Bu 3 CY2002

251060
2. WELLLOCATI,N: �lilJ�C//tQQEi
Nearest Town: O�.W�pC�it4NICIJKi.., County `)
/Po LI&b Ues �
(Street Name. Number, Community, Subdivision, Lot No., Zip Code)
3. OWNER: )0et (7) &2.- af'')CS
(Street or Route No.
C(a)a,NA NOR /1VC,
City or Town Site Zip Code
Area code- Phone mimes:
4. DATE DRILLED 3-2X'02
5. TOTAL DEPTH: Li 62'
6. DOES WELL REPLACE EXISTING WELL? YES D NO (9
7. STATIC WATER LEVEL Below Top of Casing: FT.
(Use "1-- if Above Top of Casing)
8. TOP OF CASING IS 3 / FT. Above Land Surfaces
`Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 1C .0118.
9. YIELD (gpm): METHOD OF TEST
10. WATER ZONES (depth):
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Naty9l urceS - Division n o Water Quality GroCERundwater
Section
Noon /
WELL CONTRACTOR (INDIVIDUAL) NAME (print) KK �t Cf �j n
WELL CONTRACTOR COMPANY NAME .c4 cDACC 0 PHONE a% )JGY� / �7s'
STATE WELL CONSTRUCTION PERMITA (i f soolicable)
(if applicable)
ASSOCIATED WQ PERMIT%
1. WELL USE (Check Applicable Box): Residential 0 Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring Er -Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
Topogtapphic/Land setting
DRidge ope DValley DFlat
(check appropriate box)
Lctitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:DGPSDTopographic trap
(check box)
DEPTH pRILLING LOG
From To -iG' F 2 cdation
J7Cr
11. DISINFECTION: Type
12. CASING:
From__De tb Ft.
From To Ft
From To Ft.
13. GROUT: Depth
From 0 To 3 7i Ft
From To Ft
14. SCREE Depth Diameter Slot Size Material
From C �' To "C,' Ft. ,�.'� in. O. o/ in. ,Sf
From To
15. SAND/GRAVEL PACK
Depth LSi
From 3 Lf' To � Ft.2
From To Ft.
16. REMARICS: 2-' tBei/TO'v1 / eal 3 2' To 3 Lh I
I.DO HEREBY CM WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
Amount
Wall Thickness
Diameter or Weight/Ft „Material
. rc�f0 /L
Afa erial
Fog. 71.4ALD
A1etbod
Pout
Ft. in. in.
Material
.SL ca. S4Ati)
CONSTRIJCfIpNIST
Submit :at original t
e No.
THAT
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.
TAC_'YC= T:USRECORD 11.SBEEN PROVIDED TOTIE WELL
NER
©Z
3-
SIGNATURE OF PEON CONSTRUCTING THE WELL DATE
the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
919) 733-3221, within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Na esources - Division ofWaterQuality - Groundwater Section
/y
( 6 m itt /� CERTIFICATION # /rfL to / /�7 �+
WELL CONTRACTOR C(IOMPANY
NAME) NAME (print) a r / c ^ PHONE # %7 )SG7' 9/7�i
WELL CONTRACTOR COMPA.`fY � 'l G1J l..W
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable)
(if aoolicabie)
251061
1. WELL USE (Check Applicable Box): Residential 0 Municipal/Public 0 industrial ❑ Agiculturat 0
Monitoring Er Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. LOCATION
15 CC-D L s -lre ' eD,
(Street Name, Number, Community, Subdivision, Lot No., Zip Code)
Address�}�-(Street or Route No.)
(1)CLNAnN0/I /V C ,
WELL
Nearest Town: WahttJQ I.. County l>tthlCiMR
City or Town State / tip Code
L�-
Area code- Phone number
4. DATEDRILLED �`ne-0a--
5. TOTAL DEPTH: LI '
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO GY
7. STATIC WATER LEVEL Below Top of Casing: FT.
r (Use "+" if Above Top of Casing)
8. TOP OF CASING IS 3W FT. Above Land Surface"
*Top of wing terminated at/or below land surface requires a
variance In accordance with ISA NCAC 2C .0113.
9. YIELD (gpm): METHOD OF TEST
10. WATER ZONES (depth):
Topographic/Land setting
❑Ridge ItQSelope OValley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutesheconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH pRILLING LOG
From To Formation Descripcion
O Li 11 oe N s,
4122 44
11. DISINFECTION: Type Amount
12. CASING: Wall Thickness
Depth..., Diameter or Weight/FL Material
Ft. :Z:' ,�:1, 90 +:iv
To Ft
To Ft.
Depth_ Material h Method
To `�cj Ft. }eT✓+ND l-but
To Ft.
Depth Diameter Slot Size
From
From
From
13. GROUT:
From
From
14. SCRE
From 9 To Lf•4' Ft. 9 " in. O. o m.
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
.SYA/NC e,S
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
''7' To_t_L Ft7O SsttC&,.-,iArlh
From
From To Ft
>
16. REMARKS: 2' IleNToN rfe- L?S -3 C' TOY?'
0
oa
IDO HEREBY,frEit THAT 1-a/ WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
---_CONS-TRUCHON,sT ACC 0= THIS F=CORD}LASBEEN PROVIDED TO THE WELL OWNER
3-2r ©2
SIGNATURE OF PEON CONSTRUCTING THE WELL DATE
nal to the Division of Water Quality, Groundwater Section,1636 Mail Service Center - Raleigh, NC
otNo. [phone], within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Nap!
essources - Divvistion of Water Quality - Groundwater Section
/y
WELL CONTRACTOR (INDIVIDUAL) NAME (print) I\IILr�OC^1�6'^/'` i( L'-e CERTIFICATION
)#'d`-t� /(�J
SHGL 7l l� PHONE # )JO7's9/7_c
WELL CONTRACTOR COMPANY NAME
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 LOCATI N: _
Nearest Town: /PO cR-b j 7 ' . , County l3l ttJCIl110dSF�
(Street Name, Numbers,,Community, Subdivision, Lot No., Zip Code)
3. OWNER: F P/'net cheer -Kg -ram
Address /b O(M aee✓ /C=fir
(Street or Route No.)
SWa,NAla NOil AAC
City or Town State Zip Code
Area code- Phone number �`-s` O�
4. DATE DRILLED L 2
5. TOTAL DEPTH:
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO [gam
7. STATIC WATER LEVEL Below Top of Casing: FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 3 / FT. Above Land Surface*
*Top of casing terminated atlor below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): METHOD OF TEST
10. WATER ZONES (depth):
Topographic/Land setting
❑Ridge 17Srlope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
Foj ation ../W Ltjon
awc/LMp4,e ite/
/toe.
DEPTH
Fri �0
wit C2'
11. DISINFECTION: Type Amount
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. ilariai
From 0 To 5/7' Ft. Z„ _ ,5c`n ?tit
From To Ft.
From To Ft.
13. GROUT:_Depth aterial Method
Frotr-3_ To S�' EL roeND 1 j i r' )
From To Ft.
14. SCREEN- Depth Diameter Slot Siie Material
C/
From .1 1 To 6 2. Ft. 2' in. a 0 / in. laintgNL2S
From To Ft. in. in,
15. SAND/GRAVEL PACK
Depth Size Material
From S.< To t aL' Ft.. ` Si L t CA, S4AD
From To Ft. 16. REMARKS: X B€MTOo 6,. ?S fl'Ttr3 JJ /
WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
TAC THIS RECC'RD HAS BEEN PROVIDED TOTHE WELL OWNER
' I DO ITREBY sCER'
L L CONSTRUCTION S
u4,
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.
3-2?T 02.
SIGNATURE OF PE ON CONSTRUCTING THE WELL DATE
L_ Sublmc .Ie ongin\al to t a Division of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
ti'27699 1618Phi as No. (91 ) 733.3221, within 30 days. GW-1 REV. 07/2001
L LL ------i—=i

2. WELLLOCATI.QN:
Nearest Town: 5waaNICtMt , Counti 1�
I bb GC.b 86Pi n ea,
(Stet Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: 6:00/eAddress /?r1) O see ee 1:1).
(Sheet or Route No.,
sIA)(LNA/07\1O)9 C
City or Town State / Zip Code
1 -)-
Area code- Phone number
•
4. DATE DRILLED a-E.. -0 2-,
5. TOTAL DEPTH: )--„5
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO G-
7. STATIC WATER LEVEL Below Top of Casing:
3 r (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
10. WATER ZONES (depth):
11. DISINFECTION: Type Amount
12. CASING: Wall Thickness
or Weight/Ft. Material
$01.4.0 PUCE
Dept} Diameter
From n To___.., Ft. a. -
From To FL
From To Ft.
13. GROUT: Depth
From To i Gc' Ft.
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From�To / Ft_1L—in. ii.0/ in. -VA tNL¢-S
From To Ft. in.
15. SAND/G+RAAVEL PACK Size MaterialI 0 Tot_Ft2q, S..../ i,i c& SA AID
Material Method
eoRTC ott) / E r Y✓1 /
WELL CONSTRUCTION RECORD
Northaroma
C i Department of Environment and Nat}tnll esources - Division of Water Quality - Groundwater Section
K
-ep
�
^�e�am����
/� WELL CONTRACTOR (INDIVIDUAL) NAME (print) . or17/7L-6
WELL CONTRACTOR COMPANY NAME
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT*
fwolicable)
(if applicable)
2511162
CERTIFICATION/8 d6 �
f C
PHONE it %7 )S07/`-J / I /X
1. WELL USE (Check Applicable Box): Residential ❑ Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring [Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
Topographic/Land setting
❑Ridge Ctlope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
TFormation Descriptipn
From / ��.eveP� 1 6/e-s
< ,9a.9.e<,fe..—,
From
From
To
in.
16. REMARKS: 2,1 3vNTJN1fe--10" 1 p S
UarcEktm
CCI6NIi'
l«o'To /t
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and conunon road names.
0
z
WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
AT A C.:2I 71-CS PECCRD HAS SEEN PROVIDED TO TIE WELL OWNER© 2
SIGNATURE OF PE t ON CONSTRUCTING THE WELL DATE
Submit Lie on final o the Division of Water Quality, Groundwater Section, 1636 Mail Service Ceenterl Vg07NC
gF;)i '6994F636 Phddefib. (919) 33-3221, Within 30 days.
ASHE',I11E R`G'OtiAL OFFICE

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural
WELL CONTRACTOR (INDIVIDUAL) NAME (print) I imfl
WELL CONTRACTOR COMPANY NAME
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT%
(if aoplicable) (f applicable)
1. WELL USE (C ck Applicable Box): Residential 0 Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
25111E3,
Itiesources - Di ision of Water Quality - Groundwater Section
U Lee, nv'i'-t.S CERTIFICATION # 0/01
PHONE # f I) G(ciS
2. WELL LOCATION: \itJQNOP
Nearest Town: ll�� County SIAO%ilf) I i%d n e ` "tree, •
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: l 1^'\ ON :C.-
Address SAD O� a- (1-fee KCX
(Street or Route No.)
5' 1)Jr\ 00.. anc..t NC
City or Town State
Ara code- Phone number
4. DATE DRILLED C3—rXd-09.
5. TOTAL DEPTH: 3g
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 0
7. STATIC WATER LEVEL Below Top of Casing: FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS Fa 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. WATER ZONES (depth):
26�g
Zip Code
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)
pax pB1LLING LOG
From To BAN aSH-5 (})p o S Some 70
11. DISINFECTION: Type Amount
12. CASING: Wall Thickness
orWei L Material
ataS
Depth Diameter
From fD To l.R Ft. 2—
From To Ft.
From To Ft.
13. GROUT: Depth
From 0 To aU Ft. o
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.
tyethod
l�icw-M. Fek
14. SCREEN: Depth Diameter Slat Sac Mzteenal From rqSS To Ft. 2 in i n in. _,a (e 55
From To Ft. in. in.
15. SAND/GRAVEL PACK
Depth Size Material I.
From 026, To_Z&Ft. 7r� p"c1
From To Ft.
Kt Cs
_o
cn
CO Qn
r7
0 CI
fry
Ill XI
-1
0
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15ANCAC 2C, WELL
COGISTRICZ(NDARDS, T A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
rr f N
SI ATURE OF ON CONSTRUCTING THE WELL DATE
Submit rlie a Iasi o the Division of Water Quality, Groundwater Section,1636 Mail Service CenterGW-1 RHV- gb, NC
27699-1636 Ph a ie No. [phone], within 30 days.
GROUP DWA ER'SECTION
ASHEVILLE REGIOKAL OFFICE

251064
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources-ijtsion of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) NM rr k LetDiDt j• n cS CERTIFICATION % Z/01.
C,I� r+ PHONE It f -4u4 4/q S
WELL CONTRACTOR COMPANY NAMEt' )t"kr ��
ASSOCIATED WQ PERMIT%
STATE WELL CONSPERMIT% if an licable)
(if ao livabcab lee))
1. WELL USE (C)eck Applicable Box): Residential 0 Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION: A�Or 1_
Nearest Town �:pp - /.) County 6IA 1J & L\3
IfS fl4. ` e`ilr2e- i��fI� .
(Street Name, Numbers, Community, Subdivision, Lot No., hip Code)
3. OWNER: klbeeN � S)
Address IRO 016 X
(StreetorRoute No.) 1-g/� ` fi W
3tanv aNnr r C D
City or Town Star Zip Code
Area cede- Phone number -
4. DATE DRILLED 3-2-fl
5. TOTAL DEPTH: 51
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO lV
7. STATIC WATER LEVEL Below Top of Casing:
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS rQ r Rt 1i FT. Above Land Surface`
flop of caslog terminated actor below land surface requires a
variance to accordance with 15A NCAC ZC .0118.
9. YIELD (gpm): METHOD OF TEST
10. WATER ZONES (depth):
11. DISINFECTION: Type
12. CASING: Depth Diameter
aetet
From__a_To_lca—Ft 7Il /i
From To Ft.
From To Ft.
13. GROUT: Depth MatF i l
Ant
Ram_LTo FL fF
From To Ft.
•
14. SCREEN: Depth Diameter Slot Sii
From To ,Sir in.
From To Ft.
Amount
Wall Thickness
or Weight/Ft. Material
Are,
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)
DEPTH DRILLNG LOG
From To FormationDeseriotion
Desertion
Method
I /�tn..wif
—ga �s I{5 C�ayS
S 'rw2
c K
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.
Ivppterial
S ?n1leSe
in. in.
15. SAND/GRAVEL PACK: Depth S e 1SK,{tu
hN To -5I FL ;A
From
From To Ft.
16. REMARKS: i r t 7e4) K`A)`'F
I DO HEREBY CERTIFYTHAT IS WELL WAS CONSTRUCTED INACCORDANCE W111-I 15ANCAC 2C, WELL
CONSTRUCTION
N
0
CO
21.
SPA CN \-o SP C1
ARDS
, AlDSATHAT C PY OF TH1 RECORD HAS BEEN PROVIDED TO THE WELL OWNER
1 n Cam~ DATE
ATURE OF PERSON CONSTRUCTING THE WELL
inal to the Division of Water Quality, Groundwater Section,1636 Mail Service Ceenterl RRfiVgh, NC
e No. [phone], within 30 days.
GR' ND GP:
.rASEIEViLLE --

/ j
WELL CONTRACTOR (INDIVIDUAL) NAME (p l t� r�� I ram' CERTIFICATION # o 3
t.
WELL CONTRACTOR COMPANY NAME
ASSOCIATED WQ PERMIT#
STATE WELL CONSTRUCTION PERMIT# __ (ifapplicable)
(if aaPiicable) — -
I. WELL USE (Check 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: Topographic/Land setting
Nearest Town'.�,, �u� ngrt0a. Coupty h�Mbit❑Ridge ❑Slope ❑Valley ❑Flat
18 C) e 1 �1 �� I Zee ] (check appropriate box)
(Sheet Name, Numbers, Community, Subdivision, Lot No., Zip Code) Latitude/longitude of well location
3. OWNER: f30%1t'C 20 fl l CS
Address IRo cld &e- 1-tCt grt
(Sheet or Route No.)
SfalarartY\dOl N.C� '
City or Town State Zip Code
(_J
Area code- Phone number 1 _ O
4. DATE DRILLED .3 -a
5. TOTAL DEPTH: 617
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
itir
7. STATIC WATER LEVEL Below Top of Casing: FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surface`
'Top of cuing terminated at/or below land surface requires a
variance In accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): METHOD OF TEST
10. WATER ZONES (depth):
Amount Show direction and distance in miles from at least
11.2DISINFECTION: Type two State Roads or County Roads. Include the road
12. CASING: Wall Thickness
Depth Diameter or Weighr/Ft aterial numbers and common road names.
From a To 57 Ft. 2o C
From To Ft.
From To Ft.
13. GROUT: Depth Mat al 1 Method
From 0 To s3 Ft. ml�i' A Yl2smm/e=
From To Ft. NI `o
14. SCREEN: Depth Diameter Slot Kin �U R
SS
From S7 To 6 7 FL2o _in. ,.. in. lJ
From T
WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
�1►65
rfnt)A n (' r!
SAEllti C0 PHONE # T%Oth SW-1— Ig3-
(degrees/minutes/sewnds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
Formation Description
DEPTH
From To
-67
o Ft. in. in.
15. SAND/GRAVEL PACK:
Depth S`je
From .rS To /n% Ft. -a ?,
From To Ft.
Material
SALDD
LOCATION SKETCH
s� cc/lac-Le-4
Mote
O
c
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WFT L WAS ON ACCOFtDANCE WITH 15A NCAC 2C, WELL
PY OF S ORD HAS BEEN PROVIDED TO THE WELL OWNER
u t J-,z1 —O0Z
DATE
SIGNA ' •' PERSO CONSTRUCTING THE WELL
CONSTRUC(IO N3 ��NDARDS, AND
Submit the original t
_11699-1636 Phot a No.
f 0 Pi
L OFF:CE
the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
19) 733-3221, within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
Department of Environment and tu;al Resources - Division of Water Quality - Groundwater Section
�-r�
North Carolina - Dep i�
L L �yvv 1 r-e> CERTIFICATION # ate% 3
p
d JffL�'O PHONE # ort) COL-1—ckI'N
WELL CONTRACTOR (DNDEVTDUAL) NAME (print) WELL CONTRACTOR COMPANY NAME (1 A T� g
STATE WELL CONSTRUCTION PERMIT#
ASSOCIATED WQ PERMIT#
(if applicable)
1. WELL USE (Chet plicable Box): Residential ❑ Municipal/Public 0 Industrial ❑ Agricultural ❑
2. WELL LOCATION: Cork
Nearest To • i Q Couj yg kX.
/to o See -Mee, 42'
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
Monitoring ecovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriam box)
Latitude/longitude of well location
3. OWNER: ( hC r n
Address /$n A 04 e.e
(Street or Route No.)
City or Town Sate Zip Code
1 )-
Arta code- Phone number ri
4. DATE DRILLED ^ 2 ! d
5. TOTAL DEPTH: `P'S
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO lTd-
7. STATIC WATER LEVEL Below i op of CCaz ing:op of Casing)
8. TOP OF CASING IS FT. Above Land Surface'
`Top of using terminated actor below land surface requires a
variance In accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): METHOD OF TEST
10. WATER ZONES (depth):
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
Formati9 Description
DEPTH
From
11. DISINFECTION: Type
12. CASING:
Depth Diameter
Fro m____O__To 35 Ft. A
From To Ft.
From To Ft.
13. GROUT: Depth nMa(e}�al Method
•
Front+ O To 3 ( Ft. YOQ�fld./t^CI) '11PemM1t
From T
LOCATION SKETCH
Amount 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.
sck I�YS...
o Ft
14. SCREEN: Depth Diameter Slot Size Mattor'al
From__To LirFt a in. «olD in. `Y
From To Et in. in.
15. SAND/GRAVEL PACKDepth , h(aten
From � 3 �
To VS Ft. Z f 11
From To Ft.
16. REMARKS:
GROUfJMR1,:h
PSHEVILLE REGIONAL OFFICE
Submit the original
ne No
(if ap lip cable)
Sze. OA4aJ rez)
?yap
N
b
CO
Jy
MC
t'%
ti
THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WEITs s
ARDS, a - OEY F THIS RECO + iL EEN PROyIDED TO THE WELL OWNBA
SIGNA ' OF PERSO %.NSTRUC LING THE WELL DATE
o the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
[phone], within 30 days.
GW-1 REV. 07/2001

.251067
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print)71sCJAM L tere CERTIFICATION#359-3
WELL CONTRACTOR COMPANY NAME SPE D acce PHONE # (N) Celt) -01IGS
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check licable Box): Residential ❑ Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ecovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION: rz
Nearest Town .7c^Y1fl Pi CO. County 53tAt1
/-o o iJ act L2e,e 'KA
(Street Name. Numbers. Community. Subdivision, Lot No., Zip Code)
3. OWNER: ��rjln-fY✓ti. Yl ICJ
Address /a'0 o/a/4eR- %%t2-e Act
(Street or Route No.)
SWaArian oG.
City or Town State
(—)-
Area code- Phone number 4. DATE DRILLED 3 - ,,ZO J O L
5. TOTAL DEPTH: V%
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO CY-
7. STATIC WATER LEVEL Below Top of Casing: 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 I5A NCAC 2C .0118.
9. YIELD (gpm): METHOD OF TEST
10. WATER ZONES (depth):
Topographic/Land setting
❑Ridge ❑Slope ❑Valley L9fi�
(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 DescriptionSAND
CJ -- 3o IS r2sJuJN S.
30 Y'2 64Aor.r#7..- K
Zip Code
1 I. DISINFECTION: Type Amount
12. CASING: Wall Thickness
Depth Diamyter or Weight/Ft. Material
From 0 To 3Z Ft. a - Sc�. Lie
From To Ft.
From To Ft.
13. GROUT: Depth tt--�� Material Method
From 0 To �$ Ft.soS2-f' 6k.v•CA.
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From 3), To 4 Z Ft. in. <5 (D in. PVC
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From 3a To LZ , Ft. a .SA Nt
From To Ft.
-a. '
'T PC,m
>rl
Ir
b 1�
„ot7
0 f
n�
Show direction and distance in miles frmrygt,leas=
two State Roads or County Roads. Include the rot
numbers and common road names.
LOCATION SKETCH
st..e. a-h4at Xcd
Rae
\-.-ci?,L
---�L�EE1, ri: iiii ,\: �RIeI � HAT THIS WELL W
CONSTRUCTION STP r. R�
i IG ATU .F " li
_—J
i hWaCi-OaLtu th Division of Water Quality, Groundwater Section, 1636 Mail Service Center- Raleigh, NC
Y t o. 733-3221, within 30 days. GW-1 REV. 07/2001
0-BOLUS
ASHEVIL
CONSTRUCTED IN ACCORDANCE WITH 15ANCAC 2C, WELL
OPY OF T S RECO AS BEEN PROVIDED TO THE WELL OWNER
Ot'STRUCTINGTHE WELL DATE

251068
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) RICy1t/ 1. Lernire CERTIFICATION #
AM
WELL CONTRACTOR COMPANY NAME SHEDAC_Co PHONE # (,`F) Soo
STATE \YELL CONSTRUCTION PERMIT# ASSOCIATED \VQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Che 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 TownSwannav'OO_ County k3Uheomb�
/PO O/c/ ete- We<R.
(Street Name. Numbers. Community, Subdivision, Lot No.. Zip Code)
/
11�
3. OWNER: ell-eredieYIl G S
Address /80 O/d 4-e.2 I.222 RA
(Street or Route No.)
S LOOrfil AA/1rTCt A.iC •
City or Town State Zip Code
( )-
Area code- Phone number
4. DATE DRILLED 3 —a0-0X_ 3310
-13 0r,0
5. TOTAL DEPTH: �I-1 r I
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 8� —� z =t
rn
7. STATIC WATER LEVEL Below Top of Casing: FT.
(Use "+" if Above Top of Casing)
S. TOP OF CASING IS _3 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. WATER ZONES (depth):
Topographic/Land setting
❑Ridge ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:DGPSDTopographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
a — ,70 fro n 1 SAND
30— 41 C�varkav c%
11. DISINFECTION: Type Amount
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 31 Ft a _51102I6 _ PVC,
From To Ft.
From To Ft.
13. GROUT: Depth Mi terial Method •
From O To a,-1 Ft. PoRT kar c T,eo,rn 1-es.
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From 31 To 4 ( Ft. Xi' in. •c1I0 in. eal
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From •Rci To 4• I Ft. a 2— Srii3
From To Ft.
16. REMARKS:
E3 H R
A
>m
y0
am
5 ill vie
rn
u
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.
kHAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
AVD'(PAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
3 - 2a --C
SI NATE'F PticaON CONSTRUCTING THE WELL DATE
1 to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
PSHEVILLGROU"i_ �1g �? �`9:SL �� o. [phone], within 30 days. GW-I REV. 07/2001

251n69
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) /� (Cl/ V LV Leon 1Y-C CERTIFICATION # a 7
\V ELI. CONTRACTOR COMPANY NAME .5AE °P&L° PHONE # fMtl S6kit -q(q-
STATE \YELL. CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
I. WELL USE (Check plicable Box): Residential 0 Municipal/Public 0 Industrial ❑ Agricultural 0
Monitoring ecovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: S wan n 0.h0O. County Blnn coinnk
'Po 0% gee-
-rat ded
(Street Name, Numbers. Community, Subdivision, Lot No., Zip Code)
3. OWNER: e }AI n /C S
Address /70 O/r) Ace
e� (Street or Route No.)
LOannccn oa_
City or Town State Zip Code
( )-
Area code- Phone number
4. DATE DRILLED •3'-19.-Oz
5. TOTAL DEPTH:
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO -
7. STATIC WATER LEVEL Below Top of Casing: FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS r: 3 FT. Above Land Surface*
*Tup of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): METHOD OF TEST
10. WATER ZONES (depth):
11 DISINFECTION: Type Amount
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From (3 To 33 Ft. c)" Se-i\Leo PVC,
From To Ft.
From To FL
GROUT: Depth
From G To )9 Ft.
From To Ft.
SCREEN: Depth
From 33 To t-13
13
14
15
Topographic/Land setting
❑ftidge ❑Slope ❑Valley
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From 0 To Forma ion Dq ription
so —(743 SCA/JD-4C%-*AZ
LOCATION SKETCH
Show direction and distance in miles from at Least
two State Roads or County Roads. Include thud
numbers and common road names.
Mat riy11 (t Method ,
)24_9-0.NTl 1-2
Diameter Slot Size Material
FL r-in. • O la in. fVC.
From To Ft. in. in.
SAND/GRAVEL PACK:
Depth Size Material
From 3 I To C4 3 Ft. t=t. a SFi 1N
From To Ft.
16. REMARKS:
•Sa
cai-froJid
kap
HbREI}IIY �- Iif,Y
[C STIIOCtfIO'(YS
j THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CORD HAS BEEN PROVIDED TO THE WELL OWNER
•
Submit the original to he D
6f..', 9,a0I09 9) 73
ASREVILLE REGIONAL OFFICE
SIGNAT
T A COPY OF THIS
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

WELL CONSTRUCTION RECORD 251070
North Carolina - Department of Environment and NaturalRes
ources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) P I (31 y L L em Ire CERTIFICATION # ZS 93
WELL CONTRACTOR COMPANY NAME rSA e DA
f co PHONE IS J7°1) rag -919C
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential 0 Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring ecovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION: Nearest Town:S 0.^'-ta `O0. �a Corny I l (Art CO in it/yo 6/c/ 2se.-tea-e. EcY
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: (1 hem 4 rto
Address 1 So (Ad, I'-e e_ 1' 11.2-e . Rd
(Street or Route No.)
]wo. n A0.VvoO. (4%C„)
City or Town State Zip Code
Area code- Phone number
4. DATE DRILLED 3 - ,q --0 2
5. TOTAL DEPTH: 21
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 3 FT. Above Land Surface'
'Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): METHOD OF TEST
10. WATER ZONES (depth):
Topographic/Land setting
❑Ridge ❑Slope ❑Valley -
(cheek appropriate box)
Latitude/longitude of well location
(degrees/minuteslseconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Descri .on - ��D
Q 25 rou.Jr
9 - 29 t n .SA,4 0
11. DISINFECTION: Type Amount
12. CASING: Wall Thickness
Depth DiCrrteter or
From © To /? Ft. L. 5
PVC -
From To Ft.
From To Ft.
13. GROUT: Depth Material Method ,
From o To /3 Ft. ?oA,tkv" JR-erntmi-Q
From To Ft.
14. SCREEN: Depth Diameter Slot Siu MaterialC
Frotn_I 1 To 2.1 Ft. 2" in. - O I in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From 15-To on Ft. is z �J°iN N.
From To Ft.
16. REMARKS:
b
Oo
LOCATION SKETCH
Show direction and distance in miles from at Mt
two State Roads or County Roads. Include the road
numbers and common road names.
see, cxacted
Map
T THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15ANCAC 2C, WELL
S, AND T A COPY OF S RECORD HAS BEEN PROVIDED TO THE WELL OWNER
q�dz
ivision of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
3-3221, within 30 days. GW-1 REV. 07/2001
0
0
0
rn rn
a0
c
0<
>0
rrt o
7,("I
mz
ra
—4
0
z

251071
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) -Rt j 4 L .-e-n^ Ire CERTIFICATION # x�3
WELL CONTRACTOR COMPANY NAME SA € D� CCO PHONE # I rv4 rbu -9lqS--
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ❑ Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ecovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION: o
Nearest Towir n vt o4 - 00 County 13 tan en on19-2.
18c) o lc fB-ee f 2.-ex... 3Kx1
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: C V12.m412nn I CS
Address LS70 B2—C-t2,e.e- kel
(Street or Route No.)
SLAD avtI'vo..t-‘ CL A%�C-�•
City or Town State Zip Code
Area code- Phone number
4. DATE DRILLED — I Q -O
5. TOTAL DEPTH: 2.1
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO 19---
7. STATIC WATER LEVEL Below Top of Casing: Ff.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 3 FT. Above Land Surface'
`Top of casing terminated actor below land surface requires a
variance In accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): METHOD OF TEST
10. WATER ZONES (depth):
Topographic/Land settin
g
❑Ridge ❑Slope ❑Valley at
(check appropriate box)
Latitude/longitude of well location
(degtees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
aEaM. DRILLING LOG
From To Formation Description
©—a I
Si 1 p1A
Ca
Q
721
LOCATION SKETCH 9
11. DISINFECTION: Type Amount Show direction and distance in miles from at leeet
Wall Thickness two State Roads or County Roads. Include the cad
or Weight/Ft. M terial numbers and common road names.
1-1• 40 t1'C
12. CASING:
Depth Diameter
From ® To !I Ft. a
From To Ft.
From To Ft.
13. GROUT: Depth
From 0 ToFt.
From To Ft.
14. SCREEN: Depth Diameter
From / j To a I Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
From q Depth
a 9 Ft. S Z
Matq&ial1 Method
Pc, /LT taut("% Tpefr rntz,
Slot Size Material
.bit in. VC
in.
From To Ft.
16. REMARKS:
SR e a+facited
1 1 tEl L( 1 EY G&RT` Y IRA
}l/ I CONSTRUC f ION Si AN
.nn^
THIS WELL W
SIGNA
CONSTRUCTED IN ACCORDANCE WITH 15ANCAC 2C, WELL
OPY OF TF3lS RERD HAS BEEN PROVIDED TO THE WELL OWNER
lit--az
PE 1 SON CONSTRUCTING THE WELL DATE
G c e g o the D vision of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
AS1-'276914686'nazis I FaJ(g9) 733-3221, within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) WI C-A.(1 L I—eryn (V CERTIFICATION a as43
WELL CONTRACTOR COMPANY NAME SAC' DA ii 0 PHONE a PS O V - 9 rig
STATE WELL CONSTRUCTION PERMIT,/ _ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
251072
1. WELL USE (Check =cable Box): Residential 0 Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring ecovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION: 11�
Nearest Town: Stk rn Hn oxcLO CountyE uCA t+'1 Ch
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: CA ✓1-1-4Ron (C S
Address ,'Sc) O /CI
(Street or Route No.)
cldu, inart Oa /VC
City or Town State Zip Code
(--)"
Area code- Phone number O
4. DATE DRILLED 3— l9 -
5 TOTAL DEPTH: .43
KC7
Topographic/Land setting
❑Ridge ❑Slope ❑Valley at
(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 D scription
o -/3 /net Ever SAS
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO G,
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 casing terminated at/or below land surface requires a
variance In accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): METHOD OF TEST
10. WATER ZONES (depth):
11. DISINFECTION: Type
12. CASING:
Depth Diameter
© To .� Ft. P.
From
From
From
13. GROUT:
From O
From
co z
LOCATION SKETCH cmi
Amount Show direction and distance in miles from atajst ='
Wall Thickness two State Roads or County Roads. Include the road=
or Weigh M eri numbers and common road names.
To Ft.
To Ft.
Depth PMatgripl d n Method
To_ Ft. O2 vI o ‘Ns tf�
To Ft.
14. SCREEN: Depth Diameter Slot Siie Maur= l
From._ ToFt _a_in. '0(0 in. '�/�J
From To Ft. in. in.
15. SAND/GRAVEL PACK:Dep1
From c Tota i 3 Ft. S zE Z J ND
From To Ft. I�
//a -weed
i �IPiIj iA TT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION ST �ANb r 'e' a A COPY OF S RE RD HAS BEEN PROVIDED TO THE WELL OWNER
'202' 3- l? -0 a
IGNA
OF PERSON CONSTRULIING THE WELL DATE
A a 'e, ` gma the 7ivision of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh,
NC
one No. (9I9)13-3221, within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD 251073
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
�s
WELL CONTRACTOR (INDIVIDUAL) NAME (print) 1 CL L L ' 1 1 Y - CERTIFICATION # 2 �--<
WELL CONTRACTOR COMPANY NAME SA E01 (i ,a PHONE # (iO4 stU Q 1 Ci'
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable)
(if applicable)
1. WELL USE (Check Box): Residential ❑ Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ecovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION: n/�
Nearest Town:S DNA nf0r\00. County PM/I QO M be
/20 6/Cl/ dee 7E-/ZRe EC,
(Street Name, �Numbers, Community/ Subdivision, Lot No., Zip Code)
3. OWNER:f bek"c o/L/C
Address Jib o/ Rye Y1C C-
(Sheet or Route No.)
ntt0 vi 00.
City or Town State Zip Code
Area code- Phone number ice ^ O�
4. DATE DRILLED 3
5. TOTAL DEPTH: ..2, 3
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: Fr.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS ,S 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): METHOD OF TEST
10. WATER ZONES (depth):
r
Topograplaitting
❑Ridge pe 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 Descripti1-)1 S
�3 --a`> POOL �^
`� O.YL,L
11. DISINFECTION: Type Amount
12. CASING: Wall Thickness
Depth Diameter or Weigh. Nhtgrigl
From 0 To 7-3 Ft. a -hh Wit
From To Ft.
From To Ft.
13. GROUT: Depth n()O&M'
Mate (j4ethod
From 0 To % Ft. ()O )4¢b
From To Ft.
14. SCREEN: Depth Diameter Slot Size Matp',ag1
From 13 To a3 Ft. in. • 610 in. j/V L
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth S'�e e
From // To a 3 Ft. 2— attp
From To Ft.
'OO
J
GROUf2' "�" tvinaltol
As
Ii
cn
zr^
rn CD
>o
y m�
-le
SScr',
r^'G
LOCATION SKETCH co o~
Show direction and distance in miles from at lease
two State Roads or County Roads. Include the road
numbers and common road names.
Stc, C17 /QGhe4
Mao
THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
3- /g.-o
F PERSON CONSTRUL t ING THE WELL DATE
he Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
9) 733-3221, within 30 days. GW-1 REV. 07/2001

North Carolina - Department of Environment, Health, and Natural Resources
Division of Environmental Management - Groundwater Section
P.O. Box 29535 - Raleigh, N.C. 27626-0535
Phone [phone]
WELL CONSTRUCTION RECORD
DRILLING CONTRACTOR: Geologic Exploration, Inc.
FOR OFFICE USE ONLY 3. 0 `f
QUAD NO SERIAL NO
Lat Long RO
Minor Basin
Basin Code
Header Ent GW-1 Ent
STATE WELL CONSTRUCTION
DRILLER REGISTRATION NUMBER: 1175 PERMIT NUMBER:
1. WELL LOCATION: (Show sketch of the location below)
Nearest Town: SWANNANOA County:
DEPTH
OLD BEE TREE RD.
(Road, Community, or Subdivision and Lot No.)
2. OWNER CHEMTRONICS, INC.
ADDRESS 180 OLD BEE TREE RD.
(Street or Route No.)
SWANNANOA NC
City or Town State Zip Code
3. DATE DRILLED 6-29-00 USE OF WELL MONITOR
4. TOTAL DEPTH 21.0 FEET
5. CUTTINGS COLLECTLD YES ( I NO IXI - r 0
6. DOES WELL REPLACE EXISTING WELL? YES I I NO I71 Q m
7: STATIC WATER LEVEL Below Top of Casing: FT f C r;
(Use "+ " if Above Top of Casing)
8. TOP OF CASING IS2.5 FT Above Land Surface* w
*Casing Terminated at/or below land surface is illegal unless a 'm
variance
is issued in accordance with 15A NCAC 2C .0118 �m
9. YIELD (gpm): N/A METHOD OF TEST N/A V,n-
10. WATER ZONES (depth): N/A 't9 "•
If additional space is needed use bac}F4 Medd.
11. CHLORINATION: Type N/A Amount N/A o
BUNCOMBE
DRILLING LOG
From To Formation Description
RED SILTY CLAY
21.0, BROWN SILT
c
n.
12. CASING:
wall Thickness
Depth Diameter or Weight/Ft. Material LOCATION OF SKETCH
From 0.0 To 5.0 Ft. 2 INCH SCH 40 PVC
From To
(Show direction and distance from at least two State
Ft. Roads, or othe map reference points.)
From To Ft.
13. GROUT:
Depth Material Method
From 0.0 To 1.0 Ft. PORTLAND BENTONITE SLURRY
From To Ft.
14. SCREEN:
Depth Diameter Slot Size Material
From 5.0 To 20.0 Ft. 2.0 in. .010 in. PVC
From To F:. in. in.
From To F:. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From 3.0 To 21.0 Ft. 20-40 FINE SILICA SAND
From
To Ft.
SN.f?. QI-c \Qe.-94
16. REMARKS: MW-1 BENTONITE SEAL FROM 1.0 TO 3.0 FEET
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THISIIfRECORD HAS BEEN PROVIDED TO THE WELL OWNER.
SIGNATURE'tF CONTRACTOR OR AGENT ~I I] ATE 6
GW-1 REV. 9/91
Submit original to Division of Environmental Management and copy to well owner.

255556
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natyrgl esour�C Divisionfilm
of Waatter Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) xp !t /( cr CERTIFICATION
# 2.67cam+
WELL CONTRACTOR COMPANY NAME Si! �/7�� PHONE # (f7 )\5b9 ?/7_J
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 Itriecovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATI N:
Nearest Town: vvaP1fJQNCC4.,
lh=0 Ca) &0 ea,
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: F&ne2 CHer✓l7ro/l/CS
Address /b 0(7) Qre,ree,e,
(Street or Route No.
Wa,NA!QnNO/f1 ' C .
City or Town State Zip Code
Area code- Phone number .1�0�
4. DATE DRILLED Lti `
5 TOTAL DEPTH:
(Dal
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO &
7. STATIC WATER LEVEL Below Top of Casing: FT.
t (Use "+" if Above Top of Casing)
8. TOP OF CASING IS 3 FT. Above Land Surface"
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): METHOD OF TEST
10. WATER ZONES (depth):
County tJCONS E.,
Topographic/Land setting
❑Ridge l[PSlope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTHDRILLING LOG
Fri Faon n
nO �/-.S`t
swA�A�9,ersf te"
&' Ca' /too(
11. DISINFECTION: Type
12. CASING:
Depth Diameter
From 0 To ,ve Ft. 2„ _
From To Ft.
From To Ft.
13. GROUT: Depth
From Q To S,'S Ft.
From To Ft.
Amount
Wall Tbickness
orr-Weight/Ft. Materialis L to }}��
,Material Method
ro,en 4 ND `TE r r e%
14. SCREEN- Depth Diameter Slot Size Material
From St To 6 2' Ft. 2•' in. 0. O d in.
From To Ft. in. in. fAwt€S
15. SAND/GRAVEL PACK:
Depth Size Material
From ,‘,.0 To K2' Ft. ,
From To Ft.
,/' BeedIO1J 11P--' On % .i)S ,c3'-ro ‘..
s,ct at, 54AW
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
CO
JUL 3 0
WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
T A C._ %'i O THIS RECORD HAS BEEN PROVIDED TO THE. WELL OWNER
3 - 2?3=02
z
SIGNATURE OF PE ON CONSTRUC LING THE WELL DATE
GROUNDIA411 terms final b the Division of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
ASHEVILLE RPIIIIdA4341FRIBEe No. '919) 733-3221, within 30 days.
GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and NaturaC1nki L eiVA 1 CERTIFICATION,/Q3l Resources - Division of Water Quality - Groundwater Section
I2_�
WELL CONTRACTOR (INDIVIDUAL) NAME (print) I � St 4 ��' ��
WELL CONTRACTOR COMPANY NAME �� t D A 0�.�
PHONE ,/
STATE WELL CONSTRUCTION PERMIT,/ „ASSOCIATED WQ PERMIT,
(if applicable) (if licable)
1. WELL USE (Check A licable Box): Residential 0 Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring covery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest To/wn' Sr✓o.n n o-h.^ County tR tn. n PI
—Le_
"N-
/VD O/LPn//Ya c --'tee tl[
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
L ./ 1 (degrees/minutes/seconds)
3. OWNER: C o oT �AJ/CS ' q
Address /f!o �� ?lac�frCe /� Latitude/longitude source:❑GPS❑Topographic map
(check box)
(Street or Route No� C DEEM )GRILLING LOG
SuCitor r`�/ tt� rmationDescriptip (+
City or Town State zip Code From To Formation0 — /9 R/1neun gine.,.SAND
251074
o ographic/Land setting
ORidgeThel Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(—)
Area coda Phone number
4. DATE DRILLED ,3
5. TOTAL DEPTH: /
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 0--
7. STATIC WATER LEVEL Below Top of Casing: l FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 3 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): METHOD OF TEST
10. WATER ZONES (depth):
11. DISINFECTION: Type
12. CASING:
Depth p Diameter
From To ! Ft. a
From To Ft.
From To Ft.
13. GROUT: Depth
From 0 To _ Ft.
From To Ft.
Amount
Wall Thickness
or
S3,WeiLk) . Material
V C
Mal4ez, } ethod O
14. SCREE Depth Diameter
From To / dr Ft. Ain.
From_ To Ft. in. in.
15. SAND/GRAVEL PACK:
g' Material
From Tod / 7 Ft. ' `L 3 A k) b
From To Ft.
16. REMARKS:
Slot Sim Mgterial
010 in. V
c
0
a
0 „'I
On
oc
2v
a —�
7C o
LOCATION SKETCH 6 ma
Show direction and distance in miles from at last
two State Roads or County Roads. Include the., ad o~
numbers and common road names.
ample
Sere_ a Qc/J
Il `,`1I77 I�
D �tl, IIDO I R13BY CERT1 I T THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA,/CAC 2C, WELL
• • ICTION ST a ,�a S, AND THAT A C a • F THIS RECORD HAS BE OVIDED TO THE WELL OWNER
SIGNATURE OF P
STR G THE WE DATE
G R, d , „ u @AlRo the ' ivision of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
ASP E27699-11434111tbbtaR61 019 7 3-3221, within 30 days.
GW-1 REV. 07/2001

—.-- y �
North Cnrollnn - Dopartmont of Envlronmonl and Nature! Resources • Division of Water Qualify • Groundwater Secllon 269997
c/ ..) JQ(J(J
•
rl
1636 Mall Service Canter - Relalph, N.C. 27699. 1636-Phone [phone] - rr
WELL CONSTRUCTION RECORD WELLCONTRACTOR. Be, Lk, ✓JJ. �Q �S
WELL CONTRACTOR CERTIFICATION N: ,Qa g
STATE WELL CONSTRUCTION PERMITN!
I. WELL USE (Check Applicable Box): Resldenllal l2" Municipal ❑ industrial' I Agrlcullural l I Monitoring I
Rocovery ❑ Hoed Pump Water Injection n 011ler [l If Olhor, List Use:
WELL LOCATI0 Show sRelch of Iha ocation below) RR ,�.''^^---- / ^
L Nearest Town; County' San C.-FJr/I( La
L er
Road N a and umbers. COIN ?uf lyLor 5�updlvlslan and Lot No.) DRILLING LOG
3. OWNER :.t-tt e o /5 d,0_49 Isom To
Address 717
tleag
Clly or Town p
4. DATE DRILLED /6'6-A
5. TOTAL DEPTH 30 5
6. CUTTINGS COLLECTED YES NOIA
7, DOES WELL REPLACE EXISTING WELL7 YES I I NO 4
8. STATIC WATER LEVEL Below Top of Casing: ..yO FT.
(Use'.' if Above Top of Caslnp)
9. TOP OF CASING IS I FT Abovo Land Surface'
•Top of casing ler minnled ,Vor below lend surface raoulres R variance In accor-
dance wllh 15A NCAC 2C I18
10. YIELD (gpm)' 0 METHOD OF TEST
11. WATER ZONES (dopih):
ea olTOo No.l� k
�•!� Zlp Coda
Slate
DEPTH
Fommllon Dascripllon
;CO
fV
Iv
tV
12. CHLORINATION:. Type \-T1 N
13. CASING:
Amounle5i-1 t IE
If additional space Is needed use back of form
Walt Thickkness �1,,, (n,.� DepihQQ FL plae nil rlo k,L_CS1aRial
From�To 00
Flom To Ft
From To Fl
14. GROUT: �/� /1
_ ,y 1 /
From . n To a _Ft Gh2E;Molliod
& j UKo ,L-�i`J) j t l O
Depth Malarial
Frorn To FI w
15. SCREEN: CA
Fri
Depth Diameter Slot Size Material no
From To Ft In In o
From __ To Ft In in v
From To FI In In
16, SAND/GRAVEL PACK: - IV,-
Depth Size Material — ES
=
From To FI
From To FL
17. REMARKS:
I DO HEREDY ERT.IFY THAT THIS WELL WAS C 11TRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCT( N STANDARDS, ANO TI TAT AA.OF�Y Y THIS RECORD HAS BEEN ROVIOEO TO THE WELL OWNER.
FOR OFFICE LSE ONLY
Quad No:
LOCATION SKETCH
(Show direction and distance Irom nl lead Iwo Slate
Bonds, or other map soloronce paints)
Submit prig
Uy.c OF PERSON CONSTRUCTING TIIE WELL DATE
Wan of Weier Duality, Groundwater Section within 30 days
GW.I REV. 12/99
S erlal No.

From
From To Ft.
14. GROUT:
North CarolIna - bar/adman! of Environment and Natural Resources - Dlvleion of Water Quality • Groundwater Socllon
1630 Mall Service Center - Raleigh, N.C. 27699-1630-Phone [phone] WELL CONSTRUCTION RECORD WELLCONTRACTOR• Bo bin/ LU • P +
WELL CONTRACTOR CERTIFICATION F(1a R
STATE WELL CONSTIIUCTION PERMIT,:
269995
1. WELL USE (Check nppllcrble Box): Residential I yr Municipal I 1 Industrial D Agricultural fl Monitoring n
Recovery [1 Float Pump Water Injection ❑ Other I] II Olhor, LIsI Use:
2. WELL LOCATION: IlroIw�sk-etch of the location below) R/ �� J
Ne hear Town: (/a/W/i�Q/11I ' County GW/)CO'h—,ZC_t
LitruLc
(Poed Name and - rwnunl_I nnq Lot No.)
3. OWNER ilf//- �1<.Cl/J.LL/� Cr„,, From To Fommllon Oxscdptlan
Address ,��V Ce /PC
(Sheol of Tloulo rram�.
ort Y1.C• Lif
City br Town Stale Zip Code
5, DATE DRILLED 5
S. TOTAL DEPTH ��
6. CUTTINGS COLLECTED YES NO vr
7. DOES WELL REPLACE EXISTING WELL? YES I 1 NOM
8. STATIC WATER LEVEL Below Top of Casing: zr FT.
(Use 'd If Above Top of Cesing)
9. TOP OF CASING IS I FT. Above Land Surface'
•Top of cuing le l mineted ,Vor below lend surlece requires it variance In eccor-
dence with 15A NCAC 2C .9116
10, YIELD (gpm)' /O METHOD OF TEST f r�
11. WATER ZONES (doplh)'
DRILLING LOG DEPTH
s
ti.
N
LJ
v
12. CHLORINATION: Type Amounted)
13.
13. CASING:
Wall TI Icknese
Depth pI meta eMaterial
From Tom— F, �s
0 ToJ/f7 FI /O ;6 JtT fey
Depths -a 0/1 Material ii Mol_ Ilod r
From n To 1asL_PI ]�.�`fT"�`�_'{—
From To FI
15. SCREEN:
ry
N
If additional space Is needed use hack of form
LOCATION SKETCH
(Show direction and distance born et least Iwo Slate
Roads, or oilier map rolorence points)
IN A -won-.'_
Depth Diameter Slot Size Malarial =
From To FI In In N "'=
From To FI In In CO <�
From To FI In In
16, SAND/GRAVEL PACK:
Depth Size Material
From To FI
From To FI
17. REMARKS:
1 DO HEFIEOY C913TIFY THAT TIHIS. WELt WA eON3 ,,
CONSTRUCTION STANDARDS, AND TI IAT A COPY19T FOR OFFICE US ONLY
Quad No:
Serial No.
CTED IN ACCORDANCE WITH 1SA NCAC 2C, WELL
IIS RECORD HAS BEEN PROVIDED TO THE WELL OWNEF1,
SIQN
Submit originalitW
nEr OF PERSON CONSTRUCTING TI IE WELL DATE
Ion of Wnler Duality, Groundwater Section within 30 days
GW1 nEV. 12l99

North Carolina • Dnparlmont ol Environment and Nolural Fleaourcea - Olvlelon ol Water Quality • Oroundwnlor Section
1 G36 Mall Servlce Cantor - Raleigh, N.O. 27699.1638-Phone [phone] -•
(( (n•
WELL CONSTRUCTION RECORD WELLCONTRACTOn• Bo bhi US. Pe-14s
WELL CONTRACTOR CERTIFICATION If: r4)a R
STATE WELL CONSTRUCTION PERMITN:
WELL USE (Check Appuc.hie Boa): Residential Lto Municipal ❑ Industrial ❑
Rocovery ❑ Hoe( Pump Water Infection ❑ Other n II Other, List Use:
2. WELL LOCATION' how sketch o e location below) �w,
County. �Cvl rC�+��l�
/6 / GC.� i
(nose Name and Nu en. Community, or Subdly on enddf.ol No,)
3. OWNER _4q�t�flcC. O � /
Address /N�-(/I/ 624e en/
or111>i o�
Hoarser Town' iC.{
/a/ kJalktu
City Dr Town �Jy sate
4. DATE DRILLED 7—/2'Q 2
5. TOTAL DEPTH -VOS
6. CUTTINGS COLLECTED YES( NOIS/r
7. DOES WELL REPLACE EXISTING WELL? YES NOM"
6. STATIC WATER LEVEL Below Top of Casing: (05 FT.
(Use •a• II Abovo Top of Casing)
9. TOP OP CASING IS l FT. Abovo Land Surlan&
'Top of ees In p le rmln riled sUor below land surface require. a vstiance In accor-
dance with 15A HCAC 2C. le
10. YIELD (gpm): P METHOD OF TEST
11. WATER ZONES (depth):
Zip Code
269993
Agricultural ❑ Monitoring ❑
GRILLING LOG DEPTH
from To
Formation Description
94y
�-yoSr��ckr
12. CHLORINATION: Type \ Amount kZpsJ S
13. CASING:
N
v
II addillonal space Is needed use hack of loan
Wall Tldckness LOCATION SKETCH
Depth PPlamelo r/yve p rU 1, Material (Show direction and distance from ni least Iwo Stale
FromTo �/ PI. (9 'A ��`�rl � �y�-JD{L Roads, or other :nap roioronce points)
Flom
Frani
14, GROUT:
From
Frorn
15. SCREEN:
To
To
PI.
FI
Depth 1 Q Ellal Molllod
To an Ft �n2ErF f lnr,-dP*y�J
To FI
Depth Diameter Slot Size Material
From To Ft In In
From To Ft In In
From To FI In In
16, SAND/GRAVEL PACK:
Deptli Size Malarial
From To FI
From To FI
17. REMARKS:
n� Ed •
7) MN; 7LCE
co
Gl
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND TI IAT A COPY OF TFIIS ECORD FIAS BEEN PROVIDED TS-THE WELL OWNER.
FOR OFFICE 4SSEONLY
ouad No:
Seri at No.
r/�� yea-aa
F PERSON CONSTRUCTING TIIE WELL
Ivislon ol Writer Duality, Groundwaler Section within 30 days
DATE
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.C. 27699-1636-Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR.
269991
Al;Rtnigiv Z. .LA-L(.
WELL CONTRACTOR CERTIFICATION #: 440A 7
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE (Check Applicable Boa): Residential I' Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other If Other, List Use:
2. WELL LOCATIO Sho sketch of the location below) �JY'1�TT'sl.C-Q
Nearest Town: v County
60
LuALL
(Road Name A bets, Community, or Sub sion nd Lot N .)
3. OWNER (l.hQ�lri9 �,
Address
rear or
City or Town Slate
4. DATE DRILLED I b
5. TOTAL DEPTH
6. CUTTINGS COLLECTED YES I NOW1
7. DOES WELL REPLACE EXISTING WELL? YES n NOW(
8. STATIC WATER LEVEL Below Top of Casing: 5' b FT.
Zlp Code
(Use'.' II Above Top of Casing)
9. TOP OF CASING IS / FT Above Land Surface'
'Top of casing terminated atior below land surface requires a variance In accor-
dance with 15A NCAC 2C .0118
10. YIELD (gpnl): 3' fi METHOD OF TEST
11. WATER ZONES (depth)•
DRILLING LOG
From To
DEPTH
Formation Descdptlan
D - J O b a'R i-
Lbb 13&d2oc k
12. CHLORINATION: Type TT 7!7 Amount314Nils
1. SING:
v
CJ
77
N
N
If additional space Is needed use back of (arm
Wall Thickness
Depth Diameter or W IghVFI. Maledal
From U To I,DOFt L.a5 •s PW-SDsC
From To FI.
From To Ft
14. GROUT:
Depth Material Method From D To vZ0 Ft. iG//2/YCE.Iio Q.�i utP.t,
From To Ft
15. SCREEN:
Depth Diameter Slot Size Material
From To Ft In In
From To Ft In In
From To Ft In In
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft
From To Ft
17. REMARKS:
LOCATION SKETCH
(Show direction and distance from at least Iwo Stale
Roads, or other map reference points)
a. 50 r fo+J
-o
N
w
I DO I IEREDY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY • F THIS RECORD HAS BEEN PRE IDEO THE W NER.
FOR OFFICE $'ElriLy
Quad No: II / F --, ?I" • TUHE OF PERSON CONSTRUCTING THE WELL DATE
Submit Wainal d aivision of Water Quality, Groundwater Section Within 30 days
GW-I REV. 12/99
ji No
ryl
O7.
3

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] / 4 ^y1
WELL CONSTRUCTION RECORD WELLCONTRACTOR• /re iernAN Z. JA-((.
WELL CONTRACTOR CERTIFICATION #:
269990
STATE WELLCONSTRUCTION PERMIT#:
1. WELL USE (Check Applicable Box): ResidentialLO Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATIOI�I: (Show sketch oche location below)
y/� I�
rest Town:
_County' rs r Lyn CC n-.V--.2_
I PA/12 v Ka- JaoL(/L.r
(Road Name an
3. OWNER
Address
meets. Community. or Subdivision and Lot No.)
L-1-g
p 0_r 1.1 , (51 rule No •73$ ( Z
City or Town 4.
State Zip Code
4. DATE DRILLED 1' t t" b .
5. TOTAL DEPTH S 4 C
6. CUTTINGS COLLECTED YES n NO WI"
7. DOES WELL REPLACE EXISTING WELL? YES n NOI vi
8. STATIC WATER LEVEL Below Top ol Casing: `1 5 FT.
(Use'+' II Above Top ol Casing)
9. TOP OF CASING IS / FT Above Land Surface"
'Top of casing terminated at/or below land surface requires a variance In accor-
dance with 15A NCAC 2C.0 1a
10. YIELD (gpm): Q METHOD OF TEST
11. WATER ZONES (depth)•
DRILLING LOG
From To
DEPTH
Formation Descdptlon
D - 62. 1 7NR {-
(o £ - 54.5 BE-4rzock
12. CHLORINATION: Type 14 TH Amount 9_D___p, IJi
1: ,SING:
�a
0
1 r
IV
rJ W
If additional space is needed use back of form
Wall Thickness LOCATION SKETCH
Depth/ Diameter or W IghUFt. ;1MaleCdall (Show direction and distance from at least Iwo State
From To Le ` Ft G • a 5 2.k . o,�, Roads, or other map reference points)
From To Ft.
From To Ft
14. GROUT:
Depth Material Method
From b To ¢a ° _PL (DPI C2_EiE 7j1'p'I_r'F_.`,<'i%-
From To Ft
15. SCREEN:
Depth Diameter Slot Size Material
From To FI In In
From To FI In In
From To FI In In
16. SAND/GRAVEL PACK:
Depth Size Material
From To Ft
From To 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 •F THIS RECORD HAS BEEN PRE IDED TO THE WELL
WNER
FOR OFFICE US}EQNtY-
il; e
submit odgy)tlilo
Ouad No:
I No
URE OF PERSON CONSTRUCTING THE WELL DATE
slon ol Waler Quality, Groundwater Section within 30 days
GW-I REV. 12199

