A NCAC 2C 1e 0—
10. YIELD (gpm):.,pl MET}4010 OF TEST GtJ
11. WATER ZONES (depth) DO'
12. CHLORINATION: Type egg Amount /
13. CASING:
DEPTH
Farrnjort Deanpdan
n
r.
0T
rrt
rn
na e�
t
-4
Tarn
1
If additional apace is fended use back or loan
wail ThicknessLOCATION SKETCH
Depth 04rnrar or Weight/R. Mews (Show direction ante distance from at Mast two
From D To - Ft G -/L ,t 2/ OUG Roads, or other map nlerena pokes)
From To Ft.
From To Ft.
14. GROUT:
Depth 4 Material LMs i
Frern 0 To 20 FL Corneae -
From To FI
15. SCREEN:
Depth Diameter Slot Size Material
From /To Ft In. M. /
From Tolo.(1/IIn
From To FFt. ( L In. In
18. SAND/GRAVEL PACK:
Depth Size / Material
From To
From /To Ft.
17. REMARKS:
I DO HEREBY to t n•Y THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF T}MSt' RD HAS BEEN P DED TO THE WELL OWNER
IV/0-71
IFOR OFFICE USE ONLY I
Cad Na
SIGNATURE OF PERSON CONS RUG,7W6 THE WELL
Submit original to Divbbn of WYr Ouatty, Groundwater Section within 30 days
nw.t REV. WAS

North Carofna - Department of Environment and Natural Resources - Division of Water Duality - Groundwater Section 2 3 8 3 2 5
1636 Mail Service Center - Raleigh, N.C. 27699.1636-Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR.
WELL CONTRACTOR CERTIFICATION *: 02 '7 Of
STATE WELL CONSTRUCTION PERMIT*:
1. WELL USE (alma Appkable Doe): Residential e21 Municipal ❑ Industrial 0 Agricultural ❑ Monitoring ❑
Recovery 0 Heat Pump Water Injection ❑ Other If Other, List Use:
2. WELL LOCATION:,�S YW f the location below) �%
News* T c9-t.1l/ rt� ounty: %Y% �' (//07.f1-G��
zit /)344.t) 72i d - �
0
(RoedNrro�'ff' ff /urfeea a adlnlNa) DRIWNG LOG DEPTH
3. OWNER ��! U42lll U Fmm To FomtlanDeen4ton
Address elm car Oa J-624- f�•�«aiL P
try ar Town 72, cos
4. DATE DRILLED G/..ZS/D/
5. TOTAL DEPTH _a us--1
6. CUTTINGSCOLLECfED YES 0 NOJa
7. DOES WELL REPLACE EXISTING WELL? YES NOJZ
6. STATIC WATER LEVEL Below Top of Casing: c FT.
fire •+• a Above Top al Casing)
9. TOP OF CASING IS Jr FT. Above Land Surface'
'Top of m m) terwiad Sof blow Iead airhoe requites a variants In seoor-
dafu nth 1SA /CAC 2C -Oils
10. YIELD (gpm)' METHOD OF
� / c
11. WATER ZONES (depth):
12. CHLORINATION: Type TSB
19. CASING:
Mount `�
Wall Thickness
Depth Oienieta or WolofIR. Metedal (Show direction and . • from at lead two !tali ). /,c-
From To 90 Ft. U , 0.2 / P1 C Roads, or other • relaenoe pouts) Q\J.a $ O. t�
From To FL
From To FL
14. GROUT:
II additional apace N undid teas bads of lam
Depth Material
PALS../
From To 3a0 Ft nS-
From To Ft.
15. SCREEN:
Depth Diameter Slot Sae Material
From To Ft , in )) in. /
From To FL / In / in
From / To / FL ( In. - In
16. SAND/GRAVEL PACK:
Depth SW Material
Fran To % Ft.
From To
17. R
Sweet Water Well Drilling & Pump Service, Inc.
D HAS TO - - • • TO THE WELL OWNER. �j} J
FOR OFFICE USE ONLY �Gj'G r Vb2�7""'"
1fi
11Ij j E7GNATURE OF PERSON . f THE WEIL DATE
1 Submit MOMS Division of Warr Quality, Oiws slut Section within 30 days
fiw.t REV- 12i99
I DO HEREBY Gtn i ft-Y THAT INS WELL WAS CONSTRUCTED W ACCORDANCE WITH 15A NCAC 2C. WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF
O•4J IL Lim

North Carolina - Department of Environment and Natural Resources - Division of Water Duality - Groundwater Section
1636 Mail Service Canter - Releiph, N.C. 27699-1636-Phone (919) Tag-ar91
WELL CONSTRUCTION RECORD WELL CONTRACTOR- SweetWaterWell Drilling & Pump Service, Inc.
WELL CONTRACTOR CERTIFICATION 0: r-27' S
STATE WELL CONSTRUCTION PERMITS:
238329
1. WELL USE puck Applicable Boa} Residential Municipal C Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ID If Other, List Use:
2. WELL LOCATION 1 the location below
T�►1� cosy- 7YIc Qg.�J-el,
(Road Name Commaiy, or Let tea)
Address
� A
Of
ay ar Town Store Zip Code
4. DATE DRILLED
5. TOTAL DEPTH
6. CUTTINGS COLLECTED YES ❑ NOI]C
7. DOES WELL REPLACE EXISTING WELL? YES D NO®
8. STATIC WATER LEVEL Below Top of Casing: /o B FT.
on •+• at Abora Top of CuYp)
9. TOP OF CASING IS 2. A FT. Above Land Surface•
*Top of casino teraSMYd War below bed whom rsptdun a wrists in moor -
dines with 15A NCAC 2C .0116
10. YIELD (gpm): 7_4 METHOD OF TEST Tom.
11. WATER ZONES (depot /45r
12. CHLORINATION: Type -flea
13. CASING:
Depth From 0 To70 Ft.
From To FL
From
14. GROUT:
To FL
Amount
WY TNdoru
or Wdpd*R. MebsW (Show direction and
)0, / PUr Roads, or other map
DRIWNG LOG
From To
DEPTH
If additional spare Is needed use back of eft Z
•
From _IQ_ To ea D FL Le s is SN
From To Ft.
15. SCREEN:
Depth Diameter Slot Size Material
From To Ft In h
From / To / Ft In kt. /
From To FL / In. / in
16. SAND/GRAVEL PACK:
Depth Sirs Material
From / TT:
To FL J
o 1 R. (
17. REMARKS:
Li A
d
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF
FOR OFFICE USE ONLY I
Ind, 1
Q..IJ •L.
HAS BEBI FROM tD TO THE WELL OWNER
TUNE OF PERSON
WELL
sae odokwf to Division of WMsr Wilily, Seoeon within 90 days
ran-t REV_ 11Ae

