Ya CY2001

inn Carolina - Department ol Environment and Natural Resources - Division ol Water Dually - Groundwater Section n 4
36 Mall Service Center - Raleigh, N.C. 27699-1638-Phone [phone] � b
�RmN L. LZ�.
JELL CONSTRUCTION RECORD WELL CONTRACTOR -WELL CONTRACTOR CERTIFICATION 0: .7,?e.a7
STATE WELL CONSTRUCTION PERMIT.:
WELL USE (Check Applicable Box): Residential Er Municipal ❑ Industrial E Agricultural 0 Monitoring ❑
Recovery ❑ Heat Pump Water In)ectlon ❑ Other [J If Other, List Use:
WELL LOCATIQt)1: (Show sketch old') location below)
Nearest Town:
,�1y�`1 County.
ca"r"e DRILLING LOG DEPTH
(naiad Nama rynd Numbers, ommunlpp'', or Sub vision an Lot No.) Fortnellon Description
,C 1/) From To
OWNER /1_�
Address
al Z/
City or Than Stale Zip Code
DATE DRILLED l ;_ U Lc- b I
TOTAL DEPTH d'
CUTTINGS COLLECTED YES I NOV
DOES WELL REPLACE EXISTING WELL? YES a NOFV1
STATIC WATER LEVEL Below Top of Casing: FT.
/ (Use'.' it Above Top of Casing)
TOP OF CASING IS ( FT. Above Land Surface'
Top of telling terminated aUor below land surface requires a vedance In actor -
"rice with 15A NCAC 2C. 116
0. YIELD (gpm): ib METHOD OF TEST
i 1. WATER ZONES (depth)
- 7D
7b-ago
JIIR4—
BE-c{Rgrk
12 LORINATION: Type H 7H Amount. 1-S II additional space Is needed use back of form
13. CASING:
Wall Thickness
Depth Diameter or Weight/Ft. Material
From--0---To 1 D Ft le •a 5 o)'.1)5 Pv .sOR
From To--- Fl,
From To Ft
14. GROUT
Depth �Material Method,
FrFromQ To DZO 1 Ft S-01`(C��4F �'r'y'-`tl',.p `E-•'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
Ram To Ft
From To Ft
17. REMARKS:
I DO HEREBY CERTIFY NHAT`THISWELLWAS1ONS RR1OT N ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY or THIS' rill ORD HAS BEEN PROVIDED TOTI-LE WELL OWNER.
JR OFFICE USE ONI2111 I SI0NATuIS
I Ouad No: I'`1 t.: _
Submit original to Dlvlst of W ter Quality, Groundwater Section WIIIIIR 30 days
LOCATION SKETCH
(Show direction and distance from at leas) Iwo State
Roads, or other map reference points)
Cid
Serial No.
/
ERSON CONSTRUCTING TIIE WELL DATE
GW-1 REV. 12/99

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mall Service Center - Raleigh, N.C. 27699-1636-Phone (919) 733•3221 8 `n
WELL CONSTRUCTION RECORD WELL CONTRACTOR- /Ye /��Y)AN Z • 7 2�t�/ 7
WELL CONTRACTOR CERTIFICATION 0: o7O�
STATE WELL CONSTRUCTION PERMIT.:
1. WELL USE (Check Applicable Box): Flesidentlal 2- Municipal n Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATION: tow sketch of lice I cation below)
Nearest Town: S County
(noad Name and N
3, OWNER
Address
S� n-cC
friers, Communlly, or Suonhtislon and Lot No
friers:
1 11 � \ _ -♦
act\Lnkiiitiei°r ors e c
City or Town Stale
4. DATE DRILLED \ D b (
TOTAL DEPTH 1)I7
3. CUTTINGS COLLECTED YES NO[4
DOES WELL REPLACE EXISTING WELL? YES I 1 NOFVf
3. STATIC WATER LEVEL Below Top of Casing: 1,2-0 FT.
/ (Use "a' II Above Top of Casing)
3. TOP OF CASING IS ( FT Above Land Surface'
'Top of casing terminated ettor below lend surface requires a variance In accor-
Ionce with 15A NCAC 2C.OI116
\
10. YIELD (gpm): ` METHOD OF TEST �.
11. WATER ZONES (depth)
7a - 4 b
DEPTH
Formation Descdptlon
)1 'R
12 "�ILORINATION: Typo rf� Amount 16j4LILS If additional space Is needed use back of form
\SING:
Wall Thickness
Depth _r// Diameter or We!ghVFI. Maledal
From 0To_ ALFI11•oZ5 € )4,1,•sDR
From To FI.
From To FI
14. GROUT:
From
arlDS
Zip Code
Depth Material Molitod
Q To Rio Ft Opnt-2-E4r` ;in,vyyl"-
From To FI
15. SCREEN:
Depth Diameter Slot Size Materiel
From To Ft In In
From To Ft In In
From To Ft In In
16, SAND/GRAVEL PACK:
From
From
17. REMARKS:
Depth
To
To
Size
Ft
FI.
Material
LOCATION SKETCH
(Show direction and distance from al least two State
Roads, or other map relerence points)
30
7tmf'd
612,
71C,
I D0 HEREBY CERT17 THAT THIS WELL WAS'CO
CONSTRUCTIO STWNDAfDS, AND THAT AQQ
1 OFFICE US
wad No:
Serial No.
FI
Submit odglnll to Div
JCTEO IN ACCORDANCE WITH 15A NCAC 2C, WELL
HIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
URE OF PERSON CONSTRUCTING TIIE WELL DALE
Sion of Water Duality, Groundwater Section wllhin 30 days
GW I REV. 12/99
pr'E

North Carolina • Department of Environment and Natural Resources • Division of Water Quality. Groundwater Section
1636 Mall Service Center • Raleigh, N.C. 27699-1636-Phone [phone] f�
WELL CONSTRUCTION RECORD WELL CONTRACTOR. /►N RMAN G • ..L-(L.
WELL CONTRACTOR CERTIFICATION 0: cDa I
STATE WELL CONSTRUCTION PERMIT#:
I
268371
1. WELL USE (Check Applicable Box): Residential Qr Municipal ❑ industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heal Pump Water Infection ❑ Other ❑ If Other, List Use:
2. WELL LOCATI N: (Show sketch of the location below)
Nearest Town. �VYV13VIIIQ County IQ)7 CCL(.
fa_ M� O
(Road Name and Numbers, C.kommunily,aor Subdivision and Lol No.)
3. OWNER JR4 C. /An .11.n
Address Cy -QM -vie.
-et,, \di,
(Sires or oue No.)
birrnsv112 W. a$7Iz}
City or Town Slate Zlp Code
5. DATE
5. TOTAL DEPTH DEPTH Ne
6. CUTTINGS COLLECTED YES (l NO4
7. DOES WELL REPLACE EXISTING WELL? YES ri NO Vi
8. STATIC WATER LEVEL Below Top of Casing: tin FT.
(Use'' II Above Top of Casing)
9. TOP OF CASING IS ' +
FT Above Land Surface'
'Top of casing terminated al/or below land surface requires a variance In accor-
dance with 1SA NCAC 2C .0118 �;
10. YIELD (gpm): 5D METHOD OF TEST
11. WATER ZONES (depth):
DRILLING LOG
From To
DEPTH
Formation Description
30-125 BPCIRQCk
10 CHLORINATION: Type >•I 7" Amount 2.41I4S If additional space Is needed use back of form
BASING:
Wall Thickness LOCATION SKETCH
Depth Diameter or W ightFL. Material (Show direction and distance from at leas) Iwo State
From 0 To °n a I,' a 5 12.5 PIVGSDre, Roads, or other map reference points) : _
From To Ft a+w
From To Ft.
rn
Depth Material Method Cr14. GROUT: ,,` yi,, V `aCI�,.,
{ � e U) „.
From 0 To GZ-° Ft eiDrrce '4E ffund, 'burnsvill-e, Nc ,.,.
From To Ft
15. SCREEN: - - ;,�0
..It
.>
T a;
Depth Dlatneter Slot Size Material
Frorn To Ft In In
From To Ft In In
From To Ft In In
16. SAND/GRAVEL PACK:
Depth Size Material
From To Ft
From To Ft
17. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CON ,. , .. .. _ 0PY F THIS RECORD HAS BEEN PR r IDED TO THE WELLWNER.
f//10 Gila_FOR 0=EI��HSEONL
'quad NiI ��. SI NATURE OF PERSON CONSTRUCTING THE WELL
�' dginal to Division of Water Quality, Groundwater Section within 30 days
1 Serial taJ L (- 1r- 1 2 P i
DATE
GW-1 REV. 12/99

OWNER
2.
North Carolina - Department of Environment, Health, and Natural Resources
Division of Environmental Management - Groundwater Section
P.O. Box 29535 - Raleigh, N.C. 27626-0535 - 6 8 o'7 3
Phone [phone]
WELL CONSTRUCTION RECORD
,LLING CONTRACTOR: Ferguson's Well Drilling Co.
STATE WELL CONSTRUCTION
DRILLER REGISTRATION NUMBER: 541 (20.? 7) PERMIT NUMBER:
QUAD NO
Lot
Minor Basin
Basin Code
Header Ent GW-1 Ent
FOR OFFICE USE ONLY
SERIAL NO
Long. RO
1. WELL LOCATIO (Show sketch of the location below)
Nearest Town: t�M 111v3/4. County
)/44.n Ctt /
(Road. Commun' r Subdivision and Lot No.)
� lkl /z 6J�
�h
ADDRFSS 7n-P Ive,J
-(� (Street or Route No.)
( 1cipsN9v, Ile, ) NC,
City or Town State
DEPTH
From To
azirl 14 Zip Code "�
3. DATE DRILLED -I- Y- DZ USE OF WELL Lailve re✓4d / : 93
4. TOTAL DEPTH eloO -
5. CUTTINGS COLLECTED YES NQ .�-�
6. DOES WELL REPLACE EXISTING WELL? YES NO4 c UD
7. STATIC WATER LEVEL Below Top of Casing: j FT. � 0 -
6
(Use "+" if Above Top of Casing) q gj - -s�'(P
8. TOP OF CASING IS � FT. Above Land Surface` �C
• Casing Terminated at/or below land surface is illegal unless a variance is issued
In accordance with 15A CAC 2C .0118
9. YIELD (gpm)• METHODr�OF TEST /�
10. WATER ZONES (depth): c?cg0 ,.e(c)
CHLORINATION: Type
12. CASING:
ijov
./01/47AX• rS Amount
Wall Thickness
Depth Diame er or Wei Ft. Material
From <2 To •- „ D FL 44
From To Ft.
From To Ft.
13. GROUT:
Depth Material Method
From AO To - C) Ft ‘liee%- / l 1 `9a rzf
From To
14. SCREEN:
Depth
From To
From To
From To
15. SAND/GRAVEL PACK:
Depth
From To
From To
1n REMAAK •
•
fONSTRUCTION STANDAI
'-9 c
�t
Ft
Diameter Slot Size Material
Ft in in
Ft in in
Ft in in
GW-PF�E�'94-Fr
Size
Ft
Ft
Material
DRILLING LOG
Formation Description
Stsincity
bcoire.:if
4rrow(J4 i 1
/56�4se (it
4///c y-pin/0-
eurce- vs"
If additional space is needed use back of form
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other mapreference points)
O E I4i I VE,
T1HIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
,G., 3q/‘ -4027 4- 7- o;:1-
SIGNATURE OF CONTRACTOR OR AGENT DATE
Submit original to Division of Environmental Management and copy to well owner.

F OFFICF-0SE ONLY
L No:
Serial Ne
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mall Service Center- Raleigh, N.D. 27699-1636-Phone (919) 733•3221
WELL CONSTRUCTION RECORD WELL CONTRACTOR- /iN RmAN L • 2A-L.
WELL CONTRACTOR CERTIFICATION 0: aeal
268363
STATE WELL CONSTRUCTION PERMITN:
I . WELL USE (Check Applicable Boa): Residential ✓I- Municipal (l Industrial ❑ Agricultural ❑ Monlioring ❑
Recovery ❑ Heal Pump Water Injection ❑ Other LI If Other, List Use:
2, WELL LOCATION: (Show sketch of the location below) \'
Nearest Town: Y7LIY YISVIP Count' 7af'1Ce
a„"
(noad Name end Numbers, Community, or $ubdlvl'sl.a^n and Lot No.) DRILLING LOG DEPTH
3. OWNER Sere ml ni-q V, .,�U RFrom To Formation Description
'a SpV PV1 I' I;Jg S"If M
Address 3( Ireot or iloule No.
&rnsv( Ile N'C
Clly or Town L� I'1 Stale
t, DATE DRILLED y-14-0"
5. TOTAL DEPTH Hs
3. CUTTINGS COLLECTED YES I J NO{
DOES WELL REPLACE EXISTING WELL? YES I ( NO7(
3. STATIC WATER LEVEL Below Top of Casing: ?1r1 FT.
(Use ".' It Above Top of Casing)
J. TOP OF CASING IS / FT. Above Land Surface'
Top of casing terminated at/or below land surface requires a variance In 'coot -
lance with 15A NCAC 2C .0118
10. YIELD (gpm): ..2 . METHOD OF TEST �.
11. WATER ZONES (depth)
-ILI'-, 134(k
o' T71y
Zlp Code
2. r'HLORINATION: Type H T I Amount II additional space Is needed use back of form
3 3ING:
'4
Depth
From 0 To (Dill
Wall Thickness
Diameter or WfIghVFI. Ms i
FI 1 .�5 ,;) .J;5 Pv�
From To Ft.
From To Ft.
GROUT:
Depth Material Molhod
From 0 To a� rt. 0b1Y riCEC�.EfE 717D1yf,2, �lJ_
From To Ft
5. SCREEN:
Doplh Diameter Slot Size Material
From To Ft _ In. In
From To FI In In
From To Ft In In
16. SAND/GRAVEL PACK:
Depth Size Material
From To Ft
From To FI
I7. REMARKS:
LOCATION SKETCH
(Show direction and distance from al least Iwo Slate
Roads, or other map reference points)
co
-71
n
Seven bile tRicEQ d
1?-30v15vi Ile, I4C
W
0
U1
I DO IIEREDY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS AN —TU -J COPY OF THIS RECORD HAS BEEN PROVI D0 TO THE WELL OWNER.
SIGNATURE OF PERSON CONSTRUCTING THE WELL
original to Division of Water Quality. Groundwater Section Wililin 30 days
GW-I REV. 12/99
DALE

Noah Carolina - Department of Environment :Ind tlnlurnl li
1636 Mail Service Censor • RnInk l . ri C. /,Yv t6 fl: t•hr„
WELL CONSTRUCTION I tt_CUI to
WIT LI Curl l IIAC I1111
W CI_l. CON I IIACI Olt C _ C 1 ON Pr
STATE WEL t. CONSTR(ICTION PERMIT/4:
249456'
ar Section
l-11 TIf I -A -I 2-66
1. WELL USE (Check Applicable fox): Residential 1 Recovery ❑ Heat Pump Water Injection [] O:rn-r -I R Oth::r, Li :; hi
2. WELL. LOCATION: (Show sketch 911 the location bu ow)
Nearest Town:-5:7fit e Yinic (r•un, J4tci�.
(Road Name and Numbers, Community, or Subdivision and Lol Nn )
3. OWNER She,lL- i S1<rNs
Address N.} I X S c) ��
orrci
�157uRr>5vr //(StreelarHaut/UL
City or Town :;L+.n•
4. DATE DRILLED /V3/-b/
5. TOTAL DEPTH 5D o
6. CUTTINGS COLLECTED YES LJ NO[u-
7. DOES WELL REPLACE EXISTING WELL? YLS_ 'I I!O[
_p_
8. STATIC WATER LEVEL Below Top of Casing: L ('(.
(Use b' it Abner] Top of Lott /1
9. TOP OF CASING IS ' FT Above Land Surfnco'
'Top Of cuing terminated et/or below land surracn requires a vnrhn(n In nc
dance with 15A NCAC 2C .411 a
10. YIELD (gpm): ,(� METHOD OF TEST
11. WATER ZONES (depth): Nrfiof.,L
12. CHLORINATION: Type
13. CASING:
4; 1
FtilILI. INC; I f1G
to
rmn
HT/ 1 AIIIOLIII! _ __._
Wall Thickness
Depth Dian etor or Wulpllt 1 61,is,'
From -/ To ,92 Ft PH-$J__ _n✓G.
From To ' Z— FL G 4 /2Y
From To Ft
14. GROUT:
Depth Malorial tvlothnd
From d To ,p23 _Ft. Le/•te•s' f- 40Ce/re19
From To Ft
15. SCREEN:
Depth
Flom To
From To
From To
16. SAND/GRAVEL PACK:
Depth
To
To
From
From
17. REMARKS:
I DO HEREB
CONSTRUC
Diameter Slot Size
Ft
Ft
Ft
Size
Ft
Ft
frilaterial
t:lalra in!
IFY T¢)AT ThisyvELN. v.(As
TANDAlRRDS AN�O0 THAT k c
Submit on
GROUNDWATER SECTION
ASHEVILLE REGIONAL OFFICE
Agricultural 0
/ I L-/(r•' /eo
Monitoring ❑
DEPTH
Formation Description
n
WO
II additional space is needed use bq9 of f§Fm_
LOCATION SKETCf
(Show dlrecb.,n and distance from al least two Stale
Rood., a other reap reference points)
rj/On.LCy
Gn
RUC LLD IN ACCORDANCE: 'Al t9 15A NCAC 2C. WELL
I FITS RECORD tins BEEN r:::ov DGD TO THE WELL OWNER.
/
TORE Or PLifi;ON CONSTRUCTING TFII=WELL DATE
Ion or v/aler Ouallty, Grautawamr Section Within 30 days
GW-1 REV. 12/99

arofna - Department of Environment and Natural Rssouroa - Division of Water Quality • Groundwater Section
di Service Center - Raleigh. N.C. 27699-1636-Plans [phone]
L CONSTRUCTION RECORD WELL CONTRACTOR -
WELL CONTRACTOR CERTIFICATION S: _% 734'
STATE WELL CONSTRUCTION PERMITS:
246200
SweetWater Well Drilling & Pump Service, Inc.
_LL USE (Clack Applicable sox): Reeiidendal Municipal El Industrial ElAgricullural El Monitoring 0
stover), 0 Heat Pump Water Injection Other 0 If Other, List Use:
ELL LOCH (Show sketch of don below)
gest Town: 24-i trte /Li Courtly l �dsj1.lr�ijt%
load Name piq /QgQae . or &t and
d Lot No.) a DRILLING LOG
JIVER •
r7 %./.(g1d CA_ From To
Z.
Cayce Torn n /
TE DRILLED / a7
TAL DEPTH �� n-f
RTiNGS COLLECTED YES 0 NO0
:ES WELL REPLACE EXISTING WELL? YES ❑ NO[.
S
ATIC WATER LEVEL Below Top of Casing: 3.2 FT.
(Ilse •e I Above Top of CnYq)
P OF CASING IS A 5 FT. Above Land Surface'
nabs; tonnlireid miler below land ..Jt. a coquina ■ wins In moot -
ill 13A NCAC SC 111
LD (gpm): METHOD OF TESTLan"
,TER ZONES ( ) aD n I
t_ORINATION: Type 1- Amount 7
.SING:
.�. .2 471)6"
Depth
xnTo goeO
;nt _ To
To
IOLrf:
To am o o
om To
:BEEN:
Depth
To
Ft.
om 7 To Ft.
AND/GRAVEL PACK
Depth
roam To.,,r.•;Lr_
,=MARK&:
0
Ft.
Ft.
FL
I7
Vihme Thldorn
Diameter Slot Size Material
Ft in. _ In• g 1
FL
In.
11
DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED
Jk1STRUCT1ON STANDARDS, AND THAT A COPY --
}i OFFICE USE ONLY
no:
DEPTH
Fartndon Dstripban
O
a
r„
0
CO
d addlioit space la needed lea bads of form ,
LOCATION SKETCH
and distends ham al least two S „ P
, ar odor rep- - per) r-
D
0.l
5
bKOONUWAth 5EC1ION
SE x .; F :E °E (W.
SIGNATURE OF PERSON
Sutra odors, io Division of WSMr °way,
,a..

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mail Service Carter - Raleigh, N.C. 27699-1636-PMone (919) 7l3-1,s1
WELL CONSTRUCTION RECORD WELL CONTRACTOR. SweetWater Well Drilling & Ptanp Service, Inc.
WELL CONTRACTOR CERTIFICATION 0: a2 R 77
STATE WELL CONSTRUCTION PERMITS,:
246199
1. WELL USE (Oath Applicable Box): ResidpMW 51 Municipal ❑ Industrial 0 Agricukurai ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other p If Otter, List Use:
2. WELL LOCATION: sketch w of don below)Neatest Tr ��'
Count
(Resit Name �.'O"rww JtN
Cam unky, or SubdWten and lest Na)
3. OWNER �16,y 5.116-44.
Address 4 aiag
-t1.>Lsco. ACC. e l7J
or Town �_ aP today
4. DATE DRILLER
5. TOTAL DEPTH
8. CUTTINGS cOLLECTED YES O NO®
7. DOES WELL REPLACE EXISTING WELL? YES ❑ NO®
8. STATIC WATER LEVEL Below Top of Casing: // 2 FT.
gas .'lAEon Tap el Cates)
9. TOP OF CASING IS / J L FT. Above Land Surface*
'Toper aeshq toner led otter bane Sod sashes nquhes a Si.flaw in amen.
dance with RiA NCAC 2C 411a
10. YIELD (gpm): / MET11� OF TEST T e
11. WATER ZONES (depth). t. /)
DRILLING LOG
From To
12. CHLORINATION: Type Amount
13. CASING: Vs
From D
Depth
To /' CFt.
From To FL
From To FL
14. GROUT: AA
From 0To��D FL /��r�
From To Ft
15. SCREEN:
7
DEPTH
Fonntea s Desnplan
0
1 additional specs Is needed tee beck 01 m
Way Mans s LOCATION
co WaktiVR. L edd (Shaw direction and din • ad Nan two Slate
ot
, err other map - points)
Method
Iw 1�,huy/
Depth Diameter Slot Size Material
From / To R 1n in.
J�
From To l s -� /� IpI
From To �' s ?-
18. SAND/GRAVEL PACK:
Depth
From To_
From 7 To
17. REMARKS:
R.
Size MittarW
GRO INUAY,TER SECTION
ASHEVILL.E
Sea
-o
7A
Cr
'�arJ ?d
D
tJ
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A pEReCONGAS,'¢ ECORD PROVIDED TO THE WELL OWNER.
FOR OFFK USE ONLY
Cued No:
SIGNATURE OF CON18rR CTYgTIEWBL DATEwrit /4 /
Suomi alplrnat te 0Sklan d Water Duality, Groundwater Swam within 30 days
(TV.1 REV_ 12/ell

North Carolina - Department of Environment and Natural Resource. - Division of Water Ouabty - Groundwater Section
1636 Mail Service Center - Raleigh, N.C. 27e99-1636-Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR- SweetWater Well Drilling & Pump Service, Inc.
WELL CONTRACTOR CERTIFICATION 0: 7L- %2 %Sy
STATE WELL CONSTRUCTION PERMITS?:
246046
1. WELL USE (Clank Applicable sox); Residents a ® Municipal 0 Industrial 0 Agricultural 0 Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other If Other, Ust Use:
2. WELL LOCATIONh• (Sh.owsketchi of >Ih�s location below)
tierce?Town: 1ti county l 2,5-4.�,.V
(Rood Conaway, DRILLINGalk�vlebn and tones) DRILLING LOG DEPTHW
3. OWNER su�l�i/ From To FommDeenipeon
Address .%�IStGC <G1zt /il �/r
I��ar�ai'io.)
City or Town Sale Zip Coy
4. DATE DRILLED
5. TOTAL DEPTH .r
6. arrn Gs cCLLECTED YES 0 No®
7. DOES WELL REPLACE EXISTING WELL? YES ❑ NO0
8. STATIC WATER LEVEL Below Top of Casing: , 7 q FT.
(Ues e a Above Top al Casing)
9. TOP OF CASING IS 2 6 FT. Above Land Surface*
Top et seeing IreJae.d arar behove land surface requites a trrWae M seoor-
dmae t td, ISA NCAC t S11e
10. YIELD (gpm): 4 ME'LHOD OF TEST -no
11. WATER ZONES (depth) _S'
12. CHLORINATION: Type Amount --i4.
13. CASING:
From
WM Thickness
DePSt r i Diameter ®aeG
From To FL
From To Ft.
14. GROUT:
Depth ` "'
From __� To �0 a
From To Ft
15. SCREEN:
Depth Diameter Slot Size Material
From To
From
From /To FL /M. Alin
To
16. SAND/GRAVEL PACK:
Depth SW Material
To < Ft.
/ FLL / /
To
From
From
17. R
DO HER?
•.. - '! STANDARDS, AND THAT
P ' 7 2002
FOR OFFICE ONLY 1
Cued Na
s0M
P�
TI-A1 taus vreaL WAS
GROUNDWA, R SECTiUN
nk
ASHEVILLE RE IONAL OFFICE
7.1
471 0
If additional span is needed we balk of Ions
LOCATION SKETCH
(Shaw direction and dioanea hen at Sat two State
Rao, or other nap Sena poha)
ISTRIICiED IN ACCORDANCE WITH ISA NCAC 2C, WELL
OF LS RD HAS BEEN BfIOVIOED TO THE WELL OWNER.
SIGNATURE OF PERSON CONS7T11(CTelo THE was. DATE
al to Milano( wear away, Grrndaslr swan within 30 days
Caika•J L.
mit-t REV. 12Ae

North Carolina - OepBtrnant of Environment and NabaatRmounxe - Dtvisfonof Water Oudly - Gioundweter.Section
trite Ma Service Caner - Raleigh, N.C.276g9-1636~e (919) 73313221
r-
WELL CONSTRUCTION RECORD WELL. WEcoNmAcron• p'd
WELL CONTRACT»RC AMON 4 '1436
STATE WELL CONSTRUCTION PERMITS:
1.
WELL USE (Mock Appda ie god: Residential(1� Municipal El Industrial ElAgricultural ❑ Manlaring ❑
Recovery ❑ Heat Pump Water Injecdon ❑ Other ElIf Other, List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Teem /it /' Ai < Ir Ye Cow*: /a F2G�1/
(Road Name and Numbers, Community, or Subdivision and let No.)
3. OWNER To thMy LYnte VCR
Address (�
-Bus v
City or Town Siam
4. DATE DRILLED rib - &,-0
5. TOTAL DEPTH COO
6. CUTTINGS COLLECTED YES ar NOD
7. DOES WELL REPLACE EXISTING WELL? YES NOM'
8. STATIC WATER LEVEL Below Top 01 Casfr'g iD0 'FT.
(Use 44 I( Above Top d Casing)
9. FT. Above Land Surface'
'Top of easing terminated aior below and surface requires a variance U. accor-
dance with 15A NCAC 2C .0113
10. YIELD (gpm): _ IL'_ METHOD OF TEST ��
1 1. WATER ZONES (depth):
TOP OF CASING IS
1
71p Cade
DRILLING WO
Frmt To
. 1 4
DEPTH
Formation Daswl leh
a.
R tea
'ij4'
yet (004 _MLA -1-e_
12. CHLORINATION: Type f) �i 5
i3. CASING:
Depth
From -r I To N9
FTC... To
From -- To
1d. G=BOUT:
Cyder
FL j°if
Fl.
Ft.
Amount 70
Wad Titans,
or UR.
If additional apace is needed use back of form
LOCATION SKETCH
Mare dal (Show direction and distance from at least two State
G Roads, or other map reference points)
Depth aI Material , Method
From 0 To G�-3/ Ft (LemeAl "Po LLre(L
From To Ft
15. SCREEN:
Depth .Diameter Slot Slze Material
From To Ft ` In
From To Ft. In.
From To Ft. In.
16. SAND/GRAVEL PACK
Depth
From To FL
From To FL
17. REMARKS:
Size
In.
In
In.
Material
1 DO HEREBY UCTED IN ACCORDANCE WITH 15A NCAC 2C. WELL
CONSTRUCTI OA p5, ADO l�� j THIS RECORDS BEEN PROVIDED TO THE WELL OWNER.
8
/0-3Q-oi
THE WELL DATE
el Water Ouasy. Gtaadwater _. • within 30 days
GW-t REV.
GRCUNpNJgTER SECTION
ASl�rdllLE REGIONAL OFFICE

North Carolina • Department of Environment and Natural Resources - Division of Water Quality • Groundwater Section
1636 Mali Service Center - Raleigh, N.C. 27699.1636•Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR'
�/� 243759
/1'; Q m /9/1/ L .
WELL CONTRACTOR CERTIFICATION P: c70-37
STATE WELL CONSTRUCTION PERMITI:
1. WELL USE (Check Appecabte Box): Residential ✓I f Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection (l Other D If Other, List Use:
2. WELL LOCATIO (ShowI sketch o location below)
Nearest Town: ` ( FLM County:
(noad Name and Numbers. Community. or Subdlvlslon a Lol No.) DRILLING LOG
3. OWNER 1 1-Cb- Q � r From To
Address SO -" /- -
Slrea ou e oro. Lam+-c-�
ThOlau 02 �nc 2 2 77
CI or Town Stale Zip Code
4. DATE DRILLED L�'g.
5. TOTAL DEPTH s�:�
6. CUTTINGS COLLECTED YES f No4
7. DOES WELL REPLACE EXISTING WELL? YES n Wm'
8. STATIC WATER LEVEL Below Top or Casing: .4/5 FT. to .�
(Use'+' if Above Top of Casing) C7 a"rn
9. TOP OF CASING IS rn I FT. Above Land Surface' o
0 <n
'Top of easing terminated ettor below land surface requires a variance In accor- >p
dance wllh 15A NCAC 2C .0116 ▪ m-,
10, YIELD (gpm): 2 METHOD OF TEST �, - .T
11. WATER ZONES (depth): y? —co
iv -
DEPTH
Formation Description
-345
MiR
t-3 EIR Of k
1 HLORINATION: Type NTH Amount 5_42pALS
13. CASING:
Wall Thickness
Depth Diameter orWpplphVFl.lerlal From To 3 � Ft b t;5 ,)le,/;j tw
From To Ft.
From To Ft
14. GROUT:
Depth Material Method
Frorn b To s- 0 Ft NINCEE'} E .p((Q, ,_
From To Ft /
15. SCREEN:
Depth
From To
From To
From To
16. SAND/GRAVEL PACK:
Depth Size
From To Ft
Diameter Slot Size
FI In
Ft In.
Ft. In
From To Ft
17. FlEMARKS:
Material
In
In
In
Material
If additional space Is needed use back of form
O
0
�_
ON O
LOCATION SKETCH
(Show direction and distance from at least two Stale
Roads, or other map reference points)
5-nlakazat 1462b167.(1
4/2-a-ce_ /7716,
IDOIIEREDY£EF#TtFYTHAT THS-WELt WAS
CONSTRUCtlpN;0TANDAROS, AND THAT A Cqy
.1 OFFICE t15EONLY
Quad No:
Serial No
Submit oil
RUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
/124, it/ L, Rig kL /6 - /n2 Q/
TUBE OF PERSON CONSTRUCTING TIE WELL DATE
Inal o [vision of Water Duality, Groundwater Section Within 30 days
rrt S_C1ION
GW-1 NEV. 12/99