North Carolina - Deparlmenl of Environment and Natured Resources - Division of Water Quality- Groundwater Section 2 9 J 8
1630 Mall Service Center - Relelph, N.C. 27699-1636-Phone [phone] ff//
WELL CONSTRUCTION RECORD WELLCONTRACTOR• R)RN �i.EJ A tur NES
WELL CONTRACTOR CERTIFICATION 0: P7 0
STATE WELL CONSTRUCTION PERMITM:
WELL USE (Check Appllceble Box): Residential LJ Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Infection ❑ Other ❑ If Other, List Use:
2. WELL LOCATION: ( ow s tole of the location below) Se/Le_
Nearest Town: -•'ms Ceunty
234 Akbadtic ad.&
(Road Name and.Nu era. CommunityJ,9�ry Subdlylslon and Lot No.)
3. OWNER ,.- -LY[T�
Address
reef Of
City or Town Simile Zip Code
4. DATE DRILLED - D 6 at,
5. TOTAL DEPTH
6. CUTTINGS COLLECTED YES I NOjV
7. DOES WELL REPLACE EXISTING WELL? YES f 1 NO
B. STATIC WATER LEVEL Below Top of Casing: a5 FT.
(Use'.' II Above Top of Casing)
9. TOP OF CASING IS ' FT. Above Land Surface•
•Top of casing terminated eVor below land surface requires a variance In accor-
dance with 15A NCAC 2C 0118
10. YIELD (gpm): f r METHOD OF TEST ri
11. WATER ZONES (depth)'
DRILLING LOG
From To
12. CHLORINATION: Type +4Tk{ Amount 311 _rills
13. CASING:
Wall Thickness
Depth Diameter or WeighVFI. Material
0 Via.145 PVc'S_Dfi
From
From
From
14. GROUT:
From Q
From
15. SCREEN:
To s+1:—Ft jo. DS
To Ft.
To FL
Depth
To Q O
To
Depth
From To
From To
From To
16. SAND/GRAVEL PACK:
Depth
From To
From To
17. REMARKS:
Ft
Ft
FI
Material J_, Method
Ft Omar r%P±e, lacLuitexi
FI
Diameter Slot Size
In
In
In
Ft
FI
Material
In
In
In
Size Material
DEPTH
Formation Description
T
v
IV
v
II additional space Is needed use back of form
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other map reference points)
721.00-41C-5 Ca(
OS gyp' n C
I DO f IEREOY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COSY OF THIS RECORD HAS BEENEPROVIDED TO THE WELL OWNER
• .fixl.><•
SIGNATURE OF PERSON CONSTRUCTING TFIE WELL DATE
Inal to Division of Wader 'Duality, Groundwater Section within 30 days
GW-I REV
12/99

North CaroUna • Dopartmani or Environment and Natural Flesourcee - Division of Water Duality - Groundwater Section 2 6 9 9 8 8
1636 Mall Service Cooler - flalolgh, N.C. 27699.1636-Phone [phone] r y/�J `'
WELL CONSTRUCTION RECORD WELL CONTRACTOR' Et, Lk), c,U. i"E?T-bS
(--W9a 8
STATE WELL CONSTRUCTION PERMIT#!
WELL CONTRACTOR CERTIFICATION 0:
1. WELL USE (Check Applicable fax): Residential at Municipal n Indusirlat n Agricultural
nocovery ❑ i-loaf Pump Water InJeclIon ❑ Other n If Other, List Use:
2. WELL LOCATION' (Skow sketch
ofodie �lo�cration below) -
Nearest Town ��Q%L e , County..
£ &aiaAd biadinnitez
(flood Name And Nurr 15 oPr.rp ally, or Subeyyislon and Loi No.)
3. /J—/ C/i
OWNER [
Address dc`����//
(Sheol or auto o.
1itc� hr in R de
Clly or Town Slate��77 Zip Code
4. DATE DRILLED 0.5 d-
-40
5. TOTAL DEPTH
6. CUTTINGS COLLECTED YES J NO1vf
7, DOES WELL REPLACE EXISTING WELL? YES n NOM
8. STATIC WATER LEVEL Below Top of Casing: 4C4 FT.
(Use •.• II Above, Top ol Casing)
9. TOP OF CASING IS 1 FT. Above Land Surface'
•Top of oiling terminated el/or below tend surface requires R valence In accor•
dance with 15A NCAC 2C.2118
10. YIELD (gpm): % a METHOD OF TEST
11. WATER ZONES (depth).
12. CHLORINATION: Type Amounl /a St): S
13. CASING:
I
Monitoring ❑
DRILLING LOG DEPTH
From To
1� 4/0.c.
.
(� Wall Tlllckne ss
From-1L—DTolit Jo .FI. pIlm ll r tel66�v(U. M,,, Ieji
'/ to IJ j i�s'_��EZ
From To PI.
From To FI.
14. GROUT:
Depth ial Method ,
From �_ � To PI �{krnU��
Frorn To FI
15. SCREEN:
Depth Diameter Slot Size Malarial
From To FI In In
From To Ft In In
From To Ft In In
16. SAND/GRAVEL PACK:
Depth Size Material
Frain ' To
From To
FI
Ft.
Fo rmellon DA s crlpaon
=7
rV
r
It additional space Is needed use hack ol form
LOCATION SKETCH
(Show direction and distance from nt least two Stale
Bonds, or other rnap reference polnls)
bf.faileitAittic
17. REMARKS:
100 HEREBY CE lIfIFT I�
CONSTRUCTION fA DAPDk,ANip'TI 1ATIACH!PY
ni
FOR OFFICE USEbhI4Y
ii
Ousel No: U `, Slav
svbmh odoinal IaANI
Serial No.
TED IN ACCORDANCE WITH 15A NCAC 2C, WELL
IS RECORD HAS BEEN PR IDED TO THE WELL OWNEfl.
RE 0. ERSON CONSTRUCTING TIIE WELL DALE
on al Writer Quality, Groundwater Section WItliIR 30 days
GW'I REV. 12/99

•
North Carolina • Dnperimonl of Envlronmonl and Natural Flesourcen - DlvLelon of Wnler Ouellty - Groondwator Socllon
1638 Mali Service Center • flelalph, N.C. 27699.1638-Phone [phone] rr (n
WELL CONSTRUCTION RECORD WELLCONTRACTOR• Bbh O r ✓ , p&J S
WELL CONTRACTOR CERTIFICATION ": ,
26998e7
STATE WELL CONSTRUCTION PERMIT":
WELL USE (Check Appuceble Boxy. Resldenllal IY Municipal 1 1 Industrial ❑ Agrlcullural (] Monlioring
flocovery [1 Hoal Pump Water Injection ❑ II Other, List Use:
2. WELL LOCATIO : (SI ow skelch or We location below)
N)rt Town: O County
lClr.441n-/e . ?1:ett/ (hoed Nam and Nu`" rs. Co mu , or Sub1dlvlslon end Lot No.)
3. OWNERcvs -
Address
leARAvil
City ar Town Stale
4. DATE DRILLED Aa
5. TOTAL DEPTH
6. CUTTINGS COLLECTED YES J NO(Vr
7. DOES WELL REPLACE EXISTING WELL? YES � NOM
6. STATIC WATER LEVEL Below Top of Casing: t� FT.
(Use 'e' If Abovo Top of Casing)
9. TOP OF CASING IS ! FT. Above Land Surlace'
•Top of casing let mines ad al/or below lend surface requires a variance In accor-
dance with 15A NCAC 2C I1a
10. YIELD (gpm)' 4n METHOD OF TEST I C\
11. WATER ZONES (dopth):
for eC,fn&t
DRILLING LOG
From To
DEPTH
F omrn lion Descdp Ilon
Q - 10 R+
70 - a hrala.ac k.
287€7
Zip Coda
0
(A5
N 1-
=
—
7�� jj��s � N
12. CHLORINATION; Type �Th Amount 171+i_additional space Is needed use hack of loin
13. CASING:
,!4 Wall Thickness
Deplh/peiio v� M1�
Frorn To �
Flom To FI,
From To FI
11. GROUT:
Dept--nnh,� MalorlIlul Mol_ hod '
Flom � To ,g�FI �4E� E7F J''�h`(3 �tj.
From To Ft
15. SCREEN:
Depth Dlameler Slot Size Material
From To FI In In
From To Ft In In
From To Ft In In
16. SAND/GRAVEL PACK:
Depth Size Malollal
From ' To ri
From To Ft
LOCATION SKETCH
(Show dlrecllon and distance Irons nl least Iwo Slate
Bonds, or other map reference polies)
RAiat
Wizuivaittas,
Ps.)
0
17. REMARKS:
Y THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
I1IBI/410tin IANO TIitAT "Y OF TFII ECORD HAS BEEN PROVIDED TO THE WELL OWNER.
j I SIONAIUB OF PERSON CONSTRUCTING TIIE WELL
Submit oar plf ral Io Divisional Water Ouallly, Oroundwaler Secllon wllhln 30 days
GW•I REV, 12/99
I DO FIE
CONST
DAIS

North Carolina - Deportment of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mall Service Center - Raleigh, N.C. 27699-1636-Phone [phone] AC/ //
WELL CONSTRUCTION RECORD Fit fF2��Oa 9
WELL CONTRACTOR CERTIFICATION
STATE WELL CONSTRUCTION PERMIT#:
269985
1. WELL USE (Check Applicable Boa): ResidentialE - Municipal 0 Industrial ❑ Agricultural LI Monitoring ❑
Recovery ❑ Heat Pump Water Infection ❑ Other [j IIIl Other, List Use:
2. WELL LOCATION: ( tow sketch I the location below) ��� C.�a /
Ne sl Town:
County. 4c
(need N me andjJumbers�, C�om as SubdS Lot No.) DRILLING LOG DEPTH
3. OWNER //JS{/O7 4Z C7y. From To Formailon Description
Address
rreot or Houle N0.) . C • ',0/
Cityown Slate ZIp Code " a /8 5
5. DATE DRILLED
5. TOTAL DEPTH 1L.
6. CUTTINGS COLLECTED YES I I NOpr
7. DOES WELL REPLACE EXISTING WELL? YES I 1 NOLV 8. STATIC WATER LEVEL Below Top of Casing: -L/C FT.
(Use'.' II Abovo Top of Casing)
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 15A NCAC 2C 01J,11 K^ .�
10. YIELD (gpm): 1p Ci METHOD OF TEST
11. WATER ZONES (depth):
koL
0
0
0
IV
12. CHLORINATION: Type H 7H Amount 3-7-'l It additional space Is needed use back of form
13. CASING:
Wail Thickness
Depth plamelor or Weight/FI. Material
From Q To_aFt It• q)G.Ia4 -?Y SAC
From To Ft
From — To Ft.
14. GROUT:
Depth - /_Material Method
p���{
From b To ac_Ft Cp hcrcfc pnus_exi
From To Ft. l
15. SCREEN:
Depth Diameter Slot Sizo 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
LOCATION SKETCH
(Show direction and distance from et least two State
Roads, or other rnap reference points)
ed
17. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACC A RDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION:STANDARDS,-AND THNE*GEIE-Y-OF TIltSR R[LF1AS BEEN PROVI D TO THE WELL OWNER.
.) / 9^ 7-6
FOR OFFICE USEONLY J I .,,,
$1 NATURE OF PE N CONSTRUCTING T IE WELL • OATS
Quad No:
Submit ode na'I a Diviston of Water Guallly. Gmundwator Se<Ilon Wlhln 38 day5
Serial No.
1
ICE
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.C. 27699-1636-Phone [phone]
WELL CONSTRUCTION RECORD WELLCONTRACTOR• J ARialf // 2 /I SDI
WELL CONTRACTOR CERTIFICATi014
269983
STATE WELL CONSTRUCTION PERMITP:
1. WELL USE (Check Applicable Sox): ResldentlaiV Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Float Pump Water Injection ❑ Other [] II Other, List Use:
2. WELL LOCATIO : (S ow sketch orlhe ocatlon below) /, _,,
Near LTown'-4/./Ad/p County fir/ Zt-e
(Road Namo a y umbers, Commly. o Subdivision end Lot No.)
3. OWNER
Address
City or Town Stale
1
4. DATE DRILLED "O -O a
TOTAL DEPTH P. U 5
5.
6. CUTTINGS COLLECTED YES 1 NO[1-
7. DOES WELL REPLACE EXISTING WELL? YES a NOE�'
6. STATIC WATER LEVEL Below Top of Casing: Q FT.
(Use'+' II Abovo Top of Caslnp)
9. TOP OF CASING IS 1 FT. Abovo Land Surface'
•Top of casing terminated atior below land surface requires a variance In accor-
dance with 154 NCAC 2C.0118
10. YIELD (gpm): ) METHOD OF TEST
11. WATER ZONES (depth)•
/ /i iri�P eo_ or ou a%�ie ;34 7
Zlp Code
DRILLING LOG DEPTH
From To
Formation Description
D - .1),'
79 dos 13Fce-PCL
O
ry
-O
12. CHLORINATION: Type H %N Amount , 5 /11A5 If additional space Is needed use back of form
13. CASING:
LOCATION SKETCH
Wall Thickness
D Depth 7 lamelor c e g/ t. M.-, rfal (Show direction and distance from anent Iwo Slate
From To . Ft rS _ Roads, or other rnap reference points)
From To FI
From To FI
14. GROUT:
Depth - n__Malerlal Method
From b To —FI l-Yhare-i-c pQILreAI
From To FI
15. SCREEN:
Dopth 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 Malerlal
From To Ft
From To Ft.
17. REMARKS:
I DO HEREDY CERTIFY THAT THIS WELL WAS
WITH 15A NCAC 2C,
CONSTRUCTION STPNDMDS fAND THAT A COP"(CONSTRUCTED
CORDANCEWELL
4.)4S E 0' D HAS BEEN D TOTHE WELL OWNER.
BAThdA
"AL e (11 C
ca
r-*1
:V
v
IV
ca
u
1FOROFFICE USE OP LY
Ouad No:
Serial No.
I/
SIONATUR
Submit original to DIJI,Iojtj
are
F PE ON CONSTRUCTING TIIE W LL DATE
WarmDuality. Groundwater Section within 30 days
OW-1 REV. 122199

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]
WELL CONSTRUCTION RECORD WELL CONTRACTOR' R)RW kEl
WELL CONTRACTOR CERTIFICATION 0:
STATE WELL CONSTRUCTION PERMIT$:
2699801
A LJr; iv Es
/'S/D
I. WELL USE (Check Applicable Box): Residential ©� Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection n Other n If Other, List Use:
2. WELL LOCATION:
arest Town:
ow sketch of the location below) / ��,-,
O.! County K/YA ad""7�"�
Y2.acea w/1
(Road Nary( and.Number a, Community. or
3. OWNER 41
Address
ree or ou e
i.e t) n.
City or Town State
4. DATE DRILLED q-5-6
5. TOTAL DEPTH . a 5
6. CUTTINGS COLLECTED YESI I NO
7. DOES WELL REPLACE EXISTING WELL? YES NO
8. STATIC WATER LEVEL Below Top of Casing: FT.
(Use Y• If Above Top of Casing)
9. TOP OF CASING IS 1 FT Above Land Surface'
•Top of casing terminated at/or below land surface requires a variance In accor-
dance with 15A NCAC 2C .0116
10. YIELD (gpm): / 7% METHOD OF TEST 1:?1/2
11. WATER ZONES (depth):
12.A OA
frA.hC
ubdivls n an Lot No.)
°lAJA" �k eU )
agai
Zip Code
12. CHLORINATION: Type '�}T
13. CASING:
Depth 7 6' I.a.D5Diameter
From � To Ft.
From To Ft.
From To Ft
14. GROUT:
Depth
From 0 To _rap_ Ft
From To FI
15. SCREEN:
DEPTH
Formation Descdpllon
1
IV
Amount i115 If additional space Is needed use back of form tV
Wall Thickness
or WeIghVFI. Malerlal
QI&. j?5 PYc-5DR
Material H1�
Cm1c ere
l Mal
had
Depth Diameter Siol Size Material
Frorn To FI In In
From To Ft In In
From To FI In In
16. SAND/GRAVEL PACK:
Depth Size Material
To Ft
To Ft
From
From
17.REMARKS:
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other map reference points)
Mad
W
rTM
rV
CJ r,.o
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.
444e/, 4-7C 9 -S - o g-
DATE
- SIMryIRE OF PERSON CONSTRUCTING THE WELL
Submit-6dpin`afip Dl an of Water Quality, Groundwater Section within 30 days
GW-1 REV. 12/99

North Caroline • Dnperlmanl of Envlronmonl and Nolural Flesources - Division ol Water Duality • Groundwater Suction 2 6 9 9 f 9
1636 Mall Service Center - flelolph, N.O. 27699- 1636-Phone (919) 733•3221
WELL CONSTRUCTION RECORD WELL CONTRACTOR'
Bosh/ (L�. P&
WELL CONTRACTOR CERTIFICATION p:
6.;R
STATE WELL CONSTRUCTION PERMIT":
1. WELL USE (check Applicable Box): Residenllall:a" Municipal n Industrial n
Recovery ri Float Pump Water Infection n Other n If Olhor, Llsl Use:
2. WELL LOCATIO ( low sketch of the o allon below)
est Town: aatt.!/ „„, County:
A A ItAitti—,
Woad Name end Nu ••en. CP ` 1 o Subdlvislon and Lot No.)
3. OWNER °At. ,(� ..S
4.
•
5.
7.
Cily or Town Slate
DATE DRILLED -O
TOTAL DEPTH
CUTTINGS COLLECTED YES I I NO(vij
GOES WELL REPLACE EXISTING WELL? YES
8. STATIC WATER LEVEL Below Top of Casing:
(Use •s' II Abovo Top ol Casing)
9. TOP OF CASING IS 1 FT Abovo Land Surface'
•Top of casing lerminnled sitar below lind surface requires A variance In accor-
dance wllh 15A NCAC 2C.911e
10. YIELD (gpm): 3_0_ METHOD OF TEST Rl
1 I. WATER ZONES (doplh):
12. CHLORINATION: TypoAmount Liaa,L
13. CASING:
AddreSa
ft •
L01.Akt IJ. •L or Itou l Lab QS L d /
Zip Code
Agricultural 0
Monllortng ❑
DRILLING LOG
From To
DEPTH
Fomatlaa Dxscrlptlon
0 - /O P
/o S - 7VS"
N On f
R.
0
Wall TI Ickness
Deplll �y (!ammain r alp V[J. „Mate
FromTo 6-Ft +� jj
From To
Ft
From To FI
14, GROUT:
Depth C(�URE�-1 Malarial Method
/
From 0 TO FI. F
Frorn To FI
15. SCREEN:
Depth Diameter Slot Size Malarial
From To FI In In.
From To FI In In
From To FI In In
15. SAND/GRAVEL PACK:
Depth Size Material
From To FI
From To FI
17. REMARKS:
If additional space Is needed use hack of form
LOCATION SKETCH
(Show dlrecllon and distance from nl leas( Iwo Stale
Roads, or other map reference polnls)
1 DO HEREDY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION CAM -MAT A 4;UNY L.t•w.tl bRECORD HAS BEEN PR 9VIDEO O THE WELL OWNER
FOR OFFICE USE
Ouad No:
Serial No.
UV r
SIO(IIrj\�1LRE OF ERSON CONSTRUCTING TIIE WELL DATE
`: Svbndl odpinal to t an of Water Duality, Oreundwaler Section within 30 days
GW.1 REV. 12f99
is
A".

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. /le Rn1AN L • 2f t
WELL CONTRACTOR CERTIFICATION If: o?D...; 7
STATE WELLCONSTRUCTION PERMIT#:
269976
1. WELL USE (Check Applicable Box): Residential Lr'J Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring 0
Recovery ❑ Heat Pump Water Infection ❑ Other ❑ II Other, List Use:
2. WELL LOCATIO . (Show skel hroff(S'tflhar oAallon below)` I< �mJ
Nearest 9 own: � .Th/ LSS..--�L..PP� �Co�untJy.� �) LLQ
��ii�a�i�J �(iC�iT_7G_ �-4'<<Lt dSGGGC�C, L
(Road Name and _�,py-u/pert C"o�m'muunll,(or S vision and L I No.)DRILLING LOG DEPTH
3. OWNER IC � �uw�rl^ .L)LS from To Formation Description
Address
4M�O Aci S IJ CJ�r oe a e C , 2 5 70 9 � 2 - � � j—� F; . i-
City or Town (� �Stale Zip Code
4. DATE DRILLED 1 --TL- b.D'
5. TOTAL DEPTH d45
6. CUTTINGS COLLECTED YESf No 1
7. DOES WELL REPLACE EXISTING WELL? YES O NOI
8. STATIC WATER LEVEL Below Top of Casing: FT.
(Use '+' If Above Top of Casing)
9. TOP OF CASING IS / FT Above Land Surface'
'Top of casing terminated et/or below land surface requires a variance In accor-
dance with 15A NCAC 2C .0118
10. YIELD (gpm): DC) METHOD OF TEST R:5 r�
11. WATER ZONES (depth):
. '1
12. CHLORINATION: Type _Hitt_ Amount 4 at; IIS If additional space Is needed use back of form
1 \SING: -
Wall Thickness
LOCATION SKETCH
Depth ,„11 p Dlameler or Weight/Ft. ;1Maledal (Show direction and distance from al least two Stale
From 0 To 0` d FI 1,. a 5 9Jt .1%1 PVt-SDC Roads, or other map reference points)
From To Ft 9.,,,n • _�
From To Ft `(fir/eil
14. GROUT
Depth Maledal Method
From 0 To A 'C' F1 i1AlYC21"1"ETONEE,{_
From To Ft
15. SCREEN:
Depth Diameter Slot Size Material
From To Ft In In
From To Ft In In
From To Ft in In
16. SAND/GRAVEL PACK:
Depth - Size Material
From To Ft
From To Ft
17. REMARKS:
ybuaads Z^ - e
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
• c NDARDS, AND THAT A COPY a F THIS RECORD HAS BEEN PR IDED TO THE WELL WNER.
CONSTRUCTI
g-a
(ME OF PERSON CONSTRUCTING THE WELL DATE
slon or Water Quality. Groundwater Section within 30 days
GW-1 REV, 12)99

2699;'5
i
North Carolina - Department of Environment and Natural Resources - Division of Water Dually - Groundwater Secllon
1636 Mall Service Censer - Raleigh, N.C. 27699-1636-Phone [phone] -//_' �f
WELL CONSTRUCTION RECORD WELLCONTRACTOR• ki RmAN L • JR-«.
WELL CONTRACTOR CERTIFICATION #: ayea �J
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE (Check Applicable Box): Residential Er Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring 0
Recovery ❑ Heat Pump Water Injection ❑ Other If Other, List Use:
2. WELL LOCATI N: Show sketch o1 the location below)
Near Town: a�,�1))) L County.�'�
(Road Na rr(a an.g mbers. Community. or Subdivision and Lot No.)
3. OWNER
Address
City or Town Stale
4. DATE DRILLED • 3—O
5. TOTAL DEPTH Q
3. CUTTINGS COLLECTED YES n NOVA/I
7. DOES WELL REPLACE EXISTING WELL? YES n NOI vl
3. STATIC WATER LEVEL Below Top of Casing: 7 FT.
(Use '+' II Above Top of Casing)
3. TOP OF CASING IS ' FT Above Land Surface'
'Top of casing terminated aUor below land surface requires a variance In accor-
fance with 15A NCAC 2C .2118
10. YIELD (gpm): 1 METHOD OF TEST o
11. WATER ZONES (depth): ry
DRILLING LOG
From To
DEPTH
Formation Description
-
So - lP 10 c 3 -ace id-
0
(.1
247
N
•
I2. CHLORINATION: Type rt TN Amount _113.LS
1 \SING:
Depil Diameter
From D To i3 0 FI b• a 5
From To Ft
From To Ft
14. GROUT:
If additional space Is needed use back of form
Wall Thickness
or W IghVFI. Maledal
a��.r�s PW .SDI,
Depth Material Method
n
From Q To vZo Pt l dfiC2kiE .70 r Evi
From To Ft
5. SCREEN:
Depth Diameter Slot She Mated al
From To Ft In In
From To Ft In in
From To Ft In In
16. SAND/GRAVEL PACK:
Depth Size Material
From To Ft
From To Ft
17. REMARKS:
LOCATION SKETCH
(Show direction and distance from et least Iwo State
Roads, or other map reference points)
0
CO
n,1
LO
N
0
_'L
N
W
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 PRE IDEDT THE WELL
FOR OFFICE USk` ©1LY
Quad No:
Na.
SI •[ URE OF PERSON CONSTRUCTING THE WELL DATE
Submit originalo s 1 sion of Weber Quality, Groundwater Section within 30 days
GW-I REV. 12/99
- 3-6
0

North Carolina - Dopartmonl of Envlranmonl and Nolurnl Resources - DlvIaIon of Writer Oeellly - Oroundwnior Soclion
1636 Mall Service Center - Relol111, N.O. 27699-1636-Phone [phone]•
(�
WELL CONSTRUCTION RECORD WELL CONTRACTOR, 3o hhiA US. P,D L4-•
WELL CONTRACTOR CERTIFICATION N:
STATE WELL CONSTFIUCTION PERMITN:
1. WELL USE (Check Applicable eon): Flesidentlal Municipal ❑ Industrial ❑
Rocovory ❑ Float Pump Water Injection ❑
269974
Agricultural ❑ Monitoring ❑
Other 0 If Other, List Use:
2. WELL LOCATION: ( ow sketch A se location below) C�%T/ Ice_
N eat Town: County' rS�
defri
Nywbor s, 3 OWNER
Address On I2
Cmrvnunl or ubdlvlslon and Lot No.)
(hoed Name And
or tToula
lly or Town Slale
d. DATE DRILLED 'u
5, TOTAL DEPTH
6. CUTTINGS COLLECTED YESLI NO(VI
7. DOES WELL REPLACE EXISTING WELL? YES f j NO 1M
8. STATIC WATER LEVEL Below Top of Casing: a 5 FT.
(Use '111 Above Top of Casing)
9. TOP OF CASING IS I FT. Above Land Surface'
•Top of casing terminated slior below lend surface require' R variance In sccor-
dancewlih 15A NCAC 2C�.4�1�1E-1
10. YIELD Wpm): METHOD OF TEST Ri t\
11. WATER ZONES (depth):
T
l' a
12. CHLORINATION; Type _7 LTAmount If additional space Is needed use hack of loan
DRILLING LOG DEPTH
From To For merlon Da scripllon
l'. e 874'8 - aas Recod,
Zip Code
13. CASING:
Wall
Thickness ���� �n��
O Depth / bi.l „l�UejQ V� Ma7YS�dal
From To 'PI,.
From To Ft.
From To Ft
d. GROUT:
Depth Materiel
From To _IQ_ Ft CDsIRE-1F
From To FI
15. SCREEN:
MolTilhu hod
Depth Diameter Slot Size Malarial
From To FI In In
From To Ft In
From To Ft In
16. SAND/GRAVEL PACK:
Depth Size Maleilal
Frain
From
17. REMARKS:
To FI
To FI
In
In
0
0
LOCATION SKETCH
(Show direction and distance born nt least Iwo Siete
Bonds, or olher map relorence polnis)
labL:l.•5-11-43
CO
"T
0
rs
I DO HEFIEO
GONSTRUC
rcEflT4Fr 1� THAT TI1rS Wtt±WA3
+ON L4 DARD$,,AND TIIAT�AC�
FOR OFFICE
Quad No:
Serial No.
U;Sa ONLY
L
N
0
0
ISTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
P TFIIS RECORD HAS BEEN PRO IDED TO TILE WELL OWNED
Submit od9luas l
T.o'/1
, e'
NATURE Df PERSON CONSTRUCTING TI IE WELL
s Division o1 Wnlar Quality, Oroundwaler Seclton within 30 days
DATE
CW.1 REV, 12f99
ASH
J

North Cnrollnn Daperlmonl of Environmenl and Natural Resources - Division of Water Quality • Groundwater Section (�
IGJ6 Mall Service Center - Raleigh, N.C. 27699-1538-Phone [phone] r (� 2 6 9 9 6 6
WELL CONSTRUCTION RECORD WELLCONTFlACTOFl 30 bhut C. Po '�S
WELL CONTRACTOR CERTIFICATION M: c-RO P Q
STATE WELL CONSTRUCTION PEFlMITM:
1 WELL USE (Check Applicable Box): Residential IX.
Municipal ❑ Industrial n Agrlcuilural P1 Monitoring n
Rocovery ❑ Float Pump Water Injection ❑ Other if Olhor, List Use:
1
2. WELL LOCATION' allow sketch of the location below)
Near eat Town;
_SS 2"nelieed2J
(hoed Nam And...yrs. Comnaztly, or Subdivision And Lot No.)
3. OWNER / Anktfinis
Address
County:
-a/ , - e° ° nUo'e.
City or Town stale 21p coda
A. DATE DRILLED - g __ o8'�
5. TOTAL DEPTH X.� '
6. CUTTINGS COLLECTED YESn NO1v/j
7, DOES WELL REPLACE EXISTING WELL? YES a NO t7
8. STATIC WATER LEVEL Below Top of Casing: () FT.
(Use'd II Above Top ol Casing)
9. TOP OF CASING IS I FT. Above Land Surlace'
'Top of ce sing terminated A Vor below land surface require a a variance In accor-
dance with 15A NCAC 2C .4116
10. YIELD (gpm): -r00 METHOD OF TEST fC, q
11. WATER ZONES (depth):
DRILLING LOG
DEPTH
From To Formation Descrlpllon
74 -,28s pork.
w
}
12. CHLORINATION: Type _�__L_t��_.Amounl7�—�-LLS
13. CASING:
J
O
1
If additional space Is needed use back ol loan
Wall Thickness LOCATION SKETCH
Depth 7, �lal� lof eol;U[I, n klaledal'-s (Show direction and distance Iron nl least Iwo Shale
From To -FI . JC d LYS'.TILK Ronds, or other map rolorenco points)
From To FI
From To FI.
Id. GROUT:
Depth a Malodal Method r
From In To �-�FI �fj�E'�� ,�Q�_ iLg_
Frain To FI /
15. SCREEN:
Depth Diameter Slot Size Material
From To FI In. In
From To FI In In
From To Ft In. In
15. SAND/GRAVEL PACK:
Depth Size Material
From To FI
From To FI
(0,0 7 led'
.CSC
17. REMARKS:
I DO HEREDY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTIO ST monnpS ANO Ti IAT A COP�f�7R HIS RECORD HASBEENPROVIDED TO T E WELL OWNER.
1FOR OFFICE U © CY, \( I Fu A Lam ' 2-A g Q 0
.Ound No: t li -.,I
Serial No.
SIbt A Ur1E OFDERSON CONSTRUCTING TIIE WELL DATE
Subndl odpinal loT�h Won al nler Ouallly, Groundwater Section wllltln 30 days
GW-1 nEV. 12199

(1 North Cnrollnn - Dnpartment of Environment and Na?urnl Resources - Division of Water Quality - Groundwater Section 2 6 (1 (`
1G36 Mall Service Copier • Raleigh, N.D. 27699.1636-Phone (919) 733•3221 1, J -7 1) i
WELL CONSTRUCTION RECORD WELLCONTRACTOR• BO bhii Lkiv t' +
WELL CONTRACTOR CERTIFICATION N: a_ Q
STATE WELL CONSTRUCTION PERMITN:
1. WELL USE (Check Applicable sox): Residential Imo' Municipal ❑ Industrial ri Agricultural ❑ Monitoring LI
Recovery r1 Beat Pump Water Infection ❑ Other ❑ II Olhor, List Use:
2. WELL LOCATION; (S w sk Ich ol•Ihe location below)
Nearest Toy County'
a�o8 Q ��
(no Ad Name p Numbo Commuolly, or Subdivision and Lot No.) DRILLING LOG
3. OWNER 4',�V{' .-./� i�^1'fl From Ta
Address
ieo or lloulo
W,Cle
/ /> �RBa 3
Clly or Town Stale
5. DATE DRILLED=
6. TOTAL DEPTH a
6. CUTTINGS COLLECTED YES( 1 NOI�j
7. DOES WELL REPLACE EXISTING WELL? YES n NO tM
6. STATIC WATER LEVEL Below Top of Casing: ci FT.
ruse '.' it Abovo Top of Casing)
9. TOP OF CASING IS 1 FT. Abovo Land Surface'
'Top of casing le I mingled sUor below land surface re qulrea R variance In accor-
dance rvllh ISA NCAC 2C..o 110 j_ s
10. YIELD (gpm): �lJO METHOD OF TEST f(�
11. WATER ZONES (depth):
a —
50-,;gS
zip Code
12. CHLORINATION Type nL__Amounl7-;'+ L,
13. CASING:
DEPTH
Fomellon Description
If additional space Is needed Use hack of form
Wall�yTI Ickness LOCATION SKETCH
Depth a l J FI pia1 ce; A Welo�U/l. tiler (Show direction and distance from nt leastIwo Slate
From To ! J (y rI�J (o j R Bonds, or other ma reference olnls
From To II
From To It
1A. GROUT:
Depth Malarial �1�Mol_ Trod ,
From � To �FI ��2Ei& �_CLg�-
From To FI
15. SCREEN:
Doplh Diameter Slot Size Material
From To Ft In In
From To FI In In
From To FI In In
16. SAND/GRAVEL PACK:
Depth Size Malarial
From To Ft
From To FI
o is
11? 1'1C
-n
m
CO
CO
N
o%
17. REMARKS:
1 00 FIE FtED'fCETjTIfYT�T1kJflIS WELL WAS For
CONSTRUC II1N)7TACTDIij DS,-AND THAT AC4 '�YI
FOR OFFICE USE ONLY
W ad No: IL.
Serial No.
i
Submit odpliia no
TRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
F THIS RECORD FIRS BEEN PROVIDED T9-TIiE WELL OWNER.
AI URfY6F PERSON CONSTRUCTING TIIE WELL
llvlston of Wnlor Duality, Groundwater Secllon within 30 days
8eas'o 3
OATE
GW.I nEV. 12199

Noah CArollnn - 'Doperimonl of Environment and Natural Resources - Division of Water (Dually • Groundwater Section
269964
1636 Mall Service Cantor - Raleigh, N.G. 27699-1638-Phone [phone] (�
WELL CONSTRUCTION RECORD WELLCONTRACTOR- 30 bhr4 Of. Po445
WELL CONTRACTOR CERTIFICATION 0: (la g
STATE WELL CONSTRUCTION PERMITS:
WELL USE (Check Applicable sox): Flesldentlall Vl Municipal I . Industrial ( j Agricultural ❑ Monitoring ❑
Recovery ❑ float Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATION: 7 I.w skel h of the location below) LL-41Carr?ke
Nearest Town: County:
(noed me An. .eo. Coin/runt , or Subdivision And Lot No,)
3. OWNER
Address
AO ar .ua o
Clly or Towne SIalo Zip Code
4. DATE DRILLEDO 7�0'•
5. TOTAL DEPTH
6. CUTTINGS COLLECTED YES NOI�r
7, DOES WELL REPLACE EXISTING WELL? YES n NOM
8. STATIC WATER LEVEL Below Top of Casing: etQ FT,
(Use '.' II Abovo Top of CAsInp)
9. TOP OF CASING IS 1 FT Abovo Land Surface'
top of casing to rmineled elor below land surface requlrea a variance In accor-
dance with 15A NCAC 2C, 110 s
10. YIELD (gpm): G%% METHOD OF TEST 1
11. WATER ZONES (depth).
DRILLING LOG DEPTH
From To
Fomucion De scripllon
- 70
70 - ,4A13-
C4CjC
IN)
I
12. CHLORINATION; Typo ? Amount II additional space Is needed use hack of form
13. CASING:
Wall Thickness LOCATION SKETCH
Ali_
pla^Ciol iritBlgyg. MC SD 12 (Show direction and distance Iron nt Ieosi Iwo Slate
From A.L_To -PI (9 �` Ql ,�j Roads, or other map tolerance points)
From To PI, ^/
From To aJd n2M �^ c
14. GROUT: //�� 'W r ` ---
KK�� Malarial Mol_ Irod r
V �'
From To �Ft {E _�Lg �._ n
From To FI W
Depth Ma
N
15. SCREEN: rT
Depth Diameter Slot Size Malarial
From To Ft In In
From To II In In
From To Ft In In
16. SAND/GRAVEL PACK:
Depth Size Material
Front To FI
From To FI,
17. REMARKS:
0
W —
O
I DO HEREDY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION TANOAd1OSl AITITTRATA GIII'T • — t S RECORD FIAS BEEN PROVIDED TO THE WELL OWNER,
i 4* A � FOR OFFICE USE ENLVL ✓ %`/ r g-d 7-o a
Clued No: - SIC) A /OF PERSON CONSTRUCTING TIIE WELL DATE
Sulseall original to Wlfbn of Water Duality, Groundwater Section Within 30 days
Serial No. GW.I REV. 12l99

North Carolina - Dnparlmoni of Environment end Natural Resources - Division of Water (Duality - Groundwater Section
1630 Mall Service Center - Raleigh, N.C. 27699-1636-Phone [phone]
WELL CONSTRUCTION RECORD WELLCONTRACTOR• ,! /9.Pi2.! / r iej7/ 50/il
WELL CONTRACTOR CERTIFICATION S:
269962
STATE WELL CONSTRUCTION PERMITS:
1. WELL USE (Check Applicable Box): Residential E Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heal Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATION: S Jpw sketch .i the location below)
Nearest To ,t '-��, County
(Road Namo and mbers, Community, or Su.: vl on and of No.)
3. OWNER
Address Jw
ISiteo or 0U 0
DRILLING LOG DEPTH
From To
C l y or Town SlateDRILL
4. DATE DRILLED � a_��
5 TOTAL DEPTHr+
Zip Code
Formation Description
4n I45 BEaQck
6. CUTTINGS COLLECTED YES I 1 NO[
7. DOES WELL REPLACE EXISTING WELL? YES I J NOFIX
6. STATIC WATER LEVEL Below Top of Casing: SC) FT.
(Use'+' II Above Top of Casing)
9. TOP OF CASING 15 1 FT. Above Land Surface'
•Top of casing terminated et/or below land surface requires a variance In accor-
dance with 15A NCAC 2C .0118 ..
10. YIELD (gpm)' .. METHOD OF TEST
11. WATER ZONES (depth)•
LJ
:z9
0
fV
12. CHLORINATION: Type H T H Amount` / /e pith, If additional space Is needed use back of form
13. CASING:
Wall Thickness
Depth plameior or Weight/R. material
From 0 To '7n Ft. • .P)6 C_�lve
From To FI
From To Ft
1.1 GROUT:
Depth - Material Method
From b To r-20 FI l ohcrcJe pntiseti
Flom To Ft.
15. SCREEN
Dopth 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
Flom To FI
LOCATION SKETCH
(Show direction and distance from al least Iwo Slate
Roads, or other map reference points)
From _ To Ft
17. REMARKS:
I DO HEREBY TiFYtTNA7Tt11S-WEI. RUCTED I CCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTI 11 STANDAIiPS,, AND THAT A,,CO THIS C D HAS BEENOVIDEDTO THE WELL OWNER. (/,r
il
Ouad No: I I TORE OF FSON CONSTR
UCTING TIDE ELL DATE
I FOR OFFICE SE QNLY �! ' Submit odpl vision or Water Quality. Groundwater Section within 30 days
4
Serial No.
GW-I REV. 12/09

North Carolina - Dnperlmonl of Environment end Nnlurnl Resources - Division of Writer Quality • Oroundwalor Section n r i� � y'
1636 Mall Service Cenlor - Ralolph, N.G. 27699.1638-Phone (919) 733•3221 •
WELL CONSTRUCTION RECORD
WELLCONTRACTOR• B0 Tt{ U,J. Pc4+s
WELL CONTRACTOR CERTIFICATION N: . (ja R
STATE WELL CONSTRUCTION PERMITN:
1. WELL USE (Check Applluhle hoa): Residenllal112 Municipal El Industrial 0 Agricultural 1 J Monitoring ❑
Recovery IC Hoot Pump Water Infection I� Other Ej II Olhor, List Use:
2. WELL LOCATIO how sk 111 of 11e location below) dw2LJ..
Nearest To _A- feel County'
41
Mond Name And Numbers, Cormur�i o‘ Subdivision and Lot No.)
3. OWNER
Address
8'7/5
Clly or Town Stale
4. DATE DRILLED /n:? o?
5. TOTAL DEPTH r
6. CUTTINGS COLLECTED YESj i NOEvf
7, DOES WELL REPLACE EXISTING WELL? YES /[ ] NO t[ �f
8. STATIC WATER LEVEL Below Top of Casing: TP 4/ FT.
(Use •.• 11 Abovo Top el Casing)
9. TOP OF CASING IS 1 FT Abovo Land Surface'
•Tap of cesing le t miner ed aUor below lend surface require. It variance In accor-
dance with 15A NCAC 2C .911e 10. YIELD (gpm): tpfi METHOD OF TEST
11. WATER ZONES (doplh)' 12. CHLORINATION: Type --- zFt.._Amounl.l7
l } i (lS
13. CASING:
DRILLING LOG
DEPTH
From To Fomrfllon Dnscdpllon
Zlp Code
cock.
L_)
N
Wall Thickness
Depth//� �la� .gr.S1'eJoLN[L ,Mated& -
FrOm lO To FI -
Florn To PI
From To FI.
14. GROUT:
Depth Materiel
From 0 To ___L_ Ft. afjli.EI
From To FI
15. SCREEN:
MoI�"`h`
Depth Diameter- Slot SILO Malarial
From To Ft In In
From To Ft In In
From To Ft In In.
16, SAND/GRAVEL PACK:
From
From
Depth
To
To
17. REMARKS:
Size
FI
FI.
Material
r
If additional space Is needed use back of form
LOCATION SKETCH
(Show direction and distance from nl least Iwo Slate
Bonds, or other map rolorence points)
cam. ycc.
I DO HEFIEDY C ,p�xA7 'AATTR r • - •. iUCTEO IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTIO Ip'IN( rT S AND Ti IA\FA4,OP HIS r1Es'iono HAS BEEN PF_QVI9ED T THE WELL OWNER.
FOR OFFICE U CI�NLY
Ouad No:
Serial No.
SubnJI orlghiij
J
Ur}L"OFip ERSON CONSTI'TUCTING TIIE WELL
IslOn ol Wnter Duality, Groundwater Section wllhin 30 days
Paz-oa
DATE
GW-1 nEV. 12/99

North Cnrollna - Dnparlmont of Environment and Natural Resources - Divlelon of Water (Duality • Groundwater Socllon n (' (] (� 5 9
16Je Mall Service Center - Relolgh, N.C. 27699.1636-Phone [phone] (� U O iJ
WELL CONSTRUCTION RECORD WELLCONrRAcron• BP Lk � >�•. i e �s
WELL CONTRACTOR CERTIFICATION 0: (9a g
STATE WELL CONSTRUCTION PERMITM:
1 WELL USE (Check Applicable Boa): Residential Municipal ❑ Industrial El Agricultural Monitoring D
Rocovery r1 Float Pump Water Infection ❑ Other E] II Other, List Use:
2. WELL LOCATION how skeicji of the location below)
Nearest Town:
�f0,(ODvv�litcs�( hC
Mond Name''��n� /� cnban, ammo y, ub.lvlslon and Lot No.)
•
3. OWNER GV
Address
C andad
City or Town State
4. DATE DRILLED 6 '2 ¶-c .
5. TOTAL DEPTH 6.5
6. CUTTINGS COLLECTED YES NOIV
7, DOES WELL REPLACE EXISTING WELL? YES I j NOM
6. STATIC WATER LEVEL Below Top of Casing: lIcer FT.
)Use'.' if Above Top of Casing)
9. TOP OF CASING IS 1 FT. Above Land Surface'
•Top of casing terminated evor below lend sumacs requires a vedence In accor-
dance with 15A NCAC 2C .9,110 j> ,
10. YIELD (gpm): / 5 METHOD OF TEST q
t 1. WATER ZONES (depth). j
County
12. CHLORINATION
13. CASING:
leo ar ou a a.
an/6-
Zip Code
DRILLING LOG
II
DEPTH
From To Fomallon Dnscelpllon
8ins
Iv
r
Type—Amounlre } t II i II edditlonal space Is needed use hack of form
Wall Tldcknese LOCATION SKETCH
�Dep117 5_/ �1a11of'eJg�v(J. Ma;1VC S� (Show direction and distance born nl teasl Rvo Stale
Prom To FI. I /J i ponds, or other map reference points)
From To FI.
From To Ft.
1A. GROUT:
Depth MalarialMelhod
pie ,
From n To �FI alnQEfI rnu��d.
From To Ft
15. SCREEN:
Doplh Diameter Slot Slzo Material
From To PI 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:
100 HEREBY 1 PW'I TT ATTIMS WIIELL WASCQIQ3,T'TUCTED IN ACCORDANCE WITFI 15A NCAC 2C, WELL
GONSTRUCTIu N,S 1 Af1CTS, ANDITIIAT A COfiYT THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
FOR OFFICE ll Et.-ONLYvV r _ 7wa tie;
Owed No: SI@ ATUBE PERSON CONSTRUCTING TI IE WELL DARE
-I 4. Sutxnil odgtnaTTo 04vtslon of Wnler Ountlly, oroundwater Section within 30 days
Sedat No, GW1 REV. 12/99
0

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 WELLCONTRACTOR• #/RkRW 14Ef
WELL CONTRACTOR CERTIFICATION 0:
STATE WELL CONSTRUCTION PERMIT#:
269958
A (dv;/vE5
[90
1. WELL USE (Check Applicable Box): Residential��
Recovery ❑ Heat Pump Water Injection ❑
2. WELL LOCATION,(/$how sketch ol4he location be
Nearest Town: LUS-0'1- W
3. OWNER
Address
Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Other El If Other, List Use:
low)
County W,[ i', _^
(Road Name a cl Numbers, Commut9l)y, or Subdivision end Lot No.) DRILLING LOG
From To
Clly or Town Q'�Slate
4. DATE DRILLED n�P, —v
5. TOTAL DEPTH
6. CUTTINGS COLLECTED YES NOR/
7. DOES WELL REPLACE EXISTING WELL? YES ❑ NO[-----' -..
8. STATIC WATER LEVEL Below Top of Casing: 0 FT.
(Use'+' If Above Top of Casing)
9. TOP OF CASING IS 1 FT. Above Land Surface'
'Top of cesing terminated at/or below land surface requires a variance In accor-
dance wllh 15A NCAC 2C .0118
10. YIELD (gpm): �_Q METHOD OF TEST �) q
11. WATER ZONES (depth)•
0 ->/3
//3-3c;s
DEPTH
Formation Description
BeARocti
0
II
?
Zip Code
IN)
12. CHLORINATION: Type 4t-T4-1•
13. CASING:
From
From
From
14.GROUT
Amount 5 ��nu15 If additional space Is needed use back of form
Wall Thickness
Depth Diameter or WeIghVFI. Material
Via. } Mt-SDfi
From 0
From
15. SCREEN:
To // 3 Ft. lb. D5
To FI
To FI
Depth
To 0 Ft
To FI
Materlal
Cm C P.P
a4Method
ruite
Depth Diameter Slot Size Malarial
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:
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other map reference points)
- /Y/ y Yam`
(/ c Vcl� i7 c
0
G7
r'T
0
v
1V
CO
0
I DO 1IEREDY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
FOR OFFICE u" i.ew y—
Quad No: -11
Sedal No
S
Submit origlna 1
. dr.
AT R• OF PERSON CONSTRUCTING THE WELL DATE
Ion of Water ouallly, Groundwater Section within 30 days
GW-I REV. 12/99
0 n

North Cnrolinn • Onperimonl of Environment and Natural Resource, - Division of Water Ovally • Oroundwnler Section
1636 Mall Sorvica Cenlor - flelolph, N.C, 27699-1638-Phone (919) 733•3221 �. (( (�
WELL CONSTRUCTION RECORD WELLCONTRACTOR' Bo bhf 11�. f o*1LS
WELL CONTRACTOR CERTIFICATION 0: FJ� zQ
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE (Check Appticeble Box): Residential l2' Municipal ❑ Industrial ❑ Agrlcullural 1 I Monitoring ❑
Rocovery ❑ Heal Pump Waler In)ecllon ❑ Oilier fl If Other, List Use:
2. WELL LOCATION: low skel h of the locailon below)
Nearest Town. �;/} County: 70:19%124-12
(need Name end N ere, C•rmuniiy, or Spbdlvislon nod Lot No.)
�.
3. OWNER Q a./l C._ _
Address � 5c ( a0 3
+reo or Tolle No.
/ 77 C a 87/,c
Clty or Town Slate
4. DATE DRILLED 'aSI_-______
5. TOTAL DEPTH __ JR ��J--''
6. CUTTINGS COLLECTED YES (_I NO
7. DOES WELL REPLACE EXISTING WELL? YES I J NO t f
6. STATIC WATER LEVEL Below Top of Casing: 01'5 FT.
(Use'r' 11 Above Top of Casing)
9. TOP OF CASING IS I FT Above Land Surface'
•Top of on stng terminated sVor below land surface requires s vedsnca In eccor•
dance with 15A NCAC 2g.11 1p
j� r
10. YIELD (gpm): I OD METHOD OF TEST
11. WATER ZONES (doplh)•
DRILLING LOG DEPTH
From To Fornu, Jon 9r. s nlplion
a - 6 7
47 -185.
Zip Code
=�f
tack__
U
w
IV
12. CHLORINATION: Type—S_Z.C] Amounl3 I 1 (1
13. CASING:
If addillonal space Is needed use hack of form
Wan Thickness LOCATION SKETCH
Depth //PPlameis r /y,e Q �Vr{,. Material (Show direction and distance brn ont least Iwo Slate
From�To (0 7 -FI .w'� `a�•' Roads, or other map reference polnls)
From To FI. r v rC
From To It
bjf) 14. GROUT'
Depth Material Mol_ Ilod , n r q
Flom To _all_ Ft tREiE Jjlh`(`f P`F`1{` (/ ifV-✓` th .
From To F1
15. SCREEN:
Depth Diameter Slot Size Material
From To Ft In In
From To FI In In
From To FI. In In
16. SAND/GRAVEL PACK:
Depth Size Material
From 1 To FI
From To Ft
269956
O
17. REMARKS:
I 00 HEREBY C FKTNATTI II UCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
GONSTRUCTIO $4 N) A,RIb$ A$t0 TIIA�f A GDP • {� HIS RECORD HAS BEEN 1' OVIDEO TO THE WELL OWNER.
FOR OFFICEUS4WilLY.__ r,/� !/V !/ k- a4-7-dal.
Quad No: I I ', Stu / URE PERSON CONSTRUCTING IIIE WELL DATE
l� L. Submit odpinal + :Iv slon el Writer Duality, Groundwater Section within 30 days
Serial No.
ow. % NEV. I 2/99

269951
North Caroline - Department of Environment end Natural Resources - Division of Water Quality - Groundwater Section
1636 Mail Service Center - Raleigh, N.C. 27699-1636-Phone [phone]
WELL CONSTRUCTION RECORD
WELL CONTRACTOR•
WELL CONTRACTOR -
40
Cl
"BRiAN ICE/ A - LAIES
ERTIFICATION 0:
STATE WELL CONSTRUCTION PERMITO:
1. WELL USE (Check Applicable nos): Residential 0� Municipal ❑ Industrial 0 Agricultural 0 Monitoring ❑
Recovery 0 Heat Pump Water Injection ❑ Other 0 II Other, List Use:
2. WELL LOCATION: S w sketch o the location below)
"treat Town: Coun
(Road Name and,N 4ars, Common or SSuub/d�Islon and Lot No.)
3. OWNER .C�-yg i} f,Zh %c-+-[,4�
Address
4. DATE
5. TOTA
6. CUTTINGS COLLECTED YES! J NORY
7. DOES WELL REPLACE EXISTING WELL? YES NO�'
8. STATIC WATER LEVEL Below Top of Casing: (7 FT,
II (Use'.' 11 Above Tap ol Casing)
9. TOP OF CASING ISJ�. FT. Above Land Surface'
•Top of casing terminated eUor below land surface requires a variance In accor-
dance wllh 15A NCAC 2C .0119
10. YIELD (gpm): lC () METHOD OF TEST li)15t
11. WATER ZONES (depth).
Soicanice
DRILLING LOG
From To
8702 -%R5
Zlp Code
y or Town ! Stale
DRILLED a
L DEPTH
12. CHLORINATION: Type M 1 -1--
:ASING:
From 0
From
From To
14. GROUT:
From Q
From
15. SCREEN:
From
From
From
Depth rf
To ` FI
To FI
FI.
Diameter
Ln
Amount 9
Wall Thickness
or Weight/FL. Malerlal (Show direction and distance from at least two State
PYG-SDR Roads, or other map reference points)^
DEPTH
Formation Description
IV
ID
II additional space Is needed use back ol form
Depth Malerlal
TO FI C.3 CPI P.7P
TO FI
Depth
To
To
To
Ft
FI
Ft
Malhod
Diameter Slot Size Material
In In.
In In
In In.
16. SAND/GRAVEL PACK:
Depth Size Malerlal
From To FI
From To FI
17. REMARKS:
LOCATION SKETCH
/O
7 c.
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
FOR OFFICE U
Ouad No
al No.
E
L.
'S
Submit original I
N • I JRE OF PERSON CONSTRUCTING THE WELL DATE
Ion ol Waler Quality, Groundwater Section within 30 days
GW-I REV. 12/99
r=;
o
m
0

North Carolina - Dnparlmont of Environment and Natural Resources - Division of Water Quality • Groundwater Section 2 6 9 9 5 0
1636 Mail Service Center - Flnloioh, N.C. 27699-1636-Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR. /4R i/ /% Pg::7 Sooaft
WELL CONTRACTOR CERTIFICATION 0: d9
STATE WELL CONSTRUCTION PERMIT#:
1 . WELL USE (Check Applicable Box): Resldentlai tF/I Municipal ❑ Industrial ❑ Agricultural D Monitoring n
Recovery ❑ Heat Pump Water Infection ❑ Other [] 11Other, List Use:
2. WELL LOCATION: tow sVetch .I the location below)
Nearest Town: County. �j C•e—�_
(Bond Name and Numb -
3. OWNER �jtJ
Address /7ek •�%q 9 D
-IS/oterflowe r G7
5417
�o 21 Cade 5 ! 505
City or wn Slate V
4. DATE DRILLED .Dp 1.5 "0
5. TOTAL DEPTH 505
6. CUTTINGS COLLECTED YES I I NOI�(
7. DOES WELL REPLACE EXISTING WELL? YES I I NO[
8. STATIC WATER LEVEL Below Top of Casing: FT.
I (Use •+' II Above Top al Casing)
9. TOP OF CASING IS ` FT. Abovo Land Surface'
'Top of casing terminated aUor below land surface requires a variance In accor-
dance wllh 15A NCAC 2C .0)18
10. YIELD (gpm): C2 METHOD OF TEST
11. WATER ZONES (depth):
Cmmunly. r SuhQly ArVol No.)
DEPTH
Formation Description
Iv
0
12. CHLORINATION: Type H 7H Amount Capin() II additional space Is needed use back of form
13. CASING:
LOCATION SKETCH
Wall Thickness
Depth // tamale; er WeIphUF-l. �aall_edal (Show direction and distance from at least Iwo State
From t& To rff 7 FI. • iL'�'�S '—`-- Roads, or other map rolerence points)
From To Et. L
From To FI. Jai /W N •
14. GROUT:
Depth - �rMaterial Method
From b To r O Ft CchCfe.fe J)niLCPCl
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
15. SAND/GRAVEL PACK:
Depth Size Material
From To El
From To Ft
17. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED I' A CORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS - D HAS BEEN
PROVID 0 TO WELL OWNER
0
0
*1
l;J
dilfZirj.Leski Cr n3
—p
N _
co
FOR OFFICE USE ONLY
\,
Quad No:
U ,
Segal No.
SubrntI odoiny
ASH'ViL'L_r . 'NPE
URE OF P ,r' SON CONSTRUCTING TIIE WELL DATE
ton of Water Quality, Groundwater Section wllhln 30 days
GW-1 REV. 12/99

269947
Nof tl Carolina Dnparrmenl of Environment and Natural Resources - Division of Water Quality - Groundwater Section
t
1636 Mail Service Center - Raleigh, N.C. 27699-1636-Phon
[phone]
WELL CONSTRUCTION RECORD
a
WELL CONTRACTOR• /4R2l y �`��i7 4071/
WELL CONTRACTOR CERTIFICATION a: boa 9
STATE WELL CONSTRUCTION PERMITN:
1
WELL USE (Check Applicable Box): Residential he Municipal ❑ Industrial ❑ Agricultural E Monitoring ❑
Recovery ❑ Heat Pump Water Infection ❑ Other I] II Other, List Use:
2. WELL LOCATION: (Sher skel t of the location below)
County
Nearpal Town:
(Road Name d Numbers, CornrnunityQ'( Subdivision and LckNo.)
3. OWNER ( r .l;}ti-�4�1/%�LvCaill2. Cbilli-a.s
Address
jSireoi or Ilqu
Al City
4. Stale
4. DATE DRILLED as
5. TOTAL DEPTH--
6. CUTTINGS COLLECTED YES [ j NON✓
7. DOES WELL REPLACE EXISTING WELL? YES [ I NOR}'
0. STATIC WATER LEVEL Below Top of Casing: FT.
' (Use'+' II Above Top of Casing)
9. TOP OF CASING IS FT. Above Land Surface'
•Top of casing terminated atfor below land surface requires a variance in accor-
dance with 1 A(y m) ZC.p METHOD OF TEST r G�
10. YIELD (gpm)' /oSJ
11. WATER ZONES (depth):
&/2C07-11Q
DRILLING LOG
From To
4 o
-5
DEPTH
Formation Description
1)r f
BFdgpck
a 87a2
Zip Code
Z
_
12. CHLORINATION: Typo H 7H Amount Coq pills II additional space Is needed use back of Corm
13. CASING:
Wall Thickness
0 Depth plarnoter or We) :QwFt. attedal
To .�1_i.1_ Ft [e • r iye-\llK
From
From To FI
From To Ft.
14. GROUT:
Depth - �rMaterial
Frain D To �.Q. Ft. CDhcrde
From To Ft.
15. SCREEN:
From
From
From
Dopih Diameter Slot Slzo
To FI In. In.
To _— FI. In. in.
To _ Ft. __ In In.
15. SAND/GRAVEL PACK:
Depth
From To
FromTo
Ft
Ft.
Method
Material
Size Material
LOCATION SKETCH
(Show direction and distance from al leas) Iwo Slate
Roads, or other map reference points)
/804,72,,
17. REMARKS:
L
I DO HEREBY CERTIFY THAT THIS WELL W IN •, N is S F9 CORD HOANCE A9 BEEN PR9IT VIDED TO THE WELL OWNER.
CONSTRUCTIO 0.ARD,SI AND TOI1A�'„u� G' ii/ s-/ 5' /540 2
g PERSON CONSTRUCTIN HE WELL
DATE
on of Water Duality, Groundwater action within 30 days
Submit origin
Jlf/'
GW.i REV. 12/99

