Bu 2 CY2002

WELL CONSTRUCTION RECORD
North Carolina - Department of En\^,ronmeot and Natural Resources - Division of Water Quality GrounFICoundwater Section er a
\\'ELL CONTRACTOR (INDIVIDUAL) tiA!1C1lDrinr'--4J t\\ K._Smdaeliia-
_2110 Cs
ibiest)PHONE N_.� �cl,
\\ELL C'O\'1'R.\CIUR COMYANy NAME -riot,_-ac�++^i
--
V ASSOCIATED_WQ PERMIT# __
Si AlF. \\t'Li, CONSTRUCTION CTIUN PERMITM (ifa !icable)
(ifa icablel
i. WELL USE (Check Applicable Box): ResidentialA Munieipal.Publie 0 Industrial D Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection O Other Q If Other, List Use ___—
Topographio'Land setting
P DRidge CSiope ❑Valley ❑Flat
Nearest TnAvnl_ e — (check appropriate box)
_ _ -- Latitude/longitude of well location
(Street Name. Numbers, Community, Subdivision, Lot No . Zip Code)
ideg:ees.iruntac second.)
3. OWNER-.-_ Cp• S _Rice 1z4vJK•„S Latitudcloneitude source:DG ezondn:pographic map
Address Sc�\ t_1fwSa 1>,osc1-------- (caexA box)
(Street or Route No) DEPTH
DRi[.LING LOCI
iAblAtv:ge_�G _ 38810fo _,_— From
T` Formation Description
C i;a or Tnwr. State i Zip Cod: AVG(-IiP��a__
?. µ'ELL LOCAT t0 r' y1 ��n
SA t)L.County �l\L-
1.--). _
Arca code Phone uutnhe \ O7 pa
4. DAFE DRILLED --
5 TOTAL. DEPTH•-.5------
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 0
7. STATIC WATER LEVEL Below Top of Casing: ._-_.FT.
ruse "r" if Above Top of Casing)
8. TOP OF CASING IS �_—._-..
FT. Above Land Surface'
*Top of cuing terminated at/or below land surface repaires a
variante In accordance with ISA NCAC 2C .01I8.
9. YIELD (gpm):._ 5 METHOD OF TEST_R: —
10. WATER ZONES (depth).
1 I. DISINFECTION. Type1111-_ ____
l2. CASING'. t Depth Diameter
From ‘'• _I__ T o 5b FL-��
From____ To_—_ Ft. ________
From To — Ft. —
I 3 CiROI':"! Depth Nlacerin.
Method
F rom._Q_-_. To_-.na-- Ft.__._tta'att4 __Ilona_
Pion: __ _ To-- Ft'-----
14 SCREEN'. -_- Depth Domeier Slot Size Mater al
To . Ft.____In. — --_ it
Front__ From_` __ T______in
- ino . Ft.- -_-in.
li. SAND'GRAVEL.PACK: Material
Size
From. --ro___--- Ft.-----•---
Frcon __-.
To.__- Ft.-- -
A -was _
Amount
Wall Thickness
or Weight Ft. Material
-TAkCtkL&
247268
LOCAT'O\' SRELC`H
Show direction and distance in miles Iron at ? -.t
two State Roads or County Roads. Inclupothe Erfad
n-
numbers and common road names.
Co
6 REM ARKS[ —._- ________
I DO HFREGY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
BEEN PROVIDED TO THE WELL
N -`
0
0
OWNER
C'ONS1It t'C TIONSTANUARDS AVDTH ACOPY OF THIS RECORD HAS
E 1 E
nut Ow or)glnai to the D
-tbyh Phone No.1919) 73
t•.i �>i
9 2002
.ATURE PERSON CONSTRLCTING THE WELL DATE
of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
within 30 days. GW-I REV. 0712001
GROUNDWATER SECTION
ASHEVILLE REGIONAL OFFICE

1North Carolina • Department ol Envronment and Natural Resources - 636 Mall Service Center - Raleigh, N.C. 27699-1638 Phone (919) 733 Division
of Water (Duality• Groundwater Section 268372
WELL CONSTRUCTION RECORD WELL CONTRACTOR CERTIFICATION AA/ L L.
WELL coNTRAcToR. to m
STATE WELL CONSTRUCTION PERMIT#:
WELL USE (Check Applicable Box): Residential Er Municipal ❑ industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other if Other, List Use:
2. WELL LOCATIQ N: iShow sketch of the location below) �) n C C _
Nearest Town-nc")ne�( A, WQ County.(JnA
AN rc Lwu / rl�.
(Road Name and Numbers. Community. or Subdivision nd Lot No.)
3. OWNER ilia '4i5T0.YYTC YD.. (Et, M�^In watrk
Address QqU (�s T� Y IC.Ip•
Op I streell r.•ttLNbT $�n�
Lyn'+Q Code
_.ty or Town •-1 Stale Zip
4. DATE DRILLED-1 —3'?
5. TOTAL DEPTH rAtd5
G. CUTTINGS COLLECTED YES n NO14
7. DOES WELL REPLACE EXISTING WELL? YES fJ NOM/
8. STATIC WATER LEVEL Below Top of Casing: 102 FT.
(Use'+' II Above Top of Casing)
9. TOP OF CASING IS 1/ FT. Above Land Surface'
•Top of casing terminated aVor below land surface requires a variance In accor-
dance with 15A NCAC 2C.,1B
10. YIELD (gpm) METHOD OF TEST r 3
11. WATER ZONES (depth)•
DRILLING LOG
From To
DEPTH
Formation. Descdptlon
- MOS $�cLtgck
1 ° CHLORINATION: Type W 7H AmountaapillsIf additional space Is needed use back of form
ASING:
Wall Thickness
Depth_ Diameter or Weight/Ft Matedal
1LI
From 0 To D Fi V or .7 6
From .-- To---- Ft,
From To Ft
14. GROUT:
Depth Material Method
Frorn 0 To AOFt2E CwNCfE
From To FI
15. SCREEN
From
From To
From To
16. SAND/GRAVEL PACK:
Depth
From To —
Depth Diameter Slot Size Material
To. —__Ft In In
From
17. REMARKS:
To
FI In In
Ft In In
Size
Ft
FI.
Material
LOCATION SKETCH
(Show direction and distance from at least two Stale
Roads, or other map reference points)
\G4 -1-1' Cardinal
Ashev;\le, tG
1 DO HEREIN`_
CONSTRUC
FOR OFFIC
fuad No:
dedal No.
'U+rr, re•
S,TANklARQS„ A,
ONLY
FEB
GHC CIION
ASHEVILLE RL5d`.JAL 01-FICE
S ERUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
F THIS RECORD HAS BEEN PR IDED TO THE WELL WNER.
/%a2�
NATURE OF PERSON CONSTRUCTING THE WELL DATE
o Division of Water Duality. Groundwater Section within 30 days
GW-I REV. 12/99

1670 Mail Service Center - Raleigh, N.C. 27599.1636-Phone [phone]
WELL CONSTRUCTION RECORD
North Caroline - Geperimonl of Environment and Natural Resources - Division of Water Dually • Groundwater Suction ( `/J1 `' I
WELL CONTRACTOR• BD b h1a W . r r7S
WELL CONTRACTOR CERTIFICATION A:
STATE WELL CONSTRUCTION PERMITA!
1. WELL USE (Check Applicable Sox): Residential I N Municipal 0 Industrial E Agricultural 0 Monitoring
Rocovery r1 Hoot Pump Water Injection (I Other n If Other, List Use:
2. WELL LOCATION: how/hk6,c of 1 to location below)
Nearest Town: /�`L�(/1 County
SG rLr e
(Hood Name and Nu on. Covnuntly, or Sdd�j �Cdlvl. onnnd lot No.)
3. OWNER /n
0%t/HCC I�/� From To Fomrnllon On scdpilon
— r or
DRILLING LOG DEPTH
Address
Cliy or Town Slate Zip Code
4, DATE DRILLED
5. TOTAL DEPTH s6
6. CUTTINGS COLLECTED YES I I NO vf
7, DOES WELL REPLACE EXISTING WELL? YES O NOM
0. STATIC WATER LEVEL Below Top of Casing: /Q•, FT.
1 (Use'1 II Abovo Top of Casing)
9. TOP OF CASING IS 1 FT. Abovo Land Surface'
'Top of ca s In9 let urinated sUor below lind surface re quire e a variance In accor-
dance with 15A NCAC 2C .9l1e
10. YIELD (gpm): _ METFIOD OF TEST
11. WATER ZONES (depth)'
12 ' FILORINATION; Type 1 N Amount 1_
i-
ASING:
Wall TI Ickness
(� Depth r tomato .itieoyg. Matedal
From `i To SC -Ft. �.10 oUr�t 7yE-�j
From To FI
From To FL
14. GROUT:
Depth Malarial
Mol hod
From 0 To �� FI �C1Q Ei 6 j"1+1_U
From To FI
15. SCREEN:
From
From
Depth Diameter Slot Size
To Ft Ill
To FI In
From To FI In
16. SAND/GRAVEL PACK:
From
From
17. REMARKS:
I DO HE
CONSTR
r R OF
ad No;
I Serial No.
Depth Size
To FI
To FI.
Material
268369
II
If additional space Is needed use hack of loan
LOCATION SKETCH
(Show direction and distance from nt least two Stale
ra
Floods, or other map roiorence points) y/
a m77//a
xidbat
r,
DArno'
fi3SE ONLY Q{
FE1
7 I
1 T.
CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
PY OF THIS FIEQORD HAS BEEN PROVIDED TO T E WELL OWNER.
7-9-0 2-)
SIGNATURE OF V'�RSON CONSTRUCTING THE WELL DATE
nal to Division of Water Duality, Groundwater Section within 30 days
GW1 REV. 12/99

North Carolina • Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section 268365
1636 Mall Service Center - Raleigh, N.C. 27699-1636-Phone [phone]
WELL CONSTRUCTION RECORD WELLCONTRACTOR• /ra' RmAN L • 2AlL.
WELL CONTRACTOR CERTIFICATION #: .D4 7
STATE WELL CONSTRUCTION PERMITO:
1. WELL USE (Check Applicable Box): Residential [a Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, Llsl Use:
2. WELL LOCATION: (Show sketch of the location below) UYLCUYYli�2
Nearest Town: ttY non, County:
j GLT- e
(Road 1rI
Name rid Numbers. Community, or��t Lb,vlslon and Lot No..) DRILLING LOG DEPTH
3. OWNER VV ,
1' IarylQ..1G. ' 1 OYt2 r+ From To Formation Description
Address &a.14 �Iaco `bck ..
(s reaj r Fibula o.) D - 1-3 nfici-
43 '314c $1<de_ock
c a
City or Town State
7—a�a-
5. TOTAL DEPTH 3145
6. CUTTINGS COLLECTED YES n NO/1
7. DOES WELL REPLACE EXISTING WELL? YES NOI
8. STATIC WATER LEVEL Below Top of Casing: 0 FT.
(Use'i If Above Top of Casing)
9. TOP OF CASING IS ' FT. Above Land Surface'
'Top of casing terminated euor below land surface requires a variance In accor-
dance with 1SA NCAC 2C .0118
10. YIELD (gpm): :'4 METHOD OF TEST r
11. WATER ZONES (depth)• j
4. DATE DRILLED
•
Zip Code
1' CHLORINATION: Type H 7H Amount aapi-I S If additional space Is needed use back of form
CASING:
Wall Thickness
er or
From
Depth
14' FI b . 5 a7/�..125 Pve-SOK
From To Ft
From To FI.
14. GROUT:
Depth Material Method
From Q To LZO Ft C'v/YC2E4E
From To FI
15. SCREEN:
Depth Diameter Slot Size Materiel
From To Ft In In.
From To FI In In
From To _.— FI. In In
16, SAND/GRAVEL PACK:
Depth Size Material
From To FI
From To FI
17. REMARKS:
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other map reference points)
5c:hdQ l) I noc\(fir
i'
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY F THIS RECORD HAS BEEN PRIDED TO THE WELL WNER.
Oy l =U':E
! ., SI NATURE OF PERSON CONSTRUCTING THE WELL DATE
. _ —I, Submit odglnal to Division of Water Quality. Groundwater Section Within 30 days
1 .. ed,i .. .I GW.1 REV. 12199
JI
GROUFCI" ITEP f.L K)N
ASHEVILLE F[ciOILiL OFFICE

North Carolina • Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mall Service Center - Raleigh, N.C, 27699-1636-Phone [phone] / r
WELL CONSTRUCTION RECORD WELL CONTRACTOR. RiAN kE/LA ;NE5
WELL CONTRACTOR CERTIFICATION 0: W/540
STATE WELL CONSTRUCTION PERMIT":
268366
1. WELL USE (Check Applicable Box): Residentiall1W. Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heal Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATIO : how sketcl of the location below) �W/, _ _ Gin /
Nearest Town: -{N County' Y/ ["(e_a,
SLcM e
(Road Name':nd. umbers, CommuNly, of ,.b.tyislon and Lol No.)
3. OWNER
Address
by or Town
4, DATE DRILLED
5. TOTAL DEPTH
6. CUTTINGS COLLECTED YES I I NO,
7. DOES WELL REPLACE EXISTING WELL? YES a NOR'"
8. STATIC WATER LEVEL Below Top of Casing: FT.
(Use •i II Above Top of Casing)
9. TOP OF CASING IS 1 FT. Above Land Surface'
•Top of casing terminated aUor below land surface requires a variance In accor-
dance wllh 1SA NCAC 2C .0118
10. YIELD (gpm)• METHOD OF TEST �) q
57734?
Slate Zip Code
— on " '' SeAnat5
11. WATER ZONES (depth)'
12. CHLORINATION: Type -RT
1 ASING:
From
From To Ft.
From To Ft
14. GROUT:
0
From 0
From
15. SCREEN:
Depth Diameter
To Ft L•
Amount /D ails
��
II additional space Is needed use back of form
LOCATION SKETCH
Wall Thickness
or Weight/Ft.}�aM.�alerlal (Show direction and distance from at least two Stale
QIle. 1 5 PVC'SDII Roads, or other map reference points)
Depth Material
__tt-- Method r
TooDO FI Ga►I G(jPTe Tpaa.agd
To FI
Depth
From To Ft In.
From To Ft In
From To Ft. In
16. SAND/GRAVEL PACK:
Depth Slze Material
From To
From
17. REMARKS:
Diameter Slot Slze Material
In
In
In
Ft
To FI
O
W
- TT
co
W
3
1
Ql
I DO HEREDY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
FOR OF U
Quad No:
al No
1-.
[I, III
C _ SIGNATURE OF PERSON CONSTRUCTING THE WELL
al to Division al Water Quality, Groundwater Section within 30 days
DATE
GW-I REV. 12/99
ICE

North Caroline • Department of Environment and Natural Resources • Division of Water Quality - Groundwater Section 2 6 8 3 6
1636 Mall Service Center - Raleigh, N.C. 27699-1636-Phone [phone]
WELL CONSTRUCTION RECORD WELLCONTRACTOR• RIAW kE/LA � f (✓E5
WELL CONTRACTOR CERTIFICATION N: 190
STATE WELL CONSTRUCTION PERMITS:
1. WELL USE (Check Applicable Box): Residential i Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑nIf Other, List Use:
2. WELL LOCATION' Show @ket It of the location below) ry ��mn�^ /
Nearest Town: h' Court C0-170 CC
c r-L
(Road Name and be/I:{s. ComX�F yr'I/tp ^or nSubdivision end Lot No.) DRILLING LOG
3. OWNER�lY 1"-"'^f� From To Formation Description
r
DEPTH
Addreos
rea or ou a o. [/J}J
O 8A' / Q n. e 05 Bed4.�►i
ty or Town ri Slake Zip Code
4. DATE DRILLED I ' 5 /- 0 .6'
5. TOTAL DEPTH at>s
6. CUTTINGS COLLECTED YES I I NON}/
7. DOES WELL REPLACE EXISTING WELL? YES n NO( va
8. STATIC WATER LEVEL Below Top of Casing: 30 FT.
(Use'i II Above Top of Casing)
9, TOP OF CASING IS 1 FT. Above Land Surface'
•Top of casing terminated etior below land surface requires a variance In accor-
dance with lSANCAC 2C 011e
10. YIELD (gpm): 0 METHOD OF TEST �1,
11. WATER ZONES (depth)'
12. CHLORINATION: Type "�T-CI Amount ..S L-- ilia If additional space Is needed use back of form
1 'ASING:
LOCATION SKETCH
Wall Thickness
Depth Diameter or Weight/Ft. Material (Show direction and distance from at least two State
From —et To 4'? Ft. lb' 35 QIb. 145' PECtaD11 Roads, or other map reference points)
From To Ft.
From To Ft
14. GROUT:
Depth i Material Method ,
Frorn 0 To aD PI Go►lGli � j•'� udteP,—
From To Ft
15. SCREEN:
itak , 41nCL
4aii-Lo& --fcc
Depth Diameter Slot Size Material
Frorn To Ft In In
From To Ft In In
From To Ft. In In
16. SAND/GRAVEL PACK:
Depth Size Material
From To Fl
From To Ft
17. REMARKS:
1 DO HEREOY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTIO STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
i 41
FOR OFFICE U E( LW l9 �155 / &''l�s t a'
Quad No: L. 9►' URE OF PERSON CONSTRUCTING THE WELL DATE
Submit originslon of Water Quallly, Groundwater Section within 30 days
GW-1 REV. 12/99
c
n _
.al No.

268370
North Carolina - Department ol Environment and Natural Resources - Division ol Water Quality - Groundwater Section
1636 Mall Service Center - Raleigh, N.C. 27699-1636-Phone [phone]
WELL CONSTRUCTION RECORD
WELLCONTRACTOR• {vRIRW kEfL ` (Jl NES
WELL CONTRACTOR CERTIFICATION #: /1740
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE (Check Appeceble Box): Residential A Municipal ❑ Industrial ❑ Agricultural Li Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other If Other, List Use:
2. WELL LOCATION: ow ketc{1t a location below)
Nearest Town: „Lvi• County'
Sit.-r-vC�
(Road Name end r umbers. Corr] unlly or Subdivision, end Lot No.) DRILLING LOG DEPTH
3. OWNE (�/ 1/'/ (/J�t�
Address
rs 0 d »tNre or Houl Oi 8 j
City or Town Slaie Zip Code
4. DATE DRILLED 7' I (1_ V
5. TOTAL DEPTH 3y',-
6. CUTTINGS COLLECTED YESI OI
7. DOES WELL REPLACE EXISTING) WELLN? VES _ NO['
8. STATIC WATER LEVEL Below Top of Casing: �� FT.
(Use 'e' II Above Top of Casing)
9. TOP OF CASING IS 1 FT Above Land Surface'
•Top of casing terminated allor below land surface requires a variance In accor-
dance with 15A NCAC 2C .0118
10. YIELD (gpm): S METHOD OF TEST -136
11. WATER ZONES (depth):
From To Formation Descdpllon
Q - /0 -Dj9t
/a a - 34'€ BeAnb
•
12. CHLORINATION: Type 4IT4- Amount 4.12p3
1" 'ASING: l
Wall Thickness
Depth Diameter or WelghVFI. Maledal
From 0 To 10 ;"*Ft (n.D5 QUa415. PYc•5D(j
From To Ft.
From To Ft
14. GROUT:
Depth Materlal
From 0 _ To ab Ft Gn►l GFi Pre
From To FI
15. SCREEN:
Depth
From To Ft
From To FI
From To FI
16. SAND/GRAVEL PACK:
Depth
To
From
From To
17. REMARKS:
fv.ffittuthod
Diameter Slot Size Materlal
In In
In In
In In
FI
Ft
Size
Materlal
If additional space Is needed use back ol form
LOCATION SKETCH
(Show direction and distance from at least two Slate
Roads, or other map reference points)
inerthAtal
/Zv
rn
I DO HEREDY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONST?_VCTION STANDARDS, .AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
1✓. 7--/D-oa
FOR OFF
Quad No:
al No.
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
nal to Division ol Water Quality, Groundwater Section within 30 days
GW-1 REV. 12199
ri

North Carolina - Deperimonl of Environmonl and Natural Resources - Division of Water Ounlity - Oroundwnlnr Suction 26 8 37 4
1636 Mall Service Cenlor - Raleigh, N.G. 27699.1638-Phone [phone] (�
WELL CONSTRUCTION RECORD WELLCONTRACTOR• BD hint ✓A( . Po +5
WELL CONTRACTOR CERTIFICATION N: g
STATE WELL CONSTRUCTION PERMITN:
1. WELL USE (Check Applicable Box): Residential0/ Municipal ❑ Industrial ❑ Agricullural Monitoring El
Recovery r1 Hoal Pump Water Injection ❑ Other El II Othor, List Use:
2. WELL LOCATION Show sketch of the location below)
Nearest Town: (�7 en -J Gounly.
_carte
(noed Name and Nm
�j ors, orwniiyy Subdivision and Lol No.)
3. OWNER " rail'
��
Address
DRILLING LOG DEPTH
From To Fonnnllon De scdp'lon
ISheol or No.l Ll —/36 rLW
ClI122/4.4fsfrang.. C /3v - e6 - reek.
Clly or Tovm Slate 2Ip Code
4. DATE DRILLED
5. TOTAL DEPTH - c0 S NO�1/j
6. CUTTINGS COLLECTED YES i
7. DOES WELL REPLACE EXISTING WELL? YES l J NO[ 1
6. STATIC WATER LEVEL Below Top of Casing: /es FT.
(Use'+ II Above Top of Casing)
9. TOP OF CASING IS 1 FT. Above Land Surface'
•Top of casing terminated .Vor below land surface require+ R variance In accor-
dance with 15A NCAC 2C.411E
to. YIELD (gpm): c, METHOD OF TEST r
11. WATER ZONES (dopih)
r
1 HLORINATION: Type aAmounlf 11 additional space Is needed use hack of form
13. CASING:
LOCATION SKETCH
Wall Thickness
(r� Depth lamcla ril e o uI 6{atedal (Show direction and distance Irorn% nt least Iwo Stale
From —s,[----To /SO .Ft • •1� "I 'I�� ? Bonds, or other map reference points)
From To Ft. / L 7e�
'
From To Ft �/^�•',�,��,nr /�YLIiCi / `-r^
14. GROUT:
Depth�� //�� `rMe�a`7al nrilol Method
iil4444C
From Q To AtL_Fl. �rlF I"y�U_K—Ed•_. fir'.
_o
From To _ Ft ry
15. SCREEN:
Depth Diameter Slot Size Malarial :,.
From To Ft In. In
From To FI In In
From To Ft. In. in �—
16. SAND/GRAVELPACK:
Depth Size Material
Froln 1 To FI
From To Ft
17. REMARKS:
1 DO 11:0C 4TIftY TIIiATIt�NI$WE li
CON k,a GTION STA A
R OFF 6E UPEONLY,.
Dyad Ora� r_
ijj
Sub°
S CONSTRUCTED IN ACCORDANCE WITH 1SA NCAC 2C, WELL
COPY or TFIIS RECORD HAS BEEN PROVIDED TO TI E WELL OWNER.
SIGNATURE 0 PERSON CONSTRUCTING THE WELL DALE
odpinal to Divisional Writer Duality. Groundwater Section within 30 days
Gw•t nEv. 12/99
Sedal r o

North Carolina - Department of Environment and Natural Resources - Divlslon of Water Quality - Groundwater Section 268378
1636 Mall Service Center - Raleigh, N.C. 27699-1636-Phone [phone] /
WELL CONSTRUCTION RECORD WELL CONTRACTOR' /�a RiY)AM L. • 2A-Z(.
WELL CONTRACTOR CERTIFICATION 0:
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE (Check Applicable Box): Residential0- Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ II Other, List Use:
2. WELL LOCATION: tow/,skeldt o the location below)
Nearest Town: {�C County'
(Road Name end Nu
3. OWNER
Address
S4 M t
en. Community,
ubdivislan and Lot No.) DRILLING LOG
.mod
Lilt_ C a$gO5
City or Town State Zlp Code
4. DATE DRILLED1o•a8'O'�-
5. TOTAL DEPTH a0 0
6. CUTTINGS COLLECTED YES n NOS'/ I
7. DOES WELL REPLACE EXISTING WELL? YES n NOI v1
8. STATIC WATER LEVEL Below Top of Casing: ffQ FT.
J (Use •.• II Above Top of Casing)
9. TOP OF CASING IS 1 FT Above Land Surface'
'Top or casing terminated euor below land surface requires a variance In accor-
dance with 15A NCAC 2C.0111
10. YIELD (gpm): 74 METHOD OF TEST
11. WATER ZONES (depth)•
g° a o B ->e_o<k
- CHLORINATION: Type J4 TH Amount3 p;i
CASING:
If additional space Is needed use back of form
Wati Thickness LOCATION SKETCH
Depth phis
or WeIghV-F_t. ;;11Ratedai (Show direction and distance from at least Iwo State
From D To 9 as Ft. la • a 5 �I".1s5 l vt5AC Roads, or other map reference R1/4_,ctidiatpoints)
From To FI n.From To Ft. `"
14. GROUT:
Depth Material Method
AO b To O FI Ctv/YCEEf E /
From To Ft.
15. SCREEN:
Depth Dlameler Slot Size Material
From To Ft In. In
From To Ft In In
From To Ft In In
16. SAND/GRAVEL PACK:
Depth Size Material
From To FI
From To Ft
17. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONS CIPY F THIS RECORD HAS BEEN PR IDED TO THE WELL WNER.
FGF.I
FPC•,1/41-S7?-ON6-V- ----1
SI NATURE OF PERSON CONSTRUCTING THE WELL DATE
SuI1ralI d)Inai to Division of Water Quality, Groundwater Section within 30 days
EL____,/ GM' REV. 12/99
FOR OF
nuad No:
Serial No -

North Carolina - Department of Environment and Natural Resources - Division of Waler Quality - Groundwater Section
1636 Mall Service Center - Raleigh, N.C. 27699.1636-Phone [phone]
268379
From
15. SCREEN:
WELL CONSTRUCTION RECORD
WELL CONTRACTOR• �D Lin lU . r 44-
5
WELL CONTRACTOR CERTIFICATION II: e;Qa Q
STATE WELL CONSTRUCTION PERMITH:
1. WELL USE (Check Applicable Box): Resldentlal63 Municipal n Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heal Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below) ����
Nearest Town: I f VI elv County:
(Road Name and N
3. OWNER
Address
JJi`rv)cii'
City or Town
4. DATE DRILLED
5. TOTAL DEPTH 3k_
6. CUTTINGS COLLECTED YES NO(VJ
7. DOES WELL REPLACE EXISTING WELL? YES Q NO
8. STATIC WATER LEVEL Below Top of Casing: FT.
(Use •✓ II Above Top of Casing)
9. TOP OF CASING IS l FT. Above Land Surface'
•Top of easing terminated .Vor below lend surface requires a variance In accor-
dance with ISA NCAC 2C .2116
10, YIELD (gpm): 3[h METHOD OF TEST
11. WATER ZONES (depth)•
ere. Communlly, or SubdivlsIon end Lot No.)
e: or o B e
Stale
Zip 730
4
DRILLING LOG
From To
DEPTH
Fonnallon Descdpllan
D -'75 rah
7S -S rdr�.gcic.
'n. CHLORINATION: Type \k T H Amount r97 i [IS
CASING:
Wall
Thickness
nn
From YJ DTolhn� FI. Plam1.etJ rl?1.0 at .5 MaLE'i� daI
From To < FL i� b
From To FI.
14. GROUT:
Depth
s-I n/1�Ivlalorlal Mo1MuIK
d
.�S
From n To FI �hQEiE
To FI
Depth
From To FI
From To FI
From To FI
16. SAND/GRAVEL PACK:
From
From
17. REMARKS:
Depth
To
To
Diameter Slot Size Materiel
In In
In In
In. In
Ft
Ft.
Size
Material
If additional space Is needed use back of form
LOCATION SKETCH
(Show direction and distance from at least two State
Roods, or other map reference points)
-Taylor-
Tdirvf&9 f-L-
0
N
_.s
1 DO FIE 1Fv THAT THIS WFl I WAS
CONST tpCnIOIt STANDARDS; AND TFLAT[
E„LISE ONLY 1
Su
Serial No.
I FOR OFF
uad No:
ONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
Y OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
SIONATUnE OF PERSON CONSTRUCTING THE WELL DATE
al to Division of Water Ouallly, Groundwater Section within 30 days
GWI REV. 12/99

0
North Carolina • Department of Environment and Natural Resources - Division of Water (Duality • Groundwater Section
1636 Mall Service Center - Raleigh, N.C. 27699-1636-Phone [phone]
WELL CONSTRUCTION RECORD WELLCONTRACTOR• /►; RmAN L • 24,-LL.
WELL CONTRACTOR CERTIFICATION if: c V.- 7
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE (Check Applicable Boa): Residential Er Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other I] If Other, List Use:
2. WELL LOCATI (Show eket h of the location below) /.1M
Nearest Town:/ �s� County' bl
3. O
OWNER
Address 6-6
ro
e or Houf&No.j—
Co 40- n�' a g7V 2
or Town Slate Zip Code
4. DATE DRILLED - aS. TOTAL DEPTH
6. CUTTINGS COLLECTED YES Il NO[4
7. DOES WELL REPLACE EXISTING WELL? YES [ j NO
8. STATIC WATER LEVEL Below Top of Casing: SO FT.
(Use •< II Above Top ol Casing)
9. TOP OF CASING IS / FT Above Land Surface'
*Top of casing terminated et/or below land surface requires a variance In accor-
dance with 15A NCAC 2C .0 1a
10. YIELD (gpm): METHOD OF TEST r r�
11. WATER ZONES (depth):
(Road Name and N bors. Community, or Subdivision and Lot No.)
e-
d 6n . ,,
vf
9R -A-M.0
CHLORINATION: Type 4 7H Amount _—J1.5
. CASING:
DRILLING LOG
From
268380
DEPTH
To Formation Description
o - 9 3
E-rj2oc k
If additional space Is needed use back of form
Wall Thickness
Depth Diameter or W Ight/F1. Material
From D To 9 -� Fl —6-_ or
PVC'-SDZ
From To Ft
From To Ft.
14. GROUT:
Depth Material Method ,
From D To do Ft i1vNCQ.Ef..b �7Ql.tB..�d._
From To Ft 15. SCREEN:
Depth
Frorn To Ft
From To Ft
From To FI.
16. SAND/GRAVEL PACK:
Depth
From To Ft
From To Ft
17. REMARKS:
Diameter
In.
In
In.
Slot Size Material
In
In
In
Size Material
LOCATION SKETCH
(Show direction and distance from at least Iwo State
Roads, or other map reference points)
(49,(L.0_40 6.11-)
/
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COP
' OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
FOR OFFLLam, �'
ICE IUSE ONLY
Ouad No: I` ' r
I,'
Serial No.!
SIGNATURE OF PERSON CONSTRUCTING THE WELL
)Inal to DIvlslon ol Water (Duality, Groundwater Section within 30 days
DATE
GW.1 REV. 12/99

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mall Service Center - Raleigh, N.C. 27699-1636-Phone [phone] ��{1 WELL CONSTRUCTION RECORD WELLCONTRACTOR• {�R%RW kE/
WELL CONTRACTOR CERTIFICATION ft:
STATE WELL CONSTRUCTION PERMITS:
268381
h LA.hy es
/9D
1. WELL USE (Check Applicable Box): Residential LW Municipal ❑ Industrial P1 Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other Cl II Other, Llst Use:
2. WELL LOCATION: (Show sketch of the location below)` _1
Nearest Town: V JV1 �61) County (-0// /
Sc.m e
(Road Name end /Number Community. or Subdivision and Lot No.)
3. OWNER rP7i// ✓/i�<2 �Yl%i%0i / jam,+
Address ) /, .,/ i�-iy)(,J�r) /-i /- .
SIr e or ou ay o.}iji(Ag
Cl y or Town � Slala Zlp Code
7-D�
4. DATE DRILLED
5. TOTAL DEPTH
6. CUTTINGS COLLECTED YES 1 1 NO
7. DOES WELL REPLACE EXISTING WELL? YES in NO[
8. STATIC WATER LEVEL Below Top of Casing: ) 76 FT.
(Use •+" If Above Top ol Casing)
9. TOP OF CASING IS ' FT Above Land Surface'
-Top of casing terminated ot/or below land surface requires a variance In accor-
dance wllh 15A NCAC 2C .0118
10. YIELD (gpm): %d METHOD OF TEST 1:?) q
11. WATER ZONES (depth):
DRILLING LOG DEPTH
From To Formation Descdpllon
d il 1
-7o0 Bedtibr-fri
12. CHLORINATION: Type 41T-�' Amount9 If additional space Is needed use back of form
1 'ASING:
Wall Thickness
0
Depth Diameter or WeighvFt. Material (Show direction and distance from at least Iwo Stale
From To -2 FI. 16.35 alb. P5 PVC -SDI Roads, or other map reference points) -
From To Ft L Y-
From To Ft • W iG %ry '�esf r `E-
14. GROUT: r (fir
Depth Male flat Method y.�' n ; d 1 n1 A L
From 0 To QO Pi COW(' 9P 'Dnt. fld / (il )V !iC/ o
From To FI c`
T
15. SCREEN:
0
il
0
IV
Depth
Frorn To
From To
From To
16. SAND/GRAVEL PACK:
Diameter Slot Size Material
Ft In In
FI In In
FI. In In
Depth Size Material
From To Ft
From To Ft
17. REMARKS:
1 DO FIEREDY CERTIFY THAT THIS WEL a - CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C. WELL
CON • - - e ^e a rvr OPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
LOCATION SKETCH
c
L
ASF'EVILLE F'
ANC; fTH
IGE
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Inal to Division ol Water Duality, Groundwater Section within 30 days
r
GW1 REV. 12/99
cnr!
mom.
0

North Carolina - Department of Environment and Natural Resources - Division of Water Quality • Groundwater Section 8 3 6 2
1636 Mall Service Canter - Raleigh, N.C. 27699-1636-Phone [phone] C Il d.1 �v i 0 6
WELL CONSTRUCTION RECORD WELL CONTRACTOR CERTIFICATION M: o!�1Dc: 2
STATE WELL CONSTRUCTION PERMITM:
1. WELL USE (Check Applicable Box): Residential (ia/ Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heal Pump Water Infection ❑ Other ❑ II Other, List Use:
2. WELL LOCATION: ( tow sketch the location below) Can /_ _
Nearest Town:
41< County• Cei
(Road Name
3. OWNER
Address
F✓
and N en. Community, or bdtvlslon end Lot No.)
ieol or Route Noy
C y or Town
LaState Zip Code
4. DATE DRILLED 1-/-5-0
5. TOTAL DEPTH -3 t
6. CUTTINGS COLLECTED YES I NO1 V
7. DOES WELL REPLACE EXISTING WELL? YES NO 1�
8. STATIC WATER LEVEL Below Top of Casing: FT.
(Usa'C II Above Top of Casing)
9. TOP OF CASING IS I FT. Above Land Surface'
'Top of casing terminated eVor below land surface requires a variance In accor-
dance YIELD
(gpm):h 15A .Q,is1a METHOD OF TEST Rr o
10. YIELD (gpm):J )
11. WATER ZONES (depth)
DRILLING LOG
From To
DEPTH
Formation Description
r
CHLORINATION: Type 7 H Amount II additional space Is needed use back of form
I,,. CASING:
LOCATION SKETCH
Wall Thickness
Depth < 7 FI prla11J .p?W?lea5 Maw",, d l ,-a (Show direction and distance from al least Iwo Stale
From
0 To IP b rl. (c TSS.=.lid-LC Roads, or other map reference points)
From To Ft.
From To Ft
14. GROUT:
Depth Malerlal Method
From 0
To.Bsc—FI. �hp0g
From To Ft.
15. SCREEN
Depth Diameter Slot Size Material
From To FI In In.
From __ To FI __ In. in
From To Ft _.— In. In
16. SAND/GRAVEL PACK:
Depth Size Material
From To FI
From To Ft.
17. REMARKS:
I pOIF.iFRFpY CERTIFY THAT THIS WELL WAS CONSTRUCTED INQACCORDANCE WITH 15A NCAC 2C, WELL
CONSTR�(CTLO ' L 'j---�TTDS COPY OF THIS D HAS BEEN PROVIpEO O THE WELL OWNER.
FOR p>
,,QQ[[1ce USE ONLY _—�, SIONAT URE OF EDSON CONSTRUCTING TIIE WELL
DATE
Ouad'7�: I original to Division al Water Gualily, Groundwater Section within 30 days SerialI o. GW I REV. 12/99
0
-TT
C.7

North Carolina - Department of Environment and Neural Resources - Division of Water Duality - Groundwater Section
1636 Mall Service Center • Raleigh, N.C. 27699-163a-Phone [phone] � (( (� I
WELL CONSTRUCTION RECORD WELLCONTRACTOR• 3D bhr{{ US e P +
WELL CONTRACTOR CERTIFICATION p: J of Do? S
STATE WELL. CONSTRUCTION PERMIT#:
1. WELL USE (Check Applicable Boa): Residentiala' Municipal ❑ industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Infection ❑ Other n If Other, List Use:
2. WELL LOCATIO (Show
�sketch
�.of the location below)
7 rest Town: at/i -�� era--' �,•�p""��'n, County
( (Rod Name and Nu y •ers, Community, r Subdivision end Loll No.)
3. OWNER
Address
�F L. /I4I-N AL a 6
AaCte
C a ge 6-
Clry or Town //SJJlate Zip Code
4. DATE DRILLED
5. TOTAL DEPTH O____7—.6.;'
n
6. CUTTINGS COLLECTED YES n NOj v'I
7. DOES WELL REPLACE EXISTING WELL? YES I I NOf 4'
8. STATIC WATER LEVEL Below Top of Casing: FT.
(Use': II Above Top ol Casing)
9. TOP OF CASING IS I FT. Above Land Surface'
'Top of casing terminated al/or below lend surface requires a variance In accor-
Mince with 15A NCAC 2C . )te
10. YIELD (gpm): 9KO METHOD OF TEST
11. WATER ZONES (depth):
CHLORINATION Type : Amounitf>1` S
DRILLING LOG
From To
268847
DEPTH
Formation Description
D - 5D rQ�
6D - SOO Ec)24C/C.
1J. CASING:
Wall Thickness
'� a � FI Depth ^plai fig irit:l 15,i. Ma�V • al
From _L—To (.p
From To FI
From To Ft
14. GROUT:
Depth MaterialMot_ hod
From 0 To AO__ Ft �flQE�i Method
To FI.
15
From
SCREEN:
From
From
From To
16. SAND/GRAVEL PACK:
Depth
To
To
Depth
_ To
To
From From
17. REMARKS:
I DO FIER:
GONSTRU
Ft
FI
F1.
Diameter Slol Size Materiel
In. In
In. In
In In
Size
Ft
Ft.
Material
v
II additional space Is needed use back of form
LOCATION SKETCH
(Show direction and distance from al least two State
Roads, or other map reference points)
MY. Co7C)4
5-
5-
• la
'OR OFFICSdir ONLY
Quad No:
ISerial No.
L1w ae'
Submit dglnai
Cf
STRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
OF THIS RECORD HAS BEEN PROV DED TO THE WELL OWNER.
/' /
Q7-
s NATURE OF ERSON CONSTRUCTING TIIE WELL DATE
o Division ol Wetly Oualily, Groundwater Section within 30 days
GWI REV. 12l99

North Carolina - Department of Environment and Natural Resources - Division of Water Dually - Groundwater Section
1636 Mall Service Center - Raleigh, N.C. 27699-1636-Phone [phone]
268883
WELL CONSTRUCTION RECORD WELL CONTRACTOR.
Be P
WELL CONTRACTOR CERTIFICATION 0: 3 no,
STATE WELL CONSTRUCTION PERMIT.:
1. WELL USE (Check Applicable Boa): Residential I.YJ Municipal ❑ industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ - Other ❑ If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below)
areal Town:
AQ/,, L,
Yfew County. Y lu rib/the
(hat
(Hoed Nam lid Numbers, Communlllyy, or Subdivision and Lot No.) DRILLING LOG DEPTH
3. OWNER i(eSm/i/7 From To Formation Description
Address tP(Jy. fJ,X f53
ran or TlouTi Flog F25a7
Cain ir�ly /1.G.
City or Town Stale Zip Code
4. DATE DRILLED EH -0
5. TOTAL DEPTH q4
6. CUTTINGS COLLECTED YES NOM
7. DOES WELL REPLACE EXISTING WELL? YES n NO tf
8. STATIC WATER LEVEL Below Top of Casing: 40 FT.
(Use'« II Above Top of Casing)
9. TOP OF CASING IS 1 FT. Above Land Surface'
'Top of teeing terminated sVor below lend surface requires a variance In accor-
dance wllh 15A NCAC 2C .9118
10. YIELD (gpm): METHOD OF TEST 1 C\
11. WATER ZONES (depth):
19 CHLORINATION: Type T N Amount
CASING:
o
fJ
v
If additional space Is needed use back of form r11
Wail Thickness
SKETCH
Depth piammeg jIefc vg. Material (Show direction and distance from at least two Stale
From �.L To s� Ft CJ oo''jS fYGSD Ronde, or other map reference points)
From To Ft.
From To Ft aro ref y 13r.
14. GROUT:
Depth //�� Material Method , 7/ambe c",
From b To AO__ F1 ail R E4 6 ,)]Q(ln..fE. / / ll....__
From To FI /
15. SCREEN:
Depth Diameter Slot Size Material
From To FI In In,
From To Ft In In
From To FI In In
16. SAND/GRAVEL PACK:
Depth Size Material
Frorn To FI
From To Ft
17. REMARKS:
I DO IlEREDY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS R RD HAS BEEN PR VID D TO THE WELL OWNER.
FOR OFFICE U ;a LY
fad Na:—1SIOt� URE OF PEEffiiSON CONSTRUCTING THE WELL ' DATE
Islon of Water Quality, Groundwater Section within 30 days
Serial No.
OW.1 fEV. 12/99

North Caroline - Departmonl of Environment and Natural Resources - Division of Water Quality • Groundwater Section
1638 Mali Service Center - Raleigh, N.C. 27699-1636-Phone [phone] �n"
WELL CONSTRUCTION RECORD WELL CONTRACTOR CERTIFICB CERTIFICATION r� ` Pa +
STATE WELL CONSTRUCTION PERMIT":
268882
1. WELL USE (Check Applicable Box): Residential EX
Recovery ❑ Heat Pump Water Injection ❑
Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Other [] If Other, List Use:
2. WELL LOCATIO p(Shaw skeic a1 the location below) 4�� C � /-
,flearest Town: SA a - - —, i. County' 6•-2
i
710tA)iCQ nC. DEPTH • vision a dLot No.) DRILLING LOG
(Hoed Name an
3. OWNER
Address
4,
5.
6.
7
atiii 01.5
Sireotor 1_ a �•7C/(7 )00 _ a
sly or T Stab 21p Code
DATE DRILLED`
TOTAL DEPTH a a
CUTTINGS COLLECTED YES I NO(4I
From To Formation Description
ere. Community. or
(/�/s�/. ia59
louto No.
DOES WELL REPLACE EXISTING WELL? YES NO 1�
8. STATIC WATER LEVEL Below Top of Casing: 62 O FT.
(Use •.' If Above Top of Casing)
9. TOP OF CASING IS I FT. Above Land Surface'
•Top of casing terminated sVor below land surface requires variance In actor•
dance wllh 15A NCAC 2C. 11
10. YIELD (gpm): /ov METHOD OF TEST
11. WATER ZONES (depth)•
I
CHLORINATION: TypefH----Amount3.l-4.L11-S
1J. CASING:
Depth
FromAli_To J1)(d
From To
From
14. GROUT:
To
Wall Thickness
Cl?� ILifiWte g ifal JFI
Ft
Ft
1e� Depth Malorlal
From lJ To /� Ft L}+tiR &4 E
From
15. SCREEN
To
Ft
Method
/
Depth Diameter Slot Size Material
From To Ft In In.
From To Ft In In
From To Ft In In
16. SAND/GRAVEL PACK:
Depth Size Material
From To Ft
From To Ft.
If additional space Is needed use back of form
LOCATION SKETCH
(Show direction and distance from et least two State
Roads, or other map reference points)
17. REMARKS:
I DO HEREDY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUC a?f TANDARDS- AND THAT A THIS RECORD HAS BEEN PROVJDED TO THE WELL OWNER.
It I
SE.ONLY
FOR OFFICE
Quad No:
Serial No.
CO
O
(a_r agiC gi-,3-Q
Submlt orl
AT UDE OF p SON CONSTRUCTING THE WELL DATE
Ivislon of Willer Ouallly, Groundwater Section within 30 days
GW'I REV. 12199

268880
North Carolina - Department of Environment and Natural Resources - Division of Water Duality - Groundwater Section
1636 Mall Service Center - Raleigh, N.C. 27699-1636-Phone [phone] (r�
WELL CONSTRUCTION RECORD WELL CONTRACTOR. WELL CONTRACTOR CERTIFICATION u: fJ L .AP -14-
gS
STATE WELL CONSTRUCTION PERMITM:
1. WELL USE (Check Applicable Boa): Residential Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heal Pump Water Injection ❑ Other II Other, List Use:
County. nh
2. WELL LOCATIO •(Show sketch of the location below) SN^h_l n
NOareal Town:
lit? 1L7;iJ/ 1.I alk7a DEPTH
%�!✓
(Pond Nar7iq and umber, mutiny, or Sub IsloNo.) L./DRILLING LOG
3. OWNER � r From To Formation Description
Address J
�reo or ou e o.
0 - 98
_. y or Townid ei.frs Seta ZIp coda � 2+
cic
4. DATE DRILLED 01
5. TOTAL DEPTH
6. CUTTINGS COLLECTED YESI J NOIvI
7. DOES WELL REPLACE EXISTING WELL? YES n NOI 4 o
S. STATIC WATER LEVEL Below Top of Casing: (2.5 FT.
I (Use': II Above Top or Casing)
9. TOP OF CASING IS FT. Above Land Surface'
'Top of casing terminated .Uor below land surface requires a variance In accor- ,)
dance with 15A NCAC 2C. 116 —n
10. YIELD (gpm): IK METHOD OF TEST 1 C\
11. WATER ZONES (depth): lv
;HLORINATION: Typo
13. CASING:
Depth
FromTo -_t2 FI.
From To Ft.
From To FI
14. GROUT:
Wall Thickness
PP
CO metW �Jt.eIgOVJ MaLYL".1J
Depth R E-1E al Method
From d To�.—FI �fIQ�'it�uKtd.
From To FI
15. SCREEN:
Depth Diameter Slot Size Materiel
Frorn To Ft In In.
From __._— To .__ FI In In
From _._- To Ft In. In
16. SAND/GRAVEL PACK:
Depth Size Material
From To FI
From To Ft
17. REMARKS:
IDOHEREBY YTIIATI`
CONSTRUCTIO ST,4NbARi$, AND THAT A CPP
If additional space Is needed use back ol form
cJ1
LOCATION SKETCH
(Show direction and distance from al least Iwo Slate
Roads, or other map reference points) CD
1
44
0R OFFICE U'E ONLY
Quad No: l..,.
Serial No
UCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
HIS RECORD HAS BEEN PROV DED TO THE WELL OWNER.
>r Or Ak9-oa
URE OF/ERSON CONSTRUCTING THE WELL ' DATE
Ion ol Water Gualily, Groundwater Section within 30 clays
GW-I nEV. 12r95

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1638 Mall Service Center • Raleigh, N.C. 27699-1636-Phone [phone] (�
WELL CONSTRUCTION RECORD WELLCONTRACTOR• Bt. bh,A (.�. �1Yo44S
WELL CONTRACTOR CERTIFICATION 0: of Do, g
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE (Check Applicable Box): Residential EX Municipal ❑ Industrial El Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Infection ❑ - Other Ej II Other, List Use:
2. WELL LOCATION:
Neazest Town:
(Road Name and N
3. OWNER
Address C��� ����,, e////i
ajbireol or Holy°.
Clly or Town
owesketcii of the I cation below)
County.
or Subdivision and Lot No.)
c5a
A870'i
Slate Zip Code
4. DATE DRILLED - 0-0 a
5. TOTAL DEPTH
6. CUTTINGS COLLECTED YES n NOl vf
7. DOES WELL REPLACE EXISTING WELL? YES n NOI 4
B. STATIC WATER LEVEL Below Top of Casing: ,.was'' FT.
(Use •✓ II Above Top of Casing)
g. TOP OF CASING IS I FT. Above Land Surface'
•Top of casing terminated at/or below land surface requires a variance In accor-
dance with 1SA NCAC 2C. 11e
10. YIELD (gpm): 5 METHOD OF TEST tti )
11. WATER ZONES (depth):
1
DRILLING LOG
From To
DEPTH
Formation Descdpllon
268879
D - yl
¥1 - / ' - dcock,
;FlLORINATION: Type b 7 N Amount 3
1o. CASING:
Depth �(7
From _0--To -1
From To FI
From To FI
14. GROUT:
From
PP Wall Thickness
f 1 r�
101?I�lolW�lg?kJ MaLYS.LG
FI
Depth Material
0 To a0 FI (pflREig
From To FI
15. SCREEN:
Method
pf'(!ntl
If additional space Is needed use back of form
LOCATION SKETCH
(Show direction and distance from et least Iwo State
Roads, or other map reference points)
Depth Diameter Slot Size Materiel
From To Ft In In
From To Ft In In
From To FI In In
16. SAND/GRAVEL PACK:
Depth Size Material
From To FI
From To FI.
17, REMARKS:
I DO HEREBY .uLFY.THALIHIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, ANO THAT A CO f THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
I .
'OR OFFICE USE ONLY
Juad No: i
Serial No.
Submit odti
7>I �14Tyv, dr- .17/_,0:_cir
UnE OF RSON CONSTRUCTING THE WELL DATE
h dDivision of Wale( Ouallty, Groundwater Section within 30 days
GW-I REV. 12/99
0
c
CJ
O
rs

268878
North Carolina • Department of Environment and Nature! Resources - Division of Water Duality • Groundwater Section
1630 Mall Service Censer- Raleigh, N.C. 27699-1638-Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR.
WELL CONTRACTOR CERTIFICATION N:
eRmAN L. , ,4-LL,
ovOa 7
STATE WELL CONSTRUCTION PERMITM:
1. WELL USE (Check Appdc.ble Box): Residential I✓I Municipal n Industrial n Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Infection n Other n If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below) Lam,
est Town: Cle.I•L County' Y)1)InCWt1b?
is dttA /9/ 2td /z
Mood r {arr4 and Numbers, Community, or Subdivision and Lot No.) DRILLING LOG DEPTH
3. OWNER co r1 1315linp From To Formation Descdplion
Address tchqg Porcvard �, 0 I 1
�rekvi ISlre or pro.) M �Oy (oS I�r R (—
CiiyorTown Stale aZlppCode 14in- (`�`� 13Ni�Prk
4. DATE DRILLED 11'16-0a
S. TOTAL DEPTH ISIS
3. CUTTINGS COLLECTED YES I I NO4
DOES WELL REPLACE EXISTING WELL? YES [i NOW,/
3. STATIC WATER LEVEL Below Top of Casing: ',y13 FT.
(Use •.• II Above Top of Casing)
?. TOP OF CASING IS 1 FT. Above Land Surrace•
'Top of easing terminated atfor below land surface requires a variance In eccor
fence wllh 15A NCAC 2C .011E
i 0. YIELD (gpm): GC METHOD OF TEST _
II. WATER ZONES (depth): '' LI - I ;::
2. nI ILORINATION: Type nII 7N Amount _aS II additional space Is needed use back of form C.51 0
3 SING:
rV
Wall Thickness LOCATION SKETCH
Depth Diameter or Weight/Ft. Material (Show direction end distance from el least Iwo Slate
From —0—To GS Ft It ;5 ai4,U5 • Roads, or other map relerence points)
From To FI
From To Ft. ,,11 7,t
4. GROUT: L3fi # I4 ) —A✓( rg ar,E,
Depth /� Material Method J w
From 13 To PD•0 FI ( OlNCLL4E p Ado,- i, MC
From To FI
15. SCREEN:
Frorn
Depth Dlarneler Slot Size Material
To FI In In
From To FI In In
From To Ft In In
6, SAND/GRAVEL PACK:
Depth Size Material
From To FI
From To FI
0
w
CO
0
cn
co
0
7. REMARKS:
I DO HEREBY
CONSTRUCTI4NrS•7ANOARDS, AND THAT A GO
F OFFICE UrsE ONLY
L No:
Serial No.
ry,y/
Submit orlot ahI
lTTIFY THAT THIS_tAIELL.WAS CONST'IUCTED IN ACCORDANCE WITH 1SA NCAC 2C, WELL
THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
o-•a
TUBE OF PERSON CONSTRUCTING THE WELL DATE
vision of Water Duality, Groundwater Section Millln 30 days
CW-I PEV. 12/99

268364
North Caroline - Department or Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mall Service Center - Raleigh, N.C. 27699-1636-Phone [phone] p
WELL CONSTRUCTION RECORD WELL CONTRACTOR• /t d� q 171 AN Z • 21)- (
WELL CONTRACTOR CERTIFICATION 0: o7Dii
STATE WELL. CONSTRUCTION PERMITS,:
1. WELL USE (Check Applicable Box): Residentialt Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Infection ❑ Other El If Other, List Use:
2. WELL LOCATION: (Show sketch,of the location below) -�b�
Nearest Town: 1/'tea.�fC€ r v tilt County r O
Numbers. o DEPTH
(Road Name and tN,umbers. Community, or Subbddllvlllssl_on and Lot No.) DRILLING LOG
3. OWNER I "(.LY ,. I4_' Cind i X*EY� From To Formation Descdpllon
Address �Ila. WLo t �,vcv�t'_ bd.
(Street or Route o.)
W ch/en ilk K� Mitt
City or Town Slate P
4, DATE DRILLED 4'2'S-109'
5. TOTAL DEPTH 'ztqa
6. CUTTINGS COLLECTED YES n NOVI
7. DOES WELL REPLACE EXISTING WELL? YES n NO[Vf
8. STATIC WATER LEVEL Below Top of Casing: 5 FT.
(Use': II Above Top of Casing)
9. TOP OF CASING IS I FT Above Land Surface'
'Top of casing terminated eVor below land surface requires a variance In accor-
dance with 19A NCAC 2C .0118
10. YIELD (gpm): t S METHOD OF TEST m 3
11. WATER ZONES (depth)•
)D -(331 5 B&deQck
' CHLORINATION: Type H 711 Amount .f -Iis If additional space Is needed use back of form
. CASING:
FOR OF N; ONLY
Quad
Ii!
Serial No' l
LOCATION SKETCH
Wall Thickness
Depth Diameter oraWeight/Ft. ;1Material (Show direction and distance from al least two State
From 0 To ) .37 FI L •, 5 aL�25 PVC•SDr2 Roads, or other map reference points)
From To FI. r�..
.,I
From To Ft 1 _ QUS1 GI Vd Yvizf )U
14. GROUT: l-U Depth Material OII We ev v(I le / t e��((
C-
From � To AO FI I^�Ncekfi
From To FI
15. SCREEN:
Depth Diameter Slot Size Material
Frorn To FI In In
From To Ft. In in
From To FI. In In
16. SAND/GRAVEL PACK:
Depth Size Material
From To Ft
From To Ft
17. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITHH/ 15A NCAC 2C, WELL
CON C ern n•RDS AND THAT A C OF THIS RECORD HAS BEEN PRO TO THE WELL OWNER.
ee
SIGNATURE O PERSON ONSTRUCTING THE WELL DATE
odglnal to Division of Water Oualily, Groundwater Section within 30 days
OW-1 REV. 12/99

North Carolina - Department of Environment and Natural Resources - Division of Water (Duality - Groundwater Section 268876
1636 Mall Service Center - Flaleloh, N.C. 27699-1636-Phone [phone] n
WELL CONSTRUCTION RECORD WELL CONTRACTOR CERTIFICATION ba: l� wr r �P� 9
+
STATE WELL CONSTRUCTION PERMITM:
1. WELL USE (Check Appucabte Box): Residential V Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heal Pump Water Infection [I Other [] If Other, List Use:
2. WELL LOCATION:. I ow s etch of t;. location below) Q r���
N- est Town: —` � - s County. iY7
IL1J 3 /J7I /
(no d Name end N •are. Community, or S b•Ivision end Lot No.) DRILLING LOG DEPTH
3. OWNER From To Formation Description
1 �/Lt � -� /��
Address 62 / / s-
reo or ou a ao. - 0 0 ra r RA -
Zip Code
ea - 'i/41� td Cock_
City or Town ll// Slate
4. DATE DRILLED I/if 0
5. TOTAL DEPTH di5
6. CUTTINGS COLLECTED YES U NO I Vf
7. DOES WELL REPLACE EXISTING WELL? YES [ ) N0I ✓(
8. STATIC WATER LEVEL Below Top of Casing: (/ 5 FT.
(Use II Above Top oI Casing)
9. TOP OF CASING IS I FT. Above Land Surface'
•Top of casing terminated ,Vor below land surface requires a variance In accor-
dance with 15A NCAC 2C .91 9
10. YIELD (gpm): (/ METHOD OF TEST t 4
11. WATER ZONES (depth):
;HLORINATION: Type_ LE___--Amounl`Z5 tt5
10. CASING:
�J
•
C;
It additional space Is needed use back of form C'
J Wall Thickness
10 ;'���,r -� ep?r lb r11( t$1/['J Matedal
From DToth gKa-Ft..Cl
From To F.
From To Ft
14. GROUT:
Depth Material Method
From 0 To 20—PI Cnni2E46
From To Ft
15. SCREEN:
Depth Diameter Slot Size Materiel
Frorn To Ft In In
From __— To Ft In In
From To Ft In. In
16. SAND/GRAVEL PACK:
Depth Size Material
From To Ft
From To FI.
17. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTICdN- �AEll3•ARD9, ANDSHAT A COPY OF TFIIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
LOCATION SKETCH
(Show direction and distance from at least Iwo Stale
Roads, or other map reference points)
W
'TT
m
CO
CO
0
0
(11 _
TURF OF RSON CONSTRUCTING THE WELL ' DATE
Ivlston of Water Quality. Groundwater Section within 30 days
GW-1 REV. 12199

2€8869
North Coro/Inn • Department of Environmanl and Nalurnl Flesources - Division of Wnler Quality - Oroundwntor Section
1636 Mali Service Cartier • Relolph, N.G. 27699-1636-Phone (919) 733•3221 rr ((��
WELL CONSTRUCTION RECORD WELLCONTRACTOR• 3D hint UJ. Poqs
WELL CONTRACTOR CERTIFICATION p: r`). Q
STATE WELL CONSTRUCTION PERMITH:
WELL USE (Check Appucsble Box): Residential I v( Municipal ❑ Industrial 0 Agrlcullural El Monitoring IJ
Rocovery EH Host Pump Water Injection ❑ Other n If Olhor, List Use:
2. WELL LOCATIO
N arest Town:
r
14, GROUT:
(SI ow sketch of tiB location below) 06mCatt4am County:
Depth Maloriol Method
From � To �0 FI �nQE{r rntiz�.
From To Ft
15. SCREEN:
Doplh Diameter Slot Size Material
From To F1 In In.
From To Ft In In
From To FI In In
16. SAND/GRAVEL PACK:
Depth
From To
From
To
Size
FI
Ft
Malorlal
/ /
rilfirr
OP (Rood Name ye ally, or . ubdivlslon end Lot No.) DRILLING LOG DEPTH
.
3. OWNER %• _ / r- From To
Addr
/ a• 1eo or out, 1
Clly or Tawn Stale Zlp Code
A. DATE DRILLED a'
5. TOTAL DEPTH
6. CUTTINGS COLLECTED YES Li NO VI
7. DOES WELL REPLACE EXISTING WELL? YES D NO[ 14
6, STATIC WATER LEVEL Below Top of Casing: FT.
(Use'.' II Above Top of Casino)
9. TOP OF CASING IS 1 FT. Above Land Surface'
'Top of CA sing let mingled sUor below lend surface requires a variance In accor-
dance with 15A NCAC 2C 16 ,
11. WATER ZONES (depth):
10. YIELD (gpm): /2 METHOD OF TEST I C
TT-�Q� — j
'HLORINATION: Typo
IL. CASING:
Fomnllon Desalpllon
risk.
CO
r
If additional space Is needed use hack of form
Wall Thickness LOCATION SKETCH
(� Depth plain lal yr, elol;U[l. h�/M�al'e(danl p (Show direction and distance from el lead Iwo Slate
From-__-L-___--______ Ip fJ- j - -'-` ponds, or Diller
r map iolaron�ce points)
From To FI HaAP- `5 £ f- _"i -
From To Ft. Pd)
n n ffnC
N �'
-a
17. REMARKS:
I DO 11EREDY
CONSTRUCT(
R OFFICE U
Dugd No:
LEX-T HAT-114 :L71€LUd1AS-68iJaI.
IDAr1DS, AND Tt IAt A GO
TUCTEO IN ACCORDANCE WITH 15A NCAC 2C, WELL
TFIIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
tunE OF'I'ERSDN CONSTRUCTING THE WELL DATE
vlslon of Water Quality, Groundwater Section within 30 days
GW•I REV. 12/99

North Carolina - Department of Environment and Natural Resources - Division of Water Quality. Groundwater Section
1636 Mall Service Center - Raleigh, N.G. 27699.1636-Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR. BD IDhr1 ( J. t'04+S
WELL CONTRACTOR CERTIFICATION It: J D; 2
STATE WELL CONSTRUCTION PERMITN;
268868
1. WELL USE (Check Applicable Bax): Residential Lb Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring El
Recovery ❑ Heal Pump Water Injection ❑ Other If Other, Llst Use:
2. WELL LOCATION
est Town:
Jill"
(Posd Name and
3. OWNER
Address
(SI sk- clt of the location below)
County'
•
tubers. Co
l
nlly, or Su vision end Lot No.)
oITY1 Su
S .
014.
i / A_ reo or oue C n 01 g!e'de/
City or Town State/e Zip Code
4. DATE DRILLED a
5. TOTAL DEPTH .s0 . -,t
6. CUTTINGS COLLECTED YES I I NO[ v I
7. DOES WELL REPLACE EXISTING WELL? YES I I NO 4
8. STATIC WATER LEVEL Below Top of Casing: 7.5 FT.
(Use ".' It Above Top of Castro)
9- TOP OF CASING IS I FT. Above Land Surface'
•Top or casing terminated el/or below land surface requires a variance In accor-
dance with 15A NCAC 2C .990
10. YIELD (gpm): METHOD OF TEST
11. WATER ZONES (depth):
DRILLING LOG
From To
Ad 5
DEPTH
Formation Description
oo,, .''tv
CHLORINATION: Type --Amount 2(p.+11'' LUJ If additional space Is needed use back of form
• CASING:
Depth ,/
From 1 J To 77 Ft
From To Ft.
From To Ft.
14. GROUT:
Wall Thickness
iamele r eohUR. Material
(.0 � .las iVC•SD�2
Depth �� //�� Material
MoIMU 12�
To AO_ g
From
From To FI
15. SCREEN
Depth Diameter Slot Size Materiel
Frotn To FI In In
From To FI In In
From To FI. In. In
16. SAND/GRAVEL PACK:
Depth Size Material
From To FI
From To Ft.
17. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY, OF THIS /RECORD HAS/BEEN P OVIDED TO THE WELL OWNLE/R. �- (J
t '/fir l Kkv G91 r 7
LOCATION SKETCH
(Show direction and distance from at least Iwo Slate
Roads, or other map reference points)
l
n:.
(7)
cn--
n0,
0
COR OFFICE US
-load No:
Serial No.
Submit orioinaj
MLA
OFFICE
RE (F PERSON CONSTRUCTING TIE WELL DATE
on al Willer Quality, Groundwater Section wllhin 30 days
ow -I REV. 12/99

North Carolina - Department of Environment and Natural Resources - Division of Water Quality • Groundwater Section
1636 Mall Service Center • Raleigh, N.C. 27699-1636-Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR'
� 26886 5
AregmAN IALL.
WELL CONTRACTOR CERTIFICATION'S: ;Oa '7
STATE WELL CONSTRUCTION PERMIT'S:
1. WELL USE (Check Applicable Box): Residential [kr Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection LI Other 0 II Other, List Use:
2. WELL LOCATION:,(Show sketch of the location below)
mm
ke
"e rest Town• )/_'P, - h _�—yy— %Coouun/1y,,'
Ig1G !(�2 e( i C'l DEPTH
(Road nameyend
,,NumJpers, CCorrmm nYYYY' or /Subdivision end Lot No.) DRILLING LOG
Y-�r(�KY 77t% / `J From To Formation Descdptlon
3. OWNER
Address 1,Q /pO-n" - O'2J
jSlrce or ou e 'o. e<�
City r Town �11� Slate
Llp Code
4. DATE DRILLED �/'('i1%,
5. TOTAL DEPTH .*
6. CUTTINGS COLLECTED YES In NOI4
7. DOES WELL REPLACE EXISTING WELL? YES jam NO[
8. STATIC WATER LEVEL Below Top of Casing: �7 _ FT.
(Use'+' II Above Top of Casing)
9. TOP OF CASING IS 1 FT. Above Land Surface'
'Top of casing terminated aVor below land surface requires a variance In accor-
dance with 1SA NCAC 2C ,4.j10
10. YIELD (gpm): ( METHOD OF TEST I. 5
11. WATER ZONES (depth)
))a'R 1-•
1-3iR-Rc k
co __
Iv
t
CHLORINATION: Type 1-1 7N Amount 4 27 i Ls It additional space Is needed use back of form
CASING:
Wall Thickness LOCATION SKETCH
Depth /�F . Diameter or WeIghVFl. Material (Show dlreclton and distance from at least two Slate
From 0 To _LLB-5- FI Is '5 42) .Ja5 pvesDR Roads, or other map reference points)
From To FI. ,//--��n/
From To Ft K4/V Prr ve
14. GROUT: /gyp/
Cam0 /'•
Depth Material Method
/i /
From D To vZ-d FI C1nNCEE1-E-poinri.
From To FI
15. SCREEN:
Depth Diameter Slot Size Materiel
From To Ft In In
From To Ft In In
From To FI In In
16. SAND/GRAVEL PACK:
Depth Size Material
From To Ft
From To Ft
17. REMARKS:
SO :6 Ltd 6 1833 60
n
c
I DO HEREBY CERTIFY THAT THIS WF11 WAG rnw TRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUC pp-- TANDARDS,AND THAT ACTHIS RECORD HAS BEEN PROVIDED THE WELL OWNER.
�
��
FOR OFFICE • � 1 ��2(�b7J,2
Quad No: SIa ATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit odq : t alvlslon of Water ouality, Groundwater Section within 30 clays
•
GWl REV, 12/99
Serial No

North Carolina - Department of Environment and Natural Resources - Division of Water Duality - Groundwater Section 41636 Mall Service Center - Raleigh, N.C. 27699-1636-Phone [phone] }( 2„6 8
WELL CONSTRUCTION RECORD WELL CONTRACTOR LJD b hrA LU Yo44-S
WELL CONTRACTOR CERTIFICATION N: Dc: S
STATE WELL CONSTRUCTION PERMITN:
1. WELL USE (Check Applicable Box): Residential Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heal Pump Water Infection ❑ Other ❑ If Other, List Use:
2. WELL LOCATION: (Sf'pw k,� etrlr the location below) /.k�MC�' /
CG.
w.....er tnujn �T County: [� 2
(Road Name and Numbers, Corrvnunily, or Su sion and rot No.)
3. OWNER LsJ t tit CLAM 61A S-S a—
eo or Ho�ule J(O. 1 AddrC)LG�V.0.2,13 I
Cliy or Town Situ] Zip Code
4. DATE DRILLED /IL;10_6
5. TOTAL DEPTH CO-'
6. CUTTINGS COLLECTED YES MORT
7. DOES WELL REPLACE EXISTING WELL? YES [] NOI 4
8. STATIC WATER LEVEL Below Top of Casing: �� FT.
(Use '+' II Above Top of Casing)
9. TOP OF CASING IS 1 FT. Above Land Surface'
'Top of casing terminated et/or below lend surface requires avariance In accor-
10. YIELD (gpm):
dance with 15A NCAC 2C . 1 0
METHOD OF TEST
11. WATER ZONES (depth):
D - (fi
cA -ea-OOS
0
lv
CHLORINATION: Type T N Amoun 1iS If additional space Is needed use back of form
CASING: -F--
Wail ThicknessLOCATION SKETCH
O Depth tamale r e ghuR Material (Show direction and distance from al least Iwo Stale
From l� To !" Ft 0•3�� '1;5 YLID1' Roads, or other map reference polnis)
From To Ft. (COIL
From To Ft
14. GROUT: C7
Depth Material Mot/ SSSA
From Q To �FI (bhlz�iE up
From To Ft -a
15. SCREEN: w
Depth Diameter Slot Size Material
o
From To FI In In - GI
To Ft In. In
From To Ft. In. In
16. SAND/GRAVEL PACK:
Depth Size Material
From To Ft
From To FI.
17. REMARKS:
1 DO HEREBY CE o 1FY IEAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION S-LA DARDS, AND THAT A'CC}:3_'Y L r I- IS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.'OR 2
, OFFICE US = R(A9 Pa il-��o-6 C/NII / DATE
]uad ad No: S N RE OF PERSON CONSTRUCTING THE WELL
Submit oduInalitb vision or Water Duality, Groundwater Section within 30 days
GW-I REV. 12/99
Serial No.
IV
r-
cr
0

THAT THIS Y)'ELL WM
ICI ANDAR0S, ANC6 THAT AGO
North Carolina - Department of Environment and Natural Resources - Division ol Water Quality - Groundwater Section
1636 Mall Service Center • Raleigh, N.C. 27699-1636-Phone [phone] �ELL CONTRACTOR.Q !� �Y ^Q��S
WELL CONSTRUCTION RECORD WELL CONTRACTOR CERTIFICATION p: e; g
STATE WELL CONSTRUCTION PERMITM:
1. WELL USE (Check Applicable Box): Residential I ✓1 Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Other ❑ II Other, List Use:
Recovery ❑ Heat Pump Water Injection ❑
2. WELL LOCATIO (Show sketch of t e location below)
aresl Town: County. C
(noad Nam
3. OWNER
Address
4. DATE DRILLED
5. TOTAL DEPTH 36 5
6. CUTTINGS COLLECTED YES NO[71-
7. DOES WELL REPLACE EXISTING WELL? YES ❑ NOj 4
8. STATIC WATER LEVEL Below Top of Casing: � FT.
(Use': 11 Above Top of Casing)
9. TOP OF CASING IS I FT. Above Land Surface'
'Top of casing terminated eVor below land surface requires a variance In accor-
dance with 15A NCAC 2C . 116
10. YIELD (gpm): 15 METHOD OF TEST 1hci
11. WATER ZONES (depth):
CHLORINATION: Type _ 7 N—_Amounaa
',.. CASING:
Comor/ ly. or Subdivision and Lot No.)
frat x_tcct
r¢ol �toioule
Zip Cod
DRILLING LOG
From To
DEPTH
Formation Dascdpllon
rQ�
c,/Q - 65 Afriemck.
Gay or Town Slate
y-ari-o
r)
W
fV
II additional space Is needed use back of form
IV
c
Wall Thickness
(� Depth al PIa1 pr yrite vg Ma;1VC�." k
From l' To O' (Q FI (c jb rl is 7
From To FI
From To FI
14. GROUT:
Depth� Material Method
r1DU Kid.
From 0 To 1ii_12._ Ft ILR Ei r
From To FI.
15. SCREEN:
From
From
From
Ft
Ft
To FI
16. SAND/GRAVEL PACK:
Depth
To
To
Depth
To
To
FromFrom
17. REMARKS:
Diameter Slot Size
In
In
In.
FI
Ft.
Size
Metairie!
In
In
In
Material
268863
LOCATION SKETCH
(Show direction and distance from el least two State
Roods, or other map reference points)
Oz,wwtzti
+ r.
I DO 11EREOY
CONSTRUCT'
"OR OFFICE
auad No:
Serial No
RUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
THIS RECORD HAS �PEE�N PROVIDED TO THE WELL OWNER. , /,'1 �7
VV r / — / n/,VO\
4TURE OF PERSON CONSTRUCTING THE WELL ' DATE
)Ivlslon ol Water Quality. Groundwater Section within 30 days
GWI REV. 12199

1
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section 1636 Mali Service Center - R6 8 8 6 (-. eioloh, N.C. 27699-1636-Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR' J4k/eO& 1 /'F qii oSoil
WELL CONTRACTOR CERTIFICATI0: J�a 9
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE (Check Applicable Box): Flesidentiallit Municipal (1 Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ if Other, List Use:
2. WELL LOCATION
Nearest Town:
Show sketch o the location below)
Gounry•132.4_4-LC
(Road Name and umbers, Co - unity, or ffviston and Lot No.1) DRILLING LOG DEPTH
3. OWNER i a/. i _ _ I . el....) From To Formation Description
�► I
Address 1l L
_ St �� ..
ily or Town Silo Zip Cade 75 - LP9s B FG(g-PCk
5. DATE DRILLED
5. TOTAL DEPTH it
6. CUTTINGS COLLECTED YES 1 NOH✓r
7. DOES WELL REPLACE EXISTING WELL? YES ri NO !/r
8. STATIC WATER LEVEL Below Top of Casing: ;Op FT.
(Use'+' II Above Top of Casing)
9. TOP OF CASING IS ' FT. Above Land Surlaco•
'Top of casing terminated et/or below land surface requires ^a variance In accor-
dance with 15A #CAC 2C .011B 10. YIELD (gpm): f METHOD OF TEST / L r 5
11. WATER ZONES (depth):
W
ry
2. CHLORINATION: Typo H TN Amoun 9pJ //S II additional space Is needed use back of form -o ,=; __
13, CASING: r o e_r:
Wall Thickness LOCATION SKETCH
Depth ``)) . 9lameter or Weight/Ft. medal (Show direction and distance from at least two State;
From 67 To 613_ FI. V • ol1L•/�5 Roods, or other map reference points) =-
From To Ft. I ry/
From To Ft. 0) /] /,�. L 06 (/ r7 r, 4-10 ��l -
14. GROUT: `��(Jl /� ///���---"`���vvv
Depth - Material .I Methodrrl
II
From b To �Ft Co he!C_ILC f11r,renAO•..�LO
15 SCREEN
Flom To Fl o:t j_LQ.,t bij .-
Depth Diameter Slot Size Material
From To Ft In In
From To Ft In In
From To Ft In In
16. SAND/GRAVEL PACK:
Depth Size Material
From To Ft
From To Ft
17. REMARKS:
c
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTIOrf&T-A[IDARDS-AND THAT ACOPY f�. T'1IS RECORD HAS BEEN P VIDEO TO THE WELL OWNER.
FOR OFFICE US eN'4! 4/ • C„` S�
/ r — &
Ouad No: r Un F PERSON CONSTRUCTPVG DIE WELL DATE
Submit edging a t Ion el Water Quality, Groundwater Section within 30 days
GW-I REV. 12/99
Serial No.

