Av CY2002

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] 4
WELL CONSTRUCTION RECORD
WELL CONTRACTOR: Dewey Wright Well Pump Co., Inc.
WELL CONTRACTOR CERTIFICATION #• 2881
020145 STATE WELL CONSTRUCTION PERMIT#• Steve Petty
1. WELL USE (Check Applicable Box): Residential X Municipal
Recovery 0 Heat Pump Water Injection Other
Industrial
Agricultural fl Monitoring
If Other, List Use.
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: BOONE County: AVERY
PRIVATE RD OFF FLAT SPRS CFM RD OFF FLAT SPR
(Road Name and Numbers, Community, or Subdivision and Lot No.)
3. OWNER TEDDY J GREENE
Address P 0 BOX 7784
HI GHLANt8Set or Rowe Nn NC 28741
City or Town State Zip Code
4. DATE DRILLED 12/31/2002
5. TOTAL DEPTH 105
6. CUTTINGS COLLECTED YES 0 NO
7. DOES WELL REPLACE EXISTING WELL? YES I I NO
8. STATIC WATER LEVEL Below Top of Casing: 5 FT
(Use'+" if Above Top of Casing)
9. TOP OF CASING IS 1 FT Above Land Surface*
'Top of casing terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2C.011
10. YIELD (gpm) 2 METHOD OF TEST Ar
11. WATER ZONES (depth):5 ppm50-52 7 qpm 82-84
qpm 0 PPrn
12. CHLORINATION: Type PITH Amount 21
13. CASING:
X
Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 40 Ft. 5 1/8. .350 PVC
From To Ft
From To Ft
14. GROUT:
Depth Material Method
From 0 To 20 Ft Cement Gravity Flow
From To Ft
15. SCREEN:
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 Tor,—E-1.
17. REMARKS. II �r , Th—
I DO HEREBY CERT FYTHATTHIS WELL WAS CON TF
CONSTRUCTION STANDARDS, AND THAT A COP \.OFi
j:
FOR OFFICE USE O'1LY
Quad No: l
SyG NAT
Submit original to Di
DRILLING LOG
From To
0 35
DEPTH
Formation Description
DIRT
35 50 GRANITE
50 52 SHALE
52 82 GRANITE
82 84 SHALE
84 105 GRANITE
If additional space is needed use back of form
LOCATION SKETCH
(Show direction and distance from at least two State
4_, Roads, or other map reference points)
\0
c
SMi(ICES., li4
.
TED IN ACCORDANCE WITH 15A NCAC 2C, WELL
-IIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
Cn C o
f--3o -03
s v
RE OF PERSONCONSTRUCTING THE WELL DATE
ision of Water Quality, Groundwater Section within 30 days
GW-1 REV. 12/99
Serial No.

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone]
^o6992
WELL CONSTRUCTION RECORD
WELL CONTRACTOR CERTIFICATION #• 2138/
0204513 STATE WELL CONSTRUCTION PERMIT#• Steve Reece
WELL USE (Check Applicable Box): Residential I XI Municipal 1 I Industrial I I Agricultural I 1 Monitoring
Recovery Ell Heat Pump Water Injection I 1 Other If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: BANNER ELK County: AVERY
ELDERBERRY RIDGE RD. OFF BEECH MTh PRKWY OF
(Road Name and Numbers, Community, or Subdivision and Lot No.l
3. OWNER M&K DEV.
City or Town State
4. DATE DRILLED 12/2/2002
5. TOTAL DEPTH 400
6. CUTTINGS COLLECTED YES I I NO
7. DOES WELL REPLACE EXISTING WELL? YES 1 I NO
8. STATIC WATER LEVEL Below Top of Casing: 400 FT
(Use "+" if Above Top of Casing)
9. TOP OF CASING IS 1 FT Above Land Surface*
'Top of casing terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2C.011{I Air10. YIELD (gpm)' U METHOD OF TEST
11. WATER ZONES (depth) 0 ppm DRY HOLE 0 Ppm
0 PPm 0 Ppm
WELL CONTRACTOR: Dewey Wright Well Pump Co.. Inc.
Address P.O. BOX 1538 ,
BANNER 'EL °rRouteN0.i NC 28604 5 400 GRANITE
Zip Cade
DRILLING LOG DEPTH
From To Formation Description
Ixl
12. CHLORINATION: Type HTH Amount
13. CASING: LOCATION SKETCH
Wall Thickness
Depth Diameter or Weight/Ft. Material (Show direction and distance from at least two State
From 0 To 21 Ft 6 1/8 ..350 PVC Roads, or other map reference points)
From To Ft
From ,To Ft
��p VAt
14. GROUT: a `' /_.c1�C.J
Depth Material Method 1'�
From 0 To 20 Ft Cement Gravity Flow �21 �
m
From To Ft �7 .S 'I f o,
lD =r'n• t'
,I Cr- m, yrLP
're--,15. SCREEN: 're--,fi.l V -il I
Depth Diameter Slot Size Material 1 - cnz
rn�
From To Ft in in. 1814- 5 `01 y
From To Ft in in en
r
From To Ft in in l
\—_-.. iiLeoAc
0 5 DIRT
If additional space is needed use back of form
16. SAND/GRAVEL PACK:
From
17. REMARK
I DO HERE
CONSTRU
From ILt/T0— Ft +H
L i
Material
TIFY THAT THIS WELL AS C NSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
STANDARDS, AND THA A CO Y OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
FOR OFFICE(-USE=4Ni.(
Quad No:
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit original to Division of Water Quality, Groundwater Section within 30 days GW-1 REV. 12/99
Serial No.

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone]
266934
e; Material
•
l
ill �j
WELL CONSTRUCTION RECORD
WELL CONTRACTOR. Dewey Wright Well Pump Co., Inc.
WELL CONTRACTOR CERTIFICATION #: 2881
020920 STATE WELL CONSTRUCTION PERMIT#• Steve Petty
1. WELL USE (Check Applicable Box): Residential
Recovery Heat Pump Water Injection
X
Municipal
Other
Industrial
Agricultural Monitoring
If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: - LINVILLE County' AVERY
SUGAR MTN # 1 OFF HWY 181 OFF HWY 105
(Road Name and Numbers. Community, or Subdivision and Lot No.)
DRILLING LOG DEPTH
3. OWNER MICHAEL HORNEY From To Formation Description
Address P-O. SOX 1331 , 0 40 DIRT
NEWLAN`eat °` Route No NC 28657 40 48 GRANITE
City or Town State Zip Code
48 49 QUARTZ
4. DATE DRILLED 11/8/2002 49 85 GRANITE
5. TOTAL DEPTH 120 05 0O SHALE
6. CUTTINGS COLLECTED YES I I NO X 88 120 GRANITE
XI
7. DOES WELL REPLACE EXISTING WELL? YES I NO
8. STATIC WATER LEVEL Below Top of Casing: 30 FT
(Use "+" if Above Top of Casing)
9. TOP OF CASING IS 1 FT Above Land Surface*
*Top of casing terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2C.0118
10. YIELD (gpm)' 20 METHOD OF TEST Air
11. WATER ZONES (depth)•10 gpm48-49 10 ppm 85-88
0 ppm 0 ppm
12. CHLORINATION: Type HTH Amount 19
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 0 To 47 Ft 6 1/8 .350 PVC Roads, or other map reference points)
From To Ft y6
From To Ft 1(`.[ti ,(D
14. GROUT: pti,;‘' ,I?I?�
Depth Material Method LL o'� C"
From 0 To 20 Ft Cement Gravity Flow
From To Ft
15. SCREEN:
Depth Diameter Slot Size Material
From To Ft in in
From To Ftin in
From To Ft in in
16. SAND/GRAVEL PACK:
From�-hi--+-To- Ft`-
From
17. REMA"k •
I DO H:REBY CERTIFY THAT THIS WEL WA CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONST•UCT�ON STANDARDS AND T AT A COPY OF THIS REC.'' HAS BEEN PROV ED TO THE WELL OWNER.
`�� -� ' / = 3 03
jl
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit original to Division of Water Quality, Groundwater Section within 30 days
GW-1 REV. 12/99

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section " !� 3 f) 9 38
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR: Dewey Wright Well Pump Co., Inc.
2Ctf1
intnetn,
VLVtlL1
WELL CONTRACTOR CERTIFICATION #P
STATE WELL CONSTRUCTION PERMIT#' '`eve freuy
1. WELL USE (Check Applicable Box): Residential
Recovery [ I Heat Pump Water Injection
1 x1
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: INVERSHIELD
DOBBINS RD. OFF HWY 184
Municipal
Other
1
Industrial 0 Agricultural 1 I Monitoring
If Other, List Use:
County: AVERY
(Road Name and Numbers, Community, or Subdivision and Lot No.)
3. OWNER RICHARD SCHOFIELD
Address % COLVERT CONSTR. CO. , P.O. BOX 253
SUGAR GFFOV'ERoute N°NC 28879
DRILLING LOG DEPTH
From To Formation Description
0 61 DIRT
81 200 GRANITE
City or Town State Zup Code
4. DATE DRILLED 11/13/2002
5. TOTAL DEPTH 740
6. CUTTINGS COLLECTED YES I I NO
7. DOES WELL REPLACE EXISTING WELL? YES 0 NO
8. STATIC WATER LEVEL Below Top of Casing: 180 FT
(Use "+" if Above Top of Casing)
I XI
X
9. TOP OF CASING IS 1 FT Above Land Surface*
*Top of casing terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2C.01
10. YIELD (gpm): u METHOD OF TEST Air
11. WATER ZONES (depth)•2 April 200-203 13 qpm `v80-5
0 qpm 0 qpm
12. CHLORINATION: Type HTH Amount 114
13. CASING
Depth
From 0 To 114 Ft 8 1/8
From To Ft
From To Ft
14. GROUT:
Depth
From 0 To 20 Ft Cement
From To Ft
Diameter
15. SCREEN:
Wall Thickness
or Weight/Ft. Material
.188 GALV
Material Method
Gravity Flow
Depth Diameter Slot Size Material
From To Ft in in
From To Ft in in
From To Ft in in
16. SAND/GRAVEL PACK:
From
From
17. REMARKS
I DO HERE
CONSTRU
\,,Sizely, 1 Material
Ft t
Ft
TIFY THAT THIS WELL
STANDARD-A1tFF3.;11 r F
200 203 QUARTZ
203 580 GRANITE
580 585 QUARTZ
585 740 GRANITE
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)
ti
/G S
t� o
c.�
L c>
m c
rfl
'V • y• t
� ao
rn � x�
NJ
O
O o
I
Dobbins Rd-
NSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
Y OF THIS REC.PI D HAS BEEN PROVIDED TO THE WELL OWNER.
SIGNATURE OF PERSON CONSTRUCTINC-IE WELL DATE
Submit original to Division of Water Quality, Groundwater Section within 30 days
GW-1 REV. 12/99

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone]
266933
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.0117$�
10. YIELD (gpm)' 60 METHOD OF TEST Aar
11. WATER ZONES (depth).2 ppm75-76
0 qpm
58 opm 106-108
0 opm
12. CHLORINATION: Type HTH
13. CASING:
Depth Diameter
From 0 To 45 Ft 6 1/8
From To Ft
From To Ft
14. GROUT:
From
Depth
0 To 20
Amount 22
Wall Thickness
or Weight/Ft.
Material
.350 PVC
Material
Ft Cement
From To Ft
15. SCREEN:
Method
Gravity Flow
Depth Diameter
From To Ft in
From To Ft in
From To Ft in
Slot Size Material
in
in
in
16. SAND/GBAV€k-pAEit--
Size I 1
From
From
WELL CONSTRUCTION RECORD
WELL CONTRACTOR CERTIFICATION #. 2681
02071g STATE WELL CONSTRUCTION PERMIT#. Steve Petty
1. WELL USE (Check Applicable Box): Residential
Recovery I I Heat Pump Water Injection
X
Municipal El Industrial
Other If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: ELK PARK County. AVERY
PRIVATE DR. OFF BARLOW RD. OFF CUR11S CREEK R
(Road Name and Numbers, Community, or Subdivision and Lot No.)
3. OWNER WAYNE D. LOWE
Address 21504 VERANO PLACE ,
CORNELIfee1 or
Route No.) NC 28031
Agricultural Monitoring
DRILLING LOG
From To
0 40
DEPTH
Formation Description
DIRT
40 75 GRANITE
City or Town State
4. DATE DRILLED 11/20/2002
5. TOTAL DEPTH 125
6. CUTTINGS COLLECTED YES NO
7. DOES WELL REPLACE EXISTING WELL? YES I I NO
8. STATIC WATER LEVEL Below Top of Casing: 20 FT
(Use "+" if Above Top of Casing)
Zip Code
x
-71 Depth
i) T6
t 1 i"-• To
17. REMARKS:
I DO HEf�EBY _RILEYTHAT
CONSTR(JCTIO STANDARDS,.A
Ft
Ft
FOR OFFICE USE ONLY
Quad No:
Subm
XI
WELL CONTRACTOR: Dewey Wright Well Pump Co., Inc.
75 76 SHALE
76 106 GRANITE
106 108 SHALE
108 125 GRANITE
Material
If additional space is needed use back of form
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other map reference points)
sut
V
4.
8
O
w
L
tU
-0
N
O
O
AS bONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL t15
PY OF THIS CORD HAS BEEN OVIDED TO THE WELL OWNER.
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
origina(to Division of Water Quality, Groundwater Section within 30 days
GW-1 REV. 12/99
Serial No.

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone]
266905
WELL CONSTRUCTION RECORD
0208881
WELL CONTRACTOR: Dewey Wright Well Pump Co., Inc.
WELL CONTRACTOR CERTIFICATION #: 2081
STATE WELL CONSTRUCTION PERMIT#:
StCYC Feuy
1. WELL USE (Check Applicable Box): Residential
Recovery I I Heat Pump Water Injection
X
2. WELL LOCATION: (Show sketch of the location below)
Municipal I I Industrial
Agricultural [ I Monitoring
Other El If Other, List Use:
Nearest Town: BANNER ELK County: AVERY
FLATSPRINGS RD 2/10 MILE OFF BUCKEYE RD.
(Road Name and Numbers. Community, or Subdivision and Lot Nal
3. OWNER CAPTAIN ESTEP
Address 281 FLATSPRINGS ROAD ,
ELK PARktreet or Route No.) NC
City or Town State
4. DATE DRILLED 11/28/2002
5. TOTAL DEPTH 205
6. CUTTINGS COLLECTED YES NO
7. DOES WELL REPLACE EXISTING WELL? YES NO
8. STATIC WATER LEVEL Below Top of Casing: 50 FT
(Use "+" if Above Top of Casing)
I x9
I
26622
Zip Code
9 TOP OF CASING IS 1 FT Above Land Surface*
*Top of casing terminated at/or below land surface requires a variance in accor-
10. YIELD (gpm): Air
dance with 15A NCAC 2C.0118
11
DRILLING LOG
From To
0 35
DEPTH
Formation Description
DIRT
35 50 GRANITE
50 52 SHALE
52 130 GRANITE
130 132 SHALE
132 189 GRANITE
189 190 SHALE
190 205 GRANITE
11. WATER ZONES (depth): 1 ppm 130-132
METHHOpEn)is 5F2ST
2
ppm 55189-19U 0 ppm
12. CHLORINATION: Type HTH Amount 31
13. CASING:
Depth Diameter
From 0 To 40 Ft 5 1/8
From To Ft
From To Ft
14. GROUT:
From
From
Wall Thickness
or Weight/Ft. Material
.350 PVC
Depth Material
0 To 20 Ft Cement
To Ft
15. SCREEN:
Method
Gravity Flow
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
Fronp To
From }.. To
17. REMARKS.
I DO IIIEREBY CERTIFY THAT THIS WALL W
CONSTRUOTIOf4STANDARDS; AC HAT
Sije ! Material
Ft
Ft
FOR OFFICEUSEONLY
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)
7 O
w
L
w
c
0
Go
z_
ar=
nGtCkpJP przkoL..i`
rNO
k
d 00 i
S CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
CON CTING THE WELL DATE
SIGNATURE OF
Submit original to Division of Water Quality, Groundwater Section within 30 days
GW-1 REV. 12/99
Quad No.
Serial No.

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone]
267001
WELL CONSTRUCTION RECORD
WELL CONTRACTOR CERTIFICATION #• 2687
0201314 STATE WELL CONSTRUCTION PERMIT#• Steve Reece
1. WELL USE (Check Applicable Box): Residential
Recovery I I Heat Pump Water Injection
x
Municipal Industrial Agricultural Monitoring
Other E If Other, List Use•
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: BANNER ELK County: AVERY
HWY 1134 2.7 MILES FROM HWY 184
(Road Name and Numbers. Community, or Subdivision and Lot No.)
3. OWNER CARSON T. PUCKETT, SR.
Address 48 SNOW SUMMIT LANE ,
BANNER a or ROO1e N..) NC 28604 68 136 GRANITE
City or Town State
4. DATE DRILLED
5. TOTAL DEPTH
6. CUTTINGS COLLECTED YES I I NO
7. DOES WELL REPLACE EXISTING WELL? YES NO
8. STATIC WATER LEVEL Below Top of Casing: 40 FT
(Use "+" if Above Top of Casing)
11/4/2002
160
Zip Code
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): RV
11. WATER ZONES (depth)
40 THgpmc136-1A0
Air
136 140 SHALE/QUARTZ
140 160 GRANITE
u ppm
U gpm
U qpm
12. CHLORINATION: Type HI Amount 2b
13. CASING:
Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 73 Ft 6 1/8 .350 PVC
From To Ft
From To Ft
14. GROUT:
Depth Material
From 0 To 20 Ft Cement
From To Ft
15. SCREEN
Depth Diameter Slot Size
From To Ft in in.
From To Ft in in
From To Ft. in in
Method
Gravity Flow
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)
ah
UCX
1-1
Material
16. SAND/GRAVEL PACK:
�I L.))DO HERE `HPC flTIFY THAT THIS WELL W C C
CONSTRU9TION STANDARDS, AND THAT CO
CO
From ��To-
Te.—__- ft From n) i
17. REMARKS;
] �
X
WELL CONTRACTOR: Dewey Wright Well Pump Co., Inc.
Material
FOR OFFICE MJSE Ot4t'.Y'-
Quad No:
DRILLING LOG DEPTH
From 0 To Formation Description
68 DIRT
Lk
4.1
NSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
Y OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit original to Division of Water Quality, Groundwater Section within 30 days
GW-1 REV. 12/99
Serial No.

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone]
267002
WELL CONSTRUCTION RECORD WELL CONTRACTOR: Dewey Wright Well Pump Co., Inc.
WELL CONTRACTOR CERTIFICATION #: 20&7
020806 STATE WELL CONSTRUCTION PERMIT#: SievReece e
1. WELL USE (Check Applicable Box): Residential 7 Municipal Industrial Agricultural I I Monitoring
Recovery I 1 Heat Pump Water Injection Other I I If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: BANNER ELK County: AVERY
PRIVATE DR. OFF BEECH MTN PRKWY OFF HWY 194
(Road Name and Numbers, Community, or Subdivision and Lot No.)
3. OWNER ROBERT G. CANTRELL
Address 325 BEECH MTN PRKWY ,
BANNER Ea or Route "O.) NC 28804
City or Town State
4. DATE DRILLED 11/4/2002
5. TOTAL DEPTH 420
6. CUTTINGS COLLECTED YES NO
7. DOES WELL REPLACE EXISTING WELL? YES I I NO
8. STATIC WATER LEVEL Below Top of Casing 25 FT.
(Use "+" if Above Top of Casing)
II
DRILLING LOG DEPTH
From To Formation Description
0 22 DIRT
22 60 GRANITE
I >I
Zip Code
9. TOP OF CASING IS 1 FT Above Land Surface*
*Top of casing terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2C.01
Air
10. YIELD (gpm): METH OD1QF T6F3ST 0 ppm
11. WATER ZONES (depth)•0 ppm o4 0 pprn
12. CHLORINATION: Type HIH Amount /7
60 63 QUARTZ
63 420 GRANITE
X�
If additional space is needed use back of form
13. CASING: LOCATION SKETCH
Wall Thickness
Depth Diameter or Weight/Ft. Material .& (Show direction and distance from at least two State
From 0 To 27 Ft 6 1/8 .350 PVC•Roads, or other map reference points)
tk
From To Ft __ *1 t�
From To Ft W v1) ce___ 1..}, i
14. GROUT:
Depth Material Method
From 0 To 20 Ft Cement Gravity Flow
From To Ft
15. SCREEN:
Depth Diameter Slot Size Material
From To Ft
From To Ft
From To Ft
16. SAND/GRAVEL PACK:
in
in
in
in
in
in
®ryEk----- izet"'ck Material
From
1 Tq,r�,.� 'Ft
I I 1 t=-Tt1--—�t
From \(1
i 11,'
17. REMAR7�
I DO HE ERTIFY THAT THIS WELLI WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTF UCTICpN STANDARDSANDJHAT A f OPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
FOR OFFI E USEstNLY
- 0 3
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit original to Division of Water Quality, Groundwater Section within 30 days
GW-1 REV. 12/99
0
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Quad No:
CJ1
CO
Serial No.

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone]
267000
WELL CONSTRUCTION RECORD WELL CONTRACTOR.
020872
Dewey Wright Well Pump Co., Inc.
66/
WELL CONTRACTOR CERTIFICATION #.
STATE WELL CONSTRUCTION PERMIT# Steve tteece
1. WELL USE (Check Applicable Box): Residential
Municipal Industrial I I Agricultural 1 Monitoring 0
Recovery Heat Pump Water Injection I I Other If Other, List Use.
Ixl
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: SPRUCE PINE County AVERY
3. OWNER
Address
PRIVATE DR. OFF DELLINGER RD. OFF HENSON CRK R
(Road Name and Numbers. Community, or Subdivision and Lot No.)
WAYNE J. SMITH
5521 MOAT DR. ,
DRILLING LOG
From
0
To
DEPTH
Formation Description
86 DIRT
ORLANDC§"ee' or Route N°.) FL 32810
City or Town State Zip Code
4. DATE DRILLED 11/7/2002
5. TOTAL DEPTH 420
6. CUTTINGS COLLECTED YES I NO
7.
8.
DOES WELL REPLACE EXISTING WELL? YES I NO
STATIC WATER LEVEL Below Top of Casing: 20 FT
(Use "+" if Above Top of Casing)
9. TOP OF CASING IS 1 FT Above Land Surface*
*Top of casing terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2C.0113
10. YIELD (gpm): 9 METHOD OF TEST
11. WATER ZONES (depth):1 ppm 100-103
Air
X
86 100 GRANITE/QUARTZ
100 103 QUARTZ
103 420 GRANITE
0 gpm
0 Apm 0 gpm
12. CHLORINATION: Type HTH
13. CASING:
Amount 84
Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 92 Ft 6 1/4 .188 GALV.
From To Ft
From To Ft
14. GROUT:
Depth
From 0 To 20
From To
15. SCREEN:
Depth
From To Ft in
From To Ft in
From To Ft in
16. SAND/GRAVEL PACK
From
From
17. REMAR
I DO HE EBY CERTIFY THAT THIS WEL WA
CONST UCTIUN.STANAAROS, AT A
Material Method
Ft Cement Gravity Flow
Ft
Diameter Slot Size Material
in
in
in
FOR OFFItensr 7NLY-
Quad No:
Serial No.
Material
If additional space is needed use back of form
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other map reference points)
f9'
titItso-n ("fife k
a,a
fi
1l
c- 751--*
CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
OPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
--03
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit original to Division of Water Quality, Groundwater Section within 30 days
GW-1 REV
a
2/99

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]
264569
WELL USE (Check Applicable Box): Residential Municipal D Industrial I I Agricultural Monitoring
Recovery D Heat Pump Water Injection Other I I If Other, List Use•
II
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: BOONE County AVERY
PIGEON ROOST RD. OFF HWY 194 OFF HWY 421
(Road Name and Numbers. Community. or Subdivision and Lot No.l
DRILLING LOG DEPTH
3. OWNER JAMES RUPPARD From To Formation Description
0 55 DIRT
55 130 GRANITE
Address 1997 PIGEON ROOST RD.
BANNER LER or Route No.) NC
WELL CONSTRUCTION RECORD
020636
WELL CONTRACTOR. Dewey Wright Well Pump Co., Inc.
WELL CONTRACTOR CERTIFICATION #. 2681
STATE WELL CONSTRUCTION PERMIT#. Steve Petty
I x1
28604
City or Town State Zip Code 130 131 SHALE
4. DATE DRILLED 10/18/2002 131 286 GRANITE
5. TOTAL DEPTH 305 288 288 QUARTZ
6. CUTTINGS COLLECTED YES I I NO I XI 288 305 GRANITE
7. DOES WELL REPLACE EXISTING WELL? YES I I NO
X
8. STATIC WATER LEVEL Below Top of Casing 30 FT.
(Use'4" if Above Top of Casing)
9. TOP OF CASING IS 1 FT Above Land Surface*
*Top of casing terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2C.0118
10. YIELD (gpm)• 30 METHOD OF TEST Air
11. WATER ZONES (depth)•1 parr, 130-131 29 porn 286-288
0 qpm 0 gprn
12. CHLORINATION: Type 1-111H - Amount 56
13. CASING:
Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 60 Ft 6 1/8 .350 PVC
From To Ft
From To Ft
14. GROUT:
Depth Material Method
From 0 To 20 Ft Cement Gravity Flow
From To Ft
15. SCREEN:
Depth Diameter Slot Size Material
From To Ft in in
From To Ft in in
From To Ft. in in
16. SAND/GRAVEL PACK:
Depth Size Material
From To Ft
From To Ft
17. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
If additional space is needed use back of form
1
LOCATION SKETCH
rection and distance from at least two State
Roads, or other map reference points)
.4-
Fict
N
FOR OFFICE USE ONLY
Quad No•
Serial No
SIGNATURE OF`P@({SON CONSTRUCTING THE WELL DATE
Submit original to Division of Water Quality, Groundwater Section within 30 days
GW-1 REV. 12/99

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone]
WELL CONSTRUCTION RECORD
020805
264576
WELL CONTRACTOR. Dewey Wright Well Pump Ca., Inc.
WELL CONTRACTOR CERTIFICATION #• 2881
STATE WELL CONSTRUCTION PERMIT#- Steve Petty
1. WELL USE (Check Applicable Box): Residential X. Municipal
Recovery I I Heat Pump Water Injection fl Other
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: BANNER ELK
FLAT SPRINGS RD OFF HIWY 321
I Road Name and Numbers, Community, or Subdivision and Lot No.)
3. OWNER BRENT D. WARD
Industrial El Agricultural I 1 Monitoring
If Other, List Use.
County. AVERY
DRILLING LOG DEPTH
From To Formation Description
Address 284 STONEY HOLLOW RD. , 0 40 DIRT
ELK P•4RKvaet or Route No.) NC 28622 40 70 GRANITE
City or Town State Zip Code
70 72 QUARTZ
4. DATE DRILLED 10/15/2002 72 383 GRANITE
5. TOTAL DEPTH 405 363 385 QUARTZ
6. CUTTINGS COLLECTED YES I NO X 365 405 GRANITE
7. DOES WELL REPLACE EXISTING WELL? YES NO M
8. STATIC WATER LEVEL Below Top of Casing: 20 FT
(Use "+" if Above Top of Casing)
9. TOP OF CASING IS 1 FT. Above Land Surface*
'Top of casing terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2C.0118
10. YIELD (gpm)' 1 METHOD OF TEST Air
11. WATER ZONES (depth)•1/2 Apm70-72 1/2 Apm 383-365
0 Pam 0 qpm
12. CHLORINATION: Type HTH
Amount 76
If additional space is needed use back of form
13. CASING: LOCATION SKETCH
Wall Thickness
Depth Diameter or Weight/Ft. Material (Show direction and distance from at least two State
From 0 To 45 Ft. 0 1/8 .350 PVC \ ,, Roads, or other map reference points)
From To Ft \AO9 i,a/
From To Ft
14. GROUT:
Depth Material Method
From 0 To 20 Ft. Cement Gravity Flow
From To Ft
15. SCREEN:
Depth Diameter Slot Size Material
From To Ft. in. in
From To Ft in in
From To Ft in in.
16. SAND/GRAVEL PACK:
Depth Size Material
From To Ft
From To Ft
17. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
FOR OFFICE USE ONLY
Quad No'
SIGNATURE OF PE N CONSTRUCTING THE WELL DATE
Submit original to Division of Water Quality, Groundwater Section within 30 days
Serial No
GW-1 REV. 12/99

