Bk CY2002

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Robert Miller CERTIFICATION # 2675
SAEDACCO, Inc.
WELL CONTRACTOR COMPANY NAME
PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential O Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring ID Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town:71.4 htrfortA 04115,oCounty J?a;Pk"t�
3oQMtLCOLm'Qi✓d ¢ Nw1J
(Street Name, Numbers, Community, Subdi4tsion, Lot No., Zip Code)
3. OWNER: /'CmeC 7+9x71Ry#/W NCG1*9-'
Address300 /v(4LG" Lrn Rwb Q%Hm/7 J
(Street or Route No.)
City or Town State Zip Code
., �t� erfo&13o/ C/e�C, i
14. SCREEN: Depth Diameter
From :.`� To 491 Ft. 2._" in
From To Ft. in
15. SAND/GRAVEL PACK:
Depth
From )_:i; To
Area code- Phone number
4. DATE DRILLED /.L-/9-01.
5. TOTAL DEPTH: `71 '
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
266894
Topographic/Land setting
CIRidge ID Slope OValley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(dcgrecs/minutes/seconds)
Latitude/longitude source:OGPSOTopographic map
(check box)
DEPTH DRILLING LOG
Fr on
l . Formation D- 5; c -
O�f�N'vS
7,0' tN c/ Cr
to' LZr P w k
7. STATIC WATER LEVEL Below Top of Casing: .erg' FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 0 FT. Above Land Surface'
'Top of casing terminated atlor below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): /11I METHOD OF TEST
10. WATER ZONES (depth):
11. DISINFECTION: Type Amount
12. CASING: Wall Thickness
Depth Diameter or Weight/FI. Material
From i 'i ' To W `4 Ft. k $cl. 4o (w C-•
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From N To �-ij. Ft. fb1'TLQIJD p>0uk,
From To Ft.
Slot Size
O.O 1 in.
Material
p trC
in.
Size Material
I `1 ' Ft. 3 y�,, S't . c::.-Si /rl)
From To Ft.
16. REMARKS: 2-ee /tom' Seal,
I DO HEREBY CERTIFY kIA3:
r- STRUCT1ON STAND
I I �� f I \ \i
II7
LI L'' Submit the original to ti4e�Div ion of Water Quality, Groundwater Section, 1636 Mali Service Center - Raleigh, NC
127699-1636 Phone No. (91 733- 221, within 30 days. GW-1 REV. 07/2001
2.,o'yo
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roa)Kor County Roads. cJudethe road
numbers and-c
Hwy
1
G
S• �.
, Z ratr
1 c
HIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
ANDSHAZ A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
V
IGNATURE OF PERSON,EONSTRUCTING THE WELL DATE

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources -
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Robert Miller
SAEDACCO, Inc.
WELL CONTRACTOR COMPANY NAME
STATE WELL CONSTRUCTION PERMITN ASSOC (if applicable)
WQ P) RMITN
(if applicable)
266895
Division of Water Quality - Groundwater Section
CERTIFICATION N 2675
PHONE N [phone]
1. WELL USE (Check Applicable Box): Residential 0 Municipal/Public 0 Industrial 0 Agricultural ❑
Monitoring El Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION:
Nearest TownV / U1hle/55/0 (Toile
300 MQICo/M £w2 94/417
(Street Name, Numbers, Conuni;unity. Subdivision,
3. OWNER: ioeh^tf wit/
Address O rfat-Colin Q't-yD
(Street or Route No.)
,ft4 f'L eC f t.. Coiltje'. N L
City or Town State
County 84Rie-t.'
Lot No., Zip Code)
Zip Code
(_)-
Area code- Phone number
4. DATE DRILLED /2--•/9-a2
5. TOTAL DEPTH:
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO-21
7. STATIC WATER LEVEL Below Top of Casing: 2-4' FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 0 FT. Above Land Surface*
*Top of casing terminated ai/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): AlA METHOD OF TEST
10. WATER ZONES (depth):
11. DISINFECTION: Type
12. CASING:
Topographic/Land setting
❑Ridge ..,*(Slope ❑Valley ❑Flat
(check appropriate box)
Latitude longitude of well location
(degrees/minutcs/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To , Formation Description
0 ? cmxf `Pew 2L"
r. j-62 anrai.1/LrXe'Aj
..<' ?- e•
' '10,
Depth � Diameter
From 0 To )J,Ft.
From To Ft.
From To Ft.
Depth
Lj�RE YIrER'('IFY ...
C NSTRULT16N STAN/ T- • T A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
2
l' ...d. /77- ',,---- / 7.- ' LO - 0 \
Ili 't
J 1 IGNATURE OF P SON CONSTRUCTING THE WELL DATE
li
Submit the original to he D ision of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
r Pe i e.: 19) 73 -3221, within 30 days.
GW-I REV. 07/2001
A` ',L PH-,ir
13. GROUT:
From_O To� Ft.
From To Ft.
14. SCREEN:_ , Depth Diameter Slot Size ��al
From 1-(-� To '/fQ Ft. �i : in. no
in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size
�,
From %�i" To LILO Ft. 7-9'
From To Ft. so
16. REMARKS: )-; OEN*0N/71-2- `goal /c, 7`O
THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
Amount
Wall Thickness
or Weight/Ft. Material
�c io PVC --
,Material .Method
toPTRAv1.3 }but,
Material
A C"— _.17fhl�
'Yid 4)4f/: r'✓
LOCATION SKETCH
Show direction and distance in miles from at least
two State oads or County Roads. Include the road u/
number d common road names,/ 4+J
0 legli 7
CO n ,�
L
n
t
I t
0
—o
7L
r)
O

26689E
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
CERTIFICATION # 2675
PHONE # f 704) 504-9195
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Robert Miller
WELL CONTRACTOR COMPANY NAME
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
SAEDACCO, Inc.
I. WELL USE (Check Applicable Box): Residential 0 Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring ID Recovery 0 Heat Pump Water Injection 0 Other O If Other, List Use
2. WELL LOCATI
Nearest Town: t414heA,.. aQ c4 PeCounty 13.4 fee'
Zoo rnutoo Lm atva, d to 7o
(Sheet Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: / re,G!)?NiCeL'tl /
Address..5'OOMU LGot»i c?Lv). tt/!yr 70
(Street or Route No.)
if -d' (t a /: roe.) Co ii�g0, NO
City or Town 'Slate Zip Code
(—)-
Arca code- Phone number,
4. DATE DRILLED la ." / 7").
5. TOTAL DEPTH: US"
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO�X,7
7. STATIC WATER LEVEL Below Top of Casing: Z.3' FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 0 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): 4/A METHOD OF TEST
10. WATER ZONES (depth):
Topographic/Landsetting
❑Ridge ❑Slope OValley gFlat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:OGPSOTopographic map
(check box)
DEPTH DRILLING LOG
From Tq.... Formation Descripti n
11. DISINFECTION: Type Amount
12. CASING: Wall Thickness
Diameter or Weight/Ft. Material
Depth
From 0 To AS ' Ft. .l." ScHYC% A"C
From To Ft.
From To Ft.
13. GROUT: Depth
From 0 To %f 2 Ft.
From To Ft.
14. SCREEN: , Depth % Diameter Slot Size Material
From /S To .5 Ft. x' in. O.O / in. PVC --
From
To Ft in. in.
15. SAND/GRAVEL PACK:
Depth_ Size Material r N�
From %,3 r To ..i�• Ft.�2',r ,� i C. l [ `lam Y
From To Ft. '�
_cvlaterial
fc ? 1AQ
Method
.&(1
16. REMARKS: r L'8e4 w;i €— ?- i, //' / /�
p,l DQ'HEREBY CERTIFY ! w
:1 014.STRUCTIQli�
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads County Roads. Include the road-)
numbers and cOtItion toad names.
v.41t0
4
uJ
n
I4.
HIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
Submit the orEnal to thle Div
FAtI04Phbn4thl4 g1733-
GNATURE OF PERSQ,EJ CONSTRUCTING THE WELL DATE
ion of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
!21, within 30 days. GW-1 REV. 07/2001

266893
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Robert Miller CERTIFICATION a 2675
PHONE # f704) 504-9195
WELL CONTRACTOR COMPANY NAME
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMTT#
(if applicable) (if applicable)
SAEDACCO, Inc.
1. WELL USE (Check Applicable Box): Residential O MunicipalPublic O Industrial ❑ Agricultural ❑
Monitoring El Recovery O Heat Pump Water Injection O Other O If Other, List Use
2. WELL LOCATINi
Nearest Town- . 41t h etrb,CD �o%k' &county
300 /n, atlaotn't eLvb. sel-Av %O
(Street Name, Numbers, Community, Subdivision, Lot
No., Zip Code)
3. OWNER: 1 0em C1? •'7X y # %
Address1310/1'fa 1C-74h1 /3/41170
(Street or Route No.)
;e tne' < XCi
City or Town ta(ee Zip Code
( )-
Area code- Phone number
4. DATE DRILLED /Z19-6-I-
5. TOTAL DEPTH: Li `I'
6. DOES WELL REPLACE EXISTING WELL? YES O NO-0
7. STATIC WATER LEVEL Below Top of Casing: 2.Y FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS a FT. Above Land Surface*
'Top of casing terminated at/or below land so'rface requires a
variance in accordance with 15A NCAC 2C .0118.
9, YIELD (gpm): NA METHOD OF TEST
10. WATER ZONES (depth):
Topographic/Land setting
DRidge Slope OValley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrces/minutes/seconds)
Latitude/longitude source:OGPSOTopographic map
(check box)
DEPTH DRILLING LOG
Fr Ty Formation Description
Yi 3
( -' city.
11. DISINFECTION: Type Amount
12. CASING: Wall Thickness
Depth, r Diameter or, Weight/Ft. Material
To L�(- Ft. .2-"CC{ FIJ
From 0
From To Ft.
From To Ft.
13. GROUT Depth." 'Material �et d
From Q To Ft. rO 140 ! ""/ -
From To Ft.
14. SCRE Depth Diameter Slot Size
From 1-44) To 4144t Ft. i9-2) in. /%O/ in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size
From Is-- To 49' Ft. )4k
`
From To Ft.
16. REMARKS:
Mt al
Material
CIU (Ct.. S'9 Nb
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roadsepyr County Roads. Include the road )
numbers and crtnon road names,S t f1 fit/
7//
i-I1v /o O
a
Ar
f -
Ilk34
6eNf0/i/fe-/ Seat-
ONSTRTIUN DTI,
tiC
-IIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
D T Y (JF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
/✓ 2o-o L
Submit the original to th Divi.
titliribittit,PV4P1 his 733-3
ASHEViLLE RLGION.A OHCE
GNATURE OF PERSON ¶DNSTRUCTING THE WELL DATE
ion of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
21, within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Qual
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Robert Miller
SAEDACCO, Inc.
WELL CONTRACTOR COMPANY NAME
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
266892
y - Groundwater Section
CERTIFICATION # 2675
PHONE # [phone]
1 WELL USE (Check Applicable Box): Residential 0 Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring ® Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCAT
Nearest Town: et 11 CP/i,P_i) c2//t/ stounty '.3 k,2--t:/
3OJ/fs2 CCioI.A7 'VIVO. 9'!'%'t,y IC
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
/1/
3. OWNER: �P.1r7e2. ! Ati'�Rr ..,fit
Address301naucc%m eido, vJN&0%
(Street or Route No.)
„an, edittcct'ii CO/ki it NC.
City or Town State Zip Code
Topographic/Land setting
❑Ridge ❑Slope OValley Flat
(check appropriate box)
Latitude/longitude of well location
(demTecs/minutcs/secunds)
Latitude/longitude source:OGPSOTopographic map
(check box)
DRILLING LOG
Formation Dfscription
DEPTH
From /
, � 1. /4✓ L
Area code- Phone number
4. DATE DRILLED /1." 2.O "O
5. TOTAL DEPTH: a4
•
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO531
7. STATIC WATER LEVEL Below Top of Casing: 2.17 / FT.
(Use '4" if Above Top of Casing)
8. TOP OF CASING IS a 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): N 4, METHOD OF TEST
10. WATER ZONES (depth):
11. DISINFECTION: Type Amount
12. CASING: Wall Thickness
Diameter or Weight/Ft. Material
0 Ft. :'1." SC.c, - O f ✓ (✓
Ft.
Ft.
From.
From
From
13. GROUT'
From C)
From
14. SCREEN:
From
Depth
To 14
To
To
Depth
To /O
To
Depth"
To LS4
Ft.
Ft.
Diameter Slot Size
Ft. ).' in. l7• 0/ in.
Material ethod
io/yt-40* /'a ujf
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth "1 Size Material
s/ C / C 4. .5%4'0
From %vd To LT 4 Ft.
From To Ft. �•�0
16. REMARKS:
CieNin >- Seat- JO' t0 12'
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.
S WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
'/1 T iAT' A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
GNATURE OF P SON CONSTRUCTING THE WELL DATE
Submit the e original to th Divi on of Water Quality, Groundwater Section, 1636 Mail Service Center- Raleigh, NC
Uli
glR,v 43flifIlE4bSFi67(4)f0 733-3 21,within 30 days. GW-1 REV. 07/2001
ASHEVILLE REGIONAL OrfIE

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Robert Miller
SAEDACCO, Inc.
WELL CONTRACTOR COMPANY NAME
STATE WELL CONSTRUCTION PERMIT#
(if applicable)
266891
Division of Water Quality - Groundwater Section
CERTIFICATION # 2675
PHONE # j7041 504-9195
ASSOCIATED WQ PERMIT#
(if applicable)
1. WELL USE (Check Applicable Box): Residential ❑ Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring El Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATE : Qu�PK�
Nearest Town' r /heci''t (COL' County
Ljc "Mai-oatM 13tub. 9.44.0 20
(Street Name, Numbers, Commuunniity. Subdivision, Let No., Zip Code)
3. OWNER: ir;en/ >', Y7bittx aVe./ Cr'1.
Address (Z at ,cL. KKlt'J. f- #tO 70
(Street or Route No.) /
City or Town tat( Zip Code
( )-
Area code- Phone number 7
4. DATE DRILLED //-' L-C3' O
5. TOTAL DEPTH: 173 t
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO Jd'
7. STATIC WATER LEVEL Below Top of Casing:
(Use "1-" if Above Top of Casin cc
8. TOP OF CASING IS 0 FT. Above Land Surface
'Top of casing terminated at/or below'land surface requires a
variance in accordan with 15A NCAC 2C .0118.
g 9. YIELD (pm): /vA METHOD OF TEST
10. WATER ZONES (depth):
1 1. DISINFECTION: Type
12. CASING:
Depth
From V To Ft.
From To Ft.
From To Ft.
13. GROUT: Depth
From To / 9 Ft.
From To Ft.
Amount
Wall Thickness
Diameter or Weight/Ft. Material
1" Sc(,'Ki ?t)C
Topographic/Land setting
❑Ridge ❑Slope ❑Valley )51.F1at
(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
�• / 7W St Lf
1- sq�4L; tC
;tonic-
h
Material Method
"Pa der7-4,0
14. SCREEA�'3N' Depth Diameter
From ✓ To /73 Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size�
From �•-, To 1. Ft. ;/jv From
To Ft.
Slot Size
dt al in.
in.
ial
L7rL/
Material
,S%CtC=t Sql�
16. REMARKS: 2 QeMf'off /DC SeaL lt'jo
ubmit the ' ' r ivisi
27 9ETB3®Yt'tid'�ij -i 7if3-322
ASHEViLLE REGUiv
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the roar(
numbers and Ammon road name' -ice) j�
J
S WELL WAS CONSTRUCTED IN ACCORDANCE WITH l5A NCAC 2C, WELL
D T -'FA OP ( OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
T RE OF PERSON CQ STRUCTING THE WELL DATE
of Water Quality, GroundwateroSection,1636 Mail Service Center - Raleigh, NC
within 30 days. GW-1 REV. 07/2001
-0
fV
O
0

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater uSection
ecti234 i
WELL CONTRACTOR(INDIVIDUAL)NAME (print) WAYNE i.ONG 82CERTIFICATION
324-0035
WELL CONTRACTOR COMPANY NAME HICKORY WELL DRILLING CO. PHONE #( %'
STATE WELL CONSTRUCTION PERMIT# _.sSSOC1ATED WQ PERMIT#
(if applicable) (if applicable)
267011
1. WELL USE (Check Applicable Box): Residential itiX 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: BUR[
Nearest Town: MORGANTON County
E
ZERO MULL ROAD
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
,. vvv ivcS\:
Address PO BOX 856
DORAIPi ri n,
MORGANTON,te NC
28680
City or Town State
(828)- 443-8086
Area code- Phone number 12 -30-02
4. DATE DRILLED
5. TOTAL DEPTH: 185
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: 20 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 2 FT. Above Land Surface*
*Top of casing terminated ator below land surface requires a
' variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 40 METHOD OF TEST BY AIR PEST
10. WATER ZONES (depth):
Topographic/Land setting
Midge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
11. DISINFECTION: Type
12. CASING:
Depth
From 0 To 73
Zip Code
HTH TABS
From To
From To
13. GROUT: Depth
From 0 To 20
From 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.
Diameter
Ft.
Ft.
Ft.
Amount 35
Wall Thickness
PVC ght/FL
16. REMARKS:
Material
Ft. GROUT
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
PAnalI Cnumbers and common road names.
4,3:0 A/
Method
POURED
Slot Size Material
in.
in.
Material
0
0
\in
HE$EI�IV
CER
fi _. IONST
llr
e orrgtttaltthe Di ision of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
1.636PhoheNiol 221, within 30 days.
GW-1 REV. 07/2001
IN ACCORDANCE WITH 15A NCAC 2C, WELL
ORD HAS BEEN PROVIDED TO THE WELL OWNER
01-02-03
THIS WELL WAS CONSTRU a
, AND "l�tTCAA con' OF 4417
s,C(J"/
SIGNATURE OF PERSON CONSTRUi 11NG THE WELL DATE

3. OWNER:
Address
267009
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
CERTIFICATION #
WELL CONTRACTOR (INDIVIDUAL) NAME (print) ��' LCn PHONE it � R7��i5
2343
WELL CONTRACTOR COMPANY NAME HTCK Th' WEI 1 U Tl I ] MT m.
STATE WELL CONSTRUCTION PERMIT/0ASSOCIATED WQ PERMIT#(if applicable)
(if applicable)
I. WELL USE (Check Applicable Box): ResidentialXI Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring ❑ Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: �� PURE —County PUR
146
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
QYIRF.IE HEWN
146 MEADM CCK CT.
TA to 28681
City or Town State Zip Code
( 828)- 495-7128
Area code- Phone numbet „-02
4. DATE DRILLED 1L
5. TOTAL DEPTH: 63
6. DOES WELL REPLACE EXISTING WELL? YESA NO ❑
7. STATIC WATER LEVEL Below Top of Casing: 54 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 gnrn):accordance 1 with 15AMETHOD OF TEST BY AIR TEST
9. YIELD (gpm): 1
10. WATER ZONES (depth):
11. DISINFECTION: Type 1-1II-1 TARS Amount 116
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
Front 0 To 54 Ft. 02 PLASTIC
From To Ft.
From To Ft.
13. GROUT: Depth adrenal20
od
Frond 0 To Ft.
Ft.
Diameter Slot Size Material
in. in.
in. in.
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
From To
14. SCREEN: Depth
From To Ft
From To Ft.
15. SAND/GRAVEL PACK:
Depth Size
From To Ft.
From To Ft.
16. REMARKS:
HERE TSFS' - Sri
RUCTION STANDARDS,'
S9GNA
ubnu t e gxigbiaEfo `<6e'Divlson o
76994136Pb'ut�.
Material
LL WAS CONSTRU
AT A COPY OF
OF PERSON CONSTR'UCIING THE WELL
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.
ACCORDANCE WITH 15ANCAC 2C, WELL
ORD HAS BEEN PROVIDED TO THE WELL OWNER
12-23-02
DATE
Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
bin 30 days. GW-1 REV. 07/2001

266171
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) WAYNE _LONG CERTIFICATION # 7343
WELL CONTRACTOR COMPANY NAME HICKORY WFLL DRILLING CO.
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable)
(if applicable)
PHONE # 67R1374-0035
1. WELL USE (Check Applicable Box): Residential L& ( 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:
RGANTON
Nearest Town:
County BURKE
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: ROY BRREWER TREE FARM
Address 1604 WRS J RRF)WF.R RD.
MO2GAGANT0 ,NNC 28657
City or Town State
(828)- 584-2099
Area coda Phone number
4. DATE DRILLED 12-09-02
5. TOTAL DEPTH: 505
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO ZX
7. STATIC WATER LEVEL Below Top of Casing: 50 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 2 FT. Above Land Surface*
*Top of casing terminated actor below land surface requires a
variance In accordance with ISA NCAC SC .0118.
9. YIELD (gpm): 25 METHOD OF TEST BY AIR TEST
10. WATER ZONES (depth):
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degxe&minuteshecoods)
Latitude/longitude soruce:❑GPS❑Topographic map
(check box)
DRILLING LOQ
Formation Description
DEPTH
From To
11. DISINFECTION: Type
12. CASING:
Depth
0 To 87
From
From To
From To
13. GROUT: Depth
Frorn 0 To 20
Zip Code
Diameter
FL
Ft.
Ft.
Material
Ft. GROUT'
HTH TARS Amount 96
Wall Thickness
or Wet L Material numbers and common road names.
PVC PLASTIC
Method
POURED
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To FL in. in.
FL in. in.
From To
15. SAND/GRAVEL PACK
Depth Size Material
From To Ft.
Front_______To Ft.
16. REMARKS:
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
N
S
riP
Pctittit-
J„N -
•
AS LL -REIGN L
tir
nIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
AND THAT A COPY OF .vat 'CORD HAS BEEN PROVIDED TO THE WELL OWNER
Jjt `. 12-10-02
SIGNATURE OF PERSON C a - CTING THE WELL DATE
e Division of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
L19) 733.3221, within 30 days. GW-1 REV. 07/2001

2. WELL LOCATION:
Nearest Town: LIN County EUI
2243 BEAR Fk1IU BEND
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
PAIL BABBITT
2243 &AR t4AUD/ 111±1)
3. OWNER:
Address
(Street or Route No.)
ttN, NZ 28655
(828Code
jryer437-0635srm Zip
Arca code- Phone number
�
4. DATE DRILLED
205
5. TOTAL DEPTH:
6. DOES WELL REPLACE EXISTING WELL? YES)16 NO ❑
7. STATIC WATER LEVEL Below Top of Casing: 50 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 2 FT. Above Land Surface*
, *Top of cuing terminated at/or below land surface requites a
variance in accordance wills ISA NCAC 2C .0118.
9. YIELD (gpm): / METHOD OF TEST AIR UST
10. WATER ZONES (depth):
11. DISINFECTION: Type 1)IH M3S
12. CASING:
Depth Diameter
From 0 To 53 Ft 6Jt
From To Ft
From To Ft.
13. GROUT: Depth Material
From 0 To 20 FL GUT
Amount 33
Wall Thickness
or Weight/Ft. Material
PVC PLASTIC
Method
FCURED
266141
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
CERTIFICATION It 2343
WELL CONTRACTOR (INDIVIDUAL) NAME (print) �IPHONE # f aiia �4"(��5
WELL CONTRACTOR COMPANY NAME FII(M WFII FRIT ITN; ().
STATE WELL CONSTRUCTION PEANUTS/ ASSOCIATED WQ PERMIT#
(if applicable)
(if applicable)
1. WELL USE (Check Applicable Box)' Residential F Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degteeclminutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
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:
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.
14o
c
0
Oto
u"
CiP,GG — rn
op o?m
T�
`Wlfty
=N RBI 1 rl�N ifilS AND CONSTRU - f4SpCCORDANCE WITH 15A NCAC 2C, WELL
T1 F THI •-- t •, a HAS BEEN PROVIDED TO THE WFII OWNER
er."-- 11-07-02
I JAN — 2 2003 SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to tie Division of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
rt/116319AriR"S�idFl�
s) 733-: 221, within 30 days. GW-1 REV. 07/2001
ASHEVILLE REGIONAL OFFICE

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) ' Liu CERTIFICATION # 2343
WELL CONTRACTOR COMPANY NAME HIt WI MIME co. PHONE # ) 324-O)35
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable)
(if applicable)
266140
1. WELL USE (Check Applicable Box): Residential Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: 7CARi)
County BURL
4314 TAYLCAVE.
(Street Name, Numbers, Community, Subdivision, Lot Na, Zip Code)
3. OWNER: D�N1 GREEFEY
Address FO � 1315
(Street_Route No.)
L _ _2�
City or Town State Zip Code
( 828)- 244-4692
Area code- Phone number
4. DATE DRILLED 11-06-02
5. TOTAL DEPTH: 545
6. DOES WELL REPLACE EXISTING WELL? YESII NO CI7. STATIC WATER LEVEL Below Top of Casing: 50 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 2 FT. Above Land Surface*
*Top of cuing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): 10 METHOD OF TEST AIR TEST
10. WATER ZONES (depth):
11. DISINFECTION: Type
12. CASING:
HIH 'CARS Amount 10;
Depth
From 0 To 88
From To
From To
13. GROUT: Depth
From 0 To 20
From To
14. SCREEN: Depth
From To
From To
15. SAND/GRAVELPACK
Depth
From To Ft
From To Ft.
16. REMARKS:
lE
Wall Thickness
FL • PLASTIC
Ft.
Ft.
Material Method
(, Ft t)r _FIGURED
Ft.
Diameter
Ft. in.
Ft. in.
Size
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:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
LOCATION SICETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
tvY
%AyidS
AVE.
CD N
r1 a
—4
—1
G
JAN - 2 2003
Submit the original to he D
9)73
GROUNDWATER S O
ASF'EVILI_E REGIONAL OFFICE
THIS WELL WAS CONSTR
miDivelgeprepPY OF
SIGNATURE OF PERSON CONSTRUCTING THE WELL
IN ACCORDANCE WITH 15A NCAC 2C, WELL
:ORD HAS BEEN PROVIDED TO THE WFI I OWNER
11-12-02
DATE
ion of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
3221, within 30 days. GW-1 REV. 07/2001

266131
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) WLYNE Tan CERTIFICATS(It�ON # 7 .3
WELL CONTRACTOR COMPANY NAME HTCMRRT
Y 1,7F7 T DI I TIC m A
PHONE # f 82-I 324-0035
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable)
(if applicable)
1. WELL USE (Check Applicable Box): Residential& Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: Miralskinl County ELME
4935 SWARLOW PD.
(Sheet Name, Numbers, Commonly, Subdivision, Lot No., Tip Code)
3. OWNER:
Address 4935 S L RED\F BD.
MUD ERTTI:4IN
aaptf.Noa
28655
City or Town State Zip Code
( 828- 397-7451
Area coda Phone number
4. DATE DRILLED 1t4342
5. TOTAL DEPTH: 283
6. DOES WELL REPLACE EXISTING WELL? YES ENO F0
7. STATIC WATER LEVEL Below Top of Casing: 45
(Use "+^ if Above Top of Casing)
8. TOP OF CASING IS 2 FT. Above Land Surface'
. `Top of cuing terminated at/or blow land surface requires a
variance in accordance pith ISA NCAC 2C .0113. AIR 'MT9. YIELD (gpm): METHOD OF TEST
10. WATER ZONES (depth):
11. DISINFECTION: Type HIIEI TABS Amount 50
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 199 FL Fe CAT V STFFT
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From 0 To 20 Ft. ICUPED
From To FL
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
DEPTH
From To
14. SCREEN: Depth Diameter Slot Size Material
From_ To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK
Depth Size Material
From To Ft.
From To Ft.
in.
in.
16. REMARKS:
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common mad names. o
L7
s n
`= n
` tt r a-
r . / 4/ti
IN Pr rrl
SL Z
5
1
CO
AT THIS WFf I WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
AI)S, AND THAT A COPY iir I S RECORD HAS BEEN PROVIDED TO THE WELL OWNER
11-18-02
JAM - 2 2003 IL.../ SIGNATURE OFPERSOOJ
GR
ASHEO
re-
NSTRUCTING THE WELL DATE
ro the Division of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
e919)133-3221, within 30 days. GW-1 REV. 07/2001

264771
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources --Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) L/J� CERTIFICATION %77
WELL CONTRACTOR COMPANY NAME X k ., i 4 '.Lj £41ZL.1' lik; ..-/ PHONE # fCs/-2/1 / y%/! y90
STATE WELL CONSTRUCTION PERMIT# 4///7 ASSOCIATED WQPERMIT* /L/f%
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential g Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCA ION: //
Nearest Town: ,, �vr County 41,44, Q
(Street Name, 'embers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: ti
Address y///J 7` Pa-exi; raatilic //t„l
(Street or Ro a No.)
7'2d4- ) 44S4 AI' r , .,7 R/.- 5 5
City r Town State Zip Code
Area code- Phone number /
4. DATE DRILLED y//N2-60
5. TOTAL DEPTH: 3 to S
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO is'
7. STATIC WATER LEVEL Below Top of Casing: .' FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / 5 Fr. 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,
10. WATER ZONES (depth): /,/ i / f
11. DISINFECTION: Type Amount // "f
12. CASING: Wall Thickness
or Weight/Ft. Material
Depth/
From_ To G.6
From To
From To
13. GROUT: Depth Material
From 0 To 2 T) FL terize- /
Ft.
Ft.
Ft.
ameter
y
From To Ft.
14. SCREEN: Depth Diameter
From o Ft. in.
T
From / To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size Material
Method
Obi) thy
Slot Size Material
in.
in.
From / To Ft.
From 7 To Ft.
16. REMARKS: :I-) /L<'-w tt U-c-ty
rriDOfnE((£B7"C)~iinn L�� cONS*WTI oN STd13D
J 1
i i 'L L
Lea
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
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
Oi
THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WFT T
AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
13/
SIGNATURE OF PERSON CONSTRUCTING THE WELL
//J 5/0 7--
DATE
Submit the original to the Di4ision of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
221, within 30 days. GW-1 REV. 07/2001
8789946.1 Prh"bdc[l9oik( 19r) 73
0.(23.
aNii t

266175
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
(INDIVIDUAL) NAME (print) la (TX, CERTIFICATION d an_
CO
WELL CONTRACTOR I GO. PHONE # Y"") 4 5
WELL CONTRACTOR COMPANY NAME ('�Q� t
ASSOCIATED WQ PERMIUt
STATE WELL CONSTRUCTION PERMIT/! (if applicable)
(if applicable)
1. WELL USE (Check Applicable Box): Residentiat41 Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: MTICANni
4101 T(AdER MIL BD.
(Street Name. Numbers, Community, Subdivision, Lot No. Zip Code)
3. OWNER: 1I ER MILL
PO
Address 4101
(Street or Rade No.)
KRCAN1n PT' ?WM
City or Town State Zip Code
(328 )- 437-7743
Ana code- Phone ,umber
4. DATE DRILLED 11-26'02
5. TOTAL DEPTH: 125
6. DOES WELL REPLACE EXISTING WELL? YES) NO ❑
7. STATIC WATER LEVEL Below Top of Casing: 8 FT.
(Use "f" if Above Top of Casing)
8. TOP OF CASING IS 2 FT. Above Land Surfaces
• 'Top of using terminated at/or below and surface requires a
vLaccord is
9. YIEIELDD (gpm): 39 METHOD OF TEST BY AIR IP-S1
10. WATER ZONES (depth):
11. DISINFECTION: Type 111:111M8 Amount 25
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From.___ To R1 Ft M' win A ACTH -
Front__ From To FL
From_ To Ft.
13. GROUT: Depth Material
From 0 To 20 Ft. (DUI'
From To Ft
14. SCREEN: Depth F Diatnete in.t. Slot Sizein. Material
From To
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
County BURKE
Topographic/Land setting
[Midge OSlope OValley °Flat
(check appropriate box)
Latitude/longitude of well location
(degweeslrninutesfsemads)
Latitude/longitude source:0GPS0Topographic map
(check box)
DEPTH DRIi LING LOG
From To Formation Description
Method
FaRa)
From To,
16. REMARKS:
Ft
inL,rp
lirailiEttEE1f C 1
r--co sTRUe73eNS:
GROU
ASHE" ILA'
-JAT THIS WELL WAS CONSTRUCTED
S, AND THAT A COPY OF THIS
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.
coP
69
CCORDANCE WITH 15A NCAC 2C, WELL
HAS BEEN PROVIDED TO THE WELL OWNER
12-CT3-02
SIGNATURE OF PERSON CONSTRUCIINGGTHE WELL
DATE
to tli e Division of Water Quality, Groundwater Section, 1636 Mail Service Ceenterl RRaVgh, C
F. [phone], within 30 days.

266174
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
CERTIFICATION it 234+3
WEIR. CONTRACTOR (INDIVIDUAL) NAME (print)WINE 7R 1 �74-00.�
WELL CONTRACTOR COMPANY NAME FIT(1((fN T.JFI' T TR7T T TN: (T) PHONE a S
STATE WELL CONSTRUCTION PERMIT,/ASSOCIATED WQ PERMIT#(if applicable)
(if applicable)
1. WELL USE (Check Applicable Box): Residential XI Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION: H
Nearest Town: C$IN AIPNI E County
UM
5745 TTTICF Rn
(Street Name, Numbers, Community, Subdivision, I.ot No.. Zip Code)
3. OWNER: 1TNATn (RFIATIT,
Address 5245 MAIR [1SE RD.
(Street or Rode No.)
MTXaptijpT, bT: 211,55
City or Town State
(828)- 584-1251
Area code- Phone number 11-18-02
4. DATE DRILLED
5. TOTAL DEPTH: V5
6. DOES WFT T REPLACE EXISTING WELL? YES ❑ NO YX
7. STATIC WATER LEVEL Below Top o��iing:� Fr.
Above Top
8 TOP OF CASING IS 2 FT. Above Land Surface'
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
ziP Code
• 'Top of casing terminated at/or below land surface regains a
variance in accordance with 15A NCAC 2C .011a.
9. YIELD (gpm): 2 METHOD OF TEST BY AIR TEST
10. WATER ZONES (depth):
11. DISINFECTION: Type ELM WS
12. CASING:
Depth ter
From 0 To °- Ft
From To Ft.
From To Ft Method
13. GROUT: Depth Material
From 0 To 20 Ft GRaff ECURED
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From_ To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVELPACK:
Depth Size Material
From To FL
From To Ft.
Amount 64
Wall Thidmess
o light/Ft �Q ria1
[f1Lu �irrl V 641-fi -
� � ow
16. REMARKS:
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.
A/
0
tv
0
0
rV
CJ
rn
rnn
rn
G
SWFIT WAS CONSTRUCTED INACCORBEEEENCPRR VOIDEDTOTHEWE OWNERLL
WELL
THAT A COPY OF THIS
12-d+-02
S IGNATURE OF PERSON CONSTRU
WELL DATE
on of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
221, within 30 days. GW-1 REV. 07/2001

266234
WELL CONSTRUCTION RECORD
North Carolina - Deputmeau of Environment and Natural Resources - DivisionDiof Water Quality - Groundwater Section
LLL L) WcorrreAcroa (nenrvIDUANam (poor° fin e, /L 1 n / P�?� �a. P tor' CATION a ia' c/ 4- 9
war. corn:awn: oe corozarry masa PPICF WELL DQILLING, INC. raornns$2i 327 02E8
STATE WELL CONSTRUCTION PERMIT/ ASSOCtATEW WQ PERMIT/
(if applicable) 417liab1e)
1. WELL USE (Check Applicable Box): Residential VMtmicipal/public 0 Industrial CI 0
Monitoring ❑ Recovery ❑ Hat Pump Water injection ❑ Other 0 If Grits, List Use n`rt,Lc
2. WELL LOCATION: N t Town: .'� a, Cosmty 8-4 r /C e
nl/i ,ts ,,Tic Or,
(Saari Nano, Numbers. Cmmmity. Subdivttioe. Lot No.. Ms Code)
X 3. OWNER: G�FS� o11165t Ask
-1-1111444
Address I (Stow or Roue t{o.).
CODIell_Sp %, NFL, , ?/,-
OzyarTown I Stag Zip Code
Ara coda Thom menbe l
4. DATE DRILLED I O d(� U d
5. TOTAL DEPTH: dun)
6. DOES WELL REPLACE EXISTING WELL? YES ErNO ❑
7. STATIC WATER LEVEL Below Top of Casing: {O FT.
(Use •' if Above Top of easake)
S. TOP OF CASING IS � // FT. Above Land Surface*
'Top of acag tenuiaaete /for below Load Barbet requires s
ndaace la reardaace with ISA NCAC 2C.OI IL
o Wan (gpm): 5 METRCD OF TEST es r .6/eh
10. WATER ZONES (depth): I K J ". ) S 9 f M
11. DISINFECTION: Type 12/ /3i75 Amount /9da ice`
12. CASING: Wall Thickness
Depth Weiner/Pt. Material
From _a_ To 6 ( Ft. Meter 7i L (f rk
From_ To Ft.
Froth To Ft
13, GROUT: Depth Material
From d To • 2_ Ft. (onCk7ie P Li d
From To Ft.
14. SCREEN: Depth Diameter Slot Sim Matariai
From To FL . bL _ in.
Fmm To Ft in, in.
15. SAND/GRAVEL PACK
Depth Sin ?Astoria]
Front__To Ft.
From To Ft.
Topogiwhic/Land setting
❑Ridge Itetlope OVallcy ❑Flat
(cluck appmpris a box)
Luituddloogiotde of well location
(drgnevreausWsoccedr)
Latitude/longitude sourcrDGPSOTopogxaphic map
(cheek box)
DIM DRILLING LOG
F o � q Formation Description
d/.4
�(u 13e) hard J,/.,e ran,te
' 0 1 Sill pt, y1 r Af FGJc- lG
Ic/O 60 (,rc1 6/uc
LOCATION SKEIC$
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
frt. iliYan
90 :II WV EZ 330 Z0
16. REMARKS:
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A?CAC 2C, WELL
CONSTRUCTION st94DARDS, AND THAT A COPY OP THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
J.,,RE suuvtheart-Omen° the
li ie99-ls6-Moe No. (919)
J uI' .kid
,
i
S TURE OF PERSON CONSTRUCTING THE WELL DATE
a of Water Quality, Groundwater Section,1634 Man Service Cater -Raleigh, NC
1, within 30 days. GW-1 REV. 07/2001
OFTM,HISS,1ER SECTION
ASFF` L Ri:GIONAL OFFICE

X 3. OWNER
266233
WELL CONSTRUCTION RECORD
dNorth Carolina - Department of Envimmnent and N ResoDaees - Division of Water Quality • Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) lot .I CI In Teti, t-t E CEXTIPICpATIONt /.S `7
WELL coNTRACTORcOMrANY?LAME PRICF WELL Dp±LLIPi3, INC. PRONE S L'2$ 327 ,)26.2.
STATE WELL CONSTRUCTION PERMIT$ ASSOCIATED wQ PEDANT,
Cif Wvlicable)
(if applicable)
1. WELL USE (Check Applicable Box): Residential 12/Mvaicipal/7ublic 0 Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection 0 Other ❑ If Other, List Use PH s T e
2. WELL LOCATION:
Nemest Town: /- n Yl Cnmty Jul r I L L
Jll•'15 Pe, r, rP
(Senn Name, Numbers, Cetwmity. SubdNisiicc.to No., %p Code)
Address LQciI(.` rti PIE/a 6717 /
(Gilhal%F(°Ai a No) aitr)
Gty or Town
Sam Lp Cede
Ater cods- Moe number
4. DATE DRILLED i d - y -0 A
5. TOTAL DEPTH: ), 0 o
6. DOES WELL REPLACE EXISTING WELL? YES 67 NO Cl
7. STATIC WATER. LEVEL Below Top of Casing: 6,0 FT.
(Use `a` if Above Top of Casing)
8. TOP OF CASING IS / �� FT. Above Land Surface'
`Ter of atlag terminated rake below load surface requires e
esthete is aecordoa wMD ISA NCAC 2C.0110.
9 Yr_ fan (gpm): / 5 r.ZETHCD OF TEST ci ' r �ow
10. WATER ZONES (depth): I59pnn h0
11. DISINFECTION: Type 'IL 6Ie4-S Amount
12. CASING: Wan Thickness
or Waght/Ft. Manorial
FrorrtU To_5 3 Ft. Direr y V C• 4 r i-
From__ To Ft
From To Ft
13. GROUT: Depth Matexiai Method
From 0 To c{ Ft (HOC; eke pock V-
From To Ft
14. SCREEN: Depth Diameter Slot Size Material
From To Fader. _ in.
From To Ft in.
15. SAND/GRAVEL PACK
Depth size Material
Fcm�_To Ft.
From To Ft.
16. REMARKS:
.-Topographic/Land setting
°Ridge ❑Slope DValley ❑Flat
(check mom/mime box)
Latitude/longitude of well location
(drpemgnidrsasecaaat)
Latitude/tongitode source:❑GPS❑Topographic map
(chock box)
DEPT14 pit !LUNG I.(x)
From jg F : adonrt Description
3 I S 4 VI 41, e
rA h;.r.J E1,e
LOCATION SKETCH
Sbow direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA ?CAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OP THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
flo
gl 7�d_ y-dam
SIGMA OF PERSON CONSTRUCTING THE WELL DATE
1
[aster eriId Q
27690-1636 Phone No. (9
LAN
n of Water Quality, Groundwater Scotia', 1636 Man Semite Cam - Raleigh, NC
El, within 30 days. GW-1 REV. 07/2001
O
PO
Trl
c-)
CO
w
GHCIUCLC,CIA FG SECTION
ASIIEVILLL 9fFICE