269946
1
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mall Service Center - Raleigh, N.C. 27699-1636-Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR•
iRmAN 1..WA-((.•((.
WELL CONTRACTOR CERTIFICATION #: °�1 A7
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE (Check Applicable Box): Residential Er Municipal ❑ Industrial ❑
Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other If Other, List Use:
2. WELL LOCAT N: (Show sk tclt of he location below) �',,,,,, \J1.,
Nearest Town: na r�.5V '2_t County UY) CC r'Ye-
G ik_e tiA. . & i414A r Late-)
(Road Name and Number Community, or Subdivision and Lot No.)
3. OWNER El(' WIMP" 5-1-antes
Address Li(..I (p ycvev
(5ireel or Hou o.
tarnal/65v
City or Town State
4. DATE DRILLED -133-
5. TOTAL DEPTH 0
6. CUTTINGS COLLECTED YES NO WI
7. DOES WELL REPLACE EXISTING WELL? YES n NO(
8. STATIC WATER LEVEL Below Top of Casing: '7-7 FT.
1 (Use 'i II Above Top of Casing)
9. TOP OF CASING IS 1 FT Above Land Surlace'
'Top of casing terminated et/or below land surface requires a variance In accor-
dance with 15A NCAC 2C A116
ID. YIELD (gpm): '7 METHOD OF TEST r
11. WATER ZONES (depth):
DRILLING LOG DEPTH
From To Formation Description
FOR OFFICE US
Quad No:
.,edal No.
•
II
IS v.
a$l09
Zip Code
1" CHLORINATION: Type Rr 774 Amount
CASING:
From
From To Ft.
From To Ft
14. GROUT:
0
N
J
-o
If additional space Is needed use back of form
Wall Thickness
Depth Diameter or W ightFt. Matedal
D To led- Ft L'a5 dlt.l4 f PI/65U4C
Depth Material Method
From _0_ To LP..._Ft C'AlYC2k4E 7 DuE1;rL
From To Ft
15. SCREEN:
Depth
From To
From To
From To
16. SAND/GRAVEL PACK:
Depth
From To
From To
17. REMARKS:
F-t
Ft
Ft
Diameter Slot Size Materiel
Ft
jrl
In
In
In
Size
In
In
In
Material
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other map reference points)
rPOV2rk� tty.
tax naldSvi 11E/
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY eF THIS RECORD HAS BEEN PR IDED TO THE WELL WNER.
0138�13-dam
s
Submit odoinal
RE OF PERSON CONSTRUCTING THE WELL DATE
Ion of Weler Quality, Groundwater Section within 30 days
GW-I REV. 12/99
7,7
C.
i

North Carolina • Department of Environment and Natural Resources - Division of Water (Duality - Groundwater Section
1630 Mall Service Center - Raleigh, N.C. 27699.1636-Phone [phone] / ��(+
WELL CONSTRUCTION RECORD WELL CONTRACTOR CERTI4ERJ, Fief// o
STATE WELL CONSTRUCTION PERMIT#:
269944
1. WELL USE (Check Applicable Box): Residential V' Municipal ❑ Industrial LI Agricultural LI Monitoring ❑
Recovery ❑ Heat Pump Water Infection ❑ Other ❑ II Other, List Use:
2. WELL LOCATION: ( o sketch of 11 ocatlon below)
.w .. Coun �� o
N arest T
(Fl•�d Name and Cornmunl . or Su vision and Lot No.)
3. OWNER .tl' _
Address
/V
el or l touf6'flo.
City or Town SI
4. DATE DRILLED .$-/a"a
5. TOTAL DEPTH tho5
6. CUTTINGS COLLECTED YES [J NOP('
7. DOES WELL REPLACE EXISTING WELL? YES 1 I NOR:"
6. STATIC WATER LEVEL Below Top of Casing: //4— FT.
(Use'.' 11 Above Top of Casing)
9. TOP OF CASING IS I FT. Abovo Land Surface'
•Tap of casing terminated at/or below land surface requires variance In accor-
dance with 15A ?ICAO 2C.011e
10. YIELD (gpm): 4,1 METHOD OF TEST
11. WATER ZONES (depth)
7/
Zip Code
DRILLING LOG
From To
o - o
/3U- t
DEPTH
Formation Description
L r 1
Brc pc/�'
,o
CD
c,
12. CHLORINATION: Type H 7H Amount /63T l its if additional space Is needed use back of form
13. CASING: LOCATION SKETCH
Wall Thickness
Depth (Hamner or WlGQhaS pedal (Show dlrectlon and distance from at least two Stale
From
0To 1-3D Ft 4. Roads, or other map reference points)
From To Ft.
1 / / l o /t & _
From To Ft C/'� L//'A"n���
1,1 GROUT:
Depth - Material Method - 1 1"r/�
Froth 1) To , 0 Ft l 0 hate-�e pa r f ea ! /7/• / L
From To FL
15. SCREEN:
Doplh Diameter Slot Size Material
From To Ft In. In
From To Ft In In
From To FI. In. In
16. SAND/GRAVEL PACK:
Depth Size Material
From To Ft
Ft.
From —_— To
17. REMARKS:
IDO HEREBY STHAT THIS WAS CONSTRUCTEDIRCH DE WELL
CONSTRU ORTANQARDS;ARDTATrA IBEENROVID TO THE WELLOWNER.
I.
FOR OFFIC U 14T NATURE OF P ON CONSTRUCTING TF E WELL DATE
Quad No: i 1 i
$ebmR oft) Division of Wnler Duallly, Groundwater Secllon Within 30 days GW 1 REV. 12199
v
N
VD
r•
Serial No

North Caro/inn • Doperlmonl of Environment and Naturnl Resource, - Division of Water Quality• Groundwater Section 2 6 9 9 38
1636 Mall Service Cenlor - Reielph, N.G. 27699-1636-Phone (919) 733•322I •
US
(�
WELL CONSTRUCTION RECORD WELL CONTRACTOR �0 6 ht' UJ . t o� �S
WELL CONTRACTOR CERTIFICATION 0: oa g
STATE WELL CONSTRUCTION PERMITN:
1. WELL USE (Check Applicable Box): Residential I N Municipal O Industrial D Agrlcuilural I I Monitoring O
Rocovery ❑ Float Pump Water Inlecllon [1 Other n If Olhor, List Use:
2. WELL LOCATION;,(�JIA& ss kkel h of the location below)
Nearest Town. •('Q d' s "•4 County. 7�%[9a9dL.1/�P4khT71N.
/Igend Name and , u ie. Co-�r/mwdry�, p}r�jJu�bdIvIsbn And La) No.) DRILLING LOG DEPTH
3. OWNER /� )K-Lf6/r From To Fominllon Description
Address
Clly or Torn Stale
4. DATE DRILLED 12�1_�a'_ O
5. TOTAL DEPTH . `-T n 5
6. CUTTINGS COLLECTED YES I 1 NO(✓r �-�y
7, DOES WELL REPLACE EXISTING WELL? YES) 1 NOI v l tri
6. STATIC WATER LEVEL Below Top of Casing: /40 FT. C�
J
(Use 'a' If Above Top of Cnslnp)
9. TOP OF CASING IS I FT. Abovo Land Surface' _D
•Top of ca eing terminated sVor below lend surface requires s vedence In eccor-
donee wI1h 15A NCAC 2C.911e s •• r-,
10. YIELD (gpm)• METHOD OF TEST -
11. WATER ZONES (dopth): LI p 0 c.
12. CHLORINATION; Typo __S-7-E]--Amount L i p 1 (' S If additional space Is needed use hack of form
13. CASING:
`a -e65 RLg.
Wall ThIcknEty([e�ss
l
matedal
Froma--To / al Ft,
Ftom To FI.
From To Ft,
Id. GROUT:
Depth Material Mol Iiod
From 0 To 2iD n rtn2E16
From To FI
15. SCREEN:
Depth Dlamelor Slot Size Matorlal
From To Ft in. In
From To FI In In
From To Ft In In
16, SAND/GRAVEL PACK:
Depth Size Matt:Mal
From To FI
From To FI
17. REMARKS:
LOCATION SKETCH
(Show direction and distance from nl least two Stale
ponds, or other map reference points)
Aead
I D0 HEFIEOY CEP-T ' -THAT--TI#FSW{LL-WAS-C NSTni r -'TED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION
FOR OFFICE USE
Ouad No:
Serial No.
t tAnasY AND TI IAT A COO
SI
Suboill odoinal
A
S RECORD HAS BEEN PROVIDE Q TO THE WELL OWNER.
E OF PER •N CONSTRUCTING TI IE WELL ONE
n el Willer Wanly, Olvundwaler Section Wllhin 30 days
CW•I REV. 12199

•
Nodh Carolina - dnpartmonl of Environment and Natural Resource, • Division of Water Quality - Oroundwnlor Section
1036 Mall Service Center - Relolph, N.C. 27699-1630-Phone (919) 733•3221 ( 6 9 9 3 6
WELL CONSTRUCTION RECORD WELLCONTRACTOR• 30 bhri 11J . r�44-S
WELL CONTRACTOR CERTIFICATION 0: D� g
STATE WELL CONSTRUCTION PEI-MITM:
1. WELL USE (check Appltuble Box): Residential Municipal n Industrial n Agricultural I I Monllorfng n
Rocovery ❑ 1-loat Pump Water Injection 1 I Other Ell if Other, List Use:
2. WELL LOCATIONShow skelgti of the location below)
Ne o rent Town: C unty. y'
DD Numb N .)
Mond Name and{��Nu^mbAer,,, Community, or 5 bdlvielonn and Lot No.) DRILLING LOG DEPTH
3. OWNER "14"- QO2ue.,
�OAddressSts
eol or g93 0
Zip Code
L
Cily or Town . Slate
A. DATE DRILLED 3
5. TOTAL DEPTH . 0,5
6. CUTTINGS COLLECTED YES I 1 NOI vj
7, DOES WELL REPLACE EXISTING WELL? YES n NO 4
B. STATIC WATER LEVEL Below Top of Casing: T7 IT.
(Use 'r' II Above Top ol Casing) 1`3
9. TOP OF CASING IS I FT. Above Land Surface' -'3
•Top of casing terminated .Uor below lend surface requires a variance In accor- - 3
Rom To
Formellon Description
/07 -305'
dance wllh 15A NCAC 2C.01,1,16
I D. YIELD (gpm): X METHOD OF TEST
11. WATER ZONES (doplh):
12. CHLORINATION; Type Amounln S • Its
13. CASING:
N
II additional space Is needed use hack ol form
Wall WThlckne se LOCATION SKETCH
Depth/0 FI �Iamelol r� ra elacrg. Mnlei r7 (Show direction and distnce born al leastIwo Slate
FromTo CJ (p iS�.i-LLiC Roads, or other mapreference points)
From To Ft. /) C �AU)?
From To F1.eW�J—Y
14 GROUT: n
Depth !n1 - Matedol nn__MlIe�th��,o'd''' i n , �./ `J%�, `/�
To __ _ FI Ei E / tiJ icLu(N-7 1 / L \_ . om
r
From I
Frorn To Ft —o
15. SCREEN:
Dopih Diameter Slot Size) Materiel 1') r
N n
From To Ft In In k_
D o
From To Ft In In z
From To Ft In In
16, SAND/GRAVELPACK:
Depth Size Material
From To F1
From To Ft
17. REMARKS:
I DO HEREBY
CONSTRUCT
FOR OFFICE
Quad No:
Serial No.
Ga R IFM'FNATTTtiSWELEWA54,
dM A�IDARDS AND TI IAT A GO�!
5EtlNLY I I��/i O ^ 6v �,
�.-, S NATUfTE OF P SON CONSTRUCTING TI IE WELL DAt E
LI Subndl odotrrrd o Blaine al Wn&er Duality, Groundwater Section within 30 days
RUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
' THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
OW-1 nEV. 12/99

•
•
North Cnrollna Popertmonl of Environment and Nolural Resource, - Olvlelon of Water Quality • Groundwater Section 269935
1636 Mall Service Center • Retelgh, N.C. 27699-1638-Phone (919) 733•3221 f (�
WELL CONSTRUCTION RECORD WELL CONTRACTOR. 30 6hr {1.J . Yo'{bS
WELL CONTRACTOR CERTIFICATION 0: Da g
STATE WELL CONSTr1UCTION PERMITNs
1. WELL USE (Check Appllc.ble Box): Residential
Recovery r1 I -loaf Pump Water Injection r1
2. WELL LOCATION• ow s etch o
N:a est Town:
Municipal ❑ Industrial D Agricultural ❑ Monitoring
Other Ej II Olhor, List Use:
II : location below)
Gov
(Floe •©-meanors, anewrilly,
or7 bdl nao.)
3. OWNER
Address
o mfl ulo Na
Clly or Torn Stale
4. DATE DRILLED —Q_
5. TOTAL DEPTH
6. CUTTINGS COLLECTED YES[ NO(v/j
7. DOES WELL REPLACE EXISTING WELL? YES [� NOM
6. STATIC WATER LEVEL Below Top of Casing: �� FT.
(Use'.' 11 Above Top of ens6,g)
9. TOP OF CASING IS I FT. Abovo Land Surface'
•7 op of us Ing terminated el/or below lend surface require. a variance In eccor-
dencewIth 15A NCAC 2C. 116
10, YIELD (gpm): .-S i7 METHOD OF TEST
11. WATER ZONES (doplh)•
— 76
-as
•
e 9
yC427//
Zip Code
DEPTH
Fomallon Descrlpllon
II
0
n
i" ,HLORINATION: Type T N Amount
I.. ,ASING:
ro)
If additional spaco Is needed use hack of form
Wall Thickness �1l,, (n,-�
Depths/ �1a.1 rj ffel t M,LYi ,..e 1-�
From To �O Ft.,
From To FI
From To Fl.
Id. GROUT:
From
Frain To Ft
15. SCREEN:
Depth
From To
From To
From To
16. SAND/GRAVEL PACK:
Depth
From To
From To
17. REMARKS:
I DO WERE
CONSTRU
k 0FFIC
ad No:
Deplti Malarial
n To FI �G n (_r: i E'
Diameter
Ft
Ft
FI
In
In
In.
Size
FI
Ft
Molhod
Slot Size Malarial
In
In
In
Material
LOCATION SKETCH
(Show dlrectlon and distance Irorn nl least Iwo State
Roods, or other map rolorence points)
Jo -ad y� ti
-CERTIFY--THAITHIS WFI I WAS rc1NSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
f lI $ NO'ARDS A�lDrt1IATA s10 •F THIS RECORD
IHAS BEE PROVIDED TO THE WELL OWNER.7.1
r 412S
3NATUn OF PERSON CONSTRUCTING TIIE WELL DATE
Svbmll •drlyT Ho Division of Water (Duality. Groundwater Secllon within 30 days
GW-I nEv. 12199
7.7
n
a of �rr�iv•

Cou
n _,
oad Nam ndjQpmba>s,Cor{mur nhly' r Su.•I Won and Lot No.)
3. OWNER O'J—) 4 en -Yu -a-)
Address
North Carolina • Depanmenl 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.
WELL CONTRACTOR CERTIFICATION #:
STATE WELLCONSTRUCTION PERMIT#:
269933
MAN it.E. �, A t rives/1740
1. WELL USE (Check Applicable Boa): Residential LW Municipal ❑ Industrial ❑ Agricultural 0 Monitoring ❑
Recovery ❑ Heal Pump Water Injection ❑ Other II Other, List Use:
2. WELL LOCATION: how skew of the location below) �� ._.•.a l .
earosl Town:
ee or
City or Town Slate
r�
4. DATE DRILLED �1" "a -O
5. TOTAL DEPTH aO S
6. CUTTINGS COLLECTED YES NO[Y
7. DOES WELL REPLACE EXISTING WELL? YES N0IV"...
6. STATIC WATER LEVEL Below Top of Casing: � FT.
(Use -•• II Above Top of Casing)
9. TOP OF CASING IS I FT. Above Land Surface'
•Top of casing terminated el/or below land surface requires a variance In accor-
dance with 15A NCAC 2C .0118
10. YIELD (gpm): /5 METHOD OF TEST -1?) q
11. WATER ZONES (depth):
DRILLING LOG
From To
DEPTH
Formation Description
0 — 3 tigt
/03 — /6,1• 13ed4.45
I
"�g dncp
Zipp Cale
12. CHLORINATION: Type
1"-ASING:
From 0
From To Ft.
From To Ft
14. GROUT:
From 0
From
15. SCREEN:
Depth/OD Diameter
To FI.
Depth
To QC) FI
To Ft
Depth
From To Ft
From To FI
From To Ft
16. SAND/GRAVEL PACK:
Depth
From To
From To
17. REMARKS:
Amount
(4
. _ft1115 If additional space Is needed use back of form 0
Wall Thickness
or Weight/Ft. Matedal
Q) 145 PI'C•SDR
Material
GORIGIIP P
Method
l
Diameter Slot Size Material
In In
In In
In In
FI
Ft
Size
Material
LOCATION SKETCH
(Show direction and distance from at least Iwo State
Roads, or other map reference points)
Wcucta
01.r.cc4 Cw, 71 .0
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
FOR OFFICE -•
ATURE OF PERSON CONSTRUCTING THE WELL DATE
iUbni/lufF Division ol Water Quality, Groundwater Section within 30 days
Goad No:
GW-1 REV. 12/99

i
3. OWNER .3?jn 1.0S .5'n)(tali
7
Address Weil VP le a � or outs No.)
Weirvi )fVI.C. g,878'7
City or Town Slate Zip Code
4. DATE DRILLED 5 1-
5. TOTAL DEPTH 5 05
6. CUTTINGS COLLECTED YES in NO1
7. DOES WELL REPLACE EXISTING WELL? YES n NO['
8. STATIC WATER LEVEL Below Top of Casing: ILO FT.
(Use'+ II Above Top of Casing)
9. TOP OF CASING 15 1 FT. Above Land Surface'
•Top of cuing terminated at/or below land surface requires a variance In accor-
dance with 15A NCAC 2C .0118
10. YIELD (gpm): 1. _± METHOD OF TEST : 5
11. WATER ZONES (depth):
North Carolina - Department of Environment and Natural Resources - Division of Wafer Quality -Groundwater Section
2
1636 Mall Service Center - Raleigh, N.C. 27699-1636-Phone [phone]//,' / J�
WELL CONSTRUCTION RECORD WELLCONTR/Fd ACTOR• RmAN 4 •
WELL CONTRACTOR CERTIFICATION #: ate)-17
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE (Check Applicable Box): Residential2r. Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ it Other, List Use:
2. WELL LOCATION: (Show sketch of the location below) �Uhr'Omh P
Near 1 Town: County'
�a4e-c/c ,a,tii t DEPTH
Road Name and Numbers, Community, or Subdivision and Lot No.) DRILLING LOG
From To Formation Descdptlon
D -1011
toll So
19 CHLORINATION: Type J-f TH
BASING:
LOCATION SKETCH
Depth Diameter (Show direction and distance from at least Iwo State
ToJOY-- FI. L ' a 5 Roads, or other map reference points)
B A -the ock
0
—o
From 0
From To Ft.
From To Ft
14. GROUT:
Amount _Cfr64tu15
Wall Thickness
or W IghVFt. Material
�f l�s Pve-SDC
Depth Material Method
aZ
From Q To 0 Ft C1v1� NC-FE /
From To FI
15. SCREEN:
Depth Dlarneter Slot Size Material
From To FT In In
From To FI In In
From To Ft In In
16. SAND/GRAVEL PACK:
Depth Size Material
From To Ft
From To Ft
17. REMARKS:
If additional space Is needed use back of form
ttklie 'vi die, rLc ,
0
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY QF THIS RECORD HAS BEEN PR IDED TO THE WELL WNER.
FOR OF r
fuad No:
( dedal No
4S,E O�l' L r4 V/
�_ Sli 1pi ll0
MAP,
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Inal to Division of Wafer Quality, Groundwater Section within 30 days
GW-I REV. 12/99
c
r

North Cnrollnn - Department of Envlronmanl and Nnlorni Flesources - Dlvlelon of Water Duality - Groundwater Socllon
1635 Mall Service Center - Relolph, N.C. 27699. 1630-Phone [phone]
WELL CONSTRUCTION RECORD WELLCONTFlACTOn• -s
WELL CONTRACTOR CERTIFICATION 0: �r`, of Q
STATE WELL CONSTRUCTION PERMITN:
n2619930
30 bhri aft t'o,-7S
Il
1. WELL USE (Check ApplIc.ble Box): FlesIdenllal I vi Municipal n Industrial n Agricultural Monitoring ❑
Recovery ❑ Heal Pump Water Injection n Other in if Other, List Use:
2. WELL LOCATION: ( low s eloll of the location below) arriCeir7�
Near eel Town: - r --�- County
► /._A 'd / 1a_ _ aloe
Ino
3. OWNER
Address
me nndil vmber�nmon; or '. bdlolslon And Loll No.)
l/Ll/t ztG*!N
CITY or Town Stale
DATE DRILLED s
5. 4
5. TOTAL DEPTH e
6. CUTTINGS COLLECTED YES I NO(v'j
7, DOES WELL REPLACE EXISTING WELL? YES 0 NO t'
0. STATIC WATER LEVEL Below Top of Casing: KO FT.
(Use'.' II Above Top of Cnslnq)
9. TOP OF CASING IS FT. Abovo Land Surlace'
•fop of casing lei mineled et/or below lend surface requires a variance In accor-
dance wllh 15A NCAC 2C.9118 10. YIELD (gprn)• . co(
METHOD OF TEST I1
11. WATER ZONES (depth) 1'-ILORINATION: Type T N AmounI 1p
3+ i 0 s
0
DRILLING LOG DEPTH
From To
ZIP Code /O ( - .54T_5
13. CASING:
Formation Dnscripllon
zz
0
If additional space Is needed user hack of loan
r, Wall /Thickne'ss����(�Q
_1L--DTot.J�'FI Diameter "I"elgg7rr
From
From To PI.
From To FL
Id. GROUT:
From
From To It
15. SCREEN:
Depth Materiel Mot lied
To �_FI �nREi& .Ilh
Depth Diameter Slot Size Malarial
Frorn To Ft In. In
From To FI. In In
From To Ft In In
16. SAND/GRAVEL PACK:
Depth Size Material
From To FI
From To Ft
17. REMARKS:
LOCATION SKETCH
(Show direction and distance from nt least Iwo Slate
Roads, or other map reference points)
I DO HEREDY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTI1N STANDARDS
-
AND TI IiAI
--��-1 10 S dEENW EL OWNER.
N I Ft OFFICE LIE N ``yI'vision ol Wale( Quality, Groundwaler Section within 30 days DAIE1UNE OF ERSON CONSTRUCTING 711E WELL
I�!Subnlll odpa
L/ GW.I REV. 12/99
Serial No, 1 L'. Ie . . ,. .,,

Noah Caroline - Onparlmonl of Environment and Natural Resources - Division ol Water Quality - Groundwater Section 2 g g o g
1638 Mall Service Center - Relotgil, N.C. 27699.1636-Phone (919) 73.3•3221
0 MI
WELL CONSTRUCTION RECORD WELL ELL CONTRACTOR •CEF1'TIFIC3 noN it:: r . S g
STATE WELL CONSTRUCTION PEMITN:
1. WELL USE (Check Applicable Box): ResidentialE Municipal ❑ ' Industrial ❑ Agricultural 0 Monitoring ❑
Recovery n Boat Pump Water Injection ❑ Other n If Oihor, List Use:
WELL LOCATION: (SJJ-+�Qqw sk��Ich Wile location below) ��7CQYN J
County. C.i.Q
Nee at Town:
hirnbe y,a bI:an ol-'� DRILLING LOG
(Eland Name and Nun+bo . Community, ar b (vision And Lot No.)
From To
Zip Code
From To FL
From To Ft
14. GROUT:
Depth
!!11 MaloMot hod
From � To las�_FI �r,,2N6 ]�h_(1—f��.__
Frain To FI
15. SCREEN:
3. OWNER G/r SL
Address
Sheo or
SyJni
Cliyy or Town Stale
4. DATE DRILLED `) 10 a {
6. TOTAL DEPTH NOI
6. CUTTINGS COLLECTED YES �J
7. DOES WELL REPLACE EXISTING WELL? YES ( ( NOM
O. STATIC WATER LEVEL Below Top of Casing: /0 FT.
(Use'.' II Above Top ol Casing)
9. TOP OP CASING IS 1 FT. Above Lend Surface'
'Top ol cesina terminated aVor below lend surface requires a vedance In aecor-
dence WIlh ISA NCAC 2C. 116 1� s
10, YIELD (gpm): /COMETHOD OF TEST N
11, WATER ZONES (depth):
0
DEPTH
Fomrnllon Os scdpllon
d ' / (O5 1> r-ci- ck ,
7
0
ca
c
`7
r- C
N
u
I' 'HLORINATION: Type a_Amountea111, I1 additional space Is needed use back of loan
1 a.. ASING:
LOCATION SKETCH
Wall Thickness
DI I t] �f Placl r� 1yr a IIU ��M(alle (Show {� (Show direction end distance Irom nt least two Slate
From �1_To — F. " rn1 ` "I �Ip" Rondss, or other map reference points) -
6ZALillth7
Depth Diameter Slot Size Material
From __.-To Pt ___ In In.
From To Ft In In
From To FI In. In
16. SAND/GRAVEL PACK:
Depth Size Material
Frain ' To FI.
From To Ft.
17. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCT a. T e^ia ' • THIS RECORD HAS BEEN PRVIDEO TO THE WELL omen.
R OFFICE
uuAd No'.
Sedal No.
O
c,a
-•T
rn
0
lJ'1
1•
N
O
Submit or1 I9 b
IATURE 0PERSON CONSTRUCTING TIIE WELL DATE
Division al Water Quality, 0roundwaier Section within 30 days
GW.1 REV. 12/99
zzz
A rr s� t Gr

Flom To II.
From To It.
14. GROUT:
From Q
Frorn To Ft
15. SCREEN
North Cnrollne • Department of Environment and Nature; Resources - DIvlelon of Willer Ouelhy Oroundwnlor Section (� (j Q r)
1836 Mall Service Conner - nalolph, N.C. 27699-1638-Phone [phone] 269928
9 9 4 8
WELL CONSTRUCTION RECORD WELL coUTnncTon CERTIFICATION n: W Pa 85
STATE WELL CONSTnUCTION PEF MITI:
1. WELL USE (check Applicable Box): Residential130 Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery n Host Pump Water Injection n Other II Othor, List Use:
•
2. WELL LOCATIONow sketclLoWyle location below)
Courtly
Nears) Town'.
Inoed Name and s'; ore, Corrvrninljy, or Su dtvI+Ion and Lot Ho
3. OWNER 4 ��/% -•-• SJ/� Yg1�r
Address
` ^ 'eo ar l7oul0< 1 112-
Clly or Town Stale
4. DATE DRILLED '
S. TOTAL DEPTH
6. CUTTINGS COLLECTED YES Li NOI v-,)
7, DOES WELL REPLACE EXISTING WELL? YES 1 NOM
8. STATIC WATER LEVEL Below Top ol Casing: /5 FT.
(Use'.' If Above Tap ol Ceslnp)
9. TOP OF CASING IS 1 FT. Above Land Surface'
'Top of cesing kink/dad et/or below lend surface requires a variance In eccor-
dencewllh 15A NCAC 2C. 11e 1� s
10. YIELD (gpm): /Vie; METHOD OF TEST t(�
It. WATER ZONES (depth)
.9711
9°' — 566'
Zlp Code
DEPTH
Fom'ellon De scrlpilon
•
IV j' _.
�- `I
1 `ILORINATION: Type k1' ..Amount Ir additional space Is needed use hack of form
13. CASING:
LOCATION SKETCI-1
Wall Thickness
Depth m iaelre1, r e plV (Show direction and distance loom at least Iwo Slate
From 4 To 102 'FI. �':" 'j'" ?MnleAal Ronda, or other map
reference polnls)
Ia avV . YLC.
Dept-h-�a ' Material Mot lied
To gQ___.Fl Clan2ef�
Depth Diameter Slot Size Material
From To It __ In In.
From To Ft In. In
From To It In In
16. SAND/GRAVEL PACK:
Depth Size Material
From
From
17. REMARKS:
To Fl
To
Ft
I DO HEREBY a' y, T7p7)T'7Ttel-Nt[.LL WA.c rnNSTRUCTED IN ACCORDANCE WITH 1SA NCAC 2C, WELL
CONSTRUCT I' iS elDAr14Ert')0 7I IATA OPY 1 TFIIS ECORD HAS BEEN P VIDEO TO THE WELL OWNER.
ffll r W- 7-a•0 A
R OFFICE U��. ONLY
.TUBE F PERSON CONSTRUCTING TIIE WELL
pond No: DATE
Svbnel ode+ • Division of Meier °wilily, Groundwater Section within 30 days
ow.1 nEv. 12/99
liii(1Jre rJ)'
ASHEViLLE REG;
O
Ca)
m
021
rV

North Carolina - DoperImonl of Envlronmonl and Nalure/ Resource, - Division of Water Quality - Groundwater Section 2 6 9 9 4. 4 1636 Mall Service Center - Raleigh, N.O. 27699.1636-Phone (919) 733•3221 . rr
WELL CONSTRUCTION RECORD WELLCONTUACTOR• 1JP bhcA J. Pe 1S
WELL CONTRACTOR CERTIFICATION 0: e Da
STATE WELL CONSTRUCTION PERMITS:
I. WELL USE (Check Appllcsbte Bon): FlesidentlaIllY Municipal n Industrial
Agrlcullural 1 1 Monlloring ❑
Rocovery r-1 Hoet Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATIO�(SI w sketch of the to allon below)
Nearest Town: q�q�/%4a�1-/� County a
634 Cat; !2 l- ataiL sate
ate
(Pond Name /Intl Nrab ore. Crrvrunity, or Sub lion and Lot No.)
3. OWNER
Address 395
sf T Y N y26, 0`388/ 3
Clly Of Town Slate zip Code
A. DATE DRILLED b' •e as
5. TOTAL DEPTH
6. CUTTINGS COLLECTED YES 1 NO 4
7. DOES WELL REPLACE EXISTING WELL? YES NO114
5. STATIC WATER LEVEL Below Top of Casing: FT.
(Use'.' If Above Top of Casing)
9. TOP OF CASING IS I FT. Above Land Surface'
•Top of ce, Ing ter minaled et/or below 11nd eurlace requires a vedence In accor-
dance wllh 15A NCAC 2C.9118
10. YIELD (gpm): /00 METHOD OF TEST q
11. WATER ZONES (depth):
I
DEPTH
F omrellon Onscdp llon
c--
N
0
'V
c
0 f-,
12. CHLORINATION: Type Amount 71.11.] If additional space Is needed use hack of form
13. CASING:
Wall Thickness LOCATION SKETCH
Depth amel{aJ r e o tV . {��MialIedda�l {� (Show direction end distance horn nl leas( Iwo Stale
From To --C-1-- FI, �'" 'I � '-'-'"""` Roads, or other nap reference points)
From
From
I it. GROUT:
To FI.
To Ft
Depth Malor�lIlal Method
From _LE__ To �FI �1��7i � uKfd
From To FI
15. SCREEN:
Depth Diameter Slot Size Material
From To FI In. In
Rom To PI In In
From To Ft In. In
16. SAND/GRAVEL PACK:
Depth Size Material
From To FI
From To FI
17. REMARKS:
b�QCv.11Ju1. -c- n C
c,)
1.1 D a,
TI
-o
I DO HEREBY 5ERT,IFY THAT THIS WELL WAS 1.)
CONSTRUOTIiN 9 AWDAnOS, AND TI IAT ACO('
FOR OFFICE L
Wad No:
S€ONLY
J L
RUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
TEIIS RECORD HAS BEEN PROVIDED TO HE WELL OWNED.
ERSON CONSTRUCTING TIIE WELL
Submit odpihahta tdivlsion ril Wnler Quietly, orpundwaier Sedan within 30 days
�INTURE
DATE
OW-1 REV. i2/99
Serial No.
ASHEVILLE
td
r ICE

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. RIRN kE/
WELL CONTRACTOR CERTIFICATION 0:
STATE WELL CONSTRUCTION PERMIT#:
269919
h (A: ,NEs
1. WELL USE (Check Applicable Box): Residential £ Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery Heal Pump Water Infection ❑ Other ElII Other, List Use:
2. WELL LOCATIOR(Show sketch of the locya nbolo
Neatest Town:
(Road NW and.Numbers. Community, or Subd`islon end Lo No
3. OWNER
Address
-SAVQ_Ur t ik root or Roule
ClIy or Town Stale
4. DATE DRILLED
5. TOTAL DEPTH
6. CUTTINGS COLLECTED YES I NO
7. DOES WELL REPLACE EXISTING WELL? YES n NOI
6. STATIC WATER LEVEL Below Top of Casing: a, 0 FT.
I (Use -r' II Above Top ol Casing)
9. TOP OF CASING IS l FT. Above Land Surface'
•Top of casing terminated aVor below land surface requires a variance In accor-
dance with 15A NCAC 2C .0118
10. YIELD (gpm)• (j 0 METHOD OF TEST 136
11. WATER ZONES (depth):
c.
b'
ALA, In c_ a-n
ILLING LOG DEPTH
om To Formation Description
0-06 1 s - Jck?S se11fJ 4
IV
'}4I '4'f' Amount '7 prl�s If additional space Is needed use back of form 0
12. CHLORINATION: Type l
Wall Thickness LOCATION SKETCH
Depth / { Diameter or Weight/Ft. Malachi (Show direction and distance from at least two Slate
From 0 To ./ -/ J Ft tor eS Vie. I% PYG'SDR Roads, or other map reference points)
From To Ft.
From To Ft 14. GROUT:A0416.45t.
Depth Material 11�. Method
From 0 To DO FI Cfag C Here �°
C.
From
To FI 7 '
15. SCREEN:
1 ASING:
Depth Diameter Slot Size Material
From To FI In In
From To Ft In In
From To Ft In In
16. SAND/GRAVEL PACK:
Depth Size Material
From To Ft
From To Ft
17. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
FOR OFFICE U
Clued No:
al No.
Submit original
LIRE OF PERSON CONSTRUCTING THE WELL DATE
islon ol Water Quality, Groundwater Section within 30 days
GW-I REV. 12/99

North Carolina - Department of Environment and Natural Resources • Division of Water Dually - Groundwater Section 2 6 9 9 1 S
1636 Mall Service Center - Raleigh, N.C. 27699-1636-Phone [phone] �'
WELL CONSTRUCTION RECORD WELL CONTRACTOR' /1 d R1 AN L. • Z(.
WELL CONTRACTOR CERTIFICATION 0: ;ea
STATE WELL CONSTRUCTION PERMITS*:
1. WELL USE (Check Applicable Boa): Residential E Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other Ell II Other, List Use:
2. WELL LOCATION: (S aw sketch of the location below) u^
Nearest Tow /���— r - CoCounty.frriLbC
(Road Nam and Numbers, Co_ni unity, or Subdivision and Lot No.)
/
3. OWNER „Tony ne25
Address 12J �X ` 9Y
(Sirtdl b(Pbule No.)
G/�y �/er -1p 4 z
own State
4, DATE DRILLED ayp�IX17 ��
5. TOTAL DEPTH 'Z
6. CUTTINGS COLLECTED YES I J NO[✓I
7. DOES WELL REPLACE EXISTING WELL? YES I ' NOl V(
8. STATIC WATER LEVEL Below Top of Casing: rS FT.
(Use'+' II Above Top of Casing)
9. TOP OF CASING IS ) FT. Above Land Surface'
'Top of casing terminated et/or below land surface requires a variance In accor-
dance with 15A NCAC 2C .0118
10. YIELD (gpm): 1 METHOD OF TEST • 5
11. WATER ZONES (depth):
D - 9(0 _5
1
•
$ fckzoc k
0
0
CHLORINATION: Type H 7H Amount .2/45-I.5 If additional space Is needed use back of form
CASING:
LOCATION SKETCH
Wall Thickness
D Depth Diameter or Weight/Ft. Matedal (Show direction and distance from at least Iwo State
From To LZ. Ft. L • a 5 a)" •//5 Pve-5D� Roads, or other map reference points)
From To Ft,
From To FL
14. GROUT: / O
Depth Material Method �t „//er 7 C W
o To ao Ft C'vrviceefe pDJ�._ (/ //y/4lV�L i L_• r1
From fTt
From To Ft. co no
15. SCREEN: `.
Depth Diameter Slot Size Material rem
From To FI In. In re z;.,,
From To ____ FI In In - `'I
r[o
From To Ft. In In `—' J-
16. SAND/GRAVEL PACK: ut
Depth Size Material
From To FI
From To Ft.
17. 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.
J-
FOR OFFICE
Clued No:
Serial No
Submit e
ICE
ATUnE OF PERSON CONSTRUCTING THE WELL DATE
Division of Wale( Ouallty, Groundwater Section within 30 days
GW-t REV. 12/99

(
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section 2 6 9 9 1 3
1636 Mall Service Center - Raleigh, N.C. 27699-1636-Phone [phone] )
WELL CONSTRUCTION RECORD WELL CONTRACTOR. /I d� Rf79AN C. • ((.
WELL CONTRACTOR CERTIFICATION 0: a&.7
STATE WELL CONSTRUCTION PERMITN:
1. WELL USE (Check Applicable Box): Residential t Municipal ❑ Industrial ❑ Agricultural 0 Monitoring ❑
Recovery ❑ Heal Pump Water Infection ❑ Other If Other, List Use:
2. WELL LOCATION: (6h etc l the location below) 4 � �4 —
Nearest Town: y_jj,� �1//�J • County'
Oh I/ L /9a Z�-I /. `f s .aS DEPTH
(Road Name end tubers. Community, or t division and Lot No.) DRILLING LOG
3. OWNER ` _if £ . �A G �Q i From To Formation Descdptian
Address �6
S ma
City or Town Staatte Zip Code
4. DATE DRILLED—SrJO�,
6. TOTAL DEPTH
6. CUTTINGS COLLECTED YES 1 1 NO14
7. DOES WELL REPLACE EXISTING WELL? YES U NOM'
8. STATIC WATER LEVEL Below Top of Casing: ,5 FT.
(Use'+' II Above Top of Casing)
9. TOP OF CASING IS ) FT Above Land Surface'
•Top of casing terminated atror below land surface requires a variance In accor-
dance with 15A NCAC 2C .0 18
10. YIELD (gpm): METHOD OF TEST . 3
11. WATER ZONES (depth)' CHLORINATION: Type I -I 7` I L.I
Amount .lS If additional space Is needed use back of form
CASING:
3MIR
7 .5-6 13 R-Pe lc
0
.J
C7 -
IV
Depth Diameter
From 0 To FIG • a 5
From To Ft.
From To FI
14. GROUT:
Wall Thickness
or Wright/FL Material
.416,1;5 Pw.5DK.
Depth Material Method ,
From I) To vZ0 FI CImNCP.&fE �_ 7D4%kd_
From To FI
15. SCREEN:
Depth Diameter Slot Size Material
From To Ft In In
From To FI In In
From To FI In In
16. SAND/GRAVEL PACK:
Depth Size Material
From To FI
From To Ft
17. REMARKS:
c
LOCATION SKETCH
(Show direction and distance from at least Iwo State
Roa.s, or other map reference points)
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 PRO ED TO THE WELL OWNER.
FOR OFFIC
Quad No:
Serial No.
NATURE OF PERSON CONSTRUCTING THE WELL
Division of Water Duality, Groundwater Section within 30 days
ASHEViLLc.
DATE
GW-I REV, 12199

(
North Carolina - Department of Environment and Natural Resources - Division of Water (Duality - Groundwater Section
1636 Mail Service Center - Raleigh, N.C. 27699-1636-Phone [phone] .�
"'ELL CONSTRUCTION RECORD WELL CONTRACTOR. )6 RmAN L • AI(.
WELL CONTRACTOR CERTIFICATION N: ojessq '7
STATE WELL CONSTRUCTION PERMITN:
270412
1. WELL USE (Check Applicable Box): Residential2r Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ II Other, List Use:
2. WELL LOCATI
Nearest Town:
Shows a ch of the location below)
County
fr-Y%rr74°
(Road Name and Numbc
(oq. ommunll or Subdivision and Lot No.) DRILLING LOG
� From To
3. OW
NER vin FI floe,:
Address 3 re. //// !1/rn�/J/7
si)a/1na ( tree or o}Ile •.) S/79
' !T I l CCi, e'
City or Town r ,� �S�le Zip Code
4. DATE DRILLED
5. TOTAL DEPTH
6. CUTTINGS COLLECTED YES (l NOj✓I
7. DOES WELL REPLACE EXISTING WELL? YES NON
8. STATIC WATER LEVEL Below Top of Casing: �j� FT.
J (Use's' II Above Top of Casing)
9. TOP OF CASING IS 1 FT. Above Land Surface'
*Top of casing terminated sVor below land surface requires a variance In accor-
dance with 15A NCAC 2C .0/1118
10. YIELD (gpm): v METHOD OF TEST , 3
11. WATER ZONES (depth).
u o 13R.ork
CHLORINATION: Type 11 7H Amount Aff d S
. CASING:
1
If additional space Is needed use back of form
Wall Thickness LOCATION SKETCH Q.
Depth Diameter or Weight/Ft. Matedai (Show direction and distance from at least two Stale coFrom 0 To A3 Ft. G . a 5 ail.J;5 PVGSOK Roads, or other map reference points) 4'' ca
C'S
From To Ft - 0).
From To Ft m -
14. GROUT: V( /Thin. ^
Depth Material Method
To FI I eterYien2b& ///
From 0 To 91.0 FI f�NCEEi6 .,7DL.g,.._ VV
15. SCREEN: co n;o
O -c-.
cn
_.
Depth
Frorn To Ft
From To Ft
From To FI
Diameter Slot Size Material
In In.
In In
In In
16. SAND/GRAVEL PACK:
Depth Size Malerlal
To FI
From
From
17. FlEMARKS:
I DO FIER
CONSTRL
To
Ft
I FOR ()mat USA ONLY
load No: on
Serial No
NSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
OF THIS RECORD HAS BEEN
PROVIDED TO THE WELL OWNER.
MATURE OF PERSON CONSTRUCTING THE WELL DATE
to Division of Water Quality, Groundwater Section within 30 days
GW-1 REV. 12/99

266590
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources1- Division of Water Quality - Groundwater Section' /
WELL CONTRACTOR (INDIVIDUAL) NAME (print) 1"�i n D 1 Li-) ( -IL CERTIFICATION # �% �f
-r
WELL CONTRACTOR COMPANYNAME(re-tal Skit . 1-3 (I 4 Y(�iir Th.. PHONE # I8 ' La 4' - 3 /
ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
STATE WELL CONSTRUCTION PERMIT# 17 V
I. WELL USE (Check Applicable Box): Residential Municipal/Public 0 Industrial O Agricultural ❑
Monitoring 0 Recovery O Heat Pump Water Injection 0 Other O If Other, List Use
2. WELL LOCATION•-
, Near�� O ° ' G:°rvtt e�✓County Zu...nr-cntbt
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code}
3. OWNER: e h p S� n c
Address <T 3 tj se
va(i� f
� ,II ed
I CV l l4[or Route
Acg)I/ C. ,'Sz CU) 3
City or Town Slate Zip Code
(—)-
Area code- Phone number
4. DATE DRILLED I a -) 0 -o Z
5. TOTAL DEPTH: 34.5'
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: I f l 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 15A NCAC 2C .0118.
9. YIELD (gpm): cL METHOD OF TEST a h r S
10, WATER ZONES (depth): 3.2 5 I - 8 Jp
11, DISINFECTION: Type 14T1 \ Amount 39
12. CASING: - Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To I Ir Ft. (p'i PV C
From To Ft.
From To Ft.
13. GROUT: Depth Material - Method
From E> To (..D Ft. ,,. -i-u--p
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.
Topo€f aphic/Land setting
❑Ridge jape ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:OGPSOTopographic map
Icheck box)
DEPTH DRILLING LOG
From To Formation Description
aL ' 111�
345
5-Q=�-
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 De De a
0 ca z
--
to G
16.. REMARKS:
is `' 71 TAR Do HpY CERTyft�F�7
CCIn ler73TigTAN
THAT 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
2�3
7,0
SIGNATURE OF PERSON CONSTRUCTING THE WELL
DATE
SuhmiLthe_ori8lptaI to rite Division of Water Quality, Groundwater Section, 163o Mail Service Center - Raleigh, NC
['Fr Li 'I6991036-Ville $ No. [phone], within 30 days. G W-1 REV. 07/2001
ASH€ i I ;tROE
2 it
.r

26 588
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources -yDivisio(nn of Water Quality - Groundwater Section ./
WELL CONTRACTOR (INDIVIDUAL) NAME/`(print) I� YiW`�.0 Br UCl1 CERTIFICATION # 306 Y/
WELL CONTRACTOR COMPANY NAME SYrtP.he.' RY o,. >e4t - P ,wris,�`C•• PHONE # {So��G 41$ -3) 10
STATE WELL CONSTRUCTION PERMIT# / 7I,.1 ASSOCIATED WQ PERMIT#
(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 0 If Other, List Use
2. WELL LOCATION: ?-
Nearest Town: e r County /1.4-+..C-r:
(Street Name, Nudlbers, Community, Subdivision, Lot No., Zip Code)
3, OWNER: Try 0 l ./i_54-c 2.
Address ) 1 L✓ I !A, rtt 1 n S -i ii
Street or RrrbteNo.)
City or Town State
Area code- Phone number
4. DATE DRILLED 12, - I D - U
5. TOTAL DEPTH: j ' S '
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO Nil
7. STATIC WATER LEVEL Below Top of Casing: a FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS J FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance In accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): AG METHOD OF TEST of krs
10. WATER ZONES (depth): 1 3 $ ' -
L;2 71S
Zip Code
z
11. DISINFECTION: Type H T1-)
12. CASING:
Depth Diameter
From () To 1-0 Ft. LL "
From To Ft.
From To Ft.
13. GROUT: Depth
From D To aO Ft
Amount a „EX -
Wall Thickness
or Weight/Ft. Material
nijr.
CMaterial
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.
Method
Ib p
Slot Size Material
in.
in.
Material
Topogra hic/Land setting
❑Ridgepe ❑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
r) 4&, C� �
46 ' / RC' ,17.1n.
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
DC
O
C71
0
16. REMARKS:
1., CONS'I'I*UCITIQt1 ST-AN
n —7
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
- 3 / - O
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original t the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
9-L6. [,Phgrir �. 19)7 3-3221, within 30 days. GW-I REV.07/2001
Z
-4

City or Town State
^GG5$4
WELL CONSTRUCTION RECORD
North Carolina- Department of Environment and Natural Resources - Divisionsonof Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) "-r y .Ur . e i CERTIFICATION M '3/ 4 `Y I
WELL CONTRACTOR COMPANY NAMED✓t%e-t\P DrD3 PHONE */ fin / 31713
•
STATE WELL CONSTRUCTION PERMIT*/
Pal a ASSOCIATED W'Q PERMIT*/
(if applicable) (if applicable)
1. WELL USE (CheckApplicable Box): Residential Et"Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCATION:
NearreS�'�own: �f, n . County • n rry A e__,
't�aY'Q-Or—W1- 1'S t °L t—
(Street Name, Numbers, Community, Subdivision, Ett No., Zip Code)
3. OWNER: . I)e.bret.
Address 115 ParL
LLN qy
C-t- yr
Street or Route No.)
A/C
Zip Code
Area code- Phone number
4. DATE DRILLED Ii—aq-oa..
5. TOTAL DEPTH: 1 % 5
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO I5'
7. STATIC WATER LEVEL Below Top of Casing: 14 D FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING 1S 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): 15 METHOD OF TEST a h r s
10. WATER ZONES (depth): 1 4 5' - 1 5esP re..
11. DISINFECTION: Type 1-F'f'I-I
12. CASING:
Depth
From b To 1 a Ft.
From To Ft.
From To Ft.
13. GROUT: Depth
From tr) To of O Ft
From To Ft.
14. SCREEN: Depth Diameter
From . To Ft. in.
From To Ft. in.
Diameter
,t
Amount ' S
Wall Thickness
or Weight/Ft. Material
PVC-
Material Method
Slot Size Material
in.
in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Topographic/Land setting
❑Ridge ❑Slope ❑Valley E3f'�at
(check appropriate box)
Latitude/longitude of well location
(degrees-minutes/seconds)
Latitude/longitude source:DGPSDTopographic map
(check box)
DRILLING LOG
Formation Description
DEPTH
From To ,
7�
7Q
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
L
CO
00
(11
(D
16.. REMARKS:
1,� Ise 11(IERFj�HVi_EP.'F
11; J
l_ SubOtthe original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
AS) 2769 -1636 Phone;No. (9_119) 733-3221, within 30 days. G W-1 REV. 07/2001
THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
DS, AND THAT A COPY OF THIS RECORD HAS BEEN OVIDED TO THE WELL OWNER
�ylp/l /a -.11 -G
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
CD
n

WELL CONSTRUCTION RECORD
264044
North Carolina Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME
�� (print) QY/.( i2 4.2.
WELL CONTRACTOR COMPANY NAME LSrPP n e_ //rJv:y/Js .LJ) 9t- /ee-,r+l
,STATE WELL CONSTRUCTION PERMIT# /10ASSOCIATED WQ PERMIT#
'Cif applicable) (if applicable)
CERTIFICATION # ,U 9 /
PHONE # (8-0B6-V:--3/76
1, WELL USE (Check Applicable Box): Residential Municipal/Public ❑ Industrial 0 Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2 WELL LOCATION
,eu.4 2�-
Nearest Town: County
_
(Street Name,Nu rs, Community, Subdivision, Lot No., Zip Code)
Address UAc
, ,.
(Sne cz 4-Route No.) 02 ILO S-
City or Town Statd Zip Code
3. OWNER: CLJ'N-fQ/
( )-
Area code- Phone number
4. DATE DRILLED 71) -//- D -7-
5. TOTAL DEPTH: °V!o S'
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO "�
7, STATIC WATER LEVEL Below Top of Casing: 02 en FT.
(Use "+" if Above Top of Casing)
8, TOP OF CASING IS / FT. Above Land Surface*
*Top of casing terminated atior below land surface requires a
variance In accordance with 15A NCAC 2C .0118.
' 9. YIELD (gpm): //') METHOD OF TEST 2 kr s•
10, WATER ZONES (depth): /5e1 ' - .vG,S-z
11. DISINFECTION: Type F-FT HI Amount .44.3
Wall Thickness
Diameter or Weight/Ft. Material
12. CASING:
Depth
From n To 7..S Ft.
From To Ft.
From To Ft.
13. GROUT: Depth
From D To a l; 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.
Material
rxr,APu
Method
+Qr
Slot Size Material
in.
in.
Hirb'kF1)4 rkR
CONSTRUCTION S
Y»J
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Lai itude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
Forma ion Description
XJ1
DEPTH
From To
Cam'
9 - 2z 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.
rgAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
ARDS, AND THAT A COPY OF THIS RECOR AS BEEN PROVIDED TO THE WELL OWNER
/6 -3/ -a Z
DATE
SIGNATURE OF PERSON CONSTRUCTING THE WELL
GROU •q�7• f(f� al to tt e Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
AHf-VIL 6 9--11 0rhQ a (o1c) 733-3221, within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural
WELL CONTRACTOR (INDIVIDUAL) NAME �(/p rint)
WELL CONTRACTOR COMPANY NAME �41i(001 STATE WELL CONSTRUCTION PERMIT# 374
(if applicable)
264958
Resources - Division of Water Quality - Groundwater Section ILE f n CERTIFICATION # -g64/ /
//7,11'%r(PHONE # f Bat C^ 18 - / 7�
ASSOCIATED WQ PERMIT#
(if applicable)
1, WELL USE (Check Applicable Box): Residential IIVMunicipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2, WELL LOCATTIQN: - �/
Nearest TTppwn: /i/�t.u.U� 11-6L- County Adiitt..t L.,
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
Topograpghic/Land setting
❑Ridge 13$(ope ❑Valley ❑Flat
(check appropriate box)
Latitudetlongitude of well location
3. OWNER: ➢U-LC/l 1Lrl"-� ( 40-5 (degrees. minutes/seconds)
Address 13 4/...2-1Pr %.Lt-e- /[i /F4; Latitude/longitude source:DGPSOTopographic map
Q (Street or Route No.) (check box)
.42 12Y24�tI L ) It. a g % f 2 DEPTH DRILLING LOG
City or Town State Zip Code From To Fo t n Description
(—)- T� & 3 ' 2.r
Area code- Phone number to 5 ' / S'5 / Sazdt i41 z ie.,
4. DATE DRILLED M - /D -D -2-
5. TOTAL DEPTH: / 25'
6, DOES WELL REPLACE EXISTING WELL? YES 0 NO IE
7. STATIC WATER LEVEL Below Top of Casing: .72t 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): On 1-METHOD OF TEST hr5
10. WATER ZONES (depth): / /o n ' - / R 5 '
LOCATION SKETCH
11. DISINFECTION: Type N! /'/ Amount 42 9/ 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 li 3 Ft. 6 " S ie-t. e.
From To Ft.
From To Ft.
13. GROUT: Depth Material Me hod
From �pn� To ,al) Ft. lt`20
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:
ONStRIiI,CTGON
Submit the origiiial to
GROUi::;N eNo. (9
ASHEVILLE REEIO //..L. 'JFEiCE
THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
ARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
// - 3 25 Z_
/C .124�
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
he Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
9) 733-3221, within 30 days. GW-I REV. 07/2001
r

WELL CONSTRUCTION RECORD
2649r9
North Carolina - Department of Environment and Natural ResourFes - Division of Water Quality - Groundwater Section
WELL CONTRACTOR(INDIVIDUAL) NAM�EQ//((print) fit /.at- `P/0 z} -`J CERTIFICATION#a�/2
WELL CONTRACTOR COMPANY NAME ]zj'.SOO47 4 `J-L-« qL by, 3.1120 # fS� Gy� -3/ 7L�
STATE WELL CONSTRUCTION PERMIT# /T 7).2 ASSOCIATED WQ PERMIT
(if applicable) —/ (if applicable)
1. WELL USE (Check Applicable Box): Residential E7 MunicipaI/Public ❑ Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
NearestrTSown: Cam.
/, 1.-1n
County .(111dJlF7oze*�
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: (72, %72CiGUYK-e`-)
Address / 21-.Vtin /✓ 1-12+n4, JAL -
trees or Route No.)
City or Town "Mate Zip Codc
(—)-
Area code- Phone number
4. DATE DRILLED /O - //' -n2
5. TOTAL DEPTH: 6 l).5
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 13'
7. STATIC WATER LEVEL Below Top of Casing: ,Q,6 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): .3 METHOD OF TEST '. 2 li cc.
10.WATER ZONES (depth): 605 - 3�f�rm
11. DISINFECTION: Type f / %
12. CASING:
Depth
From /) To Z. 5- Ft.
From To Ft.
From To Ft.
13. GROUT: Depth
From O To ail) Ft.
Diameter
Amount /zo '7
Wall Thickness
or Weight/Ft. Material
Material
ONN-P 1.
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.
Method
1+
Slot Size Material
in.
in.
16. _REMARKS:
GROUND;^'NlL
ASHEVi(IE R,EG
Topographic/Land setting
❑Ridge WSlope ❑Valley ❑Flat
(cheek appropriate box)
Latitude/longitude of well location
(decrees, minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
D / 5
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
S, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
Y�J _ sls -tL
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
ivision of Water Quality, Groundwater Section, 1630 Nlail Service Center- Raleigh, NC
3-3221, within 30 days. GW-I REV. 07/2001
wJ

264048
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural
/Resources
,-¢Division of Water Quality - Groundwater Section '/
WELL CONTRACTOR (INDIVIDUAL) NAME (print) oL)✓L//7Arl� l-4LI'�_ CERTIFICATION#�dY/ L
WELL CONTRACTOR COMPANY NAME l7/'e PJ+4_ 23105. 4/L-/J/ col te/nig QhC PHONE a 7
ASSOCIATED WQ PERMIT*/
STATE WELL CONSTRUCTION PERMIT'S /`7`/) -
(if applicable) (if applicable)
1. WELL USE (Checic Applicable Box): Residential Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery ❑ Heat Pump Water njection 0 Other 0 If Other, List Use
2. WELL LOCATI N: ( //
Neares Town:J' iC
l,at-
(Street Name, Numbers, Community, Subdivision,
3. OWNER. 2t-4 �e i ' /!
County "�'
Lot No., Zip Codc)
s AJJan—,
Address .57) >3tz.ta ,9 V .
(Street oaRoute Now
City or Town State Zip Codc
Area code- Phone number �/
4, DATE DRILLED 9-/ 7- 4" o
5. TOTAL DEPTH: a,gS' 1vc' Wn
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7, STATIC WATER LEVEL Below Top of Casing: Me) FT.
(Use "t" if Above Top of Casing)
8, TOP OF CASING IS 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 METHOD OF TEST a A
10. WATER ZONES (depth): l 7S/ - / 60 t jPm
Topographic/Land setting
❑Ridge 5iSlope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
Idcerecsiminutcs/secands)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
Formation Qescription
DEPTH
From To
LOCATION SKETCH
11. DISINFECTION: Type /-177-7-i Amount /G 7 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 C To '% 7 Ft. 4 " ,//, .
From To Ft.
From To Ft. .
13. GROUT: Depth nMaterial M thod
FromO4T D on) Ft. l G�n�
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.
r»
16. REMARKS:
CD
7
co
D@i-fEREBY CLrRT
CONSTRUCt ION ST
t/);
N
-IAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
AND THAT A COPY OF THIS RECORD HAS EN PROVIDED TO THE WELL OWNER
/D - 3 / -
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
6 z
I
GRCUSp�wiE� tblIgWa to the Division of Water Quality, Groundwater Section, 163G Mail Service Center - Raleigh, NC
ASHEVILtt6f ltiMh66bllSb. [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) 'Re,A I I) _Id e-sA A CERTIFICATION # a'Z%/i
//1� '/ f L(. PHONE # tpi� 4 VS' —5 i "a
WELL CONTRACTOR COMPANY NAMEU'I" t1 HP , / %N$ . 1(Ja J 1 %'17�
STATE WELL CONSTRUCTION PERMIT# / i v 2• ASSOCIATED WQ PERMIT#
(if applicable)
(if applicable)
261135
1. WELL USE (Check Applicable Box): ResidentialMunicipal/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 To)vty �4.44 5 / County p heralA2
GeV
(Street Name, Nu Community, Subdivision, Lot No., Zip Code)
3. OWNER: S su i - (dcgrces:minutcs/scconds)
Address Latitude/longitude source:❑GPS❑Topographic map
/j et or :.ute Ate
0' g 7 ��
(check box)
C.4' A DEPTH DRILLING LOG
City or Town State Zip Code From � To_A I Forman Descripti n
(—) K2 / / a I
Area code- Phone number � e $
4. DATE DRILLED X --Z1 —O
5. TOTAL DEPTH: ADS— I
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO-
7. STATIC WATER LEVEL Below Top of Casing: 4.94 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 accordant with 15A NCAC 2C .0118. /
9. YIELD (gpm): ji') METHODvOFTEST ti✓-S
10. WATER ZONES (depth): �/ff I LOCATION SKETCH
Sb5 - ?ter
11. DISINFECTION: Type /7"771 Amount 99 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. fat,` Material numbers and common road names.
From 0To gi 1 Ft. /a o
From To Ft. IV
Cr)
From To Ft.
13. GROUT: Depth gD..vr11.4Material y- Me hod 'I
C.1
From �% To� Ft. GJ = _-
From To Ft.
14. SCREEN: Depth • - Diameter Slot Size Material •^t.--
From To Ft. in. in. O t,
From To Ft. in. in. ` -'
15. SAND/GRAVELt^ PACK: tv.15
Depth Size Material
Topographic/Land setting
❑Ridge ❑Slope ❑Valley i1at
(check appropriate box)
Latitude/longitude of well location
From To Ft.
From To Ft.
16..REMARKS:
'iPenal to the I ivisi
1 Ht( l%CMj9®ONALI733-32E
WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
D THAT A COPY OF THIS RE !' = AS BEEN PROVIDED TO THE WELL OWNER
_162
NATURE OF PERSON CONSTRUCTING THE WELL DATE
n of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
1, within 30 days. GW-I REV. 07/2001

