Cl CY2002

From To
From To
13. GROUT: Depth
From F7 To .90
From To
14. SCREEN: Depth
From To
From To
15. SAND/GRAVEL PACK.
Depth
To
To
From
From
16. REMARKS:
WELL CONSTRUCTION RECORD 262940
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section/ / /
WELL CONTRACTOR (INDIVIDUAL) NAME E(�(ppr�rint)\DOW1l�Cl` 5 �14 L /t l'tOf CERTIFICATION W,90)(/
WELL CONTRACTOR COMPANY NAME JO'(i//�/- /�!/T.%/" / // .i PHONE it fcai CS�tzc t7
STATE WELL CONSTRUCTION PERMITS ASSOCIATED WQ PERMITS!
(if applicable) (if applicable)
aP /
1. WELL USE (Check Applicable Box): Residential E" Municipal/Public It Industrial 0 Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATI N:
Nearest1Town: County (24/
„GE!//F( 1/1 _/4) / e
(Strebr-N1ante, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER 4 < f/i�F. Anine rittetprs 45r.
Address �(1 V it4 b
(Street or Route No.)
I-103
Ci r Town State Zip Code
Area code- Phone number
4. DATE DRILLED —90 -DA1
5. TOTAL DEPTH: //'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO Its
7. STATIC WATER LEVEL Below Top of Casing: FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 02 ' FT. Above Land Surface'
*Top of casing terminated at/or below land surface requires a
variance In accordance with I5A NCAC 1C.0118. "q
9. YIELD (gpm): 50 - METHOD OF TESTA,
10. WATER ZONES (depth):
11. DISINFECTION: Type
12. CASING:
Depth Diameter
From_12__ To. / r-1 7 ` Ft. (1, 25
Ft.
Ft.
Amount
Wall Thickness
or Weight/Ft. Material
�0L/ fur
MatpC %ial Method
Ft. prv- in� threCelrC�
Ft.
Diameter Slot Size Material
Ft. in. in.
Ft. in. in.
t ...II; /, ; M41 eri`i 7
Topographic/Land setting
DRidge ❑Slope OValley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING L(G
From To ion Descriptjo
o — 15'
/S /30/
LOCATION SKETCH
Show direction and distance in miles from at least __
two State Roads or County Roads. Include the, road
numbers and common road names. t`>
0
w
w
co
I DO HEREBY CERTIFY THAT 1S WELLCWAS'�CONST iiU C D IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRU ON STANDARDS, l titrAIddi*bi Ilci ORD -AS BEEN PROVIDED TO THE WELL OWNER
3- 2 0 oa
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division ofWater Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME y(p/rint) (-IOW a3/ �iL r ( t \ <o t\ CERTIFICATION # Qq
WELL CONTRACTOR COMPANY NAME d/r /1%1G!/ ` ,✓ // n5
STATE WELL CONSTRUCTION PERMIT* ASSOCIATED WQ PERMIT#
(if applicable)
(if applicable) J
1. WELL USE (Check Applicable Box): Residential/Municipal/Public Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other ❑ If Other, List Use
PHONE * jB13) g 37-.2q97'
2. WELL LOCATION:
Nearest Town:''W*'.�i 5�UP County�4/
,r)mlle rZ;r P-
(Street Name, Number , Community, Subdivision, Lot No., Zip Code)
3. OWNER:,L4rry aft/Ls
Address rl I CE( CIThC \\} CcrX c
(Street or Route No.)
City or Town State Zip Code
(--)
Area code- Phone number
4. DATE DRILLED
5. TOTAL DEPTH: L a 5
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: J__FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS I FT. Above Land Surface"
*Top of casing terminated at/or below land surface requires a
variance to accordance with ISA NCAC 2C .0I18.
9. YIELD (gpm): LOO METHOD OF TEST Ail
10. WATER ZONES (depth):
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
pEPTR DRILLING LOG
From Torm
r ijoat on DesEyption
n -
S — SD `
C — 424'
11. DISINFECTION: Typel-r%17 -icy% fe/s' Amount
12. CASING: Wall Thickness
Depth
Diameter or Weight/Ft. Material
521.21
From_ To LL Ft. �. p✓C
From To Ft.
From To Ft.
Mat 'ai
From._ To 070 r FL�L11 ct
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
13. GROUT: Depth
Method
15. SAND/GRAVEL PAC
Depth
From To
From To
16. REMARKS:
I DO HEREBY CERTIFY THA THIS \B60I11VDX1� a� !i �,t�'�j�,r a IN ' CCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTIO)J STAND • ' aS 'r YI&' . a•� +E.S') r-= _ • a HAS BEEN PROVIDED TO THE WELL OWNER
3 a� —Da
262930
LOCATION SKETCI-[
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
CD
•
J
€ALwc, U)AtBh2
SIGNATURE OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
27699-1636 Phone No. [phone], within 30 days.
GW-I REV. 07/2001
DATE

2. WELL LOCATION: /��
Nearest 'I own:///dyi'-< pi`//e County C /ac/
Nwk iys
(Street Name,�N//umbers, Community, Subdivision, of No., Zip Code)
3. OWNER. /6f4/6 N /Jac A /
Address , .—SEC—, 1}1.,) y I Z'
(Street or Route No.)
jig (/IX I/)fie hi 2 c-Qo q
City 6r Town State Zip Code
(—)
Area code- Phone number
4. DATEDRLLEDS— 0.2
5. TOTAL DEPTH: DOC'
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO ❑
7. STATIC WATER LEVEL Below Top of Casing: Sco ` FT.
(Use "+" If Above Top of Casing)
8. TOP OF CASING IS i FT. Above Land Surfaces
'Top of casing terminated atior below land surface requires •
varianceILDgn m): (..ice IS METHOD OF TEST 4/r/C
NCAC 2C .0118.
9. YIELD (gpm):
10. WATER ZONES (depth):
I I. DISINFECTION: Type
12. CASING:
Depth r Diameter
Front /5 To 90 Ft. 6 1a5
From To Ft.
From To Ft.
13. GROUT: Depth Matcn Method
From .0 To 2O / Ft.
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From Tr Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK: Depth Size Material
From To Ft.
From To Ft.
Amount -S
Wall Thickness
or Weight/Ft. Material
Q / Pvr
16. REMARKS:
B IC;i_ ++ l • TTHIS WELL WAS CONSTRUCTED )N ACCORDANCE WITH 15ANCAC 2C, WELL
S, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
5-I'2
262351
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural �/ N Reesoourcesn-- Division of o'f.WalIter Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) QrAYYIE--S (Z/c W { I l son. CERTIFICATION/ario67
/�
WELL CONTRACTOR COMPANY NAME � l/I�.oQ �i1 %L' f/ //!�' PHONE a jtan e57-.2QQ 7
STATE WELL CONSTRUCTION PERMITS ASSOCIATED WQ TERMITE
(if applicable)
(if applicable)
I. WELL USE (Check Applicable Box): Residential la"-Municipal/Public ❑ Industrial 0 Agricultural O
Monitoring ❑ Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use
Topographic/Land setting
[Ridge OSlope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:[GPSOTopographic map
(check box)
DRILLING LOO
tion escription
LOCATION SKETCU
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
nHR°T1�
A
GNATURE OF PERSON CONSTRUCTING THE WELL DATE
o the Division of Water Quality, Groundwater Section, 1636 Mall Service Ceenterl RRBVgh, NC
or(s• t 919) `33-3221, within 30 days.

258261
WELL CONSTRUCTION KECOI41)
North I Molina - I)epar Inienl of linviiimment and Natural Resources - Division of Water Quality - Groundwater Section
\\11 I I'(IN1 It\(It)I1 (INIII\In(IA1.) NAMELidol) ‘�1 �l^'�y-in^%C'S,---. __ __ nit rlllo\rION a -J�/�
\\ III 1 II\ I It \C I t)II ( (flhi',\N\ NAME __-
ketiof€�-.__El>N.1,L_vRILLJ..;C,-_ I'lllmr: a ittiS 7 C6PCNSS
S I.\ I I \' III. 1 ONS 1121'(-1 ION 1'Eit\111# \SSO(l.\'I'Eli WQ I EI('III#
I it applic;ddcl inapplicable)
I. \VI I.I. I:SE (('heck Applicable Box): Residential Vlunicipal/Public ❑ Industrial ❑ Apt 'cultural ❑
\Inuilnl ing ❑ Reenceiy 0 Heat Pump Water Iujeclion ❑ Other ❑ If Other. list Use
Vc P.l I.I.( )('AIlON:
Nearest lo\\n �lN C"S vt11 t,___Courtly_�jfi
i r( rl 4S''e lac1-CA es1/4_--?-i2<-kkrf
Knee, N:nrm, Nrmi ito- Community. Suhdicisiim, 1 tit No Zip Code)
( \cN[R: 77I It-- Ol-LIB J
Adds ess
_kcK -93'6
C\ I SM1«I ar Rnmc No.t
ist)d \rr� tie 715
r ih lu,s lr tit. le Z Zip Cade
Vrcn tide Phone nnnibein
-I 11.A1 p DRll Ibl) U` %' 0
S. IOf Al. DIII'IIC,_yj_.__._.._..__.__
G. DONS VVP.1.1. R1 1'I. /A('I? EXISTING WELL? YES ❑ NO ❑-
7. S I Al IC WA] ER I.I VP.I, Below fop of Casing: \SQI: F.
(Ilse "r"if Above lop or(asing)
S. 1 (bl' Of CASING IS / El-. Above Land Surplee*
• 1 np of tastily, Icunivalii aI/nr helms land surface requires a
s:u tonne lit areorrl: mr tsith 15A NCA(' 2C.(II Ia.
1.l1:.1.0 („p1111- o NI fnOD OF :IFS f '
10 WAI- F 12 lt)NLS ldcplh):2a0 Jay'
l-opogra) tc/Land setting
❑Ridge ope ❑\'alley ❑Ilal
(clunk appl pride box
I.alinlde/longitude of well locnliun
Idepreesal inures sccnudst
I :dinulr/lungiludc solace:❑GI'S❑ lopogiap11ic map
(check box)
Dill'lll DRILI.INC; I.0G
Ilunl To Ionualion Description
_ ___�, (.__ Lc-7
y r ��' 6-r19 41-xr3
LI)('AIION SKM ('I I
II. ItISINIIi(`IION: I}Hpr f _ Amount 'L L(/�
Sho\v direclinu and dislance in miles limn al least
12. CASING: — -- Wall :thickness Rim Slate (toads or Comity Roads. Include the road
Depth y)ianleIer or WWei lht/Ft maierial numbers and common toad names.
I win 0 1n y(. Ft. h-'_--,5C)�t�I / c c
from To Id.
I mill To Irt.
II (iltl bil,,,///l��� I )eplll NIaltald 1\Icthud-
Inun loaf,Y_—_ll_-.... e._—_.
I win a U - in yJ' _It_
1.1 St di1:1:N: Depth Di:m:ler ul Size NI:aerial
I Iran To ri. in. in.
I inn 10 ICI. in. -__-_ ill. ---,_--
Is_ SAND. li RRAVlll" PACK:- -
Urplh Size M1I:dcri;d
I ail li IL
11rm1 I I I.
lo. Rl-M1IARKS:
0Z:9 WV 0ZZO
I li)t) 11111 II\ ('I'RI (I V il'I I \ ly
(4-141.S4J411( 444-44 S 2 Hi-4611 Sl
� I
IS WI:I I. WAS CONSIRUCI f.D IN ACCORDANCE Will) ISA NCAC 2C. Wlill.
NDlIIA1 A COPY OF 1I11S RECORD IIAS IlFEN I'RI/VIM:I)TD 1III:Wf1.1.OWNIFR
iNAIUILIr. OF 11I[It [7 Cy.....N49R11 1111: Wlil.l. DAI I:
�nl+>;rrif tJt ti rlCrr(afttltFtt`I)iv is on of NV:11er Quality, Gruunde-:der Section, 1636 Mail Service Cr vier - Raleigh, NC
l..l,h'Ia71rt(r HrrmmN i I/k19):731-3121, vwithin 30 caws. (iW I REV. 07/211111

268282
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Divisionsiof Water Quality - Groundwater Section
'^//
WELL CONTRACTOR (INDIVIDUAL) NAME (print) \ X-aYY1GS Q. (A 11 ison CERTIFICATION Pio1
S7
WELL CONTRACTOR COMPANY NAME rl UQl'
( CA) C'IIK,(I+v19 PHONE 8 12.2 l S,2 7
STATE WELL CONSTRUCTION PENMIig ASSOCIATED WQ PERMITS!
(If applicable)
(if applicable) 1. WELL USE (Check Applicable Box): Residential 4T/
Municipal/Public ❑ Industrial ❑ Agricultura: ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest To t1 ry i UA P County ,t /
(h-knnftvo
r
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
� rc> / �.pn/er (degrees/minutes/seconds)
,f� f r (check box)
3. OWNER: J-(/n-/
Address L-Y-)\n
)
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
t.n*Dfl C@ \Pr ick Latitude/longitude source.❑GPSOTopographic map
(Street or Route No.) (801L-L DRILLING LOG
CRyorTo n From Jrm lion Descri Lion
Cry or Town State Zip Code Q /
( )-
Area code- Phone number
4. DATE DRILLED 7- /O-O o2
5. TOTAL DEPTII: (SD
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO FIV
7. STATIC WATER LEVEL Below Top of Casing:
(Use "+" If Above Top of Casing)
8. TOP OF CASING IS I FT. Above Land Surface'
Top of cuing terminated at/or below land surface requires a
variance In accordance with 1SA NCAC 2C .0I18.
9. YIELD (gpm): T) METHOD OF TEST 4.
1(1
10. WATER ZONES (depth):
DE
(7 - To
/
$! 1 - CD Zitp
11. DISINFECTION: Type
12. CASING:
Depth
From /% To L
From To
From To
13. GROUT: Depth
From /7 To ,2D ' 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
b1P,k Amount
TCWall Thickness
Diameter or Weight/Ft. Material
/D ( Ft. (n,A '1)1o2/ Pic
Method
1
i 1
100 HEREBY CER FY AT THIS WELL WAS CONSTRUCI ED IN ACCORDANCE WITH I 5A NCAC 2C, WELL
CONSTRUCTION STI S, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
A
7 //- 2?-2
SIGNATURE OF PERSON CONSTRUCTING DATE
ING THE WELL
99-1J
_ Submit the original to t a Division of Water Quality, Groundwater Section, 1636 Mall Service Ceenterl Raleigh,
NC
276636-PhnnC-t4 s1 -) 733.3221, within 30 days.
Ft.
Ft.
From To Ft.
From To Ft.
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common toad names.
LC:OJWV I£uvreo

WELL CONSTRUCTION RECORD 26823
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Dos R0(4 W I1SO� CERTIFICATION a2 ��
WELL CONTRACTOR COMPANY NAME l tr UQC t�Q-,l C\C:11''�0 PHONE a fi )
STATE WELL CONSTRUCTION PEMIITB ASSOCIATED WQ PERMIT,/(if applicable)
rif 000licablc
I. WELL USE (Check Applicable Box): Residential 6Y Municipal/Public 1 Industrial ❑ Agricultural 0
2. WELL LOCAT,I,ON:
Nearest 'lown: t4' ES V' I� County('ICrt)
Ni1-AC C CP�c\Pf
(Street Name, (Numbers, Community,Subdivision, Lot No., Zip Code)
3. OWNER: I+,40Y\ (%enIic
Address 9.2i3r) \--VI-ACY\ L_Qr-Vei 1
' 1 (Street or Route No.) LO"1
C1ii(y\\ 1�
Iy or Town Stale Zip Code
Monitoring ❑ Recovery O Heat Pump Water Injection 0 Other O If Other, List Use
Topographic/Land setting
❑Ridge OSlope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
( )
Arts code- Phone number
4. DATEDRILLEDID- 1-07
5. TOTAL DEPTH: 5 C''S
6. DOES WELL REPLACE EXISTING WELL? YES O NO D
7. STATIC WATER LEVEL Below Top of CasRasing Top --- Casing)of
S. TOP OF CASING IS I IT. Above Land Surface*
•Top of ening tenntnvted at/or below land surrare requires •
variance In •ccord•nce with ISA NCAC IC .O II B. •
n,
9. YIELD (gpm): 0 METHOD OF TEST r{ 1
10. WATER ZONES (depth):
II. DISINFECTION: Type 131-k b t tdds Ainount S
Wall Thickness
or Weight/Ft. Material
5=I PY['
12. CASING:
Depth Diameter
Front D To.)0' FT(o•a)5"
From To Ft.
From To Ft.
13. GROUT: Depth Material I Method
From iD To 2O i FL pnr+" &vtJ+
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
Front To Ft. in. in.
From To It. in. in.
IS. SAND/GRAVEL PACK:
Depth
From To Ft.
From To Ft.
* 1U-RI:M1SNtxa—i
n
OWNER
CONSTRUCTION STANI)AKDS, AND TI IAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO
! I
wt %ail
/ SIGNATURE OF PERSON CONSTRUCTING THE WELL
Submit the orlginalto the Division of Water Quality, Groundwater Section, 1636 Mall Service Ceentter' Raleigh,
C
21699-1636 Phone No. [phone], within 30 days.
Size Material
(degrees/minutes/seconds)
Latitude/longitude source:OGPSOTopographic map
(check box)
DRILLING LOG
Formation Description
DEPTH
From To
- �s
-
p` —
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common toad names.
fDOlIEREBY�EttTTFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I SA NCTCIE2C�WELL
/ - �1-oa
DATE
c
n

268428
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural�Resourrcces,,,��iof Water��i�/IQuality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) � \ l (2 \ , `t' ivision
CI<-t1--�,u . CERTIFICATION # ? I .r-1
WELL CONTRACTOR COMPANY NAME v+" r`-�vtL-reLSCU_lbu L.--(PHONE ii
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential li Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATI4 N:
Town: iat.=
al LC • MS •—•--
Bare
•
County
•
, Numbers, Community, Subdivision, Lot No., Zip Code)
.=e
(S
3. OWNE
A
Address ra«I
I
•
ity o Town S� Zip Code
MO
Area code- Phone number
4. DATE DRILLED k a -
5. TOTAL DEPTH: W4
6. DOES WELL REPLACE EXISTING WELL? YES El NO V
7. STATIC WATER LEVEL Below Top of Casing: Lk.D FT.
(Use "+•• if Above Top of Casing)
8. TOP OF CASING IS \ FT. Above Land Surface'
*Top of cuing terminated at/or below land surface requires a
variance In accords ce ith ISA NCAC 2C .0118. ate/
9. YIELD (gpm): METj-IOD 9F TEST
10. WATER ZONES (depth): ``� 1
11. DISINFECTION: Type \ �l Amount
12. CASING: Wall Thickness
Depth; Diameter or Weight/Ft. ,-Matplial
From_ To kA1C Ft. to,/4' Q2.21. (o V
From To Ft.
From To Ft.
13. GROUT: Depth 1 Mat
From 0 To Ft.
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
O
Slot Size
in.
From To Ft. in. in.
Material
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Topographic/LanOetting
❑Ridge ❑Slope alley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
PRILLING LOG
Foni(ation Description
DEPTH
From To
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road "2.
numbers and common road names. CD
CO
16. REMARKS:
11-!Iy$,TRTN�
11'
2fGn
Submit the original to t
-ritt-,k1ET¢rnePwf 733-
At:Mr ' _i h _ C,;-HCE
IS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
AND3TiAT.A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WALL 0
IGNA U E O FPERSON CONSTRUCTING THE WELL
ion of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
21, within 30 days. GW-1 REV. 07/2001
L')
r:

I I'
LL
2C6CCOO
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and
WELL CONTRACTOR (INDIVIDUAL) NAME (print)
WELL CONTRACTOR COMPANY NAME 3
STATE WELL CONSTRUCTION PERMITS
ifa licable
NaturalnResources - Division of Water Quality - Groundwater Section
r Rat�2- P. Alt CWIC
TwR CERTAT1ON*3I75
I CR S (� G(-.t_ DR I LLL I t�i G SIC PHONE ► (%S) 745 "?-1 GG
I ,AS5OCIATED WQ PERMIT'
muni (if aenlicnhlel
narasauseusimesiaran
1. WELL USE (Check Applicable Box): Residential pY MunicipalPubllc ❑ Industrial 0
Monitoring 0 Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: t3dYC-SVt tkE County CLe /
C'i-1hiRMAkre F1IP)h vt610N Lint *4
(street None, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: i o n 0 Red VC s
Adrirc o 1042 Stinm/ l�1= Uri
(Strom catRo tc No.) ,,,,,
s$L_t_1Leticeyl1P p �3.
City or Town 514144) Zip Code
('MO)- 3 % - Cl e'14
Area code. note number
4. DATE DRILLED) I-2 2.-0 a
5. TOTAL DEPTH: Co 25
6. DOES WELL REPLACE EXISTING WELL? YE 0 I)10 VP/
7. STATIC WATER LEVEL Below Top of Casing:
8. TOP OF CASING IS t/Z Pie 4." Jr Above Top of Casing) FT Above Land Surface*
'Top of valor terminated at/ur below 1aad su:fate requires t
variance In accordaace wish ISA NCAC 2C .0118,
9. YIELD (wpm): I METHOD OF TEST PI R.
0. WATER ZONES (depth):
11. DISINFECTION: Type
12. CASING:::
th
Frond_.:_-)__ Top 23
Front _,_ To F)
From To!_
13. GROUT: Depth
Frorn 2 Q To 0
From To_
14. SCREEN: Depth
From,To
From_ To
15. SAND/GRAVEL PACK:
Depth'
From To
From To
T1-1 Amount t 1/z lbs
Wall Thickness
Diarpeter or Weight(Ft. Material
Ft. b $1DIZPI PVC -
Ft. Cr) 27•G PUC
Ft,_
Ft.
Ft.
Diameter Slot Size Material
Ft. hi
Marginal
CEov1Cr(r
Method
GReVtry
Ft. yam, jn in.
Size
Ft__
Ft.
16. REMARKS:
Material
Agricultural ❑
/Topogrtpkve/Land setting
Ridge OSlope ❑Valley ❑Flat
r' (check appropriate box)
Latitude/longittide of well location
(dcgccx'miauten/acccnds)
Latiwdeflonigitude SoLtroe:OGPSU T opogTaphiG map
(check box)
DRU Li.NG I c,,G
Formation Description
TLYD So/— 6—
/ _ 35 TaN CUECIER40 Rock
RAv textufkr&ca Rcz-K
fW?K Gk. keeic
109 ?SO —Esc LlairG722 1{at=;Aoc-K
u REN/
gazD
O
From�EM To
0 -
109
4L2, -Sze
N co
LOCATION SKETC o
Show direction and distance in miles frcni at !east
two State Roads or County Roads. Include the road
numbers and common road names.
-.-��-CY141rmake�,- we(too
) �( t.celt's at entails:ifi)emea'rt
c-,
c
CD 4rz-
>0
en.e
mho
G1
440
\\L)L�
tx
MMEMI
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRULIED TN ACCORDANCE WITH 15A NCAC 2C, WELL
I.UN,1,{K�IJL i YARDS, r XHA A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
/P-2-D2
SIGNATURE OF PERSON CONS —MULL INO THE WELL DATE
Submit the originlitk the Division of Water Quality, Groundwater Section, 1636 Mail Sery ae Center - Raleigh, NC
27699-1636 Phoile No. C919) 733-3221, within 30 days, OW-1 REV. 07/2001
II
r