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR.
264551
Dewey Wright Well Pump Co., Inc.
020836 WELL CONTRACTOR CERTIFICATION #•
STATE WELL CONSTRUCTION PERMIT#. Steve Reece
2687
1. WELL USE (Check Applicable Box): Residential I X Municipal I I Industrial
Recovery El Heat Pump Water Injection I 1 Other I I If Other, List Use•
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: BOONE County AVERY
BUCKEYE P.D. OFF HWY 321 OFF F-rvw 421
(Road Name and Numbers, Community, or Subdivision and Lot No.)
3. OWNER FRED RUEPP
Address 21 HARRINGTON AVE. ,
LEXI NGTf5Kr Or Route Na.l NC 27202
City or Town State
Zip Code
4. DATE DRILLED 10/24/2002
5. TOTAL DEPTH 420
6. CUTTINGS COLLECTED YES I NO 71
7. DOES WELL REPLACE EXISTING WELL? YES NO
8. STATIC WATER LEVEL Below Top of Casing: 20 FT
(Use "+" if Above Top of Casing)
9. TOP OF CASING IS 1 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2C.01
10. YIELD (gpml' METHOD OF TEST Air
11. WATER ZONES (depth).' Opm 340-344 0 qpm
0 qpm 0 qpm
X
Agricultural Monitoring
DRILLING LOG DEPTH
From To Formation Description
0 15 DIRT
15 340 GRANITE
340 344 QUARTZ
344 420 GRANITE
12. CHLORINATION: Type HTH
Amount 84 If additional space is needed use back of form
13. CASING: LOCATION SKETCH
Wall Thickness
Depth Diameter or Weight/Ft. Material (Show direction and distance from at least two State
From 0 To 20 Ft 6 1/8 .350 PVC Roads, or other map reference points) \\ \\
From To Ft �\ b42
From To Ft
14. GROUT:
Depth Material Method
From 0 To 20 Ft Cement Gravity Fiow
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
3ucic �y e ij(
-F— c2 r j
17. REMARKS•
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPYY3OF-TTHHIIS RECORD rypS BEEN PROVIDED TO THE WELL OWNER.
FOR OFFICE USE ONLY
t'e-t // — / 5 00/N
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

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]
264552
WELL CONSTRUCTION RECORD
020848
WELL CONTRACTOR. Dewey Wright Well Pump Co., Inc.
WELL CONTRACTOR CERTIFICATION tt• 2687
STATE WELL CONSTRUCTION PERMITS. Steve Reece
1. WELL USE (Check Applicable Box): Residential X Municipal
Recovery Heat Pump Water Injection Other
Industrial El Agricultural Monitoring 0
If Other, List Use.
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: BOONE County: AVERY
PHILLIPS RD. OFF BUCKEYE RD. OFF HWY 321 OFF H
(Road Name and Numbers, Community, or Subdivision and Lot No-
3. OWNER GERALDINE TESTER
Address 629 PHILLIP RD. ,
ELK PARR' or Route No.) NC
City or Town Stare
4. DATE DRILLED 10/23/2002
5. TOTAL DEPTH 300
6. CUTTINGS COLLECTED YES
NO
28622
Zip Code
7. DOES WELL REPLACE EXISTING WELL? YES NO
8. STATIC WATER LEVEL Below Top of Casing: 70 FT
(Use "+" if Above Top of Casing)
9. TOP OF CASING IS 1 FT Above Land Surface*
'Top of casing terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2C.0118
10. YIELD (gpm)• 1 METHOD OF TEST Air
11. WATER ZONES (depth).1 Qpm 250-254 0 ppm
0 Rpm 0 qprn
X
12. CHLORINATION: Type HTH Amount 56
DRILLING LOG DEPTH
From To Formation Description
0 30 DIRT
30 250 GRANITE/QUARTZ
250 254 QUARTZ
254 300 GRANITE
If additional space is needed use back of form
13. CASING: LOCATION SKETCH
Wall Thickness
Depth Diameter or Weigheft. Material (Show direction and distance from at least two State
From 0 To 37 Ft 6 1/8 .350 PVC Roads, or other map reference points)
From To Ft From To Ft
14. GROUT:
Depth Material Method
From 0 To 20 Ft Cement Gravity Flow
From To Ft
15. SCREEN:
Depth Diameter Slot Size Material
From To Ft in in
From To Ft in in
From To Ft in in
16. SAND/GRAVEL PACK:
Depth Size Material
From To Ft
From To Ft
8ticte
/dS
17. REMARKS' OA
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 AS BEEN PROVIDED TO THE WELL OWNER,
� 1-7-1 — ,tBra //_/S —Crcc
FOR OFFICE USE ONLY
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

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]
264553
WELL CONSTRUCTION RECORD
020554
WELL CONTRACTOR- Dewey Wright Well Pump Co., Inc.
WELL CONTRACTOR CERTIFICATION #• 2687
STATE WELL CONSTRUCTION PERMIT#• Steve Reece
1. WELL USE (Check Applicable Box): Residential
Recovery n Heat Pump Water Injection
I
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: BOONE
HWY 321 12 MILES FROM HWY 421
Municipal 0 Industrial n
Other If Other, List Use.
County. AVERY
(Road Name and Numbers, Community, or Subdivision and Lot No.)
Agricultural Monitoring
DRILLING LOG DEPTH
3. OWNER WAYNE ULISNIK From To Formation Description
Address 417 HUGHES RD , 0 15 DIRT
HAfv1PST{f9°rRoute No.' NC 28443 15 250 GRANITE
City or Town State Zip Code 250 252 QUARTZ
4. DATE DRILLED 10/24/2002 250 420 GRANITE
5. TOTAL DEPTH 420
6. CUTTINGS COLLECTED YES NO
I XI
7. DOES WELL REPLACE EXISTING WELL? YES I I NO I XI
8. STATIC WATER LEVEL Below Top of Casing 200 FT.
(Use "+" if Above Top of Casing)
9. TOP OF CASING IS 1 FT Above Land Surface*
*Top of casing terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2C.0118
10. YIELD (gpm). 2 METHOD OF TEST Air
11. WATER ZONES Idepth)•2 qpm 250-253 0 qpm
0 gprn 0 qpm
12. CHLORINATION: Type NTH Amount 45
13. CASING:
Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 21 Ft 6 1/8 .350 PVC
From To Ft
From To Ft
14. GROUT:
Depth Material Method
From 0 To 20 Ft Cement Gravity Flow
From To Ft
15. SCREEN:
Depth Diameter Slot Size Material
From To Ft. in in.
From To Ft. in in.
From To Ft in. in
16. SAND/GRAVEL PACK:
Depth Size Material
From To Ft
From To Ft
If additional space is needed use back of form
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other map reference points)
17. REMARKS• t-a'I
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
FOR OFFICE USE ONLY
Quad No'
Serial No
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit original to Division of Water Quality, Groundwater Section within 30 days
GW-1 REV. 12/99

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Secti25 4 5 0 4
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone]
WELL CONSTRUCTION RECORD
020208-4
WELL CONTRACTOR.
Dewey Wright Well Pump Co., Inc.
2008
STATE WELL CONSTRUCTION PERMIT#• Leslie Reece
WELL CONTRACTOR CERTIFICATION #•
1. WELL USE (Check Applicable Box): Residential PCI Municipal I I Industrial fl
Recovery Heat Pump Water Injection 0 Other D If Other, List Use:
2. WELL LOCATION: (Show skk tch of the location below)
Nearest T LOCATION:
•BANNER ELK Count : AVERY
VALLEY HUGE Lk. UN- HWY 1Y4 OFF BROADSI NE k
(Road Name and Numbers, Community, or Subdivision and Lot No.)
3. OWNER HERMAN E. KUMPF
Address pD. BOX 427 ,
BANNER Et9R or Route No NC 26804
City or Town State
Agricultural Monitoring�l`=1
DRILLING LOG
From
0
DEPTH
To
67 DIRT rmation Description
57 202 GRANI
Zip Code
4. DATE DRILLED 10/22/2002
5. TOTAL DEPTH Bt$U
6. CUTTINGS COLLECTED YES 0 NO CAI II��II
7. DOES WELL REPLACE EXISTING WELL? YES y_I NO 71
8. STATIC WATER LEVEL Below Top of Casing: oouu 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.0118l5
I
10. YIELD (gpm): METHOD
TES OF T fur
202 203 SHALE
203 311 GRANITE
311 312 --SAJSE-
312 b50 GRANITE
550 b52 SHALE
552 660
N o
L7 —
v
11. WATER ZONES (depth) riri 2/b prim 311-312
,b prim 551-552 U pprn
12. CHLORINATION: Type HIH Amount 121
1
13. CASING:
CM1-
O<
To
Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 63 Ft 8 1/4 .,008 GALV
From To Ft
From To Ft
14. GROUT:
Depth Material Method
From 0 To 20 Ft Cement Gravity Flow
From To Ft
15. SCREEN:
Depth
From To
From io
From To
16. SAND/GRAVEL PACK:
E
Depth
To
E 00
F on,
Diameter Slot Size Material
Ft in in
Ft. in in
Ft in in
AR
HEflKfS• Y Q RJy
HA
STh ?JtTIO N' SDMK DAR
FOR ORdifieEOfpLeTION
LosailaV!LLE REGIONAL OFFICE
Size
Material
If additional space is needed use back ofform cn in)
r,
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other map reference points)
WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
ND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
SIGNATURE OF PERSQ�'GONSTRUCTING THE WELL DATE
Submit original to Division of Water•Quality, Groundwater Section within 30 days
Serial No
GW-1 REV. 12/99

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section 61 9 6-
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone]
WELL CONSTRUCTION RECORD
020568
WELL CONTRACTOR- Dewey Wright Well Pump Co., Inc.
WELL CONTRACTOR CERTIFICATION #• 286!
STATE WELL CONSTRUCTION PERMIT*Steve Reece
1. WELL USE (Check Applicable Box): Residential El Municipal ❑ Industrial n
Recovery ❑ Heat Pump Water Injection ❑ Other If Other, List Use.
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: BOONE County AVERY
BUCKEYE RD. OFF HWY 321 OFF HWY421
(Road Name and Numbers, Community, or Subdivision and Lot No.)
3. OWNER FALL CRK VOL. FIRE DEPT. STA 11
Address % ED STOREY , 831 JOE PARLIER RD.
ELK PARR' or Route No.l NC 28622
City or Town State itde
4. DATE DRILLED
5. TOTAL DEPTH
6. CUTTINGS COLLECTED YES ❑ NO
7. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
8. STATIC WATER LEVEL Below Top of Casing: 20 FT
(Use "+' if Above Top of Casing)
9. TOP OF CASING IS 1 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) 10 METHOD OF TEST Air
11. WATER ZONES (depth)•3 gprn 37-39 7 qpm 88-71
0 gpm 0 gpm
9/11/2002
125
Agricultural ❑ Monitoring ❑
DRILLING LOG
From To
0 15
DEPTH
Formation Description
DIRT
15 37 GRANITE/SHALE
37 39 SHALE
39 68 GRANITE
68 71 SHALE
71 125 GRANITE
X
X
12. CHLORINATION: Type HTH
13. CASING:
Amount 22
Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 21 Ft 8 1/4 .186 GALV.
From To Ft
From To Ft
14. GROUT:
From
Depth Material Method
0 To 20 Ft Cement Gravity Flow
From To Ft
15. SCREEN:
If additional space is needed use back of form
5
Depth Diameter Slot Size Material
From To Ft in in
From To Ft in in
From To Ft in in
16. SAND/GRAVEL PACK:
Depth
From To
From To
Ft
Ft
Size Material
LOCATION SKETCH
(Show direction and distance from at least two State
c-c`l—Roads, or other map reference points
a
ry
17. REMARKS: ', to
I DO HEREBY ql 1tA' t • TRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTI • ' ' ' NDARDS, AND THAT A ! +' OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
FOR OFFICE U
iy-
Quad No
Serial No.
ASHLVILL
SIG ATURE OF PERSON CONSTRUCTING THE WELL DATE
vJA1r rbpriginal t. Division of Water Quality, Groundwater Section within 30 days
PEGIG1,;AL GFFIGE GW-1 REV. 12/99

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone]
261826
WELL CONSTRUCTION RECORD WELL CONTRACTOR. Dewey Wright Weil Pump Co., Inc.
WELL CONTRACTOR CERTIFICATION it.2881
020E37 STATE WELL CONSTRUCTION PERMIT*Steve Petty
1. WELL USE (Check Applicable Box): Residential [ji Municipal Industrial E Agricultural P1 Monitoring El
Recovery 0 Heat Pump Water Injection P1 Other Q If Other, List Use.
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: BANNER ELK
HWY 184
County' AVERY
(Road Name and Numbers, Community, or Subdivision and Lot No.
DRILLING LOG DEPTH
3. OWNER RICARDO E. HENRIQUEZ From To Formation Description
Address 229 LEI I ERFERN DR. , 0 55 DIRT
BANNER t`L or Route No.) NC 28804 55 82 GRANITE
City or Town State Zip Code "o e' 83 QUARTZ
4. DATE DRILLED 9/9/2002 83 120 GRANITE
5. TOTAL DEPTH 505 120 122 QUARTZ
6. CUTTINGS COLLECTED YES P1 NO n 122 505 GRANITE
7. DOES WELL REPLACE EXISTING WELL? YES 71 NO P1
8. STATIC WATER LEVEL Below Top of Casing: 80 FT
(Use "+' if Above Top of Casing)
9. TOP OF CASING IS 1 FT Above Land Surface*
*Top of casing terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2C.011.0
10. YIELD (gpm): 2 METHOD OF TEST Air
11. WATER ZONES (depth):1 qpm 82-83 1 ppm 120-122
0 qpm 0 qpm
12. CHLORINATION: Type HTH Amount 91
If additional space is needed use back of form
13. CASING: Wall Thickness LOCATION SKETCH
Depth Diameter or Weight/Ft. Material
From 0 To 00 Ft 6 1/8 .350 PVC
From To Ft
From To Ft
14. GROUT:
Depth Material Method
From 0 To 20 Et Cement Gravity Flow
From To Ft
15. SCREEN:
Depth Diameter Slot Size Material
From To Ft in in
From To Ft in in
From To Ft. in in
16. SAND/GRAVEL PACK:
Depth Size Material ,b
From To Ft
From To Ft Q�a
105
17. REMARKS: ITill IFY THAT THIS WELL W
I1 INSTRUCTED
CONSTRUC
WELL
TANDARDS, AND THAT 4 Y OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
"O —/ /— 0 04-
(Show direction and distance from at least two State
Roads, or other map reference points)
rt‘R CD
FOR OFFICE
USE 0
NLY
V E
rc
0
0
--f
Quad No:
EIGNATURE OF PERSON CONSTRUCTING THE WELL
DATE
SROUND':VAT ER SECSibibit original to Division of Water Quality, Groundwater Section within 30 days
ASHEVILLE FEGIORAL OFFICE GW-1 REV. 12/99
Serial No.

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone]
WELL CONSTRUCTION RECORD
261824
WELL CONTRACTOR. Dewey Wright Well Pump Co., Inc.
WELL CONTRACTOR CERTIFICATION #• 2681
020593 STATE WELL CONSTRUCTION PERMIT#• Steve Petty
1. WELL USE (Check Applicable Box): Residential LI Municipal D Industrial I Agricultural Monitoring 0
Recovery 0 Heat Pump Water Injection fl Other 0 If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: BOONE County AVERY
HWY 321
(Road Name and Numbers, Community, or Subdivision and Lot No.)
3. OWNER PENNELL C. PAINTER
Address 210 HWY 321 NORTH ,
SUGAR ,-I6nnoYRoure No.) NC 28679
DRILLING LOG DEPTH
From To Formation Description
0 15 DIRT ROCK
15 290 GRANITE
City or Town State
4. DATE DRILLED 9/17/2002
5. TOTAL DEPTH 305
6. CUTTINGS COLLECTED YES I I NO 0
7. DOES WELL REPLACE EXISTING WELL? YES P1 NO I —I
8. STATIC WATER LEVEL Below Top of Casing: 20 FT
(Use'4" if Above Top of Casing)
9. TOP OF CASING IS 1 FT Above Land Surface*
*Top of casing terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2C.0118 10. YIELD (gpm)• 100 METHOD OF TEST Alr
11. WATER ZONES (depth):100 ppm200-227 0 pprr
0 pprn 0 ppm
Zip Code
290 297 CAVE
297 305
GRANITE
12. CHLORINATION: Type HIM Amount 57
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 0 To 20 Ft 6 1/6 .350 PVC 0-4—Roads, or other map reference points)
From To Ft \ ° LA,�\
From To Ft
14. GROUT:
Depth Material Method
From 0 To Z0 Ft Cement Gravity Flow
From To Ft
15. SCREEN:
Depth Diameter Slot Size Material
From To Ft in in
From To Ft in in
From To Ft in in
16. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft
17. REMARKS:
I DO HEREBY
CONSTRUCT
FOR OFFICE U
Quad No:
Y
TIYAT �ISt VE L S .v NSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
73 r OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
d9'
Zv--1/,-;"a�
3NATURE OF PERSaN CONSTRUCTING THE WELL DATE
Submit arigina to Division of Water Quality, Groundwater Section within 30 days
Serial No.
( FiEdi'D VATER SLCTi:)N
A,ETwil: L FE . 1rIICE
GW-1 REV. 12/99

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone]
261819
WELL CONSTRUCTION RECORD
9g610
WELL CONTRACTOR- Dewey Wright Well Pump Co., Inc.
WELL CONTRACTOR CERTIFICATION #• 2686
STATE WELL CONSTRUCTION PERMIT#• Leslie Reece
1. WELL USE (Check Applicable Box): Residential
Recovery ❑ Heat Pump Water Injection
X
Municipal n Industrial n Agricultural ❑ Monitoring ❑
Other ❑ If Other, List Use•
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: N-WLAND County. AVERY
3. OWNER
Address
19E 2.5 MILES FROM 3 MILE RD. OFF HWY 221
(Road Name and Numbers, Community, or Subdivision and Lot Noj
JEFFREY O. REYNOLDS
Oro JOR INC. , 6677 HWY 19E SOUTH
NEWLANLtreet or Route No.) NC 28657
City or Town State Zip Code
DRILLING LOG
From To
0 102
102 209
208 209
4. DATE DRILLED 9/4/2002 209 245
5. TOTAL DEPTH 245
6. CUTTINGS COLLECTED YES ❑ NO El
7. DOES WELL REPLACE EXISTING WELL? YES ❑ NO ri
8. STATIC WATER LEVEL Below Top of Casing: 50 FT
(Use "+" if Above Top of Casing)
9. TOP OF CASING IS 1 FT Above Land Surface*
*Top of casing terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2C.0118
10. YIELD (gpm)' 15 METHOD OF TEST Aar
11. WATER ZONES (depth)•15 ppm203-209 0 qpm
0 am 0 qpm
DEPTH
Formation Description
MUD/GR VL/ROCKS/SAN
GRANITE
SHALE
GRANITE
12. CHLORINATION: Type HTH Amount 40
13. CASING:
Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 105 Ft. 6 1/4 .188 GALV.
From To Ft
From To Ft
14. GROUT:
Depth Material Method
From 0 To 20 Ft Cement Gravity Flow
From To Ft
15. SCREEN:
If additional space is needed use back of form
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other map reference poi9)
O
�7
0
Depth Diameter Slot Size Material
From To Ft in in
From To Ft in in
From To Ft in in
16. SAND/GRAVEL PACK:
Depth
From To Ft
From To Ft
17. REMARKS•
I DO HEREB IFY THAT THIS WELL WA
CONSTRUC 17, TANDARDS, AND THAT' p
I -
Size
Material
FOR OFFICE SE . NLY
ASHEViLLE
G SEC$114PTitorigi
EG!C.W L OFFICE
NSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
Y OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
ti/rut/kt,
GNATURE OF PE ON CONSTRUCTING THE WELL DATE
I to Division of Water Quality, Groundwater Section within 30 days
GW-1 REV. 12/99

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone]
WELL CONSTRUCTION RECORD
020627
261818
WELL CONTRACTOR- Dewey Wright Weil Pump Co., Inc.
WELL CONTRACTOR CERTIFICATION Sr 2686
STATE WELL CONSTRUCTION PERMITS!. Leslie Reece
1. WELL USE (Check Applicable Box): Residential 0 Municipal I I Industrial E Agricultural Monitoring E
Recovery E Heat Pump Water Injection 0 Other E If Other, List Use.
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: CROSSNORE
JIM OLLIS LANE OFF HWY 221
County AVERY
(Road Name and Numbers, Community, or Subdivision and Lot No.)
DRILLING LOG DEPTH
3. OWNER JEFFRY A. BROWN From To Formation Description
Address 2211 FAIRFIELD PLACE , 0 41 DIRT
VALDOSreet or Route No.l GA 316102
41 283 ;RANITE
City or Town State
Tip Code
283 284 QUARTZ
4. DATE DRILLED 9/2/2002 284 425 GRANITE
5. TOTAL DEPTH 425
6. CUTTINGS COLLECTED YES n NO
7. DOES WELL REPLACE EXISTING WELL? YES NO El
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)• 314 METHOD OF TEST Air
11. WATER ZONES(depth).''/4 ppm 233-284 0 ppm
0 ppm 0 ppm
xl
12. CHLORINATION: Type HTH
13. CASING:
Amount 76
Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 46 Ft 6 1/5 .350 PVC
From To Ft
From To Ft
14. GROUT:
Depth Material Method
From 0 To 20 Ft Cement Gravity Fiow
From To Ft
15. SCREEN:
Depth Diameter Slot Size Material
From To Ft in in
From To Ft. in in
From To Ft in in
16. SAND/GRAVEL PACK:
Depth Size Material
From To Ft
From To Ft
17. REMARKS
I DO HEREBY CE
CONSTRUCTION
FOR OFFICE USE
Quad No:
40..
I HA I I HIS WELL WAS Ct
DARDS, AND THAT A CO
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) totem
t
m
Jim DLLsy�_
4or-3
0' r- ;
TRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
iF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
days
O
GROLNcwNATEl 9P(^I99Rginal to )ivision 3 d y
ASHEVI�LE REGIONAL OFFICE GW-1 REV. 12/99
,,e,e<z
of Wa er Quality, Groundwater Section within o
F PE N CONSTRUCTING THE WELL DATE
s
Serial No

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone]
WELL CONSTRUCTION RECORD
WELL CONTRACTOR CERTIFICATION #- 2681
020744 retty
STATE WELL CONSTRUCTION PERMIT#: ateve
WELL USE (Check Applicable Box): Residential ® Municipal Industrial n Agricultural E Monitoring E
Recovery fl Heat Pump Water Injection I I Other I If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: BANNER ELK
HWY 194 OFF HIWY 184 OFF HWY 105
County AVERY
(Road Name and Numbers, Community, or Subdivision and Lot No.)
261832
WELL CONTRACTOR Dewey Wright Well Fump Co., Inc.
DRILLING LOG DEPTH
3. OWNER BOB G. HODSIN From To Formation Description
F.O. BOX 2307 , 0 40 DIRT
Address or Route No.) 9
BANNER1C NC 8B04 40 85 GRANITE
City or Town State Zip Code B5 06 SHALE
4. DATE DRILLED 9/10/2002 BB 130 GRANITE
5. TOTAL DEPTH 145 130 132 QUARTZ
6. CUTTINGS COLLECTED YES I I NO 132 145 GRANITE
7. DOES WELL REPLACE EXISTING WELL? YES n NO n
8. STATIC WATER LEVEL Below Top of Casing: 70 FT
(Use "+" if Above Top of Casing)
9. TOP OF CASING IS 1 FT Above Land Surface*
'Top of casing terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2C.01
10. YIELD (gpm): METHOD OF TEST Air
11. WATER ZONES (depth)•2 gpm 85.-85 4 gpm 130-132
0 ppm 0 ppm
12. CHLORINATION: Type HTH
Amount 26
13. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 45 Ft 6 1/8 .350 PVC
From To Ft
From To Ft
14. GROUT:
Depth Material
From 0 To 20 Ft Cement Gravity Flow
From To Ft
15. SCREEN:
Depth Diameter Slot Size
From To Ft. in in
From To Ft in in
From To Ft in in
16. SAND/GRAVEL PACK:
Depth
From To
From To
17. REMARKS:
I DO HEREBY CEF
CONSTRUCTION
Ft
Ft
Size
Method
Material
Material
FOR OFFICE USE ONLY
Quad No:
THAT THIS WELL WAS C
DARDS, AND THAT A C
If additional space is needed use back of form
LOCATION SKETCH
direction and distance from at least two State
Roads, or other map reference points)
II4
RUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
= THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
SIGNATUREOF ERSCONSTRUCTING THE WELL
GROU JG!NATENSIh" litmg nal to Division of Water Quality, Groundwater Section within 30 days DATE
GW-1 REV. 12/99
ASHEVI(._E 7E&i0i:'AL OFRGF
Serial No.

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone]
WELL CONSTRUCTION RECORD
261830
WELL CONTRACTOR: Dewey Wright Well Fump Co., Inc.
WELL CONTRACTOR CERTIFICATION #: 2681
020743 STATE WELL CONSTRUCTION PERMIT#: Steve Petty
1. WELL USE (Check Applicable Box): Residential X Municipal 0 Industrial
Recovery fl Heat Pump Water Injection fl Other n If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: BANNER ELK County: AVERY
BOBBY HODGES LANE OFF OLD HORSE BOTTOM RD. 0
Road Name and Numbers, Community, or Subdivision and Lot No./
3. OWNER BOBBY R. HODGES
Address 84 BOBBY HODGES LANE .
BANNER Lek ar Route No.) NC 28804 35 80 GRANITE
City or Town State Zip Code
Agricultural D Monitoring El
DRILLING LOG DEPTH
From To Formation Description
0 35 DIRT
80 82 SHALE
4. DATE DRILLED 9/12/2002 82 105 GRANITE
5. TOTAL DEPTH 105
6. CUTTINGS COLLECTED YES D NO
7. DOES WELL REPLACE EXISTING WELL? YES NO El
8. STATIC WATER LEVEL Below Top of Casing: 30 FT
(Use "+" if Above Top of Casing)
9. TOP OF CASING IS 1 FT Above Land Surface*
*Top of casing terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2C.0118
10. YIELD (gpm) 8 METHOD OF TEST Air
11. WATER ZONES (depth):8 ppm80-82 0 ppm
0 ppm 0 ADM
I XI
12. CHLORINATION: Type HT, --I Amount 15
If additional space is needed use back of form
13. CASING: Wall Thickness LOCATION SKETCH
Depth Diameter or Weight/Ft. Material (Slicii.v direction and distance from at least two State
From 0 To 40 Ft 6 1/4 .188 GALV �,�`Y` Roads, or other map reference points) , N.
ei
From To Ft \�,Q�,y 105 j`tvti
From To Ft VV
14. GROUT:
Depth Material Method
From 0 To 20 Ft Cement Gravity Flow
From To Ft
15. SCREEN: \'
Depth Diameter Slot Size Material \`
From To Ft in in Dpbbt'�'
From To Ft in in �y, F— OS
From To Ft in in ''CC��
1
lil
Size Material C' 1� Wd ao
16. SAND/GRAVEL PACK:
Depth
To
To
From
From
17. REMARKS:
I DO HEREBY CERT
CONSTRUCTION $
Ft
Ft
r(it
_ 11/42..,
El P.
HAT THIS WELL WAS COI
ARDS, AND THAT A COP
FOR OFFICE USE ONLY
Quad No: GROUNDt'JATESu6krritidital to D
.ASHEViLLE REGIDE:AL OE CE
P JCTED IN ACCORDANCE ITH 15A NCAC 1, WELL
F THIS RECORD HAS BEEN PROVIDED TO ELL OWNER.
S GNA1
URE OF PE SON CONSTRUCTING THE WELL DATE
vision of Water Quality, Groundwater Section within 30 days
GW-1 REV. 12/99
Serial No.

