Ch CY2002

266260 w
WELL CONSTRUCTION RECORD
No,I ('and it a - IkimitmenI of Hnviionment end Nattire IResom cc - Division of Waver Qualify-Groundwater Section
t,F.11 ( ONIRAl-1 oft(IN nlx'I nUA L)NAME (prin0__1S_EL'up _-.-..��._.CO l•-,L-�-J S. _._ CF11I IFICA TON RV f L I 1 t l 7� p
N I It\('I Oil ll IPANY NAAIE-a ka-ke __.._ _._- .L-'DQL j1I PI ZONE N rr1�1 F5�7-�SCX)�3
51 ,1111.IA I.I ONS I Ill'(AION P ERR11TM_ -_-_ASSOCtA I Fn WQ PERMI IM _--._,-
I it applicablcl (if applicable)
I. `.\'III. UY: (('heck Applicable Boxy Residential ER Municipal/Public ❑ Inducllial ❑ npricuhural ❑
f•1 ,1111"Ime. ❑ li_cu,l•ry ❑ Heal Pump Waler Injection CI Odic) ❑ 11 (Wicl• I isl I.Isc____-
W1 1 I. 1 I R A 11(IN npngr.q,hic/Land selling
plrnl '.1 Imk u: /yJ UICp{1, County-Chepoka P— �ltc LlSlope ❑valley ❑plat
l'Y",'/ 21 /-�1�' J pR1.�11 _ W �.-� .� li hrrk ppr p,alc hnr)
/ IF
I -I I'll", N.i/n1,1k, nron-ols 1,Suhdikkion,Lo(No..Zip Code) I alinldcdUttgiledc or Well location
t 11\\ NIP Vy)4- Cp0/i._____ ___. b4•yrt c ,l rmrc'umnds)
:\iIJIr"• �JE-5' /�cw[A.wk'd___ ___... I.Wilwl i mi'ilmh• sumcc ❑(i l'S❑topographic map
1 i t l nr Rolle No.I Itbrck bor)
/Uc- a.�)oa I,�i1•I_I-I DRILL.INGLO(i
lnr... slaw zip code Ilmo to rormalion Description
Oren r,elr-I'hunr nnudmi o -'..
d 1)A 1 F Dit 11,1.1'.D�,1-/J¢/s -Q•�_-_ ../�_-_- ./o_ ll'[rC-
?n qS GRaN)� c-
`7,5- SYv-- -g� tYl-�
n. 1)OI.S l\ ITI. RI.I'1 ACF EXISTING WELL? YES ❑ NO 1
7. (;I% I R' \vAtFRI.l'VEl.Below-rot) ofC'asing: ---- --- -__--- /f
_-'_i'l 62/c/a .SCH[S7 aF RazAQYZ
N '1 Or Or CASING IS ------J '-r-�__-_ �•��l_� Sc Q r�
_.- � PI'. Above Land Surf)ce•
•I.nr n(tnalne landnalyd nl/nr below lend sur(ate requires a --------- — --
. rr imit,Lr nrurrA mrr pith ISA NCA('1('.I)11a
ud D O,pint LoD. t_.. MFrnoD or / 7 -- _ --
In. WA"I FR /.ONIiS Idc1,11i) ,—
__ LC)C'AIIUN SKETCII
11. OISINI-I(LI ION Shook 111tcclioo mom distance in miles froln al Iens1
I' CAS IN(; Wall thickness (wo Slole Roads or Comity Roads. Include the road
Deplh Dimycler or W
eight/H. t,interial numbers and conunnn road names. c
I ngo_..O__ to �-5-_.. I't-4Gt--
I;mo to 19. fV
non 11, rn
I ( (WI it Deplb Molclial t`Irlbud 47
I in ]) -.. lo fI. rV oc
non lh -.._.... I'I. ;=•o
11 114P1-INN Urplb Dianlcle, Slot Sin haulmml -m.o
I n�in to li. ail. In. �m
I non to rl. iu. in. •• ms-
IS c,.A n1 U'111(A1'I I. I'AI-K: --- CD G
Ur plh Sin Molcr6l 'Z
I Irvin..
Ilnm In PI. -
it, RI NIAI KS
n I I
Ir 1 n II ITM C1 R I-it Ill![ 11111S P/1'1.1.WAS(()NSIRW I ID IN ACCORDAN( F WI Ill 15A NCAC 2(', WELL
��� ( nNSiRUI'11n ,SIANUtiI1) � NUllIAl'A('OPYOFrIIISRLCORDIIASBI9NI'ItUVID!'DIOhIIEWPLLOWNER
S11GNAIURE01;VE.RSONCONSIRUCIING'I Ill: %\1:1.1, DATE
t�hlitnGl 1 ..�
-�1u'_migival-41++lirHr�ion of 1\'tiler Quality,(:rnund„�ater Section, 1616 pi nil Set ice l:euler-Rnl NC
2769'I lelh Photo- No.(1)11))711-1221,within 30 tines. (i1V-1 RI:V. 07/2001

2662100
}FELL CONSTRQGUON Imi Uo;r.::
North Carolina-Department o(Envirmuncnl and Natural Resources-Division orRr_ter Quality-a roundwater Scclion
CERITFiCAT1ON Ir_ 19
WELL CONTRACTOR(INDIVIDUAL)NAaIE (prinQ PHONE 111 13
WELL CONTRACTOR COMPANY NAa16` ASSOCIATED WQ rmtall
STATE WELL CONSTRUCTION PEIUIIT/ j(a licablc
if up licablc
ici
c 11 Industrial El
l. WELL Mon or gEf7 heck Applicable
tery ❑ leFD ol):esider Wolerl ittItia �jecl onMull[]paOtherl❑ If Other,List D e Agricultural❑
Rec
Topographic/Land setting
2. WELLLOCATION: ;�I^ j�IcP URidge USlope ❑Valley ❑Flat
Nearest'I own:m F �(��u,{�r--- -- Count (check oppropd,le box)
)cnd Latitude/longitude of well location
zI
(St(Streete Neme,Numbers.Community,Subdivision,Lnl No, p
(degrees/minules/se^.ends)
3. OWNER: J h V. Lalitudegongitude source:00PS01ropographic mnp
y r t \F p )w a_. (check bos)
Address DRILLING t OG
(Su DEPTHter or Route No.) Z�
From To Formation escription
or
sate zip cafe (010
City Ton'
Area code-Phone number
A. DATE DRILLED I (I
5. TOTAL DEPTI1: qn r --_
6. DOES WELL REPLACE EXISTING WLLL7 YES❑ NO F(�
7. STATIC WATER LEVEL Dclol(u°P°rAboveTop ofCesirfl)
S. TOP OF CASING IS I
[-F. Above Lnnd Surrace•
•Top or nsing terrnl^vied e°or baton lend e^rtece requlrte• -�_
variance In eccordame nhh ISA NCAC TC.aI Ifl.
METIIOD OF TEST ems— ---
9. YIELD(gp°r) ---10.WATER ZONES(depth): LOCATION SKETCH�--
�� }ab(e Amount Show direction and distance in miles from al least
a c —'— two Stale Roads or County Roads. Include the road
11. DISINFECTION:Typy�—wall Thickness
umbers and co
12. CASING: Dio peter or Weigllyrt. Materialcommon toed names.
Depth
From D To��_
FLJS SIl��- t --
From To Fl.
From To Ft. - C7) u
Material Method (V
13. GROUT: Depth
To�2f1_`_F1.�2Cu zic�s�
Frorn_�__ Ri
From T° F1'------� l
Diameter Slol Siu Materia
14. SCREEN: DepthPI, in. in. W
Front in. s a�
Frnm To
fl. ir'• rn
N
I5. SAND/GRAVEL PACK: lia
Depth size Matcr — �
Frei" To Ft '---- w c
— Z
From To Ft.
r 16. REMARKS:
i� L� lH I,
� D `r1EREB TIFYTF(ATTII�I3lUWEIAT WAS ACOOOFTIINSTI S RECORD HA BEEN PROVIDED TOTHEW�OWNER
�- CONSTRU 00 TANDARDS,
. t DATE
AN - Z SIGNATURE OF PERSON CONSTRUCTING THE WELL
-- -- - GW.I REV.07/2001
GROUT u1 H� Y�he orlgl nl to the Division o(1Valer Qunlily,Groundwater Se Mdl Service Center-Relelgh,NC
ASHFV9Lr fs U� qhn �{�' No.[phone],within 30 days.

26 '7154
WELL CONSTRUCTION RGCORI)
Not 11, (':n Mina - I)elml ln,enl of l_'nvironme nl and Na IuraI Rest 'n cc,s - Division nl'\\'alcI goal ity - Groundwater Sec l ion (
"I'll ( )N'1R.\I-f III ONIII\'IDUAI)NAPII-. (prh10_ �N��_-----Col/•rVs_\ -.. --- CeHIIFICAIIONa/ O//
IN I'll I ON IIt.V IOlt COdIPAN1 NANIr) ___ . )�fsL.K.�_{S�IQ ` IJL�l14.LA) __—PITON I: a ( )�37•-b00�
I I I,fUN Cl CI Ill'( ION I Ia(NIITq ... ASSOC IA'1 r:I,NV PERN I Ia __--
(it applicaldc) (irupplia)lc)
I AA'GI.L IISI:(('heck Applicable Ilox): Residential LK NIUnicipel/Public ❑ hldushial ❑ Agricultural ❑
N)onitolintl ❑ Recoacry ❑ Heat I'uutp Water llljecliun ❑ Other ❑ II OIher, List Use
\4'I[IT I on. A ION". n 'I tqu,graphic/Land selling
Nearest loner.._MU(3. KY-_ County��� Q���'- I.edt:e ❑Slope ❑Valley ❑Plat
I en eel N:... N.nmhe,,.G inn n.nn/ill,S uhd i I i si,n,.I.III No..7.i p Code, IllliltldClung,ilude of\Nell location
- Idc),r t. nn Ics/sttondal
\dd,csv �Y7 -. _4 v.O(s(�Fl.-)__S t I.milud\'I or iindc smIICC ❑OI'S❑l opographic limp
Il�li U , tin INN I (6,ck I'm)
- . /�7t,L.i��r'l --ov ` _���L) I)L:I'[II DRILLING LOG
rn� nr In„I, �Slulc Zip C,0e Mom fo Formation Description
l unn uunl.FD /.z So off_---
S. MIAI DLIIII1
I.. DUI S P I.LI. RI I I ACL• EVISI IN(. WliLla 1 ES ❑ NO a.3c.� - �xsL9RT.Z SiRbgifS
7, SI A I K WA I IT I.LV'I'd, Hclow"fop of Casing: `i C -
IOse"r"it Ahuvc Tip of(a,h,p)
N. '1 W 01 CASING IS- _� F'I'. Above Land Surface' -- ----- —
'lnp of r:n ine Iermina l ed:d/ar below laud serrate req nlref a - -------------- ----- _
'Al Nate in ar a,rdaa,, Ith I NCAC TC.0118.
'). \'l l'.I"I)1 Lpill): — Nil:1 1101)OI'"1 FS 119/A
10- R A I FIR /.ONUS (depth):
—_—_ ------_—_ �-----"--I,OI_A"IION SKGTCII - —
I I. I IISINPI!('"I ION: l)pc(iS/�CC r�ty_�,— Anumul.C' �o,p�_ Shoal dirt'clion :uul distance in miles lion\ al Icasl
12. ('ASIN(i: W:dl"Illickness ttvo Slate Roads or County Roads. Include the road
I)cell, Di:uncicr or 1Veightll't- Nlnlerial nunlhcls :Ind common road names.
IIhI„_ O p
—__._ fo_ II. W
Ilrntwilllb ---- FI --- -----
c:._
Il. (iHOU I Depth //,�N�l�:ocrio,I Nlclhnd ;,ra
I1 ins C_ ro «_'_
a Id. S('[it l'N: Ucplh n Uia ,cict N1:$In15izc ,lu lnl c;
I nanfo__ . li. in. in.
I ImI to
I5, S\ND.'ORAVIT I'M K N
Ucptll Size Nfael al
I inn 1-n
to VI.IMARKS:`L _
I[T,U(l �tl,Ilji ( (0111 If U(Ill/ I HIS WFLI. WAS C ONSTR II:D IN AC('ORDAM 1: W1Ill 15A NC'AC 2C,WE'LLdIII ttltilCR(�iv�TA ) , AND IIIA A COPY OF Hill, l;('ORD IIAS BITN PItOA'IDFU'fO"fll1;WELL OWNER
6NA I UR1:01:PERSON CONSIIt UCI IN(; I1II'),'N 1+1. DATh
F,� 1,2K rot" I'EL' 1w,he Di,ision of 11'ater Qu: Ill jr, Grou fit]n ater Section, 1616 Mail Service('enter- Rmicigh, NC
FqOfilN_ItFtl*FcIC14ilI!ING!0)CLE) 7})-1221,vilhiit 30 dllcs.

nfi
2664 �0
WELL CONSTRUC'f10N RECORD
N,,,if,t'a,eima - wpmtmenl of Envimmnlenl and Natural Rcsowces• Division of Wald Ouality-Groundwater Sectioon(/7
k,r,llAOxint.\(-luntINlnk'IDn4L)NAM1IR /(Lrr�ln�0 �N-nY '•C.Q., /;IC`✓^f.�J I _ _._. --- CVRTIF ICA1 ION#^!N1_v
Xi rCUNlit.%("I Olt('r1aI VAN 1'NAM1tE_y,�.ylY�SQ_ �.-IM1-�s=�I__iJrv.11�iti� -___PHONE N
91.k I f.Nil 1'lISS'I Itl'C1lUN PF RM1II"1'q_-_ _............ASSt1(IA IED WQ I'F I I N
lit npplicablcl (if applicable) __
I. W1'I L USE (C'hcck Applicable Box): Residential @' M till icipaUPollIic ❑ hlduslrial O Agricultural ❑
Nionilminc. ❑ Recovery ❑ Heat Pump Water Injection❑ Other ❑ I1`Other. [.is( Use
--
I l.l. l (WA IION 'fo)nrgrnphic/Land selling
P!r:n esll1Aw�n/:�__1 LLRY/.yKI-J�.- ��Coru-�nl-yrt-/�� bX f.Ilti,Il!r [4<)pe ❑V:Illcy ❑plar
Irtheck»ppmprilr host
i'Vny I NnenL N um lmn.l inn nvn,ilt,Suhdivi,ion,I.nl No..Zip Code) I.atiii0c1ongitud^_ of Well location
.1 1 \\ r
N1 1 _ I �II .^- — IdcFrcr<hum lcs/eecmids
r 1
\il he _.-.-. .°7.�.. �P _ ram I.alihul I. n)tinldc vatnc ❑(il'SOlbpogrnphic map
T,,cl er Route No 1 Ichcck hnsl
A -� — DI:I'III DRILLING LOU
71p Cede Floral 'I o formalion Description
fin•-+o Ir p S- Y S t✓ S//E.PKD ��
9. 101 At. DEPfn:.,2. (,S________-- .7.i G-S _-�� " (l13RTZ
( DUDS WELL RF.I'I ACE EXISTING WE:1.1,? YES ElNO ❑
7. S IA I It WAII'.It I LVIT Below Toll of Casing:.-50_ 1:1'.
nhe"�"if Ahove Top of Casing)
%. 1 DI' OF CASING IS_._1 17F. Above Land Surlhcc+ ------_--_.-__-.-___
•1 rap nr rs,lug lermina led al/or helm land surface requires a —--' "--'
vurlanrr In arron4nrr,v lth ISA NOkC 1C.a119. ',� � " - -- ---- --- —
II. 1'IItI.DIi!put) -a�'.____METIIODOFTEST49 rI T_ —__-_---------- --
In I WAIT /.ONFS(deplh): Zzs --__..--- ------- ---- - ----- --
I - Show dilcclion and distance in miles from at least
II IIISINII (`IILIN. Type-_rt , 1W—L nnmum_ �,_.c�.���
11 CASING. Will Thickness two St:de Itnads or('onnly Roads. Include the road
Depol Dinmcier n ur WeighVl't. Malrlial ntimbcl<nod common road names.
r -.
I IlvQ_lh_-.7jEjli. __ __p✓C_-
CD
Irrml - ___--"ro--- ---. FI. ----_.---. IV
I ram . --._- t o_------- Ft' r�
I1. (;POM Depth Material -- _hlelloI `^
I `o-
I Vf. _
±-c
II. MT14.10N'. Depth Diameter Sol Si?, ddd c M;itcrinl
I will To
I5. SAND/(;RANNTL PA . Gl
N c
C Sic Nlntnlld Y
It i
Iq el NIARKS: . - -- -- - ------ - - -
I UD III I'VERY (AK I!I 'i' I I A I I IIS WELL WAS CONSTRUCT F ) IN AC('ORDAM 1'\VIM 1 sn NCAC 2C,WELL
LL f r Ypltt( JS_ AND,A ip ,AND]11Kf A COPY OF THIS Rp('ORD HAS I111 N 1`ItUVI1ED�'1
90'fllli WELL OWNER
ASrr` it . P,`
- - - - --_ -- SIGNATUREOF PERSON CONS IRUCTINOI HF WELL DA11:
Subnlil the of igimd In the Division of Witter Qunlity,Gronndsrnler Section. 1636 Mail Scivice Center-Raleigh,NC
!'(An-16161'llnne No.(e19)711-1221,ollhin 30(lays. GW-I I1FV. 07/2001

WELL CONSTRUCTION RL'CORD 266419
Nmlh Carulma - Depailment (it Environment and Natural R�esouices-Division of Water Quality- Groundwater Sectioo�n/qu t!'
w FI.I.C(IN'l lt.kC Wit(INDIVIDUAL)NANIF (print) 'RA.1[,D YG,9^,.�L[_r../+$ _._.— C4.R'1-IFICATIONp/�
wr:lI ( ONI It.\("1 Oil f'ONIPANV NnnIF:-0LO.Qn�F---It �1"� -�RL�.41� r u0N F af�'
SI kIF %%F 1.1.CONS I'IMCI]ON PF,RMI"I'N_-__- AfiSOCl%I F It 1%0 PF RMI IN
e
fit applicable) (irapplir able)
_ 1
I WI 1 1. UI ;H (Ch /eck Applicable Box): Residential fiS Municipal/Public ❑ lodomri;l ❑ Agricultural ❑
\h 1111, ing f7 Recucery ❑ I Ical Pump Wale[ Injection ❑ Oil cr ❑ II()therm list Usc-___- __-
'. \\ I l I. I 1 ICA I HnIAN'.
Topi.lin Chic/Land
Ncncsl Q /� County S( upe sclting-
❑Valley ❑Flat
(,oc F.. _�5.1..'•�Y°ti___—___-___.___ Icherk appr:�p.iate hoq
I'0T,0 N;n,.r.Nuo.brrs,rbmmouily,Subdiviciun,Inl No..Zip Code) I u liludc,Inngiludc of well location
1 ( ,\\'NI'.R: ./ry(tK � � ;d�y..rrrs minors/srcnnds)
__.RT- A_._BOX _-50a. ,--- .__ Iiinlml,hi:cllmlc sumce:0e711S❑fopograpbic map
I5
1 •.o Route No -y Rheck has)
� h1 �� /� � !___,__ Di I'11_I DRILLING LOG
t . ..a.. Sim, npC'nJe I non 1: I ormatiou Description
bm.e.nod c B_ 5_ _-- mow SAN1L57o NL-
I. 0 WA( SAAdDY -5611T�
9 I(TI-ALDIiI'"I'll:_., "D,,$_
6. I)(IDS \\'ILL REPLACE EXISIING WELL? YES ❑ NO E4� rS/�S -___5D-S -/ 76
C3�_ _�J 12-�____
7. STAIIC' \\'A"fliRl.E.\'1?Lliebw'TupofC'asing: SO___hl. --
IIlse"t"i(Ahme l op or Cusing) --
R. 1I W OI' CASING IS _._J. I'T. Ab6ve Land Surface* --- ---
•I np nr rasing Irnnh.a lyd aUor below Innd aarfua requlref� -- — —
v:o
9 Y FI l)(gpml)
itl. AA'A I IT ZONES(depth):
_ L(Z'QlKIN Sk UlCI
11 1)ISINI VC1 ION. -1 ype,C&OR)Nb Amount CuP_S_ Show ditec Lon and distance in miles from at least
12. ('ASIN(i: Wall-Thickness two Slaiv Bolds or Coonly Roads. Include Ilse ro:a.
Depll Diimpcier C(it Vc.11},h/l/PI. Mntcrial nm beis:and comm f:on road names.
111,111 r0... _....._._It.------ A ^l
I l I;POUl`. Depth � Nalrnal NcIh...I CF1 =
Io:m Q _ to ':20, _ 11, *vro_c `w4'!T a
In:nl 7 -N to of =k —o
I I S( P11 N- OCplb Diameter Slut Si7C Match; - Rt
Is ti,ANNdiRAA1.1. 11 11
Dcplh SVC Malai:d
I man l�u It.
I will To
" IS WELL.WAS CONS1 RU( l FI) IN AC('ORDAM I. wl l I I 1 5A NC'AC•2C,WELL.
CI)1 11?111r'11UN ANI t:1 1pSl U'I I IA f A COPY OF l IIIS RECORD HAS BFFN PK0\'ll)I: )10 1 IIE WP.LL OWTIBH
JAN I
1 SI ;NA1UREOE PERSON CONS IRkJC1INGIIII I W11.1. DA11:
cn GROU rn r h 5 110N
N0Pelt!�IpIir,"A T IgfI),�1�1@)ffl�kgT)ivis on of Water Quality,Grulmdl\titer Section, 1616 Mail Service Center-Rnlcigh,NC.
277r,90 1e16 Phonc Nil.P)11))731,3221,within 30 daYs. GW-I RI:V. 07/2001

I lor,h Cp,ollna • Dep a,Impnl of Environment nrid fl pho of Ile eoolena • Illvlelnn of Wnln, Dunlily•(boun(l.valnr Seclio+e 1630 ',all Sprvlop Ce(jlpr•Flnlelgh,N.C.276 h
99.16361' mlo 1919) 731-3221 n/ 262382
WELL CONSTRUCT IONHECOFlU y( LL Coll IIIACI Oil cult tIfI(:Al1011it! 3
SIAI E WELL COIISIDUCI loll PC"'A'I e: ---
J. WELL USE (cheek App0eable eoq. nvsldonllal IA 01hor al U
Induslllil I _I Aglicullural U 1Aonllolirg I
flecovory 0 1]eat Pulup Wator In(ocllvn LI Olhor ❑ II Other, IJsi Use:
2. WELL LOCATION: (Show skolch of Iho Iocailon bolv`ro 1 i1y
Nearest lown:r� Mill 9)�l h 6�
UIIILI IiIG LUU LJE?f l l--
p,oaA Ilmne andIlun�f o,r.Cmnnunlly,nr Su6dlvhbn end Lnl I lu l rlom l o roll,,
3. OWf1Er1 Joe-,I� ✓51�7—L( fl'�h�/_ � i "_ ' /a
Addless
I ale Zip Coda
CHI,nrlowE
DnlE
A. Drnu.Eu _ ---
5. 101AI. DEPIII I � r101(
G. CUIlII1GSCOLLECIED YrS h�
7. DOES WELL nEf LACE EXISIILIG WEI 17 YES
0. SIAIICWAl Ell LEVEL D01OV/101) o,C^III(I:lSoj1711j1,ul
( r. Abovo I.nnd Sullaco'
--
9. l Op Or CASINO IS -Z. — _—_
.lop of<,111,p I,,minrled aVor below land ewfa"requhee II vn;ence In sccoo
dance wllh 15r'"pc 7c,olle
to. YIELD (gPn,): n MEIFIOD OF TEST — — �—
it. WAIEFIZONES (deplll): -
�---�— II nddillonol f,^acn ii nrrr!r1,rs= IrrcS nl Iv„+
T Inlg 4- Alnounl�—
12. Cl ILOFIRJAI ION: I ypo y---- __ _ - -. - —"--
13. CASIIIG: _L(7CAI1O11SI'-- -
VV.+II I hlr�„e u
Urplh ulamelor o,WelphV I. 1.1a1 (Show direction pill d%s:nnca hall 21 I Inn' e l lr
6' �� �1 >/ Ito nde.or altar e2p lcfaace Vv
rloln C5 lvrl._ —
r1e11,
Prom to --1
Id. GnOUI: blalollal hlulhoJ w
hapll,
To 0 rl. _.OQL-��u-lS
---
15. SCIIEEII: ,, IAalmlal (� -
Depth Ulamolor ,,IvI51zo w _
From __
I"rom
Ptom lo .—Fl. In.
In
16. SntID1GI1nV elalor
1. L'
rion,
Flom I'I.
17, FIE1.1An1(S:
IUOIIEr1Ep CEn LW 9C(] SI(I(7CIEUUTAGCOnpA710EYJ11111yA NCACY .'//Ell
I ou I fI ED lcEn Hti rMLf4CIF1�3I` cor or"I I11;rIECorlO 11AS IIEE1I PFIOVICED -1 O 111E 7f;'-L��r
E_ a�JNAL OFFICE _ ^ 1 �
POII OFFICE USC UIILY si((uAIMEorprllso11ca15tntY llflo l'='^ FIL
avid flo: sill O'ow,d�Alf Srccn rrltldn u7 Gs Y� GY. 1`11
SUINIJ1 aIQh,il to Ui�+Idon of lVder Ov r• CnI FI_
e
Snbllla. —

y:
WELL CONSTRUCTION .RECORD 264913
Nmlh I ;,whoa - I)cp:u I r I I of I:nvironnlent and Nat urn I Res outecs- Division or Water Oual ily - GroundwaIcr See lion
)Vll tact It It'a It(INOI\I DIIAI.)NAME rinl)_ c,1)-M�*i ___-/. _ .. __.--_ CER"1-IFICAArTIION0 nxne9<
lki I1 11%lit kt'IOIt 1"IMPANk'NAMF ( __ �.�.�._ �LIN ._.—_PII(1NF. Rj,
til t l l N\'I.1 1 ( ONSI Ill'('I ION I•EltallTq __.___._ASS()('Lk'I'ED%%I)I•FIta11TR
lil;ipplilablc) (if applicabtcl -
(Thee 1. Applicable Bos). Residential l(3' Municipal/Public ❑ Indu:lrial El Agricultural ❑
N�niilin in} Cl R •cl�u•ly ❑ Ilcat Puugr Water Injecliun CI 011wt (7 II(Ilhcl. I_isI
A I II Ibl TupIIprl ) /Land selling
NI-.u1•u 'I ,Alslf'� _._-__( aunty Ik.E-fi[��oC' IWidgr ixope ❑Valley ❑Itat
' I jof,
hurl
nl.,,,„� u,.� I..nn,�.s�d•dlrk�„n.1h,��IpN�a�_zip(l�drl I ulilud�.gnngnud�� of well location
I (IAA Ill 12- /,or-e-t� C�ti't _ I�LII nlnulerkmnn�lal
/3 9 _Goo K.. �r— r Aj I nlihnl I "nril''dc v unc:rJ(iPSUI upngrlpLic Inap
I'<Iu�•I„i knn``c No 1 (ol¢ck bnrl
/11lt 2�11 rt� � I11 1'll l DRILLING LOG
Ilnm )n Ponnalio❑ Ueseri NiUI1
I; Ix)FS %VI:I I. RITI.ACI;. EXIS FIND WELL? YES ❑ No IT— .--_-----
7 S1AIR W A I I�it 1 1:%,[:1, Below'I of) uf Casing: _ oU ,-�_ 1'1�. --
(tlae"I"if Ahovc I Op of('11ii,R)
H 11)P OI'('ASINO IS _ - L1. Above Land Sturme' ----------._.__---
'1npofra.ine IrnoM1mtrd el/nr below lend enrGtt rrgalrre ___-------
n l l rc lr. rrr....Vi ,"Ill. IsA NCAC 2C.OI III _. _ -- - ---- ----
n YIII 1) (rpnl) 11 hll 1'11OD OFI ESI, 21 ---_ — —
In t\'r\IIR /))NI S(III Ill 111: . . C, - -
I.O(A-Ilf)NSF 'LIC)I
I I I)ItilNll ('III)N. 'I cpc Amrnud (L i-i_ Still" rcliun and distance ill miles from at least
I _? (',\';INI I Will'thickness two Slane Rands or Coauh' Roads. Include the road
I1 pd, Dinnlen•r n/1 Weighb'll AI�ICIial numbcls and cmomon road names.
lam J
-l.. -- li, �, ., - IL _�. tJ_u
I win
I I IiRt tilt I)i pn( �hlclpJ ��—� blclb„d '�
-
1.1 Il'plh DiallICICI
�� tilnl tii�c plalanOl _,
li ti.V ;PA\lh-
I klih SvC hlalcn:d
I will
I h Ill \I A R L ti ---- - ----- -----..----'----
��
IjWf II I-4 II�� [ jI I III I I IIS 1t'PI_I WAS CONSI RU(I PU IN ACC UIiD 11 ( l 61111 I5;A NCAC 2(., WELL
1 uG': m'Tlrm' R AND HIM A COPY 017 MIS RE( ORD HAS Itl P N I POk'll)PD-1011li WELL OWNER
^'
SIGNAIURP.UI If•IiSUNI'S) ,;1 UI IITdU-{III \k'Ii1J. UAIh.
G fAC Tf P,rts�'�T'IJ f' lilt l) cisiOn or AA ttei Otoilit) u Grond,' ller Seclinu. IGl6 mail cl lvict.Calder-Raleigh,NC
ASh'GNiLLEIFiGBIC1614L�'F€II"2°17t -12)I, )rilhin Ul dnvs. U1V-I ItItV, 07,' 101

264912
NVELL CONSTRUCTION RF,CORD
N,,i lh ( imIma - 1)cp:ulI will of Envimmncnl and Natural Resources- Division of Wnlct Ou:dily-Groundwater Section
\\III ( ()Nill,\t'1Olt(INDIVII111AL)NAIII: (Vrho) Js.a rH `�' -5 _ CER I'IF ICAI ION llci,95c_
o r l l ( I)N I It\('10R(MI I-AN1'NAa1F.-�//c'/eulc c= (nlr_=r_t /JR,L c m%r PHONE a ,`ej-.'17-.50- —
5I A I I w'I'.I.I.('ON'S'I Rt1(-1 ION pEIIAII'I'a _ ---------ASSOC IA III I%O 1'F'A011 Ta
1 it applicable) (if applicable)
■
I. \cI 1.1, 1 I;F I('lick 6 Applicable Ros): Residential 1Tr Muniripal/Puhlic O Industrial ❑ Agricultural ❑
�.L alilln ins I_.I lick nccrr ❑ Ile:d Porlp Water Injection ❑ Olhcr f7 If(Wier• List Use_
(I( I\-I P IN.
�. I'opugral)Ilic/Land selling
k,..nrsl their /�uaPT�/ (•aunt • (�I/�7�cK�- ' 1g Whops Malley DFial
f/l�l-LU93,yC�-= /✓Qe✓L_ ��Cv33 ��_ __ _..__.. (rh<rk uppniprialr hm)
I ...nnlnn ily,Subdi vi<inn,Ink No.,Zip C...kl I e tu llludcllongide of well location
t II\1'NIR'. (Ic`KTi=IL ✓%�LCP3 _—_._.__._.____
_
i7 O- 1 ;iti ImIc/hmliihldc sourec:OCPSO fopographic till,"
f[e rrl o, It...nc N,,1 -� (check bnq
1)(1111I-I DRILLING LOCI
I it .r Io.... .elnm Zip Code Flom To Formation Description
Ilk I- Gv{/_ Y 7a7
M,.a �idr. 1'Lnnr noin6rl �� l ��
,I I)A 11; UR11.1 1'.D,./�_/S_ c
h Ili )IS N', H-1, VITI.AC'E FXISI ING WELL? YES ❑ ND I7' -
7 S I All( \VA I IT I.F.VFI, ilclow Top of Casing: r/-S V __1'1
I l lu"I"i f Ahnvr Top of('n<iva)
It. 'I I II' 01'CASING IS F'I. Above band Surface'
I"q,uI raa I.,Irr ndnalcJ st/nr hrinry Irr1II surface requires
' .o,;Hl rIn arrnrduujf',.III I SA NCAC'ZC.(II IA. �nn -- ---- --
'I. \-II.I.Dlcpnl): b METIIODOF'Ik3S'f /1
In WA LR /ONI SIdk
--__ -- 1<ILCA FION SKEI Cl
/�� -------
Amuunl Show Ililrc d d lion and in miles front m ICISI
II DItiINI IY�11ON. 1)�pc__-�./ -71� c uT
12 I \MINI F. Wall'(-hickness two Sl:gc Roads or Coonty Roads. Include file road
I kptll Driameter or Wcigh(/I'I. hLdcrial ounlherS and (741(trim) road ❑an1cS.
I nnn_.. To --�0 _. IL_p Y 'i
I loll, tb_ ____ _ FL
11. OPOI II Depth ))East lial Alctlwd
I i `:( PI PN. Ivcplli Diameter §I I�lt SiM Material -
nnn II,
I ,,ill D, ICI Jll. in. -
Is VND'I iP AA'III P \I K
I)rplh Si]e Millet al
I nvn I'n II.
PD
I( FI %lAIt I
k I f\ I I}#I 1'�;R1��II .1'r4II 1AI I I IIS 1VI[I.I.WAS('(1NSl RU( I f.0 IN ACCDR UANf 1VV1IlI ISANCAC2C.WELL
F ( ill N I Dq ANU IlIAI ACU('Y UI (IIIS IiL(•ORD IIAS [lllNpli(1A'II)L-D'tO NII?WELLOWNER
LSI(iNAIUllFOFI'ERS4NNS 112 fIN(1 Ill) NlL 1, DAIE
(3RO ., 1ntl'ir ,set to (ht Division of Water Quality,Grounfivnter Section, 1636 NIaii Service Crn(er-ItilciRh,NC
ASuEVICp6^RFCfirJPdl?L"'f1FpNoylNI) 71l_3221,within 30 days. GW-I REV.07/2001

WE,LL CONSTRUCTION RE CID F..,
264 ';'70
North Carolina-Department of Environment and NaWtal Resources-Division-
ivisi n-of Wattrer Quality-Groun� ateroN grloli
o C
WELL CONTMCrOR(INDIv1UUAL)NAaIE Indm> tt ^I , I I ; �� PHONE P r�-�1g
WELL CONTRACTOR COa1PANYNMfE ll ASSOCIATED WQ PPRMITN
STATE WELT,CONSTRUCTION PEMIITII ifapplicable)
ira licable
L WELL USE(Check Applicable Box): Residential W!iMunicipal[Public ❑ Industrial ❑ Agricultural❑
Monitoring❑ Recovery ❑ Heal pump Water injection❑ Other❑ If Outer,List Use
Topographic/Land setting
2, W F.LL LOCATION:� County�prIn b& ❑R=dg ❑Slope f lVellcy ❑Flat
Nearesl'faw": Q'—A (check appropriate box)
Latitude/longitude of well location
(Scree Name,Numbm,Community,Subdivision,IAt No.,Zip Code)
(degrees/minutev sr'a•dO
3. OWNER:] 'CSC Lalitudellongitude source:❑GFS0Topogrepitic map
Address U � (check boa)
(street or Route No.) DEPTH DRILLIN OG
C �QQr Rlr 2`t'D 0 From To Formation Description
City or Town Stale Zlp Code .. o
( )e
Aru cede- 1L - )Phone number 1_
4. DATE DRILLED
5. TOTAL DEFTII: i —
6. DOES WELL REPLACE EXISTING WELL7 YES ❑ NO ❑
7. STATIC WATER LEVEL Below Top orCasing: aQ--.Rr• _—_------
(Use"+"it Above Top of Caring)
B.,Tor OF CASINO IS orbd_,x
FT, Above Land Surraee•
rn
-Top or mine Inlnded tUor baton land aor6re cequlru•
reriente in eecordthce whh 15A NCAC IC.0110
g. YIELD(gpm) _-,620--METHOD OF TEST /
10.WATER ZONES(depth): 'ION SKETCH
Show direction and distance in miles from at least
11.tDISINFECTION:Type Amount Wall Thickness two State Roads or County Roads. Include the road
12. CASING: piarneler or Weight/Ft. Material numbers and common road names.
Depth
Frotrl�_To�-�.FL�2-2�
From To Ft. _.
From TO Ft' c
l Method
Moleria
13. GROUT: Depth o 0
From 0 To_ 01 -Ft. n' N
—
From To Ft. — rn c'!^
Diameter
Size Material e'�
14. SCREEN: Depth FI in. _
T^— in. O =M
From —
rl. In. in.
From To
15. SAND/GRAVEL PACK: Size Material
Depth N cn�
mi
From To c
Ft. _ O --
Front To Ft. ---- c
z
16. REMARKS:
HFREt{ � IAT THIS WELL WAS CONS"iRUCTED IN ACCORDANCE WITH THE
2C,
I DO Y(ER
WELL
R ARDS,AND THAT A COPY OF TTIIS RECORD HAS BEEN PROVIDEEDD T TO O TILE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL
DATE
Dlvlslon of Water Quality,Groundwater Secllon, 1636 Mall Service CdW l RE
elill"NC
I to I e V.0712001
L�Roi�r. alp �� i
-., p(ua 1636f'klw
p )eQEa.l�i )?» --1 5vhhin 30 do 's.

WELL CONSTRUCTION RECORD 266321
No III ( ;uoliva - I)cp❑r III e ut orl!nvironmenl and Nahlral Resources- I)ivision or 1A'a Ici QuaI i I -Gioundwalcr Section
w Pal ( ON IR\I"r(IR(IN UIFIIIO AL)NAnIP: IprInO M___ -_ 7C)OE�_S CERI I FICA ION 0-25G-5�
01 1 1.1IP711\I'I OR CUnll'.\N'l rvAnIF._�]�nA,2 1 tDRl d iv PHONE a 1&�.41837—SQ�g
sI,\IINNI LI IONS I If 1'("I ION PIS It III lla-- ASSOCIAI FP\\'t) P P. IM II a _.-_--- —
lil ;i 1 dicablc'1 lira 1 lieablc)
I 1\ f.I I. 1)SI`(Check A1'plieahle Ilos): Residential Alunicipel/PIIIIIis O Iodusoial ❑ Agricullwal U
M onitmiog 11 Recotcry ❑ I Ical Pump Water Injection ❑ Olhcr ❑ 11 1)Intel, List Usc_____
1 \\III I I I)( A IIO^N^ Tullogrlphic/Lnnd selling
N caresl loll m. 1/-1 UA- Countya'°C1QkP-�._ ❑RiJCe ❑Slope ❑Valle}' al
..-�� �I Q_I'll -__$(�i-Ola, -_ERR .S 1Sp[�-- Idirc4 al,pr„pour heel
1,0- i rl,n,.Np{lhus (':..noun.ily,Sul di 'rcion.Lon No_Zip Cmic) I anllid"-1oliglludc It( \YCII location
OAATJI-It_ r1Tl �_ SNt�� it -I-- 1 - - -----
.Addnss i_ t,y2 _$o�c_1.85.�L_ >-�..( Lltilodrl nt 11od- sourcclJ( PMAI opographic map
-- ISnu1... R,,wrNo-) p / IchccA h,el
aptL,/..._ w_ /�l0 DEPIII DRILLING LOCI
n t in I n /_ ILL w QQ 7ip 0,de ---- Front I Formation Description
n,ra��„IcI'hnnc nnnlhci I
5. TUTAl. PIT I I. -
6. IH)I!S \\'P.I.I, lila'LA{'li I!XIS'I ING W'GL1:1 YES ❑ NO ----��---�-- �-----�
- --- —
7. S IA I W AVA"I Fit HAIL Below Top orCesing: -
--
Mse"I"ir A6uve'rnp nCC'nsing)
8. I()I' OF C'ASINYI IS 1:1 . Move Land Surfncc'
'7 np nl ruing to ndnxlyd at/nr below land co-face regnlres n"Al!:,I,, In arrord:nicr ,if]. I SA NCAC 2C.1111 R. _.-_----
". ) 11 1 D (gpm): - P.O . NII:Tl I0D OF TGS-r -----
Iu- AA A I I1R 7ONI:S(dc111 a _
L_OC'A 110_N SKLIrCII
11. 1)ICINI-F( I ION: I q pe__[RAIIPU40� Anxmnl_ Gy P Show difeclion and distance in miles Gun)al (cast
12. ( ASING: }Nall I-hickncss ii�- two Slalc Roads or County Roads. Include the ron(I
Dcplh Diameter or WeighVFl. Material ntunbels and conuoon Pond nnnles.
rwon O -Io-_V,0 rt. so21( P✓cam_
I role l o I-I.
11„Io ll, 1'I ------- --------- o
11. Ulil)UI . Ihpnh Al llcrinl Muthnd tV O
c
11,no o 2/Q..- I1 e^'vf M1rT _ /2s7 VlZ O
I ri,n1 if Ll. Io IgQ_ 11 CLI.%T1^2.25- RHVLL. _ Crn7 C�,
I L �r'lil I N Ucpui IA unUv of Si7c Nlalclial N OG
I u,n1 l o I I. _ _ m. _ u1. C:) �-i�
I mo Ib _ -t___in. __._ In. ._.—._-_-_.— TTJ• mr-
1s_ snNn (;Rnvel rn( (:-
Dcpth Sire Ntnlcrial
Imo I II. cn
mm _ To . I 1 ----- -- ---'- N z
It, PI.III ARK'S
Ii'
11 ) 1'IIl�Q,11 '1.IiA II b I IV\1. 1-1I1 \ 1 ,I.WAS CONS IRIX 11:1)IN ACC'ORDANC P.\Vlll l 15A Now,2C. w1:1.L
C(IWFS��'ta'I i � I ACOI'yohTlllSiLCORDIlAS l� TN P ROVII)HY10 ME WELLOWNE•R
I' I
i Sit RE oP 11 . C NS'IRUCIIN(; I1I1'. R Id I. DATE
S Illolil I q»Pr mirk xM lc4,vlC n for 'Mer Qmtli(y, Groundo'e(er Seclinn, I616 Mail Scrv'ice Cenler-Ilalelgln,NC
2 Gv'I.WStiACiM14,u �dG1')a9 �C\E�I{G w' Ii1130dass. (iAV-I I(IiV, (17/21101

266320
WELL CONSTRUCTION RECORD
Nouh(amho n - Dcpmoncnl of Fnvironmcul and Natural Resnmces- Division of Water Quality -Groundwater Section
\\l II ( ON It I \(']OR(INIM IIWA I.)NAME (IrInO. 'M .�On�P-S_ _- _ CER"I IFICA'IION�M CC/
r��ylplQs
\tt:LLf (1.\l RA('lllll(' )PIIS\N1'NAPI4: IN It 1'Vj PHONE M (ft)T!;7 OQ
.SI Al L\PL1 L(ONSl RU(-1ION 1'F,ItN11TH ASSOCI:\'r F'.n\\'O PFRI\IIIM
I11 appliulhlcl (ifapplicoble) -
I. \1'EI.I. USIi (('heck Applicable Him) Residential H Monicipal/Pohlic ❑ Industrial ❑ Agricultural O
Monilming O Ret owty ❑ I Ica( Pump \Valor hljectioo ❑ Othci O 11()Ihcr, I.is1 Usc_
p. AF'lll 1, 1 O( A I ION ropngraphic/I and selling
Ncmcst Iran'.-/11a1��. Counly ao(we. iulge IJSlope ❑A'alley ❑flat
W)�t? _ R\pGE=�(n._ �RqA-_DR Iraiak q,pngrn,ichoq
cd mar P;anu'.Nmubr: (lnurnnNl)'.$uhdislsiun.lLul N(Zip C(,dc I.aoiiwic/iongltoiic ofwcii iocatloll
176_(�--�___ lJrgnc . ulr rl rckccnndrl
Laliludc I m) dude sowcc O(il'S[I opographic map
n/� ISr,orl ar [Lane No.)�- olhV,khos)
E— '
_ ti_-_ ��oL- 1)LI'I II. DRILLING LOG
iorc"�(// s77rlcC.pr Zip Coda Iuan t�o/ , I ovulation Dcscriplion
(7;Z 71- _- -y10. _JJ.D�—__- C)_
d. DA-rIt DRII.I.I'1)—._J..1.
G OOI S WITI- KI?I'LACI•: I[XISI-ING WELL? YES ❑ NO
S I A I IC WA I Eli LE.\'I[I. Hclow'fop of Casing: FT
if Ahme Top of Casing)
8. '1 01' OI' (.'ASIN(; IS F"1. Above Land Surface" ---------------
•'I
r:vi:uve In accord nncc nIll, 15A NCA('2('.11118.
'I. SII'I UIgpnQ: __-, .---_ N1H1 I10D of:'I
I0 AA'A'I I'R 7Oi lI[S(dep(h): 3 al'
L.00'A"IION SKL I CI I
I D1�INI I I t I ION: -1 ypc_C Na49 Amount Cl( Show direction and dislance in miles Imm al Icasl
12 ('/ASINCi Wall ILickness hao Slalc Roads or Coonly Roads. lucludc the road
Ik"Lpol Diia'mcief, or Wcighl!171. {latcri.d uonlbcrs and common road naancs.
I arm _-G-- o_1v1� I'L _cc vis ,SjiR,a1 --1-✓L_
I will Io FI.
I iron lb rl.
N
I7. (il?Ulll- vcplh plalm i:d hlclhnJ O n�
fTl c n
I Iran _ 10 �Q_ II ^\�� _ _C/,- 1312f f.,/ n crn
I li.iil C. 1(' 1110 1.1 Cli 1Ll"�gs_ �5 ozil VI'j'v/r
I I. S( PI I N 11r pill Ui micicr lul Siic J �I,Ilcu:d/ C jo
v m�_Is. SAND'OR Ab1:1 1'rA('I<: O m�
c
UrPiL ti17C floret ial � —'
I nan In II. N
Inmi In 1
16 PI 'I ARK ,'.
II) 71i�tl IA) IiIIli 'IIlk- 1: . WAS(ONSI RUC 11:1)INACCOROAN( t WI III IsANCAC' 2C,WELL
l'O I�r-Ltttiv�S / )S, ANL��I A C ' oF'fIIIS u(01 IAS HI'1:N PR() 1) I O I11L; WELL OWNER
�'ltj iI .• --OZ
.SIGN AI lJR I;RSON C'tAprJ '[INCi T41Ii "'Fl 1. DA"11:
So l mil Ihl(( I,yh LIR IfkI [tVr of 11'r Icr QualHy,Croundvcalcr Scclinn, ffiJG Mail Nei cice Crtu rr- Raleigh,NC
276rr)-Ia1W9i`I61JiLIFEo 111 d1n's. (iN'-I RIi V. 07/2001

Rr(
263959 Y;
WELL CONSTRUCTION RECORD
Not I ('000 I i)a - Ocinuttornt of Lovironment and Natural Resources- Division of Water Quality-Groundwater Sectiioonr/ �'
%%I:I.I.(ONI PAI'IOR(IN DI VIDOAI)NAll (prinp�MM��✓�YY��NC�s___—___._-_ CF.R"IIFICATIONIt,2S.;�v'
orl l ( ONIIt.\r-11111 CON1PAN\'NAME-_C���Lbetj ��)_1f (� _PHONE N J!? 7—ram- X
SIAII wl(1.1 CONSI111'CI ION PF.RNIITN __ASSOCIA"I'hn%VQ PEIt 110
lit applir.drle) (if applicable)
I I'CF l('heck Applicable Dos): ResidentilI Municipal/Public ❑ Induslrial ❑ Agricullural ❑
N-ImllIminc ❑ Rerocery ❑ I lea( I'uwp Waler lujecliou❑ Other ❑ If Other, List Use-
2 WI I I I (I( AI ION. 1„pograpliic/Land selling
IJt'ilevllmclr [i'14FLA_ fV,Tc✓itl'le ❑Slope ❑Valley ❑rlal
U fry_ ��y����Q�� ICIIrcY apprnpnalc hox)
1211,1 Plamr.Nmnbrr<.l nuvnn t;ly,Subdivision,11i Mt.Zip Crelrl I n6ludo'lorgllude of Well location
l (11\'NI'.It' }�L(,�AP _��\_��T�i`-� _ _ Idcprera'minulea/srcmrds)
Adth", G)7'+____ L�--_1SCt_' � ___ L.ltiludr Innpilude mutes:❑GI S❑Topographic slap
haute Na.) �.. (check bur)
DRILLING LOG
riy ra Ir11` o ti�:�lr zip Cr,dc fill) "Io Formation Description
Are h 19unu.nwnbr' J y� t _ C.�..__1 �� �✓ �_
—�-
5. lOI-AL DEP"III - ------_�---
G. D(WS WELI. ItFVI.A('E EXISIING WELL? YES ❑ NO 13-
7 S I AI W \VAII!1Z LEVEL Below'rop of Casing: .J-J h I. --.... ------�-- -
Ilhr","i(Ahnve'rnp of('n'inl')
S I OP Of CASING IS F'L. Above Land Surface' —
'1np or r�.r.ln P.Irnnlnaled ul/nr Lela,•'I»ud rllrrurr Ryulrer» -- -
,;a lour In artnnlnurr w'hL I NA NC'AC 2C.a1111.
'(. 1.111Dlpplll) b.-..._ . N1E]HIM 01-IES"rL'I °'�__ -- ---_.----
In. \\ A I FR 71N1 ti (drplh):
LOC TA ION SKETCH
11 1)11;INI I!('1 WN. hpe_ Auumnl -.-C- �r Shute din•clinn and distance in miles Frontal least
12 C/VMN(I- Wall"Iliickness two St:de Roads or County Roads, include the road:.
1lepih U 1n1cler or Weight/P1. N lerial numbers and common road names.
lain _.. In It. —_
--
It I{IN)1 I � Ur pIL NlnhnJ Nlclhr I '� -
0 I nnn CLt_. �
I I CI PI I I.: Ih.l lh DmmelcF�Slol Sizc N1:11C ial--- )
I limn
I Iran 1 n -
Is S \NW( PAAI I I' V K _
I),plh SIM Mnlcrial
I willW
I IIIS WFLI.WAS CONS-1RI I('11 1) IN AC('ORDANI'I:wi m I5A NCAC 2C,WELL
IA!JD:\ ) NU 111ATACOI'Y O" IISRFMRDIIAS RI!fN PROVIDED'I'O'f111'WELL OWNER
:' - /(-CI iNAJ URI{DR I'CRSD CUN Il CI' (;,:1 P. Wil 1. DATE
ECTION1A�Ipf�IEE�)nis on of 11 ater Quelily,Crow alel'Seclioo, 16yG Mail Service Center-Ralclgh,NC
n.l'Il of 7I1-1221,n'ilbin 11)days. (iW-I REV. 117/21101

NVGLL CONSTRUCTION IMCOKD
263956 .
Not lh Carolina - I Icp:u II I lei It of Environment and NantraI Resources- Division of Wa(er Quality -Groundwater Section
Y
U FJ L rO]q It U-]OR(INDIVIDUAL)NAM F. rind—��_.--)_IMtm —, IJ1 D_:`�" ..._-_ _._— CF:H'IIPICKAr1r0N 1�p�s
p
wl(II,('ONIRV"IOR('OaIPAN1'N,1p1 F; �2_ `r�'�__ / 1.—.ECF{(I�,'V�'__PIIONE q '
tit:\I1. \\'I':LI.((1,ltillt U('IIUN PF.HMITk_ ______ASSOCIA'rF;U\\'f)PF,HpIfEM ,
lit applicablcl u/ (if appikablc)
I. \CI 1 1, 1 iS1. (('heck Applicable Box): Residential OY Municipal/Public ❑ Industrial ❑ Agrictdtural ❑
nl„nilmiut! ❑ Rconrty ❑ Ilent Pump Water Injection❑ 011iel ❑ If Ulhcr, Lisl USe_ _
VI I I I I WA-I H IN n ❑pogiaphic/Land setting
I1c.il Qsl limlll__..4^`I'D$O-u7 j_—Counlyatagj� rid t ge Slope ❑Valley ❑Plal
1-11 LLs i t-- _.-LQ(J-e--___—___ Icheck npuvriate be')rat:,1 ra,ll� .Ipr�al:lnhr:�.( :I:nn.. lily,SQuhdiv1ti,..i""..LW No..zip cndrlrn-�---- I nlilude/Iungilurie of well location
1, I)\1'Nif R: _(SIC hR��--Rldolt�l��R L°F"_ -�--ldrgrms'min:ncs/srtnuds)
\ddicss __�,�,,_,�Q���.jLO �_ _ Lminnb.�!Inugihldc snm cc:❑Gips❑"topographic map
/� I,Gillet„r It..ate Na) (check M"a)
/Tvb�`t DRILLING LOG
11, It."' data 7i3O,de Pnnn Ib IornimiunDcseriplion
Itl I III.III'II th"
I II-A1I DRII.I.I 1) ��- IZ ` fl 1-___
I,. II(II11 WIA L IMPLAC•E. EXISTING WELL? YES ❑ NO ❑�
----------------- —
/. S I A II( WAlTR H:VEI, Below Top of Casing:—Ds_--1'r.
(O,.c"�"If Ahmn Tap of('a�inpl
8. '11 W 01 ( ASIN(i IS j_____ 1:1. Above Land Surface'
-I up ar tall",I,I...N'Ird atfur helm'Innd,urface require,■ -------------'—'
h:aco"nla tr",'In" ISA NCA('2('.Illla. "7\ -----.-------------- ---
n 1111 1) (gPln): --__--
II) WAIFF /ONFS(dcp111): _yye yzo .__-- ---------._____-- ---
_ _ LI I- -111M SK 'TCI
I I I IISINI�P.I"I1CIN. 1)pe_f�7� Amount�_e_=r r Show dire('lion and distance in miles from at (cast
12 CASING: Wall'[hickneze two Slade Roads or County Roads. Include the road
Ucpth meter or it ei"II/I I. h1lncrial numbers and ciminion road names
In,n1_0
.--- 1.1 1..�(7?_ I'C— -_ '1-1 -p'"•)U-�-- -
Lna° ---._ 1° ..
It (IPntll Ucpihl lalcri n1�lh:nl , -
/60 Ft
I 1 `:( PH N ---. 1),
p1h I)inntelcr IOr Size Motel al _J -
I will l it
Illmi
15 `iAN );1IPAVIA, PACK -
Depth Size Material
I AIm Ilr I'i._-_._.-
III Tf'S'-fIT(vT'fRTU 'I WAS C'ONS1 RM"I H)IN ACCORDANCI: WI111 I5A NCAC 2C,WI?Lt.
(-(1 - 1'MIN S I ANDARDS,ANI I A COPY OF IIS RECORD HAS E
D I'01 HE WELL OWNER
NOV 21 2002 z (�
- - - -- _81(i- - I UP ;..OF PE•It ' IN RUC:TI (I DAlliGROUNDWATER SECTIONtin util IABHfi%bbIRIj6GNAU\O 6fiIf\n' ter Qu;dily,Grin in liter, ctinerrice C'cnler-Raleigh,NC
;II,g) 16161•Inom No,1914)731 3221, ailhin 31) daps. GW-I RI?V. 07/2001

263957 ` {
WELL CONSTRUCTION RECORD >?
Not lh (';no Ikia- I)eparnnent of Environment and NawraI Resources.Division of Water Quality-Groundwater Secdon /- a
w El 1,1 ON I It:%C1 Olt(INOI\'IDUAL)NANIE (print l�ry n'V 1�L)-``'J CERTIFICATION II �s05 '
sP1:LL/11K1tt V(7 Olt 1'Oat 1'AN1'NAM F. ` 1'y tia P �(.�,� CN°).-___PHONE k (8�s1Ss�7—SoD$ -
SIAII:vVI:1AXONS I ROC'I tON PERaID'N _ASSOCIATED%VQ PIERN1I-I0 'i
l i t applird,lc I (i(appl Icablc) '�4
I. \\'f.l 1. USE(('truck Applicable Box): Residenitnitj",Ir♦unicipal/Public ❑ Industrial ❑ Agricultural ❑
Nooitorint, ❑ Recovety ❑ Ilem Pump Water Injection ❑ Other❑ 1f0ther, List Use
1 WH I LO('Al]ON: Topographic/Land setting
NL-0I CFI Il myu: yq,A) Pu�5 Countyolk",Z&S� ❑I(idge ❑Slope Malley �fFlat
f3b__ _--- Ichcdappropriale bowl
ICpoer Nadir,N,u/m b"',C'mommniily.SubJHO'i e"Loot No.,Zip Code)
„�. I.anlode/I(mgitude Of Well location
i. OWNI°R: /✓-Cr - K/IhJ1.6�1LF�'PepSO`L(`r�CS �_(O/''\M• - ldeFrecsnnimnes/se<andsl
\dJless __ —I_.,r_,>-�rAHJ>,D` Lali(odell„nghnde soulee:❑ IPS❑Topographic map
(Sera nr Itoote No 1 (check N O
� .Ib.RCu�S )C eZ$�� DI;1'I:If DRILLING LOU
f hi nt lua'1 tila/e Lip('tole tiller "jo Formation Descrlpllon
A,ra axle-Phone oumbe,' .� -__- >n.f �I�Y>L
6, OOES WELL REPLACE EXISTING WELL7 YES ❑ NO CT
7. STATIC WAI-I:R I.1:VEI-BelowTop ofCasing:
(Use"+•'If Above Top or Caeing) -
8. 'I OP OI:('ASINU IS l _FT. Above Laud Surface" ---""-----
• •l ep of rnsh,e rrrminntcd ever below land surface require a ----
vnrlance In aernrdaei will,ISA NCAC 2C.nl Id. �-1 n ----- —
n YIFLD(gpn ): _--�_-_ METHOD OF TES'iv —
10. WA'I UP ZONES(depdt): _— -- -
LOCAUON SKETCH
11 DIAINIIICI ION:Typp_g:Z�Amount_ _G- ✓/F Show dircclion and distance in mites from at least
1.) CASING: Wall Thickness two Slate Roads or County Roads. Include the road
Depth Diameter or Weight/1-1. Material ❑umb(irs and common road names. CD
I'nnn Tod-J.Cf'
Prone Q--lbl��. Pt.
I1. (iROUl` Depol Material Melhad -'
Inn,--fig_ IoJJ�__
I Y III I-N: I)e 11h D1al,rel ,Slot Size I,Inrcnal -
I noo .. . _ I I Lt'-------in. in. co _
I', SANDMMAVFII, PACK-
Uc•pIII Sizc Material
Prole__ -- to - I t.---- -- -
I ) I!lEkBCTE11'N' "IWA"1 11 \ I -L WAS CONSTIiU("t1:D IN ACCORDAN(I? WI111 15A NCAC 2C,WELL
( C u) 5fnNU.4RUS,A ATA COPY OF11115 RECORD HAS RF.F.NI'RUVIDP.D'r0TIIE WELL OWNER
- NOV -2 200?— --
Zz f"J �
SI "f RIi01'I'ERS CO (UCTIN(i- tW' .LI, DATE
. uhnttl R19ed 6"inn of idler Quo ly,Groundwater Secllon. 1636 Mall Service Center-Raleigh,NC
2 h00 MWEMI&E R15C401144L79FItM.. nin30(Inys. GW-I REV•07/2(wI

264537
WELL CONSTRUCTION RECORD
North Carolina-Department of Environment mid Natural Resources-Division of Wader Quality-Groundwater Seclion
WELL CONTRACTOR(INDIVIDUAL)NAME (Print) �d-7�-'C in CERTIFICATION 8,2 tZLP
WELL CONTRACT OR Cor"PANY NAME I 1�
ASSOCIATED WQ PF.R6IM
STATE WELL CONSTRUCTION PEM11T8 (irapplicable)
(if applicable) -
I. WELL USE(Check Applicable Box): Residential[5—Municipal/Public CI Industrial ❑ Agricultural ❑
Monitoring❑ Recovery ❑ Ileal Pump Water injection❑ Other❑ If Oilier,List Use
2. WELL LOCATION: Topographic/Lar)d setting
Nearest'Cowu:MU�n�n� County P - ❑Ridge ❑Slope g alley ❑Flat
TCv \ _)n' P,k�1 Rp�r-� (check appropriate boa)
1 Coc)ir s —(Street Name,Numbers,Community,Subdtvmtun,Lot No.,Zip Code) Latitude/longitude of Well location
3. OWN ER:_ �1 )= lOC � de source:
cs/srend)
Address Y 1P Yam\ Laliludc/longilude source:❑GPS❑Topographic map
(check boa)
(Street or Route No.) iCLo DEPTfI DRILLINGIOG
MIA Zip cale From To Formation Description
City or Ta n State P
Area code-rimn:m'^,bar
4. DATE DRILLED U - ,�
5. TOTAL DEPTI I: poi 10 t
6. DOES WELL REPLACE EXISTING WELL'I YES ❑ NO u —
7. STATIC WATER LEVEL Below sop of.'sing:np o e Ina) FT.
8. TOP OF CASING IS I FT. Above Land Surface*
'Top or mine reroommed atior blow land surface require,a
varimce In accordance with 15A NCAC 2C.0118.
9. YIELD(gpm): —METHOD OF TEST A
10.WATER ZONES(depth): I QQATION SKETCH
1 mount Show direction and distance in miles from at least
IT. rDISINFECTION:Type�p2 Wall Thickness two Slate Roads or County Roads. Include the road
12. CASING: numbers and common road names.
Depth i Diameter or Weight/Ft. Malerfal
Fronn To Fl.
From To FI. -.
13. GROUT: Depth Mat cT Method
�& BS
From _'To F1�7;
Prom To FI. -�
14. SCREEN: Depth Diameter Slot Size Material -
Front To _Ff. in. in.
From To Fl. in. in.
15. SAND/GRAVEL PACK:Depth Sim Material J
Prom To Fr.
From To Ft.
16. REMARKS:
I DO HEREBY CERTIFY THAT 1111S 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
=u DATE
SIGNATURE OF PERSON CONSTRUCTING THE WELL
eih,NC
Submit rise original to fire Division of Water Quality,Groundwater Section,1636 Mall Service Ceenterl REVg07 2001
27699-1636 Phone No.[phone],within 30 days.

264538"
WELL CONSTRUCTION RECORD
North Carolina-Department of Environment and Natural Resources-Division or Water Quality-Groundwater Scrlion
WELL CONTRACTOR(INDIVIDUAL)NAM1fE (print) � " �� fA) Ian CERTIFICATION ao? Oc
WELL CONTRACTOR COMPANY NAM1fE.
r, ASSOCIATED WQ PE"1110
STATE WELL CONSTRUCTION PERAI1T1 (if nPplicghlel
(if applicable) - _i
I, WELL USE(Check Applicable Boa): Residential Municipal,,ublic T_1 industrial ❑ Agricultural ❑
Monitoring❑ Recovery ❑ Heal Pump Water Injection❑ Other❑ If Other,Lisi --
2. WELL LOCATION: Topogrnphic/Land setting
Neste�Clown'/ CouNy�7r�rn ❑Ridge ❑Slope []Valley ❑Flat
J� Kr� (check appropriate boa)
(Sheen Name,Numbers,Community,Subdivision,Lot No.,Zip Cade)
(check
of well location
(degreea/minutes/saende)
3. OWNER: Lalituddlongitude source:❑CPS❑Topographic mnp
Address (check boa)
(Street or Route No.) cJy�ll DEPTH p�tl_LLI I OG
ID t Formation Description
zt coda From To
City or ow State P =!
Aru Cade-Phone number
4. DATE DRILLED I('D 1 - 02
5. TOTAL DEP'TI1: I(o
6. DOES WELL REPLACE EXISTING WELL? YESS NO ❑
7. STATIC WATER LEVEL Belot(pop o fnbovteg.nporCa+lnx)
8. TOP OF CASING IS__I___—vr. Above Land Surrace•
•Top or Saone tern,lnmed aUo,belae land s.rr.ce requires a
vs,tance In accordance with 15 NCAC 2C.01 OF TESTA
/Q •Y7
9. YIELD(gpm):�—
METH10.WATER ZONES(depth): 1 QCATION 5KETCH
Show direction and distance in miles from at least
11
DISINFECTION:Typeh�)^ '��e f Amount .S — two State Roads or County Roads. include the road
12. CASING: Wall Thickness
Depth t Diameter or Weight/Ft. Material numbers and common road names. —
From-6—To Ft. _ </ -L - — -
From To FI.
From To Ft.
13, GROUT: Depth Mals'at Method
From 0 Tom FI. �7 ttr2
From To Ft.
14. SCREEN: Depill Dimneler Slot Size Material r
From To—_F(. iu, in. o
From To 19. ir.. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To F(.
16. REMARKS:
I DO HERE' CEPT!FY TUATTHIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15ANCAC 2C,WELL
CONSTRUCTION STAPJDARDS,AND'I HAT A COPY OF 111100 RECORD HAS BEEP:PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING TIfE WELL DATE
Submll the original to the Division or Water Qunlity,Groundwater Section,1636 Mall Service Center
- REV`h,NC I
27699"1636 Phone No,(919)733"3221,wlihin 30 days.

WELL CONSTRUCTION RECORD 264522,
North Carolina-Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section
WELL CONTRACTOR(IN'DIWDUAL)NAME (print) FG2NZ 1) \[IGCoR _ CERTIFICATION 8 3195
WELL CONTRACTOR COMPANY NAb1E_2>�EV-S UJILU-MI tIM(, Zt-K- PHONEwtbF,)745 albs
STATE WELL CONSTRUCTION PERMITµ eS50CIATE.n WQ PERMIT[]
__Lf applicable) (if applicable)
sr+�
1. WELL USE(Check Applicable Box):Residential(la'�'Mur»cipat/Public 0 Industrial ❑ Agricultural ❑
Monitoring❑ Recovery ❑ Heat Pump Water Injection❑ Other❑ If Other, List Use
2. WELL LOCATION: TopogryyPphic/I,arld setting
Nearest T•uo1w_n:J11hUR{OF} }q County plkGER � []Ridge Cr�Slope ❑Valley ❑Flat
�` 1�erg a cF �lJ p /Q( I (CVIGaIiBppNpR4L`Lai)
(syset Nerve,Numbers,community,S"vu;on,Tat No.,Zip Code) _ Latitnde/longittide of well location
3. OWNER:_mt�RI L V N Czo c)t- Z, Gw (d gneahn nu es eaonds)
Address ?,�S LVke 4o(isF. Rib Latatude/longitude sothee:QGPSQTopographic met)
(Street or Route No) (check box)
_IMURPI}y N r Sc'fU(o DHN1'H DkILLMGLOG
Cizyor Towa 5tau Zip Cade From To Formation Description
&22S-- L al. L C/ _ O — l TO P Sot t
An*Acode.RIL number I - l _ �CD -Gip
4. DATE DRILLED lI- 2 U - 13pO-K weer g
.5. TOTAL DEPTH: ri - y0 - C�� �
6. DOES WELL REPLACE EMSTING WELLS YES D NO ids qb Q r,S
7. STATICWATERLEVELHelowTopofCas'nlg:-Iiz ^T, CIO
—
L
(Ure"+"If Above Top ofCuina) ���- 4 -(p(2f1,V-(�12owN_ ,r
S. TOP OF CASING IS .i I `Z- Above Lan
�Ian
dSurface.
w terminated _ 6 _
•Top of loy attar below toad lurrWe tequlrq a 9!�C
var(vace In iceard�c���werh 15ANCAC 2C.0118.:
9. 1 IELb(Rpm): V -METHOD OF TEST_ R ---
10. WATER ZONES(depth); 11D ?
LOCATION SKETCH
11. DISNFECTION:Type_- N -04 Amount l tlz Ih Show direction and distance in miles from at least
12, CASING; Wall Thickness two State Roads or County Roads,Include the road
Dap h Diameter or We ght Ft. Material numbers and common road names.
From ZA To�_Ft._(a'/� PVC h�•
Ft. Ovq
From To!„Ft. mauAJYSIG
13. U`J': Depth Material
Method
Ftom TTo-�Z Ft. C] hfi �il et�,__ US
From__To_—Ft.
14. SCREEN; Depth DiaV c:er S:ot SS:,: '.i T tl V'• -
Front To_FC^_jn.
From To Ft.,q�-jn.IS. SANDiGRAVEL PACK: Ro lroe h
>kP� Size Malaria t '3rn, r ti
From To FL _
Front To Ft. •yKc
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION
STANDARDS,AND THAT A COPY OF THIS RECORD HAS SEEN PROVIDED TO TIM WELL ONt NLR
SIGNATURE OF PERSON CON'
STRUCFINO THE WELL DATE
Submit the original to the Division of Water Quality,Groundwater Section,1636 NWI Service Center-Raleigh,NC
27699-1636 Phone No.[phone],within 30 days, OW-1 REV. 07MOI

North Carolina- Department of Environment, Health, and Natural Resources 't} ` "ihk --FOR OFFICE USE bNLY's
Division of Environmental Management- Groundwater Section
P.O.Box 29535- Raleigh, N.C.27626-0535 QUAD.<{dOzt, (�xL d'r4i
Phone[phone] �4 r
WELL CONSTRUCTION RECORD
DRILLING CONTRACTOR: We_L( !c r rc
—` c30r� ' STATE WELL CONSTRUCTION 266856
DRILLER REGISTRATION NUMBER: _ PERMIT NUMBER:
1. WELL LOCATION: (Show sketch of the location below)
Nearest Town:
/;oi/LLLS; xnrzA7 y:Count CAef-6hee
�'
(Road,Community,or ur'.r�Jy{�rvr on and Lot No.) DEPTH .DRILLING LOG
2. OWNER Tn M I I �e In C' QA1 �1.a ej From To /� Formation Description
ADDRESS_ZL*_%--� Lit Y e ►1 (yd. n aD+ A-C
`f
(Street or Route No.) �&1� (jro�h
�1
e_�b�•� P� � -
Al G
City or Town/ State Zip Code
3. DATE DRILLED A9'p'14( USE OF WELL A~S6ke - -- -
4. TOTAL DEPTH :WW - - - -----
5. CUTTINGS COLLECTED YES[-] NO� - ---
6. DOES WELL REPLACE EXISTING WELL? YES EJ NOEe
7. STATIC WATER LEVEL Below Top of Casing: j_ ) FT.
(Use'+"if Above Top of Casing)
8. TOP OF CASING IS_lV/ FT. Above Land Surface*
Casing Terminated al/or below land surface is illegal unless a variance is issued--"---"`
in accordance with 15A NCAC 2C .0118 —
9. YIELD (gpm): S _METHOD OF TEST �� ✓ r' _
10. WATER ZONES (depth):
11. CHLORINATION: Type Ck ICraK Amount_CP-r.r If additional space is needed use back of form
12. CASING: -
Wall Thickness LOCATION SKETCH_
Depth _ Diameter or Weight/Ft. Material (Show direction and distance from at least two State
From_ ToS Ft. Roads, or other map reference points) -
From To Ft. --
1
From ------ To------ Ft. ---
13. GROUT:
-' Depth Material Method
From _ 0 _- To ,2 -Ft. _L_, CCe-AC c 11�2.r
From ._ To _ Ft. --
14. SCREEN:
Depth Diameter Slot Size Material
Rom __ To -.- Ft _-_. in. in
From -_- To ___ Ft.-___ in. in.
From _ 70 _ L_ iq. CID ter-
15 SAND/GRAVEL- PACK
rn—
Depth Size Llateria: s
From To Ft.
- c
N —t
1�6'
I DO HEREBY CERTI F THIS WELL WAS CONSTRUCTED iN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTI�UOTION STA S, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
�-SIGN ATURE OF CON O TRACTOR R AGENT DATE
GW-1 REV.9,191 Submit original to Division of Environmental Management and copy Io well owner.

262556
NVELL CONSTRUCTION REICORD
NooIi Cam,lioa - I)cp:uuncnl of larvironmenl and Natural
Resources- Division of Water Quality- Groundwater Section
`
w I'.I I ( ON I It A( l Olt(IN171 VIDUAL)NAME. tprint) s.J�'.L'I�M� �� Y((��'' 113e 0 M5 CER-1'[FICA
T4IIONN�S
wt I L( ON I It.(CI Olt COMPANY NANIF.� � �,i�1ag_— PIIONF. NSIAII I- NVEL1.(:OSS I'RII(-11ON PERMIT N_ _-_ASSOCIAI Fn%VO PERNIIIN
lit applicable) ifa ilicablc
I WF1 L I)SI (Check Applicable Box): Residential Municipal/Public ❑ Industrial ❑ Agricultural ❑
Nhmilm ing❑ Rccovcry ❑ Ilcal Twerp Water Injection ❑ Other ❑ If(ether, List Use
2 \\ IILI. 1 17('A I (ON: / l'I'opographic/Land setting
Nralcst fo�'c}n-:-_- r�1 -//I Couulycle-6n� Vf(iilge ❑Slope ❑Valley ❑Iclat
_.`)U Q.L__�ry —_—__—_ (thcrk opprnprinte bns)
I cirri rtwnr,N.....
.jhero.('...nmm.ily.S9ubdivi,,,m,Lot No_lip G.del La(itude/longiW&of well location
1 17 MA),' _..LL2D Mh,5�_11/'�' . `r �UQ �KCr` ---" Idegr<es/minulcs/sKnnde)
Addlcss -_.5.7[�._— r�!2,5�� I.alihulc/Ir,u}.ituJc soutcc:❑GPs❑Topograpbic map
I li t-ct w Ruulf 7 ��q� '7 (check N„)
_ �� T•_.F�IAC:L�. �J_"I!�-._..__ U_I: I.I' _II FRILLING LOG
t , r 1."," Slme Zip Code Ilnnln _ _-T//o Formation Dcscriplion
177b ��
6. DOFS WHA. RHILACE EXISTING WELL? YES ❑ NO [3' -
7. S I A II(' \VA I IT I.I:VL'I. Below Top of Casing:
/ (Use"+"if Ahnve'rnpor('neing) -------
R. 1 OP OP CASING) IS ! r"I Above Land Surface' --
'"1 op of clalug tenulnnlyd nUur bdow land surface require,a ------
vnrinute It,aKonlaucr srllh 15A NCAC 2C.I1 IN. / - ---
9. \"Ir(.1) (upu,): .-Ij 0 lot)orl"Es-r --
M \VA I FR /ONFS (deplb): _J V ((L— C 0 ----- ------
_ _ 4_QCA'ITON SULC_I 1
I I I71ti1NI111:I ION.'I vpc_ Amount_� J� Show direction and distance in miles front at least
12 ('ASIN(e Wall"llucknrc_- two State Roads or County Roads. Include the road
I leplh/ / D'sl etcr or W'eighUPI. NJJacrial mnnbers and common road names.
III-0, 2M
I In to —" Fh --- -- o
Fenn 'Io I'I. _ r�
14 (iROU I Dy I"Illerill Method -
_J
I SI kI I N". I,cplh Ihinnlcic Slul Sizc NIa1QJ;1I
tom__... lit.. .
Items --- .fo 11. in. --- in. _----
I S,ANIYOPAVI'I. I'M k: r ""
Depth Sire Material c.rl
J o
f ran 1L II. _
It,. RI.NIAARI(" _ — ----__."-_---
D -x)�'tillc f Il"Ul'I' I11�1 Ills\\'r(.I.WAS CONSTIM("I ED IN M.VORDANCI: WI11I 15A NCAC 2C,WELL
AND"IIIAI"A COPY OF 1111S RECORD IIAS ByFFN PROVIDED TO'Illli WELL OWNER
SIIiNATMill 0 " r : S CnNSMUCl'IN(i 11II'.Wlil-I- DATE
N196kh MuMAPE9 M 't he Ill kiml of ales mluly,Gronnthraler Section, 106 Nlail service Ceder-Ralelgh,NC
ASH VI E (MpL?,GACp1)7t- .1221.mithin30dacs. G1V-I RliV.07/2001

M LL CONSTRUCTION RECORD 2 E 2 4 2 6
North Carolina•Department of Environment and Natural Resot},,�)Ces-` 'Division of Water Quality-Groundwater Section
WELL CONTRACTOR(DW1VMUAL)NAM;E��(pAnt)—FR2NZ ` • V I(� (Z CERTIFICATION 8 3 (-7 S
WELL CONTRACTOR COMPANY NAb1E_IJyG2S WCLt- D,2(t.LAN(o 7- IC— PHONES /�b)7U$-Z.I(o6
STATE WELL CONSTRUCTION FER ri'# ASSOCIATED WQ PERM[T11
-If app cable if applicable)
/
1. WELL USE(Check Applicable Box):Residential M Mtu»cipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring❑ Recovery M Heat Pump Water 14"tion 13 Other O If Other,List Use
2. WELL LOCATION: TopograpW&L=dd etting
NearestTown:,CUL ER SoN County G(4GPOKE6 Midge 0Slope �i'alley []Flat
nn
_l'f./4/AV U,�LIIC r PA , (check appmpriaN bez)
(Svnet Name,Numbers,Community,S 'vision,Lot No.,Zip Code) Latitude/longitude of well location
3. OWNER: I.UYY 6olaing,
Y— .(degreexrminuwsleceoads)
Address 1+5 Rrya in� Latitude/longitude sotuce:QGPSOTopographic out)
M Y hv(ISeeetof Route No. '(e-ha-k Nnx)
DEPIE DRfUTNOLS
City or Town State Zip Cade From To Formation Description
C—J S 4q4- �2ILI O ?rb GA Y
Ara code.Phone numberjn _g$!. _ TAN- t/EeAo<.s as
4. DATE DRILLED (0-1 `5,02, yr
.5. TOTAL DEPTH: S45 �- - Lie) -Li./f277(EQt,O Rout
SLZrC- �Ue
6. DOES WELL.REPLACE EXISTING WELL7 YES O NO 17-(. ISO
113 r _ c(S nAfZk 622Y .T arE
7. STATIC WATER LEVEL Below Top ofCasing: a FT,
(One"+"Ir Above Top of Cuir4)
8. TOP OF CASING IS FT.Above Land Surface` —
'Top o(culap tmminattd adur below land surfaee mquiru a
variaau In aceordaacr,w(th SSA NCAC 2C.0118..
9. 'IULD(gpm): 2 /I- MHTHOD OF TEST 811R
10. WATER ZONES(deptb): 5-30'
LOCATION SKETCH
11. DISINFECTION:Type FkTN Amount 1 s Show direction and distance in miles from at(east
12. CASING: Wall Thickness two State Roads or County Roads,Include the road
Dep h Di
ar e)er or We ght Ft. Material numbers and common road names.
From-_—) I'o 1 , Ft. �o SCR Z7;6 (OVC
From-J S _To 130 Ft. •188 TK--L-
Frorn_ To_,_Ft.
13. GROUT: Depth Material Method IC'.
From_Q-_TO-aa-Ft.�'G�Mt(�IT- -Du�,p bra r
From To Ft. � Ou�4
Id SCREEN; D.rtth D_.:tor Slot si: !dterial
From• To FtJn, in, m a
Front--Ta Ft,�jn, in. s,P
0
15. SAND/GRAVEL PACK: l�3 WLtiv ale q�rr
Depth Size - Matena'. 4. S �(i1p6 .srb IZO
From Ta Ft. , -raJ
Fron�_,_To Ft. MtL ctc
a'e '• 91" S YG2\19
7✓' C.5'7B'r'E LINE 1
f y kD
16. REMARKS: �. N' 6
I DO IMU13Y CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
D L�(� I� ARDS,AND THAT A COPY OF THUS RF,CORD HAS]SEEN PFOVIDED TO THE WFLL 01'YgEP
/ L -
SIGNATURE OF PERSON CONSTRUCTLNO THE WELL DATE
Submit the or•i' the Division of Water Quality,Groundwater Section, 1636 Mail Service Center-Raleigh,NC
27699-1636 Pbo a No. 919)733-3221,within 30 days, - GWl REV. 07/2001
GROUNDWATER SECTION
AShEVILLE R�,L r fL

262143
11'LLL CONSTRUCTION RECORD
ILn1L I :urrlina Ur p:u llne ul o(I; wit nm icn(:wt] Naltu:l RRcsourccs- Dk.kion of \V III r l 011:11ily- (;I ound\\:a lcr see lion , C
\\IIt Iu\Ilt\I IolfNNn1\'111V,U.I NAP71( (IrrL
rrL.. —.._ 1^9.^''y._-e�o"11eS 1'EI(IIFIC<A�l�I1�1yNN �.7
\\111 I Ilsln V ntlt( llnll•AN1 rv-\ME_.Cke-a0 ke - We.I � .�R\I I1^3 ..—PHONE p iOMPd7'&�Og
til \11 U11.1 IIIT<IIf1'1"1111N PF.10111 P_-____- - AtiSl11'1 CII n\\'l)l rim I IP
11'lll 'I'I'1 lil nppliclblc) -
I. 1\'hl I I ISP II Inrk Applicllldc Iloxl'. Residential Indo<ni:d ❑ Apicullurnl ❑
fJrmilrlml. 11 Pt rm cIv 11 1 tent I'nulp W n ic•t Injeeliou CI 0I11c1 C1 II'(Wicr• I.isl Ilse__ __—
;. V, I I I I (V'A III 114 Top( Im1pilic/Laud selling
I!r:u� •o lr,an MURP IL/ ......
V._�F.f>_�_ .C.C' IlVi'lpc IISlope IwIlcy UPLII
),0�e- LC O L - —_ _ . _ Lo 4 apinr.por well
r;r� r:,���,� rl,��,a••,._, ,,,�rr�rr��al,.snba//17�,��1d Ira Nn.Zip('r•1r•1 Isliludraoul!ilodc of moll location
a IM1111t �he.�)c�e4 __.MC-SUJI #'J_ Id.l•„r•am.....rd.rcundq_--
\rl�li /j G,-7 C� �=Si_. 1)'7 j'V . - _ I :ililtld, willt c'11WSOI opogla 1,11ic ltmi,
I ' ..i I'••nl N,l Iduck NnO
IIRILIANUI-Ql_
— --
I rn ,r l ,•. , qur - /fl,(r,k I\rnn In folncniou llcscl 1plion
21
Pl ll \I'F. I'xISIIN(I 11'FLI? 1'IIS ❑ Nt)
1 A I R \\ A I IT I I'\ IT Ftelim ll p u(('nsiog: -sS-DO_
11 la...,'.if nl,r„�, rr,p ,(t',6,r I
ti I 1 11' I II. (':\CRdI; IS _, F(. Above Laud Set I;u�e'
•1.n.,d r uvlup In n,l m,J nl nllor Lulu„ Imul an Lr rr rI•gnlrc,It
.rnni alrl, IS\N1'A( 2C.01111. - ---- - -""-' --
'r SII I II t11ml U .__ NIF111 )I1OI fP.SI--- /- - ---- ' -- ---- ""O--
In /(NJLS IdC1,110 _- - -- - -"--- -- -�_
I I I11`�Itd Ll t I II IN. I cpt-.(SRA.NuJ+l'` Amotud (-.G.P- Show dnl I Uou :nut dlsl llkc in miles lion d Ic!k.41 -.
I? ( I\';Illi; \\all'Ihickucss / 1\eo SI do RI ad<or ( ounfy Roads. Include Ihrn ld
I h'plli I)I;unr Cr u11\'ciplll/l'I. h11ticlil11 ❑11lllhcr<(tll'I (1,11111IP❑ load IIa111C5.
Ilrgll
I nun _ I lr - — `•� `".::
will r\j
II I�I'11111 ' Ir�plh �I:arl i:d NrlhurJ �1 =
II C, PIItl I,.plh 1liann9rr Shu time Nlarlial
umr
It
I I•lah Six Mnlel i:d
D I E C E 0
1111,Nt ltl lvi I,Ilt I111 III I S WI`.I I. \\'AS('UNS'I It(l('Il'U IN A('('I)11I)AN1.
I P14'TII itJ S lAtMAI ,I Il'I III I ('111'\'Ill'1111S Ifp(' M HAS HITN I'RI IVIDIA)10 11II°.1V111 OWNIT
GROUNDWATER SECIIGN -- - - - -
ASHEVILLE FEGI^frIAE OFFICE SI i lilt;01 ill; ;11tNAINU lilt: WI'I I. DA1P.
tiulnnil the uI it iu:ll to the Ili\iciou of�1'alep()lullily, (;raundnnit•I' Srclinn, ILIL Mall Srt\Ice( cnler- Il:drll;h,NC
"L^'1 II ,( I'brrut ^.��.1°1'll '}t 1221,nilhin 111 d:n a. GW.I MIN. 111/1II11

S,
262555
WELL CONSTRUCTION RECOItD !.� a
Nm II,('nrolina - Oepal(file ul of Environment and Natural Resources- Oivision of Water Quality-Groundwater Section
�r 11I LOSIll 1('IOIt IINUIVIUUAf.)NANIF, rint) m� _, 1y, `}��s_______ CF.NT IF I CAT
TI�ION 0_;Z.56_5p
\1FI1 LUV I It AI I Ill(( ONIPANN'NAME_
9I %11 w 61,1,('0,vRf Pt'("IION PF.RN11Tq ____ASSOCIA"1'F.n WQ PERNII Iq `
I ifa+ ialble) if applicable)
I. WI11.1, I ISF (Check Applicable Box): Residential Municipal/Public ❑ Industrial ❑ Agricultural ❑
Nlnlllhnillg ❑ Pecmery ❑ Iical Pulup Water Injection ❑ Other❑ II 01her, List Use
\\'f.I I. I (I('AII ON: Topogra hic/Land setting
Ncwc:ef I(mil M,(ett. P_ County CtTe '-06 ❑Iticlgc IldSlope ❑Valley ❑Flat
vv�'`T\'V (check aprmpria(e bor)
tin:rlN:mu•,Nmnbc;a"('nnonnnity,Suhdivision,Lot No..Zip Gxle) I.alitodellongitude ofwell location -
1 O\\'NP.It. ♦��� F l _ Idcgmcs)minutes/zernnd0
/F
Latiwdcgongitu(ic source:❑GI'S❑Topographic map
I SIu•cl nr Ittnne NO.) - ('heck ba,)
/IJU2�d N �Qq( Dlil'fll DRILLING LQU
rho h,. lh,,,h✓ sl:hlr Zipt•r,ae Pn � D Ponnotilm Description
e !}
1 IIAII'. URII.LIiD.. 0 2-
n 1)OIIS vV17 L PITLACE FXISi ING WELL? YES ❑ NO ❑�
7. S I A I W W A11iR LIiVEI, Bclow'1'op of Casing:�� P'I'. ""— ----
(Ilse"I"If Above Iop M('aal,g) ------
R. 1 OI' 017 CASING IS If _ Nf. Above Land Surlece• —
•I ap of r:h<Inl!Irnnlo:hlrA allur idol land nurf.ce requlref a --_"'—
�:n lame 6h ammtan re III. I5A NCAC 2C.011 S. _—
') SIFI.O(c 10 ��.. __ 1ETI 101)Of-IFST
.I'
Im WAIIT /ONI'.S(J,•pth): _ lo - -- ----------- --
-7- LOCA_r10N SKETCII
I I. I)NINl'P(1 ION. l vpc_ -1��_ Amount_ G Sho,c direction and distance in miles front at least
12 1"ASING: Wall Thickness two'Stile Roads or County Roads. Include the road
DO Dpilllcler or WeigbVl9. Material numbers mud COnumon road nanlCR.
I will _. _..----Ili --
c
tom To _
11. GPIitII ' Depth ,l�aher�i, Mclhnd CD
in �/ I.o �� - I-t 5-3
I non yD I o/Jq•___ It � -
I I "( PH [I 1)I PIh Di:uncic Slut Silt Material --
I will
-
15
I)cplh SI)e Material U'ICD
-
I will _ T° - - - - --- ------ —
Ill RI'MARKS,
tl)(Y ll Pffl11 'I�I,(�If{g, IrlIIIS ll',TII.WAS CONSTM1(*11:1)IN A(:('OROAN('E WI111 15A NCAC 2C, WELL
Ml! I AND'IIIAI'ACOPY 01`1HIS R1:UORD I[AS Bh.FN PROVIDED TOTIIE WELL OWNER
u 'IGNATUI !( • "'RS N f1tUC11NU TIB=.A'1•:LL DATE
i
� C I,u 'I (h'_U.Ll�tlll,llu.lJie Uiv sins of \'atrl lallty,Ground wafer Section, 1616 Ill nit Sen ice Center-Raleigh,NC
2 f'Y'i fr r6 Phnric't\o ('1°('�) 711- 221.wi(hin 30 days. GW-I REV.07/2001
i ,