266232
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resacees - Division of Water Quality - Groundwater Section /1
WELL CONrttACrOR (Ili➢LVIDUAL) NAME (pries) j Crh k I , ✓l (P t, Ur F' cnTwIcAnoN s c
WEu coNTaACTOa coaa7ANT NAME PRICF WELL DQILLIFt3, INC. raoNE 412 327 ()262
STATE WELL CONSTRUCTION PERMIT! ASSOCIATED WQ PE&aare
'fattelicable if ieable
1. WELL USE (Check Applicable Box): Residential cr Municipal/Public 0 Industrial CI Agicutnaal LI
Monitoring 0 Recovery 0 Heat Pump Water Injection ° Other 0 If Other, List Use • dct -lr"
2. WELL LOCATION:
N nest Town: / c) cr+ry -1 u n County (T k / c 1 G-E.
(Stint Name. Numbers. Comm* mStdaRvsiaco. Lot No., Lp Code)
X3. OWNER: AAA U'SJ
Address (o^F7S 1Zo\\;nS VK ZY
(sant or Rase No.)
can J Ve, c:$(ol-
(2W a - V$7sa u, sir ie3i
Ater coda?b ra mmtbar
4. DATE DRILLED I 0 - II —D d
5. TOTAL DEPTH: '3ao �
6. DOES WELL REPLACE EXISTING WELL? YES 12'NO 0
7. STATIC WATER. LEVEL Below Top of Casing: 6 6 FT.
(use so" if Mine Top dealing)
B. TOP OF CASING IS / //2 FT. Above Land Surface'
nap of easing in,ulaared attar below Mad sorbet requires a
variant h ucordun wit% ISA NCAC 2C MIL
o Y! IP (gpm):. 9 ME'RICD OF TEST (t - h
10. WATER ZONES (depth): )1 t) -- 9 9 p
11. DISINFECTION: Type T s L12fs
12. CASING:
Depth Diameter
Frond To 16i) Ft 6 `I r
From______ To Ft
From To Ft
13. GROUT
Front (1 To Ft.
From To Ft
14. SCREEN: Depth Dinneen Slot Sim
From To Ft.
From To Ft in. _ in.
15. SAND/GRAVEL PACK
Depth Size Material
Frmo__To Ft.
From To Ft.
Amount
Wall Thickness
a Wdght/Et
purr ri
viala0( method
-IP post 1^
16. REMARKS:
Material
'Topographic/Land setting
Midge °Slope °Valley °Flat
(cbedt appropriate box)
Latitu4e4aogftude of well location
oargrearnumeaseaecceen
Latitude/longitude source: °GPS°Topographic map
(tbedr box)
DE= DRILLING LOG
From To F tion Description
l .-2U r f
10d 2, v o Sofa AI,Ae
pri II;LJ tre,=n
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road Dames.
G
teKn
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
CONSTRUCTION NN STANDARDS AND AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
`2-1 SIGMA F PERSON CONSTRUCTING THE WELL { DATE
i� rtv_ CC , \,'j I:'
it S1Wmtf a originrL'
27699-1636 Phom No.
L
q
3
O
(A
vision of Water Quality, Groundwater Section,1634 Mall Senlee Coale - Rald=a, NC
221, within 30 days. GW-1 REV. 07/2001
GRGUILDV'IAIER SECTION
ASHEVILLE HESEWH IAL OFFICE

266228
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (IND1VIDUAL) NAME (pant) Sc owe l ()win, ctvrJ l-oscarrIPlcwnoN s 3000
WELL coNaRAcroaCOMPANY NAME PPICF WELL DPILLIN3, INC. PRcest e2 327 0268
STATE WELL CONSTRUCTION PERMIT'/ ASSOCIATED WQ PERMIT#
Cif applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ft. Municipal/Public 0 Industrial ❑ Agricultural 0
Monitoring O Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATIO : Q /{
N tToww ir�t?11O11 Cormh ur!�e
ti reci 1 -n Pq.
(Sweet Numbers. Community. Subdivision. Lot No., Zip Code)
3. OWNER: /I vh
Address / bS-( IJry f'Cinek. Qd
{Sass a RoZ No.)
Gitl�� lu1L-' N-r. ag%3o
ODmty or 72 --- Stara
n wader
oZlp Code
Area ,ode- PawmaL
4. DATE DRILLED kJ' /d'O ).,
5. TOTAL DEPTH: / a 3 V J
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO Ip 6 D O 600
7. STATIC WATER LEVEL. Below Top of Casing: 1/0n FT. 6490 / p OF,
l . (uu•.'ifAbove Top ofGoing) / OfJ //pp
S. TOP OF CASING IS / b- Fr. Above Land Surface* /3�0 . / 2 O
`Top or man terminated anon below land ,.site requires a
mince h stxerduce Mite ISA NCAC 2C .0r IL
9. YIELD (gpm): 2 METHOD OF TEST/4 i r Di c w r1
• 10. WATER ZONES (depth):
Topographic/Land setting
�ge OSlope Malley OFlat
(check appropriate box)
Latitude/longitude of well location
11. DISINFECTION: Type Sens*hire
12. CASING: G.0 naA�
Depth
From 0 T 2 7 FL
Fromm_ To FL
From To
13. GROUT; Depth
Front_ o To r20
From To
14. SCREEN: Depth
From To
From To
15. SAND/GRAVEL PACK
Depth
From To
Front To
16. REMARKS:
Latitude/longitude source: OGPSOTopographic map
(cheek box)
DEM DRILLING LOG
From To Forma o¢ IkscriDiion
0 2.7 i-KO -jC
00
� ra.
G ram I
0rgttrIC
ryaeira
y;Lc
&tan .'tC
LOCATION SICETCI{
Amount Show direction and distance in miles from at least
rya( Thickness L > two State Roads or County Roads. Include the road
or ei lot/ L 1.Jpterial numbers and common road names.
qic pc
FL
Material
FL Cc:rc
FL
Diameter Slot Sim Material
in.
Ft n. in.
Size Material
Ft.
Ft.
-cfo Ex; / /Cr
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, n� THAT COPY OFa THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
�C J ct,..N-e�zCa 7` Y!✓IW Li / /O /U 'Q
DATE
GROUNDWATER SEO A
ASHEViLLE RE3DOITAL OF -OE
SIGNATURE OF PERSON CONSTRUCTING THE WELL
vision of Water Quality, Groundwater Section, 1636 Man Service Center - Raleigh, NC
3-3221, within 30 days, GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
263492
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) WAYNF T(N CERTIFICATION it 2343
IIICKY/ WIT IPIIIJN OD.
WELL CONTRACTOR COMPANY NAME
STATE WELL. CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
PHONE # 028) 324-M35
1. WELL USE (Check Applicable Box): Residential& Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: M RGANDI
7115 GREEN -AWN EUJRF
County PLWE
(Street Name, Numbers, Community, Subdivision, Lot No, Tip Code)
3, OWNER: 10EERT GLAL
Address 7115 (MAVEN GMT
want Nate Route ND.)
t IC
29655
City or Town State Zip Code
( 828)- 438 -8483
Ara code- Phone number 10 22 02
4. DATE DRILLED
5. TOTAL DEPTH: 425
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO&
7. STATIC WATER LEVEL Below Top of Casing: 80 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. Ali 1T�1
9. YIELD (gpm): 7 METHOD OF TEST
10. WATER ZONES (depth):
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 ARILLING LOG
From To Formation Description
11. DISINFECTION: Type EIIH TABS Amount 72
12. CASING: Wall Thickness
Depth Diameter or Weigbt/Ft Material
From 0 To 1()() Ft EYt FS/r. PEAS I-C.
From To Ft.
From To Ft.
13. GROUT: Depth Material
From 0 To 20 Ft CUUT
From To
14. SCREEN: Depth
From To Ft.
From To Ft.
15. SAND/GRAVEL PACK:
From DepthTo Ft.
From To Ft.
Method
WIRED
Ft.
Diameter Slot Size Material
in. ln.
in. in.
Size Material
16. REMARKS:
LOCATION SKETCH n
Show direction and distance in miles from ate'least
two State Roads or County Roads. Include the'oad
numbers and common road names.
MOf2GAMI72 d N
H6ey.,8
g$tl0/2
W �d HAgFa(�. EC
G oor
c!(-
(r/vhW
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN
S AND THAT A COPY OF THIS RE
re-
CCORDANCE WITH 15A NCAC 2C, WELL
HAS BEEN PROVIDED TO THE WELL OWNER
10-22-02
ATURE OF PERSON CONSTR r ` THE WELL DATE
ubrrili the original to the D inn of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001
GROUNDWATER SECTION
ASHEVILLE REGIONAL OFFICE

263490
D
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) WVYtNE I CNC CERTIFICATION # 23/+3
WELL. CONTRACTOR COMPANY NAME HIQ %ELL EMILTI M. PHONE # 828) 374-m35
STATE WELL CONSTRUCTION PERMIT# _ASSOCIATED WQ PERMITS
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential NiC Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring ❑ Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION: �JRKE
Nearest Town: K RGANILN County
1LW 18 SXJIH
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: B.F. MUM(
Address IO BCK 1243
(Street or Route No.)
HICKEY NC
7O3
( City y1r Z„57 State Zip Code
828Area code- Phone number
4. DATE DRILLED 10-08-02
5. TOTAL DEPTH: 305
6. DOES WELL REPLACE EXISTING WELL? YESIX NO 0
7. STATIC WATER LEVEL Below Top of Casing 2 FT.
(Use '4^ if Above Top of Casing)
8. TOP OF CASING IS 2 FT. Above Land Surface*
`Top of cuing terminated at/or below land surface requires a
• variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 3 METHOD OF TEST BY AIR 11SI
10. WATER ZONES (depth):
11. DISINFECTION: Type MR TARS Amount 64
12. CASING: Wall Thiclmess
Depth Diameter or Weight/Ft Material
From 0 To 77 Ft. 6 t G4137' SILL
From To FL
From To FL
13. GROUT: Depth Material Method
From O To 7n Ft. MITT 1CIFFD
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From_ To Ft. in. in.
15. SAND/GRAVELPACK:
Depth Size Material
From To FL
From To Ft.
t6r„R M '
L= 9 ILH '
i.E rno ri7cs
CONSTRUCTION ST
Topographic/Land setting
❑Ridge ❑Slope ['Valley ❑Flat
(cheek appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(cheek box)
DEPTH PRILLING LOG
From To Formation Description
LOCATION SKETCH o
Show direction and distance in miles from at _{east
two State Roads or County Roads. Include thesoad
numbers and common road names. _=
N
tho
//Lt 7
S
ki taw
THIS WELL
[jW��ASSCONSTRUCTE s ; ACCORDANCE WITH 15A NCAC 2C, WELL
S, AND O 6�y / OF ' .i •
RD HAS BEEN PROVIDED TO THE WELL OWNER
10-15-02
SIGNATURE OF PERSON CONS CTING THE WELL DATE
GF��ip�the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
ASNE �v'Ai .� �1b, +r 3221, within 30 days. GW-1 REV. 07/2001
JJ

263489
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) WE Iaz CERTIFICATION 112T1.3
WELL CONTRACTOR COMPANY NAME HIIGKCEY ISHL EIRRU '' CD' PHONE # tQ"28) 324-0335
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential IT 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:
Nearest Town: ICARD County BURKE
Fff7 FRVTN IRTVE
(Street Name. Numbers, Community, Subdivision, Lot No., hip Code)
3. OWNER: gQ IEIH & BEAIRIC PERCY
Address PCO7 ]ZWIN_(Street or IIRTVF.
Route
ISPKII`M, IY CNo.) 2RF,17
�jj�j�r
City or Town State Zip Code
(g A 1- 397-5958
Area code- Phone number
4. DATE DRILLED 10-11-02
5. TOTAL DEPTH: 205
6. DOES WELL REPLACE EXISTING WFII? YESZ NO ❑
7. STATIC WATER LEVEL Below Top of Casing: 60 ET.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 2 ET. Above Land Surface*
`Top of casing terminated at/or below land surface requires a
variance In accordance with ISA NCAC 2C .a118.
9. YIELD (gpm): 20 METHOD OF TEST BY AIR IESI
10. WATER ZONES (depth):
Topographic/Land setting
❑Ridge 0Slope [Walley DFlat
(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
11. DISINFECTION: Type hth tabs Amount 33
12. CASING:
Depth
From 0 To 95
From_ To
From To
13. GROUT: Depth
From 0 To 20
Wall Thickness
ter
Ft 1
ne
Ft.
Ft.
Material
FLGRCUC
From To Ft.
14. SCREEN: Depth Diameter
From To Ft.
From To Ft.
15. SAND/GRAVEL PACK
Depth
From To
or Weight/Ft. Material
Slot Size
in. in.
in. in.
Size
Ft
Material
Method
FCURED
Material
From To Ft.
DO HEREBY CERTIFY
:ONSTRUCTION STAND
yr
GROUNDWATER SECTION
r• ' ion of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001
.J
�•J
LOCATION SKETCH -
Show direction and distance in miles from alleast
two State Roads or County Roads. Include the -road
numbers and common road names.
IS WELL WAS CONSTRIJ •—a IN ACCORDANCE WITH 15A NCAC 2C, WELL
dCOPY 0 1 ORD HAS BEEN PROVIDED TO THE WFf r OWNER
10-L5-02
GNATURE OF PERSON CO TRUCTING THE WELL DATE

263488
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) LGE CERTIFICATION", 2%3
WELL CONTRACTOR COMPANY NAME IIT(41I2Y VII TRTII BC CO. PHONE 1,
STATE WELL CONSTRUCTION PERMIT", ASSOCIATED WQ PERMIT',
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential la Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: VALLEE
(If) T(ITNN ST.
(Street Name, Numbers, Community. Subdivision, Lot No.. Tip Code)
3. OWNER- (XR(XIS CTTL
Address wit) (%I) TQrj4>rf Sf.
(Street or Rome No.)
�
VAL➢ESE IC
City or town State Zip Code
( R7R)- R74-7698
Arta code- Phone number
4. DATE DRILLED 10-21-02
5. TOTAL DEPTH: ZOO
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: 60 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 2 FT. Above Land Surface'
. `Top of casing terminated atlor below land surface requires •
variance in accordance with ISA NCAC 2C .011t
9. YIELD (gpm): 40 METHOD OF TEST AIIR MST
10. WATER ZONES (depth):
11. DISINFECTION: Type HIE 1Affi Amount 29
12. CASING: Wall Thiess
Depth Diameter or Weight/Ft Material
From 0 To 88 Ft 6yt F C PI Agile,
From To Ft
From To Ft
13. GROUT: Depth Material Method
FCIEED
From— Top Ft. (>TJL'
From 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.
County 1
URKE
Topographic/Land setting
°Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrxs/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
Slot Size Material
in.
in.
Material
16. REMARKS.
LOCATION SKETCH
Show direction and distance in riles from afFeast -
two State Roads or County Roads. Include theroad
numbers and common road names.
40
'3
w
%- L.0
ar—______I oto L6
J
f,
C
ON STAND
IS WELL WAS CONSTRUCTED
AND THAT A COPY OF THIS
LGNATURE OF PERSON CONSTR
CCORDANCE WITH 15A NCAC 2C, WELL
HAS BEEN PROVIDED TO THE WFI I OWNER
10-22-02
THE WELL DATE
ion of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
21, within 30 days. GW-1 REV. 07/2001

263487
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) GIAYIVE CERTIFICATION # 2143
WELL CONTRACTOR COMPANY NAME warm/ 1J4T TRH T TM; M. PRONE # R?R1 324-0Q5
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WFI I LOCATION:
Nearest Town: I1?NICN County BURKE
1633 HEMERSCN MTI l . RD.
(Street Name. Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: RRLUE 1E'
Address 1633 HEtFI911 MIL RD.
(Street or Route No.)
M CANWN a:2E655
City or Town State tip Code
09R )- 437-1991
Arca code- Phone lumbero-.t n
4. DATE DRILLED
lerui
5. TOTAL DEPTH: 565
6. DOES WELL REPLACE EXISTING WELL? YES ENO 0
7. STATIC WATER LEVEL Below Top of Casing: 7 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 15A NCAC 2C .01111.
9. YIELD (gpm): -4 METHOD OF TEST AIR TEST
10. WATER ZONES (depth):
11. DISINFECTION: Type HIP TARS Amount 5
12. CASING: Wall Thickness
Depth Dim. car eighi/Ft PC
From 0 To 38 FL a FVC
From To Et
From To Ft
13. GROUT: Depth
From To 2D
C 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
From To Ft
From To Ft.
Ca' Felled
Topographic/Land setting
[Midge ❑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
Size Material
16. REMARKS:
Scat
LOCATION SICETCH
Show direction and distance in miles from eldest ,
two State Roads or County Roads. Include the -road
numbers and common road names.
u
4 tor
F
S
0
S WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
THAT A COPY OF THIS R$CC) D HAS BEEN PROVIDED TO THE WET OWNER
10-22-02
en-
GNATURE OF PERSON CONS
THE WELL DATE
ivisi Ia of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
,33-32. 1, within 30 days. GW-1 REV. 07/2001

263382
WELL CONSTRUCTION RECORD
North Carolina — Department of Environment And Natural Resources — Division of Water Quality — Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) ROBIN MCNEELY CERTIFICATION # 2567
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT # _ ASSOCIATED WQ PERMIT #
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ® Municipal/Public 0 Industrial 0 Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: HICKORY
HONEYSUCKLE DR.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: RICK UNDERWOOD
Address HONEYSUCKLE DIL
(Street or Route No.)
HICKORY NC 28602
City or Town State Zip Code
(252) — 478-4633
Area Code Phone number
4. DATE DRILLED 10/23/02
5. TOTAL DEPTH: 54
6. DOES WELL REPLACE EXISTING WELL? YES ® NO 0
7. STATIC WATER LEVEL Below Top of Casing: 36 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 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): 18 METHOD OF TEST STEEL TAPE
10. WATER ZONES (depth):
County BURKE
11. DISINFECTION: Type CHLORYTE Amount 8.28
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 54_ Ft. 24" CEMENT
Ft.
Ft. _
Material Method
Ft CEMENT POURED
Ft.
Diameter Slot Size Material
From To
From To
13. GROUT: Depth
From 0 To 20
From _ To
14.SCREEN: Depth
From To Ft. _
From To Ft.
15. SAND/GRAVEL PACK:
Depth Size
From 36 To 54 Ft. 78M
From To Ft.
in. _ in.
in.
Material
GRAVEL
Topographic/Land setting
0 Ridge 0 Slope 0 Valley ❑ Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source: 0 GPS ❑ Topographic map
(check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
HWY. #18 N. FROM FALLSTON. RIGHT ON
GEORGE HILDEBRAN SCHOOL RD. GO APPROX.
3 MILES AND TURN RIGHT ON WILKES GROVE
CH. RD. GO APPROX. 1 MILE AND T`UlIN RIGHT
ON HONEYSUCKLE DR. 1ST DRIVE:ON RIGHT.
0
w
16. REMARKS:
I DO HEREBY CERTIFY THAT 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
lU-cd 2-6
si.
AS'HEViLLE REGIONAL OFFICE
GROLA
OF P�15O/Y CONSTRU� WELL DATE
n of Water Quality, Groundwater Section, 1636 Mail Service Center — Raleigh, NC
3221, within 30 days. GW-1 REV. 07/2001

266212
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section /
WELL CONTRACTOR (INDIVIDUAL) NAME (prim) fret el .7(--I. ✓� ft„) P CERTIFICATION a R977
WELLcoNTRAcroa COMPANY NAME PRICF WELL DRILLING, INC Paor,i n$2i 327 26Q
STATE WELL CONSTRUCTION PERMIT. ASSOCIATED WQ PERMII.
Cif applicable) Of applicable)
1. WELL USE (Check Applicable Box): Residential id Mtmicipal/Pablic 0 Industrial O Agricultural 0
Monitoring 0 Recovery 0 Heat Rump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
N tLown: /s n r. County iLCLL
(sheet Name. Numbers. Casimir, Subdlvisice. Lot No., Yip Code))
bf u 3. OWNER;,. 807 L/ �% ,- t�f
- 1 Address to , n'`r�1/ i t' `/j�aj Rf
/4-,^c__:{{)) y �r ✓�'f G' ." JU E ---E 6
stydToivy•StyeL� _ Zip Code
Aim code. Thaw number
4. DATE DRILLED «r�6f i 6 - G a
5. TOTAL DEPTH: fl
6. DOES WELL REPLACE EXISTING WELL? YES 0 N0 0
7. STATIC WATER LEVEL Below Top of Casing:
(Use`s• if Above Top afCasa )
8. TOP OF CASING IS 1 FT. Above Land Surface*
'Top of swag termfaared Woe below lead .wbce reclaims s
variance la scandium Mob 15ANCAC 2C.01IR J /
9. YIELD (gpm):. le re METHOD OF TEST et -IF /7! d Les')
• 10. WATER ZONES (depth): }'i Cry pM
11. DISINFECTION: Type- ka14 /4k Amount 6--C
12. CASING: WallThickness /
Depth Djamster or Weight/Ft. Material
From To _D C Ft 4.? C•'r ")
Front._... To Ft
From To Ft
13, GROUT: , Dt' Matnial Method
From ' % To Ft CCa1+)a.1,y ,/Y& W /-
From To Ft
14. SCREEN: Depth Diameter Slot Sim Material
From To in.
From To FL in. in.
15. SAND/GRAVEL PACK
Depth Size Material
Fmm To Ft.
From To Ft.
/ropographic/Land setting
Qft,dge OSlope °Valley ❑Flat
(cheek a-pr-Poi-e box)
Latitude/longitude of well location
(dememnaitwnlaecaada)
Latitude/longitude source:OGPSOTopographic map
(check box)
DEM DRILLING LOG
From To Formation Description
0 15 d: r
7 ; iuC'
I$-O dad
0
,'a
cn
tV
Ca)
3
LOCATION SKEICF( G7
Show direction and distance in miles from at leasto
two State Roads or County Roads. Include the road
numbers and connn road names.
(C�
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STAI�IPARD3, AJND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
Cie Le`G at-
IGNAFIRE OF PERSON CONSTRUCTING THE WELL PATE
n of Water Quality, Groundwater Section, lee Mall Service Center - Raleigh, NC
221, within 30 days. GW-1 REV. 07/2001
I L, N - 201)
GROUNLAVAfFR SECTION
ASHEVILLE RISIGNAL OFFICE

260534
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR(INDIVIDUAL) NAME (print) ASHLEY T. MORETZ CERTIFICATION # 2586
WELL CONTRACTOR COMPANY NAME MORETZ WELL DRILLING PHONE x (704)4 6 2 -132 2
STATE WELL CONSTRUCTION PERMIT ASSOCIATED WQ PERMrt
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential V unicipal/Public ❑, . Industrial ❑ Agricultural 0
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:/. opographic/Land setting
Nearest Town: %1►D f t� of % to County_ af a-idge ❑Slope Malley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(Sheet Name, Numbers, Community. Subdivision, Lot No., Zip Code)
3. OWNER: 5f,�, 4-1- e-c e
Address gyce pe-rSlMnon- A
// het or Route No.)
n�6 Sfrrn3s • A/C- ,Rg6/a
rty or Thom Seto Zip Code
Area cede- Phone number
4. DATE DRILLED T % 7-0 oZ
5. TOTAL DEPTH' 3 tin � �
6. DOES WELL REPLACE EXISTING WELL? YES �'NO 0
7. STATIC WATER LEVEL Below Top of Casing: - Q FT
(Use "V' if Above Top of Casing)
8. TOP OF CASING IS � PT. Above Land Surfaces
*Top of casing terminated actor below land surface requires a
variance In ■000rd Rh i5A NCAC 2C .0118. �� dA
9. YIELD (gpm): METHOD OF T,ES'P', l r
10, WATER ZONES (depth): 300— 3 O'
11. DISINFECTION: Type _ ,_ Amount 51' O Z
12. CASING: Wall Thickness
Depth Diameter or WeiNFt. Ma,(erial
From To a Ft t2 SD -
From To Ft. -.
From To Ft.
13. GROUT. Dcp Material Method -/
Fro To Ft. a/Mi ? zn. reCl
FroIIIIm_ To Ft.
14, SCREEN: Depth Diameter Slot Size
From To Ft. in. in
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size
From To
From To
Ft
Ft.
Material
Material
(degrees/minutes/seconds)
Latitude/longitude source:❑OPSDTopogmphic map
(check box)
DEPTH DRILLING LOG
From To t Formation Descrigtign
fP - lc) Al/
39a1
):f
JOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
frcti;rnr. Rd_
N
J
3
16. REMARKS:
r
-
7 2002
a
Er lb -NATURE
WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
T A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
PERSON CONSTRUCTING' HE WELL
9
DATE
Submit the original to th Divisron of Water Quality, Groundwater Section, 1636 Mall Service Center -Raleigh, NC
33-3221, within 30 days. GW-1 REV. 07/2001
ASHEVILLE REGIONAL OFFICE
7d WU6S:90 E00i? 9E 'daS
ZZ£SZ97170L : 'ON XUd
dWfd 8 11311 Z192i0W : WOdA

U4/U4i-U__ ..a: Ji 7i7-/i7-U�L'3
tF' L,J.".L h'GU[. tti; U1
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources/ - Division of Water Quality - Groundwater Section
WELL cOrrrEACTOR (INDIVIDUAL) NAME (print) Y tel n k /- k. �Cc (et P CflLIYIunoN a O� l 3/
vent coNTRACIon coronary mots PRICF WELL DRILL IN3, INC. 227 0L62
Padres a � Si
STATE WELL CONSTRUCTION PERIQIp I neOCIATEn WQ PERMIT/
Gf appliable)
1. WELL USE (Check Applicable Box): Residential 17 Municipal/Public 0 Industrial 0 Agricultural O
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
cif applicable)
2. WELL LOCATION:
Nearest Town:
(Sneer N•me. Nw
. OWNER: T
Address d
CoNtie t . Sims
ec $ own Sme
Ana axle- Thom sunless
4. DATE DRILLED t (D3
5. TOTAL DEPTH: / S
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 2
7. STATIC WATER LEVEL Below Top of Casing. Q&U FT.
/ (Vse`+" if above Top of Quinn)
8. TOP OF CASING IS 1 / i FT. Above Land Surfaces
'Top or easing tenanted Woe below Ind saefaee require •
cornice IN aemrduce with ISA NCAC 2C .0111.
9. YIELD Ceram):I . OD OF TEST ea; r b /Bea -en
10. WATER ZONES (depth): 1/5 9i4M lrO
an or No.)
Zip Cede
11. DISINFECTION: Type o. r-
12. CASING:
From (') To T nit
t
Depth
From___ To Ft
From To Ft
261075
/I'opographic/Land setting
midge OSlope OValley Urlat
(cbakappmpueee box)
Latitudelloagitude of well location
ocuremAnaueei/sxmetr)
Latitude/longitode somce:OGPSOTopographic map
(check box)
DRILLING LOG
From .`o Remotion Description
0d r
: S 1/SD hetr,.I -4- 5, Lj
AIne- 'rem. a-CM•,,ems
OnN
LOCATION SKETCH
Amount untun( Sbow direction and distance in miles from at least
Wall Thickness two State Roads or County Roads. Include
or Weight/ft. Malang numbers and common road
_d_L r
13. GROUT: Depth Material /Method
'
From�To�Ft CP t�PKr
From To FL
14. SCREEN: Depth Diameter Slot Size
From_ To Ft in. _ in.
From To Ft._i in.
15. SAND/GRAVEL PACK:
Depth Size Materiel
From_To Ft.
FYom To Ft.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS
CONS1: rs•. -,.0
it tlin original to ' f'
1636 Phooe No. (9 ) 73
GROUNDWATER SECTION
ASHEVILLE REGIONAL OFFICE
WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
A COPY 0 : t S RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSO
ONSTRUCITNG THE MIL DATE
n of Water Quality, Groundwater Section, 1634 Mall Service Carter - Raleigh, NC
221, within 30 days. GW-1 REV. 07/2001
0

261393
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) LIAYNE TSN} CERTIFICATION # 2343
WELL CONTRACTOR COMPANY NAME F-1VWRY VT T DRIL 1M CD. PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT/4
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residentialfl Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION: EIJRER
Nearest Town:IGeNK1N County
E
4M8 .ST I VFR (RFFR (TBfl-T I$1
(Street Name, Numbers, Community, Subdivision, Lot No, Zip Code)
3. OWNER DdIG-If REFRS
Address /ddi$ SILVER CREEK CHURCH RD.
(Street or Route No.) 2?'655
City
State Zip Code
(828 )- 584-3551
Area code- Phone number
4. DATE DRILLED 09-2
5. TOTAL DEPTH: 305
6. DOES WELL REPLACE EXISTING WELL? YES&( NO ❑
7. STATIC WATER LEVEL Below Top of Casing: 83 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 15A NCAC 2C .0118.
9. YIELD (gpm): 10 METHOD OF TEST BY AIR TEST
10. WATER ZONES (depth):
Topographic/Land setting
❑Ridge ❑Slope (]Valley ❑Fiat
(check appropriate box)
Latitude/longitude of well location
(dcgreeslmiuutes/scconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
11. DISINFECTION: Type HMI TARS Amount 47
12. CASING: WallTbickness
Depth ter or Weight/Ft.
From 0 To 20 Ft. r'"G INC
From To FL
From To Ft.
13. GROUT: Depth Method
From 0 To 20 [CURED
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in.
From To Ft. in.
Mac
C numbers and common road names.
Material
Ft. GUI'
15. SAND/GRAVEL PACK:
Depth Size
From To Ft.
From To Ft.
16. REMARKS:
in.
in.
Material
gal
pAtoR
Fria
57/,t i' EA; f l'
G "tick-
LOCATION SKETCH
Show direction and distance in mules from at least
two State Roads or County Roads. Include the road
0
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRU
CONSTRUCTION STANDARDS, AND OPY 0
IN ACCORDANCE WITH 15A NCAC 2C, WELL
CORD HAS BEEN PROVIDED TO THE WELL OWNER
09-19-02
SIGNATURE OF PERSON COISSTRUCTING 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-1 REV. 07/2001

261392
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
CERTIFICATION R 2343
WELL CONTRACTOR (INDIVIDUAL) NAME (pilot) ' IannPHONE # F> 324 35
WELL CONTRACTOR COMPANY NAME HIQC WELL �-I tC (D'
STATE WELL.ASSOCIATED WQ PERMIT -It CONSTRUCTION PERMIT# (if applicable)
(if applicable)
I. WELL USE (Check Applicable Box): ResidentiaFEl Municipal/Public 0 Industrial ❑ Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: M7RCANTM
765+ TEWE, FIR FY AVE.
(Street Name, Numbcn, Community, Subdivision, Lot No., Zip Code)
3. OWNER: Rae/ & EHARUJIIE PARKER
County PURKE
Address 7654 T FT'NTF. FPI FY AVF.
(street or Route No.) 28655
City orToTown State Zip Code
(828)- 413-9162
Area code- Phone number
4. DATE DRILLED 09-12-02
5. TOTAL DEPTH: 205
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO EX
7. STATIC WATER LEVEL Below Top of Casing: 80 ns) FT
8. TOP OF CASING IS 2 FT. Above Land Surface"
*Top of casing terminated at/or below land surface requires a
variance 8
(gpm): is accordance with 1sAMETHOD
9. YIELD OF TEST BY AIR TEST
10. WATER ZONES (depth):
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitudeiongitude source:OGPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
11. DISINFECTION: Type FAIT TARS
12. CASING:
Depth Diameter
From 0 To 57 Ft.
From To Ft.
From To Ft.
13. GROUT: Depth Material
From 0 To 20 FL rwur
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size Material
LOCATION SKETCH
Amount 76 Show direction and distance in miles from at least
Wall Thickness two State Roads or County Roads. Include the road
or Weight/Ft. MaterialTC numbers and common road names.
INC
Method
POURED
Slot Size
in.
in.
Material
From To Ft.
From To Ft.
V�O
ab
0 6 Na.
wec�
cAr1dE G! • lt/�(r V-
5
16. REMARKS:
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONST
CONSTRUCTION STANDARDS, A THAT A COP"
s _
SIGNATURE OF PERSON ¢Ii1NSTRUC1ING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service CGWrl Raleigh,
dgh, NC
27699-1636 Phone No. [phone], within 30 days.
)anD IN ACCORDANCE W1TH 15ANCAC 2C, WELL
S RECORD HAS BEEN PROVIDED TO THE WELL OWNER
09-16-02

261391
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
CERTIFICATIONy�0 7 i3
WELL CONTRACTOR (INDIVIDUAL) NAME (print) CD.
PHONE ('N"8) 324 r1
ASSOCIATED WQ PERMIT('
(if applicable)
WELL CONTRACTOR COMPANY NAME
STATE WELL CONSTRUCTION PERMIT,/
(if applicable)
1. WELL USE (Check Applicable Box): Residential M( Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ('Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
28528 (check
DEPTH DRILLING LOG
From To Formation Description
2. WELL LOCATION:
Nearest Town: MwAICIT N County H1RKE
1683 T (MTF 5TUFFT FR ST-
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: JAWS ADANS
Address IT) lib( 1158
GLEN AL1IE (Street or Rou lo.)
City or Town State Zip Code
(R2R )- 4fl-4103
Area code -Phone number 4. DATE DRILLED 09-12-02
5. TOTAL DEPTH: 2.65
6. DOES WELL REPLACE EXISTING WELL? YES EX NO 0
7. STATIC WATER LEVEL Below Top of Casing: 1(10 FT.
(Use "t" 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 is accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): 10 METHOD OF TEST BY AIR TESI
10. WATER ZONES (depth):
11. DISINFECTION: Type FIIH TARS Amount nests
12. CASING: Wall
Depth Diameter o�'ght/Ft. Material
Frotn 0 To 148
FL
From To FL
From To Ft.
13. GROUT: Depth Material Method
From 0 To 70 Ft. MTTf FOURFT)
From To Ft.
14. SCREEN: Depth Diameter Slot Size
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK: Sue��
Depth
From To Ft.
From To Ft.
16. REMARKS:
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 (\b?
cQ'
W
SHUffar0
( 11IJN!£ Rp. 6 a Welk
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED
t
CONSTRUCTION STANDARDS, AND THAT A COPY OF t S ' a
A
SIGNATURE OF PERSON CONS
ACCORDANCE WITH 15ANCAC 2C, WELL
HAS BEEN PROVIDED TO THE WELL OWNER
09-16-02
G THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Ceenterl RREVgh, C01
27699-1636 Phone No. [phone], 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) WEE ITT
CERTIFICATION it 2343
EIIQuty %3nJ, EPTJJJM CD. PHONE / KR) '17Ctl35
WELL CONTRACTOR COMPANY NAME
STATE WELL CONSTRUCTION PERMIT* ASSOCIATED WQ PERMIT/
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential Municipal/Public 0 Industrial ❑ Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
261390
2. WELL LOCATION:
Nearest Town: SLY SFRDES
7099 SPANQ AVE.
(Street Name, Numbers, Community, Subdivision, Lot No, Zip Code)
3. OWNER: t4'X N47TCQSE
Address FO BA 177
�I Y or Route No.) 28612
City or Town State Zip Code
(828 )- 879-3053
Arca code -Phone number
4. DATE DRILLED 09-10-02
5. TOTAL DEFTH:
6. DOES WELL REPLACE EXISTING WELL? YESti NO 0
7. STATIC WATER LEVEL Below Top of Casing: 50 FT.
2 (Use "+" if Above Top of Casing)
8. TOP OF CASING IS FT. Above Land Surface`
*Top of cuing terminated at/or below land surface requires a
variance to m): 6e with 1sAMETHOD OF TEST BY AIR �r
AC 2C .0118.
9. YIELD (gpm):
10. WATER ZONES (depth):
11. DISINFECTION: Type
12. CASING:
Depth
From_ To 14c)
From To
From To Ft.
13. GROUT: Depth Material
From 0 To 20 Ft. C Tr
From To Ft.
14. SCREEN: Depth Diameter Slot Site Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
To
County BURKE
EIIH
TARS Amount 58
Wall Thickness
Diameter or Weight/Ft. Material
Ft. ' CAaIT SIFI4
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)
DEPTH DRILLING LOG
From To Formation Description
Method
POURED
From Ft.
From To Ft.
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.
6 i/
6,)_
SOMJN AvE.
ry
Aux
5
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRU • ACCORDANCE AS BEEN WITH
15A NCAC TTHE WELL 2C, WELL
OWNER
eitA
CONSTRUCTION STANDARDS, ANDA COPY OF •t 'ai
SIGNATURE OF PERSON CONS - UCTING THE WFI 1 DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Ceenterl R leigh, C01
27699-1636 Phone No. [phone], within 30 days.

WELL CONSTRUCTION RECORD 261404
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) TiKNE Ili CERTIFICATION # 7%3
WELL CONTRACTOR COMPANY NAME TTlG(FL hHL l -f ' CO. PRONE #
324-0O-?S
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT/
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residentialf MunicipallPublic 0 Industrial 0 Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION: B[IRKE
Nearest Town: IaDEBWN County'
901R WUSN RT)
(Street Name, Numbers, Community. Subdivision, Lot No., Zip Code)
3. OWNER: 7BTA ARNEY/DFNNTS APNEY
Address AR1R WrISTSI RIl
(Street or Rout .)
7R7
CityloorrMTowwo State Zip Code
( 87R)- 197-RR52
Area code- Phone number
4. DATE DRILLED 09-11-02
5. TOTAL DEPTH: 205
6. DOES WELL REPLACE EXISTING WELL? YES)iSl NO 0
7. STATIC WATER LEVEL Below Top of Casing: 40 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 .ati5.
9. YIELD (gpm): 75 METHOD OF TEST BY AIR TFSF
10. WATER ZONES (depth):
11. DISINFECTION: Type
12. CASING:
Depth
From 0 To 80 Ft.
From To Ft.
From To Ft.
13. GROUT: Depth Material
From 0 To 70 Ft. art IT
From To Ft.
Topographic/Land setting
❑Ridge ❑Slope ❑Valley [Plat
(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
FM TARS Amount 35
Wall Thickness
Diameter or Weight/Ft. MFVCPT teial
�t
14. SCREEN: Depth Diameter
From_ To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK
Depth
From To Ft.
From To Ft.
Method
Fa RFD
Slot Size Material
in.
in.
Size 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.
WILSCUJ
Hwy 70
S
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONS 1RUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS SI )RD HAS BEEN PROVIDED TO THE WELL OWNER
09-12-02
SIGNATURE OF PERSON CONS T y[C3ING 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-1 REV. 07/2001

261413
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
CERTIFICATION # 2343
WELL. CONTRACTOR (U'7DiVmUAL)NAME (print) �� TiiiX� PHONE # (R%R) il45
WELL CONTRACTOR COMPANY NAME HICKORY WFI T . rn i TN' CT)
ASSOCIATED STATE WELL CONSTRUCTION PERMIT.? WQ PERMIT/1
(if applicable)
(if applicable)
I. WELL USE (Check Applicable Box): Residentialf Municipal/Public 0 Industrial 0 Agricultural ❑
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town:
MIL,M1ICN County BURKE
3758 NC RW 18 SOUTH
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: 11"71 I Y PARKFR/RTGC (RAT(
Address 3758 W HdW 18 911111
(Street or Route No.) 2i 55
CityIN
�orLTown State Zip Code
(82$)- 433-65106
Area code -Phone lumber
4. DATE DRILLED 09-16-02
5. TOTAL DEPTH: 145
6. DOES WELL REPLACE EXISTING WELL? YES EKNO ❑
7. STATIC WATER LEVEL Below Top of Casing: 20 FT.
(Use "+" if Above Top of Cuing)
8. TOP OF CASING IS 2 FT. Above Land Surfaces
'Top of cuing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): 25 METHOD OF TEST BY AIR 'TEST
10. WATER ZONES (depth):
11. DISINFECTION: Type HER IMS
12. CASING:
Depth
From 0 To 57
From To
From To
13. GROUT: Depth
From 0 To 20
From To
14. SCREEN: Depth
From To Ft.
From To Ft. in.
15. SAND/GRAVELPACIC
Depth
From To Ft.
From To Ft.
Amount 26
Wall Thickness
D_iajpeter
Ft 4
Ft.
Ft.
Material
Ft. CUTT
or W_eight/Ft. Mat nae ' 1
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
Method
FCURED
Ft.
Diameter Slot Size Material
in. in.
in.
Size Material
16_ REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED
CONSTRUCTION STANDARDS, AND THAT COPY OF THI
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.
6" -"1
SIGNATURE OF PERSON CONSTR
CCORDANCE WITH I5A NCAC 2C, WELL
HAS BEEN PROVIDED TO THE WELL OWNER
CA-23-02
G THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center l RRBVgh, C
27699-1636 Phone No. [phone], within 30 days.