North Caroline - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section 40755
1636 Mall Service Center • Raleigh, N.C. 27699-1636-Phone [phone] y//_' �j �7
WELL CONSTRUCTION RECORD WELLCONTRACTOR: /IN Rmf4N Z - —�Zy(
WELL CONTRACTOR CERTIFICATION 0:
STATE WELL CONSTRUCTION PERMIT":
1. WELL USE (Check Applicable Boa): Residential I'4 Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Infection ❑ Other ❑ 11 Other, List Use:
2. WELL LOCATION: )low sketch of -the location below)
Nearest Town: wits 7/...Lae 1 County.
(Road Name end N
3. OWNER
Address
rs. Community, or S
and Lol Na) DRILLING LOG DEPTH
PauaMS-1S.L-6- LP
(Sheol or touts onIr� -7
c �g71,4
City or Town Slate Zip Code
4. DATE DRILLED 6
S. TOTAL DEPTH a
6. CUTTINGS COLLECTED YES J J NO[4
7. DOES WELL REPLACE EXISTING WELL? YES NOW(
6. STATIC WATER LEVEL Below Top of Casing: Q FT.
/ (Use D- if Above Top of Casing)
9. TOP OF CASING IS ( FT Above Land Surface'
-Top of easing terminated etfor below land surface requires a variance in accor-
dance with 15A NCAC 2C .01 6
10. YIELD (gpm): If METHOD OF TEST R.. 3
11. WATER ZONES (depth)•
From To Formation Description
1 FILORINATION: Type H 7H Amount .5 n, IIt If additional space Is needed use back of form
13. CASING:
Depth /,, Diameter
From 0 To iW Ft G.a5
From To FI.
From To FI
14. GROUT:
Wall Thickness
or WIMh A.&&. all ,/,5
Depth Material Method
Frorn 0 To vZ0 FI C191IC2-E4E ._1�e,`
From To R /
15. SCREEN:
Depth Diameter Slot Slze Materiel
Frorn To FI 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
FI
FI
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other map reference points)
✓ct(4,r I n
at, A its e
I DO HERED t e I� RY THAT TFfLS WFLL WA -GOP b ERUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCT�r�` TANDARDS, AND THAT A COPY"THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
.1 OFFICE
Ouad No:
Sedal No.
P-5-6/
SIGNATURE OF PEnsoN CONSTRUCTING TIIE WELL DATE
Wyllie/fermi to i ivision of Water Duality, Groundwater Section wllhln 30 days
OR SEC1IOfd
'AL OFFICE cw.I nEv. 12/99

North Carolina - Department of Environment and Natural Resources - Division of Water Duality - Groundwater Seclion 0 4 Q r� r
1636 Mall Service Center • Retelgh, N.C. 27699-1636-Phone [phone] y//_' C)
WELL CONSTRUCTION RECORD WELL CONTRACTOR. NeRmAN G • 2,4L,
WELL CONTRACTOR CERTIFICATION 0: o?11-3 7
STATE WELL CONSTRUCTION PERMIT.:
1. WELL USE (Check Applic.ble sox): Residential Ir Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATION: liow sketch ortfip location below)
Nearest Town: PauC_t \ �JL,_e County:
(Road Name end
3. OWNER
Address
tubers, Community, ubdivision dand Lot No.)
CS /224 �-e_ a8777
CI or Town St Stale Zip Code
4. DATE DRILLED D -0
5. TOTAL DEPTH .�/
6. CUTTINGS COLLECTED YES 1-1 NO[f]
7. DOES WELL REPLACE EXISTING WELL? YES n NO
8. STATIC WATER LEVEL Below Top of Casing: tail FT.
(Use Y' II Above Top of Casing)
9. TOP OF CASING IS / FT. Above Land Surface'
'Top of casing terminated stfor below lend surface requites a variance In accor-
dance with 1SA .CAC 2C .011a
10. YIELD (gpm): 3 METHOD OF TEST ill 5
11. WATER ZONES (depth)•
DRILLING LOG DEPTH
From To Formation Description
03 � - LizeIS
i).'R
B dtQck
c
_c
ri
rn
oc
O fin:
rn
1 HLORINATION: Type FT 7� Amount 69 Nils If additional space Is needed use back of form
13. CASING:
Wail Thickness
n Depth Diameter �l�lgi�5 Mates2 From IJ To Ft. L • aZ or 21L
From To Ft
From To Ft
14. GROUT:
Depth Material
From b To AO FI CcNC2t'1-t pOuw-Bri.
From To Ft
15. SCREEN:
Mothod
Depth Diameter Slot Size Material
From To FI In In
From To Ft In In
From To Ft In In
16. SAND/GRAVEL PACK:
Depth Size Material
From To Ft
To
From
17. REMARKS:
I DO HERE
CONSTRUC
Ft
W ma
n
N
0's
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other map reference points)
TIFY 1 i.:01- t#11SW L WIS TRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
t ND RDSANETTitAl-A'pP F THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
II
i0t{ATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit odelnal to blvlslon of Water Duality. Groundwater Secllon wilitln 30 days
GW'I REV. 12/99
!41. OPFI: r

1
3. OWNER
Address
North Carolina • Department of Environment and Natural Resources - Division of Water Quality • Groundwater Section
1638 Mall Service Center - Raleigh, N.C. 27699.1638-Phone [phone]�//,' / ^y� r)/�` 3 ry ) 2
WELL CONSTRUCTION RECORD WELL CONTRACTOR /I N R/v?AN C L. �Jf} �` .
WELL CONTRACTOR CERTIFICATION #: c Da 7
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE (Check Applicable 8oa): Residential Er Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Beal Pump Water Infection ❑ Other ❑ If Other, List Use:
2. WELL LOCATION. tow sketch of the location below)
Nearest Town: I�A1L'LS LJ'I e County. CIM.
(Road Name and Numbers. Community, orplvtslon and Lot No.)
_ 4(Street or Houle o.)
iA��s 2/11 0 fir a-V 7/9
City or Town Slate Zip Code
4. DATE DRILLED
5. TOTAL DEPTH (� S
6. CUTTINGS COLLECTED YES ri NOF,4 c
7. DOES WELL REPLACE EXISTING WELL? YES I I NO171 C o
8. STATIC WATER LEVEL Below Top of Casing: 15 FT. C2 "'3
(Use -+• I1 Above Top of Casing) C'7 c c
9. TOP OF CASING IS / FT. Above Land Surface'
or
•Top of casing terminated at/or below land surface requires a variance in actor- 0 --I",
dance wllh ISA NCAC 2C.0118 mo
10, YIELD (gpm): I r7 METHOD OF TEST n. 3 3 0
11. WATER ZONES (depth): c.a rn
0
N -i
DRILLING LOG DEPTH
From To Formation Description
D - )3a'R +-
,2n -ap5 B RJ?Ck
1 HLORINATION: Type 1T 7 1
13. UASING:
Amount ( S 11 additional space Is needed use back of form at o
Wall Tltickness LOCATION SKETCH
Depth Diameter or Wright/FL ight/Fl. Material (Show direction and distance from al least Iwo Slate
From To D FI. L .;5 07) l rl21 Thea ae. Roads, or other map reference points)
From To Ft. .7/
///��� ///
From To Ft y / f ,�/J /J n / /� / C.
IA. GROUT: // /Tnr �•e- / ,
Depth MaterialMoles" P
d
From
b To AO FI C"t�lYf�-iE �L.._
From To FI
15. SCREEN:
Depth Diameter Slot Size Material
From To Ft In In
From To Ft In In
From To FI In In
16. SAND/GRAVEL PACK:
Depth Size Material
From To FI
From To
FI
17. REMARKS:
I DO HEREDY FEE T FY THAT T111S NEW Wh$C �T1UCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTI�IMd'QMUR- $T-4UD7TulTA 8{ t•THIS RECORD HAS BEEN PROVIDED TOTHE WELL OWNER.
4 4-1 /521/7 l- 2 ),-,a , 1O - /71-6
SIDNkURE OF PERSON CONSTRUCTING THE WELL DATE
Submit original to Division of Water Ouallly, Groundwater Section wllllln 30 days
_.. GW-1 REV. 12/99

I
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mall Service Center • Raleigh, N.C. 27699-1636-Phone [phone] 1
WELL CONSTRUCTION RECORD WELL CONTRACTOR. /ID RniRN Z • 2 (2.
WELL CONTRACTOR CERTIFICATION #: o?DA 7
STATE WELL CONSTRUCTION PERMIT#:
I. WELL USE (Check Applicable Boa): Flesldenllal +I� Murliclpal n Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other If Other, List Use:
2. WELL LOCATIO Show sketch o o location below)
Nearest Town: h.11-L/✓� )• County.
(Road Name and N
3. OWNER
DRILLING LOG
From To
DEPTH
Formation Description
PrRI-
1�TLtieQck
O
CD 0
City or Town Stale cr,l 5 CI c-,-
4. DATE DRILLED ID- 3-b1 m o2;1
5. TOTAL DEPTH ) $ PC
5 n '`'
6. CUTTINGS COLLECTED YES n NO1
7. DOES WELL REPLACE EXISTING WELL? YES O NOFS .�
B. STATIC WATER LEVEL Below Top of Casing: FT.
/ (Use'r" If Above Top of Casing)
9. TOP OF CASING IS ! FT Above Land Surface'
'Top of casing terminated at/or below land surface requires a varlance In accor-
dance wllh 15A NCAC 2C .011E
10. YIELD (gpm): l) METHOD OF TEST %Ra• 3 11. WATER ZONES (depth)•
1 HLORINATION: Type H 77-1 Amount 3D NHS
13. CASING:
Wall Thickness
Depth Diameter or W¢Ig1,VFt. Mal
From � To � [ Ft (< • o•Z P�.,51 5 �l6
From To FI.
From To FI
14. GROUT:
From
15. SCREEN:
Depth Malerlal Motes /hod
From � To AO FI l'nNC2&fE
To FI
Doplh
From To
From To
From To
16. SAND/GRAVEL PACK:
Depth
From To Ft
From To FI
17. REMARKS:
Diameter Slot Size Material
FI In In
Ft
FI
In
In.
Size
In
In
Material
If additional space Is needed use back of form
LOCATION SKETCH
(Show direction and distance from al least Iwo Stale
Roads, or other map reference points)
I DO HEREBY CERTIFY T 1
I
CONSTRUCTION STAND fl0$' AND
I OFFICE USE ONLY ,I'
Ouad No:
Serial No
trWAS CONSTRUCT PAIN ACCORDANCE WITH I5A NCAC 2C, WELL
THAT COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
on^ , ,' A z -6
SIGNATURE drtrisoN CONSTRUCTING THE WELL DATE
Submit odginal to Division of Wei r Ouellly, Groundwater Section within 30 days
•
GW1 REV
12/99

North Carolina - Department of Environment and Natural Resources - Division of Water Duality - Groundwater Section
1636 Mall Service Center - Raleigh, N.C. 27699.1636.Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR.
A7 RmAN L 2.4(L.
WELL CONTRACTOR CERTIFICATION N: 0,7O..7
STATE WELL CONSTRUCTION PERMITN:
2437 j8
1. WELL USE (Check Applicable Box): Residential la- Municipal ❑ Industrial ❑
Recovery ❑ Beat Pump Water Injection ❑ Other If Other, Llst Use:
2. WELL LOCATION: show sketch of the location below)
Nearest Town: i�l �l/VI .521j Yf-v County:
Agricultural LI Monitoring ❑
(noed Name and Numbers.CCommunity. Subdivision and Lot No.) DRILLING LOG DEPTH
3. OWNER t[ (4,0 From To Formation Descdpllon
Addr ss [/� ` � 7 1
Sir
or Houle No.) /
City or Town Stale Zip Code
4. DATE DRILLED L6"OD-6.1
5. TOTAL DEPTH .e.D- rj
6. CUTTINGS COLLECTED YESf NO(4
7. DOES WELL REPLACE EXISTING WELL? YES n NO!
8. STATIC WATER LEVEL Below Top of Casing: FT.
/ (Use •+' II Above Top of Casing)
9. TOP OF CASING IS ! Ff. Above Land Surface'
'Top of casing terminated eVor below land surface requires a variance In accor-
dance with 15A NCAC 2C.6 18
10. YIELD (gpm): METHOD OF TEST R. J 11. WATER ZONES (depth)• 1 FILORINATION: Type 1-1 7H Amount _5 If additional space Is needed use back of form
13. CASING:
h -"3D $xiRQck
Wall Thickness
Depth / / ^ Diameter or W IghVFI. Malarial
From .O To 7(J Ft L.a5 )6./;S •r.
From To
From To
14. GROUT:
F1
Ft.
Depth Matorlal
From Q To do rt ettiCLEft
From To FI
15. SCREEN:
Depth
Diameter Slot Size Materiel
From To FI In
From To Ft In
From To FI In
16. SAND/GRAVEL PACK:
Depth Size Material
From To Ft
To Ft
In
In
In
From
17. REMARKS:
0
rV C)
0
LOCATION SKETCH
(Show direction and distance from al least two Stale
Roads, or other map reference points)
I DO HEREBY CERTI'
CONSTRUCTION STANpN
D IN ACCORDANCE WITH 15A NCAC 2C, WELL
OS, AND THAT A COPY OF tRTS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
SIONA GTIEOF PERSON CONSTRUCTING TIIE WELL
Submit original to Division o Water Duality, Groundwater Section within 30 days
1 OFFICE USE 0
Ouad No:
Serial No.
/6-;-a
DATE
GW.1 REV. 12/99

_'' 2 43746
WELL CONSTRUCTION RECORD WELLCONTRACTOR• A )RmA/✓ Z. 2,41L.
North Carolina - Department of Environment end Natural Resources - Division of Water Quality- Groundwater Section
1636 Mall Service Censer - Raleigh, N.C. 27699-1636-Phone [phone]
WELL CONTRACTOR CERTIFICATION 0: c?O..; 7
STATE WELL CONSTRUCTION PERMITN:
1. WELL USE (Check Appucabte Box): Residential lr'I Municipal ❑ Industrial ❑ Agricultural I] Monitoring ❑
Recovery ❑ Heat Pump Water infection ❑ Other Ell If Other, List Use:
2. WELL LOCATION: irow sketch of the location below)
Nearest Town: County.
4/11rl_.
(Road Name end �N ers. CommunllyfA�r Subdivision and Lot No.) DRILLING LOG DEPTH
3. OWNER ! ` �e/�_,{m From To
Formation Description
Address D ��/
tttAn4(SltiILoriald C a87/e/
City or Town Stale Zip Code
4. DATE DRILLED / • ' Q
5. TOTAL DEPTH
6. CUTTINGS COLLECTED YES fl NO 4
7. DOES WELL REPLACE EXISTING WELL? YES ( 1 NOI 1,4
6. STATIC WATER LEVEL Below Top of Casing: /, FT.
/ (Use -4.' II Above Top of Casing)
9. TOP OF CASING IS FT Above Land Surface'
•Top of easing terminated et/or below land surface requires a variance In accor-
dance with 1SA NCAC 2C.0116 41 O
10. YIELD (gpm)• 30 METHOD OF TEST R t 3 Z
11. WATER ZONES (depth)•
4.0
BF-the-ece E5
CT
o �tD
1 EILORINATION: Type H 7H Amounts
13. CASING:
Wall Thickness
Depth Diameter or W IghVFI. Mattedal
From To FI is .; 5
From To Ft,
From To FI.
14. GROUT:
Depth Material
From 0 To do FI rOPICEE E
From To FI
15. SCREEN:
Molhod
l "'_"`
Depth Diameter Slot Size Material
From To Ft In in
From To Ft In In
From To FI. In in
16. SAND/GRAVEL PACK:
Depth Size Malerlal
From To FI
From To FI
17, REMARKS:
If additional space is needed use back of form
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other map reference points)
1 DO HEREBY PERGERITYTHATTRIS WELL WAS CQp$ITRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTIORSIANDARDS, AND TIIATA COp`1 OFTHIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
.a OFFICE US'�-ONLY
Ouad No: �'i I
\� hI
Sedal No
nm 64) 2, 4. C. /&-/-D7
•IS AtunE OF PERSON CONSTRUCTING TIIE WELL DATE
Submll original to Division of Water Duality, Groundwater Section wllhln 30 days
_— -- j GW-I REV, 12/99
ATEr StCl� G:
rCioNAL 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 (919) 7l3-3221
WELL CONSTRUCTION RECORD WELL CONTRACTOR.
WELL CONTRACTOR CERTIFICATION f: e2 %e V 0-a.
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE (Check Arm/liable no:1: Residential 1 Municipal ❑ Industrial ❑ Agriculture/ ❑ Monitoring 0
Recovery ❑ Heat Pump Water Injection ❑ Other El If Other, Uat Use:
2. WELL LOCATION (Show aketcfl of the location below)
Nearost� T/2 t 14-.24 County ylJ.cli(-�y%
7h n O
(Road Nms!�� fyjr�rfuigtLod/�GGMhjgnsndLot Nu) DRIWNGLAG mDEPifiso
3. OWNER dl� yLQ Lam' From To Foun Desolation
Address gT..
House No.)
N .c.• „28
Oly or Town , Semis Zlp Code
4. DATE DRJLLELD Y,/Z / /
5. TOTAL DEPTH J?'5
6. CUTTINGS COLLECTED YES 0 NO®— ,.
7. DOES WEREPLACE EXISTING ELL? YES NO® ro
LL W
- -
8. STATIC WATER LEVEL Below Top of Caaing: ? n FT.
wee Y' a Above Top et Casing)9. TOP OF CASING IS � .7 FT. Above Land Surface'
'Top of casing irmSWed SW below lead swims requites ■ verlarhee In moor -
donee nth 1SA NCAC 2C .01111 .
10. YIELD (gpm): / ,! METHOD OF TEST / .e-s-c-cP
11. WATER ZONES (depth). /40 f
12. CHLORINATION: Type Amount._
13. CASING:
244240
SweetWater Well Drilling & Pump Service, Inc.
Depth /
Ftom_0-- To /0 C2 Ft
Pom To FL
From To FL
14. GROUT:
Way TldCasse
0
r_<
o
3
my
IV o'
N ad98onsl apses Is evaded use back of form
LOCATION
or WSpt'R. (Show dkecticn and distance from leaf two Saes
�7`-► .� flirt
. nRoads, or oth map rMneslo� points)
From •
trlal
From�To __ FL /`�✓rrL
I L
To Ft
15. SCREEN:
Depth Diameter Siot Size Material
From To Ft inh.
From To J FL / (n / (/
From To !/ FL // In In
h
16. SAND/GRAVEL PACK:
Depth Size Materiel
From To FL
F
17.
No:
CERTIFY THAT THIS
OFFlCE USE ONLY
GPCJ'.n':i .. SN
AS.i
n
dwy *PI
THE WELL
WOW to Division NW,* Quality, OranMgvr Section within 90 days
LAyte
aw., REV_ 12/es
mobil_

North Carolina - Department of Environment end Natural Resources - Division of Water Clua9ty - Groundwater Seaton ? 4-0 0_5 6
1636 Mail Service Canter - Raleigh, N.C. 27699-1636-Phone [phone]-; - - ..
WELL CONSTRUCTION RECORD wELI CONTRACTOR• r s� odic)
WELL CONTRACTARCERTI ATION s: � 44.10
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE {clack Applicable Box): Residential ( Municipal ❑ Industrial ILI Agricultural 0 Monitoring 0
Recovery 0 Heat Pump Water Injection Other 0 If Otter, List Use:
2. WELL LOCATION: (Show sketch of the location below) //
Nearest Town: SPtucc ?Ott County: Y4.;c ef/
ndaid /
(Road Name en. ity, or Subdivision and tat No.) DRILLING LOG DEPTH
3. OWNER Reset
Address
(%ion Savt
Fro,'rt To Formation Description
> / y1 Odf2 .de,SoA,
(Street or Route No.)
or Town Slate Zip Cade
4. DATEGRILLED 10-o\-ot t{ (DOS
5. TOTAL DEPTH GC./5
6. CUTTINGS COLLECTED YES CRT NOD
7. DOES WELL REPLACE EXISTING WELL? YES rj NO T
8. STATIC WATER LEVEL Below Top of Casing: 'to 'FT.
(Use'+' 0 Above Top al Casing)
9. TOP OF CASING IS FT. Above Land Surface•
'Top of easing terndnated at/or below land surface requires a variance In accor-
dance with 1SA NCAC 2C.0118
10. YIELD (gpm): .l_ METHOD OF TEST Ift.
11. WATER ZONES (depth)-
•
12. CHLORINATION: Type p i Li S Amount O
13. CASING:
If additional space Is needed use back of form
Wall Thickness LOCATION SKETCH
Depth D pier or weloht/R. Male (Show direction and distance from at least two State
From 'f / To —i— Ft. — — '� a' / -�' G Roads, or other map reference points)
From To Ft.
From To Ft _...
14. GROUT:
Fromd f
i, Dep
th*,
- Ft LI'2Yhe./lMaterial � U. 1-�OfefL
From To F1
15. SCREEN:
Depth Diameter Slot Size Material
From . To Ft In In.
From To F1. In. In
From To FL In In
16. SAND/GRAVEL PACK
Depth Size Material
From To Ft
From To FL
17. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUC I tU IN ACCORDANCE WITH 15A NCAC 2C. WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
FOR OFFICE US
Quad No:
INLAY
NATURE OF PERSON STRUCTING THE WELL DATE
to Division of Water Quality. Gioundwater Section within 30 days
OW-1 REV. 12/99

•
North Carolina Department of Envi annent and Natural- Resewees - Division of Water Oudty - GroundweterSedbn 2 . R 0 0 5 9 -
163s Mall Service Carder - Raleigh, N.C. 27699-1a3B-Phahe (919) 73;f 322i".'..
WELL CONSTRUCTION RECORD WELL cam -rpm -row
WELL CONTRACTARCERTIFICATION /: 02 c /p
STATE WELL CONSTRUCTION PERMITI<:
1. WELL USE (crack Applicable Bosh- Residential LLB Municipal El 0 Agdculturai 0 MonitoringEl
El Heat Pump Water Injection ❑ Other El If Other, List Use:
2. WELL LOCATION: (Shaw ske!cti of the location below)
Nearest Town: [SG Ph 5 U / County:
la ce%
(Road Nam. nd41%uta , or Subdivision and tat No.) DRILLING LOG DEPTH
3. OWNER lea 65; t essC.14I1tt From To Formation Desaiptlon
Address 79- / DU42 tefzitti
(suet or Route No.)
City or Tov.n Sate 2Ip Code 31 ,fI')x A.1L Li-
4. DATE DRILLED %to °R '°\
5. TOTAL DEPTH f1S t��r
6. CUTTINGS COLLECTED YES ld NO El
7. DOES WELL REPLACE EXISTING WELL? YES [i NOM
8. STATIC WATER LEVEL Below Top of Casing: SO 'FT.
(Use': 2 Above Top of Casing)
9. TOP OF CASING IS_L_ 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)- 15METHOD OF TEST Me
11. WATER ZONES (deplh)-
12. CHLORINATION: Type
13. CASING:
pats Amount S
If additional space Is needed use back of form
Walt Thickness LOCATION SKETCH
Depth cIam fen or Weight/R. Mate (Show direction and distance from at least two State
From 4- l To , Ft. I p '� i-� �G Roads, or other map reference points)
From To F1.
From - To Ft.
14. GROUT:
Depth Material Melhod
From d To Ft the)?t tierj O tL y 2 (1,
From To F1
15. SCREEN:
Depth Diameter Slot Size .Material
From To Ft In. in
From To Ft. In. In
From To Ft. In. In
16. SAND/GRAVELPACit 01 m7o
Depth Size Material •
N c,
From To FL - 3
Z
From To FL
17. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C. WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
m_ d�..".U//J /O /c D/
FOR OFFICE USE }N��%Y
Quad No:
Serial No.
>o-
m�
MC am
Submit o
TUBE OF PERSON CO�THE WELL DATE
d Water Quality. Groundwater Section within 30 days
GW-1 REV. 12/99
Groundwater Section
Asheville Regional Office

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Marl Service Center - Raleigh. N.C. 27699-1636-Phone [phone]
WELL CONSTRUCTION RECORD
t O1
WELL. CONTRACTOR SweetWater Well Drilling & Pump Service, Inc.
WELL CONTRACTOR CERTIFICATION e: t2 t 97 2% a tie
STATE WELL CONSTRUCTION PERMIT,:
1. WELL USE (Check Appucade Boa): ReeldenttalLgi Municipal 0 Industrial 0 Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other p If Other, List Use:
2. WELL LOCATIOy; (Showsketch of ation below)
Nearest Town:
K "��
3. OWNE
(lbed R Neme aotl1/�/ersa la an"
M ) DRILLING LOG
Nyl�From To
Code
4. DATE DRILLED
5. TOTAL DEPTH
6. CUTTINGS COLLECTED YES NO2 2�
7. DOES WELL REPLACE EXISTING WELL? YES CZ NOE
8. STATIC WATER LEVEL Below Top of Casing: FT.
(Uss : a Above Top alCasing)
9. TOP OF CASING IS
S FT. Above Land Surface
'Toe Mousing trNreaed abbe below lend sedan media a veleta, it ascot -
dance with 15A NCAC 2C,�011•
10. YIELD (gpm): .2METHOD OF TEST �Gyyt�
11. WATER ZONES (depth).
12. CHLORINATION: Type /Alb
13. CASING:
DEPTH
Fanaltan Description
rn
• r7r
- 4
A] o
Amount adadonS space b needed use back of torn =
we a T1i laws LOCATION SKETCH
Depthor ow (Shdirection and distance from at teat two state
From D To w D F2 11��I c.. Roede, or other map referents points)
From To FL
From To FL
14. GROUT:
Depth, Meteri,l W. r
From _O _ To SZI..�FL I A /� i�t
From _._ To Ft
15. SCREEN:
Depth Diameter Siet Size Material
From To Ft In, in
From / To / Ft. 1 In. 7/ �
Fawn/ To ! FL 6 In.
16. SAND/GRAVEL PACK:
Depth Size Material
From To FL
From ( To FL
17. REMARKS:
IDO
r THAT TINS WELL WAS, TRUCTED IN ACCORDANCE WITH 13A NCAC 2C, WELL
AND THAT ft COPY D HAS DED TO THE WELL OWNER.
ft NATINiE OF THE WELL DATE
_.. Suimlk edged b Division or Water Dustily, Gramdwale Section within 30 days
nw.t REV_ tee*

4. DATE DRILLED
5. TOTAL DEPTH
6. CUTTINGS COLLECTED YES n NO.
7. DOES WELL REPLACE EXISTING WELL? YES I I NO
8. STATIC WATER LEVEL Below Top of Casing: MO 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 2C .0118
10. YIELD (gpm) METHOD OF TEST MAI
. 11. WATER ZONES (depth) r?e)l/'iz
12. CHLORINATION: Type Amount iitir
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#:
243417
`' luet( Pricbhy
1. WELL USE (Check Applicable Box): Residential ❑ Municipal ❑ Industrial
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATION: Show s�kfe h of the location below)
Nearest Town: nit County
60-7a.
(Road, Community. or Suu thy) ''on and Lot No.)
3. OWNER ra-..-( ` ?ff.
e' — ''//�,>- �+
ADDRESS G.o^F*t l f. (t ftp/w /Yi'9K/ ?j
24 (Street or Route No.) 0
Cieat i4)
ty or Town , State Zip Code
.CQf
Wall Thickness
Depth Diameter or Weight/Ft. Material
From To Ft
From 0 To —Ile— Ft.
From To Ft
14. GROUT:
From
From Q
15. SCREEN:
From
From
From
16. SAND/G''�i
From �r
From
17. REMARK.:
I DO HER:
CONSTRU
DEPTH
From To
Agricultural ❑ Monitoring 0
0 - go
DRILLING LOG
Formation Description
O
f =m
Ql
ern
m
w r* a
2/o U�
Depth Material Method
To Ft
To r Ft " - /ITC Co,
Depth
To
To
Diameter Slot Size
Ft in in
Ft in in
in
ll V lE
epth
To
To
Size
Ft-np•,-'
Ft.
Material
Material
If additional space is needed use back 64omto
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other map reference points) 1n
GPr��Ut:C'+VnIER SECTION
Y CERTTHAIA-f,.9YthS
IF.ti'tAS CO
t ION STANDARDS, AND THAT A C�,-Y
FOR OFFICE USE ONLY
Quad No•
Serial No:
RUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
F THIS R ORDEN PROVIDED TO THE WELL OWNER.
SIGNATURE
Submit origi
CONTRACTOR OR AGENT
o 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:
DRILLER REGISTRATION #: l 61)
STATE WELL CONSTRUCTION PERMIT#:
or 1t-
21
F
4c aJb.-4
1. WELL USE (CheckApplicable Box): Residential lam`' Municipal E Industrial ❑ Agricultural E Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATION:�(Show sketch of the location below)
M
Nearest Town: V'' 1u VI u Z County.
ttlit
(Road, Community, or Su division and Lot No.) DEPTH DRILLING LOG
3. OWNER 122 f 1(2.4-4-41.-rfnOh From To Formation Description
ADDRESS Q /%4
(Street or Route No.)
VIAtC(A L 2 {'i
City or Town State
4. DATE DRILLED Q'//- o/
5. TOTAL DEPTH / l29
6. CUTTINGS COLLECTED YES NO�f-�
7. DOES WELL REPLACE EXISTING WELL? YES I I NO _Lk°
8. STATIC WATER LEVEL Below Top of Casing: 5-0 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): 90 METHOD OF TEST /41 K-
. 11. WATER ZONES (depth) yn 1 igin /,rj0
12. CHLORINATION: Type. —Amount
13. CASING:
Yam,
Qr73
`%C AS -
Zip Code
Xeck
0
I
gr
1V —
If additional space is needed use back of form
Wall Thickness LOCATION SKETCH
Depth Diameter or Weight/Ft. Material (Shaw direction and distance from at least two State
From To Ft T
Roads, or other map reference points)
From p To Ft.
From To Ft t;-/ /G tc. -''
14. GROUT: � (�
o ii
Depth Material Method
From To s��„..,, Ft
From 1)_ To __ Ft y/
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. REMARE(&:-,--
I DO HE I BY, - " PHIS WELL CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTR4tT{QN STANDARDS, AND THA • 1 OPy O'= THIS RECORD HA, B EN PROVIDED TO THE WELL OWNER.
SIGNATUR
Submit odg
TRACTOR OR AGENT
lion of Water Quality and copy to well owner.
GW-1 REV. 1/98
DATE

A OFFICE USE
Quad No:
North Carolina - Department of Environment and Natural Resources - Division of Water Quality • Groundwater Section '- 9
1638 Mall Service Center • Raleigh, N.C. 27699.1638-Phone [phone] y�_'' 1 0 ) ( ✓7 15
WELL CONSTRUCTION RECORD WELL CONTRACTOR. J/ RmAN Z. 2A-«.
WELL CONTRACTOR CERTIFICATION #: o?1)3
STATE WELL CONSTRUCTION PERMIT#:
1 WELL USE (Check Applicable Bosh Residentlal ✓L - Municipal El Industrial ❑
Recovery ❑ Heal Pump Water Injection ❑ Other ❑ it Other, List Use:
2. WELL LOCATION> Iiow skelct>_ojJ I on below)
Nearest Town: 2 County:
(Road Name and Numbers, ommunlly. or Subd'l^vls�l and Lot y/o.)
3. OWNER .yytp_ )VU2 C}
Address
s,t, rl I eo�a � w1 Ne.)� c a913s
City or Town Stale Zip Code
4. TOTADRILLED 9•�B.OI
S. TOTAL DEPTH
6. CUTTINGS COLI.ECTED YES (l NO14
7. DOES WELL REPLACE EXISTING WELL? YES n NOW(
8. STATIC WATER LEVEL Below Top of Casing: al.. 5 FT.
(Use •." II Above Top of Casing)
9. TOP OF CASING IS 1 FT Above Land Surface'
•Top of using terminated etlor below land surface requires a variance In accor-
dance with 15A NCAC 2C 01 8
10. YIELD (gpm)• METHOD OF TEST R.
Agricultural ❑ Monitoring ❑
DRILLING LOG
From To
11. WATER ZONES (depth). r I
1 HLORINATION: Type Tf 77/ Amount
13. BASING:
DEPTH
Formation Description
ii)•R f
B eock
-a
r-n
n Cr
If additional space Is needed use back of form
Wall Thickness
Depth Diameter or WpIghVVFt. ;1M�aalle�dall
From 0 To �� Fl." •a5 .a1t,/?S P.SDrC
From To FI.
From To FI
14. GROUT:
Frorn
From
15. SCREEN:
Depth
To
To
To
Depth Material
D To do FI (JONCP—E E
To FI
Mothod
.�Due,l`�
Diameter Slot Size Materiel
From Ft In In
From FI. In In
From FI In In
16. SAND/GRAVEL PACK:
Depth Size Material
From To Ft
From To Ft
17. REMARKS:
LOCATION SKETCH
(Show direction end distance from al least Iwo State
Roads, or other map reference points)
.29(1.
I D0 HEREBY CERTIFY T(1AT THIS WELL WAS CONS" RAU.
CONSTRUCTION Stii\Nd$hS,111•10-THAT A-GOPY-& If HI
iUA n eri z,
SION
Submit original to dlvlsion
N�GR
REGION .
ED IN ACCORDANCE WITH 15A NCAC 2C, WELL
RECORD HAS BEEN PROVIDED TO THE WELL OWNER
OF PERSON CONSTRUCTING TIIE WELL DATE
!Water Duality. Groundwater Section within 30 days
ow-1 nEv. 12/99