WELL CONSTRUCTION RECORD 2 5 9 2 31
North Carolina - Department of Environment and NaturalalResources - Divisionis-iopof Water Quality - Groundwater Section '/
WELL CONTRACTOR (INDIVIDUAL) NAME (print) te/�rje- C a_1rn/!�,PJ . CERTIFICATION�A#,/3ry°441
GYP.ervLL- /.�rcS 1 en T iUrycP, .PHONE # (S7e__V 0 -3/7O
STATE WELL CONSTRUCTION PERMIT# A li 4 ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
WELL CONTRACTOR COMPANY NAME
I. WELL USE (Check Applicable Box): Residential qtj Municipal/Public ❑ Industrial ❑ Agricultural El
Monitoring 0 Recovery 0 Heat Pump Water njection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest T wn:�
County /JLt�I+-eer�u-G
.
(Street Name, Numbers, Community, Subdivisjpn, Lot No., Zip Code)
3. OWNER jO.L4-JGh dzc%vv
Address P o i9 erz Lt /a
(Street or Route No.)
City or Town 'State
Area code- Phone number
t.,-4: DATE DRILLED d —/'7 -
5. TOTAL DEPTH: ,
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: / OE) 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): LP METHOD OF TEST rQ h t-S .
10. WATER ZONES (depth): i - L,> %Pm
3 35' 47 '7
Zip Code
11. DISINFECTION: Type /4 T/7
12. CASING:
Depth Diameter
From A To C_ Ft._ 6
From To Ft.
From To Ft.
Amount Sig
Wall Thickness
pr Weight/Ft. Material
13. GROUT: Depth aerial /
From 7) To ,;(17 Ft. c_7
From To Ft.
gh7ood
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.
RTopographic/Land setting
idge 0Slope ON/alley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(dcgreesnninules/seconds)
Latitude/longitude source:OGPSOTopographic map
(check box)
DEPTH DRILLING LOG
From To z Formation Description
0 75
7S3aSz h.or cam.
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:
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
8 3/-�2
DATE
t-pbUut*h -1:00 tat;t9-the Division of Water Quality, Groundwater Section, 1636 Mail Sea ice Center - Raleigh, NC
?,7b99�63b-1vliong44.q9#p) 733-3221, within 30 days. GW-I REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources�- Divisionj�of Water Quality - Groundwater Section ill
WELL CONTRACTOR (INDIVIDUAL) NAME (prInt) 2 %Y!t,��( GrM2I 3r Lt-'(.0 CERTIFICATIONO# Sig
C7 L$v (95 - G i " P1 Mir PHONE # yLfd G Y6 - '7a
WELL CONTRACTOR COMPANY NAME Y �- �a'�--
STATE WELL CONSTRUCTION PERMIT('/•szD.2 ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
261129
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 LOCATION4
Nearessj.(�+T'own: (/1 H
(Street Narr , Nu�{rs, C mmunity, Subdivision, Lot No., Zi Codc)
sL.. DyY
3. OWNER: LJ/
Address
Q
reet or Route No.)
f %u-
City or Town 'State
County /81_,lzc
Zip Codc
Area code- Phone number 4. DATE DRILLED £' /D d
5, TOTAL DEPTH: 525S'
6. DOES WELL REPLACE EXISTING WELL? YES ❑'/NO4-
7. STATIC WATER LEVEL Below Top of Casing: 7t0 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 accordant wAti ISA NCAC 2C .0118.
9. YIELD (gpm): METHOD QF TEST •
10. WATER ZONES (depth): 0{
22P
I1. DISINFECTION: Type AL Amount 6
12. CASING: Wall Thickness
Depth / Diareter or Weight/Ft. ateJial
From e To /....t Ft. 4, // �/
From To Ft.
From To Ft.
13. GROUT: Depth q Material Method
From /i To ad Ft. /i 47.)
From To Ft.
14. SCREEN: Depth " Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth
From To Ft.
From To Ft.
Size Material
16. -REMARKS:
Topo raphic/Land setting
❑Ridge lope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
,Qp(, Latitude/longitude source:❑GPS❑Topographic map
(check box)
$ y 7 /S DRILLING LOG
Formatipn pescription
DEPTH
From To
e /5y'
n 4l ' .soy'
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.
Ssshmit the AV nal totheDi E Glri D7F 1 )732
Ali y
THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
LrAND THAT A COPY OF THIS REc9 B-1 tS BEEN PROVIDED TO THE WELL DOWNER L
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
dsion of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
-3221, within 30 days. GW-I REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources
WELL CONTRACTOR (INDIVIDUAL) NAM(print)
WELL CONTRACTOR COMPANY NAME C17 e?h# •SOS .
261128
Division of Water Quality - Groundwater Section , /
CERTIFICATIONQ�it �3�(6%y-/a
PHONE N((},CA1 1 4t _J / 10
STATE WELL CONSTRUCTION PERMIT#
(if applicable)
/41oz
111,
ASSOCIATED WQ PERMIT#
(if applicable)
1. WELL USE (Check Applicable Box): Residential ys, Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATIO
Nearest T n; !'_d
C unty )QL/M 7024-
(Street Name, N tiers, C unity, Subdivision, Lot No., Zip Code)
Topographic/Land setting
❑Ridge $lope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
3. OWNER: 1 %J� b1; /I�-tip..-S /i/ `tee (degrees:minutes/seconds)
Address �.'i�O ._.t.t-t`il���jjj+. ,(�O(- Latitude/longitude source:❑GPS❑Topographic map
n (Scree r out i o.) �� (check box)
z�"�'', ��r%/� DEPTH DRILLING LOG
City or Town State Zip Code From To FormatioiDescription
(-)- �f�0
Area code- Phone number p
4. DATE DRILLED D - ti -D
5. TOTAL DEPTH: J30 S'
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO 14,
7. STATIC WATER LEVEL Below Top of Casing: IN) FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): fb/) * METHOD OF TEST c2 A rS
10. WATER ZONES (depth):
/V8'
/S(' 3DS'
24D-SDs
11. DISINFECTION: Type /-i 7-7-11 Amount 477
12. CASING: Wall Thickness
Depth //// Diameter or Weight/Ft. M ert 1
From I) To /q4" Ft. a it 1C
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From D To 40 Ft. Co -,I-r_,-,✓)
From To Ft.
14. SCREEN: Depth - Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. -REMARKS:
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
}
o'
M`PtgqME k3rT
R
'1i
N=
1 T t'H(S WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
COPY OF THIS REC S BEEN PROVIDED TO THE WELL OWNER
J
OCT -- 4
�A
Anal NDTHAT A (� deL
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to tl�e Division of Water Quality, Groundwater Section, 163a Mail Service Center - Raleigh, NC
p$I➢3WPwrsEBd1@319 733-1221, within 30 days. GW-I REV. 07/2001
ASHEVILLE REGIONAL OFFICE

I DO HERE
261126
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAMrE` (print) (Y- rt-x-t CERTIFICATION Ji> I/
WELL CONTRACTOR COMPANY NAME V1'esa..G `n1 re I'S �-C)? IV 4 M4) PHONE # ea 4, �3 "4
/51D,2
STATE WELL CONSTRUCTION PERMIT#
(if applicable) (if applicable)
ASSOCIATED WQ PERMIT#
1. WELL USE (Check Applicable Box): Residential 1/Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATI
Nearest
- (Street Name, tO6mbe
3. OWNER:
Address
City or Town
(—)-
_____ /( Countatee4r-hat
Community, Subdivision, Lot No., Zip Code)
ier
Topographic/Land setting
❑Ridge lope ❑Valley ❑Flat
check appropriate box)
Latitude/longitude of well location
(dcgrces,minutcs/seconds)
L=
Jr-p Viet >Lagt _ Latitude/longitude source:❑GPS❑Topographicmap
et or Route No.), -
(check box)
DRILLING LOG
Sta e Zip Code Formatio escription
oltf / 1.S
Area code- Phone number
4. DATE DRILLED 7-IG -22
5. TOTAL DEPTH: 4/25- / /
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO IH
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 1SA NCAC 2C .0118. �I '' pD
9. YIELD (gpm): ✓i> 0 METHOD OF TEST of 7ilr e -
10, WATER ZONES (depth): 3 SD t - 4 as t
11. DISINFECTION: Type H 7W Amount 74/
12. CASING: Wall Thickness
Depth // Diameter or Weight/Ft. M rr l
From To 9'7` Ft. G �/
From To Ft.
From To Ft.
13. GROUT: Depth IAlaterial Method
From Q To %�! Ft. (tt'i.L� die
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:
BY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
, AND THAT A COPY OF THIS RD HAS BEEN PROVIDED TO THE WELL OWNER
9.3d _ 6 2
DEPTH
From TQ° 4
Y
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
Op, 01h3T
- OCT - 4 2002
Submit the original to le I Onston of Water Quality, Groundwater Section, 1636 Mail Service Center- Raleigh, NC
27699-1636 Phone No. (9 9) 733-3221, within 30 days. GW-1 REV. 07/2001
11—
SIGNATURE OF PERSON CONSTRUCTING TIIE WELL
DATE
GROUNDWATER SECTION
ASHEVILLE REGIONAL OFFICE

259242
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources -�D``ivision of Water Quality - Groundwater Section p
WELL CONTRACTOR (INDIVIDUAL) NAM (print) '.Cl CERTIFICATION# ���a
WELL CONTRACTOR COMPANY NAME-Y'E_Pxr SYO5 • /-e t)1 e( '/'/-Lly r PHONE # jfa?fd !o Sig. -- 3 / 1 °
STATE WELL CONSTRUCTION PERMIT#
/ tiv
(if applicable)
ASSOCIATED WQ PERMIT#
(if applicable)
I. WELL USE (Check Applicable Box): Residential Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring ❑ Recovery El Heat Pump Water njection ❑ Other 0 If Other, List Use
2. WELL LOCATION:
Neaeest,Town: LevCE5
(Street Name,
3. OWNER:
Address
rs, Community,
County,73ri/JCtmAe
APF
Subdivision, Lot No.. Zip Codc)
Litc r Route (4, a7,74
City or Town State
Area code- Phone number
4. DATE DRILLED 7 - /6
5. TOTAL DEPTH: %y'-
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO V
7. STATIC WATER LEVEL Below Top of Casing: 1-�- n 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 syd th ISA NCAC 2C .0118.
9. YIELD (gpm): 1 `) METHOD OF TEST
10. WATER ZONES (depth): `(-DO t — tJym
7Q5' - jl rs
11. DISINFECTION: Type I-1 T Amount I fl 9
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From D To Ft. to it PVC
From To Ft.
From To Ft.
13. GROUT' Depth Material Method
From d To ,3 Ft. C sn_An•-e.wl / c"p
From To Ft.
14. SCREEN: Depth Diameter Material
From To in.
From To in.
Ft.
Ft.
Zip Codc
Slot Size
in
in
Topo /raphic/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)
DEPTEI DRILLING LOG
From TToo� Formation
87 ` 7.1/6r Mht, t Ec
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
I DO HEREBY CE
RiJCTI
_1 A
) I I -)nn')
.1 e' Submit the original to th Divi.'on of Water Quality, Groundwater Section, 163o Mail sen ice Center - Raleigh, NC
i27699-163733-3
( s( tl, `,; L cr "iOiJ
Fc'; 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.
CO
ta,
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
E-3/ o
IGNATURE OF PERSON CONSTRUCTING THE WELL DATE
2l, within 30 days. GW-I REV. 07/2001
n

257292
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural�Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAMF1(print)__ _ O A, ✓I�/� �P. Li m� ARPPCEReI # C T ON d 21/8
3/rfp
WELL CONTRACTOR COMPANY NAME S?,i'PP»F VP S
�/ (�'
STATE WELL CONSTRUCTION PERMIT# 1 7 a a ASSOCIATED WQ PERMIT#
(if applicable)
(if applicable)
I. WELL USE (Check Applicable Box): Residential'Municipal/Public ❑ Industrial 0 Agricultural 0
If Other, List Use
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other 0
2. WELL LOCATION:
SLL%J'1nai set- Countaise a`P_
Nearest Town: AC/4SLI-Pri to s, LEAi.
(Street Name, Numbers, Community, Subdivision,�Lot No., Zip Code)
3. OWNER: /JDb A e I/i
Address
au.2a.Mnsftea) ,vt a 0 2
City or Town State Zip Code
(_)"
Area codc- Phone number
4. DATE DRILLED 7 -75 -4.2
5. TOTAL DEPTH: .34/✓"
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO FT.4
7. STATIC WATER LEVEL Below Top of Casing: CoaD
/ (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 ae)?
variance In accordance w th 15A NCAC 2C .0118.
-`mod
9. YIELD (gpm): 5 0 METHOD OF TEST_
10. WATER ZONES (depth): , 325' - ,9-_m—
(Street or
Route No.)
11. DISINFECTION: Type 1175V
12. CASING:
Depth
From 40 To 7 6 Ft.
From To Ft.
From To Ft.
13. GROUT: Depth
From .1) To o?D Ft.
From To Ft.
14. SCREEN: Depth
Diameter
//
Amount
Wall Thickness
or Weight/Ft. Material
Plitt
_.Material •
Topographic/Land setting
❑Ridge ❑Slope [Walley YiFlat
(check appropriate box)
Latitude/longitude of well location
(degrees minutes/seconds)
Latitude/longitude source:OGPSOTopographic map
(cheek box)
DEPTH DRILLING LOG
From To Formation Description
40 �� f
90 3yS'
IV
Method /
Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Material
Depth
From To Ft.
From To Ft.
CONSTRUCTION S A
GR020"F �- oth
ASFIEi � �' w
t'1699-16 6 f rout Nu. (919
Size
CJI
LOCATION SKETCH CPI 2
Show direction and distance in miles from SileastE
two State Roads or County Roads. Include the roan'
numbers and common road names.
AT 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
/iceO�CfJ� -5/-0'.2
SIGNATURE OF PERSON CONSTRUCTING \\'ELL
DATE
Division of Water Quality, Groundwater Section, 1630 Mail Service Ceenterl REeigh. NC UUI
733-3221, within 30 days.

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural,)Resources - Division of Water Quality - Groundwater Section
WELL �/
WELL CONTRACTOR (INDIVIDUAL)NAM/Jf.�,)� (print) r0 L)A( //IEQ./�Q, �{ CERTIFICATION # .21
WELL CONTRACTOR COMPANY NAME(7,6Cer E/ �',e05 Ote./.- 'T / LL h'30 J/eC PHONE # rei; !d `/iV '-3/ 9a
STATE WELL CONSTRUCTION PERMIT# 11Y" n "' ASSOCIATED WQ PERNIIT#
(if applicable) (if applicable)
259241
1. WELL USE (Check Applicable Box): Residential Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATIO
Nearest Town:
(Street Name, Nu
3. OWNER:
Address
—4
City or Town
(—)-
Area code- Phone number
4. DATE DRILLED 7-/2'-4-2
5. TOTAL DEPTH: , 323 '
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: .41-Z, 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. pp
9. YIELD (gpm): /6 METHOD OF TEST � '� 71h4
10. WATER ZONES (depth): ASS z - _3, <��J»-
�3lS'- //,-s l7/-rl
11. DISINFECTION: Type f / 7-7-7)Amount. /-5 /
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From D To 9.5 Ft. L> 'L P VC
From To Ft
From To Ft.
13. GROUT: Depth eMaterial Method
From / To n Ft. (QAIA)ALT -71-or
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.
County '�
rs, Community, Subdivision, Lot No., Zip Code)
AI
t/et or Ro
State
No.) „!!f
Zip Code
From To Ft.
Topo aphic/Land setting
❑Ridge $lope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
( dcgrees.m inures/seconds)
Latitudeilon_itude source:OGPSOTopographic map
(check box)
DEPTH DRILLING LOG
From To Forma tion Description
3' 326LJA-a ut„
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
ry
rn
rrt
0
tie
0
'-0
.75
cn r
c-;
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
DS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
_ n2
SIGNATURE OF PERSON CONSTRUCTING TH - 'ELL DATE
Submit the original titU ivision of Water Quality, Groundwater Section, 1636 Mail Scr ice Center - Raleigh, NC
27699-1636 Phone No. (919) 73-3221, within 30 days. GW-I REV. 07/2001
I.

IA.
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAM (print) '^
1 CERTIFICATION Y/O D
WELL CONTRACTOR COMPANY NAME' nit ,04reS • L(/P-// Ql .1G. PHONE N y1.� q.%ft 65 , " 3 / 7
STATE WELL CONSTRUCTION PERMIT#
(if applicable)
/f$D2
ASSOCIATED WQ PERMIT#
(if applicable)
I. WELL USE (Check Applicable Box): Residential X Municipal/Public 0 Industrial 0 Agricultural D
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELLLOCATI
Nearest Town: _
...S ipe s in, ,Plf.
(Street N , Numbers, Community, Subdivision. Lot No., Zip Code)
3. OWNER: aitzir 4Di'�`y /�'4 Ay
Address 4-3 (- ��e�w V
i(Street or RouteNo.)
I at 7/6
City or Town
State Zip Code
Area codc- Phone number
4. DATE DRILLED 7 S ' D R
5. TOTAL DEPTH: 2 WS'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NOVt.
7. STATIC WATER LEVEL Below Top of Casing: 66 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 accordancewith15A NCAC 2C .0118.
9. YIELD (gpm):
10. WATER ZONES (depth):
0DO5' -3 ipm
11. DISINFECTION: Type /f771 Amount___‘3a__
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft.
From D To Ft. & l )
From To Ft.
From To Ft.
13. GROUT: Depth gMaterial Method
From /D To ott' Ft. l Dp
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK
M tVC.
Size Material
From Ft.
From Ft.
Depth
To
To
lA RFMARKS•
' p l] 2�
I DHEREBC RTfF'
CONSTRUCTION STAN
i
-\
Topographic/Land setting
❑Ridge ❑Slope ❑Valleyat
(cheek appropriate box)
Latitude/longitude of well location
(decrees. nunutes:seconds)
Latitude longitude source:OGPSOTopographic map
(duck box)
DEPTH DRILLING LOG
From To r Formation Description
.20
ap' a 46 '
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
0
fV o
—
3.
1 cr
cat
crs
U7
c
THIS WELL WAS CONSTRUCTED IN ACCORDANCEN�WROVIDEA NCAC D TO THE 2C,
WELL
ELL OWNER
SJ AND THAT A COPY OF THIS RECORD HAS
,..,
SIGNATURE OF PERSON CONSTRUCTING TIIE WELL DATE
C n ,-..,��r�_, c-
�nrnytl: ry�rl0[ f�1 he Division of Water Quality, Groundwater Section, 163 i Mail tiers ice Center - Raleigh, NC
ASh' 769_ ]fff' "" i4 73--3221, within 30 days. GW-I REV. 0712001

2.
257306
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section �/
(print) 1 - /... CERTIFICATION ('
''// �1 rrIIONE a (� � S%g
-3/70
J416 2 ASSOCIATED WQ PERMIT('
WELL CONTRACTOR (INDIVIDUAL) NAM
WELL CONTRACTOR COMPANY NAM
STATE WELL CONSTRUCTION PERMIT('
(if applicable)
(if applicable)
WELL USE (Check Applicable Box): Residential, Municipal/Public O Industrial ❑ Agricultural O
Monitoring O Recovery O Heat Pump Water Injection ❑ Other ❑ if Other, List Use
WELL LOCATI : //JJ n
Neare Town: County \Yalege 3 -
(Street t c, Numbers, Community, Subdivision, [ No., Zip Code)
3. OWNER:
Address
/y (Street or Route No.)
l/�Ln!//.4-if/.IITI
City or Town i State
( )-
Zip Code
Area code- Phone number Z
4. DATE DRILLED 6
In -� S'
5. TOTAL DEPTH: 9RS
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO 161
7. STATIC WATER LEVEL Below Top of Casing: -I-3—
S 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 Ith ISA NCAC 2C .0118.
9. YIELD (gpm): METHOD OF TEST A
10. WATER ZONES (depth):
l I. DISINFECTION: Type
12. CASING:
From D
From
From
Topor aphic/Land setting
❑Ridge me ❑Valley ❑Flat
(check appropriate box)
Latitudellongitude of well location
(degrees minutes. seconds)
Latitude/longitude source:DGPSOTopographic map
(check box)
DEPTH DRILLING LOG
From To Forma�Description
D ,?O /
an, 98s'
/-1Y7-/
Depth Diameter
To a0 Ft. "
To Ft.
To Ft.
Amount
Wall Thickness
or Weight/Ft. aterial
13. GROUT: DepthM /)nMaterial
From © To ;pal Ft. (O.mt t-
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
.47777
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.
. N3`TRbCT;I N �$TA
S
2
�ni+n tv TEfr SE IUN
ASHEti'_LE REGIONAL OFFICE
IIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
6 VD THAT A COPY OF THIS RECORDCBEEN PROVIDED TO THE WELL OWNER
visio
3 322
ATURE OF PERSON CONSTRUCTING THE WELL
of Water Quality, Groundwater Section, 1636 Mail Seri is
, within 30 days.
DATE
Center - Raleigh. NC
GW-I REV. 07/2001

255605
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
CERTIFICATION # a V/P
WELL CON rfl�g � y83rJd
/� �ju Wt v . c. PHONE # „l,.i-_--
WELLCONTRACTORCOMPANYNAME lT/'PPnP'/�rPS LJo.JJ � r
STATE WELL CONSTRUCTION PERMIT# / 4o 4 ASSOCI fT PDlµQ PERMITS/(if applicable)
TRACTOR (INDIVIDUAL) NAME (print)
zt) b A
1. WELL USE (Check Applicable Box): Residential Municipal/Public 0 Industrial 0 Agricultural ❑
Monitoring 0 Recovery ❑ Heat Pump Water Injection ❑ Other ❑ It' Other, List Use
•
2. WELL LOCATIt/�7N �// /9/I
Nearest Town: (�Y Van., County
(Street Name, Number
Cg nn4kry, Subdivision, Lot No., Zip Code)
3. OWNER: a-4AI
Address P n 0
/J�2 / a (Street or Route No.)
City or Town State
l/a'7
a? ?AC
Zip Code
Area code- Phone number as Da
4. DATE DRILLED 5
5. TOTAL DEPTH: .Z85 /
6. DOES WELL REPLACE EXISTING WELL? YES /OnNO
7. STATIC WATER LEVEL Below Top of Casing:
(Use "+" if Above Top of Casing)
8. TOP OF CASING 1S / 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): 6n,0 METHOD OF TEST ,� A r S
10. WATER ZONES (depth): it, 5' top q r rn
11. DISINFECTION: Type 771779 Amount 1/3
12. CASING: Wall Thickness
/n1 Depth/Diameter or Weight/Ft. Material
Z. at rial
From !/ To /� Ft. '' !''
From To Ft.
From To Ft.
- 13. GROUT: Depth Material 1 Method
From /) To at) Ft. (0-»cnticr iv-ii
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.
Topo aphic/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
//41
LOCATION SKETCH
Show direction and distance in miles from at lea a�'t
two State Roads or County Roads. Includ@jhe rid
numbers and common road names. N
C ?
co
c r=t
I rz-
0 >
rrn
0 CO at
��
0Jt --�
o
16 REMAPYS•
ClD NFP c n v
CONSTRUCTION
JUL 3th
"HAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15.A NCAC 2C, WELL
AND THAT A COPY OF THIS RECORR AS BEEN PROVIDED TO THE WELL OWNER
2 -4
LL
SIGNATURE OF PERSON CONSTRUCTING THE WELL
GRGU Ct to t re Division of Water Quality, Groundwater Section, I630 Mail Service Center ' REVgt1 NC
DATE
I 01
ASHEVIL 9' 8 (9U) 733-3221, within30 days.

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and N tural Resources - Division of Water Quality - Groundwater Section //
CERTIFICATION�yp# 3S V(
WELL CONTRACTOR (INDIVIDUAL) NAME
/l(print)r 1'I�YU. ('1n-I �bNE # �v ¢/ 3 /
WELL CONTRACTOR COMPANY NAME t 9 r P.P. Ile_ WL) I 7""ia
STATE WELL CONSTRUCTION PERMIT# A 6 - ASSOCIATED WQ PERMIT#
(if applicable) - (if applicable)
255606
1. WELL USE (Check Applicable Box): Residential Municipal/Public 0 Industrial 0 Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
•
G f WELL LOCATION:
Nearest Tpwn: B i n e k f11�n . County `i5 I Vt P L2 rvi be,
(P)! fI r uwhSc-VP.-
(Street Name, Numbers, C mmunity, Subdivision, Lot No., Zip Code)
3. OWNER:
t Address
//nn�� nn // (Street or Route No..) 2. ^ n
City or Town State Zip Code
- Area code- Phone number / _ n a
1 DATA DRILLED
S. bTOTAL DEPTH: 1 R 6--
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO ht-
TIC WATERLEVEL 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
15A NCAC 2C .0118.
9 YIELD (gpm):
METHOD(yOF TESTIrS
Q. ZONES (depth): 7 g L - ! Yv1
WATER
Topographic/Land setting
❑Ridge 0Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
Cr e e rS l cl e
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To , Formation»escription
rl oZ
5 ! - SO ➢ r-n LOCATION SKETCH
11. DISINFECTION: Type i1/ Amount' a % 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. MM tom. numbers and common road names.
From D To a / Ft. 6 "
From To Ft.
From To Ft. �h
od
13, GROUT' To Material M
From To a� Ft. �Q
-� From To Ft.
4. 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.
pE CE. 5:
I DO HEREBY Cfl
JUL CONSTRUCTION '
OS:OIUV s-Mrzo
Y THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
DADS, AND THAT A COPY OF 11S RECORD HAS BEEN PROVIDED TO THE WELL OWNER
DATE
AE
SIGNATURE OF PEJLSON CONSTRUCTING THE WELL
GROUNQWATER SECTION
ASHEVILCEtl the Division of Water Quality, Groundwater Section, 1636 Mail Service Ceen\tterl REVRaleigh,
NC
27699-1636 Phone No. 919) 733-3221, within 30 days.
c
i7
c0,.
nr
cr
cirri
cr
r' c
enr,
m
n
ti

257311
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section` / p
WELL CONTRACTOR (INDIVIDUAL) NAME print) a ! /� 1 A, CERTIFICATION a.Q11 �d
WELL CONTRACTOR COMPANY NAME44 0PA..c C!/ ✓ bfsN tt&e - • PHONE # (ga(K Io Y'� ''3l 1/4�
STATE WELL CONSTRUCTION PERMIT# / & Z ASSOCIATED WQ PERMIT#
(if applicable)
(if applicable)
1. WELL USE (Check Applicable Box): Residential Municipal/Public 0 Industrial O Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATIOt /�
Neares own: -Az-)County /t:.LLG1t2.0-ivt-t .—
(Street Name' umbers, Community, Subdivision, Lot No., Zip Codc)
3. OWNER: f/1 ^
Address J 7
f(reet or Routp No.) 229 / e�
-Ul WLCw�J
Zip Code
( )-
Area code- Phone number
4. DATE DRILLED ' 7'U•2
5. TOTAL DEPTH: 2D5
6. DOES WELL REPLACE EXISTING WELL? YES NO
7. STATIC WATER LEVEL Below Top of Casing: YO T.
(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 TESTno -
10. WATER ZONES (depth): /gd ' - .30 9)Jm
11. DISINFECTION: Type itT� Amount mil. 2
12. CASING: Wall Thickness
Depth Di meter or Weight/Ft. coal
From Q To /D9 Ft. it
City or Town State
From
From
To Ft.
To Ft.
13. GROUT:. Depth Material L
From To 10 Ft. I:041 ).At7
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.
r
ftreijhod
From
From
Topographic/Land setting
❑Ridge `fZlSlope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees. minutes/seconds)
Latitude/loneitude source:OGPSOTopographic map
(check box)
DEPTH DRILLING LOG
From To p Forr170tion Description
/1)2' SOS'
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:
TROCTjON $T4ND
Submit the original to the Di
'f76994636 Phone Ne:{9-I-9) 733
THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
AND THAT A COPY OF THIS RECO HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
ision of Water Quality, Groundwater Section, 1636 Mail Sert ice Center - Raleigh, NC
221, within 30 days. GW-I REV. 07/2001

Frolq
1.4 FTone
r•� �I
Li
L� 116. REMARKS: L✓
252030
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Na ral Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAM .0(prinI /�M 1 t vs b)p1 L CERTIFICATION # a 4112
WELL CONTRACTOR COMPANY NAME (3Y Gem Q ,!Je-DS , I2.I ,) ' i Pit m l _The.• PHONE # ��R Z �� " 3 / IV)-4
STATE WELL CONSTRUCTION PERMIT# �D .1. ASSOCIATED WQ PERMIT#
(if applicable) (ifapplicable)
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: 2
Meares; Totwn'Sf ..ii J&.r countIJws.aor..
ttio tnl.0 IS Cr +Snl
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Codc)
3 OWNER: £fe.v C Q v t`S
.Address cal8 Warr PJt'5 (:Irtt_k.
Street or Route No.)
� AL c a 71 S
City or Town State Zip Code
Area code- Phone number
4.'rDATE DRILLED
5. TOTAL DEPTH'
6: DOES WELL REPLACE EXISTING WELL? YES 0 NO $1
7. STATIC WATER LEVEL Below Top of Casing: 60 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING 1S I FT. Above Land Surface*
*Top of casing terminated ator below land surface requires a
variance In accordance with 15A NCAC 2C .0118. �s
9. YIELD"(gpm):' 3o METHOD OF TEST o! r s -
• 10. WATER ZONES (depth): / 6 5 ' - p sw
/85- fyp
11. DISINFECTION: Type f-$ T H Amount' 3 &
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From in To 3L . /o Ft. /o r' PVC C.
From To Ft.
-.From To Ft.
13. GROUT: Depth Material Method
From D To aiD Ft. 12—AMP.A+ IvF
•From_ To Ft
14. SCREEN: Depth Diameter Slot Size Material
From. To Ft. in. in.
From. To Ft in. in.
15, SAND/GRAVEL PACK:
Dc rim Size Material
To' " Ft.
Tu Ft.
Topo raphic/Land setting
❑Ridge Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees ntinutes/scconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Form tion Description
0 SL.G'
36. L gas' •
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.
Il DO HEREBY CERTIFY jrHAT HIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
DQN$TRUCTION-STlfND ' a AND THAT A COPY OF THIS,RECS D HAS BEEN PROVIDED TO THE WELL OWNER
ZZ�' �1-
SIGNATURE OF PERSON CONSTRUCTING THE WELL
GO
44 -30 - a 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. G\V-I REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Naturalat)Resources-'Di1vi�sion of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) - D br n ' 1U1JC.b b CERTIFICATION # .74//9
WELL CONTRACTOR COMpANY NAME GCLC&I 3r05 . /.fJG II 4 Pami /ArPHONE # flit z,4/S'3/TO
STATE WELL CONSTRUCTION PERMIT# / 940.2 ASSOCIATED WQ PERMIT#
(if applicable) (ifapplicable)
255063
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. L-turd It/. County furiesnil&.
Lipper &lack Fork
(Street Name, Numbers, ConununictSubdivision, Lot No., Zip P'o CCode)n
,3. OWNER: zr 1 - 4 Pa'lrcell at r+)--
' Address /A/S• LLpp#r Glattt Fern
/b • (treat or ti«No.) C 444 /Va S 7 / S
City or Town State Zip Code
Arca code- Phone number
4. DATE DRILLED 're
5: TOTAL DEPTH: 3E5'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO ,C1
7. STATIC WATER LEVEL Below Top of Casing: 410 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 la accordance TIth 15A NCAC 2C .0118.
9. YIELD (gpm): /'/; METHOD OF TEST a Ars
10, WATER ZONES (depth): VAS ' /'/a. j p r.+
11. DISINFECTION: Type HTN Amount
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft.
From6 To 26 Ft. G "
From To Ft.
From To Ft.
7/
Material
Ave
13. GROUT: Depth • Method
Fromt_ TOAD Ft. 41-170
•From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft in. in.
15. SAND/G
From
From
16. REMARK
ID0 HEREBY
CONSTRUCTIO
'al
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ysFlat
(cheek appropriate box)
Latitude/longitude of well location
(degrees nrinutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
6 96'
,3gs' i4
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.
RUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
THIS RECORD tJAS BEEN PROVIDED TO THE WELL OWNER
3"-3/ -o Z
Z£ :01 WV OZ Nflr ZO
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. G W-I REV. 07/2001

255064
WELL CONSTRUCTION RECORD
'.. North Carolina - Department of Environment and Natural Resources Division oof Water Quality - Groundwater Section.If'
WELL CONTRACTOR (INDIVIDUAL) NAME (print) R0 b Y1 LL)e ), b CERTIFICATION #.I 41/ d
• WELL CONTRACTOR COMPANY NAMEf rrer.ne,./ WPC . L i* // •i Ansel ANe PHONE # en G 4/S- 3/ 76
`STATE WELL CONSTRUCTION PERMIT# /YtO.1 ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATIOs
Nearest Tpym' County A/i/le!psm'J/X,
G[�j� F A
del D✓
(Street Name, bets, Community, Su6di ision, Lot No., Zip Code) al
or
OWNER: v rrlt e, 4 7e' ' - a. Lr for hL
Address !o / �i ieet 144 Pork
(Scree o Route No )
(/ N� u� /VC fl7/S
City or Town State Zip Code
Area code- Phone number
4."DATE DRILLED 'Y " 23 -D1' 1 „i.e....
5:;:TOTAL DEPTH: G S' ' - dr; Ilcd • F yy yt:5
6., DOES WELL REPLACE EXISTING WELL? YES U 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 15A NCAC 2C .0118.
9. YIELD (gpm): METHOD OF TEST .i rs
10. WATER ZONES (depth):
Topographic/Land setting.
❑Ridge ❑Slope ❑Valley Riot
(check appropriatc boa)
Latitude/longitude of well location
(degrees ns inutcshcconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
Formation Description
DEPTH
From To
3s
3.S ii.0
we 11
11. DISINFECTION: Type /4Y/4
12. CASING:
Depth Diameter
From To 3S Ft G „
From To Ft.
From To Ft
13. GROUT: Depth
From 0 To-.b Ft
Amount //3
Wall Thickness
or Weight/Ft. Material
Prig
paterial
ems..
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/G
From
From
16. REMARK
I DO HEREBY
CONSTRUCT[
%i,!
SIGNATURE OF PERSON CONSTRUCTING THE WELL
Method
Slot Size Material
in.
in.
AA .alle..
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the rya i
numbers and common road namestso
c_
CO
N
RUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
THIS RECORD )4*-R EN PROVIDED TO THE WELL OWNER
O
CA)
fV
5-e/-so 1—
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

Address /4 ff 1 2/ saA h 1405
Sgeef or Route Nd.)
C Q.iraG.e, A/C- .? 8'7/S
City or Town Slate Zip Codc
Arca code- Phone number
4. DATE DRILLED 44 - .Z D - 0 1
'5.:TOTAL DEPTH.
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO lit
7. STATIC WATER LEVEL Below Top of Casing:
(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):' g METHOD OF TEST 0 jlrs
10. WATER ZONES (depth): / 415 1 - S p r..
11. DISINFECTION: Type !-1Tfd
12, CASING:
Depth Diameter
From Q Too Ft.h
From To Ft.
From To Ft
13. GROUT: Depth •
From A To . t Ft.
Amount a 9
Wall Thickness
or Weight/Ft. Material
Sfee /
Material
aniZA s..*
From To Ft,
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
From
From
16. REM
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and
WELL. CONTRACTOR (INDIVIDUAL) NAME (print)
WLLCONTRACTOR COMPANY NAME
-
STATE WELL CONSTRUCTION PERMITS,
• (ifepplicable)
1. WELL -USES (Check Applicable Box): Residential*. Municipal/Public ❑ Industrial 0 Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other 0 If Other, List Use
255065
Natural
!7Resources - Division99of)Water Quality - Groundwater Section
NCD hi it b ebb CERTIFICATION 14974
///
A'rn (.S�//_ •,I ' tea.[ .PHONE 8 ff2P44i8',3/7d
ASSOCIATED WQ PERMIT#
(if applicable)
zie
2: WELL LOCATION::
Nearest wn: 62. -r-+- County tk,
/SQQh A N r
(Street Name, Nushburs, Community, SsWivision, Lot No., Zip Code)
3 OWNER: rte N
u
1
Depth ti Size
To -Ft.
To Ft.
Method
Slot Size Material
in.
in.
II Ii
I DO HEREBY CERg4' WY THAT THIS I WAWE S CO STRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCION A $'ANW�41AT�ACOP OF THIS RECORD 1-IAS N PROVIDED To ThE WELL OWNER
N-177V4.14.4tt J % .r'.1/-D.L
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Topographic/Land settin
DRidge OSlope ❑Valley klat
(check appropriate box)
Latitude/longitude of well location
(degrees minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To ForrNation Description
901 Grave/
40 r /4,5' Grpa. aar'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.
0
IV
L
Co
fV
0
ca
IV
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Serviee Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-I REV. 07/2001

2520 34
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and N ural Resources - Division of Water Quality - Groundwater Sectiond'
WELL CONTRACTOR COMPANY NAME
WELL CONTRACTOR (INDIVIDUAL) NAM/F,'�(prim)I"CP_bt 06ra ZelP-b6 CERTIFICATION CERTIFICATION ei4//O
l3 3✓DS . Lea / W Poi PHONE II�g -' 3 / 90
� /
STATE WELL CONSTRUCTION PERMIT# /449 a 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 ❑ If Other, List Use
.2, WELL LOCATION:
Neamsst wn` County
U/Lk.- n . V-12
(Street Name, Numbers, Community,b' vision, Left NNoo.,, Zip Codcl
3.OWNER: /J�na- Jtt
Address P 0 t3D / R63
«get or Roue
City or Town State Zip Code
--'Arca code- Phone number '/
4.'DATE DRILLED T ' Y " 0
. 5.»'TOTAL DEPTH. �t
6.. DOES WELL REPLACE EXISTING WELL? YES 0 NO m�
7; STATIC WATER LEVEL Below Top of Casing: / AO FT.
- (Use "if" if Above Top of Casing)
8..TOP OF CASING 1S I FT Above Land Surface*
*Top of cuing terminated at/or below land surface requires a
variance la accordance with ISA NCAC 2C .0118.
9. YIELD (gpm):(DO METHOD OF TEST c inr5
10. WATER ZONES (depth): .1a5 ' — (o O o pr.
11, DISINFECTION: Type
12. CASING:
Depth
From_Q To lq 5 Ft.
From______ To Ft.
From To Ft
13. .GROUT: ' Depth . /� Material
From_ To it, L Ft. odrese-ea
From To Ft.
14. SCREEN: Depth Diameter
From__To Ft. in.
From To Ft. in.
15,' SAND/GRAVEL PACK:
Depth Size
HYH
Diameter
Amount 443
Wall Thickness
or Weight/Ft.
From To
From,_ To
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCT1ED N ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF ECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Material
See-L
Method
Slot Size
in.
in.
Material
Material
Hi
Topo aphic/Land setting
❑Ridge Slope ❑Valley ❑Flat
fffcheck appropriate box)
Latitude/longitude of well location
(degreesminutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
D /95' ki
l R 5 . 1 ' F3 n.t....Zx.,-
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
Z
o
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Sell ice Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW- I REV. 07/2001

252636
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural
/Resources - Division of Water Quality - Groundwater Section
WLL ECONTRACTOR (INDIVIDUAL) NAM£,'(print) k0 /> i 1,, U�D�O - CERTIFICATION It cry /�
/
WELL CONTRACTOR COMPANY NAME I rffl t�8rrl5 . /vel / a /i)19a fie• PHONE a Leg{G «, -3/ '»
STATE WELL CONSTRUCTION PERMIT' 4 /•5/6") c2
(if applicable)
ASSOCIATED WQ PERMIT'
(if applicable)
1, WELL 'USE (Check Applicable Box): Residential Municipal/Public 0 Industrial ❑ Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
:••.2. WELL LOCATION;
Nearest Town:
County 81GrLG C.-
(Street Nime, Numbers, Community, Subdivision, Lot No., Zip Codc)
3. OWNER. \ IS ' )
-. Address /3 >'Y,% e +
(Strnt or/Vitro.)
�� -emu; aR73.2
City or Town State Zip Codc
Area code- Phone number ,
r 4:DATE DRILLED Y ' 3 "e
•5: TOTAL DEPTH. g 05 i
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: 4 AO FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
*Top or casing terminated aVor below land surface requires a
variance is accordance with ISA NCAC 2C .0118. /
9. YIELD (gpm): r/ 4 METHOD OF TEST a /trs
10. WATER ZONES (depth):
•
11. DISINFECTION: Type /f7i/ Amount / 1i'7
12. CASING: Wall Thickness
Depth or Weight/Ft. Material
Frotn_,Q_ To / 3 o PV
From To
From To
13. GROUT; Depth •
Front/9_ To_s2 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
Ft
Ft.
Ft
leas' - '/4 pr,-,
Diameter
6,„
Material �1
-.PirnlirU--
,Size
Ft
16.' REMARKS:
Method
/if
Topographic/Land setting
❑Ridge ❑Slope ❑Valley PElat
(check appropriate box)
Latitude/longitude of well location
(degrees minutes/scconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Forma Description
/D /ess
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
I DO HEREBY CERTIFY
CONSTRUCTION STAND
Slot Size Material
in.
in.
Material
N ACCORDANCE WITH ISA NCAC 2C, WELL
HAS BEEN PROVIDED TO THE WELL OWNER
,se)-a2
SIGNATURE OF PERSON CONSTRDCTING THE WELL
DATE
Submit the original to the Division of Water Quality, Groundwater Section, t636 Mail tiers ire Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-I RFV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources -
WELL CONTRACTOR (INDIVIDUAL) NAM (print)
WELL CONTRACTOR COMPANY NAME I- r f- 1F.//3 rCS r Gll 9r Y"G
STATE WELL CONSTRUCTION PERMIT.//''7G�^02
(if applicable)
250763
Division of Water Quality - Groundwater Section/ O
CERTIFICATION #.' 41 �6
PHONE # � 4/ -3/ 91)
7,
ASSOCIATED WQ PERMIT#
(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:
Nearest Town: 13lae± IY1-1-in . County-tA.Y1CDrjt-
r� rn r- k "Rd
(Sweet Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: fl
Address Ca 31 en`a ea+ 1vl.z
(Street or Route No.)
--tieJ m n,N+ n! (', 0,8 O I a.
Cityor Town State Zip Code
Area code- Phone number
4. DATE DRILLED 3-15--Oa
5:'TOTAL DEPTH: 9 In S '
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO lir/
7. STATIC WATER LEVEL Below Top of Casing: '-{Dt FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING 1S ' FT. Above Land Surface*
*Top of casing terminated awor below land surface requires a
variance In accordaacp with ISA NCAC 2C .0118.
9. YIELD (gpm): t/ ': METHOD OF TEST �t r5
10. WATER ZONES (depth): 9 Db- 1) 4 q pin-.
I1. DISINFECTION: Type I-} T14
12, CASING:
Depth
From To Depth.,
Ft.
From______ To Ft.
From To Ft
Diameter
to r,
13. GROUT: Depth
From E To ?D
From To
14. SCREEN: Depth
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size Iv
From To Ft.
From To Ft.
16. REMARKS:
Amount ('-f L,
Wall Thickness
or Weight/Ft. Material
P VC
Material
Ft. r mnt.«-A
Ft.
Method
Diameter Slot Size Material
Topographic/Land setting
❑Ridge lB lope OValley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degreesminutcs/seconds)
Latitude/longitude source:OGPSOTopographic map
(check box)
DRILLING LOG
Formatipn Description
DEPTH
From To
A 51
h.tt�l-✓ �t�
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
JUL - i 2002
GROUNDWATER SECTION
Aol/EVrLLL fitGIONAL OFFICE
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRU ION STAN DTHAT ACOPY OFTHIS $(<CORD HAS BEEN PROVIDED TOTHE WELL OWNER
n (S'LCI 'j/
.J . .2 - fi L
t
N
N
t0
c
0
O
0
onl
�n
30
rn
=2o
CA
rrl
mz
c4
--s
0
SIGNATURE OF PERSON CON
RUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 163n Mail Service Center - Raleigh, NC
a-r<nn I<a< u,...--mn. m,of eaa i»r mb}tn 111 d•,ue GW-I REV. 07/2001

250764
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and_Na�tural Resoyrces - Division of Water Quality - Groundwater Section
•WELL CONTRACTOR (INDIVIDUAL) MAMA (prim) !� lI 1 �P`i il)./7 / CERTIFICATION e a �p
/ 6
WELL CONTRACTOR COMPANY NAMELY rte -, tl a 'o S . WCCi ainp [n 4.e • PHONE q iSte2g 4 VS -3 / 70
STATE WELL CONSTRUCTION PERMIT# / `7D� ASSOCIATED WQ PERMIT'S
(if applicable) - (if applicable)
I. WELL USE (Check Applicable Box): Residential B 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:t �iA r % rn4-1.1 . Countyet-.htt \ de_,
Nor4 Fey •
(Street Name, Numbers Community, Subdivision, Lot No., Zip Code)
3. OWNER• ,& r 4•yn NIAC
Address it) -3 '7 ..]-P Gr e n, t
(Street or Route No.)
r � n c-n - N C
City or Town Slate
Area code- Phone number
4. DATE DRILLED 3' I I— b Z
5: =TOTAL DEPTH- '7 05
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO Nft
7. STATIC WATER LEVEL Below Top of Casing: 3 SO 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
valance In accordancqq with ISA NCAC 2C .0118.
9. YIELD (gpm):' 114 METHOD OF TEST 3 k rs •
.• • 10. WATER ZONES (depth): 4 DD 1 — 11 (4 m
2RD)
Zip Code
11. DISINFECTION: Type 1-4 T 1-1 Amount I
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 13 To iS 4. Ft
From To Ft.
From To Ft.
PVC
13. GROUT: Depth Material Method
From (l To a D Ft. C o .'v,+L-v*
_From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size Mate
From To Ft.
From_ To Ft.
Slot Size Material
Topographic/Land setting
❑Ridge ❑Slope ❑Valley C3FIat
(check appropriate box)
Latitude/longitude of well location
(degrees minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
0 .-8.Lt
b '7ia-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.
16. REMARKS: GROUNDWATER SECTION
ARNE-T CE ri€E1 - 8f.H E
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RE HAS BEEN PROVIDED TO THE WELL OWNER
//} J d a .c
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
-o
W
c
0
ca73
0m
oC-5 Cm
o<
Do
RIo
Am
rnZ
rt
c)
0
Submit the original to the Division of Water Quality, Groundwater Section, 163ti Mail Service Center - Raleigh, NC
---- - -- _. — --"_ --- ---- .,, MI1.1 P FV n7111101

255068
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) 313 A.J4 # ,Brut t, CERTIFICATION # 30g/1
WELLCONTRACTOR COMPANY NAME OYPP he Rr04s LlJP// ¢ /tfrn ZZ°PHONE # (gig 444 3/70
STATE WELL CONSTRUCTION PERMIT# / 46 R ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential x. Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 It' Other, List Use
2. WELL LOCATION?? J / //��� �� �
Nearest Town: (4,01)P., CountyS,ephtk,
Ltd as /g/aa
(Street Name, Numbers, Community, S--division, Lot No., Zip Code)
3. OWNER: ( / haR La_
Address S93 m/gj U! /9/St3
e%��/(SStreet or Route No.)
tz.oz ti Alt fl7/S
City or Town tate Zip Code
(—)-
Area code- Phone number
4. DATE DRILLED a e aG -6.1
5. TOTAL DEPTH: ^105 r
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO �I
7. STATIC WATER LEVEL Below Top of Casing: 410 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): /r 5 METHOD OF TEST a Ars •
10. WATERZONES(depth): 3bt r — LS Jr.
11. DISINFECTION: Type %iT/i
12. CASING:
From D To 414 Ft.
From To Ft.
From To Ft.
13. GROUT: Depth
From__ Tot Ft.
From To Ft.
Depth Diameter
L"
Material
Amount
Wall Thickness
or Weight/Ft. Material
PVC.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
• Depth Size Material
Method
Topographic/Land setting
❑Ridge Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(decrees minutes/sceonds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
0 4<6'
Slot Size Material
in.
in.
Fib ,.? —rr�
I 'I
r
16. REMARKS: I I
`I
t DO HEREBY CER"tjIFY T
CTInN AND/
AS r-VL.-t;
SUS SIGNATURE OF PERSON CONSTRUCTING TI IE \\'ELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Sers lee Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days.
GW-I REV.07/2001
Ft.
Ft.
44 70S,
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
AT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
D$, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
5-31-61-
c_
0
cr
r
G<
-frlrr
CO
rn
G

255077
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater / 7
Section
WELL CONTRACTOR (INDIVIDUAL) NAME
(print) /yt h-t1 rp CERTIFICATION # '
WELL CONTRACTOR COMPANY NAME t.7 ree e -3rg5 lUP-I I °I Pump, J.Lt -PHONE # (dIa0 �' 0 - 3 /7i)
STATE WELL CONSTRUCTION PERMIT# l'Y'n Z ASSOCIATED WO PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: Li )e'et f r U,� %�-<_- County BLt M,C
Leppe.v- Fla) Cne.lc
(Street am Numbers, Community, Subdivision, Lot No., Zip Codc)
3. OWNER: (Tina r F 5
Address Q ,O _A))
(Street or Route N
//) aLeroi))t1
City or Town State
C� I IQ tda.-ti
(”4.) cq FL d .
n.) C 4 a g `7 g '7
�V Zip Codc
Topographic/Land setting
❑Ridge lope ❑Valley ❑Flat
check appropriate box)
Latitude/longitude of well location
(degrees minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
Formation Description
DEPTH
From To
''//
Area code- Phone number 3 3 d 5 '
4. DATE DRILLED a - — a
5. TOTAL DEPTH: 3. 5 '
6. DOES WELL REPLACE EXISTING WELL? YES 99 NO
7. STATIC WATER LEVEL Below Top of Casing: 'f'/) 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): I W * METHOD OF TEST -2 h r5
10. WATER ZONES (depth):
11. DISINFECTION: Type H TN Amount 5/
12. CASING: Wall Thickness
Depth or Weight/Ft. Material
From D To �3 Ft. PW C
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From D To 21> Ft. Co_r..a-03.
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
5.ESA L(D/GRAVCJ PtCK_, I h
✓1(—Ftorn To
From To
REMARKS:
CONSTRUCTION STAN
Diameter
[o it
Size .Material
F4
T(ThkT THI
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.
0
tV
0
C
fV
0
0
CO
CO
WELL WAS CONSTRUCTED IN ACCORDANCE WITH I 5A NCAC 2C, WELL
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, 1630 Mail tiers ice Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-I REV. 07/2001

249245
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division/of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAM//E�s (print) gt9 6 / Yt 1�t/ a42 I CERTIFICATION k .2 4 /
WELL CONTRACTOR COMPANY NAME 4/*P!'.ND ''•Br0 /�/2/I `''� Purr, NM. PHONE d J 8.ZS/n e/ -3/ 943
T//
STATE WELL CONSTRUCTION PERMIT,* / D 'Z 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 ❑ Other 0 II' Other, List Use
2. WELL LOCATIO, . rr
N st Town: jc, _paCounty IJi-Lw.P,L
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: U t rn '
w1
Address 17 D0 Lee. K t c-k-1 . 2‘4.- •
j (Street or Rout o� f7
r-�X1hC lt0"r�
City or ToaState Zip Code
( )-
Area code- Phone number
4. DATE DRILLED a I' - U a.
5. TOTAL DEPTH: .3[) S '
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 111
7. STATIC WATER LEVEL Below Top of Casing: ZD FT.
`` (Usc "+" 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 accordaggce with ISA NCAC 2C .0118.
9. YIELD (gpm): Co 0 METHOD OF TEST c2 h r S -
10. WATER ZONES (depth): a ¶{.. ' - Ce D p tr
Amount 5i
Topographic/Land setting
❑Ridge ❑Slope ❑Valley'Zlat
(check appropriate box)
Latitude/longitude of well location
(degrees minutesseconds)
Latitudc(loneitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
' Tintti
11. DISINFECTION: Type Wr 1-4
12. CASING:
Depth
From L) To 5 c2 Ft.
From To Ft.
Diameter
�tt
Wall Thickness
or Weieht/Ft. Material
Pura
From To Ft.
13. GROUT: Depth Material �Meth^od
From D To 2O Ft. COS 'v i"
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
I Da FILRLBY CERTIF
CONSTRUCTION TA
L Submit the original 1
f othe Division of Water Quality, Groundwater Section, 163o Mail Service Center - Raleigh, NC
) -4 , ti P yrritq'[phone], within 30 days. GW-I REV. 07/2001
ASHEV F F FGIOINAL OFF:—
T THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C. WELL
)S, AND THAT A COPY OF THIS RECli.AS I3EEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONS TING THE WELL
DATE

WELL CONSTRUCTION RECORD
249244
North Carolina - Department of Environment and Natural ResourcesQ- Division1of Water)Quality - Groundwater Section
'/
WELL CONTRACTOR (INDIVIDUAL) NAM (print) a0.—P .1�s2. /.L/f .P A CERTIFICATION n a7 / Si
WELL CONTRACTOR COMPANY NAME&rt.e-&L+//ern - ZI..)P .k 'f P� rJ C PHONE q i.aid L V '•3 i 9C
STATE WELL CONSTRUCTION PERMIT# /`f"d a- ASSOCIATED WQ PERMIT#
(if applicable) Of applicable)
1. WELL USE (Check Applicable Box): Residential Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring D Recovery ❑ Heat Pump Water Injection ❑ Other 0 I t Other, List Use
2. WELL LOCATION:
Neare Town: L-t. County
(Street Name, Mrp)bers, Community, Subdivision, Lot No.. Zip Codc)
3.OWNER: C7aJea Groc'nl5
Address I SD Lot. e-r Crl c‘tia. Fork -RA •
n ( Ir et or Route No.)
cr-
1
City or Town State Zip Code
( )-
Area code- Phone nutnber
4. DATE DRILLED a - ) 9 - d 7•
5. TOTAL DEPTH: l0 vS
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: Lon FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS It FT. Above Land Surface*
*Top of casing terminated atior below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9, YIELD (gpm): I METHOD OF TEST a2 hr5
10. WATER ZONES (depth): -9DS f - 1 iy m
C
28r 5
11. DISINFECTION: Type it-1 T1-1
12. CASING:
Depth Diameter
From [i To Q i Ft. LAD 11
From To Ft.
From To Ft.
Amount i `J
Wall Thickness
or Weight/Ft. Material
13. GROUT: Depth Material��
From D To a?CT Ft. Cn.vp,F,,..t
From To Ft.
14. SCREEN: Depth Diameter
From To Ft.
From To Ft.
15. SAND/GRAVEL PACK:
Depth Size Materi:d
From To Ft.
From To Ft.
Method
Slot Size Material
in. in.
in. in.
16. REMARKS:
Topographic/Land setting
❑Ridge ope ❑Valley ❑Flat
check appropriate box)
L iitudelon_itude of well location
l dcumcs. mminutcs:sec nds)
Latitude/lon_zitude source:❑GPS❑Topographic nap
(check box)
DEPTH DRILLING LOG
From To Foma ion 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.
rr,
0
0
rE1 r
11.I DO HEREBY CERTIFY
CONSTRUCTION STA
THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 1 5A NCAC 2C, WELL
AND THAT A COPY OF THIS R RD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING TI1E WELL DATE
I(Rlhylgpgrpt[gqh,fp the D vision of Water Quality, Groundwater Section, 163o Mail Sers ice Center - Raleigh, NC
ASH17699€163M hMin IQbi t4i9LW-3221, within 30 days. GW-I REV. 07/2001

2507R9
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) D b I n /.�)P� b
i7 nn CERTIFICATION a.,% cl
WELL CONTRACTOR COMPANY NAME Graf Kt8 of,v&)eii q Pa 1te inG• PHONE a �(,?ig(o 418.3/7°
STATE WELL CONSTRUCTION PERMIT# 740,2 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 To,��mn .,-nnrXsa,l le Count_rn )t sncke-.
(� rt n ct- C41 Ln .
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Codc)
3. OWNER: l .t,r
l 1. DISINFECTION: Type
12. CASING:
Depth Diameter
From_ To to I Le Ft. "
From To Ft.
From To Ft
.13. GROUT: Depth
From_12._ To :O 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.
(3ar+I ett
Address D htrzL.. ICI a1-4-
(Street or Route No.)
Lt)F lieAr1i,)le A/C, C.Z8r78'77
City or Town State Zip Codc
Arca codc- Phone number
4. 'DATE DRILLED cf - rI - O cQ
; 5: TOTAL DEPTH:
6: DOES WELL REPLACE EXISTING WELL? YES 0 NO tilt
.7. STATIC WATER LEVEL Below Top of Casing: ten 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): Ci METHOD OF TEST 2 h rs •
10. WATER ZONES (depth): (VLpS ' - 1 c( p m
48S'
I-1 Ti4 Amount-3 4 a
Wall Thickness
or Weight/Ft. Material
Material
�,.a...�
Method
Material
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTE
CONSTRUCTION STANDARDS, AND THAT A COPY OF
Ye)
i /LLL e a t
Topographic/Land setting
❑Ridge ❑Slope ❑Valley lat
(check appropriate box)
Latitude/longitude of well location'''
(degrees minutcsiseconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTFI DRILLING LOG
From To Formation Description
o �I.t (t .
Co I I n 5 o 5'
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 RECORD HAS BEEN PROVIDED TO THE WELL OWNER
4 - 2 -4 .2-
N
c
c
ni
c r,.t
< 0
of
>0
fn
am
cn
m=
c4
H
0
SIGNATURE OF PERSON CONSTRUCTING THE WELL
DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Ser. ice Center - Raleigh, NC
27699-1636 Phone No.1919)733-3221. within 30 days. GW-I REV. 07'701)1