260017
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) James tv Cam r, Jr -
CERTIFICATION N 71 1 R
WELL CONTRACTOR COMPANY NAME f ampt c Well R. Pnmp f n Tnr PHONE # [phone]
STATE WELL CONSTRUCTION PERMITN _ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential 17 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;, 17
Nearest Town: 0 ✓K�q�j a o Y( County i� iA i k
,430 Iit) AYcY Ek•IrU(
(Street Name, Numbers, Community', Subdivision, Lot No., Zip Code)
3. OWNER. 13 Ye lCa (/LJR_I Key
Address 2,
2, 130 �AYYI'c( re Y k I Yal )
//"l(1v[(I QC (streetI Route 'J C- �C76S/
City or Te4n State �N l� Zip DCode 7
Area code- Phone number
4. DATE DRILLED X - T `0.-
5. TOTAL DEPTH: 6-0 n /
6. DOES WELL REPLACE EXISTING WELL? YES al NO 0
7. STATIC WATER LEVEL Below Top of Casing: 70 FT.
(Use " i•" if Above Top of Casing)
8. TOP OF CASING IS L FT. Above Land Surfaces
• *Top of casing terminated at/or below land surface requires a
variance In accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): ,3 METHOD OF TEST
10. WATER ZONES (depth):
nit
Topographic/Land setting
❑Ridge 11Slope ❑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
17h r%1✓� 11
5 5-1'JO0 fbil6olrdo(ari rock
11. DISINFECTION: Type ('h l on na
12. CASING:
Depth Diameter
From t) To 55 Ft. 6
From_ To Ft.
From To Ft.
13. GROUT: Depth
From_# To 2 p 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.
1/4
Amount r'Kr6
Wall Thickness
or Weight/Ft. Material
SDR2I PVC
Material
N ¢t Cement
Method
Iland
16. REMARKS:
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.
I
(fro(
�fai
r,� l
I$I
—[ O! ),
IV
CO
CO
RI DO 1 LRTIF1 TH^(T IS WFI I WAS CONSTRUCTED IN ACCORDANCE WITH 15ANCAC 2C, WELL
'UNSTRUCTION STANDARD AND THAT A COPY OF THIS CORnD HAS BEEN PROVIDED TO THE WELL OWNER
SCE ^ n z_()9 J 44/1/ e.�- 7� - C��
S GNA OF PERSON CONSTRUCTING T{riE WBI DATE
9-Iv-d).
is, i KlupaagigaUtuctile Division of Water Quality, Groundwater Section, 1636 Mall Service Center - Raleigh, NC
/29189946S6f}SWiii140.((9f0F133-3-21,within 30days. OW-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]
261835
WELL CONSTRUCTION RECORD
WELL CONTRACTOR: Dewey Wright Well Pump Co., Inc.
WELL CONTRACTOR CERTIFICATION #• 2081
020671 STATE WELL CONSTRUCTION PERMIT#•nteve HeCy
WELL USE (Check Applicable Box): Residential n Municipal 0 Industrial n Agricultural n Monitoring
Recovery Heat Pump Water Injection In Other 0 If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: LINVILLE County' BURKE
BARRIER AVE. OFF HWY 181 OFF I-IWY 105
3. OWNER
Address
(Road Name and Numbers, Community, or Subdivision and Lot No.)
BILLY REEP
7845 BARRIER AVE. ,
DRILLING LOG
From To
0 75
DEPTH
Formation Description
DIRT
N ANUe reet or Route No.)
NC 28857
75 90 GRANITE
4. DATE DRILLED
5. TOTAL DEPTH
6. CUTTINGS COLLECTED YES I I NO 71
7. DOES WELL REPLACE EXiSTING WELL? YES 0 NO 71
8. STATIC WATER LEVEL Below Top of Casing: 30 FT
(Use "+" if Above Top of Casing)
City or Town State
8/30/2002
125
Zip Code
90 93 SHALE
93 110 GRANITE
110 113 SHALE
113 125 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.01 a
10. YIELD (gpm): 1300 METHOD OF TEST Air
11. WATER ZONES (depth):5 gpm 90-93 295 gprn 110-113
0 gpm 0 ppm
^±n
12. CHLORINATION: Type Amount "'
13. CASING:
From
From
From
Depth
0 To
To
To
14. GROUT:
HTH
Wall Thickness
Diameter or Weight/Ft. Material
80 Ft 6 1/4 .186 GALV.
Depth
From 0 To 20
From To
15. SCREEN:
From
From
Fro m
Depth
To
To
To
16. SAND/GRAVEL PACK:
Depth
From To
From To
Ft.
Ft
Material Method
Ft Cement Gravity Flow
Ft
Diameter Slot Size Material
Ft in
Ft in
Ft in
17. REMARKS'
I DO HEREBY
CONSTRUCT a u•T ` D
in
in
in
Size Material
Ft
Ft
D
FOR OFFICE U . = LY
Quad No:
A
A1&
If additional space is needed use back of form
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other map referrce points)
a
STRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
l-v
t NATURE OF PER aN CONSTRUCTING THE WELL DATE
Submit riginal to Division of Water Quality, Groundwater Section within 30 days
GW-1 REV. 12/99
Serial No.
F Tyr S TIO'1
ASH -VILLA:

260222
WELL CONSTRUCTION RECORD
NortCarolina -Dap tmeatofEnvironmentwMNaaaalResorces.-DivLionofWat rQuality-GroundwaterSe Lion
wnLCONTRACTORR DIVIDOAL)NAME (pis) mAP A-ti Fk(t ,. nil CSRT>o etnowte7,1l
WELL CONIRACTOR 00b0'ANY NAME Erg.(tnc! IN t rrip + t>Jf .1 / , non ! (leoCay-85r-12,
STATE WELL CONSTRUCTION PERMIT! ASSOCIATID WQ P1Q1n1:
(if applicable) (ifasvlicable)
1. WELL USE (Check Applicable Bos): Residential KMunicipdfPublic 0 Iodmtrial 0 Agricult al 0
Monitoring 0 Recovery 0 Beet Pump Water bjectionO Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: IL, kieSe Countyli2v e
`c2/ln ii,wrArysyi_P .
saeNeme, Ca wood%SalsoNok aa.LarNG,TipCade)
3. OWNER: /? : A/2, /A /t.t'/e//
Address va/(, /nii>Pr/rncp. nee
(St &e«RamNa.)
//o/r/PCP R/o026
WS> R97 - <own 3ON Zip Code
74 /
Ana axle -Thom maw
4. DATE DRILLED R- Q R - oa
5. TOTAL napl pr ��
6. DOES WELL REPLACE MISTING WELL? YES O NO 13'
7. STATIC WATERLEVEL Below Top of Codas /nn FT.
(rice' rifAhasTop cfCrios)
8. TOP OF CASING IS / FT. Above Land Waco*
*Top of eosin rarWaOod oar below Lad notesmoires i
vodome to meordoneo with ISA NCAC 2C Alle.
9. YmLD (gpm): g 1/7 METHOD OTEST 74-/
10. WATER ZONES (depth):
Topograpido/Limd setting
ORldge
(dock oppeapeloobox)
Latitudefionglitideofwellloation
(6momindsOmM000th)
Latimde/tamgkude waoe:OGPS0TopograpIde map
(riodcka)
pjTg J1RUd.ING LOG
From To Formation Des ipdon
Ci 7 S' - '- ,t7-ro WL CC`
/r)n i/C> l.row,if-C
11. DISINFECTION: Type f7 r' i Clete
12. CASING:
Depth Diameter
From To i i
From To Ft
From, To Ft
Amount__c u$�
Wan Thickoess
«wdght/FtMatedal
13. GROUT: Depot Material
From 0 To , Pt ni t. e4'
Ft
From To
14. SCREEN: Depth Diameter
Front. To FL_____In.
From To Ft, it
15. SAND/GRAVEL PACK:
Depth Sim Material
FroaL-To Ft.
Front_To Ft.
Method
(L ' /,Sage(
Slot Size Material
in.
16. REMARKS'
LOCATION SKETCI;
Show direction awl durance in miles from acleest
two State Roads or County Roads. ',Rude the road
numbers and common mad names. <n
v .
N
W
Vflijdn
11 SEP 2 5 2002
00
r
0
I DO HEREBY CERTNY THAT 7111S WEIL WAS CONSTRUCIED INACCORDA41t y:.'::
CONSTRUCTION STANDAND T)iAT A COPY OF THIS RECORD HAS BERNIRROYIPIlitif) . .
�r
;nos O
CONSTRUCTING THE WELL
DATE
MAIM
Sabmk the original to the Divblon of Water Quality, Groundwater Section,1636 Mali Service Center -Raldg%,NC
27699-1636 Pose No. (9191733-322L width' 30 days. OW -I REV. 07/2001

260532
WELL CONSTRUCTION RECORD ,
North Carolina - Department of Environment and Nang l Resources - Division of Water Quality - Groundwater Section WELL CONTRACTOR (INDIVIDUAL) NAME (pried) 454 le / /JLfert CERTIFICATION S-S#p2 b
�7�J
WELL CONTRACTOR COMPANY NAME /l/i)r -,/4'' //,4/&I/ /)r jIs'n ✓ t( PHONE # 0Y-�62 �Z J2
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ♦ l Municipal/Public E7 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use
2 WELL LOCATION• )
Nearest Town: . /-Gar
County tnrkP-
(Sweet Name, Number; Community, Subdivision, Lot No., hip Code)
3. OWNER lase- Ate
Address 9 O 7? /,7`, /Jk rim At, R
(�/��' /�/ ($ or Route No.) r7 p. �7
City or Toofm Eta / Zip Code
/14. erg. oe �.0
Area code- Phone mmbet
4. DATE DRILLED 3"02
5. TOTAL DEPTH: OS
6. DOES WELL REPLACE EXISTING WELL? YES NO 0
7. STATIC WATER LEVEL Below Top of Casing:
(Use 'F' if Above Top of Casing)
8. TOP or CASING IS / Fr. Above Land Surface'
'Top of cola` terminated at/or below dad surface requires a
mince In accords with ISA NCAC 2C .01111. qq
9. YIELD (gpm): t METHOLWFTESTAr/' /�'f
10, WATER ZONES depth): (Cs
/5Ys'
/ 11. DI$INFECTION: Type /yf%f Amount
12. CASING:
th
Fro&L ToV
From To
From To
13. GROUP // ,,,, Depth
Frotri To. 7 0
From- To
Topograyhic/Land setting
0Ridge @Slope ❑Valley DFlat
(cheek appropriate box)
Latitude/longitude of well location
(deg ecs/mimw-s/seWnds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
RETCH DRILLING LOCI
Frgm _ FSzrt,ption D ' 4
0� v_
6r' 6—/aA r >�
LOCATION SKETCH
Show direction and distance in miles from at least
wall Thickness two State Roads or County Roads. Include the road
Di r or Weight/Ft, Material numbers and common road names.
FL Sbks2/ l/4
Ft.
Ft.
Material -- //-Method
/ / S en ,
Ft. C e-.e"evt-r / Pt.
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.
j)t'/kr `,.t'/ J AC/
CredT/ h4 lalt /Cd
16. REMARKS:
critifi
iltinoisiSNIVARai,
SEP 2 7 2002
ILL WAS CoNS'IRUCIED IN ACCORDANCE WITII ISA NCAC 2C, WELL
IAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
UR
O(' NRRSON CONS'fRT1Cf NCI THE. WELL DATE
Su It the original to the Div -I so of Water Quality, Groundwater Section, 1636 Mall Service Center - Raleigh, NC
27E99ERW►ttpill jk(ne dfk.2 I,PRhin 30days. GW-1REV. 07/2001
ASHEVILLE REGIONAL OFFiKE
CD
n
e--1
IV
T
Ed Wd8S:90 ZOO? 9Z 'daS
EE2TZ9177OL : 'ON Xdd dWfld 2 1131 ZIDJOW : W02ld

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
CERTIFICATION if 2 /
WELL CONTRACTOR (INDIVIDUAL) NAME (print)_ W 1 1-- 5
WELL CONTRACTOR COMPANY NAME HICKEY WELL
L U E CD. PHONE # )
ASSOCIATED STATE WELL CONSTRUCTION PERMIT., WQ PERMIT#
(if applicable)
(if applicable)
1. WELL USE (Check Applicable Box): Residential) Municipal/Public 0 Industrial 0 Agricultural ❑
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other ❑ If Other, List Use
Topographic/Land setting
DRidge ❑Slope [Walley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
?PASS DEPTH DRILLING LOG
From To Formation Description
2. WELL LOCATION:
Nearest Town: KR ANKN Count
BURKE
2664 IE LW 70 FAST
(Street Name, Numbers, Comrmity, Subdivision, Lot No., Zip Code)
3. OWNER: WEY HLLECN
Address 2664 11S ELKS( 70 FAST
(Strut or Route No.)
M7f2(1ANYN NC..
City or Town State
( 828 )- 437-6781
Area code- Phone number
4. DATE DRILLED 08-15-02
5. TOTAL DEPTH: 605
6. DOES WELL REPLACE EXISTING WELL? YES II NO ❑
7. STATIC WATER LEVEL Below Top of Casing: 37 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 2 FT. Above Land Surfaces
*Top of casing terminated atfor below laid surface requires a
variance in accordance with 15A NCAC 2C .011S. BY TEST9. YIELD (gpm): .25 METHOD OF TEST
10. WATER ZONES (depth):
Zip Code
11. DISINFECTION: Type EH TABS
12. CASING:
Depth
From () To FD
From To
From To
13. GROUT: Depth
Front... To 20
From To
14. SCREEN: Depth
From To
From To
15. SAND/GRAVEL PACK:
Depth
Front To
From To Ft.
Ft.
Ft.
Ft.
Material
Ft. GUT
Diameter
nut
Amount 119
Wall Thickness
or Weight/Ft. Material
Ft.
Diameter
Ft. in.
Ft. in.
Ft.
FvT PLASTIC
Method
1i1URED
Slot Size Material
in.
in.
Size Material
261399
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.
Aieg ✓t�licN
My/ 70
C D 1EKt�--..
C,y
S
0
0
16. REMARKS:
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE
BEEN P 1 DED TO THE 2 WELL OWNER
, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS '
08-21-02
SIGNATURE • F PERSON CONSTR * M t: THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service CGWrI RRHV -Raleigh,
NC
27699-1636 Phone No. [phone], within 30 days.

261409
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) WAYNE NM CERTIFICATION#
WELL CONTRACTOR COMPANY NAME HTGX.PY 1J1T rRTT1 TN (.m
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT(
(if applicable) (if applicable)
PHONE it [phone]
1. WELL USE (Check Applicable Box): Residential MunicipallPublic 0 Industrial 0 Agricultural ❑
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION: &
Nearest Town: [REEL County
RKE
3122 MICANEN FLIRIVI URE RD.
(Sheet Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: 3IOM ILR
Address 3122 M%%4NRN F<IRNTTIA2E RD.
MICANIM (Street or Route27o.) 28655
City or Town State
(828 )- 433-8%1
Area code- Phone number !� no -02
4. DATE DRILLED
5. TOTAL DEPTH:
6. DOES WELL REPLACE EXISTING WELL? YES d<NO 0
7. STATIC WATER LEVEL Below Top of Casing: 53 FT.
2 (Use "+" if Above Top of Casing)
8. TOP OF CASING IS FT. Above Land Surfaces
'Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118. BY TEST9. YIELD (gpm): 20 METHOD OF TEST
10. WATER ZONES (depth):
HMI TABS Amount 33
11. DISINFECTION: Type
12. CASING:
From 0
From
From
13. GROUT:
From 0
Zip Code
Wall Thickness
Diameter or Weigbt/Ft. Material
Ft. f✓' FX Pf ASUC
Ft.
Ft.
Material Method
Ft. GM
From Ft.
14. SCREEN: Diameter Slot Size Material
From To Ft in. in.
From To Ft. in. in.
Depth
To 51
To
To
Depth
To 20
To
Depth
15. SAND/GRAVEL PACK:
Depth
From To Ft.
From To Ft.
16. REMARKS:
Size Material
Topographiclland setting
[Midge ❑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
DEPTH
From To
LOCATION SKETCH
Show direction and distance in miles front at least
two State Roads or County Roads. Include the road
numbers and common road names.
7i"
r
5
r‘,
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
G8-14-02
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-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) WANE T(TG CERTIFICATION * 2343
HLG(RI 1ThH [RILLIFU CD. PHONE 1 () 324-0Q35
WELL CONTRACTOR COMPANY NAME
STATE WELL CONSTRUCTION PERMIT* ASSOCIATED WQ PERMIT*
(if applicable) (if applicable)
261408
1. WELL USE (Check Applicable Box): Residential Municipal/Public 0 Industrial 0 Agricultural O
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: VALCTSE
3445 FIAT CAP MIN. RD.
(Street Name, Numbers, Community, Subdivision, Dit No., Zip Code)
3. OWNER: TFF FWN(LIN
Address 3445 FIAT GAP MIN. RD.
(Street or Route No.)
VAT I USE NC
( 828)Ty 879-810 m ste
Ara code- Phone number
4. DATE DRILLED OR-C -07
5. TOTAL DEPTH: 20S
6. DOES WELL REPLACE EXISTING WELL? YE3(I NO 0
7. STATIC WATER LEVEL Below Top of Casing: 2() FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 7 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordatme,with 15A NCAC 2C .0118.
9. YIELD (gpm): 3 METHOD OF TEST BY AIR IESr
10. WATER ZONES (depth):
County PLFKE
Zip Code
28693
Topogtaphic/Iand setting
ORidge ❑Slope OValley ❑Flat
(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
IIIH TARS
11. DISINFECTION: Type
12. CASING:
Depth
From 0 To 40 Ft.
From_ To FL
From To Ft.
13. GROUT: Depth
From 0 To 20 Ft.
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACIC:
Depth
From To Ft.
From To Ft.
Diameter
ay,
Amount -i9
Wall Thiclniess
or Weight/FL Material
WC PLASTIC
Material
GROUT
Method
RIFED
Slot Size Material
in.
in.
Size 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.
J/�GD„
16. REMARKS:
A
AC 2C, WELL
I DO HEREBY CERTIFY THAT 7HIS � ELL WAS CTHAT A CCOPOYN OF THIS RETRUCTED — • L HAS BEEN PROVIDN ACCORDANCE WITHED TOCTHE WELL OWNER
CONSTRUCTION STANDARDS, �
fV
1V
SIGNATURE OF PERSON CONSTR
08-14-02
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-1 REV. 07/2001

259521
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GROUNDWATER SECTION
ASHEVILLE REGIONAL OFFICE
SyfrioyG Z
sews cOMaTtuc,wao TWO twa. DAM
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OW1 ASV 07.20o

258603
WELL CONSTRUCTION RECORD
North Carolina - Department of Envirotmlent and Natural )Resources Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) I t/ty /1'ih fe,/r�t. / CERTIFICATION w�-�86
WELL CONTRACTOR COMPANY NAME Mare ' Wei/ f9,-,//I0I/ r PHONE # 07 r/62 -/3t0?
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMITS
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ❑ Municipal/Public ❑ Industrial Y"AgriculMlal 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:l/,
Nearest Town: h' /o/4144A.. County /S/n l it et,
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Coda)
3.OWNER• ROir(y CO6k
Address / &/0 1J/C7 Z.. Acf
),4/ (Street or Route No.)
chchni - N(
City or Town State
Zip Code
Area code- Fbone number an i
4. DATE DRILLED O " b " O t�
5. TOTAL DEPTH: 3 A Cy
6. DOES WELL REPLACE EXISTING WELL? YES NO
7. STATIC WATER LEVEL Below Top of Casing: —30 FT,
(Use "+" if Above Top of Caning)
8. TOP OF CASING IS / FT. Above Land Surface'
'Top or caring terminated at/or below land surface requires a
wham la acmrds a Mtb 1SANCAC 2C .011S.
9. YIELD (gpm)•, S METHOD QP TEST At Ni
10. WATER. ZONES (depth): / 7 0
3y5-
11. DISINFECTION: Type 4 %7i Amount € nZ
12. CASING: Wall Thicimoss
Depth,(i-"yter or Wd t/i t. Materiel
Front�0)li To ®� Pt. � R _yl�yC`._
From To Pt.
Fmn1==..,,,To. _._ Ft
13. (MROU'f: Depth Material / Method /
Fro nt,'-"�nf(/ To X / Pt. CAIw.T tp,_ t
Prom To PI
14, SCRI{RN: Depth Diameter Slot Sim Material
From______._ To Pt. in In
Prom To Pt. In. In
IS. SAND/UItAVllLPACK:
Depth Size Mntorinl
Prom _—. To .. Pt.
From To Pt.
In, IIIIMARKU:
/Topographic/Land setting
midge ❑Slope ❑Valley ❑Flat
(choir appro('riate box)
Latitude/longitude of well location
(degrees/minutes/getout)
LatitudeAongitude sourcc:❑GPS❑Topographic map
(chcvk box)
J2EPTH DRILLING LOG o
From To Forapan Description r`)
740`a /D 0"
C ti"
Cox/Nit et-o- e-i G
/l 2 -- 'S6C
JOCATION SKETCH ,a2"
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
bN STA uktrJ
i
WEt,i. WAS CONS IRUCI'Et) IN ACCOI(DANCR WI'I'11 15A NCAC 2C. WELL
IlIA'IA COPY OP'11118 RECORD IIAS HDILN rttovltnu'rL'1'tin WELL OWNER
A'IUIttti CiM&1RUCIINU'1'11t1, WELL DATE
Me bo11i Iha oe IgInd to the illjv don of Water Quality. Groundwater Section, 1636 Men Service Center - Ridelab, NC
37 CT hoseeNaEgl1 m3-322 , within 30 days. GW-1 REV. 07/2001
ASHEVILLE REGIONAL OFFICE
lD
tT
c7
aTd was :Lo FOCI? 9E '6nd
EE2TZ9bbgL : 'ON XCd dWfd 8 113M Z132iOW : woad

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and �N,1rural Resources - Division of Water Quality - Groundwater Section
oo �7I7
WELL CONTRACTOR (INDIVIDUAL) NAM (print) IX/54/niic ffLL CERTIFICATION/�D 7 ,\
WELL CO.N'TRACFORCONIPANYNAME .€sefjved. ittcf 4,,e - 7�4L PHONE/ # �j (pyy-%�YS�[�
N/d
STATE WELL CONSTRUCTION PERMIT#
(if applicable) (if applicable)
/Wit ASSOCIATED WQ PERMIT#
260166
1. WELL USE (Check Applicable Box): Residential% Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2.
WELL LOCATION:
Nearest Town: County
411*.i S
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: &4 en/ \
Address /o % 3
( tree[ or Route No.) ,,r
7%% CA/4 C • tali �oS:.l`�
Ot rTown ate Zip Code
PD9D
Area code- Phone number
4. DATE DRILLED 7 % 7 /0 7-
5. TOTAL DEPTH: Ay,4— rq
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO Y4
7. STATIC WATER LEVEL Below Top of Casing: ? FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / `5 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): LC M THOD OF TEST—re-1-LO
�OA1
t I. DISINFECTION: Type j¢i Amount _5 °Z
12. CASING: Wall Thickness
Depth �, Diameter or Weight/Ft. Material
From Er) /QYJ Ft. i ,a2j ,�// L'
From To Ft.
From To Ft.
13. GROUT: Depth Naethod
From 0 To c2n FL L t tart in Jr
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:
OR TI IE -S dt1P.E
S 2LJ2 9
AdWREtON
Topographic/Land setting
❑Ridge ❑Slope XValley ❑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
IV
v
(J
LO ATION SKETCH q r;
Show direction d distance in miles fromdjlleas(-1 --
two State Rsaor or County Roads. Includ - rott�
numbers a on 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
�I �c�. It3a�� %�i7/0
GNA URE OF PERSON 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) WINEL * - CERTIFICATION # �
WELL CONTRACTOR COMPANY NAME HF(ICQtY WELL �'�' �'
PHONE # (RJR) n-0035
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential I2IK Municipal/Public 0 Industrial 0 Agricultural ❑
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: MYIGpNItN County PI ERE
3190 PF FR<TN RD.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: DEAN & JULSE EPLEY
Address 3190 PFJFRFS N RD.
MICANI N (Street or Rome)
City or Town State Zip Code
(R28 )- 433-6726
Area code- Phone number
4. DATE DRILLED 07-17-02
5. TOTAL DEPTH: 425
6. DOES WELL REPLACE EXISTING WELL? YES ENO ❑
7. STATIC WATER LEVEL Below Top of Casing: 49 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 .011S.
9. YIELD (gpm): 2 METHOD OF TEST Bf AIR '1)Sh
10. WATER ZONES (depth):
11. DISINFECTION: Type [-IIH TABS Amount 79
12. CASING: Wall Thickness
Depth Dieter or Wfight/Ft. Ma t ,
From 0 To 110 Ft. kNl: Yl >ll�,
From To Ft.
From To Ft.
Material
Ftan
Ft.
Diameter Slot Size Material
Ft. in. in.
Ft. in. in.
28655
261407
Topographic/Land setting
❑Ridge ❑Scope [Walley ❑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
13. GROUT: Depth
From O To 20
From
14. SCREEN:
From
From
To
Depth
To
To
Method
FURED
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
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.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRICTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND
THAT A COPY 0 S RECORD HAS BEEN PROVIDED TO THE WELL OWNER
As
SIGNATURE OF PERSONRVSfRUCTING 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-1 REV. 07/2001
(1si-1'-02

261424
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print),4 WalUIE I i CERTIFICATION # 7
WELL CONTRACTOR COMPANY NAME HI(K(7w M 11 TRTT T Tic G PHONE # 1822 �4 LX
35-
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential.} Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: ICARD County HJRKE
EMMA) ST.
(Sheet Name, Numbers, Community, Subdivision, Lot No., Zip Code)
-3. OWNER IAWQ)1NS 7 KEN (DThE
;, Address lj pry FM
(Street or Route No-)
ICARD
( 8ty or Tov557 __.Stale Zip Code
Area code- Phone number
4. DATE DRILLED 07-05-02
5. TOTAL DEPTH: 285
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO xa
7. STATIC WATER LEVEL Below Top of Casing: EA FP.
(Use "+' if Above Top of Casing)
8. TOP OF CASING IS 2 FT. Above Land Surface'
`Top of casing terminated ahor below land surface requires a
variance in accordance with 15A NCAC 2C .01111
9. YIELD (gpm): 5 METHOD OF TEST BY AIR TEST
10. WATER ZONES (depth):
Topographic/Land setting
[Ridge ❑Slope [Walley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degreeerninutes/secoadc)
Latitude/longitude source:❑GPS❑Topographic map
(chock box)
PEPpRILLING LOG
From To Formation Description
11. DISINFECTION: Type H1H TARS
12. CASING:
Depth 1ppeta
From 0 To 72 Ft.
From To Ft
From To Ft
13. GROUT: Depth
Froth___) To 7()
Ft
Amount 47
Wall Thickness
or Weight/Ft Material
Material
air
From To Ft
14. SCREEN: Depth Diameter Slot Size
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK
Depth Size Material
From To Ft.
From To Ft.
Method
MIRED
Material
16. REMARKS:
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include tby road_
numbers and common road names. �,vr
u1 —
N tit D MMaNC
Dl(ISS
Kam" II'�—J^ ":�.-:
rV
tV
Nwy; e
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRU
CONSTRUCTION STANDARDS, ANDY OF
ACCORDANCE WITH I5A NCAC 2C, WELL
RD HAS BEEN PROVIDED TO THE WELL OWNER
07-29-02
SIGNATURE OF PERSON CO " UCTING THE WFT f 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-1 REV. 07/2001

2. WELL LOCATIO
Nearest Town:
4019 WIDSIGN DRIVE
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
. 3. OWNER: RT(HARII 1,1-ifTFD
- Address 4019 WH€TW DRIVE
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater
rou dwa er Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) l4AME TT PHONECEo# 1$ gA35
N # 2343
WELL CONTRACTOR COMPANY NAME 1-TT(i(IYY t,FII. HRH TN; (0.
STATE WELL CONSTRUCTION PERMITS ASSOCIATED WQ PERMITS
(if applicable)
(if applicable)
6142i
1. WELL USE (Check Applicable Box): Residential} Municipal/Public 0 Industrial 0 Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
Topographic/Land setting
[Midge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
County BUR KE
(Street or Route No. )_ 28655
DERGANIal
City or Town State Zip Code
($2$)- 430-8010
Area code- Phone number
4. DATE DRILLED 07-01-02
5. TOTAL DEPTH: V5
6. DOES WELL REPLACE EXISTING WELL? YES IS NO ❑
7. STATIC WATER LEVEL Below Top of Casing: 50 FT.
(Use "4." if Above Top of Casing)
8. TOP OF CASING IS 2 FT. Above Land Surface*
"Top of cuing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 5 METHOD OF TESTBY AIR TEST
10. WATER ZONES (depth):
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
11. DISINFECTION: Type 1-Iffi TABS
12. CASING:
Depth Miter
From 0 To 86 Ft. 4
From To Ft.
From— To Ft.
13. GROUT: Depth Material
From 0 To 70 Ft. ETC
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
Amount 58
Wall Thickness
oor Weight/Ft. Maul
Method
FCURFD
From To Ft.
From To Ft.
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.
C N
`° k �Vt1 vo 11 gc�
t f 1
-I
t
Lc
. v
rV
16. REMARKS:
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN,ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS ry�..y�» HAS BEEN PROVIDED TO THE WELL OWNER
07-11-02
DATE
dera-
SIGNATURE OF PERSON CONS THE WELL
Submit the original to the Division of Water Quality, Groundwater Section,1636 Mail Service Ceenter' RREVgh 2001
27699-1636 Phone No. [phone], within 30 days.

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section r�
WELL CONTRACTOR (INDIVIDUAL) NAME (print) �(] Cy0, ( .A`,)TI C'e` CERTIFICATION
#.-.l\rVa�// 7ry�
WELL CONTRACTOR COMPANY NAME \ Y �j V C 1 t,�e \\ CN �\ t'(\ C� PHONE # ttl,Lps 1 D—'T—H.L.7"
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ FERN
(if applicable) (if applicable)
259399
1. WELL USE (Check Applicable Box): Residential ❑ Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
nitAQan_i0^
Nearest Town: 11
Count;?)ur\t'E
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: 3\Np5 o ,ir rx Qr-.
Address \O'5 L—sel rtv \jD no St•
`(Street r Route No.)
M
1 r tOffllr'+c\Aan (v C
City T wn Skate Zip Code
4-3-1—I0q`b
Area code- Phone number
4. DATE DRILLED 1\Ct-0
5. TOTAL DEPTH: a'5
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO ❑
7. STATIC WATER LEVEL Below Top of Casing: FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS k 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): 5 METHOD OF TEST Pt l C
10. WATER ZONES (depth):
11. DISINFECTION: Type C\O(Xis e- AmountrAnter13%
12. CASING: Wall Thickness
Dept / Di eter or ,eight/Ft. (itgritCl
From To t tP Ft. t,�(/ -
From To Ft.
From ToW Ft.
Topographic/Land _ssiting
❑Ridge 0Slope alley ❑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
13. GROUT: Depth IVlaicrial Method I
From 0 To rL0% Ft. —) `i- I Y)lT Lkred
I
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:
scrl
C4,4 LLJ
LOCATION SKETCH ni
Show direction and distance in miles from at -least
two State Roads or County Roads. Include thesroad__
numbers and common road names
pc
turd
1 D( ,HEi2EB ' CERT1iEY
5 WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
D THAT A COPY 0 THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
NAT RE OF PER 0
STRUCTING T it WELL DATE
ision of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
3221, within 30 days. GW-I REV. 07/2001

258031
nt of E vW'unELL nment and Natural Resources _° RECORD � ty -
i Groundwater Section S--U
WEL Carolina - OR (I Department S L L CERTIFICATION Cal° yE
WELL CONTRACTOR (INDIVIDUAL) NAME (print) i L L. (Yu CI PHONE 8
D(L
WELL CONTRACTOR COMPANY NAME ASSOCIATED WQ PERM1T8
STATE WELL CONSTRUCTION PERMIT# if livable
if livable
Applicable Box): Residential IIYMunicipa /Public ❑ Industrial 0 Agricultural 0
1. WELL USE (Check Water Injection 0 Other 0 If Other, List Use
Monitoring O Recovery 0 Heat Pump
2, WELL LOCATION:
3 a I
unty
Nearest Town. � r0
'
(Street Name. Numbers, Commonly, Subdivision, LANs., Zip Code)
T�11
3. OWNER:
Address
(Street or Ro te o) n auxi,
Zip Code From To
City or Town� �(���
4. DATE DRILLED
5. TOTAL DEPTH: 1 YES 0 NO�-T--
6. DOES WELL REPLACE EXISTING WELL?FT ---
7. STATIC WATER LEVEL BelowTopof Casing:
Top of mg)
8. TOP OF CASING IS 1 FT. Above Land Surface'
'Top of casing terminated at/or below land surface requires a
variance in accordan5t� with 15A NCAC 2C .8118.
9. YIELD (gpm): rd METHOD OF TEST '9
e »? d a b0
TER ZONES (depth)'
Area code -Phone umber
•
Topographic/Land setting
°Ridge °Slope Malley °Flat
(check appropriate box)
Latitude/longitude of well location
(drgceelmmutedseconds)
Latitude/longitude source:°GPSOTopographic map
(check box)
l>•��rrOG
Formation Description
10. WA ry nTla-----� U
eCL02inJ a Amount rI, d_ 2_ C y3`, Show direction and distance Rmoads. miles
ffrom tleast
11. DISINFECTION: Type
he road
Wall Thickness two State Roads or County numbers and common road
12. CASING: Depth ter or W ' t/FL i
From_ To Ft.
— to. 1
From To Ft' !i e. �/
Fro To Ft' Method
13. GROUT: Depth Materiel
From TO Ft. c) 1 Ou 8
From To 2 C Ft.��—
Diameter Slot Sine Material
14. SCREEN: Depth Diameter
in. in.
From To
From To
Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size al
Materi
From To Ft.
From To Ft.
16. REMARKS:
0
fV
c
ANDIS 5A NCAC 2C, WELL
WELLWAS
A COPY OFF THIS RECORD HAS BEEN PRRUCIED IN ACCORDANCE O WITH
TO THE WET. OWNER
F PERSON CONSTRUCTING THE WELL
DATE
Submit the igiRR1 to -
the Di sion of WaterQuality, Groundwater Section, 1636 Mail Service Ceenterl RRSVgh, NC
/2001
k�699+i6NWini68nb�iQa I {O19) 733- 221, within 30 days.
ASHSA1 LE R_..1._ _UL _.
r

err 383
WELL CONTRACTOR COMPANY NAME
STATE WELL CONSTRUCTION PERMITS ASSOCIATED WQ PERMITS
(if applicable) (if applicable)
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Na 1 Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) / kJ/ Aihi-e / t- CERTIFICATION a� G
intleft Wei' /Or j y PRONE a Poi 962 /,,3aa
1. WELL USE (Check Applicable Box): Residential fri lunicipal/Public 0 Industrial 0 Agricultural ❑
Monitoring ❑ Recovery 0 Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WFI f LOCATIONG [/ /
Nearest Town: Ana I.41Alt rOl'v County ettIFZ
(Street Name, Num-bears, Community, Subdivision, Lot No., Zip Code)
3. OWNER:,_iclrce-/ /tie-4 .r-
Address 5.06 .1-4.9'al l4tie#Ave
(Street or Route N0.' a2 ` / sS /yw(q Aw+Oa Mt- Dt0
City etown State Zip Code
Ama cede- Phone number 7
DATE DRILLED /
5. TOTAL DEPTH: 30S' L/
6. DOES WELL REPLACE EXISTING WELL? YES !' NO ❑
7. STATIC WATER LEVEL Below Top of Casing: 6"C) FT
(Use "+" it Above Top of Casing)
8, TOP OF CASING IS FT. Above Land Surface'
'Top of caring terminated atfor below load mate requires a
variance la accordance with ISA NCAC 2C .0118. ��l1
9. YIELD (gpm): /0 METBQp OF TEST/At fr it te"
10. WATER ZONES (depth): 0Ca? C
11. DISINFECTION: Type H red Amount 7 O z
12. CASING: Wall Thickness
DiameFrom DePT'`� / / Ft ter, oae h( MaterialsrG
`P /`
From To Ft.
From - To Ft.
13. GROUT-
�� Depth Material Method
Frorrt.,,C_�JL To_.�_Ft. �ti/•u"'"f' r.Y
From_ To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft.__Jn. in.
From To FL in. - in.
15, SAND/GRAVRT.PACK:
Depth Size Material
From. To Ft.
From 'ro Pt.
4. /6' -O a
I6: REMARKS:
Topoc/Land setting
❑Ridge lope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPSDTopogtaphic map
(check box)
DRILLING LOG
Faion Description
C/r, cla,rl4
From To
.r- /20'
/.70, _ 3or
LOCATION SKETCH, 'rs,
Show direction and distance in miles from at least
two State Roads or County Roads, Include the road
numbers and common road names.
I IX) I(h1tRNY CFHVtIIW TIIAT TIIIS WELT, WAS CONSTRUCTED IN ACCORDANCE wall I3A NCAC 2C, WELL
CONd9ItUM ION n'i'ANDARDS, ANL)'fIIA'1' A COPY OP 9Rit RD TEN PROVIDED TO TILE WELL OWNER
974 as
-2 tNA't DEE0
699-1636 Phone No. (919) 733
LJ
IUtSON CONS.' It=Ct'NO '1'1 IC W rILL DATE
r, of Water Quality, Groundwater Section, 1636 Mall Service Center - Raleigh, NC
I'within 30days. OW -I REV. 07/2001
GRVLL- ,6;6 l oa £Z 'Inc
ASHEVLL- REGIOVAEDFFICE
Zz£TZ9PCOL : '0N Xdd
dWOd 'S 113M ZJ3LJOW : Wald

04/04/2 0 OS:47 S19-715-0588 NCDEB.NP/NATEP QUAL
257857
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
IVWnAL) NAME (pew SGMoeJ /Jar etioSArr cn tricealONa3oao
WELL coxraAcroa (trm Q 2 E
wELL CONTRACToacohIIANY NAME PRICE WELL DRILLIt'G, INC. Sturm a `�
STATE WELL CONSTRUCTION PERMITS n WQ PERMITS
(if applicable) (if licablel
1. WELL USE (Check Applicable Box): Residential ❑ Municipal/Public ❑ Industrial 0 Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION: County Our 14
Noun Town-
(SCaoimmS,
N/ ' �h
aes onven . el1yybdlvidoa. I.a 7Jo.. rep Code)
3. OWNER. 1(0 bo r+ YI- n4 N
Address. 6'1-/ y /R- oy kh
(Sent or ROWS Se.) G (0-
Cvnrel Ly.SWrin, li/• C.
Gt. eI ��44 Cotea$7m�— 3oZe f'
Acacode• Phone numbec a � 2_
4. DATE DRILLED 2J
5. TOTAL DEPTH: 3O0
6. DOES WELL REPLACE EXISTING WELL? YES,t ❑
7. STATIC WATER LEVEL Below ruse
p oCasing:
� acorating)'.
Above rep
S. TOP OF CASING IS I 'I. Fr. Above Land Surface`
`Tee of cubic tensioned aaor below load sent meta
variant seoo11AM HOD QF TEST /7 1 r Ll/GtWri
9. YIELD (gpm):
10. WATER ZONES (depth): aiaS`F
11. DISINFECTION: Typc5 1u Fa. bit
12. CASING: TO Die
Depth Diameter
From_a_ To go Ft. A
From _ To Ft
From To Ft
13. GROUT; Depth
Material
FromLn_To a0 Ft Cl,ncreft
From To Ft.
14. SCREEN: Depth Diameter
From_ To Ft_,_Jn.
From To Ft_in.
15. SAND/GRAVEL PACK:
Depth
Amount do ws
Wag Thickness
orWeight/Ft. MaterialIC fa Via
Size
Fro++, To Ft.
From. To Ft.
16. REMARKS:
POIEEREWLP
r�Method
YOc reci
Topographic/Land setting
❑Ridge ❑Slope Malley CIFtat
(check twopriste tar)
LBjt ude/IongitUde of well location
( /ayetrp/seceadtl
Latitude/longitude source❑GPS❑Topogaphie map
(check box)
DRILLING LOG
From To honDessnpnon
atal_
/P0
/a2 of oa
iDO afro
rpSr .0 N
t7m.(,
o noa:t.e. G-
t
CO
t)
LOCATION SKETCLL
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and cont®oroad names.
Slot Sian Material
in. a��
Material
THAT THIS CTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
, LL WASTILAT A COPY OF S RECORD HAS BEEN PROVIDED TO THE WELL OWNER
-e76roa
SIGNATURE OF PERSON CONSTRUCTING TEB WELL DATE
Submit the oa1 • the Division of Water Quality, Groundwater Section, 1636 Man Service Center - Rakish, NC
within 30 days. GW-1 REV. 07/2001
GRGUP�D4160'b9H-fb3±b170fdxNo. (19)77}3221, Y
ASHEVILLE REGIONAL OFFICE
w
rn
0

04/04/2eU2 08:a7 919-715-rJ58s
NODE&hF
257856
WELL CONSTRUCTION RECORD
North Carolina - Department of Enviromnent and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME Wrist) SgMue1 Oa.vin-/2fiie✓ can:nCAnow s30i,Q0
wag. corTRACIORCOMPANYNAME PRICE WELL DRILLING, INC. room s p2i,327 0263
ASSOCIATED WQ PERMIT/
Crf applicable)
STATE WELL CONSTRUCTION PERMTI
(if applicable)
1. WELL USE (Check Applicable Box): Residential Ifi Municipal/Public 0 Industrial O Agricultural 0
Monitoring O Recovery 0 Heat Pump Water Injection l7 Other 0 If Other, Liu Use
2. WELL LOCATION:
tTown: Morgern i'®A e
County By
(Stave, Anse.. Number. Community, Subdi, tioo. Lot No., Zip Code)
3. OWNER: 4,0 Maur e
Address (j nfl /t75
auto ar Rare No.)
/y]o rg g746/1 fl%.6 ,c786�ir
Goa Town sus Zip Code
(9-13)-87ri- 8/S7
Area axle- Phone samba,/�- O S
4 DATE DRILLED —
5. TOTAL DEPTH: M / L7 S
6. DOES WELL REPLACE EXISTING WELL? YES !$' NO ❑
7. STATIC WATER LEVEL Below Top of Casing: _ .
(Use `a" if Above Top of Casing)8. TOP OF CASING IS (V, FT. Above Land Surface'
'Top of easing terminated liner below led surface moires a
9. YIELD (gym): `I 2- verbose Iv seeepce withDAMETHOD OF TEST Air Blown
NCAC IC MIR
10. WATER ZONES (depth)'.
11. DISINFECTION: Typejavtii-A4tinvu Amotmt
12. CASING: Talalei-5 Wall Thickness
Depth Diameter or Weight/Ft Material
From O To 0 8 Ft. 1 G 91/ PVC
From To Ft
From To Ft
13. GROUT: Depth Material
Frotn,.../2_To_...4S,_ FLS'ovicre.1c
From To Ft.
14. SCREEN: Depth Diameter Slot Sim Material
From To Ft —jut _ in.
From___ To FL in. in.
15. SAND/GRAVEL PACK:
Depth size Material
MelhOd
P�
From To Ft
From To Ft.
Topographie/Land setting
Midge Oslope OValley )Flat
(cbedcapwopriur box)
LatiMdellongintde of well location
Latitude/longitude smrce:OGPSOTopographic map
(ebede box)
PIZIal DRILLING LOG
From To Did+/-01..3' on
28 WO cry n((-c
MO 500 ttr
30Q 500 Gra40-c
.5' oo 70e) Grnn,ic,
7or7 900 0,.244KJe cS .I
g00 40O reraro
e /o t; n eci G .� m
i 0�5i D 11lr
LOCATION SKETCIL
Show direction and distance in miles from at late _
two State Roads or County Roads. Include thcc gr ad n
m
numbers and coon road names.
THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
ARDS. AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL. OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL
Division of Water Quality, Groundwater Section,1636 Mall Service Colter - Ralcigb, NC
T33-3721, within 30 days. GW-1 REV. 07t2001
7-/3-C.-
DATE

II,/oa/_oo_a[�:ai-���,cy �_Lt�a:r
257855
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and
(nNatural Rnouroes - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDLVID UAL) NAME (print) env i ni Lcit.Sher crirIIPICAT1oN s 3 030
27 � 0263
WELL corrutACToa comrANY nava PRICE WELL DRILLIttG, INC. mom" s g 2 327
STATE WELL CONSTRUCTION PERMrf! ItgOCIATED WQ PERNITrd
Of applicable) of applicable)
I. WELL USE (Check Applicable Box): Residential eiMunicipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATI2N:
Nearest Teem: CO PO I I( ix S(rinys Cormty v r �Y
(Street None. Numbers, Commmdy, Subdivision. Let No., Le Code)
3. OWNER -Don fr, �i fl-7o lJ
Address 57 f(S BUrMs Rmod
(Sense or Pons No.)
Goan//y C MSG/y
tem
0as))-- 674- 3 a� Zip Cede
Area coda Phone monk(
4. DATEDRILLED 7-1( - 0a
5. TOTAL DEPTH: / %-
6. DOES WELL REPLACE EXISTING WELL? YES )a' NO 0
7. STATIC WATER LEVEL Below Top of Casing: K O FT.
(use `a" if Abo a Top daring)
8. TOP OF CASING IS / Va FT. Above Land Surface*
`Tep of min termtaated Mier below land sencm reveres s
whoa • tecerdua Mils ISA NCAC 2C.011E.
9. YIELD (gpm): ///O METHOD OF TEST 4%4/7744-9I
10. WATER ZONES (depth): 4 Sff t / 00 T- f
11. DISINFECTION: Type5Cn;,ir//ni'f
12. CASING: Ttt/hIe'E>
Depth _ Diameter
From D To 5) Ft 6
Front_ To Ft
From To Ft
13. GROUT: Depth
From (7 To_62r2 Ft.
From To Ft.
14. SCREEN: Depth Diameter Slot Sim Material
From_ To Ft,___.Jn. in.
From To Ft in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
Front To Ft.
Amount g2L-qP.3
Wall Thickness
or Weight/Ft
G/y yG
Material
CeAcrvir
16. REMARKS:
u. le I��')I40 Fig
(-- WN5TRUCTI
ASHEVILD. Kro.
Topographic/Land setting
ORidge IAlope OValley 0Flat
(check appresnisie bon)
Latitude/longitude of well location
Megreeammeitesdeceem
Latitude/longitnde somce:0GPSOTopographic map
(cheek box)
/
GrDRILLING LOG
Fo/op'
DE>
From To
0 ss
5s /00
I
O re n, +c 0
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.
t
I
THAT THIS WELL WAS CONSTRUCIED IN ACCORDANCE WITH 15ANCAC 2C, WELL
THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
ginal the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
Na (919) 7333221, within 30 days. GW-1 REV. 07/2001
r,