North Carolina - Deparimont of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mall Service Censer - Raleigh, N.C. 27699-1636-Phone [phone]
WELL CONSTRUCTION RECORD WELLCONTRACTOR•
243742
N“m>9N Z. 3,41<.
WELL CONTRACTOR CERTIFICATION N: 01O.. 7
STATE WELL CONSTRUCTION PERMITN:
1. WELL USE (Check Applicable Box): Residentlal IA Municipal ❑ Industrial ❑
Recovery ❑ Heat Pump Water Injection ❑ Other If Other, List Use:
2. WELL LOCATION;jShowsketch•ol'the locationbelow)
Nearest Town: (/ h ttS71t County'
(noad Name end umbers, Communlly. or Subdivision and Lot No.)
3. OWNER 41a(dv1(Ind. n tnel
Address
3
Urleule o.
A* 0 .
UieAArWWe" - 9+413
City or Town Stale Zip Code
4. DATE DRILLED O
5. TOTAL DEPTH
6. CUTTINGS COLLECTED YES n NO[-
7. DOES WELL REPLACE EXISTING WELL? YES n NOW(
8. STATIC WATER LEVEL Below Top of Casing: �( FT.
(Use Y- If Above Top ol Casing)
9. TOP OF CASING IS / FT Above Land Surface'
'Top of using terminated uUor below land surface require, a variance In accor-
dance with 15A NCAC 2C,4118
10. YIELD (gpm)• opt METHOD OF TEST R. 5
11. WATER ZONES (depth)•
1' 'HLORINATION: Type H TH Amount /b if S
1;. „ASING:
Agricultural ❑ Monitoring ❑
DRILLING LOG
From To
Wall Thickness
DEPTH
Formation Descdpllon
0
m
s�
C) ern
0c
3> 0
w2
Ca m-).r
rs)
0
11 additional space Is needed use back of form
Depth Diameter or Weight/FL. Material
From 10 To ° FI li 5 aide/.7g Pu[-jg
From To Ft
From To Ft
14. GROUT:
Depth Material Method -
From b To AO Pt 1�ONCP�•iETj1n`"r'rpP`_'E`.i%.
From To FI
15. SCREEN:
Depth Diameter Slot Size
Frorn To FI In
From To Ft. In
From To Ft In
16. SAND/GRAVEL PACK:
Depth Size
From To FI
From To FI
17, REMARKS:
Material
In
In
In
Material
LOCATION SKETCH
(Show direction and distance from al least Iwo State
Roads, or other map reference points)
_e
ito
tAl'o
17C
I DO HEREBY
CONSTRUCT'
T OFFICE U
Wad No:
Serial No
FUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
HIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
Rn
IRE OF PERSON CONSTRUCTING TIIE WELL
Ion ol Water Quality, Groundwater Section within 30 days
DATE
GW-I nEV. 12/99

A 0) r77 : I
ii
North Carolina - Department of Environment and Natural Resources - Division of Water Quetlly - Groundwater Section
1638 Mall Service Censer - Raleigh, N.C. 27699.1638-Phone [phone](//�' p -y�1
WELL CONSTRUCTION RECORD WELL CONTRACTOR• /T d ^ 1Yl AN Z . �7 JA ZY.
WELL CONTRACTOR CERTIFICATION 0: o?O.S7
STATE WELL CONSTRUCTION PERMITN:
1. WELL USE (check Applicable Boa): Residential ✓� Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heal Pump Water injection [1 Other El If Other, List Use:
2. WELL LOCATION: SIIow sketch of the location below)
Nearest Town: L1i S iaj County Cunt
(Road (Road Name ard, Numbers. Community, or Subdivision and Lot No.) DRILLING LOG
3. OWNER IOU tryyl'„tc^,e)/�0_, ,' , rFrom To
Address 2, °I l 1 �2
``6'LV i ( (r YJ�Ireot or Houle" d-a 1 I 4City or Town Stale Zip Code
4. DATE DRILLED "a' _p
5. TOTAL DEPTH 0 n
6. CUTTINGS COLLECTED YES n NOI4]
7. DOES WELL REPLACE EXISTING WELL? YES 1 I NOI VI
8. STATIC WATER LEVEL Below Top of Casing: -? T FT.
(Use'+ II Above Top of Casing)
9. TOP OF CASING IS 1 FT. Above Land Surface'
'Top of easing terminated of or below land surface requires a variance In accor-
dance with 15A NCAC 2C .0118
10. YIELD (gpm): .--- METHOD OF TEST
11. WATER ZONES (depth):
DEPTH
Formation Descdpllon
0 -4 n JB RQc k
c
O $
P
e 1 :a
rn
n Z`I
O
Cl
>0
t mr
cn _.
GJ 0
Ot o
1' 'HLORINATION: Type _kill_ Amount .L.RibilLS If additional space is needed use back of lorm
1o..;ASING:
Wall Thickness
Depth n Diameter or W lgh,V_FI. ;1Material
From �To 3 1 Ft. it •a5 �11.l;5 PvGSD12
From To FI.
From To FI.
14. GROUT:
Depth /1 Material
From b To do FI I,2NCPt4E
From To FI
15. SCREEN:
Molhod
Depth Diameter Slot Size Material
Frorn To FI 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
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other map reference points)
AL" Attk
r
17. REMARKS:
I D0 HEREBY C Y THAT-THISSW$ILL`WA'CO�J ,
CONSTRUCTIO I CJ bARbSSibuin1iinGoPyi bI?
.1OFFICE US
Quad No:
Serial No.
I4JCTED IN ACCORDANCE WITH 15A NCAC 2C. WELL
S RECORD I lAS BEEN PROVIDED TO THE WELL OWNER.
r,lA) z. R 9- .,.7Ol
ID01/1 ,TIRE OF PERSON CONSTRUCTING TIIE WELL DATE
Submit original to Division of Water Duality, Groundwater Section within 30 days
GW.1 nE V. 12/99

1A. GROUT:
Depth Material
Motlrod ,
Frorn n To it Ft evil t�f E ,prZue,.�.
From To FI
15. SCREEN:
Depth Diameter Siol Size Material
From To Ft In In
From To FI In In
From To FI In. In
16. SAND/GRAVEL PACK:
Depth Size Material
From To FI
From To
Ft
North Carolina - Department of Environment and Natural Resources - Division of Water Duality - Groundwater Section
1636 Mall Service Center - Raleigh, N.C. 27699.163E-Phone [phone]
WELL CONSTRUCTION RECORD WELLCONTRACTOR•
243683
RmAiV
WELL CONTRACTOR CERTIFICATION It:
STATE WELL CONSTRUCTION PERMIT.:
1. WELL USE (Check Applicable Box): Residentialia Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Rocovery ❑ final Pump Water Injection ❑ Other If Other, List Use:
2. WELL LOCATION: (Sint sketch of
the
location below)
.0/Lac 2,s.cw JCl county.
Nearest Town:
(Road Name and Numb Community, or S4bdjvII Ion and Lot No.)
3. OWNER A4? /�i/-r-C.. it—ei✓_
Address .0 ( Q r0, c r!
%% Stree or lloulo�p'o.) ( L.�
1�/(`i/4'LS7.r..ctte 77 . fO'7%'/
City or Town Slate Zlp Code
5. DATE DEPTH i •U 1
5. TOTAL DEPTH FT S
6. CUTTINGS COLLECTED YES (l NO[4
7. DOES WELL REPLACE EXISTING WELL? YES n NOW1
8. STATIC WATER LEVEL Below Top of Casing: p FT,
/ (Use •.• If Above Top of Casing)
9. TOP OF CASING IS 1 FT Above Land Surface'
DEPTH
Formation Descdptlon
D -"D l�a'Rf
4'O - J A5i
o _-
•Top of casing terminated at/or below land surface requires a variance In sccor• is it
dance wllh 15A NCAC 2C.0118 0 —p —
10. YIELD (gpm)• 30 METHOD OF TEST /\r 3 = x c_
11. WATER ZONES (depth): v
CJ m
u
IV -r
tJ 'HLORINATION: Type H 7H Amount rQbS if additional space Is needed use back of form Z
13. CASING:
Wall Thickness LOCATION SKETCH
Depth / Diameter or WaluhVFt, Material O (Show direction and distance from al least Iwo Slate
From 0 To -r v FI Ie • a 5 nail rl;s i . Roods, or other map reference points)
From To FI
From To FI
nC
234014,5 ?tate
17. REMARKS:
I DO HERE F1Y�iATTN( VLLA+ STRUCTED IN AOCORDANCE WITH 15A NCAC 2C, WELL
CONSTRU TJOry $t�NQARBS ANB T1L1 r .11 THIS RECORD F AS BEEN PROVIDED TO THE WELL OWNER.
4.
811� U OF ERS CONSTRV NG THE WELL DATEl O' -6/
Submit ogloat Ic Division of Water Duality. Groundwater Section wllitln 30 days
[Cl IG
)ROFFIC: S'IONLY
Cued No: I
iM
Serial No.
GW-I REV. 12/99
OFP.CE

North Carolina • Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1638 Mall Service Center - Raleigh, N.C. 27699.1638-Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR: )Ye RmAN Z . 3A-Z(
WELL CONTRACTOR CERTIFICATION N: o?D
STATE WELL CONSTRUCTION PERMITN:
243634
1. WELL USE (Check Applicable Box): Residential[ Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water injection ❑ Other El If Other, Lisl Use:
2. WELL LOCATION: (3J4pw.skelcli of the location below)
Nearest Town: �i �(,(f,LJ%i�.L?J County
(Road Name ad Numbers, ommunllyr Subdlvlsl jnd lot No.)
3. OWNER A/44/I7/!h
Address
MI
Ca.('
o moue `o. e
Clly or Town Slate
4. DATE DRILLED
5. TOTAL DEPTH
6. CUTTINGS COLLECTED YES (-] NO[4
NO�
8. STATIC WATER LEVEL Below Top of Casing:
7. DOES WELL REPLACE EXISTING WELL? YES l�j_FT.
(Use'4'1i Above Top of Casing)
9. TOP OF CASING IS 1 FT Above Land Surface'
'Top of casing terminated et/or below land surface requires a variance In accor-
dance with 15A NCAC 2C .0I18
10. YIELD (gpm):_ METHOD OF TEST r ,
11. WATER ZONES (depth)-
%
V
DRILLING LOG DEPTH
Formation Description
-lo3
6 • •ADD
Zip Code
' 'HLORINATION: Type H 7H Amount /a 7
13. CASING:
P R}
B&cteock
0
o
rrt n
C7 :?
_-
O c;
�o
r*1
W
• :'r
If additional space Is needed use back of form
Wall Thickness LOCATION SKETCH
Depth Diameter or Weight/FL ;� 'M'aatte`dall (Show direction and distance from et leas! Iwo State
From 0 To Ai F1 G • ;5 0114 r/%S [y g. Ronds, or other map reference points)
From To It
From To Ft
14. GROUT:
Depth Material Method
.�
From To vZ� Ft C'nNC,P.Ef E n y,
From To Ft
15. SCREEN:
Depth Diameter Slot Size Malarial
Frorn To F1 In In
From To Ft In In
From To Fl In In
16. SAND/GRAVEL PACK:
Depth Size Malerlal
From To Ft
From To Ft
17. REMARK _
I� L J rl I'
1 DO HER Ph' ERTWY THAT THIS WELL v44
CONSTRI 9 Ip, STANDARDS, AND THAT 41
USE ONLY
in OFFI
Ouad No:
Sedal No.
CAAktuf--
cCo.
NSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
oa'> >h1lh/ A- %sl1. !_. cj,- 3-Dl
SIGNATURE OF PERSON CONSTRUCTING TIIE WELL DATE
5U11ii14 odgina to Division of Wider Neely, Groundwater Section within 30 days
,. GW-I REV. 12/99

North Carolina • Department of Envlronmenl and Nalural Resources - Division of Water Duality - Groundwater Secllon s_• 4 J G 9 0
1636 Mall Service Center • Raleigh, N.C. 27699-1636-Phone [phone] �//_'
WELL CONSTRUCTION RECORD WELL CONTRACTOR: /►N RMAN L • 2A•LL
WELL CONTRACTOR CERTIFICATION P: c?O.7
STATE WELL CONSTRUCTION PERMITP:
1. WELL USE (Check Applicable Box): Residential Ifki Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring El
Recovery ❑ Heat Pump Water Injection 0 Other El If Other, List Use:
2. WELL LOCATION; ow sketch he location below)
Nearest Town: aP A7• County'
eit
(Road Name and f�fmbernily, or ubdlvlslon and lot No.) DRILLING LOG DEPTH
3. OWNER T/l/ S_.12.— From To Fonnallon Description
Address A V �3 Oa. I`
4 C.(_/rinvW Ireol ort aul ;.-7 r,a ttD) - ya 111•jt+—
Clly or Town Stale / zip Code Lip 20 D B F—c(itgr k_
4. DATE DRILLED • O f-D / —
5. TOTAL DEPTH a 0
6. CUTTINGS COLLECTED YES TI NOF4 o c? .L..,7. DOES WELL REPLACE EXISTING WELL? YES NOW( n
8. STATIC WATER LEVEL Below Top of Casing: ,S FT. -^1
(Use'.' II Above Top or Casing) v''
O
9. TOP OF CASING IS i Ft. Above Land Surface' �"
•Top of casing terminated at or below lend surface requires a variance In eccor- rnC
dente with ISA NCAC 2C.011e r�
10. YIELD (gpm): ( METHOD OF TEST R: 3 w r""
11. WATER ZONES (depth) cN.a o
z
•HLORINATION: Type 1 7N Amount ,S14d S If additional space Is needed use back of form
13. CASING:
Wall Thickness LOCATION SKETCH
Depth Diameter or WpIghVFI. Material (Show direction and distance from at least Iwo State
From 0 To Et it • a S a)4 rh5 P.L -,5DK, Roads, or other map reference points)
From To Ft
From To Ft
14. GROUT: to &CA)
Depth Material Motl�lrrPy�
Frorn . ToDe th FI In�NfJ •iE _joati ...
From To Ft
15. SCREEN:
Doplh Diameter Stol Slz© Material
Frorn To Ft In In.
From To Ft In In
From To Ft. In In
16. SANG/GRAVEL PACK:
Depth Size Material
To FI
From
From
17. REMARKS:
Ll
F
I DO HEREBY 'tit FY THAT THIS WELL WAS CON -lUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
CONSTRUCTIeh STANDARDS, AND 'RIAU C0.1 THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
/R OFFICE E ONLY / Dfil/" L. 4
Ouad No: .. I(j:.i SIGNATURE OF PERSON CONSTRUCTING TIIE WELL DATE
SubtkOAblhal Io D vision of Water Quality. Groundwater Section within 30 days
GW.1 nEV. 12/99

243630
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• Joe M. Ferguson
WELL CONTRACTOR CERTIFICATION #: 2026
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE (Check Applicable Box): Residential❑ Municipal ❑' Industrial ❑ Agricultural ❑
Recovery ❑ Heat Pump Water Injection ❑ Other If Other, List Use:
j� _Campground
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: Burnsville County:
Yancey
(Road Name and Numbers, Community, or Subdivision and Lot No.)
3. OWNER National Forests in N.C.
Address 160—A Zillicoa Street
(Street or Route No.)
Asheville, NC 28802
City or Town State Zip Code
4. DATE DRILLED 8-08-01
5. TOTAL DEPTH 400
6. CUTTINGS COLLECTED YES n NOn
7. DOES WELL REPLACE EXISTING WELL? YES rI NOn 92-1 90
8. STATIC WATER LEVEL Below Top of Casing: 210 FT. 190-195
Monitoring ❑
DRILLING LOG DEPTH
From To Formation Description
0-32 Soft Sandy Soil
32-65
65
68-78
78-86
86-92
(Use Y if Above Top of Casing)
9. TOP OF CASING IS 2 FT. Above Land Surface
•Top of casing terminated at/or below land surface requires a variance In accor-
dance with 1SA NCAC 2C .0118
10. YIELD (gpm) 30 METHOD OF TEST
I. WATER ZONES (depth)• 400
195
250
270-271
271-400
12. CHLORINATION: Type
13. CASING:
From
From
From
14. GROUT:
Depth
0 To 92
Rig
HTH Amount 40 Tabs
Diameter
Ft 6.25
To Ft
To Ft
Wall Thickness
or Weight/Ft.
216.125
Sand Rock
Flint Chunks/Surface
Blue Bedrock Water
Red Sand Rock(Very Soft)
Blue Bedrock (CASE @92)
Blue
White
Blue & White(Fairly Hard
Blue (Soften Up)
Crevice (WATER— 25GPM)
Blue Granite
Check (30GPM)
If additional space is needed use back of form
LOCATION SKETCH
Material (Show direction and distance from at least two State
PVC-SDR
Depth Material Method
To 92
From 0 Ft cement pressure
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 —�Q-- H If
17. REMARK( `�—_I-
I DO HERE '4'rC4ITIFY THAT THIS WELL WA IC}(-
CONSTRU9TiIpIiJ,SIITANOARDS.ANQt VAT Aitj
✓ ?
FOR OFFICE1USE ONLY
Quad No: -
Roads, or other map reference points)
Carolina Hemlock Camp
Yancey County, North
STRUCTED IN ACCORDANCE WITH 1SA NCAC 2C, WELL
OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
SIdNATURE OF PERSON CONSTRUCTING THE WELL
Submit original tb Division of Water Quality, Groundwater Section within 30 days
— le . /
DATE
Serial No.
GW-1 REV. 12/99

North Carolina - Department of Environment and Natural Resources - Division of Water aurally - Groundwater Section
1636 Mall Service Censer - Raleigh, N.C. 27699-1636-Phone [phone]
243'704
WELL CONSTRUCTION RECORD WELL CONTRACTOR. lI D Rm4N L -A-LL.
WELL CONTRACTOR CERTIFICATION 0:
STATE WELL CONSTRUCTION PERMIT*:
1. WELL USE (Check Applicable Box): Residential Er Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATION: (S w sketch of the location below)
Nearest Town: .[,Lh4l S,1l-(J 4J i County
City or Town Stale Zip Code
4. DATE DRILLED N •01-c I c
5. TOTAL DEPTH 3 0 0 O o
6. CUTTINGS COLLECTED YES In NO[4 n
7. DOES WELL REPLACE EXISTING WELL? YES a NOFS r�r1 o�
8. STATIC WATER LEVEL Below Top of Casing: FT. n Z^
—
(Use '+' if Above Top of Casing) 0 o--Isr-1
9. TOP OF CASING IS FT. Above Land Surface' -1�
'Top of casing terminated seer below land surface requires a variance In actor- �O rnc'
1 err,
dance with 15A NCAC 2C.0,1a W �a
L7
Cr-
10. YIELD (gpm): " METHOD OF TEST R � -i
11. WATER ZONES (depth)• N
cJ1 0
z
NoLot DRILLING LOG DEPTH
3. OWNER ah�. �"��.rL�
From To Formation Description
Address _ ie
( �eol ocfl/`'
�JAAJfl C 8 - 3�7 C ag1/� 7 & - 00 C)R_Qck
0-7R n,•Rf
;HLORINATION: Type T7 7H Amount —f`.i"r If additional space Is needed use back of form
13. CASING:
Wall Thickness LOCATION SKETCH
Depth �/ O Diameter or WeighVFI. MaleSal (Show direction and distance from al least Iwo State
From r7 To ` a Ft L •+2 5 J)` r/)S u Roads, or other map reference points)
From To FI.
From To Fl.
14. GROUT:
Depth Material Method
From ()_ To A Ft Otu41:.P.r<UE
From To Ft
15. SCREEN:
Depth Diameter Slot Size Material
Frorn To Ft In In
From To Ft In In
From To Ft In In
16. SAND/GRAVEL PACK:
Depth Size Material
From To FI
From To Ft
17. REMARKS:
I DO HEREBY CEF
CONSTRUCTION
JR OFFICE USE
Ouad No:
Serial No.
F{�T rtiS LR TAO
WL,$ C �
tc
q H
"�N N
L007 str
Submit original l
Divl to
TED IN ACCORDANCE WITH 15A NCAC 2C, WELL
5 RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
E OF PERSON CONSTRUCTING TIIE WELL DATE
i of Water Ouality, Groundwater Section within 30 days
. OUNDWATER E:r'T'i-"
1,S-1LVILLE REGION '
GW.I REV. 12/99

1
North Carolina • Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mall Service Center - Raleigh, N.C. 27699-1636-Phone [phone]//_' /
WELL CONSTRUCTION RECORD WELL CONTRACTOR: /►D�Q/�AN CL. 2t¢1(,
WELL CONTRACTOR CERTIFICATION 0: ,7O-3 7
STATE WELL CONSTRUCTION PERMIT0:
1. WELL USE (Check Applicable Sox): Residential U
Recovery ❑ Heal Pump Water injection
Municipal ❑ Industrial ❑ Agricultural ❑
Oilier ❑ If Other, List Use:
2. WELL LOCATION: tow sketch Pie location below)
Nearest Town: Couny.
piped Name and Nyebers. Comm' unllj� or Subdlvlslon and Lot No.)
3. OWNER A(/1[X WQY�
Address
F)O-k.Btb
7Slreel or !touts No.)
City or Town Slate zip Code
4. DATE DRILLED g-Da-01
5. TOTAL DEPTH 3 aD
6. CUTTINGS COLLECTED YES n NO[ J
7. DOES WELL REPLACE EXISTING WELL? YES tl NOFS
8. STATIC WATER LEVEL Below Top of Casing: 4f5 FT.
(Use'•' It Above Top of Casing)
9. TOP OF CASING IS 1 FT. Above Land Surface'
•Top of casing terminated eVor below land surface require, a variance in accor-
dance with 15A NCAC 2C.9,46
10. YIELD (gpm)' ?f METHOD OF TEST ill fi
11. WATER ZONES (depth)'
243'702
Monitoring ❑
DRILLING LOG DEPTH
From To Formation Oescdpllon
;HLORINATION: Type ri T 1 Amount
13. CASING:
Depth �J ADiameter
From To ` Ft b • 5
From To Ft.
From To Ft.
14. GROUT:
Depth Material MotlL -
_>Z From _ To ao it C'vNCPxf t �ll
From To Ft
15. SCREEN:
Wall Thickness
or W Ighl/FI. Maledal
Brits Pu• C
Depth Diameter Slot Size Material
Frorn To Ft In In
From To FI In In
From To Ft In. In
16. SAND/GRAVEL PACK:
Depth Size Material
From To FI
From To Ft
17. REMARKS:
B re k
If additional space Is needed use back of form
LOCATION SKETCH
(Show direction and distance from al least two State
Roads, or other map reference points)
Awyc y4-1,14
I DO HEREBY CONSTRUCTION S11A NI LA
JR OFFICE USE ONL`�
Ouad No:
Serial No.
L �HG SIGN
Submit original to DI Islo
0'.r.»TER SECTION
REGIONAL OFFL+
ED IN ACCORDANCE WITH 15A NCAC 2C, WELL
RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
OF PERSON CONSTRUCTING THE WELL DATE
of Water Duality. Groundwater Section within 30 days
GW-I REV. 12/99

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mail Service Center • Raleigh. N.C. 27699-1636-Phone [phone] �(((/���,
WELL CONSTRUCTION RECORD WELL CONTRACTOR�����//- `�f/ // T7 e- •
WELL CONTRACTOR CERTIFICATION #: 4/ S/ 6
STATE WELL CONSTRUCTION PERMIT#: T7
1. WELL USE (Check Applicable Box): Residential El Municipal YJ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection El Other ❑ 11 Other, List Use:
2. WELL LOCATIj' l: (Show sketch of the location below)
Nearest Town: P.O.A%.'S It t 1.1 Ps_ County.
Yihueri
(Road Name and Numbers. Communityr -SuLpdivision and Lot No.)
3. OWNER fint, ciNlQ sue'(_ c
Address p K 7 (�
neat or out
1.42
City or Town / State
4. DATE DRILLED g(I 3 d (
5. TOTAL DEPTH SSS OS
6. CUTTINGS COLLECTED YES El NOn
7. DOES WELL REPLACE EXISTING WELL? YES n
8. STATIC WATER LEVEL Below Top of Casing: 70
t 7 F Zlp Code
DRILLING LOG
From To
• c3 a
'70 ---,Si
S—/-4,0
?-etad
7 (r 0 .— o a 40 zit J Ae
DEPTH
Formation oeescrip)tion
N0p
FT.
(Usa'+ If Above Top of Casing)
9. TOP OF CASING IS r FT. Above Land Surfaces
'Top of casing terminated aVor below land surlace requires a variance In accor-
dance with ISA NCAC 2C .0118
10. YIELD (gpm): 2 METHOD OF TEST
11. WATER ZONES (depth): , L'0 — � '✓ n—
y0
12. CHLORINATION: Type ,Amount T� II additional space Is needed use back of lorrrrr m
r� V12'
13. CASING:
Mir. Sa LO frit. AA10e_ 84e Wall Thickness LOCATION SKETCH CI
Depth _ Diameter or Wei pVFFt. Material % (Show direction and distance from at (east two State
From 4To S / Ft 14 —ir T j$ �/ Roads, or other map reference points)
Frorn To Ft
From To Ft
14. GROUT: M,iM - CO r Depth
From 0 To ...CO FI
From To Ft
15. SCREEN:
ale al
J$Ofi -�^Ir
mporece
elhod emu_
4,c2
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
Ft
17. REMARK
I DO HERS 4thRTIFY THAT THIS W
CONSTAd4 TIOH STANDARDS, AND THAT
1, H-R 2 0 2002
FOR OFFICE USE ONLY
Quad No:
From To
Serial No.
GR LNDWNFTER SECT'
ASHEVII J F REGIONAL OFFIC
AI
a Aa
crl
� �m
STRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
OF THIS RECORD HAS BEEN PROVIDED TO THE
EL1 OWNEFj.�,
S iNArTURE OF PERSON CONSTRUCTING THE WELL /// Y�DA E
original to Division of Water Quality. Groundwater Section within 30 days
GWI REV. 12/99
241461
• ' 0<
C.3 sm
r•IN
0

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources • Division of Water Quality • Groundwater Section 0 'i 41 L` 2
1636 Mail Service Center - Raleigh, N.C. 27699-1636-Phone [phone]��J/',v / '(((/���)/7 V
WELLCONTRACTOR• /f' (24-mcwJ/ 'Dt7 /`7 ag TVC--
WELL CONTRACTOR CERTIFICATION #: <thfi 5/ 6
STATE WELL CONSTRUCTION PERMIT#: `7-E" ?r-9-
1. WELL USE (Check Applicable Box): Residential ❑ Municipal Er.--
Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATIQt,J: (Show sketch of t 1pcation below)
Nearest Town: 1�—(�%h� p`,�, County
(Road Nam �endNu` ems Community, or Su Ivlslon and Lot No.)
3. OWNER VYW (1)(it_
Address Tee, gen(
� et (ae or Ra o.)
13tr2WOO ((letiCr ,2e7I
City or Town 7 S aTe Zip Code
Ifl
DRILLING LOG
From To
e9 — . 3 0
.36 — 6-6
cO -- /!a D
4. DATE DRILLED � ,�l
!Gan-
5. TOTAL DEPTH 64) AD S
6. CUTTINGS COLLECTED YES n NOn
7. DOES WELL REPLACE EXISTING WELL? YES fl NOn
B. STATIC WATER LEVEL Below Top of Casing: FT.
(Use •i ti Above Top of asing)
9. TOP OF CASING IS FT Above Land Surface'
-Top of cuing terminated attor below land surface requires a variance In accor-
dance with 15A NCAC 2C .0118
10. YIELD (gpm) 3 METHOD OF TEST
11. WATER ZONES (depth)
ho
12. CHLORINATION: Type 'Amount
13. CASING: 1O O
Wart PittCr S(eWae Thickness
Depth Diameter or Weight/Ft. Material
From 0 To' Ft SKr •see]
steel
From To Ft
From To Ft
14. GROUT:
DEPTH
Formation Description
0
— v
o'"r
sra Cm
N x
w vrn
2
tii we
If additional space Is needed use back of foul 0�
+� o
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other map reference points)
Depth �MMaterial ethod ^
From 0 To �LFt �1lntfi4-!_,.,.'p�'`')`
From To Ft ibtheLitck .
15. SCREEN: Cc t-t rnc4reP 4C-41 ,
Depth Diameter Slot Size Material
From To Ft In In
From To Ft In In
Frorn To Ft In In
16. SAND/GRAVEL PACK:
Depth Size Material
To Ft Uc(LG
To Ft
From
From
17. REMAR
IDOHE
CONSTI
FOR OFF
Quad No:
Serial No.
ti
1P
:g1v ERTIFY THAT THIS WELL
C IpN STANDARDS, AND THAT
t= R :) 2002
CE USE ONLY
rpONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
PY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
) ViD
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
1 t od 1 rat to Division of Water Quality, Groundwater Section within 30 days
�yf R 0Lt'kp" g Y. Y
(MLICE GW-1 REV. 12/99

•
1
North Carolina - Department of Environment and Natural Resources - Division of Water (Duality - Groundwater Section
1636 Mall Service Censer - Raleigh, N.C. 27699-1636-Phone [phone] yy//jj__''
WELL CONSTRUCTION RECORD WELL CONTRACTOR* ij RMA,V L • 2A-LL.
WELL CONTRACTOR CERTIFICATION 0:
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE (Check Applicable Pox): Flesidentlal ✓I� Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other El If Other, List Use:
2. WELL LOCATIONaShow skelctiol the location below)
Nearest Town: 4 44 C 7X_0-LP , Couny
(Road Name and Nu ars, Community, or Subdivision and Lot No.)
3. OWNER (. rfs-7
Address
real or Tfovie No.)
/(iLvl�7rcC�v riC �87/51
Zip Code
From i) To as_ Ft CanC.2t4E
From To Ft
15. SCREEN:
City or Town Stale
4. DATE DRILLED _fir' 'O
5. TOTAL DEPTH
6. CUTTINGS COLLECTED YES E NO[4
7. DOES WELL REPLACE EXISTING WELL? YES Q NOM
8. STATIC WATER LEVEL Below Top of Casing: 1�.. FT.
(Use'•• it Above Top of Casing)
9. TOP OF CASING IS FT. Above Land Surface'
'Top of casing terminated suor below land surface requires a variance In accor-
dente with 15A NCAC 2C .94is
10. YIELD (gpm)• METHOD OF TEST 3
11. WATER ZONES (depth)•
' 'HLORINATION: Type )7H Amount.5_1
13. CASING:
Depth � p Diameter
From 0 To —_/ o FLIt•a5
From To Ft.
From To FI.
14. GROUT:
243677
DEPTH
Formation Description
FFT1
n
n
3
w
IV
If additional space Is needed use back of form
Wall Thickness
or W IghUFL Material
a)4,l;5 Pv[-sD&.
Depth Material Method ,
ffunc
Depth Diameter Slot Size Material
Frorn 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:
To Ft
To Ft
LOCATION SKETCH
(Show direction and distance from al least Iwo Slate
Roads, or other map reference points)
/34014/62720-c,
I DO HEREDYIC
CONSTRUCT'I4j hNDARDS, AND THAT A C
R OFFICE U
Ouad No:
THIS -WEDS 4dN$MAUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
?Y Q�THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
Ah) L )3a I- L. 1-(7-6(
IBIONA URE OF PERSON CONSTRUCTING TIIE WELL DATE
,_ -� "3ubm+q 64tllnai to DI Islon of Wale! Quality, Groundwater Section within 30 days
OW -I REV. 12/99