WELL CONSTRUCTION RLCORD
I I,nd1 I :o dIIt, - III'p:a I nc nl I,I f.nvinmmcnl and Nnhiml Rcsnnlccs - I)ivi lion u1 W:,IvI I)I1:di I - (;I nundwa ter Scc l�ionr
wl I I 'IN I It\I II It 0NI P I1111 A 1.)NANI F. 11^roll_. __JIM'14 "_ J ,NES CP.Il11PICAIIONM1S
I\III I IINIu.Ir It'll I lnll'AN% NAnIF;-_ Ae,Rv _.�('��LL__�...'V I 11'4).3___.._rlIONE a F� 3 7* o
SI \11 will tlr?CIIU'I-111)N 19iItN111N-___ " - ASFI ICL\'I I'n\t'I) I'pltPlll„ -___
I ISI' If 1wl t. tlpplicnblc Iln.a)'. Residculial Nhmicipal/I'uhlic LI Inthwti:d O Agficullurd ❑
N,millninf• ICI It,,,I"(Iv 1.1 1 Ical 1'uugl W:dcr Injeclioo ❑ 0111clI1 If Olhrr- I i%t Ilsc
\cl'I I Ill( A111'f) Iopu gl: ICtl andeclling
rh:w• l I'mil r�1/1��79t+r`��L Vpp ^ ('oonly��a�U F�'_. I:Illn p, I�,e Malley Ul l:d
/��Ln�"� ^L' --.- ___..__. - Irly ka..,nnpn'Ir ha.l
I•:��...., P% thr,rr l„,, n•nanua ilv,Suhdil i•i�nr.Im Nn..Zip Cmlrl I al iludrlonFlhldc of well IUcalion
11\\-t 11 V , I c l(µ ab -_-_(,c� - Fe�_'2ea- .. ,.�.1.,'r .........Ir<-.rrinl,Ll
Add .Ci. 30X__ __1fl_6 17__.____" .. . .. I.;diludr I"I'vilmIc el mt r ll(il'SO r('pugraphic map
I'.IT,-,„� I!uah'NnJ (rhrck bml
1
�"RRtx�� �•�f -'1`I-
r lv a. 1,„I„ F;I:n,� iil,f"r,dr 111r11r 1.r rounaliuo l)cseripliou
Ivy/)' 753-c�c��;% yy�/--}'- �;3
A.. ,••d,. Pl...n,.I...... r1 ..JW.J
I I),\II- Irlll11 r1) /0 - /-5 02 /s�' ' ,J'O '
5 IIII,\I I)rl'l ll' JU-5 ' -_-- N/ 1il�jJ I "JO ' —SL11-Tc --
s_ --
G InrI:C \\'I'LI RfII. \( I I[XISfIN(i�1\'PLL', )'Ii511 NO -
7 ':LAIR \\'ATrRII.\'I:1. Ilc•lum'rap ol'(-asiug:_
(Ike••I"if ALnvr lap of Cnaiug) --
X I I W 111-1':AMM; IS - �_-_-_ 1:1 Above I.;iud Sullacc'
•Lq..,I I aabru Ir1 mhmtrd el/nr Ileloo lain an Inre rrgnlfa• ---
I:vlanrr n1 nrrm dan rr Nnr I NCAC If.a 11 S.
" \ nlnl(•Illtrr Nm.r lot)or"frs"r" —
f
—
I.l)('AlIQ SKEIClI
I I. I tl':ItII 1 I I II qJ I I p1 -('y}JULp('`. Anunnd _/� cup-- Shnw ,dow, Iilm :Ind distance in mites Ilnnl al Irlsl
Wall Thickness Im, Slid • Rl,nl•: or Cuuuly Roads, Include Ills road
1),I,gi Ui_:unr cl of\\'ci�phV11. Nl:Ilrli:ll ❑IIIIIIwI[ atId connnuu [(,;Illnames.
I I,,m 1 Ill 3.3�-j 1 _ _.
0
C, „' 3c,3I1__5yl - _ . ivi6 srve(_ f�
II„rr1 l„ rl o -
1 t I;It11111 ' 11,-I.Ih Nand ial Nlydanl —r -
I ,„rnCCAI E•�.1___ -jp+1✓It'1
11„rr1 -?_G III 36,3 I.1. CUT7,1.0 ---,y AAA I. IV -..
II CI I I1 II.pn1 I)mIlIvIcr Sol SVC NI:ucli:d
I nan In II in. in.
I I„m I o I I in. ill -
1 A I11 r'(iPAA'rl101, Sin- N:acri:d �-
nnn It. II
Iww I,r I-l .
If, Itl NI,AIll's
11I
4-�) IH'PlIT,
I`I E1r I 11 I ITSWIA1, WASfONSIR(II-11-1) INMClYRDANI't' \\'1III IM N('AC2('• Wrl.l
IIIIhII'I�2IIIINSIr\NN.A''1. DIIIAT IVY( rIIIISIt1'(' ItIMAS111; NIT(W11)11)101111: WITLOWNr.R
ju
—� S UNAI 1 [OI 1'fR l' . IRII('IIN(; MF WI.11. NAIL.
A�S IYe,I �plrl Ili'i ilnl of 11';der( ulJh Crunadwalrr Srrllnn, 16)Il Nluil Srn ice( rNrr- Ilalri h,NC vII I��hF\t�GI�t�1�L �F"r�C€ 1 }',
il.11ilhin 111 days. (iW-1 RI'N. 0712001

262.951
WELL CONSTRUCTION 111;CORD
N�nlh l';uulilr,) - th'pmtn)e lit of Environment and Natural Resources- Division of Water Quality-Groundwater Section C�r
S �Nf�S CERTIFICATION II ;6GS ,r
oTll ( OBI NAr'IUIi(INDIVIDUAL)NAME wlnQ IMr1�l_, 1 _--
U F11 (T%la\( I(lit r(NII'AN1'NAME—_ ----- -
51 \ll \\ A.I.I"OSSAItt'11IMN R4:RM1"fq_ --__�\SS(ICIA'fEn\vt)PF.ItMI"FN _ -
lit` li-tl i l (il applicable)
I \\'1'.1.1. I ICI: I('hcck Applicable Box): Residential M/ Municipal/public ❑ Industrial ❑ Agricultural ❑
Mnnilol int ❑ Recovery ❑ lieal Pump Willer lujectiou❑ Oiler ❑ If Oiber, List Use
Z. 1, 1 (WA1 ION: Topographic/Land setting
Ncm ca Tov,an.—/_)9 Uj2 tJRidgc ❑Slope ❑Valley IBhlal
(check apprnpriale hm)
nr,.i>...... N..... <,( onnnunily,Suhdivicfnn,Inl Nn..Zip Ede) I;Itinide/Iongltude of well location
Nf.R'. ��1I4'IR�I ��T _ ---I deg n rees, ,Imu co es/eenJs)
Addlcr: e�..1rJ5_ Sr __- LaliluJc(IongiluJes(iunce:❑GPS❑'ropographicnlap
-- ISnre�irt Raule Nnl (check has)
DI I I It DRILLING LOG
( 'IN Ilnv vale "J ip('ale n Rr I Formation Description
,r t
6. DOPS \A'h.I,I. RIATA('H II%IS"I ING WELL? YES ❑ N(1 ❑� ____—_
7 STA I H WA FR I.I!VEl. ilclow'1'op ol"Casing:l -jr. _—
IUse"("if Ahovc li,p of('ncing)
R 1(II' OI ('ASIN(i IS_ —_ I-'I. Above Laud Surface" ---"------�- -
•I�q,of rndng Iermiu:ned M/ar helnw lend surface requires a ----
rarimar In ararnhrn c nkh 15A NCAC 2C All Ia. U --
n rB 1.D -
ill WA 11:R ZONFS (dcplll). _-- � ---
_ L� C,A'FION SKETCH
Show dil c c I ion and list aItce in miles from al lead
I I. I)IGNI I ('I ION. I)pc_ Amount - G--- two Stale Reads or County Roads. Include the road
('ASIN(F Wall"I hickncss
I)cp!h , D'an)c cr or Wcight/H. dterial nun)hcrs aid common road names.
p / L CD
I1 IIIU II II�{ (spill Mal i.l-
Ilnin V _ - To d__ rl. .Q,) --____..___ CD
II tit PI N In•Idh Di:ui ct7'Slot Sizc A1alrliul -
I lulu l
willL _ _ILL-____in. _—_ In. -• :;-:_
10 _ 11._._ —in. —._ in. - -"------ cri _
IS ;ANDAWAvI71_ I'M'K- J =
I Irpol Sic Malcri;d
Ilunl In
Ih Ill tIAVIC S. _-_- -
it I(47n i46 R1�111�°�"I'IEIf I I I''I IIIS WELT,WAS CONSTRIII"I IlU IN ACCORDANCE Willi I SA NCAC 2C,WELL
1'ON;I I?n('I ION S I DS,AND'IIIAI A COPY OF I111S RE( IiD IIAS BIiPN pizovIDED 1.O1llL WIi1.LOWNER
_--
til(INAl11128U ISI ,O co �r CIIN(iIIIFNATI,I, DATL'
I L( 'ti)Fliiiul #9)m 6i'ej;ulitil�to Ihr )i%ision or\\'aler 11ality,Groun(hi ater Section, 1(,i6 Mall Service Center-Raleigh,NC
L—a" Z'1�1kAl L'l, = �1-1221,within }IlJa)s. GW•IRP,V. 07/2001

�S {
262552
WELL CONSTRUCTION RECORD r .
: qr
Nnl Ih Candina - Delmomenl of Environment and Natural
Resources- Div ision of Water Quality-Groundwater Section
�-/ e
(v Ei LC ON'1 it M'I OR ONn1VIDUAL)NAME (It M�1'\ CF.R'FIFICATION/$ - "
(c1:1 I.I oNI R U'l olt COaI VAN 1'NAMF,�kP P— ��1 a✓ --PIIONE q
SIAIF.\\'I'.I.L('IlN;gIuIgll()N PliRaf I'rd _ASSO(iIA'f EI)1vOPEIiMI'Id
Iirapplicablc) (ifepplicablc) _ - '.i•i'
t�
I. \c1:1 1. I ISF (Check Applicable Box): Residential Municipal/Public 11 Industrial ❑ Agricultural ❑ -
t\Iuuinning❑ Reco%cry ❑ I leaf Punip Water Injection ❑ Other ❑ IMiller. List Use
2. AA'1:1 1 1 ()('A I ION Topographic/Land setting
Ncansl I mNli _ / W12 ,) County ( Ridge ❑Slope ❑Valley lal
• hn4 ppn,priale bozl
too 10l � �1N. �Q
,a,„..Na. Nnn,h�ip.r..,,nn,njoy.subnh shni.J,,l No,,.Zip codel I.olilude'Inogi(ude of well localion
Addlecs _�Y,�y�/ — -KL.C-- source:❑GPS❑Topographic map
I enrei rn Rowe No.1 (d,eck W,fl
I)LI'I:I I DRILLING LOG
t it, or I,,cn Slnle _ Zip('Me Flom -to F.ornlalion Description
--
.0---- /0 5_ Safi s
�.5/_5:_
n,,,,,,„r• _/o_T......
6. D(H!S tCIII,I. REPLACII EXISIING WELL,? YES ❑ NO 0- _
7. S I ATIC WAIT.R I.l'.\'F.I. Below Top of Casing:_�Lo-_F 1.
((Ise"+"if Ahuve'I up of Casing)
R. 1 )I' Gp CASING IS f _ 1'"1-. Above Land Surface' ----- -
"1 np of caoug Ienninaled al/nr below laud surface requires a —'
r:ml,ume In orc,,rdas a whh 15A NCAC 217.01 Ill. —
o. YII!I.h(�pnil: .>'" ME HOD OF TEST, -"----
11) %VA I FR /,ONES(depth):- ____—__ ------- -
_ _L_OCAIION SKEI_QII
I I. I)ISINIIVIION: l)pc-_ ff Amount c: up' Show direction mid dislance in miles from at least
1.1 ('ASIN(is Wall'Ihicknese two Stale Roads or County Roads. Include the road
I lcpd, i iol,cler or tv' 1,hVFt. M:ucrial olutihcis and common road names
I nonUf o"l OS.--- It" -
Flom--" --__ to. ------
Vomit to 171.
II. GIMI11 -- Joel lh — 6lmcrial binh„d 4 -
-non p_,_
Id S('RI'.I'N- Dcpth Dh1111eICr ,I'll Size hlnlaial iV -
will I
--Y.15. IAMID,(iRACF.I I';\(' :-
I)gplh Sic Malcrial _ =
11,911
lwool T n __ I I`-'----- ----------- J
FD � 1u�7,111 Iq it �t I I 1 , MIS WFI.l.WAS CONSI RUCITb IN ACCORDAN('P WI Ill 15A NCAC 2C,WELL
r
r-ftttdtil+rM'1YCrN-51"A1�1p Vlfl ,. ,AND II IA I'A COPY OF I I IIS RECORD HAS UFFN PROVIDED TO TfIE WELL OWNER
W 'I'--'� ISIGNAIU F.OF PF.ILSUN S"I itlJ . ,llll'.wFI.L DATE
l ptlilwdV i);ie 1,1;fiC�n Ili 'ision of 11'aler Qualhy,Groun(hv:der Secilou, 16J(r Mail Service Center-Relelgh,NC
ASRrVA_L@(flG�11hM,luilWEk(JW)7)7 }221,rcithin ,ltidays. GW•I REV.O7l211111 -

262551
WELL CONSTRUCTION RF,CORD
�4
NmIII Carolina - I)cp:utmenl of Envirunnlent rind Natural Resources- Division or Water Qualily-Groundwater Section ;(•!,
NN VI I ( ON DIA('I( HONDIVI DUAL)NAME (print) J I rei m, J O+O—=3 _ CERTIFICATION N[�eZ
%%F1.l.1nN1 It W 1 Olt COMPANY NAM F. `� �'� '"��Li �(�, C. C r nJ f�_PIIONE N j s
S I CI 1.yf ha l (O%SI WWI ION PERMIT#` _ASSOCIA'I Ell%VO PF.RNI11 N 31
(it applicable) (ifappllcable)
l ef,
1 1:1.1, 111F. 1( heck Applicable Box): Residential tPWP Municipal/Public ❑ Industrial ❑ Agricultural ❑
Nlomiminp ❑ Rccacery ❑ Ilea( Pump Watef Injection ❑ Olher❑ If011lcr, List Use
2 W1!1I I OUAI R IN: Topographic/Lan(( setting
H,IIICsI Ir,Wn- ,.J_J4�W3 County_L(� eK�=�— ❑Ridge Wlope ❑Valley ❑Flal
NtE.N 1--ALL_5 �d_. (check npprop,fetebox)
I en,ri Nmnr.N...nhcr<.I a,n,onity,Suhdi,kinn,Uu No.,Zip Cndc) Latitude/longilude of well location
t. 111\'NI'R'. (�VI�/,!M9" _�Gnrr'N SG Aj I,legreca,'mimnedeecmula) 7
Addicss _ZSS to Ialiludcllongilude suurce:OGPS❑Topogtapmc map
ISM,,„r Routc No.) (check hue) -
%/fRf'G,J 9116� Dh_I'fll" DRILLING LOG
I , Srue lip Code plum I n Fort ialion Description
� -
�ira, I. Ili ,•uun,hcr _ l �___A:L��.�— sr/'/)�i�. 7.�V
4. OA I1' DR 1111:0�O , /) •
IOTA1. *Pl Go5
6 DOFS Will 1. RI PLAC . EXIS"PING WFL ? YES ❑ NO l3'
7. S I A I I C WA117R I.PV1;L Below Top of Casing: —/00 I'1'.
(llec"�"if Ahovc'I'opnf Ca<inp) — ---"-- --
R. TOP OI:CASIA; IS _ FT. Above Land Sutface' -- —
•1 op of c:ntna h nnlnA.-A al/nr below land unroce requires a
:nlnnce In ammlauce wkh ISA NCAC 2C.01 IN.
tl. VII'ID(epin): � MI;TIIODOFTEST_t� r
Ill. WA"ILR /ONES (depth): S ( 0 _
LOCATION SKETCH
1 I. U I S I N I 1:('II ON: l ype Amount_Z. - uP_ Show direction and distance in miles from at least
12. C/VSlN(;: Wall Thickness two State Roads or County Roads. Include the road
Depth Diameter or Wci,hUFI. Malerial ❑uurbcis and common road names.
I non J _—lhj J-- Fl,—
twill to
CD ---.-
(III -� I) plh M:uclu0 NI",hod —
Iunn C to
-- �__. rrff--J _
14 1li P1 I N: Ih.Pih Diamcicr Slo(SiM \I:ncrial 'J
I nan In FI. in.
Il( m Ib H.
I sAIMAWAVFI. PACK:
PCpDi Si1c Material
Pnnn Ib PI. -• �.
to RI NIARI:S _ . ---- -
P((
�D�IIMII� t �1� 1 ��1U1 ISWI'LI,A4'ASCONS"fRUI'Il'.DINACCUIiUAN('Ii1V1"IIIISANCAC2C,WELL
)5 ND'I I IA T A COPY 01:TI IIS RI:( HAS REP.N PI(O\rIUFU'P0'I IIIi WELL OWNER
I KN ( 1:( r�ICONS'l-R(1CIING IIlh WELL DALE
I � III
-t�rr�rtj iq;tHar t{rr'Di Nis on of Will er Quall ly,Cruu ud wa ter Section, 1636 Dln11 Set vl cc('enter-Ralelgll,NC
dmra' I1 il)731 3 Lrrithin3l)(Iayt, GW-I RFV. 07/2001

262550
NVELL CONSTRUCTION RFICORD
No,lh 1 :uol l I I:I - Uc pal lnlcl 11 oh llnvitmiment and Nal Ual R u c^ot c" - I)iv icinn o ale f W , owiI it -(itound\s'aicr Scclion �/++
%%I I It n Tr\111%('I I)111(m UI4'IUIL41l NAMIf�(n1llL�(IhJ_I-MM Oa�S - (TI((IPICAA'11r� —D 110NO
\\III ( ()\llt\(-MR( C)MI-AN)'NANIF:__.�—.hfAo k�f_ . N (( DW11101 _ 1'IIIINE M17H) e37 p-
00S
S I \11. \\Il I I TSS 1 RI'( I II IN I4110111I P-__.,_ ASSI I('I:\l EU\\1)IT11111I P
til:ggJicablcl (il:qq,l ic:dllcl --
I \% I I I. I sill I( It(,,k Applicable Ilos). Residential V h1imicipallhildic ❑ luduchial C) Apicullural 11
N onilol ing I Rrcmm I J Ilcrll 1'uugt waler Injeclinn ❑ 0111cl El 11 f)Ihcr, List Iltt'__-_.__
1tl'I I. I 1 u'A I I(IN I opoplaphlc/Land scllilig
+ /�
N"nlr'sl ll,rvnr MU'V1-Ph-� ( umtly l.�kQ RJ � MT!I 1pr IlSlirl,e ❑Volley 01I:11
C,.. Nnnv (-I.....I"', Ilnnnunlil\',Slll,ili,i<iun,lot M'.7i1,0dl'I �- I :Illllldr"I(g11!IIIIIIC Pp\4'('ll IOea11011
:\ddicsS I�) Q (.l�,t�$__RODS�-�_ I.ali4ul�•'I�,upitnJl� annrc:Cl(il'SUlopopl:gthic Rugt
I!o,tlr Nn 1 p,�/' 1�Lor4 ln,rl
/bt�► h>✓ /v- oa� {v(�i I111'III I)I(11.�.INO_I-_l)li
- --
ci:a� /q,( ,dr I non I u I oun ltinu Ncsct iplinn
(i I n)I'S }\'I'LI. 121'111.A(T AXISI IN(; WFLI? YFS ❑ NO [` ----. -. --. -- -- --
7 S I Al h All[I( I I!\'lll. Hclnm"fop of('acing: h"I�
(t i<r"I"if Abrrvr lop of('n<inet
;l. I I W ()I ('ACl1J(i IS _ I I Above Land Sol hacc•
•1 rig nl r.nlnp In urinal nl TI/nr he6nv Ir,nrl<m Inrr rtqulr rr n -----'—
,:nl:urtr rra..11wr,J1615A N(-AC 1('.(IIIP
v
LM AI ION SRLTL'II
I I 1)1"1111 1 1 ION I Amomil _ 7T-_.�{1,(�— Show dnrrllnn :Ind dlsl utrc in miles liom al Icacl
Will lhickncoc lu'o Slant• Roads or ( hall\' Roads. Include the road
I)rplll /I)i:all 'Icl m Weight/I'1, NIalcllall Il milel-' wid t'I,mmoll loml 11,1111m
J
I non I}, Il. c
Innl In Lt. `✓ - -.
Il (W( 111 I).pill //r1'h�uulll �Mp,�lh ,d
pD v -
Ili,n, O In I.1 ^'
. �Jl/Y�S`)�. ✓IT -
II„li, It �' 7Yl-J)5 _, '
I I Y I,I I'Ij Ir,ldh I,i.lmoul Slot Svc VVvvV blab It. o_ --
I n,m I n Il. in in. u'I _
I C:\til?'G@r\\ II I'.\("IC- _.
I hplh Si 7r 611acl i;ll
I lion II, li.
ion I Il
In It1 61 \R 1<S
Ili Ilk I I IIIS WTI I. WAS l'IINSI IMCITU IN A('CORI PAN$l: R1III I NCAC 2(•.WI•.I.I.
\I' / . ,ANN'IIIAT ' )PY(Ih'IIIISItLr( il)IIASHI'pNPRIIVInL.N1(11Ill; WELL OWNER
I _
SWNAIII )1'Ill it, '11 RUCII (i IIll: WH I. DAII'-
S6hN(il'14tt HI FI4(t11LYi0 Ihr I)i isiun u(\\'tiler 011:11 ly,Gruuud\\alvi Sec(iun• 11,16 Ahtil Sonicc Culdt'1 -Illdll(;11,NC
.1221• %illdu 311 da)s. G\\'-1 RI'V 07/2001

262549
1VGLL CONSTRUCTION I(I;CURU
III I Ih f an ding - I)(p:u one nl of f.n vitm ntcnl moo NahetaI It esmoccs - I)ieicion I,I (Vast Oualily -(hound wa(er Seclioo
PIII r(,%[fix( I mt(INnl%loll A I.I NAM F „h,ll_.. 'vl trl �O��rS .. _ CF.KI IFICA-I I(INN (�
111 t If (IN I It%I'IfM l'I INIPAN I'NAME .__\..iflC..r e _. . _ .. �1--bl�� IaJ -"-__PIIONF N (p�.p7�37—yw 0
SIIII M If,IO.Nti IIt IIf'I IUN MAIM IlN __,ISSO('I:\IFn of)PERM I IN
I it ;ggrlinJdel lif appliulblei ----- — —
I. \\'I I I. 1 SI: (('heck Applicable Box) ❑ Induah i:d ❑ Agricultural O
%M ali l Ill iI Ig I.I Rcrotely 1-1 1lent I'ump (Valet Iujecdorl O Other LI If(Ilhei. I.isl
O(•A I ION /1)� � � /, (gn,irr:gllic/l anal selling
Counll•�Lel+QV I1Xtirl(•. ("%Slope ❑Valley ❑I.1a1
b I",I :rl,P......rlc I,r,.l
I'ar,+Nano.Mumbor•.I'..::rums:it,.S,&Jkkwlr.Ira N,,.Zip('rvlr9 I aliludr•:Ir rllltihlilr: of well location
t II\\-M R- .. Bt " �A�e-5 _ nbrn r<'miunlr a¢tanukl
_L___ -_ I.;IIihlrl.rLnmibldr snub c:Ll(il'SUI opographic map
Rr•me� Nru 1 pp.. �• Idrccl bo<I)It 1
III I'II_I _I LLINU LOG
( r,r,r"I„'1, �crnrf-_ ___ iip l"rrdt Inrm In Polntalinn l)cscri.linn
B I 3 7 6 77SST wo
l:;nr:,r:rr•I,r.r �sRaa IS
r
I. n \11' NRIIIfn >D—.3 —o2 _- -_ —
r, 1u117ti \\'I'LI. RI[I'LA('I? IiXISIIN(i \Vlfl.l:? )'ISS ❑ N11 L
-- - -- -- —
7 ;I A I If \\'A I IT 1.1:VIT Below"11,11 of('nsiug: �,�_-__R1'.
(i I<c••,•.it Ahutt lap of('n<incl ____._-_-. _- . ....__
s. II11' ()1 ('ASI N(i V, - _ .J_ 1:1. Above Land Surface" _._ _.__. ._. _. ____.. __._____—
'1�q•�rl rn Jnp In nd n:rhd nrLm Ltlor<'Innd vvfnce req nlrtn• "- ""--- - '-- '--
rmL.mrr ln:•rrrrrrbnrrumr lc,\NCM"IC.IIIIP. —nn n ..__ .._. .. .. . .__ _.___—__—__._
'I \'ll'IOlcpmp. Nil;II1(mol '11'.Sl_
Ili \\ A I If.R i ONPS (d,•pI1W _-
LO(.'Afl(.)N SKEICII
I I. I11•IIIJ) I'I ION. I cpcC4..d_444 pl Amount Shore diu•rtiun and distance in miles fnnn at Icasl
I?. ('r\rJN(; Nall Ihickuess Iwo SI:te Roads or County Roads Include life road
Ur pill D�iaIl�%I•I•It nr XV ighl/I 1. N�jlllen:d uuiuhcls :Intl common load names.
I non _ .�_ I o I'"t0. l I.— -> I ---[ C---
Ilrnn In
Inns lr, I1. -
I t (ihf II I ' I I.ptl: Nlolcl i.d AL•Ihrnl I _
Ilnin In �o fl �+tENT... A4v - / a -
Io I,�Q I GUT7'j,�qq,,5 `g RHVI -
1 1 1.II'ITIJ I):I•Ih Iriniuelet 51�1Sin• v Malr•li:d
O
I will lrr Il. in in.
Ihplh 71• Nl:del inl •• �"
I Erin Ln h. G.71
I will 14,
It, PI GIARKS
I LJ I L I li'1h I ti (� RIJI 1�b1l (I 1 Iti\\'I[I I. WAS( ONS"I IttWl11)IN M I IIt PA N( I Wl I It 15A NCAC 2C,WELL
J �'rml7PhrTf r , tl ,.�I'I C NO IIIA (OPY Of'fIIIS 'ORII IIAS Ill INN I'ItnVII)ED O ]III. NhLLONNGIt
I ,
- - ---
IL' I iN, ,01:I'RI S1RI1C11N(illll UI1.1. I)A11:
i
J
�InJuoi1 114t In itti 11111 lu"!Nc 1)11 is on of\Paler(j11:1 Ii1V r(roll fill lt nlel'Seel is if, 1(06 Mall tiers 1(c( crtcr- It:lrigh,N('
I`J•n')_I1 '( 111ucNi, I'li )I�3.17_ 21,1111hu .111 ( als. (iAV-IIt.IA' 07121 -

2P)21518
WELL CONSTRUCTION. RI?CORU
Nul Ih GuMiIla - Dcpanilicnl of Environment and Natural Resources- Division of Wafer Qua I i I-Groundwater Section
\\1:IL(r)v11C\('IOR(INIII\'1111IA1,)NAM, (prinr)_.. Im47 O�1�: CE1111FICATIONJI �oS
%\F.IL(ONIR\("I'OIt('IINIPAN\ NANIE64 _cJ_Kw
S I,\I P:\\lil.I,l'lINS"I It11C'1 ION I'E RN11"I'a_ -__ASSOCIA"I-En\\'Q PERNII I H
I if applicable) (if applirnbic)
I. \CF.I.I. USII(('Leek Applicable [lox): Residcrilial Municipal/public ❑ Industrial ❑ Agricultural ❑
Monioting ❑ Recovery ❑ Ilcat Pump W:+Ier ejection❑ Other❑ IMiller, List Use
2, WF11. LOCATION: Topogra 1 is/Land setting
Ncalesl 'I(,%cn �u?CN. County Cf/ � = ❑Ridge opc ❑Valley ❑Flat
CLU(.. c:.P ,t _�__o/ ___ _ _ chrck approprinle hex)
1'<orcl Name N,Inihci<,1.'o,o,nun ily,Subdivision,Lol N.',Zip Cute) Latinlde/lollgitllcle of well location
1. (11\'NL.R: (PLC=.V,V' XC'-5P14e _ ---I dcFrec<In,inams/seconds)
\tldlesc _er��3_i_-V4_>4- C K i•2d [-:if i I udc/I t iogif title sour cc:❑GPS11 Fopographie ma
y� islleel or Rome Nn,) (check box)
[�C UITIII DRILLING LOG
_j ny..I yI ,co �sl�nc zip Code --- Prom h, Pa nation Descr'{)t' n
A rra Ante-I•hunr numhr' 0 ,/l -1 '
5. TO'I Al. Dlil'-fIL___ vJ /
6. DOFS "FILL RFI'I.ACE EXISTING WELL? YES )
7. STATIC WATER LEVEL Below lop of Casing: 1'"1'.
(Use•'+•'it Above Top of Coxing)
R. '1 01' 01-CASING IS_ / _ F"f.. Above Lond Surface'
1 np of'min,Irnuholed nl/nr below land xnr(ace requires a
,'arlan cr h,acan'dm ,xilh 15A NCAC 21 11119. ---- —
'). 1"IIiLD(gpu0: fvjE11101) OF TFSI' a,
10 WA IT ZONES (depth): —
LOCATION SKI!TCiI
I I. DISINI F('IION: l ype_, ......I Show direction mid distance in miles from al least
12, ('ASINO: Wall fhick,,,T- two Stale Roads or County Roads. Include file road
ff� Ucplh 1)'nn •r or Weighl/Ist�. NI 'aI numbers and common road names.
CZD
I will to
I lon1.-- -_-_ Io
I . GliMl I` Depth' / N ncrial Niclhnd
Ilom _._ Io Y C.__ PL__
14. S('RIf N: Dcl+lh Uinmeter Slut SIM Ntnlclia -
I tmi, To
Ih and To —
I5. SAND,,61 I!I, I'M K: cJl
I)cpth Size Malcrinl _
I'nan _ I
Ilion I
Ib. PI MARKS _-- _ —_---
u� LI If171II SIN-t'i� tlr v 1 '-1111S\Vi:(.I.WAS CUNSTRIJ(''11iU IN ACCORUANCIi WIT II 15A NCAC 2C,WI:LI,
ILJI� ctIJF"lSl titl�lO SIiNI �I ' ANDI11Al'ACOPY ''fIIISWI:(0RD1IASUL•I:NI'IiOVIUp.DIOIIIEWI?LLOWNER
!n I IltJl' /O a O
SWNA 1URE 017 PERS . I z :'I1NG I . I'.LI, DATE
LSquyl�uuilyl�lyuFuu i}itt he D eision ur YN'aler Quality,GruullI vale,,ecl ion, 1636 Moil Scrcice Center-Raleigh,NC
ASH L E�FfGfO� �� F ��))7l -J221,vcilhin 711 da}'s, II REV.07/2001

263958
WELL CONSTRUCTION RECORD
North Carolina - Dcp;utment of Environment and Natural Resources- Division of Water Quality-Groundwater Section
w'F.I.I.CON'I RAC'I Olt(INDIVIDUAL)NAME (print) .✓/rs1M I/ ✓aAl�5 __ CERTIFICATION N oyS�(.J
i
It El.1,CON IRAC10RCONIPANVNANIE Crl�eoir� Wit �R2Lci�� _ruonE0
S I'A'I F.WELL CONS RUC1 ION PER111'rN ASSOCIATED\\'Q 11F,RAI ITN -
(i(appl icabie) (if applicable)
I. WELL USE(Check Applicable Box): Residential W Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monilmulg❑ Recovery ❑ Beal Pump Water Injection❑ Other❑ 1f0ther, List Use
2. WELL LOCH"LION: Topographic/Land setting
Nearest Mown'.__Hv' e*A/�/ County C�//Ysa2/�r ❑Ridge L3�ope ❑Valley ❑Flat
4>6LiS L,af ) (check appropriate bnx)
ISlreel Name,Numheerqrs,Community,Subdivision,Lot No.,Zip Code) I_alilude/longitude of well location
3. OWNER:_ le ,,I- (degrees/mioutes/seconds)
Address Art; w;veA.�J .fZr1 Lalitudcllongitudc source:❑GPS❑Topographic map
(Smect or Route No) (cheek box)
7,��.tss;ctJ,J-f N� DEPTII DRILLING LOG
Sitvnr Tor,,,, snore Zip Code 1:10111 To Formation Descriplion
Area code Pltone number /OG 70 j
4. DATE: DRILLED /0-23- O.;iL
5. TOTAL DEP"IT :_70 _
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO ❑
7. STATIC WAI ER LEVEL Below Top of Casing: /00 FL.
(Use"+"if Above Top of Casing)
8. '1"Oil OF CASING IS FT.Above Land Surface" -
'Tap of casing terminated at/or below land surface requh'es a --
variance In aveordance with 15A NCAC 2C.0118.
9. YIELD(gpm): —1 METHOD OFTEST 4,,e
10. WATER ZONES (depth):
LOCATION SKETCH
11. DISINI:FCfION:1"ypc 117-11 _ Amount Z C,..,P Show direction and distance in miles from at least
12. CASING: Wall Thickness two Slate Roads or County Roads. Include the road
Depth Diameler or Weight/Ft. Material numbers and common roar) names.
From O To /%' FL 6 % _J Ja.�i P✓c o _-
From_-- fo__ Ft. __
Front--- htt----Ft. — -- `
13- ORt)UT: Dcl,(h Material Method
Pntnt_ O To F(
I rrnndo _ ru_./O Pt 0,:T.s3__ _ -
1-1_ SCRELN: Depth Diameter Slot Size Material - -- "
I Iont fo Ft—in. in.
From 'fo_ Ft, in.
I5, SAND/GRAVEI. PACK:
Depth Size Material
Prom 1"o Ft.
lino - To FI.
16, RI!MARK((��S:
9)C)CFI�3 IEW I lkl' I HIS WELL WAS CONSTRUC FE) IN ACCORDANCE.Willi I5A NCAC 2C,WELL
CO SI R I AND THAT A COPY OFT[IIS RECORD I[AS BEEN PROVIDED TO THE WELL OWNER
IGN�FPLRSOONSIRUCTIN(i THI: WELL DATE
BFiDG111D1MT@RIR9 ION to Div sion of Water Quality,Groundwater See(ion, 1636 Mail Service Center-Raleigh,NC
AS 14Lk,,R4EPigi401NOFPltf)733 221,within 30 days. GW-I REV. 07/2001

263416
WELL CONSTRUCTION RECORD
North Carolina-Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section
�
WELL CONTRACTOR(1N'DIVMVAL)NAME (print) FPONZ V. �IG-mig CERTIFICATION A'31 _
WELL CONTRACT OR COMPANYNAME 3YEIZS G..IEL(_ L7Rl Ll_.IN( SNC. PHONE X V00 7'J�5-?-Mo
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(ifapplicable) ff licable
!. WELL USE(Check Applicable Box):Residential V Municipal/Public❑ Industrial ❑ Agricultural❑
Monitoring❑ Recovery ❑ Heat Pump Water 4cctlon❑ Other❑ If Other,List Use
2. WELL LOCATION: Topogruphic/Lalld setting
Nearest Town: hlAN County- lECRoK�-�-- ❑Ridgy 0Slope IRValley ❑Flat
_13G c-, OAK C-.R m rz R17. i (check appropriam box)
(Sour Narna,Numbca,Community,Sub&yWoa,Lot No.,Zip Code) Latitude/longittide of well location
3. OWNER: kED P u-TCA 1 N S (degreerhn au es aectods)
Address 1525 ICIPYTnWN ST. Latitude/Iongitudesource:CIGPSOTopogrxphicrosp
'T� (S9treet ar Route NoJ (check box)
9_ I7LuE 12. X C-A ---30513 DEPTH DRILLING LOG
City aTown tue Zip Code From To r�o.-^+Tier.D Ptioe
5-0d Yi lu p Cam'
Am code.PhD"tk=bcr
4. DATE DRILLED o'Z 0 2 �� CJC�t4(C2En
.5. TOTAL DEPTH: 5 C /�—?61 122 6?2.Y 2ouc
6. DOES WELL REPLACE EXISTING WELL? YES O NO Er
2a v 5 L2Z
7. STATIC WATER LEVEL Below Top of Casing: /0 FT, 175 Lre-Im'1 1Zacl5e
(Uve'Y'If Above Top ofCaeirW 175 - Zd2 D2RK 622a1 SL'ZT6
8. TOP OF CASING IS FT,Above Land Surface'
?3 17 A4rc c_rzA v etc
-Top of cube nermtnated aNur Wave land endue ne4ufra a - LI
varlaau to eceordeacee�wlth 15A#CAC 1C.0118,: aZ3 y - -1 Co�9. '1ULD(gpm): 1
- METHODOFTBST &IR ?G?_ -3(00 G2t?1-6Ro 1t 2octs
10, WATER ZONES(depth): Opmr, T-oJ 7LeTT-
10CA710N SKETCH
11. DISINFECTION:Type� Amount 1a Oz. Show direction and distance in milts from at least
12, CASING: Wall Thickness two State Roads or County Roads, Include the road
Depth Diameter or Weigbt/Ft. Material numbers and common road names, SZEE
Frot1�_1'0 _FL (o 14 Z7.(� VU - 3 Ail EppF
Front____To Ft._____,_ i? i
From To_,Ft, IE
13. GROUT: Depth Material Moth d 7
Frorra„To._2-Ft' c--M6t4T
t r
From To Ft.
14. SCREEN: Depth Diameter Slot Sim Material ),9 Mr 0/IK ago
From, To FtJn, in. Sa Z`14
rq ✓6"3 -
Fro �,-�To Ft.4me—in, in, 7 - -
15. SAND/GRAVEL PACK:
Depth: S= - Material
From To Ft. 3
From-_To_Ft. tom } ut
16. REMARKS, Ex
I DO HERHBY CERTIFY THAT THIS WELL WAS CONSTRUCTED 1N ACCORDANCE WITH 1 SA NCAC 2C,WELL
CONS U S,AND THAT A COPY OF THIS RECORD HAS SEEN PROVIDED TO THM WELL OWNER
C il- 1 -0 2
PSIONATURB OF PERSON CONSTRUCTING THE WELL DATE
N
ubn it`ihe oherial Division of Water Quality,Groundwater Section,1636Mull Service Center-Raleigh,NC
699-1636PhoneNo [phone],Within 30 bays, GW-1 REV. 07/2001
DWATER SECTIONLE REGIONAL OFFICE

• 26354
WELL CONSTRUCTION RE CO 263 5 ? 3
North Carolina-Department of Environment arid Natural Resources-Division of Water Quality-Groundwater Section
CERTIFICATION II�
WELLCONTItACrOR(INDI(INDIVIDUAL) (Print) r`11`rtA
� PIIONEN �`z S�— CFi7
WELLCONTIIACTORCOPIPANYNANIF. Y�
ASSOCIAI F,n WQ PEMIITN
STATE WELL CONSTRUCTION PEMIITN ffnpplic6le
if a licub)c
1. WELL USE(Check Applicable Box): Residential U—Municipal/Public❑ Industrial ❑ Agricultural ❑
Monitoring❑ Recovery ❑ Ileat Pump Water Injection❑ Other❑ If OUler,List Use
2. WELL LOCATION: ,,..`` __ -- i� � __
TopographiclLand selling
Nearest'[-own: Counly�.�.�.i_O�.P []Ridge ❑Slope ❑Valley ❑Flat
1 1 � (check appropriate box)
(Street Name,Numbers,Community,Sub {vision,Inl No.,Zlp Code)
Leliluddlongilude of well location
(degrtes/m lnu lesrs ec onds)
3. OWNER: iultif �IC)CO Leliluddlongitudesource:❑GPS❑Topogmphicmnp
Address Sl I 6n COfi(l(S _ (check box)
(Street or Route NO.) DEP"Fkl DRII.LINGLOG
CQLa Lip code From To gotionyescription
Cbry or wn o�.•- t l
Aru code-Phone number
4. DATE DRILLED —ma
5. TOTAL DEPTH:
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO ❑
FT.
7. STATIC WATER LEVEL Below Top of Casing: it
(Use"+"If Above Top of Cnsbig)
g. TOP OF CASING IS FF. Above Lnnd Surface'
.-Fop of rating lennlnsled djor bcluw land rurf.ce requires
v.rl.nce In accordance"Ill IS pNCAC 2D OF TEST 1{ Q —
9. YIELD(gpm):__11
10.WATER ZONES(depth): —I Cx pT"ION CH
SKET
Show direction and distance in miles from al least
11. DISINFECTION:'1 ype Wall Arno uunl liclulcss two Stale Roads or County Roads. Include the road
12. CASING: numbers and common toad names.
Depth 1 Diameter or Weight/Ft. /M�a�terial '-
Front._-To _FI..6,2—
From To Ft.
From To Ft. --�
tMethod - -
13. GROUT: Depth Mat er�Zj. t f
From To Fl. co
14. SCREEN: Deplll Diameter Slot Size" Material -
From To—._FI. in. in. -
From To - Fl. in, in.
15. SAND/GRAVEL PACK:Depth Size Materiel
From To Fl. -- —._
From To Fl.
I WELL WAS CONSTRUCTED IN ACCORDANCE WI FIT 15A NCAC 2C,WELL
STRUCTION STAND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO TILE WELL OWNER
SIG ATURE OF PERS DATE
ON CONSTRUC71N0 7HE WELL
CROUNOWATER SECTION
I9Cv
aleigh,NC
Stmbi flfby H Pr1G1!fd tie lilo of Water Quality,Groundwater Secllon,1636 Mail Service CQW-1 REV. 0712001
27699-16J6 Phone No.[phone],within 30 days.

�VLLL CONS'1'RUC'1'lON RF.l:Oi.;
263545
North Carolina-Department of Envirotu»ent mid Natural Resources-Division or Water Quality-atoun ater Sz Ntion
WELL CONTRACTOR(INDIVIDUAL)NAME ((print) iI (` II;rG PHONE N
WELLCONTRACTORCO°IPANYNANI.E ) •Oij)A..l�
ASSOCIATED WQ PERMIT N
STATE WELL CONSTRUCTION PERMITN (il aPp(iccE,lr) - J-■�-�-���
(i!applicabic) /
1. WELL USE(Check Applicable Box): Residential unicipal/public❑ Indushtal ❑ Agricultural ❑
Monitoring❑ Recovery ❑ heal Pinup Water Injection❑ Other❑ if Other,List Use
ION' Topogr e Land selling
2. W ELL LOCAT
Nf)rJr County 10 p� 1°. ❑Ridge ❑SLope ❑Valley []Flat
Nearest Town: ^� pa (checkappropdatebox)
d Latitude/longitude of well location
(Saaet Name,Numbers,Community,Subdivision.
LL/ot No.,Zip Code)
�6 /�m� ' __ (degrees/minutn/sKends)
3. OWNER /H/O \ Lalilude/longitude source:❑GPSC1Topograpidc map
Address Iu i NE 44 y (check box)
(street or Route No.) -4�'l0 DEPTH DRILL IN LOU
llrn�n C To Formation Description
City or Town State Zip Code
Fri=I I
Aru code-Phone mmnber
4. DATE DRILLED I0- 2Z-O2 —�
5. TOTALDEPTIL•_ 5_
6. DOES WELL REPLACE EXISTING WELL7 YES ❑ NO L3-
7. STATIC WATER LEVEL Below Top or Casing: CIO _-_FT• ___--
(Use"+"Ir Above Top or Ca-dng)
8. TOP OF CASING IS —_--FF. Above Land Surrace•
- -lop or aning trrminatrd aUor blow land...face require$a -_
variance in accordance with ISA NCAC 3C.0119.
9. YIELD(gpm):�--
METIIOD OF TEST
10.WATER ZONES(depth): LQCAON SKETCH
Amount Show direction and distance in miles from atjeasl
I. DISINFECTION:'fype Wall Btidmcss two State Roads or County Roads. Include tfii oad -
12. CASING: numbers and common road names. _
Depth r Diatneler or Pl. M° _
Fran
�-To Ft.Fo•� !
From_ _To— V PL cfL_
From To FI. Method
-
13. GROUT: Depth
From 0 To-�Qr material
From To
Diameler Slot Size Material
14. SCREEN: Depth in.
Front To__FI.
From To
Pl. in. in.
15. SAND/GRAVEL PACK:
Depth Size Materiel
From To rt.-
From To FL
16. REMARKS:
IIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
D1�JR �N TA AND THAT A COPY OF THIS RECORD tiAS BEEN FROVIDED TO THE WELL OWNE R -
IGNATURE OF PERSON CONSTRUCTING THE WELL
DATE
"1911,NC
Submit flit orl Inal to t Div Stan of Water Quality,Croundwaler Secllon,16J6 Mil Service Carl REV.07 2001
ASHE73J- 221,within 30 days.
REGIONAL OFF CE

WELL CONSTRUCTION RECORD 261662
North Carolow - Ucp;ut deal of Elivironuienl and Na(ural Resources- Division of Walcr Quality-Groundwater Section
1 11\\\ELL I"11\I11M I On(IN III\'I IIIIAI.)NANI F, rOrt) _4�M,�.— Or_)['� _ CER77FICA-11ON M�CS
"1 It.%(1OIt CON PAN\ NA NIF._(AQ_2_oo__ec__.W ]C�1__ 1)I �V<' rilon4: a (WD) 0�7•--p
s I A 14:\\-F.L1.(ONS I RITCl 1ON Pith rrq -__II_"--
___ASS(ICh\"I4:U tvf)1'F.RNII I q
1 if applicable) (if applicable)
I. WELT, USE (Check Applicahlc Box): Resielenlial VKM till icipal/Public O Industrial ❑ Agricultural ❑
Mmlilnring❑ Recovery ❑ Ilea[ l'uuip Water Injection ❑ other O If Other, l,isl Use
W E I.I. IA)(,/%I ION
�/ -
N c:u csl Town: Topographic/Liu)d selling
--_MaA _County- R ,E' ClRidgc ❑Slope ❑\'alley ag-la(
- -' -- U�-T�- _- (check appropriate host
(Choct Nanm.N.... <,('onnuon it,,subdl......n,Lot No_Zip CteleI I allludc/longitude of well location
----""- - ---- IdcgrasAninwes/sernnds)
/41JIcss . � k 151 I.alinulc/longitude source:❑GPS❑Topographic map
{ (snecl ar Itnule No) (check box)
/ 1('rN�('�// ' o ___ D(il'lll DRILLING LOG
q' Oily to Io`l71 / strac �j Zip Cole Plyln 'fo Formation Des'0 lion
PI
d. IlAlr'4IiIIItII,I.I'Ill�Cr •� / _ �- �_____—i -.T �/ /` r
5 101A], DFPIlC__ _1�--�_' --
G. DUBS Will, RF.I'I.AC'E EXISTING WELL? YES ❑ NO ❑" -
7. STA I ' WA"ll'.R 1.1'.VEI, Below Top or Casing:
// (Use"C'it Above 7npor C'asiog) — ----
R. MP 01'CASIN6 IS- (_ FT. Above Land Su(face` ---- - -
•I'll,ulatgng lerndonted nNnr below land suirnce requires a — -- - - -
"Phore III A,r...'danr yIII I5,\NCAC2CJn Ie, _
9. YIELD (gpol): _. NIFJ 1101) OF TEST 4 ), --
In. WAIVPZONI.S (dcpllt): /70•
��� LOCATION SKEI'CII
11. DISINI f 1)'pc
.("I MN: "' _ Anunili C.`'tT Show ditecliolt and dislance in miles from a( least
IL ('ASING: Will'fhickoess Iwo Slate Roads or County Roads. Include the road
Ucplh / U''motor 0 Wcci J 111 q:1, N at ml numbers and conmion road names.
f Loon _ "fo
frmo_ .....
li. (;R(IU M. Ile lb -- Imcrial
Ilallt (\\
FI _
RI!I N: U\lalt Dinntcicr ual Sizc Nialcri:d
Ilrnn_-.. . To _ fl._"_in.
15. SANIMiPAVEI, I'M K: ------"--
Ucplh Sole Malcri:l
I oat__. _ I o PI.
I will Tn I`I.
9 - - - —rpm-- _._._._ ------ — ----
n) 11 Ilill",'(.l f(Ill N II�II,{\l 1 5 ' :1 1 WAS CONSTRUC'HA) IN AC('ORDANCI:Willi 15A NCAC 2C,WELL
l ollO�7)N G\N?Q�@DS, ' llA'I'ACOI'Y OFIIILS RFCORD HAS BEEN PROVIDED*1 OT11EWELL OWNER
_ /0 - / - 0 2_ _
GROUNDWATER SECTIONSI(M URF.OF PI',RSUN C�ta I( (i I Ht� I.LL. —� DATE
ASHEVILLE REGIONAL OFFICE
Submit the original In the Division of Water Qua lily,Cron n(Irvale ..eel on, 1636 NIail Service Cenler- lieleigh,NC
27699 106 I'hmu,No.01q0 711-322I,Avitliin 30 days, OW-1 RIi,V. 0712001

WELL CONSTRUCTION RECORD
?_ 66083
North Carolina-Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section
��� I
WELL CONTRACTOR(INDIVIDUAL)NAME (print)
\,,...,, s (� `fin(\ CERTIFICATION L q-0-1
1 r In n fg2`053'7-299'2
WELL CONTRACTOR COMPANY NAME m 1 I P XzO V 1 I PuonE aI
STATE WELL CONSTRUCTION PEM ASSOCIATED WQ PEMIITMtIT� (jfapphcable) —
(if applicable) -
I. WELL USE(Check Applicable Box): Residential V/'Municipal/Public❑ Industrial ❑ Agricultural❑
Monitoring❑ Recovery ❑ heat Pump Water Injection❑ Other❑ If Other,List Use
2. WELL LOCATION: Topographic/Land setting
Barest ToT„F,n: m. (check appropriate box)
County`' ❑Ridge ❑Slope []Valley ❑Flat
11
��A}
(Street Name,Numbers.Co munity, ubdivision,Lot No.,Zip Code)
Latitude/longitude of well location
3. OWNER: i�`��T �i^� inut<a/saend+)
Address e F rv�V v i Latitudellongitude sonrc source:❑GPS❑Topographic map
(check boa)
(Street or Route No.)
I { U+ �o DEPTH DRILLING LOG
�1
zi Code From To Fprmalion DescrBtion
City or own State P ® , , / [ -
(—)' r -
Ares,code.Phone numbe
l9 R2r
4. DATE DRILLED � 3-0 7c) S 7 ?
5. TOTAL DEPTH: S
6. DOES WELL REPLACE EXISTING WELL? YES 0 N ❑
7. STATIC WATER LEVEL Below Top or Casing:
(Use,,+•,if Above Top of Casing) _ -
8. TOP OF CASING IS FT. Above Land Surface' _
ca
' *Top of casing terminated°Oar below land surface requires•
variance In accordance with ISA NCAC 2C.011 S. --
9. YIELD(gpm):6.-METHOD OF TEST
10.WATER ZONES(depth):— I OCATION 5KETC1
C
1 Amount 5 Show direction and distance in miles from at least
It.
S ION:'Type Wall Thickness two State Roads or County Roads.Include the road
I2. CASING:NG: , numbers and common road names.
Depth Diameter or Weight/Fl. M1
From _©To q Ft.
From To Ft.
From To Ft.
13, GROUT: Depth Mel 'al J Method
From fJ To .M r Ft. c�i2 i
From To Ft. na,• d '
14. SCREEN: Depth Diameter Slot Size' Material - --
n _Ft. in. in.
From T.—. _ . - .
From To Ft. ir. in.
15. SAND/GRAVEL PACK: Size Material
CD
Depth
From To FL
From To Ft.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STANDARDS,AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
-2-2 - 0 -2
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division or Water Quality,Groundwater Section, 1636 Mail Service Ceenterl REVgh,C
27699-1636 Phone No.(919)733_3221,within 30 days.

262142
NVELL CONSTRUCTION RECORD
c
North('amlina - I)cpan ulcnt of Envirmuucnl cord Natural Resources- Divjsion of Water Quad it -GrOURdwatef Section
-���(�
„Cl.1,Cl lNI ll\(""I OR IINn11'Inr1AL)NAME (prinll— _t2.1-.,M _—n1ES__, __— CERTIFICATION X_.¢ZtpJ
r,P:ILl'llN'l It\l-IOtt('OAIPAN1 N A DI t:_�.h�Ro�P ��i{(1'-..(--rnONE a (�y81837—goo$
IN I I' %I 1I1.1,('O N tit Ill'(IION PERNil'1'0_ __ASSO IA'I ED\YQ I-VRNII'Ia
(i(a,dic,blc) ifa,,licrblc
I. USE (( heck Applicable Rox): Residential M/Municipal/Pu lie ❑ Industrial ❑ Agricultural ❑
Mouilrning❑ Recovery O I Ical Pump Water Injection ❑ 001 1'❑ II 011ler, List Use
WI;1.1, 1 OC'A"I H)N: f� topographic/Land selling
Ncn csilmon:_._/YIUSp `�—C'ou1)tY/1� /�f� Ridge ❑Slope ❑Valley ❑Flat
(ch"knppmprialebm)
C I,, 1 N an.e,✓NCu.iJol"' ,C.... Any.Scuyubbdi vi,ion,Lot No..Zip Ci,le) I.altltrldc/longllude of well location
I IWN I'.R'. �OP1 - Is$ _ Idrgrec,lininule,/seconJ<)
D�K 6�oy I ntitudc!Iangitude source:UG I'S UTopographic map
(Soec1 or Rine No.) (check howl
MAN Ill DRILLING LOG
7.ip(',ale IrFu'11n 'fn..?,, rorloalionDcscription
7- Cis_
\irn c�ulr I'bu..nnn.bci
5, 1()IAL DI;1,111:_____ G ti
a. DOI'S \\'III.1. RHILACR EXIS"IING WEI.I 7 YES ❑ NO C3�
7. SI'All(' 1VA"IIiR I.1'.\'El. L3eluw Top olCasing: a o o_I'"1'. --
(11se if Above Top of(7a<lo,) ---
R. 'I(W OP CASING I.S . P'f. Above 1-and Surface - -
'1 np n(rosin,Iennh,ated of/or brimv Witt sorfcre require,f --
rurl:nve b,xcrardaw,r r,fill 15A NCAC 2C.OI 19,
r). YIELD Igpn(1:_.:�j _—METI IC D OF TEST - °Z _
10. WA"I FR /ONIl5ldcpihl: _ 'a do � --_.— --
—y� LO� 'IIA ON SK ETC 11
I I. IIISINIIi("IlON:'I-epc_ Anew lil G Z/�'`" Shaw dilec'lion and distance in miles from al least -
-- Iwo Str1lc Roads or Count Roads. Include the Id -
I� ('ASINr; Wall Thickness Y '�'
r' I)cpih _ %mtiicr or Wei�ht/I I, M:(lerial l000h rs and common road names. -�
J— I L_ _Y—
h oill__- ---- to - - --- 11.---- ---- --------
Fnan -
-
I {. (;R()I II C - D'- th--�--" Mawiml Nlclhod -
I I_ C(.'RUi:uncic•>'7S1rrrSin hl:neriol N nI will
Ilnm T , --
I5. SAND/GRAVIT I'M K:
111111111 Sizc Material
I, lNIAJ,th:.I: 11 - — -
D1 t I RFIIS('Fltl II-Y 11IM 'I I IS WI H WAS C'ONSTRMA 1:1) IN AU ORDANUF WI111 15A NCAC 2C,WELI,
OIJS- (IOfV NU"f iATACUI'Y OP'fIIIS li 14('gRU 1 BEEN I'RO\'IDL'D1O'IIIf;WELL 01VNfiR
ASHEVILLE REGIONAL OFFICE N �- 2 O L
Sl(;NA I URI:of:PERSON C NS tl 11 ,'I11F: WFLL DATA.
Submit the Ill i�."inid to the Dieisiun of Water Quality,Groundwater Seclioo, 1636 pinil Service Ccnlcr-Itnlrigh,NC
27691) I6161'hmn'No.(')I9)733-3221, cvilhin 31)'IO}'s. GW-I REV. 07/2001

I
r
262547
WELL CONSTRUCTION RECORD
Not Ill ('arolina - Deparu nent of Environment and Natural Resources- Division of Water Quality-Groundwater Section
l\I(1.1.(ON I RA( I OR 11-4DII'I nUA I.)NANIF. (p�r""inl)_,�IMM- (/_ �/l)f�s _ CERTIFICATION �
INI11.1'ON'I nACA OR("(INIPANI'NAME�(y�oL��_ P IIONE 0 (87$1
SIA 11,IN LIA,UONRI RUCI ION PERM IN ____ASSOCIA-1'ED IVQ PF.RNII FN _
I i I applicable) ^ (if;rpplicobic)
I. WH I: USE.(C'Ilcck Applicable Box): Residential 1p/Municipal/Public ❑ Industrial ❑ Agricultural ❑
Moni(uring ❑ Recovery ❑ I leal I'unlp Water Injection❑ Other❑ If Other, List Use
2 WIiI.L IOCA"IION. (� Topographic/Lan .etting
N.nrest Town: •n�Nl= �l Cowdy�--tCQ�o I.-V ❑Ridge ❑Slope alley 019a1
Idmck npprapriN<boal
I tilmol Nnnm.Numbe'',/t C'nnununity,S/0,livision,Lot No.,Zip Cute) I.alitode/longltu de of well location
��
3. OWNER: „�,JI{l/�A1 Moss _ Id<grees/ininwes/seconds)
Addles, �(p(".j_—,t�'1242� Lattudc/lungilude source:❑GPS❑Topographic reap
1 (Slmrl or It ni —ne blo p / (ebeck box)
(U�_I�t7/ �� [�!o _Uhl'I'I I DRILLING LOCI
('iy nl Ina-17 Snlc Zip('ndc —_— Ir ul --I o onnali I Dcs rl lion
I 1 B'3Z y L -,C- -�e
Area onlm Pbnr nwube, r � 3-�
I. DA1'I'. DRILLED_=�C1• © �
G. OOFS WELL REPLACE EXISTING WELL? YES ❑ NO ❑�2 Cam_ C,j_��• w O
7, S"I-AIICWAI ER. I.TVEL13clow Top ofCasing: Vr
(Use"r"if Above Top of Casing)
R. I OP OI:CASING IS _/___ I7"I Ahove I,:urd Stufacc' — ---
I op of :I flop terndnalyd at/or below land mrrace miulres a m
carlmicr b,accordance u'jllr I5A NCAC 217.0119. ---
n. 1'll{I.D(gi,m): h1ET,S_-- N/OD(OI TEST/'��
1II. \V/\I IT ZONU.S(dcplh): �1
_ LOCAT ION SKI:IClI
I ]. UISINI-I'C'll(.1N: 1)•pe _ Antounl_ G(/P Show direction and distance in tniles from at (cast
two Stale Roads or Count
I_. ('ASING: Wall"thickness� Y Roads. Include lire road
(� Ucpih U'un or I IUPI. nclial mlrnbcls and common road names.
limn V "fo ht. __-V— -- ---_ i4 Z/ -_
Llnm To__ _ -- fl. 1.� - .
Ilmo
11, GR011 L. Dy)h M1nlcrial Nltlbnd C7
Ilam lb_cy�1,IJ/
Id. SL'10 FN: D(plh Uinnre cr Slo Izc Malarial -
Inrm In II. in.
Ilmll
III
Ft.
ill
I5, SrANDiGRAVIIL I'M K: cn -
Depth Size Malarial --�
Ilmn ll, I't. `
I'nlm Tn II--- ----
Ib. RkNIARKS: r
D $)n6YI?1 { 1 )N51AP7t1773.il"I"l
NUI I IS IILI^ASCl1NSl'TIIISRECORDHAStANCE NVI BEENPROVIDED1OTIL'WELLOWNER
i
ON •I( N CONS]RUC IING THE WEIA, DATE
iao ua lily,Groundwater Section, IN36 Wail Service Crater-Raleigh,NC
AS iL �AG ��V L �TN 22J,widda3l) (Jars. GW-1 REV. 07/2001

�Y�LL CONSTRUC'I'lON RLl,0R
263008
North Carolina-Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section
WELL CONTRACTOR(INm VJDUAL)NAaIE (prinl)i �^S ^ (A )t I S©n CERTIFICATION r
PHONE r f$L`r�S1
WELL CONTMC"TOR C061PANY NAME
ASSOCIATED W Q PEMIITg
STATE WELL CONSTRUCTION PEINttTg if o licable
ifa licablc
1. WELL USE(Check Applicable Box): Residential unicipal/Public❑ Industrial❑ Agricultural❑
Monitoring LI Recovery d heat Pump Water Injection❑ Other❑ If Other,List Use_
2. W ELL LOCATION: TopographicfLand setting
Nearesl'fown: 1-(r' xurr alx,es Counlya P CQ Lpl ❑Ridge ([]Sloftke a []Va�blle ❑Flat
Latitudellongitude of well Iota:`
(Sueen Harbe,Numbers.Community,subdivision,Lot No.,Zip Code)
Vo �S (degrees/mtnutes/seeends)
]. OWNER: Latitude/longitude source:00PSUTopographic map
Address `0 NUJI-1 �—C1y (check boa)
(street tif RRouleNo.) q DEPTH DRILLING LOG
zI code From To orm Ito escription
city er raw state p
Ar t Phone � O /_
4. DATE DRILLEDED—
5. TOTAL DEPTII:
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO C]—
7. STATIC WATER LEVEL Below Top of Cnsing: 1 Df) _Ff•
(Use"+'•If Above Top of Cesing)
8. TOP OF CASING IS FT. Above Lnnd Surface*
-Top of cnlog lerminaled atlor bdae Imd surf.ce requires a ----
esrlance In accordanceelth ISA NCAC 2C.0I11. .n ,n --__
9. YIELD(gpm):J 8—_METHOD OF TESTIe1—
10.WATER ZONES(depth): j Of pT'ION SKETCH
Amount S Show direction and distance in miles from at least
11. DISINFECTION:'fype Wall Thickness two Stale Roads or County Roads.Include the road
12. CASING: numbers and comrnon road names.
Depth DDiamelt�er. or Wci IUFI. Hater's'
From To �i• FI. /S,� vC' -
Fron, To Fl. -
From To Ft. Method -
13. GROUT: Depth Mate r I
From D To 29 / Ft. n
From To Ft. - -
14. SCREEN: Depth Diameter Slot Size' Material _ -
Front To__Fl. in. in.
From To Fl. iu.
15. SAND/GRAVEL PACK: C _
Depth Size Material rr `
From To Ft. -----
Ff01D TD FL
16. REMARKS:
IDOIIEREBYCERTIFYTIIATTIIISWELL AS,C,ONSTRUCTEDI
ACCURUi
14
WITH 15ANCAC 2C,WELL
CONS RUCTION STANDARDS,AND THAT A COPY OF TIIIS RECORD IIASPROVIDED TO THE WELL OWNER
.0 - l9—692
SIGNATURE' F P SON.00NSTRUCTING TI E L DATE
��G�ru -DER � ;'ION
Submit the orlglnal to the Division of SVn _. errnr+yY�IfaiN'�' ftr SFr'Hbn 16 6 Mail Service Center-Raleigh,NC
GW-1 REV.0112001
27699-1636 Phoue No.[phone],within 30 days.

26300'7
WELL CONSTRUCTION RECOR
North Carolina-Department of Environment and Natural Resources_Division of Water Quality-Groundwater Section
—C p i .7. `Snl� CERTIFICATION N?9-0-9
WELL CONTRACTOR(INDIVIDUAL)NAME (print)� -I i yj'T-1S9`)
WELL CONTRACTOR COMPANY NAME VV1r 119C tLP 'k 6Ct�1rn� PHONE NL�
ASSOCIATED WQ PERMIT#
STATE WELL CONSTRUCTION PERMITN (if applicable) —
(if applicable)
I. WELL USE(Check Applicable Box): Residential I7111"MunicipalfPublic❑ Industrial ❑ Agricultural❑
Monitoring❑ Recovery ❑ Heat Pump Water Injection❑ Other❑ If Other,List Use
2. WELL LOCATION: TopographiclLand setting
Nearest Town: r�mT _--County VlpC6ka . ❑Ridge ❑Slope ❑Valley ❑Flat
N 1 Ql�f��e n n S\ f (check appropriate box)
Latitudeflon itude of well location
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) g
3. OWNER: II'Gm S (degrees/minutesh-ends)
Address " '� wu Z5L4 Latitudetlongitudesource:❑GPS❑Topographicm?p
(check box)
(Street or Route No.. DEPTH DRILLINGLGG
zt code From To FDnnatiun Description
City or To n State p _ t/+G t
A crew ode-Phone number �� 7� r
4. DATE DRILLED a/—S ©� 7S — lq/5
5. TOTAL DEPTH: )[
6. DOES WELL REPLACE EXISTING WELL7 YES ❑ NO 0-
7. STATIC WATER LEVEL Below Top of Casing: .top! FT.
(Use"+"If Above Top of Casing)
8. TOP OF CASING IS ( IT.Above Land Surface*
'Top of using terminated atlor below land surface requires a
variance In accordance with 15A NCAC 3C.a11N.
9. YIELD(gpm): )O METIIOD OF TESTiA ,
10.WATER ZONES(depth): LOCATION SKETQU
mount S Show direction and distance in miles from at least'
11. DISINFECTION:Type two Stale Roads or County Roads.Include)Me road
12. CASING: Wall Thickness
Depth r Diameter or Weightfrt. Material numbers and common road names.
From 0 To FL -- t -
From To Ft.
From To Ft. -�
13. GROUT: Depth Mat Method
From.—To ��r Fl.>��L
From To Fl. o
14. SCREEN: Depth Diameter Slot Size Material
Front To__Ft. in. in.
From To Ft.—;P. in.
15. SAND/GRAVEL PACK:
Depth Size Material
from To Ft
From To Ft.
16. REMARKS:
rt_: � r
1 DO HEREBY CERTIFY THAT THIS WELL W $'C
I TH 15A NCAC 2C,WELL
CONSTRUCTION STANDARDS,AND THAT A ,I OF THIS RECORD HAS 1 OVIDED TO THE WELL OWNER
L
SIGNATURE 0 PER ON CONSTRUCTING TH9 WEL DATE
1{Z, d(tfyNVgYectfOn,1636 Mall Service Center-Raleigh,NC
Submit the original to the Division of Wale Qua , _ OW-1 REV.07/2001
27699-1636 Phone No.(919)733_3221,within 3 s.

WELL CONSTRUCTION RECOIRWD, . 263006
North Carolina-Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section
Q S IAJ+ 1SOn CERTIFICATION N gq o(4
WELL CONTMCTOR(INDIVIDUAL)NAatE (print)� )��y[.)�� , f�j—t�2GS'1
nntll r 1 (�Ot PIIONE N (`awl
WELL CONTRACTOR COMPANY NAME n I lA7 Q.1( �C 1
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) _ (if applicable)
1. WELL USE(Check Applicable Box): Residential M� Municipal/Public❑ Industrial ❑ Agricultural❑
Monitoring❑ Recovery ❑ Ileat Pump Water Injection❑ Other❑ If Other,List Us-
2, WELL LOCATION: Topographic/Land setting
Nearp�r town: (Y]���Qh�{._—County ❑Ridge []Slope []Valley ❑Flat
r Omig y- 'i�i/�r A (check appropriate box)
1 me,N ( A u Latitude/longitude of well location
(Street Name,Numbers.Community.
/Subdivision.flat No.,Zip Code)
3. OWiNER:r r /rb�ln��"L� (degrees/minutes/seconds)
Address 'O L 12 t7$ Latitude/longitude source:❑GPS❑Topographic map
(check box)
rnitrnhr , (St Aetof Route No.) 2�qO� — DE DRILLIN OG
IV Zip Code From To Formation Desc iption
City &Town State p
A code.ode.Phone numbe /
4. DATE DRILLED - 7- — - r
5. TOTAL DEPTH: yD
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO 6L
7. STATIC WATER LEVEL Below Top of Casing: FT•
(Use"+"if Above Top of Casing)
g. TOP OF CASING IS FT.Above Land Surface*
*Top of casing terminated War below land surface requires a _
variance In accordance with 15A NCAC 2C.0118.
9. YIELD(gpm):_'5D METHOD OF TEST
10.WATER ZONES(depth): LOCATION SKETCFI
Amount Show direction and distance in miles from at Sast -,
1 I. DISINFECTION:Type two State Roads or County Roads. Include the toad
12. CASING: Wall Thickness -
Depth Diameter or�Wn�eig)h�tfFt. Material numbers and common road names.
P FI. ,5 tee[=-
From d Toq._ — - — -,
From To Ft.
From To Ft ?
13. GROUT: Depth Met ri / Method
From To Ft. o
14. SCREEN: Depth Diameter Slot Sin Material �»
Front To__Ft. in. in.
From To Ft. ir.. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONd
1 A NCAC 2C,WELL
CON ON STRUCTION STANDARDS,AND THAT A COPY , RECORD HAS BEEN PROS, I J TO THE WELLOWNER
F'
SIGNATURE OF PERS N CpNSTRUCrING THE WELL DATE
Submit (he original to the Division of Water Qualit ,GrilllndwId SCAlon,1636blall Se ce Center-Raleigh,NC
21699-1636 Phone No.[phone],within 30 days.
- '— � - OW-1 REV.07/2001

263004
WELL CONSTRUCTION REC0-R
North Carolina-Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section
11 _ CERTIFICATION 8 216E
WELL CONTRACTOR(INDIVIDUAL)NAME (y , l(print) All en (1�1`��`n - PHONE 8 rYl3t1 83�-1.q4�
WELL CONTRACTOR COMPANY NAM y
E 1 1 tl((P;( \lP\� \ ](\l�\ --------
STATE WELL CONSTRUCTION PEIN11T8 ASSOCIATED 1 Q PERMITBif 0 licablt
ife licablt
I. WELL USE(Check Applicable Box): Residential Municipal/Public[] Industrial ❑ Agricultural❑
Monitoring❑ Recovery [] Ileat Pump Water Injection❑ Other❑ If Other,List Use
2. WELL LOCATION: Tepographic/Land setting
Nearest'fown: s/ CountyL/l✓d -ems ElIddge []Slope ❑Valley ❑Flat
���/ / e S. (check appropriate box)
Latitude/lon itude of well location
(Street Name,Numbers,Community,Subdivtston,Lot No.,Ztp Code) g
/ �)1 eN eti e z (deertes/minutes/saends)
3. OWNER: //ar Latitudellongitude source:OGPS❑Topographic m?p
Address � 1 � (check box)
(Street or Route NO.) DEPTH DRILLING LOG
From To o7ationDescription
City or Town State Zip Code O /UCH - /t
Gv
Ares code.Phone number I S
4. DATE DRILLED --
5. TOTAL DEPTH:
6. DOES WELL REPLACE EXISTING WELL7 YES[] NO Ll'/'
7. STATIC WATER LEVEL Below Top of Cnsing:�FT•
(Use"+"I Above Top or Casing)
8. TOP OF CASING IS 7 FT,Above Land Surface*
•Top or tulnT terminated aUor below land aorrace requlres a
varl nice In accordance with ISA NCAC 2C.0118.
9. YIELD(gpm): /S METHOD OF TEST
10.WATER ZONES(depth): LOCATION SKETCH
�jj E Amount�_ Show direction and distance in miles from at least
11. DISINFECTION:Type Wall Thickness two Slate Roads or County Roads. Include the road
I2. CASING: numbers and common road names. o
Depth Diameter _e-, 21't. LL— i„
From Q To )�I FL 2_/�..L -
Frotn To Ft. — -
From To Ft. ! -
13. GROU,Tr�: Depth Material Method -- -,
From—
70
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material a
From To__Fl. ill• in. o
From To
Pt. ir.. in.
15. SAND/GRAVEL PACK:Depth Size Material
From To Ft.
From To Ft. ------
CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C.WELL
HEREBY CERTIFY I LL WA COPY OF THIS RECORD HAS BEEN PROVIDED 70 THE WELL OWNER
STRUCTION STANDARD THAT A C
SIGN kTUREOF PERSON CONSTRUCTING THE WELL UAIF
CR J `' 1 57ER SECTION
jgf.'t"'the7Afvlslon of Water Quality,Groundwater Section,1636 Mail Service Center
aW l Raleigh,
C
27699-1636 Phone No.[phone],within 30 days.

WELL CONSTRUCTION RECORD
2630ow
North Carolina-Department of Environment and Natural Resources-Division of Water Quality-Groundwater Sectio�ln/,^/�
CERTIFICATION/ 2Yla
WELL CONTRAC'!OR(INDIVIDUAL)NAME
�/(pdnQ� t
WELL CONTRACTOR COMPANY NAME ilk-17 A) e" TI'IIh� PIIONE g rswi43D�-----
-Y-957
A
STATE WELL CONSTRUCTION PERM SSOCIATED WQ PERMIT#lT# (if applicable) --
(if apPlicablc)I. WELL USE(Check Applicable Box): Residential 137/Municipal/Public❑ Industrial ❑ Agricultural U
Monitoring❑ Recovery ❑ Cleat Pump Water Injection❑ Other❑ If Other,List Use
2. WELL LOCATION: Topographic/Land setting
Nearesl'Cown: CountyLClfd Le- ❑Ridge ❑Slope ❑Valley []Flat
(check appropriate box)
• Latitudeflongitude of well location
(Street Neme�N rnbers,Community,Subdivision,Lot No.,Zip Code)
3. OWNER: 1f
' t utes/sccend+)
777U Latitude/longitude Source:❑GPSLTo pographic m?p
Address (check box)
1 (Strea(or Route No.) �3r'/ G DEPTH
pW LINQ OG
CnNrTwn '7rpD From Forman nDescriplion
Ci ar Town Slate Zip Code
(--)-
16)
Area code-Phone numbe,fT,,
4. DATE DRILLED
5. TOTAL DEPTH:
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO Ll�-
7. STATIC WATER LEVEL Below Top of Casing:__2L2__—FT.
(Use"+••if Above Top or Ca-cing)
S. TOP OF CASING IS __I_-_FT.Above Land Surface*
*Top of casing terminated•tier below lend surface requlrts a
variance In accordance with ISA NCAC 2C.0119.
9. YIELD(gpm):�-METHOD OF TESTA S R
10.WATER ZONES(depth): LOCATION ON SKETCH
Amount C Show direction and distance in miles from at least
11. DISINFECTION:Type Wail Thickness two Stale Roads or County Roads.Include the road
12. CASING: numbers and common road names.
Diameter or WeighUFL Material
Depth)V r Ft.�p,c.2,. 5 M2 ✓C,
From O - To !� -
From To _ Ft. ._..
From To Ft. -
13. GROUT: Depth Material Method
From To 90 r Fl.�
From To Ft- -
14. SCREEN: Depth Diameter Slot Sin Material
Front Tn__Ft. in. in. ca
From To Ft. iv. in. _ -
o -
15. SAND/GRAVEL PACK: a� -
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
1 DO HEREBY CERTIFY THAT THIS WELL W STRU
C KITH ISA NCAC 2C,WELL
CONSTRUCTION STANDARDS,AND THAT 1 OF THIS RECORD HAS B N OVIDED TO THE WELL OWNER
` SIGNATURE F PE SON CONSTRUCTINO T WE IL
DATE
GR0,�NFI'NP'I P StCTIO
163 Mall Service Center-Raleigh,NC
Submit the original to the Division of Wal udNf Caitfuhdwater-Sl#gx Af?r OW-1 REV.07I2001
27699-1636 Phone No.[phone],within 30 days,

WELL CONSTRUCTION RECORD . 263001
North Carolina-Department of Environment and Natural Resources-Division of Water Quality-Groundwater
T ION S2 Ntion Ir
WELL CONTRACTOR(INDIVIDUAL)NAME (print)
�/) (/ j2 �I / ��, 1*i') PRONE 0 tall$3-)-25S—t
WELL CONTRACTOR COMPANY NAME / it
if alicacableblc
ASSOCIATED WQ PERMIT#
STATE WELL CONSTRUCTIONON PERh11TN irapplicable)
"
1. WELL USE(Check Applicable Box): Residential Municipal/Public❑ Industrial❑ Agricultural❑
Monitoring❑ Recovery ❑ Heat pump Water Injection❑ Other❑ If Other,List Use
2. WELL LOCATION: I Topographic[Land setting
Neatest''own:
/'�n/Cv f C v/ County Pl��'P� ❑Ridge []Slope ❑Valley ❑Flat
/ ����� (check appropriate box)
(Street e,Numbeo,Community,Subdivision,Let No.,Zip Code) latitude/longittide of well location
3. OWNER: T' )� � Y (degrees mina es'sccond+)
Address 1 y "n cx -Awl)•) Latitude/longitude source:❑GPS❑Topog::phir rnap
(,�� (check box)
'(sv�eto Route No.) DE DRILLING LOG
3362
From To Formation Description
city or T wn Stale Zip Code 4 /
Ara code-Phone number ""`------
4. DATE DRILLEDr 1
5. TOTAL DEPTH:
6. DOES WELL REPLACE EXISTING WLLL7 YES❑ NO
7. STATIC WATER LEVEL Below Top of Casing:_20--FT•
// (Use,w,it-Above Top of Caring)
8. TOP OF CASING IS FT.Above Land Surface'
*Top of using ie^nin'ted atfor below lend surface requires a
variance In accordance with ISA NCAC 2C.01IS.
9. YIELD(gpm):_ —METHOD OF TEST
10.WATER ZONES(depth): LOCATION SKETCII
Amount e, Show direction and distance in miles from at least
11. DISINFECTION:Type�ll Wall Thickness two Stale Roads or County Roads.Include th;Aoad
12. CASING:
Depth Dire er or Weight/Ft. Material numbers and common road names.
From To /SD FL_ Q4
From To Ft I
From To FL
13. GROUT: Depth Ma7ri Method 7
From T°.�-Fl. d
From To Ft. CJ
14. SCREEN: Depth Diameter Slot Sim Material O
From To__Ft. in. in. rn
From To Ft.—;P. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
^
C1@ I WELL
DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTS FN ELM ?LL OWNER
CONSTRUCTION STAN S,AND THAT A COPY OF THIS
i
51GNATUIW OF PERSON CONS U IN WE -
L e Ce er-Ralelgh,NC
Submit the original to the Division of Water Quality,Grou dwaler 36 mall��eCF G -1 REV.07/2001
27699-1636 phone No.[phone],within 30 days. _a`"_-f 3

WELL CONSTRUCTION RECORD 263000
North Carolina-Department of Environment and Natural Resources-Division of Water Quality-Oroundwater Section /�
WELL CONTMCrOR(INDIVIDUAL)NAME (print
CERTIFICATION I�(i
WELL CONTRACTOR COMPANY NAME PHONE I
r It isr r (�P11 --�----
A
STATE WELL CONSTRUCTION PERMITI SSOCIATED WQ PERMITM(if applicable) —
(ifapplicablc) // -
1. WELL USE(Check Applicable Box): Residential W-emunicipal/Public❑ Industrial ❑ Agricultural❑
htonitoring❑ Recovery ❑ Heat Pump Water Injcction❑ Other❑ 1f Other,List Use
2. WELL LOCATI N: 1/ Topographic/Land Setting
Neav t'fown, /}�l _Countv�y^Pff�t� ❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
(Street Name,Numbers,Community,Subdmston,Lot No.,Ztp Code)
Latitudellongitude of well location
3. OWNER: �rs F-( �tA5 �1- L�� — (degrees/minutestseconds)
Address 7ZK4" DQK (a)n')(4 f1ceVic Lflutudeflongitudesomce:❑GPS❑Topographicmap
(check box)
t I n (Sn or Route No.) DEPIH DRILLING LOG
From To rm.tlon Description
City or Town State Zip Code O ` e
Ares code Phone numb5�
4. DATE DRILLED 7- -D a F*& /c/a
5. TOTAL DEPTH: / r
6. DOES WELL REPLACE EXISTING WELL? YES❑ NO 19--
7. STATIC WATER LEVEL Below Top of Casing:_6D FT.
(Use"+"it Above Top or Cssing)
8. TOP OF CASING IS I FF. Above Land Surface•
-Top of ruing terminaled■t/or below land surface
requires a
varianceIn accordancewith IS
9. YIELD(gp ): J4METHOD OF TESTAZ 10.WATER ZONES(depth): LOCATION 5KETCk1
Show direction and distance in miles from at least
I I. DISINFECTION:Type e W ll Thickns two Stale Roads or County Roads.Include the road
12. CASING: numbers and common road names.
Depth Diameter or Weight/Pl. Material
From b To Clc/` Ft.�
From To Ft.
From To Fl.
13. GROUT: Depth ate at Method
From_,2 To.,7FJ r Ft. -7
From To Ft. w
14. SCREEN: Depth Diarlieler Slot Size Material o
Front Tts__Ft. in.—in. rn -
From To Pl. ir.. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL
IT"
15ANCAC2C,WELL
CONSTRUCTION STANDARDS,AND THAT OF THIS RECORD HAS B OVIDED TO THE WELL OWNER
f�QV - 6 ? - 5-
SIGNATURE F PE SON CONSTRUCTING T WE L DATE
R NDWgqTER SE TIO�aa 163 Mall Service Center-Raleigh,NC
Submit the original to the Division of Wal Qugyl� gQDR2�l®4BAL fg2Nt G5y-1 REV.0712001
27699-1636 Phone No.[phone],within hTaP.

W1 LL CONSTRUCTION RECORD 262999
North Carolina-Department of Environment and Natural Resources-Division ofWater Quality-Groundwater
S Mft�-n
WELL CONTRACTOR(INDIVIDUAL)NAME (print)1
WELL CONTRACTOR COMPANY NAME ' I/' 4 P)IONE 8 fila d3a-2M
ASSOCIATED WQ PERMITM
STATE WELL CONSTRUCTION PERMITS ita Rcable
ira licable
1. WELL USE(Check Applicable Box): Residential MunicipaVl'ublic[I Industrial ❑ Agricultural O
Monitoring❑ Recovery O Heat Pump Water Injection❑ Other O If Other,List Use
2. WELL LOCATIOb: ( Topogrnphic/Landsetting
Nearest'To V N f uJ S County // l6 eQ ORidge CISIOpe ❑Valley []Flat
(check appropriate box)
Latitude/lon itude of well location
(Street Name,Numb t omm m , ubdivisinon,Lot No.,Zip Code) g
'bey 1 1 0 T — (degrea/minutexrsrendr)
3. OWNER:
Address � " LD LatitudcAongitude sousce:OGPS0Topograplric map
(check box)
y� (Sueet or RouteNo.) 2�aO1 IEPIH [ZI Dl LING LOG
f1 `l10)`� Z� Die From To Forn at• n Description
City or Town State 0 — 1 el
Arta code-rhone number
4. DATE DRILLED �/� -
5. TOTAL DEPTH:'Z
6. DOES WELL REPLACE EXISTING WL'LL'1 YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: _Fr.
(Use"+,,it Above Top or Casing)
8. TOP OF CASING IS FT•Above Land Surface*
*Top of cuing terrni^ated atlor below land surface requires a
variance In rccorda_�ncceQ,I(h ISA NCAC IC.0118-
9. YIELD(gpm): 1-2 METI OODS)F TEST i r
10.WATER ZONES(depth): s� LOCATION N SKETCIL
Q Show direction and distance in miles from at least
It. DISINFECTION:Type ount y all thickness two State Roads or County Roads.Include the road
12. CASING:
Depth Diameter oS,Wei gld/('t• Material numbers and common roadnames. �
from � To�Ft.---"
rat _— - ,
From To _ Ft. -i -
From To Ft. -
13. GROUT: Depthh,..,, ``''�� Material Method y t
From
From To Ft. -'� -
14. SCREEN: Depth Diameter Slot Sin Material
w
Front Tn_—FI. in. in. o
From To Ft ir.. in. --
15. SAND/GRAVEL PACK:Depth Size Material
From To Ft.
From To Ft.
DlAtHAW
THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTS,AN IAT A COPY OF THIS RE RD HAS BEEN PROVIDED TOT WELL OWNER
N0V
SIGNATURE OF PERSON CONSTRUCTING THE WELL ATE
RRQUNni,NyIvlsion of Water Quality,Groundwater Section,1636 Mall Service Cenler-Raleigh,NC
ASHE4'�[nl OW-1 REV.07/2001
2f - 3.3221,within 30 days.