268851
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1638 Mall Service Center - Raleigh, N.C. 27699-1636-Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR.
Bo bhf P
it�v oi+C
WELL CONTRACTOR CERTIFICATION It: 0.0, 2
STATE WELL CONSTRUCTION PERMIT":
1. WELL USE (Check Applicable Box): Residential &Er Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other Ell If Other, List Use:
2. WELL LOCATION: r•how sketch of the location below) /
Nearest Town: `� -1 • • •• • �• G County �_Cnn ,6.4
17
(Road Name a d mbers, Co unity. or Subdivlslo and Lot No.) DRILLING LOG DEPTH
3. OWNER ; �)!/ e /.I/ •.. �w /- . From To Formation Descdpllon
Address •
coo or ou e 'o. ny 3 r
pia .�! r2i--
o
CiIy or Town Slate Zip Code
5. TOOTA DRILLED ^ D--�-�-�—/I
TAL DEPTH
5. T
6. CUTTINGS COLLECTED YES f NOM-
7. DOES WELL REPLACE EXISTING WELL? YES a NO 14
8. STATIC WATER LEVEL Below Top of Casing: FT.
(Use'+' II Above Top of Casing)
9. TOP OF CASING IS 1 FT. Above Land Surface'
'Top of casing terminated eVor below lend surface requires a variance In scoop
dence with 15A NCAC 2C .9y116
10. YIELD (gpm): L. METHOD OF TEST 1 c
11. WATER ZONES (depth): j
•
17. CHLORINATION: Type ._4_AmounI 1 (f S
CASING:
Depth
From illTo A3_ FI
From To Ft.
From To R.
14. GROUT:
Wall
lwThlckknoss
PP
(01•.31,f lb;IgCS. Material
DeptAO__
h� n tyMalarial Mol_ Trod r
From 0 To �FI aIt><E4E rnuP.�
From To Ft
15. SCREEN:
Depth Diameter Slot Slze Materiel
From To FI In. In
From To Ft In In
From To Ft. In In
16. SAND/GRAVEL PACK:
Depth Slze Material
From To FI
Ft
From
17. REMARKS:
To
_?7
If additional space Is needed use back of form r9 f'-i 5
n
LOCATION SKETCH
(Show direction and distance from al least Iwo State
Roads, or other map reference points)
//v 2o'LJ
-
v
O
al
I DO HEREBY
CONSTRUCTI:P'
I FOR OFFICE
uad No:
Serial No
ASHEV1L
NSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
79F THIS FJEC�ono HAS BEEN PROVIDED TO THE WELL OWNER.
ra9-4�
SI
Submit orlpi_l
uiJJ
-FI0EE
u1TURE OFDERSON CONSTRUCTING THE WELL ' DATE
)ivlsion of Water Ouallty, Groundwater Section within 30 days
GW-I REV. 12/99

North Caroline - Department of Environment and Natural Resources - Division of Water Duality - Groundwater Section
1636 Mall Service Center - Raleigh, N.C. 27699-1636-Phone [phone]
268903
WELL CONSTRUCTION RECORD WELL CONTRACTOR.
23Db%r (U. YOBS
WELL CONTRACTOR CERTIFICATION 0: 3 e;Qa
STATE WELL CONSTRUCTION PERMIT:
1. WELL USE (Check Applicable Box): Flesidentlal I.b Municipal F 1 Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heal Pump Water Infection ❑ Other (] 1f Other, List Use:
2. WELL LOCATION: (Show sketch of the location below) L..
f�earesl Town: sal der County: %onccrb vn e
cil GA,kk icione.tl Pd Q r, 876 hca/
(Road Name and Numbers. Coopmmunll or Subdiv slon and Lel No.) DRILLING LOG DEPTH
3. OWNER YI rice UV �t rr�aiy From To Formation Descdpllon
Address TO -pm 'l5,%
)shemte 'Ire° ar jaoeNo.) O3 4 - r-�idn jJrR�
City or Town .1-6-
Ji c. Stale Zip Code of /� L�.1�. C1C
4. DATE DRILLED — -"-Oa
5. TOTAL DEPTH a ln5
6. CUTTINGS COLLECTED YES pi NO
7. DOES WELL REPLACE EXISTING WELL? YES NO[ 4
8. STATIC WATER LEVEL Below Top of Casing: (a FT.
(Use'.' II Abovo Top of Casing) d
9. TOP OF CASING IS 1 FT. Above Land Surface'
'Top of casing terminated aUor below tend surface requires a variance In accor-
dance with 15A NCAC 2C .2118
10. YIELD (gpm): ?- METHOD OF TEST
11. WATER ZONES (depth):
1 o CHLORINATION: Type _117 H Amount { i It S
CASING:
.3
If additional space Is needed use back of form IV
Wall Thickness LOCATION SKETCH
�/r�� Depth prammel yr r'/yyeig NFL ;�,Maateririall .., (Show direction and distance from at least two Stale
From —S —To Ft ((pp t� �1 b. TCS.IER Roads, or other map reference points)
From To Ft.
From To Ft
I4. GROUT:
Depth Material Mol_ hod
-�I�Q..,
From n To AD__ ���E jY�UKtd.
From To Ft
15. SCREEN:
Depth Diameter Slot Size Malarial
From To Ft In In
From To Ft In In
From To FI In In
16. SAND/GRAVEL PACK:
Depth Size Material
Ftorn To FI
From To F1
17. REMARKS:
rn
'1l
Franklin Knbll 14
A \exc ndev, KC
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
CONSTRUCTION STANDAi t _ n.•• • OF THIS RECORD HAS BEENnPROVIDED TO THE WELL OWNER.
FOR OFFIC: PS /70 'et— 3-5-0Q.
ad No: I ' •
I
Serial No.
Submit
NATUnE aF PERSON CONSTRUCTING TIIE WELL DATE
Division of Willer Ouallly, oroundwaler Section within 30 days
GW-t REV. 12/99

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mall Service Center - Raleigh, N.G. 27699-1636-Phone [phone]
WELL CONSTRUCTION RECORD WELLCONTRACTOR• / ReRv
WELL CONTRACTOR CERTIFICATW4J
STATE WELL CONSTRUCTION PERMITN:
268902
j�417 Soul
1. WELL USE (Check Applicable Box): Residential Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Infection ❑ Other (] 11 Other, List Use:
2. WELL LOCATION: (Show sketch of the location below) I��bP
Np3)ost Town: linty.
r ^ �•
(n d Namo and Numbers. Community, or b Ivision and Lot No.) DRILLING LOG
3. OWNER 67e/5 F�e Cb n ije/2SA i p
Address ,Py,,, ([Y�� /6
�� (SSl eat or IiouloNo.)
kheriik
City or Town Slate
4. DATE DRILLED .3-5 -0A
5. TOTAL DEPTH /i25
6. CUTTINGS COLLECTED YES' 1 N011.
7. DOES WELL REPLACE EXISTING WELL? YES I 1 N0fyr
8. STATIC WATER LEVEL Below Top of Casing: 10 FT.
(Use'+' II Abovo Top of Casing)
9. TOP OF CASING IS 1 FT. Abovo Land Surface'
'Top of casing terminated atlor below land surface requires a variance In accor-
dance with 15A NCAC 2C .0118
10. YIELD (gpm): / METHOD OF TEST 1
11. WATER ZONES (depth):
From To
D -31
31 1h6
2Ip Code
DEPTH
Fomallon Description
J)1
B g_ock
cr -
CO
r
=Z
V
'2. CHLORINATION: Type
H 7H Amount aF pals If additional space Is needed use hack of form iV ^:' r
13. CASING: -- - tag
LOCATION SKETCH
Wall Thickness
Depth vlametor or Welohvr--L ;�M�allerlall (Show direction and distance from at least Iwo Slate
From D To 31 Ft �. • Q/it./2i -T1e-W Roads, or other map reference points)
From To FI. O
From To Ft. /S�/e-(j � j.
co
14. GROUT: Le �" rn
Depth - Material Method / ces-17)C, • `-"
From b To _QFt kncrefe paused.
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
Frorn
From
17. REMARKS:
To
To
Ft
Ft.
C9 c.x
0
-r. E.
I DO HEREBY CERTIFY TW.ATsk.. CrsIo6' UC
CONSTRUCTIe (WARDS, AND TIIAI(A 0P �1`'
A
DH OFFICE U' s '�
ai>
D IN ACCORDANCE WITH 1SA NCAC 2C, WELL
ECORD HAS BEEN PRO y OED TO THE WELL OWNER.
441- -N 35aa
1Il D PERSON CONSTRUCTIN HE WELL DATE
Ion t Water Quality. Groundwater Section within 30 days
GW-1 REV. 12/99

North Carolina • Department of En uonmenl and Natural Resources - Division of Water Duality • Groundwater Section
1636 Mali Service Center - Raleigh, N.C. 27699-1636-Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR �D b h/ (S.
WELL CONTRACTOR CERTIFICATION 0: e;O Q
STATE WELL CONSTRUCTION PERMIT#!
268900
1. WELL USE (Check Applicable Boa): Flesidenllal L1a Municipal CIIndustrial n Agricultural El Monitoring ❑
Recovery n Heal Pump Water Infection ❑ • Other n If Other, List Use:
2. WELL LOCATI : (Show sketch of the location below) -
arestTown: 0.�1 rp�Y iF O County. 'buncombe
tjOli A)/2
(Road Name and Numbers. Cpmrnunlly, or Subdivision and Lot No.) DRILLING LOG DEPTH
3. OWNER S'I"Q.VQ- ram -weir
Address 44(42,
D l i ` I
Ashovt 1 Jlreo(or _ oylO o.) Q'R21n3
City or Town-1((((���� #Slllatee Zip Code
4, DATE DRILLED J- to'0t�i•
5. TOTAL DEPTH ;: 1./)
6. CUTTINGS COLLECTED YES f NOIV'f
7. DOES WELL REPLACE EXISTING WELL? YES I I NO
8. STATIC WATER LEVEL Below Top of Casing: L� FT.
(Use'+ II Abovo Top of Casing)
9. TOP OF CASING IS 1 FT Above Land Surface'
•Top of casing terminated et/or below land surface requires a variance in accor-
dance with 15A NCAC 2C .9110 r Vs 10. YIELD (gpm): 30 METHOD OF TEST 4
11. WATER ZONES (depth):
From To Formation Description
P) - S .REI r.QCk.
4
co
CHLORINATION: Type - Zh_Amount W) pt'LLJ
CASING:
co
-.fl
If additional space Is needed use back of form
LOCATION SKETCH
(� Depth it parryy ,f!ejQ$Vg. Maledai ,., (Show direction and distance from at leas) Iwo Stale
From v To Ft to LYL:.�K Roads, or other map reference polnls)
From To Ft.
From To Ft
14. GROUT:
Wall Thickness
Depth Material Method ,
From 0 To A0 Ft �W2b-1E�E iM"I',"Q�f1•l`-
From To FI
15. SCREEN:
Depth Diameter Slot Size Material
Frorn To FI In In
From To Ft In In
From To FI In In
16. SAND/GRAVEL PACK:
Depth Size Material
From To FI
From To Ft.
17. REMARKS:
0
W
'T1
FaA Ca-n es-1-70
Vcx\nAew, NC
W f:
n
0 —
�
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTIOftST7SN Af1DS,- • • ! s •PY OF THIS RECORD HAS BEE ROVIDED TO THE WELL OWNER.
,,I /I".". I /, /// r,
I FOR OFFICE USj Ol9trV-
rad No: . N T J E OF PERSON CONSTRUCTING TIIE WELL • DATE
•' Submit origin* its bIflslon of Water Quality, Groundwater Section within 30 days
Serial No. I'-i ` ;UI GW-I REV. 12/99
1 I
_1 I
t-__

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mall Service Center - Raleigh, N.C. 27699-1636-Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR. ¢1Rimy fl.El "% jves
WELL CONTRACTOR CERTIFICATION 0: /1"90
STATE WELL CONSTRUCTION PERMIT#:
268899
1. WELL USE (Check Applicable 9ox): Residential I" Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ II Other, List Use:
2. WELL LOCATI•pp11: (Show skel h of the location, below) `^
areal Town: Uta-CK cVn4-a%t'l County_ 'buna rnbe
(FI ad Na^^}}qy Lai
3. OWNER Lai
Community, or Subdivision and Lot No.
Address TO ^ ��( y�L. q
dF� er Slree or Via.)
City or Town Stale
4. DATE DRILLED -Cra
5. TOTAL DEPTH Lig 5
6. CUTTINGS COLLECTED YESI I NOV'
7, DOES WELL REPLACE EXISTING WELL? YES
8. STATIC WATER LEVEL Below Top ol Casing: , FT.
(Use'+' II Above Top of Casing)
9. TOP OF CASING IS 1 FT. Above Land Surface'
•Top of casing terminated eUor below land surface requires a variance In accor-
dance wllh 15A NCAC 2C :118
10. YIELD (gpm): 4j METHOD OF TEST rii
11. WATER ZONES (depth):
~G3
q3 -LI46
Zip Code
DEPTH
Formation Description
"ID hit
BeAgb l
O
12. CHLORINATION: Type T ll Amount 7 If additional space Is needed use back of form
1 'ASING: 1
IV
Wall Thickness
SKETCH
Depth Diameter or Weight/FI. Maledal (Show direction and distance from al least two State
From 0 To ‘-1-0 Ft ism DS 41 PYC"SDR Roads, or other map reference points)
From To Ft,
From To Fl.
14.GROUT: Alpine M+n• s)
Depth Material �J�, Method Tt `..
From To QO FI ctr rIjP.7P juakftedi B1a fj Mooviiam ,.1\1C.
From To FI (�l.J'1 �� \ "�.
u
15. SCREEN:
Depth Diameter Slot Size Material
From To Ft In In
From To FI In In
From To Ft. In In
16. SAND/GRAVEL PACK:
Depth Size Material
From To FI
From To FI
17. REMARKS:
uT -
—v
�r
C.J
0
I DO FIEREDY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN �OVVI�DEO TO THE WELL OWWNNER,
FOR OFFICE U'Efl(�LY % -N"Gv" ;J�Dr(Ya•
Quad No: I - URE OF PERSON CONSTRUCTING THE WELL DATE
slon ol Water Quality, Groundwater Section within 30 days
al No.
Submll odg�l
Il
L✓
J
GW-1 REV. 12199
rn
m a
0

North Carolina - Department of Environment and Natural Resources - Division of Whaler Quality - Groundwater Section
1636 Mail Service Center - Raleigh, N.C. 27699-1636-Phone [phone] / q,j s
WELL CONSTRUCTION RECORD WELL CONTRACTOR CERTIFICATIONf pq9
STATE WELL CONSTRUCTION PERMIT#:
268898
1. WELL USE (Chock Applicable Gox): Residential B/1 Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Infection ❑ Other 0 II Other, Llsl Use:
2. WELL LOCATION: (Show sketch of the location below) ("buncombe
Nearest Sown: 6a9�.n v�naa County t
Subdivision and L ,-/ DRILLING LOG DEPTH
(Road Name and Numbers, mmunily, or Subdivision and Lot No.)
1� From To Formation Description
3. OWNER Gl/�^ ���/ r �'� ,,,,y��/�� ��/
Address f3 9thch�n lrC1 D - te ..L), "-
Add ouo o.
flekchCr /_r. 2'73a Ng 5 BF-epck
City or Town State Zip Code
4. DATE DRILLED 3—ii ba
5. TOTAL DEPTH Ja©6 NO��
6. CUTTINGS COLLECTED YES
7. DOES WELL REPLACE EXISTING WELL'? YES I I NORM
8. STATIC WATER LEVEL Below Top of Casing: OK, FT.
' (Use'.' II Abovo Top of Casing)
9. TOP OF CASING IS FT. Abovo Land Surface'
'Top of casing terminated eVor below land surface requires a variance In accor-
dance with 15A NCAC 2C .0118 11/
10. YIELD (gpm): METHOD OF TEST
11. WATER ZONES (depth):
' 2. CHLORINATION: Typo I-17H Amount L r /iS
13. CASING:
NJ
If additional space Is needed use back of form IV
r _
r-r1
LOCATION SKETCH
Wall Thickness
Depth 9lamelar or WeighVFI. d�ateeriajlj� (Slow direction and distance from at least Iwo Slate
From a
To I10 Ft lG_.�- i , l ] 5 �'--"'-" Roads, or other map reference points)
From To Ft rin Glea
./ RC)
•
From To Ft ! ,1(/
�in�rnb CO - �. C . O
14. GROUT: w
Depth - Malarial Moth rn
From D To 20 FI CDhCFde F a
From To FL
15. SCREEN: -13Depth Diameter Slot Size Material _1...FromTo Ft In. In CA
From _.__ To Ft In. In From To Ft. __ In. In. o 0
16. SAND/GRAVEL PACK:
Depth Size Material
From To Ft
From To Ft•
17. REMARKS:
NCAC 2C, WELL
CONSTRUC IOMITANDARDS`WAS
AND TIiATIC({P.:i'P`- TICTE4IORD HAS BER N OVIDN ACCORDANCE WITHA TO THE WELL OWNER.
FOR OFFICE USE ONLY DATE
Quad No: , S TURF O BISON CONSTRUCTING TN WELL
Submit orfptrP Division of Water Quality. Groundwater Section within 30 days gfr
GWi REV. Iv99
serial No. i

North Carolina - Department of Environment and Natural Resources - Division or Water Duality - Groundwater Secllon
1630 Mall Service Center - Raleigh, N.C. 27699-1638-Phone [phone] ,'
WELL CONSTRUCTION RECORD WELL CONTRACTOR- /le RmAN Z - 24-C(.
WELL CONTRACTOR CERTIFICATION 0: c -
268361
STATE WELL CONSTRUCTION PERMITM:
l . WELL USE (Check Applicable Box): Residential I✓f Munlcipel El Industrial I1 Agricultural ❑ Monitoring ❑
Recovery In Heal Pump Water injection [ 1 Other n If Other, List Use:
WELL LOCATION: (Show sketch of the location below)
Nearest Town: Candicr county 'L9 Yl CCii'1'1hP
SCcin e
(Road Herne and Nuntaiss. Commonity. or Subdivision and Lot No.)
3. OWNER -ps iL� m
f, From To Formation Description
Address $S (S leo 0 oue Nrppco.) &Ends'/ fi)rk .
DRILLING LOG DEPTH
Candlev C. a-
V7 � Li - 1i5 J�,'R 4
Clly or Town Slale Zfp Code `v l� 5 4�
1. DATE DRILLED "5-ICI-CSa
TOTAL DEPTH II -Fs
CUTTINGS COLLECTED YES l ] NO(V
. DOES WELL REPLACE EXISTING WELL? YES n NOEvi
. STATIC WATER LEVEL Below Top of Casing: O FT,
(Use -s' II Above Top of Casing)
TOP OF CASING IS ! FT. Above Land Surface'
Top of casing terminated eVor below lend surface requires a varlence In smear -
since wllh 15A NCAC 2C .0118
0. YIELD (gpm)' METHOD OF TEST
1. WATER ZONES (depth):
2 'LORINATION: Type n 7! ! Amount a_ 5 (1S If additional space Is needed use back of form
3. SING:
Wall Thickness LOCATION SKETCH
Depth Dlameler or Weight/FL ;TMaaele`dallra (Show direction and distance from al least two Slate
From 0 To ii FI .1, • a 5 ail .pis P .5D1 Roads, or other map reference points)
From To Ft.
, From To Ft
d. GROUT: U p e r G lad.
s ,, IC! .
Depth Material Method I_ J a��'j
--
From 0 To 020 Ft ODD (C-P.E4'F — Cnvidlcr y I [C w
From To Ft
5. SCREEN: c.?
Depth Diameter Siol Size Materiel o
From To Ft In In --
From To Ft In In
From To Ft In In
6. SAND/GRAVEL PACK:
Depth Size Malerlal
From
From
7. REMARKS:
To Fi
To Ft
0
0
0
I DO HEREDY CERTIFY THAT THIS W, LL
CONSTRUCTION STANDARDS ANDI'
CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
OPY OF THIS RECORD HAS BEEN PRAVIOED TO THE WELL OWNER.
eh-lot-0a
SIGNATURE OF PERSON CONSTRUCTING TiE WELL DATE
ginal to Dlvlslon of Water Quality, Groundwater Secllon within 30 days
OW-1 REV, 12/99

.• W
North Caroline - Dopartmont of Envlronmont and Natural Flesourcee - Division of Water Quality • Groundwater Section 2 6 8 896
1636 Mall Service Center - Ralolph, NV. 27699.1536-Phone [phone] •
WELL CONSTRUCTION RECORD WELLCONTRACTOR• BO ohr 111. Ped4S
WELL CONTRACTOR CERTIFICATION IT:
STATE WELL CONSTRUCTION PERMIT,:
1. WELL USE (Check Applicable Box): Residentially( Municipal ❑ Industrial ❑ Agricultural 1 1 Monitoring El
Recovery ❑ float Pump Water In)ecllon ❑ Other [J 11 Other -ells' Use:
2. WELL LOCAT •N: S tow�/c�ketch of the location below)
Nearest Town: • 1 /vl — County' 2"v, (-to artj, U'C
(Bond Name d Numbare, Cornmunll�y�(./fiq�r Subdivision and Lot No.) DRILLING LOG DEPTH
Ca^M_ /IAQvr, rq� 1
Address l 1 `a. 6n �-y, (of_ a
1 ( reo or ouT No:'. o� a 7 i
ec1 �t�k�- (;
City or own Stale Zip Coda
4. DATE DRILLED 3- 14 -O a-
5. TOTAL DEPTH S l� S -
6. CUTTINGS COLLECTED YES1 1 NO vr
7. DOES WELL REPLACE EXISTING WELL? YES O NO[t�
6. STATIC WATER LEVEL Below Top of Casing: �(,D FT,
(Use •.• I1 Abovo Top of Casing)
9. TOP OF CASING IS 1 FT Abovo Land Surface'
•lop of ce 1 ing ter mineted sUor below land surface requires a variance In 'moor-
dence with ISA NCAC 2C .9118 s
10. YIELD (gpm): I0 METHOD OF TEST RI C
11. WATER ZONES (dopth):
3. OWNER3
From
17. REMARKS:
•
From To
Farm/Won ()ascription
-
girt - 5 F.d.
i'-ILORINATION: Type HAmount nS
13. CASING:
0
If additional space Is needed use hack of loan
,v
Wall Thickness LOCATION SKETCH
Depth 7 P1a1 lof jj tilo(IUV. �1M,cnle{dap�l,, (Show direction and distance from nt least Iwo Stale
From To I. 0 aj I-�- Roads, or other map rolorence points)
From To PI
From To Ft
14. GROUT:
Depth MalLorIlol Mol_ liod ,
From d ToDe M� .FI �n�G7E j1i)u tc
From To FI
15.SCREEN:
Dopllt Diameter Slot Size Material
From To Ft In In
From To FI In In
From To Ft In In
16. SAND/GRAVEL PACK:
Depth Size Material
From To FI
To Ft
Macci
uD
I DO HERED ;¢ f\TIFY THATTIIISW,ELL
CONSTRUC lunti$JANDARDS, AND TI IAT A
A OFFICE
Cued No:
TRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
F THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
III 1 ✓'P'1 �/ r Pr3 - E `j — d
SIGNATURE OF P flSON CONSTRUCTING TIIE WELL
DATE
541mrl(Sglnal 1 DIYi,Ion of Water Ovellly, Oroundwaler Section Wilhln 30 days
GWI REV. 12/99

North Carolina • Department of Environment and Natural Resources - Division of Water Quality • Groundwater Section
1636 Mall Service Censer - Raleigh, N.C. 27699-1636-Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR•
268894
�R)F}N 1LEl% %.ONES
WELL CONTRACTOR CERTIFICATION M: /1740
STATE WELL CONSTRUCTION PERMITM:
1. WELL USE (Check Applicable Box): Residential Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCA
rest Town
(Show ske c 1 of the location below) ^
County' nccTm
ck M-I-Ai. Y1C
(Road Name and,Number Community, or Subdivision and Lot No.) ,ems` DRILLING LOG DEPTH
3. OWNER II114- & aI-ia Mart n- CUte* - From To Formation Description
r
Address 1 i'a "�re.vn
Asheville (S.
inai or �g fM1jo.)d.
a c*
City or Town Slate Zip Code Yf
5. TOTA DRILLED c�=LcB
5. TOTAL DEPTH
6. CUTTINGS COLLECTED YESI NOISY 0
7. DOES WELL REPLACE EXISTING WELL? YES I NOI
8. STATIC WATER LEVEL Below Top of Casing: 40 FT.
(Use '.' II Above Top of Casing)
9. TOP OF CASING ISFT. Above Land Surface'
•Top of casing terminated .Vor below land surface requires a variance In accor-
dance with 15A NCAC 2C .0118
10. YIELD (gpm): Thn METHOD OF TEST ti) q
11. WATER ZONES (depth)'
147 � atlg Vag! l�fae$
N
IV
�y c,'I
12. CHLORINATION: Type WTl( Amount 8 If additional space Is needed use back of form
1 'ASING: - - -
Wall Thickness LOCATION SKETCH
Depth Diameter or WeighvFI. Material (Show direction and distance from at least two State
From 0 To IC Ft L. Z5 QIi , 145 PYC-Spfj Roads, or other map reference points)
From To Ft
From To Ft
14. GROUT: Depth Material 1 Method Sevy�e ( GI ens o
From 0 To QCI Ft <tintclr PI Pre its ai M� v1l
From To Fl 'black I" U a 1 1 0A
15.SCREEN:
Depth Diameter Slot Size Material
Frorn To Ft In in.
From To FI In In
From To Ft In In
16. SAND/GRAVEL PACK:
Depth Size Material
From To Ft
From To FI
17. REMARKS:
I DO FIEREOY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C. WELL
CONSTRUCTION STANDARDS AND THAT,9 PY COOF T
,
FOR OFFICE USA O1�1I_Y
Quad No: S tfNA
Submllodglnac D
al No.
IS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
-il4;na-
RE OF PERSON CONSTRUCTING THE WELL DATE
on of Water Quality, Groundwater Section within 30 days
Oa
GW.l REV. 12/99

North Carolina - Dapartmenl of Environment and Natural Resources - Division of Water Duality - Groundwater Section
1636 Mall Service Center • Raleigh, N.C. 27699-1636-Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR. /1N RmAg L •
WELL CONTRACTOR CERTIFICATION N: cD0
268890
STATE WELL CONSTRUCTION PERMITN:
1. WELL USE (Check Appuc.bi. Box): Residential I✓I Municipal ❑ Industrial n Agricultural ❑ Monitoring ❑
Recovery D Heat Pump Water Infection ❑ Other ❑ if Other, List Use:
2. WELL LOCATION: (Show sketch of the location below)
N aresl Town: e eV 1 Courky' on COm be
(Roaame/ and Numbers.-I-Corwnnunlly, or Subdivision andL,LLol No.)
Y DRILLING LOG DEPTH
3. OWNER 4�andev EdWcrrd5 Ente p se i.L.c From To Formation Description
Address -pp iony 0a)
IS reo M13
Of oue o.J
WQ(\YeYVjIL? [�(c
City or Town Stale
DATE DRILLED -o"alc- (YD.
TOTAL DEPTH ag rJ
CUTTINGS COLLECTED YES ( I N04
DOES WELL REPLACE EXISTING WELL? YES I 1 NO171
STATIC WATER LEVEL Below Top of Casing: q O FT.
/ (Use'+' it Above Top of Casing)
). TOP OF CASING IS ( FT. Above Land Surface'
Top of casing terminated aUor below lend surface requires a variance In actor -
lance with 15A NCAC 2C,0118 j)
0. YIELD (gpm): _sna METHOD OF TEST f 1
I. WATER ZONES (depth):
2. ^LILORINATION: Type Ii 7H Amount 1i% NHS
914 2,15
D - 94 1):R
E-ri te4C Jc
3 SING:
7 n 1
Zip Code
Wall Thickness
Depth Dlameler or Weight/Ft. ;TM'`O
a�ledall
From�To�—FI.]a �a5 e7h .i;.5. CAL
From To Ft.
From To FI
4. GROUT:
Dept. Matorlai'�C�-E Molhod ,
From D To pi. FI �17/i'E d._
From To FI
5. SCREEN:
Depth Diameter Slot Size Material
From To FI In In
From To FI In In
From To FI In In
6. SAND/GRAVEL PACK:
From
From
17, REMARKS:
Depth
To
To
Size
FI
FI
Material
II additional space Is needed use back of form
LOCATION SKETCH
(Show direction and distance from al least Iwo Stale
Roads, or other map reference points)
5he -vrts branch
Vsko,vQlrV%IIe , N1C
co
I DO HEREBYrreERT1FYTT#AT-TFII8 WELL WAw
CONSTRUCTIQN.ATANDARDs, ANIS THAT Ac
F OFFICE BSc/NLY
I No:
Submit or!
TRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
F THIS RECORD HAS BEEN 13 OVIDED TO THE WELL OWNER.
Gam--��o o a
is s ATUnE OF PERSON CONSTRUCTING THE WELL DATE
o '(vision of Water Ouallly, Groundwater Section wllllln 30 clays
GW-1 REV. 12/99
Ca
0
UT

North Caroline - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mall Service Center - Raleigh, N.C. 27699.1636-Phone [phone]
268889
WELL CONSTRUCTION RECORD WELL CONTRACTOR'
BD bhr (f. QO'i-+S
WELL CONTRACTOR CERTIFICATION 0: J e;O. g
STATE WELL CONSTRUCTION PERMIT.:
1. WELL USE (Check Applicable Box): FlesldentialMunicipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heal Pump Water Injection ❑ Other ❑ II Other, List Use:
2. WELL LOCATION: (Show sketch of the location below) (,, ,,
rest Town: ) x nn• County: at'mbe.
ua,c.J ,° l�iAacik'_114-N. Y'1 C .
(Hoed Name and Numbers, Community. or Subdivision and Lot No.)
3. OWNER in-}rpn-Cif Jr� &I/ dfrkirt-i
Address 1ha greoc- Q,,.) -
( Ireo or ou a No.)
A� 2eVt7her nc.
City or Town Stale
4. DATE DRILLED ,S-a4419A
5. TOTAL DEPTH WIS
6. CUTTINGS COLLECTED YES [" NO ✓T
7. DOES WELL REPLACE EXISTING WELL? YES I I NOM
8. STATIC WATER LEVEL Below Top of Casing: 40 FT.
(Use 'i II Above Top of Casing)
9. TOP OF CASING IS I FT. Abovo Land Surface'
'Top of casing terminated etror below land surface requires s variance In accor-
dance with 15A NCAC 2C.9110
10. YIELD (gpm): C METHOD OF TEST TS1 4
11. WATER ZONES (depth):
19. CHLORINATION: Type ___—Amount y
CASING:
Zip Code
DRILLING LOG
From To
D -
DEPTH
Formation Description
r,
cr
LT c
If additional space Is needed use back of form
Wall Thickness LOCATION SKETCH
Depth piameleT ji)Nejuhhv i. ;�` iaalerlaal ..� (Show direction end distance from al leas) Iwo Slate
From To�—° FI (p � (e SK Roads, or other map reference polnls)
From To Ft.
From To Ft
14. GROUT:
IIee�� Tep ll-l� n ``M//la1torlal Method ,
From U To �-Q_Ft arvcifc � UKfd
From To FI
15. SCREEN:
Depth Diameter Slot Size Materiel
From To FI In in
From To Ft In In
From To Ft. In In
16. SAND/GRAVEL PACK:
Depth Size Material
From To Ft
From To FI
17. REMARKS:
Serer 1lei25
131x1 mv-/).
n.c.
rrl
rn
0
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUr,TI0N STANDARDS, E THI$ RECORD HAS BEEN PR VIDEO TO THE WELL OWNER.
zoo
Submit olitlinpl
NATURE OF PERSON CONSTRUCTING TIIE WELL DATE
Division of Water (Duality: Groundwater Section within 30 days
GW-1 REV. 12/99

North Caroline • Department of Environment and Natural Resources - Division of Water (Duality • Groundwater Section 2 6 8 8 8 8
1636 Mall Service Center - Raleigh, N.C. 27699-1636-Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR.
�c bhf� (Lj. PO*k
WELL CONTRACTOR CERTIFICATION 0: 0a 2
STATE WELL CONSTRUCTION PERMIT":
1. WELL USE (Check Applicable Box): ResidentialLto Municipal El Industrial n Agricultural ❑ Monitoring ❑
Recovery n Heat Pump Water Injection ❑ Other Ej If Other, List Use:
2. WELL LOCATIQN: Show sketch of the location below)
Nearest Town: County'
rr-ee7mbe
(Road cue. .) 70y
(Road Name and Numbers. Co unity, or Subdly sion and Lot No.)
3. OWNER b):]re/a7P/�
Address pc %%©X l /
4r eh Slreallor l.G. o.
City or Town State
4. DATE DRILLED -3-27'0a
5. TOTAL DEPTH Wig
6. CUTTINGS COLLECTED YES I I NO 4
7. DOES WELL REPLACE EXISTING WELL? YES I 1 NOI 4
6. STATIC WATER LEVEL Below Top of Casing: % FT.
(Use'd II Above Top of Casino)
9. TOP OF CASING IS I FT. Above Land Surface'
•Top of casing terminated at/or below land surface requires a variance In accor-
dance wllh ISA NCAC 2C .QQ116 s
10. YIELD (gpm): . 8 METHOD OF TEST q
11. WATER ZONES (depth)- )
zip nCode
DRILLING LOG
From To
DEPTH
Formation Description
CO
rV
r
19. CHLORINATION: Type Z� Amount If additional space Is needed use back of form
CASING:
Wall Thickness LOCATION SKETCH
Depth be" El
jrwe(ghV . Ma�V� dal (Show direction end distance from at least Iwo State
From Ali. To FI (p (e C Roads, or other map reference points)
From To FI I
From To FI erect/ Jn P f e.
14. GROUT:
J
Depth Material MoIMU 12
From a To AO Ft &RP frig
d
From To Ft.
15. SCREEN:
Depth Diameter Slot Size Material
Frorn To Ft In In
From To FI In In
From To FI In In
16. SAND/GRAVEL PACK:
Depth Slze Malarial
Frorn To Ft
From To Ft
17. REMARKS:
I DO HEREDY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION-ST ^• a a er - w {I R CORD HAS BEEN PR!VIDEO TO THE WELL OWNER.
I FOR OFFICE US
•uad No:
Serial No.
RE 0 ERSON CONSTRUCTING TICE WELL DATE
on of Water Quality, Groundwater Section within 30 days
GW-I REV. I2199

North enrolInn • Onperimont of Environment and Natural Resources - Division of Wnler Quality • Groundwater Section
1630 Mall Service Center • Relolph, N.C. 27699-1638-Phone [phone]
268887
WELL CONSTRUCTION RECORD WELLCONTFlACTOR•
WELL CONTRACTOR CERTNFICATION 0:
0 6h14 llj. t'o��S
,-Roag
STATE WELL CONSTRUCTION PERMITS:
1. WELL USE (Check Applicable Box): Flesldenllall vi Municipal ❑ Industrial 0 Agricultural (] Monitoring n
Rocovery ❑ I-loal Pump Water In(ecllon ❑ Other EJ If Othor, List Use:
2. WELL LOCATION: (Show sk
Nearest Town:_
LIS lb
Icli of the location below)
2 P v County.LLYL Cis net
Moen Name aQ9.[Jube . Cormmr r5�division Lot
� V�m
3OW
NER
.
Address
Quad No:
Serial No.
?CAA
/ (shot or
Q eion.11.er
Clly or Town ^^ }Stale
AO
. DATE DRILLED — , a-U -a"
5. TOTAL DEPTH 3 D 5
6. CUTTINGS COLLECTED YES I NO vr
7. DOES WELL REPLACE EXISTING WELL? YES Q NOI vi
B. STATIC WATER LEVEL Below Top of Casing: FT.
(Use'.' 11 Above Top of Casing)
9. TOP OF CASING IS 1 FT. Abovo Land Surface'
•Top of cm sing terminated Oar below land surlses requires A variance In eccor-
dence with ISA NCAC 2C.QIil s
10. YIELD (gpm): _ S 0 METHOD OF TEST
11. WATER ZONES (depth):
DRILLING LOG
DEPTH
From To Fomrneon Onscdplion
el+oA Rd0 - a3
a - 3 D S—3Fd_►z��k.
1. ILORINATION: Type I,____Amounl. S
13. CASING:
0
�J
lit
If additional space Is needed use back of Iorrn
LOCATION SKETCH
/� j� Wall
Thickness
From l� Dep111To ^' PI. (phm Iticu ale Uj� Ma�� _.� (Show direction and distance from nt least Iwo Slate
r Rends, or olher map reference points)
From To FI.
From To
14, GROUT:
From a
FL
Depth Malarial
To .2112__FI anieEfg
From To FI
15. SCREEN:
Method
/
Depth Diameter Slot Size Material
From To Ft In In
From To Ft In In
From To Ft In In
16. SANDIGRAVELPACK:
Depth Size Maletlal
From ' To Fl
From To Ft
17. REMARKS:
I DO HEREBY C
CONSTRUCTI0
R OFFICE US3')IfILY
L.
0
(a
IN
RDANCE
L
T/T7I171cROS',!AMDTIAYJAC^1('Y61rTr1ff10Dtins
BEEN RIOT[LLOVINER��
DATE
Qt/51URE OF PE SON CONSTRUCTING 711E WELL
Submit odelni ldston of Wnler Quelily, Groundwater Section within 30 days
OW.1 REV. 12r99

268843
North CRroflna • Department of Environment and Natural Fleeourcos - Dlvislon of Water Quality • Groundwater Section
1636 Malt Service Cenlor - flafaloh, N.C. 27699-1638-Phone [phone] •
WELL CONSTRUCTION RECORD WELLCONTRACTOR• & bhr' its. PO +
WELL CONTRACTOR CERTIFICATION 1: CJ,7 Q
STATE WELL CONSTRUCTION PERMIT":
WELL USE (Check Applicable Box): ResidentialLrd Municipal ❑ Industrial El Agricultural El Monitoring ❑
Recovery ri Heal Pump Water Infection El Other D If Other, List Use:
2. WELL LOCAT
N3aresl Town:
\-A)t lfi01 4)
(Flaked Nartyrfl(td N
3. OWNER
Address
0
A.... D
? { ,, M./hi/ti. )2173 6
n, Community, or SubdlvIdon nnj'Lpl No.) DRILLING LOG
(Shpw skelph of the location below)
/YU_4 �„ J Gr�''L O1,J From To
, S eo or o.)
Clly or Town Stale Zip Code
5. DATE DRILLED - 02.
5. TOTAL DEPTH O.r1
6. CUTTINGS COLLECTED YES I I NOIvf
7. DOES WELL REPLACE EXISTING WELL? YES NO
B. STATIC WATER LEVEL Below Top of Casing: FT.
(Use ••• II Above Top of Cnsing)
9. TOP OF CASING IS I FT. Above Land Surface'
'Top of casing terminated slior below land surface requires a variance In accor-
dance wllh 15A "CAC 2C .9116
10. YIELD (gpm): 3 METHOD OF TEST
11. WATER ZONES (depth):
•
1- sFILORINATION: Type
13. CASING:
vf
DEPTH
Formation Oascription
- 3S1•(o5 td��sk
r._
0
C
1
\ T k Amount 7 f t ll s
I'3
If additional space Is needed use hack of form
IV
Wall Thickness LOCATION SKETCH
(� Dangle.) pinmole r e a tlVfr�. Mal'e<rt 7all p (Show direction and distance from nt least Iwo Stale
From _YL_—To )C(--) FL W''' r�PJ -�-✓�` Roods, or other map reference points)
From To FI.
From To FI.
14. GROUT:
Depth Malarial
From 0 To AO FI arug
Frorn To
15. SCREEN:
FI
Method K�
Depth
From To FI
From To Ft
From To Ft
16. SAND/GRAVEL PACK:
Depth
From ' To
From To
17. REMARKS: ''''``������ ,p
I DO HEREBY C�F�jIF f TF T T rNS WEgy W'S C -RUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTID �NDARD6, AND-IIT 1-7.1171 Y ° TFIIS RECORD HAS BEEN Pr�-VIDED TO TIIE WELL OWNER.
UR OFFICE t SE4NLYMA
I
Diameter Slot Size Malorlol
In In.
In In
In. In
Size Material
FI
Ft
(Lally.,
- an,
C ,
Chad No:
Serial No.
Submit on
L E.ELT1UN
ASHEVILLE REuiOItAL OFFICE
nal to
IATUBE OF P R50N CONSTRUCTING T11E WELL
Dlvislon of Weller °uglily, Groundwater Section wIthln 30 days
DATE
GW•1 I1EV. 12/99

North Carolina - Department of Environment and Natural Resources - Division of Water Quality • Groundwater Section (�
1639 Mall Service Censer - Raleigh, N.C. 27699-1636-Phone [phone] 0
WELL CONSTRUCTION RECORD WELL CONTRACTOR. HeRmAN Z. -3,4 •
WELL CONTRACTOR CERTIFICATION ": 4-70A
STATE WELL CONSTRUCTION PERMIT":
1 . WELL USE (ch.ck Applicable Boa): Residential ✓I.- Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ri Heal Pump Water Injection I—] Other O II Other, List Use:
2. WELL LOCATIO : (Snow skeicit of the location below) !y
Nearest Town: W�-NICK VI tit County lb 0 Y>_Cc'1'nbQ
_C a C
(naed Nameje�n1,d, Numbers. Canvnanny, or Subdivision and Lot No.) DRILLING LOG DEPTH
3. OWNER C ` 1i \ I l Y 4- ram Z From To Formation Description
Address ra .0 �'}O()--d /-,anP
Sheol or ou e 0 - at
V'feaYerv�� ac1t1 a� - atia
City or Town Stale Zip Code
1. DATE DRILLED oa-Co-flQ -
S. TOTAL DEPTH '�?o i-10
3. CUTTINGS COLLECTED YES Pi NO[4
DOES WELL REPLACE EXISTING WELL? YES D NOY(
3. STATIC WATER LEVEL Below Top of Casing: G.) FT-
/ (Use Y' II Above Top of Casing)
3. TOP OF CASING IS ! FT. Above Land Surface'
Top of casing terminated aUor below land surface requiro a variance In accor-
tance with 15A "CAC 2C.Oile
0. YIELD (gpm)' I O METHOD OF TEST
I. WATER ZONES (depth):
2 'LORINATION: Type H 71-1
3. SING:
1ir'R
Amount I 1 IiS II additional space Is needed use back of form
Wall Thickness LOCATION SKETCH
Depth Diameter or W Vitr I. Material (Show direction and distance from al least Iwo Slate
From .O To al FI 1e • a 5 �1--` c�• Roods, or other map reference points)
From To FI.
From To FI -�- �4�
4. GROUT: Qvi..9 bird €5.-a-"`r•I�
ES
From
Depth Material Method
, \Ai 'Q0.v e\A `Q i IV C. p
Q To v�. 0 Ft l'nlY C�.Ef E ,�'T^,�'r',rp'>y-`,"�'- v V -�
From To Ft
5. SCREEN: "zzz --
Dopth Diameter Slot Size Material W
r--, a
From To Ft In In p
From To Ft In In to 5
From To Ft In In
6. SAND/GRAVEL PACK:
Depth Size Material
From To FI
From To FI
7. REMARKS:
I DO IE,flt10t CERTIFY -THAT THIS WEIl{y'
CON STRI11bIdt�LSIA&BARDS, ANC TIIT
r 0 micE USE ONLY
Serial Nb.
S CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
FOPY 0 • THIS RECORD HAS BEEN P VIDEO TO THE WELL OWNER.
ubmll
_.J
Iry
SIGNATURE OF PERSON CONSTRUCTING TIIE WELL DATE
sdglnal to Division of Weber Quality, Groundwater Section wllllln 30 days
OW•l nEv. 12/99

North Carolina - Doperlmenl of Environment and Nnlurnl Resources - Division of Water Quality • Oroundwntnr Section
1630 Melt Service Center - Raleigh, N.C. 27699.1638-Phone (919) 733•3221 rr ((��
WELL CONSTRUCTION RECORD WELLCONTFlACTOn. �P /Dhrj IAJ. R1/414-s
WELL CONTRACTOR CERTIFICATION
STATE WELL CONSTRUCTION PERMIT":
268839
1. WELL USE (Check Applicable Box)Residentiat!I Municipal [I Industrial 0 Agricultural ❑ Monitoring ❑
Recovery r1 Neat Pump Water Injection ❑ Other If Other, List Use:
2. WELL LOCATIO : (Showelcll pf 1 to location below)
artist Town: �/� s County:
A6 �.
(non
3. OWNER
Address opt O DunaLuitn:
• I I 'Jrre of u10 ):1n7
atItnr—
Clly or Tovn Slate Zip Code
5. DATE DRILLED_, •aa, o� a. TOTAL DEPTH _�� �- 6. CUTTINGS COLLECTED YES f NO[If
7. DOES WELL REPLACE EXISTING WELL? YES n NOM
6. STATIC WATER LEVEL 0elow Top of Casing: 75 FT.
(Use'.' 11 Above Top of Casing)
9. TOP OF CASING IS 1 FT. Above Land Surlace'
'Top of casino terminated eVor below lend surface requires a variance In sccor•
dance with ISA NCAC ZC .411E s
10. YIELD (gpm): t METHOD OF TEST fib
11. WATER ZONES (doplh):
1_ FILORINATION: Typo T N Amount r
13. CASING:
p Wall Thickness
f^I,
(i Depth hjD lull'' I .ills,�odVJ MaLY5�2.11iC.
From v To PI,
From To FI
From To Ft.
14. GROUT:
Depth Malarial
From d To FI
From To Ft
15. SCREEN:
DEPTH
Formation Description
(.
co
s
J
iV
Iv
If additional space Is needed use hack of corm
LOCATION SKETCH
(show direction end distance Iron nl least two Stale
Bonds, or other trap reference points)
nti-
Mot%""` " 7'1 C
Depth Diameter Slot Size Material
From To FI In In
From To Ft In In
From To Ft In In
16. SAND/GRAVEL PACK:
From
From
17. REMARKS:
I DO HERESY CE T T,EtAT(THISIWEµL WI;A+S po CTED IN ACCORDANCE WITH 1SA NCAC 2C, WELL
CONSTRUCTION T DARDS'AND MAT A Copy IIS ECORD HAS BEEN PROVIDED TO THE WELL OWNER.
Depth
To
To
Size
FI
FI
Material
JR OFFICE US
Cued No:
u it
F1
L
S I1E ERSO N CONS.'RUC71N0 ItE WELL DATE
OF/1•'
Submit odpina to Dlvl Ion of Water Quality, Oroundwaler Section Within 30 days
oaJ
Serial No.
GW•I nEV. 12/99

North Caro:Inn • Department or Environment and Natural Resource, - Division or Water Quality • GroUndwnlnr Soctlon 2 6 8 8 4 9
1636 Mall Service Center - Raleigh, N.C. 27699-1636-Phone (919) 733•3221
•
WELL CONSTRUCTION RECORD WELLCONTRACTOR• �D bi'1r, Cif. Pof)-5
WELL CONTRACTOR CERTIFICATION
STATE WELL CONSTRUCTION PERMIT":
1. WELL USE (Check Applicable Box): ResidentialF7 Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery r1 Float Pump Water Injection ❑ Other If Other, List Use:
2. WELL LOCATIO
frost T wn•
6B a
(hoe Nameme
n ,jlu^S.
3. OWNER 1.1/\IJ�.X
hoy+ sketch of the location below
)
County Uyy4-(11/4,
Jht��(75i
Col fly or Subdivision end Lol N )
s eoTrto�
Stale
4. TOTA DRILLED _�`LQ' �' d.
5. TOTAL DEPTN
6. CUTTINGS COLLECTED YES n NOf V{
7. DOES WELL REPLACE EXISTING WELL? YES n NO
8. STATIC WATER LEVEL Below Top of Cnsing: .37:2_t_ FT.
(Use •.• II Abovo Top of Casing)
9. TOP OF CASING IS 1 FT Above Land Surface'
•Top of casing terminated el/or below land surface requires a valance In accor-
dance wllh ISA NCAC 2C..1258
10. YIELD (gpm): /yam METHOD OF TEST RI C
11. WATER ZONES (dopth):
Address
Clly or Town
A Zip
Coda
4
DRILLING LOG
From To
Se
,FILORINATION: Typo ? •T N Amount 7i7 i (1S
13. CASING:
aWall Thickness
Depth DlamelJ jrilaeleyg Iaedli
From_ �-
To S c FI. r°
From To PI
From To Ft.
14. GROUT:
Depth Malorlal Mnlim
From 0 To �_�FI a�E4E�ul:�d.
From To Ft
15. SCREEN:
From
From
From
Depth
To
To
To
16. SAND/GRAVEL PACK:
Depth
Frorn To
From To
Ft
FI
Ft
Diameter Slot Size Materiel
In
In
In
Material
In.
In
In
Size
FI
FI
DEPTH
Formation Dnscrlpllon
Pa -
•
c
If additional space Is needed use hack of form
LOCATION SKETCH
(Show dlrecllon and distance from nt least Iwo State
Roads, or other map reference points)
&M4thLt c»ip
w
O
w
c
17. REMARKS:
11 �, a
I DO HEREBY C f T)FY:r##iAT-THIS.WELLWAS,C UCTED IN ACCORDANCE WITH 15A NCAC 2C. WELL
CONSTRUOTIO8-1AITDARDS, AND T1 EATA GCMI O'—HISRECORD HAS BEEN PROVIDED TO THE WELL OWNEn.
I I
Uf1E OPERSON CONSTIIUCTINO TIIE WELL
khan of Water Mealy, Groundwater Section Within 30 days
DATE
GW.I nEV. 12/99

Vorth Carolina - Department of Environment and Natural Resource, - Division of Water Quality - Groundwater Section PP c ry
1636 Mall Service Center • Raleigh, N.C. 27699-1636-Phone [phone] �//_' -f
WELL CONSTRUCTION RECORD WELL CONTRACTOR. N RMAN L • 2/9-.
WELL CONTRACTOR CERTIFICATION #: cC.s
STATE WELL CONSTRUCTION PERMITN:
WELL USE (Check Applicable Box): Residential la- Municipal El Industrial LI Agricultural ❑ Monitoring ❑
Recovery El Heat Pump Water injection ❑ Other 0 If Other, List Use:
WELL LOCATIO (Show sketch o the location below)
Nearest Town: JU�'c Count'•
(nee
1. OWNER
Address
Clly or Town Slate
DATE DRILLED
TOTAL DEPTH
CUTTINGS COLLECTED YES I NO17 j
DOES WELL REPLACE EXISTING WELL? YES I� NOM' 'a
STATIC WATER LEVEL Below Top of Casing: � �uf�� FT.
/ (Use'+' it Above Top of Casing)
TOP OF CASING IS ! FT. Above Land Surface'
rn.
fop of casing terminated aUor below lend surface requires a variance In actor-
sncewith ISANCAC 2C.0Ij4 IV r"
(f m,_
0. YIELD (gpm): .'—_ METHOD OF TEST _ .�- _'
I. WATER ZONES (depth): c- c
fto —1 _
/p�- 3S`j $&4tgrk
DEPTH
Formallon Description
0
2. .LORINATION: Type n Amount 105 Jilin If additional space Is needed use back of form
3. CASING:
Wall Thickness LOCATION SKETCH
Depth 1,... Diameter or Wright/Ft. Material (Show direction and distance from al leas( Iwo Stale
From O To `- 7 FI. 1, • a 5 4414 .1,5PRoads, or other map reference points) CO
0 �-�
From To Ft. ///rci
From To FI
ri. GROUT:
Depth Material Method
From b To aP__—FI CDNC$_fri'!` d._ ,.�
From To FI O� 5W f
5. SCREEN:
Depth Diameter Slot Size) Materiel
From To Ft In In
From To Ft In In
From To Ft In In
6. SANG/GRAVEL PACK:
From
From
7. REMARKS:
Depth
To
To
Size Material
FI
FI
w
CO
I DO I IEREDY ' ER1Fj"TH.T THIS WELT. WAS'C
CONSTRUCTIa(y /uYDLfibS.AND_T)1AT ACO
1-- rt OFFICE U I' (!1NI v I
Ouad No:
Serial No.
e
Submit orio nal to
TUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
de t, o ff
TUBE OF PERSON CONSTRUCTING TIIE WELL DATE
vision of Water Duality. Groundwater Section within 30 days
GW-I REV. 12/99

268922
North Carolina • Department of Environment and Natural Resources - Dlvlelon of Water Quality - Groundwater Section
1636 Mall Service Cantor - Ralelgh, N.C. 27699-1636-Phone [phone]
WELL CONSTRUCTION RECORD WELLCONTRACTOR'
30 b h4 uf. Rf%s
WELL CONTRACTOR CERTIFICATION N:
STATE WELL CONSTRUCTION PERMIT":
1. WELL USE (Check
Recovery ri
2. WELL LOCATIO
Noareal T
(noed Name
3. OWNER
Address
Applicable Box): Residential [2t Municipal ❑ Industrial ❑ Agricultural ❑ monitoring ❑
Boat Pump Water InJecllon ❑ Other it Other, List Use:
(Show skeicll of the location below)
County
Numbers. Cos ally, or Subdivision
Clly or Town Slate Zip Code
4. DATE DRILLED a• 4_0a,
5. TOTAL DEPTH 3bC
6. CUTTINGS COLLECTED YES I ( NO( 4
7. DOES WELL REPLACE EXISTING WELL? YES ( NO 4
6. STATIC WATER LEVEL Below Top of Casing: J b b FT.
(Use we II Above Top of Casino)
9. TOP OF CASING IS I FT. Above Land Surface'
•Top of casing terminated sVor below lend surface requires a variance In accor-
dance wllh ISA NCAC 2C.9t1e k
ID. YIELD (gpm): ) A) METHOD OF TEST r CI
11. WATER ZONES (depth):
1�..:HLORINATION: Typo . H T Amounts tls
13. CASING:
DRILLING LOG
Wall lTThickness
From
�DToill-ell Ft �la•�l , Ibr�adV.� Mt�VC-SDR
From To FI.
From To Ft.
14. GROUT:
beplh Materiel Method r
Frorn � To.�_i�Ft aIIR-�uK�.
From
15. SCREEN:
To Ft
Depth
From To
From To
From To
16. SAND/GRAVEL PACK:
Depth
Frorn To
From
17. REMARKS:
1 DO NERCO
GONSTRUC
I, OR OFFICE
Ovad Na:
Serial No.
To
Diameter Slot Size
Ft In.
Ft In
Ft In
Size
Ft
Ft
In
In
In
Materlal
Matorlal
DEPTH
Formation On scdpllon
o
a
If additional space Is needed use hack of form
LOCATION SKETCH
(Show direction and distance born nt least Iwo Stale
Roads, or other map reference point:)
eed
SLuo
0
w
CO
—0
W
0
w
c
C)
0
CE¢1TIFY THAT THIS WELL WA C
IpN SrtANDARDS, AND TI IAT A jpe
ELONLY
TRUCTED IN ACCORDANCE WITH ISA NCAC 2C. WELL
F THIS RECORD HAS BEEN PLTOVIpED TO THE WELL OWNER.
SIONATLRE OF PERSON CONSTRUCTING TIIE WELL DATE
Submit ooi glnat to Division of Weiler Duality, Groundwater Section within 30 days
J
GW-t FtEV. 12/99

North Caroline - Department of Environment end Nnlurnl Resource, - Division of Water Quality - Groundwater Section 2 6 8 9 1 9
1630 Melt Service Center - Raleigh. N.C. 27699.1638-Phone [phone] (�
WELL CONSTRUCTION RECORD WELLCONTRACTOR• Bo 6h/i US.Poi--S
WELL CONTRACTOR CERTIFICATION 0: , (7 5
STATE WELL CONSTRUCTION PERMIT,:
1. WELL USE (Check Applicable Boa): Residential IX Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other I( Other, List Use:
2. WELL LOCATIOf :: (Show sketch l',I1he location below) �ny �� '
X P County' y we -
K t -N q CAC % lake_
%¢u�L7e N(2&}V/
( on Name �nd1Number e, Cot
3. OWNER
Address
Nearest Town:
u _
Q Clly or Town ccc777 Slalo
A. DATE DRILLED — -0
5. TOTAL DEPTH W
6. CUTTINGS COLLECTED YES I I NO( vi
7. DOES WELL REPLACE EXISTING WELL? YES n NOR( _s
8. STATIC WATER LEVEL Below Top of Casing: rig FT. N
(Use'.' If Above Top of Casing)
9. TOP OF CASING IS I FT. Above Land Surlace'
Ity, or Subd Islon end I of No.) DRILLING LOG
DEPTH
From To Formalton onscrlpaon
Zip Cod
-Top of using terminated •Var belowland surface requires m variance In accor-
dancewllh 15A ,CAC 2C. 118
10. YIELD (gpm): METHOD OF TEST
11. WATER ZONES (depth):
1 IILORINATION: Type 7 H Amount 14 h r(<<
13. CASING:
Wall Thickness
FromDep— Toiltn» It
PIa11al )h'e1v[J Mf VL-SD�Z
From To / FI (� �5C (��n e j
From To It.
14. GROUT:
Depth Material Mol_ IroJ ,
From �i ToDe th FI CORP El F Jj�h__(T`"J?"f"i{`
Frorn To It
15. SCREEN:
Depth Diameter Slot Size Material
From To F1 In In
From To FI In In
From To FI In In
16. SAND/GRAVEL PACK:
Depth Size Material
From To FI
From To FI
17. REMARKS:
N
II additional space Is needed use hack of form
LOCATION SKETCH
(Slow direction and distance from nt least Iwo State
Bonds, or other map reference points)
&/L/4 Seal
DO
I NSTf1UCTl t ShNOARDS,AND IA IA IS WELL n St
COf6l Cjl)THIS RECORD HAS BEEN FP OVIDED TO THE WELL OWNER.
I
,R OFFICE U'-. sNLY II'
Quad No: kJ L Ib1el ATURECe PERSON CONSTf1UCTINO TIIE WELL DATE
Submit odglrjal la ID l Aslon of Wain Overby, Groundwater Section within 30 days
Sedal No. -J GW-I r1EV. 12/99
RUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL

North Carolina - Department of Environment and Natural Resources - Division of Water Quality- Groundwater Section
1636 Mall Service Center- Raleigh, N.C. 27699-1638-Phone [phone] //
WELL CONSTRUCTION RECORD WELL CONTRACTOR- Xe RmAN L L. �f ,3,4-S7�S ,
WELL CONTRACTOR CERTIFICATION #: oT Dii
268918
STATE WELL CONSTRUCTION PERMITN:
WELL USE (Check Applicable Box): Residential(✓ Municipal ❑ Industrial ❑ Agricultural ❑ Monlloring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other n If Other, List Use:
_. WELL LOCATIOShgw sketch--.1)
of the location below)
Nearest own:
-O County:
,P� / it 792
Woad Nara jXl •. C6,-munry, or Sub ikon and Lot
Nol DRILLING LOG DEPTH
i. OWNER _ -ilia From To Formation Descdp%ion
Add\ ss
Chy or Town
h Stale Zlp Code
:. DATE DRILLED 3' -1 d- ..-C a-
/
TOTAL DEPTH &C)
CUTTINGS COLLECTED YES 1 NO[4
DOES WELL REPLACE EXISTING WELL? YES n NOFVf
STATIC WATER LEVEL Below Top of Casing: FT.
/ (Use'+' II Above Top of Casing)
TOP OF CASING IS ( FT. Above Land Surface'
Top of casing terminated at/or below land surface require. a variance In accor-
ance with 1SA NCAC 2 011E
0. YIELD (gpm): METHOD OF TEST
1. WATER ZONES (depl ):
W
2 '_ORINATION: Type H / H Amount ___41.1111,3 II additional space Is needed use back of form
3. GASING:
Wall Thickness LOCATION SKETCH
Depths_ Diameter or WeIghUFL �M�arteriall (Show direction and distance from at least Iwo State
From O To "r 7 FI. 1 .' 5 a)'° .Jos rJCe.,,,S . Roads, or other map reference points)
From To FI.
''nn''rr�A^
.t. GROUT: AUPI.
From To FL
Depth Material Moll /� ^
hod
From D To aP.0 FI C'vNCPtiE d
From To Ft O--1J
5, SCREEN:
Depth Diameter Slot Size Material
From To Ft In In
From To Ft In In
From To Ft. In. __ In.
5. SAND/GRAVEL PACK:
Depth Size Material
From To FI
From To Ft
7.REMARKS:
I DO HERESY C
CONSTRUCTIO
iTT� Y THAT THIS WELL'. WAS. CO
$T DARDS', AND TI1AT A COPY
OFFICE US: ONLY
Quad No:
Serial No.
UCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
HIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
I URE OF PERSON CONSTRUCTING THE WELL
Submit original to Dl.tsion of Water Duality, Groundwater Section wllliln 30 days
DATE
GWI REV. 12/99

North Coro:Ins - Department or Environment and Nnlurnl Resources - Division of Wnler Duality - Oroundwnler Section 2 6 8 9 0 9
1636 Melt Service Center - flelelph• N.C. 27699-1638-Phone [phone]
•
WELL CONSTRUCTION RECORD WELL CONTRACTOR. Bo 6 hs (I. P j-k
WELL CONTRACTOR CERTIFICATION .: e Oa R
STATE WELL CONSTRUCTION PERMIT.:
1. WELL USE (Check Applicable Bow): Flesldenllal Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery [-1 Hord Pump Water InfeclIon n Other EjIf Olhor, List Use:
2. WELL LOCATIQAi (Show skgtch of the location below)
Nearest T wn:
901
(noed Name n Numbers. C
WNER �.t:w-.
3. O
Address
County'
dly, or Subdivlslon and lot No.)
A n .
kth-,i1YL.Y`RJ`.
LtM � -j5 rea ar t�ulglyq.) (11 7J 5
J U�.
City or Town Slate Zip Coda
d. DATE DRILLEDa
5. TOTAL DEPTH•
6. CUTTINGS COLLECTED YES in Nor v f
7. DOES WELL REPLACE EXISTING WELL? YES ��-� NO t�
6. STATIC WATER LEVEL Below Top of Casing: L0 FT.
(Use'.' If Abovo Top of Casing)
9. TOP OF CASING IS I FT. Abovo Land Surface'
•Top or casing termInnted eVor below lend surface require, n mimics In accor-
dance with 15A .CAC 2C.911e
10. YIELD Wm)*. Q_ METHOD OF TEST f C
11. WATER ZONES (dopth)•
DRILLING LOG DEPTH
Prom To
Formation ()ascription
b Go 5
(off AO5 rde k.
o -
_.J
r
1 \ \ "T H ,;HLORINATION: Type Amounl If addillonai space Is needed u.:o back of form
13. CASING:
nn Wall Tlifcknesl
lal
From_Y.�DTolh 10 El
...la .l.f WalvG MeT YI.'J.11K
From To FI to
7
From To Ft
IA. GROUT:
Depth Matorlol
From 0 To AD__FI jnk&1F
Frorn To FI
15. SCREEN:
Molhod
Doplh Diameter Slot Size Material
From To FI In In
From To FI In In
From To Ft In In
16. SAND/GRAVEL PACK:
Depth Slze Malarial
Frorn To FI
From To Fl
17. REMARKS:
m
LOCATION SKETCH
(Show direction end distance from ni least Iwo Slate
Roads, or other map reference points)
6/,n t4 ,,( C.
0
CC;
—n
'lam
CO
0
I DO HEREBY CE
CONSTRUCTION
THIS WILL WAS QONi
AfpS,AN&T}IATACOrYQ
rUR OFFICE USE
Ou ad No:
Sl +ei f
Submit odpinal iI ,t sl
TED IN ACCORDANCE WITH 15A NCAC 2C, WELL
S RECQRD HAS BEEN PROVIDED TO THE WELL OWNER.
E OF PS(tSON CONSTRUCTINO TIIE WELL DATE
n of Willer Dustily. Groundwater Section within 30 days
Serial No.
GW-t REV. 1209

268908
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mall Service Center • Raleigh, N.C. 27699-1636-Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR.
BD bhr (iL Poi#
WELL CONTRACTOR CERTIFICATION if: e/a g
STATE WELL CONSTRUCTION PERMITS:
3.
OWNER Le -Van MQf P\
Address a\ 1 �'1d•
(Sheor d [Jostle No.)
Camel let- tlL
City or Town ^ Slate
4. DATE DRILLED a"a^tin p
5. TOTAL DEPTH 3n5
6. CUTTINGS COLLECTED YES NOWT
7. DOES WELL REPLACE EXISTING WELL? YES NOj
8. STATIC WATER LEVEL Below Top of Casing: 45 FT.
(Use 'P if Above Top of Casing)
9. TOP OF CASING IS I FT. Above Land Surface'
•Top of casing terminated avor below lend surface requires a variance In accor-
dance with ISA NCAC 2C .9118
10. YIELD (gpm): 30 METHOD OF TEST
11. WATER ZONES (depth):
CHLORINATION: Type _ Amount
. CASING:
1. WELL USE (Check Applicable Box): Flesldenllal Ea Municipal n Industrial ❑ Agricultural El Monitoring ❑
Recovery ❑ Heal Pump Water Injection ❑ Other n If Other, List Use:
2. WELL LOCATION:Ca-hiller
���,,,(Show...������sketch of the location below)
Nearest wn: M'Q 4 County
(J9} (((?, /7
(Go d Name and Numbers, Community. or Subdivision and Lot No.) DRILLING LOG DEPTH
From To Formation Description
"P ovravnbe
all IS
Zip Code
D - Con , 2i
(o 0 - S rdegc lc,
r)
p Wall
Thickness
Deolhtoe Ft IPlaatb 1(�",�°dv .C-Ma2lz
FromTo S
From To FI.
From To FI
14. GROUT:
Depth
From 0 To Ft
From To FI
15. SCREEN:
Depth
Frorn To
From To
From To
16. SAND/GRAVEL PACK:
Depth
To
To
From
From
17. REMARKS:
Ft
FI
Ft.
Material Method ,
Diameter Slot Size Malarial
In In.
In In
In In
Size
FI
FI
Material
_s
Iv
If additional space Is needed use back of form
LOCATION SKETCH
(Show direction and distance from al least Iwo Slate
Roads, or other map reference points)
07/A' fd
C.e .ncl kr, NC
O
w
-TT
m
ex7
w
--o
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C. WELL
OONSTRUCTIO TAN0M1DS;A17D IHAI, A-CUPY ,IHIS RE ORD HAS BEEN PROVIDED TO THE WELL OWNER.
• YI1N1 N--- _.._1I
FOR OFFICE US
tad No:
Serial No
S
Submit odglnal
4n
13
3-39-oa
nE OF ERSON CONSTRUCTING THE WELL ' DATE
on al Wets( Duality, Groundwater Section within 30 days
SW-1 REV. 12199

268906
North Carolina - Department of Environment and Natural Resources - Division or Water (Duality - Groundwater Section
1636 Mall Service Censer - Raleigh, N.C. 27699-1638-Phone [phone]
WELL CONSTRUCTION RECORD WELLCONTRACTOR• RmAN L. ((.
WELL CONTRACTOR CERTIFICATION #: •=v7CA 7
STATE WELL CONSTRUCTION PERMIT:
, WELL USE (Cheek Appllc.bl. Boa): Resldenllal Irl Municipal n Industrial n Agricultural ❑ Monitoring ❑
Recovery ❑ Heal Pump Water Infection ❑ Other II Other, List Use:
2. WELL LOCATION: (Show ske ch of the location below) y)/ /�(�m��n
Ne$es1 Town- / l County' i "
(Road frame nd Numbers. CommGGonl y, or Subdivision and Lot No.) DRILLING LOG
3. OWNER PO/Yier 3 Crk 1m1S Erp°-Ppihr5, 22 From To
Address pU no` 1p)
Irea or Mae No.
WrPvetoth
Clly or Town Slate
a. DATE DRILLED 3-0 z�
5. TOTAL DEPTH
CUTTINGS COLLECTED YES [ I NO[4
DOES WELL REPLACE EXISTING WELL? YES NO71
3. STATIC WATER LEVEL Below Top of Casing: TO FT.
/ (Use -+- II Above Top of Casing)
TOP OF CASING IS ! FT. Above Land Surface'
'Top of casing terminated al/or below land surface requires a variance In eocor-
lance wllh 15A NCAC 2C .011a
10. YIELD (gpm): r%
9?787
Zlp Coda
METHOD OF TEST T\.
1. WATER ZONES (deplh):
DEPTH
Formation Oescdpllon
D — )07 J,'R
10V • 2e50 $Eciregck
0
c.)
F
a
2 ILORINATION: Type H 71-1 Amount s l IIt If additional space Is needed use back of form
3 ,SING:
Wait Tlilckness LOCATION SKETCH
�Dep111� Olalneler or Weight/F`IZ. Maledal (Show dlrecllon and distance from al least Iwo Slate
From To J !! Ft. Srf •oo�` 5al]4 r Roads, or other map reference points)
From To FI.
From To . FI
4. GROUT:
Depth Malorlal rat Method
From 0 To � Ft (^�I'(C��f>`
From To FI
15, SCREEN:
Depth Diameter Slot Size Material
Frorn To FI In In
From To FI In In
From To Ft In In
i 6. SAND/GRAVEL PACK:
Depth Size Material
From To Fl
From To FI
shep-1 Or:
Lde_ovcrvz7/6) /9{.
m
17. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 1SA NCAC 2C, WELL
CONSTRUCT! ANOAfDS, AND OiOHAT Ai-00a THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
L�`1 l4 t�1,tnGL�r„ C(1%� 3
TUBE OF PERSON CONSTRUCTING TIIE WELL DATE
'vision of Water Gustily. Oroundwaler Secllon within 30 days
GW-I REV. 12/99

•
North Gerollns - Department of Environment and Nnturnl Flesourc ea - Division of Water Ouellry • Groundwater Socllon
1630 Mall Service Center • Raleigh, N.C. 27699.1636-Phone [phone]
268935
WELL CONSTRUCTION RECORD
WELL CONTRACTOR• BD b hf (U . Po' +s
WELL CONTRACTOR CERTIFICATION 0: e-R O R
STATE WELL CONSTRUCTION PERMITH:
1. WELL USE (Check Applicable Roa): Residential Municipal ❑ Industrial ❑ Agricultural I I Monitoring ❑
Rocovory ❑ float Pump Water InJecllon ❑ Other ❑ If Other, List Use:
2. WELL LOCATION: (Show sketch ohthe location below)
Nearest Town: e �y/4CtVJR..Lff �— County. jeLtr1C0-1-71
611 o s Pace ld 2<.Ccru/vv']i - (.49(7
In ad Name apdTllumbers. Community, or bdlvhlon a d j.o\No.) Z DRILLING LOG DEPTH
3. OWNER e
Add; ass
5'
\if re•'. ouo'o
City or Town Slalo Zip Code
it. DATE DRILLED d'--
5. TOTAL DEPTH
6. CUTTINGS COLLECTED YES ❑ NO VI
7. DOES WELL REPLACE EXISTING WELL? YES Q NOM
6. STATIC WATER LEVEL Below Top of Casing: �( Q FT.
(Use •.• II Above Top of Casing)
9. TOP OF CASING IS I FT. Above Land Surface'
•Top of cesinq terminated et/or below land surface requires a variance In accor-
dance wllh ISA NCAC 1C.9 11 1")s
1 10. YIELD (gpm): / METHOD OF TEST ,1 q
11. WATER ZONES (depth)•
0 - //a -
/la -�
�Z+
O
;7O
r
J r—,
HLORINATION: Typo _ILTEL____Amount9A 1 1 (1S
13. CASING:
Wait Thickness
From�Depth , • pi.1l y }v �e V[J. a SDf2
Toart W- dl(n J•
From To Ft
From To Ft.
14. GROUT:
Depth Material
From a To AO rt. anREf E
From To
15. SCREEN:
Ft
A4olhod
rtlau e
Doplh Diameter Slot Size Materiel
From To F1 In In
From To Ft In in
From To Ft In In
16. SAND/GRAVEL PACK:
Depth Size Material
Frarn To FI
From To Ft
17. REMARKS:
If additional space Is needed use hack of form
LOCATION SKETCII
(Show direction and distance Irorn nt least Iwo Stale
Roads, or other reap roforonce points)
jpd _31 ylivutet
ail
I DO HEREBY FY"TF1RTTf[IS R WAS CC
CONSTRUCT' N ST�i NQAnDS, AND TI IAT A COP
R OFFICE UE;QNLY
Quad No: I
Serial Na.
II
iDUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
NIS RECORD HAS BEEN PROVIDED TO Ti IE WELL OWNEn.
DATE
SIGNATURE OF ERSON CONSTRUCTING TI IE WELL
Submit odpirial to Dlilslon of Writer Quality, Groundwater Section Within 30 days
1
GW.I REV. 12/99

264404
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
r-� CERTIFICATION # �' 1(de
WELL CONTRACTOR (INDIVIDUAL) NAME (print) I�CaCC�CK i,{ ^s`BW,h(>�5
(/'�� Sel-v-i tl a...onL A\da eu, 2,te. PHONE # B28) 665 ao'zz
WELL CONTRACTOR COMPANY NAME l..\yde '3
STATE WELL CONSTRUCTION PERMIT# G ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential Ci) Municipal/Public ❑ Industrial ❑ Agricultural 0
Monitoring ❑ Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION: ^ -� '.,�
Nearest Town: V'o,•rv.e t County ( r..c. st
\\t' '?lco-Sk C'ceesc C'•ce\e
(Street Name. Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: lTcec Gcevv\
Address 112S C\-trs\- Ceae\c C'•Ce\t
(Street or Route No.)
Fc.:cv:ew •1C
City or Town State Zip Code
( )-
Area code- Phone number
4. DATE DRILLED tO- t- Oz
5
6.
7. STATIC WATER LEVEL Below Top of Casing: 85 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS \ FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): 5 METHOD OF TEST ck.,51
10. WATER ZONES (depth):
TOTAL DEPTH: He6
DOES WELL REPLACEEXI,STING WELL? YES 0 NO.
RI
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
t\ tulb UVec 3e:c,c•1
\45
`i35 bC•a..:te
11. DISINFECTION: Type ?.\\} Amount a
12. CASING:
Depth
From 4 s To VAS Ft.
From To Ft.
From To Ft.
13. GROUT: Depth
From 0 To ao
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.
Wall Thickness
Diameter or Weight/Ft. Material
btc. j{'- 74 ?taStic
Material
Ft. C e=enent
Method
p:,e.cet,
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
fir\
(;rich
s
Ccees:
r )
CO
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
D
GNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Ceentert RREVgh, C
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) T.\CV.C-W .1,10An
WELL CONTRACTOR COMPANY NAME C‘Aett toNar 4eSa""�r'�e\%t �m-ThP inc.
STATE WELL CONSTRUCTION PERMIT#
(if applicable)
1. WELL USE (Check Applicable Box): Residential m Municipal/Public 0 Industrial 0 Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other ❑ If Other, List Use
260605
CERTIFICATION # Z4',S6
PHONE # (a1$ Ca 5 -7. an
2. WELL LOCATION:
Nearest Town::\lc
CantS
fie Newt- V •sa ltP
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: mob MtdeAtlo+'
Address E6 Cft'oean V?o.41 Rd
(Street or Route No.)
City or Town State
Area code- Phone number
4. DATE DRILLED 9. 3 -c 1.
5 TOTAL DEPTH: oaa5
County ?Y✓. sro^+rit
tails
Zip Code
ASSOCIATED WQ PERMIT#
(if applicable)
topographic/Land setting
tdge ❑Slope OValley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:OGPSOTopographic map
(check box)
DRILLING LOG
Formation Description
OVQ4 tSercAcro,
DEPTH
From To
4l A\�
19 5 (co
6 DOES WELL REPLACE EXISTING WELL? YES 0 NO E
7. STATIC WATER LEVEL Below Top of Casing: 4,:L7 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS t FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0I18.
9. YIELD (gpm): _ ` So METHOD OF TEST RIQ
10. WATER ZONES (depth): 8
11. DISINFECTION: Type Qa%5
12. CASING:
Depth Diarmeter
From h-( To WI Ft. ID i
From To Ft.
From To Ft.
13. GROUT: Depth Material
From_ To zo Ft. C¢++ren!
Amount '
Wall Thickness
or Weight/Ft. Material
a 21 r c sA:c.
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in
From To Ft. in
15. SAND/GRAVEL PACK:
Depth Size
To Ft.
To Ft.
From
From
16. REMARKS:
ASELVI2t
KIT"'733
Slot Size
in.
in.
Material
Method
� ce�
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.
0
r
CO
-IIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
STRUCTING THE WELL DATE
IG URE OF PERS
e Divtsion of Water Quality, Groundwater Section, 1636 Mail Service Ceernterl RalRE. 2001
221, within 30 days.

WELL CONSTRUCTION RECORD 2 6 0 6 0 6
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
CERTIFICATION # Z43h
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Llerr2 K N Sa.J a'e
WELL CONTRACTOR COMPANY NAME Ct a Setsua of A Son t et\ t pull =AC' PHONE # (gal)665 • lQt Z,
u i ASSOCIATED WQ PERMIT#
(if applicable)
STATE WELL CONSTRUCTION PERMIT#
(if applicable)
I. WELL USE (Check Applicable Box): Residential ZI Municipal/Public ❑ Industrial 0 Agricultural ❑
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: Conalec County awnte A5e-
l2% P.;lemw 4 P4 - 26t15
(Street Name. Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: R:clw./`d
Address I2$ RtleA ay.,letF
(Street or Rollie No.)
ea,. er AC rei l 5
City or Town State Zip Code
( zTs)- 665 On
Area code- Phone number
4. DATE DRILLED q.t.-et
5. TOTAL DEPTH: Ito S
fka
Topogra c/Land setting
❑Ridge lope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:OGPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
4-1 (43 over &cctr
63
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO m
7. STATIC WATER LEVEL Below Top of Casing: 1D FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS I FT. Above Land Surface'
*Top of casing terminated at/or below land surface requires a
variance in accordance with /5A NCAC 2C .0118.
9. YIELD (gpm): ZC METHOD OF TEST gt%
10. WATER ZONES (depth):
1455 6rc,w: t-e
11. DISINFECTION: Type_(a:1\S
12. CASING:
Depth
From 4 \ To3_ Ft.
From To Ft.
From To Ft.
13. GROUT: Depth
From Q_ To Zo 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
Amount la
Wall Thickness
Diameter or Weight/Ft. Material
(Oy la5i:f
Material
C.ernenv
Method
potarea
From
16. REMARKS:
Ft
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.
RDANCE WITH I5A NCAC 2C, WELL
OI*T N Rg, t-HAT COPYHIS RECORD HAWELL WAS S OF TNSTUCTED IN AAS BEEN PROVIDED TO THE WELL OWNER
9-2-U2
ACT —
Sub it the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Ceentert REVgh, C
27699-INN4r itripR($m{ai"hf 221, v ithin 30 days.
01
ASHEVILLE REGIONAL OFFICE
DATE
TURE OF PERSON CONSTRUCTING THE WELL

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment andNaturalResources - Division of Water Quality - Groundwater Section
y�
WELL CONTRACTOR (INDIVIDUAL) NAME (print) cer: CK A SaW4iera
CERTIFICATION # Zit3d
WELLCOiN'TRACTOR COMPANY NAME ekt&e 6<Wil. 1-) A. jon en ISf,,,„t` ysC,P/IONE # (8ta 665 Zoli
STATE WELL CONSTRUCTION PERMIT/0
(ifapplicable)
ASSOCIATED WQ PERMIT#
plicable)
1. WELL USE (Check Applicable Box): Residential 2 Municipal/Public 0 Industrial ❑ Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:Ir�
L
Nearest Town: YUIP1/4
County Pa..noovv.10,e
uaetcon QCtQK Rd ea-ndle
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: tO.\e \'Za4l3a0ne
Address PO ("asox W5o
(Street or Route No.)
E't1KQ AC -
City or Town State
($Zs)- (e(o5- C111 S5
Area code- Phone number
4. DATE DRILLED 8-"so -Oz
28-7s8
Zip Code
5. TOTAL DEPTH: 305
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO VI
7. STATIC WATER LEVEL Below Top of Casing: 'Kt FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 5o METHOD OF TEST $-p
10. WATER ZONES (depth): d
11. DISINFECTION: Type
12. CASING:
From i1
Depth
To B°1
From To
From To
13. GROUT: Depth
From 0 To ZO Ft.
From To
14. SCREEN: Depth
From To
From To
l5. SAND/GRAVEL PACK:
Diameter
Ft. tro;i
Ft.
Ft.
Material
Amount `-
Wall Thickness
or Weight/Ft.
d! 21
Ft.
Diameter
Ft. in.
Ft. in.
Slot Size
in.
in.
261258
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
{ 1 89 over 3erUo•.
89 30 5 Geo.n: +e
LOCATION SKETCH
Show direction and distance in miles from at least
I two State Roads or County Roads. Include the road
Material numbers and common road names.
r IasKc
Method
robtrectli
Material
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARD , AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
e
GNATURE I' ' SON 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
cj

260602
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) ter Q:CK Ik 54Aoliers CERTIFICATION #_ a3to
WELL CONTRACTOR COMPANY NAME CA.* 5aa•tCet 4.60n 4.ett„Limo 'S. c PHONE # f9zW bin 5- 7 Or r
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential 0 Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection El Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: Arden
fird5 Coe
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: ZSa4oc pe ce
Address 1\ (3CotaKWooCL MeaanW S Van*
(Street or Route No.)
City or Town State Zip Code
(Sit)- (obi- 5038
Area code- Phone number
4. DATE DRILLED $-L�6-oi
5. TOTAL DEPTH: 'LoS
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 0
7. STATIC WATER LEVEL Below Top of Casing: (D FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS i FT. Above Land Surface*
*Top of casing terminated atfor below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 2a METHOD OF TEST QC%
10. WATER ZONES (depth):
28104
Topographic/Land se g
County_kn..nCe,evO❑Ridge [Elope 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
i-1 814 over Setaov.
Y -zo
11. DISINFECTION: Type 1311%5 Amount CI
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From t\ To $4 Ft. (ou it21 pkt5tzc
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From 0 To Zo Ft. e&frit.,t foufe8
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:
be am. bse
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
tT
cn `x
0
LL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
HAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
ge2,-007
_ OCT - 1 Luk 2
Submit the original to the Diviion o Water Quality, Groundwater Section, 1636 Mail Service Ceentert RaeigRE.h, C01
URE OF PERSON CONSTRUCTING THE WELL DATE
27699-1 ReW4001/19§ACS )7d*3221, 7 ithin 30 days.
ASHEVILLE REGIONAL OFFICE

261254
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Oetc:ex \k 5a"a",1ec. CERTIFICATION# 7y3fn
WELL CONTRACTOR COMPANY NAME etyde Saw.%¢c 4 Son wettar,sn t z.c.. PHONE # (gia (065 Z02Z.
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) - (if applicable)
1. WELL USE (Check Applicable Box): Residential p Municipal/Public ❑ Industrial 0 Agricultural ❑
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: F tQ4el tt County
&iwveky Rtwnet, Rd
(Street Name, NurrIf,ers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: fecry k awe
Address GC' ° "9 II tcant k 14.6.
(Street or Route No.)
i\e- kQc ftC
City or Town State Zip Code
(50.8)- tots- 1515
Area code- Phone number
4. DATE DRILLED 8- L7I • oz
5. TOTAL DEPTH: 445
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: Se FT.
(Use "+" if Above Top of Casing)
S. TOP OF CASING IS I FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 4 METHOD OF TEST 12
10. WATER ZONES (depth): d
11. DISINFECTION: Type (F; lh Amount (o
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft.
From it% To 86 Ft. (.kt zt
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
•
From 0 To ZO Ft. Centenf Foured
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
urtcon�D�
287 3t
Material
ia3 t:c
•
TopograpiticiLand setting
❑Ridge RSThpe ❑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
+ver }Stcaor•
$(a 445 6eantte
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 CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
NAT
F PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Centteert RREVgh, N00I
NC
27699-1636 Phone No. [phone], within 30 days.