�43672
North Carolina • Department of Environment and Natural Resources - Division of Water Duality0 1 1 f� - Groundwater Section
1636 Mall Service Censer - Raleigh, N.C. 27699-1636-Phone [phone] yy////__''
WELL CONSTRUCTION RECORD WELL CONTRACTOR. !1'DiniAN L • .3191(.
WELL CONTRACTOR CERTIFICATION 0: o?D.;
STATE WELL CONSTRUCTION PERMIT.:
1. WELL USE (Check Applicable Pox): Residential Er Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Idoal Pump Water Injection ❑ Other If Other, List Use:
2. WELL LOCATION: (Sip,sketch of the location below)
Nearest Town: / 1ZL/vl'LC?.vd.te County'
(nond Name and Nu.*e.s. Communlly, gtlubdllvlslon and lot No.) DRILLING LOG DEPTH
3. OWNER (r4tc AL)L[.6/0.,(e1 From To Formation Description
Address
reTTL/� oa/rI p 70
6�.f/y/i2 iricCl / / c2- �O // / /O8
CIIy or Town Stale Zip Code LJ�
4. DATE DRILLED 3'0
5. TOTAL DEPTH l7
6. CUTTINGS COLLECTED YES fl NO[ �,(
7. DOES WELL REPLACE EXISTING WELL? YES lcNOl NOW(
8. STATIC WATER LEVEL Below Top of Casing: jf
/ (Use •a' if Above Top of Casing) U rf)
9. TOP OF CASING IS ! FT. Above Land Surface' �7
rii
•Top of casing terminated at/or below land surface requires a variance In scoot- �=<
dance with 15A NCAC 2C .0118 0 <n
10. YIELD (gpm): ajOO METHOD OF TEST TN. `J
11. WATER ZONES (depth): 3 —c
. W �,z
maa
'HLORINATION: Type H T H Amount (ki¢ f1ILS
13. CASING:
If additional space Is needed use back of form
N
N o
Wall Thickness LOCATION SKETCH
%� Depth p Diameter or W IphVFt. M'atetdal O (Show direction and distance from at least two Stale
From �`0 To / 8 S Ft L '; 5 eJT h.1)5 L.S5Y& Roads. or other map reference points)
From To Ft.
From To Ft 6 �o,,
( 14. GROUT: (� /L��
Depth Material Molhod /�%
From n To v�.0 . Ft 1^cncn.14 t •rat /'� m s �� ` TIC.
From To Et
id V
15. SCREEN:
Depth Diameter Slot Size Material
From To F1 In In
From To Ft In In
From To Ft In In
16. SAND/GRAVEL PACK:
Depth Size Material
From To FI
From To Ft
17. REMARKS:
I DO HEREBY ygRTIFKTHAT THIS WFI 1 WAS'1',dN$TpUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTI ND� AND THAT A Cot ij THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
SIGN$URE OF PERSON CONSTRUCTING THE WELL
Submit ndelnal to D Islon of Water Oualily. Groundwater Section within 30 days
1FFICE
R OFFICE U,
Ouad No:
Serial No.
7-a3-6/
DATE
GW-1 REV. 12/99

North Carolina - Department of Environment and Natural Resources - Division of Water (Duality- Groundwater Section
1636 Mall Service Center - Raleigh, N.C. 27699-1636-Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR*
243671
AC) R m A/✓ L . 2A-ZL
WELL CONTRACTOR CERTIFICATION It: cDa 7
STATE WELL CONSTRUCTION PERMITN:
1. WELL USE (Check Applicable Box): ResidentialLJ Municipal El Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Hoat Pump Water Injection ❑ Other EI If Other, List Use:
2. WELL LOCATION: (lrpw sketch of the location below)
Nearest Town: 1M-4'tS z�•C.l.,�-Q County.
(Road Name and Nu>. Cgnmunlly, oySubdIvlslon end Lot No.)
3. OWNER (//Lf p([
Address
ra. oro.ou sod S 5 J 'R f
Clly or Town Slate 21p Code
4. DATE DRILLED tt , t5 Q/
5. TOTAL DEPTH ea S
6. CUTTINGS COLLECTED YES [l NO[4 cn�
7. DOES WELL REPLACE EXISTING WELL? YES pi NO[ 0
rn
-1
8. STATIC WATER LEVEL Below Top of Casing: Lie FT. (' `..—'
/ (Use •.• 11 Above Top of Casing)
9. TOP OF CASING 15 / FT Above Land Surface'
•Top of casing terminated et/or below tend surface requires a variance In actor•
dance with 1SA NCAC 2C A 8
10. YIELD (gpm) METHOD OF TEST n J
11. WATER ZONES (depth)
DRILLING LOG
From To
DEPTH
Formation 0escdpllon
•`
—o
N rn
' 'HLORINATION: Type H 7H Amount aCibLll.S If additional space is needed use back of form
13. CASING:
LOCATION SKETCH
Depth Diameter or W IghVFI. ;1Mateiall (Show direction and distance from al least Iwo State
From To SS -Ft b • a 5 47l6.b5 1� eta& Rands, or other map reference points)
From To FI
From To Ft
14. GROUT:
Wall Thickness
Depth Matelot Method ,
From n To ,�0 Ft 1�b1YCPkfrE ']j"1Qt"r•'Q`E`•r{`-
From To FI
15. SCREEN:
Depth Diameter Siol Size Materiel
Frorn 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:
I DO HERED
CONSTRUC
,R OFFICE
Quad No:
To
Ft
Ft
ccictui
S
dutk
&&Mt52 nC•
�1=TRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
ANDARDS, AND THAT A CoY1 r THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
1.. jM P/_ 13'2-L 1-ad-6/
--Submit o4
µ44 SIOT.TURE OF PERSON CONSTRUCTING TIIE WELL DATE
Inal to
S L C 01411
GW-I REV, 12/99

1
North Carolina - Dopanmont of Environment and Natural Resources - Division of Water Dually • Groundwater Section
1636 Mall Service Center - Raleigh, N.C. 27699-1636-Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR:
243657
Al RmAN 1. 14-Li
WELL CONTRACTOR CERTIFICATION 0: C7Oa 7
STATE WELL CONSTRUCTION PERMIT.:
1. WELL USE (Check Applicable Box): Residential L!_r Municipal ❑
Recovery ❑ Heal Pump Water Injection ❑ Other El If
2. WELL LOCATION: ( low sketch ol•tlte location below)
Nearest Town: j�M� 7�1.�.(� County.
(Rood Name an umbers. Community. or Subdi Ion and Lot No.)
3. OWNER .0/,v„r�,, e
Address
gbh eat or tie3 7 2
BLS ImAic2t-cam n c 87/'1
City or Town Slate 21p Code
4. DATE DRILLED
5. TOTAL DEPTH 4.4
()1 �/
6. CUTTINGS COLLECTED YES r] NO1
7. DOES WELL REPLACE EXISTING WELL? YES n NOj A
6. STATIC WATER LEVEL Below Top of Casing: 71 FT.
/ (Use 11 Above Top or Casing)
9. TOP OF CASING IS ! FT Above Land Surface'
'Top of casing terminated aUor below land surface requires a variance In accor-
dance wllh 15A NCAC 2C .011E
10. YIELD (gpm): METHOD OF TEST R, 5
11. WATER ZONES (depth).
Industrial ❑
Other, List Use:
Agricultural ❑ Monitoring ❑
DRILLING LOG
From To
4b • Km
CHLORINATION: Type 14 TH Amount /04AS
13. CASING:
DEPTH
Formation Description
�iaRf-
Bx1�Qcica -�
c�—
Tel c-:
:rr
O 'cc
'O rn
s ,c
W ni a
n
N i7
If additional space Is needed use back of form
Wag Thickness
Depth Diameter or Weight/Ft. Maalle`dall
From 0 To � Ft le • a 5 07)1 j;5 PI/L•Me.
From To Ft.
From To Ft
14. GROUT:
From
From To Ft
15. SCREEN:
Depth
Frorn To
From To
From To
16. SAND/GRAVEL PACK:
Depth
To
From
From
17. REMARK
1 DO HER
CONSTR
OR OFFI
Quad No:
Serial No
Depth Material
() To 01.0 Ff CcNCLE4 E
Method
�Cr�
Diameter Slot Size Material
Ft In In
Ft In In
FI In In
Ft
To Ft
T
STANDARDS, AND THAT A
Size
—. ... origin
Material
LOCATION SKETCH
(Show direction and distance from at least Iwo Slate
Roods, or other map reference points)
STRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
iyzin 4., i s
ONATURE OF PERSON CONSTRUCTING TIIE WELL DATE
to Division of Water Ouallly, Groundwater Section within 30 days
GW-I REV. 12/99

i
North Caroline - Department of Environment and Natural Resources • Division of Water Dually • Groundwater Section 1638 Mall Service Center - Raleigh, N.C. 27699.1636-Phone [phone] )
WELL CONSTRUCTION RECORD WELLCONTRACTOR•
i er ,q ' 1. 24•((,
WELL CONTRACTOR CERTIFICATION 0: cDJa 7
STATE WELL CONSTRUCTION PERMITN:
1. WELL USE (Check Applicable Box): Residentiait0 Municipal ❑ Industrial ❑
Recovery ❑ I-loat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATION: ( w sketch of the location below)
Nearest Town: )1-C2_, County:
(Goad Name and Nubers Cornnunlly, or Su vision and Lot No.)
3. OWNER m1 t LLk&l.
(S(r of Or f]Oule No. v ~ `
tic
City or Town Stale Zlp Code
Address
Agricultural ❑ Monitoring ❑
DRILLING LOG DEPTH
From To Formation Oescdptlon
o -sa b.•Rf
5.. - Jr75 BEl1R-e k
d. DATE DRILLED 1 - 3-0 I r-
5. TOTAL DEPTH I 'l. 5 0
6. CUTTINGS COLLECTED YES n NO(4 n
7. DOES WELL REPLACE EXISTING WELL? YES ri NO[ T+1 0%:;
8. STATIC WATER LEVEL Below Top of Casing: a) e FT. _n r-;
(Use'+ CD Above Top of Casing) - `=
9. TOP OF CASING IS / FT Above Land Surface' c
.0
'Top of casing terminated aVor below lend surface requires a variance In actor- z
cs
dance with 15A NCAC 2C.0118 3
10. YIELD (gpm)• 3-0 METHOD OF TEST n. 3 w "
m,
11. WATER ZONES (depth)• — = ,.
CHLORINATION: Type rf %i'l Amount 3041L3
13. CASING:
Wall Thickness
Depth Diameter or Weight/Ft. �M�aaledall
From Li To 3 2' FIG . 425 . 14 ./%S CYC, sp&
From To Ft.
From To Ft
14. GROUT:
From 0
FL i1t)NC214i WE,lzd,_
From To Ft
15. SCREEN:
Depth Material Method
To DZ
Depth
From To
From To
From To
16. SAND/GRAVEL PACK:
Depth
From To
From
17. REMARKS:
Diameter Slot Slze Material
Ft In In
Ft In in
FI In In
Size Material
FI
To Ft
I DO HEREBY CE
CONSTRUCTION
I
IT AT THIS WELL WAS COSI 11
ARDS, AND TIIAT COPY'Q -
R�pA)f�
OR OFFICE USE
Ouad No:
Sedal No.
tip
ViLL
a
If additional space Is needed use back of form
LOCATION SKETCH
(Show direction and distance from at least two Stale
Roads, or other map reference points)
Gt/}/YlS7l/pl� C .
TED IN ACCORDANCE WITH 15A NCAC 2C, WELL
S RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
---aIDINATUt OF PERSON CONSTRUCTING TIIE WELL DATE
'Su0sdIFOvt jkafl3oivislo of Water Ouallly, Groundwater Section within 30 days
��GW I REV. 12/99

1
North Carolina - Department of Environment and Natural Resources - Division of Water Openly • Groundwater Section
1636 Mall Service Center - Reteigh, N.C. 27699-1636-Phone [phone] y//_' J y (�
WELL CONSTRUCTION RECORD WELL CONTRACTOR: D RmAA/ c . fi L ` r� `3
/1
WELL CONTRACTOR CERTIFICATION 0: c75. 7
STATE WELL CONSTRUCTION PERMIT.:
1. WELL USE (Check Applicable fox): Residential WI Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ 1-loat Pump Water Infection ❑ Other II Other, List Use:
2. WELL LOCATION:/Allow sketch of the location below)
Nearest Town: County
(Hoed Name and Nurmb%s. Cornmunlly. or Subdivision and Lot Uo.) (`/I
3. OWNER
Address ni
n t� ou el ite
Lkrx b �L...Q.Le
City or Town slate Zip Code
rl
4. DATE DRILLED 1 -5-O
5. TOTAL DEPTH c. 7 1'
6. CUTTINGS COLLECTED YES n NOjJ I
7. DOES WELL REPLACE EXISTING WELL? YES n NO114
8. STATIC WATER LEVEL Below Top of Casing: c,2p FT.
(Use's' If Above Top of Casing)
9. TOP OF CASING IS 1 FT. Above Land Surface'
'Top of casing terminated et/or below lend surface requires a variance In accor-
dance wllh 1SA NCAC 2C.0118
10. YIELD (gpm): 3 n METHOD OF TEST R. 3
11. WATER ZONES (deplh)•
c
O o
o=
O
CHLORINATION: Type N 7ti Amount ' n, IIt If additional space Is needed use back of form
13. CASING:
Wall Thickness
SKETCH
en Depth Diameter or W IghVFI. Material (Show direction and distance from at least two State
From To i 3 o Ft L , a 5 .i/re ,l;S Thie ail. (loads, or other map reference points)
From To Ft
From To Ft
14. GROUT:
Depth Material a�.?Data_
Method
From b To � FI C't�NCP_EiE
From To Ft
15. SCREEN:
Depth Diameter Slot Size Materiel
From To ri 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 fpTi(y'�THAtri-it4WgLL
CONSTRUCTIO STD ANO THAT A Copy
OR OFFICE US
Ouad No:
ACTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
— 49•0 k. S'il�L I- S-o /
GNAT RE OF PERSON CONSTRUCTING TIIE WELL DATE
Submit odgina to Did Ion of Water Ouallly, Groundwater Section within 30 days
:LI"\r L' I_
. GW-I REV. 17199

Depth Material f) Method d
FromTo ?Z,0 F' CtNCPx4E ..,,""h
From To FI
15. SCREEN:
Depth Diameter Slot Size Malarial
Frorn To Ft In In
From To FI In In
From To Ft. In In
16. SAND/GRAVEL PACK:
Depth
To
From
From
17. REMARKS:
To
Size
FI
Ft
Material
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1638 Mall Service Center - Raleigh, N.C. 27699-1638-Phone [phone] y//_'
WELL CONSTRUCTION RECORD WELL CONTRACTOR* !►B RMAN C . 2th,
WELL CONTRACTOR CERTIFICATION II: c7Qa7
STATE WELL CONSTRUCTION PERMIT,:
1. WELL USE (check Applicable Boa): Residential Er Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water InJectlon ❑ Olhor El If Other, List Use:
2. WELL LOCATION: A.iow sketch of the location below)
Nearest Town: `A/1.415Z,—C�LC, County:
(no.d Name a Numbers ,mm ounlly. or Subdivision and Lot No) •
3. OWNER r^ i,w./�/ae/ hylN.)M
Address
%EGoi iLsatil, nU /? r a K7/`71
City or Town • oSlaate Zip Code
4. DATA DRILLED
6. TOTAL DEPTH
6. CUTTINGS COLLECTED YES [l NO[4
7. DOES WELL REPLACE EXISTING WELL? YES f NO1
1,4
6. STATIC WATER LEVEL Below Top of Casing: 410 FT.
/ (Use 'i if Above Top of Casing)
9. TOP OF CASING IS ( FT. Above Land Surface'
'Top of casing terminated aUor below land surface requires a variance In accor-
dance with 15A NCAC 2C.011E
10. YIELD (gpm): . METHOD OF TEST ill
? 5
11. WATER ZONES (depth)•
•
&41C-l-?
V
DRILLING LOG
From To
DEPTH
Formation Description
D - 416 -A•R#-
B&dtpck r,
�P-.505
CD
n_
c_) o rr-c-;.1
c`=
0
CHLORINATION: Type }ITN Amount If additional space Is needed use back of form
13. CASING:
Wall Thickness LOCATION SKETCH
Depth Diameter or Weight/Ft Material (Show direction and distance from at least two Slate
From O To Ft If • aZ 5 G/t ./)5 Pve-sx Roads, or other map reference points)
From To FI.
From To FI MD �',C 4 t4' n
14. GROUT: �w w
i
1 DO HEREDYi TtF3' THAT 414WEIL vtthS M"NE TRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUC ITANDATtaT A ♦ =P THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
OR OFFICE 0' a NLY� �i . a CO
G L2{7 /-- 7 lP -d
Quad No: "L.i I SIGNATURE OF PERSON CONSTRUCTING TIIE WELL DATE
Submit original to Iivision of Water Duality, Groundwater Section within 30 days
Serial No. , ;
OW -I REV. 12/99

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section 238339
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 is DZ7
STATE WELL CONSTRUCTION PERMITS:
1. WELL USE (pick Applicable Boa): Residential ❑ Municipal ❑ Industfiai ❑ Agricultural ❑ Montoring ❑
Recovery ❑ Neat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: r. .24.4.Gd..2 County �/ �'
of.2. 4e
wormaaaly, a and tnl Na) DRILLING LOG
3. OWNER i(�6NGtc� From To
Address Oyu/ y 4
7naf-rt or AwlsNo-)
cayorTowel
4. DATE DRILLED 7/J4/0I
5. TOTAL DEPTH 3OS
6. CUTTINGS COLLECTED YES ❑ NO®
7. DOES WELL REPLACE EXISTING WELL? YES NOR1
8. STATIC WATER LEVEL Below Top of Caning: FT.
(tree +' a Ames Top of wring)
9. TOP OF CASING 15 ' S FT. Above Land Surface*
'Top of awing Gansated Wow below lead awtaos requires' valence In scoor-
daroe atth 1SA NCAC 2C.21111 ..//•
10. YIELD Wpm). TO METHOD OF TEST jt#?-5.,
11. WATER ZONES (depth)' a as
N2R75-4/
20 Code
12. CHLORINATION: Type OR Amount 1-
13. CASING:
Depth From O To90 Ft.
Frain To FL
From
14. GROUT:
From _/ To a7 O Ft e-8401 wi(
From To Ft.
15. SCREEN:
To FL
Wall Thk bona
or Weight/R. MMadal
oaf PLh
Depth Matadai ( M.thgd
Depth Diameter Slot Size Material
From ,To Ft (n
From To Ft in./In.
InFrom r� To /FL/ In.in Z.
16. SAND/GRAVEL PACK:
Depth Size Material
From To / Ft. /
From . To R.
17. REMARKS:
DEPTH
Fanellen O.ompe n
I addit omI space le needed use back of form
(Stow direction
Roans, or
c
m
e.eren/fr
R10cc
P
1 DO HERESY Lew i tFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 1SA NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF D HAS TO THE WELL OWNER
FOR OFFICE USE ONLY ( 7/a /�/
Quad No: SIGNATURE OF PERSON THE WEIL DATE
Submit edging le Division of Water Malay, Groundwater Seaton within 30 days
n_u u.. AW-t REV. 12/99

From
14. GROUT:
Depth Materialal
From (' /^ To ate() Ft ajn�+�y
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:
North Carolina - Department of Environment and Natural Resources - Division of Water Duality • Groundwater Section 2 J 11 C (1
1636 Mail Service Center - Raleigh, N.C. 27699-1636-Phone [phone] (� [)
WELL CONSTRUCTION RECORD WELL CONTRACTOR• (21� il % Ilf 22 Th
WELL CONTRACTOR CERTIFICATION #: 4vD/ V O
STATE WELL CONSTRUCTION PERMIT#: / 5'9•2
1. WELL USE (Check Applicable Box): Residential L Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATIO : (Show sketGtyot the location below)
Nearest Town L1.1/ Wire'• County
(Road Name
3. OWNER
Address
dN
nity, or Subdivlsionn Lot No.)
2 g'7 /-/-
City or Town Stale Zip Code
4. DATE DRILLED 9-3 -0
5. TOTAL DEPTH 7r3 j
6. CUTTINGS COLLECTED YES n NO[n
7. DOES WELL REPLACE EXISTING WELL? YES n NO(
8. STATIC WATER LEVEL Below Top of Casing: x•(^(3 FT.
(Use'+' II Above Top of Casing)
9. TOP OF CASING IS I FT Above Land Surface'
'Top of casing terminated auor below land surface requires a variance In accor-
dance with 15A NCAC 2C .e 1e
10. YIELD (gpm): 3 METHOD OF TE T
11. WATER ZONES (depth): f O 3 ^1i
12. CHLORINATION: Type _II Amount i_e_
13. CASING:
DRILLING LOG DEPTH
From To Formation De npliq
d 705 �r
Wall Thickness
e Depth D rztrar or WWjel hVFL M na'
From ( / To J Q Ft 'LP 512-( f/t
From To Ft.
To Ft
c
If additional space H needed use back of Mtn 0
r _
_ c'_
LOCATION SKETCH r cr'
rV o,-
(Show direction and distance from at least two618te =
Roads, or other map reference points) a („
rs-
rt.c
0
i,7M:I
; I 9-
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION. STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
rOROFFICE US __ 611d (� 17 /✓,(fr• b I� 5
Ed,•. Y :-'......._.
'r.:ar-;'r SIGNATURE OF PERSON CONSTAUC HNC_ THE WELL
Subrr.: iginal to ti Evs'c- 'IWa'.erOur. Grrjndwas, ..•ction, w ' '^d "'

North Carolina - Department of Environment and Natural Resources - Division of Water Duality - Groundwater Section
1636 Mall Service Center - Raleigh, N.C. 27699-1636-Phone [phone]///_''
WELL CONSTRUCTION RECORD WELL CONTRACTOR. I RmAN L • 2,4LL.
WELL CONTRACTOR CERTIFICATION 0: cDa 7
STATE WELL CONSTRUCTION PERMITM:
1. WELL USE (Check Applicable fox): Residential Id- Municipal El Industrial El Agricultural ❑ Monitoring ❑
Rocovery ❑ Heat Pump Water Infection ❑ Oilier (] II Other, List Use:
2. WELL LOCATION: ( low sketch o t ie Iocailon below) /��
Nearest Town: County'W/f
(Road Name and Numbers. Commune , or Subd vision and Lot Ny.) DRILLING LOG DEPTH
3. OWNER
Address
Aka
}#14 SZ AA,�r Nau r 5,6 a 7SIO
City or Town / ��,,,!✓!!��`///// Stale Zip Code
4. DATE DRILLED (R -aQ -O/
5. TOTAL DEPTH Sfe 5
6. CUTTINGS COLLECTED YES n NO14
7. DOES WELL REPLACE EXISTING WELL? YES n NO171
8. STATIC WATER LEVEL Below Top of Casing: 2.'0 FT.
(Use •••• II Above Top of Casing)
9. TOP OF CASING IS 1 FT. Above Land Surface'
•Top of casing terminated at/or below land surface requires a variance In accor-
dance with 15A NCAC 2C .0116
10. YIELD (gpm): ri` METHOD OF TEST
11. WATER ZONES (depth)•
1
243636
From To Fonnellon Description
D - 7D
,Kd - -34 5
13�tzQcJc
CHLORINATION: Type 1-17 H Amounti)LS If additional space Is needed use back of form
13. CASING:
From
From
0
Wall Thickness LOCATION SKETCH
Depth evv Gr Diameter 5 or I pig Material (Show direction and distance from al least Iwo Stale
To V FI�(s"5 e. Roads, or other map reference points)
From
14. GROUT:
To FI
To Ft
Depth Material pit lei
From D To DZ0 FI C1DIYCP.Eit
.piFrom To F1
15. SCREEN:
Depth Diameter Slot Size Material
From To II In In
From To F1 In In
From To Ft In In
16. SAND/GRAVEL PACK:
Depth Size Material
From To FI
From To Ft
17. REMARKS'
V
TANDARDS, AND THAT A C9
IIII 'IOR OFFICE ,'C°2
1J E ONLY'"" 1
Ouad No:
SIO
Ina110
Serial No. c icr
RUCTED IN ACCORDANCE WITH 15A NCAC C. WELL
THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
h rl.ti)w h- 1314 & 6 -4-0/
TURE OF PERSON CONSTRUCTING THE WELL DATE
!vision al Water ouallly, Groundwater Section Wllhln 30 days
OW -I REV. 12/99

i
1North Carolina - Department of Environment and Natural Resources -
636 Mali Service Center - Ral gh, N.C. 27699-1636-Phone [phone]n of Water Ouatlty - �IO/r/o�undwater Section
WELL CONSTRUCTION RECORD WELLCONTRACTOR: /fd RmA/✓ Z. WA&
WELL CONTRACTOR CERTIFICATION I': ca 19A
STATE WELL CONSTRUCTION PERMITM:
2'7 Qf r 7
1. WELL USE (Check Applicable Box): Residential Er Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Rocovery ❑ Heal Pump Water Injection ❑ Other El If Other, List Use:
2. WELL LOCATION:JItow sketche of 'the location below) Qm��
Nearest Town: 1 tthet .w County'
(pond Name and Nu era. Community, o/ $ubdivislon and Lol No.) DRILLING LOG
3. OWNER 142.4l i From To
Address /3in( Si 0
ere
or HoV_le_C .) as165
Of TOWO ' (Stale Zip Code
City or Town
4. DATE DRILLED
5. TOTAL DEPTH 4 O
6. CUTTINGS COLLECTED YES r] NOjv j
7. DOES WELL REPLACE EXISTING WELL? YES [J NOI vi
8. STATIC WATER LEVEL Below Top of Casing: 35 FT.
(Use'•' II Above Top of Casing)
9. TOP OF CASING IS / FT. Above Land Surface'
'Top of casing terminated nVor below lend surface requires a variance In accor-
dance with 15A NCAC 2C .0118
10. YIELD (gpm): _ METHOD OF TEST . 5
11. WATER ZONES (depth)-
•
DEPTH
Formation Description
SLeo B&dRer k
CHLORINATION: Type 31 7H Amount (ems 11 additional space Is needed use back of form
.0. CASING:
Wail Thickness
Depth LDin01 $ �)bmeter or Weight/Ft.
,J 5 PVGSDC
From if.,
_a" Ft. ,
From To FI
From To Ft
14. GROUT:
Depth Material Method
Frorn ii Todt7 Ft 0/MU-OE Oltitcl,
To Ft /
15. SCREEN:
Depth
Frorn To
From To
From To
16. SAND/GRAVEL PACK:
Depth
To
To
From
From
17. REMARKS:
Diameter Slot Size
Ft In. In
Ft In In
Ft. In In
Ft
Ft.
Size
Material
Material
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or ether map reference points)
`Yj'1aa, - , 7 Co
0
c—)
O
a
w
1V
0
sp DUCTED IN ACCORDANCE WITH 15A NCAC 2C.
CONSTRUCI'll EvitrataSTANDARDS AND THAT A C Y THIS RECORD HAS BEEN PROVIDED TO THE WELL L0
TUnE OF PERSON CONSTRUCTING THE WELL
Ivision of Water Quality. Groundwater Section within 30 days
WNER.
-ai-o
DATE
GW-1 REV. 12/99

r
3. OWNER
r
North Carolina - Department of Environment and Natural Resources - Divlslon of Water Quality - Groundwater Section '1 � J ('U d
1638 Mall Service Center - Raleigh, N.C. 27699.1638-Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR. /I D RmAN Z • 24-LL,
WELL CONTRACTOR CERTIFICATION 0: cO.i7
STATE WELL CONSTRUCTION PERMITN:
WELL USE (Check Applicable Dox): Residential [a Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Rocovery ❑ Heat Pump Water Infection ❑ Other If Other, List Use:
2. WELL LOCATION: how sketch of the location below)
Nearest Town: l.A111yn.5ZTt County:
(Road Name and Numbers. Commit r Subdivision and Lot No.)
(Sheol or noule
av Y�a 1
Address GJ
City or Town Stale Zlp Code
4. DATE DRILLED o�-
5. TOTAL DEPTH �
6. CUTTINGS COLLECTED YES 1-1NOWI
7. DOES WELL REPLACE EXISTING WELL? YES n NOI
8. STATIC WATER LEVEL Below Top of Casing: 'I,p FT.
/ (Use'+' If Above Top of Casing)
9. TOP OF CASING IS ! FT. Above Land Surface'
'Top of casing terminated aVor below land surface requires a variance In accor-
dance with ISA NCAC 2C 1,Q
10. YIELD (gpm)• U METHOD OF TEST
11. WATER ZONES (depth)•
DRILLING LOG
From To
10
CI ILORINATION
13. CASING:
Type H T iAmount U- g.S
Dept, Diameter
From 0 To t b 6 Ft it •a5
From To FI
From To FI.
14. GROUT:
Wall Thickness
or Weight/Ft. Material
'2/4.i;5 -
DEPTH
Formation Description
,'R
BE-rIR-Of k
If additional space Is needed use back of form
LOCATION SKETCH
(Show direction and distance from at least Iwo State
Roads, or other map reference points)
Depth Material Molh,,
od
Frorn 0 To 20_FI. (crime- t $ od tvo/i `� 2/-der
From To Ft
15. SCREEN:
Depth Diameter Slot She Material
From To Ft in In
From To Ft in In
From To Ft In In
16. SAND/GRAVEL PACK:
Depth Size Material
To
To
From
From
17. REMARKS
FI
FI
0
0 o
I DO FIER Y RTiFY THAT THIS WELL WA 3 NSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRU E FSTANDAIiDb, ANu nisi A or THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
OROFFIC. 'ONLY Y(/S
i I'lYL /iYtIiF l (O'd;'6 I
Ouad No: —"�S ONATURE OF PERSON CONSTRUCTING TICE WELL DATE
Submllbdetnal to Division of Water Duatlty, Groundwater Section within 30 days
,L OFFICE
GW-I REV. 12/99