WELL CONSTRUCTION-RECORD 262998
North Carolina-Department of Environment and No ral Resources-Division of Water Quality-Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAME (print) /eu­rtl Ae_ec-e— CERTIFICATION Isaqr7 3
WELL CONTRACTOR COMPANY NAME
j,/er l f Qi-011no PHONE # (�P)837 Z957
ASSOCIA D WQ PERMIT#
STATE WELL CONSTRUCTION PERMIT# (if applicable) —
(if applicable) �-
1. WELL USE(Check Applicable Box): Residential 9- Municipal/Public❑ Industrial ❑ Agricultural❑
Monitoring❑ Recovery ❑ Ifeat Pump Water Injection❑ Other❑ If Other,List Use
2. WELL LOCATION: Topographic/Land settiog
Nearest'Cowtf:
�j���ewS County �¢/°,fee ❑Ridge ❑Slope []Valley ❑Flat
r� �f�� iQ VI 0 (check appropriate box)
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code)
Latitude/longitude of well location
3. OWNER: ©ebP`v /6 w inuteahecend+)
Address Pb Igo-) Latitude/longitude
soursource:❑GPS❑Topographic m?p
(check box)
(street or Route No.) Z$c,p( DE DRILLING LOG
Formation Description
Ciry or Town stale Zip Cade From To
Atrai
(� v — i e�
DATE DRILLED
code-Phone number 1� _ O L) / �,e rf4a 2.
4: DATE 9- °Y� °y
5. TOTAL DEPTH: 300
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO Q--
7. STATIC WATER LEVEL Below Top of Casing:_/() _FP.
(Use,,+,,it Above Top of Casing)
8. TOP OF CASING IS 6� FT. Above Land Surface*
'Top of casing terminated Wor below land surface requires a
vsrisnce in accordance with ISA NCAC 2C.0118.
9. YIELD(gpm): C o METHOD OF TEST/92/'
10.WATER ZONES(depth): z 5 b LOCATION ATION SKETCH
11. DISINFECTION:Type h T f Amount c Show direction and distance in miles from at least
Wall Thickness two State Roads or County Roads.Include the road
12. CASING: numbers and common road names.
De th Di eler or Weight/FI. Material
From
From To-z-L-Ft. _
From To Ft. o
13. GROUT: Depth etytal Method -
Dif/v2�
Fto inQ_To ?-/ Ft. -
From To Fl- i -
14. SCREEN: Depth Diameter Slot Size Material -
From To__Ft. in. in.
From To Cl. in. in. -
15. SAND/GRAVEL PACK: w
Depth Size Material o
From To Ft, rn
From To Ft.
16. REMARKS:
ANCE WITH 15A NCAC 2C,WELL
I DO HEREBY CERTIFY THAT THIS I EEN PROVIDED TO THE WELL OWNER
CONSTRUCTION TAND S,AND A COPY O F THIS RE CO
SIGN TU OF PERSON CONSTRU NO IB WELL DATE
CROU��Dh + � i �CiION
Submit (be original to the Division f w5mou"Hij,GfoW[dwite€Sect on,1636 Mall Service Ceenter'REVg R . 0712001
27699-1636 Phone No.[phone],within 30 days.

WELL CONSTRUCTION REC"ORR 262997
North Carolina-Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section r-
WELL CONTRACTOR(INDIVIDUAL)NAME (print)_ :
__0C 2 w `SOh CERTIFICATION sa l�,
WELL CONTRACTOR COMPANY NAME
n'lt . II �' Il`✓1Q PRONE Nf42Y153-L 249�
STATE WELL CONSTRUCTION PEINIIT# ASSOCIATED WQ PERMIT#
(if applicable) _ (ifepplicable) —
I. WELL USE(Check Applicable Box): Residential 0/flunicipal/Public ❑ Industrial ❑ Agricultural❑
Monitoring❑ Recovery ❑ Heat Pump Water Injection❑ Other❑ If Other,List Use
2. WELL LOCATION: I (1v, Topographic/Land setting
Nearest Town: —Count�NpCANQR ❑Ridge ustr a ❑Valley ❑Flat
(check appropriate box)
LalitudeAongitude of well location
(Street Nam ,Numbers,Community,Subdivision,tot No.,Zip Code)
3. OWNER: t
n nA 1 EP (degrees/minutdsccends)
LrC�st
Address r' '��� I "� tom — Latitude/longitude source:❑GPS❑Topographic map
Sheet or Route No.) (check box)
( �� O DE DRILLING LOG
From To on Cation Description
PTH
City r7o � State Zip Code I�—
Area code-Phone numbe
4. DATE DRILLED
5. TOTAL DEPTH: l
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO 0—
7. STATIC WATER LEVEL Below Top of Casing: "I O, FT.
(Use"+"if Above Top of Casing)
8. TOP OF CASING IS , FT. Above Land Surface*
*Top of cuing terminated atlor below land surface requires a —
variance In accordance with ISA NCAC IC.0118' ,
9. YIELD(gpm):�r —METHOD OF TEST iJ 1 R —
10.WATER ZONES(depth): LOCATION SKETCH
Amount S Show direction and distance in miles from at least
11. DISINFECTION:Type Well Thickness two State Roads or County Roads.Include the road
12. CASING: numbers and common road names.
Depth Diameter or Wei t/Fl. Material
t Ft. 1
From ® To�_ /.,
From To _ Ft.
From To FL
Mate '}I Method o
13. GROUT: Depth (�
From 9 Te �® f Fl. -' ----'
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material t
Front To—._Ft. in. in. -
From Tv Ft.—'P. in.
15. SAND/GRAVEL PACK:
Depth Size Material .. -
From To Ft. o =
Ft. m
From TD —
16. REMARKS: #OPY
1 DO HEREBY CERTIFY THAT THIS WE
CE WITH 15A NCAC 2C,WELL
CONSTRUCTION STANDARDS,AND T OF THIS RECORD N PROVIDED TO THE WELL OWNER
i�-OV
bjU,jAlJREO PERSON CONSTRUCTIN T WELL DATE
g FjBQf� 't �p€etlo ,1636 Mall Service Cenler-Raleigh,NC
Submit the origins N lv the 331-32on w Yale br tv��h OW-1 REV.07/2001
276g9-16J6 Phone No.(919)7JJ-J2I1,wl

262996
WELL CONSTRUCTION RECORD
North Carolina-Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section '
WELL CONTRACTOR(INDIVIDUAL)NAME (Print) 1''^^np� ,\ �A�tI Sr�CI CERTIFICATION Ita���
WELL CONTRACTOR COMPANY NAME �\ PHONE / O`63�-24i"7
STATE WELL CONSTRUCTION PERMITg ASSOCIATED W PERMITM
(if applicable) (if applicable) _
I. WELL USE(Check Applicable Box): Residential[11�-Municipal/Public❑ Industrial ❑ Agricultural❑
Monitoring❑ Recovery ❑ heat Pump Water Injection❑ Other❑ If Other,List Uae
2. WELL LOCATION: / Topographic/L.and setting
eBrest'Cown: DiiLCaunty( 6lnkEF ❑Ridge ❑Slope ❑Valley ❑Flat
0 el Y \ (check appropriate box)
(Street Name,Numbe�rrss.Community,Subdi ision,Lot No.�,Zip Code) Latitude/longitude of well location
3. OWNER: '� rf-fy ("0f (degrees/minutes/seconds)
Address d k .2 Latitudellongitude source:❑GPS❑Topographic m?p
we (check boa)
&�
�(sueetorRo �) — DEPTH pRILLINGLOG
L! A H
Zip Code From To Fom lion Description
City or Town State
U-
Area code-Phone numbg
4. DATE DRILLED 7- D.3—02
5. TOTAL DEPTH: aD A-I
6. DOES WELL REPLACE EXISTING WELL? YESaD NO FO
7. STATIC WATER LEVEL Below Top of Casing:
T.
(Use-+,,it Above Top or cuing)
8. TOP OF CASING IS _FT. Above Land Surface•
*Top of cuing terminated War below land surface requires a
variance In accordance with ISA NCAC 2C.0118. �p p
9. YIELD(gpm):�—METHOD OF TEST Oiir(!
10.WATER ZONES(depth): LOCATION SKETC H
11. DISINFECTION:Type Amount Show direction and distance in miles from at least
12. CASING:
Wall Thickness two Stale Roads or County Roads. Include the road
Depth. , Diameter orWe'tg1�VFt. Material numbers and common road names.
Front_____TD/5 3 FL r
From To Ft.
From To Ft.
13. GROUT: Depth r Metc Method
From-�_To n�/� Ft. -
From To Fl.
14. SCREEN: Depot Dimneter Slot Size Material -
Front Tr.__Ft. in. in. -'
From To Pt. ir.. in.
15. SAND/GRAVEL PACK:
Depth Size Material -.J -
From To Ft. _..:
From To - Ft.
CD _
16. REMARKS:
S
1 DO HEREBY CERTIFY THAT THIS WE CE i SA NCAC 2C,WELL
CONS UCTION STANDARDS,AND TF OPY OF THIS RECORD EN PROVIDED TO THE WELL OWNER
3 -
SIGNA RE O PERSON CONSTRUCTIN TH WELL DATB
Submit the original to the Division or vale pttddr� S� t�y" �etlo ,1636 Mall service Center-Raleigh,NC
g Cr!tYF l �1"�fKl GW-1 REV.07/2001
27699-1636 Phone No.[phone],wl

262995
WELL CONSTRUCTION RE-CORD
North Carolina-Department of Environment and No ral Resources-Division or Water Quality-Groundwater Section 3'
�Q/Y//
WELL CONTMCTOR(INDIVIDUAL)NAME (prinQ �/�/ —^�—
CERTIFICATION P
WELL CONTMCTORCODIPANYNAMEllPl 00 21i Vrll�l D PIIONE / (P�6'1 ���"'ZfS7
STATE WELL CONSTRUCTION PERMITO ASSOCIATED WQ PERMITN
(if applicable) (if applicable)
1. WELL USE(Check Applicable Box): Residential R'MunicipalfPublic❑ Industrial❑ Ag Itur I a,
Monitoring❑ Recovery ❑ Ileat Pump Water Injection D Other El If Other,List Use f�
2. WELL LOCATION: Topographicd=d setting
� v3 - County C4-a,�c e ❑Ridge OSlope ❑Valley OFlat
Nearest'Cown: iC�_ (check appropriate box)
( tYp(�nv1 =11� �cre1
Latitude/longitude of well location
(Street Name,Numbers,Community,Subdtvrmon,Lot No.,Zip Code)/
3. OWNER: G/�U/S/ s4� %�e� e nt4� L/�y (degrees/minuterlseconda)
Address I Latitudellongitude source:DGPSOTopograpllic map
(chec)c box)
rV ,c(Su54tQr�outeNo.) 16nQ\ DEPTH DRILLINGLOG
t tt r u ra at� �\� xL Y From To Formation Description
City or Town State Zip Code
�4
Area code-phone number //
4. DATE DRILLED �/ _03-0 Z'
5. TOTAL DEPTH: S✓V�
6. DOES WELL REPLACE EXISTING WELL7 YES D NO
7. STATIC WATER LEVEL Belo (use Top o'asingr Above np/" Fof T
8. TOP OF CASING IS Z FT. Above Land Surface*
*Top or cuing terminated at/or below land surface requires a
variance In accordance with ISA NCAC 2C.01111.
9. YIELD(gpm):�—METHOD OF TEST 'S
10.WATER ZONES(depth): �f L LOCATION SKETCH
11. DISINFECTION:Type Amount [ Show direction and distance in miles from at least
Wall Thi ckness two Stale Roads or County Roads.Include the road
12. CASING:
r WpetUFt. Material numbers and common road names.
Depth Diameter o
From D To le6 Ft. C'�S
From To Ft. o
I
From To Ft.
13. GROUT: Depth aten ).d ethod ,:�
`ir�0•e
Frotn�_To 1(f6 Ft. 41 I - -
Front To Fl.
14. SCREEN: Depth Diameter Slot Size Material
Front To_.—Fl. in. in. -- --
From To FL In, in. w
15. SAND/GRAVEL PACK: a
Depth Size Material rn
From To Ft.
From To FI•
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WE S I�ONS7'R D 1�4�AG'0 ICE WITH 15A NCAC 2C,WELL
CONSTRUCTION STANDARDS,AND TH F7Tit5�£261 B N PROVIDED TO THE WELL OWNER
� I,, "O2-
SIUNA PERSON CONSTRUCfINQ'T LL DATE
Submit the original to(he Division of oter QuoTlly,Grgpfudtr t[tr St ction�1636 Mail Service Center REV.07/2001
27699-1636 Phone No.[phone],wlt(Iirk,10 ays.

ti.
260204
WELL CONSTRUCTION RECORD
Not Ill Camlioa - Ikil:nln lent of Luvironment and Natural It esources- Division of N'ater Quality-Groundwater Section
C�
%%I I.I.('ON i IIAI I Olt(IN nI VI n It A 1.)NANI/F, prinl) yl_M��/ c.JLlMC'...�/_ _._— CER'rl FICCAr�TIIONR
it I(1.1.1 ON'I It V I Olt COMPANY NANI F;S�J�rC2L"Lf:_—LLJ/�.1.�-_� 1'.L in; PIrorve a
SI A 11,WELL('ON'S'I RUCI ION PF.RMI'I'q —ASSOCIATED\VO PERN I1H
lit applicable) (if applicable)
I. W'H I. USF.(Check Applicable Box): Residential M Alunicipal/Pulalic ❑ Industrial ❑ Agricultural ❑
Monilorinc ❑ Rc o%cry ❑ I lead Pony Water Injeclion❑ Other ❑ If Other, List Use
2 WHA, I OC•AI ION: JJ 1 C,Topographic/L surd setting
Nearest limit �1uk``� CulmtY_Cf4L ' -L"� fudge ❑Slope ❑Valley OHM
(checkappmprime hoe)
ICwal Nauv.Nu 11".".('nmin.m ity.Subdirisin//n,[-,it No.,Zip Code) Lahlud C/longitude of well location
}. O\\'P11R'. '�l�E•�N I1Z22 T'S_ _,____ Ideg¢eshninums/s<cnndsl
_- L..atiludc/loogitudc sotlrcc:❑GPsoropographic neap
(shed nl It, c NuJ (check hoe)
PP 14 � L �/C� ) - UI_I'IIl DRILLING LOG
( ly of dale zip Cade I rural "rn Formation Desvi tiarl
d. U/\'I"I'. DItILLIiU_
6. DOIfS \Vtil.l. RIIPI.ACI'. CKISI'ING WI:Lh7 YESl❑ NO ❑
7. S I'A-I IC WA"IIT LEVEL Bclow l'ol,of casing:
II (Use"+"if Above Top of Casinpl
3. 'I(W 017 CASING IS__l.__171 Above Laud Surface' — -
•1 isp or rasing lei ndualcd al/or below laud arrface requires a -----'- -
rvohoee in arcardxnee oilh lSA NCAC 2C.nI IS. �� --
o. 111!I.D(LgnnP. �..,�2__ NIF. ]IODOI "IISr _'{l
III. WA I IT ZONCS(depth): _ (1) 0 1�
LOCA-IION SKErCl1 n
11. DISINFECIION'. "frpe_/ Amount=�G�J_ Show direction and distance in miles fromEiAACIst
12. CASING: Wall I-hichim two Slack Roads or County Roads. Include qc road.-
Dcpol D'amcler or Weight/H. Material to mbers and common road names. ti -
I mill �� -Ib_� Pt.�j _ � 11 -��L
w
I-rom .1,0 -
Itom
IJ. 61MI11 - �� Ut pIL atcrial _ MJhod r� _-
I I. S(TFTN: Drldh Diameter 1 lilt Size El;dcl ial
tool._.. _ .. to ILL ill. in.
19nn1 _ 1t,
15. SANDIGRAV1;l, I'AC1,_
Ucpth Sim MalcriM
Ills❑ _ rll___.___ II.__ __
I7nm
16 RI (ARKS:
L. D I ) I lili IS WCII.WAS C•ONSTRIIC"IVD IN ACC'OROANCI:Willi 15A NCAC 2C.WELL.
RUCI ION SI-ANDAIt S, I)11IA'I'A COI'Y OF'I1115 RE • IIAS BEEN I'ROVIUF.0 l O II IB W 'LL OWNER
- - �� 99ov
tit( NAIlIItI;lJr PERSON CUNSIR Cr (" III:\VLI.I
SulORiLU'L VhtAi��•1��1'ild Nmvisio I of Water Quality,Grouudwal I. lion, 161E Mail Service Center-Raleigh,NC
CC N A
299 '�' � F L' )711J221,w'i(hin 30 days, GW-I REV. 07/2001

WELL CONSTRUCTTON RECORD 260203
North Carolina-Department of Environment and Natural Resoure J Division of Water Quality-Groundwater Section
/7$
WELL CONTRACTOR(INDIVIDUAL)NAM�iEE(rprrt�nt)�1�?N� �b •�1 rLL IQ MR CERT®IGTION e
WELL CONTRACTOR COMPANY NAME d")'rl 1c-S W C'-_LLL J[<(L.L- I 1'e PHONE # Z225 795-2/66
STATE WELL CONSTRUCTION PERMIT* ASSOCIATED WQ PERMTT0
(if applicable) !/ (ifepplicable �
1. WELL USE(Check Applicable Box):Residential iQ Municipal/Publie 0 Industrial ❑ Agricultural❑
Monitoring❑ Recovery ❑ Heat Pump Water Ejection❑ Other O If Other,List Use
2. WELL LOCATION: Topographic/Land Setting
Nearest Town: OAL,a'PA_CountyC—W=O�W� DRidge bSlope OValley OFlat
,kilrimiq Calf- L217 /13T ! 1 (check appropriate box)
(Street Namc, tubers,Community,Subdivision,Lot No.,7.ip Code) Latitutie(longitdde of well location
3. OWNER:Dot4"1 t N i l�'1_w (degntrJm awes seconds} —
Address Latitudenongltude source:OGPSQTopographic map
(Street or Route Na J (check hox)
DEPTH DRILLING LOG
ty or Towo State Zip Code From To Formation Description
3� S:— L7-2& -rod
Aran code.Phnae number .
4. DATE DRILLED 9"/9-Q Z
5, TOTAL DEPTH:
6. DOES WELL REPLACE EXISTING WELL? YES D NO
7. STATIC WATER LEVEL Below Top ofCasing:. ,(Q L—JT.
/ (Uac'+"If Above Top ofCasins) N
g. TOP OF CASING IS 2. FT.Above Land Surface"
'Top u(cm1n&terminated allur below Ind surface requires;
varf anee In accordaace with 15A NCAC 2C.01M.
9. YIELD(gpm): .!r METHOD OF TEST
10.WATER ZONES(depth): 0 ' PG'JrLJ .31-Y 3(;PX I OCATION SKETCH =_
11. DISINFECTION:Type Amount - Show direction and distance in miles from afleast
12. CASING: Wall Thiclenefs two State Roads or County Roads,Inoltgie 6 erdad
Depth r or wei t/Ft. mte?lnumbers and common road names.Fro To Ft. ' -74 c
From,./,-_To Ft..6
From To_,FL
13. GROUT. Depth
Material M2 d ' ii
Frc- Z�To FS_� Kd
1• 0• `-=a
From To Ft. Ln
14. SCREEN: Depth Diameter Slot Siw Material ul
From, To_Ft�in. in. jp'f 1 �J2 /sir
Fronk< To Ft.4w—jn. in. QOF
15. SAND/GRAVEL PACK:
Depth Size Material Kl N N is"
From To Ft.
Fro❑t,- _Tc Ft.
16. REMARKS:
T1FY THAT THIS WELL WAS CONSTRUCTED 1N ACCORDANCE WITH 15A NCAC 2C,WELL
QO TANDARDS THA A CO Y OF THIS RECORD HAS SEEN PROVIDED TO TIM WELL OWNER
J Ll ' C7
SICFNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit th origl ial to the Division of Water Quality,Groundwater Section,1636 Moil Service Center-Raleigh,NC
bone No.[phone],Within 30 days, GW-1 REV. 0712001
GROUND!MATE S_C110N
ASHEVILLE REG!01'eAL OFFICE

>r
WELL CONSTRUCTION RECORD 25996 1
Not I It Caro Ima - Delmot lend of Environment and Natural Resources- Div ision of Wader Qualify-Groundwater Section
ss Pa I. 11M 10R IINnIs'IDUAL),NANIF_Jer�inl) �2_L�r �—_ CJ�"� 1.--- — CERI'MCA7lON o
sa ra.L(oN nt.0 luRfunlrnrvv Nnnn �.LIC�Kt�I -' LL` _ i.j.l�'r` --ruorw # F��z-7-5mg
s In I r:cello.(o,�s I RucrloN relrnlrra AssoCIA I ED cvQ reunlrra e�
(it as licrblc) (it a1dicah1c
I. \\'E.I.I. USE. (Check Applicable Box) Resi(Ieutial Municipal/Public ❑ Induslrild ❑ Agricultural ❑
Nouiloring ❑ Recovery ❑ licit 11unip Water lajeclion❑ Ofher❑ IMiller, List Use
2. %\11:1 L LOCA I ION: / -I-opogta tic/Land selling
fJrn cst'fmvlr. _ /_ 1(4 �\ Countyc lPo _ ❑Ridge e ❑Valley ❑Flat -
I checkxppropriale hov)
ISnccl N: nc.r)nnihc,,,('mnmonity.subdivision,Lot No.,Zip Ct c) Lalllude/longitudc Of WCII location
1, O\\'NPR:__ >'/(AJH' ��f�rU/4.,J j,JL=.� --IJegrecshninxles/seconds)
laliluddlongiludc source:❑(il'S❑Topographic map
11 cl or It ule o.) (check hoa)
DITIII DRILLING LOG
t I gor t„"�� sl:llc Zipc,xle From o�( y Formation Description
95�1)-_ =---,'I D / J J� � ' C � �\f
Aiea code- Thane nu...he, 1_,.f._( f/)
d, UAII. DRILLED_ -
S. TOTAL Dlil'IlI:__- -
6. DOGS WELL REPLACE GXISIING WELL? YES ❑ NO ❑"-
7. S I A I W WA'l FR I.EVEI.llcluvv Top of Casing: -
(Ilse"r"if Above Tap of Casing)
3. 'I O1, 01: CASING IS -j FI. Above Land Surface' ---
I op ur caning tennlnnlcd PI/or Irelnw land snrrace requires a --"—
carlaure In aco,nlxncc old, 15A NCAC 1C.01III.
4. YIIiI.D (gpm): -_1___- METI1OD OF TESTS-
10. %VAI F.R LONGS (dcplli):�a ___-- ----LOCATION SKETCH
I I. DISINI�P('II(IN: 'I ypq_ 1! i /-�mnwd_j_- Ci� Show dilcction and distance in miles from of least
I'_. CHINO: Will']Ilichicss tNvo State Roads or County Roads. Include the mad
DePlh pp Di•nleler or WeighUPL Material numbers and common road names.
Pnnu__U-_ It'd�T F1-M7r-
I rom To 1:1. _ __—.—
from---..—_ I° ---_----
13. (TROUT Dtplh Material Metlu,rl Q
I
� r _
11 SI RI I.N. Dcplh Divncler L 4.I41 Sizc Mnlcrinl -
I will I o------ I L---nt. --- ul. --------
From_.- -- Io. . . ".__.. II. -_in. _ in. ------ --.
IS SANIMMAVFt. I'M K. -
Doplh SI]C Material
CD
_
WLL
REGIOS
AI 1 SD'I I IA1 A COI Y OFl�IIS RECORD IIAS 113EENI11ROVIIDEDTO'I 1E WELL OWNER
N --_-S iNAlllltl'.OF I'F.RS fIiUC1I II'. DATE.FICE
Submit the ariginol In the Division of Water Qunfity,Gruun(hvater Section, 1636 plotl Scrvice Center-Raleigh,NC
2710)9.1616 rhmtr No.('ll'))733-3721, within 30 Jars. G W-I REV. 07/2001

259962
WELL CONSTRUCTION RECORD
North Co olina - Ocp;u hneol of Environment and Natural Resources- Division of Water Quality-Groundwater Section
„V;I.L(ONI u m-loll(INOIVIDUAI,)NAME ( tint) 1�IM ) -�y71Ve CF.RTIFICATIONV;665 -
w'F.I LI'o�IItA('T011('ONII'AN% NAME_ ruonea (t��'1
si,Alt.w'I:LL('ONSIIMCIION PF.RMI'IN __ASSOCIATED%%'Q PF.RMITN
lif•q,pliadtic) (irapplicable)
I. (VIILI, l ISl? IChcck Applicable Eoz): Itcsidenlial Ud' Municipal/Public ❑ Industrial ❑ Agricultural ❑
Nlonitnring ❑ Recovery ❑ I lea( Pump Water Injection ❑ Othcr❑ If Olhcr, Lisl Use
WFIA, LOC'A I ION: Topographic/Land setting
Nearest Towu: _ I-N�� —_County aep—ok'QC etidge ❑Slope Malley Mat
(check.ippotplialchoe)
1::n rrl Nan¢,N...f�.it ."Cmnn.....[.-w`i ily.S'ubdivision,Lol No.,Zip Codc) I.aliludc/longitude of well location
{, (1WN1:R: 7�.�j y t�. AA?)S LI
• Idrg.ecs/nlinnles/<ecands)
tIdlccS f=• 0 ,_ _,PC 'k' /7o y Lalimderlongitndc sourcc:acrso'fupographic oral
(Sheet or Route No.) (check box)
NC �S -- Dlil_I'll DRILLING LOG
01, or Io, t stair Zip Code Prom 'fu Fn matiun Description
area ondc- I'hnnc nnmhcr 1j _—iG-u-'—
6. DOIfS W'ISLL 12111'LACE EXISI'ING WELL'! YES ❑ NO LT— _
7. STAIIC WATER LliVla,UcIow1-op ofCasiog: I'l'.
(lice'•r"if Ahnve Top of Casing)
R. '1 )I' OF CASING IS _ FF. Above Land Surface"
I op of unlng Irmo honied am.,Lelnx Imd surface regnlrtf• -
enrianrr In acun'd al ce xilh ISA NCAC 2C.nl Ia. -- -
'!. 1'11i1.0 Igpnq: _ NlI4IIIOO OF'I'I;S"I'�
1II. %VA1I;. ZONIiS(r cptlQ: a b —
LOCA-I"ION SKETCH
I I. I)ISINII{('I ION. hype _ Amount__��tJ�.J Slow direction and distance in miles frmn at (cast
12. CASIN(i: WalI'f[lick uess two Slate Roads or County Roads, include the road
Dcpth Dl 11 11 r or liVeiigld/H. h1 tint numbers and common road names.
Iloill to
Ilion 1° - ------ 11' -- —_..-----
I i. ( ROU 1 , Depth NlolcriA hlethttd
non _. I-ti V,o It. — '---- C
J
I.1. S( lit F.N: DCplh Diameter Slot Si>c Nlalclial
Ilnm _.__. I'o-_--___ 11. ill. _— In. _— — -_--
IS. SANIPGRAVPI, PA( K: _
I)rplh Sizc Mnlcrinl --� ,N;l
llool Ft
I DO I It:R :111' CIiR111.1 I 1111S W1111 WAS CONSTRUC I FD IN ACCORDANCE Wllll ISA NCAC 2C,WELL
I Itih911(AAI„�I AN I I ,AND"I11AF A COPY OF'1111S RECORD HAS BEEN I'ROVIOfI)10"Il1E WELL OWNER
LLUUUU
GROUNDWATER- WATER SECTION IG RI-� SNAIU ' I.OFPERSONCONSI C'fI OTIIF.WEI-I, DA'IE
ASHEVILLE REGIONAL OFFICE
11 rnu ,e I vision of Water Quality,Cruuudwnler Section, 1636 Nlail Seri ice Center-Raleigh,NC
276'19-1616 Phm,r No.('W)) 733-3221,within 30 dacs. OW-1 REV.0712001

25sss
WELL CONSTRUCTION RECORD
Nrnlh(;vulina - Dcp;un licit of Environment and Natural Resources- Div is ion of Water Quality-Groundwater Sect-i-onn[��r
v%V I.[.( ON I RM I I III TIN U 1 VIDU A(.)NAME rhrll_—:�i-^"r-'C� ��1C-�5 1--- CERI"IFIC�A.1TIION/�J-p
UEI L(ON lI2AC Olt('ONIPAM'N A A I E. (1�70 )� I ) `L _PHONE a
SI,\II:\N t:l.L IONS I R IVI ION PE14NI11-0 _ASSOCIA'I Ell wQ PERMI'U# _
1ifa ,Iic.Iblc) (if applicable)
I. WIA1. USE (Check Applicable Box): Residential ® Municipal/Public ❑ In(lustrial ❑ Agricultural ❑
Mouiloriog ❑ Recovery ❑ Heal Pump Water Injection❑ 0I11e1'❑ If OIIIcr, List Usc
W ITI. LOCATION: JOpogrfilfic/Land setting
Nc:uesl Im%ll �7i112 It- _County0lQ6'<JLQ_ 0�iJge ❑Slope ❑Valley ❑Flat
_CLLij___L.'v _I��_1�Q�-_____ (chttk npproprinle f•asl
C9lllel N:nna.N....l"<.('..inn umily.Sohdivi,o, ,Lu1 No..zip Code) 1,atitode/longitodc of well location
{. (1\CNI'Id:-_.—./-/i2(�/L ( C y')� W/LQ Cif_I Idcgrccslminnlcahecondc)
= c<—ti���� 11J Lalitudcllaugiludc source:06,11S❑Topographic map
ISoccl w Iroule Nor (check bu.a)
t _ Dlil'lll DRILLING LOG
loud - -smle zip Code Drum 'Io Formation Description
d. I)A 117 DRILLED__
s. 1OTALDE1''I -
6. DOES WELL RFITAC'E' EXIS-1ING WELL? YES ❑ NO Er ----
7. STATIC "'A I IT LEVEL Below Top of Casing: 1',2D _I''I'. --
(Use"+"if Above Top of C'arlog)
R. TOT' OF CASING IS- FT. Above Land Surl'acce -
''I Op Or a350,g Ier Ill ill Melt aUor h ell)w land rar6ce regnlrer a ----
varlanrc hr arnudaa e Hill, I5A NCAC 2C.III IA. ---- --
9. YBt1,D Igpnp: METHOD H��O� D Or I i:Sf —
IU \VAI171Z ZONFS(depIll): � 7" 2 I -
L.00A1lON SKEI Cll
I I. DISINI 1:(*11ON: 'I vpe_ Z2 Z �/ Amount ✓/-) Show direction and distance in miles from at least
12. CASING: Wall Thickness two SLUG Roads or County Roads. Include the road
Dcpol DJ'au�lcler or Weight/Ft. Material numbers and common road names.
Ilonl O_11(L .212_ PLLn %- __�L�'l I-tZ✓ �-
I rim_- I o_ —
I I GROU I' Uy lh hnlenal Method
Ilom �� l u �."_ LI _ 1Li✓ _ _--
Id_ S( PH N: U(l Ih Ui:uncler Slot Size Mulerial -
Ilom____-_-_. to I L _in. in. -_._ _-_. r --.
Ilom -_-
I5, SAND%GRAVI'I. PAC'Ki -_
Depih Sizc MaterialIloill
v
L
from_.___._.
El T IIS WELL WAS CONS-1RUCI ED IN ACCORDANCE WI Il I I SA NCAC 2C,WELL
CONS IIU IC 1 ION S I ANDA ). , NU"II IAT A COPY OF TI[IS RECORD I[AS BEFN PROVIDED OTHE WELL OWNER
SEP 1 9 2002
---- ----- - -- ---- - -- ti GNATUItIiOPI'ER . )NS NG-1HE Vt?Iil DATE
GRROQNDWATER SECTION
pS9f1uAwAlcia NA10Ffl�EDieis on of Walcr Qua 1 y,Groun( water Section, 16l6 plait Service Center-Raleigh,NC
ea'LIhH I'honc No.l'119)7!]-}221,wiWin 30 d:ps, GW-I RFV. 07/2001

WELL CONSTRUCTION RECORD 259678
Not lh('oralIoa - Ocpm(I')cut Of Environment and Natural Resources- Division of Water Quality-Groundwater Section
»BI.L(ON IR A('10 It(IN DI VIDUAL)NAME (pr(np �1 -)1')'ty �� p -- CERVFICpATTIIONN p Q
w EI.L CONOLAV"I.OR(OMPANY NAME��Q� �L" _J ` -[�I '1C PHONE N rv.iu)S3� O�U
S"I A 11.wELL CONS IRUC'T ION PERM I1N ASSOCIATED%VQ PERMITN
Iifapplicable) (Ifapplicablc) _
I. WFLL USE (('heck Applicable flux): Residential M- Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monil )l ing ❑ Recovery ❑ (teal Pump Water Injection❑ Other❑ If Other, List Use
2. \VIdA. LOC'AIION: 11 � ropograNhic/Land setting
Nearest Town:_LMt4R�)'t_ Coun ��� ❑
ty -� R Malley[XIope alley ❑Plat
(� (� -job Icheckappraprinte has)
I SIitt9 N:m+c.�N7iinnhcic,('ouuuunity,Subdivision.Lot No_Zip Coodel (�Q La6lude/longitude of well location
1. OWNI'.R:-[ /.¢>?5/-{I�-2-L - ����-/!7 /U �-r� (degrees/lninules/ttmnds)
Address lybo i..rat.r — A-JsT Nu.e=ill Latituden(it lgit title sourcei❑Grs❑-ropngraphicmap
(Sorel m Boole No.) (check box)
PL 3371 a DJ:11 fI l DRILLING LOG
eBy ar Ta,t1I S131e -- Zip Cade hr0111 'In P mnatioo Description
33c� a5
A+en code-Phoo,nulnher S O
A. DA'I13 DRILLED_
5. 101 Al,DIiITIIC_� (�
6. DOES %V171A.REPLACE EXISTING WELL? YES �1 NO D--
7. S I AIIC WA'IhR LIWEt, Below 1'011 of Casing: (J _PT. --
(Use"t"if Above Top or Casing) _
8. TOT+ OF CASINO IS Pr. Above Land Surface" _-
fop or casing IerndnNed al/or helory land surface requires• -
varl:nur It,atamlu¢c+00, 15A NCAC 2C'.III18. -- -'
v" YI I'.LD (gpm):--_U -- M1IETI IOD or TES'r�� -
1(l. AC'A"I IT ZONES(deplh):
I.00ArIONSKETCH
11. DISINI'IiC1lON:lype_ Amount. G C� Shaw dileclion and distance in miles fromtableaslL,
12. CASIN(.i: Wall Thickness two Stale Roads or County(Loads. Included&I-05A
Depth Di nicier or Weight/Ft. Kiterial numbers and common road names. a
from _ ro fl. —
11. 0MU I Depth ��Matcrial..yy Method
loon__-(�._ I o ZJ--PL�,�y±'r ✓
tom _ fo.____—_ IL___—_—___.--
Id. SCR11N Dep16 Diameler SIM Sizc Matcrial
I Tam _ _ "fo _ H. in. in.
1m'In ------ to_ ... rl—in. in.
1.5 SANUHIRAVIT PM K:
Depth Silt M1lalcrinl
Ilan To PI.
RE 'C E I- \N
I I "I1[IS ULL WAS CONSTRUCTED IN ACCORDANCE\WITH 15A NCAC 2C,WELL
CUNsI II l ll I ION STA I )i )S,ANO'I HAT A COPY OF 1 HIS RECORD HAS BEEN PROVIDED TO TI IE WELL OWNER
SEP 13 2002 _ - `' -Oi
SIGNATURE Of I'L•4tsoo
1RUC`IIN 'T WEI-L DATE
GROUjNDWATEER SECTIONN��
PSHEVH lP'RCSIbNFtL'�PFIL ' (Iu• )nrisioR of\Pater Quality,Groundwater Scclion, 161( 11ai1 Serricc Ceder-Raleigh,NC
within 10 days. G W-I REV. 0712001

;i
WELL CONSTRUCTION RLCORD 261323
Nlnlh( alollm - I h•pnllmenl 01'FOvironment and Natural Resources U-iiviision or Water Quality-Groundwater Section C
\\PII ( oNIH.\("I oil(IN n I\'I I)11 A 1.)N A NIF. Qvinq ISM U.N S__--. CENT(FICA-1 IIONNN .�Sr/&s
IjN I RM 11111 CONPAN\'NApll? ._ �.__bni.�-'� �----pit( N
sl,\ll.\\'I'.L1.I'flNtilltl'CIION I'Ii1N11TN__— ___—AS$(ICIA'14:11\1'l)1'F.NhJJJI I'IN
1'I"q)pliclblc) (irappliathlc) _
I. \C1.1.1. USI'. (('heck Applicable Box): Residential m tvtuuicipal/Public ❑ Industrial ❑ Agricultural ❑
Nitmitoling ❑ Rccuveq ❑ Ilctd Pump Walcr Injection ❑ Other❑ 1f Olhcr, List Use
Z VA'I [ l I O('AIION Topographic/L,;uI .etting
Nrmest hom:_�11� �(-�. — Cnunly�\e f" ❑Ridge ❑Slope PrValley ❑Flat
MAP—_ i-J:S ( _—___._ Ichrck appropriate hn.)
I$acn Na:nr,N un.Lel s.lbnu un.tity,SvhJi vi<inn,Let No,Zip Codc) I'Miludeflonglllllle t)f\VCII location
l IIU'NI'R' _._ I�IA� _ ---- Idcplccs/;ninnies/ncconJ<)
1-11l it ode/lougil udc source:❑(il'SLI topographic map
n Itinnl rILntle Nn.I ^{�C�r�/' Ichwk howl
l 11 U_ (�nit_� __-�� -�l `lJJ>�j _ I)I_I 11I DRILLING Li
-- - ( it, ." I""', stair Zip Code Fr nI I Pot mallun Ucseriptinu
\rea• h Ili lrnuwl:c: .n - t.�n
d. OAl 1. UIiILI,IiD � 1�_ _
5. IIrIA1 DIT111
h. DOI S U I.1 I. RLI'LACL EXISTING; WELL? YES ❑ NO 0—
7. S I A IlC WATER I.F%TI. Below*1 oil of Casing. --
--- — - —
J Qhc"C'i(Ahane'Ibp MCnsinCl ---�
S. It f-)I'O ('ASIN(i IS ,"-/—___ _ Pl". Above hind Surface" --i '-'-
•I iq:ur nasine Iranh. r I;o hcla•r Imol srrfnce requ Ire,n
coil la iu nccnrd mt• ••In: I SA NCAC2C III IB. --- —
n. }'ll!LUI)'pnl). y -_ ME'iIlOD01- ILS'tA
ll
In. WAll RLONLS(dcptI _�.S/o -_.--- -- �-- - --- �.
LOQMION SKLFQI o
I I. DISINI F(`IION i ype_ - �71 Amouttl _Z—��/ Show(Ireclion and distance in miles from 1111casl
\1'all'lltickncss two State Roads or Cm oely Roads. Include 1�;ro;i&_
1)C1,111 Dj;Lniyler ur Wei•hUFI. platcrial nuudacrs:utd common road names.
I mill
I will --'—
I1. (iRU11I I I ty th I:ucrlal hlethnd
Ili:m In !)_.
I man �_.. I
II CrPI'I N: Urplh Dialrelcr _—Ia15i7C N :icrial
I will
IS. SAND/IiRAVI:I. PA( K:
Depth Sin Maleikil
1 Ion1 lb
l l ou l I o... .---- H _-'--
to RLNIARKS: _
11)O I11'PI91Y('I;R ill Y lIL%I MIS WFLI,WAS CONSTRIJ('11:1) IN ACCORDANCE Whit I5A NCAC2C,WELL-
(ttNSI RI I( 1ION SIANI)ARD.S,AND'NIAI'A COPY OFI111S RECORD HAS FIFF.N I'RO\'IDFj)Il)'I III?WELL OWNER
SI(iNA I URE Oh P ERSON C'ONSTRUC'I IN II YEI_I, DATE
Suhmil the ari•„unit 11,the Division of Water Qurdily,Grow ndwater Section, I636 plait Service Center-Ralcigh,NC
27699 16u, Phour No.(')191 7It.1221,11ithin 311 days (iW-1 ItFV. 07/2001

261322
NV ELL CONSTRUCTION RECORD
Niolli l andiva - I)Cpol I ncnt of Envinnunenl and Natural Resources- Div
ision of water Quality-Groundwater SectionC,
o I'.I 1.(-ON I RV IOlt II NUICIIIIIAI.I NAME fl rinq , 1— — __Ttl1v4 r� g')U^-If��_ CEIt'1'IFICATION N 5
o1'.11AON'I Ill(-10n(, NII•ANN NAME_ e-h� '._-4L=N=LI LJII ITV CI_.1•nONE N ( i
S I \11.it ELL('O;tS I IIE(C I ION PE RMI'I'N ASSOCIA'l ED\+'Q PEItMI'1'N
(it applicable) if a,rlicablc
I. 11'I'ILL USh (Check Applicable Box): Residential 1044unicipaUPublic ❑ Industrial ❑ Agricultural ❑
Monitoring❑ RecovCry ❑ 1leal Pump Water Injection ❑ Other❑ II Other, List Use
\\'1:1 1. 1 (K A IH)N: I Tollograpl /Land selling
NCIIIC51 T nwu: 'Al Y Cmun 1F >Kf -'
_ Y --___C-. ❑liidge I ope ❑Valley ❑Flat
Ichcck gppruprialc host
I�ot'CI tJaine.Nuwhci<.(onnunnity,Subdivision.Lot No..Zip Code) LaIIIUIIL'/I(111g111IdC(1f K'Cl1 location
{. 1)%vNP.IL:- -f7 —�C�CJ I/11C �. "tD _ Idegrocslminnlcs/scernids)
r\ddless -__ Q ox __CpS?i ____ I alitude/longitude source:❑GI'S❑Topographic nnp
I SI re CI va Ruule N(I.) / Idoxk W,,)
Ll+ky_ ItL'1'TII DRILLING LOG
it,I,, o,.,/ siale� _ , Zip C'vdc � Y[!(,In Formation Description
- --- 5 c-
\re,i ci,Jr.I'hnnc nnndm tl.5
L DATI? URI ;T; �30` 0 2
5. 'IOI"At, DEPI11:_
G. DOIS NW'ELL REPLACE EXISTING 'NELL? YES ❑ NO L?`
7. S-LA11C WATER LEVEL Below Top of Casing: -_- _El'. _
(Use-r"if Allow Top of Casiog) -----
S. 1 O1' OF CASING IS .J 11% Above Land Surface' ------_--"—
"Ibp of raving(rrnilnal,__d aVur well,,Igad surface re9alres a ----
varianre by gcartdq, r vc llh 15A NCAC 2C.01IN.
9. YIISLD Igp n): _ METIIOD OF TEST if
In, WAIIIR ZONIiS(dcp(h): -----�—
_ LOCATION SKBTCII
11. 1)ISINI FCI1ON: 'Iype_ Amount—Z r—UP Show dheclion and distance in miles from M TV
12, CASING: Wall'ihickness two State Roa(IS or County Roads. Include tltejoad
Depi6 D'anlcler o`r W/'e,i�ghnVl't. It iferial numbers and cmnnlon road names.
I loop to
from
Ilion to
13. GROLII`�-- - DC,di
I hlalcri:d hk•du nl
c
FL—
I S('PUN: Nepih Diovoc! Slol Si7C Nlalcri:d
I7a111 To II—ill. in. _,—_--
I-poolfpi,
__ ----_--
15_ SANDI(iltAVEI. PA('k."
I)cplh Sizc Nialciial
I lool lb Pl.
16. KIs�INtKS: _
I DO III!RCIII'('IAR I HA I IMT I I IIS WFIL,WAS CONSTRUCT[it) IN AC'C'ORDAN(T.WI 15A NCAC 2C,WELI,
C(INS I Ill WI IONSTANDARDS,AND I I JAI A COPY OP TI IIS RECORD HAS BEEN PROVIDED I011Ili WELL OWNER
SIGNAI URE OF PERSON CONSI RUC711NG - WIAX DALE
Suhulil the uripinol lu the Division of 1Valer Qualify,G roll lilt it:,let.Section, I63r, Dlail Service Center-1(aleigh,NC
21699-I636 Photo, Nu,()19) 733_3221,within 30 days. (;W-I REV. 07/2001

WELL CONSTRUCTION RECORD
260980
North Cm olina - Dcpou(ulcn( of Environment and.Natural Resources- Division of Wler Qualily-Groundwater Section
"I:IA,ION'I WA III VI I I U A I.)NAM V IPrint) mM11 SoAJ.sS__-___ CER7l FICA110NMaj F'S _
1A F.1.LA ON'I RACI'Olt COMPANY NAME PuonE if 626 4 97ff c)o�
tit n'I k:I,'I:1.1.('UNS1l1UC O0N I'FRalfrq ASS0CIA1En%VQ PF.RMI I# t�t
(it applicable) (tfa, licable)
I WTI . USI? (C'heck Applicable Box): Rcsidenlial M
_
Municipal/Public ❑ Industrial ❑ Agricultural ❑
Mooiloring ❑ Recovery O Hear rump Water Injection O Olher❑ If 011ler, List Usc
2. W FLI, LOC•A I ION: Topogr,phic/Land setting
Nearest Town: HY A_.A,J Count CN�Ra,e��.�
___ _—_—�_ Y — ❑Ridge . lope ❑Valley ❑Flat
V'A c.t r _ Pn_ e-4 MT_Aj (check arrmprinic box)
t Snrcl tJ:un( rnl tbew,('nnnnunily Sthdirision.Lol No-zip GKIN I.Mi(ude/longilude of well location
3. 1)WNI'.R: K,}/'TUB A,,) L.,�A__ 7.4 3 ,L—t/�'_ fdcgreec/Ininulcdnecnndsl
_ Y.oj. a R6P, sourec:OGPSOTbpographic map
(Surd nr Ituule No.) (check box)
%•_S% I-u_c.�- DRILLING LOG
Ciip or Conn Slate zip Cnde hrou fo Formation Description
Arra nnlr l'hnnc nwnbcr_.-- — �0r7 S/0� .
6, DOES W'BLI. RIA'I.ACI? EXISTING WELL7 YES Q. NO O�
7. STA'I IC WATER LFVF•.I. Below Top of Casing: S `� I:T'.
(Use"• "if Above Top of CxsinFl
8. "1 OP 01:CASING IS_._ F'f. Above Land Surface"
-I"p of cadug Irrndnnled at/or belnry land snrfnre require,a
,.,,lance in accord anrr with 15A NCAC 2C.01 III.Q. 1'IIILD(gpnp: �_— MEl'1101)OP TEST J2-2
10. \VA IFR ZONES(depth): _ d.), C) __ _-- ---
LOCAT ION SKEJ Cl I
II. OISINFI V110N:'fype Amount Show direction and distance in miles from at least
12. CASING: Wall-Ihickncss two Slate Roads or County Roads. Include the road
Urplh Diameter o/rWf�igh�l/fL M Icrial munhcrs and common road nanres.
I'Tom_�
111,111__lb__--- Fl. - _---
frntll------- 10 --_- -
11. GRI)U'I : Depth Vatcrull Mclhod
CD
fa_,0C_ H.
14. SI RFF.N: Dc1,111 Diameters Inl Size hlalctial O =- __-
n
I will__- - To in. - ----
15, SAND/6RAVEI, PACK_
Dcplh Size Material
I into I11 Ft. -�
I rain__-_— .I o
W
16- FLNI ARKS: _ Co
II iil '( ?I I 'OIIS WELL WAS CONst-RuCTItD IN ACCORDANCE Wills I5A NCAC 2C.WELL
D0 11 It , AND 111A'I A COPY 0171 HIS RECORD HAS BEEN PROVIDED 10 THE WELL OWNER
_ ) - /S' - oz
--
3 I(iNATURL•OP PERSON O �IRU!Cn.11G Ifi\VL•LL DATE
Submit I Ic Divi ion of Water Quality,Groundwlder Seeliun, 1676 Mail Service Center-RalciQh,NC
2dRrtu UN 0,U I I _ 21,wilhin 31l daYs. (;W-I REV.07/2001
ASHEVILI E R.-

2609'79
WELL CONSTRUCTION RECORD
Nm(b Carolina - Deportment of Environment and Natural Resources- Division of Water Quality-Groundwater Section
�/l�
s\Ill,lllC'IIL\t-Irlli llrvl)1\'lI1lIAL)NAME(/( ho) 5—L'AMy.'� 1�1� N�S CF.RTIFIC�AAI1q111-0Npa_ L�J�CO�J(�
scF I I.l'U V'i lt,1C'1012 CI IDIPANI'rvAMr;__ Y�SSL �✓_S� Q_I1��._PIIONE a IIVV) o37^OC:.)LXM1
SIAIF w'I'L1,1 ON%I RUC'I TUN p F.RRi1Ta_ _._ASSOCIATFU H'Q PF•ItNFIa
(if applicable) (if npplicnble) _
I. \\'ITI. I ISI! (('heck Applicable Box): Residential N( l to ricipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Ileat Pump Water Injeclion ❑ Other❑ IfOlher, list Use
WH I. I OC'A I ION: Topographic/Land setting +
Neared mform JC(j County olap kv_e Clltidge ❑Slope ❑Valley ❑Plat
N— _ Irheck nppwp,inlc bon)
(�nari Nana,M,... q('nnvnunily,Suhdicision,Lot No„Zip Code) I,alllude/longltudc of well location
OWNER: e.Dl ATE 0ALI-5 _rye plegrecshninul<s/seconds)
\ddiess _ q_i5GGlc^j W A¢/2N11 L.►G fVJ Laiiludr!langitude source:❑(i PS❑Topographic map
1Snvei nr I(oule No 1 p (check hoe)
DEI'1*11 DRILLING LOG
5 ` zip Cndc Prom o Formation Description
Area avlr Phone um..b,p � or 5,-r
4. DA"Ili URILLP.D_Z_=� 3•-J 2_
5. •I-UTAI• DE11"1'11:__��s..
6, DOPS WELL RFI'I ME EXISTING WELL? YES ❑ NO 13"--
7. STATICWAIERLEVEI, Below Tell ofCasing: '?'�_I'1'. —
(Use••s"if Ahovc Up of Cnsinl•) ----
R. '1 OP OP CASING IS _ 11'. Above Land Surface" —
lln,nr rasing trnnhmtal nt/or brlow Innl snrfxce rnialres a ---'
sa,Lmr In ueordnnrr s,lth 15A NCAC IC.m la.
1'IIiLD IgpnO: 0_My'T�TOD OF 1'L•ST�
11). \%'A'I'172 7-ONFS (depth):
_ LOCATION SKEI'CII
I I. DISINI'FCII(.)N. "type_ Amount L v� Show direction and distance in miles from at least
two Stale Roads or Count Roads. Include the road
I._ CASING: Wall"thickness Y
Depih Ui:yyn•cr or Wei,ht/H. A • erlal ❑umbers and common road names.
Innn 'fa
Il. (iRllli l`. Ucpth Material M1lcihad !V
Id. S('IZII.N: Dlplli Dnu telero Slot Sl)C Malcrial
I ion, to
Ilani _ to
IS. SAND/(iRA\'I•.I. PAC'K: - �,•_-
Ucplh SOC Material
Twin To
CO c.
I I IIS WELI,WAS CONSTRUCI17) IN ACCORDANCE WI111 15A NCAC 2C,WELL
E
NSI10R I IDN STAND. l7 ND'I IIM ACOPY 0I7'I111S RECORD I(AS BEEN PROVIDED I O"II IE WELL OWNER
OCT — 3 2002 9/Zs/oz�
IGNA IUItIi OF IT is CO .l"I CT s IIIL:. wU.I, D
s=
�C� N ANT �i
A57i�U iIL�I�T �lll!gT 0 Uivi ion of Water Qi nlily, ((ryr ndwnler Section, 1636 Dtail Service Center-Raleigh,NC
one 221,within 311 days, GW_I REV. 07/2001

4
WELL CONSTRUCTION RECORD 259675
Noll Is ComIIna- Ocpamnent of Environment and Natural Resources- Div ision of Water Quality-Groundwater Section
\l'Elf,('ILNI H AC'I Olt(INIIIVIUUAI.)NAAIF. ( doll gI A ��S CERTIFICATION M�C p
wEl.l.CDN'I It:\(7T)It C'UAIPANY NAbIE �� 1••DK�2 P / �P _ 'V PIIONE I j&�i)5BL7_o�p
S I A IT: O'EIA CONS I RUC'DON PERMITq ASSOCIA"f EU WQ PERNITM
(it a,dicublc) irn s licablc
I. wrLL USE(Check Applicable Box): Residential Municipal/Public❑ Industrial ❑ Agricultural ❑
Monitoring❑ Recovery ❑ licit I'utop Water Injection❑ O(her❑ If Other, List Use
2. WI;LL LOCATION: Topographic/Land elling
Newest"I mvw__/YI N County I<eE_- ❑Ridge ❑Slope alley ❑Flat `
3 , Wt . L,�� (check appropriate boa)
(Sued Nam um m e.Nhcis,Conwnily.Subdivision,Lot No...Zip Code) ' `'/� Latint(Ic/longitude of well location
1, OWNFRI_ 1f4vlE'-S ' ' ^_—�J'1� Idegrces/mimtles)secm,de)
Address J 3_(�y _�� ,�_ «—ll Latilude/lougi(title source:❑GPS❑Topographic map
(Shcel or It au Nn.) (check boa)
�� a �� Ul:lrfll DRILLING LOG
('ityor low) S Ce Zip Code 1'r l (` Z Formation Description
Aml sale- Phone own be, Z �S
d. DATE DRILLED�- y- (7 L _
DE
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO 11 _ CD r
7. SI"ATIC WATER LEVEL Below Top ofCasillg: -(J_I I'. cn
(Use"+"if Above Top of Casing) M - --
9, *1 OP 017 CASING IS_ __ FT. Above Land Surface* - _-
•Tap of r:ning terminated at/or below land surface requires a -_
carlanec In soon-dancyy with 15A NC:AC 2C.0I Ia, -
9- A'IIiI,U(gpnt) In _ ETIdODOFTEST_ MZ
�`/ -
10. r.-�-
- LOCATION SKETCII y
I I. DISINPIIC'1lON:'fype r �f _ Amount C-W� Show direction and(lislance in miles from @yeas[_
12. CASING: Wall"[hickness two Stale Roads or County Roads. Include d$ roa3
Ucpl�11 Uial�cr or,Wcig'1U Ft.' Iv�yi numbers and common road names.
Prato l7 l"o .LZ ht. (�- ��OL
from To__ -
FlonI_ 1fo-___ ----
13. OROU 1: Dcptb M:dcrial blcduxl
loth-___ I"o___ FI._ _.-_---
11. SCRfYN: Dcplh Diameter Slot Size Malerial
I Von1__._ To_-.____ H.—ill, _ in. _-
Irmo--_- I"o__-___- Pt. in. in. --
15. SANDAiRAVEL PA('K:
Depth Size Mnlerial
I-nnn_-_ .fq---- 19._-_ ___
I'roo 1.-_--l u----Ft._—_
16. RVKIARKS:-_____
II :I '1 fll - A"IRII . 1-1,WAS CONSTRUCTED IN ACCORDANCE WI"ITT 15A NCAC 2C,WELL
D IA"r A CO' OP'rl ITS RECOR AS Uf•.L'N PROVIDED TO TI IE WELL OWNER
SEA 1"3 2002 sl 1 )Re ON cuNsr c"n i"m:WELL DATE
ubnt' on of Water Quality,Groundwater Section, 1636 Mail Service Center-Rolelgb,NC
7699 Ar g�Fpf t5� A\. 0 . 11 I,wi hin 311 dare. GW-I REV.07/2U01 _

266082
WELL CONSTRUCTION RECORD
North Carolina-Department of Environment and Natural Resources-Division of Water Quality-Groundwater Sccli�o7�n�,,(�
WELL CONTRACFOR(INDIYIDUAL)NAME (print) 30y-^^ (( / 1�n CERTIFICATION#121rzU
I1� QP1 Jr '\` r)Ot _ PIIONE # ISL%J!c3�7
WELL CONTRACTOR COMPANY NAME�'LiLLiLs—
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT# .
(if applicable) _ _ (if applicable)
I. WELL USE(Check Applicable Box): Residential 01— Municipal/Public❑ Industrial ❑ Agricultural❑
Monitoring❑ Recovery ❑ heat Pump Water Injection❑ Other❑ If Other,List Use
2, WELL LOCATION: Topograpluc/Land setting
Nearesl'1 own: Y
Count} ram;n(�F _ ❑Ridge ❑Slope ❑Valley ❑Flat
10 C ILL Q\(�Y Pam` Y) (check
gitud of well
(Street Name,Nu ben,Community,Subdivision,Lot No.,Zip Code) Latitude/longitude oCweli location
1 Y�Cf�� (deg rees/minutes/scconds)
3. OWNER: ^
Address IU�� �LlfrhlP P-'P 1'?" Latitude/longitude source:❑GPS❑Topographicm?p
(check boa)
(Sweet or Route No.)mCit hL ISC(W DEPTH DRILLING LOG
From To Formation Description
City or T n State Zip Code _ S , _
A code ode-Phone number --_
4. DATE DRILLED - Dgln-
5. TOTAL DEPTH: . 0/
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO ❑
7. STATIC WATER LEVEL Below Top of Casing: v2190 FT.
(Use,,+"Ir Above Top of Casing)
8. TOP OF CASING IS FT. Above Land Surface*
-Top of using terminoted atlor below land rurface requires a LJ
• variance In accordance with 15A NCAC 2C.0118. -
9. YIELD(gpm): METHOD OF TEST-4;,e -
10.WATER ZONES(depth): LOCATION SKETCH
e S Show direction and distance in miles from at least
11. DISINFECTION:Type Amount S
Wall Thickness two Stale Roads or County Roads. Include the toad
12. CASING:
Depth , Diameter or Weight/Ft. Material numbers and common road names.
From �To :?0_Fl.� —
From To Fl.
From To Ft. _
13. GROUT: Depth Mate al Method
From 0 To a�' Ft.
From To FL
14. SCREEN: Depth Diameter Slot Sin Material
From To__Ft. in. in.
From To Ft ir.. in.
15. SAND/GRAVEL PACK: _
Depth Size Material
Prom To Ft. o _
From To Ft. _
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STANDARDS,AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality,Groundwater Section,1636 Mill Service Center-Raleigh,NC
17699-1636 Phone No.[phone],within 30 days. GW-I REV. 07i200i

WELL CONSTRUCTION RECORD 262994
North Carolina-Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section
�/
WELL CONTRACTOR(INDIYIDUAL)NAME (print) CERTIFICATIoN a�,_.1
WELL CONTRACTOR COMPANY NAME 01111E-( IA)C�AI CIC t ✓)(� PHONE N
STATE WELL CONSTRUCTION PERbt1TN ASSOCIATED WQ PERMITN -
ife liceblc (if applicable)
1. WELL USE(Check Applicable Box): Residential U—Municipal/Public❑ Industrial❑ Agricultural❑
Monitoring❑ Recovery ❑ Heat Pump Water Injection❑ Other❑ If Other,List Use
2. WELL LOCATION: � � ��(( TopographiclLand setting
Nearest'Cown: County,., l! Aj��Pp— ❑Ridge ❑Slope []Valley ❑Flat
ate box)
Cn rJtl IM (check eppropofwell
(Street Ne e,Numbers,C�1 ,
ommunity,Subdivisiioonn,Lot No.,Zip Code) Lalitude/longitude of well location
3. OWNER: I Address /i Latitudehongitude source:❑GPS❑Topographic map
(check box)
R �'� 1 DEPTH DR)LLINGLOG
F rmatio Descri Con
- City or Tolvn rom �o State � Zip Code �
Area code.Phone number
4. DATE DRILLED
5. TOTAL DEPTH:
6. DOES WELL REPLACE EXISTING WELL? YES❑ NO ❑
7. STATIC WATER LEVEL Below Top of Casing:AFT.
(Use'•+••if Above Top of Casing)
8. TOP OF CASING IS FT. Above Land Surrace•
'Top of easing terminated aver below land surface requires a
variance In accordance with 15A NCAC 2C.Of IN.
9. YIELD(gpm):_16 METIIOD OF TEST
10.WATER ZONES(depth): LOCATION SKETCH
11. DISINFECTION:TypLUJJk�YAmount Show direction and distance in miles from at least
Wall Thickness two Stale Roads or County Roads.Include the road
12. CASING: numbers and common toad names.
Depth Diameter or WeighUFt. Material >
From T°--- —FL S j —T, -�
From To _ Ft. _
From To Ft.
13. GROUT: Depth Mnter(al Method
From To aD r Ft.` / -
From To Ft. ' W -
14. SCREEN: Depth Diameter Slot Sim Material o _ -
Front To__Ft. in. in. rn —
From To Ft.—;P. in.
15, SAN DIG RAVEL PACK:
Depth Size Material
From Tv Ft.
From To Ft.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL (C6NS�� E WITH 15A NCAC 2C,WELL
CONSTRUCTION STANDARDS,AND TH PY OF THIS RECORD HA PROVIDED TO THE WELL OWNER
L.
SIUNAIUJLEOF ERSON CONSTRUCTINO HE LL DATE
�FC qER I10�:
Submit the original to the Division of T�ler l )d11U�}Gf6flfdwaterSfLrtIon 636 Mail Service Ceenter'REVgh,C
27699-1636 Phone No.(919)733_3221,within 30 days.

262992
WLLL CONSTRUCTION RE( OR
North Carolina-Department of Environment and Natural Resources-Division of W aler Quality-Oround terON all y Uo C/
WELLCONTRACTOR(INDIYIDUA AME (p(print) ct PIIONE / 2"A5�
WELL CONTRACTOR COMPANY NAME V ASSOCIATED WQ FERMI Tit
STATE WELL CONSTRUCTION PERMIT/ Cif applicable)
ifa licablc
1. WELL USE(Check Applicable Box): Residential I1-Muuicipal/I'ublic❑ Industrial❑ Agricultural❑
Monitoring❑ Recovery ❑ Heal Pump Water Injection❑ Other❑ if Other,List Use
2. WELL LOCATION: Topographic/Land setting
LOCATION,
� Countye- � []Ridge 1`78Yope ❑Valley ❑Flat
Nearest 11- !y. n (check appropriate box)
_�'to GB('t� > f �� Latitude/longitude of well location
(Street Name,Numben,Communist Subdt tenon,w.,.o., r Code) _
Tphn 5Y290. (deg ees minu easKondl)
3. OWNER: u _ LatitudeAongitude source:❑OPS❑Topographic m?p
Address - f%O A ..t (check box)
(Street a Route Na.) DEPTH rm It I� Desc. 11
1AA u 8 6 From To F°rmation Desc iption
Ciry or oe•n
/ State Zip CodeAnoppo
r 7D� -`
Area code-Phone number Z
4. DATE DRILLED�i(� --�-
5. TOTAL DEPTH: L5'
6. DOES WELL REPLACE EXISTING WELL? B ES�O NO ffl7— �—
7. STATIC WATER LEVEL Below To of Casing: __---
(Use"+"If Above Top orcasing)
S. TOP OF CASING IS I FT. Above Land Surface* —_
•Top of Ming termin°tad a1/or below land surface requires a —_
variance In accordance with ISA NC 1 '
F _— �—
9, YIEi.D(gem):_ METHODDO OF TEST i— ��eTInN SKETCH
10.WATER ZONES(depth):
Show direction and distance in miles from at least
11. DISINFECTION:Type Amount Irl Wall Thickness two State Roads or County Roads. Include the road
12. CASING: Diameter or W Thickness
Material numbers and common road names.
Depth (From-,I) To /fS� Fl.4y `—
From To - FL
From To Ft. Material Method
t
13. GROUT: Depth -.
From To FLU--
From To Ft.
Diameter Slot Size Material
14. SCREEN: Depth
w
From To_._Ft. in. in. -
From To Ft. in. in. o
15. SAND/GRAVEL PACK:Depth Size Materiel
From To FL —
From To Ft. —
16, REMARKS:
OD�j pC CE WITH 15ANCAC 2C,WELL
I DO HEREBY CERTIFY THAT THIS WE OP n�sN PROVIDED TO THE WELL OWNER
CONSTRUCTION STANDARDS,AND c
4Z�—�
WELL o DATE
SIGNA RE F PERSON CONS7RUCTI
aterquallty;,Graundry ectloil,1636 Mail Service Center.Raleigh,NC
Submit the original to the Division o W
OW-1 REV.
27699-1636 Phone No.[phone],IV bin 30 Hags. ' __,

WELL CONSTRUCTION REt:Oi.^, 262986
North Carolina-Department of Envirotunent and Nalural Resources- v1SIID;SOWS r Quality_CERTIFICATION
WELLaater Section
U
WELL CONTRACTOR(INDIVIDUAL)NAME (print) ( l � �( "If I' nA Pt1ONE #
WELL CONTRACTOR COafPANYNMIE r ASSOCIATED WQ PERMIT#
STATE WELL CONSTRUCTION PERMIT# if applicable)
ire licablc
Industrial❑ Agricultural 11
I. WELL USE(Check Applicable Box): Residential Municipal/Public❑
fY
Monitoring❑ Recovery ❑ heat Pump Water Injection❑ Other❑ If Other,List Use
TopographiefLend setting
2. WELL LOCATION: CountyLl^o� ORidge OSlope OValley OFlat
Nearest•f Ow (check(check appropriate box)
(�9 Latitude/longitude of well location
zt cnae
(Street Name,Numbers,Commu7ty, bdtnaion,
�7 PEA�4 l� (degrces/minutes/second+)
3. OWNER: o LatitudeAongitude seurce:OGPSO m
TopograPllic ?p
Address / 1.' r� (check box)
(street or Route No.) DEPTH PRIM
LOG
P From To Formation Description
state zip code _ '
Ciry or T tan '!yj'p�r_— /�'nG�AC�` '
Area code-Phone number -Jz
4. DATE DRILLED 'K
5. TOTAL DEPTH:. �� �/g --
6. DOES WELL REPLACE EXISTING WELL7 YES O NO Q— �-
7. STATIC WATER LEVEL Below Top of Casing:_3_0�17T• _ _---
(Use-+-if Above Top of cuing)
8. TOP OF CASING IS 1 FT.Above Land Surface' —_
-Top of cuing terminated nti,below land surface requires a ---
variance In accordance with ISA NCAC IC.0118. —_
9. YIELD(gpm): I METHOD OF TEST 4;(1 -- �-
10.WATER ZONES(depth): nN SKETCI[
Show direction and distance in miles from at least
II. DISINFECTION:Type Amount SWaII Thickness two State Roads or County Roads.Include the road
12. CASING: Diameter or W Thickness
Material numbers and common toad names.
llepth ' --
From-.—To y0 r Ft.12 / - -- • -
From To Ft. ---�
From To FL i _
Metfrrial / Method
13. GROUT:From ToDepth � r Ft. --
From T° F1'----- Materiel
Diameter Slot Size [�
14. SCREEN: Depth FI in. in.
From Tn-- o --
From
To Ft. in. In. _J
15. SAND/GRAVEL PACK:Depth Size Material
From—To Ft. —
From To Ft'
16. REMARKS: P�
� ii RDANCE WITH ISA NCAC 2C,WELL
I DO HEREBY CERTIFY THAT THI T A COPY OF THIS RECO BEEN PROVIDED TO THE WELL OWNER
CONSTRUCf10N STANDARDS,
j
Si NA OF PERSON CONSTRU IN THE WELL
DATE
G��iily,, elerS cllon,1636MailServiceCenter-Ralelgh,NC
Submit the orlglnal to the Dlvlsl n ofaEntigtPd r _J OW-1 REV.07/2001
276g9-1636 Phone No.(919)733-32 ,w If30 days.

LYi
,.y
261661
WELL CONSTRUCTION RECORD
Not I l':Irn It na - I)qmi It e it of I:nvironment and Natural Resources- DivYisit)n of Water Quality- GroundwaIcr Seel ion
oI,IIA I IN I JIM10 It Ns I I I CI I III,\I.f NANIF, rtln0 �)_'l',if✓rV _-_ JONN S__---_ CF.H'I'I FICATIONIN
ssl:1.I.('ONIIt4l-1(Ill IOa1PAN\'NAME -_clllaf .�SQ 1-6--e.�.�_�R�_�l.!^��-_--_rIIONF a ODg)$37-SEro� .
SIAII AI'I:LL(ONS I IO1( I ION ITHRI I IN ___--__ASSOCIA I Elf IVQ PER.All ra
lifappliclblc) _ (irapplicable) -
I. l\'Iil.l. USI: (('heck Applicable Box): Residential Nk/Municipal/Public ❑ Industrial ❑ Agricultural ❑
hloniluliiip LI Recovery ❑ Ileal Pump Water Injection ❑ Other ❑ If Olhcr, Lis( Use
' \ ITI, I u'Al ION: pographic/Land selling
Nr;n csl fawn:__../y(-U? _CuunlyQklo� '� e ❑Slope ❑Valley ❑Flat
_... I--�.. _Rh•+)�Te __.._.1�1-:�___--_.-_ (check apprnprinte box)
(Grk0 Nnlllr.Nnnihcts,Ilnninanily SIIbdIViiF011•Lot W,Zip 00c) Lalitude/longitude of well location
1, OWNER _ -,�A C_IS,-- r:t:R V'_Ls --- Idcgrees/minulcNsernnds)
\ddtc5s -•/�.C. a� ___//J _ __._ LNilude/lougilude source:❑GI'S❑Topographic map
ISucet nr It"We Na) (check bon)
/ rP,!_.J, DRILLING LOG
- ---Ciq oiInso Talc zip CnJe From 'fo Fnnna(ion Desert ion
I. DA111IMILLI'UIC1 �� - O L �-�-��
1 /3 P'-)
5. 10 1 AI DI 1'11I .. --------[
6. DOI.S WELL RI I I Al I. EXISTING WELL'1 YES ❑ NO Ej,
7. STAI K W'A'I i;R l 1•VEI. Below Top orCasiug: "'Fo_-I''I". 1
(Ilse"("if Ahnvc ll:pnf(''10,g) / J— -
R. 11)I'Ol:CASING IS FT. Above Land Sull'ace' ------- ---
I:y:of rn vine Irr u:Ion led of/or be tow Is nd surface requ Ire,• --------- _b _
rm ianre IinanrI rn'it ISA NCAC2C.at la. -
4. YIH D(gpno: M11 �"rnGD of 1-Es"r1�
In. \\A IIiR ZGNI!S(dcp111): _ z .),1---_- — ---_— --
_ / / LOCK1lON SKETCII��
I I. HSINII;.C`I ION: l vpc_ Anxxud e� Show direction and distance in miles from at Icaal
12 1 ASINI is Wall Thickness Iwo Sate Roads or County Roads. Include life road
Depth _ U'vu Icr itW�I)!lu/ft. hlrylcri;d numbers and common road names./`��
I will
I Ilan To Ft.
I i. I IR011rI11 Dy th ;ucnnl Nlith nl
LImil V _ It
Tom
I-I. SI'R P.I Depth Dianlclel ve M;neri:d
I toil__. Tn II. •.
15, SANDAMAVIII. I'M K:
Dcpllt Si7c Malerial
Iran
milt It
DU IIF.RI[BS (TV,�Ir�I�llq'Bi
WELI.WAS CONSI-I(IY 11:1) IN ACCORDANT\1'I I II ISA NCAC 2C,WELI,
ON,'C!( 11($1' M will 'OPyOI'1UIISRECORDIIASBI'.ENPROVIDED1O'IIIEWELLOWNER
U . . �GROUNDWATER SECTAM10; fPFI(S c( SIR 1NG1IIENt11. UA'fE
A HEVILLE REGIONAL
Ic of Igina1 lu Ihr Division'o Walcr Quality,Grl and w'a let'Seel ion, 1636 Ili nit Scrvice('enter- Raleigh,NC
21699 I616 Phouc No.(9I9)733-3221,w-ilhin 31)dam GW-1 RIiV. 07/1001

i
261502 y'
WELL CONSTRUCTION RECORD
Nol th('mohim - Depai n ent of I:nvironment and Natural Resources- Div ision of Water Quality-Groundwater Sectionik
i(
xcEl.l.fONl un(`[OR(IN IH VIUUAL)NAME. rrinl) r >�C'�� CERTIFICATION,1 5
cral.r"rlvnrtcluu( ummANi'NAME. � 1_1 L0�_ PHONE a $!R837-��g
S Lll l': \\'Ii I,I.CUSS7111�C71ON I'61rM 1"rq _ASSOCIATED WQ PERNII FN -
lil'applicablc) (ifapplicable)
I. N'ITI,IISE. I(licck Applicable Box): Residential t�r/Municipal/public ❑ Industrial ❑ Agricultural ❑
N ooiu,riop ❑ Recovery ❑ Heat Pump Water lujcction ❑ Other❑ If Other, List Use
2 tF 1:.I.1. LOCAL 10W Gl���e Topographic/Land setting
Nearest Town:_�r"b pC.LtJS _County l..r ❑Kidge LI;Slope ❑Valley ❑Flat
f �Q111' r[�L�� t�lr_1� �� (check appropriate box)
hocet Name,Nfnnbri<,t'onununity,Subdivision.Lot No.,Zip Code) Lalllude/longllude of well location
g- C n10 PC
(AJJNIsst _I/'C 1QC`X •� 2'�� Laliludeilongilude source❑GPSOTopographic neap
(co,,t m Houle No.) (cheek box)
Dl�l'TII DRILLING LOU
code Fr Mn fo E no.Lion Descri lion
Ldsl 3 zj ` ' 7_
An,,oile I'hrne Hum br, T- O.il r rV
h- DOES W'E.LL REPLACE EXISTING WELL? YESp NO ❑-
7. STA'il(' WAFER LI,VE.L. Bclow'fop of Casing:
(Use"+"if Abo,e rop of Cnsiog) _
R. TOI'Oh CASING V, 171'. Above Land Surface'
I ln,or raxl ng Icrn,6,alcd RI/or hrlow lend soil it,cc relit,l res a
Ito l.occ In accoidxnre will, 15A NCAC 2C.01 Ia. -- - -
Y1EI,I)(gpm) —v-�METHOD OE TEST /_ • '�_ — r" ~
Ill. WA*I H ZONES(dep(h): _ -
LOcA,rION SKETCH
11, DISINPIVI MN:'rvpc- J Amount - '" Show direction and distance in miles from at leas( -
12. CASING: Wall Thickness two Slate Roads or County Roads. Include the road
r ' Depth D' n c(cr or Wet lht/Pt. D (trial numbers and conmlon road names.
Ilonl._y _ I o_ ,�- FL
from I 1:1.
----- ------ ----
from I"o-------- 1:1.---- --- --------
Ii. (iR(II)f -_- ocpd hhucnnl M1lclhnd
linen-r(� EI
_ _— -
14. S('RI L N. Ui plh Ui;uucicr 5 I Size Nalcrial IJ _
0
Ilion - fo
Flom _ to
IS. SANIMWAVEI. PACK: --- -- ---- 1 - _
Depth Sizc Material
Flom _Tu..."_--- hl._
I non To Pt.
ca
DIb.((�(RI[M1IAItKS. --- o�IZJ11:414 CV14IlEi I ' MIS WITI,WAS CONSTRUCT ED IN ACCORDANCE W!"rll 15A NCAC 2C,WELL _
l'I ON:f NI. R , AND 111A1'A COPY Oh TFIIS RECORD IIAS BEEN PROVIDED IO•r11E WELLOWNER
SI(iNAI URIi OF PERSON CO S G NG LHE ELL DATE
G4100NbUdNTERi((60ip�rlilhe Di ision of liYaler Quality,Groundwaler Section, 1636 Nall Service Cenler-Raleigh,NC
AS y IjyL ,R r J221,xrilhln J(1 days. OW-1 REV. 0712001

WELL CONSTRUCTION RECORD 260978 '
NotIh Cat oIina- Oepatlmcnl of Environment and Natural Resources- Division of Water Quality-Groundwater Section
1%FIT,I ON I RAC I Oil(INnI VIDUAL)NAM I. (print) SM _0, rJ _ CERTIFICATIONIII
\\FIT.('ONI R.k(."1011 COMI'AN1'NAaIF:_l�rtP_RD i/ '� PHONE
S I A'I IF N 11 1 CONST R(ICI ION PERAII14 ASSOCIA"rl:n 1VQ PERMTFN
(it applicable) (i rap pliCal C) �
i.
I WELL USE(Check Applicable [lox): Residential gAunicipal/Public ❑ Industrial ❑ Agricultural ❑
Monitmring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other❑ IfOlher, List Use
2. vVI11.1, MCA I ION: I� ^I 'Cop°grap m/Land setting
Neinest Fown:_ "�F���� County 01-e?i,t�e..� ❑Ridge ILf3lope ❑Valley ❑Flat
r00CJb (check appropriate box)
(Slreet Name,Nmhx.Cnnnnnnily,Subdivision,Lot No-Zip Cale) Lalilude/longitude of well location
1. OW'NF12: Mi}klL_ Cf�r+�'rC'.J / e K.Y���. Idegrecshninntes/s«Dods)
Address Q__— :.2:t 1'� Lnlitude/longitude source:❑GPS❑Topographic map
(tiorcl nr Route No.l (check box)
A.ti'oRe,tvsj C. DEPTI I DRILLING LOG
cilyntrow„ S11L Zip Code From o F nna(i oil De cription
4. DA'fl: DIiII 1:1)
5. TOTAL. I)FA I: V� J
6, DOFS WFLI, REPLACE EXISTING WELL? YES ❑ NO ❑'-
7. STA HC WA] FR LEVEL Below Top of Casing: :?-�_FT.
(Use"+"if Above Top of Casing)
8. 1OP OP C'ASIN(i IS FT. Above Land Surface•
"7 op of[nstnp Irrtnhmird of/or behove land sorroce requires a
carl:mm In a[arrdan[e/nigh ISA NCAC 2C.a118.
u. Y11:I.UtgpnQ: l7 MF,TIIODOFTEST
11) WA"I FR ZONES(deplh): S� O
LOCATION SKETCI I
11. DISINIACl ION: 'I NpC -Zty _ Amount V Show direclion and dislance in miles from at least
12 CASING: Wall Thickness two Slate Roads or County Roads. Include the road
Dcpihyy (q�rm lcicler or Weight/H Material otunhers and common road names.
loom To FL
liom "fo Ft. _
I1. GRO111 Depth Material Method
f`lomO 1o1,2,__ fL (_� -aCD
` O ;
Ilom J Tn 9 - _ II _ Iv
14. G'VFFN: Depth Dianicic Slot Size M:merial C-J _
I will To EI. in. in.
15 SANU/GI{AVF.I, I'M K: ----
Dcplh Size Material `—' -
I'mtlt-------
r .
Iloot--.._-----I o------ ht._
- rb
R
".91(
Wlil.l,WAS CONSTIIU('TIiD IN ACCORDANCEWffll ISA NCAC 2C,WELL
D'IIIATACOPYOFTIII RECORD HAS BEENPROVIDEDI'OniEWELLOWNER
( � - 2G - oa
NA"LURE OF PERSON 'O 511 UGTI R"'Ll WELL DATE
]CSFfEViLL'E Nt RL� n of\Voter Qunlily,Gromtdwurer Secllon, 1636 Mail Service Center-Raleigh,NC
I,within 3R Jays. GW-I REV. 07/2001

„ A
259676
WELL CONSTRUCTION RECORD
North CmobIM - Dep❑ante”( Of Environment and Natural Resources- Div ision of Water Quality-Groundwater Sectio.,n�� t
ss E1.Ll"rl�lltAC'I lilt IINUIV'IISUAL)NAb1E riot) ,I r-y(_p'�_ CER"I MICA.,TII(ONp026-0; r
wF.I.I.CON I lt.s.(-1 OR CONIPANYNAME �K Q�'-�L�/r=i ' N PIIONE N & Oi7�WIp•
SI,%II \v El.l,CONSTRUCT ION PERNII'10 ASSOCIA1 Ell%VQ PERM IN
1 if al1lirlbl•) / _ (if applicable)
I. W'ELL USI'.(Check Applicable Box): Residential Municipal/public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ flea( Pump Water Injection❑ Other❑ If Other, List Use
2. %VELL LOCATION: �I opographic/Land setting
Ncarest I own: f1U'Zh�County
y ticG -I Idge ❑Slope []Valley ❑Flat
(check ipptopriate box)
(Solo Name.Nninh//ci�� 1'01 enmity,Subdivision.Lot No.,Zip Cole) L.asiludc/Ivngilu(Ic of well location
//W
3, OlIVNER �Y�✓� Ur', Idegrecs/minuks/secnnds)
I{/o j_ �CNLNND _ atiludc/longitude source:❑GPS❑'ropographic map
Aildlcw
(check box)
(Street or Noule No.)
DHPFI{ URIILINGLOG
��-------"--- 1'r 1 T I h,71I on D�riplion
5:ily or 1 own tilalc lip Cale e J 7 33�.
1 '1d�7 _���� -
A,en axle-Phaue number A
4. DATE DRILLED 3- 2 5 - 0
5. '1 O FAL DEPI H:—�) ° 5
6. NOBS WELL REPLACE EXISTING WELL? YES ❑ NO 13-
7. S"fA'IICWA"f1iRLIIVEI,BcIowTopofCasing:___FT. rQ
(Use"+"if Ahove Top of Casing)
R. 101' OF CASING IS. FT. Above Land Surface' - - -
•'rup of caving lerndnnled anor below land surface requires a
Is rino,c to accordance"Ill' 15A NCGC 2C.01 IN.
9. 1'IIiLD(gpnl): _METHOD OF TEST_ - --`
10, NVA-1 IT ZONES -
�----� I OCA'f1ON SKETCII <�
I I. DISINITC IION:'I'ype_ _ Amount_ ) C- O' Show direction and distance in miles from alicasl'�"
11,2. CASING: Wall"Ilickncss two Stale Roads or County Roads. Include roalCG.'
Depth Di me er or Wcight/H. My[crinl u(mtbcra and common road names.
from��To-�._(� FI. _ __zL_L±5x_.
I7om__'I o Pt. —
Pronl_...-_To_------ Ft.
U. GlIMII Depth Material Nlcth.xl
171
II. S(RITN: DCpih Dianletcr r S . ize Material
Ilom__ -_— f°..__.._ _ fL_ it . _ in.
I Imo Tn _-hL---in. in. -_
I5. SAND/GRAVI'1, PA( K:
{)cptll Size Material
I—
I Tom In_, 171._ --
10. RUNIARKS:
D I )I ili�l' iR 1: T 1 BIS WELL WAS CONSTRUCT ED IN ACC 0lMANCE Will] I5A NCAC 2C,W ELL
I I S,AND 111Ar A COPY OF TINS RECORD HAS BEEN PROVIDED 10'il IE WELL OWNER
SEP .1
_-3 -M7- SIGNATURE ItSONC N51RU TIN(.11BF WELL DATE
the I ivision Of Water Quality,Graundlrater Section, 1636 plail Scrvice Center-Raleigh,NC
GR A -}22I,o'ilhin 311 days. GW-I REV.07/2001
ASHE AT_, p0I'))7

i';tt!
259677
WELL CONSTRUCTION RECORD
North Calohna - Dep:uhnent or Environment and Natural Resources- Division of W'ter Quality-Groundwater Section
Ic ra.l,('ON'I ItA('TUIt(INUIVIUUAI,)NAME CERI'IFICKrr1y�0NNQ`gyp•
scF:L1,1 ON'I It AI'I OR CI Ix I PA N\'NA NI F. PHONE p
S I At 1.NN'LLI,(ANSI 1IM I ION PElrallTp __ASSOCIA1 Ell vvQ 11F.RMITp "
(it applicable) / (if applicable) _
I. \\'ELI. USI'.(Check Applicable Box): Residential0- Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring❑ Recovery ❑ 1-leal Pump Water Injection❑ Other❑ If Other, List Use
2. WFIA. LOCATION: " "� Topogra�uc/Land setting
Nearest"Town 1/ _ /��(� �__County ❑Ridge LKope ❑Valley ❑Flat
IMP 1---L (checkappropriate box)
15iuri Nunn.Nmnhcrs,('aim miry•Subdivision.Lot No..Zip Cole) Latitude/longitude of well location
I. M%NER: �UI L ©1.Z\ (degrees/nrinules/., condsl
AJdicss _rl(py_ /c=.r•.'L/�,uJ /� Lalituddlongiludc suurcc:❑GPS❑'topographic map
(Sm•m m Itoote No.) (check box)
A)C DLSPHI DRILLING LOG
,.('aynr Inssn State Zip Code front o foila lion Description
kk )=ram 7-
Ama code- Phone number�pp Ft •� J� ��
4. 1)AII7. 1) Z11.1.1;L)
5. '10TA1, IN:P 111: 7 C)
6. DOFS WELL REPLACE EXISTING WELL? YES ❑ NO lY o -_
_ ta'
7. SIA'HC WAII7R LEVEL Bclowl'oporcasing: 2-VC Fr. rn ---
/ (Use•'+"if Above Top or Casing) f�l —
9. MP OI'CASING IS_ /_ FT. Above Land Surface` -
I op of casing trnn trmlal nt/or below land surface requires a _ _ -
sarlance In nccwd.0 sr lth IsA NCAC 2C.0119.
9. 1'l1iL.. (gpn0 _� _ METHOD Of TESI'
IO. WA"i'ER7.ONCSIrIePll9 'Z2O �)(" V I
LOCATION SKETCH
11, DISINPEC'IION:"I'ypc Amount -2„ G(/® Show direction and distance in miles from Wcast-'
12, CASING: Wgll Thickness two Stale Roads or County Roads. Include R roW
Depth�t Diameter r Wei It/Ft. h renal numbers and common road names.
Cronyy_To�2�__
I toll—To FL
from__Tu_ _ FL--
]I. GROU"1: Depth Material Mclholl
Drum _ to J cle
IlinniJ
14. SCIi Iif N. Ucplh Uiamc cr S It Size Material
To___-_— hLuI, in.
I"o_... __— Ft—ill. In.
IS. SAND/6RAVF1. PACK:
I)cplli Size Material
I'r nnl 'fo_ __171. — —
liun____I u___
DI) 111 illLS5C,1 ( [-:It I IS WELL WAS CONSTRUC'1li1)IN ACCORDANCE Wftl 115A NCAC 2C.WELL
:()NSI RIJ- 10N S'I ANDA. �UcJ ND'MArA COPY OPTIIIS RECORD HAS BEEN PROVIDEOTOTIIE WELLOWNER
SEP 13 2002 — I Ion -
3 02
IGNAIURC OF EI0�CONSI INGIE WELL DA'1"E
A GROUNDWATER SECTION
Fwi WAhl(jKlbg Uivi ion of Water Quality,Groundwater Section, 1636 Mall Service Center-Raleigh,NC
27699,1636 Phone No.(919) .. -. 221,nllhin 30(lays. GW-I REV.07/2001

WELL CONSTRUCTION RECORD 258253
Nol I l Carnlina- Ucp;uune nl of l:ovironulenl and Natural Resources- Division or Water Quality-Groundwater Section [
(IY M 'JN �J
„T:LL l I o%('-I Olt(INIM In UU, .)NA III (Ill ion 'k CERIIFlCATION p
) _�_ _ f� _
LlL(nNn(ur Olt( onn•nnrnAnle f_1S 1N _1'IIONEgl3�s)537._g��Gv
I
I IA ( ONS I IO'C l ION I lAVill I N_ ___.__ASSOCIA I ED\rV IT101110
Ill a r Ilicablci (if a,rlicablc)
I. wi I.I. I ISIi(Check Applicable Box): Residential Municipal/Public ❑ Industrial ❑ Agriculluial ❑
Momiming ❑ Recovery ❑ Ilea Pomp Witter Injecliou ❑ O(hci ❑ II'Olhcr, List Use
2. \\'I:I.I. I(1CA I ION: JJ // Topogrt iic/Land setting
Ncan•sl 'fnan: /!1 �( � Cnunly�llC'!�K`�- Midge ,e ❑Valley ❑flat
appmpriale boO
1 Snrel N;... N.... c_Conoauoily,Sobdi,kiuu,Lot No.,Zip Clkle) I:IIII((le/loogl Elde•of we'll location
1, f)\1'N I'.11:._� y!( N XVNyIF�� _�.C-L� Idcarcct/minvlesrtccmrJvl
/\ddless �3 _._D(L' Q RS' k A'f- Latilndcnungilnac snnrcc:❑(ips❑topographic neap
is,ccI ,r lloule No I���/// V�j� Icbcck hod
�I9- �Si:''N 7C`-) _ UEI'fD DRILLING LO(i
---- -
Chyl,l SIMI I Zip code Will To I Pornndiou Description
Mra aalr I'bnnc //I
•1. DA I E DRIIA 141)__t� - - 0 2
6. DOTS %A'ELL IlI':PI.ACE I;XISI'ING WEI,LP YES ❑ NO ❑�
7. SI AIIC WA-1 FR ITVEI. Below Top of Casing:_NSi7—' F 1'. --
(Ilse'•+"if Above'top of('nsiug)
S. IOP OF CASING IS _�_ _ 17'1-. Above band Surface'
''I op of,acing lmoiloo,d a(/or bclo,r Inod sur'fnce require,a
,m i:ul,e in amrrdaur,alll. I5A NCAC 1C JII Ifl. -----
9. YIFI.D(Lplll). MI:I'l101)OF'1'1;;SI _—
In. WA"I FR '/,ONFS ldcp(h):
LOCATION SKEICII
I L DISINI PCIION: 'I ypc� _ Amount_- G- 0� Show direction and distance in miles from at least
12, CASING: Wall Thickness two Stale Roads or County Roads. Include the road
I kpth l 'amcler or Wcl•hl/PL algri:d n(uubcrs;md common road names.
Trout O _I(��O_
Iloln_—
IYonl Tu.--__-- i (.---- --- ._.-------
11. OR(M�I1' —_- Uc1,1�111 I:lCoal �, NId6oJ
CD
I'l S('llFr N: Ucplh DiameterSlot Size Nlalerial n;_t
I will _ -
Ihnl_ _ _ fa
I5_ SAND'OItA%'Ifl_ I'MK:
Ucplh Sizc Malel ial
Iloll
Lwow To fl. _
16 REMARKS: D
I — hfl III Itl 11F('I'It 111'\' lfl/y I S WIIU.WAS C'ONSI RUCI1:1) IN ACCORDANCE WI111 I5A NCAC 2C,WELL
�1�'ONSl R11( IHIN'SlrtNI)hRl UIIIA I ACOPYOFl111S RECORD HAS BITN I'ROVIDI4U'IO rill; WELLOWNER
I (n 0 /Ics ref—S —dL
-- - —
1 1, I`. ( NA rUIl I?OI• PERSON CONS—IOU1lN(i 1'IIE WELL DALE
S Ilrmit Ibc urinal lu the Ik is it a of Wit ter Quit li Iy,GruunfivatcI-See l ion, 1636 Nlnil Set ice Cc I,Icr-Raleigh,NC
27f(ggf1L61(fry!A4rinai hfre'141©�7J1-}2 I,within 311 Bars. (iW-I REV. 117/2110 1

258254
WELL CONSTRUCTION RECORD
Noll)Cmolina - Deparlmenl ol'limvironnleol and Natural Resources- Division of Water Quality-Groundwater Section
�
V%II.I.I-I IN R.N'l(III(IN I)IN I I III,11.)NAaI(: rr1nrp—I�tMM+'J_..s�C2^�('�5T_--- CF,R'I-IF ICA'1 IONXy!52 5
NNI It,I'ONIItn("I(III IONIVAN1'NAnIP: �I'\Q(2�K�.Q.__�(JS'.L�-__(,1P—c1�L'� ---FnoNF a
S I CI I' wTLL IONS I I?I ( I ION I'ERI\II IN __._ASSOCIA I EP\CO VEIN I I'I X
(it a„IicaFlcl (it applicable)
I. \CI IA. USI. 1( hcck Applica6lc [lox): Rcsidelnial Municipal/I'uhlic ❑ Industrial ❑ Agricullural ❑
Mnnilming❑ Rccowry ❑ I Ica( Punlp Water Injection ❑ Other ❑ II OBlcr, Llsl Use-
-2 WEI.I IOCAIION. 'topographic/Lan�d citing
Nc;ucsl I owl. /I(. +�'1i, Count �'4 ❑Ridge ❑Slope fj}V:lley ❑hlal
_ C,9 ti .f/ �( � _.K�_ �4�SZ+�J _ kLeck appnq,nalc Fml
isl"o N:mw,Num ".l'onmmnily,$uhdi'mon.lot Zip Cock I.allludc/li ngitude or\Yeti iocation
i 1/\\'NI'.Il:.__` f PC�r'J / ' , (�1/1-h���' _ �JcErecalnimtles!sieondal
source:❑Cil'S❑Topographic map
I�I r ur It u1,Na 1 C., IcLttk hov)
DRILLING LOG
I mnr I r,,.n SIIc Zip t'ndc -- plum 'fo to nlalnm hcscr Illion
s r(I Al,E DFPI 11 — --
6. DOES WELL RITLACI? E.XIS'IING WELL? YES ❑ NO ❑�
7. IS IA I W WAIIT I.FVI:I, Rclow'fop of Casing: �--_1:F. __
I l lsc'•I"if AFmr'1'np ul(b vine) --_.— _
S. Il II' ()P l'ASING IS I't. Above Land Surfncc'
'l,q,nl rr.iu L•Irrminalyd nlfar Irrlua'laud su r(arr rcquh i,'n
cm laurr in nccnrd unryy ,Ith IS,\NCAC 2(-.01 IN. p� ----- --- ---
I). YII;LDIepm): _ (2NI',IIIODOI'I' SSI 1(2_ i— — —
I D. WA I IT ZONf.S �.�Q -
LOCATION SKE't(711
11. DISINFIt('IION: 'I ype_ Amalu)1 C(/ Show direction and distance in miles Iroul al least
12. CASINO: Wall 1Lickncss two Slate Roads of County Roads. Include the road
Depth CC UianlcI c,r ur/W�sI I]1q�\'u/ft. I,ucrial uonncel:c and common toad names.
LI11111— __,of/J_ it.�/ v�L
Runt -Io __ fl —
11. ( I(()UI----- Dyrtl1 Matclial Mclbod _
In,"' ._— f ---- v
non O .I.o_�/s. -J ------
1.1 SI RI I'.N: DCldlr Dianlclet lul Size M;ucrial
I will 17r_
11"In to
I5. SAND,(iRAVId. I'A('K:
Dq:gl Size Malcl al cD
II nnl
I bill -tlr..
.., .. f1
i11 1 I)Pi III Itl HIY ('I R I IE5' ' I I IIS Wlil.l.\1 AS('ONSfKII(.'"I1lU IN A('('ORUAN<'I?Will[ I5A N<'AC 2C,1VI:LL.
t (i1N�I HI n I ION N I ANhi, 1t1 AN[ I A('OI'Y OF 11IIS RECORD HAS BEEN PROVIDED TO 1I Ili WELL OWNER
- -- - -
I
II1�U111bI . ON SI (,1 ItU 'IN(i I111' WLI,L UAIIi
giuO 9h} Icy ion ll it! the I)ip ision of\s alet'Qu:dily,Gromldw Jer Section, I616 hl ail Sel%ice('enter Raleigh,NC
IerV I%itI it,N 1'))7_3,>I-)221.ui(1,in111;hNs. (iW-1 REV. 07/'_001

258255
NVCLL CONSTRUCTION RLCORD
Not Ili('orolioa- Dcpa Ito lcol of Env ironmenl and Natural Resources- Division of Water Quality-Groundwater Seclio'n���
vrFLL(oNIo:\('I Olt(INDIVIDUAL)NAME (Prinl) J1I h1M,/ .ki^I`L __ _ CEN IIFICA'I'ION d—V
NN[I.[,(I)N'IIIAC loll(OMPAN1 NANIE F' N{--1•IIl1NE
S I,\l I:\\'lil.l.CO?S7R 1'("I'111N I'F.RMI'I'q _ASSOCIA'I'FA)%NO VERNI1'10
lit a, iicable) lifa„licablc)
I. \ r1l. LIST; (Check Applicable Box): Resi(lenlial Municipal/Public ❑ Industrial ❑ Agricullural ❑
Nookoting ❑ Recovery ❑ I leal Pump Water Injection El Olhcr❑ II Olher, LIST USe
2 Wlll.l. I OCA PION: "fopogra c/Lan(( setting -
Nc•arestfnwn: 11.!/ Count}' - -� ❑RiJge . lope ❑Valley ❑flat
Ichcck oppu,Frinlc howl
I tilicci N:onr.Ndmh/ert(.ouununily,Sub/mdi�vision,Lot No.,Zip C,xle) Latlludc/longllodc of vvcll loeallnn
1. Oi%'NI'.I(:.__�t5[(b /c/u/Z L —_ Idcg:en:minwvsisccnudsl
Addicss _ L _ o,u f.J' Latitude/longihulc source:O(il'S❑Topographic map
._ (Snn90 IhnacN (check host
COAJ-.�5�_I f e _ DIT111 DRILLING LOCI
1.:,,,: tinnc� Zip Codc Pr In V Po motion Dc et,,lion
Y = 77
Area uric l'honc:nnnlic: �Ap ��--IyS �j- O'A.�2cY{
d. DA"Ili DRILLI{U_
5. TOTAL 1)1:19II:__
6. DOP.S WELL R17P AC'E EXISTING WELL? YES ❑ NO Cr-
T STA'I I(- %VA'Il l( 1.1?VI?L Below Top of Casing: -5-0
Ilkc•'r"if Ahnvc'rop of Casing)
R. 'f01'01'('ASING IS _ PI. Above Land Surface' - ---
"I'np of u,a611;IermfimleA nuiir hein,r laud surface requires
ca ri:ume In accord a,er u'ilh 15A NCAC 2C.III IP. —
9. 1'IIiI.1)(gpnq: 0_—NiE1'll DQf"I'L•SF -
Ill. WAI IT lONI'S ldcplh): -
LOCA'I ION SKE I C'l i
-
1 DIS Show dil'eclion and dislauce ill (Miles Irolu al least
NO: '"(ION:Type. �� AAmountnud - _G
I 2_', CASINO: Wnll'rhickncss two State Roads or County Rualls. Indudc the nrul
!� UcptII DY'mnVicr or�WeeiighUli. Nl;&rial uumbets and Common road names.
Dunn V I u.__/ .ht-i2 �.J.��-LL(l-
I-nnl) _- l o_- -._--
Irom.-- - --
Il, (MOUI` Dcplh N1:dcn;d Nlclhod
I
rom_ _ PI. _ - -- -_---
C d
1 will
Id. S('RI:LN: Depol_J DmIIkccr Iul Sin NlalcrialI will
L
I wm
I5. SAND/GRAVFI. I'ACK: -
Depih Sizc M;Itelini
nun
Iloilo Tu H
r I yl)'H1 14111"cid2TII�T-i I T II[IS WFLI.WAS CONS]IOUCI FD IN ACCORDANCE WI I II I SA NCAC 2C.WELL
DNIDSAND'IIIATAC01'YOI•"IIIISRECORDIIASELPNI'KOVIDIiU'f0'fllliWL'IJ,OWNER
il1ji
u Li - --- - ------- L� -- SIUNAIUItIi01;IT NC'UNS'I"I( CI' OI11EWELL DADS
ccgl7, r)t-ti�e-:nri i»� n the Division of\1 nler Quality,Groundwater Seel ion, Ifi)(Nlail Sei vice ccoter-Raleigh,NC
i u ,l . r Il;„If.:; GW-1 111;V. 0712001
�/�f(919)711-.1221,within 311 dais.