North Carolina - Department of Environment and Natural Resources - Division of Water Duality - Groundwater Section
1636 Marl Service Center - Raleigh. N.C. 27599-1636-Rpns (919) nq-g1
23832'S
WELL CONSTRUCTION RECORD WELL CONTRACTOR- SweetWater Well Drilling & Pump Service, Inc.
WELL CONTRACTOR CERTIFICATION #: .2 7 y
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE (cheat Applicable soa): Rea)densal® Municipal 0 Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other If Other, list Use:
2.WELL aATtJIs ato{7 pl location below)YEc (��,
Safe(Road Name op tar i. canmerty , ar Lot Na l DRI WNG LAG DEPTH
3. OWNER 1V-0 . ? CS W? From To Famdon0acrpsan
_��d
/ Lp Code
4. DATERILLED LP//9 De/
5. TOTAL DEPTH .24 S
8. CUTTINGs COU.ECfED YES 0 NOloa
7. DOES WELL REPLACE EXISTING WELL? YES NO 0
8. STATIC WATER LEVEL Below Top of Casing: .? n FT.
(use': a Above Top or Cacho)
9. TOP OF CASING IS A 6 FT. Above Land Surface'
'Top of wing /malneeed aaa blow led surface requites a stance In scoor-
dona with ISA NCAC 2CM 1R
10. YIELD Wpm): .-.5 METHOD fl— v
11. WATER ZONES (depth) I/ES �
12. CHLORINATION: Type -775273 Amount t-
13. CASING:
Dept/
From D To [O 0 Ft.
From To Ft.
From
14. GROUT:
Dth
From 0 TToaCI FL e >11 —r _14,2AVAdetyMel4Id
WY Thickness
a WMpt*UR. Ma1Md (Stow ditedion and
If additional apace Is
0
rn
'>D 2rri
�—
H-2
back of loon
e..A s'.. ?.AI .e
horn at Nat two Site
7Pkw'1 / PRoark, or other map points)
To Ft.
From To Ft
15. SCREEN:
Depth Diameter Sot Size Material
From To / FI / k1. In.
From To / FT / In /
From To ( FL (((
16. SAND/GRAVEL PACK:
Depth Size Material
To
From r To / FL %
From
17. REMARKS.
L
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF RD HAS DED TO THE WELL OWNER.
FOR OFFICE USE ONLY '
Chad Na
!_.l .V
H
4 / 6
SIGNATURE OF PERSON THE
WEIL wL DA/.
Submit origami to Da ion of Ware Duality, Oroudmeer Section within 90 days
rnw-t REV. 1249

North Carolina • Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mail Service Canal - Raleigh, N.C. 27699-1636-Phone [phone]
WELL CONSTRUCTION RECORD
238327
WELL CONTRACTOR• SweetWater Well Drilling & Pump Service, Inc.
WELL CONTRACTOR CERTIFICATION It: a2 % R y
STATE WELL CONSTRUCTION PERMITS:
1. WELL USE (Check Applicable Boa): ReSden(ial tia MuScipai 0 Industrial 0 Agricultural ❑ Monitoring ❑
raa,ovmy 0 Heat Pump Water Injection ❑ Other p If Other, Ust Use:
2. WELL LOCATION _(Show sketch of the location below)
Nearest Town a atri-c County 1/r C
1-FM I C Pe c!l ffet
(Road Name and Numbers, Comndty, o BubdlwYon and Lot No.)
3. OWNER n-s--F A
Addsesa V1S «'jaw,, � ed
City or Town
ar �41Cp'• a�"5t-
4. DATE DRILLED/r o
5. TOTAL DEPTH •-291' '
8. CUTTINGS COLLECTED YES 0 NOM
7. DOES WELL REPLACE EXISTING WELL? YES NO®
8. STATIC WATER LEVEL Below Top of Casing: ' FT.
(Use •+• a Above Top of Casing)
9. TOP OF CASING 15 .S FT. Above Land Surface'
'Top of casting Iernktalld sake blew land serest a nooks* a oedema In ascot.
dance with 15A NCAC 1a
10. YIELD worn):..fir METHOD OF TEST T.4r r...5
7
11. WATER ZONES (depth). 0 r A.20 1
12. CHLORINATION: Type 8 Amount
13. CASING:
flDew-dro
DRILLING LOG
From To
DEPTH
Formation Description
11 additional span ts needed use back of form
WallLOCATION SKETCH
Thickness
Depth Diameter or Weight/Ft. Mss sl (Show direction and distance horn at teat . Star
From 0 To _0 Ft 4 y M.$2L rile- Roads, or other nine nascence points
From To Ft
From To FL
14. GROUT:
From 0
From
15. SCREEN:
From
TA Material Me
o Ft /-Pant-.-r�. z l L s
th
To Ft
Depth
Diameter Slot Size Malarial
Ft Jet / In
Ft./// h � h
Ft In. h
From To
From � To /.
18. SAND/GRAVEL PACK:
Depth Size Material
From
AR To
From
17. RE
To
I`
tafoOS
I DO HEREBY t.en net' THAT MS WELL VMS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
HAS BEEN ' l.1r• • TO THE WELL OWNER
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
FOR OFFICE USE ONLY
Quad No
%c1
SIGNATURE OF PERSON
Suet* Waite to Oldslon of Waal Monty,
THE WELL DATE "
Section within 30 days
nw.l REV_ 12/99

North Carotene - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mart Service Center - Raleigh, N.C. 2769S -1636-Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR- SweetWater Well Drilling & Pump Service, Inc.
WELL CONTRACTOR CERTIFICATION 0: e2 7 $9
STATE WELL CONSTRUCTION PERMITS:
1. WELL USE (Check Apptcahla Box): Residential CRI Municipal 0 Industrial 0 Agricultural 0 Monitoring ❑
Recovery 0 Heat Pump Water Injection 0 Other 0 If Otter, List Use:
Address
7nateewe _....��., a2'yx'4
Oty or Town Saar Zip tads
4. DATE DRILLED
5. TOTAL DEPTH .3
6. CUTTINGS COLLECTED YES O NOIS
7. DOES WELL REPLACE EXISTING WELL? YES D NO®
8. STATIC WATER LEVEL Below Top of Casing: ,j5 FT:
(use •+• a Above Top arguing)
9. TOP OF CASING 1S i ul FT. Above Land Surface*
'Top or mbrp tarakrled tar below lend .trace requires ■ vertano In decor.
dance with 15A NCAC 20.011111
10. YIELD (gpm)• 3 a2 METHOD OF TEST 7_4.. . •
11. WATER ZONES (depth) -
238335
Nearest Town: %y% 07� County
2. WELL LOCATION: (Show sketch of the location below) /j/J
� C d -t teGf
70 - tatitet44,Y 19C/
(Road ►Wna ar' ►urtwrs,Community, and Lot No.) DRILLING LOG DEPTH
Fw
3. OWNER From To aWonDesaipkn
/Rd
12. CHLORINATION: Type ring Amount 3
19. CASING:
r,1
CA :7.'—
.•,
0
tt additional apace is needed we basic of Gan z
Wall Thiceness
LOCATION SKETCH
Depth or WeipoRt (Show direction and drama from at Nast two
From To 3 O Ft.-rR�/,c— At/ I/!' _ Roads, or other map pokes)
Frorn To FL
From To Ft.
14. GROUT:
Depth p Material
Frown _O To 3 0Ft ter
From
15. SCREEN:
To Ft.
Method •
r ttvl tv
Depth Diameter Slot Size Material
From / To Ft In In.
From To ( Ft / in / In
From7o Ft. ( in 41
18. SAND/GRAVEL PACK:
Depth
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED W ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF
FOR OFFICE USE ONLY
Quad No:
i I:
HAS : "vim:: 00 TO THE WELL OWNER.
SIGNATURE OF PERSON .. Th -1 . THE wELL
origami N bMslon of Water Quality, Grouxtraller Saxon within 30 days
rnw.t REV. 12/PS