1
North Carolina - Department of Environment and Natural Resources - Division of Water Dually - Groundwater Section
243634
1636 Mall Service Center - Raleigh, N.C. 27699-1636-Phone [phone]//_'
WELL CONSTRUCTION RECORD WELL CONTRACTOR. IS' RMAN L • 2ACL.
WELL CONTRACTOR CERTIFICATION 0: °WA 7
STATE WELL CONSTRUCTION PERMITS:
1. WELL USE (Check Applicable Box): ResidentialL5_1 Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heal Pump Water Injection ❑ Other II Other, List Use:
2. WELL LOCATION_:.(4liow sketch of the location below)
Nearest Town: ,f 7Y P-R-- County:
Woad Name ant&Jumbers, Conmur , or Subdivision and Lot No.) DRILLING LOG DEPTH
3. OWNER .. �. .. ,,. ., .. ,_,,,. �, �•-•-_ _- Formation Description
Address
Cey or Town Slate
4. DATE DRILLED L - 1•a
5. TOTAL DEPTH 14U D
6. CUTTINGS COLLECTED YES n NO[4
7. DOES WELL REPLACE EXISTING WELLS YES I 1 NOJ 4'
8. STATIC WATER LEVEL Below Top of Casing: /Sp FT.
/ (Use's' II Above Top of Casing)
9. TOP OF CASING IS ! FT. Above Land Surface'
•Top or casing terminated atror below land surface require. a voidance In actor•
dance wllh 16A NCAC 2C1.9310
10. YIELD (gpm): / METHOD OF TEST
11. WATER ZONES (depth)•
CHLORINATION: Type rf 7H Amount &i4h1LS
13. CASING:
-5�
SA -40a
Zip Code
Wall Thickness
Depth Diameter or WeiphVFt. u Material
terial
From 0 To-S Fi G •a5 .7lferl%S p
From To FI.
From To Ft
,14. GROUT:
Depth Material Molhod
From n_ To a�.0 Ft Ccacu i .
From To Ft.
15. SCREEN:
Depth Diameter Slot Size Material
From To Ft In In
From To Ft In In
From To Ft In In
16. SAND/GRAVEL PACK:
Depth Size Material
From To Ft
From To Ft
17. REMARKS:
BrdRQck
If additional space Is needed use back of lorm
LOCATION SKETCH
(Show direction end distance from at leas) Iwo State
Roads, or other map reference points)
Ca, co
rr
rV
O o
I DO HEREBY CE
CONSTRUCTION S
OR OFFICE USE ©N
Quad No: L
Sedal No.
T MDSA'THNDTT A rnPN Yi
TED IN ACCORDANCE WITH 15A NCAC 2C. WELL
S RECORD FIAS BEEN PROVIDED TO THE WELL OWNER.
,4tx.) 2-- /274-�
RE OF PERSON CONSTRUCTING TIE WELL
Submit original IQ Dlvlsl
II
n or Water Quality, Groundwater Section within 30 days
la -I 1-61
DATE
ow-s REV. 12/99
Sheol or 1loule No.) ' 14

North Carolina • Department of Environment end Natural Resources - Division of Water Ouality - Groundwater Section
1636 Mall Service Center - Raleigh, N.C. 27699-1636-Phone [phone]
243632
1
WELL CONSTRUCTION RECORD WELL CONTRACTOR:
NoRmAN L. /AI(
WELL CONTRACTOR CERTIFICATION 0: o.340a 7
STATE WELL CONSTRUCTION PERMITN:
1. WELL USE (Check Applicable Boa): Residential L✓1 Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATION: (Shn, sketch of thg location below)
l-3 L ANIC LlaJ_te County
Nearest Town:
Leine ft-LT
(Road Name and Numbers. Communlly, or Subdivision
n and Lot No.)
3. OWNER � f1--Qi/v` 1..Li ASLO9 tt From To Fmmailon Description
Address �� e
WV ire 6r eva'n D — I IL') s��,.R I—
l;ilyorTown JY���Fif1 QStale ZipC rag `j` � otll' 3 - T 5 1J �Qiit
4. DATE DRILLED
5. TOTAL DEPTH - '
6. CUTTINGS COLLECTED YES n NOIVI
7. DOES WELL REPLACE EXISTING WELL? YES NOI1I
DEPTH
8. STATIC WATER LEVEL Below Top of Casing: FT.
(the '4' II Above Top of Casing)
9. TOP OF CASING IS FT. Above Land Surface'
'Top of casing terminated ador below land surface requires a variance In accor-
dance with 15A NCAC 2C .01Q11E
10. YIELD (gpm): 7 METHOD OF TEST
11. WATER ZONES (depth)•
DRILLING LOG
CHLORINATION: Type )i 7H Amount .724111.S II additional space Is needed use back of form
u. CASING:
Wall Thickness LOCATION SKETCH
Depth Diameter •
or Weight/Ft, Material (Show direction and distance from at least Iwo State
From D To 1 FI b •. 5 a��'"'��5 ,al/GSD.Q Roads, or other map reference polnis)
From To FI
From To F-1 �,, ^^^ c,.., ,� e„
14. GROUT: lvl�'lcJ Cl�=�.
Depth Material Mot_ hod r
From D To 020 FI Pt�NCP1ft .�otler��
From To Ft
15. SCREEN:
Depth Diameter Slot Size Materiel
Frmn To F1 in In.
From To Ft In In
From To FI In in
16. SAND/GRAVEL PACK:
Depth Size Material
From To FI
From To Ft
O
rrl
O
17. REMARKS:
IDOHER :u�E(A71FK`THAT THIS `\ ELLWA.• •NSTRUCTEDINACCORDANCE WITH 15A NCAC 2C, WELL
CONSTR * I'N �STANOARDS AND -THAT AI a •: OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
P.
ONATURE OF PERSON CONSTRUCTING THE WELL DATE
Subml iodglna to Division of Water ouallly. Groundwater Section within 30 dayS
I0.•,
GW-I REV. 12/99

i
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mall Service Center - Raleigh, N.C. 27699-1636-Phone [phone]
y//,' N J
^y243629
/I
WELL CONSTRUCTION RECORD WELL CONTRACTOR. N RMAL • A4'LL,
WELL CONTRACTOR CERTIFICATION N: o?Oay
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE (Check Applicable Box): Residential Er Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water injection ❑ Other Ej If Other, List Use:
2. WELL LOCATION;46»ow sketch of the location below)
Nearest Town: U / sSzt-en County: (4lM
(Road Name and Numbers, Community, or Subdivision and Lol No.)
W-
3. OWNER ` 'o-kvn L.LLJi
Address
WIM57)--L(.1) b oula Nq.( A -7
'
City or Town Stale Zip Code
4. DATE DRILLED to - 15-0 1
5. TOTAL DEPTH 2 R 5
6. CUTTINGS COLLECTED YES n NO[4
7. DOES WELL REPLACE EXISTING WELL? YES
NO IS
B. STATIC WATER LEVEL Below Top of Casing: '5 FT.
/ (Use '+' If Above Top of Casing)
FT Above Land Surface'
'Top of casing terminated a&or below land surface requires a variance In accor-
dance with 15A NCAC 2C .011
10. YIELD (gpm): be7 METHOD OF TEST n,
9.
TOP OF CASING IS
11. WATER ZONES (depth):
DRILLING LOG
From To
D-62D
o -ag.5
12. CHLORINATION: Type H 7H Amount
3. CASING:
DEPTH
Formation Description
Tir'R F
$Trot k
If additional space Is needed use back of form
Wall Thickness
Depth Diameter or Weight/Ft. Material
From LI To IsD Ft L'?5 s?)t.b5 PvtsDc.
From To Ft.
From To Ft
14. GROUT:
From
From
15. SCREEN:
Depth Material
1) To v'0 Ft ODPICEt#E
To
Depth
Frorn To
From To
From To
16. SAND/GRAVEL PACK:
Depth
From To
From
F1
iTholincLMothod
Diameter Slot Size Material
Ft In In
Ft In In
Ft. In In
Size
Ft
To Ft
Material
LOCATION SKETCH
(Show direction and distance from at least Iwo Slate
Roads, or other map reference points)
0
rn
n
O
C)
rV
0
17. REMARKS:
1 DO HEREBY CERTIFY THAT THIS WEI l _W__AS CON
CONSTRUCTMSTANDAFIDIL AND T(iAT A-C
IFOR OFFICE SE)(3NLY
Ouad No. I 1
Sedal No.
Igu'nn odbl
sl
TRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
iP� (r —IS-6 1
Z/p/
ATURE OF PERSON CONSTRUCTING THE WELL ' DATE
Division of Water (Duality, Groundwater Section within 30 days
GW-1 REV. 12/99

0
1
North Caroline • Department of Environment and Natural Resources - Division of Water Ouellty • Groundwater Section �2„ '4 J LI
1636 Mall Service Center • Raleigh, N.C. 27699•1636-Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR'
fo RmA/✓ I . ,4LL.
WELL CONTRACTOR CERTIFICATION 111: o?D0; 7
STATE WELL CONSTRUCTION PERMITN:
1. WELL USE (Check Applicable fox): Residential Er Municipal ❑ Industrial El
Recovery ❑ Heat Pump Water Infection ❑ Other IJ If Other, List Use:
2. WELL LOCATION: bow sketch of the location below)
Nearest Town: GtitA't County.
Address Qv� # l p 7 //
�.(/tiSn isll t.t-e-�1t_, u e o ,QP / /`i
City or Town Stale Zip Code
4. DATE DRILLED - S-O
5. TOTAL DEPTH
6. CUTTINGS COLLECTED YES El NO J
7. DOES WELL REPLACE EXISTING WELL? YES NO
8. STATIC WATER LEVEL Below Top of Casing: (] FT.
// (Use's' II Above Top ol Casing)
9. TOP OF CASING ISL FT Above Land Surface'
'Top of casing terminated Wm below lend surface requires a variance In accor-
dance with 15A NCAC 2C4.0116 D.
10. YIELD (gpm)' oG 0 METHOD OF TEST /XL 3
11. WATER ZONES (depth).
(Goad Name end/refs. Conmu Iln v.or Subdlvislon and Lot No.)
3. OWNERl- /��f")-C-.!(Jr
71x,7.kaq
Agricultural ❑ Monitoring ❑
DRILLING LOG
From To
CHLORINATION: Type H 7N Amount aSriliS
13. CASING: 1
From
From To
From To
14. GROUT:
From
From
15. SCREEN:
Wall Thickness
DEPTH
Formation Description
If additional space Is needed use back of form
Depth Diameter or W ighVFI. Material
0 To if / Ft L ,aS ail,l,5 PI/L•SD,Q
FI
FI
Depth Q To O
P�-
To
Material Method
FL ettiCPfri
FI
Depth Diameter Slot Size Material
Frorn To FI In In
From To Ft In In
From To Ft In In
16. SAND/GRAVEL PACK:
Depth Size Material
From To FI
From To FI
17. REMARKS:
LOCATION SKETCH
(Show direction and distance from al least two State
Bonds, or other map reference points)
gel
1 DO HEREBY CERTIFY THAT THIS WELL WA TRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUC TANDARDS, AND THATA C(jJl P THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER,
OR OFFICE
Ouad No:
Out r 1f"L 9 Ai g.19 LU L
1 Sig 4ATURE OF PERSON CONSTRUCTING THE WELL
'$jbmlt orictIa91JoiDlvision ol Water Duality, Groundwater Section within 30 days
'V AFER SECT
REGIONAL Oi
a5o1
DATE
GW4 nEV, 12/99

North Carolina • Department of Environment and Natural Resources - Division of Water Gustily - Groundwater Section `�
163E Mall Service Center • Raleigh, N.C. 27699-1636-Phone [phone]//_' `>? v 1 / `43
WELL CONSTRUCTION RECORD WELL CONTRACTOR: //L RMAN 1. ,4 ((,
WELL CONTRACTOR CERTIFICATION ": FDA 7
STATE WELL CONSTRUCTION PERMIT":
1. WELL USE (Check Applicable Box): Residential Er Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Float Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATION: low sketch of the location below) Nearest Town: e.,04 ,5 76.cJ-JO a County: aMe0-.0'
(need Name andd �umber. Community. or Suhdlvl on and Lot No.) DRILLING LOG DEPTH
3. OWNER A))q a
From To Formation Dascdpllon
Address
cats
Zip Code
QLJ
ov a
City or Town Stale
A. DATE DRILLED to -;-5- 0 I
5. TOTAL DEPTH ea O'S
6. CUTTINGS COLLECTED YES n No[4
7. DOES WELL REPLACE EXISTING WELLS YES n NOl v1
8. STATIC WATER LEVEL Below Top of Casing: a j_ FT.
(Use II Above Top of Casing)
9. TOP OF CASING IS I FT. Above Land Surface'
'Top of casing lermineted at/or below land surface requires a variance In accor-
dance with 15A NCAC 2C .0118
10. YIELD (gpm)• c 27 METHOD OF TEST
11. WATER ZONES (depth)•
D - b,'R
ao - a o.5 1- F-dkq k
CHLORINATION: Type IT �N Amount 35_{LAS If additional space is needed use back of form
13. CASING:
LOCATION SKETCH
Depth Diameter or W ighVFi. Material (Show direction and distance from al least Iwo State
From To ; D Ft �s • a 55 a) 4.l)S Roads, or other map reference points)
From To Ft.
From To FI. Arr.
GROUT: 7
Walt Thickness
Depth a .0 Ft Material Method �I
Frorn 0 To CON ek4Material
?CAUL
I
From To Ft
15. SCREEN:
Depth Diameter Slot Size Material
From To Ft In In
From To Ft In In
From To Ft In In
16. SAND/GRAVEL PACK:
Depth Size Material
From To Ft
From To Ft
17. REMARKS:
I DO HER
CONSTR S STANDARDS. AND T I/WA
(7. cc,
C7
`ri
Cr)mowI
N ',
OR OFFIC
Quad No:
Serial No.
Submit pnbThal
STRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
OF THIS RECOI1DD HAS BEEN PROVIDED TO THE WELL OWNER.
]NATURE OF PERSON CONSTRUCTING TIIE WELL DATE
o Division of Water Duality, Groundwater Section within 30 days
GW.1 REV. 12/99
1
RLGICRAL Gr-

North Carolina • Department of Environment and Natural Resources - Division of Water Ouelly • Groundwater Section
1636 Mall Service Center - Raleigh, N.C. 27699-1636-Phone [phone]
243648
WELL CONSTRUCTION RECORD
WELL CONTRACTOR•
RmAN l . L,91C.
WELL CONTRACTOR CERTIFICATION N: o?O..
STATE WELL CONSTRUCTION PERMITN:
1. WELL USE (Check Applicable Boa): Residential Pr Municipal ❑ Industrial ❑ Agricultural El
Recovery ❑ Heat Pump Water Injection EI Other El If Other, List Use:
2. WELL LOCATION: ( ow sketch of the location below)
Nearest Town: /.(%tni,S 2ti12.4.,) County:
(flood Name end N ers, Community, or Subjoilvislon and Lot No.)
3. OWNER r-( d CL441
Address
(Skeet or
L.thm'SA)4-4,
ou e
City or Town Stale
4. DATE DRILLED L.0 —3 (
5. TOTAL DEPTH 3 Lo S
6. CUTTINGS COLLECTED YES n NO4
7. DOES WELL REPLACE EXISTING WELL? YES a NO�
8. STATIC WATER LEVEL Below Top of Casing: ,�J FT.
ag71L+
Zip Code
/ (Use •s' 11 Above Top of Casing)
9. TOP OF CASING IS ! FT Above Land Surface'
'Top of casing terminated et/or below land surface requires a variance In accor-
dance with 15A NCAC 2C .011E
10. YIELD (gpm): _L METHOD OF TEST R,3
11. WATER ZONES (depth).
Monitoring ❑
DRILLING LOG
From To
DEPTH
Formation Description
n - gee )VR
Y62 - 36 5 B&Iie.Qc k
CHLORINATION: Type NTH Amount �0 ArnlIS
13. CASING:
From
From
0
If additional space Is needed use back of form
2
W
n,�
Wall Thickness
Depth Diameter or W IghVFI. ;1M,ale�dall
0 To A/6 Ft G . S sal4.1,5 PIG5M.
From
14. GROUT:
To FI
To FI
Depth Material Motlrod r
From 0 To 11.0 Ft ��NC�iF7jlo_ D'2_Erj__
From To FI
15. SCREEN:
Depth Diameter Slot Size Material
Frorn To Ft In In
From To Ft In In
From To FI In In
16. SAND/GRAVEL PACK:
Depth Size Material
From To FI
From To Ft
17. REMARKS:
I DO FIERED
CONSTRUC'
fV
LOCATION SKETCH
(Show direction and distance from al least Iwo State
Roods, or other map reference points)
0
437"-- ) C
OR OFFICE
IOuad No:
Serial No.
1 ik' T�`I'�T TLt-1IS� Pc)! WRS 03,It TRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
ANDARDS, AND THAT A CO'Y P THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
1
LUE.lNLW"q - 2002 /J/
Slot
Submit original to
GPOLi a SECTION
L R_ i.j,.,_ LFFiC:
iov,52_„ L 4aLu ('f2-61
IATTIRE OF PERSON CONSTRUCTING TIIE WELL DATE
Division al Water Ouellly, Groundwater Section within 30 days
GW.I REV. 12199

1
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mall Service Center - Raleigh, N.C. 27699-1636-Phone [phone] �//_'
WELL CONSTRUCTION RECORD WELL CONTRACTOR. /1 N R/nAN L • 2i4 Z(.
WELL CONTRACTOR CERTIFICATION'S: o?D.7
STATE WELL CONSTRUCTION PERMIT'S:
2436,19
1. WELL USE (Check Applicable Box): Resldontlal IJ Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring El
Recovery ❑ Float Pump Water Injection ❑ Other El If Other, List Use:
2. WELL LOCATION: ,9iow sketch of the location below) ,^
Nearest Town: (A/)i1`1S 21-1-W -, County. GV, 1
(Goad Name an:e,Jymbers, ConvnunIly SubdlvIslon and Lot No.) DRILLING LOG
[�1 at /rw
it r���� [ 1 lleule�o. 23Q 7/hf
City or Town State Zip Code
4. DATE DRILLED (0 -a -a 1
5. TOTAL DEPTH Lim
6. CUTTINGS COLLECTED YES n NO[4
7. DOES WELL REPLACE EXISTING WELL? YES n NO[�
8. STATIC WATER LEVEL Below Top of Casing: c 'i FT.
(Use's' 11 Above Top of Casing)
9. TOP OF CASING IS 1 FT. Above Land Surface'
•Top of casing terminated aVor below land surface requires a variance In accor-
dance wllh 154 NCAC 2C .0118
10. YIELD (gpm): 5 D METHOD OF TEST
11. WATER ZONES (depth):
3. OWNER
Address
CHLORINATION: Type Fi %N Amount 15..pritS
13. CASING:
Wall Thickness
Depth Diameter or WWlghVFt. ;1Material
p
From 0 To � Ft b .c25 ,2)1./%S PVGSDRL
From To Ft
From To FI
14. GROUT:
Depth Material Method ,
From 0 To Df.° Ft ea��E4E,�j"1D`!'r-Q-&`C`-
From To FI
15. SCREEN:
Depth Diameter Slot Size Material
Frorn To It In In
From To Ft In In
From To Ft In In
16. SAND/GRAVEL PACK:
Depth Size Material
To FI
From
From
17. REMARKS:
To Ft
DEPTH
Formation Description
0
it additional space Is needed use back of form rfrl i
c-c
c
LOCATION SKETCH o "-
(Show direction and distance from et least two Slate —o m..
Roads, or other map reference points) rci
to N c
_ cp
Piiii,\_,5 �U "�' N 2
BevimS7i-die—y' 11 .0
IDOHEREBY CEMT YTWA7PHIS'WELLWASEO�IISifUCTEDINACCORDANCE WITH 15A NCAC 2C. WELL
CONSTRUCTIO�h$ NDARDS, AND THAT A C"OPlif b THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
OR OFFICE US O
t
Y ?lit?' /fl AP)G� KALL �0-o`!q-ot
,>
Ouad No: •
5 GNAT JGE OF PERSON CONSTRUCTING THE WELL DAIS
Submit origin,/ to Div l Lion of Wale/ Ouallty, Groundwater Section within 30 days
From To
GWI REV. 12/99

•
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mall Service Center- Raleigh, N.C. 27699-1636-Phone [phone]
i.436,14
i
WELL CONSTRUCTION RECORD WELL CONTRACTOR'
h'd RmAN l .7((.
WELL CONTRACTOR CERTIFICATION 0: o?O.7
STATE WELL CONSTRUCTION PERMITN:
i. WELL USE (Check Applicable Box): Residential L1 Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Moat Pump Water Injection ❑ Other If Other, List Use:
2. WELL LOCATIONABhoW'ss�k''etch of the location below)
Nearest Town: "Wm/thus &tad? Count'
(Road Name and Nuprrs. Community. or Subdivision and Lot No.) DRILLING ..OG
3. OWNER 4/ Ll_Lk4._?.r.� LI2 LCA 7J
Address jSt e "'1 Houle No.)
3 T� 41
U 9 o , fC' �37/9
City or Town Stale Zip Code
4. DATE DRILLED "a�'O L
5. TOTAL DEPTH /�
6. CUTTINGS COLLECTED YES f] NO[4
7. DOES WELL REPLACE EXISTING WELL? YES n NOW(
8. STATIC WATER LEVEL Below Top of Casing: a h• FT.
(Use'.' II Abovo Top of Casing)
9. TOP OF CASING ISFT. Above Land Surface'
'Top of casing terminated .Vor below land surface requires a variance in accor-
dance with 1SA NCAC 2C .61 S
10. YIELD (gpm): CR METHOD OF TEST IN, 3
11. WATER ZONES (depth):
From To
DEPTH
Formation Description
a° - .3AO $Erbes�
rn _
C:
0
'O
3
G.r
r-a
CHLORINATION: Type HT H Amount 5l.JLs If additional space Is needed use back of form
13. CASING:
From
From To Ft.
From To Ft
14. GROUT:
Wall Thickness LOCATION SKETCH
Depth Diameter or�sWeighVFt. ;�M'arledall (Show direction end distance from al leas) two Stale
0 To al F) b .. 5 eV r/,5 PVA50K Roads, or other map reference points)
Depth Material Method
FroFromD To PZ-o F' ('t)NCP.EiET uet_EE[L
From To F1
15. SCREEN:
Doplh Diameter Slot Size Material
Frorn 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
Sm52)--cat
17. REMARKS:I DO FIERE it
Si
WELL
Il
'Y'�,jt AT,3FII9 WELL WAS 1 a 'ERUCTED IN ACCORDANCE WITH 1SA NCAC 2C, WELL
CONSTRUC AT A THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
/64,L.L (12-026-o1
OR OFFICE'U ""��l��
Ouad No:
SIGNATURE OF PERSON CONSTRUCTING TIIE WELL DATE
Submit ode trial la Ivislon of Water Ouallly, Groundwater Section within 30 days
L— R SEO1 �A GW-1 REV. 12/99
ISEUINN+L L. ;._

North Cerollna - Department of Environment and Natural Resources - Division of Water Duality - Groundwater Section
1636 Mall Service Center - Raleigh, N.C. 27699-1636-Phone [phone]
WELL CONSTRUCTION RECORD WELLCONTRACTOR•
1
243645
NDRmA!✓ L. 2,4(L.
WELL CONTRACTOR CERTIFICATION 0: a7L9-; 7
STATE WELL CONSTRUCTION PERMIT":
1. WELL USE (check Applicable aoa): Residential lCl Municipal ❑ Industrial ❑
Rocovery ❑ Meal Pump Water Infection ❑ Olher If Other, Llst Use:
2. WELL LOCATION: ( w sketch of Ur"e�l/oc�atiion below) %
Nearest Town: (//1/V),5 2i-.1y�cx County ( a on C L
DRILLING LOG
(Road Name and Number
3. OWNER
Address
Community, or Su. dvislon and Lot No.)
1
lr�ns
ue I r nu e
ly or Town slate
4. DATE DRILLED
5. TOTAL DEPTH
6. CUTTINGS COLLECTED YES El NO14
7. DOES WELL REPLACE EXISTING WELL? YES n
8. STATIC WATER LEVEL Below Top of Casing: .5.5
(Use': If Above Top or Casing)
9. TOP OF CASING IS 1 FT Above Land Surface'
•Top of casing terminated alfor below land surface requires a variance in accor-
dance with 15A NCAC 2C.o 1E
10. YIELD (gpm): LP METHOD OF TEST
11. WATER ZONES (depth)•
Agricultural ❑ Monitoring ❑
DEPTH
From To Formation Description
/)C' �'%/� 3/D5 1 F f-
Zip Code > 3 "` ritosk
NOIVI
FT.
CHLORINATION: Type i 7H Amount&_fLJ%S
13. CASING:
From
From To FI.
From To FI
14. GROUT:
Wall Thickness
Depth Diameter or W lghVFt. Material
c.1
To FI L •as n7)6./)5 g.
Depth Materiel Method
From 0 To a.o Ft CVNCPkft_ ..pewits
From To FI /
15. SCREEN:
Depth
From To
From To
From To
16. SAND/GRAVEL PACK:
Depth
From To
From To
17. REMARKS:
Dlarneter Slot Size Material
Fl In In
F1 In In
Ft In In
Size Material
FI
F1
0
O `'-
rn
C-) i .
O
If additional space Is needed use back of form
O
LOCATION SKETCH Es
(Show direction and distance from al least two State
Roads, or other map reference points)
ALthu ow-k-
rikakCil
I DO HEREBY GEM
CONSTRUCTION 51
H)eT TkfIS 41WAS Ca
\ROS, AND THAT A COPY
OR OFFICE USE
Ouad Not
Serial No.
"t P — 20
CH I
T
SIGNATUI
Submit original to Dlvislo
DWATER SECTION
REGIONAL OFFICE
TED IN ACCORDANCE WITH 15A NCAC 2C, WELL
> RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
fin) G 25-0 L L &-.27- 0 /
OF PERSON CONSTRUCTING TIIE WELL DATE
of Water Quality, Groundwater Section wllhin 30 days
GW-I REV. 12/99

238326
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mail Service Center - Raleigh, N.C. 27699-1636-Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR. SweetWater Well Drilling & Pump Service, Inc.
WELL CONTRACTOR CERTIFICATION 0: $.9
STATE WELL CONSTRUCTION PERMfTer
1. WELL USE (Check Applicable Boa} Residential Iia Municipal 0 Industrial ❑ Agricultural ❑ Monitoring 0
Recovery 0 Heat Pump Water Injection 0 Other If Other, List Use:
2. WELL LOCATION: Show sketch of (he location below) "
Nam Town: � County. i�-w�y2
Leis- ( d
(Mad Name p}d wirers. Camns fl or Subdivision and to No.) DRILLING LOG DEPTH
3. OWNER
Adder yob ,2
taaan w No.
ttji. .4t6 /r . 'V,Cy
City or Tam /
state zip Code
4. DATE DRILLED ` s
5. TOTAL DEPTH
6. CUTTINGS COLLECTED YES ❑ NODa
7. DOES WELL REPLACE EXISTING WELL? YES NO®
8. STATIC WATER LEVEL Below Top of Casing: FT.
(flss': a ADtws Top o1 Casing)
9. TOP OF CASING IS 2 S FT. Above Land Surface*
'Top or amity tersdnased sOor below lead sedum spokes a vsrWtes In anew -
dance rant 1SA NCAC 2C .01111 •
10. YIELD (gpm)- METHOD OF TEST rat...,.."
11. WATER ZONES (depth)-i f
From To Fannatbn Description
12. CHLORINATION: Type '7 745 Amount 1 if additional space Is needed use back of loan
13. CASING:
Depth
Fran 0 To SSFt
From To FL
From To F
14. GROUT:
Wall Towns LOCATION SKETCH
wel. �;it (Show direction and distance from at leant two State
+z/pelR - Roads, or other map rsSennos pokes)
FroDepth Material
La m � To ao Ft. /adss'1�.
From To Ft
15. SCREEN:
Depth Diameter Slot Size Maw
From / To a Ft {/ in In.
From
From L To
To C In / In
Ft [ in. In /
18. SAND/GRAVEL PACK:
Depth Size Material
From To
From / To
17. REMARKS:
tJ
I DO HEREBY f.tm I rt•Y THAT THIS WELL WAS CONSTRUCTED W ACCORDANCE WITH ISA MCC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY .a pjlyjjECORD HAS jY9HDty(DED TO THE WELL
FOR OFFICE USE ONLY,rf ,
Wad No
SfOMATURE OF PERSON
THE WELL / DATE
amt.
orchid to ONWon of wow Oualy,.6rotetdeeNr Section within 30 days
11141.1 AEV_ 12/94

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
234368
WELL CONTRACTOR' Dewey Wright Well Purnp Co., Inc.
WELL CONTRACTOR CERTIFICATION #• 2887
010455 STATE WELL CONSTRUCTION PERMIT#. Steve Reece
1. WELL USE (Check Applicable Box): Residential 1 i( Municipal El Industrial 0 Agricultural El Monitoring
Recovery 1 1 Heat Pump Water Injection I 1 Other n If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: Pt IPNSVILI F County: YANCY
PRI V ATF flR C)FF ARRI JCV I F Rn OFF I-IWY 1 P F
Road Name and umbers, Community, or Subdivision and Lot No.)
3. OWNER IPPPV n RnoNF
Address RT 2 BOX 1078
RI IRNS frgevr Route No.l NC 2e714
City or Town State Zip ode
4. DATE DRILLED 13/12/2001
5. TOTAL DEPTH ?0!1
6. CUTTINGS COLLECTED YES NO L_k
7. DOES WELL REPLACE EXISTING WELL? YES 0 NO Lik
8. STATIC WATER LEVEL Below Top of Casing: 40 FT
(Use "+" if Above Top of Casing)
9. TOP OF CASING IS 1 FT Above Land Surface*
*Top of casing terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2C.0118
10. YIELD (gpm): 5 METHOD OF TEST Air
11. WATER ZONES (depth): 5 flPm 70-73 0 ppm
0 qpm 0 Ppm
12. CHLORINATION: Type HTH
13. CASING:
Depth Diameter
From n To 5.ft R 9fd
From To Ft
From To Ft
Amount 54
DRILLING LOG DEPTH
From To Formation Description
0 45 DIRT
45 70 GRANITE/SHALE
7f1 74 SHAI F
73 300 GRANITE
n � 1 1 V r
Ki
Ear 1
N
If additional space is needed use leek ofYbrm
CO o
Wall Thickness LOCATION SKETCH
or Weight/Ft. Material (Show direction and distance from at least two State
9RR fAI V Roads, or other map reference points)
P ausv) LLe-
I
14. GROUT:
Depth Material Method 0k 3,1
From 0 To 20 Ft Cement Greviby Flory IQ 0
From To Ft T Llj
15. SCREEN: (. �,�/�
Depth Diameter Slot Size Material (j— 1 1310)0
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
�P(LtLC E
17. REMARKS: Pt��(r�
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
FOR OFFICE USE ONLY
fit"— 7-d-nI
Quad No•
Serial No.
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit original to Division of Water Quality, Groundwater Section within 30 days
GW-1 REV. 12/99