O4/04/200_ 0S:47 sie-r15-i5e8
rift' r
Subunit the Origin
27699-1636 Phone 1
WELL CONSTRUCTION RECORD
Nadi Carolina - Depattmad of Envirotttneat and Natural Resources - Division of Water Quality - Groundwater Section
vats-CoxrawCroa (arntvmu L)Nnnta (Pet.tLS Saud 0 clu I 1.-rO er- crar>itewnors o)o
WELL coNnwcroa.comrArhrmath PRICF WELL DRILLING, INC. mom a /32i 327 0262
STATE WELL CONSTRUCTION PERMIT. f VSOCIATW WQ PFEKITP
(if applicable) (if iaoolicabkt.
1. WELL USE (Check Applicable Box): Residential Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION: Si)Nearest Town: /)10 (31 et+o n Cotmty brue
(Sava Nurse. Numbers. Commmir. Subdivision. La No., tip Code)
3. OWNER: Viat+cr bte^nai
Address al 5 I te, L 4
9o.at or Pons No.)
PIO l nX IV LC &3&55
Mndecedode P�rdP Mn- S3 Zip Cede
Dora Zreotea
4. DATE DRILLED / a
5. TOTAL DEPTH: (C--_
6. DOES WELL REPLACE EXISTING WELL? YES el MO 0
7. STATIC WATER LEVEL Below Top of Casing: _`LET.
(Use `a. if Above Top of Geist)
8. TOP OF CASING IS / (- PT. Above Land Surfaces
`Top of each[ terminated atler below Ind surface requires •
mime. la aeonrdaa wait 15A NCAC 2C.011R
9. YIELD (Wm): y METHOD OF TEST 41 c O to *
10. WATER ZONES (depth):
11. DISINFECTION: Type 9r.i fits f/ do Amount
12. CASING: Wall Thickness
Depth Diameter or Westht/Ft.
Fran T SOFt�_ 6 fir 041:11(tal
From To Ft
From To Ft
13. GROUT: Depth Material n n Method
From C1 To t Ft CJJ(Cr L TO d
From To FL
14. SCREEN: Depth Diameter
From To FL in.
From To FL in.
15. SAND/GRAVEL PACK
Depth Size Material
From To Ft.
Slot Sim Material
_ is
in.
From To Ft.
16. REMARKS:
257854
Topographic./Land setting
ORidge OSlope SValley L1Flat
(cbera appropriate boa)
Latitude/longitude of well location
Oronseylatm tesoeccrite)
Latitude/longitude so urce:OGPSOTopographic map
(cheek box)
DRILLING LOG
Fr To Formation Description
/D
/ n D r2_5-f
J
--c
•
r7 nw
C)
0
LOCATION SKETCH T-
Show direction and distance in miles from at least
two State Roads or County Roads. include the road
numbers and common road ohms.
1 DO HEREBY CERTIFY THAT T"pH�I.S� pW EEE[[fLppAL WAS CONSTRUCTED IN ACCORDANCE WITH 15ANCAC 2C, WELL
L A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
41.t.hte Division of Water Quality, Groundwater Section, 1636 Mali Service Curter - Raleigh, NC
o. (919) 7333221, within 30 days. GW-I REV. 07/2001
GROUNDWATER SECTION
ASHEVILLE REGIONAL OFFICE

o4/:J4/2u02 FJ8:17 515-715-1J588
f {CL,Lt; L LULL
WELL CONSTRUCTION RECORD 257853
North Carolina - Department of Environment and Natural IResources -Divisionof Water Quality - Orwodwater Section
WELL CONraACToa pientv1DUAL) NAML (peru)Jart1Oe) ay_ Los ker. cnBlrftcwnoNs
WELLCONTRAC7on COMPANY NAME PRICF WELL DRILLIfl3, INC. raora s P2i 327 0262
STATE WELL CONSTRUCTION PERMIT. ASSOCIATED WQ PERMITS
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential
Z Mimicipal/Public O industrial O AgriculturalO
Monitoring O Recovery ❑ Heat Pump Water 'cotton 0 Other O If Other, List Use
2. WELL LOCATION: tyn
N iTown.L'onrleUySef'fltgS Corm
Ivy etc) ve (( S -; . re° e h'
(sigbet Name. Numbers. Community. Subilfyisite. Tut No.. rip Code)
3. OWNER
Address
ad
(Stree or Paw No. cA/i
4. DATE DRILLED / I >
5. TOTAL DEPTH: �) A
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO re
7. STATIC WATER LEVEL Below Top of Casing. �O F r.
(Use `." if Above Top of Caama)
8. TOP OF CASING IS 11/a Fr Above Land Surface*
`lop or rash[ tmulaued aver below Ind seance moires s
vaAaaee h acoardaa was ISA NCAC 2C.0IIR ^ )
9. YIELD (gpm): METHOD OF TEST/I'N�/OL.wel
10. WATER ZONES (depth): j
11. DISINFECTION: Type5a n t f ?// Amount
12. CASING: to 6 /e Wall Thickness
Diameter or Weifght/Ft. Ti(it el*
Flom,_, To�Lo0 n 6 6 /y i'Ve--
From_ To FL
From To it
editi
13. GROUT: To_ L+Uf°l_ !'
From � 70�_ Ft. (Wait p'v u
From To Ft.
14. SCREEN_ Depth Diameter Slot Sim Material
From To Ft,____in. m.
From To Ft_in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From, To Ft.
es:. Tanta a4n
16. REMARKS:
Topographic/Land setting
Midge OSlope OValley Whit
(cbeat appropriate box)
Latitudr/Ioogitude of well location
(dapaeelaimam/secoads)
Latitude/longitude so urca:OGPSOTopogaphie map
Ova box)
DEMI DRILLING LOG
From To F
0 /00
/00 a
LOCATION SKETCI( -v
Show direction and distance in miles from at let
two State Reads or County Roads. Include there read
numbers and common road names.
Sfrle
;1de b"))
1 DO HEREBY CERTIFY THAT THIS WELL. WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION S VDARDSi4ND THJLT A COSY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
n of Water Quality, Groundwater Section,1636 Mall Service Center - Raleigh, NC
1, within 30 days. GW-1 REV. 07/2001
GROU1'DWATER S O
ASHEYLLE REGIONAL OFFICE

tJ3/ -'15-D58?
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural
aH..aaal Resources - (D(iv_�✓ Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (prlatl/a r41 l'�k( IAA L<CERTIFICATION Zan)
o
WELL CONTMCroacoatrActr NAarE PRICE WELL DRILLING, INC. PBora a$ 327 02E`
STATE WELL CONSTRUCTION PERMIT/ ASSOCIATED WQ PERMIT/
Of applicable) Of applicable)
257852
i
1. WELL USE (Check Applicable Box): Residential )t Municipal/Public O Industrial 0 A6rr 1 O
Monitoring CI Recovery ❑ Heat Pump Water Injection ❑ Other 0 If Other, List Use 1
2. WELL LOCATION: ''//
N Town: / Countyt/r/4—
Lc. t% /
(Seat N.y�q Numbers. ` Subdivision. Lot No., Tip Cole)
3.OWNER. 1 aGt— t (1?
Address Z 90 //y '4', Sear
e.oe/% S�,,Saft,c G) �2 tc /Z—
(d.,�%). 177 '7 vS � LPCede
Area wee- Thom mmtba oi�"L
DATE DRILLED `/
4. r 1
5. TOTAL DEPTH: aG?
6. DOES WELL REPLACE EXISTING WELL? YES NO ❑
7. STATIC WATER. LEVEL Below Top of Casing: an_FT.
(Use I.." if Above Top of Casing)
8. TOP OF CASING IS lei FT. Above Land Surface*
flop of caste' terminated Woe below Ind aerface requires a /
nitwit/ la aecerd et with ISANCAC 2C.0r1L i^�
9. YIELD (pm): /00 METRO^Pp OF TEST
10. WATER ZONES (depth): 7 SFr- / *se? Fr
11. DISINFECTION: "type S4 n.:-Ie f t`tvtl Amount 2Cgg5
12. CASING: 1—Cr1 le di Wall Thickness
q orWer NFt Material
Fmm l/ Too Ft r (o ��/ 'Ler-
From To FL
From To Ft
13. GROUT: Depth MMuarm4 n Method
From 0 To if) avert iG fl ur<c{
From To Ft.
14. SCREEN: Depth Diameter Slot Sim Material
From+ To Ftv_.__tt. _ is
From______ To FL in. in.
15. SAND/GRAVEL PACK
Depth Size Mueriai
Fmm To Ft.
From, To Ft.
Topographic./Land setting
Midge OSlope Malley alai
(cheek appropriate box)
LadmrdcleoBNde of well location
(doOmitnaahecoadal
Latitude/longitude source: OGPSOTopographic maw
(cheek box) p
ul2Fta DRILLING 1161E
n
From �T�— jtorrpamnpac ton.m�
IUJ;(��tP. r —,
,- AO Bt rt2 4 i Jr-i
&no 6175 t ro, it /
r:
P.)
LOCATION SKETCH
Show direction and distance in smiles from at least
two State Reads or County Roads. Include the road
numbers and common road fumes.
o"- 1
0
16. REMARKS:
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONS CTION STAND AR1 AND T A COPY OF THIS RECORD HAS BEEN PROVIDED TOO THE WELL OWNER
CV ,�//—
i! QA "/ O� SIGNATURE OF PERSON CONSTRUCTING THE WELL DALE
n of Water Quality, Groundwater Section, 1636 Mali Service Center - Raleigh, NC
1, within 30 days. GW-1 REV. 07/2001
GROUNDWATER SECTION
ASHEVILLE REGIONAL OFFICE

ea/e4/=Ou_
91y-ti.D-Utd6
.r
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Nasources Natural Re - Djv/�isioonof Water Quality - Groundwater Section
WEL
L CONI wcroa (E n Cut A
DIVIDUAL) NAME (pram) 30✓PI v/Of l(A(-f CERIrPICAnoNa 3090
watt coNTRACToacoMrANYNava PRICF WELL DRILLING, INC. ?Hartz P2 327 0263
STATE WELL CONSTRUCTION PERMM JC OCtATW WQ PE3MIT
(if applicable) (if st aplliable)
I WELL USE (Check Applicable Box): Residential $- Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Ptoup Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
NEst Town: ery County ` taut .�l o
(S Nine. Numhn. Community, Subdivision. Lot No.. Zip Coda)
3. OWNER:
Address
WJ /y$ri S? in
Cky or Town State yp Z3h'S&
C—�
Area ado -phone number
4. DATE DRILLED rt6 ' 0 a-
5. TOTAL DEPTH: 'P 0 5
6. DOES WELL REPLACE/OUSTING WELL? YES GI NO 0
7. STATIC WATER LEVEL Below Top of Casing: R 0 FT.
(Use `r^ if Above Top of Coma)
8. TOP OF CASING IS / T FT. Above Land Surfaces
flip of mho' terminated atr a below lead tar require
variance h aaerduce wider ISA NCAC 2C.01IR
9. YIELD (gpm): 9 '".+— METHOD OF TEST A• /
10. WATER ZONES (depth):
1l. DISINFECTION: Type...546 // Amount
12. CASING: T 6 rb Wall Thickness
Depth or Weight/Ft.
From 0 To A b FL io ^ dL
From_ To
From To
13, GROUT: Depth
Front_ _ To a n
Ft
Ft
Adatetiat
Ft. Crttrepk
From To Ft.
14. SCREEN: Depth Dina= Slot Sim Material
From To FL_ .. j t. in.
From _ To Et_in. in.
15. SAND/GRAVEL PACK
Depth Sia Material
From_______To Ft.
From, To Ft.
Dlattiod
^ U W
16. REMARKS:
257860
Topographic/Land setting
Midge [Slope [Valley Mat
(chide appapriYe tax)
Latitudctlocgitude of well location
(agreadtnimmdaexe4t)
Latitude/Longitude source: DGPSDTopographie map
(check box)
DIM DRILLING LOG
From To
6 nor ah E Description
- / a 0 As/air /'c-
1cad) 'jaO %io„%rc�2_
2-an• 3oi y/cyi f.4.0.
r
ere
LOCATION s1cETC$ tv
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road Dames.
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTIQN STAt$8R D3, Aj1DT1L JA COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
DL l; liiiit the rii iphLl tilt
, 27699-1636 Phone Ndt 1p
i . I,.
GROUNDWATER SECTION
ASHEVILLE REGIONAL OFFICE
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Division of Water Quality, Groundwater Section, 1636 Mall Service Center - RaleiEh, NC
T333221, within 30 days. GW-1 REV. 07/2001
cn
0

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone]
258644
WELL CONSTRUCTION RECORD
WELL CONTRACTOR. Dewey Wright Well Pump Co., Inc.
WELL CONTRACTOR CERTIFICATION #: 2686
020497 STATE WELL CONSTRUCTION PERMIT#• Leslie Reece
1. WELL USE (Check Applicable Box): Residential 0 Municipal n Industrial 0 Agricultural I 1 Monitoring
Recovery Heat Pump Water Injection 0 Other 0 If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: PINEOLA County: BURKE
TURNER MILL RD OFF BROWN MTN BEECH RD OFF H
(Road Name and Numbers, Community, or Subdivision and Lot No.)
DRILLING LOG DEPTH
3. OWNER RONNIE G. GRAGG From To Formation Description
Address 3950 TURNER MILL RD. , 0 115 DIRT
MORGANY cif RonteNn.) NC 28655 115 212 GRANITE
City or Town State Zip Code 212 213 GRANITE
4. DATE DRILLED 7/24/2002 213 245 GRANITE
5. TOTAL DEPTH 265 . 245 246 SHALE
6. CUTTINGS COLLECTED YES NO I XI 246 265 GRANITE
7. DOES WELL REPLACE EXISTING WELL? YES 0 NO I —I
8. STATIC WATER LEVEL Below Top of Casing: CO 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)• 7.5 METHOD OF TEST Air
11. WATER ZONES (depth):3 ppm 212-213 4.5 rpm 245-246
0 ppm 0 ppm
12. CHLORINATION: Type HTH Amount 43
13. CASING:
If additional space is needed use back of form
LOCATION SKETCH
Depth Diameter or Weight/Ft. Material (Show direction and distance from at least two State
From 0 To 123 Ft 6 1/8 2)50 PVC lei,
raaads, or other map reference points)
From To Ft
From To Ft
14. GROUT:
Wall Thickness
Depth Material
From 0 To 20 Ft Cement
From To Ft
15. SCREEN:
Method
Gravity Flee
Depth Diameter Slot Size Material
From To Ft in in
From To Ft in in
From To Ft in in
16. SAND/GRAVEL PACK:
ze Material
17 fY ER BVCERTIFY THAT T IS LL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CbOONSITRUCTION STANDARDS AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
SIGNATURE OF PieON CONSTRUCTING THE WELL DATE
Submit original to Division of Water Quality, Groundwater Section within 30 days
GW-1 REV. 12/99
0
ro
r�

64/04/2UU2 US: 4,
WELL CONSTRUCTION RECORD 257851
North Carolina - Department of Environment and QNQatnral Res Oo) cta - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (R7mVIDUUAL) meta (prise)✓4/Y del Lhw Id 6c$'t er co nncwnona 3-020
____
7 Q
WELL corrTRAeroacomma' NAME PRICF WELL DRILLIrTG, INC. PRONE a IS27 � 327 02E8
STATE WELL CONSTRUCTION PERMIT/ ASSOCIATED WQ remora
Of applicable) (,f2liable)
1. WELL USE (Check Applicable Box): Residential ll MUmicipaUPublic ❑ Industrial 0 Ag icutwai 0
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION: Qtr rK�
N tTown://Dtw.H'f °Y1 County
(Street WoiXNumbeks. Commmitg, SVbdlvtsiot Lot No., Tip Code)
3. OWNER: U O LIRAelplc)�1 Q
Address qg5; 9h
(s4 rrRoues No.)
QOv11V j�/C v $ ' P `J.-
tltyarto:er �Sten Zip Code
c 17y— "7?'
Mn coda Phone number
4 DATE DRILLED 7 `act — 0
5. TOTAL DEPTH:
6. DOES WFT.i REPLACE EXISTING WELL? YES fly NO 0
7. STATIC WATER. LEVEL Below Top of Casing: SFT.
(Use *a` if Above Top of Cedar)
8. TOP OF CASING IS //01 Pf. Above Land Surface*
nap of castle ternhated suer below Ind surface requires
9 YIELD hisecerduawhbl3AM TODOFTESTA-10FJID"^"4
IC Al 1
10. WATER ZONES (depth):
Topographic/Land setting
DRidge fQSlope DVsllcy Coat
(check apexepmiete box)
Latintddlongitude of well location
Rep seroode)
Latitude/longitude source: OGPSOToptgraphie map
(check box)
DRILLING LOG
From To
o yo
00
�, 00 .SOD
a Hs-O
11. DISINFECITON: Type
12. CASING:
Depth
From_ To 70 Ft
From To Ft
From To Ft
Amount
Wall Thickness
or`. jtift M etal
13, GROUT: Depth Material nn Mahod
From £ To r L) Ft. ('DYCrt ie YDo c (d
From To Ft.
14. SCREEN: Depth Diameter
From To Ft in -
From To Ft_in.
15. SAND/GRAVEL PACK
Depth Sim Material
Frorq___To Ft.
From To Ft.
Slot Sim Material
in.
16. REMARKS:
yS
.4
LOCATION SKETCH v
Show direction and distance in miles from at elt
two State Roads or County Roads. Include tbeN ad
numbers and common road names.
0
Tokt- Abec RoA
It /
we i\
i ns L� � tdt7N
THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WIIii 15A NCAC 2C, WFr r
THAT OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the ongt. al to the Division of Water Quality, Groundwater Section,1636 Mall Service Center - Rale1E4 NC
27 1 Ala [phone], within 30 days. GW-1 REV. 07/2001
�$fiA+Re

256285
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section /
/ "jp�rl
WELL CONTRACTOR (INDIVIDUAL) NAMEat),AS//t- ,� CERIIF/CATION S
WELL CONTRACTOR COMPANY NAME e r"t2 " V e / I) r /// 01,5 PHONE M f 7(50'eyar/sz?
STATE WELLf �CONSTRUCTION PERMITS ASSOCIATED
applicable)
QPRM�
► applicable)
1. WELL USE (Check Applicable Box): Residential V Municipal/Public ❑ Industrial 0 Agricultural C)
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other 0 1f Other, List Use
2 WELL LOCATION/1 1 �e
Nearest Town: /7"",row County
(Street Nome. Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: / VCCI
•/ lCh• S
Address 4/ S;LS )&c 1t /,C flirt- )&
C&A► .s N47e921 Ci 2
L5ry or Ti:76tm 1' State / Lip Code
Alva code- Phone number r _ d�
4, DATE DRILLED
5. TOTAL DEPTH. n_
6. DOES WELL REPLACE EXISTING WELL? YES NO 0
7. STATIC WATER LEVEL Below Top of Casing:
J (Use if Above Top of Casing)
8. TOP OF CASING IS FT. Above Land Surface*
*Top of easing terminated at/or blow land saaact requires a
vedette In acwrdeye nth ISA NCAC 2C Silt`
9. YIELD (gpm): / 6t7 METHOQ,it `
F TEST 4 ! I
10. WATER ZONES (depth): D
11. DISINFECTION: Type ,A,LiW Amount ro o Z
12. CASING: Wall Thiclaness
C/7 DI or Went/Ft Material
FronS _.a - FL s�F"�! OpL
Froth T To Ft. J
Front_ To FL
13. GROUTi:Method
Material
From*°/ .To Ft. Ce + ee-
Front„ 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
From To Ft -
From To Ft.
Material
Topo c/La1id setting
❑Ridge tlalope °Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/mimmes/secoods)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
EMILLING LOG
F tion Description
ue _Cat
DEEM
Fpm Y4 e
'7/3 / _ caw'
c
PO 0
n __
L_
r
r -,.
xr,1
rn:r
LOCATION S1UETC11 — R,
Show direction and distance in miles from at laast
two State Roads or County Roads. Include th&road c
numbers and common road names.
PQ/SiAI or-/^d
iry
16. REMARKS:
I W Y BY CER11F1f THAT W73LLT A C CONSTRUCTED
OPY OF THIS RECORD HAS BEEN ACCORDANCE
PRO
VIDED DED TO NCAC
THE/WELL OWNER
�7 SSU -/ "0 __
SIGN���OF PERSON CONSli // TEE WELL
DATE
Ivision of Water Quality, Groundwater Section, 1636 Matt Service CenterGS 1 RSVRaleigh. C
34221, within 30 days.
Submit the original t 4 t e
Phone No.
t_ 27699-1636 (19) 7
GROUNDWATER
��NDWAfER SECTION
AS -v;II. LE Cf C OL!AL OWFIGE
Ld WUST:90 ZfdfdE ET 'Inf ZZi=Ti?9Vb L : 'ON XUA
dWfld 8 113M ZJ.3?JOW : WMJd

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Divi '`Q rt 1of1Water Quality - Groundwater Section �C
WELL CONTRACTOR (INDWIDUAL) NAME (print) o f•�k1\''t tiA CERTIFICATION r C"�t-)I
WELL CONTRACTOR COMPANY NAME � a \ kl kn C{ PHONE # ILMo)�+ C O4 VJ
ASSOCIATED WQ PERMIT#
(if applicable)
STATE WELL CONSTRUCTION PERMIT#
(if applicable)
261308
I. WELL USE (Check Applicable Box): Residential Et Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION: `
Nearest Towrc/n:mocgf�^n CountyRXt r Le
(Stitt Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER:
Address
V..otA LA)4\\ r
CA-Asy C cro96
��_ (Street or Route Nna�
tgnn��
City or own State Zip Code
Area code- Phone number
4. DATE DRILLED t45-a&'oa
5. TOTAL DEPTH:
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO Eir'
7. STATIC WATER LEVEL Below Top of Casing: tit, ( FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS I FT. Above Land Surfaces
*Top of casing terminated at/or below land surface requires a
variance In accordance with 15A NCAC 2C.0118. ^�
9. YIELD (gpm): .fl METHOF OF TEST licit 4 Er
10. WATER ZONES (depth): $4 "� •
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ft
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTtj pRILLING LOG
From To , _ Fo , _tion Description
4
4-
O
.v
rrl
LOCATION SKETCH v
11. DISINFECTION: T) pc.:k\ S Amount a 1 % 1 b Show direction and distance in miles from at leash
12. CASING: Wall Thickness two State Roads or County Roads. Include the road
Depth Diameter 0 or Weight/Ft. bateenal numbers and common road names.
From C) To Ft. (Ci, ( cox.k« C
13.
From To Ft
From To Ft.
GROUT: Depth Material (� Method
From o To Ft. te4i CA, er�-� `-rc& -4,1
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.
e�asf47� 2-q/6
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL Wy4S CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STANDARDS .AND TFIA
SIGN
COPYAFTHIS' CO: aHA B IVIDEDTOTHEWELLOWNNtER.41
/h� /i r / l na61
OF PERSON CONSTRU; ING
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-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) tJO.:1 .1 / ` )u St tC C. CERTIFICATION # .k5 0( Q
WELL CONTRACTOR COMPANY NAME St LAYS. Cie iCp\\� it\\t(1.3\ PHONE #(iSJ%gag-HT-r C)
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PG& IIT#
(if applicable) (if applicable)
259397
L WELL USE (Check Applicable Box): Residential B'>;- Municipal/Public 0 Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: (X\Ora:LiN.Aor CountyrtiLuck-e
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: 4.0-11--
Address 10f nr A re'
(Street or Route No.)
Moir fern \tNc- 3-6 Co 5 —/1rt
City wn Static Zip Code
(2- 33 t 30d1
Area code- Phone number
4. DATE DRILLED (0-13`6—a-
5. TOTAL DEPTH: . . S
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 0
7. STATIC WATER LEVEL Below Top of Casing: (o O FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surface*
*Top of casing terminated attar below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 10 METHOD OF TEST t C
10. WATER ZONES (depth):
11 DISINFECTION: Type e_AO C1/4r\2.
12. CASING:
Depth
From 0 To F
From To Ft.
From To a(n Ft
GROUT: Depth M
From C) To - Ft. )—+
13
14
15
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.
Topographic/Land setting
DRidge ❑Slope ILLY5lcy ❑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
C- 63
bin s S
LOCATION SKETCH
U
c•1
+•1
v
0
Amount%e2 Gino Show direction and distance in miles from atlast
Wall Thickness two State Roads or County Roads. Include the-soadk,;,
or Weight/Ft. Ma eri numbers and common road names.
eAti
MMthod
-a as Cecil
From To Ft.
pD{r, !„,,,,,,, ,
13171TEREBYCERTIFY
CONSTRUCTION STAND
LL
(,POOP;EN\t'i SECTiOP!
AiPPA1l!Et3YftEit - A91QbFl • nisi ion of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
9-1636 Phone No. [phone], within 30 days. GW-I REV. 07/2001
O
CY1
S CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
A COP OF THIS PROVIDED TO THE WELL OWNER
CTING THE WELL DATE
n.

i.?rth 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. Pj1ip /<c, we/i q// l/;/I)
WELL CONTRACTOR CERTIFICATION #: )Oa 0
STATE WELL CONSTRUCTION PERMIT#:
2578'70
1. WELL USE (Check Applicable Box): Residential at. Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ ether ❑ If Other, Ust Use:
2. WELL LOCATION: (Show sketch of ttje location below) Qu/ �
Nearest Town
•utiveo /✓j0(�ctn�ON County' /�
(Road None and Numbers. Community, or Subdivision and Lot No.)
3. OWNER I/049lod PG A) ✓a n j ' -
Address 4 9 02 Lth /-4 N to"
(Street or Route o.) �� S
/Ylolson-/1 c -hp Cod.
City/or Townn State
4. DATE DRILLED
5. TOTAL DEPTH 7
6. CUTTINGS COLLECTED YES ❑ NO
7. DOES WELL REPLACE EXISTING WELL? YES DI NO®
8. STATIC WATER LEVEL Below Top of Casing: MVP FT.
(Use'.' If Above Top of Casing)
9. TOP OF CASING IS ) 77- FT. Above Land Surface'
'Top of cuing terminated ator below land surface requires s variance in accor-
dance with 15A NCAC 2C .o
10. YIELD (gpm) METHOD OF TT
11. WATER ZONES (depth): "7 f'0 BB
12. CHLORINATION: Type 5at.:(4-loVI Amount leg,"
13. CASING: ?lib(trt7T
DRILLING LOG
From To
/O0
aqo
.2 CO 3bO
aerdei a,DO - goo
Yoe mop
rroo o 0
e ° ' 72"6"
Depth
From ° To Ft
From To Ft
From To Ft
14. GROUT:
Depth Material Method
From 0 To 9 O Ft Gnn7LUe- POa
Diameter
or
Wan Thelma
GIs
!l G
From To Ft
15. SCREEN:
From
From
Frofn
Depth
To
To
To
Diameter Slot Size Material
Ft , in, — in
Ft. _ in __— In
FL In. In
16. SAND/GRAVEL PACK:
Ft.
From
From
17. REMA
I DO H
CONST
FOR OF
Quad No:
Serial No.
EBY*CERTIFY THAT THIS WELI WAS
UCTI aN T NDAaDc Aun 7ti . A C
GROUNDWAILR SECTION
er�re �r-nm:n:taa DUAL OFFICE 1
Material
DEPTH
Fomalon DeScription
b�'iIt
eetrt. i"'�
�rc.nte.: -.
�o ktV
C rQn(
0cT
-c
If additional space S neededole back of fop,
Q ycl
0
LOCATION SKETCH
(Show direction and distance from at least two State
Roads. or other map reference pphtts)
4ntle5 ter/ Oit 642
kcr\ba "s
163
ONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
PY OF THIS RECORD HAS BEEN PROVIDED TO THE WEU. OWNER. L�
oZ6�
.. .... A1'4
SIGNATURE OF PERSON CONSTRUCTINOTHE WELL D_
Submit original to Division ewer Gustily, Oroundwaui Saedon withlri 30 days GW-1 REV. 12f99

25787M
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:Cl RTIF1ICATION N: if
i t - rni t
STATE WELL. CONSTRUCTION PERMIT#:
1. WELL USE (Check Applicable Box): Residential Q Municipal ❑ Industrial ❑ Agricultural 0
Recovery ❑ Heat Pump Water Injection ❑ Other If Other, List Use:
2. WELL LOCATION: Show sketch of the location below) u t
Nearest Town: OW )(- I County: A
IacS rn u i ( S-(—
(Road Name and Numbers, Community. or Subdivision and Lot No.)
3. OWNER 71C rse4jr�1g' rfon �!
OjStreelorRRou�af1�1� a$+oSJ
iti
Address
City or Town O ` St Zip Code
4. DATE DRILLED
5. TOTAL DEPTH
6. CUTTINGS COLLECTED YES ❑ NO®
7. DOES WELL REPLACE EXISTING WELL? YES ❑ NTO�
8. STATIC WATER LEVEL Below Top of Casing:
(Use', if Above Top of Casing)
9. TOP OF CASING IS / �/ a\ FT. Above Land Surface'
-Top of casing terminated at/or below land surface requires a valiance In accor-
dance with /5A NCAC 2C.1115 •
10. YIELD (gpm): ff 0 METHOD OF TEST /1 r f :ti �O'")
11. WATER ZONES (depth)'
D3
L CONSTRUCTIO
DRILLING LOG
From To
C)
1 SO ` 1 5-0
,150 -css0
G co I-0
7.50 3' 5-0
_'O -
12. CHLORINATION: Type Amount
13. CASING:
From
From
From To Ft
14. GROUT:
Wall Thickness
Depth Diameter or Weight/R. Mlatedai
D To 41 Ft. _& _
To Ft.
Depth Material Method
From (� To `.-C Ft Gail fedC rnaIC
From To Ft.
15. SCREEN:
Depth Diameter Slot Size Material
From To _ Ft _— in _ in.
From To __ Ft._— in. -- In
From To Ft.— In. — In
16. SAND/GRAVEL PACK: Depth Size Material
To — -- Ft.
From
CRCI.11
I DO HEREBY Cd
OR -OFFICE
HCE
Serial No.
Ft.
Monitoring 0
DEPTH
Formation Description
an'- - kook
If additional space is needed use back of form
Si SKETCH N --.
(Show direction and distance from at least two State, CI
=l..;
Roads, or other map reference points) ;� c-,
t
J
Ora t
w
ry
THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
DARDS, AND THAT A COPY THIS.REC .RD AS B3 PROVIDED TO THE WELL OWNER.
ON Y
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit original to Division of Water Quality. Groundwater Section within 30 days G W-1 REV. 11199

04/e4/ 2002 3S: 47 919-715-0599 r,Illncrr.;
Lr
CONSER
11
Submit the origitM446
Z57S58
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
°
wry.r. CONTRACTOR (mmlvmuA[.)Nwn�Iprt.g5anwel Davit lar 5ireCERTIFICATIONCERTIFICATIONoj02
on o
�i
waLLwtrrawcroaconnANrnwatE PRICE WELL DRILLING, INC. Paont:a$� 327 0268
STATE WELL CONSRtUCr1ON PERMIT# .A OCIATW WQ rumen*
(if applicable) of applicable)
1. WELL USE (Check Applicable Box): Residential ® Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other CI If Other, List Use
2. WELL LOCATION: ur{Lf
Nearest Town: i 1 h County
Ooldfr ne,, Nuckole d/ yb`f
(Street None. Nuwb/en. Cemmmiry, Subdivisim. Let No., rap Code)
3. OWNER: l t1 nr ✓Vvni vI f? oo kis)
Address l I � lr 9 •c o nI r a i, (1 (-
Maw oe Room No.)
tntlan orV( C aStoS
Goy or Teem Ste Zip Code
Arse code- Mows mmbor
4. DE DRILLED
AT6 ..,q`Oa
5. TOTAL DEPTH: c0 00 FI-
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO air
7. STATIC WATER. LEVEL Below Top of Casing.. T.
(Use -+" if Above Top of Cadet)
S. TOP OF CASING IS / //4. FT. Above Land Surface*
'gap of easing tenanted Ivor below Taal awatce require
mines h accordant with 15ANCAC 2C.011O R �rRIOW/)
9. YIELD (gpm): ME -MOD TEST ft
10. WATER ZONES (depth): /0 S%
11. DISINFECTION: Type Santtaf100
12. CASING: TAloolc{5
Depth, Diameter
From To O Ft A
Fromt_ To Ft
Fromt To Ft
13. GROUT: Depth Material (�"Merlins,
From f') To r� B Ft. COncrC� C ,/rta
From To Ft.
14. SCREEN: Depth Diameter Slot Sim Material
From To FL._ 1L __. in.
From To Ft m. __ in.
15. SAND/GRAVEL PACK
Depth Size Material
From To Ft.
From To Ft.
Topographic/Land setting
DRidge 0Slope MVailey OFlat
(check appropriate boa)
Latitude/longitude of well location
(b0 "imro✓aeroode)
Latitude/longitude smaee:OGPSOTopographic map
(chalc box)
DIEM DRILLING LOG
From To
1') SO
CM /00
/0709L0
L. cn
LOCATION SKETCH C n
Amount,-,1 cc/3 S Show direction and distance in miles from atleast
Wall Thickness two State Roads or County Roads. Include the road
h �t,VL Mstenanumbers mbers and common road names.iA y�
CMG( F1ineRd
16. REMARKS:
2
0
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISANCAC 2C, WELL
THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
DATE
SIGNATURE OF PERSON CONSTRUCTING THE WELL
Division of Water Quality, Groundwater Section,163E Mall Service Cooler - Raadga, NC
27699-1636 Phone 24o. (9}9) 733-3221, within 30 days. GWa REV. 07/2001
GROUNDI`:YATER SECliph;
ASHEV'IL'LL OFHCE
r•i

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print)t nOr-4t 11 F KI t LYNCL CERTIFICATION #?)\ 1l
WELL CONTRACTOR COMPANY NAME r kit irYl Pt i;TIP 4 1 K1F LL- PHONE # (90.11C1Q1-1'854-i 2.
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential Pr/Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town;/ Y.V)/r 4i Imo) County,' i /L Ai ,
(Street Name, Numbers, Community.'(\.,SubdL2 t_V t No., Zip Code)
rooccaonk3.OWNER'Nir,\\,Av-rIS
Address K�-L
(Street or Route No.)
rvincTrynk r n.C_ RLfSS
City or Town State Zip Code
(R2 )- LI'12 ,I (oCP
Area code- Phone number
4. DATE DRILLED ) O -ICI -07
5. TOTAL DEPTH: C—'
6. DOES WELL REPLACE EEEXIST WELL? YES 0 NO 0
7. STATIC WATER LEVEL Below Top of Casing: FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
*Top of cuing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .011S.
9. YIELD (gpm): 7 METHOD OF TEST p / 2
10. WATER ZONES (depth): ZC-Yt:•
11. DISINFECTION: Type Amount
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From Q To / 10 Ft. t '7,1
From To Ft.
From To Ft.
13. GROUT: Depth
From > To_.2,„„a 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.
Material Method
16. REMARKS:
L ; L O HEIWBY'tE
GROUN
°,SHEVILL
Topographic/Land setting
❑Ridge BSrlope ❑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 / 2 /7 3 /�LU- ( C ohm
/ :LI p J PS-" C -ouv:4...
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.
LID
THAT 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
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE r
he Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC C11
9) 733-3221, within 30 days. GW-1 REV. 07/2001
0
c
0

cuJs3s
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) WAYNE LONG CERTIFICATION #
2343
WELLCONTRACFOR COMPANY NAME HICKORY WELL DRILLING CO. PHONE# =0035
STATE WELL CONSTRUCTION PERMIT% -----ASSOCIATED WQ PERMIT#(if applicable)
(if applicable)
I. WELL USE (Check Applicable Box): Residentiat 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: RGANTON
Nearest Town:
7370 ANTTOCH RD.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: HAROLD COFFEY
- Address 2370 ANTTOCH _RD.
(Street or Route No.)
WP(AMY-1N Nf' 9RJS5
City or Tam State Zip Code
(878)- 437-4916
Area code- Phone number
4. DATE DRILLED 06-12 02
5. TOTAL DEPTH: 265
6. DOES WELL REPLACE EXISTING WELL? YES ITXNO 0
7. STATIC WATER LEVEL Below Top of Casing: 70 FT.
(Use'4^ if Above Top of Casing)
8. TOP OF CASING IS 2 FT. Above Land Surface*
*Top of cuing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .011g.
9. YIELD (gpm): 7 METHOD OF TEST BY AIR TEST
10. WATER ZONES (depth):
County BURKE
11. DISINFECTION: Type HTH TARS
Amount
41
12. CASING:Wll Thickness
is
Depth Ea ter or We.t/Ft.
From To
96FFt.t. From 0
From To FL
13. GROUT: Depth Material Method
From 0 To 20 Ft. GROAT POURED
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 FL
To Ft.
Material
STEEL
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate boat)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑opographic map
)
DEPTH, DRILLING LOGO
From To Formation Descripti jR
From
From
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.
/b0f4Nfd/" /1
Hwy. it
W
tfiVe//v
16. REMARKS:
1D0'Y-IE1tEBliC Tf�"1)�;
CONSTRULIIUNSI
ANUARF£
In J
U
THIS WELL WAS CONSTR
dCOPY
SIGNATURE OF PERSON C
IN ACCORDANCE WITH 15A NCAC 2C, WELL
CORD HAS BEEN PROVIDED TO THE WELL OWNER
06-18-02
TRUCTING THE WELL DATE
$uhuut'the orn he Division of Water Quality, Groundwater Section, 1636 Mail Service Center- Raleigh, NC
AS 27699463cpbom Ncif(pr) 73}3221, 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
N
WELL CONTRACTOR (INDIVIDUAL) NAME (print) WANE T (NI CERTIFICAPHONE # £ATIodx_211TS
WELL CONTRACTOR COMPANY NAME FIIQCFY 4]FIL ➢{LLI2C at
ASSOCIATED WO PERMIT#
STATE WELLCONSTRUCTIONPERMITS (if applicable)
(if applicable) )
1. WELL USE (Check Applicable Box): Residentiatfl 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:
Nearest Town: ?1B NWT#
4085 Fkf 18 CHIN
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: NASSIR M A MD DAM I BANKERS
L TIM t�F�WR V
(Street or Route No.) 3217pfi55
2 HAY FAST, M CANICN
City or Town State Zip Code
(R2R )- 411-1485
Area code- Phone number
4. DATE DRILLED C6-24-02
5. TOTAL DEPTH: IRS
6. DOES WELL REPLACE EXISTING WFI T 7 YESt1 NO 0
7. STATIC WATER LEVEL Below Top of Casing: 20 FT.
(Use's[-^ 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 g accordance vrit415AME HOD OF TEST BY AIR �I
9. YIELD (gp ):
10. WATER ZONES (depth):
County F(WF.
11. DISINFECTION: Type HE TABS
12. CASING:
Dept), Diameter
From To 128 Ft. b`Z.
From To Ft.
From To Ft
13. GROUT: Depth Material
From 0 To 20 Ft (OTC
Amount 77
Wall Thickness
or Weight/Ft.CAL1vS1ta1 L
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutoslsecondc)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
pEPTH FRILLING LOG
From To Formation Description
Method
;CURED
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 Ft.
To Ft.
From
From
CONSTRUCTION STAND
GROZQ b/VATEaR. OTI'fLL
A§H 99-163 REQBIne Divi
t /699-16s6 Phone No. In') i.+4-4221, within 30 days.
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.
)
11,
M gha" ��Hv
W
czCa
Maze
6a wok
OP
s
rn ti
▪ 0
IS WELL WAS CONSTRUL IN ACCORDANCE WITH 15A NCAC 2C, WELL cn
THAT A COPY OF THI � CORD HAS BEEN PROVIDED TO THE WELL OWNER 2
C6-26-02
DATE
A11fl OF PE
N
UCTING THE WELL
ion of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
GW-1 REV. 07/2001

255807
WELL CONSTRUCTION RECORD
North Carolina -Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) WAYNE 1_CM
CERTIFICATION a 2343
PHONE # t8781 324S1.35
WELL CONTRACTOR COMPANY NAME
STATE WELL CONSTRUCTION PERMIT/ ASSOCIATED WQ PERMIT#
(if applicable)
ITEM WFTI CRILI 1N CD.
(if applicable)
1. WELL USE (Check Applicable Box): Residential Municipal/Public 0 Industrial 0 Agricultural ❑
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: 1BrI County
BEE
2796 ET31 HA711ERY KlasID
(Street Name, Numbers, Community, Subdivision, lot No., Zip Code)
STEVE MIEFI1H
3. OWNER:
Address
2/% FTSH Humid 17i)
(Street or Route No.)
City or Town State
(828)- 433-1857
Area code- Phone number
4. DATE DRILLED ()F,-ltI-117
5. TOTAL DEPTH: 405
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO IX
7. STATIC WATER LEVEL Below Top of Casing: 120FT.
(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 .a118.
9. YIELD (gpm): 3 METHOD OF TESTY ATR 7FST
10. WATER ZONES (depth):
Topographir/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
Zip Code
11. DISINFECTION: TypQi1-i TARS Amount W`
12. CASING: Wall Thickness
Depth Diameter orWeight/Ft. Material
From,_ To 154 Ft. rb —
From To Ft.
From To Ft. Material �e�od
13. GROUT: 20 Ft. MITI' KLMhll
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
Frog To Ft. in. in.
From_ To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
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
fV
L
c=
r
0
T THIS WFI f WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL N
S, AND THAT A COPY OF THIS tyrf RD HAS BEEN PROVIDED TO THE WELL OWNER
A
SIGNATURE OF PERSON CONS
G THE WFI I DATE
N
0
z
ivision of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
3-3221, within 30 days. GW-1 REV. 07/2001