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
238334
WELL CONTRACTOR SweetWater Well Drilling & Pump Service, Inc.
WELL CONTRACTOR CERTIFICATION in ST y
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE (Gads Applicable Boat: Residential 121 Municipal C Industrial ❑ Agricultural ❑
Recovery 0 Heat Pump Water Injection 0 Other If Other, List Use:
2. WELL LOCATION: (Showpkacch o1 the location below)
Nearest Town: 711(21.1-nK. County:
3. OWNER $O...ThAy,ytyj
Address 2 , ,y et
4.
5-
6.
7.
6.
frai '/, q /� 71% e l/l//Z(i O�
(Road Nam. satthic4NteFBaea, oa,.naiy, or &tg $vSai
fad lg)Pio.) DRIWNGLOG
.82
'V aR' 7
o1Y GSole ap Code
STATIC WATER LEVEL Below Top of NOEI
rise .9 a Above Teo or Casing)
9. TOP OF CASING IS A 4 FT. Above Land Surface*
'Top d mine term Red attar Meow led one, requires a variance in sewn
dance with 15A NCAC 2C..gqffta •
10. YIELD (gpm)• //O METHOD OF TEST 7iilaci
11. WATER ZONES (depth) • /n r ' /.SO '
DATE DRILLED
TOTAL DEPTH
CUTTINGS COLLECTED YES NOlal
DOES WELL REPLACE EXISTING WELL? YES
12. CHLORINATION: Type 'Yids Amount e`L
19. CASING:
Dept op
From To , rs Ft
From To FL
From
14. GROUT:
ads Thi awao
Diameter or
To FL
PVC
Depth Method
From O To a 0 FL CD
From To Ft
15. SCREEN:
Depth
Diameter Slot Size Material
From To Ft In. n From o In h
From To
16. SAND/GRAVEL PACK:
Depth /ze Ma�
From
From , To F1.
17. RE
FL
Monitoring ❑
DEPTH
From To Formation Desolation
r
rn>
m7:7
ti eddklale specs N needed tee back of bpp o
e,.A 4%, =-,FIt ..
(Show direction • distmtee from at Nat two Stale
Roads, or r mSerino, point) S 7-5-
Hy) c-
ad
Lbatc [
D
p.s C
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A r e • - y RECORD HAS YPRO111DED TO THE WELL OWNER
NONA OF THE WELL DATE
Submit original to Division of War Duality, Grmsdwesr Section within 30 days
fw.1 REV 12A9
FOR OFFICE USE Ofen, I
Ouse Na
tacit
GR4X
lieUSc

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.
225 300
SweetWater Well Drilling & Pump Service, Inc.
WELL CONTRACTOR CERTIFICATION It: a 7$ y
STATE WELL CONSTRUCTION PERMITS:
1. WELL USE (Muck Applicable Cos): Residential ® Municipal ❑ Industrial 0 Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other p If OC1er, List Use:
2. Nearest 4-1.4
WELL LOCATI_Q t/Show sketch of the location below "He
th° 0.4"
or Subdivision and Lot Na) DRI WNG LOG DEPTH
Q 14. Nazc.e
(Road Nano aid
3. OWNER 7}%Gt�' .,
Address /7/4
City or Towle
4. DATE DRILLED a.2 l
5. TOTAL DEPTH . y S"
6. CUTTINGS COLLECTED YES NO®
7. DOES WELL REPLACE EXISTING WELL? YES NOm
8. STATIC WATER LEVEL Below Top of Casing: :a 7 FT.
(UM'f' I Abate Top at Casing)
9. TOP OF CASING IS ISS FT. Above Land Surface'
Top of casing terminated stior Wayland surface requkae ■ variance in accor-
dance nigh 1SA NCAC WAIST
10. YIELD (gpm): 7.5 METHOD OF TEST Vent,
11. WATER ZONES (depth)•
Frwn To - Formation Description
aneawro.,
Kau-0 (Rd
21p Coda
12. CHLORINATION: Type 7NB Amount 3
13. CASING:
D i.
From 0 ToloCPO Ft
From To FL
From To Ft.
14. GROUT:
Wee ThieN013
or Waholia. McMal (Show direction and durance from at
/ Pd.P. Pittede,c-o .ermaprefam>Ae
tt additional specs is needed use batik of bm
Depth Mo
From Q To 12 0 FL
From To Ft
15. SCREEN:
Depth Diameter Slot Size Material
m FL In . lo
From o
From To �/ /lo/
From To FL
16. SAND/GRAVEL PACK:
Depth
From , To
From To�Pt�
in. in
17. REMARKS:
Size Material
two State
I DO HEREBY t.EH 1 tt-Y THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
COe4STRUCT1CN STANDARDS, AND THAT A COPY /O�RD DED TO THE WELL OWNER.
FOR OFFICE USE O f Ci V� y/D /
Clad
Cl
&rhrrrt odgkw b Divison d WSMr Malay, Groudwes Section within 30 days
n�..... 1 roam REV_ 12A4
Lro.nri.