16. SAND/GRAVEL PACK:
Depth Size Material
From To Ft
From To Ft
17. REMARKS• SPeltet, 1,1ft,
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
— � 7- a-ot
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
234 G
WELL CONTRACTOR' uevrey vvnyrn veep rump �.u., np;.
WELL CONTRACTOR CERTIFICATION A. 2887
010454 STATE WELL CONSTRUCTION PERMIT#• Steve Reece
1. WELL USE (Check Applicable Box): Residential De Municipal n Industrial 0 Agricultural 1 Monitoring 0
Recovery 0 Heat Pump Water Injection El Other If Other, List Use•
2. WELL LOCATION: (Show sketch of the location below)
Nearest Toopwn•/ (BURNSpVILLE K p ( County yn,tgc i
Rda8�7WAmT RRmbofErif, t(y,,cif}b iviPDnan3F Nio /V 10
3. OWNER
Address
WI LU Aba CLAUDF E!RI GA'S
RT 2 89/ 887
treet or Route No.)
BURNyg\II LI E
City or Town State
NC
DRILLING LOG DEPTH
From To Formation Description
0 28 nIRT
218714 7R Qn GRANITE
p Code
90 B4 QUARTZ
4. DATE DRILLED 6/13/2001 84 400 GRANITE
5. TOTAL DEPTH .^.00
6. CUTTINGS COLLECTED YES 0 NO LJC II,JJiJ
7. DOES WELL REPLACE EXISTING WELL? YES 1 I NO I IK1�
8. STATIC WATER LEVEL Below Top of Casing: An FT i1I1�
(Use "+" if Above Top of Casing)
9. TOP OF CASING IS 1 FT Above Land Surface*
*Top of casing terminated at/or below land surface requires a variance in accor-
dance
with 15A NCAC 2C.0118 ..
10. YIELD (gpm): 1 METHOD OF TEST Air
11. WATER ZONES (depth) 1 aom00-04 0 aom
0 ppm 0 gpm
12. CHLORINATION: Type HTH Amount 86
If additional space is needed use back of form
13. CASING: Wall Thickness LOCATION SKETCH
Depth Diameter or Weight/Ft. Material (Show direction and distance from at least two State
From n To S t R 1/8 15n PVC' Roads, or other map reference points)
From To Ft
From To Ft
14. GROUT:
lbu2M5d1 tit-
0
Depth Material Method \-
From n To 9fl Ft C'FMFNT Grmri'Y Ftow ^
7 c�
idI— L. D
From To Ft
A Ae�$�I.u�� �
15. SCREEN: 13G'0
Depth Diameter Slot Size Material
From To Ft in in
From To Ft in in
From To Ft in in. 8 -o - -
N u
.. m::
0
CO 8
3A kEe5 I A LE,
FOR OFFICE USE ONLY
_
F.
Quad No:
Serial No
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit original to Division of Water Quality, Groundwater Section within 30 days
GW-1 REV. 12/99

i
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mall Service Center - Raleigh, N.C. 27699-1636-Phone [phone] / ti v .3 i
WELL CONSTRUCTION RECORD WELL CONTRACTOR. /►N /QMAN 4 • 2A-LL.
WELL CONTRACTOR CERTIFICATION #: cRD.7
STATE WELL CONSTRUCTION PERMITN:
1. WELL USE (Check Applicable sox): Residential ✓❑r Municipal EJ Industrial ❑ Agricultural El Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ if Other, List Use:
2. WELL LOCATION: ( ow sketch o( the location below)
Nearest Town: Nb6/ re County.
(Road Name an umbers, Community, or sub�dlv�ls n and Lol No.) DRILLING LOG
3. OWNER /.U/ .at(1i 7r'1.a From To
Address
SIP or Houle No.) 3
, Nc o387/y
City or Town Slate Zip Code
4. DATE DRILLED —
5. TOTAL DEPTH
6. CUTTINGS COLLECTED YES n NOIJ I
7. DOES WELL REPLACE EXISTING WELL? YES [l NO
8. STATIC WATER LEVEL Below Top of Casing: j 5— FT.
(Use'i II Above Top of Casing)
9. TOP OF CASING IS I FT Above Land Surface'
'Top of casing terminated aVor below land surface requires a variance in eccor-
dance with 15A NCAC 2C .019
10. YIELD (gpm): 1 METHOD OF TEST
11. WATER ZONES (depth).
D - o
ah - looD
DEPTH
Formation Description
JJ� R C
Bck
o
ri
:_
W-r
rn
s a
m
n1
o
12. CHLORINATION: Type n.Amount /Oa rills II additional space Is needed use back of form
3. CASING:
Wail Thickness LOCATION SKETCH
Depth Diameter or Weight/Ft. Material (Show direction and distance from et least two Stale
From O To d Ft L •• a 5 r��'° .�i5 PI/GS�,e Roads, or other map reference points)
From To Ft.
From To Ft .azt
14. GROUT: /�L
Depth Material Method ,) �(�,r„
From �% To AO Ft i1�7Nl:,P.&faETjb_uQ,+`[ '�,j� �J\
From To _ Ft
15. SCREEN:
Depth Diameter Slot Size Material
Frorn 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 D0 HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
FOR OFFICE 0jYL; {IC 11 \, 7
Clued No:
Serial No.
ATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit orildi4al 4 Division of Water Ouallty, Groundwater Section within 30 days
- - - •i l GW.I REV. 12/99

i
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section 7
1636 Mall Service Center - Raleigh, N.C. 27699-1636-Phone [phone] _' '- 3 `� '
WELL CONSTRUCTION RECORD WELLCONTRACTOR• /teeRMAN Z. -Lit
WELL CONTRACTOR CERTIFICATION f:
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE (Check Applicable Box): Residential Z. Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ II Other, List Use:
2. WELL LOCATION: *pow sketch of the location below)
Nearest Town:County:
(Road Name and N` ers. Community. or Subdivision and Lot No.)
a OWNER A) (IY1O (`a )
Address
4. DATE DRILLED
5. TOTAL DEPTH
6. CUTTINGS COLLECTED YES n NOI4
7. DOES WELL REPLACE EXISTING WELL? YES in NOM/
8. STATIC WATER LEVEL Below Top of Casing: yS FT.
(Use's' II Above Top of Casing)
9. TOP OF CASING IS / FT Above Land Surface'
'Top or casing terminated at/or below land surface requires a variance In accor-
dance with ISA NCAC 2C .0116
10. YIELD (gpm): 2. METHOD OF TEST : J
11. WATER ZONES (depth)• 11
12. CHLORINATION: Type i1 714 Amount /1
3. CASING:
City or Town --9�1 State
1}-
C aW7 i
Zip Code
DRILLING LOG
From To
D - Io
laa - to�/� �LdkgcJ
DEPTH
Formation Description
v
rrt
-1
C i Zfn
ci
O
ti0
� 0
rn
O
0
z
If additional space Is needed use back of form
Wall Thickness
Depth Diameter or W;luhVFI. Material
From D To le 3. Ft It . ol 5 A/4 45 PVGSD,Q
From To Ft.
From To FI
14. GROUT:
Depth Material Method
From D To 121.0 FI (',dNt„Pkfi ffarAL
From To Ft
15. SCREEN:
Depth
From To
From To
From To
16. SAND/GRAVEL PACK:
Depth
From To
From To
Dlatneter Slot Size
Ft In
Ft In
Ft In
FI
FI
Size
Material
In
in
In
Material
LOCATION SKETCH
(Show direction and distance from at least Iwo Slate
Roads, or other map reference points)
41Amisit-taLfitc_.
17. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 1SA NCAC 2C. WELL
t . a • e THIS RECORD HAS BEEN P99VIDEO TO THE WELL OWNER.
CONSTRUCTION STANDARDS, AND T
FOR OFFICE -iE Nt}LY Cif-
Quad No: '1 � �------
t
Serial No..�.•
u
ll
TURF OF PERSON CONSTRUCTING THE WELL
Submit oddlhat ion [vision al Water Quality, Groundwater Section within 30 days
GW-1 REV. 1D99

North Carolina - Department of Environment and Natural Resources - Division of Water Duality - Groundwater Section
1636 Mall Service Center - Raleigh, N.C. 27699-1636-Phone [phone]
343593
WELL CONSTRUCTION RECORD WELL CONTRACTOR. /1NRmAN L L. AIL.
WELL CONTRACTOR CERTIFICATION 0:
STATE WELL CONSTRUCTION PERMITS:
7D2 7
1. WELL USE (Check Applicable Box): Residential II Municipal [] Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heal Pump Water Injection ❑ Other II Other, List Use:
2. WELL LOCATIO (�Sftow sketch'n�the to anon below)
Nearest Town: -f �%� r«/�County: L/ ivricar
(Road Name end Numbers. Commu1�Ity or Subdivision and Lot No.) G DRILLING LOG DEPTH
3. OWNER jT 1�yys 0"H/ From To Formallon Description
fade `>;p a8Codo
Slate Zip Code "� _ 3�-r=`Dk
erc
ni
4. DATE DRILLED -D I
O n-'
5. TOTAL DEPTH s� . / n'
6. CUTTINGS COLLECTED YES n NO41/ ( 1
7. DOES WELL REPLACE EXISTING WELL? YES O NOW( — o
6. STATIC WATER LEVEL Below Top of Casing: �Q_ FT. `� nc
(Use'+' II Above Top of Casing) Z rn
9. TOP OF CASING IS 1 FT Above Land Surface' m
— cm z
•Top of casing terminated at/or below land surface requires a variance In eccor- r •�
dance with 15A NCAC 2C .1118 o- c�
10. YIELD (gpm): 3 METHOD OF TEST n., ok J Cf1 5
11. WATER ZONES (depth).
ddress
a;°dt NC g o - Si- prR±- Clly or Town
12. CHLORINATION: Type H 7H Amount ap11.13 If additional space Is needed use back of form
3. CASING:
Wall Thickness
Depth Diameter or WpIghVFl. Material
From 0 To CC Ft b •a5 ,7Jt.bs PI/GSDR.
From To Ft
From To Ft.
14. GROUT:
Depth Material Mothod
From Q To D•I.0 Ft C1aIYCe14 E
From To Ft
15. SCREEN:
Depth Diameter Slot Size Material
From To Ft In In
From To Ft In In
From To Ft In in
16. SAND/GRAVEL PACK:
Depth Size Material
From To Ft
From To
17. REMARKS:
Ft
LOCATION SKETCH
(Show direction and distance from al least two Stale
Roads, or other map reference paints)
1 DO HEREBY
CONST
FOR OFF
Ouad No:
Serial No.
u
4
O/T,ST NDODSI AND THAT
ONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
Y • F THIS RECORD HAS BEEN PR • VIDEO TO THE WELL OWNER.
I ! SIONATURE OF PERSON CONSTRUCTING THE WELL
kMd6inel to Division of Water Duality, Groundwater Section within 30 days
iFR SECTION
(UO!VAL OFFICE CE JI
DATE
GW-I REV. 12/99

North Carolina • Department of Environment and Natural Resources • Division of Water Quality - Groundwater Section 0 A. 1 2 3 9
1636 Mail Service Cer : ..� Phone [phone] r' 1
WELL CONTRACTOR• !1 • &//ditt/f=1/- //Ai///YDe.
WELL CONTRACTOR CERTIFICATION #: a/ 5/ Q G
STATE WELL CONSTRUCTION PERMIT#: y, -Y2
1 WELL USE ,ito t t 1gLry.. f ni entia Municipal ❑- Industrial D Agricultural ❑ Monitoring ❑
Reco =ry [ HEVI-- titer 0FindiclflO ectiop D Other ❑ II Other, List Use:
2. WELL LOCATI(Showskftch oft I cation below)
�Nearest Town: .i *-j�c-1-�� County
(Road Name a�n/yN) umbers, Communi r Subdivlltion and Lot No.)LOG DEPTH
3. OWNER $+k_4..t--( . ona,It.Ic From To Formation cnpti
Address p /, g 0 c75 A/Ut�t�,i.�L,.,
/ (Street or oule No. q 20 o}fis'u.�l 0
utc -sla c-zt.Q-L.__, -a-) L _5- 9---. i( loy
City or Town State Zip Code
4. DATE DRILLED S % 1- 6a )
5. TOTAL DEPTH a D 5
6. CUTTINGS COLLECTED YES n NO v
7. DOES WELL REPLACE EXISTING WELL? YE c
❑ NOf c
8. STATIC WATER LEVEL Below Top of Casing: FT. 0-3 c `_.
(Use': 11 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): '7 METHOD OF TEST
11. WATER ZONES (depth)' 7 ` 77o / N -"-t
DRILL! G
=
N ca .._
L � o
12. CHLORINATION: Type //T Amount 1/ If additional space Is needed use back of form
13. CASING:
Wall Thickness LOCATION SKETCH
y/ Depth Di meter or Weight/Ft. Material (Show direction and distance from at least two State
From - f l To Ian_ Ft Tier
'7 e / Roads, or other map reference points)
From To Ft.
From To Ft
14. GROUT:
Depth Material thod
From 0 To 27 Ft (O �t V iJ
From To Ft
15. SCREEN:
Depth Diameter Slot Size Material
From To Ft in in
From To Ft in In
From To Ft In In
16. SAND/GRAVEL PACK:
Depth Size Material
From To Ft
From To Ft
17. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF TFy6RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
FOR OFFICE USE ONLY
Quad No:
Sadal No.
c
�.. 3—r-7- /--o/
SIGNATURE OF PERSON CONSTRUCTIAOiidE1NELL DATE
Submit original to Division of Water Quality, Groundwater Section within 30 days
GW1 REV. 12/99

233076
Nonh Carolina - Department of Environment and Natural Resources • Division of Water (Duality • Groundwater Section
1636 Mail Service Center - Raleigh, N.C. 27699-1636-Phone [phone]
4. DATE DRILLE
5. TOTAL DEPTH !..�
6. CUTTINGS COLLECTED YES fl N0fl / /
7. DOES WELL REPLACE EXISTING WELL? YES NOn `f 5 -
8. STATIC WATER LEVEL Below Top of Casing: 1 t; FT.
WELL CONSTRUCTION RECORD WELL CONTRACTOR• •l 104�/ £ , iz i"
WELL CONTRACTOR CERTIFICATION #:/ SV O
STATE WELL CONSTRUCTION PERMIT#: 1T32
77
1 WELL USE (Check Applicable Box): Residential I —Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other If Other, List Use:
2. WELL LOCATIO,i7 (Show sketch of the location below)
Nearest Town: /-1/11FJ9✓/149 County: 7a-1f Cc
(Road Name and Numbers. Communnity or —Subdivision and tit No.)
3. OWNER (I: �� iM(v cC r;L'V
Address
DRILLING LOG
Fro To
1 - Cie
cr, - j0
treet or Houle No.)1 afil
p
uy or Town r St/ate
(
Zip Code
(Use 11 Above Top of Casing)
9. TOP OF CASING IS / FT. Above Land Surface'
'Top of casing terminated at/or below land surface requires a variance In accor-
dance with 15A NCAC 2C .0118
10. YIELD (gpm)• METHOD/OF TEST
11. WATER ZONES (depth): / '"�5
12. CHLORINATION: Type /1-147-717 Amount 1 6-1)
13. CASING:
From
From
From
14. GROUT:
Depth CS
To
To
Wall Thickness
Diameter or Weight/Ft.
Ft. -/}--Z(
Ft.
Ft
Depth
From D To 1-e2 Ft
Pre'
Me od
Material
Ce%,tiK ru'
•
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:
Z0 t
DEPTH
Formation Description
d o-2�Z
AA ell
O
n
C o^_
N r.:
r=t�
3
If additional space Is needed use back of form"fri
c-
—1
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other map reference points)
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION - .' r ., , • F THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
FOR OFFICE US
Quad No:
Serial No
A
- I Subrt11 od
T- a
IAURE OF PERSON CONSTRUCTING THE WELL DATE
Division of Water Quality, Groundwater Section within 30 days
GW1 REV. 12/99
0
fMwater Section
lle Regional Office

(^
North Carolina - Department of Environment and Natural Resources • Division of Water Quality • Groundwater Section2 ry 3 3 0 / 5 61
1636 Mail Service Center - Raleigh, N.C. 27699-1636-Phone [phone] i ,,/�
WELL CONSTRUCTION RECORD WELLCONTRACTOR• If ; &/ r // b..7 Ilia C-
WELL CONTRACTOR CERTIFICATION #: c/ 51 6
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE (Check Applicable Box): Residential VMunicipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCAT N: (Show sket of the location below)
Nearest Town: ASs k I - "4 County `�5,t,.e.
YiiiC \\ bK`,-6 395�
(Road Name ,and
%(umbers. Community ( Su ivision.and Lot No.)
3. OWNER I ,Q.,0 ' e, ... k_ From To
Address 1 �-19- Ce
,n
frA-Lk Lv-, (Street or Reo- 0e of c�'7 - 7e
City or Town t Stale Zip Code / i o/`i
%e�/ 4. DATE DRILLED' S^ V Z 7
5. TOTAL DEPTH 9—% r'LJ
6. CUTTINGS COLLECTED YES D NO❑
7. DOES WELL REPLACE EXISTING WELL? YES D NOn
8. STATIC WATER LEVEL Below Top of Casing: j t FT.
(Use 'i II Above Top ol Casing)
9. TOP OF CASING IS ' FT Above Land Surface*
'Top of casing terminated at/or below land surface requires a variance In accor-
dance with 15A NCAC 2C .0118
10. YIELD (gpm): 3 METHOD OF TEST at. L,.'
11. WATER ZONES (depth): ( Q l r
12. CHLORINATION: Type I t '1 G Amount
13. CASING:
DRILLING LOG
DEPTH
Formation Description
0
CO
rL-
c
'�
It additional space is needed use back ol form
Wall Thickness LOCATION SKETCH
Depth Diameter or Weight/Ft. aterial (Show direction and distance from at least two State
From 4- 1 To % iT Ft Co-24 Roads, or other map reference points) .
From To Ft n
From To Ft
14. GROUT:
Depth Material ethod
From ID To 3 O Ft C n�'-ram
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: \/
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCT IN ACCORD CE WITH 15A NCAC 2C, WELL
EN PROVIDED TO THE WELL OWNER.
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS B
FOR OFFICE USE
Ouad No:
Serial No.
]AUG - letrigina
iJcLi
URE OF PERSON CONSTRUCTING THE WELL
sion of Water Duality, Groundwater Section within 30 days
CAted.
�L
DAT
GW1 REV. 12/99
6n undllwf $Son
Asheville Rea S Office

WELCCONSTRUCTION RECORD WELL. CONTRACTOR:
Ouad No:
Serial No.
4IrA Iir./I lr/(I true:
WELL CONTIIACTOR CERTIFICATION e:
+'•"'r"'�' wr .Lt_ CONSTRUCTION PERMITO
srnrr-
•
1.'WELL USE (Check Applicable Bow): Residential l � Munir ip;i -2.3 1 74 r
Recovery 0 Heal Pump Water Injection Other
2. WELL LOCATION: (Show sketch of the location below)
. Nearest Town: W1Ar/oi..J
'f"]' 1'LlAru;ltc Rci Ncrrn
cage
(Road Name and Numbers, Community. or Subdivision and Lot Nn.) DRILLING LOG
3. OWNER 71viw.y Loude,r7
Address
rmm To
Ci in z_
Ci,.J-;`� trccl nr ouln-yG 47737 IO)..--200
ty or Town Starr.
4. DATE DRILLED, .LOO �L
5. ...TOTAL DEPTH �
• 6: (:;CUTTINGS COLLECTED YES J NO LId' /
7.''DOES WELL REPLACE EXISTING WELL? YES [ 1 NOLI
8. STATIC WATER LEVEL Below Top of Casing: 9a FT.
(Use '.' II Above Top of Casino)
9. TOP OF CASING IS I FT. Above Land Surface'
'Top of eating t.rmineted et/or below land surface requires n vertnnr.r. In ecm,-
dance with 15A NCAC 29.0118
10. YIELD (gpm): L.0 METHOD OF TEST I,3i p W ?J _ _ __
11. WATER ZONES (dopth): 1 2 S I 70 11_L—
r ) Industrial n Agricultural El Monitoring ❑
L If Olhor. List Use: .
iArucy
DEPTH
Formation Desulpllon
Olf/' I- seFt/Pack
1t1ue RocA
12. CHLORINATION: Type pre_ Amount .2 7nljirxs II nddi!innal spaco is needed use back of form
13. CASING: _
Wall 1hir.Nnr sn
Depth Darnnlnr or Wei hhfl. I.I,Irn.0
From c3 To 707 A%•'�y _ _jib .601.v_
From To FI
From To Ft
14. GROUT:
Depth Material Melhnrl
From h To 2 0 Fl 4elate,/F -- .11).-c_Fr�_
From To Ft.
15. SCREEN:
Depth Diameter Slot Size tlnlnm:!
From To Ft in.
From To Ft in in
From To Ft in. in.
16. SAND/GRAVEL PACK:
Depth Size Materiel
From To Ft
From To Ft
17. REMARKS:
LOCATION SKETCH
(Show rikeelion and distanco from at least Iwo State
Rnads, or other map reference points)
0
N
-t
0
'.0
0
CD
11.0
Co
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRI ICTED IN ACCORDANCE WITH 1SA NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECOR0 HAS BEEN PROVIDED TO THE WELL OWNER.
IFOR OFFICE USE ONLY
SIGNATUr1❑ Oc pCn ;oN CONS MUCTING THE WELL DATE
euh.nil nn,ir,al in DWI vrn ol,v.,Irr 0 ,1i(y. Gmnntr.,afer Scaion within 30 days
GW-I REV. 12/99

243545
WELL CONS IHUG 11011I1ECOI1D writ corn nne on:
WF.LI_CONTnnCTOrlern micro tau n:_-i--- U
STATE WELL CONSillUCT1011 Pr/Wile:
North Cnrbbi„ . IL1,mhin•nt nl rnvlrrnment and Natural Ileroureee • Divhlon of Water Duality • Droundw liter Section
1639 Mail Srrvirn Crnlrr - Ilnlclph, N.C. 27699.163e-Phone [phone]
1. WELL tIIE (chrck Pi orrble n •ep flosldnnlh,ILTU Munlclpnt [1 InduslrInl U Agrirullurnl IA monitoring El
Ilecovriy ill I lent rump Water Injection ❑ Other [_) 11 Other, Llet use:
2. WE.LL 1 t0CAlll)f (/•{;hpr/�w nkelch of elle location below)
Nenreel 1nvnl[_ rr•"rYe�1e�- County:
Innn,l nanm mn111 }'-r •. l'olwuuenlly, or Subdlblon mod Lol Ilo.)
3. OWriFr1 _—DGl4214 . 0 11. e/A .
Addle^ /// CP NC i9 7
L/fdn� 11 .1�u..[�cx.:.�,n No.) y .c . a1.703
CON r—_ ''LL Srdn Zip Code
4. DA1E t PI1111 r11_3 7./7_Q]
5. TO1Al ITrill ..au. S--
6. GUT1111,1:rOI.I_rrlru vr.sL_i NO`—1
7. DOES Wt 1.1- I IFI'I ACE FXIS 11110 WELL? YES Li rt.
-
rlie
8. S1ATIGWAIEf1LEVEL Dolor/ lop elCasing: .fl�
(use.a.11 Above Top lit Gill' g)
9. TOr ur r.AQIII0 I^ -_ L. . FT. Above Lnnd SnrIncn•
'lee of ceslml 1•, ndnn^d rro' below lend surface reredos a verbnee In actor-
dence rlllt ten nrAl: 2C ,n 11 n
to. YIELD (tunny ./A— ME1110GOF'TEST _-1----
DIIMLLING L0l3 _
From
10
U ' —
/vt - 074.5---
0E11l11
re,r, Mlon oelvIplion
cp
-- 8,,;
rn o•
n
a
11. WATEll 70NES (drpth):_—_—.—.— 1' __ __,_ _.__ -%--
( �"f ArnoUIi liS 11 additional rpnre N orrrloil ono blink, of form
12. CASIN 11iJAIIOIJ: lypn—.1_�1�------^"".—..,-" ._ .
13. CASING: 111CA1I9N SKEIC:N-.
Well Ihl&ne et
u1p111
Inn»ler or WrIg1 11. •plti iednl (Show direction and dhlnncn Imm nl Innsl Iwo Stole
p _Al.. !,• 2�— a�'1iS ZnR noadt, or other maP lrlerenrr polnb)
Front-- ----ln_�
__.— I1.- n gat.
Flom. —lo --11.— /( e
14. GROW: ',Moils, . 1nlborl
urhih
F,om _... U.. 1r, AO_ II. tcilagkiie_ _ 9.1i_a.
rlrnn .. . I., ..-.._—f1.
15. Scflurll: Mnlndnl
1),•ptll Moonier Slot Size
l o _ . _ _- IA -- — . In. _—.__ In..--
From ..... _ In.
ft
ri--
om __. -___ In. ___ In.
from ...__. lo. ..__fl.._---
18. SANDIurinvG1. rAGK: Size Materiel
L./flint
from ---
l o _ I I. •---"�'_
from ..... __ 10____ Fl.
17, REM r WELL
-T. 9: L 9 CONS IRLIC 1E0 IN ACCO11DANCE W11II 15A ?ICAC 2C,
IDO II'I)� r `COPY or 119 PECOhO HAS BEEN P910VIDED TO 'DIE WELL OWf/
CON r1AtIIJMD ANDT( 1 ---
fOf10 rNI :USr ONLY
" SI lJ 11111E or ,nS ON91nUCfUt1T 111E wr:r I.
Child No. I,dpind Melon et Water Oueiiry, Groundwater Sedlon Wllhhl 30 days OW1nEV, 12199
Serlsl "OIL_- .I;iei'di;•TE
IAS EMCEE REGI
I__

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mall Service Center- Raleigh, N.C. 27699-1636-Phone [phone] "j
WELL CONSTRUCTION RECORD WELLCONTRACTOR• .3; E Ff_RgLLSOW
WELL CONTRACTOR CERTIFICATION IIt:
243535
STATE WELL CONSTRUCTION PERMITM:
1. WELL USE (Check Applicable Box): Residential Ld Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATION: ((S w sketch of the location below)
Nearest Town: �1� . County:
(Road Name end Numbers, Community. or Subdivision and Lot No.) DRILLING LOG DEPTH
3. OWNER 3�11-tom dO k.. From To Formation Description
Address p1* 7 a,,,,alQ -p
(Slier, or I eNo.l 0 - Ca 2)_ .Qr 1-
1thv61 Lai 2 I'1 C a87I9 to a - �-{(0.5 _j3 0
ity or Town Slate Zip Code
4. DATE DRILLED --cs-o I
5. TOTAL DEPTH 9 /o S
6. CUTTINGS COLLECTED YES in Noiv
7. DOES WELL REPLACE EXISTING WELL? YES ( I NO(-0- o
8. STATIC WATER LEVEL Below Top of Casing: /a 0 FT.
(Use '••' II Above Top of Casing) O am.
9. TOP OF CASING IS I FT. Above Land Surface' n T`r,-',
'Top al casing terminated et/or below land surface requires a variance In SCOOT- -- o<
dance with /SA NCAC 2C 011e C 3>o
r c
10. YIELD (gpm): tY2. METHOD OF TEST �,
11. WATER ZONES (depth): 3 -mac'
cnt
m�
��// J
12. CHLORINATION: Type H / T H Amount _Il.)S if additional space Is needed use back of form 0
13. CASING:
Wall Thickness LOCATION SKETCH
Depth plameller for/WelghhVFI. �Ma ertatt (Show direction and distance from at least two Stale
From D To to . Ft (9 •..;-5UC Roads, or other map reference points)
From To Ft.
From To Ft
14. GROUT:
Depth Material MethodHokiThzu? A. 6-
"-qq
From 0 To eat, Ft Conercte pmi(ed. 2/00/76
��,/ it(
From To Ft 2 —r15. SCREEN:
Depth Diameter Slot Size Material
Frorn To Ft in in
From To Ft In In
From To FI In. In
16. SAND/GRAVEL PACK:
Depth Size Material
From To Ft
From To Ft
17. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEE�OVIDED TO THE WELL OWNER.
Ouad No: I v,I f SIGN RE OF PERSON NSTRUCTING THE WELL DATE
1 Sub ,il o4dlaat to Ivislon of Water Duality, Groundwater Section within 30 days
Serial No.
GW.I REV. 12/99
'ILL: REEUON/L

;Tit!.' Y .I. •� •"YI F.--t—ra,lrf •i :.li • .1 w+ ti•
North Cnrprur - I Irpnnnrnt nl rnv6n'rnent and Nenanl Resources • Division of Water Quality • Groundwater Section
1638 Mail Srrvirn Conlin - Ilnlelgh, N C. 27699-1839-Phone [phone]
WELL CONS TfMUC11O14 RECORD
r
2435'3
WELL cONTRACION. FEB.5U o L_
WELL CONTRACTOR CERTIFICATION S:_p_aaA ry
STATE WELL CONSTRUCTION PERMITS:
1. WELL USE (cheek Aprurable Piny NesldantlalLlU Municipal [l Industrial ❑ Agricultural U Monitoring ❑
Recovery 1 1 I teal rump Water Injection ❑ Other If Other, Llst Use:
2. WELL LOCAL IOtI:2,00'w,1sketch of the 199callon below)
Nearest oval. 11.4/412, I0/.(. County. 0..d
(Road flame and r�urrf•nr s. Cornmunlly, or Subdivision and Lot No.)
3. OWNED
Address
v DS
j�br IooUo o
Iynr Irwn ss'�1 Slate
4. DATE DIlli.i_FN,Q•'%_nQ . 4L
5. TOTAL PEI'III �P..0 �--�(
6. CIITTIt1GSCOLI.FCIED YIS0 N0I _
7. DOES WELL IIEII.ACE EXISTING WELL? YES [ TIOI-►(
8. Si ATIC; WAT ER LEVEL Below lop of Casing: 30_FT.
(use '4' II Above Top ni Cesinp)
9. TOP of CAST iIC, IS____ —_. FT. Above Lnnd Surface'
•top of casino 1•rrrdon10,d riror below Tend surface requires a whine, In aceor-
dencewhh 1Ser lir AC 2C .24ia
10. YIELD (arum): _.__ ME1I10D OF TEST i_�
11. WATEII ZONES (c•p111)•
12. CIILOIIINAIION: typo —J111-11----Amount. 1'13
13. CASING:
DRILLING LOG
From To
Zip Code
Wall Thlckncle
DepthL/,• j'Inmelor or 1ol burl _ aled&
�.�s 115
From-------- I n ------- rl.
nom _l_ FI.
14. GROUT:
Drl,pl Materiel 41alhod
From . . In Cartel/ & S0.iE-a-
FIOsl1
15. SCRErlI
Depth Diann-dor Slot Size Mntnrinl
From ._ __.-_lo .__ 11 _ In.
• Frarn .._ _..._. I n rl _ In
From To. __Ft.--- In.
16. SAND/GRAVFI. rAOK:
Dr
From
From —_
17. REMARKS:__
1 DO l IP11rnY Crfl
CONS 1 rll IC I IOFI S
(Fort orFICE usE u --
Quad No.
Seder 117
__
n
DEPTH
ro,mellon Desalption
c
O o
z
0
O o
II additional spacer Is nrednd rise bock of form
LOCATION SKE1CN
(Show dlreclion and distance from at leas) two Stale
Roads, or other map reference points)
f) r C
�1.C.
lED 111 ACCONDANCE WII11 ISA NC AC 2C. WELL
,,. �Nr.•�OF THIS nECOI1O NAS BEEN PROVIDED TO TILE WELL omen.
OUND 'N 1 FFICE ► c, /�
sins IRE Or rEnSot c.IV nUCrlU0111E WEll
Submit originals • vlslon of Water Gustily, Groundwater Section Wllhln 30 days OW 1 REV. 1L99
DAIS

i .py �, ~• Lh 1'-i ,�,r..'i. ..rT'F„�T. ..i9•.n do +i'
213' 21
North Corwin i - I tripartition' of rn liorinrenl end Nnlwnl F1e.^.ourca! • Divlklon of Water Quality • Groundwater Section
1638 Mail Srivicn Crnlnr • I1.:leigh, N.C. 27699-1636-Phone [phone]
WELL CONSTRUC1l014 RECORD writ_CONTnncron: JG� }EkRUsoa�L1_.
WELL cornnncron CEnmlric/ mlon If:�__
STATE WELL CONSTfUCTION PEF1MI10:
1. WELL USIE (Check nrpttrahls Pox): nesidontlalad Municipal [] Industrial ❑ Agricultural U Monitoring El
Recovory [] I loaf Pump Water Injection ❑ Other Ej If Other, List Use:
2. WELL LOCA t IOi . Show sketch of the location below) jjjJ��AA
Newest l own: 1,a%Yh5 county
���
jnond rIn,nn and 11[uurrn'tnis.Forrmmnily, or ../,divviisl and lot No.) DRILLING LOG __UEPT11_— —
3. OWNTri ,� From To fmnlellvn Description
Address ii n
6nvmFVv/nJ �7 / Slzle Zip Code 74' 0/
4. DATE E'I lII.LEn _1.+-�(0-•0 /.-_ --,
5. TNTT', ai&...._ (
L� NOL!'J G. CLITTIUItl E.rn1Eb YES
7. DOES WELL IIE1'LACE EMS Nrsu WELL? YES ] NO[-V
8. STATIC kVA1 ER LEVEL Below lop of Casing: 0 FT,
(Use •.• tl Above Top o1 Casing)
9. TOP Or CASII )C let _ _ L.___ FT. Above Lnnd Srnlace•
'Top of coslnn 10 rrilnnlnd ri!rr below land surface !squires II valance In aoeor•
dance with is ft lir'Ar; 2C .o1In R
10. YIELD (own). /V O. ME1110D OF LEST ___[_1-��
11. WATEll 7Ot1ES (drplh)• rj ii����
12. CI ILOI lINA I ION: Typo _.CI `A_.._ Amount 1115 II additional space Is nredod use back of loan
13. CASING:
- LOCAT IUNSKE 1 CH
WalWhlcl-ties!
``ll Drldh �/!J /rh_wmeler or Wal�l•Vrl. •nlAalednl UU (Show direction nod dialnnce horn nl InIII two Slats a
Flom-_0- ____ la .._/_7 F1. !/±�� l iS PVC- SAM1 noels, or other moo reierenc� 3)� o
•
Fwtn -- In rl. {�
Flom.-----io..-_.._.._ f.t.- l� c
14. GnOUl: / d_
Urinlr Mniella) alhod f% L,./�/p '`-'
/'/')/iAMS rcFi�`s a —o
Finrn . _ U. In aL>-_FI. C'onelLEfh Foulest shin i o
rrorn I ...---pi, = rn�
ma
15.SCWI(Lo
o
()filth Di.vrlator Sint Slze Material O o
2
Frorn _.__-___ 1n_—LI_._ In In
From — — . l o __ l t. __ in. In
rroun-__.--10- ..—FI._. In. In
16. SAND/Of1AVEI. PACK:
Dcpsh Size _ Material
From
From
17. FIEMAIIIC
I DO I IFfl
CONS T FUl
IFonn OrrHC
Ovid No:
Serial Ito
���� AApp
1 nlIMF1TfIAT 71119- :ELLw
T IOF S 1 ANDATIDS. AND THAT A COP
USE ivy I D 'TER SECVU
ASHEVILLE •EGIONAL
Submit Opel
NSTNUCTEO IN ACCORDANCE WITH 15A NCAC 2C, WELL
71119 RECORD 11A9 BEEN PROVIDED TO TI IE WELL OWNER.
.ATTIRE or PERCONSTRUCTIt1O 111E WELT. DATE
ro Division of Water Ouallty, Oroundwelar Section within 30 days oW.l NEV. I2/99