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality
WELL CONTRACTOR (INDIVIDUAL) NAME (print)T _ � )�
WELL CONTRACTOR COMPANY NAME GYP.PAtL £YcS- Gt��. `� U Ic('t
STATE WELL CONSTRUCTION PERMIT/4
;/D,1
ASSOCIATED WQ PERMIT/4
(if applicable) (if applicable)
249236
- Groundwater Section'/ p
CERTIFICAT1(OyN/#'alion jd
PHONE q ti+fg lo`t"0 -3/ 90
1. WELL USE (Check Applicable Box): Residential 13'MunicipaI/Public 0 Industrial 0 Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 I[Other, List Use
2. WELL LOCATION:
Neare} T,n.7� Al A-P.i. m�- CountyBL.UA.C-t-1. t_
I—tnr .
(Street Name, Numbers, Community, Subdivision. Lot No., Zip Codc)
3. OWNER:
Address
I I 1 F t tie- l2P, fir.
Sl.t,LLM r�-�.ts-GA Route (Street or No.)�i .2% "i / O
City or Town • State Zip Code
( )-
Arca code- Phone number - 3 ' D
4. DATE DRILLED
5. TOTAL DEPTH: tp bS
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO Ir
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): ca METHOD OF TEST oZ h r5 -
10. WATER ZONES (depth): 44-05 ' - I 'F` a'I'+
65 rn
Amot t I nCi
Wail Thickness
or Weight/Ft. Material
PVC.
11. DISINFECTION: Type
12. CASING:
Depth
From 0 To S2 Ft.
From To Ft.
From To Ft.
13. GROUT: Depth �rMaterial ethod
From 0 To at' Ft. C p.41.9
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
6 ,t
16. REMARKS:
I DO HEREBY CERTIFY
CONSTRUCTION STAN
Gi, 9.
)
r,
Togo, r apbic/Land setting
0Ridge ope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
Idegrcc mintucsv seconds)
Latitude/ longitude source:❑GPS❑Topographic map
(cheek box)
DEPTH DRILLING LOG
From To Formation escription
4>D5 '
5.2
LOCATION SKETCH
Show direction and distance in miles from at least
two Stale Roads or County Roads. Include the road
numbers and common road names.
ri�. THIS WELL WAS CONSTPvr tD IN ACCORDANCE WITH I5A NCAC 2C, WELL
' . AND THAT A COPY OF H %'CORD FIIIAS BEEN PROVIDED TO THE WELL OWNER
41111
M r NiliWf0 _ONS
ASHEVILLE REGIONAL OFFICE
Submit the original to the Division of Water Quality, Groundwater Section, 163o Mail Serf ice Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-I REV. 07/2001
_q - 3- i) 2
NG
TIIE WELL
DATE

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Na I Resources - Divisign)of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME, (print) CERTIFICATION d a/51/2
WELL CONTRACTOR COMPANY NAME l/ r�YL-eM Yam- Gam- '7 Ply le PHONE d (tcalS f '�--3j 9I'
ASSOCIATED WC) PERMIT#
(if applicable) (if applicable)
STATE WELL CONSTRUCTION PERMIT# //mod
249235
1. WELL USE (Check Applicable Box): Residential V. Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring 0 Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest
��Town: � .5u)4t .-r`� -&�ct-- County - jL-L-
L�C/A JN1.�h'(I�S / ri i `1l Y .
(Street Name, Numbers, mmunity, Subdivision, Lot No., Zip Code)
k t t
3. OWNER:
Address
1 Ta
eOA AAA :I-r-cS 1'r`�Y. r
(Street or Route No.)
M-nA.rriSt)( I�� I�IC_
City or Town State Zip Code
( Area code- Phone number
4. DATE DRILLED ) ' GI? 2 - C '
5. TOTAL DEPTH: 4DS
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO Ci
7. STATIC WATER LEVEL Below Top of Casing: I t ) 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): R METHOD OF TEST YS •
10. WATER ZONES (depth): 1451
11. DISINFECTION: Type 1--127-4-1
12. CASING:
From 0
From
From Ft.
13. GROUT'
From 0 Ft.
From To
14. SCREEN' Depth
From To Ft.
From To Ft.
15. SAND/GRAVEL PACK:
Depth Diameter
To I Oa Ft. Co bi
To Ft.
To
Depth
To jr)
From
From
16. REMA
l DO HERE
CONSTRUC
L I-2
Ft.
Diameter Slot Size Material
in. in.
in. in.
Amount % ` --
Wall Thickness
or Weight/Ft. Material
CMaterialer
I I' IV M
M+ethod
od�
CERTIFY THAN W . S CO
ION STQARUp)4r��'' `'•SEMITtI(N\ COPY
HEVILL. "GIONAL OFFICE
aterial
Topographic/Land setting
❑Ridge ❑Slope ❑Valley $Flat
(check appropriate box)
Latitude/longitude of well location
(degrees minotes. seconds)
Latitudeiloneitude source:❑GPS❑Topoeraphic map
(cheek box)
DEPTH DRILLING LOG
From To Formation Description
D I ' 02.41
1 ©a. 405
LOCATION SKETCH
Shots direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
STRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
OF THI - ORD HAS BEEN PROVIDED TO TIIE WELL OWNER
3-.5--o
CTING THE WELL DATE
SIGNATURE OF PERSON CONS
Submit the original to the Division of Water Quality, Groundwater Section, 1631, Mail Set ice Center - Raleigh. NC
27699-1636 Phone No. [phone], 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,, // p
WELL CONTRACTOR (INDIVIDUAL) NAME (print) � CERTIFICATION#n%Y'j6
WELL CONTRACTOR COMPANY NAME tiree-n/t-- Sr'5 • We —I I + Pikenp t...inc. PHONE # (ddt� 4 in-1113
STATE WELL CONSTRUCTION PERMIT# /44c ASSOCIATED WO PERMIT#
(if applicable) (if applicable)
247249
I. WELL USE (Check Applicable Box): Residential ' Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ It' Other, List Use
2. WELL LOCATIO 1
Nearest Town: .GL.Nee Y J - ,S County T D 2.
(Street Name, Numbers, Community, Subdivision,diLot No., Zip Codc)
3. OWNER: -'P-Lin cS hapt
Address /) +) ni i l k St't It emit- /2/Ci •
M ( rect or Route No,)n OPS 2 /S
. terit
City or Town Slate Zip Coda
( )-
Area code- Phone number
4. DATE DRILLED I - 7- 0 A
5. TOTAL DEPTH: aD5 '
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO IF'
7. STATIC WATER LEVEL Below Top of Casing: 4D 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)' SD METHOD OF TEST l hrs
10. WATER ZONES (depth): 1 $S' - SD cJ p
I I. DISINFECTION: Type H tk Amount L LD
Wall Thickness
or Weight/Ft. Material
12. CASING:
Depth Diameter
From 1) To 'IS 0:-/ Ft. L.P t i PV L
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From b Tom_ Ft. Cp I u p
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 F?Flat
(check appropriate box)
Latitude/longitude of well location
(degrees minutes/seconds)
Latitude/longitude sourcc:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To t Formation Description
o Sa
54 a ad-5-1 J iha
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 HEREBY CERTIFY THAT THIS WELL V
CONSTRUCTION STANDARDS, AAID,THAT
h.�
SIGNATURE
WITH I5A NCAC 2C, WELL
.OVIDED TO THE WELL OWNER
a-6-as
DATE
Submit the original to the Division of Water Qu. • YO tT{ �qh, • •� t'• t, 163 Mail Senice Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 dnl3HEVILLE REGIONAL OFFICE GW- I REV. 07/2001

247248
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME -C
(print) 61a,xt�� Wei . CERTIFICATION # .2408
WELL CONTRACTOR COMPANY NAME ! Yr Wit SOS • &La Y T9 M.M.") • PHONE # (gag 6 -.3 "7 °
/4/D -Z
STATE WELL CONSTRUCTION PERMIT#
(if applicable) (if applicable)
ASSOCIATED WQ PERMIT#
1. WELL USE (Check Applicable Box): Residential EI Municipal,/Public ❑ Industrial 0 Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection ❑ Other 0 IFOthcr, List Use
2. WELL LOCATION:
Nearest Town: u>n-t, tea-n-.o ^-
I1A-cL e :.O i.t..P
Topographic/Land setting ,/
Count 1 :Midge 0Slope ❑Valley ?flat
(chock appropriate box)
(Street Name, Numbers, Lbmmunity, Subdivision, Lot No., Zip Code)
3. OWNER: )Rvn 4 Y \Qp»y 01t.)°MSits
Address I . O '1 Plat l & #tz-. F-FW� .
r�r• v/(St or Route No.)
AJC a / n`C l
tth�
City or Town lgtate l Zip Code C
( )-
Area code- Phone number
4. DATE DRILLED I — '1 0 a
5. TOTAL DEPTH: 1 le .5
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO d
7. STATIC WATER LEVEL Below Top of Casing: 1 G FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING 1S 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 METHOD OF TEST 0 k rs -
10.WATER ZONES (depth): 145
11. DISINFECTION: Type ►-I' T. F+
12. CASING:
Depth
From L7 To e 3 Ft.
From To Ft.
From To Ft.
13. GROUT: Depth
From D To a D Ft.
Diameter
,1
Amount a, 9
Wall Thickness
or Weight/Ft. Material
PVC
Material
C
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size
From To Ft.
Method
Slot Size Material
in.
in.
Material
From To Ft.
16. REMARKS:
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCT
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
SIGNATURE OF PERSON CON
Latitude/longitude of well location
Idegrxs. minutes/seconds)
Latitude/longitude source:OGPSOTopographic map
(check box)
DRILLING LOG
Formation Description
DEPTH
From To
D S3
$3 itt'
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
O __
CO c--
Submit the original to the Division of Water Quality, Crou
27699-1636 Phone No. [phone], within 30 days.
D IN fthA 3EN�C,I F WIOT'I Etr 4E WELL OWNER
tdwat
TING THE WErLL,IiATE
r Section, 163o Mail Serci, e Cen er - Raleigh, NC
GW-1 REV. 07/2001
OROUC:D(y..'r`, SF_" TION
ASH h rgCE
CO _:
o

ELL CONTRACTOR (INDIVIDUAL) NAME (print) I J4(.Prv. /—W Pe NAG
)YELL CONTRACTOR COMPANY NAME
(j
SATE WELL CONSTRUCTION PERMIT# i
(ifapplicable)
ST
270622
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
CSreLJzl1
CERTIFICATION# oil r�J
e y �ro•, .
4 'Pt Ley, e 4-� PHONE # (2a$ L. 4 - 31%
ASSOCIATED W'Q PERMIT#
(if applicable)
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
WELL LOCATION: 1(�� t�
Nearest Town: Qlnc.k (l-i-in • County I�t.lnc-rrw-r. lZ.
toh I Ecb
(Strect Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3.'OWNER: YY\ccriFv Thug?`cm
Address t 4 t-7 C-e+-i.r l v r
Cr/� (Street or Route No.)
keVi Ile NIC.
City or Town State t
Area code- Phone number
rat DATE DRILLED 1 C — Ito C) Q
5 ' TOTAL DEPTH: 3 a 5 /
-,0;/:DOES WELL REPLACE EXISTING WELL? YES 0 NO CS'
17 STATIC WATER LEVEL Below Top of Casing: 4 Co FT.
• (Use "+" if Above Top of Casing)
TOP OF CASING IS 1 FT. Above Land Surface*
*Top praising terminated at/or below land surface requires a
:_'warlance in accordance with ISA NCAC 2C .0118.
, .'IELD (gpm): l D METHOD OF TEST in r5
10, WATER ZONES (depth): f)C3 1 o r, p m
11:tp1SINFECTION: Type
1?a QASING:
Depth Diameter
From -) To % Ft. Lv t
From ` To Ft.
From' To Ft.
a9,RC)I
Zip Code
/-I TN
Amount 57
Wall Thickness
or Weight/Ft. Material
PUC.
i
;,�fR(1UT: ` Depth Material y
r9 To e2O Ft. l P wi.0 1
'cr,^`Frcirn— To Ft.
ONSCREEN: Depth Diameter
L MR . To Ft. in
•Frpni _ _ T_ To Ft. in
4.4SANA/GRAVEL PACK:
�"c` { Depth Size Material
Frorn To Ft.
From,,,
To Ft.
Method
Slot Size Material
in.
in.
Topographic/Land setting
❑Ridge (e ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(cheek box)
DRILLING LOG
Formation Description
DEPTH
From To
0 3 'z i C12..cL44 .
Fca 3a5-' ??_- A t
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, 1,RKS:
1 p.Q l-WR,RBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
cp1N023.UprION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
�g —0_3
ist4cie SarGN r
.he orj;inal to the.►dWesiorllc
jab FbAiue No, (929) `i$221y'-
Lr-
=f1GE
f
C(,tr�
E OF PERSON CONSTRUCTING THE WELL
DATE
ter Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
n 30 days. GW-1 REV. 07/200 1

270628
;:;WELL CONSTRUCTION RECORD .
rargj4(I4t,Departmept of Environment and Natural�Resources - Division of Water Quality - Groundwater Section
A(INRAYIDUAL) NAME
� (print) 67r L,,,,,, �t J )�Yt A-F-P CERTIFICATION# '/3Dr/ /
71*UOMPANY NAME (`reeve-3✓i'.. Zt)e fl Peerr� •Ater PHONE # j Ct ley C3 - 3I 7U
«tit ,/L
�!$T$UCTIO,IY� PERMIT# % Y' ASSOCIATED WQ PERMIT#
(ifapplicable) (if applicable)
of
304,, VSE (Check Applicable Box): Residential l 7Municipal/Public 0 Industrial 0 Agricultural 0
Mopllonitg,0 ,Rcovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
Pj cT IE`;(4 ATION:
jegrs�, own cr:f.tl, e County u 1cc.a 2 L
V�
Wee( Name, Nwnbers, Community, Subdivision, Lot No., Zip Code)
WISER: . .r�t4 8.[J
4dr‘55 n/ enz J J a 3 9
�1 (Seat or Route No.) 1
1 .�5'iLM(/lji�
;City or Town 'I State Zip Code
..e•'Phone number
pRILt-ED / c7 - 9 - n 2
4Le nEPTH: .Inns I
W 14-,REP.LACEEXISTINGWELL? YES 0 NO CY
IGVApTERnYEI. Below Top of Casing: SCL) FT.
CA7^ Cr1$ l :'(Use"+" if Above Top of Casing)
,pFtFT. Above Land Surface'
Rif &a! r!g Fermlaated at/or below land surface requires a
my4metr.la,;ct:offs? with'15A NCAC 2C .0118.
PaPill) METHOD OF TEST ,3 1.1 r 5
RtONE (depth): (eS' — )1 cj
.5.„At :3LOCATION SKETCH
INF, P,TIQN Type 1-i -r I_{ Amount 92 Show direction and distance in miles from at least
MG,, Wall Thickness two State Roads or County Roads. Include the road
w �, i' Depth Diameter or Weight/Ft. Material numbers and common road names.
Rat ` t� To 0 C' Ft. ID n P a , 0w J
r,Ridt'• To Ft. 3
sera _ To Ft. =v
OUT, 1', Depth Material
ttt� `To.l_ Ft: C) A.Nc -a.
Topographic/Land setting
❑Ridge fdSlope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:0GPSLITopographic map
(check box)
DEPTH DRILLING LOG
From To Formecalio Description
4.2!) JOnS tiri.lo
spi. # Depth'. : Diameter
tptrlr 'To ` Ft. in.
Iglr _ __ To Ft, in.
Q)/QAAYEP PACK:
91' Depth Size Material
To ..Ft.
t.. ` -... To Ft.
bra '
j14. fS'
tier , .t ...:. ,
r ElgTIF3''THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
ON STAND!tI�$, AND THAT A COPY OF THIS RECORD U, 93EEt PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CON51tl.ICTING E WELL DATE
rthetrt gipalSo the Division of Water Quality, G{oundwater Section, 1636 Mail Sej
Method
c-t
Slot Size Material "'
in. _
in.
03p1)9cIe No, [phone], within 30 days.
I
—
xn
enter - Raleigh, NC
GW-I REV. 07/2001

North Carolina Department of Envlrommenl and Nature, Flesourcos - Division of Wider Duality - Oroundwnlnr Section
1639 Mali Service Center - Relelph, N.C. 27699.1638-Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR' 1JP 6Fll LJ. P iiL5
WELL CONTRACTOR CERTIFICATION.: a y"7� Q
STATE WELL CONSTRUCTION PERMIT.:
268931_
WELL USE (Check Applicable Boa): Residential WY Municipal ❑ Industrial ❑ Agricultural El Monitoring ❑
Rocovory ri Heat Pump Water Injection ❑ Other Ej If Olhor, Llsl Use:
WELL LOCATIO ' (Show sketch of he locallon below)
Nea%r� t Town 911J�-1� County A .�.LM.(` 4 e+
gAxecir cvo7 , i iycLee '7C 288306
(woad Name an, Numbers, Corrvsernit or 5 bdivision and Lol No.) DRILLING LOG DEPTH
. OWNER ��
r�� _ J . ' �l -s Fam To Fonnntlon Uascrlpllan
Address
Clly or Town Slats Zip Code
DATE DRILLED l -110 - n a
TOTAL DEPTH rl D 5 -
CUTTINGS COLLECTED YES n NOfvf
DOES WELL REPLACE EXISTING WELL? YES n NO 4
STATIC WATER LEVEL Below Top of Casing: / 5D FT.
(Use'.' if Above Top of Cnslno)
TOP OF CASING IS 1 FT. Above Land Surface'
op of casing terminated eUor below lend surface requires a valance In eccor-
nce with 15A NCAC 2C4I1a
YIELD (gpm): METHOD OF TEST
WATER ZONES (depth):
1,,FILORINATION: Typo T N Amount glop i(1S
t. CASING:
Pg.-
- i�
11 � - So c
0
CO
N
r-,
If additional space Is needed use hack of lorrn
Wall Thlcknose LOCATION SKETCH o
Depth PPlamelp icon. ;�,Mze(da,�l .-, (Slow direction and distance from nl least Iwo Slate
FromTo Ft. w'el i�YGSOlZ Roods, orother map reference points) r-- '▪ l
0
From To rt. _
From To Ft J�� I `D
GROUT; ��/1 /l,fN U,
Depth M�al`orlol Method
From 0 To -�_O�'_ rt r rl._E__ pan _
Frorn To Ft
SCREEN:
Depth Diameter Slot Size Material
From To FI In In
From To FI In In
From To Ft _ In In
SAND/GRAVEL PACK:
Depth Size Material
From To FI
From To FI
REMARKS:
LEILL
I DO IIEREDY,CEBTIFY THAT THIS WELL WAS
CONSTRUCtt'ON,$TANDARDS, AND TIIAT'AC
.. ,R OFFICE IUSE ONLY
Quad No: (!,
NSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
x i(I1F THIS RECORD HAS BEEN PR9VIDEOT THE WELL OWNER
SIONATURE {Tk PERSON CONSThUCTING TIIE WELL
Submit original Io;Dlvlslon of Water Ouallly, Groundwater Section within 30 days
DATE
Sedal No.
GW-I nEV. 12/99

;\rih Cnroflnn - Onparlmonl of Environment and Nalurnl Resources • Division of Wnler Duality - Oroundwnlor Section
530 Mall Service Center- Relelph, N.C. 27699-1636-Phone (919) 733•3221
VELL CONSTRUCTION RECORD WELLCONTRACTOR• 1Jd bhr uf, P i+S
WELL CONTRACTOR CERTIFICATION fr: ,—; Q
STATE WELL CONSTRUCTION PERMITN:
268926
WELL USE (Check Applicable Boa): Residential l v1 Municipal El Industrial Il Agricultural n
Recovery ❑ Hoal Pump Water Infection ❑ Olher n 11 Other, List Use:
Monitoring ❑
WELL LOCATIO��'j\ (Show sketch of Ilse I cation below) ((�),,,,
Nearest Town: nJ County ALA. ei> s-2--k
ZZu� e h(jVt7
(nand Name end Number "- , oi Illy, or^Su!vision ^and Lot No.) DRILLING LOG
OWNER /Q�2.<..�-.� rrom To
Address
,, S reo r IToulo
n��� ^� Wa - r
Clly or or Town Slate Zip Cod - /D0, — 3 c
A.
DATE DRILLED 0- Da
TOTAL DEPTH '
CUTTINGS COLLECTED YES I 1 NOI Vf
DOES WELL REPLACE EXISTING WELL? YES ( 1 NOrVi
STATIC WATER LEVEL Below Top of Casing: 1 j n FT,
(Use'.' II Above Top of Gallop)
TOP OF CASING IS 1 FT. Above Land Surface'
p of cnsing terminated eVor below lend surface requires a variance In eccor-
te with 15A NCAC 2C . 118 s
YIELD (gpm): 3Q7 METHOD OF TEST I q
WATER ZONES (depth):
2;FILORINATION: Type
CASING:
\-\ N Amount ®igs1
0
W
m
If nddillonal space Is needed use hack of form ry
Wall Thickness LOCATION SKETCH
Depth r _ plain lal ,pi)leiol;vG1. .1a SDI (Show direction end distance from nl least Iwo Slate
From To 1— Ft 10 +� d dj Roads, or other reap reference points)
J
0
CO
-TI
rn
From To FI. C.,
From To Fl. �b , n /• 07���Lo
GROUT: (V�_l/„�`Gt.(_ T`-��
KIr�� Depth n ' `M�aternIal (T,Mo11,wJ r
From V To .a.O_FI &nL&lr .'x>(1� !� /
Frorn To Ft
SCREEN:
Depth Diameter Slot Size Materiel
Front To FI In In
Front To It In In
From To FI In. In
SAND/GRAVEL PACK:
Depth Size Material
Frorn To FI
From To FI
REMARKS:
0
N
rat
n_
0
c
1 DO HEREDY I R79FY THAT THIS WELL WAS C
CONSTRUCT' N STANDARDS, AND TI IAT AGOI
rJFR OFFICE U E ONLY
)vad No: L.
Soda! No.
ITRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
j-3D- b7
_ TUGE Or PERSON CONSTRUCTING VIE WELL DATE
Submll odphtaI la Clvlslon al Wnler Duality. Groundwater Section Within 30 days
GW-I nEV. 12199

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mali Service Center - Raleigh, N.C. 27699-1636-Phone [phone] �/{• I
WELL CONSTRUCTION RECORD WELL CONTRACTOR. BR, AN kEl A 145 i NES
WELL CONTRACTOR CERTIFICATION II: /I/D
STATE WELL CONSTRUCTION PERMIT®:
1. WELL USE (Check Applicable Boa): Residential LYJ Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heal Pump Water Infection ❑ Other El if Other, List Use:
2. WELL LOCATION: (Show sketch of the location below)
earest Town: -u'- County
be
(Road Na and Numbers, Community. or Subdivision a d Lot No.) DRILLING LOG
3. OWNER Cvayne
Address D
F 130
Seel ar Pou(e No.)
rT-n ()C.
City or Town Stale
4. DATE DRILLED J —3/-622
5. TOTAL DEPTHS
6. CUTTINGS COLLECTED YES[ 1 NOM"'
7. DOES WELL REPLACE EXISTING WELL? YES I 1 NOFf
8. STATIC WATER LEVEL Below Top of Casing: 55 FT.
From To
fiery
Zip Code
(Use '+' If Above Top of Casing)
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 with 15A NCAC 2C .01113
10. YIELD (gpm): 5 METHOD OF TEST R9
11. WATER ZONES (depth):
DEPTH
Formation Description
/'iedirr%
0
LJ
IN)
—n
IV
12 CHLORINATION: Type 11 TH Amount 1221DIIIS 11 additional space Is needed use back of form
1 ASING: -
Wall Thickness LOCATION SKETCH
Depth Diameter or WeighVFt. Material (Show direction and distance from at least two State
From 0 To 38 Ft bay a lb.lsiJt YC S Roads, or other map reference points)
From To Ft
From To Ft.
14. GROUT:
From
Depth Material Method
To 20 Ft c yL'YP.r' p/'XF/'PG)
From To Ft
15. SCREEN:
Depth Diameter Slot Size Malarial
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:
Cathym-e
Le) /�.C.
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 lag ROVIDED TO THE WELL OWNER.
FOR OFFICE U.E ONLY
flied No: ! -...
..edal No.
L
Submit odglnal
64 . "C
• e EURE OF PERSON CONSTRUCTING TFIE WELL DATE
a vision of Water Ouallly, Groundwater Section within 30 days
GW-1 REV. 12/99
I
268925
0
0

�//,' 268924
!I
WELL CONSTRUCTION RECORD WELL CONTRACTOR' Q' RmAN l • , L.
North Carolina - Deiparimonl of Environment and Natural Resources - Division of Water (Dually - Groundwater Section
1636 Mall Service Center - Raleigh, N.C. 27699-1638-Phone [phone]
WELL CONTRACTOR CERTIFICATION It: cfD�
STATE WELL CONSTRUCTION PERMITN:
1. WELL USE (Check Applicable Pox): Residenllal ✓- Municipal n Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Beat Pump Water Injection ❑ Other n If Other, List Use:
2. WELL LOCATI9A&: ((Show, sketch of the location below)
Nearest Town: �y i ate` ec Count''
/935 . 14 AtdAiPd..-D/7Ora
((load N e/'pak� Numbers. Community, or Subdlvlslon and Lot No.) DRILLING LOG DEPTH
3, OWNER L. sI si \ Frain To Formation Description
1(1^, or I o a. 6 7/6 T
Clly or Town Stale Zip Code / . Z i) Ie Q� et,
t, DATE DRILLED �a...
TOTAL DEPTH
CUTTINGS COLLECTED YES NO[/f
DOES WELL REPLACE EXISTING WELL? YES DO NO[(
STATIC WATER LEVEL Below Top of Casing: FT.
/ (Use'.' 11 Above Top of Casing)
i. TOP OF CASING IS ( FT Above Land Surface'
Top of ceiling terminated al/or below lend surface requires a verlence In accor-
'snce with 15A NCAC 2 OI -" — 0. YIELD (gpm): 1 D METHOD OF TEST . OT o
1. WATER ZONES (depth)' T
2 LORINATION: Type IT ! H Amount la , II S If additional space Is needed use back of form
3. CASING:
a
v
N
Wall Thickness LOCATION SKETCH
Depth /� Diameter or Weight/FI. Material (Show direction and distance from at least Iwo State
From 0 To '7 7 Ft. G • a 5 .714 r1.S f ;1VC•SQic Roads, or other map reference points)
From To FI n '
From To FI. � /�
4. GROUT: S✓jO `/ D00%.tittt "'
Depth Material Mothod
Frorn Q To DZo FI. 0aNCLE-1r< / '_
From To Ft //Jay(T/�-1?/y' n / r
5. SCREEN:
Depth Diameter Slot Size Material
From To FI In - In
From To FI In In
From To Ft In In
6. SAND/GRAVEL PACK:
Depth Size Material
From To Ft
From To Ft
7, REMARKS:
I DO HEREBY C TIFY THATTHISWELL-W
CONSTRUCTION STANDARDS, AND THAT A COPY)O
li jl,._._
r! OFFICE US
Ouad No:
CTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
S RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
"get-Ce /-3/-d3
SIQE:Lfi( RE OF PERSON CONSTRUCTING TIIE WELL DAIS
Submit odainallfreviion of Water Duality, Groundwater Section Wllitln 30 days
GWI nEV. 12/99
r~ ..

North Carolina - Department of Environment and Nature) Resources - Division of Water Quality - Groundwater Section
1636 Mall Service Censer • Raleigh, N.C. 27699-1638-Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR.
WELL CONTRACTOR CERTIFICATION 0:
268855
e RmAN L . 2A-LL.
/9a 7
STATE WELL CONSTRUCTION PERMITN:
I. WELL USE (Check Applicable Pox): Resldenllal ✓ - Municipal ❑ Industrial El Agricultural ❑ Monitoring ❑
Recovery ❑ Heal Pump Water Injection ❑ Other n If Other, List Use:
WELL LOCATION (Show sk-etch of the location below) //� (J -
Ne est Town County Z..T-LN\--O IJYYv. ✓`
jnidille
•
(Road Name a ; Number, Communl or Subdivlsi an. of No.) DRILLING LOG DEPTH
3, OWNER • a From To Formation Description
Address
Or
Clly or Town Stale
DATE DRILLED I- bM•
. TOTAL DEPTH 0 O 1
CUTTINGS COLLECTED YES I NOF -,
DOES WELL REPLACE EXISTING WELL? YES I I NOW( p '
. STATIC WATER LEVEL Below Top of Casing: jo n FT- e `'
(Use -r• If Above Top of Casing)
. TOP OF CASING IS ! FT. Above Land Surface' A
top of casing terminated ,Uor below land surface requlree a variance In actor- -_
snce with 15A NCAC 2C .011a N
0. YIELD (gpm): I METHOD OF TEST _-
1. WATER ZONES (depth):
IV
2. ORINATION: Type H TH Amount ..thapilLS If additional space Is needed use back of form
3. CASING:
dK73
✓4S 1)T•R
(o5 - (gob $ 2Qck_
Zip Code
LOCATION SKETCH
Wall Thickness
Depth /,, Diameter or Welohl/Ft. ;1M�aalle�dall (Show direction and distance from al least Iwo State c. �'
From D To —ice5 Ft le • a 5 al c •JCS �-,W. Roads, or other map reference points)
rn
From To Ft. C°
From To Ft. / ,� v / ed La
h. GROUT: (jL —0
Depth Material Motlwd ---
From 0 To vi-0 Ft C1aNCP.Ef E -PD.L.BtcL_ �/l , A��� "'
From To Ft (:�-fJ o
N
5, SCREEN:
Depth Diameter Slot Size Materiel
From To Ft In In
From To Ft In In
From To Ft In In
6. SAND/GRAVEL PACK:
Depth Size Material
From To Ft
From To Ft
7. REMARKS:
I DO HERED"tE TIFY T);IAT TNISIWEV,'U WAS • STRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUC-ION TANDkN0 , ANb THAT X,iCO F THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
F"rt OFFICE
Guad No:
Serial No.
SSE ONLY
V LI.
Submit ignall
lATURE OF PERSON CONSTRUCTING THE WELL DATE
Division of Water Duality, Groundwater Section Within 30 days
GW-I REV. 12)99
l ,
ASF1EViLLE FL
I_ 'oFJ
(ICE

North Caroline - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mali Service Center • Ralelph, N.C. 27699-1636-Phone [phone]
268853
WELL CONSTRUCTION RECORD WELL CONTRACTOR• /I RMAN l . ��,
^7 2.4�y
WELL CONTRACTOR CERTIFICATION N: .FDA
STATE WELL CONSTRUCTION PERMIT#:
2.
1. WELL USE (Check Applicable Box): Residential V Municipal El Industrial n Agricultural (111 Monitoring ❑
Recovery ❑ Heal Pump Water Injection ❑ Other 0 11 Other, List Use:
WELL LOCATION • (Show sketch of the location below)
ssl Town: I Count'iltyklik
gc�/»24ds ,� k �a17(7
Moe/Name Name and 1 Nu�m�bjers, Co unit oriSSuRdivisionn and Lot No.) DRILLING LOG DEPTH
3. OWNER `ji'V.1_.Co C��.•1.1+... Fmm To Formation Description
Address 0'0 /3orc a,7nitT— uNoN7"_oa
1A) O�yL% A4S9
Cn�rlvt�Stale 1 Zlp Code ve_
4( k
a. DATE DRILLED CD�.
5. TOTAL DEPTH
9. CUTTINGS COLLECTED YES NO1 1
DOES WELL REPLACE EXISTING WELL? YES n NO
3. STATIC WATER LEVEL Below Top of Casing: k FT.
/ (Use -.' it Above Top of Casinp)
9. TOP OF CASING IS ! FT Above Land Surface'
'Top or casing terminated aUor below lend surface requires a variance In accor-
dance with 15A NCAC 2C,011a
10. YIELD (gpm): ) 0 0 METHOD OF TEST
11. WATER ZONES (depth):
O
t>
-o
12. LORINATION: Type N 7N Amount IDI n� r Ih If additional space Is needed use back of form
13. CASING:
LOCATION SKETCH
- DepthDiameter or WeIghVFt. Material (Show direction and distance from at least Iwo State
From O To --1 Ft .1e . a 5 el '^ .1,, Roads, or other map reference points)
From To Ft.
From To FI.
IA. GROUT:
Depth Material Mothod ,
From D To PZD FI CIOIY CPk•FE _j�U�Q.E-!`{_
From To FI
15.SCREEN:
Ph)
Walt Thickness
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:
1,270 &Ads ZAadtm�'
I DO HEREBY
CONSTRUCTIDI�a$
1- _ .r OFFICE Li�� JJ NLY
Ouad No: I
Serial No
ANITALaDS, 416TIbAT AtO
Submit odona t
RUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER,
TUNE OF PERSON CONSTITUCTINO TIIE WELL DATE
vision of Water Duality, Groundwater Section within 30 days
GW-I nEv. 12/99
n
IUN
ASHEWL E RL (!`FICE

North Coraline - Dopterimont of Envlronmonl and Natural Flesources - Division of Wnler °unary • Oroundwnler Saurian
1636 Mall Service Corder - Roloigh, N.C. 27699-1636-Phone (919) 733•3221
268850
WELL CONSTRUCTION RECORD WELLCONTRACTOR•
30 bh/ lx.j. f o��S
WELL CONTRACTOR CERTIFICATION #: ;Tja 2
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE (check Applicable Box): Residential Municipal ❑ Industrial El Agricultural ❑ Monitoring El
Rocovery ❑ float Pump Water Injection ❑ Other [] If Othor, list Use:
2. WELL LOCATION' Show_ ketch of the locallon below)
areal Town:
(Bond Name d N�u*mb..rs, Corrvnu`nlly, or'Suub_dlvlslan A'ndpLool (Jo.) DRILLING LOG DEPTH
3. OWNER ,` Q u�'v---r�t_M.¢e l�-•C.�.� From To Formnllon oascrlplion
Address I '1 D 2
(S r o m u No. 0 - �C
�✓v� L� a � ct 7 9,1 _3 � - 'y 0 K_ Fri C.4C k
City or Town Starr)lp Code
4. DATE DRILLED i`ir7—D',
5. TOTAL DEPTH 7 0_5"
6. CUTTINGS COLLECTED YES in NOI dj
7. DOES WELL REPLACE EXISTING WELL? YES NO NO VT
0
6. STATIC WATER LEVEL Relow Top of Casing: FT.
(Use '4-'11 Abovo Top of Cnsing)
9. TOP OF CASING IS I FT Abovo Land Surlace'
•Top of casing terminated sUor below land surface requires a variance In accor-
dance with 15A NCAC 2C Q11
10. YIELD (gpm): 1METHOD OF TEST t
11. WATER ZONES (doplh): '1
1. ,FILORINATION: Typo T H Amount -pLLLI
13. CASING:
If additional space Is needed use hack of form
Wall Thickness LOCATION SKETCH
Depth �� plain I J yle(a vgMa . terial (Show direction and dlsinnce born nt least two Stale
Horn _ To 0 Ft. (y fJ (Q Ponds, or oilier map roiorence points)
From To FI.
From To FI
14. GROUT:
pa
Depth t Malaria! Motlwd
From 0 To ail__ FI arEf-(Ls_
Frorn To FI
15. SCREEN:
Depth Diameter Slol Size Material
From To Ft In In.
From To FI In In
From To FI In. In
16. SAND/GRAVEL PACK:
Depth Size Material
From To FI
From To FI
17, REMARKS:
0
I DO HEREBY CEP
CONSTRUCTION 3 �r }34(4.NO-t 1ST krf 0
r--
. , R OFFICE USE CktY'
Quad No: L Lf
Serial No,
TED IN ACCORDANCE WITH 15A NCAC 2C, WELL
ECORD HAS BEEN PROVIDED TO THE WELL OWNER.
,r 1 7-o0t
OF PERSON CONSTRUCTING TIIE WELL DATE
of Welter Quality, Groundwater Section within 30 days
GW.I REV. I2/99

North Caroline - Department of Environment and Nnlurnl Flesources - Division of Water Ouell y - Oroundwnler Section 2 6 8 8 4 6
1636 Melt Service Center • Raleigh, N.C. 27699-1636-Phone (919) 733•3221 nn
WELL CONSTRUCTION RECORD WELLCONTRACTOU• Bo Mira US. t'C'i+S
WELL CONTRACTOR CERTIFICATION A: 10 c? 2
STATE WELL CONSTRUCTION PERMITN:
1, WELL USE (Check Applicable Boa): flesidentialV Municipal I1 Industrial I —I Agricultural ❑ Monitoring ❑
Recovery r1 Heat Pump Water Injection (—j Other ❑ If Other, List Use:
2. WELL LOCATIO((S�hoxsrkelch of the location below) or,
sorest Town: County.
(noad Nam nd umbers. Copy ally, or Subfllvlslon and I o.) /� (� DRILLING LOG
3. OWNER •U `� l OW,Yd-Ul From To
1 �/
Address
City or Town Stall Zlp Code
d. DATE DRILLED 1 - 11 Da.
5. TOTAL DEPTH a r) 5
6. CUTTINGS COLLECTED YES n NO vf
7. DOES WELL REPLACE EXISTING WELL? YES n NO[ 11
8. STATIC WATER LEVEL Below Top of Casing: ) p O FT.
(Use •a' II Above Top of Casing)
9. TOP OF CASING IS I FT. Above Land Surface'
'Top or casing ler mInated at/or below land surface requires a variance In accor-
dance wllh 15A NCAC 2C.9 18
10. YIELD (gpm): . hi-, METHOD OF TEST Q
11. WATER ZONES (depth)•
DEPTH
Formellon Unscrlpllon
o - to aRi
(p.c \ - ae
c)
r
1. iHLORINATION: Typo �' L� H--Amount I If additional space Is needed use hack of form
13. CASING:
Wall Thickness LOCATION SKETCH
Depth'^ �l.m1etat jrito elayg. Ma,-, )eclat _ (Show direction and distance from nt least two Stale
From�To U[ Ft. (p rj d ')' K Rends, or other wrap reference points)
From To Ft
From To Ft es , c
14. GROUT: co
Depth Material Method r £1� '"T
,1 , t j1bU Kid. - C
From � To a_�.FI .�hl�f�— 7% \D
From To Ft.
15. SCREEN:
Depth Diameter Slot SIzl Matorlel
From To F1 In In
From To PI In In
From To Ft In In
16. SAND/GRAVEL PACK:
Depth Size Malarial
From To FI
From To Ft
17. REMARKS:
I DO HEREDY C
GONSTRUCTIO
. ,1R OFFICE U
Died No:
Serial No.
YjtHA'f ;fl II5 WELL !I-ASit
oAnb%, Arlo fit !ALE A OP
}' I
aura
ASHES Lr
Of'
oD
UCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
HIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
URE OF PARSON CONSTRUCTING TIIE WELL DATE
vision of Water Duality, Groundwater Section within 30 days
Ow.l nEV. 12/99

North Cnrollnn - Department of Environment and Natural Flesourcos - Division of Water Quality - Groundwater Suction
1638 Malt Service Center - Ralefph, N.C. 27699-1636-Phono [phone] 2 6 8 0 O A J
NTR
WELL CONSTRUCTION RECORD WELLCOACTOR• BO �h�4 1, w .
(�4
WELL CONTRACTOR CERTIFICATION N: �}Q�2
STATE WELL CONSTRUCTION PERMITN:
1. WELL USE (Check Applicable Box): Residential V Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Rocovory ❑ Heel Pump Water Infection ❑ Other Ei If Other, Llst Use:
2. WELL LOCATIQNs (Show sketch of Ilia location below) `/�j1 •- are -
nrost l pwn: �5 :-iE- b.t' County A J_Adv C /JY" X
(nond
3. OWNER
Address
�'`1/44eV/nt
City or Town Sla)b
et. DATE DRILLED d a
5. TOTAL DEPTH D
6. CUTTINGS COLLECTED YES) I NOIvf
7. DOES WELL REPLACE EXISTING WELL? YES I I NOM
6. STATIC WATER LEVEL Below Top of Casing:35n FT.
(Use'.' If Abovo Top ol Casing)
9. TOP OF CASING IS I FT. Abovo Land Surface'
•Top or casing terminated .Vor below land surface requires a variance In accor-
dance with 15A NCAC 2Ci.9,410
10. YIELD (gpm): METHOD OF TEST r q
11. WATER ZONES (dopth)• ) —
ag7Qc/
or Subdivision end Lot t)b.)
Lc - SDI
DEPTH
Fom+nlion ()ascription
(93
Zip` Code
1- SHLORINATION: Typo IA T H
13. CASING:
,
Amount
If additional space Is needed use hack of Iorrn
WallWThicIk1ness LOCATION SKETCI
Depth/ ) plat lot i'yVelal V(J. Ma„yzeia^ r� (Show direction and distance from lit least two Slate
FrorTt�To Ft (p CJ (P dj u1� Roods, or other map reference points)
From To Ft.
From To Ft
14. GROUT:
Depth Maloriol Mol_ Iwd ,
From � To �Q_FI Q�nREfF jj'1`("(-?"f�{`
From To Ft
15. SCREEN:
Depth Diameter Slot Size Matorini
From To FI In In
From To Ft In In
From To Ft In In
16. SAND/GRAVEL PACK:
Depth Size Malarial
From ' To FI
From To Ft
17. REMARKS:
I DO HEREDY CUD Y i7 TI4 WiL
CONSTRUCTIOf' FtthkResrANO444
UR OFFICE US!: OtIILY rrJJI
I Quad No: - iI tv, R
L
Serial No
CC0" En l 'JN
ASHEVILLE RE&OcJAL OFFICE
Submit odpl
Ot'1'Ta i1UCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
SZ1Y"TUBE of PERSON CONSTTfUCTINO TIIE WELL
al to 0 vision ol Water Ouallly. Groundwater Section within 30 days
1
DATE
GWI nEv. 12/99

3. OWNER
Address
North Carolina - Dnpanmont of Environment and Natural Resources - Division of Water Dually - Groundwater Section
1636 Mall Service Center • Raleigh, N.C. 27699-1636•Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR. N4)Rm4N L• 2LY.
WELL CONTRACTOR CERTIFICATION N: .O Dii 7
STATE WELL CONSTRUCTION PERMIT11:
WELL USE (Check Appnceble Pox): Residential ✓-- Municipal El Industrial n Agricultural ❑ Monitoring ❑
Recovery ❑ Heal Pump Water Injection ❑ Other n if Other, List Use:
2. WELL LOCATIOf (show sket Itof the location below)
Nearest Town: ` ' nty'
( oad Na /Ipd Nurt�eie, {Jellyµ or Subdivision and Lot No.) DRILLING LOG DEPTH
ZaA- p1k-as�j From To Formation Description
cai$a3
eo ar 0
City or Town Stale
4. DATE DRILLED .�; 3 D—O a.,
5. TOTAL DEPTH 4?l
3. CUTTINGS COLLECTED YES [ 1 NOW1
7. DOES WELL REPLACE EXISTING WELL? YES n NOW(
3. STATIC WATER LEVEL Below Top of Casing: /��''— FT.
(Use -e• I1 Above Top of Casing)
3. TOP OF CASING IS FT. Above Land Surface'
'Top of casing terminated ,Uor below land surface requires a verisnce In accor-
lsnce with 15A NCAC 2C .011e
10. YIELD (gpm): .1 METHOD OF TEST r
11. WATER ZONES (depth):
715 - ag 5 BF- io t
•
12. L0RINATION: Type __kith_ Amount
3. CASING:
Zip Code
W
—r•
C-r;
If additional space Is needed use back of form
Wall Thickness
SKETCH
D Depth I 1Dla � pigMatedal
t tidal (Show direction and distance from al least Iwo State
From To Ft 5 �6 l)5 Roads, or other map reference points)
From To FI
From To FI.
14. GROUT:
Depth Material Method
From 0 To aC1
� FI OlYC..2E-tE _pDu.B.e.d._
From To Ft
15 SCREEN:
Depth Diameter Slot Sizo Material
Frorn To Ft In In
From To FI In In
From To Ft In In
I6. SAND/GRAVEL PACK:
Depth
To
From
From
17. REMARKS:
To
Size
Ft
FI
Material
2,tifiefelkei
ecoho1/47.,
O
CONSTRUCT IdNTDDSN�T(WNT kFC
I it OFFICE
Quad No:
Serial No
L
TRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
F THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
NATURE OF PERSON CONSTRUCTING TIIE WELL DALE
Division of Water Duality, Groundwater Section within 30 days
Gw l REV. 12199
a
268844
•
Ghr.^rin
ASHEVILLE fs_uii
FiL O'FICE

North Cnro!Inn Onparimonl of Environmonl and Nolurnl Flesourcos - Division of Wnler Quality • Oroundwnlor Suction
1636 Mall Service Center • Ralolgh, N.C. 27699.1638-Phone (919) 733•322I
WELL CONSTRUCTION RECORD WELL CONTRACTOR•
30 L J1
WELL CONTRACTOR CERTIFICATION A:
270146
of. P0k
STATE WELL CONSTRUCTION PEFlMITN:
1. WELL USE (Check Applicable Boa): Residential I vl Municipal El Industrial [1 Agrlcullural (1
Recovery r1 Float Pump Water Infection n Otller (] If Olhor, List Use:
2. WELL LOCATION: (Slipw sk\et/ch 91 po location below) (,
Nearest Town' .k i .CVt L `-e County �iA.V��CTYYL kl�
545 �t.Le zS 2d ac5kt...a-62_,)
(Hoed Name sand Nu ors, Convnunlly, o SubpIvl.slon and Lot No.)
3. OWNER 1-1-.0I. 9-11—$LLI•L-e
Address 5la5 wed
Cllyor Town '//-- Slale
4. DATE DRILLED l!c - 3.0
5. TOTAL DEPTH
6. CUTTINGS COLLECTED YES J NO( Vj
7, DOES WELL REPLACE EXISTING WELL? YES a NO of
6. 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 sUor below lend surface requbes a variance In accor-
dance with 15A NCAC 2C .115 s
10. YIELD (gpm): 0 METHOD OF TEST tts
11. WATER ZONES (dopih): ) v
1" ':HLORINATION: Type .11I H Amounl 35 + i (Is Ir addillonal space Is needed use back of lorm
1. .ASING:
DRILLING LOG
From To
1D
05
Monitoring
DEPTH
Fonpnllon Dns crlpllon
n
Zip Code
Wall Thickn[elss
Deplllao .FT.. plain l f riri elan Mf�Vf aI
From �T0 (o �C to d
From To Ft
From To Ft
14. GROUT:
From
Frorn
15. SCREEN
Depth MRIorlai TO r
Mold
0 �.�7 �n2EfF
To FI
Depth Diameter Slot Size Material
From To FI In In
From To FI In In
From To FI in. In
16. SAND/GRAVEL PACK:
Depth Size Material
From To FI
From To Fl
17. REMARI(S:
C.71 IL
J E
LOCATION SKETCH
(Show direction and distance from al least Iwo Stale
Bonds, or other map reference points)
zaRraol
6s i1k, 417(
0
CO
n
N
I DO FIEREDY CERTIFY THAT-T-HIS'W€'tt _1
GONSTDUCTIO S1ANDABDS, AND ,THAT AGO
R OFFICE USEONLY
,ad No:
Serial No.
SID
Submit odginal'1iDlvision al Water Quality, Groundwater Section within 30 days
UCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
THIS RECORD HAS BEEN PROVIDED TO THE WELT. OWNER.
F PERSON CONSTRUCTING TI IE WELL
3 _�
GATE
GW.i nEV. 12199

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. /►eRmAN Z. Z(.
WELL CONTRACTOR CERTIFICATION #: eA '7
STATE WELL CONSTRUCTION PERMIT#:
270145
1. WELL USE (Check Applicable Boa): Residential L7 Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heal Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATION:1 Show sketch +1 the location below) Y7��Q�'77 /
Ne. stTown: t*F - -' • County: (�Q
(Road Name a
3. OWNER
Add: ss
ty or Town State
4. DATE DRILLED
5. TOTAL DEPTH (�
6. CUTTINGS COLLECTED YES in NO
7. DOES WELL REPLACE EXISTING WELL? YES NOI Vi
8. STATIC WATER LEVEL Below Top of Casing: FT.
(Use •i If Above Top of Casing)
9. TOP OF CASING IS / FT. Above Land Surface'
*Top of casing terminated eVor below land surface requires a variance In accor-
dance with 15A NCAC 2C.0 9
10. YIELD (gpm)• 0 METHOD OF TEST TN r 5
11. WATER ZONES (depth):
CHLORINATION: Type 4 7H AmountSs r;I!s
. CASING:
DEPTH
Formation Descdptlon
0
0
If additional space Is needed use back of form
Wall Thickness LOCATION SKETCH
e, Depth rl L Diameter or Weight/Ft. MaIR'/ tedal (Show direction and distance from at least Iwo Stale
From To `� 7 Ft + Pl Roads, or other map reference points)
From To FI.
From To FI
14. GROUT:
Depth Material Molhod ,
From b To DZ• 0 FI irI7JV Ce,Ef t 7jjpp pTr��-
From To Ft
15. SCREEN:
Depth Diameter Slot Size Material
Frorn To Ft In In
From To Ft. In In
From To Ft In In
16. SAND/GRAVEL PACK:
Depth Size Material
From To FI
From To Ft
17. REMARKS:
0
0
rn
co
Iv
•
CJT
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT AA_); OPY-QF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
h,
f FOR OFFICE {SSE ONLY
Ouad No:
Serial No.
�SI�3I�ATORE OF PERSON CONSTRUCTING THE WELL DATE
Submit odylnM;o TAlvlslon of Water Quality. Groundwater Section within 30 days
GW-I REV. 12/99

3. OWNER Ir,5t,- Y /V\ VI.Ont`-'
Address 33,,\ 05o�={es ran Ir-_,•
Leiese_6•62Y(S /L•
(Sheel o; Hoyi lg.,[io;) 24 7 (el
ll
City or Town Slate Zip Code
4. DATE DRILLED _5- a.3 o 5-
5. TOTAL DEPTH to a O
6. CUTTINGS COLLECTED YES n NOIt/
7. DOES WELL REPLACE EXISTING WELL? YES NOR'"
8. STATIC WATER LEVEL Below Top of Casing: FT.
(Use •+• II Above Top of Casing)
9. TOP OF CASING IS FT Above Land Surface'
'Top of casing terminated at/or below land surface requires a variance In accor-
dance with 15A NCAC 2C.51p119
10. YIELD (gpm): CO METHOD OF TEST �) q
11. WATER ZONES (depth):
North Carolina • Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section 270142
1636 Mall Service Center - Raleigh, N.C. 27699-1636-Phone [phone] WELL CONSTRUCTION RECORD WELL CONTRACTOR. RIAW kE/tA LA: ; NES
/90
WELL CONTRACTOR CERTIFICATION M:
STATE WELL CONSTRUCTION PERMITM:
1. WELL USE (Check Applicable Box): Residential LJ Municipal n Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ri Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATIO : (Show sketch of the location below)
Nearest Town:Q. 1Q-5 y` County' L( h
c&nthe"
`pam ?turn II(( 0 _ cell"
(Road Name an umbers. Community, or Subdivision and Lot No.) DRILLING LOG DEPTH
From To Formation Description
Sg Tint
58 - bag o Bec4ne S
0
0
N
0
-0
y ��y
12. CHLORINATION: Type _ii1T�yr y Amount _11 D e:u8 If additional space Is needed use back of form Vi
r
1, 'ASING: 0 c•
Wall Thickness LOCATION SKETCH
Depth Diameter or Weight/FL. Matedal (Show direction and distance from at least two Stale
From 0 To �.6 Ft. LIs W a)Lt jay RC'swi Roads, or other map reference points)
From To Ft
From To Ft \ ln� _ 12 n - 4c•
14. GROUT: C t ' J
Depth Material Molhod 0 1/� C o
From Q To QQ Ft C b JIL rate
C1� / ` CO -'_
From To Ft `�
CA r,
15. SCREEN: _-
N.)
— c,--i
Depth Diameter Slot Size Material
From To Ft In In
From To Ft In In
From To FI In In
16. SAND/GRAVEL PACK: . n
Depth Size Material r
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 PROVIDED TO THE WELL OWNER.
r
FOR OFFICEjU$E.ONLY
Ouad No:
al No.
V'
z% .S-a3 -oat,
SP(1NATURE OF PERSON CONSTRUCTING THE WELL
Submit agile] Division of Water Quality, Groundwater Section within 30 days
DATE
GW.1 REV. 12199

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mall Service Center- Raleigh, N.C. 27699-1636-Phone [phone] . �/j_' / /
WELL CONSTRUCTION RECORD WELL CONTRACTOR. A RmAN C • 14((.
WELL CONTRACTOR CERTIFICATION M: c t'.-
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE (Check Applicable Box): Residential Er Municipal ❑ industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Infection ❑ Other E] II Other, List Use:
2. WELL LOCATION:,(Shovj sketch of the location below) /�J-�ZOm Z�
Nearest Town• County: ,�'% OJ
(Road Name a d Nu bets. Com s dlv slap and Lot No.)
3. OWNER n/
a �Q � �f1s
Address 2/G% /� p9
(Street drSl' (e No)
City or Town
Slate
a
4. DATE DRILLED r,?>, �I-0
5. TOTAL DEPTH tr`
6. CUTTINGS COLLECTED YES n NOI�
7. DOES WELL REPLACE EXISTING WELL? YES
6. STATIC WATER LEVEL Below Top of Casing:
(Use'+ II Above Top of Casing)
9. TOP OF CASING IS ' FT- Above Land Surface*
Top of casing terminated et/or below land surface requires a variance In ecear-
dance with 1SA NCAC 2C .0118
10. YIELD (gpm): _i METHOD OF TEST :3
11. WATER ZONES (depth)•
CHLORINATION: Type 14 TH Amount /9/
CASING:
DRILLING LOG
From To
Zip Code
(
270139
DEPTH
Formation Description
(� - �9 im r •R 1
AezZi
O -=
W
] NOlv(
5 FT-
0
1-1
N H.
If additional space Is needed use back of lorm
11 Wall Thickness
or
hVFL Material
From DToll1 1-43 Ft Diameter alli�b5 PvtsDr2
From To Ft
From To Ft
14. GROUT:
Depth Material
From 0 To 20 FI f m/YCee1-t
From To FI
15. SCREEN:
Depth
Frorn - To
From To
From To
16. SAND/GRAVEL PACK:
Depth
To
To
From
From
17. REMARKS:
Ft
Ft.
FI
Method
Diameter Slot Size Malerlal
In In
In In
In In
FI
Ft
Size Material
LOCATION SKETCH
(Show direction and distance from al least two State
Roads, or other map reference points)
'�
N
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTR TION&TANDARD , ^ •r- OF THIS RECORD HAS BEENNROVIDED TO THE WELL OWNER. /�
FOR OFFI U.' ONLY.
Quad No: `` '•
I'.
Submli b
41444i.r
IONATURE OF PERSON CONSTRUCTING THE WELL
g+ . to Diviston of Water Duality. Groundwater Section within 30 days
DATE
GW-I REV. 12/99

1
(Sr or qpa .
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] �(//�' / i7
WELL CONSTRUCTION RECORD WELLCONTRACTOR• /rep RmAN Z. .3A-((.
WELL CONTRACTOR CERTIFICATION It: es?D�
STATE WELL CONSTRUCTION PERMITN:
1. WELL USE (Check Applicable fox): Residential I1 Municipal ❑ industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ it Other, List Use:
2. WELL LOCATION: (Sho sketch of the location below)
rest Town: ` 'L�r County
l GJv
(Woad Qame /e(pd N mbets, Com Lunlly, or Subdivision and Lot No.)
3. OWNER /*/7/ ' /Cherf7t?P� From To Formation Descdptlon
Address lgi��1C74�9"9 ✓/h
/e/C X �ee� AlP
L3 77hS
DRILLING LOG DEPTH
CA
City or Town S late Zi Code
od
4. DATE DRILLED _ 07
5. TAL DEPTH
6. COUTI-INGS COLLECT D YES n NO[4
7. DOES WELL REPLACE EXISTING WELL? YES n NOl A
8. STATIC WATER LEVEL Below Top of Casing: 76 FT.
(Use •+' II Above Top oI Casing)
9. TOP OF CASING IS / FT Above Land Surface'
•Top of casing terminated eVor below land surface requires a variance In accor-
dance with 1SA NCAC 2C .0118
10. YIELD (gpm): % METHOD OF TEST . 3
11. WATER ZONES (depth):
CHLORINATION: Type %f 7r1 Amount
. CASING:
fV
0
IV
CJ1
it additional space Is needed use back of form
Watt Thickness LOCATION SKETCH
From D
Depth Diameter or Weight/Ft. Material (Show direction and distance from at least two State
To / FI L .01 5 ail •�?5 �V�'SD.c Roads. or other map reference points)
From To Ft. /// (• M 77"•
From To Ft r
14. GROUT: /e, $cp 0-C-
Depth Material Method (�
From b To AO Ft ri7NCeki'i ffiaLke_a_
From To Ft
15, SCREEN:
Depth Diameter Slol Size Material
Frorn To Ft In In
From To Ft In In
From To Ft In In
16. SAND/GRAVEL PACK:
Depth Size Material
From To Ft
From To Ft.
17. REMARKS:
0
270138
m
Cr 7:
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 BE PROVIDED TO THE WELL OWNER.
f FOROuad ONIE ONLY ri r.a-r— /� Fu - �- 4�%
FOR OFFICE US
SIliNirUFlE OF PERSON CONSTRUCTING THE WELL DATE
Submit origln1t6 Ottrislon of Water Ouallty, Groundwater Section within 30 days
Serial No.
III GW-1 FlEV. 12l99
rI

North Carolina - Department of Environment and Natural Resources - Division of Water Dually - Groundwater Section
1636 Mali Service Center - Raleigh, N.G. 27699-1636-Phone [phone]
270.1_36
WELL CONSTRUCTION RECORD
WELL CONTRACTOR• 30 b iT(T UJ . T e*) S
WELL CONTRACTOR CERTIFICATION N: J Qa Q
STATE WELL CONSTRUCTION PERMIT:
i. WELL USE (Check Applicable Box): Residential
Recovery n Heat Pump Water Injection ❑
Municipal ❑ Industrial ❑
Other D If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below)
N est Town:
d N Cale Roaa pnd Illumbers, Corrmully, of Subdlvlfion and Lot No.)
3. OWNER
Address
`/2li'`I 2s17/, Ili /vm
4, DATE DRILLED
5. TOTAL DEPTH
6. CUTTINGS COLLECTED YES 1 1 NOI
7. DOES WELL REPLACE EXISTING WELL? YES
8. STATIC WATER LEVEL Below Top of Casing: rjrj FT.
to
0
County.
-C_
Agricultural ❑ Monitoring ❑
T3unrombt'
Zip Code
(Use'+' II Above Top of Casing)
9. FT. Above Land Surface'
'Top of casing terminated nVor below lend surface requires a variance In accor-
dance with 15A NCAC 2C .2Q_116
10. YIELD (gpm): ) (� METHOD OF TEST
11. WATER ZONES (depth):
TOP OF CASING IS
DRILLING LOG
%k5Lm To
40. CHLORINATION: Type .in L_ Amount r_Z.ILLI
CASING:
Wall Thickness
Depth rie
From To 0 Ft (0 •Ae i?teIgI1VV M�V� Sal
From To Ft.
From To Ft
14. GROUT:
Depth Malerlal MoI U 12 d f
From 0 To a 0 FI rbnQE�lE irQ
From To FI
15. SCREEN:
Depth Diameter Slot Size Material
From To Ft In. In.
From To Ft In In
From To FI In In
16. SAND/GRAVEL PACK:
Depth Size Material
From To FI
From To Ft
17. REMARKS:
DEPTH
Formation Description
J
v
IV
0
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)
ndJer p t £.
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 PI3QVIDEO TO THE WELL OWNER.
FOR OFFICE SR f NLY
uad No:
Serial No.
150�
IC N(�TURE OF PERSON CONSTRUCTING TIIE WELL ' DATE
Submll odgid I I , Olvlslon al Water Dually, Groundwalor Section within 30 day s
GW-I REV. 12199

North Carolina - Department of Environment and Natural Resource, - Division of Waler Quality - Groundwater Section
1638 Mall Service Center - Raleigh, N.C. 27699-1636-Phone [phone]
270135
WELL CONSTRUCTION RECORD WELL CONTRACTOR'
30bh, L. Poi#
WELL CONTRACTOR CERTIFICATION 0: o; Oa 2
STATE WELL CONSTRUCTION PERMIT":
1. WELL USE (Check Applicable Box): Residential l v) Municipal ❑ Industrial ❑
Recovery ❑ Heal Pump Water Infection ❑ Other ❑ If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below) �n
\Nearest Town:J } YI (�� County
IP).Ac.t{— Lc I&L �--OWL)s.w3
(Road name and Numbers. Community. or Suubbdlvvlslll°n and Lol No.) DRILLING LOG
3. A WNER `ifr7y17Y1 Di'i " f la }1" 7 ) / C.'re57-
'� 4
Addres
s
,1 / Sreolo H u o.) ��
1�c �.
City or Town lalo Zip Code
4. DATE DRILLED 6-14-60�S
5. TOTAL DEPTH ;,,o �7
6. CUTTINGS COLLECTED YESf NO[7f
7. DOES WELL REPLACE EXISTING WELL? YES O NOI 14
8. STATIC WATER LEVEL Below Top of Casing: FT.
(Use '.' If 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 with 15A NCAC 2C. 119
10. YIELD (gpm)• METHOD OF TEST
11. WATER ZONES (depth):
Agricultural ❑ Monitoring ❑
DEPTH
From To Fonneilon Description
� oT79 - a0
"'i�7 Eci�AC/G
'9. CHLORINATION: Type __�L�Amount
CASING:
Depth
FromTo Ft
From To FI
From To FI
14. GROUT:
Wall Thickness
P
101�11 J "InnMai � SD�
Depth Material Molhod ,
From n To AO____ Ft (�1FIR EfF rj-�'tsr'Q'�tC'
From To FI
15. SCREEN:
From
From
From To
16. SAND/GRAVEL PACK:
Depth
From To
From To
17. REMARKS:
Depth
To
To
Diameter Slot Size Material
FI In. In.
FI In In
F1. In In
FI
Ft
Size Malarial
O
W
IN)
O
Iv
II additional space Is needed use back of form
LOCATION SKETCH
(Show direction and distance from et leas) Iwo State
Roads, or other map reference points)
/)r1h* Vie
rot rvt e
ry
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION- IIAMN ARCSU "ANTITAT-AZOF THIS RECORD/H /ASS BEEN PR.OVIDED TO THE WELL OWNER,
I FOR OFFICE USE ON-L-i -' i /"A'J' v" . F` /i/ -0,7
uad No: 10 TURJ E 0 PERSON CONSTRUCTING THE WELL DATE
Submit original() b vision of W,ler Ouallty, oroundwaler Section within 30 days
Sedal No.
GW1 REV. 12/99

•
2701341
North Carolina - Department al 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. AID RMAN L L. 2A-LS..
WELL CONTRACTOR CERTIFICATION 0: cPDa. 7
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE (Check Applicable Box): Residential a Municipal El Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATION:
Nearest Town:
ow sketch
the location below) 8aAne kn /
..oad ame and Nub;
3. OWNE, G
Ad%ess
`ers. Communitydivision and Lot o.)
S3
Ily or Town / Slate Zip Code
4. DATE DRILLED .5 / dd 0 3•
5. TOTAL DEPTH �S NOV CUTTINGS COLLECTED YES n VJ ,
7. DOES WELL REPLACE EXISTING WELL? YES ri NOI A :i
8. STATIC WATER LEVEL Below Top of Casing: ir'S FT. r"
(Use'+ II Above Top ol Casing) O .t ::
9. TOP OF CASING IS 1 FT Above Land Surface' -D r_ ,
DRILLING LOG DEPTH
From To Formation Description
7% 3.L5
B dRork
•Top of casing terminated et/or below land surface requires a variance In accor-
dance wllh 15A NCAC 2C9118
10. YIELD (gpm): •Q METHOD OF TEST
11. WATER ZONES (depth):
• CHLORINATION: Type
CASING:
fV
U1
Tr 7H Amount iii5irptiliS It additional space Is needed use back of tram
Wall Thickness LOCATION SKETCH
Depth Diameter or W}IghUUrl. Material (Show direction and distance from at least Iwo State
From 0 To 7/ FI. L -,15 al � •1s 5 PLft3DK Roads, or other map reference points)
From To Ft. ,i1., n 1 1 n�(7�„IINRd
From To Ft
Ip�1x.h(✓L�=�yk"�"��� 'j/%
14. GROUT:
Depth Material Method A,
C.
From 0 To ao Ft CIvNf�iE ��ue�d.-
From To FI /
15. SCREEN:
Depth Dlarneler Slot Size Material
From To Ft In In
From To FI In In
From To Ft In In
16. SAND/GRAVEL PACK:
Depth Size Material
From To Ft
Fr; ;Q
From To Ft
17. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS,AND-THATACOET F THIS RECORD HAS BEEN PRIDED TO THE WELL,WNER.
jFOR OFFICE USE ONLY ��
'quad No: 1 BSI NATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit or1gIr*! Division ol Water Quality, Groundwater Section within 30 days
Serial No. "--' J - GW-1 REV. 12/99
r

3. OWNER rL
•
North Corollna - Dnpartmonl of Environment and Natural Resources - Division of Wolter Quality • Groundwater Section
1636 Mall Service Censer - Ralalph, N.C. 27699-1636-Phone [phone] WELL CONSTRUCTION RECORD WELLCONTRACTOR• JAiekv/ f qiy Son!
WELL CONTRACTOR CERTIFICATION
STATE WELL CONSTRUCTION PERMITM:
270132 V
1. WELL USE (Check Applicable Box): Residential IV Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Float Pump Water Injection ❑ Other ❑ 11 Other, List Use:
2, WELL LOCATION: (Show sketch of the location below) •(�
NoarostT wyQ n: -a unty. k�LFnCir)%the
DRILLING LOG DEPTH
(Road Name and Numbers, Community. or Subdivision and Lot No.)
Address 0. Y �Or \Tiffr I Gjai
1=-j rea afr %ola
City or Town Stale Zip ado
4. DATE DRILLED
5. TOTAL DEPTH _.......�_-
6. CUTTINGS COLLECTED YES I I N014
7. DOES WELL REPLACE EXISTING WELL? YES (—] NO[a'
B. STATIC WATER LEVEL Below Top of Casing: 5 FT.
(Use •+• II Abovo Tor of Casing)
9. TOP OF CASING IS 1 FT. Above Land Surface'
'Top of casing terminotod at/or below lend surface requires a variance In accor-
dance with ISA 2C .6I10
10. YIELD (gpm): �rJ�- METHOD OF TEST
11. WATER ZONES (depth)•
From To Fcrmallon Description
�r f
Brod »ck
w
>J
O
'2. CHLORINATION: Type H 7H Amount
13. CASING:
IV
CJ1
If additional spaco Is needed use hack of lorrn
LOCATION SKETCH
Wall Thickness
Depth /plamelar or WelphUFt. Aaledal (Show direction and distance from at least two Stale
From C To Ft V ' .1)`'j.ZI'S - Roads, or other rnap reference points)
From To F1. (//,� ^
From To Ft t-il. ,ter Li .
14. GROUT:
Depth - Material Method Far 1i1 - c -
From b To /-20 Ft ly hGra e T-- I'
From To Ft.
15. SCREEN:
Depth Diameter Slot Slzo Malarial
From To F1 in In.
From To FI In In
From To Ft. In In
16. SAND/GRAVEL PACK:
Depth Size Material
Frorn To FI
From To Ft.
17. REMARKS:
IDOHERE CERTIFY THAT THIS WELLWaSCMSTRUCTEDIN CCORDANCEWITH15ANCAC2C,WELL
CONSTRUT101' SITANOARDS, AND THATA C�' OF THI A 0 D HAS BEEN PROVIDE TO THE WELL OWNER.
FOR OFFICFF W5FrONLY �i, r l . CJ" (�Jp
L
SIGNATURE OF P SON CONSTRUCTING THE ELL OATS
Quad No:
I Submit ed o Division of Water Duality. Groundwater Section Within 30 days
GW-1 nEv, 12/99
1
Serial No.