235591
Nonh Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mail Service Center - Raleigh, N.C. 27699-1636&Ptone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR.
SweetWater Well Drilling & Pump Service, Inc.
WELL CONTRACTOR CERTIFICATION S:
a 'ICY
STATE WELL CONSTRUCTION PERMITS:
1. WELL USE (Check Applicable seek Reeidentialgl Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other p If Other, Ust Use:
2. WELL LOCATION: (Show sketch of the location below) vLI pQ
Nearest Town: 7ll/ Ate—a,"
za;e-+%�% county: me /S7.t.t-K�/
LnC Ate— I
lon and Lot No.)
3. OWNER )6(Aced Marne err Q� GfliG -w
Address yi2 ' aye dis,r At Dr
Mad-1-int. N c , -2 g
DRIWNG LOG
From To
City or Town Stale lip Coda
4. DATE DRILLEDS7'7/0
5. TOTAL DEPTH
6. CUTTINGS (:oU.ECTED YES ❑ NO®
7. DOES WELL REPLACE EXISTING WELL? YES ❑ NO®
8. STATIC WATER LEVEL Below Top of Casing: (o ,.-� FT.
(Use •+• s Above Top e1 Casing)
9. TOP OF CASING IS 1 I" FT. Above Land Surface*
lop of awing teraaated etror Mow led aurtaa requires s vuSncs In moor -
dance Tier 1SA NCAC 2C .91111
10. YIELD (gpm)• y M�-�p^p- OF TEST
11. WATER ZONES (depth). 7� r
12. CHLORINATION: Type / Ain Amount 2-
13. CASING:
Depth",
From 0 To v Ft.
From To Ft.
From
14. GROUT:
From 0
To
Ft
Wel Thickness
ToT� FL / ni
From To P1
15. SCREEN:
Depth Diameter Slot Size
From ! To Ft In. J Y..
From To / Ft.7in. / Inc
From To Ft 41. In
16. SAND/GRAVEL PACK:
Depth Size Material
From / To Ft
From To /Ft
17. REMARKS:
DEPTH
Formation Desupim
11 additional spear is • • w back of form
(Show direction
La Roads, or
from at feat two State
pew)
0
I DO HEREBY tscrt I1rY THAT Tres WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDAfl0S, AND THAT A COPY OF PROVIDED TO THE WELL OWNER.
5/24
USE Y
Quad No: ‘1:1
FOR OFFICE
/IE 01' PERSON
�EiNS"^�"""'� SIGNATURE OF PTHE WELL DATE
SUbrra origin b dvidon W Waif away, Groundwater ssalon within 30 days
nw.1 REv. 12,99

North Carolina - Department of Environment and Natural Resources - Division of Water Duality - Groundwater Section
1636 Marl Service Center - Raleigh, N.C. 27699-1636-Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR• SweetWater Well Drilling & Pump Service, Inc.
WELL CONTRACTOR CERTIFICATION S: v.2783
STATE WELL CONSTRUCTION PERMITS:
235590
1. WELL USE (Check Applicable sox): Residential (Z Municipal ❑ Industrial 0 Agricultural ❑ Mon toning ❑
Recovery [] Heat Pump Water Injection ❑ Other If Other, List Use:
2. WELL LOCATIO�N:Jfth� I the location below) /%
Nearest Town: ! County(,/r e ( �LC,L•!.L'i"
//w y it 7o
(Road Name and Huebert �v ia* oc Subdivision i ) DRI WNG LOGAddress A/ DEPTH
3. OWNER j 3.i2� ANLi - / (1 From To FonrWlanDeealpecn
Noltaat
Cay orTown /, _ 7 Zip Cods
4. DATE DRILLED
5. TOTAL DEPTH
6. CUTTINGS COLLECTED YES Q NO®
7. DOES WELL REPLACE EXISTING WEU-? YES NOM
8. STATIC WATER LEVEL Below Top of Casing: FT.
tea'.' 1 Above Top al Geeing)
9. TOP OF CASING IS Z . FT. Above Land Surface*
'Top of suing terasinated attar below feed surface remise a slams In accor-
dance with 15A NCAC SC rill •
10. YIELD Wpm)* METHOD 9F TEST t-no
11. WATER ZONES (depth). /SD ,n
12. CHLORINATION: Type %R�6.- Amount *2— tt addtlwW apace Is needed has beck of form
1S. CASING:
o r:
LOCATION SKETCH
(Show direction and distaste horn at least two
Roads, or other map reference points) r )
From ( To�Ft
From To FL
From To FL
14. GROUT:
Wall TNcivwas
°re nit
Depth
(.i�^^'t
From0
To 3 D Ft. `
From To Ft
15. SCREEN:
Depth Diameter Slot Size Material
From To Ft
16. SAND/GRAVEL PACK:
Depth Size Material
From To f Ft. /
From To / 11
17. RE
I DO HEREBY Celt i it-Y THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF Tt )R Cf�RD HAS PRt99DED TO THE WELL OWNER.
/7/6/
FOR OFFICE USE ONLY
Cued Na 1 J 1CiNATUIE OF PERSON C STRUCIYI6 THE WELL DATE
%lrbmk oddball to Division of Water Duality, Ocuaealsr Section within 30 days
nw.l REV 12199
.L.

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mail Service Center - Raleigh, N.C. 27899-1636-Ph one (919) T+ 3791
WELL CONSTRUCTION RECORD WELL CONTRACTOR- SweetWater Well Drilling & Pump Service, Inc.
WELL CONTRACTOR CERTIFICATION 9: J 7R
STATE WELL CONSTRUCTION PERMIT#:
235589
1. WELL USE (Cheek Applicable Boa): Residential ($1 Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring D
Recovery ❑ Heat Pump Water Injection 0 Other ❑ If Other, Liat Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: CLui>-r-4- County- FYI e t40it•Lr.L0-ZQ
(Road Nuns or aLot No.) DRI W NG LOG DEPTH
3. OWNER ���-andFrom To Format Desadpaon
Address -7yr a
aw or Town Ste Zip Code
4. DATE DRILLED 0
5. TOTAL DEPTH St' Cr
6. CUTTINGS COLLECTED YES 0 NOJZ
7. DOES WELL REPLACE EXISTING WELL? YES El NO0
8. STATIC WATER LEVEL Below Top of Casing: 'R, S FT.
(Use e' a Above Tops Casing)
9. TOP OF CASING IS / Fr. Above Land Surface
'Top ar blip terminated sax below lead surface requires a manse M aawr-
dannnAthiSANCAC2C 1111
10. YIELD (gpm)• CMETHOD OF TEST T [i
11. WATER ZONES (depth)' "S i
12. CHLORINATION: Type A
13. CASING:
Amount
WA Thickness
Depth ran Stow dkecrion and ,.... horn at (east two
From 0 To Ft 2? Roads, or other map - points)
From To FL r F/`ubC
11 additional NADI is needed use back of form
From To FL
14. GROUT:
From
From To Ft
15. SCREEN:
FL 0 To Depthn_ J /..27lo34l
hiia,L Rd
Depth Diameter Slot We Material
From To 61 in.Zn
!
From To
From To
16. SAN RAVEL PACK:
Depth SW MattxW
From To Ft
From To FL /
17.R ///
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED
CONSTRUCTION STANDARD% AND THAT A COPY
FOR OFRCE USE ONLY `J .ee*e
Quad No: i SIGNATURE OF
sow* od,ks to Division of WaMr,
WITH 15A NCAC 2C, WELL
PROVIDED TO THE WELL
c
r—
N
0"
WBTEL TE
Sea wn within 30 days
•6.
AW.r REV. t7Aa