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone]
WELL CONSTRUCTION RECORD
020549
260686
WELL CONTRACTOR- Dewey Wright Well Pump Co., Inc.
WELL CONTRACTOR CERTIFICATION #. 2/9/
STATE WELL CONSTRUCTION PERMIT#- Jerry Wilson
1. WELL USE (Check Applicable Box): Residential n Municipal Industrial 0 Agricultural 0 Monitoring El
Recovery 0 Heat Pump Water Injection n Other If Other, List Use'
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: NEWLAND County AVERY
PRIVATE DR. OFF PETER I-IARDIN RD. OFF HWY 19E 0
3. OWNER
Address
(Road Name and Numbers, Community, or Subdivision and Lot No.l
SAMPSON GWYNN
PO BOX 305 ,
CROSSNaRE or Route No.)
NC 28816
DRILLING LOG
From To
0 80
DEPTH
Formation Description
DIRT/SHALE/QUARTZ
80 230 GRANITE/QUARTZ
City or Town State
4. DATE DRILLED
5. TOTAL DEPTH
6. CUTTINGS COLLECTED YES NO
7. DOES WELL REPLACE EXISTING WELL? YES 0 NO
8. STATIC WATER LEVEL Below Top of Casing: 20 FT
8/6/2002
245
Zip Code
X
X
(Use "+" if Above Top of Casing)
9. TOP OF CASING IS 1 FT Above Land Surface*
*Top of casing terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2C.01 5
10. YIELD (gpm): 30 METHOD OF TEST Air
11. WATER ZONES (depth)•30 ppm 230-231 0 ppm
0 ppm 0 ppm
230 231 QUARTZ
231 245 GRANITE
12. CHLORINATION: Type HTH Amount 46
13. CASING:
From
From
From
Wall Thickness
Depth Diameter or Weight/Ft. Material
0 To 63 Ft 8 1/4 .188 GALV.
To Ft
To Ft
14. GROUT:
From
From
Depth
0 To 20
15. SCREEN:
From
From
From
To
Depth
To
To
To
EL PACK:
rom 10
REMARKS:
DO HEREBY CERTIFY T
If additional space is needed use back of form
Material Method
Ft Cement Gravity Flow
Ft CEMENT GRAVITY FLOW
Diameter Slot Size Material
Ft in in
Ft in in
Ft in in
Size Material
LOCATION SKETCH
(Show direction and distance from at least two State r/
Roads, or other map reference points) (50,
,Vf"
CI)f
ry
Qv
S WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
cn
IV
}
0
CST
tV
Submit o
9 z-
NATURE OF PERSON CONSTRUCTING THE WELL DATE
ginal to Division of Water Quality, Groundwater Section within 30 days
GW-1 REV. 12/99
r
a

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Sectio2 V V c C 1
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone] O
WELL CONSTRUCTION RECORD
020470
WELL CONTRACTOR: Dewey Wright Well Pump Co., Inc.
WELL CONTRACTOR CERTIFICATION #• 2197
STATE WELL CONSTRUCTION PERMIT**.Jerry Wilson
WELL USE (Check Applicable Box): Residential M Municipal 0 Industrial fl Agricultural 0 Monitoring D
Recovery fl Heat Pump Water Injection 0 Other I I If Other, List Use.
2. WELL LOCATION: (Show sketch of the location below) AVERY
Nearest Town: NEWLAND County:
PRIVATE DR. OFF KATE DAVIS LANE OFF OLD 19E OFF
(fload Name and Numbers, Community, or Subdivision and Lot No.)
3. OWNER JOHN W. DICKER
Address 10421 S.W. 111 STREET ,
MIAMI (Street or Route No.) FL
City or Town State
4. DATE DRILLED 8/2/2002
5. TOTAL DEPTH 305
6. CUTTINGS COLLECTED YES 0 NO 7
7. DOES WELL REPLACE EXISTING WELL? YES 0 NO 71
8. STATIC WATER LEVEL Below Top of Casing: 20 FT
(Use "+" if Above Top of Casing)
33176
Zip Code
DRILLING LOG DEPTH
Formation Description
DIRT/GRAVEL
From To
0 12
12 55 GRANITE
55 56 GRANITE
56 275 GRANITFJQUARTZ
275 276 GRANITE
276 305 GRANITE
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 Air10. YIELD (gpm). 3 METHOD OF TEST
11. WATER ZONES (depth)•1 ppm55-56 2 ppm 275 276
0 PPM 0 gpm
HTH Amount 57
12. CHLORINATION: Type
13. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 22 Ft 6 1/8 .350 PVC
From To Ft
From To Ft
14. GROUT:
Depth Material Method
From 0 To 20 Ft Cement Gravity Flow
From To Ft
15. SCREEN:
Depth Diameter Slot Size Material
From To Ft in in
From To Ft in in.
From To Ft in in
LS L D thkIm
DC�N< j From To
To
1
L fi4m
I
17. REMARKS.
GRO IFft_q,Y,.c�3T•IF`AY TH,\T THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
rr" e TTII E NDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
ASH')a �j_ l �ii /J_ �_� /Z���
Size Material
If additional space is needed use back of form
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other map reference poinns
194
Psis
Ft
Ft
1
leThe>Act
g; icy
FOR OFFICE USE ONLY
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

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section 260631
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone]
WELL CONSTRUCTION RECORD
WELL CONTRACTOR. Dewey Wright Well Pump Co.. Inc.
WELL CONTRACTOR CERTIFICATION #. 2887
020335 STATE WELL CONSTRUCTION PERMIT#- Steve Reece
WELL USE (Check Applicable Box): Residential 0 Municipal 0 Industrial 0 Agricultural 0 Monitoring 0
Recovery 0 Heat Pump Water Injection 0 Other If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: BANNER ELK County: AVERY
BANNER GRANDE DR. OFF HWY 184 OFF HWY 194 OFF
(Road Name and Numbers, Community, or Subdivision and Lot No.)
3. OWNER ELK VIEW LTD.
Address 800 BRIAR CRK RD. SUITE EE-507
CHARLOTTE` or Route No.) NC 28205
DRILLING LOG DEPTH
From To Formation Description
0 35 DIRT
35 70 GRANITE
City or Town State Zip Code
70 73 SHALE
4. DATE DRILLED 8/29/2002 73 110 GRANITE
5. TOTAL DEPTH 700 110 113 SHALE
6. CUTTINGS COLLECTED YES I I NO I XI 113 700 GRANITE
7. DOES WELL REPLACE EXISTING WELL? YES 0 NO 0
8. STATIC WATER LEVEL Below Top of Casing: 70 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): 4 METHOD OF TEST f
11. WATER ZONES Idepth):2 ppm70-73 2 gpm 110 113
0 gpm 0 ppm
12. CHLORINATION: Type NTH Amount 125
13. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 42 Ft 8 1/8 .350 PVC
From To Ft
From To Ft.
14. GROUT:
Depth Material Method
From 0 To 20 Ft Cement Gravity Flow
From To Ft.
15. SCREEN:
Depth Diameter Slot Size Material
From To Ft in. in
From To Ft in in.
From To Ft. in in
L
1AX/
R [F25
From
o„ Ffom
17. REMARKS.
T
Ft
Ft.
Size Material
GRouowtuREgfra§RTIFyT
ASHEVILIMsleCOIQVNIOTANL
If additional space is needed use back of form
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other map reference points)
T
2'
180(
AT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
\RDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
FOR OFFICE USE ONLY
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit original to Division of Water Quality, Groundwater Section within 30 days
GW-1 REV. 12/99
Quad No:
Serial No.

WELL CONSTRUCTION RECORD .25 9 3 3 5
North Carolina - Department of Environment and NaturalyResources - Divisiono/JJof Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) /Ie,Y. c/A )btctN CERTIFICATION
WELL CONTRACTOR COMPANY NAME G,c(J&Cff PHONE # ( )
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other ❑ If Other, List Use /ia4 tf
2. WELL LOCATION: /
Nearest Town: Jv -ktiar f/ e
one,/ /he f h f!
County / Yee"
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: Yc'mNr tp
Address
Q (Strer Route No1-
City or Town State
c. aeTG°
Zip Code
( )-
Area code- Phone number r
4. DATE DRILLED p lrr-9 2.
5. TOTAL DEPTH: (de 0
6. DOES WELL REPLACE EXISPING WELL? YES ❑ NO RV
7. STATIC WATER LEVEL Below Top of Casing: 3€0 FT.
I (Use "+" if Above Top of Casing)
8. TOP OF CASING IS FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): / 1 METHOD OF TEST Q /`r
10. WATER ZONES (depth): 330 53S` 7S1f
?D �3/- 95d
11. DISINFECTION: Type 1VT/f' Amount c3 02
12. CASING: Wall Thickness
Depth Diar•
eter or Weight/Ft. Material
From ' / To o?b Ft. lo+I i e col@
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From 6 To 496 Ft. Gaffe -VI— Pecrte'd
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
To
To
From
From
16. REMARKS:
Ft.
Ft.
"Topographic/Land setting
C lodge 0Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
— 3 bk- %e
3 — 513 66r' ✓a nnv/ %Ivc% kreernecv -
3 SO`-i,y5L �i& s'4'thasc , tc
!.34/-6yn fi��,rrer w.Y�J�y�<�LLvi fe
bait dr'tetzo t*^r,t?rut
670 —63f<
—Co6
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
HIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
1,7
IGNATURE OF PERSON CONSTR TiNG THE WELL DATE
S@
e Divi ton of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
vTAlfPfGW-1 REV. 07/2001
fR��q)ppJpLo.QB[ltjEi33- 21, within 30 days.

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Sc.V (ni' RE,Lc:a�R &) CERTIFICATION#Q.5416)
WELL CONTRACTOR COMPANY NAME c21QA.St✓Q-1 ( f,, ( .L(Zt J 11 r—(\ PHONE # g7itt I/33— Ww:02
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
259334
1. WELL USE (Check Applicable Box): Residential ❑ Municipal/Public Er/ Industrial ❑ Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: ti2e_ County L'
rage �
(Street Name, Numbers, Community, Subdivision,'Lot No., i Cle)
3. OWNER::[ lvioAc ki. iuRch
AddresszwittgaiY
( treet or-Ryut.Nn
lily or Town State Zip Code
( )-
Area code- Phone number
4. DATE DRILLED 1-e"7-
5. TOTAL DEPTH: 00 .
6. DOES WELL REPLACE EXIS 1NG WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: /O FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
9. YIELD (gpm): O METHOD OF TES
variance in accordance ith ISA NCAC 2C .0118.
10. WATER ZONES (depth): LI t / 46
fG 57
11. DISINFECTION: Type n Neal r,-C Amount 1
12. CASING: Wall Thickness
Depth Diameter or Weil} I/ t. Mated 1
From & To L/�- Ft. 6. '!
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From 0 To 30 Ft. t vim. o - foe
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
Topogra is/Land setting
❑Ridge ope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From TT�� Formation Description
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
Po
co
rri
cn
O
d
1D r 17�littleT
CT
TT WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
, AND THA A COPY 0 THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
the :l
AgAW it 11 r6TOfF n") 7
SIGNATURE 0 P RSON CONSTRUCTING THE WELL
DATE
'vision of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
3-3221, within 30 days. GW-I REV. 07/2001

Zip Code
variance in accordance with 15A NCAC 2C
9. YIELD (gpm): z70,5 METHOD
10. WATER ZONES (depth): rr i
11. DISINFECTION: Type //the
12. CASING:
13
14
15
Depth
From r To c2 7 FL
3. OWNER:
WELL CONSTRUCTION RECORD
2t133$
North Carolina - Department of Environment and Natural�Resources;`
- Division of Water Quality - Groundwater SectiooSection
WELL CONTRACTOR (INDIVIDUAL) NAME (print)) z, 2 /Uyer A t� d �' �4.G CERTIFICATION #°`�// -
WELL CONTRACTOR COMPANY NAME ,zt)t4,fa'e-i/ PHONE # f ) ✓
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
L WELL USE (Check Applicable Box): Residential Municipal/Publlc ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use .i)r^ ic 2-de
2. WELL LOCATION:
Nearest Town: /:vvl fie.
County
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
/)t,upis FL.! Mc401
Address
(Sf eet gi Royte No.) '
City or Town State
( )-
Area code- Phone number
4. DATE DRILLED $—/3 —n
5. TOTAL DEPTH: P e
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO EY
7. STATIC WATER LEVEL Below Top of Casing: 7 D FT.
(Use ••+•• if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
.0118.
OF TEST ,4' z•
6107
Amount -7 cc',
Wall Thickness
Diam to or Weight/Ft. Material
From To Ft.
From To Ft.
GROUT: Depth Material
From t~ To 02 r Ft. C </7t'.•'7(
Method
n
7 c, /lt
From To Ft.
SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Desiription
vg0 A/Gai/e
F) O7 /.s'h% /kou-4_,
,9- 736 Lipp,v%<i,vGK.,Azieflc»fs
Cfeoi'3'/oc k eleon
er-ka-•is r'6•.1,"
7.?S- 7e26 ;irt ,,ris; /%nefole
1>-d - 9,75
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
0
CO
0
SI DHE�N4RT FY�LL
4RAgqt THIS WELL WAS
CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C,
AND HA AC9PYOF THIS RECORD HAS BEEN PROVIDED TO THE WELLOWNER
II !II
l t'
7--/ 7
SIGNATURE OF CONSTRUCTING THE WELL DATE
N
PE
t�
a a Di ision of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
C2� IKSA `tTFf1S®10 ��) 733
ASHE l'_ )'
221, within 30 days. GW-I REV. 07/2001

1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR: Dewey Wright Well Pump Co., Inc.
WELL CONTRACTOR CERTIFICATION #: 2681
020487 STATE WELL CONSTRUCTION PERMIT#• Steve Petty
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
260667
1. WELL USE (Check Applicable Box): Residential El Municipal El Industrial n Agricultural _MonitoringJ
Recovery El Heat Pump Water Injection Other I I If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: BLOWING ROCK
WILD APPLE DR. OFF HWY 221
County: AVERY
(Road Name and Numbers, Community, or Subdrvaion and Lot No.)
DRILLING LOG - DEPTH
3. OWNER SUSAN E. ROTH From To Forrr ation Description`
Address % GISELE WEISMAN , 3475 OAK VALLEY RD. 0 3 DIRT
ATLANTA(straat or Route No.) GA 30326 3 50 GRANITE
City or Town State Zip code 50 62 SHALE
4. DATE DRILLED 8/1/2002 52 270 GRANITE.
5. TOTAL DEPTH 305 270 272 QUARTZ
6. CUTTINGS COLLECTED YES I NO 0 272 305 GRANITE
7. DOES WELL REPLACE EXISTING WELL? YES r I NO n
8. STATIC WATER LEVEL Below Top of Casing: 30 FT
(Use "+" if Above Top of Casing)
9. TOP OF CASING IS 1 FT Above Land Surface*
*Top of casing terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2C.0118
10. YIELD (gpm)• 3 METHOD OF TEST Air
11. WATER ZONES(depth)'1 Wm 50-52 2 qpm 270-272
0 gpm 0 qpm
12. CHLORINATION: Type HTHI Amount 56
13. CASING:
Wall Thickness
Depth Diameter or Weight/Ft.
From 0 To 20 Ft 6 1/8 .350 PVC
From To Ft
From To Ft
14. GROUT:
Material
Depth Material Method
From 0 To 20 Ft Cement Gravity Flow
From To Ft
15. SCREEN:
Depth Diameter Slot Size
From To Ft in in
From To Ft in in
From To Ft in in.
16. SAND/GRAVEL PACK:
Depth Size Mate
From To Ft
From To Ft
Material
If additional space is needed use back of form
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other map reference points)
am"
OCT - 4 2002
a�
ru17'Iilri'fw11
U
OUNDWATER SECTION
ASHEVILLE REGIONAL OFFICE
32t ('t4l
W I kd Apple Or.
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.
.ye) 94/ e
FOR OFFICE USE ONLY
SIGNATURE OF PERSON CdNSTRUCTING THE WELL DATE
Submit original to Division of Water Quality, Groundwater Section within 30 days
GW-1 REV. 12/99
Quad No:
Serial No.

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural/Resourc s - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) /`t? V i t .), fI e_e���j Q_i CERTIFICATION # 259O
WELL CONTRACTOR COMPANY NAME (�.Lt 1 mil i e Yl'k PHONE # V`h) 7n -o%'.Z
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PE IT
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential E` Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION: ^
Nearest"Stria Town: ,a to -7044-County M-'-eRn-/
C6-75( ��4A �s4 itg `?d 111
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
259349
3. OWNER:�B/1.A.. d.. r '
Address 8 % 5 / XI> . ed.-C—zabia
(Street or Route No.)
dei ny or own State., Zip Code
Area code- Phone number
4. DATE DRILLED
5. TOTAL DEPTH:
6. DOES WELL REPLACE EXIS NG WELL? YES 0 NO d
7. STATIC WATER LEVEL Below Top of Casing: r70 FT.
(Use'+" if Above Top of Casing)
8. TOP OF CASING IS ( FT. Above Land Surface*
'Top of casing terminated at/or below land surface requires a
variance in accordanceaccordancee 15A NCAC 2C .0118.
9. YIELD (gpm): METHOD OF TEST 4-1
10. WATER ZONES (depth): CX a I® 30e'
©2
11. DISINFECTION: Type
12. CASING:
Depth
From 0 To ISO
From To
From To
13. GROUT: Depth
From 3 To lip
From To
14. SCREEN:
From
Amount
Wall Thickness
Diametter or Weight/Ft. Material
Ft ®'4 s1P PVC -
Ft.
Ft.
Material
Ft.
Ft.
Depth Diameter
To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth
From To
From To
Size
Ft.
Ft.
graphic/Land setting
Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formtiion Description
— pp- ,4=
R'7 l oO
61, - /03
/"3— '?20
Method
Slot Size Material
in.
in.
Material
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
n:
r-
C)
16. REMARKS:
AWN'
t
to tic4.I
Submit the original to the Divi
ASHEVILLE REGIONAL OFFICE
1S WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
ND A A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
O vZG 07''1
GNATURE OF PERSON CONSTRUCTING THE WELL DATE
ion of Water Quality, Groundwater Section, 1636 Mail Service Center- Raleigh, NC
21, within 30 days. GW-I REV. 07/2001

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] 2
4. DATE DRILLED
5. TOTAL DEPTH 405 268 390
6. CUTTINGS COLLECTED YES I I NO 0 390 405
7. DOES WELL REPLACE EXISTING WELL? YES n NO n
8. STATIC WATER LEVEL Below Top of Casing: 40 FT
(Use "a" if Above Top of Casing)
9. TOP OF CASING IS 1 FT Above Land Surface*
*Top of casing terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2C.01
10. YIELD (gpm)' ° METHOD OF TEST Ar
11. WATER ZONES (depth):2 gpm255-263 3 oPm 390-405
0 Ftprn 0 Apm
12. CHLORINATION: Type HTH Amount �3
WELL CONSTRUCTION RECORD
WELL CONTRACTOR. Dewey Wright Well Pump Go., Inc.
WELL CONTRACTOR CERTIFICATION #- 2545
020509 STATE WELL CONSTRUCTION PERMIT#• Dewey Wnght
1. WELL USE (Check Applicable Box): Residential 0 Municipal Industrial
Agricultural Monitoring P1
Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use.
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: BANNER ELK County. AVERY
HICKORY NUT GAP RD. OFF HWY 184 OFF HWY 105
(Road Name and Numbers, Community, or Subdivision and Lot No.l
3. OWNER JOHN L LAMBERT/DEBORAH CROCKER
Address 4645 HICKOP,Y NUT GAP RD. ,
BENNER et`W or Route No.l NC 28804
City or Town State Zip Code
7/30/2002
DRILLING LOG
From To
0 10
DEPTH
Formation Description
DIRT
10 95 SAND/GRAVEL
95 285 GRANITE
285 288
QUARTZ
13. CASING:
From
From
From
Depth
O To
To Ft
To Ft
14. GROUT:
Wall Thickness
Diameter or Weight/Ft. Material
105 Ft e 1/4 Ass3ALV.
Depth Material Method
From 0 To 20 Ft. Cerrlen t Gravity Flow
From To Ft
15. SCREEN
From
From
From
16. SAN
Fro
From
17. REM
I DO
CON
Depth Diameter Slot Size Material
To Ft in in
To Ft in in
To Ft. in in -
RKS:
EREB CERTIFYTH T . s:LLW•S
TRUC (r^ t, TAKI IRS0R(mp THAT
ASHEViLLE FEGIONAL OPRCE
FOR OFFICE USE ONLY
Material
GRANITE
GRANITE/QUARTZ
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 poiR c
(n
r
Aitead kJS
I 6thattc-u
CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
PY OF THIS RECORD HAaBEEN PROVIDED TO THE WELL OWNER.
SIGNRE OF PERSON
NSTRUCTING THE WELL DATE
ty, Groundwater Section within 30 days
GW-1 REV. 12/99
1°
Quad No
Serial No.
Submit original
sion of Water Q

WELL CONSTRUCTION RECORD 25934 2
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
G
WELL CONTRACTOR (INDIVIDUAL) NAME (print) JCNf(C'fh ,TaxisffO4 CERTIFICATION # / 6
WELL CONTRACTOR COMPANY NAME
6 reed C✓1 PHONE # f )
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED \VQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ❑ Municipal/Public 0 Industrial ❑ Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use fPirR to
2. WELL LOCATION: �t Topographic/Land setting
Neares own: ' 11/�b�r7(/�_04-d ounty %4/1:1 y agidge DSlope ❑Valley ❑Flat
,e..,� /�K..• (�.![a� tic-Z .. iJ (check appropriate box)
(Street Name, Numbers, Community, Subdivision, LdtDNo., Zip Code)
3. OWNER: G4�no 2-q / /lee. ICock
Address
SueetorRout .)• C!• (Al 4 S,
Ci or Town State Zip Code
( )-
Area code- Phone number
4. DATE DRILLED .rQ mg S- 0 2
5. TOTAL DEPTH:
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO Ir
7. STATIC WATER LEVEL Below Top of Casing: G O FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS ,f FT. Above Land Surface*
'Top of casing terminated at/or below land surface requires a
variance in accordance with l5A NCAC 2C .0118. �f
9. YIELD (gpm): METHOD OF TEST /+
IO. WATER ZONES (depth): /lS-/r90 /094'1 -2/0 o247---57,41
59O-3447 /S3al
I I. DISINFECTION: Type Amount
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From —/ To fat- FL t$4 /7? Gy/v
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From 0 To ,to- o Ft. Gt.-4twit- powecpt
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
Formation Description
teddfr yraao /�s/bc;I
a/yrvJ C
&Ofl'j r9y steel
GT tan. - fe
`/brown)," =lr
Ttor✓i>G
givka br•om u,-ArilP
9/'4n-ife
DEPTH
From To
0— y8
f8- //5
/ I r—/10
/Po —Sro
a/o—alr
62/5 -3'Vb
390-397
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
0
0
IS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
ND THA ,A COPE' OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
1"7 -p2 > `' Q 2i
DATE
Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
�, I 'e c M14)733-3'21,within 30days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
259341
North Carolina - Department of Environment and Natural Resources - Divisionof Water Quality - Groundwater Section//�j
WELL CONTRACTOR (INDIVIDUAL) NAME (print) /t'CzYN 6-i4 Jnr//of CERTIFICATION #,66
WELL CONTRACTOR COSIPANY NAME $&OJU'C // PHONE # ( )
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential Ur Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other 0 If Other, List Use ofit"lvatf.
2. WELL LOCATION:
Nearest Town: hie t 4 gindf County
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: Cif If d 4'40.doer4
Address Po4* c.2f )'1
(Street or Route No.)
/ 44-1M E/k // a a.: 4 ei ye
City or Town State Zip Code
( )-
Area code- Phone number
4. DATE DRILLED 2-3 r11102
5. TOTAL DEPTH: ff'
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO Er
7. STATIC WATER LEVEL Below Top of Casing: fa fl FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 4 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with I5A NCAC 2C .0118.
9. YIELD (gpm): /5 METHOD OF TEST %m'i`
10. WATER ZONES (depth): /Jo /;3oP''z
3 fo -393- .�fM
j/
II
. DISINFECTION: Type
12. CASING:
From
From
—!
Depth
To 80
ff/ Amount it D z
Wall Thickness
Diameter or Weight/Ft. Material
Ft. 6 4 /37 6'a/d
To Ft.
From To Ft.
13. GROUT: Depth Material Method
From D To odd Ft. CGn ea,74" 90e/eo�
Topographic/Land setting
<idge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
Formation Description
bled".-,. i-
JeOr�/ f
n rev /e
DEPTH
From To
3— /i%o
/ 8o—<.Z!
/23- 3Yo
3yo 395
-3 9 -7- rAo
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
From To Na
14. SCREEN: Depth Diameter Slot Size Material rd,
m
From To Ft. in. in.
From To Ft. in. in. I
Co
Size Material ?"'
_z
Ft.
O
Co
16. REMARKS:
15. SAND/GRAVEL PACK
Depth
From To
From To
Ft.
Ft.
t ��nn i
E BYt E Tly T AT
R CT a T^ rn/,erS A7
i
WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
?"3/— 02
NATURE OF PERSON CONSTRUCTING THE WELL DATE
Su visior of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
2707(0145 'RA P -3221 within 30 days. GW-I REV. 07/2001
0