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 WELLCONTRACTOR• /�d RmAN L .�7 2ALL,
WELL CONTRACTOR CERTIFICATION sr:05 : t9A7
STATE WELL CONSTRUCTION PERMITN:
270131
1. WELL USE (Check Applicable Box): Residential la Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Infection ❑ Other EI II Other, List Use:
2.
3.
WELL LOCATION: (S
Neal est Town: t
(Roa am
OWNER •
Address
w sketch o
umbers. Corn
if' 1G
ly or Town State
4. DATE DRILLED 5—/o' D .
5. TOTAL DEPTH c2 17.5
6. CUTTINGS COLLECTED YES n NOV'
7. DOES WELL REPLACE EXISTING WELL? YES a NOV
8. STATIC WATER LEVEL Below Top of Casing: r FT.
(Use'+' if Above Top of Casing)
9. TOP OF CASING IS 1 FT. Above Land Surface'
'Top or casing terminated eVor below land surface requires a variance In accor-
dance with 15A NCAC 2C A 1e
10. YIELD (gpm): METHOD OF TEST R : 3
11. WATER ZONES (depth)•
the location below)
Coun
or Spbdivision and Lot No.)
DRILLING LOG DEPTH
From To Formalion Description
Zip Code
$)`cJRoc k
n
CO
c
DO
Ul —
CHLORINATION: Type 14 7N Amount 1J S 11 additional space Is needed use back of form
. CASING:
Wall Thickness
Depth Diameter or WjIghVFI. Material
From 0 To &Li Ft &. 5 ea/lc.1,5
From To FI.
From To Ft
14. GROUT:
Depth Material Method ,
From D To do Ft C'vNC�.EiE� ou2�i_
From To Ft
15. SCREEN:
Depth Diameter Slot Size Material
Frorn To Ft In In c--,
From To F1 In In
From To Fl. In In
16. SAND/GRAVEL PACK:
Depth Size Material
From To Ft
From To Ft.
17. REMARKS:
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other map reference points)
0
c�
^T
1.7.77
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,
S-16-0a
SIGNAIrptl por PERSON CONSTRUCTING THE WELL
"Submit odginatte-0IOsicriol Weter Ouallty, Groundwater Section within 30 days
FOR OFFICE USE O191Y
Guad No: '..
Serial No.
DATE
GW.1 REV. 12/99
J

1
North Carollna - Department of Environment and Natural Resources - Division of Water Ouellty - Groundwater Section
1636 Mall Service Center - Raleigh, N.C. 27699-1636-Phone [phone] �� //
WELL CONSTRUCTION RECORD WELL CONTRACTOR. ACC RmAN G. • 2Li�C1C..
WELL CONTRACTOR CERTIFICATION #: o�19�
STATE WELL CONSTRUCTION PERMIT#:
270130
1. WELL USE (Check Applicable Box): Residential 21 Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other If Other, List Use:
2. WELL LOCATIONShow skel It of the location below) .}- 'Coouunty: ttoncernit n
•
Mead ame and
Numbers. Commur911,f, r Subdivision and Lot No.) DRILLING LOG DEPTH
3. OWNER / 171,k? t 1 1757.0h_' From To Formation Description
Address l(3 ry1i.J'y'�{ `yCGy .7 ^^ I-y
/ ( ree or Dula No.} �n^ � prV S ! s�_br•R f-
y�c�wd /rr'' D / - Ns 4J>
Cily orC To Slate Zip c de 12ockCr
4. DATE DRILLED 6• -0 C `
5. TOTAL DEPTH -' 6. CUTTINGS COLLECTED YES IT NOIV
7. DOES WELL REPLACE EXISTING WELL? YES n NO EV10 _
8. STATIC WATER LEVEL Below Top of Casing: 4 0 FT.
(Use'. II Above Top of Casing)
9. TOP OF CASING IS I FT Above Land Surface'
•Top of casing terminated !Vor below land surface requires a variance In accor- fv
dance with 1SA NCAC 20 pill U1
o 010. YIELD (gpm)• tMETHOD OF TEST TN r 1 o
11. WATER ZONES (depth)•
•
CHLORINATION: Type if TH Amount If additional space Is needed use back of form
. CASING:
From
LOCATION SKETCH
Wall Thickness
Dept i Diameter or Weight/Ft.;�M'ate(darl,Q (Show direction and distance from at least Iwo State
To X— Ft. L • oZ 5 ^?) 6.1iJ� i�Li�-SDR Roads, or other map reference points)
From
From
14. GROUT:
To
To
Ft.
Ft.
Depth Maledal Method ,
From D To DZ0 FI itd7N C�.EfE ��
From To Ft
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 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 OWNER,
�'�
I FOR OFFICE dSE QIi1LY
Goad No:
Serial No.
II0NATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit odgiha` Id bvlsion of Water Ouallly, Groundwater Section within 30 days -
t_.1 GW-I REV. 12/99

, . 2701291
North Carollna - 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 WELLCONTRACTOR• � /-�I
RRIAW k�l A (.(5;NE5
WELL CONTRACTOR CERTIFICATION If: /Ale
STATE WELL CONSTRUCTION PERMITS,:
1
WELL USE (Check Applicable Sox): Resldentlai I: Municipal ❑ Industrial n Agricultural ❑ Monitoring ❑
Recovery n Heat Pump Water Injection ❑ Other (J II Other, List Use:
2. WELL LOCATIOANN,^1: (Show sketch of lh localldn below)
Nearest Town:
Vl V 1 County'
J
%l�z"/1 / [/ -cd y-' al-14/
( oad Name a Numbers, Comm Ily, or Subdivision and Lot No.) DRILLING LOG DEPTH
3. OWNER jrs Qvt 0VQ-5 From To Formation Description
own) V(a ew J2'`?ja
Sireat or Hou a W 3 O
Address (O
t--eisi-Alle
City or Town Stale
4. DATE DRILLED — 15 a-
5. TOTAL DEPTH C! O •-,
6. CUTTINGS COLLECTED YES I I NOIvr" "3
7. DOES WELL REPLACE EXISTING WELL? YES (. J NOI y
8. STATIC WATER LEVEL Below Top of Casing: i4 O FT. --.
f (Use "t' it Above Top of Casing) iv r
j ; 7
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 .019 ,.
10. YIELD (gpm): METHOD OF TEST �L✓
11. WATER ZONES (depth)' ✓
0 o
lJ ofO .Ujij I
Zip Code
12. CHLORINATION: Typo Amount 3 If additional space Is needed use back of form
1 'ASING:
Wall Thickness
Depth Diameter or WelghUFI. Maledal
From 0 To lb Ft 10.D5
From To FI.
From To Ft
14.GROUT:
From 0
From
15. SCREEN:
f'YC-S011
Depth Material 11 Method
To QC) Ft (`.n air-11 P+P TAivlir.rl
To Ft
Depth Diameter Slot Size Material
From To Ft In In
From To Ft In In
From To Ft In. In
16. SAND/GRAVEL PACK:
Depth Size Material
From To Ft
From To Ft.
17. REMARKS:
LOCATION SKETCH
(Show direction and distance from al least Iwo State
Roads, or other map reference points)
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTICh1STANDARDS ANDSHAT A OnPv nF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
I'
FOR OFFICE USE;ON(.Y
Quad No: sib IJATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit original Id, Div on al Water Quality, Groundwater Section within 30 days
.al No. .` i i GW-1 REV. 12/99
0
0
L

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]
270128
WELL CONSTRUCTION RECORD WELL CONTRACTOR.
Bc bhr as t'o4+S
WELL CONTRACTOR CERTIFICATION p: t;Qa Q
STATE WELL CONSTRUCTION PERMITN:
1. WELL USE (Check Applicable Box): Residential ray Municipal ❑ Industrial O Agricultural El Monitoring ❑
Recovery ❑ Heal Pump Water Injection ❑ Other El If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below) rest Town'410-1yQr yr County iE5Ldr ilcL "'
l A11.u.t.c) S- . 2J.0hLva. hC
(Road Name �an"d' N�umbers, Convpunity, or Subdivision and Lot No.)
3. OWNER tYI)1� Plus �jtJTJlyrJ)�
Address p0,Vb )
Z
» yule (Q24401111,
fn St
Clly or Town / Stale
4. DATE DRILLED : J" 7"0A.
5. TOTAL DEPTH�'1
6. CUTTINGS COLLECTED YES In NO VI
7. DOES WELL REPLACE EXISTING WELL? YES I-1 NO(1�
8. STATIC WATER LEVEL Below Top of Casing: FT.
DRILLING LOG
From To
DEPTH
Formallon Description
26P2/ 0 - r 2�
Zip Coda
ji 4�
(Use Y' II Above Top of Casino)
9. TOP OF CASING IS I FT. Above Land Surface'
•Top or casing terminated aVor below land surface requires a verlance In scoot--
dance with ISA NCAC 2C. 118 k
10. YIELD (gpm): METHOD OF TEST p.1 C\
11. WATER ZONES (depth)
12. CHLORINATION: Type _ 7 N Amount r (1 S If additional space Is needed use back of form
CASING:
0
w
C1 —,
Wall Thlcknass
From_YL_DTolhnOS Ft to*pim3tJ .(�loeloolv5'. Ma�V� dal
From To !! Ft (p l��j (o
From To FI.
14. GROUT:
Depth Material Method ,
From in TO A Ft ahQ-.E'i gJ)'�",('1'_�—J_
From To Ft.
15. SCREEN:
Frorn
From
From
Depth
To
To
To
16. SAND/GRAVEL PACK:
Depth
Frorn To
From
17. REMARKS:
Diameter
Ft
FI
Ft
Slot Size Malarial
In. In
In In
In In
Size
FI
To Ft
Material
LOCATION SKETCH
(Show direction and distance from al least Iwo Slate
Roads, or other map reference points)
ZEkaverVik ni -
0
r.)
ry
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THATA COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
i ai v2/ , (41 5 a� FOR OFFICE USEIONLY �
Nuad No: SIGNAII111E OF PER ON CONSTRUCTING THE WELL DATE
Submit orlolnal to Dlvlelbn of Water Gualily, Groundwater Section within 30 days
Serial No. • GW.I REV. 12/99

270126
North Carolina - Department of Environment and Natural Resources - Division of Water (Duality • Groundwater Section
1636 Mali Service Censer - Raleigh, N.C. 27699-1636-Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR.
B O b h,4 ca.l. P 4-S
WELL CONTRACTOR CERTIFICATION If: J 0.c. 2
STATE WELL CONSTRUCTION PERMIT":
1. WELL USE (Check Appllceble Box): Residentia11127 Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Infection ❑ Other n it Other, List Use:
2. WELL LOCATION: (Show sketch of the location below)
west Town: /`.�csv r 1/1' j lLCounty. Y✓O/ Y©gibe
C rook vAo sf . (.J.ectuotA.-tit.
(Rood Name and
and Numbers, Co`` rrunlly, or Subdivision and Lot No.)
3. OWNER ' IYV�, pCo e
Address PO • J?irx Ff
5 o or Noui O.
isleMO.G.
Cry or Town Slate
4. DATE DRILLED lJ —CA
5. TOTAL DEPTH yI $
6. CUTTINGS COLLECTED YES In NOI Vr
7. DOES WELL REPLACE EXISTING WELL? YES
DRILLING LOG
From To
DEPTH
Formal/on Description
2,g7'7 r2i
zlpcode
NOI VI
8. STATIC WATER LEVEL Below Top of Casing: , 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 ISA NCAC 2C .9119 s
10. YIELD (gpm): y METHOD OF TEST t C
11. WATER ZONES (depth): _Ink__)vim
r 9. CHLORINATION: Type Amount /411h
CASING:
Wall Thickness
Deollt plamsel rk-UP r Maledal
TV� SD�
From O To � FI (p 0C jo J i
From To FI
From To Ft.
14. GROUT:
0 Depth Malarial MotMU IK&
From To AO FI rchaE g
From To FI
15. SCREEN:
From
From
From
Depth
To
To
To
16. SAND/GRAVEL PACK:
Depth
To
To
From
From
17. REMARKS:
FI
F1
F1
Diameter Slot Size
In
In
In
Size
Ft
FI
Material
In
In
In
Material
II additional space Is needed use back of form
nt
0
LOCATION SKETCH ‘.)
(Show direction and distance from at least Iwo Slate V7
Roads, or other map reference points) p
0
L vervis n . L • M
c hv i eze;
0
0
r'
0
SO
ONSTRUCTION SP\NOARDS, ANTHAT A COP ['lc THIS ACCORDANCE REECORD HAAS BEENWELL WITH 15A NCAC 2C,
PROVIDED
TO THE WELL OWNER. /;
FOR OFFICE U ,EONLY `� Uf/ t f ,� ^v,2
tuad No: I$ G \TURE OF ERSON CONSTRUCTING THE WELL DATE
Submit od0llal1dslon al Water Ouallty, Groundwater Section Within 30 days
Serial No. GW.t REV. 12/99

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section 270125
1636 Mail Service Center - Raleigh, N.C. 27699-1636-Phone [phone] WELL CONSTRUCTION RECORD WELL CONTRACTOR. MAN kE A (Ai 4E5
WELL CONTRACTOR CERTIFICATION 0: /4740
STATE WELL CONSTRUCTION PERMITS:
1. WELL USE (Check Applicable Bog): Residential I Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Infection ❑ Other II Other, List Use:
2. WELL LOCATION: (Sr ew sketch or the location below) ����mh
Nearest Town: County
1- .s - 1};'•n,I �,.1/,/�',Jsam(.t4.
oatl Name end.Numbera•Communll or Subdivision and Lot No.) DRILLING LOG
DEPTH
3. OWNER a / From To Formation Description
Address
City or
TownILLE 7 Skate
4. DATE DRILLED r/�1,��'d
5. TOTAL DEPTH
6. CUTTINGS COLLECTED YES I NOI V
7. DOES WELL REPLACE EXISTING WELL? YES I 1 NOIV"
8. STATIC WATER LEVEL Below Top of Casing: l/Q FT.
(Use's' II Above Top of Geeing)
9. TOP OF CASING IS 1 FT Above Land Surface'
'Top of casing terminated eUor below land surface requires a variance In accor-
dance with 15A NCAC 2C//�01,1l0
10. YIELD (gpm): 1Pft METHOD OF TEST li)) q
11. WATER ZONES (depth)'
a
a1272Y /00 -S8�`' B,An L1fi
Zip Code
12. CHLORINATION: Type -}IM Amount -E . __ LW % If additional space Is needed use back of form —
1 ASING: { -
LOCATION SKETCH IV r z
Wall Thickness `_:
Depth Diameter or Weight/Ft. Matedal (Show direction and distance from at least two State C1 _
From 0 To `0D FL L. Zi QIL.1* RC-SDfj Roads, or other map reference points)
� _ c
From To Ft. I^ ,1 /�- -�-� J
From To Fr /[/{/'/L/t%�0
14. GROUT:
Depth Material 1�
From 0 To a0 Ft COIL:CAIP.fe
From To Ft.
15. SCREEN:
Method
J
Depth Diameter Slot Size Material
From To Ft In in
From To Ft In In
From To FI. In In
16. SAND/GRAVEL PACK:
Depth Size Material
From To Ft
From To FI
17. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION_STANDALlDS ANn THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
Vi<. <L 7—'�—a c-
Ii °NATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit'Or0144l to Division al Water Quality, Groundwater Section within 30 days
_/ ( GW-I REV. 12/99

North Ceroline - Daperlmonl or Environment And Nolural Resources - Division of Wnler Quality • Groundwater Section
2'70122
1636 Mali Service Center - Raleigh, N.Q. 27699.1636-Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR' %hri . Po4+S
WELL CONTRACTOR CERTIFICATION p: . ocR g
STATE WELL CONSTRUCTION PERMITN:
1. WELL USE (Chock Applicable Pox): Residentially( Municipal El Industrial ❑ Agricultural D Monitoring ❑
Rocovery ri Heat Pump Water Infection ❑ Other L] If Olhor, List Use:
2. WELL LOCAT •N: Show sketch bf the location below)
Town: � -�� _ _ _ ' Courtly 4.1,nAfereS ed5
(none Name And Nunb,u. Co m+un y, or Subdivision and Lot No.) DRILLING LOG DEPTH
3. OWNER L/' Rom To Fommllon De scdpllon
Address
R/ Aa_
Cllyor Torn Stale
4. DATE DRILLED 1'+a-6 �a
5. TOTAL DEPTH Lilo,T
6. CUTTINGS COLLECTED YES I NO( v f
DOES WELL REPLACE EXISTING WELL? YES NOM
6. STATIC WATER LEVEL Below Top of Casing: /4t FT.
(Use '1 II Above Top of Cesioe)
9. TOP OF CASING IS I FT. Abovo Land Surface'
•Top of teeing ler minal art iVor below land surface requlree a variance In accor-
dance with ISA NCAC 2C. 16
10. YIELD (gpm): METHOD OF TEST
1 I. WATER ZONES (doplh)•
`HLORINATION; Type Amount/L 1 t ( es
13..,ASING:
Si, al /SO
Orf ulo No 4?/
C Zip Code
fl
D - /ma R�-
/op
o
c
::))3
IJ
If additional spats Is needed usa hack of form Iv —
Wall Thickness
Depth O ;Amory- r ala'p(1 kl�Y(ICD1Z
FromAnTo .Fl. [`3 jj
From To Ft
From To FI
14. GROUT:
Depth Malarial
From 0 To aO____FI Ct42E1E
From To FI
15. SCREEN:
Method
LOCATION SKETCH
(Show direction and distance Irorn nl least Iwo Slate
Bonds, or other map rolorence points)
MonLaia
co«/ddC�
I
Depth Diameter Slot Size Malorini
Front To FI In In
From To Ft In In
From To Ft In In
16. SAND/GRAVEL PACK:
Depth Slze Material
From To FI
From To FI
17. REMARKS:
I DO HEREDY QERTIFY THAT THIS WELL WAS Gen— UCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION $TI>rNOAROS, AND TIIAT A COP Cif IrHIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
R OFFICE U'E,ONLY
uuad No:
URE OF'ERSON CONSTRUCTING TIIE WELL DATE
Submit odplrjalllo O*Aston of WMer Ovalily, Groundwater Section Within 30 days
CW•I REV. 12199
Serial No.

North Cnrollne • Onperimonl of Environment and Nolurnl Flesourcee - Dlvialon of Water Quality • Oroundwalor Section
1636 Mall Service Center - Raleigh, N.C. 27699-1636-Phone (919) 733•3221 ( (�
WELL CONSTRUCTION RECORD WELL CONTRACTOR• 36 b hr4 US. Yo ,I-S
WELL CONTRACTOR CERTIFICATION If: —I D.:.? 2
STATE WELL CONSTRUCTION PERMITS!
270120
2.
WELL USE (Check Appnuble Box): Reslden11a11( Municipal
Recovery. [1 Float Pump Water Infection n Other n
WELL LOCATIONhow sketch of the location below)
Neatye{Town: 4ACounty:
(Hoed Name And Numbers. Con -money, or Subdlvlslo end Lol No.)
3. OWNER - S . iilr
Address
�,1]. (may'+-�✓� •eo ar ouYir
oNo.,
Clly or Torn Slale
A. DATE DRILLED ____
5. TOTAL DEPTH
6. CUTTINGS COLLECTED YES I I NO Vr
7, DOES WELL REPLACE EXISTING WELL? YES
6. STATIC WATER LEVEL Below Top of Casing: .41.0
(Use'.• II Abovo Top of Casing)
9, TOP OF CASING IS FT. Abovo Land Surface'
'Top of us ing lei mineled elfor below land Audios require, a variance In accor-
dance wllh 15A NCAC 2C.9J.ky
10. YIELD (gpm)' }l METFIOD OF TEST
11. WATER ZONES (depth).
LI `C
17 'LILORINATION; Type 7_Amount 5S-�iI
�S
S. �ASING:
Zit Code
Il
NO t[
FT.
II
Industrial D
If Olhor, List Use:
WhCan Ica
Agrlcullural0 Monlioring
DRILLING LOG DEPTH
Rom To
• -3as
Fort- al:on De scrlpaon
From
Flom
From
14, GROUT:
II additional space Is needed use hack of form
Wall Thickness
Depth Y(i% lame n(�Inelo;, Maledal
f VLS1S
To. FI.D
To PI.
To Ft.
From 0
Frorn
15. SCREEN
From
From
From To
16. SAND/GRAVEL PACK:
Depth
Frorn To
From
17. REMARKS:
Depth Malarial
To AO___FI CohR_Eig
To FI
Doplh
To
To
Ft
Ft
Ft
Diameter Slot Slzo
In
In
In
Size
FI
To FI
Molliod
Malarial
In
In
In
Material
LOCATION SKETCH
(Show direction and distance Irons nl least two Slate
Bonds, or other map rolorence points)
v1
0
0
—r1
P1
G7
N TT
01
I DO FIEFlEDYt RTIFY, THAT THIS WELL WAS i
CONSTRUCT ON STANDARDS ANO TI IAT AC°F''r(
r T OFFICE tlISE,ONLY
ad No:
Sedai No.
1.1
Submit or1 In o
RUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
TFIIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
_(J/lit/, (0- , / - 0 GNr
ATUBE OF PERSON CONSTRUCTING TI IE WELL DATE
!visional Wnler Duality, Oroundwaler Section within 30 days
GW.I REV. 12199

i
North Carolina • Department of Environment and Natural Resources - Division of Water Quality • Groundwater Section
1636 Mall Service Center - Raleigh, N.C. 27699-1636-Phone [phone]�//�' N C J
WELL CONSTRUCTION RECORD WELL CONTRACTOR. /1 N RinAL. q-«.
WELL CONTRACTOR CERTIFICATION 0: .4C.a 7
STATE WELL CONSTRUCTION PERMIT":
270118
1. WELL USE (Check Applicable Box): Resldenllal Z. Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection EJ Other ❑ If Other, List Use:
2. WELL LOCATION: Sh.w sketch o41he location below) /1`�C��
Nee r=:l Town; /- 1--- - - County r 67..c
(Road Name = • d N bets. ommunlly, nupdbelsion and Lol No / DRILLING LOG
3. OWNER f I/. ' - relit/a/Lad cam,- . From To
Address
m /8 /
tee or •ou e s0
7.
CIIy or Town tale Zip Code
4. DATE DRILLED O •7.0 a
5. TOTAL DEPTH
6. CUTTINGS COLLECTED YES I 1 NO1
7. DOES WELL REPLACE EXISTING WELL? YES in NO11,4
S. STATIC WATER LEVEL Below Top of Casing: /,O FT.
ibeg - Flo
DEPTH
Formation Description
0 - /00 J Rf
'3>zer k
I (Use': II Above Top of Casing)
9. TOP OF CASING IS FT Above Land Surface'
'Top of casing terminated eVor below land surface requires a variance In accor-
dance with 15A NCAC 2C .0118
10. YIELD (gpm): W METHOD OF TEST . 3 _D
11. WATER ZONES (depth):
0
'" CHLORINATION: Type H 7"N Amount yl¢...p,11S
CASING:
1.1
J
y c;
If additional space Is needed use back of form
U1
O
Wail Thickness LOCATION SKETCH
Depth Diameter or WelghVFt, ;TMaledal (Show direction and distance from at least Iwo Slate
From D To /0 0 FL I,.; 5 mvl •%%P vS e-5k. Roads, or other map reference points)
From To Ft g.
From To Ft.
14. GROUT: //_ 5 Ci
Depth Material Method �i I,
From 0 To AO Ft. noncF.Ei t L is JxO f11 ,(i(
From To FI -Ti
15. SCREEN: rn
CO
NJ 7.
Depth Diameter Slot Size Material
From To Ft In In
From To FI In In
From To FI In In
16. SAND/GRAVEL PACK:
Depth Size Material
From To FI
From To Ft
17. REMARKS:
Cfi
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 PRQYIDED TO THE WELL WNER.
FOR OFFICE USE ONLY C/i'YI,GLti.i
V%y ,/3 _ 6.-a 76a-
uad No: SI NAWIRE OF PERSON CONSTRUCTING THE WELL DATE
Submit original lolll.Diylslon of Waler Quality, Groundwater Section within 30 days
....-/ I
I
Serial No.
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] r/ WELL CONSTRUCTION RECORD WELLCONTRACTOR• —3R)I�N / k LA W r/VE5
WELL CONTRACTOR CERTIFICATION #: /176D
STATE WELLCONSTRUCTION PERMIT#:
270117
1 WELL USE (Check Applicable Boa): Residential[ Municipal h Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ II Other, List Use:
2. WELL LOCATIO (S ow sketch •1 the location below)
Ne.: sl Town:
(Road Name an
3. OWNER
Address
County:
ben. Community, or Subdivlslo. nc Lot No.)
ree or ou a •o.
City or own Slate
Zip Code
a 41li - 4D5- Berlryd
/14 r'a i-e
DRILLING LOG DEPTH
From To
Formation Description
p -tea jilt
5. DATE DRILLED •
0 5
TO
5. TOTAL DEPTH
6. CUTTINGS COLLECTED YES I J NO"
7. DOES WELL REPLACE EXISTING WELL? YES J NO[
8. STATIC WATER LEVEL Below Top of Casing: 35-- FT.
(Use ••• II Above Top of Casing) CO
9. TOP OF CASING IS 1 FT. Above Land Surface• L.)
•Top of caging terminated et/or below land surface requires a variance In accor-
dance with 19A NCAC 2C .0118 -}
10. YIELD (gpm): (a 0 METHOD OF TEST --R) q ry
11. WATER ZONES (depth):
12. CHLORINATION: Type irT (y
1 ASING:
-70
Amountu8 If additional space Is needed use back of form
Wall Thickness
Depth ' / Diameter or WeIght/FI. Matedal (Show direction and distance from at least two State
From 0 To z f'/0 Ft t1• 35 air~ j 5 Pit-SDR Roads, or other map reference paints)
From To Ft/ /'
From To Ft.„ /�
tA. GROUT: W `� J / 6111- 1
Depth Material 1.� Method
From 0 To QO Ft CAI accjp.7e '"n"
From To FI Co
o
0
15. SCREEN:
Depth Diameter Slot Size Material
Frorn 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:
LOCATION SKETCH
01
0
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
FOR OFFICE USE Of�LY -r �'�• 6 -,2 7 Q !?°
Ouad No: SI©NA1 i E(I,pF PERSON CONSTRUCTING THE WELL DATE
Submit original to Divl$lo o Water Quality, Groundwater Section within 30 days
'. I GWI REV. 12/99
.al No.

North Carolina - Department of Environment and Natural Resources - Division of Water quality - Groundwater Section
1638 Mall Service Center - Raielgh, N.C. 27699-1636-Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR. --BRJAN k 1. A D ; pies
WELL CONTRACTOR CERTIFICATION if:
STATE WELL CONSTRUCTION PERMIT®:
270114
1. WELL USE (Chock Applicable Box): Residential E� Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Infection ❑ Other Ej If Other, List Use:
WELL LOCATION: ow sketch o'l h location below)
Nearest Town: County:
Lutz, x th OJI QS ,
(Road me endf�umb rs. Community, or S dlvl n and Lot No.)
3. OWNER LK-6. / /'!.(Qi11, LtJr�
Address 9Q7 Nni6 (j� i6 /
2ifiadiA^' ,tator nu// C a074 7
City or TownStale Zip Code
4. DATE DRILLED a Oo�
5. TOTAL DEPTH �8�
6. CUTTINGS COLLECTED YES J I NO(yf"
7. DOES WELL REPLACE EXISTING WELL? YES
8. STATIC WATER LEVEL Below Top of Casing: FT.
(Use '+' II Above Top of Casing)
9. TOP OF CASING IS ' FT. Above Land Surface'
'Top of casing terminated at/or below land surface requires a variance In accor-
dance with 15A NCAC 2C .0118
10. YIELD (gpm): 36 METHOD OF TEST 1:i:7q
11. WATER ZONES (depth): -T '/ •''
12. CHLORINATION: Type -4 1 +f Amount 92 r If additional space Is needed use back of form
DRILLING LOG
From To
DEPTH
Formation Description
,2 Jl
Az,- Ye) 13e.441. i
0
co
nt
0
1 ;SING:
Wall Thickness LOCATION SKETCH
Depth Diameter or Weight/Ft. Matedal (Show direction and distance from at least two State
From To 09 el Ft LA. e5 Q)L. 15 PYG-SD1j Roads, or other map reference points)
From To Ft
From To Ft
14. GROUT:
Depth Material + Mel!
From To QO PI GolIGFiP.7P
From To Ft
15. SCREEN:
Depth Diameter Slot Size Materiel
From To FI In In
From To FI In In
From To Ft in In
16. SAND/GRAVEL PACK:
Depth Slze Material
From To FI
From To Ft
17. REMARKS:
i C��(4,!/v/Af,
(J1
0
rn
rn
p
N
C.11
I DO HEREOY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
FOR OFFICE IFFSE©NtV
Quad No:
.al No.
1614ryTURE OF PERSON CONSTRUCTING THE WELL
SubmlrndDJit I INtIvIslon al Water Quality. Groundwater Section within 30 days
i
L
DATE
GW-I REV. 12/99

Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
Mall Service Center - Raleigh, N.C. 27699-1636-Phone (9t9) 733-3221
LL CONSTRUCTION RECORD WELLCONTRACTOR• RIRW kE/LA t.,NES
WELL CONTRACTOR CERTIFICATION It: 14740
STATE WELLCONSTRUCTION PERMIT#:
270112
WELL USE (Check Applicable Boa): Residential E� Municipal ❑ Industrial ❑ Agricultural ID Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other II Other, Llst Use:
VELL LOCATION (S sketch of tile I. cation below)
Lt e.
own! � L- t . _ County
!serest
`I cad Name and,N bers. Community, • Sub [vision :n• of No.) DRILLING LOG
TWNER Qi1J / i �- From To
\ddre 0 � ._� �_ �„ .{•� _1..
rse •r •ou • ' .Il �fi 1
Slate Zip Code
)ATE DRILLED 6 -aa-02'
OTAL DEPTH .c705
UTTINGS COLLECTED YES n NO
)OES WELL REPLACE EXISTING WELL? YES in NOj'
;TATIC WATER LEVEL Below Top of Casing: 4, Q FT.
(Use'+' II Above Top oI Casing)
OP OF CASING 15 ' FT Above Land Surface•
rl casing terminated eUor below land surface requires a variance In accor-
r with 1SA NCAC 2C J0418
•IELD (gpm): METHOD OF TEST �) q
VATER ZONES (depth):
DEPTH
Formation Description
City or Town
CD
O
HLORINATION: Type MTif Amount 3O/iaa If additional space Is needed use back of form
;SING:
Wall Thickness LOCATION SKETCH
Depth7 Diameter oorr WeI9h.VVFt. Maledal (Show direction and distance from at least Iwo Stale
RomTo d 7 Ft los Z5 WC•SDR Roads, or other map reference points)
`rom To Ft rem To FI / f �j ��
PI
a „ .-{min., p/ l0 `
Depth Material Method/J
Torn 0 To a0 Ft r.e►lc.�e:�-P 'Dn� ,/Y/�')G����5��l � Co
Rom To FI
SCREEN:
Depth Diameter Slot Size Material
corn To Ft In In
"(om To Ft In In
'rom To FI In. In
SAND/GRAVEL PACK:
Depth Size Material
=rom To Ft
=rom To Ft
rV
REMARKS:
DO tIEREDY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF TH S RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
l '2 6 -aa-o . -
)R OFFICE USE ONO' L-
lad No: srt3�11 YJAE OF PERSON CONSTRUCTING THE WELL DATE
Submit original tq l lv s en of Water Quality, Groundwater Section within 30 days
al No. �_ 1 GW-I REV. 12)99

1
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mali Service Center - Raleigh, N.C. 27699-1638-Phone [phone]y(////�_'' -y2
WELL CONSTRUCTION RECORD WELL CONTRACTOR' /1 N im AN C • ,4LL.
WELL CONTRACTOR CERTIFICATION M: 4OA 7
STATE WELL CONSTRUCTION PERMITM:
270110
1. WELL USE (Check Applicable Box): Residential Lr'J Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑' Heat Pump Water Infection Q Other Q If Other, List Use:
2. WELL LOCATION• ( ow sketch o the location below)
earest To • �� r -�/_ County. /.!/Yi Cane
(•oad Name a d N�u`flers. Communit(, • Su'.lvl Ion and Lot No.)
3. OWNER .tJ!_
Addre s
ree or'ou
Clly or Town Stale Zip Code
4, DATE DRILLED 10-19--0
5. TOTAL DEPTH a714
6. CUTTINGS COLLECTED YES NOI4
7. DOES WELL REPLACE EXISTING WELL? YES n Not vf
8. STATIC WATER LEVEL Below Top of Casing: 40 FT.
(Use N.'II Above Top of Casino)
9. TOP OF CASING IS ' FT Above Land Surface'
'Top or casing terminated sVor below land audace requires a variance In accor-
dance with 15A NCAC 2C.0118 ,�jj
10. YIELD (gpm)' 5 METHOD OF TEST !�.
11. WATER ZONES (depth):
DRILLING LOG
From To
DEPTH
Formation Description
D - 40. ,'R f -
'f(o -a76 BE-cbtock
1° CHLORINATION: Type W T N Amount S
I., CASING:
Wall Thickness
Depth Diameter or W IghVFI. _Material
From in
To We Ft L .5 _Material
From To Ft
From To Ft.
14. GROUT:
Depth Material Method
From r) To v1-0 FL Opp C2E46
From To Fi
15. SCREEN:
Depth Diameter Slot Size Material
Frorn To FI In _ In
From To Ft In _ In
From To F1. In In
16. SAND/GRAVEL PACK:
Depth Size Material
From To Ft
From To Ft
17. REMARKS:
J
N)
If additional space Is needed use back of form
LOCATION SKETCH
(Show direction end distance from at least two Stale
Roads, or other map reference points)
2
I DO ItIEREDY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 16A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COP
F THIS RECORD HAS BEEN PRQ?rIDE� THE W�NER.
FOR OFFI E�11 E ONl1`f - IE t LQ.ii/'l('rfy- el �%.da
`quad No -1I NATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit pholh(t+ to Division al Water Quality, Groundwater Section within 30 days
-serial No.-11 j GW4 REV. 12/99

North Carolina - bopartmonl of Environment and Natural Resources - Division of Wnter Quality • Groundwater Section
1636 Mall Service Center - Raleigh, N.C. 27699.1638-Phone (919) 73,1.3221 .
WELL CONSTRUCTION RECORD WELLCONTRACTOU- BD bhp ✓ f+. Ppi
WELL CONTRACTOR CERTIFICATION 11:,-2 O,-- R
STATE WELL CONSTRUCTION PERMITN:
1. WELL USE (Check Applicable Box): Residentiall Vl
Municipal ❑ Industrial El Agricultural El monitoring ❑
Rocovery ❑ Hoat Pump Water Infection ❑ Other If Olhor, LIsI Use:
2. WELL LOCATION: ($how sketch of the location below)
n
ernes Couty
(FT dnd Name and Numbersrry Conur,I or Subdivl Ion And Lot No,)
3. OWNER l (/GG,CL-/1lSYI
Ne
rest
ors
Address n
a51 1 rflouloNo YYY
Clly or Town Slate
4. DATE ORILLE01
5. TOTAL DEPTH
6. CUTTINGS COLLECTED YES( 1 NO1 vr
7, DOES WELL REPLACE EXISTING WELL? YES NO F.
8. STATIC WATER LEVEL Below Top of Casing: L445f FT.
(Use'.' II Abovo Top of Casing)
9. TOP OF CASING IS I FT, Abovo Land Surlace'
• Top of cs slno ler mInnled sUor below land surface require, a variance In accor-
dance wllh 15A NCAC 2C. 118
10. YIELD (gpm)• Le 0 METFIOD OF TEST
11. WATER ZONES (doplh):
•
90g1
Zip Code
I1
270108
DRILLING LOG DEPTH
From To Formation DAscription
(c? -32D
RA—
a
=7
i HLORINATION: Type _�.7 N_Amount ((S S
13. CASING:
(� Wall Thickness ;1�� /j�'7
From t / DToolhtk A .rt (9 •. ' l I �I�Yalo v(J. Ai;lLY 51C1`r
From To FI I� �j
From To Ft.
14. GROUT:
Depth Materiel 'Walk
From d To 2%0 IL ennalr
From To FI
15. SCREEN:
Ooplh Diameter Slot Size Materiel
From To FI In In
From To FI In In
From To FI, In In
16. SAND/GRAVEL PACK:
Depth Size Material
Ftorn ' To FI
From To Ft
17. REMARKS:
:-' 2:
1= r
II additional space Is needed Use hack of form
LOCATION SKETCH
(Show direction end distance from nt least two Slate
Roads, or other map inference points)
c
I DO FIEREDY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
CONSTRUCTION sST DARDS, AND THAT A COPY, OS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGN TIWnE OF ERSON CONSTRUCTING TIIE WELL DATE
StibUilleriginaitqyl Ion of Writer Duality, Groundwater Section within 30 days
OW.1 FIEV. 12/99

North Carollna - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mall Service Center - Raleigh, N.C. 27699-1636-Phone [phone](/j�'
WELL CONSTRUCTION RECORD WELL CONTRACTOR. /fd RMAN 4 • 24-LL.
WELL CONTRACTOR CERTIFICATION P: ao-; 7
270107
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE (Check Applicable Box): Residential fkr Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATIO a,, ho sketch•o the location below) ilynCeY»GCPear stT County.
1S,co,f
0 A-�.� uc
(Road Name end N/��nbars, Co munity, Subdlvls nand Lot No.) DRILLING LOG DEPTH
3. OWNER C—T L ,�J From To Formation Descdpllon
Address 9 �/� LO`f (r[/ I _ � mi./zi-
p
eeFor Ho / p
,u i2t' gat(,�' S - Of) B -cM of k
City or Town Slate
5. DATE DRILLED al 8-02`
5. TOTAL DEPTH
6. CUTTINGS COLLECTED YES n NO
7. DOES WELL REPLACE EXISTING WELL? YES ni_ NOI VI
8. STATIC WATER LEVEL Below Top of Casing: Sej FT.
(Use "a' II Above Top of Casing)
9. TOP OF CASING IS / FT Above Land Surface'
-Top of casing terminated et/or below land surface requires a variance In accor-
dance with 15A NCAC 2C.01 e
10. YIELD (gpm)• METHOD OF TEST
11. WATER ZONES (depth)•
' CHLORINATION: Type 4 7H Amounlaa_paS
. CASING:
n Depth Diameter
From 4) To 1� Ft L . a 5
From To Ft.
From To Ft
14. GROUT:
Wall Thickness
or Weight/Ft. Maledal
,a1.11a5 PI/L•SDR
Depth Material
From D To AO FI Cm1YC2.E4E
From To Ft
15. SCREEN:
Me1od
7"`"�""
Depth Diameter Slot Size Material
Frorn To P1 In In
From To Ft In In
From To Ft. In In
16. SAND/GRAVEL PACK:
Depth Size Material
From To Ft
From To
17. REMARKS:
Ft
0
v
If additional space Is needed use back of form
LOCATION SKETCH
(Show direction and distance from al least two State
Roads, or other map reference points)
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
TANDARDS, AND THAT AICO, CF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER. '`v'
S 4ATURE OF PERSON CONSTRUCTING THE WELL
Submit Al.} Division of Water ouality, Groundwater Section within 30 days
CONSTRUCTION
FOR OFFICE 11 E
Quad No:
Serial No,
DATE
GW-I REV. 12/99

North Caroline • (Department of Environment and Natural Resources •Division of Water (Duality • Groundwater Section 27010 6
1636 Mall Service Center - Raleigh, N.C. 27699.1638-Phone [phone] •
WELL CONSTRUCTION RECORD WELLCONTFFlACTOR•
3c bhyA uS. P +5
WELL CONTRACTOR CERTIFICATION Or (9a A
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE (Check Applicable Box): Residential LrO Municipal ❑ Industrial ❑ Agricultural n
Rocovory ❑ Float Pump Water Injection Other If Othor, List Use:
2. WELL LOCATION; hoy sketch of the location below)?C�r
Nearest Town: - County
In
[Cl
Monitoring ❑
dal Name and Nyrybere.rormvnlly, 9r Subdivision and Lol No.) DRILLING LOG DEPTH
3. OWNER From To
Address
reoTor ITu e tT.
LULL n roe. o18�'QS
City or Town Stale 21p Code
4. DATE DRILLED
5.
TOTAL DEPTH �..
6. CUTTINGS COLLECTED YES( I NO 4'
7. DOES WELL REPLACE EXISTING WELL? YES NOW
6. STATIC WATER LEVEL Below Top of Casing: 4 FT.
(Use 'd II Above Top of Casing)
9. TOP OF CASING IS FT. Above Land Surface'
-Top of casing le rminnled gVor below land surface requires a variance In accor-
dance with 15A NCAC 2C .9118
10. YIELD (gpm): (1 METHOD OF TEST
11. WATER ZONES (depth)'
Fornrnllon 0e5crlp:ion
- 4rr
9s -aa4
R4-
Le4ck.
Cs)
N
0
N n
J
' HLORINATION: Type ,h T H AmounI.Ls's pi (I S If additional space Is needed use back of form
13. CASING:
Wall TI Ickness LOCATION SKETCH
(� Depllt„.2„,„„
lamele r e p IV Maledal (Show direction and distance from nl least Iwo Sims
From L) .To ` t- El �' �( r� Roods, or other map reference points)
From
From
14. GROUT:
To
To
El
Ft
Depth Malarial Mollrod
From 0Da ar Ft et) f1n+ridp_1,+
From To II
15. SCREEN:
Depth Dlarneler Slot Size Malorlol
From Tv PI In In
From To El In In
From To Ft In In
16. SAND/GRAVELPACK:
Depth Size Material
Frorn To FI
From To El
17. REMARKS:
0
0
cn
N
r
UT
I DO )(ERE „I -CEP -TIP( -T1-+AT-TittS-W -QrSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
GONSTRUCTIOItSTANGAROS, AND TIIAT A ((o/ Or TtIIS RECORD HAS BEEN PROVIDED TO WELL OWNER.
iROFFICEUSE ONLY
Quad No:
Serial No.
Submit ddfltnal
NATURE OF'PERSON CONSTRUCTING TI IE WELL DATE
Division of Weler Ouallly, Groundwater Section within 30 days
GW.1 nEv. 12/99

North Carolina - Depanmenl of Environment and Natural Resources - Division of Water Quality - Groundwater Section O O
1636 Mall Service Center - Raleigh, N.C. 27699-1638-Phone [phone] +/
WELL CONSTRUCTION RECORD WELLCONTRACTOR• {/R)RN kLiLA W /IV ES
WELL CONTRACTOR CERTIFICATION 0: /9
STATE WELLCONSTRUCTION PERMITS:
1. WELL USE (Check Applicable Box): Residential Municipal ❑ Industrial I1 Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ it Other, List Use:
2. WELL LOCATION: (S
sk1lch of the location below)
NepsgskTown. County
tut ' CD1i0
3. O
Address } DU ( n �,_
(Street or7 ouu��� ^ • a$ 73
D•
City or Town State L Zip Code
4. DATE DRILLED ' • O �`
5. TOTAL DEPTH �n .�
6. CUTTINGS COLLECTED YES I NOV'
7. DOES WELL REPLACE EXISTING WELL? YES n N0j
8. STATIC WATER LEVEL Below Top ol Casing: erj 5 FT.
ff (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 with 15A NCAC 2C .D1 e
10. YIELD (gpm): / 7 METHOD OF TEST �) q
11. WATER ZONES (depth):
(Road Name and bets. C(iirc nlly o ubdlvislon and Lot No.)
WNER y..JCL•C� No
n
k ed.
DRILLING LOG DEPTH
From To Formation Description
93 - O1 B trlq
c.J
IV
12. CHLORINATION: Type -i}T-�}'tt Amount 9 If additional space Is needed use back ol form
1 ASING: - -
Wall Thickness
SKETCH
Depth Diameter or Weight/Ft. Matedal (Show direction and distance from at least two Slate
From 0 To 9 9 Ft to. Di aue. P5 at'____' SDI, Roads, or other map reference points)
From To Ft /� //1� ///l��
From To Ft ' / A r - , / R
14. GROUT: l� 77 �/ �(/(.,�/L C(�,
Depth Material Method "� ///```
From D To Q0 FI C.n#JLt P e ya4 eA 4:_ata,,,,,( .
From To FI
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 Ft
17. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
ter" t . wed. DAT—/E
SIr71ME OF PERSON CONSTRUCTING THE WELL
Submli odA 1oal leI on of Water Quality, Groundwater Section within 30 days _
al No.
GW-0 REV. 12/99
FOR OFFICE USFtONLY---
Ouad No:
Ir'C

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mail Service Censer - Raleigh, N.C. 27699-1636-Phone [phone]
WELL CONTRACTOR CERTIFICATION 0:
270098
WELL CONSTRUCTION RECORD WELL conrrnAcron. RiP/V /<A
uV,yes
/54o
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE (Check Applicable Box): Residential Ea' Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other If Other, List Use:
2. WELL LOCATIO/l�� (S low sketchofthe location below)L
ea esl Town: {„�.� (/1 Count' C� �'Y) hit
�r
(Road Name Numbers. Co
3. OWNER
Address � ;a,
G4\\Qv l �
1D po
fitly, or Subdivision and Lot No.)
vL _ SD
i J c a.Acz�'!y/
City or Town Stale Zip Code
4. DATE DRILLED �0
5. TOTAL DEPTH n
6. CUTTINGS COLLECTED YES( -1 NO[� o �
7. DOES WELL REPLACE EXISTING WELL? YES n NOF--"A -t-
6. STATIC WATER LEVEL Below Top of Casing: / 5 FT.
(Use'+' II Above Top of Casing) N
9. TOP OF CASING IS 1 FT Above Land Surface' o
'Top of casing terminated aUor below land surface requires a variance In accor-
dance with 1SA NCAC 2C.01 9
10. YIELD (gpm): 15 METHOD OF TEST RI q v
11. WATER ZONES (depth)
DRILLING LOG DEPTH
From To Formation Description
7� - 304 B IAR9
12. CHLORINATION: Type 4+T-if
1' 'ASING:
Amount -Ca pWa
If additional space Is needed use back of form
Wall Thickness
Depth Diameter or WeighUFt. Maledal
From 0 To 1 3 Ft. Lb. D5 Q1L. W PYG'SDlj
From To Fi,
From To Ft.
14. GROUT:
Depth Material
From 0 To ri+ 0Ft calls: lr FjP+P
From To Ft
15. SCREEN:
Method
Depth Diameter Slot Size Material
From To Ft In In.
From To Ft In In
From To Ft. In In
16. SAND/GRAVEL PACK:
Depth Size Material
From To Ft
From To Ft
17. REMARKS:
LOCATION SKETCH
(Show direction and distance from at least Iwo State
Roads, or other map reference paints)
-
0
0
P- 1
ry
- cn
0 c
° F,
I DO t(EREOY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS AND THAT A COPY QF-THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
FOR OFFICE USE
Quad No: -- SIO U OF PERSON CONSTRUCTING THE WELL DATE
of Water Quality. Groundwater Section within 30 days
al No. ) : 1! `-^' / GW-I REV. 12/99

North Carolina • Dnparimont of Environment and Natural Resources - Division of Water Quality • Oroundwelor Suction 27009 5
1636 Mall Service Center - flalolph, N.C. 27699.1536-Phone (919) 733•3221 ""�� , rr (�
WELL CONSTRUCTION RECORD WELLCONTRACTOR• BO Lt}�r4 l,tl . PEfH-S
WELL CONTRACTOR CERTIFICATION If:'- rg F)a 2
STATE WELL CONSTRUCTION PERMITN!
1. WELL USE (Check Applicable Box): Residential Lb Municipal El Industrial El Agricultural Monitoring ❑
Recovery ri Float Pump Water Infection n Other Ej II Other, List Use:
2. WELL LOCATION :4nl low skelc 1 of the location below)
(non. Name antl Non. Co,nmun or Subdlvis on and Lol No.) DRILLING LOG DEPTH
3. OWNER
Address
Formation Desrtplton
-I-
Liu G .c874e2 y6 -. a.5' park.
Iy or Town Stale Zlp Code
n. DATE DRILLED • .2D'Q0
5. TOTAL DEPTH •r
6. CUTTINGS COLLECTED YES I I NOI �I o
7, DOES WELL REPLACE EXISTING WELL? YES ri NOm. c.)
8. STATIC WATER LEVEL Oelow Top of Casing: 30 FT. -'
(Use •r' II Above Top of Casing)
9. TOP OF CASING IS I FT Abovo Land Surface'
'Top of casing terminated a Uor below land surface requhea a vsdance In accor-
dance with 15A NCAC 2C.9I1
10. YIELD (gpm): p METHOD OF TEST
11. WATER ZONES (doplh)•
1:' HLORINATION; Type _ LLB —Amount 32 + i (1 S
1 . ,.ASING:
0
If additional space Is needed use hack of form
Wall Thickness LOCATION SKETCH
Depth � plametor jr /elo Vp. Maatteririaall (Show direction and distance from nl least Iwo Slate
Prom To ,� •FI. (p �f j - --+e- Rands, or other map ratorence points)
Ftom To It
From To Fl.
14, GROUT:
From Q
Teeth Materiel
Molltod ,
To �Fl �h2EfE (�ln`riP�y,+J--
From To Ft
15. SCREEN:
Depth Diameter Slot Size Material
From To II In In
From To FI In In
From To Ft In In.
I . SAND/GRAVEL PACK:
Depth Size Maleilal
Horn 1 To FI
From To FI
17. REMARKS:
Oplew ,
41-4.(athbc
I DO HEREBY C TITtFYTHAT THIS WELL WAS Cc&fIUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTIOk1 STyNEAf1DS, AND TIIAT A COPTOOHIS RECORD FIAS BEEN PROVIDED TO THE WELL OWNER.
r 1 OFFICE USE ONLY
Ljusd No:
Serial No.
7'
$1a Rl nE O- ERSON CONSTRUCTING TIIE WELL GATE
Submll odpinrl to Olv sion al Water Duality, Groundwater Section within 30 days
GW.I NEV. 12/99
-1