WELL CONSTRUCTION RECORD 261255
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) \ QCC;C K 14. 6cti- IQrS CERTIFICATION# Z1(36
WELL CONTRACTOR COMPANY NAME Cr lypP S char( Sc.. y}e 1\ O* Ty.io, pZ++C PHONE # (SW rob $ 2e Z 2
STATE WELL CONSTRUCTION PERMIT# d ASSOCIATED WQ PERMIT#
(if applicable)
(if applicable)
•
1. WELL USE (Check Applicable Box): Residential 121 Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATI r
Nearest Town: SheJD\Xe
-n...,rJK U4S\ey
(Street Name, Numbers, Community, Suddivision, Lot No., Zip Code)
3. OWNER: FSI (Karin 1e xi
Address 33:3 L4 h:tie rte,P T r:vP
(Street or Rout No.)
Fietrlec Ale 2K7D&,
County Bte-viCDM
City or Town State Zip Code
(425S)- (44 Ri iB
Area code- Phone number
4. DATE DRILLED e- 22'OZ
5. TOTAL DEPTH: 52 S
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO fa
7. STATIC WATER LEVEL Below Top of Casing: /p D FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surface`
`Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): w METHOD OF TEST lQi�
10. WATER ZONES (depth):
Topographic/Land setting
❑Ridge PaSIO-pe ❑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
over Bacr\n.
DEPTH
From To
�i �1E1
qy 325
1 1. DISINFECTION: Type+.11 S
12. CASING:
Depth Diameter
From i \ To G`A Ft. b\q
From To Ft.
From To Ft.
13. GROUT: Depth
Amount g
Wall Thickness
or Weight/Ft.
Material
\es}:c
Material Method
From 0 To 2C Ft. Cetrotnt Tu��
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth
From To Ft.
From To Et.
16. REMARKS:
Size
Slot Size Material
in.
in.
Material
(lean ate
LOCATION SKETCH o =
IV
Show direction and distance in miles from at 1ea,94
two State Roads or County Roads. Include thed
numbers and common road names.
O
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
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)
eol.CK '. S at.Ay to cS CERTIFICATION # 'L41
WELL CONTRACTOR COMPANY NAME C d t?se ACW Gisler k 'CA Wfl\\t} turn? nq'HONE # (fl2) foc,5-"Lc
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (ifaticable)
1. WELL USE (Check Applicable Box): Residential Td Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: fat c-v:to
County ri ccn 42
Q.IsL C-g n„.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: "t Cv Ct a9nne4-r'
Addicss 4n Natwcod I -One
(Street or Route No.)
FatCY:aW (LC 2t73fa
City or Town State Zip Code
(&-2s)_ bzs o zq i
Area code- Phone number
4. DATE DRILLED ern.. • cz
5. TOTAL DEPTH: (00 5
6 DOES WELL REPLACE EXISTING WELL? YES 0 NO AJ
7. STATIC WATER LEVEL Below Top of Casing: SD FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS I FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): t METHOD OF TEST f::Q
10. WATER ZONES (depth): d
•
Topographic/Land setting
❑Ridge ope ❑Valley 0Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
,}I 2z over ties. don
z 4,05 G ro,n:a-e
11. DISINFECTION: Type; 115
12. CASING:
Depth Diameter
From Ai To 32 Ft. (oki
From To Ft.
From To Ft.
13. GROUT: Depth
From (7 To 2,9 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.
Amount 9
Wall Thickness
or Weight/Ft. Material
�21 �iasfi;e
Method
��aceC�
CONSTRUCTION STAN a Il,
r,hT .. 1 %��:-.�/I�
Material
( emrr1-
260604
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
HIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
_dam
11,
1i'.. , IGNAT • OF PERSON CONSTRUCTING THE WELL DATE
ry �N�iI E�H SE(;110N
h, NC
rt�'C�'1`iE'Glt�,'D,@7�6Ft6e Division of Water Quality, Groundwater Section, 1636 Mail Service Center
REVg07/2001
27�69999-1636 ` tone 'o. [phone], within 30 days.
•
0

WELL CONSTRUCTION RECORD
260612
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
2.436
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Ne K:OK 'FA,, tua lees
CERTIFICATION #
WELL CONTRACTOR COMPANY NAME cue S Cy%Jve( k -Sow. ..Jell * P~" P a'^cPHONE # /Etna 646 z e 21
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable)
(if applicable)
1
WELL USE (Check Applicable Box): Residential LDS Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection D Other ❑ If Other, List Use
2. WELL LOCATI tt
Nearest Town: .Site Ogre
4a a eS C10.1 e
(Street Name. Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: Aav;a tr\C 1n}v.c EF
Address '79> 'tarns C.oye Rck
(Street or Route No.)
(king AJC
City or Town State
TS lict
Zip Code
Area code- Phone number
4. DATE DRILLED 48(`Z1-4L
5. TOTAL DEPTH: 16 5
County...a a .Oe_
Topographic/Land settin
❑Ridge ❑Slopedfley 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
426 rNiee (iQeel D..
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO 0
7. STATIC WATER LEVEL Below Top of Casing: 217 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): Vto METHOD OF TEST Rif-_
10. WATER ZONES (depth):
11. DISINFECTION: Type. f;115 Amount I-
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From A\ To rib Ft. (n IA M 2l Q\QS\=C
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From 0 To 241 Ft. C.v,"eft k ?ureA
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:
q ` Vey Gtt• irt
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.
CFI ''iiU1 T1- ST u
PSrE':ILI I kCoR .kL OFFICE
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
S NATUR
ERSON CONSTRUCTING THE WELL DATE
ision of Water Quality, Groundwater Section, 1636 Mail Service Ceenterl Raleigh,
NC
07/2001
221, within 30 days.
0
L

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) terev C'< i1. 'S 0.W.a#CB CERTIFICATION# 2436
WELL CONTRACTOR COMPANY NAME CAsiae 'SeavyC'( '�' �' v-1c 1d ��+rv.�s Tort. PHONE # ( t (e)C. > nt
STATE WELL CONSTRUCTION PERMIT# V ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
2612r17
I. WELL USE (Check Applicable Box): Residential® Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATI� (ry, 0
Nearest Town: //f�et/t
s�rrr�es r Je
(Street Name. Numbers, Community, Subdiv
County uuvlcr
ision, Lot No., Zip Code)
3. OWNER: Qav;d /(A('YwiurfE
Address '-T9`1 StGrnuA CevQ.
(Street or Route No.)
9hw;Ue lac ZgSCG
City or Town State Zip Code
(Bts)- bb`r- 365'1
Area code- Phone number
4. DATE DRILLED &--21-vz
5
6.
7. STATIC WATER LEVEL Below Top of Casing: 3T7 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS I FT. Above Land Surface*
*Top of casing terminated actor below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): 2 METHOD OF TEST *:d
10. WATER ZONES (depth):
11. DISINFECTION: Type?: di
12. CASING:
Depth Diameter
From *i To R 1 Ft. Goya
From To Ft.
From To Ft.
13. GROUT: Depth
From 0 To Zp 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.
From To Ft.
Amount Ic
Wall Thickness
or Weight/Ft. Material
Material Method
Ceenent pored
Slot Size Material
in.
in.
TOTAL DEPTH: i S 5
DOES WELL REPLACE EXISTING WELL? YES ❑ NO 17
Topographic/Land tting
❑Ridge ❑Slope 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
#X si CYCr Gera tr.
$i
its
L Cen1' to
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
C/)
;-n
N
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 RECORD HAS BEEN PROVIDED TO THE WELL OWNER
DATE
NATURE OF PERSON CONSTRUCTING THE WELL
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
2F12r,9
WELL CONTRACTOR (INDIVIDUAL) NAME (print) 'Deer- es. % 5nv3/9. Cs CERTIFICATION # at't'S6
WELL CONTRACTOR COMPANY NAME 5Cuted Ne\\ ,�pvr.-4 �"C• PHONE # (SZZ) (aC�S 2o2Z
C'r k SCs
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
l
(if applicable)
(if applicable)
WELL USE (Check Applicable Box): Residential VI Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATIO>1) o/II n t
Nearest Town: ff.Shettlie County 1S aaCt)r�.De
Rase 4/7ii a
(Street Name. Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: b�+'''' Eox
Address `i15
(Street or Route No.)
\kacS2.SincC cu.
D•'8142
City or Town State Zip Code
($tS )- S91. 45103
Area code- Phone numbeh
4. DATE DRILLED 1S- Zc -02.
5. TOTAL DEPTH: 705
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO fd
7. STATIC WATER LEVEL Below Top of Casing: /OD FT.
(Use'•+•• if Above Top of Casing)
8. TOP OF CASING IS \ FT. Above Land Surface*
'Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): iris METHOD OF TEST R
10. WATER ZONES (depth): d
11. DISINFECTION: Type Q; Vy
12. CASING:
Depth Diameter
From ¥1 To ZS Ft. (oy
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From 0 To 20 FL tee env _QCucea
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.
Amount (a
Wall Thickness
or Weight/Ft. Material
lf2\ �1aSHc
16. REMARKS:
:Topographic/Land setting
rWgidge ❑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
%et 'ZR OsieC eri CAn..
2Fr Tc 5 L-t'e.w:+c
LOCATION SKETCH
Show direction and distance in miles from at {east
two State Roads or County Roads. Include the'rbad
numbers and common road names. 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
".71173IATURE OF PERSON CONSTRUCTING THE WELL
FP 20-0.2
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
C)
0

260610
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVtOUAL) NAME (print) INPcr:eK N. Sn..vec•S
CERTIFICATION # 2M 3tc.
WELL CONTRACTOR COMPANY NAME el* Sos%'or Z ��^ 41egy jYurn? +nC. PHONE # (Bn�I 666 2c7.Z
d STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#(if applicable)
(if applicable) •
1. WELL USE (Check Applicable Box): Residential Ld Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: jiaennanGa-
g ,uVeit Cade
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: 'Tannm�r:e JAC�c\n.,d
Address Bit% (njrfe•c " fta
(Street or RouteNo.)
County 4unccr- e
Solannant. C. 4r. 26'T7fc
City or Town State Zip Code
(- )-
Area code- Phone number
4. DATE DRILLED Ii't5•AZ 5Y Sfe,D (sca^:to
5. TOTAL DEPTH: S60
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO ❑
7. STATIC WATER LEVEL Below Top of Casing: 'D FT.
(Use •'+" if Above Top of Casing)
8. TOP OF CASING IS \ FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): So METHOD OF TEST R:01
10. WATER ZONES (depth):
Topogr ie/Land setting
❑Ridge lope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
cs, 0NtC yjCt ao'n
LOCATION SKETCH
Amount $ Show direction and distance in miles from at least
11. DISINFECTION: Type e:1\s two State Roads or County Roads. Include thaIDad
12. CASING: Wall Thickness PO
Depth Diameter or Weight/Ft. Material numbers and common road names. to
i^
From �__To Si Ft. Ott_3lc-�— P\o's3'�
From To Ft. ^�
From To Ft.
13. GROUT: Depth Material Method
From 0 To 20 Ft. L'er+sen\ ?etuce� o
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material --IFrom To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
E: .'T' -Y
Chi
GM#p he D
ASHEVInt iE GONA�L�OFFIiCE9) 73
.. 0
SIGNATURE OF PERSON CONSTRUCTING THE WELL
ision of Water Quality, Groundwater Section, 1636 Mail Service Ceenteri RRaleigh,
C
-3221, within 30 days.
THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
s—o
DATE
•
0

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Qualify
WELL CONTRACTOR (INDIVIDUAL) NAME (print) \ aev:CI( N. `-scAWec6
WELL CONTRACTOR COMPANY NAME e G
STATE WELL CONSTRUCTION PERMIT#
(if applicable)
a
1. WELL USE (Check Applicable Box): Residential fd Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
1' '4oC 50n
260603
- Groundwater Section
CERTIFICATION #_ a, fc
PHONE # f$ta) 665-ZcZt
ASSOCIATED WQ PERMIT#
(if applicable)
2. WELL LOCATION:
Nearest Town: Conchec County fjunccvnInra
Z>ia to t�. t4A— Necktie I,
(Street Name, Numbers, Communlry,Subdivision, Lot No., Zip Code)
3. OWNER: Vta.nic Sytvem
Address Pc. Q3cx Hot4
(Street or Route No.)
CanilLer Yle ZZ715
City or Town State Zip Code
( )-
Area code- Phone number
4. DATE DRILLED t' 1Y-ba
5. TOTAL DEPTH: ZZ 5
6. DOES WELL REPLACE EXISTING WELL? YES O NO m
7. STATIC WATER LEVEL Below Top of Casing: 9b FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surface*
"Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0119.
9. YIELD (gpm)r3 . METHOD OF TEST R
10. WATER ZONES (depth):
Topographic/Land sett g
['Ridge ❑Slope Fkalley DFlat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:OGPSOTopographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
} i tetn O %ter• c5er Ac. rn
tZ5 (x:Anite
1l. DISINFECTION: Type:u.s
12. CASING:
Depth
From Toga— Ft.
From To Ft.
From To Ft.
Diameter
Amount T
Wall Thickness
or Weight/Ft.
-Zt
Material
c tasr:c
13. GROUT: Depth Material Method
From 0 To zo Ft. "'a^+' ?otice d
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
v �R� E
HEREBY CERTI • zZij T THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTIONSTA V'.5, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
V - vtt
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the read
numbers and common road names. rso
rn
N
J
NATURE 0
()NpUSECTION
iRITtEE ,#<t it. !'vision of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
9-1636 Phone No. [phone], within 30 days.
GW-1 REV. 07/2001
ON CONSTRUCTING THE WELL DATE
O
rU

260607
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) bete:, S CERTIFICATION # Z43b
WELL CONTRACTOR COMPANY NAME CtV-141Ae eaw.tec t Seer Wedrt d ru w.1'J S^C PHONE # (828) Gfo5 j.OZ...
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT'?
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ❑ Municipal/Public Industrial ❑ Agricultural 171
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: ASheYitie County BUnea ,Ae
CIz6 esoci Roo,a
(Street Name, Numbers, ommunity, Subdivision, Lot No., Zip Code)
3. OWNER: 1.-Se4} t'IStstv:4e C'jaea::t CAwres.
Address fi26 )1aUytt (Zone
(Street or Route No.)
(}at+.lie v)C 28fw^b
City or Town State Zip Code
( )-
Arca code- Phone number
4. DATE DRILLED ire \'A • In . TOTAL DEPTH: 10K
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO 0
7. STATIC WATER LEVEL Below Top of Casing: 6 ) FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surface*
*Top of easing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): IL METHOD OF TEST R:4%
10. WATER ZONES (depth):
Topographiciand,setting
❑Ridge ❑Slope anOralley ❑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
OO'B over ?etdot.
%OS —705 Gee r-re-
11. DISINFECTION: Type FAY. Amount 8
12. CASING: Wall Thickness
Diameter or Weight/Ft. Material
From NA Ft. IA ik it Oct6i-'r
From Ft.
From Ft.
Depth
To 1O8'
To
To
13. GROUT:
From f!
From
14. SCREEN:
From
From
Depth Material Method
To to Ft. Ctrne...v FbuC9d
To Ft.
Depth Diameter Slot Size Material
To Ft. in. in.
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
r»
rn
r1
0
OCT - 1 2002
ubmit the original to th
ASHEVILLE REGIONAL OFFICE
tS WELL. WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
ND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
RE OF PERSON CONSTRUCTING THE WELL DATE
ion of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
221, within 30 days. GW-1 REV. 07/2001

North Carolina - Department of Environment and Natural Resources - Division of Water Quality -
WELL CONTRACTOR (INDIVIDUAL) NAME (print)
WELL CONTRACTOR COMPANY NAME et de
STATE WELL CONSTRUCTION PERMIT#
(if applicable)
I err .•ck
ASSOCIATED WQ PERMIT#
(if applicable)
TnCP
WELL CONSTRUCTION RECORD 2 6 0 611-
Groundwater Section
CERTIFICATION # & N 310
HONE #fi3ZS 61,5-47OZ2
1. WELL USE (Check Applicable Box): Residential FS Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection O Other O If Other, List Use
2. WELL LOCATION: v.nc0 m bC'
Nearest Town: wok very tieCounty a
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3OWNER:_
zC � /i/t.cle__
l.
Address - _- -
(Street or Route No.)
ae.a'Veet\kt C. ZipCode
City or Town State
( )-
Area code- Phone number
4. DATE DRILLED &b-�2
5. TOTAL DEPTH: 36 5
6. DOES WELL REPLACE EXISTING WELL? YES O NO A
7. STATIC WATER LEVEL Below Top of Casing: ¥t 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
varianceELDg accordance with t5 METHOD OF TEST �—
NCAC 2C .01I8.
9. YIELD (gpm): �
10. WATER ZONES (depth):
11. DISINFECTION: Type_ i11 Amount (C
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
Topographic/Land setting
❑Ridge HSTEope OValley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
.atitude/longitude source:OGPSOTopographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
�03 _ (D V t- B e_r—d
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
From_ 4 To %Z vt. -{-- ti a 5 . C
From To
From To Ft.
Material Method� (
13. GROUT: Depth po tt rrry
From�_To 20 Ft. Ge�enr
From To Ft.
14. SCREEN: Depth Diameter Slot Size in.Material
From To Ft. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK: Material
Depth Size
From To FL
From To Ft.
16 REMARKS:
OF PERSON CONSTRUCTING THE WELL
GWr1 REV.
001
Submit the original to he Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigheigh,,NC
GROUNE;!Vj�t¢4183I6CP+ppe No. (9 9) 733-3221, within 30 days.
ASHEVILLE REGIONAL OFFICE
HAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
ARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
DATE
tia
0

261251
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) ZfiLCr:C iC Sri. 5o...)Ass CERTIFICATION# 24 3(0
WELL CONTRACTOR CONIPANY NAME C\iJtape $ aW4rr * `+on Nett �-Purwy �n¢HONE # (A2 66s zt2-2
STATE WELL CONSTRUCTION PERMIT# ( ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential Municipal/Public 0 Industrial 0 Agricultural ❑
Monitoring 0 Recovery ❑ Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: uJe°&vecv:Ile
Ip77 ✓lea Sinci Rd
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: 14ar'e^ LAP
Address _ ► on Ne.l StocK Qci
(Street or Route No.)
LJRavecv:Ile nc
County es-i+cov,.. ko
City or Town State Zip Code
((e9 s7o
Area code- Phone number
4. DATE DRILLED 6/— S - D,2
5. TOTAL DEPTH: 1a4 5
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO J7
7. STATIC WATER LEVEL Below Top of Casing: SO FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): l) METHOD OF TEST (Air
10. WATER ZONES (depth):
TopograOidLand setting
❑Ridge PSiope ❑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
i*i 7b 72 Over fie r•d o n
72. To 31-1-
11. DISINFECTION: Type p;115
12. CASING:
Depth Diameter
Fromm To 7 Z Ft. to
From To Ft.
From To Ft.
13. GROUT: Depth
From 0 To Zip 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.
Amount b
Wall Thickness
or Weight/Ft. Material
17%.zi j71o5f.c
Material Method
n.en A- p6urea
16. REMARKS:
&r' n t+-C
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.
cn
rn
1 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
fSIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-I REV. 07/2001
-J

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality
WELL CONTRACTOR (INDIVIDUAL) NAME (print)
WELL CONTRACTOR COMPANY NAME
t. Sam
STATE WELL CONSTRUCTION PERMIT#__--------'
(ifa licable)
ASSOCIATED WQ PERMIT#
(if applicable)
258270
- Groundwater Section
CERTIFICATION #___a_9Lb
HONE #(42' 9 a5-5?1i"
Box): Residential 11 Municipal/Public 0 Industrial 0 Agricultural ❑
1.
2. WELL LOCATION: County
Nearest Town: ice: ye.�
(Street Name, Nurnbers, Community, Subdivision, Lot No., Zip Code)
3, OWNER:
Address Pn
WELL USE (Check Applicable ox
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
Topographic/Land setting
ORidge ❑Slope OValley OFlat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:OGPSOTopographic map
(check box)
DRILLING LOG
Formation Description
(Street or Route No.)
at, 30
City or Town
State Zip Code
Area code- Phone n
5. TOTAL DEPTH:0 S
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO VI7. STATIC WATER LEVEL Below Top ° ifAbove Top of Casing)
f Casing: FT.
8. TOP OF CASING IS
\ Fr. Above Land Surface*
*Top of casing terminated atlor below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gprn): METHOD OF TEST__Ice _----
10. WATER ZONES (depth):
11. DISINFECTION: Type iiH
12. CASING: DepthDiary
ter
Diater
From i__—To 'to FL_
From To Ft.
From To Ft.
13. GROUT: Depth Material
^'r
From To Ft
14. SCREEN: Depth
From To
From To
15. SAND/GRAVEL PACK: Size
Depth
To Ft._
Ft._
umber
4. DATE DRILLED $'1^u°2
From,
From
16. REMARKS:
i DOH. B'Y CERTIFY Tom' STRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
AHIS WELL WAS ND THAT A COPY NOF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
$ 2-02
To
Diameter
Ft. in.
Ft. in.
Slot Size
in.
in.
Amount ti
Wall Thickness
or Weight/Et.
adz► -t,--'
DEPTH
From To
LOCATIONSKETCH
ile
two State Roads or County Roads. Includz ttioad .-
Material numbers and common road names.
Method
rated
Material
Material
i
CJ
Show direction and distance n m s from atlleast
S mit/the'originnItothe D
276 9-1636 Phone No. (919) 73
ONSTRUCTING THE WELL DATE
of Water Quality, Groundwater Section, 1636 Mail Service Ceenterl Raleigh,
lREeigh 2001
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) OtCC''K 1\ SasailtrS - CERTIFICATION # 2-14340
WELL CONTRACTOR COMPANY NAME CI* +ia ate �' Soh WQ\1i Fur," TnC. PHONE # (gza CaG -2022
STATE WELL CONSTRUCTION PERMIT# + ASSOCIATED WQ PERMIT#
(if applicable)
tta_
1. WELL USE (Check Applicable Box): Residential ❑ Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use
261250
(if applicable)
2. WELL LOCATION:
Nearest Town: f arteiiee
County CS•sC.awrP
(Street Name. Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: C-ae\eb
Address L;oste_v. Cs-tei(
(Street or Route No.)
(�art\ec AC.
281\S
City or Town State Zip Code
( )-
Area code- Phone number
4. DATE DRILLED 1-1- at
5. TOTAL DEPTH: ams
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO 0
7. STATIC WATER LEVEL Below Top of Casing: (c0 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 20 METHOD OF TEST 4t
10. WATER ZONES (depth):
LOCATION SKETCH -'-
Show direction and distance in miles from aL.�east '_�..='
12CASING:
1l. DISINFECTION: Wall ThicknessION: Type pt.... Amount etwo State Roads or County Roads. Include the road__-_
.
Depth Diameter or Weight/Ft.
t. Material numbers and common road names: V.
From {-1 To tit{ Ft. (0y ...
i ?IciAt:e '�
From To Ft. (i) m
From To Ft. r' �'
s
13. GROUT: Depth Mate al Method -
q fr0uee.d J c.
From h To tip Ft. l-Cioxt vtF
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
Topographie/Land_se.Uing
❑Ridge ❑Slope 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
1 8y C7vkc C21`el°'-
4314 245 %3M^IFe
From To Ft.
From To Ft.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
o.Z
GNAT OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Ceentteer' REVgh, C
27699-1636 Phone No. [phone], within 30 days.

258225
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
K CERTIFICATION #__S- 6
(INDIVIDUAL) NAME (print) HONE # I ""gS
WELL CONTRACTOR(. ` 5n�
WELL CONTRACTOR COMPANY NAME ASSOCIATED WQ PERMIT#
(if applicable)
STATE WELL CONSTRUCTION PERMIT#
(ifa licable) Agricultural Residential fl Municipal/Public 0 Industrial 0 Agri
I.
2. WELL LOCATION:
Nearest Town:
/\ ..1)ec _ Countybe
v' ;5 CceeK �2$7\5
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: r"
4
Address
(Street or Route No.) �37I5
GAa Ec State Zip Code
City or Town
4. DATE
5. TOTAL DEPTH: i u
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO k7
7. STATIC WATER LEVEL Below Top
(use " °fAbove Top ofCasing)
8. TOP OF CASING IS lo ----
FT. Above Land Surface`
'Top of casing terminated aUor below land surface requires a
variance g accordance with tSMETHOD OFCAC 2C gTEST —
9. YIELD (gpm) �-Q— c
10. WATER ZONES (depth):
I1. DISINFECTION: Type
12. CASING:
WELL USE (Check Applicable Box):
❑ Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
Monitoring
Topograph ic/Landl,setttnS
❑Ridge ❑Slope alley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING G
Formation Description
Area code- Phone number ,/
DRILLED 73 "'L ci
Depth From_YT-- To 56
From To
From To
13. GROUT: Depth
From._ Q.—To-t
To
From
14. SCREEN: Depth
From To
From To
15. SAND/GRAVEL PACK:
Depth
From To__
From To
16. REMARKS:
PM) I'DO HER
h NC
. b
5tthmit-the nrio�!nalto� lei Divi ion of Water Quality, Groundwater Section, 1636 Mail Service Center - g,NC
22699•1636 Phone Na' &1'�)733-3i 21, within 30 days. GWr1 REV
Amount la
Wall Thickness
Diateter or Weight/Ft. Material
FLU_
Ft.
Ft.
Material
't
Ft.
Diameter
Ft. in.
Ft. in.
Ft.
Ft.
Size
a� s► IliL:
Slot Size
in.
in.
Material
Method
QputCO
Material
DEPTH
From To
LOCATIONSKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include:the road
numbers and common road names.
0
O
rV
U7
VELL WAS CONSTRUCTED IN ACCORDANCE WITH 15ANCAC 2C, WELL
THAT A COPY OF THIS RECORD BEEN PROVIDED TO `F1EWELL
D
OO
RUCTING THE WELL DATE

258227
Arca code- Phone number- 2i -O i
4. DATE DRILLED
5. $
TOTAL DEPTH: 45
7. STATIC WATER LEVEL Below Top of Casing: T
FT.
- (Use "+" if Above Top of Casing)
8. TOP OF CASING IS FT. Above Land Surface'
'Top of casing terminated at/or below laud surface requires a
variance in accordance with ISA NCAC 2C .0118-
9. YIELD (gprn): 5o METHOD OF TEST__ u�`O
10. WATER ZONES (depth):
11. DISINFECTION: TypeAmount
12. CASING: Wall Thickness
Depth Diareter or Weight/Ft. Material
From To Ft. —
From To Ft. —
13. GROUT: Depth Material
Fromm To_Zd .
From To Ft.
14. SCREEN: Depth
From To
From To
15. SAND/GRAVEL PACK:
Depth
To
To
ERTIFY THAT
WELL CONTRACTOR (INDIVIDUAL) NAME (print) CERTIFICATION # .1 N 3(s
WELL CONTRACTOR COMPANY NAME
STATE WELL CONSTRUCTION PERMIT#
(if applicable)
1. WELL USE (Check Applicable Box): Residential fa Municipal/Public 0 Industrial D Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
TopograDlxrt/Land setting
DRidge ki'Iope ❑Valley ❑Flat
2e tl (check appropriate box)
�xJtYti oI. Latitude/longitude of well location
(degrees/minutes/seconds)
3Latitudellongitude source:❑GPS❑map
ap
(check box)
DEPTH DRiLt 1NG LOG
From To Formation Description
tt i\L Ovx t3a cla>
WELL CONSTRUCTION RECORD
North Carolina - Department of Envlronmen and
d Natural Resources - Division of Water Quality - Groundwater Section
IL SOtltet HONE # ( ad1;S t
�J_ N
L7
OWNER: 1JLtnn4.e.
Address 20
(Street or Route No.)
cwcw�O—
City or Town State Zip Code
(t - 4l 7ei
6 DOES WELL REPLACE EXISTING WELL? YES 0 NO (el
2. WELL LOCATIpN:
Nearest Town: ,Z'vJ 0.al.a 0O"
Qr
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
CountyiLiie-e"�
ASSOCIATED WQ PERMIT#
(if applicable)
From.
From
16. REMARKS:
1 DO HERE
Submit the original t
27699-1636 Phone No. (19) 7
ar
—;ION
Diameter
Ft. in.
Ft. in.
Size
Ft.
Ft
Method
T
Slot Size Material
_ in.
in.
Material
0
N
cJt
711
Show direction and distance in miles from ai jl ast
two State Roads or County Roads. Include t lilhoad'
numbers and common road names.
LOCATION H
WAS CONSTRUCTED IN ACCORDANCE WITH 15ANCAC 2C, WELL
T A COPY OF THIS RECORD HAS BEEN PROVIDED TO TILE WELL OWNER
1-2 -02
DATE
0
SIGNATURE OF P
!STRUCTING THE WELL
i-' �N
ivision of Water Quality, Groundwater Section, 1636 Mail Service Ceenteri REVgh, NC
3-3221, within 30 days.
ra:a
0

258244
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Ground CATION #Section
3(u
WELL CONTRACTOR (INDIVIDUAL) NAME (print) NONE #
f, 51:04 f
WELL CONTRACTOR COMPANY NAME ASSOCIATED WQ PERMIT#
(if applicable)
STATE WELL CONSTRUCTION PERMIT#
(if app
I. WELL tApplicable Box): Residential Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring
USE (Checkoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION: Topographic/Land setting
' di County we,ti�.a ❑Ridge ❑Slope ❑Valley ❑Flat
Nearest Townnf.1 . (check appropriate box)
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Coda)
Latitude/longitude of well location
(degrees/minutes/seconds)
3 OWNER: Ool:uea,4 ��"�'' �6 *i4' Latitude/longitude source:❑GPSCITopooaphic map
Address 1593 (check box)
DRILLING LOG
Formation Description
Zip
or Town State ZP Code
(€1e )- ` Z- 40\ Area code- Phone number
4. DATE DRILLED , _Yg OZ
5. TOTAL DEPTH: Li Z
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO jcl
7. STATIC WATER LEVEL Below ( Top of 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 15 NCAC 2CMETHOD OF TEST
9. YIELD (gprn): —�
10. WATER ZONES (depth):
11. DISINFECTION: Type I LA
12. CASING: Dian
peter
Depth
From=yfL_ To SO FL..Jt j_
From To Ft._
From To Ft.
13. GROUT: Depth
From_Q_— To Zt_ Ft.
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.
Material
DEPTH
From To
�i 3Fs
�a aD4s en
�R Lf2 5 4t 4e
LOCATIONH
Amount g Show direction and distance in miles from at least
Wall Thickness two State Roads or County Roads. Include the road
or Weight/Ft. Material numbers and common road names.
16. REMARKS;
BY CERTIFY T
CT1aNS • o%',
Method
flouted.
Slot Size Material
in.
in.
Material
1S IIELL WAS CONSTRUCTED IN ACCORDANCE WITH I5ANCAC 2C, WELL
t HAT A COPY OF THIS RECO' ' r S BEEN PROVIDED TO THE WELL OWNER
`at—•-/4 1 %2 t-0
/ �� �' C! - RUCTING THE WELL DATE
Sj► k EOF
NC
Submit the original to the Drvisi t n of Water Quality, Groundwater Section, 1636 Mail Service Ceentert RREVgh, N001
27S99_163ML11.Pue No. (919) 7$3-32 1, within 30 days.
1

258239
2. WELL LOCATIO
Nearest Town: #SAP Jt
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater r Section i436
CE
WELL CONTRACTOR (INDIVIDUAL) NAME (print) K
WELL CONTRACTOR COMPANY NAME CIt sus' tS b,t An.. J ettp sniptaPHONE # I4sR .iiiS X*t�
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#(if applicable)
(if applicable)
I. WELL USE (Check Applicable Box): Residential la Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
Topographic/Land setting
❑Ridge POSThpe ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
ounty au*�SCt"0Q
LPk
(Street Name, Numbers, Community, Su 'vision, Lot No.. Zip Code)
3. OWNER: ritllL e4 .-Aan,ci. p
Address 47, 3 tJ 121 At
(Street or Route io.)
t'FQrVezt4 x IC .71573z
City or Town State Zip Code
(
Area code- Prone number- t S ` O
4. DATE DRILLED
5. TOTAL DEPTH: \bS
6. DOES WELL REPLACE EXISTING WELL? YES` NO je]
7. STATIC WATER LEVEL Below, Top ofse "+" if CAasing:ve 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): 10 METHOD OF TEST
10. WATER ZONES (depth):
11. DISINFECTION: Type
12. CASING:
Depth
From, i1__- To 4 4 Ft.
From To Ft.
From To Ft.
Material
e1�+rt w Ir
Diareter
d21
13. GROUT: Depth
From_Q—_ To_6__- Ft.
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.
Amount '7
Wall Thickness
or Weight/Ft. pM�a�teri��al�
* l l _�C
I6. REMARKS:
D0 HE
CON
Method
Pouted
Slot Size Material
in.
in.
Material
(degreeshninutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
4- I $ Cnt t * 3 Atil Nt
MIL Ab%
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 15ANCAC 2C, WELL
D THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
'1• i S-ez
itibQlt the original to the Divi
7699-1636 Phone No. (919) 733-3
L
COIN
_-v,Lr,.^.F
RSON CONSTRUCTING THE WELL
DATE
Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
thin 30 days. GW-1 REV. 07/2001

2. WELL LOCATIO})1 %
Nearest Town: ia e 1 �1 e County A'rb
e3 l�a\\Qv%% hd tear aa4
(Street Name, Number, Community, Subdi6sion, Lot No., Zip Code)
3. OWNER: as of 1VAs�,.t+_i,. IlAtit +t
Address 033
(Street or Route No.)
t'FQnrke. f1C-
CityorTown State
( )-
Area code- Phone number- 1 s _ 2
4. DATE DRILLED
5. TOTAL DEPTH: 1fl5
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO (rI
7. STATIC WATER LEVEL Below Top of Casing: -
FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS i FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 5 METHOD OF TEST Q.t�
10. WATER ZONES (depth):
a$73 Z.
Zip Code
11. DISINFECTION: Type Q vt5
12. CASING:
Depth Diameter
From'+ To 59 Ft. te'tt
From To Ft.
From To Ft.
13. GROUT: Depth
From Q To 26 Ft.
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth
To Ft
To Ft.
Material
(Plato w +t
Amount
Wall Thickness
or Weight/Ft. Material
to
From
From
16. REMARKS:
ID
Method
Pouted
Slot Size Material
in.
in.
Size Material
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and
WELL CONTRACTOR (INDIVIDUAL) NAMEr(print)
WELL CONTRACTOR COMPANY NAME CIst
STATE WELL CONSTRUCTION PERMIT#
(if pplicable)
258238
Natural Resources - Division of Water Quality - Groundwater Section
�( CERTIFICATION #_2.4a4
.'S suite fs iC 4Ow Jtu et paw(Q-LeeHONE # x zL 4S ar
`- ASSOCIATED WQ PERMIT#
(if applicable)
1. WELL USE (Check Applicable Box): Residential la Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
Topographic/Land setting
❑Ridge ❑Slope El%5T1ey ❑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
}l o v... 3sa..o o-»
51 2115 ALAskkc
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.
Subitthe original to the Di
2761636 Phone No. [phone]
THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15ANC.AC 2C, WELL
THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
-i5-o
DATE
!IATUt'
1NG THE WELL
of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
within 30 days.
GW-1 REV. 07/2001
ERCUi..![.. 1g,T'ER SECTION
Ar• .. ^.rn.rc

11. DISINFECTION: Type
12. CASING:
Depth
FromL.— Tom Ft.
From To Ft.
From To Ft.
13. GROUT: Depth
From_Q_— To—�d . Ft
From To Ft
14. SCREEN: Depth
From To
From To
15. SAND/GRAVEL PACK: Size
Depth
From To Ft._
From To Ft._
16. REMARKS:
Amount _t
Diameter
Ft. in.
Ft. in.
SuT*Iflthe, o enft ivisia
258237
WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
HONE K i4T9 . Q
n ar
WELL CONTRACTOR (INDIVIDUAL) NAME (print)
t__ .aaN.�-OYMna
HELL CONTRACTOR COMPANY NAME
Saw
STATE WELL CONSTRUCTION PERMIT#.------
(ifa ticable)
1. WELL USE (Check Applicable Box): Residential 1 Municipal/Public ❑ Industrial 0 Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other ❑ If Other, List Use
Topographic/Land setting
DRidge ❑Slope alley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
Formation Description
p�l/.[F R.R�.ti-Rr+
CERTIFICATION # a1N $6
2. WELL LOCATIO : t t ,(
Nearest Town: f( f�
ASSOCIATED WQ PERMIT#
(if applicable)
County
Lot 2-)
.rfs
(Street Name, Numbers, Community, Su division, Lot No., Zip Code)
—
3.OWNER:---
Address
(Street
or Rotte No.)
City'or Town State
Zip Code
(--)
Area code- Phone number-'
4. DATE DRILLED �45 �-
5. TOTAL DEPTH:
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO lit
7. STATIC WATER LEVEL Below Top of Casing: FT.
f Aboveof Casing)
(Use " Top
8. TOP OF CASING IS FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
NCAC 2C
variance inrn):. accordance with liMETHOD OFgTEST RT
9. YIELD (gpm): �--
10. WATER ZONES (depth):
-�15
Wall Thickness
Diameter or Weight/Et. Material
Material Slot Size Material
_ in.
in.
Method
oviced
Material
DEPTH
From To
a.4 s .I�.az�
LOCATION H
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
Tat
0
WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15ANCAC 2C, WELL
ID THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
-I5•o
NATURE OERSON CONSTRUCTING THE WELL DATE
n of Water Quality, Groundwater Section, 1636 Mail Service Ceeantr' REV. eigh07/2001
1, within 30 days.

258224
WELL CONSTRUCTION RECORD
0
iv
Dew
LO
uali CERTIFICATION Groundwater Section m 6 "'�
North Carolina -Department of Environment and Natural Resources -Division of Water -
WELL CONTRACTOR (INDIVIDUAL)NAME (prin`SaV�wt�t t ;C11�r
WELL CONTRACTOR COMPANY NAME
STATE WELL CONSTRUCTION PERMIT#
'd 1 Municipal/Public ❑ Industrial ❑ Agricultural ❑
I.
(if a licable)
ASSOCIATEDIWQQ PERMIT#
(if app
WELL USE (Check Applicable Box): Residential
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:,ti^ County 53uY
Nearest Town:---
v'e
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Coe)
3. OWNER:
Address
City or Town
(2Z$)- (010.
Area code- Phone number __ $_ O,Z
4. DATE DRILLED
5. TOTAL DEPTH: IyE —_
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 11
7. STATIC WATER LEVEL Below( se"op of Above Top of Casing) .
8. TOP OF CASING 15 \ FT. Above Land Surface*
*Top of easing terminated at/or below land surface requires a
vin accordance with 15 METHOD OFCAC 2C
TEST__R�=�----
9. YIELDIELD (gpm� ): —�4—
10. WATER ZONES (depth):
Amount (c__--
11 DISINFECTION: Type Wall Thickness
12. CASING: Depth Diameter or WeighJFt. pM�atterial p
From_ To 3; FL�tiJ—_ 14`-t'_--_
From To Ft.
From To Ft13. GROUT: Depth . Method
Material P
FromFt.
From To Ft. Material
Slot Size
14. SCREEN: Depth Ft in in.
From To in. in.
From To Ft.
l5. SAND/GRAVEL PACK= Size Material
Depth
From To Ft. �—
From
To Ft. ---
16. REMARKS:
1 DO HEREBY
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds) a }lie map
Latitude/longitude source:❑GPS❑(check 'opogr p
DEPTH DRILLS LOG
From To Formation Description
HONE #
UI
3_'� ItjS
LOCATIONSKETCH
Show direction and distanceRoaes from at least
ds. Include Infrode the road
two State Roads or County ads
numbers and common road names.
RTIFY THAT THIS WEL"I. WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
D-THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
G THE WELL DATE
SIGNATURE OF PERSON CONSTR
IU
GW-1 REV. 07/2001
NC
1
Submit the original to t � � i ision of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh,
27699-1636 Phone No. (91') 733 3221, within 30 days.

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural - Division of Water Quality - Groundwater r Section
CEtint % R, is 5 aaJ..tee s
WELL CONTRACTOR (INDIVIDUAL) NAME (print) C o ZKpHONE #
WELL CONTRACTOR COMPANY NAME C Licit Saavessic fir` I k 0' P r
ASSOCIATED WQ PERMIT#
STATE w'ELLfa livable) NPERMIT# (if a livable)
(ifa livable)
1. WELL USE (Check Applicable Box): Residential U1 Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION: Nearest Town: O"!,4Q County BCov+jfe
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER:
Address
City oor Town r Town State Zip Code
( )-
Area code- Phone number
4. DATE DRILLED 'i* 5 • oz
5. TOTAL DEPTH: TO 5
•
6. DOES WELL REPLACE EXISTING WELL? YES O NO 3
7. STATIC WATER LEVEL Below Top of Casing: FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS l FT. Above Land Surface*
*Top of casing terminated atfor below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): t 5 METHOD OF TEST N.1/4
C
10. WATER ZONES (depth):
258235
TopographiciLandjetting
ORidge ❑Slope QValley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:OGPSOTopographic map
(check box)
DRILLING LOG
Formation Description
V _C anAdnr,
DEPTH
From To
i- t 23
t2.3 Zes
11. DISINFECTION: Type! _ _—! Amount fc
12. CASING: Wall Thickness
Depth Diareter or Weight/Ft. Material
eta iaS LC
From�i.—To l�'3 Ft.______
From To Ft.
From To Ft.
Material Method
13. GROUT: Depth Ft.nli+ew 4' foutBC]
From_a_ To
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From
To Ft. in. in.
From
To Ft. in. in.
15. SAND/GRAVEL PACK: Material
Depth Size
From To Ft.
From To Ft.
16. REMARKS:
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.
WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
THAT A COPY OF T S RECORD HAS BEEN PROVIDED TO THE WELL OWNER
1 URE 1. • . ICTING THE WELL DATE
r. lJ
Submit the original to the Di ision of Water Quality, Groundwater Section, 1636 Mail Service CeGnWrl REV g07/2001
27699-1636 Pitone No. (919)-733-3221, within 30 days.

2. WELL LOCATI�O! N: /n
N arest.Towm IAA County
e
ar c t
(Street Name, mbgers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: ('GI* 3L.Z. i. Red
Address Ic to �9rve
(Streeto
(g2_s)- tclo5• 3935
Area code- Phone number
4. DATE DRILLED -7- L1- `t
5. TOTAL DEPTH: din S
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO W
7. STATIC WATER LEVEL Below Top of Casing: FT.
(Use"+^ if Above Top of Casing)
8.
COS YRoute No.)
NC r28115
City or Town Stare Dp Code
TOP OF CASING IS r FT. Above Land Surface*
`Top of casing terminated at/or below land surface requires a
variance in accordance with LSA NCAC 2C .0118.
9. YIELD (gpm): '36METHOD OF TEST
10. WATER ZONES (depth):
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) C%Id'e. K Soul -pates
CERTIFICATION # 2.436
WELLCONTRACTOR COMPANY NAME C Liras .sa rs .csa 'Sort t] CAL sr pump 'LnePHONE#
ASSOCIATED WQ PERMIT#
STATE WELL CONSTRUCTION PERMIT# (if applicable)
(if applicable)
258240
(4zt_e755 7637
1. WELL USE (Check Applicable Box): Residential to Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
Topographic/Land_s_ening
❑Ridge ❑Slope Piralley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic reap
(check box)
DEPTH DRILLING LOG
From To Formation Description
��)
'3o iCn6 inn.ifi
11. DISINFECTION: Type P416
12. CASING:
Depth
From *1 To 36 Ft.
From To Ft.
From To Ft.
GROUT: Depth
From Q To ZO Ft.
Diameter
Vt1
Amount 7
Wall Thickness
or Weight/Ft. Material
Material
tea or le
From To Ft.
SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
SAND/GRAVEL PACK:
Depth Size
From To Ft.
From To Ft.
16. REMARKS:
I DO
Method
fouled
Slot Size Material
in.
in.
Material
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
o
1�
w
O
CPI
rV
GNA
LL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
AT A COPY OF THIS RECORD HAS BEEN V1DED TO THE WELL OWNER
CONSTRUCTING THE WELL
7-4-Oi
DATE
Sth originalgto th Di?, ion of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
Submit 699-1thePhone
th@ GW-1 REV. 07/2001
733-3 21, within 30 days.

258220
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality C Groundwater Section
ction 3
WELL CONTRACTOR (INDIVIDUAL) NAME (print) ouCORE # (iTI 2%54
SaV
WELL CONTRACTOR COMPANY NAME sr
ASSOCIATED WQ PERMIT#
(if applicable)
STATE WELL CONSTRUCTION e PERMIT#
(ifapp i
I.- WELL USE (Check Applicable Box): Residential Eil Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Infection 0 Other ❑ If Other, List Use
2. WELL LOCATION: "��� p1Topographic/Land setting
/% BQ County ©� e-+�� ❑Ridge 0Slope ❑Valley ❑Flat
Nearest Town: blL(check appropriate box)
c � Lot
No., Zip Code)
ee
Latitude/longitude of well location
Community, Subdivision, Lot N
(degrees/minutes/seconds)
3. OWNER: Latitude/longitude source:DGPS❑Topod aphic map
Address (check box)
DEPTH DRILLING LOG
From To Formation Description
A- 104OYs.t_ ia�uslerr__
(Street Name, Numbe
R1c6NSTk
I_.�5r
1
it Ili
Submit the original to the
ASHEV.,.LE L`•:'-
EC'iol;
JHHCE
(Street or Route No.)
City or Town State
Zip Code
Area code- Phone number
4. DATE DRILLED
5. TOTAL DEPTH: `t"'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO je]
7. STATIC WATER LEVEL Below ( Use , Topof Casing: FT.
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 75A NCAC 2C METHOD OFTESTR-t4
9. YIEIELD-(gpm): � 6
10. WATER ZONES (depth):
11. DISINFECTION: Type_Y
12. CASING:
Depth Diarveter
From •kL_To lot-% FS
From To FL
From To Ft.
13. GROUT: Depth Material Method
Poute
From._,Q__- Toted Ft. !taw.* w } d
From To Ft.
14. SCREEN: Depth Diameter Slot Sizetn Material
From To Ft- in.
From To Ft. in. in.
15. SAND/GRAVEL PACK: Size Material
Depth
To Ft.
Ft.
D4
n5 Aloe t"
LOCATION SKETCH
Amount to Show direction and distance in miles from at least
Wall Thickness two State Roads or County Roads. Include the road
or Weight/Ft. Material numbers and common road names.
Air to _ _ ..o
From
From
16. REMARKS:
To
pQ (ILrRCA ., R7y''T11-t 14
GNATURE OF PE t 0
tV
L WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL (it
AT A COPY OF THIS RE IN - A = - PROVIDED TO THE WELL OWNER
TING THE WELL
-
-I•ri -oz
DATE
Divis on of Water Quality,Gl od water Section, 1636 Mail Service Center - Raleigh, NC
33-3.21, within 30 days.
GW-1 REV.07/2001
0
0

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources Division of Water Quality - Groundwater Section
K
2. WELL LOCATION:
Nearest Town: Fare
3. OWNER:
Address
cei. l4 State Zip Code
City or Town
CILL )- , 2S - a \e31
Area code- Phone number
4. DATE DRILLED 7- 2'c'
5. TOTAL DEPTH: �'�`a_-------
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 1
7. STATIC WATER LEVEL Below tTopof f asing: FT.
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
varianceIELDg accordance with liMETHOD OF TEST (L
9. YIELD (gpm):
10. WATER ZONES (depth):
Amount (a two
12. DISINFECTION: N: Type AaQ?S Wa11 Thickness
12. CASING: numbers and common road names.
Depth Diatpetcr or Weight/FL pM�ate�ri�ah�
FromAl______ To ll $ Ft._� — --Z'�- - P
From To Ft.
From To Ft.
Material Method
13. GROUT: Depth pov4 3
From,— To Z Ft. ^_'s Y —'
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
To FL m. in.
From in.
From To Ft. in.
15. SAND/GRAVEL PACK: Size Material
Depth
From To Ft. From To Ft.
258223
CERTIFICATION24
WELL CONTRACTOR (INDIVIDUAL) NAME (print) # ' I?WELL CONTRACTOR COMPANY NAME
Saw HONE # t
STATE WELL CONSTRUCTION PERMIT#
(ifa icable)
ApplicableBox): Residential [a Municipal/Public 0 Industrial 0 Agricultural 0
ASSOCIATED WQ PERMIT#
(if applicable)
WELL USE (Check very ox
64onitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ 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:OGPS❑Topographic map
(check box)
DRILLING
Formation Description
ea
intaik R.
bers, Community, Subdivision, Lot No.. Zip Code)
County i3 rn�" e
16. REMARKS:
C,10N AN
Submit the original t
71.759.9 -td36 ,}manel`in_
the 1
19) 7
DEPTH
From To
3yJ-' tj#%a rrt
tit
LOCATION SKETCH
Show direction anast
ds or County Roads. Include thdistance in miles from at e road
O
h)
7
T TFHS WEIL WAS CONSTRUCTED IN ACCORDANCE WITH 15ANCAC 2C, WELL
A D AT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
IN(2.THE-WELL DATE
SIGNATURE OF . "'ON C
Ral
ivision of Water Quality, Groundwater Section, 1636 Mail Service Ceentrl REVg07 2001
h, NC
3-3221, within 30 days.
a
0
G

North Carolina - Department of Environment and Natural Resources
WELL CONTRACTOR (INDIVIDUAL) NAME (print) plat
WELL CONTRACTOR COMPANY NAME
WELL CONSTRUCTION RECORD 2 5 8 2 2 6
- Division of Water Quality - Groundwater Section
5 a.a-hues CERTIFICATION #_2136
wn ZwBHONE # eta-2A5-71ar
•- 5titi t
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
2. WELL LOCATIOljS / oI/
Nearest T wn' S ke_J ` e
1
WELL USE (Check Applicable Box): Residential Cd Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
SP p (check appropriate box)
-}� •�Cl� Latitude/longitude of well location
vg ••-.J
(Street Name, Numbers, Community, Subdivision, Lot No Zip Code)
County 3`'t t'-L,e
3. OWNER:
Address '-i17
- ,,r (Street ofir�Rouce No.)
Ci:.. or Town State
(3 8)- fo fn`7 -
f{d
Zip Code
Area code- Phone number
4. DATE DRILLED b - 2.1 - 02
5. TOTAL DEPTH: 12 5
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO ( I
7. STATIC WATER LEVEL Below Top of Casing:
(Use if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surface*
'Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): So METHOD OF TEST
10. WATER ZONES (depth):
11. DISINFECTION: Type 04
12. CASING:
Depth Diareter
From 41 To 3O Ft. 1p'CI
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
_
From 0 To_6 Ft. ,,.. ar po%SCPol
r�
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth
From To
From To
MO
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
N 'be
Amount
Wall Thickness
or Weight/Ft. Material
L1 TO C
16. REMARKS:
I
j_Submit the o-r,ioinal to he D
87 09 161-4 Minterr1%Hk 019) 73
iTICE
Ft
Ft
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.
Cr)
N
WELL WAS CONSTRUCTED IN ACCORDANCE BEEN PROVTH 15A NCAC 2C, WELL
IDED DED TO THE WELL OWNER
•DTH.4TACOPY O�' _Z ..02
SIGNATU
*r�r�F PE UCTING THE WELL - DATE
�F PEA -- •�
ision of Water Quality, Groundwater Section, 1636 Mail Service Ceenter' �Vgh, NC 1
-3221, within 30 days.

2. WELL LOCATION:
Nearest Town: MAcetZS _ County etrnalt rbP
,(1,+Z.&atei7Y den On
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: .%ani
Address inCC460Q f 4A I
(Street or Rohde No.)
Ri.4d.r UM. Ale -
City or Town State
&ti y2
Zip Code
( )- (0$3 4o'Is
Area code- Phone number
4. DATE DRILLED (o2(0'02
5. TOTAL DEPTH: 30 6
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO pa
7. STATIC WATER LEVEL Below Top of ifAboveCasing: f g) FT.
8. TOP OF CASING IS 1 FT. Above Land Surface*
'Top of casing terminated arlor below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): I 0 METHOD OF TEST IZtt.4
10. WATER ZONES (depth): J
11. DISINFECTION: Type 9'QQp Amount '7
12. CASING:
From *1
Depth
To (a-1
From To
From To
13. GROUT: Depth
From Q To_ ZO _ Ft.
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.
Wall Thickness
Diateter or Weight/Ft. Material
Ft. VC{ S st P1a*nC
Ft.
Ft.
WELL CONSTRUCTION RECORD 258241
North Carolina - Department of Environment and Natural Resources - Division of Water Quality Groundwater Section
ction $(o
oiJ.�2C
WELL CONTRACI'OR(INDIVIDUAL)NAME (print) C � 'e K S S
CEatti
WELL CONTRACTOR COMPANY NAME C t%$ C .Sal.' .-b t Apts. of elk d- p at" ...4DONE # L, L Mfl
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WO PERMIT#(if applicable)
(if applicable)
1. WELL USE (Check Applicable Box)' Residential E$ Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring 0 Recovery ❑ Heat Pump Water Injection ❑ Other 0 If Other, List Use
Topographic/LandisUmg
❑Ridge ❑Slope alley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPSOTopographic map
(check box)
DEPTH DRILLING LOG
From To - Formation Description
{ j (07 cIVJen f3Q.4:thr r
Material
aeon ' It
16. REMARKS:
1 DO HE
rl CO
Method
foucea
Slot Size Material
in.
in.
Material
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names. -•
-
t� 7•
•
m
O
rV
U7
RTIFY T
,WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15ANCAC 2C, WELL
HAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNA
THE WELL
(ts• 2(p'02
DATE
Submit the original to he Division of Water Quality, Groundwater Section, 1636 Mail Service Center- R£Vgh, N001
2T699=1636Phone No, 9) 73_-3221, within 30 days.

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
\V ELL CONTRACTOR (INDIVIDUAL) NAME (print) C 1 ifit K S CERTIFICATION #213C.
WELL CONTRACTOR COMPANY NAME C 1((( 11. $0.1a tcsir Sow V ett tip tat, "L.(4
r5HONE #74 a57EaFY
ASSOCIATED WQ PERMIT#
STATE WELL CONSOIC PERM IT# (if applicable)
(if applicablecab1e))
L WELL USE (Check Applicable Box): Residential la Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION: d9
Nearest Town:nn0Ahk.N+CYA.-
ttrt�? GO La A
(s reet Name, Numbers, Community, Subdivision, Lot No., Zip Code)
County QauweADnin
Topographiciancl5ettffig
❑Ridge ❑Slope alley ❑Flat
(check appropriate box)
Latitude/longitude of well location
3. OWNER:
® (degrees/minutes/seconds)
Address $Z �,-nCgitude source:❑GPS❑Topographic map
� oo. Rd Latitude/longitude
(Street or Route No.) (check box)
02865 DEPTH DRILLING LOG
• _ Code�j Aluc CityorTown State Zip From To Formation Description
(e7s) 29$- 5390 #-1 95 Ov-a+ e
Area code- Phone number
4. DATE DRILLED is- 21-0Z
5. TOTAL DEPTH: '-12 5
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO kJ
7. STATIC WATER LEVEL Below Top of Casing: FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 4 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): i METHOD OF TEST &
10. WATER ZONES (depth): ��nn G
I I. DISINFECTION: Type ' Ntya Amount 5
12. CASING: Wall Thickness
Depth Diareter or Weight/Ft. Material
From _To 415 Ft. 1CC, *tt P%oa c
From To Ft. CT'
To Ft. O
13. GROUT: Depth Material Method IN)"
From Q To_ (r
Ft. Cj..tw 4 pouted z.0
From To Ft. c
14. SCREEN: Depth Diameter Slot Size Materialxo
From To Ft. in. in. From To Ft. in. in. 3
15. SAND/GRAVEL PACK: <.-
Depth Size Material ••rn :co
Poa
From To Ft. Cr) c
From To FLat
s 'Li25 �j +
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.
1 DO HE t . e CERTIFY
ow{
QN
ubmit the original to th
91'
GROUNWATER SECTION
ASHEVILLE REGIONAL OFFICE
THl WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
ND THAT A COPY OF THIS RECO HAS BEEN PROVIDED TO THE WELL OWNER
2-OZ.
.1GNATURE OF ' R t ' CONSTRUCTING THE WELL DATE
Dv�v� i ion of : t tty, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
733-3221, within 30 days. GW-1 REV. 07/2001

255007
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Oldie. 14 Sn..f.reCS CERTIFICATION
.##� 2434
WELL CONTRACTOR COMPANY NAME CILO' So.uv �S a' Sew Li d- F Lair LRLPHONE # (4t9-_Zss iair
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 ❑ Recovery ❑ Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: Lives stee County IVncs nape
pj10+: ns/.. s+o-Y OP. A)evJeou,si rnam.
(Street Name, Number, Community, Subdivision, Lot No., Zip Code)
3. OWNER: -AS prle Qju c.kAec
Address Po ii:oX 5 3
(Street or Route No.)
Co ruler dU c a 87I 5
City or Town State Zip Code
()- u23z 7Stz
Area code- Phone number
4. DATE DRILLED Ir 18-e i
5. TOTAL DEPTH: .&.I45
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO del
7. STATIC WATER LEVEL Below Top of Casing: 9O FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 15 METHOD OF TEST /L:
10. WATER ZONES (depth):
I L DISINFECTION: Type Pt►II Amount •7
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
Fromw__To 105 Ft. letj Ott P1asetc
To Ft.
To Ft.
From
From
13. GROUT: Depth
From 0 To ZO
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
Material
Ft. atonewi'
From To Ft.
From To Ft.
16. REMARKS:
Method
foucea
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
+1 105 °Yea 3trelbn
1a$ aw$ Cvrattt•e
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
_ L • HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
9
NSTR;UCT1O �.1 'Y•' ^`vy� THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNEI J
6- 1-02
.' ATURE OF PERSON CONSTRUCTING THE WELL DATE
Sybmit
t the original to the 1�)riston of Water QualitygGroundwater Section, 1636 Mail Service Center - Raleigh, NC
271599__1636 Phone No. (919) 7 3-322t, within 30 days. GW-1 REV . 07/2001
I

255016
L
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) C CERTIFICATION#_�.Tu(o
i 64�v_Cj d SDr\ u^sf _3 - PHONE # (s2si a-55 74eg
WELL CONTRACTOR COMPANY NAME Clt�p 44
STATE WELL CONSTRUCTION PERMIT# v ASSOCIATED WQ PERMIT#
(if applicable)
(if applicable)
1. WELL USE (Check Applicable Box): Residential es Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery 0 Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:, //rs /
Nearest Town: roJe.
County/d,�
(Street Namc. Numbers, Community, Subd
3. OWNER: 5ktov.ee SMatt
Address PO Qom 6274
(Street or Route No.)
Amaa v Ak.
City or Town State
(flt )- 231 15W
Area code- Phone number
4. DATE DRILLED 4r11'ot
5. TOTAL DEPTH: 105
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO VI
7. STATIC WATER LEVEL Below Top of Casing: VO 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
ision, Lot No., Zip Code)
21W4
Zip Code
variance in accordance with 15A NCAC 2C .0118. q
9. YIELD (gpm): if) METHOD OF TEST 6.14-
10. WATER ZONES (depth):
11. DISINFECTION: Type ?"
12. CASING:
Depth Diameter
From Tl To ei Ft. l
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From (7 To 20 Ft. eerie/id- Pure el
Amount i
Wall Thickness
or Weieht/Ft. Material
/k2t Pi�sr.f
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Topographic/Land setting
DRidge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
-hi GI Over lierAnn
6% 305 Graeae
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.
LS:ol14V LZNflrZo
16. REMARKS:
RFRY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTILUCTIONSTi4 RDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
Submit the origin
21699,163¢ Phonet
U
to t
(91
SIGNATURE OF PERSON CONSTRUCTING THE WELL
e Division of Water Quality, Groundwater Section, 1636 Mail Service Ceentert �Vgh, NC
733-3221, within 30 days.
DATE

255013
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
(�i
WELL CONTRACTOR (INDIVIDUAL)NAME (print) aisle K Sal-119SC CERTIFICATION
WELL CONTRACTOR COMPANY NAME Clad e- 5a ysscS'a•50+. Well Yft/.+f &tC' PHONE # fiza ASS 7(obg
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
WELL USE (Check Applicable Box): Residential if Municipal/Public 0 Industrial 0 Agricultural ❑
Monitoring ❑ Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: lrleaz et' 01 �f
County Ainlux6e
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: f1/41Ke
Address d�
(Street or Route No.)
City or Town State Zip Code
(11fb- (0Is.5929
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:OGPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
41 1%4'
Arca code- Phone number
4. DATE DRILLED 6'NO2.
5. TOTAL DEPTH: 3O S
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO m
7. STATIC WATER LEVEL Below Top of Casing: Se FT.
(Use"+" if Above Top of Casing) '
8, TOP OF CASING IS 1 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with I5A NCAC 2C .0118.
9. YIELD (gpm): lb METHOD OF TEST_i_
10. WATER ZONES (depth):
11. DISINFECTION: Type 't% S Amount —1
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From ft To AXE_ Ft. t__flit
From To Ft.
From To Ft.
Material Method
FromOGROUT: l7 To
13. Topthao Ft. Cenen—
+ pidc
From Ft.
14. SCREEN: Diameter Slot Size Material
To
Depth
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size
From To Ft._
From To Ft.
Material
M "40g lrranlfie
LOCATION
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and cotnrnon road names.
C—
CD
--J
J
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANfNtgDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OOS R
�� z fDDATE
SIGNATURE OF PERSON CONSTRUCTING THE WELL
C
t` Ifh�Division of Water Quality, Groundwater Section, 1636 Mail Service Center
Raleigh,
2001
Submit the original t
I_ 27699-1636 Phone No. 19) 733-3221, within 30 days.

255017
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK: Material
Depth Size
To Ft.
To Ft.
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print).C( dP K S0.a.1,[ e5 CERTIFICATION # a-4 AG,
WELL CONTRACTOR COMPANY NAME Iu Qoet`��� �� d ]On. W PHONE # 122,akag
ASSOCIATED WQ PERMITS/
(if applicable)
STATE WELL CONSTRUCTION PERMIT#
(if applicable)
1. WELL USE (Check Applicable Box): Residential 1S Municipal/Public ❑ industrial 0 Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATIA$t ((e County �
Nearest Town: eU/ tit holie/h
(Street Name. Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: Atli Ca, tmas
Address 92:e G thas 7a
(Street or Route o.)
A • ktV: ltt Alt
City or Town State Zip Code
Rz4) (-' IOU- 04018
Area code- Phone number
4. DATE DRILLED 5.3t•o a
5. TOTAL DEPTH: 4t S
6. DOES WELL REPLACE EXISTING WELL? YES oNO VI
7. STATIC WATER LEVEL Below Top of Casing:
FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS t FT. Above Land Surface*
'Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (epm): 4 METHOD OF TEST R1 10. WATER ZONES (depth): --- —
11. DISINFECTION: Type fitrS Amount 9
12. CASING: Wa11 Thickness
Depth Diameter or Weight/Ft. Material
From tl To__IQ_ Ft. Cr 0 21 1
From To Ft.
From To_ Ft. ---
13. GROUT: Depth Material Method
From (7 To 20 Ft. Conn¢ —K-d—
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
in.
in.
From
From
16. REMARKS:
CONSTR
Submit the origin, to t
— 27699-1636 Manche. (91
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
}i 7� over /{erdcn
.�� 435 6-ran:te
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
O
C.rt
CO
HAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
RDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
s3/--c)2
SIGNATURE OF PERSON CONSTRUCTING THE WELL
e Division of Water Quality, Groundwater Section, 1636 Mail Service Ceentµerl �Vgh,0NC 1
733-3221, within 30 days.
DATE

255018
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
W ELL CONTRACTOR (INDIVIDUAL) NAME (print)] w 1i 1raa i�i r5 CERTIFICATION # ay ifs,
WELL CONTRACTOR COMPANY NAME L `at t.CS a.5or. Well Yfu..nr 'C PHONE # fg2s,i &55 748g
STATE WELL, CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential 1f Municipal/Public 0 Industrial ❑ Agricultural 0
Monitoring 0 Recovery ❑ Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION' /
Nearest Town: /�Di/`c County 6....„4,10,42
(Street Name. Numbers, Community„ Subdivision, Lot No., Zip Code)
3. OWNER: rink Vaiu• 'Homes
Address 18°lo panel. AYe..te
(Street or Route No.)
Asntstte fit 211gO6
City or Town State Zip Code
(itt)- as 3* oyyl
Area code- Phone number
4. DATE DRILLED 5.30-es
5. TOTAL DEPTH: 20S
6. DOES WELL REPLACE EXISTING WELL? YES NO El
7. STATIC WATER LEVEL Below Top of Casing:
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): '1t METHOD OF TEST RI-
10. WATER ZONES (depth):
11. DISINFECTION: Type fotSIS
12. CASING:
Depth Diameter
From tl T0__ A1— Ft. lay
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From (7 To 20 Ft. Cenen+ l4ure_d_.
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
Amount it -
Wall Thickness
or Weicht/Ft. Material
# Z I O i tint
From To Ft.
From To Ft.
16. REMARKS:
HFRFRY rFRT
CONSTRUCTION ST1
Submit the original to t
17699-1636 FhonsAb- (91
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
.1 19 Auer Aerdnn
gat
205
4ran.'te
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
ND
rV
CO
HAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
RDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
f- 3 a 'at
SIGNATURE OF PERSON CONSTRUCTING THE WELL
DATE
e Division of Water Quality, GrounchNater Section, 1636 Mail Service Ceentert REVgh, C01
733-3221, within 30 days.

255019
i
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Ctrrda K &tut es CERTIFICATION #
WELL CONTRACTOR COMPANY NAME et,Aite_ 60,00Aess-&.5ory Weil YOa/. n+P tC PHONE # ass 76,8$
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED+iWQ PERMIT#
(if applicable)
(if applicable)
1. WELL USE (Check Applicable Box): Residential 21 Municipal/Public 0 Industrial 0 Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: AL54O.4 County 4i..*cos 46;
(Street Namc. Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: L.: it4+yle 94e...tS
Address Pe cow am
(Street or Route No.)
f aktvrue Nc tern
City or Town State Zip Code
(Ate)- 05M• Wits
Area code- Phone number
4. DATE DRILLED S-it-o+•
5. TOTAL DEPTH: Wit
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: .2O FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS t FT. Above Land Surface*
'Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): %2 METHOD OF TEST Rt5--
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 DRILLING LOG
From To Formation Description
4-i 39 CJver Jier.L•n
39 Q,y s 6-Partite
11. DISINFECTION: Type PitlS
12. CASING:
Depth Diameter
From tl To 39 Ft.
From To Ft.
Amount "l
Wall Thickness
or Weight/Ft. Material
# 21 _f1sSrt
From To Ft.
13. GROUT: Depth Material
From 0 To 20 Ft. C.errent
From To
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size
From To Ft.
From To Ft.
Ft.
Slot Size Material
in.
in.
Material
Method
tocbc=re
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.
b
0
C.11
CO
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
RDS,
AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
RE OF PERSON CONSTRUCTING THE WELL
DATE
Submit the originaliwtjte Division of Water Quality, Groundwater Section, 1636 Mail Service Ceenter' REVgh, NC
27699-1636 Phone No [phone], within 30 days.

255020
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print)C CERTIFICATION # a-'(lr,
WELL CONTRACTOR COMPANY NAME Sis 1 YOLLMp TM1G PHONE # (Z%bi G55 748$
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential 7 Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION: /
Nearest Town: .$4eV. /t`�
County ecir4
(Street Name. Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: Tom awelost
Address NYL CeMrac et! 7io
(Street or Route No.)
q; tV; t..il se atlas
City or Town State Zip Code
(et( )- 1.11. 7 Lin
Arca code- Phone number
4. DATE DRILLED 5. an - o s
5. TOTAL DEPTH: (no 5
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO I
7. STATIC WATER LEVEL Below Top of Casing: ,Sr7 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): \ METHOD OF TEST_t __-
10. WATER ZONES (depth):
11. DISINFECTION: Type e;115
12. CASING:
Depth Diameter
From -I-1 To_ , _ Ft.
6-4
From To Ft.
From To _ Ft.
13. GROUT: Depth Material
From /7 To 20 Ft. Cement
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in
From To Ft. in
15. SAND/GRAVEL PACK:
Depth Sizc Material
Amount 7
Wall Thickness
or Weight/Ft. Material
/k 21 1 5r c
Method
fbt(re
From To Ft.
From To Ft.
Slot Size Material
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
4-i -714 Over Aerate,
f005 Granite
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:
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTR I ICTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
DATE
���---
SIGNATURE OF PERSON CONSTRUCTING THE WELL Submit the originaShe Division of Water Quality, Groundwater Section, 1636 Mail Service CGWrI REVgh, N001
27699-1636 Phone o.�(911 733-3221, 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) t,,.tt%ay K 'Say%I'Sa CERTIFICATION # a-t{ 114,
WELL CONTRACTOR COMPANY NAME C1tiq e Z�-asJ.{e.fs d 30 n well YPun,r sic
STATE WELL CONSTRUCTION PERMIT# 0 C ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
L WELL USE (Check Applicable Box): Residential le Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water injection ❑ Other ❑ If Other, List Use
255029
PHONE # flip a55 nag
2. WELL LOCATION:
Nearest Town: IJeavtcv:IVy
County €,L s M 6e
(Street Name. Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: 3uhSet 7drtis 9oe?eety manes-6 Ass
Address ci
(Street or Route No.)
ue a ree.rnle Air
City or Town State
42s)- (p58. 3111
2$787
Zip Code
Area code- Phone number
4. DATE DRILLED S-i% o-v
5. TOTAL DEPTH: (ee5
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO W
7. STATIC WATER LEVEL Below Top of Casing: icD FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118. +
9. YIELD (gpm): 1 METHOD OF TEST Rt
10. WATER ZONES (depth):
l I. DISINFECTION: Type P'UA
12. CASING:
Depth
From tl To Efo
From To
From To
13. GROUT: Depth
From 17 To 20
Diameter
FL (r
Ft.
Ft.
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
4-1 $a aver ,Rerilnn
80
Gas
&ran; to
LOCATION SKETCH
Amount 4 Show direction and distance in miles from at least
Wall Thickness two State Roads or County Roads. Include the road
or Weight/Ft. Material numbers and common road names.
fb 21 P t 45Ke
Material Method
Ft. Cement fbure d
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From
From
To Ft.
To Ft.
O
ry
r_
IV
a
O
co
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
rr,=,1 CONSiTRUfyTION $1 ANUARBS AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
Ii 1' I I�i GN RE RSON CONSTRUCTING THE WELL DATE
;I
'Submit the original to th ��i lion of Water Quality, Groundwater Section, 1636 Mail Service CCnWrI Raleigh,
2001
127199_1636 Phone No. (919 733-3221, within 30 days.
JPl

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality
WELL CONTRACTOR (INDIVIDUAL) NAME (print) alai.,i
K 5cua t -s
WELL CONTRACTOR COMPANY NAME CLctpe 6at4 t-cSa 50 IN wen tfTAG
STATE WELL CONSTRUCTION PERMIT# C ASSOCIATED WQ PERMIT#
(if applicable) _ (if applicable)
255028
- Groundwater Section
CERTIFICATION # a-4 21`e
PHONE # jV%Sii ov755 7t4g
1. WELL. USE (Check Applicable Box): Residential Zf Municipal/Public D Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: , S4tOi`lt
County Ubnaaode
(Street Name. Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: SunSer Oats enroll Ouns4S Ass
Address
(Street or Route No.)
&leavvv:lie Nt
24ed7
City or Town State Zip Code
(.4t8)- (ass• w$t2t
Area code- Phone number
4. DATE DRILLED 5. Caen-
5 TOTAL DEPTH: 4e3
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO m
7. STATIC WATER LEVEL Below Top of Casing: 50 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS I FT. Above Land Surface*
'Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): 1 e METHOD OF TEST 10
5.-
10. WATER ZONES (depth):
Topographic/Land setting
❑Ridge DSlope DValley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPSDTopographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
4-1 St Over Set -den
St 4oS Grano-e
11. DISINFECTION: Type F.-05
12. CASING:
Depth
From ft To S 1 Ft
From To Ft.
From To Ft.
13. GROUT: Depth Material
From (7 To 20 Ft. Cerren+
Amount 6
Wall Thickness
Diameter or Weight/Ft. Material
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size
From To
From To
16.REMARKS:
Ft.
Ft.
Method
fbure d
Slot Size Material
in.
in.
Material
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
:,
0
I DO HEREBY CERTI Mt* t T THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
LCONSTRUCTION SiANPr, WDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
1 DATE
^ i I -0IGNATURE OF PERSON CONSTRUCTING THE WELL
L_ 1
Submit the original o the Division of Water Quality, Groundwater Section, 1636 Mail Service Ceen�tteer- RREVgh, NC
-' 17699.1636 Ekrine Mir. (919)' 33-3221, within 30 days.
AB,fti.LE RE , ^',AL OFFCE

255034
' 2769946%6.-P11oue No"
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Cprrde K J0.L\tite5 CERTIFICATION # a-"{ AL,
WELL CONTRACTOR COMPANY NAME CtLde 6a0A8."vS -Ea 5On la tRat.vnr The. PHONE # f82ki c255 Won
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED IWQ PERNIIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential l f Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION: /1 A&gtt Nearest Town: G;CCf i-er County N fwt.
(Street Name, Numbers, Community, Subdivision, Lot No.. Zip Code)
3. OWNER: 'rot trow.e 7.Ierwt
Address Mai Pat Pow AV6nu10
(Street or Route No.)
AsLev:it, NC 2E$06a
City or Town State
(link)- a5E• ogg%
Area code- Phone number
4. DATE DRILLED Se01•0%
Zip Code
5. TOTAL DEPTH: 2.5
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO m
7. STATIC WATER LEVEL Below Top of Casing: t. d FT.
(Use "+" if Above Top of Casing)
S. TOP OF CASING IS % FT. Above Land Surface*
`Top of casing terminated at/or below;and surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): METHOD OF TEST RI_
10. WATER ZONES (depth): d"
I . DISINFECTION: Type 12:115
12. CASING:
From 1-I
From
From
13. GROUT:
From 0
From To
14. SCREEN: Depth
From To
From To
15. SAND/GRAVEL PACK
Depth
To
To
Depth Diameter
To 14S Ft. &'4
To Ft.
To Ft.
Depth
To 20
From
From
16. REMARKS:
Ft.
Material
Cenenf
Ft.
Diameter
Ft. in.
Ft. in.
F.
Ft.
Size
Amount G
Wall Thickness
or Weight/Ft. Material
/I2i Pi45r.
Method
(cure d
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
14 5 over $trdnn
I 45 ZGS Granite
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.
)1 CONSTRUCTION STANPA
Submit the original to th
91
FY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
ND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
GN" U -=e PERSON CONSTRUCTING THE WELL
ti
- O - 0
DATE
'Div".ion of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
733- 221, within 30 days. GW-1 REV. 07/2001

255035
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size
From To Ft.
From To Ft.
16. REMARKS:
From
13. GROUT: Depth
From (7 To 20
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) C`r44Y K St'UtakAtc• CERTIFICATION # a{ ;Ls
WELL CONTRACTOR COMPANY NAME Cilia 6We 1.#-XS- 50ec Welt *Taint mPHaim ONE aima55 nagSTATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable)
(if applicable)
L WELL USE (Check Applicable Box): Residential PI Municipal/Public O Industrial 0 Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection ❑ ' Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: MIa.a&ec County PJu.Vaewbt
(Street Name. Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: L.n4a 1/14\e. koa
Address •-i 4ottlare n.p.ra
(Sireet or Route No.)
AteYo.wdac } c ano
City or Town State Zip Code
(es0- .259• 103%
Area code- Phone number
4. DATE DRILLED S-Ws- 0
5. TOTAL DEPTH: ?' S
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO l
7. STATIC WATER LEVEL Below Top of Casing: 170 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING 1S 1 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): S METHOD OF TEST Rtc:)-
10. WATER ZONES (depth):
Topographic/Land setting
DRidge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees'hninutes/seconds)
Latitude/longitude source:OGPSOTopographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
4-) 120 Over Ateinn
110 2 45 �rrnnte
11. DISINFECTION: Type ?Z%tS
12. CASING:
Amount (.
Wall Thickness
Depth Diameter or Weight/Ft. Material
From'+'I To Ise Ft. 21AS—Ike
From To Ft.
To Ft.
Material
Ft. Cerlen+
From To Ft.
Slot Size Material
in.
in.
Material
Method
enure
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.
O
01
lD
O
O_
o--
r%t
�c
n c
am
char
rn
G
--11 DO HEREBY GERTIFY1T,H
IFONSTRUCTION STANDAR
ATV IS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
S- 04 -(1.9,
GTVA I,�tce OF PERSO ONSTRUCTING THE WELL DATE
isobmLthe oriv„final to tIu Diviion of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Pho,ie'NOAVIT) 733-3i21, 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)eir vie K Sabo le,te CERTIFICATION # a41/4,
WELL CONTRACTOR COMPANY NAME &tie_ OttJ'jttS -IL Weft tr O�.,..r fnG PHONE # f825) c255 74,81
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED IWQ PERM Ern
(if applicable) (if applicable)
252842
I. WELL USE (Check Applicable Box): Residential LS Municipal/Public 0 Industrial ❑ Agricultural ❑
Monitoring O Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION: � nn
Nearest Town:_ IO/:\�e ?- County Oe
int ole K inIk.3
(Street Name. Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: itaeece -tnve.s+at•s
Address 1�
_ (Street b7 Route
Na.)
/Iskev;Ye 1DC
Znc
028tro 4,
City or Town State Zip Code
(128 )- (0G1- A8(03
Area code- Phone number
4. DATE DRILLED Li' al-o2
5. TOTAL DEPTH: 505
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO t
7. STATIC WATER LEVEL Below Top of Casing: 1 l7 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS t FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): .2 METHOD OF TEST 64_
10. WATER ZONES (depth):
Topographic/Land setting
€fudge ❑Slope ❑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
4-) /3(o Over Retch',
ho(A 505 &ran.,'te
11. DISINFECTION: Type jt5
12. CASING:
Depth
From f'I To 1 oats
From To
From To
13. GROUT: Depth
From (7 To 20
From To
14. SCREEN: Depth
To
From Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth
From To Ft.
From To Ft.
riEMABITtfi
Diameter
FLU
Ft.
Ft.
Material Method
Ft. Certent /Coure el
Ft.
Amount ) "�
Wall Thickness
or Weight/Ft. Material
21 (IQ56.c
Diameter Slot Size Material
in.
in.
Size Material
11
O HEREBY CERTIFY THAT' i jJ`
INSTRUCTION STANDARDS A
fill
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
IN)
N
-V
N
ON
WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
D'fiiAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
GeCu.0 SIG
ASHL VALL rr'.Li :5
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Ceenterl RREVgh, NC
27699-1636 Phone No. (9l9) 733-322 , within 30 days.
AT E OF PERSON CONSTRUCTING THE WELL DATE

252841
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Cif i,V K Sal brirc CERTIFICATION #
WELL CONTRACTOR COMPANY NAME nI QQ``t'�' S CS a SO+t well 1' Oat w+; �tt-C.—PHONE # {Vs) &SS 74,8
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential e Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCATIO : rr
Nearest Town: 116he J j\C County
\(--n1 t'9-
(Street Name. Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: t&Q" s1 'V=CK
Address
(Street or Route No.)
City or Town State Zip Code
(92'S)- (08 3 - 9 91-11
Area code- Phone number
4. DATE DRILLED li'a1(o-02•
5. 'TOTAL DEPTH: 305
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO I
7. STATIC WATER LEVEL Below Top of Casing: 6a 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 l5A NCAC 2C .0118.
9. YIELD (gpm): 2METHOD OF TEST
10. WATER ZONES (depth):
R15._
L, Ct fib..
Topogr lc/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)
DRILLING LOG
Formation Description
Over Aeraien
DEPTH
From To
.}/ 10
70 305 Gfan;te
11. DISINFECTION: Type rut, 5 Amount
Wall Thickness
12. CASING:
Depth Diameter or Weight/Ft. Material
From tl To 70 Ft. (OsL
Jk 21 _ele c.
From To Ft.
From To Ft.
13. GROUT: Depth
From (7 To 20
Material Method
Ft. Certen¢ &ure el
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. REMA
r
IIDO HARE T
NSTRUCTION STANDARD?' , .(+
�I r
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.
WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
D THA3' A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
yisb
ATURE F PERSON CONSTRUCTING THE WELL DATE
of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
within 30 days.
GW-I REV. 07/2001
O
IV
a
-C
lV
N3

13. Depth Material
To 20 Ft. C'emenf
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth
To
WELL CONSTRUCTION RECORD
252856
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print)lr`rtd,_ K 54t1t-5 CERTIFICATION a�..3(0
WELL CONTRACTOR COMPANY NAME s� SS Son. wetI___�a.nr_SC ...PHONE # ($2S)i a55 76,8?
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential f Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATIO : nn
Nearest`` Town: c:,n SeCt County tl.a,,naCZK�(2
.5larve S C(1Je
(Street Name. Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: Dou.) %cco..5coc1,
Address
(Street or Route No.)
City or Town State Zip Code
Ed$/- r 30 - $ +455
Area code- Phone number
4. DATE DRILLED tk`alp -02-
5. TOTAL DEPTH: V 5
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO I
7. STATIC WATER LEVEL Below Top of Casing: 20 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS I FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 2n METHOD OF TEST_ Rtd"
10. WATER ZONES (depth):
11. DISINFECTION: Type ..U3
12. CASING:
Depth
From 1-1 To to 2 Ft.
From To Ft.
From To Ft.
GROUT:
From 0
Diameter
(1
Amount J
Wall Thickness
or Weight/Ft. Material
/k2) Of45r„
From Ft.
From To Ft.
16.REMARKS:
.r.
Method
'pure el
Siot Size Material
in.
in.
Size Material
Topographic/Land
❑Ridge ❑Slope ig,rnuey ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
.-) (o Z Over flerdon
(02 185 &eapDite,
N t a. ✓S_u
1 3 i, i i'�
LOCATION SKET E';'''
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
C
C
E;E T
O1bT
JU 2 2002
the origin
I to
GROUNNRgkCIfION No. (9
ASHA�qq��b
EVILL'E REGIONAL OFFICE
AT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
RDS, AND TH(T A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNAX12E OF PERSON CONSTRUCTING THE WELL DATE
e Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
GW-1 REV. 07/2001
733-3221, within 30 days.

WELL CONSTRUCTION RECORD
252839
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME4 (print) arks,arks,K 5c2aa Its-5 CERTIFICATION #
WELL CONTRACTOR COMPANY NAME ek A e_ SQNL_ c,S -2a.5OA well t A.LM r &tc PHONE St(87S) 0255 74,8g
STATE WELL CONSTRUCTION PERMIT'S ASSOCIATED WQ PERMIT#
(if applicable)
(if applicable)
1. WELL USE (Check Applicable Box): Residential Er Municipal/Public 0 Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: Cawd\tc County $unto 'Vibe
sia,rnaes (toe
(Street Name. Numbers, Community, Subdivision, Lot No.. Zip Code)
3. OWNER: 17. ov;d ,Ill:Ln M..scF
Address -791 .4csneg COVQ Rei
(Street or Route No.)
Ast,e-v;Ite „tic
r9t o(n
City or Town State Zip Code
( 23)_ 0(fl - 365
Area code- Phone number
4. DATE DRILLED 4-15- Q1
5. TOTAL DEPTH: \MS
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO IZI
7. STATIC WATER LEVEL Below Top of Casing: 20 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS \ FT. Above Land Surface*
`Top of casing terminated at/or below land surface requires a
variance in accordance with I5A NCAC 2C .01 I8.
9. YIELD (gpm): a° METHOD OF TEST
10. WATER ZONES (depth):
11. DISINFECTION: Type ? \1.5 Amount ..5"---
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From #t To 56 Ft.�__4 2L (Jct.:,
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From (7 To 20 Ft. Cemen# fbure el
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
To Ft.
To Ft.
Topographi c/Lai4Setting
❑Ridge ❑Slope Malley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
5(o Over $erdnn
5io OAS Granite
From
From
16. REMARKS:
Material
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
G
N
N3
—13
N
ON
0
0
cm
Do
"'tom
cri
m rri
cn
rna
0
H
0
13T' CERTI
BRI$ I!1,4te Di'
ASRE699LE6194BIWOMNUF(9711) 733
HIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
AND THMr A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNA Jr}RE OF PERSON CONSTRUCTING THE WELL DATE
ision of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
221, within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
252838
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
CERTIFICATION #
WELL CONTRACTOR (INDIVIDUAL) NAME (print)L!`ryde K tcuo es
WELL CONTRACTOR COMPANY NAME ��r.(�, QQ e cSd Soso I I 1�0�. «.; S1-t-G—PHONE # ($'J� 0255 7(47(
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
WELL USE (Check Applicable Box): Residential If Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
d
Nearest Town: t"56e✓aie County Bu.cu,+. b.z,
2e c&sire y
(Street Name. Numbers, Community,J ubdivision, Lot No., Zip Code)
3. OWNER: Macve.� bt3tas
Address 41 ee-ndwe uneln
(Street or Route No.)
A
City or Town State
(K )- (0(05- go51
Area code- Phone number
4. DATE DRILLED 4-a3-02.
5. TOTAL DEPTH: SOS
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO lil
7. STATIC WATER LEVEL Below Top of Casing: VC) FT.
(Use "h" 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 l5A NCAC 2C .0118.
9. YIELD (gpm): \ S METHOD OF TEST
10. WATER ZONES (depth):
11. DISINFECTION: Type Q',v%5 Amount I D
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 3-1 To L\4 Ft. 6,4 A2_L toi45r.e
From To Ft. 1
From To Ft.
13. GROUT: Depth Method
From (2 To 20 Ft. 'cure el
From Ft.
14. SCREEN: Diameter Slot Size Material
From Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
as
aBeo(o
To
Depth
To
From
From
16. REMARKS:
Depth
To
To
Zip Code
Material
Cenend-
R��
Topographic/Land setting
❑Ridge Fr351ope ❑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
4-I yy Over t'ierrien
yy 5o5 . Granite
O 0
Z
P1
tr
m
LOCATION SKETCH ( m�
Show direction and distance in miles fromyt-leas2
two State Roads or County Roads. Includegi roe
numbers and common road names.
Size Material ugere5 eu
Ft.
Q:n-aea
Ft.
RDANCE
TH 15A NCAC 2C, WELL
I a HEY
ERTif ^Th' -1C1I S,, AND Tlj- V A COPTHIS WELL WAS YOFTHIS REECORD HIN AS tA BEEN TO THE WELL OWNER
,2362
SIGNAT . E OF PERSON CONSTRUCTING THE WELL DATE
the D -sion o + f Water Quality Groundwater Section, 1636 Mail Service Center - Raleigh, NC
E1 3! At rt0F9
iGW-I REV. 07/2001
73 -3221, within 30 days.