WELL CONSTRUCTION RECORD
259340
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) CERTIFICATION # v'1-3—�
PHONE # ( )
WELL CONTRACTOR COMPANY NAME
SLATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable)
(if applicable)
1. WELL USE (Check Applicable Box): Residential Er-Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use ifer%defe
2. WELL LOCATION•
County Any'
Nearest Town:
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
Address
or Town State Zip Code
Area code- Phone number
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 0
7. STATIC WATER LEVEL Below Top of Casing: #6 FT.
8. TOP OF CASING IS t FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): AO METHOD OF TEST ta
11. DISINFECTION: Type
12. CASING:
Depth Diameter
From `/ To 9/ -- Ft. 4
From To Ft.
From To Ft.
13. GROUT: Depth
From 0 To a0 Ft.
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
Amount
Wall Thickness
or Weight/Ft. Material
//0
Material
GC.dife�7�-
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth
From To Ft.
Method
foci/'e-
Slot Size Material
in.
in.
Size Material
From To FI.
Topographic/Land setting
DRidge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
6 — 3S ir��'� f .BidadvN?aal
35 517 t 9rpw, tC n
9-kolot.
SO d0 In
-0
rr
Crl
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Incluuhe road
numbers and common road names.
- fVe ej/y
"-7-,
.ien S`c-- / 9 6 -
16.REMARKS:
1i0 5RBiY jEIjIF'-TE�
CON3TRUCTI N STAND4 LD$
II
i EI
Div
AgR4# E 1Th. OU N733-
IS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
ND THAT
THIS CORD HAS BEEN PROVIDED TO THE WELL OWNER
%--- 30 '02
SIGNATURE 0 ERSON CONSTRUCTING THE WELL DATE
Lion of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
221, within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - `Division of Water/Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print)/J A;M/l/€f,/ cYor'tt'esit� CERTIFICATION# a2(17
/-'1'QSIUG /7
WELL CONTRACTOR COMPANY NAME
2593°8
PHONE # f )
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential 2-7Municipal/Public D Industrial ❑ A'ricultural ❑
Monitoring ❑ Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use ' ectia 7�G
2. WELL LOCATION:
Nearest Town: _L//✓✓'��E County 4(./c.iy
C a f 4�
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: "8:14"""'
Address
(Street or iou - No.)
City or Town State
( )-
tj .c. a7/°1
Zip Code
Area code- Phone number qq
4. DATE DRILLED 9^0g 02
5. TOTAL DEPTH: .s(9O
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO lire
7. STATIC WATER LEVEL Below Top of Casing: -S d FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 3- FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance 'ith 15.4 NCAC 2C .0118.
9. YIELD (gpm): METHOD OF TEST 41r
10. WATER ZONES (depth): //o `//S a20a/ iif7-9634 q
11. DISINFECTION: Type he tfe Amount .T d T
12. CASING: Wall Thickness
Depth Diam ter or Weight/Ft. Material
From -' / To 70 Ft. 64 /9'a Gv/✓
From To Ft.
From To Ft.
13. GROUT: Depth Material Method From D To 8c Ft. CCof et) (P)OO/ees
From To Ft.
14. SCREEN: Depth
From To
From To
15. SAND/GRAVEL PACK:
Depth Size
From To Ft.
Diameter Slot Size Material
Ft. in. in.
Ft. in. in.
From To Ft.
16. REMARKS:
GROWI7N/OIf SEMltftd o the
ASHE\ Izb 9REGICRAtttiCIrFtCE919)
Material
.vu t //1r0/ /(12 af-, ,V0e_,
Topographic/Land setting
❑Ridge ❑Slope 121galley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
O — 78 tyy.ruY�fi==/z
92— //0 e
/i0'1/5— J/fc%roc-
eereatth
54.5,-963 f'/;titie.i feeu�f
9e3— flo !q /'{/Li CA-4terlIaF6-
iU p
Gl
LOCATION SKETCH_
Show direction and distance in miles from at Est _.7_�: -
two State Roads or County Roads. Include thee'toad,ft? _
numbers and common road names. Co
n
\T THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
DS, AND THAT A COPY OF THIS RECf)RD HH S BEEN PROVIDED TO THE WELL OWNER
7ra29 v 2
SIGNATURE OF PERS614 CONSTR NG THE WELL DATE
Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
33-3221, within 30 days. GW-1 REV. 07/2001

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone]
WELL CONSTRUCTION RECORD
WELL CONTRACTOR: Dewey Wright Well Pump Co., Inc.
WELL CONTRACTOR CERTIFICATION #: 2878
020384 STATE WELL CONSTRUCTION PERMIT#• Steve Price
1. WELL USE (Check Applicable Box): Residential
Recovery El Heat Pump Water Injection
I XI
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: BOONE
HWY 321 OFF HWY 321
(Road Name and Numbers, Community, or Subdivision and Lot No.l
3. OWNER DANIEL H. LAWRENCE
Address 573 BOB CAMPBELL RD. ,
VI LAS (Street or Route No.) NC 28602
Municipal 0 Industrial D Agricultural fl Monitoring D
Other n If Other, List Use.
County AVERY
DRILLING LOG
From To
0 40
DEPTH
Formation Description
DIRT
40 60 SHALE
City or Town
4. DATE DRILLED
5. TOTAL DEPTH
6. CUTTINGS COLLECTED YES NO El
7. DOES WELL REPLACE EXISTING WELL? YES NO
8. STATIC WATER LEVEL Below Top of Casing: - 80 FT
(Use "+" if Above Top of Casing)
9. TOP OF CASING IS 1 FT Above Land Surface*
*Top of casing terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2C.0118
10. YIELD (gpm): 1 METHOD OF TEST Air
11. WATER ZONES (depth):1 qpm 120-170 0 ppm
0 qpm 0 qpm
State Tip Code
7/9/2002
325
I XI
12. CHLORINATION: Type HTH Amount `4
13. CASING:
Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 45 Ft 6 1/8 .350 PVC
From To Ft
From To Ft
14. GROUT:
From
Depth
0 To 20
Material Method
Ft Cement Gravity Flow
From To Ft
15. SCREEN
Depth Diameter Slot Size
From To Ft in in
From To Ft in. in
From To Ft. in in
16. SAND/GRAVEL PACK:
Depth
From To Ft
From To Ft
17. REMARK'
1 DO HERE
CONSTRL
FOR OFFIC
Size Material
F THATDc rnoT4111wE
IANDAR1
ONLY''
60 120 GRANITE
120 170 GRANITE
170 240 GRANITE QUARTZ
240 325 GRANITE
IV o
If additional space is needed use back of -form
LOCATION SKETCH ry o
(Show direction and distance from at least two State
Roads, or other map reference points)
✓i\
Owavd
Oe ;Its
WAS'_ONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
% - 2 9 -0-?
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit original to Division of Water Quality, Groundwater Section within 30 days
GW-1 REV. 12/99
Quad No:
Serial No.
GROUNDWATER SECTION
AhM1LvrArRF( ZONAL OFFIC

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
020403
257242
WELL CONTRACTOR. Dewey Wright Well Pump Co., Inc.
WELL CONTRACTOR CERTIFICATION #• 2787
STATE WELL CONSTRUCTION PERMIT#- Jerry Wilson
1. WELL USE (Check Applicable Box): Residential
Recovery n Heat Pump Water Injection
X
Municipal Industrial n Agricultural Monitoring ❑
Other 1 1 If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: ELK PARK County: AVERY
PRIVATE DR. OFF BILL YOUNG RD. OFF BARLOWE RD.
(Road Name and Numbers, Community, or Subdivision and Lot No.l
3. OWNER THOMAS E. HOLMSTRORM
Address P.O. BOX 186 ,
BANNER t`f`_r<orRoute No.) NC 28604
City or Town State
Zip Code
4. DATE DRILLED 7/2/2002
5. TOTAL DEPTH 225
6. CUTTINGS COLLECTED YES 0 NO 7
7. DOES WELL REPLACE EXISTING WELL? YES n NO n
8. STATIC WATER LEVEL Below Top of Casing: 50 FT
(Use '+" if Above Top of Casing)
9. TOP OF CASING IS 1 FT Above Land Surface*
*Top of casing terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2C.0118
10. YIELD (gpm): 30 METHOD OF TEST Air
11. WATER ZONES (depth)-2 porn 115-116 28 gpm 210-211
0 nom 0 ppm
12. CHLORINATION: Type HTH Amount 36
13. CASING:
From
From
From
Depth
0 To
To Ft
To Ft
14. GROUT:
Diameter
108 Ft 6 1/8
Wall Thickness
or Weight/Ft. Material
.350 PVC
Depth Material Method
From 0 To 20 Et Cement Gravity Flow
From To Ft
15. SCREEN:
Depth Diameter Slot Size Material
From To Ft. in in
From To Ft in in
From To Ft in in
16. SAND/GRAVEL PACK:
Depth
From To Ft
From To .—, _ (t
S r
Size Material
17. REMARKS
I DO HERE
CONSTRU
FOR OFFICE
Quad No:
Serial No
4'I rEriTIFY THAT THIS WELL WAS C(
CjLL fffIIIIDNITANDARDS, AND THAT AD
u
SE ' NLY
fi-
V! ORorigir
DRILLING LOG
From
0
DEPTH
To Formation Description
100 DIRT/SHALE/GRANITE
100 115 GRANITE
115 116 GRANITE
116 210 GRANITE/QUARTZ
210 211 QUARTZ
211 225 GRANITE
t"1
tV t--}
2
t
4S
-4o
If additional space is needed use bac= fort
LOCATION SKETCH u•t _2
(Show direction and distance from at least two3`tate
Roads, or other map reference points)
S3j &
co r'2
cafr4's uvcck
c1 <` • 3
e 4,
NSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
'Y 'F THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
;IG" • URE OF PERSON CONSTRUCTING THE WELL DATE
al to Division of Water Quality, Groundwater Section within 30 days
GW-1 REV. 12/99
CP-

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
020452
25725'2
WELL CONTRACTOR. Dewey Wright Well Pump Co., Inc.
WELL CONTRACTOR CERTIFICATION #• 2727
STATE WELL CONSTRUCTION PERMIT#- Jerry Wilson
1. WELL USE (Check Applicable Box): Residential X Municipal ❑ Industrial Agricultural P1 Monitoring ❑
Recovery I I Heat Pump Water Injection 0 Other n If Other, List Use
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: BANNER ELK County. AVERY
PVT DR OFF FOX MEADOWS OFF SHOEMAKER RD OFF
I Road Name and Numbers, Community, or Subdivision and Lot No.)
3. OWNER R. L. HARTWIG
Address P.O. BOX 88 ,
sOSTWI ASYeet or Route No./
City or Town State
4. DATE DRILLED 7/10/2002
5. TOTAL DEPTH 645 -5585
6. CUTTINGS COLLECTED YES P1 NO 0
7. DOES WELL REPLACE EXISTING WELL? YES P1 NO In
8. STATIC WATER LEVEL Below Top of Casing: 50 FT
(Use'+" if Above Top of Casing)
FL 32007
Zip Code
DRILLING LOG
From To
0
DEPTH
Formation Description
24 DIRT SHALE GRANITE
24 75 GRANITE E SHALE
75 78 SHALE
78 585 GRANITE
645 GRANITE
C
9. TOP OF CASING IS 1 FT Above Land Surface*
*Top of casing terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2C.0118
10. YIELD (gpm): 4 METHOD OF TEST Air
11. WATER ZONES(depth)•1/4 Wm 75-78 3.75 ppm 585-588
0 qpm 0 qpm
12. CHLORINATION: Type HTH Amount 11L7
13. CASING:
Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 28 Ft 8 1/4 .188 GALV
From To Ft
From To Ft
14. GROUT:
Depth
From 0 To 20
From To
15. SCREEN
Depth
From To
From To
From To
Material Method
Ft Cement Gravity. Flow
Ft
Diameter Slot Size Material
Ft in
Ft in
Ft in
16. SAND/GRAVEL PACK:
Depth Size
From To Ft
From To Ft.
17. REMARKS
I DO HERE
CONSTRU
V
kTIFY THAT THIS WELL WISI(
STANDARDS, AND THAT'Ay
I
FOR OFFICE
USE ONLY
in
in
in
Material
N c
b L.,_
G) Ac,
=
t-,
If additional space is needed use bacf foW-
444
LOCATION SKETCH ir)
crt
(Show direction and distance from at legit twtate
Roads, or other map reference points)
)NSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
PY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
2- 23-�vda
Quad No -
Serial No
GROUNOWFTER SECT
ASHEVILLE RE GIONAL
orig
IG TURE OF PERSON CONSTRUCTING THE WELL DATE
al to Division of Water Quality, Groundwater Section within 30 days
GW-1 REV. 12/99

3. OWNER
Address
4.
5.
6.
7.
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
020404
WT 2.4 9
WELL CONTRACTOR- Dewey Wright Well Pump Co., Inc.
WELL CONTRACTOR CERTIFICATION it.2Th7
STATE WELL CONSTRUCTION PERMIT#• Jerry Wilson
WELL USE (Check Applicable Box): Residential El Municipal D Industrial ❑
Recovery Heat Pump Water Injection 0 Other 0 If Other, List Use.
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: BANNER ELK County AVERY
GILLIAN RD. OFF HWY 184 OFF HWY 194 OFF HWY 184
(Road Name and Numbers, Community, or Subdivision and Lot No.)
THOMAS E. HOLMSTRORM
P.O. BOX 186 ,
BANNERat
trrt or Route No.)
City or Town State
DATE DRILLED 7/1/2002
NC 28604
Zip Code
TOTAL DEPTH 205
CUTTINGS COLLECTED YES 0 NO EI
DOES WELL REPLACE EXISTING WELL? YES 0 NO
B. STATIC WATER LEVEL Below Top of Casing. 30 FT.
(Use "+" if Above Top of Casing)
9. TOP OF CASING IS 1 FT Above Land Surface*
*Top of casing terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2C.0113
10. YIELD (gpm)• bO METHOD OF TEST Air
11. WATER ZONES (depth)•50 qpm 185-186 0 pprr
0 qpm 0 qpm
12. CHLORINATION: Type HTH Amount 36
13. CASING:
Depth Diameter
From 0 To 23 Ft 6 1/8
From To Ft
From To Ft
14. GROUT:
Depth
From 0 To 20 Ft Cement
From To Ft
15. SCREEN:
Depth Diameter Slot Size
From To Ft in in
From To Ft in. in
From To Ft in in
16. SAND/GRAVEL PACK:
Depth Size
From To Ft
From To Ft.
17. REMARKS•r-
IDO HEREBY
CONSTRUCTI
FOR OFFICE USE
Quad No
hlllY IHAI THIS WELL V11
IIIISTANDARDS, AND THAT
I
6NLV
I X I
Wall Thickness
or Weight/Ft. Material
.350 PVC
Material Method
Gravity Flow
Material
Material
Agricultural fl Monitoring 0
DRILLING LOG
From To
0 18
18 185
185 188
DEPTH
Formation Description
DIRT/SHALE/GRANITE
GRANITE/QUARTZ
GRANITE
186 205
GRANITE/QUARTZ
r 3 r-'
sicui
c*2 c'=
ct1
If additional space is needed use back of fornx -;.'
SD -cc
n�
(Show direction and distance from at leavo Ste
Roads, or other map reference poi ttRt) 5
LOCATION SKETCH
NSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
Y OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
7-23
Ie5
frovskek
Serial No
GROUNUWPTER SEC1 P11111t
ASHEVILLE RE GIONAL OFFICE
SEG NATURE OF PERSON CONSTRUCTING THE WELL DATE
origiial to Division of Water Quality, Groundwater Section within 30 days
GW-1 REV. 12/99

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section 1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone] 257250
WELL CONSTRUCTION RECORD WELL CONTRACTOR' Dewey Wright Well Pump Co., Inc.
WELL CONTRACTOR CERTIFICATION A. 279 /
020412 STATE WELL CONSTRUCTION PERMIT#• Jerry Wilson
1. WELL USE (Check Applicable Box): Residential Municipal 0 Industrial 0 Agricultural 0 Monitoring 0
Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use•
Ixl
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: LINVILLE County. AVFRY
ASPHALT PLANT OFF HWY 181 OFF HWY 105/221
(Road Name and Numbers, Community, or Subdivision and Lot No.)
PAUL VANCE ESTATE
3. OWNER
Address
% MAYMEAD MATERIALS P.O. BOX 911
DRILLING LOG
To
115
From
0
MOUNTAI' rth1tute Na) m 37683 115
City or Town State Zip Code
4. DATE DRILLED 6/28/2002
5. TOTAL DEPTH 480
6. CUTTINGS COLLECTED YES 0 NO 0
7. DOES WELL REPLACE EXISTING WELL? YES 0 NO
8. STATIC WATER LEVEL Below Top of Casing: 10 FT
(Use "+" if Above Top of Casing)
9. TOP OF CASING IS 1 FT Above Land Surface*
*Top of casing terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2C.0118
10. YIELD (gpml' 10 METHOD OF TEST Air
11. WATER ZONES (depth).8 ppm 240-241 2 am 460-461
0 gpm 0 ppm
12. CHLORINATION: Type HTH Amount 77
DEPTH
Formation Description
DIRT/GRP.VEUGRNT
240 GRANITE/QUARTZ
240 241 GRANITE
241 460 GRANITE/QUARTZ
460 461 GRANITE
461 480 GRANITE/QUARTZ
13. CASING:
Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 125 Ft 6 1/4 .188 CALV.
From To Ft
From To Ft
14. GROUT:
Depth Material Method
From 0 To 20 Ft Cement Gravity Flow
From To Ft
15. SCREEN
Depth Diameter Slot Size Material
From To Ft in in
From To Ft in. in
From To Ft in in
16. SAND/GRAVEL PACK:
Depth
From
From
17. REMARKS:
I DO HEREB
CONSTRUC
Size
Material
c
I iCDIN)
c C.
If additional space is needed use baclaf for
yC
—4-,
LOCATION SKETCH -- w
m
(Show direction and distance from at Ie3Sj'twoA4afe
Roads, or other map reference pWfats)
rotei
(P'
/8/
IFYTHAT THIS WELL W$C¢ STRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
TANDARDS,'AND THAT A-00O',Y OF THIS RECORD HAS BEEN PRO IDED TO THE WELL OWNER.
SE ONIPCUNDV:
ASHEVILLE
1ER SECTION EGIONAL OFFICE IGrRE OF PERSON CONSTRUCTING THE WELL DATE
u. mit original to Division of Water Quality, Groundwater Section within 30 days GW-1 REV. 12l99

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]
255160
WELL CONSTRUCTION RECORD
020330
WELL CONTRACTOR Dewey Wright Well Pump Co., Inc.
WELL CONTRACTOR CERTIFICATION #: 2/1A/
STATE WELL CONSTRUCTION PERMIT#• Jerry Wilson
1. WELL USE (Check Applicable Box): Residential 71 Municipal
Recovery n Heat Pump Water Injection n Other
Industrial 0 Agricultural ❑ Monitoring ❑
If Other, List Use•
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: LINVILLE County. AVERY
HAAS HARTLEY RD. OFF WEST FORK RD.OFF JOE HAR
(Road Name and Numbers, Community, or Subdivision and Lot No.)
3. OWNER MONTE J. SIMMONS
Address P.O. BOX 1046 ,
Li NVI LLE or Route No.) NC 28645
City or Town State Zip Code
4. DATE DRILLED 6/12/2002
5. TOTAL DEPTH 405
6. CUTTINGS COLLECTED YES I NO L?J
7. DOES WELL REPLACE EXISTING WELL? YES 1 J NO
8. STATIC WATER LEVEL Below Top of Casing: OODU FT
(Use "+" if Above Top of Casing)
9. TOP OF CASING IS 1 FT Above Land Surface*
X
DRILLING LOG DEPTH
From To Formation Description
0 73 DIRT
73 150 GRANITE
160 181 GRANITE
181 370 GRANITE
370 371 GRANITE
371 405 GRANITE
*Top of casing terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2C.01
10. YIELD (gpm)•'S METHOD OF TEST Air
11. WATER ZONES (depth).'
O APm 160 181 1.
11. gpm 370-371
12. CHLORINATION: Type HTH Amount 71 If additional space is needed use back of form
13. CASING
Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 84 Ft 5 1/4 .188 GALV.
From To Ft
From To Ft
14. GROUT:
Depth Material Method 1
From 0 To 20 Ft Cement Gravity Flow 8 �_ eS.
From To Ft J,_� garlic
P'
15. SCREEN: /ttt lXlrrl KtI
Depth Diameter Slot Size Material
From To Ft in in
From To Ft in in
From To Ft in in
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other map reference points)
16. SAND/GRAVEL PACK:
Depth Size Material
From To Ft
From To Ft
17. REMARKS.
I DO HEREBY C
CONSTRUCTIO
FOR OFFICE US
Quad No
(1a
F(LTHt!t THIS YV
QNDARDS, AND THAT A C
Oft
VVesf Ir'K f2d
•S
\o
o ro ��
ociii
o
—a CTI
-r..1
—o rn )
3 cr.„ •
Ca) N `„m m—
CO
lD G
,De tio-t*leq 1 •
TRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
)F THIS RECORD HAS BEEN P OVIDED TO THE WELL OWNER.
DATE
Submit oliginal o Division of Water Quality, Groundwater Section within 30 days
GW-1 REV. 12/99
XS? 9
ATURE OF PERSON CONSTRUCTING WELL
Serial No.
j IC'

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR: Dewey Wright Well Pump Co., Inc.
WELL CONTRACTOR CERTIFICATION #: 2686
020313 LeSre Reece
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE (Check Applicable Box): Residential El
Recovery n Heat Pump Water Injection
Municipal Industrial 0 Agricultural D Monitoring El
Other I 1 If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: LINVILLE County: AVERY
ROARING CREEK RD OFF OLD 19E OFF SQUIRREL CR.
(Road Name and Numbers, Community, or Subdivision and Lot No.)
DRILLING LOG DEPTH
3. OWNER DAVID J. COX From To Formation Description
Address % FREEDOM HOMES , 3606 HWY 421 W. 0 75 DIRT MUD
WILKES8twVrRoute No.) NC 28697 75 93 GRANITE
City or Town State Zip Code 93 94 SHALE
4. DATE DRILLED 6/5/2002 94 231 GRANITE.
5. TOTAL DEPTH 285 231 232 SHALE
6. CUTTINGS COLLECTED YES 0 NO 7 232 285 GRANITE
7. DOES WELL REPLACE EXISTING WELL? YES I I NO
8. STATIC WATER LEVEL Below Top of Casing: 50 FT
(Use "+" if Above Top of Casing)
1 A
9. TOP OF CASING IS 1 FT Above Land Surface*
*Top of casing terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2C.01
10. YIELD (gpm): METHOD OF TEST Air
11. WATER ZONES (depth):1 ppm93-94 2 qpm 231-232
0 qpm 0 nom
12. CHLORINATION: Type HTFi Amount 47
If additional space is needed use back of form
13. CASING: LOCATION SKETCH
Wall Thickness
Depth Diameter or Weight/Ft. Material (Show direction and distance from at least two State
From 0 To 81 Ft 6 1/8 .350 PVC 2+'�%u -feRoads, or other map ence points) c //n Jt//E
From To Ft I�tCt�t o a //
From To Ft c)_
14. GROUT:
Depth Material Method
From 0 - To 20 Ft Cement Gravity Flow
From To Ft
15. SCREEN:
Depth Diameter Slot Size Material
From To Ft. in in
From To Ft in in.
From To Ft. in in
16. SAND/GRAVEL PACK:
Depth Size Material
From To Ft
From To Ft
t.
17 1 ARK
0
II am HER -R1tFYr HATT ELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL 4f
�a, a • t : • ' : IA a THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNS
PJFLOFFICE USE ONLY
Quad QJo:
rn=
F•a
get. 1 W � -7-Oa
SIGNATURE OF PE N CONSTRUCTING
G THE WELL DATE
Submit original to Division of Water Quality, Groundwater Section within 30 days
GW-1 REV. 12/99
SeriapNo, f:_fl�

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]
255153
WELL CONSTRUCTION RECORD WELL CONTRACTOR: Dewey Wright Well Pump Co., Inc.
WELL CONTRACTOR CERTIFICATION #: 2681
020319 STATE WELL CONSTRUCTION PERMIT#. Steve Petty
1. WELL USE (Check Applicable Box): Residential El Municipal 0 Industrial n Agricultural 0 Monitoring P1
Recovery P1 Heat Pump Water Injection P1 Other ❑ If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: BANNER ELK County: AVERY
"[RIVE I I t BRANCH RD OFF DOE RIDGE RD OFF HOWA
(Road Name and Numbers, Community, or Subdivision and Lot No.)
DRILLING LOG DEPTH
?. OWNER DAVID SMITH From To Formation Description
Address % LOGS OF AMERICA , 8649-1 HWY 105 S. 0 25 DIRT
25 86 GRANITE
BANNER !ILEX °` Route NO) NC 28604
City or Town State Zip Code
4. DATE DRILLED 6/6/2002
5. TOTAL DEPTH 305
6. CUTTINGS COLLECTED YES 0 NO
7. DOES WELL REPLACE EXISTING WELL? YES 0 NO
8. STATIC WATER LEVEL Below Top of Casing: 20 FT
(Use "+' if Above Top of Casing)
IX]
X
06 87 QUARTZ
87 270 GRANITE
270 272 SHALE
272 305 GRANITE
9. TOP OF CASING IS 1 FT Above Land Surface*
'Top of casing terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2C.011.8
10. YIELD (gpm): 1/2 ETHOD FTE ST Air
p8 1 1l2gpm 270-2
11. WATER ZONES (depth):0 gPrn
gpm837 0 ppm
12. CHLORINATION: Type H fH Amount 57 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 0 To 30 Ft 6 1/8 .350 PVC Roads, or other map reference points)
From To Ft. IR
.,p,�I
From To Ft y�W'�
14. GROUT:
Depth Material Method
From 0 To 20 Ft Cement Gravity Flow
From To Ft.
15. SCREEN:
Depth Diameter Slot Size Material
From To Ft in in
From To Ft in in.
From To Ft in in
16. SAND/GRAVEL PACK:
Depth Size Material
From To Ft
From To Ft
17. REMARK
I DO HERE
CONSTR_
JI
FOR OFFICE USE ONLY
I11,
TTIIISWELL'
NA:
N STANDARDS, AND THAT A
Quad No:
ONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
OPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
� c, omit o
TC, SECTIOf/
/i FL, ,IL OFFICE
SIGNATURE OF PERS• t CONSTRUCTING THE WELL DATE
ginal to Division of Water Quality, Groundwater Section within 30 days
GW-1 REV. 12/99
Serial No.