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mall Service Center - Raleigh, N.C. 27699-1636-Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR•
270093
RIRit/ ICE it W r/VES
WELL CONTRACTOR CERTIFICATION ": �4140
STATE WELL CONSTRUCTION PERMIT":
1. WELL USE (Check Applicable Box): ResldentlalE' Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other D If Other, List Use:
2. WELL LOCATIO S sw sketch of the location below) �r ^ ` )
�rearest Town:.
S16 0.�A.L� r . oa Avatlig
(Road Name ap Numbers, Commu�(�1y)�(or Subdlvlslo and Lot No.) DRILLING LOG DEPTH
3. OWNER l.d Di± 1'.1CAt_n QY/1p-.� From To Formation Descdpllon
lAddress t nLibill 19 Ir{ T
Q.eetor Houle e• a.gs)14 Q - 'bl/ �Ir�1'
City or Town State Zip Code
4. DATE DRILLED II•� �o
5. TOTAL DEPTH � 1
6. CUTTINGS COLLECTED YESn NON/
7. DOES WELL REPLACE EXISTING WELL? YES NOI vY
8. STATIC WATER LEVEL Below Top of Casing: FT.
(Use'+-11 Above Top of Casing)
9. TOP OF CASING IS 1 FT Above Land Surface'
*Top of casing terminated eVor below land surface requires a variance In accor-
dance with 15A NCAC 2C .0118
10. YIELD (gpm): 3 d METHOD OF TEST 1:?6
11. WATER ZONES (depth):
IN) - a45 Becgn
12. CHLORINATION: Type T-Ff-
1 'ASING:
Amount L. 3
1 raja
0
c)
rV
0
II additional space Is needed use back of form
rn
Wall Thickness LOCATION SKETCH
Depth' ^ , ` u Diameter or Weight/Ft. Maledal (Show direction and distance from at least two State
r
From 0 To D Fl. L D5 Vied W P C 5DR Roads, or other map reference points)
From To Ft. n ,�/
From To Ft
14GROUT: L,11CJji6di (/ ri
.
Depth Malarial Method , / / /p eittC
FrFromTo di O FI Gr]t•1CPI P i_ 'fin 7i /J „['/w,("� , y y /
From To FI.
15. SCREEN:
Depth Diameter Slot Size Material
From To Ft In In
From To Ft In In
From To FI In In
16. SAND/GRAVEL PACK:
Depth Size Material
From To FI
From To Ft.
17. REMARKS:
I DO HEREOY 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,
9c. •2J.; I-19- o g.
FOR OFFICE USE 4t4LYI
Quad Not
.at No.
Submit original top
t1 �
•
cr:rt
n
OF PERSON CONSTRUCTING THE WELL DATE
of Water Quality, Groundwater Section within 30 days
GW-1 REV. 12/99

1
North Carolina • Depanmonl of Environment and Natural Resources - Division of Water Quality - Groundwater Section 2 7 0 0 9
1636 Mall Service Center - Raleigh, N.C. 27699-1636-Phone [phone] - yy////__'' J�
WELL CONSTRUCTION RECORD WELL CONTRACTOR. A RmAN Z • 24.-7(.
WELL CONTRACTOR CERTIFICATION 0: o?D. rJ
STATE WELL CONSTRUCTION PERMITN:
1. WELL USE (Chock Applicable Box): Residential LJ Municipal ❑ Industrial D Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Infection ❑ Other ❑ If Other, List Use:
2. WELL LOCATIO (Show sketch of the location below)
crest Town: County'
c_NallluSb�t�Ob
j3/jnre mbe
( oad Name and Numbers, Coorrvnunlly, or Subdivision and Lot No.) DRILLING LOG DEPTH
( 3. OWNER cad") a5h From To Formation Description
Address 9 ��0,//y
Yinie
i • jSlreeZl or H6u(eAo 0 - /03 P,'K f -
n `� /03 -5 �rzd2ock
City or Town Stale Zip Code
4. DATE DRILLED ie_702
5. TOTAL DEPTH 2 5
6. CUTTINGS COLLECTED YESn NO171 o
7. DOES WELL REPLACE EXISTING WELL? YES n NOI co
8. STATIC WATER LEVEL Below Top of Casing: / /5 FT.
(Use'+' II Above Top of Casing)
9. TOP OF CASING IS ' FT Above Land Surface' 3
c--)
'Top of casing terminated et/or below land surface requires a variance In accor-
dance with 15A NCAC 2C .0118 —�
10. YIELD (gpm): 50 METHOD OF TEST R: 3
11. WATER ZONES (depth)• IN)
I' CHLORINATION: Type U 7H Amounts
CASING:
II additional space Is needed use back of form
m
Wall Thickness LOCATION SKETCH
Depth Diameter or w ight/Ft. Material (Show direction and distance from at least Iwo State
From D To Ft I,' a1 5 .2)t •f�/ T h[•aD& Roads, or other map reference points)
From To Ft
From To Ft.
14. GROUT:
Depth Material Method • den n, C.
From 0 To vP Ft OINNICP,E%i-pragak{��
From To FI.
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 Ft
From To FI
17. REMARKS:
0
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS. ANDS F THIS RECORD HAS BEEN PR IDED TO THE WELL WNER.
FOR OFFICE USE aNLY' - 1 (O4i'i*C- LA.-/ ?le -Oa.
Quad No: ' S MATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit orl lflal I) Division al Water Quality, Groundwater Section within 30 days
Serial No. - __, GW-1 REV. 12/99

North Cnrollnn Dnparimonl of Environment and Nolurnl Fleaourcaa - Dlvinlon of Wnler Cuellty • Oroundwnlor Section
1628 Mali Service Center - Flalaiph, N.C. 27699.16ae-Phone (919) 73a•3221 r (�
WELL CONSTRUCTION RECORD WELLCONTRACTOR• 3o %hr.\ OS. Yo4DLS
WELL CONTRACTOR CERTIFICATION 0: , [7a Q
STATE WELL CONSTRUCTION PERMITN:
270091
WELL USE (Check Applicable Box): Residential Li Municipal ❑ Industrial ❑ Agrlcullural ❑ Monitoring
Recovery ❑ Heal Pump Water In)ecllon ❑ Other n If Other, LIsl Use:
2. WELL LOCATION:
Nat �To�wn:
-51.- ` -Q4
(noed Name an
3. OWNER
Address
sketch of the location below)
County.
mbar', Cornmunliy, or Subd}�Ion and Lot No.)
^1L�all ;f )J4 72»fl
City or Town Slate
1. DATE DRILLED 7-18'O.r
TOTAL DEPTH ol-41.5.
CUTTINGS COLLECTED YES ( I NO 4
DOES WELL REPLACE EXISTING WELL? YESNO[4
i, STATIC WATER LEVEL Below Top of Casing: 0 FT.
(Use •d II Above Top of Casing)
I. TOP OF CASING IS I FT. Above Land Surface'
Top of ce, Ing tel •Uor below lend surface requires a variance In sccor-
mnce wllh 15A ((CAC 2C.Q is I.
0. YIELD (gpm): METHOD OF TEST Rt c
1. WATER ZONES (depth)• j
ILORINATION
3. L,ASING:
DRILLING LOG
Flom To
Zip Code �T - a s
DEPTH
Fommllon Descdpllon
II
pock,
``��--LLII
Type �1�_Amounl 1
l/1�� Depth
From-_5�--. To
From To
From To
4. GROUT:
!NJ
r —
CI CA
II additional space Is needed use back of form
WattThlcknesa LOCATION SKETCH
lameto f r'/yyvve a IiU{r). Material (Show direction and distance from nt least Iwo Stale
Ft ,LP Roads, or other map reference points)
Ft.
Ft
Depth Material Morrn(r IPY.a
From To �Q Ft aiRR
From To Ft
5. SCREEN'
Depth Diameter Slot Size Material
From To Ft In In
From To Ft In In
From To Ft In. In
6. SAND/GRAVEL PACK: Depth Size Slze Malarial
From To FI
From To Ft
0
7. REMARKS:
I DO HEREDY CgffTIFy THAT TITS WELL WAS COf
GONSTRUCTIONIISTA DAROS, AND TIIAT A COPY
1
R OFFICE USE ONLY
Uund No:
Serial No.
T GTED IN ACCORDANCE WITH 1SA NCAC 2C, WELL
IIS RECORD HAS BEEN PRO IDED TO THE WELL OWNER.
0 • //_ 7 l b' D
sic) $ ,i y nE of ERSON CONSTRUCTING TI IE WELL DATE
Submit orlulnallo Divll{lon el Miler ouatity, Groundwater Section wlihln 30 days
GW.t nEv. 12J99
)

City or Town / Slate zip Code
4. DATE DRILLED 9-1/9-0 a
5. TOTAL DEPTH -ROS-
E. CUTTINGS COLLECTED YES n NOk
7. DOES WELL REPLACE EXISTING WELL? YES NOr-
8. STATIC WATER LEVEL Below Top ol Casing: FT.
(Use 't' II Above Top ol 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 .0118
10. YIELD (gpm): /0 METHOD OF TEST RI q
11. WATER ZONES (depth): ✓�`'
12. CHLORINATION: Type 1 +' Amount - ' If additional space Is needed use back of form
1 ASING:
North Carolina - Department of Environment end Natural Resources - Division of Water Quality - Groundwater Section
1638 Mall Service Center - Raleigh, N.C. 27699-1636-Phone [phone] /
WELL CONSTRUCTION RECORD WELLCONTRACTOR• LJRIRN 71 �1 AW rNes
/'74D
WELL CONTRACTOR CERTIFICATION A:
STATE WELL CONSTRUCTION PERMITp:
1. WELL USE (Check Applicable sox): Residential 0' Municipal ❑ industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heal Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATI N: ( ow skweAtc'h, of the location below)L✓/� _
N %rest Town: LW�� Comnty �yY�IO
me ”1,DRILLING LOG DEPTH
cAKSLc�QLJS on and
Dali1 Jl Q z
(Road me y�/
3. OWNER /� K. //7.r Lit.k.( From To Formation Description
Address /{�/y/
^i'i/% fO SI el or Hou - A 8 Q 6 ,)/ I )
/ 2 r a,8787 -Ce - .QS BeAcda.1f1
CO
J
Depth Diameter
From 0 To Ft lo.Di
From To FI.
From To FI
14. GROUT:
From Q
From
15. SCREEN:
Wall Thickness
or Weight/Ft. Material (Show direction and distance from at least two State
alto ��5 Pbt-5D4
Depth Material
To a0 FI G11IG4iPTP
To FI
AMelhod
rite
LOCATION SKETCH
Roads, or other map reference points)
IV
r
rn
ca
-n
rn
Depth Diameter Slot Size Material ru
From To Ft In In
From To Ft In In 3
From To Ft In In — c.0
16. SAND/GRAVEL PACK: r y-o
Depth Size Material rn c
From To Ft Z
From To FI
17, REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
t
270088
c
FOR OFFICE USE ONLY
Quad No:
al No.
SIONATUF{Lrl PERSON CONSTRUCTING THE WELL DATE
- Submit odolnatto DWlakr{ of ler 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 2 / 0 0 8 6
1638 Mall Service Center - Raleigh, N.C. 27699-1636-Phone [phone] � (
WELL CONSTRUCTION RECORD WELL CONTRACTOR. RJAW k&:L% W;pes
WELL CONTRACTOR CERTIFICATION A: /540
STATE WELL CONSTRUCTION PERMITp:
1, WELL USE (Check Applicable Box): Residenllal Municipal ❑ Industrial £ Agricultural 0 Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ElIr Other, List Use:
2. WELL LOCATIO%(Spow sketch of the location below) �l ���/
N- -rest Town: Ct L da County' /I-J �-e
YY\Aad611.S. ka-0, n�S111Q hC__
(Roadame and.N mbo:,, communniily, or Subdlvlsjea and Lot No.) DRILLING LOG
3. OWNER u/¢. £JQQ• //( 101A (&4p• From To
Address , Cioj�j -D 0 -l�R
62-a85
City or Town Stale Zlp Code
4. DATE DRILLED 7 / 5-0 %i
5. TOTAL DEPTH A 8 S
6. CUTTINGS COLLECTED YES I I NO
7. DOES WELL REPLACE EXISTING WELL? YES NOI
8. STATIC WATER LEVEL Below Top of Casing: FT.
(Use'.' if Above Top of Casing)
9. TOP OF CASING IS I FT Above Land Surface'
•Top of casing terminated sUor below land surface requires a variance In accor-
dance with 15A NCAC 2C .011
10. YIELD (gpm): <1tr, METHOD OF TEST �) q
11. WATER ZONES (depth):
DEPTH
Formation Description
-I) ;Fit
BeA qnl
1\T
0
y
12. CHLORINATION: Type 4kt ±1 Amount p�U.9 If additional space Is needed use back of form
1 ASING: 1 - -
Wall Thickness
Depth Diameter or Weight/Ft. Material
From To g Ft Q)L 14F PYC-Spil
From To Ft.
From To Ft
14. GROUT:
Depth^
From 0 To r�7O
From To
15. SCREEN:
Material Method
Ft Go►1 G(iP�QsLFQ P 4 A1
Ft
Depth Diameter Slot Size Material
From To Ft In In
From To Ft In In
From To Ft In In
I6. SAND/GRAVEL PACK:
Depth Size Material
From To FI
From To Ft
17. REMARKS:
i
m
LOCATION SKETCH
(Show direction and distance from al least Iwo Slate
Roads, or other map reference points)
adozvd/
0
r<T
f1
Tx)
1 DO HEREOY 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.
r
FOR OFFICE UflY
Quad No:
.al No.
SIIQN RE OF PERSON CONSTRUCTING THE WELL DATE
Submit original Fla 1151on of Water Quality, Groundwater Section within 30 days
i GW-I REV. 12/99

North Carolina • Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mali Service Center - Raleigh, N.C. 27699-1636-Phone [phone]
WELL CONSTRUCTION RECORD
/}{
/ / 270084
WELL CONTRACTOR• RJ RW kg. /- W r /V E5
WELL CONTRACTOR CERTIFICATION #: /4740
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE (Check Applicable Box): Residential Municipal ❑ Industrial EJ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Infection ❑ Other 0 If Other, List Use:
2. WELL LOCATION: (/Show sketch of the location below) /
Nearest TOW11:
County Li/Y1 &Mr, C+1•-a.—
LL
j4 Y`I&.adc(wS
(RoaaName and%Ulumbepr, Communlly, or Subdivision d Lol No.)
L� 3. OWNER I\• . , 1aiut,
Address a
YY\n
^^. tflw K J .
L `Q rLLoula o c a 87 81
Clly or Town Slate Zip Code
4. DATE DRILLED 7'I I -O%-•
5. TOTAL DEPTH a
6. CUTTINGS COLLECTED YES [ j NO
7. DOES WELL REPLACE EXISTING WELL? YES (( NO['V.
8. STATIC WATER LEVEL Below Top of Casing: cTTFT.
(Use'+' II Above Top of Casing)
9. TOP OF CASING IS 1 FT Above Land Surface'
•Top of casing terminated oUor below land surface requires a variance In accor-
dance wllh 1SA NCAC 2C .0118
10. YIELD (gpm): 3Q METHOD OF TEST -R) q
11. WATER ZONES (depth):
DRILLING LOG DEPTH
From To
Formation Description
fit
g ( _a S VELAN
12. CHLORINATION: Type IL Amount S a_ U8
1 ASING; 1
Wall Thickness
Depth —an
Diameter or WeIghUFi. Maledal (Show direction and distance from at least two State
From To --8'1 FI loa ell aI(w j^i5 Tht-SDQ Roads, or other map reference points)
J
r
T -
IV
.c-
If additional space Is needed use back of form
From To Ft.
From To Ft.
14. GROUT:
Depth Material
From 0 To aQ Ft r oaCSIP. -P
From To Ft
15. SCREEN:
Method
Depth Dlarneter Slot Size Material
Frorn To Ft In In
From To Ft In In
From To Ft In. In
16. SAND/GRAVEL PACK:
Depth Size Materlal
From To Ft
From To Ft
17.REMARKS;
LOCATION SKETCH
I DO )IEREDY 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 OFFIC_ U3 ONLY ' ---- ► , h� 1/4A1%L 1— /'O r�
Quad No ATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit odgl'laa�II Division of Water Quality, Groundwater Section within 30 days
.al No.l LJf GM REV. 12/99

1
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mall Service Center - Raleigh, N.C. 27699-1636-Phone [phone]
270080
WELL CONSTRUCTION RECORD WELL CONTRACTOR.
N; RmA/✓ L. 2,4•LL.
WELL CONTRACTOR CERTIFICATION M: o?®A 7
STATE WELL CONSTRUCTION PERMITM:
1. WELL USE (Check Applicable Box): Residential r- Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heal Pump Water Infection ❑ Other If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below) ,,��� y,,,
Nearest Tow
1 �- County �l%Yl llJt"1'�L.X
kxrn(.Jn ,W(
kfLo 0` ad Narr and Numbers. Community, or Subdivision Lot No.) DRILLING LOG DEPTH
3. OWNER Dean Ed wr rcdS From To Formation Description
Address T. Q.
ee or FiouleN .)'
W Vervi1le C. ai-nrr
Cliy or Town State Zip Code
4. DATE DRILLED M-49"in'a'
5. TOTAL DEPTH 350
6. CUTTINGS COLLECTED YES ll NO[4
7. DOES WELL REPLACE EXISTING WELL? YES 1n NO vf
8. STATIC WATER LEVEL Below Top of Casing: ()C) FT.
(Use'.' if Above Top of Casing)
9. TOP OF CASING IS 1 FT Above Land Surface'
*Top of casing terminated eVor below land surface requires a variance In accor-
dance with 15A NCAC 2C .0118
10. YIELD (gpm): 'ol t/-METHOD OF TEST �.
11. WATER ZONES (depth):
l CO ' ?SD 73r--cizgck
0
0
N
4-
1 o CHLORINATION: Type rf T!r Amount ICC) -l(.S If additional space Is needed use back of form
3ASING: -
Wall Thickness LOCATION SKETCH
Depth Diameter or W IghUFt. ;1Material (Show direction and distance from at least two State
From D To 100, FI. G ..:1 5 a,?l t.1s5 PVC'S0c Roads, or other map reference points) 0
From To Ft.
From To FI
14. GROUT:
Depth Material Method
From D To AO Ft f'y/YCPkiE _plOu,Ltd,_.
From To FI
15. SCREEN:
Depth Diameter Slot Size Material
From To Ft In In
From To FI In In
From To FI In In
16. SAND/GRAVEL PACK:
Depth Size Material
From To FI
From To FI
17. REMARKS:
1 1 frig la'. _v
Wed v�vi Ik, M
r
Ul
I -VC
n
0
s
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY FTHIIS RECORD HAS BEEN PR IDED TO THE WELL WNER.
FOR OFFICE ulSE ONLY, --_ YZg///�'YLCi(�� �J GtXiC__7.-q -07
quad No: I �0 is TUBE OF PERSON CONSTRUCTING THE WELL DATE
Submit original lot Division of Water Quality, Groundwater Section within 30 days
1 dedal No. I'. GW-1 REV. 12/99

North Carolina • Department of Environment and Natural Fleeourcee - Dlvlelon of Wnler Quality • Groundwater Socllon
1636 Me/1 Service Center - flalolph, N.O. 27699-1636-Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR' 3D bhr OS. 90‘14S
WELL CONTRACTOR CERTIFICATION 0: --g y7a,'
STATE WELL CONSTRUCTION NERMITMP
WELL USE (Check Applluble Box): Residential1 Municipal CI Industrial I] Agricultural ] Monitoring O
Recovery [1 Heal Pump Water Injection ❑ Other El If Olhor, List Use:
2. WELL LOCATION:/('$)flow sketch of he be ti nn below)
oncost To n• • e' / 4 �"�`�' Courtly e
' \c
(load Name and : Lire, Community,
e, Co uniy, •r ubdlvlslon And Lot No.)
3. OWNER /4/1 17
ior
Address �/ L
1 �r llOula �A reo
(4 3 VOG
CI- ly or Town Slate Zip Code
5. DATEDRILLED
TO
5. TOTAL
L DEPTH yyf
6. CUTTINGS COLLECTED YES I NO vr
7, DOES WELL REPLACE EXISTING WELL? YES I I NOM
6. STATIC WATER LEVEL Below Top of Casing: 7e-- FT.
(Use'.' II Above Top of Cn,Inp)
9. TOP OF CASING IS I FT, Abovo Land Surlace'
'Top of car In ler minaled iUor below lend surface requires a variance In accor-
dance wllh 15A NCAC 2C. 11i
10, YIELD (gpm): PN METHOD OF TEST
11. WATER ZONES (depth):
DRILLING LOG DEPTH
Fomallon Descdpllon
From To
CO
0
119
1 'HLORINATION: Type N T Amount"ile{ i I s It additional space Is needed use hack of form
I:,. ,ASING:
Wall Thickness
'T P J
From � DToll4 -PI .is'AQ ril��elp�V� M,LCi:�lic
From To FI.
From To FI.
14. GROUT:
Depth Malarial Mol_ hod ,
From _,c�S.L_To-�.-Q_FI �tjRE�g�OKele
Frorn To FI
15. SCREEN:
Doplh Diameter Slot Slzo Materlol
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
LOCATION SKETCH
(Show direcllon and distance from nl least Iwo Stale
r0
Roads, or other map reforence polies)„ /] ��!Q rrt
Jam A.PA-dr
lets vc
.c
T
270079
C
c
17. REMARKS:
I D0 HEREDY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 1SA NCAC 2C, WELL
CONSTRUCTION STANDARDS,. AND. TUCATA.OPY OF TH S RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
r R OFFICE USE;ONLt
and No: SI9�AiUTE OF P.EITSON CONSTRUCTING TIIE WELL DATE
Subnlli original fp 7ilfiln of Wirer Ousllly, groundwater Section within 30 days
Serial No. I__,-1I GW'I nEV. 12/99
1

1
North Carolina • Department of Environment end Natural Resources - Division of Water Quality • Groundwater Section
1636 Mall Service Center- Raleigh, N.C. 27699-1636-Phone [phone]/jam'
WELL CONSTRUCTION RECORD WELL CONTRACTOR. XL' RnAN C • 2A-ZL.
WELL. CONTRACTOR CERTIFICATION It: 0 0A 1
STATE WELL CONSTRUCTION PERMIT":
270077
1. WELL USE (Check Applicable Box): Residential U Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATION:,(Show s etch of the location below)
areal Town. Leif:.' 7? County: NirroirYettj
..� OF ' cA_a rC_
(Road D e Vow)",
Community, or Subdivision and Lot No.) DRILLING LOG DEPTH
3. OWNER VVVo /)P Peziycn From To Formation Description
Addressfrlb
t/�,r�� ,p`
1e, ee tpr reel or Ronc. r
City or Town i slate
4. 5. TOTAL DEPTH
DATE DRILLED Me
6. CUTTINGS COLLECTED YES n NOI4
7. DOES WELL REPLACE EXISTING WELL? YES in NOI
8. STATIC WATER LEVEL Below Top of Casing: 50 FT.
i (Use 'a' II Above Top of Casing)
9. TOP OF CASING IS FT Above Land Surface*
'Top of casing terminated at/or below land surface requires a variance In accor-
dance with 15A NCAC 2C .0118
10. YIELD (gpm) 5 METHOD OF TEST R.
11. WATER ZONES (depth)•
Zs7y8
0-42
4a -3ePt�
BE-4Rpck
0
10 CHLORINATION: Type 1"I 771 Amount MAS If additional space Is needed use back of form
From
From To Ft
From To Ft.
14. GROUT:
U1 1
Wall Thickness
Depth Diameter or Weight/Ft. Maledal
0 To FI G ' a 5 ?)t ./J`L PVC•SUie
Depth Material Method ,
From b To AO FI 1^v1YC2EiE ']j'1`nr'r"p"=�„��-'
From To FI
15. SCREEN:
Depth Diameter Slot Size Material
From To FI In In
From To FI In In
From To FI In In
16. SAND/GRAVEL PACK:
Depth Size Material
From To Ft
From To Ft
17. REMARKS:
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other map reference points)
fnE(u�nd
e t cg-te'`f .C�.
I DO HEREBY CERTIFY THAT THIS WELL WAS CON TRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION -STANDARDS, AND THAT A c • e F THIS RECORD HAS BEEN PR IDED TO THE WELL WNER.
j FOR OFFICE USA ONLY
I ' 00/r`n.�L,�. / a_ 7- � -oa
'luad No: Sitt ATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit odpl j eivlslon of Water Quality, Groundwater Section within 30 days
GW-I REV. 12/99
( dedal No.

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 WELLCONTRACTOR• {JRIAW 1L�/L�l Cu-lip/Es
WELL CONTRACTOR CERTIFICATION P: /1740
STATE WELLCONSTRUCTION PERMIT#:
1. WELL USE (Check Applicable Box): Residential E' Municipal 0 Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Infection ❑ Other El If Other, List Use:
2. WELL LOCATION(fSShow s-Ne Ik tcll of the location below)
rl Town: ` a r d V a h� County' C_B
�Pac.A 42dif CCdu.e
(Road Name and lfymbers, Comm wll�, or Subdivision and of No.) DRILLING LOG DEPTH
3. OWNER
Address
rc n cGJ
6 . _1� 15 1
{'Ireal or Hau a o.) c. A 2 11 5
It or Town ( Stale-1�\r Zip Code
4. DATE DRILLED=moo 2-
5. TOTAL DEPTH � �_
6. CUTTINGS COLLECTED YES I I NOIyra
7. DOES WELL REPLACE EXISTING WELL? YES n NO{'
8. STATIC WATER LEVEL Below Top of Casing: „;(l FT.
(Use Y- II Above Top of Casing)
9. TOP OF CASING IS 1 FT Above Land Surface'
•Top of casing terminated at/or below land surface requires a variance In accor-
dance with 1SA NCAC 2cy .0118
10. YIELD (gpm): to.o METHOD OF TEST M) q
11. WATER ZONES (depth)'
From To Formation Description
3B - l3�f5 it
BeAn c-frS
12. CHLORINATION: Type 41T41-
1 ASING:
Depth Diameter
From 0 To Ft. L. D5
From To Ft.
From To Ft
14. GROUT:
Depth Material Method
From C To r�0 PI Go►IGfi e-.�P latuatej
From To Ft
15. SCREEN:
Depth Diameter Slot SIze Material
Frain To Ft In In.
From To Ft In In
From To Ft In In
16. SAND/GRAVEL PACK:
Depth Size Material
O
r)
N
O
:v
rs
Amount sasCr1115 II additional space Is needed use back of Iorm
Wall Thickness
or Weight/Ft. Material (Show direction and distance from al least two State
0716 1; i PYC sDR Roads, or other map reference points)
From To Ft
From To Ft
17. REMARKS:
LOCATION SKETCH
fIkch oak.
1 c.
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 PROVIDED TO THE WELL OWNER.
1,
FOR OFFICE USE ONth'
Quad No:
dal No.
-, z/. (-7- a5-8
-sto, A or, E OF PERSON CONSTRUCTING THE WELL DATE
Submit original to DI I Ihn of Water Quality, Groundwater Section within 30 days
j� GM REV. 12/99
27007,i
c
rTh

North Carolina - Department of Environment and Natural Resources - Division of Water Quallty - Groundwater Section 2 (0 0 / , )
1636 Mali Service Center - Raleigh, N.C. 27699-1636-Phone [phone] �K1 N k/
WELL CONSTRUCTION RECORD WELLCONTRACTOR• V/RIF4E/LA W i yES
WELL CONTRACTOR CERTIFICATION 0: /1740
STATE WELLCONSTRUCTION PERMIT#:
1. WELL USE (Check Applicable Box): Residential Municipal ❑ Industrial I-1 Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other El If Other, List Use:
2. WELL LOCATION: Air 0‘
sketch of th= location below)
Nearest T wn: airs • �A A - A_ County:
40 10
00 r AA-- InC,
(Road Name end.l{QTtbers. Co/m�mu Ily, or division and Lot No.) DRILLING LOG DEPTH
3. OWNER entrees. b_P From To Fonnatlon Description
tSerr ° ; -n C . a8i01
City or Tow/ n Slate y Zip Coda
4. DATE DRILLED i-.a
5. TOTAL DEPTH r p ,/
6. CUTTINGS COLLECTED YES I NON/
7. DOES WELL REPLACE EXISTING WELL? YES n NO�
8. STATIC WATER LEVEL Below Top of Casing: /�) FT.
(use's• II Above Top of Casing)
9. TOP OF CASING IS FT. Above Land Surface'
•Top of casing terminated at/or below land surface requires a variance In accor-
dance with 15A NCAC 26.1118
10. YIELD (gpm); METHOD OF TEST �) q
11. WATER ZONES (depth):
Address
(pg —5g6 BIelgc.$
12. CHLORINATION: Type 1}TTf Amount
1 'ASING:
J
0
--25—r2111.5 If additional space Is needed use back of form
N
Wall Thickness
SKETCH
Depth/n Q Diameter or Weight/Ft. Material pp (Show direction and distance from at leas) Iwo State
From To `e " Ft " Vie.I �G�'SDs! Roads, or other map reference points)
From To Ft raid Q , iN
From To Ft ll„`�J\'a_
14. GROUT:
Depth Material + Melitod
From DeTo a0 R C o►1 erial P met. e�
From To Ft
15. SCREEN:
Depth Diameter Slot Size Material
From To Ft In In
From To Ft In In
From To Ft In In
16. SAND/GRAVEL PACK:
Depth Size Material
From To Ft
From To Ft
17. REMARKS:
(l1
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 PROVIDED TO THE WELL OWNER.
FOR OFFICE CEU'EO LY 1117 1"( '",1%I' 7' 95''d?
Quad No: - - -SI N Jf, JRE OF PERSON CONSTRUCTING THE WELL DATE
Submit originilh 1 )slon of Water Quality, Groundwater Section within 30 days
.al No. 1 !! L. I GW-1 REV. 12/99
1
n

North Carolina - Department ol Environment and Natural Resources - Division of Water Quality - Groundwater Section 270072
1638 Mall Service Center - Raleigh, N.C. 27699-1638-Phone [phone] / r
WELL CONSTRUCTION RECORD WELLCONTRACTOR• "BR)AN kL- W )yES
WELL CONTRACTOR CERTIFICATION 0: /540
STATE WELL CONSTRUCTION PERMIT":
1 WELL USE (Check Applicable Box): Residential Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other [] II Other, List Use:
2. WELL LOCATION :,($ how sketch of the location below)
rest Town: County:
QGti( 4irrcutm C
(Road Nam1-apd.Numbers. Commune or Subdivision and Lot No.) DRILLING LOG
3. OWNER LQ7�- lii1tt (% 1 - Q� From To
Address
dimanumit Dula
City or Town Stale
5. DATE DRILLED
5. TOTAL DEPTH
6. CUTTINGS COLLECTED YES[ j NOkr� ✓
7. DOES WELL REPLACE EXISTING WELL? YES InN
NO I
8. STATIC WATER LEVEL Below Top of Casing: ,'jn FT.
(Usa '+' II Above Top ol Casing)
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 with 15A NCAC 2C/0p11
10. YIELD (gpm): (P ti METHOD OF TEST ri 1q
11. WATER ZONES (depth): `J
a
DEPTH
Formation Description
33-/05 B`ciRi
cS7lid
12. CHLORINATION: Type AM__ Amount
1 'ASING:
0 DepthDiameter2 Dlametar ���� �n� a
From To d "' Ft tb* Z5 saes a, . Pro-soq
From To Ft
From To Ft
1h. GROUT:
Depth Material Method ,
From Q To a0 FI Go►Gf I1E.�P � p4 Ed
From To Ft
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
From To
From
17. REMARKS:
FI
To Ft
Size Material
Wall Thickness
or WeIghVFI. Material (Show direction and distance Irom et least Iwo State
Roads, or other map reference points)
'EL- cif glak &?it
If additional space Is needed use back of form
LOCATION SKETCH
CT
CO
rn
rn
h)
0r
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
FOR OFFICE LISIE't LY
ouad No:
4a1 No.
10
Submit od061 I Ic
Li
1‘. o 7-aq-69,
ATURE OF PERSON CONSTRUCTING THE WELL DATE
=lvston ol Water Quality, Groundwater Section within 30 days
GW-1 REV. 12/99

North Carolina - Department of Environment and Natural Resources - Division of Water Quality • Groundwater Section
1636 Mall Service Center - Raleigh, N.C. 27699-1636-Phone [phone] / r
WELL CONSTRUCTION RECORD WELL CONTRACTOFI• R) :i h WINES
/'74D
WELL CONTRACTOR CERTIFICATION #:
STATE WELL CONSTRUCTION PERMIT#:
270071
1. WELL USE (Check Applicable Box): Residential
Recovery ❑ Heat Pump Water Infection ❑
2. WELL LOCATION: (Show s(s )ch of the location bet
N esl Town: WPavP. InV i t/ e
g
Municipal ID Industrial 1-1Agricultural❑ Monitoring ❑
Other El If Other, List Use:
ow) ��]"
county' !yl romb e
(Road Name and Numbers,��C^^om�munity, or Subdivision end Lot No.)
3. OWNER 61 Core
Address �© ,(7 f* %
S rea or Houle o.
l(rVlile .C,
City or Town Stale
4. DATE DRILLED
5. TOTAL DEPTH —,'
6. CUTTINGS COLLECTED YES( I NOW
7.
8. STATIC WATER LEVEL Below Top of Casing:
DOES WELL REPLACE EXISTING WELL? YES
Zip Code
DRILLING LOG
From To
DEPTH
Formation Description
rs��5 Bfela'i
NO[--••
Fr. c,b
(Use Y' II Above Top of Casing)
9. TOP OF CASING IS I FT Above Land Surface'
-Top of casing terminated atior below land surface requires a variance In accor-
dance with 15A NCAC 2C .0118
10. YIELD (gpm): METHOD OF TEST
11. WATER ZONES (depth): ✓
12. CHLORINATION: Type rtT ry Amount 3� �.118
7" ASING:
Depth
From 0 To Ft
From
From
14. GROUT:
From C
From
15. SCREEN:
To FI
To FI
Depth
To 0 Ft
To FI
Wall Thickness
Diameter or Weight/Ft. Material R (Show direction and distance from at least two State
Vie. 1^
L 5 flocSpfi Roads, or other map reference points)
r finer
Material Method /,9eatie rv1/`e z / • "
Cat PiC 4jPtrP lataaltext
—J
0
rV
If additional space Is needed use back of form
cJ1
Depth Diameter Slot Size Material
From To Ft In In
From To Ft In In
From To Ft In. In
16. SAND/GRAVEL PACK:
Depth Size Material
From To Ft
From To Ft
17. REMARKS:
LOCATION SKETCH
c
I DO HEREDY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A CO OF THIS RE OFI HAS BEEN PROVIDED TO THE WELL OWNER.
FOR OFFICE"'
Quad No:
I
NATURE OF PERSON CONSTRUCTING THE WELL DATE
Division of Water Quality, Groundwater Section within 30 days
GW-1 REV. 12J99

North Cm -cline Department al Envlronmenl and Natural Resources - Division of Water Duality • Groundwater Section
1036 Mall Service Center - Raleigh, N.C. 27699.1636-Phono (919) 733,3221
270068
3. OWNER
Address
WELL CONSTRUCTION RECORD WELL CONTRACTOR•
WELL CONTRACTOR CERTIFICATION 0:
Pe s
��a A
STATE WELL CONSTRUCTION VER MITM:
1. WELL USE (Check Applicable Box): Flesidenllal ls/ Municipal EJ industrial (] Agrlcullural
Recovery ❑ }-foal Pump Water Injection Ej Other If Other, List Use:
7M i ���/ lh� L(O'J)"J
/ (nee( or oua U
L a d�� 'r7 r . A.77/5
Clly or Town Slate Zlp Code
4. DATE DRILLED
5. TOTAL DEPTH M±
6. CUTTINGS COLLECTED YES I I NO
7. DOES WELL REPLACE EXISTING WELL? YES O NOM
8. STATIC WATER LEVEL Below Top of Casing: FT.
(Use 'r' I1 Abovo Top of Casing)
9. TOP OF CASING IS I FT Abovo Land Surface'
•Top of ca s Ing ler mineted sVor below land surface requires a variance In eccor.
dence wlih 15A NCAC 2C .9118
10. YIELD (gpm): (o . METFIOD OF TEST
11. WATER ZONES (depth):
I1
Monitoring ❑
2. WELL LOCATION• �ho/y/,' �skelclr of the location below) �.(f. --CC7�
Nearest Town: � 1Jl� � County, �,JuiT7
abt_e PC.
Mond Name And Nymbar d Corwnunitynor, Subdivision And Lot No.) DRILLING LOG
From To
.� -
DEPTH
Fomre lion Description
P4r !c.
f
O
N
u
rs
1
1 'FILORINATION: Type Sail__
1 J�L�—AmounlaIf additional space Is needed u5o hack of loan
Ia. CASING:
Wall TI Ickness
Depth 1a11e r ale IuF1.�vc solz
From v To $ -FI IJ
From
From
14. GROUT:
To FI
To FI.
Depth Malarial Method ,
From 0 To .��FI. Cba2EiF J]"�_-IT_-�"�{"
Ram To FI
15. SCREEN:
Depth Diameter Slot Site Malarial
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.
LOCATION SKETCH
(Show direction and distance Irorn nl least two Stale
Bonds, or other map tofu/once points)
17. FlEMARI(S:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
GONST RUCTIgFI STANDARDS, AND TT ITT A -COT'( •y.(. [MIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
r
R OFFICE USE ONLY
Ouad No:
Serial No.
S
Submll origins
TUITE OF ERSON CONSTRUCTING TIIE WELL
vision of Writer Quality, Groundwater Section within 30 days
DATE
GW.l nEv. 12/99
c;

ry C 'y
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section 2 ( 0 0 U f
1636 Mall Service Center - Raleigh, N.C. 27699-1636-Phone [phone] ,/ /
WELL CONSTRUCTION RECORD WELL CONTRACTOR t(J R) F}N Tl l% W /V ES
WELL CONTRACTOR CERTIFICATION #: /'7`0
STATE WELL CONSTRUCTION PERMIT#:
WELL USE (Check Applicable Box): Residential R Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring 0
Recovery ❑ Heal Pump Water Injection n Other D If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below) {�
Nparest Tow : l/*°CLVCrVr Ile • County' 8v& 1-ine°1'
6.0.K Ed.. a k jtt-e1 kl C.
(Road Name and.Numbers, Community, or Subdivision and Lot No.) DRILLING LOG DEPTH
3. OWNER AnelerS-,p rnryrrly } hm° COorlof 'lob) From To Formation Description
Address /
2 l - (S rl ea! ar Route No.)
Alehgliilie 1D.G.
Stale
City or Town
a53R©�
Zip Code
3�1y5 ;Fit
-c-i
4. DATE DRILLED TO-
6. TOTAL DEPTH
6. CUTTINGS COLLECTED YES ri NOILe'
7. DOES WELL REPLACE EXISTING WELL? YES f] NO[V-***
8, STATIC WATER LEVEL Below Top of Casing: % FT.
(Use •+' If Above Top of Casing)
9. TOP OF CASING I5FT. Above Land Surface'
•Top of casing terminated at/or below land surface requires a variance In accor-
dance with 15A NCAC 2C .ef 16 �
10. YIELD (gpm): 7 METHOD OF TEST ri)
11. WATER ZONES (depth): •J
12. CHLORINATION: Type MT4-
1' ,ASING;
0
-,r
0
llAmount—/Licll•y3 II additional space Is needed use back of loan
rV
Wan Thickness LOCATION SKETCH
Depth7, Diameter or WeIghVFt. Material (Show direction and distance from at least two Slate
From 0 To —.1E7— Ft for e7tL-. j PY&sfQ Roads, or other map reference points)
From To Ft
From To Ft
14. GROUT: L©w'er F(cnL Creei
Depth Material Method
From 0 To QO FI !'n!lGIjP�P l.',._-,'�9�-gaJ'
From To FI
15. SCREEN:
Depth Diameter Slot Size Malerlal
Frorn To Ft In In
From To Ft In In
From To Ft In In
16. SAND/GRAVEL PACK:
Depth Size Material
From To Ft
From To Ft
17. REMARKS:
t ayerv'i)e t).C.
r
u7 c
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COOY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER,
FOR OFFICE 1SE'QNLY
Quad No: ! I
al No.
I TURE OF PERSON CONSTRUCTING THE WELL DATE
Submit origin I I (vision of Waler 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.C. 27699-1636-Phone [phone] �}{1 /
WELL CONSTRUCTION RECORD WELLCONTRACTOR• /RI4N kW E/LA /NES
WELL CONTRACTOR CERTIFICATION ft: /A740
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE (Check Applicable Box): Residential � Municipal P1 Industrial El Agricultural CD Monitoring ❑
Recovery El Heat Pump Water Injection ❑ Other (J If Other, List Use:
2. WELL LOCATI •N: (Show sketcl of the location below) r ,
Nazrest To
(R ad ame an Numbers
3. OWNER
Address
r
oL1n
un)ryor Sub
Iv�on and Lot o.)
a VIA
/Oq /
A V (sheet or Hou�eo.) a
5Lk�7,/Y i C.�Q..S'/Ey�
City or Town _ Stale Zip Code
4. DATE DRILLED 5' J-I-` b3--
5. TOTAL DEPTH 3 n $
6. CUTTINGS COLLECTED YES ri NO'
7. DOES WELL REPLACE EXISTING WELL? YES I I N0
6. STATIC WATER LEVEL Below Top of Casing: / /5 FT.
(Use '+' 11 Above Top of Casing)
9. TOP OF CASING IS 1 FT Above Land Surface'
•Top of casing terminated at/or below land surface requires a variance In accor-
dance with 15A NCAC 2C 011e
10. YIELD (gpm): /OO METHOD OF TEST �1 q
11. WATER ZONES (depth):
DRILLING LOG DEPTH
From To Formation Description
r
I Iq� - 36 s VeAn
0
rn
•
-v
270064
c
12. CHLORINATION: Type LLTTt Amount a If additional space Is needed use back of form Iu L.-)
1 'ASING: -
Wall Thickness LOCATION SKETCH u1 ,-
--
Depth Diameter or Weight/Ft. Matedal (Show direction and distance from at least two State
From 0 To Ft. L. S a)I^• 15 PVC-5D6. Roads, or other map reference points)
From To Ft.
From To Ft.
14. GROUT: c
Depth Material Mot! �� 4 C. • 0
From 0 To c7, O FI G►1 oC fiPP 0 nr,
From To FtEj T�;f,
15. SCREEN: T7N;,_
Depth Diameter Slot Size Material
Frorn To Ft In In arm
From To FI In In _
- o .
From To Ft. In In •' "''
r
16. SAND/GRAVEL PACK: ch 5
Depth Size Material
From To FI
From To FI.
17. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER,
FOR OFFICE USE ONLY
Clued No: II
.al Na._
_.Z-1• erg ,5"- 3/ - 0
SIG OF PERSON CONSTRUCTING THE WELL DATE
Submit odglnal to vl i4 of Water Quality, Groundwater Section within 30 days
GW1 REV. 12/99
J

270060
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mali Service Center - Raleigh, N.C. 27699-1636-Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR:
WELL CONTRACTOR CERTIFICATION IS: a7E9A 7
STATE WELL CONSTRUCTION PERMITS,:
Al RmAN t . 24-(1
1. WELL USE (Check Applicable Boa): Residential E2 Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heal Pump Water Injection ❑ Other (j If Other, List Use:
2. WELL LOCATIeON: (Showy sketch of the location below)
Nearest Town: ..$a i jc ee_"S/t t ''7'" County L3 LE, C.nrv\ LC.
U V -ta X{N
(Road Nann.p Numbers. C((o�rnmunil/, or Subdivision and Lot No.) DRILLING LOG DEPTH
3. OWNER Aid L3ndlIn Acli From To Formation Description
Address ---p,p -Bni 1II
ri
(Slree[or oule oT)
;JP, in. rtrr> NC' a27'IS
Cily or Town Stale Zlp Code
4. DATE DRILLED 1 i- 9- 0 a
5. TOTAL DEPTH I -INS
6. CUTTINGS COLLECTED YES n NO14
7. DOES WELL REPLACE EXISTING WELL? YES n NOI A
8. STATIC WATER LEVEL Below Top of Casing: I'10 FT.
(Use's II Above Top ol Casing)
9. TOP OF CASING IS 1 FT. Above Land Surface'
'Top of casing terminated ,Vor below land surface requires a variance In accor-
dance with 1SA NCAC 2C .0118
10. YIELD (gpm): .DC? METHOD OF TEST R: 3
11. WATER ZONES (depth): r�
' ^ CHLORINATION: Type )4 7H Amount `1%_ptIlS If additional space Is needed use back of form
CASING:
0 - 'iLin BE -the -oak
IV
Wail Thickness
Depth Diameter or WWIghVFI, Material
From 0 To _nip_ Ft L • a 5 414.1aS Puc•SDR.
From To Ft
From To FI
14. GROUT:
Depth Material Method ,
From v�- � To 0 FI etreCPkiE "")j'�O_rr'Q.E__�
From To FI.
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 Ft
From To Ft
17. REMARKS:
LOCATION SKETCH
(Show direction and distance from al least Iwo Stale
Roads, or other map reference points)
Willowr
La
ire
rV
v7
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 PRQ)/IDED TO THE WELL WNER.
FOR OFFICE USgr ONLY .044i/LeALA_/
quad No: i I) SI Nt'
Submit odglnil Y
I Sedal No.
L
RE OF PERSON CONSTRUCTING THE WELL DATE
on ol Water Duality, Groundwater Section within 30 days
OW-1 REV. 12/99

North Caroline - Department of Environment and Natural Resources - Division or Water Duality - Groundwater Section 270056
1636 Mall Service Center - Ralelph, N.G. 27699-1636-Phone [phone] /
WELL CONSTRUCTION RECORD WELL CONTRACTOR. R1AW kE/ A w)NES
WELL CONTRACTOR CERTIFICATION #: P740
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE (Check Applicable Box): Residential Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Infection ❑ Other Ej If Other, List Use:
2. WELL LOCATION: (S 6dr sketch o the location below) ��/l��t £' I - _�n I
jNe rest Town
/County tun [ 4_4_
(Road Name ant Numbers, Communl r SubdIvIsJon and Lot No.) DRILLING LOG
3. OWNER Y /en- en
Address
I,�' I reel orr -ou
f1.` City oor_Twown/aLL^/1 I i i Stale
4. DATE DRILLED I1" 1.0•h a.
5. TOTAL DEPTH a 4 5
5. CUTTINGS COLLECTED YES ] NOV
7, DOES WELL REPLACE EXISTING WELL? YES O NOVI/
6. STATIC WATER LEVEL Below Top of Casing: FT.
(Use -1- II Above Top of Casing)
9. TOP OF CASING IS 1 FT. Above Land Surface'
'Top of casing terminated et/or below land sudace requires a variance In accor-
dance with 1 SA NCAC 2C .0118
10. YIELD (gpm)• j METHOD OF TEST t<a 3
11. WATER ZONES (depth):
12. CHLORINATION: Type _InaAmount9A� If additional space Is needed use back of form
13. CASING:
From To
DEPTH
Formation Description
L/ . 'c7 S (fie vl
0
ca
0
Zlp Code I
Wall Thickness
Depth Diameter or�)�'9" M. ShR.
From 0 To � Ft
From To Ft.
From To Ft.
14. GROUT:
Depth &Material M©Mod
From 0ToDe FI l.-��VCPEfE -ITip_/ipr_�
From To FI
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 Ft.
LOCATION SKETCH
(Show direction and distance from at least Iwo State
Roads, or other map reference points)
(a
—D
17. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
zrH 116-62
FOR OFFICE US�OttILYr..
Clued No:
Serial No
11
NATURE OF PERSON CONSTRUCTING THE WELL DATE
Division of Water Duality, Groundwater Section within 30 days
OW-1 REV. 12/99

North CnrolInn • Oopertmonl of Environmonl and Natural Fleeourcoa - Div!,lon of Water Quality - Groundwater Section
1636 Mall Service Center • flelalph, N.C. 27699.1636-Phone (919) 733•3221
WELL CONSTRUCTION RECORD WELLCONTRACTon• BD tinL, J. 95)‘71-4-S
WELL CONTRACTOR CERTIFICATION,:
270053
(0ag
STATE WELL CONSTRUCTION PERMIT,:
I. WELL USE (Check Appllc.ble Box): Residential LtO Municipal I i Industrial n Agricultural I I Monitoring L I
Recovery ❑ Float Pump Water Injection n Other n If Other, List Use:
WELL LOCATION: {$how sketch of the location below)
)1.11-br-t-A-3— County. 2(1/Yl�'CFWI�
Numbo,e, Convn*illy, or Suubdlvll.sllonp a nd Lot No.)
(a-M/1.A .C-ram .
CT or Town Slate Lp Code
1, DATE DRILLED 1;-15. TOTAL DEPTH c •
•
6. CUTTINGS COLLECTED YES( I NO1 ✓f
7. DOES WELL REPLACE EXISTING WELL? YES NOS(
8. STATIC WATER LEVEL Below Top of Casing: Q ET.
(Use 'i' ll Above Top of Casing)
U. TOP OF CASING IS 1 FT. Above Land Surface'
'Top of caning lei mineled sUor below find surlece requires a variance In eccor-
dence with 15A NCAC 2C.4116 e
10. YIELD (gpm): Le__ METHOD OF TEST I 1 11. WATER ZONES (depth):
DRILLING LOG DEPTH
Fram To Fomellon De s crlpllon
o -15(e
/5&' - aas
ry
12. CHLORINATION: Type—AmounlS5 f i (1 S If addlllonal space Is needed use back of form
13. CASING:
Wall Thlcknese
Denali,.plaem�el5 j?yvelOJ�lV(j. M�yCISDf2
FromTo 'EL (D O (o �,jj
From To F1.
From To Ft
In. GROUT:
Depth Malmial Mol_ hod ,
From To h - a42EdF p(�_f�
From To FI
15. SCREEN:
Depth Diameter Slot Slze Malarial
From To It In. In
From To FI In In
From To Ft In In
15. SAND/GRAVEL PACK:
Depth Slze Material
From To Ft
From To FI
17. REMARKS:
r-
LOCATION SKETCH
(Show direction and distance from nt least two Stale
Roads, or other map rotorence potnis)
IL
SC :3 lyd 93 9]J CO
0
I DO UEFIEOY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTnUCTIOli'SLAfJOARDS, AND TI IAT A COPYf7V TrIIS RECORD HAS BEEN PRO ) DED TFIE WELL OWNER.
FOR OFFICE USIE ONLY
Ovid Not
Serial No
1
$
Subm11 odpinj 144
Jv
RE OF PiERSON CONSTRUCTING TIIE WELL OATE
Ion ol ol Wnler Ouallly, Orpundwaler Secllon within 30 days
GW•I REV. 12/99

North Carollnn - Doperlmonl ol Environment and Natural Fleaourcea - Dlvleion of Water Ouottty • Groundwater Section
1636 Mall Service Cantor - Raleigh, N.O. 27699-1630-Phone (919) 73-3•3221 WELL CONSTRUCTION RECORD WELL cowl -Ram -on. Bo b hr� l,lLr
. 9Qq-I-S
WELL CONTRACTOR CERTIFICATION If: Q
STATE WELL CONSTRUCTION PERMIT -Mr
WELL USE (Check Appllcebte BoK): Residential Municipal El Industrial n Agricultural I 1 Monitoring I
Recovery r1 Floel Pump Water Injection El Other n If Other, List Use:
WELL LOCATION; Ilow 5kelclt of the locallon below)
N or e31 Town'. �.lw.T-J y'
Mond Name An Nmm ubs. Community, or Subdivlslon And Lot No.)
OWNER •Jud ♦4cno
Addr
/e
�ss t b 7 /� 9e11\,�rh
/ \ ( IQe of elll O. aCJ Ili) r
City /ot T Slate Zip Code
4, DATE DRILLED I.0.3 I-0�
5, TOTAL DEPTH 40S._
6. CUTTINGS COLLECTED YES NO 4 7. DOES WELL REPLACE EXISTING WELL? YES I' NOES(
8. STATIC WATER LEVEL Below Top of Casing: (oJ FT.
(Usa 'r' II Abovo Top of Casing)
9. TOP Of CASING IS I FT. Abovo Land Surface'
'Top of CA s Ing ler mineled eUor below lend aurlace require. A valiance In actor
dance with 15A NCAC 2p,QI IB
10. YIELD (gpm): --ko METFIOD OF TEST
11, WATER ZONES (depth):
DRILLING LOG DEPTH
From To
-lbri
161 - 4 5'
Fo mrellon Description
R4-
0
•
N
rJ
' 1
12. CHLORINATION: Type Q Amounl tO r-pLD.S
13. CASING:
From
From
From
GROUT:
Depth Dlamete
14,
Depth Mated&
From 0 To �J,L/� —FI. �n�E�E tan d
From To Ft
I . SCREEN:
Doplh Diameter Slot Slzo Malarial
From To PI In In
From To Ft In In
From To FI In In
16. SAND/GRAVEL PACK:
Depth Size Material
From 1 To FI
Wall Thickness
Maledal
To 1I7 ri i.as .EBg Stect
To Ft.
From To FI
17. REMARKS:
N
If additional space Is needed use back ol form C
LOCATION SKETCH
(Show direction and distance Iroln nt least Iwo Stale
Rands, or other map tolorence points)
0
W
7,1
CO
I DO FIEREOY CERTIFY THAT THIS WFI L WAS-C
coNSTRUCrnAN '$TDAnos AND TIIAT AC�
' r1 FOR OFFICE SE<
' NLY
r
OuAd No:
Serial No.
Submit odg1Q]jJo
TRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
F THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
P ICI' 31-09
AZURE OF PERSON CONSTRUCTING TitE WELL GATE
>Ivlsian al Miler Duality, Orounrhvalet Section Wiglln 30 days
OW•I REV. 12199
270051

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mall Service Center - Raleigh, N.C. 27699-1636-Phone [phone] f� /
WELL CONSTRUCTION RECORD WELL CONTRACTOR. L/ RJRN 7 Lf/tA w / /✓ES
WELL CONTRACTOR CERTIFICATION ft: P740
STATE WELL CONSTRUCTION PERMITS!:
270050
1 . WELL USE (Check Applicable Box): Residential ❑ Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ II Other, List Use:
2. WELL LOCATION:. Show sk-tch of the location below)
Ne est Town: •[ 1 ' s s ., County
aufnromILia
(Road Name N mbers. Cpmmunlly, or bdivision and Lot No.)
3, OWNER -TL41� ES m-%
Address
9 or •oy
City or Town //��
4. DATE DRILLED b 0'0 D.
5. TOTAL DEPTH
6. CUTTINGS COLLECTED YES I I NOV
7. DOES WELL REPLACE EXISTING WELL? YES NOW(
8. STATIC WATER LEVEL Below Top of Casing: �.'S FT.
(Use -t- II Above Top of Casing)
9. TOP OF CASING IS 1 FT Above Land Surface'
'Top of casing terminated eVor below land surface requires a variance In accor-
dance with ISA NCAC 2C .0118
10. YIELD (gpm)' _--Z_- METHOD OF TEST t<r
11. WATER ZONES (depth): J
DRILLING LOG DEPTH
Formation Descdpllan
0 -S - �Qf
SD- yn5 Ed eacA
Slate
Zip Code
0
0
-o
12. CHLORINATION: Type 1 }4 Amount laTtilLS- II additional space Is needed use back of form
13. CASING:
Wall Thickness
Depth a Ft (AametSr or Wei I�huFi. Mac s
ToNZ.
al
From
From To Ft
From To Ft
14. GROUT:
Depth n-MalerE Method__ r
From 0 To AO Ft LUIVCQEf& �%b.2��.
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 Slze Material
From To Ft
From To Ft
17. REMARKS:
IV
LOCATION SKETCH
(Show direction and distance from at least Iwo Stale
Roads, or other map reference points)
F
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.
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Subml{ pi$olnal to Division of Water Duality, Groundwater Section within 30 days
FOR OjFIQ4 14SE ONLY,.
Clued No "r---
I
Serial Nd
(b -33 -6a
GW-I REV, 12199

North Carolina - Department of Environment and Natural Resources - Division of Water (Duality - Groundwater Section 2 7 0 0 4
1636 Mail Service Center - Raleigh, N.C. 27699-1636-Phone [phone]
WELL CONSTRUCTION RECORD WELLCONTRACTOR• RJAN kEi A tV ; NE5
WELL CONTRACTOR CERTIFICATION #: /1.740
STATE WELL CONSTRUCTION PERMIT#:
1 . WELL USE (Check Applicable Box): Residential ❑ Municipal ❑ Industrial ❑ Agricultural El Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ It Other, List Use:
2. WELL LOCATION'
Nearrst Tgwn:
3 OWNER
Address
Si- 1'141/ 4 d1uen e r G .C. . V•94 ao
City or Town Slate Zip Code
4. DATE DRILLED ' a
5. TOTAL DEPTH o
6. CUTTINGS COLLECTED YES I ( NOV
7. DOES WELL REPLACE EXISTING WELL? YES NOIVI
8. STATIC WATER LEVEL Below Top of Casing: FT.
(Use •r' if 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 with ISA NCAC 2C .0118
10. YIELD (gpm): METHOD OF TEST to
11. WATER ZONES (depth)• y
12. CHLORINATION: Type H T N Amount/
etc 1 o t o location below) a (
Countyre-01-Y7 CC
or Subdly e'en and Lot No.) DRILLING LOG DEPTH
(y� From To Formatlon Description
D - (p5 ''74
(0 6 - la o 5 -. 6d e-cc.K
a
N
13. CASING:
/ed.
N
If additlonal space Is needed use back of form
Wall Thickness LOCATION SKETCH
Depth , `. DDi3Meeler oryl el9has. MGdal (Show direction and distance from at least Iwo State
From To Ft Roads, or other map reference points)
From To Ft.
From To Ft
14. GROUT:
Depth �1.Material
From 0 To AD Ft CCQEfc
From To FI
15. SCREEN:
.2LAMelhod
Depth Dlarneter Slot Size Material
Froln To Ft In In
From To Ft In In
From To Ft In In
16.SAND/GRAVEL PACK:
Depth Size Material
From To Ft
From To Ft
17. REMARKS:
&1
finial 11.C.
I DO HEREOY 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.
SIG "U OF PERSON CONSTRUCTING THE WELL DATE
Submit odglnal to 4vlsl I Water Duality, Groundwater Section within 30 days
IL GW-1 REV. 12/99

North Carolina - Department of Environment end Natural Resources - Division of Water Quality - Groundwater Section
270044
1638 Mall Service Center - Raleigh. N.C. 27699-1636-Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR' BR;AN kE/LA 0t'lliES
WELL CONTRACTOR CERTIFICATION #: /'S`D
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE (Check Applicable Boa): Residential El Municipal El Industrial Ell Agricultural El Monitoring ❑
Recovery ❑ Heat Pump Water Infection ❑ Other ❑ If Other, List Use:
2. WELL LOCATION: (SI}er7+skQlch of the location below) ��M1"0n�
Alearest To (�L /J�' i..4.- ��� � �C�oounty
Q.f.'.�L11L�11q Pt� iE (2.+"-L.La_ (Road Name pn Numbers. Co/rp9iunity.
or Subdivision and Lot No.) DRILLING LOG DEPTH
3. OWNER C?'%Z0a £ ,?' .v-r%%��t A_� From To Formation Description
U
g /o ��.
(Sireal or HlouAe- o.) hC ^ 97
City or Town 6 J Slate O1 Zip Co
4. DATE DRILLED . ix -W-62
5. TOTAL DEPTH
6. CUTTINGS COLLECTED YES I f NOV
7. DOES WELL REPLACE EXISTING WELL? YES [ 1 NOV(
8. STATIC WATER LEVEL Below Top of Casing: 95-"FT.
(Use'+- If Above Top of Casing)
9. TOP OF CASING IS 1 FT. Above Land Surface' a
'Top of casing terminated eQor below land surface requires a variance In actor- 'v
'r
dance wllh 1SA NCAC 2C .e
10. YIELD (gpm): METHOD OF TEST Re i
11. WATER ZONES (depth)'
Address
o - 7 . le*
7a - / 8 S Edrock.
CO
•
12. CHLORINATION: Type ! R Amounl3'Lf-S
13. CASING:
Depth Diameter
From D To 7 AM FI
From To Ft
From To Ft
14. GROUT:
IV
II additional space Is needed use back of form -�
Wall Thickness
;or.IIeWei hUFt. Maledal
.Ias ? Sh2
Depth &Male Et Mell
i�of
From 0 To �0 Ft Lu�YCQ�C
From To FI
15. SCREEN:
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other map reference points)
Doplh Diameter Slot Size Material
From To Ft In. In
From To FI In In
From To Ft In In
16. SAND/GRAVEL PACK:
Depth Size Material
From To 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 PROVIDED TO THE WELL OWNER.
FOR OFFICE USE ON -YV 'I
Quad No:
Serial No.
��
OF PERSON CONSTRUCTING THE WELL DATE
Submit original to bl is of Waler Quality, Groundwater Section within 30 days
aa.6a
GW-1 REV. 12/99

North Carolina - Department of Environment and Natural Resources - Division of Water Duality - Groundwater Section
1636 Mall Service Center - Raleigh, N.C. 27699.1636-Phone [phone] f {/ r r
WELL CONSTRUCTION RECORD WELLCONTRACTOR• ��JRJRW kE/LA W; es
WELL CONTRACTOR CERTIFICATION It: 190
STATE WELL CONSTRUCTION PERMIT'S:
WELL USE (Check Applicable Box): Residential ❑ Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heal Pump Water Injection ❑ Other ❑ II Other, List Use:
2. WELL LOCATION:
Nearest Town:
w sketch A ofIthe location below)
G� ithi County'
/1 s Ritcetts *el 4)1VZ1,—t,/
(Road Name and.NumbpA. Communlly. or Sub Islon and Lot No.)
WNER •.//T/
3. O
070
%/q / p
Addressr -1 c/IS �u /5I
((////w�� Sreel or Houy�A ^ ���/`
City or Town Stale C- Zip Cade
D- •6?
4. DATE DRILLED
6. TOTAL DEPTH
6. CUTTINGS COLLECTED YES I I NO
7. DOES WELL REPLACE EXISTING WELL? YES I I NO[V1
8. STATIC WATER LEVEL Below Top of Casing: 70 a FT.
ff (Use 'h' II Above Top of Casing)
9. TOP OF CASING IS t FT. Above Land Surface'
'Top of casing terminated at/or below land surface requires a variance In accor-
dance with 1SA NCAC 2C .0119
10. YIELD (gpm)• a 0 METHOD OF TEST f<r
11. WATER ZONES (depth): T �/ 1
12. CHLORINATION: Type )-{ 1 N Amounlya�1-µ1S ..
13. CASING:
DRILLING LOG DEPTH
Formation Description
From To
JO 5 . a qs ' edeoclt
O
-73
II additional space Is needed use back of form
Wall Thickness LOCATION SKETCH
Depth/oDiameter or
M slot (Show direction and distance from at least two State
5 FI
From O To ^1 Roads, or other map referencepolnls)
From To Ft.
From To Ft
14. GROUT:
0
Depth�ir n-Material
From To O�� FI elACPEfE
From To FI
15. SCREEN:
Depth
From To
From To
From To
16. SAND/GRAVEL PACK:
.f2LAMelhod
Diameter Slot Size Material
Ft In. In
FI In in
Ft In. In
Depth Size Material
From To FI
From To FI
17. REMARKS:
&waits cr2A-e_.
R4
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS AND THAT A COP`4F THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
FOR OFFICE yS
Quad No:
NLY ''
Submll od01nd11
Serial No
-X W 10-al-o
TURE OF PERSON CONSTRUCTING THE WELL DATE
Ivision al Water Duality, Groundwater Secllon within 30 days
GWI REV. 12/99
270041
0

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. RIRN kEILA I�J;NE5
WELL CONTRACTOR CERTIFICATION 0: /540
STATE WELL CONSTRUCTION PERMITO:
1. WELL USE (Check Appltceble sox): Residential ❑ Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water InJectIon ❑ Other ❑ If Other, List Use:
2. WELL LOCATION
Ne al Town:
(Road NATO and.Num s, Community, Subdivislan and Lot No.)
3. OWNER nn----�C--.//�( sflt)
Address
(Show ske Fh of the location below) £areirinn Cft-t..
aQDh% County'
/6
City or Town Sale
4, DATE DRILLED b' g'6
5. TOTAL DEPTH ad
6. CUTTINGS COLLECTED YESI I NOV
7, DOES WELL REPLACE EXISTING WELL? YES n NOIV1
8. STATIC WATER LEVEL Below Top of Casing: FT.
(Use'r• II Above Top of Casing)
9. TOP OF CASING IS i FT. Above Land Surface•
•Top of casing terminated stior below land surface requires a variance In accor-
dance with 15A NCAC 2C .0118
10. YIELD (gpm): 7 METHOD OF TEST Re J
11. WATER ZONES (depth): a
Rd.
DRILLING LOG
DEPTH
From To Formation Description
O - /D3 1274
/0 3 ca 0 5 Edraoc%
0
w
7
O
(Slreaa lau�le o.6 ,327/5
M Dh Zip Code
12. CHLORINATION: Type >4 1 Amount 1 rrllt
13. CASING:
From
From
From
14. GROUT
0
If additional space Is needed use back of form
IV
Wall Thickness LOCATION SKETCH
Depth 2 Diameter or Wei 9�h__VF"t. •�Maaterlall (Show direction and distance from at least Iwo Slate
To /0 J FI lA • s5 it1�Roads, or other map reference points)
From
From
15. SCREEN
From
From
From
To Ft.
To Ft
Depth] Material
0 To AO Ft eat 2E><6
To Ft
Depth
To
Diameter
Ft In
To Ft In
To Ft In
16. SAND/GRAVEL PACK:
Depth
To
To
From
From
17. REMARKS:
Slze
Ft
Ft
Mall
Slot Size Material
In
In
In
Materlal
OaArclbA 1 1 C.
1 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.
Submit original to
-2: i/tArtfrid
/6- (Si0 2'
LIRE OF PERSON CONSTRUCTING THE WELL DATE
Islon of Water Quality, Groundwater Section within 30 days
GW-1 REV. 12/99
270039
r�
c�
0
c.