256284
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and N�totti,„�7{ roUrces/-- Division of Water Quality - Groundwater Section S�6
WELL CONTRACTOR (INDIVIDUAL)NAME (prlat)_._r �'—L"7r�~Yf�� �""J"�•AL / CERTIFICATION#4�"t7
WELL CONTRACTOR COMPANY NAME 410 tE ' - 4 e,/( r'r�//f/ PHONE# er1/4:9/3..2
STATE WELL CONSTRUCTION PERMrf _.,,onsOCIATED WQ PERMTP#
(if applicable)
(if applicable)
1. WELL USE (Check Applicable Box): Residential k 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:m„,
Nearest Town: a0 rfMt 0I' County 4th i e.
(Sheet Neme.Numben, Commu&ry,
3. OWNER:.
7 ST 0 Address
Ce4 Jif�(shee`1=P� a' �G e2 gg/R
City or ToWa �Staze yP
Area Phone manber p
4. DATE DRILLED C'�
5. TOTAL DEPTH: -2 on
6. DOES WELL REPLACE EXISTING WELL? YES f Casing; �❑�NO !6'
7. STATIC WATER LEVEL Below 9CTpn- jC if Above Top of Casing)
8. TOP OF CASING IS � FT. Above Land Surface"
'Top of casing ferminattd at/or below land aar6ee requires a
swum to accarda a with 15A NCAC 2C .DIM as�/f•I-,rL
9. YIELD (gpm); METHOT9 Q_F TEST , T
10. WATER ZONES (depth): if9S•
I, /40/
H
11. DISINFECTION: Type tY Amount .CO Z
12. CASING: Wall Thickness
Depth Di o�gghhtt/Pt.
From Tod 96 Ft
From_ To Ft
From.. To Ft.
13. GROUT:
Fro / To Et.
From._. To Ft.
14. SCREEN: Depth Diameter Slot Size Material
Prom To Ft. in. in.
Prom To Ft in. in.
15. SAND/GRAVEL PACK: Depth Size Material
Froth To Ft.
Prom To . Ft
al
VG
Topogap}lic/Land setting
[Ridge ope ❑Valley ❑Fiat
(check appropriate box)
Latitude/longitude of well location
(deyeet/misutes/secwda)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
gram. T F 'on Description
y-
�,�`-,j,/J"f �`, see 11
.ion'
Material Method_
16 RFMARKS:
Is P ,1
D&HFiEBTHIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 1 SA NCAC 2C, WELL
CONSTRUCTION STAN> S, AND THAT A COPY OF THIS RD HAS BEEN PROVIDED TO THE WELL OWNER
SI A F PERSON CONSTRUCTING THE WELL
DATE
Ggitbnihogntionak olio Ph lsion of Water Quality, Groundwater Section, 1636 Mail Service Ceenterl RREV Raleigh,
NC 1
ASF 69 bI iNNik(Ale) 7333221, within 30 days.
G
r--
c
n
LOCATION SKETCH O <n._
Show direction and distance in miles from at l�r st c�� "`
two State Roads or County Roads. Include t1ltroad:
numbers and common road names.
pony Acl
tit
8d WbST:90 EWE ET 'Inf
&EIaS P0L : 'ON Xdd dWfd 8 113M Z1360W : W021d

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - CERTIFICATION
#ti3
Th
WELL CONTRACTOR (INDIVIDUAL) NAME (print) WME L.t`�.T PHONE # (A'H �'J4-(
WELL CONTRACTOR COMPANY NAME I-(LQtFY WFIL IIRILIIN3
ASSOCIATED WQ PERMIT#
STATE WELL CONS/XV PERMIT# (if applicable)
(if applicablecable))
I. WELL USE (Check Applicable Box): Residential Il( Municipai/Public 0 Industrial 0 Agricultural 0
Monitoring ° Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: MR(#IISN County WRIT
3598 PITIS FPR1 RD.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: RIQ1ARD Da+NILaN
Address 7921 N. IETSSVYY ER.
(Street or Route No.)
CARASTA, FT 3421+0
City or Town State Zip Code
(9411377-0713
Area code- Phone number�5-17-{71.
4. DATE DRILLED
5. TOTAL DEPTH: 645
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO Xll
7. STATIC WATER LEVEL Below Top ofA�g:(Use opof Casing)l
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 1SA NCAC 2C .0118.
9. YIELD (gpm): 10 GEM METHOD OF TEST BY AIR `IFSr
10. WATER ZONES (depth):
Topographic/Land setting
°Ridge °Slope °Valley °Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:°GPS0Topographic map
(cheek box)
DEPTH pR1LLING LOG
From To Formation Description
11. DISINFECTION: Type F{ThL1MS
12. CASING: D
DeP
From 0 To w Ft.
From To Ft.
From To Ft.
13. GROUT: Depth Material
From 0 To 70 Ft C WT IT'
Amount 115
Wall Thidcness
CT or Weight/Ft MASTIC
Method
A 11RFT1
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:
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the rote!)
numbers and common road names. n
aft
FAQ 174)'
S
EFIAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WFJ I
ARDS, AND THAT A COPY OF TI ECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON COICfING THE WF.i i DATE
e Division of Water Quglity, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
733-3221, within 30 days. GW-1 REV. 07/2001

254464
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality
WELL CONTRACTOR (INDIVIDUAL) NAME (print) (j A it :� r 1 sY ' f c I=
WELL CONTRACTOR COMPANY NAME ,-i ')S 4-; c v U3 e.tQ r t L C. or
- Groundwater Section
CERTIFICATION # rb.S.R3
PHONE # f ) 7e9"F
STATE WELL CONSTRUCTION PERMIT# _ASSOCIATED WQ PERMITS
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential t�Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: /nage ' 4 County A?� i It'JC
EC iL ,/,,,, t
(Street Name, Numbers, Community, Subdivision, Lot NNo.,- Zip
,Code)
3. OWNER: /2y2�C�J- 04't4'1 t—r''`t (degrees/minutes/seconds)
Address 7 o igo% Q2 `L' Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
(Street or Route No.)
City or Town tate Zip Code
()- e>3— 0//7
Area code- Phone number LP} ^ '2 2
4. DATE DRILLED MAT / £- ?")t
5. TOTAL DEPTH: Da
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 11V-
7. STATIC WATER LEVEL Below Top of Casing: 6,0 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 1SA NCAC 2C .al1g.
9. YIELD (gpm): 7-e9 METHOD OF TEST 4i%Z'
10. WATER ZONES (depth): .2 0 `/nt tV z`w
Topoge lLaDd setting
❑Ridge ( Slope ❑Valley❑Flat
(check appropriate box)
Latitude/longitude of well location
11. DISINFECTION: TypeCA°Y-4'"—C Amount
12. CASING: Wall Thickness
Diameter or Weight/Ft.
Depth
From To Ft.
From 0 To 70 Ft. .�, O
From To '7Z Ft. G iy
13. GROUT: Depth Material
From To Ft.
From C To 2t Ft. 25/
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size Material
To Ft.
To Ft.
From
From
70 - 2 22
c
IV O
z'
n
>o
3oz. 23vhow direction and distance in miles from eastr,
two State Roads or County Roads. Include re ro> Z
numbers and common road names. •- m a
no 5_
� t LS L
Material
Method
Slot Size Material
in.
in.
16. REMARKS:
LOCATION SKETCH V
HEREBY C R}�,iYITIAT2ry♦ ]IS WEL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
C^rit rr'�In ct'4Ni5 .rit S f4ND'T A COPY OFTHISSECORD HAS BEEN PROVIDED TO THE WELL OWNER
I L3.)C ` -
I*A'EURE OFFERSOf CONSTRUCTING THE WELL DATE
al to the Divis on of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
.W`1,733-3221, within 30 days. GW-1 REV. 07/2001

254205
9d WU£S:SB ZBBZ ET 'unf
WELL CONSTRUCTION RECORD
North Carolina - Depot -anent of Environment and Nam ,Rysources - Division of Water Quality - Groundwater Sectionr��6
RA�
WELL CONTRACTOR INDIVIDUAL) NAME who) i73S4 /=, Piet
%t 74 calinCATION s:L
WELL CONTRACTOR COMPANY NAME Me /'c. ft /��Y✓G,/I " ' 1 / /fo i/ PHONE s /0 y42 / 3 Q.R
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential d" MunicipaUPublic 0 Industrial 0 Agricultural Cl
Monitoring 0 Recovery ❑ Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION: (( //��
Nearest To _ tea (d County /& r lee
Vli;✓tk/er Or_
(StreetNemo, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: £ /yid;/VG /4o/AS;it 4
Address/ Fan a.t o
/n tar;
(motor NG)
r
City a Oown Stale zip Code
&eavedo- Phone lumber it.-'"/ O a
4. DATE DRILLED
5. TOTAL DEPTH'Q-S
6. DOES WELL REPLACE EXISTING WELL? YES j7 NO V
7. STATIC WATER LEVEL Below Top of Casing: 0
(Use'+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
'Top of wing terminated .tlor below load surface requires a
name actordanee wJ ISA NCAC 2C .0118. _ ^,o- 1 'A�
9. YIELD (gpm): /'iMETHO6 OF
10. WATER ZONES (depth):
/90'
11. DISINFECTION: Type /JTA< Amount 6 Oz
12. CASING: Wall Thickness
TTAmeter or Wel2ht/Ft.
Prom T hgeS Ft.,
Frorq_ To Ft.
From To Ft.
13. GFrom ': _ Top
From �0e_De p FL
From__ To Ft.
14. SCREEN: Depth Diameter
From_ To Ft.. _fin.
Front,_, To FL _in.
15. SAND/GRAVEL PACK:
Depth Size
From To Ft.
From To Ft
Ma rial
Dwt-
Ce mar-4- pleetthrod r
16. REMARKS:
Slot Sim Material
in.
in.
Material
oopograpluc/Land setting
dge OSlope ()Valley OFIat
(wink appropriate box)
Latitude/longitude of well location
(dogty a/minutea/sco0ads)
Latitudc/longitude source:❑GPPSO opographic map
d
DEPTH PRILLTNG LOG
FA? Tits,
6Bro4SA. ora'frow-
Formation
Description
$o' — ,220'
Pant
LOCATION SKETCH
Show direction and distance in stiles from at least
two State Roads or County Roads. Inc de the road
numbers and common road /ire
O2 TAr r_
:drd -4 dMs5 Ad
W14 kler Dr
0
IV
c_
1 DO HERESY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL tea,.
CONSTRUCTION STANDARDS, AN9 THAT AI r
,,CCOPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWN
SIGNATURE OF PERSON CONSTR 'T}TEWELL,
Submit the original to the Division of Water Quality, Groundw tet clion, 1636 Mall Service CenterRaleigh, NC
27699-1636 Phone No. [phone], within 30 days. �(}AkJREV. 07/2001
I `
GROYi- LR r
Zz£TE944aZ : 'ORF`> 'LRr! DF'144kinrl '8 iiin Z13?JCW : WO?Jd
Sµr '-61af0

254204
Ovine S nttA.5 ,vc-
GtyorTc4n r State / Zips
Arta coda Phone tombs
4. DATBDRILLED 5'—J7--t2
5. TOTAL DEPTH'
6. DOES WELL REPLACE EXISTING WELL? YES �j �NOtri
,.�
7. STATIC WATER LEVEL Below Top of Casing: [!/3 /_.. •
(Use ^+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
Top of rosin terminated Woe below mad surface requires a /
variance g mordant p({a is METHOD NCAC 2C 01F TE T%i/t /
18.
9. YIELD ZONES p 97,1
10. WATER (depth)' / 7 1
11. DISINFECTION: Type Amount
12. CASING: Trig Wall Thiclmess
From/Of To `b y Ft MTh .O/t t1Ft.
Fronj_,• To Ft,
Front_ To Ft.
13. GROUT Meal Matted
nett
tjFL Ceniert- footed
From f To Ft.
14. SCREEN: Depth Diameter
From To Ft.. _in
From To FL_._._1n•
15. SAND/GRAVEL PACK:
Depth Size Material
Front_To Ft.
Front _To Ft
/topographic/Land setting
1t(dge OSlope DValley Plat
(creek "Forum box)
Latitude/longitude of well location
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural�titeissourcces-/r7J�/vrsion of Water Quality - Groundwater Section 6
WELL CONTRACTOR (INDIVIDUAL) NAME (piloott)� A../S4 ley Aid ie c- CERTIFICATION
WELL CONTRACTOR COMPANY NAME A) %e,7L- e✓c-// Pr'//Ay PRONE 0Par'.V62-13eW
STATE WELL CONSTRUCTION PERMIT* ASSOCIATED WQ PERMIT:
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Rcsidential(� Municipal/Public 0 Industrial ❑ Agricultural 0
Monitoring 17 Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: ,S%Oryry l] County r
ite
(Street Name, Numbers, CanmaNd. Subdivision, Lot Nu,, Zip Code)
3. OWNER: / I OLV (S ! /( Ce J/�y (degrees/mieuies/seconda)
Address At? - e 1" Ni / r d_ Latitude/longitude sourcc:❑OPS❑Topographic snap
(Stunt a Na.) (check boa)
paPTH DRILLING LOG
To�� Fo s'onDesc' lion
Fr_ $ a
89 q 5' G Ai fc
Slot Size Material
in.
in.
LOCATION SKETC$
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
L
N
16. REMARKS: as
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUL. tY:U IN ACCORDANCE WITH ISA NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND TIi/LT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER9
SIGMA
PERSON CONS.]
Submit the original to the Division of Water Quality, Groun
27699-1636 Phone No. [phone], within 30 days.
Ed Wd2S:SO EBB? ET 'unf
4?-r._�_ - /7 da
itrie:tion, Mail Service
3E2TZ9bbBL : „� Pk;,
l
Raleigh, NC
1 REV. 07/2001
rrt
0 az
rn
>0
m0
0
to
mz
0
6-1
Ild 2 n an ZJ SbOW : WONd

254470
2. WELL LOCATION:
N/1 rota tt-�•�,—County
u 2
Nearest Town: .
(Street Name, Numbers, Community Subdivision, LotNo., tip
ri lid- 14
3. OWNER: 1 LL
Address
City or Town
Area code -Phone number
4. DATE DRILLED
5. TOTAL DEPTH: 5�
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Belo NT` p o fCasing _1.
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. !S a ;� .JtrOd%�-
9. YIELD (gpm): —METHOD OFF TEST C_-- —
10 WATER ZONES (depth):
WELL CONSTRUCTION RECORD
nt of Environment and Natural Resources - Division of Water Quality - Groundwater Section
North Carolina - Department .fJ L (; CERTTPICATION N �� /[1
WELL CONTRACTOR (WDMVIDVAL) NAME (print) jL/5l L�
WELL CONTRACTOR COMPANY NAME 7fe PRONE 0
ASSOCIATED WQ PERMIT*
STATE WELL CONSTRUCTION PERMITB if licable
if liceble /
1 WELL USE (Check Applicable o Box): Residential l Municipal/Pubhc ❑ Industrial 0 Agricultural ❑
Water Injection 0 Other ❑ If Other, List Use
Monitoring 0 Recovery 0 Heat Pump J
T ographic/Land setting
dge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(deweplminutcslseconds)
1/4..).44de/longitude sotrce:❑GPS❑Topographic map
(check box)
pR1IrrNGIOG
Fop tionAescription
DE T
From To
State Zip Code
Rv t
N
"—
LOCATION SKET1 a m--
e C abet- C- Amount 73 6 Z C 73"t, Show direction and distance in miles frji at
12. DISINFECTION: ION: Type two State Roads or County Roads. Inclue th ro`ad
12. CASING: c
Depth
From _ To Ft.
Front_O To Iz 2 Fir
From i n To. eS - Ft
13. GROUT: Depth
From To Ft. .1 Ft._ o� :_
Diameter Slot Size MH1erial
Ft. in. in.
Ft in. in.
Wall Thickness numbers and common road names.
Diameter or Weight/Ft. Material
14. SCREEN: Depth
From To
From_ To
15. SAND/GRAVEL PACK:
Depth
From To
FromTo
16. REMARKS:
Ft,
Ft.
LtG
16e dual
.terial Method
Size Material
f THAT IN ACCORDANCE WITH 15A NCAC 2C, WELL
S, AND THAT A COPY OF THIS REECORD HAS BEEN PROVIDED TO THE WELL OWNER
F PERSON CONSTRUCTING THE WELL
ATURE
DATE
'nai t I the Division of Water Quality, Groundwater Section, 1636 Mail Service Centerl REV. Raleigh,hNC
GR0UP:i`: ykip&. fAne No. 919) 733-3221, within 30 days.
ASHE\IEEE E \ OFFICE

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural/Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print)/ +..) c)S+( Cc W f (L D 11-I LEA / �(— C' CERTIFICATION # N
(T N `)
�Q{(' TOM) c-C PHONE # f
STATE WELL CONSTRUCTION PERMIT# - JaSCOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential V 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: rr,�,,,,,,4�
Nearest Town: gLite '�`ad County iSUI'L
DLp fca
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER:
Address
(Street or Route No.)
ryr t t y45/UC
City or Town State
Zip Code
(62e)- 4o70-57 ,7
Area code- Phone number
4. DATE DRILLED 0
5. TOTAL DEPTH: a?/1S
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: /.00 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surfaces
*Top of casing terminated at/or below land surface requires a variance in accordance with ISAMETHOD OF TEST gig'
AC 2C .011g.
9. YIELD (gpm): 30p
10. WATER ZONES (depth):: g3C7lP`i4 P /50
11. DISINFECTION: Type (XepS, Amount f'itnete '9a
12. CASING:
Depth
From To
From To 9 2
From f Z To 6 4/
13. GROUT: Depth
From To
From 0 To Q6)
14. SCREEN: Depth
From To
From To
15. SAND/GRAVEL PACK:
Depth
To
To
Wall Thickness
Diameter or Weight/Ft. Material
Ft.
Ft. l
Ft.
Material
Ft. '
Ft. ,Q C /
Diameter Slot Size
Ft. in. in.
Ft. in. in.
Lid P
Method
Size Material
From Ft.
From Ft.
254469
WELL CONTRACTOR COMPANY NAME
16. REMARKS:
Material
lEte�epographic/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)
DEPTH FRILLING LOG
From To Formation Description
D% /Zc2CL'/G
0- fro
r✓
n —
IV
J ,l
LOCATION SKETCH 3 c
Show direction and distance in miles frommtleagy,
two State Roads or County Roads. IncludrSe rope
numbers and common road names. al
egg
kJ-
(r am > cijwfl
�k'OI TRl T ct T/
Submit the original to thi
GROUA' 9»r1P6IttoRp!So.(919)
ASHEJILLE REGIONAL OFFICE
T THIS WF1.1 WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
)S, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
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
North Carolina - Department of Environment and Na 'Resources - AD.iivision of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) u� IyC^/`/ Or °l�ooI is 1 �- CERTIBIrCAT�IOON a Q g 6
WELL CONTRACTOR COMPANY NAME AI brf. Pz- VVt'rJ/ 27, 4o. PH0NE AJ Q7)" 0L,2
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
{if applicebk) (ifapplicable)
1. WELL USE (Check Applicable Box): Residential EY Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town• frb r%AA 4OA. County [%
(Street Nemo, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: l e7 � e dC//s
Address 7 69/ err n ^ -�
(atrat w Ron No.)
iildrq aA *j NG �
cit9,4 Town State Zip Code
1-)-
Area Cede- Phone number 6-0
4. DATE DRILLED
5. TOTAL DEPTH: VY0
6. DOES WELL REPLACE EXISTING WELL? YES NO ❑
7. STATIC WATER LEVEL Below Top of Casing: 0 FT,
(Use "f" if Above Top of Cuing)
8. TOP OF CASING 13 / FT. Above Land Surface'
*Top of casing tern lasted atior below land surface requires a
variance hi aetordpa Ith 15A NCAC 2C.011S.
YIELD (gpm): METHOD OF
TE
ST EST/9,r�.
10. WATER ZONES (depth): %6 O
11. DISINFECTION: Type 1/
12. CASINO:
Prom topTotiSi/FL
From To Ft
From To Ft.
13. GROUT: Depth Material
Fron> To 2 / Ft, C.Cme i r
Topogi Ic/Iand setting
[Midge lope ❑Valley ❑Flat
(chuck appropriate tax)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitudenongitude saurce:❑OPS❑Topographic map
(cluck box)
DEPTH DRILLING LOG
From To /i
fitf7 r Formation
sDescription
/Vo' l?y.r C
O
xrr
LOCATION SKETCH x'
Amount 1c 02 Show direction and distance in miles from at lit z
Wall Thicicness two State Roads or County Roads. Include the road
1)ia�alpjer or Wei 1 numbers and common road males. —''
g al z
From To Ft.
14. SCREEN: Depth Diameter Slot Size
Ftony„_.,,__„-, To Ft. in.
From To
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Material
in
in.
fE,d AteN # Rd
,#I(3 1ML /lN
16. REMARKS:
IDO HEREBY CER t THAT THIS WEI.I WAS CONSTRUCTED 1N ACCORDANCE WITH 15A NCAC 2C, WELL
IAN,? E, AND THAT A COPY Off' THIS RECORD HAS BEEN PROVIDED TO THE WELL 0�
I'LJ 6' bFPERSON CONSTRUCTINGTHE WELL 4DATE
276§§-leS4Tiki
AS.' = i RrGIONAL.,I
SIGNATURE
al to he Division of Water Quality, Groundwater Section, 1636 Mail Service Center-Raldgb, NC
No. [phone], within 30 days. GW-1 REV. 07l2001
Id WdBt:LB E0ME bT 'F2W
EEETE917170L : 'ON XUd dWfld ' 11Rf1 =NOW : Wald

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mail Service Center - Raleigh, N.C. 27699-1636-Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR- r/-t`eC(ltlC(/Or ) /1n9 PIC
WELL CONTRACTOR CERTIFICATION #: 519020
STATE WELL CONSTRUCTION PERMIT#:
266242
WELL USE (Check Applicable Box): Residential In Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATION (Show sketch of the location below) Burk
Nearest Town :,J red Q CountyB K
Gofd Mivic-, tit&95tff, Fwybq
(Road Name and Numbers, Community, or Subdivision and Lot No.)
3. OWNER I Cr f/v.Si fly
Address
400 0 cr Ey\ P;.L Rd
ut q.
%\OY nr-rObeet or hjr To065
Ciro or To State Zip Coe.
4. DATE DRILLED "23-43'a-
5. TOTAL DEPTH aO
6. CUTTINGS COLLECTED YES ❑ NO®
7. DOES WELL REPLACE EXISTING WELL? YES El NO®
8. STATIC WATER LEVEL Below Top of Casing: )ffi FT.
( (Use': If Above Top of Casing)
9. TOP OF CASING IS J r FT. Above Land Surface'
'Top of casing terminated atlor below land surface requires a variance In accor-
dance with 15A NCAC 2C.0118 Q e
10. YIELD (gpm): .r(') METHOD OF TEST r✓b%w!1
11. WATER ZONES (depth):
12. CHLORINATION: Type _lam4R1-0/1 Amount ,� (IVY
13. CASING: TQb/
Depth
From To 133
From To
From To
14. GROUT:
DRILLING LOG DEPTH
From To o tion escdpoon
D J 3� Wit oek-
130 0100 gran, i-c
.900 3-00 Fi rtn/k,
too oo C fa Ktie
kfco Soo 0rgn.-I-C
Wall Thidowas
Diameter or WeighVR.edal
Ft �o 41 fit ° (--
Ft
Ft.
Depth Material,
From To 0% Ft Co fief-1 -e
From To Ft
15. SCREEN:
dvinme,threct
Depth Diameter Slot Size Material
From To Ft _ in _ in
From To Ft in in
From _ To _ Ft. in. _ In
16. SAND/GRAVEL PACK:
r Depth i
To
,j
To
MAR'< o
I DO HEREBY CERTIFY THAT+HIS
CO %t*F ! •
z
Material
ELL WAS
AT A C
c
o
o
o c•
-
W o-
If additional space is needed use back of Grn�c
53
LOCATION SKETCH en -i
(Show direction and distance from at least twdatate i
Roads, or other map reference points)
JP .
/bbfa' Pa Doe cp
)NSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
Y OF THIS RECORD »AS BEEN PROVIDED TO THE WELL OWNER.
1-1-a3- cd.
SIGNATURE OF PERSON CONSTRUCTING THE WELL
Submit original to Division or water. Quality, Groundwater Section within 30 days GW1 REV. 12l99
DATE

From
15. SCREEN:
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• &e We// f7n.'//th9
WELL CONTRACTOR CERTIFICATION #: 3O 'O
STATE WELL CONSTRUCTION PERMIT#:
261n99
1. WELL USE (Check Applicable Box): Residential m Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, Ust Use:
2. WELL LOCATION:(Show sketch of the location below)
Nearest Town: (nNi/a/%1 Sfirin/- County
Pegroil.e 2I r a
(Road N and� N%p'ntben, Communi or Subdivision and Lot No.)
3. OWNER itP.nne_ i LLI✓f+
Yr J4-01(nwn �d
Address
6
or
Lnnr,llySfrrea is
City or Town State
4. DATE DRILLED
5. TOTAL DEPTH
6. CUTTINGS COLLECTED YES ❑ NO®
7. DOES WELL REPLACE EXISTING WELL? YES NOO
8. STATIC WATER LEVEL Below Top of Casing: /, o FT.
(Use •.' Above Top of Casing)
9. TOP OF CASING IS / �It I FT. Above Land Surface'
-Top of casing terminated at/or below land surface requires a variance In accor-
dance with 15A NCAC 2C .e11
10. YIELD (gpm) /O METHOD OF TEST Ar rS/u uwl
11. WATER ZONES (depth)'
tascio 1 ?-
21p Code
DRILLING LOG DEPTH
From To Formation Description
o •'/2 ,0 A.PocK
y� /oo (9 cnly/,�-
/00 nierS lea Grgn1({e
o
o -aa
tin F
12. CHLORINATION: Type fin)
13. CASING: 4.0
From
From
From
14. GROUT:
0
Depth,
To
To Ft
To Ft
Amount YCy%
Wall Thickness
Diameter or W 4g UFt. Netted
Ft - S r�J
Depth
From O To __0 Ft
To Ft
It additional space Is needed use back of form
Material ,leethod
Corcreie Vour-rd a
C
c3-
Material �ti "C' 93.
in
In s
ere
Depth Diameter Slot Size
From To _ Ft _ in
From To __ Ft _ in
From To Ft. in
16. SAND& of p KE V S
iip
ToTo
Ft--
O u Ft
From
From
17. REMA'
1 DO H
CONS
-s2
LOCATION SKETCH
( how direction and distance from at least two State
Roads, or other map reference points)
In
Material
14
0
r.;
0
!REB'v RTIFV THaX TRIS WFI . WAQ‘OCONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
RUC
�ALET A/PS REvORD HAS BEEN PROVIDED TO THE WELL OWNER.
J Y-0�\
y,C
SIGNATUREE OF 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:
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. (Price Well Dri 1 1 iris LAC
WELL CONTRACTOR CERTIFICATION *: St290
STATE WELL CONSTRUCTION PERMIT*:
1. WELL USE (Check Applicable box): Residential Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below)
Newest Town: Al /' Cj 0 A' -h/V County'
ix
(Road N and Nu a or Subdivision and t No.)
3. OWNER. _ tA.)Iar4re'shtp
Address
P 1 s�--
ir Or A uta No.
lNrwinaToh �c a�ipn
C or Town State Zip Code
4. DATE DRILLED
5. TOTAL DEPTH AP ©O
6. CUTTINGS COLLECTED YES ❑ NOT
7. DOES WELL REPLACE EXISTING WELL? YES ❑ NOTO
8. STATIC WATER LEVEL Below Top of Casing: / 5'—FT.
(Use'.' a Above Top of Casing)
9. TOP OF CASING IS / P—FT Above Land Surface'
'Top of casing terminated aUor below land surface requires a variance In scoot.
dance with 15A NCAC 2C .oJia
10. YIELD (gpm)• G 0 METHOD OF TEST kf e/flwh
11. WATER ZONES (depth)•
gorge
DRILLING LOG
From To
b CR
<lc 00
261098
DEPTH
EomygnrpesCgetc—
CIre?
n»-C
12. CHLORINATION: Type , OS ytki Amount s3 r S If additional space Is needed use back of form
13. CASING: ` L.�
LOCATION SKETCH
Wall Thickness
Depth /� Diameter or Weight/Ft. Material (Show direction and distance from at least two State
From �—To ¥7 Ft. g //1.9 V Roads, or other map reference points) ( red
From To Ft. G ��C hj) }cietrt9r1 5 U�
From To Ft.
14. GROUT:
Depth Material )Aeeshod
From 0 To aO Ft Cofef-% wvrrp(
From To Ft
15. SCREEN:
Depth Diameter Slot Size Material
From To Ft in in
From _ To _ Ft _ in — In
From _ To _ Ft. __ In. _ In
16. SAND/GRAVEL PACK:
Depth Size
From To Ft
From
17. REM
IDOH
CONS
Material
Magi SI
4 CERTIFY THAT THIS WE II 11
ON $ATIDAR6S.�' P TH tll�la
FOR OF
Ouad No:
Serial No.
ICE
SE ONLY
GROUNDWATER SECTION
am irvll LC REG ONAL OFf806nu b
0
•
• CONSTRUCTED OR THIS REC•RD HBEENE
WITH 15A NCAC 2C, WELL
Y OFPROVIDED TO THE WELL OWNER.
r
0
c�
ry
-01
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
nal to Division of Water Duality, Groundwater Section within 30 days GW-1 REV. 12199

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]
ke
WELL CONSTRUCTION RECORD WWELL CONTRACTOR.
CONTRACTOR CERTIFICWONtof C
:3 1 H
STATE WELL CONSTRUCTION PERMITS:
1. WELL USE (Check Applicable Sox): ResIdentia4 Municipal ❑ Industrial ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
261091
Agricultural ❑ Monitoring ❑
2. WELL LOCATION: (Show sketch of the location below) Cl r rr l_
Nearest Town' Co el de( Cy SDri n13S county:.I� 1�
Old NW /8 Scr441, DEPTH
DRILLING LOG
(Road Name an Numbers, Conmucity, or Subdivision and Lot No.) //��Fonnation De criptio�
3. OWNER r�riP 6s / / /I-n-oc
Address pi/ 7� ! /Q�
de
6//'' 5,.4..7 (Street Touts No. ��� (Z ��
NNe.� i?:yt,.,c) t ,1 C J�a �%� ra
City Town+ 1 State Zip Code
4. DATE DRILLED - i -act
5. TOTAL DEPTH
6. CUTTINGS COLLECTED YES ❑ NO®
7. DOES WELL REPLACE EXISTING WELL? YES NO0
8. STATIC WATER LEVEL Below Top of Casing: f(� Fr.
cuss.; 5 Above Top of Casing)
9. TOP OF CASING IS FT. Above Land Surface'
'Top of easing terminated atlor below land surface requires a variance In aeeor-
dancewtthISANCAC 2C.11
10. YIELD (gpm)• "VC METHOD OF TEST r r1 v /JjWn
11. WATER ZONES (depth)* m' t"J
From To
•
1
12. CHLORINATION: Type 2aylQ�"
Te /C5
13. CASING:
Amount
Wall Thickness
Depth D r orvgrigry, fire,
From 0 To 7S Ft P //�' !�
From To Ft.
From To Ft
14. GROUT:
Depth
From To Ft
From To Ft
15. SCREEN:
From
From
From
16. S
F
17. R
Depth
To
To
_To.
FOR FFICE USE ONLY
Quad No:
Material
Cone rc
Diameter Slot Size
Ft
Ft.
Ft.
Method ,
f-dOu/ra/
Material
in
In
Material
n
in. .__— i
in.
In.
It additional apace is needed use back of form
r OCATION SKETCH
(Show direction and distance from at least two State
Roads. or other map referenda points)
kike WO)/
oNL.e1 t-,o&s-& 44f' ChGkL
besrdeq 9a frhwlC / ale
0
.r "
r11 c.
Q--
7
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit original to Division of Water Quality, Groundwater Section within 30 days Gw-1 REV. 12199
AS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
A COP OF THIS - COR2 AS BE, PROVIDED TO THE WELL OWNER.

Ft
Ft.
Ft.
North Carolina • Department o1 EnvironmentN.C. 2 and Natural
ReSOUlCeS
e (919) - Divisionv221of Water Quality • Groundwater Section
1636 Mail Service Center • Raleigh, P
WELL CONSTRUCTION RECORD WELL CONTRACTOR CERTIFICATION ,'/DOgZ/ ��, nc
STATE WELL. CONSTRUCTION PERMITS:
1. WELL USE (Check Applicable Box): Residential 123 Municipal ❑ Industrial ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATION: (Shows etch of the location below) V y/
NearestJJTow//n• C%unty: ^ e
kane {nl.pKrt 'ylV laelvAU
(Road Name and Numbers, Community, or Subdivision and Lot No.)
3. OWNER PI rl.[ 1)1pore
Address
((yy -_ bit-•U. •b. I
°AANgk\ 1i(l. NG `l-%I I- /00
City or Towns � � tat* 2lpCads
4. DATE DRILLED F/-er a
5. TOTAL DEPTH
6. CUTTINGS COLL CTED YES ❑ NOM
7. DOES WELL REPLACE EXISTING WELL? YES NOEI
B. STATIC WATER LEVEL Below Top of Casing: / 6 FT.
(use •.• if Above Top of Casing)
9. TOP OF CASING IS / la FT. Above Land Surface'
'Top of easing terminated atlor below land surface requires a variance in sceof-
dancewith15ANCAC2C.0118
10. YIELD (gPm): —. MET}10��JEST i'l`r { iL/Q��
11. WATER ZONES (depth)' ADO/
12. CHLORINATION: Type ctn,M+toil Amount
13. CASING: Tablets
,j00
:pro
From_Q--To 6d Ft .—(at _ Piz
Wall Thickness
Depth Diameter or eig�t
From To Ft.
From To Ft
14. GROUT:
Depth Materialethod
From (e) To JD Ft (bu- ff p ut�
From To Ft.
15. SCREEN:
Depth
From To
From __._ To
From __ To
16. SAND/GRAVEL PACK
Fro
Fro
17. RE
IDO
CON
In
Diameter Slot Size
in. _ i
In.
in.
Material
In
Material
n
Agricultural ❑ Monitoring ❑
DRILLING LOG
From To onnation Description /C
O 6 p i r4 f-Roc
/%io Granik
caa ercnik
' 0
261089
DEPTH
.00 Grit Kt
Crean/Ye—
ean/
If
If additional apace Is needed use back of form
LOCATION SKETSH_
(Show direction and distance from at least two State
Roads`or other , p reference points)
Ze
eildciegd
CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
01
SIGNATURE OF PERSON CONSTRUCTING THE WELL
DATE
Submit original to Division of Water Quality, Groundwater Section within 30 days GW-1 REV. 12N9

City or Town _O�
te Zip Code
4. DATE DRILLED i
5. TOTAL DEPTH a
6. CUTTINGS COLLECTED YES ❑ NO
7. DOES WELL REPLACE EXISTING WELL? T'ES NOcgi
8. STATIC WATER LEVEL Below Top of Casing: 0 FT.
fuss •4.' II Above Top Cuing)
9. TOP OF CASING IS I //tr FT. Above Land Surface*
?op of casing terminated at/or below land surface requires a variance In accor-
dance with 15A NCAC 2C .011 ^ /1 /_ n
10. YIELD (gpm)• /) METHOD OF TEST /tr/ikv
11. WATER ZONES (depth). / G'vp'm' 9,001i
It{ en,d,M, S65
North Carolina • Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section 261087
1636 Mail Service Center - Raleigh, N.C. 27699.1636-Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR• Pr/re cVJrIIOM i Iny 4_ qv_
WELL CONTRACTOR CERTIFICATION #: }J Odd
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE (Check Applicable Box): Residential® Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection 0 Other ❑ If Other, List Use:
2. WELL LOCATIO`,N (Sow sketch•of the I/occation below)
Nearest Town. /T 144' tL(d 6./ - le County
( au- A care. Lei- A fib
(Road NamearANumoers.Cfomwnunityo rSubdivisionandLotNo.) DRILLING LOG DEPTH
3.
To f � escd on
p
OWNER
po
(J liv ru L (� direr rr p
Address c n.61 cal twat! Ayres Clerk s g
eel or Ho No.)
F-C'iJlIOr, ( /V� 9�In Li /00 300 Gr�n
S goo ,5Z7o Aawl ;
WO h 00 Oran I A-
12. CHLORINATION: Type S'UII+Q/lul Amount 1coyr
13. CASING: TQb/Z ¢s
Was Thickness
Depth Diameter orb /
From 0 To 7- Ft
From To Ft
From To Ft
14. GROUT:
rit
Depth Mat/M�pthod/
From d To Ate_ Ft nil"
en "^" "'
From To Ft
15. SCREEN:
Depth Diameter Slot Size Material
From To —. Ft __ in. — in
From To Ft. In in
From To In
16. SAN
From
From
17. REM
IDOH
CONS
FOR OFFICE USE ONLY
Quad No:
Material
'and
If additional space Is needed use back of form
LOCATION SKETCH
(Show direction and distance from at least two State
Roads,� opreterencepolnts)
ll,�Q05e
(!I
t.�
CD
(oi,itfll s5,
90 0-0-0 es
flhPi
X-14q
west
1 Id
cr1
Lai- $b
ONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
Y OF THIS RECOD Z 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 GW1 REV. 12199
Serial No.