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone]
255152
17. REMARKS•
WELL CONSTRUCTION RECORD
020309
WELL CONTRACTOR Dewey Wright Well Pump Co., Inc.
WELL CONTRACTOR CERTIFICATION it1t16/
bteye
STATE WELL CONSTRUCTION PERMIT#• Reece
1. WELL USE (Check Applicable Box): Residential
Recovery I I Heat Pump Water Injection
X
Municipal 0 Industrial 0 Agricultural 0 Monitoring P1
Other 0 If Other, List Use.
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: BOONE County: AVERY
PRIVATE RD. OFF COY HARRIS RD. OFF BUCKEYE RD.
I Road Name and Numbers, Community, or Subdivision and Lot No.)
3. OWNER BONITA WILCOX/MI KAEL HICKS
DRILLING LOG DEPTH
From To Formation Description
Address % MICKAEL HICKS , 212 COY HARRIS RD. 0 50 DIRT
ELK ptr0et or Route No.) NC 28622 50 210 GRANITE
City or Town State Zip Code 210 212 SHALE
4. DATE DRILLED 5/24/2002 212 245 GRANITE
5. TOTAL DEPTH 245
6. CUTTINGS COLLECTED YES P1 NO 7
7. DOES WELL REPLACE EXISTING WELL? YES 7 NO
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.01 8
10. YIELD (gpm)' METHOD OF TEST fur
11. WATER ZONES (depth)•3 ppm 210-212 0 ppm
0 ppm 0 ppm
AI
12. CHLORINATION: Type NTH Amount 43
13. CASING:
Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 58 Ft 6 1/8 .350 PVC
From To Ft
From To Ft
14. GROUT:
Depth Material Method
From 0 To 20 Ft. Cement Gravity Flow
From To - Ft
15. SCREEN:
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
L' fl }
I DO HEREBY CERTI AT THIS WELL WAS CON'T CTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STA ARDS, AND THAT A COP' f 1HIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
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)
�y/
1'
FOR OFFICE USE ONLY
Quad No'
SHEV:LLE REG
1tGNATURE OF PERSON CONSTRUCTING THE WELL
ti„Tf7Lto Di'sion of Water Quality, Groundwater Section within 30 days
Serial No
DATE
GW-1 REV. 12/99

rh'rw' J 'r WELL CONSTRUCTION RECORD „ r
�0 *,;t 'Ary A. .. •
artment onnvironment and Natural Resources - Division of Water Qual ty
1 DI. IDUALJ NAME. (print)
aar.._
COMPANY PIAME~
G,QNSTRUCTI ON PERMIT#
ifapphcable)`,.
ASSOCIATED WQ PERM[Tq fir`=
(if applicable)
oringSE (Check Applicable Box): Residential Rf Municipal/Public 0 Industrial 0 Ag cut u
O,' Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use yY'
TION: ,
t r)
1; M+()
am -,Numbers Community, Subdivision, Lot No., Zip Code)
.cP$Fhope number'
FRILLED ,:
!DEPTH;
Count
Zip Code
Y _D
Topogra , ic(J ncisetting
❑Ridge .. lope �; O Valle e
(check appropriate box -
Latitude/longitude of well locatio
aW )1
(degrees/minutes/seconds;
Latitude/longitude source;OGPS❑
PT
Frorn
DOES�WEI LREPLACE EXI TING WELL? YES ❑ NO l
S ICrWATER LEVEL Below Top of Casing: _FT. -
r (Use "+" if Above Top of Casing)
i TOP�OF CASING IS 1 FT. Above Land Surface*
!- Topiifcasing terminated at/or below land surface requires a
varlance In accordance wl h 15A NCAC 2C .0118. ,
, ELD (gpm) `c� METHOD OF TEST
W, tERZONES(depth):
A!$lNFECTION: Type n c ca; R Am•.unt C d�
:,CA$I �'`"4'>,` ,. Wall Thickness '
.,Froti}_Q_•To `J Ft - �`� fits D1 ?VG—,
(—:.x.•ari: •.
`w Depth Diameter or Weight/Et. Material
'From4'' ,. To Ft. 2 .
From To Ft.
Dc tit
GROUT vrp p Material.'
From' '%.ti "'To . t.5 Ft. Cc' .y-e._1.7-
i „',,,t tlaM,A3;:To, Ft.
Frorn
14 `SCREEN , ;.Depth Diameter Slot Size
P '`' .�flP;h: ,,TQ Material
From' Ft. _in.
;From . To'Ft._ in. in.
5 ;SANnD/GRAVEL PACK: o.
S 'Depth Size Material
From ' To Ft.
From'ec To Ft.
16 `'(tEMARKS:''
Subitrtt
276s%;
Lk I016.04.i(At.9 993
LOCATION CKATf•ir4
Show direction and distance in m ey frottut
``
two State Roads or County Roads Include
numbers and common road names ,,,
aleaackakas
WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELLI%
THAT • • 0= THIS RECORD HAS BEEN PROVIDED TO THE WELL CAINE
SIGNATURE OF PERSON CONSTRUCTING THE WELL
DATE
isidn of Water Quality, Groundwater Section, 1636 Mail Service Center-Ralejg �'Q
1U6221, vitliin 30 days. g ._„ nO
GW-I`REV 07/,2001
r" a� rzar

` Depth
From To
From ^wr-To
mGROU3' rI.- Depth
,From * O To 90
s SCREEN b rL;tDepth
tFrom "' To
atural Resources , Division of Water Qualit
ASSOCIATED WQ PERMITS/
(ifa licable)`r" 3;?
USE'(Cheek Applicable Box): Residential Municipal/Public 0 Industrial 0 Agricultural
r; g O Recovery ❑ Heat Pump Water Injection 0 Other 0 if Other, List Use
WELL CONSTRUCTION RECORD` }
artment'orEnvironment and
NDIVIDUAL) NAME (print)
CTOR COM PANY NAME
I,ICONSTRUCTION PERMIT,/
ONION:
>),q'd County r1-tfe/
14-1;; !✓larJ st 2
Street'e ame. Nu'hbers mmunity, Su ivision Lo N Zi
• P Code)
Al .Pt--3
yr:
,-eet or Route,) (o s'
i. •State Zip Code
ric,a,,fode�Phone number
DAigl.D iLLED 2"
PT41;PEPT 4
DQ,F�S,WELL'REPLACE E ISTING WELL? YES ❑ NO,19'
T TI %W. TER LEVEL Below Top of Casing: 15- FT.
(Use"+" if Above Top of Casing)
Ok (E,CASING IS f FT. Above Land Surface*
jop of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
"gD,(gpt)t) h. ?Q METFUOD OF TEST {� &
E ZONES (depth): g5 --p-
¢ r
ASINFECT1ON: Type r atAR; a,K Amount c)Z
CASI]sIG� �. i- - Wall Thickness ;
Di fn ter or,l SIC_ FI, Material
Ft.
Ft.
Ft.
Ft.
Mat&ia
ce
�( ��Method s
V R
Ft.
Diameter Slot Size Material
Ft. in. in.
r3. ;From ` '''',To Ft in. in.
I5.SAND/GRAVEL PACK: - '
, >NHa... "r..Depth - Sizc Material
To FL
To Ft.
[REMARKSi.d# It
DOHER,M3YrntrrtPY TPAT TkI
.wc,3N5AgfS,i$
SIG nA CE OF PERSON ONSTRUCTING THE WELL
Su amit le original to the Divisiot of Water Quality, Groundwater Section, 1636 Mail Service Center-
2709 16 6 Phone No. (919) 733-322i with n 30 days. Rale gh,"NC`
(9 v%/M1 P LEGION GW-I REV Dp200 r.
LC R_ ,IC'N4 OFFICE
Topograp�hlc/and settin
❑Ridge' ❑STope „.❑Valley
(check appropriate box)c
Latitude/longitude ofwell loca
(degrees/rninutes/sec0nds)
Latitude/longitude source;❑GPSOropogra•
checkbox)`
D PT. "�•
From s' a C teIC[�c��
3C3
`e) -- /±e,
LOCATION SKETCF(r
Show direction and distance in miles froln Asa
two State Roads or County Roads Include th0.ro
numbers and common road names::
S
•
WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2e, WELL,
T A CO Sava•.. S CORD HAS BEEN PROVIDED TO THE WELL OWNER
DATE

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
020257
WELL CONTRACTOR. Dewey Wright Well Pump Co., Inc.
WELL CONTRACTOR CERTIFICATION #: 2797
STATE WELL CONSTRUCTION PERMIT#• Jerry Wilson
1. WELL USE (Check Applicable Box): Residential In Municipal 0 Industrial n Agricultural 0 Monitoring 0
Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use-
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: SPRUCE PINE County- AVERY
PRIVATE DR OFF HWY 221
(Road Name and Numbers, Community, or Subdivision and Lot No.)
3. OWNER JACK R OLLIS
Address 2070 ST EY BRANCH RD
NF VI N treet or Route No.) NC 28857
City or Town State
4. DATE DRILLED 5/2/2002
5. TOTAL DEPTH 305
6. CUTTINGS COLLECTED YES P1 NO
xi
Zip Code
DRILLING LOG
From To
0 135
DEPTH
Formation Description
DIRT/SHALE/GRANITE
135 753 GRANITE/O11AR17
261 254 GRANITE
254 7R7 GRANITF/OtJAF
287 288 GRANITEo n
289 305
7. DOES WELL REPLACE EXISTING WELL? YES n NO n
8. STATIC WATER LEVEL Below Top of Casing: 100 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 (gpmb 12 METHOD OF TEST fir
11. WATER ZONES (depth)-3 qpm 253454 9 qpm 287-288
0 qpm 0 qpm
12. CHLORINATION: Type HTHI Amount 43
13. CASING:
Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 143Ft B 1/8 .350 PVC
From To Ft
From To - Ft
14. GROUT:
GRANITEISUAW3I,
y crn
G cm
W zEr-i
W u,z
ma
c..3 ti
0
If additional space is needed use back of form
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other map reference points)
r
Depth Material Method Do �soOS SW' Or
From 0 To 20 Ft SPmPnt Gravity Flow 1
From To Ft rCO,1,w
15. SCREEN:
16.
Depth Diameter Slot Size Material
From To Ft in in
From To Ft in. in
From To Ft. in in
01 \f'E/- k Cl
Deptl(
To Ft
To Ft
Material
17. EMA
I HERIltnalPPNWTSFATITHIS WE L WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
NS154H kDN StiSMARlUS 7€ND T AT A COPY OF -THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
FOR OFFICE USE ONLY
Quad No•
Serial Nn
SIGk?iTURE OF PERSON CONSTRUCTING THE WELL DATE
Submit original to Division of Water Quality, Groundwater Section within 30 days
GW-1 REV. 12/99

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone]
254514
Dewey Wright Well Pump Co., Inc.
WELL CONSTRUCTION RECORD WELL CONTRACTOR: 2880
020276 WELL CONTRACTOR CERTIFICATION #: Leslie Reece
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE (Check Applicable Box): Residential
Recovery 0 Heat Pump Water Injection
X
Municipal n Industrial In Agricultural I I Monitoring El
Other n If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest T BANNER ELK County AVERY
HI C"KORY NUT GAP OFF HWY 184
(Road Name and Numbers, Community, or Subdivision and Lot No.l
3. OWNER WALDREN CO. LLC
DRILLING LOG
From 0 T o
68
Address 214 CHARLES ION BLVD.
ISLE OF FSiN6outeNo.) SC 29451
DEPTH
DIRT SANQUn Description
98 101 GRANITE
City or Town State
4. DATE DRILLED 5J23J2002
5. TOTAL DEPTH Alb
6. CUTTINGS COLLECTED YES ElNO ral r
7. DOES WELL REPLACE EXISTING WELL? YES �I NO I l
8. STATIC WATER LEVEL Below Top of Casing: U FT
(Use'+' if Above Top of Casing)
Zip Code
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.0110 oE Air
4
10. YIELD (gpm): ET HOD 101T Egi
102
11. WATER ZONES (depth):U ppm 102 U ppm
12. CHLORINATION: Type Hlhi Amount d1
13. CASING
Depth
0 72 Ding
From To Ft o /
From To Ft
From To Ft.
14. GROUT:
Wall Thickness
orA7 ghttFt.
101 102 SHALE
102 1/4 IMKANI It
1/4 1/5 SHALE
1 /5 Alb CMKANI I t l:
o
L
C
nv
b ppm 1/4-1/5
fvjatg�al
Depth Material Mr<thp�
From 0 To 20 Ft Cement Gravity F ow
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
17
rr
GftfYV LPA,CIi
�Doptia-t:
To
To
Size Material
T —0
m
N2
r,rN
If additional space is needed use be, of fatm
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other map reference points)
jz4
RE ARKS.
I DO ffplikattffkT4PfaltiAgTHIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
coNpnvg-u(Ar p9nclo IFs, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
�r,� �✓ ADAC 46 -7-0 a,
SIGNATURE OF P ON CONSTRUCTING THE WELL DATE
Submit original to Division of ter Quality, Groundwater Section within 30 days
GW-1 REV. 12/99
FOR OFFICE USE ONLY
Quad No:
Serial No.

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone]
254516
WELL CONSTRUCTION RECORD
020317
WELL CONTRACTOR. Dewey Wright Well Pump Co.. Inc.
WELL CONTRACTOR CERTIFICATION #• LtSkit3
STATE WELL CONSTRUCTION PERMIT# Leslie Keece
1. WELL USE (Check Applicable Box): Residential EK Municipal Industrial 0 Agricultural 0 Monitoring 0
Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use-
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: BANNER ELK County AVERY
OLD FARM RD OFF LEE GUALTNEY WAY OFF HWY 194
(Road Name and Numbers, Community, or Subdivision and Lot No.) DRILLING LOG DEPTH
3. OWNER DAVID T. MCMANUS From To Formation Description
Address PO BOX 424 , 0 23 DIRT
BANNER EtK or flOote No 1 NC 28804 23 34 GRANITE
City or Town State Zip Code
4. DATE DRILLED 5/22/2002
5. TOTAL DEPTH 125 91 92 SHALE
6. CUTTINGS COLLECTED YES 0 NO
7. DOES WELL REPLACE EXISTING WELL? YES 0 NO 7 o
8. STATIC WATER LEVEL Below Top of Casing: 10 FT L cr
(Use "+" if Above Top of Casing( -- .r:
c
34 36 SHALE
38 91 GRANITE
92
125 GRANITE
I
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.0114,
10. YIELD (gpm) METHOD OF TEST Air
11. WATER ZONES (depth):5 ppm34-38 15 ppm 91-92
0 Wm 0 Wm
12. CHLORINATION: Type HTFI Amount 23
13. CASING
Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 26 Ft. 6 1/8 .350 PVC
From To Ft
From To Ft
14. GROUT:
Depth
From 0 To 20
From To Ft
15. SCREEN:
Depth
From To
From To
From To
16. SAND/GRAVEL PAC
Material Method
Et Cement Gravity Flow
Diameter Slot Size Material
Ft in
Ft in
Ft. in
D::ptft�
i
v
To
'AKISL ` - -
I D• HEREBY CERTIFY THAT HIS
CO ST: ! ` - .'ren it , AN
GROUNDAN(0 _
- , luww OPFIOE
NLY
in.
in
in
Size Material
o
t.-i
n t=
•ir r=
a cn
If additional space is needed use baQ1of fobth
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other map reference points)
/O S
T
5-�
LL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
Rate .6 7-0
W o
Z
1CC
SIGNATURE OF PJON CONSTRUCTING THE WELL DATE
Submit original to Division of Water Quality, Groundwater Section within 30 days
GW-1 REV. 12/99
Quad No
Serial No.

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone]
254517
WELL CONSTRUCTION RECORD
020298-3
WELL CONTRACTOR• Dewey Wright Well Pump Co., Inc.
WELL CONTRACTOR CERTIFICATION #• Lti>itl
STATE WELL CONSTRUCTION PERMIT#• Leslie Keece
1. WELL USE (Check Applicable Box): Residential I XI Municipal 0 Industrial ❑ Agricultural D Monitoring D
Recovery fl Heat Pump Water Injection 0 Other I I If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: BANNER ELK County: AVERY
VALLEY RIDGE DR. OFF HWY 194 OFF BROADSTONE R
(Road Name and Numbers, Community, or Subdivision and Lot No.)
3. OWNER HERMAN E. KUMPF
Address PO BOX 427 ,
BANNER ail or Route No.) NC 28804
DRILLING LOG DEPTH
From To Formation Description
0 57 DIRT SHALE
57 245 GRANITE
City or Town State Zip Code
4. DATE DRILLED 5/20/2002
5. TOTAL DEPTH 245
6. CUTTINGS COLLECTED YES 0 NO Er
7. DOES WELL REPLACE EXISTING WELL? YES 0 NO
8. STATIC WATER LEVEL Below Top of Casing: FT
IUse "+" if Above Top of Casing)
I XI
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.0183
Air
10. YIELD (gpm): ET ppm DRY HOLE 0 ppm
QF TEST
11. WATER ZONES (depth)O
L Ed"
r•— 1
o�
DG
0 ppm 0 ppm
12. CHLORINATION: Type HTH Amount
13. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To B3 Ft. 8 1/8 .350 PVC
From To Ft
From _ To Ft.
14. GROUT:
Depth Material Method
From 0 To 20 Ft Cement Gravity Flow
From To Ft
15. SCREEN:
16.
Depth Diameter Slot Size Material
From To Ft in in
From To Ft. in in.
From To Ft in in
MARKS:
HEREBYCERTIFYT THI
t€NB»BDS, A
ASHEVILLE REGIONAL OFFICE
FOR OFFICE USE ONLY
Quad No
Size Material
v m
x
If additional space is needed use bak.pf font;
W
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other map reference points)
/C
4
t
WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
D THAT ACOPYY OOF-THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
>
SIGNATURE OF PECr' WELL DATE
Submit original to Division of Wa r Quality, Groundwater Section within 30 days
GW-1 REV. 12/99
Serial No.

•
Size
Method
fie, on eV
Slot Size Material
in.
in.
Material
WELL CONSTRUCTION RECORD 2531
..,North Carolina = Department of Environment and Natural Resources —Division of Water Quality - Groundwater Section WELL CONTRACTOR (INDIVIDUAL) NAME (print) zee /r'w :074 r.
`• -
CERTIFICATION WELL CONTRACTOR COMPANY NAME
STATE WELL CONSTRUCTION PERMIT#
(if applicable)
ASSOCIATED WQ PERMIT#
(if applicable)
PHONE # ( ) 41"" `
1. WELL USE (Check Applicable Box): Residential El-- Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑' Recovery El Heat Pump Water Injection ❑ Other ❑ If Other, List Use I,. err
2.. WELL LOCATION:
Nearest Town: /t%L..LQA..c/ County i c-e.,.>
Tor /=ar in
(Street Nat a Numbers, Community, Subdivision, Lot No., Zip Code)
3...OWNER: : {/"Fe...a/
Address Y•O• 6(4 o G,
Streeto ut No.)
.Gty or Town . State Zip Code
Area code- Phone number
4. DATE,DRILLED /} 0. 9— 02
5,.TOTAL DEPTH• j(o
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO Et'
7 STATIC WATER LEVEL Below Top of Casing: 40 FT.
8 TOP OF CASING IS (Use ••+•• if Above Top of Casing)
FT. Above Land Surface*
':!Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118. A 9.,;YIELD (gpm): /a M
METHOD OF TEST r
10. WATER ZONES (depth): /Y D /3 r /0 5y /
11. DISINFECTION: Type /74 TA( Amount 307
12. CASING: . Wall Thickness
Depth ` Diameter oc-.W ight/Ft. �M+aterial
From —/ To 1?3 Ft. 64 '/8B W6 /U
From To Ft.
From To Ft.
13. GROUT: Depth
From G To 4710
From To Ft.
14. SCREEN: Depth Diameter
From To . Ft. in
From To Fi. in.
15. SAND/GRAVEL PACK:
Depth
From To Ft.
From To Ft.
Material
Ft. C-tseoLdi -
Topographic/Land setting ;
ige ❑Slope ❑Valley ❑Flat'
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
MILLING LOG
Formation Des
t'&d/n6
DEPTF( `
From To
6 95t
$ f/' /3n
/Ye —/.3f
/7.r - An
,&_r rr/ r4
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
•
RE / • �3 ` ©ol
CONSTRUCTING THE WELL DATE
ater Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
within 30 days.
GW-I REV. 07/2001
L WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
AT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
OFP

•
WELL CONSTRUCTION RECORD
• -
North Carolina Department of Environment and Natural Re•sources -.Division Seaton,
Water Quality - Groundwater Seon,
WELL CONTRACTOR (INDIVIDUAL) NAME (print) - z{ •
CH.r�G 7Zl9e�%Di'�Ob� ,.s
WELL CONTRACTOR COMPANY NAME-
CERTIFICATION Goo-4
STATE WELL CONSTRUCTION PERMIT# PHONE # ( )
ASSOCIATED WQ PERMIT#
(if applicable)
I. WELL USE (Check Applicable Box): Residential 161" Municipal/Public 0 Industrial 0 Agricultural 0 Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other List Use
2 WELL LOCATION: n
Nearest Town: Get ,._ 32 County ✓�(y Topographic/Land setting
❑Ridge ❑Slope [Walley OFIat
(check appropriate box)
Latitude/longitude of well location
` q
(degrees/minutes/seconds) y >T
,Latitude/longitude source;❑GPS❑Topographic ma
(check box) -"_! i -a:
DEPTH RILLING LOG•
v
Slot Size Material
in.
in.
Material
Fro:
nt To ottn honDescn ppt
99— SS A04-4le
Sy- 5C /a /a
JG— Cat
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
RE OF PERSON CONSTRUCTING THE WELL
(Street NameNumbers, Community, Subdivision, Lot No., Zip Code)
3 OWNER a CeI x M r-
Address'!�d c
(Street r Ro to No.)
City or Town State 4 Zip Code
Area code- Phone number
nv
4. DATE DRILLED
(i f appl icable)
•5--0.2
5: TOTALDEPTH: A
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO IS
7. STATIC WATER LEVEL Below Top of Casing: ,5' FT.
8. TOP OF CASING IS �, (Use "+' if Above Top of Casing)
FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordant with 15A NCAC 2C .0118.
9. YIELD (gptn): 5 METHOD OF TEST %A
IO..WATERZONES (depth): S"6f'/ .�Fe/
11. DISINFECTION: Type bill"
12. CASING:
Depth Dian
From ,I/ To c{-( Ft. 6
ic
From__ To Ft.
From To Ft.
13. GROUT:
Amount 302
Wall Thickness
ter or Weight/Ft. Material
eke Co
Depth MatSriall --- Method
From 6 To_ Ft._ G&t , d
From �<
To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
From
From
16. REMARKS:
z\
S bin tithe on inal to the Divisi n of ater Quality, Groundwater Section, 1636 Mail Service Center- Raleigl(etC o
i
2 699 1636 P71t1Hti N,6 9d 9 a rn z
( )'T33F79.Z_1,witiin30days. ins
Depth Size
To
To
Ft,
Ft.
S1Q
te)
2531
—
N o..
L WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL y3,
T A COPY •F THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER cm
i
�5-0� ort rr,
DATE
— — GW-1 REV. (t3�'001<'
0 t7
2

r
WELL CONSTRUCTION RECORD . 2.5 315 5
North Carolina - Department of Environment. and Natural Resources -Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) �r CrL.'YYC// �pp�,� ��//��
/ CERTIFICATION 0,aK/ 10
WELL CONTRACTOR COMPANY NAME leleaB..77
PHONE if ( )
STATE WELL CONSTRUCTION PERMIT
(if applicable)
ASSOCIATED WQ PERMIT#
(if applicable)
1. WELL USE (Check Applicable Box): Residential8"Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use /%7t%ra fe
2. WELL LOCATION: �—
Nearest Town: County C/`O.53;00, c '
(Street Name, Nuiabeis, Community, Subdivision, Lot No., Zip Code)
3. OWNER: h sai4 node /.vJ/O Yi
Address
C, (Street or Route No.)
C.�LCJ•ad�t-�r.�� � -7-
:'wCity orTown State
'0--- • do 4'A0..
Zip Code
Area code- Phone number
4. DATE DRILLED /% —6.2
5. TOTAL DEPTH: 20 o
DOES WELL REPLACE EXISTING WELL? YES ❑ NO el -
FT.
I1. DISINFECTION: Type
12. CASING:
6.
7. STATIC WATER LEVEL Below Top of Casing: /b
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS FT. Above Land Surface*
'Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118. �J
9. YIELD (gpm): /6 METHOD OF TEST /Yii
10. WATER ZONES (depth): 75^ 30 07n%
d7-/9/ aJ'4
13
14
15
ahr
Amount e 02
Wall Thickness
Depth Diameter or Weight/Ft. Material
From .-/ To 50 Ft. 44 12/ de/v
From To Ft.
From To Ft.
GROUT: Depth Material'
From 6 To a Ft. t ,$Ao'/
From To
SCREEN: Depth
From To
From To
SAND/GRAVEL PACK:
Depth
From To Ft.
From To Ft.
16. REMARKS:
Ft.
Diameter Slot Size Material
Ft. in. in.
Fr. in. in.
Method
/YC De (/
Size
Material
Topographic/Land setting
❑Ridge ❑Slope L9i'ralley ❑Flat- I
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographtc map,
(check box) '
DEPTH :e: +,sy'' RILLI_ NGL
From Top ':.FormationDescrl ti
O— /Z t&t'dfA 4.: r_ , QS)
/2 - 30
30— 33
33- &'3
i`3 - 9.r
lam —/77
s— 80
/77 /fa
No -.zoo
LOCATION SKETCH Lijr,.7
Show direction and distance in miles froiWt le4=
two State Roads or County Roads. Includahe ad
numbers and common road names. �C
fSBR8BY C'HR IF\ THAT WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
b 1 RUCTION STANDARDS C THAT A COPY OF T REC RD HAS B EN PROVIDED TO THE WELL OWNER
TURE OF PERSON C• STRUCTING THE WELL DATE
Subrt7itecort r F4 i®A, sion of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
2769101434Thinfedled(i0ng)3FA(S221- It Rhin 30 days.
GW-1 REV. 07/2001
c
N
IGN

WELL CONSTRUCTION RECORD .25 315 s
North Carolina - Department of Environment and Natural Resources - Division of Water Quality Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) -
/� CERTIFICATION #�.� v.
WELL CONTRACTOR COMPANY NAMEB/44,vCLL!//.� //�
de-1/PHONE # ( )
STATE WELL CONSTRUCTION PERMIT#
ASSOCIATED WQ PERMIT#
(if applicable)
(if applinable)
1. WELL USE (Check Applicable Box): Residential Er- Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use a
2. WELL LOCATION:
Nearest Town: C^B 5 00� Countytveo7
(Street Name, Numbers, Community, Subdivision, Lot No., hip Code)
3. OWNER: claw 'dV
'Address //[[ (Street or Route lo.)
Ac-k %%.Vf X0
w State Zip Code
Area code- Phone number
4. DATE DRILLED �/ /%'tsa
5. TOTAL DEPTH: �j'Oo
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO er
7. STATIC WATER LEVEL Below Top of Casing: -9O FT.
8. TOP OF CASING IS (� (Use "+" i f Above Top of Casing)
FT. Above Land Surface*
?`Top of casing terminated at/or below land surface requires a
variance In accordance with 15A NCAC 2C .0118. ,,�
9. YIELD (gprn): _&f METHOD OF TEST /1`"`n
10. WATER ZONES (depth): -'93 "Sy 2 4 /
11. DISINFECTION: Type /r//74 Amount 3D2
12. CASING: Wall Thickness
Depth Dam ter or Waight/Ft. Material
From To 6l Ft. _gar e •Pe
o Ft.
i4.vrt fJ * iflfis•,e
ASr
�tmvi /5 CS'He qfs
—' "tom -
LOCATION SKETCH .
Show direction and distance in miles fro&tat lea"'s %
two State Roads or County Roads. Inclu9Ptthe r ad
numbers and common road names. tT e
Topographic/Land setting
(edge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic maps.,
(check box)
DEPTH xa v�pRILLING LOG L'
From To p'ormation Descrrt/or,'
3— 90Qd
97
- »
From 7' Prom_ToFt.rte.
13. GROUT: DepthMaterial'r Method
From_o_.To �D Ft. i' - „�butie l
From To Ft. l� "'
14. SCREEN: Depth Diameter Slot Sizc
From Material U
To Ft. in. in.
From To 'FL in.
15. SAND/GRAVEL PACK: - in. or�'��k
Depth Size Material
From To Ft.
From -To Ft.
16. REMARKS:
L WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
iT A COPY THISgRD HAS EEN PROVIDED TO THE WELL OWNER
E OF PERSONONSTRUCT1NG THE WELL DATETE O2.-
ter Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
30 days. V
GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
opertinent otEnvironmcnt and Natural Resources • Division of Water Quality. 3 oundwa
INDIVIDUAL) NAME (print) Tr3Z 404J FAO RSol0 ?..:+.t + ^CER IFI
`C, ,Q,/N, STRUCTION PERMIT*
(if applicable) it
OR COMPANY 4 Xi11 tr-3e •7Ri�,, k..J PHONE'*
ASSOCIATED WO PERMITS -'''
(if applicable)
$ (Check Applicable Box): Residential Er-"Municipal/Public 0 Industrial 0 Agricultura 0
ttortngp Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use xTy
TION:.
j°'i•CMroYviefti County
,Numbers, Community, Subdivision, Lot No., Zip Code)
611.4; Hog
hes
i,i`• (Street or Rowe No.)
'or,Town State Zip Code
rca cod'e Phone number
4,,�llATgDRILLED' H—
5 A;TOTAII DEPTH: I %O
6'{DOES WELLkREPLACE EXITING WELL? YES 0 NO lEr.
$ ATI WATER LEVEL Below Top of Casing: 10 FT.
QIf • (Use "+" if Above Top of Casing)
TOP QEjCASING IS j FT. Above Land Surface*
*Top oof casIng terminated at/or below land surface requires a
. yarlance In accordance with 15A NCAC 2C .0118. :
,Y1RLD (gpfn) ^ '`" •9 METHOD OF TEST i3 J,
TERZONES•(depth): 9D i I'10 140
ION: Type chim2(se, Amount bi e<„
Depth
ro r+ ';To F3 `-1 Ft.
rorn hr 'To Ft.
Ft:
GROUTo:rDepth
grxomrw"f>-l'To 191 Ft.
,From tpt$1!ti.[rM To
4:3SCREEN, CDepth
Flom '•To Ft. in.
5:SAND/GRAVEL PACK: s
Depth - Size Material
rorti"'^':",;'=.'" To Ft.
Ft.
Wall Thickness
Diameter orrWeight/Ft. Material
G r�Y Cs'? _391164,
MARKSi''`hie
Ft.
Ft. in.
Diameter
Method
Slot Size Material
in.
in.
a. L�
n a
I DO ¢,R)IBY ERt(ilFlt 7'H • i
AL .
NATURE OF PERSON CONSTRUCTING THE WELL
Topogr_uphic/Land setttri
❑Ridge> C9"Slope yD alley
(check appropnate box)
Latitude/longitude of well locati
(degrees/minutes/seconds)
Latitude/longitude source pGP$OTopogra
y--A;`; (check box)'".,;"-1.
DEPTH
From •.:To
©— '76''
74—l50
I So--)sS
17S— IG!>
LOCATION SKETCFjr
Show direction and distance in miles'from a 4e9
two State Roads or County Roads, Inchldetlio roa
numbers and common road names `"''+;
cAsl vhe_Am
IS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C WELD,{?
ND THA •PY of THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
•
���i>•
DATE
n of Water Quality, Groundwater Section, 1636 Mail Service Center Raleigh, NO,
I, within 30 days.
GW-I REV. 07/2001
•