WELL CONSTRUCTION RECORD
North Carolina • Department of Environment and Natural Resourcess-�Dirviissiioon of Water Quality - Groundwater Sectio o
n
WELL CONTRACTOR (INDIVIDUAL) NAME (print) t- R?.M2 C P. \Y t UDR. CERTIFICATION 4,530.c
WELL CONTRACTOR COMPANY NAME -3 YERS y.1 C-(_L butw u(, The PHONE ii-Zr2)2151166
STATE WELL CONSTRUCTION PERMIT* ASSOCIATED WQ PERMrrd
'if applicablet
if licable
I. WELL USE (Check Applicable Box): Residential MunicipaLPublic 0 Industrial ❑ Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCAT,IiQN:
Nearest Towp YeSkaLIE County CLt Si
7CLJ/� tSudcNc4Q)
(Snret None, Numbers, Community, Subdivision, Lot No., Zip Code)
;
3. OWNER: D6V(D 3e ot,
Address I a(,-7 Uppayer a -AI Rd
, (Street OrTtoute No.)
t.a TTIQtsf e to30jy(n
City or Town State Zip Code
Cam- 24Ct — 4434
Area code- Phone aumbeir
4. DATE DRILLED l�� C7' O
5. TOTAL DEPTH: AC
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing:
8, TOP OF CASING IS 4 it Z tun ��y " If Above Top of Casing,)
FT Above Land Surfaces
'Top of cuing terminated actor below land surface requires a
variance In tccordaa with ISANCAC 2C .0118..
9. VIEW (pm):(0Q METHOD OFT?ST @i2
10. WATER ZONES (depth): SQ,
11. DISINFECTION: Type j 4T{4
12. CASING:
Depth Diane:ter or W i t/Ft, Material
Fronrp23 _ To i) FL r ,_5 -C.
From Fro To Ft. (pail �I SAG
From To, Ft.
13. GROW': Depth Material Metho
F1'OITLO To ra.o Ft Cep twi Z(/.4{
From To Ft.
14, SCREEN; Depth Diameter Slot Size Material
From, To Ft___in, in.
From To Ft..e __jn. in.
15. SAND/GRAVEL PACK:
Depth: Size - Material
From To Ft
From To Ft._
Amount 3 oZ
Wall Thickness
16. REMARKS'
Topographic setting
QRidge °Slope alley ❑Flat
i (check appropriate bon)
Latitude/longitride of well location
(dexreci/n:iauwi+won e0
Latitude/longitude sotuce:❑GPS❑Topographic map
(check box)
D� PTg DRILLING LOG
From i To Formation Description
O ,+ L
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads, Include the road
numbers and common road names.
IOLAA 9ucJcMFa2'CO
tv�
rs
L WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
AT . COPY OF THIS RECORD HAS BEEN PROVIDED ZO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the origins to tit-: Division of Water Quality, Groundwater Sectlon,1636 Mail Servlee Center - Raleigh, NC
GROURT5Mbelf le6Efidgiltio. (919 733-3221, within 30 days,
ASHEVILLE REGIONAL OFFICE OW-1 REV. 07 2001

264536
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME, lariat) 30VN PS C2-1// �� t L Senn CCRTIFICATION 0.-7Q0 CZ'
�/yl r//F?F /f%S/ N r//'ij PHONE a fi62 )V51-PL� C1
WELL CONTRACTOR COMPANY NAME ///i
STATE WELL CONSTRUCTION PERMITS ASSOCIATED WQ PEIU.:r`M
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential ID/Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring ❑ Recovery ❑ Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCAT N:
Nearest 'fown: YPStl2 RI Ile // Count Y�
�� z, ///r'0/ Qri✓C
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER:
Address
lYi1PL JMt(FC kfr
lnt-(l o A--DyeKN
(Street or Route No.) 2��0
\\ ne NC`
City or Town State Zip Code
(--)-
Ares code- Phone number
4. DATE DRILLED //- /S"- 0.2
5. TOTAL DEPTH: /.00 r
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO ❑
7. STATIC WATER LEVEL Below Top ofasCaring)
ing:: 6DIT.
N
8. TOP OF CASING IS I Ff. Above Land Surface*
•Top of cuing terminated at/or below lend surface requires a
variance In accordance with ISA NCAC IC .011R.
9. YIELD (gpm): 30 METHOD OF TEST ;111
10. WATER ZONES (depth):
a hlil pQ(IPR Amount PE)
-I
DISINFECTION: Type TT
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
Front 0 To (OS Ft. 4 ,25' 0/ pile'
From To Ft.
From To Ft.
13. GROUT: Depth Mat riot Method
From /J To 2,O i 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.
.1111M1rr
Topographic/Land setting
[Midge tllStope Malley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To fjorrr)ation Description
5"/
S — .i0/
3(o (
.SE") - //.S/
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
16. REMARKS:
I DO I IEREBY CERTIFY TIIAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE Wire! ! 5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
21:
A//- /5-DATE
SIGNATURE OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality, Groundwater Section,1636 Mall Service Ceenller, REVgh, C
21699-I6J6 Phone No. [phone], within 30 days.

264910
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and NaturalN�Resources-.o/- Division of Water Quality - Groundwater Section
\1 F.I.I. ( rev It.\fi Olt (INmvlitlAL) NAME (print) 4 rrrm/ .1S u'S CENTIFICA'ilON Yc,J lo.i
\\ tli. I l )YI It \(' I int Co\IIANI' NAME Cii-B<X't /J4 e—I- 1J_,a_'iec..d; ___.,____ PHONE M er..57-cfa
rer
St.\II \ci:l. I. CONS [WTI ION 1'EItMITH ASSOCIA a ED W1) 1'F0D11'IM
Ill applicable) (ifapplicable)
I WLI.I. krSF (Check Applicable Box): Residential IV Municipal/Public 0 Industrial ❑ Agricultural 0
hInriiiainc LI Recovery ❑ I (cat Pump Water Injection ❑ ' Other 0 If Other, List Use
2 VA'I!I.1 I II('AI ION:
Net esl'I awn' M.i,?r?Nl County lli-'9
/-1,')<...isr .=/t RJ
i `r Furl Nmnr Nmnbr¢. t om nwnily. Subdivision. Lot No.. Zip Code)
1 I l \\' N 1112: ,2 )/ 4%s / ,J
Address P. 0_ +3.,t • l.L/a
Gd ateor lltont< No
f / C)
care n Lot n Srnie Zip Code
�37-eX?5'
,Aire Ada I')s tin nomhn
4 DATE DRILLED )9 s .3°" o )-‘
S. II IFAI. DI?1'TII: 2S
A. In iiiS \VEIL(. RITI.AC'F. EXISTING WELL? YES ❑ NO ❑
7. SIAll('WAII'RLEVEL Below Top ofCasing: „. FT.
(Use "r" if Above lop of Casing)
S. 11 or I IP CASING IS L FT. Above Land Surface'
• Pao of rnsiug Irrmivalrvl alior below land surface require. a
•n rbnce In accordance will. ISA NCAC 2C.ar 18.
V. \'lll.D(gpmY 2,51___METHOD OFTEST
�
III. WA -I FR ZONES (depth): 'Do' //v'
Gl
II. I)ISINI-El-(ION. I}re _/7_ //
__ Amount C Y
12. ('ACING: Wall Thickness
! I repel Di, meter or Wei '((VEIL Material
I Non (,) t o / � Ft.J /d.�'' -5t7'�?TC1
I-tiom .U_.-fo 0_ FI.__ L_d. SGZI'!O ___.l.V_�
Farm 1 t' I't.
I I. IMOW Depth Material Metlrod
I Ann 0 to d.0 ' H. ./
I tuna '.LO l o y I' rt.
I I S(PIEN'. Depth Diameter'/iol Size Motelnil
b nvn_,j_0_-I-a._7.0 II. Z in. .020 in. r ✓L
I lam lb Ft. in. in.
IS. SAND!I III A VEIL I'A(-It;
.
Depth Size Material
1 Ann lL PI
loouw_ fo El
1It RI NI, \RKS
n,�rl l��, i)rRltRlllll if li �I
� Ii
L1S
Topographic/Land setting
❑lthige ❑Slope Malley Cflat
(check appropriate box)
I aliludo'longitude of well location
«legs rcc'minules'srconds)
Latinate/longitude source:❑CPS❑Topographic map
(check hurl
DLI'III DRILLING LOU
Flom lt' Ponnalim Des r )Bull
2J'
iS '
PPS J )
LOCATION SKETCI)
Show direction and distance in miles front al least
two State Roads or County Roads. Include the road
numbers and common road names.
c)
ITS WELL WAS CONSTRUCT( D IN ACCORDANCE WI III I SA NCAC 2C, \VELL
NI) TIIAT A COIX-f)I•THIS RECORD HAS BEEN PROVIDED 10 THE WELL OWNER
(iNAI IIRI? OF 11511.
norlita.IgllilTN)r!)2r Duds on of A1'nleir,Qfia lily, Oro
q{,apmllf lr.r)pgyp,'Nu.TWp,O©J)-! 21. within 311 days.
Jo Ja "0 7--
DATE
Idwnter Section, 1636 Mail Service Center - Raleigh, NC
OW -I REV. 07/2001

WELL CONSTRUCTION RECORD 262181
North Carolina • Department of Environment and Vitural Resources (- Div`isiion of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAM,Fb((print)) r1—�21�I Z E' �L (C %� CERTIFICATION t 3 ( 7 5
WELL CONTRACTOR COMPANY NAME v t4 C/s WC L O {VW W6 .1/4CHIONE ► J ) 216+6
STATE WELL CONSTRUCTION PERMIT* ASSOCIATED WQ PERM1T0
if licablo
��.__...�.. - ------ __ —_. if Feeble
1. WELL USE (Check Applicable Box): Residential tY Municipal/Public E Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other Cl If Other, List Use
2. WELL LOCATION:
Nearest Town: It aYSVILUC= CountyCLSQ
;4 vc-ect' S C12o6G5 2.D
(Street Name, Numben, Community, 5ubdiviaien, Lot No., Zip Code)
3. OWNER: rniKC �i �RfSoj�,!
Address S CblUf raQOD RD-
(Strect or Route No.)
13I212i*lr1.L6 `3 (7—
City City or Tows S Z1p Code
)- SZ; —.Sl6G
Mn code- no at number
4. DATE DRILLED/Q _ O Z
5. TOTAL DEPTH: /
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing:
I ((i.e "+" If Above Top wing)
8. TOP OF CASINO IS /12_ FT Above Land Surface'
'Top ur cuing terrntnated at/ur below land surhoe requires a
varlauu In accorde c,4wlrh 1SANCAC 2C .0118,.
9. YIELD (gpm): /'t HOD OF T4.S.T i �2
10, WATERZONES(depth):
11. DISINFECTION: Type
12. CASING:
Depth.
2i
From Q To
From_ To
From To
13. GROUT Depth
Fromit) ,To
From To
Id_ SCREEN: Depth.
From, To
From To
15. SAND/GRAVEL PACK:
Dept
From To Ft
Amount -a oZ
Wall Thickness
Di7tet Ftor Weight/Ft.
.� f l(
F
L
Ft,
Material
Ft. CQwtcrAu ' DU°didp,
Ft.
DI:.S.ttcr Siui Sizc Material
in.
Ft. �gra�n. in.
Material
From To Ft.
Topographic/L,and setting
ERidge OSlope ❑Valley ❑Flat
i (check appropriate box)
Latitude/longitdde of well location
(degrees/minutes/wands)
Latitudeilongitude sotuue:03PSQTopographic map
(check box)
i21.nd pgrPPRmuNi3LoG:
FrQm 40 Fyrjan roc '
GRPY
LOCATION SKETCH,
Show direction and distance in miles from at least
two State Roads or County Roads, Include the road
numbers and common road names.
TRvcr�
C2rk P
tv
,
vcieV
'O
ca
N
0
14AYccv.t1.E r tc
avid
I . REMARKS: G 4
I Do HEREBY CERTIFY THAT THIS WELL
E Cr
OCT
SA
St1btdit the origit .. o
27699-1636 Phone No. (9
GROUNDWATER SECTION
ASHEVILLE REGIONAL OFFICE
vo
AS CONSTRUCTED )N ACCORDANCE WITH I 5A NCAC 2C, WELL
ARDS,ft4D THAA COY OF THIS RECORD HAS BEEN PROVIDED TO MS WELL OWNER
•
(� JO-3—o2
SIGNATURE OP PERSON CONSTRUt:11NO THE WELL DATE
be Division of Water Quality, Groundwater Section,1636 Moil Service Center - Raleigh, NC
9) 733-3221, within 30 days. GW1 REV. 07/2001
a iYC-e-L

D
2. WELL LOCAT N:
Nearest 'Iown: (GSSt0(4 County C' \Cc\I
Pine \rma 'c\cflQ-
(Street Name, Numbers, Comm nity, Subdivision, Lot No., Zip Code)
3. OWNER: KPV;✓) D n7r3
&)
Address PO Y
0.�
(Stied
or Route No.)4�2
PiTISSkvWn MC Zip'21Code
City or Town State
(r—_)
Aru code- Phone number
4. DATE DRILLED iW - 211 -oa
5. TOTAL DEPTH: ,-225e-
6 DOES WELL REPLACE EXISTING WELL? YES 0 NO EL —
7. STATIC WATER LEVEL Below Top of Casing: 3V' FT.
(Use "+" If Above Tnp of Casing)
8. TOP OF CASINO IS I FT. Above Land Surface
' •Top of casing terminated atior below land surface requires a
variance In accordance with ISA NCAC IC .0118.
9. YIELD (gpm): 5 METHOD OF TEST iiric-
10. WATER ZONES (depth):
I. DISINFECTION: Type
12. CASING:
Depth
Front D To 23
From
From
13. GROUT: Depth
Prom /5 To „?D'
From To
14. SCREEN: Depth
Front Tv_ — Ft. in.
Front To FL in.
15. SAND/GRAVEL PACK:
Depth Size
From To Ft.
From To Ft.
In
Wall Thickness
Diameter or Weight/Ft. Material
FL £,,,25 SDr.t �y
To Ft.
To Ft.
�G� e,}SArnount ,,•
Matccri I Method
Ft. pont/avi
Ft.
Diameter Slot Size Material
in.
in.
Material
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) N )CiWtQ S w t‘SA() CERTIFICATION CAN3 99
WELL CONTRACTOR COMPANY NAME 'Mi\\PC ka)i',,1 girl` (\t �
STATE WELL CONSTRUCTION PEM11T8 �
ASSOCIATr,D WQ PERMIT" PHONE s
(if applicable)
fif amDlic¢blc
263547
I. WELL USE (Check Applicable Box): Residential ❑ Municipal/Public ❑ Industrial ❑ Agricultural 0
Monitoring 0 Recovery ❑ heat Pump Water Injection 0 Other ❑ If Other, List Use
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
Formation Description
DEPTH
From To
)S" ,,72S`
(.f,ht
LOCATION SKETCH.
Show direction and distance in miles from at least
two Slate Roads or County Roads. Include ^ct.p road
numbers and common road names. ;;
MARKS'
s i�ss
-FtJv HEREBY CC iT FAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I SA NCAC 2C, WELL
CONSTRUCTION STATE IDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
• 112-021—©.2
GROUNDWATER SECJJIIV�N
ASHEVIIStfbIlEht C!9/11501 Rnto Ih
276go-I636 Phone No. (sly
r
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Division of Water Quality, Groundwater Section, 1636 Mall Service Ceentteerf Raleigh,
NC
733-3221, within 30 days.

CONSTRULIJun SIA
WELL CONSTRUCTION RECORD 2 6 3 J 3 0
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
\ S A3 I \ ci CERTIFICATION 8.2404/
WELL CONTRACTOR (INDIVIDUAL) NAME (prinQ�-QY1�IQ I �' . ($2$)`63'T'1��
WELL CONTRACTOR COMPANY NAME On , II (2)` 1 op (3ppONE
I l df+ l l r✓79
ASSOCIATED WQ PERMIT.
STATE WELL CONSTRUCTION PERMIT. (if applicable)
(if apeicabic)
I. WELL USE (Check Applicable Box): Residential irMunicipal/Public 0 Industrial U Agricultural 0
Monitoring 0 Recovery C] Ileat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCAT
Neatest'[own: 41449Svi lSvil0 Countyi?/n4/
l
(Sheet Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: Mak& l xx'54)n
Address 1404 Tapec De •
(Street or Route No.)
Tampa Ft. 3310 (g
City or Town Stile Zip Code
(- J-
Ares code- Phone number
4. DATE DRILLED/0 -
5. TOTAL DEPTIIi b'
6. DOES WELL REPLACE EXISTING WELL? YES p NO (-
7. STATIC WATER LEVEL Below Top of ^aOVng:npnr/F
f.
titling)
8. TOP OF CASING IS I FT. Above Lnnd Surface•
•Top of casing terminated War below land wrt.ee requires a
variance In accordance with ISA NCAC 2C .0118.
•
9. YIELD (gpm): iO METHOD OF TEST/7/ P
10. WATER ZONES (depth): 1
I I. DISINFECTION: 'type li)
12. CASING:
Depth Diameter
Fro To rz3+ FI. 4,2S
From To Ft.
From Tn Ft.
13. GROUT: Depth
From D To 02/9 ( Ft.
From To Ft.
14. SCREEN: Depth D
Front To Ft.
Front To - Ft.
15. SAND/GRAVEL PACK:
Depth
From To Fl.
From To Ft.
Q
Amount
Wall Thickness
or Weight/Ft. Material
</V2/ / C
;MILL Method
t G
inflicter SlotSiz_e Material
in. in.
in, in.
16. REMARKS:
Size Material
Topographic/Land setting
❑Ridge ❑Slope ❑Valley DElat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:CIGPSE1Topographic map
(check box)
DRILLING LOG
Formation Description
DEPTH
Front To
( t
�t _ pt
�o - <5aa
LOCATION SKETCH(
Show direction and distance in miles from at least
two State Roads or County Roads. Include throad
numbers and common road names.
CJ
W
LC= 14) IkRE113YiEltfeFv t
JfA
T THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I 1 SA NCAC 2C, WELL
)S, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
wu
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Division of Water Quality, Groundwater Section, 1636 Mail Service Ceenller, REVgIi0NC
33-3221, within 30 days.
GRQiif1DiNA1ER 6t$Clt(1Ii to the
ASH EVj lock' jlleJd(fin@f1teiCt9191

263540
WELL CONSTRUCTION RE(X1111)
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
\,, R. (A:Isn(1 CERTIFICATION
WELL CONTRACTOR (INDIVIDUAL) NAME (print) �.[ An'1P 5 WELL CONTRACTOR COMPANY NAME MiPf tA9C-\ '�C'� )�GJ PHONE a ,QLI._'—S-
-7
ASSOCIATED WQ PERMITS
STATE WELL CONSTRUCTION PERAftTg (if applicable)
(if applicable)
WELL USE (Check Applicable Box): Residential ILI --Municipal/Public O Industrial ❑ Agricultural 0
Monitoring O Recovery O heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Near
est'fown: mv.}V U`LQ
County_—_
m; 14.6
(Street time, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNERkw) (1
Address $fit WY\urFtea
(Street or Route No.) �-OQ�
NodkesvtIle NC. OY
City or Town Stale Zip Code
Arescode- Phone number
4. DATE DRILLED l,n t a D�
5 TOTAL DEPTH• Zy�
Topographic/Land setting
❑Ridge ['Slope ❑Valley OFIat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude Source:OGPSOTopographic map
(check box)
)7EP R IRILLINO LOG
Front To nFogrriatio Description
6. DOES WELL REPLACE EXISTING WELL? YES LI NO E3
7. STATIC WATER LEVEL Below Top of Casing: cf.) FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS , __ FT. Above Land Surface•
*Top of using terminated •ilor below land surface requires a
v•accordance with ISA
CAC IC .0110.
9. YIELD
gpm): ETI(OD OF TEST1�rL_
10. WATER ZONES (depth):
I I. DISINFECTION: Type
12. CASING:
Amount S
Wall Thickness
Depth r Diameter or Wei It/Ft. Material
t. Fron_To -- FLCar,.2$ -y—
From To Ft.
From To Ft.
13. GROUT: Depth
Male r MethodFrom th To ),o r Ft.
From To Ft. 14. SCREEN: Depth Diameter Slot Size'
Material
From n TFt. in. in.
t — From To - rt. in. in.
15. SAND/GRAVEL PACK: Depth Size Material
From To Ft. From To Ft.
16. REMARKS:
I OCATI�_ ._ ON SKETQI.
Show direction and distance in miles from at least
two Slate Roads or County Roads. Include the road
numbers and common road names.
r-,
Po
J
C.
CO
O-HEI BBY>CERTIF TIIAWELL WAS CONSTRUCTED IN ACCORDANCE WITII I SA NCAC 2C, WELL
NSA- ACT ION 8 TA DIUU$ THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
rT I /D
ATURE OF PERSON CONSTRUCTING THE WELL
DATE
Suirndt the original to the El vls omjof Water Quality, Groundwater Section, 1636 Mall Service Ceentµer' Raleigh,
NC
N001
2766S13H®ll11011Mii REGIONAL
oA E-3221 within 30 days.

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) es vl. � ' Se\ r1 CERTIFICATION N 2(1D�i
WELL CONTRACTOR COMPANY NAME PA l t 1EC u0e..11 �J\
263003
(', (,rCi PHONE a fflt) E -2aR7
STATE WELL CONSTRUCTION PERA1ITH ASSOCIATED WQ PERMIT.
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential fly Municipal/Public ❑ Industrial ❑ Agricultural 0
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest 'town.
Cr-Pen (o
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: C) R k5-f nac
Address as9 erriaa/n ret'e /QJ.
County
/ (Street or Route No.)
Zr RSS I'0. c'7 N• C, c28961,2
City or Town State Zip Code
( )-
Area code- Phone numbs(
4. DATE DRILLED (-(�-^1a—b2
5. TOTAL DEPTH: SOS'
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO ❑
7. STATIC WATER LEVEL Below Top of Casing: 6b ' FT.
(Use "+" If Above Top of Casing)
8. TOP OF CASING IS I FT. Above Land Surface'
'Top of casing terminated at/or below land surface requires •
variance In accordance with 15A NCAC 2C .0118. nn
9. YIELD (gpm): 3 METHOD OFTESThf.'/1
10. WATER ZONES (depth): --��
II. DISINFECTION: Type 1'lI--Y1TGIntPI< Amount S
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From C) To S X FL4r.2S S»td I pVC
From To Ft.
From To Ft.
13. GROUT: Depth Mate9rial
From () To -249 tFt. pnrtIavtc-i
Front To Ft.
14. SCREEN: Depth Diameter Slot Size
Front To Ft. in. in.
From To Pt. in. in.
15. SAND/GRAVEL PACK:
Depth Size
From To Ft.
Method
From To Ft.
16. REMARKS:
Material
Material
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
Formation Description
DEPTH
From To
- Ib'
�nr- Co'
Sn" - SOS'
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
1DOHEREBY CERTIFY TFIATTHIS WELL WAS T C�D-FI C S Ri) i'' ACC
CONSTRUCTION STANDARDS, AND THAT A C gY OF THIS RECORD HAS
iu-c, . .ems
SIGNATURE OF P
RSON CONSTRUCTING T
E WITH 15A NCAC 2C, WELL
PROVIDED TO THE WELL OWNER
-©z
LL DATE
Submit the original to the Division of Wa a Ql 1k'rF'bund{vaterlSiEt on,1636 Mall Service Center - Raleigh, NC
27699-1636 Phone No. [phone], wlthlfti 39 days. ---- 0W-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater
ror undwateSection
ONSection
,
WELL CONTRACTOR (INDIVIDUAL)NAME (print) �CtmPS ;\snn CERPHONE � s47 a1
WELL CONTRACTORCOMPANY NAME 1Mt\ QC (,JP.�i �r� t✓)�
ASSOCIATED WQ PERNITN
if applicable)
STATE SWELL CONSTRUCTION PERMIT[
(if applicable)
I. WELL USE (Check Applicable Box): Residential Er Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use
262991
2. WELL LOCATIQN:
Nearest Town.
County L hA1�__
v
(Sheet Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER:
Address
Citf%or Town State
Area code- Phone nu ' _ (,a
4. DATE DRILLED
5. TOTAL DEPTH: 3bSi
6 DOES WELL REPLACE EXISTING WELL? YES ❑ NO ❑
(Use "+" if Above Top of Casing)
Topographic/Land setting
()Ridge Wlope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographie map
(check box)
ULM Hart I INO .OG
From To foation Description
n
r 3S rr _3Q
Zip Code
7. STATIC WATER LEVEL Below Top of Casing: ___SfZ_FT•
8. TOP OF CASING IS _ —_ FT. Above Land Surface'
•Top of casing terminated at/or below land surface requires�pa
variance In accordance with I.1vNCAC
ET110D OF TESTy1-1J,L---
9. YIELD (gpm): _Jo_
10. WATER ZONES (depth):
II. DISINFECTION: Type Amount
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
Frorrt_Q—To--lJ--Ft. 5-_ £( -CFrom To Ft.
From To Ft. Method
13. GROUT: Depth Mae 'al
t
Frnm�_Q__ To�— Ft.
From To Ft.
Diameter Slot Size Material
14. SCREEN: Depth From To Ft. in. in.
From
To Ft. in. in.
15. SAND/GRAVEL PACK: Depth Size Material
From To Ft. — -- From To Ft. ----- —
16. REMARKS:
1 DO HEREBY CERTIFY THAT This WELL
CONSTRUCTION STANDARDS, AND THA'
SIGNATURE OF
r OCATION SKETCH
Show direction and distance in miles from at least
two Slate Roads or County Roads. Include the road
numbers and common road names.
ERSON CONSTRUCTING I
A6`H>ath{''�5rtdr®ic Ion,
Submit the original to the Division of R ater t i'JAL CFFJ r
27699-1636 Phone No. [phone], within s0 days.
E WITH I5A NCAC 2C, WELL
PROVIDED TO THE WELL OWNER
ELL DATE
636 Mall Service Center - Raleigh, NC
GW-1 REV. 07/2001