Jt31TM .wr rr.>n
i.__' 1 .• ?
>t"4't*T-Ar a-`.-n+'y 1 ro ,- _^" .:
•
(nond roan rn nr Motor s, Co fly or Subdivision end Lol No.)
3. OWNER NI
INS2-0 aQ?fp
lyly or iI r,-n' II 7 slits Zip Code
J 4. DAIE 10111.LEM -) �L'15 I
5. TOTAI I tEr n I 3,..6 Cl : ��
1G
6. CLITTIrs Gnu .ECIED YES NU
7. DOES MA I_ NEr•LACE nos ruin WELL? YES 0 t101 01
0. SIATIC WAlEll LEVEL Below lop ofCasing: Ai"- FT.
(Use's' 1I Above Top nl Casio())
9. TOP OF CASING In _-_L._- FT. Above Lend Surface'
• top of casino t•r mhml•d rl'or below land surface requires II whines In scoot•
donee with inn IICAC 2C.(71i1
10. YIELD (nhm): MEI I IOD OF TEST Jill
11. WATEn ZONES WorthyJ
he location below) / I
IN • County v`a+194-y
C J1 DFTILLIING LOG
From To
DEPTH_ __
formation oescdplion
to
0 - 3aS EsL(4c k
243497
North Cnrpl.n.n . 1,rpm nnrrq nl r-nvbenrnrnl and Winn l flemourcee • Division of Water Gustily • °roundwaler Sectiion
1636 Mail Sriv rr Cnnlnr • llnlnlph, N C. 27699-1636-Phone [phone]
WELL C0NS1IUUC1I014 RECORD WELL coNTnnclon: 1EiRgU..SOnL).
WELL C0llTfAcron cERTIrlcnnoN e:�_ pa {gas
STATE WELL CONSTRUCTION PEWITS!:
1. WELL USE (check errorehin Pox)! flesIdontlatLl(1 Municipal [] Induslrinl ❑ Agricultural L, Monitoring ❑
necovnry [] I lent Pump Water Infection ❑ Other (] If other, Llel Use:
2. WELL LOCAll C}f I (Show sketch of
Nenresl town: LtL4A
Address
12. CHLOrIIr4AIION
13. CASING:
From
typo _.L1J.EL___Amounl .ear 1 If additional space Is nrednd nee bock of farm
ono )11r
0 to 2_0 Ft 19.35
Well Motor se
er WWg11/11. rdalcdnl
alLd1S PVC SaR
Florn__— - to FI
From _ --lc FI.
14. GfOul: Urpll Material,jj�1l,,,t
nlliod
From . U__ In 212_11. __6233Lelare Flom --......... to ------rt.
15. SCItt_I t1:
Depth Dimmnter Slot Slze Mninrial
From -- - - l n -------it._.. In — In. __.
From ---- In_. ---FL_—_ In. __In.
Front to FI In In.
. m iv
2CC .
1 oQ IImur(rLN ., .HIS WNEf.
i orCO �trcC rft,�1p16, (:I}Mp(.Lial , /AND TIIAT A C0PY 11113 PEC0r10 HA9 BEEN PROVIDED 1O 111E WELL - O �
F.eTT{fi �lYCI'-115T"-C7lILV�rt rc DATE
Wed No: SI IAIME Of PE II ConsTnuCTINO 11IE WELL
`____.__. Submit odpine to t)IvI Ion el Water Gustily. Oroundwelu Section wllhin 30 tin ye OW.I NEV. Ib99
ze Matorinl
_LOCALION_SKE(CH_
(Show direction and dininnce from nl loos% two Stale
Floods, or other map reference points)
ELL WAS CONS IntIC1ED IN ACC0r10ANCE W1111 1SA NCAC 2C.)C ILLL

i.!.ra .1111 .71it y MLLi.VYw1 tin!
1ryi .,.
74 r
North Cnrpl•,ln - Itrlrnrhnrrd nl rnvIrotunerd and Nnlurnl nesources • Divlelon of Water Quality • Groundwater Section
1638 Mail Srrvlrn Crnlrr • Nalelph, N.C. 27699-1638-Phone [phone]
243496
WELL curisi FIUC1ION RECORD wrLLcoNTnncTon: 3SL _I ERQUSoN
WELL CONTIACTOR CEnhIrictunoN.:
STATE WELL CONSifUCTIOfI PERMIT.:
1. WELL tint: (Check n r•rnrehle Wu): Ilesidnnllal[i Municipal El Industrial El Agricultural Li monitoring El
Recovery [] Hord rump Water Injection ❑ Other [] It Other, List Use:
2. WELL 1.0CATion. (Sh`o.w��sketchoJ �Yto location below)
Nenresl town. ALIA, eV l' u • County.
formation iption
mood rlarr,n mid uornhrrs, Corm/ runs y,aa-utyllvlslon and lot No.) DRILLING LOG DEPTH__ _
3. OWNFR _ sf.p Wl'E1ii. -----
eftr
Addre'c �?TNo. Bet /074
ati„„Seri or N.c - a7ya
Cnp er I mot Sale Zip Code
4. DATE PIill ,IFIT Li- _/7-0 (
5. TOTAI PEI-III __-/ 0 L�
6. CULT 1U( tCOLLFt'IED YES NO _
7. DOES WFU_ IIFMAGE rxl!f1IIG WELL? YES L i � _ NOV
0. SIATIC WAIEnLEVEL Dainty lop01Casing: 7.0FT.
vise '+' if Above Top of —Casing)
9. TOP or CArtlIJG IS __ 1__." " FT. Above Lnnd Sulfacn'
• Top of ceebn, t•rndnnl^d trig below Irrd outraoe reritdrae II Zane* In scoot-
dence with 15A IIrAC 2C rair
0. YIELD (mire): �7 9 MEI1100 OF TEST
11. WATEIT 70r JES (drpll
D—AO �a
'•o - /a SEdre>ck
12. CIILOItIITA I ION: I ypn
13. CASING:
--it! 7
U1I11 V G, Ir�5r
From i , FI
From- -------.._ 1n_.__---- FI._
From - --_i0 -__.._ TI._
14. GROV 1 :
Amount .2 if pas If additional spncn Is nrednd 'inn bock of torrn
_ LQQAT IQNSI<E fC11
Wall 1hic&nc se
or WrlgbVil. 6lalednt (Show direction and dlnlnnce horn al mist Iwo Slate
i j[e,I,aS. PVC- Skit Roads, or other map relerencn polnts)
Dr pill Material M elltod
From _ U." in 21Q_rl.. (ronCgE!6_ _gout
est
Flom -.. In _.._._I' 1. -- --
—
15. SCUP =I1
16.
17.
Ur14h
Frorn ._____-Tn_
Frorn __""_-1_
Front "__. _ to -
DLvnnter Slot Size Mnlndnl
- f t ___ In. __ In. --
." In. In.
— Ft —.__ in. _._ In.
�-oDd[+lnti
in __Ft
to rt.
11(At. un 2002
1
DO 11- -a crrtune111AT 1111S WE
ONS rit9.01}lCflT'ST6NBAOPOt\IANDTI
ASF VILLE HEGICiNft, OFFICE
ron OrrICE USE ONLY
Clued Nm.
Malaita'
14 4.,
L WAS cousin ICIED IN ACCORDANCE W1111 ISA NCAC 2C, WELL
AT A COPY OF ZIU9 RECO3 HAS BEEN PROVIDED TO TIIE WELL OWrJ n
rrUDE OF or Or131nUCTIr10111E N1Ell
DATE
Ivl3lon of Water Gustily, Groundwater Section WIIIIII1 30 days OW 1 nEV. 12/99
SIO
Submit original t
Serial fro

11.7217
^
I b':
7t./12-1 ..fs & IFY .`".-R"'""".'l.'!i;.su *:!I.'31_':t# t:!
I
1":i9' 1 .....
North Cnrhb„n . I rrpmbw„I rl f nvlro ,nwnl and Nmmnl Ile metes - Oivlslon of Wale Duality • Omundwnier Section
'636 Mail $rrvirn Croton . Ilntel0lt, NC. 27699-1838'Phone [phone] WELL GUNS',RUGIION RECORD wrll.coNTnACToll: —t-
9&__.��r_R pAL3.
WELL CONTfACTOft ern-firm/mart M:
SLATE WELL CONSTPUCTIO11 PEnMIIM:
243490
1. 1VELL UPI: (check Orrnr,I I fl'v). flnsidanllnlNi Muulclpnl LI IndustrialAgdcuilwnlMonllorhtg (_I
►locovrly 1 _I I teal rungs Water Injection ❑ Oilier FJ If Other, LIs1 Use:
2. WELL I.00A I IOr I: low sketch °Ulu) locnlion below)
Nemesl tcw:n' �� ,L5!�i1tS�i�p10 County.
(fined !loon mid Ups. Cement ntlly, Or bdlvl
3. oWt.I111 /) ll��A�
Address
Flom------ To fl
From --10---... .
14. G11OU1: nlhod
north ����M�n�l��Plh�o��lt� .
Flora) U .. T o 2) 2_ F 1. __S._y�.ixki+e— _ 141-E-•--
Flom _
15. SCIILPII
Drell'
nom ----- -- -L)_
Fr
Ft
1r). S
f 1AV F-I. 1'
Depth
Fr �,�' o __ LOCt.
rr m ._.— Tct rt.
17.11 MAN WELL
10 lrfw-erni WAX !Pr Oita A9 CONSIntic fEO 1N ACCOODANCE WIN115A MAC 2C.
CONS t ntic11011 !It AtIDA11D.^.. AND TIIAT A COPY OF 119 nECOI1D NA9 BEEN rnoVIDEO 10 711E WELL OWNEn..
it
----- aMefir UEPTII-
endlolNo) UFlILLINGLOG -_
l - from To ro rontren pesulption
J%J
Clo,'i '•.�;"'__.--. dale Zip Code
4. DATE UI 111I I I) _L/Cy' o
5. TOT AI. Itf: I'III _ .._6*'%-
• 6. CUT III I'ISC111I.1-1:1EU Yri9L.J NOL17J
7. DOES Wrl I_ IIEI'IACE EXIS IINO WELL? YES l_] NOI ►(
8. STATIC WAIEnLEVEL Delonlop ofCasing: _ S Ft
Oise'•' M Above Top nt easing)
9. TOP Or CA!i111; 1.7___ __.. FT. Above Lend Smenco'
'Top of cesion I.nnhmfrd Hip; heiow lend surface requires a vellums In Scoot.
s■nee',libilia WAG 2C111te Q _ __
O. YIELO ((writ_J5. MEII IOD OF TEST I J _.-_
11. WATEll ZONES Worth):_—_ _ -
—
R Lacock---
12. CI ILON NATION
13. CASING:
typo 714
Amount lecip. 11 eddittonet epnce h needed me bock of lorm
LOCA1 IONSKF. I (.;N_
W O l McKee sI
Drpli, )Inmeter or welgl VI 1. 'OMalednl D (Show dlrecllon nod dielnnce from nl Inasl Iwo SIete
Lfawls. I-I-��QM1 Hoed,, or other asap Weisner points)/ ��{j
From _—O -----1 °--`-�'_' rL 1. l�+c%i
CLitk en c
C o
o
DiamPlor Slot Size
In. ___.- In.
FL,
Welt: Iu [
r011 OFFICE USr OIILY
(Ned PO:
Mntodnl
Mnloflnl
rrnsol Of191nVCTIr1011tE Writ
SIn �tIltlE Or _
Subnit original to Olvblon M Water Overtly. Groundwater Section within 30 day, OW-1 nEV. I L„
2
Serial Po ___-

1
North Carolina • Department of Environment and Natural Resources - Division of Water Quality • Groundwater Section
1638 Mall Service Center - Raleigh, N.C. 27699-1636-Phone [phone]
243 506
WELL CONSTRUCTION RECORD WELL CONTRACTOR. .JPE f4SoIV
WELL CONTRACTOR CERTIFICATION 0: o26o2[Jt
STATE WELL CONSTRUCTION PERMITS?:
1. WELL USE (Check Applicable Boa): Residential Ld Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ if Other, List Use:
2. WELL LOCATION:4 51ow sketch of the location below) �1 ',,
Nearest Town: Ir.1 P4.'.ttt-=• County. ct4'r C-4-Cy-
(Bond Name and tubers. Community, r Subdivision and Lot No.) DRILLING LOG
3. OWNER `1050}V j�t.(11Lso From To
Address 7JJ e�/Q . O� 3 3 a
��-y� ISlceol o {outs No.)
ui;
City or Town State Zip Code
4. DATE DRILLED /-ci(i-0
5. TOTAL DEPTH ..-2'S°•s
6. CUTTINGS COLLECTED YES f NOI✓f
7. DOES WELL REPLACE EXISTING WELL? YES n NOF0'
8. STATIC WATER LEVEL Below Top of Casing: (e fl FT.
(Use's' If Above Top of Casing)
9. TOP OF CASING IS I FT. Above Land Surface'
•Top of casing terminated etfor below land surface requires a variance in accor-
dance with 15A NCAC 2C .0118
10. YIELD (gpm): �n METHOD OF TEST r
11. WATER ZONES (depth)•
r7a7
as7s
DEPTH
Formation Descdpllon
12. CHLORINATION: Type _mil- H Arnount Yra.. f if additional space Is needed use back of form
13. CASING:
Wall Thickness
Depth �/ iamet r or Weight/Ft. Maledal
From D To-L�-Ft &'a� a06'15 in.
From To Ft.
From To Ft c
DepthMaterial Methodv / o15. SCREEN:
From 0 To aid Ft ConCreke poured ( rr
From To Ft
11
Ah,,..we .. /a_
0
as tm
cz
yc
A �a
= =o
O ma
co
U1 --1
vD o
z
Doplh Diameter Slot Size Material
Frorn 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
LOCATION SKETCH
(Show direction and distance from at least Iwo Stale
Roads, or other map reference points)
17. REMARKS:
I DO HERE
CONSTRU
FOR OFFIC
ouad No:
Serial No.
2
$ AN✓v\nts3S,FIANDTHA A�
i
USE ONLY
CCQQP STRUCTED IN ACCORDANCE WITH 1SA NCAC 2C, WELL
J!P'Y or THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
NATURE OF PERSQ4 CONSTRUCTING THE WELL DATE
I to Division of Water Ouailty, Groundwater Section within 30 days
GW-i REV. 12199
GROUNEIWA ER SECTION
AR __illiE R`GIONW_ OFFICE

J1.112:2!a:24
al—T_ 1-2rI atty. .^ II _'4'_tt11=2!
'I i1 ,,., •i.,,.
North Cnrpi.n.n - t ,rP❑,unrrd of rnvIronmenl and Nnturnl flesourcei • Division of Water Ouallly • Groundwater Section
1636 Mail Srrvicn Comm' flnlelgh, N.C. 2769e-1638-Phone [phone]
243 504
WELL CONS111MAION RECORD WELLcoNTRACT0n: JS LE FE R U..SON_
WELL CONTfACTOR CERTIFICATION ll:_
STATE WELL CONSTRUCTION PEnMITn:
1. WELL 1111E (cneck ni•pnrable nor): nesldentlal(YJ Municipal El industrial ElAglicullural EllMonitoring El
R[ ecovery 1 I lenl Pump Water Injection ❑ other (] If Other, Llst Use:
2. WELL LOCATION: (Itow sketch of the location below)
/JA41Z 2 ..tt e County.
Nenresl town:_
Inord rlan in red Nurnbr,s, CC/ormiuonyy oo S�ubdlvllslon and lot No.) DRILLING LOG __DEPTH____
3. OW NFn rl ! G,C .- F ldCd1K From io rormellon Descdpnon
Address
rr -auln o.
4441,5_ o71Y a' . aas drop
k_
City PI I twirl,/ Shale zip Code
4. DATE tirtit.Lr1)L?-7'.0) _
5. TOTAI.I1f_rlll __..aLeS.—S-__
G. CUFTTIOSI.:ULU:n.1E1) YES Li NOM 7. DOES WEI.I_ IIPr'I ACE F.XI S MG WELL? YES _ I NOE yV
8. STATIGWATEnLEVEL Beiowlop ofCasing: _ FT.
ens I.' a Above Top of Cestrio
9. TOP or CASIIin is. __.1__ . Er. Abovo Lnnd Surface'
•fop of cesi n, tnr rdnnhd riser bnlnw lend surface requires a variance In scoot-
, 0. Wu) (grim): _./ MEI!IODOFTEST Ji�j
11. WATEU ZONES (drpih):_
12. CIILOi1UiAIION: Iypn 1- 1 rI
13. CASING:
Win 1hlc6ness . _ LOCAL IONSKE I CH
urldh Iorneier or Wolgbvrt. FA:11SM (Show direction And dhlnnce born tit toad Iwo Stele
Flom U 'lo c 7 rt. 1t• 35 11114135. fiCeStkR Roads, or other mop rrler env* olnts)
Amount ills II additional apace Is nrnded use hock of form
Flom to rl.
Flom -----._10.---.._-- FI.
14. GnOU
Pr! 'III Mnlerlal 4Iethod
From .._. U-.. In AQ_1i. (2olleJEk6_. _SA(Ek
From _... In - _.--I I.
15. SCI1Ef II
urlrnt Diamnlor Slot Size Malarial
Flom ___.__To_ -.__—_II_ In. _ In
From __.... 1 n _ .___ Ft._ In. In
From ___..._ To. — rt.__ In. In
16. SAND/GNAVEI. PACK:
Drill'
From __ _____ Tn _ f 1.
From ..
Size
17. REMAIII
Material
12Ad gJt,
0
O
0 E2
n1
c7 —..
CD
too lot - I -r1i IEVII MATT1113 WELL NS IntICIED IN ACCOnDANCE WIlil I5A NCAC 2C,WELL
CONSTru SIAtIDAnDS; AMOrjFIAT's"sT!•Y OF THIS IlECORg HAS BEEN PROVIDED 10 711E WELL owNEn.
, r r - + I- /h/ — a q— e
Iron orric use, orit_Y
Ousel No
ER SEC1;S4ii?i+l origin
31uNAL 01-FIC�-
ATtI E r rERSO11,COt19� IIN4 INE VittL
Dlvbton of Water Ouatlty, Orouodwalsr Section wllhln 30 day!
,
DATE
OW'1 nEv. 12199
Serial1ln I __.- -r

North Cerollna • Department of Environment and Natural Resources - Dlvlslon of Water Quality • Groundwater Section
1530 Mall Service Center • Raleigh, N.C. 27699-1636-Phone [phone]
269125
WELL CONSTRUCTION RECORD WELL CONTRACTOR- /IPRmAN L. ,f}ZC .
WELL CONTRACTOR CERTIFICATION N: cIO.9
STATE WELL CONSTRUCTION PERMITN:
1. WELL USE (Ch.ck Applicable Box): Residential Er Municipal ❑ Industrial n Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Infection ❑ Other ❑ If Other, List Use:
2. WELL LOCATION tow tow sketch, of the location below)
Ne rest Town: .,_�L�iA�.51-Q—o County'
£C/.L e41e.S Z(.r_A�e•%Ieder/
oed Name and Numbers. Common 1y, or u Melon and Lol No.)
WNER
Address
(Sheol or HouNo
U MN.S\TLD.LL. CY
Clly or Town Stale
4. DATE DRILLED lb -a -b
5. TOTAL DEPTH
6. CUTTINGS COLLECTED YES NO4
7. DOES WELL REPLACE EXISTING WELL? YES I I NO[VI
6. STATIC WATER LEVEL Below Top of Casing: 35 FT.
(Use'.' It Above Top of Casing)
9. TOP OF CASING IS FT Above Land Surface'
'Top of casing terminated eVor below land surface require. a variance In accor-
dance with 15A NCAC 2C .011a
10. YIELD (gpm): 1 METHOD OF TEST �.
11. WATER ZONES (depth)
DRILLING LOG DEPTH
From To Formation Oescdpllon
D - D )�,'R t-
c'o - 31e5 B 4RQck
12 CHLORINATION: Type
SING:
Zlp Code
0
Amount If additional space Is needed use back of form j
Wall Thickness LOCATION SKETCH
Depth Dlameler or WpeIgINPt. Malerlal (Show direction and distance from al leas) Iwo State _,_
From O To -h FI i� 07 5 e) 6 ,ins wGsDR Roads, or other map reference pains) o
From To FI. co
From To Ft. ?LC-it
`(J�"�-'� an
14. GROUT:SDepth Malollal MotlbuL N
From Q To �0 Ft. C'1lnC��fEwr, U o/ri. r l
From To Ft o
15, SCREEN: --T ='
Depth Diameter Slot Size Materiel A --
From To Ft In In —
From To FI In In CD
From To FI In In
16. SAND/GRAVEL PACK: •
-
Deplh Size Malerlal
From To Fl
From To FI
17, REMARKS:
v
0
u1
cn
rn
G
G
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUC -t a trlN d,fO; ANU T)IAI.A L Jr THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
�H .i ft; 11Li , �e { J
T OFFICE US IONLY �"'^I-�
ad No: IC wI
Serial No
AAR
6Vpmll
ma,
NATURE OF PERSON CONSTRUCTING TIIE WELL DATE
Division of Water Quality, Groundwater Secllon wllliln 30 days
OW fEV. 12/99
ASHEVILLE f- SiONAL O4-ICE

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Secllon
1636 Mall Service Center • Raleigh, N.C. 27699-1636-Phone [phone]
269126
WELL CONSTRUCTION RECORD WELL CONTRACTOR'
e R rn AN l . 2,47(.
WELL CONTRACTOR CERTIFICATION N:
STATE WELL CONSTRUCTION PERMITN:
1. WELL USE (check Applicable Box): Residential 21.
Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heal Pump Water InJecllon ❑ Other n II Other, List Use:
WELL LOCATIO
..Nirest Tow
row sketclt.ol the location below)
-CUR County' SZ nein/0
(Road Name and �Number, Communly, or Subdlvlslon and Lot No.)
�/
3, OWNER t s 1thrtLA.
Address R a, n%�
I - (Shea or Houle No. n
a8'l5 �
Cily or Town Stale Zip Code
4. DATE DRILLED It)-
5. TOTAL DEPTH
5. CUTTINGS COLLECTED YES n NO4
7. DOES WELL REPLACE EXISTING WELL? YES (l NOW(
3. STATIC WATER LEVEL Below Top of Casing: a 5 FT.
(Use 'ell Above Top ol Casing)
9. TOP OF CASING IS FT. Above Land Surface'
'Top of casing terminated aVor below land surface requires a variance In accor-
dance wllh 15A NCAC 2C .011E
10. YIELD (gpm): 3 0 METHOD OF TEST
11, WATER ZONES (depth):
DRILLING LOG DEPTH
From To
Formation Description
S 85
CO
12 "HLORINATION: Type H Amount npti S II additional space Is needed use back ol form
to SING:
Wall Thickness
Depth Diameter or WjIghVFC ;TM,,ale(dall
From LI To _)� FL-" ,o15 rt/4.b`L �j[ •
From To FI
From To FI.
14. GROUT:
Depth Matelot Motlrod ,
From Q To AOFI. C1aNC3�'iF �011�.rf-��
From To FI
15, SCREEN:
Depth Dlameler Slot Slze Materiel
From To Fl In In
From To FI. In In
From To FI In In
I6. SAND/GRAVEL PACK:
Depth Size Material
From To FI
From To Ft.
17, REMARKS:
LOCATION SKETCH
(Show direction and distance from al least Iwo Slate crCD C.0
:T
Roads, or other map reference points) r'
cr
C; rn o
OD
I DO HEREQY C RT,IEY THAT THIS WELL WA
CONSTRU TION SrlOC A'FIlPS) Air THAt?,
TRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
OP THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
NATURE OF PERSON CONSTRUCTING TIIE WELL DATE
Division ol Wnler Ouallly, Groundwater Secllon within 30 days
GW.r REV, 12/99

North Carolina - Department of Environment and Natural Resources - Division of Water Duality - Groundwater Section
1636 Mall Service Center - Raleigh, N.C. 27699.1636-Phone [phone] �
WELL CONSTRUCTION RECORD WELL CONTRACTOR- A///_'7 Rh')AN L. 2,q-�y«.
WELL CONTRACTOR CERTIFICATION ": 070.,.;
STATE WELL CONSTRUCTION PERMIT":
1. WELL USE (Check Applicable Box): Residential U Municipal ❑ Industrial n Agricultural ❑ Monitoring ❑
Recovery ❑ Heal Pump Water Injection ❑ Other n II Other, List Use:
2. WELL LOCATIONShow sketch o the location below)
estT wn: _ -�Ta a e County I�IWYI
(Road N
3, OWNER
slloon and
Lot No.)
t�L+.LA l
Address V B I
Street or Route�n el I L{/—
� 5� a o 1 n Zip Code
Cuy or Town 11 Stale
t. DATE DRILLED I.1—a—b
TOTAL DEPTH 3D5'
3. CUTTINGS COLLECTED YES NOI4
DOES WELL REPLACE EXISTING WELL? YES O NO WI
3. STATIC WATER LEVEL Below Top of Casing: Cs FT.
/ (use'.' II Above Top of Casing)
3. TOP OF CASING IS ! FT. Above Land Surface'
'Top of casing terminated et/or below land surface requires a variance In actor -
'fence with 15A NCAC 2C .0ti6
10. YIELD (gpm)' 4 METHOD OF TEST
DRILLING LOG
From To
DEPTH
Formailon Description
O 1.9
`13 -305
AIR 1-
8ie_4ck
11. WATER ZONES (depth):
12. rHLORINATION: Type TI 71-1 Amount .111-I..5
1< ,SING:
Depth
From D To 9
From To
From To
14. GROUT:
Diameter 5 Ft.
Ft
Ft.
Wall Thickness
or WpleliVFl. Material .
If additional space Is needed use back of form
Depth Material
From Q To do FI (MI CR-B4f
From To Ft
15. SCREEN:
Froln
From
From
16. SAND/GRAVEL PACK:
Depth
Flom To
From
17. REMARKS:
I DO HEREBY
CAECAA;
CONSTRUCT' OAROS, AND THAT
A'CO
Depth
To
To
To
rt
Ft
Ft
Diameter Slot Size
In.
In
In
Size
Ft
To Ft
Method
1tBte-
Material
In
In
In
Material
LOCATION SKETCH
(Show direction and distance from al least Iwo State
Roads, or other map reference points)
ral-6102‘Ai
—o
W
CPI
RUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
..e_ter II 2 o I
'TUBE OF PERSON CONSTRUCTING TIIE WELL DATE
)Ivislon el Water Quality, Groundwater Section Wllhln 30 days
GW.1 nEV. 12/99
269129
c-)
c

North Caroline - Department of Environment and Nalural Resources - Division of Water (Duality - Groundwater Section
1638 Mall Service Center • Raleigh, N.C. 27699-1638-Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR-
2691311
e Rmmi Z.
WELL CONTRACTOR CERTIFICATION II: �O.a 7
STATE WELL CONSTRUCTION PERMITS?:
1. WELL USE (Check Applicable Boa): Residential Er Municipal n Industrial n Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ II Other, List Use:
2. WELL LOCATION{�( Show sketch) of tpe location below)
1�1 1�U1'�� LN QLL County: 4-4—A
(rloed Name and Numbers, Co oily, or S(u�_bdlvvislon ror�'✓d Lot � No.)--� DRILLING LOG DEPTH
3. OWNER a1, " _.c---r (S�LI4. roil I From To Format/on Description
AddCresss lb i T�Slre E r, 7wv - r
�i11 lb-T'aioule 9r ID -l),'
Jo. n C. Dt t f� T
Cl y or Town Slate 21p Code 41 g' Ala 5 BE -the -QC k
4. DATE DRILLED 11 66-0I
5. TOTAL DEPTH Ia ri
3. CUTTINGS COLLECTED YES I ) NO
7. DOES WELL REPLACE EXISTING WELL? YES I I NOW(
3. STATIC WATER LEVEL Below Top of Casing: e.,45- FT.
(Use'.' II Above Top of Casing)
9. TOP OF CASING IS ! FT Above Land Surface'
-Top of casing terminated evor below land surface requires a variance In accor-
dance wllh 15A NCAC 2C. 11e R;
10. YIELD (gpm): METHOD OF TEST
11. WATER ZONES (depth):
12..HLORINATION: Type N Amount'/ 5 pl IIZ
15 .SING:
0
II additional space Is needed use back of form
Wall Thickness LOCATION SKETCH
Depth[ Dlameler or Weight/Ft, Material (Show direction and distance from at least Iwo State
From O To I g Ft 11.; 5 ,?14 •bS Roads, or other map reference points)
From To FI. n
From To Ft. U'LR— ri'1;aM�J
14. GROUT: iiK��� From b To 920 n e1(C.2...Eff -pQ11nd_ CI /✓'_T 0
r-4Avti
- Oephh Material Method
From To FI
15. SCREEN:
Depth Diameter Slot Size Materiel
From To Ft In In
From To Ft In In
From To Ft In In
16. SAND/GRAVEL PACK:
Depth Size Material
From To FI
From To FI
17. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
THAT A66PH3E T IIS RECORD HAS BEEN PRROOVVIIDED TOT E WELL OWNER.
CONSTRUCTIO
TURF OF PERSON CONSTRUCTING THE WELL DATE
Ion of Water Ouallly, Groundwater Section wllllln 30 days
GW-I REV. 12/99
Np?rest Tern: ( ,