17.
1636North
or M Duane - span in •• ent of Environment and Natural R - Division of Water Oualty . Groundwater Section
Raleigh. N.C. 27699-1636-pique [phone] q , �Q ,,/
WELL CONSTRUCTION RECORD WELL CONTRACTOR: �J.r�. J4, LateAP2
Inc
WELL CONTRACTOR CERTIFICATION 8: ‘..27R 3' ""T'
STATE WELL CONSTRUCTION PERMIT,:
233545
1. WELL USE (Chick Applicable sock R6ddenUS CO Municipal 0 Industrial 0 Agricultural 0 Monitoring ❑
Recovery ❑ Heat Pup Water hrivalun ❑ Other 0 If other, List Ube:
2. WELL LOCATION: (Show akp(ch of the location below) �/ J�
NearoatTown: .d/ ✓ _.a . Gouty: %%%C W
Ar,„
(Road Nenr and
3. OWNER
Address
City orTown
4. DATE DRILLED
5. TOTAL DEPTH
6. CUTTINGS COLLECTED YES 0 NO
7. DOES W91 REPLACE EXISTING WELL? VEB
la
8. STATIC WATER LEVEL Below Top of Casing: FT.
9. TOP OF CASING IS �J`_ (u`
as • 1 Above Top at CNh�
_[ Z FT. Above Lard Surface
'Topa a nk a aarebWad attar bales lead sadaaa maids; a voidance In moor -
dance with ISA NCAC title
10. YIELD (gpm): X a X{Op OF TEST Tern n
Z
11. WATER ZONES (depth):
12. CHLORINATION: Type
13. CASING:
Amount -
DEPTH
Furnace DeaWption
it additional spool is deeded use back of tome
Wall Mari a !.— M, :,lDepthate.
Dlontor °ram- M�danW (Show d irodion and dilate • • al least Mo Stale
From 0 To_
%,�t7 . Ft �a / Gpi7a / vi'c. Roach, Or other mop pokes)
From To FL
From To FL (A-)4Ld'
14. GROUT:
Dank,From /9 T,in a (-i a
From To FI.
15. SCREEN:
Depth Diameter Slot Size Material
From To / Ft r 1n. h,
From
To Kin.
/ Min.
/
From To/f/ FL (/
16. SAND/GRAVEL PACK
/]Depth Size Maeda
REFromMARKS: To
To Pt / FI. /
From
1 DO HEREBY
CONSTRUCTION ST
FOR OFFICE USE ON
Gad No:
Submit what
Groundwater Section
Asheville Re ional Office
OP PERSON
al Warrouasy. tkoundnWrsecaon wMhun 30 days
IL

233544
North Carolina - Department of Environment and Natural Resources - Division of Water Duality - Groundwater Section
1636 MLI Senvice Carte . Raleigh. N.C. 27610-163&Phono [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR: £ets. C2-4040_414-
WELL CONTRACTOR CERTIFICATION is n� 7 8' y�
STATE WELL CONSTRUCTION PERMITit
1. WELL USE (aaoi Appmapl sou): Residential (a Mur psi ❑ Irdustdai ❑ Apricullurad ❑ Monitodng ❑ Recopy O 7CATION:�Hleet Pump water Injection O Other Il Otter, List Use:
2 NearsetTWELL Toown /n - "itch of the IOceton below) I /�
Rams and, 6, .�rrcar C°'e"). -Me wlV rut
3. OWNER jWmears CouaharincanBibthl Mrn �Ne) DRILLING LOG
Address 4/ 9
City *limn
Zip taada
4. DATE DRILLED
5. TOTAL DEPTH
6. CUTTINGS COLLECTED YES NO
7. DOES WELL REPLACE EXISTING WELL? 0 NO
la
8. STATIC WATER LEVEL Below Top of Casing: / 4 ET.
L
2-se II sTop alCaarp)
9. TOP OF CASING IS
FT. Above Land Surface'
'Top of awing Mrai sled atbr bawled steam neeuies a variance M maw
dame SA 154 !CAC 2C,gag
10. YIELD (gpm): S METHOD OF La t.o
11. WATER ZONES (depth): CO ' 0 I
Rom To
12. CHLORINATION: Type —7—A7R Amount 2-
13. CASING:
DEPTH
Foreman Dmodpaon
Wall Thie a LOCATION SKETCH
From D 7%%.F50/?k.2 Y//C(ShowdiectionanddMbessafomallwNtwo
Rohde, or other map referenceFrom To FI.
From To FL y
14. GROUT:
From 0 TTo aFL a ra-
From To Ft.
15. SCREEN:
Depth Diameter Slot Sins Material
From To Ft in. in.
From / To / Ft / M / In. 7
From To FL in. in
18. SANWGRAVEL PACK
Depth Size Haters
From To
From AAk. To
17. R
IDO
FOR OFFICE
Gad No
"^ems
Groundlfater Section
Asheville Regional Office
SIGNATURE OF PERS0N
to Okeipn ot WOK Duality Sedon wittln 30 days
b
(.
Zc/
ISA NCAC2C, WELL
DED TO THE WELL OWNER.
THE W6L DATE

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mal Service Censer - Raleigh, N.C. 27699-1636-Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR'
WELL CONTRACTOR CERTIFICATION 0: t 7 ' //
STATE WELL CONSTRUCTION PERMITS:
1. WELL USE (sack Applicable awn: Residential Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, Ust Use:
2. WELL LOCATION: (Show sketch of the location below)
2.-2'a-ct IL PT/it 8
(wad Name end taunters Conmray.«Subdivision and Lot No.) DRIWNG LOG
3. OWNER /9 l/ / D #t ,L Z
Nearest Town:
233543
SweetWater Well Drilling & Pump Service, Inc.
laittiA
Address
C/t-e---
City«Town
4. DATE DRILLED
5. TOTAL DEPTH o! O S r
6. CUTTINGS COLLECTED YES Q NO®
7. DOES WELL REPLACE EXISTING WELL? YES NO®
8. STATIC WATER LEVEL Below Top of Casing: FT.
(Uri -4,* a Abate Tap of Casing)
9. TOP OF CASING IS / .9 FT Above Land Surface'
'Top at using tradnsid saw below and lafaoe requites ■ vrWne In aeoor-
danee with 15A NCAC 2C .ojjl
10. YIELD Wpm). METHODr OF TEST
-5"cp
11. WATER ZONES (depth)'
N.C, N2 27512
From
To
Zip code
12. CHLORINATION: Type 7-7 .a
13. CASING:
Amount
Wail Titoism
Depth a/Weight/FL MSS
// From 0 TO 4 a Ft. —L2 -- £0,9/
From To Ft.
From To FL
14. GROUT:
From /7 To Depth,
Ft. `s444 17 �/
From To F(
15. SCREEN:
Depth Diameter Slot Size Material
From To / Ft // in. / In.
From To / Ft. / In. / In
From To / FL / In. In
16. SAN GRAVEL PACK: (/)
Depth Slze Material
From To FL
From To 1
17.RE
DEPTH
Fomnsaon Oesr+4Wn
11 additional apace is needed use bads of form
IDO