2 ;5643
WELL CONSTRUCTION RECORD.
NodhCardin* -DeprmmatefEariroameetaid Nagai Rmmcas-Divi iouofWstarQualty-GwsadwaktSco6un
WELL CotrrRAcroR (avoavmuAL NAxt Ode WAIF: IIIC cntrmcanote 2343
costa. CONiMCTOR COPflAtiY itAIYIE
[IIGtW %l7.L ERIII.StC co. rsord a 1828) 324-c035
SPATE WELL Cotlantarnaltmalean ASSOCIATED vWQPEWAIza
or applicable) arable)
1. WELL USE (Check Applicable Bock Residential (il Miakd talluble 0 Industrial ID Apiculture! 0
Monitoring 0 Recovay ID fleet Pump Water lnjccdoaCI Other 0 If Other, LietUse
2. WELL LOCATION:
NeatntTaW MICAN N
7093 TSE DRIVE.
(Banat Nana. Numbers, Caaaaarias Sebiriia. laeNs- Cade)
3. OWNER- CAROM TANF.
Address 2083 LANE DRIVE
(Stentarns W) 2 i55
NIT ANICN
Lg28Sti5g Sam
Arrada•Tama Draw
4. DATE DRILLED Oj-V-W
5. TOTAL DEPTHS DO
6. DOES WELL REPLACE EXISTING WELL? YE 1& NO 0
7. STATIC WATER LEVEL Below TopofCsainc
(rbe^rwacros gatt}aial
8. TOP OF CASINO IS 2 Fr. Above Lod Surftce
aTah daubs trr.bded War aabw bad sun ran ■
inks=S * hae.12
ISM*9. YIELD (gMETHOD OF TEST BY AIR TEST
10. WATER ZONES (depth):
county RWE
zgtbw
Topographic/Land setting
MRidge [Mope Malley CIF7at
(ask swirls. b
Ladnoddlaagiladc of well location
(M gestk ir- _-_)
Ladaddlaogrde sonreetIGPSOTopogrepide asp
Oink bit)
Doi DRILLING LOG
From To FotmaioaDescriptiaa
11. DISINFECTION: Type Hlti 1Plt
12. CASING: _
Diner
From _Q_To 73 FL Frl"
From To Ft
From_ ___. To FL__
13. GROUT: Dept Mandel
From 0 To 20 Ft. GCUT
Front, To Pt.
14. SCREEN: Drph Eimer Sim sae WwiM
From` To Ft,,._io. in.
From To Ft. --_ _In. in
15. SAND/GRAVELPACK:
Depth Size Material
From To Fr
From To R
Amount 01
Wall Thickens
Weigh/Pr. Handal
PvC Pf ASTIC
Method
POURED
16. REMARKS:
0
w
0
LOCATION SICSfCH
Show direction and distance in miles tram at least
two State Roads or County Roads. Include the,toad
mambas and common road asses.
N
//
S
IRS WELL WAS CO r- • 1NACCORDANCE WITH 1$ANCAC 7Cn WELL
TEAT A • • • RECORD HAS BEEN PROVIDED TO THE WELL OWNER
O -10-02
SIGNATURE OF ' c r r' r' DOTING THE wEi.L DATE
Submit dee original to the Diablo* of Water Quality, Greaadwater Seedar,1676 isa Bence Caner -Raleigh, NC
GROG N376!!#fIF14 etNa- (9If)133-3211,within 30days. Ow-1REV. 07/2001
ASHEVILLE REGIONAL OFFICE

r
5584
WELL CONSTRUCTION RECORD
North Caolim-Department ofgarnoameatmad Noland Roams - Division ofWater Quality -OaaaodwalerStatics
were. con -rum -rot prommu mate ac ameist [14VNE T (N; anmvicariom 7 43
WELL CONTRACTOR COMPANY NAMR I{ICICCR(lkII. E talIN 01 mom s [phone]
STATE WELL. omannoC71O#J tle4111 A68/w+� awn 'HQ MAIM
Efsppliablel
1. WELL USE (Check Applicable Bork PUmdentAVla Miwiapol/Pablic 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pomp Water Injection CI Oda 0 If Other, ListUss
2. WELL LOCATION:
Narest Towir
4972 utt BRANCH BD.
county BURKE
(Beat Nano Ewan, Ceerweiq. Saint*" lee Napo p Cdd
3. OWNER;__N F PKW
Address m inc VW,
ff�RAN (54emwRaaNC 28637
City aawe Sam Do Oda
( )-397-5483
Awe weePhawnssier
4. DATE DRILLED 0+-05-02
5. TOTAL DEPTH:___35
6. DOES WELL REPLACE EXISTING WBLLt YES I2KNO 0
T. STATIC WATER LEVEL Below Top oECasiq;
gnome Abswiepe(CuiO
8. TOP OF CASINO IS 2 F7. Above Land Suth.ot
tie f of calm Wattaaata War ISW Ind maw mare I
Velem Y amarrraewlq. 15A NCAC 2C Sit
9. YIELD (gm 15 METHOD OF TEST RV ATR 1F
10. WATER ZONES (depd):
A
Topographic/Land setting
Midge OSlope IJVaU.ey Mat
(check apRwelre box)
Latilodeiloagitode of well location
LadwdSkoglsde soaocOGPSOTepograpFuc map
PACE Box)
1112311 DRILLING LOG
From To Famsri °Description
11. DISINFECTION: Type Hill 1M
12. CASINO:
Dina
Froth 0 Depth r
168 FL 6%?'
From_To Pt
Ameant 51
Wall Thickness
ceWelpistiFt PLASTICMoeda
From_____To—
Ft-- l MOW13. GROUT: Dept From_ 0 To Z0 Ft. GRIM Ii7MID
From To Ft
14. SCREEN: Depth Dinar Sot Sine mateeia
Frog To Ft in in.
FrontTo FL._JO. in
15. SAND/GRAVELPACK:
Depth Size
From To Ft
Front.- To FL
l tusial
16. REMARKS:
fV
L
LOCATION SKEUCII — c
Show direction and distance in miles from Orlascj
two State Raids or County Roads. Iacludo4hs said
mambas sad eemmon road names.
o
r 0
W c,
tit
boit
LoNGB/dwu, 610jtW
CFP
Cshadt the arig(oal to t
ns;;F���GFONAL OFFICF
S1t0S WELL WAS CO
AND,TAQOPYOF
ACCORDANCE VAIN 15ANCAC 2C, WE71.
HAS BEEN PROVIDED TO THE WELL OWNER
SiONAILIRE OF PERSON UCDNOTHE WELL
JY.-17-07
DATE
Maly a of Water Quality, Groundwater Section, ICU Men Soviet Coster -Rakish, NC
7313231, within 30 dap. Owe REV. 07/2001

J.%
48
WELL CONSTRUCTION RECORD.
North Carolina -Department oiEanilonnxt sad Natural Rdasas -Division of Wales Quaity - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL)NAME tprl•O WAYNE LONG CERTITIDATIONi 2343
wetscoNTRACron colOANY Naha HICKORY WELL DRILLING CO. nnoea a 828) 324-0035
ETATS WELL CONsTROCOON PnR ITm Aa9OQAsRD WQ ltwcn
(aaaplkable)
liriesle)
1. WELL USE (Check Applicable Box): ReaideadaO MtwicipdRabtic 0 Itdacnial 0 Agricultural 0
Moaitor(ng❑ Recovery ❑ Neat Pump Water lnjeetiaaCI Other IfOther, LKtvaa
2. WELL LOCATION:
Newest Vow=: MORGANTON County BURKE
3976 L-21 Avery Hill
(Seen Nine, NeaMn.Oat%Sliivilkes Lae No. Tap Cale)
3. OWNER;_ PERRY S TT VMS
Addma 3976 1 —91 AVFRY FITT T
82
(Sheet aritsleNoJ
MORGATNON NC 28655
Z 9499sn1e RDCoer
Ara ceaeo- hM. rtdtt
4. DATE DRILLED no.-9 1-07
s. TOTAL DEPTH`42 5
6. DOES WELL REPLACE EXISTING WELLt YES 0 NO
7. STATIC WATER LEVEL Below Top *Maniac _60_i7.
(Vr-v"inAban Tap on:wi W
8. TOP OF CASING IS 2 FT. Above Land Surface
•Tap vs oast k.rlaaW afar hew Ind arks reeds a
vrbs= n emera.ace with ISANCAC 2C BY AIR TEST
9. YIELD (gpm} 4 METHOD OF TEST
10. WATER ZONES (depth):
11. DISINFECTION: Type
12. CASINO:
Depth
From 0 To 58
nun_ To
Front _.. To
13. GROUT;., Dspi4L0
From To
From To
14. SCREEN: Depth
From To
From. To
1S. SAND/GRAVELPACK:
Depth Size
Frot�_To Ft
Fromi_To Pt.
16. REMARKS:
HTH TABS
FT. 6"
er
IT.
F1
Ft
Pt
Dinneen S1ot Sine Mania
Ft. in. m.
Ft )e. is
Topographic/Lend setting
O$lope Malley 17Flat
(check apptopow a box)
Latitoddloogitode of wdl location
oisansoimeanottreo
Latitude/longitude aomec0GPSOTopographic map
oisos too)
MOB DEG LOG
From To Formai=Description
r cE
0
v
LOCATION SIQ;rCg
c-�
Amara 77 Show direction and dbtmce in miles Prom af- jeans-,
Walt Tbklmess two State Roads or County Roads. Include tie rot
¶VC - Cnumbers and common road names.
Gittti pflItt
Materiel
r
i tie iiiiRSBY aiR
LAMS !KULtIUN
ts!
GRMIrctruatak A H LL iv, L .. C'ip
1
TTHIS WELL WAS CONSTRUCIuD
JS. AND THAT ACOPY Of T1DSR)ia
COOItDANCE WITH ISA NCAC 2C, WELL
D HAS BEEN PROVIDED TO THE WELL OWNE t
SJGNA�PERSON 'Fs &:GTHE WELL DATE
r Division of Water Quality, Greaadwater Seeder,163ai marl Series Canter -Rakish, NC
133-1131, within 30 daft GW-1 REV. 07/2001
04-30-02

255847
WELL CONSTRUCTION RECORD.
North Carolina -DepartmentofBavirommataadNWaalResouaa-DiviraaofWakrQAlly-CaouodwaterSmitiaa
wsucoraRAcroa(NoWIDU41dNAMt(pA4 WAVNFTnN(: ariarxCArttsnk71L11
Hal. CONTRACTOR COMPANY NAME HICKORY WELL DRILLING CO. rxwaea S281 324-0035
STATI WELL CON67RDCHON POMfta ASSOaAinD WQ PaaMISo
Of applicable) anamli a*le)
1. WELL USE (Check Applicable Emc): Residentid GX bthadelpaYPnblic 0 Indttttial 0 Apiculture! 0
Monitoring Recovery D Hat Pump Water injection13 Other 13 If Other, UMW*
2. WELL LOCATION:
NarestTo.ra: VALDESE
3518 TOM DEAL AVE.
Crotty BURKE
(grewNant, Swam Cwiari4.Ail ii:ae.Wk. HpCO4
3. OW;_CLIFFORD BROWN
Address 3518 TOM DFAT. AVE.
(sited eRunNa)
VALDESE NC 28690
82 of +1-096r ZIP Code
Ana eeaarime washer
4. DATE DRILLED 04-10-07
5. TOTAL DBPTIL 75
6. DOES WELL REPLACE EXISTING WELLt YES 021O II
7. STATIC WATER LEVEL Edow Top of Csa(ad ____SO__FT.
1vs-rWAtowAp ACNIC
8. TOP OF CASINO IS 7 FT. Above Load Suttees
slop deotea wolawa athr haw lard ants rapine 4
Inera* METHOD 2C AM
9. YIELDODOFTESTBY AIR TEST
(�mx 3
10. WATER ZONES (depth):
1!. DISINFECTION: Type HTH TABS Amount /9
12. CASINO: Wall 'Maass
Fro
pro„m, 0 To To b 88 FtFt 1�IC
itrier
-
1 C
Frottt= To Ft. —.
13. GROUT: Dept Maaedal Method
From_Q._To 70 Ft. (ROUT POIIRFTI
From_ To Pt
14_ SCREEN: Deph Dunes SiotShe Maxial
From To F_ Rio. in.
From To Ft, —in. is
15. SAND/GRAVELPACK:
Depth Sian Material
From To Ft
From To_ Ft
Topogeaphio/Land setting
17Ridge Metope (]Valley Mat
(deck spinpsiaeebox)
Lati/idd&kagiludc of well location
Latitude/longitudemareed3GPSGTopographic map
MEM PULLING LOG
From To Fomation Descdptioa
16 REMABYS-
"' YtsSi+airtrV RTtP. THAT Ti13WELL WAS CONSTRUCTED INACCORDANCEWYIH1SANCAC2C,WELL
CONS[RUCfON '7A(igrARDS, AND THAT A -COPY OP '• t •.•• HAS BE N PROVIDED TO THE WELL OWNER
asafrt - 04-17-02
0
c
c
a
jOCATION SISEtC$ -- o
Show direction and distance in miles from at least
two State Roads or County Roads. laclude the road
numbers sad common road names.
-c
0
c=
L!<
0
=
zn;
cn
W
Nci
Meter,'
O
-1)4JL
(Ci Ent/ELL
5
THE WELL
DATE
a! to lie DivSea or Water Quality, Gr eaadwater Seeds, lei Marl Service Cower -Raleigh, NC
A0REVLLEP2 f A.$)733'3211*lniia30daya OW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and IV
WELL CONTRACTOR (INDIVIDUAL) NAME (print)
WELL CONTRACTOR COMPANY NAME
STATE WELL CONSTRUCTION PERMIT#
(if applicable)
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)CIL
%CRej
3.. OWNER: eR
Address
(Street or Route No:)
2531
ral Resources -.Division of Water Quality - Groundwater SectMion,._',
CERTIFICATION # 2SC1 b
PHONE tt
ASSOCIATED WO PERMITP
/ (if applicable)
1. WELL USE (Check Applicable Box): Residential E M`1nicipal/Public ❑ Industrial ❑ A.
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use Agricultural ❑
2. WELL LOCATION:
Nearest Town:_g iZ County Ru2ke Topographic/Land setting
COC"'?� �'� 1.�': I)o age ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location j
(rg) `73p'Z-4,z
rt2 �n ,tic 216 I
City or Town State
�I33- r" Zip Code
2 F. - -
Area code- Phone number
4. DATE DRILLED a5- 0 2
5. TOTAL DEPTH:
6. DOES WELL REPLACE EXI TING WELL? YES ❑ NO ca--
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 sv'th ISA NCAC 2C .0118.
9.. YIELD (gpm): d METHOD OF TEST ! &
10. WATER ZONES (depth): _ q'Q
11. DISINFECTION: Type C
12. CASING:
From 0 Depth �'• Diameter
To S sFt.. j_
From_5,✓z To ' cK Ft. k t4
From To Ft.
13. GROUT: Depth
From O To_aa5_ Ft.
From To Ft.
14. SCREEN: Depth Diameter
Slot Size Material
From To .FL in. in
From To Ft' in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
'Ate Amount
Wall Thickness
or Wczght/Ft. Material
16. REMARKS
2764)6
RE6rCjRTIFY' A t 1
r5 f R C'Tfi
visio
-322
Material
Method
(degrees/minutes/seconds)
Latitude/longitude so„rce:OGPenT - aphtc map
DEPTH ray*-1,11
From To bRILLI__ NG LOB.
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.
5et�w R.Ae_
(IraCam- O,ea .
tV D
3 " ,
3 WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
P ►�::F_\IIa\, OP OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
ATUR
F PERSON CONSTRUCTING THE WELL
DATE
i of Water Quality, Gnay ndwa ter Section, 1636 Mail Service Center -Raleigh, NC
, within 30 days.
GW-1 REV. 07/2001
is
rn L
Nz
r

255797
WELL CONSTRUCTION RECORD
meth Carolina-Depatment of Eaviroomeat and Natural Rc avws -Divi$ion of Water Quality - Geamdvnla' Scotian
2343
WELL CONTRACTOR(adorv1DUAL)NAME (peal WA3d1M .a eurrrte+►noNs
wau,coNTRACTO& COMPANY NAME HICKORY WTI DR TT T.TNG C'.0. PHONE a (828 324-0235
STATE WELL CONi7ROCTION ISRM1ri _Joonevancovernoaszo
0fapplitaWc) arable)
1. WELL USE (Check Applicable Box): R.eddential V( Municipal/Public 0 Iadialrial 0 Agricultural 0
Monitoring 0 Rocovay 0 Heat Pump Water Walton s Other 0IfOther, LiatUae
2. WELL LOCATION:
Nearest Towa' RTTRKF.
71_73 HTT.URBAN rfT'N. AVE.
aunt Nam Nude% Ctuaaentas Atitheidae. La Ns.. rap Cote)
3. OWNER' WI EN DYMORA
Address 711(s77�33�aHLLDE�BRAN MIN. AVE.
CONNELLY SPRING*S,sNC 28612
City a Ton Sue 22pCaat
627R )- 47-F757
Ana mew Phan washer
4 DATE DRILLED 04-27-07
5. TOTAL DEPTAz /.7 5
6. DOES WELL REPLACE EXISTING WEILt YES ENO 0
7. STATIC WATER LEVEL Below Top of Cam
tUc`riwAbsnT afOtaiW
8. TOP OF CASINO IS 2 FT. Above Land Surface
nap ercWq temlaatea afar kW/ lW starter tapirs a
veraeeawith ISA NCAC 2C.gtt
9. \IEnLT( '*am.tiaeex METHOOOFTEST BY AIR TEST
10. WATER ZONES (depth):
Topographic/Land setting
Midge (]Slope Malley f7Flat
(checkappactie box)
Latitude/longitude of well location
LadardellongSd� k map
Pa= DRILLING LOG
From To Famadoa Description
11. DISINFECTION: Typo
12. CASINO:
FrOM 0 Tom 82
Froco__ To
From= To
13. GROUT:GTor 20
Front. To
14. SCREEN: Ylepth
Front_ To
From TO
15. SAND/ORAVELPACK:
Depth Size hints'
groin To Ft
HTH TABS Amount
c_
1— c'2
—
v _
LOCATION SKETCH A
77 Shot direction and distance in miles emit least
Wall Thidaen two Stabs Roads or County Rands. IDclud ae mat:
Ft, �eV/eight/Ftet numbers sad common rood names. CO 2
PVC PLASTIC
FL
Ft
Mod
FL � OUT
�
Ft
)D
Disomor Slot Site Material
Fy�s. in.
From To Ft
16. REMARKS:
MOUP
giuOCE
N/ta✓d/.
5
GROUND
ASHEveI_F
b0 \iYc
CONstRUC.r1UN
THAT INS WELL WAS CO
to
`_... W ACCORDANCE WITH ISANCAC 2C. WELL
AND THAT ACOPYofl S RECO1ta HAS BEEN PROVIDED TO THE WELL OWNSIC
04-30-02
SIGNATURE OF PERSON pONSTRUCTA4O THE WELL
DATE
the Million ofWater Quality, GreaadwatetSection, I 36 Mgt Service Cooler -Rakish, NC
2* 733.3231, within 30 days. OW-1 REV. 07/2001

254465
WELL CONSTRUCTION RECORD
Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
/S)
North Carolina - Dep S, C G CERTIFICATION 81L`�--- '/
WELL CONTRACTOR (INDIVIDUAL) NAME (print)_ h n (L t. 1 lu C I PHONE 0 u�.-�—`— t / S7 L
WELL CONTRACTOR COMPANY NAME OCIATED WQ PERMITS
WELL CONSTRUCTION PERMITS ASSif liable
if livable
1. WELL USE (Check Applicable Box): Residential MunicipaVPublic 0 Industrial 0 Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town:
(Street Name, Numbers, Canmuaity, Subdivision, lot No, Zip Code)
3. OWNER:
Address
County
121City ot �1 Zip
Area code- Phone number
4. DATE DRILLED i' / 70 2
5. TOTAL DEPTH: `) 25
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO R✓"
7. STATIC WATER LEVEL Below Top of Casing: . FT• _
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / YZ FT. Above Land Surface*
'Top of casing terminated at/or below land surface requires a .
variance In accordance with ISA NCAC 2C .01 i8.
9. YIELD (gpm): _S4_.__ METHOD OF TEST
10. WATER ZONES (depth): (n Finn e !GO
11. DISINFECTION: Type e/.otN e-
12. CASING:
Depth Diameter
From To FL
From 0 To (/! Ft.
From To —. Ft.
13. GROUT: Depth Materiel
From To Ft.
From 0 To a B Ft. E 1
14. SCREEN: Depth Diameter Slot Size Material
From To FL in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK: Sue��
Depth
From To Ft.
From To Ft.
TopographiC/Land setting
❑Ridge ❑Slope ❑Valley at
(cheek appropriate box)
Latitude/longitude of well location
(de.eeslminuta/seeonda)
Latitude/longitude source:❑GPS❑Topographic map
DEPTH (cheek box)
DEPTH DRrr r�G LQG
From To Formation Description
V jr
Lnr ATi()N SKETCH_ -9 m�
Amount 2 C` 73 a , Show direction and distance in miles fro at lgsf
. Inclt� thelroad
Wall eight/et. N --+
or Weight/Ft. Material numbers and WUM' n road names. Q�
ss two State Roads or County Roads r a
G
16. REMARKS:
Ii I,.� 1!1$(HERE113
\..1
11<,—--eeNIeN
n�!
—Sutbttu�jttt
La sd
(do (!S'
n CD'")
THAT THIS WELL WAS CONS I RUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
e . aS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SI ATURE
PERSON CONSTRUCTING THE WELL DATE
the Division of Water Quality, Groundwater Section,1636 Mail Service Center
GW-1 REVg07 2001
19) 733-3221, within 30 days.

252253
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) � "t T'V g/'' //(_,( ki' CERTIFICATION M3/ �`3�
WELL CONTRACTOR COMPANY NAME Ur C /p pot, ./ ,( ke€ PHONE # J%kiY /AV SVL
STATE WELL CONSTRUCTION PERMITS /�� __ASSOCIATED WQ PERMITS
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:, 7
Nearest Town: /r1�/ d �$ P County / ! (/' ic
e fumbs +a/C
(Street Name. , Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: 7) t 3 imp 'E'(-,
Address
(Street or Route No.)
City or Town State Zip Code
Area code- Phone number
4. DATE DRILLED Li-caS-C)7
5. TOTAL DEPTH. 3 7--a-
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 0
7. STATIC WATER LEVEL Below Top of Casing:
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface'
*Top of cuing terminated atlor below laud surface requires a
variance In accordance with ISA NCAC 2C .011&
9. YIELD (gpm): /(m METHOD OF TEST /0
10. WATER ZONES (depth):-2C,1() — .3nO
Topographic/Land setting
❑Ridge @Slope ❑Valley ❑Flat
(duck appropriate box)
Latitude/longitude of well location
11. DISINFECTION: Type !)g fJ P Y/fr- Amount /C
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From'_ To r/X) Ft. G .c3 / 14/P
From _ To Ft. a
From To Ft.
13. GROUT: Depth Material Method I L t�
From f) To 5'L) Ft. /r) JXP et b %I eCQ Method,
Front To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To FL in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
(degrees/minutes/seconds)
Latitude/longitude source:❑GPSfTopograpbic map
(chid( box)
DRILLING LOG
Formation Description
DEPTH
From To
C7 �( )
G a 6 »
16. REMARKS:
c
O �.,
ro
N�
?m
�c
o
LOCATION SKETCH = am
Show direction and distance in miles fron($t leaj¢,'l,
two State Roads or County Roads. Includpyme rd
numbers and common road names. r
v
Ex?
/ DO HEREBY CERTIFY THAT THIS WELL WAS CON
CONSTRUCTION STANDARDS, AND THAT A COPY
SIGNATURE OF PERSi
NSTRUCTINO1111/0LL
4 NCAC 2C, WELL
TO THE WELT OWNER
DATE
Submit the original to the Division of Water Quality, Grnndwater Section, 1636 Mail Se -vice Center - Raleigh, NC
27699-1636 Phone No. (9191733-3221. within 30 days. =a SECTION GW-1 REV. 07/2001
:AL OFFICE

1
3. OWNER:
Address
WELL CONSTRUCTION RECORD
252252
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section SS
WELL CONTRACTOR (INDIVIDUAL) NAME (print) SF /J)A/1 I-/ Er l lr el CERTIFICATION CR/. ?
WELL CONTRACTOR COMPANY NAME ,GKI U A d / oni(%Q b)c I L PHONE # 2v_i_Qazaeszea
STATE 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 ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: 014_14LSC Coumy >3ccrL
'5C1t en,-3/Qr_l Rd )k QQ
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
CPI \ D )Rbrq//1) 3r
13-!A/3Ay /.]p2
(Street or Route No.)
lJaiCies-e nfe
City or Town State Zip Code
c(?)- 8T'4*&/fD
Area code- Phone number
4. DATE DRILLED q- J t-I -0 Z-
5. TOTAL DEPTH: 5 —
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO 2'
7. STATIC WATER LEVEL Below Top of Casing: /DQ 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 l th ISA NCAC 2C .0118.
9. YIELD (gpm): METHOD OF TEST F) t i?
10. WATER ZONES (depth): IS a g s
11. DISINFECTION: Type petL&4Jc Amount 1 r (nip
12. CASING: Wall Thickness r
Depth _ Diameter or Weight/Ft. Material
From r) To i / S Ft. if
From To Ft.
From To Ft.
GROUT: Depth Material
From O J�
To -O Ft. .t1(t Cs*
From To
SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
SAND/GRAVEL PACK:
Depth Size
From To Ft.
From To Ft.
16. REMARKS:
Ft.
Slot Size Material
in.
in.
JJTopographic/Land setting
l2Ridge DSlope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minuue/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From o Formation Description
0 S&,Ld eIOV
GO Sol cork
1(�i0 i i S S hu (e Qr,A,
c
ro
2 �rn
om
^1
o�
To
o
LOCATION SKETCH tiz
Show direction and distance in miles from at€ast
two State Roads or County Roads. Include troad+
numbers and common road names.
C'c1 'vlt u-
ethod -�
Material
aleL
J
3Z/ S'
I DO HEREBY CERTIFY THAT THIS WELL WAS
CONSTRUCTION STANDARDS, AND THAT A CO
•
F IS`1t'I IAS BIN
,7✓'H I5A NCAC 2C, WELL
tlDVIDED TO THE WELL OWNER
ATURE OF P
Cu1t1STROC`TING tilE
ATE
Submit the original to the Division of Water Quali Groundwater Section, A636 Mil Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GROG:r 1N GW-1 REV. 07/2001
/SHE'' ICE

252552
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Naturals��Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print)ZSt\M e 1S1 kA) CAM �% ' I CERTIFICATION #yL..itii2
WELL CONTRACTOR COMPANY NAME (^I I, es- Weil_ Li.. QU M'Q CO W C PHONE # &t ilia _ f 2 t
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMITS
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential VMunicipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town:'N (51-4
County e tAl� i
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNERJ\A 0
Address r O C , `u s \
(Street oaRmrCNo.)
�tVY g %.()
Cityy o ownwState Zip Code
Arta code- Phone number
4. DATE DRILLED `-k- % , U 1
5. TOTAL DEPTH: 'A D
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO V,
7. STATIC WATER LEVEL Below Top of Casing: ail FT.
(Use "r" 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 .0I18.
9. YIELD (gpm): 1(') MMTHOD OF TEST (1AJ1
10. WATER ZONES (depth): c5 \D 0
11. DISINFECTION: Type r
12. CASING:
Depth
From () To q
From To
From To
13. GROUT: Depth
From_ To to Ft.
From To Ft.
Amount a f 1 L .
Wall Thickness
D' eter or Weight/Ft. paten
Ft. # d C (1 prat
Lr
Ft.
Ft.
aterial 0,
Meting'
MAU
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth
From To Ft.
From To Ft.
Slot Size Material
in.
in.
Size Material
16. REMARKS:
I'} pONSTR�I ST#ai .
Eheeriginat-te
y4i'696#1$net+ti:,(
rl ki
Divis
�733-3
Topographic/Land setting
❑Ridge ❑Slope @caley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLINGL.OG
From To Formatn Description
b Ro
Q u t10'S
0An
LOCATION SKETCH
Show direction and distance in miles from a least
two State Roads or County Roads. Include a road
numbers ommon road names.
IS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
ND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNERce?
01
GNA
G1S=F PERSONO NSTRUCTING THE WFI T
q-'b
DATE
on of Water Quality,Groundwater Section, 1636 Mail Service Center - Raleigh, NC
21, within 30 days. GW-1 REV. 07/2001
c
T
'
Zrn
o.-
Ko
-4
rn
me
tnz
r*t
r-r
G
z

2`:0826
WELL CONSTRUCTION RECORD.
North Carolina - Department of Baritommaat aad Natural R smote •Diviaioa ofwaar Qrality - Cuxadsaar Sectioa
WELL CONTRACTOR (a4DIYDfmAL) NAME (prim) HICYLRY WIT CRTT I TN'; CLE , INC. cnttinc►r►ow a 2343
WELL CONTRACTOR COMPANY NAMEGAYE I puma •j28) 324-0Q3.5
STAIR Wal. CONST*Ir1ION Pretielte AMOCIAnRD WQ Mourn
(ifaadlatk) Oftt?lic ID)
I. WELL USE (Check Applicable Box) Residential Et MrwicipiWobfc 0 bonnie' 0 Agricultural 0
Monitoring 0 Recovery 0 Nut Pump Water Il(ec$m 0 Odor 0 If Other, Litt Use
2. WELL LOCATION:
Nearest Town: VAIIkSE Comfy BURKE
3118 1st. STREET
(Yew Nwe, Njmbsn, Caaaaio: SWi.ida, Let No. Ep Cede)
3. OWNER. JAMS FE =AIN
Addlwn 3118 1st. STREET
VALDESE sue
NCC;; (se.mm enter
ars or rave s
(3- 432-0890
ue Ceal
28690
Anacede. Pass mrMr
4. DATA DRILLED 03-07-02
5. TOTAL DEFT* 1)5
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO U
7. STATIC WATER LEVEL Below Top of Casng ECL ET,
meow
8. TOP OF CASING IS 7 FT. Above Land Surface'
*Tap of emiaa terehds seer aekw Wd Siam retake a
Tarram 1 aue4act *Mk ISANCAC EC.4IL
9. YIELD (gpm) S METIUOD OF TEST at alp
10. WATER ZONES (depth).
Topographic/Land setting
Midge OSlope Malley OFlat
@Mak wpawi a Mg)
Lati/oddlomgitode of well location
phee«a.• %.a.de)
I.atimtdeiloosiade aoorecOGPSC Topographic map
and ( DEG LOG
From To Fota.aion Description
11. DISINFECTION: Type HIH "I)1H6
Free/ 0 To 1-36 Ft. 6-4
From_ ToFt
es
From_ To Ft
13. GROUT Depth �p�.l
From D To Depth,
FL i
From
12. CASING:
Depth
Amomt 51
Wall Thickness
r4 H C
To Ft,
14. SCREEN: Dept Dimmer Stet Sive maamtisl
From To in.
From To Ftr_n. in.
15. SAND/GRAVELPACK:
Depth Size Material
Fromt__To Ft
FromL�To Ft
41121
16.RE
rr
T
Ito '50
— nr
N
-9
rn
rn
N
I.CATION SKETCH; Cn
Show direction sod distance In miles From at lee
two State Roads or County Roads. Include the road
isrhae and common road names.
INACCORDANCB WITH 15ANCAC2C, WELL
RAS BEEN PROVIDED 70 THE WELL OWNER
03-18-02
SIGNATURE DF PERSON es UCIINOTHE Will DATE
of Wafer Quality, Groundwater Seethe, maw CAMP* C.- RahLehigh, NC
within 31 days. GW-I REV. O7/2001

WELL, CONSTRUCTION RECORD
Noah Carolina - Department of Envlroamoat and Natal Rrsemon - Dfvkda of Warm Quality - Groundwater Section
WtLl cmtTRattoRcacaminu,es)Nmer crud,Wayne Long atrtruncaTI0Na 2343
wruscore 7tACTURcoar7AMYNAMg Air Drilling Co. Thom s 00S-872-7614
STATIC WELL OQNSTRUCrro$ TILAMILN *ernrl&IE WQ mains
(1f epptliablc) repplkable)
I. WELL USE (Chock Applicable Box): Rcddcntlal ® Muoieip.UPublic0 )advatrW ❑ AgkuIun d Cl
Monitoring D Recovery O Hat Ptonp Water !Weldon 0 Other 0 If Other, Lilt Use
2. WELL LOCATION:
Newt Toatc . Valdese Cow Burke
Rocky River Road
(Sa.a1ICm►►aa berg Coasuelsy, Saki tioa. Latta 220Code)
3 GINNER. Southern Pride Carpentry
Addtoa /061 Vashti Road
(Setae
Hiddenite, NC 28626
art (828 632-0697�
Arm soda- Pbooa saber
4, DATE DRILLED
5. TOTAL DOTE:
6. DOES WI IS.REPFAC EEXISTING WELL? YES 0 NO 0
7. STATIC WALTER LEVEL Below Top of Casing FT.
r(Ut. v IfAbasTap aft wou)
8. TOP OF CASING IS 1 5 _ FL. Above Land Surface*
?op a rasa uaretsaerd st/or beoa, W d cornea regents a
•..taro ar.ceordlM eM 11ANCAC2C.01It
9. YIELD (gym)• 1 METHOD OF TEST Air
10. WATER ZONES (dgsb): 597'
03-22-02
24 Cade
bUS'
11. DISINFECTION: Type HTH
12. CASING:
rivet DUcceocr
Ram 0 To 310 Ft_
From__ To Ft.
From To FL
13. GROUT: Depth Material
Frorc 0 To 20 FtL Grout
Ftaen To Ft.
Amoral
Well Tt icba
ccweisbnik Memel
PVC
14. SCREEN: Depth Diemear
Frorn To FL in.
Prom To Fi.In.
1S. SAND/GRAVELPACK:
Depth
Prwq__To FS
From To Fr
16. REMARKS;
Matbod
Poured
Slat Sim Ma alai
_in.
in.
Mad&
LULU
. From • To
0 110'
Topographic/Land Paling
CIRidgu OSlope OVWZY 0Flar
.(eadt Inaprtaz bog)
' Iadmddkagiade tura)ocslioo
250517
Oreweelmieweehorae4)
Ledtnde/1 cagiest/ souttcOOPSCToporaphic nap
west tau)
DRILLING LQ9
Fouration Description
Dirt
DO' 605' Rork
i
Shorn dal lea Gold distance in calla from at laegt,
two Ste* Roads of County Roads. Iostude the raid
numbers tad common rod sass.
CO
w
0
'/0
1 DO FOIREBY CERTIFY THAT THIS WELL WAS CONSIRM=
commTAUC110N STANDARDS, AND THAT A COPY OF THIS
SIGNATURE OF PERSON CONSTRU
Qualify, Gromedtnhr SKIM, L M Mar San to Cecar- Saida NC
dam OW-1 REV, 07/200I
III '
L—
GROUNDWATER SECTION
ASF:Th
ANCR WITH 1SA NCAC 2C. WELL
Halt amnow0= TO THB nu.
3Jaa
ma WELL DATE
TOTAL P.01
I•d
Tfl/ 4 ) RP Or
nr 9Iir r r. in
..non r- .1

266240
.i
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. Pere Well l-/rtr')IEnt
WELL CONTRACTOR CERTIFICATION #: , 7 V. F VeVeo
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE (Check Applicable Boa): ResidenVaI Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATIQ-N: (Show sketch of the location below)
Nearest Town: nil Q frintiO County
Es�e�l Cft)rMMP fr�.
(Road Name and Numbers, Comnunity, or Subdivision and Lot No.) DRILLING LOG
3.
Address OWNER 7ertjev'ssbet rt Crvv1P
/3`� f�(tN1 �' /'
(titres( or out. No.)
ain(,M}^yittOr)
City ortown - State 0a% p � % On -Ion
("1
4. DATE DRILLED A - P - 0 2-
5. TOTAL DEPTH l050 Pk
6. CUTTINGS COLLECTED YES ❑ NO }'
7. DOES WELL REPLACE EXISTING WELL? YES jIg NOS J 50 - G. 00
8. STATIC WATER LEVEL Below Top of Casing: -j FT. fs roc" - Tot,
(Use'i it Above Top of Casing)
9. TOP OF CASING IS i I/a FT Above Land Surface'
'Top of casing terminated suor below land surface requires a variance In scow- l U n Ste
dance with 15A NCAC 2C .01111 /�
10. YIELD (gpm). 0 METHOD OF TEST 4t f 0101.1/}
11. WATER ZONES (depth):
From To
0 9 5
,9on 3c 0
30c— LW C)
a 5
s/00 h' K 0
7vn —9,040
12. CHLORINATION: TypeC7c'4riAe GG.tn-fr, Amount 3 az
13. CASING:
From
Depth
0 To
Wail Thickness
Diameter or Weight/Ft. Material
W
Ft _�— 3' fVC
From To Ft
From To Ft.
14. GROUT:
Depth Material J1ethod)
From 0 To r. Fl Cohn'k 1-ouLTr'-1
From To Ft
15. SCREEN:
Depth Diameter
From To Ft in
From To _ Ft. _ in
From To FL_ in
16. SAND/GRAVEL PACK:
r F Depth\, "1
To
iMA
p g •
r
1H� -
I . e HEREBY CERTIFY THA THIS
Cabn......'!d,AN
�'� �����
LOCATION SKETCH
(Shaw direction and distance from at least two State
Roads, or other map reference paints)
Slot Size Material
in
In
_ In
ze Material
DEPTH
Formation De caption
Granik/
C- re!
GR.4NITr
GRAru17Lr
. i,,,,4eo
o
C cavt,��r n
rctN1 i'�n�
Nravv:+c
^ rn
If additional space 15 needed use back of f
cx
4i
1'
ELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
THAT A CO OF R ORD HAS BEEN PPS VIDED/TO THE WELL OWNER.
SIGNATURE OF PERSON CONSTR NG THE WELL DATE
Submit original to Division of Water Quality, Groundwater Section within 30 days
0
Iv
0
GW-1 REV. 12199

266236
North Carolina - Department of Environment and Natural Resources - Division of Water Quality • Groundwater Section 1636 Mail Service Center • Raleigh, N.C. 27699-1636-Fhone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR. Price well nill ing lrn.
WELL CONTRACTOR CERTIFICATION 0: a0-90
STATE WELL CONSTRUCTION PERMITS*:
1. WELL USE (Check Applicable Box): Residential Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below)
Near st Town: 4---?r+ ' 0 r County'
iff
(Road flame and Numbers, Community, or Subdivision and Lot No.) DRILLING LOG
, 3rr,-/lr
DEPTH
3. OWNER Lao,
L/rr.-, S From To ormatn/p/ascdptioon
Address 4-Yid Q'—� M�' Q@ ( i�0 .3 .7 r7`T7c0e,
(Street d ��g�,d".i ar6 4e S '31 14')
/,rcV (/' ' jC
Cily or Town State Zip Code i
4. DATE DRILLED �_c/-o3
5. TOTAL DEPTH rJ 45 0
6. CUTTINGS COLLECTED YES Q NO,Q
7. DOES WELL REPLACE EXISTING WELL? YES 0 NOai
8. STATIC WATER LEVEL Below Top of Casing: 1/ a FT.
/ (Use's 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 pile
10. YIELD (gpm): 4. METHOD OF TEST tw /3A i�,1
11. WATER ZONES (depth):
„00 0Sa
12. CHLORINATION: Type
13. CASING:
From
From To Ft
From To Ft
14. GROUT:
Amount
Wall Thickness
Depth Diameter or W ' ,h�VFFL yea!
0 To 1'7 Ft Y%�
Depth /�Material// /�'�ethod
From . C2To & a Ft r h nri'P >' /'� vtea1
From To Ft ll
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:
EFrbm 1E 1 p'�
From To
7. REMARKa:
— /UUJI
I DO HEREBY CERTIFY
couSTaucnoNSTAN
GFr LINE,��i SsCT10N
AtitbEFICEL
Quad No:
Material
Size
Ft.
rnn l jl '
rrcY/n%
If additional space is needed use back of form
f
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other map reference points)
0
n
SAjrNi o}
AT IS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, ELL
ARD ,ANOTHAT ACO YOFTHISREC RDH BEEWt122
DEDDTTOTHELLLWNER.
:,/�)
SIGNATURE OF PERSON CONS
Submit original to Division of Water Quality, G
WELL DATE
star Section within 30 days
GW1 REV. 12199
Serial No.

North Carolina - Department of Environment and Natural Resources - Division of Water Duality - Groundwater Section
1636 Mail Service Center - Raleigh, N.C. 27699-1636-Phone [phone] WELL CONSTRUCTION RECORD WELL CONTRACTOR. Pr/et Well Dnlfuij fnc
WELL. CONTRACTOR CERTIFICATION *: 3 oa O
STATE WELL CONSTRUCTION PERMIT*:
1. WELL USE (Check Applicable cox): Residential I Municipal ❑ Industrial 0 Agricultural ❑ Monitoring 0
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATI�N (Show sketch of the location below) �%,
Nearest Town. f7 Orya ''t-loh County /3 ufFe
—Ko F- f lit nth Pe i k k s ip s d.0+ 36)
(Road Name an umbers, Corr ity. r Subdi sio6sne Lot No.) DRILLING LOG DEPTH
3. OWNER b e t�`-nc- e5 --- From To /� FomLudon esedption
Address r g We,1 1` (91v O 4s pr'-HKock
_g - loin Grans r
City • own tate Zip Coda
4. DATE DRILLED a --`'C99
5. TOTAL DEPTH 3 fin Fr
6. CUTTINGS COLLECTED YES ❑ NOEI
7. DOES WELL REPLACE EXISTING WELL? YES 0 N011i
8. STATIC WATER LEVEL Below Top of Casing: TO FT.
(/ (Use N. a Above Top of Casing)
9. TOP OF CASING IS 1 / 01' FT Above Land Surface'
`Top of casing terminated stlor below land surface requires a variance In accor-
dance with 15A NCAC 2C 11, ^
10. YIELD (gpm)' S METHOD OF TEST 1'ti I'6lmui+l
11. WATER ZONES (depth)'
12. CHLORINATION' Type r`x ache .4
13. CASING: fahirt5
Amount If additional space is needed use back of form
L
Was Thickness LOCATION SKETCH
Depth Dianetw or aigpVR. ►111attdsl (Show direction and distance from at least two State
From0 To 97 Ft �r2— //V Y C Roads. or other map reference points)
From To Ft. A j
From To Ft.
14. GROUT:
Depth Mated �}Methodd�
From 0 To Ft Con t �'� t'1
From To Ft
15. SCREEN:
Depth Diameter Slot Size Material
From _ To _ Ft _ In ___ in
From To Ft in In
From To Ft. In in
18. SAND/GRAVEL PACK:
Material
Fr
F
17. R
C
R •F
Quad No:
Serial No.
i Ft
NOV — I LI,'uc
HER BY CERTIFY THAT THIS ELL
STR CTIO :.. =• AT
NDWATER SECTION
uiv L OFFICE
L.)
li
k
NC Dept. of Environment
& Naturel Resources
Asheville Regional Office
CCT 2 9 2002
AS CONSTRUCTED IN ACCORDANCE WITH ISAANCAC 2C, WELL
COPY OF TFIIS^HAS GE E WELL OWNER.
slAtp
SIGNATURE OF PERSON C STR THE WELL DATE
Submit original to Division of water Duality. Groundwater Sad ion within 30 days
GW-1 REV. 12/99

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mail Service Center - Raleigh, N.C. 27699-1636-Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR- Price Well Dr-t I) ins T h
WELL CONTRACTOR CERTIFICATION #: 30<00
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE (Check Applicable Box): Residential ® Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below) r�/e
Nearest Town: 0 r�G1n 4Off County: U
/Aux M.t/
(Road flameAnd Numbars, Corpmuniry, or Subdivi¢nnpnd Lot No.)
3. OWNER ekFr(' f0ntc-S
Address :IC /(a /QCU�" Ri4ge Lv'
�)r or Fto,i. n,)J
CIO or Tovm State „ZIpCode
�
4. DATE DRILLED -��`��n
5. TOTAL DEPTH 0 O
6. CUTTINGS COLLECTED YES ❑ NOZ
7. DOES WELL REPLACE EXISTING WELL? YES NO®
8. STATIC WATER LEVEL Below Top of Casing: Q FT.
(Use': 9 Above Top of Casing)
9. TOP OF CASING 1S / Va FT. Above Land Surface'
'Top of easing terminated Wor below land surface requires a variance In accor-
dance with 15A NCAC 2C.e lie �f
10. YIELD (gpm)• c,b METHOD OF TEST Ar (UAW vl
11. WATER ZONES (depth). / i' F- .n200 ill-
1 )
DRILLING LOG
0 ¥#
if1 / 00
/0o a oe,
£oo_co
12. CHLORINATION: Type %the fa; OA
13. CASING: TOMeff
Amount
Wag Thickness
® Depth Diameter or OP
Pre
From To yg Ft . 4 �(P (NYC
From To Ft.
From To Ft.
14. GROUT:
Depth Matedal Aiftethod
From © To 010 FL deVICtrie repot
From To Ft
15. SCREEN:
DEPTH
Formation pti
G/rtn (
(7a2er
Crane
If additional space is needed we back of form
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other map reference points)
Depth Diameter Slot Size Material Kr
From To Ft in in CE
From To Ft. in in
From To Ft. In In y
16. SAND/GRAVEL PACK:
Depth ctz. Material r
Fr. Illo—qt -- IX
Fr r♦ Tv > tlFr II
17. RE
02
BY CERTIFY TH TCTHIS v
CO VSTRUCTION STANDARDS, AND
NC Dept. of Environment
& Natural Resources
Asheville Regional Office
ULT 2 9 2002
VFAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
THAT S COPY OF THIS R9C0 HAS BEEN PROVIDED TO THE WELL OWNER.
CprninptArnTcc ofCTION
FOR PFFICI)V$EL@IS1IONnL OFFICE
Quad
.�•�.- SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit original to Division a water Quality. Groundwater Section within 30 days
GW-1 REV. 12N9
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] �,%n�
WELL CONSTRUCTION RECORD WELL CONTRACTOR. 0 Kc weI/,)r/ // Tr
WELL CONTRACTOR CERTIFICATION #: ?Di n
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE (Cheek Applicable sox): Residential ® Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATI N: (Show sketch of the location below) lei
Neares Town' )n o rga 41-o n County
afns
r✓ I /O
(Road N Nu�¢ , Community, or Subdivision and Lot No.)
3. OWNER ,j9n )3rci99
j SOlA4)
/�� swat or Route o.
/V)onriApnfal r7 . at,sc
City or+fown Stan p Code
a -r s-as
Address 51 O
4. DATE DRILLED
5. TOTAL DEPTH yn
6. CUTTINGS COLLECTED YES NO El
7. DOES WELL. REPLACE EXISTING WELL? YES NO®
8. STATIC WATER LEVEL Below Top of Casing: FT.
(Use •.• n Above Top of Casing)
9. TOP OF CASING IS / // k FT Above Land Surface'
'Top of easing terminated sit/or below land surface requires a variance In accor-
dance with 'SA NCAC 2C .011jj n (�
10. YIELD (gpm): 3 %�- METHOD OF TEST Ot f rigrx..'A
11. WATER ZONES (depth)'
DRILLING LOG
12. CHLORINATION: Type Cam eri! Amount
13. CASING: a�i'
From
From
Wan Thickness
Darter orwslyate
To 1a Ft hfFt f'
To Ft
From To Ft.
14. GROUT:
From
From
15. SCREEN:
O
Depth Material ethod
To aO Ft. C4/Krrfe Our
To Ft
Depth Diameter Slot Size Material
From To _ Ft __ in _ in
From — To _ Ft _— in __. In
From To Ft. in In
16. SAND/GRAVEL PACK:
Fro
Fro
17. REM
IDO
CONS
FOR 0
Quad Na
GROUND"
-yam. rJ1.mr -
EREB
RUC
CERTIFY THAT THIS WE W
"s 1' AT A to.
OFFICE 4
Material
If additional space Is needed we back of form
LOCATION SKETCH
(Shaw direction and distance from at least two State
r map reference points)
10,T 't'
Roads, or o
5,
0
NC Dept. of Environment
& Natural Resources
Asheville Regional Office
COT 2 9 2002
CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
� 0� RECOgpAS BEEN PROVIDED TO THE WELL OWNER.
`�//� a is .0—
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Sutra origins to Division of Water Quality. Groundwater Seaton within 30 days OW-1 REV. 12f99

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- Prier Lc%/l/Jrn //JAg-L-hc
WELL CONTRACTOR CERTIFICATION #: 300, 0
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE (Check Applicable Box): Residential E Municipal 0 Industrial 0 Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection 0 Other ❑ If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below)
u
Nearest Town• orgaaN n �County: -aKC
(Road Name and Numbers, Community, or
lion . an p ttJ From To Lot No. DRILLING LOG
3. OWNER 194fit Fp��f{ 'jY6H1eS w
Address / 2/ 7 P N n Al Q 0 S S
City &Town Stan rip Cod. 3 00 YOC)
4. DATE DRILLED a - co- Epp y OO
5. TOTAL DEPTH in SC� COO 5 00
6. CUTTINGS COLLECTED YES ❑ NO©
7. DOES WELL REPLACE EXISTING WELL? YES 0 NOE t-cv 7b°
8. STATIC WATER LEVEL Below Top of Casing: FT. 700 9067
900 /oso
(Use '✓ If Above Top of Casing)
9. TOP OF CASING IS /'I - FT. Above Land Surface'
Top of cuing terminated at/or below land surface requires a variance In accor-
dance with 15A NCAC 2C .0115
10. YIELD (gpm)• AC METHOD OF TEST A i r NNOLL/
11. WATER ZONES (depth)• /000
12. CHLORINATION: Type Snn,4i°
13. CASING: 70bIE4
Amount
Wail Thickness
Depth Diameter or Weig,hVR. Sktedal
From O To 56- Ft —&--- 6 /8 "-
From To Ft
From To Ft
14. GROUT:
Depth Material Method I
From 0 To 00 Ft CCncrek' POvrd:Y
From To Ft
15. SCREEN:
From
From
From
16. SAND/GRAVEL PACK:
Depth
Depth Diameter Slot Size Material
To Ft in in
To Ft. In in
To Ft. In in
r C-1ETll-
wr To_
ARKS:
e Material
DEPTH
Formation Description
i-1-C/trcciJ
Grefff4
Br(a, 1L
G"nth Me
6eon tic
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)
NC Dept, of Environment
& Natural Reeouree5
Asheville Regional Office
OCT 29 2002
I D� HENgy CEPITliAAT
CO STRUCTION STANDARD'
IFOR Na)g(aTOFICE
awl No.
AND
ELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
AT AC OFTHIS
RRECA( BEEN P DEDTO WE _,,OWNER.
/.lr.rrs- � r //////I ;_n-O9-
SIGNATURE OF PERSON CONSTR THE WELL DATE
Submit original to Division of Water Quality, Groundwater Section within 30 days GW1 REV. 12/99
Serial No.