258 if' 60
WELL CONSTRUCTION RECORD
Nm Ih(';ImIi ua - I)Clmluncnt of Frivironment and Natural Resources- Division of Water Quality-Groundwater Section
L
ANI'.LL(ON'I l(.\("IAlit I INDIVIDUAL)NAN1F (prinl)_�_"Y�n�l �J'1U111C.. S CF.R'f IFICATIONN c-G J�aS
\\F.i.I.(-O♦-IRA('IOR(ONIPANl'NAME Z;; rn(L4t �I PIIONF, N
,S I,\I if AN I:1.1.(I INS I R11("I]ON PERN11TN_ ASSUCIA'I ER\YQ PF.RMfIN
I if:gvplic;IblN (if npplicablc)
I. \\'lil.1, USE (C Beck Applicable Box): Residential d Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monkminn ❑ Recovery ❑ Ileal hoop Water Injection ❑ Other❑ If Other, List Use
2. \\'ITI. LUCA"I ION: f' .Topographic/Land selling
Nrarca Tmvm. _ /1 I U \ aK'`'-
1 ' County Midge []Slope ❑Valley ❑Flat
✓�:F-�l4_Li` %�� 27l '7`lam<<- ��� (check appropriate box)
1':burl Hninv.Nnmbel<,C'u roily.Sluhdi,kiin�n,Lot No_Zip ode) Iafifude/lougi(ude of well location
t f)\\'NF.R Addlc _/L'' -�� r/Cl�� •�n� _ plegrecs/minwes/zeanWs)
ss /\_'7"J r ,j Latitude/l ougi little source:❑GPSOTopographic neap
_ (snvo nt Itaulr N,, .y (check hux)
/41�TIA:= I C'_6iatJ �•t) �7J / ' llL'I'I'll DRILLING LOG
city or Im.m Slnre �t>•�- 7,ip Cndr Floor 10 Formation Description
c'L ;47
I. I)A Ilf I I 'I.ED
- ��-
5. '101-At, DFI''fl l:
G_ DOES W'F.Ll, RF.I'I.ACF. EXIS'ZING WELL? YES ❑ No Q
7. S I A I K' WA I Elf I+.V l'.I, Bclow Top of Casing: )-� FT.
(Use•'I••if Ahore'I op of Casing)
9, 1 01' OF CASING IS F'I'. Above [,,and Surfacc'
'l np of owing Irrudn:ned allnr helasr IanA carfare requlree a -
.arlana•Io acaa dvnra n'ith ISA NG\('2C.0118. i --
9. )'IIILD (g1llll): "S NJF.I I IOU OF I FS1'�>)
10 WA1l1R LO N I[S(d epl I i): . —
LOCAIION SKE ICI I
I I I)ISINI I.0 l 1(IN T)J'c"- )I-i // Amount VP Show dircclion and dislancc in miles from at (cast
12. CASIN( Wall'Ihickncss two Stale Roads or County Roads. Include fire road
DcPIII 1)anleler or Weighu Fl. Material numbers and common road names.
Ilnm U To (20, FI. 1 _l Q0 )_� P u
From
I-cool_..
11. GROUI Depol t`bucrial� NIClllod rQ �-
Cz
1 ml° ) 7___ to
I I_ S(l(I N Dvpol fir mwlcl+/ SIu1.Si7C Material N - -
U
Faun To FI. in.
I-rnm -
IS SANOAMAA'IT PACK-
Drptll Sizc Malcrial
I umt fit
I
to Itl!N/J(K&.
tI D✓JA Il ltj B4 ( I'�t 1I6 1111S WITI,WAS CONSTRUCTED IN ACCORDANCE WITII I-SA NCAC ZC,WELL
—k 1,11S I itt-ICttt-tN-St2ttdh�r If AND I1IA I A COPY OF fI IIS RECORD IIAS BEEN PROVIDED 1O'rlIt;WELL OWNER
S1 ' �_3 0Z
I' SIGNAI t1Rli 01:1(76N&i] C11NG 111F WIiLL UATF
i I
N�iitoi,iiflhe oi'1glfu-;rt7{F-fhe Ili isiun of Water Qunlilyt Groundwater Section, 1636 Mail Service Center-Raleigh,NC
2767946e161'hmte No.Mot 73.1-3221.a%ifliiii 31) daps. 6W-1 REV. 07/2001

WELL CONSTRUCTION RECORD 2 6 2 3 25
North Carolina-Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAME (printl `C.. oipS tom. 1� "y t \5o'fl CERTIFICATION 0--wC"7
WELL CONTRACTOR COMPANY NAME Y14 (9 � \/.�i'',11 b�- (I1 -1 PHONE / (424) k37--Z4i I
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
I. WELL USE(Check Applicable Box): Residential El]—ivlunicipaVPublic❑ Industrial❑ Agricultural❑
Monitoring❑ Recovery ❑ Ileat Pump Water Injection❑ Other❑ If Other,List Use
2. WELL LOCATION: Topographic7Land setting
Nearest'loww�1� In 1A. Count - Midge ©Slope Malley ❑Flat
(check appropriate boa)
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) LalitudeAongltude of well location
3. OWNER:1
42(-L)1� 4-- /` ii= 7-g F_< (degir"s/minutes/smonds)
Address ')5c) roll AluAr 1("/ Latitudellongitude source:❑GPS❑Topographic map
(Street or Route No.) (cheek boz)
�15« DEPTH PAL[ILI(Qi, G
City or To n Stare Zip Code From To Foa(io Descr'T iption
Area code-Phone number '
4. DATE DRILLED,7 - q(" 1 l - L� ILI zcl i `
5. TOTAL DEPTH: �)V/
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO ❑
7. STATIC WATER LEVEL Below Top of Casing:_L2L FT.
(Use"+"if Above Top of Cuing)
8. TOP OF CASING IS Ff. Above Land Surface'
*'top destine terminated Wor below land mrfsce requires a
variance In accordance with ISA NCAC 1C.0116.
9. YIELD(gpm): a METIIOD OF TESTe!,9/
10. WATER ZONES(depth):
LOCATION SKETCH
11. DISINFECTION:Type '-Amount Z/ Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads. Include the road
Depth Diameter oar We:iRhVFI. Material numbers and common road names.
Front /9 To L Ft. /,,.,�ti. >+V'� Ll _ p
From To - Ft. ry _
From To Ft. o
13. GROUT: Depth Material / Method —s
From To-,J_e2_�F1 '01x r"y
From To Ft. -J
14. SCREEN: Depth Diameter Slot Size Material
Front To__Ft. in. in. —
From To Fl. 1e. in.
15. SANDIGRAVEL PACK: o
Depth Size Material From To Ft.
From To Ft.
16. REMARKS:
I L WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
C S T A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
'."i F( -%�
SI OF PERSON CONSTRUCHNO THE WELL DATE
S bmlt he original to the Division of later Quality,Groundwater Section,1636 Mall Service Center-Raleigh,NC
2 699-I will In30days. GW-1 REV.07/2001 _
ASHEVILLE REGIONAL OFFICE

• WELL CONSTRUCTION RECORD 262324
North Carolina-Department of Environment and-Natural Resources-Division of Water Quality-Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAME (prinQl )CA P--' K i.l7� LS F1� CERTIFICATIONB,2 �q
WELL CONTRACTOR COMPANY NAME M� UPC-NA)0-h C'�6: I), J)G PHONE 0 (4dY) S31-20P
STATE WELL CONSTRUCTION PERMITB ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE(Check Applicable Box): Residential ❑ Municipal/Public❑ Industrial ❑ Agricultural ❑
Monitoring❑ Recovery ❑ (lest Pump Water Injection❑ Other❑ If Other,List Use
2. WELL LOCATION: Topographic/Land setting
Nearest'(own:ffll1l County ❑Ridge ❑Slope 01Valley ❑Flat
is l I -I rP P l- (check appropriate box)
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) Latitude/longitude of well location
(3. OWNER:�h PyAn h (n 1\!4(I.PYCn (degrees/minutes/sccende)
Address el S- 0 !e LatitudcAongitude source:❑GPS❑Topographic m?p
T(Street or Route No.) (check box)
VY)U r I� u( I 0 RC>D� DE DRILLING LOG
Cityor Town Stale Zip Code From To 'nOTt tion Descriplion
(�- o - � ` 1 k
Ants
code-Phone number D
4. DATE DRILLED ~I - 01 - 02
5. TOTALDEPTH: ,2U�' D '
6. DOES WELL REPLACE EXISTING WELL7 YES 9--J10 III
7. STATIC WATER LEVEL Below Top of Casing:
(Use••+••if Above Top of Cuing)
8. TOP OF CASING IS I FT.Above Land Surface'
*Top of cuing terminated War below land surface requires a
variance In accordance with 15A NCAC 3C.0118'
9. YIELD(gpm):=�_METHOD OF TEST
10.WATER ZONES(depth):
LOCATION SKETCH
11. DISINFECTION:Type Amount A Show direction and distance in miles from at least
12. CASING: Wall Thickness two Stale Roads or County Roads. Include the road
Depth Diameter or Weight/Ft. Material numbers and common road names. -
From To faQ F 1,)( kr —
v
From To - Ft.
From To FL
13. GROUT: Depth Mete ' Method >
From_0 To 26) ' Ft.
From To Ft. -
14. SCREEN: Depth Diameter Slot Size Material
From To_._Ft. in. in.
From To rt. in. in. = -
15. SAND/GRAVEL PACK:
Depth Size Material
From To FL
From To Ft.
16. ((RR�EM((��ARpKS::pp
D �QgEI�BVICL',RTI IS WELL WAS CONSTRUCTED M ACCORDANCE WITH ISA NCAC 2C,WELL
AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
IGNATURE OF PERSON CONSTRUCTING THE WELL DATE
p @®XIhe Div sion of Water Quality,Groundwater Sections 1636 Mail Service Center-Raleigh,NC
AS}yF914A$ 211,within 30 days. 0 W-I REV.07/2001

WELL CONSTRUCTION RECORD 25 82 � s
North Carolina-Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAME (print)— gadlZ - �G� CERTIFICATION Y 17S
WELL CONTRACTOR COMPANY NAME 1/\In i 'DriI lin,Gj Th(' PHONE N ('I(Yt✓
STATE WELL CONSTRUCTION PERMrIW ASSOCIATED WQ PERMIT'S
__�Lfapplicable) _ (ifaoolicable�
I. WELL USE(Check Applicable Box):Residential ly' MuolCIpal/Public❑ Industrial ❑ Agricultural❑
Monitoring❑ Recovery ❑ Heat Pump Water Injection❑ Other❑ If Other,List Use _
2. WELL LOCATION: opographic/Iandsetting
Nearest Town: O L i County [ Ridge OSlope ❑Valley ❑Flat
/ (check appropriate box)
(Sceet Name,Numbers,Community,Subdivixioo,Lot No.,Zip Cade) Latitude/longitude of µell location
3. OWNER:-2D fJ A/)L((( a (derraha auks seconds)
Address —�3(cQ 1 01A 3,n Id Nk-h = Latitude/Iongitude souice:QGPSCITopographic mao
(Stott ar Routo Na.) (check box)
�QlrSyiIic Get 3o�1a DEPTH DRILLING LOG
City or Town State Zip Code From To F rrDatiOA DOSCrI on
( 5�- 3(,,-iei O R G
Aran code.Phone number !
4. DATE DRILLED '1-I�i 0�
ME
5. TOTAL DEPTH: I Orn' /
6. DOES WELL.REPLACE E)CISTINIG WELL? YES ❑ NO E
7. STATIC WATER LEVEL Below Top of Casing;t FT.
(Una"+"IrAbove Top ofCasiol)
8. TOP OF CASING IS C2 FT.Above Land Surface'
*Top of casloy ttrminattd atfur below land surface mqulres;
varianm In ucordaaca whit 15A NCAC 2C.011L.
9. YIELD(gpm): a. METHOD OF T,E Q i� i TEt?yt —'
10. WATER ZONES(depth): (02
LOCATION SKETCH
11. DISINFECTION:Type ! i�lI Amount 1 z Show direction and distance in miles from at least
11 CASING: Wall Thickness two State Roads or County Roads,Include the road
Depth r or Weight/Ft. Ma al numbers and common road names. o
From D To Ft.� .5�27/.fo .
From To Ft, C—
Front____To_,FL -
N --
13. GROUI': Depth Material Method
From To FL
14. SCREEN: Depth Diameter Slot Sirs Material W 0 �q"~` yip
Q ,C•anrrY =„
From, To Ft in. is �',p�RKs o cn
From_ To F �t. an. in. 32rcM .i Ln o
15. SAND/GRAVEL PACK: I.6 i•
Depth: Size Material Q f0E612o6xLi RD
From To FL �` (mot sQig,TZ
From L To Ft. ti VIVdlZE,
16. REMARKS: ?`
� T THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
1 CDNS-TR,L,C (pN,ST S,AND THAT PY,QF THIS ,XRD HAS BEEN PROVIDED TO 7H5 WELL OWNER
U - 6- 02
' Sl ATURE OF PERSON CONSTRUCTING THE WELL DATE
u i!
Submit the original to the Division of Water Quality,Groundwater Section,1636 Mail Service Center-RAeigtq NC
(919) 3-3221,within 30 clays, GW-1 REV. 07/2001
GROU��dGVJATER SECTION
AGHEVILLE REGIONAL OFFICE

WELL CONSTRUCTION RECORD 4- 0 812 7
North Carolina-Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section
WELL CONTRACTOR(IIV =DUAL)NAME T(print) LOn illQrd CERTIFICATION 03131
WELL CONTRACTOR COMPANY NAME_-� !h1 er6 Welt-Dri 11 i nab, inc. PHONE # LLa 745'2i�vlp
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT!!
(if applicable) (if applicable)
1. WELL USE(Check Applicable Box):Residential 0?-� Munldpal/Public 13 Industrial❑ Agricultural❑
Monitoring O Recovery Cl Heat Pump Water Injection 0 Other O If Other,List Use
2. WELL LOCATION: Topograpbic2andsetting
Nearest Town: Mt-k }Rho, NG County he OKee Swidge OSlope OValley ❑Flat
A11Ch Rd. r (check appropriate box)
(Swett Name,Numbers,Community,Subdivision,Lot No.,Zip Code) Latitude/longitude of Well location
3. OWNER: 61cy) -FranIG ;(degnes/nnutes/ceconds)
Address 27e) Allen Rol. Latitude/longitude sotuce:OGPSOTogographic map
(Street or Route No.) (check box)
_�n PrKil (N 3731�1 DP,PTH DRILLING LOG
0 or Iowa State Zip Code From To Formation Description
('7W)- Ua3-841�LA 6- 36 DQ-14D I Clay
rea A code-Phone number 30_ I� : o
4. DATE DRILLBD =T-p1-t7Z u 5 ct
aa
5. TOTALDEP7-H; �85 I AQ tarnni i
6. DOES WELL REPLACE EXISTINGWELL7 YES O NO m/ 2p_�,n� .Qe:ani k, Lhi WA Cr)
7. STATIC WATER LEVEL Below Top of Casing:,�O._FT. -
_T
(Uae"+"if Above Top of Cuing)
8. TOP OF CASING IS�_FT.Above Land Surface'
'Top of cum=terminated ab'ur below land surface requires it
valance In accordsace with SSA NCAC 2C.0118.,
9. 1ULD(gpm): 4-5 METHOD OF TUT A,]) 21N
10, WATER ZONES(depth):
LOCATION
11. DISINFECTION:Type Amount 1 16. Show direction and distance in miles from at least
12. CASING: Well Thickness two State Roads or County Roads.Include the road
Depth Diameter or Weight/Ft. Material numbers and common road names.
Front_() To 30 Ft. Cv'l*' _ C7,
c.
From__,___To Ft. ^'
From To_,FL
GROUT:13GROUT: Depth Material Method Gel.•Ca.u5c.
From To LL Ft. Con
From_To Ft. rJ
14. SCREEN; Depth Diameter Slot Sim Material C-
From, To Ftjn. in. NG/•ft�l rn
Fton>R„To -in. in. lines o
15. SAND/GRAVEL PACK: _
Depth: Size Material to
From_To-Ft.
From _To Ft. m N
lb. REMARKS:
TIiAT T14IS WELL WAS CONSTRUCTED 1N ACCORDANCE WITH 1SA NCAC 2C,WELL
Df� ((�CQIIVS'f1RlIG7fI - S ARDS,AND A PY THIS RECORD HAS SEEN PROVIDED TO THM WELL OWNER
LS llli IS ll U _//Av 0
i' SlUNATME OF PERSON CONSTRUCTING THE WELL DATE
AK
Submit the original to be Division of Water Quality,Groundwater Section,1636 Mail Service Center-Raleigtt,NC
276gy 1636 Phoneo.(9 9)733-3221,Within 30 days, GW-1 REV. 07/2001
CFOLL!i':1 s E4C110d!

256543
NVELL CONSTRUCTION RECORD
No III(aIll Ila - Department of I:ncironmenI and Natural Resources- Division of Water Quality-Grout dwa(er Section r
11 ra i. ON I it v loIt I IN III\'lll(IAL)NANIF./((Kin+I) I'c�1'h^'\ _ wn��� C4:ICf1 FICA'll(I`N p ���S
111:1.1 ('(INlll Af"I(nt('0111',\N1'N:\NI4:__�` {_1 ��%{sL �-I1 __�RI �I( -_fIl(IN4, N (5it)
SI \11. 1c L l ( ONSIM l HON Pk:14MITN_,_______ _AStiUCI,\TF.II\\'OPF:It\II'IX _
li( plJ icablcl -/ (i1";Ipplicahlc)
11SP. (('heck Applicahle Box): Residential lN" Muo icipal/Public 0 Industrial ❑ Agricullural ❑
M,mi1nl ing❑ Recovery ❑ I leat Pump Water Injection ❑ Other ❑ If Other, List Use _
\\'Itl.l. LJ WA ION: Topographic/Land setting
Ne:Ire l 1mvil /31U+' j County_ llaluk 611ge EISlopc Ovalley ❑flat
Ichnk nppmpriric hnq
G,rcI NI:I m.N.....1 rn,('on nnn:il),SubJivmm11,La(No..Zip C,ulc) I.Illllldl'/I llllgllllele'of well location
{. I Nl'lt: ____��.n'1."�\7�,l,. L-'—_�� �J�_ Idaprc¢chniuulecl�cconda
Adds css J.�SLL�.St —k> ' �EitilCif7C'� LaliluJr/IongiluJc soulcc:O(il'SOTupugiaphic map
(tin, l aI ILnnc Nu,I / / Idlcck burl
1IA C`_ —. �j�� \G' Di!l,III DRILLING LOG
-_- I o r c sl::`C_ �,� zip C,Ic Flom "o Formation Description
L9
VICI o•aa i'h�,no n,nnb.r �,Q� ���7� /t
(I_ DOfS 1A'lll.l, RIII'LA(-I'. I'XISTING WELL? YISy NQ
7. SI A'I K WA I IT I.IIVI71, 13clow"fop of f asing: -!�—_I'I' - -- __
Illsc"I"if Abucc'I i:p of('nainpl
S. 101'(W CASING IS F'I Above Laud Sul face' - --- -_
•l�q:or vaaiue Mrminaled ai/or Lrinw Innd sm$Iar rrquircf u --_— _
,:ni:ume bl:arvn A:: 1'nill, IS\ N("ACZC.IIIIN.
'). 1'II!L ) lepwl: .11IOD 0I ITS(__ --
10. AVA 11;R --
LOCATION SKFI CI I
11. I)tYNI'P.l'IION. Type% /� Amount __)`L Show direclion noel distance in miles from al (cast
12 CASI N(l: Wall Thickness Iwo State Roads or County Roads. Include the mad
Depth Diameter or Wciehlfl I. NI;krill Illillibels and colonlon lead tlallles.
�VG - -
N
II ORl llll : -- - Depth pnnl��alc�/ll It I.� Nlcthod C
om _
I t Q ln_�Q�._ h. f i" -- ---— r -
fnnn to
V1.1 N' Uy:ll, Diunlc"- Slot Six NI IICIinI _
will To 171 __.____in.
I5. SAND.(i RAA'I'A, PAl'K: � r
I)cplh Size Nt:ucrinl O �,
I mill _ -- -.Io -
-----
Iloin
1(I. PLNIARKS: _-----------__—_-- --- —
r Ir ,
II 'I p+ Il14I!I`yy K�If -1 \'I'11115 NI'LI,R'AS CONS1ItUC I1rD IN ACCORDANCE \Vffll 15A NCAC 2C,1VLLL.
—t-r-rl3ttFtt+(-YtrJI�S'f� I) DS AND IIIAIA COPY OI 11IISRFMIM]]ASBFI.NI'ROVIDCD"I-0111CWELL OWNER
-" "SI( NAIl)HL01 I'I.RSON(ONS4 lJ(.IING 1111; \1'l l l DAII:
I
— nixrntf]T �k �� a Ih( 3rvismn of\\;rler Quality,(;I oundn Iles Section, IGJG Mail Set%ice(enter-ILJcigh,NC
,ROu G\ I RI,\1. 07/2011I
ASH,EA 'VRUC)k0 Ill Ill '10'Pfi( flt'I) .1 1121,within 31)da)S.

NVLLL CONSTRUCTION RECORD ry 6 9 8 3
Not Ih Cato ina - Dcpal It of Enviionutent and Natural Resources- Division ol'Walcr Quality-Groundwater Section�/
\\I'.I1 ('ON I It.\('IOIt I IN'DI\'II111AL)NARIF�('o M4t
,bit) �t ✓ �C — CEIRTIFICA'(ION aaJ((JE;
n I I l'nrvnt\( n)a coin Arv\ rvnalr: h�al ' __&k_hj d ruorvE a ( 31 837-ADO g
S IA I I( %`i I I .( ONS'I RV( I ION PERAll'I'a_..-- ------ASSUCI A'I'ED WQ PElrhli'I'#
I it as liclllc) oila)rlicablc
I. \\'1'.I.I. I ISI: (("Iteck Applicable Ro.e): Residential Muoicilial/Public ❑ Industrial ❑ Agricultural ❑
M,mioaing ❑ Recovery ❑ I Ical Pump Water Injection ❑ Other❑ II Oilier, List Use
2. %\'1:11 1. 1 1)CA IION: "hopographiciLan , .cuing
Ntmcsl Imk'n:-r_� /�-- .fuhaf .IL_ C'uunly' t ' —� ❑Itidge ❑Slope Malley Opal
_�/q1 15- it/it wk D Ichcckappnq,riatc hos)
1 Givct N:rn....N.nr. ,,,(lnn/mhmti ly,suhdrii��cisinu,Cut No..Zip C,�IcI L:II I(IId C!lUng1l lldC 01'u'CII I(tealinn
I. O\VNI',R'. 1 I LV�S� IJcgncshninnlcslscnmdsl
Addless (p-Q _ `��I-JSU/L/S� lG,(_ Latitude/longitude source:O(il'S❑Topographie map
f1 ISi,vo m Itnute Nn.) Ichcck Foal
OS_ nl $�1Q1 _ DEP III DRILLING LOG
nc, or)o,co slale zip C'udc I'- m Lo F ilion Description
Ama note ,.oe tto�oh
.1 DA
1M Al. DITI It
h. DOFS \C FLI_ Rl'.I'I.A(T FXIS I ING WE❑.7 YES-❑��NO C3—
7. SIAIICWAll?RI.IIVRL Below I op of Gasing:�D_—FT.
(llsc"a-if Abovc'fop of Cmio4)
R. '1 OI' ()I'C'ASIN(i IS P'1. Above Land Surface'
'l op of cadnG Ivnnlnaed a/nr helun land surface requires a
s:viaorc ha acandan Sysrilh I5A NCAC 2('An 19, —
4. VIVID (epin):�_J_ Nil;1 [lot)OI'"I�Es'I'_�._�__-- — --
In. \VAI FR ZONI'.S Idcplh)_ 't7' - --------- - — --
_ _ LOCATION SKH Cl l
/-
I I I)ISINIIi('l ION 'I Amount direction and dislance in miles I"ruin al least
. : '}'pc_�� _'�"�J�_
12 C'ASIN(i: Wall IIlickness two SIMI: Roads or County Roads. Include the road
Depth yy/ . [Iiimpcler or C•'gI Vfl (Material nutnhcis and common road names.
linlu _ to _—. PI. _ O c
IIt to In
G
I1. Rull -- Ucpt alrnd Mclhnd
ft _�/ -- r I nnn to C.J _
Id. S('Rlll-N: Ihpth I)i:uncicr ,'I'll Sin• Metcliol
f Tin Ta
I will Tu 11. in. in. ri
IS_ SANI)AWAV171, PACK u7 n�
I)cplh Size Mat CI al 0 0
Fran lL Pt.
I will To PI.
Itt RI MARKS:
I' ,GIP6al I I ITS \1'PLI.WAS CONS"I RUCI hD IN AC('ORDAN('1:WI'fl 115A NCAC 2C. WI
iLL
L t(lil;\ all) i NI)�IIIAI�A C OPY OF"IIIIS RITORD HAS HEFN I'ROVIDPUTO'fill; WLI.1,OWNER
ARMl UIT UI' I'L'RS ('U IRUC IIN(i lllp R'lll.l, UAII?
roil-llu-w ly,.inal II>1llr Die Sion of Walel Quality, Groundwater Sec'lion, 1636 Nlail Service Cculcr-Italaigh,NC
A ' l h ' arVo 221,rsilhin 11 flays. (AV-I It :V. 1712001

25G992
NVGLL CONSTRUCTION RLCORD
Nm dl(';it ul ina - I)c pa r l l I I of I'.nv it unmetil and Natural Resources - Division of Water Qualify-Groundwater Section
NNI I'I ( ON IIt.\(-101t(IN I)IN 11)11A I.)NANI P�Q1rL,ll�- _M/ JOa(�5 ._.-- CERIIllCAII pIONp�6_5 (`
V\IAI AONI IM 101I I011 'AN\'NAME�yIr.�O�GC�, �' ( 1�[1'V —1'IIONE (b/.7�N ,3�''O U06
S1.\I r \\I:1.1.1 l INSI Ill'1 I ION 11FRINIITN lNStiUC'h\'I Ell\\'Q PERNNIII'I N
Iil:Ipldicablc) �/ (ifapplicable)
I. 1\'1:1 L I ISV (Check Applicable Box): Residential is Municipal/Public ❑ Industrial ❑ Agricultural ❑
Nnnilm iug❑ Recovery ❑ Ilea( Pump Water Injecliun O Other❑ If Other, Lisl Use
/'fopogr;glhic/Land selling
Nrure—slTmvu:--rr'Mntlh'�C _Counly1CQe. ®Ridge ❑Slope ❑Valley ❑flat
Y1 Ve- -Fop,Iis__-La � _ (chcck n pinnpr imc hm)
1'airat N,.... Nn//myYb�1a<,Conmmnily,$uhuJiei^inn,Lua Na_Zip Cudcl L'allllldc/lnllgllllllc of w'CII location
1, 1)\\'NIIR:_,'L/Q nl•'U�/ �je&JA '� —_ Idcgrccs/nlinW rshcun.Asl
A ddlcsS _� r3.._2 �_L$3!�'� GI— Latitude/longitude scurcc:❑Cil'S❑l7)pugraphic map
(5alCO ar I(nwc Nn.l Idutk hurl
L DRILLING LOG
t it, I....n slate Zip C.,dc PI 1 yt I n lion Des ripti)m
,ben
5. "IMALDITII1'._>� Jam_._..__-- _
6. DUI(S N'I'LI. RfPl.ncf. f.XISTING well:? YES ❑ NO 17--
7. S1All(' 1VA1-I[Itl.li\'I[LUcluw"fapofCtasing: S�Q�P"I ---
I(w"1"ir Ahuve'rnp ,r(,n,ing)
S_ 1(W Of CASING IS 1:1*. Abovc Land Surllce"
1 up nr araiai;Irnui nalrJ nUor Lim.'land surface requires
.:ni:n,ce L:a1u1111 u rc„ilb It,\ NC.%('ZC III IA. ) —
t). Y1111.Dfupnl):_ � MI'1'1101) I'I•,Sf_ —
10_ WA 111R /ONI'.S(deplll): (7
LOCATION SKID ClI
I I. DISINI'PC'ITON. Type"_ _ Anu)ul1 Cop Slaw direclion and dislancc in miles Ir nl al (cast
12, ('/\SING: Wall]Ilickness hro Slate Rua(IS ur Cuunly Roads. Include Ills road
0g)(11 / I)i:uncicr n/r�Weighl/fl. �pBeer a1 utmlhels and common road mutes. O
Tu_YU_ IL_�__ ,�ij1� 1 Y tV
Droll ___ l o _ PI. __ r —
I I. GRO(II I)y,lll -._ N ucnal Method
I nm1 To t / t7 I I &C— O -r
.__.. 1 .-- , - --- _
limn 14, Pt_
1.1. Sf'RI.I`N Ucp1h Di:unclel Slut Size Macrial
cn—
Innn
I"will To II. iu. iu. Ca
15 SrA N WGRA V 1!I. I'A('K: o
Ucptli SIYC Nh icri:d
Ilnm Tn IL
[ will lL
L �l II ILICII r N'1;klII I AI I I I I S\Vfl.l.AVAS( ()NS IIt I JCIT'1) IN ACUOR DAN('li WI-fll I5A NCAC 2C,WLI 1.
_4tkS+Jt 1JUN 0A D, DS.AND'I1IAI A COI'1'0I' I1IIS RIV II HAS 'PN I'ROVIDfDIY)'I III;WELL OWNER
SIGNATIIIt Ii Of I'IiItSON CON lR Cl IN ' � i WELL DATE
GR,)J' m/�1t'I'r'I • 4L1j1 d In Ill Division of Waller Oualily,Ground\rulet,Section. 1636 Mail Service('en(er- Raleigh,NC
ASHEVIL 'a( IYT({f,Titi©1Sn.l'l l') 733-3221,IN it Ili 1131) d:q s, (iW-1 I(EV. 07/2001

2rfi981
WELL CONSTRUCTION RECORD
Not Ib Carolina - I)ep:ulnle nl of Environment and Natural Resources- Division of\Niter Quality-Groundwater Section
w l l.r.('OS I It:%(-10It IIN 01 VI D t l A L)NAhI I` Iprinp 1�_'�K/.h _ F� CFR"1'IFICA110144 a �6
wI'LLl'll\'I Ii.\('f(11i CUM1`,\N 1'N'AaIE- (r ___ -J^�� •i.�.LLf_ruoNF, a (J 18i7-$c7�
s t %I I Nil'I.I.('O SI1(I'I I MIN I'IClihllTq-- -----nSS(1C1.\'FFII\\'Q 1•r71 a11'(a _—
li(npplic:d+lig _ / (i(n....cahcl l
(('heck Applicahlc Ros): RCSirlClllial O�Municipal/Public ❑ Indosirial ❑ AgricuUural O
Mmlilming ❑ Rccomy ❑ heal Pump Water Injection ❑ Othcr ❑ If Other, I-is( Use
'_ \C'EI.I. I OCAIION. 'I'opoLtra I(JLand sclting
NCall'FI T11%Nll. 177 1{_�,A . _CouulyC �. ❑Ridge Uopc ❑Valley 011m
�'— 9 Idtcek appl nprialr heel
i1 uwcl N'auv.N..... a.('onj+in...y.Suhdicisinn•Lot No_Z.iipLp�,Cudc) Latilrlde?longilude of\VCII location
J. OWNI[R:.-_-_ _IGh/�P Ll--l1._rP hhg—i•.c�/ininiuealseennJ•)
AJdlcss _---(' � _f1JNR f>UN. 2 lalilildc/loogilude source:c1(;PS0-fopoginphic map
/ (Nn,o m Roo1r No) Idu•ck bnr)
- --_/-/ywp_.S��/;I-� _ �Cl _ DI;I'1'II DRILLING LOG
I in or „ slam I Zip O'd, from To ISuwalinn Dysc fiplion
) a%i Q P Sn 4c-
k
S. TOIAI. DFPIII: -----
b_ UOI:S VA'FLI, REI'LACT. FXIS"PING WELL? YES ❑ NO ❑r v
7. SI AIIC \VA"Il!R I.1iV1.I. 13cloa•'fop of Casing:_,-�-2_I:'I-.
(Use"1"if Aboec'I np of('a<inFl
I( I OP 0I7 CASING IS 1: Above band Surlace'
•Top nl raaiva lenniu arnA alhrr hrtnw laud sarfacr m1ulrer x ---
vaii:v�n•h�a......ulre++Ilh ICA N('AC 2C VI la. - —'-
9" 1 HAP(gpol): _�--5�__- b'll;11lol) OI' I I:S I'_ -C/ "—
Io. WA I ZONI'.S(dcplh): _/NJ D'��- .1.[���l�i� -- --- —
LOCA'I ION SKI;I Cl I
II. DISINI'FJ IION:"INile Anenutl _C
Show dircClion and distance in miles Irool al least
12 CASING: Wall thickness two Stale Roads or County Roads. Include the road
Dr1,111 Di'me ier or\Vci hVli. nl'lerial numbers olld common road mores.
Ft ---------------
I Wml II Ucplrhb Nlar1' pldh,+d
I non 0 1 /-D I I
I Imo 2O � It, 1 C_' I:I — __.— N
I 1 St'RI I N Ihl lh Diamcicr( lot S17C Nlalcrial ='
CI will
IS SANDI(;RAVIA. I'M'K:- - -- C3 _-
Depih SiM Alaacrial _
a
Flinn It, FI.
Ilom To_ -- .--_ H."._
Ca n
DJPLt I O 1Lf�'.R�4D- �'I:LN�I ll:-11 - I I IIS 11'I�.LI.\VAS('ONSTRII('ll!D IN AC CORDAN('li\Vlll l I SA NCAC H',\1'ITI. `
( 1 I AND HIM A COPY 01:1111S RECORD I IAS IlRli_N I•ROVIDIiD l0'fill; 1VP.LL OWNER
'IGNA1URL'0I PERSO, ON '" (UCI1N(i It IE \VITI, DA'1li---�.
�RbtlP71!'1.fy1,,aK1;�l11 -I T) c Dir siun of\\'alcr Oil,11 ily.G roll utlrralcr Seel ion, IGiG Mail Set rice('cId(•r- Rnlcigh,NC
AS¢C�1l LF1,RE81G( ulA' (iAV-1 IZI:V.I17/2Uo 1
6rC`i�)71}. 221, u'ilhin )11 flan s.

) R580
WELL CONSTRUCTION RECORD
Not I Caul Iina - I)cpa I I leoI al'Tn\i rmanew and Natural Resotaces- Division of Water Quality-Groundwater Section
\\1'.1.1,('ON'1 R\('1014(INIII\'I IIUA L)NAp1I-,(j(I"lull— V 1 M.MJ`y'- _ )O°•�1'�>_q_ C4;li'II FIC�\'fl(IN k�-7
IIIII(MIPAN\'N:\Mh;`Jlr:c+s�-'.-� .�" L� �LJ1r_)--PIIONE M
51.\l F: \1'P:I J.CONS'1 It I'1'1 IIIN' 1'litiNl ll'N_ ____"-__ASSO('I,\TEII\\'Q 14:I1N1✓ITN
lit;yrplicahle) (il applicable)__
I. \cP.IJ, I ISI'. (('heck Applicable Box): Residential Municipal/I'uhlic ❑ Industrial O Agricullural ❑
NhmihaiIIg❑ Rccm'c IN, ❑ I Icat Pump Water Inject inn ❑ Other❑ 11 Other, List Use
7. \\'FI.III.O('A IION' n) TOI)ogI a I I I l is/Lan , selling
Ncaresl T l}r�acn: 0-'•j bRP^_Lu:S u Conty G�� ❑Ridge ❑Slope dlcy ❑Flat
_ �lJ,'.)'\)LC�l�L1 l<�__ _ Ichc<k appr:,lnialc hall
l tin coI N:aue,N... 1'nn unmlily.Suhdi,kk-,l,Lot Na.,Zip('arlel IAllllld C/Illllgl hl(ll'Ill Well loeallon
} O\\NI-It �}�/ IJc4mr•ituinmrsh..... l
AdIhcsv -SG.Cab Latitude/langiludc suwcc:❑(iP5❑Topugrtphic mop
151.rc.or It outs Ni.) --��7. (check ho<)
---�RA-I)-KI-1-0 tiC ot9� ---- I)I;��rll URIL.I.LNGI.OG
('i.e or-1..ra„ ['.Ill Zip Cade From 'Po Formation es•n Janl
A:va ernle III vere number O _
.1. UAII{ IwlI I.F.U_ �2 l7 ?S. IOI A1, ---
M1. UOFS \\'FIA. RILI'I.ACI; EXISTING WTLL;? YTS ❑ NO EF —
7. S I A I R WA I IT I. Vld, Below"I op ol'C'asing: 'ZDI"1'
10sc"t"if Ahavc'I'np nf('nsinpl
S. 1 011 OI CASINO IS L —
1:1 . Above Land Sot Free*
•I up of rnciug Irnniu:ad al/ur Ir,o,land owkcc milliles a
:mixn rr In...... :v¢r Dill. 15A NCAC 2C.11118. -
'). 1'II!I.Olepmg�9__—p11CIlIO1)O17'FIiST �• -- --
11). WA I FIZ ZONI:S —
LOCA'I ION SKI I"CI I
I I. OISINIIC"(ION: "Iypc �_ Amount C U Shaw dire(aion and distance in miles Gam it( least
12 CASING Wall"I hickness 1\vu Sl;ac Roads or County Roads. Include the nlad
Ucplh U'one of�Wcighl/FI, taterial numbers and common road names.
Tonto
11, (i1t1)UI`. UCplh ,tj�/dcnul Nlclhod rV 'o
17on1_C7._.
Ilnm l n FI'.. -
I I S('Rl 1:N: Depth Diameter SI111 Size Nl:amial
I-uml -- _..--- l o
15. SANO (iltAVILI. I'MK: "n
I eplll Size M11felia
I will
1L I41,.V1ARha —_--
i" 111
I ,+N-k+111'ti-ttttl l 111,NI. I111S\\'I LL\VAC(.'DNS 11211('ITI) IN AC('URUAN('L Willi 15A NCAC'2C,WELL
( UN Sit I t It I ION Sl ANDA' Ip` .AND I I IA I A COPY OF Il IIS Il li(�OItD HAS L)ITN pROVIDED'LO Il Ili WELL U1VNIiR
U(iNAllllt 1,Uh I'F.RSUN CONS(KUC 1NG II 11: WI'.LI. DA I F.
TQp I
Submit I Ii�TC1olF�ly Di\'siou u(\\';der Quality,GruundWnler Section, 163G plait ticrrice('eater-Raleigh,NC
27699.1616 I'loml . . -t221,Within 111 dacs. (',\V-1 RI:V. 07/2001

WELL CONSTRUCTION RECORD
NnIIh ('al olinn - Ucpm uuenl illlinvironulenl and Natural Resources- Division of Water Quill ity-Groundwater Section
Y a�
\cla.l.C ON 111.\CaOn(INnIY IDIIAI.)NAME (rrin'l)___ ^21.�n'� !`1JU�S"t-T_ CER11FICATI�o N�7lr'y-�7+ p
wT'.U,( ON llt A('lYllt('ONI'AN\'NAME
tit.\'11'.\\I'.1.1.1"1)Nti'l ltl'('1111N I'I(INIO'q""—_ ____ASSIICI,\'Thar\\'Q 14;H�11'Iq —_
lif ppli-Ibl•) (ifapplicablc) _
I. \\ ITI. USP. (('heck Applicable Box): Resideuli:d 01 Municipal/huhlic ❑ Indushi:d ❑ Agricullutal ❑
Nlmiloiout ❑ Recovery ❑ Ilcal pump Water Injection ❑ Other ❑ If Other, LIM Use
2 \\ PLI. LO('A I ION. 'topographic/Land s ling
Neal,It Town: ,�_l.(_ML _ County- � ❑Ridt- ❑Slope Icy ❑IAM
JJ ra:�//��//./ O4b_tV r /tu". �CrI..LUiI� Icncck iIppo.prinle boO
ISli'l-o/J:onr.Nu..Zc.,,(lnn.I.un ily,Suhdivicinn,tIll Nn..Zip CI de) 1.:II II IId C/IOII�HIIII(1l' Of well IIICAIIUII
/0_ Al � �Ij-- Idclavcc!ininwccicra�nJcl
Adds css --_ .Q�C—_/C�71! Laliludr/Iongil Utle source:❑("k N,x)opoErlphic nlap
—�'- --- 1— Idreck hncl
llaic l``ry/ Dlir_rll Dlatul I e Loa
t 1, toe - tS,;,l zip coat I lyiln f Pot la l'an I cscllp( nn
nl,�»r•i.le rLi•m�IIIII:d,.
III'.I'III:
6 U Ii1 nl:S WI;1,1. R 'IACT. FNISI'ING WPLL? A•ES ElNO D�_
7. STATIC' \1'All'R1.1[Vl71. Ilelow•'I'oporCesing: �.,"�—_P]
II I<c"r"if AIsnvc'I i:p of('»<inpl
s. I OP OF CASING IS J __" P'I. Above land Surface' --
1 np n(r.I.iug tvrmbulted»tlur Lenox land nlrflre requires a -
rariann In»ceurJ;1�yr wllIs IS\ NCAC 2C.III I8. ---
n. M111i'111OD l l I;S r�y�-� -- -----
IIL W,\I VR lONFS ldcplh): -
LOCA"IION SKEI"ClI
I I. UISINIIi('I-IIIN:"type_ Amount Show direction:md distance in miles fronl at lead
1— 1-- —
(':\SING: Wall'lhickncss Iwo Stale Roads(it C'ounly Roads lOchulc the load
UC1,111 1).,m ICU or Wci�IIVI I. I`Iatelml nunlbcls and common road names.
,/
--lom
I'lmll
I.; (MM1I .__._ IkpIL ..._._ plolcnnl Mcllnnl C cam,
Inns D la�Z� II (��,<r�•tf - +—
_— - _ � �� r .
Id. Sl'RII.N: Depth Di:under . IulSi7C pl ucl i;d o =
w
1 will----- - - lo- -- - -- 1L—__in' ----- in.
IS SAN Y(WAVIA, I'A('K
I)cplh SOC hl;ucrialI will
G
Inln II)__._.
16. RIlNIARKS:
11" it AT MIS 111I?I I.WAS('ONS I RI I( 11'.0 IN AC'C'ORIMN('If N'lll l I SA NCAC 2C,WI:LI.
r ) SIRII( III— IN SIAN�).k US.AND IIIAI ACOPYOP 1111S ItI:('ORD HAS IILHN PROVIDID TOI III:WELL OWNFR
`I 1 SIGNATURE OF I'PR3ON ) 1 CI I III'.\41'.1_I, DA 11:N
4�—
GRL ((@+f/f;ThP Ir»uko�C 1 Ihr )icision of\\'airr Qualily,Grouudtvalcr Srclinn, 163E Dlail Scrricc('cer- It:dcikh,NC
ASHEIJ4,bIf i vt4 ,' � , 3-3221,willlin 311 dacs. (;W_I Rl:,V. 07/2001

NVELL CONSTRUCTION RF,CORD 2r- 56978
Nm Ih('ondi I - Della I I nenl of lalvironwent and Nalural Resources- Uivisiolt of W;Itter Quality-Groundwaler Section\Vci 1..('.ON I It.\C. I OR(IN nl\'InUAI.I NAnl6�ll _ CER IIFICA1'$IIO) N$N3--;76—`dCC
\\ILI ( ON I u\('[OR COnl 'ArvY NAME � ` — � O
_: L bPjW P SI.\II, %%1Ll.('ONS'I RI'( I ION 1'E.I(nll'I-k_ ___ASSOCIA'I-ED%%Q ITIMIIIM _
(it;Ipplicnblc) ,�/ (if applicable)
1 \\'I I.I. Oel; (Check Applicable Ilex): Residential ly' Municipal/public ❑ Industrial ❑ Agricultural ❑
Mnnilming❑ Recoxcly ❑ I1eal 11wnp Water Injection ❑ Other❑ If Olher, List Use
2 \VI:I.I. I ()(7Vl ION' fopopyltic/Land selling
Ncalesl lorcu: �V _County_ 't. IF'Itidge []Slope ❑Valley ❑plat
� +/ H )j,•• � ___ (check appn gninle hnq
tln,o N:.... Nun.bna,f,nnnnmily,Suhdivio,a.%Lot No.Zip C„dcl I:II II Iidc/l Oliglt title Of%%c11 locatioll
{. 0%k NI'.R: Egni HA ��K —_ Idrprecrgninolcckrt'unJsl
Addle- .____7..z.�___�.F�� i'•) D� I;I(ilu(IC/longitude source OGIVS❑Tupogr;lphic nrgr
/� ISb ccl nr It ..
Nol khcck bu.l
L�..h.NC1L{kl 3 - 3 Dlil'lll DRILLING LOCI
("II,oI ,rn Seal- C 7.ip CnJe Plum To Poe nation Ucscriplion
\¢a role Phnne nun,bet 2
1. I1AIliURILI.I[D___� _O `
G. DOIIS WELT. RI.I'LACE EXISTING WELL? YES ❑ NO ❑-
7. S"I AIIC' %V•A'l IT I.I:Vlil. liclow Top of C•:Ising:
if Ahuvc WPnr(:lciiq!1
R. IOP OF CASING IS -__ H. Above Land Surface' -
•'I,q,of rrtinl!Irnuivalol al/ar bela:.III(1,1,urrnce require,a
c:nl anrr lu nrrunl:ulrr ei(h ISA NCAC 1C.11118. —
9. 1'II:I.Dlepnp: Fill() 01• 'IFSI -
10. WA'11:R ZONES(dcpih): ,� 00 — —
LUCA'fION SKIiTCII
11, UISINI RAION: 1}•pc /h/Z_ Anunud_ GL Show direction an(I distance in miles Gum al Irtsl
12. CASING: 1Vall'fhickncss Iwo Stale Roads or C•ounly Roads hlclude the road
"III•Ice o Wcighl/1'1. Maal`e ial nunlhcrs;uxl common road non(cs.
Ilonl_L7_ to •�.- I'1.�` ( _ ��1-_L `1C�
Ilom --"In____-___
_
to _._ ._._... 1 1. -- O
U. I;RUIJ I : Depth M;Itrli;l Mm cl7d
Inn, 0___
I I nn 20_ to 1 Q '_ I L _ __--.— Co
II. Sl RI I':N: Urplh Uian!cicr Sloi Sic Nla Olcrial _ —
lorl
IInol.____._. fn. .
n
I�. `,AND (;IZA% F,1, PACK: n
Ueplh Sizc Material r\) _n
lion To PI. _—
IIoul To
EI�1'(W.Rl4hl'- I I I IIS V1'ELI.AI'AS GUNS"I-RUC'IIiU IN ACCORDANCE WI 111 1 SA NCAC 2C,WELL
CI1NS I lit IC I IUN S I A A S, AND"I IIAI A COPY( P'I IUS RE 'ORD I IAS BFFN PROVIDED 10111E WELL OWNER
—� SIGNAT(MFOF P,R C t C'IINGIl11:Wi;[,t. UA'I li
GRDII i �j YiIFRISf f( iflNln the I iaision of 11'aler Qllali(i,',Grutuld(raler Section, I616 Mail Seri ice Center-Itr igh,NC
ASHEVIL F- I';' : S.!r6 q }1221,o'ilhin 111 dacs• GW-I REV. I17120111

25G9 75
NVELL CONSTRUCTION RECORD
No,Ill I moIina - Dcp:uunenl of LovironmenI and Natural Resources- Division of Water Quality-Groundwater Section
K� ['
NVIA.I YISIIt\f'I(IIt IINIII\'IUID\I•I N,\ash: rrinp )_AIM 1� C`l— _� _ ('1313'1'161CA'I'IOYp fJ�17J (^�
V,I II I ()NIIt\('IO It C(IJ I PA INI'N A I\I h:— l.L iL_ 1I V�]_1'IIONE p (�
S I A'I I(\IF,1.1.CO C571t R('I II1N I'hati\I I'fq__ ____-_,\SSUCI A'f hat N'Q I'h:I1DIT�j/p
ill a++Iicablcl (if a 1 rlicablc)
I. \\'1:1.1, USE (Check Applicable Box): Residential Municipal/Public ❑ ludusiri;d ❑ Agricultural ❑
Moniluriog❑ Itecocery ❑ I Ices Pump Water Injection ❑ Other❑ If(tiller, List Use-
2. \\'P.LI. L(H7\-I ION
: ��/�opogniphic/Land selling
Ncarr�a llrnv: '��u��/�� CoulllY K�C @'_ WfUdge ❑Slope ❑Valley ❑Plat
_ F76���__U�-f\_,2 -_t-yJ���_ Idicck:q+plaprialc heel
(Sn,cl `4 M,... �sl,Comm nmily,Subdicisi m,1 of�N,l.Zip Code) I:I(i(kId C1I0IIg IItIdC of wl•Il I(1C:1111/o
i 1)\l'NI!Itl n/ {q�'L�1,� �-rWri"�/r✓ �� Ideprccc�nlinlnc</<crnndsl
\ddlesx _—_ 55.2 f ?Pb (..I_ Lalitudc/Iongilude source:1101'S❑Topographic neap
IS(rl'CI or Itnolc No.) /' (check bne)
DEPIII DRILLING LOG
1 iI, -lo"n �Slalc Zip C 1:1 ock Frool -fo F r 1 on Dcscri nion
\i ra Dole Phone nnmhe 0
5- 'f()fAl. UI'I'"III: _
G. DOHS \\'FLI. RITI.A('F. EXISTING WELL;? YES ❑ NO ❑ —
7. S I A I K WA I FR I.E\'11_ Below"f(1p of Casing: /<�o I71'. --
(lke")"K AN,vc'I'op of Caaiog)
R, '1 OP OF CASING IS 17'1. Above Land Surface'
'I np of raring I...id olcd al/or h6o,land sanccc rtqulree a
arlanrc hl arartdal r +IIh ISA NCAC 2(' III18.
Yn:1 D Igpllu: -_ nrn root)of resr01
Y ----- —
10. WAIR LONIIS (depth): _h -�
LGCAIION SKE"hCII
I UISINPI'.C'IlON: l ypc _ Auunull_ GJ Show direction and distance in miles Gum at Icast
12. CASING: W:dl Thickness Iwo State Roads or Counly Roads. Include Ih(Wid
Ocpth 1) u�cr (it Wcigld/FI. Mya�l(•ri'll numbers and common marl names. c—
n
Rom TO hI.
Flom To FL CD -
II. GROI11 141,111 Nlatrl i' , Willod -
I It, �� -- It
1.1_ S('RP.I'N: Ucplh Di:o i is Iul Sizc Malcoal
I will To li. �IL ill. \� c
I non lb II, in. ill.
IS SAND/(iRAVFI, PACK:
Depth Size hlaterml
Flom to Pt.
Isom To II.
D 't' 1 01It: `;I , It(.;WFI,I,WAS CONSI IMC DID IN ACCORDANCE\VIM I5A NCAC 2C,WELL
I! I ONSIRII1, I10N1,IA l D' AND IHIM A( F''OI'YODIIS RE ' )RDIIAS BITNPROVIDEDTO'I-I11; WELLOWNER
I' l
� •IGNAIUItI'.UP I'IiRSUN CU tl1C} G1111 WELL DATE
G� IC Di Won of Walet u:di( JGromldwaler Seelion, IG]b Mail Service Censer- Raleigh,NC
°�7V(L't ��� vrllkGU(110A; Q )'+ k
2 ( ' ` � rf.f;)1ai17331221,vv it hio 111 daps. (;W-I REV. 07/2001

n `
WELL CONSTRUCTION RECORD `- 8
North Carolina-Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section
WELL CONTRACTOR ONDIMIJAL)NAM (prWI)F��cwk - CERTIFICATION$3f/
75
WELL CONTRACT OR COMPANY Noll Coe—` r 1DRiL L . -
PHONE
STATE WELL CONSTRUCTION PERMICµ ASSOCIATED WQ PERKM
1. WELL USE(Check Applicable Box):Residential V2 Munlcipal/Publie C1 Industrial ❑ Agricultural❑
Monitoring Cl Recovery 13 Heat Pump Water Injection❑ Other E3 if Other,List Use
2. WELL LOCATION:
Nearest Town:_ Couaty 'i�j E Topographic/Land setting
Ridge OSlope ❑Valley ❑Flat
(Street Name,Numben,Community,Subdivision,Lot No.,Tip Code) / (chock appropriate box)
Latitude/iongittide of well location
3. OWNER: rd l �e
Address �a �n 1 Y Yr 1 (degrade mLtu as aecoads)
(Saect c autr I � Latitude/iongitude sotuce:QGPSOTopographic mat,
_�,' 1 V'f1 Ci t\tom (check box)
City w Town . State Zie('rv!n Frc DEPTH
SLING LS
C—� �C (t- r- 7t w F , nc oa Dcooript on
Area code.Pbau number - C
4. DATE DRILLED -O Z a
.5. TOTAL DEPTH:6. DOES WELL REPLACE EXISTINGL'•L
W .L? YES 13NO 17, STATIC WATER LEVEL Below Top of Casing; S(n FT• �3a«1.�PD
(Vac If Above Top of Cuing)
S. TOP OF CASING IS---I FT.Abovo Land Surface-
'Top of wlat terminated at/ur below toad eurfaee requires it
varlanulnucord ce VUh I1ANCAC2C.oIM
9. YIELD(gpm): MBTHOD OF TEST_Qu__ __
10. WATER ZONES(deptb): o
11. DISINFECTION:Type d (� 199ATION SKETCH e
12. CASING: T �AOuat Show direction and distance in miles 4pm atlesst
S i t`C-L Wall Thichess two State Roads or County Roads.InciWs the-road
Dept orpW�eii t/Ft. Material numbtrs and common road names.From-0—Tc ISM Ft._ - C4
_,_From To Ft. �P
From To—_Ft,
13. GROUT: Depth Material 2
Fro �oa rt�_To1Q_Ft.("rn/I'p<'�-j From To Ft ^'1 `
14. SCREEN: Depth Diameter Slot Size Material a
From.._._To,.. Ft i iw %
From To Ft.aw-jn, in.
15. SAND/GRAVEL PACK: 3 h
Depth Size Material p
From, -TO Ft.
From To Ft.
w2eNe �c.
16. REMARKS:
THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
UCT[p*t$T S,AND THAT PY 0 'PHIS CORD HAS BEEN PROVIDED TO THE WELL OWNER
r - 3 -p2
SI ATURE OF PE ON C STRUCTINO TIDE WELL DATE
Submit the orie al to be Division of Water Quality,Groundwater Section,1636 NWI Service Center-P-Ceigit,NC
Lnti 1 n,ni t 3GNI FIVo.(9 9)733-3221,Within 30 days,
ASilEV iLi Rb�.,..� �,_ ;;FFICF GW-1 REV. OW2001

258163
WELL CONSTRUCTION RECORD
North Carolina-Department of Environment and1 Natural Resources-Division of Water Quality-Groundwater Section
WELL CONTRAC[OR(DSDIYIDUAL)NAM1�E,,�(pprrint�)W/tU-� ' CERTIFIC
A
T
I
ON# 29-
WELL CONTRACTOR COMPANY NAME tl\vvzt�"(LI"� -' V=LLLLt)G, PHONE # I�o)��D7"9�`S�
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 ZdRe
graphic/Land setting
N are tTown: C mty ❑Slope ❑Valley ❑Flat
(chock appropriate box)
(Strut Name, mben,Communi ,Subdivi ion,Lot No.,Zip Code) LatitudcAongitude of well location
3. OWNER: (degreeslminutee/sewnds)
Address LatitudeAongitude source:❑GPS❑Topographic map
«„_._,_ (chock box)
"Ol"I /�"� � DEPTH DRILLING LOG
City o n _ gla{eY Zip code From ' o Fomr tj n Description
Area code•Phone another r-t
4. DATE DRILLED 1
5. TOTAL DEPTH: /
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO Er 95 0
0
7. STATIC WATER LEVEL Below Top of Casing: FT.
(Uae'W'if Above Top of Cuing) c:z
8. TOP OF CASING IS ' Fr.Above Land Surface" 4
-Top of cuing terminated at/or below land surface requires a --
variance in accordancF kith 15A NCAC 2C.011S.
9. YIELD(gpm):IS METHOD OF TEST
10.WATER ZONES(depth): LOCATION SKETCH s C^'
,.
11. DISINFECTION:Type Amount Show direction and distance in miles from avast
two State Roads or County Roads.Include thoroacl—�'
12. CASING: Wall Thickness
er r We � yy(al numbers and common road names.
From y To Ft. �Y'y
From To Ft. �S �vlr 1) C'1
From To Ft. 1 _1
13. GROUT: IkptJ1 Mat I Aod �^ f?�
From To : - —1 ,
From To Ft.
14. SCREEN: Depth Diameter Slot Stu 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:
_ TIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
D
O 5 C*' $T S,AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL O
�}� #� /
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the originate to t Division of Water Quality,Groundwater Section,1636 Mail Service Center-Raleigh,NC
-------27699-E636Yhone No.(91 733-3221,within 30 days. GW-1 REV.07/2001

258165
WELL CONSTRUCTION RECORD
North Carolina-Department of Environment and Natural Reso -Division of Water Quality-Groundwater Section
g2Lj
WELL CONTRACTOR(INDIVIDUAL)NAME (print) CY�S � 1(_� CERTIFICpArTpI�ON#2 `�/ _
WELL CONTRACTOR COMPANY NAME �m���� �' PHONE 11
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if a licable ifapplicable)
1. WELL USE(Check Applicable Box):Residential Municipal/Public❑ Industrial❑ Agricultural❑
Monitoring❑ Recovery ❑ Heat Pump Water Injection❑ Other❑ If Other,List Use
2. WELL LOCA I ((��11 ��""� � TopogrVgc/Land setting
eat Coun@�rv`U, ❑Ridge Mope ❑Valley ❑Flat
.1lnn.... (check appropriate box)
(street ame,Num n,Community, 's(oq Lot No.,Zip Code) Latitude/longittide of well location
lAddress
(degrealminuteslseconds)
LatitudeAongitude source:❑GPS❑Topographic map
(Street or to No.) (check box)
DE DRII LING LOG
wn state Zip Code Fro To i tion De^ riptio
�`-�e numberLED. PTH:
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO Er
7. STATIC WATER LEVEL Below Top of Casing: (ten FF. -"
(Use"+"if Above Top of Casing)
8. TOP OF CASING IS FT.Above Land Surface' E,—
-Top of casing terminated st/or below land surface requires a _
variance in accordane with ISA NCAC 2C.0118.
9. YIELD(gpm):I—MET OD TEST �� p
10.WATER ZONES(depth): T"
LOCATION SKETCH
Show direction and distance in miles from at least
12. CASING: Wall 11. DISINFECTION:Type tt two State Roads or County Roads.Include the road
Wall Thickness
Dep!
�r r vp„� g��( numbers and common road names.
From.�To Ft. � t+Y�
From Tc FL I
From To Ft. Mat W Method t^`
13. GROUT Depth.,d
From+
From FL
De
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in. p•
From _To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRU I T A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WE OWf4ER
IF S GN}y'{'URE OF PERSON CONSTRUCTING THE WELL D
11690-1,636
WWI the original to the Divisiomo Water Quality,Groundwater Section,1636 Mail Service Center-Raleigh,NC
Phone No.([phone],whin 30 days. GW-1 REV.07/2001
� r
i� i r

re-,
WELL CONSTRUCTION RECORD
Not di C:u olina - Ucpaltlncu( of lincironmcnl and Natural Res(/(IICCS- Uivislot,of Water Quality-Groundwater Section
\\1'1.1.0(IN IIt.\('IOil(IN111\'lI1lIAld NAME (Ill It uq CEIi'1lFIG'1lONa�J(/Ij
uLI nt tcrou cunn nnv Nnnus_ ��ROJL _E ��I.Z)a 1vy! ruone, a 5
5I \'II w r I.I.('(INS'I Ill,(I ION I ERRII I#_ __A55OCIA'I'ED VO ITRMII_a
Iil';tppl iceblcl (ifapplicable)
I. \l'1!1,I. I ISP. ((-beck Applicable Box): Residential iu/�,till icipal/Public ❑ Industrial ❑ Agricullural ❑
IUonilm inE ❑ Recucery ❑ I Ie;ll I'umq)Water lujcction ❑ Oilier ❑ If Oilier, List Use
2. \\TILL IJK A"IION* /'1 I' -Lopogra 1 C/Lan(I selling
Ncou csl "I mvn'. "!!)c4C ' L _Count 1.�h 4wu ke ❑Ridge IJKlope ❑valley ❑Flat
�1 I'Dee4" D— (check:ipp.t,pristc hm)
I Strom Nn.. N..... on.nn..my.Suhdi ,w,,n,Lot No..Zip('tde) I'altlttlle/lollgtude of well location
1. O\CN I'R: `�_�_ UL plcpn•cdmimnczscu,ndcl
Add, -___- Q.,. X _ Lnli(udc/longilud" source:❑qPS❑Topograp�icmap
L'ttecl or I(aute Nall L (check hat)
ll
_1 IN �S_�'_ I�-(� ✓V C DEI'TII DRILLING LOG
stair zq,codr frrnn To Formation Description
nirn oido I'lontc ininthr
6. DOLS WITI, RRI'LACII I'.XIS"PING 1V131,1,? YES ❑ NO
7. S I A ITC WA I IT LEVlil, Below"fop of Casing: J_�_I'I*.
(Ow•'I••if Ahnvc'rnp of('acin)•)
R. l Oil OI'CASING IS 1'"f. Above [,,all([ Smracc'
•l'a].ar"a"ing Irrm'.Mrd al/nr bclo,r land surrnrc rcgnlres x --
,arho.""In aco,rt6umr,c llL 15A NCAC 3C.11118' --- —
n. 1'IIiLU(epml: -ID. - MGf1101)oil "IES-f n•, .___—._ — —
Itl. \VA"I I.R LONI',S(dcplh)'.
Lt�� LOCATION SKF I CI I
11. DISINI.I FCIION: I)pc1 Anwuul C Show direction and disl:mCc in miles I}um at least
12. CASING: Wall Thickness two State Roads or County Roads. Include the road
U Icplh_ , Ui•acier or Weighl/Pl. Alnlcrial numbers and common road names.
Iloa t O Pl. `2-
— -- — — -_
Ivnm To I'I.
Flom to _ __ p
IJ. (iR(MI -- DcPth ---" Melelial Mc•Ihod N o
Innn To 9' II.
— _a - - � �m
Id. M 11, PN: Dcptlt Uinntckr S17C Malcti;d 4Ln a�
Imo _. I It in. _ _ in.
Thin to _ Irl in. iw
IS. SANW(WAV11. 1'M K: W ern
Ucplh Si7c Malcrial
I woo 7n ~
Iloot To II.
1 P�V)I ti;pl �IS W P.LI. WAS CONS rRU( II'.D IN ACCORDANCE AV I'Il 115A NCAC 2C,WELL
rf I iiat-l-F(-)N- t`rt NtT"\ 1) HIM A COPY OI'Il IIS RECORD HAS BEEN PROVIDED 10 1111:WL'LL OWNER
MNAIURFI °i' S INS"I PKI
N(i IIll; WELL DATP,
S ggqqlJ qq )irisi( n of 1\':Ilcl'Quality,Groundwater Section, 1(P36 'Ilail Set%ice Center-Raleigh,NC
2{�� EV��Cr�bP9K1�0. 1'fRFMQB3 3221,within 31) days. GW-I I(EV. OW2001

WELL CONSTRUCTION RECORD 2558741
Not lh (;.Mina - Ucp;rl i l lei l( of I'.nvhomnenl and Natural Resources- Divi -sio``n or Water Quality-Groundwater Sect i^^o-nn���//
„I'11,fON'IItACIOlt(INDI,'IDIIAL)NAMIl (rbnl_ •�/.�'1LV( __l.)C)'V—S CV.1111PICATIONp
„I:LI, "NIRV I'Olt MIIPANYN.ANIF._-0191 7 �•-U- l�_�EZI�_L'J c—rimr4r a aAS 37- Y),
,S I ,'I I:„'l LI ('ONSI III C I ION PERNI I I M_— ASSOCIATED\\'Q PERNII'I N
lit applicable) (if applicable)__
I. WFLI. IISE (Check Applicable [lox): Residential V Municipal/Public ❑ Industrial ❑ Agricultural ❑
kInniim ing❑ Recuvmy ❑ l lcat Pump Wa(er Injection❑ Other❑ If Olher, List Use
2. %A11'.1I. LOCATION: Topographic/Lan telling
IJcalest'fown: ,Q)(.(..� It_ Cnunly C�12UJ _ ❑Ridge ❑Slope alley ❑Plat
(check nppnq,rialc hoc)
ISI I Cel Nan@fNW llhl•rI.Cmoolololy.Subdivision.Lot No I Zip Gxkc I'milude/longitodc of well lr catioll
1. O\\'NI'.R:___ UPL'� nc'"�VL� IJcgrccs/luinulcshccnndsl
Address ----�_3._I_ HIQ ' III Lntilude/longitude source:❑GPS❑Topographic map
CNIncel or Itaule Nor (check hm)
1 p�r�5s<�_ DLI'III DRILLING LOG
I�iK m I $IMC Zip Code m/- Pro To Formation Description
own ac
\n•a rod. Phone ullmh� .e� r^ ,Z �OD (�0,5 ���1 -�
4. IL\TI�. DRll.l.11p_�` c7 V
5. 11 1 A1, 1)1;P II I:_.-_yam`'_
,. DOT'S WELL RI'.I'LACF. IiXIS'I'ING WELL? YES ❑ NO lT
7. STA'IK' \VA'l Fit H:VI;LBehov loll orCasing:
(I)sc"+"if Ahovc top of Cnsin(tl -
R. TOT' OF CASING IS_._� FT. Above Land Surface'
'lop orracioe acrudnated avor Leto,.laud sat race require,a
vlo Wile In nccordaT call. 15A NCAC 2C.01 18. y
Q. VIAL., ,, ...l: -J._-_— MIiTIIODOFTI:SI_ -
10. WA'hFit ZONES(depth): �-LO ' 3 Co
ll�� LOCATION SKGhC'I I
11. OISINI FC-1ION: 'f5'Pe_./_�' �— Amount -- Gd P Show direction and dislance in miles From at Icasl
12, CASING: Wall"Ihickness two Slate Roads or Comity Roads. Include the road
Ucptl. Diameter or WcichVPl BI'llerial numbers and common road names. c
Ilona 0 To_�'a��_ It.-� ��31 _1_.'J G O
I-will
Ilona
I l (iROII I - Del dl Alatcrial -� MUhI d r c:I
�. Cn
I will.
IJ. SI'I:I PN Ucplh Uinnlcicr r�lul Size Mareliol n� -
c.
15. SANDIGRAVId. PACK: o
Dcplb Sim Malerml :-
linen
i PI nIAItAC
r4Jl
�.JJ Ifi-i(+}}1=1FF•;i�I-I�JZX111.11}yf II(IIIS Wpl.l.WAS('ONSTRII('ll'U IN ACCURI)ANCIi 1VI'fl 115A NCAC 2C.WIiLL
ON I R Ill I ON S I A N DA� 1). 1AN1)'I11AI A('OI' 'OP'111IS If FCOR1)IIAS B1:1;N PROV IDCD-10'1-Ill;WI:11 OWN I:I(
I) I �I d -0�
L S (iNAIURf:OI• RSON( IN.` C1IN(; II it: WELL DATE
—)
F c, f
F(�pNniii Oil tea l),a Y,j Y'fja llf mvi.lull of Water Quality,(;I ouudwalcl Section, Illy, Nlail Set,ice('cnler-11a1cigh,NC
-77bTrrT7.�-f"PliiiTii'7>!I. .. . 21.,r ithin 311 days Ci1V-I RIiV. II7R11111

2558 '70
WELL CONSTRUCTION RLCORU
No1II,t mohna- DcpmImeal of Enviro nnenl and Na(uraaIYI R' esources- Division of Willer Quality-Groundwater Section
w fa t.(YIN-I ItA('101t ON UIC 11111%I.)NAME prhtl)��k M _Jv'(- CEN"I7rICUA'1'ION
%%I,IL("ON'I It III[ I Olt("M IVAN'1'NAnik:_ eRo^_—� �C`'-li �(Zl( I1�1•IIONF, q IV�
S 1 \'11 %%1 1.1.(ON'S I It l'('I ION 1.1 aMI I#__"—_,___---_.----A5511('r\T Ep\\'O 14:ItM l'Pq _
1 il'npplialhlcl � / (ifnpplirlhle)
I. %VI IA, 1ISI:(Check Applicable [lox): Residential un icipd/I'uhl is ❑ Indusli i:d ❑ Agricultural ❑
Mooiloliog❑ Reco cl.v ❑ Ilea( hilly Water lujectiotl ❑ Other❑ If Other, List Use
2. WI'LI, L )CA IION: I, Topogr, uc/Land Setting
N c;u cs( fown._ k. ^i S ��� �'F Midge - lope ❑Valley ❑Plat
New. cN�_ktiS I�T�� (check nl+fin i,rialc hn<1
1S1nr1 Nnnm,Nnmhci4 l'o......ly,SubJkisToulot No.,7,ip Code) Lativale Imlgllu(Ic of weii iocation
1. f I\\'NI'.Ft: __�1��--� lam/ �� __ Idcprcrdminulcs/sccnnJal
Addrrss �-/p�76_- /1/ 6t.+ 11.3 r%.. Hdt-- La I i I udedong l(ude soul cc:❑GPS❑I opograpl l lc loa11
�— (Slr,'el m Itoute�No,,) `� y - (check hue)
_�L `�,Z� DE I+'111 DRILLING LOG
I itc�n 1��,,,� I Slate zip Cndc 1'ronl To Formation Description
Description)-
.,Iv plunm nnnJrer
6. UOFS WIILI, REPLAC'li EXIS"IINC, WELL? YES ❑ NO 0-
7. SIA'Ill' WA"IITLIiVEL Below Toil ofCasing: F1'.
(Ilse"C'if Ahave'loop of(losing) -----
X. 10V 01 CASING IS_J 1'1. Above Laod Surl'ncc•
"Ibp of,ming lei nil ogled m/or Lrlua laud surface requires a —
I lo-hoce Io acrurdaure nllh ISA N('A('2('.l)I IR.
4. YIHD(gplo): - I-._ -__ Mli'i'1IODOPTI:Sr 'a"e --_-_-
10. U'A"I IT ZONI'S(dcplh): 9 / 0
LOCATION SKI I'Cll
11. DISINITCI ION. 'I Alnoont Show diocctloll and distance ill miles Floor at least
12, CASING: Wall'I hickne" Iwo Slate Roads or Counly Roads. Include the road
Ucpilll 91;lalojer or Weight/PI. Nlalcri;d numbers and conunou road names.
((per ( _
I;om __TIL----- 171' -- -- ---- c
From Io
13, 102OIJI I- --Depth - --- �o hlalelinl - - Method tV
rL_
1-1 SCIZITN: Ucplh I)1111„elCl`j Slot SoC Material C.T7 0
Iloo1 To .._ I't. io. in. D•o
I font -'fo Pt, ill. in.
I'i SANUItiRAVIII. PACK: y ��
Ucp1h Sizc Malcrial W �^
loom lh _. 1:1.
Inns lb I'I.
/ i L
111 >O I IP.ItI Ill ( I.ItI11 1' II l; 1 'I S WPLI.WAS CONSI RUCIYU IN AC'C'ORUANU WITH 15A NCAC 2C,WELL
�l INS 110ICI ION S I AND,AR U MAT A COPY OFI I[IS RECORD I IAS BEEN PROVIDED"I0'Il IIS WELL OWNLR
- - oL
L_--- SI( NATUItP UPI:1' It50 1 C INS 11tl1C1lNG TI IF WIiLI, UAII'
GROUNDWATER SECTION
Sflt4gUl'th61R9GIp1 J I ul Water Quldily,Groundwater Section, 106 Illail Senicc Cculer-Raleigh,NC
2.7679-1616 1'hmle No.(11111)7 3-3221,o'itlli i 30 dm's. GW-I RFV.07/2001

262318
WELL CONSTRUCTION REC;On^,
North Carolina-Department of Environment and_Natural Resources-Divisionof Water Quality-Groundwater Section '
r)(-' 0 1/
WELL CONTMCTOR(INDIVIDUAL)NAME (print) -S / \J�\ A /_�
WELL CONTRACTOR COMPANY NAME JMJ " ( ��� // �� �� PRONE 0 ("v41 o/i7--2
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
I. WELL USE(Check Applicable Box): Residential❑ MunicipaUPublic❑ industrial❑ Agricultural❑
Monitoring❑ Recovery ❑ heat Pump Water Injection❑ Other❑ If Other,List Use —
2. W ELL LOCATIO / Topographic/Land setting
Nea esrt.'lown: Jq _County ❑Ridge ❑Slope ❑Valley ❑Flat
t 1 1l�YlC'1E;Ex1 �S Q}�Jc (check appropriate box)
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) Latitude/longitude ofwell location
3. OWNER: l'iP YI Q (degrees/minutes/seconds)
Address 401 — Latitudeflongitudesource:❑GPS❑Topographiemap
(Sneer or Route:No.) (check box)
IGub i f n faL 6 )O DEPTH DRILLING LOG
City or Town State Zip Code From TO/ Or ation Description
( —) D
Are+code.Phone number
4. DATE DRILLED/n DD R
5. TOTALDEPTFI:(0-,�;`1'
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO ❑
7. STATIC WATER LEVEL Below Top of Casing:_JA2__FT.
(Use'•+"if Above Top or Casing)
8. TOP OF CASING IS FT. Above Land Surface*
-Top orusing terminated after below land surface requires a
valance In accordance with 15A NCAC 2C.0118.
9. YIELD(gpm): Ya _METHOD OF TEST A-(Z
10.WATER ZONES(depth): LOCATION pTION SKETCH
11. DISINFECTION:Type I1 Amount Show direction and distance in miles from at least
12. CASING: Wall Thickness two Slate Roads or County Roads.Include the road
Depth Diameter or Weight/Ft. Material numbers and common road names. _
Frorn___C_To 9e , FL L 5A C94 L— o
From To _ Ft. C
From To Ft. �
13. GROUT: Depth Met at Method
70
From !ZTo 229_r FL n0
.0
From To Ft. _ -
14. SCREEN: Depth Diameter Slot Size Material
From To—.—Ft.—ill— in.
From To Ft. in.. in.
w -
D
r' U 'D t Size Materiel
Ft.
From To Ft.
16. REMARKS:
ASA YscEPJTAG TIIA THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C,WELL
" STAMNDAP S,AND THAT A COPY OF THIS RECORD 11AS BEE14 PROVIDED TO THE WELL OWNER
- 7 6 - //- DQ
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality,Groundwater Section,1636 Mill Service Center-Raleigh,NC
27699-1636 Phone No.[phone],within 30 days. GW-I REV.0712001

262923
WELL CONSTRUCTION RECORD
North Carolina-Department of Environment and Natural Resources-Division^of water Quality-Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAME (print' �'" ��" < (n ) IGO(1 CERTIFICATION a.?ye
WELL CONTRACTOR COMPANY NAME t I p( I n�P I C Y s� I I t� PHONE / t ,d)
ASSOCIATED WQ PERMIT#
STATE WELL CONSTRUCTION PERMIT# i(g licable
ira Iicablc
1. WELL USE(Check Applicable Box): Residential li MunicipaUPublic❑ Industrial ❑ Agricultural❑
Monitoring❑ Recovery ❑ Ileat Pump Water Injection❑ Other❑ If Other,List Use
2. W ELL LOCATION: Topographic/Land setting
Neatest'f own:41A It CQCounty ❑Ridge ❑Slope ❑Valley ❑Flat
�^ (check appropriate box)
(Soket Neme,Numben,Community,Subdivision,Lot No.,Zip Code) LalltudeJlongltude of well location
3. OWNER: 7�qq C L I D b D J0 (degrees/mI ules/secends)
SHt (71 1^N P U 12 LalitudeAongitude source:❑GPS❑Topographic map
Address " c '
�gb)tree or Route No.) DEPTH
box)
/�_ _, DEPTH DRILLING LOG
zl code From To o anon Description
- City or Town StateP �..� _ � -
Ara code-rbonc nvmher �
4. DATE DRILLED
5. TOTAL DEPTH:
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO CI ! —
7. STATIC WATER LEVEL Below Top of Casing:�O FT•
(Use"+"If Above Top of Casing)
8. TOP OF CASING IS�—FF.Above Land Surface'
*Top of casing terminated at/or below land surface requires a �J -
variance In accordance with ISA NCAC 2C.0119. _
9. YIELD(gpm): 3_ —METHOD OF TEST o
10.WATER ZONES(depth): LOCATION SKETCIJ
11. DISINFECTION:Type VA Amount S Show direction and distance in miles from at least
Wall Thickness two State Roads or County Roads.Include the road
12. CASING: numbers and common road names. CD -
Depth r Diameter or Wgh�•l. Material - ..,
From_To FL r —ts C —
From To FL
From To Ft. -
13. GROUT: Depth .M,,ate Method
From To�Ft. - -
From To
14. SCREEN: Depth Diameter Slot Size Material
Front To —Ft. in. in. D
From To Ft.—;P. in. -
I5. SAND/GRAJTRAT�'R�#$��*A�TPK�
(�yiz( �MKkri
v
From
From l•
616, REMARKS:
DOHEREBYCERAGTRU D M ACCORDANCE WITH I SA NCAC 2C,WELL
CONSTRUCIIONI1WTCI B� IS CORD HAS BEEN PROVIDED TO THE WELL OWNER
-- l D-7
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality,Groundwater Section,1636 Mail Service Ceenterl REVgh,C
27699-1636 Phone No.[phone],within 30 days.