0-1
SIGNATURE F I'EILSON.PUNgT CTING THE WELL DATE
258967
WELL CONSTRUCTION RECORD
North ('at Mina - Department of Environment and Natural Resources - Divisionviof Water Quality - Groundwater Sectionio
N('` /
'ELL (IN I lt,\C'1 OR (INDIVIDUAL) NAME r-
/i�t) cl1alMDi
�I
/ )CJ Aka iS CERTIFICATION /.2%5
VEl.l. CO20lIACI.OIR COMPANY NAME heya � �' lA � � QI,J(42 q PHONE M fS $.37 twg
SEA I E WEl.l, CONSl1l11C'mION PERMIT'S - ASSOCIATED WI) PERMIPIN
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential % Municipal/Public 0 Industrial 0 Agricultural ❑
Monitoring ❑ Recovery ❑ Iieat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELT. LOCATION: Neatest Town: Hrtyes✓;de County
Cat) Cove_ Qp
(Street Name. Numbers. Conununily, Subdivision. Lot Noo.�.'Zip
` Code)
3. OWNER' _ ,cuA)e rL ifica
Address 3su0 Gaeerouse IQ,t l
fleet� or Route No.). NC 'f0
, C:_ty or i inr,, SelzLitZip Code
Are:, code. Phone number p
4. DATE DRILLED c7 9-7 u 2-
5. TOTAL DEPTIITiet.5
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO Lim
7. STATIC WATER LEVEL Below Top of Casing: ‘5"--(. FT.
(Use "4" if Above Top of Casing)
8. TOP OF CASING IS % FT. Above Land Surface"
'Top of casing lerndnaled al/or below land surface requires a
variance In accord er wlO, ISA NCAC 2C .0MIN. ,/Th }�
9. YIELD (win): ): 'L METHl�OD OF TEST i' ' L
10. WATER ZONES (depth): Zeio
1 I. DISINFECTION: Type //17/5/
12 CASING:
Depth
Fromm 0 To (7O Ft.
Front To It.
From To Ft.
D sunder
Amount Z C C' lP
Wall Thickness��
5 WOUhUFt. 2j v'l
13. GROUT` Depth ,yl:tcrial
From O In 20 Pt. yr
From 12_0 To -JqJ' FL ei�'
1.1. S('REEN: Depth Diameter •--) Slot Size
Flan To I't. in. hi.
From To Ft. in. in.
15. SAND/GRAVEl. PACK:
Depth Size Material
Et tun To Ft.
from To FI.
Method
Topographic/Lanpdtting
❑Ridge ❑Slope alley ❑Flat
(check appropriate Eros)
Latitude/longitude of well location
(degrees/minutes/seconds)
Lalilude/lougimde source:❑GPS❑Topographic map
(check box)
DEP'HI DRILLING LOG
From To Formation Description
r� <,l(>��7 G94
n .l(c' 5/-9 7,„e
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
a
tV
Material rn
ET1
CO
CO
C),a
n
al
la. REMARKS:
Bum'. I T THIS WELL WAS CONSTRUCTED IN ACCORDANCE WIT11 15A NCAC 2C, WELL
it t: i NSisidA )}( DS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO TIIE WELL OWNER
SEP -
Subulii the originaln the P ivision of Water Quality, Groundwater Section, 1636 Mall Service Center - Raleigh, NC
644k)9,NsE(919) 7. 3-3221, within 30 (lays. OW -I REV. 07/2001

WELL CONSTRUCTION RECORD
North l';volina Ocpmilueul or Environment and Natural Resource�,$))- 1)i
W 1 1.1. ruN i l!.\ I -I I)It (INDIVIDU AL) NANO,. wlnl) ..._.__ s� L'ti//( r
Will 1'IISIii\( I(Ilt((r.11'AN\'NAnII•: Leen.°�I'cef_-_(t-..r(E?1-L
258259
vision or \'aiei (Quality - Groundwater Section
C
11�5 CER I IFTUATIONa .S�UJ
i--1ti6_ I'llONE 11 Yj1' a37-sec-20Cj
1\II \\11I.(l1♦S IItl'(" 111)N 1'f:14\Ilr#I ASSO('I.\IEI)wgI'I'fln111#
lit ;ggdic ldc l (il applicable)
I. \el-1. I. I ISP Whet]. 'heck Applicable Rux): Resideulial LB" Municipali l'uhlic ❑ Induslri:d ❑ Aericuhurtl ❑
\I„nil,l ine ❑ Recovery ❑ I !cal Pump Water Injection CJ 011ier ❑ I1.0l11er, List Use
N I.I I I (1('A I II lit
NI;n ra I W. I3001SS TO v_r Caunty <<r+j'__
nA r'f21ec-eft Coy'@ --
ICIn rI Naun: NnniI t-iq Community, Suhdis i<irnl I ul No-, lip Cods)
t I I\\NI•IZ' Res..
.Address 1 2.0 CRRLJ jPP COkLE 7N
I [Nude N, )
1)l1i1SS ei-c•"-) N)C ICI C�
1 it, on lu,vl ,Ic lip ('ode
fi12y 1- ch-3 L$ 1 5L\ CtJ
A ,..n r„de flans nm:-,
I. IlAll' Ultll. I.PI>__��' _
5- 1(1Al, I )PI'11I: �„
.. I l IPS \\ I1 I. Kill'I.ACT FSISIIN(i WFI.I2 1'ES ❑ NO IT-
7 HAIR' l\'Al ER I.F\'EI. liclow'lop or Casing: SQ FT.
(I I<c"I"it A tune lisp nr Casing)
H. lit Ol ('ASIN(i IS / 1'l. Above band Surhlce+
'lap r.1 raying ter nitiated :Wm- lotion laud surface requires a
s:IIinner in arc,n-A:v�yy, nilIt 15,\ N('A(' ?('MOS.
I). AIILI-I)(cpm} b MI IIIOOOI: 11.SI' 1)-
Ill.%\'AIllU/ONIfs Idlpill); ._/_9___ Z 0-_---
'I l) !ta ncll.and selling
CJRidge L . lope ❑Valley ❑Plat
(rhea apploly Hie bon)
I alit ide 'longil tide or well locally!'
Idcgre eo mint let hrcnndsI
Loliulde/Inng lltlde' soulec:O(il'SEI Topographic neap
idled: kiwi
0EI' I.I I DRILLING LOG
1 nn To Formation lescriplion
C
d o
1OCAI ION Skl;f('ll
I I. I )ISINII!( IIIIN. I ypc_� /`_ Amount 2 Show dirt-diou and dislancc in miles from at least
12. CASING: Wall lhickuvss Iwo Slate Roads or ('aunty Roads. Include the road
I inputer o �VVei litil. Material numbers and collation road names.
I Ilan ---. to
Ilonl ll:
15. SANU.Y'RAA'I-I.I's'I(;
I )(pill
I low lb
I clan l n
If. I+I MARLS:
Male, y Mdhod
I )i:mleler Inl Sim N;Ilt'riul
I.
PI. in. in. ._.
Sic Material
r I )'II I I �ipl Vl1'I LUpl
n ((uJ; CRI I)^1 ti IN S'I-APIb
!I —�I
SliLmil lhc�i"i nail,( the
I(,C( IYIInm'�Oli':. rim}
?el c,;
111 IIS Wil I. WAS CONS IIUP ILO IN Al'('OItI)AN('E \VIlII Ito NCA(' 2(. W'EI.1. /V
IS, /ANO II IA I A C OI'V OE 111IS Rli('OI21) I IAS IIIIEN I'IU)VII)EI) 1(11111i WELL ( )AA'Nbt`P
SIGN.((111E (IF PI
IN
NSl !TUC TING 11 IF WELL. (JAI li
ivision of \\'a(cr Vitality, Groundwater Sculiun, 1636 (Mail Service Center - Raleigh, N('
! '221, )silhin 30 days. ( w-I REV. 117/2001

262326
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division` _
of Water Quality - Groundwater Section
(.A.);WELL CONTRACTOR (INDIVIDUAL) NAME (print). \CME)5 Rr i 1Son CERTIFICATION 2 / Oq
WELL CONTRACTOR COMPANY NAMEW1; \ 1e ( LCE11 r\c11lv✓)G1 PHONE 8 fan) Cs 37'.2Q9T
STATE WELL CONSTRUCTION PERMITI ASSOCIATED WQ PERMITB
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential 11--1Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATIN:
Neareste/Town: A�ICSU/ lie County CI0r i
K'.'v 4,4
(Street (Jame, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: tQtV1 eM non 7©Vairifi
Address O 913V O(nC1
(Street r Route No.)
1—It(�wa�ee 3c 4&
City or Town Stale Zip Code
Area code- Phone number
4. DATE DRILLED 7- L2 -pa
5. TOTAL DEPTH: 6262s
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 0
7. STATIC WATER LEVEL Below Top of Casing: C & FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surfaces
•Top of cuing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118. c
9. YIELD (gpm): (a METHOD OF TESTA t r
10. WATER ZONES (depth):
I I. DISINFECTION: Type11 PeiIEFS
12. CASING:
Depth Diameter
From D To 50r FL 4,,2s
From To Ft.
From To Ft.
13. GROUT:
From 0
From
14. SCREEN:
FronL_
From
Topographic/Land setting
ORidge ❑Slope OValley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
orm;tlion Description
12Efill
From To
- oVo'
/ID — V S
Amount
Wall Thickne s
or Weight/Ft. Material
Soiid I pvc
Depth Maty'J� � � Method
To .20 r Ft.��te
To Ft.
Depth Diameter Slot Size Material
To Ft. in. in.
To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
tv
fv
IS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
/�� 7- /�-O
n'ICrNATURE OF PERSON CONSTRUCTING THE WELL DATE
a tot e Division or Water Quality, Groundwater Section, 1636 Mall Service Center - Raleigh, NC
W OW -I REV.07/2001
�� Ntl�dolf Btl19) 7333221, within 30 days.

()
10
2
6974
WELL CONSTRUCTION RECORD
Noi di (luolino - Depailulent of Environment and Natural Resources - Division of Water Quality - Groundwater Section
/C
1T IIfll)
\\ el.I. ('AI\ I RAC' (lit (INDIVIDUAL) NAME Irl1nt) cl /.Mtt✓� 3—i)NL,S'CERTIFICATION N �1)YJ.7
I I.I. CON I It MIMI'AN\ NAME ka/
e_ ,✓E QJ, b�'V9 I'IIONE q V37"9pCCE
SI Al I'. \\'I'.I I. ('(INS'I ltl'(l ION 1'Eltalll p ASSOCIATED WO IT:ItMI'IK
III. ;Win: I e) (if applicable)
rrs /
I. WELL I ISE (('heck Applicable Box): Residential I Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring O Recovery ❑ I lent Pump Water Injeclion 0 Oilier ❑ IfOlher, List Use
2_ W1.1I. Ft)('A"IION: /
Ne:u es!
lo\clr .&. nSS Tv IJM1i Court_ y
3'3&O ,ZiRRis'%u“.(i -J A)U f
(Slice) Nana' . Nllnhels, Community. Subdivision. Lot No.. Zip Code)
1. OWNER: l�(AG-Li CqloR,c
Addlcss 334,0 _If' 5STbLJ&J fat
I Sueel or Houle No.)
OASS retrau ,JC -e-Z)%(7
Idoilo'vn SI21e % Zip Code
I S. s)---__ 5537.-=73 1 a
Aira r„sic I'bwuc numb
.I. DATE DRILLED L' /9 . 0 (2-
5 TOTAI. DEIrlll:
6. DOES WP.LI. REPLACE EXISTING WELL? YES ❑ NO D-
7. S VATIC WATER LEVEL Below "Fop of Casing: __ET.
Wee if Above Top of Casing)
R. TOP OF CASING IS % Ft. Above Laud Surface'
• lact orcasing terminated al/or below land surface requires a
ari:nce hi arrardancc ss Ith 15A NCAC 2C .(II IS.
YIELD (epm): .5 D_ ly11.11RI.) OF•IEST_
WATER ZONES (depth): v-30
I I. DISINIFC IION. l ypc_/-2 77/
12 {� CASING:
Dcph / 1 lamcicr
I;IOII tirnj7 (-- EI. t9 y
I ono "ro Ft.
Irmll i n Et.
13. GROtH), lcp-�7Mateiial
I run_ (.% rn.2 rt. ` e-n
win mn 20�N
I n (/_ E1.
Topographic/Lan citing
❑Ridge ❑Slope alley ❑hhll
(check appn•priaie box)
Latitude/longitude of well location
I degrrerninmes/secwnds)
Latitude/longitude soul ce:OGI'SOTopographic map
(check bo,)
Dli11-11 DRILLING LOG
horn To Foimalion Description
/65 G%4 s
yGs-
LOCATION SKETCII
Amount _ _OLE Show direction and distance in miles From :l least
Wall Thickness two Slate Roads or County Roads. Include the road
or Weight/Et. Material numbers and common toad names.
/61 .31--c/
Method
y
II. til'It I�I•N: Ucp(h Diameter (/ $Iol Size Material
Iran —__- To —__-- II. in. in.
I win Tn 11.
15. S,\NtHiltAVEI. PACK:
Depth Size Maffei ial
I loll( 1L 1'1.
Ilnm Tn ICI.
1it 'A� I IrL
D DL'
I DO III RI l (PRl ll' 1
ri
( ONSI Itl IC I IONS 14, I
Lk
:11TIOi1
/ r SiktOditthe iiivj;i iJii 11Fil I • is ision of Water ()wilily, Groundwater Section, 1616 Mail Service Crider- Raleigh, NC
27694_1616 Plume No. (nlq) 731-3221, n'illlin 30 days. (1W-I REV. 07/2(11)1
1/'1111S WELL WAS CONSTRUCTED) IN ACCORDANCE WIIII I5A NCAC 2C. WEI.I,
)S, AND TI TAT A (D'V OF THIS RECORD HAS BEEN PROVIDED TO I11C WEIT, OWNER
Si(i N Altilt I.
UCTING'tl IE WELL UA1Ii

r
258162
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print)pW\�'1'1 eklIV S. (��m5 CERTIFICATION
llq p
WELL CONTRACTOR COMPANY NAME F� I v4 � (�� ���ibgi L'i"l `) PHONE 8 (a'J9 Oh / - //6S
STATE WELL CONSTRUCTION PERMITS ASSOCIATED WQ PERMIT'
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential IB" Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. `W•ELL LOCATIly :
(
V`leares own:
(S
opographic/Land setting
Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
3. OWNER: N � '• ' I (degrees/minutes/seconds)
Address Latitude/longitude source:❑GPS❑Topographic map
(Street or Route No.) (check box)
PRILLING LOG
Formatioq /Description
City or Town State
Arcode- Phone
4. DATE
DRILLED � oaI
5. TOTAL DEPTH: rl /
6. DOES WELL REPLACE EXISTING WELL? YES j] NO 1d
7. STATIC WATER LEVEL Below Top of Casing: 'KU FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surface'
*Top of casing terminated at/or below land surface requires *
variance in accordanc ith 1SA NCAC 2C .0118.ali.
9. YIELD (gpm): METHOD OF TEST
10. WATER ZONES (depth): RD
11. DISINFECTION: Type
12. CASING: q
From O TDo� (D
From
From To Ft.
Zip Code
V� 11-t Amount
}��j f Wall Thickness�
Ft. b / iv �(1C'.s, !% tetial
pEPTU
From To
9 ' fs,C'
0 CI
LOCATION SKETCH
Show direction and distance in mil from at Yeast =_ —
two State Roads or County Roads. elude the road__
numbers and common road es.
C—
-- o:-
To Ft. cn
O
13. GROUT: Dep�j, Mat Meth. '.� `_>
From D To `l n Ft. rgiali
From To Ft.'
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
L
Submit the original to the Di
L276-99-1636 Phone Ne.(919) 73?
hE
THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WE ,.L 0
SIGNATURE OF PERSON CONSTRUCTING THE WELL DA
ision of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
3221, within 30 days. GW-I REV. 07/2001

258161
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME ((priint)-.I kk-3.1.fWV\ S , —VCR MSy� CERTIFICATION #d i
WELL CONTRACTOR COMPANY NAME R� Pv lam' '4,U � ' �-� Lt. -�'( Nes if Im6PHONE ) 3g2'71 `sC
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMITS/
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential lB' Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCAT
3. O
�v
alias
Address
(Street or Route No.)
Zip Code
7. STATIC WATER LEVEL Below Top of Casing: ,0O FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS I FT. Above Land Surfaces
*Top of casing terminated at/or below land surface requires a
variance In accord ce ith ISA NCAC 2C .0II8.
9. YIELD (gpm): pia ME OD OF TEST �-n
10. WATER ZONES (depth):
City or Town State
Area code- Phone number
4. DATE DRILLED rI �k D�
5. TOTAL DEPTH: ?`91
6 DOES WELL REPLACE EXISTING WELL? YES ❑ NO al/ try' Fpr7 '
Topographic/Lan etting
❑Ridge ❑Slope alley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formaton Description
n 1p1 n mt a
101
1St .2)�
ti n
LOCATION SKETCH Lo
11. DISINFECTION: Type Amount Show direction and distance in miles from at -{past
12. CASING: Wall Thickness two State Roads or County Roads. Include thcroa
From_ To Ul
From To
From To
C
pippletgr or We t 4 iNvrerial numbers and common road names. rn
Ft
Ft.
t� 1 .ackualsba((II
Ft.
13. Depth A4at riV
From C
Fro To b0 Ft.
From To Ft. I
14. SCREEN: Depth Diameter Slot Size
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth
From To Ft.
From To Ft.
16. REMARKS:
l Do HFRFRY f FRTIFY THAT THIS WELL,WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
NS11t 1CT1Qj1$,TANDD THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELLTM'
/7/aa
Size Material
Material
Sul trJ
Submit the original to the Dvision
2769.2:16311h#ne_Nt [phone]
URflL r JTIOi
qC- L kE ,rhiLk
ATURE OF PERSON CONSTRUCTING THE WELL DA
of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
within 30 days. GW-I REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater SectionA
\\ J-1 et-CN \ S v �-�-r • FJ CERTIFICATIONIa,
WELL CONTRACTOR (INDIVIDUAL) NAME (print) PHONE # t oND) �� �l SS
WELL CONTRACTOR COMPANY NAME kJ R t ES�\'t'"E W L""� 12-tL"�" (
ASSOCIATED WQ PERMIT#
STATE WELL CONSTRUCTION PERMIT# (if applicable)
(if applicable)
1. WELL USE (Check Applicable Box): Residential E Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCAT O]_
Nearest Town:-SU- 0
3
County 03_313`i
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER:
Address
City or
(-- )-
State Zip Code
Area code- Phone number n a.„ t Da
4. DATE DRILLED , lkik( 6l t
5. TOTAL DEPTH: ?J
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO IV
7. STATIC WATER LEVEL Below Top of Casing:
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS l FT. Above Land Surface"
*Top of casing terminated at/or below land surface requires ■
variance in accordancf with ISA NCAC 2C .0118. n ,
9. YIELD (gpm): Co ME HO IOF TEST CW1--
10. WATER ZONES (depth):
11. DISINFECTION: Type 1
12. CASING:
Depth, 9 n ter
From b _10 Ft. "'v
From To Ft.
From To Ft.
13. GROUT: Depth11% Mat ripl
From�To%`K) Ft. i`'r"'''`
From To Ft. _
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Amount
Wall Thickness
qr weight/Ft. tel
258160
jtopographic/Land setting
Midge ❑Slope OValley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
FonpaA'on Description
16. REMARKS:
DEPTH
From To
b 611l
E711 13C/
1,51 34.5
tv
C) :r
LOCATION SKETCH
Show direction and distance in miles from atylast
two State Roads or County Roads. Include the. add
numbers and common road names.
L Submit the origin it to thi
;"'1;760-1656thoseNo. (919'
.T THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
S, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WJLL OWNER
oa
SIGNATURE OF PERSON CONSTRUCTING THE WELL
Division of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
733-3221, within 30 days. GW-1 REV. 07/2001

258159
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Ressouurcess-- Division of Water Quality - Groundwater Section '[/�
WELL CONTRACTOR (INDIVIDUAL) NAME(print) W`�-U`--,k v • % CERTIFICATION�A# �/ 9
WELL CONTRACTOR COMPANY NAME,W� AIrkn 1 U.XS CIA L PHONE # (r�E l ' 91/56'
STATE WELL CONSTRUCTION PERMIT# __ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential 121 Municipal/Public 0 Industrial 0 Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL
Neares
(S
3. OWNER.
Address
Street or
City
ion, lot No., Zip Code)
Diet
Zip Code
Area code- Phone number R J
4. DATE DRILLED
5. TOTAL DEPTH: b� /
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 13
7. STATIC WATER LEVEL Below Top of Casing: (00 FT.
(Use ••+" if Above Top of Casing)
8. TOP OF CASING IS t FT. Above Land Surface*
*Top of cuing terminated at/or below land surface requires a
variance in accordan wit 15A NCAC 2C .0118. �A •
•
9. YIELD (gpm): MET QpOF TEST
10. WATER ZONES (depth): bpAn o
11. DISINFECTION: Type
12. CASING:
From To
From. To
From To
13. GROUT: Dept\
From 0 To O�
From To
14. SCREEN: Depth
From To
From To
15. SAND/GRAVEL PACK:
Depth
From To
From To
b2
�Tt4 Amount
Wall Thickness
pitapnrpei r or Weight/Ft. �atplial
Ft. to/tk S57.42
PVC
Ft.
Ft.
coalMalal
Ft.
Ft.
Diameter Slot Si3'e
Ft. in. in.
Ft. in. in.
Material
16. REMARKS:
Size Material
Ft.
Ft.
)r opographic/Land setting
Midge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
Fotmajon Description
DEPTH
From To
1
,DI vi
't l' 3b5'
r..
LOCATION SKETCH
Show direction and distance in miles from at least'
two State Roads or County Roads. Include the rotE
numbers and common road names.
0
1
YdER` IF
T THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELO'
SIGNATURE OF PERSON CONSTRUCTING THE WELL DA
the i ivision of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
rtiy e�i 19 7 3-3221, within 30 da s GW-1 REV. 07/2001
eu �� - n PtQP ) y