WELL CONSTRUCTION RECORD
252837
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAMpE' (print) Cirri'? K .Sa[dte_t- CERTIFICATION # a-y At,
WELL CONTRACTOR COMPANY NAME CtLe 'acSd SOxc _ LJft� �' ; C. PHONE # ($;Sji o255 70g
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential es Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: Cuaawee
s' gJ`a0ei Ctt3C
(Street Name, Numbers, Community, Subdivision, Lot No.. Zip Code)
3. OWNER: VJ=USS
Address -Vk-s S\utrtt etvt Ra
(Street or Route No.)
Ast,ev',ac Nc
City or Town State Zip Code
(P, )- blot - 3eo 1
Area code- Phone number L`_ 5 -C 2
4. DATE DRILLED
5. TOTAL DEPTH: (a5
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO VI
7. STATIC WATER LEVEL Below Top of Casing: AO 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): 3—_ METHOD OF TEST
10. WATER ZONES (depth):
a88cb
County tur.conbe,..
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 T,Q Formation Description
over Aerdan
Ols Its 6raet; fe
11. DISINFECTION: Type PL
12. CASING:
Depth Diameter
From tl To 9 5 Ft.
From To Ft.
From To Ft.
13. GROUT: Depth
From (7 To 20 Ft.
Amount
LOCATION SKETCH
Show direction and distance in miles from at (east
Wall Thickness two State Roads or County Roads. Include the road
or Weight/Ft. Material
/k 21LgS�
Material
Cement
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
Method
/bure d
Slot Size Material
in.
in.
numbers and common road names.
O
-t
N
.-o
.L"
T
DIRERL ERI<IE,Y7TI171ST
'''
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270006, Pligtye No. E9191)''7'�r} -3221
WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
r THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
VyX;—C17
ATURE OF PERSON CONSTRUCTING THE WELL DATE
of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
within 30 days. GW-I REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print)Ciryde K S0.t\eyCCS
WELL CONTRACTOR COMPANY NAME Qn. , n. Wn i
STATE WELL CONSTRUCTION PERMIT#
(if applicable)
252848
CERTIFICATION #
PHONE # {VMi ass 7(08g
ASSOCIATED WQ PERMIT#
(if applicable)
1. WELL USE (Check Applicable Box): Residential V Municipal/Public D Industrial ❑ Agricultural D
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: LQ'.CtSFee County Buneow+.lie
por s.„ T&"uey CrefeK Rd 84148
(Street Name, Numbers, CNrimunity, Subdivision, Lot No., Zip Code)
3. OWNER: Stl:+ta Recker
Address 1041 Pee fi. T,rntq
(Street or Route No.)
Leicester }1c
City or Town State
(g2s)- (o(e&• &R??
CCe.a Rd
AV148
Zip Code
Arca code- Phone number
4. DATE DRILLED IA'Z>{-aZ
5. TOTAL DEPTH: /3S
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO I
7. STATIC WATER LEVEL Below Top of Casing: AP FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS I FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): SO METHOD OF TEST
10. WATER ZONES (depth):
ppographic/Land setting
idge DSlope 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
--1 Ye Over jterdon
1(0 125 Granite
11. DISINFECTION: Type F'tt5
12. CASING:
Depth Diameter
From ti To 7fio Ft. (04
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From (2 To 20 Ft_ Cement poure d
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Amount 3
Wall Thickness
or Weight/Ft. Material
la1 fIR5ie
Slot Size Material
in.
in.
16. REMARKS:
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.
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ASHEViLLE R1!GCi1_OFFICE
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WELL S CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
D THATT COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
2F2tj 02.
4ATURE OF PERSON CONSTRUCTING THE WELL DATE
n of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
within 30 days. GW-I REV. 07/2001
O
2

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAMEC (print)rel./ yip K &LA -I sLC5 CERTIFICATION # 2-4 T.(e
WELL CONTRACTOR COMPANY NAME ett.t4Q 6ata..rtW tS a Son. etl t'Oo wC. +P &LPRONE #f/%10 &5nay 5
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED IWQ PERMIT#1
(if applicable) (if applicable)
252847
WELL USE (Check Applicable Box): Residential PI Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATIO
Nearest Town: ..1; 1
c, ` P
N.5 e cs/ j C L
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3, OWNER: Bon Sepyc
Address o77 1}0.n.ha tn•. Q ha6e
(Street or Route No.)
ASi,tv:ltr Alt areas
City or Town State Zip Code
(gas )- 299 1 fe t(e
Arca code- Phone number
4, DATE DRILLED R' lt•-121
5. TOTAL DEPTH: `-1a 5
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO I
7, STATIC WATER LEVEL Below Top of Casing: SD FT.
(Use "+" if Above Top of Casing)
8, TOP OF CASING IS 1 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): 4 METHOD OF TEST Fr _
10. WATER ZONES (depth): —_
11. DISINFECTION: Type p: Its
12. CASING:
Depth Diameter
From }1 To 81 Ft.
From To Ft.
From To Ft.
13. GROUT: Depth Material
From 0 To 20 Ft. Cement
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15, SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
County U c1/4,n1C a rn\ao
Topographic/Land setting
tdge ❑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
4-1 71 Over fierdnn
81 415 Granite
Amount '
Wall Thickness
or Weight/Ft. Material
21 Plasr.�
Method
�6:re el
Slot Size Material
in.
in.
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
N
CPI
D E,,IERfxD\ncEIr1Tlfl, TIIAT" IS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
[ TRUTT'ON $TiAN�DARDs D THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
05 — /—c_>2
DATE
mit the original to the
2769Q�+6'�6-_,,,,,,0.one-Na. r C 710N
ASHEVILI_E REGIONAL OFFICE
SI ATURE • PERSON CONSTRUCTING THE WELL
ivi on of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
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) Cj4 i4B K Sa1.blts- CERTIFICATION # ay'�fe
WELL CONTRACTOR COMPANY NAME Ctr-ipe aco4 it vS d,SOn. well traa.n+r C- PHONE # (g75) ass 'nogg
STATE WELL CONSTRUCTION PERMIT# C ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
252843
1. WELL USE (Check Applicable Box): Residential li Municipal/Public ❑ Industrial ❑ Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: A3 Le v;11 e
Scl‘ocX
County &tea. be
(Street Name. Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: Sect- Mot}n..
Address bat sae.ok (i
(Street or Route No.)
As tav: ne A)C
2880 3
City or Town State Zip Code
(g36)_ (0814— ?Stets
Area code- Phone number
4. DATE DRILLED Li-IS-02
5. TOTAL DEPTH: oia5
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO m
7. STATIC WATER LEVEL Below Top of Casing:
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surface*
`Top of casing terminated actor below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): Co METHOD OF TEST R;a�_
10. WATER ZONES (depth):
/Topographic/Land setting
edge 0Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
}2 11(e Oder Aerden
it& ago Gran:+e
11. DISINFECTION: Type fits
12. CASING:
Depth Diameter
From f'1 To Ole Ft_
From To Ft.
From To Ft.
13. GROUT: Depth Material
From (7 To 20 Ft. Ceeren+
Ft.
From To
14. SCREEN: Depth
From To
From To
15. SAND/GRAVEL PACK:
Depth
To
To
From
From
MANR
:D
Amount y
Wall Thickness
or Weight/Ft. Material
1k21 rt45r.7•
Diameter
Ft. in.
Ft. in.
Ft.
Ft.
Method
?cure cl
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.
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STRUCTION STANDARDS
ELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
Li
���
SIGN 4TURhrt)FRERSON CONSTRUCTING THE WELL DATE
G AND YA;iEP �F('TI4,.�.y sion of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
tut enone No. 9�3- GW-I REV. 07/2001
t /bYY-163b none 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) Q, e K tatIy ct- CERTIFICATION #
WELL CONTRACTOR COMPANY NAME l tcl.�Q en i
252846
PHONE # (4'2hi a55 76,8g
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
WELL USE (Check Applicable Box): Residentially Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: Met ntder
at 4•1 \vr.e a Qg-.
County tKA,(xc orhire
(Street Name Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: Pew% mace
Address no GftarIKe+uiW\ Qri
(Street r Route No.)
Ak42441Mier Ac a670
City or Town State Zip Code
(S2%)- 4,45.75(05
Area code- Phone number
4. DATE DRILLED 4-1a-Oz
5.TOTAL DEPTH: abs'
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO VI
7. STATIC WATER LEVEL Below Top of Casing: lop FP.
(Use "+" 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 ISA NCAC 2C .0118.
9. YIELD (gpm): a METHOD OF TEST PI_
10. WATER ZONES (depth):
Topographic/Land setting
❑Ridge ❑Slope CY4ey ❑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
4.J Vrr fierdnn
a7
4285 Gran ;tc
11. DISINFECTION: Type 13; Il5
12. CASING:
Amount r
Wall Thickness
Depth Diameter or Weight/Et. Material
From *1 To 2:t FL 69.4 A21 ficiS e
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From (J To 20 Ft. Cement foure d
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
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.
-0
T
0
0
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rzt
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2:
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I DO HEREBY CERT
RU ION STANDARDS,
it the original to the Div
1636 Phone Lik,1919)_Z334221,
CPI, C> LUFHCE
ASHEV,rE G
ELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
AT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
U)2
ONSTRUCTING THE WELL DATE
OF PERSON
Vater Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
ithin 30 days. GW-I REV. 07/2001

258247
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Grnouunndwa erIFICAT�SN Section
WELL CONTRACTOR (INDIVIDUAL) NAME (prinQ K
t 5ntait� �. �• •Se �! �L tr sI;ItcPHONE # f4s, 4 ._a�5-5 7K8Y
WELL CONTRACTOR COMPANY NAME!
STATE WELL CONSTRUCTION PERMIT#
(if applicable)
ASSOCIATED WQ PERMIT#
(if applicable)
I. WELL USE (Check Applicable Box): Residential la Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION:
Neare t Town: County. "Ca.
lete
(Street VarA. Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: 4- 1 .f.^crf,
Address fn fb�Tx 560
(Street or Route No.)
City or Town State
(8?@)- a1 s • /a %to
Area code- Phone number y 9 ��
4. DATE DRILLED
5 TOTAL DEPTH.
7. STATIC WATER LEVEL Below Top of Casing: T
FT.
f
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS t FT. Above Land Surface'
• *Top of casing terminated at/or below land surface requires a
vIELD g accordant` ith tSAMETHOD .0OFgTEST___
9. YIELD(gpm):
10 WATER ZONES (depth):
P/‘tm
Zip Code
6 DOES WELL REPLACE EXISTING WELL? YES ❑ NO WI
pographic/Land setting
e ❑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
! t LI
U�72 5
OYs ��---
LOCATION SKETCH
Amount is.' Show direction and distance in miles from at least
1 2. CASING: I. DISINFECTION: Type 'A Pn Wall Thickness two State Roads or County Roads. Include the road
Depth Diareter or Weight/Ft.Material
�ate 111--- numbers and counon road names.
rial
From To 42 Ft.�' — —1r1. . f . C rr
From To Ft.
From To Ft.
Method 13. GROUT: DepthC = } pcMaterial Met.,
From_,__ TooZO Ft.�.--
From To Ft.
14. SCREEN: Depth Diameter Slot Size
rn Material
From To Ft. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK: Material
Depth Size
From To Ft. From To Ft. --- ---
16. REMARKS:
I DO HER
(.._ CON *. i
St
`Submit the original to the'.Riyis
27699-1636 Phone No. (919) 733-3i
}
0
N
CERTIFY T WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISANCAC 2C, WELL
D THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
N NATURE 0 RUCTING THE WELL DATE
45 R .t.
on of Water Quality, Groundwater Section, 1636 Mail Service Ceenter1 �Vgb, C
21, within 30 days.
rnr

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Ciy.he k. Sa WU s' CERTIFICATION # o�y3fp
WELL CONTRACTOR COMPANY NAME d d
251584
PHONE # 182bl r?55-744g
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable)
(if applicable)
1. WELL USE (Check Applicable Box): Residential Ja Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATIOO:
Nearest Town: Mktv:Ile
Cordell Act es
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: Nacve. OWNS
Address
(Street or Route No.)
County f)trt corn6c
City or Town State Zip Code
( ZS')- (0(05- 9051
Area code- Phone number
4. DATE DRILLED 0 4- 03 - o 2.
5. TOTAL DEPTH: 445
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO Q
7. STATIC WATER LEVEL Below Top of Casing: 20 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS I FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with I5A NCAC 2C .0118.
9. YIELD (gpm): 2O METHOD OF TEST
10. WATER ZONES (depth):
I I. DISINFECTION: Type Pow Amount /D
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From +1 To 85 FL - ffiu #2I /0/O5h'C
From To Ft.
From To Ft.
13. GROUT: Depth
From 0 To ZC) 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
Centen f TOO tr/ed
Topographic/Land setting
❑Ridge ope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
+1 gS Or.., BefeiOa-
85 44*5 Over
er
cV
co
z
rno
m�
w n
LOCATION SKETCH ko p
Show direction and distance in miles from at leas'K
two State Roads or County Roads. Include the road
numbers and common road names.
Cova-,eA estre-
/sheo ee
16.REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
r'-CQN TRUCT 6N SiTA�JWA!tDS . 1 THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
ICI l
�" ����i✓ 0
•3 O
TURE OF PERSON CONSTRUCTING THE WELL DATE
iii
unit the original to the Di ision
2769t9-1636_Phone No. (919) 733�3221,
of Water Quality;'Groundwater Section, 1636 Mail Service Center -Raleigh, NC
within 30 days. GW-1 REV. 07/2001

251585
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Ctyit K. -4 as. CERTIFICATION # QH36
WELL CONTRACTORCOMPANY NAME Ciydt Se Nd4!tr5 - San Ne l/ � p,,a? PHONE # (871j .�-65. 76Sg
STATE WELL CONSTRUCTION PERMIT# d ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential 0 Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring 0 Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: &e V➢Ile County QV11toM6e
54o.rne5 Cove Road 2860(a
(Street Naine, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: Zautd MCTghve 4e
Address -797 5+arnes Oovt Road
(Street or Route No.)
ASAe,.tlit Nc
2 flO(
City or Town State Zip Code
(Fla)- Co67- 3(e57
Arca code- Phone number
4. DATE DRILLED 3-2g-OZ
Topogra m/Land setting
❑Ridge ope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
4-1 77 Over Rerdon
C
5. TOTAL DEPTH: 70S 76 Jos'
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO 0
7. STATIC WATER LEVEL Below Top of Casing: ro FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surface*
•Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): 2 METHOD OF TEST /1;-
10. WATER ZONES (depth):
1 I. DISINFECTION: Type f,115
12. CASING:
Depth Diameter
From 4 / To 73 Ft. Sia.
From To Ft.
From To Ft.
13. GROUT: Depth Material Method/�,,
From 0 To 20 Ft. Cement /•'they/
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.
Amount S
Wall Thickness
or Weight(Ft. Material
O
I �T
-V
eD Frn
>0
73�
NZ
• ->
LOCATION SKETCH %D 3
Show direction and distance in miles from at leastZ
two State Roads or County Roads. Include the road
numbers and common road names.
//,)/ ,' t 2 3
e
54 cx r NCS
coJz
r
16. REMARKS:
O HEREBY GBPTIF- =t' 4-T TLISWELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
N 3'RUCTI N S1rANDA DI THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
;I(
Submit the original to the Di ision
27649-4636-Phone-Nu.(9-4 p3J-322I
URE OF PERSON CONSTRUCTING THE WELL DATE
of Water Quality;Groundwater Section, 1636 Mail Service Center - Raleigh, NC
within 30 days. GW-I REV. 07/2001

2515'79
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section WELL CONTRACTOR (INDIVIDUAL) NAME (print)_ C.t�t K Sao.ttc6 CERTIFICATION# o2r, 3(
\YELL CONTRACTOR COMPANY NAME Ct•Vet Baum(( i"So o 'Jett a- pan.? PHONE # (Q34) 25$ 7/7
STATE WELL CONSTRUCTION PERMIT#
(if applicable)
ASSOCIATED WQ PERMIT#
(if applicable)
1. WELL USE (Check Applicable Box): Residential IA Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ if Other, List Use
2. WELL LOCATION:
Nearest Town: rn:ev:e w County B,,ncosnhe
( n..ruea Gt.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: Latin .} Latty`j uu9\.Ct
Address Wei &stte.. Gc4s. Re4
(Street or Route No.)
f o',rv,c aJ
City or Town State Zip Code
(Y28)- 855-791t
Area code- Phone number
4. DATE DRILLED 03- 35 -Ot
5. TOTAL DEPTH: tto5
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO 17
7. STATIC WATER LEVEL Below Top of Casing: 5t FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS l FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 30 METHOD OF TEST al10. WATER ZONES (depth):
Topographic/Lartd setting
ge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degreeshninutes/seconds)
Latitude/longitude source:❑GPSOTopographic map
(check box)
DEPTH DRILLING LOG
From To Formation Descriptio&
1 12l flyer geedor.6
12 t 14,5
11. DISINFECTION: Type i?'tl j
12. CASING:
Depth Diameter
From } 1 To 113 Ft, CA
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From 0 To 70 Et. Ce.obc. f- routed
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.
Amount
Wall Thickness
or Weight/Ft. Material
z ?lots Cit.
A =I=
Can
& ran; t ,,
e-COlern
Yo
mrn
-
-yrn
Nat
rn=
T
p3
43 N
1.0 —
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.
16. REMARKS:
THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTjLUCIFION' STAN Y?CS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
2+1 1.
e>.
SIG
1 Submit the original t the D
77F99-1656 Phunc�JJ19) 73
0125/ot
E OF PERSON CONSTRUCTING THE WELL DATE
ivision of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
3-3221, within 30 days.
GW-I REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
t
WELL CONTRACTOR (INDIVIDUAL) NAME (print) CI Vie PCS ant, es CERTIFICATION# d W3%
WELL CONTRACTORCOMPANY NAME Click .fainters - -San Well t pan, is PHONE # ffl 55'7bd8
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
251518
I. WELL USE (Check Applicable Box): Residential I Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: Con elk r
Curf;s Cnea Read
County 13 tt?Corn be
(Street Name. Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: Paul Revs
Address Curia Ceeee
(Street or Route No.)
Conti/or, i(/r
City or Town State
(818 )- (0(07 • 3.2 2B
Area code- Phone number
4. DATE DRILLED 3•aa-o2
5. TOTAL DEPTH: 185
Zip Code
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO .
7. STATIC WATER LEVEL Below Top of Casing: 70 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS f FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): 31 METHOD OF TEST 45
10. WATER ZONES (depth):
Topographic/Land setting
idge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To
{� 75
75 1,315
11. DISINFECTION: Type p: //5
12. CASING:
Depth Diameter
From d'I To 75 Ft. % v 3k 7) P/OSi.t
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From 0 To Q0 Ft. ('Cnen r "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: .1�)/
Depth Size Material /�
From To Ft. /51
Formation Description
Over $erda.'
c
(nag ;Mero
\n
-rI am
0
Do
Amount IP
Wall Thickness
or Weight/Ft. Material
From To Ft.
S
n.
LOCATION SKETCH t..)
Show direction and distance in miles frotizt le$t
two State Roads or County Roads. Include the t ead \\
numbers and common road names.
✓/ r itril IBKL BY CER t31`Yi THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
T)I CONSTRUCTION STANL7AR6S, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
6,1
03/2 a. /o z
SIG'ATUR PERSON CONSTRUCTING THE WELL DATE
J
ditiLl�lhikh\+, oxly_iroflyg3he DIN ision of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
Phone No. [phone], within 30 days. GW-1 REV. 07/2001
rTi
ern
en=
nta

249869
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) CqE'- 6• .fsco 'r_t.,, CERTIFICATION# ALIJit
WELL CONTRACTOR COMPANY NAME C yde y'J. CS 3 �Oy\ 0i\\ PHONE # (S2S) a5576SK
STATE \YELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
WELL USE (Check Applicable Box): Residential kt Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION: /�
Nearest Town: an etCounty !✓+..t ne o.++ge
Vitt
(Street Name. Numbr , Community, Subdivision, Lot No., Zip Code)
3. OWNER: 70e Conseil
Address
(Street or Route No.)
City or Town State Zip Code
( )-
Area code- Phone number
4. DATE DRILLED 3-II-01
5. TOTAL DEPTH: 705
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO El
7. STATIC WATER LEVEL Below Top of Casing: /00 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS \ FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): f METHOD OF TEST R:51
10. WATER ZONES (depth):
Topographic/Land setting
DRidge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
—1-1 35 Over tie;da.,
35 705
11. DISINFECTION: Type ?-vv3
12. CASING:
Depth
From 4\ To 35 Ft.
From To Ft.
From To Ft.
13. GROUT: Depth
From O To° Ft.
From To
14_ SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size
From To Ft.
From To Ft.
16. REMARKS:
Diameter
(c 4
Amount O
Wall Thickness
or Weight/Ft. Material
8.-a\ Fle.sllt-
Material Method
e
Ft.
Slot Size Material
in.
in.
Material
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
bmit the original to the
ACNE
visi
3-32
S WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
3
N URE OF ERSON CONSTRUCTING THE WELL
DATE
n of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
1, 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)yV`At`e 14°ot €S3 CERTIFICATION it try : I.
%VELI. CONTRACTOR COMPANY NAME Gt S.V.nc\ PHONE # (5.:'E) 155'7
-J
ASSOCIATED WQ PERMIT#
(if applicable)
STATE WELL CONSTRUCTION PERMIT#
(if applicable)
1. WELL USE (Check Applicable Box): Residential Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town:
Apunty
d cc SRZSI d ac all ��S
(Street Name. Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: $C` otix
Topographic/Land setting
❑Ridge ❑Slope OValley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Address Latitude/longitude source:❑GPS❑Topographic map
Qvyh
(Street or Route No.)
City or Town
( )-
State
Zip Code
Area code- Phone number
4. DATE DRILLED .3-15- 01
5. TOTAL DEPTH: a (e 5
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO B
7. STATIC WATER LEVEL Below Top of Casing: 30 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): 5 METHOD OF TEST R19
10. WATER ZONES (depth):
(check box)
DEPTH DRILLING LOG
From To Formation Description
.fit 85 C?Vec Re; don
83 aG5
11. DISINFECTION: Type Q.\\5 Amount 5'
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft.
From \-\ To $5 Ft. (it L`-t 9--a\
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From L: To 9_c Ft. L¢,�e n} tooui
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Size Material
Material
t lcs e',L.
Depth
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.
6£ :£ Ud Z- adb ZO
16. REMARKS:
1 DO HEREBY C
7 ?nr,
-
it the original to the Divi
1636 Piton
GROUNGWtTr R
ELL \VAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
3"/J—o'
TUR • ' - ON CONSTRUCTING THE WELL DATE
Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
thin 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division
WELL CONTRACTOR (INDIVIDUAL) NAME (print) CVit v, :Sat.=`A e.55
WELL, CON't RACTOR COMPANY NAME C"U \ C /2“—!-tjfCS k Set W;\\
249871
of Water Quality - Groundwater Section
CERTIFICATION # c'i "I z
PHONE # r.2.55 7 6,8 W
O\\_n \
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: C 2
(Street Name, Numbers, Community, Subdivision,
3. OWNER: AAAA A, tcsn,
Address Qo roisi a13is
r
County es...into/n/-4i
4
5. TOTAL DEPTH: 425
(Street or Route No.)
WQovety:%le Ii-
State
0 Blast
City or Town
(12. )- (AS S
Area code- Phone number
DATE DRILLED 3-t9-o 2-
Lot No., Zip Code)
4797
Zip Code
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO a
7. STATIC WATER LEVEL Below Top of Casing: -C FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS k FT. Above Land Surface`
`Top of casing terminated actor below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): S METHOD OF TEST c
10. WATER ZONES (depth):
Amount G
11 DISINFECTION: Type F, \\5
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft.
From 4\ To a3 Ft. Cc `t4 4--a\
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From 0 To 'a-O v Ft. t�,-e',v- ;deo.r.ad
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.
Topographic/Land setting
DRidge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
±1 a ever Rscac„
23
1425 4cne.:e.
Material
Y!rs etc.
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.
—4
0
I DO HEREBY CERT
S7 U1
ar_
,►it
ELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
HAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
56-0
ERSON CONSTRUCTING THE WELL DATE
RE
-s
2nn^, it the original to the Diviion o Water Quality, Groundwater Section, 1636 Mail Service Ceenter, REVgh, NC 1
27699 1636 Phone ' _21, \ 'thin 30 days.
GROUNDWATER SECr9 Iii;E
ASHEVILLE REot."N 1__
b

STATE WELL CONSTRUCTION PERMIT#
(if applicable)
WELL CONSTRUCTION RECORD 249874
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
CERTIFICATION # A"1 3 1"
WELL CONTRACTOR COMPANY NAME UL de `'''V-CS k ' - Wt\\ US.W.r C\ PHONE # 7 C S '
ASSOCIATED WQ PERMIT#
(if applicable)
WELL CONTRACTOR (INDIVIDUAL) NAME (print) C\v. =sa t,),A
1. WELL USE (Check Applicable Box): ResidentialjMunicipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2, WELL LOCATION: )/
Nearest Town: jile �K e u County Ar
G dots got
(Street Name. Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: Pcea SoloofxSors.
Address \%\ AUmaies H;tl
(Street or Route No.)
ea-ve(vale NC
City or Town State
(046 - 441e4
&ba4
28787
Zip Code
Area code- Phone number
4. DATE DRILLED 3-04 -e,
5, TOTAL DEPTH: fool
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO El
7. STATIC WATER LEVEL Below Top of Casing: 70 FT.
(Use "+" if Above Top of Casing)
S. TOP OF CASING IS \ FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 1 METHOD OF TEST RI
10, WATER ZONES (depth):
Topographic/Land setting
❑Ridge ❑Slope ❑Valley DFlat
(check appropriate box)
Latitude/longitude of well location
(degreeshninutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
13� ovcC Re; ckn
13 - GIGS
11. DISINFECTION: Type 4':st3
12, CASING:
Depth Diameter
From 42 To 133 FL (c`ci
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From Cs To Ft.
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
Amount Se
Wall Thickness
or Weight/Ft. Material
+—a\
From To Ft.
From To Ft.
16. REMARKS:
6co..r; to
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.
hT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
S, A ; THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIG
RE 8F-RERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
19) 733-3221, within 30 days. GW-1 REV. 07/2001
GROUNDWATER SECTIOI
ASHEVILLE I/r. " !AL OFFID_

WELL CONSTRUCTION RECORD
249876
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
CERTIFICATION # ,1ti 'c tv
nn PHONE # (4.:NA) 955 7 C:-5 $
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED wQ PERMIT#
(if applicable) (if applicable)
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Ck i', 4. :So t,Y.A e 3
w'ELLCONTRACTOR COMPANY NAME Clyde J C-CS k ' - 1SL\\
WELL USE (Check Applicable Box): Residential Municipal/Public ❑ Industrial ❑ Agricultural 0
Monitoring 0 Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION: /
Nearest Town: la ered CountyAis,nec.n4
t* be
(Street Name, Numbers, Community. ision, Lot No., Zip Code)
3. OWNER: Vte. -SO% \San
Address %$I A\\+ran t\l\\ Bead
(Street or Route No.)
0eava;'.\\e NL Qinff1
City or Town State Zip Code
05_a)- (e4S- 44(e4
Area code- Phone number
4. DATE DRILLED 3-0k-o a
5. TOTAL DEPTH: 3(oS
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO 6
7. STATIC WATER LEVEL Below Top of Casing: y0 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS \ FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): 3 METHOD OF TEST K:9
10. WATER ZONES (depth):
Topographic/Land setting
❑Ridge ❑Slope OValley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
—I'I ll7 OVcc II\ et; den
t\i 305
11. DISINFECTION: Type 4,Nc5
12. CASING:
Depth
From \\ To tCI Ft.
From To Ft.
From To Ft.
13. GROUT: Depth
From 0 To So Ft.
Diameter
�L 4
Material
Amount S
Wall Thickness
or Weight/Ft. Material
a\ Ytcs
Method
From To Ft.
14. SCREEN: Dcpth 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:
C•car:! e_
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.
THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
D THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
F PERSON CONSTRUCTING THE WELL
DATE
Submitsbe-ariginaLte Division of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
(21)4'174.30'q lion`h.fa'#:01Q) 733
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) Ck131E- K• S`3V^,\''�'VS CERTIFICATION# 3-9'5to
WELL CONTRACTOR COMPANY' NAME Cu�de jcl.J'\CCS $ �O^ t.s&\\ PHONE # (/a..'S) :9 557res�r
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
249880
I. WELL USE (Check Applicable Box): Residential Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Newest Town: Cand
DUI Ow
ec
County {6w"ceo.be
(Street Name, Numbers, Community, Subdivision. Lot No., Zip Code)
3. OWNER: DCbcf�a� - Ra.rd. 5cif ce�
Address !al Wv.G Cct s.
(Street or Route No.)
Candler .Me
City or Town State
n7r5
hip Code
( )-
Area code- Phone number
4. DATE DRILLED a-06-oa
5. TOTAL DEPTH: Ia6
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO &']
7. STATIC WATER LEVEL Below Top of Casing: /0 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS \ 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): 90 METHOD OF TEST
10. WATER ZONES (depth):
I I. DISINFECTION: Type
12. CASING:
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
To Formation Description
(al Cvcc Pyt. do„
From
H-I
(a
1aS
Depth Diameter
From 4 \ To (, I Ft. lc "mot
From To Ft.
From To Ft.
13. GROUT: Depth
From O To
From To
14. SCREEN: Depth
From 'I'o
From To
15. SAND/GRAVEL PACK
Depth
From To
From To
Material
r0.o Ft. t.r -e .a}
Amount
Wall Thickness
or Weight/Ft. Material
16. REMARKS:
I DO
Ii73TRdC INN flo
Method
1?cur rl
Ft.
Diameter Slot Size Material
Ft. in. in.
Ft. in. in.
Size Material
Ft.
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.
mit the original to the Divisio
9-1636 Rhotu-.Ne.{919) 733-322I
GRU liNnhlN CE-//
WELL WAS CONSTRUCTED IN ACCORDANCE WITH I SA NCAC 2C, WELL
THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
DATE
1
TURE
_ERSON CONSTRUCTING THE WELL
of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
within 30 days. GW-t REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality
WELL CONTRACTOR (INDIVIDUAL) NAME (print)_ CAxsA*----
WELL CONTRACTOR COMPANY NAME Cittle. Samoa ytci a Sort 1J Z11�� t}mod'
ASSOCIATED WQ PERNIIT#
STATF,, WELL CONSTRUCT ION PERMITS/_ (if applicable) __` {(�i
Of applicable)
WELL USE (Check Applicable Box): Residential5E Municipal/Public 0 Industrial ❑ Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water injection 0 Other ❑ if Other, List Use
249540
- Groundwater Secti�{It+� y
CERTIFICATION MJ, W.`1=
PHONE a S_E 4 .7121
WELL LOCATION:C4_v4
Nearest Town:
1rcr)n .1c
Count} B=~. C t be'
(Street Nome, Numbers Community. Subdivision. Lot No.. Zip Code)
3. OWNER: .xu<-s zl Mta64e t-lenxe_s
Address =5SR ?Q})•,•,, A,'tnue
(Street or Route No.)
ties ev:1L NG 2RA'JG
City or Town State Zip Code
( )-
Area code. Phone number
4. DATE DRILLED _atl-oa.
5. TOTAL DEPTH: I RS
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surface*
•"fop of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118. n_
9. YIELD (gpm): /5 METHOD OF TEST CZ
10. WATER ZONES (depth):
Il. DISINFECTION: Type Pitt. Amount
12. CASING: Wall Thickness
Depth Diameter or WeightTt. Material
From t1 To ticl Ft. lr"k ik dl ila4tr<_
From_ To Et.
From To Ft.
13. GROUT: Depth Material Method
Frorn 0 To at Ft. CeMear poured..
From To Et. ---
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To—_-- Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From _ To Ft.
From To Ft.
Topographic/Land setting
❑Ridge 0Slope a -Valley ❑FI:ta
(check appropriate box)
Latitude'longitude of well location
(degreeshninu:es/seconds)
Latitude/longitude souree:OGPSOTopographi rea p
(:heck box)
DEPTH DRILLING d j
From To Formation Desprij':iot
4 1 Qy Over Fr 'rali
y`I errs Gras.;tG
LOCATION SKETCH
Show direction and distance in miles from t ast
two State Roads or County Roads. Include tFrc roa
numbers and common road names.
16.REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STANDARD = ND THAT A COPY OF IS RECORD HAS BEEN PROVIDED TO THE WELL OWIFY;I:
GNATURE OF PERSON CONSTRU - THE WELL DATE
on of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh. Sr
I, within 30 days. GW-1 REV. ( : `2 id
I.S
7699-1636 Phone No. (919)
r_n
C'
c�
0
GROUNDWATER SECTION
ASHEVILLE REGIONAL OFFICE

2498'79
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) CVAN e- V% :Son.=-s=t) CERTIFICATION # taut
WELL CONTRACTOR COMPANY NAME E't..ae &.21/4NI �ECJ 'b 5Q^ PHONE # (C(1S) .a.557&aY
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) ,, (if applicable)
1. WELL USE (Check Applicable Box): Residential Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ IfOther, List Use
2. WELL LOCATION: ?'l.Q0A9
Nearest Town. VJ' a, td
•�+VtPvJ
County 13u4 es.nbr
(Street Name. Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: OgKutonei Meb'.\t IAes.nes
Address 1543 Pd4tan Avenue
(Street or Route No.)
Mttev:tle AC.
at2oto
City or Town State Zip Code
( )-
Area code- Phone number
4. DATE DRILLED oo(- 24-og
5. TOTAL DEPTH: 4015
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO 21
7. STATIC WATER LEVEL Below Top of Casing: Tn FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS l FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): a METHOD OF TEST RI
10. WATER ZONES (depth):
Topographic/Land setting
DRidge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
—1-1 (05 0Vet- Rt;den
11. DISINFECTION: Type ?"v
12. CASING:
Depth Diameter
From t- \ To L5 Ft. (c lilt
From To Ft.
From To Ft.
Amount (�
Wall Thickness
or Weight/Ft. Material
8-a\ et.sllL
13. GROUT: Depth Material
C' To 'i` FL Merle ak-
From
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.
16. REMARKS:
Method
Slot Size Material
in.
in.
Material
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
cn
r
c
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
DATE
ubmit the original to th
exe-Nam�-{e�t� ' 733-3
LROUNDV'/ ER SE('1 i U
r1S°EV, I _liONt1I OFFICE
RE OF PERSON CONSTRUCTING THE WELL
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 Quality
WELL CONTR ACTOR (INDIVIDUAL) NAME (print)___CA4iii. K_ .jakAcyci s
w ELL CONTRACTOR COMPANY NAME C14AS__SaJ4«h a can 1-kW,. 1JC•\1)1A
ASSOCIATED WQ PERd�-IIT�
STATE WELL f placable) PERMITN (if applicable)
(if applicablei
249550
- Groundwater Sect'a.-. o r�y
CERTIFICATIONS S¢7-3
PHONE # .:2s"t
1. WELL LSE (Check Applicable Box): Residential21l Municipal/Public O Industrial ❑ Agricultural O
Monitoring O Recovery ❑ Heat Purnp Water injection O Other ❑ !f Other, List Ut>e
2. WELL LOCATION:
l,)eayec_ : t[e County B:u-cw be
Nearest Towm_ VkJ'
SFOC lc,. kJ'e_s--__
(S r c Non: Numbers. Community'. Sub'icision. Lot No, Zip Coda
3 OWNER: OCiwwpa.ie t10 eL_ ----
Address _ISA3_Patt" Avenue
(So eat or Route No.) nn /
Its ke f, I dglS(t
C i:. or Towr. State Zip Code
2 a.. a413(_
Ai ea code- Phone number
4. DATE DRILLED__i2' I -Oa _
5. TOTAL DEPTH:_ r2CJ5
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO m
7. STATIC WATER LEVEL Below Top of Casing: t
(Use "t" if Above Top of Casing)
€. TOP OF CASING IS 1 _ FT. Above Land Surface'
*Top of casing terminated atlor below land surface requires a
variance in accordance with 154 NCAC 2C .0118.
9. YIELD (gpm): —(6 METHOD OF TEST R
l0. WATER ZONES (depth):
11. DISINFECTION: Type P:u.
12. CASING:
Depth Diameter
From t\ To Lk& Et. toll..__
From To — Ft.
'
From l'o _ Ft.
13. GROUT: Depth Material Method
From_.O to .-!o Ft. Cement- _-- erred
From—-- To,^_. Ft -------- — —.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. _ in.
From To Ft. in. — m, _--
15. SANL)r GRAVEL. PACK: MaterialDepth Size
Amount __--
Wall Thickness
o> WeighNFI. Material
iLI ._PLF=14—
From
From
To -- Ft.
To Ft.
a4Jrlh �irtl�1
TopographiciLand setting
❑Ridge Mope ❑Valley ❑FI'.'
(check appropriate boxy
Latitude/longitude of well location.
(degrees,nonu:es'seconds)
Latitude/longitude source:OGPSOTopogatp'li rn:p
(check box)
DEPTH DRILLING A. ;t
From To Formation De-: 'i; Son
-iftt,5 ____OrtL firs : ir.__
IED5 /20 i _ Grar~ S
LOCATION SKETCH
Show direction and distance in miles from ut
two State Roads or County Roads. Include- road
numbers and common road names.
0
ry
TiC
O
CJl
rr
16. REMARKS: _ ---- —
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AN "HAT A COPY OF HIS RECORD HAS BEEN PROVIDED 'f0 THE WELL OW ' :.
<=tom
TURF OF PERSON CONSTRL ,TING THE WELL DATE
ivision of Water Quality. Groundwater Section, 1636 Mail Service Center - Raleigh. 9•
OW-1 REV.
J L_'
Submit the original
27699-1636 Phone No
33-3221, within 30 days.
1
GROUNDWATER SECTION
ASHEVILLE REGIONAL OFFICE

WELL CONSTRUCTION RECORD 2 4 9 5 4 7
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section ,
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Cl e 14• ;i 44 ',t
QrS CERTIFICATION# 2 'i3C
\\ELL CONTRACTOR COMPANY NANIE C' ),t S&U`it.etS +` 5o Fenn be: 11: etyPd—
HONE itfg2s$ CO12-7321
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED \VQ PERMIT#
(if applicable) (if applicable)
1. W'ELL USE (Check Applicable Box): Residential Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATIO �j1
Nearest Town: /eUr ii e County Qk•oCp l*{L)e
(Street Name, Numbers. Community, Subdivision, Lot No.. Zip Code)
3. OWNER: (Zbbtt't ?(O. Vt.
Address
(Street or Route No.)
City or Town State Zip Code
( )-
Area code- Phone mmnber
4. DATE DRILLED I'• 343 —0'1
5. TOTAL DEPTH: 'MS-
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO ❑
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 casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): (�i. METHOD OF TEST g:
10. WATER ZONES (depth):
Topographic/Land setting
❑Ridge GiS'lope ❑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
4 Cot Over Serda
Cal 485 (wen:Fc
11. DISINFECTION: Type J°f w5
12. CASING:
Depth Diameter
From +( To 6 f Ft. (±4.
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From 0 To 20 Ft. Center(•' �OUfed
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.
Amount
Wall Thickness
or Weight/Ft.
tt IJ
Material
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 navies.
tONTSRt(TT N $A
AT THIS WELL W
DS, Ay THAT A
ONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
PY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
D2
Submit the original to the
GROPOWAG@k PiPETM• (919)
ASHEVILLE REGS;IP,.L'_
IGNATURE OF PERS
ONSTRUCTING THE WELL DATE
Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
33-3221, within 30 days. GW-I REV. 07/2001

249546
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Gino¢- K• CERTIFICATION # ?Li AL,
\\'ELL CONTRACTOR COMPANY NAME CA.) e 5&UVA. S' 6c^ Ue\i tjc••it•"�jj_ PHONE # (`(Zi) 0. 7.311
STATE WELL CONST RUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
2
WELL USE (Check Applicable Box): Residential gl Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use
WELL LOCATIO6
Nearest Town:
itq
\ lam- (CA)
County
l�+tifoC�r'l�
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER:
Address
na>;tacocl Moe it t}o�
1S9'D palro,N AVettat
(Street or Route No.)
A6t,e-Y. t1e QC MAD
City or Town State Zip Code
(bn)- a5a amok
Area code- Phone number
4. DATE DRILLED 1- aS* 04-
5. TOTAL DEPTH: .345
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO Ili'
7. STATIC WATER LEVEL Below Top of Casing: FT.
(Use ••+" if Above Top of Casing)
8. TOP OF CASING IS 't FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with I5A NCAC 2C .0118.
9. YIELD (gpm): (D METHOD OF TEST R:lr-
10. WATER ZONES (depth):
1I. DISINFECTION: Type
12. CASING:
Depth Diameter
From_H To 5.3 Ft. (o 4' .#b a' Pia Si-: c
From To Ft. i
From To Ft.
13. GROUT: Depth Material Method
From 0 To 20 Ft. (e -c.n-- �%u«
From To Ft. f
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
Topogra Land setting
❑Ridge lope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/mimues'seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
Formation Description
cave{ 8 ercl0
DEPTH
From To
41 S3
.5'3 3`{5
P:iis
From To Ft.
From To Ft.
16. REMARKS:
Amount
Wall Thickness
or Weight/Ft. Material
(teach }c
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.
L; I[' DWI-14E4a' CILERT
CONS I KUL I IUNSI
IAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
RDS, AND THAT (: COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
`OUHI1,R iTicCs1!•}'dflda to th
ASHFViL2_T69,1C{3'fi/Rholi'cfd6, (919
CIJ
SIGNATURE OF PER
NSTRUCTING 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

1
249545
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print)'C\ .tde, V.. SRW tiC rJ CERTIFICATION H e2Y3(C
WELL CONTRACTOR COMPANY NAME Clypz JG �t GC5 SGA Uit(-,(\) •,PIIONE N fa2 God a. 731t
S-IA'tt: WELLCONSTRUCTION PERMIT* ASSOCIATED ASSOCIATED WQ PERMIT*
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ® Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
WELL LOCATION:
Nearest Town: Bite- 1 County AB c.✓�Ct�MP�
Rode
(Street Name. Numbers, Community', Subdivision, Lot No.. Zip Code)
3. OWNER: OaAk uec4 /k41,1C_ F\ct+.e
Address 1 bet3 tecttun Ave n..e.
(Street or Route No.)
AsLrv; RC AK
City or Town State Zip Code
(_ fl)- � 5'a oZ 4 n \
Area code- Phone number
4. DATE DRILLED i- a .4-0 'a
5. TOTAL DEPTH: Lka-5
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO ❑
7. STATIC WATER LEVEL Below Top of Casing: FT.
(Use "+" i f Above Top of Casing)
8. TOP OF CASING IS t FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 3 METHOD OF TEST
10. WATER ZONES (depth):
a BR000
ographic/Land setting
ihR dgc ❑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
rt ( 71 nve f Strati
71 Lia5
6-rc.n i hG.
11. DISINFECTION: Type P.- 115
12. CASING:
Depth Diameter
From 11 To 11 Ft. 6
From To Ft.
From To Ft.
13. GROUT: Depth
From 0 To 20 Ft.
Amount 1
Wall Thickness
or WeiglWFt. Material
4 a( ?ttL5ist
Material
GEn-eni-
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
Method
Slot Size Material
in.
in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Fri 6.f ft VSIJ
s
ID 1 ILREBY CERTIFY-IIA
CONSTRUCTION STANDAR:
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.
THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
ND THAT A COPY(JF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
GNATURE OF PERSON CO ' TRUCTING THE WELL
f-2S D2—
DATE
AStii'tt.M�Ct ttl3Gnri�ja14�fthe Ui tision of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
r-kn:rt9P3g73-33221,within30days. GW-I REV.07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources • Division of Water Quality - Groundwater Section
249543
CERTIFICATION NNtE. a
WELL CONTRACTOR (INDIVIDUAL) NAME (D nr PHONE N�RLr�
t3 Car
DELI COy"1'R ACTOR COUVANI'NAME o 0
ri )Se .. W
ASSOCIATED WQ PERMITS
S'I AT F.\\FLLCONSTRLCTION PCRMITN - - ;irapplicable)
�.(appli<able)
i. WELL USE (Check Applicable BoxT. Residential% Municipal/Public 0 Industrial 0 Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other ❑ IfOther, List Use__
2 WELL. LOCATI �: /�
i C��C' c'iA\C County e,.L' COf)OQ
(Sired Name. Nuinhzn, Community, Subdivis,on, Lo
t No . Zip Cote,
q S' 7tes+^ci.
3. OW'NER:---i_Cp'-'�:tC.c 3uild....'�
Address _. - -- ---
(Sure' or Route No.l
❑tvorTo-.r ta«Ca a ci�
Zip Code
Acca ads Phone cumber
4. DATE DRILLED_ i_15
r
S. TOTAL DEPTH' 1t
6 DOES WELL REPLACE EXISTING WELL^ YES 0 NO FT
STATIC. WATER LEVEL Below Top of Casing:
(Use "i' if Above Top of Casing:
8. TOP OF CASING 13 �-- FT. Above Land Surface'
'Top of casing terminated attar below land surface requires a
variance in accordance with ISA NCAC 2C .011g.
9. YIELD (gpm): ! a METHOD OF TEST__ ft
10. WATER ZONES tdepth).
Topographic'Land setting
❑Ridge ❑Slope OValley ❑Flat
(check appropna t box)
Latitude/longitude of well location
(degrees rninutcs: sc. ondn )
Latitude.'longitude source:❑GPS❑I opographic map
whecit`yixl
DRILLING LOG
Formation Description
11 DISINFECTION: Type ____ Amount
12 CASING'. Wall Thickness
Depth Diameter or WeightFt. MateclC
From lei To "--7 Ft. 11
From _-- To__-.__ Fi.
From 'CO - Ft.
Material Method
J. GROUT Depth fouiti
From__Q_._. Tt, An Ft. C�sali0.f — ..
Ftom To _Ft.----`
14. SC. RLEN: - Depth Diameter Slot Size Material
from-,__ o TFt._ in. If:
From_ __ - To
Ft._in. In
1>- SAND:GRAV EL PACK: Vl aterlal
Depth Size
From ----T o- Ft. -
From Tn Ft.
16. REMARKS:
1 DO HEREBY CERTIFY 1 HAT THI
CONS II<GC I ION SrAND ARD
l v (i r'
R��u�ljtit the Uri haldcr t
anc Nn. Iv
DEPTH
From To
racSSiBlri-
�K 175 Grait:te
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.
WELL WAS CONS UCFED IN ACCORDANCE WITH I SA NCAC 2C, WELL
D THAT A COSY O THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
i /'-17- D
GNP.TU(cE OF PERSON CONSTRUCTING THE WELL DATE
lision of Water Quality, Groundwater Section, 1636 Mail Service Center- Raleigh, NC
-3221, within 30 dacs. GW-I REV. 02;2001
re(
0
C71
m
ri
m
0 ✓
0
GRoulas,^tA,ER sEcrlonl
ASHEVILLE REGIFO2.SL OFFICE

WELL CONSTRUCTION RECORD
North Carolina • Department of Environment and Natural Resources - Division of Water Quality GrCEoundwater
SectionN
K Stasalt i_
WELL CONTRACTOR (INDIVIDUAL) NAME
� (PHI^t) � � PHONE N ��--��
w ELL CONTRACT OR COMPANY NAME asiei..at+LO A-`SI'�-.-�•r �',in�_
5'I ATE w
UN PERMIT# ASSOCIATED WQ PERMIT#
ta.
t.
CQNSTRLCTI
(if apD licahle)
(:f appli,.ablel
I. WELL„USE 0 Reco eryApplicable
Heat Pump Water( Inect on 0 pa O'thert0 If Other. Industrial
Oe Agricultural 0
249542
2 WELL LOCATIO'*:
Nearest Toownt: _ J9 p
_ II�-e, —_
($nevi Nmne, Number
, Conununit}, Subdivision, Lot No . hip C xer
Adores, _e2.3
( Sneer nr Route No)
axsC3
Citv nr TOM! State Zip Code
IL
County_3sATJC:.rtP�
Area code- Phone njmber
4. DAFE DRILLED_ 1_L$rt=k
5. TOTAL DEPTH: n5 6 DOES WELL REPLACE EXISTING WELL? YES 0 NO et
7 STATIC. WATER LEVEL Below Top of Casing: FT
Rife "+" if Above Top of Cisme
R. TOP OF CASING IS -_._I -
FT, Above Land Surface'
•Tup or casing terminated .tior below laud surface requires a
variance In accordance with ISA NCAC 2C .0112.
9. YIELD (gpm): _ia__ METHOD OF TEST
10. W'ATER ZONES (depth).
11 DISINFECTION:TypeO'll• _— Amount
t C'.ASING' Wall Thickness two State Roads or County Roads. Include, the road
12
Depth Diameter or Weight. Ft. Material numbers and common road names
ahoer
From 4'--1---- 1 0 7 � -- Ft.��l--- i ti
From To Ft
R�
Topograp is/Land setting
❑Ridge QS pe ❑Valley OFtat
(check appropriate box}
Latiluderiongitude of well location
idegrces'ininrtes'seaonds)
Lentudr'longitude sourre:OGPSOTopographie map
(cheek Sax)
DEPTH DRILLING LOG
From To Formation Description
—fL1 i vti
gJ� _ &rai: to
From___-_— To_ Et_
13 CiROU f Depth
Material Method
Frurn-_Q__- To_ 20 . Ft._ C*MIA4
hotly__ -...i-o Ft.
t4. SCR EIEN: Depth Diameter Slot Size Mater.rl
Frurn-, To__ Ft... -in. _-
n.
Rom
_ To Ft ____ in. in
I,. SAND/GRAVEL PACK:
Depth
Flom, To Ft.
f rmn To Ft.
;6. REMARKS:
Size Material
I DO HEREBY CERTIFY THAT THIS WELL WAS CC
CONSTIU.( TION STANDA 'AND THAT A,COP'
t
t t n%if Ih origin tuithe
'699-Ibi6 Phan: No 4919)
GRCU a Tap SEG11-ON
ASHE I, LE FI . -.I OFFICE
A
NATION SKETCH
• direction and distance in miles from at least
]STRUCTED IN ACCURDANC:E WITH 15A NCAC 2C, WELL
)F THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
l-19 -62
L''RE OE PERSON CON CTING THE WELL DATE
ion of 1\ ate:. Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
21,within 30da)s. GW-I REV.07/2001

249541
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Reso�es�-,�Division
` of Water Quality Groundwater
Section
on
43
WELL CONTRACTOR IIFDIVIDL�AL) "TAME (print)-5��.
WELL CONIRACI'OR COMPANY NAME ♦ — --'—'—
r
YHONE p D7102ii71-1N
ST Al ENEt. CONSTON PERMITS/ ASSOCIAIED WQ PERMIITN
(!fapp1kable) of applicable)
1. WELL USE (Check Applicable Box): Residential B Municipal/Public 0 industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other ❑ If Other, List Use
2 \VELL LOCATIO
Nearest Town:_-!e Jy --
hac (kvc, a
County_ %-Allys.Cakoc .
(Street Natne. Numbers, Community, Subd.vision, Lot N.. bp Code,
3. OWNER:__° -t'^=";a.kva•\,:1
Address 1..$9:3.
Street or Route No.1
�" 2 3 e't
C.t:y or To..e Stec Zip
(hasCode
,- .-� is _.__
Arca rude- ?hone number
4. DATE DRILLED_ _\
5 TOTAL DEPTH:
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO a
7 STATIC WATER LEVEL Below Top of Casing:
FT
(use "i' if Above Top of Casing)
S. TOP OF CASING IS L---
FT. Above Land Surface'
*Top of casing terminated actor below lend surface requires a
variance In accordance with ISA NCAC 2C .0118.
9. YIELD (gpm):. CO METHOD OF TEST Re-%
10. WATER ZONES (depth).
n�—
1 l DISINFECTION: Type— ---Wall -thickness
Amou
12 CASING.
Depth Diameter or Weight:Ft. Material
From. I• _To 5Ei Et. ft
From__ -----------
From .To.__.— Ft
13. GROUT: Depth Material
From._Q. F
From_ _..._._. To_-r— Ft. --------
Id SCREEN: Depth Diameter S'.ot Size
—._-- FrFt ___in. in
om— —.. To___.
15. SAND/GRAVEL PACE: Material Size
From. To Ft. — -----__`
From .__To___ Ft.__---- --
3- .4xki5c.s.
Topogrt ctLandsetting
❑Ridge lope °Valley OFlat
(check appropria a box)
Latitude/longitude of well location
(degrees minutes seconds)
Latitude'tosgitude source:OGPSOTopographic map
(eherk bax)
DEPTH DRILLING LOG
From To Formation Description
Method
pouts J
Material
Gram: to
LOCATION SICETC_H
Show direcnon and distance in miles from at least
two State Roads or County Roadsinclude the road
numbers and common road names.
16 RENI ARKS: -- —� -----
i p0 HEREBY CERTIFY THAI THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 1.5A NCAC' WELL
WELL
OWNERE
CtiNSI It UC Tll1N sTnV UARUS.AVDT TOPY OF THIS RECORD HAS BEEN PROVIDED
RSII:amil::tloCorigtinit tnn e"&
hone No. 191
' 1-17-
SIGNATURE OF PERSON .ONSTRLCTING TiIE WELL DATE
n of \\ ater Quality, Gromidwater Section, 1636 Mail Service Center - Raleigh, NC
1. within 30 days. GW-I REV. 07/2001
c.
0
GROUNPIKFER SECTION
ASN ` ILLt t {.dGAL OFFICE

WELL CONSTRUCTION RECORD 2 4 7 2 r p
North Carolina - Department of Environment and Natural Resources - Division of Water Quality- Groundwater Section
K. Saintcis__- CERTIFICATION M__ki_2`
WELL CON1'R.4C'lOR (INDIVIDUAL) !vAME (Prins)--�Ll.ai- --
tiA)4ti .S i a.fC t Ne\\ te.tl:01 PHONE k Set GPg na\
wCLI. CONTRACT OR COMPANY NAME � � d
SiATE. VE:1.1. CONSTRUCTION PERMITS/ ASSOCIATED WQ PERMITS _ ---. ---
Iif app!'wablc) (if applicable)
1 WELL USE (Check Applicable Box)'. Residential E Municipal:Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Hear Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCATION'
Neatest Tewn:__J
County
(Siren Name. Number.:. Community, Subdivision, Lot No Zip Code,
3. OWN ER:__i..)_co tte._01.1t
Address ---
(Street or Rothe No 1
Topographic'Land setting
ORidge OSlope OVailey OF!Jt
(check aspspnare box(
La titudet!ongitude of well location
t degreas. minmessmonds l
Latitude 'longitude source'.OGPSOTopographic map
(cheek box)
DEPTH DRILLING LOCI
City or Town State Zip Code
From To Formation Description
—f1 -rar�— ejVCf_J3 on-.
A ica code Phone number _
4. DATE DRILLED— \' \o_o a2
5 TOTAL DEPTH: Lj35 -
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO et — yt- ____Ij�,4_._. ". freer* ' te.
7. STATIC WATER LEVEL Below Top of Casing: FT ------------
iUse"*' if Above Top of Casing:
8. TOP OF CASING IS __) __ FT. Above Land Surface*
*Top of rising terminated attor below land surface requires t
variance ire accordance with 154 NC4C 2C .0118.
9. YIELD (gpm): can METHOD OF TEST ni____—_ ---
10. WATER ZONES (depth): — — . �OCATIUN SKETCH
1Wrll Thickness Amount %__—"— - Show direction and distance in miles from al least
1 2 CASING.Wall DISINFECTION: Type O:I I a - two State Roads or County Roads. Include the road
I? Ft
MMaterialr numbers and common road names.
Depth Diameter or Weight/R.
From 4• _ To 44 Ft. 4I24 AiLai. _'�12 Lt
From_ _ To______ Ft. Ft. — \lethod CD -_
From To Ft
tsO
Cr%
13. GROUT: Depth Materia'. rTl
�outeJ cO
from ._.Q_T�°3QR _.Gefrw4
_ e.__ ._ T'-:.-
FtomTo Ft._ _ —. — — --
I4. SCREEN: Depth _ Diameter Slot Size Maternil —D ,,
FromTo Et. In in. -0 rrl ,
fP=-;
Flora--- . To Ft. in. in --- P....? rim ca;a
I5. SAND'GRAVEL PACK: r'
Depth Size MaterialCO r --1 .T..)Rom,____To Ft. __
.—
Etom 1o-------- Ft
16. REMARKS: -- --._—.
i DO HER 813Y CERTIFY T HAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH. 1 SA NC AC 2C, WELL
CONS"IItU( TION STANDARDS. AND •� Ttyl� A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
mit the original to thr Di
9-)Sl-PhdhetNoildni)73-
GROUNDWATER SECTION
ASHEVILLE REGIONAL OFFICE
A'1-URE OF PER30N CONSG THE WELL DATE
of ater Quality, Groundwater Section, 1636 Mali Service Center - Raleigh, NC
within 30 da)s. GW-1 REV. 0712001

WELL CONSTRUCTION RECORD 247269
North Carolina • Department of Environment and Natural Resources • Division of Water Quality - Groundwater Section
CERTIFICATION p al.( la
WELLLL CONTRACTOR (INDIVIDUAL) NAME, (Prin-idPl
Q—��L JSe..3ytc,z i- r9
WELL. C'ONTkACrOR COMPANY NAME \_• VIst,,-SS t 5On Ori.a i e\\k:nO PHONE it,� t frall ,21411
SI ATE \v ELL CO'\STRLCTION PERMITN ASSOCIATED WQ PERMITS
('.fa
pp, icable) (if apolicable)
WELL USE (Check Applicable Box): kesidentialEC MunicipaliPublie 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other O If Other, List Use_`___
2. WELL LOCATION:
Nearest Town•__AV_Ct��-{�-- County aaL
(Street Nmne. Nqunbers. ComAmunity, subdivision, Lot No . Zip Codr t
3. OWNER:. /_a_11a_.1�ltitCSon
Addross QIl__ ,Y-_at_at_
(Street o, Route No.1
11 exvec alit Ale acd1% -2
C:iq nr tour State Zip Code
Ana code Phone (,umber
4. DArt DRILLED_J-09±/0Q
5 TOTAL DEPTH: 3%5
6 DOES WELL REPLACE EXISTING WELL? YES 0 NO el
7. STATIC WATER LEVEL Below Top of Casing: FT.
(Use "4' if Above Top of Castes:
g. TOP OF CASING IS _1 _ FT. Above Land Surface•
'l'up of csaing terminated stlor below land surface requires
variance in a<ordance with ISA NCAC 2C .011g.
9. YIELD (gpm); Q0 METHOD OF TEST_(i
10. WATER ZONES (depth).
I! DISINFECTION; Tyne r114 ___— Amount 10
12 CASING: `` Wall Thickness
Depth Diameter or WeightiFt. Mucha!
Front —ill --To 11(D FL 41 Aka .4.1944;s,
From __ To--- Ft.
From To Ft.
13. GROUT: Depth Matcnai Method
From _QTo_.20_Ft. C,e,ntn4 _ fouftJ
Ftom To _ Ft. 14. SCREEN:Depth Diameter Slot Size Material
From-------- Tn.----- Ft. in. in.
From - TO Ft on in
I5. SAND/GRAVEL PACK:
Depth Size Material
Front_--. . 10_---- Ft.
----
From__ _ Fo _ _ Ft.
TopographiciLand setting
❑Ridge ❑Slope ❑Vatley OFiat
(check appropriate boa)
Latitude/longitude of well location
(degrees minnteisc:ond=)
Latitude/longitude source. DGPSOT opographie map
;cheek bux)
DEPTH DRILLING LOG
From To Formation Description
11(0 nue(S sta __
11(., 3S Granite
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. REMARKS.
1 DO FIEEEGI" CERTIFY THAT THIS WELL \VAS CONSTRUCTED IN ACCORDANCE WITH l5A NCAC 2C, WELL
C0N,1 RUC LION 'TANDARDS, AND T T A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
nit the orippinaI t%�jn(iJle Di
9.1646 Thant•`4444) 733
GROUNDWATER SECTION
ASHEVILLE REGIONAL OFFICE
"IL OF PERSON CONSTRUCTINC THE WELL
DATE
f ater Quality, Groundwater Section. 1636 Mail Service Center- Raleigh, NC
ithin 30 doss. GW-I REV. 07/2001

261486
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
REUBEN CALDWELL CERTIFICATION ,/ 214Q
WELL CONTRACTOR (INDIVIDUAL) NAME (print) r�
WELL CONTRACTOR COMPANY NAME REUBEN CALDWELL DRILLING, INC. PHONE`II�8 I?54 - 3581
STATE WELL CONSTRUCTION PERMIT" 1537 ASSOCIATED WQ PERMIT,/
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential L9' MunicipaUPublic 0 Industrial 0 Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCAT
Nst Town
Snot IL
County
(Street Nurse, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER.
Address 0 I 41:-; C ‘/AW
(Stierit or Route No.)
I.0eA-r)efzU t ►aC, 7.e7J7
City or Town State Zip Code
CM- Cs (145=1 k
Area code- Phone number
4. DATE DRILLED 2 — I� —lira--
5. TOTAL DEPTH: / 50
6. DOES WELL REPLACE EXISTING WELL? YES NO
7. STATIC WATER LEVEL Below Top of Casing: !%I FT.
(we "+" if Above Top of Cuing)
8. TOP OF CASING IS / FT. Above Land Surface*
*Top of cuing terminated at/or below land surface requires a
variance In accordance with 15A NCAC 2C .0118. �✓� t
9. YIELD (gpm): 20 METHOD OF TEST / `" Y'
10. WATER ZONES (depth): 20 C/.:1 - iffy
11. DISINFECTION: Type ij[Y Amount FDA-
12. CASING: Wall Thickness
Depth Dii ter or Weight/Ft. Material
From To rS Ft. 4 Y y p..tt. rye
From To Ft.
From To Ft.
13. GROUT: Depth atonal Method
From t� To 9.D Ft.
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
Front To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
GROSiu6iF(ftiiIFe
ASHEV ` °Carr
to the
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 Formatio9Des ription
9 8Q
o / ts
115 (8'3_
//',\ C('-''
LOCATION SKETCH
Show direction and distance in miles from at (east
two State nun oa a road
nu
T THIS WELL WAS CONSTRUCTED M ACCORDANCE WITH 15A NCAC 2C, WELL
S, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELLOWNER
,
�ll 2
SIGNATURE OF PERSOf CONSTRUCTING THE WELL
Division of Water Quality, Groundwater Section, 1636 Mall Service Center- Raleigh, NC
33-3221, within 30 days. GW-1 REV. 07/2001

248248
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and
REUBEDeNatural Resources
CALDDHLLn of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) CERTIrF;ICATION# 2140
WELL CONTRACTOR COMPANY NAME REUBEN CALDWELL DRILLING, INC. PAONER28 I?54-3581
STATE WELL CONSTRUCTION PERMIT# 1537 ASSOCIATED WQ PERMIT#
(if applicable)
(if applicable)
1. WELL USE (Check Applicable Box): Residential IV-Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCA: Wir ��HJ /J
Nearest Town: 1 ,v"i/(� County
(Street Nome, Numbers, Community, Subdivision. Lot No., Zip Code)
3. OWNER: Let/ c
Address
(Street or Route No.)
City or Town State
Area code- Phone number �Q
4. DATE DRILLED 2 —
5. TOTAL DEPTH: / 505
6. DOES WELL REPLACE EXISTING WELL? YES NO $
7. STATIC WATER LEVEL Below Top of Casing: //(2tr. 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 15A NCAC 2C .0118.
9. YIELD (gpm): 20 METHOD OF TEST
10. WATER ZONES (depth): `2OCiit1 - fri
Amount 10A--
Zip Code
11. DISINFECTION: Type 197261
12. CASING:
Depth Dtpp?eter
From - / To ? FL I y
From To Ft.
From To Ft.
13. GROUT: Depth
From To Ft.
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
Material
Wall Thickness
or Weight/Ft. MAterial
S/Q-( i
From To Ft. in.
15. SAND/GRAVEL PACK:
From
Depth Size
To Ft.
From To Ft.
CONSTRUCTION ST
AS
Slot Size
in.
in.
Material
Method
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
FormatioyyDes Fription
IND
CD
o:
LOCATION SKETCF[ � r cc
Show direction and distance in miles from -at lean
two State Roads or County Roads. Inclufahe r tad
numbers and common road names.
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
SIGNATURE OF PERSON CONSTRUCTING THE WELL
DATE
�[�e Di) ision of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
�) "" 3221, within 30 days. GW-1 REV. 07/2001

251135
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and
RELBENResources
CALDDBLLn of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) CERTIFICATION N 214Q
WELL CONTRACTOR COMPANY NAME REUBEN CALDWELL DRILLING, INCPHONE Y?(8 )254-3581
STATE WELL CONSTRUCTION PERMIT. 1537 ASSOCIATED WQ PERMITS 7jJ5 '0 / .- n n — in
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential 0 MunicipaVPublic L94ndustrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Near t Town yf�'Y,yt Count k Yll1
mf T
(Street Name, Numben, Community, S t Subdivision, Lot No., Zip Code)
3. OWNER: C4 'S4
Address bee o4�� ////�
Depth
From/ To 'j-IIsIFt.
From To Ft.
From To Ft.
13. GROUT: Depth
From - To // Ft.
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.
fiCity orTc;�Ar t �I Code
(P' } /Jeffr�
Area code- Phone number
4. DATE DRILLED 7-4/ D Z-
5. TOTAL DEPTH: .o .f
6. DOES WELL REPLACE EXISTING WELL? YES 0J?40 0
7. STATIC WATER LEVEL Below Top of Casing: 'wVe FT.
(Use "+" if Above Top of mg)
8. TOP OF CASING IS / FT. Above Land Surface'
*Top of cuing terminated atfor below land surface requires a
variance In accordance with ISA NCAC 2C .011S. n
9. YIELD (gpm): D METHOD OF TEST f"7 / iv-
10. WATER ZONES (depth):
11. DISINFECTION: Type Amount /
12. CASING: Wall Thickness
o i eeighUFt. Material
81-4241
Slot Size Material
in.
in.
Material
16. REMARKS:
l DO HEREBY CERTIFY THAT
CONSTRUCTION STANDARD
S
Iy
WELL WAS CONSTRUCTS
THAT A COPY OF THIS
j h4
SIGNATURE OF PERSON CON •
UFDU [ A U U'
Submit the original to the D vislotiOt Water 44ttia.l ti. Grdlludwater Section, 1636 Mall Service Center- Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-I REV. 07/2001
Topo8gr�phiclLand setting
❑Ridge G7SIope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degree uminutciseconds)
Latitude/longitude source:❑GPS❑Topographic map
(cheek box)
DEPTH DRILLING LOG
From To Formation Descg'ption
D- ld
o -
/S-
en
n
= c'a
>y 0m
-< cn
zm
DO
LOCATION SKETCH = ao
Show direction and distance in miles from at ler 0.,z
two State Roads or County Roads. Include the Mad 1 =
numbers and common road names. N
z
1
(tCCORDANCE WITH ISA NCAC 2C. WELL
s • s HAS BEEN PROVIDED TO THE WELL OWNER
cEp / O t_
UCTING THE WELL �i A1E

248251
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural
Resourc
CALDDELLn of Water Quality - Groundwater Section
REWELL CONTRACTOR (INDIVIDUAL) NAME (print) - CERTIFICATIONFp# 214 Q
WELL CONTRACTOR COMPANY NAME RF.UBEN CALDWELL DRILLING, INC. PHONE•it�8 1254_3581
STATE WELL CONSTRUCTION PERMIT# � ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential d Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATIO. n
Nearest Town: RD0n/ County e.SJriCc0r`'`
g c� ( G t i� rJ (� 6�)tiG 2D i A)206
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: C- C. L E I Crf I
Address #1 V Lt. sec tJ G -i DG e
(Street or Route No.) 0-1) a y Oq—
(1\) N L
City or Town State
($ Ls' A--
Area code- Phone number / /
4. DATE DRILLED a I o 0(
5. TOTAL DEPTH:
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
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 casing terminated at/or below land surface requires •
variance In accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): �7 0 METHOD,OF TEST t7
10. WATER ZONES (depth): ( S - S e G i) r m
Zip Code
11. DISINFECTION: Type W -11-1 & p '7 Amount d `'p
12. CASING: Wall Thickness
Depth (\/AA Diameter or Weight/Ft. Material
From To Ft.
From To Ft.
From To Ft.
13. GROUT: Depth To N/ (t Ft. Material Method
From 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
To
From
From
To
60.
CONSTRUCTION STAND
ope
Ft.
Ft.
L O CLfl Lo L.t_ ePe2 boy bio /
Size Material
Topographic/Land setting
❑Ridge ❑Slope ❑Valley QFIat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From / To / Fo on Description
05 - 6'l o ITt
a
CO
CO
-'O
CO a
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.
4 .
E
Nkr-
z
4
Ww/ 19 I
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
OTC ,A) evvnA a/ 1 I o o%
SIGNATURE OF PERSON CONSTRUCTING THE WELL DA
G. b the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
Asp L 9 3221, within 30 days.
GW-1 REV. 07/2001

248250
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and
RELTBENNatural Resources
CALDDBLLn of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) CERTIFICATION,/ 2140
WELL CONTRACTOR COMPANY NAME REUBEN CALDWELL DRILLING, INC. PHONE`p48 )?54-.358I
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT,/
(if applicable) (if applicable)
/
1. WELL USE (Check Applicable Box): Residential a Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION: �E �(JNcoM��
Nearest Town: A(z f`) County
$4--1 GL€NrJ R-1c&t g. ,, A(tb€t))ac_
(Street Name. Numbers, Community, Subdivision, Lot No., Zp Code)
3.OWNER: ( p3€ L1 (GNT
Address S'4-1 Co LEt3ta t3(ttbrGe. (2-D.
Alt-0
g (Street or Route No.)na% 1 D 4—
City or Town State" Zip Code
(Sat;)- b % 4 - iS [T
Area code- Phone numbers / 5 l//
4. DATE DRILLED
5. TOTAL DEPTH: °t O S
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 12(
7. STATIC WATER LEVEL Below Top of Casing: 0 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS - FT. Above Land Surface*
*Top Messing terminated at/or below land surface requires a
variance lit accordance with 1SA NCAC 2C .0118. ( G
9. YIELD (gpm): 0 METHOD OF TEST F
10. WATER ZONES (depth): 0
11. DISINFECTION: Type
12. CASING:
From To Depth,`t"
From To Ft.
From To Ft.
13. GROUT: Depth
From To a O
Amount
Wall Thickness
DI eter or Wet t/Ft. Material
Ft. 6 " SDR. i Pd�-
Material
Ft. Cl (AC at
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.
Method
QovRED
E1 t `°
I DU HEREBY CERTI- F▪ j
CONSTRUCTION STATE A]
1
Topographic/Land setting �
❑Ridge ❑Slope ❑Valley I]Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/scconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH FRILLING LOG
From , Tos / Formation Description
4 °Nee_ urLot9
0
r-t
CQ
J r„
LOCATION SKETCH r'. rrc
Show direction and distance in miles froth -at least "
two State Roads or County Roads. Includpthe Eoad
numbers and common road names.
GRE T c- y the
nsrlE�4O�' (tf
[1699-163 yen., 0 910)'
T THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
�S, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
en\ t•Ja9 ic,,v,A•6 a/ oa,
SIGNATURE OF PERSON CONSTRUCTING THE WELL TATE
Division of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
33-3221, within 30 days. GW-1 REV. 07/2001

248252
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and
RHUBEAeNatural Res
ources - CALDDELLn of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) CERTIFICATION it 2140
WELL CONTRACTOR COMPANY NAME REUBEN CALDWELL DRILLING, INC. PHONE448 ?54-.3581
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential 0' Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring ❑ Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: ktJ 6A dt; 2v l LLE- County b' CC,''
Gavoit„->00o 5-Ia`-L.5
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3.OWNER: J uun asc CA/
Address
(Street or Route No.)
City or Town State Zip Code
8)-
(Sa645-9YI¢
Area code- Phone number rn
4. DATE DRILLED o t
5. TOTAL DEPTH: \ b 5 '
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: 4- 0 FT.
(Use'+" if Above Top of Cuing)
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. ( v
9. YIELD (gpm): 15 METHOD 9F TEST t`
10. WATER ZONES (depth): I a S — \i G e
11. DISINFECTION: Type 1A i 11 CIO l
12. CASING:
Depth Diameter
From To 115 Ft. 16 I"
From To Ft.
From To Ft.
13. GROUT; Depth
From To 09-0
Amount 1 C L P
Wall Thickness
or Weight/Ft. Material
Material
Ft. C ritear
co Nejli/e2tiehodo
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 Malley Mat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
Fr m To , Formation Description
ll0'' ta5' (9l Ni1'C wiitre 4ZctYL
IDS ' C, - o3 TSc, Gwi=c e
\a5'- 165'
LOCATION SKETCH 5
Show direction and distance in miles from at least —
two State Roads or County Roads. Include the road
numbers and common road names.
6g.oc/utcG
(Iyore5
(:1, (I
74 ALE
g,2ANU-I
IQ-�3 rLrm
WolaElJE R'HFY T,-1 IS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
ONSTRUCTION STAND
S AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
/3joa\
SIGNATURE OF PERSON CONSTRUCTING THE WELL DA
„rL ►4 gal ig Divisi m of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
069941636 Ph6Nd Wd. (9l( b3-32 1, 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
REUBEN CALDWELL CERTIFICATION# 2140
WELL CONTRACTOR (INDIVIDUAL) NAME (print)
WELL CONTRACTOR COMPANY NAME REUBEN CALDWELL DRILLING, INC •PHONE[phone]
STATE WELL CONSTRUCTION PERMIT# 1537 ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential 12Municipal/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: (&i AJ E e_ t t-t-L County &.1 N cemi3E1
3. OWNER:
Address
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
SAtJE-T ROAA
(hoe Dye Coft_.
(Street or Route No.)
WCt4EKJtt a rJL
a��tg1
6. DOES WELL REPLACE EXISTING WELL? YES �NO ❑
7. STATIC WATER LEVEL Below Top of Casing: 6 c 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 15A NCAC 2C .0118. p, G
9. YIELD (gpm): 10 METHOD OF TEST 14
10. WATER ZONES (depth): 2.-'9
i o — o 1 U P re-,
'II - GPrn
11. DISINFECTION: Type WTu - °t o f Amount a cues
12. CASING: Wall Thickness
Topt� `5 Ft. 444Diameter or SDWei It/Ft. Material9VC
From
From To Ft.
From To Ft.
13. GROUT: A Depth Material
From To 090 Ft. C e tvkp NT
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
Area code- Phone number
4. DATE DRILLED
5. TOTAL DEPTH: 4-4 5'
City or Town State Zip Code
(8a(6)_ C,45 40l"7
1/a el /oa
From To Ft.
From To Ft.
BFMPBKS•
rl -nrY TWAT 1
NSTRUCTION STANDARD
247977
Topographic/Land settingg/
❑Ridge ❑Slope ❑Valley lat
(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
S - A5 oocfL600mi to
R5- a-oo GI-4tit TC
¢.o o 1. G Prn
aoo - 4-(0 GPIoiTE
II ct GPn+
4-to-445 GRANITC
LOCATION SKETCH
Show direction and distance in miles from at leas
two State Roads or County Roads. Includtgre road
numbers and common roa names. tv c
-n E
ro i::; =rn
- r,,
WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
AT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
n i ern U xQQ V a a /O P-
tSIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
IV
/
Sut%fdt tlheorlgtinfit) Ilielbivision of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
` q»r GW-1 REV. 07/2001
14=�6�hontiiVo(9Y9)'=�33- ,within 30 days.

248247
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) RELTBEN CALDWELL CERTIpFICATION% 2140
WELL CONTRACTOR COMPANY NAME REUBEN CALDWELL DRILLING, INC. PHONEY2(8 ?54-.3581
STATE WELL CONSTRUCTION PERMITH 1537 ASSOCIATED WQ PERMIT%
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ❑ Municipal/Public ❑j Industrial ❑ Agricultural Ly7
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other If Other, List Use , gar G A' I o
2. WELL LOCATION: �/
Nearest Town: 6AQ.Na -f S.)1LuE County 6uPacC imaC
�Ioo hie�.CcM1; x= P,p_`AtaCU WeAJ Leo)LIC.
(Street Name, Numbers, Community, Subdivision, Lot No.; Zip Code)
/Topographic/Land setting
Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
3. OWNER: v I M e A p_K (' ( (degrees/minutes/seconds)
Address i 6 O I1 o t- Co So l';Q GtLA to (Zbfl0 Latitude/longitude source:❑GPS❑Topographic map
(Street or Route No.) (check box)
WRA4e9_\/tLLC t3C a8lgi DEPTH DRILLING LOG
City or Town State Zip Code From, To / Formation Description
(t3l8)- bab - 33 44 A. — a ER-(3vRAa.ro
Area code- Phone number t / a / 3 5 - - 1 & 5 ' (J /GPM —
4. DATE DRILLED k 5
5. TOTAL DEPTH: b O 5 ' 9--ccj / — 5 G5 C: d .o to ,-t=
I GI
11. DISINFECTION: Type !M i N c10`7r Amount 9, C 0Q5
12. CASING: Wall Thickness
Depth Di ter or Weight/Ft. Material
From �- To -a O FL 6 i '/ Slog a t PI C
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
A_.From �To a 0 Ft. C 6n, \C-r l'ico2oD
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.
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO f17 c. GS
7. STATIC WATER LEVEL Below Top of Casing: `60 FT. 665'-(oo5/ C(zAsu,-�-:_-
(Use "+" if Above Top of Cuing)
8. TOP OF CASING IS a- FT. Above Land Surfaces
*Top of wing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): a METHOD OF TEST e-I C,
10. WATER ZONES (depth): )- 8 5 - 1 G Pi-`" _
S65 — 1 G P r^ LOCATION SKETCH
Show direction and distance in miles few atgust
two State Roads or County Roads. Include theioad
IV
U
-,e
numbers and common road names.
DNA KOSvl Ll lr )`I 1�/
5 M,Li>
I DO 'a .
CONSTRUCTION ST
;,GP
THIS WELL WAS CONSTRUC I liD IN ACCORDANCE WITH 15A NCAC 2C, WELL
AT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
GROUN[JW,r(
H$UYT P!cPM'
A S
SIGNATURE OF PERSON CONSTRUCTING THE WELL
DATE
he 1 vision of Water Quality, Groundwater Section, 1636 Mall Service Center -Raleigh, NC
3-3221, within 30 days. GW-1 REV. 07/2001

247224
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) REUBEN CALDWELL CERTIqFICATION# 2140
WELL CONTRACTOR COMPANY NAME REUBEN CALDWELL DRILLING, INC. PHONE`#$ 54-3581
STATE WELL CONSTRUCTION PERMITS/1537 ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential th MunicipaVPublic ❑ Industrial ❑ Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION: ee
hy
Nearest Town: Sax County ,r�u a.'1 _
(Street Name, Numbe
Community, Subdivision, Lot No., Zip Code)
3. OWNER:
Address C 4 7'd avrl acsmiti
tree'torpe No.)
City or or Town State Zip Code
(fl )- z5-2 — Acor 8'
Area code- Phone number
4. DATE DRILLED /— 2 2 — 0 2-
5. TOTAL DEPTH: I4 S
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO ,L9�
7. STATIC WATER LEVEL Below Top of Casing: /54 o FT.
/ (Use "+"if Above Top of Casing)
8. TOP OF CASING IS ( FT. Above Land Surface'
*Top of cuing terminated at/or below laud surface requires
variance in accordance with ISA NCAC 2C .0118. „i/
9. YIELD (gpm): 20 METHOD OF TEST 7,4
10. WATER ZONES (depth): „2-0,4-//5
11. DISINFECTION: Type
12. CASING:
2- g"f?-D 6
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
Formatiop Dessription
PEPTH
From To
0 Fe'
ro 4(4—
fV
CO ci_
'D
/R-0,41- /t./p / LOCATION SKETCH ••
//T/f 9b / Amount 2 - / tiC.t Show direction and distance in miles frotflt least
Depth Diameter
From 't ( To .�- Ft. i a
From To Ft.
From To Ft.
13. GROUT: Depth
From_C__ To 2 f 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.
Wall Thickness two State Roals or County Roads. Inclu a the rid
or Weight/Ft. tenet numbers and c mmon road names.
SZP.
Material ethod
16. REMARKS:
A
1 DO HEREBY CERTIFY THAT THIS WELL WAS
CONSTRUCTION STANDARDS, AND THAT A C
5o n y l(l p I,✓i lfr f7
S ATURE OF
t �' (. DYN ACC
THIS RECORD HAS BEE
N CONSTRUCTING THE
-II I5ANCAC 2C WELL
IDED TO THFGCVELL O
Submit the original to the Division of Water Quality,(4 r i nJWater Sectioq{0636 M1
27699-1636 Phone No. [phone], within 30 lays. ASHEVILLE Re.0
1 Service Center - Raleigh, NC
GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and NatuBl ENs CALDDELLn of Water Quality - Groundwater Section
REUWELL CONTRACTOR(INDIVIDUAL) NAME (print) CERTIFICATION# 2140
WELL CONTRACTOR COMPANY NAME REUBEN CALDWELL DRILLING, INC. PRONE`llFq%8 ?54- 3581
STATE WELL CONSTRUCTION PERMIT# 1537 ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
24'7223
1. WELL USE (Check Applicable Box): Residential Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town• 44Curd / 4,-de
County 4144-4i)
(Street Name, Numbe97 Community, Subdiv(sion, Lot No., Zip Code)
3. OWNER:
Address r
/emst.,I(M
NVti Ga'cwr4'
tree[ orpe No.)
City or Town State Zip Code
(fl )- 25-2 — %Jf i'
Ares code- Phone number
4. DATE DRILLED /_ 22 — © 2-
5. TOTAL DEPTH: /f h C
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO [IV
7. STATIC WATER LEVEL Below Top of Casing: /54 0 FT.
/ (Use "+" if Above Top of Casing)
S. TOP OF CASING IS ( FT. Above Land Surface*
*Top of casing terminated at/or below laud surface requires ■
variance In accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): .20 METHOD OF TEST
10. WATER ZONES (depth): 2-G'P.M-I%S
/8-CIS-' to
11. DISINFECTION: Type
12. CASING:
Depth
From 'f ( To .
From To
From To
13. GROUT: _Depth MaMari A Afethod
From 0 To z f Ft. •✓`� e*'t"�'
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.
Diameter
Ft. 6
Ft.
Ft.
Amount 2 - o `_
Wall Thickness
or Weight/Ft. lvlaterial
5W.2r C
16. REMARKS:
1 DO HEREBY CERTIFY THAT THIS WELL WAS
CONSTRUCTION STANDARDS, AND THAT A C
10 14.1(l p i✓1/fr`QR�
SI r fATURE OF
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic reap
(check box)
DEPT$ DRILLING LOG
From To Fomtatio Des ription
,ce
W cc
—w rr
N rTt�
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roar or County Roads. Include the road
numbers and c mmon road names.
CH("S,TRf y INGTIIE W
Submit the original to the Division of Water Quality, Groundwater Section, 1636
27699-1636 Phone No. [phone], within 30 days. GROUNDWATER SECT;DN
ASHEVILLE P GI^'-Prr
�17
15A NCAC 2C, WELL
IDED TO THIc'CVELL 0
I Service Center -Raleigh, NC
GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and
REUBEN Res
ources - CALDDi Lion of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) CERTIFICATION # 2140
REUBEN CALDWELL DRILLING, INC.PHONE`#p48 54--3581
WELL CONTRACTOR COMPANY NAME -
STATE WELL CONSTRUCTION PERMITS I J ASSOCIATED WQ PERMITS
(if applicable) (if applicable)
`/
1. WELL USE (Check Applicable Box): Residential 6t Municipal/Public 0 industrial 0 Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
246264
2. WELL LOCAT�(}�F� L >LVl /t xtk
Nearest Town: County
(Street Name, Numbers, Comunity_Subdivision, Lot No., Zip Code)
3. OWNER:
Address �t T n �le tr d
(Street or Route No.)
4 ,.Yin /Z/ C . 9—T 46—
City or Town State Zip Code
(9.2g)- ,‘s— #ci-_7
Area code- Phone number
4. DATE DRILLED f _ %)- - (7 2
5 TOTAL DEPTH: 3 0 5—
6 DOES WELL REPLACE EXISTING WELL? YES 0 NO B"
7. STATIC WATER LEVEL Below Top of Casing: `37) 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. r
9. YIELD (gpm): METHOD OF TEST
10. WATER ZONES (depth): ,„2- (VA - not
11. DISINFECTION: Type H714 70cAmount l 4 Gc-i
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
Froml( To %S FL 4ki: iQQ-zi PtiC-
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From_le_. To�Ft. eSsna+il—
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
From
From
16. REM
t
rt.
1
Material
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degre&minutes/seconda)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
Fomtatiolt escription
DEPTH
From To
�/
7/ 90
7'0 70 5
c_
C.
CD
=m
0
LOCATION SKETCH ° o
Show direction and distance in miles from at least
two State Roads or County Roars. Include the road
numbers and common road nam s.
Wi(1
I DO HERSBY C iiRTIFY THAT THIS WELL WAS OONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRL CTION &imp # T A COPY OF THIS CORD HAS BEEN PROVIDED TO THE WELL OWNER
ASHEVILLE REGIONAL (`C.) _KA Gait". \/ - a Jo 9
SIGNATURE OF PERSON CONSTRUCTING THE WELL ATE t
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

246127
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and
RB Natural
ResoCALDDivision of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) CERTIpFICATION# 2140
WELL CONTRACTOR COMPANY NAME RRUBEN CALDWELL DRILLING, INC. PIrONE` 48 }254- 3581
STATE WELL CONSTRUCTION PERMIT'S 1537 ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential IMunicipal/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: C-A N b1.6 R- County ` /3 cc'
aa1 Cutern 5 Ci (a CANOLgaa,l NG
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: (UuC cSret L6
Address acl1 au/LTiS cite -GA
(Street or Route No.) a 15
CANbLEK- r,)C
City or Tot State Zip Code
b
ai
(08) 6 i_n 7
Area code- Phone number O n
IX
4. DATE DRILLED_ 1 (S' (/ /
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO f�J
7. STATIC WATER LEVEL Below Top of Casing: Inn FT.
(Use "+" if Above Top of Cuing)
8. TOP OF CASING IS 4 FT. Above Land Surface"
*Top of wing terminated at/or below land surface requires •
variance in accordance with ISA NCAC 2C .0118. ��/1 G
TEST
9. YIELD (gpm): ab METHOD OF -1
10. WATER ZONES (depth): iS 0 / - as) (G e M
5. TOTAL DEPTH: 1 R 5
11. DISINFECTION: Type
12. CASING:
A, Depth
From .1-_ To
From_ To Ft.
From To
13. GROUT: Deptha
From 6- To 1
l H- go Amount CAP
Wall Thickness
Diamtjey/ or WyiRht/Ft. Material
Ft. (D/ t} sag/
Ft.
Ft.
Material Method
mu,r Qou2dD
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Sim Material
From To Ft.
From To Ft.
Slot Size Material
in.
in.
16 RFMARKC.
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degreWminutesheconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
Fro�tt,eTo Formation Description
— `� (� V be e-6 u e-() (3 a.)
3F 156 G AaiTc
9b Gen
Ise
lSs�'
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. p�
3
EP
(3 Ct`
1.) (S N
CO -ea V.--
S CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
D 1 CONSTRUCTION
ONSTRUC ONSTAND $ YI 1 THAT AS WELL pC OPYYF THIS RE EORD HAS EN PROVIDED TO THE WELL OWNER
_ ( MAR 2 7 20J2
L----_ ___
GSUbhlltTheEDrfg'ifl 1 to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
A?! 27699-1636 Phone No. (919) 733,3221, within 30 days. GW-1 REV. 07/2001
1,i7
SIGNATURE OF PERSON CON
TRUCTING THE WELL
/DATE

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) REUBEDI CALDWELL CERTIFICATION # 2140
WELL CONTRACTOR COMPANY NAME REUBEN CALDWELL DRILLING, INC. PHONEQ%8 )254-•358I
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential Mt/Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION•
Nearest Town: (JA't)A e. County �L)uCoben (
(2 -re (4-1 p c; ik) A� ) LA Ns uE )C_
(Street Name, Numbers, Community, Subdivision, Lot No., Zip ode)
4. DATE DRILLED 1 / 1 bib
5. TOTAL DEPTH: A 4S s
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO 1�
7. STATIC WATER LEVEL Below Top of Casing: - o 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
valiance In accordance with 15A NCAC 2C .0118. nn
9. YIELD (gpm): .9-0 METHOD OF TEST b` t G
10. WATER ZONES (depth): t © o eJ G %'
�I t0 S'- \5 GYa)
11. DISINFECTION: Type { Y t J n Amount . C�
12. CASING: Wall Thickness
Dept1 ter or Wei It/Ft. IttptpG
From To 1}- Ft. !{-�' SD l�J
From To Ft.
From To Ft.
13. GROUT:A Depth
From "A_ To at'
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
Material
Ft. C€w Si
15. SAND/GRAVEL PACK:
Depth
From To Ft.
From To Ft.
CONSTRUCTION STq
—Th
1 THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
AND THATA COPY OF THIS I21nCORD HAS BEEN PROVIDED TO THE WELL OWNER
Size
Method
Po �(Le,p
Material
246117
Topographic/Land setting
❑Ridge ❑Slope ❑Valley Flat
(check appropriate boa)
f Latitude/longitude of well location
3. OWNER: 14A, I 't C Imo.) N N 6' (degrees/minutes/seconds)
Address g..70 ( (Li We 40/1 "/ 0 Latitude/longitude source:❑GPS❑Topographic map
(Street or Route No.) l (check box)
l iA N D L , n IJC '' 116 EP DRILLING LOG
(�.ty or b s �ate zip code Fr m 3Tp i Fo tion Description
S:
"5 O L 1t t.-"&UR06i�
Asa coda Phone number (p e - \ 00 '
tt0 '
toe ' - aoS'
�05 r
is - a4-s'
(� 2Ar tTh
S Gen-
16 G tan
Cn R-A,3 it c
c-
ry
N -z
LOCATION SKETCH
Show direction and distance in miles fronE leak)
two State Roads or County Roads. Include
numbers and common road names.
SIGNATURE OF OF PERSON
CONSTRUCTING THE WELL `/ DATE 6 "•
G GAIi31(tki the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
ASI 9h / , Grp, che9 9) 7333221, within 30 days. GW-1 REV. 07/2001