North Carolina - Department of Environment and Natural Resources - Dlvlslon of Weber' Quality - Groundwater Section
1636 Mall Service Center - Raleigh, N.C. 27699-1630-Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR•
269153
eRmAN Z. 2,4(.
WELL CONTRACTOR CERTIFICATION A: a?.0.-; 7
STATE WELL CONSTRUCTION PERMITN:
I . WELL USE (Check Applicable Box): Residential L_0 Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heal Pump Waler Injection ❑ Other ❑ II Other, List Use:
2. WELL LOCATIO : (Show sketclii or the location below)
serest Town: ,y , Ai-r-4 County'
a K
02 7VP
(no 4 Name enNumbers lddANumbel ,C�onm�wtry, or 5 • 4 Ion and Lol No.) DRILLING LOG DEPTH
3, OWN R out c taA_,teq �4) From To Formation Descdpllon
Address 0 (fy �y ',,
Q �7770 n 1pU l�a'Rf
2-
l� o a-a5 "$xlre_4<k
liy or Ton Sale 21p Code
4. DATE DRILLED I—� -D
5. TOTAL DEPTH rt
o. CUTTINGS COLLECTED YES NOf
7. DOES WELL REPLACE EXISTING WELL? YES NOM'
8. STATIC WATER LEVEL Below Top of Casing: FT.
/ (Use'.' if Above Top of Casing)
9. TOP OF CASING IS / FT. Above Land Surface'
•Top or casing terminated et/or below land surface require. a variance In accor-
dance with 15A NCAC 2C.0I1e
10. YIELD (gpm): $ METHOD OF TEST
11. WATER ZONES (depth)•
ILORINATION: Type Fi 7 1-1 Amount "rt""""
13. CASING:
Ca
If additional space Is needed use back of form
Walt Thickness LOCATION SKETCH
Depth Diameter or Weight/FL ;�,M/arle`darl, �r (Show direction and distance from at least Iwo Stale
From0To (C0 Ft b ' a 5 a]i .1,5 Pv/SDR Roads, or other map reference points)
From To F1.
From To Ft
14 GROUT: �p
Depth Material Mol�rr t W� r
From D To vt° Ft �'vff CPtfE 7"`...e.`...`
From To Ft
15. SCREEN:
Depth
From To
From To
From To
16. SAND/GRAVEL PACK
Depth
To
To
From
From
17. REMARKS:
I DO FIEREDI*> EWIFY THAT THI$ WELL WAS 1 • •TRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION) STANDATiDS, ANb THATA CNA aF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
NATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit o g nal I, Dlvlslon of Wale( Duality, Groundwater Section Within 30 days
GW1 NEV. 12/99
Diameter Slot Size Material
Ft In In
FI In In
Ft In In
Malerlal
Size
Ft
Ft
JR OFFICE
Ouad No•.
Serial No
OSE,ONLY

North Carolina - Department of Environment and Natural Resources - Division ol Water Quality - Groundwater Section
1638 Mall Service Center - Raleigh, N.C. 27699-1638-Rhone [phone] 7(//�'
WELL CONSTRUCTION RECORD WELL CONTRACTOR' /rs' RMAN L • �7 2.4«.
WELL CONTRACTOR CERTIFICATION ": of 0.1 7
STATE WELL CONSTRUCTION PERMIT":
269143
I . WELL USE (Check Applicable Boa): Residential LJ Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heal Pump Water In)ecllon ❑ Other n If Other, Llsl Use:
2. WELL LOCATIQ{J: (Show sketch of (I I cation below) �
/
Brest Town: ,/L—�y'` County Vw•"`�"�.d
ai, s> its 875'P
(noed Nam nd Numbers. Commanlly,o S gclivlslo nd Lot No.) DRILLING LOG
3. OWNER From To
�/ -5 5- 3
Address
Ally or Town
au2 7/ 21
r1 slate Zip Code 4 rtq 1,25
4. DATE DRILLED / 7 —1 q `0 )
5. TOTAL DEPTH is 5
6. CUTTINGS COLLECTED YES I I NOE
4
i. DOES WELL REPLACE EXISTING WELL? YES NO71
8. STATIC WATER LEVEL Below Top of Casing: 0 FT.
/ (Use •t• II Above Top of Casing)
9. TOP OF CASING IS ( FT. Above Land Surface'
'Top of easing terminated et/or below land surface requires a variance In accor-
dance with 15A NCAC 2C.0118
10. YIELD (gpm): / S METHOD OF TEST
11. WATER ZONES (depth):
12 ILORINATION: Type H 7N Amount 2)5
13. CASING:
DEPTH
Formation Description
BE-cl2or k
If additional space Is needed use back of form
-T1
r7
W
Wall Thickness LOCATION SKETCH
Depth // Diameter or wflghtTi. ;� 'M/aate`iall��r (Show direction and dislance from al leas) two State
From O To 3 `T FI • a7 5 a)4,hS P uL• 5DR Roads, or other map reference points)
From To Ft.
From To FI.
14. GROUT:
Depth Material Method
hod -
From D To vZ-o FI OdtYC�.E'iE es
From To FI
15.SCREEN:
Depth
Frotn To
From To
From To
16. SAND/GRAVEL PACK:
Depth
To
To
From
From
17. REMARKS:
Diameter Slot Size Material
Fl In In
FI In In
FI In In
Size
FI
Ft
Material
12) ayeLi/LA
cp
W
"*T
rn
Ciucate—
w cotr7;
_ c
G
z
I DO HEREBY C
CONSTRUCTIO
JR OFFICE US
Ouad No:
Serial No.
CTED IN ACCORDANCE WITH 1$A NCAC 2C, WELL
IS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
S :�T nE OF PERSON CONSTRUCTING THE WELL DAt E
Submit origins to DWI on ol Wale( Ouallly, Oroundwater Section within 30 days
GW.I REV. 12/99
ICE
ASfit L_.

North Carolina - Departmonl of Environment and Nalural Resources - Division of Water Quality • Groundwater Section
1636 Mall Service Center - Raleigh, N.C. 27699-1638-Phone [phone]
269142
WELL CONSTRUCTION RECORD WELLCONTRACTOR•
eRmAN C. LL,
WELL CONTRACTOR CERTIFICATION 0: agDA7
STATE WELL CONSTRUCTION PERMITN:
1 WELL USE (Check Applicable Box): Residential Er Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Infection ❑ Olher f ] If Other, List Use:
2. WELL LOCATI : (Show sketch of the c Ion below)
Nearest Town: p County: '\(.1./1�-i�C-�
444-52,412,40 n',217/y(
(Rood Name end uuomben,(/pommuniiii(y,� or Subdivision and Lot No.) DRILLING`LOG DEPTH
3. OWNER �(�/�. L)(il(,-d' From To Formation Description
Address 3 t3 L �' "7 �}-
�2 i L it%)lah.1.4 S.- pr l{o�e o.) • t 7) Lf s R
City or Town ��� Slate Q' Zip Code
4. DATE DRILLED - i a-- 0 I
5. TOTAL DEPTH
6. CUTTINGS COLLECTED YES NO{4
7. DOES WELL REPLACE EXISTING WELL? YES NOM/
8. STATIC WATER LEVEL Below Top of Casing: FT.
/ (Use'e' II Above Top of Casing)
9. TOP OF CASING IS ! FT. Above Land Surface•
'Top of casing terminated eUor below lend surface requlrea a variance In accor-
dance with 15A NCAC 2C.0118
10. YIELD (gpm): 3 O METHOD OF TEST R : t�
11. WATER ZONES (depth):
3 e 0 3CoS 0 l�
tBL-deeck
ILORINATION: Type Fi 7H Amount -" If additional space Is needed use back of form
13. CASING:
Wall Thickness LOCATION SKETCH
Depth Diameter or WeIghUFt. Maleilall (Show direction and distance from al least Iwo Slate
From O To FI it • a 5 e7)4�
.1,5 �1e,n Roads, or other map reference points)
From To Ft.
From To FI
lei GROUT:
Depth Material Motlrod
From D To AO Ft C1s711C211E '_j�lntr_,_?-E'ii`
From To Ft
15. SCREEN:
Depth Diameter Slot Size Material
From To Ft In In
From To Ft. In In
From To FI In In
16. SAND/GRAVEL PACK:
Depth Size Material
To
From
From
17.FIEMARKS:
I DO HERE
CONSTRUC
rA OFFICE
Quad No'.
Serial No
To
FI
Ft
J
l$Ntlh61D$,;ASD TI1ATrA C
12h
ASHEr.L,- C'HOE
TRUGTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
F THIS RECORD HAS BEEN cr TO THE WELL OWNER.
NATURE OF PERSON CONSTRUCTING TIIE WELL DATE
Division of Water Duality, Groundwater Section wllhin 30 days
GW.I REV. 17J99
0
CD

North Caroline - Department of Environment and Natural Resource, - Division of Weler Dually • Groundwater Section
1638 Mall Service Center- Raleigh, N.C. 27699-1638-Phone [phone]
269137
WELL CONSTRUCTION RECORD WELLCONTRACTOR•
�RmAN L. —3A-Z(.
WELL CONTRACTOR CERTIFICATION %:
STATE WELL CONSTRUCTION PERMIT%:
1
WELL USE (Check Applicable Box): Residential ✓- Municipal ❑ Industrial n Agricultural ❑ Monitoring ❑
Recovery ❑ Heal Pump Water Infection ❑ Other D 11 Other, List Use:
2. WELL LOCAT
ieNr� sal Town:
(nso/ d Name qr
3. OWNER
Address
(Show sketch 91 the location below)
1AMri 1 ✓ •• 1 / County:
lr,c'd_ les ,l_Pnet 11I
d Numbers, Communll or SubdhIsion and Lot No.)
n5L..f en5[e-
r
-E. q
ir � or out
A. rYls ✓, fieyag7/
Cliy or Town 7 Stale Zip Code
5. DATE DRILLED / / -1) TOTAL TOTAL DEPTH �T
5. CUTTINGS COLLECTED YES NOIV1
7. DOES WELL REPLACE EXISTING WELL? YES [i• NOW(
6. STATIC WATER LEVEL Below Top of Casing: _5 FT.
/ (Use •e- II Above Top of Casing)
9, TOP OF CASING IS ! FT. Above Land Surfacer
•Top of casing laminated etlor below land surface require it a variance In accor-
dance wllh 15A NCAC 2C.011E
10. YIELD (gpm): __ METHOD OF TEST /\
11. WATER ZONES (depth)•
DRILLING LOG
From To
L
/t 5
1 HLORINATION: Type HT H Amount -'
ibiLLS
13. CASING:
Wall Thickness
Depth Diameter or WJIghUFI. M�u� dal
From Q To //-- � Ft. la e 5 Alto•
From To Ft
From To Ft
14. GROUT:
From Q
Depth Material
To a0 F1. C'cr(C.2..EfE
From To Ft
15. SCREEN:
Method
Depth Diameter Slot Size Material
From To Ft In In
From To FI in In
From To Ft In In
16. SAND/GRAVEL PACK:
Depth
From To
From To
Size
Fl
Ft
Material
DEPTH
Formation Descdpllon
��rR
B Fd2e c
II additional space Is needed use back of form
LOCATION SKETCH
(Show direction and distance from al least Iwo Slate
Roads, or other map reference points)
2 C e ay- 4_e.
L�rYXs V; lie AR---7-3
0.3r—
c
17. REMARKS:
I DO HER
CONSTR
R OFFI
Ouad No:
Sedal No,
IFY-THAT TNiS VJEOE WAS I INSTRUCTED IN ACCORDANCE WITH 15A NOAC 2C, WELL
ANDARDS AND THAT -A C• I OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
yr
Submyodglna
ONATUIE OF PERSON CONSTRUCTING TIIE WELL DATE
to Division of Water Duality, Groundwater Sedlon Within 30 days
GW.l NEV. 12/99

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1638 Mall Service Center- Raleigh, N.C. 27699.1636-Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR- ND RmAN Z . ,9-L.
WELL CONTRACTOR CERTIFICATION 0: c O..3 7
STATE WELL CONSTRUCTION PERMIT#:
269136.
WELL USE (Check Applicable Box): Residential I✓f Municipal n
Recovery [1 Heal Pump Water Injection n Other n II
2. WELL LOCATIO (Show sketch ,qpl the Iocalion below)
Neal ,i Town: (-L)TIv1.S `�'� County:
"p6zx/r & ezi s2,4.l.C¢- i»Cf 877
(noed Name en umber, Co unlly, or Subdivision and Lot No.)
3. Ul J
OWNER
Address
2 Streator
Iioule No. c 6 I I
1.w.5� •c19e, t�.C. ,DS7/24
ty or Town Stale Zip Code
DATE DRILLED b 1
1. TOTAL DEPTH O
3. CUTTINGS COLLECTED YES 1 NO1 f
DOES WELL REPLACE EXISTING WELL? YES 1 NOM'
3. STATIC WATER LEVEL Below Top of Casing: (3 FT.
(Use'.' II Above Top of Casing)
3. TOP OF CASING IS FT Above Land Surface'
'Top of casing terminated aUor below land surface requires a variance In accor-
ience wllh 15A NCAC 2C Stile
I D. YIELD (gpm): a. METHOD OF TEST �.
11. WATER ZONES (depth):
Industrial I1 Agricultural ❑ Monitoring ❑
Other, List Use:
am
DRILLING LOG
From To
DEPTH
Formation Descdpnon
6 7 - 306
12. "HLORINATION: Type TT 7H Amount � }11IIS
I5 .SING:
Wall Thickness
Depth/ Diameter or Weight/FL Mal„ edal _
From O To Ca nl Ft I• a 5 a)G,iis P SOR
From To FI
From To FI
14. GROUT:
Depth MateriariCLE Method
From Q To PZO Ft Ct�lYf�.EiE
From To Ft
15. SCREEN:
From
From To
From To
16. SAND/GRAVEL PACK:
Depth
To
To
From
From
17. REMARKS:
Depth
To Ft
Ft
FI
Dlameter
In
In
In
FI
FI
Slot Size Material
In
In
In
Size Material
3�xeck
If additional space Is needed use back of form
LOCATION SKETCH
(Show direction and distance from al least Iwo State
Roads, or other map reference points)
—.1
I DO VIER Y CEI3IIEYTHAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTFI oT 1 STANDARDS, AND Dig A OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
IONATURE OF PERSON CONSTRUCTING TIIE WELL DATE
to Division of Water Duality, Groundwater Section Wlildn 30 days
GW I REV. 12/99

North Caroline - Department or Environment and Natural Resources - Division of Water Quality - Groundwater Section 7 7 0 4 2
1630 Mall Service Center. Raleigh, N.C. 27699-1636-Phone (919) 733•3221 __''
WELL CONSTRUCTION RECORD WELL CONTRACTOR- He mAN L • 2/TLL.
WELL CONTRACTOR CERTIFICATION II: 4,70.; 7
STATE WELL CONSTRUCTION PERMIT'S:
1. WELL USE (Cneck Applicable sox): Residential I✓I Municipal l-1 Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heal Pump Water Infection ❑ Other ❑ ll Other, List Use:
2. WELL LOCATIOyj: (Show sketch of Vie to ailon below)
Ne azest Tow vvi � . ^ ` /^County I �A{"'
(Road Name tend Numbers, Como Ily, or Subdivision and Lot No.)
3. OWNER A teD C� a t(I /-^ V q
G7ess Add'r
lrgs or ioule Ai a.
Clly or Town Slate �
4. DATE DRILLED - D 3— D '
5. TOTAL DEPTH 3
5. CUTTINGS COLLECTED YES I f NOWI
DOES WELL REPLACE EXISTING WELL? YES I I NO 71
5. STATIC WATER LEVEL Below Top of Casing: .LQ FT.
/ (Use'.' if Above Top ol Casino)
9. TOP OF CASING IS 1 FT Above Land Surface'
'Top of casing terminated al/or below land surface requires a variance In accor-
dance wllh 15A NCAC 2C .0118
10. YIELD (gpm)' / 0 METHOD OF TEST Q
11. WATER ZONES (deplh)'
to - 3oq
/ L{
Zip Code
le•
DRILLING LOG DEPTH
From To
Formation Oescdpllon
D — CQ 3 Nit
B&4tpr k
11 ILORINATION: Type TT 7 H Amount e_i'LibilLS If additional space Is needed use back ol form
13...ASING:
Walt Thickness
SKETCH
Depth Diameter or Weight/Ft. Maledal (Show direction and distance from at least Iwo Slate
From 0 To 3 FI. / '; 5 a)G r%?5 1wGSDR Roads, or other map reference points)
From To Ft.
From To FI.
14. GROUT: p, 4
Depth Malorlal Method
From D To AO Ft C'QIYCi.E'FE .7D%.�dDlt—
From To FI.
15, SCREEN:
Depth Diameter Slot Size Materiel
From To Ft In In
From To Ft In In
From To FI In In
16. SAND/GRAVEL PACK:
From
From
17. REMARKS:
Depth
To
To
Size
Ft
FI
Material
0
CO
I DO HEREDY
CONSTRUCTI
I OFFICE
t_tauad No:
Serial No
EI';L.WA
THAT A'CO
'RUCTED IN ACCORDANCE WITH ISA NCAQ 2C, WELL 'o
THIS RECORD HAS BEEN PROVIDED THE WELL OWNER. c.�
iL5 t44!LIRE OF PERSON CONSTRUCTING TIIE WELL DATE
Submll odpinal to Ivlsion of Water Duality, Groundwater Section within 30 days
j GW-I REV. 12/99
•
cc,

Uorth Carolina - Department al Environment and Natural Resources - Division of Water Dually • Groundwater Section 270421
636 Mall Service Center • Raleigh, N.C. 27699-1636-Phone [phone] //_`
NELL CONSTRUCTION RECORD WELLCONTRACTOR- /yTs'RmAN L. —3.4((.
WELL CONTRACTOR CERTIFICATION 0: cQO,i
STATE WELL CONSTRUCTION PERMITN:
WELL USE (check Applicable Boa): Residential I.± Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water injection ❑ Other n II Other, List Use:
2. WELL LOCATION' (Show sketch of the lo;allon below) --/
•
Courtlyl/^
esl Town:
i I • • / . �_. / ' I ecr O
(nced Name an DRILLING LOG DEPTH
3. OWNER AW—_ S_
Address s �'�rI77Ii�i _t
Numbers, Community or Subti Ion and Lot No.)
From To Fonnellon Description
0 - lrl 0 A.R.)-
Ill. A A _ r . e .• Cob - rk Lc 5 $.F-Afe_o ck
City orTown Slate
6/ Zlp Code
4. DATE DRILLED
5. TOTAL DEPTH r�
3. CUTTINGS COLLECTED YES n r.71
'. DOES WELL REPLACE EXISTING WELL? YES Q NO71
3. STATIC WATER LEVEL Below Top of Casing: SS' FT.
/ (Use Y' it Above Top of Casing)
9. TOP OF CASING IS ! FF. Above Land Surface'
•Top of casing terminated sUor below land surface requires a variance In scow-
-lance wllh 15A NCAC 2C.011e R.
10. YIELD (gpm): SO METHOD OF TEST
11. WATER ZONES (depth)•
12 ILORINATION: Type 11 7H Amount
13. CASING:
From
Wall Thickness
Depth (Diameter or Weight/Ft. ;1 Materia
l
0 To IRO Ft it • a 5 ,QJ&•1;5
From To Ft
From To FI,
14. GROUT:
Depth Material Method
From D To .02- 0 Ft COlYCLL-•it _pDL1.2.><'d,_.
From To Ft
15. SCREEN:
Depth Diameter Slot Size Materiel
From To Ft In In
From To Ft In In
From To Ft In In
16. SAND/GRAVEL PACK: •
Depth
To
From
From
17, REMARKS:
I DO TIERED
CONS -MC
JR OFFICE
Ouad No'.
Serial No
IT
SE ONLY
To
Size
FI
Ft
Material
11 additional space Is needed use back of form
LOCATION SKETCH
(Show direction and distance from al least Iwo Slate
Roads, or other map relerence points)
0
w
0
C.%
r TFIATjTiISrEkv,INS
DAMSI;rAN j THAT
1
f
F
TRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL y
F THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER. o C
-7 _} 19d� A; -C o /
ATURE OF PERSON CONSTRUCTING THE WELL DAZE
Ivlslon of Water Duality. Groundwater Section Wilton 30 days
GW.I REV. 12/99

rorth Carolina • Department of Environment and Natural Reeourcea - Division of Water Dually- Groundwater Section
638 Mall Service Center - Raleigh, N.C. 27699-1638-Phone [phone]
270418
HELL CONSTRUCTION RECORD WELL CONTRACTOR. RmAN L.
WELL CONTRACTOR CERTIFICATION,:
STATE WELL CONSTRUCTION PERMIT,:
WELL USE (Check Applicable Box): Residential lI Municipal ❑ Industrial n Agricultural ❑ Monitoring ❑
Recovery in Heat Pump Water Infection n Other n II Other, List Use:
c�a v
(Floe Name and nNumben, Communll or $ubdlvisl nand Lol N J DRILLING LOG
1, OWNER `% r �.gefieL � P C.i- From To
Address
WELL LOCATION: (Show sketch of ll a locallon below)
Ne rest Trifn: p 415 County*
Ala fireY S
,AA t 4 UN
•�
City or Town Slate
t, DATE DRILLED / '-•, 0 i — t
TOTAL DEPTH . 0 V
3. CUTTINGS COLLECTED YES n NOF
4
DOES WELL REPLACE EXISTING WELL? YES Q NO(Vf
3. STATIC WATER LEVEL Below Top of Casing: (� FT.
(Use -s' II Above Top of Casing)
3. TOP OF CASING IS j FT Above Land Surface'
'Top of casing terminated at/or below land surface requires a valance In accor-
dance with 15A NCAC 2C .0118JJrr'�
-T
10. YIELD (gpm): METHOD OF TEST
11. WATER ZONES (depth)•
DEPTH
Fonnallon Description
In S - 3 b $ F-citp c_k
•
2
Code
I' `ILORINATION: Type )4 7H Amounts, ItS If additional space Is needed use back of form
13. JASING:
Wall Thickness LOCATION SKETCH
Depth Dlameler or WeIghvFI. ;�Maa�le`dall (Show direction and distance Irom al least Iwo State
From_ To El is ' 5 414.1,5 Thtt 2PL Roads, or other map reference points)
From To Ft
From To FI.
14. GROUT:
Depth Material MethodJ
From Q To A 0 FI e�1YCp-E'f!z D.._
From To Ft
15. SCREEN:
Depth Diameter Slot Size Material
From To FI In In
From To FI In In
From To FI In In
16, SAND/GRAVEL PACK:
Depth Size Material
From To Ft
From To FI
17. REMARKS:
J
r1
0
I DO HEREBY
CONSTRUCT
)R OFFICE
Ouad No:
Sedal No,
SE ONLY
AP
TF.f[S WEt''1W,
S,LAND'TIIAT AGO
tRUCTEO IN ACCORDANCE WITH 15A NCAC 2C, WELL
THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
V
,I1ATURE OF PERSON CONSTRUCTING THE WELL
Submit odpina to )IvIslon of Water Duality, Groundwater Section wil)tln 30 days
DATE
GW-I GEV. 12/99

e
Vorth Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1638 Mall Service Center - Raleigh, N.C. 27699-1638-Phone [phone]
JVELL CONSTRUCTION RECORD WELL CONTRACTOR- /T d' RmAN L • 2(.
WELL CONTRACTOR CERTIFICATION
STATE WELL CONSTRUCTION PERMITN:
1. WELL USE (Check Applicable Box): Residential ✓� Municipal ❑ Industrial n Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other n 11 Other, List Use:
2. WELL LOCATIO Sltow sketch of t111)1e/Ip�ca tion below)
Neared Town: M " ' "' ^' Courtly
I oe me a Numbers. Co unit r Su..IvIsion end Lol No.) DRILLINGLOGDEPTH
3. OWNER a. �, l� From To Formation oescdpllon
Address
W ✓Vl
270416
NA
Clly or Town tale Code D Y - ` J 62 D B E—[I �qc k
4. DATE DRILLED � — / I —0
5. TOTAL DEPTH / £P 0
5. CUTTINGS COLLECTED YESj J NO171
7. DOES WELL REPLACE EXISTING WELL? YES I NO
S. STATIC WATER LEVEL Below Top of Casing: 3 0 FT.
/ (Use Y' If Above Top ol Casing)
9. TOP OF CASING IS ! FT. Above Land Surface'
'Top ol casing terminated eVor below land surface requires a variance In accor-
dance with 15A NCAC 2C .0116
10. YIELD (gpm): 3 0 METHOD OF TEST
11. WATER ZONES (depth)'
12 LORINATION: Type FT TH Amount rT If additional space Is needed use back ol form
13. uASING:
Wall Thickness LOCATION SKETCH
Depth Dlameler or Weight/Ft. ;�'M'aater`iall (Show direction and distance from al least two State
From D To FI 1a • a 5 ,?l 4 ,h5 J�I/C•SDK Roads, or other map reference points)
From To Ft,
From To Ft.
14. GROUT:
Depth Material Molhod
! _
Frorn0 DeTo th0 It C'o/Y serial
From To FI
15. SCREEN:
Depth Dlarneter Slol Site Material
From To Ft In In
From To Ft In In
From To Ft. In In
16. SAND/GRAVEL PACK:
Oeplh Size Material
From To Ft
From To FI
17. REMARKS:
I DO HERE IY
CONSTRUC I� rb
OFFICE
Quad No:
TY4A4tlS W
ANDARDS, AND THAT A
-j 2003
Pq"
TRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
F THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
SIG ATURE OF PERSON CONSTRUCTING TIIE WELL DATE
--SubadMrlginal t Division of Water Quality. Groundwater Section within 30 days
r `•, INN cw.i nEv. 1v99
_.. FFICE
01

Nth Carolina - Department of Environment end Natural Resources - Division of Water Dually - Groundwater Section
536 Mall Service Center - Raleigh, N.C. 27699.1636•Phone (9I9) 733•3221 �/� �j
NgRmAM L. 7 �» (.
JELL CONSTRUCTION RECORD WELL CONTRACTOFI• ELL CONTRACTOR CERTIFICATION #: aSts 7
STATE WELL CONSTRUCTION PERMITM:
270414
WELL USE (Check Applicable Sox): Resldenllal ✓" Municipal n Industrial n Agricultural ❑ Monitoring ❑
Recovery in Heat Pump Water Injection in Other 0 If Other, List Use:
WELL LOCATI• : (Show sketch of the location below)
County:
Ne.a=s1 Town:
(noed N
I. OWNER
Address
umbers, Co moplly. or
UJ•Subdivision and Lot No.) r �,
(S a to Houle No
City or Town �s Stale
4, DATE DRILLED 1 d-" 0 5- O 1
3. TOTAL DEPTH Jrgs 53. NO��
CUTTINGS COLLECTED YES Li,.�(
DOES WELL REPLACE EXISTING WELL? YES ( d N 1j it
3. STATIC WATER LEVEL Below Top of Casing: .C/_
FT.
I (Use'+' II Above Top of Casing)
9. TOP OF CASING IS ` FT. Above Land Surface'
'Top of casing terminated etfor below lend surface requires a variance In accor-
dance whh 15A NCAC 2C .011a n as a,tsJ
10. YIELD (gpm). 3 b 0 rMETHOU OF TEST
11. WATER ZONES (depth)•
999
cI
a$740
33- sa5
Zip Code
DEPTH
Formation Description
Pi'Ri-
-LR-ec k
0
12. LORINATION: Type NTH Amount Bf.s If additional space Is needed use back of form c,3
13. CASING:
Depth
3 3
From To
From To
From To
14. GROUT:
Ft Diameter
Ft. lL d 6
Ft
Wall Thickness
or W ight/Ft, Maiedal.
ah] ,b5 Pv •
Depth NC- MaterialMethod ,
From 0 To PZD Ft i��nCF�f E ".jr_Ll_�)~"d.....
From To FI.
15. SCREEN:
Depth Diameter Slot Size Material
Frain To Ft In In
From To Ft In In
From __ To Ft. In. In
16. SAND/GRAVEL PACK:
Depth Size
From To Ft
From To Ft
17. REMARKS:
I DO HEREBY
CONSTRUCT'
Ii
. JR OFFICE NLY
IQuad No:
Serial No.
Material
, EllVE
tt-W
STANDARDS, AND TI1AT A C
- 1 23133
LOCATION SKETCH
(Show direction and distance from et least two State
Roads, or other map reference polnis)
RUGTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
—OS-O/
SION TURF OF PERSON CONSTRUCTING TIIE WELL DATE
---_.:— Y .,bra'Ir. g nal to etvision of Water Gustily, Groundwater Section willtin 30 days
CI=FI ow.I REV. I2/99

North Carolina • Department of Environment and Natural Resources - Division ol Water Quality • Groundwater Section
1636 Mall Service Censer • Raleigh, N.C. 27699-1636-Phone [phone]
270413
WELL CONSTRUCTION RECORD WELL CONTRACTOR•
eRmAN Z. 27)-L(.
WELL CONTRACTOR CERTIFICATION #: a? 0-9 7
STATE WELL CONSTRUCTION PERMITM:
1. WELL USE (Check Applicable Boa): Residential I Municipal n Industrial ri Agricultural ❑ Monlloring ❑
Recovery Fi Heat Pump Water Infection n Other n If Other, List Use:
2. WELL LOCATION: J.�jlow sketch of the location below)
unrest Town: ^+-� Z County
(Road Name and u^'Qen, Corrmunhly, u , or SbdWllslon and Lol No,)
I
3. OWNER l o his_,,,,) Aj 9n-CLU--)
Address 6t,gr1LI
u'inSSheol or II uq Ie Now)
tte
,; 8'114-
Slate Zip Code
4. DATE DRILLED 1II- I5-6 1
5. TOTAL DEPTH 3 .RO
6. CUTTINGS COLLECTED YES [ I NOI4
7. DOES WELL REPLACE EXISTING WELL? YES I NO71/
8. STATIC WATER LEVEL Below Top of Casing: a 0 FT.
/ (Use'.' II Above Top of Casing)
9. TOP OF CASING IS ! FT Above Land Surface'
•Top of casing laminated aVor below lend eurlace requires a variance In actor• C
dance with 1SA NCAC 2C .0118 W
10. YIELD (gpm): .421)11 METHOD OF TEST
11. WATER ZONES (depth):
DRILLING LOG
From To
cJ - 130
DEPTH
Fonnallon Oescdpllon
JB E-r{e-Q c k
Cby or Town
12 ''HLORINATION: Type
1 .SING:
-I 7ti Amount 411LS
Wall Thickness
Depth 1 Diameter or W%iphUFL Material (Show direction and distance from at least two State
From To FI !s • a 5 or; )'" •1•7 • Roads r other map reference points)
From To Ft CC 6ce[J /,
From To FI. F+ K
14. GROUT:
Depth Masons- Method
From D To AO FI it�lY C�.E •FE ..) �-E
From To Ft j
15. SCREEN:
c.a
II additional space Is needed use back of form �.
-�r
Depth Diameter Slot Size Material
From To FI In In
From To Ft In In
From To FI In In
16. SAND/GRAVEL PACK:
From
Ram
Depth
To
To
17. REMARKS:
I D0 HERE
CONSTRU
1 OFFIC
.,ad No:
Size
Ft
Ft
Material
LOCATION SKETCH
0
0\
O
W
rn
CO r—
CO
c
iN
(i FICE
TRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
F THIS RECORD FIAS BEEN PROVIDED TO THE WELL OWNER.
NATURE OF PERSON CONSTRUCTING THE WELL DALE
o Division ol Water Quality, Groundwater Secllon within 30 dayS
GW.I REV. 12199