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mail Service Center - Raleigh, N.C. 27699-1636-Ptori [phone]
233542
WELL CONSTRUCTION RECORD WELL CONTRACTOR- SweetWater Well Drilling& Pump Service, Inc.
WELL CONTRACTOR CERTIFICATION *: a 7 8,3
STATE WELL CONSTRUCTION PERMIT*:
1. WELL USE (Check Applicable Sox): Residential MI Municipal 0 Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below) Inc J 0
Address e
.P "di# y
7rI - "Air. " b2775-7
4. DATE DRILLED
City or Town Sfax z4 Code
AZ D
5. TOTAL DEPTH 8 s
6. CUTTINGS COLLECTED YES 0 NO2
7. DOES WELL REPLACE EXISTING WB14 YES NO2
8. STATIC WATER LEVEL Below Top of Casing: _� FT.
fuse •. I Above Tep al Owing)
9. TOP OF CASING IS 1 FT. Above Land Surface'
'Tope wing teranineeed stir Wow lend suri0e requires a Valorise In scoot -
dance with 1SA NCAC 2C ow
10. YIELD (gpm): 0 METHOD OF TEST T��r D
11. WATER ZONES (depth). /if 0 i
DRIWNG LOG DEPTH
From To Formation Deaa4tian
12. CHLORINATION: Type
13. CASING:
7T14,3
Amount
0
L
N
n
cs
fl
o
LOCATION SKETCH
Depth Dlerritrrr yat>Idv Twr (Show direction and distance hen at tact two state
From0 To �/D Ft. Roads, or other map reference points)
From To FL
From To FL
14. GROUT:
From _� To �a D FL r =tv / Lel- /fitL,/
From To Ft
15. SCREEN:
Depth Diameter Slot Size Material
From To 1 Ft in. in. /
From To / Ft./ In. / In //
From To / FL In. %j iIn
n
18. SAND/GRAVEL PACK:
Depth SW Material
From To
From / To /
17. REMARKS:
IDO
0
Croundwate Section
Asheville Regional Office
ACCORDANCE WITh ISA NCAC 2C, WELL
D HASTO THE WELL OWNER
SIGNATURE OF PERSON
i Weir Division of WeQuality,
THE WELL ATE
Swoon within 30 days
RW.1 REV I2A9

233547
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mail Service Center - Raleigh, N.C. 27699-1636-Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR.
WELL CONTRACTOR CERTIFICATION S:
STATE WELL CONSTRUCTION PERMITS:
1. WELL USE (Check Appikabis Sox): Residential ® Municipal 0 Industrial 0 Agricultural 0 Monitoring 0
Recovery ❑ Heat Pump Water Injection ❑ Other If Other, List Use:
2. WELL LOCATI el :
Nearest/own.
town.
a
(Road Name
3.
OWNER
Address p 3
-{�/�1al.Ga7c-
City or Town Slats
Show sketch of the location below) / �%Q
//i iqa / County; j%%(i G?.(X-G/
.0-r A. gd
Qorryerdty, or SubdnWon and Lot No)
4. DATE DRILLED y/LZ/D
5. TOTAL DEPTH /9S'
6. CUTTINGS COLLECTED YES ❑ NO®
7. DOES WELL REPLACE EXISTING WELL? YES NOE]
8. STATIC WATER LEVEL Below Top of Casing: /O FT.
L Nairn.? a AboveTop et Casing)
9. TOP OF CASING IS / Z FT. Above Land Surface*
'Top of casing tsrminated War Wow Sid surface requires a varlanes In aeeor-
danee with 15A NCAC 2C.-Q4va
10. YIELD (gpm): METHOD OF TEST T�r+2o
DRIWNG LOG
DEPTH
From To Fontana' Deaaipaon
Poi
0% �75,2
Zip Code
11. WATER ZONES (depth)* S/ Yon`
12. CHLORINATION: Type -nif3 Amount 2
13. CASING:
Depth
From D To Ft
From To FL
From
14. GROUT:
To
FL
Wall Dadaists LOCATION SKETCH
awalglVR. M 1M1al (Show direction and distance from at least two S
S OR+St 2% YU!' Roads, or other map reference po
Deepth ^ M�aterial U From Da O F(, L P �
From To Ft.
15. SCREEN:
Depth Diameter Slot Size
From To / Ft / in In
From / To ! Ft. / In. / In
From To !!! Ft. ((( In In
16. SAND/GRAVEL PACK:
Depth Size Material
From / To / Ft.
From / To / Ft.
17. REMARKS:
Material
I
I DO HEREBY CERTIFY
CONSTRUCTION ST
r s
L
FOR OFFICE USE ONL4
Quad Na
0..2.1 •L
Trill'
AUGLA 'egg e
5 J': ! , ILL
i5
D IN ACCORDANCE WITH ISA NCAC 2C, WELL
CORD HAS 8 DEO TO THE WELL OWNER.
OF PERSON THE WELL/DATE n
of Water Quality, Sear within 90 days
riW.t REV. 12/94
E.
Groundwate- Section
Asheville Regional Oaice

North Carolina - Department of Environment and Natural Resources • Division of Water Quality • Groundwater Section
1636 Mali Service Centro • Raleigh N.C. 27699-1638-Phone [phone] �/
WELL CONSTRUCTION RECORD WELL CONTRACTOR* ) 7 ,,� 271 s #21-ni-c
WELL CONTRACTOR CERTIFICATION t:.Z 9 g' y
STATE WEU. CONSTRUCTION PERMITl:
2 3'. ` 70
1. WELL USE ChedcAppkable sox): R9eid,ndat2 Municipal D industrial ❑ Agricultural ❑ Monitoring ❑
Recovery 0 Heat Pump Water Injection ❑ Other ❑ If Other, Liet Use:
2. WELL LOCATION: ( ow earn of the location blow)
Nerwt Town: 12-14-e u 4 C • County. MC
( and Nutitrs,Conom ity.errDuechisie aanliLeli )
3. OWNER Tout. 44C 10.44- ra 0
Address //,5 via Lot
io. tall nt�77,
iYIGi,L/.vyc 4/r, rfl2SZ
at/ or Town aP Co
4. DATE DRILLED
5. TOTAL DEPTH de
B. CUTTINGS COLLECTED YES ❑ NO
7. DOES WELL REPLACE EXISTING WELL? YES ICI NO®
i
8. STATIC WATER LEVEL Below Top of Casing: D FT.
/ Wee •VAbove TopaCasig)
9. TOP OF CASING IS , v
- FT. Above Land Suitcv
'Tap of aS lsreanseed Wet balm lend sic as requite to a variance In aeoer-
dansewfMSSA CAC IC 19
10. YIELD (gpm): CL METHO9 OF TEST T c
11. WATER ZONES (depth): 5 (o g 1=
•
DRILLING LOG
From To
12. CHLORINATION' Type %di1Si Amount -3
13. CASING:
Tr VWSThrow
From DTo� 0..(L. Ft. �° LIT
From— To Ft.
From To FL
14. GROUT:
j� �r Materiel�_
From To .S iL Ft. Lr -+-r� 1
From To Fl
15. SCREEN:
Depth
Diameter Slot Size Ma*dal
ToFt / in. / In..
To FL In 1 In.
To Ft In In.
RAVEL PACK:
Depth Size _ Materiel
From . To
From To
17. RE •
I DO HEREE
If addaonal spear Y
DEPTH
Fannon pawipdon
0
•
teak of formo
LOCATION SKETCH
(Show direction rid distance from at Ise two Slate
Roads, or other map reference points)
A.&c c.
ti
0
M DARD8, AND THA
FOR OFRCI
Quad Na
ACCORDANCE win( ISA NCAC2C, WELL
IRD HAS BERI BSOVIDED TO THE WEU. OWNER.
BpNATUIE OF PERSON
WELL DATE
IleR a SectIke
to tti a Weer O iat. Omurdwatst Son with 30 days
AW.1 REV. 12N9