246128
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) REUBEN CALDWELL CERTIrF;ICATION# 2140
WELL CONTRACTOR COMPANY NAME REUBEN CALDWELL DRILLING, INC.PHONE`#?f8 54-•3581
STATE WELL CONSTRUCTION PERMIT# 1537 ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential 21 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: L3 1$10-A\ t...Lk County 0N6C
t�oc'CEr-' c=J>✓
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: C e ASEE iT
Address `6 S b 1-414-E P t A3 GS L. At
CQ124)0 /(Street m Route No.) 3 aC 1
City or Town State Zip Code
(qci)- 3Sa- L5ED
Area code- Phone number
4. DATE DRILLED t !/ \ b / o a'
5. TOTAL DEPTH: 3 o 5
6. DOES WELL REPLACE EXISTING WELL? YES NO ❑
7. STATIC WATER LEVEL Below Top of Casing: lo 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 15A NCAC 2C .0118. )
9. YIELD (gpm): lD METHOD OF TEST K
10. WATER ZONES (depth): c(o / — 1 v G ern
11. DISINFECTION: Type
12. CASING:
Depth
From ' To 36
{ aoc7
).)
T
Diameter
Ft. 6'/1
From To Ft.
From To Ft.
13. GROUT: Depth
From , To 0 i,
Amount :1 coe
Wall Thickness
or Weight/Ft. Material
5mQa1 PIG
Material
Ft. C 06;01"
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.
R,,6.,F"4„
1 DQO�(ff HEREBY CERTIFY
CM 2g1TirAM
GROUNDWATER SECTION
ASHEVILLE REGIONAL OFFICE
Su ix the orlglnaf 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
Method
Slot Size Material
in.
in.
Material
Topographic/Land setting
❑Ridge ❑Slope ❑Valley teFiat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
Formation Description
e4Sei3v9 OEtJ
fp (2-i`lNl'iC
DEPTH
From To
L •- 33
33'" °to'
RO
�Co ' 3DS
1 or-
D> F2-A ,.r t rt
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.
GUct'Te rJ
inn L�
IV
THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
\
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE

IJ
245766
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
REUBEN CALDWELL
WELL CONTRACTOR (INDIVIDUAL) NAME (print) CERTIFICATION # 2140
WELL CONTRACTOR COMPANY NAME REUBEN CALDWELL DRILLING, INC .8 1254- 3581
STATE WELL CONSTRUCTION PERMIT#
(if applicable)
7
ASSOCIATED WQ PERMIT#
(if applicable)
1. WELL USE (Check Applicable Box): Residential 0 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: BARN f1fMMSQ%1 Lit`' County a coMe'
5 (/((l rTen cR-C 1Z/1t)C7t
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: 0 t Q G N ,.) pt g-S
Address - 0 . 3v ? k 4- 4-
(Street or Route No.)
f'N,.1ARDSJIu.0 fJ C ag i 69
City or Town State Zip Code
( - Gab-aaga
Area coda Phone number /
4. DATE DRILLED 1, cb ! o G,
5. TOTAL DEPTH: 1 as
6. DOES WELL REPLACE EXISTING WELL? YES f NO
7. STATIC WATER LEVEL Below Top of Casing: 4-0 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 Ith ISA NCAC 2C .0118.
9. YIELD (gpm): METHOD OF TEST ft I G
10. WATER ZONES (depth): n o '- 4 G Pn\
11. DISINFECTION: Type 11-rN Q0".Amount a.. CQP
12. CASING: Wall Thickness
,n7 Depth Dieter or Weigt. Material
From 1 To 3 Ft. b 14 �' S Ogat � �
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From 1 To ao Ft. estineOT POUF-21)
From To Ft.
14. SCREEN. Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
1\r CYTII#"
'�DO`{(E 'CE
Topographic/Land setting
❑Ridge ❑Slope ❑Valley IdFlat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
Frgm / To , Formption Description
1 - 3o 0./4, SvROI? �
3o'- Soy
l a `J'
c_ -
CO
LOCATION SKETCH ry rn
Show direction and distance in miles fronrat least
two State Roads or County Roads. IncludNie rda)1
numbers and common road names.
J
)-
3
(3AtNAkl1S.)ILL2 ht7
CONSTRUCTION STAND
L _—
Submit the originalWithe Div lion of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
216904616 Phone- Na i(9[0 731-4221, within 30 days. GW-1 REV. 07/2001
IS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
THAT
OF THIS HAS BEEN PROVIDED TO THE WELL OWNER
7GNATURE OF PERSON CONSTRUCTING THE WELL DA

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and
REUBEN Resources
CALDDELLn of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) CERTIFICATION p 2140
REUBEN CALDWELL DRILLING, INC. PHONE`aFp48 ?54-•3581
WELL CONTRACTOR COMPANY NAME •�t-��'7
STATE WELL CONSTRUCTION PERMITS/�"`�` ASSOCIATED WQ PERMITS/
(if applicable) 7 (if applicable)
245771
1. WELL USE (Check Applicable Box): Residential W 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: LA ti 0 Le la' County 6�'0 Goo 6E
&ASicrJ •moo J et iRt .)
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
-3 L.t %t 6 AC
3. OWNER:
Address
(Street or Route No.)
Vityor
G (0 _ 54- 5( (O Zip Code
Area code- Phone number / IJ a-
4. DATE DRILLED II /`�
5. TOTAL DEPTH: ci o 5 /
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO I"
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 Ith 15A NCAC 2C .0118.
9. YIELD (gpm): IVa— METHOD OF TEST (LAG
10. WATER. ZONES (depth):
11. DISINFECTION: Type g q D ° v Amount 3 COPS
12. CASING:
A Depth( Di eter
From To ¢5 Ft. b' u
From To Ft.
From To Ft.
13. GROUTDepth ,{`'�aterial Metho
From i. To �O Ft. l,eMENC as °At
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
To
To
Wall Thickness
1
From
From
iLtEIur 9: I
�, I„� HIDUIImREBY CERTIFY
111r{'. CONSTRUCTION ST
��(rR S_L
� t
Ft.
Ft.
pographic/Land setting
dge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
PEPTU DRILLING LOG
From, To i ForpadorpDescription
1 4-0 O Ve213URAZ *(J
c
co
Cz
c, i
r
N
JOCATION SKETCH ._.
Show direction and distance in miles fi6m at ast
two State Roads or County Roads. Include the road
numbers and common road names.
S A fUs S C-aAD
IS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
�u,� 'r.U'i.i. t F
A IR[ 6 Phone No. [phone], within 30 days. GW-1 REV. 07/2001
IGNATURE OF PERSON CONSTRUCTING THE WELL DATE
ion of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC

26;728
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
REUBEN CALDWELL
WELL CONTRACTOR (INDIVIDUAL) NAME (prlal) CERTIrF�ICATION, 2140
WELL CONTRACTOR COMPANY NAME REUBEN CALDWELL DRILLING, INC. PHONEY8 )254-3581
STATE WELL CONSTRUCTION PERMIT, 1537 ASSOCIATED WQ PERMIT,
(if applicable)
(if applicable)
1. WELL USE (Check Applicable Box): Residential Er-Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCAT
�b-e.e�CJdL�-
Nearest Town:.!
my
(Street Name, kumbers, Community, Subdivision, No., Zip Code)
3.OWNER: 1?(CM RL 4 ,4
Address (� ( 1,}fAt
a/", Q /� (Street or �ute,No.)
4.
5.
6.
7. STATIC WATER LEVEL Below Top of Casing: .3_ FT.
(Use "+" if Above Top of Cuing)
'8. TOP OF CASING IS / FT. Above Land Surface*
*Top of cuing termloated at/or below lad surface requires a
variance In accordance with 13A NCAC 2C .011 a. �/
9. YIELD (gpm): %1-- METHOD OF TEST
10. WATER ZONES (depth): 2 ✓�� — L,
11. DISINFECTION: Typef tWt ib%.,Amount 3 4//r
12. CASING:
Wall Thickness
Depth� D}gn+eGr 2-ight/Ft. Material
Fro To Ft.
From To Ft.
From To Ft.
13. GROUT: Depth 1j�aterial
From Q To 2-/P Ft. L'ilrril�
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.
g
_ i-' Fer rbr
L
't I DO HEREBY CERTIFY lAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
S, AND THAT A COPY OF THIS ayb' a RD HAS BJ3 PROVIDED TO THE WELL OWNER
grip /9 72 to
SIGNATURE OF PERSON CONSTRU NG THE WELL DATE
City or Town State Zip code
Area coda Phone number
DATE DRILLED /D/ - 3 /D 2�
TOTAL DEPTH: %T
4!
DOES WELL REPLACE EXISTING WELL? YES 0 NO ❑ y, O 'r - 2-45-
Topographic/Iand setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check app y^ate box)
Latitude/longitude of well location
Negras/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
Formation Description
DEPTH
From To
7 - et S
LOCATION SKETCH
Show direction and distance in miles from
two State Roads or County Roads. include
numbers and common road names.
u : (.0e a
I' east2
road;
J
GROirh: C':ATEA SEOIION
AS`'tvi ih, P(ii6likigiiiQ@o the Division of Water Quality, Groundwater Section, 1636 Mall Service Center -Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-I REV. 07/2001

266076
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment andllahualjResoturc y.- Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME�(prt.t) AF 4Acr)IPIrV \ "( I�lw� LL.. CERTIFICATION / /5.31
WELL CONTRACTOR COMPANY NAMEt'el 4 or'ril (2Q' i4i air I/ 1'li(1NCf r-l— PHONE I j�-t5L s -358
STATE WELL CONSTRUCTION PERMIT/ ASSOCIATED WQ PLRMITI
(if applicable)
(if applicable)
1. WELL USE (Check Applicable Box): Residential* Mtmicipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Purnp Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATIO
Nears. To
Name, Num
3. OWNER:
Address
(Street or Race No.)
City or Town Stab Zip
62E6- 7z7"o/cs'R'
Area code Phone number
4. DATE DRILLED et ild�D
5. TOTAL DEPTH: 4JO
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: 4. t— FT.
(Use "t" if Above Top of Casing)
8. TOP OF CASING IS % FT Above Land Surface•
ge7I7
'Top of cuing terminated atfor below Ind surface requires ■
variance 1a accordance with ISA NCAC 2C .011S.
9. YIELD (gpm): ti METHOD OF TEST
10. WATER ZONES (depth):
J°CATION SKETCH
11. DISINFECTION: Type Ark Oil: Amount 'j- ayes Show dnwtion and distance in miles from at least
12. CASING: Wall Thictmess two State Roads or County Roads. Include the road
Dept numbers and common road names.
Topographie/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(dockappropriate box)
Latitude/longitude of well location
(decemAniamu/ee000d.)
Latitude/longitude source:❑GPS❑Topographic map
(check boa)
DRILLING Inn
Formation Description
DEEDI
From To
From f To gf FL
From To FL
From To Ft.
13. GROUT: Depth
From Q To Ft.
From To Ft.
14. SCREEN: Depth Diameter
From To Ft.
From To Ft.
15. SAND/GRAVEL PACK
DepthFrom To Ft.
From To Ft.
Dameter or eigbt/FL Material
16. REMARKS:
Slot Sin Material
in. in.
in. in.
Site Material
r�
rn
0
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE W1TH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WFI 1 OWNER
SIGNATURE OF P
RSONCONS7RUCIiNG THE WELL/`! DW
0 z—
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mall Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001
CD
;
r
:cm
o`er
rn
Do
r�
G
z

264691
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources
CIiLDWELLn of Water Quality - Groundwater Section
REUBENWELL CONTRACTOR (INDIVIDUAL) NAME (print) CERTIFICATION a 2140
WELL CONTRACTOR COMPANY NAM! REUBEN CALDWELL DRILLING, INC.INC• ?HONEY8 )54-3581
STATE WELL CONSTRUCTION PERMIT/ 1 537 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 If Other, List Use
2. WELL LOCATI
Nearest Town:
3. OWNER: , �•'
Address A7) 41, ! �� 04 Latitude/longitude source:❑GPS❑Topographic map
` t or A No. (check box)
2 7 / j DEPTH DRILLING LOG
CountyJte%ie-s-
Numbers, Community, Su .vision, is No., Zip Code)
•
Topographic/Land setting
[Midge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(depeuhn inu res/secoods)
City or Town Stale Zip Code From To Formation Description
09)- (o%Z -1 tit '-
Area coda Phone number
4. DATE DRILLED /D (2 ,-3 it 2_
5 TOTAL DEPTH: f P-.f
6. DOES WELL REPLACE EXISTING WELL? YES ONO L7 f
7. STATIC WATER LEVEL Below Top of Casing: 3 a1 FT. r�
(Use "a' if Above Top of Carina)
8. TOP OF CASING IS / FT. Above Land Surface'
*Top of cuing terminated at/or below land surface requires a
variance In accordions with 1SA NCAC IC .011a.
9. YIELD (gpm): 3 0 METHOD OF TEST
10. WATER ZONES (depth): fi7
,/ � LOCATION SKETCH
11. DISINFECTION: Type 49-`to,77,-Artlount / _ Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads. Include the road
Depth ; or Weight/Ft. N4 ie a) numbers and common road names.
J
/� Diamete
From+( To —! Ft. ;,( / C_
From To Ft.
From To Ft.
13. GROUT: Depth Malet a nisi _ From & To 7 n Ft.
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.
let
16. REMARKS:
ethod
Material
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 WE OWNER
SIGNATURE OF PERSON CONSTRUCTING THE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mall Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

10. WATER ZONES (depth): Ibe t
270524
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and watural Resources -` Division of Water Quality - Groundwater Section
WLLL CONTRACTOR (INDIVIDUAL) NAME (prima) (� I f j � 4 CEATIIICATION 1 2117
wELLCONTRACTORCOMPANYNAME_RF.USEN CALDWELL DRILLING, INC. rRONErPY�(8 ?54-3581
STATE WELL CONSTRUCTION PERMIT/ ASSOCIATED WQ PERMITS
(if applicable)
(if applicable)
1. WELL USE (Check Applicable Box): Residential E -Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATeION: •
Nearest Town' 11I I ( e County Anti r)
�3�iQAt S�Svil L^r I{D %es -7(%A LA-rc
(Street Name, Number, Community, Subdiviei%n, lot No., Zip Code)
3. OWNER: Gira1 " 1L
Address
+ eve or Route No.)
c. SIPA. 2 /2° •7" t 7 d
City'or Town Stale Zip Codc
)-�n(p'2_73g
ra Acode- Phone* number
4. DATE DRILLED /P-21 2.v/0
5. TOTAL DEPTH: f�
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO E"
7. STATIC WATER LEVEL Below Top of Casing: 3 ' FT.
(Use "+' if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surface
*Top ofcwlag termlaated alfor below land 'errata requires •
variance le accordance with ISA NCAC IC .0111.
9. YIELD (gpm)• sy• METHOD OF TEST pEST as
} vrn.
11. DISINFECTION: Type lilt* g0 ,t Amount f o
I2. CASING: d Wall Thickness
Depth Diameter or Weight/Ft.
From* / To 24 FL `p Jar
From To FI.
From To Ft.
13. GROUT: Depth Material Meth
From To pi Ft. Ciao aryl
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
Material
From To Ft.
From To Ft.
16. REMARKS:
LCc*4STRCUCtION sr
x,PA 2
2
Submit the original t jT the 1
I_-"`-37699-1636-Ahoue-No-6919) 7
Topographic/Land setting
❑Ridge 0Slope ❑Valley Griot
(check apprepriste box)
Latitude/longitude of,well location i
N 35° 46 A4a I u 8a° ag,555
(degreeahnimuufseronds)
Latitude/longitude source:OGPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
6 — 8,
c
114
jhd -l(b
LOCATION SKETC1i o `c
Show direction and distance in miles frompt lead
two State Roads or County Roads. include roil;
numbers and common road names.
0
T THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
S, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
61.1(1 A) J L�7 Lc. (0
SIGNATURE OF PERSO?C()NSTRUCi117 rC {E WELL DATE
(vision of Water Quality, Groundwater Section, 1636 Mall Service Center -Raleigh, NC
3-3221, within 30 days. GW-I REV. 07/2001

2'7125(-I
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
REUBEN CALiDWELL .1'-/ \
WELL CONTRACTOR (INDIVIDUAL) NAME (print) CERTIFICATION Ma d, I
WELL CONTRACTOR COMPANY NAME REUBEN CALDWELL:' DRILLING, INC. PHONEY2(8 )254-3581
STATE WELL CONSTRUCTION PERMITS 1537 ASSOCIATED WQ PERMITS
(if applicable) (if applicable)
IT
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 LOCAT
Neare/A Town:
County aJ4.44e4,.. tiQt Q
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: ��lc r /t �eT11t
Address �?
(Street or Na.) . c. 77z,
City or Town State Zip Code
(fit)- 77 r - 0 ',;(_ 6316
Ara code- Phone number f
4. DATE DRILLED : t I $ I. O 1-
5. TOTAL DEPTH: 9 1 e.
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
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 casing terminated at/or below land surface requires a
variance In accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): D METHOD OF TEST 2/ tS--
10. WATER ZONES (depth):
From To
From To
13. GROUT: Depth
From 0 Tofl
From To
14. SCREEN: Depth
From To
From To
15. SAND/GRAVEL PACK:
4-
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degreeimimnes/secmds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
f— 30
3d an)
frp Ss6
FT. `f e10
:. �l
L.)
�f,, LOCATION SKETCH -x' ; o
11. DISINFECTION: Type C, l") %Amount Show direction and distance in miles frank at Ian12. CASING: Wall Thickncss�1 two State Roads or County Roads. Include the road
Depth Diameter or Weight/Ft. Material i numbers and common road names. =-
From't ( To Co Ft. CD '1.1
Ft.
Ft.
Material
Ft.
FL
Diameter SlotSize Material
Ft. in. in.
Ft. in. in.
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
CpwAr2
t_ n pJf
1(L
ti
31
01
CO
v S -7 4-
17m,I I pa HEREBY‘CERTIFY
_ `I CONstRUCT1014,ST"
T THIS WELL WAS CONSTRUCTED M A:CORDANCE WITH 15A NCAC 2C, WELL
S, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
) 1j,>� 1�
•'�` i SIGNATURE OF PE 0 C NSTRU NG THE WELL DA
Submit the original to the 'vision of Water Quality, Groundwater Section, 1636 Mall Service Center- Raleigh, NC
27699-1636 Phone No. (919) 7 3-3221, within 30 days. GW-1 REV. 07/2001

270875
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and natural Resouryes - Division of Water Quality - Groundwater Section ,QQ
Lj
WELL CONTRACTOR (INDIVIDUAL) NA`�1�E, (Prlot) ��
4(�eit CERTIFICATION#
WELL CONTRACTOR COMPANY NAME eTA,bni ll.Il�.Wr1I Vial/tied •'LNC-. PHONE if )
STATE WELL CONSTRUCTION PERMIT# / .` 3 -1 _ASSOCIATED WQ PERMITS,
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential 0 Municipal/Public 0 Industrial 0 Agricultural I'
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATIO :
Nearest Town:Q L
County
(Street Name, Number, Community, Subaivisior., Lot No., Zip Code)
3.
OWNER:
Address 7 72�u`S�
aucc (Scree t oriaArte No.) n,$ 2c
City or Town State�L ZipCode
($3 & 2w 3 2J Area code- Phone number
4. DATE DRILLED 12. J 1 to l 1)
5. TOTAL DEPTH: 5 ( 0
6. DOES WELL REPLACE EXISTING WELL? YES FT.
F0
7. STATIC WATER LEVEL Below Top of Aasing: Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surface'
'Top of casing terminated at/or below laud surface requires a
variance In accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): � METHOD OF TEST Ri �.
.
10. WATER ZONES (depth):
11. DISINFECTION: Type kk-rIA-
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Mate
From_ To !. w� Ft. 4. . e - ere
From To Ft.
From aciatv TeBIle Q- Ft.
13. GROUT: Depth
From b To 2.0 Ft
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Amount g gi
Slot Size
in.
in.
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Descries
0- 49•
G9 - /0-5'
/LS• l3f
/,;s- /Sew
Material
16. REMARKSL
I 13Q3IER$HY CERTIFY flMiti l
CONSTRUCTION STANDARDS,
LOCATION SKETCH W
Show direction and distance in miles from at leas
two State Roads or County Roads. Include the road
numbers and common road names.
2
/hZ
SIGNATURE OF P
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mall Service Center ' Raleigh, NC
Phone_ No. (919)1lt3221. Within 30 days.
WELL WAS CONSTRUCTE6 IN ACCORDANCE WITH 15A NCAC 2C, WELL
THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
/eke
DATE
J'IG—�L
ON CONSTRUCTING THE WELL

255S74
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment andREUBENatural
N oCALDDELLn of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (prlat) CERTIFICATION0 214Q
WELL CONTRACTOR COMPANY NAM! RF.UBEN CALDWELL DRILLING, INC. PHONE[phone]
STATE WELL CONSTRUCTION PERMIT. 1537 ASSOCIATED WQ PERMIT/
(if applicable)
(if applicable)
1. WELL USE (Check Applicable Box): Residential LW/Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: it I KA/ et-3 County �el CO n vgC
A) A L A rJ e—
(Street Name, Number, Community, Subdivision, lot No., Zip Code)
1ie070ro )v"1 A#c 3. OWNER: VI kaj Al-,T6n� 33
Address 11 IJ5fA0A At%
^ (Street or Roue No.) SA61t��Es tic o
City or Town Stale Zip Code
(Stag} a4a. - 6655
Arta code. Phone number
4. DATE DRILLED to /t o /O a
5. TOTAL DEPTH: 9 O 5
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: 4i 0 FT.
Rise if Above Top of Casing)
8. TOP OF CASING IS .1 FT. Above Land Surface'
*Top of cuing terminated at/or below lad surface requires a
varluu he accordanta iti ISA NCAC 2C .01U.
9. YIELD (gpm): i /a METHQD OF TEST eA 6 - A 112-
10. WATER ZONES (depth): 5 o e I '�7 C f o"
11. DISINFECTION: Type i±Tri rioiX Amount a c"P5
12. CASING: Wall Thicmess
Depth Di!t9eter or Weight/Ft. Ivlekpal
From To 45 Ft. (e /8 Sato
From To Ft.
From To FL
13. GROUT: A Depth Material
From To a Ft. Len160,r
From To FL
14. SCREEN: Depth Diameter Slot Sire Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVELPACIC:
Depth Size Material
From To Ft.
From To Ft.
M��ethod
Pa
16. iREMARKC ._�
L9 J ';
1 DO IIEREB�
CONSTRUCTION ST
opographic/Land setting
dge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(depeeahniautes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG Description
Fr. 3 D To nn �/ t&►� 45 20600
1 Y.:z 6 Pr
(042,,troitt
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the mad
numbers and common road names.
IV
L
C
r—
r
CAad C(L
T THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 1SA NCAC 2C, WELL
S, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE OWNER
0
S
SIGNATURE OF PERSON CONSTRUCTING THE WELL
O
n mlFtil�'dil itaI to t Division of Water Quality, Groundwater Section, 1636 Mall Service Center -Raleigh, NC
A Crr iT6�$.Y�i61'h e Ri (91 733-7221, within 30 days. GW-1 REV. 07/2001

D),
WELL CONSTRUCTION RECORD 259822
North Carolina - Department of Environment aancl_N rResourc Div/ilsion of Water Quality - Groundwater Section
WELL CONTRACTOR
WELL CONTRACTOR CCOOMPANY NAME f F' LI be IV On' I )(Loci/ 1 (t i`t � t.-1—NV' PHONE * yi a5 58
STATE WELL CONSTRUCTION PERMITS ASSOCIATED WQ PERMIT/
ifeoolicable) _i (ifappliable
1. WELL USE (Check Applicable Box): Residential IU' Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATI9N: ,
Neajest Town: County
(Street Name, Number, Cambuoity, Subdfvirian, Lot No., Zip Code)
3. OWNER:
Address - 33
Sic.
/1 Lie[ ar Rautarge t _ ,/
/!'l�Citi/�tyar Town '`r�}�'State,t /��1:�Zip
Code Q��-
(f i- 25f 7"
Arcoda Phone number /
4. DATE DRILLEDc Tom.!
5. TOTAL DEPTH: fSj
6. DOES WELL REPLACE EXISTING WELL? YES @'NO 0
7. STATIC WATER LEVEL Below Top of Casing: / /%'D FT.
/ (Use "+" if Above Top of Casing)
8. TOP OF CASING IS ` FT. Above Land Surface*
'Top of cuing terminated at/or below Wd surface requires a n /
variance In accordant with ISA NCAC 2C .0118.
9. YIELD (gpm): METHOD OF TEST
10. WATER ZONES (depth): !ir J
vytat� t cuz4
Topographic/Land setting
[Midge ❑Slope ❑Valley ❑F1at
(check appropriate box)
Latitude/longitude of well location
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
tt LOCATION SKETCH
11. DISINFECTION: Type / _ qn Amount : 53 j Show direction and distance in miles from at lea
12. CASING: Wall Thickness two State Roads or County Roads. Include the mad
Depth, Diameter or Weight/FL IN. atri'at numbers and common road names.
From'*_ To F^ g FL (Q l
From To FL
From To FL
13. GROUT: Depth terisl
From__. To %O Ft. .45,-Leer
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
From To Ft.
IF RFMARKC•
(Iv^ fll� r� �r,
`i
IvYilP RY r'Fli4I`Ir
CONSTRUCTION STANE
' 2002 ii
T THIS WELL WAS CONSTRUCTED IN ACC6RDANCE WITH 15A NCAC 2C, WELL
>S, AND A COPY OF THIS RECORD HAS BEEN PROVIDED TO OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL
Submit the twirl to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
0
27699-1636 Pho' a No. (919).733.3221, within 30 days. G W-1 REV. 07/2001

2. WELL LOCATION: r�j
Nearest Town: P3 kti 1 <. County f�sld(ft
(Street Name. Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: RDArflrkt.e-
Address i Q( fey -fey- �iv.n-ii ay.ra/e- /yr w{.
(Street or Route No.) n �D L�
/-' l^r'r ied we. b
City or Town
08_)- G6-1 -
Area code- Phone number
4. DATE DRILLED
5 TOTAL DEPTH'
State Zip Code
7j,'6X
d-.29-6
2.23
6. DOES WELL REPI.ACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: Lop _FT.
(Use "+" irAbove Top of Casing)
S. TOP OF CASING IS / FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance �w� th ISA NCAC 2C .0118.
9. YIELD (gpm): —� / METHOD OF TEST /h.Z
10. WATER ZONES (depth): 3&6
I I. DISINFECTION: Type g_e:v)ldied Amount L
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From % To 77 Ft. lD R% 0 t`"
From To Ft.
From To Ft.
Material Method
l3. GROUT: Depth From ! To 2,b Ft. w^-t_ ptk-d
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK: Material
Depth Size
From To Ft.
From To FL.
16. REMARKS:
120 HFR FRY
jJ U CFRTIFY THAT THIS WELL WA
pT IAE' • ate. AND THAT A
SIN
0 SIGNATURE 0
AN N 1 1 2002
Submit the original to t
636 Phone No. (91
GROUNDWATER SECTION
ASHEVI'LLE REGIONAL OFFICE
ision of Water
733-3221, within 30
Slot Size Material
in.
in.
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
�-r rn4R�o u CERTIFICATION
WEILCON'1'ItAC"rOR (INDIVIDUAL) NAME (print) twe.S
PHONE # fL4h)�, /�Y
WELL CON't RAC-1'OIt COMPANY NAME [ .1P S / fI) r.-✓ 6✓eI
ASSOCIRf ED WQ PERMIT#
star: A fl: wE.LI, CONSTRUCTION PERMIT# (i(;tpplic:tble)
l if applicable)
254640
I. WELL USE (Check Applicable Box)' Residential Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other Or If Other, List Use
Topographic/Land setting
DRidge rag -lope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds}
Latitude/longitude source:❑GPSOTopographic map
(check box)
DEPTH DRILLING LOG
From To Formatio
n on .651C
/ GC s e.e. t d c
rt-
to 6 39-5
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.
24
' /9I t 4-As -
02'k' t )-i"t
> Qix.t-r'-- 14-:
,:,, ,,H, , „..,i7 r
STRU;ff bN ACC:a/RO'AN
r�
OF I HIS RLCORD HAS BE P}t
I11I1
N CONSTRUCTING THE
uali yE xent 1®ft, 1636
ays.ASHEVILLE REGIONAL O!-FICE
TFI 15A NCAC 2C, WELL
VIDED TO THE WELL OWNER
DATE
ail Service Center - Raleigh, NC
GW-1 REV. 07/2001

254643
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - DivisionDf'ofWaterQuality - Groundwater Section �j
WELL CONTRACTOR (INDIVIDUAL) NAME (print) i( 4AJ r v L-Adc. 4+�-"�' CERTIFICATION # 2.'�r7�
W ELI. CONTRACTOR COMPANY NAME l i aws— W A 1 WJ/at PHONE # [phone] L\
SPATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
lit applicable) (i I.applicable)
1. WELL USE (Check Applicable Box): Residential IiMunicipal/Public ❑ Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other ❑, If Other, List Use
2. WELL LOCATION: ,�/
Nearest Town: aica. rif rwri!/-e-
County fF1.a4s„,
(Street Name. Numbers, rCommunity, Subdivision, Lot No., Zip Code)
3. OWNER:
Address 14/.e0. &-az4-Ur PVC
(Street or Route No.)
yy,,�-''-k'p5 led a.6lag
City or Town Statce Zip Code
(gAt)- 4 sit 36
Area code- Phone number
4. DATE DRILLED S- i-a1'
5. TOTAL DEPTH: 2 2-5- /
6. DOES WELL REPLACE EXISTING WELL? YES C' NO 0
7. STATIC WATER LEVEL Below Top of Casing: /d 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 surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): S0 METHOD OF TEST '.'w
I0. WATER ZONES (depth): 261-
Topoggr hic/Land setting
❑Ridge WSlope ❑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
1iG
To
LD6-
c
N o
L
LOCATION SKETCH
I L DISINFECTION: Type aia.�d2le Amount 'IY Show direction and distance in miles from aP2ast
12. CASING: Wall Thickness two State Roads or County Roads. Include the road=
or Weight/Ft. Material numbers and common road names.
Depth Diameter
From / To b t- Ft. /o
From - To Ft.
From To Ft.
13. GROUT: Depth Material (-----) Method
From �? To ? - ; Ft. Ct-'tttPt1 --c ,aG..);e_-
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
i)1-izl goto.r
16.REMARKS:
c 94 /Ca rs-i Grl fr. f_
••' T BVIOI VSTT C
J N 1 14002
f
if, l� Li I -1
THIS WELL WAS C TRUCTED IN ACCORDANGIC. Wnr
, AND THAT A COPY lj THIS RECORD HAS BEEN( rRQtV
J
.�.1 SIGNATURE OF 1
E (SON CONSTRUCTING THE WELL
he Division of Water Qualit46 6bS IL1 36 NI
gi21199T, rbrHelt()IP 9) 73:-3221, within 30 mays.
ASHEVILLE REGIONAL OFFICE
Submit the original to
H I5A NCAC 2C, WELL
IDED TO THE WELL OWNER
DATE
it Service Center - Raleigh, NC
GW-I REV. 07/2001

254644
EEC
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section [/
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Mc.,..r) F �r�l<acid i.t.:5 CERTIFICATION# 5383l
WELL CONTRACTOR COMPANY NAME (a4.Fl�/V .a. --cr W.#i, PHONE # ()-lam) L.2.2-7f(84
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
Iifapplieablc) (if applicable)
WELL USE (Check Applicable Box): Residential CV Municipal/Public D Industrial 0 Agricultural 0
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other 0, If Other, List Use
2. WELL LOCATION:
Nearest Town: ern ivi 6( ll+'_
County 73U ML
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: �`i3 /r4Ai
Address "VIntue Bite: /d;ll ,ialw-
(Street or Route No.)
�'wej'l/ Tut/ if 3 ? lr SD
City or Town State Zip Code
(Nx a )- 7443 a l 21
Area rode- Phone number
4. DATE DRILLED 5- 2V-69--
5. TOTAL DEPTH: 3Uic
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO Fr
7. STATIC WATER LEVEL Below Top of Casing: 3L) 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)• 1 6 METHOD OF TEST
10. WATER ZONES (depth):
11. DISINFECTION: Type /4rOn.Cfn fry Amount 1
12. CASING: Wall Thickness
Depth or Weight/Ft. Material
From / To /%4 /g/G /14.c./4-I
From To
From To
13. GROUT: Depth Material
From / To -0
Ft. .rrv-t_
Diameter
FLU
Ft.
Ft.
From To
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size
From To Ft.
From To Ft.
16. REMARKS:
Slot Size Material
in.
in.
Material
Method
rP -
i1 FQ 0..4)1 l e L 4-, if",/31e,(C rerf/�est 6,4 J
Topographic/Land setting
❑Ridge ❑Slope Galley ❑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
/ / lG
/17G - 3//5
O -_
e.
CD
rn
N
zm
LOCATION SKETCH c,p
Show direction and distance in miles from atcast 5
two Stale Roads or County Roads. Include the road
numbers and common road names.
.2 azij /O.C�-C'K(aLt tvt'
-121
I DO HEREBY CERTIFY THAT THIS WELL WAS CON2
C ICSST CS, AND THAT A COPY 0
SIGNATURE OF PERSON CONSTRUCTING THE WELL
C(/
S'%1mit 2hi otrt9Pi iI to
27699-1636 Phone No.
flinn L�'Is,
( TED IN ACCORDANCE WII
RECORD HAS BEEN PRO -J J
LJ
�,
j4 NCAC 2C, WELL
ED TO THE WELL OWNER
DATE
' RCti n I a S C LOIN
.., .. vision of Water Quality, Grb&#ldf ih�fht`&eeftbn*l©361Mail Se -vice Center - Raleigh, NC
9) 733-3221, within 30 days. J GW-I REV. 07/2001
i
GROUNDWATER SECTION
ASHEVILLE REGIONAL OFFICE

254647
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) 7J, ;5 L. /Mt a4o.4 `j CERTIFICATION # 25gr
WELL CONTRACTOR COMPANY NAME l.14-el1.1 dt'r we,/ ( PHONE ev2t)d%,Z-') 9A9
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERNIIT#
( if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential g' Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other 0. If Other, List Use
2. WELL LOCATION: Nearest Town: f/2/ Creel- County /�^�
1utnett✓
(Street Name. Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: Y .fk RILL
Address 31 4M.ifi sue �kd
(Street or Route No.)
0.c dier NC, R8715-
City or Town State Zip Code
(928)- .755- eo 93
Area code- Phone number
4. DATE DRILLED S 22 _ d Z-
5
6.
7. STATIC WATER LEVEL Below Top of Casing: e0 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
•Top of casing terminated aUar below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): ID METHOD,QF TEST 171it-
10. WATER ZONES (depth):
TOTAL DEPTH: IQS
DOES WELL REPLACE EXISTING WELL? YES ❑ NO le
Topographic/Lan setting
❑Ridge ❑Slope alley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees.hninutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
/z 0
1 I. DISINFECTION: Type C.a,w—dilsk i Amount 340
12. CASING: Wall Thickness
or Weight/Ft. Material
27/ahr
z1 plater
Depth Diameter
From / To 40 Ft. ,
From 40 To /3.2 Ft. 6
From To FL
13. GROUT: Depth Material
From / To 20 Ft. Ce
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth
From To FL
From To Ft.
Size
- 0
J tF
✓C
s —�
n c-_
LOCATION SKETCH •- r'^'
ca
Show direction and distance in miles from at fedst —"
two State Roads or County Roads. Include the road
numbers and common road names.
0
N
- 12)
ant--
r� Kr
Method O (M,
cet:Lctii roves -
Slot Size Material
po r d j �. 4t L , ace
GG: ``' . /1c I �^' t
in.
in. e+-c '
Material
16. REMARKS:
JUN 1 1 002
Submit the original to he D
acMroid`119) 73
ASHEVILLE REGIONAL OFFICE
THIS WELL WAS CO
S, AND THAT A COPY
SIGNATURE OF PER
vision of Water Quail
-3221, within 30 days.
LTED IN ACCOR-- DANCE , H
IS RECORD HAS BEEN PR 0 I
I
1
ON CONSTRUCTING THE WELL
GPo ,NL11°i/.TEP.SECION
y, Gnsnt&natef,Sedtioii, CfritUBail S
A NCAC 2C, WELL
D TO THE WELL OWNER
5 2-
DATE
rvice Center - Raleigh, NC
GW-1 REV. 07/2001

254649
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Naturalr//Resources- Division of Water Quality - Groundwater Section `
WELL CON'fItACTOR (INDIVIDUAL) NAME (print) zat,„'f�ze %/-lrf�ux•i CERTIFICATION # �`�ODJr
WELL CONTRACTOR COMPANY NAME 4+gn / (Aga / e v wit I I PHONE # (f2f L 22-7V8'?
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
1 if ;ippl icahlc) (i f appl icablc)
1. WELL. USE (Check Applicable Box): Residential Er Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other 0, If Other, List Use
2. WELL LOCATION:
1
Nearest Town: j{j" "avert:, / County /�z. e.
(Street Name, Numbers, Community,, Subdivision, Lot No., Zip Code)
3. OWNER: f nrvcier414 clic'c',
Address 74 C A-Lel &.«h. "Cd'
(Street or Route No.)
Ai i'ako-li . rye- &92 3
City or Town State Zip Code
(€28 )- 68' /973
Area code- Phone number
4. DATE DRILLED Jr --2 D - 0'2-
5. TOTAL DEPTH: 2.0 5-
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO Er
7. STATIC WATER LEVEL Below Top of Casing: Go FT.
(Use "+" i f Above Top of Casing)
S. 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): 5 METHOD OF TEST R:a-
10. WATER ZONES (depth): /G4�
I I. DISINFECTION: Type
12. CASING:
Depth Diameter
From / To 77 Ft. 4
From To Ft.
From To Ft.
13. GROUT: Depth
From / To 2O Ft.
From To
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Material
d r,ti.d 4.aa Amount
Wall Thickness
or Weight/Ft. Material
/27 A4,/rc:-
Ft.
Slot Size Material
in.
in.
Method
/jtic d
16.REMARKS:
Topographic/Land setting
❑Ridge FTSIope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic tnap
(check box)
DEPTH DRILLING LOG
From To Formation (Description
/ - G � ftU,.2 /n - .26.ia U.zvcr..:.T
�
O
C
0
0
rri
0<
>G
m
LOCATION SKETCH -,-
Show direction and distance in miles from at 6st c
two State Roads or County Roads. Include the -wad E,
numbers and common road names.
"cdt./,c)
CONSTIi
0h4STI�� �O 1 A�IDv R I:, f AND HAT A HIS WELL COPY OF TU
A r
j U N
.i UO2 J
r SIGNATURE OF PERSON
� /
1
Submit the original to the Di) ision of Water Quality, Grou
CAil3 tOV>lkTIntiBEtlyt N19) 733 3221, within 30 days.
ASHEVILLE REGIONAL OFFICE
CW`H Rl4:,CC[,D,�NC' /W�
RUCTING THE WELL
iL
ttep M 636aillServita Center - Raleigh, NC
ROU It ELF SEel ION GW-I REV.07/2001
ASHEVILE RrniCHAL ,I MICE
CAC 2C, WELL
0 THE WELL OWNER
DATE

13. GROUT:
From /
WELL CONSTRUCTION RECORD 254650
North Carolina - Department of Environment and Natt/uf, al Resources�r-rDivision of Water Quality - Groundwater Section /
WELL CONTRACTOR (INDIVIDUAL) NAME (Uwe
1-64,t, ifj(J L/ /Ni a JCL/`-�" CERTIFICATION # / 4BJ
WELT. CONTRACTOR COMPANY NAME (Uwe -a ad tua .c. v tin f( PHONE ii azo i22- 7448L(
SI A'rE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
tit -applicable) (if applicable)
WELL USE (Check Applicable Box): Residential Q. Municipal/Public ❑ Industrial 0 Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other ❑. If Other, List Use
2. WELL LOCATION
Nearest Town:,61L_ �— County
(Street Name. Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER:
Address
�COit) edl tt.ji
9/ a/d 14 Ly gideSr
(Street or RouttrNo.)
fr-g ,a 4, NG 2E726j
City or Town State Zip Code
e9.2e )- 89 I - /4G 3
Area code- Phone number
4. DATE DRILLED ,Jl�— /2- D 1--
5. TOTAL DEPTH: 96 S
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 83'
7. STATIC WATER LEVEL Below Top of Casing: 30D FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with I5A NCAC 2C .0118.
9. YIELD (gpm): / METHOD OF TEST 4,».
10. WATER ZONES (depth): _S�4
11. DISINFECTION: Type drenwashat
12. CASING:
Depth Diameter
From / To 3 7 FL t
From To Ft.
From To Ft.
Depth A To O
Amount % es,Pt
Wall Thickness
or WeighUFt. Material
/29 /p/dS[C-
Material
Ft. Lg,vfl.Kr
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.
16. REMARKS:
Slot Size
in.
in.
Method
IJfrd
Material
Material
Topographic/Land setting
Q 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 Format'on Dy_cription
2 7 /(/u LT
O
IV
J
LOCATION SKETCH 'E—
Show direction and distance in miles from aeZast K-; EJ
two State Roads or County Roads. Include tbyroad
numbers and common road names. o
I DO HEREBY CERTIFY THAT THIS WELL WAS CONST
AND THAT A COPY OF
,,II''nn,, 1
Salm the origin to t
27699-1636 Phone Nn. (919
GROUNDWATER SECTION
ASHEVILLE REGIONAL OFFICE
733
IGNATURE OF PERSON CON'TRUCTING THE WELL
on of Water Quality, Grounfh4(itLrti38ciidt Tilltt5 It1 Scry
221, within 30 days. ASH r iL-`L ,....` OFFICE
NCAC 2C, WELL
TO THE WELL OWNER
3- -ot
DATE
re Center - Raleigh, NC
GW-I REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) lat.a/.Nf NLcdaaeA CERTIFICATION # 2,525o
w'ELL CONTRACTOR COMPANY NAME Cpr,/A1J Loa/1Cv c✓e_a PHONE # (Sx8)G127Vp 7 I'
SLATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential cr.-Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION: LL
Nearest Town: ,? rJA)r/ County
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: 'Pitt MQe re,
Address 15 CIAe
(Street or Route No.)
et. n�
cOWri awl
City or Town State Zip Code
bga)- 89/-5ti33
Area code- Phone number
4. DATE DRILLED ,/'Jc/-0t
5. TOTAL DEPTH: 29S
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO V'
7. STATIC WATER LEVEL Below Top of Casing: fo 0 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS FT. Above Land Surface*
`lop of casing terminated at/or below land surface requires a
variance in accordance with I5A NCAC 2C .0118.
9. YIELD (gpm): / METHOD OF TEST w-,Q
10. WATER ZONES (depth): 2 NS
L L DISINFECTION: Type Crw.d/aieed Amount wr
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From / To 7 7 FL /o 97- 2 / ? U —
From To Ft.
From To Ft.
13. GROUT: Depth
From / To 10 Ft.
From To Ft.
14. SCREEN: Depth Diameter Slot Size
From To Ft. in. i
From To Ft. in. in.
Topographic/Land hic/Land setting
DRidge 9dslope 0Valley ❑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 Formatio Description
/ 6b JJ,a
60 - 77 ar-,.a•w.ol
ct
L
C
J
0
0
-ri
c;
rn8o
LOCATION SKETCH 0
Show direction and distance in miles from at (cast z
two State Roads or County Roads. Include the road
numbers and common road names. /
z> (1-en.� �/l,e-uv
1
Material Method,�„� y�a.d OtiN A���
,o6 v et p� y ijTe �
5
Material µto✓- /�f^
2)tklc'y' to
Material if go
15. SAND/GRAVEL PACK
Depth
From To
From To
16. REMARKS:
J N tIOt w
Submit the orioi 11) ppt•� he D
ASHEVILL E OONAL OFFF\C�) 73
Size
Ft.
Ft.
THIS WELL WAS CONSTRUC-
T, AND THAT A COPY OF THIS
SIGNATURE OF PERSON CO
ision of Water Quality;Gro
-3221, within 30 days.
R
ndn
A8HF 'II
CbRD,kG C¢ WITH 115A
C 2C, WELL
E WELL OWNER
/510(Q,
CTING THE WELL DATE
.ul,r bchiall. !,i lice Ccnter- Raleigh, NC
,,,i Otri,^E GW-I REV.07/2001

254657
WELL CONSTRUCTION RECORD
North Carolina - Deparnnent of Environment and Natural Resources - Division of Water Quality - Groundwater Section
VA' ELI. CONTRACTOR (INDIVIDUAL) NAME (print) 4c','yLt /2/?-' rt' -. CERTIFICATION
58-3
HELL CON'rRVCrOR COMPANY' NAME (2)11#' la ':Jfti and -✓l PHONE # ¢J/2)LZ2 -7 Vefk
ST AI E WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
I. WELL. USE (Check Applicable Box): Residential Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 Il Other, List Use
2. WELL LOCATION:
/%
Nearest Town: ejAL",-/i< County /31rn -
(SIr et Name. Numbers, Community. Subdivision, Lot No.. Zip Code)
3. OWNER:
Address
3 Pm�i%
� o,
Street or Route No.)
City or Toss n State Zip Code
(n 512 3 "/
Area code- Phone number
4. DATE DRILLED
i.
6.
TOTAL DEPTH: 3-1
DOES WELL REPLACE EXISTING WELL? YES 0 NO Er-
7. STAT!C WATER LEVEL Below Top ofCasing: hD FT.
(Use "+' If Above Top of Casing)
S. 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): (o METHOD OF TEST Aft
10. WATER ZONES (depth):
11. DISINFECTION: Type Cs - /hi -A Amount y<
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From / To/If FL G Q) in.
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From / To %O Ft. /'�,.j,jar-
From To Ft. >� h.a� c ✓u,'-<-i^-
I-t. SCREEN: Depth Diameter Slot Size Material
C ��k��
From To Ft. in. in./� ��,c�, ty,..,t .l 1"4°
From To Ft. In. in.CV-v"/w� w
Id. SAND/GRAVEL. PACK: di, J —( i�t--«- Qw0j
Depth Size.Material i"
From To Ft.
From To Ft.
Topographic. Land setting
❑Ridge (lope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/nullifies/seconds)
Latitude longitude source:❑GPS❑Topographic map
)check box)
DEPTH DRILLING LOG
From To Formation DDescription
/ - / /C) /-�G+�f. /
I/O - 34/r Gt e.4w:.t
ry
CES
v
to
.. ra
LOCATION SKETCH CJ
Show direction and distance in miles from aReast z
two State Roads or County Roads. Include the road
numbers and common road names.
rt 6c.cr- /tc L't-✓
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTR_
L
I�t4�/ ST N - ' S, AND THAT A COPY OF T
qq U
•
7402
Su mtit the original to tl e D
27699-1636 Phone No. (119) 73
G30Uw1DWATER SECTION
ASHE,'ILLE REGIONAL OFFICE
SIGNATURE OF PERSON
vision of Water Quality
-3221, within 30 days.
TRUCTING`THE WELL
Group p )SY,gtiorf,,
AS L i„ e - t Oi
L 4N i(CCQI{DANCtr WITH ..1115A' CAC 2C, WELL
b RD IIAS DEED PRO\'Dip it THE WELL OWNER
Ids
Sery
DATE
c Center - Raleigh, NC
GW-I REV. 07/2001

254619
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Nat raI Resources - Division of Water Quality - Groundwater Sectioonrp!
CERTIFICATION # .C70J
GY PHONE #(8itf)LX%-7W41
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Jai/
WELL CONTRACTOR COMPANY NAME 4/ea nJ boa (.
LLU'
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
if applicable) (if applicable)
1
WELL USE (Check Applicable Box): Residential Ili-Municipal/Public ❑ industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
WELL LOCATION: 11
Nearest Town: fi u�de- County ,aa kit,
(Street Nance, Numbers, Community. Subdivision, Lot No.. Zip Code)
3. OWNER: Mak Waiun)a — 14G c\ VQt,1.
Address ?G X \QLo.15
(Street or Route No.) ^ �
\ 2 \ C
City or Town State Zip Code
a, S)- (X 0-D(1)-
Area code- Phone number
4. DATE DRILLED S- / - d 2
5. TOTAL DEPTH: % Th
6, DOES WELL REPLACE EXISTING WELL? YES ❑ NO re"
7. STATIC WATER LEVEL Below Top of Casing: 2,91) FT.
(Use "+" if Above Top of Casing)
S. TOP OF CASING IS / FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): 1 METHOD OF TEST /22iK
10. WATER ZONES (depth): gigQ
1 I. DISINFECTION: Type
12. CASING:
From
From To
From To
13. GROUT: Depth
From / To 2.D
From To
Depth
To 9g
rei Amount 2 CStf
Wall Thickness
Diameter or Weight/Ft. Material
Ft. 4 Al- 21 pfed-
Ft.
Ft.
�f Material
Ft. atrrt.r..sr
Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth
From To
From To
16.REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS COW' A ORDACF I
Method
�.y� (�
Midge
setting
IfdRtdge ❑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 qua-w.�w
Bd -em-
0
0
iJ
C—
C
Slot Size Material
in.
in.
Size Material
Ft.
Ft.
ern
J o^
>0
LOCATION SKETCH
Show direction and distance in miles from at $'dst m
two State Roads or County Roads. Include tht. ad
numbers and common road names. 0 q� L
e,d ��Sh� �UCLR .�2e��
1Cc� S ccz�Ch . ZC� \ en
AND THAT A COPY O RECORD HAS BEEN PROV
IGNATURE OF PERSON CONSTRUCTING THE WELL
�(� - I L
Submit the ohgi**I'to tf M anion of Water Quality, CroUiiid tatBtf$e'EBoiF,O61t M2ut Sc
27699-1636 Phone No. (9199 733E 221, within 30 days.
dSHLIIILLE El GIIIIIAL OFFICE
H NCAC 2C, WELL
D ,D TO THE WELL OWNER
DATE
vice Center - Raleigh, NC
GW-I REV. 07/2001
GROUNDWATER SECTION
ASHEVILLE REGIONAL OFFICE

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natal Resources - D'vision of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print
WELL CONTRACTOR COMPANY NAME
STATE %YELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
254628
WELL USE (Check Applicable Box): Residential C3 Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION: R
Nearest Town: £!%taoAitIlt� County F3^au-e
(Street Name. Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: St4wl. r L/`Win/
Address pa Ra qqt
(Street or Route No.)
City or Town State Zip Code
(15)- G sg a5
Area code- Phone number
4. DATE DRILLED 9../ 9.tL
5. TOTAL DEPTH: (tbtr
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO r'
7. STATIC WATER LEVEL Below Top of Casing: 14 FT.
(Use "+•' if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface'
*Top of casing terminated at/or below land surface requires a
variance in accordance with I5A NCAC 2C .0118.
9. YIELD (gpm): / METHOD OF TEST AIL
10. WATER ZONES (depth): nr —
DISINFECTION: Type en-2I.t[% Amount _j4__
CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From / To4_
From To Ft.
From To Ft.
13. GROUT: Depth
From_ _ To_ ..Ft.
Ft.
Slot Size Material
in.
in.
12.
a e A CERTIFICATION #isjiRsr
<i iI PHONE #fiZs)4U1QS9
Material
From To
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
Method
ptiti
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minuses/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
To Formation Description
toars;t
From
/
40
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.
Lesat I AO. kte. Lit /_ a
fi` to ks 'rti-‘ct- a _ f /—at70 coact.
tic Cam-
O r'6EIj YI tr i mac fHIS WELL WAS CONST
Nu/1(( l'l Ij A/ DA1�`_, AND THAT A COPY
JUN 1 1 2O '2
Submit the original to t
d thaftwtEetyr 733 d221, within 30 days.
ASHEVILLE REGIONAL OFFICE
' al NATURE OF PERSON
e Div sion of Water Qualityt
1.
•� 11111. EV4fF11P
CORD HAS BEEN PROVIU D I
i h..✓
N rUCTING THE WELL II
romldttli u' SNa rdWah 1636 Iu rScrviet
CAC 2C, WELL
THE WELL OWNER
-o
0
�7 a Z
DATE
Center - Raleigh, NC
GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Nat
WELL CONTRACTOR (INDIVIDUAL) NAME (pSlnt
WELI. CONTRACTOR COMPANY NAME
254629
ral Resouryes - D/visioq of Water Quality - Groundwater Section t�
-'� CERTIFICATION/# -gar
PHONE # (R2B) C.22 21 L�
e� (,asp_/(
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
fif applicable)
(if ap licabp Ic)
L WELL USE (Check Applicable Box): Residential Q" Municipal/Public ❑ Industrial 0 Agricultural ❑
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCATION: �f't
Nearest Town: Owatv&s R� County eeML
(Street Noire. Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: AAAi ILav ✓a Qwtl jplrty l
Address9O QOX (o—►5
(`Street or Ryge h t,)
City or Town State
����^�,( f�o(� / Zip Code
11 21 - cY E-De0%
Area code- Phone number� /
4. DATE DRILLED `7-AS 6 2--
5 TOTAL DEPTH: y A—
O DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: /*Q 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 accordancextth 15A NCAC 2C .0118.
9. YIELD (gpm): /%Z METHOD OF TEST %Ai e
10. WATER ZONES (depth): y6 r
11. DISINFECTION: Type Cr tAt_dk id Amount / AN
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. rMaterjkl
From To SC' Ft. Ao :/ 7 V
From To Ft.
From To Ft.
13. GROUT: Depth
From / To % U Ft.
/�Material
l-t M-3 46}-
Method
,¢OKc
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
Ft. in. in.
From To
15. SAND/GRAVEL PACK
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS
Topographic/Land setting
❑Ridge @Slope ❑Valley ❑Flat
(check appropriate bon)
Latitude/longitude of we!I location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
I 144.-
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.
/2 0 4
n o t )0 �ifka d4a�
Gl-Ar— U
44_5: -( r
I DO HEREBY CERTIFY THAT TH S WELL WAS C
JUN 1,1, 2002
ubmit the ortgma to the
9D THAT A CO
GNATURE OF P
skin of Water Q
699-1636 Phone Nu. (919) 33-32 1, within 30 da
6)E1
�'
TrsY7
ACCO
R ANTE
v��1 ,-
Y
p
: -!THIS
RECORD HAS BEEN I1RD'V
(C
0 'ONSTRUCTING THE WE
aJ'
al ty,'pH0!kLY"tllfmr$S@PI0kt36 Mai
's litHEViLLE REGIONAL OFFICE
r
I5A NCAC 2C, WELL Co
DED TO THE WELL OWN
9—/3-62-
DATE
Service Center - Raleigh, NC
GW-I REV. 07/2001
GROUNDWATER SECTION
ASHEVILLE REGIONAL OFFICE

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natu al Resources -,Diivisionn of Water Quality - Groundwater Section�j/
WELL CONTRACTOR (INDIVIDUAL) NAME (print) (i/!/L {�/Y/ /eA116..) CERTIFICATION # .�7 //7�9�/
WELL CONTRACTOR COMPANY NAME �w 44'O/
8 a2e L' /22 / PHONE # f2zZ4229y4
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
254630
1. WELL USE (Check Applicable Box): Residential 0Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION: Nearest Town: fidod/e,
County Bent e--
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: &ItW /� awct-
Address 6-7,/:r %Y ylfi/ LcAe Tripe
(Street or Route No.)
�ap,i✓ S G 1.903
City or Town State Zip Code
003 )- 1 no - Nyuy
Area code- Phone number
4. DATE DRILLED ./ -//- 62
5. TOTAL DEPTH: .y2,6
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO L9"
7. STATIC WATER LEVEL Below Top of Casing: /I/ FT.
(Use ••+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): accordance/with
METHOD OF TEST /9 r e
10. WATER ZONES (depth): 3 2.6
11. DISINFECTION: Type gram./% /ed Amount /7Z
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From / To /s % Ft. G
From To Ft.
From To Ft.
13. GROUT: Depth �MaterialMethod
7
From / To 26 Et. ! v/vtciy peril
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:
JUN 1
S WELL WAS CONS1
ND THAT A COPY 0
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formatiol Description
/- 12 dovt r
4',aw Nf�
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.
yo cad f to
xci
-. ca Rack
GNATURE OF PERSON CON
ubmit the ori°• i ••. r r Divis on of Water Quality,
2�®Up86611M ERc 33-3.21, within 30 days.
ASHEVILLE REGIONAL OFhIut
;IYw'"a�r f''AN F VkT , SA
LECORD HAS BEEN PROV 2EO
J
TRUCTING THE WELL
•
NCAC 2C, WELL Ca)
—O THE WELL OWNER
-44/
DATE
�p, �(�7��,S g��0{i ail Senlcc Center - Raleigh, NC
Grot�p�E �� E REC•I�TPF, OF ICE GW-I REV. 07/2001

254632
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Nat Re/sources� - Divisionsiof Water Quality - Groundwater Section
f
WELL CONTRACTOR (INDIVIDUAL) NAME (print)///LI/-(/�lf11l�t AI 9CICW S CERTIFICATION # / "l��/
WELL CONTRACTOR COMPANY NAME Cie a n/gVa LC/C- Lad I PHONE #( )
STATE WELL CONSTRUCTION PERMIT/4 ASSOCIATED WO PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential L9-Municipal/Public 0 Industrial ❑ Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION: 1J�cM
Nearest Town: IOt,ivo t rill lG County v
(Street Name, Numbers, Con>'htunitty, Subdivision, Lot No., Zip Code)
3. OWNER: c -a Lesvi4
Address N51. # Ma(1•Q..._.t'CC.LN C U V-0
(Street or Route No.)
G )aSuN\1 iNc Q?
City orro -3Stac to Zip Code
STATIC WATER LEVEL Below Top of Casing: /5/b FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with I5A NCAC 2C .0118.
9. YIELD (gpm): I METHOD OF TEST /2i'/Z
10. WATER ZONES (depth) .S 6D
11. DISINFECTION: Type (waitdlared Amount "/,CscP
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From / To . % FL 6 X 7-G
From To Ft.
From To Ft.
13. GROUT: Depth Material Method i
From To %6 Ft. reast.s. Dn
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.
Area Phone number
4. DATE DRILLED y- 9- 6 2
5. TOTAL DEPTH: /o644—
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO W
7
Topogrwhic/Land setting
❑Ridge 19Slope ❑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/ - 40 draws-11- lfa.r-
t.9Yaiw r
46 fi Fa.r
16. REMARKS:
nw� is (ccWu Qdal l
-3 t MochattV
Wt. /Oj- House -
�6tx
LOCATION SKETCH
Show direction and distance in miles Gorr at least
two State Roads or County Roads. Include the road
numbers and common road names.
rr 7 -M/j Ct.Zs
t6
O µP
O picnc,gy CERTIFY THAT THIS WELL WAS CONSTR
NUR IN VA A AND THAT A COPY OF T
a/c/ 5
L/!
IGNATURE OF PERSON
fv
�3IN ACCORDANCE WITH
JIIx :CORD HAS BEEN PROVII
CONSTRUCTING THE WELL
0
A t1LAC 2C, WELL
DT b THE WELL OWNER
u y. 9_ a2.-
DATE
JUN 1 1 2002 GROUNDWATER SECTION
Submit the original to the Div sion of Water Quality, Grout# diibleirSeile011iIb360V130EScrvise Center- Raleigh, NC
moo Nn ON 733-. 221, within 30 days.
GW-I REV. 07/2001
sEcASHEVILLE ONCE

254633
WELL CONTRACTOR COMPANY NAME
SLATE \VEI.I. CONSTRUCTION PERMIT'# ASSOCIATED WQ I'ERNIITI
1 if applicable)
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Nast`urraal�,��sources s--tDivision of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) I,r,� - Plea/e '//}-�f/1 CERTIFICATION II qrt
CiSfrA t 1/421 F�'�-- PHONE i Lm (,»-N
(if applicable)
I. WELL USE (Check Applicable Box): Residential unicipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATIO�
Nearest Town: County
e
(Street Name. Numbers, C.mmmnity, Subdivision, Lot No., Zip Code)
3. OWNER: ^ [, / /
Address O ) _is e-n.7
^ ' (Street or IS: No.) A79D�
City or Town
)tr0&-
Area code- Phone number �+ pp
L(—
4. DATE DRILLED l-Od�
5. TOTAL DEPTH: L/ 45
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO LfY
7. STATIC WATER LEVEL Below Top of Casing: FT.
(Use"+' if Above Top of asmg)
8. TOP OF CASING IS FT. Above Land Surface*
'Top of casing terminated at/or below land surface requires a
variance in accordan with I5A NCAC 2C .0118. (
9. YIELD (gpin): METHOD OF TEST
10. WATER ZONES (depth):
1 I. DISINFECTION: Types nm°Va
12. CASING: 1 n
T6graphic/Land setting
a4 -Ige ❑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 For ation Description
0 5� (I" z
5 g t-V-175 cca e
LOCATION SKETCH
Amount 1'l3 0 Show direction and distance in miles from at least
Wall Thickness two State Roads or County Roads. Include the road
Depth Dy�'am9r or(�`�etghVFt. Mate�nal numbers and common road names.
From �� To A3 Ft. (n if?'(D J ui n k J
From To Ft. C,at.() Al If
From To Ft. /_
13. GROUT: Depthater%al thoriyt,,.t�/fit cif/ (�%D�-
From !� To �. r) Ft.____ _ f - Jv ///��� (/
From To Ft. .¢- / c/� ')!. k
14. SCREEN: Depth Diameter Slot Size Material
-
in.
in.
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
N 1E ItEtiv
OC
TIFY THAT THIS WELL WAS CONSTRU
JUN l(1(20Q2
Submit the original to
/7699-1616 'limn Nu. (9
GROUNDWATER SECTION
ASHEVILLE REGIONAL OFFICE
AND THAT A COPY OF TH
-^,l
LS
kN ACCORDANCE WITII I .,A N AC 2C, WELL ���cc
_RD HAS BEEN PROVIDE) T HE E L OWNER—
J` el oa
SIGNATURE OF PERSON CONSTR$JCTING THE WELL
he Division of Water Quality, Ground aLf
9) 73;-3221, within 30 days.
v
DATE 0
erice Center - Raleigh, NC
GW-I REV. 07/2001

254638
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Na ral Resources - D. ision of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (prinnt) .r/ik/Y/ G/r4W�-a CERTIFICATION# 3
Mri
WELL CONTRACTOR COM
PANY NAME l�/lgr) water Le2e.11 PHONE it OlinJ2 - 7(a,/
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
WELL USE (Check Applicable Box): Residential 8"---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: g5h.4, -1 /P County ,&'MG
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: jet sutnd stii)
Address °MA /'zuilic f.:i1'y aa. la
(Street or Route No.)
146/1LniIe_ Nc. .Z9(465"
City or Town State Zip Code
t )- z9R 91131/,
Area code- Phone number
4. DATE DRILLED I/- 2- 0 9-
5. TOTAL DEPTH: 9.Qh
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO ®'
7. STATIC WATER LEVEL Below Top of Casing: _SO 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): 4 METHOD OF2 _TEST /1-/
10. WATER ZONES (depth): 2J.3
11. DISINFECTION: Type Ci-awl
12- CASING:
Depth
From / To /DV
From To
From To
13. GROUT: Depth
From / To %D Ft.
Amount 3//Y
Wall Thickness
Diameter or \Veight/Ft. Material
Ft. 6 /RA 5la]
Ft.
Ft.
Material
('CNt.wr
Method
pod
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:
FDOVTEIkEB CE'RTI TF AT
CONST TION STAND A tell id
D,
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 For ation Description
/ toy c+-swc
101-1 (1f Crawnli
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.
az.1A" 10 Cce r � oz�l (rait--
(ooft-akt iz:s/f
J�
Le_ Lr I daub e
2,, i �tr i, ; (8,_ < b s�
939, 5frg- Xvea6
Nb '
a&Jfifj6,4'' Ctte.6
rHIS WELL WAS
AND THAT A C
SIGNATURE OF
D
Y
f'p'HH,
TRUCTED IN ACCORDAN
F THIS RECORD HAS BEE
PERS(1)N CONSTRUCTING THE W
ELL
TH l5A NCAC 2C, WELL r
VIDED TO THE WELL O\V ' R
DATE
GROUNDWATER SECTION
(iNMimumbRiap710Nthe Division of Water )ualiei µiitkhdifitlifSkcf]hfitl;E636 b ail Service Center - Raleigh, NC
ASM§}�yL ftl��rjAI cIN®F ��1731-1221 within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
254639
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME riot) v ) rc14l nli�WS CERTIFICATION # .JR
WELL CONTRACTOR COMPANY NAME tIe aWwa Le, Loci PHONE # .1e) G22746V
SLATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
I. WELL USE (Cheek Applicable Box): Residential Municipal/Public 0 Industrial ❑ Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: Mack 8l{ / County
-Pet.( Ccat D e
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER:V.Q6C� Nt/11.I1A(N
Address C \, C>k �a
(Street or Route No.)
fluke e i1 c 3? 79D-
� City/ or Town State Zip Code
�y'�
n_�=x )-CLA f n -(A t .� O
Area code- Phone number /�
4. DATE DRILLED,- 2 TJ - a 1-
5. TOTAL DEPTH: 3 2,5-
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO [Er
7. STATIC WATER LEVEL Below Top of Casing: a 0 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): w METHOD OF TEST 9i R
10. WATER ZONES (depth): .36_5"
I I. DISINFECTION: Type 6ra.vd14 tad Amount / Ca /'
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From / To '74 Ft. 6 'i-) 7 1? V C
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
�t-r From / To AO Ft. Ctvcn+y pole_
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.
16. REMARKS:
E vs Y - i — WELL WAS CON .;
illitI TRj TEN1TAt�t1'CD' ITHAT ACOPY QFThi
arait
JUN 1 2002
S bmit the original to the 1
27664Kiglplj M 'E N
ATURE OF PERS
J
i( d
TED IN ACCORDANCE Wit
i RECORD HAS BEEN PRO
)N CONSTRUCTING THE WELL
GROUNDWATER SECTION
ivisio or Water Quail by,GrASIIMatlatRIC$CORAL163niMail Se -vice Center - Raleigh, NC
3-322 , within 30 days. GW-1 REV. 07/2001
ASHEVILLE REGIONAL OFFICE
I A NCAC 2C, WELL
D TO THE WELL OWNER
DATE
Topograyhic/Land setting
❑Ridge Ik}'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 For tion escription
�7 902t�
- SAc L'J 2d NlU•1
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.
m�I Gld1D g-„d-:
old roll Rd O't-d'k`-(L) tL
fVntCc NAvd DW So`t-twoo Rrd3:
Material •t0 td k
eit
L
V —

254566
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Na
(p ral Resources -nDivision of Water Quality - Groundwater Section pr
M ELL CONTRACTOR (INDIVIDUAL) NAME (print) /i XL��0/--t � ( rcµ4 Lett l..ew',J CERTIFICATION # .ZJ�e7
w ELL CONTRACTOR COMPANY NAME Cl��,,, L•,Ftp4 atte.{ PHONE # (iti6) he21'2I94
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATIO,
Nearest Town: rA4cpie 1-e L
County e-•
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: 6' wn Ai
Address 3tCc
(Street or Route No.)
ire- 9,871S 997/
City or Town State Zip Code
)- 44 7 'e'er
Area code- Phone number
4. DATE DRILLED -,2 8 6 %
5. TOTAL DEPTH: 14 5"
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO t
7. STATIC WATER LEVEL Below Top of Casing: $U FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with I5A NCAC 2C .0118.
9. YIELD (gpm): . METHOD OF TEST
10.WATERZONES (depth): %g(—
II DISINFECTION: Type Amount
12. CASING:
From
From
From
/
Depth
To (p
To
To
13. GROUT: Depth
From / To 0'1O
From To
14. SCREEN: Depth
From To
From To
15. SAND/GRAVEL PACK:
Depth
From To
From To
ASE AN
Wall Thickness
Diameter or Weight/Ft. Material
Ft. '7
Ft.
Ft.
Ft.
Ft.
Diameter Slot Size Material
Ft. in. in.
Ft. in. in.
Material
Method
r a d
Size Material
Ft.
Ft.
„Topographic/Land setting
01kridge ❑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
4-0
d
4-
fV
LOCATION SKETCH W
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
at,-r,r i923 Z ,Q-s.w„eci ,r a
9 4 ,(/jj„ /1,.-„c5 x-/�j��f'r"'� (/)
c uP
Hzei
16.REMARKS:
It713Y FET
R6 111121" C 'OA
71NI HIS WELL WAS CONSTRL
DSi AND THAT A COPY OF
AC 2C, WELL
THE WELL OWNER
IGNATURE OF PERSON C NTRUCTING THE WELL
L ,
I
S.'b'nit she eri^innl tg tin Division of Water Quality, roun'il\vater Section, 1636 MailiServi
lier33-3221, within 30 days.
DATE
Center - Raleigh, NC
GW-1 REV. 07/2001

254578
WELL CONSTRUCTION RECORD
North Carolina -Department of Environment and Natural Resources-��D,//ivisioo/n of Water Quality - Groundwater Section
`A _
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Zile:// Ahaniaw CERTIFICATION# 26--.4
/Q.d/✓� __� 11
\\'ELL CONTRACTOR COMPANY NAME C W3L..//-
GK wag
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
PHONE # (g7d)621-7QQBy
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: �5h vr�/� et County [4 ntC •
(Street Nance, Numbers, Community,, Subdivision, Lot No., Zip Code)
3. OWNER: r�Nr2 C� y,Jl ;kind
Addresa.T 1l °PoX \23
(Street r Route No.) r-sC A 1
4
5. TOTAL DEPTH: •R6 6
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO Et"--
7 STATIC WATER LEVEL Below Top of Casing: WO FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0I18.
9. YIELD (gpm): 50 METHOD OF TEST /3 %/L
10. WATER ZONES(depth): Aer
City or Town State Zip Code
Area code- Phone number
DATE DRILLED 3 -g - 6 z
11. DISINFECTION: Type
12
CASING:
Depth Diameter
From / To_ 80 Ft. 1,
From 8o To /20 Ft. G
From To Ft.
13. GROUT: Depth
From / To 9.0 Ft.
From To Ft.
Material
Topographic/Land setting
❑Ridge ❑Slope 11*7-alley ❑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 �....T�ooy�
" _ /L2
//2 rat 36/6`
0
S
0
m
LOCATION SKETCH N -t
Amount Show direction and distance in miles frointelease
Wall Thickness two State Roads or County Roads. Include the road
or Weight/Ft. Material numbers and common road namess.. 41
it
t I./a: ) aA^ /Yeti 4: (..c /--f Qd-
LfCty-)(30y -7 fs4'L,-�/r-ker
5v av- Pp ��
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Method
fetYCP f1
Slot Size Material
in.
in.
16.REMARKS:
HIS WELL WAS CONSTRUCT
AND THAT A COPY OF THIS
NATURE OF PERSON CON
2C, WELL
WELL OWNER
62
ATE
ion of Water Quality, Grin.ndw•l -� r u •. er\ ee Ce \ter - Raleigh, NC
21, within 30 days. GROUNDWATER SECTION G W-I REV. 07/2001
ASHEVILLE REGIONAL OFFICE

254580
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natu I Resources - Division`of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) MI it -.,//.K�✓Wd CERTIFICATION# Inc
WELL CONTRACTOR COMPANY N 1ME d1<.a“/µlai W1../f PHONE # etc LZ%.-7 WM
STATE WELL CONSTRUCTION PERMIT#
(if applicable)
ASSOCIATED \VQ PERMIT#
(if applicable)
1. WELL USE (Check Applicable Box): Residential " Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ IFOther, List Use
WELL LOCATION:
Nearest Town: f%.'3toi l'L
County 8z41ac-.
(Street Name, Numbers, Community, subdivision, Lot No., Zip Code)
3. OWNER: CG4/O.14 TWA I it.
Address y/y eyessea c-,2ee.)L 2d
(Street or Route No.)
Mew. /,(NI in A89.Sy
City or Town State Zip Code
IS2d> 4D 498a
Area code- Phone number
4. DATE DRILLED 3- % - O 2
3Qs
5. TOTAL DEPTH:
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO I1V
7. STATIC WATER LEVEL Below Top of Casing: gaga 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): ,f METHOD OF TEST sits
10. WATER ZONES (depth): 1.80
11. DISINFECTION: Typ
12. CASING:
Depth
From__ To_t _
From4.Q _
From To
13. GROUT: Depth
From To _24_
From To
14. SCREEN: Depth
From To
From To
1 n
AN‘. et /v- Amount L tq
Wall Thickness
Diameter or Weight/Ft. Material
Ft._r4
Ft.
Material
Ft ._es wywr
Ft.
Diameter
Ft. in.
Ft. in.
15. SAND/GRAVEL PACK:
Depth
From To Ft.
Slot Size
in.
in.
Material
Size Material
From To Ft.
thltAIVATEffkgtriiillONhe
A9.9641L1.638581Q0M
HIS WELL WAS CONS"&
AND THAT A COPY OF
Topographic/Land setting
❑Ridge P51ope ❑Valley DFlat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
Formation Delriptiion
4rasimrat
DEPTH
From To
8t 3 0
c
O
r Ct�
r.
—rrnc
LOCATION SKETCH t" CX)
m
Show direction and distance in miles fron'j leaf
two State Roads or County Roads. Include real
numbers and common road names Csn'
n1/444, A.- r
Y_
•
k'OCORD�NC+@ W 5 CAC 2C, WELL
M'�1� CORD HAS BEEN PR E T THE WELL OWNER
IGNATURE OF PERSON CON`TRUCTING THE WELL
DATE
,ion of Water Quality, GroundISfitittlet1OPR j�1b � Servi:e Center -Raleigh, NC
221, within 30 days. ASHFVILLE GW-1 REV. 07/2001

254581
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources-c- Division of Water Quality - Groundwater Section
\VELL CONTRACTOR (INDIVIDUAL) NAME (print) Dr e),G1 /- me Arl/t uj6 CERTIFICATION
WELL CONTRACTOR COMPANY NAME /
C-Cln/Qua( n wtiII PHONE # f4»F) 62.2-9 yey
SLATE 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 ❑ If Other, List Use
2. WELL LOCATION: --'� II{�x
Nearest Town: fir/ L /- County /7 //N ��1rf4/a
(Street Name, Numbers, Commuunity, Subdivision,diLot No., Zip Code)
3. OWNER: A7y'/yrYL u'rLrt_; sit
(-c-
Address 'q GII0/'Vat L el 4'?
(Street or Route No.)
�-[.
City or Town State
rG )- 612 a572
Area code- Phone number
4. DATE DRILLED 3, - dZ
5. TOTAL DEPTH: A6.4.—
6. DOES WELL REPLACE EXISTING WELL? YES CVNO ❑
7. STATIC WATER LEVEL Below Top of Casing: ijc 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): /2 METHOD OF TEST gi.L
10. WATER ZONES (depth): /of-
Zip Code
9 231
Topographic/Land setting
❑Ridge ❑Slope ❑Valley
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
To Formation D scription
G-1
From
6 D 0?BD
/Lib
11. DISINFECTION: TypeCtaM0\0..A Amount 1/Q Q-
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From / To 78 Ft. L i I r VC
From To Ft.
From
13. GROUT: Depth Material Method
To Ft.
From To Ft.
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
From
From
Depth Size
To Ft.
Ft.
To
Slot Size Material
in.
in.
Material
16. REMARKS:
THIS WELL WAS CONSTR
D A(' S, ANDTHAT A COPY OFT
SIGNATURE OF PERSON C
N)
N
r-a
a
Tom:
LOCATION SKETCH tV
Show direction and distance in miles frotr�yleasg
two State Roads or County Roads. Include the roe'ir
numbers and common road names.
Wa44,..2_ '- 'J434-r
ORD HAS BEEN PROVID
• C 2C, WELL
T 1 HE WELL OWNER
6 2-
CTING THE WELL DATE
Submit the nr ,rnnl to he D vision of Water Quatty, Grrundwt-LIOO'R ;Ef',
�Qyy y�q ��$ ppfy� ASHEVII F Rto, ; AL
ASHEVIL�LE•fi"r N c-yFF1te" 733-3721, within 30 days.
enter - Raleigh, NC
GW-1 REV. 07/2001

254582
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natur Resources.- Division of/ Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print)in�_ /44%/ kt: M v dQ6�' 6 CERTIFICATION # %a ie�
WELT. CONTRACTOR COMPANY NAME C/l d /V IA1di I.r g- j.(i4 ( PHONE # ea) 1- Z 2 '? t/8N
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERNIIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential Municipal/Public D Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town:______f vie-14)
County61/4.T (:_eacA Q
(Street Name, Numbers, Community, Subdivision, Lot No.,,/Zip Code)
3. OWNER: Br RJce- ('toes k- t
Address tie I.. 4 ( C
(Street or Route No.) a
wcweFediOr- NC, ),R9 7
City or Town State Zip Code
(fzy)- Z76-• a744-
Topoggra�hic/Land setting
❑Ridge L+jSlope ❑Valley ❑Flat
(check appropriate box)
// Latitude/longitude of well location
Wile 5 (degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
Area code- Phone number
4. DATE DRILLED 3- 5- 0 2_
5. TOTAL DEPTH: a 41 C
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 19r-
7. STATIC WATER LEVEL Below Top of Casing: _'i-O 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): /0 METHOD OF TEST li i 2
10. WATERZONES(depth): /RO
it. DISINFECTION: Type?mt. Amount -MLA 0.
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From / To�: Ft. G 9-9 ?ki C-
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From C'..) To2 0 Ft. C Q MC AVV
o.Co
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
Ft. in. in.
Ft. in. in.
From To
From To
15. SAND/GRAVEL PACK
Depth Size Material
From To Ft.
To Ft.
From
16. REMARKS:
S WELL WAS CQ
JD THAT A COP
NATURE OF PE
0
From To Formation Description
6--o *yS %nnfvi
4
Dc
LOCATION SKETCH
Show direction and distance in miles from at st
two State Roads or County Roads. Include the road
numbers and common road names.
cam' -"'
r9 ittAL.o M.a CNB-r�KC
N C.rAJ J✓�--cam- oZY�
U&TEtYIN 'ACC DROANI
ONSTRUCTING THE WELL
15A NCAC 2C, WELL
ICED TO THE WELL OWNER
ll/I
�✓
ubmit the original to the Divi on of Water Qu tlity, GF, tiff1,1 4WF (nq; Mail
33-3721, within 30 days. AS_t..'_.-_R
213/i/MOMNIAITER'
ASHEVILLE REGIONAL OFFICE
3-5
DATE
Service Center - Raleigh, NC
GW-1 REV. 07/2001

254584
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) e� it d.1 4 GaJocoA CERTIFICATION # ��CRS"
WELL CONTRACTOR COMPANY NAME alto i & Ltoa. bcz, (' PHONE # (818 6 2.2- / q sty
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential Er-Municipal/Public 0 Industrial ❑ Agricultural ❑
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: rrlt%'!>tr'Gi) County
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: AG /I r.CS/6tZ✓
Address «R� /Ce i- ictV'- fal
(Street or Route No.)
fa Ue CO Pr(r
City or Town State Zip Code
(Bag)- bZR /,2 yR
Area code- Phone number
4. DATE DRILLED
5. TOTAL DEPTH: b 65
7R73 0
6. DOES WELL REPLACE EXISTING WELL? YES f o ❑
7. STATIC WATER LEVEL Below Top of Casing: 136 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): / METHOD OF TEST nit
10. WATER ZONES (depth): 4/ 6
11. DISINFECTION: Typearth\k)\Cln Amount 6-:2_Q......Th
12. CASING: \ Wall Thickness
Depth Diameter or Weight/Ft. ^Matet%al
From / To 24 FL _6 .Z7
From 74 To q4. FL 4- 9x! ' \j C-
From To Ft.
13. GROUT: Depth
From / To 0
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
M,,tor; 01
Ft CPC(
15. SAND/GRAVEL PACK:
Depth
From To Ft.
From To Ft.
16. REMARKS:
Method
Sokice c
Size Material
„,..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)
DRILLING LOG
Formation Description
DEPTH
From m 76 i.Q.. „a-
? 6 1,0C 1,9.c% 6n.....71,
J
- rs`
LOCATION SKETCH rn
Show direction and distance in miles from at IeasE ^'
two State Roads or County Roads. Include tge roM
numbers and common road names.
a a- 7 y X
t ikeceic
J/r tDi
¢J.r%u
S WELL WAS CONSTRU �D'CRITANf P WITi'C15 N AC 2C, WELL
AVD THAT A COPY OF TH S R ORD HAS BEEN PROVID ITO HE WELL OWNER
2-Ca r rgo..e-. J L
NATURE OF PERSON CONSTRUCTING THE WELL
___ _ ..._--!
vision of Water Quality, G oundvg1 rliketiOnr 1636 Mail Service; enter - Raleigh, NC
_-----'::
"�33-32?1, within 30 days.- _ GW-I REV. 07/2001
Z
DATE

254587
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Naty� 1 Resources - Division of Water Quality - Groundwater Section p
WELL CONTRACTOR (INDIVIDUAL) NAME (print) t.do {'� / Mali 0 a CERTIFICATION # 2CA
dADA) watts- LrnJ . PHONE # (84) 413 1 Q q
\\ELI. CONTRACTOR COMPANY NAME
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WO PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:yy
Nearest Town: r1��4J16i /�C CountaQ CAM
)
(Street Name, Numbers, Community, Subdivision, Lot No.. Zip Code)
3. OWNER: 4 pnaJi mpd'G
Address 2. tome/[ /td
(Street or Route No.)
rdn. v«W Ale, ,0930
City or Town State Zip Code
( )- G2$ yq &
Area code- Phone number
4. DATE DRILLED ,4•2 7- 6 t
5. TOTAL DEPTH:
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO P�
7. STATIC WATER LEVEL Below Top of Casing: ',i 0 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS f FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): / S METHOD OF TEST
10. WATER ZONES (depth): / pa
PIZ
I I. DISINFECTION: Type` \C`a1v`\C.A Amount rj Ti iS
12. CASING: 11 Wall Thickness
Depth Diameter or Weight/Ft. Material
From / To_,3Q_Ft. /. S,'% YVC'.
From . To Ft.
From To Ft.
13. GROUT: Depth Material / Method
From / ToC'
Ft. s iwM ...c305- `�--,
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth
To Ft.
To Ft.
From
From
16. REMARKS:
r
JU
Size Material
E� K
lts
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
220
A _ /2S
O
C
C
n
LOCATION SKETCH -=7.
Show direction and distance in miles from at -zest ==i
two State Roads or County Roads. Include thAoadza.
numbers and common road names.
rr, a
?e 8 t.%ccCa rte-xi ait"-z
'+{6ube-
ac/o,„ a.-.Dg4tbw Tr
LC/.I o w Lick i�6t4st
t THIS WELL WAS CONSTR
IS, AND THAT A COPY OF T i
�eta d....__ t)
SIGNATURE OF PERSON CONSTIRUCTING THE WELL
ORD HAS BEEN PROVID
AC 2C, WELL
THE WELL OWNER
l) 2'
DATE
(32.9W C ftI R
Glimit � pthn ortgi^aql �to���he Division of Water Qualify, Grou pr¢!iziv e vtit i1 36 ait.Servic` Center - Raleigh, NC
ASH iLLE-" e6gil�Df'�IL"'E9) 733-3221, within 30 days. GW-1 REV. 07/7001

254588
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Nat al Resources
,{-�Division of Water Quality - Groundwater Section D�
WELL CONTRACTOR(INDIVIDUAL) NAME (print)ri�//thy hiAle-at' b CERTIFICAAUTION/I L 7nn
w'ELL CONTRACTORCOMPANY NAME (14.9�//J)leF L//!/I PHONE # {Rz') /22'%y41/
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential 111 Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION: 1 _
Nearest Town: J�Ln pity2X-iRt7C- County Bthaenm-.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER:44frA/iN3 /104.rr.
Address 44- Ma dtce./
(Street or Route No.)
1161u-211 c- .2.886I
City or Town Stare Zip Code
9'Z2
Area code- Phone number
4. DATE DRILLED a- 2 t - d f
5. TOTAL DEPTH: GAS
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO in
7. STATIC WATER LEVEL Below Top of Casing: ,d FT.
(Use "1' if Above Top of Casing)
8. TOP OF CASING IS FT. Above Land Surface*
*Top of casing terminated Jr below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): / METHOD OF TEST /i / i
10. WATER ZONES (depth): Itch
11. DISINFECTION:TypeginfBO\QA Amount__ __ •t4S
12. CASING: 11 Wall Thickness
Diameter or Weight/Ft. Material
/ FL Iv 27 'UC
From
From
Depth
To 36
To Ft.
From To Ft.
13. GROUT: Depth Material
From / To :O Ft.
From To Ft.
14. SCREEN: Depth Diameter
From To FL in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Method
Slot Size Material
in.
in.
16. REMARKS:
t2
Topographic/Land setting
I 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/t�Description
9A - 31>
3D-4Dr
f_
N
LOCATION SKETCH "'' z
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names
to 5-9
-4 6 r" t
t %
OUI�
04a (iy /60
xe aite.,11#2A
u.,,ov
JUN 1 1 7(f02
Submit the original t
THIS WELL WAS CONSTR C
S, AND THAT A COPY OF T C
Zedefijaca—/ 11 L 2 .? G O Z
SIGNATURE OF PERSON CONSTfUCTING THE WELL DATE
E ) tti 4r�
he Q'vision of Water Qualtty, G-ounce�E�1� ��ftoir 16361Y1�f,�.$crvice Center - Raleigh, NC
it'f'o84e 9) 733-3221, within 30 days. GW-1 REV. 07/2001
'1
ttN ACCORDANCE-WETH-}5A I'IICttA,,,C 2C, WELL
CORD HAS BEEN PROVIDEt 7b1`HE WELL OWNER
ASHEVILLE REGIONAL OFFICE

254592
WELL CONSTRUCTION RECORD
North Carolina - Department of' Environment and Natural Resouurces- Division of Water Quality - Groundwater Section t
WELL CONTRACTOR (INDIVIDUAL) NAME (print) ' Vtai4 lit1 Mail41s CERTIFICATION # 268
WELL CONTRACTOR COMPANY NAME r1i
ei 4%I watss ofici1
PHONE # (aft) t2.2e7 q84
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential Gel' Municipal/Public 0 Industrial ❑ Agricultural 0
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: a 1C
Topographic/Land setting
County_ 2s.4VCOWS#2... IEKidge ❑Slope ❑Valley ❑Flat
(check appropriate box)
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: tj kit /i Iarnt.J
Address /a ptguw%L Mt' RA
(Sleet or Route No.)
At bhp
City or Town State Zip Code
Area code- Phone number
4. DATE DRILLED P-19- G Z.
5. TOTAL DEPTH: Mr
it
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO eli[
7. STATIC WATER LEVEL Below Top of Casing: y6 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surface*
"Top of casing terminated at/or below land surface requires a
variance in accorda•re with ISA NCAC 2C .0118.
9. YIELD (gpm): 7 METHOD OF TEST Gig
10, WATER ZONES (depth): / iS
11. DISINFECTION: Type �t nM IR,r Amount ! `��
12. CASING: Wall Thickness
Depth Diameter or Weight'Ft.
From__ _ Tommy__ Ft. L
From To Ft.
From To Ft.
13. GROUT: Depth
From / To__ 21 _ Ft.
Ft.
From To
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Material
Material
Method
Latitude/longitude of well location
(degreeshninutes/seconds)
Latitude/longitude source:❑GPSOTopographic map
(check box)
DRILLING LOG
Formation Description
DEPTH
From To
SS
SS 4 y Goa
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.
. 3 s N rw2
-Lk— j$ Cia4
no fioet,„N µrate
Slot Size Material
in. t �/ �j
o
{.. Lad
plv y0 r a Ls, c_>
ika"O� 1^
N� _ =r.•i
--1 -cn
y
= t''- cn
z,r,
C ct:z
m:c
0
t,D a
z
16. REMARKS:
IE
11111)
5 S
T THIS WELL WAS CONSTRUCTE,DD 4CCORDANC&-L'dlI'.fi1-5,AC
DS, AND THAT A COPY OF THIS FE �' 1 HAS BEEN PROVIDED Ili
C, WELL
WELL OWNER
i
JUN 11 2002
Submit the original tt he
GROU(dYltRP$'G't10N' 919)
ASHEVILLE REGIONAL OFFICE
SIGNATURE OF PERSON CONSTRUC ING THE WELL i D
TE
ivision of Water Quality, Groundwate' 4t itr'-�43,g0tl Otice Ccn.er- Raleigh, NC
Fi 1 I_ • .�'t;r'h OFFICE �iVV_I REV.07/2001
3-3221, within 30 days.