258158
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print)r'�\L-U fC' S'\�c'—S CERTIFICATIONI�i{O 3Q
kt z
WELL CONTRACTOR COMPANY NAME I `1ti L-g a—L-1—'let W. � t� PHONE N Oft) 1L t
STATE WELL CONSTRUCTION PERMTTB ASSOCIATED WQ PERMTTU
(if applicable)
(if applicable)
I. WELL USE (Check Applicable Box): Residential 11Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCA
N
(Street Name,umbers, C
County,
3. OWNER
Aare
City or Town ate Zip Code
Area code- Phone num
4. DATE DRILLED
5. TOTAL DEPTH:
6. DOES WELL REPLACE EXISTING WELL? YES P NO
7. STATIC WATER LEVEL Below Top of Casing:
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surface*
'Top of casing terminated at/or below land surface requires a
variance in accords with 15A NCAC 2C .0118.
9. YIELD (gpm): ZD MF,TJ4 D OF TEST
10. WATER ZONES (depth):
11. DISINFECTION: Type Amount
12. CASING: th,pate Wall Thickness i�at�5}
To ' FL (o/� "ter PLW„C l (o `1'V C.
From £�v� t
From _ To Ft.
From To FL
13. GROUT: Depth
From b To VI FLO
From To Ft.
14. SCREEN: Depth
From To
Diameter
Ft. in.
Slot Size
in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
graphic/Land setting
idge ❑Slope OValley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To , Formatijgn Description
16. REMARKS:
Material
LOCATION SKETCH 0
Show direction and distance in miles from at st ^,,
two State Roads or County Roads. Include thgoad
numbers and common road names. _ -=
rn
0
IS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE LL i WNER
GNATURE OF PERSON CONSTRUCTING THE WELL
pubmit the original to th Divh ion of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
1036 P unicN 733-3d21, within 30 days. GW-1 REV. 07/2001
ASi- Ly Cr

LI
Address Q2�>_,r
35 t\rnf) Crr- FCj
I -I VI UP (\C 264 0-1-
or Town State Zip Code
Area code- Phone number
4. DATE DRILLED- 2F>- i92
S. TOTAL DEPTH: ) ?,<
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 0
7. STATIC WATER LEVEL Below Top of Casing: SE r FT.
(Use "+" if Above Top of Casing)
S. TOP OF CASING IS ( FT. Above Land Surfaces
•Top of ruing terminated at/or below land surface requires •
variance In accordance with ISA NCAC 2C .0118. n�7
9. YIELD (gpm): /.5 METHOD OF TESTA if
10. WATER ZONES (depth):
II. DISINFECTION: Type h7t1) Ict/fR7C Amount S
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 ( To /r FL(c,.2S` .5%x-4/ /)Vr"
From To Ft.
From To Ft.
13. GROUT: Depth Mate al
From h To 22C t Ft.
From To Ft.
Depth Diameter
To Ft. in.
To Ft. ir..
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) tniF 1\+'i\Soil CERTIFICATION /'2y°11
WELL CONTRACTOR COMPANY NAME Olt \ pc 1,v P-k\ (t-, l,:Y)_5
STATE WELL CONSTRUCTION PERMIT% ASSOCIATED W PERMITN
(if applicable) (if
PIIONE 8 1327) 3't 7-29s 7
1. WELL USE (Check Applicable Box): Residential ❑WMunicipalfPublic 0 Industrial ❑ Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATkION:
N N i 5 / I I CountyL\ .6_
ffe�aaresl'fown: �Q
lMWY1?d(:AOS ('Rpe ( i21i
(Street Name,
,NNumb dd/nJ, Community,/itSubdivision, Lot No., Zip Code)
3. OWNEP(:fS H4i 17.i7fion
14. SCREEN:
Front
From
r G
From
From
(Street or Route No.)
06. REMARKS:
EF(1(JI L IAT R Sr_f,1L
AlDOtHERVEUY
CONS ON
262321
Topographic/Land setting
❑Ridge ❑Slope OValley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From _ To orm tion Description
6 S
4-r — �S
SS' - i srs
Method
Slot Size Material
in.
in.
Size Material
t.
LOCATION SKETCEI
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
IS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 1SA NCAC 2C, WELL
, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
4%tCr CA--riAl 2(.4/"-
SIGNATURE OF PERSON CONSTRUCTING THE WELL
l - olr^z)a
DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mall Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. OW -I REV. 07/2001

WELL CONSTRUCTION RECORD
262316
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print)(p 'DCIVY1P5 R//, L.) , 15nC1 CERTIFICATION &C�/
4/
WELL CONTRACTOR COMPANY NAME fees (/)... AZ Nn aO, PHONE I ftr) 537-.2 C47
STATE WELL CONSTRUCTION PERMITN ASSOCIATED WQ PERMITN
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential WMunicipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION:
Nearess Town:H/ Gr
Countyt /at/
(Street Name, Numben, Community, Subdivision, Lot No., Zip Code)
3. OWNER: POW lowers
Address $ Ji'EWbtrd boric
(Street or Route No.)
1-10,t)105U ilQ r2-Sg04
C'dr or Town State Zip Code
(—)-
Ares code- Phone number
4. DATE DRILLED b - y- 0,2
5. TOTAL DEPTH: f CI,2
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO 0
7. STATIC WATER LEVEL Below Top of Casing: 20jp FT.
(Use "I" 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 I5A NCAC IC .0118. 9. YIELD (gpm): / METHOD OF TEST ,a,/7
10. WATER ZONES (depth): �� �y
II. DISINFECTION: Type/271- f-4h� 24 Amount 5
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From To Ft.
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From To Ft.
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
Fronr To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
r •ro
16. REMARKS:
I
__ I DO IIEREBY CER FY T THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I 5A NCAC 2C, WELL
a R ('CONSTRUaLAND S, AND TEAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Size Material
Ft.
Ft.
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formatio Description
/%S «va rro.-r,'7`e
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
d r; E t 1 wet ( ci s
Ve'r
-rc 165' down 1S (4r
-
_J
CJ
w
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. ,CW-I REV. 07/2001

262929
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) ' )6 wi Q.S K1 ( AD°1 b >n CERTIFICATION #aioQ
�otuts) $S7-ag47
WELL CONTRACTOR COMPANY NAME 11 � PC t�el1 s 111i✓\6PHONE 0 (
�
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#(if applicable)
(if applicable)
I. WELL USE (Check Applicable Box): Residential p" Municipal/Public 0 Industrial ❑ Agricultural 0
Monitoring ❑ Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION: Nearest Town: 1-i4PS,I, t? CountyIat/
10)... VhPt
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: i 0L
Address Uri I %AYDV(e.t� \fir
(Street or Route No.) ��`-1� 1 or Zip1
t-\cwe ow ��-
ty or Town State Code
C—)e
Area code- Phone number
4. DATE DRILLED 7e, - r2'7- 12r).
5. TOTAL DEPTH: 3OSi
6. DOES WELL REPLACE EXISTING WELL? YES ONO FT.
7. STATIC WATER LEVEL Below Top of Casing:
(Use "+" If Above Top of Casing)
8. TOP OF CASING IS I FT. Above Land Surfaces
*Top of casing terminated at/or below land surface requires a
variance In accordance with ISA NCAC IC .0118. pp
9. YIELD (gpm): METHOD OF TEST 4.
10. WATER ZONES (depth):
I I. DISINFECTION: Type T/IWp k Amount S
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From b To 111 Ft.61.25 Sf)i11 Or_
From To Ft.
From To Ft.
13. GROUT: Depth
From 0 To ,2D' Ft.
From To Ft.
Depth Diameter
To Ft. in.
To Ft. in.
14. SCREEN:
From_
From
15. SAND/� I PHCKT Szc
From
From
16. REM
1 DO HERE
CONSTRU
To Ft.
Ft.
Slot Size
in.
Material
Material
Topographic/Land setting
❑Ridge ❑Slope OValley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/ongitude source:❑GPS❑Topographic map
(check box)
pandemic LOG
ormation Description
DEPTH
From To
C7 - 1&'
lD - gib'
"ID ' - ,'79J5'
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
TH 15A NCAC 2C, WELL
IION SIANL !L rrY s,SCONOSF ISRED ORDHASBEENPRON ACCORDANCE IVIDEDTOTHEWELLOWNER
ti2trt . 6- ? �r -0
Q^� """`DATE
6/ SIGNATURE OF PERSON CONSTRUCTING THE WELL
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.

2. WELL LOCATION: C/�Gr/
Nearest Town: bon L)')'P County
New \son Wick 1(Xfilon
(Street Name, Numbers, Commu Wicket -
Subdivision, Lot No., Zip Code)
3. OWNER:DOYln Pnq ne
Address C13u1-9 QI(l N \t\ k.oll
(Street or Route No.)
bckS\own r%
City or Town State Zip Code
Area code- Phone number
4. DATE DRILLED (-2 — (9�
5. TOTAL DEPTH: r2Os
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO FT.❑
7. STATIC WATER LEVEL Belo ( Top o (AbovegTop of Casing)
8. TOP OF CASING IS i FT. Above Land Surface'
•Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC IC .0118. qq
9. YIELD (gpm): S METHOD OF TEST Hr"
10. WATER ZONES (depth):
II. DISINFECTION: TypeIn4k kvib{P6-Amount '
12. CASING:
Depth Diameter
From To i(O r Ft. 6,..q.5
From To Ft.
From To Ft.
13. GROUT: Depth Mate al Method
From 0 To 2O r Ft.n(:
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAN
Wall Thickness
or Wet UFt. Material
()tic
From
From
16. REM
Material
262928
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division� o� frrW�alter Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) >a✓l'lQS Wi I Son CERTIFICATION IT-QQfly
M OJ PHONE M rGYl i'
WELL CONTRACTOR COMPANY NAME 1! 1t11P f- Lti�%p �' �C` �` � J
ASSOCIATED WQ PERMITM
STATE WELL CONSTRUCTION PERMIT/ A
(if applicable) (if applicable)
/
1. WELL USE (Check Applicable Box): Residential'EI Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Ilcat Pump Water Injection 0 Other 0 If Other, List Use
Topographic/Land setting
ORidge ❑Slope OValley [liar
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
7� - ,— 7DC2-
—D
W
LOCATION SKETCH
Show direction and distance in miles froma�t IeasC
two State Roads or County Roads. Include the road
numbers and common road names.
DO HEREBY - WAS CONSTRUCTED IN ACCORDANCE WITH I 5A NCAC 2C, WELL
CONSTR X-T[60 8fFAN_v 'i : ;'� a� a7i, TA COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
A SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mall Service Center ' Raleigh,
NC
27699-1636 Phone No. [phone], within 30 days.

14. SCREEN:
Front
From
15. SAND/G
From
From
262927
WELL CONSTRUCTION RECORD
North Carolina - Department
rtm t f Environment and Natural Resources - Division of Water Quality - Groundwater Section
o
_ L)NAME (pit) rrfeII 5 P L�. ISBC CERTIFICATIONK ory0U
WELL CONTRACTOR(INDIYIDUA (print)
r1
WELL CONTRACTOR COMPANY NAME inn. 11 tC (doe..c (-SC, C, 11`i ng
WQ PERMITK
STATE WELL CONSTRUCTION PEMIITK ASSOCIATED(if applicable)
(if applicable)
I. WELL USE (Check Applicable Box): Residential Ed/Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION: )
Nearest'fown: /1-A.1 QS I%t Ile County/.4,/
Sf,3c5 to
(Street Name, Numbers, Community, Subdivision, Lot No., Zip
3. OWNER:)-I;n"ftn C,t,tCal C.QXl-YA.V
Address -PC) PIN ti
,,^�� (Street or Route No.)�,. t
�'(�a,),P)SY(Ue. (tom V`Y
airy or Town State Zip Code
Area code- Phone number I a
4. DATE DRILLED CP
5. TOTAL DEPTH: e `6 S t
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO ❑
7. STATIC WATER LEVEL Below Top of Casing: 70 r FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS FT. Above Land Surfaces
*Top of caring terminated at/or below land surface requires a
variance In accordance with IS 1 NCAC2C .0118.
OF TEST �! r R
METHOD
9. YIELD (gpm):—
10. WATER ZONES (depth):
II. DISINFECTION: Type �1��5Amount
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From
From
From
13. GROUT:
From C
C
To /sa Ft. l ,25 S()C-) ( PVC
To Ft.
To Ft.
Depth Mate�'al
To a2 9 Ft.�
From To Ft.
Depth Diameter
To Ft. in
it
- WETS
16. REMARKS:
0
0
Ft.
Ftp
Code)
\3,vld 3\o& rtr\
PHONE K tra"a 53 Y
Topographic/Land setting
❑Ridge IklSlope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To ,)For1natio Description
-
Method
pre c(X t
Slot Sim Material
in.
in -�� in.
GROUNDWATER SECTION STRU_
1 DO HEREBY CER7�1-iFVk1Y+9'F{gBS)Pb7EL TFA C POYbD IN ACCORDANCE WITH I 5A NCAC 2C, WELL
OF THIS RECORD HAS B EN PROVIDED TO THE WELL OWNER
CONSTRUCT .
.r r.4..,t iA.4,,Lilg vt 6- ,2t- On2
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mall Service Ceenter' RREVgh, C01
27699-1636 Phone No. [phone], within 30 days.
aterial
LOCATION SKETCi(
0 0
Show direction and distance in miles from at least -
two State Roads or County Roads. Include the road
numbers and common road names.
C.

WELL CONSTRUCTION RECORD
264323
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section WELL CON"! R.ACTOR (INDIVIDUAL) NAME (print) /Llre GrAnc CERTIFICATION -#361q
/
WELT. COST RACrOIt COMPANY NAME c.-rA/le BY65 (g e// \I-k N4q,c1/C PHONE # (!�20 iCo2 j"P�f�/
STATE WELL CONSTRUCTION PERMIT#
(if applicable)
I. WELL USE (Check Applicable Box): Residential Er Municipal/Public ❑ Industrial
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List
2. WELL LOCATION:
Nearest Town: A{yeSV,%(G
-2cc{} p-41 IQtc,
County uiy
(Street Name, Numbers, Community. Subdivision, Lol No.. Zip Code)
3. OWNER:
Address
4
5
6
7
/1/1f. IJOt-✓Je
3itY • (rri 5� 4
(Street or Route No.)
CY73y
City or Town State Zip Code
)-
Area code- Phone number
DATE DRILLED (O
ASSOCIATED WQ PERMIT
(ifat licable)
TOTAL DEPTH: 4i&.s
DOES WELL REPLACE EXISTING WELL? YES 0O ❑
STATIC WATER LEVEL Below Top of Casing: 720 FT.
(Use `+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): 30-i- METHOD OF TEST di(
10. WATER ZONES (depth):
LOCATION SKETCH
Show direction and distance in miles fromat:east-_ _
two State Roads or County Roads. Include ti>f road.:
numbers and common road names. CPI _.
Topo
❑Ridge
(check appr< pr
Latitude/longitude of well location
Hti
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
429
`%S
II
12. CASING:
DISINFECTION: Type
Depth Diameter
From 0 To ia9 Ft. (0-i-ii
From To Ft.
From To Ft.
13. GROUT: Depth
From 0 To 2-D
From To
14. SCREEN: Depth
From To
From To
15. SAND/GRAVEL PACK
Depth
From To
Front To
16.REMARKS:
Amount
Wall Thickness
or Weight/Ft. Material
Material Method
Ft. CeJPtem f- 1)04t-
Ft.
Diameter Slot Size Material
Ft. in. in.
Ft. in. in.
Ft.
Size Material
n.12.3110PAFEA L
�h�E�rfJ
Ft.
HIS WE
AND TI
%9
O
__)
OF THIS RECORD H
OCT 2 1 2002
C)
NCE WITH I5A NCAC 2C, WELL
PROVIDED TO THE WELL OWNER
1 ( 2002 SIGNATURE 07 PERSON CONSTRUCTINC THE WELL
/o-/S-1)2
DATE
Submit the original tot e Div sion of 4YateA �i� �t� Cction 1636 Mail Service Center - Raleigh, NC
5NiitttiND firbtEiRalM9) 733-1221, within 36 dais. t GW-1 REV. 07/2001
ASHEVILLE REGIONAL OFFICE

262352
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources- Division of Water Quality - Groundwater Section /'
WELL CONTRACTOR (INDIVIDUAL) NAME (print) )C1�� -//R. LAD, I so n CERTIFICATION N � Y
WELL CONTRACTOR COMPANY NAME 7/Per to e // ryl i //r'49 PHONE H Scow) FSZ7'29P 7
STATE WELL CONSTRUCTION PERMIT/I ASSOCIATED WQ PERMITH
(if applicable) —. (if applicable)
I. WELL USE (Check Applicable Box): Residential (d Municipal/Fublic ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATICN:
Nearest Town. 1-(P51(HIIP CountyL'/cR/
3hpnfw\O\ C rPP. Soh ;
(Street Name, Mmbe s, Community, Subdivision, Lot No., Zip Code)
3. OWNER6 Df e 2 Ur
Address 9g g/ %G/.Spurijee £-
(Street or Route No``.})
//ayasv//4 N6 28-9oe/
City or Town State Zip Code
Area code- Phone number O�
4. DATE DRILLED 6- cOo.2'
5. TOTAL DEPTH: 30l I'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 0
7. STATIC WATER LEVEL Below Top of Casing: `SC/ FT.
(Use "+" If Above Top of Casing)
8. TOP OF CASING IS I FT. Above Land Surface'
*Top of casing terminated al/or below land surface requires •
variance In accordance with ISA NCAC IC .0118.
9. YIELD (gpm): ) METHOD OF TEST 4 (12
10. WATER ZONES (depth):
h�-(1 icateletsAmount
Wall Thickness
or Weight/Ft. Material
.sdr21 ?pc
Topographic/Lan citing
DRidge ❑Slope alley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitudeflongitude source:❑GPS❑Topographic map
(check box)
DE DRILLING LOG
From To F,orrryation Description
�9 - 5'
< - 4/S'
ys- 39./'
I I. DISINFECTION: Type
12. CASING:
13.
Depth
From O To S6 Ft.
From To Ft.
From To Ft.
Tran
Depth Mate 'a
To a2D' Ft.
Front To Ft.
14. SCREEN: Depth Diameter Slot Size Material
Front To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Method
GROUT:
From !9
16. REMARKS:
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
r,
ry
0
ci
_J
0
CA)
r.0
1130 FIEREBYGERTTETT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCT' t4 S'fAN 7ARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
DATE
SIGNATURE OF PERSON CONSTRUCTING THE WELL
_ Submit the original o the Division of Water Quality, Groundwater Section, 1636 Mall Service Center - Raleigh, NC
GROIJIWW00& Iyfmicth• (919)' 33-3221, within 30 days. OW -I REV. 07/2001
ASHEVILLE REGIONAL OFFICE

262346
GRsne •'
ASHEVILLE REGIONAL OFFICE
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) \ )QY% l Q s (mil l t \ Son CERTIFICATION N a2q cJ
WELL CONTRACTOR COMPANY NAME / ///GP •j.? )0// %/r//r/25 PHONE 0 (Y241 -S.TegcF rl
STATE WELL CONSTRUCTION PERMITS/ ASSOCIATED WQ PERMITS/
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential li Municipal/Public ❑ Industrial ❑ Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATI N:
Nearest Town: HAkQS 1% t (�'L County( ICS 1
(Street Name, Numbed, Community, Subdivision, Lot No., Zip Code)
J 3. OWNER: 0lnf'i
Address In LI lSgr/OG) P /(✓ ionfr
,a (Street or Route No.)
/-f44V Psv,'% N C'i
City of Town State
Ain code- Phone number
4. DATE DRILLED S - �''1 - 0.9
5. TOTAL DEPTH: ,2o S-
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 0
7. STATIC WATER LEVEL Below Top of Casing: SD t FT.
(Use "+" it Above Top of Casing)
S. TOP OF CASING IS ( FT. Above Land Surface`
*Top of casing terminated at/or below land surface requires a
variance In accordance with ISA NCAC 2C .0119.
9. YIELD (gpm): r7 METHOD OFTEST 44t'fL
10. WATER ZONES (depth):
11. DISINFECTION: Type n�
12. CASING:
From 0
From
From
Zip Code
Depth Diameter
To /60 / Ft fo..,ZS
To Ft.
To Ft.
%1 -kk /P7C Amount S
Wall Thickness
or Weight/Ft. Material
sort/ /wc
13. GROUT: Depth Mated Method
From 0 To 20 r Ft.
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth
From To Ft.
From To Ft.
Size Material
16. REMARKS:
Topo hic/Land setting
❑Ridge 416lope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
otrr)ation Description
MTH
From To
® - cS `
S - /50
/s,r- ar0S`
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
C�
co
:7
--I
r,I
Submit the original t the
19) 7
T THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
S, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
9-o
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
[vision of Water Quality, Groundwater Section, 1636 Mall Service Center - Raleigh, NC
3-3221, within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - DivisionofWater Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) �iC(t'1'I R S "r (A)a) s, M-) CERTIFICATION N
WELL CONTRACTOR COMPANY NAME 779///eG 4-)el/ C✓�,//"?9 PHONE % (ssn) YS7-.- 9 7
STATE WELL CONSTRUCTION PERMIT% ASSOCIATED JWQ FERMIT/I
(if applicable) (if applicable)
262444
I. WELL USE (Check Applicable Box): Residential MunicipaUPublic 0 Industrial ❑ Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: >M If-ekv County
I-1iBJMC)StP 1n,e[ Pck
(Street Name, Numbers, Community,mJSubdivision, Lot No., Zip Code)
3. OWNER: 8reno'bn �� /P,,/1l7
Address FJClLp NinsArsSP( 2tve t
(Street or Route No.)
phki P�)C'_ ri.`6C1()In
City or Town State Zip Code
Arcs code- Phone number rJ n O�
4. DATE DRILLED
5. TOTAL DEPTH: :SCCE?'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO IY
7. STATIC WATER LEVEL Below Top of Casing: IC r FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS I FT. Above Land Surfaces
•Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): 3X.2 METHOD OFTEST C4i/C
10. WATER ZONES (depth):
4
a
Topographic/Lan setting
❑Ridge ❑Slope alley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
Formation Description
DE
From To
E - to'
/6) -
11. DISINFECTION: Type/
12. CASING:
Depth
From b To Ft.
From To Ft.
From To Ft.
l3. GROUT:
From f'
From To Ft.
14. SCREEN: Depth Diameter
From To Ft.
From To Ft. ....
15. SAND/GRAVEL PACK:
Depth
From To Ft.
From To Ft.
G R sAmount rS`-
Wall Thickness
Diameter or Weight/Ft. Material
sbral
Mate • Q2 Method
To �' � Ft.
Depth
16. REMARKS:
Slot Size Material
in. in.
in.
Size Material
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
0
CO
I DO HEREBY CERTIFY THAT THIS WELL
CONSTRUCTION STANDARDS, AND THAT
c-c-r ce
SIGNATURE
Submit the original to the Division of Wa
27699-1636 Phone No. [phone], within
S OkSISTRUCCBD IN ACCORD rr WITH 15A NCAC 2C. WELL
q 0 DI PROVIDED TO THE WELL OWNER
OF PERSON CONSTRUCTING TEL DATE
er QuoFIt7)tGtoup'dwater Section, 1616 Mall Service Center - Raleigh, NC
GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD 262922
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME fpprintL j C) VY1SS 1� , (J�J�t I Sr) R CERTIFICATION q/2yG(/
WELL CONTRACTOR COMPANY NAME /d'i //e r %/e// (I/ i /Z✓/y PHONE it L )
STATE WELL CONSTRUCTION PERMIT/I ASSOCIATED WQ PERMITS
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential Er Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION:
T2 '
Nearest Town: V,f QSS��j t.'1 ✓�)J County��G(
YJTS;S oft/".7 21/C Xeec. 1e1
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: /S, /lV PP
Address (3.\VI) PPre C(
p� (Street or Route No.)
n_ rue a$aoa
City or Town State Zip Code
Area code- Phone number
4. DATE DRILLED<`1- O 2 - n.Q
5. TOTAL DEPTH: 730.5
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 0
7. STATIC WATER LEVEL Below Top of Casing: t' 5 ' 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 1SA NCAC 2C .0118.
9. YIELD (gpm): 5 METHOD OF TEST 4 %Z
10. WATER ZONES (depth): //
11. DISINFECTION: Type 1t�1t -4etb(Ptc Amount 6
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From CJ To /flit Ft. 6r-54- . /
From //'-/ To Mg ' Ft. t,d ,/,4k
From To Ft.
13. GROUT: Depth an enal Method
From P To 2es r Ft.. /7r�
From To Ft.
14. SCREEN: Depth Diameter
in.
in
From To Ft.
From To Ft.
15. SAND/GRAVEL PACK:
Depth
From To Ft.
From To Ft.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS
CONSTRUCTION STANDARDS,
Slot Size Material
in.
in
Topographic/Land setting
[Midge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
EEEPTH DRILLING LOG
From To r dun Description
/&'-/off
/.;5-'-/.K5-'
/ 3b - .-io '
LOCATION SKETCH W
Show direction and distance in miles fromatleast
two State Roads or County Roads. IncludelTie road
numbers and common road names.
C)
CD
IN)
0
CO
ANCE WITH I 5A NCAC 2C, WELL
BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL
/2,.? -fir
DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center- Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Q.� LA) \SOR CERTIFICATION 11,240(
WELL CONTRACTOR COMPANY NAME ti�to ' �r &�eff CYlrfit%1`J�'
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if a- licthlel ifa,.licable
262935
PHONE # fiiSIR) Ss37-.2947
1. WELL USE (Check Applicable.Box): Residential a Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If GL.c., List Use
2. WELL LOCATION:�1
Nearest Town: I) rOSS"If1IA)'(1 County (-1, 1
i;rep_n (- u (r1
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: Macy Cr;Strncl
Address 811-3 Marla Ave_
(Street or Route No.)
Crlando FL '32_SIX(
City or Town State Zip Code
(9-07 )- 1 — C +k
Area code- Phone number
4. DATE DRILLED 6.-- 3 "'d a
5. TOTAL DEPTH: r22S
6. DOES WELL REPLACE EXISTING WELL? YES (IYNO t-
7. STATIC WATER LEVEL Below Top of Casing: An ` FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surfaces
*Top of casing terminated at/or below land surface requires a
variance In accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): . 0 METHOD OF TEST id,
10. WATER ZONES (depth):
11. DISINFECTION: Typeh-4t 4-AWe-S Amount
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From_)._ To 77' Ft. /0.a5 .5,0(-7l
From To Ft.
From To Ft.
13. GROUT: Depth
From & To 'al)' Ft
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
Slot Size
in.
in.
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To lion Des tiop;
— ICE
l&' 7Q'
7Yi' ,5 '
Material
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road_
numbers and common road names.
tN
r•.)
CO
w
I DO HEREBY CER-IFY THAT THIS WELL WAS COg4STRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRIICi ION STAN®)1ARDg4OP OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
PSHE!/i Le H Jrir-LL FICE ,S /9-c— Or)
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of W�atteer Quality - Groundwater Section `J,
WELL CONTRACTOR (INDIVIDUAL) NAME (print) w,, rr\, °'c 1 "� 5� . -reel- r vS (� CERTIFICATIONTI(#�`-'? _
WELL CONTRACTOR COMPANY NAME \A1'CT �vl x-�-C. W �-Ll_ 1 �LUN G) PHONE 8 tS 60-%S
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable)
(if applicable)
258157
1. WELL USE (Check Applicable Box): Residential Ei Municipa1/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LO
Neatest To
(Stmefoj ite to No.)
1 Stqatte
1ST-�4�'
City or
ant)-
Areacode-number D 1 Da
4. DATE DRILLED II
5. TOTAL DEPTH: \U. '
6. DOES WELL REPLACE EXISTING WELL? YES .4,NO CVT LES' \ ta'
7. STATIC WATER LEVEL Below Top of Casing: 40 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS I FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accord. h ISA NCAC 2C .0118.�
9. YIELD (gpm): METHOD 0r TEST
10. WATER ZONES (depth):
11. DISINFECTION: Type Vrijk Amount
12. CASING: Wall Thickness
Depth„ Ser or\Wgig�ii/Ftt •tWi>)11 numbersandcommon mad names.
From 0 To SO Ft. 4 ..-- - 1 'l/
From To Ft.
From To Ft.
13. GROUT,LDeptL_._ Mat rit
From (i To L ' Ft.
From To Ft. I
14. SCREEN: Depth Diameter Slot Size
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Zip Code
Topographic/Lanctetting
❑Ridge ❑Slope 0Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
L
DEPTH
From To
0 5-'
an i 4s
F
on Description
n
ru
Material
16. REMARKS:
LOCATION SKETCH
Show direction and distance in miles from at last
two State Roads or County Roads. Include th( ad
ths'H04
I DO HEEgY CCRTIF
n Il,CONSTRU ION ST
t�
Submit the original tolthe Division of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
i—;g699.}6}6 notte-616.[phone], within 30 days. GW-1 REV. 07/2001
l' _ « lION
4SrL• LL ' liF
THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL
b?/o�0
SIGNATURE OF PERSON CONSTRUCTING THE WELL DA