Size
WELL CONSTRUCTION RECORD .253150L
North Carotin:} ;Department of Environment and Natural Resources - Division of Water Quality
WELL CONTRACTOR (INDIVIDUALINAINE / Q Y-GroTIFCATr NLt. j
,,pp �• CERTIFICATION q. Q WELL CONTRACTOR COMPANY NAME' �P/f7.T'�C �/
PHONE # ( v v `-
STATE WELL CONSTRUCTION PERMITq
ASSOCIATED WQ PERMIT/4
(if applicable)
(if applicable)
1. WELL USE (Check Applicable Box): Residential 0 Municipal/Public 0 Industrial O Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION: / . t
NearestTownt�rt16yi/`teP" hAfie_Count aver
7
(Street Name,Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: ' DQ
Address, ' 4.-1`
/! 1Stor to `sir e✓ -.Div v/ ry
oyor_Town9 Stale - •
Zip Code
Area code- Phone numbe
4. DATE DRILLED -,la? p 2
5. TOTAL DEPTH: 3 2 0
6. DOES WELL REPLACE EXISTING WELL? YES O NO J •
7. STATIC WATER LEVEL Below Top of Casing: 7 O FT.
8. TOP OF CASING IS (Use "+" if Above Top of Casing)
FT. Above Land Surface*
!Top of casing terminated at/or below land surface requires a
(variance In accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): ge METHOD OF TEST l; r
10. WATER ZONES (depth): c/O Pt 1 -
15. SAND/GRAVEL PACK
Depth
From To Ft.
From To Ft.
11. DISINFECTION: Type J/t4{-_ Amount 3 p z,
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From -1 To (e a -Ft. 64 /Net/ P"G
. From To Ft.
From To Ft.
13. GROUT: Depth Materials
From & To SIC Ft. Ce/Rct.• (-
From t b To G 3 Ft. 6 e..tc-t-t'/e
14. SCREEN: Depth Diameter
From To Ft. in.
From To F. in.
16. REM
UCTION STANDARDS, A
SIG ATU
Method
O .dam
Slot Size Material
in.
in.
Material
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:DGPSOTopographicmap
(check box)
DEPTH
�w RILLING LOC
From To -"Portnanon D SCrl�i
90— 7 J
G— ff-/o rfal¢
9C -tf/d 7t%r- /[5 tin bl
+'/r t & i/5 �, .-
Ylot -S.< o
r ,ten
LOCATION SKETCH �•
Show direction and distance in miles from AeasfoR
two State Roads or County Roads. Includeq roalA
numbers and cot • •n road names. O 0
-' ,` bib rn -
5/4- *cc -r•ce Z
6
1—/C" yo,C,r,
"Ow Alta,
L WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
T A C.PY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
51 a e2—Q2
DATE
EOFP
?SON CONSTRUCTING THE WELL
27 Su mit thew laaq ,WyNR1Eter Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
-I, within 30 days. -
GW-1 REV, 07/2001

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Gro€r5a3rletit
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone]
WELL CONSTRUCTION RECORD
WELL CONTRACTOR: Dewey Wright Well Pump Co., Inc.
WELL CONTRACTOR CERTIFICATION #- 2797
020131 STATE WELL CONSTRUCTION PERMIT#• Jerry Wilson
1. WELL USE (Check Applicable Box): Residential Municipal 0 Industrial In
Recovery n Heat Pump Water Injection D Other 0 If Other, List Use:
X
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: MARION County AVFRY
FAE MCKINNEY RD. OFF BIG PLUMTREE CRK RD. OFF
(Road Name and Numbers, Community, or Subdivision and Lot No
3. OWNER BRUCE R. BENFIELD
Address 88 TRIM BRANCH RD.
NEvsitANEtreet or Route Na) NC 78658
City or Town State Zip Code
4. DATE DRILLED 4/15/2002
5. TOTAL DEPTH 425
6. CUTTINGS COLLECTED YES n NO
7. DOES WELL REPLACE EXISTING WELL? YES n NO
8. STATIC WATER LEVEL Below Top of Casing: 50 FT
(Use'+" if Above Top of Casing)
9. TOP OF CASING IS 1 FT Above Land Surface*
*Top of casing terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2C.0118
10. YIELD (gpm)• 2 METHOD OF TEST
11. WATER ZONES (depth)•2 QPm395-396 0 gpm
0 ppm 0 Wm
Air
12. CHLORINATION: Type HTH Amount 74
13. CASING:
1 xl
Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 51 Ft 6 1/8
From To Ft
From To Ft
14. GROUT:
.350
Depth Material
From 0 To 20 Ft Cement
From To Ft
15. SCREEN
Depth Diameter Slot Size
From To Ft in in
From To Ft in in
From To Ft in in
PVC
rr�m
Fr m
17 REMARKS:
To
To
Agricultural D Monitoring 0
DRILLING LOG
From To
0 47
DEPTH
Formation Description
DIRT/SHAI E
47 395 GRANITE/QUARTZ
395 396 GRANITE
396 425 GRANITF
o
IV 1—'
a �m
N
CO
W viz
If additional space is needed use b6cb of f2m
0
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other map reference points)
E
Material n_A L'1
Slze
• ,ftC
WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WEL
JD THAT A COPY OF THIS RECORD HAS BEEN PR(WIDED TO THE WELL OWNER.
I DO(j4103 Y,:P T I THIS
CQlMR8L Tnr. $ 5, Al
FOR OFFICE USE ONLY
Quad No:
Serial No.
S GATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit original to Division of Water Quality, Groundwater Section within 30 days GW-1 REV. 12/99

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Grour2v5t31105
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone]
WELL CONSTRUCTION RECORD
020221
WELL CONTRACTOR.
Dewey Wright Well Pump Co., Inc.
WELL CONTRACTOR CERTIFICATION #• 2707
STATE WELL CONSTRUCTION PERMIT#• Jerry Wilson
1. WELL USE (Check Applicable Box): Residential I XI Municipal n Industrial n Agricultural in Monitoring Q
Recovery n Heat Pump Water Injection n Other El If Other, List Use.
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: BANNER El K County AVFRY
PRI VATE RD OFF OLD BEFCH MTN RD OFF SAM ELLE
(Road Name and Numbers, Community, or Subdivision and Lot No.)
3. OWNER SEAN G W MCKEE
Address P O BOX 528 .
BANNER gereout6N0.) NC'
fl
City or Town State
4. DATE DRILLED 4/16/7002
5. TOTAL DEPTH 405
6. CUTTINGS COLLECTED YES I I NO
7. DOES WELL REPLACE EXISTING WELL? YES n NO
8. STATIC WATER LEVEL Below Top of Casing: BO FT
(Use "+" if Above Top of Casing)
9. TOP OF CASING IS 1 FT Above Land Surface*
*Top of casing terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2C.0118
10. YIELD (gpm)• 20 METHOD OF TEST Ar
0
0 qpm 0 qpm
Zip Code
DRILLING LOG
From To
0 6
R
385
386
DEPTH
Formation Description
DIRT
SR5 GRANtTF/Ql1ART7
388 GRANITE
405 GRANITEfQ AR
N cD
N
co
0
Cn
na
11. WATER ZONES (depth)•20 qpm 386'386
I �►
12. CHLORINATION: Type HTH Amount 67
13. CASING:
Wall Thickness
Depth Diameter or Weight/Ft.
From 0 To 20 Ft 8 1/4 .188
From To Ft
From To Ft
14. GROUT:
I xl
Material
OALV
Depth Material Method
From 0 To 20 Ft Cement Gravity Flow
From To Ft
15. SCREEN:
Depth
From To
From To
From To
Diameter Slot Size Material
Ft. in in
Ft. in in
Ft in. in
FOR OFFICE USE ONLY
s
,17
CO GI
qpm CO
O
If additional space is needed use back of form
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other map reference points)
WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
AND THAT A COPY OFJHIS RECORD HAS BEEN PROVID TO THE WELL OWNER.
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit original to Division of Water Quality, Groundwater Section within 30 days
GW-1 REV. 12/99
Quad No
Serial No.

WELL CONSTRUCTION RECORD• 251152
North Carolina -. Department of Environment and NaturalrResources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) ICAf)/e7th ..%O"�d/U ' CERTIFICATION #
WELL CONTRACTOR CONIPANY NAME 4A,d/uc- / l
STATE WELL CONSTRUCTION 1'ERMI'r# ASSOCIATED WQ PERM ITN
(if applicable) (if applicable)
PHONE # f
I. WELL USE (Check Applicable Box): Residential Municipal/Public 0 Industrial 0 Agricultural 0
(Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use /pr J✓47%C
2. WELL LOCATION:
'-.Nearest Town: /A/"Qn K County g r—Ny
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3: OWNER: /L' :.a sie g�//
Address
(Street or f}oute No.) C p 77
7
City or Town State Zip Code
)-
Area code- Phone number
4. DATE DRILLED V—/ O oC
5.-_TOTAL DEPTH: / / O
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO Via
7. STATIC WATER LEVEL Below Top of Casing: 3 6 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS FT. Above Land Surface"
*Top of casing terminated at/or below land surface requires a
variance in accordancg with I5A NCAC 2C 0118
9.. YIELD (gpm): of
10. WATER ZONES (depth)
11. DISINFECTION: Type
12. CASING:
METHOD OF TEST �i n
SS- 9.5" €A54l///o%ASse/
/JS /i.2 /0'4 /
NTH Amount ."or,
Depth
From I To SO Ft.
From To Ft.
From To Ft.
13. GROUT: Depth
From 20 To /b 0
From Q To A-6
14. SCREEN: Depth
From To Ft.
From To Ft.
15. SAND/GRAVEL PACK: -
Depth Size
From To Ft.
From To Ft.
Wall Thickness
Diameter or Wcight/Ft. Material
Mattriat Method
Ft. 6G,vecite twee/
Ft. Cc/nen-4- `Jeor a
Diameter Slot Size Material
in. in.
in. in.
Material
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds) r
Latitude/longitude source:❑GPS❑Topographic ma
(check box)
is.s,DR1LLING LOG a:;
Formation Description.
/cc/dr,•F,Fe/•row
, ra.v/ fc
lira le
DEPTH
From To
6 FG
80-- 9s
9s� gr
%f- //e
//o—//
//7 /Jr
/33—/5•/
/ P O
,14e,/P
i'ON/
-rn./d M2 'Cr
10 „.:.pert:
.T7
LOCATION SKETCH a •
-
Show direction and distance in miles from eas
two State Roads or County Roads. Include t9i e ron?z,
numbersand common road names. t ni
j-M/a^C Z
0,
plvrcni
F /r / —'
16. REMARKS:
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 45A NCAC 2C, WELL
CONSTRUCTION S —ANCARDS AND AT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
L 9-/—o z
Jhyr
Q S\/J4
Submit the origin illWt
27699-1636 Phone (to. (91
GROUNDWATER SECTION
ASHEVILLE. REG!H AL OFFiC`-
S'QATURE OF PERSON CONSTRUCTING THE WELL DATE
to Division of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
)) 733-3221, within 30 clays. GW-1 REV. 07/2001

D
WELL CONSTRUCTION RECORD , 2551157
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
'''z
WELL CONTRACTOR (INDIVIDUAL) NAME (print) CERTIFICATION I/ ece--"
WELL CONTRACTOR COMPANY NAME se^RS/I!a / PHONE # ! )
STATE WELL CONSTRUCTION PERMASSOCIATED WQ I'ERMITN
(if applicable)
(if applicable).
1. WELL USE (Check Applicable I3ox): Residential [J—Municipal/Public ❑ Industrial 0 Agricultural 0
-
:-Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other 0 If Other, List Use ip>,'✓a �C
2. WELL LOCATION:
Nearest Town: Ea %' County lye-0 y
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: c79olr OS/cc-n/
• Address
^, z, '(Street rip Routy lo.) C / ` Ai;
C -
' Cny or Town State .Zip Code it.2X G
Area code- Phone number
4. DATE DRILLED /J/
5. TOTAL DEPTH: g-9O
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO IV
7. STATIC WATER LEVEL Below Top of Casing: % O FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): /0 METHOD OF TEST
10.WATERZONES(depth): %o"i ..Sh/aoc( 027e/
- // ib'i e /
11. DISINFECTION: Type Amount
12. CASING: Wall Thickness
Depth Dian jter or Weight/Ft. Material
From "/ To 8S Ft. 6 7tt2/ P0'C
From 8S To S' FL 6 4 ,3 /30 Ga/v
From - To Ft.
13. GROUT: Depth Mat&ial' Method
From 0 To /0 Ft. Cp�rc n4n e
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Fa. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
•
16. REMARKS:
Topographic/Land setting
ledge ❑Slope DValley ❑Flat;.'
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source: ❑GPS ❑Topographic map __
(check box)
DEPTH y DRILLING LOG
From To'("°Formation Descnpllo�t�kx+
e)— to ',ed./b.!i/:%rr�ite,.:
go- 96 one✓:/c
90 - 9 5 /40,4Pock
93— /bT ,/'.rrofft
/or // 7 >�P%�`OaK
A CC r„CDM
o<
LOCATION SKETCH a -f."':
Show direction and distance in miles from alteastar9
two State Roads or County Roads. Includes roaI
numbers and common road names. t 2
�= lk Pon / GJ o
/A9-
E 3m./a
I D0 HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
QN4RLC LiWN ine-buti DS, AND THAT A PY THIS REC HAS BEEN PROVIDED TO THE WELL OWNER
Ili [5 l` =
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
'Submit the original
27699-1636 Phone No
r!1/e
GROUNDWATER SECTION
ASHEVILLE REGIONAL OFFICE
919)
Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
133-322I, within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD 251160
North Carolina ;Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section '
1VELL CONTRAC9'Oli (INDIVIDUAL) NAME (print)Xe,r, / /J2,- 4'42 j CERTIFICATION # #401
AVELL CONTRACTOR COMPANY NAME ICI' QJ#CI6// PHONE # ( )
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED] WQ PERMIT#
(if applicable)
(if applicable)
1. WELL USE (Check Applicable Box): Residential ❑ Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATIOj'J:
Nearest Town: t/,�
County
(Street Name, NrHybers, Community, Subdivision, Lot No., Zip Code)
3. OWNER:
I• �)
Address a • 7S (o
(5 reef or o f j.) •GI o f
City or Town State Zip Code
Area code- Phone number
4. DATE DRILLED r O2
5. TOTAL DEPTH: /80
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO ❑
7. STATIC WATER LEVEL Below Top of Casing: / 0 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS -4 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .01I8.
9. YIELD (gpm): /& METHOD OF TEST /li n
10. WATER ZONES (depth): %' j5-
1 1. DISINFECTION: Type
12. CASING:
Depth
From —! To lt•2
From To
From To
13. GROUT: Depth
From 0 To to
bi%/"- Amount
Wall Thickncss
Diane er or Weight/Ft. Material
Ft. G ,77a do /'-
Ft.
Ft.
Material'
Ft. teext f
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To F3. in.
15. SAND/GRAVEL PACK: '
Depth Size Material
From To Ft.
From To Ft.
Method
fog-"q'
Slot Size Material
in.
in.
Topographic/Land setting
❑Ridge ❑Slope ❑Valley DFlat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographicmap
(check box)
aaatDRILLING LOG
ormatton Descngtlone ',.
re✓o(iofJ
9rev!% _.•
5,00t,i f e
DEPTH
From -To"'
D— 6&
62- 90
9o—ar
rl5 /RO
O
Al Q.•
�m
LOCATION SKETCH tV oz-
Show direction and distance in miles from leas ern
two State Roads or County Roads. Include/lie rot
numbers and common road names. = am
O L>Z
mp,
F n
W o
z
z
N
Fond"
fr-Ae
16. REMARKS:
I D0 HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
- - AND THAT A COP X OF THIS HAS BEEN PROVIDED TO THE WELL OWNER
ry 9%D _v ti
IGNATURE OF PERS CONSTRUCTING THE WELL DATE
(
Submit the o'rigbrdhto th
27699-1636 Phone No. (919
GROUNDWATER SECTION
ASHEVILLE REGIONAL OFFICE
733-3
ion of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
21, within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD -;
251162
North Carolina - Department of Environment and Natural Resources�- Division of Water Quality - Groundwater Section :-'
WELL CONTRACTOR (INDIVIDUAL) NAME (print) kezcI/!.T[/L1 c7 rbesa,J
WELL CONTRACTOR COMPANY NAME /✓Kt,4
STATE WELL CONSTRUCTION PERAIITM ASSOCIATED WQ PERMITt4
(if applicable) (if applicable)
CERTIFICATION N Mil
PHONE M ( )
1. WELL USE (Check Applicable Box): Residential ❑ Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other 0 11Other, List Use
2. WELL LOCATION: 0 `
Nearest Town: County e s,
(Street Name, Numbers, Cominunity, Subdivision, Lot No., Zip Code)
3. OWNER: in ke LciPAer
Address 5
(Street or Route No.) N Ctµ- ---�/ "VI •G
I{cvy /9,E
City or Town State Zip Code
Area code- Phone number
4. DATE DRILLED r i/ O 2
5. TOTAL DEPTH: / 3 0
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO R.
7. STATIC WATER LEVEL Below Top of Casing: /'a FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS .44 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118. ,.?
9. YIELD (gpm): .20 METHOD OF TEST MA
10. WATER ZONES (depth): iS' 9 8 6s.
/S/r—<s/ /S17r/
11. DISINFECTION: Type Amount
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From ^1 To y'S Ft. G 1 ,177 oq//i
From To Ft.
From To Ft.
13. GROUT: Depth Mat'ctrial' Method
From 0 To r0 Ft. Geese--4- "an/
From Z8 To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds) t..
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH TRILLING LOG
From To 'Formation Descri tio8
D — /o rred d rr- ..;. -3 ,..
/G— /7 �r.pvc-,'Lf 'M'
d i/ s 4 /brat-[
/ 7 — 90
4t7— 57 1 ea4.1f(rj 3 is k./K•t
.i 7 7 v.1 o%C
7
77—/93 I Ao4r4c
79 i - /s/ //ens Avon
/f/—/b0 5„q-4re,
LOCATION SKETCH
Show direction and distance in miles from at (east
two State Roads or County Roads. Include the road
numbers and common road names.
47
taxi/
`� ri` hJy /r C
bayillyr/.re' PS.` /
/i4' ppn —
at
NS , ni 7
-4o
m�
tnm
rna
ma
c-4
0
Tim
0
CO
D IN
RDANCE WITH 15A
CAC 2C,
LL
DC J U IC V ISTA1t4P AN THA A CO Y F TH STE CORD HAAS BEEN PROVIDED O THE WELL OWNER
t� 9- ter— ©.2.
"�ni 5 GNATURE OF PERSON C TRUCTING THE WELL DATE
Submit the original to the
Divis on of Water Quality, Groundwater Section, I636 Mail Service Center -Raleigh, NC
-` ?&r �r?cM /33-3221, within 30 days. GW-1 REV. 07/2001
ASHEVILLE REGIONAL OFFICE
1 :itn /oGot Y

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundivatdrae 112
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone]
WELL CONSTRUCTION RECORD
WELL CONTRACTOR- Dewey Wright Well Pump Co., Inc.
WELL CONTRACTOR CERTIFICATION #- 2687
020092 STATE WELL CONSTRUCTION PERMIT#. Steve Reece
1. WELL USE (Check Applicable Box): Residential I Xl Municipal 1 1 Industrial Agricultural D Monitoring IE
Recovery D Heat Pump Water Injection 0 Other El If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: BANNER ELK County AVERY
HICKORY NUT GAP RD. OFF HWY 184 OFF HWY 105
(Road Name and Numbers, Community, or Subdivision and Lot No.)
3. OWNER GREGORY B. KAHALY
Address 6045 WOODVINnte ) ERD..
Teat SC 29206
City or Town State Zip Code
4. DATE DRILLED 3/6/2002
5. TOTAL DEPTH 760
6. CUTTINGS COLLECTED YES 0 NO In
7. DOES WELL REPLACE EXISTING WELL? YES D NO n
8. STATIC WATER LEVEL Below Top of Casing: 480 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)• 10 METHOD OF TEST Alr
11. WATER ZONES (depth) 1/4 ppm43-44 9 3/4 Mom UNKNOWN
0 ppm
12. CHLORINATION: Type HTH
DRILLING LOG
From To
0 35
35 43
43 44
44 760
DEPTH
Formation Description
DIRT
GRANITE
QUARTZ o
GRANITE z m�
s o^
Tm
u
13. CASING:
0 ppm
Amount 139
Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 42 Ft 6 1/4 .1B8 GALV
From To Ft
From To Ft
14. GROUT:
Depth
From 0 To 20 Ft Cement
From To Ft
15. SCREEN:
Material Method
Gravity Flow
Depth Diameter Slot Size Material
From To Ft in in
From To Ft in in.
From To in. in
l Depth ill I Size Material
IL tTo-I�-'-�
To_ Ft
From
rom
ci om
Toc
3 Sin
CJ m?
Ca)
C3
1
G
If additional space is needed use back of form
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other map reference points)
C S-
a.s��
Ref.
17.
pPiThHERE BW RV9UF&fthig . S WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
. t • NDARDS, AND THAT A COP* OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
�i9 2rcA S
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit original to Division of Water Quality, Groundwater Section within 30 days GW-1 REV. 12/99
FOR OFFICE USE ONLY
Quad No:

DRILLING LOG DEPTH
3. OWNER FAYE MAYBERRY From To Formation Description
Address % MIKE DAVIS , 239 JOHN JONES RD. 0 34 MUD/GRAVEL
ELK P, or Route No.) NC 28822 34 47 GRANITE
City or Town State Zip Code
4. DATE DRILLED 3/26/2002 49 305 GRANITE
5. TOTAL DEPTH 305
6. CUTTINGS COLLECTED YES 0 NO 0 X
7. DOES WELL REPLACE EXISTING WELL? YES 0 NO I I X
8. STATIC WATER LEVEL Below Top of Casing 10 FT.
(Use '4" if Above Top of Casing)
9. TOP OF CASING IS 1FT. 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 Igprnk 12METHOD OF TEST Aar -v m''-..
11. WATER ZONES (depth)• 12 ppm47-49 0 ppm _- o:/m
0 ppm 0 qpm
12. CHLORINATION: Type HTH Amount 59 If additional space is needed use bagof form
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]
251456
WELL CONSTRUCTION RECORD WELL CONTRACTOR: Dewey Wright Well Pump Co., Inc.
020134
WELL CONTRACTOR CERTIFICATION #: 2686
STATE WELL CONSTRUCTION PERMIT# Leslie Reece
1. WELL USE (Check Applicable Box): Residential 0 x Municipal 1 1 Industrial 0 Agricultural 0 Monitoring
Recovery 0 Heat Pump Water Injection Other 0 If Other, List Use.
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: ELK PARK County. AVERY
DARK HOLLOW RD. OFF DAVIS RD. OFF HWY 19E
(Road Name and Numbers, Community, or Subdivision and Lot No.)
47 49 SHALE
0
13. CASING:
Wall Thickness
Depth Diameter or Weight/Ft. Material
From - 0 To q. 8 1/4 .188 GALV.
From To Ft
From To Ft
14. GROUT:
Depth Material Method
From OTo 20Ft Cement Gravity Flow
From To Ft
15. SCREEN
Depth Diameter Slot Size Material
From To Ft. in in
From To Ft in. in
From To Ft. in in
16. SAND
From
From
17. REMP
IDOF
CONS
vL r'•kS,lcfr. I ,.
LDebth
5jze
To Ft
To Ft
Material
LJ
RKS
EREB" CERTIFY THAT THIS WF L W
fRUCTIDMVANDA €,CANDTHAT
ASNEVILLE REGIONAL OFFICE
FOR OFFICE USE ONLY
O o
y tre—
' c^
N =m
in a
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other map reference points)
Y plc �eiledRy_
S CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
Vr'(l�(A/h) J 1 P 2rn
Quad No•
Serial No
SIGNATURE OFSON CONSTRUCTING THE WELL DATE
Submit original to Division of Water Quality, Groundwater Section within 30 days
GW-1 REV. 12/99

WELL CONSTRUCTION RECORD ; - 6
=gP 15
North Carolina'; Department of Environment and Natural Resources -. Division,�of Water Quality - Groundwat ec ionn
WELL CONTRACTOR (INDIVIDUAL) NAME (print) /r c,rde/`/ <jn .rO%dA CERTIFICATION gsg'y{
WELL CONTRACTOR COMPANY NAME PHONE # ( )
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential 0 Municipal/Public ❑ Industrial ❑ Agricultural ❑
' IVIonitoring 0 Recovery 0 Hcat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION: Dp /
Nearest Town: _Ile q w r'(4�e' County "Let,
p€fr f / O lc cif
(Street ame, umbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: I.Q£e ee.aeh
Address
titedd,' (Street or. ute No )
•.City or Town State Z Code
"Area code- Phone number —O ,{
4. DATE DRILLED
5. TOTAL DEPTH: Li 00
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO Er
7. STATIC WATER LEVEL Below Top of Casing: /6 ° FT.
(Use "+" if Above Top of Casing)
FT. Above Land Surface"
'Top of casing terminated at/or below land surface requires a
variance In accordanceArith ISA NCAC 2C .0118.
9. YIELD (gpm): J METHOD OF TEST i-
10. WATER ZONES (depth): 76 /.q/ 360 %a/
8. TOP OF CASING IS
11. DISINFECTION: Type JVTN
12. CASING:
Depth Diameter
From — i To lr 2 Ft. .r
From To Ft.
From To Ft.
13. GROUT: Depth
From d To .j
From 3 To le, Ft. A'..rt,.'te y^VQ^e(
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Amount 30,2 ,
Wall Thickness '
or.Weight/Ft. Material
/9? C!(4/
MattriallMethod
Ft. eta, ewJ a/' ! G0-iG f
in. in.
Topographic/Land setting
❑Ridge DSlope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds) ' ' • •
Latitude/longitude source:❑GPS❑Topographic map
(check box) - -
,w„:DRILLING LOG c,
DEPTH
From To
G2
62- 70
70 73
73 —3 6-0
c`jli d ,f‘.11
3Co 9L do
Formation Description
wide /rasa.-7
grsrdile fO ra
a• cm
sin
Do
rn
LOCATION SKETCH 3 =m
Show direction and distance in miles from a3as(ma
two State Roads or County Roads. Include tJ .roaC
numbers and common road names. to 3
16. REMARKS:
t nn UPRPRV f FRTI FY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
O TITc orc ,p11DaA S, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
3—egeoz
SIGNATU
OF PERSON CONSTRUCTING THE WELL
DATE
Submit the original to t le ision of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
Lnd
27699-1636 Phone No. (91 ) 733.3221, within 30 days. GW-I REV. 07/2001
GROUNDWATER SECTION
ASHEVILLE RGION'AL OFFICE