North Carolina - Department of Envtronment and Natural Resources - Division of Water Duality • Groundwater Section
1636 Mal Service Center - Raleigh, N.C. 27699.1636-Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR. Luca, 62lc
WELL CONTRACTOR CERTIFICATION a: .2 9 93
STATE WELL CONSTRUCTION PERMIT#:
231ri76
1. WELL USE (Check Applicable Boa): ResidentialI Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ other ❑ If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below) C /,��
Nearear� 7�'I/1�/�.�.� ��^�.t,�wmY MC ,/f/
Q>° Af. L LaTS-9
�RNEName apd Cu�a SubdivIdon and nto No.) DRImLLINGTOG
3. OWNER vi )
Address h/,�
% ial..G,r..L t o< IV, C' .) 4 S? 7.52
City «Town Stele Zip Cods
5. DEPTH
DATE
5. TOTAL DEPTH 1
6. CUTTINGS COLLECTED YES 0 NO[2]
7. DOES WELL REPLACE EXISTING WELL? YES El NO(]
6. STATIC WATER LEVEL Below Top of Casing: Lc" FT.
(Use e: Il Above Top of Casing)
9. TOP OF CASING IS / FT. Above Land Surface'
'Top of casing terminated Wor blow land surface 'souks* a oedema In accor-
dance with 15A NCAC 2C.01111
10. YIELD (gpm): .2 S' MET .• • OF TEST fl4.7 e
11. WATER ZONES (depth)' CO r
12. CHLORINATION. Type 8 Amount
13. CASING:
DEPTH
Fonnatan Descdpaon
It additional space Is needed use back of torte
Well ss LOCATION SKETCH
Depth c7 or WsigIWR. Material (Show direction and distance from at least two
From o To Ll D Ft. — G-PJ?.e.2 / P vC Roads, or other map reference pokes.
From To Ft.
From To Ft.
14. GROUT:
Method •
From �_ To lain Ft. �� L[%-4t0-Jr
From To Ft.
15. SCREEN:
Depth Diameter Slot Size Material
From To Ft in.in. /
From ! To / Ft. / In. / In
From To FL In. In
16. SAND/GRAVEL PACK:
Depth Size Material
To Ft.
To / FL
From
From
17. REMARKS:
I DO HERE
CONSTRU
/%vabb fli«
Esvtics
111 Ocat cc
IFOR OFFICE
Cad No:
5'rJN 7 20! is
OF
UCTED w ACCORDANCE WITH 1SA NCAC 2C, WELL
DHAS B DED TO THE WELL OWNER.
SIGNATURE OF PERSON THE WELL DATE
to Division of Water Malay, Groundwater Section within 30 days
nWA REV. 12N9
Groundwater Section
Asheville Regional Office

Nonh Carolina - Department Of Environment and Natural Resources • Division of Water Duality - Groundwater Section
1636 Mal Service Center - Raleigh, N.C. 27699-1636-Phone [phone] f//f �
WELL CONSTRUCTION RECORD WELL CONTRACTOR- 1lL�rio 4) da l,iJ& Y Parer —
WELL CONTRACTOR CERTIFICATION 0: .27R51
STATE WELL CONSTRUCTION PERMITN:
231.575
1. WELL USE (Check Applicable Box): Residential Municipal ❑ Industrial 0 Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection] Other El If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below)
('�21t ..e) iQcJ �nn
Nearest To�w"qp�; Ne h n��1. C C. County MO VYm<1/4�
(Road Name and Numbers.
3. OWNER 0,g rY/ )
Address
City or Town j r Sete
4. DATE DRILLED
5. TOTAL DEPTH
6. CUTTINGS COLLECTED YES 0 NO®
7. DOES WELL REPLACE EXISTING WELL? YES ❑ NO®
8. STATIC WATER LEVEL Below Top of Casing: /lj FT.
DRILLING LOG
From To
DEPTH
Formation Desedgion
0
(U.s .•aAbove Top MCasing) !u o<
9. TOP OF CASING IS FT. Above Land Surface'
'Top et casino terminated Wee Wow land surface requios a ~lance In actor- e m
dance with 15ANCAC 2C a a �m
10. YIELD (gpm): / METHOD OFTEST /�l>r rscur
11. WATER ZONES (depth): /Z2O I J3 O I ON o
12. CHLORINATION: Type
19. CASING:
-TAB
Depthi,rnr�
From To 112SL Ft.
From To Ft.
From To Ft.
14. GROUT:
Amount 2-- u s4mio1ai space is needed toe back of loam
Wd ThamesLOCATION SKETCH
S?R?t.2j
or Wslgt'R. (Show direction and distance from at least • State
/'U(: Roads. oe.r map refetence PO ^)
Deem d 6� M a
From 77 To Ft If
From To Ft.
15. SCREEN:
Depth Diameter Slot Sae Material
From To Ft in. in.
From To ( F
From / To / FL / In. In.
t. ( In. in
16. SAND/GRAVEL PACK:
Depth Size Material
From To r Ft. • r
To 1 Ft
17. REMARK
From S
s.
I DO HEREBY
CONSTRU
IFOR OFFICE
gjad Na
0.4.1 •L.
iTURE OF PERSON CONSfRy1L" i1Nti THE DA
to Division a Water Duality, Groundwater Section within 30 days
RW.t REV. 12/99