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mail Service Center - Raleigh, N.C. 27699.1636-Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR- p-ier A/e/1 tO r)/, n� r
WELL CONTRACTOR CERTIFICATION #: -300
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE (Check Applicable Bo:): Residential yrZ1 Municipal ❑ Industrial 13 Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injectio(t ❑ Other ❑ If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below) ry n `/-, (lie
Nearest Town: " 1 Or34i 1+}'O'1 County- l7
-tfD W l '%�% /-�fg�I h Pea.(: cs4, Ps co/ #/
(Road Name a dNumben, mty, or SubdiWsid+and Lot No.) DRILLING LOG DEPTH
3. OWNER / 7 r Vr tie From To /�Fo on Description.
Address JAI; R i Coczch Tn I 0 OR Oi l(a-Q t zk
`<°rnersvle or u ; 72T 3r /Do ar4n/I/a
11Y��� r `
City or Town Stab zlp Code /oo Sao
4. DATE DRILLED 0 -476 _Ca
5. TOTAL DEPTH 6 SO
6. CUTTINGS COLLECTED YES ❑ NO
7. DOES WELL REPLACE EXISTING WELL? DES NO®
8. STATIC WATER LEVEL Below Top of Casing: ( FT.
/ (Use': a Above Top of Casing)
9. TOP OF CASING IS I ,r3' FT. Above Land Surface*
'Top of cuing terminated atfor below land surface requires a variance In seeor-
dance with 16A NCAC 2C .q1�/a
10. YIELD (gpm)• 3 METHOD OF TEST r rovv//t
11. WATER ZONES (depth).
12. CHLORINATION: Type SI h r 1 a I/O? Amount If additional space is needed use back of form
13. CASING: Tq b1 i
roc, 3 oO
3vo ybb
1/
iI
1r
From
From
0
From
14. GROUT:
From
From
15. SCREEN:
Wall Thickness
Depth Dtar}btar orw6 •R yyt•ltjl
To 3S Ft I/7 i c
To Ft.
To Ft.
Depth /r Material! Method
To Q0 Ft roncre,€ vrc-
To Ft
Depth Diameter Slot Size
From To Ft in in
From To Ft In In
From To Ft. In In
16 SAND/GRAVEL PACK:
nosh
7
¥, t
To
RKS:
NOV - 1 2002
EREBY CERTIFY THAT
CONFTRUCT1ON STANDARDS, AND
Si7r1
;OR &LIO$ )i kCOFICE
quad No: dW�l
Material
Material
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, o other map reference points)
NC Dept: of Environment
& Natural R4Btotrr r?s
Asheville Regional Mire
OCT 29 2002
TELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
11-IAT A C PY OF THIS RE D 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]
261074
WELL CONSTRUCTION RECORD WELLCONTRACTOR• ?rite Uk/iDr,N;Y�Tnc
WELL CONTRACTOR CERTIFICATION #: 3 °&O
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE (Check Applicable Sox): Residential® Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: (41Jry4'if0V1 Couny 8udie.
Nron C; rcic
(Road Sarno and Numbers, Conxnunity,r[lofr�S`'bdivision and Lot No.) DRILLING LOG DEPTH
3. OWNER-"`.1>%41�P$ fl\ rnb,YVSI? M From To onnation Description
Address >>9gA_.)� tQCC_iiILSS__t� 0 30 '
m` p strae or outs i fie, Sri 700
city or To
State ip Code
4. DATE DRILLLED�-9 - 0 7-
5. TOTAL DEPTH 4077
6. CUTTINGS COLLECTED YES ❑ NO12
7. DOES WELL REPLACE EXISTING WELL? YES Q NO©
8. STATIC WATER LEVEL Below Top of Casing: FT.
r (use •+ if Above Top of Casing)
9. TOP OF CASING IS / /•� FT. Above Land Surface'
'Top of cuing terminated atlor below land surface requires is variance In accor-
dance wit 15A NCAC 2C .01111 /
10. YIELD (gpm): } METHOD OF TEST /r R/O can
11. WATER ZONES (depth).
•
12. CHLORINATION: Type We tIa hi-inti o i Amount If additional space is needed use back of form
13. CASING: 1 abiet$
Wall Sidman
A�te
Depth - Diameter or Weigh M VC
From 0 To ce) Ft �-- A / g
From To Ft
From To Ft
14. GROUT:
d'
Depth Material f ethod .�
From f� To id Ft (sncr k " vr� �4
From To Ft
15. SCREEN:
Depth Diameter Slot Size Material
From To Ft in in
From _ To _ Ft _ In _ in /‘;-
From _ To _ Ft. ___ _ in in
Orr
v16
17.
th
1
10_ Ft.
To Ft.
RK&CT
Material
LOCATION SKETCH
(Show direction and distance from at lout two State
Roads, or other map reference points)
CO
uGY� CD
�c\4
o: v_
o
-,
Snc-4Y� = eCi•
o-,e-ti // c y °%
sir
I DO I- : a r. _ r- S WE WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C. WELL
CONSTRBOTIONIS ftb )AND AT A CO Y OF THIS RECORD HAS BEEN PROVI • ' • Te THE WELL OWNER.
ASHEVILLE REGIONAL OFF GE / (J � �
FOR OFFICE USE ONLY ! i/d/10ta/�r ont`in 14 am
Quad Na
SIGNATURE OF PERSON CONSTRUCTING WELL
Submit original to Division of water Quality, Gmundwuer Socuon withlri 30 days DATE
GW1 REV. 12199
Ssdal No

North Carolina • Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section 261068
1636 Mail Service Center - Raleigh, N.C. 27699.1636-Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR* Vlr(/ tv-,// 1. •,1) 1 /1 /
WELL CONTRACTOR CERTIFICATION #: -3/1 i, /5
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE (Check Applicable Box): Residential IS.
Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ It Other, List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town' jO:- CSC L' County.
(PRPr l`I
(Road Nacho and Numbers. Community. or Subdivision and Lot No.)
3. OWNER k a tS L a t/J
Address 3 7 0 27 LI eg 6 c?"12 . L? a
(gtreet or Route No.)
li,1 L o C- S c IV- I --
City or Town Sy.
4. DATE DRILLED ?/7"f 47 —.
5. TOTAL DEPTH '2,-3 J
6. CUTTINGS COLLECTED YES ❑ NO®
7. DOES WELL REPLACE EXISTING WELL? YES ❑ NO®
6. STATIC WATER LEVEL Below Top of Casing: FT.
(Use'Above Top of Casing)
9. TOP OF CASING IS / I/ : it
Above Land Surface'
'Top of casing terminated atlor below land surface requires a variance In accor-
dance with 15A NCAC 2C .0113 /J 9 %_
10. YIELD (gpm): r20 METHOD OF TEST i /(L/bW�
i 25- 0- /5F D
/3 etfr
DRILLING LOG DEPTH
From To
Sr
S /00
11. WATER ZONES (depth)'
12. CHLORINATION: Type
13. CASING:
Tip Code
Situ iUfrcN Amount
Wail Thickness
Depth Diameter or Weight/R. Nate
From 0 To S-s Ft - 6 , /�
From To Ft
From To Ft
14. GROUT:
Depth Material A4pth�odd /
From 0 To �° Fr /ehr7rr*,oJ "'
From To Ft
15. SCREEN:
Depth
From To Ft
From _ To _ Ft.
From To Ft.
16. SAND/GRAVEL PACK:
Depth
Diameter Slot Size Material
In in
in in
in In
Size
Ft.
ppliEsire re
CONSTRUCTIO+TAN
S130,1E.LE REGIONALOFFICE
Material
Formation D-scrip
a
If additional apace Is needed use back of form
LOCATION SKETCH
14 (Show direction and distance from at least two State
Roads, or other map reference points) o
0
iJ
0
.G-
r-,z
IS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
, AND THAT AC Y OF THIS R OR HAS BEEN PROVIDED TO THE WELL OWNER.
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Sub mt original to Division of Water Quality, Groundwater Section within 30 days GWt REV. 12/99
Social No

250823
WELL CONSTRUCTION RECORD.
Nana Carolina - Depsnmmt ofa..laoommc and Nun! Resohwas -Division of Waist Qaafity - Grohadwater Section
was cosrnACIDR (a4Di.®ImALINAME (plat) LIMP T rnt: CQTRic,�&ties. 7)0
waLLCONrmaACIORCOMPANY NAIis mow WENT DRI 1-11C ►Ha
QJ. as a 21 324-0035
MIS Vita COWIRO nONH104114 WQraaaaat
6fappl(a 1e) (lftnnliable)
1. WELL USE (Check Applicable Box): Residential D( Ma(cpal/Pablic D Industrial 0 Agriwltual 0
McStenog a Ramsay D Heat Pump Water Infection CI Oar 0 If Other, Litt Use
2. WELL LOCATION: 7T
NearestTowe• n= SPRIAZ county BURKE
KAiLA S RIECE PD.
OWN Nen, Nweben. Qs* Saatsiras. Lag Nat. f9 CS$
3. OWNER SE ELTI DIN; & DEVELOP/TENT' CCRP.
Address 1420 1st. AVE. SW
EIICK tsawtelt NeJ
NC 28601
City or Ten sae aptbae
($2$)- V7-AT,F,
Ala ee&- t'aeee maw
4. DATE DRILLED 02-7&W
5. TOTAL DEEM __3:15
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO AR
7. STATIC WATER LEVEL Below Top ofCaala' 60 FL
weer itAnnsTiontOiw
8. TOP OF CASINO IS 2 FT. Above Land Sunhat°
fl.p elate sepneeed deer below Ind ante make a
vatbose r penman( rota LTA NOW 2C Alt
9. YIELD Sark h METHOD OF TESTRY AIR TFST
10. WATER ZONES (depth):
11. DISINFECTION: Type HIE 1pffi knows S1
12. CASINO: WallItdelnm
Depth a WeigbJPt Ialaearial
From 0 To 103 tt 64' Pt AASTIC
Fr __�To Ft
Fran_, To FL
13. GROtf1 Malai F bod
From_ To Ft. ( It
Fran(__ To Ft,
14. SCREEN: Depth Dimmer Mot size Nineriat
From_ _ To Ft,_io. m
Fmo� To Ft ___Jo. is
1S. SAND/GRAVELPACK:
Depth SSaa Mensal
Ften�To FL
From _To FL_
FDaD�
F =—�!Ct�LOeaa
WELL was CONS RUCIRD
THAT AOOPY OF
JURE OF PERSON CONSTR
Topographic/Land setting
Midge Dslope CWalley Clplat
(chat apecapeie bar)
Letitot dloogitdde of well location
(areal)
Latitlddlaoglede nn OCPSOTopojaphic map
(etaakbest)
Mtni DRI .LING LOG
Fmm To Fomnaion Dcsaipti%
C
;�
N
tv
m
CI
LOCATION SKEICEL
Show direction and distance in miles from at least
two State Roads or County Road& blclude the road
mambas and common road Dunes
t-�
tV
.2,10 xR
�6a�G�
Pedeev Hlu RD.
WIERISA.NCAC3C WELL
HAS BEEN PROVIDED TO THE WELL OWNER
INE WELL DATE
of Water Quality, Greande Ater Seeder, Iasi MM Sankt Cana -Rakish, NC
wiahla 38 ayes Gwa REV. 07n001

250822
WELL CONSTRUCTION RECORD
North Carolina-Deparment ofBankomomt ad Natural Remotes -Division of Watt (tray - teuadwater Seance
WELL CONIRACTOR(H/DIVIDVAL) ?NAME anion GAYNE IfIZ Cotrmcwnw+ a 2343
WELL CONTRACTOR COMPANY NAME FTT(TC(72V WIT MILT TN'' m PHONE s UM) 'zv'mz5
STAIR WELL CON$TRUCTTON P 11041Ts AM1W1S e10 WQ PRIDATIlt
(lf applicable) Ofsnnitablc)
1. WELL USE (Cheek Applicable Box): Residential t< MiwicipaVPabik O lod axial 0 Agricultural D
MonhoeLig 0 Recovery D Heat Pump Water Igjectia 0 Mar D If Other, Lit Use
2. WELL LOCATION:
Neatest Town- P1TIHFRFFIRD MET FIT Cony 141124(F
715 RTTIT P r112i1/F (TTNFTTV CPRINTN/Nr 7PA17
(lteenNene. Numean. Genera: Malta" LaN... SP Cole)
3. OWNER IV ii-N (TT�
Adds 420 PARKER AVE.
L1EMIR (saeec a.erllaJ 28645
82� 7 Tan
race 2;1CoA AnetebNine rasher
4. DATE DRILLED 02-21-02
5. TOTAL DEPTH- 475
6. DOES WELL REPLACE EXISTING WELL? YES D NO pc
7. STATIC WATER LEVEL Beiow Top of as 93 .
other
8. TOP OF CASINO IS 2 FT. Above Land Surface•
flap darts. t..i.W it Wee tale etee. .Males e
ens=! aeuMe.ee Nab ISA NCAC 2C.p1L
9. YIELD Wok __5—_ METHOD OF TESTRY ATR 'TEST
10. WATER ZONES (depth):
Topographic/Land setting
Midge Mope OValley Mac
(ebeck wtawos bee)
Lat14d0&Ioagin'dc of well Location
(iapeermi..ee4aorM)
LC4ldellaoglade soniccOGPSOToporgaphic map
(cite* WO
D2/2111 DAD Lt1G
From To Formed oDescription
0
a rn
C-) cm
fV .gin
11. DISINFECTION: Type EffIl TAB Amount 70
12. CASINO: Wall'I3eknata
w
From 0 To S74 Ft 4
From,_ To Ft
From_ ' To FL
13. GROUT: Depth Merit' Meshed
From L1—To_ m Ft slut rr FIT ¶ FT1
Pron.! To Ft
14. SCREEN: Depth tint Stet Size west
From --_To Ft in, in.
From_____ To Ft r_ jo. M.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft
Ftoa_To_ Pt.
16. REMARKS.
ir 11 I'itq Witils t I7 R
N
se
-Ts
IV
es
Cr.
en
in=
-4
-y
0
LOCATION SKETCH
Show direction and distance is miles ttom at least
two State Roads or County Roads. Include the road
amebers sadeoaomm read ?ten
tv
WELL WAS CONSTRUCTED
A1mTHAT &COPY OF -DES
ter
... ANO3 Wr1H ISA.NCAC 2C, WELL
HAS BEEN PROVIDED TO THE WELL OWNER.
,
C2-27-02
Ls�it .
y'0
TU RE OF PERSON CORM
r
WELL DATE
of Water Quality, Grealwater Swiss, Ma man Swint Cesar -Rakish, NC
, within 341 days. OW -I REV. mn001

2769,2!14T heap �{o�. (919;
E
^)J'.t831
WELL CONSTRUCTION RECORD.
North Carolina -Department of Environment and Natural Renounce -Division of Water Quality - Grouudvatar Section
WELL CONTRACTOR (INDWWWUAL)ISAME (plat) WANE TLtC mortwiC*►no$ * 72LCI
WELL CONTRACTOR COMPANY NAME HIS WELL PRILINL' W. puww a 828) 324-0035
STATE WELL CONSTROCnON PE*at1Te A7ED WQ fRMTH
(ifavoliceblc) Ctrizable)
1. WELL USE (Check Applicable Box): Resideatia) MuJdpol/Publlc 0 Industrial 0 Agricultural 0
Monitoring CI Recovery 0 Heat Pump Water Injection CI Other 0 If other, Lit Use
2. WELL LOCATION:
Nearest Town: GC NELLY SPRMS County BURKE
8114 F7ARDlS GAP RD.
(Seat ertm, Nude. Qatettate, netiaao. Lot Na., re Code)
3.owNERL_L_RYINIAN COCK
Address R114 WARD'S CAP in
(SoettallamNW
CWELLY SPRIISE NC 28612
Sae Z1/41036
828 4-ll84
flea cede -Pion ember
4. DATE DRILLED 02-2G-02
5. TOTAL DEPTH. 705
6. DOES WELL REPLACE EXISTING WEILt YES 0 NO c
7. STATIC WATER LEVEL Below Top of Cm* SI FT.
(Uow"itAbsnTepofCoat)
8. TOP OF CASINO IS 7 FT. Above Land sodiu °
asap of tubas tensisated Wet bdew had aatha require a
velana la susardno with 1SA ?CAC 2C .pia.
9. YIELD (gpm)c METHOD OF TEST BY AIR TEST
10. WATER ZONES (depth):
11. DISINFECTION: Type ice{ TABS
12. CASINO:
Depth rer
From 0 1C0 FL
From To_ Ft
FL
Front—__ To
13. GROUT: Depth
From D__To 7f1
Fro_ To
14. SCREEN: Depth
From To
From To
15. SAND/GRAVELPACK:
DePth
From To
Front To
16. REMARKS:
� TUNS -ire
Amount 33
Wall Zilches:
ormgM/Pc PLASTICPVC
Mania)
Ft. OM'
Method
ITT 1RFTl
Ft
Dimes Slot size Material
FL.-D. In.
Ft —Jo. is
Size Material
F<.
FL
Topogtaphio/Land setting
Midge CISlope Malley OF1at
(that appoprime bin)
latitod&longitude of well location
A
mignuravararemin
Latitndeflaogitade atwrteDGP50Topognphie map
Waage)
g_g_ DRILLING LC10
From To Formation Description
0
N
-a.
-O
23
LOCATION SKETCH m o
Slow direction and distance b mites from ate
two State Roads or County Roads. Include the road
mambas sad ceoamooroad omits.
on Pow-
Izn•
lei �/
oho
Ego
5- 0,
e e-
ee
6
TunS WELL. WAS CONSTRUCTED
AND THA 0PYOFT1iIS
SIGNATURE OF PERSON CONSTR
ANCB WTIB ISANCAC2C. WELL
HAS BEEN PROVIDED TOTHE WELL OWNER
02-27-02
WELL DATE
Submit the originalto the Divhlon of Water Quality, Grscadwater Section, 2636 Man Service Center -Raleigh, NC
733,3221, within 30 days. GW-1 REV. 07/2001

248477
WELL CONSTRUCTION RECORD
North Carolina — Department of Environment And Natural Resources — Division of Water Quality — Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) ROBIN MCNEELY CERTIFICATION # 2567
WELL CONTRACTOR COMPANY NAME PITTMAN WELL BORING, LLC PHONE # [phone]
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 ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: VALE
OLD LAUREL RD.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: RAY HEAVNER
Address 7373 OLD LAUREL RD.
(Street or Route No.)
VALE NC 28168
City or Town State Zip Code
(828) — 217-1659
Area Code Phone number
4. DATE DRILLED 02/07/02
5. TOTAL DEPTH: 59
6. DOES WELL REPLACE EXISTING WELL? YES ® NO ❑
7. STATIC WATER LEVEL Below Top of Casing: 47 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1-1/2 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): 12 METHOD OF TEST STEEL TAPE
10. WATER ZONES (depth):
County BURKE
11. DISINFECTION: Type CHLORYTE Amount 5.52
12. CASING: Wall Thickness
or Weight/Ft. Material
From CEMENT
Depth Diameter
0 To 59 Ft. 24"
From To Ft.
From To _ Ft. _
13. GROUT: Depth Material
From 0 To 20 Ft. CEMENT
From To Ft.
14.SCREEN: Depth Diameter Slot Size
From To _ Ft. _ in. _
From _ To _ Ft. _ in. _
15. SAND/GRAVEL PACK:
Depth Size
From 47 To 59 Ft. 78M
From To Ft.
Method
POURED
16. REMARKS:
Material
in.
in.
Material
GRAVEL
Topographic/Land setting
0 Ridge 0 Slope ❑ Valley 0 Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source: ❑ GPS 0 Topographic map
(check box)
DEPTH
From To
DRILLING LOG
From To
LOCATION SKETCH
Show direction and distance in miles from at least
Two State Roads or County Roads. Include the road
number and common names
HWY. #I8 N. FROM. FALLSTON. RT. ON
GEORGE HILDERBRAND SCHOOL RD. RT. ON
OLD LAUREL RD.
0
IV
cn
w
0
J
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
S�t4initthe original to the Divisi
27699-1636 Phone No. [phone]
CONSTRUCTING THE WELL
- 7 - o c
DATE
ater Quality, Groundwater Section, 1636 Mail Service Center — Raleigh, NC
within 30 days. GW-1 REV. 07/2001

2508Q3
WELL CONSTRUCTION RECORD
North Corals -Deportment aftatr aetandNaeralReams-DiwiwofWaterQoality-CtooadwaterStation
WELL CONTRACTOR (RtDIVWUAL1NAME wan catunorao$ it 2316
grp,L coaTncroa COMPANY NAME EIIQd Z IdIL IFcILI.l1`� W. nun e 18 324-0035
STATE WELL CONSTaUC12ON fEVMN# ASSOCIATED WQ PERMIT.
(IIaaallceble) oftktblol
1. WELL USE (Check Applicable Box)Residual II Municipal/Public D Industrial D Apiculture! D
Monitoring 0 Ramsay D Heat Pimp Water Injection D Other D If Other, List Use
2. WELL LOCATION:
NeussTown: UN= SEEMS comity HIdCE
5877 BUZZ ILWPN RD.
Ono NamaNvmb*n.C,uu. w.Svle ake.LmNew! Cob)
3. OWNER`S anN*1
Address 5877 RQZ IOGMAN RD.
MELLY sEemaNy 28612
(�itme ��4 M��R77c)-Ycff R Tor &MC zit Cot
4. DATE DRILLED 01-02-02
5. TOTAL DEPTH: 475
6. DOES WELL REPLACE EXISTING WELL' YES WNO D
7. STATIC WATERLEV61.Below Top ofCKIM 80 ft
(racerWAtwttidamn
8. TOP OF CASING IS 2 FT Above Land Sutc
no, erwt.qm trt+�w..h�e.� tSr ben Mai awatutwinsta
vIELD(s L with tfmt MAC 2C Ala
9. YIELD (gpok METHOD OFTESTBYAIK in
10. WATER ZONES (dept$:
Topographic/Land setting
DRidp CISlope DValley DFlat
Oita appraptimie hex)
latitudenongiale of well location
(arpaaaA. uis a•AS)
L ' imp
Matta
phi DRutab
From To Farmatioal
N c`�
11. DISINFECTION: Typo HIM TARS Ataoont 77
12. CASINO: Wall Means
Dimmer orWeigSR MoatFrom.. 0 TToo 48.--Ft, an PVC: HASPEC
Froot--To FL
..... --
From______ To_ Ft
13. iom0 To 20 gt err Method
P_FCCRED
Prom
Froth- To Ft
14. SCREEN: Deph Dimmest: Slet Site Maeetial
Fro` To Ft---.1. ia.
From To Ft,.. ---JD. is
15. SAND/GRAVELPACK:Deleh Sias MatnMl
From Te F
Fnona To Pt
16. REMARKS'
tV
G
0
v
rn
LOCATION SICECCR
Show direction and distance in ndles from at least
two State Roads or County Pads. pint the road
numbers and cannon road names.
s �� to/ E
ti
rAs"i°"
JUM 2 a
R..L
t VO E PHI
TUT THAT Tins WELL WAS CONSTRUCIBD INACCORDANCE WITH ISANCAC 2G WELL
A1mARDS,AND TBATACOPY OFTHIS R8 HAS BERNPROVIDED TOTHE WE LOWNER
01-08-02
SIGNA ''t:O "ERSON DATE
to the DltdsMm of Water Quid*, Groundwater Seethe',1i36 MaU Sondes Center -Raleigh, NC
(91917334221, within 30 days. OW-1 REV. 07/2001

250807
WELL CONSTRUCTION RECORD'
North Carolina -Department of Environment andNat ral Rawmoaa -Division of WaterQuality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME tp it et kat/JAYNE T cnn n noNa7-4E3
WILL cONTMCIOR COMPANY NAMME
FIRXEY FEEL ORIILIINU CO- PHONE a f828) 34-0035
STATE WELL CONSIRUCIIGNfinte t ASSOCIATED WQ PERIRTt
(ifaoalkable) Ofspoltable)
1. WELL USE (Check Applicable Box): Residential 0 Mlaicipu VPublio 0 industrial 0 Agttoultutal 0
Mooitoring 0 Reeovvy 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WBLLLOCATION:
N Wars Town.
SWIMS County 1 �
Mont Nutt, Numbers, CN,mwib%Stda rlitmLas Ns. 24pCodt)
3 A� 1� 6 11BIG JOIN WYID
1IGIN le am`N0.) LyIX+S
Guy at Tara Set
Cala> 7'f,-1RSR
Amu Gets those Mather
4. DATE DRILLED 01-16-02
5. TOTAL DEPTILYS
6. DOES WELL REPLACE=SZ1NG WEIL? YES 0 NOAll
7. STATIC WATER LEVEL Below Top of Casinr
e"r:swtmwtapW{t dO
8. TOP OF CASING IS 2 (v FT. Move Land Suitt*
*Tap *Cassias gas a044 War bens lad Meath relates a
miaow la ecsMaact sttb 35A NCAC 2C Da AIR 1
9. YIELD (�k ° METHOD OF TEST BY
10. WATER ZONES (depth):
11. DISINFECTION: Type HMI TARS AIDwnt 68
12. CASINO: Wag Tbklvea
Nkattial
From 0 � 71 Fe
Dingle RCS PLASTIC
Fromm To_ Ft
Front To Fe
13.OROUI: Depth mites]
From 0 To 20 Ft._E
From To Ft
14. SCREEN: Depth Dimmer Mot Size Madatial
Front --Toy_ In.
Fmm_. To Fr -rib is
15. SAND/oRAVELPACK: Depth SiMaterial
Size
From To Fr
From To Ft.
Speedo
par
Topograpbio/Land setting
ORidge OSlope OVaDey Mat
(check a -Pea- n
Latitodc/1oagidide of well location
Iatieuddlao�dee a01 SOfopoeteWhic map
(drank ban)
pRILL.ING LOG
From To Formation Description
c
16. REMARKS'
JUN 2 6 2O�
Submit the oto Mahlon of Water Quality, Grande/ate Settion,146 MNd1 Service Cover -Raleigh, NC
,>
Cr)
2
v
I.00ATION SKEfCE z
Show direction and distance ha mile from at least
two State Roads M County Roeda. Include the road
numbers and common road names.
o
V. n
0
-9 0
7C Er^
Ton
N son
ne
na
N
<ej
ACCORDANCE Whit 15A NCAC 3C. WELL
HAS SEEN PROVIDED TO THE WELL OWNER
01-17-02
GRo'--U3(9 ta4s(919
ASHFVIt L- "._Uiti M. OFFICE
DATE
I, within 30 days. OW-1 REV. 07/2001

ASN-Etmd E
250812
WELL CONSTRUCTION RECORD'
North Carolina -Department etEs*o aientandNabnlRastas -Division of Water Quality - Groundwater Scotian
NELL conTRActoa pretvainaLrumeQs1 taw tar. cznurscAscolr 2343
nu. conncroawean Nona HLGLWGkLL IRIII-M m• enora s (R7Rt 176
41119
STATE vans Coressn iCnON Pawn_ ASSOCIATED WQ KEMIT#
Of aoollable) (itappllobie)
1. WELL USE (Check Applicable Box): Radduidal 0 >NIm1cipslloblio 0 lndmhial 0 Agdeultu al 0
Monitoring 0 Recovery 0 Heat Pump Water Igjeadm CI Other 0 If Other, List Use
2. LOCATION:
N NeaussT Y SEMIS comer EWE
WARLICK W EL (1110i BD.
aura tem% NaaNn,c ,..saladianLsNu.ZpCoin
> �oviCEEREIuDENER
3. Adtkass 2606 an [CIF RUE IN. AFT'. C.-
0113ELLY sir 2PL17
atyvTon Ste SCAM
(82$„). R9R4Yd1R
ANea oar Pb. corker
4. DATE DRILLED 01-16-02
5. TOTAL DEPTH;.._ Tn
6. DOES WILL REPLACE EXISTING WELL/ YES 0 NO i17'
7. STATIC WATER LEVEL Below Top a/C�n6
(M-flM.aToricoasd
8. TOP OF CASINO Is 7 FT. Above Land Sumter
nap et woke Nastiare SirbaMw had arts seethe a
vIE s,eo..+a " ISA D
9. YIELDD (WO Ala
a" TESTBP AIR 'TEST
10. WATER ZONES (depth)*
I I. DISINFECTION:1ype HIH 'TABS Amara 54
12. CASINO: Wall team
From 0 To�83 Ft, W ATV
Fmk Te
Frew To Pt
13. GROUT: Depth htatetrl MS?d
From.._0 To 90 __TM n Tr muFn
From To F1
14. SCREEN: bier Dien Slot Sher Medal
Fr�i�e �
F1;om.._ To
15. SANDIGRAVELPACK: Slow Material
From Te
From To Re-
a
Topographic/Land setting
Midges slope Money OFlrt
Itddapposprine
otwell location
iatiasdd
eta boy
Fatale LOG
Emm a=Dwodper
Nail
From To
0
--
Z rn0
x N3
-*42
m
J.00AUON SKb7CI& 2
Show dreationand d dams in flees tom at least
two Stale Roods or CountyPaeda Lxlode One road
numbera sod common road names.
vjo, Lon 6�e41
Iti ui•pt.. a° E
y (sk°4 *,t>A
-B
TEAT IHIS WELL WAS CONSTRUCTED IN ACCORDANCE vents NCAC 3C. WELL
CONSTR AND /HATACOPYOETIISHAS BEEN PROVIDED TOTHE WELL OWNER
01-1-oz
OF PERSON WELL DATE
]
`i�F .o�d
o the DW Won of Water Quality, Groundwater Saetlon, tp6 man Suvia Center -Raleigh, NC
t . one Pie. (919) /33 3271, within 30 days. OW -I REV. 07/2001

250811
WELL CONSTRUCTION RECORD
North Caolioa-Deputed ofHavLmmeat add Natal Rttomw-DiviSoa of Weser Q.a6ly - Grouedntm. Station
WEL conitscton(D(D1V m4*AMZ Irmo WAVW TCIS; ciRTH}1CAaore 2343
Ana. carcinoma E MMETNAha HIGOt5C 1411- IRIILIW (0. recta a PM) 326.411)19
STATE WELL CON62RvcnONPERMS AINOCINIEDwQt3msr[a
(itsaallable) NWINable)
1. WELL USE (Cheek Applicable Box): Pesidatial MttddpiYPubne 0 Industrial 0 Avicenna! 0
Monitoring 0 Recovay 0 Hat Pump Waterlgjeeden Other 0 1fOher, List Use
2. WELL LOCATION:
Nang Tows; greall otm9' m
STi/FR (R FTt (HBCH RD.
(WAN Nan, Maims. Camrin thaw irm. lee Ns.lb tell
3. OWNER:2JVFR CREFK BAPTIST Q-LE H
Address t VKRN 7XYTW 9 FA917FR S14S R'RFTYiDLST.
camettateN0
MTGANJCN
` 1+ 73Abu web- Pis wrdwrd
sm
4. DATE DRILLED
5. TOTAL DEPTH
6. DOES WELL REPLACE EXISTBQG WELLt YE NO 0
7. STATIC WATER LEVE1. Below Top of Casing 29J FT;
(UaesM'WAtr nivonada.
8. TOP OF CASINO IS 2 IT. Above Lend tmtcea
*up ereulsa wef W4 Wes telw Nat suer Meier •
setting
Midge d
'works
IadWddloigibideofa location
Lmmd finny des sourcaterapogrepldc nap
AbstrW
EMIL pRU&ING LOG
than To Formation Desalption
varkaAaao,4aatwabISANCAC2CAUUL BY AIR
1PJ1
9. YIELD(mmk 2 METHOD OFmS!
10. WATER ZONES (depth:
11. DISINFECTION: Typo t{IH 'TARC Amount 11(1
12. CASINO: Wall Indolent
Depth Dba ser oewdgtIWL MaidC
From To 118 i1. 6�'r �_
From.—Tn Ft
Frain—_ To Ft.
13. GROUT: Depth MetetNl WWI
prom 0 Te 22Ft CHIT
Front__,_To Ft
14. SCREEN: Depth Diener Scot Sin :Menial
Frnm _To Ft, --to. in.
From To Ft-1.. is
15. SAND/GRAVELPACX:
Depth Sim Amain
From _To Ft
From To Ft
THAT BUS WELL WAS
coNs1xucrHOKi3T ;
474allAT ACOPY o
SIGNATURE OF PERSON
C x
N
a
TV z2rT
-L ~`
LOCATION SKETCH N m 570
Stow dkeetim end6sta = in miles Bout at last
Iwo States Raab or County Roads. bears Woad
aembas end noun=road names.
to
N
kork6f: [Nov
E
otuf
s
DIACCORDANCB swat ISANCAC 3C. WELL
RECORD HAS SPNPROVIDED7o7HEWELLOWNER
01-31-02
TRH WELL DATE
CROU U �t �F�}�Ipdto DlrWonofWater Quality, GroundwWrSecdoe0636MgSonde* Cesa-Raleieb,NC
ASHEVI�I.E LIB1k> +Hs-(9n17334221,witbin30days. OW-1 REV. 07/2001

250814
WELL CONSTRUCTION RECORD.
North Carolina -Department ofgavirommeet and Natural Resources- Division of Water Quality - Groundwater Section
WELL CONDUCIVE (DVD1YTUAIaNAME (pro. W&VNE IfiNE CLRTlf7CATION N 2'
WELL CONTRACCOR COMPANY NAME EIIQCCYtY Iu1•Tl. ERILI.II m• PHONE a LR2RI32 6- fi
STATE WELL CONE INICTlON PERMIT# Ai6OCIA7ED WQ ME
appllcable) Of rame)
1. WELL USE (Check Applicable Box): Residential felK Municipal/Public 0 Industrial 0 Agricultural Cl
Monitoring ❑ Reeovay ❑ Heat Pump Water Injection O Other Cl If other, List Use
2. WELL LOCATION:
Nearest Town- Y SIRII`13S Cry 13JR E
Motet thine, Numbers, Caawei7, S Isitiaw. LmNe.. re Cods)
3. OWNER:_ KA ERDE CLINE
Address 9(16(n 0PRIMES
s
SLY SHUN NC 28612
City or Tow Sete DP Cede
(R21)- RQ7-0Q51
Alec eons Hen maw
4. DATE DRILLED 01-29-02
5. TOTAL DEPTH; 2/,S
6. DOES WELL REPLACE EXISTING WELL? TETA NO I7
7. STATIC WATER LEVEL Below Top ofCm*
__T•
gh `rifabawmapdCurd
8. TOP OF CASING IS 2 FT. Above Land SurAwe•
•Ty deeds( ten Iona War anew had ashes requite
vELD (g n)c _20 with fsA =ROD OF TES1BY �T
9. YIELD (�1:
10. WATER ZONES (depth):
11. DISINFECTION: Type HMI TARS
12. CASINO:
DiameterFrom 0 Depth Diameter
Ft. 611+
From`, To
From_ To
13. GROUT: Depth
From 0 To p
From_ To
14. SCREEN: Depth Diameter
From__ To Ft._.�in.
Front____._ To Ft.,_Jt
15. SAND/GRAVELPACK:
Depth Sim
From To tot
Front_ To Ft.
16. REMARKS.
Amon 47
Wall Thickness
al Weight". C
FVC
F+ Material
Ft. rcur
Ft
Slot Sly
in.
is
•'til'L7�1
Topographic/Land setting
ORidge OSlope Malty OFlat
pack epptepriee tom)
Latitedefloagit ide of well Location
LalituddlaogAude epowrrbK map
plea ban
MEM pRIUJNG LOG
From To FormuionDcscription
Material
Material
0
N o
4�
N Sr
-c, T�
Nz
N
F.00ATION sflTCII(In o
Show direction and distance in miles from at Est
tw State Roads or County Roods Include the Toed
numbers and common road names.
Arc'
o
e y, #74:
5
NA _ f�'df THAT THIS WELL WAS CONSTRUCTED
DO 2
GR00N' qq Yi
AS'r.EY_LL. i3m�LA,.FL
AND THAT A COPY OF TWS
i
SIGNATURE CONSTR ;Pa: ' t
CCORDANCB WT'(H I5ANCAC 2C. WELL
HAS EBEN PROVIDED TO TEE WELL OWNER
02-05-02
DATE
THE WELL
to Mahlon of Water Quality, GrSQRdwater Bettina, 1636 Mall Service Center -Raleigh, NC
(g :) 733 3221, within 30 days. GW-I REV. 07/2001

250816
WELL CONSTRUCTION RECORD.
North Carolina -Department of Envimument and Natural Raaounms - Division of Water Quality - Groundwater Station
WELL CONTRACTOR prm wmmAL) NAME fildmiLthiAVNE LCI casermesai z'a 72/43
WELL CONTRACTOR COMPANY NAME HIQIrwN WFT T FRTTI TIP. M PHONE a1828) 324-(RS
STATE WELL CONSTRUCTION PEtl1Ta ASSOCIATED WQ MUG U
(ifawltable) (ifnpliable)
A
1. WELL USE (Check Applicable Box): Reaideadal 0 Municipal/Public 0 Industrial D Agricultural D
Monitoring D Recovery D Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town' MIXEL Cry BIKE
3768 BASS DRIVE
(Saeat Nama. Madam Camla l%, Subeataiaq La N.., Sp Cole)
3. OWNER;_ M'I�91A1F RB t(
Address 3768 BASS CLJVE
(Sven enawHo.)
VALLFSE IC 28693
Cay arTawa Sat ZIP Col.
(328 1- 4TI-71 19
Asado %ae maw
4. DATE DRILLED Ot-02-02.
5. TOTAL DEF11$_d)S
6. DOES WELL REPLACE EXISTING WELL'? YES gt NO D
7. STATIC WATER I.EVEI. Below Top of Caskog
ctheriorancep toad
8. TOP OF CASINO 1S 7 FT. Above Land Surface
flop et ragas t.,al.atM War Wiwi Ind wan. regattas a
vaelae= 10 .wrda.ctwab ISA NCAC SC MIL9. YIELD (gpm): METHOD OF TESTS' AIR TEST
10. WATER ZONES (depth:
11. DISINFECTION: Typo HiT-1 TARR
12. CASING:
To Front_ Q_To 58
From To.
From To.
13. GROUT: Depth
From 3 To 20
From To
14. SCREEN: Dept
From To
From To
15. SAND/GRAVEL PACK:
Depth Sim Material
From To
From To Ft.
16. RP -MARKS:
Submit the o to
Mita 1
GE,CUD:D cAFIC 9
ASNEvIILLE GUN
Amount F7.
Wan Tbidmasz
t) r orWeeat MCA
FL 6'l.' RC HASTIC
Fr
Material Dal d
Ft acur
Ft
Dimeer 9101 Size Material
in.
Ftin.
THAT THIS WELL WAS CONSTRUCTED IN
AND THATerf OF THIS
SIGNATURE OF PERSON CONSTR
Topographic/Land setting
ORidge °Slope Walley OFlar
(cheek appropriaie box)
Whe a/loagii ide of well location
tatimddlongit.de aoutccOGPSOTopograpthic map
(eltacic boa)
MEM PULLING LOG
From To Formation Dcxriptioo
c
v ..
a ��
Cc,
Z -
N�
�b A
LOCATION SKETCI{ en o
Show direction and distance to miles from aghast
two State Roads or County Roads. Include the road
numbest; and common road names.
N
))nx(L
S
5t.
ANCE WITH 15A NCAC 2G WELL
BEEN PROVIDED TO THE WELL OWNER
02-10i-02
WELL DATE
L
Division of Water Quality, Grscadwater Sat(oa,1636 Mail Service Caster - Rakich, NC
733.3221, within 30 days.. OW-1 REV. 07/2001