262926
WELL CONSTRUCTION REC 0R
North Carolina-Department of Environment and Natural Resources-Division of Water Quality-Groundwater
Section
CER-ri
WELL CONTRACTOR(INDIVIDUAL)NAME^ ll _
(Print) � N n` rl.
WELLCONTRACrOR COMPANY NAME Inn- PItONE It (K2`t) 244
ASSOCIATED WQ PERMIT#
STATE WELL CONSTRUCTION PERMIT# ire licable
ire licable
1. WELL USE(Check Applicable Box): Residential W Municipal/Public❑ Industrial ❑ Agricultural❑
Monitoring❑ Recovery ❑ Ileat Pump Water Injection❑ Other El if Other,List Use
2. WELL LOCATION: 1 Topographic/Land setting
` 1�_—County�(LpChICpA ❑Ridge ❑ pprop❑ebox) ❑Flat
Newest'fown: JYIt➢c� (check
Latitude/longitude of well location
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) 1/
nt 1,(�Yri l ICY y (degrees/minutes/seconds)
3. OWNER: tr . v .
_ rv,•„. .� �t.kp Wt or (�t1c5 1r0.ceLatitudeAongitude source:❑GPS❑Topographtc m?p
Address (check box)
T— (Street or Route No.) DEPTH DRILLING LOG
31Jouiuo
zl code From To tiou Description
iur-rl t r
Cityor Town Stale P orm C r
AM code-Phone number
4. DATE DRILLED
5. TOTAL DEPTH: --
6. DOES WELL REPLACE EXISTING WELUI YES❑ NO ❑
7. STATIC WATER LEVEL Belo(Top of Casing:
—orC 00'Fr
t p
F,
8. TOP OF CASING IS \ Ff. Above Land Surface•
*Top of casing termineted atior below laud surface requires a -
variance In accordance with ISA NCAC 2C.0118.
(gP ) METHOD i r
9. YIELD m : D OF TEST
��— _-
10.WATER ZONES(depth): —j OCATION SKETCH
( _ Amount S Show direction and distance in miles from at Mast
11. DISINFECTION:Type µall Thickness two State Roads or County Roads.Include dpe-oad
12. CASING: numbers aced common road names. CD
Depth Diameter or Weight/FL Material From To��Ft. _ �1 yam—
From To Ft. _
From To Ft. v
Material Method ^�
13. GROUT: Depth J
From Tom Ft. L✓
From To FL o r,.
14. SCREEN: Depth Diameter Slot Size Materiel
w
From To Ft. in. in.
From Tn Ft. .,-
15. SAND/ ` ' � SVe aterial
From To Ft.
From 'To m Ft.
16. REM S: ��qq
I DO HEREB CEFpi�tt�RP61 S C STRUC(ED IN ACCORDANCE WITH 15A NCAC 2C,WELL
I DO IIE U OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
- D
SIGNATURE OF PERSON CONSTRUCFING THE WELL
DATE
Submit the original to the Division of Water Quallly,Groundwater Section, Mall Service C(W I REVg07 2001
27699-1636 Phone No.[phone],within 30 days.

WELL CONSTRUCTION REC 0JmD 262941
North Carolina-Department of Environment and_Natural Resources-Division of Water Quality-Groundwater Section
��,��
WELL CONTRACTOR(INDIVIDUAL)NAME (print) 5 CERTIFICATIONO2LJ1L9
WELL CONTRACTOR COMPANY NAME tM sl df I,t-le(l cirll I I /IQ PIIONE 8
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(ifapplicable) (if applicable)
1. WELL USE(Check Applicable Box): Residential d Municipal/Public❑ Industrial❑ Agricultural❑
Monitoring❑ Recovery ❑ Ileat Pump Water Injection Cl Other❑ If Other,List Use
2. WELL LOCATION: nn Topographic/Land setting
arcs ity,Subd v
cs TO ` CountyS„� - ❑Ridge ❑Slope []Valley []Flat
(check appropriate box)
(Street Name,Numbers, ommunision,,,((LLJot W.,Zip Code) Latitude/longitude of well location
3. OWNER' �' (( P �� uteahecends)
` jTx� 1S1ri0 LatitudeAongitude source:❑GPS❑Topographic map
Address (check box)
(Street or Rome No) DEPTH DRILLINGLOG
Q—W-O ll1 �� 25S D(o Fr Teo / o atio Des ription
City or To State Zip Code Tom
Ares code-Phone number - �y-'--
4. DATE DRILLED
5. TOTAL DEPTH:
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO ❑ -
7. STATIC WATER LEVEL Below Top of Casing:J_J6 _F F.
(Use"+"it Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surrace•
-Top of cuing terminated aUor below land surface requires a --
variance in accordance with 15A NCAC 2C.0118.
9. YIELD(gpm):­2F2_METHOD OF TEST _
10.WATER ZONES(depth): LOCATION SKETCH '
11. DISINFECTION:Type IaFmount S Show direction and distance in miles from at leash
Wall Thickness two Stale Roads or County Roads.Includgt*road
12. CASING: numbers and common road names. o
Depth�` Diameter or Wet UFt. Material
Frorn To r s2 .Ft. �2 — - -t -
^J
Frotn To Ft. w
From To Ft.
13. GROUT: Depth Maten Method
From To-.2� Ft. o
From To Ft. ca _
14. SCREEN: Depth Diameter Slot Sim Material sD -
Front To_.—Ft. in. in.
From To rt. in. in.
15. SAND/GRAVEL PACK:
Depth jj
From To i$ .
From To —
16. REMARKS:
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTR. IN A CORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STANDARDS,AND THAT A COPY OP THIS RECORI HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original In the Division of Water Quality,Groundwater Section,1636 Mail Service Center-Raleigh,NC
I7699-1636 Phone No.[phone],within 30 days. OW-1 REV.07/2001

255860
NVGLL CONSTRUCTION RF,CORD
Nooll(':Imblia - Wpm IIIlcIn of P.nviromocnl and Natural Resources- Division(I'Water Quality-Groundwater Section /
\\I LL 1.11�711.\('lull llN nI\'IIn AI.)NAMF prlull_^-I-_-�)-'h - JUTTN�"�- CEIt'I I FICA'IIONNN -- -5C- c
\\1'LI ('l IN IR.\( I On CONIPANI'NAME?_ _ !"� — L—Y�ILIj, r- PliONF. N OA K3 -�U
L('OINS I It l'('l I(IN ITIVI IIq ___"ASSO('L\'I'ED\\'Q PER%IIIN __
(it a,,licablc) (it applicable)
I. \\'I.l.l. usiE (check Applicable Rox): Resldcniial bt till icipal/I'nblic ❑ ludnslrial ❑ Agricultural ❑
M,IIiwl iog ❑ Izm,%Cry ❑ I ICal Pump Water Inj eclion ❑ 011ler ❑ If 011ler, List Use
2 W11.1. LOCA I H)N: /�' topographic/Land setting
llc
Ncaleslnn�._. 1�1.u-��)� Counlyl�U2l�Js'� tidge ❑Slope ❑Valley ❑Ilal
-r -P-1 b(yE _ bkI v e WICA-k appn'pdi lte hot l
1 tintt•1 Narnc,No...Ill ,1'nnnnuuily,Sobditieinn.Lol W-Zip Code) l.11lllude/Ionglludc of well location
}. U\1'N 'Tt: ,J._�V_V-^'�(_ 2 7U k3 (dagrccs,m il'W"Ammdsl
Addn•ss _ _J$._�i�.l.�A nJ1J'-L-- 1 to���_.— Lalilude/longitude source:❑(.il'S❑Topographic map
ISncel nr Itoulc No. (check NU,I
(�,��`.�. �fL2�� DLI'�"II DRILLINGLOQ
-s�lY-Ya1-�a.a I/...�._ scale �3 zip code Pooh �'I ol Porm:diun Descl\iption
Ana rank I'hrn¢.mo.I, -�}} � �o O ll✓�7Y
I. IIAIII
6. I)OES W'EIA, RVI'LACI; EXIS"PING WIILI:7 YES ❑ NO 13�
7, SI A M' WA"I FR LI;\'lit. l)clow Top of(';Ising:20
(Use..C'if Ahnve llq,of C'asiuFl
S. l OP Of CASMI IS _ El'. Above Land Sorracc' -
•llgr or ennui!imitinaled Wor heluw Will turfnce requires a - -
s:niance In nccard:nace nlll. IsA NCAC 2C J)11 P. —
9. YIELD(pill): - )_. — M1:1 I IOD OF I P.SI' -
10. WA1l1R ZONES(dc)lb):
—� LOCATION SKI:I CI
P.0 1 I. DISINI" 'I]ON, "I'ypc-/ Mi o t C- U Show direction and distance in miles From at least
12. CASING: Wall thickness two Slate Roads or County Roads. Include the road
Ucplll , I inlpcler prWeighUPL Material Rulllbcis and common road names.
rmlu ) To_,J -J. --
n
I1 (;ROD f: Ucplh Nl:ncri:d_ Ncnnnl p
I1. S('RIIN: Dcplh 1ianlcic7-' Slot tii7C I,h CIial r fir,
Iloln_ Tn 1`1, in. in. ;= �
-- --- --- c.)1 =c m
will .. I_„_----_--
15_ SAND/(i R AV 1711. I':\('K: m
Dcplh Size Material tn:
Lrum To Irl. --- ti
—.--
li
�D J I�I IIq ITS 1\'Ill.l.K'AS CONSTRII( 11:1)IN ACC'OR DA NCE With 15A NCAC 2C,WELT.
i ('ONSIRII('IIONSI-AND,�RI).�.I NDIIIA1'A COPY OFI HIS 10TORD HAS BITNI'ROVIDED'fO till: WELL OWNER
SGNA IURF UI PERSON CUNSI ltt) INGI Ill: WELL DA"11;
AS f{�VI[Lt'RE b�Ir�1�I1�OPrCE D n iri,iu of 11'ater Quality,Gruund\caler Section, 1636 Mail Smice Center-ltatcigh,NC
S 21,\cilhin JII days (iW-I Itp.V. 07/2001

255109
WELL CONSTRUCTION RECORD
Noilh Co rot ina - Dcpa rh neat of Environment and Natural'Resources- Division of Water Quality-Groundwater Section`/ [
\Y EI.I.C'ON I RA("I Oil UNDIN'IDUAL)NAME prrinn—,-) I tithe :Tci-,K.. CER'PIFICATION N J565
� � � � p c
P'ta.I,1 ON I It;t("1.0 It COM PANY NAME; Ittgfln kr2 C''._ �l_) � s '1'V PHONE 0 (Y 33S7-D�-'ilC,
SI A 11:%%ELI,('1ITSI RUCTION PFIj.%II"rq ___ASSOCIATED NYQ PERM11N
1 if applicable) (if applicable)
I. W I-L USE(Check Applicable Box): Residential [Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ I-leaf Pump Water Injection ❑ Other❑ If Other, List Use
2. WELL LOCATION: J topographic/Land setting
Nearest Tow .1n: /')H'-}� Cowriy CftE�2:%ke� Ridge ❑Slope ❑Valley ❑flat
�U.✓�,. �� �1C � R� (check appropriate box)
(Streel Name.Numbers,Comugm/ily.S(uub'dd Subdivision,Loll No.,Zip Code) LatilLIde/longitude or evell location
3, OWNER: 'T-�/ � ( �rICJ Idegrees'minuleskcmndsl
Address j 3� �C H��Y �:'� Gc�NS j Latitude/longitude source:❑CI'S❑-I'opograpilic map
1(Street or Roole No.) / V (check bos)
.41 t14 `�D IE1F> UEI'-IH DRILLING LOG
City or"Io�,a _�State� Zip cod, Pryor Tod I oration De�cLi plion
Area code-Phone number O 2_ a `.�.0 T
4. DATE DRILLED �`� ' z �� -
5. TOTAL, DEPTH: k(? S ' --
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO E?--
7. STATIC WATER LEVEL Below Top of Casing:_S�O I'"r.
(Use"+-if Above Tap of Casing)
8. -101' OF CASING IS / FT. Above Land Surface*
•I op of cuslog terminatol n0or below land surface requires a
variance in accordance with 15A NCAC 2C.oi IH. ^
e. YIEE.D(epn,): ----
10, WATER ZONES(depth): 0 ' — -
LOCA-I ION SKEFCII
I I. DISINPEC1 ION: Typc— /L Amount G v _ Show direction and distance in milts from al (cast
12. CASING: Wall Thickness hvo State Roads or County Roads. Include the roil
Depth I lal toter or Weight/Pt. laterlal numbers and common roar) names.
o
Prom_To�� Pt. N.-�,�/ V�
From To
prom _To Ft
IC. OROUI Depth�1 �t NIiterlal Method
I I c>
-rom � _ =ice
14. SCR LL:N N. Depth DinnlclSlol Size Material �-
O
[:[out _-- Io _- Pt. in. _ in. _ C.J
Prom —'Io_ FL—in. in. CJ7 0
15, SANDIGRAVI.L PACK: `
Depth Size Material
Prom I o Pt. _
From 1 1'I.
16, RE'NL\RKS:
t I O I,11 = (11 I %I I I IS 1VEI.I,WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
-J F33%1 11 ND-1IIAT A COPY OI'1lHIS RECORD HAS BEEN PROVIDED 1.0111E WELL OWNER
L1. GNA'rUR60Pl'L•I2S0 NSTRUCTING THE WELL DATE
r1+r.w1-JJruL.r'n' t fh Divi.idn of\V;dcr Quality,Growldreatcr Section, I616))tail Scnicc Cculcr-Raleigh,NC
O1Yt161 bxiuri-(r t 0))733 } 21,rcilhin 30 days. - GW-I REV. U72(101
L E
IC

WELL CONSTRUCTION RECORD 255110
Not h Caro lira - Department of Environment and Natural Resources- Division of Water Quality-Groundwater Section /
ON'IIiA("UOR(INDI\'I D UAL)NAME (print) Ih ry�(``J CF,Ii'I'IfICA"r10Na ft s�
\\'E.I L CON'I'It\CTOR('OMPAN'Y NAME�. .r L<�� (�_�E. /�� ^L.CI PHONE a (S�`Sl Fs 31--`dr'SC7�S
SI,\'I'IS\\'ta.l.CO NS'fRUC'r10N PER\II'rq ASSOCIATED w'Q PEI(all'fa _
(ifapplicablc) (if applicable) _
I. wELL USE(Check Applicable Laos): Residential lv Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Meal Pump Water Injection ❑ Other ❑ If Otllcr, list Use
2. WELL LOCATION: n I Topographic/Landsetting
Nearest Town: MweS V;He- _County ` �(C'PA-c 12 iige ❑Slope ❑Valley ❑Flat
,�y LzgS C.fl ek- Coil (L (check appropriate boll
IS(ruct Name.Numhcrs.Convounity,Subdivision,Lot No.,Zip Code) Lalllnd0/longltudc of well loca(lon
3. 0%VNFR:____)ts_b+ j'� 1 f���� Idcgrecs/minuleskeconds)
Address _�./� OIL hs= .,+ :y - ,k UR Latitude/longitude source:❑GPSOTopographic map
ISlrucl or Route No. (check box)
C' DEPTFI DRILLING LOG
city or Stan zip code Prop "ho FnnmtiotU f..iplion
Arcs code-Phenc nun her + ` ^ L _�
4. DA"Il DRILLED ` V
5. TOTAL DEPTI1: O
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO ❑�
7. STATIC WATER LEVEL I3elowTop of Casing: \5"(ZFT.
(Use"+"it Above Iop of Casing)
3. '1 OP 01 CASING IS FT. Above Land Surface*
•Top of casing terminated atfor below land surface requires a
sariauce in accordance uith 15.A NCAC 2C.0118.
9. YIELD (gpnl): �.� _ MF,TIiOD OP'rEST `
10. WA'I ER ZONES (depth): S o — —
LOCATION SKF:TCI-I
11. DISINFFCI ION: 'I ype Amount -- C Show direction and distance in miles from it least e
12. CASING: Will T hickness two Slate Roads or County Roads, Include tleDrOaet
Depth Diameter or Weight/Ft. N terml numbers and common road names. Cam... c
Front 0 To_� V- r cam;
Front To
From To Ft.
13. GROUT: Depth Material Method
From 1 V Io�hO
—1� C
14. SCREEN: Depth Diameter Int Sizc Material
I:1m "ro Fl. iu. in. o
From 'fo FI. in. in.
I5. SAND/GRAVh.L PACK:
Depth Size Material
Prom To Ft.
Frrnn To PI.
16. RLMARKS:
EASHEVLL�
�I DII tit Ef�arhrZ Cjijl(" IIAT THIS WELL WAS CONS"fRUCTGU IN ACCORDANCE Wffll ISA NCAC 2C,AVL•LL
' tj 10(IbS" �I'i %RDS,AND TIIAT A COPY 01:TIIIS RECORD HAS BE17N PROVIDED 10 THL• WELL OWNER
L
SIGNAT URI:OF PERSO .ONSIR GIIiG WELL DATE
the origil al to he Division of Water Quali(y,Groundwater Section, 1636 Mail Sen ice Cetder-Raleigli,NC
UP! �^/��jj77��f yIn plit IN (9 9)733-3221,viilhin 30 days. GW-I REV. 07/2001
f7�"LIUNAL OFFICE

WELL CONSTRUCTION RECORD 2 5 5 8 ry 5
Nor(h Carolina- Depamile nl or Environment and Natural Resources- Division of Water Quality-Groundwater Section
1Y ELL(ON I RAC I.Oil(INDIVIDUAL)NAME (prinn 1/V\^�` —^J��JS CERTIFICATION01
wF.1.1.(ON'111 AC I Olt COMI'ANl'NAME�'j��K�-F' Leh' I a rDONE a LTA� p C 3-7
s'L\T F.w 1:1.1.CONS r RUC I ION I'F.RMIT4 _ASSOCIATED WQ PERMIT
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Beal Pump Water Injection ❑ Other ❑ ll'Olher, List Use
2. WELL. LOCATION: /I Topogra uc/Land setting
Nr,Dcsl Down: i14 "R 1 County C�p l_'o k@r_ ❑Ridge pe ❑Valley ❑Flat
IAA Uj F (check appropriate box)
(Sreo Nance.Numbers,Community,Subdivision,Lot No..Zip Code) Latitude/longitude of well location
} Addi ess OPPe(Z N LJ, -' -Latitude/longitude sourccnr❑GPS❑Topographic map
(street or Roure Nn.) (check box)
/1 ?u,zn I C DF:r"r11 DRILLING LOG
('llyorl-mv State Zip Code From To Formation Descri lion
Area code Phmic oumbcr6 / D- Z —� �!•`7,L, bL
4. DATE DRILLED D
5. TOTAL DEPTIL _S-
6. DOES WELL REPLACE EXISTING WELL? YES [; NO C�
7. STATICWATERLEVEI-BelowTopofCasing: \.)-u FT.
(Use"+"if Above Top of Casing)
3. TOP OF CASING IS FT. Above Land Surface*
'Top of casing lernibmted at/or below land surface requires a
variance ill accordance Mill 15A NCAC 2C.01 IA. /�
9. YIELD(gpnQ:_ G FTHOD OF TEST_/ '
10. WATER ZONIS (depth):
LOCATION SKETCH
I I. DISINFECTION. Type_ Amount Show direction and distance in miles from a( least
12. CASING: Will Thickness two Slade Roads or County Roads. Include the road
O Del Ill _ D'at c r or Vei ght/FL venal numbers and common road names.
From To /DS�Fl. 13M
c
From To FL _ C
From "f0 Ft. 1V
13. GROUT: Depth pte . I Method e—
From�!\�/(r� To �_ Ft. F- c�
Protn�a -10 _ 1=1.� — c,L
14. SCREEN: Depth Diameter Slot Size Malcrinl CT! ➢c
Irum_ To Ft. in.
L
From _"f0 Ft. in. "..m
C� u
15. SAND./(iKAVIL PACK:
Depth Size Malcrinl — -1
Front 'Io 1f1. _
Front 'fo Ft.
16, REMARKS:
_ 9
� 13t)I6A(I YSfi'A
IS WELL WAS CONS'I RIICfISD IN ACCORDANCE WITI I ISA NCAC 2C,WELL
ON,1RA- I] S NDTI IA TA COPY OFTI US RECORD HAS BEEN PROVIDED TO THE WILL OWNER
S GNATURE OP PER CONSTRU .T G THE WELL DArE
ivi.ion of Water Quality,Groundwater Section, 1636 Mail Seri ice Center-Raleigh,NC
.3 21,within 30 days. GW-1 REV. 07/2001

254490
WELL CONSTRUCTION RECORD
North Carolina- Depar(ment of Environment and Natural Resources- Division of Water Quality-Groundwater Section
\YELL CON I'RAC'I'Olt(INDIVIDUAL)NAIVE (priuu 1 , 1 M _'{'j-)(J S CERTIFICATION N C fat
%N EILI CfI,;'IRAC'roil COMPANVNANI F.
Sl'A 11. N\'PILL C(1NSI RUCTION PERMITq ASSOCIA'I"ED\VQ PERNIrr#
(if applicable) (if applicable)
I. WELT. USE (Check Applicable Box): Residential N11micipal/Public ❑ . Industrial ❑ Agricultural ❑
hloniloring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other❑ II'Other, List Use
2. WELL LOCATION: Topographic/Land setting
Nearest'town:_ /'7 UP�County , Z' - G'E? ❑Ridge ❑Slope ❑Valley at
Tj..S C& e K (cheek appropriatebox)
lStrcel Ivamc,Numbca,Conununily,Subdivision,Lot No..Zip Code)
Latitude/longitude of well location
— _ _'I6, , �rIVIK - (degrees/minutes/seconds)
3. OW'NIIR:
Address j_K! C , del 11VCe Latitude/longrtude source:❑GPS❑Topographic Map
(Strcct or Route No±- (check box)
2cr7aa/ DI'.Pl'FI DRILLING LOG
Zip Code
��(ot or 1 own state
F Fo Description
Arco nnls-I'honc numbc J
4. DATE DRILLED� -
5. DOTAL DEPTH: moo( �_ —
G. DOES WELL REPLACE EXISTING WELL? YES D NO 13—
7. STATIC. WATER LEVEL Below Top of Casing: �- F1. --
(Use"+-if Above Top of Casing)
S. 'TOP OF CASING IS_/_Ft. Above Land Surface'
'"rap of casing lermi rated agar below buul surface requires a _—
vuriancc in acco"In"',will, 15A NCAC 2C.0119 C�
9. YIELD (gpm): __1 .,_METIIOD OF TEST__ --
10. %VATHR ZONES(depth): �je --
LOCATION SKFTCII
I I. DIS INFF('11ON:Type�� Amount o G U Show direction and distance in miles from al least
H two Slate Roads or County Roads. Include the road
. CASING: Will t hickness
Depth Iameter or WeighVhl.- aattcllal numbers and common road names.
Penn lb_�D PL �.�-!
Fran1 'to FL
Fronl --To
N
13, OROUF. Depth Matcrin Method c— P
Pl, C �m
From10 To- _ � cr
Id. SCREEN: Depth Diametcr`� SlotSizc Material --10
From To FL_
From To _
15. SAND/GRAVEL PACK:
Depth Size Material
Cn o
Prom _To_ FL
(� I(G(�. REMARKS:_
D L's II�D I(gR1�3ti�GI IF ' T THIS WLLL WAS CONSTRUCTED IN ACCORDANCE 1VITU ISA NCAC 2C,WELT.
lttt
US,ANU 111A1'A COPY OF MIS 12ECORL'IIAS FIEEN PROVIDEDTO111E WELL OWNER
v 02
�I
SIGNATURE .LSON C( RU I ING THE WELL DATE
Io the Division of Water Qual ty,Groundwater Section, 163E Mail Service Center-Raleigh,NC
GROMt of t 9I9) 33-3221,within 31) da}s. GW-I REV. 072001
ASHEVA]L(�PNI L 0 L"E�

256214
NVELL CONSTRUCTION RECORD
Not lh('a roli na - I)CIIa Ionenl of FmiroumenI and Natural Resources- Division of Water Quality- Groundwater Section
II I,1,1,1 ONIIt,%( I lilt ON I)I\'I )1 AL)NA➢IF (etteQ \ IF[CAI�/� � IaJ�T;+��- � CERI ICA'I'ION M
))ELI.ION'I It.\(C IOR(COAIPAN)'NApl t: _ [�F� C<t-�l ��L'1L^�Q1--PHONE 11
SIAII:��lil.l.CIINSI ItCC'1IUN I'hatAllTq_ ___ASSOCIA'I P.I)w'Q PEIt.NIII'I-M
(if applicable) (if applicable)
I. 1\'P.LI. I ISE IChcck Applicable 13us): Rcsidenli;ll <tY Municipal/Public ❑ hlduslii; l ❑ Agricullural ❑
Mouiloring❑ Recovery ❑ Ileat Pump Water Injeclion ❑ Other ❑ If Olhm, List Use
2. WH 1. 1 OCAI ION: // Topograph /Land selling
Ncaresl T 1tl 'own: n County Cj,0,1C/, Midge C;7Fi ope ❑Valley ❑Plat
-_- _I.(-JO-L-t-- __.F� Ichcckopprnp6:le hest
ItihaaI N:unc.Nmnlm,.Cam in Onilp.$ubdicisiun.1 ul NO_Zip(7ndc) Latllud('/10I1glludc Of well lllcalioll
1. OA\'NER: rt N I�2 plegreeaniin�nc4scumdsl
Addlcss -__J � �_1(ii� i7� _— Lnlinalc/longitude sumcc:❑GI'S❑Topogr;q,hic m;qt
�, IS`n ccl ur Itoum NOI (check heel
Q) � _�,-�� DI'I'I II DRILLING LOG
r ely nr Ia", Sr•' Zip O)& frnm To Imitation Description
Alan"'de Ph.nrc ,und'cr
J. DAIF1)RILL.1:1)
5. -101 At, 1)Ell I11: Do
6. DOES \1'I:LL REPLACE EXISTING WELL? YES ❑ NO BZ
T SI AIIC WATFit IA;V11, Below-1 oil of Casing: _—�C1P'I IV �=
(U5c••+••if Abavc'fap Of Casing)
S. TOT' OF CASING IS�_ F'I-. Above Litid Surface''
'7 Op nr cis tea ten pin a led al/ur helmv land sit rracc reel it tree a M)
sarianre hl arrnnlanrc ssilh ISA NG\C 2C.III Ifl. =n=
9. vml. )(gpnt):�v MErFnOD or
10, W'AII7R 7ON1;S(depth): / 35
/ � _ LOCA"IION SKI:IC'II rs
11. DISINFLCIION: l}pc CJ7 s.I(I-/i� Amount .Z 4, J Show direction and disinnce in miles from ai Tcasl
12. CASING: Wall"thickness two S(alc Roads or Cuunly Roads. Include Ihpnsl(g-
I)cp171 Diameter or Weight/1'1. Material tlumbeis and common read metes. _
From!*I(I I L-(�)� ----
li-om to Ft.
Iianl Tu R.
Il. (NMU'I` Depth Material Method
Imm 'fu__.7J It CE''�
I Toin_ lj Tu7 - 171.- C:L fi S_ -LL�tIL'i
Id_ S( MIEN: Depth Dialncle,�ol Si7c ✓ NI;;lcriav
Ill,m Tu Pt. in. in.
Prom To
IS- SAND/GRAVIA. I'M K:
Depth Sim htatcrinl
Ilmn Ta
linen To PI.
16. REMARKS- _
MF1IE Ill , WELL WAS CONS IFIM0 ED IN ACCORDANCE N'fflt I5A NCAC 2C, Wl;LL
(,NSIRIl( 1IONSIANDARI D'DI�A'I/'/y//('01'1'OFTIIISREC RDIIASBEENPROVIDED"10111EWELLOWNER
Sit OP I'lil NS"IIZUCTING'1-Ill:WELL DA"I L'
of Water Quality,Grounfirater Section, 1636 Mail Scrrice Center-Raleigh,INC
i_271A, 4A444hn` _-. ,INilhin 30 da(.s. (;W-I REV.07/2001

WELL CONSTRUCTION RECORD
Not Carolina - Department of Environment and Natural Resources- Division of W'alcr Quality-Groundwater Section
.�
wELI.(ON I RAC IOR ONIII\'IDUAL)NAME (priut) o2_� CF;R"I'l l'IG\'IIONa ,-)_t6�5
NN F.I.L CON NI RA(I Olt CO111',ANV'NAME 7�1�. � 1 �1L=`J—ruoNE a (Si3)`5 37—`�oLi j
S f.%[l!\\'f:l F,(CONS I RUT I]ON PERnll la ASSOCIA'l ED\VQ PERNILI N
(ifupplicable) (if applicable)
I. WELL. USE(Check Applicable Box): Residential Municipal/Public❑ Inrluslrial ❑ Agricultural ❑
Monilm ing ❑ Recovery ❑ Beal Pump Water Injection ❑ Other❑ If Other, List Use
2. WELL LOCATION: Topographic/Land selling
Nearest Town: .flu County CAcV-)e)/- Q`'_ ❑Ridge ClSlope ❑Valley ❑Hat
/2/4(i� Q) (check appn:prout,box)
(Street Nam,Nonthcrs,Community,SuMnision,Lot No..Zip Code) Laiitudc/longitude Of well location
3. OWNER: FReb S e,,t (degrees/minulcs'seconds)
Address j— y atitude/longitude source:❑GPS❑Topographic map
(Street: R .te No) (check box)
�,L;)• -nL.� t'r4C� El- 3's k) DEPTH DRILLING LOG
city or-I state T From l'o Formation Description
S; s/'/ 1 0 ??°' s Y--/L�
Area code-Phone oomher
4. DAI1; DRILLED
5. TOTAL DEPTH: 95` . o
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO Q— N �'
7. STATIC WATER LFVEL EclowTop ofC'asing: $�, FT.
(Use"+"i f Above Top of Casing) c_�•i
8. "fop OI'CASING IS FI Above Land Surface` t e9
•I op of cuing tenninaled al/or beta,,land surface requires a >=;:
>c
vari:urae in accordance with 15A NGAC 3C.01IA. �
9. YIELD (gpnl): -40 METHOD OF TEST_/ __al
10. WATER ZONES (depth): /�O' _
LOCAL ION SKETCII y•. �`'
I I. DISINFFCIION: Type 44 // Amount Show direction and dislance In miles trom odeistE
12. CASING: Wall Thickness two State Roads or County Roads. Include the roiriT
Dept) miter or/W,eiieht/Pt. aerial numbers and common road names.
From 0 Toi � Fv.��L �,�uy`Z/� �✓C
From To Ft.
From To Ft.
13, 6ROUI Dcpih Malcri: Nclhod
From To _
17otn�i? To.
14. SCREEN: Depth Uiaincicr Slut tiizc Malcri;:)
From To
From To Ft. in. in.
15. SAND/GR.AVEL. PACK:
Dcpih Size Malerial
From To Ft.
From Tu Ft.
10. REMARKS
DO hI�
D DOIF '14 C'\14I Ili'" I r ' HIS WELL.WAS CONSTRUCTED IN ACCORDANCE WITTI 15A NCAC 2C,WELL
AN t AND THATA COPY OF THIS RECORD HAS BEEN PROVIDED101 LIE WELL OWNER
- � �rN. �16 7- J•t3
j 'IGNATURE OF PERSO ONS-f 2UCT Nffll HE- WELL DATE
�JH�k2 r� 110"le Uivi ion of Water Quality,Grountlwaler Section, 1636 Mail Service Center-Raleigh,NC
A� LLg RM61 21,within 30 clays. GW-I REV. 07/2001

2562 ] 2
WELL CONSTRUCTION RECORD
North Carolina - Dcpaitn)ent of Environment and Natural Resources- Div is ion of Water Qua lily- Groundwater Section
\\'f;1.1.CUTIRACI UIt(ITDI\'IDUiLL,)NAAIE Ip - 0 J1lYI t I, \�S� CERTIFICATIONM rUS
\\'EI.LCON'IR%(IOR(U?ll'AN\'NAnIE=),pJ2n rN I-L LI-1J1aIJ1 � rnoNE e
S IA I F.wF.I.I.CONS'I RUCriON PERPI I'19 ASSOCIA I ED\\'Q I'ER 11
(it applicable) (irapplicablc)
I. WELL USE(Check Applicable Box): Residential Municipal/Public ❑ Industrial ❑ Agricultural ❑
hloniloring ❑ Recuvery ❑ kcal Pump Water Injection ❑ Other❑ If Other, List Use
2. WELL LOCATION: //� Topographic/Lan ting
Nearest Toes: 41 ue - �' '\ County Gwl_'114ek:_ ❑Ridge ❑Slope alley ❑Flat
I.�j j/) /-gib b1-�l,J '' (check apprupria,c hos)
lSlrocl Nnme.Nun,hcrs,Caron)roily/Subdivision,Lot No_Zip Code) Latitude/longlmde of well locatio ll
3. 0WN F-R: Z—A-a A&6cl S (degrees/u,inutes/seconds)
A d d I c s s // � 7 C k)Ll / �./� P La lit udc/l ongi(tide Suurcc:❑GPS❑Topographic map
(�/� ISlracl or Ramie No) J (check bo.e)
Gat)-i j 1 y (S, 6 DEP'fl1 DRILLING LOG
city ,,To,sn glum Zip Code Fr m To Formation Descriplion
IZ�')-
Area code-Phone number
4. DATE DRILLED
5. TOTAL DEPTH: R
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO I]— (_ n
7. STATIC WATER LEVEL Below Top of Casing: _ l7 FT.
(Use"+"if Above Top of Casing)
S. 'I Oil OF CASING IS FT. Above Land Surface* �- {
•710,(of vasing terminated at/or below land surface requires a
r ariasac in area d ec a''Ib 15A NCAC 2C.011a.
9. YIELD(gpill): METHODOFTEST�
IQ WAI'ERZONES(depth): VO r'^
LOCATION SKETCH
11. DISINFECTION: Type _7 ��Y Amount L- L y� Show direction and distance in miles from at Iris
12. CASING: Wall Thickness two Stale Roads or County Roads. Include the road
Depth DIat!Zcr m \t ,gh /FL Material numbers and common road names.
From b To_/Q,f� El. �
From "ro Ft.
From To Ft.
13. GROUI Depth Material hlcthod
Prom, 0_To J��9,., Pt.
Frum�.7 To / �S_ Pt. ff
14. SCRE m M EN: Depth Diameter lot Sizc aterial
From To Ft. in. in.
From ,10 FI. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
74
iron To Pt. _
Frolli—To Ft.
FiI ' 11 S WELL WAS CONSTRUCTED IN ACCORDANCE WITII 15A NCAC 2C,WELL
.rONSTRUCIION STANDAI D THAT A COPY OF THIS RECORD HAS BEEN PROVIDED IO THE WELL OWNER
43--o l
SI NATURE OF PERSON CONS R G I W 'LL DATE
I n of Water Quality,Groundwater Section, 1636 Mail Service Center-Raleigh,INC
--. I,within 30 days. GW-I REV. 07/2001

256211
WELL CONSTRUCTION RECORD
Nortl1 Guulina- Ucp;ulinent of Environment and Natural Resources- Division of Water Quality-Groundwater Section
\\k:1.1,CONllt:1,C]Olt ONDIN I DUAL J(.
)NAME (prinQ�L�j2�,_ ]r-iL..S CE RTIFICATIONa �r('
wk:l.l.CON-I HAC'I OR COM PANY NANIE rDONea (Vu
SI,\Tk:\1'F:LI.COSSIItUCIIUN I'k:RNt1'I'# ASSOC LYI'F,U\\'O PERNI rra
(if applicable) (inapplicable)
I. WELL USE (Check Applicable Box): Residenlial Municipal/Public ❑ Industrial ❑ Agricultural ❑
Moni Wring❑ Recovery ❑ Heat Pump Water Injection ❑ Other❑ If Olhcr, List Use _
2. WELL LOCATION: Topogr 1c/Land setting
Nearest Tomi !))a1) 1 County `I1f k'r .�N.Q_ ❑Ridge Slope ❑Valley ❑Flat
� NoeAg 47 q.-vi tZ t S (check appropriate box)
ts,,"t Name.Numbers,Cononunily,$umivision,L(l No.,Zip Code) Lalllll(IC/1011gitude Of well location
3. OWNER:1/NZTfy 1) Cp )))AP_15 7�a Latitude/longitude source❑GPS❑Topographic map
Address
t Slrecl or Route Nu.l / (check box)
i/Z�LU1I)�✓ ti1i_ ��21�1�a DFPTII DRILLING LOG
Cilyorh"an su� Zip Code From "I.0D Formation Description
Rica ualo Phone nuniher
d. DATE DRILLED �—/7' C
5. TOTAL DEP"I If: OS
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO C}--
7. STATIC WATER LEVEL Below Top ofCasing: S00, FT'. kv D
(Use"r"if Ahove'fopof Casing) C_ =�r;
8. 'f01' OF CASING IS FTC Above Land Surface' n
of of casing he nn i it a ted al/nr hebov land su rhme re0 hires a tV
va riancc in acourdanm n ilh 15A NCAC 2C.0118. C]�
r;
9. YIELD (gpnl): MF,THOD OF TEST
10. WATER ZONES(depth):
LOCATION SKETCH
11. DISINFECTION: Type Amount 7f U Show direction and distance in miles fiom:l-leas(2-
12. CASING: Will Thickness two State Roads or County Roads. IncludcT6 raG
Depth Dfamocter or Weight/Ft) Marcriml numbers and common road names.
Front To�� FI.�L � do
From To Ft.
Front To Ft.
13. GROUT Depth ;aerial Method
Pron1�To�o FL
Id, SCRLL•N: Depth Diameter 'III SVC Maleri;d
Front 'I.o F1, in. in.
From To Fl, in. in.
15. SAND/GRAVEI- PACK:
Depth Sizc Material
Front 'fo Ft.
Froill—To Ft.
16. REMARKS:
((rr�D t �
``��rrttff����IF t3�rI}�C' -11 1 1[IS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
DIYiOIV�TIi IY AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED l0 THE WELL OWNER
PA G- /�-oz
r -- IGNATURE OF PERSON CONSIM UC 1E 1*1 NU WELL DATE
Submit the or'r' • 1)iYi ion of Water Quality,Groundwater Section, 1636 Mail Service Center-Raleigh,NC
2�fEVIL fE RECIIRNAL 733-3 21,within 30 dars. GW-I REV. 07/2001
T
ASHEV!LLE REGIONAL b

2401. 3 �
M.LL CONSTRUCTJ.ON RECORD
North Carolina-Department of Environment and Natural Resources•Division of Water Quality-Groundwater Section
��
WELL CONTRACTOR ONDIVIDUAL)NAME (�pr)tn�t+)_rP9 U-2 Q_V(C i�r? CERTSFICATION ey_,t,—
WELL CONTRACTOR COMPANY NAbtE 'l l`�S �A;<aL ll�4 TNC PHONE a'Gil .BLS—Z�G�a
STATE WELL CONSTRUCTION PERMrr# _ ASSOCIATED WQ PERNEM
_- _Lf applicable) Itf eenliceble)
�rstaf
1. WELL USE(Check Applicable Box):Residential❑ MunicipaVPublle V- Industrial ❑ Agricultural❑
Monitoring❑ Recovery ❑ Heat Plump Water 14ection[ Other❑ If Other,List Use
2. WELL LOCATION: Topogr°�c/Land setting
ScD
Nearest Town: F r County�t�0 C- 13Ridge UKope ❑Valley ❑Flat
IVt (chock appropdatobox)
(sveei Name,Numbers,Ccmmuni.y,Subdivision,Lot No,,Zip Code) Latitude/longitdde of µell location
3. OWNER: -Faivl
Address Vo Spx rl nnuke/sewods)
LatiNde/Iongitudede souiice;QGPSOTopographic map
(Street err R,outt No.) (check box)
1l cl W Q SSef r-A 3 o DEPTH I DRILLING LQG
City w Town stare Zip Code From To Formation Description
(- )- ricu-2cu -
Am code-Phoee number
4. DATE DRILLED 1 -5 O.2 d�+uaF� ncCaa
5. TOTAL DEPTH;_ ?-C �ZCa[ZF�dC ram_
6. DOES WELL REPLACEBXISTING WFLL7 YES ❑ NO _ Qjy�c i rt 4lA�
7. STATIC WATER LEVEL Below Top of Casing;
(Uco"+^Ir Above TopofCuin>J
g. TOP OF CASING IS I FT,Above Land Surface* rYF Close,3-s �f ,p✓ck Clore'Top of cular tttminattd ahbr het"14ad suriatt rr4ui et a
varfaeet In uaordaaeo with 15A NCAC 2C.011& I
9. YIELD(gpm): METHOD OF TESTA
10. WATER ZONES depth): 37S 3iY
j,(�CATION STCETCH
11. DISINFECTION:Type Amount Z LZ - $how direction and distanoe in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads,Include the road
/�
Depth Diameter or . Matcriai numbers and common road names. s
From-- --To ]2_Ft.� t/Pt ZI-C a
From To Ft. Uision d F
Front_To—,_Ft.
13. GROUT' Depth Material Meth d 1 j
Fro To2_Ft.�MAVA vita -,'� 1-�vJ . (n4
From To Ft. a.8 r'r o
14. SCREEN; Depth Diamtta Slot Size 7 Material
From, Ft�in, in. C= c
From To in.
15. SAND/GRAVEL PACK: _ o
Depth size Material
Fror - Tc Ft. 9 M,
From To rj
Ft. — -r
tV m
cn -C-)
lb. REMARKS' �
na
I rso 1RE6Y - THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
S,AND AT A MY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
G � a
efUNATURE OF PERSON CONSTRUCTING THE WELL DATE
L $ubrnitthCard al to be Division of Water Qualityt Groundwater Section,1636 Mull Service Center-Raleigh,NC
?h 99 T6l�P 1n No.(9 9)733.3221,within 30 d3tys, OW-1 REV. 07/2001

2) 40 1 4WELL C N TR CTT.O RECORD
North Carolina-Department of Envircrunent and Natural Resources-Division of Water Quality-Groundwater Section
WELL CONTRACTOR(,INDIVIDUAL)NAM�.$Ke (print) �� CERTIF•IICAATTION ia75
WELL CONTRACTOR COMPANY NAME�l2 CoFI L uu6�ILJC PHONE ,e
STATE WELL CONSTRUCTION PERMIT* ASSOCIAM WQ PERMIT*
ifa liable if liable
1. WELL USE(Check Applicable Box):Residential L7 Municipal/Public Industrial ❑ Agricultural❑
Monitoring 0 Recovery ❑ Heat Pump Water Igiection 0 Other O if Other,List Use
2. WELL LOCATION: Topo c/Lartd setting
Nearest Town: MUi�U Coua `/70KE� MRidge Pope ❑Valley ❑Flat
'CrnJ 4 AAtn 2a�lr)r-t- i I (check appropriate box)
(Sueet Name,Numbers,Community,subdivision,Lot No.,Zip Code) Latitude/longittide of µell location
3. OWNER:_ SC C) +L�I FCl Yl (degea m nu as exoods)
Address T.0 Pnx 93R Latitude/longitude soluce:QGPSQTopographic mar,
(Strecr cr Rcvc:No.) (check box)
_ i-6 01A145SP- (-A DEPTH D-ULLILQ12Q
City or Towo State Zip Code &18noFo on Deseriptioo
C-�- rIN,�G(o-Am code.Phnoe aumbc4. DATE DRILLED — 132
.5. TOTAL DEPTH:_ 69�6. DOES WELL REPLACE EXISTING WELL? YES 0 NO7. STATIC WATER LEVEL Below Top of Casing; > T. aLc� fla>F�Jr7(l6Zacv!
(Use'4"ITAbove Topof Cuirq)
TOP OF CASINO IS� FT,Above Land Surface`•Top urealar terminated■t/ur blow load eurfaoe feylra s -.varisuet in ucordaacey�lrh ISANCAC 2C.e11R9. YIELD(gpm): G! METHOD OF T$STQ f, ���tl
10. WATER ZONES(depth);
LOCATION SKETCH
11. DISINFECTION:Type Amount Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads,Include the road
Depth Diameter i e or�W�e�i me
t/Ft. Material numbers and common road nas, s
FronLo—ToS�- Ft.�_ a ti (-Y 7 L _
From_To Ft. SuIIIIiViSioh � Q �
From—To_,Ft,
13. GROUT: Depth al M od ll '
Frotr0_ToT� Ft. 7 NA '&
Froth To Ft.
14. SCREEN; Depth Diameter Slot Size Material 0.1 „ ;
From, To FLJn, it, �j c`
From To Ft.�jn. in. _ L R_
15. SAND/GRAVEL PACK: o C c
Depth: Size Material Z cm
From To Ft. 3 CO *r.
Frorn_ To Ft.
y =c
l6. RE m Ll R(7 h t N n
7�o PtaleY THAT THIS WELL,WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION THAT A COPY O THIS RD SEEN PROVIDED TO THB WELL OW1 t
_I
SIUNATM OF P ON CUNSTRUCTTNO THE WELL DATE
L n, _$tylMact tficong al to he Division of Water Quality,Groundwater Sectlon,1636 Mail Service Center-Rileigh NC
'2 769 941 6 1 6 Rhotia'f o. 9)733.3221,within 30 Uys, OW-1 REV. 07/2001

254493
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources- Div ision of Water Quality-Groundwater Section
I Y
N% ;LL I ON]RAC'I'OR(IN D IN DUAL)NAME (print) IM+t�y .JO ti(_S CERTIFICATION q�
tYELL Con I RM I Olt Coau'ANY NANIE � nukk���� T PHONE
s r,%I E w'I I.I.COTS rItl!C noN I'ERallT'q ASSOCIATED WQ PERNII rp
(it applicable) / (ifapplicable)
I. WELL USE (Check Applicable Box): Residential ll� Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection❑ Other ❑ If Other, List Use-
2. WELL. LOCATION: I topographic/Land setting
Ncerest T��o�w��n: i' h- County ���. '�" �e"`e Idgc ❑Slope ❑Valley ❑Flat
r r v C nook LCI.F Jl_L It-- L/ (check appropriate box)
(Snael Ne.me.Nnnlhers,Community,subdivision,Lot No.,Zip Code) L'ahtUde/longitude of well location
3. OWNER: /77A•. N, y /
f�PL_):t:An/CIQ.`.L (degrees/minutes/seconds)
Address /5S'I iJ /V k l 5i [ r> C(:, a,l T- Latitude/longitude source:❑GPS❑Topographic map
IStrcet or Rnule No.) (check ban)
tIt/q--rt / V L_ - Q QFP"fH DRILLING LOG
City )r lo,o State Zip Cale From �To_ _ F rmation Description
cl,
Area code-Phone number � � _�o,�
4. DATE DRILLED_
5, TOTAL DEP-1 It O �
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO ❑` _
7. STAI TIC WATER LEVEL Below Top ofCasing: _C_O ' FT.
(Use"+"if Above fop of Casing)
S. 'I OP OP CASING IS FT. Above Land Surface*
•'I'np of casing terrninatcA ntier belmr IanJ surface requires a
cariamce in ammlanee with 15A NCAC 2C.0118.
9. YIELD(gpm): -3i7 METI-IODOFTEST [� —
10. WATER ZONES(depth): CIAO _
_ LOCATION SKETCH
11. DISINFECTION: l ypc Amount GU Show direction and distance in miles from at (cast
12. CASING: Wall Thickness Iwo State Roads or County Roads. Include the road
De pill D'amcter or W'ci'h(/Ft. N It trial numbers and common road names.
From 'To-,L7_FL �Ci
From 'I'o Ft. C
O
From To--- Ft. _
13. GROU"I-: Depth Material Method C ��
From 0 _"1-0_�]C2__Ft. �
From To Ft._
14. SCREFN: Depth Diameter Slut Size Mnlerial V O�
„n
I`rom To FI.
From To
IS. SAND/GRAVEL PACK:
Depth Size Material N
Frmn fo FL
from T FL_
: IiRlll '"f T THIS WELL WAS CONSTRUCTED IN ACCORDANCE WI"fll ISA NCAC 2C,WELL
C'ONSTRUCIION SEA I S,AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED 10 1 HE WELL OWNER
JUL 29 rti lTc� ls " OZ
J S IGNAIURE OF PERSON CO T 'TRUCTIN E WELL DATE
G yNDV�ATER SECTION
FISH€°1L)LVI�Vgl@(ti4:i tUflFIG5 eision of Water Quality,Groundwater Section, 1636 flail Service Center-Raleigh,NC
1 - 6 1'hnuc No.[phone],within 3l) days, GW-I REV. 07/2001

25A4494
WELL CONSTRUCTION RECORD
North Caro Iina - Department of Environment and Natural Resources- Division or Water Quality-Groundwater Section
�/
\t'F.1.1.C:ON'l RAC]Olt ONUIC'IDl1A1.)NAME (Print)_ .E'f'v(' CER"rI FICATION N�.4xL`S,p
w'BL1.CO.\"IIiAC"1'OR CO\(('ANY NMIF,_CtiY ILpp 1 l' II i25 PIIONEN (J1! � l-JwO
5I,\'I'f:\CELL CONS'I'ItUCI'ION I'E RaI I'I'q ASSOCIATED WQ PERMIT4
(it applicable) (ifap licable)
I. WIEHA, USE(Check Applicable Box): Residential Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monion'ing ❑ Recovery ❑ Heat Pump Water Injection ❑ Other❑ If Other, List Use
2. WELL LOCATION: Topographic/Land setting
NeamslTown: County C�tQR� �'� 041ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
(Street Name.Numbers,Community,Subdivision,Lot No.,Zip Cmle) Lat i l ude/longi[tide of well location
3. OWNER: 1?iq�J'Ut/ NEP—"u/Q") C, _ (degrees/minutes/seconds)
/ •Iyk) SS'i rib .T Lali(uddlonLitudc sourer.❑UPS❑Tubr od hic ma
Atldress /$S��ai P P P
(Svicet or Route No.) (check box)
„yt 3 1G DEPTH DRILLING LOG
City or Town Syyyye Zip Code F)ygt o formation Ucs ript ion
Cj• ' Doti VT
A rcn code-('bone nun:her // `� '1 r �
4. DATE DRILLED b lJ /�
5. TOTAL DEPTH:
6. DOES WELL,REPLACE EXISTING WELL? YES ❑ NO ❑'
7. STA FIC WATER LEVEL Below Top of Casing:��FT.
(Use"+"if Abovc Top of Casing)
8. TOP OF CASING IS FT. Above Land Surfacc•
•'fop of rasing terminated at/or below land surface requires a
variance in accordI e'i tb ISANCAC2C.nl IR. (jf
9. YIEI"D(gpm):S •h-Y ME"fl-IOD OFTEST ' C
10. A1'A'I'I:R ZONES(depth): — —
LOCATION SKETCll
11. DISINFFCI [ON: hype_ Amount G-LI Show direction and distance in miles from at leas(
12. CASING: Wall']hickness two State Roads or County Roads. Include the road
De th mmeter or Weight/Ft. Jerial numbers and common road names.
From To �5 Ft. � 4 ,5 PvL
From To FL - — CD
Front To I-L O
13. GROU'� Depth Material Method tV
c�
Pro To;2.� Ft. C m
From L7•Tom( �_ FI. �^
14. SCREEN: Depth Diameter Clot Size Material J o�
t r-
From To_ Ft. in. in. c
From To Ft. in.
r-t
15. SAND/GRAVF.L PACK:
Depth Size Material
N
From To F —L -�-t
U o
From To FL
16. REMARKS:
140 �F.RIYEI I IIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C,WELL
ND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED 10 THE WELL OWNER
6 _ CZ
S GNATLIRE OF Pb ON CON lit 'TI t THE WELL DATE
bU, 1.WA1'CIilS£ ml� a DI,i. on of Water Quali(y',Groundwater Section, 1636 Mail Service Center-Raleigh,NC
1�9114N'1Lfl1rflERiOyJNinJIif1�F733-3 21,w'ilhin 30 days. GW-I REV. 07/2001

254495
WELL CONSTRUCTION RECORD
North Carolina- Department of Environment and Natural Resources- Division of Water Quality-Groundwater Section io / `C
FELL CO\IR:\CI Olt(INDIVIDUAL)NAME (prian CERTIPICATIONM
%%ElI.CoxTnk( IOR(0%IPAn) Nnnlr: 4�v�'4 _�J�� _� —ru0Ne a (Si5)F5i7-S�(h�
ST,t i F:\\'h:LL COSS"fltUCiION 1'EIZNII'I"a ASSOCIATED\\'Q I'ERPIIT#
(if applicable) (if applicable)
I. WELL USE(Check Applicable Box): Residential ll!' Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monlloring❑ Recovery ❑ Heat Pump Water Injection ❑ Other❑ If Other, List Use_
2. \FELL LOCATION: Topographic/Land setting
Ncarest Town:_ f11(4Q_ Counlyrl,_er__� Idge ❑Slope ❑Valley ❑Flat
/CI NfZTIJG �'nyE?t_� (checkappropriatc hox)
IStrcc(N.nne.Numbers,Connnunity,Subdivisioa,Lot No-Zip Codc) Latitude/longitudc of well location
3. OW NER: in ' A,j6N1��ol1 Idcgrecs/minuses;seconds)
Address 3Z�I-11�IGt)2✓ �11-L bd� l_autude/longitude SOurce:❑GPS❑Topographic map
(Street or 11 e��--')`6'(J (check box)
� �\ /J � O�v DEPTH LOG
e 1) or lo, n _ Stalc Zip Code 1'rg(n 7 /S Formation Description(/ l�
Area code-Phone number r
d. DATE DRILLED v-�-
S. TOTAL DEPI H: o s
h. DOES WELL REPLACE EXISTING WELL? YES ❑ NO 0-
7. SI'AIIC WATER LEVEL Below Top ofCasing: 52 F"f.
(Use"+"if Above Top or Casing)
8. 'I OP OF CASING IS FT. Above Land Surface*
'Top of casing terminated at/or below land surface requires a
variance in accordance wish 15A NCAC 2C.a11A.
9. YIELD(glim):
10. WATER ZONES (depth): -
LOCA'IION SKETCH
11. DISINFECTION: Type /y Anlouot t C�v Sllo\V(III'ectlon and distance II1 miles from at leas(
12. CASING: Wall'ihickness two Slate Roads or County Roads. Include the road
Depth Diml cicr or WcigitUFt. Material numbers and common road names.
From Q To 6S Fl. 0 _PYL -
Ffolll l'o FL ro o
Fronl To Ft --- C
13. I: Depth - Mat Method
Floor cm
Drum o
From
14. SCRI`EN: Depth Diameter Slot Size Material
3 �m
Front_To FI. in. Or _ (fi-
IV -�
15, SAN WGRAVEL PACK: o
Depth Size Material z
From fo FL
Front To__Ft.
10. REMARKS:
II - I T TI IIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
D IE N. 12C "I N A D DS,AND-I HAT A COPY OFT[its RECORD HAS BEEN PROVIDED TO I[IF WELL OWNER
0nr3
SIGNAIURE Oh PEILSON C( t 'TRUCTING THE WELL DATE
SuIlln I (he on„inal t the ivision of Water Quality,Groundwater Section, 1636 Nlill Service Center-Raleigh,NC
,I4E}TIl7N(919)7 3-3221,within 30 days. G W-1 REV.07/1001
GR
P'SHEVILLE REGIOPJAL OFFICE

254496
WELL CONSTRUCTION RECORD
Not Ill Caw Iina - Department of Environment and Natur
al Resources- Division of Water Qualify-Groundwater Section /--[
WELL COSI ItAC'fplt(INDI\'IDUAI.)NA01 F. (print +��1 \^ 11 -� CF.R"111FICATION N
\\'ELL Cfl\"I li:\CI'(7R CODII'AN l'NAMF. Q 1����-'_ h�Q' l N PHONE N ('� Q�7— C DO&
ti I'A'fh;\\'ELL CO,\'S'I RCCIION PEIt�11TN ASSOCIA F. )U'Q PERNIITN
(if applicable) (if applicable)
I. WELL USE(Check Applicable Box): Residential (municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring❑ Recovery ❑ Heal Puntp Water Injection ❑ Olber ❑ If Other, List Use
2. WELL LOCATION: ) // ��upographic/Land selling
Nc�:resllbw'n: CounlyC`tQ/t' 9! 11R idge ❑Slope ❑Valley ❑Flat
n A (check appropnatc hor)
(Street N:nne.Numbers.Commuairy,Subdivision,Lot No..Zip Code) /7 Latitude/longirude of Well location
3. OWNER: In�'I'k��� tm�« F` ( (dcgrccs'minmes/seconds)
A(Idress n b'1{ l i/S©�1//Tl"C�Q� Latitude/longiaidc source:❑GPSOTopogrtphic map
/// ,, (st 5t or Route No.) ^p (check bos)
-/ )4 ll/i�/F NC L-D �`(� y DEPILI DRILLING LOG
Cary or Town Stae Zip Code From To onration Description
(fit)- 38�I �05 J 0 '
Arr.+code-Phonc number
4. DATE DRILLED �-
5. TOTAL DEPTH: 1_
6. DOES WELL REPLACE EXISTING WELL? YES El NO ❑�
7. Sl"AFIC WATER LEVEL Below Top of Casing: , %-V , ET.
(Use"+"i f Above Top of Casing)
S. TOP OI'CASING IS FT. Above Land Surface'
I op of casing lerminaled ar/or below land surface requires a
rari:uae in accomaiU wir11 I5A NCAC 2C.0118.
9. YIELD (gpm): l9 METHOD OF TEST
10. WATER ZONES(derdll): �,yJ rJ 6
LOCA LION SKETCH
11. DISINFECTION:I ype Amount (iv Show direction nild distance in miles from at least
12. CASING: Wall Thickncss two Slate Roads or County Roads. Include the road
Depth mn c(er or Wei+it/Ft. NIA tt ndl numbers and common road names.
From_To FL _ �'( � N c
Fron) To
Prone To
Z c
13, GROUT: Depth T
a(criali Meduul _ x—
From l7 Too Vd EL _
Prom__To_Ft.
14. SCREEN: Depth Diameter Slot Size Material 3 a�
From _To PI.
ma
from To fl. IV -�-t
I5, SAND/GRAVFE. PACK U11
Depth Size Material
From _fo_ Ft. _—
Front _To_ FI.
16. REMARKS:
D L= EIY' ) ' 1 �'�1 AT TI EIS WELL WAS CONSTRUCTED IN ACCORDANCE Wll It 15A NCAC 2C,WELL
CONS-1 RUCI]ON S"I / MS,AND THAT A COP F THIS RECORD I1AS BEEN PROVIDED TO TIIE WELL OWNER
I,Ut 9 c
` SIGNAI'URL•OF 'I . . 1RUCTI ' I F WELL DAL
L- - -
GR08ftlDIWfITNPeStGCP'T�j�'I�'1q� 7 the Division of Water Quality,Groundwater Section, I636 Mail Scnice Confer-Raleigh,NC
ASHEVIbk_�_6J �F{rs!1 „k:-Nir 33-3221,vvi(hin 30 da)s, GW-I REV. 0712001

254497
WELL CONSTRUCTION RECORD
North Carolina- Deparuncnt of Environment and Natural Resources- Division of Water Quality-Groundwater Section WELT,CO\TRACTOR(INIIIVIDUAI.)NANIE (print) ,� !'VI')'c ,/ �O rJ es CERTIF'ICAI"ION N D56S
%%EI.LCONIIt,%CIOIt CONIPANYNANIF. �F ^� o ��.-L_L_J-,j Lj1n--INIONE N
S i'.k i f:t\'ifl.l,CONS"I RUCIION PERNIITN ASSOCIATED WQ PERMI #
(ifnpplicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential QY Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring❑ Recovery ❑ Beal Pump Water Injection ❑ Other❑ If Other, List Use
2. WELL LOCATION: // /�i // Topographic/Land setting
Ncaics:Town: /)1 up- pK- County L.�/(° '-Or`Qe ❑Ri(Ige ❑Slope []Valley lal
ail �I r"A S'41 I S r_ 1'1 ('-1•^)(J (check appri)priale box)
L 2'
(51recl Nanm.Numbers,Ctnunumily,Subdivision,Lot No..Zip Code) Lalitu(Ie/longitude of well localim)
3. OWNER-
Address I A-1 ?& - /Y)a^1n F' Lali(u(Ic/l ongi tulle sour cc:Oct PS❑Topographic map
� 15necter�Houle Nor (check hox)� DEP'riI DRILLING LOG
oily or Toren stale Zip code Flom I'llFormation Description
-<�7 i
Are; code-Phone nun,he
4. DAI -, DRILLED_ —
5. 1OTALDEPTH: CI '�
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO Cl'
7. STATIC WATER LEVEL Below Top of Casing: 0 . FT,
(Use••+••if Above'rop of Casing)
S. I OP OI'CASING IS FT. Above Land Surface'
'"1 np of casing termivateA at/nr below land snr(ace requires a
rariance in accordance wish 15A NCAC 2C.0118.
9. YIELD(gpm):_L2:__METHOD OF TEST
10. WATER ZONES(depth):
LOCATION SKE'I'CII
11. DISINFECTION: Type Amoun(
l/ Show direction and distance in miles from al least
12. CASING: Wall Ihickness two Stale Roads or County Roads. include the road
Deptl D'an ter or
o_ WeeiggPub/Ft. lter ai numbers arld common road names.
Pram h p
Froltt To FI. N
From_ To
13. GROU"f: Depth hlatcria Method
From �_ To_�,D_ Ft
From . o__� SFt.__ 1 Du-
14. SCREEN: Dcplh Diameter U Slot Size Material
$ —G
I rom To 171. in. in.
N-�
Front To FL—ill
N 15. SAND/GRAVEL PACK: (XI
�
Depth Size Material
Front To FL
Prom 'fo_ FL_ _
M. REMARKS:
I� (�` � .. , ' 1is
O lY'P:IZYIiltilPl�' "I [IS WELL WAS CONSTRUC"IED IN ACCORDANCE WITH ISA NCAC 2C,WELL
itK110 S FAN I) ND THAN A COPY OFTHIS RECORD I IAS BEEN PROVIDED]011 I/FF WELL OWNER
� - r S GNAIURE OP PERSON C70NSTRUCTINCaff WELL DATE.
_
itSxFX:ItiIQNe J Divis on of Water Quality, Groundwater Section, 1636 Mail Scrrice Center-Ralc. 0 NC
21,1ci(bia 30 da)s. GW-I REV. 07/20(11

254At98
—WELL'CONSTRUCTION RUCTION RECORD'
North Carolina - DcparUnenl of Environment and Natural Resources- Division of Water Quality-Groundwater Section / S�
\\'ELL CON"I RAC IOlt(INDIVIDUAL)NAME (print) ^�'✓� —]t=i �L- cISRTIPIcnTloNa 4
\VF,1.I,CON'I' ACfOlt COM PANYNANI F, y\CL�ss rl-1-t1J Cr rllorve a (ff xl
R St7-t`�00�
STAFF:\\'F;1,1,CONS"IRCCIION PERMIT# ASSOCIATED WQ PERNIITa
I if applicable) (if applicable)
I. WE LI. USE (Check Applicable Box): Residential Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring❑ Recovery ❑ Heal Purnp Water Injection ❑ Other❑ If Othcr, Lis( Use_
2. WELL. LOCATION: ! Topographic/Lan setting
Nearest Town: /°7U �\ _County Chen��ee ❑Ridge ❑Slope alley OF1al
7%-l��Q l.C�l.i.:Un `-[)��5 "J- (check apprnprintc has)
(Street Name.Nunttie ,Community.Subdivision,Lot No-Zip Code) 111(ittRIC/lOngdude of\cell location
7
3. 2
C e'Ontinmes/seconds)
Address
: �-37��� 1de g
As P 'Ct UX /:2 S Latitude/longitude source:❑GPS❑Topographic map
Slreel or Ito we No.) (check box)
�I1 u� n�r,� QJ� JT��i✓���1_— DEI'TI I DRILLING LOG
wn / Stale zip code Fr u2 1 Too�Von Description
Area code-Phon elu01nher /___,
4. DATE DRILLED (5J 0
5. TOTAL DEP"fH: 7, D S' '
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO If _
T STATIC WATER LEVEL Below Top of Casing:_�i_-_FT.
(Use"+"if Above"fop of Casing)
S. I OP OF CASING IS I Fr.Above Land Surface`
•I op or casing termirrtted at/or below land surface requires a
variance in accordance\rill, 15A NCAC 2C.0118.
9. FIELD (gP11t): —)--S- _METHOD OL'TEST _
10. WATER ZONES(depth): C�t7 r --
LOCATION SKETCH
I I. DISINFEC'IION:Type Amount 5- G[/ Show direction and distance in miles from al lead
12. CASING: Wall Thickness two State Roads or County Roads. Include the road
Depth Diem,er o�rW,ewh Ma
terial aterial numbers and common road names.
From To� Ft._�j- .�]u�L�-� G
c
From To Ft. p61
'
From To__ Ft. C_
`G
e-
13. Ci120U1': Ucpth t Itcrctl fdclh Cnd
From_-1 o_�r�_. -
Ftonr 'fo F( o"=
z sm
14. SCREEN: Dc1,111 Diameter Slot Size Material Do
9
From To_"_ 171. in.
From__To--Ft. in.
I5. SAND/GRAVEL PACK:
Depth Size Material
� G
1:1'our—,[o Ft.
From To - I"I.
16. REMARKS.
I�O Itl l''IF1 a C, '1 -IIS WELL WAS CONSTRUCTED IN ACCORDANCE WI I'll 15A NCAC 2C,WELL
_ JC HON STAN I)A{IRf) ND THAT A COPY OF TI[IS RECORD I IAS BEEN PROVIDED"TO IIiE WELL OWNER
" M✓1 �Df? Cs -3-DZ,
SNA'fUKH OF PEILSON C. NS"TRUC NG TLIE WELL DATE
t {R�ULlbVJut,��f'ilfi�d�,FW� k ivisi it of Water Quality,Groundwater Sect in 1636 NIaiI Ser\'ice Cenlcr-Raleigh,NC
A�1� i '4 I,within 30 days. GW I REV. 117/2001

WELL CONSTRUCTION RECORD 2 6 2 9 25
North Carolina-Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section
,•� n )t`�C771 CERTIFICA:IQN Xe2�� _
WELLCONTMCTOR(INDIf'1DVAL)NAME (print) PHONE #
WELL CONTRACTOR COMPANY NAME /r/ //Pl-
twc
ASSOCIATED WQ PERMIT#
STATE WELL CONSTRUCTION PEMIIT# if applicable)
ifa applicable)
1. WELL USE(Check Applicable Box): Residential Municipal/Public El Industrial❑ Agricultural❑
Monitoring 0 Recovery ❑ Ileat Pump Water Injection❑ Other❑ If Other,List Use
2. WELL LOCATI N: �" Topograpi»c/Land setting
NearestT wn: County4 .ui� ❑Ridge EISlope OVelley OFlal
�� n'^/ (check appropriate box)
r )'( "' .' a fC J Latitude/longitude Of well location
(Street Name,Numbers,Community,Subdtvision,Lot No,,Zip Code) _
nn pp (degrees/minutes/secends)
3. OWNER:// I// / s/7
Address � •fin nr ('-tint �YTi ) Latitude/longitude sotuce:OGPSf_lTopographic map
(check box)
(Street or Route No.) DEPTH DRILLING LOG
t state p FrAom To rrrt lion Description
City or To Zip Code ICJ ��nC l
DATE lJ_/YfL-: —
Arse code-Phone number r
4. DATE DRILLED S �U-��
5. TOTAL DEPTH: 305-'
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO GL
7. STATIC WATER LEVEL Below Top of Casing: (n17r FT.. -
(Use"+"if Above Top of Casing)
I FT.Above Land Surface*
8. TOP OF CASING IS _ -
'Top creating terminated at/or below land suratce requires a -
variants In accordance with 15A NCAC 2C.01 Is- , -- -
9. YIELD(gpm):2_METHOD OF TESTQ_—
10.WATER ZONES(depth): i QQ Tl( N SKETCH
Amount / _ Show direction and distance in miles from a(3east
II. DISINFECTION:Type Wall.thickness two State Roads or County Roads.Inaude Ae road
12. CASING: terial numbers and common road names.
Depth r Diameter or Weightfr Me
From f2 To Ft. G,2S —
From To FL
From To Ft.
13. GROUT: Depth
Materi9l I Method
Fromm To 2A
From To FI. -
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
in.
1 S G A
�Depth i. Material
To Ft. _-----
F i`01 -FcR - --
I RE '
GROUND S OI
WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
1
F THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
CONSTRUCTION STANDARDS,AND THAT A COPY O
G -C1
SIGNATURE OF PERSON CONSTRUCfINO THE WELL DATE
Submit the original to the Division of Water Quality,Groundwater Section,1636 Mall Service Ceenter'REVgh,C
27699.1636 Phone No.[phone],within 30 days.

262937
WELL CONSTRUCTION RECORD .
North Carolina-Department of Environment and Natural Resources-Division of Water Quality-Groundwater S•ectio�n��,,.,''
WELL CONTRACTOR(INDIVIDUAL)NAME (print)
CERTIFICATION N_YLL`1
WELL CONTRACTOR COMPANY NAME X)�'/141— /,yP11 PHONE # (CSC)E z7—7�y7
STATE WELL CONSTRUCTION FERMI TO ASSOCIATED WQ PERMIT#if a licablc
Ira licablc
1. WELL USE(Check Applicable Box): Residential -Municipai/Fublic❑ Industrial❑ Agricultural❑ --
Monitoring❑ Recovery ❑ Heat Pump Water Injection❑ Other❑ If Other,List Usc
2. WELL LOCATION: Topographic/Land setting
NearestTown:(»(IC-,Q 1`i County kp`��PP []Ridge (❑eckoppp�❑riateblox) []Flat
__
Latitude/ton nude of well location
(Street Name,Numbers,Community,subdivision.Int Na.,Zip Code) g CD _
(degrees/minutes/seconds)
3. OWNER: Fin r t (Z1uS _
Address � nti Latitude longitude source:❑GPS❑Topographic rnap
(check box) ~
(Street or mute No.) DEPTH pRILLING LOd_
zi code From To o ation Description
Cityor wn Stale P Q 6 ,
Ares e-Phone number m r
4. DATE DRILLED -I y"f)
5. TOTALDEPTH: lQS` �-
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO IA— --
7. STATIC WATER LEVEL Below Top of Casing: 15 ' FT.
(Use"+"if Above Top or C"ing)
8. TOP OF CASING IS FT.Above Land Surface*
*Top of casing terminated attor below land surface requires a
variance In accordance with 15 METHOD OF TEST
9. YIELDIELD(gpm): —
10.WATER ZONES(depth): LOCATION SKETCH
(C Amount S Show direction and distance in miles from at least
1 I. DISINFECTION:Type two State Roads or County Roads.Include the road
12. CASING: Wall Thickness o
Depth�El I` Diameter or WeighVrt. Material numbers and common road names. ry
Fron T° -
t_ r S tp P L
From 2D To Ft. IOe 7\0
From To Ft. w
13. GROUT: Depth at jGn r/ Method
From_To Ft.
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material c —,
Front To_ Ft. in. in. -;
From To Ft.
15. SAND/GRAVELP
Depth
From To Ft.
From To Ft.
16. REMARKS:
GROUND!'d97ERSEGiiON IN ACCORDANCE WITHISANCAC2C,WELL
IDO HER FBYCERTIFY T•�'I YW' I*''�ASMNsVMJCfE
CONSTRUCTION STAND TroppY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
'�'— /q -O
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division or Water Quality,Groundwater Section,1636 Mall Service Ceenter'RRBV gh,N001
27699-1636 Phone No.[phone],within 30 days. ,

262936
WELL CONSTRUCTION RECORD
North Carolina-Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section -
ISOL CERTIFICATION May
WELL CONTRACTOR(INDIVIDUAL)NAME
y((ppr7int)
WELL CONTRACTOR COMPANY NAME /,/I �l l Z 2/r�Q PHONE N (&2P1 kL7—r� 7
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#if a licable
(if a licable
1. WELL USE(Check Applicable Box): Residential Municipal/Public❑ Industrial❑ Agricultural❑
Monitoring❑ Recovery ❑ Heat Pump Water Injection❑ Other❑ If Other,List Use
2. WELL LOCATION: �,I �� �, Topographic/L.and etting
Nearest Town: Countycllo- � ❑Ridge ❑Slope alley ❑Flat
I� 1 AI 1 (check appropriate box)
rJ 0 P r Latitudeflon itude of well location
(Street Name,Numbers,Community,,Subdivision,
Lot No.,Zip Code) B
3. OWNER: /�-// �'`�`�"-"' r (degrees/minutei'seconds) - -
n Latitude/longitude source:❑GPS❑Topographic t ap
Address
(check box)
(Street or Ropte No.) Z�q�� DE p�l)_LING LOf -
h Z; Code From To F nation Descri.plitln City or own State p b /D . e�Z
Ares Code-Phone number �� A/0 r _-
4. DATE DRILLED 6 - 1�3 r;2 /yq /5S o
5. TOTAL DEPTH: 7gS
6. DOES WELL REPLACE EXISTING WELLI YES❑ NO o
7. STATIC WATER LEVEL Below Top of Casing: IoD FT• __
(Use"+"if Above Top of Casing)
S. TOP OF CASING IS ( FT.Above Land Surface'
*Top of casing terminated atlor below land surface requires a
variance In accordance with IS METHOD OF TEST�,S_.--
9. YIELD(gpm):�—
10.WATER ZONES(depth): )OCATION SKETCH
Amount .S Show direction and distance in miles from at least
I1. DISINFECTION:Type Wall Thickness two State Roads or County Roads.Include the road_
12. CASING: terial numbers and common road names. CD
Depth Diameter or t. Ma
From_ C-')
From i ua To Ft. /
From To Ft.
13. GROUT: Depth Matert i Method
From_Q_TO 4;) Ft.
From To Ft.✓ o
Diameter Slot Size Material -- '-
14. SCREEN: Depth
Front To—._Ft. in. in.
From To
15. SANDIGRAV t u V t ri
From Ft.
From
16. REMARKS:
SECTION
1 DO HEREBY CER Y I � tplAS 0111 D IN ACCORDANCE WITH I SA NCAC 2C,WELL
CONSTRUCTION ST COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
S- -2
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality,Groundwater Section,1636 Mall Service Ceenter'REVgh,C
27699-1636 Phone No.[phone],within 30 days.