253431
+©Wf 0113/JMR9/3P IF ) 713-.
AS131-1/1 REG)3 JAL OFFICE
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
%VEI.LCONTRACTOR (INDIVIDUAL) NAME (print) _ 5I Pint y, CERTIFICATION N 2.5(r75
sV ELL COSIR.\CTOR CONIiANN' NAME CaeoO Lee LOE-I, bQI'l it') PHONE N BJd)g.gOD6
ICI Al I: )Vta.I. CONSTRUCTION i'ERMI # ASSOCIATED NVQ I'ER)IITN
of applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential VMuuicipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Ilea( Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: Pot e Jr lie County CM -
Sit( /�;� I. S I 013 tkos '-0 T -. y�v
(Street Name. Numhets, Community, Subdivision, Lot No.. Zip Code)
3. O\\'NLR: /Y L ( mac.-Lr 6)NA)
Address 2/5'e l ,'✓� :�.`l T,t /ib'e
(Street or Route
±/9/A-J,ouse lolar�L 3.106 V
Lb, or T own State p Code
( y S-01102
Area code- Phone number
4. DATE DRILI.liI) LY 0
5. TOTAL DEPTH: 2 (, ti '
s
(. DOES WELL REPLACE EXISTING WELL? YES 0 NO ❑--
7. STATIC WATER LEVEL Below Top of Casing: S� ' FT. oft
Topogra ) is/Land setting
❑Ridge O ope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/Minutes/seconds)
Latitude/longitude source-.❑G PS❑Topograph is hap
(check box)
DRILLING LOG
o Formation Description
0'
DEPTH
Front
(Use "+" if Above lop of Casing)
8. tIOP OF CASING IS / FT. Above Land Surface`
"Top of casing terminated at/or below I:uul surface requires a
variance in accordance with I5A NCAC 2CMIDI
9. YIELD (gpnl):�° METHOD OF TEST t'�
10. WATER ZONES (depth): / 0'
II DISINFECTION: Type H7/8/ Amount G
12. CASING: Wall Thickness
Depth/
From 0 To So e Ft
Front _ To Ft.
From To Ft.
13. CiROUt Depth ,
From +ICI "I o r 2 Ft
From LO To je e Ft.
14. SCREEN: Depth Dianteleb Slot Siz
Prom 'fo Ft. in.
From to Ft. in.
15. SAND/GRAVEL PACK:
Depth Size Material
Froth To Ft. _
From To FI.
newt rterial
c)0cV ll�tI
16. REMARKS:
Method
Material
in.
III.
Se-7 (' /9 6
/f97c
40P7- Aor,/T
5/ Atte
/2/is G Qrriv/r
S//-27ti
LOCATION SKETCII
Show direction and distance in miles froth al least
two State Roads or County Roads. Include the roa€
numbers and common road names. ICj C
Ca)
IIS WELL \VAS CONSTRUCTED IN ACCORDANCE WIT11 I5A NCAC 2C, WELL
ND THAT A COPY OF Ti llS RECORD HAS BEEN PROVIDED TO TI IE WELL OWNER
-S- Z (/-DL
IGNATURE OF PERSON COfdS�IRU`TIIN ,"l) YELL DATE
nut the original to the DIN' - ion of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
221, within 30 days. OW -I REV. 07/2001

STATE WELL CONSTRUCTION PERMITS ASSOCIATED WQ PERMI•fy
ifa licable) Ifapplicable)
232623
I. WELL USE (Check Applicable Box): Residential dr****MunicipatPublie 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection C. Other 0 If Other, List Use
2. WELL LOCATIqN: ei a Topo c/Land setting
Nearest Town: tii4Yl�V(Lle County r
❑Ridge 2Slope ❑Valley ❑Flat
MCC R &CK IC-'t4 CnVVE thrr OtF Q5 7_5 i (check appropriate box)
(Street Name, Numbers,rCommunity, Subdivision, Let No., Zip Code) Latitude/longitlide of well location
3. OWNER: I? (W 03 F (deYrealm nu as aecaodt)
Address !an)C 4 7 Latitude/longitude source:OGPSQTopographic map
Streetor RouticiLac e No.) (c tok Ica)
r `� �i©Q47 DEPTI1 • DRILLING LOG
City or Town State Zip Code Fr m To Fo �? Description
Area code. Phone number,
4. DATE DRILLED S _I 3 -0 Z
5. TOTAL DEPTH: f ? 5
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing; '��%1 �.�{,
(Urc"+" It Above Topp Cuaf ing)
8. TOP OF CASING IS I FT Above Land Surface*
'Top of casing terminated adur below land turbot requires t
variance In ueordaace�wra ISANCAC 2C.011g: '
9. YIELD (pm):CR- / ME OD,OF TEST P in &T2i .
10. WATER ZONES (depth):
11. DISINFECTION: Type 4TI+
12, CASING:
Depth Diameter
From (') To 35 Ft. (Cs tti t
From,S . To .6 c Ft. Y4
From To__ Ft e
13. GROUT': Depth lslerial
From_ To 7Cl) Ft.__Q TE
From To Ft,
14. SCREEN: Depth Diameter
From To Ft_ _in.
From To Fte__jn.
15. SAND/GRAVEL PACK:
Depth Size
From To Ft.
From To Pt.
Amount. -`t O Z ,
Wall Thickness
or W NFt. Material
16.REMARKS:
--
10ERTIFi' TN„f�T'THIS WE'LL WAS CONSTRUCTED 'ACCORDANCE
Feo
S U I TANDARDS, TH T A IIY OF THIS RECORD FIAS BEEN PROVIDED TO THE WELL OWNER
'4 1
Method
method
Let RE
Slot Size Material
in.
in.
Material
LOCATION SKETCij
Show direction and distance in miles front at least
two State Roads or County Roads. Include the road
numbers and common road names.
Neyeeyruk, A1C,
,, cCr�
Ca c..
C
C
cm
tv
S 92,
a
v
Cl
s
AC
m_
/I(,ato .Site G 7z
SIGNATURE OP PERSON CONSTRUCTING THE WELL DATE
Submit the original to\tbe D vision of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
qi p,C(919) 73 -3221, within 30 days,
GROUP D O N- GW1 REV. 07/200:
.SHEVILLE REGIONAL - CH ICE
JUL
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and tNaatura�ltResource- Division of Water Quality - Groundwater Section
WELL CONTRACTOR (UWIVWDUAL) NAME (Print) f-' R anZ ?, V 1 GTC IC CERTIFICATION Y 3I7'
WELL CONTRACTOR COMPANY NAME 8UEi2s Lu GLL lJ /2 ( Lli i4Ce PHONE a 174 -2l L,E,
Erb IC

WELL CONSTRUCTION RECORD
262343
North Carolina - Department of Environment and Natural Resources n-- Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME
(print) \JCtYPIP.S R �/^, I So () CERTIFICATION # 2c/0�/
WELL CONTRACTOR COMPANY NAME �i A)/ T, // .7 q
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
PHONE # (S i'5 s-2 7--29'> `r
I. WELL USE (Check Applicable Box): Residential ilk-Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCAT
N(R/Arest Town: /Coupty
4- 7/f < Free!(
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code) II
3. OWNER: I') 1 mQx t\C.I
Address LI r1.1(l Ken* Or the
(Street or Route No.)
`. rf Ft- 33`1rl 2-1
City er Town State Zip Code
Area code- Phone number
4. DATE DRILLED S/,629- 0_2
5. TOTAL DEPTH: ,27,5 '
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO ❑
7. STATIC WATER LEVEL Below Top of Casing: `�c'>r FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS I FT. Above Land Surfaces
*Top of casing terminated at/or below land surface requires a
variance In accordance/with ISA NCAC 2C .0118.
9. YIELD (gpm): C METHOD OF TEST 0, 2
10. WATER ZONES (depth):
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
l 1. DISINFECTION: Type - Ci Wet Amount G
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From <7 To L// ' Ft. 6„2S` (51)!fl1/ por
From To Ft.
From To Ft.
13. GROUT: Depth Mate ' Method
From 0 To ,.;2O ` Ft. �Dr 77ci/7C✓
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.
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include -Alm road
numbers and common road names.
i�
16. REMARKS:
IS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
IGNATURE OF PERSON CONSTRUCTING THE WELL DATE
sion of Water Quality, Groundwater Section, 1636 Mall Service Center - Raleigh, NC
221, within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resource(s7- Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) , ' f W1 P5 1\ ,/ t A): k Sort CERTIFICATION Na�%�(
WELL CONTRACTOR COMPANY NAME 1vii�(/er /�v // Snit
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMITS
(if applicable) (if!ppiicab!•)
1. WELL USE (Check Applicable Box): Residential EV-Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
PHONE # ft2R) Kai-
2. WELL LOCATION:
Nearest Town: Q County &c?y
IATh 1-e 1c er vAnntrY�P
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: \ /O`(1 R tt')4S
Address e4O nndt1 IaRArC\ atl 1,\1k0rl9YnotlDr
(Street or Route No.)
?)rc*s own NC . Sa`tA
City or Town State
L)-
Area code- Phone number
4. DATE DRILLED y — Iq O�
5. TOTAL DEPTH: ,7 CS
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO ❑
7. STATIC WATER LEVEL Below Top of Casing: f>[') ¢ FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS I FT. Above Land Surface'
*Top of casing terminated at/or below land surface requires a
variance In accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): 70 METHOD OF TEST 4 r'12
10. WATER ZONES (depth):
Topographic/Land setting
❑Ridge ❑Slope OValley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To F t n Description
D— (f7' L/G
- Sri'
s©- ems'
I1. DISINFECTION: Types\h i/IP\Amount S
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From To 'VO/ FL 4.25 ShFpig/ pi
From y,Q To '/' FL (a.t) .,°/ .Sjop/
From To Ft.
13. GROUT: Depth Material Method
From To Ft.
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
JOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
rJ
NJ
0
—i —
•
CJJ
co
16. REMARKS:
III r
Zip Code
262339
EREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
D(f N U 1 w•e 'a •a'-=< 'THAT A COPY OF THIS RECORD HAS REEN PROVIDED TO THE WELL OWNER
tea!■,
�I
Submit the original to t v
- 636 Phone No. (91 ) 733-
GROUNDWATER SECTION
ASHEVILLE REGIONAL OFFICE
L
9
IGNATURE OF PERSON CONSTRUCTING THE WELL DATE
don of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
221, within 30 days. GW-1 REV. 07/2001
(

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) OQr✓12S C. GO; l SOY\ CERTIFICATION # J44'4
!*
WELL CONTRACTOR COMPANY NAME // /&t /.t% e /l d-• (//// /t 9
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
262337
PHONE # LR2f) cin,"02997
1. WELL USE (Check Applicable Box): Residential Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATIQN: /
Nearest Town: rA sit, Nl n Countye/ay
Cr'Pm gave. r
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: alt/• &G/Se Pier
Address ) X of
(Street or Route No.)
hv(ISSitowti VS ` q.YRQOa.
City or Town State
(--)-
Area code- Phone number
4. DATE DRILLED 4-/>- c 2
5. TOTAL DEPTH: /C/.S e
6. DOES WELL REPLACE EXISTING WELL? YES 111-14O 0
7. STATIC WATER LEVEL Below Top of Casing: 60 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS I FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): iS METHOD OF TESTA P
10. WATER ZONES (depth):
11. DISINFECTION: Type Aill 4die lcAmount
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
tr
From_ /Of Ft.ln•2S. SOM/ p✓L
From To Ft.
From To Ft.
13. GROUT: Depth Materi Method
From 0 To 020 r Ft.
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
Zip Code
Topographic/Land setting
❑Ridge ❑Slope OValley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
"LEM DRILLING LOG
From To ); orrpation Description
/6 - Poe
Poo - /45'
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
CJ
to
PO THIS WELL WAS CONSTRUCTE
IN ACCORDANCE WITH I5A NCAC 2C, WELL
CCQN (4LRU i'1O RI �APr ,, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
DATE
C
ubmit the original to the
0
ASHEVILLE REGIONAL OFFICE
$ GNATURE OF PERSON CONSTRUCTING THE WELL
Div sion of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
733-3_21, within 30 days. GW-1 REV. 07/2001

/A)e(I ?
262335
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
V
WELL CONTRACTOR (INDIVIDUAL) NAME (print) E:ffti_P/S l�, LA); \ SO(1 CERTIFICATION 1/0240U
WELL CONTRACTOR COMPANY NAME %f%i//t�/ (�l)N_// CYr///ii, PHONE II f-.») 4S3'7-e2 Cc"7
STATE WELL CONSTRUCTION PERMIT" ASSOCIATED WQ PERMIT"
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential al---Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: 414 V e S toe County C/a,
S'Miorlio /52
(Street Name, Numbers, Community, Subdivision Lot No., Zip Code)
3. OWNER:'Ivvl bvl t�
Address 1g. kaM o \AP W Cr)
(Street or Route No.)
Ncai�y`ut�(e Pic avicAOLI
Ci►y or Town State Zip Code
Area code- Phone number
4. DATE DRILLED LI-®)S-fQ
5. TOTAL DEPTH: r9L4'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO ID-
7. STATIC WATER LEVEL Below Top of Casing: MO FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surfaces
*Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9 YIELD (gpm): yP METHOD OF TEST%
10. WATER ZONES (depth):
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
Topographic/Land setting
DRidge ❑Slope OValley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTFL DRILLING LOG
Fro To F eriion Description
- /b
1 i. DISINFECTION: Type Mil /oL/efAmount S
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From P To 3S Ft. (.2 S 5A1.2I lc
From To Ft. /
From To Ft.
13. GROUT: Depth Mat Method
From © To 2o' Ft. n
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
CO
LID
16. REMARKS.
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
2 699-1636 Phone No. (919)
GROUNDWAI , SECTION
ASHEV!t!_l riLOIONAL OFFICE
NATURE OF PERSON CONSTRUCTING THE WELL
DATE
n of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
33-32 1, within 30 days. GW-1 REV. 07/2001

262933
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources
- Division of Water Quality - Groundwater Section WELL CONTRACTOR (INDIVIDUAL) NAME (print)✓ / YltY1A S 1�. ,C1'SFi41 CERTIFICATIONM .2q6�/
WELL CONTRACTOR COMPANY NAME V1714r ii7,P/� (/iV//!Gf PHONE # f .Y+i1 5T 7- 2 Ci cj %
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) / (if applicable)
[d"
1. WELL USE (Check Applicable Box): Residential Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCA. P e/G(
t"
Nearest �TowrrlwJi�J,b4/-i,' �%/ la 1 / P County
eicves
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: I/ I 1'7(//7 f
Addres„ TKO •% ,0 .
(Street or Route No.) 225(
(54u111e c
�1ty or Town State Zip Code
Area code- Phone number
4. DATE DRILLED Li— e24/— b.2
5. TOTAL DEPTH: ,2/..)
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO IY
7. STATIC WATER LEVEL Below Top of Casing: SO / FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS I FT. Above Land Surfaces
*Top of cuing terminated Nor below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): I DO METHOD OF TEST 4 2
10. WATER ZONES (depth):
11. DISINFECTION: Type 1 4 k 4tlik(P.1-5Amount S
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From-Q_To PE/ Ft./..25 . / /OW
From To Ft.
From To Ft.
13. GROUT: Depth Mate r1a) d Method
From G� To ,$G' Ft.
From To Ft.
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
num DRILLING LOG
From To Fo tion Desertion
77
ro
ire?- �L/o2' �w�i,i'1P%
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
Slot Size
in.
in.
Material
15. SAND/GRAV
From
From T
16. REMARKS:
I DO HEREBY CEF T1FY THAISER )9Jb1#p)1 ' F • STRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION :TINt INNEE'IRA ' 5* ; OF T`IIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
Ft.
ab4
kize
EM
trial
W
LOCATION SKETCH
Show direct nn and distance in miles from at least
two State Roads or County Reads. Inciude-c mad
numbers and common road names.
0
r
0
LO
?"7-1/11,- �2�n EOFP
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

8. TOP OF CASING IS I
*Top of cuing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C.er1B.
9. YIELD (gpm): ilk, METHOD OF TEST // R
10. WATER ZONES (depth): /
11. DISINFECTION: TypeJn fh /1-*WPbAmount C.
12. CASING: Wall Thickness
Diameter or Weight/Ft: Material
From 0 k Ft. 6,.2S Of:2i put'
Ft.
Ft.
Mate
Ft.
Ft.
Diameter Slot Size Material
Ft. in. in.
in
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) /
NAME (print). )(AWI P i R .Go; i co ✓\ CERTIFICATION #.2 y0 U
WELL CONTRACTOR COMPANY NAME ' //per [veil [ ^•-,Y%,n9 PHONE I f3,2$) 8'37-.2CA7
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential li/ Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCATIO
Nearest Town: 41 06 14/IQ County/Gt
,Sinoie ,'st
(Street Name, Numbers, Community, Suon, Lot No., Zip Code)
3. OWNER:it inly SMi {'
Address .55( \ IPI)3 ik iY
V , wN(Street or Route No.)\IR9.$n �I
111C Cede
C or Townn State Zip Code
(�-
Area code- Phone number
4. DATE DRILLED numb.
%oZ - D a
5. TOTAL DEPTH: / 7€ '
6. DOES WELL REPLACE EXISTING WELL/ YES 0 NO 0
7. STATIC WATER LEVEL Below Top of Casing: .b ' FT.
(Use "+" if Above Top of Casing)
FT. Above Land Surface'
Depth
To If -
From To
From To
13. GROUT: Depth
Fromt_ To -20
From To
14. SCREEN: Depth
From_ To
From
15. SAND/GRAN
From
From
-n
16. REMARKS:
Method
Ft
L
TTFt.
T Ft.
W eU�
262932
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
tion Description
0
pEPT$
From To
b - /O
- 70 '
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
c.0
I DO HEREBY CER-1FY
CONSTRUCTION S' tend
/'.. 18. �TR
ram
_ D IN ACCORDANCE WITH 15A NCAC 2C, WELL
S RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Ses: ce Center - ia:eigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resourcesr- Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print). )QW .$ r<. ALA); SO Yl CERTIFICATION 82...404
WELL CONTRACTOR COMPANY NAME 7J%i P / IA) E// !Y/i 1/ //I,'
STATE WELL CONSTRUCTION PERMITS/ ASSOCIATED WQ PERMITS/
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential air Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCAT ON:
Nearest Town: d o S V e_ County e/Aty
e te- Ri
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER:. i (vv't SVY\i t V1
Address `iij V\QU STh
�� " (Street or Route No.)
yt svkkkk re_ - ZipCode -{
t�;}t Code
ty or Town State
Area code- Phone number
4. DATE DRILLED di- / 1 0.2
5. TOTAL DEPTH: aVS'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 0
7. STATIC WATER LEVEL Below Top of Casing: FT
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface'
*Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): e20 METHOD OF TESTiit fe
10. WATER ZONES (depth):
11. DISINFECTION: Type
12. CASING:
Depth Diameter
From D To 54 Ft. l r625
From To Ft.
From To Ft.
Aid/ #1-
262943
PHONES/ tan fs3 % 049 7
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(cheek box)
DRILLING Top
thin Descnphon _..
DEPTH
From To
JO
/d- US`
_ .2�
��� �f LOCATION SKETCH
`1Tyt-t-A�ote/eAmount 4 Show direction and distance in miles from at least
Wall Thickness two State Roads or County Roads. Include the road
or Weight/Ft. Material numbers and common road names. c)
,Sae2/ IQ/LC— • -
13. GROUT: Depth Mate Method
From n To_ Ft.
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
I DO HEREBY CERTIFY THAT-H
CONSTRUCTION STANDARDS
t,q 17
Vi Ls
IN AIC'CORDANCE WITH 15A NCAC 2C, WELL
T A COPY OF THIS RE Ofvlb HAS BEEN PROVIDED TO THE WELL OWNER
-`t
3
w
GNAIURE OF PERSON CONSTZUCTING THE WELL
DATE
(� � � ' TI ate Sectlon,1636 Mall Service Center - Raleigh, NC
Submit the original to the Div shin ert,tt ,;, e ebv
27699-1636 Phone No. (919) 733--:,221, vat n days..- GW-1 REV. 07/2001