250815
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Ramwees - Division of Wafts Quality - Groundwater Section
WELL cormtACTOR (a(Dnne)VAL) NAME Wtami WANE IEtc CERTIFICATION,g2343
watt mammon COMPANY NAIVE HIQCW WEIL Ind -MU CD. PRONE s j<i9R) 27/[-C1Th
STATE WELL CONE RUCTION IMISD4ITO ASSOCIATED WQ moat*
(ff applicable) Dir 1 cable)
I. WELL USE (Check Applicable Bon): Residentiail Municipal/Public 0 Industrial D Agricultural ❑
Monitoring 0 Recovery D Heat Pump Water Injection 0 Other O If Other, ListUse
2. WELL LOCATION: "ICE
Town•' 0WY
3786 BASS'Yt1VE
(Seat Nana Nathan, Common% M4.iia Let He. rip Code)
3.OWNER;._rKlR 4AL1.,RECICR
Address 3786 BASS IPIVE
Road No
VALD6E ( or28693
cityoft:me Sale no Cot
Lai) L"t ,_71'24
Ant adze Piro amber
4. DATE DRILLED 01- 7
S. TOTAL DEPTH:SS
6. DOES WELL REPLACE EXISTING WELL? YES CT NO O
7. STATIC WATER LEVEL Below Top of Casingj F.
(their Haase Top de:WNj
8. TOP OF CASINO IS 9 FT. Above Land Surface
`Top deals. Iaeahated war War• tad arer aquas a
values Pe ameSaa wnh ISA NCAC 2C .pla.
9. YIELD (gpm): • /3 METHOD OF TESTBY AIR UST
10. WATER ZONES (depth):
Topographic/Land setting
ORidge OSlope OValley OFlat
(check .ppaptia hat)
Latitaddloogieide of well location
esechinshicark
Latimddlcogiade so>aCGOGPSOTopot npbic soap
(chock box)
D€PTE pR1 .IN
From To Formation
11. DISINFECTION: Type HiH TARS Amount 110
12. CASINO: Wall Tim
or Weighr/Ft.
FrooL Two 6 EL /VC
From To Ft
F�
From To
13. GROUT: Dtptltn
From To
From To
N. SCREEN: Depth
From To
From To
15. SAND/GRAVELPACK:
Depth Sim
From To Ft
From To FL
Ft airs'
Pt`
telemeter Slot Size Martial
in.
Ft -in. is
Mated al
ro
T oc
e
Ni foci
T �r
N
na
a0
mZ
n
tin
LOCATION SKEICK
Show direction and distance in miles from at least
two Sate Roads or County Roads. Include the road
mambas and common road tames.
N
ldwy9v
tAl
P6;,0,,fit-
THAT T IS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISANCAC2C. WELL
AND THAT A COPY OF THIS '?• HAS BEEN PROVIDED TOTHE WELL OWNER
« _ 02-C6-02
SIGNATURE OF PERSON COWER
THE WELL
DATE
to Dledalon of Water Quality, Groundwater Sec8nr,1636 Man Soviet Colter -Rakigh, NC
SPOOGNw (91
733-3221, within 30 days. GW-1 REV. 07/7001

North Carolina • Department of Environment and Natural Resources • Division of Water Duality - Groundwater Section
1636 Mail Service Center • Raleigh, N.C. 27699-1636•Phone [phone]ELL CONTRACTOR. '`n"/ LnC
WELL CONSTRUCTION RECORD WELL CONTRACTOR CERTIFICATION #: �
STATE WELL CONSTRUCTION PERMIT#:
247717
1. WELL USE (Check Applicable Box): Residential® Municipal ❑ Industrial ❑ Agricultural ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATION�(-dSh w sketch of the location below)
Nearest Town: �%e 5 Counry
Mr nwzll Sprinelzctnucla ac1, 7 (_ec)r-,- Rci
(Road Name end Numbers. Community, or Subdivision and Lot No.)
3. OWNER / Crry .Tacicr'rrri en
Address - Do /ec,t EC/
( /2 niece (Street 7:30te No.)
City or Town State
4. DATE DRILLED 1
5. TOTAL DEPTH ' 7
6. CUTTINGS COLLECTED YES ❑ NO®
7. DOES WELL REPLACE EXISTING WELL? YES ❑ NON]
8. STATIC WATER LEVEL Below Top of Casing: /ib FT.
1
(/n fuse '+' a Above Top of Casing)
9. TOP OF CASING IS � FT. Above Land Surface'
'Top of casing terminated aUor below land surface requires a variance In accor-
dance with 1SA NCAC 2C.0118
10. YIELD(gpm): IV METHOD OF TEST irl3/oc✓r.
11. WATER ZONES (depth): da.05-7- A
DRILLING LOG
From To
(i e?
R5j ova
aoz3 .3aa75
•
2n90
Zip Code
12. CHLORINATION: Type Gl01."0/ Amount---
13. CASING:
Wail Thickness
Depth _ Diameter or WeighVFLr/y
From ° To 9h Ft --(a--
To Ft.
From To Ft
14. GROUT:
Depth Material {Meethyo�d if
From 0 To J _ �Ft (o,y ' u '
From To- Ft
15. SCREEN:
Depth Diameter Slot Size
From _To Ft _ in. ____ in
From _ToFt.— in —in.
From _ To _ Ft. _._ In. __ In
16. SAND/GRAVEL PACK:
From —
From _
17. REMARKS:
Material
Material
Monitoring ❑
DEPTH
Fo�ytion Description
Al`r7 ¢ieocjC
JrgnitC
aran,I-c,
N
If additional apace is needed use back of form
Depth Size
To — .— Ft.
To Ft.
l0
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other reap reference points)
Hwr l$ -W
ytt
c
t4STRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
I O HEREBY -
CONSTRUC-`OM TITANDARDS, AND THAT A P F THIS RECO HAS BEEN PROVIDED TO THE WELL OWNER.
acid /-l6 —&-a
FOR OFFICE OSd'CrNLY SIG NATURE OF PERSON CONSTRUCTING THE WELL DATE
Quad N0: I . _ .
a,itvnu giny w Division of water Quality. Groundwater Section within 30 days
Serial No.OW1 REV. 12N9
G J•JL! v/T' SECTION
--^^++'r'. L R '.. Ui-FILE

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] f/}}
WELL CONSTRUCTION RECORD WELL CONTRACTOR. Pei( e 1(/r/! DDri'//J)19 c
WELL CONTRACTOR CERTIFICATION S: 3 01 a
STATE WELL CONSTRUCTION PERMITS:
247715
1. WELL USE (Check Applicable Boa): Residentialp Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATION: (Show sketch1of the location below)
Nearest Town: /'"fof4,7rt/Q/ County.
Z5/i// °R(I)P I !-
(Road Name and Numbers, Co nity, or Subdivision and Lot No.)
3. OWNER I Pre -
Address 1 3 Li. E I m '\
(Shea or Route No.
/Thcatn�nry tJ'C. f C)k 'SS
City own State Zip Code
4. DATE DRILLED /-'.5/'off
5. TOTAL DEPTH 45 O
6. CUTTINGS COLLECTED YES ❑ NOIN:I
7. DOES WELL REPLACE EXISTING WELL? YES NOLO
8. STATIC WATER LEVEL Below Top of Casing: FT.
( (Use'+' if Above Top of Casing)
9. TOP OF CASING IS /a FT. Above Land Surface'
'Top of casing terminated at/or below land surface requires a variance In actor -
dance with 15A NCAC 2C .011 a /�
10. YIELD (gpm): (7 METHOD OF TEST / rIJlbry .1
11. WATER ZONES (depth):
DRILLING LOG DEPTH
From To Fgmution Description
0 $ �Ir�l`QOC/C
ag bo G
-000 Grant
-3o0 - 6 00 eraAtYC-
6o0 • 735— CMill {r'
735- -85-0 Aron
air-
12. CHLORINATION: Type Cetrisr
13. CASING: G�-Fe.t1v1rS
Amount 3 v z
Wall Thickness
CD
PJ
If additional apace is needed use back of forgl_ cn
Depth �/ Diameter of2ei�rytFL Plz
From 0 To of Ft — //A //
From To Ft
From To Ft.
14. GROUT:
Depth Material ethod/
From 6 To - 6 Ft CCAC%Ck f ' a p
From To Ft
15. SCREEN:
Depth Diameter Slot Size Material
From To _ Ft _ In. _ in
From To Ft In In
From To Ft. in in
16. SAND/GRAVEL PACK:
Depth Size Material
From
From
17. REMARKS:
I DO HEREBY C
CONSTRUCT!
ToFt
To Ft
FOR OFFICE US O tI
Quad No:
4THAT'TH)s WEL2wA5CO4:
DARDS, AND THAT AC C
LY
SflNA
Submit odgirrl to Di
W
LOCATION SKETCH LEI
(Show direction and distance from at least two State
Roads, or other map reference points)
UCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
THIS RECOR HAS BEEN PROVIDED TO THE WELL OWNER.
WRE OF PERSON CONSTRUCTING THE WELL DATE
Nsion of water quality, Groundwater Sadion withlti 30 days GW1 REV. 12i99
0
Serial No.
'r;1`EP SECTION
1 iCL OFFICE

04/04/2002 09:47 919-715-05E9
rICPE2NP/w4TEP DUAL-'-
268313
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Nattral Resources (- �Division of Water Quality - Groundwater SectioZn^^ /t
WELL CONTRACTOR (INDIVIDUAL) NAME (print) ) (IIIJId1 I a S L r t^ CERTIFICATION a 30010
WELL CONTRACTOR COMPANY NAME PRICF WELL DRILLING, INC . ?RoNE a $2 327 0263
STATE WELL CONSTRUCTION PERMIT)) esoCIATW WQ PERMTTP
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential Muuicipal/Public O Industrial O Agtieuhural ❑
Monitoring ❑ Recovery 0 Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: MI) fga/1'io (1 CountyJ\ii f1;4-
(Street Name. Numbers. Community, Subdivision. Lot No.. rip Code)
3. OWNER: 6re-as CO
Address WO MOO(\ti.t\ \It -.
(Sant or Noun No.)
H\O1 bcx<V \ Pi- 7 S t, S
City or Town State Zip Code
(Y2sn- 431— ov43
Ana code- Phone number
4. DATE DRILLED I d 'f o 0
5. TOTAL DEPTH: ir 7 tic() Yf'
6. DOES WELL REPLACE EXISTING WFT T ? YES ❑ NO 1
7. STATIC WATER LEVEL Below Top of Casing:
(Use>e. if Above Top (Casing)
S. TOP OF CASING IS I '/1 rr. Above Land Surface*
'Tap or cash[ terminated aloe below Mad surface rustic*
vt YIELD
s in): cue wlta 15AMETHOD OF TEST f7 r t h /Ocf/1
2C .01I
9. YDiL.D (spin): ( �
10. WATER ZONES (depth): 0
11. DISINFECTION: Type Sca r t4 l' o n Amount
12. CASING: G'-z+t "t rs Walt Thickness
Depth Diameter or Weight/Ft
From To .3 1C Ft. & 11 C
q , Fmm>_ To Ft
From To Ft.
13. GROUT: Depth Material
From0To )_Cpt LC4c/!It
From To FZ
14. SCREEN: Depth Diameter
From To
From To FL in.
15. SAND/GRAVEL PACK:
Depth
From To
Frorn. To Ft.
Size
Slot Sim Material
_ is
in.
Material
Ft.
Topographic/Land setting
12/Ridge oslope OVallcy ❑Flat
(check ap-ropri.t boa)
Latitude/longitude of well location
(dagromnninu Wsemode)
Latitude/Iongitude source:OGPSOTopographic map
(the& box)
rl DRILLING LOG
From To Formation Desuiption
0 35 q:r4rtot IC
.3S - Ido prod,',".
i6„ '
/ n0 .AO t\
non_ Son
Soo --coo
5-00-- 700
SOU 7CO
goo - 1 too
It9LJ- 1100
Atte-1295' mh,fe
LOCATION SKETCH
Show direction and distance in miles from at least
two Stale Roads or County Roads. Include the road
numbers and common road names.
D --1z
,-cr
16. REMARKS:
l DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15ANCAC 2C, WELL
CONSTRUCTION STAND ' • . AND - T A COPY OF 1 S RECORD BEEN PROVIDED TO THE WELL OWNER
i �� li Sl TURE OF PERS CONSTRUCTING THE WELL DATE
F.
Submit the originalto the Division of Water Quality, Groundwater Section, 1636 MAD Service Center -Raleigh, NC
27699-1636 Phone No. 019) 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
WELL CONTRACTOR(INDIVIDUAL)NAME rint) �eV)It ) RcC)
WELL CONTRACTOR COMPANY NAME SCce I Lt- JI' ,Del) I c•-)C`
269122
- Groundwater Section
CERTIFICATION# :54r0
PHONE
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PEFLMIT#
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential s' Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection O Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: ales A, County "3v e
I°trl e_
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: 7411 PI (-' 'Aoki �)SC`YJ
Address /,,K-I r
(Street or Route No.)
Iasq�1
City or Town State Zip Code
( Area code- Phone number
4. DATE DRILLED 10-
5. TOTAL DEPTH:
6. DOES WELL REPLACE EXISIFING WELL? YES D NO
7. STATIC WATER LEVEL Below Top of Casing: 10 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): a a METHOD OF TEST A f (k
10. WATER ZONES (depth): gen t
11. DISINFECTION: Typee!Iil0L.&. Amount ]e e--ttf
12. CASING: Wall Thickness
Depth D,Jame er or W tY� ++ jt/FL MatenQ1
From To FL L?Sq , 1 .4-( V. r
From To Ft.
From To Ft.
13. GROUT: Depth
�-sue` Material Method
From 0 To Ft. Ce
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
Topograp is/Land setting
❑Ridge ope ❑Valley ❑Flat
(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
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
CO
P1
CO
r')
r
O
0
7.7
O
L ( ' 1 1. IT;
L� l' ! DO'fi iN
TI
r CONSTRUCTIO ,nT/
MAR "'
1 (7F -'i. Submit the lo Igginal to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
ASPEViLLt 2/6189_ij646Lp15blnoF No (?19) 733-3221, within 30 days. GW-1 REV. 07/2001
YT
T THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
ARDS, AND A C PY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
%en--.30R
SIGNATURE OF PERSON CONSTRUCTING THE WELL
DATE

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Sectiono
WELL CONTRACTOR (INDIVIDUAL) NAME (print)AA CERTIFICATION#42Lw,75"
WELL CONTRACTOR COMPANY NAME P/I/5/4,G// PHONE # ( )
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
269118
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 f f i va f e
2. WELL LOCATION: ,/�
Nearest Town: /7'r.D o^ff o 4-1K./ /O " County q r• se
Dcs.s-f40 ()-Ai fz R 0
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: z/VP///? Add rns
Address `f-y- I ,'fkds (t1tAf.nn/..k-i
(Street or Route No.)
V") ) 0 SF Fl4ran Arc- d 8'S:c-
City r Town 7 State Zip Code
(%fl)- 437 _ £363
Area code- Phone number
4. DATE DRILLED / / ` /5 G
5. TOTAL DEPTH:
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO �-
7. STATIC WATER LEVEL Below Top of Casing: 310 FT.
(Use'+" if Above Top of Casing)
S. TOP OF CASING IS 1 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): 0-3 METHOD OF TEST iir
10.WATERZONES(depth): i3- I /iP-/is3 /
/70—/'3- /d.f+>'/
11. DISINFECTION: Type /-/ 7/f Amount .Y 0/
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From O To 7 9 Ft. ('--S SPR4 i.'L.
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From 0 To & Ft. °Y+ <..- ) Dcu. ere
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:
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)
DRILLING LOG
Formation Description
isn't;h,k,s-eut2r-A-
VS/to/PtLae;
?'/,',.17t nJ.- /r o—ue,:fr
Ltd •t'trf4
DEPTH
From To
O - P1ij
//D
//s-- / 9 et
/9o--/ 'r
i)s - /Yt7
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.
r-r N
r\ 4Y'4.R6Y
EITIF T
) CONSTRUCTION S7 AND/
L' MAR 2 C2,903
S WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15ANCAC 2C, WELL
AND THAT A COPY OF.THIS CORD HAS BEEN PROVIDED TO THE WELL OWNER
// f. = d.1
SIGNATURE OF PERSON TRUCTING THE WELL DATE
a1;2, e:orlgmCaitry lUtl Divi don of Water Quality, Groundwater Section, 1636 Mail Service Center- Raleigh, NC
AS91ffA9'1&36PhrineittoM18g733-3221, 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) Erie /1 ndnrV
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 IfOther, List Use g e kieriF
2. WELL LOCATION:
VEI.1. CON"! RACIOI( COMPANY NAME
268992
CERTIFIC{ATION#a6Gy
y
PHONE # b1 /3-rxC"i
Nearest Town: 'Sot --As ?. p County
(Street Name. N u mbus, Community. Subdivision, Lot No.. Zip Code)
Rif» Kr.
3. OWNER: tee zee / a9c.
Address 2,9yg (ai i•-Ke4 CAF3r��.
[S reet or ROM • No.
)clea)/ r 9 vas 7
Zip Code
City or Town
State
( )-
Area code- Phone number
4. DATE DRILLED % .
5. TOTAL DEPTH: k2 ci
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO a-
7. STATIC WATER LEVEL Below Top of Casing: a 0 FT.
(Use "+" i f Above Top of Casing)
8. TOP OF CASING IS Q— FT. Above Land Surface*
'"fop of cuing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): .. METHOD OF TEST /5"%/'
10. WATER ZONES (depth): /00 —// %
11. DISINFECTION: Type /717/7/ Amount .3 o2
12. CASING: Wall Thickness
Depth Diameter or \Vcight/Ft. Material
From `"/ To 2 ? Ft. 6 j _5ARA/ /'1[i -
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From 0 To .lc, Ft. :o�,v/- p,ftvI et,
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Et. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To
Ft.
db)f,NI4VRI,:s i�
_ ,
1-00 HEREBY CERTIFY THAT
jC®NSTRUCTION STANDARDS)
Topographic/Land setting
Ci�idge ❑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— 7T /1c(2,.,71
/Ur0 ._/e? v/rt rb/pa,e
/6-2/2 . Er:rr_--7�t'
O
LOCATION SKETCH .17
Show direction and distance in miles frmrf'f IeasrG `
--
two State Roads or County Roads. Include rohd,-r_
numbers and common road names.
0
Sj
nRri:P
VELL WAS CONSTRUCTED IN ACCORDANCE WITH I SA NCAC 2C, WELL
THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
Z-r7
_I SIGNATURE OF PER S' t' CONSTRUCTING THE WELL
DATE
_ps:igjnal to theilTiiision of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-I REV. 07/2001

/ s,
2 7 0 ° °
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources -II Division of Water Quality - Groundwater Secriu.i
WELL CONTRACTOR (INDIVIDUAL) NAME (prtatOotedU< I tier v ,di Lot5IIC r cnwxcnor* 3 Opp
WELLCOCrtRAaOa COMPANY NAME PPICF WELL DPILL IbTG I .C. PRoNE a ty� "'p— 327 02E8
STATE WELL CONSTRUCTION PERMIT* OCIATLn WQ PERMTIN
Of applicable) (ifrioable)
1. WELL USE (Check Applicable Box): Residential tr.-Municipal/Public 0 Industrial 0 Aytieulnnal 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Newest Town: n h CountyR urKC
, 0aj fc cotes irf- /7
(Save Nam Numbers. Community. Subtlivtsioo. Lot No.. fp Code)
3. OWNER: UV rOcci—C.)ci r__ .I^^'(('{ H�Yn ozo
Address ' i (7 1 (a 1-o c't) � # f j" 1 r nr
(Suva or Rowe No.)
Un1o11;1js , A' a5 I (ct7
City or Town State 21p Code
Akw coda Phone mutter
4. DATE DRILLED
5. TOTAL DEPTH:
6. DOES WELL REPLACE EXISTING WELL? YES ( NO J$
7. STATIC WATER. LEVEL Below Top of Casing: y0 FT.
ruse `+" if Above Tap of Ca,h.g)
8. TOP OF CASING IS (U PT. Above Land Surface'
"Top of eosins terminated aVor bebw load surface readies a
various la aecerduce th 1SANCAC SC .0116.
9. YIELD (spun): . O a T i (�i10W r
10. WATER ZONES (depth): ♦ (-,'?. 6
11. DISLNFECCION: Type
12. CASING: 77j(O1e
Depth Diameter
Frou_p__To ing Ft. 6
From______ To Ft.
From To Ft.
13. GROUT: Depth Material
Fromf_ To itn Ft (7 d!C2°4C
Topographic/Land setting
Ridge (Slope (Nalle), UFlat
p (check appropriate box)
' j,pj i' Latitude/longitude of well location
(d restmiouadsemodd
Latitudenengimde source: DGPS(Topographic map
(cheek box)
QRILLTNG LOG
tion DicsctiDt
2EPTii
From To
© /62
/oraea
t—
ttO0 //71
�0n
LOCATION SKErC$
Amount Show direction and distance in miles from at least
Wan Thickness two State Roads or County Roads. Include the road
or Wei�NFt. )4*IWial numbers and common road names.
From To Ft
14. SCREEN: Depth Diameter
From To Ft�in
From To FL in.
15. SAND/GRAVEL PACK:
Depth Sine
From To Ft.
From To
Ft.
Slut Size Material
_ in.
m.
Material
1/43/4%4'0'1 n)
0
i�J47A
rcOl
a Dili :-
4 :
v.16. REMARKS: ``/ AU
CJI
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WFI T
CONSTRUCTION STANDARDS, AND T�iA Y OP THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
'vision of Water Quality, Groundwater Section, 1634 Mall Service Center - Raleigh, NC
3-3221, within 30 days. GW-1 REV. 07/2001
><i

270261
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Divt on of Water Quality - Groundwater Saco
WELL CONTRACTOR (INDIVIDUAL) NAME (print) C� t>7 1 1) • Las It a t^ CERTIFICATION a-D4% 515
WELL coNTRALTaa COMrNY NAME PRICF WELL DPILLI!4G, INC. PRONE ae2$ 327 02E2
STATE WELL CONSTRUCTTON PERMrra ASSOCIATED WQ PERMrra
(if applicable) ¢f tppliable)
1. WELL USE (Check Applicable Box): Residential Mtmicipal/Public 0 Industrial ❑ Agricultural O
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATI N: J/
N t Town: a P County U�'• K_
it At'!�
(Sean Name. NNs bet. Caaubmiry. Subdivision. Lot Nye.. rap Co*)
3. OWNER ._/ f /l'L ,J hi ✓`je V Iye.temetwmimuwbecwsal
Address 1q k `nevi i l f Latitude/longitude somce:OGPS°Topographio map
"ram
No. ( (cheek box)
C. byl (1Q 1 fI ffoj S ��l/�/ pEPIH pRII.L[NG LOG
/s IlCuy/,v 1 Sme ') 21P Cede Fsr>fq 70� F �•::On s _ _'pyi
C%J"1 niwibi,, V (J e) � l L SIG,
4. DATE DRILLED /h- 1 J L' 64 D71
5. TOTAL DEPTH: n7 c 0 r0 az�
6. DOES WELL REPLAN E?QSTING WELL? YES 0 O
490tr
7. STATIC WATER LEVEL Below Top of Casing: y/ ET.
(Use -w' ifAbove Top of Casing)
8. TOP OF CASING IS _, PT. Above Land Surfaces
Rap of twine tensioned .Yee below lard .atce retwira a
9
ransom to manduce with 15A NCAC 2C .01gTEST • ict
11.
Ynap(gpm): 7 _ METHOD OF
10. WATER ZONES (depth): /..-)rj`"-" / 26—
Topographic/Land setting
Mitiidge °Slope °Valley °Flat
(chock apptaptiue hex)
Latitude/longitude of well location
11. DISINFECTION: Type yy.9, n. - .f-tv Amount
12. CASING: U /'q n✓fie Wall Thickness
Depth ! Diameter or Wd
From 4) To $t Ft 787
Fro[»_ To FL
From To Ft
13. GROUT: Depth Material j)/ahod
From f i To 70 Ft rl /1c ran fl
From To Ft
14. SCREEN: Dept Diameter Slot Sim Mania'
From To Fl_jn. _ in.
From To FL in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
Frorq__To Ft.
Flom To Ft.
vnuinb
c
LOCATION SKETCH
Show direction and distance in miles from at least
two Stale Rods or County Roads. Include the road
and common road names.
0
CO
PO
0
16. REMARKS: 4
0
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL t
CONSTRU ST ,gyp/yp/ATHAATT COPY OF THIS RECORD HAS BEEN PROVIDED TO THEE WELL OWNED
= r-- 27699-163T6 Phase Nu.
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
vision of Water Quality, Groundwater SecUdn,1634 Mail Service Cater - Raleigh, NC
221, within 30 days. GW-1 REV. 07t2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Eavimmneat and Natural Resources - Division of Water Quality - Groundwater Section
0
WELL CoxrRACtoa (INDIVIDUAL) NAME (pr .t) 'Co AI tee 1 t l La S her cnWIC5�ATION a C-hz coreron corona's'watt coT aAcrcorona's'NAME PRICF WELL DRILLING, INC. eaoNr: a 1'2 ❑i' 327 02E3
STATE WELL CONSTRUCTION PERMIT/ ASSOCIATED wQ restaerrd
(if applicable) Of spoilable)
1. WELL USE (Check Applicable Box): Residential lB Mimicipal/Public ❑ Industrial ❑ Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCATION: /�
Nearest Tonern. 17etj�l.'finy'County Gor Le
(Seen Nome, Numbers. Commmey. BAdivisico. Lot No., Zip Code)
3. OWNER:
Address
(Sow or Rods No.)
%t'. l—tr7it7i.i'i /j "( •) &ice(; /2
Gay or Torn Stria Zip Cade
( `cc). A / 7 �) — `! 4
Ana coda /bore number
4. DATEDRILLEDa
5. TOTAL DEPTH: FI-
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO L9'
7. STATIC WATER LEVEL Below Top of Casing: _/O FT.
(use '+• if Above Top of Gnaw)
S. TOP OF CASING IS 1 laFT. Above Land Surface*
'Ten of egoist NnWated Was below Wed satin resigns a
virtue la stardom with ISA NCAC 1C.011R /) i
9 Yt_FLn (gpm): b b fsE3'UCD F TEST I u f l>f cv n
10. WATER ZONES (depth): +I ESL) Fr
11. DISINFECTION: TypeStl. o 4i- Dv) Amount 3rron
12. CASING: C r c ri j e' i Wan Thielaesa
Depth , Diameter n 'ght/Ft tid}osfial
Froth To yg Ft
Froth_ To Ft.
From To Ft_
13. GROUT: Depth Material
From 0 To .9i� Ft. t /l OnerrC lc
From To Ft
14. SCREEN: Depth Dimmer Slot Sim Mabedsl
From To Ft,e_bi. _ in. " )
From To
15. SAND/GRAVEL PACK
Depth sin Material
Frotn_To Ft.
FSorra____—To Ft.
16. REMARKS:
270262
//Topographic/L.and setting
midge ❑Slops Malley ❑Flat
(chat appropriate tem)
Latitude/longitude of well location
(dapemrtn /xcoemp
Latitude/longitude source❑GPS❑Topographic map
(elude box)
DE DRILL.Is; ran rNrGG LOG
ac
//R /no O;Ylnrfc
/0o a1i, 6're? n iv I-r
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or C.oimry Roads. Include the road
numbers and common road tames.
Err /
W
0
_ry
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL o
CONSTRUCPINN STANBARDS. ANLyTHApIA COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWN[. it
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
*vision of Water Quality, Groundwater Section,1636 Mall Service Center - Raleigh, NC
3-3221, within 30 days. GW-1 REV. 07/2001
0

16.
WELL CONSTRUCTION RECORD
North Carolina - Department of Eavi °amen and Natural Rnoowas - Division of Water Quality
WELL cureTRACroa nie n emuAL) NAME (Prtat 4) CI ,' f (d L(} % h e r
WEtt. coNfa.Acroa costumer NAME P R I C E WELL
STATE WELL CONSTRUCTION PERMIT,
Cif applicable) 64f Ionizable)
O ILLIN3, INC.
PRONE a $ 2 $
270646
- Groundwater Section
CEYTIFICunoN a 3 Q()
327 (112E3
ccOCIATED WQ PERMITS
1. WELL USE (Check Applicable Box): Residential);' MimicipalRublic ❑ Industrial 0 Agricolwal D
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION: ^�
Nearest Town: 'Or( . r r -County 17Jt' tE'
/lithe © III( P.4banYiHge
(Snot Name, Numbers. (°°among./Subdivision. to No.. rap Code)
3.OWNER: JOi I�Uto n
Address 0
(Soso or No.)
Conn ly' 5e ties !U c
Gry m Toro Sie Zip Code
(.l- 7Cy- /Lyv
Area was Thom maibm
4. DATE DRILLED t ; ' -,7 0 r
5. TOTAL DEPTH: q 7 C
6. DOES WELL REPLACE EXISTING WELL? YES C NO l
7. STATIC WATER. LEVEL Below Top of Casing:
(use if Above Top of easier)
8. TOP OF CASING 1S / �/ FT. Above Land Surfaces
°ter of min terraiaued Woe below load sa6ce requires s
mimeo A eeardune with 15A NCAC 2C.011R n
v YTFLP(gpmi). / ALETHCDOFTEST Iiir jj/C- n
10. WATER ZONES (depth):
Topographic/Land setting
piRidge °Slope Malley OFlat
(check wwepti� boa
Iatitude/laogitude of well location
onnemnaimadaecomo
Liaituelo?o:gitade swzc :OCIPSDTopowrep`I-^
DEPTH
From To Err"-,
lion D�iwrt
c') </'3 E r -,I cr lC
.1 tt •�frEi Cron. /C
YOt' t/.- C o r rCk VI) Fc
( )0 �,OO C�3,Zint 4-r r-,
C.Y7 Ci' 73 1-7r-vh/=>LC C_J
11. DISINFECTION: Type 5ck n i4nVic,i
12. CASING: !! err.. nu 1-t>
Depda
iatienes
From e"; To `` Ft D
From_ To Ft
From To Ft
13, GROUT; Depth MastriaW
From ( .) To -4,0 Ft. CO,ic re e
From To Ft
14. SCREEN: Depth Diameter Slat Sim Material \
i.<.^ Fs _ To_ .
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Muaial q � IC
Front _To Ft. :..1
From To Ft. f� if
REMARKS:
Amount
Wall Thickness
a Weighs/Fs blatecial
F'VC-
Method
1)c'� i,'reed
DRILLING LOG
�ro.v i fc
r.
LOCATION SKEICR ---
Show direction and distance in miles from atltast
two State Roads or County Roads. Include t-road_;
numbers and common read names. r� c,
(`artt)r'
Ridgen
co
O c
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONS UCTTON STAND AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
Solna teeoriginj}Itojt f
SIGNATURE OF PERSON CONSTRUCTING THE WELL
//-. - 03.
DATE
1ll1111111 vision at Water Quality, Groundwater Section, Mali Service Center - Raleigh, NC
27699-1636 Mose.Na.fp}9j tt3-221, 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 CONTIACTOR (INDIVIDUAL) NAME (pflr) /Oet tf.. / q SLi Pr -
watt ccorraw TOY COMPANY NAME PRICF WELL DDILLIN ., I'TC.
STATE WELL CONSTRUCTION PERMITS ASSOCIATED WQ PERMIT/
(if applicable) cif applicable)
1. WELL USE (Check Applicable Box): Residential % Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, Liu Use
2. WELL LOCATIO _.
Nearest T r• - -n County 1> K -e
eft r'r K jhi-j. 2 qui k
(Street Number,
Cammmny. Subdivision. Lot No.. Zip Code)
3. OWNER: B
Addrtn
1 p1 crycln*GA fru, C'.
City arrows Steve
f - ys 3 ysy
Ate. ado- Phone manta
4. DATE DRILLED /U -" 7 —0
5. TOTAL DEPTH: .77y Ft
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO ,CH'
7. STATIC WATER LEVEL Below Top of Casing: � FT. _ e,w
(V•�" if Above Top of elflike
S. TOP OF CASING IS 1 //at ,„). PT. Above Land Surface*
'Tea easing terminated soar Wow Ind eorece again
variance A eearduce vela ISA NCAC 2C.0/ IL q�fll
v war' (wm): `p :,OTHCD �OFL TEST r i-, r1
10. WATER ZONES (depth): G R// f
LOCATION SKFIQ
Show direction and distance in miles from at 1e9t
two State Roads or County Roads. Include the road
Yak/•
Topographic/Land setting
:Ridge :Slope ®)Valley ❑Flat
(shed( app-Wriete box)
Latitude/longitude of well location
Latitudeloreitode sctpnT:GPST]Topagaphis roar,
DIEM
Frtim To
3r
ti /op
/0t0 m70t7
270645
cznWICATION a -3 00)0
malt 2i 327 0262
CYZI oo
oo 7 75
sec C M71V
new a o.)
Zip Cot
11. DISINFECTION: Type5),1. /ipn Amount >Ct:t Pj
12. CASING: G trot,' t't'3 Wall Thickness
. Depth Diazieter
From (5 To 3 7 Ft
From__ To Ft
From To Ft
13. GROUT: Depth Material.
From (% To -711 Ft.riehr'refc.
From To Ft.
14. SCREEN: Depth Diameter Slot Sim Material
cr.,. To FT. itt
_
From To Ft. a. in.
15. SAND/GRAVEL PACK
Depth Sim Material
From To Ft.
Front To Ft.
a Wet tart
6y 1-
16. REMARKS:
MWO(r X;(
DRILLING LOG
c n4 tXoc
(7 met/Lc
(3vat z.. .
1-.err, is
numbers and common mad mores.
2
I DO HEREBY CERTIFY THAT THLS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND T A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WEI L OWNER
SIGNATURE F PERSON CONSTRUCTING THE WELL DATE
n of Water Quality. Groundwater Section, 1434 Mail Service Coster - Raleigh, NC
1, within 30 days. GW-1 REV. 07/2001
` Subput Ike osigihYl t&
I 27699-106?home No-(418)
01
0
0
rn
0
w

c cr
270644
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL)NAME (priat)ji/i 1) 1 ( (-li 5/lam/ioCYHnntunoN #-&A(1
WELLCONTRACTOR COMPANYNAME PRICF WELL DPILLIi'G, INC. pnora e2$ 327 0262
STATE WELL CONSTRUCTION MOOTS -A V%°CIATW WQ YeRMrrd
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential . Municipal/Public 0 industrial l7 Agrituhutal O
Monitoring 0 Recovery ❑ Heat Pump Water Injection ❑ Other 0 If Other, List Use
2, WELL LOCATION:
Nearest Town:.710 f f3. /1 /1 Jr'iY1 County fL
Sr'n/aP'3 %It-e), ['rimy/tin Sy'
(Street Name, Numbers. Caouamity, SebAHsioo, Lot No., tp Code)
3. OWNER: R n Fors
Address �, 3 SJ 1-Wrjh Pen it" /714n1. (zc�
(Sant or Rouse No.)
711C-1y7=,,47/ N,C. a8655
City or Town Shoe Zip Code
k'='S} < 3 -
Ann cede- Pboox number
4. DATE DRILLED /O-o -C% )i
5. TOTAL DEPTH: I.3 1-0
F f
Topographic/Land setting
JRidge 0Slope Malley OFlat
(sleds ppro-ritte box)
Latitude/longitude of well location
(cegteetiOniouteilsecood0
Latitudellor.grmde srruce:OGPSOTopograp}dc taw
(check box)
DE'PIE DRILLING LOG
From To
0 79
a0 100
f/' UC IOC
6. DOES WELL REPLACEEXLSTING WELL? YES O NO !31° FCn S'�0
7. STATIC WATER LEVEL Below Top of Casing: . 300 /no D
(Ust's.' if Above Top of Casing): en' 7
S. TOP OF CASING IS / Yk PT Above Land Surface a •
step of casing terminated xtror below lead surface regdres d o U
9. YIELD (gpm): _ "'i _ METHOD OF TEST tT, R / o Q1 n
10. WATER ZONES (depth): f Oran r 7
variant la mordant with IJANCAC 2C.0111t. /o70J /.j SO
nc
11. DISINFECTION: Type Seen C;1 Amount
12. CASING: ' cgtt r/ } Wall Thickness
Depth, Diameter or Weight/Ft Material
Front G To )4t Ft b 6 //ti Pc'L
From-_ To Ft.
From To Ft
13. GROUT: Depth Material Method
From 0 To 3 0 Ft. t'0,2tre- 4 Pcw/Ci
From To Ft.
14. SCREEN: Depth Diameter Slot Sim Material
From_ To FL jn. _ in.
From To FL in, in.
15. SAND/GRAVEL PACK:
Depth Sim Material
From To Ft.
From To Ft. [[� `
16. REMARKS: U,t(// fish/Q-�� r c' 0r7 LP_.7j"boo r) j,[)et
Submit the originaffb� Ie Ole 'vision of Water Quality, Groundwater Section, 1634 Mali Service Center - Raleigh, NC
27699-1636 Phone No. (919J 3-3221, within 30 days, GW-1 REV. 07/2001
Formation Description
pno-k
Coin/
sea
a rti n ,+C
(1t-e-44. c-
0raniic
6 icna
a4-e
f a,
e yryki+c
fy
LOCATION SKETCH `-
Show direction and distance in miles from affeast c
two State Roads or County Roads. Include the road`
numbers and common road names.
=� v
c
•
•
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CON {UCT1ON STAN4 ARD3, Af)D THAT A COPY OF THIS RECORDTiA.S BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WFT t DATE

VVELI. CONTRACTOR (INDIVIDUAL) NAME (print)
VA'EI.1. CONTRACTOR COMPANY NAME
WELL CONSTRUCTION RECORD
271162
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
CERTIFICATION #;G 6Y
PHONE # ( )
ASSOCIATED WQ PERMIT#
(if applicable)
cA-wr f /, Je...
42 '. q.Jct-r /f
SLATE \\'ELL CO\STRU'CTION PERMIT#
(if applicable)
7
WELL USE (Check Applicable Box): Residential ❑ Municipal/Public 0 Industrial 0 Agricultural ❑
Monitoring ❑ Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use
WELL LOCATION:
Nearest Town: Pfo.tie 111
I
County ,(1uriJ(,
(Street Name, Numbers. Comtnul{ty, Subdivision, Lot No., Zip Code)
3. OWNER: ricciA AAA le
Address / l Y ( J,o. ere -re l(P R 0
(Street or Route No.)
/V e,v ti-c(
City or Toss n State
( )-
Area code- Phone number
4. DATE DRILLED 9—c20
5. TOTAL DEPTH: /
Zip Code
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO CY
7. STATIC WATER LEVEL Below Top of Casing: .3 C'' FT.
(Use "+" i f Ahove Top of Casing)
8. TOI' 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): 2 METHOD OF TEST 4/z,
10. WATER ZONES (depth): /(a —//a J5"f
/9/-/97 6,7rt(
11. DISINFECTION: Type // /V Amount a 67
12. CASING:
Depth
From 0 To F( Ft.
From To Ft.
From To Ft.
13. GROUT: Depth Material
From C' To at Ft. "e'l'nc'f
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size
Front To Ft.
From To Ft.
Wall Thickness
Diatpcter or Weight/Ft. Material
E 4z i' al (LA -
Method
Slot Size Material
in.
in.
Material
Topographic/Land setting
:Ridge ❑Slope DValley ❑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— aO PG.�9�c f� ries. /r
Pr e' avlr
19!-/92 /)rt>r,.V>/e/•
/9) -/ re, 7 a,t-' fe
/r //O
/«— /e--
lies /u/
'1
CO
LOCATION SKETCH N =
Show direction and distance in miles from aTfeast-
two State Roads or County Roads. Include the roach-:2
numbers and common roacl names.
cal
75
0
1
a
Po
16. REMARKS:
100 HEREBY CERTIFY-7 AT TIIIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
CONSTRUCTION STAND#IDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
_tee, --(7)_
SIGNATURE OF PERSO ONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center- Raleigh, NC
27699-1636 Phone No.-(919)' 33-3221, within 30 days. GW-I REV. 07/2001
Ca

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) WAYNE LONG CERTIFICATION # 2343
WELL CONTRACTOR COMPANY NAME HTCKORY WFR ,T, DR TT TN/1 ('G PHONE # (R7W ' Th-n035
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMTT#
(if applicable) (if applicable)
271859
I. WELL USE (Check Applicable Box): Residential C)0( Municipal/Public ❑ Industrial 0 Agricultural ❑
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: CONNELLY SPRINGScoimty
7172 KNOX AVE.
BURKE
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: TAN FT FMTNC:
Address 7172 KNOX AVE.
CONINELLYRMNL13GS, NC 28612
City or Town State Zip Code
(828)- 874-4879
Arca code- Phone number
4. DATE DRILLED 12-31-02
5. TOTAL DEPTH: 385
6. DOES WELL REPLACE EXISTING WELL? YESXff NO ❑
7. STATIC WATER LEVEL Below Top of Casing: 50 FT.
(Use "t" 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): 3 METHOD OF TEST BY AIR !EST
10. WATER ZONES (depth):
Topographic/I-and 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
11. DISINFECTION: Type HTH TABS Amount 70
12. CASING: Wall Thickness
From 0 DepthT148 Ft. Di *ter o SYght/Ft.P M�
From To Ft. b VV LLAA
From To Ft.
13. GROUT: Depth
From_ili To 20 Ft.
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.
Material
GROUT
Method
POURED
Slot Size Material
in.
in.
From To Ft.
16.i2EtvtARICSI
I DO -HEREBY CERTIFY
CONSTRUCTION STAND
it
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the roadCD
numbers and common road names.
f,„
LI w /.
0'
w
Hl1-)
�i�onl�lssl
S
0
9i'/N ft-P
HIS WELL WAS CON MULLED IN ACCORDANCE WITH 15A NCAC 2C, WELL
AND THAT A COPY •,- S RECORD HAS BEEN PROVIDED TO THE WELL OWNER
ers
iSIGNATURE OF PERSON,
`, 'Submit the original to. the Dil ision of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. (919) 93S 3221, within 30 days. GW-1 REV. 07/2001
01-07-03
-®NSIRUCTINGTHE WELL DATE