259156
WELL CONSTRUCTION RECORD
North Carolina-Department of Environment and11 Natural Resources-Division ofWater Quality-Groundwater Section
WELL CONTRACTOR(INDMDUAL)NAM (prlot)W 5� `EC ``. ^� CERTIFICATION#X3c�9 _
WELL CONTRACTOR COMPANY NAME '�' �e-L �l•�'`k) PHONE # J 13-ff /SS
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if a licable (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 LOCA IO j1'opographic/Land setting
st o n pppjjjtltt dge []Slope ❑Valley ❑Flat
(check appropriate box)
(Street Name, bare,C unity,Su 'vision,Lot No.,Zip Code) LatitudcAongitude of well location
3. OWNER• - (de gteeestminuteslseconds)
Address Latitudellongitude source:❑GPS❑Topographic map
trect or ute NoJ c� (check box)
(6DEPTH DIUL LING LOG
z' Cade From To Formatio escription
,Q�j�/C�ity or m States 1 N -1LCL7�
lk t
Area coda Phone number D
4. DATE DRILLED 1121,
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 Cuing)
8. TOP OF CASING IS ' FT.Above Land Surface•
-Top of cuing terminated atior below land surface requires a
variance in accord�nrFeL�Ith ISA NCAC 2C.0I19. 1-1
9. YIELD(gpm):�—MET$O()Of TEST
10.WATER ZONES(depth): ; LOCATION SKETCH
11. DISINFECTION:Type Amount Show direction and distance in miles from aJ yl ast
12. CASING: Wall Thickness two State Roads or County Roads.Include tlwroad�
�ptt�� pp��am��er qW t/Ft. eri numbers and common road names.
Fro mQ_To 1 Ft. (s
From To Ft. D a
From To Ft.
13. GROUT: Dap Ma Method ^
From To Ft• £ 111) -�
a
From To Ft. =0
14. SCREEN: Depth Diameter Slot Sim Material so r_
From To Ft. in. in. 1�-
From To Ft. in. in. V
15. SAND/GRAVEL PACK:
Depth Sin Material
From To Ft.
From To Ft. y /�
-
16. REMARKS:
I DO HEREBY CERTIFYA T THIS�T A CCOAS PONSTRUCTED IN ACCORDANCE Y OF THIS RECORD HASEEN PROVIDED TO THE WE R
r� r
r SIGNATURE OF PERSON CONSTRUCTING THE WELL DA
I
Division of Water ,Groundwater Section,1636 Mail Service Center-Raleigh,NC
n
Quality,uali tb
l� Submit the original ,� GW-1 REV.07/2001
27699-1636 Phone No.�(919) 33-3221,within 30 days.
oFFECE

WELL CONSTRUCTION RECORD 258164
North Carolina-Department of Environment and Natural Resourc -Division of Water Quality-Groundwater Section
�.s�,y�
WELL CONTRACTOR(INDIVIDUAL)NAME (print) �1 e577 CERTIFICATION 01Gv ' _
WELL CONTRACTOR COMPANY NAME WV, '-ASt» k�--�11 t I LLG PHONE 8 - /1SS
STATE WELL CONSTRUCTION PERMITS ASSOCIATED WQ PERMITS
(if a licable ifapplicable)
1. WELL USE(Check Applicable Box):Residential Municipal/Public❑ Industrial❑ Agricultural❑
Monitoring❑ Recovery ❑ Heat Pump Water Injection❑ Other❑ If Other,List Use
2. WELL LOCAT N: Topograpinc/Land setting
Qa arest T wn: 5" ZipCodc)
❑Ridge Mope ❑Valley []Flat
(check appropriate box)
(street Nan Numbers,Coo nity,s ivision, Latitude/longitude of well location
3. OWNER: (degroulminutna/seoonds)
Address Latitude/longitude source:❑GPS❑Topographic map
(Street o ute No) ^' (check box)
evq
arbll>!�_ DEPTH DRILLING LOG
ty o , te� Zip code From T��1�ot i Fo ati D •cription
Area coda Phone number
4. DATE DRILLED bo 9tLS�r
5. TOTAL DEPTH:
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing:— LD FT.
(Use"+"if Above Top of Casing) O
8. TOP OF CASING IS FT.Above Land Surface* s c
c�
-Top of cuing terminated at/or below land surface requires a r- _
variance in accord*9955elgq�ith 15A NCAC 2C.0118. �� c
9. YIELD(gpm):=METHO rr OF TEST =-
10.WATER ZONES(depth): t _
LOCATION SKETCH --
11. DISINFECTION:Type Amount
Show direction and distance in miles from ataeast
12. CASING: Wall Thickness two State Roads or County Roads.Include tla road
h —Depla fer o Wei t ,AQaV� numbers and common road names. p r-
From_L) To l Ft.
From To Ft.
From To Ft.
13. GROUT: ��}} qq Mat a� _ . Method
From Tom_Ft. � r ,_ �t� 1I1 i6Q
From To Ft. 1 Sr*+
14. SCREEN: Depth Diameter Slot Size Material a
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft. a
From To Ft.
16. REMARKS:
I DO HEREB SWELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
r5 S %"'Al p THAT A COPY OF THIS RECORD HAS BEEN PROV IDED TO THE O R
/ D
5I ATURE OF PERSON CONSTRUCTING THE WELL DOE
limit the original to the Division of Water Quality,Groundwater Section,1636 Mail Service Center-Raleigh,NC
1 99_1636 Phone No.(91"3-322`1,within 30 days. GW-1 REV.07/2001
�J
c,

253430
WELL CONSTRUCTION RECORD
North Carolina - Depailnrent of Environment and Natural Resources- Division of Water Quality-Groundwater Secti-o�nK/
11'4:LLC(1.\'IR.\CrORII\IIIVIULIAI,)NAPIE/1x'11ri'�t) .�I q_ 1T CERTIFICATIONq.t5((p1 Q
NNE LI.COI;I RA CI OR COnI FAN1'N,\NIE��Ro 6—le ctJ�ll 1JRi ��ta euoNE # (�
S11%11:wI:III Itl'('1[ON PI?RNII I ASSOCIA]Ell t1'Q P ERNII'1'!I
(if applicable) / (ifapplicable)
I. WELL USE (Check Applicable Box): Residential ICY Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Iant Pump Water Injection ❑ Other❑ If Other, List Use_
2. WELL LOCATION: I Topogra�c/Land setting
NcaleslTo%vn: NAC.I-ITge-&- County Cl�(I�il�e ❑Rictgc C1Kope ❑Volley ❑Flat
.n1 i.J YZI E' (check appropriate hns)
(Strecl Name.Nunthcre,('onununity,Suhdicision,Lot No.,Zip Code) Lalilude/longitude of well location
3. OWN FIR IN.))A F�-� LL— (degrees/minutes/seconds)
Address 7.ri L> Ab AiJ h Tl�pi L- LalitudeAOTILI tude source:❑GPS❑Topographic map
/ (Sired or Route .) �. (check hns)
�
_/�11-�a LL A) No �C� J DEI''rII DRILLING LOG
Cip or Town State Zip Code From To ForjnaIioTjjJcscnpj Ion
Arch code-phone number /C)V
d. DATE DRILLED — �� —L
5, TOTAL DEPTI-I_�l�
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO ❑_ N
7. S"FAIIC WATER LEVEL Below Top of Casing: NY0 IT. C_ E
(Use"+"if Above Tap of Casing)
S. "1 01' OP CASING IS Fl-. Above land Surface* o
"top I)[casing termiu:Jed ath r helnsr land surface requires a a
earial in accordant ntrh ISA NCAC 2C.0118.
u
9. v -LD(gpn,): _( METHOD of TEST /J • °al �-��
I0. WA'rER ZONI;S(dcpth): lye 2.'].a
LOCATION SKETCH cis
11. DISINFEC"IION: Type /� Amount� Show direction and distance in miles frony�ii Ieat-
12. CASING: Wall'fhickness two Sude Roads or County Roads. Include the TOW
Depth , Diane- or Nta✓C numbers and common road names.
From 0 To ��� Ft.( J,� ,`Z,I _ - -
From To Ft.
Front To Pt.
13. GROUI : Depth Materiak, Method
From_-O -10 )r _PL_ G _
From _�,J To /0 o• 1. _
Id. SCREEN: Ucplh Dinnlelcr IotSize Material
Front To FL—ill. in.
Iron To Ft. irl. in. _
15. SAND/GRAVEL PACK:
Depth Size Material
hifin_ 10 Ft.
Frnln 'Io FI.
16, RFNIARKS:
WAS
ED IN ACCORDANCE
N R( I�I N At1tWl;1 D IND THA1S WELLT A COPY OI'T I SFRECORD IAS BEEN PRNOVIDE l TO THE WELL OWNER
IGNATURE OF ' SO NST I'IN , 1E WELL DATE
nil the .....nal to II c Div Sion of Water Quality;Crtxlndlvaler Section, 1636 Mail Service Center-Raleigh,NC
11111!IVA 66n, fit TI IFII'll 733- 221,within 3O daps. GW-I RFV 07/2001
ASHEVILLE REGIOIJr,L OFFICE

253197
NVELL CONSTRUCTION RECORD
N(II III Carolina- Dcpn I nenl of I'nvironment and Natural Resources- Division of Water Qua lily-Groundwater Section
\\'F:I.t.('ON IRM I ORQIS I I I\'IDILM,)NAPIrl yrlup Mc D CE,RI 1171CA I ION
\\ra L(O-MId. AORCoan'ANN NAPIE e 1.('t O i I IA)q--rnom: a ( 2AI-37-7CO-6
SI Alr;\\I:L1,CU,�SI Rl'C1ION I'E.I(PIII# _ASSOCIRI'EDwOI'E,R\III#
61 applicable) - / (ifapplicablc)
I. WELL USE (Check Applicable Box): Residential N' Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring❑ Recovery ❑ I lent Punnp Water Injection ❑ Other ❑ If Other, List Use
2, WFLI. LOC'A-I ION. nI topographic/Land selling
Ncalest'Iom /IIu� Counly �-�P Le Zidge ❑Slope ❑Valley ❑plat
ram// T/ ) rid hL/g_ /y (check npproprialc hna)
ISl:rcl Name,NE... lc�"7Cinnnuwily.Subdivision,Lon o,zap Crr,le) Latltudedonglludc of well localion
3. OWNLR:_-/ OAA)V, &Oke—S IJcgrccs/minnlc</ucondsl
Addicss _�c� , /SOK plop Latitude/longitude sourcc:❑GPS❑Topographic map
M/� ISbccl or haul No) (check hna)
/ r/O �4+1(Cl DLPIII DRILLING LOG
( it) r n Stec zip Code From r I o Formalion Description
(7'()) �Y— S�IO -SS ' Ser7 C�s/xbo
r\rea code-I'wne nulul'c'r -70V J j&TE n i O
d. DAl li DRILLED 5 '�.$—O — m_
S. rornl. DEPrn:_���
a
6. DOES WELL RFITACE EXISTING WELL? YES ❑ NO N
_ EI
7. S"fnllC R/n"fER LIVFL Rcluw'I'op of Casing:,__��P"1'. N
M,,-s"it Above 1,,p or Casing) y\
8. "101' Of CASING IS [_ F"I-. Above Land Surface* +'+
•I np of rwinl;Icnuhla lcA al/nr Lelnn'will snrrnce requlrra a
N9
vxrl:oar nl aecnrdancr ,Ill. ISA NCAC 2C.111 IA. p N m�
9. YIL'I-D(gpm): METIIOD 01:'I-E.SI' 1911`_ ._ x-
-ni
10. W'A"I"FR 7.ONFS(depth):
LOCn-I ION SKIN Cl I
11, DISINF iCIION. "l yp YP-/QNUb2 c � N Amount Show direction and distance in miles fmro at bast
12. CASING: Wall*thickness two Side Roads or County Roads. hnclode the road
De11111 D' nl�cr or Weight/11 Material numbers and common road names.
I rom Q To SS 1:(. a su ),I �oc-
Irom To Ft.
I:Iona -1b Et.
I3. GROUT'. Depth M:uerial Method
I-ronl_0_ ro -> 11. �E'r'rN^�T_ /2A✓ T
I1'nm —'?O'fn5 - 1:1._C4z2)„�s yJ
I I. SCRI!IIN: Dcpol Diameter Slut Size Maleria
I Ioul __ to 1:1. ill. in.
From . Ft. in. _ in.
15. SAND/GRAVFI. PACK-
Dcptll Size Material
Ilom to FI. _
Iron To Fl.
D "'I I WELL WAS CONS FRUCITD IN ACCORDANCE WITII 15A NCAC 2C,WELL.
NSlR11 '11ONSIANDARI D )111A'r A COPY OP'4)N
CORDIIASBEI PROVIDI—101 EWELLOWNEIZ
SIG ATURI;Oh PER 1Z " I IIL WELL DAIIs
41 GgOUNDWACER SECTIO isim of Water Quality,Groundwater Section, I636 Mail Ser%ice('enter-Ralci'h, NC
�SNt�r:ekhl���e Q > �
wi(hio al) days. GW-1 REV. 07/2001

4 , 3198
WELL CONSTRUCTION RECORD
North Carolina- Department of Environment and Natural Resources- Division of Water Quality-Groundwater Section`
IN ELL CON'I RACI Olt(INDIVIDUAL)NAM E (prinp J/Aimj� �UnJc'S CERTIFIC'AAT�IION0 nz
I%E1.1.CON"i'RAC I'Olt CONIPANI'NAME CAF,2cXa-_ �s.l '[.G.. ����-c i.J! PHONE #
Sl'A'I'E\\'F.LL CONS'Il2UC'I"ION I'ERNIIT# ASS(1CIA'(ED WQ PFRNII"(#
l if applicable) (if applicable)
I. WELL USE(Check Applicable Box): Residential Municipal/Public O Industrial ❑ Agricultural ❑
Monitoring❑ Recovery ❑ Heal Pump Water Injection ❑ Other ❑ II Other, Lis( Use
2. WELL LOCATION: Topographic/Land setting
Nearest Town: Al' _County PJ/�RUKc't.= ❑Ridge ❑Slope ❑Valley ❑Flat
.JUNA/ Rbi (check appropriate box)
I Street Name.Numbers, (mmunity,Subdivision,Lot No.,Zip Cale) Latitude/longitude of well location
3. OWNER: Ag e = f' = 1//127,y (degrees/minutesAcconds)
Address 16 f A4c7Z �wF�' �J Latitude longitude source:❑GPSOTopographic map
(Street or Route No.) (check box)
NC � l�lv DEPTH DRILLING LOG
iry or Torrn State Zip Code prom To Formation Description
Area corle-Phone number S r Z{i9� IRAN�TL'
a. DATE DRILLED S-�o_ na
5. TOTAL DEPTH: �/Oy
6. DOES WELL REPLACE EXISTING WELL? YES g NO DO/ _ c_
7. STATIC WATER LEVEL Below Top of Casing:6 o _FT. o
IV
(Use"+"ir Above Top o(Casing) 3 0_
8. TOP OF CASING IS FT. Above Land Surface' A.
'"fop of casing terminated at/or below land surface requires a _C
variance in accordance with 15A NCAC 2C.0118. co �<
9. YIELD (gent):�_METHOD OF TEST A/zZ �r
C
10. WA'I'ER ZONES(depth):
LOCATION SKETCH 3 aT
Show direction and distance in miles from at (cast
II. DISINPECIION: TypcIR�YA�a.22 Amount «�+° rr'^'
Include the road
two Slate Roads or County Roads. t
12. CASING: Wall Thickness pp
Depth Dian7ctcr or Weight/Ft. Material members and common road names.
2ai f�v'`
From � To_hJ PL�_ Sd
From To Ft.
Prom To Ft.
13. GROUT: Depth Material Method
From_(To a0 Ft.
Fromm To S.�Pl. CLiT7.tksi
Id. SCREEN: Depth Diameter Slot Size Material
From TO Ft. in. in.
Front To FL in.
15. SAND/GRAVEL PACK:
Depth Size Material
Prom 1"0 Ft.
From To Ft.
16, REMARKS: �1�
D Up I{F;R ON RA C:�RIW'Y kI I SWELL T iAT A COI'ONSF TH SI RECO ED INRD IOAS BEEN PROVRDANCE IIIUED O VIF.?C,WELL
ELL OWNER
I
.t,r, �..-.x O L
I ' ATURE O PEI SON CONSIRUC"rING THE WELL DATE
Su�gOf RN❑L Cf A1!t.8nE��fl TF )ivisi l of Water Quality,Groundwater Section, 1636 Nlail Service Center-Raleigh,NC
AMQV kA FfiWQ�rvN Qf5 I3-32 L within 30 days. GW-I REV. 07/2001

253199
WELL CONSTRUCTION RECORD
North Carolina- Deparmuent of Environment and Natural Resources- Division of Water Quality-Groundwater Section t)'EI.L CON I RAC"I'OR(INDIVIDUAL)NAME rfnt �Q ls'�,S CERTIFICATION#k ZS -5
V,ELL CON"I[tAC'I OR COPIPAN\'NAME. , Ake 7 I I �?j PHONE M &I
S J A I E\TELL CONS"I-RUCI[ON PERM' ASSOCLVrm)%VQ PERaIM
(if-applicable) (if applicable)
1. WELL USE(Check Applicable Box): Residential Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring❑ Recovery ❑ Heat Pump Water Injection ❑ Other❑ If Other, List Use
2. WELL LOCATION: //``�� j� � l Topogr7��,',�-iic/Land selling
Nearest s, County / L' ❑Ridge l- lope ❑Valley []Flat
wn t F tCtvo Il - T 1-0T -I— (checkappronrialebox)
(Street Niioe,Numbers.Conununity,11Subdivisim,Lot No-Zip Code) Latitude/longilude of well location
3. OWNER: 4I^RN Ke I -n_I (degreeshninulcs/seconds)
Address 14 1 (,- 73 Rh CIRGLP_ ri Latitude/longitude source:❑GPS❑Topographic map
(Street or Roure No.) (check box)
TP FL -3 7_IC DEPTH DRILLING LOG
Cnv or Town state Zip Code From o F rn alion Desc iptiot
Area code-Phone number p
4. DATE DRILLED /1*')- 0
5. TOTAL DEPTH: Sa c
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO n Pad o`
7. STATIC WATER LEVEL Below Top of Casing: FT. c),
(Use'.+'•if Above Top of Casing) xa c^
8. TOP OF CASING IS I FT. Above Land Surface`
•Top of casing terminated at/or below land surface requires a
earimrce in acwrdau a n' Is 15A NCAC 2C.0118. v >rn
9. YIELD (gpin): METHOD OF TEST�
10. WA'I-ER ZONES(depth):
LOCATION SKETCH TV '
11. DISINFECTION: Type Amount 'L d Show direction and distance in miles frr cm al Bust
12. CASING: Wall Thickness two State Roads or County Roads. Inc6W, thii:oad
Depth Diameter or Weight/Ft. WAterial numbers and common road names.
From To 145 FL
From To Ft.
From To Fl.
13. GROUT Depth Material Method
From "fo� Ft.
Front ).2 To Ft _
14. SCREEN: Depth Diameter 5,t Sizc Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
hronl To Ft.
From To I'
16. REMARKS: rr�i�pp
D -IF&JCBI7 119 A HIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
AND AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SO n C
6UL IGNATUItE Oh PERSON CONSTRUCTING THE ELL DATE
A �1K5tEl(41IoNie Divi ion of Rater Qualify,Groundwater Section, 1636 Mail Service Center-Raleigh,NC
A� ��L@(R�a406RLt. 21,1$rithin30daps. GW-I REV. 07/2001

253209
WELL CONS TRUCnON RECORD
North Carolina•Department olEnvironment and Natural Reso es-Division of Water Quality-Groundwater Section
WkLL CONTRACTOR axDlWDUAL)NAME (prlint)�r�n �1 C l`c)? ceRTmcATioN s 3c75
WELL CONTRACTOR COMPANY NAb1S 1�YC(ZS PHONE 0 ?a5174,5-21(nc,
STATE WELL CONSTRUCTION PERMrr* ASSOCIATEX WQ PERMM
(ifapplicable)__ _ _ _ (I{a`Ooh/cable) '
1. WELL USE(Check Applicable Box):Residential❑ Municipal/Publlc L�7 lndustrb0 ❑ Agricultural❑
Monitoring El Recovaty CJ Heat Pump Water Injection 0 Other M if Other,List Use
2. WELL LOCATION: Topographic ssettin
Nearest Town:12 IIZP14 V c County 13Ridgb d 1S1S ope OValley, ❑Flat
r Q M TV1 �-rt� + / (check appropriate box)
(scot Nu ,Numbers,Cornmunity,subdivision,Lot No.,Zsp Code) Latitude/longitudo of acll location
3. OWNER:_S�af y /I I Y1 ;(dcWWmiautes/aeconds)
Address Vi 'BtiX LatirudcAongitude soruee:QGPSQTopographic map
(Street or Route�Non.) (check box)
�G (S 3054{o DEPTH DRiLING L_S
City or Town state Zip Code From To Formation Description
(.�2)- a- I nQ _Q j � - L
Ara code.Phone number �7 .
4. DATE DRILLED�-23-L2 _�U Ccr„2u C3As�
.5. TOTAL DEPTH; (n J S / C _
6. DOES WELL REPLACE EXISTING WELL? YES 11 NO M' O _ �V C -,r—, TAN. x.7
7. STATIC WATER LEVEL Eelow Top ofCasing:
(Vac"+"Ir Above Top of Casing Z,
8. TOP OF CASINO IS, 3 FT.Above Land Surface'
*Top of emIny terminated at/ur below land 3urfaos rvg4iresa
variance in ueordaa irk ISANCAC 2C.011A:
9. YIELI)(gpm): METHOD OF TEST I i ✓
10, WATER ZONES(dcptb): 2—S-7( of 74 S- I cas_-
I�OCATTON�F'fCH
11. DISINFECTION:Type I rl( Amount L�Z _ Show direction and distance in miles from ai lesst
12, CASING: Wall Thicimeas two State Roads or County Roads,Include the road
Depth Diameter or Weiabt/Ft. Material numbers and common road names.
From__a_To G I Ft,_ (4" _ �, _ Eat 3
From—To—_Ft, �Abdj YI S 0 n 5 N F
13. GROUT': Depth Material Method ' �_ C
From f") To _•Ft. # 7 A::y1UMr mil' , �4 I in
From To Ft._
14. SCREEN; Depth Diameter Slot size Material 8 +�
From, To_Ft In. in.
Frort-To Ft..�jn, in. �
15. SAND/GRAVEL PACK: 7
Depth Size Material ro 0
FromL—To Ft. —
FrorrL_____Tc Ft. a n�
� c
rY,
iti— mtil�uY � o-
r
THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WE= c
r,l,�SHEVILL
CONSTRUCTIO ARDS, TH T A PY OF THIS RECORD HAS BEEN PROVIDED To TIM WBL.IlQj\trNFrArn
.L 0SIUNATURE OF PERSON CONSTRUCTING THE WELL DATE GRODNDSaf&t146b alto he Division of WaterQualitypGroundwaterSecdon,1636MailServlceCenter-Raleigh,NC
E29 i>fkkdkE 9)733.3221,within3odglys, GW1 REV. 07/2001

253428
WELL CONSTRUCTION RECORD
N or(It CmoIina - Department of Environment and NaturYal Resources- Division of Water Quality- Groundwater Section
\\'t:LL CON'i'It. CIOIZ(INDI\'InUAI,)NANIE (print) t21�M',' 1 , + a1a^�`t�- CER1161C\TION q C�pC
%NEI .CUNTIL\('-I(llr(-O\Ilb\N\'N:\a1E erZ0 4VF.�L bmL II rlIONE a ( )
S'I A 11. )\ELL(ONS'IRI,CI ION PE.RNI 1'I 11 ASSOC L\TED\6Q PERMII'q
1 if applicable) (i l'appl icabIc)
I. AVI{LL USE(Check Applicable Box): Residential (Municipal/Public ❑ Industrial ❑ Agricultural El
Monitoring ❑ Recovery ❑ 1feat I'un)p Water Injection ❑ Other❑ If Other, List Use
2. WELL. LOCA FION: eopographic/Land setting
Nearest"town: e-) W-P �y CountyGtegJew [Ji I(Igc ❑Slope ❑Valley ❑Plat
k sL_Q= 1h 1 'J (check appropriate box)
(Street Na.nc.Nwnbcrs,Conwuwily,SubdiLdiossiion.Lot No..Zip Code) Latitude/longitude of Aveil location
3. OWNER: aCr rl�l`I` (degrecs'ntinw<s/seconds)
Address _3"10 H 7 Al ( j, b Latilu(Ic/longitu(Ic source:❑GPS❑Topog aphic map
(Sl �"�I o_r Rnulc No.) Icheck boO
tyi�A .AYE r ( L 0o x� DlilFII DRILLING LOG
olyl inwn swle Zip Code Prom To Formation Descri tion
NI 3 - T-75_3f�
Area code('hone number 5���
d. DA'IlF DRILLED - O2 r
5. TOTAL DEPTH: o
6. DOES WELL REPLACE EXISTING WELL? YES Y NO 0'
7. S"FA'I IC WATER I,EVEL Below"fop _. Casing: O F"f.
(Use••c"if Above Top of Casing)
S. TOP OP CASING IS PT. Above Land Surface'
fop of casing terminated al/or helmr land surface requires a
eariaucc in accordant with 15A NCAC 2C.01 18.
9. YIELD(gpm): -1 _ METHOD OP TEST_ --
10. WA"I Fit ZONF-,S(depth):
LOCATION SKEICH
11. DISINFEC FION. I ypc Ammnit )�C�/ Shoo, direction an(I distance in miles from at Ic;Ist
12. CASING: Wall'rhickness Iwo State Roads or County Roads. Include the road
Dcplh Djaln�cr orSW/e,ight/FI N enal cumbers and common road males.
From 'Fu_L�L I:[G_y UL
From_ To Pt.
From I Fl. _ C_ �-
13. OROU'F: Dcplh N1111CtI;I Method z p
from O to Pt.,�
F- -� i c
(loin-��, PL Ip/f
14. SCREEN: Depth Uianutc Slut Sizc Material
Prom To IT. in. in.
From To Pt. in. in.
_
15. SANU/(iRAVEL PACK: Qi
Depth Sizc Material O c
Pram To
Rom To Ft.
16 REMARKS:
[It�Y' ili�IP rI lh' I ' 'ELL WAS CONSTRUCTED IN ACCORDANCE Wll 11 15A NCAC 2C, WELL
l IIHAT A COPY OF THIS RECORD HAS BEEN PROVIDED IO THE WELL OWNER
^u�zt ,s 2U 'oti
.i Li'_ - --' IURE 01:PERSON CONS RUCTM '2A E WELL DALE
Sub Sion IF Water Quality,Grourdivatei Section, 1636(Nail Smice Center-Raleigh,NC
276'�u,.,L,L0'mratP �i v21, 'ithin 30 days. GW-I REV. 07/2(I01

WELL CONSTRUCTTON RECORD 2-5 40?71
North Carolina-Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section
WELL CONTRACTOR aNDWWVAL)NAME (print). Lon D4lard - CERTWICATION II 313 I
WELL CONTRACTOR COMPANY NAME `IfrS w eII Dt,l ii ,I�G . PHONE r /'70(d 'P+562I(a Ce
STATE WELL CONSTRUCTION PERMrT* ASSOC1ATEb WQ PERMM
if applicable) if applicable)
I. WELL USE(Check Applicable Box):Residential❑ Mttnicipa . ub' Mli Industrial ❑ Agricultural❑
Monitoring❑ Recovery ❑ Heat Pump Water Li ection 1 Other U If Other,List Use
2. WELL LOCATION: Topo�gaphic/Land setting
Nearest Town: UMlf)t/ AID. Counl`YT r3Ridge Zlope ClValley ❑Flat
owl c f u l' i (check appropriate box)
(street Name,Numbers,community,Subdivision,Lot No.,Zip code) Latitude/lorigihide of well location
3. OWNER: D I re S (degroa(mnuteseecmds)
Address I Greee Latitude/longitude source:QGPSQTopographic map
I � (SaectorRoureNoJ 1CC '(check-box)
_N—1 t I�rri—l�f f� N C_ too DLP Jam$ � DRILLING LOG
,
City or Towii State Zip Code From To Formation Description
Am Code•PEone number
, ode Q✓lis7t .{f.
4. DATE DRILLED
5. TOTAL DEPTH; 5� (. / L17 - 1c2�
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO l3 * _ �S a _
7. STATIC WATER LEVEL Below Top of Casing; FT, 1$� _ �05 a
(Use"+"If Above Top of Casing) _a0`i=aot �Lce Slhk.
8, TOP OF CASINO IS j FT.Above Land Surface"
'Top of caslua terminated■Nor below taad surface requires a
variance In ucordaace wish iSA NCAC 2C.011& L,
9. 1'1ELD(gpm):_$ - METHOD OF TEST t( lU
10. WATERZONES(depth): moo' a /a
LOCATION SKETC
11. DISINFECTION:Type HT Amount - /4 1 h 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 Wcigbt/Ft. Material numbers and common road names,
From_0 To�Ft. (y WC.
From To Ft. OwL-
From To—__FL
cR,�-
13. GROUT: Depth Material Methoa RD
Frorr_Q _To � FL (- V)n rL� Giza v }v
From To Ft. - T wq� 66�
14, SCREEN: Depth Diameter Slot Sire - Material
Fror; To Pt it. in. 33
From—Tc Ft,ma--jn. in. z Cw o
15. SAND/GRAVEL PACK: 3
Depth. Size Material
FrorrL_To FL 'c ern
From To Ft. wCO4<
D`o
16. REMARKS:
m
N
I Do HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCrEp IN ACCORDANCE WITH ISA NCAC 2C WELL
CONSTRUCTION ST S,AND THAT A COS Y P HAS SEEN PROVIDED TO TH5 WELL�VNr�
S= 2 -
MIGNATURE OF PERSON CONSTRUCTINO THE WELL DATE
D �VI t e Division of Water Quality,Groundwater Sections 1636 Mail Service Center-Rsleigh,NC
27699-1636 Phone ( )733-3221,within 30 days, OW-1 REV. 0712001
r
GROUN'i 1',1:
ASHP/C.Li :OFFICE

WELL CON TTRUGTT.ON RECORD 252073
North Carolina-Department of Environment and Natural Resources-Division of Water Quality-Groundwater Sectiou
WELL CONTRACTOR ONDMDUAL)NAME
(print) F=RaHZ P. V ICTa2 CERTIFICATION Y 3175
WELL CONTRACTOR COUPANYNAME B3 &R& Lo C-u- ►71ZILL(tg( PHONE
STATE WELL CONSTRUCTION PERMITM ASSOCIATED WQ PERM17W
(if applicable) ((Y applicable)
1. WELL USE(Check Applicable Box):Residential❑ Municipal/Publie e Industrial ❑ Agricultural❑
Monitoring❑ Recovery 0 Heat Pump Water Injcctlon O Other M If Other,List Use
2. WELLLOCATION; Topol;Whic/Lan4etting
Nearest Town: PAURPAS' County L°-1'� d iO a 13Ridge 13SIope alley []Flat
i (check appropriateboz)
(Soot Name,Nombers,C�o�mmuntty,Subdivision,Lot No.,Zip Cade) Latitude/longinide of well location
3. OWNER: ��LNCI�Uln (deateet/mnuusteeonds)
Address En. 7353 - Latitude/longitude soulve:QGPSQTopographic map
(Street or Ronte Ne.) '(cheek box)
_ NIQuJaSScc CA 33gKI DPPTI3 DRiI.LTNGLOG
r7cleCity or Town Snte Zip Code From To Formation Deacrlption
Area code.
DRILLED-,t $p ' 93' �� IjaRD C.YBC.t4
4. DATE DRILLED 5 - 7 -O� L&S
WELL?
C.tasy r�E�nt
5. TOTAL DEPTH; -,2,5 / R 5 i g Doctc na2t< 6Qd�
6. DOES WELL REPLACE EXISTINWELL? YES O NO W ?7 0 -�So Ltctx- aaav L40,2o 2ocr.
7. STATIC WATER LEVEL Below Top of Casing: I _F I. 2 So - 6 S SL.ETE DARK Caatl
(Use"+"I(Above Top ofCuitt�
8. TOP OF CASING IS�_FT,Above Land Surface-
*Top of cuing terminated adur below land surface ft9uhW a
varituee in mcordaae with ILANCAC3C.6II&.
9. YIELD(gpm):�ME D OF TEST�4
10. WATER ZONES(depth): �Q °� 302i.3h
LOCATION SKETCH
11. DISINFECTION:Type J 'T µ Arnoulit jh Show direction and distance in miles$nm at lesst
12. CASING: Wall ThiChC63 two State Roads or County Roads,Include the road
Depth emeter or weigbt/Ft. Material numbers and comet road natr>gs.
FrornQ_To�_Ft. S03OSvt5toN i
From To Ft. V O
Front,__,-To_—Ft,
13. GROUT. Depth Material Method ej
FronLO_ To.—/yG^1—Ft.bTCPiJj) fK G- F(tY &I
F De Ft, 2 z
14. SCREEN; Depth Diameter Slot 5iu Material
From To Ft�ln. in, zz CO no
From To Ft.43p--in. In, nQi 9 m�
15. SAND/GRAVELPACK: ;:Jm
Depth. Size Material J fV rn�
Frorri__To Ft. 3 w c-�
Front To Ft. aD o
tUvr2PitY Z
16. REMARKS:
)DO 1mREBY CERTIFY THAT THIS WELL,WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONMUMO?AXANDARDS,AND THAT A OO OF THIS RECORD HAS BEEN PROVIDED TO TFM WELL OWNER
D t, SIGNATURE OF PERSON CONSTRUCTINO THE WELL DATE
l �
Submit the o to the Division of Water Quality,Groundwater Section,1636 Mail Service Center-Raleigh,NC
�699-1636 Ph a [phone],within 30 days, GW1 REV. 07/2001
Ij
(;ROUNDWAIER. Si Ci!0(I
ASHEVILLE REGii,' f,E

25279Z
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources- Division of Water Quality-Groundwater Section ��
\vE LLC03"1'ItACI'O It(IN DI VIDUA L)NAIVE (/prrInt) •.Y )Mrf1x� - lIn Pie S CERTIFICATIONq;tl
U'ELL CON T RAC"I Oil COIMPANYNAME \ 1.nkj)kQ`�' y��t lIZIt IL' _— PHONE 012)jl 37— Vo
S IA I'1,VI ILL,CONS'I RUC r1ON PF.INU I'q ASSOCIAI'F.D\\'Q PERMITif
(ifapplicable) (if applicable)
I. WELL USE(Check Applicable Box): Residential U 1unicipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heal Pump Water Injection ❑ Other❑ If Other, List Use
2. WELL LOCATION: �1 %pographic/Land setting
Nearest'Fown: AIU1 Courtly L P e'2 Idge ❑Slope ❑Valley ❑Flat
CA I 1 —I &t-I S 1�� (check appropriate box)
(Street Namc.Numbers,Community.Subdivision,Lot No.,Zip Code) -at itude/longIttide Orwell location
3 OAVNER tzvIL' C-oc degrees/ininmcs/seconds)
Addess r /�c;t..'aiJ.�'� /,t'd Latitude/Imtgiludc source:❑GPS❑Topographic map
(Street or Rome No.) (check box)
A) �c�9Ga DEPTH DRILLING LOG
0tyorTown State Zip Code F'onl o Formation Description
(%fi)- S�7- 7_SG(ti 4 V ell G7 '
Area code-Pbune number 9
4. DATE DRILLED
5. 1"O'lAL DE PT[1: 70S N
6. DOHS WELL REPLACE EXISTING WELL? YES ❑ NO Ll�
7. STATIC WATER LEVEL Below Top of Casing: O 0 PT.
(Use"+"if Above Top of Casing) _ o�
8. TOP OF CASING IS FT. Above Land Surface` y�
'Tull of casing terminated at/or beloxv land surface requires a
variance ba acca dance wtth 15A NCAC 2C.0118.
9. YIELD (gpm)�3 METHOD 01:TEST�P
r
10. WATER ZONES(depth): yOo ' � e'
LOCATION SKETCH cn
11. DISINFECTION:Type l/ Show direction and distance in milts from al IcasIZ
Amount
12. CASING: Wall Thickness two Stale Roads or County Roads. Include the road
Dc tl]y' i Dij�''m�$teer'r or Vsl ght/Ft. N enal numbers and common road nanus.
From c b� FL V �r�[-
From To Ft.
From To Fl.
li" GROU1: Depth iatcrial Method
from To ) 0, Ft. i
Frk,m'ZSZ'fo_(,_t/-L I'l.
14. SCREEN: Depth Diameter Slot Size Material
From 'fo PI. in. in.
From To FL—in.
15. SAND/GRAVEL PACK:
Depth Size Material
hronl To Ft. _
From l2t Ft.
R PNIAR KSdA '
PQ it )) y7 n,;�1-r ry"rs.`ry"rr4ELL WAS CONSTRUCTED IN ACCORDANCE\VITI I I SA NCAC 2C,WELL
Vf STR CIC'1ZON STANUARIIA'I'A COPY OF ll I15 RECORD I IAS BEEN PROVIDEDTO THE WELL OWNER
ij1 1 V� �• v2IJ URE Of PERSON CONSTRUCI'IN ' " 1E WELL DATE
' "P I \Paler Quality,Groundwater Section, 1636 Mail Sersice Center-Raleigh,NC
.... ayhrmcYWr���fithin 30 tl:q's. GW-I REV. 07/2001

Z52'791
WELL CONSTRUCTION RECORD
Not Carolina - Deparunent of Environment and Natural Resources- Division of Water Quality-Groundwater Section
N'F1,1,CON(RAC I'Olt(INDIVIDUAL)NAME (print) ,Mk
!_�' CF"RTI FICATION qJ
t,ELL CON'IRACI'Olt COMPANY NAME @ , - it 1 c PIIONE N (S'tsa)
S-I'AI E N'ELL CONS IRUCI ION PERN11'1'q ASSOCIATED N'Q PERMrrA
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential W- Municipal/1'ublic ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ kcal pump Water Injection ❑ Other❑ If Olher, List Use
2. WELL LOCATION: Topographic/Land setting
Nearest"town: 416u2.pky County-( rtl' � ��'- ❑Ridge ❑Slope []Valley ❑Flat
:1 Lici: 11 1)C-f-c S (check appropriate box)
(Street N;unc,Numbers.('onnumity,Subdivision,Lot No-Zip Code) Latitude/longitude of well location
3. OWNER: I A V t( R) I I Z (degrees/minutes/seconds)
Address /f. ,j J.2- Latitude/longitude source:❑GPS❑Topographic map
� (Sheet or Route No.) (check box)
t 4' rN ti.` DEPfII DRILLING LOG
('It, or f talc zip Code From To Formation Description
A«a code-Plmne nomber_
4. DATE DRILLED
5. TOTAL DEPTI-I:
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO 13
7. STATIC WATER LEVEL Below Top of Casing: F'I'.
(Use"+"if Above Top of Casing) 'gym
8. TOT'Oh CASING IS FT. Above Land Surface*
"op of casing terminated at/or heloss land surface requires a
variance in accordance n'ith 15A NCAC 2C.0118. n — m
9. YIELD(gpm): METHOD OF TEST
10, WATER ZONES(depth): _ r
LOCATION SKETCII i
11, DISINFECTION:]ype Amount C.(/ pShow direction and distance in miles from at (cast
12. CASING: Wall Thickness two State Roads or County Roads. Include the road
Dcp(h Din sr oj: V I,I Ft. aterial mtmbers and common road names.
From To FL J L'
From To Ft.
From To_— Ft. __
13. GROUT: Depth Material Z, Method
From To 0 Ft.
To Ft.
14, SCREEN: Depth Diameter tut Size Material
From To F1. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Sizc Material
From To FL
Front To FL_
16. REMARKS:
L WAS CONSTRUCTED IN ACCORDANCE WIT"It 15A NCAC 2C,WELL
RUC I�qN$1A� AILbS;;kAN 1 T A COPY OF THIS RECORD I IAS BEEN PROVIDED TO THE WELL OWNER
IL 0
SI(� A RE OF P " C CTING 711E WELL DATE
LI u.
S lbntil the orD�t tit to the Divtsi n of 'titer Quality,Groun(Irvater Section, 1636 Nlail Service Cenlcr-Rateigll,NC
2 699-I ,Nrr#�1,wit tin 30 days. GW-I REV. 07/2001
r _ c..ITf uN .
Aa F' .I 4L OFFICE

WELL CONSTRUCTION RECORD 25 1- 484
North Carolina- Department of Environment and Naltu'al Resources- Division of Wa(cr Quality-Groundwater Section
O'ELL CO]"I It:\CTOIt(IN UI\'IIIUAI.)N,\NIE (print)-JIMMY a,lls CERTIFICATIONN � -C�
NNVALCONIR.\r'-I Olt(OMPANYNAMt: C/Jr`Qesh'c- ` �r2'i t/S rlIONEa cF37-�"Oca�
S'1':%I L N1 i;l.l.CONS"Iltl'C"rION I'ERNll'I'H ASSOCIMED\\'Q PERNIITI/
(it applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential Municipal/Public ❑ Industrial ❑ Agricul(ural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Libel ❑ If Other, List Use
2, WELL LOCH FION: �Topographic/Land setting
Nceresl Town: t County CXe fl� M<1wgc ❑Slope ❑Valley ❑Fla(
—._ 7;l2,t EE /I/tOQ 1 �� (ch.ck appropriate hurl
(StRCt Name.Nunibe,s.Community,Subdivision,Lot No.,Zip Co&) / Latlllld C/1011g1llldC OF Well I0Ca110ll
3. OWNER:_ , /114/Ne.5 IdcgrccsAninmtcxseconJsl
Address Latitude/longitude source:❑GPSO'iopographic map
Ichcck h
DRILLING
//Y/ ,a pgt7 DIiP-rn LLING LOG
cuyorToro, 5t.ae Zip Codc h"un1 To Fonnalion Des}ripli011
Ama code-Phone numhcr
d. DATE DRILLED 2.' (7 L
5. 1OTALDLPTH: oS'
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO ET-
7. S1 A I IC WAFER LEVI?L Below Top of Casing: S I-T.
/ (Use"+"i'Above'rop or Casing)
S. TOP OF CASING IS / FT. Above Land Surfacc*
"I op or casing terminated at/ur below land surrace requires a
cnrianee in accm.do)a•MR1 I5A NCAC 2C.0118. ,S
9. YIELD (gpnl): METHOD OF TI?ST
10. WATER ZONIiS (depth): Zyo , _ --
LOCATION SKEI'CII
1 L DISINFECTION. 'I'ypc Antolini « Show dircc(ion and dislancc in miles 0-om at least
12. CASING: Will Thickness two Slate Roads or County Roads. Include the road
Depll r mi icier or WeighVFt. M: el ial numbers and common road names.
Front 0 To l 1'l,� l/L
From To 1.
Front To Pl.
13. GROUT Depth Matel Method
From 0 ,
Ft.
ro
Pm_To I. N o
14. SCREEN: Depth Diameter lot Size Material a �n�
From To _ I.1. in. in.
r o-
15. SAND.'GRAVEL PACK: �,-
Ucpth Size Material a —ate
3 m�
From_ 'ro Fl. _ �o
Front 'ro 1:1. O coz
n
N �
16. REMARKS: i
�;:�l DO III RL E1 C IZ I'll 1 T]I - IS WELL WAS CONSTRUCTED IN ACCORDANCE WITII 15A NCAC 2C,WELL
t )r 1N�S11i11E-F IL�N-Si-APJL�Ai} 11
ND TI IAT A COPY OP 1 HIS RECORD I IAS BEEN PROVIDED TO THE WELL OWNER
1 ;
j a -791 'NATUI2L OF PERSON CONSTRUCT i THE WIELL DATE
I I I
SHlr+rtrl the original In thgi)ilisi m of\7 aler Quality,Groundtratei Seclion, 1636 Mail Scrrice Center-Raleigh,NC
L �7•li9a:-�11(t Pbnncl\a (PI7)7}3 32 1,within 311 da1s. GW-I REV. 07/2001

262344-
WELL CONSTRUCTION RECORD
North Carolina-Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAME
((pprint) ��Um C/ (n1 Is n n CERTIFICATION 82(10 q
WELL CONTRACTOR COMPANY NAME //i�/P` bt-)ell L/l zG✓l Ci PHONE # Kt24) RT 7 C-2 r 7
J�
STATE WELL CONSTRUCTION PERMITN ASSOCIATED WQ PERMIT#
(if applicable) (ifapplicable)
1. WELL USE(Check Applicable Box): Residential EL­Municipal/Public❑ Industrial ❑ Agricultural❑
Monitoring❑ Recovery ❑ Heat Pump Water Injection❑ Other❑ If Other,List Use
2. WELL LOCATION: Topographic/Imd setting
Nearest Town: County,�,�J�o//J� ❑Ridge []Slope Malley ❑Flat
l�F,. I I n(' (Pc R6" (check appropriate box)
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) Latitude/longitude of well location
3. OWNER: 1, P C) re-P (degrees/mimdes/seconds)
Address 44") lhi11 (LTApf Qb Latitude/longitude source:❑GPS❑Topographic map
(Street or Route No.) ^ - (check box)
NAU f J�L,e ( ( C7.`nnt/1 DEPTH DRILLING LOG
City or To4n State Zip Code From To Formation Description
(--J 0 — 1 h r
Area code-Phone number 16, - 00 , 0,0 k
4. DATE DRILLED-�J- 3D-(') 2
5. TOTAL DEPTH: Re)S
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO lj�,-
7. STATIC WATER LEVEL Below Top of Casing:—,5.fL!—FT.
(Use'+"if Above Top of Casing)
8. TOP OF CASING IS FT.Above Land Surface'
-Top of cuing terminated at/or below land surface requires a
variance In accordance with ISA NCAC 2C.0118.
9. YIELD(gpm):_IQ_METHOD OF TEST_
10. WATER ZONES(depth):
LOCATION SKETCH
11. DISINFECTION:Type .mount S 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. o
Frnm_ f7 Tom Ft.�� S�/ /r
From To Ft. -�"->
From To Ft. ""I
V
13. GROUT: Depth Material Method
From To Ft.
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARL
KS:�]
DCBRTI IS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
ON ST AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
(iSaHH(it thkE&W0*4 the D ision of Water Quality,Groundwater Section,1636 Mail Service Center-Raleigh,NC
ASIi{ 6b 6f9H73 -3221,within30days. GW-1 REV.07/2001

WELL CONSTRUCTION RECORD 262340
North Carolina-Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAME (print) )l.Aoq P-S /yeakt Imo) '. nk-\ CERTIFICATION#o7�DU
WELL CONTRACTOR COMPANY NAME �Z7i��t°/� l t%Ell & IG✓/�_PHONE It ( )
STATE WELL CONSTRUCTION PERMITS ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
I. WELL USE(Check Applicable Box): Residential Cl--municipal/Public❑ Industrial ❑ Agricultural❑
Monitoring❑ Recovery ❑ Heat Pump Water Injection❑ Other❑ If Other,List Use
2. WELL LOCATIO i• // Topographic/l.and setting
Nearest
/'j�own_: !7t C unty I, ❑Ridge ❑Slope ❑Valley ❑Flat
l n4 � (check appropriate box)
(Street Name,Numbers, ommunity,Subdivision,Lot No.,Zip Code) Latitude/longitude of well location
3. OWNER:ZZ7 - °. r (degrees/minutes/seconds)
Address '�)q n St Lnr t I p1Ln} i2 Latitude/longitude source:❑GPS❑Topographic trap
(S (check box)
�Hl t��h.t� i-X 9,2DELO DEPTH DRILLING LOG
ciry or inwn state Zip code From To F nnath n Description
Area code Phone number �� n F
4. DATE DRILLED L� -2-2 - O 66 _ /,I- sL12 f?
5. TOTAL DEPTH: / �'S'
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO ❑
7. STATIC WATER LEVEL Below Top of Casing: 5.Q FT.
(Use'+"if Above Top of Casing)
8. TOP OF CASING IS�_FT.Above Land Surface'
-Top of casing terminated at/or below land surface requires■
variance In accordance with ISA NCAC 2C.0118.
9. YIELD(gpm): 2�METHOD OF TEST1_
10. WATER ZONES(depth):
LOCATION SKETCH
11. DISINFECTION:Type e. Amount -5`" 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 —To 2 r Ft. 5 f /
From To FL a
From To Ft. r" _
13. GROUT: Depth Mete 'al Method o
From--'- T--2 Q r Ft. OLIci
From To Ft. J�
14. SCREEN: Depth Diameter Slot Size Material _ _
From To Ft. in. in.
From To Ft. in. in. o
15. SAND/GRAVEL PACK: 7
Depth Size Material
From To Ft. --
From To Ft.
16. REMARKS:
d� T THIS WELL WAS CONSTRUCTED IN ACCORDANCE WrTH 15A NCAC 2C,WELL
I9N S' At�'JAITS, T A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER .
LSS
1 TURE OF PERSON CONSTRUCTING THE WELL DATE
Sumit the original to the D s on of Water Quality,Groundwater Section,1636 Mail Service Center-Raleigh,NC
276�9-1426-P.Lone.Na,,j919 73 -3221 within 30 days. GW-1 REV.07/2001

WELL CONSTRUCTION RECORD 262338
North Carolina-Department of Environment and Natural Resourcess7-Division of Water Quality-Groundwater Section
WELL CONTRACTOR(INDMDUAL)NAM'EE ((print) ��l'iyY1 A lrS �D �Sn,n CERTIFICATION N�q
WELL CONTRACTOR COMPANY NAME (�cy PHONE # (Cs 0 $17-2c, 7
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
I. WELL USE(Check Applicable Box): Residential M--Municipal/Public❑ Industrial ❑ Agricultural❑
Monitoring❑ Recovery ❑ Heat Pump Water Injection❑ Other❑ If Other,List Use
2. WELL LOCATION: / TopographicAmd setting
Nearest Town: r rr,/7� ham(/ County l ❑Ridge ❑Slope ❑Valley ❑Flat
\Ox exy— t'F-#" (check appropriate box)
(Sheet Name,Nu hers,Community,Subdivision,Lot No.,Zip Code) Latitude/longitude of well location
3. OWNER:fiQie// �G'(/��� (degrees/minutes/seconds)
Address & 7 i/ :C= deP ! n. Latitude/longitude source:❑GPS❑Topographic map
(Street or Route No.) (check box)
12L4/ 611 /I/.7ei dR°lOrp DEPTH DRILLING LOG
City o ow state Zip code From To Formation Description
(P999A, /-) </) i oc/Fs
Area code-Phone number
4. DATE DRILLED
5. TOTAL DEPTH: /US
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO Uli
7. STATIC WATER LEVEL Below Top of Casing:—ID _FT.
(Use"+"if Above Top of Casing)
S. TOP OF CASING IS FT.Above Land Surface'
-Top of casing terminated at/or below land surface requires a
variance In accordance with 15A NCAC 2C.0118.
9. YIELD(gpm): Ps METHOD OF TEST
10.WATER ZONES(depth):
LOCATION SKETCH
11. DISINFECTION:Type Q ount C, 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. I'�
From_ To ZD ' Ft.15,2S � J)VC CD
From To Ft. / —
From Tc Ft.
13. GROUT: Depth Mat,e,(ri/al � Method
From___To—,,, 0 ' Ft. [ � 7—,
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in. C-0
rD
From To Ft. in. in. _-
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISANCAC 2C,WELL
[[17
U6TA THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
� -ATURE OF PERSON CONSTRUCTING THE WELL DATE
Li
S bmit'OU thefvb original to the ivisi n of Water Quality,Groundwater Section,1636 Mail Service Center-Raleigh,NC
2 ;t�7 3-32 1,within 30 days. GW-I REV. 07/2001
- C
AS"EVILi r ' f =

WELL CONSTRUCTION RECORD 253429
North Carolina - Dcparhncnt of Environment and Natural Resources- Division of Water Quality-Groundwater Section
V,ELL(ON"I'R:\CI Oft(INDIVIDUAL)NAME (prnior) / . 55-411-X /� CERTIFICATIONM�- p�
V,LI.I,CON IRACI Olt CO;M PANY NAME 1,1 IL"Q &-96) LJ/Q/��/'y� PHONE qEI$)�3� '�OCS
Sr All:\\'I:LI.CONS'I1RUCIION I'ERMYIN ASSOCIATED wQ PF.R\IITM
_(if applicable) (if applicable)
I. \VELL USE(Check Applicable Box): Residential Municipal/Public ❑ Industrial ❑ Agricultural ❑
Moniloring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other❑ II'Olher, List Use
2. W ELI. LOCATION:
Topographic/Land setting
Neares(Town . PTfV C0LiInyCAe�Ke--- L]Ritge GSlope ❑Valley ❑Flat
, T,Yia PyJ C2ff—y kb (check appropriate box)
(Street N.nne.Numbers.Community,Subdivisi
`on,
Lot No.,Zip Code) Latitudc/longitude of well location
3. O\VN1:R:_ �)JE rn� Y (degreeshnimnes/seconds)
Add less .LC,z / 1Zkr-uJ S clze—c-k Latitude/longitude SOurcc:❑GPS❑Topographic map
(Street or Route No.) ��CL 19 (check box)
DEPTH/ VZU2J��y �' DRILLING LOG
cirynne zip Code From To Formation Description
Sc
Area code-Phone numheff.. 0
4. DATE DRILLED Y �'2 ° �' - ,�
5. TOTAL DEPTH: 2Y; ' /.�° �..y6— CtrM�.• 7,
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO LY '
7. STATIC WATER LEVEL Below Top of Casing: O Z' FT.
(Use"+"if Above"Fop of Casing)
8. 1 OP 01:CASING IS FT. Above Land Surface*
'lop of casing terminated at/or below land surface requires a
varimtce io accordance with 15A NCAC 3C.0I IP. /1
9. YIELD (gpm):_/METHOD OF TEST
10. WATER ZONES(depth): f AO •
LOCATION SKETCH
11. DISINFE.CTION: 'Fype Amount 2. Show direction and distance in miles from at lead
12. CASING: Wall'1ltickness two Slate Roads or County Roads. Include the road
Depth Di m ter or Wei lit/Ft. Material numbers and common road names.
From 0 To lq0' 1 `Zj Wei
ir,c
from To/E_L'17Ft. SC C pi/C,
From To Ft.
— — c
13, GROUI : Depth �Maletiaall Method p
From rolg,° Ft. / N P
c
from To z o 'FL C
14. SCREEN: Depth Diart'il/ocr 'Iot Size Material a �m
Froill To 9,Y0 Ft. in. "20 in. t cz'
W
From To hl. in. in. e
15, SANU/GRAVEL PACK:
Depth Size Ma(crial
tV mA:
from To H. _
From "Ib H. cJl -�+
a �
16, REMARKS: qq
I IZ 19Y(E-R�II:IUfiIIki qI ELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C,WELL
COPY OF 1111S RECORD HAS BEEN PROVIDED TO THE WELL OWNER
oz
TUBE 01:PERSON CONS]RUC G THE WELL DATE
Suhl l hvlsion r Water Quality,Groundwater Section, 1636 Rtail Service Center-Raleigh,NC
2769X ' tL4'R'E1t7 NMIL�)0??-121,v'ilhin 30 da)s. GW-I REV. 07/2001

254491
WELL CONSTRUCTION RECORD
Not It Carolina- Ocparluunl of I;it vironnlent an(1 Natural
Resources- Division of Water Quality-Groundwaler Section
�/•,[
4Y 111A.(I N I JIM I Olt(INDIVIDUAL)NAME: (prIpO_�JJ M�n�Q_��\_ CF.RII FICA'IIONp_�z�Q�
NN I:I.I,cl)nI uAc rDu(ontrANY Nnn1e(kQR_1a���� 112 --r11orvF a (81d) 8 7—Sc�pN
S 11%1 F w'I(I 1,CMS'II(L'C'I ION ITIM I H ASSOCIA'I'F)N%0 I'ERnll'I N _
(it applicable) (ifapplicable)
I. WFI.I, USE(('heck Applicable Ilox): Residential Id Municipal/Public ❑ Industrial ❑ Agricultural p
Monilotieg❑ Recovery ❑ I Ical Pump Water lijcclion❑ Other❑ II Olher, List Use
2. WI:1.1. 1.0CAI ION: / ropogrI c/Land selling
N[•an:s('r-Temit: /1 'a �u County Cxeao pRidge UTSlope pVullcy ❑Phil
(,'heck appropriate hos)
f Street Wuoe.Nun.bcas,C�mmunityy.SoIldivismil.Lol M1,7ip/0�dc) Lplhlll[Il•/I011glllldl'of well location
3. OWNFR:_ 'Ri l—I� V��Q_�.,/)'I e(t Idcprccshniinilcs/sccandsl
Addicss L( /?� Nt lb Ka--e_ S 1 I,aIiItIdC/Iongilude source:0GPS0 I"opographic map
Il Snael or Itonte Nn.1 �2 (check host
—� 11,n�EI,iV - i C �%' 7 b Ulil,I I I DRILLING LOG
-I"I'n 7—scale 7ip Code Prom to Formation Description
Arc:.ode-I'Lone non.her 7(D _�L/�'-rG
d. DA'I1: DRILLIiD -�2;t-0,), _
6. DOES WELL REI'I.ACE EXIS'IING WELL? YES ❑ NO M
7. STATIC' WA"I ER LEVEL Below Top or Casing: S('3 , FF.
M,,c-+-if Ahnvc I,,,,or Casiun)
S. 101' 01:CASING IS PT. Above Lard Surface'
'Tap of exsiva Icnuinated at/or beluo land surface requires a
carhnce in accord:mce will. I5A NCAC 2C.I11 Ill —
9. 1'II:LD (gPIII):�U MF;fIIODOF II:S"i- A/�. _
10, WA FIR ZONES (dcI)II* _1 y0 � -
LOCA'I"ION SKI 101
11. DISINFIfC`IION: 'I ypc_ R N� Amount Show(brcclloo and dislance ill moles h-oln m least
12. CASING: Wall Thickness two Slate Reads or Comply Roads. Include the road
Depth Di meter or\Vcight/fI. Mntcrial numbers and common road moues.
hall) SbQ 21 �✓C_ p c
Prone To Fl. N o
�.
I loop_----- 1°-- ll. --- ---- C
II" 61OM1 Depth Maloiul Method Z c�
I'lool Q_'fo ._ 1'1 C�Qtj I '/�pJ1 T�_ �
I non Io ryO__ I't CUT7 T5_ Q�ill/!1(/_ r j'
I-1. S('RI LN: Dy.lh Di under Slat S17c J M:acl al --0 m;
I`rool_�. - To I I. in.
15. SAND/6RAVI:1. PA('K' --- N !
Dcplh S17c Material N Z
loon To i'I.
I rom�--�--.fo----- 1,1 -- --
F(0)(NS Y- A I 1IIS\1 ELI.W S C'ONS'IRUCDi0 IN ACCORDANCE.WI I I I I5A NCAC 2C. WELL
D tl AND-111A A 'OPY01'IIIIS R ; ')ItD HAS BEEN PROVIDED10"IIIEWELL.OWNER
" —� IG RE Uf I'Elt vC 1RUCI-ING'fIIE WELL DATTI'
GROUNDWATER�AL OFOFI E
A 'Ision ur\Paler Quality, Ground realer Sect loll, 1636 Mail Scrcice C'culer-Raleigh,N('
27699-I636 I'houc Nip.[phone],erilhiu 30 days. GW-I RFV. 07/2001 -

NVGLL CONSTRUCTION 11111"CORll
North C:u-olina - Dcpmi file nl of Environment and Natural Resources- Division of Water Quality-Groundwater Secti-o�n,��
%%VLL(-ON I RAC'I Olt(INDIVIDUAL)NAME (vinl) M/'rL �J O�A)V—S' CER I IFICA"I ION a�
\\'k;l.l.C()��'1 I1,\('f(1R CI)nll•n N\'NAME��e-13o�e- LL J JKL1J'v 9 PHONE a ff2 $37—%(308
tit \'I F:\\'l:1.1.CONSI Itl'CI IUN I•IS ItM 1'I'q ASS(/CL\'I ED\1'l)1'F,Itnll'1'0
(if applicable) -/ (ifapplicable)
I. \VI'LI. llSli (Check applicable Bo.Q: Residential IN Municipal/Public Industrial ❑ ngricul(ural ❑
Monitoring❑ Recovery O I Icat Pump Walcr Injection ❑ Other❑ II Diller, LIST Use
2. WFIA, LOCATION: /� TopographicIlan selling
Neared To%%11 41 UA County 01tellJ �ec ❑Ridge OSlo, Valley ❑Peal
_ Iff)k9l i lam__ heck:grpmprialc hnvl
(Strvcl Non.c.Nom bm,C... nunity,Stflohv lion,Lot M,_Zip C:a1c) I.atllude/lollglludc of well location
1. OWNER, R�j L� SIl W 'V (JcBrcosAninulrs/sca:udsl
AddreSS ____ �-I�,. In) VC I0j S CQe� I.atitudc/longitude souice:OCiPSOTopographic map
isimcl or Rome No) Idreck ho.)
Mu1Z��y _N �� 7?7�j Dl:f*nl DRII'l-ING I,OG
('iiv ar loan Slam Zip C'uJc from 't o Foinmtiou Dcscriplion
06aeb)- $37- �;L n (0Q SP , CnSi-16-
Area code-Pbonc number con
I. DA 11: DR I.I_El) I-
5. *10LAI. DEI''I'11:yoS'
G. DOES WELL REI'I.AC'E EXISTING WELI,? YES ❑ NO M
7. S I A'I K' WAI IT I,EVEI, Below Top of Casing: FO h'r -
(Usc"4"if Abovc lop of('nsing)
8. 1011 OP CASING IS Ff. Above Land Surface*
"I op of caning leroduated al/fir bdnn Imnl surface requires a
Penance In arxortanre nlll, I SA NCAC 2C.0118.
9. YIELD (gpnt): / NIL:1 l IOD 0P 1 FS f
IU, WA 11:R ZONES death '
LOCA"IION SKIT 0I
11, DISINITCIION: "l"ypc Cjj­j cfkL^ e_ Amount Cvth Show diicc(ion and disl:ulce in miles liom all lead
12, CASING: Wall"Ihickocss two Slate Roads or County Roads. Include life road
Depth Diameter or Weight/H. Material nuntbcl:s and common road names.
Front_�l To-fo-Q_ rl. GV
fo Pl.
Drool 'to Ft, O -!E
N
1 3. (;ROU 1 : Depth Material Method e�
from O To_ �� - I`t.aM,Qnl)_ Rav IT` -a=C c^
y e�
Ilofil__�l"Z I o_CC_n_ I'I.__�{(1[1�:�S"-- �yJT✓ 1 xm
Id. SC'R1.1:N: ucplh Diameter Slut Size Material
�
�m
I will
15. SAND/GRAVEI. PACK:
Depth Size Mnlcrial y
I-ram
from To PI.
z
16. RI'.NIARKS:
^�� II� S WITI,WAS CONS"Nmc RD IN ACCORDANCE Willi 15A NCAC 2C,WEI,I,ID 11n N `UAI +) J1) I11AI 'I PY UP I IIIS lili ' )IiD IIASI:IiN I'KOVIUI!U TO IIIE 1VLL1.U\VNER
SI( NAT ,Of I'LR 11tUC'r f:WHIZ, DATG
SuI q+l�Qirly':IYh.M;E+:Btlwll hl�,Divisit n of\\':der Quality,Gromldwaler Secliou, 1636 al:dI Service Ccn(cr-Raluigb,NC
2m�ad[WY i -IMF 6 I,widiiu 31)days, (I\V-I REV. 07/2001

WELL CONSTRUCTION RECORD 2 J 012
North Carolina- Department of Environment and Natural Resources- Division of Water Quality-Groundwater Section !! [[
(VELL CONI RACI'Oil(INDIVIDUAL)NAME (print) ��IMnti✓ �x7• S CERTIFICATION p P_w[]J
VNELLCON'"RAC"I'ORCOMPANVNnMe, j,� 112r, ) �J_jJ.LILL(•J�r PHONE N fg�83- -73oUFf
Sf A'I I:w'1:1.1,CONS'I RUC'I ION PERNII I# ASSOCLct ED\\'Q PERMIT P
(if appl icablc) / (if ap plicable)
I. WELT. USE (Check Applicable Box): Residential CR" Municipal/Public ❑ Industrial ❑ Agricultural ❑
Moniloring ❑ Recovery ❑ Heal Pump Water Injection ❑ Other❑ If Other, List Use
2, WELL LOCATION: /� Topographic/Land setting
Nearest Town: %IIUI�'���✓Counly 0 KZo ❑Ridge ❑Slope ❑Valley ❑Flat
13:"I,I-L wI( (check appropriale box)
(Sucm Nnnn,Nwnbers.Community,Subdi Lot No,Zip Code) Latitude/1011glltltle Of well location
TT _ 11 /
3, OWNER: J ) III PPS LC CO"110l 1-11 al� "`C� Idcgrccs/minoics/seconJsl
Address P o k '`Y EX 3 Latitude/longitude source:❑GPS❑Topographic map
(Sn�c'cyor lioutc N�o.)/
(check box)
f1�, ES (' / e /ijL -; /K DEPTH DRILLING LOG
City rrgmsn state Zip Code From To lynnaln Description
Area code-Phone number � � 7-S r n h• ��
4. DATE DRILLED_''
5. TOTAL DEPTTi `/1
G. DOES WELL REPLACE EXISTING WELL.? YES NO ❑�
7. STATIC WATER LEVEL Below Top of Casing: O • FT.
(Use"+"if Above Fop of Casing)
8. TOP OF CASING IS FT. Above Land Surfacc*
fop of easing terminated at/or belov,land surface requires a
v:rri:wee in accord au with 15A NCAC 2C.01 IN. ^
9. YIELD (cpnl): b METI-IOU OF TEST_
10. WATER ZONL_S ((lepth):
LOCA"PION SKETCH
11. DISINFECTION:Type Amount Cii Show direction and distance in miles from al least
12, CASING: Wall Thickness two Slate Roads or County Roads. Include the road
Depth po Di,nnglcr q Weight/Ft. 0 Material numbers and common road names.
From � To 3 � Ft.—IT .�-b_Rv t/
Prom To Fl. c
Front TO FL c
13. GROU"I': Depths Material Method
m
Fro '1� A o ) n= FL � o
Front c Tv�x�• FI. y
14. SCREEN: Dcp(h Dianlctcr lot Sizc Matefial 1T Do
From To Ft. in. in.
Front To Ft. in. rn
15. SAND/GKAVLI. PACK:
Depth Sizc Material CA)
r
H
I'IUill 1U FL N �
16, REMARKS:
r,
� T" 115 WELL WAS CONSTRUCTED IN ACCORDANCE WITH I SA NCAC 2C, WELL
ID Coll
. f OPO'TI-IIS RECOD BEEN PROVIDED TO THE WELL OW NER
SIGNATURE 01;PERSON RU E WELL DAiG
GR LI 1Lt711A RryEt 4 'the icision of Water Quality,Groundwater Section, I636 plait Service Center-Raleigh,NC
ASHES'R(1.4D-R6�CbONfdurDlk�'.QFIY 7 3-3221,within30days. GW-I REV. 07/2001

2n1r,A9
WELL CONSTRUCTION RECORD
North Carolina- Depaitnsnt of Environment and Natural Resources- Division of Water Quality-Groundwater Section
NN FI.I.('ON'I RAC'I Olt(IN In VI O UA L)NANI E (,, d) _ M�rY N e S CIERTIFICA7 ION Noc56S
w EI.I.CON"I It%C'I Olt(ONY'ANN NAME._ �_? k, Lk)Lt PHONE a S-4ug 7-g009j
S IA I F 1%FIA,CONS I'R UC'IION PERAII'I'N ASSOCIA'I FI)NN'Q PEItAII I N _
(ifapplicablc) (ifapplicablc)
I. WF.LI. USE (('heck Applicable Box): Residential Municipal/Public ❑ Industrial ❑ Agricultural ❑
Moldturing❑ Recovery ❑ I Ica( Pump Water Injection ❑ Other❑ If Other, List Use
2. WELL LOCATION: / / Topogra iic/Land setting
Ncares('Rrvn: ,n16I I� County /vC'�'�/�-�L ❑Ridge ® ie ❑Valley 111=1a1
— tt_.:Clk—k� �A)0 F--tl- -,_;fS (check appn-pdale boxi
(Street Nan,c.Numhcrs,('onununily,Su��bdivision,Lot No.,Zip Code) L'allltlde/longi(t((Ie of well location
//
3. OWNER: AL,4Aj F` ei nj (Acgrccs/ininmeshcmnds)
Address .06:_ I-alilude/longitude source:❑GI'S❑Topographic map
///, .�.5� (Saecl or Roble No.) (check boa)
c�%�c`�ZSTurF! J7370a DG'lll DRILLING LOG
cigorlmcn Scvc Zip('ode Prom To Formation Description
( 27)- 5:&— 7 FS 7 0 — 712 Sew i C4S1-.J 6r—
A ren cudc-Phan,,number ,�� s `6r,� s SLR"1
d. DAIE DRILLED_ V-!w --02
5. "1"OT At, DEPTIL Kr'JS ' /
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO 2r
7. STATIC WATER LEVEL Below Top of Casing: FT.
(Use"+"if AMnro'Ibp of Casing)
S. '1-01) OI'CASING IS FT. Above Land Surface*
•'I op of cash:C Ienainmed at/or belnnv land surface requires a
cariancc lu accortlance,01. I5A NCAC 2C.0118.
9. YIELD(grim): ME] HOD OF I Es r 4 1 P, — —
10_ WATER ZONES (dcp(ll):
LOCAI ION SKETCH
11. DISINFECTION. Type CIx�nL'lA)(' Antounl u Show dircclion and dislaucc in uli IC5 front al IC:ISI
12, CASING: Wall I-hness ick two Slate Roads or County Roads. Include the road
Dcplh Djamcicr or Wcighl/P1. Malcrial numbers and common road names.
From I o Wit) pl 't sDQ�) ��✓�_
19'nm "fo PI.
0
Prom To 1:1. — 1V n
13. GROUT` � Depth Malcrial Mclhod a �a
0
From U 'fo_''__)i) rL CPMFt1'T- 9 99VI =
from 'to PI. N om
Id. SCR IiP.N: Ury,lh Uinmcicr Slot Size Material to
nm
m
Prom Jo -
15. SAND/6RAVI!L PACK: N m�
Depth Size Malcrial C.0
V)
From 'to PI. c
Front 't o PI.
16. REMARKS:
ri
IAli I�13 d11IR Ill 1' I IIAI 111S 4i/IiLL WAS CONS]RUCIED IN ACCORDANCE WI I If 15A NCAC 2C WFLI,
AND`,filAT OI'Y 0.lulls RL(' )HAS BEEN PROVIDED TO"1 HE WELL OWNER
l i i —�
Stt.. 01;PERSO O RUCI ING II IE WELL DA"It's
I
Subl it, it ( f Water Qu:di(y,Croundwva(er Section, 1636 Mail Servicc Ccn(er-Raleigh,NC
2769#g f�ILLNI(Rf�l{h)!'Jl'Fliluf221,1-ifhin 30 this. G1V-I REV. 0721101

WELL CONSTRUCTION RECORD J r� 48
North Carolina - Department of Environment and Natural Resources- Division of Water Quality-Groundwater Section
w'ELL CONTRACI'Oil(INDIVIDUAL)NAME (print) 1 MM� �sM1iC'_..S CERTIFICATION IN 5
w ELI.CON"I'RACY Oil CON]PANY NAME 1+F2neB �A_a= �� .1 )Ql l'`Jq PHONE # WJJaV-K1-X11
SI AI I,\\'ELL CONSfRL'CTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential 9/Municipal/Public ❑ Industrial ❑ Agricultural ❑
Nioni(oring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other❑ If Other, List Use
2. WELL LOCATION: Topogr is/Land setting
Nearest T will, 'it yn 5 _County e(Zvk ❑Ridge lope ❑Valley ❑Flat
�yy-NNO CILP�> L/ (check appropriate box)
(Street Name,Nun�nununity,Subdivision,Lot No.,Zip Code) Latitude/longitude of well location
3. OWNER: X[41,'Yd 10• GP-T -ITFI (degrees/minutes/seconds)
Address 1,15 ZA S r4D V 4,1 e- Latitude/longitude source:❑GPS❑Topographic map
(Street or Route No.) (check box)
�a.b(h� -��(�� DEPTH DRILLING LOG
coy or Town Stat< Zip Code F fit To Fomalion Desert lion
WL'1- 30 1 �0' 61<
Area code-Phone nmnber p D :2D
4. DATE DRILLED
5. TOTAL DEPTH:
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO B-
7. STATIC WATER LEVEL Below Top of Casing: FT.
(Use"+"if Above Top of asmg)
8. TOP OF CASING IS FT.Above Land Surface'
`Top orcasing terminated at/or below land surface requires a
variance in accordance"with 15A NCAC 2C.0118.
9. YIELD(gpm): —VO METHOD OF TEST Y
10. WATER ZONES(depth): ���a i
LOCATION SKETCH
It. DISINFECTION: Type Amount 2- Cy Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads. Include the road
Depth Dia numbers and common road names. ZE
ZE
�eter or WeighVR. V I G C �
From 0 To 70 Ft. G� l� Sb� �.� N
From To FL ap o^t
From To Ft. �m
13. GROUT: Depth tatcrial Method N o<
D �o
Prom 9�_'I FL
� ,.�
From�,,.�To �F . Z am
14. SCREEN: Depth Diameter of Size Material enz
IV m�
Pram To FL—in. in. [.A cl
y
From To Ft. in. in. U� o
15, SAND/GRAVEL PACK: _
Depth Size Material
Prom To Ft.
From To Ft.
16. REMARKS:
TMA"r-fHtS, LL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
f[ U�'GION$'f NDARDS,AND�:'�HAT OPY OF IS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
�`
I
t 51 „y U 2E O P 6 N NSTRUCTING THE WELL DATE
I
Sohn it the original to the Divi ton o Water Quality,Groundwater Section, 1636 Mail Service Center-Raleigh,NC
2769 -Y�Ttt�!L-rTc1X�, [ 221,r ilhin 30 days. GW-I REV. 07/2001
MV-4 �Tsdnil c.,li
ASHEIILLE REGIT,:A 0FF1GE

WELL CONSTRUCTION RECORD 251 47
North Carolina- Department of Environment and Natural Resources- Division of Water Quality-Groundwater Section
�� C
w'ELL CON TRACT OR(INDIVIDUAL)NAME ( rint) )1MM(� )•,}�`_S CERTIFICATION#-2 J
w'E[.[.CON'I'RAC Olt CON(('ANY NAME ENP VD kep ), r)Q�II � ILL) PIIONE # 1�1_,�Z7"'�'��
S LA'"I E\\'ELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
I. WELL USE(Check Applicable Box): Residentialo/Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring❑ Recovery ❑ Heat Pump Water Injection❑ Other❑ If Other, List Use
2. WELL LOCATION: Topographic/Land setting
Nearest Town:--.ej'1 tur County 9A-1-E ❑Ridge e ❑Valley ❑Flat
r) V— (check appropriate box)
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) Latitude/longitude of well location
3. OWNER: 2 1 LL-'Y/ hALLeA& ) (degrees/minutes/seconds)
Address I el5'q 1 LeA)t_F Latitude/longitude source:❑GPS❑Topographic map
(Street or Ito Na.) (check box)
/U L ZR�[ DEPTH DRILLING LOG
City m T wn State Zip Code From To Formation Description
739 I o --_ _�zo 5e7 G!
Area code-Phone numberd
4. DATE DRILLED ` 7- �-
5. TOTAL DEPTH: ' -/
6. DOES WELL REPLACE EXISTING WELL? YES El NO E
7. STATIC WATER LEVEL Below Top of Casing: 2-J • FT.
(Use"+"if Above Top of Casing)
S. TOP OF CASING IS FT. Above Land Surface*
•Toy of casing terminated at/or below land surface requires a
variance in accmrr!Te,v h 15A NCAC 2C.0118.
9. YIELD(gpm): •LL METHOD OF TEST
10. WATER ZONES(depth): I7O
LOCATION SKETCH
11. DISINFECTION:Type Amount 1 Show direction and distance in miles from at lead
12. CASING: Wall Thickness two State Roads or County Roads. Include the road
Depth Dia eter or Weight/Ft. tonal numbers and common road names.
From To 0 Ft "(LD7(2)
From To Ft. N o
From To Ft.
13. GROUI- Dept atonal Method
t� To `� Ft.�
From-rr����
Front To /�� FL � �n
14. SCREEN: Depth Diameter Slot Size Material
From To Ft.—in. in. S �m
From To Ft. in. in. rnz
15. SAND/GRAVEL PACK:
Wes+
Depth Size Material 0-6 p
From I-o Ft.—
From—To—Ft.
16. REMARKS:
( III r�`T'B1f'tCE IIFY' T, ATi WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
TR JCT ,iA THAT A COPY OF THIS RECORD BEEN PROVIDED TO THE WELL OWNER
f-- z-
! ATUREOFPERS TI HE WELL DATE
Su of ,r • '€sion of Water Quality,Groundwater Section, 1636 Mail Service Center-Raleigh,NC
27699�, __ °iCfj��,,t�Iyy,��� 9tt �` t 3221,within 30 days. GW-I REV. 07/2001

WELL CONSTRUCTION RECORD 2 515 4 6
North Carolina- Department of Environment and Natural Resources- Division of Water Quality-Groundwater Section
\%ELL CON'I RAC I.Olt(INDI\IDUAL)NAME (print) `-1'I Mmb/ ��('1r�e.S CERTIFICATION N .r
x�ELL CON'I'RAC"I Olt COMPANYNANIE J%QfZC1kf= P bi_l_(J_i N,`�—PIIONEN5 ) '37—'&C'C)�6
S'IA I F wELL CONS'I RUCTION PERMIT# ASSOCIATED WQ PERNIITd
(if applicable) (if applicable)
I. WELL. USE (Check Applicable Box): Residentialt�l/Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other❑ If Other, List Use
2. WELL LOCATION: /'�� Topographic/Land setting
Ncaicst Town:_;�1LU2/���V +lrCCounty LJt ,O E' ❑Ridge ❑Slope ❑Valley ❑Flat
CJ l-,/Z t e t_ r_}J (check appropriate box)
(Street Nenic,ivumbcrs.Coinnhmnity,Subdivision,Lot No.,Zip Code) Latitude/longitude of well location
G \ } ✓x/
3. OWNER: t �.C�/` (degrees/minutes/seconds)
Address _ V Latitude/longitude source:❑GPS❑Topographic map
(Street or Route No.) (check box)
J_A4NJE n I.0 , (— L 3qGn 5 _ DEPTH DRILLING LOG
Citv nr Town sta e Zip Code Fro 1 To Formation Description
Q-Z
Area code-I'ho,c oua her
4. DATE DRILLED
5. TOTAL DEPTH:
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO LJ
7. STATIC WATER LEVEL Below Top or Casing:_(WY0 FT.
(Use"+"if Above Top h Casing)
S. 1'01' OF CASING IS FT. Above Land Surface'
•Tap of casing terminated at/or below laud surface requires a
variance in accordsyce�u'rth 15A NCAC 2C.0118. ,
9. YIELD(gpnl): 'Y9 _METHOD OF TEST r
10. WATER ZONES (depth):
LOCATION SKETCH
It. DISINFECTION: 'I'ype Amount L!/ Show direction and distance in miles front at least
12. CASING: Wall Thickness two State Roads or County Roads. Include the road
Dept Dim o aeter Wet'lit/Ft. M lenal numbers and common road names.
From/�y _To_/00 Ft. �� �/ v�'
From To I't.
c
Froth To FL O E
13. GROUT: Depth^ Material Method (V
Prom To ol.0 Ft. V own
From To� l'L � Cm
14. SCREEN: Depth Diameter C S&S¢e Material 4m
Front_ To Ft. in. in. �c
From To Ft, in. in. "O
S a�
15. SAND/GRAVEL PACK: fn=
Depth Size Material
Prom 10 Ft.
N o
Frorri—To Ft. z
16. REMARKS:
•\—TI)i5;([EREM HIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
R�IJ o SFRUt FIPN STANDJ N, ANDTHAT A COPY OFTHIS RE C HAS BEEN PROVIDEDTOTHE WELLOWNER
IGNATURE OF PERSON CON TIN ' E WELL DATE
I
Subnut the original to(l a Div siml of Water Quality,Groundwater Section, 1636 Mail Service Center-Raleigh,NC
(_puncE Rl,,i! )733- 221,within 30 days. GW-I REV. 07/2001
ASP,EVILLE EE611 j;,L GFF10E

NULL CONSTRUCTION RECORD
009
North Carolina - Deparluteul of Ell virrnu rent and Natural Resources- Division of Water Quality-Groundwater Section e/
\\'E I.1.I ON IRAI I OR(IN U IN II UAL)NAME (/p'rrint _ �i 1 AV" .j CF-Rf IPICA'IION 0��0�
IN VIA,( ON I It ACI OR(OPI PANY NAME: C�(.4 '�� Lf9r✓11 _R_!1-LA G- PIIONE a 1V i� y) n7`�{008'
S 1 A 11: %1 I:1.1.(ONS I III'( I ION rER,%]I 10__-"--- ASS(ICIA'1'ED WQ 1TTIN11Ta
(if applicable) (if applinlblc)
I. WI`.LI. OSI{(Chuck Applicable Box): Residential Q Nllmicipal/Public ❑ Industrial ❑ Agricultural ❑
Muoilming ❑ Recoccly ❑ Ileat Pump Water Injection ❑ Other❑ If Other, 1-isl Use
2- W EI.1- I,OCA I"ION I: n/ / To to it nc/Land selling
Nearest ToAcn:_f )141 w.y Couuly `—heRUK� ❑Ridge is ❑Valley ❑Plat
Icl eck appnoprialc n(ix)
(sheet Nmale.Nu..d'e",,V Inninil)'.Suh,li cisinn,LL7ul Na.,Zip C,aIe) Lahhlde/lollglludc of well location
1. O\l'NI{R: 1tn �_ �r�� (degrees/n.i uuka8ecnnJx)
Address - _{V��.�D Ql t/�_" LalittldC/longitude s0urt'c:0(il'S❑Top0graphic m;lp
//� ISI,ed or IAnac Nu.I p p (check hus)
_e ' uapky N�`�}� 1�� 1)FPIII DRILLING LOG
Oily ar'In sn l—slab Zip 00, from To Formation Description
Alea code Phone aunt"'r L to r - 7g x r Si--,47-E
4. DA 11'. DRI1A fiD_
5. DOTAL DF.I'"I I /
6. DOES WELT. REPLACE. EXISTING WELL? YES ❑ NO CND
7. SI AIIC WA"I IT LEVEL Below Top of Casing: _F 1'
(lJsc"+"i f Abasc'I i�p of Casing)
8. TOP OP CASING IS_�_ f°I'. Above Land Surface*
'llq,of caslhg lerminalyd nl/nr Lelass'land surface regalree a
1:11 hence In am,likinee ss 1, ISA NCAC 2C.(1118.
9.
10. )PATER ZONES(depth):
LOCA"PION SKEICII
11. DISINFECIION. Type Amount 1 Cv Show direction:md distance in miles from al least
12. CASING: Wall Thickness f-- two Stale Roads or Comity Roads. Include the road
Depth Diamcler or Weight/:1. Material numbers and common mad names.
from ll(___ Ft. _ c
rrnm _ _"t o
0
13- (7RUlIl: Depth Mamrial Mcthud � c-t
Ir,lni(.'J _"fo QO It.�MP.�_� ✓CT7f c
I-nnn _"fo_�`c7__ PL_�l(_r -✓ .5_ _V_(_'(-,y-/ L m
III SCRI`1:N: Depth n Di:actel Slut Size T[L;Malcir a% O
Do Ilnm
I5. SAND/(iRAVI?I. PACK C.O N�
ra
Depth Size Mnlerid F. e)
_H
1 r0111 I I(1 1 t. _
DLI�I"'Ill F1 Im I I-R' , 1 I 3 WFIJ,WAS CONSTRUCTED IN ACCORDAN(E Willi I SA NCAC 2C, WELL
hNS IRl IC'IION S I-AND:\R }� I)'f 'f A COPY OF II S RECORD IIAS BEEN PROVIDED TO 11I1:WELL OWNER
ICI
2_
�SI( r lUP ,( IJ N CUNSTRUCIINO II1E WFj_t- DATE
GGOU(..Ji VLJ.WES SEC TICiI ~
S.0$t*u1thF(B65L6NrAlr10hM;IiiuiSII t of Water Quality,Groundwater Seclion, 1636 Flail Service('enter- R:dcigh,NC
27697-1636 Phone No.[phone],tv ithio 31) Ila)'s. GW-I REV. 07/2001 -

2520P8
WELL CONSTRUCTION RECORD
North Carolina - Deparunent Of Environment and Natural Resources- Division of Water Quali(y-Groundwater Section
w VIA,('ON"I'It:%C"I OR(INIM IDUAL)NAME (prior) I � t JO'JLS CEIt1l ElCAIIONq �5�5
w ELL CON'I RACfOR COM PAN i NAM ES 1vPlL;�c�-"� 6�%Q.�� ]D21/h Vj rnonE a
S1 A I f:w'ELL('ONS I RUC ION PE,RiMI'1'a ASSOC[Al ED w'Q PERNII'1'a
(if applicable) (if applicable)
I. 1VELL USE (Check Applicable Box): Residential Municipal/Public ❑ Industrial ❑ Agricultural ❑
Moniluring ❑ Recuveiv ❑ Heal Pump Water Injection ❑ Other ❑ If Olhcr, List Use
2- WELL LOCATION Topographic/Land setting
Ncarest'fuwn: !)h/) County Pz,,kv e PlfIdge ❑Slope ❑Valley ❑Flat
Cc'v7 - e P't,j'�t A-Ple J i (ebeck appmpriale box)
(SI¢cl N:une.N nbcrs.Colnmonily.Sub(IMS1011.I.ol No..Zip Code) Latitude/longitude of well location
3. OWNER:. ]_ -/ p (degrees/minuics/seconds)
Address - �'C I' i A °/S''� Latitud(2/Iongilude source:❑GPS❑Topographic map
(Slrecl or Rnutc No.) (check box)
iCi ) DEPTH DRILLING LOG
City Zip Code Prone To I)m inalimn Description
)- W37, ( C,-7S O 50' Jam- 1
Area code-Phone numher —���
d. DATE DRILLED y' Z S• C� �-.
5. TOTAL DEPI IL O S
6, DOES WELL REPLACE EXISTING WELL? YES ❑ NO ❑`
7. STATIC WATER LEVEL Uclowl'opofCasing: Ode FT.
(Usc '+-if Abosc Top of Casing)
8. "IOP OF CASING IS FT. Above Land Surface"
'Tup of casing tenoionled at/or below land surface requires a
rariauce in accord:mq•,ri(it I5A NCAC 2C.0118.
9. YIELD (gpnn): E'er NIHTHOD OP TEST__.
10. WADER ZONES (depth): — (-/,'g'
LOCATIONSKETCH
1 I. DISINFECTION: Type - Amount C-61 Show direction and distance in miles front at lead
12. CASING: Wall Thickness two Stale Roads or Counly Roads. Include the road
Depth DI meter or Weight/Ft. M nal numbers and common road names.
From To�0' FL _ <
From To Ft.
From To H. c
13. GROUT: Depth Matenal Method O
0
Prom To P(. 3 ��
Float_Z�_ lo_ 171.
14. SC121!FN: Depth DIaI11CICl' ("/SlotSize Material zn
1
From to Ft. in, ill. pn
Front _To Ft. in. in. +moo
15. SAND/(TRAVEL. PACK: = ao
Depth Size Material W Nz
From to Ft. •. ma
Prom To Pt.
IV o
z
6.
fir-- 1
I
tfYttFS" I I1ff} IS WELL WAS CONSTRUCTED IN ACCORDANCE WITII 15A NCAC 2C,WELL
IONSTR UC HON S fANDM I S, D THAT A COPY OI'THIS RECORD HAS BEEN PROVIDED T01 HE WELL OWNER
_. 0 .
i� SK NA-I UR E OF PERSON O ,I1 �GTHE WELL DAIE
E. TIO ;
sitlfrhfl'dtt�tr♦ Y o' 1F I I I r �61t�1t � 1'pMQ&cisio t of Haler Quality,Groundwater Section, I636 Mail Scn ice Center Raleigh,NC
c o.(919)733-322I,within 3O(lays. GW-1 REV. 0712001

WELL CONSTRUCTION RECORD 232007
North Carolina- Dep:ul stew or liuvironmenI and Natural Resources- Division of Water Qua lily-Groundwater Section
w F:IA,(ON IMM]OIt(INDIVIDUAL)NAME (prh,t) Jlmm q�_, CERHFICA'I IONH��05
)vF.I.I.CON'IIt.%('I Olt('ON]VANV NAME._S�-f�ER Q_L'� �(ZI��/fV_9 rl1ONe a (S,*J)B�-6w
SI A'I I:NN ELI.('ONS'I1M 11ON I'Ii12M1'rH--- ASSOCIA I ED WQ rER511 la
ail applicable) (it applicable)
I. WFI.I, US1? (('heck Applicable Box): Residential H-/Municipal/Public ❑ luduslrial ❑ Agricultural ❑
Munilm ing ❑ Reeocery ❑ Beat Pump Water hgcclion ❑ Other❑ If Other, List Use
2. WFIA, LOC•AFION: / i•opogiaphic/Land selling
Nemest Town:_ ./7?Uk�"�1 y County( t RoK� QRidgc ❑Slope ❑Valley OFlai
— 1�lade kLP� S—_— (check nppngvinlc hna)
(Slrcrl Name.Nm n,beis.(ammunily.Sohdnki nn,IInl No_Zip Code) Lanlude/lunglllltle of Well location
�,). OWNER: ZL.� CAPIR1106:It ldcprccsAninulcshcconJsl
Address _ -20 C7I�92geP. Cf)VE 2 Lali ludo/longitude source:❑GPS❑1'opogiaphic map
(St I or It, No.) (check bm)
_ .R4_S5_�1w4_0()- Nc az9c")�z DI:PrII DRILLING LOG
('ilr nr)oan slate Zip C"'Ic prom 'to formation Descriplion
Awa ndc- I'hnnu mm�hor U
d. DA I DRI AJ41) "/
5. TOTAL DIAlI11: Gas '
G. DOE'S WELL REPLACE EXISTING WELL? YES ❑ NO lla'
7. S I A IIC WAl"ER LEVEL Below Top of Casing: 7,�1:"I"
(Use"I"if Ahnvc lop of Cnsing)
9, "1Oil OP CASING IS �_ FI Above Lnod Surface•
'I op of casing h•rndnaled nl/or hrlo+s land sm Garr req am a
cm h..cc ha aaanl:oar+sIll. I5A NCAC 2C.al Ie.
9.
IU. WATER ZONLS(depth): 2/120
LOCATION SKE•I CI I
11. UISINFECIION: "I"yp c Amount Cup Show direction and(lislancc in miles From at lead
12, CASING: Wall Thickness r two Stale Roads or Couuly Roads. Include the road
Depol Diamcler m Weight/H. Material numbers:md common road names. o
11
Front s1Q"fo0 - I't. Co1�_ �C__ N fl
Front Tn
a ^,
19ont_ I o o
_— Pl. _ — _ _ � cm
13, 6ROU1: Dcpol Malcrial Nlc(Ilud I a{
rn
fnnn O "fo_o2U ft. Ce^'IeNr_ ?siVln/ fir"
I lool_'Z(D_ Io11)n- ft.Cur_ (^- S_ _ 3r2V�7j 4a
1-1, SCRIif N: Dcplh Diaotcter Slot Sim Mtacr m
tJl2
From To Pl._ ill. in. �::� Rix
15- SAND/GRAVPI. PACK: N z
I)cplh Size Malcrial
Paolo To EI.
Pram To P(.
-H9-f-t-IYTTI'�II Iji, IIIIS WFIJ, 1 \S CONSI RUCI FI)IN ACCORDAW F WNII I5A NCAC 2C.WELL
1 ( UNS I IIU( I ION SI ANI 1\ 2 AND Ill A )I'Y Of I1I15 RP ' )RD IIAS BEEN I'ROVIUfU"I'O"fall: 1VLL1,DINNER
-�' L.1
IUN f 1 OI?PL�.0 fRl1CIIN(i'I11EW1iLA�-02
irl7 I l n jiil'Yrt�IQu4 Uiv siou of Wafer( ualil GI'oundurnlcr Section, 16J6111 ail Set Cculcr-Raleigh,NC
Ci1 .4>z 2 y t
)Y=trFIF untc•No.(II 19)733-3221,1%i(hin ]I)days (iW-1 RFV. 07/2001

WELL CONSTRUCTION RECORD 252272
North Carolina-Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section
WELL CONTRACTOR(AYDIYIDUAL)NAME (print) LON D 1 u Al2D CERTIFICATION 71 3131
WELL CONTRACTOR COMPANY NAME 'B`IEIZS 1AiE LA— -D�P-I LLA NGy IIJG, PHONE
STATE WELL CONSTRUCTION PERMITA ASSOCIATED WQ PERMIT!)
Cif applicable) `� Cif applicable)
qd'1. WELL USE(Check Applicable Sox):Residential Municipai/Public El Industrial ❑ Agricultural❑
Monitoring❑ Recovery Q Heat Pump Water Injection❑ Other E3 If Other,List Use
2. WELL LOCATION: Topographic/Lanfi setting
Nearest Town: Mi V - _Connty h r KC� 13Ridge, OSlope OValley OFlai
J i M on rid I P . (check appropriate Dox)
(Street Name,Numbers,Commmuunhy,Subdivision,Lat No.,tip Cede) Latitude/longitude of well location
3. OWNER: lCrr� tturr Pl - (degneshnnuus/eewnds)
Address ED- j>! 7 aroma- Latitude/longitude sotrce:QGPSOTopographic map
(check box)
V\I(11r1 arCo)
3QR3 _ DEP19 DRMLINa O
city orTowa State zip Code From To Formation Description
Area code-Phone number
4. DATE DRILLED 4- II-D� In rive
5. TOTAL DEPTH: I S( 10 13 b5i A�
6. DOES WELL REPLACE EXISTING WET I? YES ID NO 13 ao ve.v n gathered rtrJG
7. STATIC WATER LEVEL Below Top of Casing: —FT. Jo �.L vvea-ttncrrdn�r
(Uge"+"if Above Top of Casing
a. TOP OF CASING IS�,FT.Above Land Surface" 37 3-7 -0 ni ,
-Top u(taslnE terminated atiur below land surfue nquirer a �h=yi
variaote In accordance wlm 15 K
A NCAC 2C.a11& 5 a c r �m f`
9. YIELD(gpm,): I g METHOD OF TEST--Air85 12S ~Gjr[n i 1-e— hcl<
10.WATER ZONES(depth):
LOCATION SKE .H
11. DISINFECTION:Type Amount�()_ Show direction and distance in miles from at least
12. CASING: ��L Wall Thickness two State Roads or County Roads.Include the-road
Depth Diameter or Weight(Ft. Material numbers and common road names.
Frottt_ O To 3-7-Ft. &`'1S Pul
FrotrL__To Ft._____,__
From To_,Ft,
13. GROUT': Depth Material Method
Frorr�'._To �t7 FL, ._ eme✓7l-"�rraV o
From _To FL
14. SCREEN: Depth Diameter Slot Size Material = 2�
From- To_Ft in. om
From To Ft.� jn. in. dim CurdClI zm
15. SAND/GRAVEL PACK: Co Q`�m
Depth. Size Material -o m
From To__Ft. x �
From- To Ft. M=
M� lJ
16. REMARKS: an c
z
I DO HEREBY CERTIFY THAT THIS WELL WAS CON iRU D ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STAND , '1ND THAT A Y F HAS BEEN PROVIDED TO T'IM WELL OWNER
5-03 Da
C (? W r� SIGNATURE OF PERSON CON -CMNG THE WELL DATE
LS !Submit t tc on Lna Division of Water Quality,Groundwater Section.,1636 Mail Service Center-Rsh igh,NC
27699-I636 Pboae N 9 733-32Z1,within 30 days, GW 1 REV. 07/2001
Z"02
GROUNDWAiFF: SECTION
ASHEVI(i.F --' "^.'- OFFICE