254593
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Na ural Resources - Division of Water Quality - Groundwater Section /�
WELL CONTRACTOR (INDIVIDUAL) NAME (print) gev,:Id/ Atecg4f2/ CERTIFICATION # L�/Tc
WELL CONTRACTOR COMPANY NAME ?/sanJ L la. (t.L loci( PHONE # (R12 -2 q
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential tld' 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: County_an GO
(Street Name, Numbers, 6 Community, Subdivision, Lot No., Zip Code)
3. OWNER: h(X.CQ,Eca t%A.0 /I
Address �G0 (3pk \R3'3
c�) (trees orXu�No.) @ l() LD
Cit�r Town State Zip Code
(fill)-4g- Rsoi) al-311
Area code- Phone number
4. DATE DRILLED „% -/8- 6
5. TOTAL DEPTH: 4 4-
6 DOES WELL REPLACE EXISTING WELL? YES ❑ NO E
7. STATIC WATER LEVEL Below Top of Casing: 'D FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): •7 METHOD OF TEST Pei/ /G
10. WATER ZONES (depth): /1_3
I I. DISINFECTION: Type lf,Ilre,_Amount //t C-
12. CASING: Wall Thickness
Diameter or Weight/Ft. Material
From / g r\)C
From / P\)e_
From
13. GROUT: Material / Method
From / Ft. de..zy ,c.:r./� pocreA
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.
Depth
To / / 3 Ft.
To A0 Ft.
To Ft.
Depth
To 10
AT THIS WELL WAS CONSTRUC'E
RDS, AND THAT A COPY OF THIS Ik
SIGNATURE OF PERSON CONSTRUCTING THE WELL
topographic/Land setting
tdge 0Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
/ qh
q0- !/?a %/ OCII
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.
( 1--to 0 ' t Z s
G t I"33
t /—f)
ON /j ulti CD
IV
L
C
v
RD HAS BEEN PROVIDED
2C, WELL
WELL OWNER
ATE
-O
IV
tD
Division of Water QualiT9, GroT ndw. W4,t4 R6cc Ce tter - Raleigh, NC
733-3221, within 30 days. - GW-I REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Na ral Resources - Division of Water Quality - Groundwater Section p
WELL CONTRACTOR (INDIVIDUAL) NAME
/(priint) LLK.�.L{11 � r.' / CERTIFICATION# 25Gr
WELL CONTRACTOR COMPANY NAME C1 4a1/z.P'l tc T f2-"r"f PHONE # pen) /c 2i_ 7 44 k
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(it -applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION: r�/
Nearest Town: km.ventlf — Countyr�rw.w-r
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER
Address
Topographic/Land setting
,!%3Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
G � G.n Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
(Street or Route No.)
,mot 1Ce N e 217 sY
City or Tow State Zip Code
Sn)- Gaul— y5%q
Area code- Phone number
4. DATE DRILLED :Z"/3 — 6 v
5. TOTAL DEPTH: / Ei r
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO ❑
7. STATIC WATER LEVEL Below Top of Casing: Sd 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 .0118.
9. YIELD (gpm): /8 METHOD OF TEST
10. WATER ZONES (depth): / 0
1 I. DISINFECTION: Typ mt .c`..� Amount � a Q.
12. CASING. Wall Thickness
Depth Diameter or Weight/Ft. Material
From / To QQ FL �+ / 1-/ PVC
C
From / 11 % .v U e-
From To Ft.
13. GROUT: Depth
From / To 2 0
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
To__ao Ft. (.
Material
From
From
Depth
To Ft.
To Ft.
16 REMARKS
Slot Size
in.
in.
Material
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.
a3Yc0 7U St KG r•-L
e . Qv. \-e
et-
IY
il Y � tC d CN' S I�N D R
tvtslo
tVtEPRNOIONA1(9019 jIGO-322
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WELL WAS CONSTRUC
D THAT A COPY OF THI
AO
ATURE OF PERSON CC
• i-l�t➢S USE PR(7V1
JCTING THE WELL
of Water Quality, Gr lundv ater Section, 1636 Mail S
within 30 days. GROUNDWATER SECTION
ASHEVILLE REGIONAL OFFICE
254594
tV
2C, WELL 'D
E WELL OWNER
/3-6
DATE
%ice Center - Raleigh, NC
GW-I REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment an
\
WELL CONTRACTOR (INDIVIDUAL) NAME (print) 1
%YELL CONTRACTOR COMPANY NAMI \ QC-(Sl
STATE WELL CONSTRUCTION PERMIT#
(ifa Iicable)
Natural Resources - Division qf Water Quality
CT1 cacti(
G,PQ l \CA\ Jlc;)r\Cp—K
ASSOCIATED WQ PERMIT#
(if a) licable)
254595
- Groundwater Section
CERTIFICAT
TI�I
�`ON 11 t% '"'-D
PHONE # y�a't7 (003-7 Lt `S'4/
1. WELL USE (Check Applicable Box): Residential Er...--Municipal/Public 0 Industrial 0 Agricultural ❑
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Usc
2. WELL LOCATION:
Nearest Town:UPauQ ),\\\ Q County_
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: G� eim\
Address l 01 V tN` 'flS"- 04
(Street or Route No.)
City or Town State Zip Code
c)- (84-0-L1(1C)G ExT
4. DATE DRILLED a ) (I Ca
5. TOTAL DEPTH: . )Cf5
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 8�
7. STATIC WATER LEVEL Below Top of Casing: Li 0 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS t FT. Above Land Surface"
*Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): )--{ METHOD OF TEST OWL
10. WATER ZONES (depth):
Area code- Phone number
11. DISINFECTION: Typ
12. CASING: t Wall Thickness
Diameter Weicht/Ft. „MaterialFt. t L9 5Q2._ 21 \-) Ft.
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 T n For •ation Description
0
8a 3o
Fromt 1.
From To
From To
13. GROUT: .Depth
From C ) To 20 Ft.
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.
Depth
To S
O mraJ,C„r- Amount \ O--
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. D3\ ci Mc--c 3\\ \\ — 5hQ'1 —'"_
r3c o_Se\ - tcL) ✓v-�DLO-- CQ
Method UQ. Qp �a-t-„®
16. REMARKS:
Material
Cl t flM (NT
Go ✓r` On'- en
Material qy '' •.�1
-
Vi0s2" "Kb jt(\ Q W`C\Q MO
® coo T0URe(a QeN
N
L
G ROM VOTEP+,SS&&
uwll I E REGIONAL_
T THIS WELL WAS CONSTRUC
S, AND THAT A COPY OF THIS
SIGNATURE OF PERSON CO
vision of Water Quality, Gro
-3221, within 30 days.
-11
R HAI BgtN R� U �' h E WELL OWNER L.—
\ ak?) \ lND
TING THE WELL ATE
ndwa er Section, 1636 Mail Sertj ce Cc ter - Raleigh, NC
GROUH(UJPa[R SECTIOR CW-1 REV.07/2001
ASHES ICU: R P.L OFFICE

254597
From To
14. SCREEN: Depth
From To
From To
15. SAND/GRAVEL PACK:
Depth
To Ft.
To Ft.
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Nat al Resources - Division of Water Quality - GroundwaterteSection�LL/
WELL CONTRACTOR
UAL) NAME
W'ELI. CONTRACTOR COMPANY NA Mli -\ (pr�..4\L. A est-L`k--\� �r 11. �t PHONEI #ICja,(' •W
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residentialrclunicipal/Public ❑ Industrial 0 Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town::AS\IIP v N\} ,Q
Count�•-s{`Co-“.\3
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNERr',1/457ChS\c\_o
Address 5SS%R1 e . P.. \�t..JH
(Street or Route No.)
\ 4�,\\ \AC cD `19
y oStateZip Code / Ste-3
Area code- Phone numbers
4. DATE DRILLED
5. TOTAL DEPTH: Lk° -3-
6 DOES WELL REPLACE EXISTING WELL? YES 0 NO C�
7. STATIC WATER LEVEL Below Top of Casing: LOCI 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): l 5 METHOD OF TEST CULL
10. WATER ZONES (depth):
t
11. DISINFECTION: Typ ` mt��.t`- A Amount \ Z C
12. CASING: Wall Thickness
Depth
From f I To HU Ft
From H/ To %1.P Ft
From To Ft
13. GROUT: Depth
From 0 To ao
Diameter or Weight/Ft. Material
to SDR 2t 'PvC
Ca2 SIR_ al PVC
Material
Ft. CP 6A Q. 11
Topographic/Land setting
❑Ridge L%fope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
Fortuation Description
( .- 1lD
DEPTH
From To
J O LD 4c S
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.
\U-QQ._LACCZi\- a1/45 C
�L' (�C\S��Lic 0 4UC-
2 v--1
QD
�Qgaa__ 0 \AIL V1ew-\13 -\Ae_
Method
Ft.
Diameter Slot Size Material
Ft. in. in.
Ft. in. in.
From
From
16. REMARKS:
JU ' ' 2002
Submit the original to he D
2'6.09 t634 Phano Nn (9i 9) 73
GROUNDWATER SECTION
ASHEVILLE REGIONAL OFFICE
Size Material
THIS WELL WAS CONST
AND THAT A COPY OF
SIGNATURE OF PERSON
ision of Water Quality,
3221, within 30 days.
CONSTRUCTING THE WELL
roun 'ntei $C Io ` .16SiFServi
N
C
J
n.�
rri
<
_;
.. nt`
CAC 2C, WELL co
THE WELL OWNER
-o
DATE
Center - Raleigh, NC
GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
254598
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME(print) AU al J4.f ISA A.?�/G t..IS CERTIFICATION # %.5�%'
\YELL CONTRACTOR NAME (2/dallt)wa (<r Wy ( PHONE IIOS)L,22-79 6 z(
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
I. WELL. USE (Check Applicable Box): Residential IP/Municipal/Public ❑ Industrial 0 Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION: ff
Nearest Town: SY. to 11 4-
County >(� Y1 comSa
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER:
Address po ,]3i3,h /9S 7
/ (Street or Route No.)
a& a LAt-
City or Town State
( )-
Area code- Phone number
4. DATE DRILLED 1- 67- .R 6 U'L
5. TOTAL DEPTH: r
Zip Code
I5
1-
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: /2.0 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS if 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): / 14- METHOD OF TEST : /2-
10. WATER ZONES (depth): //26"--
I1
12. CASING:
From
From
From
13. GROUT: Depth
From / To 1 Q
From To
14. SCREEN: Depth
From To
DISINFECTION: Type
ga j/If[dAmount / 34/ C
Depth
To /'/e Ft.
To Ft.
To Ft.
Wall Thickness
Diameter or Weight/Ft. Material
Z7 pie -
Material
Ft.
Diameter Slot Size
Ft.
�tid
Method
Material tcLizyte 441-g- "f5l.- r
Topographic/Land setting
Ridge ❑Slope OValley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
/ - �G ,mt,
//€ 47s Cc-a,�;t
in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
CONST
r 0
HIS WELL WAS CONSTR
AND THAT A COPY OF 1
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
ut st/XZCJ
CM°4— JL`3Lt j e ` "e `
/34 &'P ( c:
-
J :Tr'
CORD HAS BEEN PROVID
GNATURE OF PERSON ONS RUCTING THE WELL
C 10 GR � 14A7EH
I F Divi^ on of Water Quality; rouy��)yer,0e�5e�t4 i*,001,.Servi
9) 733-322I, within 30 days.
fret -
AC 2C, WELL z
THE WELL OWNER
DATE
e Center - Raleigh, NC
GW-1 REV. 07/2001

3. OW
NER
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mail Service Center - Raleigh, N.C. 27699-1636-Prone [phone] \
WELL CONSTRUCTION RECORD WELL CONTRACTORCA FCro rw xz 9_.)--k3PCO Lit 11 nC
WELL CONTRACTOR CERTIFICATION #:R-
STATE WELL CONSTRUCTION PERMIT#:
254599
1. WELL USE (Check Applicable Box): Residential O Municipal 0 Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATION: ( ow sketch, q the location below)
Nearest Nearest Town•, C P t R (j tY"
(Road N and Numbers. Co nary, or Subdivision and Lot No.)
l �C'``CD�C'�
Address (-Y�(C \%C3 CooQ_,
I l ! ) 1 I 1.e
(Street or or.)
City or Town Stale Zip Code
5. TOTAL DEPTH ;-4 -1
6. CUTTINGS COLLECTED YES ❑ NO
7. DOES WELL REPLACE EXISTING WELL? YES ❑ NO© —
DRILLING LOG
From
i b
8. STATIC WATER LEVEL Below Top of Casing: FT.
l / (Use '+' 11 Above Top of Casing)
9. TOP OF CASING IS.J (0 FT. Above Land Surfaces
'Top of casing terminated atfor below land surface requires s variance In accor-
dance with 15A NCAC 2C .0115 10. YIELD (gpm)• 1 METHOD OF TEST rt t A_
11. WATER ZONES (depth)•
12. CHLORINATION: Type C' C-^INL.-.ct- Amount
13. CASING:
o
�e Wall Thickness
qa?or Depth (--1I LI r 5�2 Weight/Ft. PV
From4 ( To 0 Ft
From To Ft
From To Ft
14. GROUT:
De th r Material
From CD To % Ft (Ai MP R \
From To Ft
15. SCREEN:
DEPTH
onnalion Description
If additional space Ls needed use back of form
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other map reference poin)c1-17�
0, CAS CAL vC
�vlethod OE(Zi ( (Oue
o
CNN -
Depth Diameter Slot Size Material
From To _ Ft _ In _ in
From __ To — Ft — In _ In
From _ To _ Ft..__ In _ In
16. SAND/GRAVEL PACK:
From From
17. REMARKS:
Depth Size
To Ft
Ft
To
Material
I DO HEREBY
CONSTRUCTI
FOR OFFICE
Quad No:
Sedal No.
IFy°,TF RT -4s LIVEii WiSS
1 200 ills'
Submit wig al to
GIIOU; DWATER SECTION
ASHEVILLE REGIONAL OFFICE
CYO w (' f Ci hr. -co
RUCTED IN ACCORDANCE WITH 15A NCAC 2C, WE
THIS R ORD BEEN PR VIDEO TO THE WELL
!19 ce4w"2;
` B
_ E OF PERSON CONSTRUCTING THE WELL ATE
'vtslortol Water Quality. oroundwaler Section within 30 days
-o
ao
--4
GVkri
}cli4MATER S'ECTiOR
!IEEE GEGJOk:i L (MC,'"
4 DATE DRILLED 1 t \3

FROM : CLERN6JRTER WELL DRILLING INC FRX NO. : 828 622 9564 Nov. 20 2003 10:51AM P2
WELL CONTRACTOR COMPANY NAME
STATE WELL CONSTRUCTION PERMIT#
annlicable)
. WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Nat/wal Resources 7-, Division of Water Quality - Groundwater Section r.
WELL CONTRACTOR(INDIVIDUAL)NAME (print) /r U4.7 .irA4 fan
.�Q[y! 5 CERTIFICATION a .i 9r
t�e Ind £ /eV LOr.I t PRONE If PIA 6.1a7c/t9
ASSOCIATED WO PERMIT#
lif apnlicablc)
I. WELL USE (Chock Applicable Box): Residential 0' Municipal/Public 0 Industrial O Agricultural ❑
Monitoring O Recovery ❑ Heat Pump Water Injection D -Other O, If Other, List Use
2. WELL LOCATION:
Nearest Town: i atc-k' M r County 'f ,.-tv'
(Street Name. Numbers, Community, Subdivision, Lot No., rtp Code)
3. OWNER: TruY 40etr
Addresso n 1 Ci 31.( q
(Street or Ro No.
1ac\C Mee co C Q '7 k (
Crtyor o Zip Code
)-c -r`o �a
Area code- Phone number
4. DATE DRILLED "/D-•R— d?-
5. TOTAL DEPTH: 3o
6. DOES WELL REPLACE EXISTING WELL? YES D NO 1�
7. STATIC WATER LEVEL Below Top of Casing: MO FT.
(Use "+" if Above. Top of Cuing)
S. TOP OF CASING IS / FT. Above Land Surface"
*Top of casloe terminared arbr below land surface requires a
variance in accordance with ISA NCAC 2C .8118.
9. YIELD (gpm): .0 METHOD OF TEST fl. 47
10. WATER ZONES (depth): 2 u.0
1L DISINFECTION: Type 4r,,...tantzJAmount
12. CASING: Wall Thickness
Depth Diameter • or Weight/Ft Material
From_ To % 4, Ft.
From To Ft.
From To Ft.
Depth Material
To 1. o Ft. (Lcra,x
t
13. GROUT:
From
From To Ft
14. SCREEN:. Depth Diameter Slot Size Material
From To Ft. in. in.
From_ To Ft in. _.. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft
From To Ft.
Topographic/Land setting
Midge ❑Slope OValley DFlat
(check appropriate box)
Latitude/longitude of well location
(dcgrces/minutuPoeconds)
Latitude/longitude source:GGPSDTopogmphic map
(check box)
QF.PTH DRILLING LOG
rn � ,To Fo tiorr escription
64 A66
LOCATION SKETCH
Show direction and distance in miles from al least
two State Roads or County Roads. Include the road
numbers and common road names.
R9-L �IaAt de
p (-0-674 No `1
K r , ._p er,
Method
eaYrJ
. ii.t,yt'
d� . '
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONS ION -STANDARDS, AND THAT A COPY of THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
fr Au—) ',.. /0- 2-0 2
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. OW-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) t Q c:CK i{, g•ati[S
WELL CONTRACTOR. COMPANY NAME l..Vdd.e
STATE WELL CONSTRUCTION PERMIT#
2.
L:IC .
ASSOCIATED WQ PERVIIT#
(if applicable) - ' (if applicable)
266274
CERTIFICATION # a.`+:S(c
PHONE # our) hes gt`Zt
•
WELL USE (Check Applicable Box): Residential {y Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring ❑ Recovery ❑ Heat Pump Water Injection 0 Other ❑ If Other, List Use
WELL LOCATION:
Nearest Town: Froic„
\-nAns.J \11
(Street Name, Numbers, Community. Subdivision, Lot No., Zip Code)
3. OWNER: 'o-v'•c? aacv..eC
Address - 'Jhe.ca‘,S
(Street or Route No-)
City or Town State
(14t)- ((i • 3G5' 1
Area code- Phone mmnber
4. DATE DRILLED ta(o-67-
5. TOTAL DEPTH: aL)5
6. DOES WELL REPLACE.EXISTING WELL? YES 0 NO id]
7. STATIC WATER LEVEL Below Top of Casing: IS FT.
(Use "+" i f 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 15A NCAC 2C .0118.
9. YIELD (gpm): EC METHOD OF TEST
10. WATER ZONES (depth):
a%i15
Zip Code
County C-lo.y-'C cc3m Ve
} \-QC Yte 5 Cove ;03-1 i j
Topographic/Land setting
❑Ridge DSlope MValley ❑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 Fomration Descriptior
-V 3\ v\Lec /Ledo*\
31
ao5
11. DISINFECTION: Type I:AA1 Amount Fi
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From IA To 3 \ Ft. Lott 1? d ( r,c1 FiC
From To Ft.
From To Ft.
GROUT: Depth Material Method
From 0 To aN Ft. C€m°nt ect Cea
From To Ft.
SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
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. b
0 —
N
O Aji
I'll c
o cc'
rn
IV or
O ern
a
3
O
ut
Y CERT)FY'IH IS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
`f i iCP/NSTRUCTION STANDA ND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER,
Ii-- 0 a
NATLeRE OF PERSON CONSTRUCTING THE WELL DATE
ubmit the original to the ivisipn of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
{1
99 7-4-3G CHonc Nk (8it4J1733-32 I, within 30 days. GW-1 REV. 07/2001

266272
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
((print) C.:CK # �y•S(C
WELL CONTRACTOR (INDIVIDUAL)NAME1�11' � :�Aw'sE�S CERTIFICATION
WELL CONTRACTOR COMPANY NAME S0Q-ItA2S'511841'-�`\ t.in-1 tie. PHONE # 665 gcZL
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ® Municipal/Public 0 Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery 0 Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: ;yt3ann •noo, County Lr \Osunt:4,�Me'-
NCi4 ne�## (, C-'n\�\\_ 1n
'S.."'ann0-CFL tJIL) %1
(Street Name. Nwnnb2rs, Community, Subdivision, Lot No., Zip Code)
3. OWNER: \-9-vet Sanccv- O',xc n
Address aoc \-en t3_co.ne4N (is\
(Street r Route No.)
S\ao.nnea ince` 11C. a-• -iic
City or Town State Zip Code
(704 )- '739 - 1 O°i4
Area code- Phone number
4. DATE DRILLED \" OS-vz
5. TOTAL DEPTH: Mc
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO m
7. STATIC WATER LEVEL Below Top of Casing: MS FT.
- (Use "+" if' Above Top of Casing)
8. TOP OF CASING IS I FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): ri METHOD OF TEST IR:•°a
10. WATER ZONES (depth):
I I. DISINFECTION: Type Av6 Amount 8
12. CASING: Wall Thickness
Depth Diameter or eightiFt. Material
From k i To lB Ft. ICLW W> a\ �'\c�,4:C
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From 0 To ':17 Ft. 0 e- rant- 1 aux-se\
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.
To Ft.
From
16. REMARKS:
PIIi4 SO 14ERibBY'tEa . <' . r-- CONSTRUCTION STA
Hi I: ')11q?
t_ J
12, Submit them$€ m�aY p�the [�ivision of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
3-322I, within 30 days. GW-1 REV. 07/2001
Topographic/Land setting
DRidge Slope OValley 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 Descriptior
-)g Oyes- 3eca:,n
72
L.05
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
01
W
T THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C WELL
S, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL
DATE

266271
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL)NAME (prior) 11, e'C'CK -112o.iL.., `Jaw4e5--S CERTIFICATION #S11'13b
o.,z ec ¥Sat�invt n .. Tne PHONE 14(Friel 66Er zezz.
WELL CONTRACTOR COMPANY NAME C�Q 5 � ?....„Thy
STATE WELL CONSTRUCTION PERMIT#= • ASSOCIATED WQ PERMIT#
(if applicable) - - (if applicable) mum
t. WELL USE (Check Applicable Box): Residential X Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: CQnd\ae County _\3..,C.T-.'t'tVS_
kei 2f1 Q -,coh ')i'c t '- .811 Fa
(Street Name. Numbers, Community. Subdivx on, Lot No., Zip Code)
3. OWNER: (kocK CflC:W.n(&'
Address \qZ1 . \a\ ik;o twna
(Street or Route No.) ��, ($
City or Town State
($'2S)- tziS- (utakk
Zip Code
Area code- Phone number
4. DATE DRILLED \\-z.
5. TOTAL DEPTH: \t-\
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top ofCasing: A FT.
(Use "+" if Above Top of Casing)
S. TOP OF CASING IS 1 FT. Above Land Surface*
*Top of casing terminated atfor below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): \S METHOD OF TEST'
10. WATER ZONES (depth):
Topo phic/Land setting
❑Ridge 11.rlope ❑valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographi reap
(check box)
DEPTH DRILLING LOG
From To Formation Descriptun
t \ (03 CYVies (3,Q d e
l -3
\4.5-3 etCevrt tre
11. DISINFECTION: Type \5
12. CASING:
Depth
From 1r To b3 Ft
From To Ft.
From To Ft.
13. GROUT: Depth
From D To 9-0
Front To Ft.
14. SCREEN: Depth
From To
From To
15. SAND/GRAVEL PACK:
Depth Size
To Ft.
To Ft.
Diameter
Amount `g
Wail Thickness
or Weight/R. Material
t 1.3 fine\
Material
Ft. C./nen-I
Method
Diameter Slot Size Material
Ft. in. in.
Ft. in_ in.
From
From
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.
O
N
O
rn
N
O
0
<!1
W
c
rt
0
•
cri
yno
1-
r*m n
Sri
crz_
c�-i
0
z
4i1 t CONSTRUCTION ST
So h
Li�',':9Udluit the t1t_irglial to the
T THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
S. AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
I-
SIGMATU PERSON CONSTRUCTING THE WELL DATE
Ralei
ivision of Water Quality, Groundwater Section, 1636 Mail Service Centter, REVgh, NC
3-3221, within 30 days.

WELL CONSTRUCTION RECORD
264403
North Carolina - Department of Environment and Natural+Resources - Division of Water Quality - Groundwater Section
r
WELL CONTRACTOR (INDIVIDUAL) NAME (print) QCKCK Ain: ,ag C S CERTIFICATION # �4 3(d
WELL CONTRACTOR COMPANY NAME e\.4ae 50."3Aec- �^t,Zc',\ae-4 \ -'AC' PHONE # (`a2si 6+S ;3zz.
STATE IVELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential Jgl Municipal/Public ❑ Industrial ❑ Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: 2.2
/� ���
tu.,4C t1 &U ak
County Av++c-vr-0-6"—
(Street Name, Numbs, Community. Subdivision, Lot No., Zip Code)
3. OWNER: Ct\e\r.cc 'Moran
Address PC e M°e
(Street or Route No.)
Nat. Vtictl. 1\C ag't It
City or Town State Zip Code
(S2A)- tt`y- C tQ
6.
7. STATIC WATER LEVEL Below Top of Casing: WO FT.
\ (Use'•+•• if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): r'>t METHOD OF TEST vl
10. WATER ZONES (depth):
Area code- Phone number
4. DATE DRILLED om
5. TOTAL DEPTH: tiltS
DOES WELL REPLACE.EXISTING WELL? YES 0 NO. E
•
Topographic/Land setting
DRidge ❑Slope ❑Valley 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
+1 aver azcdt,,,
74± 485—Ctin;ie
11. DISINFECTION: Type O•lv5 Amount 1
12. CASING: ` Wall Thickness
Depth Diameter or Weight/Ft. Material
From t \ To 1 to Ft. (a1/43,-21 t\0.S\ •e-
From To Ft.
From To Ft.
13. GROUT: Depth
From 0 To g-O 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
From To Ft.
From To Ft.
Material
Method
toutpa
Material
LOCATION SKETCH
Show direction and distance in miles frotn at least
two State Roads or County Roads. Include the road
numbers and cornmon road names.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
IG
RE 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
264409
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) 41Q42C:c' 4 .jP.WxaECS CERTIFICATION# J-4.t4
WELL CONTRACTOR COMPANY NAME e Set-va•-pc- Oaa\\atrarv.� Z-ic • PHONE # (VI) eeS atQZL
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED` WQ PERMIT#
(if applicable) ' ' (if applicable)
I. WELL USE (Check Applicable Box): Residential 6p Municipal/Public 0 Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION: Nearest Town: C a.A&Wc` County QVCINCLUDAle
cbco:-Nn \-WICAN Rd Qc.td\gc
(Street Name. Nwnbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: Eton `C ‘-.0.n'?,01\
Address kpw..r i -2.1-?0,4. RA
eAA4Isp (Street or .Fbute No.)
City or Town State Zip Code
(n9)- a.M- San
Area code- Phone number
4. DATE DRILLED to- \T• oa
5. TOTAL DEPTH: MS
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: 15 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): METHOD OF TEST 0i q 9
10. WATER ZONES (depth):
11. DISINFECTION: Type P: iAmount it
12. CASING: Wall Thickness
Depth Diameter or WeighuFt. Material
From +1 To 4% Ft. 6 v -* 9-\ fiVka"c
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From C To 'aC Ft. ae'hetvt VOyCC�
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 Fi.
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
-14 S15 C'Yec 3etdon
98 \yS &cosltt
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
C5
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
\o- I •oz
DATE
-z-
ATURE OF PERSON CONSTRUCTING THE WELL
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

264406
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
ttCK \k. Seaa,.+Ae'S CERTIFICATION# �4.Sic
WELL CONTRACTOR(INDIVIDUAL) NAME (print) ���1' i
WELL CONTRACTOR COMPANY NAME atie. Szt-vatsS35on1, sh. <.tc, PHONE # t$28) 645 aczz
sTAi'E WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable)
(if applicable)
•
I. WELL USE (Check Applicable Box): Residential IN Municipal/Public 0 Industrial ❑ Agricultural 0
Monitoring O Recovery O Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: CA-'^ale�
n: County
1� (*ev\ \SCe.eK \woe rXB�115
(Street Name. Numbers. Community. Subdivision. Lot No., Zip Code)
3. OWNER: L-et••:Se Lo9g4at.c n
Address \2 evert , C?t€4-
(Street or Route No.)
Cs+dlec f\c a<61t5
City or Town State
StS)- (cloti • .'a3\`\
Area code- Phone number
4. DATE DRILLED \o' 11
5. TOTAL DEPTH: \7.5
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVELBelowTop of Casing: 10 FT.
(Use "+' if Above Top of Casing)
8. TOP OF CASING 1S 1 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 15 METHOD OF TEST Q"`j
10. WATER ZONES (depth):
Amount Id
Wall Thickness
gotta
Zip Code
'VZ
11. DISINFECTION: Type "4'A\5
12. CASING:
Depth Diameter or Weight/Ft. Material
From +\ To 30 Ft. Ly t -ti jIGSr:\
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From 0 To ab Ft. C,em e.'-t _ Oss g.A
Topographic/Land setting
DRidge $ISlope DValley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:DGPSOTopographic map
(check box)
DEPTH DRILLING LOG
From To Fomation Descriptior
i 1 Go Qve, cla. &v'
30 115 Gear.:+¢
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
From To
Ft.
Ft.
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.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STAND RDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER-
��_ \0-11-0z
DATE
SIGNATURE OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center -REVgh, C
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)_ S SflS K_ '{_gy�yeCS CERTIFICATION #
WMM'�
�4 Sti'
WELL CONTRACTOR COPANY NA E l Avafl 692-als A\O-rate PHONE # (}SAS) +65 aCZ2—
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
264408
I. WELL USE (Check Applicable Box): Residential ❑ Municipal/Public ❑ Industrial ❑ Agricultural 0
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: laskpv:' Ile County �13 u nCc "4:
. s '(%fln A ;5\ ...Aar lie]
(Street Name, Numbers. Community. Subdivision, Lot No., Zip Code)
3. OWNER: '(V\oe Eawoca5
Address (0 5R R2.0 a\,,,,ckes tea.
(Street or Route No.)
City or Town State
( )-
ac6, o
Zip Code
Area code- Phone number
4. DATE DRILLED
5. TOTAL DEPTH: 3t5
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO ®.
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 casing terminated atlor below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 3 METHOD OF TEST C1/42-l•0
10. WATER ZONES (depth):
\v-\\- OZ.,
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 Descriptior.
{\ cl Cvec Qtc: c.,
98 '9ns
11. DISINFECTION: Type e Xtai
12. CASING:
Depth Diameter
From 't\ To Ft. bz.
Ft.
Ft.
From To
From To
13. GROUT: Depth
From 0 To 30 Fr
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND,'GRAVELPACK:
Depth Size Material
Amount 7
Wall Thickness
or Weight/Ft. Material
Material Method
Ce.r.en+ `nt::.cCa
Slut Size Material
in.
in.
From To Ft.
From To Ft.
16. REMARKS:
�rCe-n,t�
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the mad
numbers and common road names.
r
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, • ND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
\O-\\-a z.
DATE
GNATURE OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-I REV. 07/2001

WELL CONSTRUCTION RECORD
2641n7
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
CERTIFICATION # 2---411c
WELL CONTRACTOR (INDIVIDUAL) NAME (print)_
WELL CONTRACTOR COMPANY NAME aksete SeVia iC'JA'alttniS ^.\\ a aea+rvl fag,• PHONE # (}iZ1) eh g It
STATE WELL CONSTRUCTION PERiY11T# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): ResidentialX Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: Oo.n-k ee County Vlyuv e..)-t)
?�y Fyie a8115
(Street Name, rM tubers. Community, Subdivision, Lot No., Zip Code)
3. OWNER: Ro\cl.)-4
Address .�, L\ f.e Y:ew
(Meet or Route No.)
City or Town State
($Zc3)- Cdo1 in5LI
Area code- Phone number
4. DATE DRILLED W' ' 2-
5. TOTAL DEPTH: 3.05
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO pi
7. STATIC WATER LEVEL Below Top of Casing: 2-f3 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. q
9. YIELD (gpm): cab METHOD OF TEST 0t0
10. WATER ZONES (depth):
a8l
Zip Code
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPSOTopographic map
(check box)
DEPTH DRILLING LOG
From To Formation Descriptior
t\ III [Wee PNCacA
\ ao fi (veoin:+e
I1. DISINFECTION: Type P•W8 Amount .l
12. CASING: Wall Thickness
Depth., Diameter or Weight/Ft. Material
From +\ To (1\ Ft. 1.0 k If- 2\ PtCC t.0
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From Q To Cit3 Ft. ee.-.ev.et pct:des+
From To _ Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
To
To
From
From
Ft.
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.
tID
r0
0)
16. REMARKS:
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
\0-R oz
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center- RHV- gh, NC N001
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
p,
WELL CONTRACTOR (INDIVIDUAL) NAME (print) ,�CPr5.,`K �`� 'A•xECS CERTIFICATION# .2-44(2
%YELL CONTRACTOR COMPANY NAME l0-\yae Sa"' e��\\dda__ —st -LAC: • PHONE # S) 665 g3 ZL
G ASSOCIATED WQ PERMIT# -
STATE WELL CONSTRUCTION PERM11IT# _ (if applicable)
(if applicable)
264402
t•
1. WELL USE (Check Applicable Box): Residential g Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: C1ttttret County Os•—•-Lovs•si,e
5E-A F.3.3-x oox& £a*+ •- ari12
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: N;lit \tosq`N
Address Tat pc>_"s 0o.K3 f See.
(Street or Route No.)
1titc\wat nC al32
city or Town State Zip Code
Area code- Phone number
4. DATE DRILLED 10-t -o2
5. TOTAL DEPTH: Soy
6. DOES WELL REPLACE.EXISTING WELL? YES 0 NO IA
7, STATIC WATER LEVEL Below Top of Casing: 75 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): 4METHOD OF TEST
10. WATER ZONES (depth):
11 DISINFECTION: Type ' \\ti Amount g
12 CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From -NA To \'6% Et. Ic "v 1es 2\ Te%eda4:c-
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From 0 To an Ft. Let v* ?o.xtea
From To
Depth Diameter Slot Size Material
in.
in.
14. SCREEN:
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size Material
Ft.
From To Ft
From To Ft
Topographic/Land setting
DRidge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
\3R cwev peeatr
13`d SOS
t-e-
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
r-,
co
(LI)
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARg5, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Ceenterl REVgh, C01
27699-1636 Phone No. [phone], within 30 days.
\Ca•2-0z
DATE

271407
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources • Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (prinl) Jeregly H. Bowman' CERTIFICATION Y 2809
WELL CONTRACTOR COMPANY NAME D Brakeman We 1 fri 111 nrd Tnr PHONE # 7R 2E2-7779
STATE WELL CONSTRUCTION PERMIT ASSOCIATED WQ PERMITi
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential Q 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 TownBarnardsvilleounly Buncombe
222 Mart' r k Rnari �R709
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: David Shope
Address 89 Madeline Avenue
(Street or Route No.)
Asheville NC 28806
City or Town State Zip Code
( )-
Arcs code Phone number
4. DATE DRILLED 11 /13/02
5. TOTAL DEPTH: 1C0'
6. DOES WELL REPLACE EXISTING WELL/ YES 0 NO IX
7. STATIC WATER LEVEL Below Top of Casing: 40 FT.
(Use "a" if Above Top of Cuing)
8. TOP OF CASING IS 1 . 4 FT. Above Land Surface'
•Top of using terminated at/or below land surface requiro a
variance In accordance with ISA NCAC 2C .0111.
9. YIELD(gpm): 12 METHOD OF TEST`. rotary air
10. WATER ZONES (depth): 1 40'
Topographic/Land setting
❑Ridge ❑Slope OValley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:OGPSOTopographic map
(check box)
DF.PTI{ DRILLING LOG
From To Formation Description
II. DISINFECTION: Type tablet Amount ---
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From O To 77 Ft.bi /8 SCh_.$A PVC'
Ft
Ft.
From To
From To
13. GROUT: Depth
From 0 To 20 Ft. concrete gravitv flow
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
From To Ft.
14. SCREEN: Depth
From To
From To
Material Method
Diameter Slot Size Material
Ft, in. in,
Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
O
CO
=J
CO
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL O
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER CO
#4-4-4" 1 N So2.a, 117, 5 /6 2—
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mall Service Center •Raleigh, NC
27699-1636 Phone No. (919) 733-322I, within 30 days, GWl REV. 07/2001

272175
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Jeremy H. Bowman' CERTIFICATION S 2809
W ELL CONTRACTOR COMPANY NAME n Rnwmnn Well flri 11 ingr Tnr PHONE I BM 252-7779
STATE WELL CONSTRUCTION PERMITS ASSOCIATED WQ PERMITS
(if applicable) (if applicable)
I WELL USE (Check Applicable Box): Residential ll 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:weavarvi 1 1 a County Rnncnmhe
66 Vernnn Ridge, Weverville 28787
(Street Name( Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: Jack Melissa Metcalf
Address 66 Vernon Ridge
(Street or Route No.)
Weaverville NC
28787
City or Town State Zip Code
( )-
Area code- Phone number
4. DATE DRILLED 1 /a2/o2
5.TOTAL DEPTH: 400'
6 DOES WELL REPLACE EXISTING WELL? YES 0 NO IX
7. STATIC WATER LEVEL Below Top of Casing: 60 Er.
(Use "+" i( Above Top of Cuing)
8 TOP OF CASING IS 1 • 4 FT. Above Land Surface'
•Top of casing terminated al/or below land surface requires a
variance In accordance with 15A NCAC ZC .0113.
9 YIELD (gpm): 4 METHOD OF TEST' -rotary
10. WATER ZONES (depth): 3 0 0 '
340' and 400'
DISINFECTION: Type
12. CASING:
Depth
From 0 To 96
From To
From To
13. GROUT: Depth
From 0 To 20 Ft.
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
air
tablet Amount 6
Diameter
Ft.61/8
Ft
Ft.
Wall Thickness
or Weight/Ft. Material
S ah._aO PVC`
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.
Material Method
concrete gravity flow
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.
Slot Size Material
in.
in.
Material
16. REMARKS:
ri L-' Ruu��11BY',,gE iF
dNd(1CTION StA
SuhmiLlb osi Ina jo the
27.699-I636 fittmit Nb. (919)
T THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
S, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
1 lit /o%
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Division of Water Quality, Groundwater Section, 1636 Mall Service Center -Raleigh, NC
33-3221, within 30 days. GW-I REV. 07/2001
H

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources • Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Jereply H. Bowman' CERTIFICATION 2809
WELL CONTRACTOR COMPANY NAME IZ RnWmBn Well I)T'I111 ng, Tnr PHONE YA7fl 252-7779
STATE WELL CONSTRUCTION PERMIT* ASSOCIATED WQ PERMIT*
(if applicable) . (if applicable)
272176
I. WELL USE (Check Applicable Box): Residential CZ 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: Fa rviP
283 Owenby cove Road
9OUO vco,1'%30
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
3 OWNER: John Stribling (degrees/minutes/seconds)
Address 12502 Apache Ave. , Apt. 2 Latitude/longitude source:OGPSOTopographic map
(Street or Route N9.) (check box)
Savannah Georgia 31419 DEPTH DRILLING LOG
City or Town State Zip Code From To Formation Description
( )-
Area code- Phone number
4 DATE DRILLED l 2 D S Q 2
5. TOTAL. DEPTH: 720'
6. DOES WELL REPLACE EXISTING WELL? YES Q NO IX
7 STATIC WATER LEVEL Below Top of Casing: 40 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1 • 4 FT. Above Land Surface*
•Top of casing terminated at/or below land surface requires a
variance In accordant; with 15A NCAC IC .0118.
9. YIELD(gpm): 17 METHODOFTEShrotary air
10. WATER ZONES (depth): 600 r
LOCATION SKETCH
I I. DISINFECTION: Type tablet Amount 6 Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads. Include the road
Depth Diameter or Weight/Ft. Material numbers and common road names.
From 0 To 40 Ft.81 /8 Srh Ft Q Pvr en
From To Ft. c,a
From To Ft. -=
13. GROUT: Depth Material Method 'rti
From 0 To 20 Ft concrete gravity flow
From To Ft.
I4. SCREEN: Depth Diameter Slot Size Material From To Ft. in. in,
From To _ Ftin. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
1 D0 HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
Ens NTR
CTNET
LS
S, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
11
Submit the original 'Ito the
L27699-1636 Phone No.1(919)
GFOLII /if EB SECTION
pSt EV LE r OFFICE
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Division of Water Quality, Groundwater Section, 1636 Mali Service Center -Raleigh, NC
33-3221, within 30 days. GW•I REV. 07/2001
.4

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Jeremy H. Bowman' CERTIFICATION v 2809
WELL CONTRACTOR COMPANY NAMED "Thurman We1 1 lit-{ 111 nue Tnr PHONE S fi2A 257-7779
STATE WELL CONSTRUCTION PERMITS ASSOCIATED WQ PERMITS
(if applicable) (if applicable)
2'77179
WELL USE (Check Applicable Box): Residential CX 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: Leicester Count Buncombe
2627 New Leicester Hwy. 28/45
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3.OWNER: Mike & Elizabeth Culbertson
Address 2627 New Leicester Hwy.
(Street or Route No.)
Leicester NC 28748
4
5
6
7
City or Town State
( )-
Area code. Phone number
DATE DRILLED 12/19/02
TOTAL DEPTH: 520'
Zip Code
DOES WELL REPLACE EXISTING WELL? YES 0 NO fa
STATIC WATER LEVEL Below Top of Casing: 40' FT.
(Use "+" if Above Top of Cuing)
8. TOP OF CASING IS 1 • 4 FT Above Land Surface'
'Top of casing terminated at/or below land surface requires a
variance In accordance with 15A NCAC ZC .0118.
9. YIELD(gpm): 5 METHOD OFTEST'-rotary air
10. WATER ZONES (depth):300'
500'
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
II. DISINFECTION: Type tablet Amount 6
12. CASING'.
Depth
From 0 To_4p_,ELL 1/8
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From 0 To 20 Ft. concrete gravity flow
From To Ft.
Wall Thickness
Diameter or WeighllFt. Material
5ch-8-0 Pvr
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
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
CO
0
0
CC.
•� �r-t; ' AT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
L o TR! C YOM:ST ARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
/; %,..W iL7/5. /o2_
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to th$ Division of Water Quality, Groundwater Section, 1636 Mall Service Center -Raleigh, NC
27699-1636iPhonc No, (919 733-3221, within 30 days. GW-I REV. 07/2001
M

26711'7
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
REUBEN CALDWELL
WELL CONTRACTOR (INDIVIDUAL) NAME (print) CERTIFICATION 0 214Q
WELL CONTRACTOR COMPANY NAME REUBEN CALDWELL DRILLING, INC. PHONefi2(8 )254-3581
STATE WELL CONSTRUCTION PERMIT/ 1537 AecOC1ATED WQ PERMIT/
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential I ' Municipal/Public 0 Industrial 0 AgriculturalC1.
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Uso'T., a. tie p. lU't'7L L
2. WELL LOCATION:
Nearest Town.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER:AQ.NBtVy f L c
Address /I5 I/a ey 1/ea-t ;Q .
(Street
Laltift-ai (,ta Route
uCNo.) City or Town State Zip Code
Arta coda bona number
4. DATE DRILLED /
5. TOTAL DEPTH:
6. DOES WELL REPLAC• EXISTING WELL? YES ❑ NO 0
7. STATIC WATER LEVEL Below Top of Casing: / a 7 FT.
• (Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
'Top of culog terminated at/or below land surface requires a
variance la accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): /$ METHOD OF TEST
10. WATER ZONES (depth): � H 2f 3 D . l
11. DISINFECTION: Type ; 14L Y/5 Amount
12. CASING:
Depth i Diameter
From* / To To Ft. �m
From To Ft.
Wall Thickness
or Wet. terial
From To Ft.
13. GROUT: Depth
From pj Tot / Ft. e8f
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 I DO HEREBY CERTIFY
W
CONSTRUCTION STA
Topographic/Land setting
DRidge ['Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
Formation DescSiption
DEPTH
From To
— 60
r QS
Q'r r
� ' 5 ib
fyp— 70
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 THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
JS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
et
rn
0
4/%l 4y / �3/7 -2--
SIGNATURE OF PERSON CONSTRUCTEN HE WELL ATE
GF,(OUf 2WA!i=n SECTCIN
ASH ENu'R1��rlflE!}ie'O p,(ti' 48 the VIvisfon of Water Quality, Groundwater Section, 1636 Mall Service Center- Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

26'7119
2. WELL LOCATIQN:
Neecest To
WELL CONSTRUCTION RECORI
North Carolina - Department of Environment anYghual Resoure Division of Water Quality - Groundwater Section 7
WELL CONTRACTOR (INDIVIDUAL) NAM5(prlat) f F Lf 1)Q t✓ A Ll W I L--= CERTIFICATION a I55 /
WELL CONTRACTOR COMPANY NAME�F A i3t' 1J ()tr la We I 1\-f1 (1(`+�1--1—t�G PHONE it Si
WQ PERMIT/
STATE WELL CONSTRUCTION PERMIT* ASSOCIATED(if applicable)
(if applicable)
1. WELL USE (Check Applicable Box)' Residential 6/Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
Topographic/Land setting
❑Ridge OSlope ❑Valley ❑Flat
(check appropriate box)
Latitude/longimde of well location
County /-•61/4_
((Street(StreetNu
fame, Nume4 unify, Subdivision, Lot No, cood:)
barr�aom
3. OWNER: VI De e4nn lVln.d'vt,-✓
Address ?r Lo Nf t 2JO-AXZ Y ``
4 41 /. Xk'pptet ec J e'L-- f y
11 City or Town State 2iP Code
Ara coda Phone number
4. DATE DRILLED /g%2 7/e 2-
5. TOTAL DEPTH: S tO
6. DOES WELL REPLACE EXISTING WELL? YES tr,NO 0
7. STATIC WATER LEVEL Below NTop o if
nrCasing)
' 8. TOP OF CASING IS / FT. Above Land Surfaces
'Top of cuing terminated at/or below Ind surface requires • varinou In accordaace th ISA NCAC 2C .011L ,
9. YIELD (gpm): METHOD O TEST
10. WATER ZONES ( epth): ( — ac, iIn /
wareethanuter/aecooda)
Latitude/longitude source.❑GPS❑Topographic map
(check box)
DEPTH DRn.1.ING LOG
Formation Description
From To
Q- 30
tot
r
co
.2430
11. DISINFECTION: Type /`* t (: Amount g' /i
12. CASING: Wall Thickness
Depth Diameter or Weight/FL Withal
From t To ' Ft (.ok7/`
: Z/
From To FL /
Fron _ To Ft.
13. GROUT: Depth Material Method
From _ To Ft.
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From _ To Ft. in. in.
15. SAND/GRAVEL PACIC: Depth Size Material
From To Ft.
From To Ft.
ro,'•
1 DO HEREBY CER u' T THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION ST a a S, AND THAT A COPY OF THIS RECORDC BEEN PROVIDED TO THE WELL 0
SIGNATURE OF PERSON CONSTRU G THE WFI l
ATE
LOCATION SICETQji
Show direction and distance in miles from at le
two State Roads or County R• ads. Include th
numbers and common road
c.)
t t 'Up!
SiibtAYEthe ed litial)to t t Division of Water Quality, Groundwater Section, 1636 Mall Service CenterREV l Rgh, NC
27699-1636 Phone No. [phone], within 30 days.

(degrees/minuteesecoads)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
Formation Description
266534
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and /Resources 'vision of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAM5 (print) r/� il.bP. AI TT �-/61,0 1 ( CERTIFICATION N4/y V
WELL CONTRACTOR COMPANY NAME/re-0hesP I l b./r�w. iJ /A : /I , Alt _J-Ive • PHONE N g) y ' U/
STATE WELL CONSTRUCTION PERMIT# / 7 ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential b Municipal/Public ❑ Industrial 0 Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION: ((_� �•
Nearest Town:/ r� Countaece
Be do- I 0 6-e 4-tea
Topographic/Land setting
❑Ridge 0Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
DEPTH
From To
moo
LOCATION SKETCH
11. DISINFECTION: Type 1-l- Amount °� pill r Show direction and distance in miles from at (east
p
12. CASING: Wall Thickness two State Roads or County Roads. include the roa
Depth Diameter orWeight/Ft. terial numbers and common road names.
From ) To Ft. 17
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From To Ft.
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From__To Ft. in. in. 15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
(Street Name, Numbers, Community, Subdivision, Cot No., Zip Code)
3. OWNER:OQ•
Address 3G
y1G4�
a• C et or R o.) 2d-t &a
Cityor TownStale Zip Code
(Q7g)- 7 7 j- 1-/ S 3
Area code- Phone number
4. DATE DRILLED i 77t.' l0 =
5. TOTAL DEPTH: La.'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 0
7. STATIC WATER LEVEL Below Top of Casing: `a O 0 FT
(Use "+^ if Above Top of Cuing)
8. TOP OF CASING IS ( FT. Above Land Surface'
' 'Top of cuing terminated at/or below land surface require a
variance In accordancej#tth ISA NCAC 2C .0118. C.;
9. YIELD (gpm): L-' METHOD OF TEST
10. WATER ZONES (depth):
•
R"I{IF' TH�ET
NSTRUCTION STAND—AltltD
1
Submit the original to the Iiivision or Water Quality, Groundwater Section, 1636 Mall Service Center - Raleigh, NC
---27699-1636 Phone No. [phone],jwithin 30 days.
WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
_i
THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE OWNER i! I � �Q6-1.�.b-k- 1 a a Ie 0 Z
SIc4TURE OF PERSON CONSTRUCTING THE WELL DA
c
O
GW-1 REV. 07/2001

266533
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment an Nyural Resou/rc /q- Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAM[)(prtat) he LC (1),42 n \ - A (-S\ w E t-L. CERTIFICATION a .37
WELL CONTRACTOR COMPANY NAME (\.F Lt hrry Oa' )1 turll Il"ll (1 N t-1-i� PHONE a 1(.45,15 •35S /
STATE WELL CONSTRUCTION PERMIT/ ASSOCIATED WQ PERMIT/
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential fH' Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCAj�
Nearest Town: ����
County kCtilaeit.
Cr '`'.V-
(Street Name, Numbers, Comm Subdivision, Lot No., Zip Code)
3. OWNER: %
Address �.[ " V r 4&
Or Rywtad
CirywTown _Q State 7 77 Zip Cade
l'AreaK?�focda Phone /nummbber~ /
4. DATE DRILLED f L f he l O Z
5. TOTAL DEPTH: 3 f e,
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO C
7. STATIC WATER LEVEL Below Top of Casing: fo& FT.
(Use `+' if Above Top of Casing)
$. TOP OF CASING IS / FT. Above Land Surfaces
'Top of casing terminated at/or below lad surface regalres a
variance la accordance with ISA NCAC SC .011a.
9. YIELD (gpm): Z. in METHOD OF TEST Rt !r
10. WATER ZONES (depth): k L -- 1 ?
2_1 a- ,-
11. DISINFECTION: Type
12. CASING:
Depth
From 1 ( To / a
From To
From To
13. GROUT: Depth
From d To 2-6
From To
14. SCREEN: Depth
From To
From To
15. SAND/GRAVELPACK.
Depth
From To
From To
hint
Diameter
FL G,
Ft.
FL
16 RFMARKS•
\\\1111 `' ) I DOI IIPRFBY_CER
CONSTRUCTION
Amount
Wall Thickness
or Weight/FL Material
tlz/ PO
Material
Ft. 6ocmt
Ft.
Diameter Slot Size
Ft. in. in.
Ft. in. in.
Size
Ft.
Material
Ft.
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(duck applo/Nista box)
Latitude/longitude of well location
(degre umimmuhecooda)
Latitude/longitude source:❑GPS❑Topographic map
(cbeck box)
DRILLING LO(L
Formation Description
DEPTH
From To
J
/ZQ - 0.30
? ?3(1) - 7 /-. to
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.
THAT THIS WFI I WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C WELL
ARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WFI I OWNER
D TE
7)11 -�
SIC RE OF PERSON CONSTRUCTING THE WELL
GP n l: tiyt)giIQ 1Gf OtYgfhal to tie Division of Water Quality, Groundwater Section, 1636 Mali Service Center - Raleigh, NC
ASr.tViLiifbi(b o. 191d) 733-3221, within 30 days. GW-1 REV. 07/2001
6

267542
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment antiNatural Resource? Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) f F u:')P. is/ \ " A (-11 toI-1-- CERTIFICATION,/ /5.3
WELL CONTRACTOR COMPANY NAME�F IA_ 13e r1 Os )J ` Writ li1(v CL }-1-1vt PHONE / rgkbi d5� 335R
STATE WELL. CONSTRUCTION PERMIT* ASSOCIATED WQ PERMIT{
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential 0 Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATIO
Neale • To
Name,,/ Nuum
3. OWNER:IL�/� T
Address
(Street or Route No.)
1{) e A-f/pi�L U Yl e
City or Town State 'Zip
Area code- Phone number
4. DATE DRILLED //itd4D Z"
5. TOTAL DEPTH: 470
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: ' -- FT.
(Use "t" if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surface*
'Top of wing terminated at/or below laad surface makes ■
variance In accordance with ISA NCAC 2C .011*.
9. YIELD (gpm): ai METHOD OF TEST
10. WATER ZONES (depth):
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
• (check appropriate box)
Latitude/longitude of well location
(degrees/mimmra/aecooda)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
Formation Description
DEM FromTo
11. DISINFECTION: Type in gat Amount 2- ayes
12. CASING: Wall Thickness
/ Depth ter or eght/FL Material
From 11ToFt. ( •2.(
From To Ft.
From To FL
13. GROUT: Depth
Mr__ .F,pd n
From � To 2� Ft. �lJ �'J7��(�_
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.
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�AikSi \
a • HEREBY CERTIFY
aNS�'glifTIObl STANAA$j
Nit
S WELL WAS CONSTRUCTED 1N ACCORDANCE WITH 15A NCAC 2C, WELL
THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
c
C1 c�
0 !:-
ATURE OF P RSON CONSTRUCTMGG THE WELL DATE
of Water Quality, Groundwater Section, 1636 Mall Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001
0

265946
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and,', Resourc[( - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAM J(orlat) Al- Lf 1)P d \ "4 L_Il w f L-L/ CLRTW-'ICATION N �3
WELL CONTRACTOR COMPANY NAME('F Lt pep"Ntl Oil' W CI( 1 ;\(211 1N� -1--{vG PHONE', fg1-258/
STATE WELL CONSTRUCTION PERMIT', ASSOCIATED WQ PERMIT{
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residentialt9" MunicipaIPublic 0 Industrial 0 Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: Coup
(Street Name, Numben, Canmuaity, Subdivision, lot No., Zip Code)
3. OWNER: `iT'1 t�t.r IitT k
Address , . - 1<.... 6_ L'cre-te
46L<,egtreet«ttNG ,2-cam ®6
City or Town State Zip Code
b2-t} 29-4/ - // 7 7
Arta coda Phone number 4. DATE DRILLED 12t d Z
5. TOTAL DEPTH: '2- o (
6. DOES WELL REPLACE EXISTING WELL? YES O NO IV
7. STATIC WATER LEVEL Below Top of Casing: 1 g FT.
(Use "+^ if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surface•
'Top of wing terminated at/or below Ind surface requires ■
variance la accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): 5 METHOD OF TEST l !3-
10. WATER ZONES (depth): Zm b r - 1 t6 -
/8O- -.s-
II. DISINFECTION: Typt 17< Y a x Amount 2. p i/
12. CASING: Wall Thickness
Depth cc WeighUFL Material
Frond' ( To lib Ft. Dirl 2/ /VC -
From To Ft.
From To Ft.
13. GROUT: Depth
From—$ Tom Ft.
From To Ft.
Material Method
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth
From To Ft.
From To Ft.
RfpM
DO HEREBY CERTIFY
flCONSTRUCTION STAND
Slot Size
in.
i n.
Size Material
Topographic/Land setting
[Midge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(deareedmimtlf+/secmde)
Latitude/longitude source:❑GPS❑Topographic map
(box)
DRILLING LOG
Formation Description
12Eiral
From To
Z
Lo-
/o� - / rh
g-'G-
Zia C # e
•
LOCATION SKETCH
Show direction and distance in miles at Iktst
two State Roads or County Roads. Inch& the43ad
numbers and common road names. 0
C�'3rr
or_
7
rn
fV m
NI --
tr
4)
IS WFI I WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC
THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
L.ROUHDV±\!". ilOf!
Se y the�eF1iitBFi)ILSTL.t. on of Water Quality, Groundwater Section, 1636 Mall Service Center -Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001
i OWNER
i

265475
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (prim) REUBEN CALDWELL CERTIFICATION / 2140
WELL CONTRACTOR COMPANY NAME RF.UBEN CALDWELL DRILLING, INC.PHONEYi8 )254-3581
STATE WELL CONSTRUCTION PERMIT/ 1537 ASSOCIATED WQ PERMIT/
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential Of Municipal/Public ❑ Industrial 0 Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATIO
Nearest Tswn: , e , Coun
(Street ame, Numbers, Community, Subdivision, Lot No., p C.. )
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(duck appropriate box)
Latitude/longitude of well location
3. OWNER:L' Aa' �L A i 9. i ail) AluD 2e tp..) 4{t u (dev nimucchernads)
Address Z° Ya.l.: aQ i4s1I1eg.atitude/longitude source:❑GPS❑Topographic map
(Street or Rowe No.) (check box)
Or1 p✓' //2? y �fi �F Pali DEPTH DRILLING Lon
(
Shy or Town _.. SWS .3 —7
76' �S3�-
2Code From To Formation Description
2N-
Area code- Phan number 5Il i P - 16
4. DATE DRILLED .4/2 7/0 7-----�Fh
tIntito
5. TOTAL DEPTH: in. is 0 4 - to G L,„,l,
6. DOES WELL REPLACE EXISTING WELL/ YES ❑ N ❑ p r /ly al-0
7. STATIC WATER LEVEL Below Top of Casing: /n 3 FT. Ofp _1.0x#
(Use "�" if Above Top of Casing)
8. TOP OF CASING 1S / FT. Above Land Surface• ha B (a5
�G0B /
*Top of casing terminated at/or below Ind surface requires a 45
variance In accords a with 13A NCAC 2C .0111.
9. YIELD (gpm): i METHOD TEST in (vFbr.
10. WATER ZONES (de th): to 1 >Cal -
/ate / l.�if .
11. DISINFECTION: Type /(bl..«. 4o7,1? Amount 1 Cot"
12. CASING:
Wall Thickness
Depth Diameter or Weight/Ft. Material
Front"t"� To 24> Ft. /24 "We
From To Ft. /
From To Ft.
13. GROUT: Depth Material Method
From 0 To {r0 Ft. Ct8"^tvl %%)1 KC)
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.
`) C' t k. HF�RFRV (IR
CONSTRUCTION ST
J OCATION SKETCR
Show direction and distance in miles from at (east
two State Roads or County Roads. Include the road°
numbers and common road names. N =�
he I/PAa r R
car-
I `oc
30
T THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL rn
ARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWaR mz
/! w1i ///i--7 /i%t5a0
2
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit thefldiglhal to the Division of Water Quality, Groundwater Section, 1636 Mall Service Center- Raleigh, NC
27699-1636l'hone No. [phone], within 30 days. GW-1 REV. 07/2001

265476
WELL CONSTRUCTION RECORD
North Carolina - Departrnent of Environment and Natural Resources - Division of Water Quality - Groundwater Section
REUBEN CALDWELL
WELL CONTRACTOR (INDIVIDUAL) NAME (print) CERTIFICATION/ 2 1. 40
REUBEN CALDWELL DRILLING, INC.PHONE
WILL CONTRACTOR COMPANY NAME 4 Z(8 54-3581
STATE WELL CONSTRUCTION PERMIT/
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential Municipal/Public 0 Industrial 0 4gricu
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
L 5 37 ASSOCIATED WQ PERMIT/
2. WELL LOCATION:
Nearest Town:071 (Street Name, N
3. OWNER:
Address
e_. 2J.s#.4
Community, Subdivision, Let No., Zip Code)
32- '9
�,(A,�e or Route No.) � �//
.�7o ktccct a r-pos
City or Town State
(62026-3"4<2—
Ard coda Phone 0umbcr
4. DATE DRILLED /% .ti/D 2—
5. TOTAL DEPTH: 70
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO 0
Zip Code
7. STATIC WATER LEVEL Below Top of Casing: L O FT
(Use "+- if Above Top of Cuing)
'8. TOP OF CASING IS / FT. Above Land Surface'
'Top of cuing lermlaated at/or below lead surface requires a _
variance in sewrdsae Ith ISA NCAC 2C .0i 1 B.
9. YIELD (gpm):_ METHOD OF TEST )( A7
10. WATER ZONES (depth): .eL ?--O J1
11. DISINFECTION: Type
12. CASING:
Depth Diameter
From Tom Ft.��
From To Ft.
From To Ft.
13. GROUT: Depth .�yyttaterial
From 157 To .2.0 Ft. G/IA'/fr
From To Ft.
14. SCREEN: Depth Diameter Slot Sire Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Amo
Wall Thickness
or i t/Ft. ,Maatterriiaal
/' e
Mcthod
/'—'.r
I DO HEREBY CERTIFY
CONSTR1RION STAN4
ty`;" t"--
Topographic/Landl setting
❑Ridge ❑Slope ❑Valley ❑Flat
(cheek app.w^ato bac)
Latitude/longitude of well location
(dc rtahoinmeilasoada)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
Formationscripeon
DEPTH
From To
am
77
77-
22-0
04,-2 - 3op
•
2. Grs
2Z0
JOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road name
\\4
THIS WELL WAS CONSTRUCTED M ACCORDANCE WITH ISA NCAC 2C, WELL
, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
2_--
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
subinittjle oi1'glnaf to the Dvision of Water Quality, Groundwater Section, 1636 Mall Service Center -Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

264524
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
REUBEN CALDWELL
WELL CONTRACTOR (INDIVIDUAL) NAME (print) CCRTIrfiFICATIONN 214Q
WELL CONTRACTOR COMPANY NAME PHONE[phone]
STATE WELL CONSTRUCTION PERMIT/
(if applicable)
REUBEN CALDWELL DRILLING, INC.
1537
ASSOCIATED WQ PERMIT/
(if applicable)
I. WELL USE (Check Applicable Box): Residential triMunicipal/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:
2ae
(Street Name, Numbers, Community. Subdivision. Lot No.. Zip Cod
3. OWNER.C144/I1Q ,. YYIG I�fw{ far e
4/ryfie/v tor Town Stare Zip Code o prmaborr i j cnptuo
(Qzq- Lt P — op*s t%3 Z c — 1po
Area code- Phone number G0
4. DATE DRILLED // it) 2- Oaf 3 n_
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO 3D Z~
7. STATIC WATER LEVEL Below Top of Casing: % D FT.
mz —
/
(Use "+"if Above Top of Casing)
FT. Above Land Surface
*Top of cuing terminated at/or below land surface requires a
variance In accordance tb ISA NCAC IC .0118. a
9. YIELD (gpm). METHOD OF TEST
10. WATER ZONES ( epth): .1 ea '" 4c
11. DISINFECTION: Type it;
12. CASING:
Topographic/Land setting
❑Ridge ❑Slope OValley ❑Flat
(chock appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Address p OL.n Sew / "
Q 4� /ret.a/ Latitude/longitude source:❑GPS❑Topographic map
or Route Nq.) /( (check box)
5. TOTAL DEPTH: re r
8. TOP OF CASING IS
J Depth Di tfr
From'' / To g6/ Ft.
From To Ft.
From To Ft.
13. GROUT: Depth atcnal
From__ To 7ot7 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.
From To Ft.
t7 DEPTH DRILLING LOG
From T F
ste
y7O
LOCATION SKETCH
Amount 4 , Show direction and distance in miles hn at least
Wall Thickness two State Roads or County Roads. Include -the road
or Weigh t. Myyj�i numbers and common road names.
Slot Size Material
in.
in.
16. REMARKS:
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 SEEN PROVIDED TO THE Nf:LL
mme
SIGNATURE OF PERSON
NSTRUCTING THE WELL
1
C4rG,
R a'lrr%
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mali Service Center -Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

262738
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
REUBEN CALDWELL
WELL CONTRACTOR (INDIVIDUAL) NAME (print) CERTIFICATION # 214Q
WILL CONTRACTOR COMPANY NAME REUBEN CALDWELL DRILLING, INC. PRONEY?(B >254-3581
STATE WELL CONSTRUCTION PERMIT# 1537 ASSOCIATED WQ PERMI7a
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residentials MunicipaVPublic 0 Industrial 0 Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATI
Nearest Town:.
(
jai
mben, Community, Sull4ivtaion, Lot No., Zip Code)
County A hem
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
3. OWNER:�;1 (depoeahnuiuts/secoods)
Address -ff3> eke- ..//!! / d 04 Latitude/longitude source:❑GPS❑Topographic reap
- ar R9d No
City or Town State Zip Code
(flog)-/k1 —/4/5L
Ara code- Phone number
(cheek box)
DEPTH DRILLING I.OG
From To Formation Description
4. DATE DRILLED /0/�
5. TOTAL DEPTH: / 2-,C Y" Tr
�
6 DOES WELL REPLACE EXISTING WELL? YES ❑ NO 17/
7. STATIC WATER LEVEL Below Top of Casing: 3 a. FT. is .° !) L
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
*Top of cuing terminated at/er below land surface requires a
variance la accordance with 1SA NCAC 2C .011a.
9. YIELD (gpm): 3 0 METHOD OF TEST
10. WATER ZONES (depth): 21Y1
11. DISINFECTION: Type to Znkmount / . 05 _
12. CASING: Wall Thickness
Depth Diamete or Weight/Ft. Material
From+( To Li- FL �a-( /) ifL
From To Ft.
From To Ft.
13. GROUT: Depth Material .elhod
From 6 To 7 an Ft. cult.
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
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.
15. SAND/GRA
From
From
16. REMARKS
is LEs&e1I L2
--ht.
Ft.
rial
1 DO HEREBY C 3RTIFYHRQl11lJHW[17— (�(, ONS7RUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION ersA'If&E:E/@!ml'®HA[['(4j Y OF THIS RECORD HAS BEEN PROVIDED TO THE WE OWNER
f/W , 40/z 7e 2
SIGNATURE OF PERSON CONSTRUCTING THE D
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mall Service Center -Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

th
From / / To f
From To
From To
13. GROUT: Depth
From_t5 To LO
From To
14. SCREEN: Depth
From To
From_— *+aN
15. SAND/GRAVEt1 A
2G2739
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and
REUBEN s CALDWELL
Division ofWater Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) CERTIFICATION, 2140
WELL CONTRACTOR COMPANY NAME REUBEN CALDWELL DRILLING, INC. ?HONEYB 54 -3581
1537
ATE WELL CONSTRUCTION PERMIT,
(if applicable)
ASSOCIATED WQ PERMIT,
/ (if applicable)
1. WELL USE (Check Applicable Box): Residential E( MunicipaWPublic 0 Industrial 0 Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATIQJ:
4
Nearest Town: ���
(Sou Name umbers, Community
,
Subdivision, Lot No.. Zip Code)
•
3. OWNER:/& \ 4.4) Li rj
Address / s ie 1r G 2p was nJ /I Pit eS
l ,seta L ' 1 R ►.tyl. gyfi 7 15
City or Town State Zip Code
75-* B V Oo (Eel ( maup
County.Zz '4
Arca coda Phone number DiG/�% J--'
/
4. DATE DRILLED % /
5. TOTAL DEPTH: 3 .0 K-
6. DOES WELL REPLACE EXISTING WELL? YES ❑,NO B'
7. STATIC WATER LEVEL Below Top ofCasing:/a FT.
(Use "+" if Above Top of Cuing)
8. TOP OF CASING IS / FT. Above Land Surface*
*Top of cuing terminated aVor below land surface requires a
variance In accordance with ISA NCAC 2C .01 U.
9. YIELD (gpm): f 2-- METHOD OF TEST t &
10. WATER ZONES (depth): 2- &Cr ' / L
11. DISINFECTION: Typg 7403Amount
12. CASING: Wall Thickness
Dianater or Weight/Ft. Material
FL o, Sr.,/
Ft.
Ft.
C_
eterial , ,� Method
Ft. (��
Ft.
Diameter Slot Size Materiel
Ft. in. in.
in.
From
From
16. REMARKS:
Ft.
Ft.
GROUN
1 DO HEREBY CERT1F%ij11
CONSTRUCTIO
SIGNATURE OF PERSON C
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Fiat
(check appropriate box)
Latitude/longitude of well location
(deg eeahnioulcehecoods)
Latitude longitude source•.❑GPS❑Topographic map
(check box)
DRILLING LOG
Formation Description
From To
Z.G. 3 45-" enarrQO
J.00ATION SKETCH.
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
07
NSTiUCTED M ACCORDANCE wrrifick NCAC 2C, WELL
THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
NiiSS���� `tqE71;
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mall Service Center -Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. OW-1 REV. 07/2001

262558
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and
RELBENResources
CALDDHLLn of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) CERTIFICATION it2 1. 40
WELL CONTRACTOR COMPANY NAME REUSES CALDWELL DRILLING, INC. PHONE I254-3581
STATE WELL CONSTRUCTION PERMITS 1537 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 LOCATI a N:
Nearest T.
Cow
eta -5k'y
(Street Name,,' Numbers, Community, Subdivision, I.ot No., Zip Code)
uA4 3. OWNER: 4 .C^L.av '
Address 1 c /4 of (a % _-
Street R to No.)
.572
fil
ity or Town State Zip Code
71C(- j9 9 7
Area code- Phone number
4. DATE DRILLED / / 44/9 2
5. TOTAL DEPTH: / O C . / y
7. STATIC WATER LEVEL Below Top of Casing: L o fl FT. 7 etc 0
/ (Use"+" if Above Top of Cuing) 7 ice — tie S-
8. TOP OF CASING IS C FT. Above Land Surface'
*Top of cuing terminated at/or below laud surface requires a
variance In accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): D- METHOD OF TEST ✓ i' I' C.-+
10. WATERZONES(depth): / 1'6 — 74C0 -
Topographic/Land setting
❑Ridge 0Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Descriptio
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO l Qp
11. DISINFECTION: Type} c trap ` Amount f O
12. CASING: Wall Thickness
Depth / Diamet�� or Wjight/Ft. a rial
From'"�7 To 2 Ft. dF
From To Ft.
From To Ft.
13. GROUT: Depth aterialu. ethod
From Q To Ft.
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REM .• S, l5 gib &r'(5- 6c
�I Df,j1EREB
1i Vi
Submit the original tojthe D
Giy6»gt4636fhtine:Na. (919)73
ASrFVd_.F , i'`1.pL J `IC-
�N
770
! £ II-yr—
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Includelly road
numbers and common roalr o
j
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
SIGMA OF PERSON CONSTRUCTING THE WELL DATE
PO / t --
vision of Water Quality, Groundwater Section,1636 Mail Service Center - Raleigh, NC
13221, within 30 days. GW-1 REV. 07/2001

262542
i1. WELL USE (Check Applicable Box): Residential Er Municipal/Public c ❑ Industrial 0 Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other Qif Other, List Use .iWQ C -
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
REUBEN CALDWELL
WELL CONTRACTOR (INDIVIDUAL) NAME (print) CERTIFICATIONS 2140
WELL CONTRACTOR COMPANY NAME REUBEN CALDWELL DRILLING, INC. PHONE[phone]
STATE WELL CONSTRUCTION PERMITS 1537 ASSOCIATED WQ PERMIT/
(if applicable) (if applicable)
2. WELL LOCATION:
Nearest Town-
^ n
AvileCrile County /5Cse R
(Street Name, Melbas, Continually, Subdivision, Lot No.�o.,__Zip Cole)
3. OWNER: eaeseor`r .414 n a)
Address fA:Z Lfi/...- ea
/a%�' �/ � �=/ (Street or owe No.)
ittee//v /i2 2 -p reye-
City or Town Stale Zip Code
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appcpristc box)
Latitude/longitude of well location
(degreea/minute isecoads)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
Area code Phone number 0
4. DATE DRILLED Io MVO a.
5 TOTAL DEPTH: Ie(t5
�`
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO to
7. STATIC WATER LEVEL Below Top of Casing: (o C FT.
(Use "+" if Above Top of Cuing)
8. TOP OF CASING IS 1 FT. Above Land Surface'
*Top of cuing terminated at/or below land surface requires a
variance la accordance wltb 15A NCAC 2C.0118. ,p
9. YIELD (gpm): 0 MET/HOD OF TEST /` ( G
e
10. WATER ZONES (depth): dif ' / rB •
a&-O.n- A OC.
11. DISINFECTION: Type itrI-•-Rm Amount lr /of
12. CASING: Wall Thickness
Depth Diameter or}Vmght/Ft. Jyje(eriel
Fro To k.'5 Ft �F2'� (��_
From To Ft.
From To Ft.
13. GROUT: Depth Meterialethod/J
From es *2-__ 20 Ft. �frrnJttte'�
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.
ft lttJ' CE4A fr}5:1F
U L!
I DO HEREBY CERT Y
CONSTRUCTION STATjj
eiLP
3 a�
'ice>iss�.
LOCATION SKETCH r^>
Show direction and distance in miles fro` t !cur
two State Roads or County Roads. lncludedhe road
numbers and common road names. r )
/14
AT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
RDS, AND THAT A COPY OFIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
to/Z37o t.
SIGNATURE OF PERSON CON 7RUCTING THE WELL DA
GRouNiNvA,: P;
ASHE VliA„ky*q tt:4 Division of Water Quality, Groundwater Section, 1636 Mall Service Center -Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

8. TOP OF CASING IS / FT. Above Land Surface*
*Top analog terminated at/or below Ind surface requires ■
variance In accordance+xlib ISA NCAC 2C .011 S. no •
9. YIELD (gpm): / ` METHOD OF TEST rl r!s
10. WATER ZONES (depth): 5G.2Q - / 26-71/1-1-
11. DISINFECTION: Type,
12. CASING:
Depth
From*/ To 21
From To
From To
13. GROUT: Depth
Frotlt_0 To 2 /
From To
14. SCREEN: Depth
From To
From To
15. SAND/GRAVEL PACK:
Depth
To
To
IDO
CONSTRUCT(
From
From
0
Amount i//5.
Wall Thickness
Diameter or Weight/Ft. Material
2/ floe
Ft.
Ft.
Ft. n atoal !
Ft.
Diameter Slot Size
Ft. in. in.
Ft. in. in.
Material
Ft.
Ft.
Size Material
261861
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
REUBEN CALDWELL
WELL CONTRACTOR (INDIVIDUAL) NAME (print) REUBENCERTIF�ICATIONa 21..40
WELLCONTRACTOR COMPANY NAME CALDWELL DRILLING, INC. PRONEE 48 )?54-3581
STATE WELL CONSTRUCTION PERMIT/ 1537 ASSOCIATED WQ PERMIT/
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential'O- Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCA
Nearest Town::
County
(Street Name, Number, Community, Subdivision, Lot No., Zip Code)
3. OWNER: 476 key /LcQraQ
Address fJ m /D 6i% /D / 7
e
(Sires Dote No.)
Nkb, 2-t7/s—
City or Town State Zip Code
( )- 7-75&-1 Q e/
Topographic/Land setting
❑Ridge ()Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(depea/miuutea/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
Area code- Phone number-
4. DATE DRILLED
5. TOTAL DEPTH: ' / 2._
/
6. DOES WELL REPLAC EXISTING WELL? YES 0 NO 0 r as
7. STATIC WATER LEVEL Below Top of Casing: 0 FT. 33s-.
(Use-t" if Above Top of Casing) 3.3S- ip,t
LOCATION SKETCH
Show direction and distance in miles frotl3t least
two State Roads or County Roads. Inclu4Jhe road
numbers and common road names. tv -"
le-2_3 Eder
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
SIGNATURE OF PERSON ONSTRUCfl G THE WELL
l9 /plh 2,
ASAmPtIT 46 ui w,ATE Q e Division of Water Quality, Groundwater Section, 1636 Mall Service Center - Raleigh, NC
27699-I ituBTKh1fmK1fMM44LL n�!Fo 3221, within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and
REUBENNatural Resources
CALDDBLLn of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) CERTIFICATION SS 2140
WELL CONTRACTOR COMPANY NAME REUBEN CALDWELL DRILLING, INC. PHONEY )?54-3581
STATE WELL CONSTRUCTION PERMIT/ 1537 ASSOCIATED WQ PERMIT/
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential Er'MunicipaVPublic 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATI N:
N st Town: '.L_ya' County
(Street Name, Number, Community, Subdivisio.^^.Lot No., eip Code)
3. OWNER: R
Address 9,1„5-~
trot or Route/'No.)
rY
City or Town Stale Zip code
Area coda Phone number
4. DATE DRILLED /40e
5. TOTAL DEPTH: / .S
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 0
7. STATIC WATER LEVEL Below Top of Casing: 5 tea FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
*Top of cuing terminated actor below Ind surface requires a
variance In accordance wltb 15A NCAC 2C .011a.
9. YIELD (gpm): 7 D METHOD OF TEST R! kr'
10. WATER ZONES (depth): /1t,8T It/W
11. DISINFECTION: Typtfil �a Amount 2
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From%' To "42 Ft._ e tT acreW
From To Ft. ,%fir
From To Ft.
13. GROUT: Depth Material Meth
From /D To 24 Ft. t
From To Ft.
14. SCREEN: Depth Di gleter Slot Size Material
in. in.
in. in.
15.
From
From
11 �C•
ONSTRUCTION STANDARDS
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Material
Topographic/Land setting
❑Ridge ❑Slope [Walley ❑Flatuck (cluck appropriate box)
Latitude/longitude of well location
(depea/minutes/secoods)
Latitude/longitude source:❑GPS❑Topographic map
(cluck box)
DEPTH DRILLING LOG
From To Formation Descgption
Ce 20'
20 Lr
—//R-
//?- /s
LOCATION SKETCH.
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and comm r road names.
71�
STR JU ED IN ACCORDANCE WITH 15A NCAC 2C, WELL
THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO T$E WJrLL OWNER
fih-ss /e/
Subl (Itthe original to the Divisi�n of Water Quality, Groundwater Section, 1636 Mall Service Center - Raleigh, NC
27699 1636 Phone No. (9191/33-31 I, within 30 days. GW-I REV. 07/2001

Address „2. �/
V, - tJ 4y/ DEPTH
261874
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and
REUBENNatural Resources
CALDDELLn of Water Quality - Groundwater Section 1,
WELL CONTRACTOR (INDIVIDUAL) NAME (print) CERTIFICATIONS/ 2140
WELL CONTRACTOR COMPANY NAME RRUBEN CALDWELL DRILLING, INC • PHONE 448 I254-3581
STATE WELL CONSTRUCTION PERMIT# 1537 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:
6o
Jlr County Pas+mbc.
unity, Subdivision, Lot No., Zip Code)
3. OWNER: E.U1 . Etn f !Lb
or Route N
City or Tow, Stale
Zip Code From To
r
Area code- Phone number
4. DATE DRILLED 29,,<VD
6. DOES WELL REPLACE EXISTING WELL? YES a NO ❑
7. STATIC WATER LEVEL Below Top of Casing: -T' FT.
(Use "+" if Above Top of Cuing)
8. TOP OF CASING IS / FT. Above Land Surface*
*Top of cuing terminated at/or below laud surface requires a
variance In actardsace with ISA NCAC 2C .0113.
9. YIELD (gpm): 6-*METHOD OF TEST / '
�.
5. TOTAL DEPTH: ZS/
10
. WATER ZONES depth):.3 3
�
�- /z
1'--- A-p
2n-3T6
' 4 Sit
/. / fZ,y—
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(depxslmiwteshecoods)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
Formation Descriptio
� J ()CATION SKETCH
d 11. DISINFECTION: Type Amount3 "'•'7Z` Show direction and distance in miles frotfat least
12. CASING: Wall Thickness two State Roads or County Roads. Inclu the road
Depth To_ls±
Diameter or Weight/Ft. paterial numbers and common road names.
<1
From To Ft.
From To Ft.
13. GROUT: Depth atc
From� e_ To_�Ft. NT
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.
LS
(�16 nA�1U 111/ E �•
'—'1150•IiERDWfEERTIPI
T THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C. WELL
CONSTRUCTION STAh S, AND THAT A COPY OF THIS RECOR4 HAS BEEN PROVIDED TO T WE OWNER
OCT 2 1 2002 TURD ke la /40
SIGNA F PERSON CONSTRUCTING THE WELL D
GI
ASH
the Division of Water Quality, Groundwater Section, 1636 Mall Service Center- Raleigh, NC
to) vas 3221 within 30 days. GW-1 REV. 07/2001