258155
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Reesonurrcess-- Divisiionnvoff Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print)w� u'�r[• , • CERTIFICATION # r'
WELL CONTRACTOR COMPANY NAME k '1 \CtL -1E LOELL.:11211_141.16s PHONE # 1 S 1 u SJ
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential E7 Municipa1IPublic 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery El Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCAII# :
st o . •,
ty
(Street umbers, Community 'visi� Lot No., Zip Code)
3. OWNE'
ddress
" IStreet
No.)
City
Zip Code
Area code- Phone number
4. DATE DRILLED ei. 0
5. TOTAL DEPTH:
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: t:), FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS I FT. Above Land Surface*
'Top of casing terminated at/or below land surface requires a
variance In accordatle rth ISA NCAC 2C .0118.
9. YIELD (gpm): 14- METHOD OF TEST 0.-X.-
10. WATER ZONES (depth):
graphic/Land setting
dopoge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
Forma typn Despription
11. DISINFECTION: Type Vlii
12. CASING:
ter
From O To OD Ft. _ `_
From To Ft.
From To Ft.
13. GROUT: Depth
From D To 5 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
DEPTH,
From To
9611141)
fin`
LOCATION SKETCH
Amount Show direction and distance in miles from at least
Wall Thickness two State Roads or County Roads. Include the road
Wei t/C. ate 'al numbers and common road names.
(P
From To Ft.
From To Ft.
16. REMARKS:
c
rp,t1 4c
aQ 11/ozi
�_,.,-IIY €ERTWy T[IeT TWIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH i 5A NCAC 2C, WELL
rj� ION$TRUCTlON STAI4D' -+� AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WEJII/Y
J .411
ivJ
Submit the original to th7fe Div
gT6p9-)634Ptex�i?[u.{417) 733-,
li Lt 4EG::f<r.L OFFICE
IGNATURE OF PERSON CONSTRUCTING THE WELL
Lion of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
221, within 30 days. GW-1 REV. 07/2001

258154
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
CONTRACTOR (INDIVIDUAL) NAME (print) LJSVU \. S . (t tW\ S CERTIFICATION %P93g
��
WELL CONTRACTOR COMPANY NAME Wayy,,pr�Zzb* U(LI_.0 'L)5 ,�ti21L.1...( NIA PHONE # Iww (- 1(SS
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
Neare
(Street
3. OWNER:
A=..rss
City or T. State Zip Code
Area code- Phone number
4. DATE DRILLED
5. TOTAL DEPTH: on /
6. DOES WELL REPLACE EXISTING WELL? YES CJ NO Q
7. STATIC WATER LEVEL Below Top of Casing: /O FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS I FT. Above Land Surface'
*Top of casing terminated at/or below land surface requires a
variance in accordan,��e����'ith 1SA NCAC 2C .0118.
9. YIELD (gpm): n'L METHQp OF TEST
10. WATER ZONES (depth):
11. DISINFECTION: Type WA to Amount
12. CASING: Wall Thickness
pyameter Qr Weiahj/Ft. ,atrial
From (J To � Ft. Fw �Ldi fP F" v
From To Ft.
i6/ba
From To Ft.
13. GROUT: Depth Mate all
From D To Ft.
From To Ft.
14. SCREEN: Depth
From To
From To
15. SAND/GRAVEL PACK:
Diameter
Ft. in.
Ft. in.
Slot Size
in.
in.
Material
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
Topographic/Lan thng
❑Ridge ❑Slope alley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DE DRILLING LOG
From To , Forrt,(a)jon Description
0
ry
n
LOCATION SKETCH v = .7
Show direction and distance in miles from atlgast
two State Roads or County Roads. Include the.road_;
number3tapd common road names. rn
O
Co
I..
WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WE
ATURE OF PERSON CONSTRUCTING THE WELL DATE
S bmit the original to the tvisio of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
2i IW6ThfiaN (929i. 3-322 , within 30 days. GW-1 REV. 07/2001

251165
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division
io�f�Water Quality - Groundwater Section
�y�
WELL CONTRACTOR (INDIVIDUAL) NAMEE'(print) `W \ -1--� � S • ( C`� l < S, (CERTIFICATION�y-y#ram. /.3 r
WELL CONTRACTOR COMPANY NAME SY 6V ("^"' PHONE q (X�JHI 3B / ' /1SJ
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential li Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LO-:TIO
NearesTsuais
City or Tpw
Area code- Phone number
4. DATE DRILLED Da
5. TOTAL DEPTH:
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: rib FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordanfe,fib 15A NCAC 2C .0I18. akii..
9. YIELD (gpm): 1 M �THO? OF TEST
10. WATER ZONES (depth): 11 11 C)
11. DISINFECTION: Type T c Amount
12. CASING: Wall Thickness
From To Ft. Icl'pleter Wet/�t�p(#t�yal
From To Ft. (�c(. i
From To Ft.
13. GROUT: DepthtL\�..1JA1.
From 0 To0/5 FtS
From To Ft.
14. SCREEN: Depth Diameter Slot S
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:
Topograplfic/Land setting
❑Ridge 8Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
LL
Forma Description
DEPTH
From To
aOS
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
ta
a•
o rn
c
T THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
D THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WE L
SIGNATURE OF PERSON CONSTRUCTING THE WELL
IV
ivision of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
33-3221, within 30 days. GW-1 REV. 07/2001
cc

251164
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Sectionon/�A
WELL CONTRACTOR (INDIVIDUAL) NAME (print) �lL1,LYNM ���r1�IE"CY� CERTIFICATION
WELL CONTRACTOR COMPANY NAME �II�r• \ ' �•'f sLU iGi PHONE If SS --
STATE WELL CONSTRUCTION PERMIT# __ASSOCIATED WQ PERMITS
(if applicable) (if applicable)
2. WELL LOCATI
Nearest
1. WELL USE (Check Applicable Box): Residential [9' Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
Topographfc/Land setting
ORidge Slope OValley ❑Flat
(check appropriate box)
Latitude/longitude of well location
3. OWNER:' • w - (degrees/minutes/seconds)
A.. ss ► Latitude/longitude source:❑GPS❑Topographic map
._, _. _ (check box)
DRILLING LOG
Formatiory,Description
State Zip Code
4 DATE DRILLED ba
6 DOES WELL REPLACE EXISTING WELL? YES Q,_NO
City or To
Area code- Phonenumber / �,
5. TOTAL DEPTH: J • r i
7. STATIC WATER LEVEL Below Top of Casing: FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance In accordan with ISA NCAC 2C .0I18.
•
9. YIELD (gpm): MW[U}tOD OF TEST ��--
10. WATER ZONES (depth): �`
11. DISINFECTION: Type kTk E
12. CASING:
Depth Diameter
From b To /00 Ft. Liiii-
From To Ft.
From To Ft.
13. GROUT: Depth
From h 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.
DEPTH
From
b
LOCATION SKETCH c
Amount Show direction aa
and distance in miles from at M st
ID
,.a.....ickness two State Roads or County Roads. Include Meted
o�'ght/Ft aterial numbers and common road names. —p
16. REMARKS:
o the
(919)
Y t
KA? 7P"
T THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
S, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE } LLJC)WNER
Da
SIGNATURE OF PERSON CONSTRUCTING THE WELL
Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
733-3221, within 30 days. GW-1 REV. 07/2001
am
cn
c
zr

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
p�jo
WELL CONTRACTOR (INDIVIDUAL) NAME (print) W1u'��m S rEE(nAS CERTIFICATION #OI�O
WELL CONTRACTOR COMPANY NAME LIB al LU "'4 PHONE # 1301) SB9-9/S -
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
/
1. WELL USE (Check Applicable Box): Residential l7 Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATIO)J
Nearest •, : SI4i�a �_' County
�i�
(Street Name,
3. OWNER:
Addre s
sion, Lot No., 'p Cod
ty or • S
dedii
Zip Code
Area code- Phone number
4. DATE DRILLED
5. TOTAL DEPTH:
I
es
6. DOES WELL REPLACE EXISTING WELL? YES IZNO a
7. STATIC WATER LEVEL Below Top of Casing: FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS � FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a ,
variance in accorda th 1SA NCAC 2C .0118. 1
9. YIELD (gpm): M� AF TEST ! K/L
10. WATER ZONES (depth):
0.0 I
11. DISINFECTION: Type ff lf/
12. CASING:
Depth q Liapyeter
From U To t9I Ft.
From To Ft.
From To Ft.
13. GROUT: Depth
From6 To ao f/ Ft.
From To Ft.
14. SCREEN: Depth Diameter Slot Stu
From_ To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
Amount
Wall Thickness
o Wei t/F,t. lv]a�erj31
From To Ft.
From To Ft.
16. REMARKS:
pographic/Land setting
gitidge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
251168
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
From To Formatit1Description
/S
DEPTH
f30 14
c�o.' 3 r
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
a / ( I Y(� a��,l F� i 4HIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WET 1
a 1R II�N=Y •
Aj� AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE L
/
U
Submit the original to the Div
Z7699#Th3fAFFIRME1441W19) 733-.
ASHEVILLE REGIONAL OFFICE
IGNATURE OF PERSON CONSTRUCTING THE WELL
Sion of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
221, within 30 days. GW-1 REV. 07/2001

250935
1VELL CONSTRUCTION RECORD
Noah Carolina - Dcpartncnl of Environment and Natural
Resouces - Division of Water Quality - Groundwater Section
\cp.l.l, ('o• I RAC loll (INDIVIDUAL) NAME Ina J1 AIM k 'So tJCS CERTIFICATION 4 ascoe
% LI 1, CON I RALrult CONIPANY NAnn• p.Ro lleP L le l 1 --)R)LLI', c PHONE II f$}8) isr7-00g
S I Al I: \\ I:1,1. ['DNS 1 I ITAION PEIt\III# ASSOCIATED WO i'ERMIT/I
lirapplicable) (ifappliclble)
I. WELL USE (Check Applicable Box).Residential t/ Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pomp Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCA IIOI�N:
Nearest Town: t3RASS Io tO'-)
n7450.1/4-1 R h
County ei-/-1 /
(Shed Name. Nurnberg, ('onuuunily. Subdivision iil No Zip Code)
3. OWNER: 8ARoy hybego
Addlcss JJQ PLDN
Sneer or Route No
LLCpt Nc aX706
lit I n Slalc Zip Code
W37- OG-7
,Area node- Plume number
Fe.T€ )3uP-C
RIVe_
4. I)Alli DRlI.I_YI) -y-O �.
5. TOTAI. DEI'111: Goat
6_ DOES WELL REPLACE EXISTING WELL? YES 0 NO V
7. STATIC WATER LEVEL 13cIow lop of Casing: /0 0 ET.
(use "I" if Above 'l op of Casing)
8. TOP OE CASING IS / FT. Above Laud Surface'
' l op of caging lerminaled at/or below- land snriwee requires a
rail:nice hi accordanre e talc I5,\ NCAC 2C .01 I ll.
9. YILLO(cpul): / ML'IIIODOE TEST /9/le,
In. WAT[It ZONES (depth): 14'0
Midge
setting
6QRidge ❑Slope ❑Valley OHM
(check appropriate hurl
Latitude/longitude of well location
Itlegrecs'nl inulcg/seconds)
Latitude/longitude source:❑Ci1'S❑Topographic map
(check hits)
DITTII DRILLING LOG
Prom To Formation Description
6%5 se r C..ls f.i 6-
C S'— GooSl cure
11 DISINFECTION: Type (,lu 'rliR4 Amount PT Cap
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From C) To (05 Fr (-2, s'bk>I Pv'c
cram To El.
From To Er
Il. GROUT: Depth Material Method
I -rom fo D [1 ft. _Cettel % q 4 '/
Ilum. _ 3_(_- lo_Cps I 'I. Cu1.LL'r' s iY-
Sl'RIP.N Depth Diameter Slml
n ILA
I(ISR��t�'IA'P�3<W 'L'
CJMu'L ya/
Id. I Size Il M1l;lteri;(I
I tutu T o I t in. in.
I roes1b...____ Ft, in. in.
15. SAND:;RAVEL PACK:
Depth Size Material
I tom I o_. El.
I -tole lIv El.
LOCATION SKL-'fCII
Show direction and distance in miles front at least
two Slate Roads or County Roads. Include Ike road
numbers and common road names.
1 UU IIEREIti (I R IRA I L S WELL WAS CONS TRUCLI EI) IN ACCORDANCE Wi l ti I5A NCAC 2C. WELL
g
ti)NS fltL)( I ION S I''ASIDAI2 I) 11IAT A COPY OF 1111S RECORD IIAS BEEN PROVIDED TO fl IE WEll. (AVI-!lR
crC�`ir F SECsR
ASREVILLI: FIG GL`:CL Cr.CE
u mot the original to the Division of Water Quality, Groundwater Section, 1636 Mail Scribe ('enter- Raleigh, NC
276(P9-1616 Phone No. [phone], within 3(1 days. G1V-I REV. (17/2001
IC jZ Nd S I &dV ZO
t IRI! 01
CONSI R11(" I ING lI IF WELL DATE
c
c
cam
Cm
Cn
m
0-c
1m
rn
m
rn
C)rJ
—y
0

NULL CONSTRUCTION RECORD
250932
North Carolina - I )cpaitnicnt of Environment and Natural Resources - Division of Water Quality - Groundwater Section
wEli. (llNA RAC I Olt (INIII\IlL!Al.) NANII! Idol) '.J I NIM. (�\VFl. I, CON.' It (I Olt CONI('ANY NAN11'l .h.agiDi e—_ el R LI ENO
.SI Al I; WEt.l, CONS-IRCC! ION 1'EltAll TN ASSOCIATED \VI) I'EItNIFfa
lilapplicublc) (if applicable)
I. W111.1. I1S1'. (Check Applicable Box): Residential M Municipal/I'uhlic ❑ Industrial 0
Moniiming ❑ Recovery 0 Ilea( Pump Water Injection ❑ Other 0 IfOlher, List Use
2. WI:I.I. COCA ION.
Ncm est Town: %-a✓PS tJ( HE' County 1/
rB.e-S ' CPEek kb
I Street N:nne. Numbers, Community. SvhJirision, Lai No_ Zip Cade)
3. OWNER:
Address Coo71 Fr2Fs C2e(K Qn
(Street or Route No )
C 2 10 y
()ivt l us',, Stale ' Zip Code
(%1)- 837-- G G)'-/
Area code- Phone number y/ 'J/
4. DAIT [MU, NI) /— —02
5. TOTAL DEPTH: ()S'
6. DOHS \VI',I-L RFI'I.AC'I? EXISTING \VELIJ YES ❑ NO (Y
7. STATIC WATER LV VET. Below Top of Casing: _5(1 FT.
(Use"(" if A hove Cop of Casing)
8. TOP OF CASING IS / FT. Above (.and Surface•
•7 mp of rasing terminated at/or below haul ,urfare require, a
voli:umc in accurd:met uitr I5A NCAC IC .111 IR.
9. YIFI.D(gpind �j NIFIIIODOFTEST /9/se,
10. WATER ZONES (depth): 90 /OO'
II. UISINI ITC'"(ION:'type CiEAti141.-A2 Amonnl KKi Cr(
I2. CASING:
Prom
trout
I)epth Diameter
C Ill go I:(._G, *„
To It
From To Ft.
13. ( TROUT: Depth Nlnteri; I
ITuul 0 To aG\ I'I. Centre) I
From gC To m__ ft. CUi±iLjyq
s('IT l l`N: I)eplll Diameter Slot Size
I run, To Pt. in
Wall Thickness
or Weight/Ft. Material
SbQ2) P✓c
iu
farm Ti..__- PI. in. in
15. SAND/GRAVEL PACK:
Depth Size
I Mont In fl,
I Toni To I:I.
litterial
Method
oNe ,S
CEltaIFIC i'IONN r�- 5Cc;S
PHONE a f8 ) 037—$0o$
Agricullural 0
//:Topographic/Land setting
'it7Ridge ❑Slope ❑Valley Orlin
(check appropriate ho,)
Latilude/longitude of \yell location
t deg rees/m i n, n c ciccc muds l
I -alit tide/longitude source:❑(il'S❑Topographic map
(check hoc
DI:I'l'tI DRILLING LOG
Tana pTo I ortnalion Description
_CDOC) I P i CAsit it
Yslo ,e)c• NJ ITE
LOCATION SKEJ i I
Show direction and distance in miles from at least
Iwo Stale Roads or County Roads. Include the road
numbers and common road names.
c.
ILi )II fOc:('PRIIVY MA
I 'CCWNS FRll('IION STAN,I)/AINI
\ JUL _
GRUll(DVATEP SECTICN
fI
�i SuPBHtYllti_iii''Lul r- t h CE. - , of Nader Quality, Groundwater Section, 1636 Mail Sereice ('cuter - Raleigh, NC
27699-16.16 Nome No. (919) 70-3221, within 30 (lays. (iW-I REV. 1)7/21101
'll ^ LC
I \VEI.I- WAS CONSTRUCTED IN ACCORDANCE W III I I5A NCAC 2C, WELL
)II TAT-('OI'YOP-IIlls RE(f.)jiDIIASBEEN PROVIDED10TI1EWELL OWNER
v -0 2-
IIt UCII NC TIIE WELL DAT It

251182
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Nna`t`u,rraal1R1 essourrce - JDDivissio/n of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Cal `--t• `""k� CERTIFICATION 9
WELL CONTRACTOR COMPANY NAME tr—l•1t•:.k-g""" as) PHONE # g)ce) e§a- II SSA
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential Da/Municipal/Public ❑ Industrial 0 Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other ❑ If Other, List Use
2 L LOCAT O.
Ne st • o Co
tY
(S . -! Nam , umbers, . Subdivi-ion, Lot No., Zip Code)
3. OWNER:
Address
(Street . �)o.)
City or Town State Zip Code
moo- B% Vati.-
Area code- Phone number
4. DATE DRILLED \\ Da)
5. TOTAL DEPTH: \
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO di
7. STATIC WATER LEVEL Below Top of Casing: ,S FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS i FT. Above Land Surface'
*Top of casing terminated at/or below land surface requires a
variance in accordsJe with ISA NCAC 2C .0I18. l )
9. YIELD (gpm): �C� _ MENTIIOD IOF TEST
10. WATER ZONES (depth): c953
11. DISINFECTION: Type \ "VI \-i Amount
12. CASING: Wall Thickness
Depth ter o Wei �r - kiial
From_ 56 Ft. 4 V C
From To Ft.
From_ To Ft.
13. GROUT: Depth Mate
From O To -� Ft.
From To Ft. I
14. SCREEN: Depth Diameter Slot Size" Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
Topographic/Lan etting
DRidge ❑Slope alley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH pRH.LING LOG
From To Form ('on Description
et iat
I r
l \3 '
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
(to ' fl3 \ &
I DO HEREBY CERTIFY THAT THIS WELL WAS CO
CONSTRUCT aN STANDARDS, A9J THAT A COPY
er 2pe
SIGNATURE OF PE
Submit the original to the Division of Water Quality, Gr GROUNDWATER SECTION
27699-1636 Phone No. [phone], within 30 days. ASHEVILLE REGIONAL OFFICE
ail Service Center -Raleigh, NC
GW-1 REV. 07/2001
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251181
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural`',�� R�er.sourrc ivision of�Water Quality - Groundwater Section
p�jq
WELL CONTRACTOR (INDIVIDUAL) NAME (print)
0-) LS4'ae�\` "'�l(� �/, CERTIFICATION�r8, /
WELL CONTRACTOR COMPANY NAME r�V( - �1'�, 11U LI- I KZ) PHONE a eat) ?M? 91C
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential & Municipal/Public 0 Industrial ❑ Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER:
Address
ity or
b
(Street Me No.)
34to90
Zip Code
Area code- Phone number
4. DATE DRILLED 3 Oa
5. TOTAL DEPTH: U` rt i
6. DOES WELL REPLACE EXISTING WELL? YES Q _NO g///
7. STATIC WATER LEVEL Below Top of Casing: L+D FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS ` FT. Above Land Surface'
'Top of casing terminated at/or below land surface requires ■
variance in accordance with 15A NCAC 2C .0118. `
9. YIELD (gpm): \ METT�I�1j O9 OF TEST l
10. WATER ZONES (depth): 1`t'\
11. DISINFECTION: Type \"mac Amount
12. CASING: Wall Thickness
FDlar/ er `Weighsate
From To a I From To Ft.
From To Ft.
13. GROUT: Depth Mat1S � Method
From To t�c. Ft
0t cJ+aan?l+
��u v
From To Ft.
14. SCREEN: Depth Diameter Slot Size
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
GRI
ASHEVI
Material
TopoKic/Iand setting
❑Ridge p lope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
LL
Fo s do ,/ # e ; ption
L7EPTH
From To ,
20
' W'
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
5
.T THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
:DS, ANJ) THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE L O'
SIGNATURE OF PERSON CONSTRUCTING THE WELL
o0lr1lnal to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
°finE(919) 733-3221, within 30 days. GW-1 REV. 07/2001

State
251180
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Sectioni
WELL CONTRACTOR (INDIVIDUAL) NAME (print) VV 1 LU-UY`iv� S ' —ittM5 CERTIFICATIONI3 ffk l 3:2
WELL CONTRACTOR COMPANY NAME W s� It (Ut 3E1—L Q"(' U- PHONE # FY )l - IF/St--
STATE WELL CONSTRUCTION PERMIT# _ASSOCIATED WQ PERMIT#
(if applicable)
(if applicable)
1. WELL USE (Check Applicable Box): Residential lB Municipal/Public 0 Industrial ❑ Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATIQN:\
Neares(71'own: k.1, d'County
(Street dame, Numbers, Community, Subdivisi • Lot No., Zip Code)
3. OWNER:
Address
City o Town
Area coda Phone number
4. DATE DRILLED ,-5
5. TOTAL DEPTH: Alit
6. DOES WELL REPLACE EXISTING WELL? YES,(] NO
7. STATIC WATER LEVEL Below Top of Casing: /0 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS I FT. Above Land Surface*
'Top of casing terminated at/or below land surface requires a
variance In accordance((««ith ISA NCAC 2C .0118.
9. YIELD (gpm): H METHOD OF TEST
10. WATER ZONES (depth): ,fly t
Zip Code
11. DISINFECTION: Type Amount
opographic/Land setting
idge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/secoods)
Latitude/longitude source:❑GPS❑Topographic map
(cheek box)
DEPTI-1 DRILLING LOG
From To . Formatjon IescriptiQn '
12. CASING: Wall Thickness
Depth {er or W t/Ft. ten
From 0 To 14q Ft./t{ \7J n0
From To FL
From To Ft.
13. GROUT:Depth. II nn
Fromb To `-1 I Ft.
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size
To Ft.
From
From
16. REMARKS:
Material
To Ft.
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
I
1:01 WV ZZ dd ZO
I� A +-R1 Y EIi F , iT S,,AAND THAT A COPIS WELL WAS Y NOF THIS RECORD HAS STRUCTED IN ACCORDANCE EN PRO PROVIDED TO THE WITH 15A NCAC C L WNER
j zoo? Ir SIGNATURE OF PERSON CONSTRUCTING THE WELL
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'vision of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
3-3221, within 30 days. GW-1 REV. 07/2001