WELL CONSTRUCTION RECORD 251218
North Carolina- Department of Environment and Natural Resources- Division of Water Quality-Groundwater Section
CON
NAME (prinO 11 -Sr7nS ��
1e_ CERTIFICATION#�_S
1vELL CON"IItAC"I'Olt COMPANYNAME C \P DKeP L)P �t PHONE �fi37-�QaSS
STA'I I "1'1.1.CO,N'S'1'RUC"I'ION I'l'IINII'I'# ASSOCIATED N%'Q PERNIIT#
(it applicable) (if applicable)
I. WELL, USE (Check Applicable Box): Residential O�M Lill icipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Olher, List Use
2. WELL LOCATION: /A P� topographic/Land setting
Nearest Ibwm /1�l•12D N.Y County �' - Q Idge ❑Slope ❑Valley ❑Flat
— .DUn11Qr.3 NIL—L—S (check appropriate box)
(Sorel N:mic.Numbers,(7lmuuunity,Subdivision,Lot No.,Zip Code) Lalilude/longitude of well location
3. 0WNFR: �dl. l•N'il C'- (degrees/minutes/seconds)
Address Lali(uddlongiludc Sourcc:❑GPS❑"topographic map
(SI«el or Route No. p (cheek box)
A t�k LV A) `0(1 DF11FII DRILLING LOG
01,vor 1, sn si, e ZfpCode From To Formation Description
Y
(�-_lr�! y- 5 _ 0
Areu m n du-Plmne umb / der
d. DATE DRILLED Z Q }'
5. TOTAL DEPTH:
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO EJ-
7. STATIC WATER LEVEL Below Top of Casing: _5 0' FT.
(Use"+"if Above Top of Casing)
S. TOP OF CASING IS / FT. Above Land Surface*
."rop of casing terminated at/or below laud surface requires a
vari:u ce it,accordance will, 15A NCAC 2C.0118.
9. YI ELI)(gpni): :LJ METHODOFTEST
10. WA'I'ER ZONES(dcp(I* —
LOCATION SKETCH
11. DISINFECIION:Type H Amount 2 C Show direction and distance in miles from at [cast
12. CASING: Wall Thickness two Slate Roads or County Roads. Include the road
Depth D i peter or Weight/Ft. Material numbers and common roar) names.
From 19 To / �0, Pl. _
From To FL o
From TYi Ft. CD
13. GROUI: Depth Material Method N
From To FU -MI =3M
From To Ft. P2m
Id, SCRL'F.N: Depth Diameter Iot Size Material N 1=7m
From "fo Ft. in. in. Ya
Front To 1'1. in. in.
7C �m
15. SAND/0RAV1 L PACK: IV yz
Depth Size Material n�
From To Ft.
v o
From To Ft. x
10, REMARKS:
J341-41r T T THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
�I S, AND"THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THIE,WELL OWNER
FR _
7 - 1Z - 0 z
ri�I---- -7 � SIGNATUREOFPER O C.ON I CTING'I'HEWELL DATE
GR A t�� o the is ision of Water Quality,Groundwater Section, 1636 Mail Sep ice Center-Raleigh,IN
ASHEWbV9-ACBI1%Ab00A6lgffI9 7 3-3221,within30days. GW-I REV. 07/2001

WELL CONSTRUCTION RECORD 250933
North Carolina - Dcparunent of Environment and Natural Resources- Division of Water Quality-Groundwater Section
wt:LI.CUNTR:\CTUR(I:\DI\'IDILU.I N,\hI F. (Print)_ ) I 111' 1 J 1�� CERTIFICATION# .�.SCS
v VI.L CONIR.V 1ORCOMPANYNA\I F;��cPlL[ � F� t�U �� f�i ll_(.� PnON'E # (9)3) ]S 3,7'-FO(l�
S'1A I F.1l't:[,I,CONS"I RUC'I[ON 1 ERNIIT#_ ASSOCL\'(F.0 N'Q PF.RdII'I#
(if applicable) (ifapplicable)
I. WELL USE (Check Applicable Box): Residential 71�lunicipal,'Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION: Topogra uc/Land setting
Nearest Tuwtc 1'itu.: {I_V Com)Iy- hE) /�� ❑Ridge Mpe ❑Valley ❑Flat
niY�I�C�_(.��/ C.P—&Q V, Rb (check appropriate box)
(Sleet Na,,o.Nunthm,Cou mmnity,Subdivision,Lot No..Zip Code) Latitude/Iongitudc of well location
1
3. 0%%NHR: emao L k-r If (degreeshn inures/seconds t
Address � �_CeF�� ,.,a r. 'Ti2A) e, Latitude/longitude source:❑GI'S❑Topographic map
(Street or Route No.) (check hos)
DRILLING LOG
('ity urlmat St.to Zip Code From To Forn a Lion Description
_12 '
Area unto Phone nu oh,
4. DATE DRILLED L/ Z _
5. TOTALDEPTEE
6. DOES WELL REPLACE EXIS"FING WELL? YES ❑ NO ❑'
7. STATIC WA-1 ER LEVEL L3elow'rop of Casing: 1c) FT.
(Use"+"if Above Top ofCasing)
8. "1 Oil OF CASING IS I FI. Above Land Surface'
''I op of rasing Iermln:rtrd al/or below land surface requires a
variance in accordance o'11h 15A NCAC 2C.01 M
9. YIELD(gpnQ: METHODOP'CEST
In WA"I ER ZONES(depth):
�O �j� .
LOCATION SKETCII
11, DISINFECTION: Type Amount - C(/ Show direction and distance in miles from at Icast
12. CASING: Will Thickness two Slate Roads or County Roads. Include the road
Depth Di:njyr or Weight/Ft. M tonal numbers and common road names.
From `� To— FL SO/Z71 �� c
O From To Ft. N o
Fron) To IT
13. GROUP Depth Material Method 6r;
From 0 To Pt. _ rn
oG
Flow�,p T'v � Ft. r— cn yc
fi
14, SCREFN: Depth Diameter Slot SIZC Material
From To Ft, in. in. _ �rG•-.
From To Ft, in. in.
cos
15. SAND/GRAVEL. PACK: C')
Depth Size Material t o
Z
From To IT
From To Ft,
ntA
,v.,r cc+lai c� IC, A IIIS NVEI-L WAS CONSTRUCTED IN ACCORDANCE WITII 15A NCAC 2C,WELL
I ION S"F 1) , AND TIiATA COPY OF iIS RECORD IIAS BEEN PROVIDED TO l"I IE WELL OWNER±,�Frx rrcs y--� . 16NA I URE 01'PERS 'O UCTTNG THE WELL DAIL•t , , , , .f t':Irr)r1+Au(ad ltp.Irf Divi.ion of Water Quality,Groundwater Section, 1636 Mail Scrcice Center-Raleigh,NC
anc o.[phone],within 30 days. GW-1 REV. 07/2001

` r-. C'i 8
WELL CONSTRUCTION RECORD � � `
Not Ill Carolina - Department of Environment and Natural Resources- Division of Water Qua]ily-Ground water Section
w'EI.I.CON ItACI OR(IN DIN I D UA L) ji NANIE rng . ) 1-M�+'t ;)�x�J('S CERTIFICATION#_ (a[�
vvFI.L CON'I R.kCI'OR COMPAN) NAnIE. 0Qr L 19. > a�"L)19�1 N`r' PHONE M (f7ja [{�7"—&C
S'I M E wF.I.I.CONS'f RUC1 ION PERNII"r# ASSOCIATED w'Q PERMITH
(if applicable) (if applicable)
I. AFELL USE (Check Applicable Box): Residential 42 Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovcry ❑ Heal Pump Water Injection ❑ Other❑ 1f0ther, List Use
2- #'ELL LOCATION: Topographic/Lan etting
Nearest Town: V%w _It.'$ County Utoi1DL_�L ❑Ridge ❑Slope110allcy ❑Flat
(check appropriate box)
(Street Nanic,Nwn'be7rs,Conaanity,Subdivision,Lot No.,Zip Code) Latitude/longitude of well location
3. OWNER: %//E(..-L�/N �h�S (degrees,hninutcs/seconds)
Address HS .SL�pi�fa/� 1--,.222-yC Lalintde/longitude source:❑G PS❑Topograph i c nail
(Street or Route No.) (check box)
n?li r OkY /VC 9!(7 DEPTH DRILLING LOG
city or lo,t State Zip code From To ormation Desc rip(ion
Area code"('hone number // / /--2 z-c
4. LIMF. DRILLED J ' 0Z
5. TOTAL DEPTH:
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO 93
7. STATIC WATER LEVEL Below Top of Casing:
(Use"+"if Abovc Top of Casing)
8. TOP OF CASING IS�_ FT. Above Land Surface*
-rop of casing terniiiated at/or below'land surface requires a
vari:...cc in acrnrdai�with I5A NCAC 2C.111IR.
9. YIELD(ep ll): �— METHOD OF TEST
10. WA'fERZONES(depth)��,3�5!D,
LOCATION SKETCH
I I." DISINFEC'rION: 'fypc Amount 7 LU P Show direction and distance in miles from at (cast
12. CASING: Wall Thickness two State Roads or County Roads. Include the road
//�� Depth D wipes or Wei flit/Ft. anal numbers and common road names.
Prom V To VD FL� :/Z%I M(-
Prom To FL p
From To Ft. N ca
13. GROUT: Depth Material Method -gyp o
From -Toa.O, ill, y c�
rr
Fronts To yo, Pt. o.c
14. SCR FEN: Depth Diamete4 Slot Sizc Material jo
From To FI in. in. MEmo
a
From To Ft, in. in. N u+z
15. SAND/GRAVE(- PA(K: M=
Depth Size Material C.) -+
r o
Fn,m to _Ft.
From To Ft.
)R9s: (, I�
I DO IIEREBY('ER"IIFY I HIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CQN�"[) PU ,:(ION S-IAND , AND 1IIAr A COPY 01-IIIIS RECORD HAS BEEN PROVIDED TO TIIE WELL OWNER
- 0 - Q . y �
GROUNPNWER SECTION IGNAIURF.01:PERSON CONS"rRU r Ci-I."ELL DATE
ASHEVILLE REGICNAL OFFICE
u nnI le orlgula to the Division of Witter Quality,Groundwater Section, 1636 Mail Service Center-Raleigh,INC
2 7699-1 6 16 Phone No.[phone],within 30 days. G W-1 REV_ 07/2001

J0937
WELL CONSTRUCTION RECORD
North Cat - Department of Environment and Natural Resources- Division of Water Quality-Groundwater Section
\Y f:LL CO N'IR:\C'f01211,\DI VIDUAL)N,1D1/F.' (print)_ r)1'mM t/ •.�'trJJl_ CERTIFICATION
\\"F.I.L(CON'f RAC"IOR COMPANS"N:\bl F, Cx �'\ P_p (t 1E; ( ' t-J IIIdQ PHONE q (`�'>Y.)SS3�—Yiik� �j-
STA"rE\\'ELL CONS I RUCTION PF.RM1101 ASSOCL\T En\VQ PERAIM
(if applicable) (if applicable)
I FLL USE (Check Applicable Box): Residenlial'(/Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recoccry ❑ Heat Pump Water Injection ❑ Other❑ If Other, List Use
2. WELL LOCATION: topographic/Land setting
w Nearest Ton: 2 R 1, k County ' v Ro kt_� Idge Mope ❑Valley ❑Flat
l Ji: 1"ti ^�.J�I (check appropriate box)
(Shrcch Nome-Nuobco,Community,Subdivision,Lot No.,Zip Code) Latitude/longitude of well location
3. OWNER:_-_I )C_ -J SSC Mf
Address lS I CORK �+-2ot, � Latiuldc/longitude source: PS❑Topographic map
(Street or Route No.) /� (check box)
17 .nl>�y _ �lCn 1� DEPTH DRILLING LOG
City or T yn r Stale Zip Code From To Formation Description
Area code-Phone number
4. DATE DRILLED V -d' 0 2
5. TOTAL DEPTH: 2}' S
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO 0--
7, S"FATIC WATER LEVEL Below Top of Casing: 7S- ' FT.
(Use"+"ifAbove Top ofCasing)
8. TOP OF CASING IS FT. Above Land Surface'
`Tap of casing terminated at/ur below land surface requires a
variance in accord anc9 nl1 I5A NC.\C 2C.011R.
9. YIELD(gpnl): / � METHOD OF TEST__1—/ '
10. WATER ZONUS(dcpth): Z:�.C/
_ LOCATION SKETC11
11. DISINFECTION: Type Amount C.(/ Show direction and distance in miles from at (cast
12. CASING: Wall Thickness two Slate Roads or County Roads. Include the road
�1 Depthl L}im ter of Wei'h Ft. Amend numbers and common road names.
Fronk v To._()® Fl— _ _ _ 1I F G-
From To FL
—
Front To Ft.
13. GROU F: Depth Material 4 Method �O o
Prom 0 To t,
Ito] _7..J-fo F FL X11. cm
14. SCREEN: Dcphh Diameter Slut Size Material z_
I lonl To H. in. in. t.71 oat
From -1-0 Ft. in. in. �o
15. SAND/GRAVEL PACK: Z -;;qo
Depth Size Material enz
From To I:(. N CC')
GJ —i
From_ lb Ft. F C5
z
16. REMARKS-
I DO III REl31 CLR IIFti fIIAT"UIIS%YELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
r THAT A COPY OF THIS REC 2D HAS BEEN PROVIDED TO THE WELL OWNER
j . c z
S ATURE OF PERSON CO S-11 CT G_ E WELL DATE
I '' I
Subluit (he original to the 0[�'u I of Water Quality,Groundwater Section, 1636 Mail Scr%ice Centcr-Raleigh,NC
t_ ,36 Phanc No.(919)7}3-322 ,o-ithin 30 days. GW-I REV. 07/2001
J -

WELL CONSTRUCTION RECORD 250472
North Carolina - Dcpamilent of Environment and Natural Resources- Division or Water Quality- Groundwater Section / r
OT:L1.COSIIt:\C fOli QSUI\-IDL',\I,)N,\pIE (print) t MM _"SLO NeS CER'rIEIC\TION k dSsG"J
%%El.LCO%ilt%C'roli(o\IrAN\ NAnIE C\eeokgc- �J e_�I `I7R11f1i ruoNEa (t- $8) 7-�OQ$
5'1\'I'l:\\l:Ll.('1)NSIIiCCfiUN 14;It\ll'I'k ASSOCIA'I ED\\'Q PE.RMI'1'W
fit applicable) (inapplicable)
I. V\'ELL. USE (Check Applicable Box): Residential Municipal/Public ❑ Industrial ❑ Aericullural ❑
Monitoring❑ Recovery ❑ I Ical Pun)p Water Injection ❑ Other ❑ II Olhcr, List Use
2. WELL LOCAL [ON* 'opographic/Land setting
Nemestlbwn. ✓)1ariP�-Y County QRDk,2V 'Rd,c ❑Sloe ❑Valle ❑19al
�� 6' P Y
&C-t-S0rV R16C,C (check appropriate hox)
(Slmoi Nuns.NNr... rs.Community,Suhdicision, Lot No.,Zip Cole) Latitude/longitudc of well location
3. OWNER: -JTePNel-J` HEi'uCH©J Idegrees'minule,"ondsl
Addtcss 14_c 4 7 4v'L- tvo2'Ti-i Laliwde/longitude source:❑GPS❑Topogrlphic nmp
(Sln,o or Route No) Iclsck host
VA-R_qo FL, �-S ;77 V NFPTH DRILLING LOG
(ilyor rorvn1-swic Zip COLIC From To ) Formation Fie lion
—ORYO 50 SEl 0.1 �1��
Arco code-Phone number
A. DATE DRILLIi1) -0 _
5. TOTAL DEPI IL
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Bclow Top of Casing: ZZsF'T.
(Use"r"it Abocc'rop of Casing)
8. TOP OF CASING IS FT. Above Land Surface'
''lop of casing lerniinated al/or belo, land surface requires a
,.rime,in accurdence,cilh I5A NC\C 2C.0118.
9. YIELD(gpm): _/e METHOD OF TEST /9IP
10, WATER ZONES(depth): a_S"o a
LOCATION SKITCII
11, DISINFLCT ION. I,vpe��RR.oU 4112Amounl Ct Show direction and distance in miles from at (cast
12. CASING: Wall"Thickness two Static Roads or County Roads. InCILdc the road
Depth Diameler or Weight/Ft. Material numbers and common road names.
From -1-0 9C7 Ft._6aN W.�1 I PVC_
From To Pt. N
13. GROM : Depth Material Method o
From 0 Fo 40 Ft. ce-n e-j 5kan-,I W -
1
From ��C� fo_Q!• FL Corr "% -
14, SC'RL.GN. Uepih Diameter SlotSizc Male —O -
I rom To
Floor to Fl, ili. in.
I . SANWGRAVEL PACK: _
Ucpth Sizc Nhitcrial
-ram to FL _-
From To Ft.
p CUM
Jll -1111�AAAAIttr,,r�1.�11�
Cl(YJSRIR �Ufd`S"f'ANI li IIISD TIIAI`A(()PYELL WAS NS!111$ R CIORU HAS BRHN ACCORDANCE
I'IiOVWIT[
11U15U1)I IE WFIILL
L OWNER
GROUNDWATER E 'IGNATU UP SUN CONS1ltUCllNG iIIE WELL [)At 1;1
ASHEVILLE REGIONPL OFFICE
Submit fhe original to the Division of\\'titer Qualify, Groun 1waler Section, 1636 Mait Ser\'ice Cenler-It:dcigh,NC
27699-1636Plimic No.[phone], ssiihin 30 daN s. (iW-1 RLV. 07/2IIOI

232607
WELL CONSTRUCTION REICORD
Nollh(';onliva - Ucpm ln)cnl of linvirunn)enl an(I Natural Resources- Diviisioll of\Niter Qualify-Gruundwa(cr Section
\\F(.I.('l/S-Ill.\(-101t(IN 111\'IDUAL)NAME (prLrq 'i Monti - 9-LJ�II _�) CF It I 1 F ICAI[ON# D5Gi5
N ELL('O♦'In.\CIY1R('Dall',\N1' N,\ni4;—_ , �a-_l��__�(..a�-1_L—�2111)_ I'lIONF.
Si AI F m I .('O,SSI Rt'f-1111N 1'4:IfPllTq_ _. ___ASSIIC I,\'IF.0\\'1)1'F:I(o IITN
(if applicith1c)
I PSI: ((*heck Applicahlc Box): Residcnlial P municipal/Public ❑ Industrial ❑ Apicullural ❑
monilol ing❑ Recovery ❑ I Icat I'unlp Waler Iljcclion ❑ 011ie' ❑ If (idler, Lis( Use
2. WIA 1. I OCA"IION: //� l opogra c/Land selling
Neal T(o,.it _ �t2Q�C1 County Ciok,a,�
ep
'=tp / ❑Ridge LYSIc11\c ❑Volley ❑Fhd
I_ (check appu,p,iaie hoc)
I$heel Na.....Nmohe,c,Coloollood).Suhdi,ixiou,Lot No..Zip C...le) Lndllude/longllude of\%ell location
). O\\'Npl(: j L.�v— I/ ��Ff j,/r)�?2 Idvgrrcc;inimnccLcttnndq
Ialidudc/Iuupiludc.source:❑(ll'S❑Iopot-Niphicmnp
I Sncc1 or IGnuc No I (chcck box)
DRILLINGLO(;
('it, nr lo"n smlc Zip emle Drum Tn FnOnation Description
Area code- Phone nwoher LU.'_1- �--�?G
J. DA-11; 1)RII.I.1;1)_" -0), --.L-
5. TOI At, DFPTII:__-L�$------ —
h. DOGS WFLL RIT1 ACT GXISI ING WELL? YES ❑ NO L'
7. S I AI W WAII R LEVIiL Below"fop of(,asing: SC,) —
f Use"+•'i f Above Top of('asing)
R. 1OP OI CASING IR.__� ' FT. Above Land Surface'
"I op of caring Irrmiu aged:Jlnr helm.hold surface rnpdree a -- --
,;vi:u,re to arcordaure 1111. 15A NCAC ZC.11118. _
9. 1'II:LDlepnn). __�S�__-mI':fIIODOP'I'I:S1" A/rL'. _
10, WAI FIR ZONGS(dcpUl):_ lfy0 —
_ LOCAT ION SKFICII --
I I. DISINI IA'I ION: I Ypa__OUe7P Amount Slow direclioo and distance in miles linen a1 Icast
12. CASING: Wall Thickness hvo Stale Roads or Comity Roads. Include Ills road
Depll UI m•Icr or WeighiTt. Material numbers and common road names.
Lnnn_Q -fu_y�.__ IC� 5�27-1 i-•_�-
I rum-____ I°_-_--_ I'(. _
I Joni To ___ 1:1. _
I7. (NO M I . ncpnl NnIe1'ial --- Moll o l
Iloln Q, Tn r�C7_ II C�-n��1 j _ j�17 S
Ilool -7�0.. fo 3/(.7 fl Cu 7i_v,7_5 _ -CZA- vij N o
14 SCRI 1 N: Dcplh Di.uncicr Slul S17c r� AI uc1'al 3
a C)
in. o�
I5. SANW(WAV11- I'M K:
Dc1,111 SI]C nl alcrial
I will
I nml -.-----.fo--- -- I.1 ----- - - -- �. ti�
_.__.._-- ------- ----- ---- -- r^
IG. KI MARKS: _
r lr)M I II'R_I Ill ( IT I LANWARM,
51\F.f LI.1V S(pNSIIiUCII:D INACCORUANCG 1VI111 ISA N(-AC'2C,1\1:1.1
15 IiA A OPY OF IIIIS I( ' ' )RD HAS BITN PROVIDEDIO ME WHI,OWNER
1",• _ -ItG UI I'GIt (" "1I ucliNG III[ 1\'GL.SnlnfGRit 111irlimlu a N"tiler Secliau, 1(et(r Mail Ser\ice('elver- 10104h,NC
IhinJlldacs. MV-I REV 0717,001

262365
WELL CONSTRUCTION RECORD
North Carolina-Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section
�,,/
WELL CONTRACTOR(INDIVIDUAL)NAME (print? Mm'l � . ( Ar) 1 �SW CERTIFICATION AEI
WELL CONTRACTOR COMPANY NAME^///i//P!�./Jr� i ) PRONE p ( A SC�7=2nFJ}
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(ifapplicable) (if applicable)
1. WELL USE(Check Applicable Box): Residential al--Municipal/Public Cl Industrial ❑ Agricultural❑
Monitoring❑ Recovery ❑ Heat Pump Water Injection❑ Other❑ If Other,List Use
2. WELL LOCATION: Topographic/Land setting
NnearestTown: �County 10 ❑Ridge ❑Slope Malley ❑Flat
��/np/ ✓�� _ F/Y �1 Cn (check appropriate box)
(s Name,Numbers,Community,Subdivision,Lot No.,Zip Code) Latitudeflongitude of well location
3. OWNER: �(�_{'�lt S f�tfl (degn:n/minutestsewnds)
Address 51)4n jccJzlcg- (Yi yS Myna Latitudeflongitude source:❑GPS❑Topographic map
(Street or Route No.) (check box)
mQs l O � W ohm p(o DEPTH DRILLING LOG
City or Town State Zip Code 177n To rm tion Description
�)- 'Q/ —
Am code-Phone number
4. DATE DRILLED 3-lS-Dot /-2�i
5. TOTALDEPTH: /025'
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO E3'
7. STATIC WATER LEVEL Below Top of Casing: FT.
(Use"+"if Above Top of Casing)
8. TOP OF CASING IS _f FT.Above Land Surface*
*Top of casing terminated allor below land surface requires a
variance In accordance with TSA NCAC 2C.0118.
9. YIELD(gpm): 50 METHOD OF TEST_ — —
10.WATER ZONES(depth):
LOCATION SKETCH
11. DISINFECTION:Type Amount .S 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 I2 To—LCL Ft.
0
From To Ft_
From To Ft. o
13. GROUT: Depth Material Method —t _
From_Q_To_2i2-L Ft.
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15, SAND/GRAVEL PACK: W
Depth Sin Material
From To Ft.
From To Ft.
16. REMARKS:
S WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
Da
THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
NATURE OF PERSON CONSTRUCTING THE WELL DATE
ivisi n of Water Quality,Groundwater Section,1636 Mail Service Center-Raleigh,NC
3-32 1,within 30 days. GW-1 REV.07/2001
ASHEVILLE REGILiNAL OFFICE

262363
WELL CONSTRUCTION RECORD
North Carolina-Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section
��
WELL CONTRACTOR(INDIVIDUAL)NAME (print)J CERTIFICATION 0AZZL
WELL CONTRACTOR COMPANY NAME P/�Q�� f1 �j r✓/T PHONE fl 1`6�Efl FS37-- F1
STATE WELL CONSTRUCTION PERMITN ASSOCIATED WQ PERMITN
if applicable) (if applicable)
1. WELL USE(Check Applicable Box):Residential Qv-Municipal/Public❑ Industrial❑ Agricultural❑
Monitoring❑ Recovery ❑ Heat Pump Water Injection❑ Other❑ If Other,List Use
2. WELL LOCATION: Topographic/Land setting
Nearest Town: I Countyo ❑Ridge ❑Slope ❑Valley []Flat
77 & (1 (cb—k appropriate box)
(Street-Name,Numbers,Community,Subdivision,Lot No.,Zip Code) Latitude/longitude of well location
3. OWNER: Ptiro ]tpe L ueIP ksex (degrea/minutealseconds)
Address �?n PA>( UA,u Latitude/longitude source:❑GPS❑Topographic map
1 1 11 t (� (Street or , No.) (check box)
t r�'RQOI D DEPTH DRILLING LOG
Cityor Totate Zip code From To ormation Description
C--J- 0 _ /0 r
Am code-Phone number
4. DATE DRILLED -
5. TOTAL DEPTH:
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO ❑
7. STATIC WATER LEVEL Below Top of Casing: &DO FT.
(Use"+"if Above Top of Casing)
8. TOP OF CASING IS�_FT.Above Land Surface•
-Top of casing terminated attor below land surface requires a
variance In accordance with/SA NCAC 2C.0118.
9. YIELD(gpm):/—METHOD OF TEST_
10.WATER ZONES(depth):
LOCATION SKETCH
11. DISINFECTION:Type Amount 5 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. o
From-6—TO 2D Ft. 6p ?!2 .In[a� nv� I,JCD
From To Ft.
From To Ft. _
13. GROUT: Depth Ma fin / Method
Fromm To 2A L Ft. /o n/
From To Ft. -_-
14. SCREEN: Depth Diameter Slot Sim Material
From To Ft. in. in. ;-
From To Ft. in. in. c�
o�
15. SAND/GRAVEL PACK:
Depth Sim Material
From To Ft.
From To Ft.
16. REFMMARKS:
LL
O H C T Iy tJJST 1 WELL WAS THAT A COPY OFTHIS RECORD EE ORD HAS BEEN PROVIDED TO THE WECE WITH 15ANCAC 2C,LL OWNER
ATURE OF.PERSON CONSTRUCTING THE WELL DATE
S bmit the or igiaal to the ivisi of Water Quality,Groundwater Section,1636 Mail Service Center-Raleigh,NC
2 1 iJ4®E0P141PD33-322 ,wit:In 30 days. GW-1 REV. 07/2001
ASHEVILLE REGIONAL OFFICE

WELL CONSTRUCTION RECORD 262931
North Carolina-Department of Environment and N\atural Resources-Division of Water Quality-Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAME (print) 1(lt�/I Apo ,,,�y_�x� 1 IC(fll^ CERTIFICATION#<�✓Y �i
WELL CONTRACTOR COMPANY NAME p� �-�u. �' '�, PHONE # j�3 Z-, f`
J
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
I. WELL USE(Check Applicable Box):Residential 13 Municipal/Public❑ Industrial❑ Agricultural❑
Monitoring❑ Recovery ❑ Heat Pump Water Injection❑ Other❑ If Other,List Use
2. WELL LOCATI N: Topographic/Land setting
Near stTown: e County2yz'e /l,�w ❑Ridge ❑Slope ❑Valley ❑Flat
/� (check appropriate box)
(Street Nar ,Numbers,Community.Subdivision,Subdsion,Lot No,Zip code) Latitude/longitude of well location
3. OWNER:Address Jar `l C'p (degsea/minntes/sewnd+)
h) �tQr Latitudeliongitude source:❑GPS❑Topographic map
(Street or Route o.) (check box)
on r - r�� $) DEPTH DRILLING LOG
City or Town state z p code From To Formation Des ipt(on
(—) n- -2/6
Area code-Phone number v2© — ��r t•�
4. DATE DRILLED a-�5-D J
5. TOTAL DEPTH:/2 S`
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO ❑
7. STATIC WATER LEVEL Below Top of Casing: toL f• _
(Use'W'if Above Top of Casing)
8. TOP OF CASING IS FT.Above Land Surface*
-Top of cuing terminated atlor below land surface requires
Varian"In accordance with ISA NCAC 2C.0118. q
9. YIELD(gpm):�_METHOD OF TEST_/{-r 2
10.WATER ZONES(depth): LOCATION SKETCH
11. DISINFECTION:Type Amount 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 ` Ft. - `
From To_Ft. -I
From To Ft.
13. GROUT: Depth Mat al Method -
From--A2_To „2` F) ( Ft.
From To Ft.
14. SCREEN: Depth Diameter Slot Sim Material - `5 _
From To Ft. in. in. ^'
t9
From To Ft. r
15. SAND/GRAVEL PPACDepth
I
From_ To
From To _
16. REMARKS:
OUNDWATER SECTION CCORDANCE WITH 1SANCAC 2C,WELL
1 DO HEREBY CERTIFY THA THISKA141*6anmm
CONSTRUCTION STAND OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OV✓NER .
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality,Groundwater Section,1636 Mail Service Center-Raleigh,NC
27699-1636 Phone No.[phone],within 30 days. GW-I REV.07/2001

WELL CONSTRUCTION RECORD 262939
North Carolina-Department of Environment and Natural Resource -Division of Water Quality-Groundwater Section
���/�
WELL CONTRACTOR(INDIVIDUAL)NAME (print)-JOM J/ CERTIFICATION 0-2?
WELL CONTRACTOR COMPANY NAME Ael- �,Je// �iV//1� PHONE of
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
if licable ifa licable
1. WELL USE(Check Applicable Box):Residential Municipal/Public❑ Industrial❑ Agricultural❑
Monitoring❑ Recovery ❑ Heat Pump Water Injection❑ Other❑ If Other,List Use
2. WELL LOCATION: Topographic/Land setting
Nearest Town: `7t County ❑Ridge []Slope ❑Valley ❑Flat
h
l, n it r (check appropriate box)
(Sorter Name,Numbers,Community,Subdivision,Lot No.,Zip Code) LatitudeAongitude of well location
3. OWNER: %Ldl/ �/7eh t / (degreea/minutes/uwnds)
Address P ) Latitude/longitude source:❑GPS❑Topographic map -
(S Veer or Route NoJ (check box) n -
T�/e�D�t(/ J I c° o? sO GDEPTH DRILLING LOCv
City 6r Tolmn state Zip Code From TC Forma:3on DescriptI It
Arta coda Phone number
4. DATE DRILLED �-/R�,9 a
5. TOTAL DEPTH: a(2
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO P- -�
7. STATIC WATER LEVEL Below Top of Casing: 7F FT.
(Use"+"if Above Top of Casing)
8. TOP OF CASING IS FT.Above Land Surface*
-Top of casing terminated at/or below land surface requires■
variance In accordance with ISA NCAC 2C.0118. � �
9. YIELD(gpm):�—METHOD OF TEST .�
10.WATER ZONES(depth):
LOCATION SKETCH
11. DISINFECTION:Type 1 Amount .,r: 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. r -
Frortt�_To 5 Ft. (, $ ��02/ C CD
From To Ft.
From To Ft.
w
13. GROUT: Depth Material Method
From r_To 20 ' Ft.
From To FL o
14. SCREEN: Depth Diameter Slot Sim Material -
From To Ft. in. in.
cn �
From To
15. SAND/GRAVEL PAC)
Depth rtas---
From To
From To
F .
�
16. REMARKS:
;ROUi`d 0'-TER SEJ�I�iy""J
I DO HEREBY CERTIFY THl$�'(S(II�L�NAFGQ111$TkoJP D IN CCORDANCE WITH 15ANCAC 2C,WELL
CONSTRUCTION STAND HAS BEEN PROVIDED TO THE WELL OWNER
3 -1 -o
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality,Groundwater Section,1636 Mail Service Center-Raleigh,NC
27699-1636 Phone No.[phone],within 30 days. GW-1 REV.07/2001

WELL CONSTRUCTION RECORD 263018
North Carolina-Department of Environment and N`atural Resour�QJes-Division of Water Quality-Groundwater Section/^//
WELL CONTRACTOR(INDIVIDUAL)NAME (print) , 11 F1 1Q-S /\l to:
f Son CERTIFICATION M�7
WELL CONTRACTOR COMPANY NAME„ �i��P_.E� L//'���CY/i��nA PHONE p
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) � (if applicable)
/
I. WELL USE(Check Applicable Box): Residential M Municipal/Public❑ Industrial❑ Agricultural❑
Monitoring❑ Recovery ❑ Heat Pump Water Injection❑ Other❑ If Other,List Use
2. WELL LOCATJW. , Topographic/Land setting
Nearest Town: County P .10-10 ❑Ridge ❑Slope Malley ❑Flat
/QQ Ai} -i ec (st e C�+yn-y:'t.- (check appropriate box)
(Street ame,/N,unumbeers,Community,,Subdiviisio�n,Lot No.,Zip Code) Latitudellongitude of well location
3. OWNER: ,,V /"/�. Y� (degrees/minutes/seconds)
Address - O�_ Latitude/Iongitude source:❑GPS❑Topographic map
_ (Street or Route No.) � 7� (check box)
l a4lgn A/. 33 DEPTH DRILLING LOG
ct or Town sae zip Code From To Fo tion Description
Area code-Phone number 1
4. DATE DRILLED �-/u- A,1
5. TOTAL DEPTH: 4.25 1,
6, DOES WELL REPLACE EXISTING WELL? YES ❑ NO ❑ 77,-
7. STATIC WATER LEVEL Below Top of Casing: 4-40 '_FT.
(Use"+"if Above Top of Casing) t -
8. TOP OF CASING IS / FT.Above Land Surface*
-Top of casing terminated atfor below land surface requires■
variance In accordance with 15A NCAC 2C.0118. - -- -
9. YIELD(gpm): ,, METHOD OF TEST
10. WATER ZONES(depth):
LOCATION SKETCH
11. DISINFECTION:Type Amount S Show direction and distance in miles from at IRA =--
12. CASING: Wall Thickness two State Roads or County Roads.Include theTo ad
Depth Diameter or Weight/Ft. Material numbers and common road names. r•
From To Ft. dkL
_ ZD
Fro:^. To Ft. c� -
From To Ft.
13. GROUT: Depth Mat Method o -
From_�To �i�r Ft._7— 9rrfFrom To Ft.
14. SCREEN: Depth Diameter Slot Size Material -
From To Ft. in. in.
From To Ft. in. in. _-
15. SAND/GRAVEL PACK: CJ
Depth Size Material —
From To Ft. =
From To Ft.
16. REMARKS: o.n
I DO HEREBY CERTIFY THAT THIS WELL WAS CON& D RJ ACCORDANCE WI I NCAC 2C,WELL
CONSTRUCTION STANDARDS,AND THAT A COPY 01(i� 'RECORD HAS BEEN PRO i TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
i zcz:c ,;iQN
Submit the original to the Division of Water Quality,-GrgGZid3ydtet Sections'1.63iilYfbl Se ce Center-Raleigh,NC
27699-1636 Phone No.[phone],within 30 days. GW-I REV.07/2001

WELL CONSTRUCTION RECORD 251167
North Carolina-Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section A
WELL CONTRACTOR(INDIVIDUAL)NAME (print) M�s 'CMS CERTIFICATION#0 _b
WELL CONTRACTOR COMPANY NAME � A-' WLt-.�.. , PHONE # )��-�J�s�
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
if a livable 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 LO own:
O is T e Mope V setting
NF rest own: un Midge lope ❑Valley ❑Flat
(check appropriate box)
is No rs,Coca miry,s bdi 'lion, t No.,Zip Code) Latitude/longitude of well location
3. OWNE (degrees/minuteslseeonds)
res s Latitude/longitude source:❑GPS❑Topographic map
(Street or t N0. (check box)
DEPTH DRILLING LOG
yCity or Town _ S Zip Code From To , Formati i Desc i tion
.L d is
Area coda Phone number
4. DATE DRILLEDT2D S`
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 ' FT.Above Land Surface*
-Top of casing terminated atlor below land surface requires a.
variance in accordsme Twiith 15A NCAC 2C.0118.
9. YIELD(gpm):�M$r�14�OF TEST
10.WATER ZONES(depth): + l
LOCATION SKETCH
11. DISINFECTION:Type Amount Show direction and distance in miles from at least
12. CASING: �tpe Wall Thickness two State Roads or County Roads.Include the road
To FL / �r o Wn teG numbers and common road names.
From
From To Ft. 7CD
From To Ft.13. GROUT' DepthFrom b ToFrom De Ft.14. SCREEN: Depth Diameter Slot Siu Material From To Ft. in. in.From To Ft. in. in.15. SAND/GRAVEL PACK:Depth Size MaterialFromTo Ft.FromFt•
16. REMARKS: z
.. ma
F , T THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WEIel,
D L C®NS U S,AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TOT L OWN Z
_ � as
+' SIGNATURE OF PERSON CONSTRUCTING THE WELL A
Submit the origift"the ivision of Water Quality,Groundwater Section,1636 Mail Service Center-Raleigh,NC
GRg2690W636(�16�iie'1 ((919)7 3-3221,within 30 days. GW-1 REV.07/2001
ASHEVILLE REGIONAL OFFICE

WELL CONSTRUCTION RECORD 251178
North Carolina-Department of Environment and Natural Resources-Division of�yWater Quality-Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAMEE((^print) �( Y��C `S �L-,r am:-1"1 t`tS , CERTIFICcAyTIION
�`1 CGI\f2#�p�1 y�
WELL CONTRACTOR COMPANY NAME ` w •� \ � UL( KL I -PHONE # IrdU `7D 1 9(�
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
if a licable ifapplicable)
1. WELL USE(Check Applicable Box):Residential Municipal/Public❑ Industrial❑ Agricultural❑
Monitoring❑ Recovery ❑ Heat Pump Water Injection❑ Other❑ If Other,List Use
2. WELL LO /Topographic/Land setting
restT wn: t� Coun QRidge []Slope ❑Valley []Flat
(check appropriate box)
(Street Nam umbers, m mnity,Subdi ' on,Lot ip Code) Latitude/longitude of well location
3. OWNER: (degreedminutcalseconds)
Address Latitudellongitude source:❑GPSOTopographic map
(Street or u No.) (checkbox)
DDEPTH DRILLING LOG
C,ity S Dbg Zip Code From To I Fo on Description
Area code-Phone number l\ D
4. DATE DRILLED
5. TOTAL DEPTH:
6. DOES WELL REPLACE EXISTING WELL? YES O NO
7. STATIC WATER LEVEL Below Top of Casing:_`AFT.
(Use"+"if Above Top of Casing)
8. TOP OF CASING IS 1 FT.Above Land Surface'
'Top of cuing terminated atlor below land surface requires a
variance In acmrdar a with I5A NCAC 2C.0118. y
9. YIELD(gpm):10 METHOD OF TEST
10.WATER ZONES(depth): `ot D t T OCATION SKETCH
11. DISINFECTION:Type Amount Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads.Include the road
/� Depth Ilrer r,Weii t.--�MM�at numbers and ommon road names.
Frorn_L —To�Ft. 6/qir �+ •`P r
From To Ft.
From To Ft.
13. GROUT: Dep Ma al Method �'•`•"""
From To �0 Ft.
From To Ft- l ht
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. _ in.
15. SAND/GRAVEL PACK:
Depth Size Material b
From To Ft. n N o
From To Ft.
�1 cn
r (16. rn
(REMARKS:(�, N orn
D Ls tVOJEIt� VC ILfr N �m
B E T THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL >o
--CpFSiRtlC'pI S,�r THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE L I o
tn2
u
I - SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
t y
N p
GR0 to th Division of Water Quality,Groundwater Section,1636 Mail Service Center-Raleigh,NC
z
ASHEVIL29§"EOR* (919 733-3221,within 30 days. GW-1 REV.07/2001

WELL CONSTRUCTION RECORD 250471
North CIuoI ma - Department of Environment and Natural Resources - Division of Water Quality-Groundwater Section
��/ [
\CI:I.1.C'(IS'IR,\C7(112(INI)1%11)LIAI,)NANIE (print) 1 h .)C• PALS CERTIFICATION p_1]5c:-J
\\FIT,(ON I R,kCI Olt CON11I NAME I\ irk L -c 1I J�F�t vc PHONE a Bid) 33 tS�C1�
ST,\lli\CELL CONS'1 Rl'C1lON 1'F.Ral l'Lp ASSOCIATED\CQ PERMIT#
(it applicable) (if applicable)
I- k('L'LL USL(Check Applicable Box): Residential Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ 1-Ical Pump Water Injection ❑ Other❑ IfOther, List Use
? WELL LOCH IION: n Topographic/Land setting
Nemcsl I own: /1I td/� 1�� Count • `_ �tel::.:�ef
Y ❑Ridge ❑Slope ❑Valley ❑frat
LLC (check appropriale boll
(Svi //cet Nam",pumhem Cnnununity,subdivision,Lot No,Zip Code) Lalltude/longitude of well location
t. OW NI,R: 'L' �f— �.�11�)C'l� [(J. 'LS (degreeshuinweckeconds)
Address QC �z✓—C LLC:C ZL) Latlnude/longitude source:OGPS❑Topographic map
(Smc"1 it Runtu'No.) Cr (ch"ckboe)
u/�nl ✓ L ,ZD lU �� DePflu DRILLING LOG
Cdynr f ots„ Slate Zip Code From To Formation Description
Arcn a;dc I'bonc nunibcr
d. DA"fE DRILLED- �.J- 0
5. TOTAL DEPTIL A (
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO 0-
7. STATIC WATER LEVEL Below Top ofCasing: SD FT.
(Use"+"it Ahmve'rop of Casing)
K l O P OF CASING IS F"f. Above Land Surface'
'Top of casing terminated aUor belusv land surface requires a
eariaace in accmnfan a with 15;1 NC 2C.0118. n,
9. YIELD(gpm): _METHOD OF TEST /_Z
10, WATER ZONES (depth): y�
LOCATION SKEICII
1 I. DISINFECTION: "Type Amount f Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or Coun(y Roads. Include(he road
De th _ m peter or Wet• UFt. alenal numbers and common road names.
I:ron1 To���FL Z� UL
Front To FL O
IV —
From I o Ft.
z
13. GROUT. Depth Material Method -
From '� � 1
Prom=To
la. SCREEN: Depth DIm1letef slotSizc Material
'o
From To Ft, in. in.
1:1 oil1 To Ft. in. in.
15, SAND/GRAVEL PACK: -
Depth Size Material
Front to Ft. '-
Prom To FL _
'ft('Y'I i 7within31) &Us.
AS CONSTRUCTED IN ACCORDANCE WI Fit 15A NCAC 2C, WELL
E CC,
TR U(C'IIONS TAND It COPY 0171 HIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
JUN 2 6 'L"D2
Il� t_- l( NSfI(UC"LING TIIE WELL DA hE
c S 1 1 N c Ui r ualil ',Grot ndwa(er Section, 1636 Mail Service Center- RaleiVh,NC
aldpQ >
-�-tfr~)y-h(rtF-1�11 Pn� _ 3??i, GW-I REV_07/2001

250120
WELL CONSTRUCTION RECORD
North Carolina- Dcparintent of Environment and Natural Resources- Division of Water Quality- Groundwater Section
�
w FI.I.(SON"I It.Wl Olt ON'DI%'IDUAL)NAME ((print) 1 M"cl�� -� i;r.i C' `1 CERI"IFICAT10NN#
w'F.1.I.CON"IItACTO It CONI PAN1'NANI F, c— �C/'iU KE' P ^%� PIIONE # (TA;M ff S7 -U4
t k.)'�'
SI-AT f;%%ITT,('ONS'I RU("IION PERNI IT# ASSOCIATED\PQ PERNIIT#
lira%%licablc) (if applicable)
I. WLI_L USE(Check Applicable Box): Residential 9 Municipal/Public ❑ Industrial ❑ Agricultural ❑
slonituring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other❑ If Other, List Use
2. WELL LOCATION: pographic/Land setting
Nemcs(To_wn: 'I1 qtZj)1C'/ Counll t?120 OaRedge ❑Slope Malley ❑Flat
&u IA I 1- "I.Ili e (IL_1, 14� po Lv4-)r (check appropriate box)
(Svcct Name Num hers,Comnumity,$uhdivisou,.Lot N%-, 'p Cole) Latitude/longitude of well location
%
3. OWNER: a",it, Cue)L �67-1 HILL) (degrees/minutes/secon(ls)
Address SL.S e-,•.J Ayitt. n Latitude/longitude source:❑GPS❑Topographic map
j� tSto,o or Itoule No.) (check hox)
1)t~ISS_T". -, !L Z) OC1U � DEPTH DRILLING LOG
C'i ty or To%sn Smte Zip Code F in To Formation Description
A ren enJe-Phone numher _72 S �/ej-G
4. DATE DRILLED J — tip' D Z
5. TOTAL DEPTH: J oS •
6. DOES WELL REPLACE EXIS"LING WELL? YES ❑ NO 0-
7. ST'AIIC. WATER LEVEL Below Top of Casing:P FT.
(Use"+" f Ab(ye Top of Casing)
S. "1"0I3 OF CASING IS FT. Above Land Surface"
'Tap of eaing termivated at/or belmv hand surface requires a
variance in accordance%%fill 15A NC\C 2C.0118.
9. YIELD(gpm): 10 METHOD OI'TESTA
10. WATER ZONES (depth): 2 D O' 2L Yo,
LOCATION SKEI C1I
11, DISINFECTION: Type Amount Gv Sliow(lirection and distance in miles from al Ic;isl
12. CASING: Wall"Ihickness two Stale Roads or County Roads. Include (he road
Depth Diameter or aterial numbers and common road names.
From 0 ToLS0' Ft. 6-;;T S/A
Front To Ft.
From To Ft. -
13, GROUT: Depth Material 1 Method o =
From_To 10 ' FL C�-t n+w✓• -
Ftom 'LJ9 To Ft_ a
Id_ SCREEN: Depth Diameter Slot Size Materia — _ I -
r-=
From To _ Ft. in. in. t W
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size hlalerial ��� �� tV r-�_..
c
From To EL fV -
From "fo Pt. W o
GROUNDWATER SECiI"i! I _
16. REMARKS: ASH
I DO I IERFUY(FRTIFY TIIAT IIIIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCT ION STANDARDS,AND THAT A COPY OF THIS RECORD ITAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OI'PERSON CONSIRUCTING THE WELL DATE
Submit the original In the Division of Water Quality,Groundwater Section, 1636 Mail Service Center- Raleigh,NC
27699-1636 Phone Nu.[phone],%%ithin 30 da%'s. GW-I REV. 07/2001

WELL CONSTRUCTION RECORD 250119
North Carolina - Department of Environment and Natural Resources- Division of Water Quality-Groundwater Sectio-- ((n��
w'EI.I.(ON-I ItAC'"1'O R(IN D 11'1 D UA I.) U)NAME ((Prinn 51m,lxv .\ "JLS CERTIFICATION W�n �'S
w ELI.CON r RA( IOR COMPANY NAME l j►--Ro KLE Wf=1-1- PHONEaL'S�)y
SI-All:\\FLL C'ONSI'RUCI'ION PERNIM ASSOCIATED WQ PERNI(TH
(if applicable) �� (if applicable)
I. WELL US[--' (Check Applicable Box): Residential 14Y Municipal/Public ❑ Industrial ❑ Aerieullural ❑
Monitoring❑ Recovery ❑ heal Pump Water Injection ❑ Other❑ If Other, List Use
2, WELL LOCATION: 1• Topograp>ic/Land setting
Nearest Town: .")I �� County 7C�(�-i=KCE- ❑Ridge Dope ❑Valley ❑Flat
(-,14 4 F 14R/ \ 1(\_�7 (check approp,mic box)
(Street Name.Nooduh,Cmnnumity,Subdivision,Lot No.,Zip Code) Latitude/longitude of well location
3. OWNER: .y ,e ° qN/11/''T J (degreesAninutcs/sceonds)
Address -O 12(7X i'nr r K Latitude/longitude source:❑GPS❑Topographic map
(Urel or Roidc No.� //'' (check box)
41l.f��(.\-,� ��L ,� l�j DEPTEI DRILLING LOG
City or"rossn Slate Zip Code From To Formation De. tion
Area code-Phone in mbec�'
d. DATE DRILLEO�.I -S
5. TOTAL DEPTH: lob
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STAI IC WATER LEVEL Below Top ofCasing: ,r0_FT.
(Use '+'•it Above'Fop of Casing)
8. TOP OP CASING IS_� FT. Above Land Surface"
'Top of casing terminated at/or helu,v land surface m luires a
variance in accordance with ISA NCAC 2C.01 18. '
9. YIELD(gpm): 5-°ME
THODO TEST —
10, WATER ZONES(dcpth): o ' /�U• /�o '
LOCATION SKETCI-1
11. DISINFECTION: "Type A... unl C ll Show direction and distance in miles from al (cast
12. CASING: Wall Thickness two Slate Roads or County Roads. Include (he road
Depth Dian •ter or We�t yghVF(. Matcnrd numbers and common road names.
From 'Fogy Ft.
Front To IF
O -
Froln_ To Ft. fV
13. GROUT: Depth ,Materia Method
From_To 0 Z. IF f _-
From' o To-„j� Ft._ f -
Id. SCREEN: Depth Diameter -FrulSize Material
Front To _ P(, in. in. .::.
Front _To
15. SAND/GRAVEL PACK: N n_`
Depth Size Materi W
I fV `'
Prom To Ft. i
o
From Tn_ FL J U N,
16. REMARKS:
GROUNDWATER
I DO IILPF.BY CERIIFYTIIA"TTHIS WELL WAS CONST V 14116E WITH 15A CAC 2C, WELL
CONSTRUCI IONS I ANDARDS, AND THAT A COPY Oh 1 HIS RECORD HAS BEEN PROVIDED-TO THE WELL OWNER
J- 2s - 02
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit (be(it b,inal ill the Division of Water Quality,Groundwater Section, 1636 Mail Service Center-Raleigh,NC
27699-1636 Phone No.[phone],wi(hin 30 days. GW-I REV. 07/2001

249710
WELL CONSTRUCTION RECORD
North Catalina - Department of Environment and Natural Resources- Division of Water Quality-Groundwater Section
\\'F.LL(ON"I RAC I Olt(INDIVI DUAL) (prinl) SJ_J-ryk�l C)�C�S CERIIFICAIIONk�p6S
\\'F.LLC.'UR'I It.\("r(1R CONII'AN\'NM1F,NAM—ECNpk � �Rl//f1 PHONE HLtrB 7=0ONO�
S'['A'I F IN ELL CONS"I'RUCI]ON PERMI'1'9 ASSOCLI"rED WQ PERM ITN
(if applicable) / (if applicable)
I. WELL USL(Check Applicable Box): Residential W Mtmicipal/Public ❑ Industrial ❑ Agricultural ❑
Moniloring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other❑ If Other, List Use
2. WELL LOCATION: / Topographic/Land setting
Nearest Town: !11N t/ CountyRO/�ep— ORidge ❑Slope ❑Valley EFhlt
_ to -C AV 11 t IZ Ep_L (check appropriate box)
($trot Nnmc,Numhcre,CC(.nunun ity,Subdivision,Lnt No..Zip Code) Tait l rtd C/longs l tide of well location
3. OWNER: A 4A, © I LOLL.
(degreeshuinutes/secon(Is)
Address . 6;'A �• p JP zc�(� Latilude/longi(ude source:❑G PS❑Topographi c map
(Street or Rome No.) e? (check box)
)c �0 70G DEPTH DRILLING LOG
Chyor- own glate Zip Code From To Formation Description
(� �,- 57-- 72/55 0 .sue
A,rn code Phone numher
4. DATE DRILLED—/Y� 1.
5. TO"FAL DEPTH: SVO-5-'
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO El'
7. SfA"FIC WATER LEVEL Below Top of Casing: t'f ' I
(Use"+-if Above Top of Casing)
8. TOP OF CASING IS FT. Above Land Surface*
'Tay of rasing terminated at/or below land surface requires a py�
variance in accordauce,vitb 15A NCAC 2C.0118. I to
9. YIELD(gpm): METHOD OF TEST�' C:)
r�a
10. WATER ZONES(depth):_.2 C t21 --
LOCATION SKETCH O _o
11. DISINPfiC1lON: Type �l Amount G t/ Show direction and distance in miles Goal at (east
12. CASING: Wall Thickness two State Roads or County Roads. Include (lie road
Depth Diam ter or Wei'1 t/F(. Material numbers and common road names.
From_(To 1�0 1'LD A)kU C
From To 11
From, To Ft.
13. GROUT: Depth ,, Material Mellott
Fromm To 0 PL rrus
Front_-,O To fa' Ft.s _
14. SCRHF.N: Depth Diameter ize Material
From To FL in. in. _
Front "Ib H.—in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
1710111 To F(.
From To FI.
16. REMARKS:
lS WELL WAS
ED IN ACCORDANCE WITH 15A NCAC 2C,WELL
FD
Fq,NSI,l 1�L U�TI TN§AI INO THAT A COO OF THSTRECOU HAS BEEN PROVIDED O THE WELL OWNER
� j - /Y 0z I iNATURE OF PERSON CONSTRUCTING THE WELL DATE
L
1lbnli( the on„'imtl to the Divisi m of Water Quality,Groundwater Section, 1636 Mail Service Center-Ralcigh,NC
i 6y9-16,M%{Trap-N ,� 33-32 I,within 30 clays GW-I REV. 07/2001
5� C¢ VA �

- - WELL CONSTRUCTION RECORD 1249709
North Carolina - Department of Environment and Natural Resources- Division of Water Quality-Groundwater Section
tVELL CON'I RACIDR(IN'DIVIDUAL)NAME (print /YI JEI J _->' CERTIFICATION _ 5E,5
\\'EI.LCONIltAC'IORCONII'ANVNANE 0119Davc, t 'xJ-�3 PHONE q (QX)uZ 7
S'1'A'I E\N'FI.L CONS'[RUCIION PERMIT# ASSOCIATED wQ PPERMI'rN
(if applicable) (if applicable)
I. WELL, USE (Check Applicable Box): Residential Ld' Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ fleat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION: / Topograpjfic/Land setting
Nearest'rows: �77u4 h5 County C�te[':;�e ❑Ridge ❑S1ope ❑Valley ❑Flat
on
/-IfFAM�w 7\b (check appropriate box)
[Street Name,Number''s,//Community,Subdivision,Lot No.,Zip Code) Latitude/longitude of well location
1OWNER: K0-V C1101111)'o)A V (degrees/minutes/Seconds)
Address _3i I%;eJ I_ nNe Lal itude/I ongi(tide source:❑GPS❑Topographic map
Aln,, (Street or Route No.) _ / (check box)
(Street
f.tn /5 l •/ /l C —') `/(fit;, DEI''1'l I DRILLING LOG
City or T� Slot, Zip Codc Ft nl To Formalion Description
Area code-Phone mmtbe55
4. DATE DR IL___
5. TOTAL DEPTH:
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO ❑—"
7. STATIC WATER LEVEL Below Top of Casing: -SO ' FT.
(Use"+"if Above Top of Casing)
8. 'I OP 01:CASING IS FT. Above Land Surface'
'Top of casing termitrated at/or below land surface requires a
rari:mce in accord" cc with ISA NCAC 2C.OI IR.
9. YIELD(gp71 . METHOD OF TEST� '
10. WATER ZONES( cplh):,3/0 t
LOCATION SKETCH
11. DISINFECIION:'I'ype Amount 7- r-11f 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 Wet LhUFt. h�jlertal numbers and common road names.
From To //D Ft. ti!J I'L7 v�- fV
Front "I Pl.
From To Ft. �o c---
13. GROU"1-: Depth Material Method
From 0 To
14. SCREEN: Depth Dmoneter Slot Size Material
Prom To Ft. in. in. o r'g-_
c,
From To Ft. in. in. —
15. SAND/GRAVEL PACK: �=
Depth Size Material
From I o Ft.
From To Ft.
16. REMARKS:
I,QO BF.12F,13Y QERTlhr'..T HS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
C(`ONS'fkU ND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
I NATURE OF PERSON STRUCTING'fHE WELL DATE
Ll L, ubmit th 'Lt' •_(('�� Avisi n of Water Quality,Groundwater Section, 1636 Mail Service Center-Raleigh,NC
MMI L6`yll�'})A '1 L_l U-V3-32 I,within 30 days. G W-I REV. 07/2001
ASHEVI'',LE REP�.�.a.�

WELL CONSTRUCTION RECORD 249708
North Carolina- Department of Environment and Natural Resources- Divisionof Water Quality-Groundwater Section
��
%IELI,CONr RAC I.Oil(INDIVIDUAL)NAMES ((prior) I, �)I Alln v)O rdC, S CERTIFICATIONq S
NN'F.LL CONE RAC'I'Olt COMPANY NAME ( �xeeokF'C-' If k'11 )P- I'j PIIONE q fu1{)1 2_yLXx?
Sl,\'rt:w'ICi,I.CONS'IIZUCIION I'ERh11'I"N ASSOCIA'I ED%VQ PERhlll"p
(if applicablc) (ifapplicable)
I. WELL USE (Check Applicable Box): Residential 0-/Municipal/Public ❑ Indus(rial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other❑ If Olhcr, List Use
2. WELL LOCATION: II Topographic/Land setting
Neatest Tov,ti 1)4f/�jyltz_ County .�aN�'c'.Kee ❑Ridge ❑Slope ❑Valley QFI'at
.�iA fZ�P Il i I�1-J (check appropriate box)
(Street Name,Numbers,Gnnmmnity,Subdivision,Lot No.,Zip Code) Latitude/longitude of well location
3. GWNER: IC R 1 S 4 r 11/T- (degrees/minutes/seconds)
Addi ess (AJI+t hI J(— E) I LL 1 R Latitude/longitude source:❑GPS❑Topographic map
(Street or lioute No.) G (check box)
��� UR{���/ ti C_ � 0 DEPTH DRILLING LOG
city or "owrS Stare Zip Code From 'fo Formation Description
7 o
Area code-Phone number p
4. DATE DRILLED.'" ')--i ' Z
5. TOTAL DEPTH: (0 0.5_
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO CY
7. STATIC WATER LEVEL Below Top of Casing: , S_ FT.
(Use"+"if Above Top of Casing)
8. TOP OF CASING IS FT. Above Land Surface'
•Tap of casing terminated at/or below land surface requires a
rariauce In accordance with 15A NCAC 2C.0118.
9. YIELD(epm): I METHOD OF TEST
10. WATER ZONES(depth):
LOCATION SKETCH
11, DISINFECTION:Type Amount b C-00 Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads. Include the road
Depth Damctcr or WeighUR. Material numbers and common road names.
h10111 Tod FL SQ� 21 c�
From To Ft, 0
From To FL
13. GROUT: Depth Material Method
From 0 To �O _PL
Fronk To Ft. :Il -
14. SCREEN: Depth Diameter Slot Size Materinl
From 'to Ft. in. in. =
From To Ft. in. in.
15. SAND/GRAVEL PACK: .._
Depth Size Material CD c
Front To Pt.
L
Fronk l2h Ft.
�+ 16. REMARKS:
kREY�El6''E THrS
1 IS Wl WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
IVI 12U> 18WS JND1ll1LA�T A COPY OF THIS RECORD HAS BEEN PROVIDED 7 0 THE WELL OWNER
}'
l
1 I' I§I NAT E OF PERSON CONSTRUCl'ING THE WELL DATE
Di
'is on of Wafer Quality,Groundwater Section, 1636 Mail Service Center-Raleigh,NC
tc ���� J3-32 t,within 30days. GW-I REV. 07/2001

24970i
WELL CONSTRUCTION RECORD
North Carolina- Department of Environment and Natural Resources- Division of Water Quality-Groundwater Section
������ [
\Yrl.l-CO.N1RAC'I'Olt(INDIVIDUAL)NAME (print) )I "I o'J LS CERTIFICATION#�.�Y�_J
w'ELL CON"I-RAC"r Olt COMrANVNAME CHERo10El, WILL .I�(-ZI L,LI��r PIIONE # (J2'&4i37"S
SIA'I F, %l VIA,CON'Sr RUCTION PERMIT# ASSOCIATED WQ PERMrr#
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential V/Municipal/Public ❑ Industrial ❑ Agricultural ❑
Moniloring❑ Recovery ❑ Ileaf pump Water Injection ❑ Other❑ If Other, List Use
2. WELL LOCATION: Topographic/Land setting
Nearest Town: "JARI;LE County CNCRu KEE ❑Ridge ❑Sloe ❑Valle
p Y pFfat
f� b ^
fib (check appropriate box)
(Street Name Numbers,C nnmunily,Subdivision,Lot No.,Zip Code) La(itude/longilude of well location
3. OWNER: ?RUCP L-e (degrees/minutes/seconds)
Address 3,) Ctu� /Z�
ee Latilude/longilude source:❑GPS❑Topographic map
(Street or Route o.) (check box)
DEPTH DRILLING LOG
Cityor"town State Zip Code From To Formation Descriptinn
Area code-Phone numh
4. DATE URILLED 3— / ) `0 2-
5. TOTAL DEPTH: / V,5-'
G. DOES WELL REPLACE EXISTING WELL? YES ❑ NO E�—
7. STA'IIC WATER LEVEL Below Top ofCasing: '1,o, FT.
(Use"+"i f Above'rop of Casing)
S. TOP OF CASING IS_�FT. Above Land Surface*
'Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C.01 IA.
9. YIELD(gpm): 2.D METHOD OF TEST '
10. WATER ZONES(depth): 8
LOCATION SKETCH.
11. DISINFECTION:Type 1 Amount ). C.J Show direction and distance in miles from at least
12. CASING: Wall thickness two Slate Roads or County Roads. Include the road
Depth Dianuter or Weight/Fl. K41crial numbers and common road names.
From To 7J FLU .0 21 v/ o -_
From To Ft.
Front To FL -
13. GROUT: Dcpth Material Method
From O To Ft.
Front '2.� To 70• Fl.
Id. SCRFFN: Deldh Diameter lot Sizc Material
J t:
From fo Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK: O o
Depth Size Material
From To Ft.
From To 1:1
IG. REMARKS:
7S�ITEREB j, l 1', 7 VELI,WAS CONSTRUCTED IN ACCORDANCE WITII 15A NCAC 2C,WELL
N'STRUCIIf 'S7AM�A THAT A COPY F THIS 'CORD HAS BEEN PROVIDED TO THE WELL OWNER
—mot
F}. I A TUBE OF Pl1 N C NS RUCTING THE WELL DATE
Sul mit the ors inal to the Di ision of Water Quality,Groundwater Section, 1636 Mail Service Center-Raleigh,NC
2769$4611J)UWAit N)S@109DCW3-3221 ni(hin 30 days. GW-I REV. 07/2001
ASH, ViLLE RFGIONAL OFFICE

WELL CONSTRUCTION RECORD ti `� I
Not Carolina - Depart men( of Environment and Natural Resources- Division of Water Quality-Groundwater Section
tt'I'.LL COCIIt,\Cli)li(IN Ui\'IDII,\IJ NAP7 F. (phint),, ., 17M m�V rJ� 1 S CERTIFICA10NN 9p�
U'I.I.1.CO.\I IZ.%CTOif(:ONII'AN)'NAME_C_1i02 FAD( a7e_ /L(3C// / _PHONE N Ii FLi37—�(��
S'i,%f1C kN EI.I.CO.NS'I RCC"IION I)FIINII"IN ASSOClA'I'ED%\Q PER:xll'1'N
(if applicable) (if ap)licable)
I. WELL USE (Check Applicable Box): ResicientialvMunicipal/Public ❑ Industrial ❑ Agricultural ❑
Manikning❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ IfOther, List Use
2. WELL LOCATION: �n1 [ Topographic/Land settingg
Nearest Town: I/ W,2 ki /�� d I`\Count}' `�160PD /E9_ ❑Ridge ❑Slope ❑Valley � 1:t
1t�ao4e- IZOT✓ (checkappn;primebox)
(Street Name,Numbca,Community,Subdivision,Lot/Now.,Zip Code) . Latitude/longitude of well location
3. OWNER- ��4^I40-0 �/WMP T YOU�/ iPIp, (degrmfolinweS/se m n(IS)
,f AddreSS � ,4L_V_6P , P_Q 1 b Latitude/longitude source:❑GPS❑Topographic map
(Street or Route No.) (check Eon)
"iC -� 8�O(r, DEPTH DRILLING LOG
Chyor loran Swm Zip Code Fronl To Formation Description
(�8)- 'W�Z- moo- 0 _So' c vG
A,ea cod,-Ploo,nwnhcr r� fx
4. DATE DRILLED fit'-13 ­0�
5. "I OTAL DEFT IL6s- r
G. DOES WIELL REPLACE EXISTING WELL? YES ❑ NO 61_^
7. S T ATIC WATER LEVEL Below Top of Casing: SO FT.
(Use"+"if Ahnve'fop of C'asiug)
S. TOP OF CASING IS_ FT. Above land Surface'
*I op of easing lerminated at/or belnn'land surface requires a
variance in accord:mce nith 15A NCAC 2C.0118.
9. YIELD (gpm): _ METHOD OF TEST
10. WATER ZONES(depth): (,—,(')17 061---
LOCATION SKETCH
11. DISINFECTION: Type '-A_u4A2 Amount cup Show direction and distance in miles front at least
12. CASING: Will-Thickness two Slate Roads or County Roads. Include the road
Depth Diameter or Weight/Ft. Material ❑umbers and common road names.
From To so FL C Y ,I -Sw7J ✓L
From -fo F( - c�
Front To Ft.
13. GROU- : Depth �Ialcrial Method
From To_� FL �(✓ICrJ L ✓/7 r-'"'
Prom To -- p(. �%bJT7"Nq 5 I2F7vi —
14_ SCREEN: Depth Diameter Slut Size Malem _-
Front _"fo Ft, in. in. -p
Front To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material _
Front Tb H. co
I:ron1 To Ft.
1/ RENIARKO
C'
VI k E=EIt i 1 1 11tA1i 1 1 WELL WAS CONS'1 RUCTED IN ACCORDANCE WIT-1 15A NCAC 2C,WELL
��I JA NS1liUCIION SIANDAl2 THA ' 'OPY OF T'HISR "ORD IIAS BEEN PROVIDED TO'IIIE WELL OWNER1� I
SIG EOF PE,�;0N,,K,6STRUCTING1IIE WELL DAIE
Subifl4i PfiguLl }1lii) �q IA)ef s'isiol of Water Quality,Groundwater Section, 1036 Mall Service Center-Raleigh,NC
I__-,7(,')V)-F&tbI4Tmc n. 22LIvithin30d:)s. GW-I REV. 07/2001

WELL CONSTRUCTION RECORD 249461
North Carolina - Department of Environment and Natural Resources- Division of Water Quality-Groundwater Section
�/
wE LL CON"1'RACfOil(INDIVIDUAL)NAME (print) M e.e 5, CER77FICA'rION 9
WELL CON I RAC'I OR COMPANY NAME C�1 koap__ �P �' �QI_ PHONE 0 ($)B) &3 7—Y(
S'l,k'fE wF1.1.CONSTI2UC"I'ION PERdIIT# ASSOCIATED\YQ PERMI r#
of applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential t1/Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monilming ❑ Recovery ❑ Heat Pump Water Injection ❑ Other❑ If Other, List Use
2, WE'Lt. LOCATION: // Topograp /Land setting
Nearest Town: /)14/1�h CountXCjLeR )Li-_ ❑Ridge OPKrope ❑Valley ❑Flat
0 t.'MP SA P)A tll b (check appropriate box)
(Street N:nnc.Numbers,C'o.niounity.subdivision, of No_Zip Code) Latitude/longitude of well location
3. OWNER:9I IS 1L 4e.2 (JCgTCCS/n111101CS!SCC011(IS)
Address E/4;:?S nwEQS A70r22Y Latitude/longitude source:❑GPS❑Topographic map
(Sir et or Route No.) (check box)
-�19,J1Fl t_r,L� ,303� 7 DEPTH DRILLING LOG
City nr"rmvn Slat zip coJc Fr lm To" .Formatiog Description
D
I 7 Cam.
Area code-Phonc nnod,cr
4. DATE DRILLED
5. 'DOTAL DEPTH: h�
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO El-
7. S1 A'FIC WATER LEVEL Below Top of Casing:2$_FT.
(Use••+"if Above Top of Casing)
8. TOP OF CASING IS FT.Above Land Surface*
fop of cuing[crndnated at/or belunr land surface requires a
variance in accordat!e isith 15A NCAC 2C.0118. / /a
9. YIELD(gpm): 2 METHOD OF TEST J ( _(
10. WATER ZONES(depth):
LOCATION SKETCH
11, DISINFECTION: Type Amount ') (.'P Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads. Include the road
Depth D'v ter o�r\/4�'ei��ch{(�t. N teria1 mmtbers and common road names.
From 0 To '� `� R.V .�tr'�}J �CCG
From To Ft. _a
From To Ft. N
13. GROUT: Depth `� lcna Method !~-_
FLU..
Prowl To Ft. — ---__"
14. SCREEN: Dcpth Diameter slot Size Mmcrild � -_-
From 'to Ft. in. in.
From To I' in. in. --
N nT
15. SAND/GRAVEL PACK:Depth Size Size Material $'
From To 171. c
Frmn To Ft.
16. REMARKS: �1
1 -I EBY ERTI1 T�IBAFTH1 L WAS CONSTRUCTED IN ACCORDANCE WITH 15ANCAC 2C,WELL
I L txtl)AitD&-Ate TA COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
ON CONSTRUCTING THE WELL DATE
Sikillit khc_ru4girla44e the FNristtlh of N liter Quality,Groundwater Section, I636 Mail Service Center-Raleigh,NC
21(i99-IG36 i'11mtc N'o.(919)733-,1221,wiN"ii d0 days. GW-I REV. 07/2001

249468
WELL CONSTRUCTION RECORD
North Carolina- Department or Environment and Natural Resources- Division of Water Quality-Groundwater Section C,
\\'FI.LCO.Nllt,%CIOR(INDI\'IDUAL)NANIE (p� t)Lt��
riint)� "TimAt./ �0,jelS CERTIFICATION 0
wet.1.coN"runcroRCoau'nnrN.vblE_.ty_�- WALL DRILLING,- PHONE a (8A)837—&-�0$
S'I'.\"I'F,r)'I.1,L CONSI'RCCrION rF.RMITa ASSOCIA I'ED wQ PE12S11"Ia
l ifapplicable) �/� (if applicable)
I. WELL USE (Check Applicable Box): Residential Ad Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other❑ If Other, List Use
2, WELL LOCATION: Topoviohic/Land setting
Nearest'how'n: nl KPH County �l@RD� ❑Ridge IldSlope ❑Valley ❑Flat
_ he yee' Q ci- (check appropriate box)
(Strcct Nome Nuoilms,Community,Subdivision,Lot No..Zip Code) Latitude/longitude of well location
//3. OWNER:_ /iQ-�( C70"Sit)AJ (degreeshninutes/seconds)
Address / 950 B'4 P-ke- -r ),AKeS 13LVb Lalitude/longitude source:❑GPS❑Topographic map
(Street or Ronte (check box)
KeµvesS uo . /L/,/ DEPTH DRILLING LOG
C'ityor"Ibo,n Stye zip Code P and To onnation Description
(�) .21R - 1 1 93 £T '5O)I � e-7
Area node-Mnooe number
4. DATE DRILLED.?` 7 ' D �S`2
5. TOTAL DEPTH: -J--Y-5
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO ❑'
7. STATIC WATER LEVEL Below Top of Casing: `�-S' FT.
(Use"+"if Above Top of Casing)
8. 1 OP OI'CASING IS FT. Above Land Surface*
'"Ibp of casing terminated atlor below land surface requires.1
rarianee in accordance with 15A NCAC 2C.0118.
9. YIELD(gpm): 6 METHOD OF TEST
10. WATER ZONES (depth): y Rl , 1Zo0
LOCATION SKETCH
11. DISINFECTION: Type�7� Amount LV Show direction and distance in miles frontal least
12, CASING: Wall Thickness two Slate Roads or County Roads. Include the road_
Depth Diameter or Wei'ht/H. Material numbers and common road nam O es.
Fi oil, Cnn 1-0 -
3
From To FL
From -1"0 Ft' -
13. GROUT: Depth lateral Method t='_
>7
From To r C_PL
From Q-0 To l� Irl.
14, SCREEN: Depth Diameter• Slot Size Material fV 5a'
Prom 'I'0 Ft, in. in. r <'
Froin To 171. in. in. co _o
15. SAND/GRAVEL PACK: `
Depth Size Material
prom To Ft.
Front l-o Ft.
16. REMARKS:
f'"'V I I�$Rf}�1' El��i,]ITlf r4"It I IIS WELL WAS CONSTRUCTED IN ACCORDANCE WITII 15A NCAC 2C,WELL
11 I CONSpVh E�, I__$�Y.[�IY�lIA� ND THAT A COPY 01711IIS RECO(tD HAS BEEN PROVIDED 10 TIIE WELL OWNER
^ i11 I -NATURE PERSON CONSTRUCTING THE WELL DATE
ub nit the o'rr' Divis a of Water Quality,Groundwater Section, 1636 Mail Sen ice Center-Raleigh,NC
27&®Sl.d'n'iG IMnHtg l'y,6 (� �T,13-32 I,within 30 days. GW-I REV. 07/2001

249165
WELL CONSTRUCTION RECORD
Not Carolina - Department of Environment and Natural
Resources- Division of Water Quality-Groundwater Section
„'ELL CON I RACTO It(IN DIVIDUAL)NAN]E ( ant) c>IMMs Y ^1(2j CERTIFICATION# :2SGS
1v ELL CON r HA(TORcoau•nrvrrvAnle Iv PIIONE # )B
S'I',\"rf:\\'Fa.l.C'OFST ItCCI'ION I'E lint l"1"a_ ASSOCIATED WQ PERBI rra
(ifapplicaNe) -/ (ifapplicable)
I. WELL USE (Check Applicable Box): Residential M Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other❑ IfOthcr, List Use
2. WELL LOCATION: Topographic/Land setting
Nearest lomi` � AL4 �Y County 0-""e ❑Ridge I♦Kope ❑Valley ❑Flat
y [Y NE1LR (checkappropriate boxl
(Sneel None.Numbers.Community,Subdivision,Lot No.,Zip Code) Lalilud C/lOIlglludC Of WCII location
3. OWNER: Do,xly4 COnlMe, (degrees/mhmles/seconds)
Address nr7, 13ra� �Y2 Latitude/longitude source:❑GPS❑Topographic map
t Street or Rmae No.) / (check box)
_P? ah�/ /1/C_ `AC(0 G7 D1;PTH DRILLING LOG
Chy or'I ,,,1, f stte Zip Code Front To Formation Description
Area code-Phone number
4. DATE DRILLED',
5. TOTAL DEPTI1:
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO ❑-
7. STATIC WATER LEVEL Below Top of Casing: .1 s FT.
(Use"+-if Above"rop of Casing)
8. TOP OF CASING IS / FT. Above Land Surface'
"lop of,.dag Icnnianted at/.,below land surface requires a
variance in accordance with ISA NCAC 2C.0118.
9. YIELD(epm): ­3 METH
0D OF TEST
10. WATER ZONES(depth): �3 2C • _
LOCATION SKETCI-I
11. DISINFECTION: Type j-l*-17,1-Z Amount f C- Show direction and distance in miles from at (cast
12. CASING: Wall Thickness two Slate Roads or County Roads. Include the road
Depth D)'mpetcr pr Wel lifFt- Mntcrial numbers and cotnn,on road names.
Front_(- o_�c FL l" I— 1j -)/ L_I v-''
Fronl -to Ft. -
From To FI.
13, GROU"I Depth M O
�[ aterial � Method IV -_
From To i1 1:1. `.l A'KW ' --
Prom 'to Pl. � _ -
14. SCREEN: Depth Dimneter Slot Size Material a - -
Front Tb 1:1. in. in. tv -
From To Pt. in. in. --
15. SAND/GRAVEI. PACK: r--.
Depth Size Material O en
From To Ft. _ 1�
From lb Ft. F- F5
D ' ' ,''1 TAT Ti ITS WELL WAS CONSTRUCTED IN ACCORDANCE WITTI 15A NCAC 2C,WELL
CONSTRUCT ION Sl'tttttt RDS,AND THAT A COPY 01:1111S RECORD HAS BEEN PROVIDED TO ME WELL OWNER
,
SI(INAIUREOFPEI�CONS'fltUCTINGl11EWELL DATE
GROU /i{ I���. ), Liu Ilr Division of Water Quality,Groundwater Section, I636 Mail Service Center-Raleigh,NC
ASHEVIt - - A' t 733-3221,within 30 days. GW-I REV.07/2001

WELL CONSTRUCTION RECORD 249164
North Carolina - Department of Environment and Natural Resources- Division of Water Quality-Groundwater Section
%I FLL(ONII?:AC'IOlt ONDI%'IDUAL)NANIF (print) I M/VA CERTIFICAITON R e�56�S
%%EI.L CON RAC I OR(OMPAN'1 NAME '� E' �) RtIN� 1'I[ONE kGfi]_ S — (�U$
S'I A 11:U EIA.(-ONS"I RL C'I ION PERNII'I a ASSOCIAI ED WQ PERDII'I H
(i f appl icable) (if applicable)
I. WELL USE (Check Applicable Box): Residential Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Hcat Putnp Water Injection ❑ Other ❑ ICOlher, List Use
2. WELL LOCA"PION: �/�•� ���� Topographic/Land is/Land selling
Nearest Town:_ Aq y County clot ❑Ridge �e ❑Valley ❑Plat
KR4,vl, al kry D� �.o 1 q (check appropriate box)
(Sheol Natne.Num-cis.('anmumity,Subdivision,Lot No.,Zip Code) Latlt❑de/l onblt tide or well location
3. 0\VNER: kole12T' cl- e)O6,1 Shem� (degreeshoimltes/seconds)
Address —B-4 [_r Fi LLmo%ie- ff-l1E Latitude/longitude source:❑GPS❑Topographic ,,at,
Street or Route No.) (check box)
aPop__, C�7gQ4j�tg Cl. FL_ � 1K I DEP"FH DRILLING LOG
city or Tocn State Zip Code hronl o Formation Description
( ) 9R /
- �o�T t &z-i �tir.�
Arce cnnle-Phone numb r E G - �) �V/C
4. DA"fE DRILLEt
5. "10TAL DEPTI1:
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO ❑'
7. STA'I IC WATER LEVEL Below Top of Casing: Y%G' Pl".
(Use"W'if Above Top of Casing)
8. TOP OF CASING IS FT. Above Land Surfacc`
*lop of easing terminated at/or below'land surface requires a
sarimae in aceordnucte n'ith 15A NCAC 2C.0118.
9. YIELD (gpm): `1 _METHOD OF TEST
10.WATER ZONES (depth):
LOCATION SKETCH
11. DISINFEC1lON:Type Amount � Show direction and distance in miles from at least
12. CASING: Wo11 Thickness two State Roads or Courtly Roads. Include the road
Depth D6an cter or WeighVl71. Material ❑umbers and common road names.
�,L�
from To Ft _ S1 PVC
From To Pt.
from To Pt. -
13. GROU"I : Depth tabam Method O
Front G. To .Z i� FI. 1's
Prom_T To L 2 -FL
14. SCRFEN: Depth Dmmeler�Si7e Material -
From To Ft. in. in. fV
Flom 'Ib Ft. in. in. ;'
15, SAND/GRAVEL PACK: ZI
Depth Size Material p �a-
m:c
I=rom lb Pl. O
Prom_ To Pt. -171 o
z
16. REMARKS:
UIEYF tk -• - ' i THIS WELL WAS CONSIRUCFED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUC HON STANI R ,AND"I HAT A COPY 017 llHIS RECORD HAS BEEN PROVIDED TO TIIE WELL OWNER
' SIGNATUKE OP f' SON CONSTRUCTING TIIE WELL DATE
gw1UNR41M14vT5 Ffis1261le Di ision of APater Quality,Groundwater Section, 1636 Mail Service Center-Rnteigli,NC
AS '� 'r'__(( -- 3221,within 30 days. GW-I REV. 07/2001

llonh Cemllna • Department OI Utivlrnrnnnnl a,ld Ilolu(nl Ilesomcne - I,Ivlelo❑oI Wnlnr Oil ill ly -(Lvundwnlnr Seilion 262360
16361.I2;1 Service Center• I1nle1911,N.C.21699-1636 I'hono (919) 731 a221
WELL CONSTRUCIION IIECORU WIiLLColliflAU1011.
W[LL Coll IIIACIoil Cull IrICA11011
S IA"I E WELL CONSIIIIICI loll pEfllAl I n:
6lduslllal Ll Agllcullufal U IAonllofirg U
(• WELL USE (Check Appnceble oov)! no9ldvnllal IA1011vo s(-LJ II Other, Ilsl llsc:
necvvery D I teal rump Walor In)ocllon L1
2, WELL LOCAI ION: (Sho,v skelcll 011110 Ivcatlml bnloY/)
County:
Neareal lown� --�-- -
UIIILUIIGLUo U`?I11_.__
pload 113 ,e end j�nLnp•Co., ma,ly.nr Su6dlvlslon nnJ LoI Iln I rlon, to
3. OWIIEII �f1/fG[/ � .e -
nddlcss -�y0_ /
I56eo or ul�n Ito. 12
6 Stale Zlp CnJa �---
Clyfnl
A. UAI E UnILLEo
S. lolaorp111
G. CUI-lItF1GSCOLLEC1Eb Y(i5 11U1(�__
7. DUES WELL nEf LACF EXISTIr1U WEII.7 YLS �� -
0. SIn11CWAIEn LEVEL UoIo,v*1111101
Jule'r'If Ahove lop of CadnO( — --
IfI. nbovo Lnnd Sullacn'
q. l or, or cnswG IS�--- — --
-lop of ceelnp Irlrnlnelod odor below land eud¢e lequbea a vellu,ce In eccm-
dence wld, ISA ncAC 2G.01 h1CI I lOU Ur TEST
10. YIELD (gpnl)I
11. WAl En ZONES (depth): - — - - --
II nddidnnol e;ace is nrrdrJ!se bac: Ivtn
po
E' nnloun( � of
_
12. Cl It on tlAl ION. I1 - - -- - - - ---
19. CASIIIG: -LQUAlION-SKc-ICII_
\Nall (Sl I hL lvw1. 6lalolal v,w dheellon erd d:z"ance ban
Upplh Ulamolor o,W Y eIVI'
Or OUKr n<71CIfrt'4e tMlnu!
rluo�—1 ol¢-'- P1.1 --
rlol„ to r1.
rfoo to rl. -- --, _ .-
0
14. GIIOUC ldulhvJ
Uvplll hlaly� --!
Flom -_Gz-- l ri. 70' -- -- a
rrom ----------
15. SCIIEEII: M11011al
Ucpnl Ulmnvinr ,,Iol silo
--
I'ronl -
I"Ivm
glom _lo _-
rl. In.
16. SANDlGnA �� t;,,l llalullal
rion,
rloin __----
17. nE61AnKS: 1 iELI
Ib011EnED CEnI CUI INW'lCUIllAGM011C8YlIIIIISA �OIII
L1lt Pa, 1 I'Y r I I ITS n_C011U IIAS DEEII rnOVICED - /�
CONS1nUC1 Oil S SY 'R ICN _Q/J �2�
FUIIOFFICEUSEUIILY SI011A1(11111UrrrIvIONCOlsm1J 1111anK'^Flt
OmdIla SulNIJIad0lndtoUivldonoflVtlerUVelll7,O'ourw3wetaS.ccn ,nlUdn°7a�Y1 CnI 'rgv. 1`n
Sedellle. __-_---

llor,h Calnllna Deparbnenl of cFWlIN.CidnI an 116361Photo t"r ' (Ilvi 211 of WOInI ounity •1LounclwnInr Se=,lw* 262357
1636 LIaO Servlce Center.nnlelp
WELL CONSTRUCI ION RECORU WELL Coll JnAClofloEr lr•nuoNn: 241103
S I A I E WELL CONSI IIoCl loll PE111A11 n:
Indusblal U !lg
lcullu,al U TA011110tir9 U
), WELL USE Icheck Appllcibli 001P nosldonllal��F'It011mral till Olhcl,List us(!:
11ecov01y U I],jai I*unq,Waler In)6cll0n LI � �
2, WELL LUCA110L v skolch of 'Ito locallurl bolo,•+)
Counly:-- 2
Treated lownt
UIIILLII_IG LUG Uf�ll I
-------._.._...----. ...._ - --
p,*aA llmne e,+d liunban.Cmrvimmly ur Su6dlvlslon and lal llul IIou1 la ro„I�yi Uesc,Iprn
9. OWIIEn
Address Ce6
C�QyI511c*I of lloulallo.1 `� l /sue-' .C20 sly --
IP-X� Stile Zlp Cod*
City or l 0r*1
---------
5. ---_--
1 : CunIt10SCOLLFCIEII Y� sCI �— I- 1 flul -lam— —
7• L,UEB WELL nErLACF. EXISTING WEI-L7
6. SIAMIVAI Ell LEVEL U01oW-Iopofunshg: _ �_.,11• -----__ __--
1 IV,I,"'It ntmve lop
a, l OP Or CASINO IS 2i-_- Fl-. Abovo Lnnd Sw hr,O' _
•Top of u111,0101ndnilad ivar below land iwlics roquiies i vululce In iccnr ---_
dance wllb IS IICAC 2C.0116
IV. YIELD I91011). (9 me-III000I°TEST' ,f - - —__----
If. WAIEl1ZOIJESIdepll,): _ ----
- — — I/(/ L��/q II nJdidonnl s;acn i< ncrr!r9,rs' hoc'al I in1
�T1-1
12. CIILUMNA1loll: typo -- - - --
LUGn i ICI CII
21 In a _
13. CASInG: - -
1'/.aa Il,l,tne*s clew direcllon erd dh'nnre Ilan C
Ulamol*r or W*I hVl'1. L1 aie'I.I
Upplh )Ae z 1 �dL 1100d7,of 00411,2�IC1Br!4!
z0 rl. 6.Zs'
not, O to _—
rl.
10 PI. ---- o
fltt, -,
IA. GnoUl: Mulllod -'
hopll, nludal �J�e pr=F ^J .
rmll,
P 10u, l 0 r 1. -
15. SCIlEE11: ,,r lAtlnllal
Ucpll, UIam0lor 101 Slzo ca __
vloill
_—
rltll'
from
lo _— rl. III.
16. SAnU11 11AVEL PA <:
UOPII "Sloe II r F,' `
rlon, 10
Flum 10 1"L.----
17. nEl.1AnK5: Y! rEIL
n9Mf1 lilt ;IEUVIAGCOIl0110E IIIIISA "Jlll�/%' LO,1}Er'•..
I DO I IE1lEUY CEn IPY 1I TAT 1I ITS YJELL W r.11 IS IIECOIIU I IAS UEEI I Pr10VICEOlo
CONS1f1UC110115 ANU�fSL#SL' JO, S,. ,iI,fV
full OrfICE USE uNLY =
Swun uncopr•pnsoucalsmtY.•Ilnallt neu.
Ovid 110, d11 O'owrf• list src-cn wI1111n yl G�Y1 pn I F E v 1`11
Sub,�1 odpinil l0 Uivldon of IV tiff OU 1.
— r
S4'111110. ----

llorlh Carolina :Der arlmenl of Envlr Ono all end IIalurnl Ile a mnrnf •Illvbinn of walnr ounli I •0"I"Id Nn In Sec,ion 19) 733 3221 262356
1636 1.131 Service Censer• Ilnlelpb,N.C.27699-16361'honn (9 /� -- �// r --—
WELL CONSTRUCTION RECORU WELL COIII IIAC I)II Crimi- CA11OrI
SIAIE WELL CONS111UC1loll PEnlAlln!
I• WELL USE (Check Appucabla rio.), flasldenualL� Munlclpal U
Industrial U Agilcullaal U IAonlioricg U
hecovor)'❑ I leal Pungt Walor In)0cllon U Olhor I—I II Oilier,IJsI Use:
2• WELL LOCATION: ISh9� skolch 01 Iho locnllal bolo,•!)
Iieauesl sown:
Ul11LLII IG LUG _ _
p1o1A Ilanm aed,llunbot f.C47imm�lly,yr S bJlvl sloe nnJ lul IIu I —"rjpi11 to f,,,'r�pr Ue x"Ipl
3. owner i �"�jn
Address
ISGe6I'or 11.
jai
..1ir1- L@�M ale— z p Cnda — ------
cupoflawn
n. LIM E UnI1-1.EU 2- /2 `tea _-- --
g, JoTALDEPIII '-- -- —
E. CLIIlII 1GS C OLLECIEo Y(�S
�_� I
7, NOES WELL nEPLACE EXISIIIdG WE1.1 7 YES IU� --
D. SIAIICWAlEnLEVELUolowlopofCnsing: _�,j_..
IUfe'e'If Ahove lop of Cadnyl
g. 1 op Or CASING IS -- rr. Abovo I.nnd S011317
•T nn yr uth,p InnJnded aVor below land outface lequbef a valiance In occur.
dance woh lsn rlcnc 2c j 1 ME I I IOU Or TES r — —
11. WAIER ZONES (depth): _
11 nddidonnl f.^ate n nn rr!ed,-s^ bats of I^im
12. Cl ILonINAI IU1J: l ppo - _
13. CASIIIG: oCAIIoIJ.SKEI CAI
-
Slvtw direcllon aid If s lrlce ban 21
Inaa!emu =i1"
Vl all IldrLne of
Ulamelor or YlelyhVl"1. Llaledal (- Inl1,'
Uoplh r /h�1V n/`� llonde.or oU'ern2D!clonv_ tM
Flan---101 VI.
rlonl
rion, -
14. GIIUUT: 1.1a dal blull,od -�
r i nn, ----
F 1 o n
15. SCrIEEII: o -
Ucp1i, Ulamolor Sloi Sizo fA;dndal
From —_ lo-- Pl
glom
lb _.--rL._—
—_
rlom _—
10 FI.__ -
16. SAt101011AVEL PACK: �l01101
U rL'
Flom
rla,l
17. PIE1.1AnKS: TELL
c L pn�Ef:
111AT 11115 YlGLL WA'l l' I SIF 11CU h 1Ei ACCOf1pAl
I DU I IEt1E0Y CE IIFYI ICE VlI11)lSA Ncr.c .,v
coN51nUC11ollSIANl]AL1[15-1)1JRlllA--- 001YUr IIISIl��EC01117111�SUEENPnOV[ED
DR
FUnL1FFICEUS — 61011A1UIIEDpfF119O11CC!Sllll} IIIIOUc'eYFII.
Doedllo: Subldlodpindl0UivblonVI Willer Uudh7.0'oure3weluSeeen wlUdn97G�Y1 Ce.l`IEV. I`tl
a
Se�hl llo. —

Ilor,h Carellna Deparlmenf of Emlronmenl and Ilnlu,nl flesnorrns •I,Ivbinn of Wnlnr Ouallly •moundwnlnr Se^_liar, 26 2 355
1636 I.1A Service Cenler•11nle1ph,N.C.27699'1636 Phon
e 19191 731.3221 /
WELL CONSTRUCTION nECOFlU WFLLL'orlNlnclull. //n
WULL COALIIAC1Oil cull11FICA110I1 0: �2 —
S IA I E WELL COIISI II tic 11011 P MIA IIN! ---
Il,dushlal U A911cullural U 'Aonllotir9 U
1, 17ELL USE 1Che[k APpll['III' °°`) naeldonllall� rA�IcoPa'J It Olhcr, Llsl Usc: -
hecovoly U Ilent Pump Wolof In)ocllon L1 l
2. WELL LOCALKaN: iS ION"/`l`o�h of Illo Iocallun bolo(!) telly:
Clearest sown!
/1 � 5-e - - L)IIILLIIIG LUG
Ilload Ira a end IlunLor Couvrn�lnlly,m SuhJlvlslon enJ Lo,Ilu 1 horn to rums xis Uexah�'^
///�L� / — i / -
�. Ow11En � —
Addless h
_IS » ---
RidsStile Zip,Code
Clly rn IV-
A: UAIE UNLJ.Eua2._f1-s-�� - --
5. 10I-AL OPPI I I
6. COI-TINGSCOLLECIEU
7, nOES WELL nEPLACE EXISI ING WEI 1 7 I1UIR
1' _
0. SIA]IC I4AI En LEVEL Oo1o,v liUPeo' I /�Iw1ve tv 12C z'inol
10P Cr CASING Is
1 PT. Abovo I.Mill Sullaco•
g. � — ---
'Tnp of ndnp Inminrled aUor below IanJ ,,if Ice lequhee a valence n ecror� --
dan[e will, Ise 11CAC 2C.one h1EI ITOU OF TEST
1Q. YIELO19pm): -3�--
1 1. W A I En ZUNES Idepllt): -
( Nnuunl s Z 11 nddidonnl s:+cn is nrr ri I se Ira[ of I im _ -_
12. CIILOnINAIIOIJ: typo r�� "� -- I
19. CASIIIG: _LOCAIIUIISK=-: CII-
(Slww[hrec Oan erd J�s[ance bar,
1'l all I luhVI H
Drplh ' '//t DI amo,or or WeC �u�; ('lai°1'1 Ilonde,or 064r n�7 lelelu. e tMl"u
LZ-10 1l-� rl. 6'as
rmlll 10 rl.
doll,
14. GnOUT! blalo I I Molhod :'
Doplh o
Flom
]5. SCIIEEI I: IAalmlal -- -
Urpll, Ulmnolnr Slol Slro .
l o Ft
f"ton, In.
-
1"tom
rlo!u ._Io — rl.
16. SAIIDIUMVEL PACK: L1alo11a1
Ueplh Slte
r10111
to
room lu I'I• —
17. nEIAAms: �' r I SELL
1 b01IEnE0Y C 11IAT 11II
`' 1 IUC1 EU Ill ACconofflcr- VIIlll ls� r cn.c r.v
70111E
I I IIS IIECOIID I IAS UEEII PnOVICEO -
collsinucuor T #bonus,nNu II IA AC
FUIILIFFICEUS ON Y SRltl IUororPrns011CUl,Sillll^TVIOUKwEII.
I Caed Ilo: GR)U JD!", r, ,el to ivlllonollveler Or1dh7.0,wtrr3-At If Sretn ,.rlUdn 91 G3 Y
1 Ce I F!Ev. I_N
FFrt , OFFICE '
Sedilllo.