26243
WELL CONSTRUCTION RECORD ,Z
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) REUBEN CALDWELL CERTIFICATION a 2140
WELL CONTRACTOR COMPANY NAME REUBEN CALDWELL DRILLING, INC. PHONE448 )i54-3561
STATE WELL. CONSTRUCTION PERMIT# 1537 ASSOCIATED WQ PERMIT%
(if applicable) (if applicable)
1. WELL USE (Check Applicable Hox): Residential �Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring ❑ Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2, WELL LOCATION:y`
Neares.0/540 Cyun
( Name, Numbers, C canny, Subdivision, (let No., Zip Code
3. OWNE1012ei FZC
Address tfr ietY fin .
, (Street or Route No.)
City or Town State
°5
Zip Code
Lin' are- aoir
Area code- Phone number
4. DATE DRILLED !O/Jl/D %
5. TOTAL DEPTH: 4te O
6. DOES WELL REPLACE EXISTING WELL? YES 13 NO ❑
7. STATIC WATER LEVEL Below Top of Casing: Tr FT.
(Use "a" it -Above Top of Cumg)
8. TOP OF CASING 1S � FT. Above Land Surface*
*Top of cuing terminated st/or below Ind surface requlru a
variance la accordance Ith ISA NCAC 2C .0111.
9. YIELD (gpm): .li MET OD OF TEST
i �
10. WATER ZONES depth):
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appsaprine hoe)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
fe
— «do
.soo
11. DISINFECTION: Type fr Amount G .
Wall Thickness
or Weight/Ft. awia1
374.1(
12. CASING:
� // Depth
Frortl�[_ To AC'
Diameter
Ft.
From To Ft.
From To Ft.
13. GROUT: Depth
From_ To le" 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 F1.
From To - Ft.
16. REMARKS:
Submit the orie(nal to th DI
/ 1143,,G;ft:_an(a N0119119) 733-:
ASHPIILLE FE0101?AL OFFICE
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Inclu4e,the road
numbers and common road names. U'3
Pet)
1S WELL WAS CONSTRUCTED IN ACCORDANCE WI H 15A NCAC 2C, WELL
AND THAT A COPY OF T.TIiS RECORD HAS BEEN PROVIDED TO THE 11.
GNATURE OF PERSO
A.
ONSTRUCTING THE WELL
PA-1-
Ion of Water Quality, Groundwater Section, 1636 Mall Service Center- Raleigh, NC
21, within 30 days. GW-1 REV. 07/2001
late(

261485
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) REUBEN CALDWELL CERTIFICATION/ 2140
WELL CONTRACTOR COMPANY NAME REUBEN CALDWELL DRILLING, INC. PHONEY$ 54-3581
STATE WELL CONSTRUCTION PERMIT/ 1537 .L�SOCIATED WQ PERMIT/
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential Eel/Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATIN: .'
Nearest Town: ) County,r
(Sheet Name, Numbers, Community, Subdivision, tut No., Zip Cole
yts) ;j
3. OWNER: /II ePritlint4fite /f1[QJ.Q, In QiD—Su �y (depw/minutedraconds)
Address the, /24,04 �=r`C.� Latitude longilude source:❑GPS❑Topographic map
L (Street or rta„t/yo.) p ,, / (check box)
1
r-'`�..Gci, s"_,.ci,`eT`✓,_� ihV/ • ! `�/ c�S/7.y� I DEM DRILLING LOG
City or Town State / Zip Code 4F8Mm4�^EFrom To
NC,
14. SCREEN: Depth
From To
From To
15. SAND/GRAVEL PACK:
4. DATE DRILLED) B
Area code Phone number
1e
D A
5. TOTAL DEPTH: �i ger
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: '.36 FT.
(Use "+" if Above Top of Cuing)
8. TOP OF CASING IS / FT. Above Land Surface*
'Top of cuing terminated actor below land surface require
variance la accordance with ISA NCAC 2C .0118. ���
9. YIELD (gpm): / i METHOD OF TEST
10. WATER ZONES (depth): ^ � 1/
11. DISINFECTION: Typc7 O133. t Amoun
12. CASING: Wall Thickness
Depth seer or Weight/Ft. ?Sal
From_ Tom Ft. (l� 2�
From To Ft.
From To Ft.
13.
ethod
`Er
GROUT: Depth aterial
From 67 To 2./) Ft. cLii/Ift
From To Ft.
Diameter Slot Size
Ft. in. in.
Ft. in. in.
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 tames.
1
Is
0
O
Material
Depth Size Material
From To Ft.
From , To Ft.
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(Sick appropriate boa)
Latitude/longitude of well location
T THIS WELL WAS CONSTRUCTED IN ACCORDANCE Wrin 15A NCAC 2C, WELL
>S, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
4) /ylJ 7
SIGNATURE OF PERSON CONSTRUCTING THE WELL
,a/1.07—
DA
Division of Water Quality, Groundwater Section, 1636 Mall Service Center -Raleigh, NC
33-3221, within 30 days. GW-1 REV. 07/2001

262576
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
REUBEN CALDWELL
WELL CONTRACTOR (INDIVIDUAL) NAME (prim) CERTIFICATION/1) 214
WELL CONTRACTORCOMPANY NAME REUBEN CALDWELL DRILLING, INC. PHONE[phone]
STATE WELL CONSTRUCTION PERM If/_ 1537 ASSOCIATED WQ PERMIT/
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential Er/Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION: Topographic/Land setting
Nearest own: 6tAALAA- _ •� County T9L C7 +-C ❑Ridge ❑Slope ❑Valley ❑Flat
T'^UN 04-P 7�r (check applapriate box)
Latitude/longitude of well location
(Strad Name, Number, Community. Subdivision, tot No., Zip Code)
3. OWNER: 1/ 0 Me-44 1-4
Address 10 fin rt_TQR
(Street or No.)
PCerc4An NC -
City or Town
ALa4-
CA r5? . LRt✓e
"473 y
Zip Code
(Dal%- &,u (- 4173 O •
Area code. Phone cumber /
4. DATE DRILLED `I! 2- 57 ° 2-
5. TOTAL DEPTH: e74 2-S
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: B` A
Btu -+- If Above Top of Caging)
8. TOP OF CASING IS / FT. Above Land Surface'
*Top of cuing lermlnsted at/or below load surface repatru a
vas -lama loaccordmca with ISA NCAC 1C .01111.
9. YIELD (gpm): 2-0 METHOD �OFTiST
10. WATER ZONES (depth): 3 LO q
- " I
via
390-
I1. DISINFECTION: Typ�Amount j
12. CASING: Wall Thickness
Depth Diameter
From-h I To I__ Ft. -(j- Z- k
From To Ft.
From To Ft.
13. GROUT: Depth Material
From O To t C Ft. Ce.h e N l
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Slot Size
in.
in.
(degreesh irostea/sccooda)
Latitude/longitude source:❑GPS❑Topographic map
(check boa)
DRILLING LOG
Formation Descriptio
DEIM1
From To
— y�
rCa - /7 y
-3mo
3G
Er-3t O-390
FT. 3�
jyo-g7i
or WeighVFI. Material
uC
16. REMARKS:
1D$Om03mc4
rcpNc'rnUZ'1'r0
sr�ri.Cs- 'AP /:�+"--1
/ras/.-Zof20
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road name
fi
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
Imo(W ..,rh 9/75r/o7.
',; SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mall Service Center- Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

2618F0
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
REUBEN CALDWELL
WELL CONTRACTOR (INDIVIDUAL) NAME (print) REUBEN
N 2 L 40
WELL CONTRACTOR COMPANY NAME RUBEN CALDWELL DRILLING, INC. PHONEY?J8 54 -3581
STATE WELL CONSTRUCTION PERMITH 1537 ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL. USE (Check Applicable Box): Residential Ea/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:
_ dearest Town?✓
694'L
County. L_ tt
NoZip Code)
(Street Name, Number, Community, Subdivia
3. OWNER: ki-..mot,
Address 6. Atns.BL '&11,4
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
ark I/1 . (degrees/minutes/seconds)
e-t-.
n fret a Routes� No.)
l.1),Qruit ULY ) A9Cr
City or Town State ' Zip Code
(fiQ)- loci- 1-tog
Area code- Phone number
4. DATE DRILLED t/2. /0 2
5. TOTAL DEPTH:
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 0
7. STATIC WATER LEVEL Below Top of Casing: 6o3 FT.
(Use -+^ if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
'Top of eaaing terminated at/or below land surface require •
variance la accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): 3 METHOD OF TEST
10. WATER ZONES (depth): /e 9 /
11. DISINFECTION: Type/ Lo7GAmount _3
12. CASING: Wall Thickness
Depth , Diameter or Weight/Ft.
From// To!ISt Ft. Co "./
From To Ft.
From To Ft
13. GROUT: Depth Material
2aterial /.tethod4
Froo To 0 Ft. CeA,tclr
From To Ft.
14. SCREEN: Depth Diameter Slot Sire 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
ve-
CONSTRUCTION STAND
1 J2
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
Formption Description
DEPTH
From To
3
.3 - 10 1
/7- 1117tK
/ 42
36s
0
n
JOCATION SKETCI{
Show direction and distance in miles from at (east N
two State Roads or County Roads. Include the road ����\
numbers and common road names.
0
®w
ro
pact
"-IS WELL WAS CONSTRUCTED TN ACCORDANCE WITH 15A NCAC 2C, WELL
AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
-eP illcjvU 1'1I,i lb -a,
iIGNATURE OF PERSON CONNSTRUCTING THE WELL DATE
A - Dlysion of Water Quality, Groundwater Section, 1636 Mall Service Center -Raleigh, NC
• 221, within 30 days. GW-1 REV. 07/2001

4. DATE DRILLED
261484
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
REUBEN CALDWELL
WELL CONTRACTOR (INDIVIDUAL) NAME (print) CERTI[FiICATION, 2140
WELL CONTRACTOR COMPANY NAME REUBEN CALDWELL DRILLING, INC. PRONEW �254-3581
STATE WELL CONSTRUCTION PERMIT, 1537 ASSOCIATED WQ PERMIT,
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential Er Municipal/Public ❑ Industrial 0 Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATI N: O
Nearest Town: �v County / rerve4L
l kC4 e(
(Street Name,Numben, Catnmuniicy, Subdivision, Lot No., Zip Code)
3. OWNER: A -dam'
Address _5 7 pis"�+'ea4-"c Arcs
� ( t or RguteAJoJ
(��
City or Town State Zip Code
- 25A" ;'� /5 SS' viq -gq,o
Area coda Phone number • 2—
5. TOTAL DEPTH:
6. DOES WELL REPLACEXISTING WELL? YES 0 NO el
7. STATIC WATER LEVEL Below Top of Casing: 70 FT.
/ (Use "+' if Above Top of Casing)
8. TOP OF CASING IS ( FT. Above Land Surface'
`Top of cuing terminated at/or below load surface requires •
vart•nee le accordance with ISA NCAC 2C .0113.
9. YIELD (gpm): 3 METHOD OF TEST /Ci &m
10. WATER ZONES (depth): 2 iffri
11. DISINFECTION: Type / r7 . '9707..a Amount Z pi:--
12. CASING: Wall Thickness
Depth Disinter
Fromill To fir) Ft. L
From To Ft.
From To Ft.
13. GROUT: Depth
From f% To Depth,
Ft.
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.
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(deve alminuteaAecoods)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
d - 3.1-
3s- (Po
-Co7
Je7- 3 ® Z
5bb2
Zy_ 3Ti,
Cjytu��c 6/-
9• C — 5423- eireta
'f� 5 °irk etadi Z
OLlttt-r`n
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
or Wei rt. Mpter) numbers and common ro@d names.
I ( fiPRF'RYY`pity
CONSTRUCTION STAPJ)
�J
T THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
)S, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL 0
(7
SIGNATURE OF PERSON CONSTRUCTING THE WELL �( DATt ���j
(vision of Water Quality, Groundwater Section, 1636 Mali Service Center -Raleigh, NC
3-3221, within 30 days. GW-1 REV. 07/2001
GlItantildtlhe WOWto the
ASH [IH649A666'1@ AinLlSfdc&19)

261501
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) REUBEN CALDWELL CERTIFICATION a 2140
WELL CONTRACTOR COMPANY NAME REUBEN CALDWELL DRILLING, INC. PHONEQ48 )254-3581
STATE WELL CONSTRUCTION PERMIT/ 1537 ASSOCIATED WQ PERMIT/
(if applicable)
(if applicable)
1. WELL USE (Check Applicable Box): Residential amicipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATI
Near citTown.
user Name, Nuben, Commu+ity. Subdivision, at No., Zip Code)
3. 0
Address fbP i(Street or Route
, / 7
id141 zd 4( 1)c No.) 70 /
���j City(or Town State Zip Codc
"t! ^�J- ICC
Area code- Phone number
4. DATE DRILLED
5. TOTAL DEPTH:
a
6. DOES WELL REPLA E EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: / 3 /) FT.
(
(Use"+" if Above Top of Casing)
8. TOP OF CASING IS FT. Above Land Surface*
*Top of cuing terminated atior below Ind surface requires a
variance to accordance/with �ISA "NCAC 2C .0118.
9 YIELD (gpm):! METHOD OF TEST �3"-,
10. WATER ZONES (depth): 2 Z n eZ 7 /1-vt2
770 — 620ew
11. DISINFECTION: Type / - 70 Amount
12. CASING: Wall Thickness
Depth Dieter or WeighUFt.4
Fro 7 Ft. To / �
From To Ft.
From______ To Ft.
13. GROUT: Depth n)Material
From S / To_ZieFt.
From To Ft.
14. SCREEN: Depth
aato
Diameter Slot Size
Front To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size
From To Ft.
From To Ft.
IA RRMADVO•
.sa a
CONSTRUCTION ST
Material
COunty‘,..cooree.-e--/
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
O
DEPTH
From To
— 1/
J'7 _
77n
0
J ()CATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. include the road
ai numbers and common road names. -
Material
'' THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 1SA NCAC 2C, WELL
S, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL 9DATE Z_
GFsiontatowfrtgaseto the Division of Water Quality, Groundwater Section, 1636 Mail Service Center- Raleigh, NC
ASH 04:ji13310iii4to(}f.l6j9) 733-3221, within 30 days. GW-1 REV. 07/2001

II. DISINFECTION: Type
12. CASING:
Depth Diameter
From+ , To It-,/ Ft. to
From To Ft.
From To FL
13. GROUT: Depth aaj7
From 7 Tom FL Set- /
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.
262'702
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment tumefy nlResot /act(..-JDvvssion of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME Orlin) /' 6' LL/che t \ "4 w �-�/� CERTIFICATION I /5-3 7
WELL CONTRACTOR COMPANY NAME LL1,P rJ ( a J� U/f!I t '\Yli (1N Cr t—/—N)C' PHONE / jYlb'S n15 51 •3.55 /
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMITS
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential Q"Municipal/Public 0 Industrial 0 Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION
N st Town: CO County
/
o/zulo-er �rT ?fvu-c ✓
(Street None, Numbers, Community, Subdividm, Lot No, Zip Code)
3. OWNER: 'tt aJ Q
Address
/r cK- Ee or Rowe
City or Town Spey tip Code
Ata code- Phone number,
4. DATE DRILLED 7' /0 .2---.5. TOTAL DEPTH: r'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: Qr7 FT.
(Use "+- if Above Top of Casing)
8. TOP OF CASING 1S FT. Above Land Surfaces
`Top of casing terminated at/ r below had surface regdre a
variance Is accordance wttb ISA NCAC 2C .0118.
9. YIELD (gpm): / 6,0 41 METHOD OF ST
10. WATER ZONES (depth): ).. c
Topographic/Land setting
[Midge 0Slope ❑Valley ❑Flat
(dtedt appropriate box)
Latitude/longitude of well location
tr- (eepedmimnnnecmds)
LaLatitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOLL
Formation Description
From To
%
LOCJTION SKETCH
Amount 74 ,- Show direction and distance in miles from at least
Wall Thickness two State Roads or County Roads. Include the road
Of Weight/Ft l>¢ate(al Hampers and common ran¢ names
From
From
16. REMARKS:
NSTRUCTION STAND
NOV — 1- 2nn2
viz
S 7G i�) crtLJ
3 WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WFr r
THAT A COPY OF THIS RECORD HAS BEEN,PR�VI ED TO THE WELL OWNER
�zda 2—
ATURE OF PERSOTf'CONSTRUCTING THE WELL DATE
Sulgp(I(jheysnitinflN911M Division of Water Quality, Groundwater Section, 1636 Mall Service Center - Raleigh, NC
itaelifftrtbilAkks€M013-322a,within 30days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
REUBEN CALDWELL
WELL CONTRACTOR (INDIVIDUAL) NAME (print) CERTIFICATION / 2140
WELL CONTRACTOR COMPANY NAME REUBEN CALDWELL DRILLING, INC. PHONEQ7(8 ?54-3581
STATE WELL CONSTRUCTION PERMIT/ 1537 ASSOCIATED WQ PERMIT/
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential CYMunicipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCAT N: ,t1
NearestTown: et�ue0 t County B-Us.'ll C<nn„
(Street Name, Number, Conununity, Subdivision, Id No.. Zip Code)
3. OWNER•'4k0-12__ a-ax.st—
Address 7 / I3 o Di't2 144 M IP ei! _
t(Street or Route No.)
am -
or Town State Zip Code
(3'L -
Area
Ara code- Pharr nwn
4. DATE DRILLED '7 / % Y 1 b
5. TOTAL DEPTH: _
6. DOES WELL REPLACE EXISTING WELL? YES NO 0
7. STATIC WATER LEVEL Below Top of Casing: /Sr FT.
(Use "s" if Above Top of Cuing)
8. TOP OF CASING IS / FT. Above Land Surface*
*Top of cuing terminated at/or below laid surface requires a
variance to accords ce with 15A NCAC 2C.0111. p
9. YIELD (gpm): METHOD QF TEST 4 , O. WATER ZONES (depth): / 0SG - 7. 61041
l ekh9 - TO
11. DISINFECTION: Typgt, Amotm
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. tyfpterial
From "% 1 To / 7 C( FL to lg 1 D 2 1 y-' UC
From To Ft.
From To Ft.
13. GROUT: DDeth, � icnal �ethod
From Ta�-� Ft. C j�'bLCt�t/\
From To Ft.
14. SCREEN: Depth
CONSTRUCTION ST
OCT - 2
Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
From
From
Depth Size
To Ft.
To Ft.
Slot Size Material
in.
in.
Material
16 RF.MARKS:_�
- \,I
D iE ? CERTFY'lMa* C BTHIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
?. AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO TWELL WNER
j)/IEE
W��.C1i�vjLL DATE a _
260829
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(cluck appropziate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
�-- are
/ 4t--pl c
/ E--e0
'2 a-70-r
2s D xi- r-o-ru.(a
1 f
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.
-)
r1
W
cl1
SIGNATURE OF PERSON CONSTRUCTING THE
6411h)pEnhtemrigg0#Isfl the Division of Water Quality, Groundwater Section, 1636 Mall Service Center -Raleigh, NC
ASIY.lOS4h®f9in6'AINIF.R€19)733-3221,within 30days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
260830
North Carolina - Department of Environment andREUBENCALDDBLLn of Water Quality - Groundwater Section
WELL CONTRACTOR (INDWIDUAL) NAME (prlet) CERTIFICATION 121 40
WELL CONTRACTOR COMPANY NAME RE.UBEN CALDWELL DRILLING, INC• PHONEY2(8 )254-3581
STATE WELL CONSTRUCTION PERMITS 1 537 ASSOCIATED WQ PERMITS
(If applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential d MunieipsVPublic 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: k+ na Celt— County 3 U eras dQ
‘71,n,i' 1-1; / a<v
(street Name, Numbers, Community. SubSivirion, let No., Zip Code)
3. OWNER:I r) iV I e U .✓ rC A. nn
Address t_— 8'/ 1 L; r- ?-I 711 /2 N
A�//��(Street or Route No.)
CY.i the Rogi.t`%C
ry or Town Stare
Ili, 'ir• ',/co(1
Mea cods Phone Dumber /
4. DATE DRILLED '9 /7 r< /0 2---
5. TOTAL DEPTH:
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 0�
7. STATIC WATER LEVEL Below Top of Casing: .3$ FT.
(Use "+" if Above Top of Gaol)
8. TOP OF CASING IS ( FT. Above Land Surface*
*Top of castes larmlaaled actor below land tartars regalrsa a
varlat* la aceordsara wills 15A NCAC 2C.011a.
9. YIELD (gpm)• 7. i+ METJf1P OF TEST
10. WATER ZONES (depth): I'(
11.
DISINFECTION: Type
12. CASING:
Depth
From 'f To / 3 0
From To
From To
13. GROUT: Depth
From 0 To `t O
From To
14. SCREEN: Depth
From To
From To
IS SAND/GRAVEL PACK:
R.Ca�,
zip Code
/Fr)t--RD - Amount
ltri� E 7 N E
From
Wall Thickness
Diameter or Weight/Ft.
to �G Z
FL
Ft.
Diameter
Ft. in.
Ft. in.
RE KS:3 2''92_
Topographic/Land setting
❑Ridge ()Slope ❑Valley ❑Flat
(th.ck appropriate box)
Latitude/longitude of well location
(deaeedmimun/eecords)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEMI 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
Material numbers and common road names.
cthod
Slot Size Material
in.
in.
Slit Material
/.
1 Da LIRREHY CERTIFY THATHIS WELL WAS CONSTRUCTED IN ACCORDANCE WDTI ISA NCAC 2C, WELL
cominutnvonrAmtwos. AND THAT A COPY OF THIS% RECORD/HAS BEEN PROVIDED TO THE WELL OWNER
ASHEVILLE REGIONAL OFFICE 1 / / Iv A", I` . q/i /Q 2
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mall 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 anplyuralResou/rce/�.,-Division of Water Quality - Groundwater Section 7
WELL CONTRACTOR (INDIVIDUAL) Nat (print) /\e LichIPI N \ dizi ,%I-i\ w � (—�1./CP.RTIFICATIONa
WELL CONTRACTOR COMPANY NAME f'e LLhe/d CCPIrt writ i i �11 In CP 1'"LN� PHONES f 1)4 5-358 /
STATE WELL CONSTRUCTION PERMITS ....ASSOCIATED WQ PERMITS
(if applicable) (if applicable)
260068
1. WELL USE (Check Applicable Box): Residential MuaicipallPublic ❑ Industrial 0 Agricultural 0
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: i3496)
''/rC7—A-4
(Street NanV, Numben, ComSubdivision,Lot No, Zip Code)
3. OWNER Q/ie• m U tf e LC)
t-n t County -)i: •+1 C D
Address
(
(Surat
nnr N or Roma N3i — q 711
fiC,try or Town Stu. Code
� �-p � •C(,. f{/ "3
Area code- Phone number /
4 DATE DRILLED 9 / / / �'
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(cheek appropriate box)
Latitude/longitude of well location
(depeu/mimmadsc odds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEMI DRILLING LOLL
From To Formgtion Description
/a/
y1 , 17 P7
5. TOTAL DEPTH: CL bo- / / 7_.n
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO 0 i i p )
7. STATIC WATER LEVEL Below Top of Casing: / FT.
(Use'+" if Above Top of Cuing)
8. TOP OF CASING IS / FT. Above Land Surface'
'Top of cuing terminated ator below land surface requires a
variance la
9. YIELD (gpm). METHOD OF TEST 1/
accordance with ISA NCAC 2C .011a.
10. WATER ZONES depth): I aO
1
11. DISINFECTION: Type k/r f N43 Amount 9 K'%1
12. CASING: r • wall Thickness
Depth Diameter or Weight/Ft. Matni
From `' To L. / Ft. Q /
Ft.
From_ To
From To Ft
13. GROUT: Depth Material
From._ To 'r—/ Ft. 7fslis/--r-
From To Ft.
14. SCREEN: Depth Diameter
From_ To Ft. in.
From__ To Ft. in.
15. SAND/GRAVEL PACIC:
Depth Size Material
Slot Size Material
in.
in.
From To Ft.
From To Ft.
E16CRT �IY/ . 1
1461.. a 14,41• • Ili ,n
CONSTRUCTION ST
SEP 2 3 2002
ASHE !
9
oS9gfd9utn the
l` i{..PgfilCi919)
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
r.
n
1- THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 1SA NCAC 2C, WFI
)S, AND THAT A COPY OF THIS RECORD BEEN PROVIDED TO THE WELL OWNER
(V it,'t (t �J A�/)
SIGNATURE OF PkON CONSTRUCTHE'WELL DATE
'vision of Water Quality, Groundwater Section, 1636 Mali Service Center -Raleigh, NC
3-3221, within 30 days. GW-1 REV. 07/2001
l.�t

259824
WELL CONSTRUCTION RECORD
artrnent of Environment and Natural Resources - Division of Water Quality - Groundwater Section
North Carolina -Dep REL'BEN CALDWELL CERTIFICATION 214t?
WELLCONTRAc�ORCO rim°AL)NAa'REUBEN CALDWELL DRILLING, INC. PBONeQ?f8 )254-3581
WILL CONTRACTOR COMPANY NAME 1537 WQ PERMITa
STATE WELL CONSTRUCTION PERMITS ASSOCIATEDP)
(ifapplicable) /
icable
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 LOCA4 3,,,t�N\
Nearest Town:: �� 15jj `xC F� Tf\ County ' Jai ��{;
Celt-A-IG-( nu . a -A -La__
(Strew Name. Numbers, Commuairy, Subdivision, ld No.. Zip Code)
2
Topographic/Land setting
❑Ridge ❑Slope ❑Valley OFIat
(check appropriate box)
Latitude/longitude of well location
(deehnimco
nes/sends)
Latitude/tongitudesource:❑cGecPtl0 re
H T oPograPhicap
DR(NG LAG
Formation Description
From To
YTI
10. I DCATION tKE Irta
Amounc s � StateoShow on ads and County Roads7Incdistance in tlude thm at e road
ast
1 ]. DISINFECTION: Type ! � ' � e Wall Thickness �
12. CASING: planner or Weight/Ft. t (trial numbers and common road names?
C43
3. OWNER:.
Address �T
(Sneer or Roue No.)
154Ac/t mT_ NC-
.City or Town State Zip Code
lqi 'i'' -Y " 2- Ca- Ct• • yr'JO
Area code- Phone number A
4. DATE DRILLED 41
5. TOTAL DEPTH:
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO'CC
7. STATIC WATER LEVEL BelowTopP of
AbbooveeTop of Casing)
8. TOP OF CASING IS ____L__— FT. Above Land Surface*
'Top of cuing terminated at/or below lead surface requires a
variance In accordance with ISA NCAC 1C.011a.
9. YIELD (gpm): METHOD OF TEST
WATER ZONES (depth):
From -+ ( ToSi$-- Ft —_A. — '2 /
From To Ft.
From To Ft.
Material Me
13. GROUT:Dry SnT
Fro Ft.�--
From To Ft.�-
14. SCREEN: Depth Diameter Slot Sim Material
To Ft. in. in.
From________ From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Sim Material
From To Ft.
From To Ft.
Crt
• y I
FY THAT THIS WELL WAS CONSTRUCTED TN ACCORDANCEC�WITH ISA NCAC 2C, WELL
PP
ARDS,AND THAT ACOFTIES RECORD GHASBEEN PROVIDED TOTHE WELL O�I
•
SIGNATURE OF PERSON CONSTRUCTING THE WELL
GROUNDWATER SECTION
o the Division of Water Quality, Groundwater Section, 1636 Mall Service Center1 -Ralelp
27699-1636 Phone No. [phone], within 30 days. OWREV. Of

259823
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and)? Resourc Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Pi((Ich IQ Al L "',_�(d -\ tee) E LW—, /� CERTIFICATION a it 53
WELL CONTRACTOR COMPANY NAMELt_�hr tJ f a, 1 d1 well I Yl!' IN et 1—(—Nv PHONE / 014 .-1S f -35S
STATE WELL CONSTRUCTION PERMITS ASSOCIATED WQ PERMITS
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential DMtmicipaUPublic 0 Industrial ❑ Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATIO : ' / /
N st Town: -e - u-C
County .seinvi----
'jA.:Ilse r'4"
(Street Name, Numbers, C on unlry, SS,((ubd(vianas, Lot No, Zip
3. OWNER: W4W-4'J'l �
Address S) i?ar<1. �i 1Me�.+t ;it
eau (s. ce Route No,) ?—ftK 77
City or Town State �/I Zip Code
9)- ,,vvS-6/97—
Area code- Phone number
4. DATE DRILLED L.� LR ✓o 7-/� Ge'-
5. TOTAL DEPTH:.
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 0
7. STATIC WATER LEVEL Below Top of Casing: C/ FT.
(Use's' if Above Top of Cuins)
8. TOP OF CASING IS
FT. Above Land Surfaces
"Top of cuing terminated at/or below bud surface regains ■ 1.
variance In accordance with 15A NCAC 2C .0111.
9. YIELD (gpm): 3 METHOD OF TEST
10. WATER ZONES (depth):
11. DISINFECTION: Typei4 / :ems
12. CASING:
Depth
+
From To
From To FL
From To FL
13. GROUT: Depth
From_a_ To Z/) Ft.
From To FL
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK
Depth Size Material
From To Ft.
From To Ft.
FL (o
irter
Material
Amount
Wall Thickness
or Weight/FL al
II 2. �c�
Medved
Slot Size Material
in.
in.
46., tEmArticS:
L� .' LL
I DO HEREBY CERTIFYITHAF
CONSTRUCTION STANEAR�B
w
0
Topographic/Land setting
'Midge ❑Slope ❑Valley ❑Flat
(cheek appcoptiare box)
Latitude/longitude of well location
(decerLeimmehecoods)
Latitude/longitude source:❑GPS❑Topographic map
(chat box)
DEPTH DRILLING LOG
From To Formation De icription
<n
_,-1
LOCATION SICETQJ{
Show direction and distance in miles fronrat least,
two State Roads or County Roads. Include
numbers and common road names.
0
0
THIS WFr I WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO 7J-IE WEL}.OWNER.
SIGNATURE OF PERSON CONSTRUCTING THE WELL
road;:
c
DA'
__ _
Sn o i'the O'rlg'6L1 i' the DMslon of Water Quality, Groundwater Section, 1636 Mali Service Center - Raleigh, NC
27699-16:S6Phone No (419)73:0-3221,within30days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment andeiN rOII_Resourc` Division of Water Quality -
WELL CONTRACR(INM
DIVIDUAL)NAG(Prtat) FUh•P t✓ "i I LL, E
WELL CONTRACTOR COMPANY NAMEfi"Uhe rat Ca' )r! wcil I J17(tl`4 +—(-
259884
Groundwater Section
CERTDPICATION a /5_3 7
PHONE a C r.5 V •35S
STATE WELL CONSTRUCTION sERMITs ASSOCIATED WQ PERMITS
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential Cd' Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCAT
Nearest Town:
County-c"rrei—•-
(Street Name, Numbers, Community, Subdiviaim, lot No, Zip Code)
3. OWNER: (—erS
Address if / 1 .. no c htV el,at�
(Stret
Drift A c.No.) 7 ,5
City or Taw Suite Zip Cods
(tLCfl- 23 c — N-sLfc &-
Ara code- Phone Dumber
4. DATE DRILLED g/&')JO 2-
5. TOTAL DEPTH: 9 of f
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 0
7. STATIC WATER LEVEL Below Top of Casing: /RP FT.
Wm '+' if Above Top or Casing)
8. TOP OF CASING IS ' FT. Above Land Surface'
'Top of castes terminated attor below Ind surface requires a
variance to accordance with 15A NCAC 2C .OIU.
9. YIELD (gpm): 52 METHOD OF TEST
10. WATER. ZONES (depth): '7 /G' - l
q;20 - /
11. DISINFECTION: Type/t• 9`r/'S Amount,rzf&Qs'
Wall Thickness
Depth Diameter or Weight/FL
From+ To t'Si FL Zo
From To Ft.
From To Ft.
13. GROUT: Depth
Frorr(_to___ To '2-0 Ft.
From To Ft.
14. SCREEN: Depth Diameter
Front_ To Ft. in.
Fron To Ft. in.
15. SAND/GRAVEL PACK
Depth
From To
From To
12. CASING:
16. REMARKS:
Topographic/Land setting
Mudge 0Slope ❑Valley ❑Flat
(cheek appropriate box)
Latitude/longitude of well location
(dtoed/mimJt& meds)
Latitude/longitude source:❑GPS❑Topographic map
(etaxic box)
DEMI DRIf.1.ING T.00l
From To __ fprmatign Descri3jion
41
(-74l
J ()CATION SKETC}{
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
i5 CjEIBJTI RAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
CONSTRUCTION ARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
u 1:14 r Imo 9(2-770 7_
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
GR09kNW (N1e9('O:19Alto th Division of Water Quality, Groundwater Section, 1636 Mali Service CGVerl REV Raleigh,
NC 1
ASP E\9� en46D(dt`Ntio0fNNE(919)733-3221, within 30 days.

259902
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment Mand blahualResource .-DDvvision of Water Quality - Groundwater Section -/
WELL CONTRACTOR (INDIVIDUAL) NAME AP U()/IP J c --.S ' C L��,/� CERTIFICATION. /5-3 /
WELL CONTRACTOR COMPANY NAME pc-IAi)PN ( -[I' Iri WCIl ' I 211(\N� t—LNt PHONE a jgl1 a 3.58 /
STATE WELL CONSTRUCTION PERMIT. ASSOCIATED WQ PERMIT'S
(if applicable)
(if applicable)
I. WELL USE (Check Applicable Box): Residential'❑ Municipa1/Public 0 Industrial 0 Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection ❑ Other 0 1f Other, List Use
2. WELL LOCATI02)1:
Nt�(est Town: 4141t-41 •CC�[� `County 04-4-4-`trith-Q—
i j,24,24,
(S`beet N e, Numbur, Community, Subbdiviuoo, Lot No., Zip Code)
3. OWNER:Cber5 �7��L. Ter
�
,
Address l% /✓ ¢:
l�LS -Pr /V,"
i
�} ?�31 - S" rp 2- -.5
4. 9,` to
1ti�.t,,4. ?� 7f7
,fity or Tail Zip Code
Ann code- Phone nwnber /
DATE DRILLED j i/`
5. TOTAL DEPTH: / D p .
6. DOES WELL REPLACE EXISTING WELL? YES 0 NOt� /� -0.
7. STATIC WATER LEVEL Below Top of Casing: 3 FT. 4�T* n
(Use "+" if Above Top of Casing) /y�U
8. TOP OF CASING IS � FT. Above Land Surface*
'Top of cuing terminated at/or below iced surface requires •
variancelu accordance with I5A NCAC 2C.0118. nn ,,
9. YIELD (gpm): )T4? METHOD OF TEST
10. WATER ZONES (depth). SS' 0 t 3
11. DISINFECTION: Type
¥ o -3?
✓, /Fi . Anwunt.:-i p t / / 5
12. CASING: Wall Thickness
Depth
From_ To
From__To
From To
13. GROUT: Depth
From /7 Tom— FL
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
From To Ft.
From To Ft.
Ft G
eter
FL
F,
or Weight/Ft. Material
Material
L ()YlylitZ—
Material
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(theck appmpti• a box)
Latitudellongitude of well location
(degreulmimtTM+/sec'oods)
Latitudellongitude source:❑GPS❑Topographic map
(cheat box)
DRILLING LO(i
Q Formation Descriptio
From
=,
/ - 0 Crtu-rr 0
z 2.-t ,t/., < 3
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.
THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
AND THAT A COPY OF THIS R):CORD HAS BEEN PROVIDED TO THE WELL 0 R
O
ry
SIGMA ERSON6C UCTMGTHEWELL 'ATE L
e Division of Water Quality, Groundwater Section, 1636 Man Service Center - Raleigh, NC
f't33rk221, within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment amp" ResourcDivision of Water Quality - Groundwater Section %
/
WELL CONTRACTOR (INDIVIDUAL) N. (priatt) f Uct) IP nl d I�l w L _ CERT WICATION a
WELL CONTRACTOR COMPANY NAME 'LL be ( (P )ti Wt!1 1 -.1 ( IN Ej t--I— /C PHONE IS 01/1 S5L •3.5S
STATE WELL CONSTRUCTION PERMITY ASSOCIATED WQ PERMIT/
(if applicable) (if applicable)
260069
1. WELL USE (Check Applicable Box): Residential CT Municipal/Public ❑ Industrial ❑ Agricultural 0
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCAT(DN:
N• Town:.Nt1
County 1 A -✓t-n'
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
ff���_
3. OWNER: »& e 5
Address l q
�dl (Street� qode Ne, t
�"� et N. z. F' 7 5
City a Town State Zip Coda
e'n- '2-3 ° - nie
Am code- Phone number
4. DATE DRILLED g/& /40 y
5. TOTAL DEPTH: 944r
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 0
7. STATIC WATER LEVEL Below Top of Casing: /. P FT.
I (Use"+" if Above Top of Cuing)
8. TOP OF CASING IS FT. Above Land Surfaces
'Top of cuing terminated at/or below Ind surface requires a
variance In accordance with 15A NCAC 2C .011a.
9. YIELD (gpm): �2 METHOD OF TEST
10. WATER ZONES (depth): '7 /t -
q — 7/-fl
11. DISINFECTION: Type Art.. fl, Atnount� r�/ckfl>
12. CASING: Wall Thickness
or Weight/FL
Deplb Diameter
Fro mDTo C7g' Ft. lis
From To Ft.
From _ To Ft.
13. GROUT: Depth serial
From.. To '7 n Ft. C- -77"e'=
ve-
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(
RPM etrit
CONSTRUCTION S
SEP 2 3 2002
GROIg8httrat66 APS1 to th
ASHEVI.. • ?, „! s.,,
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(cheek appropriate box)
Latitude/longitude of well location
(dep eahni tree✓second/)
Latitude/longitude source:❑GPS❑Topographic map
(cheek box)
DEPTH DRILLING LOf}
From To FrrmatignMatti 'on
L
.t i (-10411
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 THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
a S, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
tadLLI,v, 9(2.77c 7-
-SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Division of Water Quality, Groundwater Section, 1636 Mall Service Center -Raleigh, NC
733-3221, within 30 days. GW-1 REV. 07/2001

258796
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and n Rel source(`pJ'DDiv� ision of WateQuality - Groundwater Section
WE
to E
WELL CONTRACTOR CONTRACTOR (INDIVIDUAL)
NAME IA ben/ ( m,�ri well (n I —l—t`i��' PHONE , jgki SS /
STATE WELL CONSTRUCTION PERMIT/ ASSOCIATED WQ PERMIT/
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential a Mtmicipal/Public ❑ Industrial 0 Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATIO
Nearest,Town:
(St9'Name, Numbers, Community, Subdivision, Lot No, Zip Code)
(/.2
3. OWNER: 72; e€d 4' 1
Address ��f
Lt/Gi (S �ta No.) 3 r eet t
2t State /v039 Zip coda
Area code- Phone number
4. DATE DRILLED 02
5. TOTAL DEPTH: o,
6. DOES WELL REPLACE EXISTING WELL? YESC NO 0
7. STATIC WATER LEVEL Below Top of Casing: 76, FT.
(Use "t' if Above Top of Cuing)
8. TOP OF CASING IS / FT. Above Land Surface*
`Top of casing terminated at/or below Laid surface requires a
variance V accordance with ISA NCAC 2C .0111.
9. YIELD (gpm): 2-0 METHOD 9F TEST
10. WATER ZONES (depth): a 2 0
11. DISINFECTION: Type
12. CASING:
I // Depth
From ' To /a. FL
From//7To FL
From To FL
13. GROUT: Depth
From_ To 7O Ft. O?/
From To FL
14. SCREEN: Depth Diameter Slot Size
From+ To Ft. in. in.
From_ To Ft. in. in.
15. SAND/GRAVEL PACK:
Dept Size Material
From To Ft.
From To Ft.
p E. resWt
1 DO HEREBY CERTIFY
Amount
Wall Thiclmess
or W7 VFL Iy1}terytl
ti
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
&beds appropriate box)
Latitude/longitude of well location
(degoea/miovualaemods)
Latitude/longitude source:❑GPS❑Topographic map
(clack box)
DEP QRJLLING LOG
From To „ ti , De
)C
JIATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road s.
CD
tV
THIS WFI 1 WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL O
CONSTRUCTION STAND i, AND THAT A COPY OF TH1 RECORD HAS BEEN ROVIDED TO WELL O
`
AUG 3 0 2002 i .you%9 22i1
DATE
SIGNATURE OF PERS TRUCICT TNG THE WELL. cr _—.
O m--
GROUNDWATER SECTION aDivisionofWaterQuality,GroundwaterSection,1636MailServiceCenter-Rileiglt,¢iC
AS27699- stanitinal PA 636ThoneNo.(919 GW-1 REV.07,20010
27699-1636 Phone No. [phone], within 30 days.

259903
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME Ant REUBEN CALDWELL
(print) CERTIFICATION Y 2140
WELL CONTRACTOR COMPANY NAME REUBEN CALDWELL DRILLING, INC. PRONEY7f8 1254-3581
STATE WELL CONSTRUCTION PERMITS/ 1537 ASSOCIATED WQ PERMITS/
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential f ' unicipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION: ( I
rest Toww)sj e.tt 414. County��� r> t
rr .e. 4
(Street Name, Numbers. Community, Subdivision, Lot No., Zip Code)
3. OWNER: ! eit't - C Y
Address teas,_, , ! IVC�
(Street or Route No.)
City or Town State Zip Code
(124)-777- /04'f7#
Arm coda Phone number/ /
4. DATE DRILLED 8:tJ/i3 ��
5. TOTAL DEPTH: <1.ZS"
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO 2'
7. STATIC WATER LEVEL Below Top of Casing: �% S4 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 ■
variance In accordance with ISA NCAC 2C.0118. n r
9. YIELD (gpm): �'o METHOD OF TEST 4 -7--
10. WATER ZONES (depth): ?;D r L� /
1 I. DISINFECTION: Typef
12. CASING:
m / Dop Diameter
/./.2
Fro / To � Ft. Cv
From To Ft.
From To Ft.
13. GROUT: Depth
From '=� To 2_ Ca
From To
14. SCREEN: Depth
From To
From To
15. SAND/GRAVEL PACK
Depth
From To
From To
RffC�HEREBY CERTIFY
CONSTRUCTION STAND
rirc
S:
r °02
0 i Lu
y0�yqy� ATE' SECTION
A P9REE"P4E411 r. a �1(ORM Divi ion of Water Quality, Groundwater Section, 1636 Mall Service Center - Raleigh, NC
crow-Ib3a Phone No. [phone], within 30 days. GW-1 REV. 07/2001
'�''.- "T c'_. Amount , R
Wall Thickness
or Weight/Ft. serial
0zJ
Material 1
Ft.
Ft.
Diameter
Ft in.
Ft. in
Slot Size
in.
in.
Size Material
Ft.
Ft.
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degre&mioutes/scconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
Formati
DEPTH
From To
n S/.1 S
er'if`
//J1v /v
irf�+lt
LOCATION SICETCF[
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
fzt A l tiN <:
1S WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
.11,-t--11., seytio ').
IGNATURE OF PERSON CONSTRUCTING THE WELL DATE

258571
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment andhlatwal(Reaourentj Division of Water Quality - Groundwater Section 7
WELL CONTRACTOR (INDIVIDUAL) NAM� (prt tt) /'F1/1. JP t� \-,A-1�11w LL CERTIFICATIONa
WELL CONTRACTOR COMPANY NAMEte Li V eIV ( P A W(II "`'t ('I t--L PHONE a jS�U{351- -355
STATE WELL CONSTRUCTION PERMIT, WQ PERMITS
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential El/Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery ❑ Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION: AA
Nearest Town: I t �L- -a/te , r CO (, County Oeaz /�� eyk
{
(SnedName,
''Numbers, Community, Subdivision', Lot No, Zip Code)
P�
3. OWNER: 44--"Y11 n .t t `) } ar a 1 e
Address 17 2 7Zrra-s4 r
Street or Romallo.) / rf 7
State tip Code
f' iS • .9 -
Area cods. Phone number
4. DATE DRILLED */t 7 / 2_
5. TOTAL DEPTH: 2- 7 S
6. DOES WELL REPLACE EXISTING WELL? YES NO 0
7. STATIC WATER LEVEL Below Top of Casing: 1%a ET.
(Um '+' if Above Top of Casing)
8. TOP OF CASING IS FT. Above Land Surface'
`Top of casing terminated allor below lad urfacs requires a
variance In accordance with ISA NCAC 2C .011 L
9. YIELD (gpm): 2 ° METHOD OF TEST ./N., 47
10. WATER ZONES (depth): / R q' - , 3
11. DISINFECTION: Type “TA ?0,- Amount / f,/i
12. CASING: Wall ThicknO17
Depth Diameter or Weigbt/FL Material
Fromm L_To 11 Ft. /O ,?..'./ ?dr.
From To FL
From _ To Ft.
13. GROUT: Depth
From To 7
From To
14. SCREEN: Depth
From To
Fron(_ To
15. SAND/GRAVEL PACK:
Depth
To
To
vf1/Iides12
CityaT
From
From
16. REMARKS:
DEPTH
From To
Z 7
'a •/ " i
/U
145 -2(n0
7 /60
1Co /7 -1"2C
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(rhea appropriate box)
Latitude/longitude of well location
(degre dmiaaed,soodr)
u
Latitude/longitude sace:❑GPS❑Topographic map
(check tor)
DRILLING LOG
Formation Description
1c
Coil /4aa%�
)aCATION SKETCH r�
Show direction and distance in miles from atieatt
two State Roads or County Roads. In a the road
numbers and common road names. _ "1 p
P
Material shod D
O Ft. : %%/1 /."` 6 _
FL
Diameter Slot Size Material
Ft. in. in.
Ft. in. in.
Size Material
Ft.
Ft.
ti
HEREBY CER1FYd NAT
$1 RUC I ION b I ANDARDS,
J
u Li -
Submit she origimsktupep! Ion
27699 1636 ithaie.Np• 01911884221,
WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
T A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WFI T OWNER
s
TUBE OF PERSON CONSTRUCTING THE WELL BATE
d Water Quality, Groundwater Section, 1636 Mall Service Center - Raleigh, NC
vRhin 30 days. GW-1 REV. 07/2001

261876
WELL CONSTRUCTION RECORD
North Carolina Department of Environment an�Wural Resourot Division of Water Quality - Groundwaterrat'Section
PHONE / J ' 0.5 it '3.58 /
o aroi
- WECOUAL)NA5(mnt)R /, c'i C` t ---•- I/'CERTIFICATION IS3 /
LL CONTRACTOR MPA a'Iri well Y(
STATE WELL CONSTRUCTION PERMIT/ ASSOCIATED WQ PERMIT*
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential 0 Municipal/Publtcp Industrial ❑ Agricultural p 7
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other If Otha, Use -R /1 / /L�1m /✓
�t}�� Wst �2 i 1 s� p �( 1D..i /< /4/G W/freC
2. WELL LOCATION: ; TopographiefLand setting
NearestaTown: u�iu0 , County o cores-e ❑Ridge ❑Slope ❑Valley ❑Flat
itid\1 P,\.0AnrtCCCPP/ 5, (clackappropriste box)
(Street Name ben, Community, Subdivision, Lot No., Zip Code) n /(l Latitude/longitude of well location
3. OWNER:a-pet / iQK ,rlyd . .1^¢ ¢tea (dao «�)
Address �29 Al /1 read,/ nit- Latitude/longitude source:❑GPS❑Topographic map
- (sate or Route No.) (cback box)
C' or Town Stan Zip Code / From To Formational escription
26ca - 27// 'XI- ,.o / Z 6-4eff A9 = z . _
Arta coder Phone number / Ale ej�
4. DATE DRILLED 8/`b/D 2—
5. TOTAL DEPTH: 3r20++
6. DOES WELL REPLACE EXISTING WELL? YES NO ❑
7. STATIC WATER LEVEL Below Top of Casing: /c/ FT.
(Use "+^ if Above Top ofCoifing)
8. TOP OF CASING IS / FT. Above Land Surfaces
'Top of casing terminated at/or below lead surface requires a
variance In accordance with ISA NCAC 2C .011a.
9. YIELD (gpm): In METHOD OF TEST
10. WATER ZONES (depth): / a a - / O / LOCATION SKETCH
/6,o' ID ton /oi
11. DISINFECTION: Type -2-b c ' o Amount 2. Show direction and distance in miles from at least
12. CASING: NT it' �f D Wall Thiclmess two State Roads or County Roads. Inc*nde the road
,,1- (th Dieter or numbers and common road names. ;-„
From't 1— To S. Ft. L C'-� A) c i
From To Ft.
From To FL
13. GROUT: Depth %� et-h.o'd`�n/I/�
Fro.., To Ft. G""��vli `�� - 1 S%...:..._r ��
From To Ft. � �?
Diameter Slot Size Materia) (•% f - N %e,j4
.7---:
�
/d 0 - ZPd
Ati 7-AC.
14. SCREEN: Depth
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size
From To Ft.
From To Ft.
ritar
UCTION ST1 2002 /
GR VSUblOWC SECI(Q �o the Division of Water Quality, Groundwater Section, 1636 Mal Service Center - Raleigh, NC
ASHEV2U69-ibm GW-1 REV.07/2001
27699-�733-3221, within 30 days.
in.
Material
cST
T THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I SA NCAC 2C, WELL
)S, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNAf�9F PERSON CONSTRUCTING THE WELL DATE rL�

258798
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and_Natural Resource(3. Division of Water Quality - Groundwater Section
S3 7
WELL CONTRACTOR (INDIVIDUAL) NAM5(prlat) RP L/ \
I.P rJ \ "a I3\ L � CERTIFICATION 0
WELL CONTRACTOR COMPANY NAMEel( hen/ Cat 1ri we(1 7 Illl`i� 1-1-
PHONE I PAki d51-.358 /
STATE WELL CONSTRUCTION PERMIT', ASSOCIATED WQ PERMIT',
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ❑ MunicipalPublic ❑ industrial ❑ Agricultural ❑
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
•
Nearest Town: () Ji County (-) he 3 M
I 4-1 e' hcaq �25�
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: 4.ed 8)�,.e. e()l P'7
Address / K '�4J t 4/kg
(Street ot RewJ No.)
xv/,a t;et� u - 2— E r3
City or Town S L g, %p Code
Z3 I
Arm coda Phone number
4. DATE DRILLED is //6 , 0 —
5. TOTAL DEPTH: £Jr 7/ S'
6. DOES WELL REPL.(CE EXISTING WELL? YES 0 NO 0
7. STATIC WATER LEVEL Below Top of Casing: 3 ?- FT.
(Use "+" if Above Top of Cuing)
8. TOP OF CASING IS / FT. Above Land Surface'
'Top of cuing terminated actor below land surface regains •
variance le accordance y�1��1aISA NCAC 2C .0111I. A
9. YIELD (gpm): `dY1 METHOD OF TES �i /.—
10. WATER ZONES (depth): / P D — Z & e-Aki
11. DISINFECTION: Type f r / tmt /,
12. CASING: Wall Thickness
�/� / Depth Diameter or Weight/FL Materi numbers and common road names.
From4L_To Ste FL___C,F__ Jr2, / "_S�. JP-,•vcr-
FromTo FL y y/ r'c
From Deo FL ---Cc-----------od �,av�
13. GROUT: Depth Material
d7 To '2-0FL reFiti Mt .
From To Ft. Dyry-
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK a,
Topographic/Land setting
❑Ridge ()Slope ❑Valley ❑Flat
(cleat appropria0e box)
Latitude/longitude of well location
(eepem/miui2sls«reds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
Formation Description
DEPTH
From To
— �.
37- 5es.
Tom. - / (Q
/ tea '.11(AiC
G
1�
UG 3 0 2^32
BY CERTIFY THAT THIS WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
THAT
A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE OWNER
i
EGI'`JAL OFFiCE
SIGNATURE OF PERSON
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mall Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001
Material
J OCATION SKETCH
Show direction and distance in miles froIn{9lleast_
two State Roads or County Roads. Include`t3e road
c�
2-
CONS11& GTHEWELL DATE

258569
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment a4Natural Resou/rcetp Division of Water Quality - Groundwater Section 3 7
WELL CONTRACTOR (INDIVIDUAL) NSW (prim) /\F/LLI(i).e 11/4l ";�4 Li" to L.L.. CERTwICATION i 3.y7 8 /
WELL CONTRACTOR COMPANY NAMED' u be ni ( fr l � W e 1I I Y1111(`l � t--1- PHONE e f +1)'{Si.5 Y-
STATE WELL CONSTRUCTION PERMIT. D WQ PERMITS
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential�Mumicipal/Ptlblic 0 Industrial 0 Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATIQ : ty , t� �� b 4,Nearest Town: /� r ll CQ
'14 4 fin UJ (n t 1��
(Street Nun0. Nurnberg, Community, Subdivision. id No. Zip Code)
3. OWNER: 10sd t N. A ‘ 2
Address 19 it ss !+ m tki < 1,
City or Town _ State Zip Code
( } logy 3o3S
Ara code- Phone number
4. DATE DRILLED Y I "I) 0 1_
5. TOTAL DEPTH: n h
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO 0
7. STATIC WATER LEVEL Belo NaTop o fCasing:Above ofFCaine) FT
8. TOP OF CASING IS ( FT. Above Land Surface'
'Top of wing termlaated at/or below lad ..dace regalrn a
variants V accord �� am with ISA NCAC 2C .0111. <'
9. YIELD (gpm): CA METHOD OF TEST R
10. WATER ZONES (depth): 2 0 µ - !p q i n.1
11. DISINFECTION: Type fk - cI n Amount -1 P`,:. ,
12. CASING: Wall Thiess
Depth Diameter or Weight/FL Material
From t Tom 2 FL U ,11• e ( ta 0C....
Front_ To FL
From_ To FL
13. GROUT: Depth
From_i. To_21 FL _P r)h P A/ l
From To FL
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:
p00((FIERE,B��jjCEI('TIF1' THIS WEII WAS CONSTRUCTED IN ACCORDANCE WITH1SANCAC 2C.WELL
TR
U1f 1 tori RRU61'ION,STA}LD .AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO WALL
Lf v [�J /r J a////
SIGNATURE OF PERSON CONSTRUCTING THE WELL
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑F1at
(dedt &myop ias box)
Latitude/longitude of well location
oagreedmiomnheenoad
Latitude/longitude soumce:❑GPS❑Topognphic map
(chock
DRILLING I.Gr
Formation Description
DEEM
From To
6 - '3eD
y z_? 0 •// ai trt
0
Q ` :415
r �
i"e_el es•lt/it
J.00ATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
)7'
11 H
N
i
Submit the original to tie Dlvblon of Water Quality, Groundwater Seetion, 1636 Mali Service Ceenter1 RREV gb. NC 1
2 699-kta4-rgonent-i 1/) 733-3221, within 30 days.
.. C'FHCE

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and), Resou/rce,.
Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAML>(priaat) t ucl)PN /\'tea (11w F 1—LcERTIFtcATIONa/5-
WELL CONTRACTOR COMPANY NAME f e LLi3P Al ea, id Wei/ I Y1I11N t-N�/�--� PHONE a PA Uis15-3.58 /
STATE WELL. CONSTRUCTION PERMIT/ ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
261875
1. WELL USE (Check Applicable Box): Residential CrivitmicipaUPublic 0 Industrial ❑ Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town:
�, ss '' Topographic/Land setting
County t"��'"`e^"�a❑Ridge ❑Slope ❑Valley ❑Flat
rLect tox
( Namc, Nuen, Community, Suvidoq No., Tip Code) Latitude/longitude ofwell location
3. OWNER: �JL�
Address Srr S
fStreet ar At 7 ?rat
4
lry.7 Si-_& / Cade
A
Area code- Phone gum
4. DATE DRILLED
5. TOTAL DEPTH:
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 0
7. STATIC WATER LEVEL Below Top of Casing. FT.
also --en if Above Top of Cuing)
8. TOP OF CASING IS / FT. Above Land Surface*
*Top of wing terminated at/or below lad surface requires a
variance he accordance,with ISA NCAC 2C .011a.
9. YIELD (gpm): n METHOD OF TEST
10. WATER ZONES (depth):
Wald
11. DISINFECTION: Type iff4/ C) Amount /
12. CASING: Wall Tbirlaess
FromDepth _ i;t L
_ To Z`? FL z
From To Ft.
From To Ft.
13. GROUT: Depth �tatuul 1e dd a
Fro11t_�To Z© Ft. CP.-hI,Set s,
From To FL
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.
(demo s/miutmtwsmds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
pj DRILLING LOG
From To Formation Description
2t — 2-7
7— 70
JK)CAT1ON SKETCH
j',Show direction and distance in miles froth at least
two State Roads or County Roads. Inclu the road
_Tnumbers andmmon mad names. t\
viisreH
From
From
16. REMARK
RE C
D
OC
CUL
CONSTRUCTION S
VI\ \�`��• 1 7D
T THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
S, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL ATE
GROr' "6goi=altot
ASHEVIIA1F910:40 101AFa` gi. 9
4.
Division of Water Quality, Groundwater Section, 1636 Mall Service Center - Raleigh, NC
733-3221, within 30 days. GW-1 REV. 07/2001

258572
WELL CONSTRUCTION RECORD t North Carolina - Department of Environment an�atural(Resourc` - Division of Water Quality - Groundwater Section
/
WELL CONTRACTOR (INDIVIDUAL)NaM5(Prt.t) AeuchhP r✓ \-41-1�w F LLi--CERTIFICATIONa o
WELL CONTRACTOR COMPANY NAMEf V"U hest Orr hi well +'-J( N L ,.a_Nt Mon a tbi as 358 /
STATE WELL CONSTRUCTION PERMIT'S ASSOCIATED WQ PERM[Tf
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential Gil'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:
County I'•" AL
With C4 ap. g/nrfe29CNue .
(Street None. Numbers, Ccenmunity. Subdivision, Lot No., Zip Code)
3. OWNERiL,
Address
M 4 !-*V g
/r?Route No
(ram t), h k 7 _ g 7 2- 5 Zip Code
Area code- Phone number
4. DATE DRILLED Rl9(1)
5. TOTAL DEPTH: Z 0 5
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 0
7. STATIC WATER LEVEL Below Top of Casing: it 0 FT.
/ (Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface'
`Top of cuing terminated at/or below Ind surface requires ■
variance In accordance with 15A NCAC 2C.0118. {1 ,
9. YIELD (gpm): 10 METHOD OF TEST tS ((r'.
10. WATER ZONES (depth): t- 9 D
11. DISINFECTION: Type, q 6 tAmount
12. CASING: Wall ThicknC7s
Depth or Weight/Ft.al
r., w°i J
From To
From To
From To
13. GROUT: Depth Material Method
From To Ft.
From To FL
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.
Diameter
FL
FL
FL
16. REMARKS:
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check wptopdate box)
Latitude/longitude of well location
(dav seeeass)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
-
Ca - 2_(
'2 '1 �> Q>
.a_tin
fi
LOCATION SKETCFI , =
Show direction and distance in miles frotmat least
two State Roads or County Roads. Incluthe dad
numbers and common road names. c-> ' r
N
CO
WY
NSTI� BYty ST
VCNATURE OF PERSO
IS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
ND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
A
CONSTRUCTING THE WELL
Submit the original to the Divis a n of Water Quality, Groundwater Section, 1636 Mall Service Center - Raleigh, NC
27641Ef&36TIWS6NoE(9I19Nf33-322I, within 30 days. GW-1 REV. 07/2001
FEGiCiNsL OFFICE

4 Amount / f
12. CASING: Wall Thiess
DDyye� or Wei t/FL al
Frorr _ Tom— Fir r�
th
From_ To Ft.
From To Ft.
13. GROUT: Depth
From_.,_ To Ft.
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From_ To Ft. in.
15. SAND/GRAVEL PACK:
Depth
From To
From To
ARKS:
r,
rytxil'tE12EBY C011TItir THD THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C. WELL
CONSTRUCTION STANUARCS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
DATE
258568
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and_NyurallIR�esourc Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NASA[ [print) f\t° (i 1P n 4 _11W LLa CCRTIFICATION• /537
WELL CONTRACTOR COMTANY NAME f'N' IA be Pi ( a' id WC!! ' � 'I't h � 1'"LOC rHONE a ( 1 d5 51 -358
STATE WELL CONSTRUCTION TERMITI ASSOCIATED WQ TIMID
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential Er/Municipal/Public ❑ Industrial ❑ Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATIO :
Nearest Town: iae
�Lo iL/ - a'(.,
(Street Name. Numbers, Commu)lny, Subdivision. Lot No, Zip Code)
3. OWNER: Rier.bistrOr.
Address -G c1.4441 c7ati.e.
(Street or Route .)
user. ,./ Air .2— e 7.??D
County_P4A .4-n4-
t try or Town State Zip Code
Area code-Moe
EDnumber /,7
4. DATE DRILLED
5. TOTAL DEPTH: O 5
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 0
7. STATIC WATER LEVEL Below Top of Casing: H-4' FT.
(Use "t' if Above Top of Cuing)
S. TOP OF CASING 1S / FT. Above Land Surfaces
aria c casingterminated
with
ah 15 below
NCA 2 .016n rega4es -
variance V accordance wits ISA NCAC 2C.OIIL
9. YIELD (gpm): METHOD OF TEST
10. WATER ZONES (depth): l n
11. DISINFECTION: Type
n / 4
Slot Size
in.
in.
Material
Topographic/L and setting
❑Ridge ❑Slope ❑Valley ❑Flat
(clerk appropriate box)
Latitude/longitude of well location
dep (eealmiram/aaonds)
Latitude/longitude source:❑GPS❑Topographic map
(chair(cbbox)
DEPTH DRILLING LOG
From To Formation Description
• 7 i7
ileare
r.I s.I y �"/rfie
.c 9,4-n I
0-1
J ()CATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Incle road
numbers and common road names.
� c7
Size Material
Ft.
FL j
P f \
J
0
SIGNATURE OF PERSON CONSTRUCTING THE WELL
csamiggiworiginaklo he Division of Water Quality, Groundwater Section, 1636 Mali Service CGWrI RBVgh, NC )1
° 'fit M656Flinn t Not (9t9) 731-3221, within 30 days
r-e

258570
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment anc21 Resourcatppivision of Water Quality - Groundwater Section WELL CONTRACTOR (INDIVIDUAL) NAP45(prlet) tc" Uch e \ CERTIFICATION /S3 /
WELL CONTRACTOR COMPANY NAMEf"Lt esnWC!I llN L -LAX- PHONE a 010
fay f '358 /
STATE WELL CONSTRUCTION PERMIT/ ASSOCIATED WQ PERMIT*
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential 0 Municipal/Public 0 Industrial ❑ Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCAT ON:
Nearest T,gvm: County
(Street Nun.c N
3.OW/Address Ocite
a
NEER: p
9-71
CitynT s�te3 ,Z 0
ofliz
Area coda Phone member
4. DATE DRILLED
AS J %
5. TOTAL DEPTH: t t•I .
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO tree-
7. STATIC WATER LEVEL Below Top of Casing: 1 /y( ET.
(Use'+' if Above Top of easing)
8. TOP OF CASING IS / • Ff. Above Land Surface'
'Top of casing terminated st/or below laud surface regains s
variance V accordance with ISA NCAC 2C .011S.
9. YIELD (gpm): METHOD OF TEST
10. WATER ZONES (depth): I t S 40 ?/4/1"--
/ Topographic/Land setting
ettil-, Midge ❑Slope ❑Valley ❑Flat
(check appropriate boa)
Latitude/longitude of well location
40-wi
(deveeNmiu6uhecandc)
Latitude/longitude source:❑GPS❑Topographic map
13 tit' I it b g (check box)
METH DRILLINOLOG
zip code Z 9 7�_S From To Formation Description
11. DISINFECTION: Type (`
12. CASING:
From'f') To Depth,
Fro Ft.
From T6 Ft.
From._ To Ft.
13. GROUP: Depth Material
From— To f
Ft. fFJtFK.,
From To FL
14. SCREEN: Depth Diameter Slot Size
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Matetial
To Ft.
To Ft.
:-i 4qo Amount z OX
Wall 7LicJm
« a
ass
Diameter
UFL _ r
Material
From
From
16 RFMARKS.
1 DOUr1RFr1V rJeit
CONSTRUCTION S
NC
LGCAT(ONSKETCH
Show direction and distance in miles from at feast
two State Roads or County Roads. Include ffiC road; C.
numbers and common road names. 0 1?e
'HAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
4RDS, AND THAT A COPY OF nu CORD HAS BEEN PR9VIDED TO TH� WELL WNER
SIGNATURE OF PE ON CONS
DATE
„R 0UStubrltitll@EWI hal to It e Division of Water Quality, Groundwater Section, 1636 Mall Service Ceenterl REV. Raleigh, NC
ASH E11lLtff69§.Qa& th®& & a.f91k)733-3221,within30days.

258567
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
T
WELL CONTRACTOR (INDMDUAL)NAM,1 • E(/(prlQnt)CERTIFICATION ,/ 6 3
A � N
WELL CONTRACT '
OR COMPANY NAME LUA 4�' PHONE a fTL1 —251-, '3 ,Yet
STATE WELL CONSTRUCTION PERMIT. ASS s IATED WQ PERMIT,/
(if applicable)
(if applicable)
1. WELL USE (Check Applicable Box): ResidentiaPOrMtmicipa1Public 0 Industrial 0 Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Neare*Town:
(S(rfEi Name, Numbest, Community, Subdivision, Lot No., Zip Code)
3.OWNER: .7X.Uta h1"1 CJ7p t ) Loft.
Address / E/ c e,? (°e*?Q Kb.
," 1�-� -� jsueetorRoute_ JJo.)
LOC_G1-Ortv0t//e NC.
City
Qor Town State
Ze 7j'7
Zip Code
Area coda Phone number
4. DATE DRILLED S
5. TOTAL DEPTH: 3 /O ❑
6. DOES WELL REPLACE EXISTING WELL? YES C�3 iNJ
7. STATIC WATER LEVEL Below Top of Casing: ,fig, FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
*Top of casing terminated at/or below laud surface requires a
variance la accordance with ISA NCAC 2C .01113.
9. YIELD (gpm): Lc, METHOD OF TEST A -
10. WATER ZONES (depth): 245'
County f -€—
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minuees scconm)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOO
From To Formation Description
S
2,4 - Z-4 C
Z.los, 3o6
LOCATION SKETCI-(
11. DISINFECTION: Type .1 T,F 90 7 Amount 3 ts7=3 Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads. Include tt soad_ 2
Depth Diametel or Weight/Pt. Aerial numbers and common road names. ND_
From,_To ZO Ft. 4v ie Yt� 7
From To Ft.
From To Ft.
13. GROUT: Depth
From To Z D Ft.
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.
16. REMARKS:
01ISOl301t S
II,
L'
t&IA,,,
Material
S WELL WAS CONSTRUCTED IN ACCO' a 1 CE WITH 15A NCAC 2C, WELL
4D THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THF WELL OWNER
47/ Ala,/
�GNATURE OF PERSON CONSTR CTING THE WELL
DA
0 2—
S bmit the original to the D vision of Water Quality, Groundwater Section, 1636 Mall Service Center - Ralekgh, NC
2 6 Phone 1gr4t9) 33-3221, within 30 days. GW-1 REV. 07/2001
rF

Area coda Phone number
4. DATE DRILLED 7
5. TOTAL DEPTH:
6. DOES WELL REPLA
7. STATIC WATER LEVEL Below Top of Casing: % f FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING 1S ' FT. Above Land Surfaces
'Top of cuing terminated Wor below Ind surface requires a
variance In aceordeace Ira ISA NCAC 1C .0111.
9. YIELD (gpm): METHOD OF TEST
10. WATER ZONES (depth): 1 "- O
LOCATION SKETCH — E
Show direction and distance in miles from at East
two State Roads or County Roads. Include the road
numbers and common road ttames. r \\
258797
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAM E (prtat) REUBEN CALDWELL CERTIFICATION if 214t?
WELL CONTRACTOR COMPANY NAME RF.UBEN CALDWELL DRILLING, INC. PHONE42j8 I254 -3581
STATE WELL CONSTRUCTION PERMIT/ 1537 ASSOCIATED WQ PERMITS
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential-H-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: tAZ- 4-UG'UI \\\ P County bo vet,
(Street Nurse, Numbers, Community, Subdivision, Tot No., Zip Code)
3.OWNER: /1'LI14-- Co
Address
(Street or Route No.)
City or Town State Zip Code
(rig} tip -If R'
L
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
E EXISTING WELL? YES 0 NO D / 2 _ / q
6-1 adag,
rrl
cn-
11. DISINFECTION: Type Amount
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
� Frorn� To_C Ft. to I e r Sr e
From To Ft.
From To Ft.
13. GROUT: Depth Material
From 0 To 2 0 Ft. Ceti_017t
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
-Method en
From
15. SAN4�GRA1a
E)I�A�C: At I
Depth Si
From To Ft._
From I PIG ? 0 Fl:
16. REMARK4:
1 in
Material
� n^ tkeml
GRnullP.A'eR SiC7lON
1 DO HEREBY tA.htbV}YETHATWEILIEWAS ONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A C PY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF RSON CONSTRUCTING THE WELL DA
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mall Service Center -Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

i7G85
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
REUBEN CALDWELL
WELL CONTRACTOR (INDIVIDUAL) NAME (print) CERTIFICATION/ 214Q
WELL CONTRACTOR COMPANY NAME REUBEN CALDWELL DRILLING, INC•PRDNE42(8 )254-358I
STATE WELL CONSTRUCTION PERMIT/ 1537 ASSOCIATED WQ PERMIT/
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential 0 Municipal Public 0 Industrial 0 Agriu�tural 0 )
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use ll I (-r+T) O +Y
2. WELL LOCAT.
Nearest Town:
N:
(L�
/7 Sf/iJram..,,7a-1 t t'eI
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER$gt
Address P( 3'r�lnurr J �( 'e /L 1t
f--7 (Street Route No.)) r.
ounty 13utaro
_city or Town State 21 Code
'I sr y — 7 7—zg '
Area code- Phone number
4. DATE DRILLED `//P�Q '2-
5. TOTAL DEPTH: 7 C
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: $9 FT
(Use "+" if Above Top of Casing)
8. TOP OF CASING 1S / 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): a— METHOD OF TEST IT/ C- .
10. WATER ZONES (depth): / - 611/2 - /Oo
/'-10 - 6 cs—
I1. DISINFECTION: Type 7, Amount
12. CASING: Wall Thickness
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/secoads)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
Formation Description
DEPTH
From To
0
_ /00 •
/,06 .
LOCATION SKETCFI
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road,
Depth Dieter or eight/Ft. Material numbers and common road names.
From / To -en Ft. ` Z/ r✓Le—
From To Ft.
From To Ft.
13. GROUT: Depth Material lethod
From /5 To g-O Ft. (°. . cz—tAr
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From_______To Ft.
16. REMARKS: I) 0.1 11 �k.ck `) Ph -."74
Submit the original to the D
G weLv; !tie 19)73
ASHEVILLE RLGIONAL. OFFICE
THIS WELL WAS CONSTRUCTED T1 AC
, AND THAT A COPY OF THIS RECORD HAS BE
SIGNSrURE OF PERSON CONSTRUCTING THE
LL
st• 7
5yv ZQ
0
LTJ
0)
0
(n
0
Ivision of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
3-3221, within 30 days. GW-1 REV. 07/2001
0

258573
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Na Resources
CALDDELLn of Water Quality - Groundwater Section / S3 7
RWELL CONTRACTOR (INDIVIDUAL) NAME (print) CERTIFICATION #
WELL CONTRACTOR COMPANY NAME REUBEN CALDWELL DRILLING, INC•PHONEV8 95 3581
STATE WELL CONSTRUCTION PERMIT',1537 ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential 94:unicipa1/Public ❑ Industrial 0 Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATIO
NearestTown:
D�fCounty
(
t Name, NGmben, Commuuunity, SSuubdivisi/. Lot No., Zip Code)
l3- 3. OWNER:AK r /i, FJ2Q
Address
(,qy�t or Rout No.)
r,e
City or Town
Wk DEPTH
Zip Code
Ara coda Phone Dumber /
4. DATE DRILLED 6�/ / 0
5. TOTAL DEPTH:
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: FT.
(Use "t" if Above Top of Cuing)
8. TOP OF CASING IS FT. Above Land Surfaces
*Top of cuing terminated at/or below land surface require a
variance In accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): METHOD OF TEST
10. WATER ZONES (depth):
11. DISINFECTION: Type
12. CASING:
Depth Diameter
From To Ft.
From To Ft.
From To Ft.
Amount
Wall Thickness
or Weight/Ft. Material
13. GROUT: Depth Material Method
From To Ft.
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVELPACK:
Depth Size Material
Front To Ft.
From To Ft.
16. REMARKS:
the
F 1d E
Topographic/Land setting
DRidge ❑Slope DValley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
From To Formation Description
p S9
CO —
LOCATION SKLTCF(
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common roanames.
e4
y��9�t,`Az-
THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A 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
]vision of Water Quality, Groundwater Section, 1636 Mall Service Center - Raleigh, NC
3-3221, within 30 days. GW-1 REV. 07/2001
GF"
ASH"'

256572
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
REUBEN CALDWELL
WELL CONTRACTOR (INDIVIDUAL) NAME (print) CERTIpFICATION * 214t?
WELL CONTRACTOR COMPANY NAME REUBEN CALDWELL DRILLING, INC. PRONE%B )254 -3581
STATE WELL CONSTRUCTION PERMIT* 1537 ASSOCIATED WQ PERMIT*
(if applicable) j (if applicable)
1. WELL USE (Check Applicable Box): Residential i3 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:
pNea stTo�yywn: ��ll _i• . t �'
Street Name, um`beCommunity, Subdivision, Lot No., Zip Code)
3. OWNER: /(4
Address
County� _
puce orR te o. f
it aU.l d1 ! --2--Sr 70
City or Town Sw�-Z Zip Code
- I d± - sJ 7 jo
Area code- Phone number
4. DATE DRILLED
5. TOTAL DEPTH:
DEPTH
From To
a — IS
/ 2_O
9ro - /Q-0
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 0 / - a - i 3 0
7. STATIC WATER LEVEL Below Top of Casing: FT. 2^
/ (Use"+" if Above Top of Cuing) J
8. TOP OF CASING IS ( FT. Above Land Surface* d Z hti }
*Top of casing terminated at/or below land surface requires a
variance In accordance with ISA NCAC 2C .0118. -
10. WATER ZONES (depth): !tr9. YIELD (gpm):Z METHOD OF TEST>l
. /
230 - ¶j - zr
11. DISINFECTION: Type -r $/ ` - 0 Amount 0--F,
12. CASING: Wall Thickness
Depth Di ter ocr lWeight/Ft. M rial
vC
Front. Tor t Ft. Y r-2_t
From To Ft.
From To Ft.
13. GROUT: Depth
From 0 To �0 Ft.
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.
16. REMARKS:
C4'
Material
Topographic/Land setting
DRidge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(depeulminuuy/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
Formation Description
,1
6-1
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. ,tyk
N
T THIS WELL VMS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
ARDS, AND S1{AT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
ISTRUCTING THE WELL
DATE
Submit the o'4 . to the Division of Water Quality, Groundwater Section, 1636 Mall Service Center - Raleigh, NC
ASHEVILIEE'�"RR{GGiSII,
GROU4iiieg{,Rk66Zyf, UFFIC`y.2 [phone], within 30 days. GW-1 REV. 07/2001

2,5R9?1:
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL corrrRAcroaOrrotYmuAL)NAME (print)REUBEN CALDWELL
CERTIFICATION # 2140
STATE WELL CONSTRUCTION PERMIT,/1537 ASSOCIATED WQ PERMIT/
(if applicable)
(if applicable)
WELL CONTRACTOR COMPANY NAME REUBEN CALDWELL DRILLING, INC•PNONE$2(8 )54-3581
1. WELL USE (Check Applicable Box): Residential 02 Municipat/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATIOj•I:
Nearest Town: aU.t,UDqu/be CountyJ3t)taitC
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER:A/44k 01t2 kiD&J
Address
(Streeter Route No.)
L(JNf�'L�'ai(e�
City or Town Zip Code
(Si- 7 ztaleE — % 2-z�
Area code- Phone number / D — .I
4. DATE DRILLED �/ � b %i 3 Z �7
5. TOTAL DEPTH: 4 /� , _
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO (� S
Vv
7. STATIC WATER LEVEL Below Top of Casing: FT. 15,E r
(Use ^+^ if Above Top of Cu�Q le,
Casing) / ••0
8. TOP OF CASING IS 1' 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): / /#METHOD OF TEST /Q/
10. WATER ZONES (depth): / £n — / 6-Pat
Topographi d setting
❑Ridge ope ❑Valley ❑Flat
(cbeck apprcpriate box)
Latitude/longitude of well location
(degreedminutes/seeoods)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
PTH DEDRILLING LOG
From To Formation Description
11. DISINFECTION: Typ
12. CASING:
Depth
From ± To J 7 Ft.
From To Ft.
From To Ft.
13. GROUT: Depth
From d5 To 7-0
From To
14. SCREEN: Depth
From To
From To
15. SAND/GRAVEL PACK
Depth
To
From To
16. REMARKS:
e �77E
`67e, Amount
Wall Thickness
or Weight/Ft. Material
rf2/ pvc
Diameter
Material
Ft. CeM.Pr
Ft.
Diameter
Ft. in.
Ft. in.
Iethod
Slot Size Material
in.
in.
Size Material
Ft.
Ft.
LOCATION SKETCF-j
Show direction and distance in miles from at least
two State Roads or County Roads. In Id tte malts;
numbers and co • on road names.o, fl o
ri) co
r rn
THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 1SA NCAC 2C, WELL
AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE LL OWNER
SIGNATURE OF PERSON.CONSTRUCTING THE WELL DA
pQ�I9�73
e DI
ASHEN1fli LLEE REGIONAL 1LE"
sion of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
i221, within 30 days. GW-1 REV. 07/2001

256322
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) REUBEN CALDWELL CERTIFICATION s 2140
WELL CONTRACTOR COMPANY NAME REUBEN CALDWELL DRILLING, INC.
PHONE£I%8 )Z54-3581
STATE WELL CONSTRUCTION PERMITS/ 1537 ASSOCIATED WQ PERMITI
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ❑ Municipa1Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCAT a :
Nearest To
13sJ
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER:li4ti S-4
� ress//we//,%1
(Street
• 1) v' e_
`'.riAlA,IV (Street or Rowe (Jo�
, (�l 2cf 7.7 0
City or Town State tip Code
OAS } Cs z 8, q tee,
Area code- Phone number
4. DATE DRILLED -7 4:9 4 Y
5. TOTAL DEPTH: /cp r
6. DOES WELL REPLACE EXISTING WELL? YES-f NO ❑
7. STATIC WATER LEVEL Below Top of Casing: FT.
(Use "+" if Above Top of Cuing)
8. TOP OF CASING IS / FT. Above Land Surfaces
*Top of cuing terminated at/or below land surface requires ■
variance In accordance with 1SA NCAC 2C .0118.
9. YIELD (gpm): 1 METHOD OF TEST 1? I
10. WATER ZONES (depth): ?
•
11. DISINFECTION: Type j irs Amount /
12. CASING: Wall Thi ess
Depth Diameter or Weight/Ft. Material
FrornL 4To te... Ft. l �L/ pY/P
From To Ft.
From To Ft.
13. GROUT: Depth Material ,Method
From ® To r ( Ft. Patti Cot- 1 iy, ....AS).
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.
6.-RE$Ai{�QS:�i `, r is , �;..,�
HEREBY CERTIFY THAT WELL WAS CONSTRUCTED IN ACCORDANCE WITH I SA NCAC 2C, WELL
NSTRUCTION STANDARIJ�, 41•1D THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO WELL OWNER
n ,2 i ayru/ 7 7 �6 �
1 SIG ATURE OF PERSON CONSTRUCTING THE WELL DATE
G OUNDWATER SECTION
SR WFVOICEoglgaIFal4p (IftIDfvisio of Water Quality, Groundwater Section, 1636 Mall Service Center - Raleigh, NC
s 1099-16.i6 Phone No. [phone], within 30 days. GW-1 REV. 07/2001
Topographic/Land setting
County Rtittrrel4t Rve ❑Ridge DSlope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH pRILLING LOG
From To Formation Description
/co
`D — ,to
�o-
1 - S
c 57-6 Pats
ry o
LOCATION SKETCH ` 2
Show direction and distance in miles front lea;;
two State Roads or County Roads. Include -the ist
numbers anll cgromjn road names.
tj m m�
C
IV
c-3

From/ v ✓ To ��" Ft.
From To Ft.
From To Ft.
13. GROUT: Depth Material Meth
From To Ft.
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.
256570
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME
(prim) REUBEN CALDWELL CERTIFICATIONS 2140
WELL CONTRACTOR COMPANY NAME REUBEN CALDWELL DRILLING, INC. PHONEYi8 1254-3581
STATE WELL CONSTRUCTION PERMIT# 1537 ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential 0 Municipal/Public 0 Industrial m-gricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use /Z73
2. WELL LOCATION: _
Nearest Town: 44'41e a "'r County Pudved (c__
�UOa�riG'� jr I/.D 421- 6ToA-e
(Street Name,
Numben, Community, Subdivision, Lot No., Zip Code)
3. OWNER:'Teez Stco
Address T&O -Mind/feat
1AJ ,a..., trecto<RoutNo.)
try or Town State
7 ) 6--- rO - 3
Arm code Phone number
4. DATE DRILLED
g'7R�
Zip Code
Za S f tv�I
v
5. TOTAL DEPTH: 5o r r
6. DOES WELL REPLACE EXISTING WELL? "YES ❑ O ❑
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 .0118.
9. YIELD (gpm): ? O METHOD OF TEST
10. WATER ZONES (depth): 3 /v.7 — Z.o a:, ie
Topographic/Land setting
❑Ridge 0Slope ❑Valley ['Flat
(check appropriate box)
t� Latitude/longitude of well location
M(r.5 th N (degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
From To Formation Description
Coin
aftG//pl4L (L'k((
DEPTH
9 5 - .5oS-
11. DISINFECTION: Type Amount le 03
12. CASIN1 Thickness
r Wcight/Ft. Material
16. • MARKS: 1
n 1e11-1-
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the
numbers and common road names. p
tV
bt e_et)/av
T TH • 1 AS N D�� E µ7rkPt C�2S
T IS WELL CO R CI% INACCORDANCE ISA NCAC WELL
S, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
uejefl (&
SIGNATURE OF PE�N-CONSTRUC I THE WELL TE v
ivision of Water Quality, Groundwater Section, 1636 Mali Service Center -Raleigh, NC
33-3221, within 30 days. GW-I REV. 07/2001

A922
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (pint)REUHEN CALDWELL CERTIFICATION 12140
WELL CONTRACTOR COMPANY NAME REUBEN CALDWELL DRILLING, INC•FHONE448 )254-3581
STATE WELL CONSTRUCTION PERMIT# 1537 ASSOCIATED WQ PERMITS
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential 0 Municipal/Public 0 Industrial ❑ Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATT:
Nearest Town• /3
,\12N1.1f,
(Street Name, Numbers, Community, Subd'v:ision, Id No., Zip Code)
3. OWNER:��LI /1!W �Cjta'/e
Address 77777
(Stsgutr Rowe No.)
County.
itir.
City or Town State Zip Code
(fag- b c/5' -/kayo
Area code- Phone number
4. DATE DRILLED
5. TOTAL DEPTH:
6. DOES WELL REPLACE EXISTING WELL? YES! NO 0
7. STATIC WATER LEVEL Below Top of Casing: Er FT.
(Use "+" if Above Top of Cuing)
8. TOP OF CASING 1S / FT. Above Land Surface*
Top of cuing terminated at/or below land surface requires a
variance In accordance wltb ISA NCAC 2C.0118.
9. YIELD (gpm):METHOD n JF TEST 7
10. WATER ZONES (depth): /
11. DISINFECTION: Type / rt/q ,3nount 3 E>3
12. CASING: Wall Thickness
From TowDepth
From To Ft.
From To Ft.
13. GROUT: Depth A,.( atcnal
From 6 To Z.Z2 Ft. t. 'l
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.
DEEM
To
EEM
c2 - t'O
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check ap xopriate bor)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
Formation Description
ry
c
LOCATION SKETCH ry
Show direction and distance in miles frorh4t least.-
two State Roads or County Ro:.. IncludJhe road;
numbers and common road
$
Ft.. -
n w r.:�
Outer or et_glt/ t MAtyr,
Slot Size
in.
in.
Material
From To - Ft.
16. REMARKS:
AUG 13 2002
he D
) 73
act ptet
go,
THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
, AND THAT A COPY OF IS RECORD HAS BEEN PROVIDED TO THE WE OWNER
SIGNXrURE OF PERSON CONSTRUCTING THE WELL D TE
lon of Water Quality, Groundwater Section, 1636 Matt Service Center - Raleigh, NC
3221, within 30 days. GW-1 REV. 07/2001

256571
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
REUBEN CALDWELL
WELL CONTRACTOR (INDIVIDUAL) NAME (print) CERTIFICATION w 2140
WELL CONTRACTOR COMPANY NAME REUBEN CALDWELL DRILLING, INC. PBONEY2f8 )54-3581
STATE WELL CONSTRUCTION PERMIT, 1537 ASSOCIATED WQ PERMIT/
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential D 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 own: i P C r s Mil—)Topographic/Land setting
County J' C o tt BC ❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
n C. . e) Latitude/longitude of well location
3. OWNER: e-1 // / /4-44/ 5 e
Address /
/ (Street or Route No.)
Gire• Air. 71 le 2--
q City or Town State Zip Code
(B a 7- e4—a44-97
Area code- Phone number
4. DATE DRILLED d.?/
5. TOTAL DEPTH:
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO ❑
7. STATIC WATER LEVEL Below Top of Casing: FT.
(Use "+" if Above Top of Cuing)
8. TOP OF CASING IS ' FT. Above Land Surfaces
*Top of cuing terminated at/or below land surface requires a
variance In accordance with ISA NCAC 2C .0118. ci ..
9. YIELD (gpm): 6, METHOD OF TEST 'f (rs
10. WATER ZONES (depth): % Z 6
11. DISINFECTION: Type Amount
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 7C' To ii� jft/ �F2'e
From To
From To
13. GROUT: Depth xatcnal % ethod
From D To %S� Ft. r'��t¢sr,T"
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.
(Street Name, Numbers, ommuniy, Subdivision, Id No
Ft.
Ft.
Ft.
16. REMARKS:
1Y
L .
!J
DEPTH
From To
fro
— 2_5-
z�r-y c
ZCoS
2-(0 5 - 'LPS'
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
Format n Description
4 /
LOCATION SKETCH
Show direction and distance in miles frorzLgt least
two State Roads or County Roads. Inclu*.the road
numbers and common road names.es-
THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
S, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO TIC WELL OWNER
_ajezC
SIGNATURE OF PERSON CONSTRUTHE WELL 7/
DA
Ca nrIginappithe D vision of Water Quality, Groundwater Section, 1636 Mall Service Center - Raleigh, NC
/ ci H27/661k1oligthpne Mx(9;19) 733-3221, within 30 days. GW-1 REV. 07/2001
eFet

255873
(Street or Rout
cariaAli
sty Town State Zip Code
&� r �
Am code- Phone number'
4. DATE DRILLED0
5. TOTAL DEPTH:
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO ❑
7. STATIC WATER LEVEL Below Top of Casing: t, % • FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surfaces
`Top of cuing terminated at/or below land surface req ulna a
variance in accordance A NCAC 2C .0118.
9. YIELD (gpm): METHOD OF
10. WATER ZONES (depth):
'3
11. DISINFECTION: Type Amount 'Z G�
rmt _ Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
e) Latitude/longitude of well location
;fib✓
12. CASING: Wall Thickness
Depth
From`f _To V Ft.
From To Ft.
From To Ft.
13. GROUT: Depth Material
From To jam" Ft. Cb-rtiatttthod
—
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.
Diameter
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and
RELBENs CALDWLLn of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) CERTIFICATION # 2140
WELL CONTRACTOR COMPANY NAME REUBEN CALDWELL DRILLING, INC.PHONEA28 )254-3581
STATE WELL CONSTRUCTION PERMITS,_ 1537 ASSOCIATED WQ PERMIT,/
(if applicable) / (if applicable)
I. WELL USE (Check Applicable Box): Residential LI Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring 0 Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATIO
Nearest Town: e-t—County,
(Street Name, Numbers, Community, Subdivision, Lot No., Zip C
3. OWNER: in s c
Address &L /I Z -7l ' Latitude/lon itude source:❑GPS❑To 0
5 8 P graphic map
(chat box)
-ry 7 is DEM DRILLING LOG
From To FortpationDescription
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
Weight/Fferia numbers and common mad names.
16. REMARKS:
I 1-t'EREB` W4HP� CSIJ
CONSTRUCTION ST
c 6
r\ O
L nQ
t— c
thirfretrrIL
""'RI
Cn
G
THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
AND THA CgPY OF THIS RECORD HAS BEEN PROVIDED TO THE LL OWNER
SIGNATURE OF Y ON C NST��ING THE WELL 5 ATE �/� 2�
(Sia(t 4* the negkl$I (1Q'the Division of Water Quality, Groundwater Section, 1636 Mall Service Center - Raleigh, NC
AS/1699-1636 Pb6iteNOF(939) 733-3221, within 30 days. GW-1 REV. 07/2001

255051
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and NatuuraaEResourc
CALDDDELLn of Water Quality - Groundwater Section
REUBWELL CONTRACTOR (INDIVIDUAL) NAME (prlat) CERTIFICATION# 214Q
WELL CONTRACTOR COMPANY NAME REUBEN CALDWELL DRILLING, INC. PHONE$48 )54-358I
STATE WELL CONSTRUCTION PERMIT# 1537-ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential unicipaVPublic 0 Industrial 0 Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: LeCletecreR-
6501 brie Ala.D g Z Q D
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: �. A I3 4,
Address Pk. Pat- y/.e7 �
County ICJ 0 A/ COW_
(Street or Route No.)
L /rgir/L Me_
City or Town State Zip Code
Area code- Phone number
4. DATE DRILLED Ea/2-f�/2 2—
5. TOTAL DEPTH: . .tl /-
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO el
7. STATIC WATER LEVEL Below Top of Casing: yr FT.
/ (Use "+" if Above Top of Cuing)
8. TOP OF CASING IS / FT. Above Land Surface*
*Top of cuing terminated at/or below laud surface require
9. YIELD (gpm): 7 METHOD OF TEST 4)/
10. WATER ZONES (depth): 2- 1 l7 -
variance In accordance with 15A NCAC 2C.0118.
11. DISINFECTION: Type
12. CASING:
Depth Diameter
From t7 To 7 / Ft. ,
From To Ft.
From______ To Ft.
13. GROUT: Depth
From el To '7_4' Ft.
From To Ft.
Amount "t. T•.Z
Wall Thickness
or Weight/Ft. al
ZzZ/
Material
t'124 te..4AC
Method
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:
L. 'be H, ERBBY:.CERi1F
G
ASH
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(&gre lminutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Fomuyion Description
— 3
3 -- •rep
Ito-
7%
Ito 7 /e
;2/2) ._ 7ieat° dNLU/S
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.
4
d31.
"0
T THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
S, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL 0
SIGNATURE OF PERS
o the Division of Water Quality, Groundwater Section, 1636 Mall Service Center -Raleigh, NC
�tfL'LL 1'b ]k, siOH ICF(919) 733-3221, within 30 days. GW-1 REV. 07/2001
0
c

5fe
255052
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and
REUBEN CALDDELn of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) CERTIFICATION II 2140
WELL CONTRACTOR COMPANY NAME REUBEN CALDWELL DRILLING, INC. PHONE47f8 )254 —3581
STATE WELL CONSTRUCTION PERMIT# 1537 ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential Municipal/Public 0 Industrial 0 Agricultuiai 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATIO ..
Nearest Town: Countyatt inn S'
'e
erte
(Street Na&. Num C natttyy� Sutdivision. Lot t.#p,, odbe)
3. OWNER: 4eM) I ',le (depeu/minuteilraoods)
Latitude/longitude source:❑GPS❑Topographic map
(chock box)
DE = DRILLING LOG
From To Formatiotl�escpption
D
Address / 7 a 4�d- /2k
J (Street orArC �' z_ r 73 23
City or Town State ZIP
Code
(gam G2�- DYe
Area code- Phone number 4. DATE DRILLED G / 75 L/
O t
5. TOTAL DEPTH: 7 O
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO -B>
7. STATIC WATER LEVEL Below Top of Casing: 0 FT.
(Um "+^ if Above Top of Cuing)
8. TOP OF CASING IS / FT. Above Land Surfaces
*Top of cuing terminated at/or below land surface requires ■
variance In accordance with ISA NCAC 2C .0118. _
9. YIELD (gpm): O METHOD OF TEST /et G •
10. WATER ZONES (depth): 't'`t
11. DISINFECTION: Type /_QO Amount _
12. CASING: Wall Thickness
Depth Di ter or Weight/Ft. M erial
1-f Fron/ To 7 C FL (o #f a pee -
From To Ft.
From To Ft.
13. GROUT: Depth Material
From 0 To 9fS Ft. PS,.r.R.`t
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.
Metho
16. REMARKS:
11' n v,,`n` P.
��. 115D HERiBY,tERiti
CONS -MUG HION S1 AC
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
J,OCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names
VtertAb
T THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 1 SA NCAC 2C, WELL
)S, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL llA�`
(. r tk}kRgtit rite otwool to the Division of Water Quality, Groundwater Section, 1636 Mall Service Center -Raleigh, NC
A`'rF`27099400Phogq t9r>.[phone],within30days. GW-1 REV. 07/2001

254680
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment andREUB Ns CAesDWELLn of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) CERTIpFICATION% 2140
WELL CONTRACTOR COMPANY NAME REUBEN CALDWELL DRILLING, INC. PRONE Pf8 954-3581
STATE WELL CONSTRUCTION PERMITS/1537 ASSOCIATED WQ PERMIT%
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential 13 Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATI N:
Nearest Town: D L (Z County 3d
Li VDAba (i19-11l D 1 IFIL Qe)u tt 8 eX Zl'l S'
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER:wt (I ltavv> l4. 3111 f4t.55 IL
Address t(3 Mere'_e( PAH Dort Co oa_T-
(Street orl Route No.)
ei}tuD[.-rt_ AIC. 2 ff 7iS.
City or Town State Zip Code
'J " )- 4,47 - ft/S1f
Area codo- Phone number i
4. DATE DRILLED G//O/B Z
5. TOTAL DEPTH: Z (sS
6. DOES WELL REPLACE EXISTING WELLS YES 0 NO Ir
7. STATIC WATER LEVEL Below Top of Casing: '/E FT.
(Use "+" if Above Top of Cuing)
8. TOP OF CASING IS / FT. Above Land Surface*
'Top of cuing terminated at/or below land surface require' a
variance In accordan a with i3A NCAC IC .0118. p•
9. YIELD (gpm)- 2--METHOD OF TEST ill Ar-
t0. WATER ZONES (depth). 2 3
11. DISINFECTION: Type #7W 90,1 Amount tg-727.
7
12. CASING: Wall Thickness
Depth Diameter
From'%' 1 To iR e7 Ft. c,
From To Ft.
From Tc Ft.
or Weight/Ft. Material
p vP
13. GROUT: Depth Material
From 0 To 't-a ✓7
Ft. ee n -e. Method
Method
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.
Slot Size Material
in.
in.
Material
16. REMARKS:
I1t30 HEREBY CERTIFY
'CONSTRUE t ION STAND
Topographic/Land setting
I31ge ❑Slope OValley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(devrees/minute hecobds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTii DRILLING LOG
From To Formation Description
!ti - f e".5
2t —73
7-2-
7 3 i<' - tta5-
o _J
L�r��
0
(V
LOCATION SKETCFj'.
Show direction and distance in miles front at leas
two State Roads or County Roads. Include the roc
numbers and common road names.
'
S WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
( 1/a/o1—
GNATURE OF PERSON CONSTRUCTING THE WELL DATE
eforTgTpaF(pctpe Division of Water Quality, Groundwater Section,1636 Mall Service Center- Raleigh, NC
GW-1 REV. 07/2001
z
gfi"494'tIOCT11904A%.S91101733-3 21, within 30 days.