Co
ty
unity, Subdvision, Lot No., Zip Code)
251179
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Sectionrronr�
WELL CONTRACTOR (INDIVIDUAL) NAME�(print)nL.l�t(j,iL A'PN < . -- S CERTIFICATION
0/91 1b
WELL CONTRACTOR COMPANY NAME "t-tRY 5J I,L�.0 �}' u� �QIL -A PHONE # lose)3S i 9k SS --
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential 21 Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCAT
Near s To
(Street Name, Numbers, C
W
3.OWNER a. it IL INa'lk•
ddress ti:—gnadra ailTha
-tor Rout N .) Ili
•
•
City or own SW_ Zip Code
( 0- :y — ND:-
Ara code- Phone number
4. DATE DRILLED • -
5. TOTAL DEPTH: W.. /
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO L7
7. STATIC WATER LEVEL Below Top of Casing: ' b FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordanich 15A NCAC 2C .0I l8.
9. YIELD (gpm): 1 METHOD OF TEST
10. WATER ZONES (depth): fib' \ 0
\1S — - CAN
11. DISINFECTION: Type \-K 4 Amount
12. CASING: Wall Thickness
or ght/Ft. ate
Depth
From_Q_ To (o-e Ft.
From To Ft.
Diameter
From To Ft.
13. GROUT: Depth Mat
From) To %? Ft. (`
From To Ft.
14. SCREEN: Depth Diameter Slot Size
From To Ft. in. in.
in.
Material
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size
From To Ft.
From To Ft.
Material
Topographic/Lanfrtetting
[Ridge ❑Slope rgi alley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
Frgm TT000 l Forma ' n Description
T ' C-b
L,b ' n-3'
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the mad
numbers and common road names.
4
I
I
O
C
N
16. REMARKS:
T THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
a S, THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WEL
t ,
SIGNATURE OF PERSON CONSTRUCTING THE WELL DA
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
GROTtii i ?WV [phone], within 30 days. GW-1 REV. 07/2001
ASHEVILLE REGIONAL IUE
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251166
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - DivisionYof Water Quality - Groundwater Section {�J
WELL CONTRACTOR (INDIVIDUAL) NAME.(print) Wk 1 11 VW S• T l Eeiv'. . CERTIFICATION
N##q�/.i�
WELL CONTRACTOR COMPANY NAME YSMtit-zSJL�-I-C tn-L I A kt G PHONE # Sts16 9'(S
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable)
(if applicable)
I. WELL USE (Check Applicable Box): Residential El Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LO TI
Ne tTo
(Street Name, Num . rs, tiry, Subdivi ion, Lot No., 7rp Code)
3. OWNERS
Address kt (r�
a, (Streep i t oute No.)
SacID-b
Zip Code
Area code- Phone number
4. DATE DRILLED
5. TOTAL DEPTH: b t /
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO L9'
7. STATIC WATER LEVEL Below Top of Casing: I b FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surfaces
*Top of casing terminated at/or below land surface requires a ,
variance in accordapv rith ISA NCAC 2C .0118.
9. YIELD (gpm): 1 Di-) METHOD OF TEST (3-0\-
10. WATER ZONES (depth):
Topogaphic/Lan4,.setting
❑Ridge ❑Slope Malley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
Fotma(jon Description
DEPTH
From To
air (cs4'
11. DISINFECTION: Type
12. CASING:
Depth
From b To 35
From To
From To
13. GROUT: Depth
From To
From To
14. SCREEN: Depth
From To
From To
15. SAND/GRAVEL PACK:
Depth Size
From To Ft.
From To Ft.
t 1 rr
"Ili Amount
tinter Wall Thickness
Ft. (cy`E' ea
Ft.
Ft.
Ft
Ft.
Diameter
Ft. in
Ft. in.
16. REMARKS:
E CjIISU( 1c
5
02
_n ,
Slot Size
in.
in.
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
terial numbers and common mad names.
Material
Material
THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
S, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL 0
SIGNATURE OF PERSON CONSTRUCTING THE WELL
c
No
CD
orn
otIIts{ eo tv Do
2 m
O en=
ma
n
ti
Submit the original to the D vision of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
G Y it f /J'•'"� g4£ , ' 19) 73
ASHEVILLE REGIONAL OFFICE
-3221, within 30 days. GW-I REV. 07/2001

251170
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) W\LULL .' . S CERTIFICATION 1h)p�1 �a
WELL CONTRACTOR COMPANY NAME Wecf4 \ rl L E\. -/11a.U. t Al( IN PHONE # ( 3b 1 B
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable)
(if applicable)
1. WELL USE (Check Applicable Box): Residential le-Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Othcr ❑ If Other, List Use
2. WELL LOCA !N:
Nearest
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER:
Address
Zip Code
Area code- Phone number
4. DATE DRILLED
5. TOTAL DEPTH: 00 /
6. DOES WELL REPLACE EXISTING WELL? YES NO fB"
7. STATIC WATER LEVEL Below Top of Casing: 11b.0 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surface'
'Top of casing terminated at/or below land surface requires ■
variance In accordan th ISA NCAC 2C .0118.013
J
9. YIELD (gpm): METHOD OF TEST
10. WATER ZONES (depth): `, it 5
11. DISINFECTION: Type kittitk Amount
12. CASING: Wall Thickness
Dept(t ter p1%Wgikht/Ft. ( fermi
Fro To % Ft. 1 p �UQ�(
From To Ft.
From To Ft.
rr
13. GROUT: Depth Mate aQ
From To VV1 Ft.
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Slot Size
in.
in.
Material
16. REMARKS:
0
Il E-.R le\�EmpF
Rev
Submit the orfpinal t} the
ASHGR F(VILLE REGONAL O%.(919)
opographic/Land setting
idge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Fonna a. n Description
Jr—r !
5' lqD' R10AII
(�6D S%3 ► T.S.
LOCATION SKETCH
Show direction and distance in miles from at lea t
two State Roads or County Roads. Include th • oad
numbers and common road names.
I
T THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
S �// ,THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE L 0
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
i
I
1,1
rtzt
ivision of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
3-3221, within 30 days. GW-1 REV. 07/2001

251169
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources�d- Division of Water Quality - Groundwater Section (J
WELL CONTRACTOR (INDIVIDUAL) NAME (print) /Aii�iI 'IR S S. S' , ' , /� CERTIFICATION ##,•(=On
WELL CONTRACTOR COMPANY NAME .i V i L t 11--) C-. aig§ PHONE # to - / iSS
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#/
(if applicable)
i (if applicable)
1. WELL USE (Check Applicable Box): Residential le" Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCA a N:
y< r�y�a'� County. t I et
(Street Nam.
Nu
hers, C
1/4
3. OWNER: \ILS I
dress
Na ip Code)
City or wa State Zip Code
Area code- Phone number I
4. DATE DRILLED O l ba
5. TOTAL DEPTH:
(� I /
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO L9
7. STATIC WATER LEVEL Below Top of Casing: ,S7D FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS I FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance th ISA NCAC 2C .0118.
9. YIELD (gpm): M$'�IJQ,C,F TEST CL)'n-
10. WATER ZONES (depth): •`}`66
LOCATION SKETCH
11. DISINFECTION: Type `\14 Amount Show direction and distance in miles from at least
12. CASING: tj� Mgt Wall Thickness two State Roads or County Roads. Include the road
C% To 1�� Fib n er L. t eripht/Ft. Q Material numbers and common road names.
From 119D �qp4
From To Ft.
From To Ft.
13. GROUT: Depth Ma tVal
From To krq Ft.
From To Ft. I
14. SCREEN: Depth Diameter Slot Size
From. To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Topographic/Land setting
❑Ridge ❑Slope OValley lat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTIt ► ' LIN
From To Fo :ionDescri.tion
16. REMARKS:
Material
GR9Irn1+1 MPoe
ASHEVILLE REGIONAL OFFICE
rno
otz
ma
THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2 WEL
S, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WN
de
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
the L$vision of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
9) 730-3221, within 30 days. GW-1 REV. 07/2001

2511'77
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Sectiono
WELL CONTRACTOR (INDIVIDUAL) NAME
.((,nnpr�iin�t�)) �� �L}-' Rim- - a' Ta^�S CERTIFICATION
N##.gfl�'�g
WELL CONTRACTOR COMPANY NAME "i-tC Htti.l\ UJc' l,S�l.,t_. W LL.,I PHONE # Pt) -9IS5
STATE WELL CONSTRUCTION PERMITM ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential 2 Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCAT
Neares
County,
(Street N e, Numbers,/.o n` unity, Subdivision, Lot No., Zip Code)
3. OWNER:
Address
tret or o to o.)
City o Town S
a' -
Zip Code
Area code- Phone number
4. DATE DRILLED
5. TOTAL DEPTH: �?=
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO V
7. STATIC WATER LEVEL Below Top of Casing: Sp FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordagce Ith ISA NCAC 2C .0118. a*3‘-
9. YIELD (gpm): METHOD OF TEST
10. WATER ZONES (depth): \'3
Topoc/Land setting
❑Ridge 2Slope OValley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH
From To
1
90 g t
�7 t nag"'
11. DISINFECTION: Type k-k-Drk
12. CASING:
Depth Di
From b To cicR Ft. (., LI"
From To Ft.
From To Ft.
13. GROUT: Depth Ma rtpl
From b To Scil. Ft.0b
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Amount
Wall Thickness
or Weight/Ft. t al
Ae.a--l. c, rc_.
1 UV HtKtBY Lt:K1.
CONSTRUCTION ST
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
.T THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
S, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WEL
/4-624120
SIGNATURE OF PERSON CONSTRUCTING THE WELL DA
GROU,,NppWATT (li SECTII.0N 3o t
6 No.
Yhone No. [phone], within 30 days. he Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
2 /699-16
ASHEVI2tio�S ne GW-1 REV. 07/2001
2

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources
WELL CONTRACTOR (INDIVIDUAL) NAME (print) w\7..1�1 -1/4iN�s•
WELL CONTRACTOR COMPANY NAME ykIP 1E9j(-e ki3Cu'
251176
- Division of Water Quality - Groundwater Section
![n
IttWIS CERTIFIC�ATTIIONn#pQ�/C✓b
i PHONE # l/nel.2b t' 1I5J
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential 6 Municipal/Public 0 Industrial 0 Agricultural ❑
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other ❑ If Other, List Use
City o To State
USCdI-� --• tJ[.d
Area E Phone number�,t�I, a
4. DATE DRILLED
5. TOTAL DEPTH: ELF
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: 30 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS I FT. Above Land Surface"
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): is MET Op OFFT Q
10. WATER ZONES (depth): ' D r
\SS` - `1
11. DISINFECTION: Type Wk Arno
12. CASING: Wall Thickness
th, er or Weight/Ft. —Material
From_To VI Ft. b'4 512.tt`(.(9 VC_.
From To Ft.
From To Ft.
13. GROUT: Depth ]vial ,\ ,
From 0 Too�9 Ft. CR.iwaI��'�dJU�A'
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
r
15. SAND/GRAVEL PACK:
Depth
From To Ft.
From To Ft.
16. REMARKS:
E MU'CT/ONST/
-1 J �C
i
Size
Material
opographic/Land setting
dge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Forma 'on Description
o a'i
,,S` 14S'
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road nam s.
T THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15ANCAC 2C, WE
S, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE FELL
0
WNERN
iV
0
Division of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
GR Ol23699AP63b Bh0091No. [phone], within 30 days. GW-1 REV. 07/2
ASHEVILLE REGIONAL OFFICE
Submit the original o th
SIGNATURE OF PERSON CONSTRUCTING THE WELL A

251175
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and �`` Natural Resources - Division of Water Quality - Groundwater Section ? Q
WELL CONTRACTOR (INDIVIDUAL) NAME(print)W �U - �rn S. \ yT't�-����(� CERTIFICATIONN + `c,� PCB
WELL CONTRACTOR COMPANY NAME kMESALLE. kr•S I2J .L1 NtQ> PHONE # �rt) 3 R' IIsJ—
STATE WELL CONSTRUCTION PERMITM ASSOCIATED WQ PERMIT"
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential t Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCAT
ea t oo n
3. OWNER:
Address
t or Rou r ,
�^3C)iry or $CatG.,J� Zip Code
O b
Area code- Phone number
4. DATE DRILLED
5. TOTAL DEPTH: �- /
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO l9"
7. STATIC WATER LEVEL Below Top of Casing: 1 D FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surface*
'Top of casing terminated at/or below land surface requires a
variance In accordagqc} ith 1SA NCAC 2C .0118.
9. YIELD (gpm): 1 METHOD pF TEST �-)''
10. WATER ZONES (depth): 1�
11. DISINFECTION: Type W_C-i Amount
12. CASING: th ape Wall Thickness
From CD To _ Ft. %v� r aht(Ftr-�vf_ at�al
3%Da
From
From
13. GROUT:
From
From
14. SCREEN: Depth
From To
From To
15. SAND/GRAVEL PACK:
Depth
From To
From To
16. REMARKS:
To Ft.
To Ft.
: t9 Ft.
Diameter
Ft. in.
Ft. in.
To Ft.
Slot Size
Material
in.
in.
Size Material
Ft.
Ft.
Topographi setting
❑Ridge ❑Slope alley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
pR1LLING LOG
Formation Description
MTh
From To
b 1 '
15' Pa
' Ste-'
?of.°' '
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
c
IV
o
Ti Sr
� cm
z_
tV �r1
t -4
T THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL N '_
S, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WE R
b Q
SIGNATURE
OF PERSON CONSTRUCTING THE WELL DA
Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
733-3221, within 30 days. GW-1 REV. 07/2001

North Carolina - Department of Environment, Health, and Natural Resources
Division of Environmental Management - Groundwater Section
P.O. Box 29535 - Raleigh, N.C. 27626-0535
Phone [phone]
WELL CONSTRUCTION RECORD
DRILLING CONTRACTOR: LON /O,'///qr0
DRILLER REGISTRATION NUMBER: 3/ 5/
QUAD NO
Lat
Minor Basin
Basin Code
Header Ent
FOR OFFICE USE ONLY
SERIAL NO
Long. RO
250155
GW-1 Ent
STATE WELL CONSTRUCTION
PERMIT NUMBER:
1. WELL LOCATION: (Show sketch of the location below)
Nearest Town: R4yCounty.
DEPTH
2. OWNER go O/i/it 0- 6rActi? Cnf/D From To
ADDRESS © _3
(Road, Community, or Subdivision and Lot No.)
(Street or Route No.)
/14y/fsy'///C. Ne—
City or Town State Zip Code
3. DATE DRILLED 3-/9-04 USE OF WELL //rx-./i1
4. TOTAL DEPTH 6/2-
5. CUTTINGS COLLECTED YES NO
X
3
/ 2_
/Z (8
Gy o
Go 90
00 22G
6. DOES WELL REPLACE EXISTING WELL? YES $C NO 227 • 3 Ft
7. STATIC WATER LEVEL Below Top of Casing: V// FT. 3 it y z f-
y (Use'+' if Above Top of Casing)
8. TOP OF CASING IS a FT. Above Land Surface*
• Casing Terminated at/or below land surface is illegal unless a variance is Issued
in accordance with 15A NCAC 2C .0118
9. YIELD (gpm)• 7 METHOD OF TEST /lir/L
10. WATER ZONES (depth).
11. CHLORINATION: Type H ik' Amount ?A 64/
12. CASING: eVC-
(� Wall Thickness
From O DepthTo% Ft Diameter
r or Weight/Ft. Material
D
From To Ft.
From To Ft
13. GROUT:
Depth Material Method
From 0 To a 0 Ft nit" CA-141541 Sr+iry
From To Ft
14. SCREEN:
Depth Diameter Slot Size Material
From To Ft in in
From To Ft in in D
From To Ft in in i
15. SAND/GRAVEL PACK: 'I
Depth Size Material
From To Ft
From To Ft
16. REMARKS:
DRILLING LOG
Forma on Description
.r.,4-o
G{,/yS7A/J//1 /Cocy
G,79/Y,'7/1
6r44-•'7/C ccif 26/°nt
d
to a
If additional space is needed use back of form
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other map reference points)
RAW b.%//P
GROUNDWATER SECTION
ASHFvu l E R€C'2rnL 0(rll
&wG.0
C
6
l'
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.
GW-1 REV. 9/91
SIGNATURE OF CONTRACTOR OR AT
Submit original to Division of Environmental Management and copy to well owner.
DATE

(forth Cerotna • Depnrlmenl ol Erwlrenreenl nod flatten! Ileenurens Million of Water Duality • (Mound wnuu Seston
16J6 Hall Service Center • flnlelgh, N.C. 27699.1696 Phone (9I9) 733.3221 WELL CONSTRUC110N RECORD writ_ cow IlAClVII: S, // AL 'di//'>7
WELL colllnACIOIICI:Il1IrlCnil0ll n:
StAlEWELL COIlS111UC11011PE111diin:
I. WELL USE (check nppneebie 6oa)t Rasldonllal Lia--1dwdclpal U
Industrial LI
hecovory Ll I loaf Pump Walor Injection LI Olhor LI II Other, List Use:
2. WELL LOCAL ION: (show sketch of the locallun baluv!)
7�CYi /ice— — Comity
Nearest lawn:
Invert Dame
S. Owt1En
Address
lid Ilunban.novo only. m Subdivision nod to; I lu I
lC
'74 g — —
IreotJillo`u olioT
Stalee Iota' Zip Curia
C�Y or Tow"^
4. DA1EDliILLED2
5. 1OIAL DEP11I & — -
6'. CUIl111OS COLLECT Ell 'ITS LI fioI Y -- 7. DOES WELL REPLACE EXISIIt10 WELL? YES IJ NU L
D. S I Al IC WA1 ER LEVEL Below 1bol Cnsing: S_O_.
I I.
lute tr.' II Alcove lop of Dello°,
u 10P or CASINO IS__t--__ Ft. Abovo I.nnd SullnC.o'
-Top of cotton Iatmb,eled etior below land cutlets requires s valence In eceor•
dance will' ISA IICAC 2C.e1le h1CI I IOU Or TES
10. YIELD (gmrll):_
1 I. WA1 Ell ZONES (depth):
12. CIILoIuA
n1ION: typo Amuunl .,,--
13. CASING:
plan I111r Lot el
Diameter or WelylrUl'1. I.laleilal
Depth0 s? --
Prom to rt.
From 10 FL
14. G11oU1:
PI0111
FOr! to El
15. SCREEN:
f rum
Pion,
rlorn
16. SAIIO!GII
Maio al I.lullrod
Depth �_.,.,✓
_IP— To e20 ` ri
From
now
17. nE61AnRs
Depth
le_
To.
lo.
I D° 11ELIE
C011sInu
1
p,ri
Fl
rt.
o PI.
t
Diameter Slot Sire IAoindai
In. _ In.
In. _
In
o l`
hlalollnl
II
AS D.r
Uollt% glfapGftlP clltirffoECOP
UIIILLII IO LUU
from to
262361
Agricultural Li 1/1onl1orirg LI
-
r our nl Ue>alpr;n
11 nddidonol s; ece is roe reel r.s e Iran of Ivrn -
LOCAl loll.SKE LCI1_
(Slow dir ecllon lord diz-ance Iran 21 IeaP tom E-ale
Da or other ri 2 reloerce porno'
lisinUclED III ACCORDANCE: Whit ISA ?ICAc Y:. Y,ELL
or -tills IIEC011U HAS UEEH PflOVIEEO10111E 715-LL p,nEr
m t:
Fort OFFICE USE DULY
Ouad Ito:
send la.
Sub
SIOt1A1 UIIE or 111119011CODSIDUCIltio Tic WEII.
IIoriginal toUivletonofWrierpt7dlly,6rourid alefSeem wlUdnY)C2y1 En.IFie V.1:T1
e

251172
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and `Nat\ural Resources - Division of Water Quality - Groundwater Section
R
WELL CONTACTOR (INDIVIDUAL) NAME (print) 11-Kt S S. —`tgs CERTIFICATION# J�
WELL CONTRACTOR COMPANY NAME 1 at221.LLUti1C-1 PHONE#llt) -)9 I SS —
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) / (if applicable)
1. WELL USE (Check Applicable Box): Residential M" Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: \ LI-E County
mil' (233\
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: z b L4Fb v
Address
(Street or Route No.)
t 1t t� R-Ir, `(BL-
Cityo Town State
( Z)- 6%9 -S1S
Area code- Phone number Ai
4. DATE DRILLED `\ as
Zip Code
Topoc/Land setting
❑Ridge lope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutedseconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
PRHLLING LOG
Fon Description
DEPTH
From
0
rlt
Ian
5. TOTAL DEPTH:
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO U 0 1n'
7. STATIC WATER LEVEL Below Top of Casing: -m0 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS , FT. Above Land Surface"
'Top of casing terminated at/or below land surface requires a
variance In accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): c3-D METHOD OF TEST
10. WATER ZONES (depth):
11. DISINFECTION: Type ¥*ltt
12. CASING:
Depth /
From C) To Ft. (o4
From To Ft.
From To Ft.
13. GROUT: Depth
From b To (-a, Ft.
From To Ft.
14. SCREEN: Depth
From To Ft. in.
Amount
Wall Thickness
ter o_EWeigh Ft. ate�a1
Slot Size
in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth
From To Ft.
From To Ft.
Diameter
16. REMARKS:
Size Material
Material
a{0
22•S'
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names. \crestu_lui1
T THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
I IkDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WEL 0
SIGNATURE OF PERSON CONSTRUCTING THE WELL DA
Submit the originallto the Division of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
GROUAR499h#0644"Rt Pr. [phone], within 30 days. GW-1 REV. 07/2001
ASHEVILLE REGIONAL OFFICE
0
2

251173
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resourceso�- Division of Water Quality - Groundwater Section 3�
WELL CONTRACTOR (INDIVIDUAL) NAME
1 J(pprint) W \1— _ `'rl' Y f� \ S . S((�� CERTIFICATION # 9 1
WELL CONTRACTOR COMPANY NAME t*A`f ES..M-LC 11a 9ALLINICA PHONE # 43SF- 9 IS
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential I2 Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATI
Nearest Town:
aqs
(Street Nam- Numbers, munity, ubdivision, Lot No., Zip Code)
Zip Code
Area code- Phone number
4. DATE DRILLED
5. TOTAL DEPTH: co i
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO IV
7. STATIC WATER LEVEL Below Top of Casing: trib FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS I FT. Above Land Surface''
'Top of casing terminated at/or below land surface requires a
variance In accordag with ISA NCAC 2C.O119. Q�L..
9. YIELD (gpm): METHOD (JF TEST
10. WATER ZONES (depth):D-'T1
11. DISINFECTION: Type k-VM Amount
12. CASING: Wall Thickness
Depth Divnetter Weight/Ft. `-MattoO
Frotri_CTo �'6 Ft.__' �•�p 't""
From To
a-
Ft.
From To Ft.
13. GROUT: Depth
From O To 3� Ft.
From To Ft.
Da
i
14. SCREEN: Depth Diameter Slot Size " Material
From To Ft. in. in.
From To Ft. in in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
Topoggraayhic/Land setting
❑Ridge WSlope OValley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Fonnapjon Description
O - �t
8a' -
35i - r'3•til
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names. o
2s
ZU
N
N
6
Ci
L'a ttvN 4,4 5%tooTiNG C.ktte
kitoq
t}FvfE3 I
J
Submit the original tt the
GR(}(jNEkP§PRTITIf4 (919)1
ASHEVILLE REGIONAL OFFICE
T THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
S, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELI/O
SIGNATURE OF PERSON CONSTRUCTING THE WELL DA
ivision of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
3-3221, within 30 days. GW-1 REV. 07/2001