24832_3
WELL CONSTRUCTION RECORD
North Carolina- Department of Environment and Natural Resources- Division of Water Quality-Groundwater Section r
\\'ELL CONI'RAC"I'OR(N DIVI DUAL)NAME (print) JIM jr•1E'S CERTIPICATIONM
w'EI,I.CO.NIIZAC"IOIt C0011'ANYNAME CNj:-_Po GE1�:_ f.Je.L _ J*)RIL"06- PIIONE a (4a$1 8.17'-ROo�
s'I'A'l E. %l Fi,C CoNs i nuc"rloN TERM ITN ASSOCIAT E.D%VQ PERMIT#
(ifapplicablc) — (ifapplicablc)
I. W /ELL USE(Check Applicable Box): Residential Ltd' Municipal/Public ❑ Industrial ❑ Agricultural Cl
Monitoring ❑ Recovery ❑ Hcal Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION: /_ Topographic/Land setting
Nettre$t Town: Al (4/21���Y Coum(y\ It�or`�'e' ❑Ridge ❑Slope ❑Valley ❑Flat
YLI (:cZ'A G a_r j e? JI12. (check appropriate box)
(Street Name.NUMITM Community.Subdivision,Lot No_Zip Code) Latitude/longitudc of well location
3 OWNER:___Ia�j _i4<a
ILo (degrees/minutes/SecOndS)
Address IS im�_ <AtQn v C.e_7p V lalitude/longitudc source:❑GI'S❑Topographic map
(Streca Route No.) �� (check box)� VN 7/Jp�� r� � DEPTI-I DRILLING LOG
City or Town State zip Code Flop) To Formation Description
(S�)- - r; q'O'L(- U /2� Sc;
Area code-Phone number r`�U )-Y.5 •_j��d c ✓
4. DATE DRILLED .)- ',�-)- D
5. TOTAL DEPTH: -1 V ''
G. DOES WELL REPLACE EXISTING WELL? YES ❑ NO ❑'.
7. STATIC WATER LEVEL Below Top of Casing:-,�_D _FT.
(Use '+•'if Abovc Top of Casing)
S. TOP OF CASING IS Fr. Above Land Surface*
'Top of casing terminated at/or below land surface requires a
rarimrce in accordance aith I5A NCAC 2C.0118. / —
9. YIELD(gpm): -20 METHOD OF TEST
ES i
10. WATER ZON (depth): � 2�0 ,)()
LOCATION SKETCI-I
11. DISINFECTION: Type -/ Amount )- L' Show direction and distance in miles from al (cast
12. CASING: Wall Thickness two Slate Roads or County Roads, Include file road
Depth Diameter or WeOt/Pt. Iv4verial numbers and common road names.
From �'' To� FLU �J�✓)� 1� -Cc
From To Ft.
O
Front To Fl. fV
13. GROUII Depth - Material. Method T i
From roJ_:] Pl. i'nrtL✓- -
To
14, SCREEN: Depth Diameter' SlotSize Material _-
From_ "ro Fl. in. in.
From To Ft. in. it,
15. SAND/GRAVEL PACK:
Ucpth Size Material —
Prom To FL o
Prom To Pl.
16. REMARKS:
S CONSTRUCTED IN ACCORDANCE
C TRi)CV IOAYST 1 ,fAND THAT AHIS WELL ACO OF-1IIS RECORD HAS BEEN P OVIIDEU OT HE WELL OWNER
MAY 1 55 2002 SIGNATURE O�PERSM CONSTRUCTING TI I WELL DATE
Submit the original to he D vision of Water Quality,Groundwater Section, 1636 Mail Scrvice Center-Raleigh,NC
G®flNfM MOR166CM101019)73 -3221,within 30 days. GW-I REV. 07/2001
ASHEVILLE REGIONAL OFFICE

248 :? ? 8
WELL CONSTRUCTION RECORD
Not'IIi Carolina- Depmunent of Environment and Natural Resources- Div is ion of Water Quality-Groundwater Section
-�( o 7a E• �W ra.1. sn tncroR lrvon�nutnl.)NAME (print) l m rvt t/ Jo,./�---, cea�nFlcnnoN a
%%EI.LCUN'112AC'I'OR('ONIPANN NAME a
s-I A I I:tc LLI.(ONS'I RI( I ION'PERINII"Ia ,\SSOCI N I ED\\'Q PERNI Ira _
of applicable) (ifapplicablc)
I. W'IiLL LIST (Check Applicable Box): Residential IR( Municipal/Public ❑ Industrial ❑ Aericullural ❑
(Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WFLL LOCH IION: Topographic/Land selling
Nrncst Town: /-/4 County /'�/.-.1�^k�=a=- ❑Ridge ❑Slope ❑Valley ❑llal
(checkappropri;te box)
(StrcclN:u le.Numbers.Cnmmunily,SubdMsi,m,Lot No..Zip Code) Lalltll(IC/lOnglto(Ic ofweii location
3. OWNER Idogree<hninulcsiucondsl
AddresS 2 I-miludc/lungiludc SOurcc:❑GPS❑Topographic map
(Strecl or POnte No.) (check hoa)
F4 Yc%,5c.d DEPIli DRILLING LOG
O, I""t State Zip Code From 'To Formation Description
('770)- 5zT - 7cZ f D GO ..T, _:t,:tJil'
Area code-I'hmu-numher G•O 5lJ.i s[/'i Tom-
4. DATE DRILLED r,7-N=O.W
5. I"OTAL DEPTH: S�o7i
6, DOES WELL REPLACE EXISTING WELL? YES ❑ NO IJ/ Iv
7. SI AT IC WATER LEVEL Below I"op of Casing: 3 y FT. _
(Use"+"if Above Top or Casing) _
S. TOP OF CASING IS / FT. Above Land Surface*
`Top nl etsiug lenninalcd at/or 6ctno Imrd snrfare requires a
variance in acmnl:nae frith 15A NCAC 2C.0118.
9. YIELD (gpm): MEIIiOD OFTEST
10. WATER ZONES(depth):
LOCATION SKI:fCII •• '"'^
n
11. DISINFECT]ON: Type IV,? AmOUld ' c.,to Show direction and distance in miles from+''�r� easC
12, CASING: Wall Thickness two Slate Roads or County Roads. Include Illc ro:L3
Depth Ditty, ler or WeightrFt. Material numbet:s and common road names.
li oln To (5L- PI. F' +' _ .��R,7/ y✓L
Fmnt 'fo Ft.
Front To Ft.
13. (iROU1: Depol Matcriol Method
From 0 To_ ac,
14. SCRLLN. Depth Diameter Slot Size Material
l:ruin To FI. in. in.
From To H.—ill. in.
15. SANINGRAVEL- PACK:
Depth Size Material
Front To Ft.
Front To Fl.
16. REMARKS:
EI,ICIIEEt�1' R 1' "Ti SR-', LI.AVAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, W'EL-L
ND" IIAI-A COPY 01'-IIIIS RECORD IIAS BI:I;N PROVIDED TO THE\YELL OWNER
r - tl'leii 11 -I) -o ;__
I(JN TURF 01;PERSON CONSTRUCTING I HE WELL DATE
GR he 1) vision of Water Quality,Groundwater Section, 1636 Mill Service Center-Raleigh,NC
ASHL�(L� (SI qLd' ��rM9)7i -322I,Nvi(hin31) da).s. GW-I REV. 07/2001

251171
WELL CONSTRUCTION RECORD
North Carolina-Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section y oa
WELL CONTRACTOR(INDIVIDUAL)NAME (print) W\\.-Ly
f , - S T� CERTMCAATTIION
WELL CONTRACTOR COMPANY NAMEWKIt �u--E Wes)"' �-L L�•-•1 PHONE
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT# .
ifs licable ifapplicable)
1. WELL USE(Check Applicable Box):Residential Municipal/Public❑ Industrial❑ Agricultural❑
Monitoring❑ Recovery ❑ Heat Pump Water Injection❑ Other❑ If Other,List Use
2. WELL LOCA N: DPog aphic/Land setting
N tTo i:_ County dge ❑Slope ❑Valley ❑Flat
(check appropriate box)
(Stn:ee me, umbers,Cm munity,Subdivision,Lot No.,Zip Code) Latitudellongitude of well location
3. OWNER: (degreWminutes/seconds)
dress Latitude/longitude source:❑GPS❑Topographic map
trout to No.) (check box)
DEPTH DRILLING LOG
'ty or Tovtate Zip Code From To Fo 'on Description
rea A code-Phone number
4. DATE DRILLED
5. TOTAL DEPTH:
6. DOES WELL REPLACE EXISTING WELL? YES❑ NO Erl
7. STATIC WATER LEVEL Below Top of Casing:_�SD_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 accordancf with 15A NCAC 2C.0118.
9. YIELD(gpm): METHOD OF TEST
10.WATER ZONES(depth): ` . LOCATION SKETCH
11. DISINFECTION:Type_' F Amount Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads.Include the road
Dept ter °s Wei�p.Latep numbers and common road names.
From To Ft._ 4 U
From TO Ft.
From To Ft. H
13. GROUT: Depth Mat 1t� Meth
From � To � Ft.�_ �
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in. 7 c
O
From To Ft. in. in. IV o
15. SAND/GRAVEL PACK: a
a
Depth Size Material \�
From To Ft. .Q ro
From To Ft. bit N ao "
a m�
r16. REMARKS: Ni
D L �ipO Ei{7EBY�Cl�Tom, T THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,E y z
S,AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE /ALL WNl'ei� o
dr a Z
SIG OF PERSON CONSTRUCTING THE WELL ATE
GRO o th Division of Water Quality,Groundwater Section,1636 Mail Service Center-Raleigh,NC
0 919 733-3221,within 30 da s GW-I REV.07/2001
ASHEVI " E( ) y .

249163
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources- Division of Water Quality-Groundwater Section [-
wF.L1.CON'I R%CIOR(INDIVIDUAL)NAME (prinl) 1 Onl@$ CERTIFICATION N ;256�J
l\ELL CON"r RAC r Olt CONIPAN'YNANIE (ih C.fLi�P�� u )eJJ�/L(�r�J �l PHONE q fgJ`�) �i37--gC2J�
S'I,%I E N\1.1,t.COT'S'I'RUCIION I'ERN11"I'N ASSOCIAI"ED%N'Q PERNIFFN
l if applicable) / (if applicable)
I. WI'.LL USE (Check Applicable Box): Residential 0 Municipal/Public ❑ Industrial ❑ Agricultural ❑
Nlonilming ❑ Recovery ❑ Hear Pwnp Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION: n / Topoprapoc/Land setting
Nearest Town: L1
(County l._'�/i/���paK@� ❑Ridge 81ope ❑Valley DAM/ylA�j,NS CA Q,[ � NkeAp_S )2,b (chcckappmpriate boa)
(Sired Namc.Numbers,Commm�ity,Su
b
divis
ion,tl t No..Zi Code) Latitude/longitude of well location
3. OWNER' M1I�r ��o��Qel (degrcesrminwes/seconds)
Address �r"1 }S o2oC _s14, 2 Latitude/longitude source:❑GPS❑"topographic map
(Street or Route No.) (check bos)
/y,
' Z1uxJDk>/ /✓C �`((�c DEPriI DRILLING LOG
Ctlyorlosvn State Zip Code From To Formation Description
(gam )- �37- gi99 c C,
Area code ('hone number
4. DATE DRILLED -%- '-
5. l'OTAL DEPTH: ) CS
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO 0-
T STATIC WATER LEVEL Below Top of Casing: J ''' FT.
(Use"+"if Above top or-Casing)
8. TOP OF CASING IS FT. Above Land Surface*
''I'up of casing Iermivated at/or Mao,land surface requires a
variance in accordance with 15A NCAC 2C.01Ill.
9. YIELD(gpm): '- METHODOFTEST
10. WATER ZONES(depth): �. G e
LOCATION SKETCI-1
11. DISINFECTION: Type Amount_j G Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads. Include the road
Depth Djalpcler or Weight/I'l. Material numbers and common road names.
(
I\From t To_` R. _ /.,�, /
c i
From To Ft. _ —
Front To Ft. C�
13. GROU"1: Depth Material, Metla)d
c
Prom_ v To
Et.
FL
14. SCREEN Depth Diameter Alot Size Material N -
Front To Ft. in. in.
From To Ft. in. _ in. _ � --_
15. SAND/GRAVEL PACK: o
Depth Size Material
From To Ft, _ t— o
Prom To Ft.
16. REMARKS:
HIS WELL WAS
ED IN ACCORDANCE WITH 15ANCAC2C,WELL
D tMSTFR b1C IY0N fl . US,f AND THAT A COPY 01 THIS r RECORD HAS BEEN PROVIDED 10 THEWELL OWNER
SIGNATURE OP PERS NCONSTRUCTING'HIEWELL DAME
lif the on oinal to flu Division of Water Quality, Groundwater Secliou, 1636 Mail Scrvice Center- Raleigh,NC
GROL}JNMAk%,*$ R0No.[phone],within 30 days. GW-1 REV. 07/2001
ASHEVILLE REGIONAL OFFICE

WELL CONSTRUCTION RECORD 249162
North Carolina - Department of Environment and N^atu'ral Resources- Division of Water Quality-Groundwater Section
\f't:LL CON('It:st C-1Olt(IN'Dlb'IDUAL)NAME (print) Q� \t—I MMM%,/ ,,JC1. CERTIFICATION q D5
M'ELL CON I It AC CI OR CON]VANYNAME Oh(206LD"Oe k3cll 2rZ1 1IJj PRONE # IVA) R37-gp o�
SIA'I'E%%FLL CONST RUCTION PERNIM ASSOCLAI ED%N'Q PERNIITff
(if applicable) / (if applicable)
I. WELL USE(Check Applicable Box): Residential 11 Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring❑ Recovery ❑ Heat Pump Water Injection ❑ Other❑ If Other, List Use
2. WELL LOCATION: Topogra 1c/Land setting
Nearest ToWn:�n k_� County �ERr7�<Q� ❑Ridge e ❑Valley ❑Flat
/yJN/2TItiS C/2aL' IL Tn .toh�s R� (check appropriate box)
(Street Name.Number,Community,Subdivision,Los N. Zip Code) Ladlude/longilude of Well location
n / .— �o�y RelO
3. OWNER' �d Aa- /�/�U--� � (degreeshninutes/seconds)
Address RoX .�_�/� Latitude/longitude source:❑GPS❑Topographic map
(Street or Route No.) (check box)
Ui DEPTH DRILLING LOG
C'ny or To,rtt state Zip Code From To Formation Description
Area code-I'hene number /y5 7C5 S 11y%r
4. DATE DRILLED ). ' .1.(. J 2
5. TOTAL DEPTH: W-5
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO ❑-
7. Sl'A'FIC WATER LEVEL Below Top of Casing 7-5 FT.
(Use"+••if Above Top of Casing)
8. TOP OF CASING IS FT. Above Land Surface*
•Top of casing terminated at/or belwi land surface requires a
variance is.accordance with 15A NCAC 2C.01I8.
9. YIELD(gpm): / METiIPDOFTEST ✓�•
10. WATER ZONES(depth): J/0
LOCATION SKETCII
11. DISINFECTION: Type f 7171/ Amount ` COP Show direction and distance in miles from at (cast
12. CASING: Wall Thickness two State Roads or County Roads. Include the road
Depth D"ameter or W.iy ht/Ft laterial numbers and common road names.
From To Ft.
From Io Ft.
13. OROUF, Depth Miterial,L Method
Front ('� To_`lo' Ft, E'E��u.✓- N
Front To /4y_ Ft.---------�� c_
14- SCREEN: Depth Diameter -" Slot Size Material m -=
a
From To Ft. in. in. _ ---
From To PI. in. in. N --
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft. p cn
Prom__ To_ FL—_ O c, -
o
16, REMARKS: [[ttnn r� `
D11k I6t4-'d-[l WI;YmI IS WELL WAS CONSTRUCTED IN ACCORDANCE WITII 15A NCAC 2C,WELL
ToFST ut_11UN S I AIV r S D THAT A COPY OF TI IIS RECORD HAS BEEN PROVIDED l THE WELL OWNER
J; r�W� � JJneS � - Ii . 02_
I NATURE 01:PE SON CONS'I RUCI ING THE WELL DATE
„( �{,71?'Pillgprg VI W Di,iSioll of)Pater Qualify,Groundwater Section, 1636 Mail Service Center-Raleigh,NC
2764tA-ILfil6rMfo 3"L(MC733-32 I,within 30da)'s. GW-I REV. 07/2001

249161
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources- Division of Water Quality-Groundwater Section
w ELL CON"I RAC'I'Oil(INDWIDUAL)NAME (print) 11 MM -10'y C--S CERTIFICA"FION9
\\'EI.t.CON IIt.\CI'OR COAI1'ANY NANIE C�\�RC KE L t,=P�D21 rnoNE s fBxx)TS 37--8c=C'g
S'F,\lT:\\FLI.CONSI RUCl'ION PERMITN ASSOCIA"I'ED\VQ PERMITk
(if applicable) (if applicable)
I. WELL USE(Check Applicable Box): Residential Municipal/Public ❑ Industrial ❑ Agricultural ❑
Llonitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Olhcr❑ If Other, List Use
2. W FLL LOCATION: /�Topographic/Land setting
Nearest Mown: 4Iu2/>kl County S116AIIICC pf2idge ❑Slope ❑Valley ❑Flat
-i 2 (check appropriate box)
(Slrect N;t o.Numbers.Community.Subdivision,Lot No.,Zip Code) Latilude/longi(udc of well location
3. OWNER: 4L/9.J ke ITl`I (degrees/minules/seconds)
Address /y/ 734z» CIRCLE �1.�1= Latitude/longitude source.❑GPS❑Topographic map
(Street or Route No.) _ (check box)
S I ' F J .� JC` DEPTH DRILLING LOG
it,or-foss„ Stat Zip Code From To Formation Description
(7J7)-_ 3� '♦ - ?13I o "30'
Area code-Phone number
4. DALE DRILLED 7-- /•J- \' JN
5. TOTAL LEM 11 E
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO Q'
7. STA"f IC WATER LEVEL Below Top of Casing: FT.
(Use"+"if Above Top of Casing)
8. "1OP OF CASING IS I FT. Above Land Surface*
"Fop of casing terminated at/or helom,land surface requires a
variance in accordance s rh1l ISA NCAC 2C.01 18.
9. YIELD (Lint): METHOD OF TEST
10. WA1 Ell ZONES (depth):
LOCATION SKETC1I
11. DISINFECF ION: Type 17"T Amount G ✓p Show direction and distance in miles front at (cast
12. CASING: Wall thickness two State Roads or County Roads. Include the road
Depth Diameter or Weie it/Ft. Material numbers and common road names.
I-rom�- To jo F(
From To Ft.
From TO Ft.
13. GROLLI Depth Materials Method
Lion) a ho J-0 FL Et nt.,7 N —"
From To Ft.
14, SCREEN: Depth Diameter' ) Slot Size Material
From To Ft. in. in. —
From To FL in. in. fv
15. SAND/GRAVEL PACK: �.° rt•
Depth Size Material r-i
Prom To Ft. O m
From To Ft. O
� o
16. REMARKS:
D DC IE E C If IAT TI IIS WELL WAS CONSTRUCTED IN ACCORDANCE WITI I I5A NCAC 2C,IVELL
RDS,AND T1 T A COPY OF I HIS RECORD I IAS BEEN PROVIDED TO THE WELL OWNER
1 _ SIGNAPUV OI^PEl& 'ONS-1RUCTINGTIiE WELL DATE
f� (�1u,.(o th Division of Water Quality,Groundwater Section, 1636 Mail Service Center-Raleigh,NC
ASH
Gi OOV )V-T-nj %L,,A I-It,0919) 13-3221,\\ithin 30 days. GWA REV. 07/2001

249160
WELL CONSTRUCTION RECORD
Noilh Carolina- Department of Environment and Natural Resources- Division of-Water Quality-Groundwater Section
W ELL(ONIItn CI'Olt UNDIN'IDUAL)NAME (print) V ti:L S CERTIFICATION q •�S�c_�
NNE If,coN-III.%CroRamr VAN cNAME C.1`1�2oKCt' k.^.Ft..L ]>2f1_f-f�`G rnonE a (81;) 837-$r
s'I ATF:w'ISI.1.('ONS'I RUC'I ION PERM I'I-d ASSOCIA"I ED\1'Q PERMI"I'N
(if a t tlicablc) (if a)plicable)
I. W'LLI, USE(Check Applicable Box): Residential or,Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ I feat Pump Water Injection ❑ Other❑ If Other, List Use
2, WELL LOCH"IION: //� /Topographic/Land setting
Nearest Town:_ /llcti2 . County ��r E.ac KF P
M)tidge ❑Slope ❑Valley ❑Flat
_ It^O e N k O f ka I.- /I (check appropriate box)
(Sheet Nntc.Numbers,Community,Subdivision,Lot No.,Zip Code) Latitude/longitude of well location
3. OWNER: --1 I 1 11 1 olegrees/minutes/seconds)
Address / `/ 16 7L Cf 1 - /Y�l= Latitude/longitude source:❑GPS❑I"opographic map
j� (Scout or Itoulc No.) (check box)
Si FTC �� �37o,Z DEPIIT DRILLING LOG
Cityor Torn See Zip Code Prom To Formation Description
(717)- 3x y - 7`/.3 7
Areacude-Phonenumber
4. DATE DRILLED -cz
5. TOTAL DEPTH: �e 5
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO C17/
7. STA'I"IC WATER LEVEL Below Top of Casing: FT.
(Use"+"if Abovc Top of Casing)
8. TOP OF CASING IS Ff.Above Land Surface`
`'fop of casing terminated al/or beloe,land surface requires a
rariatae iu accordance n'IIh ISA NCAC 2C.0118.
9. YIELD(gpni): METHOD OF TEST
10. WATER ZONES(dcplh):
LOCATION SKETCH
11, DISINFECTION. Type (`e-Pd-t1e"A2 Amount C a Show direction and distance in miles from al least
12. CASING: \Vall'fhickness two State Roads or County Roads. Include the road
Depth Diameter or WcighbFt. Material numbers and common road mmies.
Front To i 7. FL tl 2 71 ✓L.
From To Ft. _
Front -10 Fl.
13. (iROUT: Depth Material Method
Front C` To .)C _ P(. (—C2KE � y r
From To 3 FL_C•rt 7-Ti�45 C�_ {s.-77— O
1-1. SURI[EN: Depth Oiamcler Slot Sizc Matcl al y _
From To --
� :'cV
From To Ft. in, in. _-
15, SAND/GRAVEL PACK:
Depth Size Material
a
Prom To FI.
From To 171. p ��
rn
CD
16. REMARKS:]
� 'I TH IIS WELL WAS CONSTRUCI D IN ACCORDANCE Wrfll I5A NCAC 2C,WELL
r' (!617S'Ptt1JC"I jU1N7 TA N,AND TIIAT A COP OF THIS RECORD HAS BEEN PROVIDED l0 THE WELL OWNER
Lt SIG UIL F PERSON CONSTRUCI ING-1 HE WELL DALE
3R S Mt t t3 CT1 11 the [),Vision of Wrifer Quality,Groundwater Section, 1636 Mail Service Center- lialcigh,NC
AS!i gy0`)`X IiGOf lGldhis•LFF ',('787)73 -3221,within 30 days. GW-I REV. 07/2001

WELL CONSTRUCTION RECORD 248055
North Carolina- Department of Environment and Natural Resources- Division of Water Quality-Ground water Section
L\\'ELL(ON]RAC OR(1N'DI\'IDUAL)NAME Ar�iot) I Mn.q 1 QtiLS CERI HFICA7 ION M -n�S
n\'EI.LC'ON'l RA(JOR CONIPANI'NANIE \ itr-QO V.EF 1C��' LL� I ti'- 1`110NE N fM �3�7-k(2e Yj
S I:%i t:%%ELL CONS'IRL'CHON PER,%Il'I-N ASSOCIA'I'I;n\YQ PERMIT#
(ifapplicublc) (ifapplicablc)
I. WI;LI, USE ((Check Applicable Box): Residential 19
/ Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recmeiy ❑ Heat Pump Water Injection ❑ Olhei O II Othei List Use
2. WELL LOCATION: Topographic/Land setting �
Nearest fownn:�. )]a � V County IltAZ� _ ❑Ridge ❑Slope ❑Valley [Road
1 —I-12(� pt> (check appruprialc box)
(Stmcl Name.Numbers.Community,Subdivision,Lot No..Zip Code) Lallludc/Iongllude or Well location
3. 0WNE ioc
I2: �i4 A,IE `> JQe (Jcgrccs/minntcs/seconds)
A ddress T I ri V( `3rll Lalilude/longitude Source:OGPSOTopognnphic map
(Stree(or 1(oulc No.) Idicck box)u2T1.P'T(nLAj q UI!1'l'li DRILLING LOG
Chy or Tara, State Zip Codc Pronn To Formation Description
( 6 )- `6 7z,-/— `1 —(") /2( t S P % Cq Sitil
Arca mdc-Phone number /-,D�t .- 3g /%E
4. DATE DRILLS - 19 -0 )_
5. TOTAL DEPTH: 3 B S ,
G. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of casing: ;D5FT.
(Use"+"if Above Top of Casing)
S. TOP OF CASING IS FT. Above Land Surface'
`lop of casing termivated at/or below land surface requires a
vari:mce in accordance with 15A NCAC 2C.01 IS.
9. YIELD (gpin): ',a-c_N METHOD OF TEST f9-t
10. NVATER Z..ONES (depth): �� /
LOCATION SKETCH
11. DISINFECTION: Type Amount t ,r Show direction and distance in miles from al (cast
12. CASING: Wall'Ihickncss two State Roads or County Roads. Include the road
Depth Diameter or Weight/Ft. Material ❑umbers and common road nanncs.
Frnnn_ To FL 1,10 Alf
From To H.
c-
0
From Jo PI. o_ Iv
13, GROUI` Depth Material Method '*l
From To ',ae _ PL�f�4c.�i
Ft.C.14 ire v 5 (9A4 0/ fV
14. SCRLEN: Depth Diameter Slot Size Materi.l cfl -
Fann To FI. in. in.
From To -
15. SAND/GRAVEL PACK: n`
Depth Size Material
Prom To Ft. irn 0
From To FL
IG. REMARKS:
D D IlikB C ll TI-(IS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
R 1 ,A THAT A COPY OF T IS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
-2
� NATURE PER CONSTRUCTING THE WELL DATE
nc Di 'ision of Water Quality,Groundwater Section, 1636 Mail Service Center-Raleigh,NC
-I REV. 07/2001 one dHlI)733 3221, within 30 days. GW

WELL CONSTRUCTION RECORD 24 8 056
Not Guolina - Deparnnent of Environment and Natural Resources- Division of Water Quality-Groundwater Section
NPEI.I,CON"I ItACIOR(IN DI VIDUAL)NAME (print) .)I -I nic/ �1.7rn)C'S CERT IFICATION N
%NEI.L CON"I RAC"10 R CON]PANVNANIE FI I;R[�{CL 1c �3;h-LRIL..L/•tit PRONE Al a2D 637_`6( 7
SIA I F IN ELI,CONS"I It UC I ION PERNlil'N ASSOCIATED\VQ PF,RNIITN
(ifapplicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential Itd Municipal/Public ❑ Industrial ❑ Agricultural ❑
Moniloring ❑ Recovery ❑ Heal Pump Water Injection ❑ Other❑ If Other, List Use
2. WELL LOCATION:
t Topoggra)hic/Land setting
Nearest"lowwn Ltd 1" Coounty IE94t-'( ❑Ridge LVSope ❑Valley ❑Plat
l 'RFT (s- —W PL (check appropriate bos)
(Sneer Nome Numbers ,Cnnnumily,Subdivisian,Lot No..Zip Code) q Lati(ude/longitude of well location
3. OAVNEIZ: a)[��l'A R- '•>R���i�Mrt J (degrccshninmes/seconds)
Address o X C1,9 LatiltRIC/Iongi(u(IC source:❑GHEITopographic map
(Slreel or Rouse No-) (check host
10 ry��C / —lateNIC 4i�[L1`c` DEPIII DRILLING LOG
Cngorl vn r S Zip Code From To Formation Description
X 3 z(, Le c /�
Area code-Ph nne number
4. DATE DRILLED -Z' ,z/ - V .Z
5. TOTAL DEPTH: J 15
6. DOES WELL REPLACE EXISTING WELL.? YES ❑ NO O
7. STAIIC WATER LEVEL Below Top of Casing: I FT.
(Use"+"if Above Top of Casing)
8. TOP OF CASING IS `I FT. Above Land Surface*
'Tap of casing terminated it/or below land snrhtce requires a
curianra in accordance with 15A NCAC 2C.0118. -
9. YIELD(gpm): VC, METHOD OF TEST
10. WAl'ER ZONES(depth): /l%C /C-i
LOCATION SKETCH
11, DISINFECTION: Type Amount s (, Show direction and distance in miles from at least
12. CASING: Will Thickness two Slate Roads or County Roads. Include the road
Depth)) Diameter oorWeight/17C -vaterial numbers and common road names.
From L� Tom''`` Ft, L A '-(•[-
From To Ft. _
From To - Ft. 0 =_
13. GROUT, Depth (vlatcrial Method !V "
Flom C. To ',)—.c' Ft.
14 SC EN: Dcplh Diameter- Slot Sizc Material
I`ronl 'fo Pt. in. in. Q'
Fran To Ft, in. in. _� r-,
15. SAND/GRAVEI. PACK:
Depth Size Material
Prom_ "To Ft. _
Front "Io FL cJl o
z
16. REMARKS:
O,ry�y�pr�1t'q,a;.R Y T IFEL -IIS WELL WAS CONSTRUCTED IN ACCORDANCE WIT]-I 15A NCAC 2C,WELL
QON NO t NO THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
I aF�'1 L GNAIURE OF PERS N CONSTRUCTING THE WELL DATE
ubnlit 11 Divis on of Water Quality,Groundwater Section, 1636 Mail Scrrice Cen(er-Raleigh,NC
27(RAI4AIP�.[21'd S'i� g33-32 I,within 30 days. GW-I REV. 07/2001
C

WELL CONSTRUCTION RECORD 2 4 8 057
Not Carolina - Department of Environment and Natural Resources- Division of Water Quality-Groundwater Section
�Cc /
V,ELI.CON[RAC"I Olt(INDIVIDUAL)NAME (print) 14N\t/ CERTIFICATION# tom. .Cj
w FLL CONTRACTOR COMPANPNAME CNNERo1�ct_E F. t-L PHONE # (S$ 7 -$cr$
STA'IT:NN ELL(ONS'I'RUCI'ION I'ERJMI'I"# ASSOCIA'I LI)N%'Q PERMIT#
(if applicable) / (il'applieable)
I. WELL USE (Check Applicable I3ox): Residential Q Municipal/Public ❑ Industrial ❑ Agricultural ❑
Ntonilm ing ❑ Recovery ❑ Beat Pump Water Injection ❑ Other❑ If Other, List Use
2. WELL LOCH"(ION: /� Topographic/Land setting
Nearest Tovt nl42 >I(. County l..11cho�e C- ❑Riclgc ❑Slope ❑Valley ❑Flat
— I ✓B2 (check appropriate bon)
(Street Name Numbers,Cmnmunity,Subdivision,Lot No..Zip Code) Lahludc/longitude of well location
3. OWNFR: �f}' ' h y / C t4c.pl (degrees/minutes/seconds)
Address L��)Z / Lalitude/longitude source:❑G PS❑Topograph is map
(�N t vet or Rowe No.) (check box)
.^'' C `� DEPTH DRILLING LOG
Ciry or Iocvn State Zip Code Front 7'o Formation Description
(�)- GZC6 - `1.5 �SCI O Cis. .
Arc;,axle-Phone number
4. DATE, DRILLED �-..�(Y
5. TOTAL DEPTH: I.,, •
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO 0 iv
7. S'FATIC WATER LEVEL Below Top ofCasing: mac' PT. -
rn
(Use"+"if Above top of Casing)
3. TOP OF CASING IS / FT. Above Land Surface*
o_-
•'iap of casing tenninaleJ al/or bclutr IanJ surface requires a
variance in uccordauce with 15A NCAC 2C.0118. "C'
9. YIELD(gpm): VO METHOD OF TEST
10. WATER ZONES(depth): -2/c
LOCATION SKETCH c"'-,"'
11. DISINFECTION: Type Amount ')- L yJ" Show direction and distance in miles frr twat l8m
12. CASING: Wall"thickness two State Roads or County Roads. Include the=mad
Depth Diameter or Wet'ht/Ft. terial numbers and common road names.
Front D "ro� C PI. n �� PC/c
Front 'fo Ft.
From To PI.
13. GROU"h: Depth Material L Method
Front O I o ti/ _
Front 1 "fob Pl.
14, SCR FEN: Depth Diamctcr Slot Size Material
From To Fl. in. in.
Krum rho 171. in. in.
15. SAND/GRAVF1. PACK:
Depth Size Material
Prom To FL _
I four--To Ft.
16. 1RFNIARKS:
HIS WELL WAS
STRUC
ED IN
RDANCE
D ( T� Ic 10SlVdJl I �ANDTTI T A COPY NOFTISI RECORD HAS BEEN P OVIIDED OTHE WELL OWNER
ln
AFR 2 2 2002 SIG04B Eou sO CO s mucTING 111E WELL DATE
Submit the orioinal to he D! vision of Water Quality,Groundwater Section, 1636 Mail Service Center-Raleigh,NC
GB®6NMV6AABRiFACIFI N919)73 -3221,n'ithin 30(lays. GW-I REV. 07/2001
ASNEVILLE RFGi0NA.1_ OFFICE

262354
rlorlh Carnllna • Deparlrnenl of Bnvlrnnn,enl and Nehunl Ilesmnrnf -Ulvlflnn of Wain,Ounllly •Moundi nlnr Section
1636 I.Iall Servlce Center•rinlelgh,M.G.27699.1676 r11011e 1919) 791 9221
WCLLCONSTRUCIIONFiGCOf1U WEIL Coll IIIAC1011CL�rICAlltoI10:
S I A I E WELL CON S1110CIloll PEIIr"llff: --
(, VI ELL USE (Check ApplIcablo oo.): Noslda nil al L� Municipal U Induslrlal U Agrlcullural U U
l4onlloriry
(lecovaly U I leal Purlq,Walor In)ocllon LI Olher ❑ 11 Other,Hsi Use:
2. WELL LOCAL ION: (Shoe skolch of Ito Iocollun bnlov
Ilearesl louvre
p��, UIIILLIIIG LUG _UP111
Inoed Ilene end Ilunbaro,Canv nunlly,m Subdlvls,on and lol Ilu 1 __flo„'---,Q �on,.a n,UeYcrlltll^'
�. ownrn a --
Address /!Jr -
(
Scale Zlp Coda
Clly nr town —_A. UAl E UNILLEO /- �2C/-O� - ------------
5., 101ALUErIII --_, 2.�--- - --------
F. CUrlII101SCOLLECIED )'(:S(_ l WIL --
7. DOES WELLr1ErlACE EXISIIIJG WE11.7 YES __-
6. S I A]IC WAl EU LEVEL U01MY I Ill cl' ifill:
If A lop of •a'I"gl
9. l OP OP CASING IS—�-- rr• Abovo Lnnd Swlt,r-n' _—
'Inv or c.fh"p In ndn dfd.Uor belowland Nll.0 requhef a vnl.nce In.ccm-
d.nce will, 154"AC 7C'a'to
IU. YIELD (gPnl): _ — MEI I IUD UP TEST
11. WAI Ell ZOIIES (deplll): —
/� -- 11 ndd'nlonal s;ate s nrrCfd I ST bac:of 1'iIn
12. Cl ILLIMHAIION: lypo ` " -- -"-An ounl- -
19. UASIIIG: LUIGA loll SKE_I Cl I"
VIA lhlrhrtff (Slww dlr ecllon rod d(s[anre lwn 211na:::wo
Orplll Ulamolor or or oil Kr nr:) lell'4! {alms`
r ..JfaL Ilonde.
Flom__—/2—lo rl.
rrom--- to rL
14. 011OUt!
haplh hialollal Mulhod _
!"role to rL -- ---------
15. SC11EE11: =
Ucpll, Ulamolor SIo15176 IAalmlol .�
--
Pwm -_ -
Prom _10 _
rl. In. In.
16. SA110/011AVEL PACK: blalo,lal
Uaplll Size
riot,, to rl.
r,om l o r I. ---- ---- —
U - F-
I bOIlEf1EUY CE I IICI EII III AGC YI1111SA r"Ic .c r,OIIUAI,CC
IIAT11IISPellWANC( I IJISIIECOtIOI ! S6EEll PNOVICEDO111E "I
r'_ELL OI
IOEr-
COI151rUC11011 A ADDS. ACOP
FOIL OFFICE USE UIIL - o.
_ .lonntuneorrrnsou�arstntr nnant nFlr
OuadNo: SiJS,kf,o6l�MlelloUivdonallYtlerO,7elllr,U�Nr,O..aluSeetn rrNdn"7G�Ys I`Ti
GF F4 l FIE Y
g031110 —

' mlh CaIvU'+a � an
(7epa'hnenl of 6wLonlnanl d Ilnhuel Ilczvv�rne � ItivbL+n°I Wnlnr Ou;dhy •IL°und wn,m
I 9383
16J6 1.1oB Sorvlce center• Ilnlelph, N.C.276991GJG1'Lonv (9191 7:1'1J221 -�1 J jL / ---- --
�ii�
WELL CONS1f1UCIION nL=conu wiLLColIIIJAC1 0
11ITIII" 10AtIOII —
SIAIE WELL CpII51I111ctIUIIpE11L111n: —_
)• hneldvrtllalt L_I nl_. Indusblal - A9
Ilcullu(al U
)Iv/ELL USr IchcckAppllubl. q IAIIIUfIUlller, 1,151 Use:
flecvvnlp JI Ival I' nq, wnlor In)oclor IAonllorirg—U
-
y, YVELI_ LUCAI ION: ISIm� skvlch al life lucnllun bvlow)on ly _ /'/E���
Ileareelio�^'n' G-L' C� Uc7111
J In 11 I 111 lll_LII1G LUU_
p,v+d Ilama nnJ Ilu'Ibn n,C°�nlnlnn�;n� SubAblsl°'I nnl �� 1
r on,rn�Uts dnh
ffm 1
Adl
Add rs^,
, r qy y, 5ble ---_��
A. [)At E UIII0LE1) — ----
5, IOIALUr;rlll - — _- - ---
6. CLIIIIII(IS "ILFciEO 1"�'sL I Iu.1lLl — _---
I_I I --____--.---
7 UUFS wFLL r1ErLACF. Lx151IIJG WLI 11 YLS .
U. SIAIICwAIEr1LEVELUolowlvPvlUnslmr _�5/U_,.. I'I. --
Use'r'II Al+vve lrp nl Cad"UI
Abow Lnnd Su,lnr,n' _
�—
•,°I`vl tnhp IrnnL,rl^d rUm Lal°w IanJ still requLes a 2 Au+ce Lt acc°t --
anncaw111, IsAIICAc2C.v 11C1110D01' 1L'Srt� --
IU. YIELD )9Pn,)1 - --- --._ _-----
1 I. \VA1 Erl ZUI IES IJepll,):-- — 11 n�ldlllonal S.acn is IiarCri 1 6aci of I i+"
11. CIILUr11NA11Ull: 'Itpa I ' �-- - - LULgIIC1115Y,EJC11_
1 J. UASII IG'
w.0 Ud�s"t+s (FIww dhecllon e"d ds:anrn lean zf lna:!!^�
Drplh
Ulamolor w Wnlpnvl,. Llnlolol Ilande,yr vUKr n27"Icmc= F,oLal`
—lo & l'L1
glom --
rl. -
rlom--
rlol„
14, GIIUUI: blulhud ' ?
Uop1I, binl?
F10111 to
lv I-I. / ---- --- - -
15. SCREEII: SIu151t htal°Ilal `�
Urpll, Ulnmolor 6 _
r l v o,
_--
Ilvn, _----
rlpin
17.
16. SAl1D1Ul ' Idnlall:d
rlon, to rl. �� ---
rtont I to !?1. . . .
17. r1FMAIII S! J TELL
WA(1 1titi511111GIR)Ill ACCO11Ut'1ICCvlIIIIISA jO1jIr•j/' LOtt�EP
1 UOIIEI FUY cumlOK11Y L AC pY U1:IIIIS IIr:UUIID IIAS MEN PtIOVICEO
U
UIILY u�ncIFa,O,'solwlldlr��nI�l1la5.n�t<c^'�F G�Y1
r ou
c°1U Ito SublJlp I111110Uv11101101IfUll
Eh IEIEY. Cn

North Carolina-Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section 445505
1638 Mail Service Center-Raleigh,N.C.27699.1636-Phone[phone]
WELL CONSTRUCTION RECORD WELLCONTRACTOR:
WELL CONTRACTOR CERTIFICATION 0: as 4 L
STATE WELL CONSTRUCTION PERMIT#:
1. WELL USE(Check Applicable Box): Realdential El Municipal ❑ Industrial❑ Agricultural❑ Monitoring❑
Recovery❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: County: ('�N<'Rsak',L--
Salt
(Road Name and Numbers,Community,or Subdivision and Lot No.) DRILLING LOG DEPTH
3. OWNER �c,3. ,1_. From To Formation Description
Address 7-s;-
(Street or Houle Nc.) S 3� L✓�=�:i.�n�r
City orTo" Slat* Zip Code Y 3
a. DATE DRILLED L -7 a 70 -26— L N P<^ s<,f)A T,-,)
5. TOTAL DEPTH 607
6. CUTTINGS COLLECTED YES❑ NO[]
7. DOES WELL REPLACE EXISTING WELL? YES ❑ NO[✓a
S. STATIC WATER LEVEL Below Top bf CASIng: lo FT.
(Use'**8 Above Top of Casing)
9. TOP OF CASING IS / FT.Above Land Surface*
*Top of casing terminated stfor below land surfed requires it vertance In amor-
dance with 1SA NCAC 2C.0118
10. YIELD(gpm): / METHOD OF TEST
11. WATER ZONES(depth):
12. CHLORINATION: Type 1Vri11 Amount L'" - It additional space Is needed use beck of form
13. CASING:
Wag Thickness LOCATION SKETCH
Depth Diiaamiltor or WelghVR. Malarial (Show direction and distance from at least two Stele
From D To `F� Ft.� Roads,or other map reference points)
From To FL
From To _ Ft.
14. GROUT:
Depth Material Method o
From O To a0 FL tnc'M�=N%� m
From To Ft.
15. SCREEN:
Depth Diameter Slot Size Materiel .
From To Ft In. _In.
From _To Ft._ In. _ In.
n
From To_FI._ In. In — —�
16. SAND/OR II v
R /� o
t S siz u i starlet
From Fl.
From �.;�.Ft.
J
17. REMARKS:
1 DO HEREB CER ,fit,7NgyT,Tf91Si WE1 t IWNs CON TRUCtED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUC ON SIM' hARDS;_9Wd, THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
— (� (�
FOR OFFICE USE ONLY
Wad No: =NATURE OF kttdoN CONSTRUCTING THE WELL DATE
Submit original to bivlslon bl Water Quality,an tudwatef Section Within 30 days
Serial No. GW-1 REV. 121"

24580'7
North Carolina•Department of Environment and Natural Resources-Division of Water Quality•Groundwater Section •�
1636 Mail Servk:e Confer-Raleigh,N.C.27699-1836-Phone(919)M-3221
WELL CONSTRUCTION RECORD WELLCONTRACTOR: O'eApkee_ tt,111 bkjj'Ijr,
WELL CONTRACTOR CERTIFICATION M: 1-.5 t- S
STATE WELL CONSTRUCTION PERMITII:
f
1. WELL USE(chock Applicable Box): Residen8el ER/ Municipal ❑ Industrial❑ Agricultural❑ Monitoring
Recovery❑ Heal Pump Water.Injection ❑ Other If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below) ff
Nearest Town:� County: 3112 ADKQ.E
61 Hi1) Pb - Les-T 14��,,",N PcLr
(Road Name and Numbers.Com rxmI or Subdivision and Lot No.) DRILLING LOG DEPTH
3. OWNER 5_0kN (s.Gaa b he-FLn From To Formation Descrlpaon
Address /00 f'4}7>< 7)Qpp / 0 1>G .(st C/Y�'•
_/044AIZ �� roe or -oNis�, aD /� SO yC � C7 L`J'Ji-�)• 7rt,
City or TmP I _ state Zip Code
4. DATE DRILLED L
5. TOTAL DEPTH l
6. CUTTINGS COLLECTED YESM NO[,
7. DOES WELL REPLACE EXISTING WELL? YES Ej NOQ
8. STATIC WATER LEVEL Below Top of Casing: -)j FT.
(Use'.'Of Above Top of Cuing(
9. TOP OF CASING IS / FT.Above Land Surface-
*Top of casing terminated sVor below land surface requires a variance in accor.
donee with 15A NCAC 2C.e11 e
10. YIELD(gpm): _� METHOD OF TEST / °Z
11. WATER ZONES(depth): 12t
12. CHLORINATION: Type H Amount i t' If additional space is needed use back of form
13. CASING:
Wall Thickness LOCATION SKETCH
Depth Dlrrm��e"�ter or Woigf wt. 14�tedat (Slow direction and distance from at least two State
From To y" Ft.-� 1 f �`` `- Roads,or other rap reference points)
From To Ff, p
From To Ft. c
14. GROUT:
Depth Material/ Method N c_
From To 117 ' Ft, EQ, ,un Z r\)
From 2° To UG Ft. ('4_
15. SCREEN:
,� to
Depth Diameter Slot Size Material
c.0
From _To Ff In. — In. [Jl o
From _To FL In. _ In.
From To_Ft. In. _ In.
16. SAND/GRAVEL PACK: i
Depth Size Material
From To Ft.
F FL
17. R ra ( � 11 ni 2
i EBY CERTIFY THAT THIS L AS CONSTRUCTED IN ACCORDANCE WITH 1SA NCAC 2C,WELL
C CTTNSTANQARPS AN A COPY OF THIS R CORD HAS BEEN F'ROVIOEO TO THE WELL OWNER.
FO OFF E USE ONLY I \(
Out No: _J ISIANR PERSON CONS1f1UCTINO THE WELL DATE
GEOUP.GVVNiFR.3E 1[ON Su lodglnuloDM$1436orWUMQuWty,OmWi&41#r8ocaonWlthln30days
Ui01A OFRCE OW-I REV. 1719f

North Carolina-Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section 2.46218
1636 Mail Service Center-Raleigh,N.C.27699.1638-Ptwns(919)733-3221
WELL CONSTRUCTION RECORD WELL CONTRACTOR: ��1e�/�� �' �2' Ilr^'✓
WELL CONTRACTOR CERTIFICATION 0:_ Kia S
STATE WELL CONSTRUCTION PERMITN:
1. WELL USE(Check Applicable Box): Residential Municipal❑ Industrial❑ Agricultural❑ Monitoring❑
Recovery❑ Heal Pump Water Injection ❑ Other 0 It Other, List Use:
2. WELL LOCATION:(Show sketch of the location below)Nearest Town: /Yl ITKK L.E County: - akF�ll'
ee--e-
r2r C k 2D
(Road Name and N e1rs.Comrnm`itry�,or Subldlvislon and Lot No.) DRILLING LOG DEPTH
3. OWNER t<EZ/tIZIS LJPL � ^ From To Formation Description
Address 1 y60 to, ,J y hpnor1. �!J J •� ) c� C�fa r,
�"'to or oua o r4' J' may_ (l/`y7 h:7c nL u ePt%
/11nP-,ble� tjC_ S
Cay or Town State Zip Code
4. DATE DRILLED
5. TOTAL DEPTH
6. CUTTINGS COLLECTED YESM NOD
7. DOES WELL REPLACE EXISTING WELL? YES E] NO0_
8. STATIC WATER LEVEL Below Top of Casing: ) O ' FT.
(Uu'+'If Above Top of Cuing)
9. TOP OF CASING IS FT.Above Land Surface'
'Top of easing terminated atfor below land surface taquftes a variance In accor-
dance with 16A NCAC 2C.011e .e
10. YIELD(gpm): (i METHOD OF TEST
11. WATER ZONES(depth): 30
12. CHLORINATION: Type Amount '+ c— If additional space Is needed use beck of term
13. CASING:
Wall nadviess LOCATION SKETCH
.� Depth meter or WelghtfFl. Material (Show direction and distance from at least two State
From `' To i� � FL — U 2/ JOLv C
Roads,or other nap reference points)
From To Ft.
From To Ft.
14. GROUT:
Depth Materia Method c
From To _Zr_Ft. r:
From �� To _+1'_Ft. ` El
15. SCREEN:
Depth Diameter Slot Size Material N '
From —To— Ft — In. _In. a _
c
From —To Ft. in. — In. -0 n_o
From To Ft. In. In
N M
16. SAND/GRAVE IQ
1 � � �11 �� c
�. ',
0
zo
From Ft.
From F.t. -mot
17. REMARKS:
I DO HEREBY C RTIFY(f 4ATIAMiWIiI l�'AbtONS UCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTIO STAM M ft IS RECORD HAS SEEN PROVIDED TO THE WELL OWNER.
- •Zf •02
FOR OFFICE USE ONLY
Wad No: 9MATUAt btOtASON CONSTRUCTING THE WELL BATE
Submit original Id DWI of Waler Quality,atefkidwsur&coon within 30 days
Soda)No. OW-1 REV. 12/91

WELL CONSTRUCTION RECORD 247256
North Carolina-Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section
�
WELL CONTRACTOR(INDIVIDUAL)NAME ((pprint)\'3wU�� S' �IMS1r CERTIFICATION#4'1 U Q"
y
WELL CONTRACTOR COMPANY NAME jt ' ES:�lu ELF' PULL !' -'f PHONE #
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
if licable (if applicable)
I. WELL USE(Check Applicable Box):Residential Municipal/Public❑ Industrial ❑ Agricultural❑
Monitoring❑ Recovery ❑ Heat Pump Water Injection❑ Other❑ If Other,List Use
2. WELL LOCATION: 6pographic/Land setting
N estTotgm: W� County Rai dge ❑Slope ❑Valley ❑Flat
I (check appropriate box)
(Street Nam , tubers;6 nmt ity,Subd'wsion,Lot No.,Zip Code) Latitude/longitude of well location
3. OWNER: (degreestminuteeseoonds)
Address Latitudellongitude source:❑GPS❑Topographic map
(S t or R e o.) ?5 (check box)
O DEPTH DRILLING LOG
�City r 3 3 zip code From To Fo ion Description
Are-Phone number 4 5 1 t
4. DATE DRILLED b c 1— -
5. TOTAL DEPTH: I /
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO H-
7. STATIC WATER LEVEL Below Top of Casing:— 'Zj?D FT.
c
(Use"+"if Above Top of Casing)
S. TOP OF CASING IS FT.Above Land Surface" — N
-Top of casing termluated atlor below land surface requires a
"Tl
variance in accordance with 15A NCAC 3C.0118. '-
9. YIELD m): S METHOD OF TEST �: =`
10.WATER ZONES(depth): ��� t _-r
LOCATION SKETCH
11. DISINFECTION:Type Amount Show direction and distance in miles from at ler
12. CASING: Wall Thickness two State Roads or County Roads.Include the roaa
Depth ter Qr Wei t/Ft.' Qa al numbers and common road names. <J
From b To �S Ft. �Yd-I•(t T��
J
From To FL Y4 z
From To Ft.
13. GROUT: Depth Ma Method
From L s To Ft,De i ?✓
From Ft.
14. SCREEN: Depth Diameter Slot Size T Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft. i
From To Ft.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WEL C E WITH 15A NCAC 2C, LL
CONSTRUCTION STANDARDS,AND TH7 C PROVIDED TO THE WE O R
s -e 20 C�
SIGNA ERSOALCO�SffRMNG LL DAAE
RR'i""��
Submit the original to the Division of W ter ality,Groundwater Sec on,1 36 Mail Service Center-Raleigh,NC
27699-1636PhoneNo.[phone],withi 30d 001DWATERSECTION GW-1 REV.07/2001
ASHEV!LLE REGICFAL OFFICE

24 '7264
WELL CONSTRUCTION RECORD
North Carolina-Department of Environment and Natural Resources-Division oof.Water Quality-Groundwater Section Q
WELL CONTRACTOR(INDIVIDUAL)NAME
((prriint)�\ l�U-�` �``[` t OEYA' 1 Ivt1(� CERTIFICCAyTIIONN##2aSINQ
U
WELL CONTRACTOR COMPANY NAME\ AA t C J" L"— '' w �-`1 V' PHONE
STATE WELL CONSTRUCTION PERMITq 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 LOCAopographic/Land setting
crest 'own: Ce my dge ❑Slope []Valley ❑Flat
(check appropriate box)
(Strtct N be ocn unity,Su ry ion,Lot N .,Zip Code) Latitude/longitude of well location
3. OWNER: (degrees/minutestseconds)
Address Latitude/longitude source:❑GPS❑Topographic map
(Street or e N ) (check box)
DEPTH DRILLING LOG
City or Town State Zip Code From To
o Forma 5escription
Area Phone number ^ O
4. DATE
DRILLED d
5. TOTAL DEPTH: /
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO Er
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 N r-
variance In accordao a with 15A NCAC 2C.0I18.
9. YIELD(gpm):�METH�I 4F TEST r�
10.WATER ZONES(depth): ��5 Co =-'
LOCATION SKETCH _
11. DISINFECTION:Type Amount Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads.Include thekad T
_ Depth Doter r W ' atf al numbers and common road names. N
From b To Ft.�` 't"v
From To Ft. CO
CO
From To Ft.
z
13. GROUT: Depth Ma real Metho
From_To Ft. l a
From To Ft. t
14. SCREEN: Depth Diameter Slot Stu Material
From To Ft. in. in. _
From To Ft. in. in.
15. SAND/GRAVEL PACK: •
Depth Size Material '
From To Ft.
From To Ft.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS D A CO "Clo'Mq NCAC 2C,WELL
CONSTRUCTION STANDARDS,AND THAT A COPY ITO THE WELL O
SIGNATURE OF PERSt
S'IJ�JICTIIHGT DATE
Submit the original to the Division of Water Quali=A. E
all Se cc Center-Raleigh,NC
27699-1636 Phone No.[phone],within 30 days. S CTION GW-1 REV. 07/2001
NAL OFFICE

WELL CONSTRUCTION RECORD 247743
North Carolina - Department of Environment and Natural Resources- Division of Water Quality-Groundwater Section
NIF.1-L CON]RACTOR(I.NDIVIDL'AL)NAME (prior) CERTIFICAATION# a�6S
w ELLCO.NTRACI �='ORCOMPANI'NAME ��.--��K�.-� A� PHONE # C"W-907- XGe>�
S'I'A'1'E%%i.'I.L CONSTRUCTION PF.R\IIT# ASSOCIA"rED wQ PERMIT#
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential Municipal/Public❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other❑ If Other, List Use
2. WELL LOCATION: Topographic/Land setting
Nearest Town:_ HL,RfV County ❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate boa)
(St,cot Nome.Numbers,Community,Subdivision,Lot No..Zip Code) Latitude/longitude of well location
3. OWNER: d/Mat, AJ5 (degrees/mi nu tes/secoads)
Address ,/Y A;"e= A CJ/� e,S 2 Latitude/longitude source:❑GPS❑Topographic map
(Street or Route No.) (check box)
/u C dF i o(o DEPTH DRILLING LOG
City or To,,a Stare Zip Code From To Formation Description
(tt)- -3SFa- 03f;91 119 fAs, c:
Area code-Phone number �ru ri2@ j �_
4. DATE DRILLED I/S/t?-1
5. TOTAL DEPTH:�r�E� —/
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO L7
7. STATIC WATER LEVEL Below Top of Casing: c FT.
(Use"+"ifAbove Top ofCasing)
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): a o METHOD OF TEST 41 2
10. WATER ZONES(depth): Js o `
LOCATION SKETCH
11. DISINFECTION: Type -,z.9.Je«/LZ Amount 4a c° 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 L" To �-v FL &/I " S)eai P✓-c
From To Ft.
From To Ft. c
13. GROUT: Depth Material Method O ._.
From a To �� _FL , . N _
From a� To F" Ft. e­V_T ]6 s C/+1�a,i„ r
14. SCREEN: Depth Diameter SlotSize Material _ =
From To Ft. in. in. 1- -
From To Et. in. in. — -
15. SAND/GRAVEL PACK: -- - �-:
Depth Size Material N m
From To Ft.
From To Ft. tV o
16. REMARKS:
E6'1'CART ISI ELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
Fin�� ,TRUCTION STANDARDS, Njlb HA A COPY OF THIS RECORD HAS BEEN PROVIDED l'O THE WELL OWNER
_ Il.y. /-c;l�)= o�-
GNA IAE OF P - SON ONSTRUCTING THE WELL DATE
ubmitGMoL0r1l#tAff ihiQJM1 ' 'on o Water Quality,Groundwater Section, 1636 Mail Service Center-Raleigh,NC
7699G)GIG ` R I - i- thin 30 days. GW-I REV. 07/2001

WELL CONSTRUCTION RECORD 247742
North Carolina- Department of Environment and Natural Resources- Division of Water Quality-Groundwater Section
w'ELL CON1 RAC I Olt(INDIb']DUAL)NANIE (print) CERTIFICATION# "?
R'ELL CON"I'RACI'Olt CONIPANYNAME �y'y nsti'�-a= C�.1c=t.� .C�rz.c.z_.,.l f, PHONE # eFv 7-F1)0k
S'IAT E O'ELL CONSTRICTION'PEIt NIIT# ASSOCIATED WQ PERNIIT#
(if applicable) (if applicable)
L WELL USE(Check Applicable Box): Residential E�/Munieipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other❑ If Other, List Use
2. WELL LOCATION: Topographic/Land setting
Nearest Town:
�7 County C'>-/=%�✓/<�_� ❑Ridge ❑Slope ❑Valley ❑Flat
(cheek appropriate box)
(Street Name.Numbers.Community,Subdivision,Lot No-Zip Code) Latitude/longlludc of well location
3. OWNER: �,,J ETT✓? (degrees/minutes/seconds)
Address Latitude/longitude source:❑GPS❑Topographic map
(Street or Route No.) (check box)
/k/c,/?AVY Nr- 2fY� DEPTH DRILLING LOG
City or Tmvo Smte Zip Code From To Formation Description
( �) 6yy— �'6 7 c0 336, Pa 5, G
Area code-Phone number .TA, $07 : l.17 i eF
4. DATE DRILLED /✓✓ VV
5. TOTAL DEPTH: j L-7
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO R/
7. STA'PIC WATER LEVEL Below Top ofCasing: 3-6 FT.
(Use"+"i f Above Top of Casing)
S. TOP OF CASING IS / FT. Above Land Surface"
-lop of casing terminated at/or below land surface requires a
s'ariatce in accordance with 15A NCAC 2C.0118.
9. YIELD(gpm): 3o METHOD OF TEST 4,/Z
10. WATER ZONES(depth): 3yC' 3he ,
LOCATION SKETCH
11. DISINFECTION:Type Amount Show direction and distance in miles from at least
12, CASING: Wall Thickness z two State Roads or County Roads. Include the road
Depth Diameter or Weight/Ft. Material numbers and common road names.
From O To 336 Ft,
Front To Ft.
From TO Ft.
13. GROUT: Depth Material Method
From O To _Z1v FL o
From .70 To Y36 Ft, N
14. SCREEN: Depth Diameter Slot Size Material f'r'1
l37 -
From To Ft. in. in. _ ---
From To Ft. in. in. Z7- ---
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
M
From To Ft. ,�
N E5
16. REMARKS: `
�I D�HLE1344CIJ11T1iY'1� ]SWELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
- THAT A CO Y OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
I NATUI 'OF ERSON CONSTRUCTING THE WELL DATE
S ivisi n of Water Quality,Groundwater Section, 1636 Mail Service Center-Raleigh,NC
169141616 PIioitCNu.HWt7D3-321 1,within 30 days. GW-1 REV. 07/2001

268810
WELL CONSTRUCTION Rla:iu.;:
North Carolina-Department of Enviromnenl and Natural Resources-Division of Water Quality-Ground GTr undwater S al ion
WELL CONTRACTOR(INDIVIDUAL)NAME (print) 2i1.-1
I I + P 11 ,T'l` nc1 PHONE N 15�81 61-1-
WELL CONTRACTOR COMPANY NAMEYI
ASSOCIAT"ED WQ PERM1IITM
STATE WELL CONSTRUCTIONNPEMtITI ifa applicable)
i(alicablable
I. WELL USE(Check Applicable Box): Residential ls�— MunicipaVPublic ❑ Industrial ❑ Agricultural❑
Monitoring❑ Recovery ❑ flea[Pu:::p Water Injection❑ Other❑ If Other,List Use
2. WELL LOCATION: l
ornoraphic/Land setting
Nearest'Iown: arm County h r)4( P ❑Ridge cheeks p Slope ❑tebe*) Gi'ia(
(check appropriate be*)
rr t '?`OE( Latitudellon iludeofwelllocation
(Sheet Name,Numbers,Community,Subdlvrsian,Los No.,Zip Code) g
�— 1 vV)� � (degrto/minutolsrend+)
3. OWNER: �\ Lalitudcllongi(udesourcc:❑GPS❑Topographicmap
Address (check boa)
(street or Route No.) 2 o`r Oc DEPTH State
IOG zl code Prom To ormalion Description
City or To n slate P D 15
Arc'code-Phone number
4. DATE DRILLED 1D —
5. TOTAL bBFTII: 39 d `
6. DOES WELL REPLACE EXISTING WELL[ YES ❑ NO ❑
7. STATIC WATER LEVEL Belot(Top o'Above&op or Casing)
Fr.
8. TOP OF CASING IS Fr. Above Land Surface*
'Top creating lertnlnvled atfor below land surface requires a
earlance In accordance with ISA NCAC lC.01Ig.
9. YIELD(gpm):._METIIOD OF TEST
la.WATER ZONES(depth): IOCATtDN SKEICH
Cb1 Arnounl S Show direction and distance in miles from at least
1 L(DISINFECTION:Type Wall Thickness two Slate Roads or County Roads. Include ale road
12. CASING: a numbers and common road names.
Depth Diatncler or Wei hUfl. Material
To .25' Ft. GDEIU
Frorrt�_ 4
L1'— (V
To . O 7
From Ft rTl r.ri
From To Ft n c
—
13. GROUT: Depth Material Method ro CD ,
c Cot
Frorn __To Ft.
y.
Ftoltt To Fl.
14. SCREEN: Depth Diarneler Slot Size Material
From Tr—_FL—ill- in.
co m
From To Ft.
ir, in. — —'
W G
15. SAND/GRAVEL PACK: _
Depth Size Material
Frmn To Ft.
From To FL
16. REMARKS:
AC2C.WELL
R BY CEktF I T TBIS AND THAT
A COPY F 1111SED IN ECORD HAS BEEN PROVIDED TO THE WELL
�ONSTRUCT10NSf1CN� S,AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
S- O a
n n DATE
tF� SIGNATLP_ _F PERSON CONSTRUCTING THE WELL
G 6iiliiidt the arlg�na{to the Ivlslon of Water Qunlily,Groundwater Sections 1516 Mall Service Center-Raleigh,NC
ASHEIV01):1636_ a ne_Nb; 33-3221,wllhln 30 days.
OW-1 R I.n7/2(l0)

268809
!NULL CONSTRUCTION RECORD
North Carolina-Department of Environment mud Natural Resources-Division orwaler Quality-Groundwater Saclion
WELL CONTRACrOR(INDIVIDUAL)NAME (print) �"`•"^n -, 1'n �?tSC s/� CERTIFICATION► 2
WELL CONTRACTOR COMPANY NAME 1 ')� e.f ',N(� CTat,,v PHONE :Jl-Z9q�
ASSOCIATED WQ PEIN11Ta
STATE WELL CONSTRUCTION PEM11Ta (i fgpplicablc)
1. WELL USE(Check Applicable Box): Residential(fd- Municipal/Public❑ Industrial ❑ Agricultural❑
Monitoring❑ Recovery ❑ heat pump Water Injection❑ Other❑ If Other,List Use
2. WELL LOCATION: Topographic/Land setting
Nearesl'f own:Ma�_ CountyLl-p-� ❑Ridge ❑Slope ❑Valley ❑Flat
n/l Qr (check appropriate box)
(Street Name, umbtters,Comnwnity,Subdivision,Lot No.,Zip Code)
Latituddlongilude of well location
3. OWNER: L)OF1s1 WL'It�P1 (degrces/minmea/sttends)
Address t ` f "`�� P � LatitudcAoligitude source:❑GPS❑Topographic mnp
(check box)
(Sheet or Route No.) 2�gCk9 DEPTH pItILI,INGLOG
From To Form on Description
City or Tom Stale Zip Code
Ar code.Phone number C/s �, C
4. DATE DRILLED ��
5. TOTAL DEP"rll: --
6. DOES WELL REPLACE EXISTING WELL7 YES ❑ NO ILI—
7. STATIC WATER LEVEL Below Top of casing:-- FT.
(Use"+-Ir Above Top of Cuing)
g. TOP OF CASING IS I FF. Above Lnnd Sutrace•
'Top of using irrminalea,for beton I,nd rurrace requires a
,,,lance In accordance nilh ISA NCAC]C.01Is. n e
9. YIELD(gpm):�_METHOD OF TEST YtIK
10.WATER ZONES (depth): I OCABON SKETCH
I L�DISINPECTION:Type Amount Show direction and distance in miles from at least
Wnll Thickness two Slate Roads or County Roads. Include the road
12. CASING: numbers and common road names.
Depth IDim'ne`ler or Weight/Ft./-) nMm're�ial
Front_!To_� -FL��z_ (
From TD FI. —
From To Ft.
13. GROUT: Depth Mac at Method
To Ft. O o
From :v
From To FI. �-'
C
14. SCREEN: Depol Dimneter Slot Size Material c"-)
7 � n
Frmn To__Ft. ill. in. ro
From To Pl. in. in. w
15. SAND/GRAVEL PACK:
Depth Size Material
CO u
From To Ft.
From TD Ft
W G
16. REMARKS:
r
1 it,l ' II�RE�y RT7e T IIS WELL WAS cobimUCrED IN ACCORDANCE WITFI ISA NCAC 2C,WELL
I ) f CONSTRUCTION ST I S,AND THAT A COPY OF TT11S RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCFINO THE WELL DATE
Submit fhe originIIIIll the vision of Water Qunllly,Groundwater Secllon,1636 Mail Service Ceenter'Raleigh,
2001
A`"}Iiaa-F6J(FlrwteNo-(# 3221,within30de}'s.

WELL CONSTRUCTION RFCORU 270699
Nnuh 1 ;lndina - Ucp;ulnleni of Envin)nutenl and Natural Resources - Division of\\'ales Duality- Groun(lwater Section
k,F.11 l (IN lit l<l(lit IINUIk'IU(I AL)NAA1E (pr Ir_ RAr✓b Q_LL �.\-2J _ CER111FICATION/ ��J7„rlI ('(IN I It k('10 It COMPAN I NAN F,-___— $Q � 4Sl�.�lf�li-�� PHONE
SLk 11Nor:I.L I.OCSIHn( IION rr:Ralll'q A9SUCh\TF.1)W'O PERa1110
1 if applic;J`1cl (if applicable)
I. \t'F.I I. I ISF. I( hrck Applicalde Box): Residential 9--l"Municipal/Public ❑ Industrial ❑ Apicullurai ❑
;\I-minoing LI Rcco,cry ❑ llcal ['unit) Water Injection LI Other 17 111 Mher, List
I (I('A'i ION: Topogfnphic/Land setting
No"Iwo;I I n l,11 A Lk_ County cltep,,ke l0u dgco ❑Slope ❑Valley ❑Flat
FPIENbS1ll-`' Ct`1.KPlf� P_U hcrknppraprinlehot)
1':"I1"N,nir,Nnn,he(,,('rmmw,il Y.Snhdivikwo.Loot No.,Zip Cade) I alihidt')longihide of Well location
-
Add,css ---J.3s......ZY �,� 4'.�'�S L/J __ Lalinldc'Inueihulc. source:❑GPS❑Topographic nlap
n rcl rt Italic No) (check ban)
ky NC _ -2;���___._ I)I,I'I11 DRILLING LOU
a I 51,Ie lip G,k From "fo Fonnalion Description
50 _ $�t,E P•„PAn
s lrrrni. Dhl'r1I
!, 11OFS \\FI.1. Rr 111( E FXISI ING WE[,[.? YES ❑ NO
7 SIAIK WAIFR I.I',VFl. Below ]op of Casing:,�,�'�'-_f
M,,"I"if Aho,elopof('aaiog)
S l()POI'CASIN(; IS ---_ FT. Above Land Surlhce' -------- -- - --- -
•l np it rnga4 trrnniaatrd attar below hod surfate requires a z+ .-� --
r,riante h,arrarda nor alit. I5A NCAC 2C.0 11 A.
') 1'llflDlcpm) "_2 root E"1'i lot) or,9'Es"I'AL/l�IFr
I„ WAI lilt /ONI:S (dcplh):.2�5_L_rJ _ N
I I)(, ) ION SRETCII
_.
------------ --------
1 I. OISINI`I ('[ION: "I}'pc C/f,C�y� Amount—_ Shaw thirclinn and distance in miles front al least
12. ( .1SIN1 is Wall'rhickness hvo SI:IW Rand, nr County Roads. Include the road
L`rpol Diavier or WeighVi9. Imaicrial n1II116;•r S Trod c,muuon road names
I non To FI. o
Inn„ I FC p t
— - -- -
I1. (;POHI Ucpl6 Malcrial Melhnd N
I ,,, „ C--- 'In 2� II C 1e a r- CQ3-�t,7 n
II Cu-(?lam S- �jtA All n" N c, c
t $1-FI-I U I)cp]h -- Divncicr MIASi7C Material CD _ r:
I umi _ Io
I
Drpdi Sirc Mnlelyd
I will Io
1 I ) I Itl4i1 Vil li,` I I 'I"I I IIS WI:H,WAS CONSTROCI1:1) IN ACCORDANC I lVl I II 15A NCAC 2C,WELLf ( WTN I[I I It I I( SIA )t I )R,AND 111A"r A COPY OF'IIIIS RECORD HAS 13ITN ITOVIDFD 10 1I Ili WELL OWNER
l SIGNAIUIU:01'ITRSON CONS rRIJCTIN(j'l Ill: Wl:I 1. OA1E
, Su bolit I Ile(ulainu_Nto the 1 ivision of Rater Quality,Crunndo flier Sect toil, I61(, Mail Service Center-Raleigh,NC
uunc " it " ( 1.12211,Within 30 days. GW-1 REV. 07/2001

s
VVLLL CONSTRUCTION RECORD 270700
a
Nol III ('tuobna - Oepaumeal of Environment and Natural Resources- Division of Wafer Qualily-Groundwater Section
\I PII f11N7 R%( IOP I IN I IIVIDUAL)NAMF. �i._� 1LA) C j
p T� q� �Q/.I __._S_.-- CERI'IPICArI0N/ :D33 � j
w F'll l'gNllt\("I(IIt('UNI I'AiV I'NAME— `, jl. -_4(LC-1_Ld1�_q P110NE p `o,g) �37`O QOg
S I A I1 MAA [ANSI It U(C I ION I'ERNIITM _,__ASSOC L\TEII%V0 PER\Ill 407
I if applicolrlc) (if app!icnhlc)
I (\'P.I I. I 'SE (Chcck Applicable Box): Residential O Mwo6flal/Public O Industrial O ngricullura) ❑
%1"Ililorioe LI Recovery U Ilea( Pump Wafer Injeclinn Cl C)Ibcr U II 1)Ihcr. List Use
1\ i L1 1 O('A-I ION
: flop°gt; hiciiand scllirg
IJr.ura/'mrn _�11�,?fyqq_/�V (�uwuY_ �.G.C�_L 1=1Rirlge 11iSlope []Valley ❑Plat
.GRM)C-
N:vnv.Nwuhrr<,(',nn....miry.sti"I"i'mn.Lnr Nu..Lip Cudcr 1anlutcllonglturlC(1fsVCIl localmn
M% NIT IIA)
--_ C- — _ �5> `1 ___._ Idrgrervmim Ves/eeamdcl
1_�.d15._ R_L H St_.._ I.dihul:9i arpli:de snwce:0U1S❑I-opograplric mop
ISnyy��•'or t IWwe N, 04 - -- I>)`1')_LI DRILLINGLOQ
zip Code Fan❑ Ilr Formation Description
G .
v _ w Sa.vnV P.✓r�%
N, 11'Iranr r
4. UAI1. UItILLI.I) = _
6 1)OFS \VF.LL R1:11[A UF EXISTENG WELL p YES U NO E� ----- ---" — - �j
7 STATIC WAIF R I.FVEI. IIelowTopofCasing' 'r-g-5J� 1 1 -"-- - -- _-- --- ---GCS _-
(Us<"+"if Ahuve Tap of('aving)
R. I OP OP CASING IS. FT. Above Land Surfucc" --'_-""------------ -
z
'l,qr of ca.InG k•rmhrnlrvl altar btlorr land surface requires a ------------------ — -, c
.:n iante Lr acuvdan rallh lsA NCAC 2C.01 Ia.
\ n.LD g l) 2 MEI noD of rEsr�i /R
(. rot
I0. l\'A1lilI LONI75ldcplh):_ 38� - _...----. ,---- -- ,.-I
I DISIN1 I ('I JOIN I}pe_. Amount Shmv docclion nod dislance in miles front at least
12 CASING Wall'fhickness hvo Slate @oats mr Comity Roads. Include the road
Deplh pp 1),lipeler or Weight/Fl. N Icrial runnbers and common road names.
I will
I ran To li.
1'nnn 1T Ff
1 S t i1 OU I : Dcplb Material w Melhod
1 moi_..Q__ Tn_.-�(?_
I rnnr lll. .
-- c
I4 ti1 R11 N: Uepd, Dimncler Slat Size Maicri l
O
I
r u
o will -_._. lo._ __ It------_in. In. __. _--- N
T
n zr-r
I acprh Size Malerinl ON o<
I non In �o
I I"In fn _ _--- I"(------_' -- a�
r�
N
l rlr) I ll ltl 111 ('BR I III§HvIsion
LL WAS CONSTRUC1 ED IN ACCORDANT WI I I I I sA NCAC 2C, WELLN;IRI1r IIONSIAEATA(' I'Y OF TF IIS PFCOR 1)1 AS PIT N PROVE DEL) 1011 IF WELL OWNER
U II I'OF PERSON CONS I RUCTI N61 I1I N'PI.1. DAIl:
Sulrpril Ihl of ig11141 l Water Quality,Groundwater Secliun, 1616 Nlail Service Crider-Raleigh,NC
i.1616 Plnav Na. [phone],within 30 (Inys• (iW-1 REV.07/2001

WELL CONSTRUCTION RECORD 271122
North Carolina-Department of Enviromnent and Natural Resources-Division of Water Quality-Groundwater Seclion
WELL CONTRACTOR(INDIVIDVAL)NAME (print) � 2 \ ' 1'Sf'`1 CERTIFICATION 0_2_�LVU
_
WELL CONTRACTOR COMPANY NAME 0:11e ' ted — l�'.�i= PIIONE a f-M)EZ�7
STATE WELL CONSTRUCTION PERMITa ASSOCIATED WQ PERMITM
(if applicable) ��// (ifapplicable)
I. WELL USE(Check Applicable Box): Residential h�Municipal/Public ❑ Industrial ❑ Agricultural❑
Monitoring❑ Recovery ❑ Heat Pump Water Injection❑ Other❑ If Other,List Use
2. WELL LOCATION: Topographic/Land setting
Nearest'lowu:M`.t —A _Co/unty_ - 1, ❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
(Sheet Name, umbers,Community,Subdivision,Lot No.,Zip Code) Latitude/longilude of well I c)tion
7
, N35 t01 ;sq, ruB9: 11 f_
3. OWNER: L`'1� �� t`�� (dellrees/minutes/tccends)
Address 191 l\STh1P YP ( �r',ll Latitude/longitude source:❑GPS❑ h m
Topograpic ?p
(check box)
(Sheet or Route No.)UL
LfiaUID DEPTH DRILLING LOG
City or Tow state Zip Cale From To F/fiI}alion Description
D _
Area code-Phone number
4. DATE DRILLED 0-F
5. TOTAL DEPTH: 205
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO ❑
7. STATIC WATER LEVEL Below Top of Casing: 50 ' Fr.
(Use"+"if Above Top of Casing) n -
g. TOP OF CASING IS Fr. Above Land Surface* I
*Top orarsina terminaled aUor below land surface requires s
varlonce In accordance with ISA NCAC 2C.0119.
9. YIELD(gpm): Si METHOD OF TEST__— —
10. WATER ZONES(depth): LOCATION SKETCH ^
11. DISINFECTION:Type '><- " Amount S Show direction and distance in miles from�leasr --
12. CASING: Wall Thickness two Stale Roads or C Pity Roads. Include&3e road
Depth Diarneler or Weight/Ft. Material numbers and cottlmo toad names. 8
From U To J'(." Ft.
From To Ft. -
From To Ft.
13. GROUT: Depth Mot rial Method �
From 0 To >u) ' Ft.
Prom To Ft.
14. SCREEN: Depth Diameter Slot Sin Material n / —
/'
From To__Ft. in. in.
From—To—Ft.—ill. in. r\)p --
>, N c
15. SAND/GRAVEL PACK:
Depth Size Material
From To FL
From To Fl.
r 0 �� V ��
11 DO) I LL WAS CONSTRUCTED IN ACCORDANCE WITHISA NCAC 2C,WELL
(CONSTRUCTION STANDARDS, IIAT A COPY OF TIIIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
/-.2-
SIGNA URE OF PERSON CONSTRUCTING THE WELL DATE
I
_J
SublRlt the orlRlnRl(011r�,V Ion o 1Vater Quality,Groundwater Section, Mall Service Center-Ralelgh,NC
�"`—' �-- [thin 30 days. GW-I REV. 07/2001
2769V-16J6fiotic'Flb:j