WELL CONSTRUCTION RECORD ..
North Carolina, Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section-7:
WELL CONTRACTOR (INDIVIDUAL) NAME (print) CERTIFICATION 0 Ai '34. •
WELL CONTRACTOR COMPANY NAME PHONE # f
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable)
(if applicable)
1. WELL USE (Check Applicable Box): Residential ❑ Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 11Other, List Use
2:".WELL LOCATION:
Nearest Town: 1)O.VIL e b
County /T!/Lrcy
(Street Name, Numbers, Corn iunity, SSubdixisio Lot No., Zip Code)
3 OWNER:aUG �Jp/
71- LT/-h�- J`�'{—..
/—�Strcec or o4zJTc N3s Ss-ry
rTo n '. State Zi Code
Address
eto Gtyo P
Area code- Phone number
4. DATEDRILLED 3 —.2& "0.2.
5. TOTAL DEPTH: / 80
6. 'DOES WELL REPLACE EXISTING WELL? YES ❑ NO ❑
7. STATIC WATER LEVEL Below Top of Casing: /0 FT.
(Use "+" if Above Top of Casing)
8. .TOP OF CASING IS i FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance In accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): METHOD OF TEST
10. WATER ZONES (depth): /0 6 /03 /Osal
/GO •-/G3 /B y q
t 1. DISINFECTION: Type Amount
12. CASING: Wall Thickness
Depth Diameter or Wuight/Ft. Material
From To 7 C Ft F ,723 6o/[r
From To Ft
From To Ft
13. GROUT:
From 0
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds) lr • .
Latitude/longitude source ❑GPS❑Topographic map''
(check box) .41
DEPTH, z; • .w3v.;+DRILLING LOG
From To ` FormationDescn?t4oq,y'.
_ye,./ PO /'-.'
/'5 i fi fides- ock
1,5 71 Sechea _A-ft.,."
/o /J
9LL it/
/a3 //.c
Depth Matti -jai l Method
To ..O Ft. er,trr,vf /0eaes/
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
. From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
"'fry ,t/yi ft
it iv' i
LOCATION SKETCH
Show direction and distance in miles from at (east
two State Roads or County Roads. Include the road
numbers and common road names. o
O o
N ca
Sim o
'O or^ _
70
N pr'
N .>o
a m�
O NZ
mA
c.4
� y ,
Crf o-
16. REMARKS:
-IAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
RDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER:: -
Submit the nrigina to th
GR0( VIiia306`IEI'drii`2V'o. (919
.ASHEVILLE EQ IAL CFFIIE
SIGNATURE OF PERSON CONSTRUCTING THE WELL
DATE
Division of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
733-3221, within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD 2514
North Carolina - Department of Enviromnent and Natural Resources - Division of Water Quality - Groundwater Section .-,
WELL CONTRACTOR (INDIVIDUAL) NAME (print) j CERTIFICATION 0 oleo 7 ..
WELL CONTRACTOR COMPANY NAME PHONE it
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT/ '
(if applicable)
(if applicable)
I. WELL USE (Check Applicable Box): Residential ❑ Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION: pp
Nearest Town: t.`pece ce 1/Y.A4 County A✓6r3,
OWNER: &_:) � J
Addresss '�
(S)rz0 or Route No.)
City or Town State Zip Code
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
t�
Area code- Phone number
4. DATE DRILLED '7. 1'1° -2--
5. TOTAL DEPTH: Lib
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 0
7. STATIC WATER LEVEL Below Top of Casing: G 0 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING is FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance In accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): S METHOD OF TEST /%'n
10. WATER ZONES (depth): /30 by /
VL
11. DISINFECTION: Type li%// Amount 36/
12. CASING:
Depth Dimncttr
From ITo 4.2- Ft. 6 1
From / / To Ft
From (' To Ft
13. GROUT: Depth
From 0 To a20 Ft.
Wall Thickness
or Weight/Ft. Material
,79p 6c///
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To F4. in.
15. SAND/GRAVEL PACK:
Depth Size
From To Ft.
From To Ft.
Slot size
in.
in.
Material
Material
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH ... DRILLING LOG
From To ' { 'To at onDescriptiOn
0 4:3 'p tiro ,t.�;
sd - 6 z J•A:ft ree'kayreG:
ol l fleet e
56./e. .9e.k' i_. `
e_ciB rJ rul�in
f NI .A �T va =7;'
nva
✓ ccm.-'..
m
ca - /30
/3.2
ya— Aft
9S/ ' 302 rc
IVir*t
yo
pp� Nm
Show direction and distance in miles from at' east ("xi
two State Roads or County Roads. Include tgroao
numbers and common road names.
LOCATION SKETCH
16. REMARKS:
DI S OeTE E 01gTI
Submit the origina to th
G R C U2769N-1i f6a 6fho$P No. (919
ASHF E Pit „
iAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
RDS, AND THAT APOPY F THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
�" a.z-
SIGNATURE OF RSON CO STRIATING THE WELL DATE
Division of Water Quality, Groundwater Section, 1636 Nlail Service Center -Raleigh, NC
733-3221, within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwat
•
WELL CONTRACTOR (INDIVIDUAL) NAME (print) % r, wet
CERTIFICATION 8249
WELL CONTRACTOR COMPANY NAME PHONE # ( )
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable)
(if applicable)
I. WELL USE (Check Applicable Box): Residential 0 Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION: ,�
Nearest Town: �/e, Au(' County /Nt
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: B66 MY Ior
Address
„ (Street or Route t.)C
^CiW or or Town State �'5
Zip Code
Area code- Phone number
4. DATE DRILLED 3 %a `6 2
5. TOTAL DEPTH: 9 4'fl
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO 0
7. STATIC WATER LEVEL Below Top of Casing: FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS -1 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118. ,y
9. YIELD (gpm): So METHOD OF TEST /rr'r
10. WATER ZONES (depth): °fo-5'3
`its 5`i7
11. DISINFECTION: Type ti rAt Amount •j 6T
12. CASING: Wall Thickness
Depth Diameter or Woight/Ft. Material
From "' / To 4-79- Ft. 6 •4 5Z'4j /2tC
From To Ft.
From To Ft.
13. GROUT: Depth Material' Method
From d To 3 Ft. Gene(-4-)EC O..'rr?
From 3 To &D Ft. hni. c /e id ea.., c-7
14. SCREEN: Depth Diameter Slot Size / Material
From To Ft. in. in.
From To Ft, in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Topographic/Land setting
DRidge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH > a„ 1 RILLING LOG
onn
From To Formnation Descnpdoo,
U f feeie;4^F4 . b..
'f I %C r
yi^ovJ 7C
C Awes-
;* iv9 P. N o
d ]Y cox
Tl orri
0
NI 2m
N r,
LOCATION SKETCH 3 ��
Show direction and distance in miles from9leay Ta
two State Roads or County Roads. Includeahe roan
numbers and common road names. w o
if !=
ra,r6D
>v�
16. REMARKS:
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
t Si. :. 1 RDS AND THAT A OPY 0 THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
k
Subtllit the origl'n4to tbe�
27699-1636 Phone No. (919) 733
GROUNDWATER SECTION
ASFIEVILLE REGIONAL OFFICE
iIGNATURE OFFERSON CONSTRUCTING THE WELL
DATE
sion of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
221, within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina.- Department of Environment and Natural Resources - Division of Wa r Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME p(p�riJnt) ad Aft /-A J ° CM- CERTIFICATION q �w,G �
\YELL CONTRACTOR COMPANY NAMES 7`S ts1£LL eta- DRr/�a/i/ PHONE it (g4 733 -.-?<i°a
STATE WELL CONSTRUCTION I'EttMIT0 ASSOCIATED WQ PERMIT#
(if applicable)
(if applicable)
1. WELL USE (Check Applicable Box): Residential 0 Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: "4.iryeel TI/l County
hh g/o,, ,/14 Pc A/omo✓r/c4
/7 ue;'/
(Street Name, Nu ers, Community, Subdivision,
Lot No., Zip de)
3. OWNER: C/>
Ad ress `%• 0 • a9 oval (4,
4 !
p:7;c: Route No.) 7) C • ddG o/
fff�C��ity orr Town State Zip Code r
)-
Area code- Phone number
4. DATE DRILLED 3' 9 -ea
5. TOTAL DEPTH: . f 2 o
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO fd/
7. STATIC WATER LEVEL Below Top of Casing: /d FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS .- FT. Above Land Surface*
"'Top of casing terminated at/or below land surface requires a
variance In accordance with I5A NCAC 2C .0118.
9. YIELD (gpm): 30 METHOD OF TES; .
10. WATER ZONES (depth): 9-3 ==5` `%Jv/ / fr-5,,“,/Q/
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:OGPSOTopographic map
(check box)
DEPTH :. h , spR1LLING LOG t.
From To - -'fFdrrnation Description.
b- P- rcidi/f > '7
j- 33
2 3— ., 54
,99- &r
8S— 8 / CAcv�a
S9 -.Sao
9 coo if�
sh/C Pock
11. DISINFECTION: Type
12. CASING:
Depth
From ' I To ;20
From To
From To
13. GROUT: Depth
From 3 To ;6
From 0 To 3
14. SCREEN: Depth
From To
From To
15. SAND/GRAVEL PACK:
Depth
From To
From
/fTH Amount
Wall Thickness
Diameter or.Weight/Ft. Material
Ft. G •I22 6q//!
Ft.
Ft.
Material Method
Ft. J'cac,v,'/C i Cv,2r%
Ft. Cc./ f)cr/. to
Diameter Slot Size Material
Ft. in. in.
Ft, in. in.
Ft.
To Ft.
Size Material
L reverie
5 tondo;
n
N
-n
LOCATION SKETCH rvt.zi
Show direction and distance in miles from at least yo
two State Roads or County Roads. Include troat2c=
numbers and common road names. S en=
m23
r �
W
*mei
16. REMARKS: "sty Need leo /Air, IC !/CiN a I. hie? ee c {may be.f/ it, i,vgfe-.,
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
1AR=S, AND THAT 9 COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
—Dg
SIGNATURE ERSON CONSTRUCTING THE WELL DATE
Submit the orighi'al tor -Resivision of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
27699-1636 Phone No. ('' )) 733-3221, within 30 clays. GW-I REV. 07/2001
GROUNDWATER SECTION
/ SHEVII_LE REGIrThUs!,_ Oi:1ler

WELL CONSTRUCTION RECORD ;
251161
North Carolina L. Department of Environment and Natural Resources - Division of Water Quality - Groundwater Sectii�Vionn�
W
ELL CONTRACTOR(INDIVIDUAL) NAME (print) Ii4NL/-,1 <etiO i✓ j CERTIFICATION #P-Y
WELL CONTRACTOR COMPANY NAME /$rtf$mC-// PHONE # f )
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED \VQ PERMIT#
(if applicable)
(if applicable)
1. WELL USE (Check Applicable Box): Residential 0 Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection O Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: t%/C Pan !<
County itel*:(
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: 7n c /=cG%e.r
Address aGo Tet e. kt-y K .'oaf hat, e
(Street or Route 1To.)
gIKPdek A(C 2r6dx
City or Town State Zip Code
�959)_ 7 Y3 —
Area code- Phone number
4. DATE DRILLED 3-a g- 0 2
5. TOTAL DEPTH: S ZO
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO la-
7. STATIC WATER LEVEL Below Top of Casing: (a o FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1. FT. Above Land Surface*
*Tap of casing terminated at/or below land surface requires a
variance In accordance with 15A NCAC 2C .0119.
9. YIELD (gpm): 4L METHOD OF TEST /Ti r
10. WATER ZONES (depth): H / P :154 /
11. DISINFECTION: Type /71cT!f Amount o-62
12. CASING: Wall Thickness
Depth Diameter or,Weight/Ft. Material
From To Ft.
From To Ft.
From To Ft.
•
13. GROUT: Depth Material Method
From To Ft.
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To . Ft. in. in.
From To Ft, in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS: f2 i/cof lye/% D.g vier
Topographic/Land setting
DRidge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:OGPSOTopographic map
(check box) ,A
DRILLING LOQr .4.
Formation Description q::
p; -kI err Vieth
',swirrl7fey r//e ..
DEPTH --
Flom To
Sao "/7
5/7 Hdo
Hao sao
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
F2.0o f'tJOr //ntVil/2-/9-01
O
v
N
a
O
F
GJ
1 DO HEREEIY CERTIFY TIIAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
SC STR-UCi I0\KSTEUNDA�W6, AND THAT A COPY OF T�HI ECORD HAS BEEN PROVIDED TO THE WELL OWNER
0
c
0
or"
c7
Cm
o<
>0
rn�
zm
co z
rn
ma
e7
"I
0
u/,
Submit the original to It he D
Phone No49i 9) 73
GROUNOYIATER SECTION
ASHEVILLE RE1,M0^IAL OFFICE
SIGNATURE OF PERSON
STRUCTING THE WELL DATE
vision of Water Quality, Groundwater Section, 1636 Mail Service Center- Raleigh, NC
-3221, within 30 days. GW-1 REV. 07/2001

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
020123
25031:
WELL CONTRACTOR: rahray Wright Well P'Inc.
WELL CONTRACTOR CERTIFICATION #' 2,1E17
STATE WELL CONSTRUCTION PERMIT#: SFava Recce
1. WELL USE (Check Applicable Box): Residential
Recovery ❑ Heat Pump Water Injection
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town:
LINVILLC
Municipal
Other
I
Industrial I I Agricultural I I Monitoring
If Other, List Use'
3. OWNER .k"MIE PERRIN
Address p O.
No.l
City or TEt„UM TREE state
P1C 2.2 Mde
4. DATE DRILLED 3/7/2002
5. TOTAL DEPTH 205
6. CUTTINGS COLLECTED YES I I NO I XI
7. DOES WELL REPLACE EXISTING WELL? YES I I NO
8. STATIC WATER LEVEL Below Top of Casing: 50 FT
(Use "+" if Above Top of Casing)
9. TOP OF CASING IS 4 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
Sir
11. WATER ZONES (depth)3 awn R5nS8 0 grm
0 gprn 0 Pam-
12. CHLORINATION: Type I-IT41 Amount 31
13. CASING:
X
Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 75 Ft 8 1/0 .350 F'VC
From To Ft
From To Ft
14. GROUT:
Depth Material
From 0 To G0 Ft. Ccnleid
From To Ft
15. SCREEN
From
From
From
Method
Gravity Rl.,w
Depth Diameter Slot Size Material
To Ft in in
To Ft in in
To Ft in in
16. SAND/GRAVEL PACK:
Depth
From To Ft
From To
17. R
C
to
e■
Size
EBY CERTIFY THAT THI
UCTION ST D S,
ZU
JUN 2b
Material
DRILLING LOG
From To
DEPTH
Formation Description
J
0
zv
,a
0 —
If additional space is needed use baS of f6rir.
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other map reference points, �.
/9
n\A
Ae
WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
AT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
1
'17
CK;
-;4-0;
FO
Qu
r
OFF
E USE ONLY
No: ^l1-3EC
Serial No.
ON
^C s
SIGNATURE OF PERSON CONSTRUCTING THE WELL
bmit original to Division of Water Quality, Groundwater Section within 30 day':
GW-1 FE /
DATE

WELL CONSTRUCTION RECORD 251163
•
North Carolina •;Department of Environment and NaturalResources- Division of Water Quality - Groundwater Section . p
/J
WELL CONTRACTOR (INDIVIDUAL) NAME (print) /P✓iJ Jrojm C !/ " CERTIFICATION q /3J
WELL CONTRACTOR COMPANY NAME r`¢1Nt// PHONE $( )
STATE WELL CONSTRUCTION PERMIT,/ ASSOCIATED WQ PERMIT,/
(if applicable)
(if applicable)
I. WELL USE (Check Applicable Box): Residential ❑ Municipal/Public IZ"Industrial ❑ Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATI
Nearest Town:
[s�JAct—
County
�v wry
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER:,i'nwvf�//[%�;r%g/ O„red/Iy
Address >db • t4 %o Y
(Street or Route No.)
LacJ y(D• - / ,C
City or Town State
-aeY(oxo
Zip Code
Area code- Phone number
4. DATE DRILLED 3--/7--0a
5. TOTAL DEPTH: r C6
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO Ci'
7. STATIC WATER LEVEL Below Top of Casing: /6 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS ,- FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance In accordance with ISA NCAC 2C .0118. /7 "-"/ 9 (
9. YIELD (gpm): 90 METHOD OF TEST "ifs /1 /^ 6490
10. WATER ZONES (depth): 73—f/- 30,11 //4—//9-02.512(
/Y3—/ 49- /.-5QI f78
Amount
11. DISINFECTION: Type
12. CASING:
Topographic/Land setting
❑Ridge ❑Slope OValley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH •., R1LLING LOG I,
.. 'F ..,a. Y
From To ''rForma4on Description ;
6 S♦/ b(noRd,' 105. 4.43;
,4-?-90 q--ow;yL
ik(L
7r9— �(
'/— /fit
//Y —(/7
// /' /-5
/3 J /9/
/0-/— /7,
Atf6
CZOj
,/3 FiNv�
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
Material numbers and common road names.
From -'/ To -s/ Ft. G 641/
Depth Diam ter
From To Ft.
From To Ft.
Wall Thickness
or Weight/Ft.
/22
13. GROUT: Depth Material' A Method
From Cs To 51 Ft. GCmw t f?z4/ ecf
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Iran
3
w
16. REMARKS:
T THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH l5A NCAC 2C, WELL
S, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
3 —/ 7 '—CI,
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original tohe D vision of NVater Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
27699 1636.Phnu,. No. (9 9) 73. -3221, within 30 clays. GW-1 REV. 07/2001
GROUNDWATER SECTION
ASHEVILLE REGIONAL OFRGE

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone]
WELL CONSTRUCTION RECORD
WELL CONTRACTOR' Dewey Wright
248201
Pump Co.,irrc.
WELL CONTRACTOR CERTIFICATION #: 2476
020049 SSTATE WELL CONSTRUCTION PERMIT#- `eve Price
1. WELL USE (Check Applicable Box): Residential XI Municipal
Recovery 1 Heat Pump Water Injection 1 I Other
Industrial
Agricultural D Monitoring
If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: DRILL DEEPER County' AVER"'
M TCHELL HILL LANEOFF BUCKEYE RD. OFF I-N1/ 321
(Road Name and Numbers, Community, or Subdivision and Lot No.)
DRILLING LOG
3. OWNER LARKY JONESAVADE H.AGIE From To
Address 8 MITCHELL HI I L nrt E n 125
ELK PARR'reet or Route No.l NC 28522
City or Town State Zip Code
4. DATE DRILLED
5. TOTAL DEPTH
6. CUTTINGS COLLECTED YES NO D
1/251 2002
DEPTH
Formation Description
A
0 0 DRILL DEEPER
125 180 GRANITE
1811 181 QUARTZ
181
19.8 GRANITE
19(1 197 QUARTZ
7. DOES WELL REPLACE EXISTING WELL? YES I1 NO n 197
8. STATIC WATER LEVEL Below Top of Casing: 50 . FT
(Use "+" if Above Top of Casing)
9. TOP OF CASING IS 1 FT Above Land Surface*
*Top of casing terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2C.011?
10. YIELD (gpm)' METHOD OF TEST
11. WATER ZONES (depth)' 2 ppm 0-125 1 porn 180-181
1 porn 19l 197 0 porn
12. CHLORINATION: Type HITH
13. CASING:
From
From
From
it
Depth
To
To
To
14. GROUT:
Amount
Walt Thickness
Diameter or Weight'Ft. Material
21Ft 6 1i4 .168 CALV.
Ft
Ft
Depth Material
From - To Ft CemElrit
From To Ft
15. SCREEN:
Depth
From To
From To
From To
16. SAND/GRAVEL PACK:
Depth
To
From
From
17. REM
I DO
CONS
FOR OF:j OSE ONLY
Quad No
Y
To
Method
Grav1t'd Flea
Diameter Slot Size Material
Ft in in
Ft in in
Ft in in
Ft
Ft
Size Material
trtitALTS
205 GRANITE
c
IVcl
-- c2
Fri
ta'7
N c
_D
If additional space is needed use back of fora
em.
LOCATION SKETCH p o
(Show direction and distance from at least two State ye -CV
Roads, or other map reference points)
aS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
t, COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
- ZcJ —c-2
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
ubmit original to Division of Water Quality, Groundwater Section within 30 days
GW-1 REV. 12/99
Serial Nc
GROUNDWATER
AAFV11FRFGIO
SECTION
JAL OFFICE

249457
North Carolina • Department or Environment n nil rlol:y:1I I
1636 Mail Service Ceninr - I1:Jclyh, ti r, 7 rr. r, II; I m.„„, (.,
r Section
WELL CONSTRUTIUNI(LCUI(U vl. %ll.cuu1IACltut Hi' 'ctr'—1I �l-'e.�� 1t��rti�3
C
WELL. CONIIIACTOR CEP TII ICATION 0: a66q
STATE V:CL. L. CONSRI(ICTION PERMIT#:
1. WELL USE (Check Applicable Box): Residential Municipal (11 Industtlai Agricultural 15
Recovery❑ Heat Pump Water Injection ❑ Ottrr (_1 If Other, Lint lb, Cer'yeitz
2. WELL LOCATION: (Show sketch of the location below) I /
Nearest Town: Ne-LO P(C cowry AVtRy
(Road Marna and Numbors, Community. or Suhnivislon ant Lot rL) )
3. OWNER (_t_,AYLC AU IQY
Address
�est+lo.- ei e ene f.e) el ta-
- 7
City or Town
51.=.tr
4. DATE DRILLED o/ -o, -02
5. TOTAL DEPTH 3r
6. CUTTINGS COLLECTED YES [ I NOM
7. DOES WELL REPLACE EXISTING WELL? YES D rl .)NI
8. STATIC WATER LEVEL Below Top of Casing: 60 El .
(Ilso -+• it Above Top el Casing)
9. TOP OF CASING IS / FT Above Land Surface'
'Top of casing terminated aVor below land surface requires n In accor-
dance with 15A NCAC 2C .0118
10, YIELD (gpm): QC METHOD OF TEST
11. WATER ZONES (dcpth): 9CI e2sor
9`/\ i67o,
12. CHLORINATION: Type Brit
13. CASING:
f zou1
Dilll.lJrl(; LOG
Fnvn To
Q - i
5/— S-
la— a 7
2Y7' 25i
12r/— 3eo
Monitoring ❑
DEPTH
Formation Description
F/P c v ✓a /',.' 25 Line /: (n Ny
9 /' P R-• i A-, /lene3 )i/ •p
/' tea' l we 5//tree L�
tk'n acid
kel
%.9�e /i er,rs liOrie .
c
IV 0
55 o
Amount 7 i' h Le—r-S If additional space is needed use bz)s ,o( fOrrtrr
fT �_
Wall Thicknes
Depth Diameter or Woiut.VI t.
From To 5�7 Ft 6Y O.IB8
From To Ft.
From To Ft
14. GROUT:
LOCATION SKETCFP o
1.1;derial (Show direction and distance from at least two Slate
501 80 Flonds, or other map reference points)
Depth Material t.lalhn<t
From v To ° Ft NCI" Cent.NT fcc4OD
From To
15. SCREEN:
Depth
Froth To
From ' ' To
From To
16. SAND/GRAVEL PACK:
Depth
To
To
From
From
Ft
Diameter Slot Size Matorfnl
Ft in in
Ft in
Ft in ill
Ft
Ft
Size Matta
17. REMARKS:
1 DO HEREB
CONSTRUC
Submit or It
It
GIOUNLWs FLn SECTION
ASHEV'iLLE REGICRAL OFFICE
r7
l8/
rt-eP
n:r
TIIUC IELI IN ACCORDANCE WI rl 15A NCAC 2C, WELL
F 10 3 FIECORD HA' BEEN FHJVIDED TO THE WELL OWNER.
VTi 11E or PCnGON CO rtuc imG THE WELL DATE
Irvr.inn of Water Oualily, Gruur iN. tCI Sacl:on within 30 days
GW-1 REV. 12/99

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural ResourcesCrc- Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) /�Q.V It-! KCs 6?Pc1,0 CERTIFICATION # g ) C
WELL CONTRACTOR COMPANY NAME lYgoa 2Q-Il ttifzj ( t
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential t3" Municipal/Public 0 Industrial ❑ Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
PHONE #$ram)%
2. WELL LOCATION:
Nearest Town: ,erAI' County
/0 � SVaR t2�
(Street Name, Numbers, Community, Stbdivisien, Lot No., Zip Code)
3. OWNER: Ake. e. 111 . .Xj
Address JO —1 A -) A j a4q "?d
(Street or Route No.)
P3ew' f d � C as I
Zip Code
From
From
From
13. GROUT:
From 0
From
14. SCREEN: Depth
From To
From To Ft.
15. SAND/GRAVEL PACK:
Depth
From To
From To
City or Town State
( )-
Area code- Phone number
4. DATE DRILLED /0-1-O
5. TOTAL DEPTH: / LjQ
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO cf.
7. STATIC WATER LEVEL Below Top of Casing: 3o FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
'Top of casing terminated at/or below land surface requires a
variance in accordance h I5A NCAC 2C .0118.
9. YIELD (gpm): METHOD OF TEST An
10. WATER ZONES (depth): /On 10`�j
I . DISINFECTION: Typec}\ oe"r--,P Amount C r .f
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
C--> To C(cb Ft. 6'7.8 >)% ,J_
To Ft.
To Ft.
Depth Material Method
To 'VC Ft. C----e-,-- P'E
To Ft.
Diameter Slot Size Material
Ft. in. in.
in. in.
Size Material
Ft.
Ft.
269100
ographic/Land setting
dge ❑Slope ❑Valley DFlat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:OGPSOTopographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
a-- 90 a- A
cjo - 1 LP9aA,e_ ;
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
O
16. REMARKS:
1 DO HERERY CFRTIFYTFIA
;C¢ NST?t TI *1 S-' AN
i1
LI,.
T THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
S, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
/0- 7-OR
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the the 'vision of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
L 27699-1636 Phone No (5119) 73c-3221, within 30 days. GW-I REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resourcesj - Division of Water Quality - Groundwater Section
v WELL CONTRACTOR (INDIVIDUAL) NAME (print) Ke., /I--) 70 belt c ) CERTIFICATION # 2-SC/C)
WELL CONTRACTOR COMPANY NAME rp)Pekcstt II /—` i' :YR,'iitt-1* PHONE # %33-XilDR
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable)
(if applicable)
1. WELL USE (Check Applicable Box): Residential �nicipal/Public ❑ Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other 0 1f Other, List Use
2. WELL LOCATION: ,�yy ``
Nearest Town: C &,YYt!> CountyK}es'42-V
h C7,�Me ...J
(Street Name, Numbers, Community, Subdivision, Lot o , Zip Code)
3. OWNER: I--y PC(uCC. #4-)A.�}
Address 23aM 1' ock Alt 7l ,
t ( trees or Route No.)
CS1—i
City or Town State Zip Code
( )-
Area code- Phone number
4. DATE DRILLED d- / -O_
5. TOTAL DEPTH:
6. DOES WELL REPLACE EXISS ING WELL? YES ❑ NO L'r
7. STATIC WATER LEVEL Below Top of Casing: Al2 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surface*
'Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): ) METHOD OF TEST Are (C
10. WATER ZONES (depth): b/a.
I1. DISINFECTION: Type Q,} 1ti.P_ Amount w tit,
12. CASING: Wall Thickness
p Diameter or Weight/Ft. Material
From(f YI �JQ a1 •7'VC.
Depth
0 To 3'3
From To
From To
13. GROUT: Depth
From ("*, To <41L:'
From To
14. SCREEN: Depth
From To
From To
15. SAND/GRAVEL PACK:
Depth
From To
Ft.
Ft.
Ft.
Ft.
Ft.
Material Method,
Diameter Slot Size Material
Ft. in. in.
Ft. in. in.
Size Material
Ft.
From To Ft.
269099
,,Topographic/Land setting
2kidge ESlope ❑Valley 0Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Descriptio
C-3` _tick
.27-'-/',i wkJa',rcck
c -CC.) t�
4©.- l eo
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names. o
r*I
tV -
0
r
16. REMARKS:
[Hi I;PD��!!3iE.ES&CERTi
�"tONSTRUCT_I0 'i. • N
j
_Submit the original to th
27699-1636 Phone No. (919
-F
AT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
RDS, AND TH • T A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIG
C
ATURE OF PERSON CONSTRUCTING THE WELL
%o- /—b�
DATE
Division of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
733-3221, within 30 days. GW-I REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural
Resources - ey`Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) /'t e,itz!4 cf osm%it.CERTIFICATION #0,2ay
WELL CONTRACTOR COMPANY NAME era J Uc—// re../I l,t(2t )//i- PHONE # IY4) '7Y3--c6`v(
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential J' Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use ft
2. WELL LOCATION
Nearest))Towir nteicedJ4lU4 County
(Street Name, Numbers, Community, Subdivisi , Lot No., Zip Code)
3. OWNER: At.res �i�p,rwG//
Address 25'� '6Roo k4Ree .2
1 (Street or t, No.)
/ � to +[y
City or Town State
a)- 7 21 - - -/ yy
Area code- Phone number
4. DATE DRILLED /D ot/-ea
Zip Code
5. TOTAL DEPTH: 1.3490
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO IJ'
7. STATIC WATER LEVEL Below Top of Casing: 60 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS J. FT, Above Land Surface*
'Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): C METHOD OF TEST gin
10. WATER ZONES (depth): %d -.to
II. DISINFECTION: Type ff7/4 Amount Set
12. CASING:
Wall Thickness
Depth Diameter or Weight/Ft. Material
From —/ To is 8 Ft. A /I Gb//C
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From 6 To %i 8 Ft. GGAle-v/L Po 4,-Ne
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
H S �7 L LI
1130 HEREBY CEYRTIFTHE
'f ONSTRUCTION STANDARL'pI,
L l
tc
S
Stdatnit the original to thei79ivisi, n of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001
268997
ographic/Land setting
Idge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
Formation Descriptpipn
to et. JN d /tA
DEPTH
From To
D— (ST
-Cr 07
62- 72
7 2— M
77 -25ro
r
TC
ota.,,( r
LOCATION SKETCH
Show direction and distance in miles frolet lea(
two State Roads or County Roads. InclueWhe IrsSd
numbers and common road names. m'
tXY C rt: r
0
3
i8 ,��
O/d roe = r.- ryi
/C COcn O n
G
6ru• la
1-7 ..z. k'*.4°'r0"
�D-o2/ o
WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
D THAT A COPY OF THIS REC 0 RD HAS BEEN PROVIDED TO THE WELL OWNER
—
NATURE OF PERSON CRUCTING THE WELL
DATE