North Caroline - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1630 Mall Service Center - Raleigh, N.C. 27699-1636-Phone [phone] �f / r
WELL CONSTRUCTION RECORD WELLCONTRACTOR• IJRJAW kWEILA f NE5
WELL CONTRACTOR CERTIFICATION 0: /4740
STATE WELL CONSTRUCTION PERMIT0:
1. WELL USE (Check Applicable Box): Residential ❑ Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery n Heal Pump Water Infection ❑ Other 0 If Other, List Use:
howaketc,h of the location below) --
County.
(Road Name and.Nurr�e s. Commu�nK1 orSubdtvlslan and Lot No.)
3. OWNER
Address
2. WELL LOCATIO
rest Tow7
S ree'r •0101en Jed
n 71S2
ty or Town �Stale Zip Code
5. DATE DRILLED -
5. TOTAL DEPTH
6. CUTTINGS COLLECTED YES n NOI�
7. DOES WELL REPLACE EXISTING WELL? YES NOI yf
8. STATIC WATER LEVEL Below Top of Casing: 47 FT.
(Use'+' If Above Top of Casing)
9. TOP OF CASING IS / FT. Above Land Surface'
Top of casing terminated at/or below land surface requires a variance In accor-
dance with 15A NCAC 2C 0118
10. YIELD (gpm): lye.. METHOD OF TEST r�
11. WATER ZONES (depth): / r1 F =
12. CHLORINATION: Type / / /� TR. Amount 10AP,rh If additional space Is needed use back of form
13. CASING:
From To
270032
DEPTH
Formation Description
O
Wall Thickness LOCATION SKETCH
Depth Digm � elghv IS wadi! (Show direction and distance from at least Iwo Stale
From To�Ft �( `(e,/ /�'e Roads, or other map reference points)
From To Ft
From To Ft
14. GROUT:
Depth Material Method
From To Ft
From To FI.
15. SCREEN:
Depth Diarneter Slot Size Materiel
Frorn To Ft In In
From To FI In In
From To FI. In In
16. SAND/GRAVEL PACK:
Depth Size Material
From To FI
From To Ft.
17. REMARKS:
r.
i
I DO HEREDY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDAClDS,.-AAIB-THATA C F THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER. `
FOR OFFICEr)1$$'ONLY ` J6 . !1,4%�'/'T"/
6 a
Quad No:• !l , S ATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit orjpl(tadt Dlvlsion of Water Quality, Groundwater Section within 30 days
`/
Serial No. G11.1 REV. 12199

•
North Cnrollnn - Dnparimont of Environment and Natural Flesources - Division of Wnter Oooltly - Oroundwntor Section 270031
1636 Mall Sorvlce Cenlor - Ilalalph, N.C. 27699-1636-Phone [phone] ' (
•
WELL CONSTRUCTION RECORD WELLCONTRACTOn, !JD bhys of • P9�+
WELL CONTRACTOR CERTIFICATION IS:(49c2 9
STATE WELL CONSTRUCTION PERMITS:
WELL USE (Check Applicable ern): Residential [2" Municipal n Indusirlal El Agricultural i I Monitoring
Recovery [1 Heal Pump Water In)ecllon ❑ Otlier If Other, List Use:
2. WELL LOCATIOI ( how ketch • he location below)Id
/
Ne., aQi•'/C-o�u�n�l/y• / //�7CL%iYiLC�2.
DRILLING LOG
(Road Na and (-1%is.vn Conuntly, or Sub. Ivlslon Ind Lot No.)
3. OWNER �z •� �•�!
Address
,Q AS , �� . e. 2>£f'7//
Clly or Town Slate Zip Coda
4. DATE DRILLED 0-/L-O.
5. TOTAL DEPTH
6. CUTTINGS COLLECTED YES NO{V{
7. DOES WELL REPLACE EXISTING WELL? YES O NOM
8. STATIC WATER LEVEL Below Top of Casing: FT.
(Use .4F If Abovo Top of Camp)
9. TOP OF CASING IS i FT. Abovo Land Surface'
•Top of cm ling Ier mineled sUor below Irnd surface faquires a varlince In accor-
dance wllh 15A NCAC 2C .9116 r
10. YIELD (ypm)' !7G METHOD OF TEST Rt t\
11. WATER ZONES (depth):
•
12. CHLORINATION: Type —Amount l0 I p t tk
13. CASING:
Wall Thickness
(� Depth
s/-��/ Plareela .pr a p�1�V 1. y��M aal�e(da�l p (Show direction and dlsinnco Irom nt least two Stale
From ±) —To les F-I. W ' ''D d � rl d" r-'-'�„-"-`.` Roads, or other map reference points)
FrOFF1 To It From To II.& �J ,01 �/% A
14, GROUT: / I v
4%4ti•,,
DEPTH
From To Fomnllon Dnscdpllon
D -/alQ
/2G -L/0 5
v
I( additional space Is needed use hack ol form
4-
Ca)
,c� Depth ���M��at�erri�ial Method
From _3. To Ft Quznri-.LIE_ _ plants _.
From To Fl
15. SCREEN:
Depth Diameter Slot SILO Material
From To Ft In In
From To Ft In In
Frorn To Ft In In
16. SANOIGRAVEL PACK:
Depth Size Material
From To
From To
FI
Ft
LOCATION SKETCH
II
17. REMARKS:
1 DO I IEREO'�ATIFY THAT-TtitSW " "'TRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
GONSTRUClI ONITrt,N0Af1,DS, AND TI IAT A C• 7 F THIS RECORD FIAS BEEN PROVIDED TO TI IE WELL OWNER
FOR OFFICE SE iNLY
(hied No: I rgQt AIURE of ' -RSON CONSTRUCTI O TIIE WELL DATE
Submit on ttrgrio •Melon ol Water Oualliy, oroundwater Secllon wlthln 30 days
Se dal No. 1 GW-1 REV. 12199
as

270029
North Carolina - Department of Environment end Natural Resources - Division of Water Quality - Groundwater Section
1638 Mall Service Center - Raleigh, N.C. 27699-1638-Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR l�RI�N 1 El h (tom r/VES
WELL CONTRACTOR CERTIFICATION 0:
STATE WELL CONSTRUCTION PERMIT#;
WELL USE (Check Applicable sox): Residential lig".# Municipal ❑ Industrial I-1 Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other If Other, List Use:
2. WELL LOCATION' how kelclt of the location below) fC
Neal a� Nearest Towp a_ I-
Countyer
(Road Name and,Nup70eommunll , of S I Isloo a d Lol N,(,o.)A •�l
3. OWNER LL��i1(( i, i
Address {greet _Q r r �'G _AIL
wSig. ��o�iou e o. AS'`la
ly or Town Stale Zip Code
4. DATE DRILLED /a P-0 .,
5. TOTAL DEPTH 3 VS c_.,
6. CUTTINGS COLLECTED YES NO r.1
7. DOES WELL REPLACE EXISTING WELL? YES [] NO[ -P
8. STATIC WATER LEVEL Below Top ol Casing: a 5 FT.
(Use Y' If Above Top of Casing)
9. TOP OF CASING IS I FT Above Land Surface'
•Top of casing terminated et/or below land surface requires a variance In accor-
dance with 15A NCAC 2C 0118
10. YIELD (gpm): (a (J METHOD OF TEST 1:?6
11. WATER ZONES (depth)-
Z&nCcrmte-c
DRILLING LOG DEPTH
From To
Rs- s5
Formation Description
)ifit
Bee
1I
12. CHLORINATION: Type LL 1 l Amount _s 21.111E
13. CASING:
Wall Thickness
Depth Diameter or WelghVFI. Maledzl
From 0 To Ft Ie.D5 Via. R5 Pit-SDR
From To Ft
From To Ft
1A. GROUT:
From n
From
15. SCREEN:
Depth Material ��tL
To _O.-Q_Ft c nktc P.TP
To FI
Method
d°T
Depth Diameter Slot Size Material
Frorn To Ft In In
From To Ft In In
From To Ft In In
16. SAND/GRAVEL PACK:
Depth Size Material
From To FI
From To Ft
17. REMARKS:
II additional space Is needed use back ol form
LOCATION SKETCH
(Show direction and distance from al least two Slate
Roads, or other map reference points)
ccre q€d
I D0 HEREOY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND. THAT.A COPY nF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
FOR OFFICE U$EiOI
Quad No:
Sedal No
II!
LY
SI rvy
Submit original ?o )
i.J
t t>.. .A. !0- 1-0 2
URE OF PERSON CONSTRUCTING THE WELL DATE
slon of Water Ouallly, Groundwater Secllon within 30 days
GW I REV
2/99
LIt
0

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Secllon
1636 Mall Service Center - Raleigh, N.C. 27699-1636-Phone [phone]�(////,_'' / --yp�11
WELL CONSTRUCTION RECORD WELL CONTRACTOR- /TNRMAN L. _ ,4-((.
WELL CONTRACTOR CERTIFICATION M: 4D '7
STATE WELL CONSTRUCTION PERMITM:
1. WELL USE (Check Applicable Box): Residential Lrl Municipal ❑ Industrial EJ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATIO how sketch o the loca Ion below 1 ._^
Nearest T•vn h M/T n . ! County IA4
(Road Name and Numbers.ACommunily er.Subdivision and Lot No.)
3. OWNER
Address a.
AA
,517(.1
City or Town Slate
4. DATE DRILLED I b- c� 1-Q
5. TOTAL DEPTH ) rl 0
6. CUTTINGS COLLECTED YESf NOI✓I
7. DOES WELL REPLACE EXISTING WELL? YES n NOWI
8. STATIC WATER LEVEL Below Top of Casing: s 0 FT.
(Use -: 1l 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 with 15A NCAC 2 01
10. YIELD (gpm): h6 METHOD OF TEST
11. WATER ZONES (depth):
DRILLING LOG
From To
DEPTH
Formation Descdptlon
- h Be_Qck
Zip Code
0
0
.1
Iv
1' CHLORINATION: Type Tn Amounta.l_p.r-US If additional space Is needed use back of form
.3ASING:
From To Ft
Wall Thickness LOCATION SKETCH
O Depth tDiameter er or�/�.l'S uCeSal (Show direction and distance from at least two Stale
From To Ft RSor other map reference points)
14. GROUT:
From
Depth Material
To do n (cMC2EiE
From To FI
Method
70r
15. SCREEN: m
Depth Diameter Slot Size Material v
cm
From To Ft In In
From To Ft In In
From To Ft In In N
16. SAND/GRAVEL PACK:
c-a
Depth Size Material
From To Ft
From To Ft
17. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COOPPYYf�F THIS RECORD HAS BEEN PR IDED TO THE WELL
WNER.
FOR ]PFJ d''US� ONLY 1 / / (0441/L. tiL-/ ICJ GCXX— spy` q-o grandtd Mg / -. � __, -( S16NATURE OF PERSON CONSTRUCTING THE WELL DATE
b original to Division of Water Quality. Omundwaler Secllon within 30 days
s
1 .,edal Nd 1 ' GW-I REV. 12/99
ASHEVILL
ii Si_S ION
C+VAL OrFICE
270026
c
,

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. �JRIAN /CLi A / W r NE5
P740
WELL CONTRACTOR CERTIFICATION If:
STATE WELL CONSTRUCTION PERMITM:
270025
1. WELL USE (Check Applicable Box); Residential Lg.'. Municipal E Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heal Pump Water Infection ❑ Other D If Other, Llsl Use:
2. WELL LOCATION: (S;•aw sketch o the location below) // n
earesl Town: �_ - — - - - _Coanty. �A7 �-�D `e-�.
(Road Name and misers, Communl) , .r Subdivision and Lc No.) DRILLING LOG DEPTH
3. OWNER From To Formation Description
Addr ss1.0
80 or Due
by or Town � „ Idle
4, DATE DRILLED O
5. TOTAL DEPTH �+
6. CUTTINGS COLLECTED YES ( NO
7. DOES WELL REPLACE EXISTING WELL? YES
8. STATIC WATER LEVEL Below Top of Casing:
Zip Code
NO
FT.
(Use'+• II Above Top of Casing)
9. TOP OF CASING IS 1 FT Above Land Surface'
•Top of casing terminated eVor below land surface requires a variance In accor-
dance with ISA NCAC 2C .0118
10. YIELD (gpm): 3 METHOD OF TEST �i q
11. WATER ZONES (depth):
s4. B tail
-e-j•
12. CHLORINATION: Type MT-k}
13. CASING:
u
W
773
ry
J
'o
Amount . If additional space Is needed use back of form no
Wall Thickness
Depth Diameter or Welght/Fl. Maledal (Show direction and distance from at least two Slate
From 0 To 113 FI Im D5 QM. pat PYC"SDR Roads, or other map reference points)
From To Ft
From To FI
14. GROUT: G
From 0 To Q 0 FI GoDepth Material T Method
►lcc;P. P 'Dnr. E�
From To FI.
15. SCREEN:
Depth Diameter Slot Size Material
From To Ft In In
From To FI In In
From To FI In In
16, SAND/GRAVEL PACK:
Depth Size Material
s
From To Ft
From To FI
17. REMARKS:
LOCATION SKETCH
Ca.)
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
FOR OFFICE U
Quad No:
Serial No
-,�13I
Submit odglnal o
'1
yZ --(l rL _/0-9-6
URE OF PERSON CONSTRUCTING THE WELL DATE
Isbon of Water Quality, Groundwater Section within 30 days
GM REV. 12/99

North Carolina • Department of Environment and Nolurnl Resources - Dlvlelon of Water Quality • Groundwater Section
1038 Mall Service Center - Raleigh, N.C. 27699.1636-Phone [phone] }� ( n 'L
WELL CONSTRUCTION RECORD WELLCONTRACTOR• Lo 6 hi of - Po4-5
WELL CONTRACTOR CERTIFICATION N: oa g
STATE WELL CONSTRUCTION PERMITN:
1. WELL USE (Check Applicable Boa): Residential l' Murdclpel ❑ Industrial ❑ Agricultural 1 1 Mongering ❑
Recovery r1 Float Pump Water InJecllon ❑ Olher If Other, Lisl Use:
ELM
WELL LOCATI
Nearest Town:
( how ketch of II : location below)
Co
(nand Name and Numbers. Carrvnut' y. or Subdivision and Lot No.)
Beal or lToulo N2
3. OWNER
Address
t\1(5)11
Cllr of Town
4. DATE DRILLED
5. TOTAL DEPTH
6. CUTTINGS COLLECTED YES( J NOIvir
7. GOES WELL REPLACE EXISTING WELL? YES NOM
B. STATIC WATER LEVEL Below Top of Casing: FT.
(Use •a' II Above Top of Casing)
9. TOP OF CASING IS I FT Above Land Surface•
•Top of camp terminated slier below lend surface require. a verlance In accor-
dance y llh 15A NCAC 2C4`16
10. YIELD (gpm): r-A METHOD OF TEST q
11. WATER ZONES (doplh)• j
12. CHLORINATION: Type--Amountg& } t US
ty
DRILLING LOG DEPTFI
From To
r 2 4
Fomellon Da s crlpllan
J 19 - 5 5 hFd eack e
13. CASING:
lase
D.S7s 7
Zip Coda
0
r�
ry
0
-a
II additional space Is needed use hack of lornr
LOCATION SKETCH
Wall Thickness
Depth PPla metal gin ug . Mar ale � (Show direction and distance born nt least Iwo Slate
From To / Pt FL .I° [�J (P f�j i5. Roads, or other map reference patois)
From To FI. r r e /
From To FI /,WI O�
1el. GROUT: r �/ C
Dept-hs� 0/_� Materiel Mol_ )rod /� k- f a/4V / u-,, •
From
d To2&_FI CnRE1F jfUK �-vr
From To FI
15. SCREEN:
Ooplh Diameter Slot Size Malarial
From To FI In. In
From To FI In In
From To Ft In In
15. SANG/GRAVEL PACK:
Depth Size Malarial
From To FI
From To Fl.
17. REMARKS:
Cr
CO
I D0 FIEREDY CERTIFY THAT THIS WELL WAS
CONSTRUCTION $l-ANDAROS AND II IAT AGO
FOR OFFICE IkE ONLY
Cared No:
Sedal No.
Submll orldlnal o
J
RUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
TFIIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
ERSON CONSTRUCTING TIIE WELL DATE
aler Quality, Groundwater Secllon within 30 days
GW.I REV. 12/99

North Carolina - Dnparlmant of Envlrommnnt and Nolurnl Resources - Division of Wnter Quality • Oroundwnlnr Soction 270022
•
1636 Mall Service Center • Raleigh, N.C. 27699.1636-Phone [phone]
WELL CONSTRUCTION RECORD WELLCONTFlACTOR•
WELL CONTRACTOR CERTIFICATION 0:
STATE WELL CONSTRUCTION PERMITN:
i. WELL USE (Check Applicable Box): Flesidenllat0' Municipal ( 1 Industrial ❑
Recovery ❑ Heal Pump Water injection ❑ Otlrer El If Other, List Use:
WELL LOCATION: (SIB s -I tl* ���Qlocation below) E
NBA, est Townl - County' eirnl[�
ib-I�j�' - "-`- , DRILLING LOG
(Woad N a and Nu •ors. Community, or S bdlvlslon and Lot No.)
3. OWNER
Address
tool Of Iloula
T,t,2a, nC dTuu a
City or Town rr Slate Zlp Code
4. DATE DRILLED 1 6'``7'b'1
5. TOTAL DEPTH Sns NO� A6. CUTTINGS COLLECTED YES
7. DOES WELL REPLACE EXISTING WELL? YES fi NO(tf
8. STATIC WATER LEVEL Below Top of Casing: it5 FT.
1 (Use'.' II Abovo Top of Casing)
9. TOP OF CASING IS 1 FT. Abovo Land Surface'
•Top of casing ler urinated at/or below land surface require. variance In accor-
dance with 15A NCAC 2C. I16
10. YIELD (gpm): ri. METHOD OF TEST iU Q
11. WATER ZONES (dopih): j
o -qI
91 -5os
DEPTH
Formation On s crlpllon
v
iV
r—.J
12. CHLORINATION: TypeAmount SJ pi-LS II additional space Is needed use hack of form c�
13. CASING:
Wall Thlckne s5 Depillo p1a11
jltieltn MaLYS.'.111.LC
From Q To -I 1 •Fi.
From To F(.
From To
14, GROUT:
Ft
Depth �,�M�al�olLlal[ Mal_ liod r
From � To �_FI �"'�d"`-'-'�-_ �k�u Kf�l.
Frain To FL
15. SCREEN:
From
From
Depth Diameter Slot Size
To Ft In __.. In
To __— Ft In
From _—To Ft. In.
16. SAND/GRAVEL PACK:
Depth Size
Frain To FI.
From To FI.
17. REMARKS:
In
In
Material
Material
Be bhr ✓.J. PDFi-S
.wag
Agricultural 1 1 Monitoring
LOCATION SKETCH
(Show direction and dislance Irom nl least Iwo Stale
Roads, or oilier map tolerance polies)
Qom. C.
it
-17
ry
I DO HEREO'(CETITIFY THAT THTnVELL WAb
CONSTRUCTION �TANDARDS, AND TIIAT A.0
1 -7
FOR OFFICE OE, ONLY
Owed No:
1
Serial No.
Submit on
TRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
r TFIIS RECORD FIAS BEEN PROVIDED TO THE WELL OWNER.
lb-5�0�
P(//
AIURE OF (✓ERSON CONSTRUCTING WELL DATE
Division of Miler Ounllly, Oroundwaler Section within 30 days
CW•1 nEV, 12/99

2'70021
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1638 Mail Service Center - Raleigh, N.C. 27699-1636-Phone [phone]
WELL CONSTRUCTION RECORD WELLCONTRACTOR• /Fa' RmAM L . _ A-Z(.
WELL CONTRACTOR CERTIFICATION #: o?D.; 7
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE (Check Applicable Boa): Residential E Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATIO tow eketcl 1 of the location below)
Neatest To -�---�5 h—z- County.
ou
(Road Name and Nursers, Communl)yyr Subdlvlsion e d Lot No.)
3. OWNER V/r'/i_A�J,./KI-�--�
Address
<S
Ciy or Town Syale Zip Code
4. DATE DRILLED b" " ld
5. TOTAL DEPTH ��
6. CUTTINGS COLLECTED YES n NO[J J
7. DOES WELL REPLACE EXISTING WELL? YES ri NO Vi
8. STATIC WATER LEVEL Below Top of Casing: i S FT.
I (Use '+' II Above Top of Casing)
9. TOP OF CASING IS FT. Above Land Surface'
•Top of casing terminated at/or below land surface requires a variance In accor-
dance wllh 15A NCAC 2C .e11a
10. YIELD (gpm): .L 0 METHOD OF TEST : 5
11. WATER ZONES (depth):
GCIr�CU�1_
DRILLING LOG
DEPTH
From To Formation Description
o - g(D 71),•a
!a • 1 h Bf-deock
0
w
as
_O
1')
12. CHLORINATION: Type _Ifni— Amount-4, II t If additional space Is needed use back of form
1 \SING:
W c,
Wall Thickness LOCATION SKETCH
D Depljeh/ 1Diameter or WRIghVFt. uCeSra (Show direction and distance from at least two State
From To 44 (p Ft, �110 PRoads, or other map reference points)
From To Ft S - I J %��LAt - ���-
_
From To FI ..e�
14. GROUT:
Depth Material Method
From Q To 020 Ft iIA/YCPi"it<
From To FI
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 Ft
0
L3
rn
ry
v
r
17. REMARKS:
I DO FIEREDY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTIOJI STANDARDS, AND THAT A COPY F.THIS RECORD HAS BEEN PRO/IDEDT O THE WELL WNER.
Ib.� a2
FOR OFFICE UE ONLY
Clued No:
ai No.
4I
7.4iY1'I.GLti-/'
SIrffNATURE OF PERSON CONSTRUCTING THE WELL OATS
Submit original tg..0 slon of Water Quality, Groundwater Section within 30 days
GW-1 REV. 12J99
rn
c-3

270019 '
ea ar
2%7S
Zlp Code
CONSTRUCTION STANDARDS, AND THAT A COPY
FOR OFFIC ps oityY
Qua
llorth Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwaler Secllon
1636 Mall Service Center - Raleigh, N.C. 27699-1636-Phone [phone]//,' /
C
WELL CONSTRUCTION RECORD WELLCONTRACTOR• Xe R»AN • 24((.
WELL CONTRACTOR CERTIFICATION #: o4D..; 7
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE (Check Applicable Box): Residentla114 Municipal ❑ industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Infection ❑ Other ❑ If Other, Llsl Use:
2. WELL LOCATIO
est Town:
Show sketch of the location below)
ahlD Q S County. 14--In�'C3�'r- 1.�
(Road Name `pnd umberCommu Rr Subdivision and Lot No.) DRILLING LOG DEPTH
,C
3. OWNER LLCIjpcL From To
Address
arAnai IA
City or Town , \ Stale
B "D. D-3
4. DATE DRILLED b-3-0
5. TOTAL DEPTH
6. CUTTINGS COLLECTED YES n NOJ4
7. DOES WELL REPLACE EXISTING WELL? YES NOM/
8. STATIC WATER LEVEL Below Top of Casing: FT.
(Use Y If Above Top of Casing)
9, TOP OF CASING IS 1 FT Above Land Surface'
'Top of casing terminated at/or below land surface requires a variance In accor-
dance with 15A NCAC 2C.011a `�
10. YIELD (gpm): tnCD METHOD OF TEST r l
11. WATER ZONES (depth):
12. CHLORINATION: Type IT 7H
1. \SING:
Amount astpill..5
Formation Description
SS -Ask{
S 5 - lln5 $tci2gr k
-V
J
r)
If additional space Is needed use back of form
-
c.,.1
Wall Thickness
Depth Diameter or W 4ghLFI. Maledal
From To FIB • roar c /�
From To 5 5 FI. L'a5 I g$ •'1L�=-I ^raj - A �UI.-rLI�d_•
From To FI. ^�-�-�-`J�
14. GROUT: / 1, ' n ^ - Y1 Q -
From 0
From To FI
15. SCREEN:
Depth Material
To aa° FI eippecLE4E
Method
Depth Diameter Slot Size Material
From To Ft In In
From To F1 In In
From To Ft In In
16. SAND/GRAVEL PACK:
Depth Size Material
From To Ft
From To Ft
17. REMARKS:
LOCATION SKETCH
(Show direction and distance from at least two Slate
Roads, or other map reference points)
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
F THIS RECORD HAS BEEN PR IDED TO THE WELL WNER.
(a4A-k cy- j 00 - 3-6
NATURE OF PERSON CONSTRUCTING THE WELL
to Division of Water Quality, Groundwater Section within 30 days
DATE
GW4 REV. 12/99

North Cnrollne - Doperimanl of Envlrommonl and Nalurni Resources - Divlelon of Water Ouallry • Oroundwolor Socllon 2 / 0 0 1 8
1636 Mall Service Center • Relalgh, N.O. 27699-1636-Phone [phone] (�
WELL CONSTRUCTION RECORD WELLCONTRACTOR• Bo Lint J. PQs
WELL CONTRACTOR CERTIFICATION 0: Dc 9
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE (Check Appuc.ble Box): Fiesldenllal l N Municipal I I Industrial ❑ Agrlcullural l I Monitoring I1
Recovery n Beat Pump Water infection ❑ Other f] II Olhor, Llsl Use:
2. WELL LOCATION; (Sho)sketcjl of Ilia location below)
(hoed Nam dA nd Numbers. Coy Subdivision And Loi No.)
,V or at
(n�lJ
Address rea m oula r� �j��O 0�[ - 5 9. 'I I(In.T� /'
��orToin Stale YLlpcode,z S'j sS S t4 cacic
City or Town
4. DATE DRILLED 0- -0 a
5. TOTAL DEPTH
6. CUTTINGS COLLECTED YES ( 1. NO[ Vf
7. DOES WELL REPLACE EXISTING WELL? YES i J NO[✓(
0. STATIC WATER LEVEL Below Top of Casing: SO FT.
(Use'.' if Abovo Top ol Casing)
9. TOP OF CASING IS I FT'. Abovo Land Surlace'
'Top of caslny terminnled .Uor below I.nd surface requires a variance In accor-
denee wllh 15A NCAC 2C. 11n
10. YIELD (gpm): 6g 0 METHOD OF TEST f(� G
11. WATER ZONES (dopth): j
3. OWNER
DRILLING LOG
DEPTH
•
From
To
Fommi:on Dns crlplion
s
12. CHLORINATION: Type p�Amount 65l)t i
13. CASING:
0
a
0
II additional space Is needed use back ol form o
Wall Thickness LOCATION SKETCH
DepthPPlamelo r we iV Mnied al ,-� Show direction and distance Irom nt least Iwo Stele
From AL— Ft. "'3 Ila,le� T�.S�.)-11.K ( Roads, or other map roloronco polies)
From To 01
From To FI
14. GROUT:
Depth _ _T Malarial Mol Ilod
From 0 To _FI evaR_Ef6 Jj"Th U�fYf.
From To Ft
15. SCREEN:
Depth Diameter Slot Size Mslodo,
Froln To FI In In
From To Ft In In
From To FI In In
16, SAND/GRAVEL PACK:
Depth Size Malaita)
From To FI
From To FI.
17. REMARKS:
I DOITIEREDY.CERTIFY THAT THIS- WEI At
CONSTRUCTION STANDARDS, AND TI I
FOR FF10E USE ONLY
Ouad ho:
L.
Serial to.
11
laA cb4_ n C
S CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
COPY OF THIS nECORD HAS BEEN PROVIDED TO THE WELL OWNER
O'3-0a
SIONATUR F PERSON CONSTRUCTING TI IE WELL
odginai to Dlvlslon ol 'aster Quality, 0roundwaler Section within 30 days
GW-i REV. 12199
DATE
LOT
ION
O. OFRIGE

3. OWNER
Address
North Cnrollnn Dnperlmonl of Envlrnnmant and Noturnl Fleaourcee - Division of Writer Ovally • Oroundwalor Section
1636 Mall Service Cantor • Fleiolpit, N.C. 27699-1630-Phone (919) 733•3221 rr
WELL CONSTRUCTION RECORD WELL CONTRACTOR' }��} LIP bhr.k L J • DEfi lk
WELL CONTRACTOR CERTIFICATION M:
STATE WELL CONSTRUCTION PERMITM!
270017
1. WELL USE (Check Applicable Boa): Residential lYJ Municipal 1 1 Industrial 1 1 Agricultural 1 I Monitoring
Recovery In Boat Pump Water Infection n Oilier If Other, List Use:
WELL LOCATION: (SI) sketch of the location below)
Nee Town'.
S
County'
%/I ,-'
lnoad Nam% sfp$ urnbora. Casmunlly. or Subdivision and Loylo.)
WA/4d lAzt.10
a
A96,90
City or Torn I Slate
4. DATE DRILLED o' 0'
5. TOTAL DEPTH o0.�i
6. CUTTINGS COLLECTED YES( I NO vir
7. DOES WELL REPLACE EXISTING WELL? YES 1 J NOM
8. STATIC WATER LEVEL Below Top of Casing: 65 FT.
(Use's• If Abavo Top of Casing)
9. TOP OF CASING IS 1 FT. Above Land Surface'
'Top of casing let minaled a Vor below land surface requires a variance In accor-
dance with 15A NCAC 2C. 118 j� s
10. YIELD (gpm): TO METHOD OF TEST j(C q
11. WATER ZONES (depth): j
12. CHLORINATION: Type-a-L-ElAmounItO 31 L J s
13. CASING:
Retz4-2rtOYr2 `"
From
From
From
14. GROUT:
From
From
15. SCREEN:
Zip Code
DRILLING LOG DEPTH
From To
a - so
So - €os
Formation On scrip lion
CO
:TO
J
0
N
If additional space Is needed use back of form C.
LOCATION SKETCH
Depth Ala Bien �r we pf�UrFJ. ,.T Material (Show direction and distance Irorrl nl least Iwo Slate
Ponds, or other map tolorence points)
Depth Malarial Method ,
�- To �(�rl �6g2�{E _ �Q(lg�•
To FI
Depth Diameter Slot Size Malarial
From To FI In In
From To FI In In
From To FI In In
16. SAND/GRAVEL PACK:
Deplh Size
Frorn To FI
From To FI
Material
0
CO
IT- T
cZ
N
C7T
17. REMARKS:
I D0 FIEBEDY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
tit- • • ;,Af✓O,T P COPY OF THIS RECORD FIAS BEEN PROVI CO TO THE WELL OWNER.
CO
IIJN
IAL
C FIDE
SIGNATURE OF P RSON CONSTRUCTING TIIE WELL DAIS odolnal to Division of Wnler Ounlily, Oroundwaler Secllon Within 30 day5
GW.I REV. i2/99

270015
i
North Carolina - Depanmenl of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mali Service Censer - Raleigh, N.G. 27699-1636-Phone [phone] �'
WELL CONSTRUCTION RECORD WELL CONTRACTOR' /IN RmAN Z . A-C�.
WELL CONTRACTOR CERTIFICATION *: 4D�
STATE WELL CONSTRUCTION PERMIT*:
WELL USE (Check Applicable Box): Residential L✓ - Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Infection ❑ Other ❑ If Other, List Use:
2. WELL LOCATION: how sketch of the location below)
est Town:r1'�T-Its- Count' �n'S'� �--�
r, _�—�py- JC S3. � 4M.r-a,,er- -
( oad Name an. Numbers.
s. Communnl}ly., or Supd�lsk in and Lot No.) DRILLING LOG DEPTH
UL 3. OWNER titak, 6p:Y4E.NI-- From To Formation Descdpllon
Address 9 5
C W� I Ifeaor•oue`o.c Vic o - ay ��rR�'
Y � o c�Li - a S
tBE-cj2ock
Ily or Town Slate Zip Code
4, DATE DRILLED D- -O -
5. TOTAL DEPTH,
6. CUTTINGS COLLECTED YES I I NO WI
7. DOES WELL REPLACE EXISTING WELL? YES NOW(
8, STATIC WATER LEVEL Below Top ol Casing: FT,
(Use'' 11 Above Top ol Casing)
9. TOP OF CASING IS / +
FT Above Land Surface'
'Top of casing terminated aL/or below land surface requires a variance In accor-
dance wllh 15A NCAC 2C A118
10. YIELD (gpm): 1 b ()METHOD OF TEST R.: 3
11. WATER ZONES (depth): o
1' 'HLORINATION: Type TI 7N Amount R 1 r If 3 if additional space Is needed use back of form
1 ASING:
Wall Thickness LOCATION SKETCH
Depth LL II Diameter or WelohVFL MM ledal (Show direction and distance from at least Iwo State
From O To a '7 FI it' a 5 / F 8_ '`5-/- / - Roads, or other map reference points)
From To Ft ^+lam
From To Ft 1�i—
14. GROUT:
Depth Material _potful_
//,, rr .� ,� ,,,�, ��i,�,�77
From b Toa�0 Ft f1�1YC 4E / WL���vvril -crAi
From To FI
15.SCREEN:
Depth Diameter Slot Size Material
From To Ft In In
From To Ft In In
From To Ft In In
16, SAND/GRAVEL PACK:
Depth Size Material
From To Ft
From To Ft
17. REMARKS:
r37
PO
cix
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTIONSTANDARDS,STANDARDS, AND THAT A COPY f�FTHI�S RECORD HAS BEEN PR IDED�TTO THE WELL WNER,,
FOR OFFICE USp'ONLY {/ 14 /��'l.C�Lti� rC.J C.CX��.— /6 r i-6a
d No'.{IRE OF PERSON CONSTRUCTING THE WELL DATE
ion of Water Duality, Groundwater Secllon Wllhin 30 days
.ul No. GW-1 REV. 12/99
S
Submit odein-a-10 Dil I

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section 270013
1636 Mall Service Center - Raleigh, N.C. 27699-1636-Phone [phone] WELL CONSTRUCTION RECORD WELL CONTRACTOR. MAN kal
WELL CONTRACTOR CERTIFICATION A:
A Lu;yvss
/-90
STATE WELL CONSTRUCTION PERMITN;
1. WELL USE (Check Applicable Boa): Residential lgMunicipal ❑ Industrial I1
Agricultural El Monitoring ❑
Recovery ❑ Heat Pump Water injection ❑ Other It Other, List Use:
2. WELL LOCATION
Neare��s/�t Town:
t�(.,Name an'•
(Road Name end.Nu
3. OWNER
Addres Q �SA
ree or
Clly or Town
�S wsketchWhe location below)
' ] Cl� County 164,-- nke
of No.)
Slate Zip Code
4. DATE DRILLED /D /• O
5. TOTAL DEPTH .5OS
6. CUTTINGS COLLECTED YES NO�'
7. DOES WELL REPLACE EXISTING WELL? YES flJ NO
8. STATIC WATER LEVEL Below Top of Casing: 70 FT.
(Use's' If Above Top of Casing)
9. TOP OF CASING IS l FT. Above Land Surface'
'Top of casing terminated at/or below land surface requires a variance In accor-
dance wllh ISA NCAC 2C .0118
10. YIELD (gpm): /5 METHOD OF TEST --R) q
11. WATER ZONES (depth):
II
DEPTH
Formation Description
0
J_)
—v
12. CHLORINATION: Type -tT Amount .D.Sc_pL�9 II additional space Is needed use back of form
13. CASING: 1t
Depth((r�jj�Diameter
From Q To ram FI. ten D5
From To
From
14. GROUT:
To
Ft.
Ft
-v
Wall Thickness
SKETCH
or Weight/FL Maledal (Show direction and distance Irom at least two State
aIG. wc-5DR
Depth Material
From 0 To QC) Ft Cm?!r fiPTP
From To FI
15. SCREEN:
Mall '
erihod
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 Ft
From To FI
17. REMARKS:
Roads, or other map reference points)
N
W
ry
W
W
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.
am, "Zia /6- /— o a
f NATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit odpir al to Division al Water Quality, Groundwater Section Within 30 days
GW-1 REV. 12199
FOR OFFICk U$bNLY
Ouad No: /--.__.....
Serial No.

North Carallns - Doparimanl al Envlmnmonl and Nelurni Resource, - Division of Wnler Ovally • Oroundwnlor Socllon 270011
1638 Malt Service Cantor - Relolph, N.O. 27699-1638-rhono (919) 733•3221 ( (�
•
WELL CONSTRUCTION RECORD WELLcoNTRACron. Bo Lin C. P +
WELL CONTRACTO CERTIFICATION p: CO.; g
STATE WELL CONSTRUCTION PERMITS:
1. WELL USE (Check Applicable sox): Residential LY] Municipal l 1 Industrial El Agricultural
Recovery r1 Noel Pump Water Inlecllon ❑ 011ler E] If Olhor, List Use:
WELL LOCATION: how $ etch Jof the location below)
Near �a tTown'' °WAD County
ea4:3.00-biztc
Monitoring D
1Rond?Jame a Nurnbors. Cormv , or Sub Ivlelon end Lot No.) DRILLING LOG DEPTH
3. OWNER D/Lt/» /O/LJ V d_fin
Address {% aciN ice 3 (e
(_reo orTfoulo hjpj • C. a2727
Cliyor Ton'n� Slale{v ) Zip Coda
A. DATE DRILLED -4 2
5. TOTAL DEPTH p�
6. CUTTINGS COLLECTED YES NO 4
7. DOES WELL REPLACE EXISTING WELL? YES ( 1 NO17
0. STATIC WATER LEVEL Below Top of Casing: , 5 IT.
(Use'.' If Abovo Top of Caslnp)
9. TOP OF CASING IS I FT. Abovo Land Surface'
-Top of ces In p terminated sUor below lend surface requires a variance In accor-
dance wllh 15A NCAC 2C..QQ,,I IS ,
10. YIELD (um):�J O METHOD OF TEST 1 C\
11. WATER ZONES (dopth):
•
From To Formation Description
12. CHLORINATION: Type 1-'I T N AmounI3_7L 11J1
13. CASING:
Wall Thickness
Depth / tiara lot if(t'l(21.
From �To.-lLb-FI. IW- FF�0 j� aj S•
From To FI
From To FI
IA. GROUT:
From 0
Frorn To FI
15. SCREEN:
Depth Material
To A0 Ft CDtIQ
Doplh Diameter Slot Size Material
From To Fl In In
From To FI In In
From To FI In In
16. SAND/GRAVEL PACK:
Depth Size Material
From To FI
W
CD _
-o
IV
If additional space Is needed use hack of form __ r
LOCATION SKETCH
(Show direction and distance from nt least Iwo Stale
Roads, or other map reference points)
C, c,
From To Ft
17. REMARKS:
I DO )IE71E11Y CERTIFY THAT THIS WELL WAS COI• STRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
GONSTRUCTIOtfSTA DARD$, AND T)IAT A COPY IIS RECORD HAS BEEN rno IOTHE WELL OWNER.�.i. kit / 9- a 7-0 °.
FOR OFFICE US$ ONLY
Se dal No.
Chard No: ' J 510I'NAI'v Ur1E,0f-PERSON CONSTRUCTING TIIE WELL DATE
jI submit
edpina(I&- I Ion of Weler Duality, Groundwater Section within 30 days
GW.I REV. 12199

North Carolina - Department of Environment and Natural Resources - Division of Water Duality - Groundwater Section
1636 Mall Service Center - Raleigh, N.C. 27699-1636-Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR' RIRW kEl
WELL CONTRACTOR CERTIFICATION It:
STATE WELLCONSTRUCTION PERMITH:
270010
/90
WELL USE (Check Applicable Box): Residential tJ Municipal ❑ Industrial E Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Infection ❑ Other II Other, List Use:
2. WELL LOCATION: ( ow skelc 1 of the location below)
Nearest Town: d D> - Count'. (LP
l (Road
Name lZrnsion
(Road Name yrttlNumbers, Comminly7,�, or Subdiv slats and Lot No.) DRILLING LOG DEPTH
3. OWNER \ _ 111h±15 �-11 Pie e.l_�+-i 5J/��G-T Ram To Formation Descdpllon
Sheet a ,ou Ia No. c-
Address
CIIor Town Slate Zip Code
4. DATE DRILLED 2=P!-!�_�
5. TOTAL DEPTH (� `D 0
6. CUTTINGS COLLECTED YES I f NO[ r''
7. DOES WELL REPLACE EXISTING WELL? YES ff NO[ '
8. STATIC WATER LEVEL Below Top of Casing: 70 FT. _ _-
(Use '+' If Above Top of Casing) N
9. TOP OF CASING IS 1 FT Above Land Surface' ._P
-Top of casing terminated et/or below land surface requires a variance In accor-
dance wllh 15A NCAC 2C 118
10. YIELD (gm): METHOD OF TEST �) q rye11. WATER ZONES (depth): `l
0 /AD "Digit
/Qo 4'/S BeAlnc-A
12. CHLORINATION: Type 4}T+ Amount 8 If additional space Is needed use back of form
13. CASING:
Wall Thickness LOCATION SKETCH
From O
Depth Diameter or Weight/Ft. Material Rp (Show direction and distance from at least two State
To D FI L. (Pile. f �G�.S�rl Roads, or other map refelt OW/ %reJlnce points)
From To Ft, W/
From To Ft
14. GROUT: C .
Depth Material Method ,/�� _—�j-e ) --4
From To QQ FI GOlIGPI P i le4 ed C l�„�',(__(s;Zft"
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
16. SAND/GRAVEL PACK:
Depth Size Malerlal
From To Ft
From To FI
17. REMARKS:
1 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.
/� .1-- -As-oa
FOR OFFICE USE O�ILY-�; - -- �---�7 4r
Quad No: SIGNATUfi' JP PERSON CONSTRUCTING THE WELL DATE
Submit original to.O ki Ic4+l Water Duality, Groundwater Section within 30 days
Serial No. GW-I REV. 12199

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 WELLCONTRACTOR• "BRJAW kE, A W,NE5
WELL CONTRACTOR CERTIFICATION A• /90
STATE WELL CONSTRUCTION PERMITH:
270004 r
WELL USE (check Applicable Box): Residential EQ Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heal Pump Water Infection ❑ Other ❑ If Other, LIst Use:
2. WELL LOCATION: (floc11 I h w sk 1e location below)
Ne est Town: 1 County
n cad . > ad/ m+N .
(Road Name an ummbeers,, co—m'mu`ni.hinub'dlvl'sio"n hand LLol No.) DRILLING LOG DEPTH
3. OWNER ( CY1WiW C(lY D a'-cL4 -.v
Address '/J/U ) v
C ()1. Iree or Via
070<7
Cli.•yoorr Town L State �J Zip Code
4. DATE DRILLED 41—a0-0 a.
5. TOTAL DEPTH
6. CUTTINGS COLLECTED YES
I I
8 D — 3 o5 -13e,a1Rq eA
From To Formation Description
0
7. DOS WELL REPLACE EXISTING WELL? YES LJ NO � �'
8. STATIC WATER LEVEL Below Top of Casing: �.� FT. Iv
(Use 'a' II Above Top of Casing) O
9. TOP OF CASING IS ' ET. Above Land Surface' --ti
'Top of casing terminated at/or below land surface requires a variance In accor-
dance with 15A NCAC 2C All!,
10. YIELD (gpm): 0 METHOD OF TEST nit., c-
11. WATER ZONES (depth) r --
N0yY
12. CHLORINATION: Type LLTt_ Amount sa 9 If additional space Is needed use back of form
13. CASING: `�
/n� Depth Q Diameter
From Id To (' v Fl. �. ^
From To Ft.
From To Ft
1.1 GROUT:
Wall Thickness
SKETCH
or WeIghVFI. Maledal (Show direction and distance from at least Iwo Stale
a)L• ,15 Pvc-SDR
Depth Material
From CI To QC) Ft !'.nbl Gf3PTP
From To Ft.
15. SCREEN:
Method
°cl
Depth Diameter Slot Size Material
From To Ft In In
From To Ft In In
From To Ft In. In
16. SAND/GRAVEL PACK:
Depth Size Material
From To Ft
From To Ft
17. REMARKS:
Roads, or other map reference points)
A (Tact
arc W ffC
"0
1V
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.
. �.� 9 -d-oa
SIGNS W E OF PERSON CONSTRUCTING THE WELL DATE
-- . Submit originalto,mlplsydr of Water Quality, Groundwater Section within 30 days
GWd REV. 12/99
FOR OFFICE USE ¶NtY
Clued No:
Serial No.
(7:

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 WELLCONTRACTOR• "BRIAW W '<E h / pi CD
WELL CONTRACTOR CERTIFICATION A: 3/'A%D
STATE WELL:CONSTRUCTION PERMITS:
1. WELL USE (check Applicable Box): Residenllal12-.4 Municipal ❑ Industrial 1-1Agricultural❑ Monitoring El
Recovery ❑ Heal Pump Water Injection n Other ❑ 11 Other, List Use:
2. WELL LOCATION: (S
areal Town:
w sketch ,of the location below)
�l e.al/it. County:
oad Name end umbers
3. OWNER
brass f1
Clly or Town
4. DATE DRILLED
5. TOTAL DEPTH
Community, or Subdivision and Lot No.)
Slate
aooa
a
actociect
6. CUTTINGS COLLECTED YES 1 I NO
7. DOES WELL REPLACE EXISTING WELL? YES Q NOIV-"
8. STATIC WATER LEVEL Below Top of Casing: �'� FT.
(Use Y' if Above Top of Casing)
9. TOP OF CASING IS I FT Above Land Surface'
•Top of casing terminated aUor below land surface requires a variance In accor-
dance with 15A NCAC 2C.0118
10. YIELD (gpm): c 0 METHOD OF TEST �) q
11. WATER ZONES (depth):
Zlp Code
ZO2 Cen-n2-e
DRILLING LOG
From To
o-711
7y - dos
DEPTH
Formallon Description
Beaty/5411
rV
ZD
IV
rV
12. CHLORINATION: Type Amount z2 nt(In r(IS If additional space Is needed use back of form
13. CASING: tt
0
Depthry L./ Dlameler
From 1 To / Ft tbi D5
From To Ft.
From To Ft
14. GROUT:
Wall Thickness LOCATION SKETCH
or Weight/Ft. Malerlal (Show direction and distance Irom at leas) Iwo Stale
all, j�5 'PVC-5DR
Depth x� Malerlal Method
From 0 To QC) Ft Go alGijPie -rah girl
From To FI
15.SCREEN:
Depth Diameter Slot Size Malerlal
Frorn To Ft In In.
From To Ft In In
From To Ft In. In
16. SAND/GRAVEL PACK:
Depth Size Malerlal
From To Ft
From To Ft
17, REMARKS:
Roads, or other map reference points)
cueinorii athk,
0, ,
(V
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 OFFICE -US ONLY.
Quad No:
Sedal No.
SI NATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit o igln21? Dlvlslon al Water (Duality, Groundwater Section within 30 days
GW-1 REV. 12/99
270003'
Cr)

North Carollnei • Dnparlmonl of Environment and Nolurnl Flesourcea - Division of Water (Duality - Groundwater Section 270002
1630 Mali Service Center - Raleigh, N.C. 27699.1636-Phone (919) 733•3221
WELL CONSTRUCTION RECORD WELLCONTRACTOR• BO )it lU. 9 +
WELL CONTRACTOR CERTIFICATION p: 0a A
STATE WELL CONSTRUCTION PERMITN:
1. WELL USE (Check Appllc.ble Box): ResidentialLa'
Municipal ( I Industrial ❑ Agricultural n Monitoring U
Rocovery r1 bloat Pump Water Infection ❑ Other n II Other, List Use:
2. WELL LOCATIOly7($)lowkelch the location below)
Reveal Town /vu/-��
•
n P•
t d . ?ells />.!/4 (6hf Z/-
County.
(3 OWNER .Yenurnbore, Convmrntry� r Sabdivlslon end Lot No.) DRILLING LOG
nand Nam
e/4Ae C41-7g&Ir„ From To
Addres3
rec o '
Clly or Toms
L' Slale Zlp ode
5. DATE DEPTH
5. TOTAL DEPTH
6. CUTTINGS COLLECTED YESI I NO14
7, DOES WELL REPLACE EXISTING WELL? YES ( I NO tf
0. STATIC WATER LEVEL Below Top of Casing: 3/, FT.
(Use'.• II Abovo Top of Casing)
9, TOP OF CASING IS I FT. Abovo Land Surface'
•Top ol cm sing ter minnled sVor below lend auriace requires a variance In accor-
danca wllh 15A NCAC 2C.9115 a
1O. YIELD (gpm): Q METHOD OF TEST 1
11. WATER ZONES (doplh)•
12 CHLORINATION: Typo 7 AmounIE
13. CASING:
DEPTH
Fomrnllorn Oa script lon
"s
r-
N EC C_
N
If additional space Is needed use back ol form
Wall Thickness LOCATION SKETCH
Depth .5 plammelol fir, eta V[l. Material (Show dlrecllon and distance from nl least Iwo Stale
From To . FI [�J j Bonds, or other map reference points)
From To FI
From To FI,
Iri. GROUT:
Depth �L �Nsnal�Lo1L. Mol_ hodMr
From 0 To Ft lolirl � T1t�u Kid.
Frorn To FI
15.SCREEN:
Depth Diameter Slot Slzo Material
From To FI In In
From To FI In In
From To FI In In
16, SAND/GRAVEL PACK:
Depth Size Material
From To FI
From To FI
17. REMARKS:
o
CO 171
/6",}4747
c'J
cry
I D0 HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C. WELL
CONSTRUCTION STANDARDS, AND TIIAT A CDPTOF THIS ECORD HAS BEEN PROVIDED TO THE WELL OWNER.
FOR OFFICE USE43-NLY i t r a q-/f-oa.
Could No:
Serial No.
AS -
SIP
submit odgirpll{a
„i' iJ
E. -FICF
NATURE OF PERSON CONSTr1UCTINO TI IE WELL DATE
Division al Wale( Quality, Groundwater Section within 30 days
... GW•1 nEv. 12/99

North Carolina • Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Ma/I Service Center - Raleigh, N.C. 27699-1636-Phone [phone]�///_'� JJ
C WELL CONSTRUCTION RECORD WELLCONTRACTOR• NARmRN • 24.-ZL,
20001
WELL CONTRACTOR CERTIFICATION #: a7D.1 7
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE (Check Applicable Box): Residential lJ Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Infection ❑ Other ❑ If Other, Llst Use:
2. WELL LOCATIIOLy (Show sketch of.the location below)
Dearest Town: 1A-t4iJVU•dJ° -, , County. w1',C/.Sl'h ,
0510.3A60 Rd- U l tadl- 2 e
• (Road Name inskifs. Commly, or Subdivision and Lot No.) DRILLING LOG
3. OWNER U�C.21 From To
Address ti• ,...� ea_ _
( n A r or o IeQo D.J CC.j DAn r 7
�Cittyy jor Town _ v v Slate Zip Code
4. DATE DRILLED 9 • 19-b
5. TOTAL DEPTH t. -4
6. CUTTINGS COLLECTED YES [l NO4
7. DOES WELL REPLACE EXISTING WELL? YES a NOrci
8. STATIC WATER LEVEL Below Top of Casing: FT,
(Use 'a' it Above Top of Casing)
9. TOP OF CASING IS / FT. Above Land Surface'
'lop of casing terminated at/or below land surface requires a variance In accor-
dance with 15A NCAC 2C .0118
10. YIELD (gpm): .Dr2 METHOD OF TEST R:
11. WATER ZONES (depth)•
12. CHLORINATION: Type_EMI__ Amount 12.p.ilLS If additional space Is needed use back of form
1• SING:
DEPTH
Formation Description
1)`C? Da S Betoc k
n
CO
a
N uu..
PO
Wall Thickness LOCATION SKETCH
Depit) 1 Diameter or Weight/Ft. Maledal (Show direction and distance from at least Iwo State
From 0 To ''"Y� Ft L • a 5 al .J;5 PVc•SD.0 Roads, or other map reference points)
From To FI, �ll
From To Ft Y5CL ), l,,cr� cc,�ee
14. GROUT: ( C�
Depth n Material Method hod `� , \ p /1 r (,kl)-lb_.�,i C_,
From D To gl-0 Ft L d ic.214E U\l'"""
From To FI
15. SCREEN:
Depth Diameter Slot Size Material
From To Ft In In.
From To Ft In In
From To Ft In In
16. SAND/GRAVEL PACK:
Depth Size Material
From To Ft
From To Ft
17. REMARKS:
IC:Z Wd 93fl3dG0
I DO FIEREDY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION qTANDAll DS, AND THAT A THIS RECORD HAS BEEN PRqVIDED TO THE WELL WNER.n
FOR OFFICE VISE ONLY
O'i•d No
1
b.,'al No
Submit odpipil d1/[
1TURE OF PERSON CONSTRUCTING THE WELL DATE
Ivlsion of Water Quality, Groundwater Section within 30 days
GW.1 REV. 12/99
0