IO
Morel Cercilia - Deparime nl al ErIranw ell end1IIal ci lingo
ie (°, vie
• mmina221 t of Wain; Dv allay • (l,ountiwntnr Section
I678 Mall Service Censer • flnielpl q�
WELL CONSTRUCTION nECOIlh WIg. WELCoNmACIOIUGEM hNI I° 249
SrAtE WELL. collsllltic11011 PEIIIAIIf:
I, WELL USE (chick d aIIndesidal El A9
rlcuwlal Umonitoring Li
hecovary Heal Applicable
Water InIoellon LI Other L11 Oer, LIs1 Use:
2. WELL LOCAL IQN: (showskald' of Illo Ivcallun baloOorl sly C��(
Deal ell sown: /
p!
.12- ,�g_�J_ _dry -- lid UIIII_U_I_l0 LUG
Lute, �---- � -- �'- ---
ploaAllama d Ilw en. Coi•uunlry q�evl vn nodrQSStowe, liWA WAN now to
C'/ /l/v Fiat .0 s r
0. oWress /l!-e % 3 -- —_i- __ t_
Addle55 �S
P j I aet o rr�� no l
Z.CQ'i
SW,
zip un+ie
City lnw+l
A. DA1EUNILLEN /-3�0-�t2 _
5., 101ALUE.P111.2—
6. CDll1110SCOLLEC1El) `ITS[_ I IMIj4- __1
11UIL-I-
-
7. DOES WELL NEPLACE EXISI IIJtl WEI 19 YES Ili I I. —
D. S1AlICVVAIEflLEVEL Dolowlapa? two-ellCasAlmivelop ofCeel"01
P. l0 P or, CASINO Is_L— Pf. Above Land Solace "—
dance of caelup In mineled War below land collect IequLef,/a/ve�rlulce In eceor• .—
dance will' l5n ilcfte 2C.0116 h16111OD OF TEST !to. YIELD Nom): _
1 I. WAIEN ZOIIES (depth): _
12. Cl ILOrpNA11011: 'I ypo
13. CASIIIG:
1Vall 1111 lime
Deplll y
Ulamolor or WelpilVll. Idaltdal
glom—�--1a 1rl. hc2s _- `_ Y-
Pwm
lo FI.
From 10 PI.
14. G110U1:
Depth
Flom _CZ_— To --'ri.
to — FL
r
--
15. SCIIEEII
From
Depth
Male`lal Method
Ulamolnr Slot Site Malmlal
1 a
clam -- 10 — I
Flom lo
t E. SAN01GI1AVEL PACK: i L Site
DepthL
Flom to II.��
Flom lo rt. I-e,.,,
17. LIEMAn1<S: _ 1 ,Eu
'
I DO IIEnEDY CEUIIPY MAT 11115 WELL WAS I UtIS I llllClEl1III ACC011U/'JICE YlIIII ILA !CAC C.
coilS1 nuct moll SlAN0A11U5, AND 111A1 A COPY or 1111911ECUWID IIAS DEE11 PIIOVICEO -10111E 7r= LO++tiEP
/_`3(--rQ7.2
co _r
UEPIII
ronua� Ut'sc dpY,r.
II ntididonal space k Orreel tree bet: of Iczyn
--��- LOGAI1O1.SKE_ICII-
(Siww dir ecllon nn1 drz.:mue L:.rn nt moat: I«o a �nlq
Ilondo. or oilier rr271elelr'ce point
a
0
_.0
i
I-Anlollal'L
Foil110: USE UIILY I IUll�rliSo�lllY•11110l,c WEl I. Duedlo: SubIJIJIod0ln010UivlelonpiWile'Wullif,0,owufolle15.ccn :14) y3
:A
Fn i FIEY. 1`l1

251174
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) \n1Nl..)--\1�1f� . 1c..c., �—�S/� CERTIFICATION 32.
WELL CONTRACTOR COMPANY NAME t3 f€ 'StL.IE at— fa_l.t__1-1 f1% PHONE # 1)33%9-9ISt;
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential El Municipal/Public 0 Industrial ❑ Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCAT
Neaa
(Street orR,oute No.) 33g51
Area code- Phone number
4. DATE DRILLED 1
5. TOTAL DEPTH:
Zip Code
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: ft
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS I FT. Above Land Surface'
*Top of casing terminated at/or below land surface requires a
variance in accordancsmith 15A NCAC 2C .0118.
9. YIELD (gpm): METHOD OF TEST k% 'CL
10. WATER ZONES (depth): aria
11. DISINFECTION: Type rMn tt Amount
12. CASING: Wall Thickness
Depth II D(apreter oI W_ei�ltt/Ft.1AQa_tyra'al
From To (D`{' Ft. Co 4 SOl d7 (v Y'VC.
Topogltfbic/Land setting
DRidge [Slope OValley DFlat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
013 Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTI-( FILLING LOG
From To Fortt,(at�on Description
b
FT.
From To
From To
13. GROUT: Depth.
From O To
From To
14. SCREEN: Depth
From To
From To
15. SAND/GRAVEL PACK:
Depth
To
To
Ft.
FL
Mat al
Ft.
Ft.
Diameter Slot Size
Ft. in. in.
Ft. in. in.
Size
From Ft.
From Ft.
16. REMARKS:
Submit the original tthe
GRQl7lil9A RERPF iS N01(919)
ASHEVILLE REGIONAL OFFICE
Material
Material
4a
4-a' (co'
(mob'
ai J PSIS
?Ian t
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
b
101)
tV
ti (off —
OTC ttsG 0'+Q l"E1C.--
T THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL
SIGNATURE OF PERSON CONSTRUCTING THE WELL DA
ivision of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
3-3221, within 30 days. GW-1 REV. 07/2001

North Carotin - Department of Environment and Natural Resources • Division of Water Quality - Groundwater Section 2 4 6 2 1 7
1636 Mail Service Center - Raleigh, N.C. 27699-1636-Phone [phone]
WELL CONSTRUCTION RECORD WELL CONTRACTOR.
0-4.aohee t II bac MI
WELL CONTRACTOR CERTIFICATION I:
STATE WELL CONSTRUCTION PERMIT.:
1. WELL USE (Check Applicable Boa): Realdenuat[] Municipal ❑ Industrial ❑ Agricultural ❑ Monitoring ❑
Recovery ❑ Heat Pump Water Injection ❑ Other rj I( Other, List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest TownL3Rr4SS i D W County. CLA
C►tfk,oiat /11TA-J
(Road Name end Nunbe4. Community, ororSubdivision and Lot Na.) DRILLING LOG DEPTH
Formation OWNER l)gvi KI r% From To Description
Address i5/V /- Loy 621 LJJeS 1 el v;, -Sri C. /l:.l
(Sires or •' pus No.) / .g ! 0 G YS ) 0 S Ah
C' i . 7tlJ12( opc':itr,-r
City or To l,�r �State Zip Code
4. DATE DRILLED-/`.-C.:/
5. TOTAL DEPTH ) ° _i
6. CUTTINGS COLLECTED YES n NOL3
7. DOES WELL REPLACE EXISTING WELL? YES Q NO)
8. STATIC WATER LEVEL Below Top of Casing: ,5 0 ' FT.
(Use'+' If Above Top of Casing)
9. TOP OF CASING IS ' FT. Above Land Surface'
'Top of casing terminated at/or below land surface require* a variance In accor-
dance with ISANCAC2C.011a nn .�
10. YIELD (gpm): .)- METHOD OF JEST 77 r
11. WATER ZONES (depth). L o 11 i V
12. CHLORINATION: Type /717// Amount t ✓ 11 additional space b needed use back of lorm
13. CASING:
Depth
From To (1,5
Wall ThIcknese LOCATION SKETCH
Diter or We hurt. Mitten& (Show direction and distance from at least two Stale
Ft b ' )✓ 2) tv Roads, or other map reference points)
From To Ft
From To Ft
14. GROUT:
Depth Mal I Method
From V To 'Li') Ft Cc
From '1 To LiS Ft Cw
15. SCREEN:
Depth
From To
From To
From To
18. SAND/GRAVEL P
Dep
From T
From To
17. REMARKS:
Diameter Slot Size Material
Ft • In In
Ft
C
O
N
GROUNDWAitn 5t�OFFICE
SAL OFFICE
I DO HEREBY CERT F t:r=� D IN ACCORDANCE PROVIDED
ISA NcAc 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY Ok THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
mrot font) /-/j- e
FOR OFFICE USE ONLY
Quad No:
SiGNATUfE OF lithSON CON5TUCt1NG TVIE WELL DATE
Submit original to Divided of Wifer Ou101y, Git1sWwltit *action Within 30 days
ow -I REV. 11/94
Serial No

247263
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and, Natural ,Resources - Division of Water Quality - Groundwater Sectiong3�
WELL CONTRACTOR (INDIVIDUAL) NAME (print) �U fig.. W` V\ S� S. ^f��`'p``� A . � �(' CERTIFICAATTIONN tolqa �p
WELL CONTRACTOR COMPANY NAME WP<<t�vl.l w�'-1�''-+"--`L4 ' PHONE # Sg�l3 t—l(SS—
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential 011 Municipal/Public ❑ Industrial ❑ Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCAT
Nearest Town:
County
(Street Name, N mbers, Co a > , Subdivisii , Lot No., Code)
3. OWNER: \�►L,_ _r .lt.. �.ui 1 r.1!<1
City
Area code- Phone number 1
4. DATE DRILLED
5. TOTAL DEPTH:
6. DOES WELL REPLACE EXISTING WELL? YES J_l NO (3(
7. STATIC WATER LEVEL Below Top of Casing: }b FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surface"
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118. n , `
9. YIELD (gpm): _hp MIYT OI? OF TEST t_7�.J\.
10. WATER ZONES (depth):'' �1,aa
11. DISINFECTION: Type TT 1 tt
12. CASING:
DeP
From_ To Ft.
From To Ft.
From To Ft.
13. GROUT Depday
From U) To W3 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.
Zip Code
Amount
Wall Thickness
tTirf{ efy✓eigh�t a(eAal
16. REMARKS:
Topographic/Lanfrietting
❑Ridge ❑Slope GIValley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH t . LIN 0
From To 1
b
N "J
LOCATION SKETCH ''n
Show direction and distance in miles from at a
two State Roads or County Roads. Include the -road c 7-
numbers and common road names. _
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY ., v,}vw . i, '. t v., TO THE WEL' ^'
���JR/�✓4' /
SIGNATURE OF PERSO a' STRUCTING THE WELL DA
Submit the original to the Division of Water Quality nd'water Section, it:36 ice Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001
GROUNDWATER SECTION
ASHEVILLE REGIONAL OFFICE

13. GROUT:
From b To- lt.q Ft. E.From To
14. SCREEN: Depth
From To
From______ To
15. SAND/GRAVEL PACK:
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) '2 —t -1 YklY\ S • NS CERTIFICATIONp�#dd�t32
q
WELL CONTRACTOR COMPANY NAME v 1L-1—E k%Y t 11:1uA ICA PHONE # 10701 SC'q�� i — 1 (SS
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
247261
1. WELL USE (Check Applicable Box): Residential Er/Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery ❑ Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCAT
Nearest Town:
\�5
(Street Name, Numbe
3. OWNER: • y;�ra
NCity or own Styte 1
Zip Code
Area code- Phone number '' ``
4. DATE DRILLED \l 1`k r7 �
5. TOTAL DEPTH: c
6. DOES WELL REPLACE EXISTING WELL? YES NO 0
7. STATIC WATER LEVEL Below Top of Casing: FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS k FT. Above Land Surface"
*Top of casing terminated at/or below land surface requires a
variance in accordant with ISA NCAC 2C .0118. Qa.)�.
9. YIELD (gpm): METJIODOF TEST
10. WATER ZONES (depth): atoll
11. DISINFECTION: Type Wit i Amount
12. CASING: Wall Thickness
Depth Di ter or W ''ght/Ft. ate
From Z> To 14`1 Ft._ __ P'?))W. R t11
From To Ft.
From To Ft.
Depth Mat
Ft.
Diameter Slot Size
in. in.
in. in.
Ft.
Ft.
Method
Material
Size Material
From Ft.
From Ft.
Depth
To
To
16. REMARKS:
"Topographic/Land setting
liffRidge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
FRILLING LOG
Fotg{iftion Description
DEPTH
From To
d 15
is, 14-a'
c
LOCATION SKETCH tvv
Show direction and distance in miles from atrleast'
two State Roads or County Roads. Ipclude road
numbers and common road names.
rk-uYi6,4.
1 DO HEREBY CERTIFY THAT THIS WELL WAS CON
CONSTRUCTION STANDARDS, AND THAT A COPY
/--g2/YYt o
SIGNATURE OF PERS
Submit the original to the Division of Water Quality, G_-GROUND'NATER SECTION
27699-1636 Phone No. [phone], within 30 days ASHEVILLE REGIONAL OFFICE
!A NCAC 2C, WELL
TO THE WEy'L 0
ail S mvice Center - Raleigh, NC
GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources�-
WELL CONTRACTOR (INDIVIDUAL) NAME (print) WLLU AN \
WELL CONTRACTOR COMPANY NAME
247260
Division of Water Quality - Groundwater Section�
l E�Cbs CERTIFICATION #�q ___
(!� () t l F �El l 12.1t✓L L PHONE it) 3%1 9IsC
STATE WELL CONSTRUCTION PERMIT/0 ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential I Municipal/Public 0 Industrial ❑ Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCA
rest
0
County
Street N
3. OWNER.
e, Numbers, Com ity, S
Lot Nk Zip Code
_�
Aress jaitO�j ATI . M EI5
ity State
Zip Code
Area code- Phone number
4. DATE DRILLED
5. TOTAL DEPTH:
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: , O FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surface`
*Top of casing terminated at/or below land surface requires a
variance in accords e with 15A NCAC 2C .0118.
9. YIELD (gpm): METHOD OF TEST 0.
10. WATER ZONES (depth):
b
Cas
Topographic/Lan etting
❑Ridge ❑Slope alley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
LIN
DEPTH
From To
5' la'
lb'
1`T�ti
11. DISINFECTION: Type WTh Amount
12. CASING: Wall T
hickness q�{
Depth parpt;intreter
From_Q_To �o Ft. YL11t
From To Ft.
From To Ft.
13. GROUT: Depth Mat rsl
From_ To_�i FtL12h�9L ..
From To
14. SCREEN: Depth Diameter Slot Size
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft. \
16. REMARKS:
Ft.
F
rmatio Des j'ption
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the mad
I DO HEREBY CERTIFY THAT THIS WELL WAS C
CONSTRUCTION STAND.j,RDS, AND THAT A COP
SIGNATURE OF PE
Submit the original to the Division of Water Quality,
27699-1636 Phone No. [phone], within 30 dayis.
ONSTILUCTINGi
oundwater Section, 163
C h0':NON AT/ R SECTION
.-rkVILEf7_(t....OFFICE
TI
rn
CO
—1
IV
CO
15A NCAC 2C, WELL
ED TO THE WEO'
DA
ervice Center - Raleigh, NC
GW-1 REV. 07/2001

247259
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources�- Division of Water Quality - Groundwater Sectionio
WELL CONTRACTOR (INDIVIDUAL) NAME 1(prrinntt) W �U_A �t Y s J - , C�-`'-vS CERTIFICATION�,#odc'I -2)51 --
WELL CONTRACTOR COMPANY NAME Y-1'rz ?Es\JLU-E U e_LT P LLLL q PHONE ii t Orl S11 CZI' -9 IC
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable)
(if applicable)
1. WELL USE (Check Applicable Box): Residential Er/Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injectioti 0 Other 0 If Other, List Use
2. WELL LOCATE
Neaze�tTP dnt County
(Street Name, Numbers, Conimbnity, Subdivision, Lot No., Zip Code)
3. OWNER:
Address
City or l' lth0)ryoZip Code
$-l(O - . S
Area code- Phone number
4. DATE DRILLED
5. TOTAL DEPTH: J • /
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO I3
7. STATIC WATER LEVEL Below Top of Casing: FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surface'
*Top of casing terminated at/or below land surface requires a
variance In accordanfexIth 1SA NCAC 2C .0I18.
9. YIELD (gpm): MF.,TJ-IQI, OF TEST ��
10. WATER ZONES (depth): l�-k'o.
11. DISINFECTION: Type
12. CASING: IhafpQ �%Q�j
From To Ft. bY`%tRr (• lon t r t
From To Ft.
From To Ft.
13. GROUT: Deptp, From b To —Ica Ft.
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth
From To Ft.
From To Ft.
Amount
Wall Thickness
Size
Material
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CO
CONSTRUCTION STA1nIDARDS, AND THAT A COPY 0
SIGNATURE OF PERS
Submit the original to the Division of Water Quali y
27699-1636 Phone No. [phone], within 30 days.
opographic/Land setting
idge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
PRILLING LOG
Format' n Description
DEPTH
From To
fl
94' au
"dl(' 2la'
ala''
ate' a>'1
aai ' �4 rlo'
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers an. co. 1 Ilt[i•a. r.. • s.
,q�
O
lT r ;
rI
W
-o
fV
C
J
NSTpyGTIIrICOTI6i.F
Gr undwater SectioLLnUU,U1636 Mail S
GROUNDWATER SECTION
ASHEVILLE REGIONAL OFFICE
- i-tbiAb(4
NCAC 2C, WELL
TO THE WE 0
/64
DA
ice Center -Raleigh, NC
GW-1 REV. 07/2001

247258
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) W`W rl t r 1 S. S (` CERTIFICATION�I#�q/` q`��C
WELL CONTRACTOR COMPANY NAME 'j" P `T t` �'�� CLI mq PHONE # Fes) O i -9 ( J�
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential El/Municipal/Public 0 Industrial ❑ Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELLLOCA'��,ON:
Ndarest To
.
(S umbers, C ity, Subdivision, Lot Na., Zip Code)
1
3. OWNER .—t - - •- - • �Ol�
Address RA W/ fiital k malt,��-
City or own Zip Code
S- S ti
Area code- Phone number
4. DATE DRILLED
5. TOTAL DEPTH: /
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO fd
7. STATIC WATER LEVEL Below Top of Casing: 00 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surface'
`Top of casing terminated at/or below land surface requires a
variance In accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): Pe METHOD 9F TEST 03--3l-
10. WATER ZONES (depth): \�JS
11. DISINFECTION: Type Amount
12. CASING: Wall Thickness
Depth (� Diameter or Wei t. - tatea)
From b To b Ft. (AC" YV C�
From To Ft.
From To Ft.
13. GROUT: Depth
From n To (o%
From To
14. SCREEN: Depth
From To
Ft.
Ft.
Diameter
Ft.
From______ To Ft.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
in.
Slot Size
in.
in.
Material
in.
Topographic/Lan$etting
❑Ridge ❑Slope Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Forr)<I ton Description
b la'
fa-'61s'
J OCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
.a
Qaa
O
CO
CO
-v
N
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS C
CONSTRUCTION STANDA,)LDS, AND THAT A COP
SIGNATURE OF PE
NSTMC811(0
Submit the original to the Division of Water Qua 'ty, G oundwater Section, 1636
27699-1636 Phone No. [phone], within 30 day
GROUNDWATER SECTION
ASHEVILLE REGIONAL OFFICE
5A NCAC 2C, WELL
D TO THE WEL). O R
nice Center - Raleigh, NC
GW-1 REV. 07/2001
cn
J
a

247257
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section/4�
WELL CONTRACTOR (INDIVIDUAL) NAME
v(print)�‘%13 ht A` V` S .. I titl. lSr CERTIFICATION N g ` aS
WELL CONTRACTOR COMPANY NAME W I't�C'as/Li—LE PHONE # "A 389 -'l iss
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable)
(if applicable)
1. WELL USE (Check Applicable Box): Residential L7 Municipal/Public 0 Industrial D Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATI a N:
st Town:
(Street Name
3. OWNEF
Address
Num
s` ( Count• 1
Comm , Sub ivi ion, Lot No., Zip Code)
LF
City o own State
flia)- rll-
Area code- Phone number
4. DATE DRILLED
5. TOTAL DEPTH: ..__
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO V
7. STATIC WATER LEVEL Below Top of Casing: \ 57) FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS l FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance In accordan with 15A NCAC 2C .0118. ��
9. YIELD (gpm): METHOD qF TEST
10. WATER ZONES (depth): 3b$
oNo.) alab`i
Zip Code
11. DISINFECTION: Type
12. CASING:
Depth
From C) To \3G
Vt.-CIA Amount
Wall Thickness
Ft. (o `4r 13r etg6r/Ft.
From To Ft.
From To Ft.
13. GROUT: Depth Ma al • _ Method
From 0 To_ I3SFt.
From To Ft.
14. SCREEN: Depth Diameter Slot Size
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
opographic/Land setting
idge ❑Slope OValley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From o Formljion Description
3n 3(o%
�f10' L(41 ant)
466 t
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road `'
numbers an
common road names.
—t� c
c:
—o r 1 ;
3 ,
r
.. m�
o
)
cy-
tsl_D t t ` 64
16. REMARKS:
I DO HEREBY CERTIFY THATRDTHIS WELL WAS
CONSTRUCTION STAND S, AND THAT CO
SIGNATURE OF P
Material
C7RMYCrEr
Submit the original to the Division of Water Quail , Groundwater Section, 1
27699-1636 Phone No. [phone], within 30 days.
GROUNDWATER SECTION
ASHEVILLE REGIONAL OFFICE
36 M
DA'
it Service Center -Raleigh, NC
GW-1 REV. 07/2001

247741
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality
VA'ELI. CONTRACTOR (INDIVIDUAL) NAME (print) .J , ter ybn� fOn1✓5
WELL CONTRACTOR CONIPANV NAME Ci4LZ,z-oK�ti W�=LL 45,2, t_c „may
PHONE
- Groundwater Section
CERTIFICATION # ot7 S. H s
ef37-,FoVie9
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential Municipal/Public D Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection D Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: 146-Ies J, 1% County C't.,/
(Street Name, Numbers, Community, Subdivision, Lot No.. Zip Code)
, +/
3. OWNER: J c%i'/,�, Z7 .4'L7/ c krtrI
Address yF LAe0cc; knt
4
5
6
7
Depth
From 0 To.269
From To
From To
13. GROUT: Depth
From O To a o
To 0.26V
14. SCREEN: Depth
From To
From To
15. SAND/GRAVEL PACK:
Depth
From To
From To
1-1 I treet or Route No.)
City or Town State Zip Code
(fca�)_ 3F 9- e-ao9
Area code- Phone number
DATE DRILLED // Ca
TOTAL DEPTH: V 0
DOES WELL REPLACE EXISTING WELL? YES ❑ NO
STATIC WATER LEVEL Below Top of Casing: 5?0
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
"Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): H0 METHOD OF TEST 42,
I0. WATER ZONES (depth): -Fero ' / c/70
II
12
C3
FT.
DISINFECTION: Type 614C ..4J2 Amount /z r
CASING: Wall Thickness
Diameter or Weight/Ft. Material
FL 6/ce .0.9 3
Ft.
Ft.
Material Method
,./
From aO Ft. Cc2-7,N4s 6;7AZ. --
Diameter Slot Size Material
Ft. in. in.
Ft. in. in.
Size
Ft.
Ft.
Material
Topographic/Land setting
❑Ridge ❑Slope DValley ['Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
0 dE l is (r,-s,,.�c;
r269
yfo
61,7n..v 7c=
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
ten
C)
0
16. REMARKS:
Sub Lit_ ?Aim
276Q JIj� n pilaw
ision
E3221,
HELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
T RE
PERSON CONSTRUCTING THE WELL
/-So.oa
DATE
of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
within 30 days. GW-I REV. 07/2001

Depth
From O To 90
From To
From To Ft.
13. GROUT: Depth
From G To ac Ft.
From .ac T-o 9v
14. SCREEN: Depth
From To
From To
15
3. OWNER:
Address
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Qual
WELL CONTRACTOR (INDIVIDUAL) NAME (print) J rl'1m/ J°AK;S
WELL CONTRACTOR COMPANY NAME Ccxcc
STATE WELL CONSTRUCTION PERMIT#
Of applicable)
4)/7a
247740
y - Groundwater Section
CERTIFICATION ## E 1 /
PHONE # (ef3ec 7 -C-Vere(
ASSOCIATED\VQ PERMIT#
(if applicable)
I. WELL USE (Check Applicable Box): Residential NI Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: N4/cO.1-//e- County C'z.4y
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
�<<r/ /?0
�y02 /7 LaG /2a
(Street or Route No.)
idAde, 7- it)C a.e%70
City orT vn State Zip Code
tFA-)- Jj7- o?s li
Area code- Phone number
4. DATE DRILLED // 9�d
5. TOTAL DEPTH: S6iJ�
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO Cv'
7. STATIC WATER LEVEL Below Top of Casing: 7a— FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
*Tup of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): a METHOD OF TEST /10-e
10. WATER ZONES (depth): Q2S0 410,0
II. DISINFECTION:Type6,2/we<z,Y/L Amount ,- e-<{,
12. CASING: Wall Thickness
Diameter or Weight/Ft. Material
Ft. 6+ A Sot a / ?vv.-.
Ft.
Material Method
C. Mc,.r. 6RAc,-r
Ft. CuTT,N63 i7_A-.;•:T-I
Diameter Slot Size Material
Pt. in. in.
Ft. in. in.
SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Topographic/Land setting
DRidge OSlope OValley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To z Formation Description
0' 9.9 5.- 64-4 du ,
yoS�z
�12f}.a1� Tc=
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
r';d hIZO
N
.C*
rV
16. REMARKS:
jf•F .. 2 <_
Submit the original to th
A3HEVILL01Ct/EGIO NAL OFFICE
IS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
D THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
7- Oa
l
GNATURE OF PERSON CONSTRUCTING THE WELL DATE
Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
733-2221, within 30 days. GW-1 REV. 07/2001
c