228057
1EIaWMSwieeA Z7lia1R16a cn.(919)7n s21 dWaMrOwfty-G�owdw Section
WELL CONSTRUCTION RECORD WEU. CONTRACTOR:
wets CONTRACTOR CERTIFICATION
STATE WELL CONSTRUCTION PERMITS:
1. well Recove yE0 HeMA � * Edon ❑ MEn Ot. U.W A°statung ❑ Moe°«rw ❑
2. Newest
01�k (� dheboaloa �r m C ,l 4 L-t
6611-t-P 71i/al t (1f t _ - _ , l lay Ma) 0fIIUJ4G LOG
Ira revue lu ue tX title '.�-c '°
3. OWNER �CZ��' Ram T°
AddnM
ed
lit c 4' XX7SZ—
qrorTem ., j . EPa.
4. DATE DRILLED 07 sus'
5. TOTAL DEPTH
a CUTTINGS Ca.LECTED TESTED NO®
7. DOES WELL REPLACE EXISTING WELL? YES El No®
IL STATIC WATER LEVEt.Rdow Top d FT.
(We V Babes Wool CNN)
a. TOP of CASING Is -FT. Above Land Surface
(Top Moeielon lodieerw..r.dawlsmuteso..r.onIs.raw
and, ,S'ICAO
YIEW10.,Srg DETEST T-' G
11.WAT ZON dptMEn,Fe2W.S'
11. WATEfiE0t�3(daplh): /}�"
12. CHLORINATOR Type TV B Man - 3
13. CASING:
WS DMus
rmm —TToo Sur Ft. � PA
Fran To FL
From To FL
14. GROOT:
pth
From �_ To �Q_FL tide"
Rem To Ft
15. SCREEN:
Dealt
From
From
Rom
16. SAND/GRAVELPa
Mph
To P1../
Dirnal.r Slat Ski
Man
in.
In. h
n.
Rom
From
17. REMARK&
I DO HERESY
She MOSS
a AND TIU k
IMROFRCEOr d to 1 2 ?MI
God Mx
DEPTH
Forme* Os upon
N
(Slow Smote end . . tow Wiest Moo Sere
Rode,aother r afenoepoints)
w 0
NctJ
US?tL
0
AshvilleReggionter alOffice
sad

226336
North Nara Mar Carolina
Service Guenter -Mof oEnviroonh.0 utd and Natural 27699-89&Pl Resources s 7- Division1 of Water Malay• Groundwabr Section
WELL CONSTRUCTION RECORD WELL CONTRACTOR: d ia-e--s/A1 Wail ti chs 4
WELL CONTRACTOR CERTIFICATION *: 2 ; g'
STATE WELL CONSTRUCTION PERMIT*:
1. WELL USE Aaal�w. nfdp& ❑ Rsddentlal MuIndusblal ❑ AAgricultural C3 MonitoringMonito9
Recovery
Heat Pump Water Injection ❑ Other 0 It Other, List Use:
2. WELL LOCAT rWiathe location below) %C
News* Town: County
entae
" Mood �� t,Y Dent tat No.)9. OWNER �j,*. 06 ���/fi.)
Address
Gay or Toe
4. DATE DRILLED5. TOTAL DEPTH
& Cur T*4GS COLLECTED YES ❑ NO®
7. DOES WELL REPLACE DUSTING WELL? YES? NO®
6. STATIC WATER LEVEL Below Top of Casing: b FT.
je (Uas t•1AbwsTapolCS*
9. TOP OF CASING IS / FT. Above lard Surface'
Tep d mac asre a atad Mar below heed whoa nqulnss s variance In wirer -
dance wnal6ANGAO1GaT1a FTESTT/�G
10. YIELD (wMETHOD m): ss Q
11. WATER ZONES (depth)* /D D
12. CHLORINATION: Type rn Amount 2-
2t/
DRILLING LOG
Fran To
19. CASING:
Depth WWI 'Mena west
From._ in FL air.
Frent_-- — To FL
From To FL
14. GROUT:
Depth
From To .20 FL Iri—rr.� LL
From To R.
15. SCREEN'
Depth
From o
From To
From To
16. SAND/GRAVEL PACK:
Depth
Diameter Slot Ski Material
.h.
In. in.
n.
Sire
From To To
From � R.
17. REMARKS:
lFOR OFFICE USE ONLY
Gud Na
DEPTH
Foreman O - aa'
T
II addNons space Is needed use back d loon
LOCATION SKET�N
(Show dim d on and dun from at t Two State
or other rasp ratrren= pates)
iwiti. la LcaNsrauarEo 94 ACCOlwATCEwrit! 15ATOTHEWELLOWt1ER
fl* THATA6GPY� 1/„5
SIGNATUREOF PERSON THE W61 Ge
Bubo* eAalydbOtArlwrdWe* away. tastsrd.ersrttactlon wtiHrt 30 days

226337
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
ELL CONTRACTOR CERTIFICATION #:
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE (Check Applicable sox). Residential Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other El If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below) c
�Neaqres�t Towin: / ��P_ County: � Q�
l/N. in l/ D —W Cou DRILLING LOG
(Road Name en4 Nu ommuruty, bdi ' and Lot No.)
3. OWNER f.(/O .41-4, 2L12. From To
CiceffAddress Vo/ !�
City or Toow,n — (, �( 7i
5. DATE DRILLED L%
5. TOTAL DEPTH
6. CUTTINGS COLLECTED YES ❑ NO®
7. DOES WELL REPLACE EXISTING WELL? YES O NO
8. STATIC WATER LEVEL Below Top of Casing: �/ / _ FT.
t (Use'; a Above Top of Casing)
9. TOP OF CASING IS / FT. Above Land Surface
'Top of casing terminated aUor below land surface requires s variance In accor-
dance with 15A NCAC 2C pa
10. YIELD (gpm)• �/,( METHOD OF TEST Ai c
11. WATER ZONES (depth)• Po
12. CHLORINATION. Type Tom✓? Amount a-
13. CASING:
Zip Code
DEPTH
Formation Description
It additional space is needed use back of form
LOCATION SKETCH
Wall Thickness
Depth Diameter or Wa4tVFL Material (Show direction and distance from at least two State
From D To 0 Ft 6 9 `�° 4 .5Tec � Roads, or other map reference points)
From To Ft.
From To Ft
14. GROUT:
Depth Materia
From _0 To `10 Ft.
From To Ft
15. SCREEN:
Depth Diameter Slot Size Material
From To Ft a in in
From (To /Ft. / In. / In
From / To Ft._ In. ((( In
16. SAND/GRAVEL PACK:
Depth Size Material
From To Ft
From To f Ft.
17. REMAR S:
I DO HEREBY CERTIFY TFIATTHiklAr t.L WAS CbNStRUCTED IN ACCORDANCE
CONSTRUCTION STANDARDS, AND THAT ACOPY OF D HAS RPFN'
FOR OFFICE USE ONLY
Quad No:
TH 15A NCAC 2C, WELL
D TO THE WELL OWNER.
SIGNATURE OF PERSON CONS71IUCTING THE WELL
Submit original to Division of Water Quality. Giokadwaler Section within 30 days
DATE
GW-1 REV. 12199
Serial No