268996
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division ofWaterQuality - Groundwater Section
�j
WELL CONTRACTOR (INDIVIDUAL) NAME (printt)d)2 /t Ci(/.f/C Ah `&ooly^1X19, CERTIFICATION #,X4
WELL CONTRACTOR COMPANY NAME itc5 ve/� well d/+S,ir llr'#-�Q PHONE #rD) 757— W19
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
WELL USE (Check Applicable Box): Residential Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other ❑ If Other, List Use f N: da
2. WELL LOCATION'::/ / ��]7
Nea/.1estTown: fief✓LQan, County Ali<ry
/- (% /O / iu /at�t/
(Street Name, Numbers, Community, Suhdivision, Lot No., Zip Code)
a
3. OWNER: )fe/�el':y it.ii%tootl'Snio
Address c �G ' /F 7
(Street or Route No.)
ei=-4.:4r/ We 2%57
City or Town State
Zip Code
( )-
Area code- Phone number
4. DATE DRILLED 1-26 - 6.2
5. TOTAL DEPTH: .2 2a
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO la
7. STATIC WATER LEVEL Below Top of Casing: r2 0 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS L FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordan a with ISA NCAC 2C .0I18. �JP
9. YIELD (gpm): bLO METHOD OF TEST
10. WATER ZONES (depth): a a/
Topographic/Land setting
O1dge 0Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
0 "- //a Iecer//oaAO'
,7c
/Jo .-/20 . by/Bnvc�
ilo /f, 9,o,e✓,'le
/c/7 -aod l7novii-i.5h4,4'
Jre-kb f4
aoo-a.20
/44—/00 95q/ /oi)otco J c/ LOCATION SKETCH
11. DISINFECTION: Type 29 t-.N Amount o2 0 z Show direction and distance in miles from at least
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From —/ To /1.2 Ft. 6-g-YQRog! ('Ivc
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From 0 To o2.0 Ft. eenrr.c//- focirc /
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth
To Ft.
To Ft.
From
From
16- PEMARKS
Size
Material
ro .
((n CPRIWY
ONSTRUCTION STANDAR
two State Roads or County Roads. Include the road
numbers and common road names. W �;
rn
IA, He 'I.
Ji-...,1>n r
o
n-t
,ew �1r3(
oInsras—
S WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
D THAT 4-COPX OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
NATURE
DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. (919031-32M, within 30 days. GW-1 REV. 07/2001
=-c

268995
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural'JResources - Division of Water Quality - Groundwater Section /
WELL CONTRACTOR (INDIVIDUAL) NAME (print)(p)/I eyN>D/^I .% .:-Le/ CERTIFIvCAATIION#dl/Gy
WELL CONTRACTOR COMPANY NAME J ?4St'_e-l/ 14a11 .IJKI ii0' PHONE #(25 )733- .
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
WELL USE (Check Applicable Box): Residential llMunicipal/Public 0 Industrial 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCATION: Nearest Towna�i.NM1% 1i County tee',
--Ceigrty
(Street Name, Num rs, Community, Suhdivision, Lot No., Zip Code)
3. OWNER: <? $c 4-(p/s1M,➢
Address / 1) vt r'i e., ( k
(Street or Route No.)
City or Town State Zip Code
( )-
Area code- Phone number
4. DATE DRILLED le -2-
5. TOTAL DEPTH:/, /%
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO J-
7. STATIC WATER LEVEL Below Top of Casing: / 5 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS L FT. Above Land Surface'
`Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): rar—. METHOD OF TEST it/-
10 WATER ZONES (depth): //U . // - o`1Jn /
1 I . DISINFECTION: Type /VCA/ Amount :� O 2
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From - ) To 5 y FL !r .2a /T'e A14)
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From %) To Ft. GCif el' 7` flee,rer7
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
Agricultural 0
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
5 S //b (
// 5' �)n),ru v /k, /o
LOCATION SKETCH
Show direction and distance in miles frat least
two State Roads or County Roads. Inclu the'Mad
numbers and common road names. =-.c.
r
CO
J
O
0J1
(JI
c-
rif
iq DOHEREBY' CEfRTIEY TBAfl'Till
C5NSTRUCTION STANDARD, Al'
SI
S WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
JD THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
lt���i
NATURE OF PERSO ONSTRUCTING THE WELL DATE
/L)-2, 0z-
Submit the original to the Divisir, n of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

City or Town State
( )-
Area code- Phone number
4. DATE DRILLED /D ---I 6 `02
WELL CONSTRUCTION RECORD 271150
North Carolina - Department of Environment and Natural Resources - Division of WaterppQuality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) /t C4'4 ro h tJ(2 .e pO CERTIFICATION #22617
WELL CONTRACTOR COMPANY NAME � /14 i:� [Jr/ L✓'e// /ThR, /714;:
PHONE to �r )733 — D Lk
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ❑ Municipal/Public ('Industrial 0 Agricultural 0
Monitoring 0 Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION: ,n/
Nearest Town: (i/CJ #Orr County /t`-v=,...„
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: NC -
Address (Ian 3a
COJ (Street or Rou a No.)
,cam/- S'• ,i Code
Zip Code
5. TOTAL DEPTH: Jot.o d
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO ❑
7. STATIC WATER LEVEL Below Top of Casing: g 0 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING 1S .3 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gum): '7. D METHOD QF TEST fir r
10. WATER ZONES (depth): /%t✓" /is °Zfc/
1,3 / ,n/ /!SF -//60 "Y /
11. DISINFECTION: Type /7 7W Amount S. ex
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From —1 To /`/( Ft. L>I,. /8t1 ,Jy
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From 0 To / 5` G Ft. t z to e"t Dy,�Jrt�,P
From To Ft.
14. SCREEN. Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Slot Size Material
in.
in.
16. REMARKS: 713 - 7 N.:,
1 DI) HEREBY QFRt FV'ItH
ICONStRU6T1O1 STANDAR
Midge
setting
L7Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
D - /2/6 r ediriekr 'Ant
Jr /To
i 90 / 9 *' //.<r
ry- 1rt:3
7?) 79s
7 95` -//2-2
11s7 - //coo
i/GC - /Ace,,
u/.-.¢. bier
r
"wfic
tin ie
ca
LOCATION SKETCH =o
Show direction and distance in miles from ataeast.
two State Roads or County Roads. Include Eye road
numbers and common road names.
7 727--78o //-5"S floc
-0
(.2
9 2
C/1
tT o_
C/'e et, Cy /Dam./( /1 Osi. 24-evoe -s
IS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
ND THAT AAT COTHIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
/O -- 30 — 02
NATURE OF PERSON CONSTRUCTING THE WELL DATE
§ubmit the original to the'sDivis on of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27:699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural,/Resources - Division of Water Quality - Groundwater Section j��j
WELL CO\TRACTOR (INDIVIDUAL) NAME (print) 16.4.0Vr/1' 7o- rL�, CERTIFICATION#O°(R'OJ
Lie 1
\\'ELL. CONTRACTOR COMPANY NAME
271149
I44/f `Pe'//i(t PHONE # C )737-
STATE WELL CONSTRUCTION I'ER.NIT# ASSOCIATED WQ ItRHIT#
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential VI/Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Usefr zt...6 r
2. WELL LOCATION: y�
Nearest Town:/1 County /9✓ eq.; y
10La &ye% "SA/3 3, Q7cyr.L7`
(Street Name, Numbers, Cot munity,,/Subdivision, Lot No., Zip Code)
3. OWNER: .c'�y //ri�,FFjfvr4,�� ?
�- � " �
Address 1-7 .1/Albeit
(SIr Rowe No.)(c
City or To.
i
State Zip Code
( )-
Area code- Phone number
4. DATE DRILLED 57 -/S•-c'
5. TOTAL DEPTH: - 760
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO ❑
7. STATIC WATER LEVEL Below Top of Casing: G b FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance to accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): . METHOD OF TEST A,',.
10. WATER ZONES (depth): Gd •4 ' /5o!
2 92-a93aycf
1 1. DISINFECTION: Type Amount
12. CASING: Wall Thickness
Depth Diameter or WeighUFt. Material
From "/ To ?Cr Ft. 64 / 2 7 CVIte
From To Ft.
From To Ft.
13. GROUT: Depth Material Method From 6 To 2C,, Ft. CCiriO-v7( fc ,ecia
From To Ft.
14. SCREEN: Depth Diameter Slot Sizc Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Sizc Material
From To Ft.
From To Ft.
16. REMARKS:
Topographic/Land setting
G3Kidge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
Formation Description
.�)
/ic Clis
l1ets folic'
reels4 / y S r
bt^t,�rw s /,c51 4'
even-- r
DEPTH
From To
O— J
3•- 60
40- 64L
441 -a72
a>a-a9r
aft"—.3oo
Q
LOCATION SKETCH -,-I
Show direction and distance in miles from agast �=c
two State Roads or County Roads. Include thproad: t-r
numbers and common road names.
O
:1
\ rl D(AH C"FP.T €,Y
i t (LC(%NS1- 131C"r10;1i1ST
THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
pi�rvci`
SIGNATURE OF PERSON CONST CTING THE WELL
/S-o,z
DATE
Submit the original to he Di Ulan of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone:No.191)) 733-3221, within 30 days. GW-I REV. 07/2001
cJ
LO

WELL CONSTRUCTION RECORD
271153
North Carolina - Department of Environment and Natural(4 v
Resources - Divisionivof Water Quality - Groundwater Section/ / p
WELL CONTRACTOR (INDIVIDUAL) NAME (print) /r- ve/J o�o4N CERTIFICATION#26
WELL CONTRACTOR COMPANY NAME PHONE # ( )
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential 0 Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other ❑ If Other, List Use
3. OWNER: #Vsc/
Address %ff.a C-c.u.,incer,/?ex I154e//Fn/()
Ai(Street or Route No.)
✓Ji iu 2 e'/K NCI
City or Town State Zip Code
( )-
Area code- Phone number
4. DATE DRILLED /,2 3 /- o -
5. TOTAL DEPTH: 3 w
6. DOES WELL REPLACE EXISTING WELLS YES ❑ NO EY-
7. STATIC WATER LEVEL Below Top of Casing: 020 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS tL FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): /L METHOD OF TEST 4; P
10. WATER ZONES (depth): /0f-/47- /y,/
aid a93— 36d
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
Formation Description
Sic, r oc-A
3P— /dy
/O 5- / ra. Sh.//r rv��
''aN/ /e
r79e •- i/l•vJ ert.a ett3y roe,/
5 }±<
yg'- 3J o
LOCATION SKETCH
11. DISINFECTION: Type 11If/ Amount 30f Show direction and distance in miles from at IeasY_
two State Roads or County Roads. Include rota
Depth Diameter numbers and common road names. r1
From --1 To Y/ Ft. i rn
From To Ft. tv
From To Ft. -.1
12. CASING:
2. WELLLOCATIO,N:
Nearest, /Town: rrt.tCr Cl� County
/? T (//jaa_.> C O-,..
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
geCt` 1-ro
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
DEPTH
From To
D ^ 961'
//2- rzQo
13. GROUT: Depth
From f) To ao
Wall Thickness
or Weight/Ft.
Material
Ft. cc-4 rNf
From To Ft.
Material
Go/G
Method
0 0'/t rna
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
I bO HEREBY CERTIFY'I A j
'CONSTRUCTION STANDARDS ,
S
qU�e
2
0
01
C+J
!J rfo✓ri -7J
IIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL — _-
�ND THAT A COPY
OF OFTHIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
GNATURE OF PERSON CC�E WELL DATE
/a-3/-
Submit the original to the Divis on of Water Quality, Groundwater Section, 1636 Mail Service Center- Raleigh, NC
27699-1636 Phone No. (919).733-3;21, within 30 days. GW-I REV, 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print)t)KG, / NG#h c O rolettu CERTIFICATION # -2GG 9
WELL CONTRACTOR COMPANY NAME 19 ro Ocet // PHONE # ( )
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential frMunicipal/Public 0 Industrial 0 Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other ❑ If Other, List Use O r / vQ./G
2. WELL LOCATION/•
Nearest T?wn: 6.aG County rTve"P
J.3 IO JJe Laa.) Coal)
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: Ke-NNGt/r / 4o o/
Address /3 le ffe.u5 a 4. C/. eK R /)
(Street or Route No.)
/l/e-a•/aet.ri ACC .ZA'6C 7
City or Town State Zip Code
( )-
Area code- Phone number
4. DATE DRILLED /0— //— 0 i2
5. TOTAL DEPTH: 2Z 0
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO PY
7. STATIC WATER LEVEL Below Top of Casing: 2S FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS Q FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): S METHOD OF TEST /Ur
10. WATER ZONES (depth): `tS^ /o o .2
/fl-/eo 3 cyst/
I1. // -M Amount JOZ
12 Wall Thickness
or Weight/Ft. Material
DISINFECTION: Type
CASING:
Depth Diameter
From '/ To .27 Ft. 6-f r50RA/ PPt
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From 6 To 2 U Ft. Cnnr e r f r 0 get sof
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
271154
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
Formation Description
re.J b•oak soote
J�oti/.{e
b ernt-W SA, /le-
eL/&fP �ij nmv/%
(Walt - fII4tiJ
DEPTH
From To
0— 20
2o- 15
�,f— /en
/n t,
/tG!ZOO
&co -02.2o
O
LOCATION SKETCH _
Show direction and distance in miles frotriat leaf
two State Roads or County Roads. Include4tjie raad-
numbers and common road names. - _
Jae er
,-y 1/c'//w
)
C40-
TtD =c
ni
//st,vo4
G,( — 4/a It 1-eeG
icn
16. REMARKS:
1 DO. HEREBY. CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STTAMJ7N{tPS, AND THAT A COPY OF THIS RECORQ HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON COkSTRUCTING THE WELL
/6 —//
DATE
Submit the original to'the ivision of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
27699-1636 Phone No. (919) 33-3221, within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
2711.55
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NANIE (print)in/I � 42frer0/_ ,��,c4.c_ CERTIFICATION #42Yld'7 ,.
WELLCO\"IRAC'"FO12 COMPANI'\A\1E U� S.X-G /f Ii+i( t(�(1 1 PHONE # (54) 7J—` V LQ
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT/4
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential L9' Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use pl✓o,/t
2. WELL LOCATION:
N�FFarest Town: i3addVyla bik Cou
5'lit Dtedbti c-4 ilitr .eo
(Street Name. Numberrs, Community, Subdivision, Logo.. Zip Co
3. OWNER: p/bean , Par G/ c.o\
Address 61 89 r'Trh4 c sn.>c n
y
/��/t re(Street or Ro to �1 age"2
City or Town State Zip Code
)- P%? 0'7
Area code- Phone number
4. DATE DRILLED P-a_ b .`.t
5. TOTAL DEPTH: .5 P 0
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO Q..
7. STATIC WATER LEVEL Below Top of Casing: /gZ-G FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS X FT. Above Land Surface'
'Top of casing terminated at/or below land surface requires a
variance in accordance vjth I5A NCAC 2C .0118.
9. YIELD (gpm): %+i METHOD OF TEST Stir
10. WATER ZONES (depth): 5'YS-5/P0/1.1fr,0
II
12. CASING:
DISINFECTION: Type
Depth
From — / To ali
From To
From To
13. GROUT: Depth
From 67.) To c--U
Front To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size
From 'To Ft.
From To Ft.
16. REMARKS:
`t rf7 Amount S D X
Wall Thickness
Diameter or Weight/Ft. Material
Ft. 64 /yb Ce
Ft.
Ft.
Material Method
Ft. Ce-.2' Z "Dv/act
Slot Size Material
in.
in.
Material
��Topographic/Land setting
L�Rtdge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPSOTopographic map
(check box)
DEPTH DRILLING LOG
From To
D— 3
3�391
3 is— 7Ltj
:Cbo, 5 70
Formation Description
ts7A ; rL p 44
.17c
W
T'"
LOCATION SKETCH b - Show direction and distance in miles frompa&least
two State Roads or County Roads. Include ttie rogd
numbers and common road names. p'
o1
0
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
CONSTRUCTION STA7RA 2DS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNitR
Submit the original to the
27699-1636 Phone Ni (919)
SI
TURE OF PERSON CONSTRUCTING THE WELL
DATE
Division of Water Quality, Groundwater Section, 1636 Mail Service Center- Raleigh, NC
733-3221, within 30 days. GW-I REV. 07/2001

WELL CONTRACTOR (INDIVIDUAL) NAME (print)
WELL CONTRACTOR COMPANY NAME
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable)
(if applicable)
I. WELL USE (Check Applicable Box): Residential 0 Municipal/Public ❑ Industrial 0 Agricultural
Monitoring 0 Recovery ❑ Heat Pump Water Injection ❑ Other21f Other, List Use (A)aisi+2
2. WELL LOCATION:
Nearest Town: nen,.0 en k County
156?. A // R!)
3. OWNER:
Address
(Street Name, Numbers, Community, Subdivision, L& No., Zip Code)
pia 7:JHr.� Q�L� rtr //�
A0' / /Y
(str et or Route No.)
City or Town State Zip Code
( )-
Area code- Phone number
4. DATE DRILLED g / 6 - 0 2.
5. TOTAL DEPTH: 76 c'
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO ❑Y
7. STATIC WATER LEVEL Below Top of Casing: `d',h FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS -.I, FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance In accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 3 0 METHOD OF TEST g
10. WATER ZONES (depth): / ;25- / G 7 — S".yo /
11. DISINFECTION: Type
12. CASING:
Depth
From ` / To 2 Ft.
667-(70 g,C10j
/t //# Amount itC Z
Wall Thickness
Diameter or Weight/Ft. Material
/ wF C /t
From To Ft.
From To Ft.
13. GROUT: Depth Material Method From e To =C Ft. c errc- prtir',.2Y/
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
Formation Description
rcz/d/r.J/f/5'e ..4..544
./ tJ!'' / , k 1 i /L it 4(on5
r,ct F/laV./ 6/c crc/c.:fs
9tz le
DEPTH
From To
t— 6c
- /cif
1/27- FG7
(62-67c
t7e- Pen
LOCATION SKETCH
Show direction and distance in miles from atle-'dst L- two State Roads or County Roads. Include the road
numbers and common road names. �"•1
ea
O
CO
rn
U./
rV
O
16. REMARKS:
I DO HEREBY -CERTIFY T T THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
Ii JNStRf1 TION STANDAO AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
>a
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section/
/f r' N/l/C�/( �O!`.�roip CERTIFICATION #�Iy, CI
6 is .S 22e-/ 7
271156
PHONE # ( )
X /c' O2
SIGNATURE OF PERSON CIRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-I REV. 07/2001
cr
G

3. OWNER: /l1�S�
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natura Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) tit,/ 'f/t JO/tdq� CERTIFICATION #oty
WELL CONTRACTOR COMPANY NAME PHONE # ( )
271159
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential (Municipal/Public D Industrial 0 Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use plivufo
2. WELL LOCATI
Nearest Town: County Aiv or
/iZtr-aa -e o rs the'✓14elgoli5 JB).J U.S )`1 tr 1141�
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
Awl CIS
Address 1P 5 Its 14 Z 1.T
treetor Route No.) c JGcC7
City or Town State' Zip Code
( )-
Area code- Phone number
4. DATE DRILLED 9 - 3 cs — 0.2
5. TOTAL DEPTH: '/:7-e
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO 8'
7. STATIC WATER LEVEL Below Top of Casing: 0 % FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS -1 FT. Above Land Surface*
`Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): Jo METHOD OF TEST %t/
10. WATER ZONES (depth): //4'//S 029ei/
,33 v . 3.2 as19/
11. DISINFECTION: Type /i7,44 Amount 3et:
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From `/ To `lU Ft. e 5/'%cl1 pat
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From To o"-D Ft. C-C-.0 ✓-v i- f�c<-,o�
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Topographic/Land setting
midge OSlope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
Formation Description
/,
7 Y4lrtn 4
DEPTH
From To
b— fl
go— no
//a — !/,5—
/X5'— y3o
33 e 3J2
3.3; — %1ri
LIvt-:Per
treL
ca
-J
LOCATION SKETCH U
Show direction and distance in miles from-gleast
two State Roads or County Roads. Include the road
numbers and common road names.
/9C
4
to
-a
r
16. REMARKS:
--- h DO#IEREB .CERTIEY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CC(NSTRIJCTION STANT
Submit the original to the D
27699-1636 Phone. No. (919) 73
, AND THAT_1 COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE O ERSON
% 30 `a2
DATE
vision of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
-3221, within 30 days. GW-I REV. 07/2001
CONST
RUCTING TRUCTING THE WELL

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality
WELL CONTRACTOR (INDIVIDUAL) NAME (print) `list-Netila Cmpt,?QRrt9/J
WELL CONTRACrOI( CONIPANI' NAME t.t_X_t1 A.$2..t1 Va.. 1,,139
STATE WELL CONSTRUCTION I'ER.MIT# ASSOCIATED WQ PERMI'P#
Of applicable) (if applicable)
271161
- Groundwater Section
CERTIFICATION u264-C)
PHONE #
'• l' 1r67
I. WELL USE (Check Applicable Box): Residential IV Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use 'tea le
2. WELL LOCATION: �-49l,}{�
Nearest(`Town:�/�6 r' -_LIO, ,3 County ndd' y
\pFC-CD L--[� t- r7 3
(Street Nance, Numbers. Community, Subdivision, Lot No., Zip Cod
3. OWNER: nCA esf.Vct t9 ea,s./L//6'tez
Address /•V ' !'1 vy
(Street or Route No.)
City or Town State
( )-
Zip Code
Area code- Phone numbe
4. DATE DRILLED / 3— C,72....
5. TOTAL DEPTH:
6. DOES WELL REPLACE EXISeIG WELL? YES ❑ NO @I
7. STATIC WATER LEVEL Below Top of Casing: /O FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS _i FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with I5A NCAC 2C .0118. �I
9. YIELD (gpm): )47 METHOD OF TEST /rir
10. WATER ZONES (depth): 1434800 y/
I I. DISINFECTION: Type /{f%,i Amount Gin or...
12, CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From —/ To /.Z Ft. ' a /87 Ho /%/
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From C To v20 Ft. Er' <•' r,✓f-
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16, REMARKS:
Topogra is/Land setting
❑Ridge lope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
Formation Description
J,,//aa telttvs�
n 7/ '
/4 /re r r l✓ i r'zt.0 dr
,n1,ti'fe
r n- fC
DEPTH
From To
p - Sb
.to
3c
Gz )o
70 9
75-- 47z
�n0 3,aa
CS
LOCATION SKETCH rn
Show direction and distance in miles frompthleasFi H
two State Roads or County Roads. Include -Mk, roa-4'=
numbers and common road names.
if-..c
w
N
1I DO HEREBY CERTIF1T_T)- AT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I SA NCAC 2C, WELL o
CONSTRUCTION STA'NDtti 2DS, A THAT A THIS ECORD HAS BEEN PROVIDED TO THE WELL OWNER
--TA , 7--23-0R
ATURE OF PERSO,' CONSTRUCTING THE
the original to the
27699-1636 Phone No. (919)
WELL
SIGN DATE
Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
733-3221, within 30 days. GW-I REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print)/1 /1 C-Aritie .CA s/sio �•e'4 p CERTIFICATION # die*
WELL CONTRACTORNi7
CO?IPA V NAME ttiec.,N'(r PHONE # f
STATE \VELI. CONSTRUCTION PERMIT# ASSOCIATED \VQ PERMIT#
(if applicable) (if applicable)
271163
1
1. WELL USE (Check Applicable Box): Residential ®Municipal/Public ❑ Industrial ❑ Agricultural 0
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use //ir r/4 f e
2. WELL LOCATIO : %i /�jj
Nearest Town: pCC-t- 4 ' -t County ilintry
(Street Name. Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: ifcwiv •{'j ,c,,,vc.y
Address 0299 eat."'/%/n,7L /Q
/
��jj (Street oroRoute No.)
K oa,t, f' Ar reel) A) -7 .i sI /• I'/
City or Town State Zip Code
)-
Area code- Phone number
4. DATE DRILLED J —/— 0 2
S. TOTAL DEPTH: 3 '7`J
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: '6 FT.
//��
(Use "+•• if Above Top of Casing)
8. TOP OF CASING IS _e FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gptn): J METHOD OF TEST irjen
10. WATER ZONES (depth): fO `f>'-/iPt
/Yo-Ts2
1 I. DISINFECTION: Type // A// Amount 2 02
12. CASING: Wall Thickness
Depth Diameter
From '- / To -902- Ft. C--a
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From & To 020 Ft. C-in etiL /ov/tit
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
or Weight/Ft. Material
Y4ef / Rv.
From To Ft.
From To Ft.
16. REMARKS: MMOc'4iy
I Do HEREBY CERTIFY-TTT+
CONSTRUCTIONSTANpA)
Submit the original td the ❑
27699-1636 Phone No019) 72
Topographic/Land setting
LZ] 'idgc DSlope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
Formation,Description
hMla, , f-i4 k
t on/; 7�L
✓/mesfo. t s� 1 t/
f/vnv/fC , ct,tcc-
h�oW/✓�S•!e to
DEPTH
From To
o- 9G
96— Pc
to `?>
fY `/71-
c
O
CO
LOCATION SKETCH
Show direction and distance in miles from
two State Roads or County Roads. Include
numbers and common road names.
'-n
_
tV
at-IQ2st
the, oad='
1 1C. N O n
=
N-r
/y
THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I SA NCAC 2C, WELL Ca
S, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
Oat n
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
ivision of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
3-3221, within 30 days. GW-I REV. 07/2001
'c c4
rn
r-