255059
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and
REUBEN Resources
- BLLn of Water Quality - Groundwater Section
CALWELL CONTRACTOR (INDIVIDUAL) NAME (print) CERTIFICATION# 214Q
WELL CONTRACTOR COMPANY NAME REUBEN CALDWELL DRILLING, INC. PHONEQ%8 I254_3581
1537
STATE WELL CONSTRUCTION PERMIT# _„ASSOCIATED WQ PERMITM
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential /Municipal/Public ❑ Industrial ❑ Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCA O
Nearo�-s�-tyyT-��o"—w'-n:K� ,bounty -.-r�-�
(Stint N1ml, Numbbeen, Common' rdivisi�on, Lot No., Zip Code)
3. OWNER: k"er {��'��� C��n,S 14br r
Address / Wz-Sf +'rock S9it n.e e-
W it'2_.1 L,3 .
t(Street orRoute No.)
r�i(le
2 g8-0
C
City or Town State Zip Code
)- 25a,-70/n
Area code- Phone number
4. DATE DRILLED (P - 7 - O �-
5. TOTAL DEPTH: a A 5
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO tf
7. STATIC WATER LEVEL Below Top of Casing: /I FT.
(Use "+" if Above Top of Cuing)
8. TOP OF CASING IS / FT. Above Land Surfaces
*Top of cuing terminated at/or below land surface requires a
variance In accordance with ISA NCAC 1C.0118. ,rJ
9. YIELD (gpm): l a. METHOD OF TEST " r Cr'
10. WATER ZONES (depth): / 77
11. DISINFECTION: Type , 7. (cAmount 1
12. CASING: Wall Thickness
Depth r Di let or Weight/Ft. tvJ@tyr�)
Fromf ( To g0 Ft. (p -✓ems �lU(_
From To FL
From— To
13. GROUT; Depth
From 0 Z-
To 0
From To
14. SCREEN: Depth
From To
From— To
15. SAND/GRAVEL PACK:
Depth Size Material
From To FL
From To Ft. \/1
&Wi 1T �t e N 1..,t
Topographic/Land setting
❑Ridge BS%pe ❑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 from at least
two State Roads or County Roads. Include the road
numbers and common road names.
c
FL
Material �^- nth <I
FL CPM.P_NI y--
Ft.
Diameter
FL in.
FL in.
Slot Size Material
in.
in.
16. REMARK
l4
1DO I{EIBYf'GE 1 j THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
tONSTRUCTIOtj . BARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL
Ll_li
fI
5,1'iGW-I REV.07/2001
4 ,r� v 2i99r�; d�+lrgPF No. ('19)733-3221, within 30 days.
N
art;
3ginal t
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
the Division of Water Quality, Groundwater Section, 1636 Mali Service Center -Raleigh, NC

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Na Resources
CALD- DBLLn of Water Quality - Groundwater Section
RWELL CONTRACTOR (INDIVIDUAL) NAME (prlat) CERTIFICATION # 214Q
WELL CONTRACTOR COMPANY NAME REUBEN CALDWELL DRILLING, INC,•PHONEEP8 )?54-3581
STATE WELL CONSTRUCTION PERMIT, 1537 ASSOCIATED WQ PERMIT'S
(if applicable) (if applicable)
254237
I. WELL USE (Check Applicable Box): Residential 0 Municipal/Public ❑ Industrial 0 Agisultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use(4
2. WELL LOCATION:
Nearest Town:\ Q i "Lf - County
L1)ti:FQV -OE
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
V j1
3. OWNER: !-1(.1 t (' IC. IN 1' 4
Address 43 ea et 6-+ /0
(Street or Route No.)
L')c'a-tf'id/t) r./C
City ale or Town St.
K,zs4 I., l5 = l).j k 0
Area code- Phone number /
4. DATE DRILLED C
5. TOTAL DEPTH: • Z7S
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 0
7. STATIC WATER LEVEL Below Top of Casing: 2 v O ' FT.
(Use -+" if Above Top of Cuing)
8. TOP OF CASING IS I FT. Above Land Surfaces
*Top of wing terminated at/or below laud surface requires •
variance In accordance with 1SA NCAC 3C .0118. •
9. YIELD (gpm): `3 r> METHOD OF TEST 4 / /.-
10. WATER ZONES (depth): .`-POo /0 C ftr•.----
zS7S/
Zip Code
11. DISINFECTION: Type / 1-J"x/. VC Amount ,-.3 r i//i
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From. , To " .) Ft. 7,- # :2-7 Ali'' e'
From To Ft.
From To Ft.
13. GROUT: Depth Material —ethod
Fro4) To „.7-0-G Ft. (ccs//�Fr1I� Jct11
m 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.
16. REMARKS: 4 II -1-79
I DO HEREBY CERTIFY THAT THIS WELL
CONSTRUCT STANDARDS, AND THAT
SIGNATURE OF PE
DEPTH
From To
y� 94
- 5-P5
J U e tSM W C,
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrea/minutes/secoods)
Latitude/longitude source:❑GPS❑Topographic map
(cluck box)
DRILLING LOG
Formation Description
Q
O
N
LOCATION SKETCH ce
Show direction and distance in miles fro at leasg`
two State Roads or County Roads. Inclut the rjd:
numbers and common road names. i6 N
.. m.c
O
ONSTRUCTED IN ACC°
OF THIS RECORD HAS
WITH I5A NCAC 2C, WELL
ROVIDED TO THE WELL OWNER
RSON CONSTRUCTING THE WE111
GROIljE,Wi [ER `ECT'CI,
Submit the original to the Division of Wa er QualityyjtSoptudnyattir on, 16
27699-1636 Phone No. [phone], within 30 days.
r
A
O
6 Mall Service Center -Raleigh, NC
GW-1 REV. 07/2001

L
254238
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and
RELBENNatural Resources
CALDWELL
Division ofWater Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) CERTIFICATION to 2140
WELL CONTRACTOR COMPANY NAME REUBEN CALDWELL DRILLING, INC. PRONE4%8 )254-3581
STATE WELL CONSTRUCTION PERMIT/ 1537 ASSOCIATED WQ PERMIT/
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential/Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION: n�J
Nearest Town: ASI4€4 1.-LE County 6010coinee
(\ \ t I�cZ-eo IL (� u 0
(Street Name, Numbers,
Community, Subdivision, Lot No., Zip Code)
3. OWNER: J t ^^ VJ A iL i r= Y- S
Address �- 0 - 4So/ al 3
(Street or Route No.)
CAiiCO1CI agiSo
From To
From To
13. GROUT: Depth
From -1- To a0
From To
14. SCREEN: Depth
From To
From To
15. SAND/GRAVEL PACK:
Depth
From To
From To
11. DISINFECTION: Type )-11-1-4 - 9 0 %' Amount a C-UPS
12. CASING: Wall Thickness
piputer orp ght/Ft. Material
// Ft. (� 4- rSD Y S 1 ( G
Depth
From 3- To 0 a
Ft.
Ft.
'r6. ddEMARKS ';7
I DO HEREBY CER7I1'Y
CONSTRUCTION STAND,
Material Method
Ft. Cema) eo.2Eb
Ft.
Diameter Slot Size Material
Ft. in. in.
Ft. in. in.
Size Material
Ft.
Ft.
Topographic/Land setting /
❑Ridge ❑Slope ❑Valley setting/
(check appropriate box)
Latitude/longitude of well location
(degrees/minutesiseconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
(Sa} a k- 4 g61 O Zip Code From - .To� Foe, o U20tio�
Area coda Phone number 1 ' — 3 0 5 ' tee- 44
4. DATE DRILLED
'i 5 o a 30 5 F. ` a
5. TOTAL DEPTH: A- a S / 3os /-- 5 I
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO E/
7. STATIC WATER LEVEL Below Top of Casing: `6 D FT. e c
wit "+" if Above Top of Casing) =!-'.
8. TOP OF CASING IS FT. Above Land Surface* w <
*Top of cuing terminated at/or below laud surface requires a l e
variance 1u accordance with ISA NCAC IC .011l. —t
9. YIELD (gpm): a- METHOD OF TEST el ' d1 2 t _ E.'r
10. WATER ZONES (depth): SO 5 "- a Ca Orwm ^ "' =
•
LOCATION SKETCH . -
Show direction and distance in miles firma at fast
two State Roads or County Roads. Include the road
numbers and common road names.
woh
1411IS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
AND T A COPY OFTHIS RECORD HAS BEEN PROVIDED TO THE WE OWNER
O
SIGNATURE OF PERSON CONSTRUCTING THE WELL
GRCiLALI.!YA FR .°EClJyit
ASSSCubI. 043MAIP�.iF49Lipe DI islon of Water Quality, Groundwater Section, 1636 Mali Service Center - Raleigh, NC
27699-1636 Phone 3221, within 30 days. GW-1 REV. 07/2001

we (7 L 253343
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) REUBEN CALDWELL CERTIFICATION. 214Q
WELL CONTRACTOR COMPANY NAME REUBEN CALDWELL DRILLING, INC. PHONE4
4
8 )254-3581
STATE WELL CONSTRUCTION PERMIT. 1537 ASSOCIATED WQ PERMIT.
(if applicable) {if applicable)
1. WELL USE (Check Applicable Box): Residential 1 " Municipal/Public 0 Industrial Cl Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest To
(Street N Numbers, Community, Subdivision,
3. OWNER:
Address /Q /3.4a r €104- wile'
(Street of Rqu)e No.)
Lot No., Zip Code)
2 nc G'L
City or Town Stale Zip Code
ems- 7 - / 161
Area code- Phone number 2 Q 2
4. DATE DRILLED,
5. TOTAL DEPTH- re 5—
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO &
7. STATIC WATER LEVEL Below Top of Casing: / go FT.
(Use "+" if Above Top of Cuing)
8. TOP OF CASING IS / FT. Above Land Surface*
*Top of cuing terminated at/or below land surfen requires ■
variance In ateordanceyelth 15A NCAC 2C .0118.
9. YIELD (gpm): METBQQ OF TEST /'PLe7
10. WATER ZONES (depth): 14 UFri SO
11. DISINFECTION: Type di"( l4' Amount
12. CASING: Wall Thickness
Depth Di ter or Weight/Ft. Material
From 1 / To �f FL %CF CDQZ tf Ov G
From To Ft.
From To Ft.
13. GROUT: Depth Material
From 0 To .2-/. Ft. iinnirvit pethod
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(cheek appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(cheek box)
DRILLING LOG
Formatio De ption
DEPTH
From
4)
90
A
zrr
5m
Dc
gc
LOCATION SKETCFj tv~
Show direction and distance in miles frorr}t Ieag
two State Roads or County Roads. Include the real
nutnbers : d common road names.
0
16. REMARKS:
iIi111<Di4E4YCiR
CON3TRUCtIONS
GPOUI
ASHEVIL
T THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
ARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
.bZ3( ,2
SIGNATURE OF PERSON CONSTRUCTING THE WELL ATE
i*Ole,t10t(919
19
e Division of Water Quality, Groundwater Section, 1636 Malt Service Center- Raleigh, NC
733-3221, within 30 days. GW-1 REV. 07/2001
x
r;

Dnr-CONSTRUCTION ST
I
253342
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and
REUBENNatural s CALDD Division
of Water Quality - Groundwater Section
WELL CONTRACTOR (INDWIDUAL) NAME (print) CERTIFICATION # 2I4t)
WELL CONTRACTOR COMPANY NAME REUBEN CALDWELL DRILLING, INC. PBONE348 )254-358I
STATE WELL CONSTRUCTION PERMITS 1537
ASSOCIATED WQ PERMT #
(if applicable) {if applicable)
1. WELL USE (Check Applicable Box): Residential d Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATI
Nearest Town: C3 1-"Cf2" n County �v;-)cccr.Q C
S63 S. Q6& q( Ar r1
(Street Name, Numben, Community, Subdivision, Lot No., Zip Code)
Topographic/Land setting
❑Ridge ❑Slope ❑Valley TdFlat
(check appropriate box)
Latitude/longitude of well location
3. OWNER: I ""I c(t ray M1Q'J e R )-1 (degrees/minutes/seconds)
Address te- 0 . C3 ii( '3 i b C Latitude/longitude source:❑GPS❑Topographic map
/ (Street a Raise No.) (check box)
City �ppStlfticQ �C �1g�i)3 DEPTH DRILLING LOG
(S�-p } or Town (o (,1- State G a Zip Code Frgm /— Tp g / Fo0tm�tion Desc iolt�
Ara code- Phone number 3 K /— , p / (9 n) 1 C N
4. DATE DRILLED 03`0 1 g0 i 3o G ern
5. TOTAL DEPTH: l dr 5' N 4 to/ e ilG O/- 1 +s i (,' p A pi (-re
6. DOES WELL REPLACE EXISTING WELL? YES 121 N0 ❑ 15 c
7. STATIC WATER LEVEL Below Top of Casing: 4- 0 FT.
I (Use "+" if Above Top of Cuing)
8. TOP OF CASING IS -1- FT Above Land Surface*
'Top of cuing terminated at/or below laud surface requires a
variance In accordance with ISA NCAC 2C .0111I.
9. YIELD (gpm): 3 0 METHOD OJ TEST t-t G - A ( g-
10. WATER ZONES (depth): S b 3 o Gem
11. DISINFECTION: Type dTId - 9O. o Amount 0
12. CASING: Wall Thickness
A Depth q 5ter or Weight/Ft. Material
From 1- To 4 3 Ft. g'l4 $EE )—
From To Ft.
O
p, %.="2,m
T rn
Do
LOCATION SKETCH S �o
Show direction and distance in miles from Ieaab
two State Roads or County Roads. IncludAhe rine
numbers and cgmmon road names.
From To Ft. S kti
13. GROUT+ Depth ,I�``'',�atcrial ethod t
From -.1- To 9..,0 Ft. `-'d' e�� pi4,ef DQ-AQc
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. REM
�,/ao jib¢ eiple dd to the
ASHE`AL� 1031 llidniffiC
61c1 is!
T THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
S, AND THAT AC9PY OF THIS REC RD HAS BEEN PROVIDED TO THE LL O
5 off
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
ivision of Water Quality, Groundwater Section, 1636 Mall Service Center - Raleigh, NC
3-3221, within 30 days. GW-1 REV. 07/2001

b., IiM EAit)C
--, r-TIIO HEHbti r
--) CONSTRUCTION STAND
J u
255058
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and
RSIIBENNatural Resources
CALD- DDivision of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) CERTIFICATION# 214Q
WELL CONTRACTOR COMPANY NAME RF.UBEN CALDWELL DRILLING, INC;. PHONES pB )254- 3581
STATE WELL CONSTRUCTION PERMIT# 1537 ASSOCIATED WQ PERMITS
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential 0 Municipal/Public Industrial 0 An"e
g^ric-ultural,❑ J�
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other If Other, List Use ‘Pace... Tr tie. a 143
2. WELL LOCATION: ��
Nearest Town:SXatit County
/gl t Name,q .6jm
(Street Name, Numbers, r wiry, Subdivision, Lot No., Zip Code)
3. OWNER:edf.teal 1/%// ipAtieni %-f,
Address 'LC
(Street a Route No.)
e
City or Town StateZip Code
(ar)- ZS). — t t 3
Area code- Phone number
4. DATE DRILLED �/ �t!0
5. TOTAL DEPTH: 3 a, C
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 0
7. STATIC WATER LEVEL Below Top of Casing: 3 3 FT.
(Use "+" if Above Top of Cuing)
8. TOP OF CASING IS / • FT. Above Land Surfaces
*Top of cuing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118. p
9. YIELD (gpm): /.< METHOD OF TEST // /I-••
10. WATER ZONES (depth): CO
��2
11. DISINFECTION: Type 44 f$%aAmount 77 44
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft.
From-/ l M renal
To .Fc
From To
From To
13. GROUT: Depth
From O Tom Ft.
From To FL
14. SCREEN: Depth Diameter Slot Size Material
in. in.
in. in.
Z_>f?o6
PMethod
Ft.
Ft.
Ft.
From To Ft.
From To Ft.
15. SAND/GRAVEL PACK:
Depth
From To Ft.
• From To - Ft.
Size Material
DEPTH
From To
.Co
,CO — ZD
70 _ �o
Topo c/Land setting
❑Ridge ad Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degreea/mioute✓ceconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
Fomlption 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.
c4,I,. ap,e,- 6-,?.wa..0 ttJ.t7tA 2e-6® /40,0At • 478Zoy �—
. PA t it l 52; t -4cnt Pn,tf,D so -(e c.a A-09 G i ed-o t
THIS WFI I WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
AND THAT A COPY OF
THIS RECORD HAS BEEN PROVIDED TO T yn�WELL OWNER
STT�RSON CONSTRUCTING THE WELL TO
CO
r o
5uiniiiG4fte prigfn'tip.�e Division of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
— 27b99YET6 Phmte No. (� 9 -?3? 3221, within 30 days. GW-1 REV. 07/2001

253346
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural
BEN Resources
of Water Quality - Groundwater Section
RWELL CONTRACTOR (INDIVIDUAL) NAME (print) CERTIFICATION # 2140
WELL CONTRACTOR COMPANY NAME REUBEN CALDWELL DRILLING, INC. PHONE[phone]
STATE WELL CONSTRUCTION PERMITN 1537 ASSOCIATED WQ PERMITS
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential 13 MunicipaV'ublic 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: IA) L' n`It'2V LLe County QQN torn
%3 \-1e-12_12-orJ CoJe (.0AD
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: -I A ra e r�
Address Pia He iLR-or)
(Street a Route No.)
CAD EA e2JIUX r3C—
City or Town State
I-.1a
Topographic/Land setting
❑Ridge ❑Slope ❑Valley Nat
(cheek appropriate box)
Latitude/longitude of well location
lre(degrea/minutes/reconds)
Cole CdA cD Latitude/longitude source:❑GPS❑Topographic map
DEPTH
Zip Code From 7 To
(81X)- (d-S- 3Fl9-f
Ara code- Phone number
4. DATE DRILLED 5,/a 0/ O c.
5. TOTAL DEPTH. Q I o
6. DOES WELL REPLACE EXISTING WELL? YES NO 0
7. STATIC WATER LEVEL Below Top of Casing: 4-0 FT.
(Use "+" if Above Top of Cuing)
8. TOP OF CASING IS I- FT. Above Land Surface'
*Top of cuing terminated at/or below land surface requires a
variance In accordance with ISA NCAC 1C .0118.
9. YIELD (gpm): b D METHOD OF/TEST
10. WATER ZONES (depth): I G O G ern
11. DISINFECTION: Type N I 1 ' ct ` o Amount Gt%
12. CASING: Wall Thickness t qn�
From SOLI t (I YC%
s'`a3
Diameter
Ft. 6I/`'
From To Ft.
From To Ft.
13. GROUT: Depth
From A To a O Ft.
From To Ft
Material Method
Ce(V\ hidJ2e0
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.
' < I DO HEREBY CERTIF
CONSTRUCTION ST"
GROUNDWATER SECTION
ASHBabkfiivlfdatigh t6Ethe Division of Water Quality, Groundwater Section, 1636 Mill Service Center -Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001
i
(check box)
DRILLINWS
Formation Dmript
D 1459-(LTSCCISia
C� pk
bo rr-.
S a�
rnZ,Z
r„—
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.
THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
S. AND A COPY OF ThI CORD HAS BEEN PROVIDED TO
NJELL OWNER
WXf� 1ocj,_
SIGNATURE OF PERSON CONSTRUCTING THE WELL
ATE

253345
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) REUBEN CALDWELL CERTIpFICATION* 2140
WELL CONTRACTOR COMPANY NAME REUBEN CALDWELL DRILLING, INC. PHONE11%8 54-3581
STATE WELL CONSTRUCTION PERMIT/ 1537 ASSOCIATED WQ PERMIT*
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential { I� 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:n� eAds 2 t) (LL(L County ngQ�60C-A�gl
51 TILL MAr3 KIUa l2.oy\D
(Street Name, Number, Community, Subdivision, Lot No., Zip Code)
3. OWNER:
Address
(data
(Street or Route No.)
?7I y
City or Town State
Zip Code
Area coda Phone number
4. DATE DRILLED .5— / 7- 0 2_
5. TOTAL DEPTH: 4 SS
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: b 0 FT.
/ (Use "+" if Above Top of Cuing)
8. TOP OF CASING 1S / FT. Above Land Surface'
*Top of casing terminated atior below land surface requires a
variance to accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): / 5 METHOD OF TEST C-t " i (-
10. WATER ZONES (depth): a-a©r — \5 C-7Pr'r`\
11. DISINFECTION: Type N i l0 o Amount CJ f
Wall Thickness
S0� t. MgtCa1
12. CASING:
Depth
From / ' DTeop/A g
From To
From To
13. GROUT:. Depth
From / To a i
From To
14. SCREEN: Depth
From To
From To
15. SAND/GRAVEL PACK:
Depth
From To
From To
16. REMARKS:
Di ter
Ft. C,1
Ft.
Ft.
Material Method
Ft. COGt'U3tol POJf-t) I�
Ft.
Diameter Slot Size Material
Ft. in. in.
Ft. in. in.
Size Material
Ft.
Ft.
TopographidLand setting
❑Ridge ❑Slope ❑Valley ❑Flat
(cheek appropriate box)
Latitude/longitude of well location
(degreeslminutestscconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
Fr�m l d / FoI naho0 Description,
f4`v�lfLld
o � 8&
l a.5'- a 9--A� t r�
as©� 15 C)Pn-t
aao'- QS5' C Ar3
7-1
.. -C
� �n
—� mo
rn
JOCATION SKETC11 • c
Show direction and distance in miles froraat leg
two State Roads or County Roads. Include the road
numbers and common road names.
2
Q
4
J
ccos G�oJ�
1l
0
/4 r^,t_C
2r
f D-�� 66HEREE'Y CERTiPY
CONSTRUCTION STANj
I
G,4ts�0#I(hq the D
ASI 449.4 dtlilt. t1�Y9)73
THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
, AND THAT COPY OF THIS U.FORD HAS BEEN PROVIDED TO T WELL OWNER
5 1-1 0a
SIGNATURE OF PERSON CONSTRUCTING THE WELL DA
Sion of Water Quality, Groundwater Section, 1636 Mall Service Center -Raleigh, NC
3221, within 30 days. GW-1 REV. 07/2001

258574
WELL CONSTRUCTION RECORD
North Carolina - Department of Envirotunent andrAturallResourcC/ - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME_(prtlaLt,) f \(° �.d) IP ni I \ - a 1�llw E LL. Cutronca 10N a /557
WELL CONTRACTOR COMPANY NAME�F u_be rJ ( tP 1Ii well I�1I t t tr -1- piton a pttfi as 1- -358 /
STATE WELL CONSTRUCTION PERMITI ASSOCIATED WQ PERMITS!
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential 9" MunicipaIIPublic 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCAT
Nearest To
644
(Snort Name,
County /634 • • '+�Q
wnben, Community, Subdivider, Lot No., Zip Code)
3.OWNER: LjtLA15 -/,2.
Address ('7 n CsC'� .l
Street« N� `� 73o
hfurf� h
aLI
ity or Town Stets Zip Coda
L 2R'— 0 71(9
Area coda Phone number /
4. DATE DRILLED StC6 0�
5. TOTAL DEPTH: '7 �b 6
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 1r7"
7. STATIC WATER LEVEL Below Top of Casing: CD FT.
(Usa "s" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
`Top of wing terminated actor below bud surface noshes a
variance In accordance wit ISA NCAC IC .011E
9. YIELD (gpm): D METHOD OF TEST
10. WATER ZONES (depth): D
11. DISINFECTION: Type ht$ 47a7 Ar ounrl 77-:VAL1
12. CASING: Wall Thiess
Depth / Diameter or v�((eght/FL
From I To SbFL () i
From______1 To FL
From To Ft.
13. GROUT: Depth
From To Z-)
From To
14. SCREEN: Depth
From To
From To
15. SAND/GRAVEL PACK:
Depth
From To
From To
Material A
Ft. ratfatole
Ft.
Diameter Slot Size Material
Ft. in. in.
Ft. in. in.
Fr
CONSTRUCTION STAND
Size Material
Ft.
Ft.
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latituddlongitude of well location
(demo dmuanes/mconda)
Latitude/longitude source:❑GPS❑Topographic map
(c.beck box)
DRILLING LOG
Formation Deagription
12EIMI
From To
CrO
LOCATION SKETQJ( G'
Show direction and distance in miles (gm at -least
two State Roads or County Roads. Include -a' !
numbers and common road names. r - .
b
t
l
f
D' c1
COP
v
coo-
IS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I SA NCAC 2C, WELL
AND THAT A COPY OF THI ' CORD HAS EEN PROVIDED TO THE WELL OWNER
>JIte,oripttl OP DI
4636Phoire-Mtr (9rv) f!4
IGNATURE OF PERSON C a TRUCTMG THE WELL DATE
on of Water Quality, Groundwater Section, 1636 Mall Service Center- Raleigh, NC
221, within 30 days. GW-1 REV. 07/2001

11. DISINFECTION: Type
12. CASING:
th
From '1- To I a 0
From To
From To
13. GROUT: Depth
From ,- To a� D
253340
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Resources
CAL DWELLn of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) CERTIFICATION S 2140
WELL CONTRACTOR COMPANY NAME REUSES CALDWELL DRILLING, IN. 54-3581
STATE WELL CONSTRUCTION PERMITS 1537 ASSOCIATED WQ PERMITS -
/ (if applicable)
(if applicable)
1. WELL USE (Check Applicable Box): Residential el Municipal/Public 0 Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCATION: �7
Nearest Town: W-e-AUEqg4\ l_l County )COm
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: M -11Ce C o
Address
(Street or Route No.)
City or Town State Zip Code
(glX}—(il—l13g
Area code- Phone number
4. DATE DRILLED 5/ 15 �O .a
5. TOTAL DEPTH: 1 6
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO E{
7. STATIC WATER LEVEL Helow Top of Casing: 4- v 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 1SA NCAC 2C .011S.
9. YIELD (gpm): 1 S METHOD OF TEST Q-(G " A l�
10. WATER ZONES (depth): t 2- Op�pp/ - 15 &Pin
I4 q 0 (e Amount euP
Wall Thickness
Ft. S(LDiameter Weight/Ft. �� Maul
Ft.
Ft.
Material Method
Ft. befvVevOT Quoek,
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.
• OM "n
I DO HEREBY CERTIFY
CON,STRUeTION STAND
Topographic/Land setting
❑Ridge ❑Slope 0Valley
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From f To / Fomigtton Description
- I I S ol/m-14.-4&)20eN
1.S '— i ao (2Ara I7d
aci
Gm
pi gc
o -
W
2 c
zm
ti
LOCATION SKETCH o m x
Show direction and distance in miles front $3east2,
two State Roads or County Roads. Include 0t6 roat
numbers and common road names.
Juplrei ecb
0
.T'P1IS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
AND AT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE LL OWNER
2
SIGNATURE OF PERSON CONSTRUCTING THE WELL
GROUND; ATER SECTION
A�}itlFbVllMi EtpoE -igik•FiCi Dt•^<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

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) REUBEN CALDWELL CERTIFICATIONS/ 2140
WELL CONTRACTOR COMPANY NAME REUBEN CALDWELL DRILLING, INC. PHONEY?J8 )254-3581
STATE WELL CONSTRUCTION PERMIT/ 1537 ACSOCIATED WQ PERMIT/
(if applicable) (if applicable)
253341
I. WELL USE (Check Applicable Box): Residential IB" 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: A9/hvdf County/ *"tL 4f
%"Y+�� noo-otia-
(S e,IfNumbers,
Community, Subdivision, Lot No., Zip Code)
3. OWNER: W °- A ( l'\,c r/fit )
Address 10 ltn-��i A .
4,5 i n for Route1�_ O No) (%/
City or Town Stale Zip Code
( )- ak'(- /?k,T
Area code- Phone number
4. DATE DRILLED S S %t, Z
5. TOTAL DEPTH: //9O �i /
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO EY
7. STATIC WATER LEVEL Below Top of Casing: Na NP 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
riCt
variance 1n accordance wltb ISA NCAC 2C .0118.
9. YIELD (gpm): 0 METHOD OF TEST
10. WATER ZONES (depth):
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(chock appropriate box)
Latitude/longitude of well location
11. DISINFECTION: Type f/%F,r
12. CASING:
Depth eter
From -h / To .2 / Ft. /5
From To Ft.
From To
13. GROUT: Depth Material Method
From D To 2,0 FL ease -r Muni
Amount j.a OZ.
Wall Thickness
or Weight/Ft. tonal
f -2-1 G.G
From To Ft.
14. SCREEN: Depth Diameter Slot Size
Front To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To - Ft.
REMARKS:
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
Formatioption
DEPTH
From To
D /S
?2 /00he-
0
IV
thi
crrr
r
o-
>c
T �a
LOCATION SKETCI-I O cn i
Show direction and distance in miles fro , t leta�
two State Roads or County Roads. Inclut$he wed
numbers and common road names.
D
s
�o'
: Y
D
r}5hev1/I_,o
HLgtEI&Y �Rj1F
e 7 : v.
Antes ik3f;F:•'
S WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
r 1 a THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE LL OWNER
s1s ✓ if/ 1 6 .2--
NATURE OF PERSON CONSTRUCTING THE WELL ATE
Divi
733-3
lon of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
21, within 30 days. GW-1 REV. 07/2001

252439
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) REUBEN CALDWELL
CERTIFICATION N 2140
WELL CONTRACTOR COMPANY NAME REUBEN CALDWELL DRILLING, INC. PHONEQ�j8 )254-3581
STATE WELL CONSTRUCTION PERMITS 1537 ASSOCIATED WQ PERMITS
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential I�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: er �� County t�Cy4l/G mn,(,4e
/4f-1 M / v/l (a 'S .D
(Street None, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER:N.9 /ZdlAtl % t>C
Address
(Street or Route No.)
4
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
h
DEPTH
From To
©— ��-
9 r — 3
/� - 3 ,a
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO Cf
7. STATIC WATER LEVEL Below Top of Casing: 8./ FT. �� — ���
/ (Use "+" if Above Top of Casing)
8. TOP OF CASING IS
C�w'..1 ID c_e 6t AJC a €>
airy or Town State Zip Code
�- is-3�z
( > 3
Ara code- Phone number
4. DATE DRILLED .S/�o/D `Z
5. TOTAL DEPTH:, S
FT. Above Land Surface*
*Top of wing terminated odor below land surface requires a
variance In accordance with ISA NCAC 2C .01 I9.
9. YIELD (gpm): 3 METHOD OF TEST IC( r
10. WATER ZONES (depth): 3 !vD
(c eck box)
DRILLING LOG
Formation aescric fo
S a o CD
—C '
_i
LOCATION SKETCH f;? m
11. DISINFECTION: Type 4- Amount / c..0 9 . Show direction and distance in miles fromat' east-t-t L 6
12. CASING: Wall Thickness two State Roads or County Roads. Include . ro i/•'`
Depth Diameter or Weight/Ft. ?renal numbers and common road names.
Frortl'f"� To �i-� Ft. (p --It- y� C) (--
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From 0 To L!� Ft. i2�pM.iQ7
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
1 DO HEREBY CERTIFY THATTJ�JS WELL WAS CONSTRU
CONSTRUCTION STANDA(2L�5, THAT A COPY OF THIS
ATURE OF PERSON CO iSTRU :TING THE WELL
GP OJvL �i;l'GN
Submit the original to the Divisi®fiftWirteP Qluality,'tffnitndwater Section, 1636 Mall Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001
ACCORDANCE WITH I5A NCAC 2C, WELL
HAS BEEN PROVIDED TO THE LL OWNER
BATE
A a-
-s‘„ 2—
LtGle3re,

WELL CONSTRUCTION RECORD
252404
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) REUBEN CALDWELL CERTIFICATION a 2140
WELL CONTRACTOR COMPANY NAME RRUBEN CALDWELL DRILLING, INC. PHONE[phone]
STATE WELL CONSTRUCTION PERMITS 1537 ASSOCIATED WQ PERMIT,/
(if applicable) / (if applicable)
1. WELL USE (Check Applicable Box): Residential W 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: Woll R.t AP4 14iLLF,
County gAiNCOf+'1
(Street None, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER:
Address 'f-{ L. ILLas ST
(Street or Route No.)
6Ag,OAQ.DSV1tl.0 NC
a% Toc{
City or Town State Zip Code
(sas)- (a6— agF{5
Area coda Phone number /
4. DATE DRILLED 5/ 3 ! 0 a.
5. TOTAL DEPTH: 4 a 5 /
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 01/
7. STATIC WATER LEVEL Below Top of Casing: 8 O FT.
(Use -9' if Above Top of Cuing)
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 .0118.
9. YIELD (gpm): `02 O METHOD OF TEST 416 - A(2-
10. WATER ZONES (depth):
Topogphic/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 1.O(L
From To Formation Description
11. DISINFECTION: Type {-1Flo c Amount a c .,p5
12. CASING:
Depth
From To a O Ft.
From To Ft.
Di ter
fi
From______ To Ft.
13. GROUT: Depth
From 4 To a o Ft.
Material
Wall Thickness
°sror_at Material
Method
co0fekD
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.
i j ix Impiarr`Eineat7A'II •
CONSTRUCTION STANDARRII S
l
L J
PO
a
r-,
CD
o"
r n
LOCATION SKETCH N
Show direction and distance in miles from at ld3st
two State Roads or County Roads. Include the road
numbers and common road names.
1
c;‘,L7
WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Subtiif the roriginal ttiitIOEDivisioa of Water Quality, Groundwater Section, 1636 Mall Service Center - Raleigh, NC
27$691\636Patine No. (419if313-32ZLwithin 30days. GW-1 REV. 07/2001

251995
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural
aual Res CALDWELL of Water Quality - Groundwater Section
REUBWELL CONTRACTOR (INDIVIDUAL) NAME (print) CERTIFICATIONS' 2I40
WELL CONTRACTOR COMPANY NAME RRUBEN CALDWELL DRILLING, INC. PHONE •254-358I
STATE WELL CONSTRUCTION PERMITS' 1537 ASSOCIATED WQ PERMITS'
(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 LOCATIOt)ijs ff
Nearest Town: jji�i P
County s lc.JIC'Ork6C'
(Street Name, Numben, Community, Subdivision, Lot No., Zip Code)
3. OWNER: UOlt !/Od //
Adcess '''7 �i Ln I? et4.C2 Coy.n
(Stra/q( Aute No.)
fA g S e l
O!r%1��t.L'lti �L r
City or Town S./9
Zip Cade
t7
Azt code- Phone number
4. DATE DRILLED 5 4 'O')—
5. TOTAL DEPTH: / 70
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO W
7. STATIC WATER LEVEL Below Top of Casing: do FT.
(use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface'
*Top of casing terminated at/or below land surface requires a
variance In accord■ss:3 withISA NCAC 2C .0118.
9. YIELD (gpm): 4METHOD OF TEST
10. WATER ZONES (depth): /!/O -� /VS'
11. DISINFECTION: Type 94,2 L' lit').
12. CASING:
Depth
From // To l 3
From To
From To
13. GROUT: Depth Material,
From D To %1O Ft. iCMet/-
Diameter
Ft. 6- 1r
Ft.
Ft.
Amount
Wall Thickness
or We�t nt/Ft. Material
$7) fl / _alas,
From To Ft.
Method I
r
14. SCREEN: Depth Diameter Slot Sim Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Sim Material
From To Ft.
From To Ft.
HEREBY CERTIFY THAT
STRUCTION STANDARD
190
Topographic/Land setting
Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degreec/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOCI
From To Jortnat''on Description
el 60
CD c
ms
3
1
ate
ma
sz
LOCATION SKETCI{ .r 1-
Show direction and distance in miles from s leas
two State Roads or County Roads. Include the road
numbers and common road names.
LL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE
Dn 1-14)The va irrci5
SIGN TORE OF PERSON CONSTRUCTING THEVELL
S
DATE
the :M:Igitat eialtli2110 . f Water Quality, Groundwater Section, 1636 Mall Service Center - Raleigh, NC
ScliansFoice No. [phone], within 30 days. GW-1 REV. 07/2001

251997
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) REUBEN CALDWELL CERTIFICATION II 2140
WELL CONTRACTOR COMPANY NAME REUBEN CALDWELL DRILLING, INC. PHONE[phone]
STATE WELL CONSTRUCTION PERMIT/ 1537 ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential,H 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:_,Op
Nearest Town: G t e re a- County /emu ,vCo evt 8 -e_
geoTen gfl-t w+C.wv ( Ito Je
(Street Name. Numbcn, Community, Subdivision. Lot No., Zip Code)
3. OWNER: I-4)u 0P� LC) 1*-4.nPoi 0
Address y�-ettas
G�ittit se-1A-•.)
. _ . (Sneer or outeAtry
Zip Code
�.3
Area code- Phone number
4. DATE DRILLED 6-7/ d 2-
5. TOTAL DEPTH: 'Z.S
-
1—or Town 91--3
6. DOES WELL REPLACE EXISTING WELL? YES ❑ O 0
7. STATIC WATER LEVEL Below Top of Casing: 7 FT.
(Use "4" if Above Top of Cuing)
8. TOP OF CASING IS / FT. Above Land Surface'
*Top of cuing terminated at/or below land surface requires •
variance In accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): 2 METHOD OF TEST Rib
10. WATER ZONES (depth): %-V ' —
11. DISINFECTION: Type J4'7 Amount 1
12. CASING: Wall Thickness
,.gyp Depth, / Diameter orWeight/Ft. Material
From /'! To O( FL /r ` ezI //Pa -
From To Ft.
From To Ft.
13. GROUT: Depth aterial
From 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.
From To Ft.
Slot Size Material
in.
in.
16. REMARKS:
u LinciiiEI�EBY c RTI
'"'2 1 CONSTRUCTION STAND
i
,
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 LOQ
Formation Description
DEPTH
From To
2
-a-
Boa
c-
n
Z='
rn "rn
LOCATION SKETC.. mo
Fj
Show direction and distance in miles from a€isast 73m
two State Roads or County Roads. Inclu
numbers and common road n
THIS WELL WAS CONSTRUCTED IN ACCO
, AND THAT A COPY OF THIS RECORD
SIGNATURE
CE WITH ISA NCAC 2C, WELL
BEEN PROVIDED TO THE WE 0
PERSON CONSTRUCTING THE WELL
imtilite aright*pglthe Division of Water Quality, Groundwater Section, 1636 Mall Service Center -Raleigh, NC
0,276994636 PlioniNititi101133,3221,within30days. GW-1 REV. 07/2001

25065
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
REUBEN CALDWELL
WELL CONTRACTOR (INDIVIDUAL) NAME (prior) CERTIFICATION a 2140
REUBEN CALDWELL DRILLING, INC. 4%g 1254-3581
WELL CONTRACTOR COMPANY NAME PHONE
STATE WELL CONSTRUCTION PERMITS 1537 ASSOCIATED WQ PERMITZeh ft%OQ-/ _
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ❑ Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION: - / n
Nearest TownAbLi/ " County a 44-424lVLk-g-
(Street Name, Numbers, Community, Subdivision, lot No., Zip Code)
3. OWNER:T -r4-
Address / O 'L
� rAin rat or Route No.)
City or Town State
aa-7 / J
Zip Code
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degreu/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
Formation scrip ion
DEPTH
From To
H e-
IV
�� LOCATION SKETCH "c
11. DISINFECTION: Type I Amount y, Cr-NYf74i 4. Show direction and distance in miles from at least 1
12. CASING: Wall Thickness two State Roads or County Roads. Include the roar'
Depth Diameter r Wcig$t/Ft. Material numbers and common road names. -D
From/--� To 7 Ft. 4;�i(( . Ci
From To Ft.
From To Ft.
13. GROUT: Depth
rt(q.
14. S RE N: Depth cr 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.
Area code- Phone number
4. DATE DRILLED �22r
5. TOTAL DEPTH: , 5-25 .
6. DOES WELL REPLACE EXISTING WELL? YES E-NO ❑
7. STATIC WATER LEVEL Below Top of Casing: XG, FT.
(Use"+" if Above Top of Cuing)
8. TOP OF CASING IS / FT. Above Land Surface'
*Top of cuing terminated at/or below land surface requires
variance In accordance with 15A NCAC SC .011S.
9. YIELD (gpm): / 5� METHODQFTEST re-1
10. WATER ZONES (depth): / 1
I BO hERnn Y LER I IPR
CONSTRUCTION ST
THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I SA NCAC 2C, WELL
AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
OF PERSON CONSTRUE t ING THE WELL
1V
GJ
2-F—
D2 ATE /
P PTTA-LON
ectiglnacterthe DI Sion of Water Quality, Groundwater Section, 1636 Mall Service Center-Italelgty NC
6-Piro
3221, within 30 days. GW-1 REV. 07/2001
Q
2,0
o
Cr'
rn
0<
y0
rn�
tnn,
c7
ti
0

251725
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
REUBEN CALDWELL
WELL CONTRACTOR (INDIVIDUAL) NAME (print) CERTIFICATION. 214Q
WELL CONTRACTOR COMPANY NAME REUBEN CALDWELL DRILLING, INC. PHONE448 ?84/-3581
STATE WELL CONSTRUCTION PERMIT. 1537 ASSOCIATED WQ PERMIT.
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ❑ Municipal/Public f/Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town. ,�•County�f�f
Z di,/ z[/i rz_a t
(Street Name, Number, Community, Subdivision, lot No., Zip Code)
3. OWNER7gl*Y//V ir�4 Address ! D 2—
�1 0 orRoute
1� C. ) 0) e 7l/
Zip Code
City or Town State
U
Area coda Phone number
4. DATE DRILLED 942-2--/e 2
5. TOTAL DEPTH: Cgs
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO ❑
7. STATIC WATER LEVEL Below Top of Casing: L FT.
(Use "+" if Above Top of Cuing)
8. TOP OF CASING IS / FT. Above Land Surfaces
'Top of cuing terminated at/or below Iced surface requires •
variance 1n accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 0 METHOD OF TEST
10. WATER ZONES (depth):
/4,
11. DISINFECTION: Type. Amount 2 '" f {
12. CASING: Wall Thickness
Depth DiJmeter or Weight/Ft. Material
l-i'r Fron/ Tom � Ft. /� l B > . c-/l
From To Ft.
From To Ft.
13. GROUT: Depth _Material
From tO To , <3 FL
From B,7-76B4 F
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
DIVA
�6. REMARKS:
I DO HEREBY CERTIFY
C,_QNS'tRl lfTLQN ST,pe
r t IO r SECTION
AS OFFlC
1Si A
SIGN fTURB OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mall Service Center -Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001
Topographic/Land setting
❑Ridge ❑Slope ❑Flat
(check appropriate box)
Latitudr/longitude of well location
(degrcafmioutesheconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
Fro To Formation De;criptio,
it4 —
xs"3
c5:3—as-4r
s o{
Do
sae rri
LOCATION SKETCFI
Show direction and distance in miles fro
two State Roads or County Roads. Include ie n J
numbers and common road names.
rn z
i &t leasbb'
1S WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER

WELL CONSTRUCTION RECORD
O 1)''
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) REUBEN CALDWELL CERTIFICATION OS 2140
WELL CONTRACTOR COMPANY NAME REUBEN CALDWELL DRILLING, INC. PHONEr1%f8 )254-3581
STATE WELL CONSTRUCTION PERMIT# 1537 ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residentialt Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATI
Nearest
Town
Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER:
Address -9 44it -e
C,ark
veer orto No
Zip Code
Area code- Ph. ne number
4. DATE DRILLED
5. TOTAL DEPTH:
re 03
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 0
7. STATIC WATER LEVEL Below Top of Casing: , 4 I..- FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surfaces
*Top of cuing terminated at/or below land surface requires a
variance In accordance wit 15A NCAC 2C .0118.
9. YIELD (gpm): METH(JD OF TEST
10. WATER ZONES (depth): /
11. DISINFECTION: Type_ Amount
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. at
To�_Ft. t�9� %��
From To Ft.
From _. To Ft.
Front _ 4,
P
13. GROUT: Depth Material._
From ,% To Car) Ft. i.�aGX`L%'
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 ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/saonds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
Formation Description
DEPTH
From To
c
1C49— Go
�//e5 �log4'.
c
N n
-c 0�
in rn
� Em
yC
LOCATION SKETCFL sm
Show direction and distance in miles from afllast
two State Roads or County Roads. Include tbibroarg
numbers and common road names. rn -6
tS
:DO F}ERi{�V CEn•T��C���IF
CONSTP I I�'TIGH.SiB„
T THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
S, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIG OF OF PERSON CONSTRUCTING THE WELL
DATE"
I. _Submit the original 4, the Jivision of Water Quality, Groundwater Section, 1636 Mall Service Center- Raleigh, NC
l47O99 Sd3ePkoii Nd. [phone], within 30 days. GW-1 REV. 07/2001

251344
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
REUBEN CALDWELL
WELL CONTRACTOR (INDIVIDUAL) NAME (print) CERTIpFICATIONS/ 214Q
WELL CONTRACTOR COMPANY NAME REUBEN CALDWELL DRILLING, INC. PHONEYi8 )254-3581
STATE WELL CONSTRUCTION PERMITS/ _ 1537 ASSOCIATED WQ PERMITS/
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATIGN:
—ASV uL'w
Nearest Town:
County e Q,43 co rn �
(Street Name, Numbcn, Community, Subdivision, lot No., Zip Code)
3. OWNER:
Address
QICIC .Nrvt.36s
b WtOGib Wood
(Street or Route No.)
(
City or Town State Zip Code
osa%)- 6%4--14S,
Area code- Phone number
4. DATE DRILLED
5. TOTAL DEPTH: (o O 5 '
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO 0
7. STATIC WATER LEVEL Below Top of Casing: I 0 0 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1- FT. Above Land Surface'
*Top of casing terminated at/or below land surface requires a
variance In accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): I/ P. METHOD F TEST 0-1 (7
10. WATER ZONES (depth): 3 Y Va-(9PM
11. DISINFECTION: Type
12. CASING:
Depth
From, S To GI a
From To
From To
13. GROUT. Depth
From To A 0
From To
14. SCREEN: Depth
From To
From To
15. SAND/G • AVM' p&rtl•
r
To
16.
I DO HERE 'f
CON TRUC11 i4-'STAMDAAH ;
Di ter
U
Ft.
Ft.
Ft.
Material
Ft. C n wr
Ft.
Diameter Slot Size Material
Ft. in in.
Ft. in. in.
Amount
Wall Thickness
or W500__Q t/Ft. MatSCrial
Method
Vouxen
Ft.
Material
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ItdFiat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPSOTopographic map
(check box)
DEPTH DRILLING LOG
Fr1 — Fame 'on.6 ptio
gb r- 3 W 5 ' 66(`lxs GR-41J 1 j 6-
3 `6 S i/1- O p r.-i
'3 C. 5 "- 6 0 5 ' G «-A 44 I-CC-
a
c;R
IU zni
at rC
..m
�c
LOCATION SKETCI; a,
Show direction and distance in miles from illeastcn
two Stat- Roads or County Roads. IncludeRite root)
numbers : nd common road names. cp
AS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL
DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mall Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

3. OWNER: t1 Q. r 3 G a rJ i tom) CDS (degrcWminutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
/� (Street or Route No.) 0 (check box)
toe �C g ! 4' DRILLING LOG
City or Town State Zip Code Fo ton Description,
()- 6g 4- 1 451 9 (� D �24 oitE)0�(MO-
Area code- Phone number
4. DATE DRILLED
5. TOTAL DEPTH: I0 5
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 0
7. STATIC WATER LEVEL Below Top of Casing: 4 0 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 surface requires ■
variance In accordancqp with ISA NCAC 2C .0118. �
9. YIELD (gpm): L METHOD OFT ST l4
10. WATER ZONES (depth): (D 4' S a- G P M
11. DISINFECTION: Type FfT' Amount S Ct)(
12. CASING: Wall Thickness
Depth Diameter
From To Ft. 6 % 8 ''
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From .d. To A 0 Ft. Cemer T QoU201)
From To Ft.
14. SCREEN:
DEPTH D
Frqm To
CND — 6 4-
6 S
c�4S=ROS'
�2ia c-) (Ye
O
Al
hl
iT
Ina
LOCATION SKETCH G rrnc
Show direction and distance in miles fronld leaf'
two State Roads or County Roads. Includ&9ie rdrid
oS�a t. Materialnumbers and common ro. r names.
251345
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) REUBEN CALDWELL CERTIFICATION 2140
WELL CONTRACTOR COMPANY NAME REUBEN CALDWELL DRILLING, INC.
PHONE [phone]
STATE WELL CONSTRUCTION PERMIT# 1537 ASSOCIATED WQ PERMIT#
(if applicable) r (if applicable)
1. WELL USE (Check Applicable Box): Residential Ol 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: r 4 i AJI e County gilt") f- ✓'x 6 C
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
Topographic/Land setting
❑Ridge 0Slope ❑Valley 'gnat
(check appropriate box)
Latitude/longitude of well location
Address b LA.) Oi iY6 co co n
Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in in.
15. SAND/GRAVEL PACK:
16
DCPd
To
ARK
BY CERTIFY THAT THIS
�WN31'
Material
We(
LL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
THA'" A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center- Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

251555
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) REUBEN CALDWELL CERTIFICATIONS/ 2140
WELL CONTRACTOR COMPANY NAME REUBEN CALDWELL DRILLING, INC. PHONE[phone]
STATE WELL CONSTRUCTION PERMITS 15 37 ASSOCIATED WQ PERMITS/
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential G7 Municipal/Public ❑ Industrial 0 Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION: ff Nearest Town: ]t_Tino (LC ro S Co ity OJn)C_c i 4 C
3 !9 e t e
(SUeet Name, Numbers, Community, Subdivision, Int No., Zip Code)
3. OWNER: /GLf�Gf�
Address P 7f h r2
s( Route .)
1/r�
City or Town Stele Zip ode
2-7 )1,— 3(v`l%
Area code- Phone number
4. DATE DRILLED
5. TOTAL DEPTH:
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO 0
7. STATIC WATER LEVEL Below Top of Casing: ,' ' FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surfaces
*Top of cuing terminated at/or below land surface requires a
variance In accordance with 15A NCAC 2C.0118.
9. YIELD (gpm): _ METHO,D OF TEST
10. WATER ZONES (depth):
11. DISINFECTION: Type
12. CASING:
Depth
From+f To 9.3 Ft.
From To Ft.
From To Ft.
13. GROUT: Depth
From B To 7-0, Ft.
From To Ft.
Topographic/Land setting
❑Ridge ❑Slope ❑Valley LRFlat
(check appropriate box)
Latitude/longitude of well location
3
(depeea/mioul s/samds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
Formation Descriptio
DEPTH
From To
o0
Ge P3
1f?fs /fir
/ re
/SiS /v0�
N m=
LOCATION SKETCH c.) -2-1
Amount 2 ri .q4 Show direction and distance in miles fronfift lead
Wall Thickness two State Roads or County Roads. Include the road
or Wfigh t. erial numbers and common road names.
itl�.»-
1
14. SCREEN: Depth Diameter Slot Size
From To Ft. in. in.
in.
Material
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size Material
To Ft.
To Ft.
16
From
From
j
I DOHEREBY CCRf1F
CONSTRUCTION S
)(Ai?
a
I�
flIAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
(=R l t$'ubrrx')tih2c4 1 to th
L t46j4:t' d}hOhik .-[phone], within 30 days.
THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO I-IB WLL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL ' s DATE
Diameter
e Division of Water Quality, Groundwater Section, 1636 Mall Service Center - Raleigh, NC
GW-1 REV. 07/2001

251 556
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and
REL'SENNatural Resources
CALDDHLLn of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) CERTIFICATION# 2140
WELL CONTRACTOR COMPANY NAME REUBEN CALDWELL DRILLING, INC. PHONE )254-3581
STATE WELL CONSTRUCTION PERMIT/_ 1537 ASSOCIATED WQ PERMIT/
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential Er/Municipal/Public 0 Industrial 0 Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: G' i oun/N7:e7Y/rC---)
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: j4i �f / h(si/--& -/L
Address 7-' ii-Th.aO - A etB
//9� (Street �r Route No.)
/7l.�7iiA822P fT
City or Town State s Zip Code From To
—
Area code- Phone number
4. DATE DRILLED
5. TOTAL DEPTH:
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 0
7. STATIC WATER LEVEL Below Top of Casing: 7 Ca 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 ■
variance In accordant with ISA NCAC 2C .Otte.
9. YIELD (gpm): • METHOD OF TEST
10. WATER ZONES (depth): TrF>— 67m
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(depeea/minuus/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
Formation Descriptio
m Y
•
11. DISINFECTION: Type # 4i . Amount it
12. CASING: Wall Thickness
Depth Diameter
From't/' To : r Ft.
From To Ft.
From To Ft.
or Weight/Ft. aterial
— 3
�s p
gap ,S--w
‘./3m -o,s
13. GROUT: Depth alerial ,Method
From0 Tom Ft. Pfv
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:
m
IN, 7G
SD rrn
Do
z c
rn z
LOCATION SKETC �� Fj
Show direction and distance in miles from Weast
two State Roads or County Roads. Include the roe*
numbers and common road names.
L_v4 4
I DO HEREBY CERTIFY
CONSTRUCTION STAND
WAS CONS1RU
THAT A COPY OF TO
SIGNATURE OF PERSON C
IN ACCORDANCE WITH 15A NCAC 2C, WELL
ORD HAS BEEN PROVIDED TO THE WELL OWNER
g/I2/6
NSEI RUCTING THE WELL ATE
Submit the original tote Divisiot) Of Water Qtaa{fitgi-GioundWater Section, 1636 Mall Service Center - Raleigh, NC
27699-1636 Phone No. (919b 733-32271, Within '30' days. 's-- GW-1 REV. 07/2001

12. CASING:
Depth
From 1 To 3 0
From To
From To
13. GROUT: Depth
From To ctO
From To
14. SCREEN: Depth
From To
From To
15. SAND/GRAVEL PACK:
Depth
From To
From To
16. REMARKS:
I DO HEREBY CER
CONSTRUCTION S"
�i tL'
as
Ft. in
Ft. in.
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment andNatural RELTBENs CALDDELLn of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) CERTIrFtICATION# 2140
WELL CONTRACTOR COMPANY NAME REUBEN CALDWELL DRILLING, INC. FHONE`#4g I254- 358I
STATE WELL CONSTRUCTION PERMIT# 15 3 7 ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
251557
1. WELL USE (Check Applicable Box): Residential &i Municipal/Public ❑ Industrial ❑ Agricultural ❑ r
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: 13 1 E n. o 2C; County Q V N r O in.e
�o ST 39b� VA,.,o(tt-15tLT
(Street Name, Numbers, Co ....unity, Subdivision., Lot No., Zip Code)
3.OWNER:fVr 'pAoL- L1mpA.,C./G
Address l jgeTa e-a / 6YAtQ--
, (S or Route No.)
it�mre -> csr- �'G P f a 3
City or Town State Zip Code
( - 774ew3Ll
Area coda Phone number
4. DATE DRILLED 3/c2_(o
5. TOTAL DEPTH: 50 ° �(/
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO i
7. STATIC WATER LEVEL Below Top of Casing: (oo FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS �- FT. Above Land Surface*
*Top of wing terminated st/or below land surface requires •
variance In accordance9 with 1SA NCAC 2C .0118.
9. YIELD (gpm): I 1/a- METHOD OF TEST �(iV
10. WATER ZONES (depth):,, II I 10 - — t t/a GP-'
11. DISINFECTION: Type It-I14 So% Amount R c oQS
Wall Thickness
Di eter or Weight/Ft. Material
Ft 6 ii So2al el C_
Ft.
Ft
Material Method
Ft. CsnsPT Qo,4eesD
Ft.
Diameter Slot Size Material
in.
in.
Size Material
Ft.
Ft.
✓ ' /2
LiTh Il
Topographic/Land setting y
❑Ridge ❑Slope ❑Valley 9Dlat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
Frgin To Formation Description
3 a5 ot3R(��20u�
d5/-- no' C,f.A&t ‘E-
ft to • t Va. C-q�C
1to'— 505' GRA tJ a%�
c°
lC� o'rt
Do
m
.v `n
m�
Cal =i
J.00ATION SKETCH - z
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
A oeL
HIS WELL WAS CO
S, AND THAT A COPY
t4. / a'_i -
D IN ACCORDANCE WITH 15A NCAC 2C, WELL
RECORD HAS BEEN PROVIDED TO THE WELL OWNER
3 — 2.163 6
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
E.ECTION
Submit the origina to thg 4i$' 4jgi o WatOr.Q)HF tw, Gr.jundwater Section, 1636 Mall Service Center - Raleigh, NC
27699-1636 Phone No. t919) /3s-31t1, within S0 days.
GW-1 REV. 07/2001

251135
16. REMARKS:
& RFE\ EilF
CONSTRUCTION ST
GR
ASHEV
3. OWNER:
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) REUBEN CALDWELL CERTIFICATION$ 2140
WELL CONTRACTOR COMPANY NAME REUBEN CALDWELL DRILLING, INC. PHONE`p48 I?54-3581
STATE WELL CONSTRUCTION PERMIT/ 1537 ASSOCIATED WQ PERMIT/
(if applicable) (if applicable)
1 WELL USE (Check Applicable Box): Residential Cl/Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: k 5r<ts
County Q u>v ec mr3r
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
AL-LerJ t8L )43--
Address(Street or Route No.)
,City or Town State ,1 Zip Code
(8'a )- 66�r 1-
Area code- Phone number `
4. DATE DRILLED 3/ 14 5 O cif
5. TOTAL DEPTH: 1 c`(S - /
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO P
7. STATIC WATER LEVEL Below Top of Casing: 3 e O FT.
(Use "+" if Above Top of Cuing)
8. TOP OF CASING IS FT. Above Land Surface*
*Top of cuing terminated at/or below land surface requires a
variance in accordatn0 with ISA NCAC 2C .0Ir8.
9. YIELD (gpm): / et METHOD OF TEST Ai- 12't C,
10. WATER ZONES (depth):
Topographic/Land setting
❑Ridge ❑Slope ❑Valley Mat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From / To i F"orntioq De ription
a8.5 - laS Ar41'
11. DISINFECTION: Type FIT H aot%
12. CASING:
Depth Diameter
From To Ft.
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From To Ft.
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
bil-lt-una 048 ef eV -
Amount a c-4 PS
Wall Thickness
or Weight/Ft. Material
r-11
tV
c
LJ
a<
W em
Do
a. m�
eni
LOCATION SKETCFL ••
Show direction and distance in miles fromast:a4
two State Roads or County Roads. Include the roaC
numbers and common road names.
tr LAu-z&CDA L
/4
3
rk.
&Le )SS7— 7a6 /
‘2I1\AT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
S, AND THAT A COPY OF THIS R({CORD HAS BEEN PROVIDED TO THE WELL OWNER
S1GNA
OF PERSON CONSTRUCTING THE WELL DATE
the Division of Water Quality, Groundwater Sectlon,1636 Mail Service Center -Raleigh, NC
41: 19) 733-3221, within 30 days. GW-1 REV. 07/2001

249805
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) REUBEN CALDWELL CERTIFICATION # 2140
WELL CONTRACTOR COMPANY NAME REUBEN CALDWELL DRILLING, INC. PHONE[phone]
STATE WELL CONSTRUCTION PERMIT# 1537
ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential'/ 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: vledivaVije County Atm/GOA16L
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER:7(44dC. eipeN
Address tral. MA 6a VP
(Street or Route No.)
u a lii4g v l/v .U_ C. 9-g7 9-7
City or Town State Zip Code
Irgn- 6'i - 7/2- G
Area code- Phone numbegr ✓
4. DATE DRILLED S -- eF
5. TOTAL DEPTH: 70 S
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: le 0 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 accords a Ith 15A NCAC 2C .0I1#.
9. YIELD (gpm): EXHOD OF TEST
10. WATER ZONES (depth): 3 to PA1
Topographic/Land setting
❑Ridge ['Slope ❑Valley ❑Flat
(cheek appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From Tp Forfnatio; Desc 'ption
11. DISINFECTION: Type ff7761
12. CASING:
Deptlj� Diameter
From 4-i To 70 Ft. (4
From To Ft.
From To Ft.
13. GROUT:Depth Material
From_ qTo'-0 Ft. COIP4V7—
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.
Afrawir
Avow,
LOCATION SKETCH
Amount 24- 07 Show direction and distance in miles from at least
Wall Thickness two State Roads or County Roads. Include the road
or Weight/Ft. Materia) numbers and common road names.
SO- C IN)
Method
P6 uAel
16 �R,EIJM/'VKS•
41"1J0 H17 FRY CBP.
CONSTRUCTION S
FY
J
CFI
G R P C Submit the original to th
27699-1636 Phone No. (914
[AT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
' # S, AND THA'�A COPY OF THIS�B CORD HAS BEEN PROVIDED TO THE \ ELIf OWNER
(n) tr- R 0a-
SIGNATURE OF PERSON CONSTRUCTING THE WELL
a Division of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
733-3221, within 30 days. GW-1 REV. 07/2001
fi
dtc

2119806
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) REUBEN CALDWELL CERTIFICATION# 2140
WELL CONTRACTOR COMPANY NAME REUBEN CALDWELL DRILLING, INC. PHONE42f8 1254-.3581
STATE WELL CONSTRUCTION PERMIT# 1537 ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential Er/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: VVPf(/PRV,i
County 40 Alit/ tie
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: rWotitiS £ ee4/
Address 7r,Tvtt# Go v•e
�, U(Street or Route No.)
,
Weary (My /f/C •
City or Town State Zip Code
(San- 4 re,-- 7/2- 6
Area code- Phone number
4. DATE DRILLED 3 --"— D
5. TOTAL DEPTH: 7 0.9-
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO tY
7. STATIC WATER LEVEL Below Top of Casing: , 5 V 0 FT.
(Use "+" if Above Top of Cuing)
8. TOP OF CASING IS / FT. Above Land Surface'
*Top of wing terminated at/or below land surface requires a
variance In accords ce with 1SA NCAC 2C .0118. ,
9. YIELD (gpm): METHOD OF TES'
10. WATER ZONES (depth): 2. CP.4f - 4444
2_
11. DISINFECTION: Type /617 *
12. CASING:
Depth / Diameter
From,[_ To 37 Ft. it/ -
From To Ft.
From To Ft.
13. GROUT: Depth
From a To 9-0
From To
14. SCREEN: Depth
From_ To
From To
15. SAND/GRAVEL PACK:
Depth
From To
From To
it;
,L,
r-1D'flett.nr LtKI1FY 1RA1
CONSTRUCTION STAND AR/
-s
Amount 54- ei
Wall Thickness
or Weight/Ft. Material
G
Material
Ft. evMP.vr
Ft.
Diameter
Ft. in
Ft. in.
Ft.
Ft.
Method
Muted
Slot Size Material
in.
in.
Size Material
Topographic/Land setting
DRidge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
FomtatioDescription
DEPTH
From To
0 ?.>?
37 575
fr 7Df
LOCATION SKETCH
Show direction and distance in miles from at leas
two State Roads or County Roads. Include the roa
numbers and common road names. o
tV
IS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WJ:LL QWNER
IGNATURE OF PERSON CONSTRUCTING THE WELL
ASY Y'tY1 � C4 gihaito1he Div sion of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
27699-1636 Phone No. (919) 733- 221, within 30 days. GW-1 REV. 07/2001

249807
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
REUBEN CALDWELL
WELL CONTRACTOR (INDIVIDUAL) NAME (print) CERTIFICATION # 2140
WELL CONTRACTOR COMPANY NAME REUBEN CALDWELL DRILLING, INC. PHONE`r48 1?54- 3581
STATE WELL CONSTRUCTION PERMIT# 1537 ASSOCIATED WQ PERMIT#
(if applicable) {if applicable)
1. WELL USE (Check Applicable Box): Residential Et Municipal/Public 0 Industrial 0 Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: t_ Ac t< MTn1
County G cocoa-,
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
Topographic/Land setting
❑Ridge ❑Slope ❑Valley at
(check appropriate box)
Latitude/lonaitude of well location
3. OWNER: 1 t\ A ('`r C. A 2 t- S 0 (degrees/minutes/seconds)
Address Latitude/longitude source:❑GPS❑Topographic map
(Street or Route No.) (check box)
DEPTH DRILLING LOG
City or Town State Zip Code Fr lty— i5 To Fnrdtation Descriptiop
(fl )- aq`l--Ia9f 0'1e ,4:.P60%-i
Area code- Phone number
4. DATE DRILLED O 3 c 1/ C a
5. TOTAL DEPTH: `(0 r7 ' /
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO H
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 casing terminated at/or below land surface requires a
variance In accordance wJth 1SA NCAC 2C .0118.
9. YIELD (gpm): 6 1/ 0 METHOD OF TEST k.-f G
10. WATER ZONES (depth): — I /.2 L Piv.
5 G9.r
11. DISINFECTION: Type FI r4 c10 4 Amount a c uP5
12. CASING: Wall Thickness
Depth Di ter or Weight/Ft. Material
From To `6 0 Ft. 6'74 17 S/)CCRI PJC-
From To Ft.
From To Ft.
13. GROUT: Depth A Material „Method
From '. To Ft. Cc/Ad K ( eo,)(2-t-, D
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in. Wtt;,y ,-
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
c
0
LOCATION SKETCH
Show direction and distance in miles fromN(pt least=-
two State Roads or County Roads. Include the mid:_
numbers and common road names.
v
J6
nI , ;ul, a'a • 9 : • RTIFY 1 THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
—,, \ CONSTRUCTION ST a r+� . , AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
GEWATER SECTION
e prtgi(npjfta'the Di i
sit th sion of Water Quality, Groundwater Section, 1636 Mail Service Center- Raleigh, NC
27699-1636 Phone�o. [phone], within 30 days. GW-1 REV. 07/2001

11. DISINFECTION: Type
12. CASING:
Depth
From1/_ To ti /
From To
From To
13. GROUT: Depth
To9-0
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
249124
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) REUBEN CALDWELL CERTIFICATION�fcc# 2140
WELL CONTRACTOR COMPANY NAME RRUBEN CALDWELL DRILLING, INC .FHONE`17 8 )254-3581
STATE WELL CONSTRUCTION PERMIT# 1537 ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential / Municipal/Public El Industrial ❑ Agricultural ❑
Monitoring El Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LO__ Au
Nearest Town:wn:�_ County
(Street Name, Numb(eJ Comm
3. OWNER:
Address (/
(Street or Route No.)
S
-sr
City or town State Zip Code
(ffl )- 17 - '/qq /
Area code- Phone number
4. DATE DRILLED a —`2- 7 — O 2
5. TOTAL DEPTH: �, Q r
6. DOES WELL REPLACE EXISTING WELL? YES ID NO L5�
7. STATIC WATER LEVEL Below Top of Casing: g 0 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS I FT. Above Land Surface"
*Top of cuing terminated at/or below land surface requires a
variance In accordantp ith ISA NCAC 2C .0118.
9. YIELD (gpm): IP METJI�OD OF TEST
10.WATER ZONES (depth):pi rill -go' 7-Iihv- /71
//Th90/Amount pi 43
Wall Thickness /
or Weight/Ft. L
Dit meter
Ft. 6 SO
Ft.
Ft.
Material
Ft. �r r.wl�
Topographic/Land setting /
❑Ridge ❑Slope ❑Valley lat
(check appropriate box)
Latitude/longitude of well location
(degreea/mioutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
Formation pescgption
DEPTH
From To
7` 3`d
rs, 0-05
ethod
From
From
To Ft.
To Ft.
n bers and common road names.
LOCATION SKETCH
Show direction and distance in miles from iineast'
two State Roads or County Roads. Include-roa��—
--
16. REMARKS:
'-'HIS WELL WAS CONSTRUCTED M ACCORDANCE WITH ISA NCAC 2C, WELL
I e, AND THAT A COPY�) OF THIS RECORD,HA� HAS BEEN PROVIDED TO THE WELL JOWNER
i
ILL' SIGNATURE OF PERSON CONSTRUCTING THEI WELL ATEkO /Oa
Submit.the originaLtalite Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
`i7re4_ 1636 Phon¢Nbl.Q919) 733-3221, within 30 days. G W-1 REV. 07/2001

249122
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) REUBEN CALDWELL
) NAME (Prt"t) CERTIFICATION 2140
WELL CONTRACTOR COMPANY NAME REUBEN CALDWELL DRILLING, INC. PHONE4%8 )254-3581
STATE WELL CONSTRUCTION PERMIT,/ 1537 ASSOCIATED WQ PERMIT,/
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ❑ Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION;
Nearest Town: ,Eff40-Vi//
CountyCRYG.Mie
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: YL44CR SLk5o.✓
Address r i/Aar- IA'Oa £( s
(Street or Route No.) s -
City or Town State Zip Code
Area code- Phone numbe _ r e 2_
4. DATE DRILLED D
5. TOTAL DEPTH: 2 2--5
6. DOES WELL REPLACE EXISTING WELL? YES la/NO ❑
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 15A NCAC 2C .0118. np
9. YIELD (gpm): tD ° METHOD OE TEST �F-I
10. WATER ZONES (depth): I G 5 /— I C C G PTV\
11. DISINFECTION: Type
12. CASING:
Depth
From -i-/ To 2 L
From To
From To
13. GROUT: Depth
From 1) To 12... o
4.1l N f Xi Amount .1 C
Wall Thickness
Di eter or Weight/Ft. Material
Ft. SeA2->z t it/c-
Ft.
Ft.
Material
Ft. Pa/4yj
Method
ociAel
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
From To
Size Material
Ft
Ft.
- I6. I�EMtARK :
- Ii i!7 !h
" . 1 LDO HEREBY CERTIFY
L' CONSTRUCTION STAND
r
Topographic/Land setting /
❑Ridge ❑Slope ❑Valley tlFlat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
Formatiop Des ription
DEPTH
From To
4 17
/7 2a6
rV
LOCATION SKETCH
Show direction and distance in miles from atpleash
two State Roads or County Roads. Include the road
numbers and comn\on road names. Lt
T
4IS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
j
IGNATURE OF PERSON CONSTRUCTING THE WELL 7 DATE
A Sltbmlt the original to &he Division of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
27699-1636 Phone No. (919) 739=3221, within 30 days. GW-1 REV. 07/2001

21Rn4F
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) REUBEN CALDWELL CERTIFICATION it 2140
WELL CONTRACTOR COMPANY NAME RRUBEN CALDWELL DRILLING, INC. PHONE448 ?54-3581
STATE WELL CONSTRUCTION PERMIT./ 1537 ASSOCIATED WQ PERMIT./
(if applicable)
(if applicable)
1. WELL USE (Check Applicable Box): Residential 17 Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring Cl Recovery ❑ Heat Pump Water Injection Cl Other ❑ If Other, List Use
2. WELL LOCATION: County
e. Nearest Town: a r
P.)Ktl - RpA4 oari\ r &tA
(Street Name, Numbers, Cpmmunity, Subdivision, Lot No., Zip Code)
3. OWNER: r,4• _a '
Address A 12ee IC o o A 4 (L]'I
(Street or Route No.)
City or Town State Zip Code
an- Ggat- Irok
Area code- Phone number
4. DATE DRILLED S-^ / 9-0 2--
5. TOTAL DEPTH: 9' 9-7
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO f
7. STATIC WATER LEVEL Below Top of Casing: fit5— 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 .0118.
9. YIELD (gpm): /$90 METHOD OF TEST
10. WATER ZONES (depth): /GPiv /C(' 99eh 55 f'
Topographic/Land setting
❑Ridge ❑Slope ❑Valley IRPlat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
Formation Description
DEPTH
From To
/TC /3W
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11. DISINFECTION: Type 61-TW t07 Amount /t 0 7-
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From+/ To /If- Ft. ,fit 5-iAt-
From To Ft.
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13. GROUT: Depth Material Method
From___a_ To "9/ Ft. Patna,- Piru.r.42--
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14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
—O
LOCATION SKETCH — 2
Show direction and distance in miles frorot at I st
two State Roads or County Roads. Include t - ea
numbers and common road names.
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CONSTRUCTION STANI
'FHA]
)ARD
THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
AND THAT A COPYn^
OF'THIS
ARECORD HAS BEEN PROVIDED TO THE WELL OWNER
R fblAPP.OtLIIhCFi ,j1t:
-27694-163$Pftone No:
he D
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
vision of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
-3221, within 30 days. GW-1 REV. 07/2001